1. Slide 1 Winter Evaluation 2013/14 Board of Directors Wednesday 16 July 2014 Kirsten Major, Ellen Ryabov & Lisa Needham

2. A Winter Story…

3. Slide 3 Outline The beginning - description of Winter 2013/14 compared to 2012/13. The middle – what did we do? What worked well? The end – planning for next winter.

4. Slide 4 IN THE BEGINNING…

5. Slide 5 Winter 2012/13…

6. Slide 6

7. Slide 7 Relentless Never seen so much pressure for such a long time Considerable staff pressure We’re running out of ideas… Last Winter….

8. Slide 8 WHAT ABOUT 2013/14 THEN?

9. Slide 9

10. Slide 10 National Picture – 2013/14 Emergency admissions highest level ever during the last 10 years Total of 3.8m admissions in 2013/14 versus 2.8m in 2004/05 - +38% 2% increase between 2012/13 and 2013/14 Reduced A&E attendances by 0.3%

11. Slide 11 STH’S EXPERIENCE…

12. Slide 12 4062 more admissions

13. Slide 13

14. Slide 14

15. Slide 15

16. Slide 16 WAS IT EASIER WORK?

17. Slide 17 No real change in ambulance arrivals 12/13 & 13/14 - Overall Acuity Same

18. Slide 18 THE MIDDLE…

19. Slide 19 WHAT THINGS DID WE DO DIFFERENTLY?

20. Slide 20 Expansion of Clinical Decisions Unit (CDU) increased throughput +27%

21. Slide 21

22. Slide 22 Extended weekday opening hours to 8pm and w/e opening improved usage

23. Slide 23 The Trust has an internal mechanism for recharging medical outliers to the responsible speciality The recharge value for 2012/13 was £3,574m as compared with £1,334m for 2013/14 An overall reduction of 6042 bed nights equating to £2,240m fines reduction of 63%

24. Slide 24 A SUMMARY OF FLOW IN NGH…

25. Slide 25 Performance in Q3/4 2012/13 = 91.1% whereas Q3/4 in 13/14 = 95.48%

26. Slide 26 Summary of Winter Story 2012/13 compared with 2013/14 Period 12/13Period 13/14 Difference% Improved A&E 4-Hour Average Performance in period91.10%95.48%4.38%4.81% All admissions - Total in period10739811146040623.78% Elective IP Admissions – Total in period14618153026844.68% Non Elective IP Admissions - Total in period41872424746021.44% All Day Case admission – Total in period509085368427765.45% Hospital Cancelled Operations67195851-868-12.92% Outlier bed nights by Week3652230480-6042-16.54% All Discharges - Total in period10734911151241633.88% Comparison on Month 8 versus Month 12 Variance from Mth 8 Target Pro-Rata to Month 12 Month 12 Actual Improved Position Financial Improvement – Total in period£2,253,000£3,528,000£6,890,000£3,362,000

27. Slide 27 THE END…

28. Slide 28 More & ongoing System change – working with partners internally and externally Cultural change – wide ownership from the outset Discharging and discharge processes More systematic processes and escalation Admissions avoidance and admissions process Managing sickness absence Profiling work across week and days and responding Managing elective flow Planning for bank holidays New & next…

29. Slide 29 AN EPILOGUE…

30. Slide 30 We did more work We performed better We performed better than many others We did a lot and what we did made a difference Winter is coming…