UCLH priorities for 2013/14 Simon Knight Director of planning and performance 5 th February 2013
Aims of the session To let you know what our plans / priorities currently are To hear what you think of them
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
What s happening in the NHS and at UCLH The general environment Funding and finances What patients say about UCLH What members say What GPs say How we perform against targets
The general environment Patient empowerment: nothing about me without me Go-live of Clinical Commissioning Groups Increased emphasis on integration Movement to specialised commissioning Awaiting the Francis enquiry report Significant pressures on funding
Financial challenge Growth in Health Spending since 1999/2000 - 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
Financial challenges Prices paid to hospitals reduced We aren t growing as quickly as in previous years Parts of our health sector have a large deficit Other parts of our health sector will soon lose some of their funding
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
What does this mean for UCLH 50 45 40 43 40 40 35 30 31.7 34 25 20 15 15.2 21 10 5 0 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 (E) 2014/15 (E)
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
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 Emphasis from governors on: Reducing medication errors Reducing pain Improving how care is integrated
What members and governors say Initiative Priority Improve safety 1 Cancer waiting times 2 Reduce infections 3 Reduce appointment waiting times 4 Reduce patients waiting in A & E 5 Improve patient experience 6 Improve clinical outcomes 7 Improve administrative processes 8 Improve communications with GPs 9 Make UCLH a better place to work 10 Make it easier to contact staff 11 Move care to other settings 12
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) Not so much now on length of patient journeys through UCLH
How we perform against targets Doing well Hospital standardised reported mortality Patient surveys 18 week waiting times MRSA Cancer waiting time targets
How we perform against targets Room for further improvement A&E 4 hour wait Clostridium difficile cases Diagnostic waiting times Cancer patient experience Waiting times in the new cancer centre
Other achievements in 2012/13 Dr Foster Guide: strong performance Opening Cancer Centre on time / budget Smooth welcome to the Royal National Throat Nose and Ear Hospital Launching our new values
Our values
Questions and thoughts?
So what does this all mean for our plans?
Draft objectives for 2013/14 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
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
Clinical outcomes Deliver Excellent Clinical Outcomes Improve performance on hospital mortality Reduce avoidable emergency admissions Generate specific clinical outcome measures for specialties
Maintain our good performance on hospital mortality Improvements based on learning from adverse outcomes Action on infection and other safety initiatives 120 100 80 60 40 20 0 UCLH HSMR improvements from 1999/00 to 2010/11 1999/00 2000/01 2001/02 2002/03 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 Relative Risk (observed number of deaths as a percentage of expected number of deaths) RR Low High Data year average
Reduce avoidable emergency readmissions Hospitals not paid for patients admitted as an emergency within 30 days of discharge 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 Signs of improvement in 2012/13
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
Patient safety Reduce hospital acquired infections Reduce hospital acquired pressure ulcers and patient falls Reduce number of blood clots and medication errors Reduce the level of adverse incidents with harm related to missed/delayed diagnosis and failure to escalate abnormal results Improve communication and handover through use of surgical safety and ward safety checklists
Further reduce levels of MRSA MRSA coming down fast 120 100 80 60 40 20 0 2002-3 2003-4 2004-5 2005-6 2006-7 2007-8 2008-9 2009-10 2010-11 2011-12 YTD 2012-13 Number of MRSA bacteraemias Year
Further reduce levels of MRSA.. and currently it looks as though we may meet our very demanding annual target 6 MRSA - All Services 5 4 3 2 1 0 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 MRSA actuals monthly MRSA actuals YTD MRSA threshold monthly MRSA threshold YTD
Clostridium difficile Clostridium difficile: just within our targets. But very demanding target of 44 in 2012/13 (55 in 2011/12) 50 Clostridium difficile - All Services Performance team to update 45 40 35 30 25 20 15 10 5 0 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 CDiff actuals monthly CDiff threshold monthly CDiff actuals YTD CDiff threshold YTD
Reduce blood clots 2012/13: more focus on appropriate action on high risk patients 100% VTE Risk Assessment Compliance - All Services Performance team to update 90% 80% 70% 60% 50% Dec 11 Jan 12 Feb 12 M ar 12 Apr 12 M ay 12 Jun 12 Jul 12 Aug 12 Sep 12 Oct 12 Dec 12 Percentage of Completed evte Risk Assessments Percentage of Completed evte Risk Assessments target
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
Patient experience Improve the appointment and booking services we offer to patients Implement the Making a Difference Together programme Improve the quality of communication and interaction between clinicians and patients Pain: work towards the pain-free hospital Specifically improve patient experience in cancer services
Compared to other London hospitals Peer London Teaching Hospital Position against peers Score out of 10 2010 score (position) UCLH 1 7.83 7.92 (1) Guy s & St Thomas 2 7.76 7.71 (2) Imperial 3 7.67 7.52 (5) St George s 4 7.42 7.61 (3) Chelsea & Westminster 5 7.40 7.40 (6) King s College 6 7.39 7.53 (4) Royal Free 7 7.36 7.27 (8) Barts & the London 8 7.31 7.31 (7)
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
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
Patient pathways and services Transformational objective on integration Transform care pathways for key services Improve timeliness and quality of all communications with GPs and community care provider An NHS number and accurate GP details recorded for every patient in order to support integration and reduce duplicate registrations
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
Research and education Implement the Biomedical Research Centre programmes of work, with a focus on experimental medicine Deliver top quartile experience for all staff groups going through educational programmes at UCLH Contribute to the re-accreditation of UCL Partners as an academic health science centre
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
Develop clinical services Implement plans to further develop our strategic service priorities: neurosciences, cancer and womens health Progress plans for Proton Beam Therapy and other phase 4 projects Shape and deliver London Cancer and London Cardiovascular
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 In April 2012 the Government made available 250 million for two proton beam therapy treatment centres, one at UCLH and one at the Christie NHS Foundation Trust, in Manchester. Proposed PBT facility on the Odeon site
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
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
Referral to treatment waiting times Achieving all key 18 weeks targets at present 100% Referral to treatment % completed and incomplete pathways under 18 weeks 95% 90% 85% 80% 75% 70% Jan 12 Feb 12 M ar 12 Apr 12 M ay 12 Jun 12 Jul 12 Aug 12 Sep 12 Oct 12 Nov 12 Dec 12 % Non-admitted closed pathways under 18 weeks % Admitted closed pathways under 18 weeks % inco mplete pathways < 18 weeks Challenge to deliver targets at specialty level in 2012/13 92% of open pathways to be under 18 weeks in 2012/13
A&E waiting times Performance is slipping but better than London average Type 1 performance Q1 12/13 Q2 12/13 Q3 12/13 UCLH 95.7% 96.7% 94.2% London 94.7% 95.3% 93.8%
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 Waiting time for appointments on the actual day
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
Financial health Achieve income, expenditure and cash targets Develop service line management and patient level costing Developing strong, robust relationships with new GP and specialist commissioners
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
Quality and efficiency programme Deliver QEP savings target in 2012/13 Develop 3-year efficiency and productivity plans, including extension of the coverage of the productive programmes of work a transformational plan for a step change in the efficiency of hospital care delivery Improve support service efficiency (including radiology & pathology)
Tower flow programme Clinical teams surveyed 1,502 patients over two days in April Were they experiencing avoidable delays to their discharge 47% of patients experienced delays Only 35% were on an agreed pathway 60% did not have a known predicted discharge date 16% were medically fit to go home
The Tower Flow programme 1 2 3 4 5 6 Every patient on a prescribed pathway Ward rounds every day Medication does not cause delay Therapy input does not cause delay Patients given predicted discharge date All working from the same patient info
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
Develop staff Improve the experience of staff by embedding the new UCLH values Ensure all staff benefit from appraisal and mandatory training Create a new leadership development programme to deliver the Trust s aims and objectives Implement the liberating the Sister to lead programme to increase the time that Sisters spend on their wards with staff and patients
Develop staff Appraisals: April - May: Phase 1 - All direct reports to the Chief Executive By end of June: Phase 2 - All staff reporting to a Director who has been appraised by the Chief Executive By end of October: Phase 3 - All staff at band 7 or above By end of December: Phase 4 - Whole workforce
Develop staff
Questions and thoughts?
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 2013