Welcome to our AGM 2016 Please take a

Welcome to our AGM 2016 Please take a seat, the AGM is about to begin Welcome Chairman, Sir Richard Sykes 2015/16 review and a look ahead Chief executive,

Dr Tracey Batten Highlights More care for more people Focus on improving quality Innovative care Progress on digital strategy

Working in partnership Maintained cancer care standards Highlights from 2015/16 Challenges Our financial position A&E and waiting list access standards The state of our estate Looking ahead: 2016/17 and beyond Financial improvement and sustainability

A&E access improvement Reduce waiting lists Sustainability and transformation plan (STP) Looking ahead: 2016/17 and beyond New models of care St Marys Hospital phase I redevelopment Continued investment in our staff Financial accounts 2015/16 Chief financial officer, Richard Alexander

Agenda Headlines for the year 2015/16 Statement of Comprehensive Income Where does the income come from? How do we spend it? A look ahead Headlines for 2015/16 Year-end deficit: Made up of: outturn 47.9m

30.1m operational 17.8m estates provisions Cash balance: 24.2m Capital expenditure: 34.4m Savings delivered : 28.9m Performance against plan over last 3 years Plan versus actual 2013/14 to 2015/16 (18.5m):15/16 planned

deficit 20.0 10.0 0.0 2013/14 2014/15 2015/16 m -10.0

-20.0 -30.0 -40.0 -50.0 -60.0 Plan Actual (c8m): unplanned fines and challenges from commissioners (c4m): slower growth in private patients

(c18m): provided for poor quality estate Statement of Comprehensive Income 2013/14 Revenue from patient care activities Other operating revenue Total revenue Employee benefits Other costs* Operating surplus Net financing costs Surplus for the financial year* Public dividend capital payable

Adjustment for donated assets Retained surplus/(deficit) for the year* * Adjusted for impairments m 774.4 204.9 979.3 -526.2 -419 34.2 -0.8 33.3

-18.8 0.6 15.1 2014/15 m 795.7 204.9 1000.6 -553.4 -418 29.3 -0.4 28.9

-14.4 0.9 15.4 2015/16 m 832.2 187.7 1019.9 -582.7 -470.9 -33.7 -0.5 -34.2

-11.5 -2.2 -47.9 What were the key changes in 2015/16? Major changes in income : 40m increase - services for local patients no increase - specialised services reduction - education, training and research income removed - 24m subsidy for complex specialist care

Increases in expenditure: the cost of delivering additional activity inflation and other NHS cost pressures implementing new patient administration system costs and provisions associated with estates 1billion income: Income generation; 0.34%

Rental revenue from operating leases; 0.77% Othertorevenue; 2.21%3.91% Non-patient care services other bodies; Education, training and research; 11.18% Non NHS Patient Care; 6.12% NHS Patient Care; 75.48% 120.0 Snr mgrs

HCA 60.0 Substantive Bank/Agency 180.0 Admin & Estates 15/16 Admin & Estates 14/15 Admin & Estates 13/14

Senior Managers 15/16 Senior Managers 14/15 Senior Managers 13/14 Scientific & Tech 15/16 Scientific & Tech 14/15 Scientific & Tech 13/14 Healthcare Assts 15/16

Healthcare Assts 14/15 Healthcare Assts 13/14 Nursing 15/16 Nursing 14/15 Nursing 13/14 Other Medical 15/16 Other Medical 14/15

Other Medical 13/14 Consultants 15/16 Consultants 14/15 Consultants 13/14 0.0 Nurses 200.0 Admin

Scientists 100.0 Consultants Oth med. 80.0 millions 1billion spending staff 583m 160.0 140.0

40.0 20.0 1billion spending non-staff 471m Other Expenditure; 6.97% NHS Bodies & Healthcare Costs; 6.33% Traing & Education and R&D; 5.58% Clinical negligence; 5.32% Supplies and services - clinical; 20.93% Depreciation; 7.33% Establishment & Transport; 4.31%

Supplies and services - general; 7.50% Premises; 9.06% Supplies and services - drugs; 26.66% Looking ahead: 2016/17 plan 2015/16 Financial plan 2016/17 2016/17 Actual Plan

Movement between years m m m Income* 1,019.9 1,045.4

25.5 Expenditure 1,067.8 1,097.4 29.6 (47.9) (52.0)

4.1 CIP 28.9 54.1 25.2 Capex 34.4

32.9 1.5 Cash 24.2 20.8 3.4 Surplus / (Deficit)**

*Including investment revenue **Excluding technical adjustments Looking ahead: 2016/17 and beyond Challenging financial position in 2016/17 and into the future, savings target almost doubled Financial improvement programme, agreed with NHSI, supported by PwC Investing with charity support in maintaining and improving our estate and equipment, including: A&E outpatients paediatric intensive care

Preparing for major redevelopment Questions and answers Chairman Sir Richard Sykes Chief executive Dr Tracey Batten Chief financial officer Richard Alexander Director of nursing Professor Janice Sigsworth Medical director Dr Julian Redhead

Also here to take any questions are our divisional directors: Professor Tim Orchard - medicine and integrated care Professor Jamil Mayet - surgery, cancer and cardiovascular Professor TG Teoh - womens, childrens and clinical support Professor Tim Orchard Divisional director for medicine and integrated care

A partnership to explore accountable care in Hammersmith and Fulham Anna Bokobza Integrated care programme director Imperial College Healthcare NHS Trust Professor Simon Barton Associate medical director Chelsea and Westminster Hospital NHS Foundation Trust The challenges were facing Health and wellbeing The challenges were facing Care and quality

The challenges were facing What should great care look like? So what should great care look like? Helps people to be as healthy as possible Helps people who become unwell to get better as quickly as possible Joins up care and services and makes it easier for individuals to have the right health and care support for them Genuine partnership working between health and care providers and the individuals they serve

Why can accountable care help? Because: It puts the individual at the centre It aligns incentives so everyone is pulling in the same direction Success and funding reflect what is achieved for the individual, not how much is done to them The needs of the whole population are important, not just those who are acutely unwell It demands joined up information and care planning Developing accountable care in H&F Hammersmith and Fulham Integrated Care Programme,

a formal partnership launched in July 2016 between: Hammersmith and Fulham GP Federation Imperial College Healthcare NHS Trust Chelsea and Westminster Hospital NHS Foundation Trust

West London Mental Health NHS Trust Plus lay representatives on key governance structures Developing accountable care in H&F With a lot of collective resource, experience and skills: Developing accountable care in H&F The partnership is working to: Design a practical accountable care approach for the

borough Identify and implement more immediate improvements to join up care, primarily through two pilot projects Build strong foundations for potentially forming or becoming part of a formal accountable care partnership Familiar faces pilot project

Objective: to test the principles of the partnership in practice Identified 71 patients who had visited A&E 10 times in 10 months, of whom 13 had visited > 20 times Local GPs obtained special consent from 19 patients to share their clinical records between all partners Brought together senior clinicians from across the partnership to review specially consented cases Clinicians also individually reviewed the other case records Identified key themes to inform potential care pathway improvements Familiar faces pilot project Achievements and learning so far

Building trust and knowledge between clinicians across the partner organisations Important to bring together all clinicians involved in an individuals care to achieve insights BUT it is time-intensive Different information systems and information sharing rules are acting as a significant barrier to better care We have a better understanding of this vulnerable patient group characterised by complex health and mental health conditions, in contact with GP but also often requiring out-of-hours urgent or emergency care GP and social care need to be involved in care planning and multi-disciplinary team planning Familiar faces pilot project

Next steps Working with some of the specially consented patients to see how we can improve the design of urgent and emergency care pathways Looking at how we could improve outcomes and experience for patients who stay in hospital for a long time One example: the Alzira model (Spain) How accountable care can work The Alzira model records achievements including: How to get involved in H&F

We are developing a programme of workshops, interviews, and research to ensure local people, patients and carers are at the heart of the design process for new care pathways and ways of working Please register to get involved and we will keep you informed of opportunities complete one of our get involved forms or email [email protected], indicating your interest in integrated care Q&A panel Professor Simon Barton Associate medical director Chelsea and Westminster Hospital NHS Foundation Trust Anna Bokobza Integrated care programme director Imperial College Healthcare NHS Trust

Dr Sarah Elkin Clinical director for directorate of integrated care, Imperial College Healthcare NHS Trust Dr Stephen Hirst, Medical director Hammersmith and Fulham GP Federation Thank you Chairman, Sir Richard Sykes

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