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A 10-year strategy for Moorfields Eye Hospital

Our Vision of Excellence

Contents 1 Executive summary 3 Background 3 Our mission and values 3 Analysis to inform our strategy 4 Conclusion 6

2 Introduction 7

3 Background 8 Moorfields: the leading international eye centre 8 The changing context within which we work 10 An early assessment of the impact of the health white paper 11

4 Developing our new vision and strategy 13 Strategy development process 13 Outputs of the strategy development process 16

5 Our mission and values 17 What our values mean to us 18

6 Analysis: what we found 20 Stakeholder perceptions 20 The London context 21 Moorfields’ place in the market 22 SWOT analysis 24 Summary 26

7 Our vision of excellence 27 What we do: how the service portfolio of the organisation will change 28 Where we work: how the geographical reach of the organisation will develop 30 Our reputation and quality: how we will ensure quality is the defining

characteristic of all that we do 35 Our role and influence: the part we will play as the market leader in

ophthalmic care 37 Our vision of excellence: summary 38

8 Our strategy: the plan to deliver our vision of excellence 39

9 Our staged and prioritised action plan 45

10 Conclusions 55

Our Vision of ExcellenceA 10-year strategy for Moorfields Eye Hospital


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Executive summary

Background

1.1 Moorfields Eye Hospital NHS Foundation Trust is the leading provider of eye health services in the UK and a world-class centre of excellence for ophthalmic research and education. Moorfields has a reputation developed over two centuries for providing the highest quality of ophthalmic care, and more than 1,400 staff who are committed to sustaining and building that reputation and ensuring we remain at the cutting edge of developments in ophthalmology.

1.2 Set against the context of a challenging financial climate over the medium to long term, and the need to drive up quality and productivity alongside rising consumer expectations and demands, the board of Moorfields Eye Hospital NHS Foundation Trust launched a process in 2009 to refresh the trust’s vision and strategy. The process involved periods of evidence gathering, analysis, synthesis and planning and involved a wide range of internal and external stakeholders. As a result, we were able to refresh our mission (which states why we exist and what we do), clarify our values (which express what we believe in and how we behave), articulate our vision (which sets out what we aspire to be by 2020) and describe our strategy (the action we will take to deliver our vision).

Our mission and values

1.3 In summary, our mission is to be the leading international centre in the care and treatment of people with eye disorders, driven by excellence in research and education.

1.4 Our values drive the approach we take to delivering the strategy, and to how we will develop our organisation over the next 10 years. They build on the principles within the NHS constitution but reflect our philosophy, and are that:

We strive to give people the best possible visual health so that they can live their lives to the full

We put patients at the centre of everything we do by treating everyone with respect and compassion

We undertake to use our resources effectively and efficiently to deliver high-quality care

We seek to build on our pioneering legacy by leading innovations in eye health

We recognise the worth of our staff by providing rewarding careers and supporting personal and professional development

We aim to provide seamless care through professional teamworking and strong innovative partnerships

We are committed to acting responsibly and being held accountable for all we do

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Analysis to inform our strategy

1.5 In developing our strategy, we worked hard better to understand the environment within which we work, and the needs of our patients, partners, staff and other key stakeholders. As a result of this analysis, we concluded that, as Moorfields develops over the next 10 years, we need to:

Ensure that future services evolve and expand to be more flexible and responsive to patients’ needs

Deliver ‘more for less’ in an increasingly volatile and constrained financial environment

Exploit opportunities to develop more innovative partnerships and pathways of care, with a particular focus on opportunities in primary and community care

Generate more value and impact from the Moorfields brand, and lever this to influence the ophthalmic agenda

Invest appropriately to develop facilities that are world class and support excellence in patient care, research and education across all our sites

Respond to our competitors and improve our market intelligence to identify new development opportunities

Our vision and strategy

1.6 In this context, we developed our vision for 2020. This is that by 2020, we will be providing a more comprehensive range of eye care services operating through a network of centres linked to a state-of-the-art facility in London, shaping the development and delivery of the eye health agenda nationally (rather than just responding to it), known for delivering the highest standards of patient experience, outcomes and safety across all of our sites, at the forefront of international research with our partners, and maintaining our leading role in the training and education of eye care clinicians.

1.7 We have described where we are going and where we want to be under four strategic themes: what we do: how the service portfolio of the organisation will change; where we work: how the geographical reach of the organisation will develop; our reputation and quality: how we will ensure quality is the defining characteristic of all that we do; and our role and influence: the part we will play as the market leader in ophthalmic care. Our direction of travel related to each of these themes is summarised below:


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1.8 We have also set out our strategy – what we need to do to deliver this vision. Our planning identified the actions associated with each of the four strategic themes, but also identified additional work we need to do as an organisation to enable the delivery of the strategic themes. We grouped these enablers into five clusters:

Improving our estate – redeveloping our facilities to deliver a central base and local services in accommodation that is fit for the 21st century and provides a consistently excellent patient environment

Increasing our productivity and efficiency – developing and delivering a programme to maximise productivity and efficiency in all of our clinical and non-clinical services

Developing our workforce – ensuring we have the right workforce, skills and capacity to implement our clinical model and strategy

Developing our leadership and organisational design – ensuring we have the leadership, culture and organisational design we need to deliver the strategy

Improving our IT and information – putting the IT and information in place so that we understand what we do and how well we do it, maximising the potential of technology to reduce our cost base and improve the care we give

Strategic themes

What we do

Where we work

Our reputation and quality

Our role and influence

Securing our referral base, increasing our market share and broadening our catchment by developing new community-based services in partnership with commissioners, and, through proactive marketing, create new business opportunities for our clinical and commercial operations

Developing a balanced and responsive network of service locations including a central London base, with district hubs (our larger outreaches) supported by local community-based facilities

Ensuring our services are of a consistently high quality across all sub-specialities and locations, building on our reputation for safe and effective eye care, supported by cutting-edge research and education, and providing an excellent patient experience

Maintaining our independence as an autonomous provider with a clear identity and a world-class reputation by shaping, rather than responding to, the ophthalmic market for integrated and comprehensive research, education and clinical activities


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Conclusion

1.9 Taking the four strategic themes and the five enablers, we grouped our actions into nine areas. These are not discrete and independent; rather, they are interlinked, interdependent and mutually supportive. We need to make progress across all of these areas in order to deliver our vision of excellence.

1.10 In July 2010, the new coalition government published its health white paper, “Equity

and Excellence: Liberating the NHS”. Our vision and strategy is wholly consistent with the themes in this white paper of placing patients at the heart of all we do, a relentless focus on improving outcomes and of empowering clinicians to deliver results. Engaging with clinicians in primary care to develop local services to meet local needs is at the core of the strategy we have developed. The white paper also presents us with further opportunities for growth through the increased foundation trust freedoms.

1.11 The work we have undertaken to date describes the direction of travel for Moorfields’ development over the next 10 years – but the strategy document is not an endpoint in itself. Our strategy will continue to develop and be refined as our organisation matures further and as the context within which we operate also continues to change.

1.12 The actions we need to take are being embedded in our annual planning processes and progress with the delivery of the plan will also be monitored by the trust board.


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2Introduction

2.1 Moorfields Eye Hospital NHS Foundation Trust is the leading provider of eye health services in the UK and a world-class centre of excellence for ophthalmic research and education.

2.2 This document sets out our vision and strategy for the next 10 years. It was developed during 2009/10 and describes Moorfields Eye Hospital in 2020 – the nature of the services we will be providing and the type of organisation we want to become – and how we will achieve this as an organisation.

Section 3 describes our background, history and the changing context within which we operate that led us to refresh our strategy

Section 4 sets out how we developed the strategy and who we involved in the process

Section 5 articulates our refreshed mission and the values that underpin our organisation

Section 6 summarises what we found as we took an objective look at our organisation, the market within which we operate and our place in it

Section 7 describes our vision for the future – where we are going and what we want to be

Section 8 sets out our plan to deliver this vision, what we are doing now and will do next – our strategy

Section 9 shows our staged and prioritised action plan to deliver the strategy

Section 10 is our conclusion

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Background

Moorfields: The leading international eye centre

3.1 Moorfields Eye Hospital has been serving the community for more than 200 years. During this time, we have developed a unique reputation for high-quality patient care, research into eye disease and teaching eye health professionals. These three core aims remain at the heart of our mission today.

3.2 Moorfields has come a long way since its establishment in 1804 as the first hospital devoted to the treatment of eye disease, following the return from the Napoleonic wars of many soldiers suffering from trachoma. The following year, the new Dispensary for Curing Diseases of the Eye and Ear opened in Charterhouse Street in the City of London, but it quickly outgrew its premises and, in 1822, the hospital moved to new, purpose-built premises in lower Moorfields, and was renamed the London Ophthalmic Infirmary. When Queen Victoria granted the hospital a royal charter in 1837, the name changed again, this time to the Royal London Ophthalmic Hospital – but everyone still called it Moorfields.

3.3 Even in these early years, Moorfields was renowned for its pioneering work. For example, in 1854, Moorfields’ surgeons became the first to use cocaine as a local anaesthetic agent. By the end of the 19th century, the hospital had again outgrown its buildings, and it moved once more, this time to a state-of-the-art new hospital on London’s City Road, which contained such novel features as air conditioning, central heating and electrical lighting, as well as an x-ray department and ultra-violet treatment rooms.

3.4 Throughout the 20th century, Moorfields continued to evolve, building an extension to the main hospital in 1935 with the generous support of voluntary subscriptions to the grand total of £120,000. With the founding of the NHS in 1948, Moorfields became a post-graduate teaching hospital. In the same year, the Institute of Ophthalmology was formed, an organisation with whom we continue to have a crucial partnership today. During the 1960s, the pioneering work of Professor Barrie Jones invigorated the process of clinical research and introduced micro-surgery and sub-specialisation to Moorfields. Specialist clinics established at this time covered viruses, lids, orbits and corneas. In 1986, we opened our first primary care clinic and subsequently developed community outreach facilities throughout the 1990s.

3.5 Moorfields’ pioneering tradition continues. We were one of the first 10 NHS organisations to become a foundation trust in 2004 and are an integral part of UCL Partners, one of the UK’s first academic health science centres, announced in March 2009. We are home to the world’s largest children’s eye centre, which opened in purpose-built premises at our City Road site in February 2007 and have an overseas branch in Dubai, which now successfully attracts private patients from Abu Dhabi, some 125km away. Moorfields Pharmaceuticals, our specialist manufacturing arm, which operates as a discrete commercial division, ensures that we have a guaranteed supply of the specialist products we need to treat our patients.

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3.6 Today, nearly all patient care is provided on an ambulatory or day-care basis and we

have a 24-hour specialist A&E specifically to treat eye emergencies. We provide care in our main hospital in City Road and at 12 ‘outreach’ centres in and around the capital. Although these centres were initially predominantly based in hospitals, their scope has increased in recent years to include more community-based locations too. We now run an ophthalmic service in London’s first purpose-built polyclinic in Loxford and are currently involved in a pilot project with high-street opticians chain Boots in Watford. In Harrow, we have joined forces with a local group of GPs to provide more eye care in the community.

3.7 Our main focus is the treatment and care of NHS patients with a wide range of eye problems, from common complaints to rare conditions, many of which require treatments not available anywhere else in the UK. Our services are organised into 10 ophthalmic specialties, which are supported by a range of clinical support services, including optometry, orthoptics and diabetic screening. The unique case-mix and volume of our larger services means that our surgeons can develop expertise in different areas of the sub-specialty.

3.8 We remain a major force in ophthalmic teaching in the UK for students, ophthalmologists and other health professionals, training more than half of the ophthalmologists practising in the UK today, and many more overseas. Increasingly, we are working to develop ophthalmic nurse training, for example enabling nursing staff to undertake YAG laser capsuloctomy procedures.

3.9 Our partnership with the UCL Institute of Ophthalmology continues to go from strength to strength, with numerous headline-grabbing examples of ground-breaking research, including the development of the world’s first gene therapy treatment for inherited eye disease, novel anti-scarring treatments and potential treatments for age-related macular degeneration (AMD) using stem cell therapies.

3.10 Together, we have the highest measure of scientific productivity and impact in the world for our research activity and are one of only 12 sites nationally to be awarded National Institute for Health Research biomedical research centre status for translational research.

3.11 In April 2009, we celebrated five years as a foundation trust. During this time the

number of patient attendances has increased steadily year on year. In 2009/10, we recorded 335,000 outpatient attendances, almost 70,000 attendances at our specialist A&E and 27,000 inpatient and day-case admissions.

3.12 Our financial position is robust, with surpluses above plan since 2006/07 and a strong financial risk rating of 4 with Monitor throughout 2008/09 and 2009/10, which means that we are currently rated as ‘excellent’ – the highest score possible – for financial management by the Care Quality Commission (CQC). Our income has almost doubled since we became a foundation trust.


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3.13 Our performance against quality measures as monitored by the CQC and its predecessors has also improved steadily since 2006/07, and, in the most recent assessment, we were assessed as one of the 13 most improved trusts in the country by the CQC and rated as ‘good’. For 2009/10, we submitted a declaration of full compliance with all 24 of the core standards monitored by the CQC, and were also registered without conditions under the new, more rigorous national system for regulating NHS organisations. We also met or exceeded all of the key national performance indicators and targets.

3.14 This strategy is designed to ensure that our services continue, over the next 10 years, to live up to the reputation we have built and to ensure that we continue to be at the forefront of ophthalmic care, education and research.

The changing context within which we work

Internal drivers

3.15 Our primary motive for refreshing our vision and strategy is to harness the strong internal desire within Moorfields to drive excellence and ensure that our services fully and effectively meet the needs of our patients and commissioners. Moorfields has a reputation developed over more than two centuries for providing the highest quality of ophthalmic care, and more than 1,400 staff who are committed to sustaining and building that reputation and ensuring we remain at the cutting edge of developments in ophthalmic care.

3.16 Our facilities – in particular those at City Road in central London – are antiquated

and require substantial investment to ensure that they are world class and support excellence in patient care, research and education. This vision and strategy will set the context for and clinical strategy within which the redevelopment of our estate will take place.

External drivers

3.17 In addition to these internal drivers, Moorfields faces several external pressures for change. The scale and scope of the changes over the next five to 10 years will be at least as great as at any other time and will fundamentally change the way we do business.

3.17.1 Competition and contestability: services that are not excellent (or able to demonstrate excellence) might not be sustainable, as patients and referring clinicians will choose alternative providers.

3.17.2 An increasingly constrained financial environment within which we will need to improve productivity without reducing quality.

3.17.3 A progressive focus on service integration and partnership working to ensure patients experience co-ordinated pathways of care – providing opportunities and potential threats in the delivery of primary and community care.


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3.17.4 Increasing demand as the population grows older, coupled with rising public expectations and new technologies which extend the availability of a wider range of treatments.

3.17.5 A shift in responsibility for commissioning closer to primary care, placing even greater importance on the development of relationships with referring clinicians.

An early assessment of the impact of the health white paper

3.18 In July 2009, the board of Moorfields Eye Hospital NHS Foundation Trust launched a process to refresh the vision and strategy of the organisation, establishing how we should respond to this changing internal and external environment.

3.19 As we were finalising our strategy, the new coalition government published its health white paper “Equity and Excellence: Liberating the NHS” in July 2010. In this key area of public service reform, the Conservative thinking on markets, choice and competition is added to the Liberal Democrat belief in advancing democracy at a much more local level, creating a new vision for the NHS.

3.20 The aims of the white paper will be delivered through four key themes, as set out below:

Putting patients and the public first:

• Greateropennessthroughshareddecision-making–‘therewillbenodecisionsabout me without me’

• Informationrevolutionenablingdataontreatments,servicequality,andhealthrecords to be accessible by patients

• PatientswillhaveincreasedchoiceandcontrolforGPs,hospitalprovider,namedconsultant, diagnostic tests, and treatments

Improving health outcomes:

• DevelopmentoftheNHSoutcomesframework,settinggoalscoveringeffectiveness of care, safety and the patient experience

• AbolishingprocesstargetssuchasA&Efour-hourwaits,with150qualitystandards developed and implemented within five years

• Continuingsupportforresearch

• Incentivisingqualityimprovementthroughcommissioningforqualityandinnovation (CQUIN) targets, pathway tariffs and best practice tariffs


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Autonomy, accountability and democratic legitimacy:

• LocalGPcommissioningconsortiawillcommissionthemajorityofservices,primary care trusts will be phased out and an autonomous NHS commissioning board will be responsible for allocation and accounting for NHS resources

• ThepowersoftheSecretaryofStateforHealthwillbelimited,whilelocaldemocratic legitimacy will be provided through the increased power of local authorities

• AllNHSproviderswillbecomefoundationtrustswithincreasedfreedomandgovernance options, and the private patient cap will be abolished

• Monitorwillbecometheeconomicregulatorfortheentirehealthandsocialcare sectors, the Care Quality Commission will continue to act as the quality inspectorate, and providers will need to be licensed by both regulators

• Paywillbefrozenfortwoyearsforallstaffearningmorethan£21,000withpaydecisions set thereafter by local healthcare employers, and public sector pensions will be reviewed

Cutting bureaucracy and improving efficiency:

• Reducingmanagementcostsby45%overfouryears

• Primarycaretrustsandstrategichealthauthoritieswillbeabolished,andthescale and scope of arm’s length bodies will be reviewed

• Regulation,datareturnsandmedicalresearchbureaucracywillbereviewed

3.21 The new environment envisaged by the white paper, where GPs have authority over commissioning, patients have much more control, and clinicians are empowered to ensure there is a relentless focus on improving clinical outcomes and patient experience, reinforces the challenges for Moorfields that were considered as we developed our strategy.

3.22 The white paper also presents us with opportunities that were not available before; for example, the abolition of the private patient cap will enable us to grow our commercial operations, providing further support to our NHS services. Similarly, the increased foundation trust freedoms offer opportunities for acquiring other service lines.

A 10-year strategy for Moorfi elds Eye Hospital

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Developing our new vision and strategy

Strategy development process

4.1 In July 2009, Moorfi elds launched an inclusive, rigorous process to review its strategy. The strategy process was overseen by the strategy and investment committee, a board sub-committee, and followed the four-step process set out in fi gure 1 below.

4.2 We involved a variety of stakeholders, including patients, foundation trust members and partner organisations in developing our new strategy, using both face-to-face andwrittencommunicationschannels.Morethan25%ofourconsultantscontributedtothework,witharound70%attendingbriefingstoensureclinicalsupport for the new strategic direction, which will be crucial in ensuring its delivery. Further explanation of each of the four steps in our strategy development process is set out in the following paragraphs.

Outline strategic planning process

What is our vision?

Where are we now?

Where do we want to be?

How do we get there?

Begin setting out the long- term vision

Gather evidence and identify contextual issues

Articulate and prioritise the key contextual factors which will shape the strategy

Engage with stakeholders

Identify and assess opportunities and risks

Gather the evidence and information to work up potential scenarios

Defi ne, assess and agree the strategic options

Engage with stakeholders

Actions needed to deliver

Measures of success

Assess risks

Defi ne enabling strategies

Figure 1: Strategy development process

Gathering evidence

Analysis Synthesis Planning

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Phase 1: gathering evidence

4.3 The strategy development process began by gathering evidence and identifying the contextual issues that would enable the trust to set out its long-term vision.

4.4 The early evidence gathering identified the four most significant contextual factors and other considerations which were expected to impact on the trust’s future strategy. These were: the future healthcare economy (including the challenging medium-term financial climate), the future models of delivery of eye health services nationally and internationally (including the likely vertical integration with primary care, community services and optometrists), the need to influence/shape the market (including Moorfields’ market share), and demonstrating quality of services (including addressing estate issues, efficient and productive pathways, and translating research – putting the best evidence and technology into practice).

4.5 At this stage, three overall messages for Moorfields were emerging:

1. Moorfields needs to be more agile and flexible in the future, with a business model(s) that can more rapidly adapt to change

2. Moorfields needs to set the eye health agenda, not respond to it, and take a stronger lead on shaping the services that are commissioned and provided both locally and nationally, acknowledging that the NHS could look radically different in 10 years’ time

3. Moorfields’ future strategy will more than likely need to include an element of vertical integration with primary care and community-based services, and consideration of how a stronger national presence can be established

Phase 2: analysis

4.6 A comprehensive review of the current and likely future context enabled the trust to have a realistic and objective understanding of the organisation and the market within which it operates.

4.7 This included active consideration of other health systems; our participation in the European, American and world ophthalmic associations gave us unique access to a wealth of information and professionals from across the globe.

4.8 The review covered several topics and workstreams, including:

Market assessment to develop a clearer understanding of the market for eye services and our market share

Stakeholder perception audit to develop a clear picture of stakeholder views of Moorfields’ existing strengths, as well as the challenges we will need to address in order to build on those strengths

Review of our outreach models to understand what works well within our current approach to outreach centres and what existing challenges need to be addressed


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Work to better understand the current workforce and organisational design in termsofsize,skill-mixandpotentialtorecruitandretainstaffandpreparednessforchange

Information audit to assess the current state of our clinical, financial and operational information and establish whether this meets future requirements

Thinking about education and training to understand what excellence in education and training looks like for the entire workforce and how this might be achieved

Consideration of how we can realise our ambitions to maintain our position as the premier site for research in ophthalmology and how to maximise the benefits of existing relationships at the same time as considering new and innovative partnerships

Assessment of the local health economy and the role the trust plays, and a review of current and future commissioner plans

An international perspective, in order to establish what works and what doesn’t work for ophthalmic care in other countries

Consideration of how demand for ophthalmic services is likely to change

Identification of national policy drivers that will impact on the ophthalmic health market and on Moorfields Eye Hospital

4.9 Alongside this analysis and based on its findings, the board developed a summary of the political, economic, social, technological, legal and environmental factors influencing the development of the organisation (PESTLE analysis) and assessed the key strengths, weaknesses, opportunities and threats facing the trust (SWOT analysis). The outputs of the analysis, and a summary of the SWOT can be found in section 6 of this document.

Phase 3: synthesis

4.10 Rooted in the evidence and in our analysis, we developed a clear sense of the strategic choices facing the trust, and by reviewing the choices, we refreshed our vision, creating for ourselves clarity about what Moorfields should be like in 10 years’ time. We described our strategic direction under four themes:

What we do: how the service portfolio of the organisation will change

Where we work: how the geographical reach of the organisation will develop

Our reputation and quality: how we will ensure quality is the defining character-istic of all that we do

Our role and influence: the part we will play as the market leader in ophthalmic care

4.11 This vision and the underpinning themes are set out in section 7 of this document.


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Phase 4: planning

4.12 Having created our vision, we developed our strategy to deliver that vision, describing the actions we need to take, the success measures we will use to ensure we are making progress and assessing the risks we face, and the associated mitigating action. This strategy and implementation plan is set out in section 8.

Outputs of the strategy development process

4.13 The outputs of the strategy development process – set out in the remainder of this document – are a mission statement; a statement of the values of the organisation; the vision of the trust; and the strategy for achieving the vision.


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Our mission and values

5.1 Moorfields’ mission, developed when we became a foundation trust, was to be ‘the leading international centre for excellence in the care and treatment of eye disease, and to be at the forefront of research and teaching in the field; and to provide a flexible and responsive service guided by patient needs’. Set against the context of a challenging financial climate over the medium to long term, and the need to drive up quality and productivity alongside rising consumer expectations and demands, the board launched a process in 2009 to refresh our vision and strategy. Although this process was not about redefining the our mission, it was revalidated and refreshed as part of the process.

5.2 Figure 2 below sets out our refreshed mission (which states why we exist and what we do) and our values (which express what we believe in and how we will behave). These statements, which were developed and refined with engagement from the board, membership council and management team, underpin the vision and strategy we have set out for the next 10 years.

Our mission:To be the leading international centre in the care and treatment

of people with eye disorders, driven by excellence in research and education

Our values build on those within the NHS constitution but reflect our philosophy:

1. We strive to give people the best possible visual health so that they can live their lives to the full

2. We put patients at the centre of everything we do by treating everyone with respect and compassion.

3. We undertake to use our resources effectively and efficiently to deliver high-quality care

4. We seek to build on our pioneering legacy by leading innovations in eye health

5. We recognise the worth of our staff by providing rewarding careers and supporting personal and professional development

6. We aim to provide seamless care through professional teamworking and strong innovative partnerships

Figure 2: Our mission and values

7. We are committed to acting responsibly and being held accountable for all we do

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5.3 Our values build on the NHS constitution (which was endorsed in the July 2010 health white paper ‘Liberating the NHS’), which listed six key principles for the NHS: respect and dignity, commitment to quality of care, compassion, improving lives, working together for patients, and everyone counts.

5.4 From these, and based on local experience and our unique position as a leader in ophthalmic care, research and teaching, Moorfields has developed its own statement of values. We are now in the process of communicating them to our staff and other stakeholders and embedding them in our everyday activity.

What our values mean to us

5.5 The following paragraphs describe what each of our seven values means to us:

5.5.1 We strive to give people the best possible visual health so that they can live their lives to the full

This value covers our wider societal responsibility as part of the NHS family to ensure that everyone is as fit and healthy as possible, in this case in terms of their visual health, and that no one is denied access to treatment if they need it. It also reflects our aim of continuing with our leading role in research to develop new cures and treatments for the benefit of patients and the wider society now and in the future. At the same time, it recognises our expertise in treating those who already have eye conditions and preventing those conditions from worsening by ensuring that they are treated at the right time, in the right way by the right professionals.

5.5.2 We put patients at the centre of everything we do by treating everyone with respect and compassion

This value reminds us that our services should be all about patients, not just in terms of the quality of their care, but with respect to their experience of our services. It is a commitment to improving the everyday things that make people’s lives better. It also recognises the need to value each person as an individual, respect their aspirations and commitments in life and seek to understand their priorities, needs, abilities and limits by listening to them and taking their concerns seriously. Our new behaviour code for staff will help to embed many of the behaviours that will be necessary to live up to this value.

5.5.3 We undertake to use our resources effectively and efficiently to deliver high-quality care

As a public sector organisation, working in a tough financial climate, we have a responsibility not to squander scarce resources, but to ensure that they are properly used. We need to ensure that every penny we spend provides the maximum possible benefit to our patients and to the wider community. This value also reinforces the fact that we are not being efficient for the sake of profits, but because the end point is higher quality care for more people. This value supports the acceptance outlined in the NHS constitution that some people need more help and that difficult decisions have to be taken, and that when we waste resources, we waste others’ opportunities. Cost improvement projects and revised patient pathways are examples of this value in action.


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5.5.4 We seek to build on our pioneering legacy by leading innovations in eye health Moorfields has a proud tradition and a strong reputation, dating back more than

200 years. This value recognises that history, at the same time as establishing the need to continue to innovate and evolve to respond to changes in how healthcare is provided and account for technological developments and scientific breakthroughs. New research initiatives are an obvious part of this value, but of equal importance is the need to embrace new ways of working, models of care and technological developments, just as we have done in the past. Crucially, this value talks about ‘leading’ innovations, reminding us of our responsibility as one of the world’s leading eye care organisations to share our knowledge and expertise with others for the greater good of the wider community.

5.5.5 We recognise the worth of our staff by providing rewarding careers and supporting personal and professional development

Moorfields’ staff are key to our success and need to be recognised as such. Living up to this value will not only mean that we retain existing high-quality staff, but that we encourage others to join us in future, to ensure that our expertise continues.

5.5.6 We aim to provide seamless care through professional teamworking and strong innovative partnerships

This value seeks to reinforce the need to work across professional boundaries to provide a seamless service to patients and to put the needs of patients and communities before organisational boundaries. All staff have a role to play in providing high-quality patient care, regardless of whether they actually see patients on a routine basis. At the same time, we need to remember to look outwards to bring in external expertise where necessary to strengthen or develop our services. Working with GP colleagues in new outreach ventures is an example of this. Partnership working is also important in achieving cost efficiencies and higher productivity – the back-office functions work taking place at UCL Partners is an example of this.

5.5.7 We are committed to acting responsibly and being held accountable for all we do

This value is about trust as a public sector organisation and the need for bodies that are funded by taxpayers to be open and transparent about their operations. It is about ensuring safety, confidentiality, professional and managerial integrity, accountability, dependable service and good communication. It also means that we must welcome feedback, learn from our mistakes and build on our successes.

5.6 Our values drive the approach we have taken to develop our vision and strategy, and have guided our strategic planning and thinking. We will uphold the values as we implement the strategy. As an early step in the delivery of our vision, and to embed these values further in the organisation, we will translate the stated values into statements of the behaviours that are needed in our organisation to underpin them. These behaviours will be integrated into our recruitment, appraisal and performance management processes (see section 8 for further details).

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Analysis: what we found

6.1 Our analysis led us to a better understanding of the current context within which we work, our place in the market, and the current and future needs of our patients and commissioners. The analysis enabled us to summarise the political, economic, social, technological, legal and environmental (PESTLE) factors influencing the development of the organisation. The key messages from the analysis are summarised below.

Stakeholder perceptions

6.2 A stakeholder perceptions audit sought views and opinions from a wide range of stakeholders – including patients, carers, staff and partner organisations – of Moorfields at present and the direction it should take in the future. The audit obtained 85 opinions derived through a range of formats, including telephone interviews, focus groups and questionnaires.

6.3 The most striking feature of the audit was the significant reputation and brand strength of the Moorfields name. Some organisations invest huge amounts of resources in developing the awareness and esteem that Moorfields already has. This tremendous strength of brand and reputation offers Moorfields some clear strategic planning opportunities. Many stakeholders, for example, would like to see Moorfields build on the clinical and research speciality for which it is known to take even more of a leading role in the wider UK vision sector. Some of the areas suggested include Moorfields acting as a quality assurance provider, a partner on the high street, a force for lobbying and campaigning, and an advocate and example of best practice in providing services and facilities for people with visual impairments. Moorfields’ clinical staff are viewed as extremely dedicated.

6.4 Some of the key challenge areas for consideration that emerged from this research are:

6.4.1 Improving the Moorfields patient experience Staff, patients and carers all related experiences where the quality of care delivered

to patients did not meet expectations, sometimes in quite basic areas such as appointment administration, visitor information, and provision of adequate facilities for patients with visual impairments. Even in cases where clinical care and treatment are excellent, this erodes some of the quality of the overall patient experience and can lead stakeholders to question Moorfields’ reputation. This was reinforced by the experiences from other health systems where these patient satisfaction issues were addressed quite differently, with extremely active monitoring and competition between providers to deliver the highest satisfaction scores.

6.4.2 Management and staff issues Some of the issues pointed out by staff relate to broader changes and shifts in the

NHS, particularly an increased level of professional management culture. However, there are also clear areas in which action must be anticipated if Moorfields is to maintain the level of care it wants to deliver to patients. Prioritisation and marked commitment to delivery of staff development and training – across all staff areas,

6


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rather than just clinical and research staff – will be key to success in this area. Again, the overseas experiences supported our conclusions, particularly around clinical leadership and general staff awareness of the financial aspects of care delivery.

6.4.3 Clinical facilities and services A constant theme among stakeholders is the need for long-term strategic planning to

address some of the antiquated facilities at the City Road site. We visited a number of units where the layout of clinical facilities actively supported efficient service provision, something we are often unable to do with our current estate. Many stakeholders also felt that there is a need to raise the level of the non vision-related specialist services and staff offered at Moorfields as part of a wider improvement in patient services.

6.4.4 Outreach sites Stakeholders view the development of outreach sites as extremely positive in principle,

butsomewhathaphazardoradhocinpractice.Stakeholderssingledoutkeyareasfor strategic planning and improvement for outreaches, including improved patient facilities and clarity of management and quality assurance procedures and a need for better communications between City Road and outreach sites. In our research of overseas health systems, it was apparent that, within any hub and spoke system, there must be a common understanding of what each component does, an acknowledge-ment that all components are equally important and together form the organisation in its entirety, and that the patient experience and clinical quality must be uniformly high across all components of the system. We therefore need to redefine the role of our outreach services, so that they consistently offer the highest quality of service, are organised such that the portfolio, critical mass and capability of each type of outreach is clear and well understood, and where the management, logistics and facilities at outreaches meet the highest standards.

6.4.5 External partnerships Many stakeholders raised questions about the perceived dangers of external

partnerships, including brand reputation and management issues, the potential for loss of clarity about speciality, and financial and resource risks. However, it is also clear that there are several opportunities for Moorfields to leverage external partnerships, including improvement of services for patients (through partnerships with sight charities) and contributing to improvements in public eye health through strategic partnerships with other health organisations and commercial sector organisations. A key message from outside the UK was the need to maximise philanthropic opportunities.

The London context

6.5 Our analysis also examined the local environment within which we work. In terms of demand,weanticipatean8.5%increaseintheLondonpopulationby2020.Atthesame time, the population of the UK is ageing, and elderly people make up two thirds of the patients we treat.


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6.6 The increasingly challenging economic climate is placing considerable pressure to increase productivity and efficiency, at the same time as driving up quality and innovation.InLondon,commissionersfaceanestimatedfundinggapof~15%overthe next five years and anticipate the need to deliver major reconfiguration of A&E and urgent care services as well as the transfer of acute and outpatient services into community settings.

6.7 These plans require further testing to ensure they have the support of local stakeholders, but informed estimates suggest that commissioners wish to see approximately50%ofoutpatientactivitytransferredoutofacutesettingsintolower-costcommunitysettings.ForMoorfields,a50%reductioninoutpatientactivitywouldhaveafinancialimpactintheorderof10%ofturnover.

6.8 A greater emphasis is being placed on measuring and demonstrating improvements in patient safety, patient experience and outcomes. Commissioners and patients alike will expect us to be able to demonstrate through evidence the quality on which our reputation is based.

Moorfields’ place in the market

6.9 Moorfields Eye Hospital is the largest ophthalmic provider in England, undertaking 27,000 episodes of inpatient/day case treatment and more than 335,000 outpatient appointments per annum – approximately double the number of the next largest ophthalmicunitinEngland.InLondon,Moorfieldshas30%marketshareoverall,anddelivers50%ofthespecialistophthalmiccare.

6.10 Our commissioners intend to redesign referral routes for ophthalmic care, and are committed to the development of community-based alternatives to acute ophthalmic care. Commissioners, supported by national policy, will seek to drive down the tariff for the activity we carry out.

6.11 Referrals from 10 primary care trusts (PCTs) represent half of the activity undertaken by the trust. Securing this referral base by understanding and fully meeting the needs ofthesecommissionersisakeybuildingblockforthefuture.Approximately40%ofthe activity we carry out is delivered in the trust’s 12 satellite locations. The map in figure 3 below shows how market share (deeper colours denote greater market share) is greatest around those sites where outreach services are provided.

6.12 Outreach appears to be effective in terms of securing a share of the market, and having a ‘front door’ in a location enables the trust to attract more complex and specialist activity into the organisation. However, there are some significant gaps in our market share in London, and our market share outside of London is minimal.


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6.13 We train more ophthalmic trainees than anywhere else in Europe and the Moorfields training programme is favourable in comparison with the major US institutions. This is something we need to protect throughout the significant changes ahead in the provision of medical training across London. There is a lack of structure and consistency in many of our programmes and considerable focus is required to support the provision of education and training to the entire workforce.

6.14 In terms of research, Moorfields will seek to maintain its position as one of the leading ophthalmic research institutions is the world. Our analysis of other ophthalmic systems from across the globe supports our eminence in research stature and results. We will need to maximise opportunities through partnerships with the National Institute for Health Research (NIHR) and UCL Partners, ensure there is sufficient research capacity to continue to attract the resources required to fund future research projects, and find innovative ways to maximise the adoption of research outputs across health communities.

Figure 3: Moorfields’ market share in London


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6.15 Our workforce is ageing too, and we have difficulties in recruiting to some posts. We have a largely traditional workforce model – the workforce model in the US for example is very different, with a much more significant role for technicians, which suggests potential opportunities for nurse practitioners/optometric roles further to support clinical teams to provide a more cost-effective model of care.

6.16 Although there are some examples of excellent information provision, we have significant gaps in both IT and information systems. There is a need to implement robust systems to consistently capture information that can be used for clinical benchmarking. The availability of reliable financial, clinical and operational information is essential for any future devolvement of management across the organisation. We do not have consistent outcome data truly to reflect our perceived position for clinical excellence across all specialities.

SWOT analysis

6.17 A detailed assessment of the key strengths, weaknesses, opportunities and threats facing the trust (SWOT analysis) was also undertaken. This is summarised in

figure 4 overleaf.


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Strengths

Our track record and reputation as a world leading centre for eye research, teaching and clinical care

Our business model with the freedoms of a foundation trust and the critical mass to provide comprehensive 24/7 subspecialty care and a network of satellite centres

Our flexible, talented, multidisciplinary, dedicated workforce and strong partnerships through which we deliver world-class services

The loyalty of patients, which has given us significant market share and access to one of the largest patient populations of any ophthalmic centre in the world

Weaknesses

Quality of the estate and infrastructure at City Road (and at some of our outreach facilities) which impacts on the patient experience and on our operational efficiency

Lack of information to support clinical and operational practice, or to demonstrate and improve outcomes

Feedback from patients that “City Road is the only place that feels like Moorfields”

Perception of inadequate non-clinical support

The development of our allied health professional and nursing workforce does not match that of our medical staff

Opportunities

Potential to extend our service portfolio into primary and community care

Potential to expand the ‘Moorfields@’ model through innovative high-quality outreach approaches

To provide thought leadership, shaping the eyes and vision agenda nationally and internationally

To further exploit the foundation trust freedoms to offer greater choice, greater excellence and deliver new technologies

Threats

Desire from primary care trusts and GP-led commissioners to deliver local alternative models of service

Greater, slicker competitors, feeding off a profitable high volume sector of the ophthalmic market

Economic downturn leading to reduced activity and reduced income for the trust

Unable to exploit ICT for efficient communications, record management and stakeholder information, especially if the number of sites across which the trust works increases

Summary of strengths, weaknesses, opportunities and threats

Figure 4: Summary SWOT analysis


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Summary

6.18 In summary, we concluded that we need to:

Ensure that future services evolve and expand to be more flexible and responsive to patients’ needs

Deliver ‘more for less’ in an increasingly volatile and constrained financial environment

Exploit opportunities to develop more innovative partnerships and pathways of care, with a particular focus on opportunities in primary and community care

Generate more value and impact from the Moorfields brand, and lever this to influence the ophthalmic agenda

Invest appropriately to develop facilities that are world class and support excellence in patient care, research and education across all our sites

Respond to our competitors and improve our market intelligence to identify new development opportunities


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Our vision of excellence 7.1 Moorfields Eye Hospital is a leader in eye health services. We provide a mix of hospital-

based inpatient and outpatient services and a world-class centre for research and education. Our vision for 2020 is that Moorfields will be:

Providing a more comprehensive range of eye care services operating through a network of centres linked to a state-of-the-art facility in London

Shaping the development and delivery of the eye health agenda nationally

Known for delivering the highest standards of patient experience, outcomes and safety across all of our sites

At the forefront of international research with our partners

Maintaining our leading role in the training and education of eye care clinicians

7.2 We have described where we are going and what we want to be under four themes. These are summarised in figure 5 below and explained in more detail in the remainder of this section.

Strategic themes

What we do

Where we work

Our reputation and quality

Our role and influence

Securing our referral base, increasing our market share and broadening our catchment by developing new community-based services in partnership with commissioners, and, through proactive marketing, creating new business opportunities for our clinical and commercial operations

Developing a balanced and responsive network of service locations, including a central London base, with district hubs (our larger outreaches) supported by local community-based facilities

Ensuring our services are of a consistently high quality across all sub-specialities and locations, building on our reputation for safe and effective eye care, supported by cutting-edge research and education, and providing an excellent patient experience

Maintaining our independence as an autonomous provider with a clear identity and a world-class reputation by shaping, rather than responding to, the ophthalmic market for integrated and comprehensive research, education and clinical activities

Figure 5: Strategic themes

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7.3 Moorfields is currently a hospital-based provider of secondary care for the local population (approximately two thirds of our business) and of tertiary and very specialist care for a regional, national and international catchment population (approximately one third of our business).

7.4 Asweconsideredtheserviceprofileandsizeoftheorganisation,andhowthisshouldchange over the next 10 years, we asked ourselves whether Moorfields should seek to expand and continue to grow (and, if so, how). We reflected on whether our focus and concentration should be on tertiary work or whether we should seek to broaden our portfolio, developing a more comprehensive ophthalmic service, and whether we should remain a hospital-based provider or should develop services that will be provided in primary care settings. In terms of the delivery of community-based initiatives, we considered whether we should continue to work in collaboration with a ‘third partner’, or develop these independently.

7.5 We concluded that Moorfields should seek to remain the leading provider of specialist ophthalmic care nationally, but should also aim to become a leader in community-based eye services. We will also continue to be at the forefront of research and education in ophthalmology. We will do this by:

Continuing to grow all aspects of our activity while further developing specialist, sub-specialty and community-based ophthalmology services

Broadening the development of services in primary care with primary care trusts (PCTs) and partner not-for-profit organisations

Further expanding our research and education capabilities through UCL Partners (the academic health science centre of which we are an integral part) and the North East London, North Central London and Essex health innovation and education cluster (HIEC)


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7.6 Figure6belowillustratesthenatureofthechangeweenvisageinthesizeandportfolio of our services.

7.7 By growing activity across all sectors of the market, Moorfields will be able to drive efficiencies through high volumes of routine activity, while also having the headroom to develop and deliver the specialist portfolio that makes us distinct. It is important that the portfolio of the organisation continues to provide Moorfields with access to one of the largest patient populations in the world to support research. Patients and commissioners want improved access to our services in community settings. By expanding our portfolio into primary and secondary services, we have the opportunity better to meet the needs of our patients, to secure our referral base, and to apply our service and clinical expertise into this market area.

2010:Moorfieldsdelivering~30%

specialist,60%secondarycareand10%primaryandcommunity

care

30%specialist care

30%specialist care

60%secondary care

50%secondary care

20%primary and

community care

2020:Growth across all sectors with a new service line of primary and community care representing ~

20%ofthebusiness

2010 – 2020: The shape of our service portfolio

Figure 6: The changing shape of our service portfolio

10%primary andcommunity care


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7.9 Moorfields currently delivers its activity from a central base at City Road and 12 outreach locations. All 12 outreach services operate as spokes of the City Road base and we tend to categorise them all in a similar way, even though they are quite differentinsizeandfunction.WhereMoorfieldsdeliversoutreachservices,thetrust’smarket share increases; patients have access to the very best quality ophthalmic care in local settings and they tend to be willing to travel to the City Road site for more complex services that are not provided locally.

7.10 As we considered the appropriate geographical focus and reach of Moorfields in future, we asked ourselves whether the future model of outreach should remain ‘hub and spoke’ or transform into a distributed network of more clearly defined facilities. We considered whether we continue to have a need for a central hub to support a networked outreach model, and, if so, what its focus should be. Looking at our current outreach services, we examined whether we should continue to provide services from all current locations and, in order to increase activity, which areas should be explored as a priority.

Moorfields is the leading provider of ophthalmic care in the country.We focus our clinical efforts on high complexity, teriary referrals and secondary care for a local population. Primary and community care is a very small proportion of our overall activity. Through our outreach services we have gained considerable experience about which models are most clinically and cost effective for the delivery of community-based ophthalmic care.

Moorfields remains the leading provider of specialist ophthalmic care nationally but is now also a leader in community-based ophthalmic care. We are still the first to deliver the latest advanced treatments for the most complex conditions and provide highly competitive routine secondary care services, but our involvement in the delivery of a broad range of community-based ophthalmic services has significantly expanded our referral base and allowed us to grow patient volumes, secondary and specialist care practices, and enlarge our population base for research and development.

To move from in 2010 Moving to in 2020

7.8 In summary, in terms of what we do, our journey over the next 10 years is:


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7.11 We concluded that Moorfields should seek to deliver services through a structured network of facilities across London and the south east, supported by a state-of-the-art specialist centre in London, which will be the focus for our most specialist and complex clinical services. This will be achieved by:

Redefining our outreach model to include a central hub supported by a highly distributed network of services, working within defined standard operating procedures and with a clear remit

Aiming to increase our market share, initially focusing on parts of London where we do not provide an outreach service; and proactively engaging with partner organisations to seek out opportunities to attract new business in new locations or increase market share in existing facilities

Seeking to play a greater role in service provision where we currently provide sub-specialty expertise

Maximising opportunities to provide community-based services within polyclinics, prioritising the establishment of such services in areas where we currently have poor market penetration

7.12 The following diagrams illustrate a generic model for our outreach portfolio, categorising them into four levels of provision, with a fifth category for services where we partner with other providers.

Current services Outreach redefinition

Example naming

Central site

District hub

Local surgicalcentre

General and/or sub-speciality

Medical support and joint working

Moorfields Eye Hospital

Moorfields Eye Centre at Ealing

Moorfields Local Surgical Centre

Moorfields Community Clinic

Moorfields in partnership with ...

City Road

St George’sBedfordEalingNorthwick Park

St Ann’sMile EndPotters Bar

Upney LaneLoxfordHarrowWatford(Wandsworth)

MaydayWatford (hospital)HarlowHomerton

Figure 7: Our generic outreach model


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7.13 These four levels of provision are:

Community clinics will deliver Moorfields’ eye services in a local setting, for example in primary care GP or high street opticians’ facilities, polyclinics or other community-based locations. We will focus predominantly on outpatient and diagnostic services, with general and sub-specialty ophthalmology provided as local demand requires. This will allow us to put services where our patients want them to be, in the heart of local communities.

Local surgical centres will provide more complex outpatient and diagnostic services alongside day-case surgery. These centres will support a number of community clinics as well as providing a local facility to support the district hubs and central base, for example by delivering routine surgery from across a network locally, thereby providing a better patient experience as well as relieving capacity at the hubs.

District hubs will undertake more complex eye surgery, with some having facilities for planned overnight stays, access (in hours) to urgent care, and – due to their co-location with acute district general hospitals – will provide access where required for patients to a wider range of acute hospital services (eg high dependency unit beds, radiology etc). Some district hubs will undertake work we are currently unable to deliver at the central site due to the lack of these acute hospital services. The district hubs will also act as a local nexus for research and education, both as an outreach of our main research and education facilites at the central site, but increasingly as research and education facilites in their own right.

The central site, currently at City Road, sits at the heart of the organisation. As well as providing the range of services found in district hubs, the central site is where we will undertake emergency surgery and where the ophthalmic A&E will be located.

7.14 The model acknowledges that more than one of these services can be co-located on a single site. For example:

A community clinic could be located on the same site as a district hub, although patient pathways will provide a clear distinction between the two units

Our main base would include a district hub as well as a community clinic serving the local population

7.15 We envisage district hubs providing clinical governance and oversight to local surgical centres and community clinics, with the central site providing clinical governance and oversight to district hubs. Figure 8 overleaf summarises the range of services we anticipate being provided in each type of facility.


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Figure 8: Classification of outreach models

Outreach type

Central site

District hub

Local surgicalcentre

General and/or sub-speciality

General and sub-speciality outpatients

Routine surgery

Urgent access

(in hours)

Complex surgery with facility for

overnight stay

Access to acute hospital

services, e.g. HDU

Ophthalmic trauma/urgent surgery A&E

7.16 Moving to this networked model of provision gives us greater clarity about patient pathways, an increased ability to manage and sustain quality and productivity at all sites, and is expandable as we reach into new communities.

7.17 Services organised in this way are more likely to match the local demand and access needs of the communities we serve and provide a route through which we can actively engage in community services.

7.18 This model is most likely to work effectively within London and the south east, where

our focus is for business development. Ophthalmology services outside of the defined London-based network could provide profit-making opportunities, but cannot be supported by the rest of the network, and any such opportunity will need to be appraised as an independent business unit, such as Moorfields Dubai.

7.19 The current and future networked model of service provision is illustrated in figure 9 overleaf.

some sites only


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Central site

Districthub

Districthub

Districthub

Localities

Localitieseg Ealing

Localities

Now

Figure 9: Moving to a networked model of service provision

Future

Central site


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Our reputation and quality: how we will ensure quality is the defining characteristic of all that we do

7.21 Moorfields’ Care Quality Commission (CQC) and Monitor ratings are good and improving. We have a reputation for high-quality clinical outcomes, particularly relating to our specialist services, but there is limited evidence to demonstrate that this reputation is valid. We have one of the best performing A&Es in the country, but the reported patient experience in terms of waiting times in outpatients and pre-surgery is poor. The brand perception of Moorfields is strong, but there is a feeling that we are not leveraging this brand equity as an organisation to ensure the best possible services to all of our stakeholders.

7.22 We reflected on what Moorfields should strive to be known for, and on what ‘excellent’ quality means for Moorfields. We considered the feedback we have received from patients and partners, and what we want our patients, partners and commissioners to say about us by 2020.

7.20 In summary, in terms of where we work, our journey over the next 10 years is:

Moorfields delivers services from a hub in central London and other locations across London. Expansion to date has evolved based on invitation from a host trust or commissioner. There is wide variation in the range of services and operational models in each outreach location – and there are inconsistencies of quality, efficiency and effectiveness. Where we deliver services, there is high market penetration which secures patient flow for specialist referrals back to City Road. However, there are large areas of London where patients do not come to Moorfields and our market penetration is low. As a result, we have a confusing strategy of where Moorfields operates and why.

Moorfields delivers planned and urgent care services through a defined structure of networked facilities (including hospitals, polyclinics, opticians and primary care settings) across London and the south east, supported by a state-of-the-art specialist centre in London which is the focus of our most specialist and complex clinical services. Market share has increased through expansion into north east and south east London, Essex and to the west of our City Road site, generally through a process of partnership working with other provider organisations. Outside of London, we have actively sought to deliver clinical services in locations in south and east England which stengthen our network around our London hub.



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7.23 We concluded that we wanted it to be the case that wherever patients use our services, Moorfields would be the safest place to have ophthalmic treatment, the provider with the best outcomes for routine and specialist treatments, and be known for offering an excellent patient experience. We want Moorfields to provide training set apart by its high quality, and research that continues to be world leading.

7.24 We will accomplish this by:

Improving the patient experience and environment

Developing outcome measures where they do not currently exist and demonstrating best outcomes

Becoming the best performing organisation against existing defined measures

Ensuring a reputation for safe and effective eye care

Continuing to cultivate our commercial operations

Developing and strengthening Moorfields’ overall brand to ensure quality and consistency across our entire portfolio (clinical service delivery, education and research)

7.25 In doing so, we will be addressing the areas of negative feedback from patients regarding their experience of using our services, as well as gathering the clinical outcome evidence to support our world-leading reputation. We now publish annual quality accounts and will need to demonstrate year-on-year improvements in the quality of our clinical services

7.26 In summary, in terms of our reputation and quality, our journey over the next 10 years is:

Our Care Quality Commission and Monitor ratings are good and improving. Moorfields has a reputation for high-quality clinical outcomes, particularly relating to its specialist services, but there is limited evidence to demonstrate that this reputation is valid. We have one of the best performing A&Es in the country. Reported patient experience in terms of waiting times in outpatients and pre-surgery is poor. The brand perception of Moorfields is strong, but there is a feeling that as an organisation we are not leveraging this brand equity to ensure the best possible services to all of our stakeholders.

Moorfields is known for providing the very highest quality of care. We routinely measure what we do, benchmark it with other UK and international providers, and consistently seek to improve. As a result, we are known for, and can demonstrate that we are, the safest place to have ophthalmic treatment, the centre providing the best outcomes for routine as well as specialist treatments, and that we offer excellent patient experience. Wherever we deliver services, the quality of what we do is the same. The experience patients and customers have of our brand is consistent; we do not compromise quality.



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7.27 Moorfields is a successful stand-alone NHS foundation trust. We are involved in a variety of national groups, but this is mainly uncoordinated and we are not making the most of our huge potential to influence the market or shape policy. We are a relatively small NHS trust and have a largely self-provided back-office infrastructure to support the organisation. Where we work in other trust facilities (in outreach locations), our services operate discretely, which does not allow us always to offer full comprehensive care to patients.

7.28 We asked ourselves what part we should be playing as the market leader in ophthalmic care, and to what extent Moorfields should help shape the eye health agenda. We considered whether Moorfields should seek to remain as a stand-alone organisation, and whether it could benefit from being sited close to, or partnering with, another organisation.

7.29 We concluded that Moorfields should seek to retain its autonomy and identity, and use its knowledge, skills and experience to help shape, rather than simply respond to the ophthalmic market. This will be delivered by:

Leveraging existing and developing new partnerships to maximise benefits

Making measured efforts to become more influential in shaping the international, national and local strategy and focus for eye care services

Working with the RNIB, Royal College of Ophthalmologists, College of Optometrists and other influencers to stimulate debate and change

Remaining at the forefront of research and education, leveraging opportunities that arise from new partnerships, including the local HIEC and UCL Partners to create innovative models of service delivery

7.30 In developing this view, we saw that Moorfields remains financially healthy with low governance risk ratings, and sufficient scale to give critical mass, clinical and financial sustainability. However, we see opportunities to use existing partnerships to enhance value, minimise overheads and to support the delivery of better quality services. Moorfields is unique in that it is a stand-alone ophthalmic trust and has a board focused solely on eye health. This autonomy should be protected to ensure we maintain our ability to innovate and our readiness to adapt to changes in the external environment. The feedback we received from stakeholders suggests that we are ‘punching below our weight’ and that we should be more at the forefront in delivering the eye health agenda.


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Our vision of excellence: summary

7.32 This section has set out our vision for Moorfields in 2020, and described where we are going and what we want to be under four themes:



Our reputation and quality: how we will ensure quality is the defining characteristic of all that we do


7.33 The next section (section 8) describes the action we need to take in order to deliver this vision. Our planning identified the actions associated with each of the four strategic themes, but also identified additional work we need to do as an organisation to enable the delivery of the strategic themes. We grouped these enablers into five clusters:

Improving our estate and facilities

Increasing our productivity and efficiency

Developing our workforce

Developing our leadership and organisational design

Improving our IT and information

7.34 Our plans for each of the four strategic themes and five enablers are set out in section 8.

Moorfields is a successful stand alone foundation trust. We are involved in a variety of national groups but this is mainly uncoordinated and we are not making the most of our huge potential to influence the market or shape policy. We are a relatively small NHS hospital and have a largely self-sufficient infrastructure (back office) to support the organisation. Where we work in other trust facilities, our services operate discretely which does not allow us always to offer full comprehensive care to patients.

We continue to take the view that we offer most value by continuing to operate as an autonomous provider of ophthalmic care, focused entirely on the eye health agenda. By consistently achieving quality, performance and productivity targets, and by maximising the benefits of shared non-clinical services, we have been able to continue to demonstrate high value from our foundation trust status. Our strong partnerships have further boosted our reputation. Across the ophthalmic world, people ask, “what does Moorfields think?”


7.31 In summary, in terms of our role and influence, our journey over the next 10 years is:


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Our strategy: the plan to deliver our vision of excellence

8.1 We have identified the action we need to take to begin to deliver our vision. These actions fall into two broad categories:

Action directly linked with the delivery of each of our four strategic themes – what we do: how the service portfolio of the organisation will change; where we work: how the geographical reach of the organisation will develop; our reputation and quality: how we will ensure quality is the defining characteristic of all that we do; and our role and influence: the part we will play as the market leader in ophthalmic care

Actions we need to take to enable the delivery of these themes and to develop our organisational capacity and capability to drive our strategy. We have grouped these enablers into five areas – improving our estate and facilities, increasing our productivity and efficiency, developing our workforce, developing our leadership and organisational design and improving our IT and information.

8.2 Our actions are, therefore, grouped into nine areas. These are not discrete and independent, rather they are interlinked, interdependent and mutually supportive. We need to make progress across all of these areas in order to deliver our vision of excellence. As an example, we have identified the need to improve our IT and information as a key enabler. Each of our strategic themes requires us to have better information – to grow and develop our business, to implement a clinically and financially sustainable outreach model, to measure and improve quality and to shape the market within which we work.

8.3 The nine components of our strategy are therefore:

1. Strategic theme: What we do Secure our referral base, increase our market share and broaden our catchment by developing new community-based services in partnership with our commissioners, and create new business opportunities for our clinical and commercial operations.

2. Strategic theme: Where we work Agree the new outreach model, establishing what type of work we are going to do at which type of facility and redistribute our activity in line with this new model.

3. Strategic theme: Improve quality Ensure our services are of a consistently high quality across all sub-specialties and locations, building on our reputation for safe and effective eye care and providing an excellent patient experience.

4. Strategic theme: Our role and influence Shaping, rather than simply responding to, the ophthalmic market for integrated and comprehensive research, education and clinical activities, and maintaining our independence as an autonomous provider with a clear identity and a world-class reputation.

8


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5. Enabling theme: Improving our estate and facilities Redevelop our facilities to deliver a central base and local services in accommodation that is fit for the 21st century and provides a consistently excellent patient environment.

6. Enabling theme: Increase our productivity and efficiency Develop and deliver a programme to maximise productivity and efficiency in all of our clinical and non-clinical services.

7. Enabling theme: Developing our workforce Ensure we have the right workforce, skills and capacity to implement our clinical model and strategy.

8. Enabling theme: Developing our leadership and organisational design Ensure we have the leadership, culture and organisational design we need to deliver the strategy.

9. Enabling theme: Improving our IT and information Put the IT and information in place so that we understand what we do and how well we do it, and maximise the potential of technology to reduce our cost base and improve the care we give.

8.4 For each of these nine components of our strategy, we have identified the actions we need to take to begin implementation. As would be expected, we have been able to set out in greater detail the early actions we need to take, which, as we deliver them, will lead to greater detail about the subsequent steps, which will then be described. These staged actions are set out below and summarised with timescales in section 9.

8.4.1 Strategic theme: What we do Our aim is to secure our referral base, increase our market share and broaden our

catchment by developing new community-based services in partnership with our commissioners, and create new business opportunities for our clinical and commercial operations. The action we need to take is:

a) Develop robust business intelligence so that we have a timely and accurate understanding of the needs of our commissioners (including practice-based commissioning clusters and GPs) and the market in which we work (including intelligence about our NHS and private sector competitors and partners)

b) Develop our relationships with commissioners (including GPs) and NHS provider organisations in order to ensure that we understand their needs, respond rapidly to the issues they raise and identify development opportunities

c) Identify target areas (services, geographical locations, providers, commissioners) for business development, prioritise those opportunities and create plans to translate these opportunities into growth. Examples include the opportunity to consolidate 24/7 ophthalmic A&E departments into Moorfields, and mergers and acquisitions of other ophthalmic services.


41

d) Expand community-based services (including polyclinic sub-tariff services) to expand Moorfields’ portfolio into activities that support commissioners to manage demand

e) Strengthen ophthalmic networks across pathways, delivering the London-wide retinopathy of prematurity (ROP) network and attract new partners/referrers through, for example, GP education events, optometrist training etc

f) Grow the existing commercial operations (developing strategies to expand the private, pharmaceuticals and Moorfields Eye Hospital Dubai operations) and develop new commercial opportunities (developing a commercial strategy, including consideration of partnering with the main high street optician chains)

8.4.2 Strategic theme: Where we work Our aim is to agree the new outreach model, establishing what type of work we are

going to do at which type of facility and redistribute our activity in line with this new model. The action we need to take is:

a) Describe and agree the outreach model in high-level terms

b) Undertake sub-specialty level service reviews (taking account of likely future advances in treatment) to identify the appropriate location for the current and future clinical activities at sub-specialty level

c) Describe and refine the model for service provision at the central base, district hubs and hospital and community-based local facilities to demonstrate that it is clinically and financially sustainable

d) Agree and implement a plan to redistribute activity into this model

8.4.3 Strategic theme: Improve quality Our aim is to ensure our services are of a consistently high quality across all sub-

specialties and locations, building on our reputation for safe and effective eye care and providing an excellent patient experience. The action we need to take is:

a) Review the progress we have made in delivering our annual plans and our overall organisational performance over the last three years

b) Define the standards we apply to all of our services regarding safety, outcomes (including best practice pathways) and experience, and apply them to all locations

c) Develop processes routinely and consistently to gather data on the outcomes of the work we do, benchmark with others and use these to drive performance improvement

d) Define the pathways of care for common conditions and treatments, and ensure that practice in Moorfields’ services follows these agreed pathways (for example, a two-hour cataract pathway), and address the principal causes of patient dissatisfaction (clinical waits, waits on day of surgery)

e) Develop carbon and corporate social responsibility strategies, ensuring we act responsibly


42

f) Develop a strategy for our business as an education provider, setting out how we will continue to maintain our position as a world-class educator of clinical professionals

g) Develop a strategy for our research, setting out the direction of travel for the nature and funding sources of the research we will do, and how we will continue to translate the outputs of research into clinical practice

8.4.4 Strategic theme: Our role and influence Our aim is to be shaping, rather than simply responding to, the ophthalmic market

for integrated and comprehensive research, education and clinical activities. We will maintain our independence as an autonomous provider with a clear identity and a world-class reputation. The action we need to take is:

a) Develop an influencing strategy and communication strategy, including stakeholder management plans

b) Establish existing involvement on national and local ophthalmic groups/bodies, identify gaps and put in place a process to co-ordinate this

c)Developcapabilitytoundertakehorizon-scanningandthinktankactivities,involvingpartners and publishing the outputs

d) Actively raise Moorfields’ profile and its integrated clinical, education and research activities through co-ordinated action /promotion of successes, thinking and world-class findings

8.4.5 Enabling theme: Improving our estate and facilities Our aim is to redevelop our facilities to deliver a central base and local services in

accommodation that is fit for the 21st century and provides a consistently excellent patient environment. The action we need to take is:

a) Undertake assessment of existing estate and facilities management performance

b) Develop a plan to address the most urgent issues in our existing facilities to ensure that they offer an appropriate environment in the short and medium term (includes addressing the most urgent backlog maintenance issues)

c) Identify future estate needs based on service model developed under the ‘where we work’ strategic theme

d) Undertake a strategic options appraisal for the location of the central base, followed by a business case for its development addressing how the trust will be able to meet the planned quality and efficiency improvements (for example, introducing a two-hour cataract pathway)

e) Agree and implement a fundraising strategy for the redevelopment of the central base

f) Identify capital investment required, funding sources and a programme to support the interim City Road issues and the outreach requirements


43

g) Develop estate improvement plans for the outreach locations, including redevelopment strategies for the St George’s, Ealing and Bedford sites, with the aim of creating a consistent high-quality branding and presentation for Moorfields’ services across all locations

8.4.6 Enabling theme: Increase our productivity and efficiency Our aim is to develop and deliver a programme to maximise productivity and

efficiency in all of our clinical and non-clinical services. The action we need to take is:

a) Undertake a scoping study to determine the maximum potential for cost-reducing efficiency savings within the trust

b) Prioritise the productivity opportunities and put in place a programme to deliver them

c) Undertake productivity/workflow reviews of theatres, outpatients and A&E

d) Introduce the routine use of benchmarking information to drive performance improvement and reduce variation in the trust

e) Introduce performance and financial systems to underpin the outreach model

f) Identify opportunities to work in partnership with other providers to reduce non-clinical service costs

8.4.7 Enabling theme: Developing our workforce Our aim is to ensure we have the right workforce, skills and capacity to implement our

clinical model and strategy. The action we need to take is:

a) Identify and agree future workforce models to deliver the clinical strategy

b) Develop a workforce strategy in line with these models, establishing how many people with which skills are needed

c) Develop and implement talent management and succession planning processes in the organisation

8.4.8 Enabling theme: Developing leadership and our organisational design Our aim is to ensure we have the leadership, culture and organisational design we

need to deliver the strategy. The action we need to take is:

a) Identify the organisational design needed to deliver the strategy, including the development of clinically-led business units, with integrated operational and clinical management structures

b) Put in place a leadership programme to develop the leaders and leadership skills and capabilities necessary to develop the organisation and deliver the strategy

c) Translate the identified organisational values into the behaviours needed within the organisation and embed these through appraisal, recruitment and performance processes


44

8.4.9 Enabling theme: Improving our IT and information Our aim is to put the IT and information in place so that we understand what we do

and how well we do it, and to maximise the potential of technology to reduce our cost base and improve the care we give. The action we need to take is:

a)Identifytheprocessandclinicaltechnologyopportunitiesonthehorizonwhichcould further improve processes and service quality, and develop responses to them

b) Develop an IT strategy

c) Develop business cases for workflow and document management systems which improve processes and reduce cost

d) Implement the Open Eyes electronic patient record

e) Develop and implement a management information system (MIS) strategy


45

Our staged and prioritised action plan

9.1 The tables below set out our staged and prioritised action plan to deliver our vision. The key actions associated with each of the nine components of the strategy are identified, alongside our current assessment of the broad timing and sequencing of those actions. The tables show in detail the timing and sequencing over the first three years of implementation, as well as indicating those streams of work which will extend beyondthisthree-yearhorizon.

9.2 The critical interdependencies between streams of work are indicated, as well as the high-level outputs that are anticipated from key workstreams. Many of the actions are, in fact, complex projects in their own right and the next level of detail of implementation planning associated with these areas is being developed.

9.3 The following tables identify separately the timelines for planning activities and for the ongoing implementation and embedding of change so that it becomes ‘business as usual’ for the trust, using the key below:

Key

Planning activity

Ongoing implementation/embedding

9


46

a)

Dev

elop

rob

ust

busi

ness

inte

llige

nce

so t

hat

we

have

a

timel

y an

d ac

cura

te u

nder

stan

ding

of

the

need

s of

our

co

mm

issi

oner

s (in

clud

ing

PbC

clu

ster

s an

d G

Ps) a

nd t

he

mar

ket

in w

hich

we

wor

k (in

clud

ing

inte

llige

nce

abou

t ou

r N

HS

and

priv

ate

sect

or c

ompe

titor

s an

d pa

rtne

rs)

b)

Dev

elop

our

rel

atio

nshi

ps w

ith c

omm

issi

oner

s (in

clud

ing

GPs

) an

d N

HS

prov

ider

org

anis

atio

ns in

ord

er t

o en

sure

tha

t w

e un

ders

tand

the

ir ne

eds,

res

pond

rap

idly

to

the

issu

es t

hey

rais

e an

d id

entif

y de

velo

pmen

t op

port

uniti

es

c)

Iden

tify

targ

et a

reas

(ser

vice

s, g

eogr

aphi

cal l

ocat

ions

, pr

ovid

ers,

com

mis

sion

ers)

for

bus

ines

s de

velo

pmen

t, p

riorit

ise

thos

e op

port

uniti

es a

nd c

reat

e pl

ans

to t

rans

late

the

se

oppo

rtun

ities

into

gro

wth

d)

Expa

nd c

omm

unity

-bas

ed s

ervi

ces

(incl

udin

g po

lycl

inic

sub

-ta

riff

serv

ices

) to

expa

nd o

ur p

ortf

olio

into

act

iviti

es t

hat

supp

ort

com

mis

sion

ers

to m

anag

e de

man

d

e)

Stre

ngth

en o

phth

alm

ic n

etw

orks

acr

oss

path

way

s, d

eliv

erin

g th

e Lo

ndon

wid

e RO

P ne

twor

k an

d at

trac

t ne

w p

artn

ers/

refe

rrer

s th

roug

h, f

or e

xam

ple,

GP

educ

atio

n ev

ents

, op

tom

etris

t tr

aini

ng e

tc

f)

Gro

w t

he e

xist

ing

com

mer

cial

ope

ratio

ns (d

evel

opin

g st

rate

gies

to

expa

nd t

he p

rivat

e, p

harm

aceu

tical

s an

d D

ubai

op

erat

ions

) and

dev

elop

new

com

mer

cial

opp

ortu

nitie

s (d

evel

opin

g a

com

mer

cial

str

ateg

y, in

clud

ing

cons

ider

atio

n of

pa

rtne

ring

with

the

mai

n hi

gh-s

tree

t op

ticia

n ch

ains

)

This

mea

ns

we

nee

d t

o:

Year

1Ye

ar 2

Year

3Ye

ar 4

an

d

bey

on

dC

riti

cal i

nte

rdep

end

ence

Ou

tpu

ts

1. W

hat

we

do

We

need

to

secu

re

our

refe

rral

bas

e,

incr

easi

ng o

ur m

arke

t sh

are

and

broa

deni

ng

our

catc

hmen

t by

dev

elop

ing

new

com

mun

ity-

base

d se

rvic

es in

pa

rtne

rshi

p w

ith o

ur

com

mis

sion

ers,

and

cr

eate

new

bus

ines

s op

port

uniti

es

for

our

clin

ical

an

d co

mm

erci

al

oper

atio

ns.

Ob

ject

ive

Crit

ical

act

ivity

Crit

ical

act

ivity

Dep

ende

nt o

n 1(

a)

Dep

ende

nt o

n 2(

a)

Rout

ine

corp

orat

e bu

sine

ss

inte

llige

nce

repo

rts

Mar

ketin

g pl

an

Com

mis

sion

er in

fluen

cing

and

G

P en

gage

men

t pl

ans

Busi

ness

dev

elop

men

t pl

an

Tend

er p

ipel

ine

Stak

ehol

der

com

mun

icat

ion

plan

Priv

ate

sect

or e

ngag

emen

t pl

an

Com

mer

cial

str

ateg

y


47

a)

Des

crib

e an

d ag

ree

outr

each

mod

el in

hig

h-le

vel t

erm

s

b)

Und

erta

ke s

ub-s

peci

alty

leve

l ser

vice

rev

iew

s (t

akin

g ac

coun

t of

like

ly f

utur

e ad

vanc

es in

tre

atm

ent)

to

iden

tify

the

appr

opria

te lo

catio

n fo

r th

e cu

rren

t an

d fu

ture

clin

ical

ac

tiviti

es a

t su

b-sp

ecia

lty le

vel

c)

Des

crib

e an

d re

fine

the

mod

el f

or s

ervi

ce p

rovi

sion

at

the

cent

ral b

ase,

dis

tric

t hu

bs a

nd h

ospi

tal a

nd c

omm

unity

-bas

ed

loca

l fac

ilitie

s to

dem

onst

rate

tha

t it

is c

linic

ally

and

fina

ncia

lly

sust

aina

ble

d)

Agr

ee a

nd im

plem

ent

a pl

an t

o re

dist

ribut

e ac

tivity

into

thi

s m

odel

This

mea

ns

we

nee

d t

o:

Year

1Ye

ar 2

Year

3Ye

ar 4

an

d

bey

on

dC

riti

cal i

nte

rdep

end

ence

Ou

tpu

ts

2. W

her

e w

e w

ork

We

need

to

agre

e th

e ne

w o

utre

ach

mod

el, e

stab

lishi

ng

wha

t ty

pe o

f w

ork

we

are

goin

g to

do

at

whi

ch t

ype

of f

acili

ty

and

redi

strib

ute

our

activ

ity in

line

with

th

is n

ew m

odel

.

Ob

ject

ive

Crit

ical

act

ivity

Dep

ende

nt o

n 2(

a)

Dep

ende

nt o

n 2(

b)

Dep

ende

nt o

n 2(

c)

Out

reac

h m

odel

in c

once

pt

Sub-

spec

ialit

y le

vel s

trat

egie

s

Agr

eed

clin

ical

ly a

nd

finan

cial

ly s

usta

inab

le m

odel

of

out

reac

h

Out

reac

h de

velo

pmen

t sc

hedu

le


48

a)

Revi

ew t

he p

rogr

ess

we

have

mad

e in

del

iver

ing

our

annu

al

plan

s an

d ou

r ov

eral

l org

anis

atio

nal p

erfo

rman

ce o

ver

the

last

th

ree

year

s

b)

Defi

ne t

he s

tand

ards

we

appl

y to

all

of o

ur s

ervi

ces

rega

rdin

g sa

fety

, out

com

es (i

nclu

ding

bes

t pr

actic

e pa

thw

ays)

and

ex

perie

nce,

and

app

ly t

hem

to

all l

ocat

ions

c)

Dev

elop

pro

cess

es t

o ro

utin

ely

and

cons

iste

ntly

gat

her

data

on

the

outc

omes

of

the

wor

k w

e do

, ben

chm

ark

with

oth

ers

and

use

thes

e to

driv

e pe

rfor

man

ce im

prov

emen

t

d)

Defi

ne t

he p

athw

ays

of c

are

for

com

mon

con

ditio

ns a

nd

trea

tmen

ts, a

nd e

nsur

e th

at p

ract

ice

in M

oorfi

elds

’ ser

vice

s fo

llow

the

se a

gree

d pa

thw

ays

(for

exa

mpl

e, a

tw

o-ho

ur

cata

ract

pat

hway

) and

add

ress

the

prin

cipa

l cau

ses

of p

atie

nt

diss

atis

fact

ion

(clin

ical

wai

ts, w

aits

on

day

of s

urge

ry)

e)

Dev

elop

car

bon

and

corp

orat

e so

cial

res

pons

ibili

ty s

trat

egie

s,

ensu

ring

we

act

resp

onsi

bly

f)

Dev

elop

a s

trat

egy

for

our

busi

ness

as

an e

duca

tion

prov

ider

, se

ttin

g ou

t ho

w w

e co

ntin

ue t

o m

aint

ain

our

posi

tion

as a

w

orld

-cla

ss e

duca

tor

of c

linic

al p

rofe

ssio

nals

g)

Dev

elop

a s

trat

egy

for

our

rese

arch

, set

ting

out

the

dire

ctio

n of

tra

vel f

or t

he n

atur

e an

d fu

ndin

g so

urce

s of

the

res

earc

h w

e w

ill d

o, a

nd h

ow w

e w

ill c

ontin

ue t

o tr

ansl

ate

the

outp

uts

of r

esea

rch

into

clin

ical

pra

ctic

e

This

mea

ns

we

nee

d t

o:

Year

1Ye

ar 2

Year

3Ye

ar 4

an

d

bey

on

dC

riti

cal i

nte

rdep

end

ence

Ou

tpu

ts

3. Im

pro

ve

qu

alit

y

Ensu

re o

ur s

ervi

ces

are

of a

con

sist

ently

hi

gh q

ualit

y ac

ross

all

sub-

spec

ialti

es a

nd

loca

tions

, bui

ldin

g on

our

rep

utat

ion

for

safe

and

eff

ectiv

e ey

e ca

re a

nd p

rovi

ding

an

exc

elle

nt p

atie

nt

expe

rienc

e

Ob

ject

ive

Crit

ical

act

ivity

Dep

ende

nt o

n 2(

c)

Dep

ende

nt o

n 5(

f&g)

Qua

lity

stan

dard

sSe

rvic

e st

anda

rds

Qua

lity

impr

ovem

ent

plan

Out

com

e m

easu

res

Cor

pora

te a

nd s

ocia

l re

spon

sibi

lity

stra

tegy

Educ

atio

n st

rate

gy

Rese

arch

str

ateg

y


49

a)

Dev

elop

an

influ

enci

ng s

trat

egy

and

com

mun

icat

ion

stra

tegy

, in

clud

ing

stak

ehol

der

man

agem

ent

plan

s

b)

Esta

blis

h ex

istin

g M

oorfi

elds

invo

lvem

ent

on n

atio

nal a

nd

loca

l oph

thal

mic

gro

ups/

bodi

es, i

dent

ify g

aps

and

put

in p

lace

a

proc

ess

to c

o-or

dina

te t

his

c)

Dev

elop

cap

abili

tyt

o,a

ndu

nder

take

,hor

izon

sca

nnin

gac

tiviti

es a

nd t

hink

tan

k ac

tiviti

es, i

nvol

ving

par

tner

s an

d pu

blis

hing

the

out

puts

d)

Act

ivel

y ra

ise

the

profi

le o

f M

oorfi

elds

and

its

inte

grat

ed

clin

ical

, edu

catio

n an

d re

sear

ch a

ctiv

ities

thr

ough

co-

ordi

nate

d ac

tion/

prom

otio

n of

suc

cess

es, t

hink

ing

and

wor

ld-c

lass

fin

ding

s

This

mea

ns

we

nee

d t

o:

Year

1Ye

ar 2

Year

3Ye

ar 4

an

d

bey

on

dC

riti

cal i

nte

rdep

end

ence

Ou

tpu

ts

4. O

ur

role

an

d

infl

uen

ce

Shap

ing,

rat

her

than

re

spon

ding

to,

the

op

htha

lmic

mar

ket

for

inte

grat

ed a

nd

com

preh

ensi

ve

rese

arch

, edu

catio

n an

d cl

inic

al a

ctiv

ities

. M

aint

aini

ng o

ur

inde

pend

ence

as

an

auto

nom

ous

prov

ider

w

ith a

cle

ar id

entit

y an

d a

wor

ld-c

lass

re

puta

tion.

Ob

ject

ive

Influ

enci

ng s

trat

egy

Com

mun

icat

ion

stra

tegy

Stak

ehol

der

man

agem

ent

plan


50

a)

Und

erta

ke a

sses

smen

t of

exi

stin

g es

tate

and

fac

ilitie

s m

anag

emen

t pe

rfor

man

ce

b)

Dev

elop

a p

lan

to a

ddre

ss t

he m

ost

urge

nt is

sues

in o

ur

exis

ting

faci

litie

s to

ens

ure

that

the

y of

fer

an a

ppro

pria

te

envi

ronm

ent

in t

he s

hort

and

med

ium

ter

m (i

nclu

des

addr

essi

ng t

he m

ost

urge

nt b

ackl

og m

aint

enan

ce is

sues

)

c)

Iden

tify

futu

re e

stat

e ne

eds

base

d on

ser

vice

mod

el d

evel

oped

in

(2b)

abo

ve

d)

Und

erta

ke a

str

ateg

ic o

ptio

ns a

ppra

isal

for

the

loca

tion

of t

he

cent

ral b

ase,

fol

low

ed b

y a

busi

ness

cas

e fo

r its

dev

elop

men

t ad

dres

sing

how

the

tru

st w

ill b

e ab

le t

o m

eet

the

plan

ned

qual

ity a

nd e

ffici

ency

impr

ovem

ents

(for

exa

mpl

e in

trod

ucin

g a

two-

hour

cat

arac

t pa

thw

ay)

e)

Agr

ee a

nd im

plem

ent

a fu

ndra

isin

g st

rate

gy f

or t

he

rede

velo

pmen

t of

the

cen

tral

bas

e

f)

Iden

tify

capi

tal i

nves

tmen

t re

quire

d, f

undi

ng s

ourc

es a

nd a

pr

ogra

mm

e to

sup

port

the

inte

rim C

ity R

oad

issu

es a

nd t

he

outr

each

req

uire

men

ts

g)

Dev

elop

est

ate

impr

ovem

ent

plan

s fo

r th

e ou

trea

ch lo

catio

ns,

incl

udin

g re

deve

lopm

ent

stra

tegi

es f

or S

t G

eorg

e’s,

Eal

ing

and

Bedf

ord

site

s, w

ith t

he a

im o

f cr

eatin

g a

cons

iste

nt h

igh

qual

ity b

rand

ing

and

pres

enta

tion

for

Moo

rfiel

ds’ s

ervi

ces

acro

ss a

ll lo

catio

ns

This

mea

ns

we

nee

d t

o:

Year

1Ye

ar 2

Year

3Ye

ar 4

an

d

bey

on

dC

riti

cal i

nte

rdep

end

ence

Ou

tpu

ts

5. Im

pro

ve

ou

r es

tate

an

d

faci

litie

s

Rede

velo

p ou

r fa

cilit

ies

to d

eliv

er

a ce

ntra

l bas

e an

d lo

cal s

ervi

ces

in

acco

mm

odat

ion

whi

ch is

fit

for

the

21st

cen

tury

an

d pr

ovid

es a

co

nsis

tent

ly e

xcel

lent

pa

tient

env

ironm

ent.

Ob

ject

ive

Crit

ical

act

ivity

Dep

ende

nt o

n 1(

a)

Plan

to

addr

ess

imm

edia

te

esta

te is

sues

Esta

tes

stra

tegy

, inc

ludi

ng

rede

velo

pmen

t an

d ne

w

prem

ises

Opt

ions

app

rais

al a

nd r

isk

asse

ssm

ents

Cap

ital p

lan


51

a)

Und

erta

ke a

sco

ping

stu

dy t

o de

term

ine

the

max

imum

po

tent

ial f

or c

ost

redu

cing

effi

cien

cy s

avin

gs w

ithin

the

tru

st

b)

Prio

ritis

e th

e pr

oduc

tivity

opp

ortu

nitie

s an

d pu

t in

pla

ce a

pr

ogra

mm

e to

del

iver

the

m

c)

Und

erta

ke p

rodu

ctiv

ity/w

orkfl

ow r

evie

ws

of t

heat

res,

ou

tpat

ient

s an

d A

&E

d)

Intr

oduc

e th

e ro

utin

e us

e of

ben

chm

arki

ng in

form

atio

n to

dr

ive

perf

orm

ance

impr

ovem

ent

and

redu

ce v

aria

tion

in t

he

trus

t

e)

Intr

oduc

e pe

rfor

man

ce a

nd fi

nanc

ial s

yste

ms

to u

nder

pin

the

outr

each

mod

el

f)

Iden

tify

oppo

rtun

ities

to

wor

k in

par

tner

ship

with

oth

er

prov

ider

s to

red

uce

non-

clin

ical

ser

vice

cos

ts

This

mea

ns

we

nee

d t

o:

Year

1Ye

ar 2

Year

3Ye

ar 4

an

d

bey

on

dC

riti

cal i

nte

rdep

end

ence

Ou

tpu

ts

6. In

crea

se

pro

du

ctiv

ity

and

effi

cien

cy

Dev

elop

and

del

iver

a

prog

ram

me

to

max

imis

e pr

oduc

tivity

an

d ef

ficie

ncy

in a

ll of

ou

r cl

inic

al a

nd n

on-

clin

ical

ser

vice

s.

Ob

ject

ive

Crit

ical

act

ivity

Dep

ende

nt o

n 6(

a)

Dep

ende

nt o

n 3(

c)

Cos

t im

prov

emen

t pr

ogra

mm

e

Opt

ions

app

rais

al


52

a)

Iden

tify

and

agre

e fu

ture

wor

kfor

ce m

odel

s to

del

iver

the

cl

inic

al s

trat

egy

b)

Dev

elop

a w

orkf

orce

str

ateg

y in

line

with

the

se m

odel

s es

tabl

ishi

ng h

ow m

any

peop

le w

ith w

hich

ski

lls a

re n

eede

d

c)

Dev

elop

and

impl

emen

t ta

lent

man

agem

ent

and

succ

essi

on

plan

ning

pro

cess

es in

the

org

anis

atio

n

This

mea

ns

we

nee

d t

o:

Year

1Ye

ar 2

Year

3Ye

ar 4

an

d

bey

on

dC

riti

cal i

nte

rdep

end

ence

Ou

tpu

ts

7. D

evel

op

ou

r w

ork

forc

e

Ensu

re w

e ha

ve t

he

right

wor

kfor

ce,

skill

s an

d ca

paci

ty t

o de

liver

the

str

ateg

y.

Ob

ject

ive

Dep

ende

nt o

n 2(

b) a

nd 8

(a)

Wor

kfor

ce s

trat

egy

and

plan

Lead

ersh

ip d

evel

opm

ent

prog

ram

me


53

a)

Iden

tify

the

orga

nisa

tiona

l des

ign

need

ed t

o de

liver

the

st

rate

gy, i

nclu

ding

the

dev

elop

men

t of

clin

ical

ly-le

d bu

sine

ss

units

with

inte

grat

ed o

pera

tiona

l and

clin

ical

man

agem

ent

stru

ctur

es

b)

Put

in p

lace

a le

ader

ship

pro

gram

me

to d

evel

op t

he le

ader

s an

d le

ader

ship

ski

lls a

nd c

apab

ilitie

s ne

cess

ary

to d

evel

op t

he

orga

nisa

tion

and

deliv

er t

he s

trat

egy

c)

Tran

slat

e th

e id

entifi

ed o

rgan

isat

iona

l val

ues

into

the

be

havi

ours

nee

ded

with

in t

he o

rgan

isat

ion

and

embe

d th

ese

thro

ugh

appr

aisa

l, re

crui

tmen

t an

d pe

rfor

man

ce p

roce

sses

This

mea

ns

we

nee

d t

o:

Year

1Ye

ar 2

Year

3Ye

ar 4

an

d

bey

on

dC

riti

cal i

nte

rdep

end

ence

Ou

tpu

ts

8. D

evel

op

le

ader

ship

an

d o

ur

org

anis

atio

nal

d

esig

n

Ensu

re w

e ha

ve t

he

lead

ersh

ip, c

ultu

re

and

orga

nisa

tiona

l de

sign

to

deliv

er t

he

stra

tegy

.

Ob

ject

ive

Crit

ical

act

ivity

Trai

ning

and

org

anis

atio

nal

deve

lopm

ent

plan


54

a)

Iden

tify

the

proc

ess

and

clin

ical

tec

hnol

ogy

oppo

rtun

ities

on

the

horiz

onw

hich

cou

ldf

urth

erim

prov

epr

oces

ses

and

serv

ice

qual

ity, a

nd d

evel

op r

espo

nses

to

them

b)

Refr

esh

the

IT s

trat

egy

c)

Dev

elop

bus

ines

s ca

ses

for

wor

kflow

and

doc

umen

t m

anag

emen

t sy

stem

s w

hich

impr

ove

proc

esse

s an

d re

duce

co

st

d)

Impl

emen

t th

e O

pen

Eyes

ele

ctro

nic

patie

nt r

ecor

d

e)

Dev

elop

and

impl

emen

t a

man

agem

ent

info

rmat

ion

syst

em

(MIS

) str

ateg

y

This

mea

ns

we

nee

d t

o:

Year

1Ye

ar 2

Year

3Ye

ar 4

an

d

bey

on

dC

riti

cal i

nte

rdep

end

ence

Ou

tpu

ts

9. Im

pro

ve

ou

r IT

an

d

info

rmat

ion

Put

the

IT a

nd

info

rmat

ion

in

plac

e so

tha

t w

e un

ders

tand

wha

t w

e do

and

how

wel

l w

e do

it. M

axim

ise

the

pote

ntia

l of

tech

nolo

gy t

o re

duce

ou

r co

st b

ase

and

impr

ove

the

care

w

e gi

ve.

Ob

ject

ive

Dep

ende

nt o

n 2(

b)

Inno

vatio

ns r

evie

w

IT s

trat

egy


55

Conclusions

10.1 Moorfields Eye Hospital NHS Foundation Trust is the leading provider of eye health services in the UK and a world-class centre of excellence for ophthalmic research and education. Moorfields has a reputation developed over more than two centuries for providing the highest quality of ophthalmic care, and more than 1,400 staff who are committed to sustaining and building that reputation and ensuring we remain at the cutting edge of developments in ophthalmology.

10.2 Our vision is that by 2020, we will be providing a more comprehensive range of eye care services operating through a network of centres linked to a state-of-the-art facility in London, shaping the development and delivery of the eye health agenda nationally (rather than just responding to it), known for delivering the highest standards of patient experience, outcomes and safety across all of our sites, at the forefront of international research with our partners, and maintaining our leading role in the training and education of eye care clinicians.

10.3 In July 2010, the new coalition government published its health white paper “Liberating the NHS”. Our vision and strategy is wholly consistent with the themes in this white paper of placing patients at the heart of all we do, a relentless focus on improving outcomes and of empowering clinicians to deliver results. Engaging with clinicians in primary care to develop local services to meet local needs is at the core of the strategy we have developed.

10.4 The work we have undertaken to date, and set out in this document describes the direction of travel for the development of Moorfields Eye Hospital NHS Foundation Trust – but is not an endpoint in itself. Our strategy will continue to develop and be refined as our organisation matures further and as the context within which we operate also continues to change.

10.5 The actions we need to take are being embedded in our annual planning processes and progress with the delivery of the plan will also be monitored by the trust board.

10

Moorfields Eye Hospital NHS Foundation Trust

162 City Road, London EC1V 2PDTel: 020 7253 3411www. moorfields.nhs.uk

© September 2010, Moorfields Eye Hospital NHS Foundation Trust

our vision of excellence - moorfields eye hospital...take to deliver our vision). our mission and...

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