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UCLH priorities for 2014/15 Simon Knight Director of planning and performance 27 th January 2014.

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Presentation on theme: "UCLH priorities for 2014/15 Simon Knight Director of planning and performance 27 th January 2014."— Presentation transcript:

1 UCLH priorities for 2014/15 Simon Knight Director of planning and performance 27 th January 2014

2 2 Aims of the session  To let you know what our plans / priorities currently are  To hear what you think of them

3 3 Agenda  What’s happening across the NHS  What’s the current state of play at UCLH  Time for questions and observations  Our plans for 2013/14  Your views on our plans  Next steps

4 4 The general environment  Patient to be at the centre of all planning and delivery: “nothing about me without me”  Impact of the Francis report  Care Quality Commission inspections  Clinical Commissioning Groups and specialised commissioners  Increased emphasis on integration  Drive to centralisation of specialised care  Significant pressures on funding

5 5 NHS culture and care questioned Francis report Patients ‘failed by a system which ignored the warning signs and put corporate self-interest and cost control ahead of patients and their safety’ 290 recommendations Keogh review 14 hospitals with ‘excessive’ deaths Identified key risk factors and warning signs Berwick report Focus on patient safety and regulation NHS remains an ‘international gem’

6 6 Key recommendations: a new NHS culture Renewed focus on quality Openness, transparency and candour Empower patients and staff Develop outstanding leaders New inspection regime: Chief Inspector of Hospitals

7 7 NHS financial challenge: save £30bn by 2020

8 8 Financial challenges for hospitals  Prices paid to hospitals reduced: NHS efficiency  Some CCGs have a large deficit  Some CCGs have been affected by funding changes  Impact of Better Care Fund  Specialist commissioners need to make big savings  Contract penalties

9 9 What does this mean for UCLH?

10 10 What patients say  UCLH performs well in patient surveys: Overall rating of care Would you recommend the hospital  Key areas for improvement from surveys:  Trust and confidence in nurses  Nurses: answers you could understand  Hospital food was fair or poor  Planned admission: date changed by hospital  Key lesson from complaints: booking processes

11 11 What members and governors say  Key things we hear from members and governors: Booking processes Getting in touch with staff in the hospital Waiting times in the new Cancer Centre  Emphasis from governors on: Reducing medication errors Reducing pain Improving how care is integrated

12 12 What GPs say

13 13 What GPs say  Positive about the clinical services that we provide  Things that GPs want us to get better on:  Clarity around our billing for services  Booking processes  Getting in touch with staff in the hospital  Discharge letters (following A&E visit, outpatient appointment or inpatient stay)

14 14 What the CQC said about our services “Our judgement is that this is an excellent hospital in many ways – but the failings we identified are preventing it from achieving excellence across the board. The trust has told us it is taking action – and we expect to return in due course to find that the problems have been fixed.” “Our judgement is that this is an excellent hospital in many ways – but the failings we identified are preventing it from achieving excellence across the board. The trust has told us it is taking action – and we expect to return in due course to find that the problems have been fixed.”

15 15 What the CQC said about our services “The vast majority of patients spoken to were very positive about the care they received, and staff were proud to work at the trust and of the level of care they were able to deliver. The trust has a strong board and clear governance structure which has led to high levels of care being maintained in most areas.” “The vast majority of patients spoken to were very positive about the care they received, and staff were proud to work at the trust and of the level of care they were able to deliver. The trust has a strong board and clear governance structure which has led to high levels of care being maintained in most areas.”

16 16 What the CQC said about our services “It has a stable and experienced Board and the trust’s Governors act very much as patients champions, providing challenge” “We were also impressed with the emphasis placed at all levels from the trust’s board and governors down to ward level on putting the needs of patients first” “It has a stable and experienced Board and the trust’s Governors act very much as patients champions, providing challenge” “We were also impressed with the emphasis placed at all levels from the trust’s board and governors down to ward level on putting the needs of patients first”

17 17 What the CQC said about our services `we observed many instances of good and in some cases outstanding care’ ‘vast majority of patients … were very positive about they care they received’ `staff told us they were proud to work at the trust and proud of the level of care they were able to deliver’ `people we spoke to were extremely complimentary about the compassionate care and treatment they received’

18 18 What the CQC said about A&E ‘Commitment of A&E staff to delivering good care’ In A&E `excellent caring staff, including positive caring interactions with patients’ `the patient feedback of their experience of A&E was overwhelmingly positive’ ‘The A&E is inadequate and compromises the safe delivery of care and treatment ‘

19 Compliance actions from the CQC report 1. Completion of the World Health Organisation safe surgery checklist 2. Review current A&E and children’s A&E provision Staff Leadership Environment 3. Improve the quality and completeness of people’s care assessments, care plans and care delivery records 4. Improve the care and security storage of patient records

20 20 How we are performing against targets Where we are on track:  Hospital standardised reported mortality  Patient surveys  MRSA: but close to the target  Cancer waiting time targets; but room for improvement still

21 21 How we are performing against targets Our key challenges: Running out of space: A&E, beds, theatres  A&E 4 hour wait  Referral to treatment waiting times  Clostridium difficile cases  Cancer patient experience

22 22 Other achievements in 2013/14  Dr Foster Guide: strong performance  Driving the programme to reconfigure cancer and cardiac services in the area  Running our organisation according to our values

23 23 Our values

24 24 Questions and thoughts?

25 25 So what does this all mean for our plans?

26 26 Fundamentals Draft objectives for 2014/15 Differentiating our patient services Financial health Deliver cost savings Deliver wait times Develop staff Integrating care with partners’ R&D and education Develop clinical services Clinical outcomes Patient safety Patient Experience Delivering quality for our patients

27 27 Clinical outcomes Fundamentals Differentiating our patient services Financial health Deliver cost savings Deliver wait times Develop staff Integrating care with partners’ R&D and education Develop clinical services Clinical outcomes Patient safety Patient Experience Delivering quality for our patients

28 28 Patient safety and outcomes  Reduce hospital acquired pressure ulcers  Reduce number of blood clots  Reduce medication errors  Improve communication and handover through use of surgical safety and ward safety checklists  Reduce hospital acquired infections  Specialty outcome measures

29 29 Maintain performance on hospital mortality  Learning from adverse outcomes  Action on infection and other safety initiatives

30 30 Further reduce levels of MRSA MRSA coming down fast ……

31 31 Clostridium difficile Clostridium difficile: above our target of …. But very demanding target of 39 in 2013/14 (44 in 2012/13)

32 32 Patient experience  Improve the appointment and booking services we offer to patients  Improve the quality of communication and interaction between clinicians and patients  Pain: work towards the pain-free hospital

33 33 Compared to other London hospitals Peer London Teaching HospitalPosition against peers Score out of score (position) Guy’s & St Thomas’ (2) UCLH (1) King’s College (6) Chelsea & Westminster (5) St George’s (4) Imperial College (3) Barts & the London (8) Royal Free (7)

34 34 Issues arising from 2012 inpatient survey  Planned admission: date changed by hospital  Trust and confidence in nurses  Nurses: answers you could understand  Hospital food was fair or poor  Improving experience for  maternity patients  cancer patients  outpatients

35 35 Developing services Fundamentals Differentiating our patient services Financial health Deliver cost savings Deliver wait times Develop staff Integrating care with partners’ R&D and education Develop clinical services Clinical outcomes Patient safety Patient Experience Delivering quality for our patients

36 36 Research and education  Implement the Biomedical Research Centre programmes of work, with a focus on experimental medicine  Increase patients going through clinical trials  Deliver top quartile experience for all staff groups going through educational programmes at UCLH

37 37 Patient pathways and services  Transformational change in how we care for people across social care and health, supported by the Better Care Fund  Transform care pathways for key services  Improve timeliness and quality of all communications with GPs and community care provider

38 38 Develop clinical services and facilities  Implement plans to further develop our strategic service priorities: neurosciences, cancer and women’s health  Shape and deliver London Cancer and London Cardiovascular  Move to a two site campus model

39 Cancer and cardiovascular Centralising specialist care saves lives (e.g. stroke) World-leading centre for cardiovascular services at Barts Merger of the Heart Hospital and London Chest UCLH to become specialist hub for most cancers Engagement exercise underway Could save 2,000 lives

40 1 3 UCLH Head and neck Prostate and bladder Brain Haematology Oesophago-gastric 4 2 Renal Haematology Brain Queen’s Hospital Barts Health Royal Free London Haematology Radiotherapy 5 5 North Middlesex Radiotherapy Proposed Specialist Cancer Changes

41 PBT focuses the radiation on the tumour. This is of particular importance when there is close proximity to key organs

42 ‘Phase 4’: Proton Beam Therapy and further inpatient capacity A new inpatient facility with additional theatre capacity and the UK’s first Proton Beam Therapy unit Additional inpatient and theatre capacity required ‘above ground’ in response to the London Cancer discussions and service growth at UCLH (around 100 new inpatient beds and 10 new operating theatres at UCH)

43 Proton Beam Therapy and Phase 4 First Proton Beam Therapy unit proposed to be built on the old Odeon site. Completion is scheduled for Additional inpatient and theatre capacity required ‘above ground’ in response to London Cancer discussions and service growth at UCLH (around 100 inpatient beds and 10 operating theatres)

44 Accelerator Using magnetic fields, the hydrogen protons are accelerated to two thirds the speed of light. Gantry Each of the three gantries is three- stories tall and weighs 200,000 Ibs Electromagnets The magnets focus and route the proton beams to the gantry

45 ‘Phase 5’: Ear, Nose, Throat, Auditory, Dental and Oral Medicine services The ‘Phase 5’ design involves a plan to relocate these services into a new purpose built facility on the Ear Institute site (Huntley Street) Relocation of all ear, nose, throat, auditory, dental and oral medicine from the Grays Inn Road to purpose-built facility on the main UCH campus This creates the opportunity for collaboration across specialties and greater efficiency of service provision It also creates opportunities to locate into modern and more suitable facilities to improve patient experience and encourage an environment of translational research, teaching and learning Outline Business Case anticipated spring 2014

46 Other key developments A proposed expansion of maternity wing (Elizabeth Garrett Anderson wing) to increase capacity for births at UCH to 8,000 per annum (currently around 6,000 per annum): 2016 Additional neurosciences capacity required following significant increase in specialist work over past five years: joint initiative with University College London (UCL) and Great Ormond Street Hospital (GOSH) on the Queens Square site to enable increased capacity: A&E department redevelopment over next two years, with new in-fill building on lower floors between phase 1 and phase 2

47

48 48 Fundamentals Differentiating our patient services Financial health Deliver cost savings Deliver wait times Develop staff Integrating care with partners’ R&D and education Develop clinical services Clinical outcomes Patient safety Patient Experience Delivering quality for our patients

49 49 Deliver waiting times targets  Reduce waits for planned care to make UCLH the provider of choice  Deliver A&E waiting times and targets  Meet the cancer waiting time targets

50 50 Referral to treatment waiting times  Our backlog of patients waiting has grown and we need to treat more patients to get back on target

51 51 A&E waiting times  Performance is slipping but better than London average Type 1 performance Q1 13/14Q2 13/14Q3 13/14 UCLH95.2%96.1%92.5% London92.9%93.2%92.3%

52 Preparing for more patients

53 OptionBenefits (bed numbers) Likelihood of medium case Current prediction Upper limit MediumLow Jubilee Ward %17 Additional ward at St Pancras %14 23hr day surgery %5 Reduce length of stay %2 Conversion of Tower spaces to beds % 2 Clinical decision unit % 6 Emergency ambulatory care % 3 Increased use of the Hospital at Home scheme %2 Preparing for more patients

54 54 Creating alternatives to acute bed days April 12Nov 13 Jubilee Ward0368 Home050 Cotton Rooms0602 Hotel use51374 Outpatient Antibiotics13171 Total Sub-acute nights Beds equivalent 18 42

55 55 The Tower Flow programme Ward rounds every day Medication does not cause delay Therapy input does not cause delay Patients given predicted discharge date All working from the same patient info Every patient on a prescribed pathway

56 “Previously, all patients were brought back for an OP appointment after their Endoscopy regardless of the results. We have now changed our way of working so that doctors review diagnostic results on a spreadsheet and discharge patients with clear results on the phone or in writing.” Improving our efficiency: Gastroenterology outpatients

57 57 Cancer waiting times  GP referral to treatment waits: now meeting the 85% target more consistently  GP referral to appointment: more that can be done by GPs and by our appointment teams  Screening referral to treatment waits: still risky because of low numbers, need rigorous tracking of patients

58 Cancer waiting times 58

59 Cancer waiting times 59

60 60 Financial health and efficiency targets  Achieve income, expenditure and cash targets  Deliver QEP savings target in 2013/14  Develop 3-year efficiency and productivity plans  Developing strong, robust relationships with GP and specialist commissioners

61 61 Develop staff  Improve the experience of staff by embedding the new UCLH values  Developing our leadership across the Trust  Ensure all staff benefit from appraisal and mandatory training  Building the capability of all our staff and of the organisation as a whole

62 62 Questions and thoughts?

63 63 Next steps  Incorporate views from this meeting  Further consultation within hospital  Governors’ comments on annual plan  Final version of objectives and annual plan for April 2014


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