UCLH priorities for 2012/13 Simon Knight Acting director of performance 8 th February 2012
Aims of the session • To let you know what our plans / priorities currently are • To hear what you think of them
Agenda • What’s happening across the NHS • What’s the current state of play at UCLH • Time for questions and observations • Our plans for 2012/13 • Your views on our plans • Next steps
What’s happening in the NHS and at UCLH • The Health and Social Care Bill ……. • Funding and finances • What patients say about UCLH • What members say • What GPs say • How we perform against targets
The Health and Social Care Bill • Patient empowerment: “nothing about me without me” • Commissioning: GPs in the driving seat, but other clinicians in the car • Increased competition: “any willing provider” • Increased integration between providers
Financial challenges • Some protection for health: growth of 0.1% • Inflation for health � not as rosy as 0.1%
Financial challenge Growth in Health Spending since 1999/2000 - UCLH vs. NHS (in England) as a whole 200% % growth since 1999/00 150% 100% 50% 0% 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 NHS expenditure in England UCLH Turnover
Financial challenges • Prices paid to hospitals reduced • We aren’t growing as quickly as in previous years • North central London has a large deficit
What this means for our commissioners • NCL plans for 2011/12 are to deliver savings of £137m, and this only gets tougher in 2012/13. • The most significant items in this savings plan are as follows: 1. Hospitals to be more productive £46.7m 2. Local schemes, including moving care out of hospitals £14.1.m 3. Low Priority Treatments £11.3m 4. Management costs £10.1m
What this means for our commissioners • Problem much worse in the north: Enfield, Haringey, Barnet. Some signs that Trusts in the north will start to take more of their share of this problem • Signs that referrals from the north are being diverted to hospitals in the north
What does this mean for UCLH Pressure on referrals to UCLH � more difficult • to find savings • Moving work out to different settings • Pressure on the prices that we charge for work • Penalties for not delivering more efficient pathways: for example numbers of follow up appointments • Significant pressure on funding
We aren’t growing as quickly G rowth in first outpatient attendances 20% 18% 16% 14% 12% 10% Growth in new outpatient 8% appointments has fallen away 6% 4% 2% 0% 2008/09 2009/10 2010/11 2011/12 (forecast 2012/13 forecast outturn)
We aren’t growing as quickly •Our income only grew by about 2% this year •Similar levels in 2012/13 Which means …. •We can’t rely on growth for productivity •We must remove costs from what we do •Only savings will enable re-investment for improved services
What does this mean for UCLH Efficiency saving requirements: QEP £m Savings as proportion of 2.5% 3.3% 4. 9% 6. 9% 5.9% 6.1% 6.1% x% expenditure 50 45 45 40 40 40 38 35 31.7 30 25 21 20 15.2 15 10 5 0 2008/09 2009/10 2010/11 2011/12 2012/13 (E) 2013/14 (E) 2014/15(E) •(Estimated figures that may change; 2010/11 and beyond includes requirements for locally managed incremental drift. •Source: UCLH Finance; NHS Confederation Dealing with the downturn: using the evidence; UCLH Capital plans; UCLH annual reports
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: – Availability of hand gel – Bothered by behaviour of other patients’ visitors – Hospital food • Key lesson from complaints: booking processes
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
What members and governors say Priority Ranking Meet waiting times 3.7 Reduce avoidable harm 4.2 Reduce infections 4.4 Improve outcomes 4.5 Reduce appointment waiting times 5.3 Reduce A&E waiting times 5.8 Improve patient experience 5.9 Easier to contact staff 7.1 Improve communications with GPs 7.2 Better admin processes 7.3 Make UCLH a better place to work 7.7 Move care to other settings 9.2
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 letters (following A&E visit, outpatient appointment or inpatient stay) – Cost / length of patient journeys through UCLH
How we perform against targets Doing well • Hospital standardised reported mortality • Patient surveys • 18 week waiting times • MRSA • Clostridium difficile cases • Cancer waiting time targets
How we perform against targets Room for further improvement • A&E 4 hour wait • MRSA cases
Other achievements in 2011/12 • Dr Foster London Trust of the Year • NHS Litigation Authority level 3 assurance • Improved patient experience results • Improved staff survey results
Questions and thoughts?
So what does this all mean for our plans?
UCLH objectives and priorities
Draft objectives for 2012/13 Clinical outcomes Delivering quality for our patients Patient Patient safety Experience Integrating Develop Differentiating our R&D and care with clinical patient services education partners’ services Financial Deliver cost Deliver wait Develop Fundamentals health savings times staff
Clinical outcomes Clinical outcomes Delivering quality for our patients Patient Patient safety Experience Integrating Develop Differentiating our R&D and care with clinical patient services education partners’ services Financial Deliver cost Deliver wait Develop Fundamentals health savings times staff
Clinical outcomes Deliver Excellent Clinical Outcomes � Improve performance on hospital mortality � Reduce avoidable emergency admissions � Achieve 100% participation in clinical audits
Maintain our good performance on UCLH HSMR improvements from 1999/00 to 2010/11 Relative Risk (observed number of deaths as a percentage of 120 100 expected number of deaths) 80 60 hospital mortality 40 20 0 1999/00 2000/01 2001/02 2002/03 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 RR Low High Data year average � Improvements based on learning from adverse outcomes � Action on infection and other safety initiatives
Reduce avoidable emergency readmissions � Hospitals not paid for patients who are admitted as an emergency within 30 days of being discharged from hospital � Significant lost income: £4-5 million � Reinvested in projects to reduce readmissions: � More careful discharge arrangements � Single place to call once discharged � Working closely with community services
Patient safety Clinical outcomes Delivering quality for our patients Patient Patient safety Experience Integrating Develop Differentiating our R&D and care with clinical patient services education partners’ services Financial Deliver cost Deliver wait Develop Fundamentals health savings times staff
Patient safety Improve Patient Safety � Reduce hospital acquired infections � Reduce hospital acquired pressure ulcers and patient falls � Reduce the number of blood clots
Further reduce levels of MRSA MRSA coming down fast …… Infection - MRSA 14 12 10 8 6 4 2 0 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 2007/08 2008/09 2009/10 2010/11 2011/12 UCLH Peer Average
Further reduce levels of MRSA ….. and currently it looks as though we may meet our very demanding annual target MRSA bacteraemia / infections - All Services 6 5 4 3 2 1 0 Apr-1 1 M ay-1 1 Jun-1 1 Jul-1 1 Aug-1 1 Sep-1 1 Oct-1 1 Nov-1 1 Dec-1 1 Jan-1 2 Feb-1 2 M ar-1 2 M RSA actuals monthly M RSA threshold monthly M RSA actuals YTD M RSA threshold YTD
Clostridium difficile Clostridium difficile: just within our targets …. But very demanding target of 44 in 2012/13 (55 in 2011/12) Clostridium difficile infections post 48 hrs - All Performance team to update Services 70 60 50 40 30 20 1 0 0 Apr-1 1 M ay-1 1 Jun-1 1 Jul-1 1 Aug-1 1 Sep-1 1 Oct-1 1 Nov-1 1 Dec-1 1 Jan-1 2 Feb-1 2 M ar-1 2 CDiff actuals monthly CDiff threshold monthly CDiff actuals YTD CDiff threshold YTD
Reduce blood clots 2012/13: more focus on appropriate action on high risk patients VTE Risk assessment - All Services Performance team to update 1 00% 90% 80% 70% 60% 50% 40% 30% 20% 1 0% 0% Jan-1 1 Feb-1 1 M ar-1 1 Apr-1 1 M ay-1 1 Jun-1 1 Jul-1 1 Aug-1 1 Sep-1 1 Oct-1 1 Nov-1 1 Dec-1 1 Percentage of VTE Risk Assessments Completed Target
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