Annual Public Meeting - Barts Health NHS Trust

Annual
Public Meeting
18 September 2013

Sir Stephen O’Brien
Chair

Peter Morris
Chief Executive

Purpose of today
• Looking back at the 2012/13 year, our first as Barts Health NHS
Trust
• Taking stock of 2013/14 so far, and the issues and opportunities
we are dealing with, so that we end the year in a good position
against our service, academic and financial objectives
• Delivering on our public health vision
Barts Health – Changing Lives

Barts Health at a glance 12/13
Waltham Forest
• Largest NHS Trust in the
country
• St Bartholomew’s is
London’s oldest hospital
established in 1123
• £1.25 billion turnover
• 15,000 employees
• 15,000 births
• 53,000 operations
• 213,000 diagnostic tests
• 420,000 emergency
patients
• 1,300,000 outpatient
attendances
Hackney
Population 272,906
(includes City)
City of London
Barts
Tower
Hamlets
Population 242,618
Population 270,702
Whipps Cross
London Chest
Royal London
Mile End
Newham
Newham
Population 333,256

A few first year highlights
• Clinically-led Barts Health structure went live on 1 October 2012
• We delivered cost improvements of £49m
• HRH Her Majesty The Queen opened the new Royal London Hospital in February 2013
• The Royal London Hospital’s Hyper Acute Stroke Unit (HASU) was recognised as best
unit in London
• Strong performance against national operational targets, meeting ten of the twelve
national standards
• We delivered healthcare support for the Olympic and Paralympic Games
• Opened new services across Barts Health:
– Emergency Department at Newham University Hospital
– Emergency Department at Whipps Cross University Hospital
– 24/7 emergency arrhythmia service at St Bartholomew's
– Renal dialysis unit at King George Hospital in Redbridge
– Barking Birthing Unit, with the first babies born in November 2012

Under way in year two
• Excellence in Older Persons Care programme: all staff from our elderly care wards
undertake a dedicated week of intensive integrated team working with a view to
securing excellence in patient care and experience
• Further improvement in infection control with 30% lower MRSA rate compared with
2012/13 and meeting Clostridium Difficile stretch target. Whipps Cross went over a
year without an MRSA infection
• Focus on delivering A&E and elective care referral to treatment time targets
• Our hospital mortality rates consistently place us in the top ten in the country
• Successful recruitment of six consultants in A&E at Whipps Cross, bringing
substantive consultant numbers to eight
• Among the country's top performers in recruiting patients for clinical research, and
appointed host for the region's governance of £28m National Institute for Health
Research (NIHR) funding
• Identified £63m cost savings this year, with a full year effect next year of £82m

Financial performance 2012/13
• Delivered a surplus of £0.4m
• Secured cost savings of £49m
• £49m underlying deficit after merger
support and other non-recurrent income
• Cash held at the year-end was £66m
• £31m Capital investment
• Royal London and St Bartholomew’s PFI
payments from £71m in 2011/12 to £109m
in 2012/13 (20% of legacy Barts and The
London Trust turnover)
• Newham PFI payment was £13m (8% of
legacy Newham Trust turnover)

Financial position 2013/14
• Cost improvement target of £78m savings by the end of 31 March 2014
(compared with £49m delivered in 2012/13) primarily based on the national
tariff efficiency, reduction in merger support and changes education funding
• 58% increase in cost savings required, £6.5m per month on a 'flat' profile
• Move from fixed income contract with east London Clinical Commissioning
Groups to 'Payment by Results' funding, with a further commissioning
reduction of £10m non-recurrent support
• By June, £50m 2013/14 cost savings identified
• Turnaround launched in July to deliver the £50m identified, bridge the
outstanding gap, and meet the income targets through activity plans and
avoiding contractual fines under Payment by Results
• Cost improvements to the full year value of £82.6m
• All cost improvement schemes go through a clinical approval process with
final validation from the chief nurse and medical director

Key areas of focus for this year
• A&E and elective care performance, and
other quality improvement objectives
• Delivering on our financial objectives safely,
and further improving the underlying position
• Strategy proposals for services and
hospitals, including proposals for change in
specialist cardiovascular services and a
range of specialist cancer surgery across
north central and east London.
• CQC standards, #becausewecare campaign
and improving patient experience and how
we support patient involvement
• Delivering regular staff feedback and
meeting mandatory training and appraisal
requirements
• Further increasing our recruitment of patients
in research studies
• Public health

#becausewecare
• A call to action to deliver compassionate care
everywhere and to improve the patient experience of
healthcare
• Three key priorities:
– The environment and cleanliness
– Welcoming and listening to patient and staff
feedback
– Ensuring everyone is supported through team
meetings, appraisals and effective supervision
• Teams to agree actions, monitor progress and
provide evidence
• Collaborative working with other teams e.g. facilities
• Observational visits to speak to staff and review
folders
• Friends and Family Test (FFT) is an important
indicator of how we are performing in each area.

Promoting and
improving public
health
Dr Steve Ryan,
Medical Director

Question one: In Tower Hamlets, early deaths from heart
disease and stroke are higher than the England average by
over...?
35%
45%
55%

Question two: What percentage of Waltham Forest
residents aged over 18 meet the Government guidelines for
physical activity of 30 minutes at least 3 times a week?
20%
30%
40%

Question three: Which of the following areas has the
highest rates of both infant breastfeeding and childhood
immunisation?
Surrey
Tower Hamlets
Berkshire

Question four: What percentage of 11 year old children
living in Newham are obese?
6%
16%
26%

Question five: What is the greatest factor causing
preventable illness and early death in east London?
Alcohol
Smoking
Lack of exercise

Dr Ian Basnett
Director of Public Health

Overview of health issues in east London
Indicators Newham Tower
Hamlets
Waltham
Forest
England
Average
Life expectancy (males) 2 76.2 76.7 77.4 78.6
Life expectancy (females) 2 81.1 81.4 81.9 82.6
Infant death 2 5.3 4.0 5.4 4.6
Deaths from smoking 4 249 300 221 211
Early deaths: heart disease
and stroke 4 115 106 86 67.3
Early deaths: cancer 4 112 135 114 110.1
People diagnosed with
diabetes 5 6.9 5.8 5.9 5.5
New cases of TB 4 124 61 50 15.3
Acute sexually transmitted
infections 7 1673 1743 1359 775
Source: Association of Public Health Observations, Health Profile, June 12
Key:
Significantly worse than
the England average
Not statistically different
from the England average
Significantly better than
the England average
1. Newham is the 2 nd most deprived borough in England, City and Hackney the 4 th most deprived, Tower Hamlets the 11 th most deprived,
Waltham Forest the 15 th most deprived out of 152 in England.
2. At birth 2008 – 2010
3. Rate per 1000 live births 2008 – 2010
4. Per 100,000 population aged 35+ directly age standardised rate 2008 – 2010
5. % of people on GP regulators with a recorded diagnosis of diabetes in 2010/11
6. Crude rate per 100,000 population 2008 – 2010
7. Crude rate per 100,000 population 2011. Chlamydia screening coverage may influence rate

Our catchment population and deprivation
Areas of
highest
deprivation in
east London
have two to
three times
higher
deprivation
scores than
the average
for England
For comparison average Index of Multiple Deprivation score in 2010 in England was 21.67.

Public Health vision
• Published in September 2012
• Identified three domains:
– Improving the health of patients
1.5m
– Improving staff health and
wellbeing 15k
– Promoting local employment, local
sourcing and sustainability
• Appoint Public Health Director

Tobacco
• Aiming to create a smoke free
environment
• Referrals to specialist services
– Last year 533
– We aim to train 750 staff
– We aim to refer c1800 patients
from Whipps Cross Hospital
alone
Complete online VBA training in 10
minutes
• ‘Stoptober’
www.ncsct-training.co.uk/bartshealth

Healthier and engaged staff
Targets: Objective: Healthier and more engaged staff
• More physically active Targets: staff More physically active staff
• Improved mental health and Improved wellbeing mental health and wellbeing
• Reduced level of tobacco use
Reduced level of tobacco use
Healthier food options
• Healthier food options
Key activities:
Key activities:
Smoke Free Consultation
• Smoke Active free Lives consultation programme including comprehensive signage encouraging the use
• Active Lives programme of stairs and including promotion comprehensive of physical activity signage options encouraging the
use of stairs and Mental promotion Health of and physical Wellbeing activity programme options developed
• Mental Health and Wellbeing
Copper
programme
Box sports
developed
day on 18 August
Further needs assessment and review of scope
• Copper Box sports day on 18 August
• Further needs assessment and review of scope

Community employment and careers
• 84 local people were placed into employment
• 170 work placements were provided, including 47 by those on health related
benefits.
• 335 local people were engaged with information, advice and guidance,
• 100 residents attended the NHS Community Awards event in October 2012.
• The apprenticeship programme supported 67 apprentices in roles in Theatres,
Pathology, Sexual Health, Audiology, Central Appointments, Renal Outpatients,
Public Health
• Over 240 work experience placements for local school and college students
were provided
NHS Community Awards
Inspire the Future event

Community Links
Frances Clarke
Thamannah Miah
Nida Thamenah