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

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

Agenda What’s happening across the NHS What’s the current state of play at UCLH 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 3

The general environment Patient to be at the centre of all planning and delivery: 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 4

NHS culture and care questioned Francis report Patients ‘failed by a system which ignored 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’ 5

Key recommendations: a new NHS culture • Renewed focus on quality • Openness, transparency 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 6

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

Financial challenges for hospitals Prices paid to hospitals reduced: NHS efficiency Some CCGs have 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 8

What does this mean for UCLH? 9 What does this mean for UCLH? 9

What patients say UCLH performs well in patient surveys: • Overall rating of care What patients say UCLH performs well in patient surveys: • Overall rating of care • Would you recommend the hospital ØKey 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 ØKey lesson from complaints: booking processes Ø 10

What members and governors say Key things we hear from members and governors: • 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 ØEmphasis from governors on: • Reducing medication errors • Reducing pain • Improving how care is integrated Ø 11

What GPs say 12 What GPs say 12

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

What the CQC said about our services “Our judgement is that this is an 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. ” 14

What the CQC said about our services “The vast majority of patients spoken to 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. ” 15

What the CQC said about our services “It has a stable and experienced Board 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” 16

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

What the CQC said about A&E ‘Commitment of A&E staff to delivering good care’ 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 ‘ 18

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

How we are performing against targets Where we are on track: Hospital standardised reported 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 20

How we are performing against targets Our key challenges: Running out of space: A&E, 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 21

Other achievements in 2013/14 Dr Foster Guide: strong performance Driving the programme to reconfigure 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 22

Our values 23 Our values 23

Questions and thoughts? 24 Questions and thoughts? 24

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

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

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

Patient safety and outcomes Reduce hospital acquired pressure ulcers Reduce number of blood clots 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 28

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

Further reduce levels of MRSA coming down fast …… 50 45 40 No of Further reduce levels of MRSA coming down fast …… 50 45 40 No of MRSA bactearamias 35 30 25 20 15 10 5 0 2006 -07 2007 -08 2008 -09 2009 -10 2010 -11 2011 -12 2012 -13 YTD 2013 -14 30

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

Patient experience Improve the appointment and booking services we offer to patients Improve the 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 32

Compared to other London hospitals Peer London Teaching Hospital Position against peers Score out Compared to other London hospitals Peer London Teaching Hospital Position against peers Score out of 10 2011 score (position) Guy’s & St Thomas’ 1 8. 15 7. 76 (2) UCLH 2 7. 96 7. 83 (1) King’s College 3 7. 85 7. 39 (6) Chelsea & Westminster 4 7. 82 7. 40 (5) St George’s 5 7. 78 7. 42(4) Imperial College 6 7. 76 7. 67 (3) Barts & the London 7 7. 59 7. 31 (8) Royal Free 8 7. 56 7. 36 (7) 33

Issues arising from 2012 inpatient survey Planned admission: date changed by hospital Trust and 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 Ø maternity patients Ø cancer patients Ø outpatients 34

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

Research and education Implement the Biomedical Research Centre programmes of work, with a focus 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 36

Patient pathways and services Transformational change in how we care for people across social 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 37

Develop clinical services and facilities Implement plans to further develop our strategic service priorities: 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 38

Cancer and cardiovascular Centralising specialist care saves lives (e. g. stroke) • World-leading centre 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 •

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

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

‘Phase 4’: Proton Beam Therapy and further inpatient capacity • • A new inpatient ‘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)

Proton Beam Therapy and Phase 4 First Proton Beam Therapy unit proposed to be Proton Beam Therapy and Phase 4 First Proton Beam Therapy unit proposed to be built on the old Odeon site. Completion is scheduled for 2018. • 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) •

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

‘Phase 5’: Ear, Nose, Throat, Auditory, Dental and Oral Medicine services • The ‘Phase ‘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

Other key developments • • • A proposed expansion of maternity wing (Elizabeth Garrett 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: 2016 -2020 A&E department redevelopment over next two years, with new in-fill building on lower floors between phase 1 and phase 2

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

Deliver waiting times targets Reduce waits for planned care to make UCLH the provider 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 49

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

A&E waiting times Performance is slipping but better than London average Type 1 performance A&E waiting times Performance is slipping but better than London average Type 1 performance Q 1 13/14 Q 2 13/14 Q 3 13/14 UCLH 95. 2% 96. 1% 92. 5% London 92. 9% 93. 2% 92. 3% 51

Preparing for more patients Preparing for more patients

Preparing for more patients Option Benefits (bed numbers) Likelihood of medium case Current prediction Preparing for more patients Option Benefits (bed numbers) Likelihood of medium case Current prediction Upper limit Medium Low Jubilee Ward 17 17 0 100% 17 Additional 17 ward at St Pancras 23 hr day 10 surgery Reduce length 9 of stay. 17 0 80% 14 8 6 50% 5 7 5 25% 2 Conversion of 12 Tower spaces to beds 6 3 90% Clinical decision unit 6 8 Emergency 10 ambulatory care Increased use 34 of the Hospital at Home scheme. 2 0 100% 6 3 1 90% 3 3 0 80% 2

Creating alternatives to acute bed days April 12 Nov 13 Jubilee Ward 0 368 Creating alternatives to acute bed days April 12 Nov 13 Jubilee Ward 0 368 Hospital @ Home 0 50 Cotton Rooms 0 602 Hotel use 513 74 Outpatient Antibiotics 13 171 Total Sub-acute nights 526 1265 Beds equivalent 18 42 54

The Tower Flow programme 1 Every patient on a prescribed pathway 2 Ward rounds The Tower Flow programme 1 Every patient on a prescribed pathway 2 Ward rounds every day 3 Medication does not cause delay 4 Therapy input does not cause delay 5 Patients given predicted discharge date 6 All working from the same patient info 55

Improving our efficiency: Gastroenterology outpatients “Previously, all patients were brought back for an OP Improving our efficiency: Gastroenterology outpatients “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. ”

Cancer waiting times GP referral to treatment waits: now meeting the 85% target more 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 57

Cancer waiting times 58 Cancer waiting times 58

Cancer waiting times 59 Cancer waiting times 59

Financial health and efficiency targets Achieve income, expenditure and cash targets Deliver QEP savings 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 60

Develop staff Improve the experience of staff by embedding the new UCLH values Developing 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 61

Questions and thoughts? 62 Questions and thoughts? 62

Next steps Incorporate views from this meeting Further consultation within hospital Governors’ comments on 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 63