Blackpool Teaching Hospitals NHS Foundation Trust

1. Blackpool Teaching Hospitals NHS Foundation Trust Aidan Kehoe Chief Executive

2. The Trust and its services…. • 330,000 catchment (1.6m Cardiac & Haematology) • Sites: • Blackpool Victoria Hospital (577 beds) • Clifton Hospital (64 beds) • Bispham Nurse Led therapy Unit (40 Beds). Social Enterprise • Rossall Hospital (40 beds) • Wesham Hospital (40 Beds) – Currently unused • Fleetwood Hospital (Outpatients) • National Artificial Eye Service • Turnover: £260m • Employees: 4,000

3. Background….. 2006 Financial Turnaround Development of the Blackpool Way Foundation Trust status December 2007 Patient safety – Infections / Mortality Investment for the future £65m capital schemes Alert Electronic Patient Record Service development 2010/11 Financial challenge & Monitor

4. Awards / Recognition….. National Patient Safety Awards Investors in People Gold Award The Information Standard Kite Mark for patient leaflets NHS Litigation Authority Risk Management Standard Level 3 Imaging services accreditation scheme Sunday Times Top 75 2010 Boorman / Macloed Reviews Healthcare 100 – Top Acute Trust & Best Large Employer Healthcare People Management Association Award – Joint working with Trade Unions

5. Awards…

6. Our Vision Quality Safety People Delivery Environment Cost Quality Safety People Delivery Environment Cost

7. Our Values

8. Blackpool Way • Deep Employee Engagement • 4 Key Pillars • Recognition • Management style • Communication • Continuous improvement • Vision and Values

9. Policy Context • Independent NHS Board - Resource allocation - Guide commissioning • Greater transparency • Concentration on outcomes – Advancing Quality • Communication of change • Prevention & public health • White paper – decision awaited • Real NHS growth - Impact on other sectors

11. Budget commitment for real growth across public sector 2011/12 onwards Highest annual average by Government administration (1997 - 2011) Lowest annual average by Government administration (1951 - 63) 21st century average annual increase 20th century average annual increase Annual real spend increase since 1948 0 1 2 3 4 5 6 7 Percentage Real Growth in NHS Expenditure NHS Growth Rates

12. Policy Context Patient led NHS Strengthen role of GPs in commissioning Primary Care Trust role commissioning Patient choice extended to GP Out of hospital care More front-line control

13. We know the current system has…… High levels of avoidable hospital attendance and admission – utilisation management Wide variations in Length of Stay Unacceptably high rates of readmission Suboptimal management of chronic illnesses An unacceptable rate of harm and error leading to avoidable suffering and even death Concentration on beds rather than pathways

14. The “Quality, innovation productivity & prevention gap” The QIPP gap - £15 to £20 bn Expenditure Income £ BFWH - £45m Time

15. Five Levels of Action 5 - National 4 – Regional 3 - Whole health economies 2 - Organisations and their main bilateral partners 1 - Individual organisations Lobbying upwards Sharing best practice Reconfiguration - doing the right thing Not being an island of success in a sea of failure Systematic collaboration - managers, clinicians & support teams to improve

16. Transforming Community Services (TCS) • National policy of commissioning/provider spilt • Requirement for Primary Care Trusts (PCTs) to divest themselves of provider arms • Preferred providers • Development of better integrating patient pathways • 1500 staff 60 million budget

17. Transforming Community Services - Staff Main staff groups 339 Whole time equivalent (WTE) District Nurses 172 WTE Allied health professionals (therapists) 365 WTE Paediatric services 38 WTE Community Matrons 64 WTE Community Dental 48 WTE Prisons 39 WTE Community Management 39 WTE Learning difficulties 75 WTE Sexual Health

18. Transforming Community Services - Timeline • July 2010 - Commenced working with Blackpool and North Lancs. Primary Care Trusts to prepare a business case • September 2010 - PCTS received approval for the business case from the Strategic Health Authority • November 2010 – March 2011 the Trust undertook a comprehensive review of the Community finance and governance arrangements • April 2011 – present day the Trust is undergoing a review by Monitor. (Trust regulator) • 27th June 2011 - The Trust Board will be interviewed by the Monitor Board • 1st August 2011 - The Community services transfer and the Trust become a “New “ organisation

19. The need for partnership …. Patients who experience better care without delay Environment that facilitates the work of organisations Organisations that facilitate the work of patient-centred teams High-performing patient-centred teams Clinical systems improvement Organisational development Whole systems alignment

20. Level 1 opportunities Workforce – staffing/pay/sickness absence Better Care Better Value Threshold management Innovation and informatics Lifestyle modification (smoking; alcohol; eating) Care pathways – alternatives to hospital, telehealth, self care, work with Practice Based Commissioners Patient centred-care. Quality costs less Standardisation

21. Level 2/3 Issues Variability in risk management strategies Standardisation Demand management Mutual Interdependency trumped by individual interest Practice based commissioning Vertical & horizontal integration Different models of ownership – Collaboratives/federations/Social Enterprises

22. Mindsets doomed to fail It won’t happen If it does, we’ll grow our way out of trouble I’ll do what I’ve always done No-one up there will let me make the changes I need to do The public won’t let us do what we want to do I’ll be OK if I do it all myself because we can never agree if everyone’s involved It’ll be someone else’s fault when it goes wrong It’ll be OK if we all fail I’ll wait ‘til it starts to bite I’ll talk the talk Even if it does happen, I can dodge the bullet We can do this on our own We’ve had to do this before and done it, so we’ll do it again I’m retiring anyway

23. Mindsets offering best chance of success I’ll ensure that we’re open and transparent We will work collaboratively We stand together We need to act now Patient safety and quality will be uppermost Success will be delivered through the Blackpool Way We will work with partners to better manage patient pathways We will invest in programmes to support new ways of working and staff development

24. Admissions per ‘000 population 2008/9 By Primary Care Trusts – England (152 PCTs)

25. Admissions per 1000 population

26. Key Projects and Measures Top 50% for lowest Mortality rates Reduction in Hospital Acquired Infections Reduction in Inpatient falls Reduction in Hospital Acquired pressure ulcers Implement risk assessments to reduce risk of blood clots Reduction in avoidable harms – e.g medication errors Global Trigger Tool

27. Key Projects and Measures Patient Experience Surveys Nursing Indicators - Change to Nursing Care Indicators Advancing Quality Productive Ward – Releasing Time to Care Blackpool Nurses 10x10 Quality Framework Map of Medicine

28. The Way We Do Things “Counter clockwise, Red Eagle, Always counter clockwise”

29. Any Questions? Quality Safety People Delivery Environment Cost