DGT Clinical Strategy 2020 - 2025

Dartford and Gravesham NHS Trust

Clinical Strategy Providing outstanding care that is skilled, trusted and kind every time. 2020-2025

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Clinical Strategy Summary

Introduction

Dr Stephen Fenlon Medical Director

Dr Gill Jenner Non-Executive Director

It is our pleasure to introduce the Dartford & Gravesham Trust’s (DGT) Clinical Strategy for 2020- 2025, that will support our journey to becoming an outstanding Trust which provides outstanding care that is skilled, trusted and kind every time. This strategy builds on the successes that we have had in the past five years in delivering our previous strategy which set out to transform our core services, become a “hospital without walls” and to provide specialist services locally. We achieved this by focusing on the productivity and efficiency of our services, using digital solutions to change the way services are provided and, working in partnership with a range of NHS providers to improve pathways and provide more local specialist advice. The impact of this is evident in our recent Care Quality Commision (CQC) rating of “good”. This clinical strategy supports the delivery of our Trust strategy and in particular two of its priorities for the next five years: Journey To Outstanding and Working Together. In turn, the clinical strategy will be enabled by the quality, people, estates and digital strategies that have also been refreshed and are available alongside the clinical strategy on our Trust website and intranet. Whilst our clinical strategy is set in the global, national, NHS and Kent and Medway wide context, we have been unable to fully consider the impact of Covid-19 on the implementation of this strategy, and will do so in due course. • Specialist services: We have been announced as one of the three hospitals in Kent and Medway to provide stroke services, and this provides an opportunity for us to enhance inter-linked services such as neurology. We are also considering the potential for becoming a trauma unit. Our priorities for this strategy are:

• Children and young people: Children and young people are seen in a variety of areas across the Trust and it is important that we make sure that wherever they are seen, the care and environment is safe, trusted, kind and is appropriate for them and their families. • Integration and pathways: Pathways across health and care boundaries are often fragmented, duplicative or create gaps in service. Working Together with health and care providers in Dartford, Gravesham and Swanley as an Integrated Care Provider presents us with a fantastic opportunity to improve the overall health and wellbeing of the local population. We will continue to foster our relationship with GSTT Healthcare Alliance, clinical networks as well as the Kent and Medway and South East London Integrated Care Systems. • Excellence: Our Journey To Outstanding requires a culture that sets high clinical standards and prioritises excellent clinical practice. To achieve this, we need an unrelenting focus on our processes, policies and procedures. Getting the basics more than right will rely on innovation, excellent supporting systems (particularly IT) and committed and skilled teams that value one another and enjoy their work. This also means expanding our research involvement by capitalising on the innovation and recruitment seen during Covid-19. We aim to, year-on-year, increase our portfolio, recruitment onto trials and adoption of innovative clinical pathways. Excellence also relies on our clinicians in high pressure roles having the support required to perform at their best. We are excited to oversee the implementation of the strategy and will be closely monitoring its progress over the next five years at the Quality Trust Leadership Team, Quality Committee and Trust Board.

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Clinical Strategy Summary

Contents

Introduction by Steve Fenlon, Medical Director and Dr Gill Jenner, Non-Executive Director

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Our Vision, Values and Strategic Priorities

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Our context

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About the Trust

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Our successes: how we delivered the 2014-2019 strategy

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Our challenges

Trust and Divisional Focus for the next 5 years

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Delivering the Strategy

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Overview plan

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Supporting our clinical leaders

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Enablers

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Clinical Strategy Summary

Providing outstanding care which is skilled, trusted and kind, every time.

Our vision

Our Trust strategy identifies six key strategic priorities for the next five years:

Working Smartly within our means

Journey to Outstanding

Joy at work

Digital first

Working together

Continuous quality improvement

The Clinical Strategy is set in the context of the Trust Strategy and other enabling strategies (Quality, People, Digital and Estates) that have been refreshed for 2020-2025. The Quality and Clinical strategies are closely linked as improving the quality of the care we

provide is central to an effective clinical service strategy. The Clinical Strategy underpins the delivery of our strategic priorities, particularly Journey to Outstanding and Working Together.

Our values

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Clinical Strategy Summary

Our context

Recognising our health population context makes sure the focus of our clinical strategy is on the needs of the population and that we take into consideration the global, national and NHS wide responses to these challenges in our plans. Covid-19 provides an excellent example of how a global challenge can impact on global, national and NHS wide policy and priorities. The health, safety and wellbeing of our local patients is of primary importance to DGT and informs the plans of our divisions as well as the strategy of the Trust. Health population context at global, national, NHS, Kent and Medway levels

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Clinical Strategy Summary

About the Trust

Significant growth is expected over the next ten years • Bexley is projecting an increase in population by 10,000 in 2025, and by 18,000 by 2030. • DGS is projecting an increase in population by 24,000 in 2025 and 37,000 in 2030. This includes over 30,000 homes being built in Ebbsfleet, Dartford, Gravesham and Swanley by 2030 Population demographic profile of Bexley and DGS is very similar, with a younger than national average population, which will result in a significant increase in our over 65s in the coming years • High rates of elderly population growth with comorbidity • High air pollution rates variation in deprivation, education and employment • High obesity rates (children and adults) • High numbers of admissions due to falls and alcohol related conditions • Low breast feeding, lower bowel screening and lower MMR immunisation rates

From 2020, we have been working as an Integrated Care Partnership. The ICP works as an alliance to improve our population’s health and wellbeing, reduce health inequalities and proactively support service users with integrated service delivery and personalised care. Total population served 400,000 • Serve Dartford, Gravesham and Swanley (DGS) which has a population size of approximately 265,000 • Serve 135,000 population from Bexley (of a total approximately 247,000 population) • Local development will see our populations increase to approximately 435,000 by 2025 and 455,00 by 2030

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Clinical Strategy Summary

Our successes: how we delivered the 2014-2019 strategy

The Trust achieved a wide range of quality improvements and service developments, and also introduced new ways of working with partners and technology that have improved the care we provide and experience for our patients and their families.

The Clinical Strategy developed for 2014-2019 focused on three key areas: 1. Transforming our core services 2. Becoming a “hospital without walls” 3. Offering specialist services as close to home as possible.

Transform Core Services

Hospital without Walls

Local Specialist Services

Aims:

Aims:

Aims:

Delivered through: • Constantly improving patient safety • High quality patient experience • Expanding seven day services • Ensuring the right staffing levels and right leadership • Providing responsive care • CQC ‘good’ rating • Planned Care Centre at Queen Mary’s Hospital (QMH) • Enhanced Recovery Programme • Additional beds at DVH • LEAN • Rapid improvement • Red to Green days • Infection prevention and control • THINK programme • GPs in Emergency Departments • Emergency Department streaming • Theatre productivity • Lord Carter recommendations • Ambulatory Care unit

• Transform traditional

• Sub-specialty regional services • Provide best-in-class care locally through innovative partnerships

hospital services to treat patients closer to home • Help people grow old well • Improve coordination and support to commissioners and partner providers to give joined up care

Delivered through:

Delivered through:

• Vanguard programme – GSTT Healthcare Alliance – cardiovascular, paediatrics, POPS service, AI in Radiology • Urology TruNTH • MSK Triage • Hospital at Home team • Repatriation • Ebbsfleet

• Urology – stone centre • Renal dialysis • COPD • Satellite fertility unit • Paediatric epilepsy • Dartford Health Partners: Eye Surgery – Moorfields; Oral, MaxFacs and Plastic Surgery -Queen Victoria; Haemodialysis Satellite – Kings • Pathology • Stroke

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Clinical Strategy Summary

Our challenges

The Trust has a wide array of challenges, those illustrated here are those that particularly impact on our ability to deliver outstanding care. We can influence many of these challenges, a number of them are system, national or global challenges. This strategy particularly focuses on: • Children’s services • Improving the emergency care pathway

• Working with others to improve the population’s health and out of hospital services • Expanding our research offer • Improving the support we offer to our clinicians in high-pressure roles The strategy supports in setting the direction focusing on our people, digital and estates strategies.

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Clinical Strategy Summary

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Clinical Strategy Summary

Trust and Divisional focus for the next 5 years

Trust strategic priorities

Trust Priorities

Divisional Priorities

Specialist services

• Enhance and expand the stroke service (Comprehensive Stroke Centre) • Leading to the developments of neurological and frailty services • Consideration of Trauma Unit status • Improving unwell child (emergency) pathway • Co-designing pathways with children, young people and their guardians • Developing a children’s centre with outreach and transition care pathways including frailty, respiratory, cardiology, gastroenterology, end of life care, mental health and learning disabilities and maximising cold-site diagnostic capacity pathways – length of stay and out patients • Improved community care • Outstanding practice across core specialties • Award winning innovation • Nationally acclaimed workforce • Supported clinical leaders in high pressured roles • Growing research and adoption of innovative clinical pathways • Improving internal • Developing integrated

• Cancer • Artificial Intelligence augmenting radiology • Interventional radiology capacity

Working together

Journey to outstanding

• Children and young people Strategy delivery • Pathways with

Children and young people

Journey to outstanding

Community and Mental Health services

• Safeguarding, compliance and standards

Integration and pathways

• Emergency care

Working together

pathways including Frailty service • Long term conditions • Clinical Nurse specialists • Covid-19 recovery

• Surgical Admission Unit at DVH • Post operative anaesthetic care unit at QMH Maternity transformation • Respiratory Centre of Excellence 7 Day Gynaecology assessment unit

Excellence

Journey to outstanding

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Clinical Strategy Summary

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Clinical Strategy Summary

Delivering the Strategy

The clinical strategy supports the delivery of the Trust’s strategic priorities:

Journey to outstanding

Working together

Each strategic priority is underpinned by a series of objectives and measures. The key measures for the Clinical Strategy in the first two years include:

• Successful implementation of a comprehensive stroke service • Clarity on the direction of trauma services for the Trust

Specialist services

• An agreed strategy for children and young people • Revised policies and procedures including new unwell child pathway

Children and young people

• Increase in non face-to-face outpatient attendances • Reduced ED attendances and reduced length of stay in ICP respiratory, cardiology, frailty, gastroenterology and end of life care, as a result of integrated pathways across acute and community services • Reduction in surgical ED attendances due to Surgical Assessment unit • RTT delivery against plan through optimisation of the Planned Care Centre at QMH

Integration and pathways

Excellence

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Clinical Strategy Summary

Overview plan

The clinical strategy will be underpinned by a series of implementation plans that span the priorities and divisions. These will be owned by the divisions and reported through the Trust Leadership Team meeting, as well as to the Quality and Safety Committee and Trust Board. Overview plan for years 1-2 Below is the overview plan for years 1-2 (2020/2021-2021-2022) of the clinical strategy. Specialist services • Feasibility assessment for Trauma Unit • Comprehensive Stroke Unit established Children and young people • Strategy agreed, including implementation plan • Unwell child pathway embedded Integration and pathways • Outpatient and emergency care pathways • Improved pathways with community: respiratory, cardiology, end of life, frailty Excellence • Elective care pathways: SAU, POACU • Expanding research (years 1-5)

Whilst there are some clear plans for years 3-5, there will also be emerging opportunities (particularly through the ICP) that will be taken into consideration during the annual planning process. Specialist services • Progression of business case for Trauma Unit (if appropriate) • Development of neurological and frailty services Children and young people • Transition Services for chronic conditions and acute care • Outreach services including neonatal outreach Integration and pathways • Mental health services including learning disabilities • ICP pathway development Excellence • Respiratory Centre of Excellence • Maternity Transformation Programme (years 1-5) Overview plan for years 3-5

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Clinical Strategy Summary

Supporting our clinical leaders

• Provide one-to-one mentoring through the GSTT Healthcare Alliance to clinicians in high- pressure roles • Develop a programme of support based on feedback from clinical colleagues and learning from others • See our people strategy for further details about our ambition for colleagues development and support over the next five years.

We recognise that many of our clinicians face complex clinical and managerial decisions on a daily basis. They are often required to be made at short notice, and at times with little guidance. The Covid-19 pandemic has added to the complexity and pressure that our clinicians face. We recognise the importance of supporting our colleagues to develop the technical and psychological skills required to deliver their roles to the best of their abilities. As such we are seeking to:

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Clinical Strategy Summary

Enablers

The delivery of the clinical strategy priorities, at both Trust and divisional levels, is supported by a series of enabling strategies and Trust-wide ways of working/services.

The strategy requires the right capacity in the right place, improved governance, robust policies, reliable and integrated IT systems and a workforce that is committed and supported to delivering outstanding care to our patients.

Excellence

Children and young people

Intergration and pathways

Specialist services

Excellence

Clinical

priorities

Quality strategy

Continuous improvement

People strategy

Estates strategy - DVH and QMH

Governance

Enablers

IT systems and digital technology

Research and development

Financial performance

Partnership working

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Clinical Strategy Summary

Dartford and Gravesham NHS Trust

If you have any questions or comments about this or any other guides please contact a member of

the communications team by emailing dgn-tr.communications@nhs.net

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Clinical Strategy Summary