Annual Members Meeting 2012 September 15 th 2012
Agenda o Minutes of previous meeting o Financial Performance 2011/12 o Review of 2011/12 o Membership report o Changes to the constitution o Improvements through integration
Financial Performance 2011/12
Bolton NHS Trust • Annual Revenue £283m – Provider Arm – Salford Maternity & Neonatal – Bury Maternity • Staff (Average Number) 6396 • Approx 1,000,000 patient contacts
Our Health Economy • We face enormous financial pressures – £20bn National savings target – Growing numbers of patients – Tougher contracts – Commissioning intentions • Annual efficiencies of 6% required
Financial Position • In breach of our authorisation • Headline Loss • Slippage on efficiency programmes • Lack of clarity in reporting • Impact on 2011/12 • Transformation Plan
Financial Performance £m Revenue 283.1 Operating Expenses 275.1 EBITDA 8.0 Depreciation, PDC, interest, other 9.9 Surplus before impairments* (1.9) Deficit after impairment of £10.4m (12.3)
Activity Analysis Actual Variance % v Plan Elective activity 29,760 841 2.9 Non-elective activity 46,146 1,906 4.3 New outpatient attendances 80,429 -1,303 -1.6 Follow-up attendances 154,719 17,565 12.8 Outpatient procedures 42,729 11,208 35.6 A&E attendances 110,720 -553 -0.5
Statement of Position 31/3/2012 31/3/2011 £m £m Non current assets 127.7 129.8 Current assets 19.2 15.5 Total assets 146.9 145.3 Current liabilities -20.9 -15.2 Assets less current liabilities 126.0 130.1 Non current liabilities (borrowings) -21.8 -13.9 Total assets employed 104.2 116.3
Points to Note • Our year-end financial position was disappointing – Costs rising faster than income – Slippage against planned efficiency programmes – Higher running rates of expenditure than expected – One off savings masked our underlying position • As a result, we are in Breach of our Authorisation • The task in 2012/13 is very stretching – Tariff reductions – Cash implications of ongoing losses
Financial Priorities Sustainable Top Quality Services Clinically Led Recovery Plans Providing Excellent Integrated Care Upper Quartile Performance Financial Balance A Better Deal for Patients
2011/12 – Review of the year
2011/2012 – a year of change July 2011 transfer of community services November transfer of maternity services from 2011 Salford February Transfer of maternity services from 2012 Bury
Awards 2011/12 – focus on quality • Clinical Leader of the Year 2011 ‐ British Medical Journal Group Awards. • Nurse of the Year 2011 ‐ Nursing Standard Awards. • North West Clinical Leader of the Year ‐ NHS North West Awards. • Best Process Improvement Project in Service & Transaction 2011 ‐ National Process • Excellence in HRM Award 2011 ‐ Healthcare People Management Association. • Patient Safety in Surgery ‐ National Patient Safety Awards 2011. • Apprentice of the Year 2011‐ NHS North West. • Working in Partnership to Narrow the Gap in Health Inequalities ‐ Community Empowerment Awards 2011.
Performance 2011/12 • However found in breach of terms of authorisation for failing to achieve 18 week (admitted) and urgent care targets. • Other compliance targets achieved full list in annual report • Our redesign plan clinically agreed and implementation began – Significant improvements to urgent care and 18 week performance – both achieved consistently in 2012
A&E four hour wait performance Month Attendances Performance April 12,880 97.2% May 13,916 97.2% June 12,789 97.7% July 13,082 97.2% August 9,900 99.0%
18 week (admitted) performance Month Performance April 92.7% May 94.7% June 93.8% July 92.3% August 93.9%
Current Performance against targets and standards Standard Data Period Threshold Actual Comments RAG Clostridium Difficile 1st April to 26 th August (Post 72 Hours) 2012 30 Financial Year target = 28 1st April to 26 th August MRSA 2012 2 Financial Year target = 2 1st April to 26 th August A & E 4 hour wait 2012 95.0% 97.6% Q2 prediction 98% 18 weeks RTT- Admitted July 2012 90.0% 92.3% Q2 prediction 91.5% 18 weeks RTT - Non Admitted July 2012 95.0% 97.1% Q2 prediction 97.0% 18 weeks RTT - Incompletes July 2012 92.0% 96.5% Latest data is 96.7% RTT information July 2012 50.0% 99.9% Q2 prediction 99.9% Referral information July 2012 50.0% 100% Q2 prediction 100% Treatment activity information July 2012 50.0% 100% Q2 prediction 100%
Clostridium Difficile
Membership Report 2011/12
Membership Report 1 st September 2012 4,812 public members Gender Male 47% Female 53% Age 16 - 24 10% 25 - 44 31% 45 - 64 33% 65 - 74 13% 75 - 84 10% 85 + 3%
Membership FT Membership (Public Members) September 2012 5500 5000 4812 4617 4519 4500 4385 4298 Members 4000 3834 3500 3000 Date
Constitution changes
Changes to constitution in line with the requirements of the 2012 Act • The continuation of the body corporate known as Monitor; • Requirement for the principal purpose (i.e. provision of goods and services for the health service in England) to be stated in the constitution; • Introduction of the new legal duty to ensure that income of NHS funded goods and services is greater than income from other sources; • Introduction of additional oversight and scrutiny by the Council of Governors over activities generating non-NHS income; • Replacement of HM Treasury with Secretary of State as regards giving guidance over FT accounts
Questions
Improvements through integration
Integration of Musculoskeletal Services in Bolton “A modern marriage” Phil Wykes September 2012
What was the past like?
Spare The musculoskeletal capacity in Duplicate the CAT service old state appointments of average 70 per month each for pre- assessment and OPD 75% CAT Conservative appointment treatment 25% Health 50% assessment Other surgical Referral Long waits provider at RBH 50% Surgical RBH appointments appointment used for non- surgical patients 35% 65% Conservative Post-op Pre-operative Ward Theatre treatment intervention assessment
What did that mean? • Complicated • Expensive • Duplication • Long waiting times (up to 13 weeks) to see a surgeon • Difficult to manage • Fractured • Poor communication
What Did Integration Mean? • PCT provider arm merged with the Hospital • Two MSK services → one • New model of care • Opportunity to relocate and redevelop
How did we organise it? • Bolton Improving Care System • Mapping week- June 2011 • Established a core group • Clinician-led, staff-driven • Patient involvement at every stage • Several improvement events, including – Present state – Ideal (future) state – How to bridge the gap
Mission Statement “ I would like a truly human experience provided by the right caring professional at the right time in a clean, safe place that delivers the best possible outcome ”
Aim of the new & improved service Improve patient journey Realign non-surgical and surgical capacity to help achieve 18 weeks Reduce waste
This means…. • Right pathway early • Right clinician first time • Reduce visits / investigations / pre-assessments • More cost effective • Ensure high quality care – equitable, standard • Patient-centred & with Shared Decision Making • Patients better prepared for surgery to reduce the time spent in hospital • Capture the work • Maximise income
Process for The integrated surgical opinion musculoskeletal service if required by Generalists Conservative Non-surgical treatment appointment Triage rules written Feedback loop Referral Triage re quality of referrals Post-op Surgical Pre-operative Ward Theatre intervention appointment assessment Enhanced Recovery Programme Clinical Pathways Shared Decision Making Patient Education
Bolton One • Joint development between:- – University – Council – Foundation Trust • Generalist and support staff moved May 2012 • Surgeons moved May to July 2012 • Redesigned templates and allocated clinic space • Joint triage system developed that happens daily
Waiting Area
Reception
AOP consultation
Surgical consultation
X-rays
Pre - Assessment
Results so far….. • Co-located over May to July 2012 • Reduced surgical waiting times:- Was 12-13 weeks Now: – Foot and ankle 2 to 4 weeks – Upper limb 7 weeks – Lower limb 6 weeks Better than predicted (10 weeks) without drop in referrals and without impacting on non-surgical waiting times • Reduced unnecessary investigations e.g. halved use of nerve conduction studies – saving £25k • Revamped Back Pain service
Problems Bolton One is not perfect • Change is painful – Staff – Patients – Working practices • Split-site working has its own problems • Need to fully integrate teams & encourage cross referral
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