Annual Members Meeting 12 October 2016 Excellence in specialist and - - PowerPoint PPT Presentation

Excellence in specialist and community healthcare

Annual Members’ Meeting 12 October 2016

Excellence in specialist and community healthcare

Sir David Henshaw, Chair Introduction

St George’s – Challenging times

• New leadership team
• CQC draft report
• Estates, IT, performance and governance
• St George’s staff and patients
• Our strategy/the future

Annual Members’ Meeting/ St George’s University Hospitals NHS Foundation Trust

New leadership team

• A distressed organisation
• Lack of cohesive strategy and vision
• New Chair appointed March 2016

Priorities

• Refreshed Board confronting the reality
• Non-executive directors to be appointed soon
• Strengthening leadership at every level

Annual Members’ Meeting/ St George’s University Hospitals NHS Foundation Trust

CQC inspection report

• Inspection carried out in June 2016
• A difficult report, but no surprises
• We were open with the CQC about the problems we

face

• Final report to be published in November

Annual Members’ Meeting/ St George’s University Hospitals NHS Foundation Trust

Estates

• Major investment required
• Maintenance regime resumed
• Moving services to ensure

patient/staff safety

Annual Members’ Meeting/ St George’s University Hospitals NHS Foundation Trust

IT

• Basic tasks often difficult due to poor IT

infrastructure

• £1.3 million invested to stabilise the situation
• Long-term IT strategy being developed

Performance

Annual Members’ Meeting/ St George’s University Hospitals NHS Foundation Trust

• Emergency Department performance much

improved

• Reduced waiting lists through better use of theatres

Governance

• Data quality issues identified
• Overarching Quality Improvement Plan
• Accountability lines (Board to ward, and ward to

Board) now priority focus

Our staff and patients

• These are challenging times

for staff

• Patients continue to praise

the care they receive – which is fantastic

• We will continue to involve

them in re-shaping and modernising our services

Annual Members’ Meeting/ St George’s University Hospitals NHS Foundation Trust

Our strategy/the future

• Focus on getting the basics right
• Major issues to resolve across the organisation
• Developing a strategy to equip St George’s for the

future

• We need to make St George’s better
• Staff and our stakeholders are a key part of this

mission

Annual Members’ Meeting/ St George’s University Hospitals NHS Foundation Trust

Excellence in specialist and community healthcare

Professor Simon Mackenzie, CEO Review of 2015/16

St George’s Hospital Queen Mary’s Hospital

St George’s cares for a population of 1.3 million across south west London. Two main hospitals, plus a wide range of community settings.

As well as our two main hospitals, we provide care in health centres, GP surgeries, schools, people’s homes and HMP Wandsworth. We share our Tooting site with St George’s University of London.

Annual Members’ Meeting/ St George’s University Hospitals NHS Foundation Trust

9,000 staff 21,500 Foundation Trust members 330 volunteers 637,000 outpatients treated each year 5,200 babies delivered per year We provide services from 12 health centres Emergency Department sees 400 patients each day 28,500 elective procedures every year

We are a teaching hospital, a tertiary referral centre, and a community

• provider. We touch the lives of thousands of people.

Annual Members’ Meeting/ St George’s University Hospitals NHS Foundation Trust

2015/16 in review

• A difficult year
• Financial challenges
• Failure to deliver waiting

times

• Hard working staff providing

good care

• Some positive outcomes

Annual Members’ Meeting/ St George’s University Hospitals NHS Foundation Trust

Financial position 2015/16

• Lost control of our finances in 2014/15
• Serious weaknesses in finance and management

systems (PwC)

• Monitor found Trust in breach of license
• KPMG turnaround support
• Deficit of £55 million for 2015/16
• Continuing to lose money every month

Annual Members’ Meeting/ St George’s University Hospitals NHS Foundation Trust

Performance 2015/16

Indicator Target 15/16 performance ED 4 hour >= 95% 90.44% RTT incomplete pathways >=92% 90.25% 62 day wait for first treatment for urgent GP cancer referral >=85% 82.5% Chlostridium Difficile <31 cases 29 MRSA 3 SHMI (Oct14- Sept 15) <1.0 0.91

Annual Members’ Meeting/ St George’s University Hospitals NHS Foundation Trust

Service developments 2015/16

• Charles Pumphrey Unit for

cardiology patients

• Wolfson Rehabilitation Unit
• pened at Queen Mary’s

Hospital

• Gordon Smith cancer ward
• pened at St George’s

Hospital

• Youth violence project in ED
• Improving cancer services

with Macmillan

Annual Members’ Meeting/ St George’s University Hospitals NHS Foundation Trust

Organ donation at St George’s

• Highest organ donation rate

in the UK

• Excellent renal transplant
• utcomes
• Tree of life annual

celebration event at St George’s

Annual Members’ Meeting/ St George’s University Hospitals NHS Foundation Trust

External recognition 2015/16

• Hyper Acute Stroke Unit: Sentinel

Stroke National Audit

• Haematology: VTE Exemplar Network

membership

• Mortality: one of only two Trusts with

no ‘avoidable deaths’ in a study published in 2015

• Foetal monitoring team wins Health

Service Journal award

• C4’s 24 Hours in A&E profiles work of
• ur Emergency Department at St

George’s

Annual Members’ Meeting/ St George’s University Hospitals NHS Foundation Trust

Learning from 2015/16 to Make St George’s Better

• We need to do:
• Improve quality and
• Deliver access targets and
• Meet financial goals
• We must:
• Do these together
• Do these with our staff
• Do these with our community

Annual Members’ Meeting/ St George’s University Hospitals NHS Foundation Trust

Excellence in specialist and community healthcare

Margaret Pratt, Chief Financial Officer Financial summary – 2015/16

2015/16 results

• The NHS Trust accounts show

a deficit of £55.1m for 2015/16.

• When compared to the

previous year, operating income went up by 6% but

• perating expenses rose by

11%.

• The key issues contributing to

a rise in operating expenses, and in the absence of increased operating income, were the introduction of safer staffing levels in nursing, and inflation.

• £3.1m of costs associated with

2014/15 were reported within the 2015/16 position. A decision was taken with the auditors not to reopen the accounts due to immateriality.

STATEMENT OF COMPREHENSIVE INCOME 2015/16 2014/15* Change Change £m £m £m % Operating income from patient care activities 621.59 612.66 8.94 1% Other operating income 129.36 98.40 30.96 31% Total operating income 750.95 711.06 39.90 6% Operating expenses

• 795.00
• 716.89
• 78.11

11% Operating surplus/(deficit)

• 44.05
• 5.84
• 38.21

655% Finance income 0.09 0.16

• 0.07
• 45%

Finance expenses

• 4.26
• 3.29
• 0.96

29% PDC dividends payable

• 6.90
• 7.69

0.79

• 10%

Net finance costs

• 11.07
• 10.82
• 0.24

2% Surplus/(deficit) for the year

• 55.12
• 16.66
• 38.45

231% Other comprehensive income Revaluations

• 1.18

0.00

• 1.18

100% Other recognised gains and losses 0.00

• 0.15

0.15

• 100%

Total other comprehensive expense for year

• 56.30
• 16.81
• 39.49

235% *2014/15 figures are the totals for the 10 month and 2 month accounts for comparative purposes

Where did St George’s get its income from?

• There was an increase of 1% in

income from patient care activities.

• The big increase in income from

local authorities relates to the change in the commissioning of GUM services effective from April 2015.

• Other operating income increased

by £31m however this includes an accounting change and the recharge to other trusts of the cost of GP trainees paid on their behalf (since Aug 15). When this item is excluded the increase in

• ther operating income is £4.2m.
• Overall total operating income

increased by 6%.

23 INCOME FROM PATIENT CARE ACTIVITIES 2015/16 2014/15* Change Change £m £m £m % CCGs and NHS England 592.42 571.61 20.81 4% Local authorities 10.94 0.17 10.77 6450% NHS Trusts & NHS FTs 1.78 28.05

• 26.27
• 94%

Private patients 3.61 3.93

• 0.32
• 8%

Overseas visitors 2.28 1.22 1.06 87% NHS injury scheme 3.69 4.47

• 0.78
• 17%

Other clinical income 6.87 3.21 3.66 114% TOTAL - FROM PATIENT CARE ACTIVITIES 621.59 612.65 8.94 1% OTHER OPERATING INCOME 2015/16 2014/15* Change Change £m £m £m % Education, training and research 47.36 50.98

• 3.62
• 7%

Charitable donations 2.92 0.88 2.04 231% Non-patient care services to other bodies 45.83 31.07 14.76 48% Income in respect of staff costs - gross basis (new cat) 26.79 0.00 26.79 100% Other income 6.46 15.47

• 9.01
• 58%

TOTAL - OTHER OPERATING INCOME 129.36 98.40 30.96 31% TOTAL OPERATING INCOME 751.0 711.1 39.9 6% *2014/15 figures are the totals for the 10 month and 2 month accounts for comparative purposes

Where did we spend it?

• Total operating income (previous slide)

rose by 6% overall.

• In contrast, operating expenses rose by

11% from £717m to £795m.

• Some differences in the treatment of

items between FT accounts and NHS Trust accounts make year on year comparisons slightly more complex but the overall message is the same.

• Staff expenses dominate our expenditure

at £486m (£446m in 14/15). The increase is due to inflation (3%), the GP pay recharge as as well as investment in capacity and quality initiatives.

• Clinical supplies and services have

increased along with demand, including increased spend on Hep-C drugs (£4m pass-through).

• Other expenses include consultancy

(KPMG turnaround) and services from non NHS bodies as the trust has come under increasing pressure from rising demand.

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2015/16 2014/15* Change Change OPERATING EXPENSES £m £m £m % Employee expenses 485.67 446.29 39.38 9% Clinical supplies & services 161.27 142.90 18.37 13% Premises 49.77 43.99 5.78 13% Other expenses 31.57 20.11 11.46 57% Depreciation 22.30 21.15 1.15 5% General supplies 16.68 15.49 1.19 8% Services from non NHS bodies 8.41 6.63 1.78 27% Services from other NHS bodies 7.38 6.97 0.41 6% Transport 7.15 5.84 1.31 22% Establishment costs 4.81 7.54

• 2.73
• 36%

Total operating expenses 795.00 716.91 78.09 11% *2014/15 figures are the totals for the 10 month and 2 month accounts for comparative purposes

Capital investment 2015/16

• Capital spend overall was

£31m for the year against the budget of £48m, an under spend of £17m

• The main components of

this underspend are the Infrastructure Renewal Programme (under spend £5.7m) and Major Projects category (under spent £6m).

• The under spends related

to slippage on projects, which will complete instead in 2016/17.

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Capital expenditure vs plan 2015/16 - month by month

1,000 2,000 3,000 4,000 5,000 6,000 7,000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Budgeted capex Actual capex

Capital expenditure vs plan 2015/16 - by category

2,000 4,000 6,000 8,000 10,000 12,000 14,000 16,000 18,000 20,000 Budget Actual

Cash position 2015/16

• The Trust’s cash balance was £7.4m at

March 16 compared to £24.2m at March 15

• However, as the chart shows the

underlying cash position has deteriorated significantly over the year as a result of the £55.1m deficit

• The trust had to borrow £40.4m during the

year from the Department of Health to support its cash position

• In addition the cash position continued to

benefit the London Energy Efficiency Fund (LEEF) loan for the Energy Performance Contract that was drawn down in 2014/15. Minimal expenditure was incurred on this capital project in 2015/16 and at the year end the unexpended balance of this loan - included within the cash balance - was approx £11.5m.

• The purple line on the graph shows

notionally what the cash balance would have been without the borrowing from DH and the LEEF loan.

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Cash balance and borrowings month by month 2015/16

• 50.0
• 40.0
• 30.0
• 20.0
• 10.0

0.0 10.0 20.0 30.0 40.0 50.0 £m £m £m £m £m £m £m £m £m £m £m £m Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Cash balance Borrowings DH LEEF loan Cash bal excl borrowings & LEEF

Excellence in specialist and community healthcare

Kathryn Harrison, Lead Governor Council of Governors

Excellence in specialist and community healthcare

Any questions?

Excellence in specialist and community healthcare

Celebrating 200 year of Nursing and Midwifery: Past, present and future

Hazel Tonge, Deputy Chief Nurse Alison Ludlam, Divisional Director of Nursing and Governance for Community

Then to now

1733 Lansborough House 1973 - 2016 Tooting Now St John’s Therapy Centre The Nelson Health Centre (2015)

Queen Mary’s Hospital

Wandsworth Prison

Visionary leadership

Florence Nightingale 1953 Crimea War Edith Cavell Early 1900 Mary Seacole 1954 Crimea War Carmen Brookes Johnson 2011

Uniforms past to present

1930s 2016

Nurse education past to present

1960s

1950s

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1990s 2016

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Childbirth tools to specially designed birthing rooms (Carmen Suite) Whoosh to beeps Tincture to inhalers Iron railing cots to baby friendly incubators

Technology and care facilities transformation

1904 Victorian Nitty Nora to Specialist Community Public Health Practitioner 1916 Royal Sanitary Institute to Specialist Community Public Health Practitioner 1859 Nursing in the home to Clinical Caseload Managers 2004 transfer from MoJ to DH to Healthcare professionals

Community Nursing

Proud to be a St Georges Nurse/ Midwife

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Essence of a St George’s nurses/midwives ‘Where meaningful care matters’

Essence

• Compassionate and brave
• Professional and hardworking
• Proud to care about patients

and proud to care about each

• ther
• Supportive and highly skilled
• Our nurses and midwives

choose to work at St George’s because of the good reputation

• f the standards of care and

the quality of our services, plus the easy accessible London location.

Professional identity

Present to future… What next?

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With grateful thanks to……

• St George’s Hospital

Charity for allowing us to use photographs and stories from the book (on sale today)

• Divisional Directors of

Nursing and director of Midwifery for sharing their stories

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