Way forward delivery programme plan

London North West University Healthcare

NHS Trust

Way forward delivery programme

Autumn 2020

Executive Summary Our world has changed. The NHS is emerging from the greatest challenge we have ever faced. Now confronted with numerous complex issues and significant uncertainty, we must change rapidly to continue providing safe and effective care for patients, and protect and empower our staff.

Our Way forward delivery programme will help us build on what we have learned during the pandemic so far. Here, we set out the principles that will govern our response, as well as our new Trust objectives and work programmes.

2

Phase 1: mitigating the impact of COVID-19 During the first half of 2020, we were united by a common goal: mitigating the impact of COVID-19 as best as possible. Alongside countless extraordinary achievements, we learnt many lessons, on responding to the coronavirus clinically, adapting our care pathways, empowering clinical decisionmaking, and working collaboratively. To help, we made significant changes to both

our workforce and our ways of working. All of this was done while our staff faced very significant personal challenges and risks affecting themselves, their family, colleagues and friends. We also learned sharp lessons about the disproportionate impact of the coronavirus on our BAME population.

Phase 2: rebuilding better than normal As we enter Phase 2, we must aim to rebuild better than normal. To do this, we will focus on:

• our work programme describing the considerations and priorities for what now needs to happen. These cover the running of highly reliable, effective and safe hospitals; transforming community services; partnerships including the role of North West London Integrated Care System; staff engagement; finance; estates; digital; and other next steps impacting our organisational structure and culture

• Trust objectives for 2020/21 and beyond to direct and measure the implementation of the programme of work.

It is vital that we learn from our recent past, changing the way we work in a sustainable way. This won’t just help us overcome our immediate challenges, but will also support us to address the longer term issues affecting our communities, such as:

Way forward delivery programme

•

demographic change

•

the rise in long term conditions

•

rising public expectations on accessing care (or aspects of it) online and receiving care closer to home

•

creating an environment where we can rapidly bring the benefits of key medical advances to our local population (eg in genomics and personalised medicine).

We must use our resources as efficiently and effectively as possible. Before the pandemic, our underlying deficit showed that we needed to transform how we work and organise ourselves. Although there have been some temporary changes to NHS funding arrangements, we must still continue this transformation to improve our services and reduce waste.

This will strengthen our Trust in preparation for reforms we expect to see in the NHS financial system.

3

Some of the changes that will help us do this are described in the table below.

4

Before COVID-19: “Normal”

After Disruption: “Better than normal”

Face-to-face appointments/clinical practice

Virtual and digital by default, face to face when needed

Managing waiting times – retrospective

Managing schedules – prospective

Executive decision making and low levels of clinical engagement

Joint decision making with Clinical Divisional Directors and wider discussion with clinicians. A new Trust Executive Group (TEG) and Clinical Cabinet

Systemic variation

Highly reliable standard work

Focus on cost and savings

Focus on value and waste reduction

Focus on governance and assurance

Focus on leadership supported by governance and assurance

Frontline disempowered

•

Empowered frontline

•

Involvement in decision making

•

Trust our people

Internal focus

System (ICS) focus

Operationally opaque

Operational transparency

Hierarchy

Team LNWH

Focus on inputs

Focus on outcomes

Disempowered patients

Patients as experts

Siloed management and behaviours

Cross hospitals and service management and collaboration

Disconnected corporate services

Integrated corporate services

Management processes

Collective leadership and processes

Focus on workforce cost

Focus on workforce value

Staff wellbeing too often undervalued

Make LNWH one of the best places to work

Experiences of prejudice and structural discrimination

Faster action on creating a climate of inclusion

Running safe, effective and highly reliable hospitals We have identified a number of essential priorities.

We will:

We acknowledge the challenges of getting back on track with planned care, which are shared by trusts across the NHS. These include:

•

prioritise operational and clinical excellence, to provide care reliably and without unnecessary variation

•

reinforce the good practice that has taken place in management over recent months, as we know this reduces duplication and leads to higher reliability

•

re-imagine how we deliver care and how we use space, from meeting COVID-19 infection control requirements, to harnessing the convenience, efficiency, and safety benefits of working virtually wherever possible

•

improve urgent and emergency capacity and capability at Northwick Park and Ealing Hospitals, while also recognising COVID-19 infection control standards

•

improve capacity for planned care, including using Central Middlesex Hospital to provide COVID-protected elective care, as part of the North West London (NWL) Elective Services Plan

•

fully participate in the North West London review of specialist services, noting that such a review will need to be based on clear evidence on what is best for patients

•

continue to deliver high quality maternity services whilst working closely with system partners

•

provide care in the right place, at the right time, by arranging services appropriately at our three main sites as well as offering more care virtually.

Way forward delivery programme

•

essential infection control measures to prevent the spread of COVID-19

•

making our planned care pathways protected and resilient, so they can continue through any future rise in patients requiring our care due to COVID-19.

These factors mean that we will not deliver the volume of activity that we are used to providing for some time. We aim to meet the targets set for trusts by NHS England, which are designed to help us recover swiftly. In the meantime, to help us prioritise the most urgent care, we must discuss our pathways with our neighbours and partners in health and social care, including primary care.

It is vital that we use all our estate as extensively as we can: this offers a positive future for all our sites. We commit to making the additional investment we need to secure safe services and recovery. At Ealing Hospital, for example, we are creating surgical theatre and ward capacity in the building formerly used as a maternity block.

5

Transforming community services It’s essential that we continue to focus on responding to COVID-19 in our hospitals and restarting our planned care. However, it is also important to make sure that our community services receive the management support that they need.

For this reason, we have formalised our work with Central London Community Healthcare NHS Trust (CLCH). CLCH will continue to provide senior line management and

supervision for our community teams. All our staff members remain employees of LNWH, and we remain accountable for these services.

We will continue to actively participate in conversations with our health and care partners and our communities about longer term plans, which are not yet decided, on providing the best possible community care for our local people.

Building partnerships and transforming our services Across the NHS, working across a defined geographical area (sometimes called an Integrated Care System) has become a key part of how we organise, govern and provide services.

We want to develop deeper relationships with our health and care partners across north west London, including: •

primary care partners

•

local authorities

•

third sector and commercial partners

•

other care providers, particularly Hillingdon Hospital NHS Foundation Trust (HHFT).

To transform our care, we have developed six themes based on programmes that span the north west London NHS. These are:

6

•

clinical configuration

•

future outpatients model

•

future elective and theatres model

•

future flow model

•

working digitally

•

workforce and organisational development.

To act on these themes, we have reformed our Transformation Programme, putting clinical leadership at its heart. We will work with our patients and our staff to help us design and implement initiatives for each of these themes.

Ultimately, they will support our three key goals of improving care, improving staff experience, and reducing waste.

We are grateful to all our health and care partners in north west London and beyond for their support during the pandemic so far. The North West London Health and Care Partnership has been central to the management of the pandemic, through coordinating activities, making decisions and maintaining communications. We are committed to continuing to work constructively with the Partnership and play a full role in the north west London health and care system.

Engaging with our staff We aspire to be a workplace where our colleagues are motivated, feel involved in decisions and consider our Trust to be an outstanding employer. Using what we have learned through the pandemic, we want to create a working environment where our staff are happy, healthy and at their best.

The pandemic has had huge impact on and implications for our BAME staff. We must continue to acknowledge and reflect this fact as we improve staff engagement. We have agreed a number of actions to respond effectively to inequalities, indicated by our Workforce Race Equalities Standards metrics.

We know it is vital to engage with colleagues at all levels of our Trust. Our new Clinical Cabinet is already helping us improve clinical engagement, but we must expand and enhance this work. We particularly need to engage with those teams and colleagues who have been most affected by changes to their work, such as our nursing and theatre staff.

It remains important to communicate our many successes, so our colleagues can rightly feel proud to work here. To achieve this, we must build on proactive communication initiatives, such as positive media coverage on the BBC and London regional newspapers.

Our teams feel at their best when:

I work as part of a multi-skilled team and we are empowered to make decisions, improvements and work across teams

I have role clarity, achievable goals and a purpose which connects me to colleagues, my team, patients and others

I know how to get things done at pace, supported to try something new and learn without fear of blame or retribution

I am enabled and supported by a leader who behaves with compassion They meaningfully communicate with me, create safe space for me to speak, develop me, hold me to my responsibilities and have my happiness and health as their top priority

Way forward delivery programme

I feel emotionally and psychologically safe to speak up, look after myself and to stay healthy

I am recognised and rewarded for my efforts and supported to develop my skills and my career

I am treated with respect and feel included, the opposite is not tolerated

7

Using our HEART values, we will focus on taking the best of our colleagues’ experience and making it a core part of a better culture in the future.

We will clearly set out our approaches to: •

resetting the culture and role of the leader through our HEART manifesto (our cultural standard)

•

behaviours that demonstrate respect (how we treat each other), including a new behavioural framework

•

wellbeing and wellness (how we support our health)

•

organisation design and talent management (how we are structured and developed for the future).

We will develop the key aspects and behaviours associated with our new culture by holding conversations and surveys with our staff members, our trade unions and our patients.

Our leaders must role model this new culture and the behaviours that support it, such as: •

openness, transparency and engagement on our Trust objectives

•

communication and engagement on our progress in delivering our objectives, so our stakeholders can hold us to account.

•

include efficient workforce models and consequences for non-pay spend

•

minimise excess agency cost, instead supporting our staff to work most effectively and productively

•

support the approval process for capital requirements

•

support clear accountability for financial decisions and effective financial management through improved information and analysis.

Finance We need to focus much more on providing the best patient outcomes and experience while also minimising waste and delivering value for money.

National evidence shows that improving quality and operational performance will improve our financial performance.

We will change the way we discuss money. We must spend less time on detailed scorekeeping and budget reconciliations, while also retaining our grip and control on taxpayer’s money. We will drive improvements to efficiency and productivity through our service changes, and our Recovery and Transformation programmes.

When we are designing services, we will include senior and high quality input from our finance team, helping us to develop evidence-based and compelling cases for change. This will:

8

We will develop a new Performance Management Framework which will help us adopt leading practices that balance finance with the other key elements of delivery. We will develop rounded performance management scorecards across quality, performance, workforce, money and system contribution, and use them to support our key management areas.

Supporting our organisation We will bring our support roles, such as HR or finance, closer to our clinical and operational leaders. We will work collaboratively with the north west London NHS on other kinds of roles, and will participate in the work that is taking place across our health and care system to identify these opportunities.

Estates need to provide safe, segregated theatre and bed capacity so that we can: • meet London’s first three tests in the near term • meet our demographic demand in the longer term.

Digital Services need to provide effective and modern IT which provides evidence on patient outcomes and experience. This will support our daily management, but also our broader strategy.

Our Electronic Patient Record outline business case is a major step forward with our ambitious digital programme.

We recognise the vital importance of investing in our clinical infrastructure.

This is essential to: • maintain our resilience • provide a platform for mobile and increased online working, which in turn supports key priorities such as virtual clinics, advice and guidance for GPs, and the use of MS teams.

We will test our strategy against the priorities and requirements that arise from our recovery, transformation and delivery programmes.

This includes: • the quality of infrastructure and relevant platforms • improved training and communication to support adoption • stronger process controls (e.g. ensuring data quality) • improved staff and patient satisfaction.

Key next steps Our Respect for People framework

Review our operational and clinical leadership arrangements

Developing a highly reliable performance culture

We will:

We will:

We will:

•

•

empower and support clinical leaders by adding strong clinical voices to key operational and decision-making groups

•

•

make decision making groups a central part of improving organisational culture through high levels of staff engagement

develop a new integrated performance management framework, which will include prospective forecasting and improvement alongside retrospective reporting

•

emphasise caring for our patients, caring for our staff and caring for our money within in this new framework

work with our staff to develop a new Respect for people framework based on our HEART values

•

use this approach to drive the design, delivery and performance of clinical services both now and in the future

Way forward delivery programme

9

Our goals and objectives for 2020/21 and beyond We have updated our objectives, which make up our three goals, to better reflect our current environment and circumstances.

In particular: • our second goal now recognises the need to make transformation part of our organisational culture • our third goal places more emphasis on the importance of building partnerships with purpose.

1. Excellent care quality and patient experience a. Minimise excess deaths and maintain services at a near-normal level during the COVID-19 pandemic b. Support the safe delivery of care with robust infection prevention and control measures c. Continue the journey to outstanding with a ‘good’ rating in our next CQC assessment

10

d. Improve compliance with our statutory duties in referral to treatment, two week wait, and our A&E waiting time performance e. Implement our Digital Care Record (DCR) f. Run more appointments and clinics online and on the phone g. Improve our hospital and community estates, including our critical care areas

2. An organisational culture that engages with our staff to develop them and transform services a. Deliver our financial plan and contribute to the wider north west London financial plan b. Work together with our partners to reduce waste and increase efficiency

f. Create a respectful and inclusive culture through our HEART values and a new behaviour framework

c. Reduce inequalities in the workplace and improve our staff’s working lives

g. Develop and nurture our current and future leaders and increase BAME staff representation at senior levels across all services

d. Increase the proportion of our staff receiving the annual flu vaccination

h. Learn from new collaborative clinical service reviews with clinical colleagues and patients

e. Have more than 60% of our staff complete the national staff survey

i. Implement a transformation programme that trains and empowers our staff to think and act differently, to improve patient care, staff experience and reduces waste.

3. A sustainable organisation that builds partnerships with purpose a. Create a sustainability strategy for use in f. Improve our working relationships with future developments and supply chain other acute, community and mental contracts, to make sure our supplies are of a health organisations high standard, and arrive promptly and reliably b. Help our support and enabling services improve what they offer to the organisation c. Align our strategy and work with North West London Integrated Care System d. Work more closely together with The Hillingdon Hospitals NHS Foundation Trust

g. Work with councils, patient groups, residents, third sector and charitable organisations, and politicians to support our local communities h. Build confidence in our organisation, improve our relationships with our stakeholders, and improve the way we communicate with our audiences

e. Create more effective patient pathways across services and across the wider NHS in north west London, including with our local primary care networks

We will measure our goals and objectives using clear, evidence-based metrics. We will report on our objectives to the Trust Executive Group, and to the Trust Board.

Our goals will guide us as we navigate the challenges before us and seek to accomplish our aspirations.

Way forward delivery programme

11

London North West University Healthcare

NHS Trust

Way forward delivery programme

Our Trust covers:

Contact and follow us at:

Central Middlesex Hospital

Trust HQ London North West University Healthcare NHS Trust Northwick Park Hospital Watford Road Harrow, HA1 3UJ

Ealing Hospital Northwick Park Hospital St. Mark’s Hospital Community services across Brent, Meadow House Hospice and the Willesden Community Rehabilitation Hospital

T. 020 8864 3232 E. lnwh-tr.trust@nhs.net (general enquiries)

@LNWH_NHS London North West University Healthcare NHS Trust www.lnwh.nhs.uk

@lnwh_nhs