University College London Hospitals NHS Foundation Trust

University College London Hospitals NHS Foundation Trust Members Event Simon Knight, Nina Griffith, planning and performance Jonathan Gardner, strategic development

Purpose of this session To give you an overview of UCLH s priorities for 2017/18 To give you a summary of future plans for development of our clinical services To give you a chance to ask questions about these plans 2

Our Hospitals University College Hospital Royal National Throat, Nose and Ear Hospital Elizabeth Garrett Anderson Wing (maternity services) University College Hospital Macmillan Cancer Centre National Hospital for Neurology and Neurosurgery Hospital for Tropical Diseases Institute of Sport, Exercise and Health University College Hospital at Westmoreland Street Eastman Dental Hospital Royal London Hospital for Integrated Medicine

Our values 4

UCLH vision UCLH s vision and strategic approach remains broadly the same Our three specialist areas where we pursue national and international renown: neurosciences, cancer, women s health. Top quality patient care Excellent education World class research We need to provide better care for local people and a grounding in general medicine and surgery for our trainee doctors and other health professionals. Over the longer term, we are considering our role as part of an accountable care system that provides population health for the south of NCL (Haringey/Islington/Camden). 5

New Planning Environment Sustainability and Transformation Plans Accountable Care Organisations Integrated Care Vanguards 6

Financial challenge for 2017/18 In 2016/17 we are forecasting a year end deficit of around 11m. This is in line with our budget targets and an improvement on the previous year when we reported a 31m deficit. In 2017/18 we are aiming for a surplus position of 5.3m. This is within the context of significant financial challenges including: 2% tariff efficiency Loss of 3.1m of education funding 2m increase in PFI costs We need to deliver efficiency savings worth 42m 7

OPERATIONAL OBJECTIVES FOR 2017/18: DRAFT Provide the highest quality of care within our resources Improve patient pathways through collaboration with partners Support the development of our staff to deliver their potential Achieve financial sustainability Generate world-class clinical research Deliver Sign up to Safety campaign pledges so that we further reduce harm to patients Maintain upper-decile Standardised Hospital Mortality Index results Achieve hospital acquired infection targets Maintain / Improve patient experience ratings Improve booking and correspondence with patients and GPs Progress the cancer vanguard project and further develop the strategy Meet cancer waiting times targets Work with system partners to deliver A&E waiting time targets Meet 18 week and diagnostic waiting times targets Deliver phase 4, phase 5, ED and Queen Square development milestones Improving staff experience Improving the quality of education and development Prove UCLH to be an employer of choice To be confirmed: STP workforce related objective? To be confirmed Achieve financial targets Deliver workforce, procurement and pharmacy efficiencies in line with Carter agenda Take a leadership role within the STP to deliver North-Central London s financial objectives Improve utilisation of beds, theatres, imaging and outpatient resources Objective related to estate efficiencies Further develop the biomedical research centre Increase recruitment of patients into portfolio studies and early phase trials Achieve project milestones for CRUK and dementia research institute bids Objective on utilisation of clinical research facility Deliver on our responsibilities for the 100,000 genome project Ensure that we check and action all patient test results Work with STP partners to develop integrated pathways for our local patients To be confirmed Implement our decision on next steps for electronic health record system Progress clinical academic appointments with UCL

OPERATIONAL OBJECTIVES FOR 2016/17:DRAFT Provide the highest quality of care within our resources Deliver Sign up to Safety campaign pledges so that we further reduce harm to patients Maintain upper-decile Standardised Hospital Mortality Index results Achieve hospital acquired infection targets Maintain / Improve patient experience ratings Improve booking and correspondence with patients and GPs Ensure that we check and action all patient test results 9

Sign up to safety: our quality priorities for 2016/17 We will continue with the following priorities as part of our sign-up to safety pledges: 1. To reduce surgery related harm 2. To reduce harm from unrecognised deterioration 3. To reduce patient harm from sepsis 10

Achieve hospital acquired infection targets: MRSA 11

Achieve hospital acquired infection targets: Clostridium difficile UCLH have reported 89 cases by the end of December 2016; 8 of these cases have been determined as not being the result of lapses in care Annual target of 90 cases Relatively low number confirmed to be as a result of lapses, so we are likely to meet our target 12

2015 Inpatient Survey Peer London Position against 2014 Score & Score Teaching Hospital peers position UCLH 1 8.4 8.1 (2) Guy s & St Thomas 2 8.3 8.3 (1) Chelsea & Westminster 3 8.2 8.0 (3) Kings College 4 8.1 7.8 (7) St George s 4 8.1 8.0 (3) Royal Free 6 8 8.0 (3) Imperial 7 7.9 8.0 (3) Bart s 8 7.6 7.8 (7)

OPERATIONAL OBJECTIVES FOR 2016/17:DRAFT Support the development of our staff to deliver their potential Improving staff experience Improving the quality of education and development Prove UCLH to be an employer of choice STP workforce related objective? Two more objectives to be confirmed 14

Right staff working in the right way NHS Annual Staff Survey 2015 2014 2013 Would you be happy with the standard of care at UCLH if a friend or relative needed treatment? 82% National average is 70% 83% National average is 65% 83% National average is 64% Would you recommend UCLH as a place to work? 66% National average is 61% 70% National average is 58% 73% National average is 59% 15

OPERATIONAL OBJECTIVES FOR 2016/17:DRAFT Achieve financial sustainability Achieve financial targets Deliver workforce, procurement and pharmacy efficiencies in line with Carter agenda Take a leadership role within the STP to deliver North-Central London s financial objectives Improve utilisation of beds, theatres, imaging and outpatient resources Objective related to estate efficiencies Implement our decision on next steps for electronic health record system 16

Digital Transformation UCLH s vision requires world class digital which means investing in our electronic patient records system. Timeline to EHRS: 2015: OBC approved 2016: Procurement completed and Epic preferred bidder Now: FBC completed and being reviewed by BoD with decision expected March 2017 17

Benefits of digital transformation A key benefit of digital transformation will be the ability to share comprehensive care records supporting integrated care across the sector. 18

uclhfuture milestones in 2016 and beyond (subject to approval of business cases) 19

OPERATIONAL OBJECTIVES FOR 2016/17:DRAFT Generate worldclass clinical research Further develop the biomedical research centre Increase recruitment of patients into portfolio studies and early phase trials Achieve project milestones for CRUK and dementia research institute bids Objective on utilisation of clinical research facility Deliver on our responsibilities for the 100,000 genome project Progress clinical academic appointments with UCL 20

OPERATIONAL OBJECTIVES FOR 2016/17:DRAFT Improve patient pathways through collaboration with partners Meet cancer waiting times targets Work with system partners to deliver A&E waiting time targets Meet 18 week and diagnostic waiting times targets Work with STP partners to develop integrated pathways for our local patients Progress the cancer vanguard project and further develop the strategy Deliver phase 4, phase 5, ED and Queen Square development milestones 21

Meet cancer waiting times targets 22

Meet cancer waiting times targets 23

Meet cancer waiting times targets 24

Meet 18 week and diagnostic waiting times targets Consistently achieving the standard since November 2014 25

Meet 18 week and diagnostic waiting times targets Diagnostic waits have been too long in MRI and endoscopy Trust compliant in December 2016 for first time since September 2013 26

A&E access times Waiting times in A&E have been challenged, as has been the case for many trusts We have a recovery action plan in place and are working closely with the Camden and Islington emergency care boards to address the issues. One of the main issues has been high occupancy levels for beds at UCH Key actions include: A new primary care service in Emergency Department (started in November) Additional step down beds at St Pancras (opening on 16 th Jan) Weekly senior level meetings with Camden and Islington partners to manage delayed transfers of care Discharging patients earlier in the day Type 1 performance Q1 14/15 Q2 14/15 Q3 14/15 Q4 14/15 Q1 15/16 Q2 15/16 Q3 15/16 Q4 15/16 Q1 16/17 Q2 16/17 Q3 16/17 UCLH 95.2% 94.2% 94.0% 95.1% 97.7% 94.9% 90.6% 86.9% 89.4% 89.1% London 91.6% 91.8% 87.6% 87.9% 91.2% 93.1% 87.1% 82.2% 84.5% 86.7% 86.6% (as of Oct- 16) 83.3% (as of Oct- 16) 27

The imperatives to integrate health & social care services Around 1.5 million people live in North Central London. Around 22% of local people use 63% of health and social care services. More and more people have multiple conditions and have increasingly complex needs. Our population is also getting older. Enabling people to manage their multiple conditions requires partnerships with patients and other health and social care providers, not unconnected episodes of care. In the future, to make do with the limited resources we have, we must act proactively to prevent ill health and further deterioration. I need more help to understand decisions, so that attempts to involve me in decisions about my care and treatment are understood by me. I'm not always sure what I'm agreeing to. I had to stay four extra days in hospital, because there was no integration between the hospital and my local borough s adult social care dept. UCLH patient quotes

Reminder: the national context Sustainability and transformation plans (STPs) are local plans to help deliver the aims of the Five Year Forward View. 44 footprints across England, each with their own STP. UCLH is part of the North Central London (NCL) footprint. In November 2016 the NCL initial plan and case for change were published. 30

The NCL STP puts integrated care front and centre As part of the NCL STP, there is an increasing focus on reducing emergency bed days by systematically ensuring the right care is delivered when and where people need it, in the most efficient and effective way. Care closer to home More care closer to home through CHINS: networks covering population of c.50,000. They will provide integrated multi-disciplinary teams, to provide care planning and care coordination for identified patients. Quality improvement support teams to provide practical help in practices to develop consistent standards and offer to all patients. Urgent and emergency care Rapid advice in the community, in person or by phone/skype Alternatives to hospital attendance and admission e.g. MH liaison For patients who do attend hospital, GPs at the front door and rapid assessment of need, proactive management of long term conditions. 31

UCLH involvement in NCL STP UCLH is actively contributing to the majority of the work streams (show in jade) and we are leading three work streams (orange) and the productivity group. We are on the clinical cabinet and the programme delivery board. Governing Bodies of the Statutory Organisations NCL STP Advisory Board (Political Leaders/NHS Chairs/Healthwatch) Clinical cabinet NCL STP programme delivery board Finance and activity modelling group Prevention Health & care closer to home Urgent & emergency care Mental Health Cancer Provider CEOs NCL Estates NCL Digital Local workforce action Elective care Maternity work stream (governance tbc) Finance and activity monitoring group Productivity Communications and engagement 32

UCLH is involved across the north central London footprint We are part of the Camden local care and exploring accountable care partnership as well as working on MSK and integrated pathways for diabetes and frailty. UCLH is part of the Haringey and Islington well-being partnership and the Islington integrated care network. NCL UCLH We are collaborating clinically with Whittington Health on acute services to improve resilience and sustainability, including on maternity, breast cancer and emergency surgery. Across the five boroughs that make up NCL STP, UCLH is heavily involved in the following areas: care closer to home, urgent and emergency care, digital planned care. We're also involved in the London Specialised Planning work, and continue to lead the UCLH Cancer Collaborative. 33

UCLH is working to deliver integrated care now I can plan my care with people who work together to understand me and my carer(s), allow me control and bring together services to achieve the outcomes important to me : National Voices definition of integrated care We need services that provide holistic care when and where people need it. Living a full and healthy life in the community Coordinated community, primary and social care Specialist community based support Secondary care (hospital) support Tertiary specialist services At the moment we have: 1 2 Teams from UCLH working in the community to help people stay well at home. E.g. MSK, frailty and diabetes, UCLH@home, integrated care network Teams from the community working at UCLH to get people home. E.g. GPs in ED, Mental health liaison, community in-reach 34

To support better care for local people we are working increasingly closely with Whittington Health Collaborating with Whittington Health will help improve our clinical sustainability and operational resilience in a number of services. The collaboration aims to: improve the quality, safety and experience across a common local population in Haringey, Islington and Camden by improving services across the two acute trusts and supporting a population approach to health care. reduce costs to the health system by sharing best practice improving pathways. Possible areas for collaboration: Maternity Breast cancer Lung cancer Imaging MSK Lower urinary tract service Surgery 35

An evolving UCH Campus Vision and Strategy delivery Phase 1: The UCH Tower (new build on Euston Road) opened 2005 Phase 2: The Elizabeth Garrett Anderson Wing (maternity services) linked to the Phase 1 development opened 2007 Phase 3: The Macmillan Cancer Centre (on Huntley Street) opened 2012 Phase 4: Proton Beam Therapy, Short Stay Surgery and Specialist cancer facility Phase 5: A world leading Head, Neck and Dental Hospital on the UCH Campus 36

Phase 4 & 5 location: UCH Campus 37

A brief reminder of Phase 4 38

Phase 4

PBT: Better Outcomes and Benefits to Patients PBT equipment solutions are primarily based on a standalone accelerator feeding multiple gantries Accelerator Using magnetic fields, the hydrogen protons are accelerated to two thirds the speed of light. Gantry Each of the three gantries is three-stories tall and weighs 200,000 Ibs Electromagnets The magnets focus and route the proton beams to the gantry 42

The Phase 4 facility Inpatient and surgical capacity in Phase 4; 135 adult inpatient beds (85 NHS and around 50 Private - 31 of which will transfer from UCH Tower -) Largest haematology centre in Europe 8 shorter stay operating theatres (adult only) 20 short stay surgical beds (adult only) 10 bedded adult critical care unit (including PACU) Imaging facilities (adult only) PBT Centre (4 gantries, one accelerator) Retail facility on the ground floor (Tottenham Court Road) Set to complete in late 2020 Increased surgical capacity in the Tower (focus on paediatrics and complex care) 43

P4 AG: Case for Investment in Surgical Services The vision of the Phase 4 investment in surgical services is to create the the most effective and efficient environment to create world leading New Pathways in Short Stay Surgery: A new Short Stay Surgical Centre in Phase 4 will consolidate day surgery and short stay surgical services at UCLH. This will allow the surgical pathway to become more efficient and increase patient satisfaction by ensuring only those requiring inpatient stays have them. This facility is supported by a 48hr stay facility to ensure that every opportunity of taken to improve the productivity and efficiency of the pathway. New Pathways for Specialist and Complex Surgery: The relocation of current UCH short stay surgery activity and the enabling of the conversion of inpatient to additional short stay surgery work will release UCH theatres for more complex inpatient activity to deliver the UCLH cancer vision. New Pathways for Paediatric Surgery: The consolidation of all children s services from the Tower at UCH and the RNTEH and EDH to a dedicated children s surgical unit on T2 with an efficient, standardised pathway for all children s surgery. 44

The use of the Heart Hospital for Interim Capacity The Heart Hospital became vacant in May 2015 with the transfer of cardiac services to Bart's Health It now operates with 7 operating theatres up to 78 beds plus a CCU/PACU and recovery capacity Interim clinical use until late 2020 and the opening of Phase 4 Its use has allowed the implementation of London Cancer work, supporting some growth in demand and helping manage access time challenges Urological and thoracic surgical services now operate form the site 45

A brief reminder of Phase 5 46

Phase 5

Phase 5 Development The Need for the Phase 5 Development Business Transfer Agreement signed with Royal Free London Trust in March 2012 clearly outlines UCLH s obligation to relocate RNTNEH services to the main campus RNTNEH site is held on two co-terminus leases that expire no later than 31 March 2019. Ability to extend assessed as limited due to commercial value of site Significant capital investment required to maintain EDH site in a satisfactory operational condition -Inability to radically transform or re-build on site due to planning constraints and current build

Phase 5- Ground breaking has happened 51

The Emergency Department (ED) Development The ED was designed to support around 60,000 attendances per annum. It now sees around 130,000 patients. We are already transforming pathways of care and ways of working A development scheme (9 Phases) is now underway to ensure the ED is expanded and developed to enable new models of emergency care to be delivered (i.e. Ambulatory Care and Urgent Treatment) 52

Cancer Vanguard Year 2 (17/18) funding signed off for the cancer vanguard bid Based on the principle of providing networks of care to deliver cancer services that align to cancer pathways Comprises 3 elements: Improved access to diagnostics by rolling out early diagnostic pathways across the network Standardised provision of chemotherapy across the network, and provision of radiotherapy in two centres Investment in sector wide pathway management infrastructure 53

Thank you.. 54