Warrington and Halton Hospitals NHS Foundation Trust. Annual Report and Accounts

Transcription

1 Warrington and Halton Hospitals NHS Foundation Trust Annual Report and Accounts

2 2

3 Warrington and Halton Hospitals NHS Foundation Trust Annual Report and Accounts Presented to Parliament pursuant to Schedule 7, paragraph 25(4) of the National Health Service Act

4 4

5 Contents 1. Chairman s report 6 2. Background to the trust 8 3. Directors report and business review Quality - Our Quality Report People - Our staff Sustainability - Our environmental report Foundation Trust membership The Council of Governors The Trust Board Remuneration Report Accounting Officer s Responsibilities Annual Governance Statement Independent Auditors Report Financial Statements 164 5

6 1. Chairman s report Welcome to our latest annual report and accounts reporting on an excellent year overall for our trust. At a time when many trusts have seen staff confidence in their services fall, ours positively increased and levels of engagement have grown. Last year in my introduction to the annual report, I set out our vision of High Quality, Safe Healthcare - underpinned by a new framework of Quality, People and Sustainability - QPS as it is known. This year we have delivered that vision. In terms of quality we have seen major improvements in reducing infection rates, falls and pressure sores. The CQC has rated our services highly following their unannounced visits this year and we have achieved both the NHSLA and CNST level 2 quality standards. We ve also invested in a range of service improvements that are directly benefiting our patients from redesign of A&E through to the development of new surgical and medical assessment units. We ve also taken ownership of the Cheshire and Merseyside Treatment Centre on the Halton General campus. Our teams have worked incredibly hard to ensure a very smooth move of our planned orthopaedic work first outpatients, followed by diagnostics and then surgery to the centre from Warrington. People are the lifeblood of our organisation and I was particularly pleased to see positive improvement in the results from the national NHS Staff Survey. At a time when many trusts have seen staff confidence in services fall, ours positively increased and levels of engagement have grown. We ve encouraged our team to be proud of the achievements that they have made visitors to the hospitals will see our proud posters around the corridors, on which our staff tell them about some of the things they take personal pride in. We ve taken an honest and open approach with our staff. We address issues head on and give them the opportunity to talk to us about the challenges that we face, however difficult some of the messages might be. This has been particularly important this year when it comes to the third element of sustainability. Like all public sector organisations, we face challenges in the future as we work to meet national efficiency targets. As we moved towards , we explained to our staff that this could have some impact on posts in the coming year as we need to save 11 million. Rather than sit back, we were overwhelmed with suggestions and ideas from staff at all levels in the hospitals on how they could positively contribute. Over 400 ideas were received within a month to our suggestion schemes and many of those ideas will be put into place over the next 12 months. As that suggests, it s not been a year without challenges. We have continued to see periods of pressure on our emergency services at times. We ve moved to address these by completely redesigning our emergency admissions systems through the acute medical unit and a greatly strengthened A&E department. 6

7 It s all about creating the very best environment for our patients, so that we can provide the very best care. This ethos is being reflected in the feedback that we receive on our services. Our trust is now amongst the best rated in the NHS on the NHS Choices feedback service. I am confident that the newly introduced Friends and Family test will back this up once the results come in during the coming year. It would be impossible to talk about the NHS over the last year without mentioning in the Francis Report. The report into the events that took place at Mid Staffordshire Hospitals NHS Foundation Trust makes for difficult reading at times but it is essential reading. Like all trust boards, we have reviewed and responded to the Francis report recommendations. I think that the results that you will read about in this annual report will give confidence that our trust is one that is improving safety, has an ever improving culture and has the right standards and monitoring in place to ensure that similar events could not happen here. Our CQC visits this year provide the external scrutiny to back this, and the information you can read in our quality report section provide the open level of detail to judge us yourself. As always, I'd like to take this opportunity to thank all of our staff, governors and volunteers, for their hard work over the last 12 months. Meeting the standards that I have mentioned above would not be possible without their commitment, ideas and delivery. I will also make mention of our members. Over 12,900 local people have now shown their interest in our trust by joining our Foundation Trust membership scheme and the way we are working to engage with them here in Warrington and Halton has been showcased this year as best practice to the wider Foundation Trust network. Your views as members of the public have helped shape and improve our trust and that can only mean that we can look forward to a bright future despite the challenges. We look forward to serving you in and in the future. Allan Massey Chairman 29 th May

8 2. Background Statutory information and history Warrington and Halton Hospitals NHS Foundation Trust manages Warrington Hospital and Halton General Hospital. This includes the Cheshire and Merseyside Treatment Centre facility on the Halton General campus. The trust was formed on 1 st December 2008 and was previously known as North Cheshire Hospitals NHS Trust. The trust provides health care services across the towns of Warrington, Runcorn (where Halton General Hospital is based), Widnes and the surrounding areas. It became an NHS Foundation Trust on 1 st December 2008 and changed its name from North Cheshire Hospitals NHS Trust. Our board of directors During the period 1 st April 2012 to 31 st March 2013, the following were members of the trust s board of directors: Name Allan Massey Allan Mackie Rory Adam Clare Briegal Lynne Lobley Carol Withenshaw Title Chairman Deputy Chair Non-Executive Director Non-Executive Director Non-Executive Director Non-Executive Director Mel Pickup Chief Executive Jonathan Stephens Director of Finance and Deputy Chief Executive Karen Dawber Director of Governance and Workforce & Interim Director of Nursing (1) Simon Wright Chief Operating Officer Phil Cantrell Medical Director Resigned 13 th May 2013 Jason DaCosta Director of IT Started 14 th February 2013 Helen Bourner Director of Commercial and Corporate Development Started 16 th April 2012 Resigned 31 st March 2013 David Melia Director of Nursing Resigned 14 th January 2013 Mark Halliwell Interim Medical Director Started 13 th May 2013 (1) Following the resignation of David Melia, Karen Dawber was appointed to the temporary post of Interim Director of Nursing on 14 th January 2013 in addition to her role as Director of Governance and Workforce. On the 16 th May 2013 the Board Nominations and Remuneration Committee approved the creation of the position of Director of Nursing and Organisational Development which combined of the roles of Director of Nursing and Director of Governance and Workforce and Karen Dawber was appointed to that position. (2) Jason DaCosta is a non-voting Executive Director 8

9 Principal activities of the trust During the period 1 st April 2012 to March 31 st 2013, in accordance with the Trust s Constitution the trust s principal activity was the provision of goods and services for the purpose of the health service in England, Our vision Warrington and Halton Hospitals NHS Foundation Trust s vision is to provide High Quality, Safe Healthcare. We deliver this vision through our Quality, People and Sustainability (QPS) framework. 9

10 Our sites and services Warrington Hospital Warrington Hospital is a major general hospital which is home to a wide range of NHS services. There are over 500 inpatient beds at the hospital. It focuses on emergency and urgent care and has all the back-up services required to treat patients with a range of complex medical and surgical conditions. Services provided at Warrington Hospital include: Accident and emergency, surgical services, general medicine, children's services, intensive care, cardiac care, endoscopy, stroke care, cancer care, elderly care, obstetrics (maternity), gynaecology, orthopaedic, critical care and ophthalmology. Support services include: Occupational therapy, pathology, physiotherapy, pharmacy, dietetics, outpatient services, diagnostic services, radiology and a range of specialist nursing services. Halton General Hospital Halton General Hospital in Runcorn provides a wide range of NHS services with a focus on planned specialist surgery. There are around 100 inpatient beds at the hospital. A range of care for medical and surgical conditions is provided from the hospital and it houses a mix of inpatient and outpatient services. Services provided at Halton General Hospital include: General surgery, urology, minor injuries (not accident and emergency), endoscopy, intermediate rehabilitation, cancer care, renal dialysis, outpatient services and genito-urinary medicine. Support services include: Occupational therapy, physiotherapy, dietetics, outpatient services, diagnostic services, radiology and a range of specialist nursing services. The Cheshire and Merseyside Treatment Centre The Cheshire and Merseyside Treatment Centre is home to our planned orthopaedic work. It is located on the Halton General Hospital campus and provides surgery and treatment in all aspects of bone and joint care. The centre has four operating theatres, a 44 bed ward, day care unit, MRI and CT diagnostic facilities and full outpatient, physiotherapy and other support services. We took over the centre in

11 3. Directors report and business review Alongside quality of services, it is vital that our finances are secure and that long-term financial plans are achievable and support future development. The trust has met all of the quality targets it set for the year and embarked on a series of major transformational change projects. End of year financial position During the trust had an operating income of 208,366,000 ( ; operating income 201,190,000). We finished the year with a reported deficit of 1,109,000 (0.5%). The reported deficit of 1,109,000 includes a non-cash charge of 1,989,000 relating to impairments of fixed assets, which is a one off technical adjustment for the permanent downward valuation in some property, plant and equipment owned by the trust. The underlying financial position for 2012/13 excluding impairments is a surplus of 880,000 (0.4%). In the previous year the trust had a surplus of 926,000. Copies of the full accounts of the trust are included in this report and are available on the following websites: Key achievements in year Our Quality Report provides full information on the care received by our patients over the course of the year. The Quality Report includes detailed information on our clinical and patient care performance including survey results, complaints handling and key quality improvements. During the year, the trust has had a clear focus on quality and safety at the heart of everything that it does. We have been able to demonstrate real improvements in a wide number of areas that are directly benefitting our patients. In addition to this, the trust has also seen services receive accreditation from national bodies and regulators in year which provides our patients and local community with the assurances that we are delivering care in the right way and to national standards. 11

12 Some of our key clinical achievements during the year include: Meeting the 4 hour accident and emergency waiting target for the year Reducing hospital acquired MRSA to just one case in the year Reducing hospital acquired Clostridium difficile to 19 cases a reduction of 50% Reducing the number of hospital acquired pressure ulcers by 34% Reducing the number of patient falls in hospital that result in major or catastrophic harm to zero Reducing instances of mixed sex accommodation occurrences in our hospitals to 23 a reduction of 44% Achieving NHSLA Level 2 and Maternity CNST Level 2 quality accreditations in year. These achievements are the result of a clear framework in place to develop sustainable improvements in quality and safety, backed by integrated governance and risk management across our services. 12

13 Transforming our services Through the year we have also developed a range of new services and transformational change projects in the hospitals. These have been grouped into three main areas of work based on priorities identified by working groups of staff across the trust Elective Care, Emergency Care and Community Care Reform encompassing the main strands of work of the trust. The trust s transformational change projects were developed in partnership with staff through our QPS framework. 1. Emergency Care Reform This programme of work looked at changes in the emergency care area of the trust and has included: A 1.4 million redesign of Accident and Emergency department at Warrington Hospital during the year. This created a new resuscitation bay and larger assessment area to support the flow of patients in Accident and Emergency and co-locate services. The work also saw appointment of extra staff in the department, including six extra staff-grade emergency doctors and filling vacant nursing posts. Development of the Acute Medical Unit. A new Acute Medical Unit model was introduced in December This restructured our assessment and admission wards into clear areas and strengthened medical and nursing support. The aim is to provide faster assessment and shorten length of stay in hospital by ensuring the appropriate care planning in place from arrival. 2. Elective Care Reform This programme of work looked at changes in the way we provide surgical services in the trust and has included: Taking ownership of the Cheshire and Merseyside Treatment Centre (CMTC). The trust worked to secure ownership of the former private treatment centre located on the Halton General Hospital campus. We reopened the CMTC and moved elective orthopaedic surgery services to the unit in January 2013 increasing our capacity and protecting this elective work from emergency pressures and making use of an excellent facility for local patients. Development of the Surgical Assessment Unit. A new Surgical Assessment Unit was opened at Warrington Hospital in the autumn of This unit locates urgent surgical admissions with our main surgical wards for improved care and assessment. 3. Community Care Reform Our third major programme of work looked at changes that we can influence in the way primary care and secondary care services work together preventing hospital admission and re-admission. It is an on-going programme of work that includes development of dementia strategies and mental health support but in included: Establishment of the Home Safe telephone discharge project. In partnership with Halton Clinical Commissioning Group and Halton Borough Council, we established a new project that provides patients registered with a Halton GP who are discharged from our trust with a telephone follow up within 24 hours of going home. The service aims to support patients 13

14 with any problems following their discharge and over 5,000 patients have been contacted by a trained nurse as part of the project. Nursing home outreach services. The trust has led a programme to provide outreach services in local nursing homes. Consultant support is provided in the homes to proactively prevent hospital admission by providing medical support and review to residents before they require hospital admission. Our activity in year activity activity % change Elective inpatients and Day Cases Emergency inpatients Outpatients (including ward attenders and outpatient procedures) Accident and Emergency 35,780 37, % 43,269 43, % 306, , % 100, , % The transformational change projects outlined above are so important as during , the trust has seen an increase in the overall demand on its elective inpatient and Accident and Emergency services. The trust has had some of the busiest periods of emergency pressure it has experienced in recent years. Through the winter months and even into , demand has been constant on accident and emergency in particular. The acuity of patients has meant more complex admissions to our services this year. Staff across the trust worked extremely hard to ensure that high quality, safe healthcare was provided to patients during this period whilst maintaining a good performance against the activity targets that we have in place, and delivering the transformational change projects. 14

15 Financial summary Warrington and Halton Hospitals NHS Foundation Trust was established on 1st December 2008, and therefore the financial results reported for 1 st April 2012 to the 31 st March 2013 represent the fourth complete financial year as an NHS Foundation Trust. This section aims to provide an overview of the financial position of the trust and is supplemented by the information provided in the full accounts in this document. Alongside our quality improvements and transformation work, financial sustainability has been key. Summary: Actual Income and Expenditure results compared with plan Narrative Planned 000 Actual 000 Variance 000 Operating Income 200, ,366 8,166 Operating Expenses (194,832) (203,500) (8,668) Restructuring costs 0 (100) (100) Impairments 0 (1,989) (1,989) Operating surplus 5,368 2,777 (2,591) Finance Costs (3,958) (3,886) 72 Surplus (Deficit) 1,410 (1,109) (2,519) The trust finished the year with a reported deficit of 1,109,000 (0.5%). The reported deficit of includes a non-cash charge of 1,989,000 relating to impairments of fixed assets. This is a one off technical adjustment for the downward valuation in some property, plant and equipment owned by the trust. The underlying financial position for excluding impairments is a surplus of 880,000 (0.4%). Each NHS Foundation Trust is given a financial risk rating by Monitor the Independent Regulator of NHS Foundation Trusts. Based on these financial results the trust has assessed its Financial Risk Rating as 3 which is good performance and in accordance with the planned rating at the start of the financial year. A risk rating of 1 represents highest financial risk and a risk rating of 5 represents the lowest financial risk. Q. What did we get paid for? Operating income The total operating income generated in the year was 208,366,000. An analysis of income is provided in the table below. 15

16 Income from mandatory services Elective income 37,877 37,401 Non elective income 68,218 67,302 Outpatient income 32,336 32,457 A & E income 9,757 10,496 Other NHS clinical income 33,662 41,197 Income from non-mandatory services Private patient income Other non-protected clinical income 1,882 1,669 Total income from activities 183, ,654 Other operating income Education and training 7,344 7,363 Non-patient care services to other bodies 2,547 2,478 Charitable and other donations Reversal of impairments 45 0 Other 7,370 7,718 Total other operating income 17,406 17,712 Total operating income 201, ,366 The definition of other operating income includes income relating to training and education, research and development and the provision of non-healthcare goods and services to both NHS and non NHS bodies. This non-healthcare income supplements the income generated from healthcare services and therefore allows the trust to maximise the income potential and associated investment opportunities. The time and resource incurred in generating this income is not delivered from clinical resources, so does not impact on the amount of time and resource available to deliver healthcare services and generate the associated income. Q. Where did our money come from? Income from clinical activities The majority of income was received from Primary Care Trusts for health care services provided to patients Primary care trusts 181, ,706 NHS: other Non NHS: private patients NHS injury scheme 1,882 1,669 Total 183, ,654 16

17 Q. Where did we spend our money? Operating expenses The total operating expenses incurred in the year were 205,589,000 with the majority of expenses incurred on salaries and wages (employee payroll costs). An analysis of operating expenses is provided in the table below Services from other NHS bodies Purchase of healthcare from non NHS bodies 1, Employee expenses (payroll costs) - executive directors Employee expenses (payroll costs) - non-executive directors Employee expenses (payroll costs) - staff 140, ,369 Employee costs termination costs Drug costs 10,485 10,812 Supplies and services - clinical (excluding drug costs) 17,475 18,154 Supplies and services - general 2,614 2,631 Establishment (Printing and stationary, Postage, Telephones & communication, Staff recruitment and advertising) 2,325 2,367 Transport Premises 8,124 8,560 Rentals under operating leases Increase/(decrease) in bad debt provision (111) 75 Depreciation on property plant and equipment 5,249 5,530 Amortisation of intangible assets Impairments of property plant and equipment 390 1,989 Audit fees - statutory audit - Audit Commission 11 3 Audit fees - statutory audit - PwC Other auditors' remuneration - PwC 4 44 Clinical negligence 4,429 4,466 Legal fees Consultancy costs Training courses and conferences Patient travel Commercial Insurance Losses, ex gratia & special payments 7 5 Other 717 1,076 Total operating expenses 196, ,589 Q. What other costs were incurred? Finance Costs The total finance costs incurred in the year were 3,886,000 with the majority incurred on Public Dividend Capital payments. An analysis of our finance costs is provided in the table below. 17

18 Finance Costs Public Dividend Capital payments (3,561) (3,900) Finance Income (Interest receivable) Finance Expenses (Interest payable) (99) (49) Total finance costs 3,603 3,886 Q. What did we invest in new buildings and equipment? Capital Investment During the year the trust completed 16,072,000 of capital investments which has significantly improved services for both patients and staff. A summary of the capital investment undertaken in the year is provided in the table below. Capital Investment Scheme Investment Benefits Value 000 Acquisition of Cheshire and Merseyside Treatment Centre Purchase of medical equipment The acquisition will ensure the trust has sufficient capacity to deliver demand for elective orthopaedic services Replacement of old equipment with new to modernise services 12, Service development Improved facilities for patients 857 Health and Safety improvements Site repairs and maintenance Information technology Improvements to buildings, services and public areas resulting in improved patient and public safety General improvements to buildings, services and public areas Hardware and software additions improving clinical and corporate information and services Total 16,072 Q. What did the trust borrow during the year? The Prudential Borrowing Limit and compliance with the Prudential Borrowing Code As an NHS Foundation Trust, Warrington and Halton Hospitals is required to comply and remain within a prudential borrowing limit. This is made up of two elements: The maximum cumulative amount of long term borrowing. This is set by reference to the four ratio tests set out in Monitor s prudential Borrowing Code. A copy of this code is available on the Monitor website The amount of any working capital facility approved by Monitor. 18

19 The trust had a prudential borrowing limit of 49.6m and a working capital facility of 15m for the financial year. As at 31 st March 2013, following principal and interest repayments during the year, the trust has a remaining principal balance of 0.5m on a previous capital loan taken to develop the Warrington Hospital Critical Care Unit in The NHS Foundation Trust working capital facility of 15m has not been utilised during the year and the trust did not take out any new loans or borrowing in Q. How safe are the trust s finances? Performance against Monitor s Compliance Framework As part of the on-going regulation the trust carries out a self-assessment against the financial risk rating metrics developed by Monitor. These metrics which are set out below assess the financial risks to the trust based on its historical financial performance. A rating of 1 being is highest risk and 5 being is lowest risk. This self-assessment is carried out monthly by the trust and reported and verified by Monitor on a quarterly basis. The metrics based on the annual accounts are detailed in the table below and for the year the rating is 3 which is in accordance with the planned rating and indicates there are no regulatory concerns at this time. Risk Rating Metrics as at 31 st March 2013 Financial Criteria Metric Rating Rating Underlying Performance EBITDA margin % 3 2 Achievement of Plan EBITDA % of plan achieved 5 4 Financial Efficiency Net return after finance 3 3 Surplus margin 2 2 Liquidity Liquid Ratio (days) 4 4 Overall Rating 3 3 EBITDA means Earnings Before Interest, Taxes, Depreciation and Amortization. It is created by considering a company's earnings before interest payments, tax, depreciation, and amortization are subtracted for any final accounting of its income and expenses. The EBITDA of a company gives an indication of the current operational profitability of the business, i.e. how much profit does it make with its present assets and its operations on the services it provides. The dip in the EBITDA margin rating (from 3 to 2) and EBITDA % of plan achieved (from 5 to 4) in 2012/13 from that achieved in 2011/12 represents the challenge the trust faced in responding to the increase in activity whilst at the same time delivering against our 9 million costs savings target for the year. 19

20 Other summary financial information Related Party Transactions The trust has a number of significant contractual relationships with other NHS organisations which are essential to business. A list of the organisations with whom the trust holds the largest contracts is included in the accounts. Disclosure to Auditors The Board of Directors would confirm that at the date of the approval of this report that: So far as the directors are aware there is no relevant audit information of which the auditors are unaware and further that each director has taken all steps that they ought to have taken as a director in order to make themselves aware of any relevant audit information and to establish that the auditors are aware of that information. Going Concern As set out in the notes to the accounts below, the accounts have been prepared on a going concern basis. This decision has been made by the directors of the trust on the basis that after making enquiries the directors have a reasonable expectation that the NHS Foundation trust has adequate resources to continue in operational existence for the foreseeable future. For this reason we continue to adopt the going concern basis in preparing the accounts. The directors confirm that the trust has complied with the cost allocation and charging requirements set out in HM Treasury and Office of Public Sector Information guidance. Appointment of External Auditors The trust appointed PricewaterhouseCoopers LLP as the external auditor of the accounts at a meeting of the Governor s Council on 15 th September Principal risks and uncertainties during the year The trust continues to face risks to achieving its strategic objectives and developments and has established and maintained a comprehensive Assurance Framework and supporting Corporate Risk Register to identify, understand and manage risk. The trust has a clear strategy to identify, manage and monitor risk. The Assurance Framework and Corporate Risk Register are subject to regular review and appraisal to ensure risks and reduction of risk are managed proactively. Systems and controls have been established to manage the risks, which are monitored by the Board on a regular basis following review at the trust s Governance Committee. 20

21 In accordance with the risk management strategy the trust keeps under constant review all potential significant risk exposures. The trust s strategic plan has been assessed to identify future risk exposure. These risks are reported within the trust s Strategic Plan which is reviewed by the Board of Directors and submitted to Monitor. In summary the significant risks facing the organisation relate to: Delivery of the Quality Strategy Operational pressures and capacity of the workforce might limit the trust s ability to implement and maintain the changes required Failure to reduce the level of harm events Failure to provide a robust response to the Francis Report action plans Failure to maintain the required momentum for the delivery of the plans Challenge in delivering Clinical Commissioning Group designed quality indicators. Delivery of the Financial Strategy Managing the financial impact of the transfer of vascular services from Warrington to the designated specialist units as part of the regional vascular review Delivering 11 million cost savings required to balance the books in and avoiding slippage Ensuring the planned productivity and service improvements presented by the Cheshire and Merseyside Treatment Centre are delivered to cover the costs of this facility. Managing down our inpatient length of stay and delivering improvements for our patients from our new Acute Medical Assessment Unit which in addition to improved patient experience, will also reduce our bed capacity and save money. Achieving our contract performance and quality improvement targets for Clinical Commissioning Groups (CCGs) to avoid financial penalties. Future trends and factors likely to affect the trust The board of directors has responsibility to implement robust assurance, governance and performance management arrangements to deliver its corporate objectives, which it does through a number of assurance and management committees and a rigorous and regular analysis of risk. We intend to deliver a small surplus of 0.3 million in and spend 8 million on capital schemes. As part of the annual planning requirements the trust must develop a three year strategic plan (referred to as the annual plan) covering the period to These medium-term plans contain a number of assumptions including levels of income and expenditure inflation and forecasts of the financial impact of changes in clinical activity on income and costs. This plan is reviewed periodically at board-level in the trust and revised, as required, to reflect updated information. 21

22 Looking ahead to , the trust is looking to continue with its track record of delivering against its financial plans and investing in our hospitals to improve services for our patients and staff. The financial outlook is very challenging but the trust in planning to deliver a small surplus of 0.3million in and spend circa 8 million on capital schemes aimed at maintaining and improving our buildings and the purchase of new equipment. In order to do this, the trust must deliver savings of 11 million during the year. The requirement to deliver these savings recognises the reduced level of funding the trust will receive next year as a result of reductions made to national tariffs (the prices set nationally for healthcare services provided by hospitals) coupled with the need to provide for increases in pay costs and price inflation for the goods and services we buy. As the trust will not receive an inflationary increase in , these cost increases will need to be financed from these internally generated savings. Cost Improvement Plans The financial plans for include revenue investments which recognise and address the main service pressures experienced delivering activity during In total, the cost increases and income reductions for the coming financial year are forecast to be in the region of 5.3%, requiring the trust to deliver the cost savings of circa 11 million referred to above. The trust has identified a range of potential cost savings and efficiencies that can be achieved by doing things differently across the hospitals. Whilst understanding that the most significant cost to the trust is salaries and wages, the trust is planning to reduce the established number of posts in the trust by between 100 and 200 posts in Work began to look at this process in March 2013 and the aim is to use vacant posts and workforce and service redesign to achieve this rather than compulsory redundancies. A wide range of cost improvement projects have been identified for the year that will allow the trust to make the savings that are required whilst freeing up investment to allow us to invest in our three priority transformational change programmes introduced in Capital Investment Programme The capital programme for is planned to be 8 million. This includes investment in a number of services that form part of the trust s annual plan and include: 1.4million on technology improvements 1million on medical equipment 1.1million on ward improvements 3.4million on the maintenance of our estate and buildings including energy efficiency 1million supporting the reform of our elective services 22

23 Other major service changes The trust is working with partner organisations on the delivery of sustainable clinical services, including: the transfer of specialist vascular services from Warrington to Chester, the provision of pathology services and the development of service integration plans with the community provider. Following the acquisition of the Cheshire and Merseyside Treatment Centre, the trust will expand the catchment for elective orthopaedic and spinal surgery provision. To meet the needs of the local communities in both Warrington and Halton, the trust will continue to work with commissioners and partners on the provision of emergency and urgent care. Regulatory Ratings The trust has achieved both NHSLA Level 2 and Maternity CNST Level 2 accreditation in the year. These are Care Quality Commission ratings national quality standards of Standards for Better Health is a set of standards that the National health services. Health Service in England must meet. The standards were set out by the Department of Health. NHS Trusts must declare their level of compliance with these standards annually as part of the Annual Health Check. The trust declared compliance with all 44 health care standards. The Care Quality Commission has now published a set of standards which supersede those used in the Annual Health Check. The trust must demonstrate ongoing compliance with these as part of its registration requirements. Care Quality Commission visits and action plans The Care Quality Commission made an unannounced visit to Warrington Hospital in January 2013 as part of its on-going inspections programme. The trust met all standards it was assessed against. A team arrived unannounced and had full access to all wards and departments. The inspectors were supported by a patient representative. During the inspection the CQC spoke with patients, relatives and other visitors in various wards and departments. Their report, published in March 2013, says that most of the feedback received was positive with comments such as "the staff are brilliant, nothing is too much trouble for them and "staff have been good." The inspectors spoke with relatives of different patients who were all extremely satisfied with the way their family members were treated. Patients the CQC spoke with told them they were always asked for their permission before care or treatment was given. They found that the hospital had robust procedures in place to ensure that the rights of patients who did not have capacity to make certain decisions for themselves were protected. The inspection looked at how the hospital managed medicines for patients and found that they were managed safely and effectively. Staffing levels were also checked by the CQC and found to meet national requirements. Staff the inspectors spoke to were enthusiastic about ensuring high quality care was delivered to all patients within their wards. 23

24 The report says they received very few negative comments about the services. One person felt they had a long wait in the accident and emergency department and another person stated that their food was not always as hot as they liked it. Whilst the trust met all the standards, the inspectors looked at sets of patient records during the visit and found that they were not always immediately kept up to date. The report acknowledges that the trust was introducing a new style of patient record shortly to address this. The seven standards the CQC measure hospitals against and the report scores for Warrington Hospital were: Consent to care and treatment Met this standard Care and welfare of people who use services Met this standard Safeguarding people who use services from abuse Met this standard Management of medicines Met this standard Staffing Met this standard Assessing and monitoring the quality of service Met this standard Records Met this standard Hospitals are scored as met this standard, action needed or enforcement action taken against each standard. In March 2013, the Care Quality Commission made an unannounced visit to the Microbiology Department at Warrington Hospital as part of its inspection programme of these services. The report of this visit has not been published at the time of writing, but verbal feedback provided at the end of the visit was very positive. The inspectors said that the trust had a safe and quality controlled Microbiology Department that was well led and managed with a very good multidisciplinary approach especially learning and development. The Care Quality Commission has not taken enforcement action against Warrington and Halton Hospitals NHS Foundation Trust during Quality standards achieved in year During the year, the trust achieved two major quality accreditations Maternity CNST Level 2 and NHSLA Level 2. Maternity CNST Level 2 The maternity unit at Warrington and Halton Hospitals achieved CNST Level 2 status after the assessment which took place in June The NHS Litigation Authority (NHSLA) provides an 'insurance scheme' to NHS Trusts against claims for clinical negligence through the Clinical Negligence Scheme for Trusts (CNST). Trusts have to meet standards of care that show they are promoting and using effective risk management to minimise the risk of harm to patients. Because of the nature of claims in NHS maternity services (where payments for incidents are high as they often have to support the baby in later life), a separate set of CNST standards are in place for maternity services. 24

25 Each standard covers an area of risk and has ten specific underpinning criteria, each with detailed breakdown, against which trusts are assessed. The NHSLA assessors visited and assessed notes retrospectively and live notes and fetal heart recordings on the labour ward and antenatal and postnatal ward. Trusts can score from Level 0 (lowest) to Level 3 (highest). The trust has moved from Level 1 to Level 2 following the assessment. The trust passed 44 out of 50 criteria - scoring 88% and above the required 75% pass rate. In practical terms it demonstrates the high standard of care we provide to our local population. NHSLA Level 2 The trust achieved the NHS Litigation Authority (NHSLA) Level 2 standard in November This quality standard looks at the risk management processes in place across the hospitals and measures them against the national standards in place. There are 50 standards that have been designed to address organisational, clinical, and nonclinical or health and safety risks. The assessors found that there was clear evidence in practice to assure them that the risk management processes described in the hospitals policies and procedures are in use. Two assessors were on site - with one spending the whole time on the wards at both Warrington hospital and Halton General hospital looking to review practice from consent through to discharge. This included checks on how health records are managed, that procedures for avoiding patient slips, trips & falls are carried out, how observation charts, clinical handovers and patient discharge procedures are followed and also things like transfusion procedures and medicines management are followed by staff. The assessors found that the trust achieved an excellent 46 out of the 50 standards they were assessed against to reach the NHSLA Level 2 rating at the first time of asking. Monitor ratings Monitor, the Independent Regulator of Foundation Trusts, has created a forward-looking, risk-based system of regulation which informs the intensity of monitoring. It identifies actual and potential financial and non-financial problems, and deals with them effectively. Monitor requires each foundation trust board to submit an annual plan and quarterly reports. Performance is monitored against these plans to identify where potential and actual problems might arise. Monitor publishes quarterly and annual reports on these submissions and assigns each foundation trust with an annual and quarterly risk rating. These risk ratings are designed to indicate the risk of a failure to comply with the terms of authorisation. There are two ratings a Governance Rating and a Financial Risk Rating The Governance rating describes the effectiveness of an NHS foundation trust's leadership. Monitor use performance measures such as whether foundation trusts are meeting national targets and standards, such as a reduction in MRSA rates, as an indication of this, together with a range of other 25

26 governance measures. Monitor considers these areas when assessing the annual and quarterly governance risk ratings which they publish for each trust: Legality of constitution NHS foundation trust constitutions are legal documents that describe how each is governed Growing a representative membership NHS foundation trusts are accountable to their local communities and must have plans in place to develop and grow a representative membership Appropriate board roles and structures - Monitor checks whether the appropriate roles exist and are filled within each NHS foundation trust. Monitor also look for evidence that a collaborative but challenging relationship exists between the board of governors and the board of directors, and the executive and non-executive members of the board of directors Co-operation with NHS bodies and local authorities NHS foundation trusts have a duty as part of their terms of authorisation to cooperate with a range of NHS bodies and with local authorities Clinical quality NHS foundation trusts board of directors must be satisfied, and certify to Monitor, that their NHS foundation trust has effective measures and arrangements in place to monitor and continually improve the quality of healthcare it provides Service performance (healthcare targets and standards) NHS foundation trusts board of directors have to confirm to Monitor that plans are in place to ensure that priority targets and standards will be met continually Other risk management processes NHS foundation trusts board of directors must address and resolve any risks that have been identified. If issues are outstanding, the board must demonstrate to Monitor that robust plans are in place to address them. Financial risk ratings are allocated using a scorecard which compares key financial information across all foundation trusts. A rating of 5 reflects the lowest level of financial risk and a rating of 1 the greatest. When assessing financial risk, Monitor assigns quarterly and annual risk ratings using a system which looks at four criteria Achievement of plan; Underlying performance; Financial efficiency; and Liquidity. The risk rating is forward-looking and is intended to reflect the likelihood of an actual or potential financial breach of the foundation trust s terms of authorisation. Monitor also assigns a rating for mandatory services. Mandatory services are the services which each NHS foundation trust must provide as detailed in their terms of authorisation. There are specific processes which must be followed if an NHS Foundation Trust wishes to request a change in these services or to dispose of assets required to provide these services. Warrington and Halton Hospitals NHS Foundation Trust performance against Monitor risk ratings Trust Annual Plan 2011/2012 target Quarter /2012 Quarter /2012 Quarter /2012 Quarter /2012 Financial Risk Rating Governance Risk Rating Amber Red Green Green Amber Green Amber Green Mandatory Services Green Green Green Green Green 26

27 Trust Annual Plan 2012/2013 target Quarter /2013 Quarter /2013 Quarter /2013 Quarter /2013 Financial Risk Rating Governance Risk Rating Green Green Green Green Green Mandatory Services Green Green Green Green Green * In the tables above, Quarter 4 represents the cumulative outcomes for the trust at the financial year end. Statement on data loss in year During the financial year there was one incident of loss of personal data which was reportable to the Information Commissioner s Office. The Parliamentary and Health Service Ombudsman was supplied with information by the trust on 30 th May 2012 which related to a patient who is a complainant against the trust. Contained within the information supplied to the Ombudsman were seven pages of person identifiable and clinical information relating to a patient that was unconnected to the case the Ombudsman was dealing with. The Information Commissioner investigated this incident and concluded that no action against the trust was necessary. The trust uses the Information Governance Toolkit in conjunction with its Information Governance and Corporate Records Group to identify areas of weakness in relation to the management of its information. Any areas of weakness in control and or risk management identified or highlighted from internal audit review are then targeted with action plans to ensure that we continue to strive to be information governance assured. The Annual Report, and the financial statements held in this report, were approved by the Board of Directors on 29 th May 2013 and were signed on its behalf by: Mel Pickup Chief Executive 29 th May

28 4.Quality Our quality report The quality report is taken from the trust s Quality Account which is also published separately as a stand-alone document. Quality is our number one priority. Our quality report sets out how we have performed against the targets we set last year and what we will achieve in the coming year. Part 1. Statement of Quality from the Chief Executive Warrington and Halton Hospitals NHS Foundation Trust is dedicated to the provision of high quality care and clinical excellence which puts the patient at the centre of everything we do. To achieve this we have established robust systems to ensure that we are accountable for continuously monitoring and improving the quality of our care and services. Our highly skilled workforce is dedicated to pursuing the best outcomes for patients through review of service, service re-design and through delivery of patient focussed clinical care. As such we welcome this opportunity of demonstrating through our Quality Account (QA) to patients, their families, and the wider public the relentless focus that the Trust has on improving the quality of our services. Importantly we believe that our staff, governors, members and patients are the eyes and ears of the organisation as such their views are constantly sought to ensure that we are focussing on the things that will make the most difference in supporting our overriding ethos of high quality care for all. Importantly this QA also offers the Trust an opportunity to describe a range of quality initiatives which are central to our strategic framework supporting Quality, People, and Sustainability. The Trust services the community across two sites. The Warrington Campus provides acute and emergency facilities including Accident & Emergency, intensive care, maternity, medicine, surgical services, paediatrics, outpatients and a full range of diagnostic and back up services. The Halton campus provides a range of diagnostic, intermediate care, antenatal and outpatient services including a minor injuries unit for local patients. More recently, the development of the Cheshire and Merseyside Treatment Centre at Halton General provides orthopaedic surgery for both sites and includes a radiology centre with facility for Magnetic Resonance Imaging MRI and Computerised Tomography CT scanning. The Trust has a robust performance management framework and within year it has continued to monitor services across the three domains of quality being patient safety, clinical effectiveness and 28