Welcome to our Annual
General Meeting 2014
1 October 2014
Watford Hospital
Welcome and
opening remarks
Mahdi Hasan
Chair
@chairwhht
An overview of last year and
our plans for the future
Samantha Jones
Chief Executive
@SamanthaJNHS
What do we stand for?
Our values
Our objectives
 We involve others
To deliver improvements in the quality,
deliverability and sustainability of our
services through:
 We are all leaders
 Achieving continuous improvement in the
quality of patient care that we provide and
the delivery of service performance across
all areas
 We are proud
 Setting out our future clinical strategy
through clinical leadership in partnership
and with whole system working
 We work in partnership
 Creating a clear and credible long term
financial strategy
 We are transparent
 We add value
About us…
 Three main hospitals
 Serves 500,000 people
 600,000 patient contacts a year
 83,433 A&E patients
 14,411 minor injuries unit visits
(St Albans Hospital)
 29,356 urgent care centre visits
(Hemel Hempstead Hospital)
 5,787 babies delivered
About us…
 425,813 outpatient appointments
 41,415 planned admissions
 49,934 emergency admissions
 £290 million turnover
 4,000 doctors, nurses, midwives,
porters, cleaners andother staff
 500 volunteers
 Four clinical divisions, plus
support services
Celebrating success…
 ‘Onion’ – peeling back the layers
 20% reduction in mortality,
inc for hip fractures
 40% reduction in C. difficile
 95.6% of A&E patients treated,
admitted or discharged in maximum
of four hours (standard = 95%)
 Extra £9m invested in patient safety,
inc £3.9m on 160 new nurses
Celebrating success…
 Opened The Granger Suite,
inc Bluebell and Winyard wards
 Opened ambulatory care unit (ACU)
 £25.5m to be invested on IT
 £16m investment in upgrading
wards, clinics and other areas
 New senior team including Chief
Nurse, Director of Finance and Chair
 ‘Developing our Organisation (DO)’
The official opening of The Granger Suite
Celebrating success…
 Opened new emergency surgery
assessment unit (ESAU)
 Opened new dietetic kitchen
 Launched new cycle facilities
across all three sites
 £600,000 upgrading theatres
 Launched iWantGreatCare
 Shortlisted for HSJ (Health Service
Journal) patient safety award
Cycle facilities official opening
Our performance against
key standards 2013/14
Standard
Target
2013/14
Emergency access – patients attending
A&E should be seen within a maximum
of four hours
>95%
ACHIEVED
(95.6%)
Infection control and prevention – MRSA
(bacteraemia)
0 cases
UNDER ACHIEVED
(3 cases)
Infection control and prevention –
Clostridium difficile
Max 24
cases
UNDER ACHIEVED
(28 cases)
All cancers – patients should have a
maximum wait of 14 days for all urgent
referrals of suspected cancer
>93%
ACHIEVED
(95.8%)
All cancers – patients should not wait
more than 31 days for diagnosis to first
treatment
>96%
ACHIEVED
(98.1%)
Our performance against
key standards 2013/14
Standard
Target
2012/13
All cancers – patients should not wait
more than 31 days for second or
subsequent treatment
>94%/
>98%
ACHIEVED
(99%/100%)
18 week wait – patients who require
admission to hospital should wait no
longer than 18 weeks from referral to
treatment
>90%
UNDER ACHIEVED
(78%)
18 week wait – patients who do not
require admission to hospital should wait
no longer than 18 weeks from referral to
treatment
>95%
UNDER ACHIEVED
(85%)
Moving forward…
 ‘Onion’ – peeling back the layers
 Learn from complaints, incidents and
litigation – centralised
 Achieving our financial target (£14m
deficit, including savings of £13.4m)
 Transformation programme
 West Hertfordshire strategic review
 Trust clinical strategy including
Watford Health Campus
Artists’ impression of Watford Health Campus
Transformation Programme - Structure and Design
Strategic change - Future state of organisation
Clinical Strategy
Doing today right
Ensuring
Services are
Caring
Ensuring Services
are Responsive
Ensuring
services are
Effective
Clinical Effectiveness
Patient
Experience
Workforce and
Safety
Operational
Effectiveness
• Obstetrics and
Gynaecology
• Hospital 7/7
• Job and Team
Planning
•Mortality
• Complaints &
Serious
Incidents
• Patient
Experience &
Strategy
• Estates &
Health and
Safety
• Nursing
•HR Systems,
Recruitment and
Retention
• Referral To
Treatment
• Unscheduled
Care
• Cancer
• Diagnostics
Ensuring Services
are Well Led
Ensuring Services are
Safe
Governance and
Leadership
• Quality
Governance
• Clinical
Leadership
• Corporate
Governance
• Organisational
Restructure
Financial Viability
LTFM, Efficiency savings, Cost reduction, Income generation, Financial support
Organisational Development Change Programme
Communications and Stakeholder Engagement
Information & Communication Technology & Decision Support (including Coding )
Working in partnership
 Herts Valleys Clinical
Commissioning Group
 Hertfordshire Community NHS Trust
 Hertfordshire Partnership University
NHS Foundation Trust
 Hertfordshire County Council and
other local councils
 Healthwatch, our Patients’ Panel and
other patient groups
 many, many more…
Financial overview
and looking forward to 2014/15
Don Richards
Chief Financial Officer
Income and expenditure 2013/14
£m
Income from patient care activities
Other operating Income
Income
2013-14
259.3
31.8
291.1
2012-13
249.0
29.2
278.2
(300.6)
(9.5)
(272.1)
6.1
Dividend and interest
Reported NHS financial performance position surplus/(deficit)
(3.9)
(13.4)
(4.2)
1.9
Asset revaluation
Retained surplus/(deficit) for the year
2.3
(11.1)
(2.8)
(0.9)
Operating expenses
Operating surplus/(deficit)
Financial summary 2013/14
 Financial delivery
 Deficit of £13.4m
 Savings delivery of £7.6m
 Capital investment of £17.6m
 Challenges
 Significant increase in emergency activity
 Slippage against savings target of £15m
 Increase in agency costs
 We spent an additional £7.5m in frontline staff to improve quality of care
provided to patients
 Non-recurrent transformation funds of £4.1m received to support the cost
of maintaining our three hospitals and initiatives to improve efficiency
Activity performance 2013/14
Trend of inpatient activity
45,000
40,000
35,000
30,000
25,000
20,000
FY09
FY10
FY11
FY12
Emergency
FY13
FY14
FY15
Elective
Trend of outpatient activity
Note:
400,000
Emergency activity excludes other non-elective
activity such as maternity due to the changes in
350,000
counting from 2013/14.
Outpatient totals exclude activity relating to
300,000
maternity due counting changes for these services from
2013/14.
250,000
200,000
FY09
FY10
FY11
FY12
FY13
Outpatients (attendances and procedures)
FY14
FY15
Trend of pay expenditure
250
25
200
20
150
15
100
10
50
5
-
FY07
FY08
FY09
FY10
FY11
FY12
FY13
Year
Total
Bank
Agency
FY14
Temp Pay £m
Total Pay £m
FY07 to FY14
2014/15 planned sources of income
2.6
31.6
£m
23.7
14.0
236.3
NHS Clinical Revenue - HVCCG
NHSE Specialist Commissioning
NHS Clinical Revenue - Other
Non-NHS clinical revenue
Other Operating Income
FY15 Plan vs. FY14 Outturn
100.0
93.5
90.0
80.0
79.1
70.0
65.2
68.4
£m
60.0
55.0
49.7
50.0
53.4
49.3
40.0
30.0
20.0
11.3
11.6
10.0
0.0
Non-Elective
A&E
Outpatient
FY14 Act
FY15 Plan
Elective
Other Clinical Income
2014/15 financial outlook
 Financial plan
 Income of £281.9m
 Planned deficit of £14m
 £13.4m savings programme
 Capital investment of £15.4m
 Investment in IT (£6.1m) and Organisational Development (OD) (£1.5m)
 Challenges
 Delivery of savings programme
 Cost of transformation programme
 Cash balance
 Suitable payment for emergency work
 Working collaboratively with our commissioners to ensure we are reimbursed
appropriately for our emergency work
 We are in continuing discussions with the NHS Trust Development Agency
(NHS TDA) who are supportive of our wider transformation programme
Quality developments in care
of the cognitively impaired –
‘people not patients’
Hello My Name is: Dr Tammy Angel
Clinical Director of Elderly Care and Stroke
Dementia
Dementia is a progressive
Complex
Memory/
and largely
irreversible motor
recall
tasks
syndrome that is
characterised by a
widespread impairment
Recognition
of mental function.
Verbal
communication
and
reasoning
Dementia in hospital...F.A.I.R
Screen and
identify
people
Bluebell
specialist
care
25% of people in hospital have
Dementia.
40% of people with hip
fractures
Outreach
for general
wards
Appropriate
discharge planning
and signposting
T
R
A
I
N
I
N
G
Dementia Nurse Specialist
Audit
Point of
contact/support
advice- patients/
relatives/staff
Dementia
specific care
plans
Satisfaction /
feedback
survey
Dementia
champions
+ link nurses
Discharge
information
End of life
care
Screening
Outreach
support
Training
programme
Other frailty units…
Queen Elizabeth Hospital, Gateshead: Future Hospital
Commission case study
 Challenge: older people with both physical and mental
health illness cared for on general wards by staff with
limited expertise
 Dual care ward increased focus on basic care and
nutrition, by staff with specialist skills
 Outcome: reduced falls, reduced need for IV fluids.
Better care for this group of people
 “staff.. see these people as ‘their kind of person’
and not people who should be moved somewhere
else”
… Right care for person is also most cost
effective care for the ‘system’…
Improved quality of patient care
Staff more
knowledgeable
to your needs
Reduced
risk of falls
Good dementia care is just good
care
Better toiletting,
and continence
management
Reduced stay
in hospital
Better
fluid hydration
Better nutrition
Bluebell ward..
Tell
me
about
Mr H
Tell me
Something
personal
about the
people
here
He doesn’t like mornings so we leave him
last, he prefers male carers; you have to
speak slowly otherwise he won’t catch
what you say – but if you take it slow – he
is a pussycat. Oh and he will only eat
porridge for breakfast and likes his tea
really hot.
He’s easy no bother at all!
Mrs M has had 10 children- amazing!
Mrs L loves knitting and gardening
Mr R was a world renowned author of
American Military history.
Mr D was a cinematographer.
Mrs R has been feeling low since her
dog died who was her companion since
bereaved of her husband.
The problem
with being confused...
 We ‘wait’ for delirium to resolve in hospital
 Just staying in hospital may be prolonging the
condition ... long hospital stays
 Whilst waiting run risk of infections, falls in unfamiliar
environment + further confusion/distress
 Limited options to date: physically able but
not safe for discharge
 Option to transfer to residential care. Also unfamiliar.
 All above carry significant cost both for the individual
and the health social care purse
... There is no place like home!
Delirium Recovery Programme..
multiprofessional collaboration with patient in centre
Physician
Occupational
therapist
Psychiatrist
Person in
need and
family
Integrated
Discharge
Team
commissioners
Social worker
Care worker
DRP: Delirium Recovery
Programme
Bluebell ward
Physical+
mental health
review
Care plan
Family
meeting
Hospital
Day 1 at
Home
Re establish
routine.
24hr care
Day 4
Occupational
therapist
reviews at
home
Care plan
adjusted
Discharge
planning
starts
Day 7
Home visit by
Occupational
Therapist and
Social worker.
Meet with
family to
discuss
progress
Discharge
plans
Day 10
Physical and
mental health
review in
Ambulatory
care
Any further
review
arranged as
needed.
Admitted onto Virtual ward
Day 14
Discharged
with care as
needed
HOME
DRP: Delirium Recovery
Programme
Reduce
Length of stay in hospital
Enable recovery and
reduce need for long term
care
ACHIEVED!
16/20 stayed at
home
Reduce antipsychotic
prescribing
Avoid long term placements
from hospital
‘Our kind of people’
92.3% Extremely
Likely to
recommend
7.7% Likely to
recommend
1st
PRIZE
inpatient
ward
Transforming our IT
Lisa Emery, Chief Information Officer
@LisaEmNHS
David Gaunt, Associate Medical Director for IT
@davecas48
42
“The single biggest investment in IT across
Watford, Hemel Hempstead and St Albans
hospitals for more than a generation”
“The new investment will help revolutionise
the way that we work. The benefits for our
patients, as well as staff, are immense
and will truly help us to improve the care
we provide to our patients”
Background
 Our current IT systems are very old, slow and it’s
hard for us to connect them to the latest software
 Our Information Management and Technology
Strategy set out the creation of a ‘digital hospital
environment’
 On 16 June 2014, we signed a 5 year contract with
CGI Limited to transform our IT Infrastructure
 This is an investment of £25.5m, supported by the
NHS Trust Development Authority (NHS TDA) and
our partners, which will enable us to transform our
services
44
What does this deliver for west Herts?
 A new 24/7/365 service
desk
 Faster networks
 New devices
 An improved email service
 Mobile working
 Single sign-on
 Single document store for
policies and guidelines





WiFi access at all sites
Messaging services
Patient kiosks
Electronic patient tracking
Unified communications –
single point of contact for
phone, email, messaging
2015/16
2014/15
Q3
Q4
Q1
Q2
Document Portal
Q3
Q4
Unified
Communications
Email Upgrade
1Gb Mailboxes
Service Desk
Data Centre Ready
Wifi Rollout
Complete
Reliable Modern
Networks
Desktop Replacement
Complete
Asset, Patient and
Lone Worker Tracking
Data Centre Migration
& Disaster Recovery
Complete
What will this mean for our staff and patients?
For our staff:
 Less time spent at the
computer
 Mobile working e.g. at other
sites or patient’s homes
 More agile ways to work
with colleagues e.g.
videoconferencing and
instant messaging
 One sign-on for all systems
 Enhanced patient and
equipment tracking
For our patients and visitors:
 Staff have more time to
spend with patients
 Improved patient safety
 Ability to use WiFi at our
sites
 Patient kiosks to speed up
appointment check-in
 SMS (text) appointment
reminders
 Information shared more
quickly and securely
48
Equipment, patient and lone worker tracking
Using our new WiFi network and electronic tags:
 Tracking of vital medical equipment, reduction in delays and
loss
 Safety for staff within our sites and in remote locations
 Improved safety for vulnerable patients
 Ability to direct equipment and staff to where needed
Staff badge/pager:
Asset
tags:
Patient tags:
Temp/RH sensors:
49
Real time tracking and communication
 Improved safety for vulnerable patients
 Safety for staff within Trust sites and in
remote locations
 Tracking of vital medical equipment,
reduction in delays and loss
 Ability to direct equipment and staff to where
needed
 Utilising our investment in WiFi
Staff
badge/pager:
Asset
tags:
Patient tags:
Temp/RH
sensors:
Messaging services
• Appointment reminders for
patients (our Did Not Attend
(DNA) rate is 9% – saving
money and speeding up time to
be seen)
• Increased patient choice
• Important patient
communications
• Important staff communications
Reminder:
Appointment
Rheum WGH
12.00 29 Sep 2014
51
2015/16
2014/15
Q3
Q4
Q1
Q2
Document Portal
Q3
Q4
Unified
Communications
Email Upgrade
1Gb Mailboxes
Service Desk
Data Centre Ready
Wifi Rollout
Complete
Reliable Modern
Networks
Desktop Replacement
Complete
Asset, Patient and
Lone Worker Tracking
Data Centre Migration
& Disaster Recovery
Complete
“The new investment will help revolutionise the way that we
work. The benefits for our patients, as well as staff, are
immense and will truly help us to improve the care we
provide to our patients.”
53
Questions
and answers
A special thank you to our
charities, volunteers and other
supporters
Professor Tracey Carter
Chief Nurse
@CarterTreacle
Thanking our volunteers
 Over 500 active volunteers aged
between 16 to 80
 200,000 hours ‘gifted’ last year
 Support wide range of activities,
including reception, drivers and
befriending/feeding patients
Our main charities we
work with are:
 Watford Hospital’s League of Friends
 Watford Hospital Radio
 Royal Voluntary Service (RVS)
 Macmillan Cancer Information and
Support Service
 CVS (local volunteer organisations
funded by councils)
 Voluntary car groups
Video:
Staff make a song and dance
for sepsis
For more information
Tel: 01923 436 280
Web: www.westhertshospitals.nhs.uk
Twitter: @westhertsNHS
Facebook: facebook.com/westhertsNHS
Email: info@whht.nhs.uk
YouTube: youtube.com/WestHertsNHS