uclh annual plan 2015/16

UCLH annual plan 2015/16

2 UCLH annual plan 2015/16

Who we are

University College London NHS Foundation Trust Hospital (UCLH) is situated in the heart of London. Our mission is to deliver top-quality patient care, excellent education and world-class research. We deliver services from six hospital sites: University College Hospital, National Hospital for Neurology and Neurosurgery, Eastman Dental Hospital, The Royal National Throat Nose and Ear Hospital, The Heart Hospital, The Royal London Hospital for Integrated Medicine.

In 2004 we became one of the first NHS foundation trusts. This means that while we remain firmly part of the NHS we have more control to manage our own budgets and shape the services we provide to better reflect the needs and priorities of our patients and local community. Through our Council of Governors we are able to listen to the views of patients, local people, staff and partners and by doing so, offer patients faster, better and more responsive healthcare. Greater involvement from patients, public, and staff brings lasting improvements to patient services and better health for communities.

Our values of safety, kindness, teamwork and improving are at the heart of everything we do, both for our patients and for our staff.

We provide academically-linked acute and specialist services, both to the local population and to patients from across England and Wales and abroad.

We balance the provision of nationally recognised, specialist services with delivering high-quality acute services to the local populations of Camden, Islington, Barnet, Enfield, Haringey and Westminster.

We are proud of our close partnership with University College London (UCL), which is consistently reported as one of the best performing universities in the world. UCL’s facilities are embedded across much of our hospital campus and the partnership is linked through a large number of joint clinical and academic appointments.

We are one of the country’s five biomedical research centres and were a founding member of UCLPartners, designated as one of the UK’s first Academic Health Science Centres.

We have a turnover of £888 million and contracts with over 90 commissioning bodies. On average we see 950,000 outpatients, 125,000 A&E attendances and admit over 156,000 patients each year. We employ over 8,000 staff working across all of our hospital sites.


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Our performance in 2014/15

We had an exciting but challenging year in 2014/15:

• We once again enjoyed a positive set of results in the annual inpatient survey and staff survey.

• We continued to embed the UCLH values to guide us in all that we work on as an organisation.

• We delivered our financial plan to deliver a £2m surplus

• We narrowly missed the 4 hour wait in A&E across the year, although we achieved in Q1 and Q4 and were consistently in the top performing Trusts nationally

• We reported 109 cases of Clostridium difficile, and 8 of these were found to be due to lapses in care by the Trust, against an annual threshold of 56 (there are 24 cases still under review)

• We reported 109 cases cases of Clostridium difficile, and 45 of these were found to be lapses in care against an annual threshold of 71.

The Trust has seen a 30% increase in elective referrals over the last five years and in 2014/15 we experienced significant waiting list pressures. We failed to meet the three national Referral to Treatment (RTT) standards from April to November. 2014/15 marked a year of recovery against these standards as we delivered a trust-wide programme of work to improve. Through this we put in place robust waiting list management processes in divisions, undertook extensive review and revision of all of our RTT information reporting and treated more patients to shorten waiting lists. By year end we were achieving two out of the three targets and expect to be full compliant with all three by Q1 2015/16.

We have seen a similar increase in cancer referrals, and we did not deliver the 62 day wait to treatment from urgent GP referral in all quarters of 2014/15. There have been challenges to cancer performance and a large number of breaches were caused by patients being referred late in the pathway from other trusts. This should be seen alongside the London Cancer work over the period which has increasingly centralised treatment of cancers from North East and North Central London at UCLH. This means that an increasing number of the cancer patients that we treat arrive in the trust as tertiary referrals from other hospitals. We have a detailed recovery plan in place which aims to get us to meet the targets by July 2015. Actions include working with referring trusts and commissioners to streamline pathways as well as addressing internal issues such as capacity and improved tracking of patients. Achieving the standard will be dependent on us being able to reduce late referrals from other trusts.



Strategy

We remain committed to the strategy signed off by the Board in In November 2011 which was to focus on and become world leading in the following areas:

• Cancer Services

• Neurosciences

• Women’s Health

Alongside developing these specialist services, we have a strategic aim to deliver excellence in our core medical and surgical services.

Cancer Services

The Trust is leading the implementation of the London Cancer programme to centralise specialist cancer services into fewer, specialist hospitals. As part of these, UCLH will be the North Central and North East London specialist centre for prostate, bladder, gynaecology, upper GI, head and neck, brain and haematology cancer work. These exciting plans were approved by NHS England on October 2014 and will be fully implemented in 2015. Linked to this, from end of April 2015 all inpatient cardiology and cardiac surgery will move from the Heart Hospital to a new site at Barts NHS Healthcare Trust.

The Trust Board approved the Full Business Case for Investing in Cancer and Surgical Services and the Full Business Case for the development of Proton Beam Therapy therefore enabling the Trust to establish a state-of-the-art facility providing Europe’s largest inpatient haematology centre, critical care beds, imaging, and a short stay surgical centre alongside the UK’s first Proton Beam Therapy Centre. Development of the site will commence during 2015.

As part of our approved mandate to help lead specialist cancer delivery across the sector, UCLH has also submitted a bid for Vanguard funding

with partner organisations. This proposes further development of existing networked cancer care to provide improved cancer diagnostic services in local hospitals with a pathway into UCLH for specialist treatment.

Neurosciences

We already have a world-class neurosciences service at Queen Square. There has been a dramatic expansion of clinical services and research activity in the last five years, with growth in activity close to 80%. Neurological diseases such as stroke, dementia, Parkinson’s disease, multiple sclerosis, neuromuscular diseases, epilepsy and brain tumours represent an enormous and growing health burden on society. By 2020 one million people in the UK will have dementia, costing 1% of GDP (World Alzheimer Report 2013). We are ideally suited to lead national and international research in dementia, and we will be putting forward a proposal for a new £300m dementia research facility to be based at Queen Square and be provided jointly with Alzheimers UK. Success of this will be dependent on securing government funding.

It is clear however that growth in demand for our neurosciences service will consume all existing spare bed and theatre capacity. Neurosciences will be one of our capital and estates’ priorities for the next 10 years. This is being undertaken in a phased programme of work, with £25m committed in 2015/16.

Women’s health

UCLH is currently a major provider of maternity services to the local population delivering almost 6,000 births per annum. UCLH supports acutely ill and pre-term babies from across North and Central London and beyond, as well as maintaining a national and international


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reputation for gynaecological service provision especially in the field of gynaecological cancer.

The key short term strategic objectives will be:

• Grow UCLH’s national and international reputation in the field of gynaecological cancer service and translational research delivery

• Develop UCLH’s role as the network lead for neonatology and complex maternity service provision and continue to deliver world leading outcomes in neonatal care

• In partnership with London Cancer, ensure the most appropriate sector configuration for breast cancer surgery and local diagnostic provision

As part of the annual planning process we have undertaken a review of our strategy in light of recent national and local developments, as part of this, there are two further core elements to our strategic direction:

Local Services Strategy

The Five Year Forward View and Dalton Review provide a framework which the Trust will use to refine its strategy as a provider of both nationally leading specialist activity and excellent services to its local population.

We will develop an integration strategy with Camden CCG in 2015/16 to set out a clear road map for improved integration in our local services. The strategy will incorporate the learning and progress from a number of specific schemes that we are already implementing with Camden and Islington CCGs across the following pathways of care:

• adult diabetes

• paediatric diabetes

• musculo-skeletal services

• chronic obstructive pulmonary disease

• frail elderly

In each, we are exploring different provision and commissioning models to deliver integrated services that incentivise a reduction in hospital attendances and other costly interventions

Transformation

We are facing significant financial challenges in 2015/16, as well as ongoing operational pressures, as shown in RTT A&E and cancer waits performance. In order to face these challenges, whilst also improving the patient experience, we are initiating a 3-5 year trust-wide transformation programme. Entitled UCLH Future, this will deliver excellence in our operational processes that matches the excellence in our clinical processes. This programme will re-design emergency and planned care pathways to ensure that we deliver lean, efficient services.

The following are some of the different elements of the programme:

• Re-designing our contact centres to improve how we book and communicate with our patients

• Introducing a Co-ordination Centre based in the Tower to manage inpatient bed capacity

• Defining what excellence in ward care looks like and developing a set of metrics to monitor this

• Delivery of a full electronic health record so that technology supports care delivery (in place in 2018)

We will launch the UCLH Institute to co-ordinate and focus training and development for the transformation programme and to develop new approaches to staff induction, quality improvement and leadership development.



UCLH top ten operational objectives

1. Improve patient safety

• Achieve hospital acquired infection targets

• Deliver “Sign up to Safety” campaign• Deliver progress towards 24 / 7 working

2. Deliver excellent clinical outcomes

• Maintain upper decile Standard Hospital Mortality Index results

• Agree an integration strategy with CCGs• Avoid increase in emergency admissions

3. Deliver high quality patient experience and customer service

• Maintain patient survey satisfaction ratings

• Reduce the number of outpatient cancellations

• Avoid increase in the number inpatient cancellations

4. Enable staff to maximise their potential

• Reduce the level of nursing vacancies• Maintain/achieve improvements in staff

satisfaction survey • Improve the effectiveness of performance

appraisals for all staff

5. Reduce waiting times

• Achieve the 18 week RTT targets • Meet cancer waiting times targets • Achieve the 95% 4 hour A&E standard

6. Achieve sustainable financial health

• Agree contracts with commissioners• Deliver cost improvement programme • Improve cash-flow performance

7. Develop and implement our transformation strategy

• Standardise and improve patient pathways

• Agree preferred option for future IT infrastructure

• Agree strategy for organisational development

8. Develop the research agenda

• Increase the number of participants in clinical trials

• Move the Clinical Research Facility to new premises

• Progress clinical academic appointments with UCL

9. Develop education

• Develop plans for the UCLH Institute• Improve staff compliance with

mandatory training• Improve satisfaction with medical

education programmes

10. Progress service developments

• Progress phase 4 and 5 developments• Implement cardiac/cancer strategy• Continue Emergency Department

expansion project


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1. Improve patient safety

We convened a Clostridium difficile task force in 2014/15 to deliver our action plan to reduce the number of cases. This oversaw the delivery of improvements to our cleaning and isolation protocols. There was also a change in the reporting process to reflect the fact that not all cases are within the control of hospitals to avoid. Therefore a new appeal panel reviewed all cases to agree which ones were due to lapses in care in our hospital. Across the year we reported 109 cases and only 8 of these were found to be due to lapses in care by the Trust, against an annual threshold of 71.

We saw a reduction in MRSA cases, from 6 in 2013/14 to 3 in 2014/15. This was under the Monitor threshold set for the Trust, although the national performance standard was zero.

The target for MRSA in 2015/16 will again be zero while our threshold for Clostridium difficile is 71. We will continue to assess all our infections and our learning from each case to refine our action plans.

‘Sign up to Safety’ is a new national patient safety campaign that aims to make the NHS the safest healthcare system in the world. We have made the following pledges through this campaign in 2015/16:

• reduce number of cases of sepsis

• increase escalation of patients to the Patient Emergency Response Team

• increase the recording of vital signs for all inpatients

• reduce the number of cases of harm to patients in operating theatres.

We will monitor how we are doing against these targets through the year.

We have undertaken a baseline assessment of 24/7 working across our clinical services. We will agree with commissioners which areas to progress 24/7 working in, and implement these by Q2 of 2015/16.

• Achieve hospital acquired infection targets

• Deliver “Sign up to Safety” campaign

• Deliver progress towards 24/7 working

2010/11 2011/12 2012/13 2013/14 2014/15

140

120

100

80

60

40

20

0

Actual Threshold Lapses in care

14

12

10

8

6

4

2

0

Actual Threshold

2010/11 2011/12 2012/13 2013/14 2014/15

MRSA annual performance

Clostridium difficile annual performance

2010/11 2011/12 2012/13 2013/14 2014/15

140

120

100

80

60

40

20

0

Actual Threshold Lapses in care

14

12

10

8

6

4

2

0

Actual Threshold

2010/11 2011/12 2012/13 2013/14 2014/15




We made significant improvements in reducing the number of pressure ulcers that patients get whilst under our care, meeting challenging targets agreed with commissioners in three out of four quarters. We had no grade 4 pressure ulcers and saw a reduction in grade 3 pressure ulcers. We continue to educate staff and promote and enforce the use of best practice in pressure area care; these protocols make sure patients are assessed, regularly moved and treated to minimise the risk of getting a pressure ulcer. We are also undertaking analysis and feeding back to primary care about pressure ulcers on our patients that are acquired in local care homes. Working with community partners to reduce pressure ulcers across the whole health economy is a core objective for 2015/16.

We made limited progress on reducing the number of patients who hurt themselves by falling when staying on our wards. This remains a priority for us in the coming year. There have been very few cases where patients have experienced a serious injury. Through 2015/16 the falls prevention group will provide a forum for reviewing best practice, sharing learning and developing prevention plans.

We did not consistently achieve the national standard to risk assess 95% of inpatients for Venous Thromboembolism (VTE). Although there is no evidence of a correlating increase in hospital acquired thrombosis, the assessment is a necessary step to ensure that all patients that require it do receive appropriate prophylaxis. Improving VTE care will be focus of 2015/16, driven by the Trust VTE lead.

Following the roll out of a dose omissions toolkit we have made significant progress in reducing the number of cases where we failed to give a patients medication as prescribed. We expect the learning from this to be shared amongst nursing and pharmacy teams to maintain good performance through 2015/16.

We will be developing a ward accreditation programme that monitors each ward against key quality metrics providing a more granular picture and allowing us to understand and address any variance between wards.

Inpatient falls with harm - all services

Hospital acquired pressure ulcers by grade - all services

6

4

2

50

45

40

35

30

25

20

15

10

5

0

Ap

r 14

May

14

Jun

14

Jul 1

4

Au

g 1

4

Sep

14

Oct

14

No

v 14

Dec

14

Jan

15

Feb

15

Mar

15

Inpatient falls with serious harm

Inpatient falls with harm

Inpatient falls with harm threshold

14

12

10

8

0

Ap

r 14

May

14

Jun

14

Jul 1

4

Au

g 1

4

Sep

14

Oct

14

No

v 14

Dec

14

Jan

15

Feb

15

Mar

15

Grade 3

Grade 2

Threshold

6

4

2

50

45

40

35

30

25

20

15

10

5

0

Ap

r 14

May

14

Jun

14

Jul 1

4

Au

g 1

4

Sep

14

Oct

14

No

v 14

Dec

14

Jan

15

Feb

15

Mar

15

Inpatient falls with serious harm

Inpatient falls with harm

Inpatient falls with harm threshold

14

12

10

8

0

Ap

r 14

May

14

Jun

14

Jul 1

4

Au

g 1

4

Sep

14

Oct

14

No

v 14

Dec

14

Jan

15

Feb

15

Mar

15

Grade 3

Grade 2

Threshold

9


2. Deliver excellent clinical outcomes

We continue to be in the top five Trusts for Standardised Hospital Mortality Indicator (SHMI). This is the actual number of deaths against the expected number of deaths, the expected number takes account of the case mix and the population that the hospital serves. A lower SHMI indicates fewer deaths. We aim to stay in the top 10% of trusts during 2015/16.

We monitor the rate of admissions from A&E and currently about 17-18% of attendances result in an admission. This is low compared to other trusts and suggests that we have effective ambulatory care and admission avoidance pathways.

We will work to maintain these through 2015/16.

We continue to be in the best 25% of peers for our readmissions and want to contain this low rate in 2015/16. Internally, we will ensure that effective discharge planning takes place from the point of admission, and we have developed a discharge planning assessment tool to support this. We will also ensure that patients are sent home with appropriate medications.

The factors that influence our re-admission rate and the rate of admissions from A&E are multi-layered and not wholly within the hospital’s control. It is therefore important that we continue to work closely with primary and social care colleagues to ensure that the whole system meets the medical and social needs of the patients. We will therefore develop an integration strategy for the Trust. This will define our interfaces with primary care, social care and public health, as such we will develop it in partnership with CCGs and local authorities. This will be signed off by quarter 2 of 2015/16 and we will monitor delivery of it from quarter 3.

• Maintain upper decile Standard Hospital Mortality Index results

• Agree an integration strategy with CCGs

• Contain avoidable emergency admissions

Emergency readmissions within 30 days

In hospital summary hospital mortality indicator: April 2014 - February 2015

100

80

60

40

800

1200

1600

2000

2400

2800

3200

3600

4000

Expected deaths

64

Peer Trust

0%

2%

4%

6%

8%

10%

12%

0

50

100

150

200

250

300

Ap

r-14

May

-14

Jun

-14

Jul-

14

Au

g-1

4

Sep

-14

Oct

-14

No

v-14

Dec

-14

Jan

-15

Feb

-15

Mar

-15

Number of readmissions % Readmission rate



3. Deliver high quality patient experience and customer serviceWe performed well in the 2014 national inpatient survey with an increase in the number of areas that performed above the national average on previous years. We conduct electronic surveys with our patients continuously throughout the year. On average 97% of inpatients across all trust sites said they would recommend UCLH to friends and relatives. This is known as the friends and family test (FFT) and is seen within the industry as the definitive marker of quality.

We also introduced the friends and family test question into A&E and maternity services and we have seen in year improvements in the score in these areas. In 2015/16 we will expand the survey into day case and outpatient areas and to users of the transport service.

We recognise that cancellations of planned admissions and outpatient appointments are disruptive and potentially distressing for patients. We currently cancel 0.6% of all planned admissions at the last minute. This is below the national standard of 1.2% and we will work to maintain this low rate. In outpatients, we currently cancel or re-arrange 14.2% of scheduled appointments. This is too high and benchmarking with other trusts shows that we could achieve 7%. This will require a step change over a number of years so in 2015/16 we are aiming to reduce this to 10%. Measures to improve it will include improved scheduling of appointments and better forward planning of consultant leave.

• Maintain patient survey satisfaction ratings

• Reduce the number of outpatient cancellations

• Avoid increase in the number inpatient cancellations

Inpatient survey questions significantly better or worse than Picker average

0

10

20

30

40

50

60

70

80

90

100

2009 2010 2011 2012 2013 2014

% R

ead

mis

sio

n r

ate

Better Same Worse

DateFFT Score %

Inpatients A&E LabourSeptember 96 92 88October 98 91 88November 97 91 88December 97 94 90January 96 95 94February 96 94 93

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4. Enable staff to maximise their potential

We have seen some slippage in the 2014 staff survey results compared to 2013. Key areas that need to be addressed include training, appraisal quality, objective setting, recognition and support and engagement from senior managers. We continued to score worse than average on staff reporting that they had experienced bullying and discrimination from their manager. We were disappointed with these results and have developed a range of actions in response.

Following the same cascade approach as last year, we achieved our target that 90% of staff get an appraisal. In response to messages from the staff survey we will focus on improving the quality of appraisals and we will use the staff survey to monitor this. We will also aim to complete job planning for all consultants by July 2015.

One of the greatest challenges in 2014/15 was nursing recruitment and retention. Our current nursing vacancy rate is 13% (and due to rise to 17% in August due to the movement of cardiac and heart services around our sector). Delivering high quality services is difficult and expensive with a reliance on temporary staffing. We have creative recruitment plans in place to bring this down to 7.5% by year end, which is in line with the best performing London trusts. These include more targeted recruitment campaigns, use of social media and international recruitment. We will also reduce the number of nurses leaving UCLH using a range of measures including improved development opportunities specifically for band 5 and 6 nurses.

• Reduce the level of nursing vacancies

• Maintain/achieve improvements in staff satisfaction survey

• Improve the effectiveness of performance appraisals for all staff

The annual appraisals cycle

By the end of April - Tier 1 All direct reports to the Chief Executive.

By the end of June - Tier 2 All staff reporting to a Director who has been appraised by the Chief Executive including all DCDs.

By the end of July - Tier 3 All remaining AFC staff at Band 8C and above including all DCDs.

By the end of October - Tier 4 Remaining of the workforce.

Trust appraisal completion rate - all services

UCLH Staff Survey Results 2003-2014

Ap

r 14

May

14

Jun

14

Jul 1

4

Au

g 1

4

Sep

14

Oct

14

No

v 14

Dec

14

Jan

15

Feb

15

100%80%80%70%60%50%40%30%

20%10%

0%

Tier 4 (overall) Tier 1 Tier 2 Tier 3

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

to 2014

Bottom 20%averageTop 20%

Bottom 20% Average Top 20%



5. Reduce waiting times

We started 2014/15 with long referral to treatment (RTT) waits across a range of divisions. Some of the loingest waits were in Queen Square, Surgical Specialties and GI divisions. We were failing to meet the three national RTT standards; 90% of patients treated via admission and 95% of patients treated in out-patients to be within 18 weeks, and 92% of patients waiting for treatment to be under 18 weeks. This position was driven by increasing referrals, with a 30% increase in elective referrals seen over the last 5 years. In 2014/15 we underwent a Trust-wide programme to improve RTT performance, supported by an 18 week turn around team. The improvements have been through three main areas: increased activity, improved waiting list management and improved RTT reporting to support managers.

We are now achieving two out of the three RTT standards, and are projecting full compliance from May. We have a sustainability plan in place to ensure that we continue to keep our waiting lists as short as possible.

In A&E we narrowly missed achievement of the 4 hour wait across the year, although we did achieve in quarter 1 and quarter 4.

The improved performance in quarter 4 was the result of a range of initiatives that were put in place in the department and across the UCH tower to deal with winter pressures. These included introduction of a GP to manage primary care issues in the department, a second rapid assessment team in the department at busy times, increased therapies support to wards and ongoing roll out of the “Home for Lunch” programme to facilitate discharge earlier in the day. We also rolled out UCLH@Home, which allows patients to be cared for at home, therefore releasing bed capacity for patients who do need to be in hospital.

We are using learning from quarter four to try and maintain current good performance into 2015/16.

Referral to treatment % incomplete pathways under 18 weeks

Referral to treatment % admitted and non admitted pathways under under 18 weeks

% incomplete pathways < 18 weeks

Target% incomplete pathways <18 weeks

70%

75%

80%

85%

90%

95%

100%

Ap

r 14

May

14

Jun

14

Jul 1

4

Au

g 1

4

Sep

14

Oct

14

No

v 14

Dec

14

Jan

15

Feb

15

Mar

15

70%

75%

80%

85%

90%

95%

100%

Ap

r 14

May

14

Jun

14

Jul 1

4

Au

g 1

4

Sep

14

Oct

14

No

v 14

Dec

14

Jan

15

Feb

15

Mar

15

% Non-admitted closed pathways under 18 weeks

% Admitted closed pathways under 18 weeks

Non-admitted target

Admitted target

• Achieve the 18 week RTT targets

• Meet cancer waiting times targets

• Achieve the 95% 4 hour A&E standard

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We did not achieve the 62 day wait for cancer treatment following GP referral across 2014/15. A number of other hospitals with specialist cancer services have also seen deterioration against these standards through 2014/15.

Breaches at UCLH have resulted from a range of issues including capacity or administrative delays. However, most of the breaches are caused by issues that are outside of the Trust’s direct control such as late referrals from other Trusts, patient choice and pathway complexity. In November we introduced a new process that provides a much fuller analysis of breaches, allowing us to understand all factors behind patients waiting too long on their pathways. The learning from this is crucial to improving our position.

We have a recovery plan in place which forecasts achievement from July 2015, although this is dependent on being able to reduce late referrals from other trusts.

Actions include:

• Introduction of a trust-wide waiting list meeting to review all potential breaches – this has been in place since November.

• Introduction of timed pathways in all tumour sites to provide early escalation when a pathway starts to veer from agreed timescales.

• Working with referring trusts and commissioners to address this issues that are causing late referrals and seeking to agree sector wide standards for timely transfers.

• Improved tracking of patients by ensuring our MDT co-ordinators are all fully equipped to do their jobs and working to a trust wide standard.

• Improved performance reporting to support operational teams to manage patient pathways.

Cancer two week referral targets

% incomplete pathways < 18 weeks

70%

75%

80%

85%

90%

95%

100%

Ap

r 14

May

14

Jun

14

Jul 1

4

Au

g 1

4

Sep

14

Oct

14

No

v 14

Dec

14

Jan

15

Feb

15

Mar

15

Cancer GP referral to appointmentCancer 14 day wait from referral (symptomatic breast)Target

Cancer 62 day referral targets

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Ap

r 14

May

14

Jun

14

Jul 1

4

Au

g 1

4

Sep

14

Oct

14

No

v 14

Dec

14

Jan

15

Feb

15

Mar

15

Target (GP referral to treatment)

Cancer 62 Day GP referral to treatment

Cancer 62 day referral from screening to treatment

Target (screening to treatment)

...Reduce waiting times



6. Achieve sustainable financial health

We delivered our financial targets in 2014/15, which was to hit a £2m surplus. On-going uncertainties around Project Diamond funding and CQUIN monies mean that there are significant financial challenges in 2015/16. Coupled with this it is becoming more challenging to identify and deliver a high level of efficiencies while improving or maintaining quality of our services.

In our 2015/16 budget we are planning for a £20m deficit. This assumes that we will receive no Project Diamond funding, and that we will deliver £43m cost improvements.

In 2015/16 the cost improvement programme is based on more large-scale Trust-wide schemes that sit within the transformation agenda such as developing more efficient patient pathways and reductions in length of stay.

We are projecting 6% activity growth in our plans. This will put pressure on the hospital estate and will require creative solutions. Bed capacity in particular will be constrained, and we will only deliver our activity plan through a phased reduction in LOS (from 4.8 days to 4 days) through the year. This will be delivered through implementation of agreed pathways of care through the transformation programme.

We are working to reach earlier sign off of our contracts in 2015/16. We are also aiming to reduce the number of unresolved commissioner challenges across 2015/16. This will deliver benefits of improved activity billing processes and improved relationships with our commissioners.

• Agree contracts with commissioners

• Deliver cost improvement programme

• Improve cash-flow performance

Budget & actual performance generated in 2014/15

-12.0

-10.0

-8.0

-6.0

-4.0

-2.0

0.0

2.0

4.0

Q1 Q2 Q3 Q4

£m

Budget Actual (as reported)

15


7. Implement year 1 of our transformation strategyThe financial challenge facing UCLH is significant and we feel that this can only be addressed by a wide-scale programme to transform our operational processes. The aim from this is to deliver efficient, lean operational processes that are as high in quality as our clinical services and deliver an excellent patient experience. There are a number of different streams of work within transformation:

• Urgent care – improving emergency pathways & greater integration with primary care and community services

• Planned care – improving elective pathways

• Diagnostics – having pathways that define what tests are required and delivering one-stop diagnostic clinics so that patients only need to attend once for all of the tests that they require

• Improved IT to support patient care, leading to a fully electronic health record system (EHRS) by 2018.

The changes to patient pathways in each of the above will be developed in partnership with our patients

The programme will be delivered in phases over a three to five year period. In 2015/16 we will launch the UCLH Institute which will support the programme by providing training

and development of our staff including new approaches to staff induction, quality improvement and leadership development.

Linked to this, we are also implementing an organisational development programme. Such a programme involves a planned, organisation-wide effort to change the beliefs, attitudes, values and structure of the organisation such that it can better adapt to new technologies and challenges, and the rate of change itself without losing the engagement of its people. We appointed a Director of Organisational Development, and OD is one of the pillars of the transformation programme. In 2015/16 the Board will agree our OD strategy

This first year will also be about re-design of operational and clinical pathways working with advisors to ensure changes are EHRS compatible. We are looking to appoint our supplier by the end of 2015/16.

• Standardise and improve patient pathways

• Agree preferred option for future IT infrastructure

• Agree strategy for organisational development

Transformation will be delivered through 4 ‘pillars’

Care Delivery System• Defines the standards and processes we use• Manages resources in real time• Actively matches capacity to meet demand

Academy / Institute• Train our people in the care delivery system• Develop leaders that others want to role-model • Home of quality improvement programmes

Organisational Development• Develops a new level of engagement “owner mind set”• Create a deep resonance between culture and what organisation needs

Informatics• Delivers technology to drive the efficiency of our processes• Delivers performance data to manage and plan• Business & clinical intelligence that reaches beyond our walls

Transform our patient staff

experience

PeopleSystems



8. Develop the research agenda

Our work to build UCLH’s position as a world-class leader of research to improve patient care is continuing to flourish with a host of major research activities. Research activity at UCLH is very broad and is centred on the National Institute for Health Research (NIHR) Biomedical Research Centre, a joint UCLH/UCL centre that focuses on providing world class infrastructure for UCLH’s experimental medicine portfolio. The UCLH research portfolio includes over 1,000 studies addressing important clinical questions.

In 2015/16 we will be moving the Clinical Research Facility (CRF) to a new fit for purpose facility outside of the main tower. The time-table is being developed but the aim is to deliver this in the 2015 calendar year. This will provide additional capacity to meet the growing demand for experimental medicine studies within a facility that is configured to meet research patients’ needs. This also gives much needed additional space to the emergency department which will expand into space that will be vacated by the CRF.

Through 2014/15 we saw an increase in the number of patients recruited to clinical trials. In 2015/16 we hope to increase this further, therefore giving access to patients to the latest developments in healthcare innovation.

• Increase the number of participants in clinical trials

• Move the Clinical Research Facility to new premises

• Progress clinical academic appointments with UCL

250

200

150

100

50

0

Ap

r 14

May

14

Jun

14

Jul 1

4

Au

g 1

4

Sep

14

Oct

14

No

v 14

Dec

14

Jan

15

Feb

15

Mar

15

Number of trial participants

Number of approved research studies

Commerical UCL UCLII Other All study

350

300

250

200

150

100

50

0

2012 2013 2014

noncommercial

types

17


9. Develop education

We have a strong focus on delivering success through people. Ensuring that our people are trained to deliver their jobs to the best of their abilities is a key objective.

We have recruited a new director of education who will develop a new strategy for education, training and development at UCLH. This will bring together the various strands of education activity under one overarching strategy in order to maximise the benefits for our staff and patients from our education and training programmes.

We will develop the UCLH Institute, one of the pillars of transformation and will be an in-house facility to provide the leadership capability to our staff to deliver the transformation programme.

UCLH worked hard to achieve the target of 90% of staff being compliant with mandatory training requirements during 2014/15. This proved a challenge in the context of increased activity and challenges in meeting access targets. The year-end position was 86%, and although under target was in the top quartile of London trusts.

Improvements to systems and processes for mandatory training will help us achieve the target in 2015/16. We have also undertaken a review of the mandatory training requirements. This has delivered a more streamlined and relevant suite of training for each professional group.

We are also looking to improve the experience of medical students receiving training in our hospitals. This is monitored via an annual survey and we aim to see positive feedback for students moving through our hospitals in 2015/16.

• Develop plans for the UCLH Institute

• Improve staff compliance with mandatory training

• Improve satisfaction with medical education programmes

Ap

r 14

May

14

Jun

14

Jul 1

4

Au

g 1

4

Sep

14

Oct

14

No

v 14

Dec

14

Jan

15

Feb

15

100%

90

80

70

60

50

40

30

20

10

0

Ove

rall

% c

om

plia

nce

Actual Target

Mandatory training compliance April 2014 to February 2015

% Sickness absence rate

Ap

r 14

May

14

Jun

14

Jul 1

4

Au

g 1

4

Sep

14

Oct

14

No

v 14

Dec

14

Jan

15

Feb

15

Mar

15

4.5%

4%

3.5%

3%

2.5%

2%

1.5%

1%

2013/14 2014/15



10. Progress service developments

During 2015 we shall complete the commissioner agreed reconfiguration of cancer and cardiac services across west Essex, north central and north east London. This will begin with the transfer of cardiovascular services from the Heart Hospital to Barts Health in late April and early May. From the early summer to December all agreed specialist cancer related transfers to UCLH from the sector will be complete. With approval now secure for proton beam therapy and our new cancer and surgical services investment (Phase 4), the rest of 2015 will remain focused on finalising all building design and associated transformational modelling for service delivery. Building work has already begun in early stage for the Phase 4 development and the main construction is set to begin in July. The drawing together of cancer expertise in the new building, using the most advanced equipment, will give us an opportunity to make very significant improvements to the outcomes for cancer patients both locally and nationally.

During 2015 the Phase 5 Full Business Case will also be presented formally to the Trust Board for consideration. This case will outline investment in the colocation of all Head and Neck services into a new state of the art facility on the UCH Campus. Services currently located at the Eastman Dental and the Royal National Throat, Nose and Ear Hospitals will form the main services delivered from the Phase 5 building supported by some diagnostic services from the Macmillan cancer centre and a number of clinical services from Queen Square. If the case is supported demolition would likely begin in November.

Our agreed capital and service investment in new facilities at Queen Square will enable us to continue to deliver world-class neurosciences care for the growing number of patients that

need access to our services. Work begins to increase clinical capacity at Queen Square this spring and should complete in late 2016.

Plans to achieve are as follows:

• London Cancer Services Transfer – June to December 2015

• Proton beam therapy/Phase 4 full contract close and final Government sign off – July 2015 (latest)

• Proton beam therapy/Phase 4 – Final design and transformational planning (December 2015)

• Phase 5 Full business case approval – submitted to EB and IC in May 2015 seeking Board approval in July 2015

• Progress phase 4/5 developments

• Implement cardiac/cancer strategy

• Continue Emergency Department expansion project

Proposed Phase 4 development which will contain the Proton Beam facility, day surgery theatres and specialist cancer beds

Proposed Phase 4 development which will contain the Proton Beam facility, day surgery theatres and specialist cancer beds

uclh annual plan 2015/16

Documents