UCLH priorities for 2012/13. Simon Knight Acting director of performance 8 th February 2012

Transcription

1 UCLH priorities for 2012/13 Simon Knight Acting director of performance 8 th February 2012

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

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 2012/13 Your views on our plans Next steps

4 What s happening in the NHS and at UCLH The Health and Social Care Bill. Funding and finances What patients say about UCLH What members say What GPs say How we perform against targets

5 The Health and Social Care Bill Patient empowerment: nothing about me without me Commissioning: GPs in the driving seat, but other clinicians in the car Increased competition: any willing provider Increased integration between providers

6 Financial challenges Some protection for health: growth of 0.1% Inflation for health not as rosy as 0.1%

7 Financial challenge Growth in Health Spending since 1999/ UCLH vs. NHS (in England) as a whole 200% % growth since 1999/00 150% 100% 50% 0% 99/00 00/01 01/02 02/03 03/04 04/05 05/06 06/07 07/08 08/09 09/10 10/11 11/12 12/13 Financial Year NHS expenditure in England UCLH Turnover

8 Financial challenges Prices paid to hospitals reduced We aren t growing as quickly as in previous years North central London has a large deficit

9 What this means for our commissioners NCL plans for 2011/12 are to deliver savings of 137m, and this only gets tougher in 2012/13. The most significant items in this savings plan are as follows: 1. Hospitals to be more productive 46.7m 2. Local schemes, including moving care out of hospitals 14.1.m 3. Low Priority Treatments 11.3m 4. Management costs 10.1m

10 What this means for our commissioners Problem much worse in the north: Enfield, Haringey, Barnet. Some signs that Trusts in the north will start to take more of their share of this problem Signs that referrals from the north are being diverted to hospitals in the north

11 What does this mean for UCLH Pressure on referrals to UCLH more difficult to find savings Moving work out to different settings Pressure on the prices that we charge for work Penalties for not delivering more efficient pathways: for example numbers of follow up appointments Significant pressure on funding

12 We aren t growing as quickly 20% 18% 16% 14% 12% 10% 8% 6% 4% 2% 0% Growth in first outpatient attendanc es Growth in new outpatient appointments has fallen away 2008/ / / /12 (forecas t outturn) 2012/13 forecas t

13 We aren t growing as quickly Our income only grew by about 2% this year Similar levels in 2012/13 Which means. We can t rely on growth for productivity We must remove costs from what we do Only savings will enable re-investment for improved services

14 What does this mean for UCLH Efficiency saving requirements: QEP m % 3.3% 4. 9% 6. 9% 5.9% 6.1% 6.1% x% Savings as proportion of expenditure / / / / /13 (E) 2013/14 (E) 2014/15(E) (Estimated figures that may change; 2010/11 and beyond includes requirements for locally managed incremental drift. Source: UCLH Finance; NHS Confederation Dealing with the downturn: using the evidence; UCLH Capital plans; UCLH annual reports

15 What patients say UCLH performs well in patient surveys: Overall rating of care Would you recommend the hospital Questions about doctors and nurses Key areas for improvement from surveys: Availability of hand gel Bothered by behaviour of other patients visitors Hospital food Key lesson from complaints: booking processes

16 What members and governors say Key things we hear from members and governors: Booking processes Getting in touch with staff in the hospital Service culture

17 What members and governors say Priority Ranking Meet waiting times 3.7 Reduce avoidable harm 4.2 Reduce infections 4.4 Improve outcomes 4.5 Reduce appointment waiting times 5.3 Reduce A&E waiting times 5.8 Improve patient experience 5.9 Easier to contact staff 7.1 Improve communications with GPs 7.2 Better admin processes 7.3 Make UCLH a better place to work 7.7 Move care to other settings 9.2

18 What GPs say Key things we hear from GPs, in particular from GP survey: Booking processes Getting in touch with staff in the hospital Discharge letters (following A&E visit, outpatient appointment or inpatient stay) Cost / length of patient journeys through UCLH

19 How we perform against targets Doing well Hospital standardised reported mortality Patient surveys 18 week waiting times MRSA Clostridium difficile cases Cancer waiting time targets

20 How we perform against targets Room for further improvement A&E 4 hour wait MRSA cases

21 Other achievements in 2011/12 Dr Foster London Trust of the Year NHS Litigation Authority level 3 assurance Improved patient experience results Improved staff survey results

22 Questions and thoughts?

23 So what does this all mean for our plans?

24 UCLH objectives and priorities

25 Draft objectives for 2012/13 Delivering quality for our patients Patient safety Clinical outcomes Patient Experience Differentiating our patient services Integrating care with partners R&D and education Develop clinical services Fundamentals Financial health Deliver cost savings Deliver wait times Develop staff

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

27 Clinical outcomes Deliver Excellent Clinical Outcomes Improve performance on hospital mortality Reduce avoidable emergency admissions Achieve 100% participation in clinical audits

28 Maintain our good performance on hospital mortality Improvements based on learning from adverse outcomes Action on infection and other safety initiatives UCLH HSMR improvements from 1999/00 to 2010/ / / / / / / / / / / / /11 Relative Risk (observed number of deaths as a percentage of expected number of deaths) RR Low High Data year average

29 Reduce avoidable emergency readmissions Hospitals not paid for patients who are admitted as an emergency within 30 days of being discharged from hospital Significant lost income: 4-5 million Reinvested in projects to reduce readmissions: More careful discharge arrangements Single place to call once discharged Working closely with community services

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

31 Patient safety Improve Patient Safety Reduce hospital acquired infections Reduce hospital acquired pressure ulcers and patient falls Reduce the number of blood clots

32 Further reduce levels of MRSA MRSA coming down fast 14 Infection - MRSA Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 2007/ / / / /12 UCLH Peer Average

33 Further reduce levels of MRSA.. and currently it looks as though we may meet our very demanding annual target MRSA bacteraemia / infections - All Services Apr - 11 M ay- 11 Jun- 11 Jul- 11 Aug - 11 Sep - 11 Oct - 11 Nov- 11 Dec- 11 Jan- 12 Feb - 12 M ar - 12 M RSA actuals monthly M RSA actuals YTD M RSA threshold monthly MRSA threshold YTD

34 Clostridium difficile Clostridium difficile: just within our targets. But very demanding target of 44 in 2012/13 (55 in 2011/12) Clostridium Performance difficile infections team post to update 48 hrs - All Services Apr - 11 M ay- 11 Jun- 11 Jul- 11 Aug - 11 Sep - 11 Oct - 11 Nov- 11 Dec- 11 Jan- 12 Feb - 12 M ar - 12 CDiff actuals monthly CDiff actuals YTD CDiff threshold monthly CDiff threshold YTD

35 Reduce blood clots 2012/13: more focus on appropriate action on high risk patients 10 0 % VTE Risk assessment - All Services Performance team to update 90% 80% 70% 60% 50% 40% 30% 20% 10 % 0% Jan-11 Feb-11 M ar-11 A pr-11 M ay-11 Jun-11 Jul-11 A ug-11 Sep-11 Oct -11 No v -11 Dec -11 Percentage of VTE Risk Assessments Completed Target

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

37 Patient experience Deliver High Quality Patient Experience Enable patients to manage their appointment more easily Implement the Transforming Patient Experience programme Specifically improve patient experience in cancer services

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

39 Improvement areas Hand gel not available or empty Noise from other patients and visitors Food was fair or poor Improving experience for maternity patients cancer patients outpatients

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

41 Patient pathways and services Integrate care more effectively with partners care Improve customer relationship management with GPs Improve timeliness and quality of discharge letters Evaluate urgent care centre and implement if agreed with GPs

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

43 Research and education Develop R&D and Education Develop the Biomedical Research Centre with focus on effective output Participate in the devolution on educational commissioning Contribute to new UCLP patient pathways

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

45 Develop clinical services Implement Service Developments Open the new Cancer Centre Progress plans for Proton Beam Therapy and Phase 4 Transfer RNTNEH services to the Trust

46 Cancer centre 100m project designed by high profile architects Hopkins 14,000 sq metres of space designed around needs of modern cancer care Specific areas for specific patient groups Innovative artwork funded by charitable donors First PET-MRI in UK to improve diagnosis and research in cancer Opening on time and on budget in April 2012

47 Cancer centre 3,000 new cancer patients per year One day in the cancer centre: 80 day cases, 250 outpatients, 150 visits to the Macmillan Support and Information service Activity growing at 5% per annum Over 800 patients treated through the ambulatory care scheme in a local hotel now extended to teenagers 450 patients per year in cancer clinical trials

48 Bringing Proton Beam Therapy to UCLH PBT is one of the most advanced and effective forms of radiotherapy in the world, with the potential to improve the treatment of thousands of UK patients UCLH were informed by the Department of Health in September 2010 that we were the preferred bidder for a 2 site and 3 site solution. We continue to work with the Department on developing the first PBT centre in the U.K. Proposed PBT facility on the Odeon site

49 RNTNE transfer to UCLH In October 2011, UCLH and RFH Boards agreed to the transfer of the Royal National Throat, Nose and Ear Hospital to UCLH We plan to start operating RNTNE services from 1 April The longer term vision is for the RNTNE and its services to be an integral part of a Head & Neck centre within the Phase 4 development on the Odeon and Rosenheim sites

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

51 Deliver waiting times targets Deliver waiting times targets Deliver mandated in-patient and outpatient waiting times Deliver A&E waiting times and targets Meet the cancer waiting time targets

52 Referral to treatment waiting times Achieving all key 18 weeks targets at present 60 Referral to treatment 95th percentile wait times (weeks) Jan 11 Feb 11 M ar 11 Apr 11 M ay 11 Jun 11 Jul 11 Aug 11 Sep 11 Oct 11 Nov 11 Dec 11 95th percentile waiting time (completed admitted pathways) 95th percentile waiting time (completed non-admitted pathways) 95th percentile waiting time (incomplete pathways) Challenge to deliver targets at specialty level in 2012/13 92% of open pathways to be under 18 weeks in 2012/13

53 A&E waiting times Performance is slipping but better than London average Type 1 performance Q1 11/12 Q2 11/12 Q3 11/12 UCLH 97.9% 96.9% 96.0% London 96.0% 96.4% 94.1%

54 Cancer waiting times GP referral to treatment waits: now meeting the 85% target more consistently better waits for diagnostic times more rigorous tracking of patients Screening referral to treatment waits: still risky because of low numbers, need rigorous tracking of patients

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

56 Financial health Achieve Sustainable Financial Health Achieve income, expenditure and cash targets Develop service line management and patient level costing Replace the financial management system

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

58 Quality and efficiency programme Deliver cost savings Deliver QEP savings target in 2012/13 Develop 3-year efficiency and productivity plans Improve support service efficiency (inc. Radiology & Pathology joint ventures)

59 What does this mean for UCLH Efficiency saving requirements: QEP m % 3.3% 4. 9% 6. 9% 5.9% 6.1% 6.1% x% Savings as proportion of expenditure / / / / /13 (E) 2013/14 (E) 2014/15(E) (Estimated figures that may change; 2010/11 and beyond includes requirements for locally managed incremental drift. Source: UCLH Finance; NHS Confederation Dealing with the downturn: using the evidence; UCLH Capital plans; UCLH annual reports

60 Efficiency successes so far In 2010/11 we achieved 31m in efficiency and productivity savings In 2011/12 we are on track to deliver a further 45m

61 Key areas for savings Efficient use of beds on wards Efficient use of theatres Efficient use of outpatient clinics Reviewing the grades of our staff Utilising our assets Buying goods at lower prices Doing more specialist work Finding other opportunities to provide services

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

63 Develop staff Enable Staff to Maximise their Potential Improve the experience of staff working at UCLH Achieve full staff appraisal and mandatory training Review Organisational Development and implement new leadership development programme

64 Develop staff Trust Appraisal completion rate - All Services 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Overall Phase 1 Phase 2 Phase 3 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Phase 1: April M ay All Direct ors Phase 2: M ay Jun - Direct reports t o Direct ors Phase 3 : Jun Oct- Rest of workforce Current Phase

65 Develop staff Statutory and mandatory training compliance 60% 50% 40% 30% 20% 10 % 0% Jan-11 Feb-11 M ar-11 Apr-11 M ay-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec / 12

66 Questions and thoughts?

67 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 2012