Page 1 of 19 - Croydon Health Services NHS Trust

croydonhealthservices.nhs.uk

Page 1 of 19 - Croydon Health Services NHS Trust

Page 1 of 19


Key contacts at Trust (name, telephone number, email address)

Name Title Telephone Email

Executive

Leads:

Sally Smith

Tony Leonard

Finance:

Paresh Patel

Workforce:

Debbie Eyitayo

Director of

Finance and

Director of

Strategy

Associate

Director of

Finance

SECTION 1: STRATEGIC OVERVIEW

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Tony.leonard@croydonhealth.nhs.uk

sally.smith@croydonhealth.nhs.uk

paresh.patel@croydonhealth.nhs.uk

debbie.eyitato@croydonhealth

.nhs.uk

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

2011/12.

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

care.

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

home

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

Clinical Revenue

Page 4 of 19

2010/11

Forecast

Outturn

£'000'

2011/12

Plan

£'000'

2012/13

Plan

£'000'

PbR - Elective

2010/11 Plan

£'000'

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

LSCG

NCG

Tranisitional funding

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

Tariff/price changes:

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

Investments/Divestments :

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.


Other revenue

£000's

Plan

2010/11

Forecast

2010/11

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Plan

2011/12

Plan

2012/13

Research and

Development

Education and training 7,951 8,225 7,637 8,361

Transitional PFI

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

Expenditure

Please explain the significant changes in expenditure

Pay

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

Drugs

Prescribing inflation has been set at 5%

Clinical Supplies and Services and Other Non Pay

Inflation has been provided for at 2.5%

Overall Position

£000's

Plan

2010/11

Forecast

2010/11

Plan

2011/12

Plan

2012/13

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

B/F 1997

- 2003

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

I&E: Retained

(Deficit)/Surplus

Adjustments for

Impairments

Break-even in Year

Position

Break-even

Cumulative

Position

(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

Revenue

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

Operating Expenses

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

CIPs £13.4m

Contingency

The Trust has included a 0.5% of income as a contingency.

Cash

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

Key assumptions

2011/12

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

incremental increases

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

prescribing lead.

Key risks included within the plan

Explanation of the risk High/

Medium/

Low risk

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

emergency readmissions

CQUINS

Medium

Medium

1.0%

2.5%

5.0%

Mitigating actions

The Trust has agreed QIPP plans for 2011/12 with

commissioners

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

COPD 270

Acute Oncology Service 540

End of Life Care 270

Medicines Management 270

ERP 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

reconciliation.

The use of enhanced recovery plans, with particular

reference to reduced LOS, increased admission on

the day

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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

Corporate 2,619

Diagnostics & Clinical Support 2,351

Women & Children 552

Emergency Care 2,832

Planned Care 2,775

CCHS 2,300

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

PACE 528

Planned Care Bed model 939

Procurement Clinical Supplies 1,000

Estates and Facilities 705

General Supplies 1,369

Prescribing 877

Service Redesign Admissions 151

Theatres 398

Workforce Redesign Clinical Support Staff 1,148

Management and Administration 1,305

Medical and Dental 1,019

Nursing and Midwifery 1,871

Therapies 1,068

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

(QIPP) programme.

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

Community Services;

To engage, inspire and empower staff through communication, and developing a leadership

culture;

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

future.

The workstreams for QIPP drive the Trust‟s vision and how service development will continue into the

future.

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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SLA Triangulation

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

productivity gains.

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

expected benefits

Demand Management

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

£500k.

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

plan

2010-11

Reinvest

ment

2010-11

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Net impact

2010-11

FYE plan

2011-12

Reinvestme

nt 2011-12

Net impact

2011-12

£000s £000s £000s £000s £000s £000s

Perinatal Mental Health 85 48 37 89 89

TB Screening and LAC

Refresh

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

Attendance Efficiency)

238 238 1,978 1,978

MCATS (Muskuloskeletal) 1,423 893 530 1,785 893 892

ENT 321 257 64 363 363

Gynaecology -

Hysteroscopy Daycases

375 255 120 -121 -121

Intermediate Dermatology

Service

43 43

End of Life 562 562 362 362

Long Term Conditions 141 135 6 195 45 150

COPD Community Service

Redesign

321 180 141 643 180 463


Telehealth 57 45 12 111 55 56

Sexual Health Service

Redesign

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

Outpatient Demand

1,763 882 882

Management

-

Total 5,973 2,688 3,285 13,173 5,113 7,761

Items where notice has been provided

Direct Access Cardiac

Physio

300 300

Clinical Haematology - Anticoag

and Lipids

320 320

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”

survey).

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

Forecast

2010/11

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Forecast

2011/12

£000 £000

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

Funding Assumptions

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

Description of

Risk

Lack of clarity

of long term

commissioning

intentions

Income loss

with Integration

Pathway

Redesign

resulting in the

movement from

Acute services

under PbR to

Likelihood Impact Mitigating Actions

4 4 Establish and drive forward the key deliverables of the Trust

agenda

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

arrangements.

Establish supporting processes in the Trust, such as

communication plans, cross linkage with directorates, GP

engagement plans and partnerships with community

providers.

Develop pathways with commissioners and GPs.

Actively engage with PBC, Acute Commissioning Unit and

NHS Croydon.

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

Programme.

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

redesign work.

Engagement on pathway redesign with GPs through the

monthly Service Development meetings.

Page 16 of 19


the community

service under

block contract

New Executive

and Non

Executive

Board

appointments

3 4 Establish Board development programme.

Director of Operations joined the Trust on 25th October

2010.

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

and compassionate

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

expect.

Page 17 of 19

Developed patient promises

“Just a minute” score cards

Productive Ward and “you are

the difference” programs

Leadership Development

Quality Board reviews

Patient experience

measured/reviewed using

Patience Experience Tracker

(PET)

Customer Care Training for

frontline staff

Hourly ward rounds

implemented

Global trigger tool implemented

Mortality review group

Patient safety first initiatives

Use of Trust/Dr Foster

comparative data

Monthly infection control

meetings

Ensure compliance with NICE

and other guidance

SUIs investigated, actions

agreed and reviewed

Datix incidents

reviewed/actioned

Data analysis of falls and falls

prevention group

Medicines management and

reconciliation and blood

tracking initiative

Vitalpac introduced

Introduction of hourly ward

rounds

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

services

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

learning.

Strive for excellence by meeting

national targets, standards and

regulatory requirements ensuring

effective governance

arrangements and maintaining

financial strength.

mandatory backlog

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

and registration

Staff survey results indicate

staff would not recommend

the Trust as a place to be

treated may impact

recruitment, retention and

motivation.

Funding as a result of current

economic conditions and

demand management plans

has a detrimental impact on

finances.

Page 18 of 19

monitoring of its implementation

Robust process for capital

programme including

prioritisation

6 facet surveys prepared and

reviewed on annual basis -

including identification and

prioritisation of back

maintenance

Ongoing site surveys and

asbestos register

Asbestos action plans in place

“just a minute” net promoter

patient experience score cards

Patient and Public Involvement

Strategy

Patient Assembly

Patient representatives on

pathway redesign groups

Members engagement events

and newsletters

Appointment of external

stakeholder engagement

manager

Programme of GP visits by

Exec and Clinical Directors

GP evening meetings and

newsletters

Implementation of workforce

and recruitment and education

and training plans

Talent Management

Aspiring clinical leaders

programme

Monitor PDR rate to deliver

98% PDR target across

integrated organisation

Implementation of Patient

Revolution

Directorate Staff Survey Action

Plans

CiPs identified by directorates

and departments

CIP/Service improvement

initiatives

Project Management Office

Financial monitoring, reporting

and budgetary control

Weekly finance meetings with

directorates


Unplanned loss or increase

of activity and income

Page 19 of 19

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

appropriate

Effective relationships with

commissioners

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.

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