Clinical  Strategy

North Cumbria Integrated Care NHS Foundation Trust – 2025 to 2030

On this page:

Welcome

Our purpose is to deliver ‘safe, high quality care, every time’ aiming to be a ‘nationally recognised centre for excellence for integrated rural and coastal medicine and care’;
our Clinical Strategy will enable us to deliver this.

I would like to thank all those involved in developing this including our patients, our communities and our people who have provided a wealth of information which has been key to informing our strategy.

We are an integrated Trust working within a system and recognise the need to collaborate with our partners including within the Great North Healthcare Alliance to ensure care is available for our patients in the right place and at the right time.

It is an exciting time in Cumbria as we work with University of Cumbria and Imperial College, London to open the first medical school located in Carlisle. Pears Cumbria School of Medicine opens in September 2025 and provides an opportunity to locally train and retain doctors within Cumbria.  

In addition to opportunities for education we want to increase our focus on research and learning; we want all our people to work with us and be involved in continuous innovation so we can improve pathways of care for patients within Cumbria.

Other enabling strategies will be developed alongside this; including the Cancer Strategy and the Mental Health and Learning Disabilities Strategy as directed by the Trust’s Corporate Strategy.

We look forward to working on this together.

Dr Adrian Clements
Executive Medical Director

Introduction

Our Purpose: "Safe, high, quality care for our patients every time"

Our values:

Kindness - Kindness and compassion cost nothing, yet accomplish a great deal
Respect - We are respectful to everyone and are open, honest and fair - respect behaviours
Ambition - We set goals to achieve the best for our patients, teams, organisation and our partners
Collaboration - We are stronger and better working together with and for our patients

This Clinical Strategy will enable us to deliver our Corporate Strategy and our ambition to become a ‘nationally recognised centre for excellence for integrated rural and coastal medicine and care’.

As a clinically led organisation our Collaboratives have been leading the development of this. 

Over the next year, we will turn this 5 year strategy into a programme of implementation. We will work with our teams and our partners to turn our ambition into reality to better serve our patients and communities.

As we move forward we want to make sure where improvements and transformations are required our patients are central to the review and re-design process and through co-production we can meet the expectations of our communities.

We have engaged with Our People, Our Patients and Our Communities adopting a co-design approach for this strategy.

Research, Learning and Continuous Improvement

At North Cumbria Integrated Care NHS Foundation Trust, (NCIC) we have a strong commitment to Research, Learning and Continuous Improvement. These offer opportunities for our staff to develop and maintain skills to provide high quality care for our patients and will be key areas in developing and delivering our strategies.

Over the next 5 years we will continue to develop a culture which promotes positive learning environments for our People, across all professional groups, to ensure they are equipped with the capabilities to develop their skills and see research, learning and continuous improvement as integral to their role. 

We commit to delivering the NHS Long Term Plan and work with partners across health and education to support new initiatives.

Our Research and Development Manager says:

“Over the next 5 years the NCIC research department’s strategic priorities are to both align ourselves with the national strategy of the National Institute for Health Research (NIHR) and with the needs of our local population. Through research we aim to generate data that will allow leaders and policy makers to successfully advocate for our patients. We will help in the delivery of excellent clinical care by supporting innovation, and in the recruitment and retention of high calibre academic clinicians.”

Our key priorities are:

• To increase opportunities for patient participation both by streamlining our research processes and by creating a positive research culture within the organisation so that we are able to work at our full capacity to deliver NIHR portfolio projects.
• To develop the research workforce by providing research and training opportunities for healthcare professionals and researchers to develop their research skills and developing a clear career structure for the research workforce.
• Foster collaboration by continuing to support and develop our alliance-based approach to research work in North Cumbria. This includes ensuring the resilience of the primary care systems supported by NCIC research systems, continuing to support the role of the Direct Delivery Team in North Cumbria, and continuing to collaborate with other academic research and clinical partners in North Cumbria.
• We will seek opportunities to develop further partnerships and activities with existing and emerging clinical and research structures associated with North Cumbria.

PCSM Research Hub; co-Directors Professor Jonathan Weber CBE and Professor Sophie Day say:

“We have established a Research Hub at the new Pears Cumbria School of Medicine (PCSM), funded initially through the Imperial NIHR BioMedical Research Centre (BRC). The Research Hub will work in close collaboration with Imperial College, the University of Cumbria and with NCIC and other NHS Trusts in Cumbria.

“Starting in 2025, the Research Hub will fund research degrees, research projects and protected research time for clinicians and Nursing, Midwives and Allied Health Professionals at NCIC. We aim to build research partnerships between the NHS and PCSM, together with Cumberland Council and other Universities in NW England. A public Webinar series will commence in Q2 2025, showcasing medical research and clinical care at NCIC.”

Our Head of Nursing, Clinical Education and Practice Development says:

“We will support our nurses, midwives, allied health professionals and care support workers to access learning opportunities to advance their knowledge and skills to enable them to provide high quality, safe and effective care for our patients. 

“Working in partnership with our further and higher education providers we will provide quality placements and learning experiences for all our learners ensuring our future workforce has the knowledge and skills to provide exemplary care.”

Our shared purpose statement is:

We inspire and empower our staff and learners to develop and grow to confidently achieve their potential and provide high quality safe care.

Our Director of Medical Education says:

“NCIC NHS Foundation Trust is in a good place for Medical Education, and we are very proud of that. We now have the largest number of doctors in training and medical students ever, coming to join us in North Cumbria to work and learn. 

“We have moved out of a very challenged position to a strong and positive reputation for competence and quality within our region with increasingly positive outcomes and more opportunities for innovation and expansion coming our way.

“High quality clinical services go hand in hand with high quality learning programmes and environments, where the evidence shows that clinical outcomes improve where educational performance improves, and this also serves to make us a more attractive place for doctors to come and work with us in the long term.”

Pears Cumbria School of Medicine:

2025 sees the opening of the new Pears Cumbria School of Medicine, our partnership with the University of Cumbria and Imperial College, London. Over the next few years we will welcome these new postgraduate students into our services, supporting them to learn and develop towards obtaining their medical degree and qualifying as doctors. 

This is a major strategic step forward for NCIC and the wider Cumbria Health Care system, one which is designed to attract and retain doctors to Cumbria for the needs of Cumbria and part of our shared direction towards being a centre of excellence for rural and coastal medicine.

Our Approach

Our Clinical Strategy is designed to deliver the purpose, ambition and objectives set by our Board in our Corporate Strategy.

To develop this we used Population Health data from our experts and we listened to our people, our patients and our communities in the following ways:

We used what we heard to develop our Clinical Strategy Principles and Themes which informed, and will continue to inform the work of our Collaboratives.

Population Health

North Cumbria’s overall population has remained static over the past 10 years, but with a significant demographic shift towards an older population, the number of adults aged 65+ has increased by 20%.

Based on the information above if our healthcare system remains unchanged we will need an additional 55 beds in the next 5 years.

To enable people to live longer, healthier lives we need to focus on prevention and earlier intervention which means empowering patients and supporting our communities to look after their health and wellbeing with our healthcare system re-designing pathways to enable this.

Our aim is to improve equity of access and outcomes for all.

We Heard

We heard from our communities, our patients, their families and our people.

Over 72% of responses were completed by people who had been treated in hospital or had a family member who had been treated in hospital within the past 12 months.

We asked you:

What was most important to you in regards to your care?

We asked: Where would you prefer to be treated whilst you recover from illness?

You said:

• Letters are difficult to understand; they are not accessible and need to be improved.
• You did not feel informed about your healthcare.
• Relatives feel disconnected from patients and their care and are not given timely information.
• You felt frustrated at the lack of information sharing and communication between
  health partners.
• Last minute cancellations were an issue.
• Follow-up processes were not working for you.
• You were frustrated at discharge pathways both timeliness and processes.
• You want your dignity and privacy to be maintained at all times.
• Car Parking was not adequate for attending appointments or visiting patients.

All feedback has been considered and thematic analysis has allowed the Clinical Strategy to be developed. Our Clinical Strategy includes Principles, Themes and Strategic Outlines; all derived from what we heard. Strategic Outlines will be either Trust-wide aspects of care that must be considered by all our services or Collaborative specific.

Our clinical strategy: Thematic Analysis

We read and considered all feedback and completed a thematic analysis; this has resulted in the following underpinning principles and themes.

Clinical Strategy Principles

We heard from our patients, our people and our communities what mattered to you and what should underpin all healthcare services, these are our principles:

Our principles and their definitions are broad and came out in most themes from across stakeholder groups. They provide the foundations upon which all our projects, improvements and services should be designed and delivered.

Clinical Strategy Themes

Building on our principles our themes have been developed from what we heard. We analysed and grouped feedback to identify what was important for our patients, our people and our communities; these are our themes:

Details are provided under the themes to give context to what we heard and seek to give focus of the priorities when Collaboratives are detailing their strategic outlines, implementation programmes and project plans.

How we will get there:

Our Clinical Strategy is the initial piece of our framework but further development is required to implement a comprehensive Performance Management Framework which the Trust can use to demonstrate progress and improvement.

Strategies and plans:

The Collaboratives will now develop their implementation programmes which will include details of the required projects with appropriate objectives, measures and timelines. Each project will then progress using project management and/or quality improvement methodology and co-production with our patients, people and communities.

We will use a golden thread to ensure each objective can link from its project area to the Themes within the Clinical Strategy and objectives within the Corporate Strategy to demonstrate how the work is supporting the progression of Trust strategic direction as well as improving the Trust’s position. 

We expect the underpinning principles to be considered as part of each project/initiative as the basis upon which the Trust needs to operate.

The enabling strategies will be considered and interdependencies detailed within the Collaborative implementation programmes and individual project plans.

How the current priorities and high level aims link to the Clinical Strategy Themes and Corporate Strategy objectives are demonstrated in Appendix 1; this will be developed as we progress implementation.

In all planning and co-production we will work with our partners, including the Great North Healthcare Alliance and North East & North Cumbria Integrated Care Board.

NCIC Trustwide Strategic Outline

We provide hospital and community health services over 2,600 square miles to more than 320,000 people, everywhere from Carlisle to Kendal and the Cumbria coast to the North Pennines.

We’re responsible for delivering over 70 services across 15 main locations and our people number over 6,500.

The Strategic Outlines are intended as a high level overview of some priority areas which have been detailed as ‘Aims’ at both Trust level and Collaborative level.

‘Enablers’ are areas of work, actions or projects that could be considered to enable the Aims to be delivered; this document does not intend to form a delivery plan and one enabler could link to one or more aims.  The enablers also do not fully encompass the work required in its totality; this level of detail will be included in the Collaborative implementation plans.

Aims: We Will

• Be proactive in listening to OUR patients, OUR people and OUR communities voices when planning for our future to redesign pathways to deliver safe, high quality care every time.
• Ensure the Patient is at the centre of all care, decisions and actions.

• Ensure whilst a patient is in our care their privacy and dignity is protected at all times.
• Improve communication mechanisms for OUR Patients, including their families, OUR People and OUR Partners.
• Review and where necessary modify patient discharge, follow-up and cancellation pathways to achieve best practice and improve efficiency and productivity.
• Provide timely care across all our services.
• Deliver end of life care to our patients and their families, in their preferred place.
• Ensure best value services by using improvement methods to minimise waste for our patients and our people.
• Maximise our use of technology to enable patients to access clinical expertise.
• Maximise the use of all clinical space across NCIC where face to face contact is required.
• Match staffing capacity to demand including the development of Trust roles as pathways are re-designed.
• Effective utilisation of existing and new digital enhancements and technology.

Enablers:

• Renewed focus on Trust values and actively demonstrating required behaviours from our people to maintain our patients are at the centre of all we do.
• Ensure representation in coproduction groups from across communities within North Cumbria.
• Improve design and accessibility of written communication to take into account health literacy to enable equitable access to care.
• Work within and across Collaboratives to enhance pathways, both Trust wide and specialty specific.
• Collaborative working to enable earlier discharge to receive treatment and recover at home.
• Improved and increased use of telehealth to include remote monitoring, rehabilitation and clinician contact.
• Consideration of estate usage for procedures based on care closer to home, requirements for diagnostics and treatment and the benefit of moving to ‘one-stop’ clinics, where appropriate.
• Effective service planning to ensure procedures are done in the most appropriate setting.
• Interface development with partners to improve information sharing.
• Development of staffing roles delivering the right care, in the right place at the right time which includes 7 days working, increased use of digital technology and multi-site working.
• Develop a consistent approach to assessing, evaluating and delivering new technology in a timely way.
• Collaboration with Healing Arts initiative.
• Collaboration with Alliance partners to deliver sustainable models of care.
• Use feedback to take the learning points so we can continuously improve our processes, efficiency and productivity.

Strategics Outlines: Our Collaboratives

NCIC Collaboratives

Each of our eight Collaboratives is chaired by an experienced clinician and, together with our executive directors, they form our senior leadership team.

Critical Care, Anaesthesia and Theatres

Aims:

• Aim to deliver a range of high quality services which support a range of Trust requirements.
• To deliver timely, high quality care.
• Continue to grow our workforce to meet demand.
• Aspire to be an excellent place to work.
• To move forward and develop our services in a financial sustainable way.
• We will work in close partnership with fellow Collaborative teams across our trust in delivery of strategic goals.

Enablers:

• Deliver an elective surgical hub at West Cumberland Hospital.
• We will work to meet the recommendations of the North of England’s Critical Care Network Peer Review
• Flexible and right-sized workforce that has the right skills to deliver the care required across North Cumbria.
• Encourage positive learning environments which enable staff to develop the skills they need
• Improve productivity of theatre services.

Community Care

Aims:

• Integrated community responses to keep patients closer to home where possible using access to speciality care and increasing provision of services in patients home or closer
  to home.
• Increase care delivered in community hospitals rather than care being at our acute sites
• Development of community hubs to support closer to home care and diagnostic pathways to enable different opportunities.
• Increase our Frailty service.
• Providing high quality end of life care.
• Increased integration and ensure sustainability of specialist services.
• Retention and resilience with a flexible workforce that can deliver care over varying services and locations.
• Improve equity of access.
• Standardise the preventative health access across the ICCs to support patients before crisis.
• Standardise skills required for Community Hospital workforce.

Enablers:

• Develop a Single Point of Access.

• Increase ability to step up and step down into community hospitals.
• Provide a Hospital at Home service able to respond to community need. Reviewing services including Virtual Wards, Urgent Community Response Team, Day Units and Community Hospitals.
• Work with teams on staff satisfaction and empowering the teams to support change.
• Considering and improving culture and environments within teams utilising TED tool.
• Increasing support network across the Collaborative to reduce isolation and support small teams.
• Enabling more patients to have end of life care in their preferred place.
• Review where clinics are sited to reduce inequity of access.
• Review capacity and demand to meet community need.

Provide learning and development to enhance skills of our workforce to deliver the right care to our population.

Diagnostic and Clinical Support

Aims:

• Make sure the Patient is at the centre of all care, decisions and actions.
• Improvement of health literacy within the Trust.
• Improve communication mechanisms to OUR People, OUR Partners and OUR Patients; including their families.
• Review discharge pathways.
• Identified changes which will result in reduced waiting times.
• Improved follow up pathways.
• Review and adhere to cancellation procedures.
• Maintain and modernise/digitalise equipment eg blood sciences testing, CT scanner, Radiopharmacy, aseptic suite and dispensaries.
• Pharmacy to continue to provide organisational expertise on medicines usage and optimisation ensuring the right medicines are getting to the right patients at the right time in the right place.

Enablers:

• Maintain a stable, workable management structure that provides direction and support to the departments within the Collaborative.
• Listen to patients and staff about how services are run – active coproduction.
• Maintain and modernise equipment e.g. Blood sciences testing, CT scanner, Radiopharmacy.
• Improving use of Point of care testing.
• Digital histopathology – enabling closer links with colleagues in other Trusts (improving partnership working).
• Collaborative improvement of lipid management pathway.
• Make sure the right medicines are getting to the right patients at the right time.
• Community Diagnostic Centre (CDC), opening – providing additional capacity for diagnostic imaging.

Emergency Care

Aims:

• We want to continue to recruit and be able to provide consistent senior medical staffing at both CIC and WCH.
• To develop Same Day Emergency Care (SDEC) services at both sites and be able to provide a consistent 7 day SDEC service at Cumberland Infirmary including more of our specialty teams.
• Strengthen Urgent Treatment Centre (UTC) resources to provide services close to our patient population.
• Develop a system of continuous flow to manage unplanned admissions.
• Continue to develop our reputation for education and training to consolidation our recruitment and retention of all staff groups.
• Ensure robust governance processes are in place to facilitate continual learning for improvement, improved patient experiences, patient and staff safety and provision of quality care.
• Strengthened staffing at UTCs.
• Review estate provision on CIC site for emergency and acute care.
• Working with internal and external partners to improve pathways of care.
• We will listen to our patients so we develop appropriate services that are easy to navigate.
• We will listen to our staff to ensure their wellbeing and have a reputation as a great place
  to work.

Enablers:

• Work closely with the development of the Care Co-ordination Hub/ Single Point of Access to move away from the Emergency Department (ED), being the default for unplanned healthcare needs.
• Develop relationships with community services to enhance patient care and provide care as close to home as possible.
• Upgrading of ED at CIC, expansion of SDEC at CIC and relocating the Acute Medical Unit  (AMU) closer to ED and SDEC at CIC.
• To work with the frailty team to develop services that are appropriate to patients needs and facilitate discharge home where appropriate.
• Work with specialty teams to develop same day services and other resources to avoid admission.
• To make full use of technology to support patient care and integrate ED into Electronic Patient Record (EPR).
• Increase availability of Consultant / Senior Decision Maker presence at CIC and WCH
• Continue to base nurse staffing establishments benchmarked against Safer Nursing Care twice yearly audits throughout the collaborative.
• Integrated UTC at CIC site and development of similar service at WCH site with need to develop safe staffing and leadership provision.
• 7 day SDEC services at CIC and extended service at WCH.
• 7 day radiology services at Penrith.

Speciality Medicine

Aims:

• Ensure equity and timely access to care for patients.
• Enable more patients to have acute care and their recovery at home.
• Review and improve patient pathways.
• Improve access to Neurology services across Cumbria and improve patient experience.
• Enhance Alliance working by developing pathways to increase quality of care across services for patients.
• Further enhance input from medical specialities into WCH.
• Increase provision of kidney dialysis across North Cumbria.
• Increase screening and preventative healthcare for cancer and diagnostic work closer to home within respiratory pathways.
• Enable more patients post stroke to access hyper acute therapeutics and enable increased recovery at home.
• Early invasive and appropriate care for all patients in North Cumbria.
• Develop ability to see patients in outpatient settings across North Cumbria rapidly as an alternatively to admission.

Enablers:

• Collaboration – working together in all areas.
• Regional Partners – support and working relationships.
• Improve diagnostic capabilities to increase time window for hyper acute intervention for patients post stroke.
• Increase availability of rehabilitation at home to improve earlier discharge to enable recovery at home for patients post stroke.
• Review pathways in Haematology.
• Effective capacity utilisation of catheter labs.
• Develop frailty services at CIC and WCH to provide alternatives to admission and earlier discharge.
• Pathway development of one stop model for outpatient clinics.

Specialist Surgical Care

Aims:

• We want to provide safe, high quality, timely care every time for all.
• We will ensure patient care is facilitated in the place best for the patient.
• We want to efficiently utilise our WCH elective hub.
• We want to be an excellent place to work.
• We want to have the right sized multi-disciplinary substantive workforce in place to support the needs of our patients.
• We will encourage and facilitate flexible and cross-site working.
• We will improve communication with our people, our patients and our communities; share good news and achieved improvements.
• We aspire to meet national statutory, regulatory and contractual requirements, national targets and KPIs.
• We will be responsible with our finances.

Enablers:

• We will use the elective hub with its efficiencies following Get it Right First Time (GIRFT) pathway to improve efficiency, productivity and financial sustainability.
• We will strengthen our links with our Community Teams to better support our patient pathways.
• Increase virtual clinics and community based care to provide care to patients in different ways.
• Consider equity of access and consider how services changes could improve access.
• Develop an attraction, recruitment and retention programme.
• We will be a supportive workplace by actively encouraging Trust values and behaviours and challenge where those are not demonstrated.
• We will develop a learning and listening culture where we can improve services based on both, patient and service experiences.
• We will support our teams in flexible cross-site working; ensuring job plans and rotas facilitate this.
• Aim to work with our education teams and increase the number of resident doctors into our collaborative.

Surgical Care

Aims:

• We aspire to improve the efficiency and delivery of services to meet our local patient requirements.
• Recruit and retain a highly skilled clinical workforce to work alongside managerial teams to meet service demands.
• Continue working to transform colorectal, upper GI and urological cancer pathways to lead performance regionally.
• Utilise the estate and workforce investments we have made to improve Referral to Treatment Time (RTT) performance particularly around High Volume Low Complexity (HVLC) activity.
• Efficiently utilise our Elective Surgical Hub at Whitehaven, Community Diagnostic Centre at Workington and existing estate.
• Improve equity of access to our surgical services across North Cumbria.
• Further develop our digital strategies, virtual care and virtual pathways for our patients as we recognise the need to ensure equity of care for our entire population.

Enablers:

• Enabling infrastructure to deliver high quality care across North Cumbria.
• Utilising existing resources effectively.
• Development of effective partnerships with other services and teams across the region.
• Transformation of culture within the Trust to instil accountability, ownership, fairness and professionalism.
• Delivery of the workforce strategy to improve recruitment and retention of our workforce with a view to maintaining and always delivering high professional standards.

Women and Children's

Aims:

• We want to an exemplar service for providing high quality teaching and learning environments for all staff groups and students.
• Continue to develop governance to ensure a safe and sustainable service and to ensure our workforce are well supported and work effectively together.
• Promote a culture of continuous improvement.
• Be an excellent place to work.
• Our teams will work effectively together and with both internal and external partners to deliver the best possible care to our patients.
• We will develop our people with the skills they need to perform their roles to a high standard.
• We will have teams that are right-sized to meet patient demand.
• Increase substantive staff (medical, midwifery and nursing) to improve capacity to meet patient needs.
• Meet constitutional standards for RTT with a focus on Cancer pathways.
• Comply with all areas of the Maternity Incentive Scheme over the next 5 years.
• Deliver clinical pathways that adhere to the Core 20 plus 5 public health priorities for reducing health inequalities for children and young people.
• Redefine our neurodevelopmental pathways for children and young people in line with national best practice to reduce waiting times for autism diagnosis.

Enablers:

• Use capacity and demand modelling including job planning to develop an effective service plan
• Actively recruit the right people to deliver right care in the right place to retain the expertise within our medical teams.
• Review requirements and appropriate allocation of resources to meet demand and requirements for Maternity Incentive Scheme and elective care. 
• Continue regular Maternity Champions meeting to increase profile of service within Trust.
• Increase day case rates to provide a sustainable and timely service to patients.
• For children and young people (CYP) deliver on the following:

• Asthma: decrease number of asthma attacks and reliance on medication.
• Diabetes: increase access to real time continuous glucose monitors and insulin pumps.
• Epilepsy: increase access to specialist epilepsy nurses for those with autism or and learning disability.
• Oral Health: decrease tooth extraction numbers due to decay for children aged under 10.
• Mental Health: act as partners that can support with improve access rates to CYP mental health services.

• Support our partners with an effective care pathway for neurodevelopmental conditions.
• Develop the contribution of Advanced Nurse Practitioners to the Paediatric medical team and empower these roles to strengthen our governance and best practice guidelines.
• Promote a safe working environment where there is consistent collaboration with maternity, neonatal and paediatric care to provide high quality and safe outcomes to our CYP.

Taking this forward

Thank you, for reading our Clinical Strategy 2025-2030

In order to deliver our Clinical Strategy, we will develop our implementation plans covering the next 1-5 years alongside other enabling strategies including our Estates and People strategies.

We will be making changes within NCIC, working in co-production with our patients, our people and our partners to redesign pathways across our Integrated Care System to ensure our patients in North Cumbria receive high quality, timely care.

If you’d like to work with us on this or share ideas on how we can deliver our Clinical Strategy then please contact us: Medicaldirectorate@ncic.nhs.uk