Clinical Strategy 2021-2025 - Northern Lincolnshire and Goole - Northern Lincolnshire and Goole NHS ...

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Clinical Strategy 2021-2025 - Northern Lincolnshire and Goole - Northern Lincolnshire and Goole NHS ...
Northern Lincolnshire
                        and Goole
                      NHS Foundation Trust

Clinical Strategy
2021-2025

             Kindness • Courage • Respect
Clinical Strategy 2021-2025 - Northern Lincolnshire and Goole - Northern Lincolnshire and Goole NHS ...
2   Clinical Strategy
Clinical Strategy 2021-2025 - Northern Lincolnshire and Goole - Northern Lincolnshire and Goole NHS ...
Contents

           Executive Summary						4
           Foreword								5
           Introduction							6
           National Policy and Guidance					7
           Partnership Working across the Region			8
           Humber Acute Service Review					9
               Principles							10
                Programmes						11
                Capital Investment					12
           Northern Lincolnshire and Goole NHS FT Overview        13
           Enabling Strategies						14
           The Trust Priorities							15
           Our Clinical Services						16
           Our Plans and Milestones					17
           Conclusion 								22

                                                             Clinical Strategy   3
Clinical Strategy 2021-2025 - Northern Lincolnshire and Goole - Northern Lincolnshire and Goole NHS ...
Executive Summary
    This Clinical Strategy sets out our ambition to deliver a high quality service and experience to the population that we
    serve. This must be set within the context in which we operate. Despite having made significant progress over the past
    18 months the Trust remains in double special measures for both finance and quality. We will continue to focus our
    efforts on ensuring that we improve the efficiency, effectiveness and safety of our services.

    The strategy recognises that our         We must also recognise that we will       As we deliver our strategy we will
    local health system faces many           need to partner across organisations      ensure that we reflect the following
    challenges and that we need to           to recruit and retain specialist staff.   principles:
    work with our partners to do things      Only by doing this will we be able to
                                                                                       •   Right care, right place, right time
    differently. Our pathways of care        provide them with the opportunity
    often rely on in-house provision.        to build their careers.                   •   Patient centred care

    As we move forward we must focus         We must not lose focus on the fact        •   Whole system thinking, whole
    on how we can work across primary,       that we are the largest employer              system practice
    community and social care to deliver     within North and North East               •   Transformation of services where
    more services for you that are either    Lincolnshire.                                 appropriate
    closer to or at home.
                                             We must build on our expanding            Our aim is to maintain our Trust
    We must harness the changes              local partnerships with schools,          vision and to deliver our priorities.
    that are taking place in the use of      colleges and partners to build a local    The strategy outlines the challenges,
    technology to deliver services. This     workforce across the 150 plus roles       type and range of clinical services
    will improve our efficiency and          that we have.                             we want to provide, how we will
    effectiveness and provide new ways                                                 provide those and the outcomes we
                                             Our ambition must be set within
    in which you access services.                                                      will seek to achieve.
                                             the context of national and regional
    Recruiting and retaining staff           policy whilst also being focused on       Given the nature of the changes that
    remains a significant issue across our   delivering services at pace. There are    are taking place around us nationally
    health economy.                          many changes taking place whether         and locally we recognise that this
                                             through the requirements of the           strategy must be kept under review.
    We must invest and continue to
                                             National Long Term Plan or People         We will therefore provide updates to
    look to new ways of working and to
                                             Plan.                                     the framework and our plans on a six
    promoting our Trust as an “Anchor
    Organisation” within our local           There are also changes taking place       monthly rolling basis. Only by doing
    economy.                                 within the NHS Commissioning              this, will we maintain our focus to
                                             Landscape along with wide changes         deliver improvement in what is a
    We must look to partner with local
                                             across the Humber. These provide          rapidly changing environment.
    institutions to build our reputation
                                             us with significant opportunity to
    and to recruit, train and develop
                                             harness our collective endeavours to
    more local staff.
                                             deliver and implement change that
    We must accelerate the need to look      will improve access to and quality of
    to new types of staff who can operate    health and care services.
    across many pathways, for example
                                             Our Clinical Strategy describes how
    Advanced Care Practitioners and
                                             we will develop our clinical services.
    implement recruitment, training and
                                             We will ensure that no matter what
    development pathways for those
                                             we do that we are consistent with
    roles.
                                             our Trust vision ‘committed to caring
                                             for you’.

4         Clinical Strategy
Clinical Strategy 2021-2025 - Northern Lincolnshire and Goole - Northern Lincolnshire and Goole NHS ...
Foreword
This Clinical Strategy sets out our ambitious commitments to ensure the people who rely on our services receive high
quality and accessible care and treatment. For our Trust to achieve this, the way services are currently delivered will
need to change. Proposals have been designed with the needs of patients central to our thinking.
These changes are required for a          necessary change, we believe we           In the past few months our Trust
number of reasons set out in this         will be able to provide sustainable,      has been tested like never before.
document. They relate to staff            safe services for our local population    To respond to this meant doing
availability, the health needs of the     and improve the quality of the care       things differently. We did that and it
population we serve, the fact we are      and experience we provide. It is a        worked.
not currently delivering timely care      big task which will take several years
                                                                                    These changes have given us a
to all our patients, and the poor state   to achieve.
                                                                                    strong foundation to build on over
of our building and information
                                          It is also complicated because we         the next three to four years to
technology.
                                          need to work with our partners            ensure we provide the safe, high
We recognise that we have been            as we cannot do what we need              quality and sustainable clinical
unable to provide assurance that          to on our own. However, by                services that our community
we are providing the care and             working together we can create            deserves.
treatment that we should be, which        the catchment area of patients
                                                                                    Our ambition is to deliver the best
is not acceptable. We know from           we need to offer rewarding and
                                                                                    care to our patients and in doing
conversations that people are             interesting specialist jobs for future
                                                                                    so we believe our regulators will
concerned and nervous about what          doctors, nurses and other health
                                                                                    recognise those improvements. This
the changes will mean for some that       care professionals and ultimately
                                                                                    document sets out in more detail
use our services, as well as those        improve patient care.
                                                                                    how we intend to do this and will
that deliver them.
                                          As we write this foreword the NHS,        be reviewed as we progress over the
We will listen to concerns and of         nationally and locally, is starting to    next 12-18 months.
course make changes where we              emerge from the most significant
see there is opportunity to build         crisis it has ever faced – the
on the work done so far. However,         Coronavirus pandemic.
we suspect that not everyone will
want to support making changes to

deliver the improvements necessary.
This doesn’t mean we shouldn’t
change though. By embracing

                                                                  Terry Moran                       Dr Peter Reading
                                                                  CB Chair 		                       Chief Executive

                                                                                                    Clinical Strategy        5
Clinical Strategy 2021-2025 - Northern Lincolnshire and Goole - Northern Lincolnshire and Goole NHS ...
Introduction
    We understand that we do not always deliver the timely care and treatment we should. Tackling this problem means
    looking at our clinical services differently. We have made many improvements over the past 18 months but we must
    continue our focus and drive for continuous improvement in our clinical services.
    As an organisation we face many and multiple challenges. This strategy sets out not only the nature of the challenge we
    face but the actions we will take to respond and the impact that we will seek to have.
    These actions are focused on ensuring that we deliver high quality, safe and accessible services for all when you are in need.

        Challenges               Where we are now                                Where we will be                             How we will get there

                             •   Recruitment of multiple grades and       •   Accelerate to recruit local, national and   •    Develop new roles with partners
    Workforce                    types of specialist staff                    international                               •    Different ways of working
                             •   Challenges with recruiting and           •   Training partnerships                       •    Training partnerships
                                 retaining non-specialised staff          •   Continue to ‘grow our own’ where we         •    Local recruitment
                                                                              can with the right investment and
                                                                              infrastructure                              •    Cross provider specialist recruitment
                                                                                                                          •    Working with Health Education
                                                                                                                               England to support new courses

                             •   Long waiting times to be seen and        •   Delivery of national access waiting         •    New models of care
    Quality of Care              treated                                      times                                       •    Integrated pathways of care
                             •   Lengths of stay in hospital              •   Improved partnerships with                  •    Increased use of digital healthcare
                             •   People at end of life not consistently       community, primary and social care to            – self-help, monitoring, early
                                 identified                                   reduce length of stay in hospital and            intervention
                                                                              end of life support
                             •   Advanced care planning between                                                           •    Partnerships with community and
                                 community and hospital services is       •   Maintain the progress made with the              other providers
                                 sometimes inconsistent                       hospital level mortality indicator
                                                                                                                          •    Utilise benchmarking and best
                             •   Addressing challenges in the care        •   Embedded mental health care as part              practice models
                                 and outcomes for mental health care          of core services
                                                                                                                          •    Working collaboratively across
                                                                                                                               organisations to implement the five
                                                                                                                               year forward view for mental health

                             •   £97.7m backlog maintenance across        •   Invest in our existing infrastructure to    •    Continuous funding applications
    Estates and                  our hospital sites                           reduce backlog                                   – digital, Emergency Departments,
                                                                                                                               specialist, sustainability
    Infrastructure           •   Ageing infrastructure                    •   Access national funding to redevelop
                                                                              our hospital sites                          •    Strategic Capital Business Cases
                             •   Buildings which are not
                                 environmentally sustainable

                             •   Lack of investment in Digital            •   Access digital accelerator funding to       •    Digital Accelerator Funding
    Digital                      Technology                                   drive infrastructure improvement            •    Interoperable ICT Platforms
    Technology               •   Lack of interoperable Information
                                 and Communications Technology
                                                                          •   Look to implement technology
                                                                              solutions to improve efficiency and
                                                                                                                          •    Investment in Patient Administration
                                                                                                                               System
                             •   Limited use of technology to deliver         access
                                                                                                                          •    Investment in Informatics and
                                 services                                 •   Increased access to IT equipment                 Analytics
                             •   Reliance on paper based systems                                                          •    Use of Artificial Intelligence
                                                                                                                               technologies

                             •   Inconsistent pathways of care in         •   Integrated pathways of care                 •    Implementation of the Humber
    Service                      some areas                               •   Improved out of hospital services                Acute Services Review

    Sustainability           •   Poor deployment of specialist
                                 resources
                                                                          •   Implementation of Humber Acute              •    Implementation of the Out of
                                                                                                                               Hospital Programmes
                                                                              Services
                             •   Updated the outgoing Sustainable         •   Have a clear defined action plan to         •    A clear action plan of work
                                 Management Plan with the Trusts              achieve carbon reduction in line                 completed, ongoing, and scheduled
                                 Green Plan                                   delivering a “Net Zero” National Health          to reduce all scopes of carbon
                                                                              Service                                          emission areas

                             •   Underlying cost base challenges          •   Improved cost management to ensure          •    Shared corporate services
    Finances                                                                  delivery of control total                   •    Reduced overheads
                                                                          •   Sustainable financial position              •    Reduced agency spend
                                                                          •   Minimised variation on service delivery     •    Clinical productivity and pathway
                                                                                                                               improvements

6        Clinical Strategy
Clinical Strategy 2021-2025 - Northern Lincolnshire and Goole - Northern Lincolnshire and Goole NHS ...
National Policy and Guidance
Our Clinical Strategy reflects national policy and guidance:
The environment within which the NHS operates is changing. Our population is increasingly ageing, there are
significant advances in medicine and surgery, patient expectations are changing and there is a need to harness
research, innovation and technology in delivery.
We need to focus on how we support the delivery of out of hospital services and that our population only access
secondary care when they need to do so. Our services must be provided more closely to home, or indeed at home.
The NHS Long term plan published in January 2019 sets out the policy context and guidance for the delivery of services
over the next 10 years. Our experience during the pandemic has resulted in changes in practice, new ways of working and
introduced use of technology.
The NHS Long term plan framework below provides a summary of the principles, priorities and initiatives that we will be
considering as we implement our Clinical Strategy;

  Integrated Approach to
                                      Deliver a New Service                                       Ensure a Sustainable
 Strategic and Operational                                              Priority Areas
                                              Model                                                     System
    Planning Principles
 •   Clinically led               •    Transformed out of        •   Increased focus on       •    Ensure that the NHS is
                                       hospital care                 population health             the ‘Best Place to Work’
 •   Locally owned
                                  •    Support for Primary       •   Better care for major    •    Improve leadership
 •   Realistic workforce
                                       Care Networks                 conditions                    and culture
     plans
                                  •    Relieve pressure          •   Cancer                   •    Transforming the
 •   Financially balanced
                                       on emergency                                                workforce
                                                                 •   Cardiocascular disease
 •   Place based on local              departments
                                                                                              •    Investing in digital
     need                                                        •   Diabetes
                                  •    Give people more                                            transformation
 •   Reduced variation                 choice about their care   •   Respiratory conditions
                                                                                              •    Improving productivity
 •   Focused on prevention        •    Research and              •   Focus on long term
                                                                                              •    Reducing variation
                                       innovation based              conditions
 •   Delivers innovation
                                                                                              •    Ensuring that research
                                  •    Maternity Services        •   Smoking
 •   Engaged with partner                                                                          and innovation drives
     local authorities                                           •   Obesity                       new models of care
 •   Quantified impacts                                          •   Alcohol
 •   Mental Health services                                      •   Air pollution
 •   Addressing inequalities                                     •   Anti-microbial
                                                                     resistance

Our strategy is set within not only national requirements but also the programme of change within our region which
includes the Humber Acute Service Review and the potential changes and investment that may be made within
Urgent and Emergency Care, Maternity and Paediatrics and Planned Care programmes, Out of Hospital transformation
programmes and Capital Developments.
https://www.longtermplan.nhs.uk

                                                                                                          Clinical Strategy   7
Clinical Strategy 2021-2025 - Northern Lincolnshire and Goole - Northern Lincolnshire and Goole NHS ...
Partnership Working Across the Region
    We are working with partners on a wide ranging programme of change across the
    Humber to strengthen in and out of hospital delivery.
    The Humber Coast and Vale Health          •   Developing primary care – so          •   Securing a long-term, sustainable
    and Care Partnership is a collaboration       that every neighbourhood has              future for our hospital services –
    of health and care organisations who          access to a single team of health         so that our hospitals are working
    became an Integrated Care System              and care professionals who can            together to provide high quality
    in April 2020. This strengthens our           meet a wide range of their needs          care for our populations when
    collaboration with local councils and         locally;                                  they need to be in hospital.
    other health and care partners.
                                              •   Joining up services outside of        Our Clinical Strategy cannot be
    The principal aim of the partnership is       hospital – so that care is designed   created or delivered in isolation.
    to “improve the health and wellbeing          around the needs of the person        The changes taking place across
    of the population it serves through           not the needs of the different        the health and care system mean
    collective responsibility of managing         organisations providing it;           we must look to strengthen how
    resources to deliver health and care                                                we work with partners including
                                              •   Developing our unplanned care
    services”                                                                           Primary Care Networks, voluntary
                                                  services – so that appropriate
                                                                                        sector, social care and all other
    As we strengthen the collaborative            care, advice and support is
                                                                                        health and social care partners.
    working across the health system, our         available to citizens of Humber,
    priority is to improve patient access,        Coast and Vale when they need it      https://humbercoastandvale.org.uk/
    reduce duplication, use technology and        unexpectedly;                         partnership-long-term-plan
    strengthen our workforce through;

8        Clinical Strategy
Clinical Strategy 2021-2025 - Northern Lincolnshire and Goole - Northern Lincolnshire and Goole NHS ...
Humber Acute Services Review
A major element of the Clinical Strategy will be the implementation of the Humber
Acute Services Review;
The Humber Acute Services              The review will have a focus on a        We need to look at our approach to
Review commenced in 2018 across        number of challenges including:          recruitment and work more closely
Northern Lincolnshire and Goole                                                 with our local communities and
                                       •   The low volume of patients for
NHS Foundation Trust and Hull                                                   partners more effectively to “grow
                                           many services across this rural
University Teaching Hospitals Trust.                                            our own” whilst also recognising we
                                           and coastal geography leading
                                                                                need to enhance our approaches to
The review is focused on ensuring          to the difficulty of specialists
                                                                                building academic partnerships and
that we improve access to deliver          maintaining their skills
                                                                                international relationships.
high quality care for patients. We
                                       •   The inability to meet many core
must improve access to services,                                                Only through this approach will
                                           NHS standards and waiting times
patient outcomes and experience                                                 we ensure we have a high quality
whilst also harnessing new ways        •   Understand mortality rates and       sustainable workforce for the future.
of working if we are to deliver a          address quality of care concerns
                                                                                Across the Humber we experience
sustainable model of healthcare in         where appropriate
                                                                                shortages of specialist staff within
the future.
                                       •   The limitations of our estate and    a number of services. This impacts
The review produced a Case for             the lack of access to the latest     our ability to meet national clinical
Change in February 2020 detailing          information technology and           standards, to support effective
the challenges and reasons to              equipment                            training rotas and to deliver services
review the acute services across the                                            in a high quality manner, across
                                       The review will consider how we
Humber. This was subject to a review                                            multiple sites, on a 24 hour, 7 day
                                       can provide the best possible care
by the Clinical Senate review and                                               week basis.
                                       for local people who need to use
published report in May 2020.
                                       acute hospital services within the       The work we are undertaking will
We are now moving at pace to           resources (money, staffing and           look at how we can ensure that we
develop the potential options          buildings) that are available to         deliver safe pathways of care which
for service change. These will be      the local NHS. This may include          meet national standards whilst also
coproduced with commissioners,         delivering some aspects of care out      ensuring we meet local patient
patients, carers, partners and         of hospital in GP surgeries or other     needs.
staff during 2021, resulting in the    community settings to better meet
                                                                                This is not an easy process and
publication of a Pre-Consultation      local people’s needs.
                                                                                one in which we must ensure we
Business Case and statutory
                                       As a health and care system we           continuously engage. We will ensure
consultation during late 2021 early
                                       face significant challenges in our       that we use multiple approaches to
2022.
                                       workforce. A critical element of the     engage with you as the options for
This will address the potential        review is focused on ensuring we         this important review are developed
options for future service delivery    recruit, retain, train and develop our   during 2021.
with a focus on models of care,        staff.                                   https://humbercoastandvale.org.uk/
workforce, infrastructure and                                                   wp-content/uploads/2020/02/HASR-Long-
financial sustainability.                                                       Case-for-Change/Final-for-Publication.pdf
                                                                                http://www.yhsenate.nhs.uk/modules/
                                                                                reports/protected/files/YH%20Senate%20
                                                                                Report%20-%20HASR%20-%20Final%20
                                                                                May%202020.pdf

                                                                                                 Clinical Strategy          9
Clinical Strategy 2021-2025 - Northern Lincolnshire and Goole - Northern Lincolnshire and Goole NHS ...
Humber Acute Services Review – Principles
 There are a number of principles, agreed in 2018, which underpin how the
 Humber Acute Services Review will be co-designed and implemented.
 These principles will underpin how we engage with you not only during the review but also as we develop our Clinical
 Strategy within the Trust.

         Principles
         • Patient-focused, safe and sustainable services – meeting the needs of our population
           now and in the future
         • Clinically-led review of services
         • Evidence-based – taking into account best practice
         • Focus on hospital services – not hospital buildings and organisations
         • Take account of developments in out-of-hospital care – developing solutions that join
           up different types of care
         • A transparent, collaborative and inclusive approach – engaging with key stakeholders
         • Plans for future provision will be developed in accordance with the levels of human,
           physical and financial resource expected to be available
         • Plans for future provision will include Urgent and Emergency Care and Maternity Care
           in Hull, Grimsby and Scunthorpe
         • The review will follow an agreed programme plan that sets out objectives, processes,
           timescales and resources.

10    Clinical Strategy
Humber Acute Services Review
– Programmes
The review is made up of three major programmes of change consisting of:

         Programme 1                             Programme 2                              Programme 3

      Interim Clinical Plan                   Core Service Change                        Strategic Capital

                                          •   Urgent and Emergency Care
  •   11 Specialties within both                                                   •   Strategic Capital
                                          •   Maternity and Paediatrics
      organisations                                                                    Investment
                                          •   Planned Care

           Delivery 2021                       Implementation 2022                       Business Case 2023

Our strategy will reflect the outcomes that are delivered through the implementation of this important review.

Programme 1: Interim Clinical           Programme 2: Core Service               Programme 3: Strategic Capital –
Plan is focused on delivering           Change is focused on delivering         is focused on how we maximise our
improved access, sustainability and     long term change in our models          ability to access significant capital
performance within 11 specialties.      of urgent and emergency care,           funding – circa £750 million – to
All of these have issues with           maternity and paediatrics and           build new hospital infrastructure
numbers and skills of staff, patient    planned care. We will co-produce        in both Northern Lincolnshire and
demand, access, waiting times           and implement new models of care        Goole Hospitals and Hull University
and clinical outcomes. We will take     which will address key performance      Teaching Hospitals.
actions to improve to integrate         issues, reflect the need to deliver
pathways of care, pool resources and    new and evolving national standards
improve access during 2021.             of care, and allow us to address our
                                        workforce challenges.

                                                                                                Clinical Strategy       11
Humber Acute Services Review
 – Capital Investment
 Strategic Capital Investment
 Our estate is not fit for purpose. We        We will transform our current               •   Development of new inpatient,
 have significant issues with backlog         hospital estate using leading                   diagnostic and treatment
 maintenance – circa £97.7 million            edge design to provide new                      facilities at Hull Royal Infirmary
 across our sites. This impacts upon          state-of-the-art health and care
                                                                                          •   Development of facilities on
 our ability to invest in new service         campuses, as part of wider plans
                                                                                              hospital sites at Grimsby, Goole
 models of care and limits our ability        for the development of local areas,
                                                                                              and Castle Hill
 to maximise our use of new and               driving employment opportunities,
 emerging technologies.                       collaboration, learning and                 Developments are in progress with
                                              innovation across the region.               new builds for additional diagnostic
 Given this is one of the main
                                                                                          scanners, emergency departments
 challenges the Humber is facing,             Our investment plans are:
                                                                                          and acute assessment units within
 there is a commitment within our
                                              •   Creation of a brand new hospital        Grimsby and Scunthorpe.
 region to committing significant
                                                  and healthcare facilities in
 capital investment to build a
                                                  Scunthorpe
 healthier future for the Humber.
 We want to ensure our infrastructure
 can meet the ever-changing
 demands of 21st century healthcare
 and COVID-19 requirements such
 as isolation facilities, whilst also
 supporting an improved level
 of environmental sustainability,
 improved research and innovation
 and partnering along with being an
 attractive place to work to support
 improved recruitment and retention.
 Capital investment in our hospitals
 will act as a catalyst for the
 continued regeneration of the
 region, because of the opportunity
 a cash injection brings in terms of
 employment, education and mental
 and physical well-being for local
 people.
 It also provides an opportunity
 to build on the regions skills and
 expertise in green energy to develop
 a lower carbon future for our
 healthcare facilities and support the
 development of green jobs in the
 region.
 Healthcare facilities that are fit for
 the future will significantly improve
 patient care whilst also promoting
 research, innovation and greater
 employment prospects.

                                     https://humbercoastandvale.org.uk/wp-content/uploads/2020/05/HASR-Capital-Development.pdf

12     Clinical Strategy
Northern Lincolnshire and Goole Hospitals
Overview
We operate across a wide complex geographical footprint;
Northern Lincolnshire & Goole          The Trust employs 6800 staff and          Locally the Trust is part of the
NHS Foundation Trust provides          operates from three hospital sites        Northern Lincolnshire health system
services across the North and          with two acute district general           working with local commissioners,
North East Lincolnshire area and       hospitals; Diana, Princess of Wales       primary care, community and
the boundaries of East Riding of       Hospital, Grimsby, Scunthorpe             local authorities and providers of
Yorkshire and Lincolnshire to a        General Hospital and Goole District       health care to continuously build
population of 450,000.                 Hospital.                                 upon improvements in health care
                                                                                 provided to the local population.
It is important to set our Clinical    Diana, Princess of Wales Hospital,
Strategy and plan to deliver within    Grimsby and Scunthorpe General            Our success will be dependent on
the overarching health and care        Hospital both provide acute hospital      working together.
landscape and in the context of        care and a range of community
the existing challenges and more       services across North and North
recently, the challenges that          East Lincolnshire with Goole District
COVID-19 brings to the organisation.   Hospital predominantly providing
                                       outpatient, diagnostic, planned
                                       surgery and rehabilitation.

                                                                         Population
                                                                          of 450,000

                                                                     3
                                                               Hospital sites,
                                                                 860 beds                6800 Staff
                                                                                         employed

                                                                                               Clinical Strategy       13
Enabling Strategies
 Our Trusts Strategic Framework and Enabling Strategies
 The Trust has worked with patients, staff and
 stakeholders to develop and revise our Strategic Plan,
 Quality Strategy, People Strategy (workforce), Digital
 Strategy, and Estates Strategy.                            Quality
 These all underpin this 				                               Strategy
 Clinical Strategy and
 are significant enablers
 success.
                                 Finance
                             to ensure its
                                                                                Strategic
                                 Strategy                                         Plan

                       Digital                            Clinical                      Risk
                                                                                     Management
                      Strategy
                                                          Strategy                    Strategy

                                                                                 People
                                  Estates
                                                                                Workforce
                                 Strategy
                                                                                Strategy
                                                           Nursing Midwifery
                                                           Allied Health Care
                                                             Professionals
                                                                Strategy

14    Clinical Strategy
The Trust Priorities
Our Trust Strategic Framework developed in 2019 is shown below (this will be subject to review in 2021):

The six Trust Priorities will be evolving through transformation over the next four years, formulating into the Clinical
Strategy and driven by the Clinical Divisional plans.

                                                                                                         Clinical Strategy   15
Our Clinical Services
 The Trust operates through five Clinical Divisions. The Clinical Divisions provide a range of clinical services and are
 supported through a number of corporate functions as set out below:

                                     Surgery and Critical           Family Services       Clinical Support            Community and
         Medicine Division
                                        Care Division                  Division           Services Division          Therapies Division

     •    Emergency              •     Critical Care            •   Obstetrics        •   Radiology              •    Physiotherapy
          Department             •     Theatres                 •   Gynaecology       •   Endoscopy              •    Occupational Therapy
     •    Acute Medicine         •     Acute Surgery            •   Paediatrics       •   Pharmacy               •    Nutrition and Dietetics
     •    Cardiology             •     Anaesthetics             •   Community         •   Pathology              •    Speech and Language
     •    Stroke                 •     General Surgery              Paediatrics       •   Medical Physics        •    Community Dental
     •    Respiratory            •     Trauma and               •   Breast Services   •   Audiology              •    Podiatry and orthotics
     •    Diabetes and                 Orthopaedics             •   Neonatal Care     •   Medical Illustration   •    Neuro Rehabilitation
          Endocrinology          •     Colorectal                                                                     Centre
                                                                                      •   Mortuary
     •    Gastroenterology       •     Upper                                                                     •    Rehabilitation
                                                                                      •   Outpa tients
     •    Clinical Haematology         Gastroenterology                                                          •    Nursing - Community
                                                                                      •   Cancer
     •    Dermatology            •     Urology                                                                        and Specialist
                                                                                      •   Medical Engineering
     •    Rheumatology           •     Ophthalmology                                                             •    Community Response
     •    Palliative Care        •     ENT                                                                            Team
     •    Neurology              •     Maxillo Facial Surgery                                                    •    Psychology
     •    Elderly Medicine                                                                                       •    Equipment Stores
                                                                                                                 •    Wheelchair Services

 Our Clinical Divisions are at the heart of delivering front line services to our patients to achieve our six Trust Priorities and
 each Division has a detailed operational plan.
 Divisional plans articulate the visions, challenges, aims and objectives which are built from the Trust Strategic Framework
 and priorities aligning to Care Quality Commission requirements and quality priorities. These plans underpin the delivery
 of the vision set out in this strategy.

16         Clinical Strategy
Our Plans and Milestones
We cannot deliver this alone; we will need to work collaboratively across the Health
and Care system, community and public;

Our Clinical Strategy will be delivered through multiple approaches to the delivery of transformational change. This change
will take place at three levels: Integrated Care System, Humber wide and locally-based population health strategies.
These are summarised below:

                          •   Strategic Workforce Planning
   Integrated             •   Digital Solutions - System inter-operability
  Care System             •   Regional Diagnostics / Rapid Diagnostic Centres
                          •   Acute Collaborative
                          •   Outpatient Transformation
                          •   Primary Care Transformation
                          •   Mental Health Transformation

                          • Interim Clinical Plan (Fragile and vulnerable services) (2020-22)
    Humber                • Acute Services Review - Urgent & Emergency Care, Maternity & Paediatrics,
                            Planned Care (2020-26)
                          • Large scale capital investment in the Humber hospitals - Creating a healthier Humber
                            (2020-31)
                          • Humber Workforce Planning

                          0-2 years
       Local              •   Integrating care pathways across Primary, Community & Secondary Care
                          •   Urgent & Emergency Care - Acute Assessment Units
                          •   Diagnostics - Increase in MRI and CT scanners
                          •   Outpatients & Cancer Service Transformation
                          2-4 years
                          • Reorganise our specialties and hospitals to address the challenges

                          • Clinical Divisional plans (Trust priorities)
                          • Enabling Strategies (i.e. People Plan, Digital, Estates, Finance)

                                                                                                     Clinical Strategy        17
Our Plans and Milestones
 Where We Are Going To Be;

 We have a number of really great health and care services in our area and many people have excellent experiences
 of the care they receive. However, our current services are under increasing pressure due to rising demand and in
 many cases are finding it extremely challenging to adequately staff and resource all the services that are provided in
 their current form.
 Our Clinical Strategy is set within the context of achieving the six Trust Priorities to deliver the following outcomes;

                                                             Outcomes
     Trust Priorities          Improved    Improved        Reduced      Equity of
                                                                                       Safe     Sustainable        What Will be Different
                                Patient     Clinical       Waiting      Access for
                                                                                     Services    Services
                              Experience   Outcomes         Times        Patients
                                                                                                              Reduced attendance, waiting times,
     1.                                                                                                       out of hospital care, decreased
     Integrated Urgent
     and Emergency Care
                                                                                                        ambulance conveyance, improved
                                                                                                              environment and reduced length of
                                                                                                              stays in hospital

                                                                                                              Reduced waiting times. Virtual and
     2.
                                                                                                              telephone consultations. Primary
     Transformed
     Outpatient Services
                                                                                                        Care partnerships and increased
                                                                                                              provision of services out of hospital

     3.                                                                                                       Redesigned clinical pathways – more
     Working in
                                                                                                              locally based services and one stop
     Partnership with
     Primary Care
                                                                                                         shops. Community provision and
     Networks                                                                                                 seamless working

     4.                                                                                                       Consolidation of speciality services
     Reconfigure
                                                                                                              to provide 7 day continuous
     Specialities to
     One Site Where
                                                                                                          care. Reduced waiting times and
     Appropriate                                                                                              improved outcomes

     5.
                                                                                                              Improved times to diagnosis and
     Restructure Cancer
     Services
                                                                                                        treatment. Quicker access

     6.                                                                                                       Utilisation of space and increased
     Create Sustainable
     Services at Goole
                                                                                                          services across the region. Decreased
                                                                                                              length of stay in hospital

                           Along with the six Trust priorities,the Clinical Strategy will align to improving quality standards

                                                                                                              Improved performance standards/
     Improve Quality
     Standards                                                                                          waiting times and length of stay in
                                                                                                              hospital

18        Clinical Strategy
Our Plans and Milestones
We will ensure that we have robust governance to deliver our changes;

As we move forward new models of care will emerge. Clinical pathways may change the way we deliver care and it will be
essential that change is planned, reviewed and impact assessed.
Any proposed changes will be carried out following full engagement with colleagues, patients and the wider public. We
will ensure that our decisions are clinically led and engage the right stakeholders at the right time making sure service
changes align to the system plans.
Our programmes of change will be assured and managed both internally and externally. The external assurance will be
provided though the Integrated Care System, Humber Acute Services and NHS England and Improvement assurance
process set out below;

                                                     Discussion

     Joint Strategic Needs                   Joint Health and                    Proposal
     Assessment                            Wellbeing Strategy
                              Ongoing                                                   Assurance
                          and continuous
                         patient and public                                                   Consultation*
                           engagement

                                         CCG, local authorities,                                          Decision
     Service re-design
                                                STPs and FYFV
                                                                                                              Implementation

* Public consultation may not be required in every case. A decision about whether public consultation is required should be made taking into
account the views of the local authority.

Our Trust governance and assurance structure set out below will ensure that any proposed changes are subject to
assurance reviews, that implementation is reviewed and that post implementation outcomes are scrutinised to ensure we
not only learn from experience but that we have delivered the outcomes we proposed.

       Humber Coast & Vale
      Health Care Partnership
                                                                      Trust Board (TB)                             Council of Governors
 Humber Acute Services Executive
       Oversight Group
                                                            Trust Management Board (TMB)

  Commission Governing Bodies

                                                                      Divisional Board
  Overview Scrutiny Committees
             (OSCs)
                                                                       Delivery Group

           Citizens Panels
         (where appropriate)
                                                                         Formal Reporting

                                                                                                                     Clinical Strategy         19
Our Plans and Milestones
 Whilst we develop and progress our Clinical Strategy within the Region and the
 Humber, we will continue to progress with the following local transformation;

     •   Increase rapid access to assessment with
         prompt review, diagnosis and treatment
                                                                                          •    Partnership working
     •   Same Day Emergency Care
                                                                                          •    Focus on preventing
     •   Ambulatory Care                                             Integrating               admissions to hospital
     •   Improve support in flow in hospital                         Care
                                                                     •    Pathways        •    Improving discharge to out of
         and out of hospital
                                                       Integrating   across 		                 hospital
     •   Purpose build new Emergency Departments
         and Acute Assessment Units                    Urgent and    Primary and          •    Redesign of planned care
     •   Developing Frailty models across           Emergency Care   Secondary Care            pathways
         the system

     •   Incorporating additional MRI and CT
         scanners to support demand for both            Increasing
                                                             acute   Outpatient       •       Increase used of non face-to-face
                                                                                              appointments
         and planned care                               Diagnostic   and Cancer
     •   Additional CT scanners at both                                               •       Improve waiting times
         DPoW & SGH (2021)
                                                         scanning    Transformation
                                                                                      •       Improve timeliness of cancer
     •   Additional MRI scanner and new suite
                                                          capacity                            diagnosis and treatment
         build in DPoW (2021)                                                         •       Clinical service redesign with
     •   Additional MRI scanner and extension                                                 system partners
         in SGH (2022)

20        Clinical Strategy
Our Plans and Milestones
Milestones:
Our timescales and the improvements that will be achieved through delivering our Clinical Strategy, set within the
context of achieving our six Trust Priorities, our Quality Priorities and the progression of the Humber Acute Service
Review, are summarised below;

                                                                             Timescales
    Priorities
                                   2021-2022                                     2022-2023                                2023-2025
                       •   Implement an Urgent Care Hub                  •   A new dedicated Acute                  •   Continue to work in
  Integrated Urgent                                                          Assessment Unit and Emergency              partnership to improve
                       •   Increase access to Same Day Emergency
  and Emergency            Care and Ambulatory Care                          Department at both DPoW and                performance levels
                                                                             SGH
  Care (U&EC)          •   Reduce the length of stay in hospital
                                                                         •   Implement Humber Acute Service
                       •   Implement Talk before you Walk, Frailty           Review models of care
                           model and Community Response Team

                       •   Expand the use of non face-to-face            •   Developed digital devices and          •   Increased virtual and
  Transformed              appointments                                      systems to support patient record          community clinics
  Outpatient           •   Reduce the back log of follow up                  sharing                                •   Reduced 30% of face-to-face
  Services                 appointments                                  •   Implemented joint pathways with            appointments
                       •   Reduced waiting times and progressed              Primary care                           •   Eliminated overdue follow ups
                           recovery from COVID                           •   Patient initiated follow ups and
                       •   Increased digital technology to manage            patients apps
                           patient pathways

  Worked in            •   Implement Cardiology clinics within the       •   Develop shared training,               •   Formation of teams within
                           community                                         recruitment and retention                  each location, sharing skills
  Partnerships with                                                          approaches                                 across the system
  Primary Care
  Networks
                       •   Deliver the HASR Interim Clinical Plan        •   Implement Humber Acute Service         •   Continue to work in
  Reconfigured                                                               Review models of care                      partnership across the
                       •   HASR Core service change:
  Specialities to                                                                                                       Humber to improve the
                       •   Completed pre-consultation                                                                   delivery of patient care
  one site where           engagement
  appropriate          •   Submission of pre-consultation business
                           case

                       •   Explore and develop new models of             •   Implement additional MRI               •   Full deployment of digital
  Restructured             care to ensure faster diagnosis and               scanner in SGH                             pathology and digital
  Cancer Services          treatments                                    •   Alignment of histopathology                outsourcing
                       •   Implement additional CT and MRI                   service to support faster diagnosis
                           scanners in DPoW                              •   Implement all stratified pathways

  Created a            •   Ensure full utilisation of our theatres and   •   Reshape the workforce working          •   Continue to work in
                           clinics to meet demand                            in different ways to effectively use       partnership with local and
  Sustainable                                                                specialist skills of staff                 regional partners
  Hospital at Goole

                       •   Improved quality and timeliness of            •   Eliminate 40 week waiting lists        •   Maintained better support
  Quality Priorities       patient discharges to appropriate safe                                                       for patients at end of life
                                                                         •   Reduce 26 week waiting lists
                           environments                                                                                 and maintained reduced
                                                                         •   Reduce overall referral to                 admissions to hospital
                       •   Better support patients at end of life            treatments
                           and reduce admissions to hospital                                                            where avoidable through
                           where this could be avoidable through         •   Continued reduction of the                 strengthened planning in
                           improved care planning in collaboration           number of patients at the end              collaboration with primary
                           with primary care networks to improve             of life phase  having emergency            care networks
                           effectiveness of care                             admissions in the final 3 months       •   Maintained the Summary
                                                                             of life                                    Hospital level Mortality
                       •   Reduction in the out of hospital
                           Summary Hospital Level Mortality              •   Continued reduction in the out of          Indicator (SHMI)
                           Indicator (SHMI)                                  hospital Summary Hospital level
                                                                             Mortality Indicator (SHMI)
                       •   Increase of patient observations
                           recorded on time in line with policy
                       •   Increase of clinically indicated patients
                           to have a sepsis six screening
                       •   Improved administration of insulin
                           within the required time and a reduction
                           in medication omissions

                                                                                                                             Clinical Strategy          21
Conclusion
 The challenges we face are multiple and the solutions for improvement will require not only us but our partners to
 work in new ways, to pool resources and to implement new models of care.

 We are actively working with             We are also focused on                    us to address our issues of backlog
 our partners in the Integrated           implementing new in-hospital              estate maintenance and digital
 Care System and have a leading           pathways, which make use of new           infrastructure whilst also seeking to
 role within the design and               ways of working and deliver not only      gain national support for strategic
 implementation of the Humber             an improved patient experience,           capital investment in our major
 Acute Services Review.                   but also shorter lengths of stay and      hospitals.
                                          improved outcomes.
 We are actively engaged in the                                                     In doing so we will be working
 development of local Place Based         We recognise that this cannot be          with our local authority and
 services with our partners in Primary,   achieved in isolation and that we         academic partners to ensure we
 Community and Social care.               must look further to recruit, retain      align our strategies for economic
                                          and develop our workforce.                development, local sustainability
 We are focused on ensuring that
                                                                                    and local regulation.
 we implement new models of care          We will accelerate working with
 which improve access ensuring that       local partnerships to recruit and         The environment within which we
 you get access to services in a timely   develop our local workforce whilst        operate is dynamic and requirements
 manner and that those services can       also ensuring that we provide             are changing regularly. This strategy
 be delivered either closer to home       an attractive environment for             will be subject to ongoing review
 or at home where appropriate.            specialist staff recruitment aligned      and challenge with updates being
                                          to enhanced training, development         undertaken every six months.
 We are focused on ensuring that
                                          and research and teaching
 we maximise our use of technology                                                  Only through this approach will we
                                          opportunities.
 to deliver improved self-care, early                                               ensure that we deliver our aspirations
 intervention and monitoring.             Our infrastructure is not fit for         and that we implement the changes
                                          purpose and we will work to               that we are committed to.
                                          secure national funding to allow

22     Clinical Strategy
Clinical Strategy   23
Contact Us:

Telephone: 03033 303035
Email:		 nlg-tr.comms@nhs.net
Visit:		 www.nlg.nhs.uk

     NHSNLaG

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