1. HEALTH GROUP REPORT Russell Patmore Medical Director, Clinical Support

2. Structure 4 Health Groups for the clinical services Medicine Surgery Family and Women’s Health Clinical Support Each led by a Medical Director supported by Nurse and Operations Directors Autonomy earned on the basis of performance

3. Challenges Clinical performance Increasing demand in many areas Poor local health outcomes and an ageing population Financial environment How do we improve quality and deliver much greater efficiency?

4. Health Groups United Work together and use all our talents Deliver better care for our patients Improve our pathways to reduce harm, time in hospital and waste Maximise efficiency to deliver savings and allow investment without compromising on quality What did we achieved over the last year?

5. Enhancing Patient Safety Dedicated sessions for anaesthetists to optimise patients for surgery Enhanced recovery project Reductions in C-Diff and MRSA Antibiotic drug chart National early warning score introduced Reduction in all mortality measures Revalidation of medical staff

6. Enhancing Patient Experience Charge nurses now supervisory Antenatal day unit and early pregnancy assessment centralised in W+C hospital 2 new neonatal ICU cots opened Intestinal failure team established and peer reviewed Interventional Radiology granted exemplar status after national review

7. Enhancing Patient Experience Butterfly project to identify dementia Non-cancer palliative care service established Reduced turn around in cellular pathology Nurse led community outreach neurology clinics Friends and Family survey results

8. Innovation and Efficiency Structure –Surgical admissions lounge at CHH –New gynaecology inpatient and day case unit in W+C hospital, Cedar Ward –New ED for children and minor cases –New ED majors department by July

9. Innovation and Efficiency Equipment –Digital breast screening introduced –New radiotherapy machines installed –New radiology screening room at CHH –Pathology analysers replaced –ARIA electronic chemotherapy prescribing

10. Innovation and Efficiency Pathways –Productive operating theatre project now trust wide –Rapid access children’s clinics established –Midwives trained to treat tongue tie –Multidisciplinary elderly short stay unit model at HRI with national recognition –Move to 7 day working

11. Partnerships Palliative Care Network Community based chronic pain service developed with CCG’s Palliative and Elderly medicine support to East Riding Hospital HIV and Hepatitis C networks with York and South Bank Neuropathology linked with Sheffield

12. Partnership York –Pathology –Head and Neck Cancer –Renal –Cardiology –Opthalmology –Paediatric Surgery –Urology –Orthodontics

13. Can we see the future?

14. There will be less money around

15. Can we see the future? There will be less money around Everyone is getting older

16. What Pyramid?

17. Can we see the future? There will be less money around Everyone is getting older All roads lead to the emergency department

18. Increase in over 80s 17.5% 11.6%

19. Increase in ‘Majors’ attendances 5.8 % 1.8 %

20. Can we see the future? There will be less money around Everyone is getting older All roads lead to the emergency department If your in, your in

21. AAU Admissions (2006-)

22. Can we see the future? There will be less money around Everyone is getting older All roads lead to the emergency department If your in, your in We will try to fix you, like it or not

23. Can we see the future? There will be less money around Everyone is getting older All roads lead to the emergency department If your in, your in We will try to fix you, like it or not Its hard to say goodbye

24. Can we see the future? There will be less money around Everyone is getting older All roads lead to the emergency department If your in, your in We will try to fix you, like it or not Its hard to say goodbye The system will collapse

25. It can be different Avoid admissions –Not the default –Expand ambulatory care –Community based pathways Frail Elderly End of life Chronic lung diseases Heart failure

26. It can be different Minimise hospital stay –Discharge planned from admission –PREDICT project –CAYDER electronic patient management –Expected Date of Discharge –Electronic patient record and prescribing Rapid discharge and community support –Discharge Hub –Community partners

27. HGU Summary Another successful year delivering significant improvements in patient care and experience whilst releasing greater efficiency savings than ever before Clear risks for the future if we are to continue to deliver great care for our community

28. We need your help Our staff –Focus on patients –Identify and report poor quality –Ask yourself how this could work better Our partners –Work with us to develop new pathways Our patients –Tell us if its not working and what you need –Be prepared to embrace change