University College London Hospitals NHS Foundation Trust Past... · Sustainability and...
Transcript of University College London Hospitals NHS Foundation Trust Past... · Sustainability and...
University College London Hospitals NHS Foundation Trust Members’ Event
Simon Knight, Nina Griffith, planning and performance
Jonathan Gardner, strategic development
• To give you an overview of UCLH’s priorities for 2017/18
• To give you a summary of future plans for development of our clinical services
• To give you a chance to ask questions about these plans
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Purpose of this session
Our Hospitals
Elizabeth Garrett
Anderson Wing
(maternity
services)
Hospital for
Tropical Diseases
Institute of Sport,
Exercise and
Health
University College
Hospital Macmillan
Cancer Centre
University College
Hospital at
Westmoreland Street
University College
Hospital
Royal London
Hospital for
Integrated Medicine
National Hospital for
Neurology and
Neurosurgery
Royal National
Throat, Nose and
Ear Hospital
Eastman Dental
Hospital
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Our values
UCLH’s vision and strategic approach remains
broadly the same
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Top quality
patient care
Excellent education World class research
Our three specialist areas where we pursue national and international
renown: neurosciences, cancer, women’s health.
We need to provide better care for local people and a grounding in
general medicine and surgery for our trainee doctors and other health
professionals.
UC
LH
vis
ion
Over the longer term, we are considering our role as part of an accountable
care system that provides population health for the ’south’ of NCL
(Haringey/Islington/Camden).
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New Planning Environment
• Sustainability and Transformation
Plans
• Accountable Care Organisations
• Integrated Care
• Vanguards
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In 2016/17 we are forecasting a year end deficit of around £11m. This is in line
with our budget targets and an improvement on the previous year when we
reported a £31m deficit.
In 2017/18 we are aiming for a surplus position of £5.3m.
This is within the context of significant financial challenges including:
• 2% tariff efficiency
• Loss of £3.1m of education funding
• £2m increase in PFI costs
We need to deliver efficiency savings worth £42m
Financial challenge for 2017/18
OPERATIONAL OBJECTIVES FOR 2017/18: DRAFT
Provide the highest
quality of care within
our resources
Improve patient
pathways through
collaboration with
partners
Support the
development of our
staff to deliver their
potential
Achieve financial
sustainability
Generate world-class
clinical research
Deliver ‘Sign up to
Safety’ campaign
pledges so that we
further reduce harm to
patients
Maintain upper-decile
Standardised Hospital
Mortality Index results
Achieve hospital
acquired infection targets
Maintain / Improve
patient experience
ratings
Improve booking and
correspondence with
patients and GPs
Ensure that we check
and action all patient test
results
Progress the cancer
vanguard project and
further develop the
strategy
Meet cancer waiting
times targets
Work with system
partners to deliver
A&E waiting time
targets
Meet 18 week and
diagnostic waiting
times targets
Deliver phase 4,
phase 5, ED and
Queen Square
development
milestones
Work with STP
partners to develop
integrated pathways
for our local patients
Improving staff
experience
Improving the quality
of education and
development
Prove UCLH to be an
employer of choice
To be confirmed: STP
workforce related
objective?
To be confirmed
To be confirmed
Achieve financial
targets
Deliver workforce,
procurement and
pharmacy efficiencies
in line with Carter
agenda
Take a leadership role
within the STP to
deliver North-Central
London’s financial
objectives
Improve utilisation of
beds, theatres,
imaging and
outpatient resources
Objective related to
estate efficiencies
Implement our
decision on next steps
for electronic health
record system
Further develop the
biomedical research
centre
Increase recruitment of
patients into portfolio
studies and early phase
trials
Achieve project
milestones for CRUK
and dementia research
institute bids
Objective on utilisation
of clinical research
facility
Deliver on our
responsibilities for the
100,000 genome
project
Progress clinical
academic appointments
with UCL
• Deliver ‘Sign up to Safety’ campaign pledges so that we further
reduce harm to patients
• Maintain upper-decile Standardised Hospital Mortality Index
results
• Achieve hospital acquired infection targets
• Maintain / Improve patient experience ratings
• Improve booking and correspondence with patients and GPs
• Ensure that we check and action all patient test results
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OPERATIONAL OBJECTIVES FOR 2016/17:DRAFT
Provide the highest
quality of care
within our
resources
We will continue with the following priorities as part of our “sign-up to safety” pledges:
1. To reduce surgery related harm
2. To reduce harm from unrecognised deterioration
3. To reduce patient harm from sepsis
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Sign up to safety: our quality priorities for 2016/17
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Achieve hospital acquired infection targets: MRSA
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• UCLH have reported 89 cases by the end of December 2016; 8 of these cases have been determined as not
being the result of lapses in care
• Annual target of 90 cases
• Relatively low number confirmed to be as a result of lapses, so we are likely to meet our target
Achieve hospital acquired infection targets: Clostridium difficile
Peer London
Teaching Hospital
Position against
peersScore
2014 Score &
position
UCLH 1 8.4 8.1 (2)
Guy’s & St Thomas 2 8.3 8.3 (1)
Chelsea &
Westminster3 8.2 8.0 (3)
Kings College 4 8.1 7.8 (7)
St George’s 4 8.1 8.0 (3)
Royal Free 6 8 8.0 (3)
Imperial 7 7.9 8.0 (3)
Bart’s 8 7.6 7.8 (7)
2015 Inpatient Survey
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• Improving staff experience
• Improving the quality of education and development
• Prove UCLH to be an employer of choice
• STP workforce related objective?
• Two more objectives to be confirmed
OPERATIONAL OBJECTIVES FOR 2016/17:DRAFT
Support the
development of our
staff to deliver their
potential
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NHS Annual Staff Survey 2015 2014 2013
Would you be happy with the
standard of care at UCLH if a
friend or relative needed
treatment?
82%
National
average
is 70%
83%
National
average
is 65%
83%
National
average
is 64%
Would you recommend UCLH
as a place to work?
66%
National
average
is 61%
70%
National
average
is 58%
73%
National
average
is 59%
Right staff working in the right way
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Achieve financial targets
Deliver workforce, procurement and pharmacy efficiencies in line with
Carter agenda
Take a leadership role within the STP to deliver North-Central London’s
financial objectives
Improve utilisation of beds, theatres, imaging and outpatient resources
Objective related to estate efficiencies
Implement our decision on next steps for electronic health record
system
OPERATIONAL OBJECTIVES FOR 2016/17:DRAFT
Achieve financial
sustainability
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Digital Transformation
UCLH’s vision requires world class digital which means investing in our
electronic patient records system.
Timeline to EHRS:
• 2015: OBC approved
• 2016: Procurement
completed and Epic
preferred bidder
• Now: FBC completed and
being reviewed by BoD
with decision expected
March 2017
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Benefits of digital transformation
A key benefit of digital transformation will be the ability to share
comprehensive care records supporting integrated care across the sector.
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uclhfuture milestones in 2016 and beyond
(subject to approval of business cases)
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• Further develop the biomedical research centre
• Increase recruitment of patients into portfolio studies and early phase
trials
• Achieve project milestones for CRUK and dementia research institute bids
• Objective on utilisation of clinical research facility
• Deliver on our responsibilities for the 100,000 genome project
• Progress clinical academic appointments with UCL
OPERATIONAL OBJECTIVES FOR 2016/17:DRAFT
Generate world-
class clinical
research
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• Meet cancer waiting times targets
• Work with system partners to deliver A&E waiting time targets
• Meet 18 week and diagnostic waiting times targets
• Work with STP partners to develop integrated pathways for our local
patients
• Progress the cancer vanguard project and further develop the strategy
• Deliver phase 4, phase 5, ED and Queen Square development milestones
OPERATIONAL OBJECTIVES FOR 2016/17:DRAFT
Improve patient
pathways through
collaboration with
partners
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Meet cancer waiting times targets
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Meet cancer waiting times targets
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Meet cancer waiting times targets
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• Consistently achieving the standard since November 2014
Meet 18 week and diagnostic waiting times targets
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• Diagnostic waits have been too long in MRI and endoscopy
• Trust compliant in December 2016 for first time since September 2013
Meet 18 week and diagnostic waiting times targets
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• Waiting times in A&E have been challenged, as has been the case for many trusts
• We have a recovery action plan in place and are working closely with the Camden
and Islington emergency care boards to address the issues.
• One of the main issues has been high occupancy levels for beds at UCH
Key actions include:
• A new primary care service in Emergency Department (started in November)
• Additional step down beds at St Pancras (opening on 16th Jan)
• Weekly senior level meetings with Camden and Islington partners to manage delayed
transfers of care
• Discharging patients earlier in the day
A&E access times
Type 1
performanceQ1 14/15 Q2 14/15 Q3 14/15 Q4 14/15 Q1 15/16 Q2 15/16 Q3 15/16 Q4 15/16 Q1 16/17 Q2 16/17 Q3 16/17
UCLH 95.2% 94.2% 94.0% 95.1% 97.7% 94.9% 90.6% 86.9% 89.4% 89.1%86.6% (as of Oct-
16)
London 91.6% 91.8% 87.6% 87.9% 91.2% 93.1% 87.1% 82.2% 84.5% 86.7%83.3% (as of Oct-
16)
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• Meet cancer waiting times targets
• Work with system partners to deliver A&E waiting time targets
• Meet 18 week and diagnostic waiting times targets
• Work with STP partners to develop integrated pathways for our local
patients
• Progress the cancer vanguard project and further develop the
strategy
• Deliver phase 4, phase 5, ED and Queen Square development
milestones
OPERATIONAL OBJECTIVES FOR 2016/17:DRAFT
Improve patient
pathways through
collaboration with
partners
The imperatives to integrate health & social care services
Around 1.5 million people live in North Central London.
Around 22% of local people use 63% of health and social care services.
More and more people have multiple conditions and have increasingly complex
needs. Our population is also getting older.
Enabling people to manage their multiple conditions requires partnerships with
patients and other health and social care providers, not unconnected ‘episodes’
of care.
In the future, to make do with the limited resources we have, we must act
proactively to prevent ill health and further deterioration.
“I need more help to understand
decisions, so that attempts to
involve me in decisions about my
care and treatment are
understood by me. I'm not always
sure what I'm agreeing to.”
“I had to stay four extra days in
hospital, because there was no
integration between the
hospital and my local borough’s
adult social care dept.”
UCLH patient quotes
Reminder: the national context
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Sustainability and transformation plans (STPs) are local plans to help
deliver the aims of the Five Year Forward View.
44 footprints across England, each with their own STP.
UCLH is part of the North Central London (NCL) footprint. In November
2016 the NCL initial plan and case for change were published.
Care closer to home
• More care closer to home through
CHINS: networks covering
population of c.50,000. They will
provide integrated multi-disciplinary
teams, to provide care planning and
care coordination for identified
patients.
• Quality improvement support teams
to provide practical help in practices
to develop consistent standards and
offer to all patients.
As part of the NCL STP, there is an increasing focus on reducing emergency
bed days by systematically ensuring the right care is delivered when and
where people need it, in the most efficient and effective way.
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The NCL STP puts integrated care front and centre
Urgent and emergency care
• Rapid advice in the community, in
person or by phone/Skype
• Alternatives to hospital attendance
and admission – e.g. MH liaison
• For patients who do attend hospital,
GPs at the front door and rapid
assessment of need, proactive
management of long term
conditions.
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Governing Bodies of the
Statutory Organisations
NCL STP Advisory Board
(Political Leaders/NHS
Chairs/Healthwatch)
NCL STP programme delivery
board
Clinical cabinet Finance and activity
modelling group
Health
& care
closer
to
home
Urgent &
emergency
care
Mental
Health Cancer
Elective care Maternity work stream
(governance tbc)
NCL
Estates
NCL
Digital
Local
workforce
action
Provider
CEOs
Prevention
Communications and engagement
UCLH involvement in NCL STP
UCLH is actively contributing to the majority of the work streams (show in jade)
and we are leading three work streams (orange) and the productivity group. We
are on the clinical cabinet and the programme delivery board.
Productivity
Finance and activity
monitoring group
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We are part of the Camden local
care and exploring accountable
care partnership as well as
working on MSK and integrated
pathways for diabetes and frailty.
We are collaborating clinically with
Whittington Health on acute
services to improve resilience and
sustainability, including on maternity,
breast cancer and emergency
surgery.
Across the five boroughs that make up NCL STP, UCLH is
heavily involved in the following areas:
• care closer to home,
• urgent and emergency care,
• digital
• planned care.
We're also involved in the London Specialised Planning
work, and continue to lead the UCLH Cancer Collaborative.
UCLH is part of the Haringey
and Islington well-being
partnership and the Islington
integrated care network.
UCLH is involved across the north central London footprint
UCLH
NCL
UCLH is working to deliver integrated care now
Living a full and healthy life in the community
Coordinated community, primary and social care
Specialist community based support
Secondary care (hospital)
support
Tertiary specialist services
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We need services that provide holistic care when and where people need it.
“I can plan my care with people who work together to understand me and my carer(s), allow me control
and bring together services to achieve the outcomes important to me”: National Voices definition of integrated care
At the moment we have:
Teams from UCLH
working in the
community to help
people stay well at home.
E.g. MSK, frailty and
diabetes, UCLH@home,
integrated care network
Teams from the
community working at
UCLH to get people
home. E.g. GPs in ED,
Mental health liaison,
community in-reach
1
2
To support better care for local people we are
working increasingly closely with Whittington Health
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Collaborating with Whittington Health will help improve our clinical sustainability and
operational resilience in a number of services.
Possible areas for collaboration:
The collaboration aims to:
• improve the quality, safety and experience across a common local population in
Haringey, Islington and Camden by improving services across the two acute trusts
and supporting a population approach to health care.
• reduce costs to the health system by sharing best practice improving pathways.
Maternity
Breast cancer
Lung cancer
Imaging
MSK
Lower urinary tract service
Surgery
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• Phase 1: The UCH Tower (new build on Euston Road) opened 2005
• Phase 2: The Elizabeth Garrett Anderson Wing (maternity services) linked to the Phase
1 development opened 2007
• Phase 3: The Macmillan Cancer Centre (on Huntley Street) opened 2012
• Phase 4: Proton Beam Therapy, Short Stay Surgery and Specialist cancer facility
• Phase 5: A world leading Head, Neck and Dental Hospital on the UCH Campus
An evolving UCH Campus Vision and Strategy delivery
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Phase 4 & 5 location: UCH Campus
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A brief reminder of Phase 4
Phase 4
Phase 4
Phase 4
PBT equipment solutions are primarily based on a standalone accelerator feeding multiple
gantries
Accelerator
Using magnetic fields, the hydrogen protons are accelerated to two thirds the speed of light.
Gantry
Each of the three gantries is three-stories tall and weighs 200,000 Ibs
Electromagnets
The magnets focus and route the proton beams to the gantry
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PBT: Better Outcomes and Benefits to Patients
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The Phase 4 facility
Inpatient and surgical capacity in Phase 4;
• 135 adult inpatient beds (85 NHS and around 50 Private - 31 of which will transfer
from UCH Tower -)
• Largest haematology centre in Europe
• 8 shorter stay operating theatres (adult only)
• 20 short stay surgical beds (adult only)
• 10 bedded adult critical care unit (including PACU)
• Imaging facilities (adult only)
• PBT Centre (4 gantries, one accelerator)
• Retail facility on the ground floor (Tottenham Court Road)
Set to complete in late 2020
• Increased surgical capacity in the Tower (focus on paediatrics and complex care)
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The vision of the Phase 4 investment in surgical services is to create the the most
effective and efficient environment to create world leading……
New Pathways in Short Stay Surgery:
• A new Short Stay Surgical Centre in Phase 4 will consolidate day surgery and short
stay surgical services at UCLH. This will allow the surgical pathway to become more
efficient and increase patient satisfaction by ensuring only those requiring inpatient
stays have them. This facility is supported by a 48hr stay facility to ensure that every
opportunity of taken to improve the productivity and efficiency of the pathway.
New Pathways for Specialist and Complex Surgery:
• The relocation of current UCH short stay surgery activity and the enabling of the
conversion of inpatient to additional short stay surgery work will release UCH theatres
for more complex inpatient activity to deliver the UCLH cancer vision.
New Pathways for Paediatric Surgery:
• The consolidation of all children’s services from the Tower at UCH and the RNTEH and
EDH to a dedicated children’s surgical unit on T2 with an efficient, standardised
pathway for all children’s surgery.
P4 AG: Case for Investment in Surgical Services
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• The Heart Hospital became vacant in May 2015 with the transfer of cardiac
services to Bart's Health
• It now operates with 7 operating theatres – up to 78 beds plus a CCU/PACU
and recovery capacity
• Interim clinical use until late 2020 and the opening of Phase 4
• Its use has allowed the implementation of London Cancer work, supporting
some growth in demand and helping manage access time challenges
• Urological and thoracic surgical services now operate form the site
The use of the Heart Hospital for Interim Capacity
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A brief reminder of Phase 5
Phase 5
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The Need for the Phase 5 Development
• Business Transfer Agreement signed with Royal Free London Trust in March
2012 clearly outlines UCLH’s obligation to relocate RNTNEH services to the
main campus
• RNTNEH site is held on two co-terminus leases that expire no later than 31
March 2019. Ability to extend assessed as limited due to commercial value of
site
• Significant capital investment required to maintain EDH site in a satisfactory
operational condition
-Inability to radically transform or re-build on site due to planning
constraints and current build
Phase 5 Development
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Phase 5- Ground breaking has happened
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The Emergency Department (ED) Development
• The ED was designed to support around 60,000 attendances per annum. It now
sees around 130,000 patients.
• We are already transforming pathways of care and ways of working
• A development scheme (9 Phases) is now underway to ensure the ED is
expanded and developed to enable new models of emergency care to be
delivered (i.e. Ambulatory Care and Urgent Treatment)
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Cancer Vanguard
• Year 2 (17/18) funding signed off for the cancer vanguard bid
• Based on the principle of providing networks of care to deliver cancer
services that align to cancer pathways
• Comprises 3 elements:
• Improved access to diagnostics by rolling out early diagnostic
pathways across the network
• Standardised provision of chemotherapy across the network, and
provision of radiotherapy in two centres
• Investment in sector wide pathway management infrastructure
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Thank you……..