Agenda item

Simon Knight, Director of Planning, and performance at University College London Hospital provided an update on how UCLH are doing against targets for quality of care. The indicators included infection targets, patient surveys, referral to treatment times, cancer waiting times, waiting times in the emergency departments and delayed transfers of care.
The committee was informed that UCLH have tracked rates of two main infections MRSA and Clostridium difficile. MRSA trends over the last ten years have kept in line with most other NHS trusts, so far there have been 4 infections in the last year.
UCLH has broadly kept on top of Clostridium Difficile infections but there has been a small rise in the last few years which have been linked to cancer and oncology as patients had immunosuppressed conditions which made them more susceptible.

The committee were informed that the 2021 Inpatient Survey results showed patients liked the care from UCLH when compared with other London boroughs.

The pandemic influenced services UCLH could offer to patients this includes impact on waiting times. The referral to treatment time (RTT) showed that the percentage of patients waiting to be less than 18 weeks for treatment, the target was around 93% however the graph presented showed the big dip was in during the pandemic. At the time of reporting UCLH was above the London average. The main focus within the NHS is the longest waiting time, the committee was informed that UCLH is on track to meet the target in March 2023 for not having any patients wait more than 78 weeks. The target UCLH is aiming for next year is not to have patients waiting more than 65 weeks. UCLH was currently on 10% of the pre-pandemic baseline for treating patients therefore managing to keep on top of waiting times.

On diagnostic waits the percentage of patients waiting less than six weeks for a diagnostic test from the request being sent showed that once UCLH went live with the new systems there was a decline, and then a further decline in figures due to the pandemic. Biggest issues were in MRI’s due to scanner outages, problems with tests in neuroradiology and non-obstetric ultrasound due to staffing issues.

UCLH was proud of their access to cancer care so far. In the past six months UCLH have been one of the top performing trusts for the A new target set for the NHS which ordered diagnosis or ruling out of cancer to be within 28 days.

Currently not doing well on the overall target for 31 Day turnaround for patients with cancer receiving treatment however, this is mostly due to when the patients have been referred to the trust.

A&E access times showed that currently UCLH was 65-70% on the decision to admit or dismiss within 4 hours, this is mostly to do with staffing issues and lack of beds. The target for the NHS in the coming year is to get back to 76%.

The Trust has significant financial challenges such as delivering deliver a £0.8m surplus, which is £10.7m behind plan. The smaller than expected surplus is due to:

Higher than budgeted costs relating to inflation charges on the Trust’s PFI contract and utilities (-£13.9m). Another reason is due to non-receipt funding expected to offset the impact of a change in accounting standards (-£2.9m). To add to this the Partially offset by higher-than-expected interest income on the Trust’s cash and income from investments (+£6.1m). Although there are challenging targets next year the importance of demonstrating productivity for ongoing funding was noted.

It is likely to be a very financially challenging year, with inflation costs expected to be £37 million higher than likely funding for inflation.

UCLH was able to open a new building called Grafton Way with an advanced form of radiotherapy and blood disorder treatment. This is aimed to avoid sending children across to the US for treatment there are new beds and theatres.

The following points were noted in the discussion:

·       UCLH have focused on hand washing and hygiene to prevent further Clostridium Difficile infections

·       MRSA can be eradicated however with Clostridium Difficile the approach is around minimizing the infections.

·       For the 78-day patients are waiting for treatments across all services but mostly outpatients and to admit to care setting.

·       A key reason for the delayed discharge was ensuring the patient had an appropriate care package at home. John Everson noted that the new reablement service should mitigate against the delayed discharge.

·       The Chair noted that the council should work with the UCLH trust to develop a plan to investigate the gaps in adult social care services and public health.

·       The £37 million figure was noted as a funding gap for inflation while the overall figure may be larger UCLH has not predicted staffing cuts. UCLH has continued to make use of assets and have more patients seen in response to this. Patients have been encouraged to self-test, UCLH has used data analysis to reduce blood tests and MRI. It was noted that addressing the funding gap will require a combination of productivity and improved quality of care.

ACTIONS:

Simon Knight agreed to provide further information on these points:

·       What are the dangers if you are immunocompromised and contract Clostridium Difficile?

·       Why is it that our cancer patients are the ones more likely to get Clostridium Difficile, and does it have a particular impact on them?

·       What is the “other” category in the analysis of delayed discharges?

·       Is the PFI contract in addition to the £37 million or included within this figure?

·       An oversight of the staff survey results, showing staff morale etc.

Is there a plan in place so that junior doctor strikes do not impact patients at UCLH?