South East Coast Ambulance Service NHS Foundation Trust. Trust Board Report. 2013/14 to 2015/16 Annual Planning Return (APR) Presentation

Size: px
Start display at page:

Download "South East Coast Ambulance Service NHS Foundation Trust. Trust Board Report. 2013/14 to 2015/16 Annual Planning Return (APR) Presentation"

Transcription

1 South East Coast Ambulance Service NHS Foundation Trust Trust Board Report 2013/14 to 2015/16 Annual Planning Return (APR) Presentation 1. Introduction 1.1. The objective of the plan is to lay out the activities of the Trust for the coming three years to meet the three complementary objectives of: Raising Clinical Outcomes Operational Performance; and Financial Stability The plan is instrumental in our ability to use our resources to maximise the patient care provided to our public. In order to meet these challenges the APR presented has included an assessment in the following areas Activity and resource planning The plan is based on a detailed assessment of the activity. This forecast takes account of the current trends externally driving demand as well as our internal objectives with respect to Hear and Treat, See and Treat and Conveyance This forecast, completed on a despatch area by despatch area basis, is then used to assess the number of resources needed, measured as staff unit hours. This is done by applying the Unit Hour Utilisation (UHU) which is flexed depending on the historic performance and other factors Workforce planning also includes detailed assessments of the key abstractions; leave, learning and development, sickness and light duties, maternity and so on The forecast was also used to inform our negotiations with Commissioners with respect to expected activity and we are committed to ensuring that our planning assumptions align with those of our Commissioners We aim to improve on this approach which also formed the basis of the APR for 2012/13 by identifying local resource constraints more accurately and by adapting our plan more quickly as the year progresses by improving the process of quarterly reforecasting Bottom up assessment of departmental budgets A detailed bottom up calculation of spend has been prepared on a department by department level assessing both pay and non-pay items. This assessment includes known cost pressures and it factors in the 147_13 APR Presentation Final of 7

2 activity planning. The assessment also includes the key elements of inflation. In the current year these include pay inflation driven by an expected 1% increment in pay levels, the increase due to staff who move up pay points and the larger increase for lower paid staff. In addition we factored in inflation for other costs at 2% and an additional 6p per litre on fuel prices CiPs (Cost improvement programs) CiPs represent a critical part of the balance between patient care, clinical outcomes and financial stability Externally the Trust is expected to deliver 7M in savings which are built into our contract pricing and passed back to Commissioners who have to use this to support the additional activity on the system each year In addition the Trust is seeking to release resources to invest in key initiatives to address patient, operational or clinical needs The APR identified opportunities for CiPs totalling 12M. Each opportunity is supported by an action plan and key operational metrics to measure progress We know from experience that some CiPs will not be delivered. This can be because the actions cannot be delivered, because the actions have an impact on clinical or operational performance or because the actions do not have the expected effect As a result the APR assumes that 9.0M of these are delivered. Less will present a financial risk to the Trust and more will represent an opportunity to invest The CiPs are built into the bottomsup planning costs. Where CiPs affect costs directly the cost budgets have been adjusted. Where CiPs affect operational matters we have adjusted either the unit hours or abstraction levels used to calculate the workforce plan and costs The APR process also needed to ensure that CiPs do not jeopardise clinical performance. This has been done through a risk assessment which has identified that some CiPs do present a potential risk to clinical or operational performance as they have the potential to affect the provision of services. Where these have been identified they will be monitored closely in the most suitable committee of the Trust In addition this year we will aim to drive savings through the implementation of Carbon Reduction strategies in our Fleet, Estates and Workforce. 147_13 APR Presentation Final of 7

3 Service, Commissioners and Income % of the Trust s income comes from the contract to deliver A&E services and is negotiated under the terms laid out by the Everyone Counts document. Agreement with Commissioners about the impact of the increase in activity, the requirement to meet a 4% productivity improvement target (which is referenced in more detail in the section on CiPs), and agreement about CQUINs are key to resolving the outcome of the contract. Negotiations are well advanced and, at time of writing, heads of terms are being prepared. The APR presented is consistent with the terms In addition the Trust needs to manage the impact of the full year of service for Surrey PTS, the loss of Kent PTS and the performance of the 111 service These matters have been factored into the overall contract Operational and clinical requirements The Trust s plans need to give reasonable assurance that the key operational KPIs and clinical CQIs are met. The key targets for the Trust will be: Red 1 75% Red 2 75% Cat A 19 minute 95% Conveyance rates to A&E reduced to 52% Hear and Treat rates at 12% % compliance with PADRs and key skills training In order to meet these requirements we are planning to introduce the concept of an Intermediate Tier to provide transport support to each EOC relieving clinicians to respond to emergencies We will also need to expand our support for Community First Responder schemes and Public Access Defibrillation. Both schemes provide a very important role in savings lives by improving outcomes from cardiac arrest Investments We plan to continue our investments in the current year. This will include Make Ready Centres in Brighton and Polegate and a combined Make Ready and HART Centre in Crawley. In addition we will develop proposals to move our HQ to a site in Crawley as well as integrating functions from the regional offices Our investments will include fleet replenishment and modernisation of the IT infrastructure supporting key systems. In addition we will need to take 147_13 APR Presentation Final of 7

4 on board the outcome of the Southern Cluster procurement of an electronic patient care record. 2. Plan Key Themes 2.1. In the current year three key themes have emerged throughout the planning process: Workforce planning; Innovation; and Operational Strategy Workforce planning Very early on the Board requested that this would be a key focus of this year s planning to ensure we considered the level and skill mix of resources by despatch area as well as to consider the specific requirements of training, development, clinical education, and workforce productivity The final workforce plan takes into account the clinical operations staff unit hour demand by despatch area, and the requirements from 111 and PTS. The process by which it has been arrived at is outlined above The development of the workforce plan includes significant work on Learning and Development. This includes specific training aimed at Paramedics to support their confidence in deciding to convey to non-a&e locations safely Additionally the APR lays out the operational staffing requirement by despatch area. The plan will require the Trust to manage this carefully looking at both skill mix and the source of staff hours (i.e. core hours, overtime, external providers or bank staff) The workforce planning in the APR includes an emphasis on increasing the leadership and management skills within the Trust Innovation There has been concern that the Trust has lost its momentum for improving clinical outcomes. In developing the plan we have reinvigorated the Trust s attention to clinical outcomes and the drive for innovation This is manifested in targets for Cardiac Arrest, Acute STEMI and Stroke Additionally we are aiming to develop an alternative model of care for rural towns where distance to other facilities presents us with a significant risk. This involves developing a program for Community Paramedic schemes with associated near patient testing capabilities. 147_13 APR Presentation Final of 7

5 We have also recognised that there is a need to address our use of the Directory of Service. This includes identifying gaps in the DoS and providing this information to the wider health economy. It also involves looking at the way our systems interact with the DoS to improve the pathways outcomes Finally we plan to benefit from development work into new fleet solutions including a new vehicle for paramedics and paramedic practitioners and the potential to use some van conversions Operational Strategy The Trust outlined a clear strategy some years ago under the banner Front Loaded Service Model. This contained key strands including raising the level of clinical education, the introduction of specialist Paramedics, and the introduction of Make Ready Centres. The drivers for this change were the need to respond to increasing demand for patients for whom hospital attendance is not necessarily the most appropriate pathway whilst improving operational performance. Other drivers are to improve clinical outcomes and reduce resources to ensure financial stability in a time of reduced funding. The Trust Board confirmed its support for this strategy but this year s APR refreshes our understanding of what is required to deliver this strategy. The impact of this includes: revisiting the designs for Make Ready Centres to reduce the investment costs; revisiting the clinical operations strategy to look at the creation of an Intermediate Tier to manage less acute journeys in a scheduled manner; and a plan to develop a model for providing community paramedic schemes We are very conscious of the potential impact of the Francis Report, which will include an assessment our patient care and our response to it. This will involve our raising the consistency of performance across the Trust to reduce variation in patient care 3. Uncertainties 3.1. As with all plans there are potential uncertainties which will affect our financial performance The largest risk relates to the assessment of the activity. The run-rate on activity increased sharply during the year creating challenges throughout the health economy. In addition there is evidence that the introduction of 111 has resulted in a significant increase in activity in some parts of the country. The agreement with Commissioners on the A&E contract is based around a 5% increase in activity. However the Commissioners have negotiated a risk-share arrangement for activity above this figure. We have accepted this on the basis that the underlying activity in the contract is robust and that we have the ability to somewhat influence 147_13 APR Presentation Final of 7

6 activity passed through from 111, and on the basis that we can manage this level of risk without undermining the financial stability of the Trust The 111 service itself provides additional financial uncertainty. A high level of planning has gone into this service. However given that: the service is new, there is no track record of performance, and the workforce needs differ; we are aware that the real levels of activity, income and cost may all vary from the current planning assumptions. 147_13 APR Presentation Final of 7

7 Annual Planning Review - Key Performance Indicators 2012/ /14 Plan Plan Compliance - Finance and Goverance Financial Risk Rating Governance Risk Rating CQC Compliance Status NHSLA Level IG Toolkit Assessment 4 Green Fully Compliant Level 1 Satisfactory Operational & clincial requirements Activity units 630, ,500 Hear & Treat (%) 10% 12% See & Treat 35% 36% See & Convey 55% 52% Red 1 75% 75% Red 2 75% 75% People Sickness - Total Appraisals 4.50% 92% 95% Statutory & Mandatory Training 95% Financial Stability Income 174.1M 179.5M EBITDA 15.5M 17.0M Cost Improvement Programme 9.3M 9.0M Capital expenditure plans 12.5M 18.5M Income deflator -2.0% -1.3% Cost inflation 1.9% 2.0% Capital expenditure plans 12.5M 18.5M 147_13 APR Presentation Final of 7