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Key contacts at Trust (name, telephone number, email address)
Name Title Telephone Email
SECTION 1: STRATEGIC OVERVIEW
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Provider Landscape and timescale to end state as a result of implementation of
Commissioners Intentions. Where do you expect to be at the end of 2010/11 and
Please include a note on expected movements in activity, services and expenditure
The Trust has developed its 5 year Integrated Business plan (IBP) which describes its strategy, vision
and service delivery plans an Integrated Care Organisation (ICO). The IBP and long term financial
model (LTFM fully reflect the known PCT and GP commissioning intentions and has been signed off by
NHS Croydon, the Primary Executive Committee, GP Practice Based Commissioners and South West
London Sector Joint Commissioning Board.
The Trust expects to deliver its service development plans for 2010/11 and is on target to deliver its
planned forecast outturn of £4.9m.
The Trust is working closely with GPs, the PCT and Acute Commissioning Unit (ACU) to firm up the
detail underpinning the demand management plans and contract for 2011/12. These plans see a
movement of care from the acute sector, particularly in the areas of out patients and elective inpatient
The Trust continues to work closely with commissioners and GP in the delivery of 2010/11 and planning
of 2011/12 and onwards service development plans, which include:
Development of Urgent Care service on the CUH site and development of the Acute Medical Unit
Refurbishment of Purley site and development of Urgent Care Service
Improve efficiency and value for money through the movement of care to the most appropriate
setting from inpatient to day case and day case to out patient
Redesign of care pathways across the acute and community interface to provide care closer to
Delivery of all CQUIN initiatives
Implementation of CERNER across the ICO
What productivity improvements are expected by 2011/12 and 2012/13?
The focus of the Trust productivity improvements are:
Continue to secure all efficiencies through centralising of back office functions as an ICO
Length of stay reductions and closure of 54 beds in 2011/12 and 28 beds in 2012/13 through:
o Review of the emergency care pathway
o Acute medical unit
o Post acute care enablement (PACE)
o Inpatient activity to day case setting
Analysis of HRG cost driver tree model to target and develop plans for improved efficiency
Review of out patient specialties to deliver agreed new to follow up ratios
What impact are the productivity improvements envisaged to have on the workforce, including
the impact on workforce utilisation?
The workforce implications of the Trust service development and cost improvement plans have been
described in the IBP. In summary for 2011/12 these are a:
Reduction in 36 wte due to bed closures
Reduction in temporary staffing (agency and locums) of 211 wte.
The Trust expects that the future shape and size of some of some services to change as it continues to
work with GPs to redesign care pathways to deliver care closer to home in the community setting.
What impact are the productivity improvements envisaged to have on asset utilisation?
A key aspect of the Trust clinical strategy is to provide care closer to home in the most appropriate
setting and to close acute bed capacity. Over the next five years CHS plans to reduce its bed stock by
124 beds which equates to approximately 4.5 wards.
The estates strategy describes a long term vision of providing unplanned emergency activity including
maternity into the improved facilities in the Jubilee and London Wing of Croydon University Hospital,
which would free up the north end of the hospital in the Woodcroft wing to be used for potential
development of an elective centre or private provision of care.
The community estate is currently being reviewed, and the Trust plans would shadow the proposed
alignment and subsequent disposal options outlined in the current CIAMS strategy for the community
estate. This will reduce costs on estate charges and utilities and is built into our CIP plan for the next
two years. The organisation is also embarking upon a partnership approach with local providers to
review estate utilisation and realise a plan for ongoing revenue savings/efficiencies.
CHS is also working closely with NHS Croydon and Croydon Council to regenerate the Purley site.
SECTION 2: PERFORMANCE
Please describe your interaction with your Sector Acute Commissioning Unit
Are all operational targets forecast to be met? If not, which ones are unlikely to be met,
is there an action plan in place and what is the timescale for achievement?
The Trust has a constructive relationship with the ACU who attend all of the monthly acute service
development, contract monitoring and performance meetings.
The Trust is on trajectory to deliver all targets with the exception of cancelled operations and the 13
week out patient standard as articulated in the Board integrated performance report. Corrective action
plans are in place.
However, improving the patient experience remains a top priority for the Trust as it performs poorly in
the national in-patient survey. CHS has invested heavily in this area through a number of initiative which
include the „Patient Revolution‟ a major patient and staff engagement exercise to develop a set of values
and promises for the people of Croydon, the implementation of „Just a Minute‟ feedback mechanism, the
net promoter score and the new post of Head of Patient Experience who is triangulating all patient
experience information into a single strategy and plan for Croydon.
Patient experience is clearly identified as a significant risk on the Trust‟s risk register and it has been
outlined as a priority for improvement in the Trust‟s Quality Account. The integrated care organisation is
committed to delivering a patient experience to be proud of; evidenced by patients who would
recommend the organisation to their family and friends.
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SECTION 3 FINANCIAL PLANNING
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PbR - Elective
29,416 29,706 28,790 29,276
PbR - Non-Elective 68,654 68,051 64,028 61,943
PbR - A&E 11,514 11,593 9,945 7,325
PbR - Outpatient
PbR - Other
41,260 36,573 33,678 31,907
Non-PbR: critical care
Non-PbR: mental health
Non-PbR: community care
7,678 7,863 7,420 7,314
Non-PbR: other 39,516 47,087 58,127 57,578
Excluded drugs & devices 3,050 3,914 3,274 3,448
Non Contract Activity 2,725 2,683 2,725 2,725
7,001 6,960 7,008 6,952
Total 210,814 214,430 214,995 208,468
Commentary on clinical revenue
Please explain the significant changes in clinical revenue including:
The Trust integrated with Croydon Community Services on the 1 st August 2010 therefore the full
year effect of this income is reflected in 2012/13
The Trust has reflected the 2011/12 PbR tariff and the changes to the tariff notified in the 2011/12
Operating framework. In addition to the tariff deflator, the Trust has also reflected a further 1% for
National KPI including non-payment for emergency readmissions. The Trust has also agreed a cap with
commissioners on KPIs of £2.1m.
Market Forces Factor:
The Trust has based it 2011/12 income on the latest notified market forces factor of 1.204473
Transitional funding: CQUIN and Other:
The Trust has reflected 1.5% of CQUINs within its plan for 2011/12. This comprises of 0.3% for National
CQUINs and 1.2% for local CQUINs.
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Education and training 7,951 8,225 7,637 8,361
Other 4,729 4,707 5,944 5,960
TOTAL 12,680 13,032 13,581 14,321
Commentary on other revenue
Please explain the significant changes in other revenue
Following the delay to the implementation of the MPET funding changes, the Trust has reflected the MPET
change from 2012/13 onwards
Please explain the significant changes in expenditure
Pay Inflation - Agreed rate for 2010/11 0% for two years, however 1% assumed impact of increases for those
earning less than £21k plus NIC‟s, as per emergency budget. The Trust has calculated the impact of
Incremental increases of £1.1m
Prescribing inflation has been set at 5%
Clinical Supplies and Services and Other Non Pay
Inflation has been provided for at 2.5%
Revenue from Patient Care activities 210,814 214,430 214,995 208,468
Other operating revenue 12,680 12,859 13,581 14,321
Operating expenses (216,072) (217,450) (218,884) (212,757)
Operating Surplus/(deficit) 7,422 9,839 9,692 10,033
Other gains and losses 100 0 0
Investment Revenue 12 21 0 94
Finance Costs (100) (33) (100)
PDC dividends payable (5134) (4915) (5154) (5211)
Retained surplus/(deficit) 2200 4,913 4,438 4,916
Impairments included 0
IFRS impact included 0
Retained surplus/(deficit) excluded impairments and
IFRS 2200 4,913 4,438 4,916
Contingency included 1,000 1,000 1,042 1,117
Commentary on overall position
Please provide an explanation of your overall financial position including sections on:
Medium term Financial Strategy and historic debt
This section describes the turnaround achieved in the Trust‟s financial performance, how the deficit position in
2005/06 has been eliminated and how the cash position is being resolved.
The financial position deteriorated towards the end of 2004/05, when an underlying deficit was declared.
Croydon Health Services received non-recurrent support from the SHA of £2.7m, and therefore delivered a
small surplus in year, but the underlying financial problems were not resolved. As a result, in 2005/06, the
year ended with a deficit of £5.8m and temporary cash brokerage was provided from the SHA to support a
forecast £11m working capital requirement in 2005/06 (table 6.1). Consequently, a new executive team was
appointed, led by a new Chief Executive and new Finance Director, to deliver the turnaround plan.
Cumulative Deficit Table
2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10
£000s £000s £000s £000s £000s £000s £000s £000s
Turnover 134,794 149,361 161,102 166,030 177,771 184,653 198,499
Break-even in Year
(163) 252 (5,847) 122 5,044 2,149 1,098
0 0 0 0 0 0 8
(163) 252 (5,847) 122 5,044 2,149 1,106
(154) (317) (65) (5,912) (5,790) (746) 1,403 2,509
The plan was developed with 3 key objectives:
break even in 2006/07;
repayment of £11m working capital loan over 3 years;
sustainable financial surplus.
The implementation of the recovery plan in 2006/07 achieved the first objective, delivering savings of £7.8m
and a year end surplus of £0.122m.
There has been significant progress in the Trust‟s financial standing and management. A surplus of £5.0m
was delivered in 2007/08, enabling the first year‟s repayment of the working capital loan. A further repayment
was made in 2008/09, and the final instalment was made in 2009/10, which means the Trust will now retain
surpluses in 2010/11. At this stage the working capital position of the Trust will improve.
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Forecast financial projections for the period from 2010/11 to 2013/14
Summary forecast income and expenditure over the medium term period is shown in the table below
The Trust plans to increase its surpluses year on year, despite year on year decreases in income.
Summary Forecast Revenue & Expenditure
Forecast Forecast Forecast Forecast
£m 2010/11 2011/12 2012/13 2013/14
NHS Clinical Revenue 211.0 212.0 205.5 202.3
Other Clinical Revenue 2.5 3.0 3.0 3.0
Other Revenue 13.8 13.6 14.3 14.9
Total income 227.3 228.6 222.8 220.2
Pay Costs (150.7) (153.4) (147.9) (144.3)
Drug Costs (11.8) (11.2) (11.0) (10.8)
Other Costs (49.9) (48.5) (48.9) (45.8)
Total Operating Expenses (212.5) (213.1) (207.1) (201.5)
EBITDA 14.8 15.5 15.7 19.5
EBITDA % 7% 7% 7% 9%
Depreciation (5.4) (6.0) (5.5) (5.8)
Interest receivable/payable 0.0 0.1 0.1 0.1
PDC\Interest etc (5.0) (5.2) (5.2) (5.4)
Impairments Losses 0.0 0.0 0.0 0.0
Surplus 4.5 4.4 4.9 8.4
% Surplus 2.0% 1.9% 2.2% 3.8%
* Please note that 2010/11 includes the part year income and expenditure for CCHS.
Following the Integration with Croydon Community Services (CCHS) on the 1st August 2010, the 2010/11
position includes 8 months of Income (£26.3m) and Expenditure (£26m). The remaining years show the full
year effect of CCHS Income and Expenditure.
Income is forecast to reduce in both nominal and real terms from 2010/11. This is a combination of expected
reductions in tariff and PCT demand management plans to reprovide activity in community settings. The
assumptions on tariff are consistent with the latest DoH/NHS London Planning assumptions.
Expenditure forecasts are consistent with assumptions on levels of income, and reflect the direct and indirect
nature of the cost profiles. The Trust will continue to focus on productivity and efficiency to achieve lower unit
costs and higher quality of service for patients. The continuation of the transformation programme will ensure
financial strength and investment in clinical services. The expenditure forecast also reflects the costs of the
implementation of Cerner Millennium with the majority of costs being incurred in 2012/13.
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The net result is a forecast surplus over a 3 year period, with surpluses approximately of £4.4 m in 2011/12,
rising to a £7.8m (3.8%) surplus in 2013/14.
Bridge between 2010/11 and 2011/12
The significant changes shown in the Bridge movement between 2010/11 and 2011/12 are the following
Full Year effect Community Services - £12.7m
Population Growth/Price changes £3.5m
QIPP - £10.0m
AfC Increments – £1.1m
VAT Increase - £0.8m
KPI Emergency Readmissions – £2.1m
The Trust has included a 0.5% of income as a contingency.
The working capital position is forecast to improve from net current liabilities of £6.0m in 2010/11 to net
current assets of £10.0m by the end of 2013/14. This is mainly due to increased cash balances generated as
a result of in year surpluses.
The impact of IFRS
The Trust restated its 2008/09 Annual Accounts on an IFRS basis, and the external auditors issued an
unmodified audit opinion on this. The main changes related to additional disclosures and terminology within
the primary statements. There was no revenue or capital impact on the reported 2008/09 outturn position.
Plans and systems were well embedded for production of the full 2009/10 and onwards accounts under IFRS,
and the additional disclosure requirements were factored into the year end timetable. The external auditors
recently issued its Annual Audit Letter, and found no issues with the production of the 2009/10 year end
accounts under IFRS. Again, no additional revenue or capital impact is expected in future financial years.
Key Assumptions included within the plan
Croydon Health Services has used the following planning assumptions to develop its income and
expenditure plans These are as per the Trusts LTFM, 2011/12 Operating framework and the latest
NHS planning assumptions
Efficiency Target 5.9%
Tariff Inflator/deflator -1.5%
National KPIs/Emergency Readmissions -1.0%
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Pay Inflation - Agreed rate for 2010/11 0%
for two years, however 1% assumed
impact of increases for those earning less
than £21k plus NIC’s, as per emergency
budget. 2013/14 per non-pay inflation. Also
need to take into account impact of
Non Pay Inflation - HM Treasury – average
of independent forecasts (as at April 2010)
for 2010 and 2011.
Prescribing Inflation . Local discretion to
be applied, subject to:
• Expected minimum of 5% growth;
• The data source being provided and its
use supported, and;
• Sign-off obtained from the sector
Key risks included within the plan
Explanation of the risk High/
PCT QIPP (Demand
Management Plans) The Trust
currently has a difference
between the PCTs QIPP plans
and the Trusts IBP
KPIs The Trust is still to agree
KPI with commissioners
The Trust is assessing the
impact non payment for
The Trust has agreed QIPP plans for 2011/12 with
The Trust has agreed a cap on KPIs for 2011/12
Medium The cap on KPIs includes the impact of non
payment for emergency readmissions. The Trust
has also agreed an initial investment of £0.5m for
re-ablement,funding in 2011/12
Describe what your commissioners have contracted for in relation to CQUINS
Commissioners have proposed the following CQUINs for 2011/12. There are on-going discussions
with commissioners regarding the detail and trajectories.
Name of CQUIN 2011-12 £ooo Description
Part b of the two year national CQUIN. In line with
Unify submission, this measures the number of
patients that were given prophylaxis following
VTE 270 identification of risk.
Patient Experience 270
This will be in line with national guidance on
Patient Experience CQUIN.
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Urgent Care Toolkit 540
Acute Oncology Service 540
End of Life Care 270
Medicines Management 270
This audit toolkit is designed for use in A&E and
Urgent Care Departments, and provides feedback
on performance to staff on an individual level to
aid staff and service development.
This set of quality measures is aimed at improving
the COPD service.
This CQUIN ensures patients with either
complications or undiagnosed cancer will be seen
by a member of the Acute Oncology team.
This CQUIN measures the number of patients
having their choice of preferred location to die
This continuation of 10-11 CQUIN aims to audit use
of medicines, reduce spend and ensure medicines
The use of enhanced recovery plans, with particular
reference to reduced LOS, increased admission on
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Cost Improvement Programme (expenditure savings only)
Please provide detail narrative to support your CIP’s to include risk rating (gross values vs.
risk weighted values included within the plan), Full Year Effects, recurrent vs. non recurrent
and the level of unidentified CIP’s.
Cost Improvements – 2011/12
The overall Trust CIP target for the year is £13.4m. This will be 6% on the Trust‟s cost base and is
challenging, but deliverable.
The CIPs for 2011/12 identified so far are as follows:
Improved productivity focusing on LoS, admission on the day of operation, delayed
discharges, DNA rates, cancelled operations, outpatients new to follow up ratio, theatre
utilisation, reduction in agency and locum expenditure;
Redesign of Care pathways to support the reduction in LoS;
Redesign of 13 care pathways to ensure that care is delivered in the most appropriate setting
closer to home as part of the integration;
Integration of back office functions;
Service realignment from service line reporting and cost driver tree analysis;
Procurement and materials management;
Centralisation of appointments and bookings;
Voice recognition schemes;
Improved clinical coding.
The table below shows the overall risk assessed summary of CIPS by directorate for 2011/12.
CIPS Summary 2011/12
CIP Summary 2011/12 £000’s
Diagnostics & Clinical Support 2,351
Women & Children 552
Emergency Care 2,832
Planned Care 2,775
Grand Total 13,429
The detailed plans are shown in the table below:
CIPS Detail 2011/12
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CIP Type Project Area £000’s
Agency usage All Staffing 236
Estates Estates Rationalisation 244
LOS Acute Physician/ Flexing bed models of care 571
Planned Care Bed model 939
Procurement Clinical Supplies 1,000
Estates and Facilities 705
General Supplies 1,369
Service Redesign Admissions 151
Workforce Redesign Clinical Support Staff 1,148
Management and Administration 1,305
Medical and Dental 1,019
Nursing and Midwifery 1,871
Grand Total 13,429
Quality, Innovation, Productivity and Prevention (QIPP)Agenda
Recognising the need for transformational change, the Trust has not only developed a PMO for
supporting this transformation throughout Croydon Health Services, but is setting out to embed these
characteristics across the Directorates through the Quality, Innovation, Productivity and Prevention
The key objective is to align everything the Trust does to the QIPP programme, such as:
To improve quality and productivity through integrated pathways and service re-design with
To engage, inspire and empower staff through communication, and developing a leadership
To create a legacy of change leaders and a quality culture, through innovative programmes
and forecasting towards the future on sustainability, rather than cost cutting.
A structure of documentation, governance and monitoring underlies all service development into the
The workstreams for QIPP drive the Trust‟s vision and how service development will continue into the
CIP Clinical Cabinet
The Trust has established a Clinical Cabinet to review and approve proposed cost improvement
plans to ensure they are adequately risk assessed. The medical director leads this Committee and
membership comprises clinical directors, with support from the directors of governance and strategy.
The wider consultant body is represented by the Chair of the Consultant Committee. All CIPs are
assessed to ensure that implementation will not have a detrimental effect on quality of care, safety,
outcomes and effectiveness of service. Risks are logged and reviewed to ensure that there is a
continuous process of monitoring and appropriate management of CIPs.
The overarching aim of the Clinical Cabinet is to give the executive team assurance that the CIPs do
not affect patient quality or patient safety
The Trust has invested in the development of a programme management office to oversee the
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Please provide additional narrative to support your triangulation data in the operating plan
spreadsheets including explanation and resolution of remaining variances.
The Trust has now agreed head of terms with it host and associate commissioners
implementation and delivery of all the cost, service improvement and CQUIN initiatives.
This approach will ensure that detailed project plans are developed, with leads and resources
assigned to ensure that delivery of milestones are both tracked and achieved. Risks to achievement
have been outlined in the above section of this plan and include non delivery of CQUIN and
Demand management schemes (amount notified by commissioners, have they been
included within your plans, how realistic are they, timing of implementation, how are you
expecting to manage their impact etc.)
Note: must be scheme specific with clear explanation of implementation, activity reductions and
Based on NHS Croydon 2011/12 commissioning intentions the Trust has modelled the demand
management plans in table 2.4 below. In 2010/11, demand management plans equating to £5.9m of activity
was reduced from the Trust SLA and growth totalling £3.5m was invested, leaving a financial pressure of
£2.4m. The CIP target for 2010/11 for the acute Trust was set at 3.5%, £6.8m to enable the Trust to deliver
a surplus position with reduced income and increased cost pressures.
In the current economic climate there is additional pressure on PCTs to generate savings through demand
management plans, whilst improving the patient experience by moving care closer to home. The plans for
2011/12 show demand management schemes and commissioning intentions totalling £14.4m of which
£5.1m is urgent care, £5.7m outpatients and £0.9m decommissioning.
The Trust has modelled a reduction of £14.4m in income within the base case of the Long Term Financial
Model (LTFM) to reflect NHS Croydon commissioning intentions and QIPP agenda for 2011/12. Table 2.4
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shows the detailed break down of NHS Croydon plans and the Trust has factored £4.3m reinvestment to
Croydon Health Services within the LTFM base case. The impact to the Trust of these schemes is a net
income loss of £10.0m. The above includes slippage on delivery of schemes from 2010/11.
A significant component of these proposals is urgent care which plans to remove £5.1m from the Trust
baseline. However the Trust has included within the LTFM the PCT‟s proposed investment of £2.3m to
create an urgent care centre. This leaves a net reduction in funding of £2.8m for urgent care. According to
2009/10 reference costs, the total cost of A&E including overheads was £11.9m. However, 2009/10 contract
monitoring data shows that only £11.4m was received in income under the national tariff, making a loss of
To address this cost pressure and the PCT demand management plans for urgent care, Croydon Health
Services has the potential to significantly improve the way urgent care is provided and to enable greater
integration of the wider unscheduled care system. The Urgent Care Centre at the front of A&E will be staffed
by multidisciplinary teams that include GPs and nurse practitioners (including emergency nurse
practitioners) who are able to access support and advice, when necessary, from consultants in emergency
medicine. This shift in skill mix in addition to the reconfiguration of A&E staffing will reduce cost and is
reflected within the Emergency Care directorate CIP plans.
The urgent care centre will be prototyped by the Trust at the front of A&E from April 2011. Over the next few
months NHS Croydon intends to formally procure urgent care which should be completed by January 2012.
NHS Croydon demand management schemes based on 2011/12 commissioning intentions.
Schemes already mentioned in 2010-11 plan
Name of scheme Original
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£000s £000s £000s £000s £000s £000s
Perinatal Mental Health 85 48 37 89 89
TB Screening and LAC
BCG Immunisations 587 111 476
20 20 13 13
Polysystem 724 598 126 4,308 2,627 1,681
Children - A&E 72 63 9 522 285 237
CORS - FYE 400 400
Waste Avoidance (OP
238 238 1,978 1,978
MCATS (Muskuloskeletal) 1,423 893 530 1,785 893 892
ENT 321 257 64 363 363
375 255 120 -121 -121
End of Life 562 562 362 362
Long Term Conditions 141 135 6 195 45 150
COPD Community Service
321 180 141 643 180 463
Telehealth 57 45 12 111 55 56
Sexual Health Service
104 103 1 208 146 62
Children‟s planned care 300
Decommissioning 500 500 654 654
Total 5,973 2,688 3,285 11,410 4,231 6,879
1,763 882 882
Total 5,973 2,688 3,285 13,173 5,113 7,761
Items where notice has been provided
Direct Access Cardiac
Clinical Haematology - Anticoag
Grand total 5,973 2,688 3,285 13,793 5,113 8,381
Capital investment and disposal (including sources of funding)
The Board approved an updated Estate Strategy in November 2008, focusing on the priorities for
development over the next 10 years. This will be refreshed by a recent detailed site survey (“sixfacet”
As part of an ongoing review of the use of the estate, a space utilisation committee ensures that all
allocation of space is undertaken in a coherent, planned way.
A summary of the Trust‟s capital programme for the 2011/12 is shown in the Table below,
Summary Capital Spend 2011/12
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Cardiac Catheter Suite 1,390 941
Cerner Millennium Patient Care System 91 1,509
Urgent Care & Paediatrics Refurb 0 700
Backlog Maintenance 2,486 1,418
Medical Equipment 655 58
ICT 774 328
Contingency 0 1,106
Total Capital Programme 5,396 6,060
It is planned to fund all capital expenditure from within internal resources, rather than to borrow
money externally for improvements to infrastructure.
Key risks and opportunities not included in the financial plans
Key risks not included in the plan with mitigating actions
Strategically, the three most significant risks for CHS that have been outlined in the IBP are:
Lack of clarity on long term commissioning intentions.
Income loss with Integration Pathway Redesign resulting in the movement from Acute services under
PbR to the Community service under block contract.
New Executive and Non Executive Board appointments and a vacant Non Executive position.
The risks and mitigating actions have been detailed below:
Top Strategic Risks and Mitigating Actions
Lack of clarity
of long term
resulting in the
under PbR to
Likelihood Impact Mitigating Actions
4 4 Establish and drive forward the key deliverables of the Trust
Incorporate all known local commissioning intentions and
SW London Strategies.
Build on the Trust‟s engagement with the local community
and take the opportunities presented by an engaged
membership and elected governors to shape services
which meet the needs of local people.
Work in partnership with GPs and primary sector.
Partnerships: Explore further opportunities to work with
the local authority and local health economy on the health,
social care and regeneration agendas.
Drive the supporting financial and contractual
Establish supporting processes in the Trust, such as
communication plans, cross linkage with directorates, GP
engagement plans and partnerships with community
Develop pathways with commissioners and GPs.
Actively engage with PBC, Acute Commissioning Unit and
Use the financial freedoms associated with FT status to
invest in technology and the estate where these
investments will enhance the quality of patient care.
Improve links with NHS London Programme for IT to
influence the development of the Connecting for Health
Work with PCT to best position the Trust, by designing
pathways such as Urgent Care.
3 4 Negotiations underway to develop a block contract for new
pathways to enable development and progression of care
closer to home without financial loss to the trust.
Continually review the impact of integration on service
delivery. Involvement of Clinical staff and GPs in the
Engagement on pathway redesign with GPs through the
monthly Service Development meetings.
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3 4 Establish Board development programme.
Director of Operations joined the Trust on 25th October
Interim Director of Nursing in place with substantial
experience of the organisation.
Non-executive director and chair of audit committee,
appointed in October 2010.
Full induction and training programme to be implemented
for all new directors to address any skills gaps.
Ongoing programme of board development.
Ensure transparent decision making.
Building the capacity and capability needed which will
continually be under review.
Principal Objective Principal Risks Key Controls in place
Improve the patient experience to
ensure that care is not only safe
and effective but also
personalised, dignified, respectful
Deliver high quality safe and
effective clinical care
Feedback from national
patient survey reflects poor
patient experience which
may impact public confidence
and patient choice
The clinical treatment of
patients could be below the
standard that patients could
and should reasonably
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Developed patient promises
“Just a minute” score cards
Productive Ward and “you are
the difference” programs
Quality Board reviews
Patience Experience Tracker
Customer Care Training for
Hourly ward rounds
Global trigger tool implemented
Mortality review group
Patient safety first initiatives
Use of Trust/Dr Foster
Monthly infection control
Ensure compliance with NICE
and other guidance
SUIs investigated, actions
agreed and reviewed
Data analysis of falls and falls
Medicines management and
reconciliation and blood
Introduction of hourly ward
Failure to meet statutory and 5 year estate strategy and
Have active engagement with the
public, patients and their carers to
improve patient satisfaction and
take account of their view in the
planning and delivery of future
Attract retain and develop a
skilled workforce that is
committed to delivering high
quality, safe, compassionate care
to the local population within an
environment of continuous
Strive for excellence by meeting
national targets, standards and
regulatory requirements ensuring
arrangements and maintaining
maintenance affects ability to
provide quality car
Level of engagement with
public and patients to take
account of views in planning
and delivery of services
impacts on CQC evidence
Staff survey results indicate
staff would not recommend
the Trust as a place to be
treated may impact
recruitment, retention and
Funding as a result of current
economic conditions and
demand management plans
has a detrimental impact on
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monitoring of its implementation
Robust process for capital
6 facet surveys prepared and
reviewed on annual basis -
including identification and
prioritisation of back
Ongoing site surveys and
Asbestos action plans in place
“just a minute” net promoter
patient experience score cards
Patient and Public Involvement
Patient representatives on
pathway redesign groups
Members engagement events
Appointment of external
Programme of GP visits by
Exec and Clinical Directors
GP evening meetings and
Implementation of workforce
and recruitment and education
and training plans
Aspiring clinical leaders
Monitor PDR rate to deliver
98% PDR target across
Implementation of Patient
Directorate Staff Survey Action
CiPs identified by directorates
Project Management Office
Financial monitoring, reporting
and budgetary control
Weekly finance meetings with
Unplanned loss or increase
of activity and income
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Monitoring forums in place to
identify referral pattern changes
and corrective actions
Workforce strategy promotes a
flexible workforce plan to
reduce capacity and costs
Submitting tenders where
Effective relationships with
Could you provide an explanation of the impact of up to a 10% downside funding scenario?
The immediate actions the Trust would take; recruitment freeze, centralise control, and reassess CIP plans
for future years.
The Trust recognises this may not be enough and would also consider delaying parts (up to 50%) of the
capital programme to improve the cash position which would release cash of £3m per annum over the four
year period as well as closely monitoring the Trust run rate and cashflow.