Agenda item

To provide an update on the refresh of the Trust Strategy

Andrew Statham, Director of Strategy, Royal Berkshire NHS Foundation Trust (RBFT) presented the report on the Trust Strategy refresh and the new Clinical Services Strategy (Agenda Item 5). The context for the refresh was explained and followed by an overview of the new Strategy. It was explained this was not a change to the mission of the hospital which still resonated and was a strong message to staff and partners. The objectives had been tweaked; the first strategy to stress ‘for all’; the third a shift to delivery in partnership instead of integrated care; and the fifth to include environmental sustainability and to recognise the significant contribution of the Trust to the environment in communities. Work was being done on how they would track their progress. Metrics would be reported on through RBFT Board and progress tracked on an operational basis.

The Trust presented the final slide on the Clinical Services Strategy. It was noted that the priority about the quality of care remained unchanged; to aspire to outstanding services every day. Secondly it was highlighted that services were to fit around patients, rather than patients around services to provide seamless care. There was merit in organising the building around level of acuity. The third objective was to get more services into the wellbeing space and more expertise of professionals in supporting primary care and social services in the community. Finally it was highlighted that the need was recognised to meet patients where it was best for them. This meant making use of technology, all hospital sites and other places where people could receive care. It was noted that different thinking was required about the workforce for tomorrow, use of technology and buildings provided.

The Chairman asked for clarification on the changes to the first priority to be ‘for all’. The Trust confirmed whilst the services were available for all, they might not have fully understood the difference in support they might need to provide for all to benefit from them. They were exploring some of the impacts around health inequalities. They had undertaken some research around their outpatient appointments with NHS England. The ‘did not attend’ rate was double for the two lowest socio-economic groups. They had held focus groups to understand why that might be. It appeared very simple but was not incorporated into their operational process. Those groups had higher rates of household instability, changing phone numbers and employment circumstances making 9-5 appointments difficult for them.  The Trust need to think differently to support the outcomes the NHS promised and made it explicit in the Strategy.

Councillor Linden asked for clarification around staff satisfaction in the Strategy, how the Trust would engage with those digitally excluded and how the Trust would provide the highest quality of care for all whilst living within their means. It was confirmed that the Trust regularly tracked staff satisfaction and also found retention data useful. Staff engagement was a key indicator also. Regarding digital exclusion, the Trust advised that digital was an additional channel available for those who preferred it but they did not take it for granted that people can use it. In response to the question regarding finance, the Trust confirmed that it was a challenge at all times. They were mindful of using money wisely and it could be a potential limiter on ambitions, but they absolutely strived for the highest quality of care for all whilst still living within their means.

Councillor Linden asked what the current level of staff vacancy was. The Trust advised vacancies went down during the pandemic. This was from 14-15% to 12% approximately.  There had been some increase in turnover post-pandemic. This included all staff and vacancies differed significantly across different staff groups. Councillor Linden asked about the impact of Brexit. The information was not available to answer this question. Councillor Linden asked what the recruitment strategy was and how it affected retention and retirements. The Trust advised they were always actively recruiting against the vacancies they had. They worked with colleagues nationally and locally to fill those vacancies. Councillor Linden queried the retention rate and the Trust confirmed their ambition was to have a slightly lower staff turnover rate. They were not complacent on retention or vacancies, but they were hugely proud of their work on cultural engagement and their employee benefit package which held them in good stead during the pandemic. Staff survey results had been published and they were really pleased to be one of the top performing acute Trusts against their peers. Councillor Linden asked whether they had a structural problem of retirement numbers in the future. The Trust confirmed they were not exposed any more than other public services to that particular challenge. Councillor Linden asked if there were plans to improve ethnic diversity at Board level.  The Trust advised that diversity and inclusion was a big agenda for the Board. They had several initiatives including staff forums to support that agenda. This was particularly focused on supporting people with career development opportunities. They recognised that they had representative levels of staff but overwhelmingly white leaders and managers and so they were keen to do what they could to better support people taking advantage of career opportunities.

Councillor Macro asked if there were any plans to enhance the minor injuries unit at West Berkshire Community Hospital and if there were partnerships to support walk-in centres in communities to help relieve pressure on A&E. The Trust confirmed that the minor injuries unit and walk in centres were provided by Berkshire Healthcare. The Berkshire West Urgent Care Board were prioritising their work to support people who had minor ailments or injury and were seeking care at the moment. The Trust and primary care need to think differently in how they could meet those care needs. The level of demand was outstripping capacity. This was from increasing self-care confidence all the way through to the Emergency Department. Councillor Macro confirmed that partnership working with Berkshire Healthcare would be very beneficial to enhance the facilities at West Berkshire Community Hospital. The Trust confirmed this was done through the Berkshire West Urgent Care Board. The specific service at West Berkshire would be enhanced by their work in enhancing diagnostic services.

Councillor Moore asked the Trust how they looked forward to where technology might be in 10 / 20 years and how technological advances could influence service delivery. The Trust confirmed they were looking at the potential of technology. They employed people from sectors with expertise in technology and regularly partook in forums with other hospitals in the U.K and internationally about where technology would take them. They had recently taken a paper through Board around enhancing existing services and how they made use of technology to allow patients to self-serve through portals.