TB2012.68
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Trust Board Meeting: Thursday 5 July 2012
TB2012.68
Title
Trust Business Plan 2012/13
Status
A paper for discussion
History
This is the fourth draft of the paper. A first draft was
supported by the Trust Management Executive Team on
22nd March and a second by the Board in Committee on
19th April 2012. A third draft was discussed by the Trust
Board meeting on 3rd May.
The Business Plan, particularly the Strategy and
associated objectives, has now been updated to reflect
the discussions at the Board Strategy workshop held on
15th March and the associated development of the
Integrated Business Plan and Long Term Financial Model
which form part of the application for NHS Foundation
Trust status.
Board Lead(s)
Mr Andrew Stevens, Director of Planning and Information
Key purpose
Strategy
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Assurance
Policy
Performance
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Summary 1
This Business Plan sets out the Oxford University Hospitals NHS Trust’s strategy
and objectives for 2012/13, the financial plan for their delivery and how the
Trust will monitor success.
2
The plan has been developed in the context of the Health and Social Care Bill
and associated changes to commissioning structure, the Comprehensive
Spending Review, the NHS Operating Framework 2012/13 and NHS Oxfordshire’s
Strategic Plan.
3
The Trust’s strategy and Business Plan are rooted in the Trust’s core values,
generated through an exercise which took place between September and
November 2011, involving staff across the organisation together with our
Patient Panel and partners.
4
The Trust is currently developing a new strategy for the organisation. Key
milestones in this process have been the integration between the Oxford
Radcliffe Hospitals NHS Trust and the Nuffield Orthopaedic Centre NHS Trust
and the signing of a Joint Working Arrangement with the University of Oxford.
The next key step is achieving NHS Foundation Trust status.
5
The financial plan recommends an opening budget for 2012/13 which would
generate a target surplus of £3.602m. In order to meet the financial challenges
for 2012/13 the Trust has developed a savings programme of at least £49.5m
for 2012/13, which is 6.5% of planned turnover.
Recommendation
The Board is asked to approve this Business Plan, incorporating:

Strategic and corporate objectives for 2012/13

Corporate financial plan (already approved at March 2012 meeting)

Methodology for monitoring delivery

Summary plan for managing the risks to delivery
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Business Plan 2012/13
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ABBREVIATIONS
ACE
AHSC/N
CCG
CIP
CNST
CQC
CQUIN
DGH
DTOC
EBITDA
EPR
FT
FYE
I&E
JR
LTFM
NHSLA
NOC
PCT
QIPP
RPI
RTA
SCG
SHA
SLA
Appropriate Care for Everyone
Academic Health Science Centre/Network
Clinical Commissioning Group
Cost Improvement Programme
Clinical Negligence Scheme for Trusts
Care Quality Commission
Commissioning for Quality and Innovation
District General Hospital
Delayed Transfer of Care
Earnings before interest, tax, depreciation and amortisation
Electronic Patient Record
Foundation Trust
Full Year Effect
Income and Expenditure
John Radcliffe
Long Term Financial Model
National Health Service Litigation Authority
Nuffield Orthopaedic Centre
Primary Care Trust
Quality, Innovation, Productivity and Prevention
Retail Price Index
Road Traffic Act
Specialised Commissioning Groups
Strategic Health Authority
Service Level Agreement
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Introduction
1.
This Business Plan sets out the Oxford University Hospitals Trust’s objectives for
2012/13, the financial plan for their delivery and how the Trust will monitor success.
1.1. Part One describes the Strategic Context in which the Trust has developed its
plans and its six strategic objectives.
1.2. Part Two describes the Trust’s strategy, including its strategic objectives.
1.3. Part Three sets out the detailed corporate objectives for 2012/13 that the Trust
has developed to contribute to the delivery of its longer term strategic
objectives.
1.4. Part Four establishes the financial framework in which the objectives must be
delivered.
1.5. Part Five describes the structure and processes that have been put in place to
establish accountability for the delivery of the plan and monitor and manage
progress.
1.6. Part Six assesses the risks to delivery of the objectives
Part One - Strategic Context
National Strategic Context 2.
In July 2010 the new coalition Government set out its plan for the NHS in the White
paper, “Equity and Excellence: Liberating the NHS” 1 . The plan has three central
themes:
2.1. Putting patients and the public first
This involves putting patients at the heart of everything we do, giving them
more choice and control, helped by easy access to information about GPs and
hospitals. They will be in charge of making decisions about their care – “no
decision about me without me”.
2.2. Improving Healthcare Outcomes
There should be a relentless focus on clinical outcomes with success monitored
through outcome measures, such as cancer and stroke survival rates, rather
than through process targets, and the introduction of a new NHS Outcomes
Framework.
2.3. Autonomy, Accountability and Democratic Legitimacy
The objective of the proposed reforms is “to empower professionals and
providers, giving them more autonomy, and, in return, making them more
accountable for the results they achieve, accountable to patients through choice
and accountable to the public at local level.”
1
Department of Health, July 2010, Equity and excellence: Liberating the NHS
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3.
The Government consulted on these White paper reforms in the second half of 2010
and in January 2011 introduced the Health and Social Care Bill to Parliament.
4.
At the committee stage of the Bill in the House of Commons, the Government
commissioned a group of 45 leading healthcare professionals – the NHS Future
Forum – to undertake a listening exercise on the proposed reforms.
5.
In June 2011, the NHS Future Forum published its 181 recommendations on changes
to the Bill, most of which were incorporated into the Bill.
6.
In September 2011, the Bill passed its third and final reading in the House of
Commons and passed to the House of Lords for debate in October 2011.
7.
The Bill gained royal assent in March 2012 to become the Health and Social Care Act
(2012).
Financial Context – the need to implement best practice and increase productivity 8.
The Government’s Comprehensive Spending Review of October 2010 confirmed that
NHS resources in England (excluding capital) would increase by a cumulative 1.3%
in real terms from 2010/11 to 2014/15 to reach £109.8 billion.
9.
After deducting earmarked funds for social care and reablement services, the real
terms growth will be virtually flat.
10.
The NHS capital budget faces a cut of 17% by 2014/15.
11.
Due to the above requirements, there is a need for the NHS as a whole to make
efficiency savings of £15-20 billion by 2014/15 for re-investment back into services.
This is delivered as the Quality, Innovation, Productivity & Prevention (QIPP) or
“Nicholson” challenge. 2012/13 will be the second year for the delivery of these
plans.
NHS Operating Framework 2012/13 2 12.
Within this context the NHS Operating Framework for 2012/13 was published in late
November 2011. As well as setting out the agenda for quality and reform for the
coming year, the Framework also lays out the financial and business rules within
which the NHS is to operate. It emphasises that strong financial management and
control are needed.
13.
The NHS Operating Framework for 2012/13 sets out a strategic vision to transform
the NHS service delivery model to focus on outcomes for patients and greater
2
Department of Health , November 2011, The Operating Framework for the NHS in England 2012/13
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involvement of GPs and clinicians in decision making. In doing so the Operating
Framework outlines the strategic aims, structural reforms, financial and quality
drivers and performance management.
14.
These strategic aims present as four key themes within the Operating Framework
2012/13:
Putting patients at the centre of decision making in preparing for an outcomes
approach to service delivery, whilst improving dignity and service to patients and
meeting essential standards of care
Completion of the last year of transition to the new system, building the capacity of
emerging clinical commissioning groups (CCGs) and supporting the establishment
of Health and Wellbeing Boards so that they become key drivers of improvement
across the NHS
Increasing the pace on delivery of the quality, innovation, productivity and
prevention (QIPP) challenge
Maintaining a strong grip on service and financial performance, including
ensuring the NHS Constitution right to treatment within 18 weeks
15.
Other key elements of the Operating Framework include:
 A range of outcome measures are set out under the domains of the NHS
Outcomes Framework.
 PCT allocations will grow by at least 2.5% in 2012/13 and PCT clusters must
ensure all patients are seen on the basis of clinical need.
 The running cost of clinical commissioning groups (CCGs) will be £25 per head
and the tariff price adjuster will see a reduction of at least 1.5%.
 All NHS trusts are expected to achieve NHS Foundation trust (FT) status by
April 2014 other than by exceptional agreement.
 There are key areas for improvement of dementia and care of older people,
carers’ support and military and veteran health.
 CQUIN (Commissioning for Quality and Innovation) will be increased to 2.5%
on top of actual ‘outturn’ value.
 A summary of the national performance measures is included below, including
the Outcomes Framework under Quality.
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Local and Regional Strategic Context 16.
The two largest commissioners of the Trust’s services have historically been
Oxfordshire PCT and South Central Specialist Commissioners. The current
restructuring of commissioning is resulting in changes to both.
Specialised Commissioning 17.
From October 2011 the ten Specialised Commissioning Groups (SCGs) across the
country have clustered into the Strategic Health Authority footprints.
18.
For 2012/13 there will be four SCG clusters. This is an interim stage prior to the
formation for 2013/14 of the National Commissioning Group as a single function
within the NHS Commissioning Board.
19.
The four SCG cluster footprints are:
-
North of England SCG Cluster
North West, Yorkshire & Humber and North East SCGs
-
Midlands & East SCG Cluster
West and East Midlands and East of England SCGs
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South of England SCG Cluster
South West, South Central and South East Coast SCGs
-
London SCG Cluster
London
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20.
All Specialised Services will be contracted separately from other NHS services.
21.
Work is underway to disaggregate Specialised Services from other services within
contracts held by the NHS with Acute and Mental Health Providers.
22.
Providers of Health Services will be expected to work with Specialised
Commissioning Teams; Primary Care Trusts; and Commissioning Support Agencies
in the disaggregation of specialised activity from other healthcare services.
23.
SCGs that currently commission non-specialised services will make arrangements to
transfer commissioning arrangements to the relevant PCT.
NHS Oxfordshire 24.
The Trust’s local non specialist commissioner is NHS Oxfordshire, the county’s local
PCT which is part of the Oxfordshire and Buckinghamshire cluster.
25.
NHS Oxfordshire assessed its financial challenge in 2011/12 and identified the need
to deliver efficiencies of over £200m over the next 4 years. Delivery of these
efficiencies is addressed through the QIPP (Quality, Innovation, Productivity and
Prevention) Programme. Across the NHS this was described as the ‘Nicholson’
Challenge to deliver efficiency savings of between £15-20 billion from 2011-14.
26.
NHS Oxfordshire has a Strategic Plan covering the years 2008-2013 3 . The PCT’s five
strategic goals are set out in the table below:
1.
Ensure that the core services purchased from primary and
secondary care providers continually improve to meet changing
health needs, giving patients optimum access to satisfactory, timely,
high quality care that also offers good value for money
2.
Improve health outcomes and promote independence for the
following key population groups:
 Older people
 Those with long term conditions
 People with mental health problems
3
NHS Oxfordshire, January 2010, NHS Oxfordshire Strategic Plan 2008-2013 (Refreshed January 2010)
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 Children and families living in areas of deprivation
27.
3.
Improve access to health services by increasing the commissioning
of integrated whole care pathways that create a proportionate and
appropriate shift of activity from hospital into primary and
community care settings
4.
Help more local people of all ages to make sustainable healthy
lifestyle choices
5.
Reduce health inequalities in Oxfordshire by improving health
outcomes for people living in wards with the highest mortality rates
at a greater rate than for the PCT population as a whole
The PCT states that the strategy will lead to “a plateau in the level of activity within
the ORH and NOC”. It stresses the importance of “transformation in service design
and delivery, demanded across the spectrum of activity. Pathways will need to be
fully integrated, services flexible and the individual patient journey seamless –
meaning providers having to work together with the PCT in different and more
effective ways”.
Clinical Commissioning Groups 28.
During 2012/13 the PCT cluster will be supporting the development of Clinical
Commissioning Groups (CCGs). The OUH is working with the emerging CCGs to
understand how commissioning intentions will change when budgets are devolved
fully to these consortia in the future. The table below describes the areas covered by
the new Oxfordshire CCG and the particular health issues that have been identified
within them. 4
Localities Population Practices North (Covers area including Banbury and Chipping Norton) 104,359 13 practices (74 GPs) North East (Bicester, Kidlington Almost 78,000 10 practices Approximate Share of Particular Issues for Locality Oxon PCT funding 15%  Teenage pregnancy  Road traffic accidents  Skin cancer (Malignant melanoma)  Combination of rurality and large market town deprivation 11%  Higher proportion of teenage pregnancy in Bicester (second 4
Source: Oxfordshire Clinical Commissioning Group website
(http://www.oxfordshireccg.nhs.uk/default.aspx) accessed 24/11/11 TB2012.68_Trust Business Plan 2012-13
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Localities Population TB2012.68
Practices Approximate Share of Particular Issues for Locality Oxon PCT funding and Yarnton, Woodstock and Islip) Oxford City (Oxford City, Blackbird Leys, Iffley, Cowley, Jericho and Summertown) South East (Covers area from Wheatley in the north to Sonning Common in the south and from Wallingford in the west to Henley in the east South West (Covers Abingdon, Clifton Hampden, Berinsfield, Didcot, Wantage and Faringdon) West (Covers Witney, Burford & Carterton) 29.








only to Banbury) High recorded rates of obesity Prolonged hospital stays with delayed transfers of care Population changes Health inequalities Teenage pregnancies Suicide Health effects of exam results Students 198,629 28 practices (146 GPs) 29% Just over 78,000 9 practices 12%  Rural area ‐ large proportion of wards classified as villages or smaller  Ageing population  Highest percentage of registered patients with dementia in Oxfordshire  Highest number of registered patients with cancer in Oxfordshire c 136,000 14 Practices 13% (96 GPs)  Older population ‐ sometimes geographically isolated.  Growing population  Diverse population  Problems accessing services 78,043 9 Practices (52 GPs)  Older population ‐ sometimes geographically isolated  Growing population  Diverse population  Problems accessing services 11% This assessment, together with analysis carried out by the OUH, emphasises the need
for the Trust’s strategy to respond to changes in the population for which we provide
services. The most prominent feature of this is the ageing population.
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Oxfordshire’s Joint Health and Wellbeing Draft Strategy 30.
As required by the Health and Social Care Act 2012, a Health and Wellbeing Board
has been set up in Oxfordshire with responsibility for improving the health and
wellbeing of people in the county through partnership working. The Board is a
partnership between Local Government, the NHS and the people of Oxfordshire.
Members include local GPs, councillors, the Local Involvement Network and senior
officers from Local Government. Organisations responsible for providing health care
are not members of the Health and Wellbeing Board.
31.
The draft Strategy, which is currently out to consultation, emphasises the need for
the organisations that provide care in the county to work together to meet the
challenges faced in a way that is more “meshed” together.
32.
This need is highlighted by the fact that in 2011/12 Oxfordshire had the highest level
in England of delayed transfers of care between the NHS and social care.
33.
The OUH has an important role to play in four of the Strategy’s suggested priorities
in particular:
Priority 1 - Integration of health and social care - a target is suggested to achieve
above the national average of people satisfied with their experience of hospital care.
Priority 2 - Support older people to live independently with dignity whilst reducing
the need for care and support – proposed targets include a reduction in delayed
transfers so that Oxfordshire’s performance is out of the bottom quarter; 50% of the
expected population with dementia to have a recorded diagnosis; and targets around
re-ablement.
Priority 3 – Living and working well: adults with long-term conditions, physical
disabilities, learning disabilities or mental health problems living independently and
achieving their full potential – suggested targets include 86% of people with a longterm condition feeling supported to manage their condition (currently 84%).
Priority 8 – Preventing early death and improving quality of life in later years –
suggested targets include 2,000 adults receiving bowel screening for the first time
(the nationally set target is 60% of 60-69 year olds).
Part Two – The Trust’s Strategy
The Trust’s Core Values 34.
The Trust’s Business Plan has been developed in the context of its core corporate
values. These values were generated through an exercise which took place from
September to November 2011. Feedback was received from over 750 staff, the Trust
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Board, a number of management committees and from focus groups held with our
Patient Panel and partners. The values exercise was a key part of the integration
process between the two former organisations that now make up the Oxford
University Hospitals (the Nuffield Orthopaedic Centre and Oxford Radcliffe
Hospitals). Discussions were held on all sites and centred on what individuals,
teams and departments said was important to them.
35.
The Trust’s core values are set out in the table below:
Excellence
Compassion
Respect
Delivery
Learning
Improvement
Expressed as:
We aim to provide excellent care with compassion and respect. We will do this by:
Taking pride in the quality of care we provide;
Putting patients at the heart of what we do and recognising different needs;
Encouraging a spirit of support, respect and teamwork;
Ensuring that we act with integrity;
Going the extra mile and following through on our commitments;
Establishing systems and processes that are sustainable.
We aim to deliver, learn and continuously improve. We will do this by:
Delivering high standards of healthcare based on national and international
comparisons;
Delivering the best clinical teaching and research;
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Adopting the best clinical research in patient care;
Striving to improve on what we do through change and innovation;
Monitoring and assessing our performance;
Learning from successes and setbacks;
Working in partnership across the Health and Social Care Community
36.
Collaboration and Partnership are also central to the Trust’s approach, particularly
in the delivery of the fundamental activities of patient care, teaching and research.
Vision 37.
The Trust’s values determine its vision:
to be at the heart of a sustainable and outstanding, innovative academic health
science system, working in partnership and through networks locally,
nationally and internationally to deliver and develop excellence and value in
patient care, teaching and research within a culture of compassion and
integrity.
38.
This vision is underpinned by the Trust’s founding partnership with the University
of Oxford.
39.
The vision reflects OUH’s position both as a provider of secondary healthcare for its
local population and of specialised and tertiary care for the population in its more
extended health economy.
40.
The patient is at the heart of everything we do. We strive for excellence in healthcare
by encouraging a culture of support, respect, integrity and teamwork; by monitoring
and assessing our performance against national and international standards of care;
by learning from our successes and setbacks; by striving to improve what we do
through innovation and change; and by working in partnership and collaboration,
and not in isolation, with all the agencies of health and social care in our healthcare
economy.
41.
The Trust is committed to be an active partner in healthcare innovation, research and
workforce education, with the aim of forming an effective bridge between research in
basic science and in healthcare service provision, and the delivery of evidence-based,
best practice care, turning today’s discoveries into tomorrow’s care. The NHS
Operating Framework for 2012/13 reiterates that the adoption and spread of
effective innovation and best practice is a priority for the NHS and that the
promotion and conduct of research continues to be a core NHS function.
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Strategic Milestones 42.
The Trust is currently developing a new strategy for the organisation.
milestones in this process have been/will be:
Key
42.1. Achieving integration between the Oxford Radcliffe Hospitals NHS Trust and
Nuffield Orthopaedic Centre NHS Trust (achieved 1st November 2011).
42.2. Sign Joint Working Agreement with the University of Oxford (came into effect
1st November 2011).
42.3. Achieving NHS Foundation Trust (FT) status – this is the key next step.
Preparing the organisation and completing the application will be a major part
of the Trust’s work programme for the coming year and this has helped to
shape this business plan.
43.
The strategy is evolving as part of the development of the Integrated Business Plan
and Long Term Financial Model for the FT application. A Local Acute workstream is
seeking to address the strategic priorities of the PCT.
Achieving NHS Foundation Trust status 44.
NHS foundation trusts (FTs) were established by legislation in 2003 and now operate
under the Health Act 2006. Although they are NHS organisations which provide
NHS services to NHS patients in accordance with the core principles of the NHS –
care that is free and based on need, they differ from non FTs in that they are:
44.1. authorised and regulated by an independent regulator, known as Monitor,
which is accountable directly to Parliament;
44.2. accountable to their local communities through a system of local ownership
with members and elected governors - the governors being elected by the
members;
44.3. not required to break even each year, although they must be financially viable.
They can borrow money within limits set by the regulator, retain surpluses and
decide on service development for their local populations;
44.4. free from central government control and strategic health authority
performance management;
44.5. required to lay their annual reports and accounts before Parliament each year.
45.
As an FT, OUH will:
45.1. be part of the NHS and provide NHS care to the best current standards;
45.2. be accountable to local people and the communities it serves via an active
membership and Council of Governors;
45.3. take its own decisions to deliver services within a framework set by regulators
and as part of a ‘family’ of local health and social care organisations;
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45.4. be able to respond quickly and imaginatively to the challenges of the economic
environment and the opportunities offered through the skills of its staff, its
facilities and networks, and its strong partnership with the University of
Oxford;
45.5. be able to use joint ventures with commercial, academic, health or social care
partners to provide benefit for the patients of tomorrow in new ways – and to
minimise the cost to commissioners of integrated care within a teaching centre;
45.6. invest and borrow, with spending no longer dominated by an artificial annual
cycle but by requirements to be financially viable; and
45.7. be required by the regulator to demonstrate that it is well-governed and
financially viable.
Key Dates 46.
According to the currently planned programme, the key indicative dates for the
OUH’s application to become an FT are:
June – October 2012
Public Consultation
January 2013
Submission of final application to Department of Health
Early 2013
Elections for Governors
Spring 2013
Application passed to Monitor to review
By Autumn 2013
Authorisation
Membership 47.
As part of our work to become a successful and effective Foundation Trust we are
committed to building a substantial and representative membership. OUH believes
that a well-informed, motivated and engaged membership will help it to be a more
responsive organisation with an improved understanding of the needs of its patients
and local communities. All staff will automatically become members unless they opt
out. Others wishing to become members can do so at
http://www.ouh.nhs.uk/foundation-trust/membership.aspx
Workstreams 48.
The diagram below shows the main workstreams for the preparation of the Trust to
become a Foundation Trust and for its associated application, together with the
workstreams’ reporting structures.
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Strategic Objectives 49.
These workstreams have generated the Strategic Objectives set out in the table below:
SO1 To be a patient-centred organisation, providing high quality and
compassionate care, whilst promoting a culture of integrity and respect for
both patients and staff – “delivering compassionate excellence”
SO2 To become a vigorous, adaptable and successful organisation with strong,
well-embedded governance systems and high standards of assurance, building
on a successful FT application – “becoming a resilient, flexible and successful
organisation”
SO3 To meet the challenges of the current economic climate and changes in the
NHS by providing efficient and cost-effective services and better value
healthcare – “delivering better value healthcare”
SO4 To provide high quality general acute healthcare services to the population of
Oxfordshire, including the development of better-integrated provision across
the local health and social care economy – “delivering integrated healthcare”
SO5 To provide support and strong leadership to healthcare partners to create
sustainable clinical networks together that provide health benefits to the
population and to all partners – “supporting sustainable clinical networks”
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SO6 To provide high quality specialist and tertiary services to the population of
Oxfordshire and beyond as part of extended clinical networks, expanding
OUH’s referral base for these services – “delivering excellence in specialist
and tertiary care”
SO7 To lead the development of a durable academic health science system with our
population, academic, health and social care partners and the life sciences
industry and business community to lead and facilitate discovery, innovation
and workforce education – “a robust Academic Health Science Network
(AHSN)”
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Part Three - Corporate Objectives for 2012/13
50.
SO1
1a
A set of corporate objectives has been developed to progress the delivery of the Trust’s Strategic Objectives in 2012/13. These
are described in the table below under the strategic objectives that they address.
Board Lead
Success Criteria
Director of Workforce
Increased levels of patient and staff
satisfaction (measured through national
and local patient and staff surveys)
Delivering Compassionate Excellence
Embed the Trust’s new values into everyday action
 Progress the Listening into Action work programme
-
1b
Integrate values based behaviour set into recruitment, induction, appraisal,
standard setting, customer care, performance management and staff
recognition practices
Maintain a focus on patient safety
Medical Director
 Develop Patient Safety Framework as part of overarching Quality Strategy
1c
Improve/maintain access to services
Director of Clinical
Services
 Implement new performance framework
 Reduce delays for patients and improve the efficiency with which resources are
used by further developing weekend and extended day working, including
access to diagnostics
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 Reduction in healthcare associated
infections
 Increasing percentage of patients free
from harm as assessed by Safety
Thermometer
Achievement/maintenance of national
standards for access to services:
- Referral to treatment times
- Cancer waiting times
- A&E standards
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Board Lead
1d
Success Criteria
 Delivery of quality standards,
including those set out in the Quality
Account for 2012/2013
Improve the quality of services, engaging with patients to Chief Nurse
establish what really matters to them
 Agreement of Quality Strategy
 Achievement of CQUIN on
electronic patient feedback
 Implement electronic patient feedback
1e
Plan and deliver a sustainable future for the Horton Director
General Hospital
Services
of
Clinical Production of a vision for the Horton,
supported by key partners
 Enhance the quality, efficiency and sustainability of services at the Horton
General Hospital, including the re-modelling of adult medical and surgical
services and the provision of a flexible, robust core medical function that
supports other specialty work, developing the Horton Vision
SO2
2a
Becoming a resilient, flexible and successful organisation
Achieve NHS Foundation Trust status
Director of Planning Authorisation as an NHS Foundation
and Information
Trust (in 2013/14)
 Finalise Integrated Business Plan (IBP) and Long Term Financial Model (LTFM)
 Undertake public consultation
 Increase membership
 Elect governors
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2b
Improve Governance and Assurance systems
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Board Lead
Success Criteria
Director of Assurance
 Successful Governance assessments
for FT application
 Review the Trust’s proposed governance framework as part of the
development of the application for Foundation Trust status
 Compliance with CQC outcomes
 Achievement of level 2 NHSLA
status for acute and maternity
 Continue to implement action plans to ensure continued compliance with CQC
services in 2013
outcomes
 Agree and implement strategy to strengthen risk management
2c
Continue to develop financial regimes and systems that Director of Finance  Delivery of agreed Financial Plan
meet FT requirements
and Procurement
 Achievement of surplus to underpin
FT application
 Removal of residual cumulative
deficit generated in 2005/6 and
2006/7
 Improved liquidity ratio
2d
Realise the benefits of the introduction of the Electronic Director of Planning  Successful stabilisation of system
Patient Record (EPR) to all sites
and Information
 Agreement of roll-out of clinical
 Progress the roll-out of the EPR
functionality
 Achievement of benefits realisation
plan
2e
Maintain a workforce plan that is in alignment with the Director of Workforce
clinical and workforce strategies and provides the Trust
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Reduced agency costs
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Board Lead
Success Criteria
with the skill mix it requires and the ability to respond
quickly to changes in activity
SO3
3a
Delivering Better Value Healthcare
Improve the understanding of financial performance Director of Finance  Delivery of Cost Improvement
through the further development of service line reporting and Procurement
Programme (CIP)
and patient level costing
 Timely and robust reference cost
data
 Improved understanding of
profitability of services to inform
decision making
3b
Increase productivity and delivery of CIPs year on year in Director of Finance  Delivery of Cost Improvement
line with the agreed financial strategy and within the and Procurement
Programme which assures patient
agreed performance framework/compacts
safety and quality
 Investigate how innovation can drive improved value, e.g. by drawing on  Downsize
commensurate
research already underway on self-care and the use of e-health technologies
commissioner QIPP delivery
3c
Improve utilisation of Trust’s estate, plant and equipment
Director of
Development and the
Estate
with
 Reduced estate footprint
 Rationalisation of plant
 Improved utilisation of resources
such as theatres and diagnostic
equipment
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Oxford University Hospitals
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Board Lead
3d
Work with partners in the local health community to Director
ensure that services are financially sustainable
Services
of
Clinical Long term financial model that is
supported by commissioners and other
partners
of
Clinical  Reduced DTOCs (delayed transfers
of care)
 Produce strategy
SO4
4a
Success Criteria
Delivering Integrated Healthcare
Work with partners to redesign local services to put in Director
place a model of care that is patient centred and clinically Services
and financially sustainable
 Reduced emergency admissions
 Work with partners to reduce the number of system wide delayed transfers of
 Reduced readmissions
care (DTOCs)
 Work with partners to respond to the needs of our ageing population,  Reduced length of stay
including improving services for patients with dementia
 Continue to improve Emergency/acute services/care pathways, both internally
and across different providers in conjunction with partners
 Work with partners on initiatives to reduce planned activity
 Continue to work with partners on initiatives to deliver care “closer to home”,
including meeting the needs of the rural populations within the Trust’s
catchment area
 Work with commissioners to move to quality/outcome based commissioning
4b
Implement workforce redesign and the development of Director of Workforce
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Development of and recruitment to new
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Oxford University Hospitals
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Board Lead
Success Criteria
new roles to support new models of care
SO5
5a
roles, e.g. Community Support Worker
Delivering Sustainable Clinical Networks
Clinical  Agreed blueprint, joint ways of
working, patient pathways, protocols
etc.
 Agree a blueprint for an effective clinical network and associated organisational
framework/business model to be used as the basis for discussions with  Improved clinical outcomes
partners
Develop and strengthen the Trust’s involvement in all Director
Clinical Networks
Services
of
 Continue to develop a Paediatric Network for Children’s Heart Surgery and
Neurosurgery in collaboration with University Hospital Southampton NHS
Foundation Trust
5b
Deliver specific network initiatives
Director
Services
of
Clinical Improved clinical outcomes, including
reduced mortality
 Implement plan to become regional Trauma Centre
 Continue centralisation of Vascular Surgery in Oxford
 Continue development of Oxford as a Hyperacute Stroke Centre
 Secure agreement of full business case for expansion of neonatal services and
commence implementation
SO6
6a
Delivering Excellence in Specialist and Tertiary Care
Build partnerships with neighbouring providers
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Director of Planning  Improved clinical outcomes
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Oxford University Hospitals
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Board Lead
Success Criteria
and Information
 Consolidation of specialist activity
and income
 Work with partners to develop new models of care which balance the
provision of specialist care locally and centrally (e.g. peripheral clinics, joint
appointments, local training and support, ambulatory surgical hubs at partners
sites)
 Develop proposals for the provision of satellite radiotherapy facilities
6b
Explore potential to repatriate specialist/tertiary activity Director
from London providers in accordance with commissioner Services
requests
of
Clinical Increase in referrals and consequent
income
 Continue to repatriate adult cardiac surgery from London providers
6c
Develop services which are strategically important to the
Trust
Director
Services
of
Clinical Various criteria according to individual
service development
 Undertake a Strategic Service Analysis to identify key areas for strategic service
development
 Establish an Integrated Spinal Pathway between the NOC, Neurosurgery and
JR Orthopaedics
 Continue to implement the Radiotherapy Modernisation Plan
 Relocate Head and Neck Cancer services
 Ensure the Trust has a robust plan in response to the Carter review of
pathology services
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Oxford University Hospitals
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Board Lead
SO7
Success Criteria
A Robust Academic Health Science Network
Advance the Oxford Academic Health Consortium Chief Executive
(OAHC) which includes the OUH, the University of
Oxford, Oxford Brookes University, Oxford Health FT,
Oxfordshire Clinical Commissioning Group, Oxfordshire
and Buckinghamshire PCT Cluster, Oxfordshire County
Council and Ridgeway Partnership - the Oxfordshire
Learning Disability Trust
 Establishment of formal partnership
7b
With partners bid to achieve designation as one of the Chief Executive
new Academic Health Science Networks, with the OUH
at its heart
Successful designation
7c
Progress the shared agenda with University of Oxford
Successful implementation of the joint
working agreement
7a
Chief Executive
 Progress the implementation of the Joint Working Agreement
 Agreed priorities for collaboration,
e.g. improving dementia services
7d
Implement education and training strategy, working with Medical Director
key partners including the University of Oxford, Oxford
Brookes University, The Thames Valley Postgraduate
Deanery and other key partners that will meet the local
and national requirements for well trained and educated
staff for all areas of the NHS
Develop effective response to changing
environment for education and training
7e
Progress the strategies set out in the successful renewal Medical Director
bids for the Biomedical Research Centre and Unit
Achievement of theme objectives
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Part Four – Financial Plan
Background 51.
As described above, there is a continuing requirement for the NHS as a whole to
make efficiency savings of £15-20 billion by 2014/15 for reinvestment back into
services. This is usually referred to as the Quality, Innovation, Productivity and
Prevention (QIPP) challenge and 2012/13 will be the second year for the delivery of
these plans.
52.
The Department of Health published the tariff for NHS services on 16 February. The
tariff reflects a reduction in prices of 1.8% and the introduction of a wider range of
Best Practice tariffs foreshadowed in the Operating Framework.
The Regional Planning Context 53.
On 20 December NHS South of England issued their own guidance on the principles
that should form the basis of operating plans in NHS organisations for 2012/13.
These principles complemented the matters set out in the overarching NHS
Operating Framework but included the following additional matters that need to be
taken into consideration by Trusts when planning for 2012/13:
53.1. PCTs will be required to levy mandatory fines that are included in the NHS
standard national contract on providers that fail to meet key performance
targets.
53.2. Guidance was proposed as to what might be included within the measures that
would attract additional CQUIN (Commissioning for Quality and Innovation)
payments.
53.3. The notional tariff uplift for 2012/13 was to be 2.2%, with an efficiency target of
4%, meaning that tariffs were to be reduced by at least 1.8%.
54.
In his letter of 14 December 2011 Sir David Nicholson confirmed that all PCT revenue
allocations would be increased by 2.8% in 2012/13.
The OUH’s own Planning Context 55.
The Trust delivered a £7.603m surplus against its break even duty in the financial
year 2011/12. This was 1% of the Trust’s turnover for the year.
56.
The Trust needs to demonstrate on-going financial stability, and to strengthen its
liquidity position, as part of its preparation for Foundation Trust (FT) status.
57.
The financial plans for 2012/13 have taken into account the following previously
agreed service developments:
57.1. Vascular surgery, with the centralisation of activity from Thames Valley District
General Hospitals (DGHs) and the repatriation of work from London;
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Oxford University Hospitals
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57.2. Cardiac surgery, with the repatriation of London activity for Thames Valley
PCTs;
57.3. Neonatology, and the expansion of Intensive Care cots as part of being
designated a Level 1 unit for South Central SHA, with work diverted from nonLevel 1 units in the SHA and the repatriation of out-of area transfers;
57.4. Trauma and Orthopaedics, with the designation of Oxford as a Major Trauma
Centre within South Central SHA.
58.
Financial pressures will also arise in the year where:
58.1. Savings targets in 2011/12 have been met only through the identification of
non-recurrent schemes so new schemes to identify recurrent savings need to be
found in 2012/13.
58.2. There are inflation increases to agreed contract values – for example, there will
be annual increases to the three private finance initiative (PFI) contracts that are
linked to the retail price index (RPI). RPI is higher than the level of inflation
assumed within tariff.
58.3. It costs more to provide the same level of service as a result of (for example)
incremental pay drift; expenditure on agency staff; patient, clinical or quality
decisions leading to an increased use of high cost drugs; required backlog
maintenance; making higher payments into the clinical negligence scheme
(CNST) as a result of increased claims nationally; and the reduction in NHS
education funding to support the training of junior doctors and other clinical
professionals.
58.4. Capital charges rise, partly as a result of increases in the value of the Trust’s
land and buildings as assessed by the District Valuer, and partly from the
investment the Trust makes in fixed assets through its capital programme.
58.5. Levels of over-performance against contracted levels are paid at marginal rates.
58.6. Penalties are applied by PCTs because key quality and other performance
measures are not met.
58.7. Not all criteria are met for receiving full CQUIN payments from commissioners.
59.
The financial context within which the Trust will operate next year presents
significant challenges. It has therefore been considered prudent to put reserves in
place in 2012/13 by including a contingency budget of 1% of planned turnover.
Commissioner Income 60.
The majority of the Trust’s predicted income will come from contracts with
commissioners. The table below summarises the levels of income agreed with each
of the Trust’s main commissioners.
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Oxford University Hospitals
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£m
Commissioner
Oxfordshire
Buckinghamshire
South Central Specialist
Other
Total SLA Commissioning Income
350.27
35.70
86.13
171.75
643.85
Income and Expenditure (I&E) Account Budget 2012/13 61.
The Trust revenue budget for the 2012/13 financial year is summarised in the table
below.
Plan
Outturn
Plan
2011/12
2011/12
2012/13
£000
£000
£000
621,464
645,489
643,846
11,350
11,514
11,580
123,769
127,142
131,526
756,583
784,145
786,952
Pay
(405,194)
(422,591)
(422,723)
Non-Pay
(280,463)
(292,040)
(298,705)
(685,657)
(714,631)
(721,428)
70,926
69,514
65,524
(64,839)
(61,911)
(63,970)
6,087
7,603
1,554
Income
Commissioning Income
PP & Overseas
Other Income
Total Income
Operating Expenditure
Total Expenditure
EBITDA *
Non-Operating Expenditure
Retained Surplus/(Deficit)
Technical Adjustments
Break Even Surplus
1,064
7,151
(446)
7,157
2,048
3,602
* EBITDA = Earnings before interest, tax, dividends & amortisation
Savings Plans 62.
In order to meet the financial challenges for 2012/13 the Trust expects to be required
to develop a savings programme of at least £49.5m for 2012/13, which is 6.5% of
planned turnover.
63.
The process for identifying CIP plans commenced in October 2011 and these plans
were developed through a workshop and subsequent discussions with the clinical
leadership.
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Oxford University Hospitals
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64.
The workshop/discussion developed ideas around the following themes; Workforce;
Service Configuration; Resource Configuration; Managing Demand.
65.
The themes for 2012/13 have subsequently been redefined and are Pay Cost
Initiatives; Productivity & Efficiency (P&E); Capacity reduction; Procurement;
Income Generation; Divisional Efficiency
CIP Programme 2012/13
FYE of 2011/12 Savings Schemes
Pay Cost Initiatives
9.4
10.0
Productivity & Efficiency
2.3
Capacity Reduction
3.6
Procurement
4.4
Procurement - Energy Managed Services
1.2
Procurement - Medicines Management
3.1
Income Generation
1.0
Divisional Efficiency
14.5
Total
66.
£m
49.5
Cost improvement plans will be designed and reviewed to ensure that patient safety
and quality are assured.
Capital Plan 2012/13 67.
It is assumed that the sum invested in new capital projects in 2012/13 is equal to the
cash generated from depreciation less the repayments of principal that the Trust has
to make on its loans, PFI contracts and finance lease agreements.
68.
It is currently also assumed that funds generated from the surplus will not be
invested in capital expenditure but will be used to strengthen the Trust’s liquidity
position.
69.
The table below shows the initial capital programme agreed by the Trust Board for
the year.
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Oxford University Hospitals
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Outline Scheme-Based Programme
Total
Cost
2,685,000
Neonatal Intensive Care
2012/13
Allocation
2,685,000
790,000
790,000
1,300,000
1,300,000
Cardiac (Adult) Business Case*
1,400,000
1,400,000
Laboratory Business Case (Block 4, Churchill) (Molecular
diagnostics Centre) £0.8m BRC*
1,200,000
1,200,000
800,000
800,000
Trauma Centre Business Case*
nd
Vascular Business Case (for 2
IR room)*
2013/14
Allocation
Endoscopy Six Day Working – additional scopes
th
65,000
65,000
4,000,000
2,000,000
2,000,000
- Milton Keynes
7,000,000
470,000
6,530,000
- Swindon
6,450,000
Endoscopy Business Case – 5 Room*
Medical and Surgical Equipment*
Radiotherapy:
6,925,000
475,000
Theatres - NOC potential purchase
250,000
250,000
Major Radiological Equipment*
600,000
600,000
250,000
250,000
IT/EPR
3,000,000
3,000,000
Laboratory IT System Replacement
1,500,000
PACS Replacement*
1,500,000
Ward Relocations:*
- Respiratory
3,000,000
3,000,000
subject to
option
subject to
option
- 2nd Robot
411,000
411,000
- Pharmacy Store Churchill*
650,000
650,000
50,000
50,000
375,000
375,000
Head & Neck Relocation (Churchill or West Wing)
Pharmacy:
Relocation of Radioactive Store – Churchill
OHIS Integration
Relocation of Occupational Health
General Estates:*
- Maintenance
- Signage
2,000,000
1,000,000
40,000
40,000
- DDA
100,000
100,000
- Bed Replacement
100,000
100,000
750,000
750,000
1,000,000
IMRT:
- Rapid arc installation
- Rapid arc upgrade
1,200,000
1,200,000
Renal Satellite Dialysis Extension:
- Milton Keynes Phase 2
180,000
180,000
PFI Disputes CH
732,000
732,000
Maternity Recovery, Ultrasound and Triage*
116,000
116,000
Wolfson Centre Contribution
900,000
900,000
TOTAL
42,369,000
21,834,000
20,535,000
Capital Available
42,369,000
20,934,000
21,435,000
Under/(Over) Commitment
(900,000)
900,000
*Investment in Existing Estate & Equipment
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Oxford University Hospitals
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Monitor Financial Risk Ratings 2012/13 70.
The OUH is not yet a Foundation Trust and is therefore not subject to Monitor’s
financial regime. As good practice, however, the Trust has calculated the ratios used
by Monitor to assess an organisation’s financial risk rating for inclusion in this
business plan and these are shown in the table below.
Scores
Financial Criteria
Underlying Performance
Risk Rating
Plan 2012/13
Weight
5
4
3
2
1
Metric
Score
EBITDA margin
25%
11%
9%
5%
1%
<1%
8.8%
3
Return on Assets
20%
6%
5%
3%
-2%
< -2%
4.7%
3
I & E Surplus Margin
20%
3%
2%
1%
-2%
< -2%
0.2%
2
Liquid ratio (days)
25%
60
25
15
10
<10
-24
1
Financial Efficiency
Liquidity
Weighted Average
Overall Rating (see rules below)
2.22
2
Note: If the Trust had a notional 30 days' working capital facility (which many Foundation Trusts arrange), then the metric for
Liquidity would be 6, giving a risk rating of 2 against that criterion. This would produce an overall weighted average score of 2.5
Part Five – Monitoring the Plan
Performance Review Committee
71.
A subcommittee of the Trust Management Executive has been established to monitor
the performance of all clinical and corporate divisions on a regular review cycle.
This committee will monitor this plan and the plans which support it, requesting
action and follow-up where performance varies from that expected.
72.
The committee is chaired by the Director of Finance and Procurement, with the
membership shown in the table below:
Director of Finance and Procurement (Chair)
Chief Executive
Medical Director
Chief Nurse
Director of Planning and Information
TB2012.68_Trust Business Plan 2012-13
Director of Clinical Services
Director of Commercial Development
and the Estate
Director of Workforce
Director of Assurance
Divisional Directors x 7
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Oxford University Hospitals
73.
TB2012.68
The committee will provide regular reports on performance against this plan to the
Trust Management Executive and Trust Board.
Earned Autonomy and Incentives for Good Performance in the new Clinically Led
Organisation
74.
The Trust has introduced a system whereby, when a clinical Division demonstrates
that it is able to perform effectively and meet key agreed targets, it will earn the right
to operate more independently, with less corporate oversight of the decisions it is
making.
75.
Any increase in autonomy will be based upon a Division’s performance in meeting
(or exceeding) agreed targets. The degree of earned autonomy will be subject to
review.
76.
The proposal for the incentive scheme is based on the premise that a Division must
exceed at the end of the financial year the financial and non-financial targets it is set.
77.
The overall performance of the Trust, and of the local health economy, will also play
a part in decisions affecting earned autonomy and the incentive scheme.
Performance Compacts
78.
At the beginning of the financial year each Division will agree a comprehensive
business plan. This business plan will form the basis of a Performance Compact
signed by members of the Executive Team and the Division. Divisions will be
expected to manage and control their operations to agreed standards within a
Performance Framework comprising:
i)
ii)
iii)
iv)
v)
vi)
vii)
viii)
79.
Primary Standards
Finance
Quality
Activity
Workforce
Performance
Contribution towards the objectives set out in this plan
Risk management
Divisional Performance Compacts will be monitored through regular Performance
Compact meetings. The outcome of these meetings, including agreed actions, will be
reported to the Performance Review Committee. This monitoring will inform
decisions about levels of autonomy and incentives.
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Oxford University Hospitals
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Performance Framework
80.
A performance framework has been developed to monitor key performance indicators. The table below shows an example of
the summary information that will be reported to the Board. A breakdown will also be available showing performance against
more detailed indicators at Divisional level.
Integrated Performance Framework
Access
Quality
Finance
Workforce
Activity Outcomes
Balance Sheet
Head count/Pay costs
Cancer Waits
Safety
Capital
Staff Experience
18 weeks, A/E and cancelled operations
Patient Experience
Cash & Liquidity
I&E
Colour
Description
Green
Target Achieved
Amber
Target Under‐achieved
Red
Target Failed
Grey
No Target
NA
No Data Available/ Not TB2012.68_Trust Business Plan 2012-13
34
Oxford University Hospitals
TB2012.68
Part Six – Risk Management
81.
The Trust Board will continue to monitor the principal risks to the delivery of the
strategic objectives set out in Part Two through the Board Assurance Framework and
by regular reviews of the risk register. Divisions and corporate departments monitor
and manage risks against the corporate objectives set out in Part Three, escalating
any risk which may impact at Trust level.
82.
Seven key risk areas have been identified. These are set out in the table below,
together with the director with lead responsibility for each and the plan for
mitigation.
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Risk
Lead Director
Manifestation
Mitigation
1. Failure to maintain
quality and
reputation
Medical Director
 Patients report poor or mediocre
experience of care
 Focus on quality and value and
meaningful benchmarks
 Poor outcomes against benchmarks
 Staff engagement and awareness of
required standards
 Not meeting national or local standards
 Unacceptable waiting times
 Negative media coverage relative to
competitors
 CIPs impact on service quality
 Strengthened quality governance
 Close liaison with NHSLA and CQC to
build trust and confidence
 Development of positive profile for OUH
services in the media
 Quality impact review of all CIP plans
2. Financial Failure
Director of Finance
and Procurement
 CIP behind plan
 Pay and agency costs uncontrolled
 Outstanding historic debt
 Failure to make use of commercial
opportunities
 Services display poor cost effectiveness
3. Failure to deliver
value for money
through estate
Director of
Development and
the Estate
 Continued utilisation of unaffordable
infrastructure
 Poor environment for patients
 Two-year rolling cost improvement
programme with contingencies
 Divisional ownership and programme
office support
 Contingency plans for strategic changes
in the Trust’s services or estate
 Space utilisation review
 Implementation of estates strategy
 Insufficient capacity to deliver required
activity
4. Failure to reduce
delayed transfers of
care
Director of Clinical
Services
TB2012.68_Trust Business Plan 2012-13
 High numbers of people waiting for
transfer from inpatient care
 Requirement to maintain additional beds
 Supported Discharge Service and
Appropriate Care for Everyone (ACE)
programme
36
Oxford University Hospitals
Risk
Lead Director
TB2012.68
Manifestation
Mitigation
 Close liaison and planning with social
care
 Collaborative work on care pathways,
education and training
5. Impact of Demand
Management
Director of Finance
and Procurement
 Activity levels unaffordable for health
economy
 Internal performance controls
Or
 Planning to deliver removal of fixed costs
 Effective liaison with commissioners
 Stranded fixed costs if demand
management reduces activity
6. Loss of
Commissioner
Support and Market
Share
Director of
Planning and
Information
 Loss of existing market share
 Strategy developed with commissioners
 Failure to gain share of new markets
 Agree assumptions and financial
approach with key commissioners
 Lack of support for business cases
 Failure to establish sustainable regional
networks
7. Failure to sustain
Effective Workforce
Director of
Workforce
 Maintain ability to be nimble in flexing
capacity
 Contingency plans for changes to services
portfolio
 Difficulty in recruiting and retaining high
quality staff
 Base leadership on values visible in
practice
 Low levels of staff satisfaction
 “Values into Action” programme
 Low levels of staff involvement in service
redesign
 Use feedback to inform training
 Failure to deliver required activity levels
 Improved recruitment and induction
materials to set expectations
 Strong focus on education and
development
TB2012.68_Trust Business Plan 2012-13
37
Oxford University Hospitals
TB2012.68
Mr Andrew Stevens, Director of Planning and Information
Ailsa White, Corporate Planning Manager
Matthew Lawrence, Head of Business Development
With input from other Directors, Divisions and their teams
June 2012
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