Annual General Meeting & Local Healthcare Event 2011

1. Annual General Meeting & Local Healthcare Event 2011

2. Welcome Gerald Coteman, Chairman

3. 6:25pm Developments in Maternity and Specialist Baby Care Debbie Twist, Head of Paediatrics 6:40pm Tailored Care for Hip Patients at PAH Dr Jane Snook, Consultant 6:55pm An Operational Overview Darren Leech, Chief Operating Officer 7:00pm The Finances, Charles McNair, Executive Director of Finance 7:05pm The Year Ahead, Melanie Walker, Chief Executive 7:20pm Questions to Speakers 7:30pm Close Agenda

4. A Year of Transition Where We Were - Under pressure from key partners due to erratic performance - An uncertain future - Changes at the top Where We Are Now - Good habits versus rocket science - Leadership and behaviours propel successful organisations - Challenging the status quo - Feet firmly on the ground - Focus on the things that matter most £/Q - Our Foundation Trust journey

5. Taking Control Health versus Hospitals - Stronger engagement with stakeholders to meet health needs (versus demand) - Clinical and patient empowerment - Long Term Conditions - Business model will be different Managing the Business - Clearer direction of travel (more later) - Cost control and efficiency - Retaining and attracting the best people - Strong working relations with customers/regulators

6. Remaining Challenges Patient Experience - NHS Achilles heel - Reminders of where we have failed and learning from them - The search is on for Gold Standard at PAH Commissioning for Health - Targets for guidance – not for health! - Managing and self managing Long Term Conditions - Deep and sustainable reform of commissioning – GPs?

7. Chairman’s Pride PAH and Harlow - Nutrition, Cleanliness, Length of Stay, Art in Hospital - Reputation - Partners/Friends Thank You! - Staff - The Board - You

8. Developments in Maternity Services and Specialist Baby Care at Princess Alexandra Hospital MaternityDebbie Twist, Head of Paediatrics

9. The Maternity Unit Births for the last 10 years • 10 years ago (2000/01) 2678 births • 5 years ago (2005/06) 3061 births • Last year (2010/11) 4146 births • Recruitment has been on-going and successful • Midwife to births ratio 1:37 • Our aim is to get this ratio to 1:35

10. Innovations in Maternity • Caesarean Section Task Force Group • Vaginal Birth After Caesarean - VBAC (80% success rate) • Expansion of the Birthing Unit – 3 pool rooms • Expansion of labour ward – 1 extra delivery room (9 in total) • Extended opening hours of Maternal and Fetal Assessment Unit (MAFU) and Triage • Coming Soon – outpatient induction of labour, telephone triage and gynae ambulatory care

11. PAH Neonatal Unit • Part of the East Of England Neonatal Network • Level 2 Neonatal Unit • 16 cots in total - 2 ITU, 4 HDU, 10 SCBU • 28 weeks gestation above • Equitable, high quality neonatal services • BAPM Standards • DOH Neonatal Toolkit • Bliss Report • Poppy Report • NSF Children and Maternity Services

12. Maintaining Level 2 Unit • Staffing levels • Appropriately trained staff • Environment • Equipment • Services provided THE NEW BUILD IS KEY

14. Our Achievements • Neonatal Consultant, Unit Manager & Clinical Facilitator in post • EOE Neonatal Network protocols • Community Neonatal Nursing team pilot • NEC care bundle • Developmental care • Enhanced Neonatal Nurse Practitioner

15. Community Neonatal Nursing Team • Pilot project June 2010 with West Essex Children’s Commissioners • Early discharge, support parents & families • Repatriation babies • Improved breast feeding rates • Reduction in readmissions

16. Community Neonatal Nursing Team • Total number of cot days saved from June 2010 – June 2011 is 1014 • Comments from service users undertaken have been very positive • Further pilot to extended to 7 days a week from 1st Sept

17. NEC Care Bundle • East of England initiative • Standardise feeding management across network • Training & support • Recent audit PAH top achiever Improved outcomes for neonates

18. Developmental Care Support the holistic development of the pre – term infant • Positioning – head and limbs • Early contact with Mum – kangaroo care

19. Tailored Care for Hip Fracture Patients at PAH Dr Jane Snook Consultant Orthogeriatrician

20. Contents • Epidemiology • Background to changes in hip fracture care • Hip fracture care at PAH • Harold ward • Integrated care pathway • Results of national audit • Future plans • Conclusions

21. Epidemiology of Hip Fractures • Commonest serious injury to older people • Can bring loss of mobility and independence • High costs for society the costs ~ £2 billion/year for the UK • Average age 83 3:1 F:M • 74% admitted from own home 20% from RH/NH • Mobility

22. Background • Traditional care lead to high mortality and morbidity • About 10% of people with a hip fracture die within 1 month and about one-third within 12 months • High prevalence of comorbidity • BOA and BGS – Blue Book • NHFD launched 2007 • Best practice tariff • NCEPOD November 2010 • NICE guidelines June 2011

23. Harold Ward • Opened in September 2009 • 28 bedded hip fracture unit • Business case developed by hip surgeons • Multidisciplinary care led by orthogeriatrician • Hip fracture specialist nurse/physio • Structured care ICP

24. Hip Fracture Best Practice Tariff • Patients admitted under joint care of geriatrician & orthopaedic surgeon • Seen by orthogeriatrician within 72 hours of admission • Admitted using an assessment protocol agreed by geriatric medicine, orthopaedic surgery and anaesthesia • Surgery within 36 hours from arrival in an emergency department, or time of  diagnosis if an inpatient, to the start of anaesthesia • Postoperative geriatrician-directed care • Multi-professional rehabilitation team • Fracture prevention assessments • Falls & bone health

25. Integrated Care Pathway • Assessment by orthopaedics & medics • Timely analgesia and investigations • Transfer to Harold ward • Discussion at trauma meeting • Surgery within 36 hours of admission • Falls risk and bone health review • Early mobilisation and patient-centred discharge

26. Multidisciplinary Care

27. Harold Ward • Daily white board rounds • Weekly full MDT meeting • Monthly team meetings – NHFD results • Mortality review group • Full notes review of all in-hospital deaths • Care of other elderly orthopaedic patients

28. National hip fracture database 2011 Results • 53,443 cases submitted • 176 hospitals • 1st April 10 – 31st March 11

29. Areas PAH Performing well • All patients admitted under joint care (6% nationally) • All patients receiving medical consultant review pre-operatively • Time to theatre <36 hrs (62% nationally 73% PAH) • Surgery during working hours on consultant lead list • All patients admitted to Harold Ward receiving specialist falls assessments by MDT (81% nationally) • All patients admitted to Harold receiving osteoporosis assessment and treatment commenced when appropriate

30. July 2011 PAH Report • 24 admissions 7 men 17 women • Average age 82 Age range 59-97 • 70 % directly admitted to Harold (100 % during stay) • Average time to ward 11.9 hours • 83 % had surgery within 36 hrs • 92 % seen by orthogeriatrician within 72 hrs • 100 % assessed for bone protection and falls • 75 % eligible for best practice tariff • Average length of stay 17.3 days (national 20.5)

31. Areas Under Improvement • Pressure sore care (rate 15.5 %) • Full nursing review to optimise nursing numbers and grades • Improvement of processes on ward to ensure optimisation of rehabilitation • Tissue viability support • Time to Harold ward • Close liaison with bed managers • Aim for ring-fenced bed

32. Future Plans • Ambulance pre-warning A&E • Fast transfer to Harold ward • Senior physio or nurse to carry bleep • Length of stay initiatives • Use of Harold ward to benefit other emergency surgical non-hip fracture patients

33. Conclusions • PAH has infrastructure to deliver best practice • Substantial improvements over last 2 years • NHFD and mortality review highlight areas for improvement • Pre-warning by ambulance crews should improve outcomes further

34. An Operational Overview Darren Leech,

35. Emergency Activity Vs Plan

36. Planned Care Activity Vs Plan

37. National Targets Planned Care Accident and Emergency Scans and Tests Cancer

38. Back Number of Patients Waiting >18 Weeks

39. 4 Hour Emergency Care Target National Target

40. Performance Against Cancer Targets

41. Quality and Safety Improving the Quality of Our Care and Treatment - Introduced protected mealtimes so patients could be helped with eating and drinking where appropriate - Introduced Doctor and Patient/Carer communication surgeries - Less unnecessary time in hospital because of a reduction in our length of stay Providing Better, Safer Services - Remained one of the best hospitals in combating infections - Offering better, safer services – the hospital standardised mortality ratio

42. Conclusion PAH is a very clean hospital that provides a good standard of care and treatment. Manysuccesseshave been reporteddespite it being a challengingyear. The Trust saw more patients than planned which impacted our operational performance in some areas. The challenge is to create a viable healthcare system within which the hospital can consistently perform to a high standard.

43. A Financial Overview Charles McNair

44. Our Financial Performance • A small surplus of £415,000 was made • Increasing demands on our own services, particularly emergency • Nearly £6 million invested in the estate, services and equipment • A £5million Cost Improvement Programme was delivered • Achieved all the main statutory financial targets

45. Performance Against Key Statutory Duties

46. Our Costs Did You Know? 2/3 of our money is spent on staff

47. Our Capital Expenditure Did You Know? PAH was one of the first to go fully digital for breast cancer screening

48. The Financial Plan for 2011/12

49. The Financial Picture for 2011/12 10 17 Critical Care Elective 0.5 Outpatients 2.5 3 A&E/Non Elective Price Deflation Cost Inflation 3 4 7 4 2.5 2.5 4.5 Savings Challenge Capacity Reduction Productivity

50. A Look Forward Melanie Walker, Chief Executive