INTEGRATED BUSINESS PLAN
In support of the Trust Application to apply for
NHS Foundation Trust Status
Draft Revision H – For Consultation
Revision
H
Date
13th June
2007
Summary of Changes
Issued for feedback from Staff and Public as part of
consultation process ending 6th September 2007
Essex Rivers Healthcare NHS Trust
FT Applicant Business Plan Rev H
CONTENTS
1.
EXECUTIVE SUMMARY ......................................................................................4
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
2.
TRUST PROFILE................................................................................................11
2.1
2.2
2.3
2.4
2.5
2.6
2.7
2.8
2.9
3.
OVERVIEW ................................................................................................11
RANGE OF SERVICES .................................................................................13
ACTIVITY ...................................................................................................15
PROTECTED ASSETS .................................................................................15
FINANCE ...................................................................................................15
TARGET PERFORMANCE ............................................................................17
SUMMARY OF CONTRACTUAL RELATIONSHIPS ............................................18
OVERVIEW OF OTHER PROCUREMENT ARRANGEMENTS ..............................19
JOINT VENTURES AND PARTNERSHIP ARRANGEMENTS ...............................19
STRATEGY.........................................................................................................21
3.1
3.2
3.3
3.4
3.5
4.
OUR VISION ................................................................................................4
RATIONALE FOR FOUNDATION TRUST STATUS ..............................................6
MARKET ASSESSMENT .................................................................................7
PERFORMANCE OVERVIEW ..........................................................................8
SUMMARY SWOT ANALYSIS ........................................................................8
KEY RISKS AND MITIGATIONS .......................................................................9
CONSULTATION .........................................................................................10
NAME OF THE NEW ORGANISATION .............................................................10
OUR VISION ..............................................................................................21
STRATEGY ................................................................................................21
RATIONALE OF FOUNDATION TRUST STATUS ..............................................24
SUMMARY OF OUTCOME OF CONSULTATION PROCESS ...............................24
NAME OF THE NEW ORGANISATION .............................................................24
MARKET ASSESSMENT ...................................................................................25
4.1
4.2
4.3
4.4
4.5
4.6
4.7
4.8
4.9
4.10
4.11
4.12
4.13
4.14
4.15
4.16
4.17
4.18
INTRODUCTION ..........................................................................................25
DESCRIPTION OF LOCAL HEALTH ECONOMY (LHE).....................................25
ILLUSTRATIVE MAP OF LOCAL HEALTH ECONOMY (LHE).............................26
DEMOGRAPHIC ANALYSIS ...........................................................................26
KEY FACTORS DRIVING DEMAND ...............................................................36
WHAT THEREFORE ARE THE MAIN FACTORS NEEDING CONSIDERATION IN
PLANNING SERVICES FOR THE FUTURE? .....................................................36
OBJECTIVES OF THE LOCAL HEALTH ECONOMY ..........................................37
CONTRIBUTION OF THE TRUSTS STRATEGY TO THE LHE.............................38
MAJOR CHANGES IN EXTERNAL ENVIRONMENT & COMPETITION .................39
SUMMARY PEST ANALYSIS .......................................................................40
COMPETITIVE FACTORS .............................................................................42
IMPACT OF PATIENT CHOICE ......................................................................44
IMPACT OF PRACTICE BASED COMMISSIONING (PBC).................................46
ACUTE SERVICES REVIEW .........................................................................46
OTHER AREAS OF IMPACT ..........................................................................47
HOW WILL THE TRUST ADDRESS THESE COMPETITIVE FACTORS? ...............47
HOW THE TRUST PERFORMS AGAINST COMPETITORS ..................................48
CONCLUSION.............................................................................................48
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Essex Rivers Healthcare NHS Trust
5.
SERVICE DEVELOPMENT PLANS...................................................................49
5.1
5.2
5.3
5.4
5.5
5.6
5.7
6.
OVERVIEW OF RISK MANAGEMENT STRUCTURE AND SYSTEMS ...................81
SUMMARY OF EXTREME BUSINESS RISKS ....................................................84
COMMENTARY ON MITIGATION ...................................................................84
LEADERSHIP & WORKFORCE ........................................................................85
8.1
8.2
8.3
8.4
8.5
9.
HISTORICAL PERFORMANCE ANALYSIS .......................................................63
HISTORICAL SERVICE AND COST IMPROVEMENT PROGRAMME (CIP) ...........68
HISTORIC BALANCE SHEET AND CASH FLOW ANALYSIS ...............................69
INCOME AND EXPENDITURE FIVE YEAR PROJECTIONS ................................71
FUTURE SERVICE AND COST IMPROVEMENT PROGRAMME (CIP) .................77
CASH FLOW 5 YEAR PROJECTIONS ............................................................78
PUBLIC SECTOR PAYMENT POLICY.............................................................80
RISKS .................................................................................................................81
7.1
7.2
7.3
8.
INTERNAL CAPACITY ASSESSMENT AND SWOT ANALYSIS ..........................49
COMMENTARY ON SWOT ANALYSIS ..........................................................51
SUMMARY OF FUTURE INITIATIVES .............................................................53
SDP NO.1 - EMERGENCY SERVICES ..........................................................54
SDP NO.2 - CENTRE FOR MINIMALLY-INVASIVE AND GI SURGERY ..............56
SDP NO.3 - CANCER CENTRE ...................................................................57
ESTATES STRATEGY ..................................................................................62
FINANCIAL PLANS............................................................................................63
6.1
6.2
6.3
6.4
6.5
6.6
6.7
7.
FT Applicant Business Plan Rev H
MANAGEMENT ARRANGEMENTS .................................................................85
WORKFORCE KEY PERFORMANCE INDICATORS ..........................................88
AGENCY AND RECRUITMENT ARRANGEMENTS ............................................88
RECRUITMENT HOTSPOTS AND ACTIONS TO ADDRESS................................89
WORKFORCE AND ORGANISATIONAL DEVELOPMENT...................................89
GOVERNANCE ARRANGEMENTS...................................................................93
9.1
9.2
9.3
9.4
9.5
9.6
9.7
9.8
HOW STAKEHOLDER INTERESTS WILL BE REPRESENTED.............................93
CORPORATE GOVERNANCE AND MANAGEMENT ..........................................99
RISK MANAGEMENT AND CNST ...............................................................101
PERFORMANCE MANAGEMENT REPORTING FRAMEWORK .........................101
FINANCIAL CONTROLS AND REPORTING ...................................................102
AUDIT .....................................................................................................102
COMPLIANCE FRAMEWORK ......................................................................103
IT SYSTEMS ............................................................................................103
10. LIST OF APPENDICES AVAILABLE SEPARATELY FROM THE TRUST
WEBSITE ..........................................................................................................106
APPENDIX 1 – Results of Consultation when complete in Sept 2007
APPENDIX 2 – Service SWOT Analysis
APPENDIX 3 – Long Term Financial Model – when complete in Sept 2007
APPENDIX 4 – Human Resources Strategy 2007 to 2012
APPENDIX 5 – Estates Strategy
APPENDIX 6 – Trust Board Pen Portraits
APPENDIX 7 – Trust Board and Sub-Committee details and Terms of Reference
APPENDIX 8 – Governance Rationale
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Essex Rivers Healthcare NHS Trust
1.
EXECUTIVE SUMMARY
1.1
Our Vision
FT Applicant Business Plan Rev H
People who use our hospital services will recommend us to their family
and friends because;
1.1.1
•
their needs and experiences are reflected in everything we do
•
our patients receive care that is safe, effective and accessible
•
the care we give fulfils the NHS Standards for Better Health
Our Strategy is to be the provider of choice by placing the patient at the
centre, based on principles of Safety, Sustainability and Accountability within
an ever learning environment.
Strategy
1.1.2
The service developments described in section 5 have been developed as a
response to a detailed analysis of the Trust’s service portfolio and are
contributing to the achievement of the Trust’s strategic goals. In summary,
the Trust’s strategy can be shown in the diagram below:
1.1.3
As shown in the diagram above, the Trust Strategy is to be a patient centred
learning organisation through our three themes of Safety, Sustainability and
Accountability.
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1.1.4
FT Applicant Business Plan Rev H
The Strategic Objectives underpinning this are set out in the table below:
Table 3A – Strategic Objectives
Theme
Safety
Objective
1. Compliant with
Healthcare
Commission
Safety domain
core and
developmental
standards
2. Compliant with
Healthcare
Commission Care
Environment
and Amenities
domain core and
developmental
standards
Success Measure
1. Core Standards
fully met and
overall Quality
Element Rating
Excellent.
Sustainability
1. Compliant with
Healthcare
Commission
Clinical and
Cost
Effectiveness
domain core and
developmental
standards.
2. Support our staff
to create an
efficient, flexible
and highly skilled
Trust.
3. Compliant with
Healthcare
Commission
Public Health
domain core and
developmental
standards.
1. Core Standards
fully met and
overall Use of
Resources
Rating
Excellent.
2. High retention
rates for staff
through
reputation as a
model employer
of highly skilled
staff
Supporting Plans
1. Refer to service
development plan
No.1 – Emergency
Services. (section
5.4)
2. Refer to service
development plan
No.2 – Centre for
Minimally-Invasive
and GI Surgery.
(section 5.5)
3. Refer to service
development plan
No.3 – Cancer
Centre.(section 5.6)
1. Achieve internal
Service and Cost
Improvement target
set each year
2. Work within Budget
set each year by
Revenue and
Resource Committee
3. Achieve activity and
income levels set
within Service Level
Agreement with PCT
4. Establish a Multidisciplinary Learning
Centre as described
in section 5.7
5. Refer also to
Workforce
Development Plans
and HR Strategy
(section 8)
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Essex Rivers Healthcare NHS Trust
Theme
Accountability
Objective
1. Compliant with
Healthcare
Commission
Patient Focus
domain core and
developmental
standards.
2. Compliant with
Healthcare
Commission
Accessible and
responsive care
domain core and
developmental
standards.
3. Compliant with
Healthcare
Commission
Governance
domain core and
developmental
standards
FT Applicant Business Plan Rev H
Success Measure
1. Core Standards
fully met and
overall Quality
Element Rating
Excellent.
Supporting Plans
1. Refer to Section
9.1.22, the Trust
Membership
Strategy when
becoming a
Foundation Trust.
2. Refer to Section 9 the
Trust Governance
Arrangements
including having a
strong membership
and member council
when becoming a
Foundation Trust.
1.2
Rationale for Foundation Trust Status
1.2.1
The key reason for this application is that the Trust would like to work with its
foundation trust membership in a way that will help it to be the provider of
choice and achieve its key aim set out in section 3 which is:
People who use our hospital services will recommend us to their family
and friends because their needs and experiences are reflected in
everything we do.
1.2.2
Becoming a Foundation Trust will be a catalyst for changing the cultural
environment of the Trust from one of providing services at the request and
control of a centralised NHS (which can be perceived by local patients to be
unaccountable to them), to one where the Trust is accountable to local
people, who will become members or governors, enabling local ownership
and thereby helping the Trust to achieve its vision of being the provider of first
choice for the population, as patients should want to choose the Trust that
they can influence, and which champions the local community.
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1.3
Market assessment
1.3.1
A detailed market assessment of the Local Health Economy is included in
section 4. This identified the following competitive factors in the market which
may impact on the Trusts activity during the next five years
•
Patient Choice
•
Practice Based Commissioning (PBC)
•
Existing Independent Sector Providers
•
New Independent Sector Providers
•
Other Foundation Trusts and NHS Trusts in the Local Health Economy
How will the Trust address these Competitive Factors?
1.3.2
The Trust vision to be the provider of first choice for the population of North
East Essex in meeting their health care needs and the Trust will therefore
need to develop a market strategy to protect it from the competitive factors
described above. The following factors affect patient choice and will need to
be addressed by this strategy:
•
Ease of Access
− The main hospital in Colchester is central and easy to access for the
patients living in the main town of Colchester.
− The Trust provides services closer to patients in the rural areas of
North East Essex by providing services at Clacton, Harwich and
Halstead, the other main towns in North East Essex.
•
Reputation of Hospital and Quality of Care
− potential patients can now compare between local Trusts regarding a
variety of national indicators, using information on the internet, such as
Dr. Foster. Therefore the Trust aim to provide high quality patient care
as part of its vision is clearly essential, and needs to be well
communicated as this continues to be achieved.
•
Patient Information
− the Trust needs to continue to improve patient information e.g. leaflets
and the Trust website. The Trust will strive to make all its information
as patient orientated as possible.
•
Waiting Times
− With the introduction of the 18 week care pathway, most local Trusts
will offer similar reducing waiting times. In order to differentiate itself
from others, the Trust will need to offer a care pathway of less than 18
weeks in the future, as patient expectations increase as shorter and
shorter waiting times become the norm.
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Essex Rivers Healthcare NHS Trust
FT Applicant Business Plan Rev H
1.4
Performance Overview
1.4.1
The Trust compares favourably with all its local NHS competitors, and will
continue to improve by learning and implementing the ideas set out in this
business plan. The table below shows the Trust recent performance against
the Healthcare Commission Annual Health Check.
Table 2G – Historical Target Performance – Annual Health Check
Key Target
2005/06
Published
Rating
Use of Resources
Financial Reporting
Adequate
Financial Management
Adequate
Financial Standing
Inadequate
Internal Control
Adequate
Value for Money
Adequate
Overall Rating
Weak
Quality Element
Core Standards
Existing National Standards
New National Targets
Improvement Reviews & Acute Hospital
Portfolio
Overall Quality Rating
2006/07
Forecast
Rating
Adequate
Adequate
Adequate
Adequate
Adequate
Fair
Almost Met
Almost Met
Excellent
Good
Fully Met
Fully Met
Good
Good
Good
1.4.2
In 2004/05 the Trust received £8.1m planned support, which as part of the
trusts recovery plan will be repaid in 2007/08. The Trust will then be deficit
free in April 2008 which enable the Trust to improve it Use of Resources
Rating from Fair to Good.
1.5
Summary SWOT Analysis
1.5.1
The SWOT analysis in section 5 has created a focus on the factors that affect
the strategic development of the Trust’s business and has helped in the
formulation of Service Development Plans detailed in this plan. In summary
the SWOT identified the following actions:
Building on Strengths
1.5.2
The Trust will build on its international reputation in laparoscopic surgery and
training by developing a Centre for Minimally Invasive and GI Surgery.
1.5.3
The existing highly regarded non-surgical cancer service represents a sound
basis from which to develop. To support this the Trust plan the centralisation
of acute services including Oncology on the Colchester General Hospital site
in new modern facilities.
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Addressing Weaknesses
1.5.4
The Trust intends to make use of the opportunity of becoming Foundation
Trust and in particular its local membership to confirm the Trust’s position as
the provider of first choice for acute services for the population of North
Essex.
1.5.5
The Trust has instilled a strong business planning culture throughout with the
Revenue Resource Committee maintaining control of these issues on behalf
of the Trust Board.
1.5.6
This approach has been supported by an improved provision of IM&T
exemplified by the implementation of PACS in May 2006.
Exploiting Opportunities
1.5.7
The socio-demographics of the Trust’s natural catchment area suggest there
will be continued growth in demand for acute services, both young and old.
1.5.8
The Trust is undertaking a programme of service improvement to ensure that
it is achieving the highest levels of performance. As part of this programme,
the Trust will improve efficiency and quality through centralisation and shifts
to day surgery where possible while also offering more local services where
this is appropriate.
Management of Threats
1.5.9
Competition, including the likely positioning of an Independent Sector
Treatment Centre (ISTC) in North Essex, represents a potential threat to the
Trust’s income base. To minimise this we will offer high quality services and
look to form partnerships both horizontal (with other secondary care
providers) and vertical (with primary and tertiary providers) to secure our
place in the care pathway.
1.6
Key Risks and Mitigations
1.6.1
The Trust risk management strategy and policy1 was updated and approved
by the Trust Board on 14th February 2007. Full details of the risk management
structure and systems and the key personnel involved are detailed in this
policy and high level information are described in section 7.
1.6.2
The key risks to the Trust including this Integrated Business Plan and our
aspiration to become a Foundation Trust in April 2008 are regularly reviewed
by the Trust Board, and set out in Table 7A in section 7.
1
Trust Document Reference 118 version 4 – Risk Management Strategy and Policy
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1.7
Consultation
1.7.1
The Trust first undertook a 10-week public consultation process in relation to
its aspiration to become a foundation trust as part of its application for Wave
1(a) Foundation Trust status, between 23 February 2004 – 30 April 2004. The
outcome of this was broadly supportive, however the Trust is now repeating
the consultation between 14th June and the 6th September 2007 as part of the
Wave 7 application and this plan will then be updated and the results of the
consultation added in Appendix 1.
1.7.2
This plan will then be submitted to the Department of Health in October 2007
for formal approval.
1.7.3
If you would like to make comments on this plan please send them to
David Hewitt,
Director of Facilities, Planning and Development,
Trust Headquarters,
Colchester General Hospital
Tel. 01206 742733
Email. david.hewitt@essexrivers.nhs.uk
1.7.4
If you would like to register to become a member of the Trust please contact
the Trust acting membership officer Becci Hurst also at the address above.
1.8
Name of the new organisation
1.8.1
Based on the results of the previous consultation the Trust is recommending
changing its name from Essex Rivers Healthcare NHS Trust to Colchester
Hospitals University NHS Foundation Trust. The benefits of this are
1.8.2
•
Using the word “Colchester” is not intended to make those who live
outside of Colchester Borough Council area feel excluded. It will give a
better geographical description of the location of the main hospital to
people than “Essex Rivers” does, which currently causes confusion.
•
Using the word “Hospital” is better understood by the public than
“Healthcare”.
•
Adding the word “University” to the name is dependent on the Trust
gaining Associate University status later this year and the term “NHS
Foundation Trust” must be used.
•
It is hoped that this cleared name will make it easier to recruit the public
to become members of the Trust, and easier for the Trust to market its
name.
As with all aspects of this document the Trust welcome feedback as part of
this consultation on the proposed name change.
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2.
TRUST PROFILE
2.1
Overview
2.1.1
Essex Rivers Healthcare NHS Trust (herein referred to as the Trust) was
established in April 1992 and is the main acute healthcare provider in North
East Essex, serving a population of over 340,000 for general, and some
specialist, hospital services as well as an extended population of 670,000 for
non-surgical oncology treatment.
2.1.2
The Trust owns and provides services from the following sites:
2.1.3
•
Colchester General Hospital
− 14 hectares main hospital location in the town of Colchester.
− The Trust continues to expand and improve the buildings and services
provided from this site as part of this five-year business plan.
•
Essex County Hospital
− 1.7 hectares old hospital location in Colchester still providing oncology
and a range of outpatient and day case services.
− The Trust is seeking to centralise and reform its services from this site
to the Colchester General Hospital site as part of this five-year
business plan.
•
Halstead Hospital
− 1 hectare community hospital located in the town of Halstead which
the Trust use to provide services closer to patients in the Halstead
area.
− The Trust is seeking to transfer ownership of this site to the PCT
responsible for the Halstead area as part of this five-year business
plan.
− The Trust will then continue to review what services are best provided
from this community location in partnership with the PCT as part of this
five-year business plan.
•
214 Turner Road, Microbiology
− Stand alone Microbiology building opposite the general hospital
− The Trust is seeking to dispose of this site and centralise services at
Colchester General Hospital as part of this five-year business plan.
The Trust leases and provides services from a number of additional sites to
those it owns above, the key ones of which are:
•
Premiere House and Brunel Court
− Private rented office accommodation in Colchester supporting Medical
Records, Supplies and outsourced IT services.
− The Trust is seeking to vacate these buildings and centralise these
services to Colchester General Hospital as part of this five-year
business plan.
•
Chestnut Villa, Severalls Hospital
− Rented from the Secretary of State for Health until April 2012,
Chestnut Villa is located on the old and now otherwise unused
Severalls Hospital site in North Colchester. The Trust uses this
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Essex Rivers Healthcare NHS Trust
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building to provide a range of Pathology services as well as housing
computer servers and some medical records.
− The Trust is seeking to vacate this building and centralise these
services to Colchester General Hospital as part of this five-year
business plan.
2.1.4
2.1.5
•
Fryatt Hospital and Mayflower Medical Centre
− A new community hospital commissioned and opened by the PCT as a
new LIFT scheme in 2006 in which the Trust rent space in to provide
services closer to patients in the Harwich area.
− The Trust will continue to review what services are best provided from
this community location in partnership with the PCT as part of this fiveyear business plan.
•
Clacton Hospital
− Owned and operated by the PCT, from which the Trust rents space, to
provide services closer to patients in the Clacton area.
− The Trust will continue to review what services are best provided from
this community location in partnership with the PCT as part of this fiveyear business plan.
•
Colchester Primary Care Centre
− A new community healthcare centre commissioned and opened by the
PCT as a new LIFT scheme in 2006, which the Trust rents space in to
provide children’s services in partnership with the PCT.
− The Trust will continue to review what services are best provided from
this community location in partnership with the PCT as part of this fiveyear business plan.
The Trust has an existing PFI scheme for residential accommodation which it
entered into in May 2000 with Swan Housing Association Limited, the works
of which were completed in 2002. Through this contract the Trust has
nomination rights to:
•
130 new accommodation units constructed on the Trust site,
•
25 accommodation units at Roman Place in Colchester purchased by
Swan Housing,
•
59 refurbished accommodation units at Hollymead Close also owned by
Swan Housing in Colchester.
The Trust has two main commissioners in North Essex as shown in the table
on the following page. The entire population from the North East Essex PCT
area is in the Trust catchment area, but only those patients living in the
Halstead & Colne Valley area of Mid Essex PCT are in the Trust catchment
area.
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Table 2A – Commissioner Table
Commissioner
North East Essex PCT
Mid Essex PCT
(Halstead and Colne
Valley Ward Areas only)
Other
Total
2.1.6
Population
315,0002
67,7053
% of Trusts
Elective Income
n/a
% of trusts Non
Elective Income
86%
12%
85%
11%
2%
4%
100%
100%
The Trust employs 3,470 staff as shown in the table below
Table 2B – Staff Numbers
Staff Group
WTE
Heads
Nursing
1,326.59
1,625
Admin and Clerical
473.82
636
Doctors
388.89
432
Professional & Technical
279.95
336
Allied Health Professionals
207.07
277
Science & Professional
73.64
86
Senior Managers
58.74
61
Ancillary
8.76
11
Non Execs
6
Total
2,817
3,470
2.2
Range of Services
2.2.1
The Trust provide a range of patient services and in the last year this
included:
2.2.2
2
3
•
305,353 outpatient attendances.
•
85,462 A&E patients, 98% cared for in A&E within the four hours
standard (from arrival to admission or discharge)
•
62,514 inpatient and daycase admissions.
•
3,574 babies delivered - around 10 every day on average
•
7,534,662 laboratory tests - around 20,600 daily
•
26,673 patients operated on in our theatres - more than 70 a day on
average
The range of services by speciality and relative size are shown in more detail
in the table on the next page.
Taken from North East Essex PCT Website (2001 cenus information confirms 294,335).
Taken from 2001 census by Ward.
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Table 2C - 2006/07 Projected Outturn Financial Position (Month 12 Projection)
Activity
A&E
General Surgery
Urology
Trauma & Orthopaedic
Ear, Nose & Throat
Ophthalmology
Oral Surgery
Orthodontics
A&E
Pain Management/Anaesthetics
General Medicine
Gastroenterology
Haematology
Clinical Genetics
Cardiology
Dermatology
Thoracic Medicine
Nephrology
Oncology
Neurology
Rheumatology
Paediatrics
Care of the Elderly
Maternity
Gynaecology
85,462
OPs
25,467
12,228
34,927
24,954
50,329
3,119
2,186
1,201
8,448
8,232
4,144
7,691
15,266
15,202
6,795
1,730
18,360
2,911
7,686
13,804
4,831
20,667
15,175
Income
Elective
5,460
3,709
3,680
1,653
2,504
905
704
38
3,291
2,530
1,013
256
46
423
8
7
44
2,392
Non
Electives
4,426
189
2,111
427
115
1
1
8,286
187
47
1,346
33
233
65
945
1
2
2,856
5,662
6,215
703
A&E
5,997
OPs
2,794
1,190
3,472
2,002
3,114
294
218
154
1,053
970
553
767
10
1,835
1,051
860
310
1,631
1,040
972
1,819
936
1,952
1,865
Electives
4,172
1,752
7,120
1,060
70
65
0
1
2
31
65
145
80
24
38
444
1
13
271
1,534
Daycases
2,488
1,337
1,713
488
1,726
634
370
12
1,394
1,133
1,239
166
16
24
6
1,002
Elective
6,660
3,089
8,834
1,548
1,796
699
0
1
371
43
1,460
1,278
1,319
190
54
468
1
6
13
271
2,536
Non
Elective
8,330
488
6,622
599
138
3
0
1
2
13,868
482
119
1,517
96
620
136
2,285
0
7
2,477
14,431
4,775
817
Pathology Direct Access
Critical Care
Other Services
MFF (Net of Clawback)
Sub Total
Other
Services
4,831
5,513
20,042
85,462
305,353
28,663
33,851
5,997
30,864
16,889
13,748
30,637
57,813
30,386
Total
17,784
4,767
18,928
4,149
5,048
997
219
6,152
1,427
14,881
2,495
2,164
10
4,671
1,147
1,670
500
4,383
1,041
985
4,296
15,381
6,998
5,217
4,831
5,513
20,042
4,558
160,254
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2.3
Activity
2.3.1
The Trust Clinical Activity Plans and historical achievement are shown in the
table below
Table 2D - Comparison between historical achievement and plan
Clinical Income in £ms
Forecast
Plan
Current Plan
/Actual
2006/07
2006/07
2007/08 2008/09 2009/10
Elective
33.2
30.6
38.3
32.0
33.6
Non-elective
64.2
63.5
64.4
69.2
68.9
Out-Patients
32.4
32.4
34.9
29.0
30.2
Other Activity
32.7
33.6
32.7
35.3
37.7
A&E
6.6
6.7
5.8
6.1
6.3
Total
169.1
166.8
176.1
171.6
176.7
Clinical activity
Activity numbers
Forecast
Current Plan
Plan
/Actual
2006/07
2006/07
2007/08 2008/09 2009/10
Elective
29,539
28,663
35,964
31,314
31,542
Non-elective
34,835
33,851
33,905
34,242
34,582
Out-Patients
289,756
305,353
307,234 267,627
249,247
Other Activity
0.0
0.0
0.0
0.0
0.0
A&E
87,035
85,462
72,242
73,326
74,426
2.4
Protected Assets
2.4.1
The Trust’s protected land assets are:
•
Colchester General Hospital as defined by the following registered title
numbers:
− EX729453
− EX461617
− EX464548
− EX464546
− EX464551
− EX464530
•
Essex County Hospital as defined by the following registered title
numbers:
− EX464554
•
Halstead Hospital as defined by the following registered title numbers:
− EX493239
− EX464531
•
All equipment contained in each of the above protected land assets.
2.5
Finance
2.5.1
The Trust high level financial information is shown in the table on the
following page.
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Essex Rivers Healthcare NHS Trust
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Table 2E – Summary of High Level Financial Information
Summary of financial performance: high-level comparison between historical plan performance
and actual performance
2006/07 plan
£m
2006/07
forecast/actual
2007/08 plan
Income
Clinical income
162.7
162.4
165.8
11.5
12.6
12.2
Other income
0.0
0.0
0
Total income
174.2
175.0
178.0
Non-clinical income
Expenses
Pay costs
-101.6
-101.3
106.2
Non-pay costs
-54.0
-55.6
60.2
Other costs
-5.6
-5.2
6.5
Total costs
-161.2
-162.1
-172.9
13.0
12.9
5.1
0.2
0.3
0.2
-4.6
-4.6
-4.9
8.6
8.6
0.4
EBITDA
Interest receivable
PDC Dividend
Net surplus/(deficit)
2.5.2
The Trust income shown in the table above for 2007/8 plan is net of £8.1m
repayment of planned support as explained in section 6.1.6. The Trust will
therefore get this additional income back in future years, as shown in table 6L
in section 6.
2.5.3
The Trust Reference Cost Index is 97.
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Essex Rivers Healthcare NHS Trust
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2.6
Target Performance
2.6.1
The Trust historical performance against key healthcare targets is shown in
the table below. In 2005/06 the system changed to the Annual Health Check
which is shown in more detail in Table 2G on the next page.
Table 2F – Historical Target Performance – Star Rating System
Key Target
12 hour waits for
emergency
admission via A&E
post decision to
admit
All cancers: two
week wait
Elective patients
waiting longer than
the standard
Financial
management
Hospital cleanliness
Outpatient and
elective (inpatient
and day case)
booking
Outpatients waiting
longer than the
standard
Total time in A&E
Cancelled operations
not admitted within
28 Days *1
Improving Working
Lives *1
Balanced
Scorecard
Clinical focus
Patient focus
Capacity & Capability
focus
Key:
2003/2004
1 Star
2004/2005
3 Stars
2005/06
A.H.C.
Published
Achieved
2006/07
A.H.C.
Forecast
Achieved
Achieved
Achieved
Achieved
Achieved
Achieved
Achieved
Under achieved
Achieved
Achieved
Significantly
underachieved
Underachieved
Achieved
Achieved
Weak
Fair
Achieved
Achieved
Achieved
Achieved
Achieved
Achieved
Achieved
Achieved
Achieved
Achieved
Achieved
Achieved
Achieved
N/A
Underachieved
N/A
Under achieved
Achieved
Achieved
N/A
N/A
N/A
Top
Middle
Bottom
Top
Top
Top
N/A
N/A
N/A
N/A
N/A
N/A
Achieved
*1 Key Target withdrawn – moved to Balanced Scorecard
N/A – Not Applicable - target changed or moved
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Essex Rivers Healthcare NHS Trust
FT Applicant Business Plan Rev H
Table 2G – Historical Target Performance – Annual Health Check
Key Target
2005/06
Published
Rating
Use of Resources
Financial Reporting
Adequate
Financial Management
Adequate
Financial Standing
Inadequate
Internal Control
Adequate
Value for Money
Adequate
Overall Rating
Weak
Quality Element
Core Standards
Existing National Standards
New National Targets
Improvement Reviews & Acute Hospital
Portfolio
Overall Quality Rating
2006/07
Forecast
Rating
Adequate
Adequate
Adequate
Adequate
Adequate
Fair
Almost Met
Almost Met
Excellent
Good
Fully Met
Fully Met
Good
Good
Good
2.7
Summary of Contractual Relationships
2.7.1
The Trust’s current significant contracts are shown in the table below.
Table 2H – Summary of Contractual Relationships
Organisation
Contract
Description
Anticipated
Annual
Value
Income or
Expenditure
Income
st
31 March 2008
Income
31st March 2008
Income
31st March 2008
Cost &
Volume
Expenditure
31st March 2008
Block
Expenditure
31st March 2008
PCT’s
Healthcare
Commissioning
Mid Essex
Hospitals
NEMHPT
Plastics
761,197
Cost &
Volume,
and Block
Block
Clinical
Support/Overheads
Orthotics, Special
Seating &
Wheelchairs
Patient Transport
Service
338,473
Block
Havering PCT
Essex
Ambulance
155,532,000
Contract
Type
(413,923)
(1,189,331)
Expiry Date
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Essex Rivers Healthcare NHS Trust
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2.8
Overview of other Procurement Arrangements
2.8.1
The Trust has a number of other procurement arrangements summarised in
the table below.
Table 2J – Overview of other procurement arrangements
Supplier
Carillion
Contract
Description
FM Services
NBS
Blood Products
Cardinal
Anticipated
Annual Value
Contract
Type
8,961,604
Cost &
Volume,
and Block
Cost &
Volume,
and Block
Cost &
Volume,
and Block
1,672,633
Catheter
Laboratory
984,200
1,139,969
Essex County
Council
Shared
Services
Charges
Equipment
Service
Alliance Medical
MRI
367,678
Essex Ambulance
Blatchford
GE Capital
Block
425,720
Orthotics
Service
264,127
Patient
Monitoring
Equipment
147,024
Cost &
Volume,
and Block
Cost &
Volume,
and Block
Cost &
Volume,
and Block
Block
Income or
Expenditure
Expiry Date
1st July 2009
Expenditure
31st March 2008
Expenditure
31st March 2010
Expenditure
31st March 2007
Expenditure
31st March 2006
Expenditure
31st January 2017
Expenditure
31st March 2008
Expenditure
31st July 2009
Expenditure
2.9
Joint Ventures and Partnership Arrangements
2.9.1
The Trust works in Partnership with a number of organisations for the delivery
of services.
Essex County Council
2.9.2
The Trust has a Section 31 Partnership Arrangement under the Health Act
1999 with Essex County Council Social Services Department.
The
arrangement, commenced in May 2002, specialises in the procurement,
delivery and fitting, collection, refurbishment and recycling of specialist
equipment and adaptations to assist in tasks of daily living.
2.9.3
This partnership facilitates the following:
•
safe and timely hospital discharges;
•
prevention of delayed admissions through A&E;
•
assistance in meeting elective admission targets;
•
contribution to the PCT achieving its performance star rating S102 target
(the delivery of all equipment and adaptations within 7 working days from
completion of assessment);
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Essex Rivers Healthcare NHS Trust
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•
promotion of independence in the community; and
•
promotion of safety and well-being of carers
Ipswich Hospital NHS Trust
2.9.4
The Trust has partnership arrangements with Ipswich Hospital NHS Trust, for
the provision of;
•
Gynaecological cancer
•
Pancreatic cancer
•
ENT
•
Vascular Surgery
•
Renal Services
•
Joint National Decontamination Partnership Arrangement
Mid Essex Hospital NHS Trust
2.9.5
The Trust has partnership arrangements with Chelmsford, its neighbouring
acute NHS Hospital Trust south of Colchester, for the provision of;
•
Non-Surgical Oncology
•
Haematology level 2 development
•
Upper GI cancer
•
Breast Screening
•
Neurology network
Page 20 of 106
Essex Rivers Healthcare NHS Trust
3.
STRATEGY
3.1
Our Vision
FT Applicant Business Plan Rev H
People who use our hospital services will recommend us to their family
and friends because;
•
their needs and experiences are reflected in everything we do
•
our patients receive care that is safe, effective and accessible
•
the care we give fulfils the NHS Standards for Better Health
3.1.1
Our Strategy is to be the provider of choice by placing the patient at the
centre, based on principles of Safety, Sustainability and Accountability within
an ever learning environment.
3.2
Strategy
3.2.1
The Trust intends to continue to provide its existing broad portfolio of clinical
services to the population of North-East Essex as a clinically effective and
financially sustainable General Hospital. Our commissioners support the
development of new acute and diagnostic services where this would support
the repatriation to the Trust of specialist activity previously referred to tertiary
centres; however, this will only be done where the expected income is
sufficient to ensure a financially sustainable service.
3.2.2
The service developments described in section 5 have been developed as a
response to a detailed analysis of the Trust’s service portfolio and are
contributing to the achievement of the Trust’s strategic goals. In summary,
the Trust’s strategy can be shown in the diagram below:
3.2.3
As shown in the diagram above, the Trust Strategy is to be a patient centred
learning organisation through our three themes of Safety, Sustainability and
Accountability.
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Essex Rivers Healthcare NHS Trust
3.2.4
FT Applicant Business Plan Rev H
The Strategic Objectives underpinning this are set out in the table below:
Table 3A – Strategic Objectives
Theme
Safety
Objective
3. Compliant with
Healthcare
Commission
Safety domain
core and
developmental
standards
4. Compliant with
Healthcare
Commission Care
Environment
and Amenities
domain core and
developmental
standards
Success Measure
2. Core Standards
fully met and
overall Quality
Element Rating
Excellent.
Sustainability
4. Compliant with
Healthcare
Commission
Clinical and
Cost
Effectiveness
domain core and
developmental
standards.
5. Support our staff
to create an
efficient, flexible
and highly skilled
Trust.
6. Compliant with
Healthcare
Commission
Public Health
domain core and
developmental
standards.
3. Core Standards
fully met and
overall Use of
Resources
Rating
Excellent.
4. High retention
rates for staff
through
reputation as a
model employer
of highly skilled
staff
Supporting Plans
4. Refer to service
development plan
No.1 – Emergency
Services. (section
5.4)
5. Refer to service
development plan
No.2 – Centre for
Minimally-Invasive
and GI Surgery.
(section 5.5)
6. Refer to service
development plan
No.3 – Cancer
Centre.(section 5.6)
6. Achieve internal
Service and Cost
Improvement target
set each year
7. Work within Budget
set each year by
Revenue and
Resource Committee
8. Achieve activity and
income levels set
within Service Level
Agreement with PCT
9. Establish a Multidisciplinary Learning
Centre as described
in section 5.7
10. Refer also to
Workforce
Development Plans
and HR Strategy
(section 8)
Page 22 of 106
Essex Rivers Healthcare NHS Trust
Theme
Accountability
Objective
4. Compliant with
Healthcare
Commission
Patient Focus
domain core and
developmental
standards.
5. Compliant with
Healthcare
Commission
Accessible and
responsive care
domain core and
developmental
standards.
6. Compliant with
Healthcare
Commission
Governance
domain core and
developmental
standards
FT Applicant Business Plan Rev H
Success Measure
2. Core Standards
fully met and
overall Quality
Element Rating
Excellent.
Supporting Plans
3. Refer to Section
9.1.22, the Trust
Membership
Strategy when
becoming a
Foundation Trust.
4. Refer to Section 9 the
Trust Governance
Arrangements
including having a
strong membership
and member council
when becoming a
Foundation Trust.
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Essex Rivers Healthcare NHS Trust
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3.3
Rationale of Foundation Trust Status
3.3.1
The key reason for this application is that the Trust would like to work with its
foundation trust membership in a way that will enable its key aim, as set out in
3.1.1, which is:
People who use our hospital services will recommend us to their family
and friends because their needs and experiences are reflected in
everything we do
3.3.2
The Trust believes that becoming a Foundation Trust will be a catalyst to
changing the cultural environment of the Trust from one of providing services
at the request and control of a centralised NHS (which can be perceived by
local patients to be unaccountable to them) to one where the Trust is
accountable to local people, who will become members or governors,
enabling local ownership and thereby helping the Trust to achieve its vision of
being the provider of choice for the population, as patients should want to
choose the Trust in which they have real influence.
3.3.3
The Board of Governors and Trust Membership will therefore work with the
Trust to influence future investments made from the surpluses that the Trust
will be free to retain and build up, to help achieve its other aims set out in
3.1.1 that our patients receive care that is safe, effective and accessible and
the care we give fulfils the NHS Standards for Better Health.
3.4
Summary of Outcome of Consultation Process
3.4.1
The Trust first undertook a 10-week public consultation process in relation to
its aspiration to become a foundation trust as part of its application for Wave
1(a) Foundation Trust status, between 23 February 2004 – 30 April 2004. The
outcome of this was broadly supportive, however the Trust is repeating the
consultation between 14th June and the 6th September 2007 as part of the
Wave 7 application and the results will be included in Appendix 1 and used to
update this IBP before submission to the Department of Health.
3.5
Name of the new organisation
3.5.1
Based on the results of the previous consultation the Trust is recommending
changing its name from Essex Rivers Healthcare NHS Trust to Colchester
Hospitals University NHS Foundation Trust. The benefits of this are
3.5.2
•
Using the word “Colchester” is not intended to make those who live
outside of Colchester Borough Council area feel excluded. It will give a
better geographical description of the location of the main hospital to
people than “Essex Rivers” does, which currently causes confusion.
•
Using the word “Hospital” is better understood by the public than
“Healthcare”.
•
Adding the word “University” to the name is dependent on the Trust
gaining Associate University status later this year and the term “NHS
Foundation Trust” must be used.
It is hoped that this cleared name will make it easier to recruit the public to
become members of the Trust.
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4.
MARKET ASSESSMENT
4.1
Introduction
4.1.1
The primary aim of this element of the plan is to analyse the impact on the
Trusts services over the next five years and any cause and effect on
‘business as usual’. A range of factors present themselves and will be
covered in this section of the document. The impact on services can be
subtle (local changes to care pathways) but also profound (a major change in
population and or a major new competitor causing activity to move away from
the Trust). This section of the plan will explore a number of significant and
other factors that the Trust appreciates in setting out its business plan for the
future.
4.1.2
Whilst the primary analysis is built around the forthcoming five years a key
factor that can and needs to be assessed over a longer time period is
population growth/decrease.
4.2
Description of Local Health Economy (LHE)
4.2.1
North East Essex, which takes in the geographic areas covered by Colchester
and Tendring, forms part of the general East Anglia area, abutting the
southern border of Suffolk and the south east borders of Cambridgeshire.
Colchester is the largest town in North East Essex – and is the host borough
in which the Trust’s two main hospitals are located – Colchester General
Hospital and Essex County Hospital. Colchester is also home to a major
army garrison, the UK base for front-line airborne assault units.
Map of the UK
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Essex Rivers Healthcare NHS Trust
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4.3
Illustrative Map of Local Health Economy (LHE)
4.3.1
The Trust is located at the centre of major transport networks. It is within 45
minutes of Stansted Airport by car and is 1 hour by train to central London. It
has easy access to major road networks including the A1, A12, A14, M11 and
M25. Harwich has a significant and expanding port some 15 miles from
Colchester.
Illustrative Map of LHE
4.4
Demographic analysis
Population Structure
4.4.1
In appreciating the future relevance/need for an acute hospital in this locality it
is necessary to first consider the population demographics which then
secondly, allow a range of strategic questions to be asked for example, what
levels of demand in the future need to be managed by an acute based facility,
is it relevant to have acute services based in and around a certain population
base? Appreciating the geographic setting of the Trust key considerations in
assessing demand on services comes from understanding the population and
its needs now and into the future.
4.4.2
The total estimated population for North East Essex (which represents the
historical main catchment area for the Trust for both Elective and NonElective care) area as at mid 2005 was 305,200 (Colchester 163,400 and
Tendring 141,800).
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FT Applicant Business Plan Rev H
Table 4A: Colchester’s Estimate Resident population by age groups (2003 CAS
Wards)
Wards
0-4
.5-14
15-24
25-34
35-44
45-54
55-64
65-74
75-84
85+
Total
Berechurch
491
1,279
1,137
1,285
1,327
1,055
692
644
371
86
8,367
Birch and Winstree
276
630
509
544
775
848
621
385
204
54
4,846
7,031
Castle
288
584
1,030
1,440
861
883
699
500
462
284
Christ Church
239
582
524
642
688
621
402
242
186
76
4,202
Copford & W. Stanway
118
214
195
212
321
308
205
121
101
81
1,876
Dedham and Langham
150
383
198
236
452
553
366
299
202
67
2,906
East Donyland
162
319
271
350
390
323
245
161
118
37
2,376
Fordham and Stour
317
677
481
603
745
875
679
381
251
106
5,115
Great Tey
174
370
236
255
441
499
379
227
139
46
2,766
Harbour
363
827
651
967
911
630
481
388
312
171
5,701
Highwoods
646
1,052
952
1,789
1,244
872
484
310
165
79
7,593
Lexden
288
646
547
543
743
826
645
597
404
194
5,433
Marks Tey
144
309
293
365
370
434
316
190
105
40
2,566
Mile End
453
683
585
1,259
1,003
818
580
434
309
90
6,214
New Town
573
850
1,720
2,159
1,177
819
509
403
302
115
8,627
Prettygate
357
1,072
804
683
1,108
1,155
899
917
584
150
7,729
Pyefleet
121
281
207
225
349
438
379
221
141
72
2,434
St Andrew's
687
1,293
2,037
1,278
1,134
1,108
885
522
307
110
9,361
St Anne's
559
1,226
1,175
1,245
1,278
1,192
897
576
445
170
8,763
St John's
235
605
565
528
669
864
732
539
334
122
5,193
1,068
1,617
1,539
2,333
1,485
864
592
466
425
141
10,530
Stanway
393
955
852
1,089
1,091
1,077
851
675
429
141
7,553
Tiptree
384
952
794
860
997
1,233
1,046
707
393
149
7,515
Shrub End
W. B'holt & Eight Ash Grn
285
654
524
579
761
777
667
438
267
92
5,044
West Mersea
331
701
597
610
864
1,008
959
934
709
213
6,926
Wivenhoe Cross
116
297
1,759
680
380
315
237
190
137
32
4,143
Wivenhoe Quay
237
587
655
563
717
823
641
383
299
84
4,989
Figure 1: Percentage Populations by age groups by wards
Colchester Population
0-14
15-24
25-44
45-64
65+
45.00
40.00
35.00
25.00
20.00
15.00
10.00
5.00
Wivenhoe Quay
West Mersea
Wivenhoe Cross
Tiptree
W Berg & Eight Ash Green
Stanway
St John's
Shrub End
St Anne's
St Andrew's
Pyefleet
Prettygate
New Town
Mile End
Marks Tey
Lexden
Harbour
Highwoods
Great Tey
Fordham & Stour
East Donyland
Dedham & Langham
Copford & W Stanway
Castle
Christ Church
Berechurch
0.00
Birch & Winstree
Percentage
30.00
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Essex Rivers Healthcare NHS Trust
FT Applicant Business Plan Rev H
Table 4B: Tendring’s Estimate Resident population by age groups (2003 CAS
Wards)
Wards
0-4
.5-14
15-24
25-34
35-44
45-54
55-64
65-74
75-84
85+
Total
Alresford
92
255
224
194
305
334
328
227
130
38
2,127
Alton Park
341
757
607
692
735
575
516
443
374
142
5,182
Ardleigh and Little Bromley
130
336
206
228
406
379
311
214
127
31
2,368
Beaumont and Thorpe
101
311
247
242
324
393
329
243
162
45
2,397
Bockings Elm
233
527
424
442
526
539
518
526
470
132
4,337
Bradfield, Wrabness & Wix
125
276
231
186
333
402
313
203
121
39
2,229
Brightlingsea
464
1,004
746
988
1,117
1,109
1,056
774
635
253
8,146
65
164
138
156
197
283
402
384
244
76
2,109
Frinton
119
367
242
227
379
455
566
672
748
314
4,089
Golf Green
180
392
292
338
420
615
843
848
554
184
4,666
Great and Little Oakley
124
308
230
236
340
364
311
225
118
50
2,306
Burrsville
Great Bentley
113
281
211
244
298
324
314
245
143
86
2,259
Hamford
140
343
272
285
378
393
486
816
738
181
4,032
Harwich East
158
332
279
356
358
315
332
235
166
50
2,581
Harwich East Central
282
580
576
599
643
640
577
422
354
163
4,836
Harwich West
229
485
386
485
520
560
618
647
410
110
4,450
Harwich West Central
314
682
571
605
651
674
589
527
437
98
5,148
Haven
52
151
110
133
167
215
326
453
362
138
2,107
168
499
365
399
527
643
647
607
475
188
4,518
47
123
91
115
142
161
274
440
476
152
2,021
Lawford
235
636
463
573
700
651
522
371
250
75
4,476
Little Clacton and Weeley
200
468
369
437
571
696
701
629
410
131
4,612
M'tree, Mistley, Lt B'tley & Tend.
243
505
368
519
634
677
542
453
293
131
4,365
Peter Bruff
300
666
560
600
621
652
493
381
309
113
4,695
4,810
Holland and Kirby
Homelands
Pier
214
544
545
595
596
553
521
500
435
307
Ramsey and Parkeston
176
353
264
316
387
364
272
203
102
49
2,486
Rush Green
410
737
529
586
543
513
545
586
423
109
4,981
St Bartholomews
117
309
239
263
342
528
707
878
765
268
4,416
St James
177
447
423
363
475
544
555
640
481
229
4,334
St Johns
249
581
396
495
526
534
636
691
510
180
4,798
St Marys
284
686
533
568
627
595
494
596
438
145
4,966
St Osyth and Point Clear
149
423
321
328
438
600
678
631
413
140
4,121
St Pauls
170
423
422
331
460
563
586
623
636
338
4,552
Th'gton, Frating, E'tead & Gt. Bromley
243
550
390
517
664
741
661
460
292
124
4,642
Walton
210
422
338
394
421
530
607
630
560
265
4,377
Table 4C Mid Essex Population by age Groups in 2005 (only part of the
Braintree area approximately 70,000 falls within North East Essex)
Age
Band
0-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85+
Totals
Braintree
M
4258
4553
4617
4299
3543
3555
4674
5832
5571
4641
4433
4997
3775
2887
2327
1816
1243
822
67,843
F
4063
4285
4503
4116
3131
3746
4787
5706
5529
4713
4571
5139
3758
2940
2570
2354
2018
2018
69,947
137,790
Chelmsford
M
4588
4945
5342
5093
4863
5020
5693
6212
6307
5642
5168
5633
4179
3400
2909
2149
1376
868
79,387
F
4355
4563
5241
5062
4621
4775
5627
6353
6530
5589
5086
5838
4350
3663
3127
2716
2198
2049
81,743
161,130
Maldon
M
1704
2025
2070
1979
1503
1238
1520
2294
2357
2251
2066
2505
2000
1618
1231
840
541
369
30,111
F
1580
1859
1906
1733
1216
1212
1785
2498
2342
2237
2066
2604
2025
1602
1167
1025
851
924
30,632
60,743
Total Mid Essex
M
F
10550
9998
11523
10707
12029
11650
11371
10911
9909
8968
9813
9733
11887
12199
14338
14557
14235
14401
12534
12539
11667
11723
13135
13581
9954
10133
7905
8205
6467
6864
4805
6095
3160
5067
2059
4991
177,341
182,322
359,663
Page 28 of 106
Percentage (%
30.00
50
25.00
40
20.00
30
15.00
20
10.00
10
5.00
0
0.00
Y00484
F81079
F81129
F81746
F81095
F81679
GP Practice Population
Figure 3: Proportion by Age Groups of GP Practice Population (October 2006)
Colchester GP Practice Population (Oct 2006)
Deprivation
Page 29 of 106
Walton
Thor, Frat, Emsd & Gt Brom
St Pauls
St Osyth & Pt Clear
St Marys
St Johns
St James
St Bartholomews
Rush Green
Ramsey & Parkeston
Pier
Peter Bruff
Mann, Mist, Lt Bent & Tend
Lt Clacton & Weeley
Lawford
Homelands
45-64
F81042
65+
F81091
45-64
Holland & Kirby
Haven
Harwich Wt Cent
Harwich West
Harwich Et Cent
Harwich East
Hamford
Great Bentley
Gt & Lt Oakley
Golf Green
Frinton
Burrsville
Brightlingsea
Brad, Wrab & Wix
Bockings Elm
Beaumont & Thorpe
Ardleigh & Lt Bromley
25-44
F81672
Alresford
Alton Park
15-24
F81141
25-44
F81109
F81716
15-24
F81044
F81636
0-14
F81115
F81005
F81736
F81094
F81067
F81069
F81133
F81012
0-14
D eprivation Score (H igh Score=H igh Depriva
60
F81028
Percentage
Essex Rivers Healthcare NHS Trust
FT Applicant Business Plan Rev H
Figure 2: Percentage Populations by age groups by wards
Tendring Population
65+
60.00
50.00
40.00
30.00
20.00
10.00
0.00
Essex Rivers Healthcare NHS Trust
FT Applicant Business Plan Rev H
Figure 4: Proportion by Age Groups of GP Practice Population (October 2006)
Tendring GP Practice Population
0-14
15-24
25-44
45-64
65+
Deprivation
0.00
F81681
0.00
F81037
5.00
F81212
5.00
F81156
10.00
F81052
10.00
F81741
15.00
F81018
15.00
F81670
20.00
F81077
20.00
F81019
25.00
F81221
25.00
F81154
30.00
F81157
30.00
F81017
35.00
F81606
35.00
F81757
40.00
F81021
40.00
F81633
45.00
F81026
45.00
F81213
50.00
F81116
50.00
Source: NEE PCT HNA
4.4.3
Whilst Colchester and Tendring represents the main population base for the
Trust other localities populations have historically also flowed to it for both
elective and non-elective care. These areas are predominately to the north
and north west of Colchester taking in nineteen wards and a total population
of circa 70,000. This population is served by the Mid Essex PCT (refer to
table 4C).
4.4.4
Based on the above the Trust currently serves a total population of around
385,000 covering both elective and non elective activity.
Population Projection
4.4.5
23% of the total Essex population live in North East Essex. There is
considerable regeneration programmes, including significant housing
developments in progress in Colchester and Tendring, which is likely to
impact on the population growth across the area.
4.4.6
Based on 2006 data there is a 16,000 population difference between
Colchester and Tendring and by 2025 this difference will have reduced to
3,000. Over the 20 year period between 2006 and 2025 (Table 4D), the
projected population is higher in Tendring with an additional projected 29,000
(20% growth) in population, compared to Colchester with a projected increase
of 16,000 (10% growth) in the population.
Table 4D: 2003 Based Sub-national Population Projections (per 1,000)
Page 30 of 106
Essex Rivers Healthcare NHS Trust
Area
East of England
Essex
N.East Essex
Colchester
Tendring
2006
5,572.0
1,344.5
306.3
161.1
145.2
2007
5,608.8
1,351.3
308.5
161.9
146.6
FT Applicant Business Plan Rev H
2008
5,645.5
1,358.1
310.8
162.7
148.1
2009
5,682.3
1,365.0
313.1
163.5
149.6
2010
5,719.3
1,372.0
315.3
164.3
151.0
2011
5,756.7
1,379.1
317.6
165.1
152.5
2012
5,794.5
1,386.3
320.1
166.0
154.1
2015
5,909.1
1,408.6
327.2
168.5
158.7
2020
6,101.3
1,447.3
339.5
172.9
166.6
2025
6,282.0
1,484.9
351.7
177.3
174.4
Table 4E: North East Essex Population Projections by Age (per 1,000)
Age Group
0-19
20-39
40-59
60-79
80+
Total
2006
70.4
73.4
81.4
63.3
18.9
2007
70.2
73.1
81.3
66.1
19.4
2008
70.1
72.9
81.6
68.3
19.7
2009
70.1
72.7
82.2
70.2
19.8
2010
69.7
72.8
83.1
71.5
20.4
2011
69.4
72.7
84.1
73.0
20.6
2012
69.2
73.0
85.1
74.2
21.0
2015
68.7
73.8
86.7
78.0
22.3
2020
68.5
76.2
87.3
83.9
25.9
2025
69.6
76.5
85.6
91.4
30.6
307.4
310.1
312.6
315.0
317.5
319.8
322.5
329.5
341.8
353.7
Source: NEE PCT HNA
4.4.7
The general trend is an increased population but it can be seen at Table 4E
that significant changes also occur in certain age groups particularly 60 years
and over. This is particularly relevant given the fact that people will continue
to live for longer and have the greatest demand on health care.
Ethnic Breakdown of Population
4.4.8
Ethnicity is an important health indicator as some diseases are more
prevalent in people of defined groups. People who are in a minority ethnic
group may also find it more difficult to access some services.
4.4.9
From the 2001 Census Colchester’s (Figure 5) minority ethnic population
(3.82%) is three times that of Tendring. The two largest ethnic groups are
people from an Asian background, followed by mixed background
communities.
Figure 5: Ethnic composition of Colchester’s Population (3.82%)
White
Mixed
Asian
Black
C hinese
Other Ethnic Group
1.15%
1.16%
0.51%
96.18%
0.53%
0.47%
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4.4.10 Tendring (Figure 6) has a minority ethnic population of 1.34%. The largest
combined ethnic group is that of mixed background followed by the Asian
population.
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Essex Rivers Healthcare NHS Trust
FT Applicant Business Plan Rev H
Figure 6: Ethnic composition of Tendring’s Population (1.34%)
White
Mixed
0.15%
Asian
Black
0.29%
C hinese
Other Ethnic Group 0.61%
0.17%
0.11%
98.66%
Source: NEE PCT HNA
Deprivation
4.4.11 There is now good evidence to suggest that deprivation and social exclusion
contribute to health inequalities. One of the common measures used is the
Index of Multiple Deprivation (IMD 2000). IMD 2000 summarises six areas
(domains) denoting social or material deprivation with these combined into
one index: Income, Employment, Health & Disability, Education, Housing and
Access to Services.
4.4.12 In April 2004 the Office of the Deputy Prime Minister (ODPM) released the
new Index of Multiple Deprivation with some changes to some of the domains
and now with deprivation indices being measured by Super Output Areas
(SOAs). These are generally smaller communities of around 1,000-1,500
people compared to electoral wards.
4.4.13 In England there are over 32,000 SOAs that make up wards and in Tendring
and Colchester there are 194 SOAs that make up the 63 wards. Using a
weighted formula, the scores for each SOA has been calculated and these
have been ranked within the East of England regional boundary.
4.4.14 The deprivation scores from the IMD2004 have been constructed from seven
different domains comprising of 37 different indicators. It should be noted that
where an area appears as ‘deprived’ there will be people within that area that
are relatively affluent and the same is also true, that in areas of relative
affluence, there will be communities/groups of individuals that are deprived.
4.4.15 The use of the SOAs means that pockets of deprivation can be targeted more
effectively with services and it also highlights the small areas of deprivation
that can be masked by being situated in a relatively affluent area.
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4.4.16 It is a widely accepted fact that areas that have high socio-economic
deprivation tend to have higher morbidity and mortality rates. Tackling
deprivation is a key priority in helping to reduce health inequalities and it is
essential that the areas of most need be targeted with the correct resources
that will be of benefit to the local community. Whilst this is a key strategic
responsibility for Public Health Departments (within PCT’s) developing
services provided by acute hospitals must account for the health ‘cause and
effects’ of such issues.
4.4.17 Within Tendring there are 26 wards that have high levels of deprivation, in
particular the ward of Golf Green which comprises the Jaywick area. Out of
all the wards within the East of England, Tendring does not have any wards
that are in the affluent quartile. Of the 90 SOAs in Tendring, 48 (53%) have
higher levels of deprivation than other SOAs in the East of England.
4.4.18 In Colchester there are 7 wards that have higher levels of deprivation, in
particular the wards of St Andrew’s, St Anne’s and Harbour. Of the 104
SOAs in Colchester, 27 (26%) have higher levels of deprivation compared to
other SOAs in the East of England. Colchester has 17 (16%) SOAs in the
more affluent quartile.
4.4.19 In summary, North East Essex has 33 (52%) wards and 75 (37%) SOAs that
are deemed to have high levels of relative deprivation and this evidence
strongly requires the continued need for the provision of local, high quality
health services.
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Essex Rivers Healthcare NHS Trust
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North East Essex Deprivation by Super Output Area (IMD 2004)
Affluent
Better Off
Less Deprived
Deprived
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4.5
Key Factors Driving Demand
4.5.1
Of the total current population of circa 385,000 served by the Trust (takes
account of residents outside Colchester and Tendring) the two key
demographic issues facing the Trust are:
•
the significant general population growth
•
and the increasingly ageing population in the Tendring area.
4.6
What therefore are the main factors needing consideration in planning
services for the future?
4.6.1
Will there be a continued demand by the population for acute based services
principally designed to serve a discreet population? With the increasing
population and the commensurate increased incidence rates of disease per
head of population the need for planned and unplanned locally accessible
care is clear certainly over the next five years but likely well beyond. Whilst
patient choice will influence some planned activity changes the need for
unplanned service access local to the population is a key factor in the future
assumptions for service infrastructure and planning. The map below shows
the catchment area for the Trust in relation to unplanned episodes of care and
clearly the catchment area is greater than that of just Colchester and
Tendring.
Catchment Populations based on Emergency Admissions
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4.6.2
The Trust will need to develop its services so they contribute to enabling the
population to benefit from health gains. To do this the trust will work with
community based clinicians for example GP’s, PBC groups, Public Health
colleagues the PCT and other stakeholders, for example the voluntary sector,
to contribute to, understand and support joint strategies which must ensure a
focus on population need.
4.7
Objectives of the Local Health Economy
4.7.1
Presently the health commissioning agenda in the North East Essex economy
is led by North East Essex Primary Care Trust (NEE PCT) a new organisation
which came into being on 1st October 2006 and covers the areas previously
served by Colchester and Tendring Primary Care Trusts. It holds the NHS
budget for the residents of Colchester and Tendring, currently some 315,000
people. The funding is used to make sure that high quality health services are
available for residents and to improve the health of the local population. The
Trust also provides learning disability services across North Essex. (The
commissioning of the balance of the population using the Trusts services is
through Mid Essex PCT).
4.7.2
The NEE PCT commissioning plan/objectives for 2007/08 aim to deliver an
overall vision developing:
•
High quality care
•
At the point of need
•
Closer to home; and
•
Affordable within given resources
4.7.3
In setting out it’s 2007/08 Local Delivery Plan the PCT highlighted the
following areas which will remain challenges beyond this next financial year:
4.7.4
Key priority areas are:
•
tackling health inequalities – Preventing ill-health and improving life
expectancy
•
Coronary Heart Disease and Stroke
•
improving access to Sexual Health services
•
Cancer
•
better provision of Mental Health services
•
the needs of children and young people, including improved parenting
•
managing long term conditions
•
tackling Drug & Alcohol misuse
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4.7.5
Practice Based Commissioning (PBC) will become a driving force in
commissioning, managing demand and improving patient pathways, as well
as managing some budgets. In this locality PBC covers 43 practices through
2 groups, one representing Colchester, the other Tendring.
4.8
Contribution of the Trusts Strategy to the LHE
4.8.1
The Trust vision and aim is consistent with those of the local health economy,
with the focus being centred on providing patients with the accessible high
quality cost effective care they need. The PCT has already notified the Trust
of the following secondary to primary care schemes they wish to take forward
and the impact of these will be factored into the activity assumptions in going
forward with planning considerations. From when implementation of all these
initiatives takes place is yet to be agreed and assumptions will be made
concerning the possible financial impact to the Trust:
•
Management of referrals by General Practitioners with Special Interest
(GPwSI) for example – Pain Services, Arrhythmia pathway.
•
Urology pathway: direct access diagnostics
•
Stroke Services – Transient Ischaemic Attacks (TIA)
•
Musculoskeletal (back) and physiotherapy
•
Intermediate Care – enhancement (step up)
•
Oral Surgery – minor operations (Flagstaff)
•
GPwSI in A&E
•
Deep Vein Thrombosis
•
Carpel Tunnel pathway
4.8.2
Also, the PCT and the Trust is working together to eliminate unnecessary
outpatient follow ups, reduce excess bed days in hospital and manage
minimal cataracts differently and assumptions will be made in the financial
analysis of the possible cause and effect of these changes.
4.8.3
Whilst the service change areas have been determined organising how best
to provide them is something the Trust will wish to support and influence.
Shifts from secondary to primary care do not necessarily mean a loss of
activity/income. The Trust will ensure it can offer service options whereby it
can provide outreach based service provision in the community care setting;
this will afford amongst other things a patient/clinician continuity of care
pathway. With two community based hospitals and a range of clinics and
other clinical facilities e.g. GP practice premises it is entirely possible to
remain the provider of services and in so doing continue to generate revenue
streams to support the services provided as a whole.
4.8.4
PCT’s/PBC will constantly be looking at service configuration options for a
variety of reasons and so service models will constantly be evolving and
changing. Importantly the Trust, as a key provider, will fully participate in the
debate.
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4.8.5
The Trust’s future activity assumptions have been developed jointly with the
PCT in 2007. However, in the future PBC will be a driving force behind the
responsibilities of commissioning.
4.8.6
The Trust will therefore develop its links with PBC to ensure it articulates its
ideas in a pro-active and supportive way. To do this the Trust will work
closely with the leaders of PBC but will also look to develop a direct
communications strategy with each of the practices and the GP’s within them.
This strategy will offer continuity for the future given the likelihood of further
change/refinement to the ways in which the commissioning side of the NHS is
structured.
4.9
Major Changes in External Environment & Competition
4.9.1
The key external strategic influences are the development of:
4.9.2
•
increased Independent Sector Treatment capacity in Essex,
•
the full implementation of patient choice,
•
the impact of PBC,
•
and the outcome of the East of England Acute Services review
The impact of these is dealt with in section 4.11.
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Essex Rivers Healthcare NHS Trust
4.10
FT Applicant Business Plan Rev H
Summary PEST Analysis
4.10.1 The Trust has used the PEST analysis tool to help develop a thorough understanding of the external environment in which it operates.
The results are shown on the following table.
Table 4C – Summary PEST Analysis
Factor
Political
Patient Choice
National Tariffs and PbR
Economic
Practice Based Commissioning
Financial Deficit in Local Economy
Assessment of Impact
• Potential impact in the longer term
Business
Risk
Potential Action and Initiatives
Timescale
Medium
• Ensure activity plans based on
conservative estimates
• Develop activity in specialist areas,
e.g. minimal invasive treatment
• Further development of outpatient
services in community setting
• Conservative estimates on capacity to
minimise any result in discounted
service deficit
All Years
• Impact of shift from secondary to primary
care outpatient services
• Development of ISTC in Essex
Medium
Roll out and potential reduction in tariff
High
Initial assessment of GP plans show
minimal change in short term
Financial pressures could restrict ability of
commissioners to fund activity and
therefore an unwillingness to commit to
realistic activity plans
High
Medium
High
Improve clinical coding systems to
ensure activity captured and correctly
costed
Ensure financial model is sensitised
and develop contingency plans for
each outcome
Conservative estimate of planned
operational work over next five years
Admission avoidance in partnership
with PCTs
Combination of initiatives to improve
day case rate, including service
redesign, shift to higher day case
rates
Manage risk of over-performance
All Years
2006/7
onwards
2007/8
onwards
2006/7
2006/7
onwards
2006/7
onwards
2005/6
onwards
2005/6
onwards
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Technological
Sociological
Essex Rivers Healthcare NHS Trust
FT Applicant Business Plan Rev H
Factor
Assessment of Impact
Business
Risk
Coastal population second highest
elderly population in England
Service provision to meet specific needs
required
Low
Potential Action and Initiatives
Continue joint working across health
and social care in the management of
discharge and emergency access
Ensure continued development of
Orthopaedic Services to meet
demographic demands
Continue joint planning with PCTs to
ensure overall activity model robust
and sufficiently flexible to meet
capacity and increased demand
Timescale
2005/6
onwards
2005/6
onwards
2006/7
Population growth over the next 5
years with extensive local building
programme
Growth in population taken into account in
overall activity model
Potential capacity overload in Children and
Maternity Services
Low
Demographic areas of deprivation
High levels of deprivation can impact on
service
Low
Connecting for Health national IT
programme
Dependency on national programme to
improve local IT systems
Medium
Technological developments in
minimally invasive treatments to
reduce length of stay in hospital
Leading edge of development in minimally
invasive treatment with potential to increase
activity in day case environment
Low
Development of protocols/ pathways
to increase day case rate to highest
percentile of performance
2005/6
onwards
Advancement in drug therapies
Cost implications of advancement in drug
therapies are sensitised in activity model
Low
Capacity and planning and cost
modelling of drug therapy
2006/7
onwards
Low
PCT partnership to ensure service
commissioning takes into account
healthcare outcomes
Trust investment to address
intermediate solutions to ensure
business continuity
2005/6
onwards
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Essex Rivers Healthcare NHS Trust
4.11
FT Applicant Business Plan Rev H
Competitive Factors
Impact of existing Independent Sector Providers
4.11.1 There is a local private healthcare provider in Colchester and in Ipswich and
Chelmsford. All have been in existence since the Trust was formed and their impact
is already felt in the Trust activity figures. Year on year the overall activity has
remained constant and its unlikely a major change will occur particularly as the NHS
moves towards delivering the 18 week referral to treatment waiting times. Indeed,
patients may choose NHS over independent care in the future if a reason for
choosing independent providers historically has been to avoid long waits.
Impact of proposed new Independent Sector Providers
4.11.2 Essex currently has a Wave 2 - Elective Independent Sector Treatment Centre
(ISTC) proposed. The delivery model is an Essex wide service with referrals drawn
from the Essex population of 1.6 million, delivering clinical services in:
•
Elective surgery – outpatient assessment, inpatient & day case
− Anaesthetic Safety Assessment categories 1, 2 & stable 3
− 16 years or older at the time of referral
− Able to be discharged independently
− No known clinical exclusions to treatment
•
Rehabilitation – generic referrals and specialist community based cardiac,
pulmonary & stroke services
− Direct referral from primary care with direct access to generic
musculoskeletal rehabilitation
− Specialist stroke, cardiac & pulmonary rehabilitation.
4.11.3 Mercury Health was given Preferred Bidder status announced on 12th December
2006. Go live date for the majority of services is set for August 2008.
4.11.4 The main impact on the Trust will therefore be from the ISTC Elective Services
Agreement (ESA) to deliver additional capacity across the whole of Essex for
inpatient & day case surgery for the following specialties:
Specialty
Essex total/
FCE’s
ERHT impact Inpatient
Day case
General Surgery
2,681
46
221
Urology
2,209
8
209
Orthopaedics
4,944
250
264
Ophthalmology
3,269
80
249
Total
13,103
1,327 or 10% of gross plan
4.11.5 Elective Surgery to be delivered from three fixed sites – Basildon, Braintree & The
Phoenix Hospital, Southend. These are all therefore outside the Trust catchment
area which may limit the impact on the Trust, compared to other Trusts in Essex.
The details of these three sites is:
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•
Conversion of a new development of a high quality warehouse unit sited on
Festival Park, Basildon. Treatment Centre will consist of:
− 16 inpatient beds & 3 bed High Dependency Unit
− 12 care spaces for recovery & Day Surgery
− Two laminar flow theatres & one day surgery
− Outpatient facility to include 3 consulting rooms
− On site X-ray & ultrasound facilities
− On site Sterile Services Unit
− Orthodontics Suite & Rehabilitation Gym
− Capacity to undertake 1883 inpatient, 4479 day cases & 6991 new outpatient
appointments.
•
New build on an existing business park, the Skyline at Great Notley, Braintree.
Treatment Centre will consist of:
− 15 inpatient beds & 2 bed High Dependency Unit
− 10 care spaces for Recovery & Day Surgery
− Two laminar flow theatres & one endoscopy suite
− Outpatient facility to include 3 consulting rooms
− On site X-ray, Orthodontic X-ray suite & ultrasound
− Orthodontics Suite & Rehabilitation Gym
− Capacity to undertake 1540 inpatient, 3665 day cases & 5720 new outpatient
appointments.
•
Existing Day Surgery facility in Southend. Phoenix Hospital will be a material
sub-contractor to Mercury Health,
− Two theatre facility approximately 18 months old, HCC registered and owned
by local consortium of consultants.
− Self-contained unit with on-site outpatient facilities.
− Provides capacity for this scheme of 1537 day cases per annum & 1704 new
outpatient appointments
4.11.6 The planned impact for ERHT is 10% of the total activity. However, it’s considered
that no more than 2-3% of patients will choose the ISTC over the services provided
more locally by ERHT. This is because around 50% of the Trusts patient catchment
population is resident in Tendring (and two practices in Manningtree and Lawford
already have well established pathways to Ipswich as well as Colchester) and
therefore unlikely to bypass Colchester to travel to, for example, the Great Notley
site (as evidenced in section 4.12.2) and the fact that for most Colchester residents
the local NHS provider is very close to where they live.
4.11.7 Regarding the elective activity in Mid Essex PCT that has flows to ERHT it is
possible that those patients may choose the ISTC given the close proximity of Great
Notley to where they live but the activity levels are small and some in specialties not
covered by the ISTC provider. The impact of this will be factored into the financial
appraisal.
4.11.8 It could be possible for the ISTC provider to outreach into for example, Tendring but
this is considered unlikely given the fact that the activity levels would make it uneconomic for them.
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Essex Rivers Healthcare NHS Trust
4.12
FT Applicant Business Plan Rev H
Impact of Patient Choice
4.12.1 Since January 2006, many elective patients have been offered a choice of between
four and five providers at the point their hospital referral is made. And we know that
from mid 2008 patients will have ‘full’ choice i.e. any provider of their choosing.
Knowing in advance the full impact of free choice is hard to predict but the evidence
thus far indicates only a limited impact and is already reflected in this years plan.
4.12.2 The Trust will not be complacent and is assuming that without continuous learning
and improvement based on feedback from our patients and referring clinician’s
patients and clinicians alike could become dissatisfied and choose other providers.
•
What factors affect patient’s choice?
− Ease of Access - 68%
− Reputation of Hospital - 59%
− Information/Quality of Care - 54%
− Waiting times - 47%
Ipswich to Colchester = 22.8 miles
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Essex Rivers Healthcare NHS Trust
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Chelmsford to Colchester = 24.6 miles
Ease of Access
4.12.3 As ease of access is the most important factor to patients when considering choice,
it is vital to assess the proximity of the competition. Ipswich and Mid-Essex
Hospitals are roughly equidistant. As the population is mainly rural Chelmsford is
well serviced by train services taking roughly half an hour from Colchester.
Chelmsford train station is in the centre of town and there are shuttles to the DGH
every thirty minutes. Colchester to Ipswich takes around twenty-five minutes. These
hospitals, therefore, comprise Essex Rivers’ immediate competition for elective care.
However, for the Tendring population by-passing Colchester is considered unlikely
particularly when significant Consultant based services are already provided within
the Tendring community hospitals at Clacton and Harwich (principally outpatients
and some diagnostic services).
Reputation of Hospital
4.12.4 Historic indicators available are the star ratings, for which Essex Rivers has three,
Mid-Essex has two and Ipswich has only one. These statistics however have not
come from either the GPs or the patients and the Trust must not be complacent.
4.12.5 The Trust will formally build on its good relationships with the local General
Practitioners (GPs) by developing, as part of its formal service strategies, a
marketing initiative the principle aim of which will be to maintain and build the
reputation of the Trust so that it remains the provider of first choice.
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Information/Quality of Care
4.12.6 Dealing first with information, Essex Rivers has excellent information for many of its
departments. However, the Trust must continue to improve information e.g. leaflets
and the Trust website. The Trust will strive to make all its information as patient
orientated as possible. The head of communications is developing patient leaflets
with the patient information officer and an improved, patient focussed website.
4.12.7 Additionally, the Trust is developing a comprehensive marketing strategy aimed at
ensuring that continuous engagement takes place with the community particularly
focusing on organisations such as PBC and local clinicians who directly influence
pathways into acute services.
4.12.8 Secondly, on quality of care, potential patients can now compare between local
Trusts regarding a variety of national indicators, using information on the internet,
such as Dr. Foster. The Trust aim will be to provide the highest possible quality
patient care and focus on surpassing other providers against the measured
outcomes.
Waiting Times
4.12.9 With the introduction of the 18 week care pathway, most local Trusts will offer similar
reducing waiting times and this may therefore be less of a factor for patients in the
future. In order to differentiate itself from others, the Trust will plan to offer care
pathways of less than 18 weeks in the future, as patient expectations will continue to
increase.
4.13
Impact of Practice Based Commissioning (PBC)
4.13.1 PBC is about engaging practices and other primary care professionals in the
commissioning of services. Through PBC, front line clinicians are being provided
with the resources and support to become more involved in commissioning
decisions.
4.13.2 PBC aims to create high quality services for patients in local and convenient care
settings. GPs, nurses and other primary care professionals are in the prime position
to translate patient needs into redesigned services that best deliver what local
people need. The Trust will fully participate in supporting the strategies for change
and ensure care pathways fully integrate with the services best placed through the
acute sector. Part of the strategy will be the pro-active marketing of services but the
Trust will ensure it effectively communicates on a constant basis with PBC both
formally and informally.
4.14
Acute Services Review
4.14.1 The Trust is aware that a review of acute providers within the East of England (EoE)
is being led by the EoE Strategic Health Authority. The review will consider both
elective and non-elective provision. The time scales for this are not co-terminus with
the FT application by this Trust. Clearly once the outcomes/impacts are known the
Trust may need to respond if any direct recommendations are explicit about the
Trust. Given the size of the current population and the fact that it is increasing
suggests that, for example, a down grading of A&E is most unlikely.
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Essex Rivers Healthcare NHS Trust
4.15
FT Applicant Business Plan Rev H
Other areas of impact
Impact of other Foundation Trusts and NHS Trusts in the Local Health
Economy
4.15.1 Essex has two NHS Foundation Trusts, Basildon and Thurrock, and Southend. Due
to the geographical position of these units, it is not anticipated that they will
significantly affect the Trust’s core business. The Trust welcomes partnership
working with local healthcare providers in the development of specialist services,
such as the Cardio-Thoracic Centre at Basildon and Thurrock University Hospitals
NHS Foundation Trust.
4.15.2 The other local NHS Trusts, based in Ipswich and Chelmsford, already work in
partnership with the Trust. Examples are the provision of uro-oncology and
repatriation of pelvic cancers by Essex Rivers, complimenting current oncology
services provided to 670,000 patients within North-East and Mid-Essex which is
underpinned by effective primary care owned pathways.
4.15.3 The Trust expects to continue to work in partnership with other NHS providers in the
LHE to ensure services are always provided in the most efficient way for the NHS as
a whole and in the best interests of patients.
4.16
How will the Trust address these Competitive Factors?
4.16.1 The Trust vision is to be the provider of first choice for particularly the population of
North East Essex in meeting their health care needs and the Trust will develop a
marketing strategy to protect it from the competitive factors. The Trust will also
articulate in its marketing plans the value of services that are unique not only for the
local population but also a wider catchment area. For example, the prominence of
cancer services locally will grow as part of the strategic development of the Essex
Cancer Network. This will expand the reputation of the Trust with patients but also
clinicians, particularly those applying for posts within the Trust.
4.16.2 The Trust will continue to play a key role in supporting the links with other specialist
providers for example Basildon and Thurrock for cardiac conditions and will continue
to support commissioner plans to repatriate services, in collaboration with our local
and Specialist Commissioners, and build on already repatriated Renal and
Angiography services. The laparoscopic services provided by the Trust are world
class and enable the organisation to promote itself far beyond its local boundaries.
4.16.3 Finally, the trust continues to develop its plans to become linked as an associate
medical school.
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Essex Rivers Healthcare NHS Trust
4.17
FT Applicant Business Plan Rev H
How the Trust performs against competitors
4.17.1 The table below shows a selection of benchmarking data relative to performance
with nearest NHS competitors.
Speciality
service area
Waiting times for
elective surgery
Waiting times for
first outpatient
appointment
Infection rates
Quality of overall
service rating
Effective barriers
to prescribing
errors
% of cataracts
performed as a
day case
LOS for hip/knee
replacements
LOS for
Arthroscopy
Re-admission
rates for
cataracts
Re-admission
rates for Hips
Doctors per 100
beds
3 year mortality
rate – 100 is the
expected level
ERHT
Provider A
Provider B
100% within 6
months
99.2% within 13
weeks
100% within 6
months
94.3% within 13
weeks
100% within 6 months
Compliant
Compliant
Good
Insufficient
assurance
Fair
4 out of 5
5 out of 5
2 out of 5
99.1%
97.3%
98.7%
6.5 days
7.1 days
7.7 days
1.8 days
1.9 days
2.5 days
1.1%
2.8%
2.1%
6%
7.7%
9.1%
41.5
23.2
42.4
107
96
100
100% within 13
weeks
Good
Source: Dr Foster current information
4.17.2 From this table it’s clear that across a range of performance measures the Trust is
as good and in areas better than its nearest NHS competitors. The positive
performance will be a key plank to promoting the Trust and areas less strong will be
focussed on for particular development.
4.18
Conclusion
4.18.1 The analysis of the market demonstrates the continued need for locally based, high
quality, efficient and accessible services for the population of North East Essex. The
service development decisions the Trust makes in the future will be based on a
range of factors which will take account of internal and external drivers. Focussing
on the needs of the population will continue to be the single most critical factor in
shaping the strategic decisions required to ensure services have relevance and are
fit for purpose. Becoming a foundation Trust therefore, where this population make
up the membership of the Trust will create more ways for the Trust to listen to and
understand its patients needs better.
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5.
SERVICE DEVELOPMENT PLANS
5.1
Internal Capacity Assessment and SWOT Analysis
5.1.1
The Trust’s Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis
has been based on individual service assessments (at Appendix 2) which were
completed as part of a clinically-led process to create a clinical services strategy in
consultation with other staff across the Trust. Account has been taken of patient
satisfaction surveys and comments from colleagues in Primary Care and other
partners. The Trust’s service development plan supports the clinical services
strategy.
Strengths
•
Safety
− Healthcare Commission Rating of Good for Quality of Services
− Strong clinical leadership and supporting management structure
•
Sustainability
− Strong financial discipline and service line reporting
− Delivery of planned repayment of £8M from surplus generated in 2006/7
− Trust will become debt-free at the end of 2007/8
•
Learning
− Good record of supporting learning needs of staff and students
− Centre of Excellence for minimally-invasive treatments
− Expect to become an Associate University Hospital by 2008
•
Accountability
− Clinical “buy-in” for NHS Foundation Trust status
− Well developed partnership working with local primary care organisations
− Founder and active Member of Local Strategic Partnership (Colchester 2020)
Weaknesses
•
Safety
− Existing facilities for emergency patients are inadequate
− Essex County Hospital is outdated and difficult to redevelop
− Split-site working increases clinical risk for certain services
•
Sustainability
− Repayment of historic debt has limited potential for other investment plans
− IM&T is underdeveloped, hindering operational and strategic decision making
− Services are currently provided on an inefficient split-site basis
− Marketing function requires development
•
Learning
− Workforce planning has not matched strategic and service priorities
− Inadequate facilities for multi-disciplinary training and education
•
Accountability
− Internal Communications with staff require further development
− No existing membership base
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Opportunities
•
Safety
− Centralisation of services presents the opportunity to redesign services
− FT Status would offer greater flexibility to renew out of date facilities
•
Sustainability
− The Trust’s natural catchment population is growing
− Demographic change within natural catchment population is likely to create
increased demand for Trust services (older people, maternity, paediatrics)
− SHA support for plans to centre aspects of cancer provision at the Trust
− Low reference cost index presents opportunity to invest PbR surpluses
•
Learning
− Well advanced plans to achieve Associate University Hospital status.
− Partnership with higher education institutions agreed to create a MDLC
•
Accountability
− FT status will consolidate the Trust’s place at the heart of the local community
− Strong links with GPs will facilitate the creation of local services under PbC,
securing and enhancing the Trust’s core market. Recent survey indicates
that ERHT is the acute provider of choice for 98% of local GPs.
Threats
•
Safety
− Governance must continue to maintain high quality standards of care
− Existing facilities are not environmentally efficient
•
Sustainability
− National tariff may be reduced and reduce surplus available
− PCT demand management, independent sector provision and PbC could
impact on Trust’s market share and income
− Facilities require significant capital investment for redevelopment
•
Learning
− Risk that future investment in training, education and research may be lost
•
Accountability
− Failure to achieve FT status may lead to uncertainty over Trust’s future with
potential impact on staff recruitment and retention and patient confidence.
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5.2
Commentary on SWOT Analysis
5.2.1
The SWOT analysis has created a focus on the factors that affect the strategic
development of the Trust’s business and has helped in the formulation of Service
Development Plans detailed below that will deliver its goals.
Building on Strengths
5.2.2
The Trust will build on its international reputation in laparoscopic surgery and training
by developing a Centre for Minimally Invasive and GI Surgery. This will include
development of a dedicated training facility with extensive use of simulators and
enhancement of research and development within the organisation. This combined
with the building of a new multi-disciplinary learning centre will support the Trust’s
plan to attain associate university hospital status in the near future and further
enhance the Trust’s ability to recruit and retain the best staff.
5.2.3
The existing highly regarded non-surgical cancer service represents a sound basis
from which to develop as the Cancer Centre for Mid & North East Essex and
potentially Suffolk as well. The oncology business case presented to the SHA offers
the opportunity to meet Improving Outcomes Guidance (IOG) for radiotherapy
provision in the most efficient way. The re-provision of non-surgical cancer services
on the Colchester General Hospital site will permit the remaining clinical services at
Essex County to be moved to the main site completing the centralisation of the
Trust’s acute services. There is also an opportunity to centralise other cancer
services at the Trust, in addition to urological cancer, such as gynaecological and
pelvic cancer treatment and to maximise use of expertise in minimally invasive
surgery to increase the cancer surgery completed in other areas such as upper GI.
Addressing Weaknesses
5.2.4
The Trust intends to make use of the opportunity of becoming Foundation Trust and
in particular its local membership to confirm the Trust’s position as the provider of
first choice for acute services for the population of North Essex. This will in turn
improve communications with the local population and provide the basis for a
marketing strategy.
5.2.5
The Trust has instilled a strong business planning culture throughout with the
Revenue Resource Committee maintaining control of these issues on behalf of the
Trust Board. This now ensures that all service developments are underpinned by a
clear understanding of risks, costs and benefits and are only allowed to proceed on
the basis of a sound financial and service analysis.
5.2.6
This approach has been supported by an improved provision of IM&T exemplified by
the implementation of PACS in May 2006. The Trust fully recognises the need for
further progress in this area and is introducing a number of schemes to provide
electronic support for the Trust’s clinical and administrative processes as preparation
for the Connecting for Health Programme.
5.2.7
The centralisation of all acute services onto the Colchester General Hospital site will
address many of the weaknesses inherent in the use of existing facilities.
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Exploiting Opportunities
5.2.8
The socio-demographics of the Trust’s natural catchment area suggest there will be
continued growth in demand for acute services. Whilst Tendring’s population tends
towards the elderly, Colchester is currently undergoing a boom in house building,
attracting young couples and families. The Trust will aim to meet the increased
demand from these two populations (notwithstanding demand management
initiatives and competition) as the local acute provider of choice across the full range
of services. The Trust will utilise its FT status and existing good relationship with
GPs to ensure that this position of local preference is maintained and enhanced.
Where specific acute services require a larger catchment population than the Trust
has it is working in partnership with adjacent acute trusts (such as Ipswich for
vascular and ENT and Mid-Essex for plastics) to ensure that a local acute service is
offered to the population of North East Essex.
5.2.9
The Trust is undertaking a programme of service improvement to ensure that it is
achieving the highest levels of performance. As part of this programme, the Trust
will improve efficiency and quality through centralisation and shifts to day surgery
where possible while also offering more local services where this is appropriate.
5.2.10 The Trust has the potential to generate surpluses under the National Tariff and
would intend to exploit FT freedoms (including NHS capital, private sector capital
and joint ventures) to bring forward plans for redevelopment and centralisation of
services.
Management of Threats
5.2.11 Reduction in National Tariff is clearly part of national policy but logically must be
limited to a level that guarantees sustainable healthcare provision across the
country. In response to this, the Trust will seek to achieve continuous service
improvement and ensure that its low costs allow it remain competitive.
5.2.12 Competition, including the likely positioning of an Independent Sector Treatment
Centre (ISTC) in North Essex, represents a potential threat to the Trust’s income
base, as does alternative provision through Practice Based Commissioning (PbC).
The Trust acknowledges these threats and plans to employ a range of business
approaches to minimise their likelihood and impact. First and foremost, the Trust will
offer high quality services through a strong marketing approach to ensure its position
as the provider of choice within North East Essex. Second it will look to form
partnerships both horizontal (with other secondary care providers) and vertical (with
primary and tertiary providers) to secure its place in the care pathway and to ensure
that it is providing services where it has a competitive advantage. It is implicit that
this may involve withdrawing from some areas of provision where appropriate.
5.2.13 The Trust has seen year-on-year increases in the number of emergency admissions;
however, the agreed planning assumption with the local PCT is that this will be 1%
per annum from 2007-8 onwards. The Trust is planning on the basis that this
reduced rate will be achieved by the PCT through demand management schemes
but will put in place contingency plans in case the reduction in the rate of increase of
demand is delayed. Nonetheless, the planned level of growth will exceed the Trust’s
service capacity to deliver service standards and would begin to impact on elective
capacity. To prevent this potential impact a major scheme is underway to re-provide
emergency services (both facilities and processes) on a more efficient basis.
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5.2.14 The Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis has been
completed via discussions with Board Members, lead clinicians and managers
across the Trust. Account has also been taken of patient satisfaction surveys and
comments from Primary Care Organisations (PCOs). The SWOT was developed as
an integral part of the Trust’s service development plan.
5.3
Summary of Future Initiatives
5.3.1
In summary therefore the SWOT analysis has identified the following key Service
Development Plans (SDP)
5.3.2
•
Emergency Services
− 24/7 Emergency Surgery
− Vascular Surgery
− Project to enlarge A&E and the Emergency Assessment Unit (EAU)
− Emergency Process Redesign
•
Centre for Minimally-Invasive and GI Surgery
•
Cancer Centre
− Resulting in the centralisation of acute services at Colchester General
Hospital
Each of these Service Delivery Plans are supported by a culture of continuous
improvement and learning and are described in more detail on the next page.
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5.4
SDP No.1 - Emergency Services
5.4.1
This provides the core of hospital emergency services for local people and underpins
the provision of a wide range of other services on site. This Service Development
Plan will impact on the following Strategic themes
Emergency Services Contribute
Specifically they will deliver on:
•
•
•
•
•
•
5.4.2
Safety for Patients
Clinical Viability
Quality
Finance
Improved Training
Community and Patient Priorities
There are a number of core elements to this service development plan as follows:
24/7 Emergency Surgery
5.4.3
The Trust is in a position to provide senior surgical support on a 24/7 basis to ensure
that local services are available to local patients. Without this level of input, many
hospitals are looking to arrangements in which they merely stabilise patients before
transferring to other more specialist providers. The Trust intends to maintain the role
of full provider of services both to secure the service to local people and to underpin
other services that can provided from this basis e.g. sub-specialist elective surgery
Vascular Surgery
5.4.4
Across the country, there are many acute hospitals that are unable to provide a full
vascular service on a 24/7 basis. The Trust has entered into a partnership with
Ipswich hospitals to ensure that this service remains available and sustainable. This
partnership will continue to be developed into the future to determine whether this
remains the best way forward or whether the Trust can justify a fully independent
service.
Project to enlarge A&E and the Emergency Assessment Unit (EAU)
5.4.5
The demand from the local population for emergency admission has been growing
for many years. Although the recent East of England review of Emergency services
forecasts that this growth is likely to continue, it has been agreed with the PCT
commissioners that the contracted level of activity will be limited to 1% per annum
from 2007/8 onwards. Even at this level, the Trust’s existing processes and facilities
will not be adequate to continue to meet Emergency Access standards. The
enlargement and redesign of (A&E and) EAU will ensure that the Trust can continue
to manage the variability in demand for emergency services while meeting target
times without impinging on elective capacity.
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Emergency Process Redesign
5.4.6
The change of facilities described above will not meet demand without a parallel
change in process. The Trust will build on, and extend existing work with partners in
the local health economy to modify the pathways of care for emergency patients.
Internally, the Trust will continue to undertake process redesign to ensure that the
care is patient centred, of high quality and that delays in the process are minimised.
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5.5
SDP No.2 - Centre for Minimally-Invasive and GI Surgery
5.5.1
Minimal access or keyhole surgery has spread rapidly in the last 10 years and is now
the dominant method of surgery for some procedures. The first specialties to
develop these techniques were gynaecology, urology and orthopaedics with
endoscopic bladder/prostate surgery accounting for over 90% of this type of surgery
and orthopaedic use well established techniques for arthroscopic joint examinations.
5.5.2
This Service Development Plan will impact on the following Strategic themes:
Minimally Invasive Surgery
Contributes
Specifically it will deliver on:
•
•
•
•
•
•
•
Safety for Patients
Quality
Training
Education
Research
Clinical Viability
Finance
5.5.3
Laparoscopic surgery lends itself to increasing Day Surgery Unit activity and data
suggests that our fully integrated laparoscopic theatre reduces turnaround time (the
downtime between cases) by approximately 20 minutes per case, thereby reducing
costs. The Trust’s Iceni laparoscopic surgical centre has now developed an
international reputation as a provider of training in this specialist area and is one of
only two centres to hold Royal College of Surgeons accreditation in the country. The
Trust intends to build on this work to provide a purpose built training centre for
minimally invasive surgery utilising state of the art simulators in partnership with
industry and local higher education institutions.
5.5.4
The recent appointment of a third vascular surgeon will enable development of
minimally invasive vascular surgery, e.g. endovascular aortic repair (EVAR). With
the introduction of screening for aneurysms the need for elective surgery for this
condition will increase. The on-call rota for vascular has now been separated from
the general surgical on-call rota and is now provided in partnership with Ipswich
Hospital NHS Trust to ensure that this vital acute service will continue to be available
locally.
5.5.5
The SHA has supported the Trust’s bid to become the Colorectal Screening Centre
for North Essex and Suffolk. If this bid is approved, there is likely to be a significant
conversion from screening to minimally invasive lower GI surgery. The Trust is also
about to appoint a third Upper GI consultant specialising in laparoscopic surgery.
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5.6
SDP No.3 - Cancer Centre
5.6.1
The creation of the new East of England SHA and the financial pressure in the
region provides an opportunity for the reconfiguration of cancer services. The move
to a smaller number of cancer centres supporting larger populations accords with
Improving Outcomes Guidance (IOG). Norfolk & Norwich University Hospital and
Cambridge University Hospital are, and are likely to remain, major cancer centres in
the North and East of the region.
5.6.2
Ipswich Hospital (IHT) has a major financial deficit which has been contributed to by
inefficiencies in its oncology service. Essex Rivers currently provides radiotherapy
services for Mid-Essex Hospital (MEHT) on the Essex County Hospital (ECH) site.
MEHT also has a significant financial problem which has resulted in the recent
decision to suspend the development of a facility intended to permit Essex Rivers’
staff to provide an outreach radiotherapy service on the Broomfield site. The future
of this project is further jeopardised by draft National Radiotherapy Advisory Group
(NRAG) guidance recommending that new radiotherapy facilities should consist of a
minimum of 3 bunkers with 2 Linear Accelerators (Linacs).
5.6.3
The map below demonstrates the geographic logic of centralising oncology services
for South Suffolk, Mid Essex and North East Essex in a replacement facility on the
Colchester General Hospital (CGH) site that would then serve a catchment area of 1
million people.
East of England
Catchment Areas
Essex Rivers
Healthcare Trust
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Service Options
5.6.4
Essex Rivers has to address the accommodation currently provided for oncology at
ECH because it no longer provides the type of quality facilities expected of for a
modern hospital service and the centralisation of acute services from ECH on the
CGH site is the Trusts preferred method of achieving this. A Strategic Outline Case
(SOC) bid for capital funding to build a replacement facility on the CGH site for the
centralisation of oncology & haematology services and a replacement of the Trust’s
pathology facilities has therefore been submitted to the SHA.
5.6.5
The scheme outlined in this SOC would bring together the Trust’s Non-Surgical
Cancer services and Regional Radiotherapy services in a modern Oncology Centre
to improve the quality and accessibility of patient care and to allow the Trust to work
more effectively as a partner in the Essex Cancer Network in line with the aims of
The NHS Cancer Plan published in July 2000 and NICE Improving Outcomes
guidelines published in 2003.
5.6.6
Split-site working between Oncology and Haematology services, the poor quality
environment and space limitations within the current facilities compromise the Trust’s
ability to achieve modern standards of patient care in line with The NHS Cancer Plan
and NICE Improving Outcomes guidelines. Therefore, the case for change is based
on:
•
The cramped conditions and the general shortcomings and inadequacies of the
existing facilities which undermine the Trust’s aim to improve the environment
for patients and deliver care to modern standards as part of the Essex Cancer
Network
•
The need for improved flexibility to manage expected increases in workload from
population growth and demographic change
•
National, Essex Cancer Network and local strategy for modernising and
strengthening services and improving standards
•
The scope for achieving quality of care improvements and operating efficiencies
through centralising services on the CGH site, including improved access to a
range of diagnosis and treatment services
•
The need to replace the LDR Selectron with a High Dose Rate (HDR)
Afterloader to maintain the Brachytherapy treatment which is essential for a
Cancer Centre.
Page 58 of 106
Essex Rivers Healthcare NHS Trust
FT Applicant Business Plan Rev H
5.6.7
The case for change towards centralisation of Non-Surgical Cancer services is
strengthened by current NICE recommendations and guidelines. For example,
advances in the understanding of how haematological malignancies arise through
disruption of the normal cellular process in the bone marrow and immune system by
a variety of molecular and cytogenetic abnormalities are transforming both diagnosis
and management of patients. Building such advances into routine patient care
places new demands on the clinicians and hospitals involved. While it is common to
see a degree of separation between clinical services for haematological
malignancies and those for solid tumours, scientific and medical advances are
strengthening the case for regarding all cancer services as part of a logical whole in
which the diagnosis and treatment of various disease types benefit from a
multidisciplinary team approach. For example, the diagnosis and treatment of solid
tumours relies significantly on haematology services to underpin safe delivery of
chemotherapy, particularly in respect of the diagnosis and management of lifethreatening complications. Increasingly, general cancer patients are managed by
clinicians with different professional backgrounds working together in multidisciplinary teams to combine skills and expertise for the most effective treatment
and management of patients. The Trust’s ability to strengthen multi-disciplinary
team working as necessary to sustain delivery of a cancer service in line with NICE
recommendations and guidelines depends significantly on centralising services into
a purpose designed modern cancer centre on the CGH site.
5.6.8
The British Committee for Standardisation in Haematology (BCSH) has defined a
range of different service levels reflecting the variety of forms of disease and the
facilities required to manage patients with haematological cancers. ERHT aims to
provide Level 2 services for remission induction in patients with acute leukaemia
using intensive chemotherapy regimes. This level of service is also required to treat
patients with aggressive lymphoma.
NICE guidance requires that each
Haematology MDT providing treatment at BSCH Level 2 or above must demonstrate
adequate arrangements for 24-hour cover by specialist medical and nursing staff.
These arrangements must be sufficiently robust to allow cover for holidays and other
absences of team members. The Haemato-Oncologists in the team should work
together as a cohesive group, sharing the management of patients. There should be
systems in place for routine information sharing and frequent opportunities for
informal discussion as well as formal meetings. Current facilities at CGH do not fully
meet BSCH Level 2 standards and dedicated beds with environmental controls to
minimise airborne microbiological contamination, with single rooms for the isolation
of all patients receiving induction therapy or other high dose chemotherapy would
need to be provided for the Trust to achieve and sustain Level 2 service provision.
The proposed Cancer Centre development would also enable the provision of care
closer to home for more patients with haematological malignancy, from a wider
population (e.g.: the northern area of the Essex Cancer Network) and thereby enable
re-patriation of some work currently sent to tertiary centres, in London in particular.
5.6.9
The preferred model of care for centralisation of Non-Surgical Oncology services at
CGH envisages:
•
An integrated Oncology Centre designed to support multidisciplinary team
working and providing ready access to associated Imaging, Pharmacy and
Pathology services
•
Inpatient accommodation for Oncology and Haematology with linked Outpatient
consulting and treatment facilities
Page 59 of 106
Essex Rivers Healthcare NHS Trust
FT Applicant Business Plan Rev H
•
A dedicated Oncology/Haematology Day Case Unit providing facilities for
chemotherapy and other medical interventions
•
Radiotherapy and Nuclear Medicine services in close proximity to diagnostic
services.
5.6.10 Key requirements to be included in the proposed scheme to ensure facilities meet
Level 2 standards were identified as follows:
•
A minimum of 8 dedicated inpatient beds, 4 of which must be single rooms with
en-suite facilities and positive pressure ventilation ring fenced for Haematology
use and enabling direct access for Haemato-Oncological patients
•
Designated outpatient facilities designed to protect the patients from
transmission of infectious agents with provision as necessary for patient
isolation, long duration intravenous infusions, multiple medications and/or blood
component transfusions
•
Facilities for 24-hour Consultant specialist medical staff cover and MDT working
•
On-site access to a specialist pharmacist as part of the MDT working
•
IT connectivity for rapid access to patient records and for data management.
5.6.11 The Trust plans develop the CGH site with sufficient flexibility to adapt to a variety of
regional service plans with the potential to have a single, centrally located cancer
centre at Colchester covering the population currently served in the Mid Anglia area.
This would ensure a critical mass of staff and patients to comply with IOG. Services
from other local oncology providers could be combined with a consequent reduction
in operating costs for the NHS.
5.6.12 This option should offer sufficient flexibility to the SHA for cost effective strategic
solution for the future provision of cancer services in the LHE. Essex Rivers already
has proven track record of running high quality cancer services for another Trust and
of providing cancer outpatient services from 8 locations.
5.6.13 This Service Development Plan will impact on the following Strategic themes:
In detail it will deliver on:
-
Safety for Patients
Clinical Viability
Quality
Research
Training
Education
Finance
Page 60 of 106
Essex Rivers Healthcare NHS Trust
FT Applicant Business Plan Rev H
5.6.14 The Trust currently provides cancer services to a population of 670,000 covering the
populations of Mid Essex and North East Essex. There is an integrated Clinical
Oncology team sub-specialising by tumour group and geographical location. Essex
County Hospital has two cancer wards, which admit a proportion of emergencies, but
also cater for elective chemotherapy and radiotherapy patients. There is currently
potential to develop the Trust’s uro-oncology and haemato-oncology services;
however, with suitable support, the Trust could also develop IOG compliant cancer
surgical services in gynaecology and upper GI.
Table 5A - Activity Implications of the Cancer Centre SDP
Plan
Actual
Oncology
2005/6
Projected Activity
2006/7
2008/9
2009/10
(YTD at Month 9)
Outpatients total Atts
12,020
11,328
10,855
11,071
539
552
907
936
4,180
4,231
2,464
2,525
39
40
(13,791)
Elective Inpatients (Spells)
including daycase
555
Non-Elective Inpatients (Spells)
952
552
(351)
928
(708)
Haematology
Outpatients total Atts
4,457
3,915
(5,576)
Elective Inpatients (Spells)
2,556
2,416
(1,911)
Non-Elective Inpatients (Spells)
37
46
(38)
Notes:
Projections modeled jointly with the PCT as part of the Strategic Planning Evaluation Project and agreed in July 2006
Outpatients totals include first and follow up for both consultant led and non-consultant led activity
Page 61 of 106
Essex Rivers Healthcare NHS Trust
FT Applicant Business Plan Rev H
5.7
Estates Strategy
5.7.1
The Trust Estates Strategy will support the Service Development Plans with the
following key projects:
5.7.2
•
Integrated Emergency Department
− As described in 5.3.7 the Trust is planning a £5M project to refurbish and
extend the existing A&E department combining it with a new Emergency
Assessment Unit.
•
Centralisation of Acute Service
− As described in 5.6.4 the Trust is planning a £55m new build Cancer Centre
at CGH which will also centralise Pathology Services on the CGH site from
their current split locations in Colchester.
− This Strategic Outline Case (SOC) proposes capital investment of £55 million
(including VAT and optimism bias) with a net annual revenue increase of
£1,580,997 to centralise and improve Oncology, Radiotherapy, Nuclear
Medicine, Haematology and Pathology services provided by Essex Rivers
Healthcare NHS Trust (ERHT). Currently Oncology, Nuclear Medicine and
Haematology services are accommodated in largely outdated and unsuitable
facilities split between the Trust’s two main acute hospital sites in Colchester.
− Also, the proposed Centre would accommodate all the Trust’s Pathology
work in one new unit providing the space and facilities to enable services to
be provided more efficiently in line with modern standards and to support new
methods of working, including participation in the Essex Pathology Network in
line with the aims of Modernising Pathology Services published in February
2004.
− To complete the centralisation from ECH the Trust will extend its existing
Elmstead day unit to provide modern accommodation for outpatient services
from ECH
•
Multi- Disciplinary Learning Centre
− As described in 5.3.11 the Trust will build a training centre of minimally
invasive surgery which will be linked to a Multi Disciplinary Learning Centre in
partnership with local universities and colleges to support the Trust in its aim
to become a continuously learning organisation.
More detail on the Trust Estates Strategy is included in Appendix 5.
Page 62 of 106
Essex Rivers Healthcare NHS Trust
FT Applicant Business Plan Rev H
6.
FINANCIAL PLANS
6.1
Historical Performance Analysis
Income and Expenditure
Table 6A: Income and Expenditure 2003/4 – 2005/6
£ million
Net Surplus/ (Deficit)
Actual
Actual
Actual
03/04
04/05
05/06
(5.8)
0.3
(1.4)
(0.1)
(0.2)
Non recurring Income
Distinction Awards
(0.1)
Planned Support
(8.1)
Transitional relief for PBR
Non Recurrent Income for activity
(0.7)
PCT Brokerage
1.2
PFI Bank Support
(1.2)
(0.8)
Non Recurring Costs
Accelerated depreciation
0.3
PFI Costs
0.5
0.8
0.8
Distinction Awards
0.1
0.1
0.2
Outsourcing of activity
1.7
(3.8)
(5.8)
(3.1)
Other Items
Profit/(loss) on asset disposls
Normalised Net Surplus/(Deficit)
0.2
(0.5)
Add:
Transfers from Donated Reserve
(0.3)
(0.3)
(0.3)
Depreciation
4.4
4.9
4.5
PDC Dividend
2.5
2.5
4.1
Other costs below operating surplus
0.0
0.0
0.0
(0.2)
(0.2)
(0.1)
2.6
1.1
5.1
2.3%
0.9%
4.1%
Less:
Other income below operating surplus
Normalised EBITDA
Normalised EBITDA Margin
6.1.1
The Trust has been significantly challenged over the last 3 years to achieve
breakeven. This has been partly caused by “block contract” arrangements with its
main commissioners, which was not reflective of the level of activity undertaken
within the Trust to meet non-elective pressures and waiting time targets. Activity
demands led the Trust to increase bed capacity in the late part of 2003/04 without
receiving an additional uplift in funding.
6.1.2
Outsourcing of activity to the local private provider also added to the deficit in 2003/4
and failure to deliver service and cost improvement programmes added to the deficit.
6.1.3
The deficit that arose in 2003/04 required the Trust to produce a Financial Recovery
Plan. The recovery plan identified that the Trust would need additional support in
2004/05 (£8.1m), should breakeven in 2005/06 and would be able to generate
surpluses during 2006/07 and 2007/08 that would repay the cumulative deficit.
Page 63 of 106
Essex Rivers Healthcare NHS Trust
6.1.4
FT Applicant Business Plan Rev H
The final position for 2005/06 was a small deficit which was mainly caused by two
late arbitration cases which were ruled against the Trust. Historic bridge charts for
the years 2004/5 to 2005/6 are shown below:
Table 6B: Historic Bridge chart 2004/5
Bridge Chart Normalised Earnings 2004/05
0
-5
£ millions
-10
-15
-20
-25
-30
Normalised
Pay
deficit
Inflation
2003/04
Pay
Reform
Non Pay
Inflation
Activity
CIP
Income Normalised
deficit
2004/05
Table 6C: Historic Bridge chart 2005/6
Bridge Chart Normalised Earnings 2005/06
0
-2
-4
£ millions
-6
-8
-10
-12
-14
-16
-18
Normalised Pay
deficit Inflation
2004/05
Pay
Non Pay
Reform Inflation
Depn
&
Funding
CIP
Activity
Income Normalised
deficit
2005/06
Page 64 of 106
Essex Rivers Healthcare NHS Trust
6.1.5
FT Applicant Business Plan Rev H
A detailed income and expenditure position is provided below:
Table 6D: Income and Expenditure Position
£ million
Actual
Actual
Actual
03/04
04/05
05/06
Income
Elective Income
21.7
24.9
32.9
Non Elective Income
42.8
48.3
55.0
Outpatient Income
22.1
24.5
26.2
2.2
2.9
3.3
22.1
17.2
25.3
110.9
117.8
142.7
0.0
0.0
(0.6)
Clinical income - NHS
110.9
117.8
142.1
Income exc. PBR transitional gain
110.9
117.8
142.1
0.0
8.1
0.0
110.9
125.9
142.1
Clinical income - Private Patients
1.2
1.3
1.7
Other Clinical Income
0.8
1.1
0.8
Research and Development
0.2
0.4
0.2
Education and Training
4.6
5.5
5.9
A&E
Other type of activity income
Total income at full tariff
PBR Clawback
Brokerage
Clinical income - NHS
Other operating income
Total income
5.5
12.4
8.2
123.2
146.6
158.9
(79.7)
(92.2)
(101.0)
Expenses
Pay Costs
Drugs Costs
Other Costs (excl. depreciation)
Total Costs
EBITDA
Profit/loss on asset disposals
(8.4)
(9.4)
(10.8)
(34.0)
(37.5)
(40.5)
(122.1)
(139.1)
(152.3)
1.1
7.5
6.6
(0.2)
0.0
0.5
Total Depreciation
(4.4)
(4.9)
(4.5)
PDC Dividend
(2.5)
(2.5)
(4.1)
Total interest receivable
0.2
0.2
0.1
Total interest payable on NHS Financing
0.0
0.0
0.0
0.0
0.0
0.0
Net Surplus/(deficit)
Total other interest payable
(5.8)
0.3
(1.4)
EBITDA Margin
0.9%
5.1%
4.2%
6.1.6
The additional wards and Theatre that opened late in 2003/04 led to a substantial
increase in pay costs with the full impact being felt in 2004/05. Relatively little
increase in clinical income was seen in comparison. In 2004/05 the Trust received
£8.1m planned support, which as part of the trusts recovery plan will need repaying
in 2007/08.
Page 65 of 106
Essex Rivers Healthcare NHS Trust
6.1.7
FT Applicant Business Plan Rev H
The table below provide the percent growth the Trust has seen, both in income and
expenditure terms over the last 3 years.
Table 6E: Percentage growth in Income and Expenditure 2003/4 – 2005/6
Income KPI's
Actual
Actual
03/04
04/05
05/06
Clinical income growth
1.4%
13.6%
Private Patients growth
-0.6%
5.4%
31.1%
6.9%
91.3%
-56.8%
R&D income growth
12.8%
Education & Training growth
19.5%
19.9%
8.9%
Other operating income growth
16.6%
128.3%
-33.9%
Expenditure KPI's
Pay Cost growth
Drug inflation
Other cost growth
6.1.8
Actual
Actual
Actual
Actual
03/04
04/05
05/06
9.1%
15.7%
9.5%
10.0%
13.0%
14.4%
-10.4%
9.8%
8.3%
Trends on average salaries including the percent impact from the various pay
reforms such as Consultant Contract and Agenda for Change are shown in the table
over the page.
Page 66 of 106
Essex Rivers Healthcare NHS Trust
FT Applicant Business Plan Rev H
Table 6F: Trends in Average Employee salaries 2003/4 – 2005/6
Consultant Costs
Number of consultants
Actual
Actual
Actual
03/04
04/05
05/06
10,636
11,894
113
113
112
0.0%
-0.9%
Number of consultants growth
Average salary
94.1
105.3
125.8
11.8%
18.4%
1,090
1,231
1,360
11,176
13,252
14,050
223
233
260
4.5%
11.6%
average salary inflation
Total income / number of consultants
14,084
Junior Medical Staff Costs
Non Agency
Number of Junior medical non agency
Number of Junior medical non agency growth
Average salary
50.1
average salary inflation
Total income / number of Junior medical non agency
Agency
junior medical agency % of total junior med pay cost
56.9
54.0
18.6%
6.0%
586
552
597
1,176
1,243
663
9.5%
8.6%
4.5%
29,758
36,434
39,282
1,313
1,360
1,102
3.6%
-19.0%
Nursing Costs
Non Agency
Number of Nursing non agency
Number of Nursing non agency growth
Average salary
22.7
average salary inflation
Total income / number of Nursing non agency
Agency
Nursing agency % of total Nursing pay cost
26.8
35.6
22.4%
7.8%
138
94
102
2,160
653
619
6.8%
1.8%
1.6%
13,400
15,567
17,243
527
597
952
13.3%
59.5%
Other Clinical Staff Costs
Non Agency
Number of Other Clinical Staff non agency
Number of Other Clinical Staff non agency growth
Average salary
25.4
average salary inflation
Total income / number of Other Clinical Staff non agency
Agency
Other Clinical Staff agency % of total Other Clinical Staff pay cost
26.1
18.1
16.2%
10.8%
234
233
160
1,049
1,082
1,530
7.3%
6.5%
8.2%
9,900
11,591
12,863
509
517
534
1.6%
3.3%
Non Clinical Staff Costs
Non Agency
Number of Non Clinical Staff non agency
Number of Other Clinical Staff growth
Average salary
19.4
average salary inflation
22.4
24.1
17.1%
11.0%
285
Total income / number of Non Clinical Staff
242
269
Agency
452
502
650
4.4%
4.2%
4.8%
79,707
92,218
100,984
Non Clinical Staff agency % of total Non Clinical Staff pay cost
Total Staff Costs
Staff Costs per bed £
Consultant
15.2
18.5
20.9
Non Agency Junior Medical
15.9
20.6
20.9
Agency Junior Medical
Non Agency Nursing
Agency Nursing
Other Clinical Staff
Agency Other Clinical Staff
Non Clinical Staff
Agency Non Clinical Staff
Total
1.7
1.9
1.0
42.5
56.7
58.4
3.1
1.0
0.9
19.1
24.2
25.6
1.5
1.7
2.3
14.1
18.0
19.1
0.6
0.8
1.0
113.7
143.4
150.1
Page 67 of 106
Essex Rivers Healthcare NHS Trust
FT Applicant Business Plan Rev H
6.2
Historical Service and Cost Improvement Programme (CIP)
6.2.1
Over the past three years the Trust has delivered £8.3 million of savings. Of this
£3.2m has been found on a recurrent basis. This has made more difficult the Trusts
ability to deliver financial balance as it deals with not only the new years CIP target
each year but also the cumulative effect of the non recurrent savings from the
previous years.
Table 6G: Historic CIP Achievement 2003/4 – 2005/6
Projection CIP Chart
4.0
3.5
3.0
2.0
£m
2.5
Non recurrent CIP
2.0
1.5
2.7
Recurrent CIP
0.4
1.0
1.8
1.2
0.5
0.0
0.2
2003/04
2004/05
2005/06
Year
Page 68 of 106
Essex Rivers Healthcare NHS Trust
FT Applicant Business Plan Rev H
6.3
Historic balance Sheet and Cash Flow Analysis
6.3.1
The balance sheets for the previous three years are shown in the table below:
Table 6H: Historic Balance Sheet 2003/4 – 2005/6
£ million
TOTAL FIXED ASSETS
Actual
Actual
Actual
03/04
04/05
05/06
91.8
122.5
127.8
CURRENT ASSETS
Stocks
3.4
3.4
3.9
Trade debtors
4.0
11.3
8.4
Prepayments & Accrued Income
2.7
0.7
1.0
Cash at Bank and in Hand
Total Current Assets
Bank overdraft / Drawdown credit facility
Trade Creditors
0.5
0.6
0.5
10.6
16.0
13.8
0.0
0.0
0.0
16.7
6.4
8.2
Other non-trade creditors
1.9
2.1
5.2
Accruals & deferred income
3.2
1.6
1.7
21.8
10.1
15.1
(11.2)
5.9
(1.3)
0.8
3.0
3.3
81.4
131.4
129.8
CREDITORS: Amounts falling due after more than one year
0.0
0.0
0.0
PROVISIONS FOR LIABILITIES AND CHARGES
1.8
2.8
3.0
79.6
128.6
126.8
NHS Financing facility
0.0
0.0
0.0
Other financing facilities
0.0
0.0
0.0
0.0
0.0
0.0
51.3
78.6
76.9
1.4
1.7
0.7
23.2
44.7
45.8
Donated asset reserve
2.9
2.8
2.6
Other reserves
0.8
0.8
0.8
79.6
128.6
126.8
CREDITORS : Amounts falling due within one year
NET CURRENTS ASSETS (LIABILITIES)
Long term Debtors
TOTAL ASSETS LESS CURRENTS LIABILITIES
TOTAL ASSETS EMPLOYED
LOANS
TOTAL LOANS
TAXPAYERS' EQUITY
Public dividend capital
Inome and expenditure reserve
Revaluation reserve
TOTAL TAXPAYERS' EQUITY
6.3.2
There was a significant rise in the fixed asset base in 2004/05 due to the purchase of
land £8 million which forms an integral part of the Estates Strategy to centralise
acute services in Colchester on the Colchester General Hospital site and also the
quinquennial revaluation of the estate.
6.3.3
The rise in trade debtors in 2004/05 was due to intra NHS agreement that was short
term with the majority of the payment being received in 2005/06. The remaining
£1.2 million will be repaid in 2007/08.
6.3.4
The improvement in 2004/05 on trade creditors was also due to the final resolution of
a long standing intra NHS issue within the whole of the Essex economy. The
increase in 2005/06 on creditors in general was to assist the Essex economy on
managing a cash shortage, where all Essex organisations were given targets to
increase creditors.
Page 69 of 106
Essex Rivers Healthcare NHS Trust
6.3.5
FT Applicant Business Plan Rev H
The cash flows for the last three years are shown below:
Table 6J: Cash Flow 2003/4 – 2005/6
£ million
Actual
Actual
Actual
03/04
04/05
05/06
EBITDA
1.0
7.5
6.6
(0.3)
(0.3)
(0.5)
(0.2)
0.0
(0.5)
1.8
(7.2)
2.9
Other current assets
(0.2)
1.9
(0.3)
Trade Creditors
2.0
Excluding Non cash I&E items
Movement in working capital:
Stocks
Trade Debtors
(2.5)
(9.9)
Other Non Trade Creditors
1.0
0.2
3.1
Accruals & Deferred income
2.5
(1.6)
0.1
3.1
(9.4)
13.4
Maintenance capex
(3.2)
(3.5)
(7.8)
non maintenance capex
(7.6)
(11.4)
0.0
0.0
0.0
0.0
Cash flow from operations
Capex spend
Cash receipt from asset sales
Interest receivable / Payable
0.2
0.2
0.2
Cash flow before financing
(7.5)
(24.1)
5.8
Public Dividend Capital received
10.6
27.2
1.0
Public Dividend Capital repaid
(0.9)
0.0
(2.6)
Movement in other grants / capital received
0.0
0.0
0.0
Movement in LT creditors and provisions
0.3
1.0
0.2
Other Capital repaid
0.0
0.0
0.0
Movement in LT debtors
0.0
(1.5)
(0.4)
Movement in Loans facility
0.0
0.0
0.0
(2.5)
(2.5)
(4.1)
Net Cash (outflow) / inflow
0.0
0.1
(0.1)
Opening Cash balance
0.5
0.5
0.6
Net Cash (outflow) / inflow
0.0
0.1
(0.1)
Closing cash balance
0.5
0.6
0.5
Dividends Paid
6.3.6
Capital expenditure on non-maintenance relates to the new wards and theatre in
2003/04. 2004/05 includes the purchase of the land for the centralisation of acute
services on Colchester General Hospital site as mentioned above.
6.3.7
The major changes in working capital balances have been detailed in the narrative
for the balance sheet above.
6.3.8
Key balance sheet ratios for the previous three years are contained below:
Table 6K: Key balance Sheet Ratios 2003/4 – 2005/6
KPI's
Movement in Fixed Assets
Actual
Actual
Actual
03/04
04/05
05/06
11.7
30.7
5.3
(11.6)
5.4
(1.8)
Stock days
59.4
52.6
54.1
Trade debtors days
12.7
28.7
19.7
Trade creditor days
143.3
49.3
58.5
Working Capital
Page 70 of 106
Essex Rivers Healthcare NHS Trust
FT Applicant Business Plan Rev H
6.4
Income and Expenditure Five Year Projections
6.4.1
The Trust operates at below national average cost. As this has been a consistent
feature of the trusts cost base over several years, the Trust has benefited from the
new financial regime, Payment by results (PbR). The full introduction of PbR was
introduced in 2006/07 although for those trusts which gain, only 50% of the gain is
available for local use. A transitional path has been introduced with 20% being paid
back to the DOH in 2006/07 reducing to 25% in 2007/08.
6.4.2
The normalised earnings table for the outturn and five-year Projections is shown
below:
Table 6L: Normalised Earnings - forecast outturn and five-year Projections
£ million
Net Surplus/ (Deficit)
Forecast
Plan
Plan
Plan
Plan
Plan
06/07
07/08
08/09
09/10
10/11
11/12
8.1
0.4
5.0
4.2
3.2
1.6
(0.3)
Non recurring Income
Distinction Awards
(0.2)
(0.2)
(0.2)
(0.2)
(0.2)
Planned Support
0.0
8.1
0.0
0.0
0.0
0.0
Transitional relief for PBR
6.7
4.4
0.0
0.0
0.0
0.0
Non Recurrent Income for activity
0.0
0.0
0.0
0.0
0.0
0.0
PCT Brokerage
0.2
(0.2)
0.0
0.0
0.0
0.0
PFI Bank Support
0.0
0.0
0.0
0.0
0.0
0.0
Accelerated depreciation
0.0
0.0
2.5
2.5
2.5
2.5
PFI Costs
0.1
0.0
0.0
0.0
0.0
0.0
Distinction Awards
0.2
0.2
0.2
0.2
0.2
0.3
Outsourcing of activity
0.0
0.0
0.0
0.0
0.0
0.0
Non Recurring Costs
Other Items
Profit/(loss) on asset disposls
Normalised Net Surplus/(Deficit)
0.0
0.0
0.0
0.0
0.0
0.0
15.1
12.7
7.5
6.7
5.7
4.1
Add:
Transfers from Donated Reserve
(0.3)
(0.3)
(0.3)
(0.3)
(0.3)
(0.3)
Depreciation
5.2
6.5
9.6
10.3
12.6
15.1
PDC Dividend
4.6
4.9
5.6
6.7
7.9
8.7
Other costs below operating surplus
0.0
0.0
0.0
0.0
0.0
0.0
(0.3)
(0.3)
(0.2)
(0.4)
(0.7)
(1.0)
Less:
Other income below operating surplus
Normalised EBITDA
Normalised EBITDA Margin
24.3
23.5
22.2
23.0
25.2
26.6
13.9%
13.2%
11.9%
12.0%
12.6%
12.8%
6.4.3
The Trust is planning to dispose of the Essex County site in 2011/12 if its business
case for the new Oncology and Pathology centre is approved. The current book
value exceeds the likely Market value and as such the Trust would need to
accelerate the depreciation to write down the book value to the expected book value
over the four years.
6.4.4
Transitional relief returned to the DoH is also shown for 2006/7 and 2007/8.
6.4.5
The repayment of planned support is also planned for 2007/08.
Page 71 of 106
Essex Rivers Healthcare NHS Trust
6.4.6
FT Applicant Business Plan Rev H
The bridge charts below detail the movements between the normalised earnings
from 2006/07 through 2011/12.
Table 6M: Normalised Earnings 2006/7 (Bridge Chart)
Bridge Chart Normalised Earnings 2006/07
20
15
10
£ millions
5
0
-5
-10
-15
-20
-25
-30
CIP
PbR
Pay Non Pay Depn
Normalised Pay
& Transitional
deficit Inflation Reform Inflation
Funding Relief
2005/06
Activity Income Normalised
Surplus
2006/07
Table 6N: Normalised Earnings 2007/8 (Bridge Chart)
Bridge Chart Normalised Earnings 2007/08
20
15
£ millions
10
5
0
-5
-10
CIP
PbR
Pay Non Pay Depn
Normalised Pay
& Transitional
Surplus Inflation Reform Inflation
Funding Relief
2006/07
Activity Income Normalised
Surplus
2007/08
Page 72 of 106
Essex Rivers Healthcare NHS Trust
FT Applicant Business Plan Rev H
Table 6P: Normalised Earnings 2008/9 (Bridge Chart)
Bridge Chart Normalised Earnings 2008/09
15
£ millions
10
5
0
-5
-10
Normalised Pay
Surplus Inflation
2007//08
Pay
Non Pay
Reform Inflation
Depn
&
Funding
Activity
CIP
Income Normalised
Surplus
2008/09
Page 73 of 106
Essex Rivers Healthcare NHS Trust
6.4.7
FT Applicant Business Plan Rev H
The income and expenditure table for the forecast outturn and the five year
projections are shown below:
Table 6Q: Income and Expenditure forecast outturn and five-year Projections
£ million
Forecast
Plan
Plan
Plan
Plan
Plan
06/07
07/08
08/09
09/10
10/11
11/12
Income
Elective Income
30.6
38.3
32.0
33.6
35.2
36.2
Non Elective Income
63.5
64.4
69.2
68.9
71.2
73.6
Outpatient Income
32.4
34.9
29.0
30.2
31.2
31.7
Other type of activity income
33.6
32.7
35.3
37.7
40.7
43.6
6.7
5.8
6.1
6.3
6.5
6.8
166.8
176.1
171.6
176.7
184.8
191.9
A&E income
Total income at full tariff
PBR Clawback
(6.7)
(4.4)
0.0
0.0
0.0
0.0
Clinical income - NHS
160.1
171.7
171.6
176.7
184.8
191.9
Income exc. PBR transitional gain
160.1
171.7
171.6
176.7
184.8
191.9
0.0
(8.1)
0.0
0.0
0.0
0.0
160.1
163.6
171.6
176.7
184.8
191.9
Repayment of Brokerage
Clinical income - NHS
Clinical income - Private Patients
1.0
0.8
0.8
0.9
0.9
0.9
Research and Development
0.2
0.2
0.2
0.2
0.2
0.2
Education and Training
5.5
5.9
6.0
6.2
6.3
6.5
Other operating income
7.9
7.6
7.5
7.6
7.8
8.0
174.7
178.1
186.1
191.6
200.0
207.5
(117.5)
Total income
Expenses
Pay Costs
(101.9)
(106.2)
(105.8)
(109.3)
(113.6)
Drugs Costs
(11.1)
(11.4)
(11.8)
(13.0)
(14.4)
(16.0)
Other Costs (excl. depreciation)
(44.0)
(48.9)
(48.5)
(48.5)
(49.0)
(49.6)
(157.0)
(166.5)
(166.1)
(170.8)
(177.0)
(183.1)
17.7
11.6
20.0
20.8
23.0
24.4
0.0
0.0
0.0
0.0
0.0
0.0
Total Depreciation
(5.2)
(6.5)
(9.6)
(10.3)
(12.6)
(15.1)
PDC Dividend
(8.7)
Total Costs
EBITDA
Profit/loss on asset disposals
(4.6)
(4.9)
(5.6)
(6.7)
(7.9)
Total interest receivable
0.3
0.3
0.2
0.4
0.7
1.0
Total interest payable on NHS Financing
0.0
0.0
0.0
0.0
0.0
0.0
(0.1)
(0.1)
0.0
0.0
0.0
0.0
8.1
0.4
5.0
4.2
3.2
1.6
10.1%
6.5%
10.7%
10.9%
11.5%
11.8%
Total other interest payable
Net Surplus/(deficit)
EBITDA Margin
6.4.8
The table below provide the percent growth the Trust is projecting both in income
and expenditure terms over the next five years
Table 6U: Percentage Growth Projections
Income KPI's
Forecast
Plan
Plan
Plan
Plan
Plan
06/07
07/08
08/09
09/10
10/11
11/12
Clinical income growth
13.5%
7.5%
-0.3%
3.0%
4.6%
3.8%
Private Patients growth
-43.1%
-13.6%
2.5%
2.5%
2.5%
2.5%
R&D income growth
0.0%
2.5%
2.5%
2.5%
2.5%
2.5%
Education & Training growth
7.1%
6.2%
2.5%
2.5%
2.5%
2.5%
Other operating income growth
3.0%
-3.8%
2.5%
2.5%
2.5%
2.5%
Expenses KPI's
Forecast
Plan
Plan
Plan
Plan
Plan
06/07
07/08
08/09
09/10
10/11
11/12
Pay Cost growth
0.7%
4.2%
-0.4%
3.3%
3.9%
3.4%
Drug inflation
4.7%
2.4%
4.2%
9.8%
11.1%
10.4%
Other cost growth
8.7%
11.0%
-1.0%
0.1%
1.1%
1.4%
Page 74 of 106
Essex Rivers Healthcare NHS Trust
6.4.9
FT Applicant Business Plan Rev H
Clinical income has been modelled using ‘Checklist’ to ensure the Trust achieves the
18 week wait from referral to procedure by 2008 and thereafter maintain that level of
wait. The underlying change in referrals is linked to population changes.
6.4.10 Choice has been modelled as neutral on the basis that to date the Trust has
experienced very little change in absolute numbers. The two nearest Trusts have a
similar waiting time which is currently felt to be the main deciding factor in patients
choosing between NHS hospitals.
6.4.11 However in 2008/09 it is currently planned that a new independent treatment centre
will open on the margins of the trusts catchments area. It is felt that this will impact
on the level of elective activity currently carried out by the Trust. The impact on this
new facility has been incorporated within the projections and accounts for the
reduction in income in 2008/09.
6.4.12 Non elective activity has been modelled based on demographic changes and the
likely impact from service changes introduced by the PCTs to reduce admissions.
6.4.13 Pay rises have been modelled at 3% for 2008/09 and thereafter 2.5%. A further 3%
has been modelled as a full hit on incremental progression as a result of Agenda for
Change.
6.4.14 Non pay inflation has been assumed at 2.5%. The effect of NNICE pronouncements
is expected to present a significant rise in drug costs and has been modelled at a
10% rise in each year.
6.4.15 Costs of changes in activity outside of specific service developments have been
modelled on the basis that for every £1 of change in income, service delivery costs
will change by 65p. 74% of which will meet changes in staff resources. The
remaining 26% is to meet the marginal costs of non-pay.
Page 75 of 106
Essex Rivers Healthcare NHS Trust
FT Applicant Business Plan Rev H
6.4.16 Trends on average salaries including the percent impact from the various pay
reforms are shown in the table below.
Table 6R: Average Salary Projections
Consultant Costs
Number of consultants
Number of consultants growth
Average salary
average salary inflation
Total income / number of consultants
Forecast
Plan
Plan
Plan
Plan
Plan
06/07
07/08
08/09
09/10
10/11
11/12
14,753
15,548
15,708
16,233
16,866
114
121
119
120
122
17,439
123
1.8%
6.1%
4.4%
-0.8%
1.7%
0.8%
129.4
128.5
132.0
135.3
138.2
141.8
2.9%
-0.7%
2.0%
5.3%
2.2%
2.6%
2,009
1,901
1,869
1,876
1,869
1,871
14,010
15,102
15,048
15,551
16,157
16,706
233
219
206
202
199
195
-10.4%
-6.0%
-11.6%
-7.8%
-1.5%
-2.0%
Junior Medical Staff Costs
Non Agency
Number of Junior medical non agency
Number of Junior medical non agency growth
Average salary
60.1
69.0
73.0
77.0
81.2
85.7
11.3%
14.7%
21.5%
11.6%
5.5%
5.5%
Total income / number of Junior medical non agency
983
1,050
1,080
1,115
1,146
1,180
Agency
871
600
500
512
525
538
5.9%
3.8%
3.2%
3.2%
3.1%
3.1%
average salary inflation
junior medical agency % of total junior med pay cost
Nursing Costs
Non Agency
40,235
41,354
41,249
42,639
44,319
45,852
Number of Nursing non agency
1,296
1,283
1,206
1,181
1,163
1,140
Number of Nursing non agency growth
17.6%
-1.0%
-6.9%
-8.0%
-1.5%
-2.0%
31.0
32.2
34.2
36.1
38.1
40.2
-12.9%
3.8%
10.2%
12.0%
5.5%
5.5%
177
179
184
191
196
202
92
240
150
154
158
162
0.2%
0.6%
0.4%
0.4%
0.4%
0.4%
17,764
19,242
19,173
19,813
20,586
21,286
549
553
520
509
501
491
-42.3%
0.7%
-5.3%
-8.0%
-1.6%
-2.0%
Average salary
average salary inflation
Total income / number of Nursing non agency
Agency
Nursing agency % of total Nursing pay cost
Other Clinical Staff Costs
Non Agency
Number of Other Clinical Staff non agency
Number of Other Clinical Staff non agency growth
Average salary
32.4
34.8
36.9
38.9
41.1
43.4
78.6%
7.5%
14.0%
11.9%
5.6%
5.5%
Total income / number of Other Clinical Staff non agency
417
416
428
442
455
469
Agency
502
240
200
205
210
215
2.7%
1.2%
1.0%
1.0%
1.0%
1.0%
13,251
13,666
13,617
14,072
14,621
15,118
521
516
485
475
468
459
-2.4%
-1.0%
-6.9%
-7.9%
-1.5%
-1.9%
average salary inflation
Other Clinical Staff agency % of total Other Clinical Staff pay cost
Non Clinical Staff Costs
Non Agency
Number of Non Clinical Staff non agency
Number of Other Clinical Staff growth
Average salary
25.4
26.5
28.1
29.6
31.2
32.9
average salary inflation
5.6%
4.1%
10.4%
11.9%
5.5%
5.4%
Total income / number of Non Clinical Staff
440
446
459
474
487
501
Agency
374
180
150
154
158
162
2.7%
1.3%
1.1%
1.1%
1.1%
1.1%
101,852
106,172
105,795
109,333
113,600
117,478
Non Clinical Staff agency % of total Non Clinical Staff pay cost
Total Staff Costs
Staff Costs per bed £
Consultant
21.9
23.1
23.3
24.1
25.1
25.9
Non Agency Junior Medical
20.8
22.4
22.4
23.1
24.0
24.8
Agency Junior Medical
Non Agency Nursing
Agency Nursing
Other Clinical Staff
Agency Other Clinical Staff
Non Clinical Staff
Agency Non Clinical Staff
Total
1.3
0.9
0.7
0.8
0.8
0.8
59.8
61.4
61.3
63.4
65.9
68.1
0.1
0.4
0.2
0.2
0.2
0.2
26.4
28.6
28.5
29.4
30.6
31.6
0.7
0.4
0.3
0.3
0.3
0.3
19.7
20.3
20.2
20.9
21.7
22.5
0.6
0.3
0.2
0.2
0.2
0.2
151.3
157.8
157.2
162.5
168.8
174.6
Page 76 of 106
Essex Rivers Healthcare NHS Trust
FT Applicant Business Plan Rev H
6.5
Future Service and Cost Improvement programme (CIP)
6.5.1
The Trust has assumed a savings programme of 2.5% per annum. It is anticipated
that in each year there will always be an element of non recurrent savings which will
support part year effect recurrent schemes.
6.5.2
A graph detailing the amounts needed to be achieved is shown below:
Table 6S: Service and Cost Improvement Programme Projections
Projection CIP Chart
9.0
8.0
7.0
2.4
£m
6.0
5.0
Non recurrent CIP
4.0
Recurrent CIP
3.0
5.5
1.8
2.0
2.4
1.0
1.2
1.2
1.2
1.2
3.0
3.0
3.1
3.2
2008/09
2009/10
2010/11
2011/12
0.0
2006/07
2007/08
Year
6.5.3
The service and cost improvement programme for 2007/08 is detailed in the table on
the next page. The performance management of the programme is achieved
through fortnightly meetings of key personnel as well as individual assurance
meetings with each manager. The Executive Director reports progress monthly to
the Finance Committee a sub committee of the Board.
Table 6T: Service and Cost Improvement Programme 2007/08
Information issued separately to SHA.
Page 77 of 106
Essex Rivers Healthcare NHS Trust
FT Applicant Business Plan Rev H
6.6
Cash Flow 5 Year Projections
6.6.1
The projected balance sheet for the forecast outturn and five years projections are
shown below:
Table 6V: Balance Sheet forecast outturn and five-year Projections
£ million
TOTAL FIXED ASSETS
Forecast
Plan
Plan
Plan
Plan
Plan
06/07
07/08
08/09
09/10
10/11
11/12
138.5
147.3
173.1
197.6
224.6
225.1
Stocks
3.8
3.9
3.9
4.0
4.2
4.4
Trade debtors
6.4
5.3
5.2
5.4
5.7
6.0
Prepayments & Accrued Income
0.8
0.7
0.7
0.7
0.7
0.7
Cash at Bank and in Hand
0.5
0.2
9.2
16.1
22.4
35.4
46.5
CURRENT ASSETS
Total Current Assets
11.5
10.1
19.0
26.2
33.0
Bank overdraft / Drawdown credit facility
0.0
0.0
0.0
0.0
0.0
0.0
Trade Creditors
7.2
6.1
9.7
9.9
9.7
9.0
Other non-trade creditors
4.2
4.4
4.4
4.5
4.7
4.9
Accruals & deferred income
0.8
0.7
0.9
0.9
1.0
1.0
CREDITORS : Amounts falling due within one year
12.2
11.2
15.0
15.3
15.4
14.9
NET CURRENTS ASSETS (LIABILITIES)
(0.7)
(1.1)
4.0
10.9
17.6
31.6
3.3
3.2
3.1
3.0
2.9
2.8
141.1
149.4
180.2
211.5
245.1
259.5
0.0
Long term Debtors
TOTAL ASSETS LESS CURRENTS LIABILITIES
CREDITORS: Amounts falling due after more than one year
0.0
0.0
0.0
0.0
0.0
PROVISIONS FOR LIABILITIES AND CHARGES
2.0
1.9
1.9
1.8
1.8
1.7
139.1
147.5
178.3
209.7
243.3
257.8
TOTAL ASSETS EMPLOYED
LOANS
NHS Financing facility
0.0
0.0
0.0
0.0
0.0
0.0
Other financing facilities
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
74.0
74.0
92.1
110.0
129.0
129.0
8.9
9.3
14.3
18.5
21.7
23.2
52.9
61.0
68.9
78.3
89.9
103.1
1.7
TOTAL LOANS
TAXPAYERS' EQUITY
Public dividend capital
Inome and expenditure reserve
Revaluation reserve
Donated asset reserve
2.5
2.4
2.2
2.1
1.9
Other reserves
0.8
0.8
0.8
0.8
0.8
0.8
139.1
147.5
178.3
209.7
243.3
257.8
TOTAL TAXPAYERS' EQUITY
6.6.2
The fixed asset base has been indexed at by the indices released by the DoH for
2006/07 and 2007/08. The assumption for 2008/9 onwards is that land will be
indexed by 5%, buildings by 7.5% and equipment by 2.5%.
6.6.3
Trade Creditors are expected to increase over the projected period mainly due to the
large spend on capital. This is expected to reduce in 2012/13.
6.6.4
Key balance sheet ratios are the projected period is shown below:
Table 6W: key Balance Sheet Ratio Projections
KPI's
Forecast
Plan
Plan
Plan
Plan
Plan
06/07
07/08
08/09
09/10
10/11
11/12
Movement in Fixed Assets
10.7
8.8
25.8
24.5
27.0
0.5
Working Capital
(1.2)
(1.2)
(5.2)
(5.2)
(4.8)
(3.7)
Stock days
52.6
52.5
52.7
52.3
51.8
51.3
Trade debtors days
13.6
11.0
10.3
10.4
10.4
10.5
Trade creditor days
41.0
32.3
43.3
43.4
43.7
43.9
Page 78 of 106
Essex Rivers Healthcare NHS Trust
6.6.5
FT Applicant Business Plan Rev H
Cash flow for the forecast outturn and five years projections are shown below:
Table 6X: Cash Flow Projections
£ million
Forecast
Plan
Plan
Plan
Plan
Plan
06/07
07/08
08/09
09/10
10/11
11/12
EBITDA
17.7
11.6
20.0
20.8
23.0
24.4
Excluding Non cash I&E items
(0.3)
(0.3)
(0.3)
(0.3)
(0.3)
(0.3)
Stocks
0.1
(0.2)
0.0
(0.1)
(0.2)
(0.2)
Trade Debtors
1.9
1.1
0.1
(0.2)
(0.3)
(0.2)
Movement in working capital:
Other current assets
0.2
0.1
0.1
0.0
(0.1)
(0.1)
Trade Creditors
(1.0)
(1.1)
3.6
0.2
(0.1)
(0.8)
Other Non Trade Creditors
(1.0)
0.2
0.0
0.1
0.2
0.2
Accruals & Deferred income
(0.9)
(0.1)
0.2
0.0
0.1
0.0
16.7
11.3
23.7
20.5
22.3
23.0
(8.6)
(6.9)
(9.4)
(7.3)
(8.8)
(11.5)
0.0
0.0
(18.0)
(18.0)
(19.0)
0.0
Cash receipt from asset sales
0.0
0.0
0.0
0.0
0.0
9.2
Interest receivable / Payable
0.2
0.2
0.2
0.4
0.7
1.0
Cash flow before financing
8.3
4.6
(3.5)
(4.4)
(4.8)
21.7
1.0
0.0
18.0
18.0
19.0
0.0
(3.9)
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
(0.9)
(0.1)
0.0
(0.1)
(0.1)
(0.1)
Cash flow from operations
Capex spend
Maintenance capex
non maintenance capex
Public Dividend Capital received
Public Dividend Capital repaid
Movement in other grants / capital received
Movement in LT creditors and provisions
Other Capital repaid
0.0
0.0
0.0
0.0
0.0
0.0
Movement in LT debtors
0.1
0.1
0.1
0.1
0.1
0.1
Movement in Loans facility
0.0
0.0
0.0
0.0
0.0
0.0
(4.6)
(4.9)
(5.6)
(6.7)
(7.9)
(8.7)
0.0
(0.3)
9.0
6.9
6.3
13.0
Dividends Paid
Net Cash (outflow) / inflow
Opening Cash balance
0.5
0.5
0.2
9.2
16.1
22.4
Net Cash (outflow) / inflow
0.0
(0.3)
9.0
6.9
6.3
13.0
Closing cash balance
0.5
0.2
9.2
16.1
22.4
35.4
6.6.6
The capital expenditure programme projection takes account of the trusts strategy to
centralise on the main acute site. Specifically 2008/09 to 2010/11 sees the major
development of an oncology and pathology centre at Colchester general. A
business case is in the early stages but it is anticipated that this will be funded from
an increase in PDC.
6.6.7
The capital programme overall is significantly less than the depreciation and the
Income and expenditure surpluses. Combined with the sale of Essex County
Hospital in 20011/12, this provides a net generation of cash resulting in a large
increase in cash balance held by the Trust.
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6.7
FT Applicant Business Plan Rev H
Public Sector Payment Policy
Table 6Y: Public sector payment Policy 2003/4 to 2006/7
Number of Invoices
Total of bills paid in the year
Total of bills paid within target
% of bills paid within target
Value of Invoices
Total of bills paid in the year
Total of bills paid within target
% of bills paid within target
Actual
Actual
Actual
03/04
04/05
05/06
06/07
49,461
19,053
38.5%
48,838
37,295
76.4%
50,993
35,411
69.4%
48,643
23,297
47.9%
Estimate
Actual
Actual
Actual
Estimate
03/04
04/05
05/06
06/07
53,804
27,946
51.9%
55,437
41,431
74.7%
55,120
41,510
75.3%
58,267
38,754
66.5%
6.7.1
Since 2003/04, the Trusts performance against the Public Sector Payment Policy
has been constrained due largely to cash shortages. However during 2006/07 to
date cash has not been the overriding factor and this has highlighted process issues
both within the department and within the Trust which need to be streamlined.
6.7.2
Processes are being addressed but the age of some invoices within the system will
continue to impact on the performance during 2007/08 with the expectation of a
steady improvement in each month as the year progresses.
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7.
RISKS
7.1
Overview of Risk Management Structure and Systems
7.1.1
The Trust risk management strategy and policy4 was updated based on the lessons
learned as part of the Diagnostic Programme in 2006 and was approved by the Trust
Board on 14th February 2007. Full details of the risk management structure and
systems and the key personnel involved are detailed in this policy and high level
information is summarised below.
The Risk Management Structure
7.1.2
7.1.3
The risk management structure and associated relational framework are designed to
optimise communication, create an efficient risk management infrastructure and
utilise fully the existing skills amongst relevant professionals. The structure will
enable a coordinated approach to support the following:
•
Further integration of the present risk management processes with other
initiatives such as business planning, monitoring national healthcare standards,
management of claims, complaints and the health and safety functions,
including fire and security.
•
Integration of risk management activity in both the clinical and non-clinical areas
in order to maximise the potential for reducing risks related to patients, staff and
others.
•
Realising the financial benefits of minimising risk.
•
Assisting the Trust in achieving and maintaining statutory compliance in all
areas of healthcare activity, including clinical governance and healthcare
standard imperatives.
•
Providing the necessary impetus for the Trust to continue work in achieving
compliance with the NHSLA Risk Management Standards for Acute Trusts.
The central strategic responsibility for steering the risk management agenda forward
within the Trust lies with the Clinical Governance Committee acting under its
devolved responsibility from the Trust Board, to whom it remains accountable.
Risk Management Committee Structure and Reporting
7.1.4
The Trust’s committee structure for managing risk is outlined below.
•
4
Trust Board
− Meets not less than bi-monthly and receives risk/governance reports from the
Clinical Governance Committee, Audit Committee and Infection Control
Committee.
− Risk is considered in its broadest sense. The Board considers the Red Risk
Register and the Assurance Framework register and whether they have
assurance that the most serious risks are being controlled.
− Before each Board meeting, the Red Risk Register and mitigation plans will
be considered by the key personnel with minutes taken of all discussions and
outcomes.
Trust Document Reference 118 version 4 – Risk Management Strategy and Policy
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•
Audit Committee
− Meets on a quarterly basis and provides an independent review of the
internal control environment within the Trust in order to provide the Board
with assurance on compliance with relevant regulatory, legal and code of
conduct requirements.
•
Clinical Governance Committee
− The Clinical Governance Committee’s primary purpose is to ensure that
patients receive the highest possible quality of care. It oversees the
organisation’s systems and processes for monitoring and improving the
quality of services and the patient’s experience of those services. It is also
responsible for the Trust’s risk management strategy and the achievement of
Standards for Better Health.
− This Committee meets quarterly and receives reports from Risk Management
Committee, Mortality Audit Committee, Clinical Audit Committee and the
Complaints & Litigation Committee
•
Risk Management Committee
− The role of the Risk Management Committee is to oversee the risk
management arrangements within Essex Rivers Healthcare NHS Trust, by
giving careful consideration to financial control arrangements, clinical and
corporate governance. This will ensure organisation-wide co-ordination and
prioritisation of risk
management issues, encouraging and fostering a
greater awareness and ownership of risk management throughout the
corporate, business and operational levels of the organisation.
− This Committee meets quarterly (however special meetings maybe convened
if required) and receives reports from Divisional clinical governance groups,
Nursing division, Ionising Radiation, Health & Safety Committee and the
Environmental Monitoring Committee.
− This Committee includes representatives from clinical and non clinical
Divisions, members of the Executive team, finance and risk specialists.
Approved terms of reference, describing membership, frequency and function
of this committee are agreed.
− The Risk Management Committee considers the ‘Trust Extreme Risks
Register’ as well as other serious risks escalated from Divisions, prior to
reporting these to the Clinical Governance Committee.
•
Infection Control Committee
− This Committee meets quarterly and considers and oversees infection risks
and controls. It reports directly to the Clinical Governance Committee, and
monthly to the Clinical Executive Board.
Roles and Responsibilities
7.1.5
The challenge for everyone working within the dynamic and ever-changing
environment of the National Health Service is to work positively and proactively to,
eliminate where possible, or at least reduce the potential for adverse incidents. Risk
management is both the collective responsibility of the organisation as a whole, and
an individual responsibility for all staff across all disciplines and departments.
7.1.6
The risk management processes will be led by all managers and overseen by the
Director of Nursing through the Associate Director for Midwifery & Governance,
Clinical Governance Manager and Risk Management Department.
7.1.7
The following key responsibilities have been identified and key outputs summarised:
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•
Chief Executive
− The overall and final responsibility for all risk and health and safety issues
rests with the Chief Executive. The Chief Executive is responsible for
providing the Trust with the necessary resources to produce, implement and
manage effective policy. In line with the general philosophy of the Trust,
maximum delegation of responsibility will occur. Individuals will be expected
to assume responsibility for their own actions.
•
The Trust Board
− The Trust Board has a pivotal role in the strategic direction of the Trust and
overseeing the implementation of objectives including those relating to risk
management.
− The cornerstone of the assurance process framework is the requirement of
the Trust Board to produce a Statement of Assurance that it is doing its
‘reasonable best’ to manage risk within the Trust. The Statement of
Assurance must accompany the Annual Report. Hospital Trust’s are required
to produce an assurance framework statement in respect of risk
management, governance and financial controls. A Statement of Internal
Control is produced on the basis of evaluating current policies, procedures
against the Statement of Internal Control Guidance.
•
Director of Nursing / Deputy Chief Executive
− Board member with delegated responsibility for ensuring that effective
systems and structures are in place for the development of risk management
within the Trust, and for the implementation of Standards for Better Health.
•
Medical Director
− Board member with responsibility for undertaking the role of the Caldicott
Guardian. The Medical Director is also responsible for maintaining and
improving the confidentiality and security of patient information.
•
Chief Operating Officer
− Board member with delegated responsibility for Information Governance.
− Responsible for the efficient management of resources within a designated
remit and to ensure the safe and effective provision of services in the spirit of
this strategy. In conjunction with Associate Directors for Emergency and
Elective Care, will oversee the risk assessments and risk treatment plans for
their areas. Together they will ensure the co-ordination and communication of
learning from risks, incidents, complaints and serious untoward incidents.
•
Finance Director
− Board member with delegated responsibility for implementation of Internal
Controls and Standards for Financial Management, Purchasing, Supply and
Performance Management.
•
Non-Executive Directors
− Non-Executive Directors are members of formal sub committees of the Trust
Board as defined in Standing Orders (S.O. 5.8, April 2006).
•
Head of Midwifery
− Responsible to the Associate Director for Emergency Care for the coordination and monitoring of risk management within the maternity Services:
ensuring clear lines of communication between the Maternity Services, Risk
Management Department and the Trust’s Risk Management Committee in
relation to identified clinical and organisational risks.
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All Staff
− Managing risk is the responsibility of all staff, it is now a fundamental part of
the work and roles of all staff.
7.2
Summary of extreme business risks
7.2.1
The Risk Management Committee last met on the 17th May 2007 and no extreme
risks were identified.
Table 7A – Extreme Risk Register reported to the Trust Board
None
7.3
Commentary on Mitigation
7.3.1
Commentary on Mitigation of each of the extreme risks would be shown in the table
above and are discussed and recorded in the Trust Board meeting.
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8.
LEADERSHIP & WORKFORCE
8.1
Management Arrangements
8.1.1
The Trust Board is committed to engaging with its staff, patients and stakeholders in
the development and achievement of its aims and objectives. Various performance
management issues are presented to the Trust Board and specific work streams are
delegated to sub-committees for investigation. Full details of the Board structure is
given in Section 9.
8.1.2
Following all formal Trust Board meetings, an organisational Team Briefing cascade,
led by the Chief Executive, is undertaken. Board Minutes and Agenda for meetings
held in public are published on the Intranet and Internet websites of the Trust. This
enhances communications throughout the Trust.
8.1.3
Emerging from the vision and aims of the organisation are distinct messages and
values, which the Board promotes. These are:
8.1.4
•
We place the patient at the centre of our planning necessitating a close, trusting
and effective relationship between clinicians and managers and local partners,
which makes so much more possible.
•
We want an organisation where employees have a tangible sense of pride.
•
We are a team-based organisation that respects the contribution of all staff.
•
We listen to and involve staff, patients and the public in reviewing and planning
services.
•
We want to be recognised for our specialist acute service contribution. While
some services may be better provided away from the hospital in local settings,
the Trust also hopes to develop specialist services to limit the occasions where
local residents are required to travel for specialist care.
•
We are open about and genuinely want to learn from mistakes.
•
We want the public to identify with and support our Trust and their hospital
service.
The Human Resource Strategy was updated and approved by the Trust Board in
2007.
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Trust Board
8.1.5
There have been some changes to the Trust Board over last two years, including the
appointment of three Non-Executive Directors (NEDs) in January 2005 and one in
December 2006 following the resignation of one of these appointees.
A new
Chairman was appointed in December 2005. This now provides a full complement
of Board Members with a wide range of experience both from the public and private
sector. The Trust Board structure and profiles of Executive, Non-Executive Directors
and those senior managers who regularly attend Board meetings are provided in the
pen portrait Appendix 6. The Board meets on a formal basis not less than 6 times
per year and informally on other occasions.
Trust Executive Team
8.1.6
The Trust Board is supported by the Clinical Executive Board (CEB), which
comprises Executive Directors, Clinical Directors and other key health care
professionals. The chair of this group is the Chief Executive. Membership of this
group is shown in Appendix 7. The Clinical Executive Board meets on a monthly
basis.
8.1.7
There are clear communication links between the Clinical Executive Board and the
Trust’s Clinical Programme Groups.
The strategy emerging from the Clinical
Executive Board is fed into the Clinical Programme Groups, each being led by a
senior clinician and a senior manager working in partnership, who will then
implement the Trust-specific elements. The Clinical Programme Director retains
responsibility for ensuring the work of the Programme Group is aligned with the
corporate strategy and for monitoring its effectiveness.
Divisional Structure
8.1.8
The Clinical Executive Board sets the agenda for these Programme Groups, and a
sub-committee, the Service Improvement Steering Group, has been established to
oversee the detail of the Programme Groups. The main purpose of the Steering
Group is to ensure that the agreed priorities inform the work of the Programme
Groups and to explore innovative ways of meeting the service improvement agenda.
8.1.9
Clinical Divisions are responsible for the day-to-day operational activities within their
areas. Each Clinical Division includes human resource (HR), financial and
information support as part of the team. In addition the Clinical Divisions have
linkages into other corporate areas such as risk management.
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8.1.10 The organisational management structure is given below:
CORPORATE ACCOUNTABILITY FRAMEWORK
TRUST BOARD
Subcommittees
Chief Executive
•
•
•
•
•
•
•
Planned Care
Anaesthetics & Day Surgery
Strategy & Sustainability
Marketing & New Business
Emergency Care
Transitional Care
Diagnostics
Clinical Programme Directors
Executive Directors
•
•
•
•
•
•
Director of Nursing*
Chief Operating Officer*
Director of Finance *
Medical Director*
Chief Operating Officer
Director of Facilities,
Planning & Development
(* Executive Director)
Clinical Executive Board
DIVISIONS
Capacity &
Service Improvement
Planned Care
•
•
•
•
•
Surgery (Gen,
T&O)
Specialist Surgery
Theatres,
Anaesthetics &
Critical Care
Radiology
Ambulatory Care
Emergency Care
•
•
•
•
•
•
•
General Medicine
Women’s Services
Cancer
Specialist Medicine
Pathology
Operations
Pharmacy
8.1.11 This structure has been conceived through a number of adjustments to the
organisational leadership of the organisation to:
•
Improve performance and capacity to deliver Trust Board priorities
•
Improve the organisation’s ability to implement change flexibly
•
Strengthen management performance and focus on a turnaround model
•
Improve clinical leadership
•
Strengthen governance and support the move to NHS Foundation Trust status
•
Speed up integration and clinical service improvement
•
Meet the affordability criteria of the organisation.
8.1.12 In the longer-term, the Trust will attempt to move towards process management,
focusing on the core processes driving an organisation, rather than on the individual
functions within it.
This will involve a higher degree of integration between
organisational functions with people focused more on patient experience and
outcomes rather than merely division or departmental needs and create an
environment where action is decided and implemented with robust project
assurance.
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8.2
Workforce Key Performance Indicators
8.2.1
The Trusts recent and current workforce position is described in the following two
tables:
Table 8A Staff in Post (WTE) – 2004/5 – 2006/7
Staff Group
Medical and Dental
Nursing and Midwifery
Allied Health Professional
Scientific, Professional and Technical
Administrative, Management and other support
Total
8.2.2
2004/5
365
1268
194
348
524
2710
Year (wte)
2005/6
393
1320
213
371
543
2856
2006/7
392
1302
204
354
529
2797
This table above describes the significant growth in workforce from 2004 as part of
the NHS plan investment and the recent reductions in workforce as part of the
Trust’s Service and Cost Improvement Plan.
Table 8B Workforce Performance – 2004/5 – 2006/7
KPI/Year (%)
2004/5
2005/6
Sickness (proportion of work
4.40
4.10
time lost)
Turnover (percentage of total
13.16
11.88
workforce leaving the Trust)
Vacancies (proportion of
7.27
5.04
established workforce)
Bank Locum and Agency
Not Available
8.10
(proportion of pay bill)
2006/7
.3.90
10.73
3.51
4.33
8.2.3
This table above highlights the sustained improvements in performance across the
Trust over the last three years, with reductions in sickness absence, turnover
vacancy rates and Bank and Agency.
8.3
Agency and Recruitment Arrangements
8.3.1
The Trust has an established vacancy review process, which places all recruitment
and bank and agency approvals through a rigorous management review before
approval. This involves reference to cost control and reduction plans, assessment of
clinical need, risks and the income/cost position.
8.3.2
The Trust has well established and effective arrangements with NHS Partners as the
primary supplier of temporary staffing – this covers the great majority of Medical and
Nursing demand. Other arrangements (for example for administrative staff) all
involve the use of Purchasing and Supplies Agency (PASA) listed organisations.
8.3.3
The Trust has achieved a significant and sustained reduction in expenditure on
Temporary Staffing. In the year 2006/7 this saw a full year reduction of 47%,
achieving a monthly spend in the last third of the year that was 63% lower than the
previous year.
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8.3.4
Activity patterns are regularly reviewed at Board level, Clinical Executive Board and
Operational Management Meetings.
8.3.5
The Trust has made extensive use of E Recruitment and achieved a 69% reduction
in expenditure on advertising media over the 2 years up to the end of 2006/7.
8.4
Recruitment Hotspots and Actions to Address
8.4.1
In general the recruitment position for the Trust is very positive. The Trust has
benefited from increases in supply of newly qualified staff and the effects of some
slow down in the labour market of the local health economy.
8.4.2
This is reflected in the significant improvements in the trusts vacancy position
described in Table 8B.
8.4.3
The Trusts workforce plan for 2007/2008 nevertheless highlights a small number of
hard to recruit areas:
Area
Haematologists
Community Paediatricians
Accident and Emergency
Advanced Practitioners (AHP)
Notes
Consultant recruitment a national
problem
Consultant recruitment a national
problem
Consultant recruitment a national
problem
Trust participating in Advanced
Practitioner Programme with SHA
Workforce Directorate
8.4.4
None of these issues will present critical barriers to the achievement of the Trust’s
objectives. The Trusts workforce-planning framework will focus on alleviating these
issues and maintaining the good position of the Trust.
8.5
Workforce and Organisational Development
Agenda for Change
8.5.1
The Trust has now fully assimilated all of its eligible staff to the Agenda for Change
pay framework. This has involved exceptional close working with staff side and
encouraged the development of sound working relationships which are now being
extended to other areas of the workforce agenda.
8.5.2
The Trust was not the earliest organisation to complete the assimilation exercise but
it’s thorough approach has resulted in a successful implementation with an very low
review appeal rate of 14%.
8.5.3
The focus of the Trust has now shifted to achievement of the benefits realisation
agenda and the experienced project resources have been retained by the Trust to
focus on workforce reform and modernisation.
European Working Time Directive (EWTD)
8.5.4
The Trust has made good progress with preparation for the EWTD. Monitoring
arrangements in the Trust are well established. The results of this monitoring are
regularly discussed at Clinical Executive Board and Operational Manager meetings.
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8.5.5
The Trust recently completed work with the SHA as part of the national review of
working towards EWTD compliance. This highlighted a number of areas for the Trust
to make progress on and these are now reflected in the Trust’s arrangements.
8.5.6
The Trusts current compliance runs at just under 40% of rotas with a further 55%
making very good progress. Action plans exist for the remaining areas of the Trust to
move forward. These are realisable in the timescale and resource as available.
Consultant Contract
8.5.7
Initial take up of the Consultant Contract was below average (55% in late 2005)
progress since that time has been significant. The Trust currently has 80% of the
consultant workforce on the new contract.
8.5.8
An established review group is functioning, with good representation from the LNC,
MSC and Management, under the chairmanship of the Medical Director. This has
recently strengthened arrangements for job plan reviews and local application of the
national terms.
8.5.9
Work is underway to review the PA position for the Trust and ensure progress is
made in maximising cost effective implementation of the framework. The Trust
current average PA position is VV against a comparable average of DD.
Relationship with the Unions
8.5.10 The Trust has well established and effective working relationships with recognised
unions and staff associations.
8.5.11 There is a fully functioning joint forum (Joint Staffs Council) and a fully functioning
Local Negotiating Committee (LNC) group.
8.5.12 Close working relationships around implementation of Agenda for Change have
already been highlighted. These have also been a strong feature of the Trust’s
arrangements for Improving Working Lives.
8.5.13 The Trust has worked very closely with staff side throughout 2006/7 in the
successful achievement of the Service and Cost Improvement Plan. This would not
have been as successful without the close working achieved, and, although at times
difficult for both parties, the process has further strengthened working relationships,
building on the good work in Agenda for Change and Improving Working Lives.
8.5.14 Staff engagement has also been strong, with continued staff involvement in the
Improving Working Lives arrangements post achievement of Practice Plus in Spring
2006 and in the service re-design work Courtyard have been facilitating.
Developing and Maintaining the HR Strategy
8.5.15 The Trust’s HR strategy has been developed with extensive input from Non
Executives, the Executives, staff side, staff in general, the HR function itself and
wider stakeholder groups.
8.5.16 The Trust’s HR strategy fully reflects the national HR strategy and recognises good
practice in people management. These national/external frameworks have been
refined and localised through the following routes:
•
review of the baseline position just described
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•
the development of the Trust’s Service Development Strategy and the
supporting workforce plan
•
the outcome of the 05/06 and 06/07 Staff Opinion Surveys and associated
action plans
•
the Improving Working Lives Practice Plus validation report and action plan from
05/06
•
Investors in People accreditation report from 2007
•
An extensive stakeholder engagement process
8.5.17 The stakeholder engagement process has involved a series of structured focus
groups during May and June 2007. The maintenance, development and review of
the strategy will involve an ongoing annual focus group approach.
8.5.18 The staff involvement and social partnership aspects of this are central to exploiting
the opportunities presented by Foundation Trust status.
8.5.19 An analysis of the outcome of the stakeholder engagement is summarised in the
table below:
Table 8C
8.5.20 In managerial terms, this process has highlighted the following priorities for the HR
strategy to achieve:
•
Support and drive the workforce cost improvement programme
•
Deliver a genuine workforce modernisation agenda that exploits the role
modernisation opportunities of national workforce reform. This requires effective
workforce development planning that underpins service modernisation
•
Further develop organisational capacity and capability in workforce management
and leadership skills
•
Drive the re-design of workforce processes, improving workforce management
practice and ensuring the provision of high quality HR processes
•
Further progress the implementation of the national workforce pay
modernisation on both Agenda for Change and the Consultant Contract, With a
particular focus on the benefits realisation agenda
•
Mainstream the post- implementation activity of national workforce reform,
especially in relation to pay modernisation
•
Develop the provision and application of workforce performance indicators,
underpinning the development of workforce productivity
•
Focus training and development activity on clear organisational priorities and
deliver high quality activity against those priorities
•
Ensure the progression of an integrated approach to workforce development
that will underpin the Trust’s ambition to achieve Associate University Hospital
status
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•
Maintain good progress in infrastructure around the Improving Working Lives
agenda
•
Develop modern approaches to staff engagement and partnership working
•
Achieve a high level of integration with other activities and processes in the
Trust
8.5.21 Appendix 4 includes the Trust HR Strategy that has been developed and designed
to comprehensively address the identified HR agenda from 2007 to 2012.
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9.
GOVERNANCE ARRANGEMENTS
9.1
How Stakeholder Interests will be Represented
Summary of Constituencies and Board Structure
9.1.1
The NHS Foundation Trust Governance Structure will comprise:
•
Board of Directors (subcommittees constituted under Standing Orders)
•
Board of Governors (to be known as Members’ Council) comprising: public
constituencies, staff constituency, stakeholders.
PUBLIC ELECTED
TENDRING
NON-EXECUTIVE
DIRECTORS
6
HALSTEAD &
COLNE
VALLEY
COLCHESTER
5
5
PREVIOUS
TRUST
EMPLOYEES
(Including Chairman)
EXECUTIVE
DIRECTORS:
•
•
•
•
Chief Executive
Finance Director
Medical Director
Nursing Director
4
BOARD
OF
DIRECTORS
MEMBERS’
COUNCIL
CHAIR
STAKEHOLDERS
1
2
1
PCT:
North East Essex PCT (or
its successor)
1
Essex County Council
Social Services
Department
1
Colchester Borough
Council
1
Tendring District
Council
Colchester Garrison
1
EXECUTIVE
DIRECTOR
Constitution includes
provision for one
additional Executive
Director
1
1
2
1
1
STAFF ELECTED
MEDICAL/
DENTAL
PRACTITIONER
NURSE/
MIDWIFE
ALLIED HEALTH
PROFESSIONAL/
HEALTHCARE
SCIENTISTS
SUPPORT
STAFF
Board of Directors
9.1.2
It is proposed that the Board of Directors be represented by 11 Members,
comprising:
•
The Chairman
•
5 Non-Executive Directors
•
5 Executive Directors:
− Chief Executive (accountable officer)
− Finance Director
− Registered Medical or Dental Practitioner
− Registered Nurse or Registered Midwife
− One Executive Director to be agreed and appointed by resolution of the
Board
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9.1.3
The Trust may confer on senior staff the title “Director” as an indication of their
corporate responsibility within the Trust but such persons will not be Directors of the
Trust for the purposes of the 2003 Act (“statutory directors”) unless their title is that
of “Executive Director” or “Non-Executive Director” and will not have the voting rights
of statutory director or any power to bind the Trust.
9.1.4
The Board Secretary will attend Board of Directors meetings. The Board Secretary
will be responsible for ensuring that board procedures are followed and that
applicable rules and regulations are complied with. The Board Secretary will advise
both the Board of Directors and the Members’ Council on developments in
governance issues and ensure that meetings of both committees are held in
accordance with the Trust’s constitution and that directors and governors receive
appropriate support and guidance.
Members’ Council
Description of Governors, Constituencies and Rationale
9.1.5
9.1.6
The Board of Governors as defined within the Health and Social Care (Community
Health and Standards) Act 2003 will be known as the Members’ Council. The
Chairman of the Members’ Council will also be the Chairman of the Board of
Directors of the NHS Foundation Trust. The Members’ Council will be a consultative
and advisory forum on behalf of the Foundation Trust’s Membership. It will have the
following responsibilities:
•
Advisory - Provide a steer on how the NHS Foundation Trust can carry out its
business in ways consistent with the needs of the members and the wider
community.
•
Guardianship - Act as guardians to ensure that the NHS Foundation Trust
operates in a way that fits with its statement of purpose and complies with its
authorisation.
•
Strategic – Consider and provide advice on behalf of the Membership on the
options provided by the Board of Directors on the long-term direction for the
NHS Foundation Trust, so that the Board of Directors can effectively determine
its policies.
The Members’ Council will consist of 23 members:
•
13 elected public members;
•
5 appointed stakeholders, and
•
5 elected staff members.
9.1.7
Formal consultation on the governance arrangements took place between 14th June
2007 and 6th September 2007, the outcome of which is given at Appendix 1. Full
details of the governance proposals and rationale are given at Appendix 8.
9.1.8
The Board is mindful of the Department of Health’s “Commissioning a Patient-Led
NHS” and the effects of this on the local economy. The Board will therefore keep
under review its proposals for the Members’ Council throughout its application
process.
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In terms of interaction with the Board, there will be opportunities for the Board to
delegate ad hoc project work to the Council by mutual consent. There are also plans
to have joint workshops on strategic planning and training.
Public Constituencies
9.1.10 There will be four areas for the public constituency. Three will be open to anyone
who normally resides within the defined local authority wards listed below, and the
fourth will cover the whole public constituency area but will be limited to previous
employees of the Trust. The constituency areas are defined as:
•
Colchester Borough Council area
•
Tendring District Council area
•
Braintree District Council area:
− Wards Included: Bradwell, Silver End and Rivenhall, Bumpstead, Coggeshall
and North Feering, Cressing and Stisted, Gosfield and Greenstead Green,
Halstead St Andrews, Halstead Trinity, Hedingham and Maplestead,
Kelvedon, Stour Valley North, Stour Valley South, The Three Colnes, Three
Fields, Upper Colne and Yeldham Wards.
− Wards Excluded: Black Notley and Terling, Bocking (North & South),
Braintree (Central, East & South), Great Notley and Braintree West, Hatfield
Peverel, Panfield, Rayne, Witham (Chipping Hill & Central, North, South and
West) Wards have been excluded to reflect that in the main, Essex Rivers
Healthcare NHS Trust, provides health care services to the rural community
northwest of Colchester.
•
All previous employees of the Trust who normally reside in the local authority
areas defined in the three council areas above.
9.1.11 No separate category of constituents has been identified for patients instead
membership of the public constituency will be open to any persons (subject to
membership exclusion rules) over the age of 16 living in the constituency areas
defined above. This reflects the Trust’s aspirations that all local residents should
have an equal opportunity to become involved in the local health service provision
and to promote strategic partnership working.
9.1.12 The category of previous Trust employees has been designated to offer the unique
opportunity to the Trust’s employees who have retired or resigned to give added
support and guidance to other governors in the complexity of the NHS business and
provide knowledge and valued input to the development of the Trust’s strategic
direction.
9.1.13 To reflect the diverse needs of the local population and in particular the socioeconomic differences of the geographical area, seats on the Members’ Council are
to be apportioned in line with the population. As a result, five governors will be
appointed from Tendring and Colchester areas, two from the Halstead and Colne
Valley area and one from the previous Trust employee constituencies.
9.1.14 Members can only belong to and therefore vote in one of the constituencies and
Governors will be required to undergo Criminal Records Bureau checks prior to their
formal appointment.
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9.1.15 It is important that governors know they are the eyes and ears of the community and
that they are prepared to consult within the constituency that elected them. They
need to know what the community is looking for from its health care provider and be
prepared to articulate the views of the members.
Staff Constituency
9.1.16 Class constituencies will nominate staff governors, via a formal electoral process. To
ensure wide representation, all staff governors will be expected to be representative
of the workforce as a whole rather than a specific professional group. Staff
membership will also be extended to people who have exercised functions for the
purposes of the NHS Foundation Trust but are not employees. Such individuals
would include volunteers, academic staff, nurses or doctors who are employed by a
recruitment agency as well as contracted out services for catering and facilities
management.
9.1.17 Constituency Sub-Divisions include:
•
Medical or Dental Practitioner (1)
•
Nurse/Midwife (2)
•
Allied Health Professional/Healthcare Scientists (1)
•
Support Staff (1)
9.1.18 The staff constituency will be left open and a mix of staff from all levels and
backgrounds will be encouraged to put themselves forward as governors.
9.1.19 The Trust will encourage all staff working on its premises to become members and
to promote this. The “opt-out” option for staff membership has been discounted. –
subject to confirmation at consultation stage. The Trust plans to recruit members
who are genuinely motivated and openly express the wish to become an active
participant. The inherent risk of low uptake in staff membership will be addressed
through improved internal communications via team briefing and other fora to
promote staff engagement in the Trust’s work.
The Trust’s organisational
development strategy referenced in Section 8, promotes empowerment and is
working towards strengthening leadership development with the aim of changing the
cultural environment of the organisation in order to meet the challenges of the NHS
Foundation Trust regime.
Stakeholders
9.1.20 One governor will be nominated from the main commissioner, North Essex Primary
Care Trust.
9.1.21 Subject to confirmation at the consultation stage the three local authority governors
will be selected by each of the following; Essex County Council Social Services,
Colchester Borough Council and Tendring District Council. The local authority
governor does not need to be elected to the board of governors nor do they need to
be an elected member of the local authority - for instance they could be a relevant
officer such as the Director of Social Services.
9.1.22 One governor will also be nominated from Colchester Garrison because this group
has specific health needs and the Trust would like to ensure they involve
representatives of this group.
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Summary of our Membership Strategy
9.1.23 To engage the local population in the activities of the Trust it will be important that
membership recruitment is embedded into the culture of the organisation and the
Communication Strategy will be updated to reflect this.
9.1.24 The membership goal will be to engage local residents and staff in the work of the
NHS Foundation Trust to enable it to achieve one of its principal objectives to deliver
high quality healthcare against locally agreed priorities.
9.1.25 In order to ensure that the Trust continues to promote the representative nature of
membership, the following actions are planned:
•
There will be no discrimination for membership on the grounds such as gender,
social background, race, political beliefs, age, disability or religion.
•
Ongoing work will take place with stakeholder groups, particularly PCT and
Local Authority Strategic Partnership Groups, to regularly promote membership
involvement.
•
The process for becoming a member will be provided in a simple, accessible
format and will be widely publicised.
•
Synergy between Patient Forums, members and the Members’ Council will be
included in the definition of the role of Member.
•
Based on the feedback from existing Foundation Trusts5 we will operate an optout system for staff meaning that they are automatically a member to reflect the
fact that employees are an integral part of the Trust and have an automatic
interest and stake in its activities and right to participate.
•
Trust communications will include membership application details.
•
Staff will be encouraged to promote the benefits of membership.
•
A Membership Register will be established and maintained and members will be
encouraged to participate in the Trust’s activities.
•
No limits are to be placed on the numbers of members, in the hope that
numbers will grow year-on-year.
9.1.26 The Trust will produce a Member’s pack of information following acceptance to
Membership and thereafter will receive the Trust’s member’s magazine. The
member’s pack will include:
5
•
Welcome letter
•
Member’s Magazine
•
Guide to the Trust
•
Details of how to become a Governor
New voices, new accountabilities published by the FTN
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•
Information on Trust events
•
Information on how to become more involved in supporting the hospital eg
volunteering and fundraising
9.1.27 In order to maximise Membership the Trust will engage in a proactive
communications by:
•
a media campaign which may include advertisements, advertorials, press
releases as well as and working with feature writers to produce more in-depth
coverage.
•
producing information leaflets for the general public, including membership
application forms, to be widely distributed throughout north-east Essex, including
our hospitals and other outlets, such as GP surgeries, community pharmacies,
dentists, opticians, community clinics, public libraries, civic buildings, Post
Offices, leisure centres, pubs, clubs.
•
leaflets specially tailored to the Trust’s own staff.
•
using the Trust’s monthly staff newsletter and the Chief Executive’s briefing and
to encourage staff to opt for membership.
•
using regular staff team briefing sessions to increase awareness among
potential staff members.
•
using the Trust’s websites to reach out to public and staff.
•
targeting organisations in “hard-to-reach groups”, such as people from ethnic
minorities, disabled people and mental health service users.
•
targeting universities, colleges, sixth-forms and the Essex Youth Parliament in
order to attract younger members.
•
placing articles and adverts in magazines produced by Colchester, Braintree
and Tendring Councils to ensure distribution to virtually all households in these
areas.
•
arranging talks to community groups in north east Essex such as Womens
Institute, Probus, Rotary, Inner Wheel, on membership.
•
encouraging employees to be “ambassadors” for NHS Foundation Trust
membership by encouraging their family and friends to join.
Empowerment within a Framework of Accountability and Managed Risk
9.1.28 The Trust has an organisational development programme, supported by the key
clinical services, human resources, finance and governance strategies of the Trust.
Section 8 provides specific details. The development of this programme has been
informed by a number of events with clinicians and managers, both inside the Trust
and across Essex. The outcomes of this programme will be to test the Trust’s
strategic objectives and to realign these to meet future demands. The real essence
of the organisational development programme is to ensure there are no significant
gaps, conflicts or overlaps in the organisation’s environment that will impair its ability
to meet its long-term plans. As an NHS Foundation Trust there will be an added
benefit of including the views of Governors in the ongoing planning of the Trust.
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Corporate Governance and Management
Overview of Trust’s Current Committee Structure: Assurance Framework
9.2.1
The Trust Board’s current committee structure for its assurance framework is given
below.
This is being reviewed in the light of revised plans to move to a fully
integrated governance structure by April 2008. The Trust’s integrated governance
plan is given at Appendix 7.
TRUST BOARD: ASSURANCE COMMITTEE STRUCTURE
TRUST BOARD
Charitable
Funds
Committee
Remuneration &
Terms of
Service
Committee
Finance
Committee
Clinical
Governance
Committee
Risk
Management
Committee
Divisional/Service
Area Risk/
Governance Groups
Key Objectives:
To monitor and implement
action to reduce all clinical,
organisational, financial and
health and safety risks and
to improve quality assurance
within Directorates
Mandatory Compliance
Committees
North-East Essex Medicines
Management
Transfusion
Control of Infection*
Radiation Safety
Health & Safety
Environmental Monitoring
*Reports quarterly to Clinical
Governance Committee.
Exception reporting on above
direct to Trust Board
INDEPENDENT
ASSURANCE
OPERATIONAL
STRUCTURE
Clinical
Executive
Board
Audit
Committee
Patient &
Public
Involvement
Revenue
Resource
Committee
Committee
Effectiveness/Good
Practice Committees
External Monitoring/
Benchmarking Bodies
Resuscitation
Clinical Audit
Mortality Audit
Product Review Group
Research & Development
Policy/Procedures Review Group
Essence of Care
Quality Information for Patients
Group
Complaints & Litigation
Clinical Ethics
Education & Training
Disability
Information Governance
Healthcare Commission
NHSLA Risk Management
NICE Guidance
Nat. Service Frameworks
Prof. Accreditation Bodies
Independent Reviews
Health & Safety Executive
Internal Audit
External Audit
CEMACH/NCEPOD
Clean Hospitals Programme
Capital
Planning
Group
Operational
Management
Group
Divisions
Services/
Departments
INTERFACE
Approved by Trust Board: 14 February 2007
9.2.2
The formal subcommittees of the Trust Board as at April 2007 are:
•
Audit Committee - provides an independent review of the internal control
environment within the Trust in order to provide the Board with assurance on
compliance with relevant regulatory, legal and code of conduct requirements. It
independently assures the Trust Board on the adequacy of its risk management
systems and processes. This committee meets no less than 4 times per annum.
•
Remuneration and Terms of Service Committee - responsible for the
appointment and/or dismissal of all Executive Directors and other senior
managers, as well as the approval of their remuneration and terms of service
and the monitoring of their performance. Meetings held as necessary, but at
least twice per annum.
•
In moving forward to NHS Foundation Trust status, the Trust proposes to extend
the Terms of Reference of its Remuneration and Terms of Service Committee to
include nomination role as defined within Monitor’s draft Code of Conduct.
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•
Clinical Governance Committee – oversees the organisation’s systems and
processes for monitoring and improving the quality of services and the patient’s
experience of those services. It is also responsible for the Trust’s risk
management strategy and the monitoring of Standards for Better Health.
Meetings held not less than 3 times per annum.
•
Charitable Funds Committee - to adhere to the principles and responsibilities
of trusteeship as defined by the Charity Commission and to review policies and
procedures for fundraising, acceptance and expenditure, including the internal
control arrangements operating within the Trust for charitable funds.
•
Finance Committee - oversees the financial performance of the Trust and
advises the Trust Board of any risks or potential conflicts.
9.2.3
The Chairman of each Committee reports to the Trust Board on the business
conducted at the sub-committee meeting. Full copies of the Minutes are submitted
to Public Board meetings. The Terms of Reference, membership and regular
reports which are provided to each subcommittee are given at Appendix 7.
9.2.4
Advisory committees to the Trust Board include:
•
Clinical Executive Board – The Clinical Executive Board (CEB) is tasked with
supporting clinical areas to focus on effective delivery and operational issues of
the organisation. In particular, the CEB’s purpose is to:
− Create and monitor the clinical service improvement strategy for the Trust.
− “Localise” the national patient-led programme.
− Ensure activities and investment are targeted to the agreed priorities
•
There are clear communication links between the Clinical Executive Board and
the Trust’s Clinical Programme Groups. The operational interface of these
groups is given in more detail in section 8.1.
•
Revenue Resource Committee – The Revenue Resource Committee (RRC)
reports to the CEB and has the following responsibilities:
− establish the total resources available to the Trust
− consider the financial and service agreement risks facing the Trust
− consider the need to establish reserves
− consider bids for service developments and cost pressures from Divisions
against agreed criteria
− manage dis-investment
− performance manage the delivery of the CRES programme
− liaise with the Capital Planning Group on areas of joint interest
− report to CEB with recommendations for approval.
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Governance Checklist and Rationale
9.2.5
Following public consultation in 2007 on the Trust’s NHS Foundation Trust
application, the governance arrangements of the Trust will be updated to reflect
comments received. Appendix 8 gives full details of the proposed governance
arrangements for the NHS Foundation Trust.
9.3
Risk Management and CNST
9.3.1
A summary of how risks are managed throughout the organisation is provided in
section 7 of this business plan.
9.3.2
Along with Standards for Better Health, the NHSLA Risk Management Standards
(April 2007) is a major set of standards that the Trust has to meet. Several of these
standards are common to both the Risk Management Standards and Standards for
Better Health. The Trust has designed evidence gathering systems to reduce
duplication and demonstrate compliance with both sets of standards, where
appropriate. This integrated audit approach continues to be developed within the
Trust.
9.3.3
The Trust participated in the NHSLA Pilot of the new Risk Management Standards in
December 2006. The Trust remains compliant with Level 2 CNST.
9.3.4
Maternity Services applied for and achieved compliance with the NHSLA Clinical
Negligence Scheme for Trusts (CNST) Level 2 in January 2006.
9.3.5
An Accreditation Working Group has taken over the role of the CNST Steering
Group, and comprises of representatives from all areas (clinical and non-clinical)
within the Trust; including representation from the local PCT. The focus of this group
is to ensure that the systems and processes identified within the Trust’s Risk
Management Strategy and Clinical Governance Strategy are followed.
9.4
Performance Management Reporting Framework
9.4.1
The Trust Board currently receives the following routine performance reports at its
bi-monthly Public Meetings:
•
Finance
•
Activity
•
Workforce Report
•
Risk
9.4.2
Quarterly reports from all sub-committees of the Trust Board are received. The
routine reports considered by each sub-committee are detailed in Appendix 7.
9.4.3
A computer aided management system (Dr. Foster Limited product) is used by the
Trust to score and document manage compliance with Standards for Better
Healthcare targets.
Progress against key targets and balanced scorecard
performance indicators are reported to the Board on a monthly basis.
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9.5
Financial Controls and Reporting
9.5.1
The main financial control committees of the organisation are the Revenue Resource
Committee and the Capital Planning Group. The Audit Committee oversees
financial probity on an independent basis. The accountability structure is given at
paragraph 9.2.1. The Terms of Reference, membership and reporting is given at
Appendix
9.6
Audit
Internal Audit
9.6.1
The Trust’s internal audit function is provided by Deloitte & Touche LLP, under a
local health economy contract.
9.6.2
No significant control weaknesses were identified by the Head of Internal Audit in his
opinion at 31 March 2005. However, non-material weaknesses were identified in
relation to the design and consistency of application of controls and the Trust is
responding to the recommendations made by Internal Audit.
9.6.3
No adverse internal audit reports have been issued to the Trust.
External Audit
9.6.4
The Trust’s external auditors are PricewaterhouseCoopers LLP. Unqualified audit
opinions have been issued for the periods ended 31 March 2004 and 31 March
2005.
9.6.5
Significant issues identified in the external audit management letter in 2003/04 are
as follows:
9.6.6
•
Culture for Change – The Board should take the lead in changing the Trust
culture to ensure that operational, financial and strategic improvements are
realised.
•
Performance Improvement – Clarity of strategic direction, leadership and coordination of management effort, both within the Trust and in dealing with the
Trust’s partners, is needed to move the Trust from a reactive to proactive
approach to performance management in the longer-term.
•
Assurance Framework – The established assurance framework needs to be
further embedded throughout the Trust.
•
Planning & Priorities Framework Targets – The Trust should continue to develop
capacity plans and review patient flow and management in order to relieve the
pressure on access targets.
No material weaknesses were identified in the 2004/05 management letter, however
areas to address were identified as follows:
•
Agenda for Change – The Trust Board should continue to monitor both the
progress made in moving staff to the new pay scales and the impact of this on
the Trust’s short term and long-term pay budgets.
•
Financial Standing – In response to ongoing concerns around financial recovery,
the Trust should agree an appropriate recovery period with the SHA and
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consider the implications for its break-even duty if a period longer than the
original five years was agreed.
•
Performance Management Arrangements – The Trust needs to develop its
performance management framework and embed this throughout the
organisation.
9.6.7
Full details of the Audit Committee membership, Terms of Reference, frequency and
sources of information provided at each committee are given at Appendix 7.
9.7
Compliance Framework
9.7.1
The Trust will update its systems and processes and begin to trial these in 2006 in
order to meet Monitor’s requirements.
Compliance with Monitoring Regime
9.7.2
Details of how the Trust will comply with the monitoring regime will be outlined in the
final submission.
Financial Risk Rating for Year 1 of Projected Period
9.7.3
Commentary on the financial risk rating for year 1 of projected period will be added
to the final submission.
9.8
IT Systems
9.8.1
The Trust welcomes the objectives of the National Programme for Information
Technology (NPfIT) in its bid to provide patients and clinicians within the NHS with
modern and effective systems to underpin service modernisation. The Trust has had
a change of Local Service Provider (LSP). Accenture continue to provide PACS
support. The Trust is now embarking on a relationship with CSC, the new LSP, to
understand the delivery and implementation timescales for NPfIT.
9.8.2
The Trust has implemented a new interface engine, which will allow for existing
modular systems to link to the NHS Spine to share demographic information. This
interface engine is used to publish outpatient clinic slots as part of the Choose and
Book Programme. The Trust has fully implemented Choose and Book, recently
upgrading to version 2.
9.8.3
The introduction of a Picture Archiving Communication System (PACS) during 2006
reduced the turnaround times for images and reports from Radiology. This has had
an impact upon achievement of healthcare targets such as cancer waits, 18-week
targets from referral to treatment, four-hour waiting in A&E Department, diagnostic
services and reduced working hours for junior doctors. With the introduction of a
highly secure broadband remote access capability, radiology images can now be
viewed on the move, especially useful for those providing on call cover.
9.8.4
The Trust has a contract with McKesson for the provision of a Patient Administration
System (PAS) until the end of 2010/11 as part of the NPfIT existing systems
arrangements. The Trust is implementing upgrades to the PAS as follows:
•
Bed Webstation—changing the way bed management happens
•
A&E Webstation—real time information capture
•
Theatre Webstation—improving the information flow in Theatres
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•
Casenote Manager—improved health records tracking
•
PAS Word Letters—integrate PAS with Microsoft Word
•
Electronic Discharge Communications—improved patient care
The Trust is also implementing other upgrades to systems as follows:
•
Datix Complaints, Risk Management and Incident Reporting
•
Replacement of Pharmacy System with an NPfIT Approved System
•
Order Communications for Pathology
•
Infection Control
•
ARDEO Cancer System eMDT
•
Electronic Staff Record National System
9.8.6
Increasing use of applications requires improved access to PCs and the Trust is
working to increase the number of PCs available for use across the Trust, working
with all areas to understand space restrictions and priorities.
9.8.7
The Trust is upgrading the computer network. The project will deliver an updated
network with better performance, higher resilience and the capacity to deliver
modern capabilities expected such as streaming sound, video, the ability to move
towards wireless and converging the voice and data networks.
9.8.8
The Trust is upgrading the server rooms – both in terms of the technology being
used as well as upgrading a communications room to a server room. With the new
high speed network fibres being laid, this will provide a dual server room setup with
server and disk capacity in each server room, synchronised so that a failure in one
server room is less likely to affect the Trust as business continuity will be provided
from the second server room. Individual elements of this project include:
9.8.9
The Trust is also undertaking considerable work in the telecommunications area the
following projects are under way:
•
New telephony switch in by end of Q2 2007/8.
•
Project to converge voice with data, Microsoft Communications Server and
unified messaging capability.
•
Switch to T-Mobile for mobile telephony to reduce costs.
•
Broadband Remote Access solution delivered and widely used.
9.8.10 The Trust is also considering further projects to improve efficiency:
•
Trust wide Digital Dictation project.
•
Trust wide Electronic Rostering.
•
Document Imaging (Health Records and across Trust).
•
Ward Handover (module to assist with notes for shift changes).
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•
Post Coding software to improve data quality.
•
Finance replacement.
•
PACS version 2.
•
Medicode to assist with medical coding.
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9.8.11 With all the above projects, the Trust will ensure that staff have the appropriate
training to be able to make best use of systems as they become available.
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LIST OF APPENDICES AVAILABLE SEPARATELY FROM THE TRUST WEBSITE
APPENDIX 1 – Results of Consultation when complete in Sept 2007
APPENDIX 2 – Service SWOT Analysis
APPENDIX 3 – Long Term Financial Model
APPENDIX 4 – Human Resources Strategy 2007 to 2012
APPENDIX 5 – Estates Strategy
APPENDIX 6 – Trust Board Pen Portraits
APPENDIX 7 – Trust Board and Sub-Committee details and Terms of Reference
APPENDIX 8 – Governance Rationale
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