1. BEDFORD HOSPITAL NHS TRUST Strategic Discussion Bedford Borough Council Health and Wellbeing Stakeholder Event NHS Reforms and Bedford Hospital NHS Trust July 2012 Joe Harrison Chief Executive

2. Overview of Bedford Hospital NHS Trust A 403 bed district general hospital providing 24/7 emergency care, acute medicine, maternity services and surgical specialties; Treat 1,200 patients each working day Average of eight new patients per hour in A&E alone (almost 70,000 emergency attendances per year) More than 3,000 babies delivered each year (between eight and nine babies a day) See 100,000 first outpatients a year Turnover of approximately £147m a year 2,400 staff (major local employer) Serve a core population of around 270,000 people in Bedfordshire Budget £147m

3. Performance – All operational targets met (A&E access, waiting time targets) – Broke-even in 2011/12 (£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' New Services – New community-based care and pathways for diabetes, COPD and heart failure – Introduction of CALS (Community Alcohol Liaison Service) in A&E to reduce alcohol-related admissions and readmissions. Achievements and Developments

4. NHS Reform Quality, Innovation, Improvement and Productivity QIPP challenge 4% efficiency 1.5% tariff deflator 2.6% growth £20bn savings target to 2014 (Bedford Hospital has a £13m savings programme this year) £4m carry forward Reduction in activity and shift to community - £6m Resulting £13m savings for 2012/13

5. Local Challenges Achieving NHS Foundation Trust status Delivering the Transforming for Excellence Programme – Capacity to deliver while continuing to meet or exceed performance targets Delivering best practice clinical models of care – Long-term clinical viability and sustainability; services that are fit for purpose for the future Transforming services to meet changing local health needs – Ageing, growing population; increase in long-term conditions Collaborative working, partnerships and networks across hospitals and health services – South East Midlands health services review (Healthier Together); Milton Keynes Community Health Services; Social Services and SEPT

6. Launch of the Transforming for Excellence Programme (TfE) – Improving quality – New clinical models of care – Service innovation and improvements – Better health outcomes for patients – More efficient Examples of success under the TfE programme include: – The opening of a new Surgical Assessment Unit – Reduction in lengths of stay = fewer beds – Theatre Utilisation – Changes in clinical practice (more ward rounds and senior medical review) – Better discharge processes – A reduction in bank and agency staff Response to Reform Challenges

7. Healthier Together (previously the Acute Services Review) Focus on developing key relationships and clinical networks Opportunity to deliver clinical critical mass to population of 1.6m Different ways of working across acute Trusts Getting the “system” to work together Response to Reform Challenges

8. The Coalition Government has set out its intention to support all NHS Trusts to become an FT or part of an FT within three years Secretary of State written to Chairs of NHS Trusts asking for their timelines and commitment to achieve this Tripartite Formal Agreements formalise this DH has established a clear escalation policy Response to Reform Challenges: Achieving FT Status

9. The national pipeline: 144 Foundation Trusts – latest authorisation – Royal Free on 1 April 2012 Only seven new authorisations in 2010/11 and seven more in 2011/12 Over 100 NHS Trusts yet to reach FT status David Flory and Sir Peter Carr appointed Central estimates around two-thirds of remaining NHS Trusts will require some support to achieve FT status Analysis suggests that trusts with: – Minor quality, financial & performance issues might benefit from a management contract (up to 29) – Major financial & clinical viability issues might require an operating franchise or NHS M&A (up to 33)

10. Options available: – Stand alone FT application – Management Contract – Operating Franchise – NHS Merger and Acquisition Next steps: – More discussion with staff, stakeholders and the public – Decision at Board level on how best to achieve FT status Response to Reform Challenges: Achieving FT Status

11. Patient Council LINKS Monthly reports to OSCs Stakeholder events and regular communications Staff Council Joint Staff Management Committee (Trade Union forum) Internal communications and engagement strategy Open and transparent media and public involvement strategy Ongoing involvement Public, Staff and Stakeholder Involvement

12. Questions