Annual General Meeting &
Local Healthcare Event
2011
6:25pm
Developments in Maternity and Specialist Baby Care
Debbie Twist, Head of Paediatrics
6:40pm
Tailored Care for Hip Patients at PAH
Dr Jane Snook, Consultant
6:55pm
An Operational Overview
Darren Leech, Chief Operating Officer
7:00pm
The Finances,
Charles McNair, Executive Director of Finance
7:05pm
The Year Ahead,
Melanie Walker, Chief Executive
7:20pm
Questions to Speakers
7:30pm
Close
A Year of Transition
Where We Were
- Under pressure from key partners due to erratic
performance
- An uncertain future
- Changes at the top
Where We Are Now
- Good habits versus rocket science
- Leadership and behaviours propel successful organisations
- Challenging the status quo
- Feet firmly on the ground
- Focus on the things that matter most £/Q
- Our Foundation Trust journey
Taking Control
Health versus Hospitals
- Stronger engagement with stakeholders to meet health
needs (versus demand)
- Clinical and patient empowerment
- Long Term Conditions
- Business model will be different
Managing the Business
- Clearer direction of travel (more later)
- Cost control and efficiency
- Retaining and attracting the best people
- Strong working relations with customers/regulators
Remaining Challenges
Patient Experience
- NHS Achilles heel
- Reminders of where we have failed and learning from them
- The search is on for Gold Standard at PAH
Commissioning for Health
- Targets for guidance – not for health!
- Managing and self managing Long Term Conditions
- Deep and sustainable reform of commissioning – GPs?
Chairman’s Pride
PAH and Harlow
- Nutrition, Cleanliness, Length of Stay, Art in Hospital
- Reputation
- Partners/Friends
Thank You!
- Staff
- The Board
- You
Developments in Maternity
Services and Specialist Baby
Care at Princess Alexandra
Hospital Maternity
Debbie Twist, Head of Paediatrics
The Maternity Unit
Births for the last 10 years
• 10 years ago (2000/01) 2678 births
• 5 years ago (2005/06) 3061 births
• Last year (2010/11) 4146 births
• Recruitment has been on-going and successful
• Midwife to births ratio 1:37
• Our aim is to get this ratio to 1:35
Innovations in Maternity
• Caesarean Section Task Force Group
• Vaginal Birth After Caesarean - VBAC (80% success
rate)
• Expansion of the Birthing Unit – 3 pool rooms
• Expansion of labour ward – 1 extra delivery room (9
in total)
• Extended opening hours of Maternal and Fetal
Assessment Unit (MAFU) and Triage
• Coming Soon – outpatient induction of labour,
telephone triage and gynae ambulatory care
PAH Neonatal Unit
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Part of the East Of England Neonatal Network
Level 2 Neonatal Unit
16 cots in total - 2 ITU, 4 HDU, 10 SCBU
28 weeks gestation above
Equitable, high quality neonatal services
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BAPM Standards
DOH Neonatal Toolkit
Bliss Report
Poppy Report
NSF Children and Maternity Services
Maintaining Level 2 Unit
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Staffing levels
Appropriately trained staff
Environment
Equipment
Services provided
THE NEW BUILD IS KEY
Our Achievements
• Neonatal Consultant, Unit Manager & Clinical
Facilitator in post
• EOE Neonatal Network protocols
• Community Neonatal Nursing team pilot
• NEC care bundle
• Developmental care
• Enhanced Neonatal Nurse Practitioner
Community Neonatal Nursing
Team
• Pilot project June 2010 with West Essex
Children’s Commissioners
• Early discharge, support parents & families
• Repatriation babies
• Improved breast feeding rates
• Reduction in readmissions
Community Neonatal Nursing
Team
• Total number of cot days saved from June 2010 –
June 2011 is 1014
• Comments from service users undertaken have been
very positive
• Further pilot to extended to 7 days a week from 1st
Sept
NEC Care Bundle
• East of England initiative
• Standardise feeding management across
network
• Training & support
• Recent audit PAH top achiever
Improved outcomes for neonates
Developmental Care
Support the holistic development of the
pre – term infant
• Positioning – head and limbs
• Early contact with Mum – kangaroo care
Tailored Care for Hip Fracture
Patients at PAH
Dr Jane Snook
Consultant Orthogeriatrician
Contents
• Epidemiology
• Background to changes in hip fracture care
• Hip fracture care at PAH
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Harold ward
Integrated care pathway
Results of national audit
Future plans
• Conclusions
Epidemiology of Hip Fractures
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Commonest serious injury to older people
Can bring loss of mobility and independence
High costs for society the costs ~ £2 billion/year for the UK
Average age 83
3:1 F:M
74% admitted from own home 20% from RH/NH
Mobility
Independently
Mobile
2%
25%
26%
47%
Walk with 1 Aid
Walk with 2
Aids or Frame
Wheelchair
Background
• Traditional care lead to high mortality and morbidity
• About 10% of people with a hip fracture die within 1 month
and about one-third within 12 months
• High prevalence of comorbidity
• BOA and BGS – Blue Book
• NHFD launched 2007
• Best practice tariff
• NCEPOD November 2010
• NICE guidelines June 2011
Harold Ward
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Opened in September 2009
28 bedded hip fracture unit
Business case developed by hip surgeons
Multidisciplinary care led by orthogeriatrician
Hip fracture specialist nurse/physio
Structured care ICP
Hip Fracture Best Practice Tariff
• Patients admitted under joint care of geriatrician &
orthopaedic surgeon
• Seen by orthogeriatrician within 72 hours of admission
• Admitted using an assessment protocol agreed by geriatric
medicine, orthopaedic surgery and anaesthesia
• Surgery within 36 hours from arrival in an emergency
department, or time of diagnosis if an inpatient, to the start
of anaesthesia
• Postoperative geriatrician-directed care
• Multi-professional rehabilitation team
• Fracture prevention assessments
• Falls & bone health
Integrated Care Pathway
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Assessment by orthopaedics & medics
Timely analgesia and investigations
Transfer to Harold ward
Discussion at trauma meeting
Surgery within 36 hours of admission
Falls risk and bone health review
Early mobilisation and patient-centred
discharge
Multidisciplinary Care
Harold Ward
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Daily white board rounds
Weekly full MDT meeting
Monthly team meetings – NHFD results
Mortality review group
– Full notes review of all in-hospital deaths
• Care of other elderly orthopaedic patients
National hip fracture database
2011 Results
• 53,443 cases submitted
• 176 hospitals
• 1st April 10 – 31st March 11
Areas PAH Performing well
• All patients admitted under joint care (6% nationally)
• All patients receiving medical consultant review preoperatively
• Time to theatre <36 hrs (62% nationally 73% PAH)
• Surgery during working hours on consultant lead list
• All patients admitted to Harold Ward receiving specialist falls
assessments by MDT (81% nationally)
• All patients admitted to Harold receiving osteoporosis
assessment and treatment commenced when appropriate
July 2011 PAH Report
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24 admissions 7 men 17 women
Average age 82 Age range 59-97
70 % directly admitted to Harold (100 % during stay)
Average time to ward 11.9 hours
83 % had surgery within 36 hrs
92 % seen by orthogeriatrician within 72 hrs
100 % assessed for bone protection and falls
75 % eligible for best practice tariff
Average length of stay 17.3 days (national 20.5)
Areas Under Improvement
• Pressure sore care (rate 15.5 %)
– Full nursing review to optimise nursing numbers
and grades
– Improvement of processes on ward to ensure
optimisation of rehabilitation
– Tissue viability support
• Time to Harold ward
– Close liaison with bed managers
– Aim for ring-fenced bed
Future Plans
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Ambulance pre-warning A&E
Fast transfer to Harold ward
Senior physio or nurse to carry bleep
Length of stay initiatives
Use of Harold ward to benefit other
emergency surgical non-hip fracture patients
Conclusions
• PAH has infrastructure to deliver best practice
• Substantial improvements over last 2 years
• NHFD and mortality review highlight areas for
improvement
• Pre-warning by ambulance crews should improve
outcomes further
Emergency Activity Vs Plan
Spells
2,500
2,000
1,500
1,000
500
0
Apr-10 May-10 Jun-10
Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11
Actual
Plan
Planned Care Activity Vs Plan
Spells
3,000
2,500
2,000
1,500
1,000
500
0
Apr-10 May-10 Jun-10
Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11
Actual
Plan
National Targets
Planned Care
Accident and Emergency
Scans and Tests
Cancer
Number of Patients
Waiting >18 Weeks
Back
4 Hour Emergency Care Target
NationalTarget
Performance Against Cancer Targets
Target
%
2010/11
2 Week Wait
93%
Compliant
2 Week Breast Symptoms
93%
Compliant
31 Day First Treatment Standard
96%
Compliant
62 Day Standard
85%
Compliant
62 Day Screening
90%
Compliant
Quality and Safety
Improving the Quality of Our Care and Treatment
- Introduced protected mealtimes so patients could be
helped with eating and drinking where appropriate
- Introduced Doctor and Patient/Carer communication
surgeries
- Less unnecessary time in hospital because of a reduction
in our length of stay
Providing Better, Safer Services
- Remained one of the best hospitals in combating infections
- Offering better, safer services – the hospital standardised
mortality ratio
Conclusion
• PAH is a very clean hospital that provides a
good standard of care and treatment.
• Many successes have been reported despite
it being a challenging year.
• The Trust saw more patients than planned
which impacted our operational performance
in some areas.
• The challenge is to create a viable healthcare
system within which the hospital can
consistently perform to a high standard.
Our Financial Performance
• A small surplus of £415,000 was made
• Increasing demands on our own services,
particularly emergency
• Nearly £6 million invested in the estate,
services and equipment
• A £5million Cost Improvement Programme
was delivered
• Achieved all the main statutory financial
targets
Performance Against Key Statutory
Duties
Duty
2010/11
Achieved
Duty to breakeven remaining within the statutory
resource limit (RRL)
£415,000
surplus
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Duty not to over-shoot the External Financing Limit
£3,306,000
under
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Duty to remain within the statutory capital cash limit
(CL)
£4,166,000
under
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Our Costs
Did You Know?
2/3 of our
money is spent
on staff
Our Capital Expenditure
Did You Know?
PAH was one of
the first to go
fully digital for
breast cancer
screening
The Financial Plan for 2011/12
£m
Clinical Income
Non Clinical Income
164.5
10.2
Sub Total
174.7
Pay
115.0
Non Pay
44.1
Sub Total
164.1
Capital Charges
10.6
Financial Balance
0
The Financial Picture for 2011/12
17
10
Critical Care
Elective
Outpatients
0.5
2.5
3
A&E/Non Elective
Price Deflation
Cost Inflation
3
4
4
7
2.5
2.5
4.5
Savings Challenge
Capacity Reduction
Productivity
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The Way We Work Must Change
National Government Reform & Shift in
Thinking About How Healthcare is Provided
Population Changes – ageing and growing
Impact of 21st Century Lifestyles/ Long Term
Conditions
Rising Drug and Technology Costs
Less Money Available for the NHS
Building for Excellence
We have exciting plans to
become one of the best
hospitals in the country.
The plans, called Building
for Excellence, aim to make
services more effective
and further improve the
experience of patients.
Financial
Performance
Patient
Experience,
Safety and
Quality
Building
for
Excellence
Operational
Excellence
Health of
the
Organisation
Our Immediate Plans
Clinical Productivity – Build consistency across our
operational performance e.g. length of stay, waiting
time targets
Workforce – Tackle some of the problem areas e.g.
sickness, bank and agency usage
Staffing – Look at how our back office departments
function to protect front line services
Other – The way the hospital and wards work
Change is Starting to Happen
People waiting less time – since April 95% of
people have waited less than 4 hours to be seen in
A&E, the backlog of people waiting over 18 weeks
has halved, and the wait for most tests is less than
6 weeks.
Ambulatory Care – patients are seen and a
treatment plan started without a need for a
hospital stay helping us to use beds and
resources better.
Conclusion
• We are committed to creating a hospital that
is one of the best in the country.
• Only by securing our financial future will we
be able to deliver the quality of care our
patients deserve.
• It will be tough but we see this as an
opportunity to change for the better.
Any Questions