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Welcome to our Annual General Meeting 2014

1 October 2014Watford Hospital

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Welcome and opening remarks

Mahdi HasanChair@chairwhht

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An overview of last year and our plans for the future

Samantha JonesChief Executive@SamanthaJNHS

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What do we stand for?Our values Our objectives

We involve others To deliver improvements in the quality, deliverability and sustainability of our services through:

We are all leaders Achieving continuous improvement in the quality of patient care that we provide and the delivery of service performance across all areas

We are proud Setting out our future clinical strategy through clinical leadership in partnership and with whole system working

We work in partnership Creating a clear and credible long term financial strategy

We are transparent

We add value

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Three main hospitals Serves 500,000 people 600,000 patient contacts a year 83,433 A&E patients 14,411 minor injuries unit visits (St Albans Hospital) 29,356 urgent care centre visits (Hemel Hempstead Hospital) 5,787 babies delivered

About us…

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425,813 outpatient appointments 41,415 planned admissions 49,934 emergency admissions £290 million turnover 4,000 doctors, nurses, midwives, porters, cleaners andother staff 500 volunteers Four clinical divisions, plus support services

About us…

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‘Onion’ – peeling back the layers 20% reduction in mortality, inc for hip fractures 40% reduction in C. difficile 95.6% of A&E patients treated, admitted or discharged in maximum of four hours (standard = 95%) Extra £9m invested in patient safety, inc £3.9m on 160 new nurses

Celebrating success…

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Opened The Granger Suite, inc Bluebell and Winyard wards Opened ambulatory care unit (ACU) £25.5m to be invested on IT £16m investment in upgrading wards, clinics and other areas New senior team including Chief Nurse, Director of Finance and Chair ‘Developing our Organisation (DO)’

Celebrating success…

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The official opening of The Granger Suite

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Opened new emergency surgery assessment unit (ESAU) Opened new dietetic kitchen Launched new cycle facilities across all three sites £600,000 upgrading theatres Launched iWantGreatCare Shortlisted for HSJ (Health Service Journal) patient safety award

Celebrating success…

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Cycle facilities official opening

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Our performance against key standards 2013/14

Standard Target 2013/14

Emergency access – patients attending A&E should be seen within a maximum of four hours

>95% ACHIEVED (95.6%)

Infection control and prevention – MRSA (bacteraemia)

0 cases UNDER ACHIEVED(3 cases)

Infection control and prevention – Clostridium difficile

Max 24 cases

UNDER ACHIEVED(28 cases)

All cancers – patients should have a maximum wait of 14 days for all urgent referrals of suspected cancer

>93% ACHIEVED(95.8%)

All cancers – patients should not wait more than 31 days for diagnosis to first treatment

>96% ACHIEVED(98.1%)

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Our performance against key standards 2013/14

Standard Target 2012/13

All cancers – patients should not wait more than 31 days for second or subsequent treatment

>94%/>98%

ACHIEVED(99%/100%)

18 week wait – patients who require admission to hospital should wait no longer than 18 weeks from referral to treatment

>90% UNDER ACHIEVED (78%)

18 week wait – patients who do not require admission to hospital should wait no longer than 18 weeks from referral to treatment

>95% UNDER ACHIEVED(85%)

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‘Onion’ – peeling back the layers Learn from complaints, incidents and litigation – centralised Achieving our financial target (£14m deficit, including savings of £13.4m) Transformation programme West Hertfordshire strategic review Trust clinical strategy including Watford Health Campus

Moving forward…

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Artists’ impression of Watford Health Campus

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Doing today right

Transformation Programme - Structure and Design

Governance and Leadership

• Quality Governance

• Clinical Leadership• Corporate Governance

• Organisational Restructure

Clinical Effectiveness

• Obstetrics and Gynaecology • Hospital 7/7

• Job and Team Planning •Mortality

PatientExperience

• Complaints & Serious

Incidents • Patient

Experience & Strategy

• Estates & Health and

Safety• Nursing

Workforce and Safety

•HR Systems, Recruitment and

Retention

Operational Effectiveness

• Referral To Treatment

• Unscheduled Care

• Cancer• Diagnostics

Organisational Development Change Programme

Information & Communication Technology & Decision Support (including Coding)

Communications and Stakeholder Engagement

Financial ViabilityLTFM, Efficiency savings, Cost reduction, Income generation, Financial support

Strategic change - Future state of organisation

Clinical Strategy

Ensuring Services are Well Led

Ensuring Services are Safe

Ensuring Services are

Caring

Ensuring Services are Responsive

Ensuring services are

Effective

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Herts Valleys Clinical Commissioning Group Hertfordshire Community NHS Trust Hertfordshire Partnership University NHS Foundation Trust Hertfordshire County Council and other local councils Healthwatch, our Patients’ Panel and other patient groups many, many more…

Working in partnership

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Financial overview and looking forward to 2014/15

Don RichardsChief Financial Officer

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Income and expenditure 2013/14

£m 2013-14 2012-13Income from patient care activities 259.3 249.0Other operating Income 31.8 29.2Income 291.1 278.2

Operating expenses (300.6) (272.1)Operating surplus/(deficit) (9.5) 6.1

Dividend and interest (3.9) (4.2)Reported NHS financial performance position surplus/(deficit) (13.4) 1.9

Asset revaluation 2.3 (2.8)Retained surplus/(deficit) for the year (11.1) (0.9)

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Financial summary 2013/14

Financial delivery Deficit of £13.4m Savings delivery of £7.6m Capital investment of £17.6m

Challenges Significant increase in emergency activity Slippage against savings target of £15m Increase in agency costs

We spent an additional £7.5m in frontline staff to improve quality of care provided to patients

Non-recurrent transformation funds of £4.1m received to support the cost of maintaining our three hospitals and initiatives to improve efficiency

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Activity performance 2013/14

Note:

Emergency activity excludes other non-elective activity

such as maternity due to the changes in counting from

2013/14.

Outpatient totals exclude activity relating to maternity

due counting changes for these services from 2013/14.

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-

5

10

15

20

25

-

50

100

150

200

250

FY07 FY08 FY09 FY10 FY11 FY12 FY13 FY14

Tem

p Pa

y £m

Tota

l Pay

£m

Year

Total Bank Agency

Trend of pay expenditure FY07 to FY14

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2014/15 planned sources of income

236.3

14.0

23.7

31.6

2.6

NHS Clinical Revenue - HVCCG NHSE Specialist Commissioning Other Operating Income

NHS Clinical Revenue - Other Non-NHS clinical revenue

£m

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79.1

11.3

65.2

49.7 49.3

93.5

11.6

68.4

55.0 53.4

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

Non-Elective A&E Outpatient Elective Other Clinical Income

£mFY15 Plan vs. FY14 Outturn

FY14 Act FY15 Plan

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2014/15 financial outlook Financial plan

Income of £281.9m Planned deficit of £14m £13.4m savings programme Capital investment of £15.4m Investment in IT (£6.1m) and Organisational Development (OD) (£1.5m)

Challenges Delivery of savings programme Cost of transformation programme Cash balance Suitable payment for emergency work

Working collaboratively with our commissioners to ensure we are reimbursed appropriately for our emergency work

We are in continuing discussions with the NHS Trust Development Agency (NHS TDA) who are supportive of our wider transformation programme

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of the cognitively impaired –‘people not patients’

Hello My Name is: Dr Tammy Angel

Clinical Director of Elderly Care and Stroke

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Dementia is a progressive and largely irreversible syndrome that is characterised by a widespread impairmentof mental function.

Memory/recall

Verbal communication

Complex motor tasks

Recognition and

reasoning

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Dementia in hospital...F.A.I.R

25% of people in hospital have Dementia.

40% of people with hip fractures

Screen and identify people

Bluebell specialist

care

Outreach for general

wards

Appropriate discharge planning

and signposting

TRAINING

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Dementia Nurse Specialist

Audit

Satisfaction / feedback

survey

Discharge information

End of life care

Point of contact/support advice- patients/ relatives/staff

Outreach support

Training programme

Dementia champions

+ link nurses

Dementia specific care

plans

Screening

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Other frailty units…Queen Elizabeth Hospital, Gateshead: Future Hospital

Commission case study

Challenge: older people with both physical and mental health illness cared for on general wards by staff with limited expertise

Dual care ward increased focus on basic care and nutrition, by staff with specialist skills

Outcome: reduced falls, reduced need for IV fluids. Better care for this group of people

“staff.. see these people as ‘their kind of person’ and not people who should be moved somewhere else”

… Right care for person is also most cost effective care for the ‘system’…

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Improved quality of patient care

Reduced risk of falls

Better toiletting, and continence management

Better fluid hydration Better nutrition

Reduced stay in hospital

Staff more knowledgeable to your needs

Good dementia care is just good care

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Bluebell ward..

Mrs M has had 10 children- amazing!Mrs L loves knitting and gardening

Mr R was a world renowned author of American Military history.

Mr D was a cinematographer.Mrs R has been feeling low since her

dog died who was her companion since bereaved of her husband.

Tell me

about Mr H

Tell meSomething personal about the

people here

He doesn’t like mornings so we leave him last, he prefers male carers; you have to speak slowly otherwise he won’t catch

what you say – but if you take it slow – he is a pussycat. Oh and he will only eat

porridge for breakfast and likes his tea really hot.

He’s easy no bother at all!

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The problem with being confused... We ‘wait’ for delirium to resolve in hospital Just staying in hospital may be prolonging the condition ... long hospital stays Whilst waiting run risk of infections, falls in unfamiliar environment + further confusion/distress Limited options to date: physically able but not safe for discharge Option to transfer to residential care. Also unfamiliar. All above carry significant cost both for the individual and the health social care purse

... There is no place like home!

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Delirium Recovery Programme.. multiprofessional collaboration with patient in centre

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Admitted onto Virtual ward

DRP: Delirium Recovery Programme

Hospital HOME

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DRP: Delirium Recovery Programme

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‘Our kind of people’ 1st PRIZE

inpatient ward

92.3% Extremely Likely to

recommend7.7% Likely to recommend

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Transforming our IT

Lisa Emery, Chief Information Officer @LisaEmNHS

David Gaunt, Associate Medical Director for IT

@davecas48

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Watford, Hemel Hempstead and St Albans hospitals for more than a generation”

“The new investment will help revolutionise the way that we work. The benefits for our

patients, as well as staff, are immense and will truly help us to improve the care

we provide to our patients”

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Background

Our current IT systems are very old, slow and it’s hard for us to connect them to the latest software

Our Information Management and Technology Strategy set out the creation of a ‘digital hospital environment’

On 16 June 2014, we signed a 5 year contract with CGI Limited to transform our IT Infrastructure

This is an investment of £25.5m, supported by the NHS Trust Development Authority (NHS TDA) and our partners, which will enable us to transform our services

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What does this deliver for west Herts?

A new 24/7/365 service desk

Faster networks New devices An improved email service Mobile working Single sign-on Single document store for

policies and guidelines

WiFi access at all sites Messaging services Patient kiosks Electronic patient tracking Unified communications –

single point of contact for phone, email, messaging

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Reliable Modern Networks

Email Upgrade1Gb Mailboxes

2015/16

Data Centre Ready

Document Portal Unified Communications

Data Centre Migration & Disaster Recovery

Complete

Desktop Replacement Complete

Wifi RolloutComplete

Asset, Patient and Lone Worker Tracking

Service Desk

Q4 Q4Q3Q2Q1Q3

2014/15

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What will this mean for our staff and patients?

For our staff:Less time spent at the computerMobile working e.g. at other sites or patient’s homesMore agile ways to work with colleagues e.g. videoconferencing and instant messagingOne sign-on for all systems Enhanced patient and equipment tracking

For our patients and visitors:Staff have more time to spend with patientsImproved patient safety Ability to use WiFi at our sitesPatient kiosks to speed up appointment check-inSMS (text) appointment remindersInformation shared more quickly and securely

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Equipment, patient and lone worker tracking

Using our new WiFi network and electronic tags: Tracking of vital medical equipment, reduction in delays and

loss

Safety for staff within our sites and in remote locations

Improved safety for vulnerable patients

Ability to direct equipment and staff to where needed

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Asset tags:

Patient tags:Staff badge/pager:

Temp/RH sensors:

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Improved safety for vulnerable patients Safety for staff within Trust sites and in

remote locations Tracking of vital medical equipment,

reduction in delays and loss Ability to direct equipment and staff to where

needed Utilising our investment in WiFi

Real time tracking and communication

Asset tags:

Patient tags:Staff badge/pager:

Temp/RH sensors:

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Messaging services

• Appointment reminders for patients (our Did Not Attend (DNA) rate is 9% – saving money and speeding up time to be seen)

• Increased patient choice• Important patient

communications• Important staff communications

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Reminder:Appointment Rheum WGH12.00 29 Sep 2014

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Reliable Modern Networks

Email Upgrade1Gb Mailboxes

2015/16

Data Centre Ready

Document Portal Unified Communications

Data Centre Migration & Disaster Recovery

Complete

Desktop Replacement Complete

Wifi RolloutComplete

Asset, Patient and Lone Worker Tracking

Service Desk

Q4 Q4Q3Q2Q1Q3

2014/15

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“The new investment will help revolutionise the way that we work. The benefits for our patients, as well as staff, are immense and will truly help us to improve the care we

provide to our patients.”

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Questions and answers

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A special thank you to our charities, volunteers and other supporters

Professor Tracey CarterChief Nurse@CarterTreacle

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Over 500 active volunteers aged between 16 to 80

200,000 hours ‘gifted’ last year

Support wide range of activities, including reception, drivers and befriending/feeding patients

Thanking our volunteers

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Watford Hospital’s League of Friends Watford Hospital Radio Royal Voluntary Service (RVS) Macmillan Cancer Information and Support Service CVS (local volunteer organisations funded by councils) Voluntary car groups

Our main charities we work with are:

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Video:

Staff make a song and dance for sepsis

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For more information

Tel: 01923 436 280Web: www.westhertshospitals.nhs.uk Twitter: @westhertsNHSFacebook: facebook.com/westhertsNHSEmail: info@whht.nhs.uk YouTube: youtube.com/WestHertsNHS