Wiltshire Health and Care Delivery Plan - Full Version 2020-2023
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Wiltshire Health and Care
Delivery Plan - Full Version
2020-2023
1
1. Introduction
Our Delivery Plan
This document sets out Wiltshire Health and Care’s plan for delivering its services over the
next three years. We call this our “Delivery Plan”.
As the pace of change quickens each year and the solution to many challenges across the
health and care sector lies in expanded and improved community services, this three year
plan is crammed full of proposed changes and delivery objectives, which cover these main
themes:
A range of activities this year to both adjust to and restart services in light of the
COVID-19 pandemic;
Development of new services and improvement of existing services to respond better
to urgent needs, support more people on discharge from hospital and work with
primary care colleagues to better meet the needs of local populations;
Improvements to the quality and standard of the tools made available to staff to do their
jobs, in particular information technology and use of buildings;
Developing our workforce through training, education and professional leadership and
maintaining, retaining and improving its diversity, resilience and skills.
How the plan was developed
Our Delivery Plan for 2020-2023 has been put together in the following ways:
1. Building on work from 2019/2020 - There were a small number of goals in our 19/20
plan that we have carried through to this plan – either because they are goals for all
NHS organisations that we need to continue to prioritise, or because we ended 19/20
with some outstanding components to our key local goals .
2. Ensuring that the long-term goals for the NHS, that are relevant to Community
Services, are included – On 7 January 2019, the Department for Health and Social
Care published a long term strategy for the NHS called the “NHS Long Term Plan”.
This plan covers all aspects of the NHS. We have made sure that our Delivery Plan
includes goals that help Wiltshire Health and Care deliver the ambitions of the NHS
Long Term Plan relating to Community Services. More recently, a number of service
specifications (documents stating how services should be delivered to patients by
providers) have been published. As part of our Delivery Plan, we have set out how
Wiltshire Health and Care will implement the service specifications relevant to
Community Services. In most cases, we will work closely with Primary Care to do this.
The other factor that we took into account was any changes to the NHS Standard
Contract. This is the contract that the local Clinical Commissioning Group asks
Wiltshire Health and Care to deliver each year. This contract evolves as the NHS
evolves, and as legislation evolves.
2
3. Ensuring that goals for the delivery of healthcare decided by the entity
representing all providers of healthcare across Bath and North East Somerset,
Swindon, and Wiltshire, known as the Sustainability and Transformation
Partnership or “STP” are included - Our Delivery Plan takes into account the
objectives for healthcare across the local area or “system”, and where these are
relevant to Community Services, we have included them in our plan.
4. Input from our staff and volunteers – In January and February 2020, we held
engagement workshops in four locations (Chippenham, Trowbridge, Marlborough, and
Salisbury). During these workshops, we gathered feedback from a cross section of our
staff and volunteers on how services, and the infrastructure supporting our services,
should be developed.
5. Input from our patients and the local public – Our Executive Committee considered
key themes from feedback received from our patients and the local public. This
feedback came from “Friends and Family” feedback; complaints; compliments; and via
our social media channels. Areas for improvement identified through this analysis were
included in our plan.
6. Adjustments to account for COVID-19 – In the latter stages of the development of
this plan, we reflected on how the plan should be adjusted to ensure Wiltshire Health
and Care was well-prepared were there to be a second wave of infections due to the
virus, and to cover the changes that are needed to the way we deliver care whilst we
operate in an environment that is proceeding in a cautious manner to minimise spread.
How the plan works
Our Delivery Plan is set out in a grid – with each line of the grid representing an objective
(or goal) that Wiltshire Health and Care would like to achieve. The goals are detailed for
the first year of our plan, and set out our outline ambitions for the subsequent two years.
In putting together this plan, we have tried to use language that is meaningful to the
population we serve. We recognise, however, the technical nature of the plan itself so, to
support understanding, we have also included a Glossary at the back of this document
(page 14).
How the plan will be delivered
The plan sets out the activities that will be pursued by the whole Wiltshire Health and Care
team and, by setting out every aspect of change in the same place, allows those teams to
work quickly and effectively together. Whilst we acknowledge that this is a large plan to
achieve across the next three years, we believe its size is a reflection of both the ambition
of Wiltshire Health and Care to continue to improve and how much needs to be done to
deliver what the people of Wiltshire and the rest of the health and care system expects and
needs us to achieve.
3
The Wiltshire Health and Care Board reviewed this plan on 25 th June 2020, and endorsed
its implementation. The Board will be monitoring progress against this plan on a quarterly
basis.
We would like to say a huge thank you to all our staff, volunteers, patients, carers, families,
and friends who continually contribute to the development of Wiltshire Health and Care.
If you have any questions regarding this document, please contact us at:
whc.communications@nhs.net or call 01249 456580. We are excited to implement these
developments in 2020-2023!
Regards
Douglas Blair
Managing Director of Wiltshire Health and Care
Stephen Ladyman
Chair of Wiltshire Health and Care
4Delivery Plan
2020-2023
5Wiltshire Health and Care (WHC) Delivery Plan: 2020-2023
Type of Objective How will the objective be delivered?
An objective from 2019/20 will Transformation We deliver our ‘transformation programmes’ with the following infrastructure. Each
continue into 20/21 (and potentially Programmes programme will have:
beyond). o An Executive-led Programme Board/ dedicated Executive oversight.
o A senior programme manager as lead/coordinator for the programme.
o A programme plan with key milestones – reported against monthly to the Executive
Committee.
o Access to a matrix of resources to inform and support the delivery, under the
coordination of the programme manager.
A new objective proposed as part of Projects We will deliver our ‘projects’ using team members who are in defined project roles, or team
normal business activities/ currently members who have work associated with the relevant Delivery Plan objective written into
commissioned activity. their annual work plan.
An objective proposed to support Service Each of our Service Developments involves us making (or planning) a step change to the
delivery of the BSW programme of Developments way we deliver services. We will deliver these step changes using team members who
work/ national requirements. have work associated with the relevant Delivery Plan objective written into their annual
work plans.
An objective to test or scope a new Ongoing Each of our ‘ongoing priorities’ objectives will require us to evolve the way we do something
idea. It would require additional priorities “long term”. We will deliver this change by ensuring that our existing team members work
funding to deliver. differently.
Understanding this document
We have tried to use language that is meaningful to our patients and local population, but to support understanding we have also included a Glossary at the back of
this document at page 12.
Most capitalised words are described in the Glossary. Clicking on these words will automatically navigate you to the Glossary section.
If you have any questions regarding this document, please contact us at whc.communications@nhs.net.
Implementing a new model of care
WHC Delivery Plan # Objectives Lead Type 2020-2021 2021-2022 22- Objective KPI
Objectives 23
Q Q Q Q Q1- Q3- Q1-
1 2 3 4 Q2 Q4 Q4
Implementing
A Quality Focus
Public and patient involvement
a new model TRANSFORMATION PROGRAMMES
of care 1. RESET AND RECOVERY PLAN
A. Our primary aim is to ensure we maintain the changes Executive Lead; All urgent and high priority
implemented during the COVID-19 response that have had a COO (LH) patients offered an appointment.
(taking into positive impact i.e.:
account Programme
Discharge processes Lead:
Wiltshire Joint
Digital transformation Service
Commissioning
Priorities) Service integration Transformation
Manager (GP)
‘Resetting’ and ‘recovering’, following COVID-19, will take time,
[STM:1]
and be implemented in a phased approach – in line with
government guidance on social distancing/ shielding, and taking
into account the availability of Personal Protection Equipment
(PPE) and services previously supplied to WHC by System
partners. We envisage phase 1 being applicable for the
remainder of 20/21, and potentially into 21/22.
In phase 1, we will:
Deliver all Urgent Care
Deliver all high priority appointments - either virtually
(ideally), and if not face to face.
Where it is not possible to deliver care on site, we will deliver
care in our patients’ homes where we are able to gain
access.
Respond in a way that maximises the safety and protection
of our staff from health and safety and Infection Protection
Control (IPC) perspectives.
Respond as required by the System if a second COVID-19
surge manifests.
SERVICE DEVELOPMENTS
2. URGENT RESPONSE IN THE COMMUNITY
A. 2 hour crisis response services: Service Home repsonse appointments
WHC will provide an agreed number of home response Transformation available within 2 hours of
appointments within 2 hours of referral: Manager (AMN) referral.
[STM:2]
- Q2: We will design the service
- Q3: Appointments will be available **
** If we have PPE and staff, and acknowledging that we might
need to engage an NHS best endeavours solution to implement
earlier.
63. OPTIMISING FLOW AND RESILIENCE
A. Home First pathway changes: Service Community and council services
We will optimise the efficiency of the Home First pathway Transformation supporting discharge are
to support hospital discharge. Key elements of this will Manager aligned.
[STM:3]
include:
- Managing at Locality level and
- Aligning WHC and Council pathways Head of
Operations –
- Defining the new ‘pull model’ from our acute partners.
Community
Teams (HK)
B. Broader bed base/ discharge processes: Service System bed base reviewed and
We will model the requirements for bed-based discharge Transformation re-designed with appropriate
within the System, and help design a change in the use. Manager clinical input and MDT.
- Community beds/ Intermediate care beds – a clearer [STM:3]
strategy for use of temporary use beds (clinical use beds;
therapy beds; COVID-19 positive beds; and delirium
beds).
- WHC to hold the ring on managing the Multi-Disciplinary
Team (MDT) type discussions in relation to these beds.
C. Covid resilience: Service WHC is able to support the
We will ensure plans are in place for our services to support Transformation System in the event of a second
Manager (AMN) wave of COVID-19.
additional demand that may be created by a second wave of
COVID-19. [STM:2]
4. IMPROVING EFFECTIVENESS OF COMMUNITY TEAMS
A. We will review and reorganise the management of Service Agreed caseload numbers and
caseloads in Community Teams and working with GP Transformation processes in place
practices. Including increased use of telephone contact Manager (GP)
(etc.). [STM:1]
In 21/22, we will review how dementia support specialist
nurses can be incorporated into community teams
B. In relation to Corsham, Chippenham, and Box Primary Care Service Preferred model agreed and
Networks (PCNs), we will redesign the Community Care Transformation implemented.
and Primary Care nursing delivery model: Manager
- We will work with Chippenham, Corsham and Box to [STM:5]
map the current nursing resource - Q1
- We will identify areas of duplication and define the ‘to be’
delivery model – Q2/3
- We will implement the preferred model - Q4
C. We will carry out a risk-based review of the number of Service Each SystmOne unit has been
assessments carried out by our Community Teams, and Transformation reviewed.
reduce the number where there is duplication. We will and Clinical
and use this information to update One functionality/ Information Fewer assessments required –
templates Lead [STM:4] optimising staff time.
“SystmOne” is the name of the electronic system that WHC
uses to keep a record of the clinical care provided to patients.
D. We will develop a model for adoption and spread of Service We capture individual
Personalised Care and Support Plans. Each patient should Transformation management plans in a manner
already have an individual management plan, but we may not Manager (AMN) that meets national
consistently be capturing this in a way that meets national [STM:2] requirements
requirements. We will develop our approach to meet national
requirements.
E. Clinical leadership: Chief Operating Clinical leadership restructured
We will ensure that our Operational Structure appropriately Officer (LH) to better support teams and
supports our staff and the services that we need to deliver. PCNs, and provide career
This will include clinical development of Community Teams. Head of progression opportunities.
Operations –
This will be carried out as follows: Community
o Plan – Q1 Teams (HK)
o Implementation – Q2
5. ENHANCED HEALTH IN CARE HOMES/ ANTICIPATORY
CARE
A. Multi-Disciplinary Teams (MDTs)/ Enhanced Health in Care Service Virtual clinics established to
Homes (EHCH): Transformation review patients in care homes –
We will implement the new PCN and community services, Manager including MDT review.
and EHCH specifications. [STM:5]
As part of this we will:
- Establish an agreed definition of the MDT
- We will redefine the role of the Community Geriatrician
- Look at ways to integrate Specialist Services with “core”
WHC services (our nursing and therapy teams).
- Create Virtual Clinics with consultants in MDT for wider
cohorts, including care home patients
- Identify and/or engage in locally organised shared
learning opportunities
- Evaluate the impact of the virtual home rounds in care
homes and define the approach to broadening to the
wider population
- Work with Primary Care Networks (PCNs) to support
discharge from hospital and transfers of care between
settings,
B. We will work with primary care to risk stratify patients and Service 20/21 – approach to risk
provide Anticipatory Care to the local population. Transformation stratification defined.
Manager (AMN)
[STM:2]
C. In 21/22, we will work with commissioners to clarify the Service Pathway defined.
pathway for the management of frail patients outside of Transformation
hospital. Manager (AMN)
[STM:2]
6. In 21/22, we will develop a common model for the provision Head of Long term model in place.
of specialist advice and support for people with long term Service,
conditions. Diabetes
This will include:
o Identifying how community service specialists optimally
7wrap around the provision within PCNs to ensure:
Appropriate escalation of the patient
Diabetes Specialist Nurses also provide support to
primary care to help up-skill their diabetes
nurses/GP’s so they are escalating at the correct
time; this can be through virtual clinics, mentoring,
training etc.
OTHER
7. We will support the expansion of the delivery of pulmonary Head of Pulmonary rehab is delivered in
rehabilitation and oxygen assessment services to patients in Operations – 4 additional locations in South
South Wiltshire. LTC MSK (CLJ) Wiltshire.
8. We will work with the Clinical Commissioning Group (CCG) to Director of Clear plan for Urgent treatment
align current Minor Injury Units to agreed plan for Urgent Infrastructure Centres in place in Wiltshire.
Care in Wiltshire. (VH)
Then COO (LH)
once model
defined
9. In 21/22, we will work with the CCG to develop personalised Head of A clear process is in place for
wheelchair budget systems. Operations – personalised health budgets.
LTC MSK (CLJ)
10. In 21/22, we will work with the BANES, Swindon and Head of Service Plan to procure orthotics at
Wiltshire (BSW) Sustainability and Transformation System level agreed.
Partnership (STP) to define a System-wide solution for
orthotics.
11. We will provide improved information about the availability Service Each PCN has access to an
and scope of specialist community services for each PCN Transformation understanding of WHC services
area (“road map”) Manager (GP) in its network.
12. In 21/22, we will ensure that patients who have a ceiling of Chief Operating There is a system in place to
care have personalised Care Plans. Officer (LH) ensure that End or Life patients
receive personalised care plans.
13. We will deliver a pilot model for First Contact Head of Pilot model for First Contact
Physiotherapy in urgent care facilities (complete). Operations – Physiotherapy in MIU trialled.
LTC MSK (CLJ)
ONGOING PRIORITIES
14. In 21/22 we will resume our goal of ensuring that no patient Chief Operating No waits over 52 weeks.
waits more than 52 weeks. Officer (LH)
15. In 21/22 we will resume our goal of reducing waiting times Chief Operating RTT target achieved.
so the 18-week RTT target is always achieved. Officer (LH)
16. In 21/22 we will resume our goal of reducing the number of Chief Operating Discharge to pathway 1 and 2
bed days occupied by patients with an acute length of stay of Officer (LH) more timely.
21 days or more waiting for discharge to Pathway 1 and
Pathway 2.
17. In 21/22 we will resume our goal of reducing waiting times Head of Service Waiting time targets met.
for patients waiting for wheelchair repair.
18. We will maximise cross working between inpatient wards Chief Operating Through our escalation
and their local community teams (complete). Officer (LH) framework, we now have the
ability to provide cross cover
between wards and community
teams.
Developing our People
WHC Delivery Plan # Objective Lead Type 2020-2021 2021-2022 22- Objective KPI
Objectives 23
Q Q Q Q Q1- Q3- Q1-
1 2 3 4 Q2 Q4 Q4
Developing
A Quality Focus
Public and patient involvement
TRANSFORMATION PROGRAMMES
our people,
and 19. SAFER STAFFING PROGRAMME Exec Lead: Managing Director (DB)
strengthening Programme Lead: Head of People (HM), supported by Paula Lye
our workforce A. We will implement E-roster across all services at team Head of People E roster implemented across
level. (HM) all teams.
B. We will implement a centralised rostering approach Head of People Inpatient and MIU rosters to be
across inpatients and Minor Injuries Units (MIUs). (HM) managed centrally.
PROJECTS
20. We will ensure there is documented workforce planning Joint Ongoing review of
across all services in WHC to provide resilience in light of accountability: development of services in line
an ageing and diminishing workforce: with workforce planning
o Develop the pipeline more creatively. Head of People principles.
o Improve manager understanding of the importance of (HM) and COO
the process. (LH)
o Ensure that new services are effectively scoped.
21. We will participate in the shared education programmes Education and WHC staff members have
and sharing of workforce resources across BANES, Traning Lead access to a wider range of
Swindon, and Wiltshire via a virtual platform and course material and at a
bookings system. higher frequency than in
2019/20.
This will improve skills in key areas that traditionally do not
access skills training (primary care and nursing homes etc.)
and allow us to identify efficiencies to allow us to deliver a
broader range of material across our System.
SERVICE DEVELOPMENTS
22. We will continue to deliver the Wellbeing Charter to Head of People To deliver and implement the
ensure that the wellbeing of staff is at the heart of (HM) milestones within the
Wellbeing Charter, and report
8everything we do, and the decisions we make progress through the
Workforce and Development
POG (WDPOG), whilst seeing
a reduction in wellbeing
concerns raised through the
annual staff survey.
23. Creating our workforce for the future: Head of People Agreed and ratified recruitment
o We will put together a marketing strategy to target (HM) marketing strategy, which
people who would be interested in “return to practice” supports the reduction of
o We will design flexible options to support “return to vacancies to a target of 8% by
work”. 21/22.
24. We will have a comprehensive plan to develop and grow Education and Fully utilise our apprenticeship
our Trainee Nurse Associates (TNAs) and Traning Lead levy.
apprenticeship levels (NHS People Plan). Work as an STP to transfer
levy to expand apprenticeships
by 10%.
25. We will expand development opportunities for both Education and We will improve retention to
clinical and corporate staff. Traning Lead target levels of 13% as an
organisation.
26. We will create networks for peer support, using the Local Education and Improved levels of
Workforce Action Board (LWAB) and training hubs for help. Traning Lead engagement and peer support,
along with recognition of
participation in the System.
27. We will extend passporting of mandatory training to Education and Success review of
Local Authorities, hospices and social care (it is already in Traning Lead development through the STP
place between WHC, local acute hospitals, Avon and and update report to WDPOG.
Wiltshire Mental Health Partnership NHS Trust, and the
CCG – achieved 19/20).
28. We will devise a work experience strategy to encourage Head of People Ratified plan for work
uptake by young people with an interest in health care. (HM) experience activity.
29. There will be central coordination of bank staff Head of People Clear approach for bank staff
employment (and central coordination of their supervision/ (HM) management, with progress
training) reports through WDPOG.
30. We will put in place a coordinated approach and strategy to Education and Success review of
support T levels (new qualifications for 16-19 years old). Traning Lead development and update
There will be a T level for health and social care. report to WDPOG.
31. We will set clear expectations for remote staff on how Head of People A ratified approach and
to work – working styles; home working; working efficiently (HM) process for staff working in
productively. remote and revised ways.
32. We will identify a way forward for more local pre- Education and Increase in appointments of
registration nurse training (in the south and west Traning Lead newly qualified staff year on
particularly) to allow us to recruit more newly qualified staff. year.
33. We will set up and Equality, Diversity, and Inclusivity Forum Head of People All members of staff and
within WHC’s existing governance structure – reporting to (HM) volunteers feel that they can
the Workforce Development POG (WDPOG). Through this achieve and be the best that
we will provide a place for our staff to express their views they can be with no fear of
on how WHC supports diversity, and take the feedback conscious or unconscious
from this forum to develop actions to make improvements. discrimination.
ONGOING PRIORITIES
34. We will continue to increase our voluntary workforce by Head of People Volunteer workforce increased
10-15% using our embedded approach. (HM) by 10-15% from March 2020.
35. We will improve flexible working options so it is attractive Head of People Clear and developed approach
to work on the WHC bank (HM) for bank staff management,
with progress reports through
WDPOG.
9Supporting staff and patients with good Information Technology &
Governance (IT and IG)
WHC Delivery Plan # Objective Lead Type 2020-2021 2021-2022 22- Objective KPI
Objectives 23
Q Q Q Q Q1- Q3- Q1-
1 2 3 4 Q2 Q4 Q4
Supporting
A Quality Focus
Public and patient involvement
PROJECTS
our staff
and patients 36. IT SERVICES
with good IT A. We will transfer the hosting of IT services, and first and Head of IT (KS) IT services transferred to
& IG second line support, from GWH to Centrality (cloud- Centrality, and WHC still has
based solution): access to data warehouse and
o Ensuring access to the data warehouse, and therefore able to submit comprehensive
able to submit comprehensive Community Services Data CSDS.
Strengthening Set (CSDS).
foundations B. In early 21/22, we will carry out a significant network Head of IT (KS) All WHC sites have network
hardware refresh for every WHC site. This is required to hardware that is vendor-
achieve Cyber Essentials Plus certification. supported.
Supporting
C. We will complete migration to Office 365 by October 2021. Head of IT (KS) Completion of migration of Office
365 by October 2021 as
our teams to
work mandated.
efficiently NEW USE TOOLS TO SUPPORT DIGITAL TRANSFORMATION (how existing technology can be utilised to enhance care provision)
37. CLARITY AROUND USE OF NEW TOOLS Links to sustainability below
Supporting A. We will put in place an agreed protocol setting-out Managing Staff survey outcome indicates
digitally expectations for when digital tools should be used. We Director (DB), that more meetings are held
enabled health will particularly encourage greater use of online tools as an supported by utilising digital meeting technology
care alternative to face to face in the following areas to enhance KHJ by the end of 20/21, than in 19/20.
sustainability:
o Internal meetings
o Delivery of training
o Patient delivery
38. ATTEND ANYWHERE
A. We will put in place video consultation software (Attend Service 15 services have access to Attend
Anywhere), so that clinicians across all of our services have Transformation Anywhere to deliver virtual
a way to conduct electronic consultations with patients and Clinical consultations to patients.
Information
Lead [STM:4]
B. We will develop Attend Anywhere so for use in Care Service An Attend Anywhere modules set
Home consultations – including use by PCNs Transformation up for each of the Wiltshire PCN
and Clinical areas, so that practice staff and
Information WHC staff can communicate with
Lead [STM:4] care homes.
39. WEBINAR FUNCTIONALITY Links to sustainability below
A. We will roll out the use of a webinar-type product that will Service Tool enabling staff to deliver
allow us to provide remote education/groups for patients, Transformation webinars approved for us; training
carers, and other health care professionals/ internal staff and Clinical developed; and application rolled
training. Information out to key staff.
This will allow us to carry out live broadcasts or share pre- Lead [STM:4]
recorded content, and track who has attended as well as
getting feedback and participation from attendees through
interactive functionality.
40. OPTIMISING ENGAGEMENT THROUGH OUR WEBSITE Links to P&PI below
A. Once we have put in place a new WHC website in early To commence WHC website has enabled chat
21/22, we will develop its content so that it is interactive and 21/22 functionality – which can be
supports patient self-management: utilised by patients to engage with
o We will enable a chat function within the WHC our clinical and support services
website to communicate with patients (PALS, central (and vice versa).
booking, and direct service health advice).
o We will use videos/ pre-recorded material to support
consultations and to support patient self-care.
41. REDUCE INAPPROPRIATE REFERRALS
A. We will align referral forms. Specifically, we will work with S1 System The forms on Ardens reflect the
the company that provides referral forms to GP practices Manager referral choices relevant to WHC.
(Ardens), to ensure recognisable WHC forms across services. (HMcC)
42. HEALTH RECORDS DIGITISATION/ SHARED CARE RECORD
A. We will progress the transformation of WHC’s health Director of WHC has its own medical records
records. To start with, this will include: Governance team (20/21); WHC has a clear
I. Establishing an internal medical records team and Legal SOP for scanning paper records
II. Ratifying a clear Standard Operating Process (SOP) for (KHJ) (20/21);
scanning paper records into electronic form in oversight, with
compliance with legislation. project WHC can articulate where paper
delivered by IG records are still in use, and has
III. Reviewing use of paper records, and scoping
manager, with put together relevant business
approaches to cease this practice. support from
IV. Putting together business case(s) for the proposed case(s) to define its approach for
Tonia Welsh ceasing this practice in each area
solution(s) to cease use of paper records, so that we
(early 21/22); procurement and
can subsequently move to procurement (subject to
implementation of the proposed
funding).
approach(is)(21/22 and potentially
V. Looking at ways to work across the STP (Local Health into 22/23)
Care Record Exemplar, LHCRE).
B. We will participate in system wide efforts to implement a Head of IT (KS) Engagement at relevant
shared care record (Graphnet). programme board.
1043. DELIVERING SYSTMONE TO WARDS
A. In 21/22 we will scope and start to implement what is needed To commence Change management plan for the
to achieve fully digitalised records on our wards (i.e. 21/22 implementation of SystmOne on
Implementing SystmOne). our wards fully scoped involving
- 21/22 – Q1 – scoping input from operational colleagues.
- 21/22 – Q2-4 – project development
- 22/23 – Go live
The change management plan will be informed by input from
operational colleagues.
B. In 21/22, we will revisit options for WHC’s data warehouse Advanced Info WHC is able to maintain continuity
provision in line with time scales for moving from Medway to Analyst (JC) of reporting
SystmOne.
44. TELEPHONE SYSTEM
A. In 21/22, we will engage professional services support to To commence Delivery of specification for new
scope WHC’s requirements for a new telephone system, 21/22 telephone service.
so that we are in a position to run a competitive tender for a
new telephone system provider.
B. In 21/22, we will procure the new telephone system. To commence Tender awarded.
21/22
C. In 21/22, we will engage professional services support to help To commence Implementation of new telephone
us to implement the new telephone system. 21/22 system completed.
SERVICE DEVELOPMENTS
45. We will make IT training available to staff, with particular IT trainer WHC has the resource and
focus on: capacity to deliver a rolling
- Training for Windows 10 programme of IT training to staff.
- Video consultation software (Attend Anywhere)
- MS teams
- New clinical applications
- Integrated clinical record (Graphnet)
- Office 365
We will also ensure that relevant staff members receive
appropriate training for Power BI and new the informatics
system.
This team will also develop and support a network of clinical
digital champions.
46. We will establish Wi-Fi for patients at community sites from Head of IT (KS) Patients at all inpatient sites have
which in patient services are provided. access to Wi-Fi.
47. We will migrate to a new data visualisation tool (we will move Advanced Info WHC is able to maintain continuity
from Business Objects to Power BI). Analyst (JC) of reporting
48. We will increase saturation of available laptops on wards, and Head of IT (KS) Increase in the number of
ensure that all staff who are not regular computer users available machines on wards.
understand how to obtain log in for occasional use.
49. We will create a new role of Clinical Information Lead and Executive Clinical Information Lead in post.
ensure that a Chief Clinical Information Officer is identified Team
in line with the NHS Long Term Plan ambition. Chief Clinical Information Officer
identified.
50. In line with our legislative and contractual requirement, we will Director of WHC has a comprehensive
put together a comprehensive Information Asset Register Governance Information Asset Register.
for WHC (a database of all electronic and physical assets and Legal
used to store personal data), and ensure that each asset has (KHJ)
a dedicated Information Asset Owner (IAO) and Information
Asset Administrator (IAA), each of whom are clear of their
responsibilities and act to safely secure personal data.
51. In line with our legislative and contractual requirement, we will Director of WHC has comprehensive data
put together a comprehensive database of WHC’s data flows Governance flow mapping.
for Personal Identifiable Data (PID) (i.e. a database of what and Legal
PID is collected by WHC; by whom; for what purpose; stored (KHJ)
where; and who shared with). We will align this with our
privacy notices.
52. We will map out WHC’s relationships with its data Director of ` WHC has data processing terms
processors, and agree appropriate schedules of processing, Governance agreed with all relevant entities.
accompanied by data processing terms. and Legal
(KHJ)
ONGOING PRIORITIES
53. We will carry out a hardware age-replacement programme IT Project Elimination of hardware that is
for desktop machines. This will get us to a position to carry Manager (DT) more than ten years old.
out an ‘annual rolling refresh’.
11Supporting patients and staff with physical infrastructure that betters
meets need
WHC Delivery Plan # Objective Lead Type 2020-2021 2021-2022 22- Objective KPI
Objectives 23
Q Q Q Q Q1- Q3- Q1-
1 2 3 4 Q2 Q4 Q4
Supporting
A Quality Focus
Public and patient involvement
PROJECTS
patients and
staff with 54. BSW ESTATES STRATEGY
physical A. We will contribute to the BSW Estates Strategy, including Director of BSW estates strategy includes
infrastructu ‘PCN plans’ and ‘place plans’. Infrastructure strategies for community estate,
re that (VH) and plans for for all areas.
betters
meets need: 55. ESTATES CAPITAL PLANNING
A. We will support BSW CCG to develop the estates capital Director of The BSW capital pipeline includes
pipeline. Infrastructure the capital requirements of the
Improve (VH) estate in Wiltshire.
quality and
efficiency of 56. INTERMEDIATE CARE CENTRES
existing A. We will contribute to the development of the financial Director of The financial business cases for
accommoda- business cases for the Devizes and Trowbridge Intermediate Infrastructure Trowbridge and Devizes
tion
Care Centres. (VH), supported Intermediate Care Centres
by Service incorporate the requirements of
Transformed Transformation WHC.
estate to Manager
support new [STM:3]
models of
care 57. LONGLEAT WARD
A. We will move Longleat ward to the ground floor of Director of The design development for the
Warminster Community Hospital. Infrastructure move meets the needs for WHC
(VH), supported including the enabling works which
by Service impact on other services.
Transformation
Manager
[STM:3]
58. ESTATES SOLUTIONS FOR CHIPPENHAM AND MELKSHAM
A. We will support BSW CCG to scope future estates Director of The estates solutions scoped for
solutions for Chippenham and Melksham. Infrastructure Chippenham and Melksham
(VH) include the requirements for WHC
within a context of working across
boundaries in health and social
care.
SERVICE DEVELOPMENTS
59. As part of changes to estates facilities arrangements, we will Director of Medical records and receptionist
transfer medical records and receptionist staff from GWH Infrastructure staff will be employed directly by
into WHC. (VH) WHC.
60. We will work with our facilities management team to eliminate Director of Report from Estates Facilities
use of single-use plastics in WHC. Infrastructure Management team demonstrating
Key areas for 20/21 will be: (VH) a reduction in use of plastic in the
o Single use plastic straws key areas higlighted across.
o Plastic cutlery Aim: to eliminate by Summer
o Plastic cups/ food containers 2020.
ONGOING PRIORITIES
61. We will put in place a lease for occupation of Malmesbury Director of Lease agreed and signed for the
Health Centre. Infrastructure space that WHC occupy.
(VH)
62. We will liaise with NHS Property Services to agree leases/ Director of WHC has signed leases/ licences
licences for the premises WHC occupies. Infrastructure in place for the premises it
(VH) occupies.
12Quality Focus – consistently improving the quality of services
WHC Delivery Plan # Objective Lead Type 2020-2021 2021-2022 22- Objective KPI
Objectives 23
Q Q Q Q Q1- Q3- Q1-
1 2 3 4 Q2 Q4 Q4
A Quality Focus x
Public and patient involvement
SERVICE DEVELOPMENTS
63. QUALITY IMPROVEMENT (QI)
A. We will put in place Quality Improvement (QI) Service All relevant staff have access to
training (bronze level), and roll this out to all relevant Transformation Q1 training module (bronze)
staff as part of their role essential training. Manager (GP)
B. We will set up a dedicated QI area on WHC’s intranet, Service Dedicated QI area set up on
to: Transformation WHC intranet. We will monitor
o Share WHC’s QI strategy. Manager (GP) usage/ engagement through an
o Promote QI tools and methodology to all staff, and analytics report.
explain how the tools can be used.
o Provide a portal for sharing QI ideas.
C. We will host carers’ strategy meetings across our Service Carers to be directly involved in
sites at regular intervals throughout the year (quarterly). Transformation the development of key priorities
The aim of this is to give direction to the development of Manager for WHC carers’ strategy.
staff, patient, and carer partnerships; ensuring that the (AMN)
carers’ voice is heard their expertise acknowledged, and
we support an integrated approach to identify and assess
carer health and wellbeing.
NB: To support carers on an individual basis, we will also
continue to host carers’ cafes.
64. FREEDOM TO SPEAK UP (FTSU)
A. We will set up and maintain a dedicated Freedom to Service We will submit on to the FTSU
Speak Up page on WHC’s intranet – to enhance staff Transformation national portal on a quarterly
awareness of how to raise a concern, and who to Manager (GP) basis.
contact.
B. In early 21/22, we will develop, train, and implement a Service To have trained champions in all
Freedom to Speak Up champion model Transformation localities, who are diverse from
Manager (GP) all services.
65. EQUALITY, DIVERSITY, AND INCLUSION (creating a culture where people feel comfortable being themselves)
A. We will ensure that our website meets Accessibility Corporate WHC website meets
Standards. Project Officer Accessibility Standards.
(JN)
B. We will carry out a project to ‘get to know’ the diversity of Equality WHC has a data set which
our patients better. We will use a variety of different Diversity and provides an idea of the diversity
engagement methods to build a picture of our patient Inclusion of its patients.
diversity. From this, we will be better informed to meet Officer (new
our patients’ E,D,&I needs, and enhance equality of Quality team
opportunity, so that we can subsequnetly implement a role)
plan to eliminate disadvantage, promote understanding
and advance equality.
PROJ
ONGOING PRIORITIES
66. CQUINs
A. We will deliver our CQUINs requirements: Director of CQUINs delivered in line with
o Continue to monitor priority aspects of suspended QPW requirements.
2020/21 schemes (all year)
o Prepare for implementation of CQUIN schemes in
2021/22 (Q4 – 20/21)
13Public and patient involvement
WHC Delivery Plan # Objective Lead Type 2020-2021 2021-2022 22- Objective KPI
Objectives 23
Q Q Q Q Q1- Q3- Q1-
1 2 3 4 Q2 Q4 Q4
Public and patient
A Quality Focus
Public and patient involvement
engagement and
PROJECTS
involvement 67. We will create a database of people who wish to actively Director of IG compliant database
participate in activities to develop the services of WHC Governance & established. In readiness for the
(a “Public and Patient Involvement Database”), and Legal return of our Public and Patient
regularly communicate with the people on this database. Involvement Officer from
Using this database, in year 2 we will create our own maternity leave in Q4.
patient group(s). In doing so we can progress towards
our aim of ensuring that our services are informed and
developed by feedback from our patients and local
population.
68. In 21/22, we will implement alternative ways to seek Service WHC website has enabled chat
feedback from patients (i.e. non-paper-based feedback). Transformation functionality, utilised by patients
The chat function within our new WHC website will be and Clinical to engage with our clinical and
one such method (see objective in IT section above). Information support services (and vice
Lead – new versa).
resource
[STM:4], PPIO
(LM)
SERVICE DEVELOPMENTS
69. Staff awareness: we will develop a Training Tracker Patient and Training tracker module
module for staff, so staff can learn why patient and Public developed for staff, and part of
public involvement/ engagement is so important. Involvement role specific training
Officer (LM) requirements.
70. Staff awareness: we will subsequently develop the Head of Patient Above module evolved to
above module, so that it includes guidance on the Safety (CW) include E, D, & I.
importance of our patients’ E, D & I characteristics.
71. We will put in place new ways to involve patients and the Patient and It perceived as the culture of
public in our activities. Public WHC to involve patients and the
Including: Involvement public in the way we develop our
o Contributing to the development of our services Officer (LM) services and the way we share
o Reading WHC patient leaflets/ other literature information about our services.
o Contributing to staff interview processes (where
applicable).
o Developing our website, and how we communicate
with the public.
Prior to the establishment of our forum (year 2), we
provide the opportunity for interested patients/public to
work with us in the above areas.
Financial sustainability and productivity/ environmental sustainability
WHC Delivery Plan # Objective Lead Type 2020-2021 2021-2022 22- Objective KPI
Objectives 23
Q Q Q Q Q1- Q3- Q1-
1 2 3 4 Q2 Q4 Q4
Financial
A Quality Focus
Public and patient involvement
SERVICE DEVELOPMENTS
sustainability and
productivity 72. We will ensure that information to support Corporate Dedicated page on Intranet with
sustainable travel plans will be made readily Project guidance and tips.
available to WHC staff on the intranet. Manager (JN)
73. We will put in place arrangements so that our lease cars Contracts Arrangements for lease cars will
Environ-mental are low or ultra-low emissions in line with the NHS Manager (SG) be low or ultra-low emissions.
sustainability Long Term Plan commitments. Next year we will review
targets for electric vehicles.
74. We will reduce travel through utilisation of digital Finance team Staff mileage is reduced in 20/21
platforms to contact and engage with patients and (AC) compared to 19/20 levels
colleagues, and to undertake training. (adjusted for COVID-19).
75. We will engage NHS Property Services and our other Director of We will be able to comply with
landlords to obtain certain data, so that we can Infrastructure our obligations under The
appropriately report on: Companies (Directors’ Report)
o Gas (kWh) and electricity (kWh) use across and Limited Liability
our hospital sites Partnerships (Energy and
Carbon Report) Regulations
We will combine the measurements provided above, with
2018.
the energy used use from transport to calculate our
Green House Gas (GHG) emissions in Co2e.
We will use the GHG emissions measurement, and
convert this into an intensity ratio (e.g. CO2e per full time
equivalent).
We will site the methodology used to calculate the above
information.
ONGOING PRIORITIES
76. 2.5% of our resources will be released from planned Executive Cost improvement plans in place
expenditure for reinvestment to support services. Committee and delivered.
14Wiltshire Health and Care Delivery Plan, 2020-2023: Glossary
“Accessibility Standards” The Government has set a specific standard for what a
website must be capable of doing in order that it is
“accessible” to those with certain disabilities.
“Acute Trust Liaison” A person that acts as an intermediary between the wards in
the acute trusts, and those arranging a bed for the patient in
an alternative setting, including a community bed.
“Anticipatory Care” Anticipatory care helps people to live well and independently
for longer through proactive care for those at high risk of
unwarranted health outcomes. Typically, this involves
structured proactive care and support from a multidisciplinary
team (MDT). It focuses on groups of patients with similar
characteristics (for example people living with multi-morbidity
and/or frailty) identified using validated tools (such as the
electronic frailty index) supplemented by professional
judgement, refined on the basis of their needs and risks
(such as falls or social isolation) to create a dynamic list of
patients who will be offered proactive care.
Community Services will be a vital part of the MDT team,
involved in proactively monitoring and caring for those
patients identified as benefiting from this kind of oversight.
NHS England and NHS Improvement have released a
service specification in relation to Anticipatory care, and
Wiltshire Health and Care must work with Primary Care
Networks to support the delivery of this Service
Specification.
“Bed-based discharge” When a patient is covered from care in a ward in one
location, to care in a ward in a different setting.
“BSW” Bath and North East Somerset, Swindon and Wiltshire.
“BSW Estates Strategy” Bath and North East Somerset, Swindon and Wiltshire’s
strategy for using buildings for NHS purposes.
“Caseloads” The number and variety of patients that an individual
clinician cares for.
“Clinical Commissioning Clinically-led statutory body, responsible for the planning and
Group” or “CCG” commissioning of health care services in a local area.
The “BSW CCG” is the Clinical Commissioning Group
responsible for planning and commissioning of health care
services in Bath and North East Somerset, Swindon and
Wiltshire.
“Community beds” Beds on a ward in a community hospital (for Wiltshire Health
and Care, these beds may be in Chippenham Community
Hospital; Warminster Community Hospital; or Savernake
Hospital, Marlborough).
“Community Care” Clinical care that is provided in a patient’s home; in a clinic in
a community hospital; or in a community bed.
“Community Geriatrician” A consultant who specialises in care for the elderly, who
provides care to patients in their homes; in a clinic; in a clinic
(rarely); or in a community or intermediate care bed. With the
developments that are taking place to embed anticipatory
care, the Community Geriatrician, may also contribute to
Multi-Disciplinary Team discussions involving patients being
cared for in a care home or nursing home.
15“Community Services Providers of publicly-funded community services are legally
Data Set” or “CSDS” mandated to collect and submit community health data, as
set out by the Health and Social Care Act 2012. The type of
data that needs to be submitted by Wiltshire Health and Care
is set out on this webpage, maintained by NHS Digital: link.
“Community Team” The clinical team that care for patients in their place of
residence. This typically includes: nurses, occupational
therapists, physiotherapists, and health care assistants as
the “core”. As part of our Delivery Plan, we are seeking to
align our specialist services with the care provided by our
core Community Teams.
Wiltshire Health and Care has 11 Community Teams. These
are aligned with the 12 Primary Care Networks in Wiltshire
(with the twelfth Primary Care Network sharing a Community
Team resource).
“CQUINs” “CQUIN” stands for “Commissioning for Quality and
Innovation”. CQUINs are targets set by CCGs for
organisations providing NHS care. They are targets that
promote improved quality of care for patients, and have
historically been paired with a financial incentive where
providers achieve the targets.
“Cyber Essentials Plus” Cyber Essentials is a Government-backed, industry-
supported scheme to help organisations protect themselves
against common online threats. Cyber Essentials Plus
involves an additional element; an external vulnerability
scan.
“Data visualisation tool” Consuming large sets of data isn’t always straightforward.
Sometimes, data sets are so large that it’s practically
impossible to discern anything useful from them. That’s
where data visualisation comes in. Data visualisation tools
provide analysts with an easier way to create visual
representations of large data sets.
“Data warehouse” A data warehouse is a system used for reporting and
analysing data. A data warehouse is a central repository of
integrated data from one or more disparate sources. They
store current and historical data in one single place that are
used for creating analytical reports.
“Digital transformation” The term has been used to describe the fact that we intend
to use a broader range of digital products to change the way
that we deliver care.
“Discharge processes” The approaches used to ensure that a patient can be safely
discharged from care in a bed in one setting, and their care
moved to a new setting.
“Enhanced Health in Care People living in care homes should expect the same level of
Homes (EHCH)” support as if they were living in their own home. This can
only be achieved through collaborative working between
health, social care, Voluntary, Community, and Social
Enterprise (VCSE) sector and care home partners.
The Enhanced Health in Care Homes (EHCH) model moves
away from traditional reactive models of care delivery
towards proactive care that is centred on the needs of
individual residents, their families and care home staff. Such
care can only be achieved through a whole-system,
collaborative approach.
16 As a Community provider, Wiltshire Health and Care is
required to participate in this scheme via additional
provisions that have been added to its provider contract by
the CCG. These provisions specify the additional support
that must be offered by Wiltshire Health and Care to care
homes – as part of a collaborative approach by providers.
The specifics actions that we will take are set out as
objective 5 of this plan.
“E-Roster” An E-Roster is an electronic roster, which supports us to
organise the shifts that our staff will work in a proactive way,
and allows staff to directly interact with the system to book
additional shifts.
“Escalation of the When a patient’s condition gets worse, they are likely to
patient” need additional input. Community care is largely non-
medical, and so it is important for our teams to have
processes in place for seeking medical or specialist input.
“First Contact This is a scheme that involves physiotherapists working
Physiotherapy” closely with GP practices (and usually working within a GP
practice). Under this scheme a physiotherapist will be the
first practitioner to review the patient with a musculo-skeletal
condition (i.e. instead of the initial assessment being carried
out by a GP). Applying certain criteria to this process, this
approach can divert patients from the GP caseload –
providing additional capacity for GPs to see and treat other
patients.
“GWH” Great Western Hospitals NHS Foundation Trust. This is an
acute hospital, based in Swindon.
“Intermediate care beds” An “intermediate care bed” is a term used when a patient’s
health condition does not require the level of oversight or
intervention that is provided by an acute trust, or a
community hospital. However, the patient does benefit from
some oversight and intervention from a clinical team
(nursing, therapy – with oversight from a GP or Community
geriatrician). Typically, intermediate care beds are located in
nursing or care homes.
“IPC” IPC stands for Infection Prevention Control. I.e. measures
that are put in place to prevent the spread of germs that
cause infections/ viruses/harm/
“Local Workforce Action “Local Workforce Action Boards” are entities established by
Board” Health Education England. There is typically one in each
STP area. The LAWB that Wiltshire Health and Care
contributes t, is the BSW LWAB. Its membership includes
health and social care providers and commissioners. Its
focus is the workforce and education of our current and
future healthcare workforce. Generally, it considers initiatives
that can be carried out “at scales” across BSW – and the
embers collaborate to give effect to the agreed strategy.
“MDT” MDT stands for Multi-Disciplinary Team. It means a
collective of clinicians +/- social care representatives, of
various specialities, who each provide a contribution into the
recommended future treatment and care of a person.
“NHS Property Services” An NHS entity that owns the majority of the real estate
occupied by Wiltshire Health and Care. In most costs, NHS
Property Services are our landlord.
17“Passporting of Where certain training is undertaken in one organisation (in
mandatory training” line with a set of common standards), it should remain “valid”
in relation to a person’s employment with another
organisation. To avoid a person unnecessarily having to re-
do training simply because they have moved organisation,
the passporting approach is used to confirm the validity of
training.
“Personalised Care and Personalised Care and Support Planning is a series of
Support Plans” facilitated conversations in which the person, or those who
know them well, actively participates to explore the
management of their health and well-being within the context
of their whole life and family situation.
“PPE“ “PPE” means Personal Protective Equipment. I.e. something
that a person wears, or dons about their person to protect
them from harm that may be caused by a hazard that they
are potentially exposed to in their work environment.
“Primary Care Networks” PCNs are groups of GP practices working closely together -
or “PCNs” along with other healthcare staff and organisations -
providing integrated services to the local population.
Since April 2019, individual GP practices can establish or
join PCNs covering populations of between 30,000 to 50,000
(with some flexibility).
“Primary Care” Primary care providers act as the first contact and principal
point of continuing care for patients within a healthcare
system. Primary care providers coordinate other specialist
care that patients may need. Patients typically receive
primary care from the clinicians in their GP practice (e.g.
their GP, nurse practitioner, or physiotherapist).
“Pull model” An initiative that seeks to identify patients being cared for in
an acute hospital, and works to coordinate whatever is
necessary so that the patient can be cared for in a setting
outside of the acute hospital.
“Quality Improvement” The term 'quality improvement' refers to the systematic use
of methods and tools to try to continuously improve quality of
care and outcomes for patients. There are a range of
different methods and tools.
“Risk Stratify“ The process of separating patient populations into high-risk,
low-risk, and increasing-risk group. Having a platform to
stratify patients according to risk is key to the success of any
population health management initiative
“RUH” Royal United Hospitals Bath NHS Foundation Trust. This is
an acute hospital, based in Bath.
“Service integration” In our plan, we use this term to mean when two services
operating independently are re-designed in some way so
that they function in collaboration or in a joined up manner.
“SFT” Salisbury NHS Foundation Trust. This is an acute hospital,
based in Salisbury.
“Specialist Services “ Services that provide expert care in a particular specialism,
such as learning disabilities, podiatry, speech and language
therapy, respiratory. A full list of our specialist services is
displayed on our website:
https://wiltshirehealthandcare.nhs.uk/our-services/
“System” The system in which Wiltshire Health and Care operates is
the “BSW” system. This means the network of health and
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