Annual General Meeting 17 September 2014
Quality Accounts Mike Wright Executive Director of Nursing & Patient Experience Director of Infection Prevention and Control
Quality Account 2013/14 2013/14 in review Three quality domains: Patient Safety Clinical Efficiency/Effectiveness Patient Experience
How we agree our priorities Past Performance Development requirements National Priorities Staff Involvement Stakeholder input Council of Governors Board
Principle It s important that we set ourselves challenging and stretching targets in order to improve and be the best at what we do. As such, we will not always meet these objectives
Safety Domain
Falls Patient Falls (reduction in incidence per 1,000 bed days) - Ambition not met but improvements made = Ambition: 7.12 Achieved: 7.57 Patient falls resulting in injury (defined as falls resulting in fractured neck of femur) - Ambition met/achieved = Ambition : 34 Achieved: 32
Care of Patients with Dementia Development of Dementia Pathway (by Dec 14) - Ambition met/achieved on track to deliver
Healthcare Associated Infections (HCAI) MRSA Bacteraemia - Ambition not met but improvements made Ambition: Zero Clostridium difficile - Ambition met/achieved Outcome: 1 (unavoidable) = Ambition: 44 Outcome: 27
Venous Thromboembolism Assessment - Ambition met/achieved Ambition: 95% Achieved: 96%
Pressure Ulcers Grades 3 & 4 Assessment - Ambition not met but improvements made Ambition: Zero Outcome: 7
Discharge Summaries Percentage discharge summaries arriving within 24 hours - Goal not met but improvements made = Ambition: 95% Achieved: 86% Development of Discharge/Going Home Guarantee - Ambition met/achieved
Incidents Rate of patient safety incidents resulting in severe injury or death from the National Reporting and Learning System (NRLS) - Goal not met but improvements made Ambition: 75 th percentile Achieved: 50 th percentile (March to September 2013 data)
Patient Experience Domain
Nutrition and Hydration Screened on admission - Ambition not met/achieved Ambition: 98% Achieved: 96.7% Screened weekly - Ambition not met but improvements made Ambition: 98% Achieved: 90.9% Plan in place - Ambition not met but improvements made Ambition: 98% Achieved: 92.3% Evidence of food intake - Ambition met/achieved Ambition: 90% Achieved: 93.7% Completed Fluid Balance Chart - Ambition not met but improvements made Ambition: 90% Achieved: 89.7%
End of Life Care (end of life pathway) Implement actions from national audit - Goal not met but improvements made Still work in progress Do Not Attempt Cardio-pulmonary Resuscitation (DNACPR) - Goal not met but improvements made Ambition: Develop an e-learning package Achieved: not completed in-year but now completed
Development of a Learning Disability Guarantee Develop and Introduce - Ambition met/achieved
Responding to Patients Personal Needs Responsiveness - Ambition met/achieved Ambition: Improved positive responses from 2012/13 Achieved: Improved result for 4/5 indicators
Staff Experience (from Staff Survey) Percentage of Staff who would recommend the Trust as a provider of care to their Friends and Family needing care - Some progress but achievement not met fully Ambition: Average (or greater) national performance (3.68/5) Achieved: Improvement but not fully (3.55/5 - improvement from 3.41 in 2012)
Clinical Effectiveness
Risk Adjusted Mortality Reduction in Risk Adjusted Mortality to within as expected range (Risk Adjusted Mortality Indicator[RAMI] and Standardised Hospital Mortality Indicator [SHMI]) - Ambition: met/achieved RAMI (April to December 2013) = 89 SHMI (July 2012 to June 2013) = 104.3
Compliance with Stroke Pathways - Goal met/achieved = all standards met (within expected thresholds) Specialist Assessment within 24 hours of admission Admitted to stroke unit within 4 hour Thrombolysis Brain Scan within 1 hour Patients spend 90% time on stroke unit High Risk Transient Ischaemic Attack treated within 24 hours
Re-admission to hospital Reduction in re-admission rate to hospital within 28 days - Goal not met/achieved Ambition: 7% rate Achieved: 12.3% rate
Emergency Department Indicators Time to initial assessment - Ambition not met/achieved Ambition: 15 mins max. Achieved: 49 mins Time to treatment decision - Ambition met/achieved Ambition: 60 minutes Achieved: 28 minutes
Emergency Department Indicators cont. Unplanned ED re-attendance - Ambition met/achieved Ambition: less than 5% Achieved: 0.6% Left without being seen - Ambition met/achieved Ambition: less than 5% Achieved: 1.7% 95% of patients to be treated/admitted/discharged from the Emergency Department (ED) within 4 hours - Goal not met/achieved Ambition: 95% Achieved: 94.9%
Patient Reported Outcome Measures (PROM s) To gain a better understanding of health improvements/outcomes following surgery (hip, knee, hernia) - Ambition not met but improvements made Ambition: To improve participation rates Achieved: Some improvement made
Summary Lots of improvements made Still lots to do to build on current performance and to stretch ourselves further A journey of continuous learning and continuous improvements in order to improve patient care and their experience Thank you
Financial Accounts and Performance Peter Dawson Executive Director - Finance
Financial Performance Financial plan outperformed Clean bill of health from our auditors Continuity of service risk rating of 3 from Monitor Challenging efficiency agenda remains
Audit Opinion Accounts - Received an unqualified opinion for the year ended 31 March 2014 Commended for the quality of our documentation Value for money The Trust has made proper arrangements for securing economy, efficiency and effectiveness in its use of resource
Financial Performance 2013/14 Surplus for year of 5.5m Capital spend of 15.1m Cash balance of 68.0m Directors confirm we are a going concern
Monitor Assessment Rating Capital service cover 2 Liquidity 4 Continuity of service risk rating 3
Financial Performance vs Targets 2013/14 Measure Target Performance Over /Under Performance EBITDA 6.34% 6.15% -0.19% Return on assets 0.93% 1.66% +0.73% I&E Surplus Margin 0.4% 1.1% +0.7% Debt service cover 1.47x 1.50x +0.03x Liquidity Ratio 17.9 days 20.5 days +2.6 days
Financial Outlook 2 year operational plan and 5 year strategic plan published, focusing on: Transforming unscheduled care Increasing integration & care closer to home Creating centres of excellence 98m - 5 year capital programme Challenging national efficiency agenda
Looking back 2013/14 Looking ahead 2014/15 Sue Jacques Chief Executive
The North East s largest integrated health service provider Health and wellbeing services Community services Acute hospital care Planned hospital care
Over 2 million patient contacts 500,000 outpatient appointments 137,800 patients admitted in an emergency 50,000 operations 380,000 radiology scans 121,000 people assessed and treated in A&E 163,000 people assessed and treated in urgent care centres 5,500 expectant mothers 606,000 district nurse home visits and appointments 195,000 health visiting and school nurse appointments
our commitment to put patients at the centre of everything we do
Best outcomes Best experience Best employer Best efficiency
In 2013/14
In 2013/14 Top performers in the North East for HCAI Top 10 ranking in CQC maternity survey NHSLA assessed at level 2 Top 25% of trusts in the inpatient survey Continued improvements in the staff survey Top in the region for staff flu vaccination rates
How we performed Achieved Target A&E patients treated within 4 hours 94.92% 95% 18 weeks referral to treatment (admitted) 92.9% 90% 18 weeks referral to treatment (not admitted) 98.4% 95% Cancer: 2 week waits 96.5% 93% Cancer: 2 weeks waits (breast only) 94.1% 93% Cancer: 31 day from diagnosis to treatment 99.6% 96% Cancer: 62 day from GP referral to first treatment 87.9% 85% Cancer: 62 day from NHS screening to first treatment 87.9% 90%
Developing services First trust wide ECDM implementation (electronic patient records) in the NHS First endovascular theatre in the North East at UHND Centre for clinical research and innovation at DMH Dementia friendly outpatient department at DMH Cardiac CT scanning at Bishop Auckland
Developing services Extended bowel cancer screening at Bishop Auckland New education centre at UHND Integrated Short term Intervention Service to support patients outside hospital New chemotherapy day units at DMH and Shotley Bridge New Gynaecology day Unit at Chester-le-Street Community Hospital Appointment of a Chief of Staff for Elderly Medicine
Responsible part of the community 14.5m procurement in the North East so far this year, supporting and creating local jobs One of the North East largest employers, creating career opportunities through apprenticeships in healthcare Supporting the role of the voluntary sector as a partner in the Good Friends scheme, and local lunch clubs Achieved our carbon reduction target a year ahead of schedule, achieving 16% reduction against a target of 10%
Looking ahead
In December 2013 we published Our evolving clinical and quality strategy
Our vision Right person Right place Right time First time 24/7
Principles agreed with our clinical teams Right person, right time, right place, first time 24/7 Deliver core acute specialties across both acute sites Specialty departments co-located delivering care across two acute sites and beyond Consultant based (delivered) care Care closer to home where safe, effective and efficient Older person at the heart of service delivery
Plans recently agreed with senior clinicians Extending the footprint of both A&Es Appoint Chief of Medicine 7 day working At UHND Additional medical ward Two-ward medical assessment area Review cath lab Reorganisation of surgical wards Surgical clinical decision unit Extended elderly care capacity At DMH Review STEM business case
Five year strategic plan Identifying services where work needs to be done to ensure sustainability Clinical Sustainability Operational Sustainability Financial Sustainability
Five year strategic plan Identifying services where work needs to be done to ensure sustainability Acute and long term conditions Care closer to home ED/UCC Obstetrics Radiology Surgery and diagnostics Elderly care Gynaecology Ophthalmology Cardiology Paediatrics Oral surgery Gastroenterology Sexual health Urology Haematology Intermediate care Breast surgery
Congratulations to our Health Call Undernutrition Team on winning the Service Improvement Award at the NHS Innovations North Bright Ideas in Health (and they ve been shortlisted for an HSJ Award too )
has been granted the North East Better Health at Work Award Continuing Excellence Standard
End of Life Care Winner: The Prison Project A partnership between County Durham and Darlington FT Macmillan Cancer Support Care UK NHS England
Trust Annual Staff Awards Congratulations to all our winners and nominees
A big thank you to our patients their families, friends and carers our staff our colleagues across health and social care our volunteers and hospital friends our governors, members and public For being with us, all the way in 2013/14!
And finally
Council of Governors and Membership Donna Swan - Trust Secretary
Growing the Membership Public Members - End of 2013/2014 Target: 9,500 Actual: 10,052 Public Members Target 2014/15 10,250 Public Members
Public Constituencies Constituency Membership at 31 March 2014: Chester-Le-Street (6.33%) Darlington (19.57%) Derwentside (14.75%) Durham City (17.97%) Easington (1.02%) Gateshead, South Tyneside, Sunderland & Beyond (1.55%) Sedgefield (14.81%) Tees Valley, Hambleton, Richmondshire & Beyond (1.58%) Wear Valley & Teesdale (22.41%)
Our Membership Goals 2014/15 Continue to grow the public membership whilst maintaining a representative membership Geography Gender (60%/40% Female/Male ratio) Socio-economic Minority communities Young people (Under 21 s = under 40% of total membership) Continue to engage with our membership
Election Turnout 2013/14 Council of Governors Bye-Election June 2013 Derwentside (27.7%) Council of Governors Annual Election 2014 Darlington (24.7%) Durham City (24.4%) Wear Valley and Teesdale (19.6%)
Constitutional Changes John Short Chair of Governors Audit & Governance Committee
Process Required to Amend the Constitution Amendments agreed by: the Trust Board 18 December 2013 the Council of Governors 18 December 2013 Amendments to the way in which the Council of Governors works to be agreed by the majority of MEMBERS at the AGM 17 September 2014
The amendments which require ratification by the members Constitutional Clause 15.1.6 Annex 5, Standing Order for the Practice and Procedure of the Council of Governors
Ratifying the proposed Amendments to the Constitution Registered MEMBERS of the Trust are asked to vote in favour of the amendments which relate to the way in which the Council of Governors works USE YOUR VOTING BALLOT PAPERS Place your completed Ballot Papers in the box
MEMBER VOTE
Public Questions
Not a member yet? Want to know more? Why not ask for more details at our Membership Desk and pick up an Application Form.