Trust Provider Collaborative

Surrey Heartlands Trust Provider Collaborative (TPC) is a partnership committed to improving patient outcomes in ways which are fair, sustainable, efficient and innovative.

Established in July 2023, the TPC consists of four NHS Trusts:

·       Royal Surrey NHS Foundation Trust

·       Surrey and Sussex Healthcare NHS Trust

·       Surrey and Borders Partnership Mental Health NHS Foundation Trust

·       Ashford and St. Peter’s Hospitals NHS Foundation Trust

The partners recognise that by working together we are better able to meet the challenges of increasing demand for services, reducing health inequalities, the pressures on our workforce, and financial sustainability, so that the residents of Surrey Heartlands receive the quality of services that they rightly expect, in a timely way.

A series of workshops between the four NHS Trusts in 2022/23 developed a strong clinical case for change built on the foundation of individual Trust strategies and the Surrey Heartlands Integrated Care System triple aim of increasing individuals experience of care, improving the health of Surrey Heartlands, and reducing the per capita cost of care for the population.

Foreword by the four chief executives

The Surrey Heartlands Trust Provider Collaborative builds on a strong legacy of joint work between clinicians, services and Trusts to improve the health of the Surrey Heartlands population.

We know that by strengthening our partnership we can continue to deliver the quality of services our residents expect across Surrey in areas such as diagnostics, cancer, mental health and children’s services.

This Annual Report demonstrates the achievements we have made in our first year and outlines our plans.

Thank you for your support, contribution and commitment to our journey so far – our ambitions are high and will not be achieved overnight, but thanks to the relationships developed and the work undertaken, we have a solid foundation to build on to improve care for the patients and the population we serve together.

Katie Fisher Interim CEO, Ashford and St Peter’s Hospitals NHS Foundation Trust

Louise Stead CEO, Royal Surrey NHS Foundation Trust

Graham Wareham CEO, Surrey and Borders Partnership NHS Foundation Trust

Angela Stevenson CEO, Surrey and Sussex Healthcare NHS Trust

Clinical Transformation Priorities

A prioritisation exercise has focussed on identifying key areas of clinical transformation including endoscopy, acute paediatrics, maternity and neonates, systemic anti-cancer therapy, mental health and the development of an elective surgery centre.

Efficiency at Scale Transformation Priorities

Since early 2024,an efficiency at scale portfolio has been established, with a focus on a ‘people scaling’ programme to reduce temporary staffing costs and assess opportunities for digital support for human resources. Trusts are working together on digital and procurement opportunities as well as supporting each other through information governance, business intelligence and quality improvement.

This report outlines the ambitions we have and the progress we have made together in our first year.

Our context

National

Provider collaboratives are partnerships that bring together two or more NHS Trusts to work together at scale to benefit their populations backed up by national policy.

‘Working Together at Scale, guidance on provider collaboratives’ (2023) stated that provider collaboratives, by working ‘at scale’, will be a key component of system working by pursuing the following objectives:

1. Reducing unwarranted variation and inequality in health outcomes
2. Improving resilience
3. Ensuring specialisation and consolidation occur where this will provide better outcomes and value for people

Surrey Heartlands

Surrey Heartlands Integrated Care System(ICS)hasapopulationof1.1m,embracing a geography of four Places: Surrey Downs, East Surrey, Northwest Surrey and Guildford and Waverley.

The population is served by NHS Provider Trusts of Ashford and St Peter’s Hospitals NHS Foundation Trust, Surrey and Sussex Healthcare NHS Trust, Surrey and Borders Partnership NHS Foundation Trust and Royal Surrey NHS Foundation Trust, as well as community and primary care providers.

Surrey Heartlands Trust Provider Collaborative

The TPC is committed to working with partners across the Surrey Heartlands Integrated Care System to achieve the aims of the Integrated Care Board (ICB).

The TPC works alongside neighbouring ICBs of South west London, including Epsom Hospital (which sits within the Surrey Heartlands geography and is part of the St George’s, Epsom and St Helier Group), and Frimley ICB, part of which sits within the county of Surrey.

Our focus

Vision

‘A group of acute and mental health providers who, working together, improve patient outcomes in ways which are fair, sustainable, efficient and innovative’.

We do this by:

• Building a culture of mutual support and accountability.
• Implementing shared vision and governance.
• Engaging and co-designing with people and communities.

Our priorities

Our priorities were developed through a series of workshops with Chairs, Chief Executive Officers, Chief Medical and Nursing Officers, and Directors of Strategy. A clinical prioritisation process assessed a wide range of potential programmes ranging from existing transformation schemes to new initiatives.

Through this process two distinct portfolios of work have been established.

Clinical Improvement Programmes

The objective of this portfolio is to:

• Improve access : establishing the Surrey Elective Centre and to focus on the elective care backlog to improve access and drive productivity.
• Quality: reducing unwarranted variation and standardising care pathways.
• Resilience : scoping new models of care to support sustainability and service organisation, moving away from a competitive environment and making best use of our collective resources.
• Transformation : identifying and progressing clinical priorities at scale which will enable better service delivery.

Clinical Transformation Programmes have been established as part of the first tranche of collaborative schemes with an executive leading each programme, supported by Chief Executive Sponsors from the four Trusts.

Services and scope

Mind and Body

• Supporting the mental health needs of people attending hospital.

Maternity

• Transforming maternity services to meet the changing needs of women, birthing people and babies.

Acute Paediatrics

• Transforming children’s hospital services to meet the changing needs of the population.

Elective centre

• Developing the new Elective Centre at Ashford Hospital to provide additional capacity for high volume, low complexity surgery.

Systematic Anti-Cancer Therapy

• Agreeing a new clinical model to reduce inequalities, deliver services closer to home and improve patient outcomes.

Endoscopy

• Transforming endoscopy capacity to provide swift access to diagnosis, screening and surveillance.

In the past year programmes have been moving through the stages of discovery, diagnostics, and into delivery, pursuing new models of care, and working through collaborative solutions to support our workforce to provide safe care and faster access for the people of Surrey.

Efficiency at Scale

The objectives of this portfolio are:

• Sustainability : focused on resilience and productivity through consolidation and collaboration of corporate services.

Programmes have been established as part of the first tranche of schemes.

Services and scope

People

• Sharing best practice and developing a collaborative staff bank Developing a case for digital solutions for people services, improving efficiency and staff experience.

Digital

• Working at scale on digital infrastructure and transformation.

Procurement

• Working together to deliver better value from NHS supplies and contracts and harmonising procurement.

Supporting Delivery

Recognising that collaborative change is complex and challenging, portfolios are supported by enabling functions to provide a platform to move forward in our journey:

• Quality Improvement (QI): our programmes are supported by a strong emphasis in quality improvement ensuring clinical leadership, attainable goals and using QI processes to achieve measurable improvements in care.
• System wide partnership working : active partnership working with ICB colleagues including access to project management, business intelligence and analytical support, has been central to delivering our plans.

How we work together

We have a strong foundation in how we work together that has built relationships and has developed an ambitious programme of collaborative work.

The TPC is steered by a Strategic Committee in Common attended by the Chairs and Chief Executives of the four Trusts as well as Lead Directors and the Managing Director of the TPC. A Memorandum of Understanding outlines ways of working.

An Oversight Committee chaired by a partner Chief Executive ensures we deliver on our ambitions across the portfolio.

Clinical Improvement and Efficiency at Scale Programme Boards receive reports on progress and support our programmes to succeed.

Regular Seminars throughout the year on topics such as Quality Improvement and Elective Care collaboration have built relationships and helped steer our priorities.

Looking back – our year in review

Elective centre

What do we want to achieve?

• A centre of surgical excellence at Ashford Hospital to bring together high volume, low complexity elective surgical services.
• This will provide treatment capacity close to home, insulated from emergency pressures associated with an acute hospital site.
• The centre will improve patient experience, reduce the risk of cancellation, and make efficient use of operating theatres.
• Opening one ophthalmology theatre and three new main laminar flow theatres, providing increased capacity for elective orthopaedic procedures, including hip and knee replacement surgery, and eye surgery by the end of 2024.

What have we done in2023/24?

• Relocated pre-operative assessment, phlebotomy and Children and Young Persons' Outpatients areas to create the space for the new theatres.
• Installed new building infrastructure.
• Established an Elective Centre Leadership and Operational Board to plan and future proof the delivery of the centre.

Mind and Body

What do we want to achieve?

• Better integration of mental and physical health, by using our collective expertise and resources to ensure people receive the best possible outcomes and experience when faced with a crisis.
• Improve patient flow through better access to the right care at the right time and preventing unnecessary hospital admissions.
• Enhance acute hospital skills, leadership and support to better meet mental health needs.

What have we done in2023/24?

• Successfully piloted five new step-down beds to support the timely discharge of patients who are clinically ready; and enabling improved planned and supported transition back into the community.
• Implemented new Mental Health leadership and specialist Registered Mental Nurse (RMN) roles in Acute Trusts working in partnership to improve care and support for patients in acute hospital settings.
• Improved effectiveness of resources, with reduced spend on agency RMN staff and future avoidable costs of inpatient beds through earlier discharges.
• Implemented a new mental health escalation policy.
• Developed a new training package and competency framework which is currently being rolled out across providers.
• Mental Health Leads have or are in the process of being appointed in two of the acute provider Trusts, with recruitment plans underway for the remaining acute Trust to enhance expertise and support.
• Standards and support have been agreed in all acute Trusts to ensure high quality care for people who have a combined physical and acute mental health need.

Endoscopy

What do we want to achieve?

• Maximiseopportunitiestoensuresufficientendoscopydiagnostic,screeningand surveillance capacity, which is clinically led, to ensure people have the right treatment at the right time.
• Supportthedevelopmentofmodern,welcomingfacilitiesthatmeetnational standards.
• Worktoreduceunwarrantedvariationinpracticebystandardisingpathwaysand managing demand across Trusts.
• Explore alternative and innovative diagnostic techniques such as cytosponge, trans-nasal endoscopy, CT colon, colon capsule endoscopy and Irritable Bowel Disease management to improve patient experience.

What have we done in2023/24?

• Established the Surrey Heartlands and Frimley Endoscopy Network, with clinical and management leadership appointed.
• Drafted an endoscopy strategy and supporting programme plan.
• Driving quality improvement and promoting excellence through shared best practice and advance the uptake of innovation.
• Modelling future demand and capacity, taking account of current service provision, population changes, new service models, and changes in the national bowel screening programme.

Systematic Anti-Cancer Treatment (SACT)

What do we want to achieve?

• SACT is any drug treatment such as chemotherapy or immunotherapy used to control or treat cancer. We have SACT services at each of our acute Trusts in Surrey Heartlands.
• Demand for cancer services and SACT are growing – we have seen 30% more patients use our services in the last four years. The prevalence of cancer in the UK is set to increase from approximately 3m people today to 5m by 2040, with one in two people being told they have cancer at some point in their lives.
• The services we offer today cannot manage the level of growth we are seeing with out transforming the way we do things. As well as providing more capacity for patients, we also aim to reduce the inequality patients face currently in terms of what cancers we can treat at our different hospital sites.
• The aim of the programme is to develop a sustainable SACT clinical model which provides capacity for the huge increase in demand across Surrey Heartlands that also reduces inequalities and deliver improved patient outcomes and experience.

What have we done in2023/24?

• A Clinical Advisory Group was established with clinical colleagues from all partner Trusts
• Collated baseline information on current service models at each of the sites, reviewing outpatient data, where patients access services and demand and capacity work.
• Agreed what cancers we would ideally be able to offer patients at all of the local hospitals.
• Agreed what medical cover is required at each site, given the risk to patients of the treatment they are receiving.
• The Surrey and Sussex Cancer Alliance undertook a demand and capacity assessment of SACT units, focusing on the number of chairs and staff, with the report due to be completed imminently.
• A ten-year growth model has been commissioned, which assesses the multiple factors that may have an impact on SACT demand and capacity in the future.

With all this data collected we are now in a position to model the changes in patient flows that would be created by moving to our ideal medical model, and what capacity we would need at each site to deliver this. This final piece of data will allow us to cost that ideal model and provide the ICB with options as to how we might deliver it.

Acute Paediatrics

What do we want to achieve?

• Deliver better experience for children by reducing unwarranted variation in clinical and surgical services.
• Reduce long waiting times for surgical care.
• Standardise clinical pathways to reduce variation between Trusts.
• Ensure smooth transition to adult services for children.
• Work across Trusts to reduce inequity in waiting time for Paediatric MRI.

What have we done in2023/24?

• Workshops have taken place to share best practice and understand key challenges across each provider.
• A Clinical Reference Group has been established to drive forward priorities for change.
• Support between Trusts has reduced waiting times for children for MRI treatment.

Maternity and neonatal care

What do we want to achieve?

• Develop a strategic solution for Surrey Heartlands that addresses quality and workforce sustainability challenges, to ensure continued safe services for women and birthing people into the future.

What have we done in2023/24

• Review seven day early pregnancy unit (EPU) provision across St Peter’s and Royal Surrey Hospitals, looking at clinical guidelines, referral data and processes.
• Developed a baseline maternity data pack for Surrey Heartlands on activity, workforce, estates and quality, to support the next stage of the programme.

People Scaling

What do we want to achieve?

• To develop a Surrey Heartlands Workforce Collaborative portfolio, which enables local delivery of workforce programmes aligned to the NHS People Plan, and local delivery of the Future of NHS Human Resources and Organisational Development report.
• To support each other in the delivery of collaborative best practice, under the four principles of scaling: simplify, standardise, automate, and consolidate.
• To develop and deliver programmes for the benefit of our workforce and patients including:
  • Being a regional vanguard for the delivery of a SH temporary staffing collaborative and provider-led managed service
  • Being a national exemplar for delivering local people digital solutions, which encourage best use of current software and automation, as well as the exploration of a single future people digital workforce solution.
  • Work with Chief People Officers to explore further opportunities for service improvement and collaboration, in areas such as rostering and payroll.

What have we done in2023/24?

• Established a People Scaling Portfolio Board, leadership team and Programme Management Office.
• Developed three key programmes: Temporary Staffing, People Digital, and Future Opportunities.
• Completed a collaborative people digital audit and explored solutions to improve productivity and staff experience.
• Completed a collaborative temporary staffing audit and agreed a Strategic Business Case for the development of a provider-led collaborative staff bank.

Our future

2023/24 has set a strong foundation for developing relationships, establishing sound governance and initiating core programmes of work. 2024/25 will be a year of delivery.

As we move into 2024/25,we are conscious of the changing environment of the NHS and will need to adapt and change our focus in response to the next NHS 10 year plan.

The TPC will need to be alive to the collaborative opportunities of emerging government policy in areas such as digital and preventative care, as well as meeting the increasing challenge of financial sustainability for all Trusts, and working closely with the developing Surrey Heartlands ICB to deliver shared priorities.

Against this context, as the Trust Provider Collaborative grows and matures, so will our ambitions with our activities focussed on:

• 2024/25 will be a year of delivery – supporting the teams within the programmes of work we have established to meet their strategic ambitions
• Keeping patient outcomes at the centre of what we do, ensuring we capture our success in relation to patient experience as well as quantitative benefits
• A shared procurement service between Ashford and St Peter’s Hospitals NHS Trust and Royal Surrey NHS Foundation Trust.
• Continuing to explore opportunities by procuring at scale across the Trust Provider Collaborative members.
• Exploring further opportunities for corporate services collaboration to deliver value for money through economies of scale
• Working with Chief Digital Officers, Chief Financial Officers and Chief People Officers to explore opportunities for efficiencies in digital and information technology, and sharing scarce skills and resources
• Building on the leadership responsibility for elective, cancer and diagnostic care delivery (from October 2024), to work collaboratively to transform services to improve the equity of access for the people of Surrey and deliver safer, faster and better elective, cancer and diagnostic care.
• Exploring the establishment of local elective Clinical Networks in key specialities to support the delivery of best clinical practice across high volume elective care.

Ashford and St. Peter’s Hospitals NHS Foundation Trust

Royal Surrey NHS Foundation Trust

Surrey and Borders Partnership NHS Foundation Trust

Surrey and Sussex Healthcare NHS Trust