Annual report and accounts 2013/14

Transcription

1 Annual report and accounts 2013/14 University College Hospital National Hospital for Neurology and Neurosurgery Eastman Dental Hospital Royal National Throat, Nose and Ear Hospital Heart Hospital Royal London Hospital for Integrated Medicine

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3 Presented to Parliament pursuant to Schedule 7, paragraph 25(4) of the National Health Service Act University College London Hospitals NHS Foundation Trust Annual Report and Accounts 2013/14 Annual Report and Accounts 2013/2014 3

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5 Contents Foreword 8 1 Introduction 10 2 Strategic report 12 a) Our strategy and objectives 12 b) Our approach 19 c) Future developments 24 d) Our performance 26 e) Risks and uncertainties 31 f) Corporate and social responsibility 40 g) Sustainability report 44 3 Financial review 46 4 Our people 48 a) Our staff 48 b) Our partners 58 5 Our organisational structure 62 6 Remuneration report 80 Appendices 1 Carbon data 87 2 Quality report 89 3 Annual Governance Statement Annual accounts 157 Annual Report and Accounts 2013/2014 5

6 The year in pictures April May UCLH featured in BBC 2 flagship documentary Keeping Britain Alive, including footage at the National Hospital for Neurology and Neurosurgery Health secretary Jeremy Hunt visited UCLH to experience a hands on shift in the Emergency Department. August September The Royal National Throat, Nose and Ear Hospital received positive feedback following its first Care Quality Commission inspection UCLH unveiled its plans for proton beam therapy a radiotherapy centre opening in 2018 December January Gary Lineker starred at the UCLH Open Event and turned on our Christmas tree lights The new Evergreen Ward opened, helping improve patient flow at University College Hospital over the busy winter months 6 University College London Hospitals NHS Foundation Trust

7 June July UCLH nurse consultant Bernadette Porter was awarded an MBE for her work for patients with multiple sclerosis The University College Hospital Macmillan Cancer Centre was awarded Volunteering Organisation of the Year by UCL October November Construction work in the Emergency Department gathered pace to create a bigger A&E UCLH launched its flu campaign urging staff to get vaccinated February March UCLH celebrated Chinese New Year with staff and patients Celebrating excellence: UCLH staff were honoured for their dedication and commitment at an event hosted by actor Julian Rhind-Tutt Annual Report and Accounts 2013/2014 7

8 Foreword Welcome to our Annual Report. 2013/14 was, as ever, an exciting year at UCLH and there is much to report. We have a clear vision for the future direction of UCLH: delivering top-quality care for all of our patients; providing an excellent education for our trainees and staff; and developing our reputation for world-class research in partnership with UCL. UCLH has consistently aimed to strike a balance between delivering world-class tertiary services and providing excellent care for local residents. Our relationships with Camden and Islington Clinical Commissioning Groups (CCGs), and more specifically with local GPs, have always been and will continue to be of prime importance. The impact of the high-profile Francis, Keogh and Berwick reports continues to be felt across the NHS. Hospitals are in the spotlight as never before, heralding a culture where openness and transparency is at the heart of everything we do. We need to empower staff to make the best decisions for their patients and arm patients with information about our performance and the high standards they should expect when they walk through our door. The hospital continues to see strong growth in demand for both its local acute and specialist services (in many cases ahead even of national trends). This has led to continuing pressures on our resources, especially on space. As a result, we have on occasions found it difficult to treat patients as quickly as we, and they, would like. We continue to redevelop our Accident and Emergency Department to deal with the growth in demand and a recent extension of the department, along with other measures, has helped us to meet the Government s four-hour waiting target in the last quarter and for the last year as a whole. Over the coming year we will continue to strive to reduce waiting times for inpatients and outpatients. It is pleasing to be able to report that UCLH has managed to cope in 2013/14 with the widely reported financial pressures on the NHS, thanks to the great efforts of our staff to respond to our quality, efficiency and productivity programme. However, it gets harder each year to find the required efficiencies and there is no sign that the pressures will reduce. In November our local acute services were visited by the Care Quality Commission (CQC) inspectors after UCLH had been chosen as a low risk provider to help develop a new inspection regime for the NHS. Overall, the feedback was positive and encouraging, although the inspectors did find a number of areas which needed improvement. Sir Mike Richards, the chief inspector for the CQC, said: Our judgement is that this is an excellent hospital in many ways but the failings we identified are preventing it from achieving excellence across the board. They found many examples of excellent or outstanding care and witnessed examples of kindness to patients. They encountered many staff who said that they were proud to work at UCLH and felt empowered to deliver high-quality care to their patients. The inspectors added: The overwhelming majority of people told us about their positive experiences of care. We welcomed the visit as an opportunity to improve our services and have responded quickly to the areas identified by the inspectors as in need of improvement. More information about the CQC inspection, our results and how we are improving patient care can be found in the Quality Report on page 110 and the Annual Governance Statement on page 147. In the field of specialist services, there is strong evidence that concentrating specialist activity in fewer centres improves patient outcomes and the overall quality of care. Therefore, along with UCLPartners, we are spearheading proposals to change the way cancer and cardiac services are delivered across London. If approved, the plans will see these services centralised in specialist centres, with the services from our Heart Hospital moving to a new building at Barts Health NHS Trust. UCLH would become the centre for a number of specialist cancers. We have a number of exciting plans to develop and modernise our estate to improve the care of our patients. These are described in more detail in sections 2a and 2c and we look forward to reporting more about these in years to come. Finally, we should express our personal thanks to our 8,000 staff who have shown their usual professionalism and dedication to patient care throughout the year. It was particularly pleasing to read numerous comments in the CQC report praising their efforts. The external environment and the financial pressures have not made it easy for the NHS this year, but it has been impressive to see how the staff of UCLH have continued to improve the overall care we offer to our patients. We are most grateful to them for their commitment. 8 University College London Hospitals NHS Foundation Trust

9 Richard Murley Chairman Sir Robert Naylor Chief Executive Annual Report and Accounts 2013/2014 9

10 1. INTRODUCTION 2. STRATEGIC REPORT 3. FINANCIAL REVIEW 4. OUR PEOPLE 5. OUR ORGANISATIONAL STRUCTURE 1 Introduction UCLH is situated in the heart of London. Our mission is to deliver top-quality patient care, excellent education and world-class research. In 2004 we became one of the first NHS foundation trusts. This means that whilst we remain firmly part of the NHS we have more control to manage our own budgets and shape the services we provide to better reflect the needs and priorities of our local community. Through our Governing Body we are able to listen to the views of patients, local people, staff and partners and by doing so, offer patients faster, better and more responsive healthcare. Greater involvement from patients, public, and staff brings lasting improvements to patient services and better health for communities. Our values of safety, kindness, teamwork and improving are at the heart of everything we do, both for our patients and for our staff. We provide academically-linked acute and specialist services, both to the local population and to patients from across the United Kingdom and abroad. We balance the provision of nationally recognised, specialist services with delivering high-quality acute services to the local populations of Camden, Islington, Barnet, Enfield, Haringey and Westminster. We are proud of our close partnership with University College London (UCL), which is consistently reported as one of the best performing universities in the world. UCL s facilities are embedded across much of our hospital campus and the partnership is linked through a large number of joint clinical and academic appointments. We are one of the country s five biomedical research centres and were a founding member of UCLPartners, designated as one of the UK s first Academic Health Science Centres. We have a turnover of 888 million and contracts with over 90 commissioning bodies. On average we see 950,000 outpatients, 125,000 A&E attendances and admit over 156,000 patients each year. We employ over 8,000 staff working across all of our hospital sites. UCLH delivers clinical services from six hospital sites: University College Hospital National Hospital for Neurology and Neurosurgery (NHNN) Eastman Dental Hospital (EDH) The Royal National Throat Nose and Ear Hospital (RNTNEH) The Heart Hospital (HH) The Royal London Hospital for Integrated Medicine (RLHIM). 6. REMUNERATION REPORT University College Hospital site includes: University College Hospital Macmillan Cancer Centre (Cancer Centre) Elizabeth Garrett Anderson Wing (EGA) Hospital for Tropical Diseases (HTD) Institute of Sport, Exercise and Health (ISEH). 10 University College London Hospitals NHS Foundation Trust

11 950,000 outpatients seen at UCLH 1. INTRODUCTION 2. STRATEGIC REPORT 3. FINANCIAL REVIEW 4. OUR PEOPLE 5. OUR ORGANISATIONAL STRUCTURE Annual Report and Accounts 2013/ REMUNERATION REPORT

12 1. INTRODUCTION 2. STRATEGIC REPORT 3. FINANCIAL REVIEW 4. OUR PEOPLE 2 Strategic report 2a. Our strategy and objectives Strategic context The shape of healthcare provision required and expected by the UK population is changing. This shift is influenced by the global economic climate, development of technology, medical and scientific advancements, and a series of high-profile reviews of NHS services as well as population health trends. As with all societies with an aging population, the UK has an increasing need to provide care for individuals who are often socially isolated and who have complex, long-term health needs. We believe this will require a radical transformation of traditional models of health and social care. The rapid development of new technology, including social media, has enabled patients and the public to access more information about the availability of novel treatments and interventions, as well as the performance of individual clinicians and healthcare providers. Alongside the high-profile reviews published by Sir Robert Francis QC, Sir Bruce Keogh and Professor Donald Berwick, this ready access to a breadth of information has served to increase the expectations of the UK population in relation to health and social care services. There is increasing difficulty nationally in staffing a number of key areas of clinical service delivery. Good examples of this include the Emergency Department and the provision of experienced middle-grade doctors; the same is true of obstetric units and the provision of appropriate consultants. In addition, there will be a reduction in the number of nursing trainees in 2015/16. The projected continuation of public spending curbs will place continuing financial pressure on the UK health and social care system. Specifically pressures on health spending are anticipated as a result of the 2015/16 spending review, with the NHS budget likely to be static in real terms for an estimated further five years. The proposed shift of 3.8 billion of funds nationally from health to help improve social care will place additional pressure on the NHS. Commissioners are responding to these challenges by reshaping traditional financial flows and models of care. Local Clinical Commissioning Groups (CCGs) are increasingly working with local authorities to construct more sophisticated payment mechanisms that will deliver fundamental changes in care delivery. We have been part of the discussions with CCGs and local authorities on the most effective ways of 5. OUR ORGANISATIONAL STRUCTURE 6. REMUNERATION REPORT 12 University College London Hospitals NHS Foundation Trust

13 using policy levers such as the Better Care Fund (BCF) to drive more efficient and effective care in the health sector. We are very supportive of the general thrust of the BCF policy and are very keen to be at the heart of the planning, decision-making and implementation of the policy in our local health economy. We are clear that this continued involvement with our local CCGs will support the best outcomes for patients and also help us manage the inevitable impact of the policy on our business. We have however asked Camden, our host CCG, to clarify how we can be fully engaged in the detailed planning and implementation of the policy, including being part of the steering group for the BCF in Camden. We have also asked for our CCGs assessment of the impact of the BCF on our activity levels, and will work this through as part of detailed negotiations for We are particularly keen to know how specific BCF schemes are intended to drive reductions in acute activity. This is the area where we feel we can work with CCGs/local authorities to devise robust and achievable plans. These discussions will be part of our broader agreement on activity baselines ready for Specialist commissioners have expressed the intent to reduce the number of contracts issued for specialist services, moving towards a lead provider model. The need for critical mass in specialist clinical expertise has been acknowledged and it is likely that in future commissioners will seek further centralisation of specialist services. We believe that in many areas this will support a flow of additional work and resources to our tertiary teams. There are also some areas where specialist commissioners are proposing that activity might move from UCLH. Discussion of these issues currently forms a substantive part of our negotiations with NHS England on the 2014/15 contract. The NHS provider landscape is changing rapidly. The foundation trust approval process is likely to trigger further opportunities for partnerships and greater alignment between provider organisations. Gradual shifts to integrated care models and the increasing concentration of specialist services will also have a significant impact on the composition and objectives of providers across London. Networked and collaborative working will increasingly become the way to pursue the best, personalised and most appropriate care for patients whilst at the same time supporting our referring partners in primary and secondary care. UCLPartners will continue to facilitate system-wide change and to identify opportunities for collaboration between providers that will improve patient care. 156,000 patients admitted to UCLH Our current strategy for services Core medical (elective and emergency) and surgical services UCLH provides secondary care services to the local population. These include core medical (elective and emergency) and surgical specialities, including general paediatrics. Responding to the increasing pressures on our urgent care and local health provision, we will continue development of our Emergency Department to meet both the needs of our patients and the national access target. We will further develop our ambulatory emergency care and clinical decision unit models; these enable clinicians to monitor patients over a longer period than is appropriate for A&E but without needing to admit them to an inpatient ward, to mitigate emergency admissions and increase our ability to provide ambulatory and/or outpatient care to a wider proportion of all medical patients. Critical care will both play a vital role in the plans for our site development and, we hope, act as an exemplar intensive care unit for the local area. Medical specialties are working closely with our integration division building models of care enabling more patients to the treated out of hospital and closer to home for patients and carers. We have grown our Care of the Elderly capacity to meet the increasing demand in this area, but also work closely with our communities to better manage patients in this group with complex conditions and to reduce inpatient admission. We will also be appointing our first professor of healthy aging, an exciting development with UCL. In pathology we plan to go live with our joint venture with Royal Free London NHS Foundation Trust and The Doctors Laboratory, our pathology partner, to take forward the vision of The Carter Report. This will support our plan to move to seven days a week working and supports our business development plans to maximise efficiencies and quality of service. In November 2011 the UCLH Board reviewed the organisation s service strategy and agreed to focus on the development of three service areas, with the potential to become world-leading from 2012/13: Cancer services Neurosciences Women s health In order to deliver world-leading excellence in these three specialties it is essential to develop a strong base in core medical and surgical specialties. Any strategic intent to grow the priority specialist services must be underpinned by appropriate investment in core Annual Report and Accounts 2013/ INTRODUCTION 2. STRATEGIC REPORT 3. FINANCIAL REVIEW 4. OUR PEOPLE 5. OUR ORGANISATIONAL STRUCTURE 6. REMUNERATION REPORT

14 1. INTRODUCTION 2. STRATEGIC REPORT 3. FINANCIAL REVIEW 4. OUR PEOPLE 5. OUR ORGANISATIONAL STRUCTURE 6. REMUNERATION REPORT medical and surgical services and in the delivery of high-quality care to the local population we serve. Cancer services Cancer is a service where we want to be a European leader. The UK continues to perform poorly in survival rates for patients across most types of cancer when compared internationally. In addition to the need to improve clinical outcomes, there are significant opportunities to improve the quality of care experienced by people diagnosed with cancer. UCLH provides a comprehensive range of services for modern and efficient diagnosis and treatment of cancer, and a wide range of personal support to patients with cancer to help them cope with the disease and treatment. UCLH already provides several nationally and internationally renowned specialist cancer services, including a robotic surgery programme for prostate and bladder and other cancers, as well as radiotherapy treatments delivered through Intensity Modulated Radiation Therapy (IMRT). UCLH has provided national leadership in developing innovative ambulatory models of care in cancer services services that are designed to reduce the need for inpatient admission. This was underpinned by the opening of the Macmillan Cancer Centre in 2012, while the Cancer Research UK Centre at UCL exemplifies the seamless integration of basic, translational and clinical cancer research with high quality treatment and care offered at UCLH. In the short term our priorities include continuing the innovative service models in our new Cancer Centre, significantly improving the patient experience (in partnership with Macmillan Cancer Support) and implementing the Proton Beam Therapy strategic development. We support the UCLPartners strategy to reconfigure cardiovascular and cancer services across North Central and North East London, concentrating specialist activity in fewer, better-equipped centres, seeing more patients with the aim to improve patient outcomes and the overall quality of care. We want the whole population to benefit from the national and international excellence in diagnosis, treatment, and care that we deliver here at the UCLH. Our work on cancer emphasises partnership working, so that patients are seen locally wherever this is possible. The key short-term strategic objectives will be: Support delivery of the proposed reconfiguration of specialist cancer services in North East and North Central London Deliver appropriate business cases for the Phase 4 building development to ensure the Proton Beam 14 University College London Hospitals NHS Foundation Trust Therapy and above-ground facility are delivered in 2018 Improve the experience of cancer patients and their families across the health system, in partnership with Macmillan Cancer support Improve outcomes through world-leading translational research, in partnership with UCL and Cancer Research UK. Reconfiguration of cancer services In early 2013 UCLPartners Integrated Cancer Programme London Cancer proposed to NHS commissioners in London that UCLH be designated the London centre for prostate and bladder surgery. There have been previous commissioner decisions to centralise most of the London brain cancer and teenage cancer services at UCLH, as part of a process to increase the volume of specialist activity in fewer centres and improve clinical outcomes and experience. London Cancer has also suggested that UCLH might be best suited to take a leadership role in the overall organisation of radiotherapy for London for the same reason, although much of this service will continue to be provided locally. In October 2013 London Cancer produced a Case for Change in Specialist Cancer and Cardiac Services. This proposal is being considered by commissioners and is based on a plan to centralise still further specialist episodes of the cancer patient s journey at UCLH across northeast and north central London. The particular areas of focus are bladder and prostate cancer, upper gastro-intestinal, head and neck and brain cancer (along with Queens Hospital in Romford, part of Barking, Havering and Redbridge University Hospitals NHS Trust). It is also proposed that haematological cancer be centralised at UCLH and Bart s Health NHS Trust with important local high-level service provision available where appropriate. As part of the discussions around cancer reconfiguration a parallel set of discussions are taking place recommending to commissioners the centralisation of cardiovascular services at Bart s Health NHS Trust. With all cardiac services moving from the Heart Hospital and the London Chest Hospital the aim would be to create an integrated cardiovascular system; while thoracic surgery will be retained at UCLH and moved to the main University College Hospital site, with a plan for growth and expansion as part of the overall desire to improve the outcomes of patients with lung cancer. Both sets of proposed reconfigurations are currently under consideration by NHS England (London) and local commissioners.

15 125,000 attendances at A&E Proton Beam Therapy In 2012 it was announced that UCLH is to be one of only two sites in the UK offering the world s most advanced radiotherapy, Proton Beam Therapy (PBT) by PBT uses a precision high-energy beam of particles to destroy cancer cells with less damage to surrounding tissues. This can improve quality of life following cancer treatment by reducing long-term side effects. In 2013/14 we began to develop proposals for a new clinical facility (referred to in our objectives as `phase 4 ) to house the equipment and services needed to provide this new service, which is currently only available overseas. We are planning to build a new state-of-the-art patient facility with a new PBT Centre below ground and patient beds and operating theatres above. The new centre will be close to University College Hospital and the University College Hospital Macmillan Cancer Centre. Consultation with stakeholders, local businesses and residents began in September 2013 with a planning application submitted to the London Borough of Camden in November. The application to build the centre was approved by Camden Council planners in March 2014 and by the Greater London Authority in April The aim is to open the centre in Neurosciences We already have a world-class neurosciences service. There has been a dramatic expansion of clinical services and research in the last five years, with growth in activity close to 80 per cent. Neurological diseases such as stroke, dementia, Parkinson s disease, multiple sclerosis, neuromuscular diseases, epilepsy and brain tumours represent an enormous and growing challenge to society. By 2020 one million people in the UK will have dementia, costing one per cent of GDP (World Alzheimer Report 2013). It has never been more important for combined clinical and research centres to develop the Annual Report and Accounts 2013/ INTRODUCTION 2. STRATEGIC REPORT 3. FINANCIAL REVIEW 4. OUR PEOPLE 5. OUR ORGANISATIONAL STRUCTURE 6. REMUNERATION REPORT

16 1. INTRODUCTION 2. STRATEGIC REPORT 3. FINANCIAL REVIEW 4. OUR PEOPLE 5. OUR ORGANISATIONAL STRUCTURE 6. REMUNERATION REPORT critical mass of expertise and facilities to advance translational research in order to develop and deliver effective therapies for more patients. There are major new opportunities to deliver high-quality integrated neurological services across UCLPartners, including better links with district general hospitals as part of a hub and spoke model; and providing general and urgent services to our local population, integrated with community services. More broadly, we will continue to recruit highly specialised staff and develop our facilities to deliver highly specialised services. We will ensure that academic and clinical priorities are aligned where possible, build on the successful bid by the Wolfson Institute for Biomedical Research at UCL for 20m funding to develop experimental neurology, and increase recruitment to clinical trials. The key short-term strategic objectives are to: Unify clinical services which are currently duplicated across UCLH and local health system Develop new models for assessing and treating chronic neurological conditions Enable the delivery of the 20-year clinical strategy by developing appropriate business cases to support service expansion In partnership with UCL, maintain the NHNN s position as the leading national European centre for neurosciences. It is clear however that growth in demand for our neurosciences service will use all existing spare bed and theatre capacity. Neurosciences will be one of our capital and estates priorities for the next ten years. Women s health UCLH is currently a major provider of maternity services to the local population, delivering almost 6,000 births per annum. It also plays a key role in supporting complex maternity services for populations much further afield than Camden and Islington. The neonatal care service is a recognised centre of excellence and supports acutely ill and pre-term babies from across north and central London and beyond as does our leading foetal medicine service in which we see patients from across the wider population. Alongside this UCLH has a national and international reputation for gynaecological service provision especially in the field of gynaecological cancer. UCLH also provides breast cancer care to just under 200 newly diagnosed women per year and plays a key role in supporting the local population with more general breast care support. The key short-term strategic objectives will be to: 16 University College London Hospitals NHS Foundation Trust Expand the existing infrastructure to support 7,000 births per annum, with appropriate medical and midwifery presence to ensure world-leading care Grow UCLH s national and international reputation in the field of gynaecological cancer service and translational research delivery Develop UCLH s role as the network lead for neonatology and complex maternity service provision, and continue to deliver world-leading outcomes in neonatal care In partnership with London Cancer, ensure the most appropriate service organisation for breast cancer surgery and local diagnostic provision. Ear, nose, throat, dental and oral diseases development UCLH s vision is to create a world leading centre for the treatment of ear, nose, throat, dental and oral diseases for adults and children. We aim to build a new facility, near University College Hospital, which would bring together services provided at the Eastman Dental Hospital and the Royal National Throat, Nose and Ear Hospital. The main objectives of this proposal are to: Develop a world leading centre facilitated by the consolidation of services on one site Improve the patient experience through streamlined clinical processes, better patient environment and care Improve education and research opportunities. Research and innovation Our aim is to build UCLH s position as a world-class leader of research to improve patient care and to ensure our patients benefit from and have access to this research. Our Biomedical Research Centre (BRC), which is a partnership between UCLH and UCL, has in the last year invested over 20 million in work to speed up the translation of new discoveries into improvements in treatments, diagnostics and patient care. The BRC supports research by investing in staff posts, equipment, facilities and training. In particular experimental medicine research, which tends to be first in man studies such as research into new therapies and devices or the mechanisms of disease, is well supported. The National Institute for Health Research (NIHR)/Wellcome Clinical Research Facility (CRF) at UCLH provides a tailored environment and support dedicated to clinical research and at any one time hosts over 50 research projects involving innovative

17 treatments. The dedicated facility ensures research studies can be conducted safely, effectively and efficiently as possible. The facility has ensured that over the last year UCLH has not only maintained a wide portfolio of clinical trials but has also been able to become a major player in recruitment to international trials. We are also a key member of UCLPartners (UCLP) one of the UK s designated Academic Health Science Centres and have been central to increasing funds and recognition of our geographical area as an international focus of academic and applied health research. UCLP brings together the expertise of clinicians and researchers from across north, central and east London. The aim is to share expertise, resources and processes to benefit research and patients. For more information and detail on research and development please see page 22. Develop and implement a comprehensive ICT strategy We launched a vision for the role of information communication technology (ICT) at UCLH over the next five years. In order to continue to deliver the very best care for our patients, we need to take advantage of the increasingly sophisticated ICT landscape. By 2017, patient care will be supported and tracked electronically from first contact through diagnosis, treatment and all aspects of care to discharge and final feedback, integrated with primary 6 hospitals in UCLH and other healthcare partners. We need to have the technology in place to provide real-time information which supports patient care whether they have attended outpatient appointments and require diagnostic tests with results supporting immediately or whether they have attended A&E during the night. Our systems will support surveillance and monitoring investigations for patients on long-term treatment programmes or who have completed active treatment. We will have a near paperless trust, with all images stored on the Picturing Archiving and Communication System (PACS), electronic notepads for clinical notes and all paper sent to UCLH scanned onto an integrated electronic patient record. We will use electronic tagging and tracking of patients and equipment. Patients will have improved access to their own treatment information, including the ability to schedule their appointments and manage their own electronic patient portal. The journey has already begun: this year we had a wide take-up of smartphone and tablets utilising our newly introduced wifi. On these mobile devices we are deploying mobile Apps to access patient details and aid care at the bedside. We have fully digital recording within our ITU centres across UCLH, and an organisation-wide digital overview of theatre scheduling and utilisation. Delivering our vision for ICT at UCLH by 2017 will transform the experience of our patients and our staff. Annual Report and Accounts 2013/ INTRODUCTION 2. STRATEGIC REPORT 3. FINANCIAL REVIEW 4. OUR PEOPLE 5. OUR ORGANISATIONAL STRUCTURE 6. REMUNERATION REPORT

18 1. INTRODUCTION 2. STRATEGIC REPORT 3. FINANCIAL REVIEW 4. OUR PEOPLE 5. OUR ORGANISATIONAL STRUCTURE Our objectives Following consultation with a range of stakeholders we have agreed our top ten objectives for 2014/15 and delivering improved patient safety is once again top of the list. This year we have placed much greater emphasis on making a real difference to how we try and improve further the experience that patients have while under our care. Transformation and getting it right the first time will be key priorities for us in the coming year. Table 1: 2014/15 objectives Objectives Improve patient safety Deliver excellent clinical outcomes Deliver high-quality patient experience and customer service excellence Reduce waiting times Achieve sustainable financial health Develop a transformation strategy based on patient pathways Develop Research and development and education Enable staff to maximise their potential Reduce hospital-acquired infections, pressure ulcers, falls and missed medications Develop plans to move to 24-hour/7-day working where appropriate Improve how we share learning across the organisation from safety incidents and patient feedback Improve outcomes against Trust-wide and specialty-specific measures Reduce avoidable emergency admissions Achieve access standards and the right clinical staff across emergency pathways Develop standards for patient experience (as customers) Develop the Making a Difference Together programme to improve patient feedback Make it easy for patients to give us timely feedback and act on it Reduce the time that patients wait for treatment after referral to our services Meet cancer waiting time targets Reduce the time that patients wait to be seen while attending our outpatient clinics Achieve key financial targets Agree a financing strategy for future capital developments Develop collaborative, robust relationships with commissioners and commercial partners Work with commissioners and other partners to develop integrated services Develop a transformation programme based on Lean methodology Create a programme to standardise patient pathways across UCLH Develop a new strategy to achieve to improve education Combine the leadership of all UCLH s research activities Implement the recruitment strategy for clinical academic appointments Continue to improve the experience of staff working at UCLH Make sure that all staff benefit from appraisal and mandatory training Design and implement an organisational development programme for UCLH 6. REMUNERATION REPORT Progress Service developments Other key strategic developments 18 University College London Hospitals NHS Foundation Trust Approve business cases phases 4 and 5 Implement cardiac/cancer strategy Develop strategic business cases for expansion of our neuroscience and maternity services Develop and implement a comprehensive ICT strategy Deliver improved pathology services with our commercial partner Develop a new strategy for procurement and logistics

19 2b. Our approach Making a Difference Together UCLH is committed to delivering high-quality patient care. We believe offering a good patient experience is one of the ways we can deliver this and recognise that the experience of our staff is fundamental to achieving this. The three-year Making a Difference Together campaign was introduced to improve both patient and staff experience at UCLH. Specifically, the objectives of the campaign are to: Positively transform patient and staff experience Develop a values-based culture within UCLH Ensure UCLH becomes as well renowned for its outstanding patient and staff experience as for its excellence in clinical outcomes, education and research. Core Making a Difference Together Projects The emphasis of the campaign this year has been around a number of key areas for improvement as identified by staff and patients. These are: Improving Pain Management Project a steering group including clinical experts, patients and managers was set up to lead this project. Supported by the Making a Difference Together campaign, an organisation-wide pain survey was conducted. This provided a snapshot survey of the pain management experience for inpatients across our hospital sites during a two-hour window in a single day. Following the analysis of this feedback, we are now piloting the services of a clinical psychologist and physiotherapist, both specialising in pain management, to support our inpatients at University College Hospital. We have also finalised the content for a staff education package to ensure that pain is assessed and responded to effectively. Patient Information Project since August 2013, all inpatients now receive a Welcome Pack on arrival. See page 50 for more information. Staff environment project the lack of sufficient lockers for clinical staff was identified as a concern, as they did not always have somewhere to store their belongings. The work of the campaign team has provided locker access to over 2,000 additional staff. Designated locker schemes for temporary staff such as medical students and junior doctors who often rotate between sites have also been introduced. Embedding our values and behaviours by incorporating them into our processes. For 5,500 babies born at UCLH example, values-based recruitment screening tools for new starters have been introduced to help us identify applicants who share our vision and values. The values are now also included in our appraisal process to encourage existing staff to discuss their values and behaviours in addition to their objectives. This helps us to ensure that UCLH staff are as committed to delivering a great patient experience as they are to delivering great clinical outcomes. Education, training and development UCLH continued to focus on providing top-quality care for all of our patients this year. Leadership training, organisational culture, and high standards of care and treatment all play a part in providing the best patient experience and we continue to make these our priorities. Our vision for Education, Learning and Development consists of three key elements. These are to ensure that everyone: has the skills, knowledge and support to do their job has access to positive education and learning experiences understands the importance of education and learning in achieving continual improvements in the care and experience for patients, carers and staff. Our strategic goals for education are competent and capable staff, an adaptable and flexible workforce, wide participation in education, and particularly that UCLH and NHS values become embedded in our work. We expect that this strategy will deliver benefits to patients and the public in terms of safer, higher-quality and more effective care; that they can be confident of consistency of care aligned to best practice; that they will be treated in an environment of kindness and compassion; and that the interpersonal communication skills between patients and public on the one hand and carers on the other hand will be improved. For more information see pages and for nursing and medical training see pages Learning from feedback We recognise the imperative to listen and learn from feedback from our patients and from our staff and we continue to explore better, more effective ways of doing this. We are proud of the high standards of care we deliver but acknowledge that there is always more we can do. To this end we are committed to learning from the findings of high-level reports such Annual Report and Accounts 2013/ INTRODUCTION 2. STRATEGIC REPORT 3. FINANCIAL REVIEW 4. OUR PEOPLE 5. OUR ORGANISATIONAL STRUCTURE 6. REMUNERATION REPORT

20 1. INTRODUCTION 2. STRATEGIC REPORT 3. FINANCIAL REVIEW 4. OUR PEOPLE 5. OUR ORGANISATIONAL STRUCTURE 6. REMUNERATION REPORT 20 University College London Hospitals NHS Foundation Trust

21 as the Francis Report as well as the findings from our own recent CQC inspection. As a result we have a programme of quality and safety improvements focused on learning from feedback and embedding best practice across all areas of UCLH. Commissioning for Quality and Innovation (CQUIN) In 2013/14, CQUIN quality incentives provided UCLH with over 15m of income, a large majority of the total funding available. The maximum level of income made available through the CQUIN scheme was increased to 2.5 per cent of contract value in 2013/14 and it is clear that CQUIN style measures will continue to be used to drive improvements in the quality of services in the future. Improving productivity and efficiency: our quality and efficiency programme All parts of the NHS face the challenge to improve quality and reduce cost. In 2010 we put in place a quality, efficiency and productivity (QEP) programme to help UCLH achieve challenging financial targets while continuing to deliver high-quality care. Over the past four years UCLH has focused on making our services more productive, based on a Lean philosophy, and has achieved total annual cost reductions and productivity improvements of 140m (with 125m achieved by our clinical services), while improving quality in several key areas, of which 36m was achieved in 2013/14. Our aim has been to create space for more clinical activity by working in different ways and to increase value for money over time. UCLH continues to perform very well on quality measures and in a number of key areas these have improved throughout the year. As detailed elsewhere in the report, we continue to maintain good levels of patient satisfaction and excellent mortality rates, and staff satisfaction levels remain high. Once again we treated more patients than ever during the year. During 2013/14 efficiencies of over 36m were achieved, which is within two per cent of our plan of 36.5m for the year. There have been three main areas of focus of our QEP programme during this year, and some highlights on each follow. Lean and the Productive Outpatients programme The Productive Outpatients programme was developed in-house at UCLH, recognising the need for a structured approach to engaging, training and empowering front-line staff to redesign and improve 20million invested by the Biomedical Research Centre services. More than 52 clinical teams have participated in the programme to date, which has affected and improved over 623 clinics across the organisation (26 per cent of clinics). Based on the Lean philosophy of involving the whole team in redesign, to drive out waste and delay in our processes and design services around the needs of patients. Results include: waiting times for first appointments in Endoscopy at University College Hospital reduced from 12 to five weeks a 142 per cent improvement in the use of dental resources at the Eastman Dental Hospital a halving of patient waiting times in sarcoma clinics in the Cancer Centre. The programme will be extended to all clinics by the end of next year. Feedback from staff and patients has been extremely positive, especially in terms of staff satisfaction, as the scheme enables teams to make improvements and introduce new initiatives in their own service. We are planning to extend this redesign work to inpatient pathways during 2014/15. Patient flow The Trauma and Orthopaedic team has redesigned care for patients having joint replacement. They have worked with patients to increase knowledge and skills to help them experience a rapid recovery, through introducing a Joint School and films about the surgery, plus increasing therapy and expert orthopaedic nursing input, and operating a best practice pathway including nurse-led discharge. As a result they have achieved marked reductions in length of stay for hip replacement, with average stay reducing by over two days in the past 18 months, and have recently made a film about their work to share the learning with colleagues. Technology One of our Flow Goals is that We will all use the same information about our patients and in the second half of 2013 we introduced a shared electronic Patient List, to replace the separate handover lists held by each different professional group. Having one list in common for the whole multidisciplinary team has huge advantages in terms of improving communications and avoiding duplication. By the end of March 2014 it was being used by every ward at University College Hospital, plus our wards at the St Pancras site. Use of this technology means our bed data is more up-to-date, which helps us ensure that patients are in the best bed for their needs. Currently, Annual Report and Accounts 2013/ INTRODUCTION 2. STRATEGIC REPORT 3. FINANCIAL REVIEW 4. OUR PEOPLE 5. OUR ORGANISATIONAL STRUCTURE 6. REMUNERATION REPORT

22 1. INTRODUCTION 2. STRATEGIC REPORT 3. FINANCIAL REVIEW 4. OUR PEOPLE 5. OUR ORGANISATIONAL STRUCTURE 6. REMUNERATION REPORT a printed Patient List is used, but we plan to make this available in the future on mobile devices, enabling clinical staff to access the electronic version at the bedside. Research and development This year has seen some development of major initiatives. This progress can be seen in the shift of emphasis of our NIHR Biomedical Research Centre (BRC) and in our development of research support and regulation. Biomedical Research Centre Our NIHR UCLH Biomedical Research Centre (BRC) is now at the end of its second year of its 100 million five year funding period. The BRC has been tasked by the National Institute for Health Research to focus more on experimental medicine and to develop closer working and partnerships with industry. In September 2013, the BRC invested 6 million in six initiatives that we believe will have a high impact over the next four years in experimental medicine. Funding awards include 1.2m over three years to set up a state-of-the-art radiochemistry laboratory. This will bring together biologists, chemists, imagers, engineers, physicists and clinicians in a new site to enable the production of novel imaging tracers for use in studies. The BRC was awarded 0.7m to establish a Computational Medical Imaging infrastructure. This imaging infrastructure aims to develop common software so that UCLH and UCL can share imaging skills and ensure these skills are translated into the clinical arena to improve diagnosis. Another major investment has been 1m into preparatory work for a trial of a drug to treat Alzheimer s disease. The BRC has led the way over the last year in the involvement of patients and the public in the design and delivery of research and in setting research priorities. The BRC has four patient panels and has established, with the Wellcome Trust, funding bursaries for researchers so they can involve lay people in the development of their work. Lay people also sit on the programme s strategic boards. BioResource UCLH is part of a major initiative, BioResource, which is gathering 10,000 DNA samples from people with and without disease, to help researchers find out how genes influence disease. Over 400 participants have been already been recruited, donating their DNA samples and consenting to be contacted at a later date about suitable research studies. 22 University College London Hospitals NHS Foundation Trust UCLPartners UCLH has been the driving force for research across UCLPartners and particularly behind successful bids for funding and recognition. UCLPartners has been redesignated an Academic Health Science Centre with funding for a further five years. UCLH was also a driving force behind the successful bid to create the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) North Thames. Over five years, it will receive nearly 44m in funding or equivalent support from the NIHR, NHS trusts, higher education institutions, clinical commissioning groups, the Greater London Authority, local authorities, industry and the voluntary and community sector groups. The funding will be invested in researching innovative interventions and models of care, and in speeding the uptake of these to benefit patients and the public in the region. Other research and development initiatives Recruiting to research studies and trials We have one of the most complex portfolios of research. We continue to support a large portfolio of clinical trials and studies. The portfolio at UCLH is one of the largest in the country (around 1,200 projects currently taking place across UCLH). We are one of the largest recruiters of patients to NIHR portfolio adopted studies, contributing over 9,558 in 2013/14. In 2013, 297 new research studies were approved to begin recruitment at UCLH. These range from clinical trials of medicinal products and device studies, through to service and patient satisfaction studies. At any one time, the number of studies involving UCLH patients and open to recruitment or follow-up, has consistently been approximately 1,200. In 2013 UCLH was presented with an award by Central and East London (CEL) Comprehensive Local Research Network (CLRN) for the highest number of participants recruited into research within the CEL network. The last year has seen a dramatic improvement in the speed with which studies were approved, with the vast majority of studies approved within the NIHR target of 30 calendar days. Clinical Research Facility The Clinical Research Facility continues to build its research portfolio in clinical research and in particular its focus on experimental medicine. The facility has enabled UCLH to progress clinical trials and participate in international studies. For instance the