HEALTH GROUP REPORT

Russell Patmore

Medical Director, Clinical Support

Structure

• 4 Health Groups for the clinical services• Medicine• Surgery• Family and Women’s Health• Clinical Support

• Each led by a Medical Director supported by Nurse and Operations Directors

• Autonomy earned on the basis of performance

Challenges

• Clinical performance• Increasing demand in many areas• Poor local health outcomes and an ageing

population• Financial environment

How do we improve quality and deliver much greater efficiency?

Health Groups United

• Work together and use all our talents• Deliver better care for our patients• Improve our pathways to reduce harm,

time in hospital and waste• Maximise efficiency to deliver savings and

allow investment without compromising on quality

What did we achieved over the last year?

Enhancing Patient Safety

• Dedicated sessions for anaesthetists to optimise patients for surgery

• Enhanced recovery project• Reductions in C-Diff and MRSA• Antibiotic drug chart• National early warning score introduced• Reduction in all mortality measures• Revalidation of medical staff

Enhancing Patient Experience

• Charge nurses now supervisory• Antenatal day unit and early pregnancy

assessment centralised in W+C hospital• 2 new neonatal ICU cots opened• Intestinal failure team established and

peer reviewed• Interventional Radiology granted exemplar

status after national review

Enhancing Patient Experience

• Butterfly project to identify dementia• Non-cancer palliative care service

established• Reduced turn around in cellular pathology• Nurse led community outreach neurology

clinics• Friends and Family survey results

Innovation and Efficiency

• Structure– Surgical admissions lounge at CHH– New gynaecology inpatient and day case unit

in W+C hospital, Cedar Ward– New ED for children and minor cases– New ED majors department by July

Innovation and Efficiency

• Equipment– Digital breast screening introduced– New radiotherapy machines installed– New radiology screening room at CHH– Pathology analysers replaced– ARIA electronic chemotherapy prescribing

Innovation and Efficiency

• Pathways– Productive operating theatre project now trust

wide– Rapid access children’s clinics established– Midwives trained to treat tongue tie– Multidisciplinary elderly short stay unit model

at HRI with national recognition– Move to 7 day working

Partnerships

• Palliative Care Network• Community based chronic pain service

developed with CCG’s• Palliative and Elderly medicine support to

East Riding Hospital• HIV and Hepatitis C networks with York

and South Bank• Neuropathology linked with Sheffield

Partnership

• York– Pathology– Head and Neck Cancer– Renal– Cardiology– Opthalmology– Paediatric Surgery– Urology– Orthodontics

Can we see the future?

Can we see the future?

• There will be less money around

Can we see the future?

• There will be less money around• Everyone is getting older

What Pyramid?

Can we see the future?

• There will be less money around• Everyone is getting older• All roads lead to the emergency

department

Increase in over 80s

2009-10 2010-11 2011-12 2012-136000

6500

7000

7500

8000

8500

9000

9500

10000

10500

11000

7458

8765

9785

10725

9.6%

17.5%

11.6%

Increase in ‘Majors’ attendances

2009-10 2010-11 2011-12 2012-1334000

35000

36000

37000

38000

39000

40000

41000

42000

36803

38949

39659

41599

4.9%

5.8%

1.8%

Can we see the future?

• There will be less money around• Everyone is getting older• All roads lead to the emergency

department• If your in, your in

AAU Admissions (2006-)

Janu

ary

'06

April '

06

July

'06

Octob

er '0

6

Janu

ary

'07

April '

07

July

'07

Octob

er '0

7

Janu

ary

'08

April '

08

July

'08

Octob

er '0

8

Janu

ary

'09

April '

09

July

'09

Octob

er '0

9

Janu

ary

'10

April '

10

July

'10

Octob

er '1

0

Janu

ary

'11

April '

11

July

'11

Octob

er '1

1

Janu

ary

'12

April '

12

July

'12

Octob

er '1

2

Janu

ary

'13

April '

13

July

'13

Octob

er '1

31000

1200

1400

1600

1800

2000

2200

2400

2600

Can we see the future?

• There will be less money around• Everyone is getting older• All roads lead to the emergency

department• If your in, your in• We will try to fix you, like it or not

Can we see the future?

• There will be less money around• Everyone is getting older• All roads lead to the emergency

department• If your in, your in• We will try to fix you, like it or not• Its hard to say goodbye

Can we see the future?

• There will be less money around• Everyone is getting older• All roads lead to the emergency

department• If your in, your in• We will try to fix you, like it or not• Its hard to say goodbye• The system will collapse

It can be different

• Avoid admissions– Not the default– Expand ambulatory care– Community based pathways

• Frail Elderly• End of life• Chronic lung diseases• Heart failure

It can be different

• Minimise hospital stay– Discharge planned from admission– PREDICT project– CAYDER electronic patient management– Expected Date of Discharge– Electronic patient record and prescribing

• Rapid discharge and community support– Discharge Hub– Community partners

HGU Summary

• Another successful year delivering significant improvements in patient care and experience whilst releasing greater efficiency savings than ever before

• Clear risks for the future if we are to continue to deliver great care for our community

We need your help

• Our staff– Focus on patients– Identify and report poor quality– Ask yourself how this could work better

• Our partners– Work with us to develop new pathways

• Our patients– Tell us if its not working and what you need– Be prepared to embrace change