Progress Report to Trust Board Corporate Plan 2007/8 Progress Report to Trust Board September 2007 Deborah Shaw Director of Strategy

CO1:To continue to improve patient safety and the patient experience Corporate Objective Strategic priority Operational Objective ED Assessment RAG CO1:To continue to improve patient safety and the patient experience To continue to Improve the quality of our services Meet the Healthcare Commission’s standards for 2007/8 set through the Annual Health Check DSD System established and progress monitored through assurance compliance unit. Reported to Board through integrated performance report. The Trust is currently not on track to achieve the MRSA target A Continue to reduce MRSA and hospital acquired infection rates CE/DS The HCAI Action Plan was signed off by Trust Board 31/5/07. New STICC arrangements in place from 31/7/07. DH review 26/9/07. The Trust has particularly focused attention recently on: revising and embedding antibiotic policies, screening policies, central and peripheral line policies establishing cohort infection wards on both sites re emphasising “clean your hands campaign” R Continue work on nursing standards The Trust has made some progress with the implementation of Essence of Care Standards, specifically focusing on privacy and dignity. Further work is planned when the Head of Nursing Practice joins the Trust. ‘Programme of Care for the Older Patient’ project has been launched within the Trust and 16 champions have been identified across the hospital. Agreement with Staffordshire University to jointly appoint a Professor of Nursing who will lead on privacy and dignity practice and development issues. The Trust has developed its own set of Nursing Performance Indicators and developed the software to support the monitoring on a monthly basis. G Deliver CNST level 3 for maternity Achieved.

CO1:To continue to improve patient safety and the patient experience To continue to improve the quality of our services Continue to improve the patient environment DSD Patient Environment Action Team is established led by the Director of Service Delivery and includes Estates and Facilities representation, infection control nurses, ,nurse managers and PPI representatives. Regular programme of planned assessments and unannounced visits in place. The Trust has consistently scored well in external assessments and both sites recently received a score of 5 (excellent) for cleanliness and food. The Trust has recently been chosen from all Trusts in the West Midlands to become a Learning Partner for the implementation of the ‘Productive Ward’ in partnership with the National Institute of Innovation and Improvement. G Continue to improve patient satisfaction DSD/DCA Ward managers identified as champions. Presentation given July 2005. To develop local action plans and exit surveys and monitor through Community Engagement Forum A

CO2: To achieve Foundation Trust Status by July 2008 To deliver a long term service development strategy for the Trust Perform a fact-based assessment of all clinical specialties and produce a 5 year market-driven Service Development Strategy DS 26 workshops completed June-July 2007. Draft outputs reviewed by Divisions, Executive and Trust Board by 30th August. Shortlist of priorities based on urgency and impact analysis has been produced that will now inform the draft integrated business plan (IBP). Next stage is to align priorities with the SHA “Investing for Health Strategy“ and commissioner intentions. G Prepare an Integrated Business Plan (IBP) that includes detailed market assessment, long term service and financial strategies and workforce plans Board SWOT and PESTLE completed. FT work streams on track to deliver individual elements of the IBP for end of September 2007. Good progress on market analysis: health profiles demographic data presented to Trust Board; Dr Fosters data on referral patterns from GPs now available. Market assessment priorities have been identified. Working with key commissioners and other stakeholders to develop a Shropshire WHE Strategy CE/DS Commissioning Strategy promised from both PCTs by 30th September 2007. Workshops scheduled for September with PCT and PBC leads to share draft outputs from service reviews. To develop and implement a number of integrated care pathways with our health and social care partners that support the priorities identified through the LDP and ISIP process Four agreed priorities for 06/07: Sexual Health, advanced primary care services (APCS), diagnostics and admission avoidance. Regular reports to ISIP Board. ISIP maturity matrix performed by SaTH, SCPCT and T&W PCT leads as part of a health economy-wide review of integrated planning processes. Draft action plan produced and identifies a need to strengthen the prioritisation process and the programme management approach to ensure that committed plans are properly resourced. A

CO2: To achieve Foundation Trust Status by July 2008 To develop the Trusts governance arrangements that are fit for purpose for a Foundation Trust Implement fit for purpose business systems into the Trust from “Board to floor” DS/FD Revised approach to corporate planning process in place. Divisional business plans developed focusing on approach to delivery of corporate objectives. Revised business case proforma implemented for consultant posts and major service developments. Performance report revised to focus on exception reporting and mitigating action. Implemented web-base analytics for activity data. A Review corporate governance arrangements and further develop the concept of the compliance unit DCA/ FD Integrated governance review to July Board. Compliance unit in place with terms of reference to be reviewed in the Autumn in line with Monitor Compliance Framework. G Implement the “Intelligent Board” concepts in decision making CE Review of committee structure completed and implemented. Consistent reporting approach at Board and sub committees against corporate objectives Review the Board and organisational capability and capacity and implementation of a Board development programme CH/ DCA Board development programme implemented. Board gap analysis planned for October 2007. Board to Board Challenge planned with auditors December 2007 and March 2008 Further development of performance management and risk management systems and processes FD/ Risk management systems well embedded. Internal audit assessment “substantial assurance”. External Audit assessed internal control as “GOOD” in Auditors Local Evaluation. Integrated performance report developed. Balanced scorecard/dashboard approach under review.

CO3:To achieve all key national targets and priorities on an annual basis To continue the Trust’s financial recovery Deliver in-year financial surplus. CE Surplus £387k at Month 4 G Deliver a CIP of at least £7.8m. FD/ DSD Divisional Finance Review Meetings have been reestablished on a monthly basis to review the operational budget position and performance against CIP. £5.3m CIP identified against a target of £7.5m. The Finance Director and the Director of Service Delivery continue to work with the Divisions to identify a further £2.2m. A Make progress with addressing the historic deficit. Resolved by working capital loan and new NHS Financial Strategy Improve on Health check “Use of Resources” assessment DCA Trust scored 3 for Internal Control. Other elements improved scores since last year. To continue to improve access to our services Make progress towards the 18 week referral to treatment target and achieve national milestones The Director of Service Delivery has Executive responsibility and the newly appointed Access Manager has project management responsibility. A project group and an IT sub group have been established to develop data collection and reporting systems. The medical secretaries are piloting the role of “patient trackers”. The group is currently developing an escalation policy for reporting information to the relevant managers/clinicians regarding patients’ progress through their pathway. Further work on reviewing pathways of care will require strong clinical engagement.

CO3:To achieve all key national targets and priorities on an annual basis To continue to Improve access to our services Reduce waiting times for diagnostics. DSD There has been great improvement in reducing diagnostic waiting times. The Trust is confident that it will achieve a maximum wait of 6 weeks by December 07 in advance of national target of December 2008. Pathology waiting times are under scrutiny as a result of some breaches of 11 week target. A Continue to achieve national access targets in A&E The A&E target has proved particularly challenging this financial year. The challenges are threefold: an increasing number of delayed discharges in acute hospital beds due to social service funding; an increasing number of delayed discharges due to inability to transfer patients to Community Hospitals; disestablishment of 40 unfunded escalation beds (which accommodated delayed discharges) to allow renal unit development at PRH and the infection ward development at RSH. Division 1 action plan is in place with signs of impact. First week achievement of 98% in early August since May 2007. R Continue to achieve national access targets in Cancer The Trust has an excellent track record of consistently achieving the cancer targets. G Achieve target for GUM 100% offered an appointment within 48hrs by March 2008 DSD/ DS The Trust has not achieved its internal profile since April 2007 although a month on month improvement is evidenced. The Trust approved the management transfer of GUM services to PCT at the July Board. This should support the achievement of the targets in managing patients in the appropriate setting. Plan for maternity services Shropshire model of care follows national guidance with consultant-led and midwifery-led units. The Trust has performed an assessment against Maternity Matters standard and has minimal gaps but is developing action plan to address. Model of care perceived as exemplar nationally.

CO3:To achieve all key national targets and priorities on an annual basis To continue to improve our productivity LOS reductions emergency and elective: to reach England upper quartile LOS over the next 18 months to reduce pre-operative LOS by 10% by March 08 DS/ DSD Not achieving monthly profile for elective and non elective LOS. Statistical process control charts show inconsistencies between sites that need to be explored. Action plan is being developed by the Head of Service Improvement focusing on patient flows and standardized patterns of working. Some progress with social care delays. A Increase day surgery rates to 78% by March 2008. The day case rate for surgical procedures was reported at 77.8% in July 2007 and is above profile and on track to achieve 78% by March 2008. G Maximise theatre utilisation Target to increase theatre utilisation to 85% Monitoring to be included within Integrated Performance report in September. Live theatre utilization system being developed through SEMA. Maximise use of outpatient capacity Outpatient review completed with action plan. Nominated project lead and service manager identified. Project group established . Plan approved and being progressed. Clinical support services review Clinical service review has identified lack of integrated systems and processes across sites. Review of Imaging and Pathology flagged within service improvement priorities. New Head of Pharmacy starts in post September 2007 with a remit to review site specific issues . Application of lean principles particularly to corporate functions CE/DS Implemented in A/E and theatres. Review of structures to be undertaken in corporate departments by September 2007 Review of all non clinical support functions FD Estates maintenance & operations workshop (phase 3 corporate services review) undertaken Implementation of Productivity Improvement action plan DS/FD Clinical element of productivity improvement action plan has been incorporated into service improvement plans. Non clinical elements incorporated into CIP targets.

CO4:To recognise and enhance through organisational development, the contribution of the workforce to the success of the organisation CO4:To recognise and enhance through organisational development, the contribution of the workforce to the success of the organisation To improve staff satisfaction and staff engagement in effective decision making Implement and maximise the value from the new management structure through staff development and KSFs. DSD The Trust has now successfully appointed 3 Divisional Directors and three Divisional General Managers for each of the new Divisions. All managers in the supporting infrastructure have also been appointed. A Management Development Programme is being developed for Autumn 2007. G Implementation of the clinical skill mix review findings Implementation of the recommendations of the Nursing Skill Mix review is almost complete. A priority for the newly appointed Head of Nursing Practice is to develop a Ward Managers Development Programme to support ‘Modernising Nursing Careers’. To respond to changes in the medical workforce to include EU WTD, Modernising Medical careers and new consultant contract FD Contingencies in place for MTAS Increasing Staff Grade and Trust Grade appointments for service Job planning tool available September 2007 A Embed the concept of “the business unit” and the culture of “earned autonomy” within the business systems and processes of the organisation The Divisional Boards are now established, with the Divisional Director and the Divisional General Manager receiving dedicated Finance, Human Resource and Professional Advisory Support. Divisional Review meetings are planned on a quarterly basis first of which is August 2007. Focus on achievement of national, organizational and divisional key performance indicators; will determine the level of earned autonomy. Develop a management and leadership programme for clinicians MD Options paper presented to Organisational development Group. Considering corporate sign-up to BAMM “Fit to Lead” Develop an OD strategy to support change management programme Ch/ DCA Work in progress with gap analysis. Interviews with key stakeholders taken place. Strategy development by October 2007 Develop more formal processes to capture idea generation from staff DS Internal communications improved through regular staff bulletins and CE briefings

CO5:To achieve Teaching Hospital Status Provision of suitable additional residential accommodation for undergraduates through a partnership approach with the private sector MD Shrewsbury and Atcham Borough Council deferred a decision on the application for planning permission from 15th August 2007 to 11th September 2007. It has now been approved with conditions. Further discussions to take place with the Secretary of State to agree use of land adjacent to Racecourse Lane for recreational purposes. A Provision of enhanced and improved professional education facilities through the development of an Integrated Education Centre based at RSH School of Health Plan on schedule Awaiting formal PCT approval Foster and facilitate research and development for all professional groups Trust now represented on the new West Midlands North Comprehensive Local Research Network. Currrent focus is a review of research governance arrangements. DH R&D funding reducing year on year as is management resource to support G Development of the clinical teaching infrastructure required to support the curriculum requirements for 96 undergraduate students by 2008 Joint teaching appointments with University on schedule. One of the aims of the R&D group is to provide an environment for the new undergraduates to “experience” research both in the form of clinical trials and as applied research. To develop an Institute of Applied Research within the Trust that supports the application of research and evidence-based practice through improving and enhancing the experience and outcomes for patients and employees. CH A group has been established to focus on best use of intellectual property and information related to the evaluation of new techniques or treatments. A key aim is the introduction of a knowledge management system that allows access for all staff to outputs from research and best practice. A conference is being organized in the Spring 2008 to celebrate applied research projects and evidence based best practice.

CO6:To improve partnership working in developing and delivering a coherent vision for the future of health and social care CO6:To improve partnership working in developing and delivering a coherent vision for the future of health and social care To improve partnership working Develop and deliver an external and internal communications action plan for the Trust DS Stakeholder mapping exercise completed and communications plan presented to Trust Board. Focused on improving stakeholder relations, developing staff as ambassadors for the organisation, strengthening media relations, and developing effective internal and external communication systems CE face to face staff briefings completed, Frequent Staff Updates and monthly Team Brief now all in place. G Develops a hospital marketing strategy Draft market assessment plan completed. Thinking around organizational values and future corporate brand management begun linked to Foundation Trust work. A Improve integrated planning processes with both commissioners and partners in health and social care CE/ Progress via Chairs/CEs meeting and STEG. Improved relationship with SCC and T&W OSCs and Powys LHB Focus on reputation management to ensure that the Trust has a high external profile “for the right reasons” Head of Communications and Business Development now in post, with a focus on reputation management with the media. Opportunities for Ministerial visits currently being scoped linked to major hospital developments.

Glossary of Terms A & E Accident and Emergency CE Chief Executive CIP Cost Improvement Programme CNST Clinical Negligence Scheme for Trusts DH Department of Health EUWTD European Union Working Time Directive GUM Genito-Urinary Medicine IBP Integrated Business Plan ISIP Integrated Service Improvement Plan IT Information Technology KSF Knowledge Skills Framework LDP Local Delivery Plan LHB Local Health Board LOS Length of Stay MRSA Methicillin-Resistant Staphylococcus aureus MTAS Medical Training Application Service OD Organisational Development OSC Overview and Scrutiny Committee PBC Practice Based Commissioning PCT Primary Care Trust PESTLE Political, Economic, Social, Technological, Legal, Environmental

Glossary of Terms PPI Patient Public Involvement PRH Princess Royal Hospital RSH Royal Shrewsbury Hospital R & D Research and Development SaTH Shrewsbury and Telford Hospital SCPCT Shropshire County Primary Care Trust SDS Service Developed Strategy SHA Strategic Health Authority STEG Shropshire and Telford Executive Group STICC Shropshire and Telford Infection Control Committee T&WPCT Telford and Wrekin Primary Care Trust CH Chairman CE Chief Executive DCA Director of Corporate Affairs DS Director of Strategy DSD Director of Service Delivery FD Financial Director MD Medical Director