Annual Members’ Meeting 12 October 2016 · KPMG turnaround support Deficit of £55 million for...
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Excellence in specialist and community healthcare Annual Members’ Meeting 12 October 2016
Transcript of Annual Members’ Meeting 12 October 2016 · KPMG turnaround support Deficit of £55 million for...
Excellence in specialist and community healthcare
Annual Members’ Meeting 12 October 2016
Excellence in specialist and community healthcare
Sir David Henshaw, Chair Introduction
St George’s – Challenging times
New leadership team
CQC draft report
Estates, IT, performance and governance
St George’s staff and patients
Our strategy/the future
Annual Members’ Meeting/ St George’s University Hospitals NHS Foundation Trust
New leadership team
A distressed organisation Lack of cohesive strategy and vision New Chair appointed March 2016
Priorities
Refreshed Board confronting the reality Non-executive directors to be appointed soon Strengthening leadership at every level
Annual Members’ Meeting/ St George’s University Hospitals NHS Foundation Trust
CQC inspection report
Inspection carried out in June 2016
A difficult report, but no surprises
We were open with the CQC about the problems we face
Final report to be published in November
Annual Members’ Meeting/ St George’s University Hospitals NHS Foundation Trust
Estates Major investment required Maintenance regime resumed Moving services to ensure patient/staff safety
Annual Members’ Meeting/ St George’s University Hospitals NHS Foundation Trust
IT Basic tasks often difficult due to poor IT
infrastructure £1.3 million invested to stabilise the situation Long-term IT strategy being developed
Performance
Annual Members’ Meeting/ St George’s University Hospitals NHS Foundation Trust
Emergency Department performance much improved
Reduced waiting lists through better use of theatres
Governance Data quality issues identified Overarching Quality Improvement Plan Accountability lines (Board to ward, and ward to
Board) now priority focus
Our staff and patients
These are challenging times for staff
Patients continue to praise the care they receive – which is fantastic
We will continue to involve them in re-shaping and modernising our services
Annual Members’ Meeting/ St George’s University Hospitals NHS Foundation Trust
Our strategy/the future
Focus on getting the basics right Major issues to resolve across the organisation Developing a strategy to equip St George’s for the
future We need to make St George’s better Staff and our stakeholders are a key part of this
mission
Annual Members’ Meeting/ St George’s University Hospitals NHS Foundation Trust
Excellence in specialist and community healthcare
Professor Simon Mackenzie, CEO Review of 2015/16
St George’s Hospital
Queen Mary’s Hospital
St George’s cares for a population of 1.3 million across south west London. Two main hospitals, plus a wide range of community settings.
As well as our two main hospitals, we provide care in health centres, GP surgeries, schools, people’s homes and HMP Wandsworth.
We share our Tooting site with St George’s University of London.
Annual Members’ Meeting/ St George’s University Hospitals NHS Foundation Trust
9,000 staff
21,500 Foundation
Trust members
330 volunteers
637,000 outpatients treated each year
5,200 babies delivered per year
We provide services from 12
health centres
Emergency Department sees 400
patients each day
28,500 elective procedures every year
We are a teaching hospital, a tertiary referral centre, and a community provider. We touch the lives of thousands of people.
Annual Members’ Meeting/ St George’s University Hospitals NHS Foundation Trust
2015/16 in review A difficult year
Financial challenges
Failure to deliver waiting
times
Hard working staff providing good care
Some positive outcomes
Annual Members’ Meeting/ St George’s University Hospitals NHS Foundation Trust
Financial position 2015/16
Lost control of our finances in 2014/15
Serious weaknesses in finance and management systems (PwC)
Monitor found Trust in breach of license
KPMG turnaround support
Deficit of £55 million for 2015/16 - Continuing to lose money every month
Annual Members’ Meeting/ St George’s University Hospitals NHS Foundation Trust
Performance 2015/16
Indicator Target 15/16 performance
ED 4 hour >= 95% 90.44%
RTT incomplete pathways >=92% 90.25%
62 day wait for first treatment for urgent GP cancer referral
>=85% 82.5%
Chlostridium Difficile <31 cases 29
MRSA 0 3
SHMI (Oct14- Sept 15) <1.0 0.91
Annual Members’ Meeting/ St George’s University Hospitals NHS Foundation Trust
Service developments 2015/16
Charles Pumphrey Unit for cardiology patients
Wolfson Rehabilitation Unit opened at Queen Mary’s Hospital
Gordon Smith cancer ward opened at St George’s Hospital
Youth violence project in ED Improving cancer services
with Macmillan
Annual Members’ Meeting/ St George’s University Hospitals NHS Foundation Trust
Organ donation at St George’s
Highest organ donation rate in the UK
Excellent renal transplant outcomes
Tree of life annual celebration event at St George’s
Annual Members’ Meeting/ St George’s University Hospitals NHS Foundation Trust
External recognition 2015/16 Hyper Acute Stroke Unit: Sentinel
Stroke National Audit
Haematology: VTE Exemplar Network membership
Mortality: one of only two Trusts with no ‘avoidable deaths’ in a study published in 2015
Foetal monitoring team wins Health Service Journal award
C4’s 24 Hours in A&E profiles work of
our Emergency Department at St George’s
Annual Members’ Meeting/ St George’s University Hospitals NHS Foundation Trust
Learning from 2015/16 to Make St George’s Better
We need to do: - Improve quality and - Deliver access targets and - Meet financial goals
We must: - Do these together - Do these with our staff - Do these with our community
Annual Members’ Meeting/ St George’s University Hospitals NHS Foundation Trust
Excellence in specialist and community healthcare
Margaret Pratt, Chief Financial Officer Financial summary – 2015/16
2015/16 results • The NHS Trust accounts show
a deficit of £55.1m for 2015/16.
• When compared to the previous year, operating income went up by 6% but operating expenses rose by 11%.
• The key issues contributing to a rise in operating expenses, and in the absence of increased operating income, were the introduction of safer staffing levels in nursing, and inflation.
• £3.1m of costs associated with 2014/15 were reported within the 2015/16 position. A decision was taken with the auditors not to reopen the accounts due to immateriality.
STATEMENT OF COMPREHENSIVE INCOME 2015/16 2014/15* Change Change £m £m £m %
Operating income from patient care activities 621.59 612.66 8.94 1%Other operating income 129.36 98.40 30.96 31%Total operating income 750.95 711.06 39.90 6%Operating expenses -795.00 -716.89 -78.11 11%Operating surplus/(deficit) -44.05 -5.84 -38.21 655%
Finance income 0.09 0.16 -0.07 -45%Finance expenses -4.26 -3.29 -0.96 29%PDC dividends payable -6.90 -7.69 0.79 -10%Net finance costs -11.07 -10.82 -0.24 2%Surplus/(deficit) for the year -55.12 -16.66 -38.45 231%
Other comprehensive incomeRevaluations -1.18 0.00 -1.18 100%Other recognised gains and losses 0.00 -0.15 0.15 -100%Total other comprehensive expense for year -56.30 -16.81 -39.49 235%
*2014/15 figures are the totals for the 10 month and 2 month accounts for comparative purposes
Where did St George’s get its income from? • There was an increase of 1% in
income from patient care activities.
• The big increase in income from local authorities relates to the change in the commissioning of GUM services effective from April 2015.
• Other operating income increased by £31m however this includes an accounting change and the recharge to other trusts of the cost of GP trainees paid on their behalf (since Aug 15). When this item is excluded the increase in other operating income is £4.2m.
• Overall total operating income increased by 6%.
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INCOME FROM PATIENT CARE ACTIVITIES 2015/16 2014/15* Change Change £m £m £m %
CCGs and NHS England 592.42 571.61 20.81 4%Local authorities 10.94 0.17 10.77 6450%NHS Trusts & NHS FTs 1.78 28.05 -26.27 -94%Private patients 3.61 3.93 -0.32 -8%Overseas visitors 2.28 1.22 1.06 87%NHS injury scheme 3.69 4.47 -0.78 -17%Other clinical income 6.87 3.21 3.66 114%TOTAL - FROM PATIENT CARE ACTIVITIES 621.59 612.65 8.94 1%
OTHER OPERATING INCOME 2015/16 2014/15* Change Change £m £m £m %
Education, training and research 47.36 50.98 -3.62 -7%Charitable donations 2.92 0.88 2.04 231%Non-patient care services to other bodies 45.83 31.07 14.76 48%Income in respect of staff costs - gross basis (new cat) 26.79 0.00 26.79 100%Other income 6.46 15.47 -9.01 -58%TOTAL - OTHER OPERATING INCOME 129.36 98.40 30.96 31%
TOTAL OPERATING INCOME 751.0 711.1 39.9 6%
*2014/15 figures are the totals for the 10 month and 2 month accounts for comparative purposes
Where did we spend it? • Total operating income (previous slide)
rose by 6% overall.
• In contrast, operating expenses rose by 11% from £717m to £795m.
• Some differences in the treatment of items between FT accounts and NHS Trust accounts make year on year comparisons slightly more complex but the overall message is the same.
• Staff expenses dominate our expenditure at £486m (£446m in 14/15). The increase is due to inflation (3%), the GP pay recharge as as well as investment in capacity and quality initiatives.
• Clinical supplies and services have increased along with demand, including increased spend on Hep-C drugs (£4m pass-through).
• Other expenses include consultancy (KPMG turnaround) and services from non NHS bodies as the trust has come under increasing pressure from rising demand.
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2015/16 2014/15* Change Change OPERATING EXPENSES £m £m £m %Employee expenses 485.67 446.29 39.38 9%Clinical supplies & services 161.27 142.90 18.37 13%Premises 49.77 43.99 5.78 13%Other expenses 31.57 20.11 11.46 57%Depreciation 22.30 21.15 1.15 5%General supplies 16.68 15.49 1.19 8%Services from non NHS bodies 8.41 6.63 1.78 27%Services from other NHS bodies 7.38 6.97 0.41 6%Transport 7.15 5.84 1.31 22%Establishment costs 4.81 7.54 -2.73 -36%Total operating expenses 795.00 716.91 78.09 11%
*2014/15 figures are the totals for the 10 month and 2 month accounts for comparative purposes
Capital investment 2015/16 • Capital spend overall was
£31m for the year against the budget of £48m, an under spend of £17m
• The main components of this underspend are the Infrastructure Renewal Programme (under spend £5.7m) and Major Projects category (under spent £6m).
• The under spends related to slippage on projects, which will complete instead in 2016/17.
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Capital expenditure vs plan 2015/16 - month by month
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
£000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000
Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16
Budgeted capex
Actual capex
Capital expenditure vs plan 2015/16 - by category
02,0004,0006,0008,000
10,00012,00014,00016,00018,00020,000
Budget
Actual
Cash position 2015/16
• The Trust’s cash balance was £7.4m at March 16 compared to £24.2m at March 15
• However, as the chart shows the underlying cash position has deteriorated significantly over the year as a result of the £55.1m deficit
• The trust had to borrow £40.4m during the year from the Department of Health to support its cash position
• In addition the cash position continued to benefit the London Energy Efficiency Fund (LEEF) loan for the Energy Performance Contract that was drawn down in 2014/15. Minimal expenditure was incurred on this capital project in 2015/16 and at the year end the unexpended balance of this loan - included within the cash balance - was approx £11.5m.
• The purple line on the graph shows notionally what the cash balance would have been without the borrowing from DH and the LEEF loan.
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Cash balance and borrowings month by month 2015/16
-50.0
-40.0
-30.0
-20.0
-10.0
0.0
10.0
20.0
30.0
40.0
50.0
£m £m £m £m £m £m £m £m £m £m £m £m
Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16
Cash balance
Borrowings DH
LEEF loan
Cash bal excl borrowings & LEEF
Excellence in specialist and community healthcare
Kathryn Harrison, Lead Governor Council of Governors
Excellence in specialist and community healthcare
Any questions?
Excellence in specialist and community healthcare
Celebrating 200 year of Nursing and Midwifery: Past, present and future Hazel Tonge, Deputy Chief Nurse Alison Ludlam, Divisional Director of Nursing and Governance for Community
Then to now
1733 Lansborough House
1973 - 2016 Tooting Now
St John’s Therapy Centre The Nelson Health Centre (2015)
Queen Mary’s Hospital Wandsworth Prison
Visionary leadership
Florence Nightingale
1953 Crimea War
Edith Cavell
Early 1900
Mary Seacole
1954 Crimea War
Carmen Brookes Johnson 2011
Uniforms past to present
1930s 2016
Nurse education past to present
1960s
1950s
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1990s
2016
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Childbirth tools to
specially designed
birthing rooms (Carmen Suite)
Whoosh to
beeps
Tincture to
inhalers
Iron railing cots to
baby friendly incubators
Technology and care facilities transformation
1904 Victorian Nitty Nora
to Specialist
Community Public Health Practitioner
1916 Royal Sanitary Institute
to Specialist
Community Public Health Practitioner
1859 Nursing in the home
to Clinical Caseload
Managers
2004 transfer from MoJ to
DH to Healthcare
professionals
Community Nursing
Proud to be a St Georges Nurse/ Midwife
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Essence of a St George’s nurses/midwives ‘Where meaningful care matters’ Essence Compassionate and brave Professional and hardworking Proud to care about patients
and proud to care about each other
Supportive and highly skilled Our nurses and midwives
choose to work at St George’s because of the good reputation of the standards of care and the quality of our services, plus the easy accessible London location.
Professional identity
Present to future… What next?
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With grateful thanks to……
St George’s Hospital Charity for allowing us to use photographs and stories from the book (on sale today)
Divisional Directors of Nursing and director of Midwifery for sharing their stories
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