Appendix C LEEDS TEACHING HOSPITALS TRUST PROFILE 1. Introduction - - PDF document

Appendix C LEEDS TEACHING HOSPITALS TRUST PROFILE

• 1. Introduction

The Leeds Teaching Hospitals Trust was formed in 1998. It was then and is now the largest Trust in the country, providing services for the residents of Leeds, West Yorkshire and beyond. Eight years in, although there remains much that still needs to be done, a great deal of progress has been made. This paper sets out that progress and also places the particular challenges the Trust still faces into context.

• 2. Patients treated

The story for patients is a very positive one indeed. Some of the headline figures include:

• Since March 1999, the number of people waiting for treatment on

inpatient and day case waiting lists has dropped by approximately 6,000. This is a reduction of 37% over 7 years.

• In March 1999, 4,570 people had been waiting longer than 6 months

and 311 of these patients had been waiting longer than 12 months for their treatment. Latest data shows only 9 patients waiting longer than 6 months (26 weeks) and no-one has waited longer than 12 months since March 2004. Progress continues to be made to reduce waiting times still further with the Trust now focussing on the interim milestones towards the target of 18 weeks from GP referral to treatment by 2008.

• For patients referred by GPs waiting to see Consultants in outpatients

the change has also been striking. There is now over a third fewer people (9,363) in outpatients than in March 2000.

• For the same group of patients referred by GPs to Consultants, 9,588

had been waiting longer than 13 weeks and 4,764 of these patients had been waiting longer than 26 weeks in March 2000. To date, no-

• ne has waited longer than 26 weeks since November 2003 and, as at

31st April 2006 there were no patients waiting longer than 13 weeks. In fact, the latest quarterly data shows that over a quarter (28%) of

• utpatients were seen within 4 weeks of referral.
• Managing performance within A&E departments is difficult due to the

unpredictable nature of the work. LTHT sees more people within its A&E departments each year than all bar a handful of other trusts in the country and has to manage variations in attendance of up to 30% from

• ne day to the next. Therefore, LTHT has had to work particularly

hard to try and meet the national target of no-one spending longer than 4 hours within A&E. Although, maintaining 98% has proved

Appendix C challenging, real progress has been made at the Trust from 62% in 2002, to 79% in March 2003 to 97% in March 2005. In 2005/06, 97%

• f all new patients attending A&E were admitted, transferred or

discharged within 4 hours.

• Improving efficiency is important for all NHS trusts. Comparisons

between 1998/99 and 2004/05 show that people are spending less time in hospital and more people are being seen. The average length

• f stay for inpatients has dropped from 7 days to 5.5 days and the

number of consultant episodes of care has increased by 6%.

• Clinical quality throughout the life of the Trust has continued to be of a

very high standard.

• 3. Staff employed

The Trust provides its service through the efforts of its staff. The high quality

• f its services are a reflection of the both the quality and the quantity of the

staff in the Trust. The transformation in the range and scale of the Trust’s staff is impressive.

• In 1999, the Trust employed 14,154 staff across the Trust. In

2006, the Trust employs 14,931 staff, an increase of some 5%.

• Care on the wards is delivered by qualified and unqualified
• nurses. In 1999 there were 5008 staff in this group but by 2006

this number has grown to 5573. This represents an increase of more than 10%.

• The Trust also employs some of the country’s leading
• specialists. In 1999, the Trust employed 425 Consultants, and in

2006 this has risen to 540 permanent consultants, a growth of around 21%.

• The future excellence of the service will depend on the Trust

fulfilling its role as a teaching hospital, training the health professionals of the future. In 1999, the Trust employed 729 junior medical staff and there are now 1103 ‘other’ medical staff including junior doctors.

• In 1999 there were around 1,234 scientific and allied

professional staff; there are now 2,051 qualified and unqualified staff in these groups; an increase of nearly 40%.

• 4. Resources

Of course, expansion in the numbers of staff employed by the Trust and with it the increases in the numbers of patients seen and treated, comes at a price. The resources that have been made available to the Trust over the timeframe

Appendix C 1998-2006 by its commissioners are a testament to the value placed on the Trust’s services by patients and commissioners, and also to the growth that has been made available to the NHS. Between 1998/99 and 2005/06, the resources available to the Trust increased from £432M to £721M, of which approximately half is provided by Leeds commissioners for clinical services to the local population . This is an increase

• f 67% or on average £41M per year. In 2006/7 resources are expected to

increase similarly, to £766M. The challenge for 2006/07 The Trust estimates that it will need to save £84m over the next three years – £25m of that in 2006/07 – if it is to maintain its record of financial balance. Trust’s total budget over three years is approximately £2.2 billion (£730 million pa). £84 million represents around 3.5% of this total. The Trust has a history of sound financial management. It achieved financial balance in 2005/06 for the sixth year running. 2005/06 was the first year since the Trust was formed that balance has been achieved without any external financial assistance. However, every year the Department of Health requires NHS Trusts to make an efficiency contribution to national pay and price rises. Last year this was set at 1.7 % per annum (equivalent to £12 million from the LTHT budget). In 2006/07 all NHS Trusts are required to contribute 2.5% (£18 million from LTHT budget). The introduction of National Tariffs and Payment by Results will have a significant impact on the Trust because some treatments provided here cost more to carry out than the Trust than will receive – i.e. the price set by national tariffs. Until very recently the Trust was expecting the impact to be £7m but a very recent change in national policy means that will now be £14 million in 2006/07. The overall target is less than the total of these two figures because the Strategic Health Authority (SHA) has agreed that 3.5% of budget is the maximum any trust can achieve in one year. The Trust has an underlying recurring deficit of £14 million. This has been reduced year on year – from £30 million when the Trust was formed in 1998 – through a range of recurring savings. In 2006/07 this underlying deficit will be eliminated completely. The financial plan The Trust Board has approved a financial plan to close the gap required during the first of the three years – a total of £25m or 3.5% of turnover. The size of the challenge facing the Trust means that the Trust staff costs are likely to decrease by the equivalent of around 435 posts – this may not mean that 435 actual posts are lost if savings can be found in other ways.

Appendix C There are no plans at this stage for redundancies. At any given moment the Trust has around 400 vacant posts – it is anticipated that by working differently and filling only the highest priority posts as vacancies arise, the Trust can achieve the necessary reductions in staff costs. A range of other measures are being considered to contribute to closing the £25 million 2006/07 funding gap. These include:

• Reviewing staff costs, including medical, nursing, administrative and

senior management costs (over and above the £7 million saving on headquarters management costs made during 2004/05)

• Reductions in non-pay costs such as office expenses, travel, etc
• Cutting the number of unnecessary early admissions and helping to

reduce the length patients stay in hospital

• The introduction of e-recruitment
• Reducing staff sickness absence
• Reducing patient administration costs
• A review of car parking charges
• 5. Capital Improvements

The Trust inherited a mixture of very new (Jubilee Wing) and very old accommodation such as that at Cookridge Hospital. The quality of the estate

• f course has a direct impact on the patient experience and many patients will

have their view of the service they experience coloured by the condition of the fabric of the hospitals. Since 1998, the Trust has steadily improved the quality of its estate, with a number of landmark achievements. These include:

• £220M new oncology wing, the building work is now advanced, with

completion expected in December 2007.

• £20M new Wharfedale Hospital that opened for patients in October

2004

• A program of major service reconfigurations is nearing completion,

costing £26M that has established a dedicated elective orthopaedic treatment centre at Chapel Allerton and improved facilities available for a wide spectrum of services.

• Improvements in Cancer facilities including new medical oncology
• utpatients space , 3 new linear accelerators and a state of the art

MRI scanner (all of which will move into the new oncology wing)

Appendix C

• Improvements to medical wards including a new infectious disease

ward, a refurbished medical admissions ward and new outpatient facilities for dermatology.

• Improvements in surgery that include a new vascular surgery ward,

a new urology centre (the Paul Sykes Centre), modernised breast screening facilities at Seacroft and new theatres for colorectal and breast surgery.

• A new hand treatment unit.
• A new endoscopy unit, refurbished wards across LGI and St James

sites and improved out patient facilities.

• The opening of the South Leeds Renal Satellite unit.
• Development of a new catheter laboratory at LGI to expand

services for coronary heart disease.

• The opening of a Walk In Centre, adjacent to A&E, on the LGI site.
• Investment in IT and Telecommunications have also benefited from

investment in this Trust including £2.9 million on a new Patient Administration System (and associated process changes), new and upgraded computer networks, a new Radiology Information System, a new A&E information system and new telecommunications and paging equipment for the new Wharfedale Hospital.

• Over £2m is being invested in improving the Trust’s medical records

and clinical coding infrastructures, with significant benefits in terms

• f clinical quality and efficiency.
• A program of development and upgrading the dental hospital is

underway, which will improve facilities for patients and support expansion in the number of dentists being trained. A record program of capital investment is planned in 2006/7.

• 6. Services

The Trust provides services from the following sites: Leeds General Infirmary; St James University Hospital; Chapel Allerton Hospital; Cookridge Hospital; The Leeds Chest Clinic; Seacroft Hospital; Wharfedale General; The Leeds Dental Institute We provide services for Leeds residents in the following specialties:

Appendix C Leeds Services General Surgery Urology Trauma & Orthopaedics ENT Dermatology Plastic Surgery Rheumatology Paediatrics Pain Management General Medicine Gastroenterology Clinical Haematology Ophthalmology Thoracic Medicine Anaesthesia Obstetrics Gynaecology Wheelchair Services Rehabilitation Oral Surgery Audio logical Medicine Accident & Emergency Geriatric Medicine We provide services for Leeds residents and the people of West Yorkshire (and parts of North and East Yorkshire also): Services for Yorkshire Neurosurgery Nephrology Cardiothoracic Surgery Kidney Transplantation IVF Paediatric Surgery Cardiology Medical Oncology Neonatal logy Clinical Genetic Neurology Infectious Diseases Genito-Urinary Medicine Prosthetics Specialist Rehabilitation Additionally we also provide a designated national service for adult and paediatric liver transplantation.

• 7. The Future

As a major teaching hospital, the Trust has a tripartite mission including teaching and research as well as service. The Trust continues to work collaboratively with the University of Leeds with respect to its teaching and research responsibilities and progress is being made in these important areas. An overview of the Trust’s resource position has been provided at Section 4. Progress on eradicating the underlying deficit continues and the Trust has reduced this from an original £30M to £14M in the 2005/6. The Trust reported a balanced financial position for 2005/6 after meeting increased efficiency targets, while at the same time maintaining safe standards, and continuing to improve our performance against activity and waiting time targets. In addition to the range of cost improvement programmes introduced by clinical management teams each year as part of the ongoing drive to become more efficient, external consultants (Price Waterhouse Coopers) have been appointed by the Trust to oversee a major change management programme.

Appendix C The Trust needs to make radical changes in the way it uses its resources. This programme is designed to identify a range of service improvements, new and substantial efficiencies and some savings measures. It will also spread best practice from one area of the Trust to another, and from across the NHS, as well as help to embed new ways of working across the organisation. Changes in services and improvements in efficiency will be made in line with the White Paper, Our Health Our Care Our Say, which signals a shift towards care being provided out of hospitals where this is better for patients. Making Leeds Better The future for NHS and Social Care services in Leeds is now firmly positioned within the ‘Making Leeds Better’ strategic service programme. This is a far reaching and imaginative strategic vision that modernises and improves NHS and Social Care, providing more services closer to peoples’ own homes in fit for purpose accommodation or at home, and a redesigned and necessarily smaller hospital service, working in modern facilities. Making Leeds Better has it its heart the much longed for Children’s Hospital development, but carries with it the promise of much more. This vision for the NHS and Social Care is supported by all NHS organisations in Leeds (the PCTs, the Mental Health Trust and LTHT) and has for the first time enabled a truly shared strategic direction to be developed. It is clear that the Making Leeds Better strategy requires demonstrable financial stability across the health community and the capital investment in a new children’s and maternity hospital requires the Trust in particular to achieve a sound financial position.

• 8. Summary and Conclusion

Leeds Teaching Hospitals has reduced the waiting times for treatment and has treated more patients than ever before. It now employs more front line staff and has been able to improve and modernise many of its facilities. Throughout this period the clinical quality of the service provided by the Trust continues to develop, as does the excellence of our teaching and research. The City of Leeds and all the patients we serve can be justly proud of the range, and quality of the services it has access to at the Trust. Ross Langford Acting Director of Communications and Corporate Affairs Leeds Teaching Hospitals Trust May 2006