Transcript Ambulatory Care - The Princess Alexandra Hospital

Annual General Meeting &
Local Healthcare Event
2011
6:25pm
Managing Diabetes
Dr Andrew Soloman, Diabetes and Endocrinology
Consultant
6:40pm
Transforming Emergency Care, the Future
Dr Yvonne Barlow, Acute Medicine 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
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
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
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?
Chairman’s Pride
PAH and Harlow
- Nutrition, Cleanliness, Length of Stay, Art in Hospital
- Reputation
- Partners/Friends
Thank You!
- Staff
- The Board
- You
Managing diabetes
Dr Andrew Solomon
Locum Consultant in Diabetes and
Endocrinology
Managing Diabetes
1) patients’ self
management
2) professionals’ role in
managing diabetes
What is diabetes and why is it
important?
It’s Very Common
• Diabetes Mellitus is
defined as:
• A clinical condition
manifest by persistently
raised blood sugar levels
• Why is it important?
• 4,7% of the population
nearly 1 in 20 people
• 1 in 10 inpatients
It’s Linked with Serious
Medical Complications
•
•
•
•
•
Heart attacks
Stroke
Amputations
Risk of blindness
Risk of kidney failure
• Longer hospital stay
Should Diabetes concern us all?
• Yes...
• Because
• 1) For individuals, many of us are at increasing
risk of developing diabetes, especially if we
are overweight
• 2) For the NHS, the concern is that there will
be an increasing presence of people with
complications if diabetes needing treatment;
requiring time, energy and resources
1) Patient’s Self Management:
When diagnosed with diabetes, what should patients do?
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See the GP and practice nurse
See a dietician
Arrange eye and foot checks
After discussion, take prescribed medication
Join Diabetes UK
Optimise diet
Increase exercise
Book a diabetes education course*
(In West Essex...these are called: DAFNE for Type 1 diabetes and EXPERT for Type 2 diabetes)
My diabetes
In Scotland..
Patients now see their own data..
2) Professionals role in managing diabetes:
New developments in clinically-led local diabetes
services
• Improved assessment of the 9 ‘key checks’
• Improved calibre of professionals deliver diabetes
care
• Improved specialist practitioner care in patients’ own
homes
• Improved sub-specialist hospital clinics designed with
patients’ needs in mind
• Improved care of inpatients with diabetes
Percentage of people with diabetes receiving nine key care processes by PCT
2008/09; 35 fold variation
In 2008–09, the NDA showed
that only 50.8% of people with
Type 2 diabetes, and 32.2% of
those with Type 1 Diabetes,
had received all nine key care
processes recommended by
NICE despite good evidence
base for these interventions.
When the five PCTs in which
the percentage of people with
diabetes receiving the nine key
care processes is the
highest and the five PCTs in
which it is the lowest are
excluded, there is still a fivefold
variation among PCTs.
How is Princess Alexandra Hospital managing
diabetes?
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New clinical guidelines
New Diabetes Specialist Nurses
New integrated care arrangements
New specialised clinics
New ways of optimising patients’ experience
Diabetes care in the future
• Patients to access their own health data
• Patients will be in a better position to liaise
with highly qualified diabetes professionals
• Patients will know their ‘treatment aims’ and
how they might be helped in achieving them
• Patients will use electronic media to share
ideas, receive updates and plan their care
• ...overall, managing diabetes is managing better
Thank you for listening
Any Questions
Transforming Emergency Care –
The Future
Dr Yvonne Barlow,
Acute Medicine Consultant
Ambulatory Care
• Ambulatory care is different from GP care in that
specific expertise or diagnostic tests provided in a
hospital may be required to include or exclude
disease e.g. chest x ray, CT scan.
• Once a diagnosis has been made, AMBU staff can be
responsible for all of that patient’s care or this can be
shared with the GP or other specialty once the
problem is identified.
• Staffed by a medical consultant and a junior
doctor from 9:00am to 6:00pm
• Dedicated nursing staff look after the patients
in:
– One female 3 bedded area
– One male 3 bedded area
– Provides continuity of care for the patient with
staff that they know
• By providing the correct environment and
qualified personnel we can:
– see and treat the medical or surgical conditions
which would normally have required a hospital
admission as out-patients
– provides space to carry out procedures e.g. chest
drain
– provide a means for review, transfer to other
specialty or transfer care back to the GP
Ambulatory Conditions - Cellulitis
• Decide if the patient is suitable for
intravenous antibiotics at home
• Insert a cannula to administer the intravenous
antibiotics.
• With the patient decide whether they would
like the district nurses to give medication or
whether they want to return for this to AMBU
when they choose.
Ambulatory Conditions - Pulmonary
Embolism or Lung Clot
• Decide whether it is likely to be a blood clot or other
pathology with chest x ray and blood tests.
• Organise a scan the same day or within 72 hours.
• Teach the patients how they can self administer their
own injections prior to having the scan.
• Coordinate seeing the patients afterwards in AMBU
and treat or discharge.
Patient Satisfaction
• These are 49 such conditions about which we have
data and which we know from experience here and
in other hospitals that are to be safe to managed on
an outpatient basis
• This allows patients who would prefer this to be
managed at home and have input from district nurse
or community teams
• Many patients choose to come back to AMBU to be
treated. They can often fit this around a work
schedule/child care.
Ambulatory Care
• Ambulation of otherwise quite well patients
avoids the need for a hospital stay thus:
– Reduces the chance of transmission of hospital
acquired infections
– Increases patient satisfaction
– May reduce time off work
– Reduces cost to the health service by being able
to discharge the patient that day or by reducing
length of time spent in hospital
Future Plans
• As we learn form our pilot we will be able to:
– Extend the number of conditions we currently
treat on an ambulatory basis
– Extend opening hours to include up to 9:00pm
and weekends
– Improve diagnostic services
– Improve our patients satisfaction with the service
as we become more efficient
Emergency Activity Vs Plan
Spells
2,500
2,000
1,500
1,000
500
0
Apr-10 May-10 Jun-10
Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11
Actual
Plan
Planned Care Activity Vs Plan
Spells
3,000
2,500
2,000
1,500
1,000
500
0
Apr-10 May-10 Jun-10
Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11
Actual
Plan
National Targets
Planned Care
Accident and Emergency
Cancer
Number of Patients
Waiting >18 Weeks
Back
4 Hour Emergency Care Target
NationalTarget
Performance Against Cancer Targets
Target
%
2010/11
2 Week Wait
93%
Compliant
2 Week Breast Symptoms
93%
Compliant
31 Day First Treatment Standard
96%
Compliant
62 Day Standard
85%
Compliant
62 Day Screening
90%
Compliant
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
Conclusion
• PAH is a very clean hospital that provides a
good standard of care and treatment.
• Many successes have been reported despite
it being a challenging year.
• 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.
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
Performance Against Key Statutory
Duties
Duty
2010/11
Achieved
Duty to breakeven remaining within the statutory
resource limit (RRL)
£415,000
surplus
√
Duty not to over-shoot the External Financing Limit
£3,306,000
under
√
Duty to remain within the statutory capital cash limit
(CL)
£4,166,000
under
√
Our Costs
Depreciation
£6,821
Dividends,
£4,063
Medical,
£37,861 – 21%
Operating
expenses,
£38,034
Drugs, £11,907
Other staff,
£39,740 – 22%
Nursing,
£40,547 – 23%
Our Capital Expenditure
Did You Know?
PAH was one of
the first to go £1,377,000
fully digital for
breast cancer
£1,602,000
screening
£807,000
£677,000
£1,592,000
The Financial Plan for 2011/12
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Balance financial plan
Year to date small underperformance
Overall Cost Improvement Target of £17.0m
Cost Improvement Programme of £13.0m
Additional transitional support to balance
The Financial Picture for 2011/12
17
10
Critical Care
Elective
Outpatients
0.5
2.5
3
A&E/Non Elective
Price Deflation
Cost Inflation
3
4
4
7
2.5
2.5
4.5
Savings Challenge
Capacity Reduction
Productivity
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The Way We Work Must Change
National Government Reform & Shift in
Thinking About How Healthcare is Provided
Population Changes – ageing and growing
Impact of 21st Century Lifestyles/ Long Term
Conditions
Rising Drug and Technology Costs
Less Money Available for the NHS
Building for Excellence
We have exciting plans to
become one of the best
hospitals in the country.
The plans, called Building
for Excellence, aim to make
services more effective
and further improve the
experience of patients.
Financial
Performance
Patient
Experience,
Safety and
Quality
Building
for
Excellence
Operational
Excellence
Health of
the
Organisation
Our Immediate Plans
Clinical Productivity – Build consistency across our
operational performance e.g. length of stay, waiting
time targets
Workforce – Tackle some of the problem areas e.g.
sickness, bank and agency usage
Staffing – Look at how our back office departments
function to protect front line services
Other – The way the hospital and wards work
Change is Starting to Happen
People waiting less time – since April 95% of
people have waited less than 4 hours to be seen in
A&E, the backlog of people waiting over 18 weeks
has halved, and the wait for most tests is less than
6 weeks.
Departments are Using Resources More
Effectively – e.g. calling patients with test results,
telephone triaging in some specialties and better
community support to care for people
at home
Conclusion
• We are committed to creating a hospital that
is one of the best in the country.
• Only by securing our financial future will we
be able to deliver the quality of care our
patients deserve.
• It will be tough but we see this as an
opportunity to change for the better.
Any Questions