Annual General Meeting 28 September 2 r 2015 1 Patient-Centred - - PowerPoint PPT Presentation

Patient-Centred & Safe Friendly Professional Responsive 1

Annual General Meeting

28 September 2 r 2015

Patient-Centred & Safe Friendly Professional Responsive

Annual General Meeting

Nick M ck Marsde den Chair hairman an

Patient-Centred & Safe Friendly Professional Responsive

Agenda

• 1. Introduction and Welcome

Nick Marsden, Chairman

• 2. Annual Report 2014/15

Peter Hill, Chief Executive

• 3. Annual Accounts and Audit Opinion

2014/15 Malcolm Cassells, Director of Finance & Procurement

• 4. Accident and Emergency Unit (A&E)

Nicky Heydon, Deputy Lead Nurse

• 5. A&E and the Trauma Unit

Jason Klein, Consultant in Emergency Medicine

• 6. Questions and Answers

Nick Marsden, Chairman

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Annua nual R Repor

• rt 2

2014/15

Peter H Hil ill Chie hief E Executiv ive

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District General Hospital Services

Orthopaedics Facilities Surgery Maternity Children’s Services Diagnostics Medicine Emergency Department

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Regional Specialist Services

Wessex Laser Centre Wessex Rehabilitation Genetics Cleft Lip & Palate Plastic Surgery Burns

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Supra-Regional Spinal Services

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Facts & Figures for 2014/15

Elective Admissions

6,400

Day Cases

22,850

Regular Day Attendees

6,600

Emergency Admissions

28,500

A&E Attendances

44,000

Outpatients

183,700

Number of Births

2,500

Number of Diagnostic scans (CT, MRI) and X-Ray

170,500

Patient-Centred & Safe Friendly Professional Responsive

Review of Performance for 2013/14

91.6% Inpatient or day cases treated within 18 weeks - National Target: 90% 98.1% Patients who did not need to be admitted were treated within 18 weeks – National Target: 95% 90.6% Cancer patients treated within 62 days of referral from GP- National Target: 85% 95.2% A&E attendees admitted, treated or discharged within 4 hours – National Target: 95%

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99.1% Patients risk assessed for VTE – (National Average: 90%) 1 MRSA bacteraemia notifications – (target: 0 )

One further case reported but was a contaminant

21 Trust apportioned Clostridium Difficile cases - (National Target: >19) 96.9% Patients who had a CT scan within 24 hours of admission with a stroke– (National Target: 100%) 94.8% Stroke patients who spend 90% of care on Stroke Unit – (National Average is 82.6%)

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What our patients say: Feedback

309 Complaints Dignity & Respect Quality of Care Recommend Hospital

95% 5%

Friends and Family Test April 2014 to March 2015

Percentage of patients that would recommend this Hospital to Friends and Family (Inpatients and A&E Attendances)

Extremely Likely and Likely % n = 12179 97.9% 2.1% REAL-TIME FEEDBACK April 2014 - March 2015 Overall, how would you rate the quality of care you received?

Good - Excellent Poor - Fair

n = 1413 99.2% 0.8% REAL-TIME FEEDBACK April 2014 - March 2015 Are you being treated with care and compassion?

Yes No

n = 1405

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What our patients say: National Surveys

Patients rate A&E services highly Cancer patients praise their care Positive findings from parents, children and young adults survey

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What our staff say:

3.30 3.40 3.50 3.60 3.70 3.80 3.90 4.00 4.10

Salisbury NHS Foundation Trust Southampton University Hospital Royal United Hospital Bath Poole Hospital The Royal Bournemouth Hospital Gloucestershire Royal Hospital Great Western Hospital Swindon

Staff recommendation of the Trust as a place to work or receive treatment

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Achievements

New Urology Centre opened Two new CT scanners operating Expansion of Mobile Chemotherapy Unit Intensive Care facilities improved

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Achievements cont…

15

Spinal Centre celebrates 30 years Salisbury Hospital – Top 100 places to work Trust wins military award Hospital signs up to National Safety campaign

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Contribution of Patients, Public, Volunteers and Governors

Patien ents a and P Public I Involveme ement:

• Patients Involved in over 30 projects – using patient stories, focus

groups and Real Time Feedback Volunteers:

• Over 650 volunteers give over 1,900 hours a week of extra support,

helping on wards and departments, acting as guides and supporting

• ne off projects
• Other volunteers: cover all types of work and includes, Stars Appeal,

ArtCare, League of Friends, WRVS and Pets as Therapy Governors: s:

• 27 Governors (Public, Staff and Nominated) representing over

17,100 members

• Link with membership, statutory duties, support services and

sample patient experience

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Our Focus for 2015/16

Challenges: Area eas f for impr provemen ment:

• Increasing demand
• Staff Recruitment
• National and local initiatives to keep people out of hospital
• Financial situation
• CQC Inspection
• Rapid treatment of sepsis
• Reduction in falls resulting in fracture or serious harm
• Prevention and treatment of acute kidney injury
• End of Life Care

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CQC inspection

• Trust inspection 1 to 4 December
• CQC look to see that services are safe, effective, responsive,

caring and well led

• Current risk rating / very low(Band 6)
• Key focus on patients’ experience (gather information from

commissioners, patients, voluntary groups, Healthwatch, staff)

• Public listening event
• Governor Focus Group
• Rating: outstanding , good, requires improvement, inadequate,
• Publication of results : CQC Report. Display ratings throughout

hospital

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CQC Inspection

St Elsewhere……

Safe Effective Caring Responsive Well ell L Led ed Overall all A&E Med/COP Surgery C.Care Mat / F.Planning Children End of Life Ot.pts & Diagnostics

G RI RI R/I RI G RI G G

Inadequate

O/S G G RI RI G G G G G G RI G G RI RI RI G RI G O/S G G G G

Inadequate

G G G

Inadequate

O/S G G G O/S G G G G RI G RI G G G

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Ratings poster

20

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Results so far (Acute Hospitals)

20 40 60 80 100 Inadequate Requires Improvement Good Outstanding Inadequate Requires Improvement Good Outstanding

16 90 32 2

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Financial Performance 1 April 2014 to 31 March 2015

Ma Malc lcolm Ca Cassells lls Dir Direct ctor

• r of
• f Finan

Finance ce an and d Procu

• curement

nt

Patient-Centred & Safe Friendly Professional Responsive

Summary Facts for 2014-15

• The SFT accounts for 2014-15 include the consolidation of Salisbury District Hospital

Charitable Fund together with the subsidiary accounts of Odstock Medical Ltd, and Salisbury Trading Ltd.

• We planned (excl charitable funds) a surplus of £806k but recorded a deficit of £1,

1,914k 4k.

• Year on year the Dept of Health has been cutting the tariff under which we get paid by 4% in

real terms. This has resulted in the need for large savings which is becoming unrealistic. We failed to achieve our savings target of £7.9m and achieved £6. £6.3m 3m.

• The national quality emphasis has added to our costs without supporting income. In addition

the ability to recruit to key clinical posts has become more difficult. In 2014/15 we spent £8. £8.2m 2m on agency staff compared with £6. £6.0m 0m the previous year in order to maintain services.

• Each day on average the Hospital spends over £0.5m
• Net Current Assets fell to £11.

1.9m 9m from £14.6m

• Our Operating Surplus fell to £3.

£3.8m 8m from £8.2m in the previous year

• Increased in-patients treated due to non-elective work and big increase in day case work
• Positive External Audit Report

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Our pe performance sin since b bein ing a a FT T (exclu ludes subsi sidiar iarie ies a s and charit itable funds) s)

• 5,000

5,000 10,000 15,000 20,000 25,000 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15E £000 surplus (+)/deficit (-) year end cash working capital

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Group Statement of Comprehensive Income 2014-15

2014-15 2013-14 £000 £000

Income: From clinical activities

181,706 178,954

Other operating income

21,980 20,539

Total Operating Income

203,686 199,493

Operating Expenses

• 199,862
• 191,321

OPERATING SURPLUS

3,824 8,172

Finance income

240 193

Public Dividend Capital payable

• 3,675
• 3,510

Other finance costs

• 1,922
• 1,930

RETAINED SURPLUS F OR THE YEAR

• 1,533

2,925

Revaluation gains/losses (-)

• 587

10,166

Fair value gains on investments

393 262

TOTAL SUPLUS (+)/DEFICIT (-)

• 1,727

13,353

RETAINED SURPLUS (+)/Deficit (-) for SFT ONLY

• 726

1,970

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2014-15 Group Revenue

• Total Group Revenue was £204.0m (£199.7m in 2013-14)
• Revenue in respect of SFT only was £197.9m
• Revenue from Patient Care was £181.7m (£179.0m in 2013-14)
• Revenue from other activities was £22.0m (£20.5m in 2013-14)
• National Tariff declined by 4%
• Laundry income through subsidiary STL grew from £3.2m to £4.4m
• Income from ‘My Trusty’ skin care products £120k

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2014-15 Analysis of Group Revenue

93,619 18,600 14,382 5,466 38,609 1,409 5,496 4,010 738 3,460 4,362 1,682 1,653 1,856 8,352

20,000 40,000 60,000 80,000 100,000 Wilts CCG Dorset CCG

• W. Hants CCG

Other CCGs NHS England Local Auths Educ & Training FTs and NHSTs Research Non-NHS care STL - laundry Charitable OML Private P Other Income

£000

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2014-15 Analysis of Group Revenue

Non-clinical, 21,980 Other clin, 58,835 O u t

• p

a t i e n t s , 2 6 , 1 3 9 Private, 1,856 Elective, 36,655 N

• n
• e

l e c t i v e , 5 3 , 2 6 4 ED, 4,957

Patient-Centred & Safe Friendly Professional Responsive

2014-15 Group Expenditure

• Total Expenditure was £205.

£205.5m 5m (of which SFT is £198.7m)

• Total Operating Expenditure £199.9m
• £125.6m (63.3%) spent on paying staff
• £36.7m spent on clinical supplies & healthcare
• £36.2m spent on buildings, departments and non-clinical supplies etc
• Good Efficiency - SFT costs are 8% less than National Average for

England [source national reference costs]

• Management and administrative costs less than 4% of turnover

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Operating Expenditure - Pay (total £120.3m – SFT only)

34,333 32,989 18,797 14,006 12,711 6,111 1,393 35,012 33,797 19,549 13,597 13,118 6,059 929

5 , 1 , 1 5 , 2 , 2 5 , 3 , 3 5 ,

Nursing & Midwifery Medical & Dental Scientific & Therapy Healthcare Assts Admin & Clerical Board & Sen Managers Other

£000

2014-15 2013-14

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Operating Expenditure - Non-Pay (total £66.5m – SFT only)

14,841 19,221 6,184 7,101 9,171 576 3,926 2,020 3,175 16,840 19,912 6,245 7,263 9,088 1,120 4,365 2,976 3,182 5,000 10,000 15,000 20,000 25,000

Drugs Clinical Supplies General Supplies Premises incl IT Depreciation Use of Non-NHS Insurance Other NHS Orgs Other

£000 2014/15 2013/14

Patient-Centred & Safe Friendly Professional Responsive

Group Statement of Financial Position

at 31.03.15 at 31.03.14 £000 £000 Non-current Assets - Property, plant & equip 146,508 146,004 Current Assets 30,963 34,119 Current Liabilities

• 19,019
• 19,546

Total Assets less current liabilities 158,452 160,577 Less Non-current Liabilities

• 19,610
• 20,300

TOTAL ASSETS EMPLOYED 138,842 140,277 FINANCED BY: Public Dividend Capital 53,631 53,339 Revaluation Reserve 56,740 58,452 Income & Expenditure Reserve 16,220 15,965 Charitable Funds reserve 12,188 12,465 Minority Interest 63 56 TOTAL CAPITAL & RESERVES 138,842 140,277

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2014-15 Capital Expenditure - £8.609m

Key schemes include: £m Medical equipment 2.002 Dementia friendly wards 655 Radnor Ward (ICU) development 1,101 Building works 1.566 Information technology 1.572 Energy efficiency 390

Patient-Centred & Safe Friendly Professional Responsive

Financial Ratings

Using earlier FRR assessment: 2013/14 2014/15 RATING EBITDA Margin 8.1% 6.4% 3 EBITDA % Achieved 103.3% 76.5% 3 Return on Assets Employed 0.8%

• 1.3%

3 I&E Surplus Margin 1.0%

• 0.3%

2 Liquidity 24.8 days 17.2 days 3

Overall FRR is 3

Monitor Risk Assessment Framework: RATING Capital Service Capacity Revenue available for debt service divided by capital service costs 3 Liquidity Cash divided by expenditure per day 4 Overall rating 4

Patient-Centred & Safe Friendly Professional Responsive

Key Messages

A challenging financial year:

• First ever loss recorded and many Trusts in deficit
• Continued cuts to the national tariff have undermined our financial

position

• Further reductions in the national tariff of 4% likely in future years
• We have done more activity but not sufficient to break even
• Focus on patient safety and service quality has driven up costs

especially on agency staff

• Concern about how to improve and renew assets if we do not

generate surpluses

• We are 8% more efficient that the national average so achieving

recurring cost savings is even more difficult

Patient-Centred & Safe Friendly Professional Responsive

Charitable Receipts 2014-15

Donations, Legacies & Grants of £905k £905k together with other net Charitable Income of £7 £764k 4k and fund raising during the previous year Enabled Two n new C CT sca canners £1 £1,040k! 040k!! Other Equipment & Facilities £393k £393k Patients Welfare & Amenities £4 £444k 4k Staff Education & Welfare £43 £437k 7k

Thank y you

• u!!!฀

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Salisbur bury Emerg rgency ncy Depar artment nt

De Depu puty Le Lead N Nurse se Ni Nicky Heydo don

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‘‘Dedic icated t to provid idin ing e exc xcellence and c compa passion i in Emergency Care’’ ’’

Patient-Centred & Safe Friendly Professional Responsive

Patient feedback

39

The Emergency department gets continuous feedback from patients and their friends and family. ‘Brilliant facilities in the play room, lovely

• nurse. Very quick and efficient.’

‘Fantastic with my daughter. Gave her a teddy bear and made her feel at ease.’ Salisbury Emergency Department have consistently scored exceptionally well in the annual national patient survey provided by the Care Quality Commission [CQC].

Patient-Centred & Safe Friendly Professional Responsive

Tour of Emergency Department

40

Reception is manned 24/7 This is not the single point of access to the hospital. Patients can be admitted directly to the:

• Medical admissions unit
• Surgical admissions unit
• Sarum ward

Patients may be reviewed by the out

• f hours GP service who are currently

co-located in the emergency department. ‘Friendly staff on reception and efficient staff even when extremely busy’

Patient-Centred & Safe Friendly Professional Responsive

Minors area

41

60 % of patients attend the department with minor illness or injuries. These patients are seen by the doctors and by the specialist nurses – the emergency nurse practitioners. Often patients will have had an X-ray before arriving to Minors for review. Currently this area is open between 8am until midnight. Common treatments here include:

• dressings
• wound closure
• plaster of paris casts & splints

‘Fantastic service. Lovely, friendly, helpful staff. Top Marks. Thank you all so much.’

Patient-Centred & Safe Friendly Professional Responsive

Majors area

42

The ambulance crews bring moderately ill and injured patients to the nurse in charge who is based in this area. Patients arriving here will often need X- rays, blood tests, heart tracings, CT scans and urine tests. There are 10 bays and this includes 2 which have doors allowing examination

• r discussion in private.

Referral to on call specialist doctors are made in this area and the specialist review will often happen here. ‘I was seen promptly and treated with courtesy by everyone I saw. Very reassuring when you are not feeling well.’

Patient-Centred & Safe Friendly Professional Responsive

Resuscitation room

43

This is the room no-one wants to visit! This contains state of the art equipment to resuscitate the most severely ill or injured patients It has 3 large bays with an X-ray machine to provide on site imaging of the body. We treat patients of all ages in this room 24/7.

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How to use the NHS

44

• 111
• GP
• GP OOH
• WIC
• Emergency Dentist
• Emergency Department

Patient-Centred & Safe Friendly Professional Responsive

Increasing Emergency Department attendance

45

36000 37000 38000 39000 40000 41000 42000 43000 44000 45000 2004 2005 2009 2010 2014 2015 Attendance

Patient-Centred & Safe Friendly Professional Responsive

Emergency department staff

46

• 24/7 Emergency Department staff
• Emergency department Consultants are available 24/7.
• Salisbury has a Consultant-delivered service

– Salisbury pioneered this Consultant model – The Royal College of Emergency Medicine in 2007 recommended

• ther hospitals should strive to provide similar models

Patient-Centred & Safe Friendly Professional Responsive

Local Hero Award

47

‘Staff in the Emergency Department won the Salisbury Journal / Spire FM local hero award for their hard work, dedication and continued excellent care, despite demands on the service’

Patient-Centred & Safe Friendly Professional Responsive 48

Em Emerg ergency Dep epar artment an and T Trau rauma U Unit Dr Jason K

• n Klein

n Consultan tant E Emergency Medic icin ine

Patient-Centred & Safe Friendly Professional Responsive

Wessex Trauma Network

49

• Network set up in 2012
• Salisbury main player throughout
• Strong collaboration with

University Hospital Southampton (UHS)

Patient-Centred & Safe Friendly Professional Responsive

Additional to most Trauma Units

50

• Salisbury also provides

– Burns Unit – Strong Plastic Surgery service 24/7:

• open # management & re-implantation of amputated

limbs

– Spinal Rehabilitation – Wessex Rehabilitation Centre

Patient-Centred & Safe Friendly Professional Responsive 51

Location – SFT to UHS 23 miles, 38 minutes by road

Patient-Centred & Safe Friendly Professional Responsive

Improved Survival with Regional Trauma Networks

52

• The odds of a major

trauma patient surviving in NHS England are 63% better in 2014/15 than in 2008/09

• Significant seven-year

improvement trend

Patient-Centred & Safe Friendly Professional Responsive

Trauma Unit Bypass Tool

53

• Directs severely injured to Southampton

– Often by helicopter

• Exceptions to Bypass

– Immediate airway problem – Catastrophic bleeding - uncontrolled – > 45 minutes transit time to Southampton

Patient-Centred & Safe Friendly Professional Responsive

Trauma arriving in Salisbury

54

• We are formidable at coping under

stressful circumstances

• We need to be flexible
• Recently tested with a Military pre-

hospital Major Incident

Patient-Centred & Safe Friendly Professional Responsive

Team working

55

• All the ED staff and doctors working hard & step up to

the challenges of any trauma incident

• We work together as a well drilled team.
• Not quite Camp Bastion but we can be impressive none

the less.

• We called the trauma team with the first patient to arrive

to the Resuscitation room

• Then divided the team to help with the other patients

Patient-Centred & Safe Friendly Professional Responsive

Military help

56

• The Captain - brilliantly organised pair of hands.

– Ensured that the patients were accompanied by interpreters. – Logged

• patients' names
• location in ED
• their injuries
• their planned disposition.

– Incident was made difficult by several of the patients having similar names.

• The Military Interpreters were obviously invaluable

Patient-Centred & Safe Friendly Professional Responsive 57

Trauma: Future Challenges

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Major Trauma is changing

58

Provided by Dr Tony Kehoe, Derriford Hospital, Plymouth

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Silver Trauma – Frailty not Age

59

• Increasing injuries to frail elderly patients

– Relatively minor mechanism of injury

• usually fall from own height

– Often anticoagulated so bleed more – Often significant head injuries on CT but look surprisingly well on arrival – Have significant other medical illnesses – Have different care needs on discharge

Patient-Centred & Safe Friendly Professional Responsive 60

Salisbury’s Trauma Performance

Patient-Centred & Safe Friendly Professional Responsive

Significant Trauma: 2014 / 2015

61

• Total no. patients

183

• Severely Injured (ISS > 15)

40

• Trauma team activated 12
• Trauma Team available 24/7
• Consultant led

24/7

Patient-Centred & Safe Friendly Professional Responsive

Time to CT

62

• From arrival to ED to CT imaging to diagnose internal

injuries

• Marker of efficiency of ED team & efficiency of Radiology

department

• Rapid diagnosis leads to rapid treatment of injuries

Patient-Centred & Safe Friendly Professional Responsive 63

• All 183 patients

2.0 hrs

• Severe Head injury

1.2 hrs

• NICE guidance Head Injury 0.6 hrs

2014 / 2015

Significant Head Injury Time to CT

Patient-Centred & Safe Friendly Professional Responsive 64

Best Trauma Unit performance in Region

Survival score: additional 2. 2.32 32 survivors per 100 expected to die

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Questions and answers