Presentation by Simon Knight 27 January 2014

Presentation by Simon Knight 27 January 2014

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 Whats happening across the NHS Whats 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 would be positive about UCLH I would be neutral towards UCLH 2011 I would be critical of UCLH 2010 No answer / 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 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 15 What the CQC said about our services It has a stable and experienced Board and the trusts Governors act very much as patients

champions, providing challenge We were also impressed with the emphasis placed at all levels from the trusts board and governors 16 What the CQC said about our services `we `we observed observed many many instances instances of of good good and and in in some some cases cases vast vast majority

majority of of patients patients were were very very positive positive about about they they care care they they received received outstanding outstanding care care `people `people we we spoke spoke to

to were were `staff `staff told told us us they they were were proud proud to to work work at at the the trust trust and and proud proud of of the the level level of of care

care they they were were able able to to deliver deliver extremely extremely complimentary complimentary about about the the compassionate compassionate care care and and treatment treatment they they received received

17 What the CQC said about A&E Commitment Commitment of of A&E A&E staff staff to to delivering delivering good good care care `the `the patient patient feedback feedback of of their their experience experience of of A&E

A&E was was overwhelmingly overwhelmingly positive positive In In A&E A&E `excellent `excellent caring caring staff, staff, including including positive positive caring caring interactions interactions with with patients patients The The A&E

A&E is is inadequate inadequate and and compromises compromises the the safe safe delivery delivery of of care care and and 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 childrens A&E provision Staff Leadership Environment Improve the quality and completeness of peoples 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 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) Guys & St Thomas 1 8.15 7.76 (2)

UCLH 2 7.96 7.83 (1) Kings College 3 7.85 7.39 (6) Chelsea & Westminster 4 7.82

7.40 (5) St Georges 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 womens 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 Queens Hospital 5 North Middlesex Brain Head and neck Prostate and bladder Haematology

Oesophago-gastric Radiotherapy Radiotherapy Renal 5 Radiotherapy Brain 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 UKs 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. Electromagnets The magnets focus and route the proton beams to the gantry Each of the three gantries is three-stories tall and weighs 200,000 Ibs 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 6 0 100% Emergency ambulatory care Increased use of the Hospital at Home scheme. 10

2 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

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