TRUST DELIVERY PLAN 2008/2011South Eastern Health & Social Care Trust 1 Trust Delivery Plan...

South Eastern Health and Social Care Trust

TRUST DELIVERY PLAN

2008/2011

May 2008

INTRODUCTION

1.0 LOCAL CONTEXT

1

2.0 Delivery Plans for PSA/ Ministerial Targets

4

Priority Area 1 – Improving Health and Wellbeing 5 Priority Area 2 – Ensuring Safer, Better Quality Services 11 Priority Area 3 – Improving Acute Services 21 Priority Area 4 – Ensuring Fully Integrated Care and Support in

the Community 38

Priority Area 5 – Improving Children’s Services 45 Priority Area 6 – Improving Mental Health Services 55 Priority Area 7 – Improving Services for People with a Disability 62 Priority Area 9 – Improving Productivity 74 Priority Area 10 – Modernising the Infrastructure 81 3.0 RESOURCE UTILISATION

84

3.1 Income and Expenditure 84 3.1.1 Financial Pressures 84 3.1.2 Unresolved Issues 84 3.1.3 2008/9 Issues Requiring Resolution 85 3.1.4 Financial Risks 85 3.2 Workforce Strategy 86 3.2.1 Learning and Development 86 3.2.2 Recruitment and Selection 86 3.2.3 Equality of Opportunity 86 3.2.4 Workforce Modernisation 87 3.2.5 Change Management 87 3.2.6 Resource Utilisation and Labour Productivity 87 3.3 Capital Investment Plan 90 3.3.1 Ulster Hospital 90 3.3.2 Lagan Valley Hospital 91 3.3.3 Downe Hospital 91 3.3.4 Primary Care and Community Infrastructure (PCCI) 92 3.3.5 Non Primary Care and Community Infrastructure (Non-

PCCI) 92

3.4 Partnership Working 94 4.0 REFORM, MODERNISATION AND EFFICIENCY

95

4.1 Delivery of Efficiency Targets 95 4.2 Financial Pro forma FP3(T) 96

C O N T E N T S

5.0 GOVERNANCE

97

5.1 Risk Management 97 5.2 Safe and Effective Care 98 5.3 Financial Governance 99 6.0 USER EXPERIENCE

100

6.1 Investing for Health 100 6.2 Measures to engage users, carers and communities in the

planning, delivery and evaluation of services 100

6.3 Measures to assess user experience in terms of level, quality and method of delivery of services.

101

7.0 CONCLUSION 102 Appendices Appendix 1 Financial Pro-formas

INTRODUCTION

This Trust Delivery Plan has been prepared to summarise the key issues facing the South Eastern Health and Social Care Trust in the coming year and identifies:

• What the Trust is going to achieve;

• The resources that the Trust is going to use to do it.

The plan also highlights how the Trust plays an important part within the local health economy, recognising that improvements in health and social care can only be delivered through partnership and collaboration with the full range of stakeholders including the voluntary, community or the private sector. The Trust also recognises the importance of reforming and modernising services and therefore this document includes plans for service improvements as well as funded service developments.

South Eastern Health & Social Care Trust 1 Trust Delivery Plan 2008/2011

1.0 LOCAL CONTEXT The year 2007/08 has seen significant political and organisational change within the Health and Social Care system. For the South Eastern Health and Social Care Trust the past year has been one of establishing the new organisation and at the same time delivering improved health and social care services. The pace of change continues in 2008/09 and the outworking of the Assembly’s first budget provides opportunities and challenges to continue the progress to date. The financial scenario provides an opportunity for transformational change and to radically transform the health and social care system thus ensuring that N Ireland has a 21st century service that delivers safety, quality and value for money. In meeting these challenges the South Eastern Trust has already laid solid foundations and clear direction has been set out in its first corporate plan 2008 – 2011. This describes the vision for the organisation, the principles it will adopt and the core values, which will underpin its work. It also identifies the priorities and provides measurable objectives thus ensuring that the organisation, the public and partners can measure progress. The corporate plan also identifies the key challenges and issues for the organisation and these include:

(i) Governance The Trust will take steps to ensure that services delivered by the Trust are safe and effective, that risk is managed and that patients and clients experience high quality outcomes.

(ii) Public and service user engagement The Trust recognises the responsibilities with regards to ensuring that it engages in effective patient/client/carer involvement and for service users and carers to be integrated into the new models of service being developed. The Trust will also engage with politicians to inform them of current services and promote, and educate our population, service users and public representatives to ensure that expectations of what the Trust can provide are realistic.

(iii) Financial management

Maintaining financial balance each year is a key responsibility for the Trust and the outworking of the Northern Ireland Budget and the comprehensive spending review will present challenges and indeed opportunities for the organisation.


(iv) Maintenance of strategic direction

The Trust has identified a range of priorities for the organisation under the Directorate headings:

• Hospital services • Adult services • Children’s Services • Older people and primary care

The critical issue for the Trust is to ensure that the reform and modernisation of these services takes place within a planned environment and ultimately delivers improved outcomes for patients, clients, carers and the wider population.

(v) Partnerships and health improvement

The delivery of improved health and social care outcomes requires a sophisticated response across organisational boundaries, involving the private, public and voluntary sector and the active participation of communities and the public. This will require the organisation to have the capacity and confidence to develop alliances and partnerships that acknowledge the role and contributions from other organisations, groups and communities.

(vi) Workforce issues

The Trust recognises the immense contribution of its staff to the delivery of a successful first year for the new organisation. The priorities and actions for 2008/09 will necessitate a continuing high level of commitment and attention to staffing issues as reform and change is delivered.

(vii) Integrated working

The Trust has a proven track record of delivering integrated working and will want to build on this success and the experiences elsewhere to ensure the most fitting solutions to service modernisation are found and utilised.

(viii) Developing the organisation

The new South Eastern Trust acknowledges the immense challenges that are still to be addressed to ensure our population receive a modern 21st century health and social care service. The organisation is confident that it will deliver to the agenda and thus will avail of opportunities to benchmark and improve organisational capability.


(ix) Improving performance

The increased focus on continuous improvement and the requirement for robust, accurate and timely supporting information is welcomed and the Trust will want to assure the public, commissioners and stakeholders of the efficacy and effectiveness of the services delivered.


2.0 DELIVERY PLANS FOR PUBLIC SERVICE AGREEMENTS (PSA)/ MINISTERIAL T ARGETS

The Trust will address each of the Public Service Agreements (PSA) and related Ministerial Targets as identified by the Department of Health & Social Services & Public Safety for the years 2008/2009. During 2007/2008 the Trust successfully addressed and achieved the majority of PfA targets. In a number of other areas, work on achieving targets will roll forward into 2008/2009 and beyond. It is recognised that Service Investments will begin to take effect and should have a long-term impact on service quality, quantity and availability. The Trust is anxious to ensure that existing services and assets are employed to best effect. The Trust will take forward the PSA and Ministerial Targets agenda to deliver all those targets, which are applicable to the Trust. It is critical that this programme is viewed and dealt with in the context of the Trust’s overall service delivery programme which will reflect the complex and comprehensive Health and Social Care agenda of the Trust.


Priority Area 1 – Improving Health and Wellbeing


Priority Area 1: IMPROVING HEALTH AND WELLBEING

PSA (if any) 1.10: By September 2008, ensure that a comprehensive HPV immunisation programme is in place, with a view to achieving a long term reduction of 70% in incidence of cervical cancer

Related Ministerial target (if any)

Trusts should, by March 2009, ensure the delivery of the second dose of HPV vaccination to 90% of girls who are in Year 9 in 2008/09

Actions/ Proposed Service Developments

Output What will you have

achieved?

Milestones/ Timescales

Associated Resource Allocation

(split by Commissioner)

Lead Director

Lead Assistant Director

1. Development of immunisation team with co-ordinator to oversee the HPV programme

Staff in post to deliver the HPV programme

September 2008 Total resource still needs to be identified.

S. McGoran Mr W Barron

2. Ensure first dose is given to year 9 girls. Monitoring of those missed through the Child Health System (CHS)

December 2008

3. Ensure second dose is given to year 9 girls and catch up on those who missed first dose. Review CHS data

March 2009

4. Ensure third dose is given to year 9 girls and catch up on those who have missed previous doses. Review CHS data

Delivery of HPV programme to year 9 girls

March 2010 As above



PSA (if any) 1.11: By December 2009, ensure that a comprehensive bowel screening programme for those aged 60 – 69 is in place, with a view to achieving a 10% reduction in mortality from bowel cancer by 2011


Bowel cancer screening: by December 2009, Trusts should have established a comprehensive bowel screening programme for those aged 60-69 (to include appropriate arrangements for follow-up treatment)



achieved?




Lead Director


Review apacity for bowel screening working in conjunction with the Trust Modernising Endoscopy Steering Group and develop business case for additional resources as required in conjunction with all specialties.

We will have achieved additional resources as identified from capacity analysis.


S. McGoran Ms R Smith

December 2008

March 2009

March 2010 10% reduction in mortality

from bowel cancer by 2011 March 2011 As above



PSA (if any) 1.12: By March 2009, extend the regional breast cancer screening programme to cover those aged 65 - 70




achieved?




Lead Director


N/A


Priority Area

1: IMPROVING HEALTH AND WELLBEING

PSA (if any)


Trusts should, by March 2010, establish screening arrangements for abdominal aortic aneurysm.



achieved?




Lead Director


DOH and Board Officers are currently debating this regionally. A number of meetings have been held involving Trust Reps but no final decision has been taken in respect of starting up this service, which will be facilitated by RJMH for the Province.

September 2008

Total resource still needs to be identified.

S. McGoran


Priority Area

1: IMPROVING HEALTH AND WELLBEING

PSA (if any)


Trusts should, by March 2010, make arrangements to extend the scope of antenatal screening for foetal anomalies



achieved?




Lead Director


There are 27 recommendations arising out of the Regional Audit of Antenatal Infection Screening.

We are currently fully complaint in 20. We will be fully compliant in the staff training as per number 11. However, all other recommendations need Department and Board directive / funding. Please see attached template.

September 2008 £10k required training for all staff and backfill of Antenatal Screening Co-ordinator to undertake same.

S. McGoran

December 2008

March 2009

March 2010


Priority Area 2 – Ensuring Safer, Better Quality Services


PRIORITY AREA 2: ENSURING SAFER, BETTER QUALITY SERVICES

PSA (if any) 2.1: By 2009, ensure a 10% reduction in the number of hospital patients with staphylococcus aureus bloodstream infections (including MRSA), and a 20% reduction in case of clostridium difficile infections


Healthcare associated infection: by March 2009, Trusts should secure a 10% reduction in staphylococcus aureus blood stream infections (including MRSA), and a 20% reduction for clostridium difficile



achieved?




Lead Director


Prevention & Infection Control Training To be provided for staff every 2 years with additional annual training for those in high risk areas such as renal and intensive care

55% of staff trained

September 2008 Allocated within Quality and Safety Resource of £793,760 for 2008/9. Final resource to be determined by commissioner.

C McArdle –IPC and All Directors

C Lee & All Assistant Directors


December 2008


March 2009


MRSA Screening Review Trust MRSA screening Policy Ref:- HSS(MD)12/2008 – Best Practice on Screening for Meticillin Resistant Staphylococcal Aureus (MRSA) Colonisation involving risk assessment to identify High Risk Groups within South Eastern HSC Trust

September 2008 Allocated within Quality and Safety Resource of £793,760 for 2008/9. Final resource to be determined by commissioner.

C McArdle & S McGoran

C Lee

Prepare Business case for additional resources for implementation of additional screening and required Infection Prevention Control responses.

December 2008 Resource requirement to be identified through Business case.

Implement additional screening as resourced.

March 2009 Allocated within Quality and Safety Resource of £793,760 for 2008/9. Final resource to be determined by commissioner.

Environmental Cleanliness Develop compliance with Environmental Cleanliness standards by having Rapid Response Teams on each hospital site to facilitate timely response to terminal cleaning of Isolation areas post patient discharge.

September 2008 Bids to DHSSPSNI have already been submitted 2007-08 aimed at facilitating Rapid Response to isolation /discharge terminal cleans.

E Molloy J Livingstone

December 2008 March 2009


Priority Area 2: ENSURING SAFER, BETTER QUALITY SERVICES

PSA (if any) Related Ministerial target (if any) By April 2008, Trusts must submit to the Department for approval and monitoring, quality improvement plans that

include Trust-specific targets for: ventilator associated pneumonia; surgical site infection; central line infection; and, the crash calls rate.



achieved?




Lead Director


The Trust is currently finalising a quality improvement plan relating to the patient safety targets identified for 2008/09. The plan (see attached) details Trust-specific targets for each of the patient safety priorities, along with details regarding measures and changes.

Quality Improvement plans submitted to DHSSPS in accordance with 30th April 2008 timescale. Monthly monitoring and reporting of compliance against patient safety targets to EMT, Trust Board and SDU. Review of data and, where necessary, action being taken in response to monthly performance and trends.

April 2008 Allocated within Quality and Safety Resource of £793,760 for 2008/9. Final resource to be determined by commissioner.

C. Martyn Lorna Telford


Priority Area

2: ENSURING SAFER, BETTER QUALITY SERVICES PSA (if any) Related Ministerial target (if any) All HSS Organisations [ Boards, Trusts, Agencies, Family Practitioner Services & Out of Hours Services ] should ensure

that, by June 2008, they have in place a plan for full implementation by January 2009 of the new HSC complaints procedure.



achieved?




Lead Director


Develop an action plan for the full implementation by January 2009 of the new HSC Complaints procedure

Action plan to ensure compliance with the implementation of the new complaints procedure (note – final document has not yet been released by DHSSPS yet. This may affect the implementation date of 1 Jan 2009 for the new procedures)

June 2008 Allocated within Quality and Safety Resource of £793,760 for 2008/9. Final resource to be determined by commissioner.

E. Molloy I Low

September 2008

Full implementation of new HSC complaints dependant upon receipt of DHSSPS document.

January 2009 As above



PSA (if any) Related Ministerial target (if any) Boards, Trusts, the NI Blood Transfusion Service and the NI Regional Medical Physics Agency should ensure that, by

September 2008, they have Improvement Plans in place to implement the recommendations arising from the governance and thematic reviews undertaken by RQIA in 2007-08.



achieved?




Lead Director


RQIA C&SC Governance Reviews: - RQIA C&SC Governance Report for legacy DLT and UCHT(October 2007): Action plans have been developed to address recommendations and progress towards implementation of these actions is being monitored via the Safe & Effective Care Committee, which reports to the Trust’s Governance Committee - RQIA C&SC Governance Review of SET (March 2008): Currently awaiting report from RQIA

Improvement plans in place for each report by September 2008 and progress towards implementation of action plans being monitored by high level Trust committee (Safe & Effective Care Committee)

September 2008 Assessment of resource requirements can only be undertaken when reports received form RQIA and actions against recommendations agreed. Allocated within Quality and Safety Resource of £793,760 for 2008/9. Final resource to be determined by commissioner.

C. McArdle L Telford


RQIA Themed Reviews: - Review of Mental Health & Learning Disability Services (October 2007): Finalised report received from RQIA on the 11th April 2008. Action plan to be developed and submitted to RQIA by 23rd May 2008. - Hyponatraemia Review (April 2008): Trust awaiting finalised report from RQIA. Action plans to be developed based on report recommendations - Clostridium Difficile Review (April 2008): Trust awaiting finalised report from RQIA. Action plans to be developed based on report recommendations - Medical Appraisal (April 2008): Trust awaiting finalised report from RQIA. Action plans to be developed based on report recommendations

September 2008



PSA (if any) Related Ministerial target (if any)

Trusts should ensure that, by March 2009, their delivery of residential, domiciliary and day care is compliant with care standards, as evidenced by RQIA inspections.



achieved?




Lead Director


* To action all care requirements identified in RQIA Inspection Reports and Quality Improvement Plans in the eleven statutory Residential facilities. * To ensure all Day care and Domiciliary staff are aware of the appropriate regulations and requirements expected to be achieved

70% Compliance with Regulations/Standards All appropriate managers familiar with Domiciliary and Day Care Regulations

September 2008 From within existing Trust resources

C.McArdle S.Browne

* To action all care requirements identified in RQIA Inspection Reports and Quality Improvement Plans in the eleven statutory Residential facilities. * To ensure appropriate systems and processes are in place to meet regulations stipulated by RQIA

85% Compliance with Regulations/Standards Appropriate processes and systems embedded in Domiciliary and Day care procedures

December 2008

Allocated within Quality and Safety Resource of £793,760 for 2008/9. Final resource to be determined by commissioner.

C.McArdle S.Browne


* To action all care requirements identified in RQIA Inspection Reports and Quality Improvement Plans in the eleven statutory Residential facilities. * To ensure all RQIA Inspection Reports are actioned within Domiciliary and Day Care

100% Compliance with Regulations/Standards Full compliance with Domiciliary and Day Care Regulations

March 2009

C.McArdle S.Browne



PSA (if any) Related Ministerial target (if any) By April 2008, Trusts must submit to the Department for approval and monitoring, quality improvement plans that

include Trust-specific targets for: ventilator associated pneumonia; surgical site infection; central line infection; and, the crash calls rate.



achieved?




Lead Director


A risk assessment is carried out on all patient discharges.

Patients who represent a significant risk to themselves or others have their discharge from hospital planned under 2004 discharge guidance.

April 2008 Will be completed within existing resources.

C. Martyn Don Bradley

September 2008

December 2008

Risk assessment will be carried out on all Mental Health patients on admission, on transfer and as appropriate during the patient episode. Team reviews will be conducted on patients in Mental Health Units on a weekly basis

To ensure that 95% of patients will have a risk assessment and management plan in place by March 2009 To ensure that 95% of patients receive a weekly multidisciplinary review detailing their progress, future management and agreed actions set against a timeframe by March 2009

March 2009 As above.


Priority Area 3 – Improving Acute Services


Priority Area 3: IMPROVING ACUTE SERVICES

PSA (if any) 3.1: By March 2011, ensure a 21 - week waiting time for drug therapies for treatment of severe arthritis

Related Ministerial target (if any) Trusts must submit to the Department, by April 2008, for approval and monitoring, quality improvement plans that

include Trust specific targets for adherence to good practice on mental health inpatient care as regards risk assessment, inpatient review and discharge planning.



achieved?




Lead Director


Directorate preparing business case for development of an Anti-THNF service in UHD.

This will enable the Trust to treat patients from Downe and Ulster areas currently on MPH waiting list.

September 2008 Circa £350K S. McGoran K McIlveen

December 2008

March 2009

March 2010

March 2011 Maximum 21 week waiting time for drug therapies for treatment of severe arthritis

March 2011 As above



PSA (if any) 3.2: By March 2009, no patient will wait longer than 9 weeks for a first outpatient appointment, 9 weeks for a

diagnostic test, and 17 weeks for inpatient or day case treatment Related Ministerial target (if any) Elective care (consultant led): Trusts should ensure that, from April 2008, no patient waits longer than 13 weeks for a

first outpatient appointment, 13 weeks for a diagnostic test, and 21 weeks for inpatient or day case treatment, reducing to 9 weeks for outpatients, 9 weeks for diagnostics and 13 weeks for treatment by March 2009. Commissioners and providers should work towards a total journey time of 25 weeks or less by March 2011 Please provide separate details on outpatients diagnostics inpatients and day cases.



achieved?




Lead Director


Inpatients and Daycases – 1. Introduction of common lists for specialities

Efficient use of all Trust sites Equity of service provision for all users

September 2008 £40K S. McGoran Ms C Allam

2. Introduction of pre assessment of endoscopy service

Reduction in DNA/CNA rates

September 2008

3. Continued reduction in waiting times for all specialities

Maximum wait of 17 weeks for inpatient and daycase elective surgery

December 2008 £7-8 Million

4. Improved use of day surgery

Reduction in length of wait for treatment

December 2008

5. Review of elective pathway and actions agreed

Reduced length of wait for entire elective care pathway Improved user satisfaction Improved user choice Maximum wait of 13 weeks for inpatient and day case elective surgery

March 2009


6. Review of theatre utilisation

Improved efficiency of theatre usage

March 2009

7. Introduction of full booking for elective pathway

Reduction in total journey time March 2011 £50K

Outpatients 1. General Surgery triage

Efficient use of all Trust sites Equity of service provision for all users Improved efficiency

September 2008

2. Review of all OPD templates, including benchmarking

Increased efficiency of outpatients

December 2008

3. Maximum utilisation of all outpatient clinics

Reduction in DNA December 2008

Maximum length of wait for 1st OPD appointment 11 weeks

December 2008

4. Review and propose extended working day

Efficiency of use of sites March 2009

Maximum wait of 9 weeks for 1st OPD

March 2009

5. Introduce one stop outpatient clinics e.g. cardiology

Improved user satisfaction Equity of service provision for all users

March 2009 £25K

6. Introduction of full booking for elective pathway

Reduction in total journey time March 2011



PSA (if any) 3.2: By March 2009, no patient will wait longer than 9 weeks for a first outpatient appointment, 9 weeks for a

diagnostic test, and 17 weeks for inpatient or day case treatment Related Ministerial target (if any)

Trusts should ensure that, by March 2009, all urgent diagnostic tests are reported on within two days of the test being undertaken, with 75% of all routine tests being reported on within two weeks and all routine tests within four weeks.



achieved?




Lead Director


Diagnostics 1. Ensure full

implementation of IEAP policy

2. Ensure PTL monitoring and adherence for all diagnostics

3. Develop robust reporting turnaround monitoring mechanisms

Reduction in DNA/CNA rates Improved reporting times Equity of service provision for all users Reduced length of wait

September 2008 £55K S. McGoran Ms C Allam

Continued performance monitoring for all diagnostics

Maximum length of wait reduced to11 weeks

December 2008

Development of pathways for cancer, elective, unscheduled

Improved user satisfaction Maximum length of wait reduced to 9 weeks Improved efficiency of service

March 2009



PSA (if any)


Elective care (AHP): Trusts should ensure that, from April 2008, no patient waits longer than 26 weeks from referral to commencement of AHP treatment, reducing to 13 weeks by March 2009.



achieved?




Lead Director


Diagnostics Ensure full implementation of IEAP policy Ensure PTL monitoring and adherence Review demand/capacity Review current working patterns Agree treatment pathways and protocols, including number of reviews and treatments

Reduction in DNA/CNA rates Equity of service provision for all users Reduced length of wait Efficient use of services available

September 2008 £250K Physio S. McGoran K. Thompson C. McArdle

Ms C Allam

Continued performance monitoring for all diagnostics

Maximum length of wait reduced to11 weeks

December 2008

Development of pathways for cancer, elective, unscheduled

Improved user satisfaction Maximum length of wait reduced to 9 weeks Improved efficiency of service

March 2009



PSA (if any) 3.3: By March 2009, 95% of patients will, where clinically appropriate, wait no longer than 48 hours for inpatient fracture treatment


Trusts should ensure that, from April 2008, 75% of patients wait, where clinically appropriate, no longer than 48 hours for inpatient fracture treatment, increasing to 95% by March 2009.



achieved?




Lead Director


Trust wide multi professional Fracture Reform and Modernisation project ongoing. Trauma Coordinators controlling emergency and TCI theatre list. Planned recruitment of third Trauma Coordinator Trauma Coordinators to be trained in pre operative assessment 6 Acute rehabilitation beds planned. Anaesthetic staff and staff grade ortho physicians to be recruited. Extended theatre days to be rolled out to 5 days per week.

75% - 85% of patients, waiting no longer than 48 hours for inpatient fracture treatment


S. McGoran

Ms R Smith


Consideration being given to include simple metal removals on Downe lists Extended working week for AHP’s commenced April/May Regional changes to be agreed to fracture access data base to ensure more efficient and accurate monitoring Increased access to community rehabilitation services

September 2008

Regional agreement with NIAS regarding service requirements to ensure timely discharges and admissions

85% -95% of patients, waiting no longer than 48 hours for inpatient fracture treatment

December 2008

As above

Fracture project ongoing as above

95% of patients, waiting no longer than 48 hours for inpatient fracture treatment

March 2009 As above



PSA (if any) 3.4: By March 2009, 98% of cancer patients will commence treatment within 31 days of decision to treat, and

95% of patients urgently referred with suspected cancer will begin treatment within 62 days

Related Ministerial target (if any) Trusts should ensure that, from April 2008, 98% of patients commence treatment within 31 days of the decision to treat;

from April 2008, 75% of patients urgently referred with a suspected cancer should begin their first definitive treatment within 62 days, increasing to 95% by March 2009.



achieved?




Lead Director


Re-structuring of cancer services team and appointment of Operational Manager

A streamlined and co-ordinated approach to implementation and achievement of the targets.

September 2008

£52,373 as per allocation in cancer bid.

S. McGoran

Mr W Barron

Appointment of an adequate team of trackers allocated to specific tumour sites to ensure timely navigation and escalation of potential breaches.

Robust navigation of all patients through timed clinical pathways

December 2008

£58,754 Band 5 and Band 3 as per allocation in cancer bid.

Review of all OPD templates to ensure adequate capacity for red flag referrals

Increased efficiency and capacity for red flag referrals

March 2009

Review and proposed extended working day in chemotherapy day unit

First definite treatment to be provided within agreed timeframes.

£32,700 Chemotherapy Nurse as per allocation in cancer bid

Continuous review and redesign of each tumour site to improve patient flows

High quality, services providing value for money and sustainability


Monitoring of timeliness of radiotherapy treatment in collaboration with Belfast Trust.

First definitive treatment to be provided within agreed timeframes.

Managed entry of new evidence based treatments

Provision of evidence based treatments to patients.

Review and modernisation of endoscopy services with establishment of a Trust Steering Group.

Adequate capacity for timely endoscopy for all patients with suspect cancer.



PSA (if any) Related Ministerial target (if any) A & E: Trusts should ensure that, from April 2008, 95% of patients attending A&E are either treated and discharged

home, or admitted within four hours of their arrival in the department. By March 2009, Trusts should ensure that this level of performance is achieved in individual hospital sites.

Actions/ Proposed

Service Developments Output

What will you have achieved?




Lead Director


Systems and processes are in place to monitor compliance against the target and will be rolled out across the 3 sites. Further development of consultant screening service across the 3 sites.

95% of patients attending A&E are either treated and discharged home, or admitted within 4 hours of their arrival in the department.

September 2008 C £150K S. McGoran

K McIlveen

December 2008

95% of patients attending A&E are either treated and discharged home, or admitted within 4 hours of their arrival in the department in individual hospital sites.

March 2009



PSA (if any) 3.5: By March 2011, ensure a 10% reduction in mortality and disability from stroke


Actions/ Proposed Preparation of Service

Developments


achieved?




Lead Director


Business case for stroke to include proactive early diagnosis and treatment through thrombolysis service and supported by recruitment of appropriately skilled staff.

Outpatients to be identified within business Case.

March 2009 Business case at embryonic stage resource likely to be £600K

S. McGoran K McIlveen



PSA (if any) 3.6: By March 2009, at least 50% of patients (rising to 60% by 2010) should receive dialysis via a fistula, and no

patient should wait longer than nine months for a live donor transplant (six months by 2010) Related Ministerial target (if any)

Trusts should, from 2008 – 09, provide capacity for an additional 40 patients per year to commence dialysis therapy (increasing by a further 40 patients in both 2009 – 10 and 2010 – 11)



achieved?




Lead Director


Business case submitted for expansion of renal services which will facilitate an additional 18 patients per year. At present more than 50% receive dialysis via a fistuyla. Subject to ongoing monitoring. 12 patients are currently awaiting live donor transplant – no suitable matches found to date.

September 2008 Resource identified in business case £1.2m

S. McGoran K McIlveen



PSA (if any) Related Ministerial target (if any) Boards and Trusts should ensure that arrangements are in place to ensure the timely and effective implementation of

the Department’s cardiovascular service framework. An action plan should be developed, in conjunction with primary care, and submitted for Departmental approval by December 2008.



achieved?




Lead Director


While the Trust is awaiting formal ratification of the framework it has been considering the resources required to deliver component parts such as expansion of the heart failure service, community rehab.

September 2008 Not known at this stage – total resource still to be determined

S. McGoran

K McIlveen



PSA (if any) Related Ministerial target (if any) Trusts should ensure that, from April 2008, all urgent GP referrals for breast cancer are seen within 14 days of the

receipt of the referral, with all urgent breast cancer referrals – from both GPs and other practitioners – being seen within 14 days by March 2009



achieved?




Lead Director


Over the last 4 months 100% of patients have been seen within 14 days of referral. The Trust will continue to monitor referrals on a weekly basis to ensure continued achievement of the target.

Continued achievement of the target.

September 2008

Total resource still needs to be identified.

S. McGoran

Mr W Barron

Development of a dedicated stand alone Specialist Breast Unit

A specialist unit with dedicated radiology and pathology to ensure that with the anticipated rise in activity achievement of the target can be sustained.

March 2009




Trusts should ensure that, by March 2009, a dedicated paediatric and neo-natal intensive care transport service is in place on a 24/7 basis.



achieved?




Lead Director


DOH and Board Officers are currently debating this Regionally. A number of meetings have been held involving Trust Reps but no final decision has been taken in respect of starting up this service, which will be facilitated by RJMH for the Province.

September 2008

Regional service funded by DHSS but 2 day transport course required for all trained staff cost approx £20K

S. McGoran

Mrs E McElkerney




Trusts should ensure that, by June 2008, they have plans in place for the immediate development of services to preserve the sight of people affected by age related macular degeneration, consistent with the emerging evidence base for treatment of this condition.



achieved?




Lead Director


Develop opthamology services at the Downe Hospital

June 2008

Discussions with the Belfast Trust for the transfer of funding

S. McGoran

Ms R Smith


Priority Area 4 – Ensuring Fully Integrated Care and Support in the Community


Priority Area 4: ENSURING FULLY INTEGRATED CARE AND SUPPORT IN THE COMMUNITY PSA (if any) 4.1: by March 2010, 45% of people with assessed community care needs supported at home Related Ministerial target (if any)

Trusts should ensure that, by March 2009, 44% of people in care management have their assessed care needs met in a domiciliary setting.

Actions/Proposed Service Developments

Output What will you have achieved?


Associated resource allocation (split by commissioner)

Lead Director


Establishment of domiciliary care brokerage system to streamline identification of available domiciliary care resource. Short term domiciliary care capacity created to support rehabilitation at home via re-configuration of in-house capacity in NDA sector

44% in domiciliary setting September 2008 Re-configuration of existing staff roles in the first instance. HWIP monies for additional care packages invested in increased overall domiciliary care capacity

C McArdle A Mayhew

Establish block contracts for all SET domiciliary care providers and increase capacity as per above to the whole Trust.

45% in domiciliary setting December 2008 Use of existing domiciliary spend and augment share of the £800K for new packages

Internal target of 46% in domiciliary setting

March 2009

48% in domiciliary setting March 2010


Priority Area 4: ENSURING FULLY INTEGRATED CARE AND SUPPORT IN THE COMMUNITY PSA (if any) 4.2: From April 2008, no older person with continuing care needs will wait more than eight weeks for a

completed assessment, with the main components of care met within a further 12 weeks Related Ministerial target (if any)

Trusts should ensure that, from April 2008, older people with continuing care needs wait no longer that eight weeks for assessment to be completed and have the main components of their care needs met within a further 12 weeks.





Lead Director


Ensuring potential breeches procure system fully utilised to alert to 2 weeks before deadline. Alert to the Assistant Director, Older Peoples Services for people waiting 6 weeks and 10 weeks respectively

We are currently meeting this target 31/3/08 and aim to continue with full compliance

September 2008 £800k indicated in HWIP as available for care packages – this will assist with meeting the target

C McArdle A Mayhew

Compliance December 2008 Compliance with target March 2009


Priority Area 4: ENSURING FULLY INTEGRATED CARE AND SUPPORT IN THE COMMUNITY

PSA (if any) 4.4: From April 2008, 90% of patients with continuing complex care needs will be discharged from an acute setting within 48 hours of being declared medically fit, and no complex discharge will take longer than seven days – in all cases with appropriate community support

Related Ministerial target (if any) Complex discharges: Trusts should ensure that, from April 2008, 90% of complex discharges take place within 48 hours, with no discharge taking longer than seven days.

Actions/ Proposed Service

Developments Output



Associated Resource Allocation (split by

Commissioner)

Lead Director


Provision of additional rapid response domiciliary care places Development of complex care teams Implementation of reviewed complex care pathway

10 additional rapid response 2additonal SW staff 2 care managers and 1 OT Fully met target

September 2008 330K EHSSB C. McArdle

Sarah Browne

Bolstered infrastructure of complex care teams

Meeting the 90% target within 48 hrs Fully met target

December 2008

Meeting the 90% target within 48hrs Fully met target

March 2009



PSA (if any) 4.5: All non complex patients will, from April 2008, be discharged from hospital within six hours of being declared medically fit.

Related Ministerial target (if any) Trusts should ensure that, from April 2008, all non-complex discharges take place within a maximum of six hours.



achieved?




Lead Director


Continue focus on early discharge planning at ward level and at daily patient flow meetings Early engagement with family re transporting patient home. Daily review of EDD’s and review of patients who were not discharged on the planned date

95%


S. McGoran

Ms D Keown

Monitor and address incorrect coding and recording with staff directly involved

96%

December 2008

Engage with NIAS regarding discharge delays and Improved response to ambulance requests for discharge Booking of appropriate vehicle for transport

98%

March 2009



PSA (if any) Related Ministerial target (if any) Boards and Trusts should ensure that arrangements are in place to ensure the timely and effective implementation of

the Department’s respiratory service framework. Action plans should be developed, in conjunction with primary care, and submitted for Departmental approval by February 2009

Actions/ Proposed






Lead Director


Telehealth monitoring respiratory patients Down Lisburn Sector

70 patients will have access to Telehealth monitoring units with a 10% drop in hospital admissions. Full evaluation

£70 k funding requested from Eastern Health & Social Services Board. Supporting People

C. McArdle

Lynda Campbell

Palliative Care Support Development of 24 hr Rapid Response District Nursing Service

December 2008 2 x Band ‘E’ Nurses Funded by EHSSB HWIP 58 k

Lynda Campbell

Telehealth Project Trustwide

150 patients Trustwide will have access to Telehealth monitoring units

February 2009 1 x Band 6 Nurse Co-ordinator £38k Funding for Telehealth monitoring 150 k Funding from Eastern Board through European Centre for Connected Health

Lynda Campbell


Priority Area 4: ENSURING FULLY INTEGRATED CARE AND SUPPORT IN THE COMMUNITY PSA (if any) Related Ministerial target (if any)

Trusts should ensure that, by March 2009, the number of direct payment cases increases to 1,000 (rising to 1,500 by March 2011)





Lead Director


Identify elements of service the trust would seek to “normally “ provide by way of direct payments and promote as such

September 2008 Use existing and additional (800K) Community Care resource to provide more packages by direct payments

C McArdle K Thompson D Bannon

A Mayhew

Explore partnership with voluntary sector organisation to act as facilitator for older people taking up direct payments

December 2008

1000 direct payment cases March 2009 March 2010


Priority Area 5 – Improving Children’s Services


Priority Area 5: IMPROVING CHILDREN’S SERVICES

PSA (if any) 5.1 By March 2011 reduce by 12% the number of children in care. Related Ministerial target (if any) Children: Trusts should ensure that, by March 2009, the number of children in care is reduced by 3% in comparison

with the figure at March 2008 (rising to a 12% reduction by March 2011)

Actions/ Proposed

Service Developments


achieved?




Lead Director


This will be met dependant on the other targets in Section 5 being achieved.

Allocated within Family Support Services resource of £695K for 2008/9

K. Thompson

J McGarvey J Toner

Actions outlined in following sections.

3% reduction in the number of children in care from the number in care at 31 March 2008

March 2009

Trust % target to be confirmed.

March 2010


March 2011

March 2010


March 2011 As above



PSA (if any) 5.1 By March 2011 reduce by 12% the number of children in care. Related Ministerial target (if any) Trusts should, by June 2008, have developed agreed regional guidance on the use of family group conferencing for

children and young people and, by March 2009, ensure that at least 500 children and young people whose assessed need is on levels 1, 2 or 3 measured on the Hardiker model should have participated in a family group conference

Actions/ Proposed






Lead Director


SET involved in developing the regional guidance.

The guidance will be developed and implemented.

June 2008 Allocated within Family Group Conferencing resource of £99K for 2008/9

K. Thompson

J McGarvey

Communicate regional guidance and ensure sufficient convenors are in place to chair Family Group Conferences for the increased numbers. Develop action plan.

Guidance in use. Additional convenors in post. Family Group Conference Steering Group [SET/Belfast Trust] to monitor achievements and targets.

September 2008 As above

SET and Belfast Trust allocation of 500 achieved.

March 2009 As above



PSA (if any) 5.1 By March 2011 reduce by 12% the number of children in care. Related Ministerial target (if any) Trusts should, by December 2008, have in place a regional, independent, birth parent mediation service available to all

birth parents where adoption is the plan, and must have agreed a regional model for a post-adoption contact mediation and facilitation service and a therapeutic support service.

Actions/ Proposed






Lead Director


SET to be involved in developing the Regional Proposal for mediation service.

Agreed model to be implemented.


K. Thompson

J McGarvey

To ensure the Regional Model is linked to the local services.

Agreed model in place. December 2008 As above



PSA (if any) 5.3: By March 2011, increase by 50% the proportion of care leavers in education, training or employment at age 19.

Related Ministerial target (if any) Trusts should, by September 2008, have in place a plan setting out how they intend to achieve an increase by March

2010 of 300 foster carers across Northern Ireland from the March 2006 total and, by March 2009, have agreed regionally a priority salaried foster care initiative targeted at older young people in care.

Actions/ Proposed






Lead Director


SET to re-profile fostering service and develop action plan identifying targets for 2008/09, 2009/10, 2010/11.

Plan developed September 2008 Allocated within preparation for adulthood £117K for 2008/9 And Support Positive Outcomes £199K for 2008/9

K. Thompson

J McGarvey

To assess the older young people in care and put in place a regional salaried foster care initiative

Agreement on priority salaried foster care initiative. 7 additional places provided.

March 2009 As above

Liaise with Belfast Trust recruitment team.

C56 additional foster carers March 2010 As Above

SET’s allocation of foster carers who are salaried is achieved.

March 2011 As above

To ensure the recruitment process of foster carers is effective and to maintain existing foster carers.

Increase of 300 in the number of foster carers from the March 2006 total

March 2010 As Above

To ensure the salaried scheme is effective

Increase the number of foster carers who are salaried by 100, focusing specifically on foster carers recruited to work with older children in care

March 2011 As above



PSA (if any) 5.3: By March 2011, increase by 50% the proportion of care leavers in education, training or employment at age

19.

Related Ministerial target (if any) Trusts should, by September 2008, confirm to the Department (via their respective Directors of Children's Services) that

all eligible, relevant and former relevant young people have pathway plans and personal advisers in place, in line with statutory requirements and Departmental guidance.

Actions/ Proposed






Lead Director


Develop Personal Advisor Scheme.

Personal Advisors Scheme in place. Development of pathway plans for all relevant young people. Appointment of Personal Advisors.

June 2008 Allocated within preparation for adulthood £117K for 2008/9 And Support Positive Outcomes £199K for 2008/9

K. Thompson

J McGarvey

To ensure the quality of the Pathway Plan and that there is sufficient Personal Advisors for young people.

Pathway plans and personal advisors in place.

September 2008 As above




Related Ministerial target (if any) Trusts should, by September 2008, have established a 6-month pilot therapeutic support scheme in two intensive

support residential children's homes.

Actions/ Proposed






Lead Director


Establish Steering Group. Develop Project Plan. Develop the Sanctuary Model for Looked After Children Services. Appoint Band 7 Co-ordinator. Develop training for staff in use of model.

Project plan in place. Model developed. 30 staff trained in use of model. Pilot schemes in place in 2 homes.

September 2008 Allocated within preparation for adulthood £117K for 2008/9 And Support Positive Outcomes £199K for 2008/9

K. Thompson

J McGarvey

Review pilot schemes and develop appropriate recommendations. Roll out the revised model across the Trust.

December 2008 As above

Roll out of the revised model across the Trust.

Model in place in approximately 50% of Children’s Homes, secure and ICUs.

March 2009 As above

Roll out of the revised model across the Trust.

Model in place in all Children’s Homes, secure and ICUs.

March 2010

As above




Related Ministerial target (if any) Trusts should, by December 2008, have put in place the regionally agreed guidance and arrangements to support

young people aged 16-17 in care to engage in part-time and full-time employment and, by March 2009, must have appointed dedicated development workers within transition teams as part of a training, education and employment support scheme for young people aged 16+ in care or who have left care.



achieved?




Lead Director


Develop regional guidance for young people 16-17 for part time and full time employment. Begin process of reprofiling teams. Develop Action Plan to include actions such as: • Increase number of

LAC with an educational mentor;

• Establish a Trust work placement scheme.

Agreement on regional model. New teams in place.

September 2008 Allocated within preparation for adulthood £117K for 2008/9 And Support Positive Outcomes £199K for 2008/9

K. Thompson

J McGarvey

Develop systems and structures to implement the model. Appoint transitional workers.

Agreed guidance and arrangements in place.


Dedicated development workers in post within transition teams.

March 2009 As above


To ensure the new model is working effectively.

To monitor this new service. March 2009 As above

To ensure effective arrangements to engage young people in education training or employment

To monitor the outcome through the LAC Outcomes Group

March 2010 As above

To continue to review the effectiveness of the service.

Increase of 50% of population of care leavers. Population in care as at 1 April 2008 who, having left care turn 19 in 2010/11 in education training or employment at age 19

March 2011 As above



PSA (if any) 5.4: By March 2011, increase by 25% the number of care leavers aged 18 – 20 living with former foster carers or supported family




achieved?




Lead Director


Re-profile teams and develop action plan to increase the number of care leavers with former foster carers or supported family.

6 additional care leavers living with former foster carers

March 2009 Allocated within Living with Former Foster Carers £69K 2008/9

K. Thompson

J McGarvey

Establish early links with foster carers. Provide support and training to foster carers.


March 2010 As above


March 2011

As above


Priority Area 6 – Improving Mental Health Services


Priority Area 6: IMPROVING MENTAL HEALTH SERVICES PSA (if any) 6.1: By March 2011, ensure a 10% reduction in admissions to mental health hospitals Related Ministerial target (if any)



achieved?




Lead Director


Development of a six-bedded Crisis House on the Enterprise Court site, Conlig to provide an alternative to hospital admission.

3% reduction in admissions across Ards, Downshire and Lagan Valley acute admissions units.

March 2009

£390,000

D. Bannon

D Bradley

Strengthen staffing levels within Community Mental Health Teams to ensure full compliance with the 2004 Discharge Guidance Agree with the Commissioner and implement proposals to enhance the Crisis Response and Home Treatment service provision by increasing staffing levels both qualified and unqualified.

7% reduction in admissions to Ards, Downshire and Lagan Valley acute admissions unit.

March 2010

£739,000

D. Bannon

D Bradley

Enhance services which operate seven days per week and out of hours.

10% reductions in admissions to Ards, Downshire and Lagan Valley acute admissions units.

March 2011

As above D. Bannon

D Bradley


Priority Area 6: IMPROVING MENTAL HEALTH SERVICES PSA (if any) 6.3: By 2009, ensure a 13 week maximum waiting time for defined psychotherapy services

Related Ministerial target (if any) Assessment and treatment: Trusts should ensure that, from April 2008, no patient waits longer than 13 weeks from

referral to assessment and commencement of treatment for mental heath issues, other than psychological therapies where the 13-week maximum waiting time is to be achieved by March 2009.



achieved?




Lead Director


Complete a capacity and demand analysis for Psychological Therapies in the South Eastern Trust area. Develop a primary targeting list. Increase the number of psychotherapy sessions provided across the Trust by 10 per week in line with the level of investment from the Commissioner. This will include increasing the current staffing complement. Contribute to the development of a Regional Stepped Care Model for psychological therapies which effectively meets identified need at Primary, Secondary and Tertiary levels.

13 week target for Psychological Therapies will be achieved.

March 2009

£484,000

D. Bannon

D Bradley


Introduce a single point of access for all referrals to mental health services to the North Down & Ards sector and strengthen community teams throughout the South Eastern Trust area. Commence Primary Care based pilot providing 16 Cognitive Behavioural Therapy sessions per week in GP surgeries.

Maximum wait for assessment and treatment reduced to 13 weeks for all patients requiring assessment and for those who require treatment in the SET area.

May 2008 Total resource still to be determined.

D. Bannon

D Bradley


Priority Area 6: IMPROVING MENTAL HEALTH SERVICES PSA (if any) Related Ministerial target (if any) Discharge: Trusts should ensure that, by March 2009, 75% of patients admitted for assessment and treatment are

discharged within seven days of the decision to discharge, with all other patients being discharged within a maximum of 90 days. In exceptional circumstances where patients are delayed in hospital beyond 90 days the Department will expect the relevant Trust to have robust plans in place to work towards the provision of appropriate care for the patient in a non-hospital setting, with that care plan beginning not later than 12 months after the original discharge date.

Actions/ Proposed






Lead Director


Establish policies and systems to identify and report on delayed discharges/transfers and agree responsibilities and action plans to affect timely discharge.

Benchmarking exercise completed identifying % of patients where target is not being achieved.

September 2008

£739,000 i.e part of the monies to strengthen Community Teams

D. Bannon

D Bradley


Identify gaps in service provision which result in delayed discharge and prepare a Business Case for the provision of alternatives to hospital care.

50% of patients admitted for assessment and treatment are discharged within seven days of the decision to discharge.

December 2008

As above D. Bannon

D Bradley

75% of patients admitted for assessment and treatment are discharged within seven days of the decision to discharge with all other patients being discharged within a maximum of 90 days.

March 2009

As above D. Bannon

D Bradley

To agree with the EHSSB the level of additional investment to relocate Acute and Dementia Services to the New Downe Hospital

New Acute provision will be established in the Downe and Ulster Hospitals

June 2009 As above D. Bannon D Bradley


Priority Area 6: IMPROVING MENTAL HEALTH SERVICES PSA (if any) Related Ministerial target (if any)

Trust should, by March 2009, provide an additional 500 dementia respite places a year (increasing to 2,000 by March 2011)





Lead Director


Block purchase 2 EMI nursing home beds ( 0.5 year) for provision of rotational respite

Block purchasing arrangements will be in place and service commenced

September 2008 D Bannon Andy Mayhew

Enhance the level of domiciliary based respite support for carers of people with dementia on Ards and North Down side, through arrangement with independent sector organisation

Agreement with independent sector organisation in place and respite service outreach service commenced

December 2008

52 weeks additional care home respite Plus 217 additional domiciliary respite sessions delivered

March 2009 £42k

March 2010 £58k 2,000 additional dementia

respite places a year provided ( 335 S/E trust)

March 2011 £67k


Priority Area 7 – Improving Services for People with a Disability


Priority Area 7: IMPROVING SERVICES FOR PEOPLE WITH A DISABILITY PSA (if any) 7.1: By March 2011, ensure a 25% reduction in the number of long stay patients in learning disability institutions Related Ministerial target (if any) Resettlement: Trusts should, by March 2009, resettle 60 patients from hospital to appropriate places in the community

compared to the March 2006 total (and a further 60 by March 2011). Actions/ Proposed






Lead Director


• Opening of new

resettlement Supported Housing Scheme in Lisburn Sector by June 2008 to offer 3 additional resettlement placements.

• Development of

community based support by extending Day Care Services and Support Services to support resettlement

3 additional resettlements

September 2008 Resettlement / Dowry funds as agreed with EHSSB

D. Bannon

B. Mongan

Confirm two placements in the voluntary/ independent sector to support 2 resettlements. Extend Day Care and Support Services to support resettlements


December 2008 Resettlement / Dowry funds as agreed with EHSSB

D. Bannon B.Mongan


Reconfigure Community Services to make available 3 additional placements in existing services.

3 additional resettlement placements

March 2009 Resettlement / Dowry funds as agreed with EHSSB

D. Bannon B.Mongan

Opening of new resettlement housing scheme to offer 3 additional placements and re-profiling of existing services to provide 1 additional resettlement placement


March 2010 Resettlement / Dowry funds as agreed with EHSSB

D. Bannon B.Mongan

Development of new resettlement service to offer 5 additional resettlement placements

5 additional resettlements March 2011

Resettlement / Dowry funds as agreed with EHSSB

D. Bannon B.Mongan


Priority Area 7: IMPROVING SERVICES FOR PEOPLE WITH A DISABILITY PSA (if any) 7.2: By March 2011, improve access to physical / sensory disability care by providing an additional 200 respite

packages a year Related Ministerial target (if any)

Trusts should ensure that, by March 2009, access to physical/sensory disability care is improved by providing an additional 50 respite packages a year (increasing to 200 by March 2011)



achieved?




Lead Director


Complete a review of Day Care and Respite Services

Modernisation reform action plan in place. 2 additional packages by September 2008

September 2008 £199K D. Bannon

B.Mongan

Person centred planning to identify Day Care and Respite opportunities in line with individual service users assessed needs and their wishes; maximising the use of Direct Payments. Employ an additional community co-ordinator to provide enhanced personalised Day Care and Respite opportunities using Direct Payments to extend respite options Develop locality based community co-ordinator services to ensure access to mainstream community opportunities.

Further Development of community based services. Further 2 additional packages by December 2008.

December 2008 As above D. Bannon B.Mongan


Develop 8 additional respite placements in 08/09 to offer enhanced respite services. Scope range of respite options within community, voluntary and independent sectors. Extend update of Direct Payments to meet individualised respite options.

Further 4 additional packages by March 2009

March 2009 As above D. Bannon B.Mongan

Increase respite options through personalised care packages

Further 3 additional respite packages

March 2010 As above D. Bannon B.Mongan

Increase respite options through personalised care packages

Further 23 additional respite packages

March 2011

As above

D. Bannon B.Mongan


PRIORITY AREA 7: IMPROVING SERVICES FOR PEOPLE WITH A DISABILITY

PSA (if any) 7.3: By March 2011, ensure a 13 week maximum waiting time for specialised wheelchairs Related Ministerial target (if any)

Trusts should ensure tha t, by March 2009, 35 additional specialised seats/wheelchairs have been provided compared to the position at March 2008.



achieved?




Lead Director


New provision will be determined by professional assessment, availability of the product on contract and the rate at which individuals with the specialised wheelchair need are referred to the service. Actual numbers will be monitored monthly.

September 2008 Total resource still to be determined.

C. McArdle

In line with the OT waiting list target, clients will be assessed within the 13 week PFA target, however the product delivery time will be determined by the contract standards and actual supply. Formal quarterly monitoring meetings with the Regional Wheelchair Service will be set up. Weekly progress check will be undertaken by the OT.'s responsible for wheelchair services.

December 2008 Total resource still to be determined.


A month on month review of users whose existing chair is 5 years or over will be undertaken through monthly assessment clinic and in line with the contracted planned maintenance programme. Where appropriate replacement specialist wheelchairs will be provided in line with the target.

35 additional specialised seats/wheelchairs

March 2009 Total resource still to be determined.

Current indoor powered wheelchair users will be reviewed to determine any change in circumstance that may result in assessment and testing for outdoor powered wheelchair provision. Month on month action by OT.wheelchair services.

March 2010 Total resource still to be determined.

A review of young adults leaving special Education Schools will be undertaken January 2009 - March 2009 to determine the need for upgrade to specialist wheelchair provision.

Maximum 13 week waiting time for specialist wheelchairs

March 2011

Total resource still to be determined.


Priority Area 7: IMPROVING SERVICES FOR PEOPLE WITH A DISABILITY PSA (if any) 7.4: By March 2011, improve access to learning disability care by providing an additional 200 respite packages a

year Related Ministerial target (if any)

Trusts should ensure that, by March 2009, access to learning disability services is improved through the provision of an additional 50 respite packages a year (increasing to 200 a year by March 2011).



achieved?




Lead Director


• Extend personalised care options and extend the use of Direct Payments to meet personalised respite options.

• Extend the use of

Residential and Day Care Facilities to offer extended opening hours and increased flexibility to extend non-residential and residential based respite.

• Purchase of one

additional respite bed

4 additional respite packages for complex health (Learning Disability) offering 219 additional bed nights for people with Learning Disability and Complex Health needs.


B.Mongan

Re-profile and extend respite services with Voluntary Sector Provider to secure 2 additional respite beds

438 additional bed nights for Learning Disability 08/09

December 2008 As above. D. Bannon B.Mongan


Re-profile and extend respite services with voluntary sector provider to secure 2 additional respite beds

438 additional bed nights March 2009 As above. D. Bannon B.Mongan

Maximise respite bed nights at statutory facility by re-profiling the user population Move 2 residents on to long term placements to release respite bed nights.

Providing the equivalent of 219 bed nights.

March 2010 As above. D. Bannon B.Mongan

Rebuild and extend statutory respite services to offer additional bed nights to extend the number of users and respite packages.

Additional 2 beds offering 438 additional bed nights

March 2011

As above.

D. Bannon B.Mongan


Priority Area 7: IMPROVING SERVICES FOR PEOPLE WITH A DISABILITY PSA (if any) Related Ministerial target (if any)

Discharge: Trusts should ensure that, by March 2009, 75% of patients admitted for assessment and treatment are discharged within seven days of the decision to discharge, with all other patients being discharged within a maximum of 90 days. In exceptional circumstances where patients are delayed in hospital beyond 90 days the Department will expect the relevant Trust to have robust plans in place to work towards the provision of appropriate care for the patient in a non hospital setting, with that care plan beginning not later than 12 months after the original discharge date.



achieved?




Lead Director


• Establish Complex Needs Panel within South Eastern Trust to ensure multi-disciplinary planning with view to preventing hospital admission and ensure timely discharge post treatment.

• Develop joint admission

and discharge protocols with Muckamore/Belfast Trust

Reduction in number of admissions. All discharged within a maximum of 90 days.


B.Mongan

Scope service model for Community Learning Disability Forensic Service which will actively monitor and support individuals with complex needs discharged to the community. Establish discharge co-ordinator to meet 2004 discharge guidance

December 2008 As above D. Bannon B.Mongan


Develop Crisis Response Services and develop community infrastructure through the development of Behaviour Support Services offering extended services

75% of patients admitted for assessment and treatment discharged within 7 days of decision to discharge.

March 2009 As above. D. Bannon B.Mongan


Priority Area 7: IMPROVING SERVICES FOR PEOPLE WITH A DISABILITY PSA (if any) Related Ministerial target (if any)

Trusts should ensure that, by March 2009, all children are resettled from hospital to appropriate places in the community.



achieved?




Lead Director


Placement identified – person centred care planning process progressed.

Discharge of one young person to agreed placement by September 2008

September 2008 £600K D. Bannon K. Thompson

B.Mongan

Scoping all available age appropriate placement options

3 resettlement placements confirmed

December 2008 As above D. Bannon K. Thompson

B.Mongan

Placements confirmed for 3 young people.

3 additional children and young people resettled (Total 4 resettled)

March 2009 As above D. Bannon K. Thompson

B.Mongan


Priority Area 9 – Improving Productivity


Priority Area 9: IMPROVING PRODUCTIVITY

PSA (if any) 9.1: Improve productivity, efficiency and effectiveness in the HSC as measured by such indicators as: - Patient throughput per bed - Ratio of day cases to inpatient cases - Use of more effective drug therapies - Greater use of generic drugs - Improved procurement practice - Proportion of people with community care needs supported at home - Staff absenteeism

Related Ministerial target (if any) Hospital productivity: each Trust will be expected to achieve a 3% improvement in hospital productivity, from its 2006-07

base year, for each year over the CSR period.

Actions/ Proposed






Lead Director


On receipt of the Productivity reports from DHSSPSNI the Trust will consider those areas where productivity needs to be improved.


E. Molloy

Hugh Mc Poland

Workshop with relevant directors to identify specific initiatives to move towards target achievement. Identification of action plans and production of monthly reports on the changes associated with action plan.

Achievement of milestone targets set out in Productivity targets in respect of attendance , staff turnover and skill mix reviews.

March 2009 As above



PSA (if any) 9.1: Improve productivity, efficiency and effectiveness in the HSC as measured by such indicators as:

- Patient throughput per bed - Ratio of day cases to inpatient cases - Use of more effective drug therapies - Greater use of generic drugs - Improved procurement practice - Proportion of people with community care needs supported at home - Staff absenteeism

Related Ministerial target (if any) Each Trust should ensure that, during 2008-09, levels of absenteeism are reduced to 10% below average 2006-07 levels

in its legacy Trusts, working towards a regional target of 5.2% in 2010-11.

Actions/ Proposed






Lead Director


Develop Revised Absence Control Policy

Revised Absence Control Policy in place.


E. Molloy

Jennifer Buchanan

10% Reduction in absenteeism.

March 2009




Related Ministerial target (if any) Each Trust should ensure that, by March 2009, the number of admin and clerical staff as a proportion of all Trust staff is

reduced to 19.5%.

Actions/ Proposed






Lead Director


• Completion of Administrative staffing review by Beeches Management Centre

• Review of use of Medical Secretaries

Identification of benchmarks for Admin and Clerical Staffing


E. Molloy

H. Mc Poland

Comparative analysis of A&C posts on HRMS with budget systems.

Quality assurance of data


Continue with work of Workforce Control and Monitoring Group

Corporate assessment of staffing trends and relevant action plans in place

March 2009 As above




Related Ministerial target (if any) Each Trust should ensure that, by March 2009, its ratio of qualified to unqualified nurses is reduced to 72:28.

Actions/ Proposed






Lead Director


Undertake in conjunction with Nursing a review of current staffing levels of qualified Nursing and where they are

Plan to reduce the number of Registered Nurses and develop a plan to increase the training for unregistered nursing staff.


E. Molloy

H. Mc Poland

Ratio of qualified to unqualified nurses is 72:28

March 2009 As above





Related Ministerial target (if any) Each Trust should ensure that, by March 2009, its ratio of qualified to unqualified AHPs is increased to 82:18.

Actions/ Proposed






Lead Director


Undertake in conjunction with Director of Nursing a review of current staffing levels of qualified Nursing.

Plan to achieve the appropriate staffing mix


E. Molloy

H. McPoland

Ratio of qualified to unqualified AHPs is 82:18

March 2009 As above





Related Ministerial target (if any) Each Trust should ensure that, during 2008-09, staff turnover (excluding admin and clerical staff) is reduced by 5%

compared to the position in 2007-08.

Actions/ Proposed






Lead Director


To assess the turnover by directorate and identify areas where it needs to be improved

Analysis of turnover by grade and location with plan to improve where appropriate


E. Molloy

Hugh McPolland

5% reduction in staff turnover.

March 2009


Priority Area 10 – Modernising the Infrastructure


Priority Area 10: MODERNISING THE INFRASTRUCTURE PSA (if any) 10.1: Ensure the timely modernisation of the HSC infrastructure to include:

By 2009 Downe Enhanced Local Hospital due to be completed By 2010 Ulster Hospital A due to be completed


Investment programme: Trusts should ensure that, throughout 2008-09, they comply with all agreed schedules for the completion of business cases, project procurement, and project delivery in respect of high priority, strategic projects



achieved?




Lead Director


New Downe Hospital Practical completion scheduled - Spring 2009

Downe Enhanced Local Hospital due to be completed

March 2009 DHSSPSNI anticipated 2008/09 = £29.9m 2009/10 = £700k

J Simpson R Coulter

Final Phase A Capital Project – Critical Care Complex on site – due to complete – Spring 2010

Ulster Hospital Phase A due to be completed

March 2010 DHSSPSNI anticipated 2008/09 = £19.8m 2009/10 = £18.8m 2010/11 = £3.5m

J Simpson R Coulter


Priority Area 10: MODERNISING THE INFRASTRUCTURE PSA (if any) Related Ministerial target (if any) Trusts should ensure that, by December 2008, in line with the schedule agreed with the Department, they dispose of

surplus assets to the value of at least £55m.



achieved?




Lead Director


Trust input to Department planned disposals programme. Potential South Eastern Trust disposals identified – Bayview 2008/2009. Downe Hospital 2010/2011.

Disposal of surplus assets to the value of at least £55million

December 2008 P Cummings J Simpson

R Coulter


3.0 RESOURCE UTILISATION

3.1 Income and Expenditure The financial pro-formas in Annex 1 attached, detail the Trust’s projected income and expenditure position for 2008/09 and beyond. The Trust is forecasting income of £425m; the majority of the source of income is from Commissioners, with centrally funded income, patient/client income, training and research income making up the balance. It is also forecasting revenue expenditure before capital charges in line with this income, split between £275m for salaries & wages and £149m for goods & services. The Trust has to achieve £10.2m of CSR efficiencies in 2008/09. This on its own is a very challenging target. Added to this is the £600k for Capitation shifts. This means £11m of savings have to be achieved by 31 March 2009. 3.1.1 Financial Pressures The Trust recognises that there is a fixed amount of funding however, in light of the significant challenges it faces, it believes that it can not be expected to absorb all financial pressures. It has not been possible to discuss the issues outlined below with the Commissioners and the DHSSPS prior to submission, however it is vital that a risk sharing approach to the pressures outlined below is agreed at the earliest opportunity. If these pressures are solely left for the Trust to deal with they would have a significant impact on patient care and the Trust’s ability to meet its PFA targets. The Trust believes that it can achieve breakeven by working in partnership with the DHSSPS and Commissioners to resolve the following issues. 3.1.2 Unresolved Issues Agenda for Change Funding: £460k This funding shortfall remains an issue and is excluding the projected cost of additional annual leave of £3m. The Trust continues to request that all national pay awards are funded in full. Social Care Procurement Efficiency: £353k This regionally lead project failed to deliver the projected savings but the funding has been removed from the Trust’s baseline. Goods & Services Efficiency: £254k The Regional Goods & Services Efficiency Programme, while achieving significant savings, failed to meet its full target leaving this Trust with a shortfall.


Delayed Discharge Targets : £1.6m The Trust received no additional funding to achieve the Delayed Discharge targets, which is in stark contrast to the Access targets. This is resulting in a significant overspend in the Community Care Programme. 3.1.3 2008/09 Issues Requiring Resolution Loss of Investment Income: £731k The change in financial regime has resulted in the removal of the Trust’s ability to invest cash. The current funding only covers the removal of income to cover capital charges. In common with all Trusts, the remaining shortfall is required to prevent a reduction in patient care. Elective Care Reform: To Be Confirmed The Trust’s current bid to meet the Elective Care Reform targets is £9m for 2008/09 and awaits information as to the proposed level of funding. The Trust does not believe it has the capacity to internally fund the meeting of these targets. Utilities: £1.4m The rise in the price of oil has resulted in an unfunded pressure of £1.4m across all the Trust’s energy costs calculated at mid May prices. The volatility of prices makes an accurate prediction of this pressure very difficult. Revenue Consequences of Capital Schemes The Trust has been notified of funding of £2.5m to cover the period 2008/09 – 2010/11. Current projections are for a requirement of £15m to cover the approved capital schemes already under construction. We will need to work closely with Commissioners to resolve this issue prior to the opening of each facility. 3.1.4 Financial Risks There are a number of issues that remain unquantifiable at this stage and may or may not result in financial pressures. These are outlined below: - Superannuation The cost of increasing Employers Contribution from 7% to 15.7%. Care Management Demographics The funding to cover the Trust demographic trends has been reduced by the earmarking of a large percentage of available funds to meet PFA targets. Residential/Nursing Tariffs The Trust is currently negotiating with Homes in line with the regional tariff. This may prove difficult given the current inflationary pressures.


3.2 Workforce Strategy With the challenges facing the Trust as a result of the Comprehensive Spending Review and the significant changes which may be necessary in realigning service delivery models the contribution of our workforce will be even more important. The use and deployment of the appropriate skills will continue to be of paramount importance. In addition, significant energy will be required to ensure that staff have the appropriate skills sets which will enable them to respond to the changing models of delivery. New systems to address workforce planning issues will need to be created to ensure a multi disciplinary approach and the delivery of an integrated service. The Trust will continue to refine its Human Resource strategies to reflect the changing context in which it works. There will be a need to further develop and improve our communication processes to ensure that staff are fully aware of the contribution that they can make to enable the Trust to meet its objectives and allow them the opportunity to innovate how they deliver services without compromising safety. These strategies will include: 3.2.1 Learning and Development A new Learning and Development strategy will be implemented during the year based on the fundamental principle that the Trust will learn from it activities, it’s success and disappointments. This learning will be factored into the individual personal development plans for each member of staff. In addition the Trust will commence the journey of Investor in People accreditation. 3.2.2 Recruitment and Selection With the compilation of the first statutory monitoring return regarding the composition of the workforce discussions will be held with the Equality Commission to determine the need for any possible affirmative action strategies. In addition a review of the recruitment and selection practices will be undertaken to ensure that current employment and career opportunities will be optimised for staff during the forthcoming period wherein the number of employees is likely to reduce. 3.2.3 Equality of Opportunity Legacy Trusts have demonstrated a clear and consistent commitment to equality of opportunity in the workplace and the range of flexible and family friendly policies will be built upon to enable staff to manage their work and family life


3.2.4 Workforce Modernisation Along with the normal range of HR activities fresh energy will need to be put into the challenge of modernising working practices within the organisation at all levels. Recent years have seen unprecedented change and while some modernisation has been achieved more effort has to be applied to ensure greater benefit realisation from the Consultant contract and Agenda for Change. The search for new ways of delivering services including flexible hours of delivery and extended working weeks and days will be facilitated by the new modernised pay arrangements. 3.2.5 Change Management The changes which will affect our workforce will require a new change management protocol which will reflect the standards set out in the Human Resources framework document developed for the Review of Public Administration while complying with the letter and spirit of the transfer regulations setting up the Trust. 3.2.6 Resource Utilisation and Labour Productivity Following the issue of the Appleby report which suggested a major difference in labour productivity across a number of features between the NHS and the Health and Social Care organisations, work has been undertaken at regional level to establish accurate comparisons of productivity across a number of measurements including

• Hospital Weighted Activity per head of staff - agreed definition • Admin & Clerical as a proportion of all staff • Nursing staff - qualified/unqualified ratio • AHP staff - qualified/unqualified ratio • Staff Turnover all TC groups (excluding Admin & Clerical) • Absenteeism rates - all TC groups

A range of targets have been established for each of the measurements and considerable work has to be undertaken to achieve the targets which are set out below.


Indicator Current position as

stated Target

Hospital weighted activity

7.95 improvement 3% annual improvement from 2006/07 position

Admin & Clerical as a proportion of all staff

19.8 (June 07) 17.48%.as at Match 2008

To achieve a target of 17.8% by March 2010

Nursing staff - qualified/unqualified ratio

78:22 (June 07) To change the qualified to unqualified ratios by 1 point each year reaching 74:26 ratio by 2011. Each Trust is expected to contribute to this reduction by achieving a 1 point change in their ratio each year.

AHP staff - qualified/unqualified ratio

87:13 June 2007 To change the qualified to unqualified ratio by 1 point each year, reaching 84:16 by 2011. Each Trust is expected to contribute to this reduction by achieving a 1 point change in their own ratio each year

Staff Turnover all TC groups

10.8% 2006/07 Targets have already been set under priorities for action (PFA9) for each Trust to reduce turnover by 5% from their 2007/08 level

Absenteeism rates - all TC groups

6.2% 2006/07 A target of a 10% reduction on the 2007/08 average absenteeism rate across former constituent Trusts has already been set by PFA 9. A further target has been set to reduce absenteeism to 5.2% by March 2011.


In addition a range of activity indicators have been established to monitor labour productivity and resource utilisation across the range of services provided by the Trust. Case mix adjusted D&Ds per consultant

D&D average length of stay (days)

Day case rates OP new to review ratio A&E attendances per A&E staff District Nursing contacts per DN

workforce Health Visitor contacts per HV workforce

AHP contacts per AHP workforce

Physiotherapist contacts per Physio workforce

Community Psychiatric Nursing contacts per CPN workforce

Admin & Clerical as proportion of all staff/ per capita

Nursing staff as proportion of all staff/ per capita

AHP staff as proportion of all staff/ per capita

Medical & Dental staff as proportion of all staff/ per capita

Social Services staff as proportion of all staff/ per capita

Nursing staff - qualified/unqualified ratio

HP staff - qualified/unqualified ratio Medical & Dental staff - consultant/non-consultant career grades ratio

Use of locum staff Use of agency staff Staff turnover per selected staff group

Absenteeism rates per selected staff group

Vacancy Rates In addition work is still ongoing at Regional level to establish a range of productivity indicators for social care services and staff and these will be assimilated in to the Trust resource utilisation arrangements when they become available. Whilst progress has been achieved across many of the targets work will commence to identify the individual directorate position in regard to the various indicators and progress against the target will be included in the Balanced Scorecard system. The change in skill mix for a variety of professional groups will require a renewed focus on non traditional learning and the deployment of new types of grades supported by vocational qualifications to ensure patient and client safety and maintenance of the quality of service across the Trust.


3.3 Capital Investment Plan 3.3.1 Ulster Hospital The following details the business processes and schemes within the Strategic Development Plan for the Ulster Hospital, which will be progressed in 2008/09. An Outline Business Case requesting approval for remaining Phase A schemes was submitted to DHSS&PS in June 2005 and received approval in September 2005. The major schemes which will be taken forward in 2008/09 are as noted below.

• Construction on the refurbishment of the Department of Healthcare for Elderly People is progressing with ward 25 to accommodate a 20-bedded dementia facility and ward 26 to accommodate a 24-bed acute psychiatry facility scheduled to complete summer 2008.

• Construction is progressing on the Critical Care Complex which will accommodate 7 theatres, a 16-bed Critical Care Unit, laboratories and CSSD, and is scheduled for completion by Spring 2010. The Trust will commence discussions with the commissioner to agree the revenue consequences associated with this development.

It should also be noted that:

• The Trust received approval to proceed to the development of a Stage 2 Outline Business Case in respect of the remainder of the Site development, the latest version of which was submitted to DHSSPSNI in December 2006.

• The Exemplar Design is complete.

• Departmental approval has been obtained to undertake a redesign of Phase B2 which currently provides for a new Emergency Department, imaging and ward accommodation. This will reflect recent guidance that requires all new build hospitals to be designed on the basis of 100% single room accommodation.

• The Capital Development Department will continue to provide appropriate Communication methods in respect of the Ulster Hospital Redevelopment. This work will be extended to include not only updates for Staff, Intranet and Internet information but also liaison with external stakeholders.


3.3.2 Lagan Valley Hospital

The Phase 1 OBC for the redevelopment of Lagan Valley Hospital site was resubmitted to the Department in May 2007. The main elements of the service model include a protected elective centre supported by diagnostic and outpatient services and the provision of rehabilitation and medical services for the local population.

An outline business case for two replacement theatres has been submitted to DHSSPS in March 2008 and the Trust plans to commence construction in winter 2008.

A new endoscopy unit is currently under construction to enable full compliance with the Hine Report recommendations and HTM 2030. This work will complete July 2008.

3.3.3 Downe Hospital

Construction work on the New Downe Hospital started on 4 September 2006. The estimated cost including professional fees and equipment is approximately £60 million. The Construction Programme will complete in Spring 2009 and will open to patients in summer 2009. The new Downe Hospital will be an enhanced local hospital providing a wide range of services including:

• 24 hour consultant led Emergency Department

• 10 bed short stay unit

• Medicine and Coronary care

• Care of the Elderly

• Psychiatric Services – Acute and Elderly

• Children’s Centre

• Diagnostic services including CT

• Day Procedures

• Maternity – An OBC was submitted to DHSSPS in April 2008 to enable the Trust to integrate a Midwifery led Unit within the Hospital. This Facility will include 3 Home from Home Birthing Suites. Approval is anticipated May 2008


3.3.4 Primary Care and Community Infrastructure (PCCI) The Trust is currently working in conjunction with the EHSSB on the development of a Business Case for the Primary and Community Care Infrastructure over the next 10 years. The Trust was given approval to progress Phase 1 schemes in April 2006 and since then has developed and agreed service models and schedules of accommodation for priority schemes. The OBC2 was submitted to the Department by the EHSSB in Summer 2007. Each Trust was required to prioritise one scheme to take forward in 2008/09 and this will be a Local Health and Care Centre in Dunmurry (replacing Dunmurry Health Clinic) providing a base for both primary and community care and children’s services including local GPs, community nursing services, community mental health, AHP services, Dental services including salaried dental provision, elderly social care and Health Visiting. The Trust Capital Plan will set out the subsequent 3 PCCI proposals, within the context of the overall Capital Programme. These will be agreed by June 2008. 3.3.5 Non Primary Care and Community Infrastructure (Non - PCCI) The following details those schemes not associated with the Primary Care and Community Infrastructure (PCCI) that will be progressed during 2008/09:

• A new facility to replace Bayview Resource Centre and the provision of office accommodation for Learning Disability Teams in Bangor on the site of the former Clifton Special Care School in Bangor. Work is due to be completed in June 2008.

• The first of two purpose built Intensive Support Units for children opened in February 2008 in Bangor. The second Intensive Support Unit on the Ards Hospital Site in Newtownards commenced in September 2007 with a completion date of September 2008.

• A revised business case has been resubmitted to both the Commissioner and the Department, for the development of two four bed units as part of a new Children’s Disability Resource Centre in Downpatrick. Subject to approval this scheme is not due to be completed until 2010.

• A new facility to replace Lisburn Adult Resource Centre will commence May 2008. Construction is scheduled for completion in September 2009. This will provide day services for clients with a learning disability within new purpose built facilities.

• The existing Appletree Childrens Home has been replaced with a new Facility adjacent to the Downshire Estate (Downpatrick). The unit provides residential accommodation for 8 young people. Construction complete April 2008.


Capital investment required to ensure compliance with statutory requirements includes the following:

• Fire Protection work will be completed in a number of community facilities as well as the Ulster and Lagan Valley Hospitals to bring them up to the required standard

• Work to upgrade the water distribution system will be undertaken in a number of facilities to mitigate the risk associated with legionella

• Electrical Safety will be maintained across the estate by the continuation of electrical testing of portable appliances annually and fixed installations on a five year cycle

• Upgrades will be undertaken in a number of facilities to make sure that they comply with the standards of the Disability Discrimination Act so that all members of the local population can access the Trust’s services.

In relation to implementation of the DHSSPS strategy for the identification, use and disposal of surplus assets the Trust declared Redburn Clinic, Holywood as surplus to requirements and is currently in the process of transferring this facility to the South Eastern Education and Library Board. It is expected that this transfer will be completed by July 2008. As part of the significant redevelopment of the Downshire site, the Trust has completed the sale of a parcel of land to enable the Police Service Northern Ireland to provide a new District Command Unit for the area. The Trust is continuing to meet with relevant stakeholders regarding the disposal of the remainder of the Downshire Estate. The Trust is continuing to work with the DHSSPSNI to identify potential facilities for disposal. The vacated Bayview site, Bangor has been identified for disposal in 2009/2010 followed by the existing Downe Hospital site in 2010/11.


3.4 Partnership Working The Trust carries out its work by developing partnerships with key stakeholders both inside the organisation and from other statutory, community and voluntary organisations. The following actions are underway or are planned to further break down barriers and promote collaborative working: • Implementation of the Community Development Strategy action plan;

• Continue to explore the opportunities provided through the Investing for Health strategy;

• Build upon the collaborative relationships with the Education Boards;

• Continuing to work in partnership with a wide range of stakeholders in striving to improve the health of the local population;

• Consider the opportunities that are available within the new organisational configuration.

Within the Human Resources arena, the development of a partnership approach in dealing with Trade Unions is beginning to pay benefits for the Trust. There will be continued investment in this partnership and new partnerships will be forged with community and social enterprise organisations to assist the Trust not only in meeting its corporate and social responsibilities but also in assisting the Trust, to develop new sources of labour as the workforce changes and as a developing Northern Ireland economy provides more employment opportunities particularly in the private sector.


4.0 REFORM, MODERNISATION AND EFFICIENCY

4.1 Delivery of Efficiency Targets The South Eastern Trust has developed reform and modernisation proposals outlining the local plans to deliver on the Department’s efficiency targets for 2008/09 to 2010/11. The Trust considers that the proposals are realistic and offer an opportunity for maintaining existing service provision to patients, clients and their families whilst meeting the obligations to deliver efficiency savings required of DHSSPS over the 3 year CSR period. The solutions offered, build upon work already undertaken by the Trust to ensure the services are safe and effective, efficient and offer value for money. The Trust would acknowledge that there are opportunities to deliver a more productive service and the Appleby Report provided the HPSS with a challenge, which has still to be fully delivered. The Trust is also confident that it can deliver efficiencies and increased productivity whilst delivering sustainable, safe and effective services, which are value for money. The Trust would however register a concern that the cumulative figure of 9% is large but more importantly that year 1 actions will occur in a very collapsed timescale. However the Trust cannot over emphasise the need for support at all levels if its proposals are to be achieved. The Trust also acknowledges that the NI Budget identified significant investment for Health and Social Care, part funded by efficiencies, and will want ensure that the additional funding is used efficiently and effectively. Trusts have been advised in the Permanent Secretary’s letter (23 November 2007) that they are required to save 2.5%, 5.5% and 9.0%, based on the closing turnover for year ended 2006/07.

Table 1 The savings required in the South Eastern Trust

% £m * Year 1 2.5 10.2 Year 2 5.5 22.5 Year 3 9.0 36.8

* These figures are cumulative

In year 1 the Trust is required to deliver £10.2m efficiency savings. Whilst, ultimately the aim is to drive a strategic reshape in health and social care which will deliver the targets arising from the comprehensive spending review, the timescales are such that year 1 will primarily focus on a combination of RPA savings, workforce control, service redesign and re-profiling of services, Voluntary and Independent sector non pay and income generation. These proposals have, in the main, received DSSPS endorsement and are being taken forward.


During 2008/09 the Trust will set in train the efficiencies for years 2 and 3 by reconfiguring services delivered to ensure that we provide safe and effective services to all patients/clients in the most appropriate setting. This will require a reconfiguration of all services across the Trust, undertaken within a context taking account of existing strategies notably:

• A Healthier Future, • Investing for Health, • The Bamford Review, • Developing Better Services.

A second key target will be to drive the six themes set out in the Draft Performance Framework for the Department of Health and Social Services. This will include:

• Make more efficient use of resource and release resource from areas of relatively low productivity,

• Improve productivity in hospitals, • Improve safety and quality, • Re-configure services for people with chronic illnesses, • Provide more appropriate community based treatments and care • Take account of the emerging themes within the Draft Rural

Medicine Strategy. In addition the Trust has adopted principles within which proposals will be assessed:

• Do they sit within existing strategies • Do they address:

• Safety • Sustainability • Value for Money • Technology • Informed Debate

The Trust has commenced the process of engagement, internally and externally, and there is little doubt that there will be much debate with regards to the proposals. This engagement is welcomed as it will generate ownership and a more appropriate outcome in te rms of the configuration of services to be delivered. The delivery of the reform and modernisation programme and the savings targets therein, requires robust project management arrangements. The Trust is currently developing these structures and processes to ensure that the timetable of reform and savings required is delivered. 4.2 The Trust’s Financial Pro-forma (FP3(T)) can be seen in Appendix 1.


5.0 GOVERNANCE

The Trust has an integrated governance model in place which comprises corporate governance and risk management (including organisational controls), safe & effective care (clinical and social care governance) and financial governance. During 2008/09 the Trust will continue to embed this governance framework at both corporate and directorate leve l through the implementation of the Trust’s Governance Strategy and annual implementation plan. The Trust will also continue to embed its organisational-wide system of risk management which focuses on a single approach to the management of clinical and non-clinical risks. This system is based on the AS/NZS 4360: 2004 standard as directed by the Department of Health, Social Services and Public Safety. A key focus at corporate level will be the establishment of all governance related sub-committees under the Risk Management, and Safe & Effective Care Committees, with the associated Terms of Reference and annual plans being ratified and implemented during 2008/09. This will ensure that key governance priorities, both internal and external, will be considered and addressed by the relevant committee and sub-committees. In doing so, this will provide an assurance to the Governance Committee, the Audit Committee and the Trust Board that appropriate action is being taken and that significant risks are being addressed. During 2008/09 the operational governance leads will continue to work with directorate leads in order to implement effective governance arrangements at service/team level. The governance workshops, initiated during 2007/08, will continue during the forthcoming year in order to ensure that, by March 2009, all directorates have fully engaged their team leads in implementing governance at directorate and service level. As part of this process, all directorates will have developed governance plans which are reflective of the overarching Trust Governance Plan and which will provide a focus for staff in embedding governance priorities at team level. In doing so, the operational governance leads will work with the Trust’s Planning & Performance Management Team to ensure that governance requirements are integrated within the overall performance management and accountability framework. This will facilitate Directors in assessing the extent to which governance arrangements and priorities are being delivered within directorates. In addition to the above strategic priorities, the following sections summarise the key issues to be addressed within the three governance strands of the Trust’s integrated governance framework:- 5.1 Risk Management

• Controls Assurance: The Trust will continue to implement the action plans arising out the controls assurance standards to ensure that all standards achieve a substantive level of compliance in 2008/2009. It will also undertake a second year baseline assessment of the extant


controls assurance standards and report the outcomes to the DHSSPS in line with the required reporting schedule;

• Corporate Risk Register: The Trust will further develop its Corporate

Risk Register in line with changing priorities/objectives and will put in place a process for the regular review and maintenance of the register ensuring regular reports on progress are made to the Trust Board. In addition, it will ensure that the priorities in the corporate risk register are reflected in the annual Internal Audit programme;

• Directorate Risk Registers: The Trust will review its schedule of

Directorate Risk Registers to ensure that all Directorates have an operational risk register which is updated on a quarterly basis. In addition, it will put in place arrangements for the storage and retrieval of Directorate Risk Registers in the Datix Risk Management System to aid the production of reports to the Risk Management Committee;

• Risk Management Programme of Work: The Trust will develop an

annual programme of work for the Risk Management Committee endorsed by the Governance Committee that encompasses the key issues arising out of the Controls Assurance Standards, RQIA reviews and other relevant internal and external reports.

• HSC Complaints Procedure: In line with Priorities for Action targets for

2008/2009, the Trust will develop an action plan by June 2008, for the full implementation of the new H&SC Complaints Procedure by January 2009.

5.2 Safe & Effective Care § Trust-wide Policies: The Trust will establish a multiprofessional Policy

Committee which will be responsible for implementing a systematic process for the development, consultation, ratification, dissemination and review of Trust-wide policies. This committee will also be responsible for baselining existing Trust-wide policies and for identifying key policies for development/review, in consultation with professional and operational leads.

§ Trust-wide Clinical Guidelines, Technology Appraisals and Drugs &

Therapeutic Guidelines: The Safe & Effective Care and Pharmacy Departments will be responsible for establishing a multiprofessional committee to oversee and co-ordinate the development of clinical and drugs/therapeutic guidelines. In particular, the committee will ensure that


an effective process is put in place to address the DHSSPS/NICE guidelines and circulars.

§ Multiprofessional Audit Committee: The Clinical Risk Director and

Assistant Director: Safe & Effective Care will be responsible for establishing a multiprofessional audit steering committee. This committee will be responsible for ensuring that arrangements and processes are put in place to co-ordinate and report upon all ongoing audit activity.

§ Patient Safety: The Trust will continue to deliver agreed best practice

principles in accordance with the Safer Patient Initiative. A key priority for 2008/09 will be to gain consensus on the content of the Patient Safety Strategy and annual plan and to have these ratified at Trust Board level. Additional, the Trust will be required to meet the Priorities for Action targets for 2008/09 relating to patient safety and for ensuring that the Patient Safety Leadership Team, EMT and Trust Board receive monthly reports relating to performance against key patient safety targets.

§ RQIA Clinical & Social Care Governance Reviews and Thematic

Reviews: In line with Priorities for Action, the Trust will ensure that action plans are developed to address recommendations arising from all RQIA governance related reviews. Compliance against agreed actions and progress towards meeting RQIA recommendations will be monitored by the Safe & Effective Care Committee on a quarterly basis.

5.3 Financial Governance The system of internal financial control is based on a framework of regular financial information, administrative procedures including the segregation of duties and a system of delegation and accountability. In particular it includes:- • comprehensive budgeting systems with a budget which is reviewed and

agreed by the board; • regular reviews by the board of periodic annual financial reports which

indicate financial performance against the forecast; • setting targets to measure financial and value for money performances; • clearly defined capital investment control guidelines; The Trust has an internal audit function which operates to defined standards and whose work is informed by an analysis of risk to which the body is exposed and annual audit plans are based on this analysis.


6.0 User Experience Active and meaningful engagement of service users, carers and the public will be fundamental to the planning, delivery and evaluation of services within the South Eastern Trust. The existing strong ethos of user consultation and involvement inherited from the previous Down Lisburn and Ulster Community & Hospitals Trusts provides an excellent basis from which to further embed partnership working. 6.1 Investing for Health Each of the four operational Directorates are developing their own health improvement plans which will detail how they will improve the health and wellbeing of the population groups that they serve. Specifically each Health Improvement Plan will deliver an increased emphasis on prevention with each of the operational Directorates. In addition the Trust continues to play an active role in a range of partnerships, such as neighbourhood renewal, which seek to address health inequalities across the South Eastern Area. The Trust’s core Performance Management Framework also incorporates a range of targets that relate to Investing for Health. Specifically these targets will enable the Trust to quantify the improvements that it has made to the health and wellbeing of the population it serves, as well as enabling the Trust to measure how successful it has been in tackling health inequalities. Moreover, this approach of integrating the health improvement targets into the Trust core performance framework will enable prevention to have parity with other priorities such as access and discharge targets. 6.2 Measures to Engage Users, Carers and Communities in the

Planning, Delivery and Evaluation of Services The main priorities for the Trust during 2008/09 in terms of continuing the active involvement of service users, carers and the wider public in decisions have been identified in the circular issued by DHSSPS; “GUIDANCE ON STRENGTHENING PERSONAL AND PUBLIC INVOLVEMENT IN HEALTH AND SOCIAL CARE” (Circular: HSC (SQSD) 29/07). These require HSC organisations as part of the self-evaluation process to strengthen and improve PPI and:

• Confirm leadership and accountability arrangements for PPI; • Using the principles in the guidance as a framework, review current

PPI work to establish the baseline from which improvements can be made;

• Prioritise the areas for improvement;


• Develop and implement an action plan with clearly defined targets to strengthen and improve PPI securing agreement and support for this plan across the organisation;

• Clarify reporting arrangements for PPI as part of organisational

management and clinical and social care governance. Arrange for the inclusion of PPI as part of the organisation’s annual report on what has been achieved and agree the priorities and targets for the subsequent year.

The South Eastern Trust has established the mechanisms to deliver these actions and ensure that personal and public involvement is embedded in all our activities and interactions. 6.3 Measures to assess user experience in terms of level, quality and

method of delivery of services Personal and public experience is a key priority for the DHSSPS and is likely to become a statutory responsibility for Trusts during 2008/09. Within the Trust, the experience of patients and clients is fundamental to the organisation’s ethos of delivering person centred care/services. In this context, patient and client experience is viewed as part of the overall assessment of the patient/client journey and the quality of the service experienced by individuals and by groups of service users. This high level prioritisation of user experience is reflected in the Trust’s governance framework, with a Personal and Public Involvement Committee established as a sub-committee under the Safe & Effective Care Committee. This will help to ensure that user experience becomes an integral component of everyone’s role in delivering health and social care. The key priorities for the Trust during 2008/09 in respect of user experience are as follows:-

• To undertake a baseline of existing user consultation exercises which are focused on assessing user experience of the quality of care/service provided

• To employ a range of methods to assess user satisfaction with the

quality and range of services provided – this will be carried out in partnership with users who will assist in identifying what is important to patient and clients in terms of service delivery

• To continue to support the work of the Trust User Forum by working

in partnership with Forum members to consider and address generic issues which are important to patients, clients and the public

• To work with the Personal & Public Involvement Committee to

develop a PPI strategy for the Trust.


7.0 Conclusion

The Trust faces a challenging agenda over the next three years as we seek to sustain and improve services and meet targets in the context of the efficiencies required by the Comprehensive Spending Review. The Trust is confident that this Trust Delivery Plan will improve the lives and experience of service of our patients and clients. The dedication and effort of all staff will be required if we are to address the challenges set before us but there is no doubt that, working together, we can succeed in this task.

South Eastern Health & Social Care Trust Trust Delivery Plan 2008/2011

APPENDIX 1; 2008/09 PRO-FORMA FINANCIAL RETURNS

South Eastern Health & Social Care Trust Trust Delivery Plan 2008/2011

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