Annual Members Meeting 2012 September 15 th 2012 Agenda o Minutes of - - PowerPoint PPT Presentation

Annual Members Meeting 2012

September 15th 2012

Agenda

• Minutes of previous meeting
• Financial Performance 2011/12
• Review of 2011/12
• Membership report
• Changes to the constitution
• Improvements through integration

Financial Performance 2011/12

Bolton NHS Trust

• Annual Revenue

£283m

– Provider Arm – Salford Maternity & Neonatal – Bury Maternity

• Staff (Average Number)

6396

• Approx 1,000,000 patient

contacts

Our Health Economy

• We face enormous financial

pressures

– £20bn National savings target – Growing numbers of patients – Tougher contracts – Commissioning intentions

• Annual efficiencies
• f 6% required

Financial Position

• In breach of our authorisation
• Headline Loss
• Slippage on efficiency

programmes

• Lack of clarity in reporting
• Impact on 2011/12
• Transformation Plan

Financial Performance

£m

Revenue 283.1 Operating Expenses 275.1 EBITDA 8.0 Depreciation, PDC, interest, other 9.9 Surplus before impairments* (1.9) Deficit after impairment of £10.4m (12.3)

Activity Analysis

Actual Variance v Plan %

Elective activity 29,760 841 2.9 Non-elective activity 46,146 1,906 4.3 New outpatient attendances 80,429

• 1,303
• 1.6

Follow-up attendances 154,719 17,565 12.8 Outpatient procedures 42,729 11,208 35.6 A&E attendances 110,720

• 553
• 0.5

Statement of Position

31/3/2012 31/3/2011 £m £m

Non current assets 127.7 129.8 Current assets 19.2 15.5 Total assets 146.9 145.3 Current liabilities

• 20.9
• 15.2

Assets less current liabilities 126.0 130.1 Non current liabilities (borrowings)

• 21.8
• 13.9

Total assets employed 104.2 116.3

Points to Note

• Our year-end financial position was disappointing

– Costs rising faster than income – Slippage against planned efficiency programmes – Higher running rates of expenditure than expected – One off savings masked our underlying position

• As a result, we are in Breach of our Authorisation
• The task in 2012/13 is very stretching

– Tariff reductions – Cash implications of ongoing losses

Financial Priorities

Sustainable Top Quality Services

Clinically Led Recovery Plans Providing Excellent Integrated Care Upper Quartile Performance Financial Balance A Better Deal for Patients

2011/12 – Review of the year

2011/2012 – a year of change

July 2011 transfer of community services November 2011 transfer of maternity services from Salford February 2012 Transfer of maternity services from Bury

Awards 2011/12 – focus on quality

• Clinical Leader of the Year 2011 ‐ British Medical Journal Group Awards.
• Nurse of the Year 2011 ‐ Nursing Standard Awards.
• North West Clinical Leader of the Year ‐ NHS North West Awards.
• Best Process Improvement Project in Service & Transaction 2011 ‐

National Process

• Excellence in HRM Award 2011 ‐ Healthcare People Management

Association.

• Patient Safety in Surgery ‐ National Patient Safety Awards 2011.
• Apprentice of the Year 2011‐ NHS North West.
• Working in Partnership to Narrow the Gap in Health Inequalities ‐

Community Empowerment Awards 2011.

Performance 2011/12

• However found in breach of terms of

authorisation for failing to achieve 18 week (admitted) and urgent care targets.

• Other compliance targets achieved full list in

annual report

• Our redesign plan clinically agreed and

implementation began

– Significant improvements to urgent care and 18 week performance – both achieved consistently in 2012

A&E four hour wait performance

Month Attendances Performance April 12,880 97.2% May 13,916 97.2% June 12,789 97.7% July 13,082 97.2% August 9,900 99.0%

18 week (admitted) performance

Month Performance April 92.7% May 94.7% June 93.8% July 92.3% August 93.9%

Current Performance against targets and standards

Standard Data Period Threshold Actual Comments RAG Clostridium Difficile (Post 72 Hours) 1st April to 26th August 2012 30 Financial Year target = 28 MRSA 1st April to 26th August 2012 2 Financial Year target = 2 A & E 4 hour wait 1st April to 26th August 2012 95.0% 97.6% Q2 prediction 98% 18 weeks RTT- Admitted July 2012 90.0% 92.3% Q2 prediction 91.5% 18 weeks RTT - Non Admitted July 2012 95.0% 97.1% Q2 prediction 97.0% 18 weeks RTT - Incompletes July 2012 92.0% 96.5% Latest data is 96.7% RTT information July 2012 50.0% 99.9% Q2 prediction 99.9% Referral information July 2012 50.0% 100% Q2 prediction 100% Treatment activity information July 2012 50.0% 100% Q2 prediction 100%

Clostridium Difficile

Membership Report 2011/12

Membership Report

4,812 public members Gender Male 47% Female 53% Age 16 - 24 10% 25 - 44 31% 45 - 64 33% 65 - 74 13% 75 - 84 10% 85 + 3%

1st September 2012

Membership

3834 4298 4385 4617 4519 4812 3000 3500 4000 4500 5000 5500 Members Date

FT Membership (Public Members) September 2012

Constitution changes

Changes to constitution in line with the requirements of the 2012 Act

• The continuation of the body corporate known as Monitor;
• Requirement for the principal purpose (i.e. provision of goods and services

for the health service in England) to be stated in the constitution;

• Introduction of the new legal duty to ensure that income of NHS funded

goods and services is greater than income from other sources;

• Introduction of additional oversight and scrutiny by the Council of

Governors over activities generating non-NHS income;

• Replacement of HM Treasury with Secretary of State as regards giving

guidance over FT accounts

Questions

Improvements through integration

Integration of Musculoskeletal Services in Bolton

“A modern marriage” Phil Wykes September 2012

What was the past like?

Referral CAT appointment Conservative treatment RBH appointment Pre-operative assessment Ward Theatre Post-op intervention

The musculoskeletal service old state

Health assessment Other surgical provider Conservative treatment 75% 50% 25% 35% 65% 50% Spare capacity in the CAT Duplicate appointments of average 70 per month each for pre- assessment and OPD Long waits at RBH Surgical appointments used for non- surgical patients

What did that mean?

• Complicated
• Expensive
• Duplication
• Long waiting times (up to 13 weeks) to see a

surgeon

• Difficult to manage
• Fractured
• Poor communication

What Did Integration Mean?

• PCT provider arm merged with the Hospital
• Two MSK services → one
• New model of care
• Opportunity to relocate and redevelop

How did we organise it?

• Bolton Improving Care System
• Mapping week- June 2011
• Established a core group
• Clinician-led, staff-driven
• Patient involvement at every stage
• Several improvement events, including

– Present state – Ideal (future) state – How to bridge the gap

Mission Statement

“I would like a truly human experience provided by the right caring professional at the right time in a clean, safe place that delivers the best possible outcome”

Aim of the new & improved service

Improve patient journey Realign non-surgical and surgical capacity to help achieve 18 weeks Reduce waste

This means….

• Right pathway early
• Right clinician first time
• Reduce visits / investigations / pre-assessments
• More cost effective
• Ensure high quality care – equitable, standard
• Patient-centred & with Shared Decision Making
• Patients better prepared for surgery to reduce the

time spent in hospital

• Capture the work
• Maximise income

Referral Triage Non-surgical appointment Conservative treatment Surgical appointment Pre-operative assessment Ward Theatre Post-op intervention Enhanced Recovery Programme Clinical Pathways Shared Decision Making Patient Education

The integrated musculoskeletal service

Process for surgical opinion if required by Generalists Triage rules written Feedback loop re quality of referrals

Bolton One

• Joint development between:-

– University – Council – Foundation Trust

• Generalist and support staff moved May 2012
• Surgeons moved May to July 2012
• Redesigned templates and allocated clinic space
• Joint triage system developed that happens daily

Waiting Area

Reception

AOP consultation

Surgical consultation

X-rays

Pre - Assessment

Results so far…..

• Co-located over May to July 2012
• Reduced surgical waiting times:-

Was 12-13 weeks Now: – Foot and ankle 2 to 4 weeks – Upper limb 7 weeks – Lower limb 6 weeks Better than predicted (10 weeks) without drop in referrals and without impacting on non-surgical waiting times

• Reduced unnecessary investigations e.g. halved use of nerve

conduction studies – saving £25k

• Revamped Back Pain service

Problems

Bolton One is not perfect

• Change is painful

– Staff – Patients – Working practices

• Split-site working has its own problems
• Need to fully integrate teams & encourage

cross referral

Future Work – continue to refine the pathways, removing waste

• Staffing needs
• Pre-operative assessment
• Pathways of care – more conditions
• Clinician –delivered Ultrasound = 1 stop shop
• Patient education & Shared Decision Making
• Audit / review our performance
• Publicity for a service that works

In conclusion…..

• Brave idea
• Many advantages
• Some disadvantages
• Lots of work
• New house and presents
• Already see early benefits
• No complacency – long-term

…………Just like marriage

Any Questions?