UCLH priorities for 2012/13 Simon Knight Acting director of - - PowerPoint PPT Presentation

UCLH priorities for 2012/13

Simon Knight Acting director of performance 8th 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
• ther 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

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

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

0% 2% 4% 6% 8% 10% 12% 14% 16% 18% 20% 2008/09 2009/10 2010/11 2011/12 (forecast

• utturn)

2012/13 forecast Growth in new outpatient appointments has fallen away

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

• (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

15.2 21 31.7 45 38 40 40 5 10 15 20 25 30 35 40 45 50 2008/09 2009/10 2010/11 2011/12 2012/13 (E) 2013/14 (E) 2014/15(E)

Efficiency saving requirements: QEP £m

2.5% 3.3%

• 4. 9%

5.9% 6.1% 6.1% x% Savings as proportion of expenditure

• 6. 9%

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,

• utpatient 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

• ur plans?

UCLH objectives and priorities

Draft objectives for 2012/13

Delivering quality for our patients Differentiating our patient services Fundamentals

Financial health Deliver cost savings Deliver wait times Develop staff Integrating care with partners’ R&D and education Develop clinical services Clinical

• utcomes

Patient safety Patient Experience

Clinical outcomes

Delivering quality for our patients Differentiating our patient services Fundamentals

Financial health Deliver cost savings Deliver wait times Develop staff Integrating care with partners’ R&D and education Develop clinical services Clinical

• utcomes

Patient safety Patient Experience

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 hospital mortality

• 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

Delivering quality for our patients Differentiating our patient services Fundamentals

Financial health Deliver cost savings Deliver wait times Develop staff Integrating care with partners’ R&D and education Develop clinical services Clinical

• utcomes

Patient safety Patient Experience

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

2 4 6 8 10 12 14

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

1 2 3 4 5 6

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)

Performance team to update

Clostridium difficile infections post 48 hrs - All Services

1 20 30 40 50 60 70 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 Performance team to update

VTE Risk assessment - All Services

0% 1 0% 20% 30% 40% 50% 60% 70% 80% 90% 1 00%

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

Patient experience

Delivering quality for our patients Differentiating our patient services Fundamentals

Financial health Deliver cost savings Deliver wait times Develop staff Integrating care with partners’ R&D and education Develop clinical services Clinical

• utcomes

Patient safety Patient Experience

Patient experience

Deliver High Quality Patient Experience Enable patients to manage their appointment more easily Implement the ‘Transforming Patient Experience’ programme Specifically improve patient experience in cancer services

Compared to other London hospitals

Peer London Teaching Hospital Position against peers Score

• ut of 10

2009 score (position) UCLH 1 7.92 7.80 (1) Guy’s & St Thomas’ 2 7.71 7.66 (3) St George’s 3 7.61 7.31 (8) King’s College 4 7.53 7.43 (6) Imperial 5 7.52 7.45 (5) Chelsea & Westminster 6 7.40 7.74 (2) Barts & the London 7 7.31 7.54 (4) Royal Free 8 7.27 7.34 (7) Peer London Teaching Hospital Position against peers Score

• ut of 10

2009 score (position) UCLH 1 7.92 7.80 (1) Guy’s & St Thomas’ 2 7.71 7.66 (3) St George’s 3 7.61 7.31 (8) King’s College 4 7.53 7.43 (6) Imperial 5 7.52 7.45 (5) Chelsea & Westminster 6 7.40 7.74 (2) Barts & the London 7 7.31 7.54 (4) Royal Free 8 7.27 7.34 (7)

Improvement areas

• Hand gel not available or empty
• Noise from other patients and visitors
• Food was fair or poor
• Improving experience for

maternity patients cancer patients

• utpatients

Patient pathways and services

Delivering quality for our patients Differentiating our patient services Fundamentals

Financial health Deliver cost savings Deliver wait times Develop staff Integrating care with partners’ R&D and education Develop clinical services Clinical

• utcomes

Patient safety Patient Experience

Patient pathways and services

Integrate care more effectively with partners’ care Improve customer relationship management with GPs Improve timeliness and quality of discharge letters Evaluate urgent care centre and implement if agreed with GPs

Research and education

Delivering quality for our patients Differentiating our patient services Fundamentals

Financial health Deliver cost savings Deliver wait times Develop staff Integrating care with partners’ R&D and education Develop clinical services Clinical

• utcomes

Patient safety Patient Experience

Research and education

Develop R&D and Education Develop the Biomedical Research Centre with focus on effective output Participate in the devolution on educational commissioning Contribute to new UCLP patient pathways

Develop clinical services

Delivering quality for our patients Differentiating our patient services Fundamentals

Financial health Deliver cost savings Deliver wait times Develop staff Integrating care with partners’ R&D and education Develop clinical services Clinical

• utcomes

Patient safety Patient Experience

Develop clinical services

Implement Service Developments Open the new Cancer Centre Progress plans for Proton Beam Therapy and Phase 4 Transfer RNTNEH services to the Trust

Cancer centre

• £100m project designed by high

profile architects Hopkins

• 14,000 sq metres of space

designed around needs of modern cancer care

• Specific areas for specific patient

groups

• Innovative artwork funded by

charitable donors

• First PET-MRI in UK to improve

diagnosis and research in cancer

• Opening on time and on budget in

April 2012

Cancer centre

• 3,000 new cancer patients per

year

• One day in the cancer centre: 80

day cases, 250 outpatients, 150 visits to the Macmillan Support and Information service

• Activity growing at 5% per annum
• Over 800 patients treated

through the ambulatory care scheme in a local hotel – now extended to teenagers

• 450 patients per year in cancer

clinical trials

Bringing Proton Beam Therapy to UCLH

• PBT is one of the most advanced

and effective forms of radiotherapy in the world, with the potential to improve the treatment of thousands of UK patients

• UCLH were informed by the

Department of Health in September 2010 that we were the preferred bidder for a 2 site and 3 site solution. We continue to work with the Department on developing the first PBT centre in the U.K.

Proposed PBT facility on the Odeon site

RNTNE transfer to UCLH

• In October 2011, UCLH and RFH Boards

agreed to the transfer of the Royal National Throat, Nose and Ear Hospital to UCLH

• We plan to start operating RNTNE

services from 1 April 2012. The longer term vision is for the RNTNE and its services to be an integral part of a Head & Neck centre within the Phase 4 development on the Odeon and Rosenheim sites

Waiting times

Delivering quality for our patients Differentiating our patient services Fundamentals

Financial health Deliver cost savings Deliver wait times Develop staff Integrating care with partners’ R&D and education Develop clinical services Clinical

• utcomes

Patient safety Patient Experience

Deliver waiting times targets

Deliver waiting times targets Deliver mandated in-patient and out- patient waiting times Deliver A&E waiting times and targets Meet the cancer waiting time targets

Referral to treatment waiting times

• Achieving all key 18 weeks targets at present

Referral to treatment 95th percentile wait times (weeks)

10 20 30 40 50 60

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

95th percentile waiting time (completed admitted pathways) 95th percentile waiting time (completed non-admitted pathways) 95th percentile waiting time (incomplete pathways)

• Challenge to deliver targets at specialty level in 2012/13
• 92% of open pathways to be under 18 weeks in 2012/13

A&E waiting times

Performance is slipping but better than London average

Type 1 performance

Q1 11/12 Q2 11/12 Q3 11/12 UCLH 97.9% 96.9% 96.0% London 96.0% 96.4% 94.1%

Cancer waiting times

GP referral to treatment waits: now meeting the 85% target more consistently better waits for diagnostic times more rigorous tracking of patients Screening referral to treatment waits: still risky because of low numbers, need rigorous tracking

• f patients

Financial health

Delivering quality for our patients Differentiating our patient services Fundamentals

Financial health Deliver cost savings Deliver wait times Develop staff Integrating care with partners’ R&D and education Develop clinical services Clinical

• utcomes

Patient safety Patient Experience

Financial health

Achieve Sustainable Financial Health Achieve income, expenditure and cash targets Develop service line management and patient level costing Replace the financial management system

Delivering quality for our patients Differentiating our patient services Fundamentals

Financial health Deliver cost savings Deliver wait times Develop staff Integrating care with partners’ R&D and education Develop clinical services Clinical

• utcomes

Patient safety Patient Experience

Deliver cost savings

Quality and efficiency programme

Deliver cost savings Deliver QEP savings target in 2012/13 Develop 3-year efficiency and productivity plans Improve support service efficiency (inc. Radiology & Pathology joint ventures)

What does this mean for UCLH

• (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

15.2 21 31.7 45 38 40 40 5 10 15 20 25 30 35 40 45 50 2008/09 2009/10 2010/11 2011/12 2012/13 (E) 2013/14 (E) 2014/15(E)

Efficiency saving requirements: QEP £m

2.5% 3.3%

• 4. 9%

5.9% 6.1% 6.1% x% Savings as proportion of expenditure

• 6. 9%

Efficiency successes so far

• In 2010/11 we achieved £31m in efficiency and

productivity savings

• In 2011/12 we are on track to deliver a further £45m

Key areas for savings

• Efficient use of beds on wards
• Efficient use of theatres
• Efficient use of outpatient clinics
• Reviewing the grades of our staff
• Utilising our assets
• Buying goods at lower prices
• Doing more specialist work
• Finding other opportunities to provide services

Develop staff

Delivering quality for our patients Differentiating our patient services Fundamentals

Financial health Deliver cost savings Deliver wait times Develop staff Integrating care with partners’ R&D and education Develop clinical services Clinical

• utcomes

Patient safety Patient Experience

Develop staff

Enable Staff to Maximise their Potential Improve the experience of staff working at UCLH Achieve full staff appraisal and mandatory training Review Organisational Development and implement new leadership development programme

Develop staff

Trust Appraisal completion rate - All Services

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

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

Overall Phase 1 Phase 2 Phase 3

Phase 1 : April – M ay All Directors Phase 2: M ay – Jun - Direct reports to Directors Phase 3 : Jun – Oct - R est of workf orce C urrent Phase

Develop staff

Statutory and mandatory training compliance

0% 1 0% 20% 30% 40% 50% 60% 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

2011/12

Questions and thoughts?

Next steps

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

plan for April 2012