Annual General Meeting 22 22 September r 201 014 1 - - PowerPoint PPT Presentation

Patient-Centred & Safe Friendly Professional Responsive 1

Annual General Meeting

22 22 September r 201 014

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 Accounts and Audit Opinion

2013/14 Malcolm Cassells, Director of Finance & Procurement

• 3. Annual Report 2013/14

Peter Hill, Chief Executive

• 4. 21 years of care and treatment at

Salisbury District Hospital Dr Shaun McGee, Consultant Radiologist Maria Ford, Nurse Consultant in Critical Care

• 5. Questions and Answers

Nick Marsden, Chairman

Patient-Centred & Safe Friendly Professional Responsive

Financial Performance 1 April 2013 to 31 March 2014

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 2013-14

• For the first time the SFT accounts for 2013-14 required the consolidation of Salisbury District

Hospital Charitable Fund. In addition the accounts of Odstock Medical Ltd, and Salisbury Trading Ltd were also consolidated.

• We planned (excl charitable funds) a surplus of £1,856k and we achieved £1,

1,869k 869k.

• We struggled to achieve our savings target of £9.2m and achieved £6.

£6.9m. The shortfall was

• ffset by revenue from activities which grew by £15m overall.
• Each day on average the Hospital spends over £0.5m
• Non-Current Assets rose in value by £10.3m to £146.

6.0m 0m reflecting the revaluation of assets.

• Net Current Assets increased by £3.4m to £1

£14. 4.6m 6m

• Operating Surplus increased to £8.

£8.2m 2m (2012-13 £6.4m), EBITDA was £1 £15. 5.4m with a margin

• f 7.7% of turnover
• Slight reduction in in-patients treated but big increase in day case work and out-patient

attendances

• Positive External Audit Report

Patient-Centred & Safe Friendly Professional Responsive

Group Statement of Comprehensive Income 2013-14

2013-14 2012-13 £000 £000

Income: From clinical activities

178,954 166,734

Other operating income

20,539 17,783

Total Operating Income

199,493 184,517

Operating Expenses

• 191,321
• 178,114

OPERATING SURPLUS

8,172 6,403

Finance income

193 327

Public Dividend Capital payable

• 3,510
• 3,254

Other finance costs

• 1,930
• 1,853

RETAINED SURPLUS F OR THE YEAR 2,925 1,623

Revaluation gains/losses (-)

10,166

• 1,811

Fair value gains on investments

262 658

TOTAL

13,353 470

RETAINED SURPLUS FOR THE YEAR - SFT ONLY 1,970 1,648

Patient-Centred & Safe Friendly Professional Responsive

2013-14 Group Revenue

• Total Revenue £199.5m including charitable (£184.5m in 2012-13)
• Revenue in respect of SFT only was £194.3m
• Revenue from Patient Care grew by £12.3m to £179.0m
• Revenue from other activities grew by £2.8m to £20.5m
• National Tariff declined by 4%
• Final settlements with CCGs in accordance with Plan
• Sales of ‘My Trusty Little Sunflower Cream’ £130k

Patient-Centred & Safe Friendly Professional Responsive

2013-14 Analysis of Group Revenue

90,859 18,648 14,393 5,307 39,363 1,139 5,260 4,120 789 4,963 3,191 2,906 8,555

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 STL - laundry Charitable Other Income £000

Patient-Centred & Safe Friendly Professional Responsive

2013-14 Analysis of Group Revenue

Non-clinical, 20,539 Other clin, 42,286 Out-patients, 29,701 Private, 1,865 E l e c t i v e , 3 6 , 9 7 2 Non-elective, 63,215 ED, 4,915

Patient-Centred & Safe Friendly Professional Responsive

2013-14 Group Expenditure

• Total Expenditure £196.8m (of which SFT is £192.3m)
• Operating Expenditure £191.3m
• £120.3m (62.6%) spent on paying staff
• £36.7m spent on clinical supplies & healthcare
• £37.2m 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]

• Working Capital Facility has been discontinued
• Management and administrative costs less than 4% of turnover

Patient-Centred & Safe Friendly Professional Responsive

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

34,333 32,989 18,797 14,006 12,711 6,111 1,393 31,812 30,868 18,107 14,048 12,198 6,120 1,412

5,000 10,000 15,000 20,000 25,000 30,000 35,000

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

£000

2012-13 2013-14

Patient-Centred & Safe Friendly Professional Responsive

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 13,098 17,552 5,690 6,387 8,496 579 3,272 2,167 2,370 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 2012/13 2013/14

Patient-Centred & Safe Friendly Professional Responsive

Group Statement of Financial Position

at 31.3.14 at 31.3.13 £000 £000 Non-current Assets - Property, plant & equip 146,004 135,737 Current Assets 34,119 30,291 Current Liabilities

• 19,546
• 19,175

Total Assets less current liabilities 160,577 146,853 Less Non-current Liabilities

• 20,300
• 21,714

TOTAL ASSETS EMPLOYED 140,277 125,139 FINANCED BY: Public Dividend Capital 53,339 51,554 Revaluation Reserve 58,452 49,106 Income & Expenditure Reserve 15,965 13,428 Charitable Funds reserve 12,465 10,989 Minority Interest 56 62 TOTAL CAPITAL & RESERVES 140,277 125,139

Patient-Centred & Safe Friendly Professional Responsive

2013-14 Capital Expenditure - £8.288m

Key schemes include: £m Medical equipment 1.281 Dementia friendly wards 737 Maternity improvements 446 Building works 2.363 Information technology 1.997 Energy efficiency 306

Patient-Centred & Safe Friendly Professional Responsive

Financial Ratings

Using earlier FRR assessment: 2013/14 2012/13 RATING EBITDA Margin 8.1% 8.0% 3 EBITDA % Achieved 103.3% 105.7% 5 Return on Assets Employed 0.8% 1.0% 3 I&E Surplus Margin 1.0% 1.3% 3 Liquidity 24.8 days 21.0 days 4

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 successful financial year – however:

• Exceedingly challenging financially - need to work closely with the

new Clinical Commissioning Groups to ensure continuity of local service provision

• Further reductions in the national tariff of 4% likely
• Some reductions in activity in 2013/14 and more activity likely to be

restricted by CCGs

• Level of tariff deflator is not sustainable
• Concern about how to improve and renew assets if we do not

generate surpluses at a higher level

• Proving very difficult to achieve recurring cost savings especially

given the Trust is one of the more efficient in the country

Patient-Centred & Safe Friendly Professional Responsive

Charitable Receipts 2013-14

Donations, Legacies & Grants of £2, £2,269k 269k together with other net Charitable Income of £548k £548k Enabled New Equipment & Facilities £7 £774k 4k Patients Welfare & Amenities £420k £420k Staff Education & Welfare £3 £375k 75k Research £1 £180k 80k And (arriving in 2014) TWO NE NEW C W CT SCANNERS RS!!!

Th Thank y you!!!฀

Patient-Centred & Safe Friendly Professional Responsive 18

Annua nual R Repor

• rt 2

2013/14

Peter H Hil ill Chie hief E Executiv ive

Patient-Centred & Safe Friendly Professional Responsive 19

Some light reading:

February Francis Report – Public inquiry into Mid Staffs Hospital April Health and Social Care Act July Keogh Review – Review of 14 hospitals with persistently high mortality rates Neuberger Review of Liverpool Care Pathway Cavendish Report – Independent review of training for healthcare assistants August Berwick Review – Improving patient safety October Clwd–Hart Report – Review of hospital complaint systems November Jane Cummings’ Report – Nursing & Midwifery staffing capacity and capability

Patient-Centred & Safe Friendly Professional Responsive

District General Hospital Services

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

Patient-Centred & Safe Friendly Professional Responsive

Regional Specialist Services

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

Patient-Centred & Safe Friendly Professional Responsive

Supra-Regional Spinal Services

Patient-Centred & Safe Friendly Professional Responsive

Facts & Figures for 2013/14

Elective Admissions

6,700

Day Cases

21,400

Regular Day Attendees

6,400

Emergency Admissions

27,700

A&E Attendances

43,200

Number of Births

2,500

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

165,000

Patient-Centred & Safe Friendly Professional Responsive

Review of Performance for 2013/14

90.3% Inpatient or day cases treated within 18 weeks - National Target: 90% 98% Patients who did not need to be admitted were treated within 18 weeks – National Target: 95% 98.5% Cancer patients treated within 31 days of decision to treat - National Target: 96% 96.3% A&E attendees admitted, treated or discharged within 4 hours – National Target: 95%

Patient-Centred & Safe Friendly Professional Responsive

98.7% Patients risk assessed for VTE – (National Average: 90%) MRSA bacteraemia notifications – (target: 0 )

Two reported cases were contaminates

21 Trust apportioned Clostridium Difficile cases - (National Target: 21) 91.6% Patients who had a CT scan within 24 hours of admission with a stroke– (National Target: 90%)

Patient-Centred & Safe Friendly Professional Responsive 26

What our patients say:

98.3% 1.7% REAL-TIME FEEDBACK April 2013 - March 2014 Overall, how would you rate the quality of care you received?

Good - Excellent

n = 1825 98.5% 1.5% REAL-TIME FEEDBACK April 2013 - March 2014 Do you feel cared for?

Yes No

n = 1740

330 Complaints Dignity & Respect Quality of Care Recommend Hospital

Patient-Centred & Safe Friendly Professional Responsive

What our staff say:

3.10 3.20 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 Poole Hospital The Royal Bournemouth Hospital Royal United Hospital Bath Great Western Hospital Swindon Gloucestershire Royal Hospital

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

Patient-Centred & Safe Friendly Professional Responsive

Achievements

Expansion of palliative care service CT Scanner campaign New Health and wellbeing programme for cancer patients social stimulation for older patients

Patient-Centred & Safe Friendly Professional Responsive

Achievements cont…

29

Spinal nurse wins national award Patient and Public involvement award Major refurbishment of general wards

Patient-Centred & Safe Friendly Professional Responsive

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 670 volunteers give up around 1,900 hours a week of extra

support, helping on wards and departments, acting as guides and supporting one off projects

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

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

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

17,300 members

• Link with membership, statutory duties, support services and

sample patient experience

Patient-Centred & Safe Friendly Professional Responsive

Our Focus for 2014/15

Challenges: Area eas f for impr provemen ment:

• Changes to commissioning and the impact on smaller general

hospitals

• National and local initiatives to keep people out of hospital
• Finance – around 9 – 10 million pound annual year-on-year savings
• Infection prevention
• Care of older people in hospital
• Patients with long term conditions – preventative care
• End of Life Care

Patient-Centred & Safe Friendly Professional Responsive

Diagnosis and Care 1993-2014

Dr Sha haun Mc McGee F FRCP CP FRCR CR Con

• nsul

ultant ant R Rad adiol iologis ist

Patient-Centred & Safe Friendly Professional Responsive 33

The challenge of leadership

Regio ional S Scientif ific ic O Officer f for W Wesse ssex c circa 1 1986 “There will never be a CT scanner in Salisbury”

Why ?

“Places like Salisbury have no need for a CT scanner” “In fact one CT scanner will adequately serve the needs of the entire region”

and where will it be?

“ of course it will have to be in Southampton ”

Patient-Centred & Safe Friendly Professional Responsive 34

Wide range of diagnostic and therapeutic imaging modalities

• Ultrasound
• Computed Tomography ( CT, CAT scanning)
• Magnetic Resonance Imaging
• Nuclear Medicine
• Positron Emission Tomography (PET scanning)
• Interventional radiology

– image guided biopsy/therapy

Patient-Centred & Safe Friendly Professional Responsive 35

How does this help Salisbury Patients?

Ultrasound

Gall Bladder Kidney Pregnancy

Patient-Centred & Safe Friendly Professional Responsive 36

How does this help Salisbury Patients?

Magnetic Resonance Imaging

Back Knee Hearing Cancer

Patient-Centred & Safe Friendly Professional Responsive 37

How does this help Salisbury Patients?

Computed Tomography (CT)

Head/Neck Pelvis Coronary Arteries

Patient-Centred & Safe Friendly Professional Responsive 38

Progress in computer processing/display

• Faster acquisition and display of images
• Improved resolution and clarity of images
• Picture Archiving and Communications Systems

(PACS) for reporting

• Filmless and paperless departments of Clinical

Radiology

Patient-Centred & Safe Friendly Professional Responsive 39

Progress in computer processing/display

Ward A & E Operating Theatre GP surgery Consultant Radiologist Home ↑ → ← → ←

Patient-Centred & Safe Friendly Professional Responsive 40

CT Colonography or Virtual Colonoscopy

Patient-Centred & Safe Friendly Professional Responsive 41

Virtual Colonoscopy or CT Colonography

Patient-Centred & Safe Friendly Professional Responsive 42

Endoluminal repair of Abdominal Aortic Aneurysm

Patient-Centred & Safe Friendly Professional Responsive 43

SDH 1967 to 2013

Consultant Radiologists Radiographer WTE Admin Exams pa (K) £ 1967 2 8 4 30 40K 2013 13 45 18 130 5.8M

Patient-Centred & Safe Friendly Professional Responsive 44

Thank you

In 2014 diagnostics is at the heart of the patient journey in virtually every field of medicine

Patient-Centred & Safe Friendly Professional Responsive

Commitment to Care – a personal perspective

Mari ria F a Ford Cons nsul ulta tant nt Nurse in Critical tical Care re

RGN GN, M , MA, , PGDH PGDHE, B , BSc( c(Hon

• ns), D

, DPSN

Patient-Centred & Safe Friendly Professional Responsive

Through the decades…

1930’s 1940’s 1950’s 1960’s

Radnor Ward

1980’s

Patient-Centred & Safe Friendly Professional Responsive

Changing the Shape of Nursing

Influencing factors

Public health issues Government policy Technology Nurse and medical education Professional accountability

Patient-Centred & Safe Friendly Professional Responsive

Professional Accountability

In my estimation obedience is the first law and the very corner stone of good nursing. And here is the first stumbling block for the beginner. No matter how gifted she may be, she will never become a reliable nurse until she can obey without question. The first and most helpful criticism I ever received from a doctor was when he told me that I was supposed to be simply an intelligent machine for the purpose of carrying out his orders.

(Matron Dock 1917)

Patient-Centred & Safe Friendly Professional Responsive 49

External Influences

Role Expansion

Ventilator in 1980 and 2000 ED 1993 and 2014

Patient transfer to spinal unit (circa 1980)

Patient-Centred & Safe Friendly Professional Responsive 50

What has not changed?

Commitment Communication Compassion Courage Competence

Amy Johnson Senior Sister Abi Rigby Senior Sister Steve Nobbs Diabetic Specialist Nurse Emma Crockett Sister

Patient-Centred & Safe Friendly Professional Responsive 51

Patient-Centred & Safe Friendly Professional Responsive

Stars Appeal

52

Patient-Centred & Safe Friendly Professional Responsive 53

Questions and answers