The Rotherham NHS FT, Community Services and Careplus

1. The Rotherham NHS FT, Community ServicesandCareplus

2. Board approved strategic direction • Diversification – to spread and reduce the risk of operating within a single market which is in decline (Acute Hospital Sector) • Harnessing the benefits of scale • Economies of scale e.g. shared services/back office functions, reduced corporate overheads, lower supplies costs, etc. • Increased borrowing capacity • Ability to recruit the highest calibre of managers • Influencing National Policy • Greater influence when working with the Private Sector • Innovation • Building flexibility in our capacity to respond to the way future services will be delivered; • Developing multi-functional expertise across our portfolio of services that can be deployed wherever there is a need; • Identifying, developing capability and meeting emerging gaps in the market for new forms of service; • Altruism • We are passionate about the NHS and believe we have much to contribute to its successful transformation into a world class health system • We believe that the strategy of supporting patients in managing themselves is correct, but requires a different approach and new models of service; we want to influence that new approach and provide those new models • We are concerned that Community Services will taken over by Hospitals eager to asset strip them to resolve their own financial challenges/deficiencies, which we fundamentally oppose • We believe that we can beat the Private Sector at what they do, and do not want to see tax payers money going to private sector shareholders without effective NHS competition

3. Our 10 areas of business interest • Operating Acute Hospitals – acquisitions and takeovers • Operating Community Provider Services • Developing and operating “Alternate Levels of Care” (reinventing the Community Hospital)* • Running and operating Nursing Homes and potential Residential Homes/hybrids* • Providing Managed Services* • Consultancy services, including turnaround* • Provision of shared services* • Professional services to the NHS and Business Sectors in a range of areas, e.g. Service Improvement (Lean), Occupational Health, IT, etc.* • Franchising and selling Intellectual Property* • Creating and building Joint Ventures with the Private Sector working at the leading edge of health care, e.g. McKesson, Microsoft, Strata Pathways, Surgicube, BAMM Construction, etc. *Careplus We are building our capacity and capability in all of these areas incrementally

4. Who we are • First Wave Foundation Trust established in 2005 • Now structured to operate as a Health Care Provider, not an Acute Hospital (Group Structure) • Trust ethos of delivering excellence in Health Care and committed to the NHS • Successful and verifiable track record in delivering quality, productivity, innovation and prevention • Ground breaking business models and strategies which empower and engage staff in the delivery of services • Partnering with class-leading businesses to develop and deliver innovation in service delivery and to stimulate growth in the local economy • Fully understand and support the need to manage care in the community, and committed to that principle

5. Track record on Quality & Performance • Double-Excellent rated by the CQC (07/08 and 08/09) • Double-Green/4 rated by Monitor • HSMR reduced from 107 to 92 in 3 years • Amongst the Lowest MRSA and C.Diff infection rates in UK • Amongst the shortest waiting times in the UK for access to services: • 9 days from GP referral to OP appointment and • 16 days from DTA to elective admission • All diagnostics <1 week; MRI same day • Voted #1 for shortest waiting times - National Inpatient Survey • CHKS 40 Top Hospitals Award Winner 2009 • Health Investor Magazine’s “Foundation Trust of the Year” 2009

6. Track record on efficiency and productivity • 6% CRES delivered 4 years in a row • 30% more throughput than 4 years ago • 150%+ increase in referrals from outside Rotherham • Maximum 9 week wait achieved for over 90% of patients • Reduction in sickness absence of 1.2% in past year • Increased staff satisfaction ratings from 3.38 to 3.43 in past year (statistically relevant) • Increased Consultants by 33% in 4 years • Generated a £4m surplus in 2008/9 AND... • Since becoming a Foundation Trust, we have never compromised or pressurised NHS Rotherham’s financial position, which is now the strongest in the Y&H Region

7. Track record on leading edge innovation • £30m investment in Digital Patient Records (outside the National Programme) – Plan to be paperless by 2012 • £50m investment in our Hospital of Tomorrow project • Brought InterQual Level of Care assessment tool to the UK and developing new “Alternate Level of Care” services • From £25k to £1m R&D programme in 3 years • National lead on Ultra Efficient Lighting & carbon reduction • Introducing community based Ophthalmology Services and theatre-less ophthalmic surgery to the UK • For 2009/10, our Governors set our objectives

8. Options for the way forward • Do nothing • Retain as ALMO • Social Enterprise? • Community Foundation Trust? • Merge with other Community Provider(s) • Vertically Integrate with local Acute Hospital 7. Outsource to a Managed Service (e.g. Careplus) 8. Join The Rotherham NHS FT Group

9. Joining TRFT • Community Services would become a Division of TRFT, and operate independently of the Acute Hospital arm of the business. • Contributes to management overheads but does not carry a major management overhead of its own • Accesses all the benefits of being part of the TRFT Group: • Unlimited borrowing (subject to adequate Business Plan) • Immediate cost reduction opportunities through shared services • Taps into full range of expert TRFT services (Clinical Effectiveness; Patient Experience; Patient Safety; Contracting and Marketing; Service Improvement; Service Transformation; R&D & Technology Adoption; IT; OD; HR; etc.) • Access to, and opportunity to provide services for, strategic business partners • Access to Marketing Division with existing business structure to allow services to extend beyond existing boundaries should they wish to grow/expand (Careplus) • Access to leading edge business models - Internal trading; surplus retention; carry forward of under-spends for investment in services; clinically led and managed services; etc. • One of the highest performing FTs in the Country, with a solid track record of progress and improvement, highly rated by Regulators.