Annual report and accounts 2014/15

Transcription

1 Annual report and accounts 2014/15 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 University College London Hospitals NHS Foundation Trust Annual Report and Accounts 2014/15 Presented to Parliament pursuant to Schedule 7, paragraph 25 (4) (a) of the National Health Service Act 2006 Annual Report and Accounts 2014/2015 3

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5 Contents 1 Introduction 6 2 Directors report 12 3 Strategic report 16 a) Strategic context 16 b) Our capital programme, activity and capacity 18 c) Performance 22 d) Quality governance 34 e) Corporate and social responsibility 35 f) Savings and activity plans 38 g) Risks and uncertainties 40 4 Delivering top quality care, education and research 48 a) Our patients 48 b) Our staff 50 5 Organisation structure 62 6 Remuneration report 82 Appendices 1 UCLH staff survey results 89 2 Quality report 91 3 Annual governance statement Annual accounts 163 Annual Report and Accounts 2014/2015 5

6 1. INTRODUCTION 2. DIRECTOR S REPORT 3. STRATEGIC REPORT 4. DELIVERING TOP QUALITY CARE, EDUCATION AND RESEARCH 1 Introduction 2014/15 A year in numbers 6 hospitals 1. University College Hospital, including: Macmillan Cancer Centre Elizabeth Garrett Anderson Wing Hospital for Tropical Diseases Institute of Sport, Exercise and Health 2. National Hospital for Neurology and Neurosurgery 3. Eastman Dental Hospital 4. Royal National Throat, Nose and Ear Hospital 5. Heart Hospital 6. Royal London Hospital for Integrated Medicine Number of staff 8,000+ Number of beds 1,093 Turnover 934 million Number of Foundation Trust members 19, ORGANISATION STRUCTURE 6. REMUNERATION REPORT UCLH (University College London Hospital NHS Foundation Trust) 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 while 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 patients and local community. Through our Council of Governors we are able to listen to the views of patients, 6 University College London Hospitals NHS Foundation Trust 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 England and Wales 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

7 What we do Patients seen per year 1,000,000+ Outpatients 1,010,950 Inpatients 170,000 Visits to our Emergency Department Babies born 131,000 Clinical trials and studies 6,734 1,200+ Patients recruited for research studies in a typical year 12, ,000 attendances at A&E Investing in the future 250 million Funding secured for new Proton Beam Therapy centres at UCLH and the Christie NHS Foundation Trust in Manchester 2 A new specialist centre for services currently provided at the Eastman Dental Hospital and the Royal National Throat, Nose and Ear Hospital The rebuilding of our Emergency Department 20 million Leonard Wolfson Experimental Neurology Centre dedicated to carrying out first-in-human studies opened in the National Hospital for Neurology and Neurosurgery Confidence in our services Inpatients would recommend us to family and friends further major developments in the pipeline 97% 83% 64% national average Staff would recommend us if their family and friends needed treatment 1. INTRODUCTION 2. DIRECTOR S REPORT 3. STRATEGIC REPORT 4. DELIVERING TOP QUALITY CARE, EDUCATION AND RESEARCH 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 934 million and contracts with over 90 commissioning bodies. On average we see over 1,000,000 outpatients, 131,000 A&E attendances and admit over 170,000 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). University College Hospital 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). Annual Report and Accounts 2014/ ORGANISATION STRUCTURE 6. REMUNERATION REPORT

8 1. INTRODUCTION 2. DIRECTOR S REPORT 3. STRATEGIC REPORT The year in pictures April The President of Ireland, Michael D Higgins, visited UCLH as part of the first official visit to the UK by an Irish head of state. August May The new Leonard Wolfson Experimental Neurology Centre opened for clinical studies and trials. September 4. DELIVERING TOP QUALITY CARE, EDUCATION AND RESEARCH An innovative new approach to cancer care that will see patients receive world-class treatment from specialist hubs at every stage of their journey was given the green light to go ahead, with UCLH designated as a centre for certain types of cancer. The vocational rehabilitation team at the NHNN won an award for its success in helping neurological patients get back to work, and their daily routine. 5. ORGANISATION STRUCTURE December January 6. REMUNERATION REPORT UCLH is one of six hospital trusts in north London to form a partnership and create the North Thames Genomics Medicine Centre to support the delivery of the Prime Minister s 100,000 Genome Project. 8 University College London Hospitals NHS Foundation Trust A research programme led by UCLH and UCL to pioneer the next generation of cancer therapies secures 30m of investment to help develop a new technology called t-cell therapy.

9 June Health Secretary Jeremy Hunt visited University College Hospital to learn more about work to improve the accountability of clinicians and communication with patients and families. October July 1,000,000+ outpatients seen at UCLH University College Hospital is the safest hospital in England after NHS England published new data on nurse staffing levels and systems of patient safety. November 1. INTRODUCTION 2. DIRECTOR S REPORT 3. STRATEGIC REPORT A Channel 4 documentary followed four UCLH patients taking part in trials of some of the most advanced cancer treatments in the world. The Public Health Minister praised the work of UCLH during a visit to see the UK s first paediatric female genital mutilation (FGM) clinic at the EGA. 4. DELIVERING TOP QUALITY CARE, EDUCATION AND RESEARCH February March 5. ORGANISATION STRUCTURE Her Royal Highness, The Duchess of Cornwall, visited teenagers with arthritis at University College Hospital to learn how the world s first dedicated research programme is helping understanding of how and why arthritis and other rheumatic conditions affect teenagers. The Department of Health gave the approval for the new proton beam therapy centre to go ahead by announcing the preferred contractors for the building and supply of equipment. The new centre will treat hundreds of patients each year at University College Hospital from Annual Report and Accounts 2014/ REMUNERATION REPORT

10 1. INTRODUCTION 2. DIRECTOR S REPORT 3. STRATEGIC REPORT 4. DELIVERING TOP QUALITY CARE, EDUCATION AND RESEARCH 5. ORGANISATION STRUCTURE 6. REMUNERATION REPORT Foreword Welcome to our Annual Report. Despite the challenges facing the NHS as a whole, UCLH has maintained its reputation in the eyes of both patients and staff. We continue to work hard to build on our vision: delivering top-quality care for patients; providing excellent education; and developing our world-class research partnership with UCL. Our strategy is to balance specialist services for patients from around the country with the best possible general care for those living in our local community. This report was written immediately after the General Election, resulting in greater certainty about the political direction of the NHS. The Conservative Party has committed to increase funding to the NHS by 8bn over the next five years. However, the NHS is expected to make efficiencies of 22bn over the same period. This situation is likely to result in the need for UCLH to make substantial cost improvements year on year by eliminating waste and improving patient pathways. This will be challenging, with the level of cost improvement at least equivalent to that delivered over recent years. Despite the financial challenges facing the NHS, UCLH recorded a small surplus again this financial year. This was achieved following recognition that additional funds should be provided to address the higher costs of delivering specialist services. There is widespread recognition that the specialist tariff is no longer fit for purpose, and UCLH will engage with Monitor and NHS England (NHSE) to ensure that the future tariff reflects the additional costs incurred. The UCLH Board has taken the view that we should implement an ambitious five-year programme to transform the way we deliver services. Our UCLH Future programme will focus on how we can continue to improve the quality and value of all aspects of services to our patients, matching the best performing hospitals in the NHS and globally. To do that we need to rethink how we deliver care shortening clinical pathways, and significantly improving core operational processes (first patient contact, admissions and bookings, ward procedures, bed managements, patient flow and customer service) to enhance patient and staff experience. We will be investing in service redesign and new technology, together with training and development for all staff. Our ambitions are high as we want to deliver improvements at scale and with pace. In 2014/15 we overcame most of our operating challenges. Although meeting the A&E four-hour target has proved challenging, our performance has been among the best in London, and the best among the major teaching hospitals against which we 10 University College London Hospitals NHS Foundation Trust compare our performance. That target is a barometer of how we perform across all of our hospitals and of how we work in partnership with our commissioners in Camden and Islington and our local GPs. The issues around Referral to Treatment (RTT) times were felt across the health service, and in 2014/15 patient demand led to a backlog of patients waiting longer than 18 weeks for treatment. Through close work with our commissioners and much hard work by staff to reconfigure our resources, we have almost cleared the backlog. The future challenge will be to sustain our performance. We did not achieve the 62-day wait for cancer treatment following GP referral in any quarter in 2014/15. A number of other hospitals with specialist cancer services have also seen deterioration against these standards through 2014/15. Breaches at UCLH have resulted mainly from issues outside of our direct control: late referrals from other trusts, patient choice and pathway complexity issues. There are, however, some breaches due to capacity or administrative delays. In November we introduced a new process that provides much fuller analysis of breaches, allowing us to understand all delaying factors on the pathway, not just the primary breach reason. We have a recovery plan in place which forecasts achievement of the 62 day wait for cancer treatment from July 2015, although this is dependent on being able to reduce late referrals from other trusts. In recent years we have seen a huge increase in patients who want their care at UCLH, particularly in the more specialist services such as cancer and neuroscience. Demand has risen at a rate substantially higher than the average for the NHS, reflecting our increasing reputation as a preferred provider for patients. This creates tension with commissioners as to whether such growth and activity can be afforded, and we will continue to work closely with them to agree a sustainable future which builds on the national direction of patient care leading to integrated budgets. Despite these difficulties, there have been exciting developments in many of our services. NHS England

11 4. DELIVERING TOP QUALITY CARE, EDUCATION AND RESEARCH 178m awarded in external grant funding to the Biomedical Research Centre confirmed our plans to make UCLH a centre for the specialist treatment of five rare types of cancer, and our cardiac services have now moved to Barts. We should take this opportunity to express our gratitude to the staff of the Heart Hospital for all the excellent care that they and their predecessors have delivered over their time in UCLH. The foundations are being laid to develop our cancer care: demolition of the Rosenheim Wing to make way for one of the UK s first proton beam therapy (PBT) centres is almost complete, part of Phase 4 of our development plans approved by the UCLH Board this year. One of the world s most advanced forms of radiotherapy, PBT will be available at UCLH in Elsewhere, we have agreed capital investments to expand A&E and to improve capacity at the NHNN, and our plans are well-advanced to bring ear nose and throat services together with specialist dental provision for patients in a new development on the University College Hospital campus site. Our partnership with UCL now fifth in the world rankings due to its strength in biomedicine continues to flourish. We continue to be vigorous in our pursuit of better care, delivered more efficiently, and have undertaken benchmarking against other leading teaching hospitals to understand how we compare and how we can improve. Against the best trusts in the UK we compare favourably, performing well above average in quality outcomes, financial performance and workforce. However, benchmarking has indicated that we need to improve a number of administrative issues around day-to-day operations, for example outpatient bookings. We are focused on reducing delays for outpatients and creating better ways of delivering care with individual patients at the heart of all we do. We remain deeply grateful to our staff for all of their efforts to improve the quality of care and service at UCLH against a very challenging backdrop. Our hospitals and staff are among the best in the NHS, underpinned by our core values: safety, kindness, teamwork, improving. We are determined to improve and develop still further to ensure that all of our services are truly world-class. 1. INTRODUCTION 2. DIRECTOR S REPORT 3. STRATEGIC REPORT 5. ORGANISATION STRUCTURE Richard Murley Chairman Sir Robert Naylor Chief Executive Annual Report and Accounts 2014/ REMUNERATION REPORT

12 1. INTRODUCTION 2. DIRECTOR S REPORT 3. STRATEGIC REPORT 4. DELIVERING TOP QUALITY CARE, EDUCATION AND RESEARCH 5. ORGANISATION STRUCTURE 6. REMUNERATION REPORT 2 Directors report UCLH has continued to progress parallel clinical strategies in 2014/15: to provide excellent services to our local community, and to develop three specialist areas of cancer services, neurosciences and women s health with the aim of becoming world-leaders in these areas. We will deliver these while maintaining focus on our delivery of excellent core medical, emergency and surgical services. At the same time we are exploring various opportunities for further local collaborative work to underpin the principles outlined in the Five Year Forward View (NHSEs vision for the future NHS) and the Dalton Review (The Department of Health s exploration of new options and opportunities to help the best leaders and organisations in the NHS to do more for patients). We have demonstrated this through our support for Camden Clinical Commissioning Group s (CCG) application for Vanguard funding during 2015, and our own application with sector partner organisations, to help drive greater cancer leadership in networked, excellent care and early diagnosis. Following an extensive, commissioner-led public consultation, on 21 October 2014 commissioner approval was granted to the cancer and cardiovascular proposals which will see UCLH become a specialist centre for the treatment of certain rare types of cancer. Cardiac services move from the Heart Hospital to Barts Health was completed in May 2015 and UCLH will become a centre for five specialist cancer services brain, prostate and bladder, head and neck, oesophago-gastric and blood cancers. Moving malignant haematology inpatient services from the Royal Free London to UCLH is scheduled for completion by December We worked in close collaboration with Bart s Health NHS Trust to develop robust plans for the transfer of all cardiovascular services. A consultation was undertaken with a focus on supporting staff and patient safely during the transfer process. To support implementation of the London Cancer reconfiguration, in January 2015 the UCLH Board approved the full business case for Investing in Cancer and Surgical Services and for the development of PBT. This capital investment, worth approximately 360m will enable us to establish a state-of-theart facility, providing Europe s largest inpatient haematology centre, critical care beds, imaging, and a short-stay surgical centre alongside one of the UK s first PBT centres. Development is due to commence during The new PBT centre is supported by the Department of Health which has invested 250m in funding to us and The Christie NHS Foundation Trust. UCLH is a founding and active member of 12 University College London Hospitals NHS Foundation Trust UCLPartners, an academic health science partnership, supporting healthcare for over six million people in parts of London, Bedfordshire, Essex and Hertfordshire. Its member organisations, from higher education and the NHS, form one of the world s leading resources in medical discovery, healthcare innovation and education. The partnership saw significant achievements during 2014/15, including its successful re-designation as an Academic Health Science Centre, a world-leading partnership for medical discovery, modelled on creating six academic medical centres, designed to boost UK life sciences. UCLH is a lead partner in the centres focused on cancer, cardiovascular disease and neurosciences. The Clinical Research Network for North Thames, aligned with UCLPartners, is the highest-performing network for patients recruited to clinical trials, giving more people in our region access to the latest medical treatments and technologies. In December the partnership, including UCLH, was designated one of the country s new centres to deliver the 100,000 genomes project, to improve diagnosis and treatment for patients with cancer and rare diseases. UCLPartners facilitated the process which led to NHSEs approval of the plans for UCLH to become a specialist cancer centre for the region. In August 2014, we saw the launch of UCLH@Home, a service run by an outsourced provider, that supports patients who are clinically stable to complete the remainder of their care and/ or treatment at home if they choose to do so following an assessment with their consultant. The newly established UCLH@Home team, recruited using values based recruitment, includes a range of specialties including nurses, physiotherapists and occupational therapists that will be based in the community. This innovative service helps to support our ambition of bringing health and social care together and offers our patients more independence, closer proximity to their family and friends and, importantly, access to community care in the privacy of their own homes. To further enhance this service, UCLH@Home launched a six month pilot project (funded by the Department of Health s Homeless Hospital Discharge Fund) for patients eligible for Pathway to Home, a specialist service for the homeless established in This patient group will complete their treatment at Olallo House, a hostel located near Euston station, and will remain under the care of the specialist consultant, receiving an agreed number of daily visits by support teams. They will also be visited by the Pathway specialist homeless team to help secure onward accommodation once discharged. We have been working with our peer

13 organisations in the Shelford Group, a collective of 10 leading NHS multi-specialty academic healthcare organisations dedicated to excellence in clinical research, education and patient care, to benchmark and assess our procurement and supply chain capability and develop a programme to deliver savings and efficiencies in our non-pay spend through procurement which involves clinicians to select the right equipment at the right cost. In the first of these trials surgical gloves were selected by auction which will now be supplied to all of the Shelford Group of trusts, creating efficiencies of scale. We will now focus on 24 of the highest value and highest clinical preference categories. At UCLH, we have significant strategic development ambitions that will enable us to deliver efficient and high quality patient care into the future (see page 16). In addition to these strategic projects and maintaining and investing in our existing buildings and equipment, we also encourage smaller scale schemes where the investment will deliver increased efficiency in the future. Plans are underway to invest in the co-location of the EDH and the Royal National Throat Nose and Ear hospital. If approved by the board, we will be able to improve patient pathways, increase clinical innovation and optimise operational efficiency. To read more about our strategic initiatives see page 16 (strategic report). Over the coming year, we will develop and deliver plans to establish an infrastructure that supports the development of an integrated care pathway. We have proposed to commissioners, to house and support a new integrated team who would play a key role in overseeing and supporting the on-going development of pathways via different London cancer tumour 6,734 babies born at UCLH site work-streams. Adopting this sector-wide view is crucial to shortening pathways whenever possible. The performance challenges addressed over the last 12 months have reinforced our commitment to our strategic direction. We will be actively driving a number of priorities in 2015/16, including greater collaborative working with partners, developing common care standards across UCLH, investing more in our informatics capability and matching capacity to demand through partner collaboration. We will consolidate the services we are able to provide through significant capital investment. For example, the Board has committed to an investment of c 20m, partially funded by charitable donations, to provide additional operating theatres and inpatient bed capacity on the NHNN site. This will enable delivery of the London Cancer reconfiguration of brain cancer, as well as supporting increasing demand in specialist neurosurgery including spinal surgery. The best interest of our patients remains at the core of our business and we strive to ensure the services we provide are reflective of their needs. Services that are no longer working well for patients will be transferred or removed. A clinically-led review of our ophthalmology services highlighted sustainability issues arising from low patient volumes, a shortage of specialist clinicians and the limitation of the current equipment and outpatient facilities. As a result, the UCLH Board made the decision to divest its non-specialist ophthalmology services. Elective, secondary care ophthalmology services will transfer to The Royal Free London during 2015/16. Our greatest asset is without a doubt the people who choose to work for us. We are committed to supporting disabled people to ensure that they are given full and fair consideration in their applications Annual Report and Accounts 2014/ INTRODUCTION 2. DIRECTOR S REPORT 3. STRATEGIC REPORT 4. DELIVERING TOP QUALITY CARE, EDUCATION AND RESEARCH 5. ORGANISATION STRUCTURE 6. REMUNERATION REPORT

14 1. INTRODUCTION 2. DIRECTOR S REPORT 3. STRATEGIC REPORT 4. DELIVERING TOP QUALITY CARE, EDUCATION AND RESEARCH 5. ORGANISATION STRUCTURE 6. REMUNERATION REPORT for employment at UCLH and are not disadvantaged throughout the process in line with our recruitment and selection procedure. We have in place a Managing Disability Policy, approved in February 2014, which ensures that staff who declare a disability are given appropriate support, if required, in the workplace. This policy applies to new and existing staff who declare a disability. The Training Policy ensures that disabled staff are encouraged to access training and career development, with appropriate support as required. UCLH works in partnership with staff to ensure that the views of staff are taken into account when making decisions which are likely to affect their interests, including updates on performance and other issues of concern. The monthly Joint Partnership Forum provides an opportunity to be involved in the development of policies. UCLH also seeks the views of all staff through the annual staff survey. We strive to keep staff informed of the financial performance and wider economic factors affecting the financial performance at UCLH and communicate through the chief executive s Team Brief to all employees, as well as regular communication through the leadership forum, reports to the council of governors, our intranet and other channels. Accounting policies for pensions and other retirement benefits are set out in note 1.4 to the accounts on page 177 and details of senior employees remuneration can be found in the remuneration report on page 82. Statement of Directors responsibility The directors are responsible for preparing the annual report and financial statements which taken together with the strategic report for 2014/15 provide a fair, balanced and understandable analysis of UCLH s activities and provide the information necessary for our patients, regulators and stakeholders to assess our performance during the year and our plans for the future. Directors who held office during the year were: Richard Murley, Chairman Sir Robert Naylor, Chief executive Non-executives Professor Sir Alasdair Breckenridge Dr Harry Bush Dr Rima Makarem Kieran Murphy Professor Sir John Tooke Dr Diana Walford Caspar Woolley (from 1 January 2015) 14 University College London Hospitals NHS Foundation Trust Executives Richard Alexander, finance director Dr Geoff Bellingan, medical director, surgery and cancer Professor Katherine Fenton, chief nurse Dr Jonathan Fielden, medical director, medicine Dr Gill Gaskin, medical director, specialist hospitals Neil Griffiths, deputy chief executive (from 2 June 2014) Professor Tony Mundy, medical director, corporate Directors are asked to declare any interests on a register of interests on appointment or during their appointment. The register is held by the trust secretary and is published annually. It is available on our website or from the trust secretary. Contact details can be found on page 79. Board members details together with declarations of their relevant interests, and committee membership are detailed on pages 69 to 74. Directors must also meet a new fit and proper persons test introduced in November 2014, set out in the CQC standards. The chairman considers that all board members met this during 2014/15. So far as UCLH s directors are aware, there is no relevant audit information of which the auditors are unaware. The directors have taken all of the steps that they ought to have taken as directors in order to make themselves aware of any audit information and to establish that the auditors are aware of that information. Signed on behalf of the Board of Directors Sir Robert Naylor Chief Executive 27 May 2015

15 4. DELIVERING TOP QUALITY CARE, EDUCATION AND RESEARCH 150+ work experience students 1. INTRODUCTION 2. DIRECTOR S REPORT 3. STRATEGIC REPORT 5. ORGANISATION STRUCTURE Annual Report and Accounts 2014/ REMUNERATION REPORT

16 1. INTRODUCTION 2. DIRECTOR S REPORT 3. STRATEGIC REPORT 4. DELIVERING TOP QUALITY CARE, EDUCATION AND RESEARCH 5. ORGANISATION STRUCTURE 6. REMUNERATION REPORT 3 Strategic report 3a. Strategic context UCLH is committed to delivering top-quality patient care, excellent education and world-class research. In November 2011, the Board reviewed the organisation s service strategy and agreed to focus on a parallel approach of providing excellent services to our local community while working to develop three specialist service areas with the potential to become world leading: Cancer services neurosciences women s health. In order to deliver world leading excellence in these three specialties, it is essential to sustain a strong base in core medical and surgical specialties. Any strategic intent to grow the priority specialist services must be run alongside appropriate investment in core medical and surgical services and in the delivery of high quality local care to the population we serve. Our focus on developing these services will ensure that our patients always remain at the core of everything we do. We are proud of our ability to deliver first-class medical and surgical services to our local population, Greater London and the south east. These include dermatology, gastrointestinal, gynaecology, infectious disease, rheumatology, trauma and orthopaedics as well as urology. We are committed to supporting the implementation of the cancer and cardiac reconfiguration proposals which will result in UCLH becoming a sector hub for some specialist cancers and Bart s Health NHS Trust the sector-wide centre for cardiac services. Our patients also benefit from leading hearing, balance, dental and head and neck services at the EDH and the RNTNEH. Clinical research underpins all aspects of our highquality services, and will be a key driver for our service developments over the next 10 years. We have already gained a national and international reputation in a number of areas of significant research and have continued to see a year-on-year growth in the number of patients participating in clinical trials across a number of specialities. We will look to grow and develop our relationship with UCL and other academic and charitable partners, supporting our key strategic aims and vision. We remain committed to the strategy which we 16 University College London Hospitals NHS Foundation Trust set out in our strategic plan submission to Monitor in June 2014, focused on the strategic intent of continuing to develop the three UCLH specialist service areas. The Five Year Forward View and Dalton Review describe how hospital service provision could develop in the near future. We will use both to help to refine our strategy as a provider of both nationally leading specialist activity and excellent services to our local population. The implications of this for partnership working and organisational form are highly significant and will require the Board to review and refresh its strategy and plans for delivering care to the local population while working in close consultation with our local CCGs, during the first half of the year. Later in this document we set out the work that we have already started through submission of collaborative Vanguard bids in response to the strong messages from the Five Year Forward View.

17 Changes in our local health economy The planned acquisition of Barnet and Chase Farm NHS Trust by The Royal Free London NHS Foundation Trust was completed on 1 July This reconfiguration was fully expected and to date there has been no clear impact on UCLH services. However, the scale of change created by this acquisition is likely to have on-going implications for the configuration and delivery of services in the north of our local health system which we will need to continue to monitor in close collaboration with our partners at The Royal Free London. The closure of several Accident & Emergency Departments in west London may have contributed to the continued increase in attendances at the UCLH department. These changes in service delivery, and on-going plans to change urgent care services, could affect us in the coming year and will be monitored closely during 2015/16. We will continue to work closely with our local health economy on delivering high-quality, highly efficient care for the local population. We have been playing an active role in developing schemes that use new organisational forms and tariffs to generate better care for our patients. As part of our approved mandate to help lead specialist cancer delivery across the sector, UCLH has submitted a bid for Vanguard funding with partner organisations. This proposes further development of existing networked cancer care with a significant focus on early diagnosis and radical crossorganisational service redesign to ensure our patients have access to the best cancer service available. We have strongly supported Camden CCG s application for Vanguard funding. In the opening quarter of 2015/16 our medicine board medical director, Dr Jonathan Fielden, will finalise a local hospital strategy for approval by our Board of Directors. We will continue to consult closely with our local CCGs and health partners on this work, aligning it with their Vanguard funding proposal. The strategy will incorporate the learning and progress from a number of specific schemes that we are already implementing with Camden and Islington CCGs. We coordinate this integration and improvement work with our local CCGs at our monthly Service Redesign Group. Initiated by Camden CCG and UCLH this group enables us to carve out a space within the contract structure where we can drive through the implementation of schemes that could otherwise be lost in more technical contract discussions and debates. At the group we are developing schemes that use new contractual models (alliance contracts, lead provider arrangements) 400+ UCL medical student placements and tariff structures (in particular outcome-based payments). The current agenda of the group represents an ambitious work programme for 2015/16: Adult diabetes paediatric diabetes musculoskeletal services chronic obstructive pulmonary disease frail elderly. This plan will help to ensure patients receive care where they need it most and reduce unplanned hospital admissions. We are also working with health and social care partners to use resources and infrastructure to deliver better care at the right time for Camden residents. Towards the end of 2014/15 we saw much clearer evidence that all organisations were starting to share data and produce analysis that would help reduce unnecessary admissions and delayed transfers of care. All parties are keen to refine the current better care fund schemes so that additional resource can be injected at points in care pathways that avoid admission and get patients out of hospital faster. Equally, our intention is to continue to work together with Camden CCG as a provider member of the Camden System Resilience Group a partnership working group, comprising stakeholders across the Camden health and social care economy, which provide oversight and assurance on urgent, emergency elective and non-elective capacity planning. In 2014/15 we played an active role in the setting up of this group, initiating and helping to develop a Camden health economy wide performance dashboard reporting tool which looks at capacity and performance across all providers in Camden. This work has already highlighted a gap in the provision of step-down facilities (the process that monitors a patient s progression through the healthcare system) in the local area which is needed to enable less acute patients to move more quickly from the acute hospital setting. Many of our delayed transfers of care are due to lack of step-down facilities. We will also use the System Resilience Group to continue to press for the commissioning of suitable neuro-rehabilitation provision in support of the smooth flow of patients along the stroke pathway. At present we face persistent problems with the transfer of patients from our hyper-acute stroke unit to their local stroke units which has a knock-on impact to patient flow in the rest of the University College Hospital wards and the NHNN. Annual Report and Accounts 2014/ INTRODUCTION 2. DIRECTOR S REPORT 3. STRATEGIC REPORT 4. DELIVERING TOP QUALITY CARE, EDUCATION AND RESEARCH 5. ORGANISATION STRUCTURE 6. REMUNERATION REPORT

18 1. INTRODUCTION 2. DIRECTOR S REPORT 3. STRATEGIC REPORT 4. DELIVERING TOP QUALITY CARE, EDUCATION AND RESEARCH 5. ORGANISATION STRUCTURE 6. REMUNERATION REPORT 3b. Our capital programme, activity and capacity We are using our capital programme to consolidate services at two locations, namely NHNN for the development of neurosciences and University College Hospital campus for cancer and all other services. These issues are more fully described in the section on service developments earlier in the directors report. We remain committed to improving patient experience and outcomes through investment in buildings and equipment. We proactively manage risk through use of the capital programme to address issues raised through our services risk registers. We retain a contingency of capital funding to address any unforeseen issues that come up during the year. We also continue to respond to opportunities that present themselves during the year in areas such as research and development and these initiatives are added to the capital programme when their funding sources are firmed up. Activity growth We have had continued growth in our patient activity and income in recent years. We expect to see similar levels of activity growth in 2015/16, with the expectation that income growth will be significantly less than activity growth as a result of the efficiency requirement placed upon NHS providers. To a degree this is similar to growth being seen across the health service as a whole, although with part of our strategic focus being in specialised services this does mean that our anticipated growth levels are higher than the average for the NHS. Innovations in healthcare, particularly in cancer and neurosciences, have enabled us to better treat patients and increase their life expectancy where historically, this had not been possible. We are also seeing our share of acute sector work increase over time. Growth in income levels in our strategic priority specialties is marked, particularly for cancer services and neurosciences. 55 per cent of our activity is under contract with NHSE as specialised commissioners. NHS England s clearly stated intention is to reduce the number of trusts providing specialised services, centralising care far more in regional hubs. We expect that this will result in a net increase in flows of referrals and activity. It will be important for our future sustainability as an organisation that 18 University College London Hospitals NHS Foundation Trust NHSE s funding mechanisms support their strategic intention to consolidate specialist care in this way. Our current assessment is we believe that we can maintain our share of activity in our sector and London, although we are mindful of the potential impact that The Royal Free London acquisition of Barnet and Chase Farm trust might have on local service configuration. In agreeing our activity plans with commissioners we have been clear where we have put additional activity into our plans to correct deficits in 2014/15 run-rates and where it is required to deal with growth in 2015/16. The growth levels that we are anticipating represent a significant challenge in terms of required staffing levels and capacity in our physical assets such as beds and theatres. Beds Demand for beds continues to increase as more patients are referred to UCLH. Seasonal demand for our services means that the number of beds we require changes through the year: winter pressures mean that we expect more demand for beds in the winter than we do in the summer. Based on our current forecasts of patients, we don t currently have enough beds to see all of our patients and meet all of our waiting times targets. We do however have a range of initiatives that we will introduce across 2015/16 that we forecast will give us sufficient bed capacity to deliver emergency and referral to treatment waiting times targets throughout the year. These are a combination of bed capacity creating schemes and efficiency measures (mostly reducing the length of time that patients need to stay with us). Key schemes that we are implementing are: UCLH@Home This scheme delivers care at home to patients who no longer need to be in an acute setting but do require regular monitoring and care. We will be increasing the number of patients who will benefit from this service. Use of Clinical Decision Unit and Ambulatory Care This scheme makes use of areas to avoid admissions to beds in University College Hospital for appropriate types of patient. The Clinical Decision Unit allows us to observe patients without admitting them to an overnight ward. Our ambulatory care pathways enable us to see patients in a setting more akin to an outpatient appointment once they have been

19 discharged from A&E, again avoiding the need to admit them to an overnight ward. Outsourcing to the independent sector This scheme makes use of operating theatres and beds at private healthcare facilities when UCLH capacity is at its limit. This only happens when patients agree to be seen at a private hospital. Length of stay reduction We have identified that we can reduce our length of stay for both elective and emergency patients. This is a key strand of our transformation programme. Theatres Theatre capacity at UCLH is similarly pressured. We have a target to achieve 85 per cent utilisation in our theatres. We monitor performance against this through our performance framework. At present a shortage of recovery space, exacerbated by delays in being able to discharge patient back to wards, is a principal driver of our theatre utilisation being at around per cent. In addition we will work on a range of issues to improve our theatre utilisation, 8,118 Twitter followers including tighter management of lists that are released by specialties, minimising the number of lists that start late, and looking for opportunities to organise lists so that short operations can be fitted into lists that otherwise may finish early. Winter plans In 2014/15 we put in place additional staff and processes to improve our resilience and patient care during the winter months. These were funded by recurrent Camden CCG system resilience funds and some non-recurrent funding from NHSE. All schemes met with the NHSE best practice guidance for nonelective resilience plans and in the main supported extended day and seven day working for supporting clinical services, improved support for discharge processes, improved patient flow in particularly vulnerable patient groups like the elderly, mental health, paediatrics and stroke and to avoid delays and manage surges in the emergency department. The following schemes worked well, and we have put them forward for continued recurrent funding via Camden CCG s recurrent system resilience funds. As we no longer have a summer lull in emergency 1. INTRODUCTION 2. DIRECTOR S REPORT 3. STRATEGIC REPORT 4. DELIVERING TOP QUALITY CARE, EDUCATION AND RESEARCH 5. ORGANISATION STRUCTURE Annual Report and Accounts 2014/ REMUNERATION REPORT

20 1. INTRODUCTION 2. DIRECTOR S REPORT 3. STRATEGIC REPORT 4. DELIVERING TOP QUALITY CARE, EDUCATION AND RESEARCH 5. ORGANISATION STRUCTURE 6. REMUNERATION REPORT patient activity, we believe most of these need to be continued for the entire year to ensure year round resilience. Extended and seven day working in clinical support teams: Additional therapy and junior doctor staff available at the weekends on the hyper acute stroke unit additional pharmacists and pharmacy technicians to improve turnaround of medications for patients, particularly those ready for discharge additional therapists to support medical and care of the elderly patients who are admitted to nonmedical wards University College Hospital afternoon phlebotomy service to ensure blood tests are dealt with quickly additional porters to work directly with the imaging departments to avoid delays in transferring patients from wards to their imaging slots additional consultant radiologist to improve reporting of acute and emergency patients imaging requests additional nursing staff overnight in recovery. Improved support for discharge processes: Saturday opening of the patient lounge pharmacy technician working to make up blister packs needed for patients discharge weekend discharge nurse to improve weekend discharges and prepare for Monday s discharges. Improved support for vulnerable patient groups: Additional consultant paediatrician working in the emergency department to improve response times and avoid unnecessary admissions additional mental health liaison nurses working within the emergency department and in University College Hospital to support improved response times and support given to patients attending or admitted with mental health problems purchasing overnight stays in specialised centres for patients admitted with alcohol problems, to enhance their recovery in the right environment nurse practitioner working to support rapid assessment and discharge of patients attending on the stroke pathway, but actually having another condition stroke mimics. Avoiding delays and managing surges: Additional emergency department senior registrar to increase number of senior decision makers in the department to avoid delays 20 University College London Hospitals NHS Foundation Trust third consultant in the emergency department at the weekends to deal with the increase attendances now occurring at weekends additional nurse in the emergency department to support streaming to ensure patients are sent to the correct section of the department according to their care needs additional GP hours at the front door of the emergency department and working as part of the urgent treatment centre team staffing to keep elective surgical bed bases open at the weekend if we get a surge in emergency admissions started seven-day therapy services for emergency service patients, giving weekend access to care which can help patients get home sooner reduced waiting times for routine physiotherapy outpatients from 20 weeks to 8.5 weeks, and for urgent cases from two weeks to one week. We will continue to work with our system partners, particularly via the System Resilience Group, to ensure our current relative success in performance from this year s work across the urgent care pathway is resilient for the future. Workforce: key challenges 2014/15 Our key workforce development challenges for 2015/16 will be two-fold: building capacity and building capability to deliver our strategic developments. Our focus will include seven-day and out-of-hours working, new models of ambulatory, urgent and unscheduled care agreed with our partners, productive outpatients, integrated care pathways, the transfer of the HH services to Barts Health and our strategic plan for cancer including PBT. Retaining and recruiting staff is one of the biggest investments we will make and one of the most challenging corporate tasks we face. The quality of our staff is key to delivering excellent patient outcomes and experiences. Our new action plan for national and international recruitment will be critical to our ability to fill the vacancies we have now and the new skills need that we forecast and is vital to the future retention of our workforce. We will also focus our efforts on improving staff experience in order to improve patient experience, developing a safe, supported and engaged workforce, deliver an aspirational approach to organisational development, improving and innovating to deliver excellent workforce processes, while using our unique position within UCLPartners to support staff with high-quality education, learning and development.

21 4. DELIVERING TOP QUALITY CARE, EDUCATION AND RESEARCH 19,224 UCLH members 1. INTRODUCTION 2. DIRECTOR S REPORT 3. STRATEGIC REPORT 5. ORGANISATION STRUCTURE Annual Report and Accounts 2014/ REMUNERATION REPORT

22 1. INTRODUCTION 2. DIRECTOR S REPORT 3. STRATEGIC REPORT 4. DELIVERING TOP QUALITY CARE, EDUCATION AND RESEARCH 5. ORGANISATION STRUCTURE 6. REMUNERATION REPORT 3c. Performance Infection control We have demonstrated good performance on infection control in 2014/15, when we had three cases of MRSA. The number of Clostridium difficile cases that our commissioners have confirmed as contributed to by lapses in healthcare has been nine at time of publication, bearing out our assessment that we did all that we could to avoid many of the cases that we report as a result of our comprehensive testing regime. Nonetheless we are maintaining through 2015/16 all of the preventative work that we have put in place to minimise the risk of Clostridium difficile cases, in particular our upgraded deep-clean regime and the use of hydrogen peroxide vapour cleaning. Waiting times During the past year we have responded to significant challenges in delivering key access targets, in particular the 18 week RTT waiting times targets and 62-day cancer target. We were in breach of the three headline RTT targets throughout most of As a result of significant investment and enormous commitment from our clinical and management teams, we reduced the number of patients waiting for more than 18 weeks to a low enough level to meet the open pathways (the status of a patients healthcare journey until it has completed) target in November We also invited the intensive support team into UCLH, they have provided expert knowledge and assurance around the robustness of our RTT reporting and management. We were able to meet the nonadmitted treatment target in February 2015 and are currently on track to deliver the admitted treatment target from June. Through a process of restructure and development we have now built a sustainable platform for providing shorter waits for our patients, based on: Clear roles and responsibilities for the delivery of short waiting times more rigorous meetings to target patient waiting lists at all levels of the organisation, ensuring more proactive operational management of waiting lists greater discipline in booking patients according to protocols that are shown to deliver shorter waiting times significant improvements to our operational reporting capability on patient waiting times, in particular much stronger PTL reporting and far tighter controls around our validation of patient 22 University College London Hospitals NHS Foundation Trust pathway information specialty level RTT demand and capacity modelling and forecasting. We do, however, continue to face a very high demand for both our elective and non-elective inpatient services. In the face of this demand, and with limited options for rapidly increasing our inpatient capacity, we must mitigate the risk that insufficient bed and theatre capacity will lead to specialty-level breaches of the RTT standards. Across 2014 we also missed the headline cancer access target of treating cancer patients within 62 days of referral from their GP. We have taken some key steps to improve our position against this target, although like all major tertiary centres our future continued compliance remains dependent upon partner trusts delivering improvements on their stages of patient cancer pathways. In response to this, we have developed a detailed action plan to deliver compliance by Q3 of 2015/16. This was agreed with Monitor and our local and specialist commissioners. Key actions include: Put in place medical director-led PTL meetings for all cancer pathways improved the breach analysis process we have in place for pathways at our hospitals, and have started a process for improving the learning about delays at referring hospitals. This will give UCLH a much richer understanding of all delays that contribute to breaches. We are now reviewing these breach analyses in collaboration with commissioners to help ensure a much greater system wide approach to improvement developed timed pathways which show the milestones that need to be met for each pathway to be compliant with the 62 day standard and structured a clear performance framework and accountable lead for each element of the pathway and compliance with standards working with referring trusts to understand the issues and streamline pathways where possible. This is happening on a number of levels, with some trusts the discussions are being led by clinical teams, whereas in other areas we are pursuing more formal communications with commissioner involvement. In addition we have taken on more of a system leadership role within our cancer network, and in 2015/16 we aim to continue developing the infrastructure to support a system wide pathway development. UCLH currently funds the majority of the London Cancer Pathway board directors who work across the whole sector on individual tumour