Welcome to
The Princess Alexandra Hospital’s
Local Healthcare Event and
Annual General Meeting
October 2010
Introduction
Gerald Coteman, Chairman
Recent Advances in Screening at Epping
Dr Anthony Aylwin, Director of Screening
Improvements in Breast Cancer Care at
The Epping Breast Unit
Mr H Bradpiece, Lead Breast Consultant
Now and in the Future
Jane Herbert, Chief Executive
Questions to the Speakers
Close
Gerald Coteman, Chairman
Taking Control
• Foundation Trust
• Clinical and Patient Empowerment (inc commissioning)
• Health versus Hospitals
Health
• Long term Conditions
• Long term Conditions
• Long term Conditions
• Biggest global disease burden facing the modern world
• PAH - reinforcing our role in both managing and
preventing ill-health
• Deep and sustainable reform of commissioning and
Local Health Economy
What Else is Important?
• Stronger and more visible Board
• Higher priority for patient quality and safety
• Engagement with staff and patients has improved
• Dialogue with our partners and stakeholders has
increased and improved
Other Things that Matter
• To you –
– Dementia
• To me –
– Carers
Thank You
• Our Staff
• The Board
• You
Recent Advances in Screening at
the Epping Breast Unit
Dr Anthony Aylwin
Director of Screening
Epping Breast Unit
The Breast Unit
• Currently provides both breast screening and
symptomatic breast services
• ‘Static’ unit based at St Margaret’s Hospital
• ‘Mobile’ mammography screening van
Breast Screening
•
•
•
•
•
Screening population (aged 50 to 70) = 36,000
Women screened every 3 years
75% attend appointments
10,000 women screened per year
Detect approx 75 cancers per year
Symptomatic Unit
• 2500 patients attend breast clinic per year
• ‘One stop’ clinic – clinical assessment,
mammogram, ultrasound and biopsy at same
sitting
• Approx 150 cancers per year
Recent Advances
• ‘Encore’ Needle
Biopsy System
– Automated, vacuum
assisted
– Better samples
– Improved diagnosis
Recent Advances
• ‘Faxitron’ Digital Xray
Biopsy system
– Better images
– Quicker
– Digital
The Next Step…Digital Mammography
The Next Step… Digital Mammography
• Advantages:
–
–
–
–
–
–
50% less radiation
Better cancer detection
More comfortable
No xray storage
Reduced running costs
Integration
The Next Step…Digital Mammography
• Disadvantages:
– Set-up costs
• Purchase
• Building
GOOD NEWS!
• Epping Breast Screening
Unit
– Complete replacement – 3 new
digital machines
• 2 at the Epping Unit
• 1 on a reconditioned, refurbished
Mobile van
• Integration with hospital-wide
computer system
• Building works underway NOW
• ‘Phased’ introduction - no interruption
to service
• All work finished by Christmas 2010
And Finally,
The MRI Scanner - One Year Later
• Installed a new MRI Scanner at St Margaret’s
Hospital
• In 12 months 3,900 patients have been
scanned
• What people have said:
“Nice staff, clean place and attended by everyone with respect and dignity.”
“I was very frightened of the scan. Staff were kind and helpful and made it all very
easy.”
Questions?
Thank You
Improvements in Breast Cancer Care
at The Epping Breast Unit
Mr H Bradpiece
Lead Breast Consultant
The Epping Breast Unit
•
•
•
•
•
An integral part of PAH
Staffed by dedicated professionals
For the benefit of our local community
Out-patients at St Margaret’s Hospital, Epping
Surgery at PAH, Harlow
We are an outstanding unit – and not
just because we say so…
We work to a very high standard to deliver the best
possible outcomes in the difficult area of breast
disease
Reports from independent reviewing bodies such as
the QA Team and Peer Review confirm it
What Makes Us Special?
• Multi-disciplinary team-working
• State of the art technology
• Up to date approaches
• Research activity
• Caring attitude
Multi Disciplinary Team
• Group of doctors, nurses, technical and
clerical support staff who run the unit
• Formal and informal communications
• Group directed guidelines, protocols and
audit
State of the Art Technology
• Digital mammography
• Stereotactic localization
• Sentinel Lymph Node Biopsy
• With intraoperative diagnostics
Up to Date Approaches
• Immuno-histochemistry in the lab to study the
chemistry of the cancer and direct specific
treatments – we were among the first to do it
• Family History Clinics – again early advocates
• Nurse-led Follow up Clinics
• Bone Health Nurse
• Early discharge with home care post-surgery
Research Activity
Extraordinary feature of our unit
•The whole team takes part
• 5 dedicated research nurses
• Active fund-raising programme
• Patients benefit by participating
Caring Attitude
•
•
•
The focus of our attention is our patients
They are supported by us throughout their
time with us
We appreciate that they are the reason that
our Unit exists
Any Questions?
Jane Herbert, Chief Executive
The Princess Alexandra Hospital
NHS Trust
Now and In the Future
Our Five Year
Vision and Mission
“To become the best general hospital in the East
of England”
“To deliver the best possible care in a safe,
reliable, effective and respectful environment”
Findings and Priorities
• Quality: patient safety, outcomes
and patient satisfaction
• Capacity and demand
• Money
• Compliance and access target
• Strategy and strategic relationships
Foundation
Trust
Application
Quality
• Patient safety and
outcomes: clinical
working groups in place
helping to deliver safe
care and best practice
• Board focus: new
assurance systems
being refined
• Patient perceptions: big
improvement but A&E
still an issue
• Patient experience more action needed
in some areas
Capacity and Demand
Activity - Emergency - Actual v Plan
Actual
3,000
Plan (I)
2,500
1,500
1,000
500
2009/10
2010/11
August
July
June
May
April
March
February
January
December
November
October
0
September
Spells
2,000
Activity - Elective - Actual v Plan
Actual
3,500
Plan (I)
3,000
2,000
1,500
1,000
500
2009/10
2010/11
August
July
June
May
April
March
February
January
December
November
October
0
September
Spells
2,500
Capacity and Demand Management
• Significant mismatch
between demand and
capacity
• Drives financial problems
• Jeopardises access targets
• Poorer patient experience
• Workforce issues
• Threatens the Foundation
Trust application
• Change in strategy needed
• More support for Care
Closer to Home
• Internal work to reduce
demand
• Refresh bed strategy
Finance – Headline Results
Steady delivery of surpluses since deficit in 2005/06
Income & Expenditure
6000
Surplus / -Deficit
Planned
Actual
4000
2000
0
2005/06
-2000
-4000
-6000
-8000
2006/07
2007/08
2008/09
2009/10
2010/11
Growth Now Decreasing
Turnover
Turnover
172.6
168.4
2009/10
2010/11
161.3
149.2
136.8
125.0
2005/06
2006/07
2007/08
2008/09
Capital
Investment
Capital Cashflow
& Depreciation
Capital
Depreciation
9,848
8,781
8,474
7,500
6,714
7,133
7,290
5,816
5,266
4,200
2005/06
5,392
4,470
2006/07
2007/08
2008/09
2009/10
2010/11
Financing
£4,163
2%
Expenses
Depreciation
£7,133
4%
Medical
£36,080
21%
Where We
Spent Our Money
Operating
expenses
£48,887
28%
Nursing
£37,119
22%
Domestics
£6,422
4%
Other staff
£31,855
19%
Staff (WTE)
3,000
2,500
2,000
1,500
1,000
500
0
2005/06
Medical
2006/07
Nursing
2007/08
Other Clinical
2008/09
Scientific & Technical
2009/10
Non Clinical
2010/11
The Auditors Local Evaluation (ALE)
Auditors Local Evaluation
"Use of Resources"
2005/06
2006/07
2007/08
2008/09
Excellent (4)
Good (3)
Adequate (2)
Inadequate (1)
2009/10
4 4
3
2 2
3 3 3
2 2
2 2
2

Financial
Reporting
3
Financial
Management
3 3 3
2 2 2 2 2
3 3 3
2 2
1
2
1
Financial
Standing
Internal
Control
Value for
Money
Overall
Compliance and Access Targets
• Delivery is varied
• Problems from increased
demand
• Focus on underlying
capacity/demand mismatch
• Prioritise
• Ensure milestones for key
targets with tight
performance management
systems
Strategy and Strategic Relationships
• Networking important for
patient care, service
planning and saving
money
• White paper maintains
drive to FT for acute
hospitals by 12/13
• GPs to become
commissioners
• New FT application with less
not more activity in the
future
• Continue to build links with
GPs, community services,
local acute hospitals
What does this mean for our
Foundation Trust Application?
Summary
• Top priority: work with primary care on “Care Closer
to Home” to address capacity and demand
imbalance to underpin other key issues
• Strategy therefore based on doing less, not more
• Continue to drive quality agenda and refine
assurance/governance
• Focus on finance and cost improvement
• Build performance management culture
• Lots to be proud of!
Any Questions
Please do hand your badges and feedback
forms back.