Summary Business Plan 2009/10

Our staff:
at the heart of our success
Our staff: at the heart of our success
Introduction
from David Astley, Chief Executive
When I joined St George’s just over two years
ago my priority was to ensure the Trust got
itself onto a firm financial footing so that it
could retain control of its own destiny and
continue to provide expert healthcare services
to the people of Tooting and beyond.
Management set budgets but it is the staff
who must deliver on them. Thanks to your
dedication and team work I am delighted to
report that we are on course to meet our
target for the financial year 2008/09, and will
even record a small surplus – so a big thank
you to you all. Your efforts mean the Trust is
now operating more efficiently, helping us to
balance the books without compromising
patient care.
But this is no time to rest on our laurels.
2009/10 will present our greatest challenge
yet as we look to move towards Foundation
Trust (FT) status. This summary business plan
has been prepared to help staff understand
the progress we have made and the future
direction of travel. There will certainly be
some tough choices ahead but if we meet
the challenges, and with your continued
support I have no reason to believe that we
won’t, then we will secure the long-term
future of St George’s.
2 S u m m a r y
Progress last year
During 2008/9 we have made substantial progress against
our stated strategic aims:
G Improved control of MRSA and Clostridium difficile
(C.diff) and achieved a hospital standardised mortality
ratio in the top ten in England.
G Submitted successful bids to be a major trauma centre
and to provide the full range of acute stroke services.
G Progressed towards establishing networks in paediatrics
and urology.
G As south west London’s largest cancer centre, work has
started on a detailed strategy to further strengthen our
cancer services.
G Worked towards establishing an academic health sciences
and social care network in south west London.
G Improved the structure for the delivery of postgraduate
medical training.
G Received approval for our outline plans for the
redevelopment of the Tooting site from NHS London.
Tough financial and clinical challenges lie ahead in 2009/10
but there are also exciting opportunities for more positive
changes that will improve services and facilities at the Trust.
The big challenges for 2009/10
The Trust’s financial position will remain a dominant factor
over the coming year.
If we are to be in a position to apply for FT status in 2010 we
will have to improve our financial position to the tune of
£50million – around 11 per cent of our total budget – to
generate a surplus of £4.5million by the end of 2009/10. We
will also be expected to generate projected surpluses of
£6.7million in 2010/11 and £7.8million in 2011/12 to meet
commitments to discharge historic debts.
The stakes are high, but the prize of having control over our
own destiny is well worth fighting for.
For the first time ever we have used a ‘bottom-up’ approach
to develop our business plan, involving all clinical specialties
in the development of service plans to help achieve the
Trust’s six strategic aims.
B u s i n e s s P l a n 2 0 0 9 / 1 0
These are:
G To be the provider of choice.
G To strengthen and expand our flagship specialist services
and network hubs.
G To develop an academic health sciences network in south
west London.
G To ensure financial sustainability.
G To be an exemplary employer with career and
development opportunities which attracts, motivates and
retains employee talent.
G To provide an excellent physical environment, fit for the
delivery of modern healthcare.
We plan to meet our tough financial targets through a
combination of income generation and changes in the way
some resources are used. These include:
G Generating £23million through increased income.
- Reducing length of patient stays to increase bed
through-put. The new Acute Medical Unit which is
planned to be open for winter 2009/10 should help
achieve this. More intensive care beds will also be
provided.
- Extra theatre capacity is to be made available by
providing planned evening theatre sessions, completion of
a second obstetric operating theatre, and by utilising six
unused operating sessions in the two operating theatres
leased by Moorfields on the St George’s site.
- Tariff rates for contracts will also be reviewed to ensure
we get the right level of funding.
G Saving £5million through improved use of medical
supplies.
G Savings £1million from a review of the way we
record and code the work that we do.
G Savings on staff pay by better management of time
and the reduction of agency costs.
- This will include electronic staff rostering, a move to
help reduce staff sickness levels and reduce our turnover
of staff.
3 S u m m a r y
Improvement of services and building projects.
The pressure on finances will not impinge on our ambitions
to develop services and make improvements in patient care.
If St George’s is to have a secure future as a leading London
teaching hospital, we need to focus on developing clinical
excellence and improving the way we run some services.
These positive changes will include:
G Trauma Centre development: St George’s bid to
become a major Trauma Centre at the heart of a clinical
network serving 2.9million people met the clinical criteria
set by Healthcare for London and the proposals were
approved by the Joint Committee of Primary Care Trusts.
The public consultation process outcome will be
announced in June 2009, but in the meantime the Trust is
preparing to have the appropriate infrastructure in place
by April 2010.
G Stroke service development: St George’s has
developed a national reputation for excellence in stroke
care thanks to developing a specialist stroke unit. The
Trust intends to build on this by becoming a hyper-acute
stroke unit. Public consultation is running alongside the
Trauma Centre consultation.
G Wolfson Redevelopment: The neuro-rehabilitation unit
at the Wolfson Hospital in Wimbledon has been
earmarked for redevelopment to provide additional
capacity and improvements in services.
G Introduction of iCLIP: The new clinical information
system will be implemented during 2009/10.
Our vision
“We will work tirelessly to give
outstanding care to all our patients.
We will enhance our position as a leading
specialist teaching hospital at the
forefront of healthcare, with excellence
in service, teaching and research”.
B u s i n e s s P l a n 2 0 0 9 / 1 0

G Improvements in children’s and maternity services:
Both specialities have been identified by the Healthcare
Commission as areas where St George’s has been under-
performing. A Maternity Service Task Force has already
implemented improvements to services including the
appointment of two additional consultant posts in the
delivery suite and reducing the ratio of patients to
midwives to 1:35; plans are in place to reduce this ratio
further in 2009/10. More action is still required on
appropriate use of caesareans, postnatal pathways and
delivery costs. In children’s services key senior staff have
also developed an action plan for improving services which
will be implemented in 2009/10. St George’s is also
working closely with Epsom and St Helier University
Hospitals on how we can best provide services for women
and children. Four working groups have been set up for
obstetrics and gynaecology, midwifery, paediatrics and
paediatric nursing.
G Urgent Care Review: The high levels of attendances at
A&E and the level of emergency admissions to the Trust
continue to cause considerable challenges in meeting
targets. An action plan to improve the way urgent care is
provided at St George’s is already in place. Acute medicine
intake has been redesigned with new consultant and
junior staff rotas. Other measures include a pilot of
weekend therapy services, a review of discharge
arrangements and additional investment for emergency
nurse practitioners.
G Establishing an Academic Health and Social Care
Network (AHSN): We have already agreed to create an
AHSN with St George’s University of London,
Wandsworth and Sutton PCTs and St Helier University
Trust and Kingston Hospital. In 2009/10 we’ll work out
the finer details to establish the structures and processes
to bring the ASHN into being and bid to become a health
Innovation and Education Cluster.
G More action to reduce hospital-acquired infections:
This is an area where we are already performing extremely
well - but there is no room for complacency. St George’s is
performing within national targets, with the number of
MRSA and C.diff cases having fallen by 74 per cent
compared to last year. Specific actions for 2009/10 will
include screening of all elective patients for MRSA as per
national guidance. We will also continue with measures
put in place in 2008/9 including performing root cause
S u m m a r y B u s i n e s s P l a n 2 0 0 9 / 1 0
analysis of MRSA and C.diff, formally investigating every
death, maintaining compliance with the hygiene code
and carrying out regular saving lives audits.
G Improvements in the recruitment process: Skilled staff
are crucial to delivering the Trust’s business plan. In
2009/10 we will be targeting student nurses and initiating
an overseas recruitment service. For example, in spring
2009 we will be launching a recruitment drive for critical
care and theatre nurses in the United Arab Emirates. We
will also review support and development opportunities
available to improve nurse retention.
G Investing in a transformation plan. A Transformation
Team has been put in place at St George’s to oversee and
support the programme of change. Its job is to support
service delivery projects. Key areas for the Transformation
Team in 2009/10 will include efficient ways of working in
the outpatient department, theatre efficiency and late
starts, and reductions in length of stay, as well as
compliance with the European Working Time Directive.
Looking ahead
St George’s main mission remains the same: to provide local
hospital services to the local population and specialist
hospital services to the people of south west London, the
south east of England and the UK.
Our strategy is beginning to bear fruit; we are being seen
by NHS London as a Trust that can deliver change and raise
standards of patient care. The public consultation on
proposals to change stroke and trauma services is just one
example of how we are being seen as a Trust with a
“can do” attitude.
To achieve these aims we need your commitment. By
becoming more productive and improving our financial
position we will be in a position to enter the FT assessment
process and demonstrate that St George’s is a financially
viable organisation with a secure long-term future.
Our values
G Treat all people with respect and dignity;
G Deliver care in partnership with others;
G Continually strive for clinical excellence;
G Ensure probity and transparency in spending public
money;
G Be an exemplary employer;
G Be committed to excellence in education, training
and research; and
G Be open and honest with each other and those
outside the organisation.
Published by the Communications Unit at St George’s Healthcare NHS Trust.
4 Tel: 020 8725 5151 Email: communications@stgeorges.nhs.uk
Website: www.stgeorges.nhs.uk