Fig 1: Strategic themes 2.1.2 Review of environmental context- has anything changed? The outcome of the Trust’s planning review of the strategic context and environmental factors has confirmed that the former NHS ‘Call to Action’ challenges as set out in our strategic plan 2014 remain current: Demography: Ageing population - projections remain true for a stepped increase both in those aged over 65 years and significantly those aged 85 years and over, the section of the population with the greatest care needs. Gateshead population has a higher percentage of older people than the national average with 21% of people above state pensionable age compared with 19% nationally and 20% in the North East of England as a whole. The impact of an aging population is reinforced during winter months with the number of older patients admitted and an extended length of stay for this age group. This is reflected in activity and the measures required to ‘escalate’ service capacity to cope with the surge in demand (Figure 2); Poor health status - people in Gateshead continue to suffer more illness and early death than the national average and there are still marked variances in life expectancy and ill-health across the Borough (variance in life expectancy is 8.9 years for men and 9.4 for women across local authority wards); More than a quarter of Gateshead’s population has a long term condition (LTC) a significant number of whom have three or more LTCs; Deprivation and lifestyle choices continue to impact significantly upon health and demand upon health services. Source: Gateshead Strategic plan 2014/15-2018/19 and Gateshead Joint Strategic Needs Assessment-Interim Report 2014). Fig 2: Managing winter Austerity The overall context of austerity and financial challenge facing our health economy and the NHS nationally remains and continues to impact upon provision across all care sectors and interdependencies with high levels of demand increasing year on year, exacerbated by an aging population with complex needs.
3.2 Key elements of our 3.2.1 Operational and financial resilience Within the current strategic and financial context and, given the size and nature of the services (largely acute) that GHNT FT delivers, ensuring operational and financial resilience and future sustainability is a necessity and will be a focus of plans for the next twelve months and into the longer term. This is especially important given the increasing pressures being placed upon services, experiences of demand in previous months and also the new rules for funding capacity to manage winter surge. Work includes: A comprehensive non–elective improvement programme involving: Improving pathways for care of the frail elderly; discharge planning; Assessment and management of patient flow through emergency services; Supporting functions (pharmacy; discharge lounge), and Improving hospital discharge; Robust analysis of the capacity required to meet demand now and in the future, including bed review; Programme of productivity improvement and delivery of efficiency plans Pro-active workforce planning: innovative solutions to building capacity (see workforce section) Continued cross-system working through the Local System Resilience Group, redesign of urgent care pathways and supporting redesign of alternatives to hospital care. 3.2.2 Reduction variation and seven day working The Trust has undertaken a comprehensive base–line assessment across all of its services and has identified the following five standards to progress in 2015/16: • Standard 1: Patient experience; • Standard 2: Time to first consultant review • Standard 4: Shift handovers • Standard 9: Transfer to community, primary and social care • Standard 10: Quality Improvement. Lead clinicians have been closely involved in arriving at these priorities 3.2.3 Transformation, integration and community services Our plans continue to prioritise service transformation, working in collaboration with partner agencies across the local health economy to deliver service models that will provide right place; right time care, as close to home as possible, meaning that patients will come to hospital only when they need to. Priorities that are all reflected in this year’s commissioning intentions include: Urgent and ambulatory care services;