UCLH priorities for 2014/15
Simon Knight
Director of planning and performance
27th January 2014
Aims of the session
To let you know what our plans / priorities
currently are


To hear what you think of them
2
Agenda
What’s happening across the NHS
What’s the current state of play at UCLH
Time for questions and observations

Our plans for 2013/14
Your views on our plans


Next steps
3
The general environment
Patient to be at the centre of all planning and
delivery: “nothing about me without me”


Impact of the Francis report

Care Quality Commission inspections
Clinical Commissioning Groups and specialised
commissioners


Increased emphasis on integration

Drive to centralisation of specialised care

Significant pressures on funding
4
NHS culture and care questioned
Francis report
Patients ‘failed by a system which ignored the warning signs
and put corporate self-interest and cost control ahead of
patients and their safety’
290 recommendations
Keogh review
14 hospitals with ‘excessive’ deaths
Identified key risk factors and warning signs
Berwick report
Focus on patient safety and regulation
NHS remains an ‘international gem’
5
Key recommendations: a new NHS culture
•Renewed focus on quality
•Openness, transparency and candour
•Empower patients and staff
•Develop outstanding leaders
•New inspection regime: Chief Inspector of
Hospitals
6
NHS financial challenge: save £30bn by 2020
7
Financial challenges for hospitals
Prices paid to hospitals reduced: NHS efficiency
Some CCGs have a large deficit
Some CCGs have been affected by funding
changes
Impact of Better Care Fund
Specialist commissioners need to make big
savings
Contract penalties

8
What does this mean for UCLH?
9
What patients say
UCLH performs well in patient surveys:
• Overall rating of care
• Would you recommend the hospital
Key areas for improvement from surveys:
 Trust and confidence in nurses
 Nurses: answers you could understand
 Hospital food was fair or poor
 Planned admission: date changed by hospital
Key lesson from complaints: booking processes

10
What members and governors say
Key things we hear from members and
governors:
• Booking processes
• Getting in touch with staff in the hospital
• Waiting times in the new Cancer Centre
Emphasis from governors on:
• Reducing medication errors
• Reducing pain
• Improving how care is integrated

11
What GPs say
2013
2012
I w ould be positive about
UCLH
I w ould be neutral tow ards
UCLH
2011
I w ould be critical of UCLH
2010
No answ er / no opinion
2008
2006
0%
20%
40%
60%
80%
100%
12
What GPs say
Positive about the clinical services that we
provide
Things that GPs want us to get better on:
 Clarity around our billing for services
 Booking processes
 Getting in touch with staff in the hospital
 Discharge letters (following A&E visit,
outpatient appointment or inpatient stay)

13
What the CQC said about our services
“Our judgement is that this is an excellent
hospital in many ways – but the failings we
identified are preventing it from achieving
excellence across the board.
The trust has told us it is taking action – and
we expect to return in due course to find that
the problems have been fixed.”
14
What the CQC said about our services
“The vast majority of patients spoken to were
very positive about the care they received, and
staff were proud to work at the trust and of the
level of care they were able to deliver.
The trust has a strong board and clear
governance structure which has led to high levels
of care being maintained in most areas.”
15
What the CQC said about our services
“It has a stable and experienced Board and
the trust’s Governors act very much as
patients champions, providing challenge”
“We were also impressed with the emphasis
placed at all levels from the trust’s board and
governors down to ward level on putting the
needs of patients first”
16
What the CQC said about our services
`we observed many
instances of good
and in some cases
outstanding care’
`staff told us they
were proud to work
at the trust and proud
of the level of care
they were able to
deliver’
‘vast majority of patients
… were very positive
about they care they
received’
`people we spoke to
were extremely
complimentary about the
compassionate care and
treatment they received’
17
What the CQC said about A&E
‘Commitment of A&E staff
to delivering good care’
In A&E `excellent caring
staff, including positive
caring interactions with
patients’
`the patient feedback of
their experience of A&E
was overwhelmingly
positive’
‘The A&E is inadequate
and compromises the safe
delivery of care and
treatment ‘
18
Compliance actions from the CQC report
1.
2.
3.
4.
Completion of the World Health Organisation safe
surgery checklist
Review current A&E and children’s A&E provision
Staff
Leadership
Environment
Improve the quality and completeness of people’s care
assessments, care plans and care delivery records
Improve the care and security storage of patient records
How we are performing against targets
Where we are on track:
Hospital standardised reported mortality
Patient surveys
MRSA: but close to the target
Cancer waiting time targets; but room for
improvement still
20
How we are performing against targets
Our key challenges:
Running out of space: A&E, beds, theatres
A&E 4 hour wait
Referral to treatment waiting times
Clostridium difficile cases
Cancer patient experience

21
Other achievements in 2013/14
Dr Foster Guide: strong performance
Driving the programme to reconfigure cancer
and cardiac services in the area
Running our organisation according to our
values

22
Our values
23
Questions and thoughts?
24
So what does this all mean for our
plans?
25
Draft objectives for 2014/15
Clinical
outcomes
Delivering quality
for our patients
Patient
safety
Differentiating our
patient services
Fundamentals
Integrating
care with
partners’
Financial
health
Patient
Experience
R&D and
education
Deliver cost
savings
Deliver
wait times
Develop
clinical
services
Develop
staff
26
Clinical outcomes
Clinical
outcomes
Delivering quality
for our patients
Patient
safety
Differentiating our
patient services
Fundamentals
Integrating
care with
partners’
Financial
health
Patient
Experience
R&D and
education
Deliver cost
savings
Deliver
wait times
Develop
clinical
services
Develop
staff
27
Patient safety and outcomes

Reduce hospital acquired pressure ulcers

Reduce number of blood clots

Reduce medication errors

Improve communication and handover
through use of surgical safety and ward safety
checklists

Reduce hospital acquired infections

Specialty outcome measures
28
Maintain performance on hospital mortality
Learning from adverse outcomes
Action on infection and other safety initiatives

120
100
80
60
40
20
RR
Low
High
2010/11
2009/10
2008/09
2007/08
2006/07
2005/06
2004/05
2003/04
2002/03
2001/02
2000/01
0
1999/00
Relative Risk (observed number of deaths as a percentage of
expected number of deaths)
UCLH HSMR improvements from 1999/00 to 2010/11
Data year average
29
Further reduce levels of MRSA
MRSA coming down fast ……
50
45
No of MRSA bactearamias
40
35
30
25
20
15
10
5
0
2006-07
2007-08
2008-09
2009-10
2010-11
2011-12
2012-13
YTD 2013-14
30
Clostridium difficile
Clostridium difficile: above our target of …. But very
demanding target of 39 in 2013/14 (44 in 2012/13)
31
Patient experience
Improve the appointment and booking services
we offer to patients

Improve the quality of communication and
interaction between clinicians and patients


Pain: work towards the pain-free hospital
32
Compared to other London hospitals
Peer London Teaching Hospital
Position against
peers
Score
out of 10
2011 score
(position)
Guy’s & St Thomas’
1
8.15
7.76 (2)
UCLH
2
7.96
7.83 (1)
King’s College
3
7.85
7.39 (6)
Chelsea & Westminster
4
7.82
7.40 (5)
St George’s
5
7.78
7.42(4)
Imperial College
6
7.76
7.67 (3)
Barts & the London
7
7.59
7.31 (8)
Royal Free
8
7.56
7.36 (7)
33
Issues arising from 2012 inpatient survey
Planned admission: date changed by hospital
Trust and confidence in nurses
Nurses: answers you could understand
Hospital food was fair or poor


Improving experience for
 maternity patients
 cancer patients
 outpatients
34
Developing services
Clinical
outcomes
Delivering quality
for our patients
Patient
safety
Differentiating our
patient services
Fundamentals
Integrating
care with
partners’
Financial
health
Patient
Experience
R&D and
education
Deliver cost
savings
Deliver
wait times
Develop
clinical
services
Develop
staff
35
Research and education
Implement the Biomedical Research Centre
programmes of work, with a focus on
experimental medicine


Increase patients going through clinical trials
Deliver top quartile experience for all staff
groups going through educational programmes at
UCLH

36
Patient pathways and services
Transformational change in how we care for
people across social care and health, supported
by the Better Care Fund


Transform care pathways for key services
Improve timeliness and quality of all
communications with GPs and community care
provider

37
Develop clinical services and facilities
Implement plans to further develop our strategic
service priorities: neurosciences, cancer and
women’s health

Shape and deliver London Cancer and London
Cardiovascular


Move to a two site campus model
38
Cancer and cardiovascular
Centralising specialist care saves lives (e.g. stroke)
• World-leading centre for cardiovascular services
at Barts
• Merger of the Heart Hospital and London Chest
• UCLH to become specialist hub for most cancers
• Engagement exercise underway
• Could save 2,000 lives
•
Proposed Specialist Cancer Changes
4
1
UCLH
2
Barts Health
3
Royal Free London
4
Queen’s Hospital
5
North Middlesex
Brain
Head and neck
Prostate and bladder
Haematology
Oesophago-gastric
Radiotherapy
Radiotherapy
Renal
5
Brain
Radiotherapy
Haematology
Radiotherapy
Haematology
Radiotherapy
3
1
2
4
PBT focuses the radiation on the tumour. This is of particular importance when there is close proximity
to key organs
‘Phase 4’: Proton Beam Therapy and further
inpatient capacity
•
•
A new inpatient facility with additional theatre capacity and
the UK’s first Proton Beam Therapy unit
Additional inpatient and theatre capacity required ‘above
ground’ in response to the London Cancer discussions and
service growth at UCLH (around 100 new inpatient beds
and 10 new operating theatres at UCH)
Proton Beam Therapy and Phase 4
First Proton Beam Therapy unit proposed to be built on the old
Odeon site. Completion is scheduled for 2018.
• Additional inpatient and theatre capacity required ‘above ground’
in response to London Cancer discussions and service growth at
UCLH (around 100 inpatient beds and 10 operating theatres)
•
Accelerator
Gantry
Using magnetic fields, the hydrogen protons
are accelerated to two thirds the speed of
light.
Each of the three gantries is threestories tall and weighs 200,000 Ibs
Electromagnets
The magnets focus and route the
proton beams to the gantry
‘Phase 5’: Ear, Nose, Throat, Auditory,
Dental and Oral Medicine services
The ‘Phase 5’ design involves a plan to relocate these services into a
new purpose built facility on the Ear Institute site (Huntley Street)
• Relocation of all ear, nose, throat, auditory, dental and oral medicine
from the Grays Inn Road to purpose-built facility on the main UCH
campus
• This creates the opportunity for collaboration across specialties and
greater efficiency of service provision
• It also creates opportunities to locate into modern and more suitable
facilities to improve patient experience and encourage an environment of
translational research, teaching and learning
• Outline Business Case anticipated spring 2014
•
Other key developments
•
A proposed expansion of maternity wing (Elizabeth Garrett
Anderson wing) to increase capacity for births at UCH to
8,000 per annum (currently around 6,000 per annum): 2016
•
Additional neurosciences capacity required following
significant increase in specialist work over past five years:
joint initiative with University College London (UCL) and
Great Ormond Street Hospital (GOSH) on the Queens
Square site to enable increased capacity: 2016-2020
•
A&E department redevelopment over next two years, with
new in-fill building on lower floors between phase 1 and
phase 2
Clinical
outcomes
Delivering quality
for our patients
Patient
safety
Differentiating our
patient services
Fundamentals
Integrating
care with
partners’
Financial
health
Patient
Experience
R&D and
education
Deliver cost
savings
Deliver
wait times
Develop
clinical
services
Develop
staff
48
Deliver waiting times targets
Reduce waits for planned care to make UCLH
the provider of choice


Deliver A&E waiting times and targets

Meet the cancer waiting time targets
49
Referral to treatment waiting times
100%
Referral to treatment % completed and incomplete
pathways under 18 weeks
95%
90%
85%
80%
75%
70%
Jan-13 Feb-13 Mar-13 Apr-13
% incomplete pathways < 18 weeks
May-13
Jun-13
Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13
% Non-admitted closed pathways under 18 weeks
% Admitted closed pathways under 18 weeks
Our backlog of patients waiting has grown and we
need to treat more patients to get back on target

50
A&E waiting times
Performance is slipping but better than London
average
Type 1
performance
Q1 13/14
Q2 13/14
Q3 13/14
UCLH
95.2%
96.1%
92.5%
London
92.9%
93.2%
92.3%
51
Preparing for more patients
Preparing for more patients
Option
Benefits (bed numbers)
Likelihood of
medium case
Current
prediction
Upper
limit
Medium
Low
Jubilee Ward
17
17
0
100%
17
Additional
ward at St
Pancras
23hr day
surgery
Reduce
length of stay.
17
17
0
80%
14
10
8
6
50%
5
9
7
5
25%
2
Conversion of
Tower spaces
to beds
12
6
3
90%
Clinical
decision unit
8
Emergency
ambulatory
care
Increased use
of the Hospital
at Home
scheme.
10
2
6
0
100%
6
3
1
90%
3
34
3
0
80%
2
Creating alternatives to acute bed days
April 12
Nov 13
Jubilee Ward
0
368
Hospital @ Home
0
50
Cotton Rooms
0
602
Hotel use
513
74
Outpatient Antibiotics
13
171
Total Sub-acute nights
526
1265
Beds equivalent
18
42
54
The Tower Flow programme
1
Every patient on a prescribed pathway
2
Ward rounds every day
3
Medication does not cause delay
4
Therapy input does not cause delay
5
Patients given predicted discharge date
6
All working from the same patient info
55
Improving our efficiency: Gastroenterology outpatients
“Previously, all patients were brought back for an OP appointment after their Endoscopy
regardless of the results. We have now changed our way of working so that doctors review
diagnostic results on a spreadsheet and discharge patients with clear results on the phone or
in writing.”
Waiting times in GI Colorectal
New Appointments
Follow Up Appointments
15
14
13
12
11
10
9
8
7
W/c 18 Jul-13 (Before POP)
W/c 02 Dec-13 (After POP)
Cancer waiting times
GP referral to treatment waits: now meeting the
85% target more consistently

GP referral to appointment: more that can be
done by GPs and by our appointment teams

Screening referral to treatment waits: still risky
because of low numbers, need rigorous tracking
of patients

57
Cancer waiting times
Cancer 62 and 31 day referral targets
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13
Cancer 62 Day GP referral to treatment
Target (GP referral to treatment)
Cancer 31 Day Subsequent Surgery Treatment
Target (Subsequent surgery)
58
Cancer waiting times
Cancer 2 week referral targets
100%
95%
90%
85%
80%
75%
70%
Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13
Cancer GP referral to appointment
Cancer 14 day wait from referral (symptomatic breast)
Target
59
Financial health and efficiency targets

Achieve income, expenditure and cash targets

Deliver QEP savings target in 2013/14

Develop 3-year efficiency and productivity plans
Developing strong, robust relationships with GP
and specialist commissioners

60
Develop staff

Improve the experience of staff by embedding
the new UCLH values

Developing our leadership across the Trust

Ensure all staff benefit from appraisal and
mandatory training

Building the capability of all our staff and of
the organisation as a whole
61
Questions and thoughts?
62
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 2014

63