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

Managing Long Term ConditionsRory McCrea, GP

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”

• Quality: patient safety, outcomes and patient satisfaction

• Capacity and demand

• Money

• Compliance and access target

• Strategy and strategic relationships

Findings and Priorities

Foundation Trust Application

Quality• Patient safety and

outcomes: clinical working groups in place helping to deliver safe care and best practice

• Patient perceptions: big improvement but A&E still an issue

• Board focus: new assurance systems being refined

• Patient experience - more action needed in some areas

Capacity and Demand

0

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3,000

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2009/10 2010/11

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Activity - Emergency - Actual v PlanActual

Plan (I)

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2009/10 2010/11

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Activity - Elective - Actual v PlanActual

Plan (I)

Capacity and Demand Management• Significant mismatch

between demand and capacity

• Causes inefficiencies• 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 ResultsSteady delivery of surpluses since deficit in 2005/06

-8000

-6000

-4000

-2000

0

2000

4000

6000

2005/06 2006/07 2007/08 2008/09 2009/10 2010/11

Income & ExpenditureSurplus / -Deficit

Planned Actual

Continued growth of the Trust which will decrease

125.0 136.8

149.2 161.3

172.6 168.4

2005/06 2006/07 2007/08 2008/09 2009/10 2010/11

TurnoverTurnover

7,500 6,714

9,848

5,816

8,781 8,474

4,200 4,470 5,266 5,392

7,133 7,290

2005/06 2006/07 2007/08 2008/09 2009/10 2010/11

Capital Cashflow & DepreciationCapital DepreciationCapital Investment

Where We Spent Our Money

Medical£36,080

21%

Nursing£37,119

22%

Other staff£31,855

19%Domestics

£6,4224%

Operating expenses£48,887

28%

Depreciation£7,133

4%

Financing£4,163

2%

Expenses

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1,000

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2005/06 2006/07 2007/08 2008/09 2009/10 2010/11

Staff (WTE)

Medical Nursing Other Clinical Scientific & Technical Non Clinical

The Auditors Local Evaluation (ALE)

2 2

1

2 2

1

2 2 2 2 2 2

3 3 3

2

3 3

2

3

4

2

3 3

2

3

4

2

3 3

Financial Reporting

Financial Management

Financial Standing

Internal Control

Value for Money

Overall

Auditors Local Evaluation"Use of Resources"

2005/06 2006/07 2007/08 2008/09 2009/10

Excellent (4)Good (3)Adequate (2)Inadequate (1)

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

• Relationship with PCT must be constructive

• 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

• Collaborate with PCT over joint targets

• 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 PCT 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!

21st Century Care in Orthopaedics

Paul Allen, Lead Clinician and Consultant

Orthopaedic Surgeon

The Department

• 11 Surgeons• All branches of orthopaedics

– Hip and knee replacement– Upper limb surgery– Spine and foot surgery

Trauma

Young Patients

High Energy Injuries

Sport, Road Accidents

Older Patients

Hip Fractures

Low Energy Injuries

Osteoporosis

Trauma

National Data

Relative Performance

Compares How We are Doing

Where Were We Three Years Ago?

High mortalityLong length of stayNo significant care of the elderly inputPatients all over the hospital

Where Are We Now?

Harold Ward opened 1 September 2010

Care of the Elderly Physician, Dr Jane Snook, started December 2009

Where Are We Now?

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% having falls assesment and osteoporosis treatment

Last 12 Months

Us SHA National

Average time to Ward 31.82 9.17 10.00

Average time to Theatres

32.73 36.68 41.04

Average LOS 23.10 18.54 21.31

Pre op Assesment 93.89 56.12 61.82

Orthopaedics

Wide range of services- Joint replacement- Upper limb surgery- Spinal surgery including neck- Foot surgery

Joint replacement

CompetitionDeveloped a new way to educate our patients

Mr Mahaluxmivala

Animated video to explain Total Hip and Total Knee Replacement to patients prior to surgery

Hip & Knee Videos