Welcome to our Annual General Meeting 2014 1 October 2014 Watford Hospital

1. Welcome to our Annual General Meeting 2014 1 October 2014 Watford Hospital

2. Welcome and opening remarks Mahdi Hasan Chair @chairwhht

3. An overview of last year and our plans for the future Samantha Jones Chief Executive @SamanthaJNHS

4. What do we stand for?

5. About us… • Three main hospitals • Serves 500,000 people • 600,000 patient contacts a year • 83,433 A&E patients • 14,411 minor injuries unit visits • (St Albans Hospital) • 29,356 urgent care centre visits • (Hemel Hempstead Hospital) • 5,787 babies delivered

6. About us… • 425,813 outpatient appointments • 41,415 planned admissions • 49,934 emergency admissions • £290 million turnover • 4,000 doctors, nurses, midwives, • porters, cleaners and other staff • 500 volunteers • Four clinical divisions, plus • support services

7. Celebrating success… • ‘Onion’ – peeling back the layers • 20% reduction in mortality, • inc for hip fractures • 40% reduction in C. difficile • 95.6% of A&E patients treated, • admitted or discharged in maximum • of four hours (standard = 95%) • Extra £9m invested in patient safety, • inc £3.9m on 160 new nurses

8. Celebrating success… • Opened The Granger Suite, • inc Bluebell and Winyard wards • Opened ambulatory care unit (ACU) • £25.5m to be invested on IT • £16m investment in upgrading • wards, clinics and other areas • New senior team including Chief • Nurse, Director of Finance and Chair • ‘Developing our Organisation (DO)’

9. The official opening of The Granger Suite

10. Celebrating success… • Opened new emergency surgery • assessment unit (ESAU) • Opened new dietetic kitchen • Launched new cycle facilities • across all three sites • £600,000 upgrading theatres • Launched iWantGreatCare • Shortlisted for HSJ (Health Service • Journal) patient safety award

11. Cycle facilities official opening

12. Our performance against key standards 2013/14

13. Our performance against key standards 2013/14

14. Moving forward… • ‘Onion’ – peeling back the layers • Learn from complaints, incidents and • litigation – centralised • Achieving our financial target (£14m • deficit, including savings of £13.4m) • Transformation programme • West Hertfordshire strategic review • Trust clinical strategy including • Watford Health Campus

15. Artists’ impression of Watford Health Campus

16. Transformation Programme - Structure and Design Strategic change - Future state of organisation Clinical Strategy Doing today right Ensuring Services are Well Led Ensuring Services are Safe Ensuring Services are Caring Ensuring Services are Responsive Ensuring services are Effective • Governance and Leadership • Quality Governance • Clinical Leadership • Corporate Governance • Organisational Restructure • Clinical Effectiveness • Obstetrics and Gynaecology • Hospital 7/7 • Job and Team Planning • Mortality • Patient • Experience • Complaints & Serious Incidents • Patient Experience & Strategy • Estates & Health and Safety • Nursing • Workforce and Safety • HR Systems, Recruitment and Retention • Operational • Effectiveness • Referral To Treatment • Unscheduled Care • Cancer • Diagnostics Financial Viability LTFM, Efficiency savings, Cost reduction, Income generation, Financial support Organisational Development Change Programme Communications and Stakeholder Engagement Information & Communication Technology & Decision Support (including Coding)

17. Working in partnership • Herts Valleys Clinical • Commissioning Group • Hertfordshire Community NHS Trust • Hertfordshire Partnership University • NHS Foundation Trust • Hertfordshire County Council and • other local councils • Healthwatch, our Patients’ Panel and • other patient groups • many, many more…

18. Financial overview and looking forward to 2014/15 Don Richards Chief Financial Officer

19. Income and expenditure 2013/14

20. Financial summary 2013/14 • Financial delivery • Deficit of £13.4m • Savings delivery of £7.6m • Capital investment of £17.6m • Challenges • Significant increase in emergency activity • Slippage against savings target of £15m • Increase in agency costs • We spent an additional £7.5m in frontline staff to improve quality of care provided to patients • Non-recurrent transformation funds of £4.1m received to support the cost of maintaining our three hospitals and initiatives to improve efficiency

21. Activity performance 2013/14 • Note: • Emergency activity excludes other non-elective activity such as maternity due to the changes in counting from 2013/14. • Outpatient totals exclude activity relating to maternity due counting changes for these services from 2013/14.

22. Trend of pay expenditure FY07 to FY14

23. 2014/15 planned sources of income £m

25. 2014/15 financial outlook • Financial plan • Income of £281.9m • Planned deficit of £14m • £13.4m savings programme • Capital investment of £15.4m • Investment in IT (£6.1m) and Organisational Development (OD) (£1.5m) • Challenges • Delivery of savings programme • Cost of transformation programme • Cash balance • Suitable payment for emergency work • Working collaboratively with our commissioners to ensure we are reimbursed appropriately for our emergency work • We are in continuing discussions with the NHS Trust Development Agency (NHS TDA) who are supportive of our wider transformation programme

26. Quality developments in care of the cognitively impaired –‘people not patients’ Hello My Name is: Dr Tammy Angel Clinical Director of Elderly Care and Stroke

27. Dementia Dementia is a progressive and largely irreversible syndrome that is characterised by a widespread impairmentof mental function. Memory/ recall Complex motor tasks Recognition and reasoning Verbal communication

28. Dementia in hospital...F.A.I.R Screen and identify people T R A I N I N G Outreach for general wards Bluebell specialist care 25% of people in hospital have Dementia. 40% of people with hip fractures Appropriate discharge planning and signposting

29. Dementia Nurse Specialist Point of contact/support advice- patients/ relatives/staff Audit Screening Dementia specific care plans Satisfaction / feedback survey Dementia champions + link nurses Discharge information Training programme End of life care Outreach support

30. Other frailty units…Queen Elizabeth Hospital, Gateshead: Future Hospital Commission case study • Challenge: older people with both physical and mental health illness cared for on general wards by staff with limited expertise • Dual care ward increased focus on basic care and nutrition, by staff with specialist skills • Outcome: reduced falls, reduced need for IV fluids. Better care for this group of people • “staff.. see these people as ‘their kind of person’ and not people who should be moved somewhere else” … Right care for person is also most cost effective care for the ‘system’…

31. Improved quality of patient care Staff more knowledgeable to your needs Reduced risk of falls Good dementia care is just good care Better toiletting, and continence management Reduced stay in hospital Better fluid hydration Better nutrition

34. Bluebell ward.. He doesn’t like mornings so we leave him last, he prefers male carers; you have to speak slowly otherwise he won’t catch what you say – but if you take it slow – he is a pussycat. Oh and he will only eat porridge for breakfast and likes his tea really hot. He’s easy no bother at all! Tell me about Mr H Mrs M has had 10 children- amazing! Mrs L loves knitting and gardening Mr R was a world renowned author of American Military history. Mr D was a cinematographer. Mrs R has been feeling low since her dog died who was her companion since bereaved of her husband. Tell me Something personal about the people here

35. The problem with being confused... • We ‘wait’ for delirium to resolve in hospital • Just staying in hospital may be prolonging the condition ... long hospital stays • Whilst waiting run risk of infections, falls in unfamiliar environment + further confusion/distress • Limited options to date: physically able but not safe for discharge • Option to transfer to residential care. Also unfamiliar. • All above carry significant cost both for the individual and the health social care purse ... There is no place like home!

36. Delirium Recovery Programme.. multiprofessional collaboration with patient in centre

37. DRP: Delirium Recovery Programme Hospital Admitted onto Virtual ward HOME

38. DRP: Delirium Recovery Programme

39. 1st PRIZE inpatient ward ‘Our kind of people’ 92.3% Extremely Likely to recommend 7.7% Likely to recommend

42. Transforming our IT Lisa Emery, Chief Information Officer @LisaEmNHS David Gaunt, Associate Medical Director for IT @davecas48

43. “The single biggest investment in IT across Watford, Hemel Hempstead and St Albans hospitals for more than a generation” “The new investment will help revolutionise the way that we work. The benefits for our patients, as well as staff, are immense and will truly help us to improve the care we provide to our patients”

44. Background • Our current IT systems are very old, slow and it’s hard for us to connect them to the latest software • Our Information Management and Technology Strategy set out the creation of a ‘digital hospital environment’ • On 16 June 2014, we signed a 5 year contract with CGI Limited to transform our IT Infrastructure • This is an investment of £25.5m, supported by the NHS Trust Development Authority (NHS TDA) and our partners, which will enable us to transform our services

45. What does this deliver for west Herts? • A new 24/7/365 service desk • Faster networks • New devices • An improved email service • Mobile working • Single sign-on • Single document store for policies and guidelines • WiFi access at all sites • Messaging services • Patient kiosks • Electronic patient tracking • Unified communications – single point of contact for phone, email, messaging

46. 2015/16 2014/15 Q3 Q4 Q1 Q4 Q2 Q3 Unified Communications Document Portal Email Upgrade 1Gb Mailboxes Service Desk Desktop Replacement Complete Wifi Rollout Complete Asset, Patient and Lone Worker Tracking Data Centre Migration & Disaster Recovery Complete Reliable Modern Networks Data Centre Ready

47. What will this mean for our staff and patients? For our staff: • Less time spent at the computer • Mobile working e.g. at other sites or patient’s homes • More agile ways to work with colleagues e.g. videoconferencing and instant messaging • One sign-on for all systems • Enhanced patient and equipment tracking For our patients and visitors: • Staff have more time to spend with patients • Improved patient safety • Ability to use WiFi at our sites • Patient kiosks to speed up appointment check-in • SMS (text) appointment reminders • Information shared more quickly and securely

49. Equipment, patient and lone worker tracking Using our new WiFi network and electronic tags: • Tracking of vital medical equipment, reduction in delays and loss • Safety for staff within our sites and in remote locations • Improved safety for vulnerable patients • Ability to direct equipment and staff to where needed Staff badge/pager: Patient tags: Asset tags: Temp/RH sensors:

50. Improved safety for vulnerable patients • Safety for staff within Trust sites and in remote locations • Tracking of vital medical equipment, reduction in delays and loss • Ability to direct equipment and staff to where needed • Utilising our investment in WiFi Staff badge/pager: Patient tags: Asset tags: Temp/RH sensors: Real time tracking and communication