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Annual General Meeting 30 September 2015

Our year in numbers

Over half a million outpatient contacts

70,000 planned inpatient and day case treatments

Just under 80,000 people attended our emergency department or urgent

care centre

Almost 55,000 emergency admissions

Over 4,300 babies born in our maternity units or supported at home births

Access to treatment

Cancer care – diagnosis and treatment

targets all met

18 week referral to treatment – 2 of 3 targets

met

99.78% of patients received key diagnostic

tests within 6 weeks

85.5% of patients treated or admitted via ED

within 4 hours

54.6% of stroke patients spent more than

90% of their stay in a stroke unit

What our patients say

• 95% of patients say they would

recommend our hospitals

• 3,157 expressions of thanks

• Complaints less than 0.45% of

overall patient contacts

What our staff say

Only 64% satisfied with quality of care they are able to provide

Worst national score for job satisfaction and recommending

RCHT as a place to work or receive treatment

Investing in new technologies and facilities

Over £20million invested in new equipment and

buildings during 2014/15

• A second £2million TrueBeam Linear Accelerator

• Dementia Friendly Environments including a

specialist older person’s ward

• Pharmacy Robot

• Electronic Prescribing

• Online requests and results for clinical imaging

and pathology diagnostic tests

Building our reputation for research and innovation

• 90% increase in number of people taking part in research

• Achieved world firsts in recruiting to new national and international

diabetes and cancer studies

• Innovation Club supporting staff to develop research and ideas

• RCHT registered the second highest number of innovations in the

local Area Health Sciences Network

Working Together

• Improving patient flow and redesigning patient pathways with our Health

and Social Care partners

• Increasing our links with the Voluntary Sector to support patients in the

community (ie, Age UK ‘Welcome Home’)

• Working with independent sector partners to deliver and improve services

(ie, Mitie, Cofley)

The Cove Macmillan Support Centre

• Continuing to enhance patient experience

through the work of the RCH Charity, our

Leagues of Friends, Volunteers and partners

such as Macmillan

One+All | We Care Awards

Trust+Respect:

• Kevin Bolt, Payments

and Contracts Manager

& UNISON staff-side

representative

Working Together:

• Point of Care Team

Inspiration+Innovation:

• Interventional Radiology &

Vascular Access Team

Care+Compassion:

• Dialysis Unit Team

Pride+Achievement

• Jo Pope, Assistant

Practitioner

Pride+Achievement

Many teams and individuals have gained national recognition for

excellence and improving quality, including:

Paediatric team presents

research and care

improvements at international

conference

Adult Inpatient Diabetes Nurse

specialists commended for

development of simulation

training programme

RCHT achieves accreditation

as a centre of excellence for

Venous Thromboembolysm

prevention

Cardiac Catheter Laboratory

team among first invited to join

international registery

Tommy’s

award for

obstetric

specialist’s

care of

compelx

pregnancies

Looking forward 2015/16

Absolute priorities

• Improving patient flow across the health + social care community

• achieving the ED 4 hour target

• new models of care – closer to home

• Reducing hospital mortality rates

• Recruiting more nurses and clinical support staff

• Engaging our staff and supporting clinical leadership

• Financial recovery

• Partnerships and integration – Devolution Deal for Cornwall

Questions

Annual Accounts & Financial Review

2014-15

Mr Karl Simkins Director of Finance

2014-15 : A Challenging Year Financially

• Deficit of £6.9m against an original plan to deliver a £3.9m surplus.

• Revised forecast (October 2014) of £7m deficit.

• First time RCHT in deficit since 2006/07

• 63% of acute sector in deficit in 2014-15

• Breach of statutory break even duty

2014-15 : Operational Challenges

• Unprecedented operational challenges nationally and locally impacting on financial performance

• Significant non-elective activity undertaken at 30% of tariff (£2.2m impact greater than plan)

• High levels of staff costs relating to non-permanent staff to maintain safety and activity. (Agency pay £7.1m in 2014-15)

• £9.7m savings delivered against a plan of £14m

Other Financial Headlines 2014-15 • Achieved other statutory financial duties in respect of capital

and cash

• Delivered a £20.1m capital investment programme in buildings and equipment

• £5.1m loans drawn down to support capital investments

• £3.9m cash support for deficit

• £18.8m historic debt repaid and replaced with new £24.7m 15yr loan at more favourable interest rate (1.65% compared to 5.32%)

• Payment of Non-NHS suppliers - 93% all non-NHS invoices paid on time (2013-14: 95%)

The Auditors Perspective

• Trust accounts produced to deadline and to a good standard

• Unqualified audit opinion received on the accounts

• Qualified ‘Except for’ conclusion in respect of the Trust’s arrangements for securing economy, efficiency and effectiveness in its use of resources (value for money conclusion), due to deficit position

£20.8m Sources of Funding £13.4m Internally Generated Funding

£5.1m Department of Health Loans £1.3m Central funding (Public Dividend Capital) £1.0m Charitable & other funding

£20.1m Expenditure included: • Additional Linear Accelerator - £2.5m • Medical Capital Equipment - £2.5m • New IT servers - £2.2m • Health informatics developments - £3.1m • Development of Endoscopy and Urology - £1.2m • Dementia friendly ward - £1.8m • Fire protection of the estate - £1.4m

Capital Investment 2014-15

The Challenge Continues into 2015-16

• Formal financial recovery

• Original planned deficit of £5.5m for 2015-16, reduced to £3.8m deficit requirement in September 2015.

• Requirement to deliver £15m savings in extremely challenging financial and operational environment

• £8.9m cash support approved (£5.7m planned) • Standard contract with NHS Kernow, enabling income to be

earned from activity delivered • Baseline £16m capital investment programme

Overview of RCHT Finances 2014-15

Income and expenditure performance £m

Operating income 342.5

Operating expenditure (360.7)

Operating deficit (18.2)

Other expenditure (finance costs, other

gains and losses, PDC dividends)

(5.6m)

Retained deficit for the year (23.6)

Impairment adjustment 16.9

Donated asset and IFRIC 12 technical

adjustments

(0.2)

Reported deficit for the year (6.9)

Overview of RCHT’s finances 2014-15 Where our income comes from:

Total Operating Income 2014-15: £342.5m

Clinical Commissioning Groups (£238.3m)

NHS England (£60.7m)

Local Authorities (3.0m)

Other patient care related income (£1.4m)

Education, training and research (£15.1m)

Services we provide to others (£7.6m)

Other income (£16.3m)

Overview of RCHT’s finances 2014-15 What we spend our income on:

Staff (£209.2m)

Supplies (£82.4m)

Services from other organisations (£5.4m)

Depreciation and impairments (£28.5m)

Premises costs (£7.4m)

Establishment (£4.1m)

Clinical Negligence Premiums (£6.4m)

Other (£17.3m)

Total Operating Expenditure 2014-15: £360.7m

• Property, plant & equipment and intangible assets @ 31/3/15 : £149.5m (31/3/14: £171.7m) • Cash in hand - £7.6m (31/3/14: £11.8m) • Loan balances - £32.3m (31/3/14: £24.2m) • Net assets - £105.8m (31/3/14: £141.8m)

Assets & Liabilities 2014-15

A full copy of the audited accounts is published on our website

www.rcht.nhs.uk

or alternatively can be obtained by contacting the Chairman’s Office at: Bedruthan House

Royal Cornwall Hospitals Trust Truro

TR1 3LJ Email: [email protected]

Clinicians Leading Change

© Optimise Limited 2015

To listen and work differently

with those closest to our

patients.

Our mission


• 11 Staff Conversations over 3 weeks – over 600 people

attended.

• We asked two questions:

1) What day to day frustrations get in the way of us providing

the very best patient care?

2) What changes would make the biggest difference to patient

care and the way we work?

• We recorded every single comment - spoken or written -

from those attending a ‘big conversation’.

LiA Big Conversations


Five main themes emerged

• Staffing, recruitment, use of agency clinicians and training

• Patient flow at RCHT – one logical, seamless system

• Integrated IT systems and single log-in

• Procurement, scheme of delegation and equipment

replacement

• Communication – compassionate, open, honest, face-to-

face

Major themes and actions required


We set up 14 pioneering clinical teams focusing on many of the themes that

came up in the initial ‘big conversations’. These teams are leading the work to

turn ideas into action involving colleagues across the Trust.

1. Optimising Operating Theatre Time – Sean Dixon

2. Reducing the number of patient moves between wards – Duncan Browne

3. Elective discharge (Home for Lunch) – Ken Woodburn

4. Early supported discharge – Katja Adie

5. Seeing patients quickly – Gabi Lockwood

6. Improve staff training – Polly King

7. Hello my name is… - Alison Moore

8. Hospital 24/7 – Will English

9. Reducing cancellations – Nic Munro

10.Reducing the Emergency Department conversion rate – Toby Slade

11. Improving the recruitment process – James Bebb

12. Improving business case process – Phil Cook

13. Improve staff facilities – Sarah Taylor

14. Improve Information Technology – Gary Matthews

Our first 14 clinical teams and Consultant leads


1) Optimising theatre time:

• Identify a golden patient - easy

patient, first on the list so

theatre can start on time.

• Better communication system

between wards and operating

theatre to aid early transfer of

patients.

• Stronger, clearer clinical

leadership within theatre team.

Examples of clinical teams work


Lead Consultant:

Sean Dixon

2) Seeing patients quickly:

• Initial focus on fractured neck

of femur (NOF) patients.

• Working with the ambulance

service to identify NOF

patients early and get them to

x-ray on arrival.

• Direct call to Trauma Co-

ordinator to collect patient for

surgery.



Lead Consultant:

Gabi Lockwood

3) Hello my name is…campaign:

• Ensure all staff introduce

themselves (name and role) to

patients, visitors and colleagues.

• Vital to make a human

connection, build trust and a

therapeutic relationship.

• Campaign launched on 21st

September.



Lead Consultant:

Ali Moore

Other actions so far:

• Reduction in car parking charges for lower paid staff

• Drip poles available with every bed

• Debit cards for ward sisters/charge nurses to buy essential

items quickly

• Reception staff to welcome patients at Trelawny entrance

from 7am

• Reduced bureaucracy in recruitment process

• Increased visibility of senior managers in clinical areas

• Pilot project for ward clerks to support patient discharge

Quick wins



Hints Achieving sustainable change

• To achieve real, long term change at RCHT we need to listen

better to our clinicians, our patients, our volunteers, our

shadow Governors, our partners and the wider community.

• In the past we have not involved our stakeholders enough in

our plans or acted quickly enough on feedback.

• Listening into Action is a campaign to change and improve.

We have started with our staff, volunteers and partners at the

recent Care Quality Commission ‘Quality Summit’.

• In 2015, we have done a lot of listening and diagnosing. Now

it is time for action to become the ‘outstanding’ organisation

we all want RCHT to be.

The Journey to

Outstanding

Dr Jon Andrewes, Chairman

Where are we today? • Regulators - Care Quality Commission overall rating is ‘Requires improvement’

with services ranging from ‘inadequate’ to ‘good’.

• Patients - 95% of patients say they would recommend our hospitals. Written

feedback is variable.

• Staff - Worst national score for job satisfaction and recommending RCHT as a

place to work or receive treatment. Some progress through Listening into Action.

• Partners, stakeholders, media and wider community want us to succeed but hold

a wide range of views from inadequate to outstanding.

• Very mixed picture. Our aim is to be consistently ‘outstanding’.

1) Recognising outstanding: We already provide outstanding care in many areas, recognised nationally:

Cancer Team

• Strong leadership, innovation and good

patient outcomes.

• Exceptional feedback in patient surveys.

• Reputation for high quality research.

• Achieve all national diagnosis and

treatment targets.

• Strong partnerships e.g. GPs and

charities like Macmillan.

2) Recognising outstanding:

Women and Children’s Team

• Paediatric and neonatal specialists

recognised for innovation at international

congress.

• Dr Rajasri winner of national Tommy’s

Award for work on complex and high risk

pregnancies – voted by parents.

• Endometriosis team worked on new

national guidelines for clinical nurse

specialists.


• Specialist expertise and hi-tech facilities make

RCHT top choice for advanced laparoscopic

surgery trainees.

• Thrombosis nursing team won Quality in Care

Anticoagulation Award.

• Pharmacy team runners up in two national

awards for medicines management.

• National recognition for Ambulatory Emergency

Care Unit for excellent patient feedback.


• Support for dementia patients and their carers in

planning their care and surgery.

• Patient Ambassadors working with staff to observe

and improve care on wards.

• Bite size learning for theatre staff praised by CQC.

• Blood transfusion team shortlisted for national

Health Service Journal innovation award.

• Epilepsy team involved in developing world’s first

‘Epilepsy Self Monitor app’ to save lives.

Achieving outstanding consistently:

• We must foster and support strong clinical leadership and decision making.

• We must understand what ‘outstanding’ looks like and how to get there.

• We must challenge poor practice, behaviours and variable care.

• We must work as one team, one system and all take responsibility to succeed.

• We must involve our patients, members and wider community in our

improvement programme.

The journey to outstanding:

October 2015 - April 2016

• Act on CQC inspection report and concerns raised.

• Aim for overall ‘Good’ rating at CQC inspection in January 2016.

• Appoint Chief Executive and build strong, stable, united Trust Board.

April 2016 - April 2017

• Focus on providing consistent, high quality, safe care – embed improvements.

• Develop inclusive leadership team with clinicians fully engaged.

• Ensure service users and local community are at the centre of our governance.

April 2017 – April 2018

• NHS Foundation Trust status.

• Integration of health and social care services.

• System leadership from RCHT clinicians.

Your views

and questions

annual general meeting › documents...research and care improvements at international conference...

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