Annual Report and Accounts

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Contents Part 1 - Statement from the Chair... 1 - Message from the Chief Executive... 3 Part 2 - Strategic report... 5 Equality and diversity... 12 Performance at a glance... 14 - Sustainability report... 22 - Quality report... 25 - Directors report... 29 The Board s sub-committees...35 Aiming to be a Foundation Trust...38 Improving patients and carers experience...44 Patient safety...46 Staff engagement...47 - Remuneration report... 53 - Statement of the Chief Executive s responsibiities as the Accountable Officer... 56 Part 3 - Annual Governance Statement as at 31st March 2015... 57 Part 4 - Financial statements and notes... 66 Related parties...73 Better payments practice code... 74 Audit opinion and report...76

Statement from the Chair Welcome to our 2014/15 Annual Report. The 2014/15 year has been an important one for our Trust. We have continued to meet our main service and quality targets and deliver a balanced budget whilst delivering the savings needed to allow the NHS to cope with demographic, service and technological change. However, I think that, in addition, it has been an important year in terms of our role within the Birmingham and wider West Midlands health systems. I believe that we have developed and demonstrated a greater confidence in our role, not least through the major part we now play in helping to manage and respond to the demand for NHS services throughout the year, alongside our colleagues in primary care, the acute hospitals and other NHS providers, and the wider social care and third sector. Clearly, we will have continuing challenges, not least from the financial situation still facing the NHS, with largely static real-terms funding but with the inflationary effects of increasing demographic pressures and a constant flow of new treatments and technologies. The solutions to some of this lie in re-thinking how and where services can be provided, and especially to shifting the location of much care and treatment from hospital to home. As a large and sustainable community provider, and as a partner within the health and social care system in Birmingham, we should be in a central and crucial position to support new ways of working and of delivering services as the NHS responds to the challenges of NHS England s Five Year Forward View. Looking forward, 2015 is an important year for BCHC as it marks the completion of the excellent new Birmingham Dental Hospital. This development is a key part of our strategy for our estate and our services. During the last year, for example, we have opened several smaller but important new services and units such as Willow House, our dementiafriendly unit at West Heath Hospital, and the Community Medical Assessment Unit at Moseley Hall. However, the Dental Hospital scheme has been long in the planning and it is wonderful to see the UK s first new dental hospital and school for many years getting ready to take its first patients and new students. Obviously, this report focuses mainly on looking back at last year. The delivery of that financial balance and meeting the majority of our service and safety targets during the year was only possible through the superb efforts of our managers and staff, who all continue to rise to the challenges that we face. As a Board, we continued to focus on quality and safety, for example, responding to the new Safer Staffing requirements, supporting and monitoring their implementation. We continue to receive direct patient and carer feedback via our Patient Stories at Board seminars, our Patient Safety Walkabouts, the monitoring of comments and complaints, back to the floor days that several of us undertake, and the excellent developing work of our Shadow Council of Governors and their Patient Experience Forum. I am also pleased to report that we continue to work to meet every requirement of good governance, in terms of what and how we report on our work. We also had the encouragement during the last year of being rated as Good across our services by CQC and receiving several awards, including a Silver award for Investors in People. 1

The Board continues to support the concept that identifying both income opportunities and savings is best done by the clinical and support service leaders themselves, rather than these being imposed from above or outside. The approach of services driving development and savings plans has been seen to be effective in previous years and in this last year has started to be reflected in our securing new contracts and new or expanded services and funding. We have also sought to reinforce and support the key role of our front-line leaders through changes to our internal management structure. Having already mentioned them, I would like also to recognise the development and impact of our Council of Governors. Part of the point of our continuing aim to become a Foundation Trust (FT) is to increase the contact with, and accountability to, the people and communities we serve. This is achieved, in large part, through our membership and our Council of Governors, the majority of whom are elected by our public and staff members. In the last year, we have developed the way in which we report to the Council of Governors, and Governors have been working alongside us by observing Board meetings, joining us on Patient Safety Walkabouts and service visits, participating in our staff awards and examining specific services and issues through the Patient Experience Forum. This will continue to evolve, particularly once we are licensed as an FT, and I am grateful to all of our Governors for their commitment, advice and ideas. Within the wider NHS, the Clinical Commissioning Group (CCG) arrangements have become more established during the year and the Trust continues to forge strong working relationships and partnerships with them. We have been looking at how we can support new models of care with the CCGs and the emerging GP Federations and we will continue to use a variety of organisational solutions to achieve this. Just as I have written in previous years, and as I have mentioned several times already this year, none of this progress can be achieved without the hard work and dedication of our staff and I would like to thank them again for their excellent efforts in maintaining and improving service performance and quality during times of continuing challenge and change. Finally, I wish to thank my colleagues on the Trust Board for their continued hard work, support and commitment over the last year as we have striven to deal with the present, plan for and shape the future, and develop ourselves as a potential FT. I truly value the commitment and effort of my Board as we continue to work together and with our staff, to ensure that our Trust and its services remain leaders in our field. Tom Storrow, Chair, Birmingham Community Healthcare NHS Trust 2

Message from the Chief Executive I am privileged to introduce the 2014/15 Annual Report from Birmingham Community Healthcare NHS Trust, and hope you will find it an informative update on our aims and activities. Throughout the year in review we have maintained an absolute focus upon providing high quality services for our patients and service users. Our 5,000-plus staff have dedicated their time to delivering and working to improve those services across all of the varied areas in which we operate. We have once again delivered more than two million patient interactions in a 12-month period for the people of Birmingham and the West Midlands. I am very pleased to report that we have received acknowledgement of high levels of patient satisfaction via various feedback routes. Our highly positive inspection rating from the independent Care Quality Commission comes as valued external validation of our efforts. An overall rating of Good, with an outstanding in a specific area of work, is an excellent first full rating for us to receive. We have also continued to play a strong and developing role within the local health economy, alongside our commissioners and other statutory and non-statutory health and social care providers. We are proving our ability to adapt to a changing landscape within healthcare, both nationally and locally, particularly in line with the aspirations contained within NHS England s Five Year Forward View. This demonstrates our commitment to developing new models of care with our partners and key stakeholders that will deliver care in a more integrated and seamless way to enable our populations to access the appropriate support to meet their needs. A number of exciting developments are already beginning to emerge in primary care, for example, in South Birmingham through the Prime Minister s Challenge fund and in West Birmingham through the Vitality Partnership being supported as a Vanguard site. We are a key partner in these developments which provides us with a fantastic opportunity to work much closer with General Practice to transform the way we provide our services for the benefit of the local populations. At the same time we are actively working to create other similar partnerships across our geographical area. Different models will suit different communities. Our Complete Care initiative is another example of how we are innovating, and developing integrated services to fit modern needs. Complete Care, part of the Healthy Villages initiative, brings together health and social care provision across both statutory and third sector organisations, to offer a joined-up service for older adults. The programme has won approval locally from patients and nationally from authoritative organisations such as NHS Providers, NHS Confederation, the King s Fund and Health Service Journal. Our commitment to the very best in modern health is further embodied within the new Birmingham Dental Hospital and School of Dentistry, under construction through the year in review. The first new dental hospital to be built in the UK for 40 years, the opening of the new facility will provide an exciting highlight during 2015/16. 3

Finally, in reflecting upon another year of delivering high-quality services and continually seeking to improve quality for our patients, I must thank all of our staff for their dedication and achievement. It is the commitment of our staff which ensures real life-changing benefit for patients and service users, as we work towards delivering better care and healthier communities. Tracy Taylor, Chief Executive, Birmingham Community Healthcare NHS Trust 4

Strategic report The strategic report has been prepared in accordance with Sections 414c of the Companies Act 2006 Introduction Birmingham Community Healthcare NHC Trust (BCHC) aims to deliver better care and create healthier communities. We are one of the UK s largest providers of NHS community services, delivering more than 130 different clinical services and 2.1m patient interactions each year; employing more than 5,000 clinical and support staff, and achieving an annual turnover of 257m in 2014/15. Our services The Trust delivers care through a structure of three clinical divisions: Adults and Community, Children and Families and Specialist Services. Each division is jointly led by a Clinical Director, who is a clinician, and a Divisional Director, who is a manager. We adopted this structure as it embodies our ethos of being clinically led and managerially supported and in the wake of events at Stafford Hospital, being clinically led has never been more important. We are proud therefore, that this has been our ethos for a number of years. BCHC delivers core community services and also other specialist services. Core community services are provided for the 1.1 million population of Birmingham. Specialist community services are provided for Birmingham plus the wider West Midlands Region, a total population of 5.5 million people. Adults and Community Services Our Adults and Community Teams are integrated multi-disciplinary teams where District Nurses, Clinical Case Managers, Occupational Therapists and Physiotherapists work closely with Primary Care GPs, Social Workers and Mental Health teams to provide high quality care to patients in their own homes. This integrated team provides 24 hour a day, 7 day a week care. In addition, we have our Rapid Response Team, who respond to calls from GPs who contact our Single Point of Access (SPA Contact Centre) and aim to visit patients within their own home within two hours where clinically appropriate, to keep patients out of hospital, avoiding unnecessary admissions. Furthermore, we support our acute hospitals by providing them with in-reach community Advanced Nurse Practitioners teams to assist in the facilitation of patient discharge working in partnership with our Social Care colleagues. These teams are supported by dedicated Tissue Viability Nurses, Continence team, Stroke Teams and Respiratory teams who are specialists in their field and give advice, guidance and deliver care to both community and inpatients teams. In addition, we provide a range of Specialist Nursing and Allied Health Professional Services to the Community that we serve, ranging from Dietetics, Diabetes, Heart Failure/Coronary Heart Diseases (CHD), Podiatry, Sickle Cell and Thalesaemia, Parkinson s, Lifestyle Services such as Smoking Cessation and our MSK (Muscuoskeletal) including Orthopaedic Triage and Pain Management Services. We also provide Primary Healthcare Services to HMP Birmingham in partnership with Birmingham and Solihull Mental Health Foundation Trust. As part of the high quality care that we deliver, BCHC has a range of inpatient services that support the wider health economy to facilitate patients in their care pathways. These inpatient services allow for patients to be stepped down from acute hospitals within Birmingham to our sub-acute care provision, including Specialist Trauma and Orthopaedics 5

Beds and Geriatric Medical Beds, or to intermediate care inpatients services where they receive a defined period of rehabilitation prior to returning to their own home or alternative health/social care provider. During the winter of 2014/2015, we have piloted our new Community Medical Assessment Unit (CMAU) for the over 65s, where GPs and other healthcare professionals are able to admit to CMAU for initial assessment by a dedicated Elderly Care Physician and Advance Nurse Practitioner to avoid unnecessary acute hospital admissions. In addition, our inpatient services team provide a dedicated unit for our Palliative Care and Respite patients at our Sheldon Unit. One of the service developments during this year was the partnership work with the Department of Health to create a dedicated Dementia-friendly unit, Willow House at West Heath Hospital. This unit cares for patients who have sub-acute care needs with the environment specifically designed for patients with Dementia care needs. Children and Families Services Our Children and Families Teams provides citywide universal and specialist services for children, up to school leaving age across universal services and up to 19 years of age for young people with Special Educational Need, with support for adults in families including pregnant women, new parents affected by post natal depression and domestic violence. The workforce is uniquely skilled in working in partnership with families in their home and education environment as well as in clinical settings. The teams have a well embedded model of partnership working with families and other organisations across Health, Education, Social Care and the third sector, in a range of locations. These include families own homes, education settings from Early Years nurseries and Children s Centres to secondary schools, including special schools, as well as within community-based clinics. Skilled Health Visitors and School Nurses, as public health practitioners, provide universal services, available to all children in the city, while paediatricians, specialist nurses and therapists work with families of children with additional health needs and disabilities. These teams make a vital contribution to integrated multi-agency provision, across a spectrum of need, facilitating holistic support, particularly for vulnerable families. Specialist Services Our specialist services include: rehabilitation (specialist care assisting people with physical, cognitive, emotional and social disabilities) dentistry provided by Birmingham Dental Hospital (also a highly regarded regional educational establishment) and community dentistry services in Birmingham, Dudley, Sandwell and Walsall; learning disability services for the residents of Birmingham. The range of services we provide enables us, uniquely, to identify where patients would benefit from an integrated approach. This enables us to develop bespoke, personalised packages of care to meet patients needs in a holistic way, meaning that patients do not have to be referred to several different providers. A key focus for the NHS in Birmingham remains the reduction of avoidable hospital attendances, maintaining an individual s independence in their place of residence. When hospital care is needed, the aim is to make the stay as short as safely possible. As the only focused community service provider in Birmingham, BCHC is able to support the shift of focus of care provision into the community. BCHC plays a central role in the health economy, working with our partners to design innovative solutions and further integrate services to facilitate the successful implementation of this approach via, for example; single point for referrals and increased multi-disciplinary working across long term conditions. 6

Where we provide services Our geographical area for core community services, universal and specialist children s services and the learning disability service includes the 1.1 million residents of Birmingham. We also provide primary healthcare services to the population of HM Prison Birmingham, in partnership with Birmingham and Solihull Mental Health NHS Foundation Trust. The table and map below sets out the geographical areas that our services cover, and the localities within Birmingham into which our core services are organised. Division Example of services provided Area Adults and Community Children and Families Core Community Services; District Nursing, Community Podiatry and Physiotherapy, community inpatient facilities and offender healthcare. Universal Children s Services including health visiting School Nursing City of Birmingham City of Birmingham Birmingham and Sandwell Birmingham Dental Hospital A range of dental services and training for dental students. West Midlands region Community Dental Services Orthodontics, special care, surgical dentistry and paediatric dental surgery Birmingham, Dudley, Sandwell and Walsall Specialist Services Rehabilitation Services Inpatient neuro-rehabilitation, brain and spinal injury clinics, wheelchair service, amputee rehabilitation and prosthetics West Midlands region Learning Disability Services Birmingham Community Assessment and Treatment Centre, respite and short care breaks, supported living and community forensic services. City of Birmingham 7

Shropshire Staffordshire Walsall Sandwell Dudley Herefordshire Worcestershire Warwickshire East and North Birmingham Central and West Birmingham South Birmingham 8

Our aims Our vision was developed by our Trust Board and is to: Deliver person centred community health services. Our ambition is to achieve Better Care and Healthier Communities. Our values The Trust s vision is underpinned by the following six values: Value Human rights principle Explanation Accessible Responsive Quality Caring Ethical Equity Inclusion Fairness Respect Dignity We will provide a range of services that reach out into the community and meet individual need where everyone counts; celebrating diversity and valuing difference. We will listen and work with our service users and partners to meet needs and improve health and well being. We will encourage innovation and excellence, celebrating success and learn from experiences. We will provide safe effective personalised care to the highest standard, providing information to support service users and their carers to make informed choices. We will deliver our services with respect, compassion and understanding where people are valued and we will act in their best interest. Promoting a culture of dignity and respect we will make morally sound, fair and honest decisions and be openly accountable. We will commit to investing wisely whilst being socially and environmentally responsible. Commitment Autonomy Through our actions and commitment, we will strive to make a positive difference to people s lives. We will value our staff, the commitment and contributions they make. 9

Patient activity During 2014/15 we had over 2.1 million interactions with our patients and service. We measure these interactions in what we call activity and the table below sets out our activity for 2014/15. Patient activity 2012/13 2013/14 2014/15 Total 2,103,782 2,101,645 2,138,899 There has again been an increase in the amount of overall activity carried out in 2014/15 as compared to 2013/14, of approximately 37,000 patient interactions. This is in line with the national agenda to develop more care outside of hospital settings. Income and expenditure Where our money comes from The majority of our income comes from the provision of patient care, which totals 229.864m. The remainder of 27.409m comes from other activities such as education, training and research. Organisation type 000 Provision of healthcare NHS Trust 257 NHS England 66,461 Clinical Commissioning Groups 149,067 Foundation Trusts 4,931 Other 9,148 Total revenue from patient care activities 229,864 Other operating revenue 27,409 Total revenue 257,273 10

How we spend our money In the financial year 2014/15 we spent 254.460m. The largest proportion of this expenditure was on the salaries and wages that we pay our staff, which totalled 181.717m. Further details on our expenditure can be found in the Income and Expenditure section of the Financial Statements section of this report. Organisation type 000 Employee benefits 180,641 Trust officer board members 1,076 Premises 22,592 Supplies and services - Clinical 20,368 Other 29,783 Total expenditure 254,460 Summary of the Trust s employees The following table states the year end summary position in relation to the Trust s Employees. Position as at 31st March 2015 Male Female Directors Employees (excl Directors) 8 5 62% 38% 749 4267 15% 85% Number of employees All staff* Senior managers ** Division Female Male Grand total Female Male Adults and Community Division 1874 274 2148 11 1 12 Children and Families Division 1060 46 1106 9 9 Corporate Division 401 145 546 26 30 56 Specialist Services Division Birmingham Dental Hospital Community Dental 172 22 194 326 122 448 2 2 4 Learning Disabilities 221 60 281 5 5 Rehabilitation 216 88 306 2 3 5 Specialist Services Division Total 928 287 1229 9 5 14 Grand Total 4272 757 5029 55 36 91 Total as percentage 85% 15% 60% 40% All data for Primary Assignments only *total staff numbers - including senior managers ** Senior Managers at 8b and above excluding Clinical Leads. Grand total 11

Equality and diversity Birmingham Community Healthcare NHS Trust (BCHC) is committed to: Equality-meaning fairness for its staff and service users through challenging and eliminating discrimination and ensuring equal opportunities. Diversity-meaning delivering personalised staff/patient care through having a workforce representative of all sections of society where each Trust staff member is respected and able to give their best; and where service users receive care personalised to their individual health need. Human rights-meaning delivery of the highest standards of care through ensuring staff and service users are treated well above minimum standards, consistent with their human rights and the FRIEDA principles of Fairness, Respect, Inclusion, Equality, Dignity and Autonomy that underpin them which are linked to the Trust Values. Demonstrating these three principles ensures staff and patient dignity. Within this Trust the Equality, Diversity and Human Rights agenda sits alongside the Organisational Development and Health and Well-Being agendas. Reporting to the Director of Compliance and Assurance, this affords the Trust a stronger opportunity to embed equalities into the core business and structures of the organisation. All trust divisions are compliant with our mandatory equality training target of 87 per cent and focused work in addressing any areas of non compliance is treated as a priority. Equality and diversity Required Compliant % Adults and Community Division 2032 1761 87 Central Services (AandC) 49 47 96 Community Services (AandC) 1130 1002 89 In-Patient Services (AandC) 550 420 76 Specialist Services (AandC) 303 292 96 Children and Families Division 1035 955 92 Corporate Division 470 434 92 Specialist Services Division 1117 920 82 Birmingham Dental Hospital Service 410 365 89 Community Dental Service 171 79 46 Learning Disabilities Service 269 220 82 Rehabilitation Service 267 256 96 Total 4654 4070 87% 12

Throughout the year a number of staff have attended tailored Forum Theatre Equality and Diversity Training and a series of Deaf Awareness Training sessions, which were well attended and well received. Other opportunities for accessing Equality and Diversity training and awareness are provided through Induction training, bespoke team events and via e-learning and an Equality and Diversity workbook. The revised Equality and Diversity Policy was approved by Trust Board in October and the Harassment Network meet regularly and have made a commitment to evaluate the current referral process. BCHC has a framework for: policy, service and organisational change Equality Analyses. This is in active use across the Trust. Human Rights principles have been included within the Equality Analysis framework for BCHC. All Trust functions continue to be subject to Equality Analysis and this features as part of Trust harmonisation, service development, and the Cash Releasing Efficiency Savings (CRES) processes. Review Equality Analyses are carried out each time a Trust function comes up for periodic review. Each Equality and Human Rights Analysis evaluates whether a specific Trust function (i.e. policy, service or organisational change process) has been designed and will be used in a manner consistent with the requirements of the Equality Act 2010 and Human Rights Act 1998. Each also contains at least one recommendation for making improvements in that function from an equality diversity and human rights point of view. 272 Equality and Human Rights Analyses have been commenced with 252 completed, mostly relating to policy and strategy documents and a number relating to service redesign and organisational change programmes. Equality Impact Analysis is conducted on all new functions, processes and policies with appropriate action plans implemented to address any highlighted areas of need. 13

Performance at a glance Performance In this section we will set out how we have performed during the financial year 2014/15 in terms of meeting targets. We are delighted to report that we end 14/15 compliant with all national targets and standards. The table below sets out our key achievements in 2014/15 and more detailed information will be provided later on in this report. Key achievements 2014/15 Care Quality Commission (CQC) - we remained fully registered with the CQC, without conditions, for the full year. The Trust was inspected by the CQC in June 2014 and received an overall rating of Good. Healthcare acquired infections - this is related to Clostridium Difficile (C-diff) infections, Methicillin Resistant Staphylococcus Aureus (MRSA) infections, MSSA (Methicillin-Sensitive Staphylococcus Aureus), and E-coli. The Trust had three cases of MRSA bacteraemia in 14/15. All cases took place in different wards, the relevant standards were adhered to and no spread of infection took place. National performance targets - we have met all applicable national performance targets by year end. Financial targets - we have met all of our statutory financial duties. How we measure performance Internal and external targets Our performance targets comprise national targets, that as an NHS Trust we are required to report against, and internal targets that are set by the Trust Board at the start of each financial year. Performance is also monitored against indicators defined in the various contracts which we have with our Commissioners. Targets are a mixture of quality, financial and general performance targets, which collectively give the Board a general picture of performance across the Trust. 14

Performance against strategic objectives The Trust Board is responsible for determining and monitoring the Trust s overall strategy and, at the start of each financial year sets strategic objectives that are aimed at moving closer towards achieving our vision. Our strategic objectives for the year are known as the 6Ps which comprise: Objective People Purpose Partnerships Promotion Price Place Explanation To have a skilled, innovative workforce, who are compassionate and caring, where staff are empowered to take action, and where customer service and clinical leadership are at the heart of our services. To transform and deliver high quality, efficient, integrated services that enable the best possible outcomes. Develop effective partnerships working with our stakeholders to provide integrated care and break down the barriers internally and externally to maximise the benefits of expertise in the organisation. Promote community services and the Trust, listen to and communicate clearly and effectively with all our stakeholders and members. Secure our future through effective contractual terms supported by robust costing and information systems to meet all our statutory duties and financial targets. Deliver services in the most appropriate location, supported by an efficient estate and effective informatics infrastructure. With each of the 6 objectives is a series of actions and timescales set out in the Annual Plan, which when achieved will move the Trust towards the objective. In addition to monitoring performance against internal and external targets on a monthly basis, the Trust Board also measures performance against these milestones on a quarterly basis to ensure that progress is being made. We achieved the deliverables against each of the 6 objectives overall for 2014/15. There were however a small number of milestones that were not achieved. These have been reported to the Trust Board and in the main relate to the following: Roll out of service line management Delivery of community wide information system project milestones The reason that we have not achieved these milestones is largely due to competing priorities, in what has been a very busy year for the Trust. As they are important and necessary developments however, the work will be carried over into the objectives for 2015/16 and we will continue to monitor the progress that we are making each quarter. 15

Our performance against national and local targets Performance against key national and local targets in 2014/15 is set out in the table below. This does not represent the full range of targets that are measured and monitored by our Board, but is intended to give an indication of how we have performed against targets that are widely regarded as important. The table below sets out in respect of each target, whether it is a national or local one, a description of the indicator and our performance against it for the year. We have also published a separate Quality Account in line with the NHS Act, NHS (Quality Accounts) Regulations 2010 which provides more detail in relation to our performance in relation to quality in 2014/15, and a copy can be obtained by contacting Trust Headquarters. Trust wide indicators 2014/15 Local (L) or national(n) target N N L L N N N Indicator Target 14/15 MRSA new bacteraemia Clostridium Difficile (C.diff) infections MSSA bacteraemia Infections E coli bacteraemia Infections 18 weeks nonadmitted patient pathways Venous Thromboembolism (VTE) Risk Assessment Compliance with Care Quality Commission(CQC) There should be no cases of new MRSA bacteraemia There should be no more than 15 cases of avoidable C.diff infections There should be no more than 3 new cases of MSSA infection There should be no more than 14 new cases of E coli At least 95% of patients should be treated within 18 weeks of referral for treatment 95% of patients should have a VTE risk assessment on admission The Trust is registered with the CQC with unconditional status, there are no restrictions placed on the Trust in provision of its services Performance 2012/13 Performance 2013/14 Performance 2014/15 1 0 3 19 7 0 2 3 1 8 9 14 97.40% 96.14% 96.04% 99.40% 99.7% 96% 100% 100% 100% 16

Trust wide indicators 2014/15 Local (L) or National(N) Target N N N N L Indicator Target 14/15 Serious Incident Root cause analysis completed in 45 days or within a commissioner approved extension time frame. Number of complaints acknowledged within 3 days Customer experience, patient surveys completed in all areas in the past 12 months Patient safety thermometer relates to harm free care in four major patient safety areas: pressure ulcers, falls, urinary tract infections in patients with catheters and VTE. Compliance with assessment and care planning for Essential Care against an agreed set of care standards in bedded areas. To ensure 100% of root cause analyses are completed within the timescales specified. 100% of complaints should be acknowledged within 3 days. Patient surveys should be completed in all areas annually For 95% of patients to receive care that is free of the four harms measured by the Patient Safety Thermometer. 95% compliance with assessment and care planning for Essential Care in bedded areas. Performance 2012/13 Performance 2013/14 Performance 2014/15 100% 100% 100% 100% 100% 100% 100% 100% 100% 94.85% 95.8% 96.99% 93.10% 96.11% 98.00% 17

Trust wide indicators 2014/15 Local (L) or National(N) Target N N N Indicator Target 14/15 CRES efficiencies Monitor Risk Assurance Framework rating (previously Monitor Governance Risk rating) The Net promoter score. Patients are asked how likely is it on a scale of 1-10 that you would recommend this service to friends and family? The organisation is required to deliver fully against its efficiencies plan. The Trust is required to score 3 or more. The target was to not score below 65 each month for 2014/15. Performance 2012/13 Performance 2013/14 Performance 2014/15 100% 100% 100% Green rating (Monitor Governance Risk rating) Rating of 4 Rating of 3 60.23 73 66 18

Areas where we have performed well Although we have performed well generally during 2014/15 there are some key areas where we are particularly proud of our performance. The following section details these areas and includes both national targets and some local targets not featured on the previous table. Health Care Associated Infections (HCAIs) We have a strong overall track record of performance against infection control priorities and targets and we recognise that this is an area that contributes significantly to the safety and quality of our services. During the year we worked closely with the NHS Trust Development Agency to further strengthen our strategic and operational response to HCAI. We have also restructured the Infection Prevention and Control Team who are now led by a recently-appointed Nurse Consultant, supported by the Medical Director in his role as Director of Infection Prevention and Control (DIPC). Our performance in relation to avoidable Clostridium Difficile (C-Diff) cases was excellent in that we had no avoidable cases against a target of 15, compared to 7 in the previous year. In 15/16 the Trust will be monitored against a target of no more than 13 cases. However, we were very disappointed to report that there were three cases of MRSA bacteraemia reported in 14/15. However all cases were subject to a full RCA and post Infection review process working with our commissioners and any lessons introduced into practice. We know that regardless of how good our policies and procedures are, this excellent performance would not be possible if it were not for the diligence and professionalism of our staff in their implementation and we recognise the excellent working relationships that exists between our specialist Infection Prevention and Control Nursing Team and our wards. Family and Friends Test (NET Promoter Score) The Net Promoter Score (NPS) was introduced in 2012/13. It is also known as the Friends and Family Test and involves asking patients at the point of discharge how likely they would be to recommend the service to their family and friends. The percentage detractor is subtracted from the percentage of promoters, and this figure is reported as the Net Promoter Score. Although there is no national target, the Trust has increased its internal target of scoring above 50 per cent each month in 2013/14 to 65 per cent in 2014/15. Performance has been consistently above a score of 60 per cent throughout the year. Although we do regard this test as an additional way of measuring the experience of our patients rather than a measure in isolation, it has proved particularly useful in that it also allows patients to make comments that we can then utilise to make improvements. In 2015/16 national guidance is changing and as a result we will be reporting a simpler Friends and Family Test which reports the percentage of patients who reported that the care received was Very Good or Excellent. In 2015/16 national guidance is changing and as a result we will be reporting a simpler Friends and Family Test which reports the percentage of patients who reported that they would be extremely or very likely to recommend the service to a loved one. Mandatory training Ensuring that staff are well trained and up to date with training has been a priority this year and it is pleasing to report that we have exceeded our contractual target this year of 85 per cent and over 90 per cent of staff received mandatory training during the year. 19

Safe staffing Ensuring that safe staffing levels are maintained in our bedded areas is, as always a key responsibility of the Trust. This year we have implemented systems in accordance with new national guidance to ensure that the number of nurses on each of our wards is maintained and is appropriate to the level of need of the patients who have been admitted over both day and night shifts. This information is reported to the Board monthly and at the end of March the Trust had an average of 108 per cent. The fill rate of planned versus actual nursing hours is 108 per cent. The overfill is due to the need to provide one-to-one supervision for patients with additional needs which is over and above the usual staffing level required by national guidance. Areas where we are seeking improvement Whilst we achieved all of the national targets there are areas where we did not meet locally set targets including sickness absence and delayed transfers of care. Sickness absence Sickness absence has remained a focus for the Board throughout the year in order to minimise the impact on colleagues and patients when staff are unable to come to work. Despite significant effort and energy we have been unable to meet the challenging target of 3.9 per cent absence rate. Whilst good progress was made in the first part of the year the Trust performance deteriorated in the middle winter months, however the sickness absence rate at March 2015 was 4.98 per cent compared to the end of year rate for 2014 of 5.11 per cent. It was recognised in the latter part of the year that there was little evidence of sustained improvement and a four point high level action plan was approved by the Trust Board. The plan focussed on the supportive intervention of line management, the full implementation of the new Occupational Health Service, the Organisational Development and Health and Wellbeing programme and the development of a revised Management of Attendance Policy. It is planned that continuation of the existing sickness absence management programme combined with the high level actions will address the long term challenges of sickness absence. Staff sickness absence Total number of days lost through long and short term sickness Average working days lost Total staff years Explanation 2012/13 2013/14 2014/15 This is the total number of Full Time equivalent Calendar days lost through sickness The total number of Full Time equivalent days lost to sickness divided by the total staff years A full time member of staff working all year is equivalent to one staff year 91,544 82,867 85,734 20.8 total calendar days 12.8 working days 18.8 total calendar days 11.6 working days 4,399 4,388 4,364 19.6 total calendar days 12.0 working days 20

Delayed transfer of care Delayed Transfer of Care (DTOC) is a measure that we use within our inpatients units where our patients have been deemed clinically fit and do not require the level of care within the inpatient units where they are currently. The Trust target is 7.5 per cent; it is disappointing to note that at the start of the year, our DTOC was reported at 18.6 per cent in April, with the highest peak in August 2014 of 26.65 per cent. However during 2014/2105, a significant amount of work has been undertaken, working in partnership with our social care colleagues, to reduce the number of patients in our inpatient beds where delays occur and during February 2015, we reported our lowest DTOC of 11.75 per cent. However it is disappointing to note that we ended the year at 19.3 per cent and this remains a high priority for 2015/2016 to ensure we build on the good progress made during 2014/2015. As part of the improvement programme during 2014/2015, we appointed a Discharge Project Matron in October 2014 which has been extended until April 2016, to embed and support new processes at ward/unit level and the continued work of accurate reporting and working with all wards and units to reduce delays. Our electronic discharge planning system is now being used by all inpatient areas and work is ongoing to embed this system into normal working practise so that length of stay remains at the target levels and preventing and managing delays in all areas improves. As part of the changes we have made, we commence planning the patient discharge with the patient at the point of admission and where necessary in partnership with our social care colleagues. Furthermore, we have streamlined the way we report our delays, giving us greater transparency and our Clinical Team Leaders and Matrons are actively involved in supporting our clinical teams in facilitating discharges. Throughout this improvement programme, we noted that partnership working with our social care colleagues was paramount. Work commenced during 2014/2015, however this continues with our social care partners to improve the assessment process, which remains the most common cause of delay. The Social Care Team is focussing on short assessments from April 2015 to expedite discharge from the bedded services. The aim is to improve patient flow, reduce the number of delays caused by social care and give a better quality of care to our patients. During 2015/16, our aim is to attain a position where delays are reducing through prevention, to continue to work with social care partners to improve the rate of assessments, to address any delay reasons that the teams can directly influence and to ensure accurate reporting of delays. 21

Sustainability report Our estate The purpose of the Estates and Facilities Strategy is to deliver the physical environment to match our service aspirations, and to meet service user and staff expectations within increasingly challenging financial constraints. The principles of our Estates and Facilities Strategy remain as follows: rationalisation of the estate to ensure fewer, better quality buildings are more efficiently utilised by maximising space efficiency and ensuring service leads understand the cost of premises as an overhead on service costs reduction of maintenance costs by rationalisation of poor estate and buildings that were not purpose built for healthcare or have high backlog maintenance costs infrastructure investment is only made on premises which will be held in the medium to long term where practical, sustainability measures will be implemented to reduce maintenance costs, energy usage and carbon emissions, in line with the Trust s Sustainability Development Strategy 2011-2016. Improving utilisation to facilitate rationalisation of the estate Positive progress continues to be made in-line with strategy objectives to rationalise the total number of locations at which BCHC services are provided. Following on from the reductions achieved with specific regard to freehold and leased premises rationalisation, (excluding ad-hoc management agreements ) against a target 47 by 2017. Active plan (the Estates and Facilities management system) is now fully populated to include all core sites where BCHC carry out clinical activity. The system is now on-line and we are working with services to improve its use as the primary tool for booking clinical accommodation. The environment We have continued to work towards our commitment to acting in a sustainable and environmentally responsible way both in the planning and delivery of services, and in supporting staff in embedding such practices into their daily routines. This section sets out the steps that we have taken during 2014/5. NHS Carbon Reduction Strategy and Climate Change Act We have a Sustainable Development Strategy in place that was developed in November 2011, which sets out a range of measures that we are adopting to play our part in carbon reduction and to ensure that we are sustainable for the future. 22