Dartford and Gravesham NHS Trust. Susan Acott Chief Executive

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1 Dartford and Gravesham NHS Trust Susan Acott Chief Executive

2 A First in Kent Retired policeman Richard Oliver aged 59 was the first patient to be fitted with the EMBLEM, Subcutaneous Implantable Cardiac Defibrillator (S-ICD) in any Kent Hospital.

3 CEO of NHS England visits Chief Executive of NHS England, Simon Stevens, visited the Trust as part of a programme to showcase innovative practice and new ways of working. He will be opening our One Stop Urology Centre at Darent Valley Hospital on Friday 14 th October 2016.

4 Ebbsfleet Garden City Transforming Healthcare in North Kent (THiNK)

5 Rising activity 5201 babies born 100,000 A+E attendances 96% of patients would recommend the Trust to family and friends

6 Investors in people We were again successful in meeting the standards required to achieve the Investors in People award. The Trust was named as one of the best places to work by the HSJ and its sister title The Nursing Times, in partnership with NHS Employers.

7 Highlights focus on urology Mr Madan & Mr Sriprasad, our renowned urologists, became visiting professors at Canterbury Christchurch University Darent Valley hosted the BAUS residential course unique for a non teaching hospital One stop urology service with state of the art lithotripter opening

8 Highlights focus on Ageing & Health

9 Queen Mary s

10 Team

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12 A new collaborative Acute Care Collaborative with Guys & St Thomas's We are out to persuade politicians, policy makers etc that groups of hospitals sharing resources whilst remaining independent, offer a third way for NHS hospitals.

13 Financial Performance 2015/16 Lorraine Clegg, Director of Finance

14 Key financial duties Return on Capital External Financing Limit Deliver Value for Money Break Even Duty Although not achieved in 2015/16, the Trust has a plan to achieve break even duty over the next 3 years and is planning a 6.1m surplus in 2016/17. Auditors: Issued an unqualified opinion on the Trust s financial statements

15 Key financial achievements Deficit of 7.6m in 2015/16 against Trust plan of 5.8m deficit. Delivered efficiencies of 10.1m (4.2%), whilst maintaining quality of care, patient safety. Steady, sustainable investment in people and equipment.

16 Summary Financial Performance 2015/16 Reduction of income of 0.7% ( 1.5m) to 224.6m ( 226.1m) Costs of delivering services amounted to 237.3m ( 228.5m) Analysis of costs: Pay: 132.9m, Non-Pay 87.4m, Financing 17.0m

17 Patient Income Total income in was 224.6m, of which 199.8m was commissioning income.

18 How was the money spent? Pay staff numbers whole time equivalents (WTE) Non-pay Expenditure by Category m

19 Activity Number of patients seen in 2015/16 by point of delivery (POD); 2015/16 First Attendances 117,629 Follow-up Attendances 207,246 Elective and Daycase 42,946 A&E 99,055 Non-Elective 37,161

20 Capital investments 2015/16 & beyond 2015/16 6.1m investment Estates 3.6m - A&E waiting area and increased bed capacity ( 1.3m), Endoscopy ( 0.8m), CCTV security ( 0.5m), Privacy, Dignity, capacity and other estates projects ( 1.0m) Clinical IM&T Schemes 1.4m Network Switches & Core Fibre replacement ( 0.4m), electronic health record ( 0.1m), PLICS ( 0.1m), PACS ( 0.1), chemo e-prescribing ( 0.1m), IT infrastructure & other schemes ( 0.3m) Other IM&T ( 0.3m) Occupational Health, Procurement Contract PC software & back-up solutions. Medical Equipment 1.3m Endoscopy Washers ( 0.3m), Mammography unit ( 0.2m), Digital Mobile X-ray Unit ( 0.1m), Laryngoscopes ( 0.2m), Urology Instruments ( 0.1m), other ( 0.2m). 2016/17 expected investment m

21 Financial outlook 2016/17 onwards NHS Facing Challenging deficit Trust planning for 6.1m surplus in 2016/17 after 12.3m improvements (4.8%) key issues; The trust will receive sustainability & Transformation Funding of 9m included within the plan. However this is subject to achievement of key performance metrics. Must transform services whilst maintaining quality & safety of services

22 Clinical Quality Vikki Leivers-Carruth Director of Nursing & Quality.

23 Clinical Quality at the Trust This is published each year in the Quality Account, which is circulated to all stakeholders What we have achieved in the last year (2015/16) Plans for improvement for this year (2016/17)

24 Just some of what we achieved in 2015/16 The A&E department refurbishment was completed, the Ambulatory Care Unit and discharge lounge also opened, improving the patient experience of emergency care at Darent Valley Hospital. Dartford and Gravesham NHS Trust was identified as one of the best places to work by The HSJ and its sister title Nursing Times, in partnership with NHS Employers. The Trust has been recognised throughout the year for the excellent patient care it provides with awards and by the number of thank you letters and cards it receive. At the 6th National Dementia Awards ceremony, Darent Valley Hospital was named as a finalist in the category Dementia Friendly Hospital

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26 What we achieved in 2015/16 Patient Safety: Safety Thermometer no new harm rate was 94% in August 2016 Reduced the number of inpatient falls and falls resulting in a fracture Partially achieved improved medication error reporting Improved awareness of prevention, detection and treatment of Acute Kidney Injury

27 What we achieved in 2015/16 Patient Safety: Safety Thermometer Harms are defined as falls, pressure ulcers, blood clots and urinary infections in patients with urinary catheters. The survey includes old and new harms. The No New Harm rate represents the % of patients who remained free from harms that occurred whilst in our care. No New Harm rate Jan 16 April 16 Jun 16 National HFC June % 96.88% 96.86% 93.9%

28 What we achieved in 2015/16 Patient Safety: Reduced the number of inpatient falls and falls resulting in a fracture

29 What we achieved in 2015/16 Patient Safety: Partially achieved improved medication error reporting

30 What we achieved in 2015/16 Patient Safety: Improved awareness of prevention, detection and treatment of Acute Kidney Injury Monitoring period Percentage of patients with a diagnosis of AKI with a care plan Target agreed with CCG achieved Apr Jun 2015 (Q1) 2.4% Audit baseline Jul Sep 2015 (Q2) 6.6% Not achieved target was 10% Oct Dec 2015 (Q3) 21% Achieved target was 20% Jan Mar 2016 (Q4) 51% Partially achieved full target was 90%

31 What we achieved in 2015/16 Clinical effectiveness: Care of patients who have had a stroke Diagnosis and treatment of patients with sepsis Developed care pathways between primary and secondary care for patients with frequent admissions

32 What we achieved in 2015/16 Clinical effectiveness: Care of patients who have had a stroke- partial achievement National average Jul to Sep 2015*** DGT Jul to Sep 2015 Direct admission to a stroke unit 78% 76% Swallow screen within 4 hours 73% 63% Assessed by Physio within 24 hours 61% 57% Assessed by OT within 24 hours 54% 38% Assessed by SALT within 24 hours (note: 50% of patients admitted to DGT had no deficit requiring SALT assessment for communication). 45% 11%

33 What we achieved in 2015/16 Clinical effectiveness: Diagnosis and treatment of patients with sepsis Time period Antibiotic administration target and achievement Quarter /16 Local sepsis protocol and screening tool agreed and in use and baseline data collection established. Achieved. Quarter /16 Internal audit target set at 80%. Achieved 87.5%. Quarter /16 Internal audit target set at 80%. Achieved 88.9%. Quarter /16 Target 90%. Achieved 91.7%

34 What we achieved in 2015/16 Clinical effectiveness: Develop care pathways between primary and secondary care for patients with frequent admissions

35 What we achieved in 2015/16 Patient experience: Reviewed the complaints process and greater involvement of clinical staff Reduced Elective Caesarean section rate Better patient representation and engagement in design and delivery of services

36 What we achieved in 2015/16 Patient experience: Complaints process How have we improved our performance? The Director of Nursing is leading change to the complaints management process to give Directorates greater involvement in the final written response. This includes a lead person within each Directorate who is the designated person responsible for coordinating the writing of the response. The HR Director and Director of Nursing have reviewed Governance management structures for each directorate. The 2015 CQC Inpatient Survey indicates that scores are similar or improved on the results of the 2014 survey.

37 What we achieved in 2015/16 Patient experience: Elective caesarean section rate

38 What we achieved in 2015/16 Patient experience: Better patient representation Patient and service user involvement in Trust groups and committees Service user involvement 2014/15 Service user involvement 2015/16 Maternity Services Liaison Committee A patient representative was included on Emergency Department redesign group. The group preparing and presenting the community tender bid had service user and patient input. Several patients told their stories and were included in the bid. The Nutrition Steering Group is advertising for a patient or other service user to join the group. The Resuscitation Committee include real patient stories, told by the patient, at the Resuscitation Masterclass training day. Research and Development Sub-Committee has a patient representative as part of the Committee

39 What we plan to achieve in 2016/17 Patient Safety: Reduce Hospital acquired infections MRSA and Clostridium Difficile Continue to reduce falls resulting in fracture Reduce number of hospital acquired grade 2 pressure ulcers

40 What we plan to achieve in 2016/17 Clinical effectiveness: Continue to improve standards of infection prevention and control Work towards seven day services Care of patients with fractured hip

41 What we plan to achieve in 2016/17 Patient experience: Consultant led daily ward/board rounds Patient input into alliance with GSTT work streams Improve patient experience of food

42 Thank you for listening. Questions?

43 The Future of Hospital Care Gerard Sammon, Director of Strategy and Planning

44 The Future of Hospital Care Key challenges to sustaining our local hospital Our journey towards a sustainable future Your thoughts

45 Key challenges to sustaining our local hospital Improving patient experience and sustaining high quality care Ebbsfleet Garden City Difficulty in attracting and recruiting certain staff Centralisation Austerity and higher costs of providing healthcare

46 Our journey towards a sustainable future

47 What s next? dgn-tr.vanguardfhg@nhs.net Webpage: