uclh priorities for 2014/15 simon knight director of planning and performance 27 th january 2014
TRANSCRIPT
UCLH priorities for 2014/15
Simon KnightDirector of planning and performance
27th January 2014
2
Aims of the session
To let you know what our plans / priorities currently are
To hear what you think of them
3
Agenda
What’s happening across the NHSWhat’s the current state of play at UCLH Time for questions and observations
Our plans for 2013/14Your views on our plans
Next steps
4
The general environment
Patient to be at the centre of all planning and delivery: “nothing about me without me”
Impact of the Francis report
Care Quality Commission inspections
Clinical Commissioning Groups and specialised commissioners
Increased emphasis on integration
Drive to centralisation of specialised care
Significant pressures on funding
5
NHS culture and care questioned
Francis report Patients ‘failed by a system which ignored the warning signs and put corporate self-interest and cost control ahead of patients and their safety’ 290 recommendations
Keogh review 14 hospitals with ‘excessive’ deaths Identified key risk factors and warning signs
Berwick report Focus on patient safety and regulation NHS remains an ‘international gem’
6
Key recommendations: a new NHS culture
•Renewed focus on quality •Openness, transparency and candour •Empower patients and staff •Develop outstanding leaders •New inspection regime: Chief Inspector of Hospitals
7
NHS financial challenge: save £30bn by 2020
8
Financial challenges for hospitals
Prices paid to hospitals reduced: NHS efficiencySome CCGs have a large deficitSome CCGs have been affected by funding changesImpact of Better Care FundSpecialist commissioners need to make big savingsContract penalties
9
What does this mean for UCLH?
10
What patients say
UCLH performs well in patient surveys:• Overall rating of care• Would you recommend the hospital
Key areas for improvement from surveys: Trust and confidence in nurses Nurses: answers you could understand Hospital food was fair or poor Planned admission: date changed by hospital
Key lesson from complaints: booking processes
11
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
12
What GPs say
0% 20% 40% 60% 80% 100%
2006
2008
2010
2011
2012
2013
I would be positive aboutUCLH
I would be neutral towardsUCLH
I would be critical of UCLH
No answer / no opinion
13
What GPs say
Positive about the clinical services that we provideThings that GPs want us to get better on:
Clarity around our billing for services Booking processes Getting in touch with staff in the hospital Discharge letters (following A&E visit,
outpatient appointment or inpatient stay)
14
What the CQC said about our services
“Our judgement is that this is an excellent hospital
in many ways – but the failings we identified are
preventing it from achieving excellence across the
board.
The trust has told us it is taking action – and we
expect to return in due course to find that the
problems have been fixed.”
“Our judgement is that this is an excellent hospital
in many ways – but the failings we identified are
preventing it from achieving excellence across the
board.
The trust has told us it is taking action – and we
expect to return in due course to find that the
problems have been fixed.”
15
What the CQC said about our services
“The vast majority of patients spoken to were very
positive about the care they received, and staff were
proud to work at the trust and of the level of care they
were able to deliver.
The trust has a strong board and clear governance
structure which has led to high levels of care being
maintained in most areas.”
“The vast majority of patients spoken to were very
positive about the care they received, and staff were
proud to work at the trust and of the level of care they
were able to deliver.
The trust has a strong board and clear governance
structure which has led to high levels of care being
maintained in most areas.”
16
What the CQC said about our services
“It has a stable and experienced Board and the
trust’s Governors act very much as patients
champions, providing challenge”
“We were also impressed with the emphasis placed
at all levels from the trust’s board and governors
down to ward level on putting the needs of patients
first”
“It has a stable and experienced Board and the
trust’s Governors act very much as patients
champions, providing challenge”
“We were also impressed with the emphasis placed
at all levels from the trust’s board and governors
down to ward level on putting the needs of patients
first”
17
What the CQC said about our services
`we observed many
instances of good and
in some cases
outstanding care’
`we observed many
instances of good and
in some cases
outstanding care’
‘vast majority of patients …
were very positive about they
care they received’
‘vast majority of patients …
were very positive about they
care they received’
`staff told us they were
proud to work at the
trust and proud of the
level of care they were
able to deliver’
`staff told us they were
proud to work at the
trust and proud of the
level of care they were
able to deliver’
`people we spoke to were
extremely complimentary
about the compassionate
care and treatment they
received’
`people we spoke to were
extremely complimentary
about the compassionate
care and treatment they
received’
18
What the CQC said about A&E
‘Commitment of A&E staff to
delivering good care’
‘Commitment of A&E staff to
delivering good care’
In A&E `excellent caring staff,
including positive caring
interactions with patients’
In A&E `excellent caring staff,
including positive caring
interactions with patients’
`the patient feedback of
their experience of A&E was
overwhelmingly positive’
`the patient feedback of
their experience of A&E was
overwhelmingly positive’
‘The A&E is inadequate and
compromises the safe
delivery of care and
treatment ‘
‘The A&E is inadequate and
compromises the safe
delivery of care and
treatment ‘
Compliance actions from the CQC report
1. Completion of the World Health Organisation safe surgery checklist
2. Review current A&E and children’s A&E provision
Staff
Leadership
Environment
3. Improve the quality and completeness of people’s care assessments, care plans and care delivery records
4. Improve the care and security storage of patient records
20
How we are performing against targets
Where we are on track:Hospital standardised reported mortalityPatient surveysMRSA: but close to the targetCancer waiting time targets; but room for improvement still
21
How we are performing against targets
Our key challenges:
Running out of space: A&E, beds, theatresA&E 4 hour waitReferral to treatment waiting times
Clostridium difficile casesCancer patient experience
22
Other achievements in 2013/14
Dr Foster Guide: strong performanceDriving the programme to reconfigure cancer and cardiac services in the areaRunning our organisation according to our values
23
Our values
24
Questions and thoughts?
25
So what does this all mean for our plans?
26
Fundamentals
Draft objectives for 2014/15
Differentiating ourpatient services
Financial health
Deliver cost
savings
Deliver wait times
Develop staff
Integrating care with partners’
R&D and education
Develop clinical
services
Clinical outcomes
Patientsafety
Patient Experience
Delivering qualityfor our patients
27
Clinical outcomes
Fundamentals
Differentiating ourpatient services
Financial health
Deliver cost
savings
Deliver wait times
Develop staff
Integrating care with partners’
R&D and education
Develop clinical
services
Clinical outcomes
Patientsafety
Patient Experience
Delivering qualityfor our patients
28
Patient safety and outcomes Reduce hospital acquired pressure ulcers
Reduce number of blood clots
Reduce medication errors
Improve communication and handover through use of surgical safety and ward safety checklists
Reduce hospital acquired infections
Specialty outcome measures
29
Maintain performance on hospital mortality
Learning from adverse outcomesAction on infection and other safety initiatives
UCLH HSMR improvements from 1999/00 to 2010/11
0
20
40
60
80
100
120
1999
/00
2000
/01
2001
/02
2002
/03
2003
/04
2004
/05
2005
/06
2006
/07
2007
/08
2008
/09
2009
/10
2010
/11
Rel
ativ
e R
isk
(obs
erve
d nu
mbe
r of
dea
ths
as a
per
cent
age
of
expe
cted
num
ber
of d
eath
s)
RR Low High Data year average
30
Further reduce levels of MRSA
MRSA coming down fast ……
31
Clostridium difficile
Clostridium difficile: above our target of …. But very demanding target of 39 in 2013/14 (44 in 2012/13)
32
Patient experience Improve the appointment and booking services we offer to patients
Improve the quality of communication and interaction between clinicians and patients
Pain: work towards the pain-free hospital
33
Compared to other London hospitalsPeer London Teaching Hospital Position against
peersScore
out of 10
2011 score
(position)
Guy’s & St Thomas’ 1 8.15 7.76 (2)
UCLH 2 7.96 7.83 (1)
King’s College 3 7.85 7.39 (6)
Chelsea & Westminster 4 7.82 7.40 (5)
St George’s 5 7.78 7.42(4)
Imperial College 6 7.76 7.67 (3)
Barts & the London 7 7.59 7.31 (8)
Royal Free 8 7.56 7.36 (7)
34
Issues arising from 2012 inpatient survey
Planned admission: date changed by hospitalTrust and confidence in nursesNurses: answers you could understandHospital food was fair or poor
Improving experience for maternity patients cancer patients outpatients
35
Developing services
Fundamentals
Differentiating ourpatient services
Financial health
Deliver cost
savings
Deliver wait times
Develop staff
Integrating care with partners’
R&D and education
Develop clinical
services
Clinical outcomes
Patientsafety
Patient Experience
Delivering qualityfor our patients
36
Research and education
Implement the Biomedical Research Centre programmes of work, with a focus on experimental medicine
Increase patients going through clinical trials
Deliver top quartile experience for all staff groups going through educational programmes at UCLH
37
Patient pathways and servicesTransformational change in how we care for people across social care and health, supported by the Better Care Fund
Transform care pathways for key services
Improve timeliness and quality of all communications with GPs and community care provider
38
Develop clinical services and facilities
Implement plans to further develop our strategic service priorities: neurosciences, cancer and women’s health
Shape and deliver London Cancer and London Cardiovascular
Move to a two site campus model
Cancer and cardiovascular
•Centralising specialist care saves lives (e.g. stroke)•World-leading centre for cardiovascular services at Barts
•Merger of the Heart Hospital and London Chest•UCLH to become specialist hub for most cancers•Engagement exercise underway•Could save 2,000 lives
1
3
UCLH
Head and neck
Prostate and bladder
Brain
HaematologyOesophago-gastric
4
2
Renal
Haematology
Brain
44
3
2
1
Queen’s Hospital
Barts Health
Royal Free London
Haematology
Radiotherapy
Radiotherapy
Radiotherapy
Radiotherapy
5
5 North Middlesex
Radiotherapy
Proposed Specialist Cancer Changes
PBT focuses the radiation on the tumour. This is of particular importance when there is close proximity to key organs
‘Phase 4’: Proton Beam Therapy and further inpatient capacity
• A new inpatient facility with additional theatre capacity and the UK’s first Proton Beam Therapy unit
• Additional inpatient and theatre capacity required ‘above ground’ in response to the London Cancer discussions and service growth at UCLH (around 100 new inpatient beds and 10 new operating theatres at UCH)
Proton Beam Therapy and Phase 4
• First Proton Beam Therapy unit proposed to be built on the old Odeon site. Completion is scheduled for 2018.
• Additional inpatient and theatre capacity required ‘above ground’ in response to London Cancer discussions and service growth at UCLH (around 100 inpatient beds and 10 operating theatres)
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
‘Phase 5’: Ear, Nose, Throat, Auditory, Dental and Oral Medicine services• The ‘Phase 5’ design involves a plan to relocate these services into a new purpose built facility on the Ear Institute site (Huntley Street)
• Relocation of all ear, nose, throat, auditory, dental and oral medicine from the Grays Inn Road to purpose-built facility on the main UCH campus
• This creates the opportunity for collaboration across specialties and greater efficiency of service provision
• It also creates opportunities to locate into modern and more suitable facilities to improve patient experience and encourage an environment of translational research, teaching and learning
• Outline Business Case anticipated spring 2014
Other key developments
• A proposed expansion of maternity wing (Elizabeth Garrett Anderson wing) to increase capacity for births at UCH to 8,000 per annum (currently around 6,000 per annum): 2016
• Additional neurosciences capacity required following significant increase in specialist work over past five years: joint initiative with University College London (UCL) and Great Ormond Street Hospital (GOSH) on the Queens Square site to enable increased capacity: 2016-2020
• A&E department redevelopment over next two years, with new in-fill building on lower floors between phase 1 and phase 2
48
Fundamentals
Differentiating ourpatient services
Financial health
Deliver cost
savings
Deliver wait times
Develop staff
Integrating care with partners’
R&D and education
Develop clinical
services
Clinical outcomes
Patientsafety
Patient Experience
Delivering qualityfor our patients
49
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
50
Referral to treatment waiting times
Our backlog of patients waiting has grown and we need to treat more patients to get back on target
70%
75%
80%
85%
90%
95%
100%
Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13
Referral to treatment % completed and incomplete pathways under 18 weeks
% incomplete pathways < 18 weeks % Non-admitted closed pathways under 18 weeks
% Admitted closed pathways under 18 weeks
51
A&E waiting timesPerformance is slipping but better than London average
Type 1 performance
Q1 13/14 Q2 13/14 Q3 13/14
UCLH 95.2% 96.1% 92.5%
London 92.9% 93.2% 92.3%
Preparing for more patients
Option Benefits (bed numbers) Likelihood of medium case
Current prediction
Upper limit
Medium Low
Jubilee Ward 17 17 0 100% 17
Additional ward at St Pancras
17 17 0 80% 14
23hr day surgery
10 8 6 50% 5
Reduce length of stay.
9 7 5 25% 2
Conversion of Tower spaces to beds
12 6 3 90%2
Clinical decision unit
8 6 0 100%6
Emergency ambulatory care
10 3 1 90%3
Increased use of the Hospital at Home scheme.
34 3 0 80% 2
Preparing for more patients
54
Creating alternatives to acute bed days
April 12 Nov 13
Jubilee Ward 0 368
Hospital @ Home 0 50
Cotton Rooms 0 602
Hotel use 513 74
Outpatient Antibiotics 13 171
Total Sub-acute nights 526 1265
Beds equivalent 18 42
55
The Tower Flow programme
1
2
3
4
5
6
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
Every patient on a prescribed pathway
“Previously, all patients were brought back for an OP appointment after their Endoscopy regardless of the
results. We have now changed our way of working so that doctors review diagnostic results on a
spreadsheet and discharge patients with clear results on the phone or in writing.”
Waiting times in GI Colorectal
7
8
9
10
11
12
13
14
15
W/c 18 Jul-13 (Before POP) W/c 02 Dec-13 (After POP)
New Appointments Follow Up Appointments
Improving our efficiency: Gastroenterology outpatients
57
Cancer waiting timesGP referral to treatment waits: now meeting the 85% target more consistently
GP referral to appointment: more that can be done by GPs and by our appointment teams
Screening referral to treatment waits: still risky because of low numbers, need rigorous tracking of patients
Cancer waiting times
58
0%10%20%30%40%50%60%70%80%90%
100%
Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13
Cancer 62 and 31 day referral targets
Cancer 62 Day GP referral to treatment Target (GP referral to treatment)
Cancer 31 Day Subsequent Surgery Treatment Target (Subsequent surgery)
Cancer waiting times
59
70%
75%
80%
85%
90%
95%
100%
Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13
Cancer 2 week referral targets
Cancer GP referral to appointment Cancer 14 day wait from referral (symptomatic breast) Target
60
Financial health and efficiency targets
Achieve income, expenditure and cash targets
Deliver QEP savings target in 2013/14 Develop 3-year efficiency and productivity plans
Developing strong, robust relationships with GP and specialist commissioners
61
Develop staff
Improve the experience of staff by embedding the new UCLH values
Developing our leadership across the Trust
Ensure all staff benefit from appraisal and mandatory training
Building the capability of all our staff and of the organisation as a whole
62
Questions and thoughts?
63
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 2014