6:25pmManaging Diabetes Dr Andrew Soloman, Diabetes and Endocrinology Consultant 6:40pmTransforming Emergency Care, the Future Dr Yvonne Barlow, Acute Medicine Consultant 6:55pmAn Operational Overview Darren Leech, Chief Operating Officer 7:00pmThe Finances, Charles McNair, Executive Director of Finance 7:05pmThe Year Ahead, Melanie Walker, Chief Executive 7:20pmQuestions to Speakers 7:30pmClose
A Year of Transition Where We Were - Under pressure from key partners due to erratic performance - An uncertain future - Changes at the top Where We Are Now - Good habits versus rocket science - Leadership and behaviours propel successful organisations - Challenging the status quo - Feet firmly on the ground - Focus on the things that matter most £/Q - Our Foundation Trust journey
Taking Control Health versus Hospitals - Stronger engagement with stakeholders to meet health needs (versus demand) - Clinical and patient empowerment - Long Term Conditions - Business model will be different Managing the Business - Clearer direction of travel (more later) - Cost control and efficiency - Retaining and attracting the best people - Strong working relations with customers/regulators
Remaining Challenges Patient Experience - NHS Achilles heel - Reminders of where we have failed and learning from them - The search is on for Gold Standard at PAH Commissioning for Health - Targets for guidance – not for health! - Managing and self managing Long Term Conditions - Deep and sustainable reform of commissioning – GPs?
Chairman’s Pride PAH and Harlow - Nutrition, Cleanliness, Length of Stay, Art in Hospital - Reputation - Partners/Friends Thank You! - Staff - The Board - You
Managing diabetes Dr Andrew Solomon Locum Consultant in Diabetes and Endocrinology
Managing Diabetes 1) patients’ self management 2) professionals’ role in managing diabetes
What is diabetes and why is it important? It’s Very Common Diabetes Mellitus is defined as: A clinical condition manifest by persistently raised blood sugar levels Why is it important? 4,7% of the population nearly 1 in 20 people 1 in 10 inpatients It’s Linked with Serious Medical Complications Heart attacks Stroke Amputations Risk of blindness Risk of kidney failure Longer hospital stay
Should Diabetes concern us all? Yes... Because 1) For individuals, many of us are at increasing risk of developing diabetes, especially if we are overweight 2) For the NHS, the concern is that there will be an increasing presence of people with complications if diabetes needing treatment; requiring time, energy and resources
1) Patient’s Self Management: When diagnosed with diabetes, what should patients do? See the GP and practice nurse See a dietician Arrange eye and foot checks After discussion, take prescribed medication Join Diabetes UK Optimise diet Increase exercise Book a diabetes education course* (In West Essex...these are called: DAFNE for Type 1 diabetes and EXPERT for Type 2 diabetes)
My diabetes In Scotland..Patients now see their own data..
2) Professionals role in managing diabetes: New developments in clinically-led local diabetes services Improved assessment of the 9 ‘key checks’ Improved calibre of professionals deliver diabetes care Improved specialist practitioner care in patients’ own homes Improved sub-specialist hospital clinics designed with patients’ needs in mind Improved care of inpatients with diabetes
In 2008–09, the NDA showed that only 50.8% of people with Type 2 diabetes, and 32.2% of those with Type 1 Diabetes, had received all nine key care processes recommended by NICE despite good evidence base for these interventions. When the five PCTs in which the percentage of people with diabetes receiving the nine key care processes is the highest and the five PCTs in which it is the lowest are excluded, there is still a fivefold variation among PCTs. Percentage of people with diabetes receiving nine key care processes by PCT 2008/09; 35 fold variation
How is Princess Alexandra Hospital managing diabetes? New clinical guidelines New Diabetes Specialist Nurses New integrated care arrangements New specialised clinics New ways of optimising patients’ experience
Diabetes care in the future Patients to access their own health data Patients will be in a better position to liaise with highly qualified diabetes professionals Patients will know their ‘treatment aims’ and how they might be helped in achieving them Patients will use electronic media to share ideas, receive updates and plan their care...overall, managing diabetes is managing better
Transforming Emergency Care – The Future Dr Yvonne Barlow, Acute Medicine Consultant
Ambulatory Care Ambulatory care is different from GP care in that specific expertise or diagnostic tests provided in a hospital may be required to include or exclude disease e.g. chest x ray, CT scan. Once a diagnosis has been made, AMBU staff can be responsible for all of that patient’s care or this can be shared with the GP or other specialty once the problem is identified.
Staffed by a medical consultant and a junior doctor from 9:00am to 6:00pm Dedicated nursing staff look after the patients in: – One female 3 bedded area – One male 3 bedded area – Provides continuity of care for the patient with staff that they know
By providing the correct environment and qualified personnel we can: – see and treat the medical or surgical conditions which would normally have required a hospital admission as out-patients – provides space to carry out procedures e.g. chest drain – provide a means for review, transfer to other specialty or transfer care back to the GP
Ambulatory Conditions - Cellulitis Decide if the patient is suitable for intravenous antibiotics at home Insert a cannula to administer the intravenous antibiotics. With the patient decide whether they would like the district nurses to give medication or whether they want to return for this to AMBU when they choose.
Ambulatory Conditions - Pulmonary Embolism or Lung Clot Decide whether it is likely to be a blood clot or other pathology with chest x ray and blood tests. Organise a scan the same day or within 72 hours. Teach the patients how they can self administer their own injections prior to having the scan. Coordinate seeing the patients afterwards in AMBU and treat or discharge.
Patient Satisfaction These are 49 such conditions about which we have data and which we know from experience here and in other hospitals that are to be safe to managed on an outpatient basis This allows patients who would prefer this to be managed at home and have input from district nurse or community teams Many patients choose to come back to AMBU to be treated. They can often fit this around a work schedule/child care.
Ambulatory Care Ambulation of otherwise quite well patients avoids the need for a hospital stay thus: – Reduces the chance of transmission of hospital acquired infections – Increases patient satisfaction – May reduce time off work – Reduces cost to the health service by being able to discharge the patient that day or by reducing length of time spent in hospital
Future Plans As we learn form our pilot we will be able to: – Extend the number of conditions we currently treat on an ambulatory basis – Extend opening hours to include up to 9:00pm and weekends – Improve diagnostic services – Improve our patients satisfaction with the service as we become more efficient
Performance Against Cancer Targets Target%2010/11 2 Week Wait93%Compliant 2 Week Breast Symptoms93%Compliant 31 Day First Treatment Standard96%Compliant 62 Day Standard85%Compliant 62 Day Screening90%Compliant
Quality and Safety Improving the Quality of Our Care and Treatment - Introduced protected mealtimes so patients could be helped with eating and drinking where appropriate - Introduced Doctor and Patient/Carer communication surgeries - Less unnecessary time in hospital because of a reduction in our length of stay Providing Better, Safer Services - Remained one of the best hospitals in combating infections - Offering better, safer services – the hospital standardised mortality ratio
Conclusion PAH is a very clean hospital that provides a good standard of care and treatment. Many successes have been reported despite it being a challenging year. The Trust saw more patients than planned which impacted our operational performance in some areas. The challenge is to create a viable healthcare system within which the hospital can consistently perform to a high standard.
Our Financial Performance A small surplus of £415,000 was made Increasing demands on our own services, particularly emergency Nearly £6 million invested in the estate, services and equipment A £5million Cost Improvement Programme was delivered Achieved all the main statutory financial targets
Performance Against Key Statutory Duties Duty2010/11Achieved Duty to breakeven remaining within the statutory resource limit (RRL) £415,000 surplus √ Duty not to over-shoot the External Financing Limit£3,306,000 under √ Duty to remain within the statutory capital cash limit (CL) £4,166,000 under √
Our Capital Expenditure Did You Know? PAH was one of the first to go fully digital for breast cancer screening £807,000 £677,000 £1,592,000 £1,602,000 £1,377,000
The Financial Plan for 2011/12 Balance financial plan Year to date small underperformance Overall Cost Improvement Target of £17.0m Cost Improvement Programme of £13.0m Additional transitional support to balance
The Way We Work Must Change National Government Reform & Shift in Thinking About How Healthcare is Provided Population Changes – ageing and growing Impact of 21 st Century Lifestyles/ Long Term Conditions Rising Drug and Technology Costs Less Money Available for the NHS
Building for Excellence Financial Performance Health of the Organisation Operational Excellence Patient Experience, Safety and Quality We have exciting plans to become one of the best hospitals in the country. The plans, called Building for Excellence, aim to make services more effective and further improve the experience of patients.
Our Immediate Plans Clinical Productivity – Build consistency across our operational performance e.g. length of stay, waiting time targets Workforce – Tackle some of the problem areas e.g. sickness, bank and agency usage Staffing – Look at how our back office departments function to protect front line services Other – The way the hospital and wards work
Change is Starting to Happen People waiting less time – since April 95% of people have waited less than 4 hours to be seen in A&E, the backlog of people waiting over 18 weeks has halved, and the wait for most tests is less than 6 weeks. Departments are Using Resources More Effectively – e.g. calling patients with test results, telephone triaging in some specialties and better community support to care for people at home
Conclusion We are committed to creating a hospital that is one of the best in the country. Only by securing our financial future will we be able to deliver the quality of care our patients deserve. It will be tough but we see this as an opportunity to change for the better.
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