North Bristol NHS Trust Strategy 2016-2021
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North Bristol NHS Trust Strategy 2016-2021
Contents 1 Executive summary 04 2 Introduction 06 3 Our values and vision 08 4 Strategic themes 10 5 Next steps and delivery plan 20 6 Conclusion 22 7 Appendix A: North Bristol NHS Trust today 24 8 Appendix B: The challenges we face 30
1 | Executive summary
North Bristol NHS Trust Achieving our vision to provide This strategy has been
the high quality care that we developed for the period 2016 -
is a provider of local aspire to within the resources 2021 to provide focus and clarity
hospital services and available is an increasing of direction for our organisation
complex specialist care challenge. By improving patient and its stakeholders. It takes
flow, maximising productivity, into account detailed analysis
for a large population using resources including our of the Trust, activity, quality,
in the South West of workforce wisely, and sharing performance, outcomes,
England. Employing over best practice across the Trust, opportunities and challenges,
our finances will be sustainable and is informed by clinician,
8,000 highly skilled and and we will meet the national staff and patient views.
caring staff, we aim to standards for operational The detail of this analysis is
performance in the coming described in appendices A & B:
deliver excellent clinical years. The aims described in
The eight strategic themes that
outcomes and a great this strategy are designed to
will form the basis of our plans
experience for all service create an organisation in which
over the next five years are:
the necessary savings and
users: exceptional efficiencies are delivered to 1) Change how we deliver
healthcare, personally enable us to do more with the services to generate
resources already available. affordable capacity to meet
delivered. the demands of the future
We will take a leading
We are one of the largest role and work with health 2) Be one of the safest trusts
hospital trusts in the UK and and social care partners to in the UK
treat some of the most difficult develop and implement 3) Treat patients as partners
medical conditions, in an a Sustainability and in their care
increasingly complex patient Transformation plan for the
population. 4) Create an exceptional
Bristol, North Somerset and
workforce for the future
We ended the 2015/16 financial South Gloucestershire area.
This will improve the lives of 5) Devolve decision making and
year with a £51.6m budget
residents by ensuring their empower clinical staff to lead
deficit, against a planned deficit
of £26m. This adverse position healthcare needs are met as 6) Maximise the use of
was mainly due to increased mandated in the NHS England technology so that the right
use of temporary staff and Five Year Forward View. We information is available for
lower than expected income, in will also work with specialist the key decisions
part resulting from difficulties commissioners and networks
of local providers to ensure 7) Enhance patient care through
managing the amount of work research
to do through our hospital high quality delivery of the
beds. In 2016/17, and in the specialist services for which we 8) Play our part in delivering a
years ahead, we aim to reduce have a wider responsibility to successful health and
our deficit year on year and the population of the South care system
return to a position of financial West of England
stability.
4We are committed to During 2016/17 the Trust
maintaining a culture of will produce a set of enabling
openness, transparency and supporting strategies
and candour in all we do including Quality, Research,
and especially in the way Information Management and
we communicate with our Technology, Workforce, Estates
patients and their families. In and Facilities, Communications
consultation with staff, the and Stakeholder strategies.
Trust developed a set of values These will provide more detail
that represent what we stand and support delivery of the
for and these will underpin overall strategy.
the way we deliver the vision
This strategy sets out a vision
through our strategic themes.
for the future and the themes
Our values are: for work streams that will
ensure the vision is realised.
• Putting patients first
Through this work:
• Working well together
• Striving for excellence
• Recognising the person
The Board of Directors at North
Bristol NHS Trust is committed
to creating a strong, vibrant
“We will realise the
organisation which is at the great potential of our
forefront of healthcare delivery
in the West of England. The organisation by
Trust Management Team is
responsible for delivering the
empowering our
strategic vision. Each year, the skilled and caring
Trust and Directorate business
plans will detail actions that staff to deliver
will specify how the strategic
themes will be progressed.
high-quality, financially
Implementation of the business sustainable services in state-of-the-art
plans is overseen by the Trust
Management Team and the facilities. Clinical outcomes will
Board.
be excellent and with a spirit of
Progress on implementation
of the strategic themes will be openness and candour we will ensure an
reported annually to the Board. outstanding experience for our patients.”
52 | Introduction
North Bristol NHS Trust This strategy has been We also provide high quality
developed for the period 2016- specialist care for some of the
is a centre of excellence 2021 to provide focus and clarity sickest patients in the region.
for healthcare in the of direction for the organisation We work in partnership with
South West and one and its stakeholders. It sets University Hospitals Bristol
out a vision for the future and NHS Foundation Trust and
of the largest hospital the strategic themes that will following a number of transfers
trusts in the UK. The ensure that vision is realised. and mergers of clinical services
The Trust strategy aims to between the two Trusts we
environment and deliver a successful, sustainable both now provide coherent,
context in which it and resilient organisation, high quality specialist services
provides services is playing a full part in an at scale for the South West
effective health and care region. We also work closely
changing rapidly. This system. with other hospital providers
strategy will ensure that in the delivery of networked
The successful opening of care, for example hosting the
we continue to provide Severn Network Major Trauma
the Brunel building on the
a high quality service Southmead Hospital site in May Centre, the South West Major
to patients within an 2014 completed an important Arterial Centre, the South West
phase of the long term Trust Burns Network and South West
increasingly complex strategy. The new hospital Neuromuscular Network.
environment whilst building has resulted in a
Having worked hard to deliver
also contributing to the transformative improvement
a safe transfer in to the
to infrastructure for services.
health of the population Starting with two medium
new hospital infrastructure,
we recognise that the
that we serve and the sized and separate hospitals in
performance, quality and
the north of Bristol and South
wellbeing of our staff. Gloucestershire, the Bristol
financial sustainability of our
service delivery is not yet at the
Health Services plan created a
standard that we would expect.
single Acute Trust, which has
This was demonstrated in the
merged the two hospitals on to
reports of the Care Quality
a single site. This has maximised
Commission hospital inspections
the opportunity for realising
in 2014 and 2015 which
the benefits of size and inter-
assessed the Trust as ‘requires
dependency of services.
improvement’.
North Bristol NHS Trust provides
general hospital services for
the local populations of South
Gloucestershire, Bristol and
North Somerset.
6This strategy and the Trust’s The NHS as a whole, including We will ensure that the views
improvement work must North Bristol NHS Trust, is facing of key stakeholders, including
address its financial position increasing pressure to deliver the local population inform
and the delays in accessing its more with less. Our plans based the implementation plans to
services, as well as continuing to on our strategic themes must enable delivery of the strategy.
develop the highest standards deliver a sustainable, recurrent The Trust Board will monitor
of patient care so that we financial surplus. Implementing and evaluate implementation
deliver excellent outcomes and our strategy will ensure that we of the Trust strategy through
a patient and carer experience make more efficient use of the the setting of objectives with
that we can be proud of. The resources available to maximise key performance indicators and
strategy has been developed benefit of our resources for outcome measures agreed on
following detailed analysis of patient care and identify where an annual basis. The strategic
the Trust taking into account cost savings can be made. themes will be reviewed each
activity, quality, performance, year to ensure they reflect an
outcomes, clinician, staff and The overarching strategy will appropriate direction of travel
patient views. It takes a fresh be supported by enabling as the environment in which we
look at our organisation, at and supporting strategies work and the population we
the opportunities available, including Quality, Research serve continuously evolves.
the challenges that can be and Development, Information
foreseen, and at our strengths Management and Technology,
and weaknesses. The detailed Workforce, Estates and
analysis can be found in Facilities, Communications
appendices A & B of this and Stakeholder strategies.
document.
The Trust strategy aims to
deliver a successful, sustainable
and resilient organisation,
playing a full part in an effective
health and care system.
73 | Our values and vision
3.1 Trust Values
During 2012, in consultation with staff, the Trust developed a description of our underlying values that
represent what we stand for. We know that embedding these shared values in everything we do will
increase staff engagement, improve outcomes and create a positive experience for patients.
Our values are:
Putting Working Recognising Striving for
patients well the person excellence
first together
Understanding the Engaging with Making staff and Continuously
impact of every role colleagues and patients feel valued reviewing what
on patient care, even patients to and worth your time we do, to seek
if you’re not in direct proactively resolve new ideas for
contact issues Looking everyone improvement
in the eye,
Taking the time to Demonstrating acknowledging Demonstrating
listen and care commitment to them, recognising commitment to
shared objectives they are people continuous learning
Protecting patient and development
confidentiality, Including and Appreciating
privacy and dignity consulting others differences and Celebrating efforts
when making the strength that and successes
Being open and decisions that affect diversity can bring
transparent when them Recognising your
things go wrong Helping the patient own limitations,
Offering understand their using mistakes
Intervening when encouragement and condition, involving as learning
others have not, feedback to others them in decision opportunities and
speaking up when making remaining resilient
necessary Becoming trusted and when facing
respected by staff Taking a holistic challenges
Treating your patient and patients approach to care
as you would expect a Going the extra mile
loved one to be cared to make a difference
for to patients and
staff, even if this is
indirectly
83.2 The vision for the future
We will realise the great potential of our
organisation by empowering our skilled
and caring staff to deliver high-quality,
financially sustainable services in state-
of-the-art facilities. Clinical outcomes
will be excellent and with a spirit of
openness and candour we will ensure an
outstanding experience for our patients.
We aim to provide best practice care and treatment with excellent clinical outcomes
that are comparable to the best in the world. Care will be delivered safely ensuring
every patient has an outstanding experience. We want to be part of a local system
of healthcare that provides high quality care to patients with an efficient use of
resources and understand that we need to continuously improve the care we offer
so that we deliver in a more productive and efficient way. We want to be nationally
recognised for our specialist services, leading regional provider networks and
developing our services through a combination of clinical excellence, research and
high quality training.
Exceptional
healthcare,
personally
delivered.
94 | Strategic themes
To deliver our vision and strategic aims the Trust Board has chosen the
following themes that will form the basis of our plans over the next five years:
1 Change how
we deliver
services to
2 Be one of
the safest 3 Treat patients
as partners
trusts in the UK in their care
generate affordable
We will improve We will develop
capacity to meet the
delivery of care for our relationship
demands of the future our patients by continuously with patients and
Within our current portfolio working to increase the their families/
of clinical services, we will consistency and reliability carers so that they are more
need to meet the challenges of our services, eliminating involved in making choices
we face now and in to the variations in care provision about the planning and
future by managing our that do not improve patient management of their care. For
resources more efficiently and outcomes. We will become example, our ‘Ask 3 Questions’
changing the way we deliver proficient in working together campaign encourages patients
care, particularly for frail and in teams to always provide the to ask three key questions
elderly patients and those right care for every individual about their condition and
with long term conditions. patient, in the right place. We treatment options. Knowing
This will include using the will then be one of the safest what’s important to the
expertise of hospital staff trusts in the UK, providing patient will help us to guide
to increase care for patients outcomes that match the best them to the best decision.
in community settings. We in the world. We will communicate in a
will also need to respond transparent way and with
to the development of candour if things go wrong.
new technologies that will This will result in significant
increasingly customise medical improvements in how patients
interventions to individual experience the service we
needs. offer.
4 Create an exceptional workforce for the future
Our highly valued, caring staff are central to everything we do.
We will develop a flexible and multi-skilled workforce that provides
the staffing needed for the future. For example, we will continue
to build on our nationally recognised apprenticeship and training
programmes and develop our partnerships with the Universities. Our
teams will be able to adapt to the changing needs of patients and
work together to deliver the vision of the Trust. We will invest in our
staff, nurture their talent and develop high performing teams. We will
care for and respect our staff, prioritising their health and wellbeing
to become an employer of choice.
10Sections 4.1 to 4.8 describe the strategic themes in
5 Devolve decision making and
empower frontline staff to lead
more detail, setting out our priorities for action during
2016/17 and our ambitions for 2021
We will be a clinically led
organisation, with frontline staff
6
empowered to make decisions
Maximise the use of technology so that the right
and implement changes in their
area of work, including clinical information is available for the key decisions
quality, operational We will innovate and transform our services through an
performance and increasing use of technology, to drive better availability
use of resources. of information to drive better outcomes for patients. This
Together the will include information about individual patient
directorate leaders care, which may be at a distance, as well as
will take the data about the processes through which care
organisation toward is delivered. Leaders and teams will then have
the strategic vision. the information they need to ensure the
Trust vision is realised.
7 Enhance patient care
through research 8 Play our part in delivering a
successful health and care system
Research active organisations We will act as leaders within our healthcare system, using
like NBT deliver better outcomes our clinical knowledge and experience to ensure the most
for patients. Also future effective care for patients. We will work with partners to
improvements in care are ensure that our patients are treated in the right place, at
dependent on development the right time and that
of today’s research. We will the most appropriate organisation
therefore build on our already provides the cost effective care that
significant and growing research patients need. We will step up to play
portfolio. We are one of the top a wider role in making the
30 research active trusts in the whole healthcare system
UK and we aspire to become a successful both through the
world leading research facility, BNSSG Sustainability and Transformation plan
delivering high quality research and also through our leadership of specialist service
of direct patient networks.
benefit. Research
will become
an embedded
component of
clinical service
delivery.
114.1 | Strategic theme 1
Change how we deliver services to generate
affordable capacity to meet the demands of the
future.
Within our current portfolio of Priorities for year one (2016/17)
clinical services, we will need
to meet the challenges we face • Minimise delays to inpatient • Develop and embed the Trust’s
now and in to the future by care with timely discharge or service improvement and
managing our resources more transfer when appropriate methodology
efficiently and changing the
way we deliver care, particularly • Improve the efficiency of • Begin work with GPs and
for frail and elderly patients outpatients, theatres and bed community providers so
and those with long term use to speed up access to care that patients with long term
conditions. We will also need and maximise effective use of and complex conditions
to respond to the development resources feel supported but hospital
of new technologies that will attendances are minimised
• Improve the quality of
increasingly customise medical information available to leaders
interventions to individual and management teams so
needs. that service line reporting is
We aim to develop a long developed to support service
term culture of continuous line management
improvement that will ensure
every patient receives the best By 2021 we will:
possible care on every occasion
they need it. We will build an • Have achieved the highest • Have diagnostic services that
organisational culture that level of rating from regulators support a growing number
prioritises patients and quality of providers to deliver
• Deliver services that meet all personalised care and ensure
care above all else, with clear NHS constitution and national
values embedded through that patients receive the best
cancer minimum standards care, first time and in the most
all aspects of organisational
behaviour. We will deliver care appropriate setting, away
• Deliver operational
in accordance with national from hospital when possible
performance standards to
and local performance which other trusts aspire • Use service line costing so the
targets; notably in relation to Trust understands how much
Emergency Department waiting • Deliver best practice emergency
each service costs and ensure
times, referral to treatment care seven days a week
costs do not exceed tariff
times, transfers of care and • Have specialist services that income
delivery against Care Quality meet best practice guidelines
Commission hospital inspection • Have eliminated the financial
for access to care
recommendations. Our services deficit, offering a portfolio
will be provided within the • In the best interest of the of services that deliver
available financial, workforce patient, rapidly repatriate a financially sustainable
and infrastructure resources. specialist patients to organisation
referring hospitals and health
• Lead networks of providers
communities
to deliver complex care that
• Have maximised the use of is centralised where necessary
the hospital infrastructure but close to home when
efficiently across the week possible
124.2 | Strategic theme 2
Be one of the safest trusts in the UK
We will improve delivery of care high quality, safe care for restricted. Quality improvement
for our patients by continuously every one of our patients, in is therefore a continuous and
working to increase the every service every time it is long term requirement.
consistency and reliability of our needed. We will continue to
services. We will become experts work with partners to share We will maintain continued
at working together in teams best practice and ensure that oversight of the outcomes
to always provide the right care safe care is embedded within of care through contribution
for individual patients. We will all pathways of care. We expect to national audit, national
be one of the safest trusts in the rapid development of new registries and monitoring of
UK, providing outcomes that technologies that will increase hospital episode statistics.
match the best in the world. personalisation of medical We will measure and monitor
treatment. Expectations of quality performance indicators
We have a long standing patients will continue to and take action promptly when
commitment to improving increase but available resources needed to ensure patients
quality and safety in our will remain significantly always receive the quality of
services. The aim is to provide care they need and expect.
Priorities for year one (2016/17)
• Ensure infection control • Ensure that at least 80% of • Meet all local contractual
processes, including monitoring annual Commissioning for requirements for quality of
and reporting are exemplary Quality Innovation (CQUIN) care
programmes are delivered
• Review learning from • Develop a suite of outcome
every patient death and • Deliver the priorities of metrics relevant to all
be transparent in our the annual quality account specialties
investigations and Sign up to Safety
commitments
By 2021 we will:
• Have a reputation for to benchmarks and with • Have reduced complexity of
excellence with outcomes messurably exceptional care in care by standardising according
that match the best in the at least 10 specialties to patient pathways
world
• Deliver services that meet • Have developed team working
• Have a culture of continuous patients’ needs seven days a that manages the complexity
learning and transparent week of individual patient needs
investigations that seek to and ensures that handover
avoid patient harm as a result • Deliver care in an appropriate, between teams (inside and
of errors in care well equipped and clean outside the Trust) promptly
environment and reliably provides the
• Reduce harm events to a necessary information enabling
minimum level that is best in • Offer rapid access to best
in class diagnostic services seamless care
class amongst UK hospitals
that meet all regulatory and • Publish quality and outcome
• Have developed services professional standards measures to ensure relentless
that are all providing good focus of the organisation on
outcomes in care in comparison • Be a centre of excellence
for quality improvement delivery of the Trust vision.
methodologies 134.3 | Strategic theme 3
Treat patients as partners in their care
We will change our relationship Priorities for year one (2016/17)
with patients and their families
and carers so that they are in • Embed partnership working • Improve involvement of
charge of making choices for the between the Trust and patients patients, their families and
planning and management of by ensuring patient and public carers in discharge planning
their own care. We will always involvement in an increasing and ongoing decisions
communicate openly and number of our activities
transparently when responding • Increase the number of patients
to individual patient needs. • Improve timeliness, who receive end of life care in
This will result in significant transparency and quality of their chosen location
improvements in how patients responses to complaints
• Use the ‘ask three questions’
experience the services we offer. • Act on information from CQUIN improvement model so
The NHS Five Year Forward patient surveys including the that patients are empowered to
View proposes that NHS Friends and Family Tests get the information they need
organisations develop new
relationships with patients and By 2021 we will:
communities. We will support
people to manage their own • Have expert service user • Have respect for patients’
health – staying healthy, involvement in all major knowledge of the needs
making informed choices about change projects and service of their own long term
care, managing conditions so developments conditions wherever they are
their dependence on health cared for in the Trust
• Patient held care plans will be
care services is reduced. This in place, including self-care • Have tailored care to meet
will decrease attendances for advice where relevant the needs of patients with
urgent care and reduce the cognitive impairment, mental
amount of time patients spend • Have clear written health issues or learning
in hospital. Our services will information to support disabilities, maximising
change so that patients have patient consent for all the opportunity for these
rapid access when needed, and procedures individuals to understand and
where possible, care and advice contribute to decisions about
• Have end of life care provided
within their own homes. their health
in the setting of choice for
patients and families with 24/7 • Have a patient experience
access to expert support programme that listens to
• Reduce follow up outpatient patients, carers and staff and
appointments to those where learns from their experiences
the only option for good care • Teams will develop the services
is a face-to-face meeting in the they offer in response to what
hospital patients tell them. Actively
• Release outpatient capacity seeking patient feedback
to provide rapid access for and responding promptly to
patients who need it urgently complaints.
• Have services that the people
who use them rate highly and
recommend to others
144.4 | Strategic theme 4
Create an exceptional workforce for the future
Our highly valued, caring staff and with clinicians working in the delivery of quality education
are central to everything that we partnership with colleagues in for health care support workers.
do. We will develop a flexible primary, community or social care. This is designed to support
and multi-skilled workforce and progression within roles and into
plan the staffing we need for Complex health care is delivered higher education, so that there
the future. Our skilled teams will through teams who have the is a sustained pipeline of future
be capable of adapting to the right knowledge, skills and workforce.
changing needs of our patients approach to deliver for the needs
and working together will deliver of today and to continually We want our staff to enjoy
the Trust’s vision. We will invest in develop new approaches for working in the organisation and
our staff, nurturing talent and high tomorrow. Our teams must work to feel valued and respected
performing teams and ensuring together so that patient care in their roles. We will ensure
time is available for appropriate is not compromised by barriers equality for all by implementing
training. We will respect and care between teams. and supporting schemes such as
for our staff, prioritising their the workforce race and equality
We are a large teaching trust in standard, and we will embrace
wellbeing so that we become an the South West with educational
employer of choice. and support talent, providing
partnerships with the regions opportunities for those who wish
We will ensure safe and competent universities, colleges and a to progress their careers and
staffing for our services now thriving schools and work achieve their potential.
and into the future. We envisage experience programme. We
a world where care could be have a National Skills Academy
provided in different settings for Health Excellence Centre, for
Priorities for year one (2016/17)
• Management skills • Workforce planning • All teams upholding
development in place and capabilities are enhanced the highest professional
impacting positively on delivery and rigorous standards
• Appropriate management of • Minimise use of temporary • Deliver the staff wellbeing
sickness and other absence staff CQUIN goals
• Improve staff engagement,
health and wellbeing
By 2021 we will:
• Have staff who are all • Create a culture of upholding • Have reliable staffing to full
appropriately trained, the values and standards of establishment
motivated and well led , with all behaviour of the Trust
the skills required for safe care • Show that our staff are proud of
• Have strong partnerships with the place they work and what
• Give all staff the opportunity the universities and Deanery they achieve
for a greater say in the future to support training of health
of the organisation so they can care professionals fit for the
effect and take responsibility future
for making things happen
154.5 | Strategic theme 5
Devolve decision making and empower frontline staff to lead
Our organisation will be Priorities for year one (2016/17)
clinically led, with directorates
taking responsibility for and • Develop and enable clinical
• Develop a detailed
making decisions about leader capability addressing
implementation plan for
their area of work including gaps in current skill sets
clinically led, service line
clinical quality, operational
management as agreed by the
performance and use of • Align corporate functions
Board. Actions to commence
resources. to support and enhance
within 2016/17 with
clinical directorate success
Clinical leadership, leads completion during 2017/18
to better solutions to the
complex problems we face.
Decisions will be taken closer
By 2021 we will:
to patient care and necesssary • Hold directorates accountable • Have clinical leaders who
changes to culture will for delivery of quality care drive the future success of the
happen more rapidly. Our and managing performance organisation as well as future
Clinical Directorates are now within available resources performance
led by a Clinical Director, through effective service line
General Manager and Head management • Have management teams and
of Nursing. These leaders will corporate functions skilled in
be empowered to take the • Have clinicians with the time supporting clinical leaders to
key decisions on behalf of the and skills required to lead be successful in their roles
organisation. the organisation and develop
succession plans for their roles • Have clinicians who are the
There is more to be done to key decision makers, playing
engage, enable and equip • Demonstrate seamless patient an integral role in shaping
clinicians to take these leading care pathways through clinical services of the future
roles and we are committed to directorates working together
providing the support, time and
training required. • Have clinical leaders focused
on collectively delivering the
strategic vision of the Trust
as well as the success of their
own area of responsibility
164.6 | Strategic theme 6
Maximise the use of technology so that the right
information is available for the key decisions
We will innovate and transform convenient and this will also be of their lives. There are also
our services through increasing applied to health provision. opportunities to use technology
use of technology to drive better to provide services in different
An important element of self-care
outcomes and experience for ways such as through remote
is enabling patients to understand
patients. Our clinicians will have consultations.
and monitor their own conditions.
accurate and relevant information
Access to their own data will be The new patient record system
to support them to deliver care
expanded as much as possible introduced in 2015, provides
to patients. Our leaders and
to enable self care by patients. a basis for future system
teams will have the data they
There are also opportunities to developments and will support
need to measure the Trust’s
use technology to deliver services the move to a full electronic
improvements. Staff and patients
in different ways, such as through patient record. We plan to be a
are increasingly used to instant
remote consultations. Enabling paperlight organisation by 2018.
access to information in their
patients to monitor their own This will include using technology
everyday lives and they expect the
conditions, is already available to support good decision making
same when working or receiving
in some services and should be such as rapid access to clinical
care. Information Technology has
expanded as much as possible guidelines.
made many aspects of life more
so that patients can take control
Priorities for year one (2016/17)
• Stabilise the existing patient • Implement electronic reports and support staff to
record system (Lorenzo) document management understand and interpret the
data presented
• Develop and implement • Agree and deliver a suite of
service line reporting management information
By 2021 we will:
• Have electronic systems that • Use technology to support the • Routinely support demand and
ensure all the information use of our clinical expertise capacity analysis and service line
required for individual patient in caring for patients at a reporting
care is always available to staff distance such as virtual clinic • Demonstrate that population
in a format that supports their consultations and advice and data such as the Joint
work flow guidance for GPs Strategic Needs Assessments is
• Have sufficient hardware devices • Have systems that are accessible incorporated
and resilient IT services in the to patients to help them into future planning
clinical environment to support understand their own data and • Have data capture systems that
use of the electronic patient support self-care support the service improvement
record • Enable leaders to understand methodologies including rapid
• Put in place systems that enable how the Trust functions, with cycle tests of change and key
connectivity across the health real time information, business performance indicators
community allowing rapid intelligence and large scale
exchange of information to analysis to support future
support care wherever patients development
are located
174.7 | Strategic theme 7
Enhance patient care through research
Future improvements in care Priorities for year one (2016/17):
are dependent on development
of today’s research. We have • Broaden our research portfolio • Increase patient satisfaction
a significant and growing to offer more of our patients with our research function
research portfolio and are one the opportunity to participate
• Make research more visible to
of the top 30 research active in research
patients and visitors
trusts in the UK. Our research
output will be expanded • Develop a five year research
and further strengthened strategy for the Trust
by actively supporting our • Invest in our research
established research strengths workforce and facilities to
in musculoskeletal, infection, increase our ability to deliver
immunology, neurosciences the research of the future
and urology. Diabetes and
respiratory medicine will
continue to be supported
alongside emerging strengths
in anaesthetics, obstetrics, By 2021 we will:
vascular, surgery and stroke
research. • Improve and integrate • Have research embedded
research access across in clinical services delivering
We aspire to become a world- the region providing our improvements in service
leading research facility, that community with as many delivery and patient
delivers high quality research of research opportunities as outcomes
direct patient benefit and possible
• Be leaders in research policy
to embed a research culture • Increase the research income and process to improve
in clinical service delivery. of the Trust research outcomes
We have worked with our
partner universities and NHS • Have patients who are integral
Trusts in the region to form partners in designing and
Bristol Health Partners. This directing our research
partnership has established 20 • Demonstrate academic
Health Integration Teams that excellence (publications and
are aligned with the research, grant income) across our
education and healthcare research strengths
strengths in Bristol. We intend
to further develop our systems
for ensuring rapid introduction
of new evidence based care for
the benefit of our patients.
184.8 | Strategic theme 8
Play our part in delivering a successful health and care system
We will be leaders in our Priorities for year one (2016/17)
health and care system, using
our clinical knowledge and • Work with partners to • Prioritise improvements to
experience to ensure the most develop and start to patient flow through our
effective care for patients. implement the Bristol, hospitals, working with key
We will work with partners North Somerset and South stakeholders and partners
to ensure that patients are Gloucestershire Sustainability across the health and care
treated in the right place at and Transformation Plan system to ensure patients are
the right time and that the only admitted when necessary
most appropriate organisation • Work with partners to design and are discharged as soon as
provides the care that patients and implement plans that possible
need. We will step up to play a ensure the sustainability of
wider role in making the whole Weston General Hospital • Minimise delays in transfers of
healthcare system successful. patients to other health care
providers through building
The NHS Five Year Forward effective provider networks
View, states that the traditional
divides between primary By 2021 we will:
care, community services,
hospitals, physical and mental • Be part of a successful • Have embraced opportunities
health, are increasingly a and sustainable health to partner with other
barrier to the personalised, and care system organisations to deliver care
coordinated health services in more effective ways; be
patients need. We acknowledge • Have developed networks they NHS, commercial
that we need to build with other providers that or third sector
constructive partnerships ensure patients are managed
with commissioners and other in the right place at the right • Continuously develop
providers to ensure that we time to meet their needs new ways to deliver services,
are working together for the designed for and by the
• Have built strong people who use them,
benefit of patients, wherever
relationships with all primary, working with partners to
they are in the health system.
community and secondary develop the whole health and
For good outcomes, patients care providers to maximise care system
need all parts of the system the effectiveness of care and
to work seamlessly together. the patient experience
Our vision is that we will take • Be working with partners to
a strong leadership role in the ensure that rehabilitation,
systems in which we work, with enablement and social care
our clinicians driving changes in are accessed rapidly and in the
how care is delivered. most appropriate location to
meet patient need, including
those with specialised needs
195 | Next steps and delivery plan
In order to deliver our vision, we must implement the
commitments set out in this strategy.
5.1 Governance
The Board of Directors at In the annual exercise of agreeing The Board will work closely
North Bristol NHS Trust is the Trust and Directorate with the leaders of partner
committed to delivering the business plans and in the setting organisations to ensure there
vision described in this strategy, of budgets, the Board will ensure is a collaborative approach
with the aim of creating a that appropriate resources are to whole system change and
strong, vibrant organisation directed at achievement of that the Trust is making an
which is at the forefront of the aims and ambitions within appropriate contribution
healthcare delivery in the the strategy. to system success.
West of England. The Board
The Trust Management Team
will agree the milestones for
(TMT) is responsible for
delivery of the strategy and the
development and delivery of
key performance indicators that
the Trust strategy. Members
will track progress. The strategy
of TMT will work with the
will be refreshed annually to
Medical Director in developing,
ensure that it continues to
enabling, and supporting
meet the evolving needs of
strategies and workstreams.
the population it serves and
responds to technological and
clinical advances.
205.2 Enabling and supporting strategies
The Trust strategy sets out • Clinical Services Strategy
the direction of travel for To forecast future changes
the organisation and the in the way clinical care is
framework that will be used delivered so that accurate
when developing detailed demand and capacity plans
plans. Each directorate are developed
and corporate area will
develop their own Strategy • IM&T Strategy
Implementation Plans setting To deliver reliable availability
out specific actions for their of information for individual
clinical areas and services. patient care and high quality
This will result in relentless data for organisational
focus on delivery of the Trust functioning
strategy as a whole. • Research Strategy
To build research capability
The following have been
and ensure rapid introduction
identified as key enabling
of new evidence based care
strategies:
for the benefit of our patients
• Quality Strategy
• Stakeholder Strategy
To ensure high quality care
To maintain open and
across all specialties including
effective relationships with
delivery of safe and effective
partners and other key
care and excellent patient
stakeholders
experience
• Communications Strategy
• Estates and Facilities Strategy
To ensure views are collated
To ensure a high quality,
and considered within
flexible estate
strategy implementation;
• Workforce Strategy and tools developed to
To ensure sufficient flexibility, ensure consistent narrative
capacity and capability in and implementation of the
the workforce including strategy throughout the Trust
professional clinical staff
and first class leadership and
management skills
216 | Conclusion
North Bristol NHS Trust Providing the high quality
care to which we all aspire,
is a provider of complex within the resources available is
and acute healthcare increasingly challenging and this
for a large population situation is unlikely to change.
This strategy is designed
in the South West of to create an organisation
England. We manage equipped to find the solutions
to the problems we face and to
some of the most difficult deliver sustainable success over
medical conditions, in the long term. High quality,
an increasingly complex motivated staff and teams that
work effectively together to
patient population with achieve the Trust’s vision are
multiple comorbidities fundamental to our future
success.
and long term conditions.
We are a component part
We have the advantage of a complex health system.
of having invested in a modern We provide services with
estate and equipment, and the a significant and growing
hospital building is designed demand. We have staff with
to enable complex care to a the expertise that can support
high quality and to provide an high quality care in different
excellent experience for patients. settings. Working closely with
partners in the system to
ensure that the Trust is used
where it adds most value to
the population’s health will be
critical to ensuring our vision for
the future is realised.
2223
7 | Appendix A: NBT today
7.1 Clinical Services
North Bristol NHS Trust is a services that serve a wider and Major Trauma centre supported
provider of acute and specialist more regional population. by seven major trauma units
health services and includes The general hospital services in other providers. The Trust
services that reach into the require a range of skill sets provides the Major Arterial
community such as maternity and infrastructure that can be Centre for the vascular network
care and diagnostics. The found in most acute hospitals. which is delivered through
Trust has 1,050 hospital beds The specialist services require a ‘lead provider’ model. This
and employs over 8,000 staff. additional skills in areas includes 24/7 access to a
In the financial year 2014/15 including diagnostics specialised multidisciplinary
we received an income of and equipping. team which has access to a
£552m. Income for patient care £1.5 million ‘hybrid operating
was split 31.6% for specialist Our services have evolved to theatre’.
services, commissioned by NHS meet the needs of patients and
England and 63% from the commissioners. Working with The plastic surgery service
Clinical Commissioning Groups University Hospitals Bristol NHS provides a highly specialised
of South Gloucestershire, Foundation Trust a number team, experienced in the most
Bristol and North Somerset. of significant transfers of complex cases in adults and
services have been undertaken children (delivered at the Bristol
In 2014/15 we treated over between the two major acute Children’s Hospital). The South
51,000 inpatients, including providers in Bristol that ensure West UK Burn Care Network is
day patients, as well as caring care is provided in the most hosted by the Trust and covers
for over 85,000 people in our appropriate setting. Where South and mid Wales, Devon,
Emergency Departments. skills are in short supply, Cornwall, Somerset, Wiltshire,
More than 6,000 babies were consolidation has taken place Hampshire, Scilly isles and
born at Southmead, Cossham, to improve patient outcomes. South Gloucestershire.
at home, or elsewhere in the The arrangements have
community and we carried always given due regard to This grouping of specialist
out approximately 295,000 the need for local provision surgical services including
outpatient appointments. where possible, to ensure a neurosurgery has established
good patient experience. As the Trust as an organisation that
We provide general hospital a result of the changes made, treats the most complex surgical
services to our local population we host the Severn Region emergency patients.
and a range of specialist
24¡ Over 85,000 people cared for in our Emergency Department
¡ Over 6,000 babies born at Southmead, Cossham, at home
or elsewhere in the community
¡ Over 56,000 inpatients treated, including day patients
¡ Over 7.9 million pathology tests conducted
¡ Approx. 295,000 outpatients seen
Consolidation of urology and Emergency care and cancer molecular biology expertise
breast care services, in addition care have high demands for provides an opportunity to be
to established skin cancer, diagnostic specialties from at the forefront of technological
brain cancer and lower gastro- both pathology and radiology. changes that will deliver the
intestinal services has resulted In recent years we’ve made personalised medicine expected
in a centre of excellence for significant investments in two in the future.
complex cancer surgery. We buildings to house pathology
also provide diagnostic and services. The second of these Radiology underpins all of
specialist components of upper opened in 2016. They are the Trust’s clinical services. We
gastro-intestinal, lung and occupied by all of the Trust’s have continued to invest in
gynaecology cancer care. We pathology services, together new technologies for both CT
do not provide radiotherapy with a city wide consolidated and MRI scans and demand for
or oncology services but service for histopathology these services continues to rise.
work in partnership with and, in partnership with Working in partnership with
University Hospitals Bristol NHS Public Health England, a Alliance Medical, we will house
Foundation Trust to ensure microbiology service for Bristol a Positron Emission Tomography
smooth pathways for patients and Bath. The Trust has a long (PET) scanner from 2016
who require these services standing genetics laboratory which will improve diagnostic
following, or in conjunction with a national reputation. capability for cancer patients
with, surgical intervention. The constellation of general in Bristol. Increasing amounts
pathology services around of what was formerly surgical
a continually developing work is now being undertaken
by Interventional Radiology. It
is expected that this trend will
continue and because skilled
radiologists are in short supply,
it is likely that Interventional
Radiology services will be
relatively centralised in the
health care system.
257 | Appendix A: NBT today
7.1 Clinical Services cont.
We need a strong Its academic strength and vascular services supporting
interventional radiology service international reputation renal failure treatment and
to deliver complex surgical for expertise in safe, team- kidney transplantation is
work and are already taking based care. There is much another example of this
patient referrals on a regional that the rest of the Trust as interdependent working.
basis. well as other organisations
can learn from its success. The Richard Bright Renal Unit
In addition to the needs of the Associated with the maternity at Southmead Hospital is the
Trust, diagnostics underpin services, the Trust provides largest of its kind in the West
much of health provision in a specialist commissioned of England. It carries out
primary and community care. level three neonatal intensive over 100 kidney transplants
The requirement of earlier care unit which specialises in every year and has led the
diagnosis, particularly for extremely premature babies, way with laparoscopic kidney
patients with suspected cancer, working within a provider transplantation, spousal
will increase demand for based neonatal intensive care donation and non-heart-
diagnostic testing as well as the network. beating donor transplants.
need for expert interpretation
of results that supports decision The services we provide today Our Neurosciences department
making in General Practice. create an interdependent is the regional centre for
Ease of access to diagnostics whole. For example, trauma neurological services for the
will be an important part of service provision requires West of England, including
future provision. This represents complex orthopaedic services. Neurosurgery, Neurology
a further opportunity for This makes Southmead hospital and Stroke, Neuropsychiatry,
the Trust to make a positive the natural home for the Avon Neurophysiology, and
contribution to the health Orthopaedic Centre, which Neuropathology. The
needs of the local population. is one of the largest elective department also leads the
orthopaedic services in the South West neuromuscular
The Trust’s maternity service country providing regional, network.
is a fundamental part of specialist complex elective
our provision for the local The Interdependency of services
care and services to the local suggests there is limited change
population, along with population. Urology and to the portfolio that could be
made without impacting on
the performance of the Trust
as a whole. The breadth of
service delivery creates the
Trust’s unique identity and as
a result of this service delivery
model the complexity of
patients attending the Trust will
continue to increase.
26The Figure 1: NBT today
interdependency
of services
suggests there Musculoskeletal
Neuroscience
is limited change Renal Local Hospital,
to the portfolio Medical, Surgical
and Maternity
that could be services
Trauma Centre
made without Arterial Centre
Cancer Surgery
impacting on Emergency
and care
Surgery
the performance Plastics/Burns
of the Trust
as a whole.
The breadth of
Diagnostics
service delivery
creates the
Trust’s unique
identity.
277 | Appendix A: NBT today
7.2 Future demand 7.3 Market analysis and Other acute providers in
the region are Royal United
context Hospitals, Bath, which
As specialist services
consolidate within networks predominantly serves the
The Trust operates in two population of Bath and North
and with demographics main healthcare markets:
indicating increased numbers East Somerset; and Weston
of people living with more • Local acute services – Area Health, which serves the
than one long term health predominantly for the population of North Somerset.
condition, we can expect population of South Both trusts refer complex or
increased demand for our Gloucestershire, Bristol specialist cases to North Bristol
services. The activity projections and North Somerset NHS Trust. A significant review
suggest that demand for of the models of care for
elective work will continue to • Specialist services – primarily hospital services in Weston-
increase for most specialties, in the South West of England Super-Mare is to be undertaken
and particularly orthopaedics and in some cases, national. in 2016 with a view to ensuring
which was expected to grow 5% sustainable, high quality
We are one of two acute services for this population.
in 2015/16. Given the resource trusts in the Bristol area.
and capacity constraints in the The review may impact the
Over recent years, there have share of care that is provided
health system, we will work been a number of service
with commissioners to deliver by health organisations in
changes between the Trust and Bristol, including North Bristol
more care in the community University Hospitals Bristol NHS
and closer to NHS Trust. We do not expect
Foundation Trust. No further a change in patient flow with
home and also work with major changes are planned and
patients to enable self- respect to Bath.
it is therefore expected that the
management. The aim is to market share will remain fairly The wider Bristol area also
minimise increases in demand stable. hosts a number of private
on hospital services. sector providers which all
There are opportunities for us provide additional elective
to grow some of our specialist capacity to the NHS.
services if national drivers to
improve cancer identification
and treatment lead to more
funding in this area. Other We play an important
role in developing the
conditions such as stroke
care may consolidate within
tertiary centres. In order to
health care workforce
meet any additional demand,
it is expected that networks
within the region will improve,
of the future.
ensuring that patients are
repatriated closer to home as
soon as they no longer require
the necessary specialist care.
287.4 Workforce 7.5 Research
The Trust employs over 8,000 staff including: We have strong links
with the University of Bristol
Medical and Dental 853 and the University of the
West of England (UWE).
Admin and Estates 1,620
We have a significant and
Healthcare and support staff 1,630 growing research portfolio
with more than 280 researchers
Nursing and Midwifery 2,210 delivering 450 research studies
Scientific and Therapy 1,373 in the past year, including
48 commercial trials. Current
Following the move to the We play an important role in research strengths include
Brunel hospital building, developing the health care trauma, urology, MSK,
staff turnover increased and workforce of the future. We obstetrics, neuroscience
a number of individuals with provide education, teaching (including movement disorders,
important skills and experience and training for undergraduate multiple sclerosis and
have left the organisation. We and postgraduate doctors, Alzheimer’s disease), emergency
will continue to concentrate nurses, midwives, allied health medicine, microbiology and
on filling gaps in staffing with professionals and healthcare diabetes. We are growing
permanent appointments scientists who work here, which in stroke, vascular surgery,
to reduce dependence on is an established, respected dementia and plastics, we
temporary staffing. There has centre for training healthcare have active research staff in
also been a focus on developing students. every directorate and all of
the necessary skilled staff in our regional specialities are
areas such as theatres and Our Apprenticeship Centre is delivering research.
intensive care. Understanding nationally recognised as an
employer based education Research, and the associated
and improving management of teaching and learning,
sickness absence and all aspects programme with a Skills Funding
Agency apprenticeship contract. supports delivery of care for
of staff wellbeing are also areas approximately 5,000 patients
requiring continued focus. The apprenticeship programme
is seen as the start for many per year contributing to
The staff survey in 2014/15 people who go on to fruitful staffing capacity. Research
was taken after the hospital health care careers at all levels, trials give patients access to
move and was a disappointing within the Trust and the wider novel treatments and the Trust
result, with the Trust being health and social care economy. leads ground breaking research
in the worst 20% for 10 of projects that are trialling new
interventions and attracting
the 20 questions. Subsequent 2,157 new patients from across the UK.
information from the staff
Friends and Family Tests, and employees joined Outcomes from Trust led
research in surgery, musculo-
the 2015/16 staff survey have
shown an improvement but
the trust, including skeletal services, microbiology
the Trust Board acknowledge 1,609 clinical staff and obstetrics have been used
that there is more to do, as to update national guidance,
the performance and quality demonstrating translation
of the services we provide into care improvements.
are dependent upon a well-
motivated and highly skilled
workforce.
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