Gateshead Health NHS Foundation Trust
OPERATIONAL PLAN 2015/16
(Summary for publication)
1.0 Introduction
In producing this Operational Plan for 2015/16, Gateshead Health NHS Foundation Trust has
reviewed its progress against its 2014/15 Plan and has revisited the strategic context to
highlight any significant changes with the potential to impact in 2015/16, year two of the
Trust’s five year forward plan and beyond.
In this document we describe the outcome of this analysis and set out our plans to address
the challenges and opportunities presented over the next twelve months.
We build on work undertaken last year and also take account of guidance contained in the
following Monitor publications and planning documentation:
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•
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Monitor guidance on the 2015/16 annual planning review for NHS;
The Forward View into Action: Planning for 2015/16; and
NHS Risk Assessment and Outcomes Frameworks
1.1 Our services
The Trust service portfolio is wide-ranging and includes those services associated with a
district general hospital. Services are provided principally from the Queen Elizabeth
Hospital, although we provide many services offsite at secondary care outpatient facilities
including QE Metro Riverside, Blaydon Primary Care Centre, Bensham Hospital; in GP
surgeries and in patients’ homes. Clinics also operate at other primary care settings across
Gateshead as well as beyond the Gateshead boundary in Washington and South Tyneside. In
addition to its DGH portfolio, The Trust provides a comprehensive older persons’ mental
health service. It is a tertiary centre for gynaecology oncology and it is also a provider of
specialist screening services, for breast, bowel and aortic aneurism. The screening services
are offered to a wider range of populations including South of Tyne, Northumberland and
Humberside, Cumbria and Lancashire.
1.2 Strategic context
1.1.2 Vision and themes
The Trust strategic themes were developed in 2014 upon a detailed analysis of external and
internal factors likely to impact upon service delivery and sustainability for the following 5
year period. These are set out in Figure 1 below. We have reviewed the work undertaken
to arrive at these themes and are of the view that they continue to provide a sound basis
upon which we can deliver our objectives and plans for 2015/16. We have sought feedback
from our local CCG, other partners on the Health and Wellbeing Board and local Systems
Resilience Group, to seek assurance that they align with the local health and social care
economy plans.
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Fig 1: Strategic themes
2.1.2 Review of environmental context- has anything changed?
The outcome of the Trust’s planning review of the strategic context and environmental
factors has confirmed that the former NHS ‘Call to Action’ challenges as set out in our
strategic plan 2014 remain current:
 Demography:
o
Ageing population - projections remain true for a stepped increase both in those
aged over 65 years and significantly those aged 85 years and over, the section of
the population with the greatest care needs. Gateshead population has a higher
percentage of older people than the national average with 21% of people above
state pensionable age compared with 19% nationally and 20% in the North East
of England as a whole. The impact of an aging population is reinforced during
winter months with the number of older patients admitted and an extended
length of stay for this age group. This is reflected in activity and the measures
required to ‘escalate’ service capacity to cope with the surge in demand (Figure
2);
o
Poor health status - people in Gateshead continue to suffer more illness and
early death than the national average and there are still marked variances in life
expectancy and ill-health across the Borough (variance in life expectancy is 8.9
years for men and 9.4 for women across local authority wards);
o
More than a quarter of Gateshead’s population has a long term condition (LTC) a
significant number of whom have three or more LTCs;
o
Deprivation and lifestyle choices continue to impact significantly upon health
and demand upon health services.
Source: Gateshead Strategic plan 2014/15-2018/19 and Gateshead Joint Strategic Needs
Assessment-Interim Report 2014).
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Fig 2: Managing winter

Austerity
The overall context of austerity and financial challenge facing our local health economy and
the NHS nationally remains and continues to impact upon provision across all care sectors
and interdependencies with high levels of demand increasing year on year, exacerbated by
an aging population with complex needs.
The most significant issue facing the Trust in the next twelve months is to ensure in-year
operational and financial resilience and sustainability, as we enter the most financially
challenging period of our time as a foundation trust.
A comprehensive, staged approach is being put into place towards ensuring financial
viability and sustainability going forward. This incorporates robust cost control by all clinical
and non-clinical services; service redesign to modernise and streamline internally and across
organisational boundaries; increasing and expanding the Trust’s portfolio of services, and
working with local health and social care partners to look at new configurations of service in
Gateshead and across the geographical area. The Trust will require sustained support and
engagement from its key partners to enable timely implementation and achievement of
this approach.
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Fig 3: Ensuring future financial viability and sustainability: GHNFT staged approach
External
Internal
CRP/Efficiency
Contractual
Business
Opportunities
System
Redesign
System
Reform
Tactical

Systemic
Activity and demand
Pressure continues to be experienced within our services, and there is no evidence that
activity is reducing. This is manifest in:
o High bed occupancy since quarter 2, 2013/14 rising towards 95% compared with best
practice of 85%, which consequentially impacts upon bed availability for emergency
admissions;
o Increasing non-elective admissions year on year (figure 4);
o Increased use of A&E services with subsequent pressure upon the four hour access
target (figure 5);
o Consequential pressure upon capacity for planned care with the potential to impact on
patient access, planned surgery and increased pressure upon achievement of access
targets.
In developing our plans we have sought to understand the drivers of local issues and
pressures more fully. Our intelligence would suggest that our services are experiencing
both increased demand and worsening levels of patient acuity together with a range of
other influencing factors that include:
 The local situation reflects national trends of increasing demand for urgent care services
(Figures 4 and 5)
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Fig 4: Increasing emergency admissions
Fig 5: A&E Growth
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Fig 6 Population estimates/projected admissions
Non Elective Admissions
Elective Admissions
Daycase Admissions
10000
15000
10000
5000
0
5000
0
Population Estimates
Population 85+
2001
2003
2005
2007
2009
2011
2013
2015
2017
2019
2021
2023
2025
2027
2029
2031
2033
2035
2037
Admissions/Projected Admissions
Gateshead Population Estimates and Projected Admissions to
2037 for ages 85+
Year
o An increase in admissions associated with an ageing population who have greater
care needs
o National policy requirements on improving efficencies and productivity in acute care
have resulted in a manged reduction of beds over time whilst, to date there is
currently a lack of viable alternatives to hospital admission with transformational
care models being slow to impact;
o The Trust is working with commissioners on a range of processes to address this,
include implementation of the Better Care Fund initiatives and the Vanguard
initiative in primary care. Transformation of community services will also lead to
better integrated services and care closer to home. It is essential that the pace and
impact of these initiatives is monitored and assessed;
o Impact of austerity on the wider health and social care system imposes constraints
upon local services that would otherwise enable effective patient flow in and out of
hospital, and provide intermediate care and reablement to help avoid emergency readmission;
o Impact of the latter on timely discharge reflected in increased length of stay for the
frail elderly;
o Inappropriate use of hospital/A&E services potentially linked to public awareness
and behaviours and some access issues in primary care.
These issues will be compounded given poor health status/deprivation in some parts of the
Borough and pressure within the health and social care system as a whole.
2.1.3 Achievements and ongoing improvement
Within the context described above the Trust has seen completion to plan of significant
developments to improve services for Gateshead residents. These included:

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New Emergency Care Centre (ECC) which opened to plan in February of this year
providing one front entrance for all medical, surgical and paediatric emergencies, short
stay, frailty assessment, integrated back-of-house services and walk-in services. This


represents a significant improvement in services for the local population supported by
state of the art technology and designed using lean principles;
Pathology Centre of Excellence: re-configuration of pathology services for South of Tyne
and relocation onto the QEH site was completed alongside the opening of the Trust’s
£12m Pathology Centre of Excellence. The new hub is enhancing diagnostic and
screening services for the local population and presents significant growth and market
development potential for the Trust;
Establishment of QE Facilities (QEF) a wholly-owned subsidiary of the Trust that creates
an exciting framework in 2015/16 and beyond to further develop Trust service support
functions whilst achieving efficiencies and income generation.
In addition, the Trust continues to demonstrate its commitment to and reputation in,
providing high quality services. This is core to its values and has been repeatedly recognised
by the Care Quality Commission (CQC) with its rating of Band 6 for quality and safety.
2.1.5 Transformational care models
Service redesign and transformation and the delivery of new service models remain high on
the Trust agenda, in line with national policy. Two significant ongoing issues include the
redesign of musculoskeletal pathways (MSK) working in partnership with Gateshead CCG
and existing providers, and transforming community-based services. The Trust is engaged in
work with the local GP federation (CBC), local authority and other providers, on the latter,
to develop an innovative approach to local service delivery.
Cross-boundary collaboration on service transformation and delivery will form an essential
element of the strategy for delivery of good affordable health and social care into the
future.
2.1.6 Better Care Fund
As referenced above, progress is being made to implement and recruit staff to support plans
established during 2014/15 and this work will continue in collaboration with our
commissioners. However, the potential to reduce pressure upon Trust services in real terms
remains to be tested, given the overall pace of demand for hospital services from the ageing
population. This has been the subject of detailed dialogue with commissioners as part of the
2015/16 contracting round and will be closely monitored throughout the year.
3.0 Delivering the strategy
3.1 Our plans for 2015/16
Our strategic themes and corporate objectives are aligned to national policy and planning
guidance. As referenced in section 1.0 of this document. They will ensure that we continue
to meet the Terms of our NHS Provider Licence and the Public and patients’ rights under the
NHS Constitution. They take account of our commissioners’ and Local Health Economy
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priorities and reflect our knowledge and understanding of the local context with regard to
need, preferences and patient flow.
A summary of our objectives for 2015/15 is contained in the table below. These are mapped
to our strategic priorities and are supported by detailed service-level plans and measureable
milestones. Achievement will be closely monitored throughout the year.
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Strategic theme
1.0 Patient-centred,
co-ordinated care
2.0 Ensuring clinical
and
financial sustainability
3.0 Integration and
Innovation
Objectives for 2015-16
We will deliver services that are clinically evidenced and that represent best practice and parity of esteem.
We will ensure all services provided comply with the CQC standards of quality and safety and that CQC registration is
maintained
We will achieve all national compliance and local clinical quality performance targets (including CQUIN)
We will ensure services are safe, clinically effective and provide excellent patient experience
We will deliver a programme of service transformation to provide clinical pathways that are “joined up” and provide a
high quality experience for patients
We will underpin the delivery of high quality care with a programme to ensure all staff, both clinical and non-clinical
are aware of our strategic vision and understand how their work supports delivery of high quality care
We will develop financial recovery plans during 2015-16 to minimise the planned in-year operational deficit and
scope the extent of the opportunities over the medium and longer term to determine whether the trust can become
financially resilient and sustainable in its current form (section 2.1 and financial commentary)
We will deliver services that are clinically sustainable through:
 Ensuring critical mass to sustain quality of clinical expertise
 Workforce planning built on rigorous capacity and demand plans for all services
 Engaging in strong clinical networks and building alliances to underpin local services
We will ensure operational resilience during 2015-16 and beyond
We will commit to continuous service improvement to ensure that the services we provide are effective and efficient
We will explore further opportunities for service and structural integration in line with the strategic service review.
We will seek to provide community health and elements of social care to Gateshead residents
We will work in collaboration with other agencies to develop new and innovative service models of care that deliver
integrated health and social care to Gateshead residents within the financial envelope available
We will develop a range of business partnerships and alliances across service sectors to provide an innovative range
of services to our catchment populations.
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Strategic theme
4.0 Provider of choice
5.0 Expanding our
portfolio
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Objectives for 2015-16
We will undertake a further review of the Estates Strategy to reflect the current context as described in the 2015/16
plan.
We will be the provider of choice to patients and commissioners for a portfolio of commercially viable services
We will develop our portfolio through new service models and new markets that are:
 Commercially viable
 Clinically sustainable
 In line with our core values
 Build upon areas of expertise and reputation
3.2 Key elements of our plans
3.2.1 Operational and financial resilience
Within the current strategic and financial context and, given the size and nature of the
services (largely acute) that GHNT FT delivers, ensuring operational and financial resilience
and future sustainability is a necessity and will be a focus of plans for the next twelve
months and into the longer term. This is especially important given the increasing pressures
being placed upon services, experiences of demand in previous months and also the new
rules for funding capacity to manage winter surge. Work includes:

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A comprehensive non–elective improvement programme involving:
o Improving pathways for care of the frail elderly; discharge planning;
o Assessment and management of patient flow through emergency services;
o Supporting functions (pharmacy; discharge lounge), and
o Improving hospital discharge;
Robust analysis of the capacity required to meet demand now and in the future,
including bed review;
Programme of productivity improvement and delivery of efficiency plans
Pro-active workforce planning: innovative solutions to building capacity (see workforce
section)
Continued cross-system working through the Local System Resilience Group, redesign of
urgent care pathways and supporting redesign of alternatives to hospital care.
3.2.2 Reduction variation and seven day working
The Trust has undertaken a comprehensive base–line assessment across all of its services
and has identified the following five standards to progress in 2015/16:
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•
•
•
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Standard 1:
Standard 2:
Standard 4:
Standard 9:
Standard 10:
Patient experience;
Time to first consultant review
Shift handovers
Transfer to community, primary and social care
Quality Improvement.
Lead clinicians have been closely involved in arriving at these priorities
3.2.3 Transformation, integration and community services
Our plans continue to prioritise service transformation, working in collaboration with
partner agencies across the local health economy to deliver service models that will provide
right place; right time care, as close to home as possible, meaning that patients will come to
hospital only when they need to. Priorities that are all reflected in this year’s commissioning
intentions include:
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
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

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Urgent and ambulatory care services;
Pathway for care of the frail elderly;
End of life care pathway;
Care for people with long term conditions (respiratory, heart failure and TIA);
Transfer of other specific services to primary care
Work will also continue on transformation of musculoskeletal pathways and the
transformation of community services.
Accelerating the transformation agenda is key to effectively managing service capacity and
ensuring best value from resources whilst enhancing outcomes for patients. The Trust will
also collaborate with Gateshead Newcastle CCG Alliance, in implementing its successful bid
for Vanguard status that will build upon the Gateshead Care Home Initiative, developing
intermediate and community care services that will support frail people with complex needs
in the community. In addition Gateshead Community Based Care (CBC) has been successful
in a bid under the Prime Minister’s Challenge Fund to explore capacity expansion in primary
care. Both of these initiatives should have bearing on plans to address need and better
manage demand within the LHE.
3.2.4 Planned growth and market development
In keeping with our strategic theme to expand our portfolio, and to promote ourselves as
the provider of choice, our 2015/16 plans incorporate reference to growth in some services
both planned and non-elective. Realistic targets have been set based upon:



Patterns of flow from neighbouring areas over the Gateshead boundary;
Demand created by limited capacity in neighbouring providers to meet their
population’s needs;
Reputation for specific expertise and clinical leadership and where there is potential for
market growth,
Where services plans incorporate people living beyond the Gateshead Boundary, the Trust
provides assurance that this will not be to the detriment of Gateshead residents and that
any benefit derived, will serve to improve the provision and sustainability of local service.
3.3 Quality, safety and performance
3.3.1 Quality priorities
Our plans, identify our intention to sustain services of quality that are consistent with our
reputation, with an integrated approach to ensuring high clinical standards and
sustainability, workforce, the patient and staff environment and information
communications and IM&T infrastructure. This is reflected in our corporate priorities
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previously described. Our new SafeCare Strategy 2014/17 aims to deliver a programme of
work that will reduce harm and avoidable mortality, improve our patients’ experience and
make the care we give to our patients reliable and grounded in the foundations of evidence
based care. We have set six key priorities for quality improvement for 2015/16 and these
are linked to patient safety, effectiveness of care and patient experience (see table).
1
2
Priority
Reducing avoidable hospital deaths,
including recognition and management
of Sepsis.
Implementing the ‘Saving Babies Lives’
Campaign.
3
Continue to reduce harmful in-hospital
falls.
4
Medication safety.
5
Patient and family Involvement in
Improving patient safety- ‘ThinkSafe’
project
End of Life Care-Family Voices’ project
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Description
Continued implementation of our 3 year mortality
reduction strategy encompassing leadership; Clinical care
and documentation and informatics.
We will Implement the NHS England care bundle initiative
and to run alongside the Royal College of Obstetricians &
Gynaecologists (RCOG) ‘Each Baby Counts’ project to
reduce the number of stillbirths, early neonatal deaths and
brain injuries in the UK, as a result of incidents occurring
during labour.
To continue the extensive work already undertaken in
reducing harm from falls within the Trust in order to make
further improvements. This work is overseen by the Falls
Strategy Group. We aim to develop integrated work with
primary care and commissioners alongside the wider frailty
agenda.
Continue to improve medication safety by increasing the
usage of Patients Own Drugs within the hospital.
Implementing the ‘ThinkSafe’ project is a user-informed,
robust approach to supporting patient/family involvement
in improving in-patient safety.
A ‘family’s voice’ diary, to help at this crucial and sensitive
time, is being tested through a research project. This is an
innovative tool for the acute hospital setting to promote
communication between families and clinical staff (in realtime) by the dying patient’s bedside. It can contribute to a
“good death” for patients through the engagement of their
family and carers. It also provides an ongoing continuous
evaluation of the quality of care as experienced by family
and carers of dying patients.
We will also continue to build upon work undertaken in 2014/15 on Improving the care of
patients living with a diagnosis of Dementia and creating a Dementia friendly hospital, and
continuing to implement our Patient and Carer Involvement and Experience Strategy.
3.3.2 Commissioning for Quality
The Trust has developed a CQUIN scheme for 2015/16, in partnership with our
commissioner. The indicators are given below. Each one is overseen and monitored by a
designated lead:
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1. Acute Kidney Injury
2. Sepsis Screening
3. Sepsis Antibiotic Administration
4. Dementia and Delirium – Find, Assess, Investigate, Refer and Inform (FAIRI)
5. Dementia and Delirium – Staff Training
6. Dementia and Delirium – Supporting Carers
7. Improving Diagnoses of Patients with mental health needs at A&E
8. Reduction in A&E MH Re-attendances
9. Patient Experience
10. Outpatient Communications
11. Collaborative Discharge
12. Communications of Results
13. A&E Discharge Summary
14. Radiology Reporting Times
15. Cancer Treatment Summary
16. Medicines Optimisation
3.3.3 Performance
At the end of 2014/15, despite in-year pressures in specific areas reflecting increased
demand within the system as a whole and unprecedented demand across winter months,
the Trust was able to achieve a total service score of 2 and was able to report a green
governance rating for performance.
Going forward, the Trust is not complacent about the challenges faced and ensuring delivery
of performance and access targets within the current context forms a central part of plans
for operational resilience as described. The Trust has been pro-active in establishing a
framework to underpin performance compliance and sustainability of access to all services.
4.0 Financial sustainability summary
The draft financial plan for 2015/16 is a deficit of £9.9m, based on delivering cost
efficiencies of £6.5m and the need for interim financial support. As such this presents a
challenging financial outlook, both short term in relation to resilience and longer term in
relation to sustainability and accordingly the Board has taken measures to minimise the
impact of this.
The Board has authorised the strengthening of the internal PMO and has appointed external
support to deliver on and generate further efficiency plans for 2015/16 and 2016/17.
Clinical service and structural realignment will be explored to underpin the future viability
and sustainability of services and to this effect the Board is scoping options for discussion
with health economy partners.
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5.0 Underpinning strategies
5.1 Workforce
The Trust will continue to develop and re-profile its workforce in support of the strategic
objectives and the national agenda. An early objective is development of the Workforce
Strategy. The overall aim is always to ensure a workforce with skills and experience to
deliver our high standards of care however our key focus must include sustainability (clinical
and financial) and setting clear objectives around productivity and resources as well as
quality.
Corporate departments and clinical business unit service plans will be further developed
building upon robust capacity and demand analysis to enable both safe and sustainable
services going forward , whilst at the same time delivering efficiency and ensuring optimum
value from resources.
Important issues for 2015/16 include:
•
•
•
•
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Operational resilience: focused and pro–active planning and targeted recruitment for
nurses and other key clinical staff, informed by capacity and demand analysis will ensure
staffing levels in patient areas are safe and in line with national guidelines and our
standards for high quality care;
Strategic shift in activity from acute to community settings arising from transformation
and our development plans will require effective change management, to deliver new
integrated models of care, the introduction of and recruitment to new roles and new
ways of working;
Changing service and practice as a result of the development of 7 Day Services and
Implementing the Trust chosen five Keogh clinical standards;
Ensuring capacity to sustain patient access and to deliver on planned growth targets,
strengthening workforce planning and ensuring capacity to sustain;
Managing attendance and developing the Health & Wellbeing Agenda to support early
return to work and sustained “wellness at work”.
5.2 Capital, The Estate and Patient Environment
The Trust continues to invest in its facilities and equipment to ensure a safe, high quality
environment for patients, visitors and staff. Given the extensive major build and
environmental improvements delivered to plan in the previous twelve months, as well as
the current financial context, investment in 2015/15 will focus upon the following:
•
•
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Essential infrastructure, including IT systems improvement and development necessary
to underpin service delivery and management;
Replacement and investment in medical equipment;
•
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Buildings and engineering backlog maintenance aligned to the strategic direction of the
Trust and to support cash releasing revenue opportunities.