UCLH priorities for 2011/12 Simon Knight Acting director of - - PowerPoint PPT Presentation

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UCLH priorities for 2011/12 Simon Knight Acting director of - - PowerPoint PPT Presentation

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UCLH priorities for 2011/12 Simon Knight Acting director of performance 8 th February 2011 Not for reproduction Aims of the session To let you know what our plans / priorities currently are To hear what you think of them Not for

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UCLH priorities for 2011/12

Simon Knight Acting director of performance 8th February 2011

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Aims of the session

  • To let you know what our plans /

priorities currently are

  • To hear what you think of them

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SLIDE 3

Agenda

  • What’s happening across the NHS
  • What’s the current state of play at UCLH
  • Time for questions and observations
  • Our plans for 2011/12
  • Your views on our plans
  • Next steps

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What’s happening in the NHS and at UCLH

  • The Health and Social Care Bill 2011
  • Funding and finances
  • What patients say about UCLH
  • What members say
  • What GPs say
  • How we perform against targets

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The Health and Social Care Bill

  • Patient empowerment: “nothing about me

without me”

  • Commissioning: GPs in the driving seat
  • Increased competition: “any willing provider”
  • Continued focus on quality: “outcomes not

process”, intolerant on safety

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Financial challenges

  • Some protection for health: growth of 0.1%
  • Inflation for health not as rosy as 0.1%

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Financial challenge

Growth in Health Spending since 1999/2000 - UCLH vs. NHS (in England) as a whole

0% 50% 100% 150% 200% 99/00 00/01 01/02 02/03 03/04 04/05 05/06 06/07 07/08 08/09 09/10 10/11 11/12 12/13 Financial Year % growth since 1999/00

NHS expenditure in England UCLH Turnover

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Financial challenges

  • Prices paid to hospitals reduced
  • We aren’t growing as quickly as in previous

years

  • North central London has a large deficit

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We aren’t growing as quickly

Growth in inpatient work (daycases, elective

  • vernights, non-electives) is slowing

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We aren’t growing as quickly

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We aren’t growing as quickly

  • Our income grew by about 10% in 2010/11
  • Currently we think our income will only grow

by 2% at most in 2011/12 Which means ….

  • We can’t rely on growth to deliver

productivity

  • We must start taking out costs from what

we do

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North / central London financial problems

We have a particular problem in north central London If we do nothing to save money: cumulative commissioner deficit (£)

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North / central London financial problems

Money that commissioners want hospitals to save (£m) over next four years

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How do commissioners intend saving money

Pushing out wait times Low priority procedures Reducing outpatient follow-ups Moving care to community settings Other threats to activity Total Reducing workload

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How do commissioners intend saving money Paying less for work: Non-payment for readmissions Moving daycase activity to outpatient setting/tariff Pay for repeat first appointments at follow up price Payment for activity beneath maximum price Various other threats to income Total

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Savings targets 2011 - 2014

* (E)stimated figures that may change; 2010/11 and beyond also includes requirement for locally managed Incremental drift. Source: UCLH Finance; NHS Confederation Dealing with the downturn: using the evidence; UCLH Capital plans; UCLH annual reports

15.2 21 31.7 45 31.6 29.1 5 10 15 20 25 30 35 40 45 50 2008/09 2009/10 2010/11 2011/12 (E) 2012/13 (E) 2013/14 (E)

Efficiency saving requirements: QEP £m

2.5% 3.3%

  • 4. 9%

6.9% 4.9% 4.5% x% Savings as proportion of expenditure

Figures are for illustration only, and have not been approved by UCLH Board of Directors

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What patients say

  • UCLH performs well in patient surveys:

– Overall rating of care – Would you recommend the hospital – Questions about doctors and nurses

  • Key areas for improvement from surveys:

– Should have been admitted sooner – Printed information about condition – Some questions relating to nurses

  • Key lesson from complaints: booking processes

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What members and governors say

  • Key things we hear from members and

governors:

– Booking processes – Getting in touch with staff in the hospital – Service culture

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What members and governors say

Feedback from survey in UCLH News: Average rankings from responses:

  • Deliver infection prevention

2.9

  • Improve waiting times

3.8

  • Meet the cancer waiting times target

3.8

  • 4 hour A & E wait

4.3

  • Improve response to deteriorating patients

4.4

  • Reduce avoidable harm: clots, line infections

4.5

  • Make it much easier to contact us

5.3

  • Improve admin processes

5.8

  • Maintain performance on mortality

6.1

  • Show year on year improvement in surveys

6.4

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What GPs say

  • Key things we hear from GPs, in particular

from GP survey:

– Booking processes – Getting in touch with staff in the hospital – Discharge communications (following A&E visit, outpatient appointment or inpatient stay)

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How we perform against targets

Doing well

  • A&E 4 hour wait
  • 18 week waiting times
  • Clostridium difficile cases
  • Hospital standardised reported mortality
  • Patient surveys

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How we perform against targets

Room for further improvement

  • Some of the cancer waiting times targets
  • MRSA cases

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Questions and thoughts?

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So what does this all mean for

  • ur plans?

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UCLH objectives and priorities

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Clinical outcomes

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Clinical outcomes

Maintain our strong performance on hospital mortality Reduce avoidable emergency readmissions Improve how we do clinical audit so that it makes a real difference to quality of care

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Maintain our good performance on hospital mortality

  • Improvements based on learning from

adverse outcomes

  • Action on infection and other safety

initiatives

UCLH HSMR improvements from 1999/00 to 2010/11

20 40 60 80 100 120 1999/00 2000/01 2001/02 2002/03 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 Relative Risk (observed number of deaths as a percentage of expected number of deaths) RR Low High Data year average

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Reduce avoidable emergency readmissions

Hospitals not to be paid for patients who are admitted as an emergency within 30 days of being discharged from hospital Significant lost income, but will be reinvested in reducing readmissions More careful discharge arrangements Working closely with community services

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Patient safety

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Patient safety

Further reduce levels of MRSA, Clostridium difficile and other key infections Reduce avoidable harm in areas including venous thrombo-embolism, central venous line care and surgical site infections Further improve how our staff recognise and respond to signs that patients are at risk of deterioration

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Further reduce levels of MRSA

MRSA coming down fast ……

20 40 60 80 100 120 2010- 11 2009- 10 2008-9 2007-8 2006-7 2005-6 2004-5 2003-4 2002-3 Year Number of MRSA bacteraemias

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Further reduce levels of MRSA

….. but not fast enough

GRAPH ON MRSA HERE: page 18 of BoD pack

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Other key infections

Work to be done in 2011/12 on MSSA and e.coli Clostridium difficile: within our targets

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Reduce blood clots

2010/11: focus on doing risk assessments on all patients 2011/12: focus on appropriate action on high risk patients

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Patient experience

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Patient experience

Improve our administrative processes so that patients can manage their appointments easily and with confidence. Improve the experience of patients at our hospitals, particularly how we look after their personal needs Make it much easier for patients, GPs and others to get in contact with the staff they need to

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Compared to other London hospitals

Peer London teaching hospitals Ranking against peers 2009 Score out of 100

UCLH 1 78.0 Chelsea & Westminster 2 77.4 Guy’s and St Thomas’ 3 76.6 Barts and the London 4 75.4 Imperial 5 74.5 King’s College Hospital 6 74.3 Royal Free 7 73.4 St George’s 8 73.1

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Improvement areas from 2010

  • Should have been admitted sooner
  • Printed information about condition
  • Hand gel not available or empty
  • Noise from other patients and visitors
  • Food was fair or poor
  • Trust & confidence in nurses
  • Nurses not knowing enough about condition
  • Improving experience for maternity and cancer

patients

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Patient pathways and services

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Patient pathways and services

Work with GPs and other partners to develop for patients the best pathways through local health services Progress plans for phase 4 of our redevelopment, including proton beam therapy and the Mouth, Ear, Nose and Throat centre Commission the Cancer Centre, redesigning pathways to deliver improved care

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Research and education

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Research and education

Develop UCL Partners as a provider of multi-professional training, including as lead for medical and dental education and rolling out the Leadership Staff College across UCL Partners Develop the research joint unit as a centre of excellence to offer support services across UCL Partners Make the clinical research facility at UCLH a market leader through the development of commercial partnerships

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Quality and efficiency programme

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Quality and efficiency programme

Deliver [£45m to be confirmed] savings and efficiencies in 2011/12 Develop and implement a strategy for long term productivity and efficiency savings Rationalise clinical and support services across UCL Partners

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Savings targets 2011 - 2014

* (E)stimated figures that may change; 2010/11 and beyond also includes requirement for locally managed Incremental drift. Source: UCLH Finance; NHS Confederation Dealing with the downturn: using the evidence; UCLH Capital plans; UCLH annual reports

15.2 21 31.7 45 31.6 29.1 5 10 15 20 25 30 35 40 45 50 2008/09 2009/10 2010/11 2011/12 (E) 2012/13 (E) 2013/14 (E)

Efficiency saving requirements: £m

2.5% 3.3%

  • 4. 9%

6.9% 4.9% 4.5% x% QEP as proportion of

  • perating expenditure

Figures are for illustration only, and have not been approved by UCLH Board of Directors

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Savings 2011/12 - 2013/14

5.3 5.3 3.3 7.3 4.5 4.3 4.9 4.9 4.9 3 3 3 2 1.5 1.5 2.6 2 1.5

4.4 4.9

2.1 8.6 9.2

0.9 4.8 6 5 10 15 20 25 30 35 40 45 50 2011/12 2012/13 2013/14

£m

Gap Local Board Schemes EAS Impact Realistic assessment of unidentified savings Budgetary savings in addition to above Incremental Drift Asset Utilisation Procurement Clinical & Corporate Support Costs Productive Clinical Services Workforce

Figures are for illustration only, and have not been approved by UCLH Board of Directors

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Key areas for savings

  • Efficient use of beds on wards
  • Efficient use of theatres
  • Efficient use of outpatient clinics
  • Sharing support services with other hospitals
  • Utilising our assets
  • Buying goods at lower prices
  • Using less agency staff

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Savings strategy for 2011-2014

  • Efficiency is “business as usual”
  • Everyone’s job to help with savings
  • Need to plan carefully to make savings last
  • Use ‘lean’ methodology to improve processes
  • Invest in order to save money

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Waiting times

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Deliver waiting times targets

Deliver average waiting times for patients as agreed with commissioners Deliver standards for timeliness of care in A&E Meet the 2 week, 31 days and 62 days cancer waiting times targets

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Referral to treatment waiting times

Good performance in recent years on inpatients

Inpatient waiting times

A) % patients waiting more than 3 months B) Average patient wait (weeks)

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%

00/01 01/02 02/03 03/04 4//05 05/06 06/07 07/08 08/09 09/10 % patients waiting more than 3 months

1 2 3 4 5 6 7 8 9 10

Average waiting time (weeks)

% patients waiting over 3 months Inpatient average waiting time (weeks)

A) % patients waiting more than 3 months B) Average patient wait (weeks)

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Referral to treatment waiting times

Good performance in recent years on outpatients But commissioners say that they can no longer pay for improving / short waiting times

Outpatient waiting times

A) % patients waiting more than 13 weeks B) Average patient wait (weeks)

0% 2% 4% 6% 8% 10% 12% 14%

00/01 01/02 02/03 03/04 4//05 05/06 06/07 07/08 08/09 09/10 % patients waiting more than 13 weeks

1 2 3 4 5 6 7 8 9 10

Average waiting time (weeks)

% patients waiting more than 13 weeks Outpatient average waiting time (weeks)

A) % patients waiting more than 13 weeks B) Average patient wait (weeks)

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A&E waiting times

Strong performance

Rank London type 1 providers YTD performance (as at 23 January 2011) 1 UCLH 98.7% 2 Chelsea & Westminster 98.3% 3 Kingston 98.0% 4 Croydon 98.0% 5 Barnet & Chase Farm 97.5% London average 95.5%

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A&E waiting times

But new challenges for 2011/12: Average waiting times Time to initial assessment for ambulance arrivals Time from arrival to treatment % patients that leave without being seen % patients reattending A&E within 7 days

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Cancer waiting times

GP referral to treatment waits: currently don’t consistently meet the 85% target more theatre time more outpatient time more rigorous tracking of patients Screening referral to treatment waits: odds stacked against us

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Financial health

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Financial health

Achieve agreed income, expenditure, efficiency and cash targets Understand more about our costs and allocate them to the teams who are in the best position to reduce the expenditure Develop financial expertise in clinical and corporate areas to support delivery of the planned financial position

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Develop staff

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Develop staff

Improve the experience of working at the trust by reducing stress in the workplace and setting a zero tolerance towards violence against staff. Further improve performance appraisal and mandatory training to help staff develop their skills and capabilities Implement a leadership and management development programme for our staff

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Governance

Continue to meet our terms of authorisation with Monitor Deliver year three of the ICT strategy in support

  • f quality and efficiency of patient care

Make further improvements to how we manage risk so that we are designated a “risk mature”

  • rganisation

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Questions and thoughts?

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Next steps

  • Incorporate views from this meetings
  • Further consultation within hospital
  • Governors’ comments on annual plan
  • Final version of objectives and annual

plan for April 2011

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