Blackpool Teaching Hospitals NHS Foundation Trust

Aidan Kehoe

Chief Executive

The Trust and its services….

• 330,000 catchment (1.6m Cardiac & Haematology)• Sites:

– Blackpool Victoria Hospital (577 beds)– Clifton Hospital (64 beds)– Bispham Nurse Led therapy Unit (40 Beds). Social Enterprise– Rossall Hospital (40 beds)– Wesham Hospital (40 Beds) – Currently unused– Fleetwood Hospital (Outpatients)– National Artificial Eye Service

• Turnover: £260m

• Employees: 4,000

Background…..

• 2006 Financial Turnaround• Development of the Blackpool Way• Foundation Trust status December 2007• Patient safety – Infections / Mortality• Investment for the future

– £65m capital schemes– Alert Electronic Patient Record– Service development

• 2010/11 Financial challenge & Monitor

Awards / Recognition…..

• National Patient Safety Awards• Investors in People Gold Award• The Information Standard Kite Mark for patient

leaflets• NHS Litigation Authority Risk Management Standard

Level 3• Imaging services accreditation scheme• Sunday Times Top 75 2010• Boorman / Macloed Reviews• Healthcare 100 – Top Acute Trust & Best Large

Employer• Healthcare People Management Association Award –

Joint working with Trade Unions

Awards…

Our Vision

• Quality

• Safety

• People

• Delivery

• Environment

• Cost

Quality Safety People Delivery Environment Cost

Our Values

Blackpool Way

• Deep Employee Engagement

• 4 Key Pillars

– Recognition

– Management style

– Communication

– Continuous improvement

• Vision and Values

Policy Context

• Independent NHS Board

- Resource allocation

- Guide commissioning• Greater transparency• Concentration on outcomes – Advancing Quality• Communication of change• Prevention & public health• White paper – decision awaited • Real NHS growth

- Impact on other sectors

NHS Growth Rates

0 1 2 3 4 5 6 7

Annual real spend increasesince 1948

20th century average annualincrease

21st century average annualincrease

Lowest annual average byGovernment administration

(1951 - 63)

Highest annual average byGovernment administration

(1997 - 2011)

Budget commitment for realgrowth across public sector

2011/12 onwards

Percentage Real Growth in NHS Expenditure

Policy Context

• Patient led NHS Strengthen role of GPs in commissioning

• Primary Care Trust role commissioning• Patient choice extended to GP• Out of hospital care• More front-line control

We know the current system has……

• High levels of avoidable hospital attendance and admission – utilisation management

• Wide variations in Length of Stay• Unacceptably high rates of readmission• Suboptimal management of chronic illnesses• An unacceptable rate of harm and error

leading to avoidable suffering and even death

• Concentration on beds rather than pathways

The “Quality, innovation productivity & prevention gap”

Expenditure

Income

Time

£

The QIPP gap - £15 to £20 bn

BFWH - £45m

Five Levels of Action5 - National

4 – Regional

3 - Whole health economies

2 - Organisations and their main bilateral partners

1 - Individual organisations

Lobbying upwards

Sharing best practice

Reconfiguration - doing the right thing

Not being an island of success in a sea of failure

Systematic collaboration - managers, clinicians &

support teams to improve

Transforming Community Services (TCS)

• National policy of commissioning/provider spilt

• Requirement for Primary Care Trusts (PCTs) to divest themselves of provider arms

• Preferred providers • Development of better integrating patient

pathways• 1500 staff 60 million budget

Transforming Community Services - Staff

Main staff groups

339 Whole time equivalent (WTE) District Nurses

172 WTE Allied health professionals (therapists)

365 WTE Paediatric services

38 WTE Community Matrons

64 WTE Community Dental

48 WTE Prisons

39 WTE Community Management

39 WTE Learning difficulties

75 WTE Sexual Health

Transforming Community Services - Timeline

• July 2010 - Commenced working with Blackpool and North Lancs. Primary Care Trusts to prepare a business case

• September 2010 - PCTS received approval for the business case from the Strategic Health Authority

• November 2010 – March 2011 the Trust undertook a comprehensive review of the Community finance and governance arrangements

• April 2011 – present day the Trust is undergoing a review by Monitor. (Trust regulator)

• 27th June 2011 - The Trust Board will be interviewed by the Monitor Board

• 1st August 2011 - The Community services transfer and the Trust become a “New “ organisation

Whole systems alignment

The need for partnership ….

Organisational development

Clinical systems improvement

Patients who

experience better care

without delay

High-performingpatient-centred

teams

Organisations that facilitate the work of

patient-centred teams

Environment that facilitates

the work of organisations

Level 1 opportunities

• Workforce – staffing/pay/sickness absence

• Better Care Better Value

• Threshold management

• Innovation and informatics

• Lifestyle modification (smoking; alcohol; eating)

• Care pathways – alternatives to hospital, telehealth, self care, work with Practice Based Commissioners

• Patient centred-care. Quality costs less

• Standardisation

Level 2/3 Issues

• Variability in risk management strategies • Standardisation• Demand management• Mutual Interdependency trumped by individual

interest• Practice based commissioning • Vertical & horizontal integration• Different models of ownership –

Collaboratives/federations/Social Enterprises

Mindsets doomed to fail • It won’t happen• If it does, we’ll grow our way out of trouble• I’ll do what I’ve always done • No-one up there will let me make the changes I need to do • The public won’t let us do what we want to do• I’ll be OK if I do it all myself because we can never agree if

everyone’s involved• It’ll be someone else’s fault when it goes wrong• It’ll be OK if we all fail • I’ll wait ‘til it starts to bite• I’ll talk the talk• Even if it does happen, I can dodge the bullet• We can do this on our own• We’ve had to do this before and done it, so we’ll do it

again• I’m retiring anyway

Mindsets offering best chance of success

• I’ll ensure that we’re open and transparent• We will work collaboratively• We stand together • We need to act now• Patient safety and quality will be uppermost• Success will be delivered through the Blackpool Way• We will work with partners to better manage patient

pathways• We will invest in programmes to support new ways of

working and staff development

Admissions per ‘000 population 2008/9 By Primary Care Trusts

– England (152 PCTs)

0

50

100

150

200

250

300

350

1 8 15 22 29 36 43 50 57 64 71 78 85 92 99 106 113 120 127 134 141 148

Admissions per 1000 population

0

50

100

150

200

250

300

350

England North West Blackpool Knowsley

Key Projects and Measures

• Top 50% for lowest Mortality rates• Reduction in Hospital Acquired Infections• Reduction in Inpatient falls• Reduction in Hospital Acquired pressure

ulcers• Implement risk assessments to reduce risk

of blood clots• Reduction in avoidable harms – e.g

medication errors• Global Trigger Tool

Key Projects and Measures

• Patient Experience Surveys• Nursing Indicators - Change to Nursing Care

Indicators• Advancing Quality• Productive Ward – Releasing Time to Care• Blackpool Nurses 10x10• Quality Framework• Map of Medicine

The Way We Do Things

“Counter clockwise, Red Eagle, Always counter clockwise”

Any Questions?

Quality Safety People Delivery Environment Cost