1. Bedford Hospital Annual Plan 2013/14

2. Performance – All operational targets met (A&E access, waiting time targets) – Break-even planned in 2012/13 (£12m savings, including £4m support) Experience – Positive patient and staff survey results – Care quality rated highly by patients and the local health economy Safety – No MRSA infections for over 400 days – Low C diff rates – No ‘Never Events' Joined up services – Carers Lounge – Introduction of CALS (Community Alcohol Liaison Service) in A&E to reduce alcohol-related admissions and readmissions. Achievements and Developments Operationally robust and clinically sound

3. Lowest seven-day readmission rates 11/12 Weston Area Health NHS Trust: 2.2% Wye Valley NHS Trust: 2.2% Hinchingbrooke Health Care NHS Trust: 2.2% Bedford Hospital NHS Trust: 2.2% University College London Hospitals NHS Foundation Trust: 2.2% ER PHO 10/11 The proportion of child A&E attendances that were recorded as ending with an inpatient admission (attendance disposal =admission) ranged from 4% in Bedford NHS Trust to 23% in Luton and Dunstable NHS Trust. Performance - Green risk rated

4. Transforming for Excellence - Service Developments Frail Elderly Model Hot Clinics/SAU/AAU Children’s Emergency Department Readmissions - COPD, Diabetes, Heart Failure, Alcohol Victoria Road Practice Pathology hub Clinical procurements – moving more assessment and treatment to primary care SchemeCommentary Acute Models of Care 7 day working (consultant, matron and social care) with increased access to diagnostics Opened Surgical Assessment Unit A combined Gastro/Colorectal Unit across medicine and surgery Advancement of plans to develop a Children's Emergency Department in line with national guidance Ward Management Closed 30 beds as part of ward reconfiguration in 2012 - achieved through work to reduce length of stay and improved discharge processes. The development of a Complex Needs Assessment Unit and new pathways of care for Frail Elderly patients in line with Royal College of Physician Guidance. Workforce Implementation of a trust-wide electronic rostering system allowing for the production of safe, efficient rosters with built-in financial assurances. Theatres Theatres savings identified in a number of areas, including increased productivity and efficiency of lists and aligning rotas with theatre start and finish times. Endoscopy Increased productivity leading to lowest ever diagnostic waits Quality Metrics Green governance rating year to date Pathology CPS preferred bidder to provide pathology services, on Bedford site, to GPs across a wide geographical patch, Beds, Herts and South Essex

5. 5 The Money 12/13 Budget £150M - 400 beds – 2,000 staff Breakeven - with support Financial risk rating Amber - Green in Q4 Financial challenge 2013/14 £12M saving required (circa 8%) Planning to meet savings target – opportunities limited Trust is relatively small and productive unlikely to be able to achieve full savings on our own

6. Productivity Opportunities 6 3,0 2,5 2,0 1,5 1,0 0,5 0,0 10 th Percentile Managing First Follow-Up Reducing Length of Stay Emergency Readmission (14 day) 0,5 0,4 0,3 0,2 0,1 0,0 Pre-Procedure Elective Bed Days 10 th Percentile 25 th Percentile The charts below show Bedford’s current performance against four indicators. Source: NHS Institute Better Care Better Value Indicators, 2011/12 Q1 Luton & Dunstable Hinchinbrook Cambridge Comm. Bedford Ipswich West Suffolk Colchester Norfolk & Norwich James Paget Peterborough Addenbrooks Basildon & Thurrock Princess Alexandra The QE Hospital Southend Papworth Mid Essex E&N Hertfordshire West Hertfordshire Luton & Dunstable Hinchinbrook Cambridge Comm. Bedford Ipswich West Suffolk Colchester Norfolk & Norwich James Paget Peterborough Addenbrooks The QE Hospital Southend Papworth Mid Essex E&N Hertfordshire West Hertfordshire Basildon & Thurrock Princess Alexandra Luton & Dunstable Hinchinbrook Cambridge Comm. Bedford Ipswich West Suffolk Colchester Norfolk & Norwich James Paget Peterborough Addenbrooks Basildon & Thurrock Princess Alexandra The QE Hospital Southend Papworth Mid Essex E&N Hertfordshire West Hertfordshire Luton & Dunstable Hinchinbrook Cambridge Comm. Bedford Ipswich West Suffolk Colchester Norfolk & Norwich James Paget Peterborough Addenbrooks Basildon & Thurrock Princess Alexandra The QE Hospital Southend Papworth Mid Essex E&N Hertfordshire West Hertfordshire

7. Vision To provide high quality, sustainable acute and integrated care serves to the people of Bedfordshire. Strategy Long term sustainability To identify the best merger partner to ensure future clinical and financial viability in line with Healthier Together proposals Planned care To provide a safe and efficient services to maximise the patient experience Respond to emergency needs To provide a safe and effective service based on best practice 24/7 Outcomes OBC approval by SHA/TDA Development of joint clinical strategy and LTFM Transformational change Transaction process completed to create new organisation Improve theatre utilisation and productivity Shift OP work to primary care Work with CCG to create integrated community services Secure private patients unit New Frail elderly model with assessment unit 7 day working (consultant, matron, imaging, pharmacy, discharge) Quality and patient safety Implement Francis Report recommendations, reduce infection rate and pressure ulcer rates, patient experience improves (friends and family and survey); resolve any concerns identified by the CQC. Organisational effectiveness Ensure all staff have appraisals and PDPs. Maintain strong relations with stakeholders and patients. Working with private sector partners and neighbouring Trusts to develop efficiencies of £8m (5.3% of turnover). Meet sustainability targets. Workforce Ensure safe staffing ratios on wards; reduce spend in line with activity changes; reduce spend on agency and additional hours. Use of E-rostering across the organisation. To improve productivity by >5%. Start Revalidation. Cross-cutting themes Strategic Plan 2013/14 95% not admitted 90% admitted by specialty Reduce outpatient session and N:FU ratio Respond to MSK procurement 95% urgent care access 10% reduction in emergency admissions (CCG dependency) A LOS reduction of 1 day Reduce readmissions

8. Financial Increased emergency re-admissions (30% of tariff does not cover the cost of care and this is exacerbated by the increase in avoidable admissions, as this is a fixed % of emergency admissions). This increase in admissions clearly has major implications for delivery of the emergency access target. More than £3M lost income in 2012/13 Loss of income owing to competitive tendering processes as work potentially transfers to another provider and the risks of managing fixed costs increases. Significant loss of income anticipated. Costs of quality improvements required in 13/14 not linked to activity. £xxx to be confirmed. Quality and Performance Quality Improvements required by the Francis Report Maintaining performance – A&E high risk owing to increase emergency admissions Staffing availability to achieve 7-day working to maintain standards 24/7 Management Capacity and Resource Maintaining a focus on performance Recruitment and retention of staff during prolonged merger/acquisition Delivery of TfE and £13m savings plan Risks and Challenges If we can reduce readmissions by 1 per day and emergency admissions by 1 per day, we would achieve excellence

9. BHT cannot be a standalone Trust Merger with another hospital needed – Critical mass for safe and effective services – Financial viability ‘As is’. – Services moving off site would require formal CCG-led consultation Discussions underway within NHS and with local stakeholders Milton Keynes NHS Trust preferred partner Decision on whether to proceed expected in April Next Steps