Our 2018-2028 Strategy - Summary Version - Nottingham University Hospitals NHS Trust
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Our 2018-2028 Strategy
Summary Version
1
Our vision is to be outstanding in health outcomes and patient and staff experience
Introduction
This is a time of significant change and transition
for Nottingham University Hospitals NHS Trust
(NUH), the system and the wider NHS.
We have recently seen a number We also have a number of Ensuring our patients receive We are determined to consistently
of organisational and leadership challenges to navigate our way consistently high quality, safe care demonstrate we listen to and care
changes. This presents opportunities through. NUH faces a significant with outstanding health outcomes for our patients and staff.
to reflect on the journey we have financial challenge, we have an and experience is at the centre of
Thank you to everyone who has
been on over the last 12 years since ageing estate and infrastructure all we do.
had their say and influenced our
NUH was formed and look closely and we need to improve our
We are very clear we need to be strategy, including our patients,
at what is needed in the future. We performance in a number of
ambitious for our patients and system partners and our staff
go into our next chapter with many areas, including the emergency
brave, bold and innovative moving (including our clinical leaders).
strong foundations, recognising we access standard, if we are to fulfil
forward. Importantly, we must The feedback we have received
have made some great progress in our true potential. We have
think differently about how we has influenced the content of
recent years to improve patient and workforce challenges due to
deliver safe, high quality and this document and will help us
staff experience and safety national shortages in some areas,
effective care for our patients. to remain focused on what we
year-on-year. and we are committed to working
set out to achieve in the future.
ever closer with our health and Leading-edge research, teaching
social care partners across and technology is an important This is a challenging, yet exciting
Nottinghamshire to part of our future strategy. If we time for NUH. We look forward
respond to our growing and are to realise our potential, we will to working with our patients,
ageing population who have work even more closely with our our partners and our staff to
more complex health and social full spectrum of partners, including shape the future of health and
care needs. our patients, those across health social care services for the local
and social care, academia and communities we serve in the next
beyond in the years to come. decade and beyond.
3
About us
We have an important QMC is where our Emergency
With 15,000 staff, we are one
of the biggest employers in the
Department (ED), Major Trauma Centre
contribution to make
city with a central role in
supporting the health and and the Nottingham Children’s Hospital
to life in Nottingham
wellbeing of our local population.
We play a leading role in research, are based. It is also home to the
education and innovation. University of Nottingham’s School
and the wider region NUH was established in 2006 of Nursing and Medical School.
and we take this
following the merger of Nottingham
Nottingham City Hospital is our
City Hospital and Queen’s Medical
responsibility seriously.
Centre. We have a budget of just
under £1billion, 90 wards and planned care site, where our cancer
1,700 beds across three main sites:
QMC, City Hospital and Ropewalk
centre, heart centre and stroke services
House. We deliver district general are based. This site also supports our
services to 2.5 million residents of urgent and emergency care pathway.
Nottingham, Nottinghamshire and
its surrounding communities.
Our expertise and specialist services
Ropewalk House is where
allows us to deliver care to 4-5 we provide a range of outpatient
million people from across the
East Midlands and nationally for services, including hearing services.
a handful of services.
4
Our vision and values
1
We will develop our local hospital
2 Our Vision
services in a way that better
integrates them with community
services, and moving forward,
Outstanding in health outcomes
Our Mission
we will ensure only patients who
need to come into hospital for and patient and staff experience.
care do so. This will enable more
patients to be treated at home or Working together with our
closer to home in the community. patients, staff and partners to
This means that we will be able deliver world class healthcare,
to grow and further develop our
research, education and
3
specialist services to secure our
future as a leading specialist centre.
training. A leading teaching
hospital and an innovative
We want our values and behaviours partner, improving the
to capture what makes working
at NUH and being part of ‘Team
health and wellbeing of the Our Promises
NUH’ special. The standards apply
communities we serve.
to all of us, are part of everybody’s
job and apply to every action we Patients People Places
take, every decision we make and
how we care for our patients, their
family members, carers and each
other. They underpin our ability
4 Performance Partners Potential
to deliver exceptional patient care
and create a great environment
for everyone who works at NUH,
We Listen.
and one where we consistently We Care.
demonstrate to patients and staff
that we listen and we care. In (Refresh our values 5
2018, we look forward to working - Summer 2018 onwards)
with our patients and staff to
refresh our values.
Our enabling
Strategies
& Plans
5
Our vision is to be outstanding in health outcomes and patient and staff experience
Our promises that can make us world-class
To achieve our vision,
we will deliver six promises.
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• A Patients People Places
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T We will ensure our patients We will build on our position We will invest in our estate,
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receive consistently high quality, as an employer of choice; with equipment and digital
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safe care with outstanding an engaged, developed and infrastructure to support
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outcomes and experience. empowered team that puts the delivery of high quality
TENTIAL
patient care at the heart of patient care.
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We will consistently achieve We will support the improvement We will deliver world-class
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make the best use of resources we serve through strong system and transform health
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models of care.
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Promise 1:
Patients
Promise 1: Patients
Consistently high quality, safe care
with outstanding outcomes and
experience is our overriding priority.
What this means Making it happen: Our year 1 goals
We want every interaction our We will change our relationship Benchmark our current clinical outcomes and develop a
staff have with patients to have with patients, their families and programme of interventions to improve performance
a positive impact on our patients’ carers so that they are empowered
Complete a full review of our services against the Care Quality
health and wellbeing and every to make choices for the planning
Commission domains (CQC) and implement any neccessary
NUH contact to add value to and management of their own care.
improvements to maintain a rating of ‘Good’ overall and improve
each patient’s experience.
We will carefully listen to the from ‘Requires Improvement’ to ‘Good’ for patient safety
Where ill-health occurs, we feedback and views of our patients
Identify services we consider ‘Outstanding’ and develop plans to
want to ensure our patients have and their families to improve our
achieve this rating by the CQC by 2020/21
outstanding clinical outcomes services and learn when we fall
from being in our care. short of the standards we and our Develop a programme to improve our Patient Experience metrics
patients expect, and we will be
We will ensure we consistently Develop a single NUH Clinical Services Strategy to enable
open and transparent where this
get the basics right and this reconfiguration of services to provide a more flexible bed base
happens.
includes cleanliness standards, across QMC and City Hospital
privacy and dignity and high We will secure our future as
quality patient information. a leading specialised centre,
growing or consolidating with
We will work towards offering
other providers. We will focus
a 24-hours-a-day, seven days a
on complex care and will reduce
week acute hospital service and
duplicated activity and unnecessary
will create an open and just culture
follow-ups that do not add clinical
of patient safety improvement
value as well as procedures of
across NUH.
limited clinical value.
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Promise 2:
PeoplePromise 2: People
Be the place people choose to work
What this means Making it happen: Our year 1 goals
The evidence proves that engaged We are a clinically-led organisation, We will further strengthen our Improve overall staff engagement through clear action plans to
and empowered staff, who are with five Clinical Divisions, programme of work to listen to improve our position against other acute trusts
well-trained, developed and supported by Corporate Services, our staff, acting on their ideas and
Develop a robust workforce plan in line with the
well-led are more likely to deliver and we embrace inclusivity and the feedback to continuously improve
Clinical Services Strategy
excellent patient care. many benefits to patient and staff our services and the experience
experience that having a diverse of our workforce. Improve retention across the Trust, specifically for
We believe that every member
workforce brings. healthcare assistants
of ‘Team NUH’ has a vital part to We aim to become the first acute
play in making our future become We are investing in a new hospital in the UK to achieve Develop a comprehensive career development strategy
a reality. leadership programme – mindful Magnet® recognition. This is a
Improve NUH’s reputation as a place to work and our recruitment
that we have leaders working at all symbol of nursing and midwifery
If we are to deliver Promise 1, we processes to reduce the number of vacancies
levels of the organisation, in a wide excellence which will provide a
need to attract and retain the best Improve accessibility of training for all staff
range of professions. platform to further meet the
people to support us to do so. We
recruitment and retention
can only do this by making NUH We will develop a new training
challenges we face.
one of the best places to work and and development programme by
becoming the employer of choice. 2020 to support new models of Many of our teams contribute
care and appropriate staff roles. to the city in other ways, including
We want to embed strong
This will include developing fundraising, working with our
teamworking across NUH and our
alternative roles such as Trainee local schools, promoting career
health and social care systems, and
Nursing Associates, Advanced opportunities and supporting
for career, development and
Nurse Practitioners and expanding the more socially-deprived areas
leadership opportunities to be
our support for apprenticeships of the local populations we serve
available at every level of the
across the organisation. and we take these responsibilities
organisation.
seriously as a major player in the
We will retain the best people
city of Nottingham.
and ensure we have a fulfilled
workforce by nurturing our talent,
creating and promoting career
opportunities and valuing and
recognising our staff. We will
invest in succession planning.
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Promise 3:
PlacesPromise 3: Places
Improving our estate and digitising our hospitals
What this means
Having a fit-for-purpose estate and We are developing our future clinical We aim to expand our neonatal
digital infrastructure is essential if models and will listen to and engage capacity so that fewer of our
we are to deliver high quality care with our patients, public and staff to smallest and sickest babies and
(and Promises 1 and 2). Yet this is inform this. Over time, we hope to their families have to be transferred
one of the areas in which we face consolidate QMC’s position as our to other hospitals, therefore
the biggest challenge with major emergency site, where we care for improving the experience of our
investment needed to address the our sickest patients, and City Hospital patients and their families.
Trust’s ageing buildings and as the site that prioritises ambulatory
Our ambition is to become the
infrastructure which increasingly and more routine procedures and
East Midlands hub for diagnostics.
impacts on patient care and our operations and long-term condition
Knowing that delivering world-
operational effectiveness. management. Ropewalk House will
class patient outcomes relies on
continue to focus on Hearing
We have developed short-term access to modern medical
Services, outpatients and vital
plans to address ‘today’s’ concerns, equipment. We will generate a
research activity in this field.
notably those about the condition surplus so we can invest in our
of our estate. We have plans to We will aim to improve the capital programme.
mitigate the highest risk areas. We environment of our Emergency
We will be expanding our robotic
are also developing Department by modernising and
services in Colorectal and
long-term plans for ‘tomorrow’s expanding our facilities through the
Thoracics. We will look to maximise
NUH’ which will involve applying development of a new Urgent and
specialist and complex surgical
for and securing significant emergency Care Centre by 2023.
work using the latest innovations
capital to transform our estate
We will explore the validity of across all of our surgical services.
and support the delivery of future
continued dual-site working for This will include owning at least
clinical models for both NUH
a number of services by the end eight modern MRI scanners and
and the wider system priorities.
of 2018/19, including Maternity, seven CT scanners, with a
Through this programme of work
Neonates and Children’s Services Paediatric Imaging Suite and new
we aim to right-size our estate,
to assess their effectiveness to Interventional Radiology (IR) facility
remove duplication of services
inform our Trust-wide clinical for Mechanical Thrombectomy
and reduce the inefficiencies
services strategy. and Vascular day cases.
that this causes in many cases.
13Promise 3: Places
Improving our estate and digitising our hospitals
What this means (cont’d) Making it happen: Our year 1 goals
We will accelerate the digitisation Implementation of the NUH Estates Strategy to improve building
of our hospitals by launching a and infrastructure resilience and reduce critical infrastructure risk
community-wide ‘Clinical Portal’
Implement our plan for medical equipment replacement to
and community-wide bed and
support our Promise 1: Patient objectives
‘flow’ management system. We
will also continue to deploy the Make progress towards becoming a Paperless Hospital and
Paperless Hospital Programme and implement plans for a network infrastructure refresh
the roll-out of an Electronic Patient
Record throughout 2019 to support
safe, high quality clinical services.
We will invest £12 million in
replacing our Network and
Telephony Infrastructure, bringing
a step-change in speed, reliability
and security of the network to
support our increasingly
bandwidth-dependent healthcare
applications. There will also be
significant improvements (best
in class) to wireless capability
throughout the organisation for
staff and visitors and enhancements
in collaboration technologies such
as video conferencing.
We will keep abreast of the latest
advancements, and also risks in
relation to Information Governance
and data protection, including
cyber-security.
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Promise 4:
PerformancePromise 4: Performance
Consistently achieving
performance standards
What this means Making it happen: Our year 1 goals
We recorded a £10.8m deficit in Like many hospitals across the NHS, We want to reduce unwarranted Improve performance in areas we are not meeting standards and
2017/18 and will need to achieve we have been unable to achieve variations and benchmark in the sustain this position
a balanced budget (and therefore the 95% four-hour emergency upper quartile nationally for Model
Develop and implement plans to improve patient flow by reducing
get into surplus) by 2018/19. access standard. We have Hospital. We will also work with
unwarranted variation in service delivery
Between 2006 and 2015, we have environmental constraints in our our local Clinical Commissioning
recorded a break-even position Emergency Department (ED) and Group to reduce new to follow-up Achieve our financial control total
every year and made modest have challenges maintaining flow ratios across a number of our
surpluses. However, these through and out of our hospital specialties, to bring them into the
successful financial results had due to high medical bed occupancy national upper quartile and to
been increasingly achieved by at QMC, resulting in inadequate implement standardised pathways
unsustainable one-off actions and availability of assessment beds, and of care across a number of
non-recurring income streams a high number of patients specialties to improve the efficiency
which have now been withdrawn, medically safe waiting to leave our of the care system by reducing
resulting in a large underlying care. There are also significant inappropriate referrals.
deficit. Nationally we do not medical vacancies
With more appropriate referrals,
envisage there being additional in ED, often resulting in extended
we aspire to expand delivery of
funding to meet the demand we waits to be seen and delays in
seven-day services to some of our
expect we will face. clinical decision-making. We are
elective specialties, including
aiming to consistently achieve the
We have consistently been one of Cancer Services.
emergency access standard by
the country’s strongest performers
March 2019 and are working with
for 18 weeks Referral to Treatment
system partners to develop future
(RTT) and for the national
urgent and emergency care models
diagnostic standard. We are
with plans to build a new Urgent
consistently strong at delivering
and Emergency Care Centre
seven out of the eight national
in the future to address the
cancer standards. A key area of
environmental and space
focus is to sustainably deliver the
constraints we have with
Constitutional Standard for at least
our current ED.
85% of patients being seen and
treated for their cancer within
62-days from urgent GP referral.
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Promise 5:
PartnersPromise 5: Partners
Strong system leadership & innovative partnerships
What this means
We are committed to working even Mid Nottinghamshire. These will be We will work closely with other healthcare providers such as University Hospitals of Leicester NHS Trust (UHL),
more closely with our system provider-led functions likely to Derby, Lincoln Hospitals, Sheffield and Birmingham to deliver outstanding care for patients in the East Midlands
partners to deliver NUH’s strategy, undertake the most of the clinical and further afield.
and contribute to the delivery of the service transformation. The
Building on our specialised service portfolio, we aim to secure our future as a leading specialised centre by:
system’s strategy. Our partners are integrated system goals will be based
our patients, their carers, our local on ambitions to reduce demand on Maintaining excellence in areas we have considerable Research and Innovation strengths or focus within our
community, our health and social our hospitals by redesigning primary Biomedical Research Centre, and also across the breadth of our specialised service portfolio (e.g. Digestive
care partners and those in academia, and community services. Diseases, Respiratory, Renal Services, Endocrinology, Ear Surgery Ophthalmology, Paediatric Surgery and
pharma and in other sectors. Medicine, HIV, Hep C and Haemoglobinopathies).
Work is already underway with
By working together with our Sherwood Forest Hospitals NHS Continuing to lead and innovate our two nationally-commissioned highly specialised services,
partners, we will meet the health Foundation Trust (SFH) where we Lymphangioleiomyomatosis (Adult) (LAM) and Ataxia Telangiectasia Service (Children), aligned to our strengths
and operational challenges our are working collaboratively to in respiratory and neurology.
Nottinghamshire system faces by develop a plan for what acute
Consolidating our services by working with other regional and national providers to create sustainable,
providing seamless pathways of (hospital) care will look like in
patient-focussed networks of care.For example, work with University Hospitals of Leicester NHS Trust (UHL) to
care, improving patient flow and Nottinghamshire going forward.
consolidate key specialist Children’s Services and improve the sustainability of pathways across the East
reducing the demand on health We are exploring ways to
Midlands.
and care services by keeping transform the models of care to
people healthy, not just intervening improve or innovate patient care Exploring opportunities to become the main cancer centre in the region for maxillo-facial cancers by
when they are ill. and operational arrangements, incorporating the workload from Lincoln as part of the nation-wide restructuring of Cancer Services.
with an initial focus on the Further developing our role as the East Midland’s Major Trauma Centre, including the underpinning specialties
We are a key partner in the
following clinical areas: Urology, such as Cardiac Surgery, Cardiology and Vascular.
Integrated Care System (ICS) and we
Neurology, Cancer, Stroke,
will work with our partners to better Developing an East Midlands hub for Neurology and Neurosciences services, supporting other centres and
Radiology, Pathology, Pharmacy,
co-ordinate the Nottinghamshire pioneering a new service for Mechanical Thrombectomy.
Renal, Sterile Services and Neuro-
health and care system through
Rehabiliation. Further expanding our expertise in specialised diagnostic areas (e.g. PET CT, Medical Genetics), working with key
strong system leadership. This will
include the development of a single partners locally and nationally.
strategic commissioning function at
ICS level and the development of
two Integrated Care Partnerships
(ICP) across Greater Nottingham and
18Promise 5: Partners
What this means (cont’d) Making it happen: Our year 1 goals
We are a key partner in a number of collaborative initiatives regionally Develop and implement a Partnership strategy and stakeholder management plan
and need to build on this. We will progress work with the Defence and
Refresh the Patient and Public Involvement Strategy and stakeholder engagement plan with a focus on
National Rehabilitation Centre (DNRC) and contribute to redesigning
how we will involve and listen to patients, families, carers and the local population
rehabilitation services across the region. This will have benefits for staff
training and development. Build on existing partnership foundations and deliver the actions already agreed for these key
partnerships
We are a key partner in the National Centre for Sport and Exercise
Medicine (NCSEM), an Olympic Legacy project, providing a focal point Develop and commence implementation of robust governance arrangements and a roadmap for the
for advice and guidance on sport, exercise and physical activity, injury development of an Integrated Care System (ICS) across Nottingham and Nottinghamshire
and rehabilitation to sufferers of chronic diseases. We aim to develop the
Understand the future implications for NUH as part of an ICS
centre further to play a key role in driving the prevention agenda forward
with our partners at UHL, Loughborough University, University of Leicester Develop a vision for acute services across Nottinghamshire through leadership of the
and University of Nottingham. ICS Clinical Services Strategy
We will work together with our partners to successfully implement: Develop and implement a framework for clear decision-making for business development and potential
East Midlands Pathology network (pathology services) and East Midlands new business opportunities
Radiology Service (EMRAD) to develop a sustainable long-term model Identify potential NHS and non-NHS business development opportunities and develop a refreshed
for Radiology Services in the region. business development strategy
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Promise 6:
PotentialPromise 6: Potential
World-class research and education
What this means
Our potential to achieve the best As one of the largest teaching Our ambition is for NUH to be a We want NUH and Nottingham Nottingham hosts one of the
quality care and outstanding health hospitals in the UK, we are an centre of excellence for education to be at the forefront of research fastest growing Life Science
outcomes can only be realised in an organisation that embraces and training by: and innovation that impacts on clusters in the UK with 14,000
environment that fosters research, innovation and research, international discovery and Life Science and Healthcare related
Continually strengthening
education and innovation. There is with a strong culture of embedding technological advancement that companies. Nottingham and the
our training environment
overwhelming evidence that learning from each other and can be translated into enhanced East Midlands has the second
and supporting and nurturing
patient health outcomes are better from colleagues across the NHS health outcomes for our patients. highest cluster of MedTech
our learners.
in such organisations. More than and internationally – with the We are involved in a range of companies in the UK with over
300 doctors and nurses work to overriding aim to provide Developing a multi-faceted initiatives, for example, we are 400 companies based in the city.
ensure that research and innovation outstanding outcomes for our high quality leadership part of the National Genomic Nottingham is home to BioCity,
is embedded in our routine clinical patients and their families. NUH programme for leaders of project with Leicester and one of Europe’s largest life science
practice and that research findings has strong links to the University a variety of levels. Cambridge Hospitals where business incubators. It houses
lead to continued improvements in of Nottingham and Nottingham we will be contributing to cutting- approximately 200 businesses
Developing our new Nursing
the quality of care and the treatments Trent University, and provides high edge research to enable more in cutting-edge industries of
and Midwifery Institute.
available to our patients. Last year level expertise in the fields of both effective diagnosis and treatment advanced biopharma and medical
more than 10,000 patients took undergraduate and postgraduate Developing regional quality of diseases in the future. technologies. In partnership with
part in clinical trials at our hospitals. learning, playing a vital role in the Doctor in Training passport to Biocity, Medicity, Medilink and the
education, training and ensure they are up-to-date with Nottingham Hospitals Charity
accreditation of doctors, nurses their NHS Core Skill Framework we aim to launch the Nottingham
and other healthcare professionals. topics without repeating Innovation and Capacity Building
training too frequently. Funds. These will support short
Developing the inter-professional term visits/fellowships between
educators forum and expertise clinicians and industry to enhance
- which includes DREEAM, Trent joint working.
Simulation Centre, Postgraduate
Education, building on inter-
professional learning and
development and collaboration
between Patient Safety Academy
and the Core Medical Trainee 21
Simulation centre.
21Promise 6: Potential
What this means (cont’d) Making it happen: Our year 1 goals
We will continue to expand Nottingham’s substantial research We are one of only eight funded Develop an innovation plan, including
portfolio through: Hyper Acute Stroke Research commercial opportunities
Centres in the UK, delivering Agree consistent improvement and transformation
Our partnership with the University of Nottingham successfully secured
clinical trials of new therapies. methodology to be used across NUH
awards totalling £26m for the period 2017-2022 for NUH to host the
We will build on our strong clinical
NIHR-funded Biomedical Research Centre (BRC) and Clinical Research Develop and start implementation of a Trust -wide
trial portfolio and high recruitment
Facility (CRF). inter-professional education and training strategy
rates by further increasing
Investing in globally-competitive research areas through the BRC: recruitment to cancer clinical trials, Number of patients recruited to National Institute
establishing NUH within the top for Health Research (NIHR) studies > 14,000
• Deafness and Hearing problems
five of recruiting NHS Trusts in the
• Gastrointestinal (including Liver and Pancreatic) disease country, continuing increase the
•M
ental Health and Technology - to be delivered in partnership effective integration of research
with Nottinghamshire Healthcare NHS Foundation Trust within clinical care, initially across
renal, breast and palliative care
• Musculoskeletal disease and then across all other Divisional
• Respiratory disease specialties and establishing a joint
Oncology/Haematology phase one
• A cross-cutting MRI theme (MRI was pioneered in Nottingham) clinical trial unit and a Cancer and
Associated Specialties (CAS) wide
phase two/three trial research
facility. We will also aim to develop
strengthened partnerships with
Pharma and our collaboration
with University of Nottingham
for translational research.
22Please refer to the full version of the NUH strategy and 2018/19 Annual Plan
for year 1-3 milestones and fuller detail on our action plans.
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