Operational Planning & Contracting 2019-20 Council of Governors – 4th July 2019 Sue Barnett, Strategy & Planning Consultant Richard Eley, Interim Director of Finance

Operational Plan 2019/20 1. Operational Plan outline Activity Planning Assumptions & Growth Waiting List Position Transformation Quality Priorities Workforce Finances & Contracting Capital Risks and Mitigation

Operational Plan 2019/20 - Outline The purpose of this Operational Plan is: To outline the Trust’s challenges and objectives for the coming year To refresh of activity, quality, workforce and financial plans for 2019/20 Consistent with the Trust Strategic Objectives Alignment to the 10 year NHS Long Term Plan Through a system-wide approach, working in collaboration to align key assumptions on income, expenditure, activity and workforce between commissioners and providers.

Operational Plan 2019/20 – Activity Planning & Growth Activity System Alignment, Planning Assumptions & Growth Three main partners, NLAG, NELCCG and NLCCG have agreed the submitted aligned activity plans Trust and CCGs have used a forecast outturn based on month 7 with overall growth rates applied based on a 3 year rolling average with the exception of: A&E 6.36% Ambulatory zero length of stay 15.31% Non-Elective 1+ length of stay -1.5%

Operational Plan 2019/20 – Waiting List Position Year End Position Total RTT Waiting List Size RTT Performance Overdue follow ups March 2018 29396 66.23% 31569 March 2019 26833 2563 75.70% 8.9% 32237 641 March 2020 24466 2367 81.20% 5.5% 18249 13988 There will no patients waiting over 52 weeks Intention is to achieve no patients waiting over 40 weeks by March 2020 Greater validation on waiting lists including RTT clock stops Continue to tail gun activity Pooling of procedures Further roll out of virtual clinics /Full implementation of Advice & Guidance eRS to full year application Follow Up Outpatient Waiting List to reduce by 13988 (for 7 specialities targeted) by March 2020

Operational Plan 2019/20 - Transformation Humber Coast and Vale Sustainability and Transformation Partnership The Partnership has been working together to deliver the collective vision of: supporting our local communities to start well, live well and age well.  Humber Acute Service Review (HASR) We recognise that we cannot deliver sustainable services on our own and continue to work with our key partners through place based provision, the Humber Acute Services Review and the Humber, Coast and Vale STP. Service Development Improvement Plans Outpatient Transformation Urgent Treatment Centres / integrated Assessment Day Case to Outpatient Procedures Medicine optimisation Pathway redesign between primary and secondary care, e.g. Implementation of the RightCare programmes and Getting it Right First Time (GIRFT) best practice

Operational Plan 2019/20 - Quality    Quality Priorities for 2019/20 Mortality reduction and the management of the deteriorating patient Medication Safety Patient flow Cancer pathways Other Improvement Plans for 2019/20 Impacting on Quality: Gram-negative blood stream infections (GNBI) Staffing numbers and engagement Priority standards for seven-day hospital services Special Measures for Finance and Quality National intelligence: Learning from relevant national investigations

6. Operational Plan 2019/20 - Workforce Workforce – key points for 19/20 Decrease agency by 113.2 wte Expected higher fill rate for junior doctors 20 nurses from the Phillipines in pipeline by end Qtr2 Anticipate intake of 65 newly qualified nurses by end Qtr2 Introduction of Physician Associates on a 2 year rotational preceptorship programme Plan to introduce 6 Band 3 Physician Assistants Advanced Clinical Practitioners – 4 year training programme Further utilisation of Apprenticeship Levy Succession Planning (CAESER / overseas recruitment) Staff engagement/Pride and Respect

Operational Plan 2019/20: Finance/Contracting Contracts signed on 21st March 2019 The Trust has been able to negotiate contracts with all the CCGs, and NHSE, except an aspect of East Lincolnshire Activity levels and key statistics such as waiting times have been fully agreed with system CCGs. The dispute with East Lincs has been resolved through agreeing an SDIP to review the position at the end of the first quarter. The contract process was concluded successfully on the due date but did not yield sufficient cash to materially assist the Trust to achieve it`s original Control Total. However the Control Total was adjusted by NHSI. The National basis for the calculation of the NEL contract, still does not give full funding for NEL work.

8. Operational Plan 2019/20: Finances/Control Total (2/4) The Trusts 18/19 out-turn position needed to be moved several times during the year The Trust has reported a year end deficit of (£58.9m) to NHSI for 18/19 This compares to the original control total deficit of (£39m), a movement of (£20m) This outturn position was the basis for the Trust’s financial planning for 2018/19 In future the basis will move to being based on budgets with the forecasts being taken into account when setting budgets Out-turn has been the basis on which CIPs were set

Operational Plan 2019/20: Finances/Control Total

Operational Plan 2019/20: Finances/CIP Cost Improvement Programme (CIP) The CIP target set for the budget units was originally £32m but this proved to be impossible Following discussions with NHSI the Control Total was revised from (£15.4m) deficit The Final CIP following an adjustment to the Control Total deficit is £20m within NLAG and a £2m system CIP ie £20m plus £2m The Control Total is a deficit of (£25.4m)

Operational Plan 2019/20 – Capital Planning 19/20 Capital allocation £7.4 m to cover: Major Schemes: SGH ward (25 beds) Backlog Maintenance (statutory requirements) IM&T / IT (Cyber risks) Equipment Replacement (high risks) STP Capital funding allocation £29.26 m Urgent & emergency Care (creation of Multi-disciplinary assessment units both main sites) SGH MRI (additional scanner) DPoW Critical Care collocated unit Lengthy process for HM Treasury approval of the funding prior to release (18-24 months) Emergency Funding £8.1m DPoW MRI (new build – additional scanner) DPoW CT (additional scanner) Risks: Critical maintenance backlog requirements (tune of £22.5 m) IM&T infrastructure to support service developments Theatre upgrades (including SGH Theatre E laminar) Wards requiring refurbishment