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).

6

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

22

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

37

Phase 4 & 5 location: UCH Campus

38

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

42

PBT: Better Outcomes and Benefits to Patients

43

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

45

• 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

46

A brief reminder of Phase 5

Phase 5

48

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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……..