2004/05 - George Eliot Hospital

Transcription

George Eliot Hospital
NHS Trust
Annual Report and Review
2004/05
Better Care Without Delay
2
Chairman and Chief Executive’s Report
year, but we
The George Eliot
congratulate and thank
Hospital plays a vital
all our colleagues for
role in our local
their efforts in
community and it is
reducing the deficit
through the dedicated
considerably.
support of our staff, our
Additional challenges
volunteers and our local
have also affected our
population, who give
overall performance
tirelessly of their time,
and we were of course
effort and kind
disappointed to lose a
donations to support us,
Frank McCarney,
star
in the Healthcare
that we continue to
Trust Chairman
Commission’s ratings.
provide excellent quality
However, a change in structure
acute care to those who need it.
and a range of new measures in
This has been a year of great
place are already showing
change at the Eliot and great
demonstrable improvements in
challenge. We have seen
some of our most challenging areas,
unprecedented increases in the
including delayed transfers of care
number of people attending our
and the impact this can have on
A&E department over the year and
A&E and cancelled operations.
whilst this speaks volumes of the
We are both extremely proud to
excellent and swift care that is
be associated with the Trust and,
provided, it has inevitably had an
despite some of the constraints that
impact on other areas of our
we have faced, the hard work of our
service.
staff has ensured we have
It is unfortunate that we were
unable to reach financial balance this demonstrated excellent outcomes in
and the qualitative
the following:
improvements
around
l Meeting urgent
the actual patient
cancer referrals
experience.
within two weeks
As you know, the
for all cancers
headlines
don’t always
l Meeting breast
reveal the full story
cancer diagnosis and
and we thank our local
referral to treatment
population for taking
targets
the time to understand
l Ensuring patients
some
of the real
wait no longer than
Duncan Phimister,
challenges
that we face
13 weeks for a first
Acting Chief Executive
and the ways we are
outpatient
addressing them.
appointment
We hope the following pages will
l Providing patients with suspected
give you an insight into many of the
heart attack with thrombolysis
excellent areas of work that are
treatment within 30 minutes of
continually improving throughout
arriving at the hospital door
the Trust, in addition to the
l Maintaining good levels of
operational information that you
cleanliness
may be interested in.
We are totally committed to
But, of course, patient care is about
providing the best quality care to
much more than hitting targets and
the people of North Warwickshire,
we welcome the Healthcare
Nuneaton, Bedworth, South
Commission’s decision to move
away from performance targets to a Leicestershire and the surrounding
areas.
quality standards based approach
We are fortunate to have an
throughout the coming year.
incredibly dedicated staff and
This means we will be required to
volunteer base who really make the
meet the Government’s ‘Standards
difference between providing good
for Better Health’, which will
provide patients with a much clearer care and an excellent patient
experience. Thank you to you all.
outline of both the quantitative
improvements such as waiting times
Frank McCarney and Duncan Phimister
Mr Tucson Dunn was the substantive Chief Executive Officer for the whole of 2004/05.
In May 2005 The George Eliot and he parted company following his suspension. The
suspension was made to enable investigations into allegations made against him and was a
neutral act, apportioning no blame. The matter is now closed and Mr Duncan Phimister
will be Acting Chief Executive Officer until a substantive appointment is made.
Key
statistics
George Eliot Hospital NHS
Trust provides acute
hospital services to the
people of Nuneaton and
Bedworth, North
Warwickshire, South West
Leicestershire and Northern
Coventry. During 2004/05,
we cared for the following:
l 4,581 elective (planned)
inpatients
l 15,825 elective (planned)
day cases
l 132,000 outpatient
appointments (new and
follow-up)
l 58,196 A&E attendances,
of which 23,803 were
admitted
This level of activity is
supported by 1,800 staff,
400 beds and an annual
budget of £85 million.
3
A profile of the Trust and our work
The Trust’s staff deliver traditional
district general hospital services to
a local population of around
250,000 and provide specialist
plastic surgery services to a much
wider area. We are based on one
site on the outskirts of Nuneaton,
Warwickshire.
Demographics
Some 61,900 people live in the
largely rural Borough of North
Warwickshire. Many of the
settlements in North
Warwickshire developed to meet
the needs of the mining industry.
This is in contrast to the towns
and villages on the western side of
the Borough, which developed to
meet the needs of commuters.
Nuneaton and Bedworth is the
second largest District in
Warwickshire, with a population
of just over 119,000 but the
smallest geographical area.
The age, gender and ethnic
structure is broadly comparative
with England and Wales.
However, there is a greater
proportion of children resident in
urban wards around Nuneaton
and a greater proportion of
elderly (over 75 years) in rural
areas surrounding North
Warwickshire. There is a
relatively high rate of teenage and
young adult conceptions and
births, with lower than national
average birth rates among women
over 30. Our feature on pages 6-7
outlines the joint approach we are
taking with North Warwickshire
PCT to work with young parents
(under 19 years old) and the
development of services to
support them.
North Warwickshire has high
rates of coronary heart disease,
obstructive pulmonary disease and
colorectal cancer in comparison
to other Districts and Boroughs in
Warwickshire.
Local PCTs, including North
Warwickshire PCT, are
responsible for planning and
providing the care needed for the
populations they serve, in
collaboration with partner
organisations. With increasing life
expectancy and a national shift
towards managing long-term
conditions, much of this will
support the development of
alternatives to acute care. The
Trust already takes a proactive
approach to providing outreach
services, which can be seen later
in this report in our features on
diabetes, osteoporosis and
physiotherapy, where the Trust is
working collaboratively with
primary care providers and
commissioners to offer care in the
most appropriate setting for
patients. This also supports our
aims of reducing occupancy rates
and length of stay to free up
capacity for elective activity and
generate additional income.
Working with our
local partners
We work closely with other
healthcare providers in clinical
networks, including cancer,
pathology and orthopaedic
services. Our key network
partners are University Hospitals
Coventry and Warwickshire,
South Warwick General Hospital
and the Arden Cancer network.
We run shared services – such
as physiotherapy and occupational
therapy - with local NHS Primary
Care Trusts, primarily North
Warwickshire PCT and Hinckley
and Bosworth PCT. We also
work closely with local Social
Services partners to deliver
integrated care.
A mission to be a
‘no wait’ hospital
Harnessing the
power of technology
The Trust’s mission is to provide
better care without delay by striving
to become a ‘no wait’ hospital.
We are committed to providing
patient-centred care in an
environment that aims to
personalise and demystify the
healthcare experience for patients
and their families.
Staff at the ‘Eliot’, as it’s
affectionately known, work to
provide outstanding clinical quality
with a sincere commitment to
patient dignity.
We also recognise the importance
of information technology in
modernising patient care and have
gained national recognition as a
leader in embracing technological
advances.
SEPTEMBER 2005
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An overview of our performance
Star rating
The George Eliot Hospital NHS
Trust was awarded one star in the
Healthcare Commission’s national
star ratings for 2003/04.
Whilst disappointed at the loss
of a star, the Trust has a clear
understanding of where the gaps
were and. more importantly, has
robust plans in place that are
already demonstrating excellent
progress in these areas.
Accident and
emergency
The Trust made good progress,
ensuring that 98% of patients
attending A&E were seen within
four hours. Unfortunately,
following an extremely busy
winter period, the Trust was
unable to maintain this target
without the risk of compromising
patient care.
We are pleased to report that
the Trust has since introduced
new ways of working and
analysing information, helping us
to pinpoint our pressure points.
A clear action plan has helped
turn performance around and,
despite the continuing high
numbers of attenders, patients are
being seen within four hours.
Delayed transfers of
care
The Trust experienced some
difficulties, often called ‘delayed
discharges, with discharging
patients who are medically fit but
who require some form of
Figure 1: Number of A&E Attenders from April 03 - June 05
Note: There is a fairly well established seasonal pattern, and now the overall trend looks more
steady.
‘intermediate care’ (i.e.,
rehabilitation, nursing care or
support at home). The Primary
Care Trust has plans to increase
intermediate care capacity locally.
The George Eliot welcomes the
support this will bring.
If we have problems moving
patients on to more appropriate
settings, it reduces the number of
patients we can admit. Combined
with an increase in emergency
admissions (and a duty to treat
patients on the basis of need), this
can unfortunately result in the
cancellation of routine operations
due to a shortage of beds something the Trust never wants
to do.
The good news is that since a
multi-agency discharge team
meeting has been established, the
number of delayed transfers of
care have been reducing
dramatically.
The meeting was established in
April 2005 and includes
representatives from both George
Eliot Hospital and North
Warwickshire PCT, Occupational
Therapy, Physiotherapy, discharge
liaison nurses, intermediate care,
Social Services, health advisors,
rehabilitation (Bramcote) and
Trust Matrons.
By working collaboratively, each
‘agency’ is able to help pinpoint
ways in which they can alleviate
constraints in the system and
ensure that patients’ needs are
addressed early, reducing the
length of their hospital stay.
5
An overview of our performance
Figure 2: Percentage of A&E attenders seen (admitted, discharged or treated) within four hours.
Waiting times
Break even
The Eliot has had a good
reputation for maintaining low
waiting times. We are pleased we
have ensured that almost every
outpatient attending their first
appointment has been seen within
13 weeks – 91.7% compared to the
England average of 83.4%.
Similarly, no patients waited more
than nine months for an inpatient
or day case admission, whilst the
Trust ensured all urgent cancer
patients were seen inside two
weeks.
NHS Trusts have a statutory duty
to ‘break even’ on income and
expenditure. Although the Eliot just
missed this particularly challenging
target, the deficit of £786,000 was
less than 1% of turnover. Staff
have been congratulated on their
efforts to keep the deficit at a
minimum.
The Trust’s reference cost index
(the measure of how ‘costeffective’ an NHS Trust’s services
are) was 79%. This essentially
means that George Eliot provides
services 21% cheaper than the
average NHS hospital, indicating
not only how economical we are
but also why there is little room
for cut-backs.
Check out Money Matters on
page 24 for further information
from our Finance Director.
OCTOBER 2005
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6
From here to maternity
It has been an action-packed year
at the George Eliot’s Maternity
Unit following its major internal
refurbishment last year.
A total of 2,671 babies were
born during the year and the team
keep adding to their support for
expectant parents and new
parents, not to mention the
babies too!
Back to birthing
basics
Using the Royal College of
Midwives guidelines, George Eliot
staff produced their own Midwife-
led Care guidelines to help bring
‘birthing back to basics’.
Two ‘active birth rooms’ have
been designed by midwives to be
sensitive to the needs of women
and their partners during
pregnancy, with the aim of
bridging the gap between home
and hospital.
Midwife Gerry Duffin said: “Birth
is a natural process and midwifery
led care offers a ‘holistic’
approach during childbirth, with
the emphasis on keeping birth
normal.
“The private and quiet
environment created encourages
women to follow their own
instincts, while the midwives
provide ‘self help’ methods and
simple solutions to ease
discomfort during labour.
“The support provided reduces
the need for strong pain relief,
reduces interventions and
increases women’s satisfaction.”
Future plans include the
provision of two early labour
rooms on the antenatal/postnatal
ward (Drayton), allowing partners
to stay and offer support in the
privacy of the purpose built room.
Midwives demonstrate the ‘home
from home’ active birth rooms.
Cottoning on…
The George Eliot recently became
one of the first hospitals in the
country to use only cotton nappies
as part of a new scheme
promoting the benefits of
environmentally friendly nappies.
The maternity unit is working in
partnership with community
learning charity, ContinYou, and
Warwickshire County Council on
the three-year project, which
ensures all new parents at the
The first babies to try
the cotton nappies
hospital are provided with a supply
of cotton nappies.
The project, which should help
reduce landfill waste in
Warwickshire, will cost the new
parent an average of £250 - instead
of £1,000 - in nappies.
New Mum Vanessa said: “I am
really impressed with how small
and easy it is to use the cotton
nappies. I think the Cotton on to
Cotton Nappies project is a great
idea.”
7
Parents and children
Preparing Young
Parents
Hospital and community based
midwives were responsible for
establishing Preparing Young Parents
(PYPs) groups that were launched
in January 2005 in conjunction
with colleagues from Connexions,
the Early Years Project and
Warwickshire Teenage Pregnancy
Strategy.
The weekly drop-in sessions are
aimed at expectant mums who are
under the age of 19, as well as at
their partners/families.
Young parents benefit from a
wide range of support and advice
from the Connexions advisor and
midwife, who are always present
at the weekly sessions.
The Connexions advisor can
provide information on benefits,
housing needs and training
opportunities whilst the groups
participate in informal discussions
that are focused around birth,
labour, coping strategies,
relaxation, emotions and feeding.
Special topics are frequently
arranged and have included baby
massage techniques, smoking
cessation advice, counselling on
breast feeding and aromatherapy
amongst others.
The sessions run at Hatters
Space, Abbey Green, Nuneaton,
every Friday 1-3pm and at the
Early Years Centre, Kings Avenue,
Atherstone, every Monday from
11.30 am to 1.00 pm.
Plans are in place to offer the
same in Bedworth.
Joined-up working
benefits children’s
services
Rotational working practices have
been established for staff working
in the George Eliot and University
Hospitals of Coventry &
Warwickshire Neonatal Units.
By working across both units,
staff are maintaining and further
developing their clinical and
management skills, which enhances
the quality care neonates receive
and also improves staff retention.
The Trust was also delighted to
appoint two new paediatricians to
the Integrated Child Health
Services.
Dr Melanie Kershaw’s specialty
is in paediatric diabetes. She also
carries the responsibility of the
Named Doctor for Child
Protection.
The other new acute based
paediatrician is Dr Kathy Bailey,
whose specialty is rheumatology.
NOVEMBER 2005
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8
Accessibility to all
The Trust is committed to
improving accessibility to our
services for everyone who needs
them, regardless of age, ethnicity,
language or disability. Over the
last year, we have been making
some important strides:
Liaison nurse for
learning disabilities
An important link between the
hospital and the community has
been established for people with
learning disabilities who need to
use hospital services.
Louise Bates, who works fulltime for the North Warwickshire
PCT as a community nurse, is
now based in the hospital two
days per week as Liaison Nurse,
Learning Disabilities.
Louise aims to raise awareness
amongst adults with learning
disabilities, as well as offering
advice, support and information to
them about their health needs.
This vital role involves close
Louise Bates works with a
member of staff
working with hospital staff, carers
and other professionals to
facilitate a smoother transition
and greater understanding
between the hospital and
community areas.
Commenting on her role, Louise
said: “I am available to offer
support on consent and capacity
issues and will be developing ‘best
interest guidance’ and preadmission assessments to assist
the ward staff in the patients’
care.”
PALS (Patient
Advice and Liaison
Service)
As it enters into a fourth year of
service here at George Eliot
Hospital, the number of people
approaching the Patient Advice &
Liaison Service (PALS) continues
to increase.
PALS staff are asked to assist
with various issues or concerns
that people have - from delays
with appointments, cancelled
operations and instances of poor
communication to passing on
praise for a member of staff who
has “gone the extra mile”.
The department also has a wellestablished team of volunteers,
whose help is invaluable. The
volunteers are involved in
escorting patients and visitors to
various departments around the
PALS volunteers
here to help
site, giving directions and meeting
and greeting visitors as they enter
through the main entrance.
They are also helping to set up a
health information resource within
PALS by sourcing leaflets and
booklets on varying health
conditions and support groups.
If you have any questions or
queries about any of the services
provided by the George Eliot
Hospital, or if indeed you would
like to pass on your thanks, please
do not hesitate to contact PALS
on (024) 76865550 or freephone
0800 0407194, Monday to Friday
8.30 am – 6.00 pm.
Cross-cultural
support
The Multi-Lingual Co-Worker
service has gone from strength to
strength and is well into its third
year as part of PALS.
Parveen Deen, Multi-Lingual
Co-Worker, has recently been
working very closely with the
Trust’s Patient & Public
Involvement Forum to introduce
them to local ethnic minority
groups.
This is in an effort to raise
community groups’ awareness of
the work the PPI Forum is
undertaking, and also to raise the
Forum’s awareness of the different
community groups within the local
area.
Plans are also well under way for
the Trust’s third annual multicultural event, the theme of which
is around the work of volunteers,
to coincide with 2005 – the ‘Year
of the Volunteer’.
If you have any queries or
questions around multi-cultural
issues or interpreting
requirements (Punjabi, Urdu and
Hindi), please contact Parveen on
(024) 76865595.
9
Communication and involvement
Accessing Expert
Advice
Patient and Public
Involvement (PPI)
Who better to tell us what is
working well and what needs
improving than our patients
themselves?
The Trust takes the
compliments, complaints and
suggestions from everyone using
our hospital very seriously. We
strive to use as many ways of
accessing your opinions as we can
to help guide and drive forward
improvements in your care.
Patient and Public Involvement
plays an important role within the
Trust.
The delay in the Trust’s
intentions to become a
Foundation Trust has prevented
some of the plans to work with
George Eliot Membership.
Members of our local community
and PPI Forum participate in
groups and activities within the
Trust. This ensures the patient
viewpoint is central to the
decisions that we make
Santa visits about service development.
our
It is planned to form a
Christmas patient information group
Fair.
to comment on all new
information leaflets
developed in the Trust.
If you would like to be
part of this group - which is
postal only - please contact
Christine Longstaff, Head of
Patient Partnerships, on
(024) 7686 5661.
A very successful
Christmas Fair was held in
November 2004, with stalls
from the community as well
as the Trust. In addition to
the money raised by individual
groups, the Trust raised over
£1,000 for cancer services.
During the coming months it is
hoped to raise the profile of
patient and public involvement to
make sure that it continues to play
a central role.
Patient surveys
The Healthcare Commission
carried out two surveys nationally
in which 140,000 patients gave
their perception of outpatient
clinics and emergency departments
across England.
The surveys represented one of
the biggest national tests of patient
attitudes, and are being used as an
indicator of whether patients
believe that services are really
improving.
In total, 367 George Eliot
Hospital patients responded to the
Emergency survey and 469 to the
Outpatient survey. Although this
represents only a small proportion
of the patients we see each year,
the Trust is using the findings to
help direct future improvements.
The overall picture at the Eliot
was in line with national results.
Key results for the Trust showed
that 94% of patients responding
rated their care in the Outpatients
department as good, very good or
excellent, and 90% in A&E.
Constructive
criticism
Complaints provide the Trust with
an opportunity to learn from our
patients’ experiences and to
improve our services. In the year
to 1st April 2005, the Trust
received a total of 238 formal
complaints. This is a slight increase
from 2003/04 (218), which may be
due to the fact that verbal
complaints are now included in
these figures.
We try to respond to complaints
within the time limits set by the
NHS Complaints procedure.
Unfortunately, unavailability of staff
due to holidays, sickness and
pressure of work sometimes
prevents this, and the Trust will
not respond within these time
limits at the expense of a full
investigation and a satisfactory
response.
In the year we succeeded in
responding to 78% of all
complaints within the 20 working
day guidance. The number of
complaints resolved at the local
resolution stage of the process i.e., the initial stage - was 229
(96%),
During the year new leaflets have
been made available to inform
patients and their relatives on the
Formal Complaints Process.
The Trust will continue to treat
all complaints with equity and to
encourage staff to use these as a
learning opportunity. A number
of service improvements, based on
concerns raised, have been made.
Two such examples are:
l All patients admitted with a
fractured femur are now
referred automatically to a
dietician.
l A number of wards have
implemented the use of ‘white’
boards as a reminder to follow
the progress of requests for
investigations.
Equally, we welcome the many
‘thank you’ letters that we receive
and ensure the relevant staff are
made aware of them. The
Comments Book in main reception
also provides an opportunity for
many to express their thanks.
These comments are always
passed on.
DECEMBER 2005
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10
The Year of the (invaluable) Volunteer
As mentioned in our earlier
article about PALS, the Trust is
extremely fortunate to have a
dedicated team of volunteers
who give tirelessly of their time
and effort to support patients
and staff in practical ways, and
by raising much appreciated
funds.
We would also be unable to
provide such a comprehensive
level of care without our PALS
volunteers or, indeed, without
the other forms of support
described on this page.
As 2005 is The Year of the
Volunteer, why not get involved
yourself?
Celebrating 50 years
of the League of
Friends
In the 50 years since they were
established in the Eliot, the
Nuneaton Hospitals League of
Friends, an independent charity
and member of the National
Association of Hospital &
Community Friends, has raised
and donated more than £2.5
million to benefit the care of
local patients through the
provision of vital life-saving
equipment.
This staggering achievement is
all down to the hard work of
the volunteers who run the
Handover of electric beds
by the League of Friends
League and provide hours of
help behind the two tea bars
situated in the main hospital
corridor and in the Maternity
department, in addition to
organising other fundraising
events throughout the year.
The many donations are too
numerous to mention, but
some of the most recent
include £194,000 (the League’s
biggest single donation to date)
to pay for 164 state-of-the-art
electric beds, the peripheral
DEXA scanner mentioned on
page 14, and £30,000 to
provide a more appropriate
setting for the Trust’s
Bereavement Centre.
Duncan Phimister, the
Hospital’s Acting Chief
Executive, paid tribute to the
League of Friends: “The League
plays an invaluable role in
supporting the quality of
patient care and we thank
them all wholeheartedly.”
League Chairman, Linda
O’Raw, also said: “I’d like to
thank the amazing team of
volunteers who give up their
time to serve on the tea bars,
arrange fundraising events and
keep the League going. They
are truly selfless. I’d also like to
Tea bar
pay tribute to those who kindly
leave legacies and donations.
These, too, provide very
valuable income for the League
and, ultimately, patient care.”
It needs a minimum of 52
people just to run the main
tea bar each week and the
League is in need of more
volunteers to keep it up.
Could you spare a few hours
to help out on the tea bar,
support the running of the
League, or organise
additional fundraisers? The
minimum support asked for
is just three hours per
month. For a chat about
how you can get involved,
please call Linda O’Raw,
League Chairman on 024 76
319057.
At the time of going to print,
the Trust was informed of
the sad news that League of
Friends former Chairman
and Honorary Life President
Ken Tyler had passed away.
Mr Tyler was a volunteering
stalwart and both the Trust
and League have paid
tribute to him.
11
Supporting our spiritual needs
As we have already established,
the link between the Trust and
volunteers goes far beyond
fundraising for vital equipment.
The hospital Chapel was made
possible from a gift by the
League of Friends 11 years ago,
while the support of volunteers
is instrumental to the success
of the Chaplaincy team today.
The work of colleagues
within the Chaplaincy is
supported by 25 lay visitors
from six Christian
denominations, in addition to
Chaplaincy team volunteers
with the Rev. Rick White
visitors from other faith groups
across the local community.
With the help of these
volunteers, the Chaplaincy is
able to offer a more holistic
approach to healthcare by
providing good levels of access
to patients requiring spiritual
support.
The integration of the
Chaplaincy service across acute
care and primary care,
including its work with local
GPs, mental health services and
hospices, is still considered a
radical and relatively unusual
approach to providing spiritual,
pastoral and religious care to
patients.
Canon Edward Pogmore, who
heads up the team, explained:
“Spiritual needs and care don’t
stop at the hospital door or
the mental health unit. By
understanding better the
spiritual needs of the patient,
we can impact on the health
and well-being of the whole
person, not just the physical
needs.”
The team works with staff
across the various healthcare
settings to improve training
and understanding in spiritual
care. It is also playing a role in
the newly launched ‘single
assessment process’ (SAP),
which aims to reduce the
number of assessments
patients receive as they move
through the health and social
care system. Said Canon
Pogmore: “By simply asking a
patient what is important to
them and what support they
have from family, friends and
their faith, we can understand
better their individual needs
and provide appropriate care
to suit them. It also reminds us
not to make unnecessary
assumptions about a patient.”
The team is continuing with
its drive to increase the role of
spiritual care in community
regeneration. It does this by
working across the many
community interfaces, including
healthcare, voluntary
organisations and multi-faith
groups, to expand support for
‘healthy living’.
Trust Chairman, Frank McCarney and Museum Curator,
Ann Cahill with children visiting the museum
The teaching role of
the Trust’s Museum
The Trust’s museum has had a
particularly successful year,
welcoming a total of more than
500 schoolchildren through its
doors. Almost 400 of them
came during three weeks in
March to visit the workshops
run as part of the National
Science Week initiative.
The museum aims to support
people in making informed
choices about their health by
reflecting on lessons learnt
from the past and connecting
them to the present.
This year’s workshop theme
for National Science Week Them Bones - was designed to
help children make the links
between bones and the way
that lifestyle can impact on
them.
The GEH Museum is one of
only seven NHS-owned
museums in the country and is
run by Curator Ann Cahill and
a small team of volunteers.
Anyone interested in
volunteering their time to help
with the museum, particularly
those with a medical, nursing
or teaching background, are
invited to contact Ann Cahill
on 02476 351351.
The museum holds a large
range of artifacts and is open
to staff, patients and visitors.
JANUARY 2006
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12
Infection control
Looking beyond the
headlines at good
practice in hygiene
MRSA is a headline grabbing topic
and any story about a healthcareacquired infection is bound to
raise concern.
There are always risks associated
with healthcare, but it’s important
that we put those risks into
perspective and understand what
we can do about them.
The good news is that we at the
George Eliot take infection
control extremely seriously. We
know that our patients and public
do too, and we are doing
everything we can to minimise the
risk of spreading infection.
Good practice in basic hygiene
and cleanliness are the most
important aspects. But we can’t
do it on our own – we need
everyone’s help.
Information on this page gives
you the facts that may be helpful
in understanding the real risks
associated with infection, the ways
we have been tackling them and
what you can do to help.
Clean Hands
Campaign kicks off
The Trust is proud to have joined
the National Patient Safety
Agency’s (NPSA’s) Clean Hands
Campaign, which aims to reduce
the risk of infection in hospitals by
reminding staff to wash their
hands before and after every
contact with patients.
One of the most important parts
of the campaign is reminding
patients, carers and visitors that
they must wash their hands too.
They are also encouraged to ask
staff if they have washed their
hands. Please join in and help us
to make this campaign a success.
MRSA reports by quarter
Date
April 03 - Sept 03
October 04 - Mar 04
April 04 - Sept 04
October 04 - Mar 05
Actual number
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10
17
9
Colleagues kick off the
clean hands campaign.
Facts and figures
The Trust is rated ‘green’ in the PEAT (Patient
Environment Action Team) Assessment that
includes cleanliness and hospital food as
indicators of our standards. Green is the
highest standard achievable.
There are a number of infections that hospital
patients may be more susceptible to, one of
which is Staphylococcus Aureus (S. Aureus).
S. Aureus is a very common cause of bacterial
infections such as boils, carbuncles, infected
wounds, deep abscesses and bloodstream
infection (or bacteraemia). It was first described
in the 1880s when doctors realised it was the
most common cause of infected surgical
wounds.
About 30% of the general population are
colonised by S.Aureus. This basically means that
30% of us live with it on our skin, causing us no
problem.
MRSA (Methicillin Resistant Staphylococcus
Aureus) means that the type of infection is
resistant to traditional antibiotic treatments,
which is due mainly to the organism’s ability to
develop resistance. MRSA only usually becomes
a problem when it enters the body, particularly
when gets into the bloodstream.
Currently, NHS hospital Trusts are required
to report the number of MRSA blood stream
infections to the Health Protection Agency.
The actual numbers are very small and are
rated nationally as incidences per 1,000 bed
days. The Trust’s most recent figures are
shown on the left of this page.
13
‘Love your hospital’
Love Your Hospital
month: Think Lean,
Think Clean, Think
Hygiene
Staff throughout the Trust joined
forces during this month-long
campaign in February to help
provide the best possible
environment for patients and staff
by ensuring cleanliness, tidiness
and hygiene were, and continue to
be, top of everyone’s priorities.
We launched the month of
activities with ‘Love Your
Hospital’ day on St. Valentine’s
Day and participated in the
national event ‘Think Clean Day’
on 28 February. As part of the
activities, Trust Directors went
‘back to the floor’ to take a few
lessons from our crucial domestic
staff.
Beverley Mushing, the
Trust’s Acting Training
Manager. said: “Our
drive is to help
improve quality and
service standards
throughout the
hospital. Gaining
NVQ qualifications
also gives staff a sense
of achievement.”
National recognition
for cleanliness
training
Earlier in the year, George Eliot
staff received the runners-up
trophies (for trainers and
students) for Centre of Excellence in
N/SVQ provision at the British
Institute of Cleaning Science
(BICS) awards ceremony in
Solihull.
The Trust’s NVQ (national
vocational qualification) training
team for hotel services beat off
competition from several collegebased NVQ providers in this
national competition.
As part of the final judging, BICS
assessors conducted a thorough
examination of the hospital’s
training regime and cleanliness.
Directors brush up
their skills
Colleagues receive their award
How you can help
Keeping it real
We try to protect patients from all bugs that may be
carried by visitors, not just the headline hitters like
MRSA. So here are a few top tips:
A summary of what we have in place to minimise risks
around infection:
l The Matron’s Charter, which focuses on ward
cleanliness
l A clear infection control strategy, including a
strict hand-washing policy and regular
mandatory training
l The Trust has placed hand gels at every bedside
for several years
l Disposable curtains have been tried and will be
phased in across the hospital
l A restrictive approach to antibiotic prescribing
(Because patients on antibiotics are more
susceptible to Clostridium Difficile Associated
Diarrhoea (CDAD), the Trust takes a cautious
approach to prescribing antibiotics.)
l Please use hand gel on entering and exiting
clinical areas and wards – this helps to reduce
infection.
l Please do not bring flowers into the clinical
areas – for the reasons of infection control,
health and safety and limited space.
l Please do not sit on patients’ beds – this helps
reduce cross infection.
l Please help reduce clutter by taking excess
belongings or washing home – this makes
cleaning easier.
l If your relative or friend is in isolation, please
seek advice from nursing staff, who will provide
an explanation and advice.
FEBRUARY 2006
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14
Proactive approach promotes power of prevention
Screening service
targets osteoporosis
and falls
Hundreds of people across North
Warwickshire have been
benefiting from a simple screening
service based at the George Eliot
that aims to reduce the number of
people suffering fractures due to
falls and osteoporosis.
The joint initiative between the
George Eliot and GPs within
North Warwickshire PCT helps
to identify those at risk of
osteoporosis by sending out a
questionnaire to all women and
men registered with them, aged
over 50 and 65 respectively.
Once the scan is complete,
Donna Baldwin, Osteoporosis
Facilitator at the Trust, explains
the results and gives diet and
lifestyle advice, answering any
questions the patient may have.
Some patients will need no
further treatment, some may be
referred back to their GP for
additional treatment and some
may be referred for a full body
scan.
Speaking from
personal experience
Vida Nash from Bedworth was
diagnosed with osteoporosis at
the George Eliot.
Until she had a scan, she was
unaware that she was at risk or
could have it.
She said: “I had no idea that I
could have osteoporosis - I walk,
knit and garden - so I am very
grateful that my doctor referred
me for a scan and I am now being
treated to help strengthen my
bones.”
GP practices taking
part
Nine GP surgeries have taken part
in the scheme so far. It is hoped
others will participate too. But
the Trust doesn’t only provide the
service to patients referred by
GPs. Excellent progress has been
made to ensure that as many as
possible of the patients who need
scanning are able to access it,
whether they come into the Trust
as an inpatient, outpatient or
through A&E.
“Avoiding unnecessary fractures due to osteoporosis will reduce the
number of hospital admissions for the older residents of North
Warwickshire, meaning they can enjoy a better quality of life whilst
keeping their independence,” said Mr Wilfred Quarcoopome,
Associate Specialist in Orthopaedics, George Eliot Hospital.
Donna Baldwin with Vida Nash
Osteoporosis facts and figures
Results from the Eliot’s screening emphasise just
how common a problem it can be. From January
2004 to December 2004, the George Eliot scanned
1,020 people, of whom 468 were referred from
the hospital’s fracture clinic and 552 by GPs. Of
the total 1,020 scanned, 349 were found to be
Osteopenic (reduction in bone density) and 388 to
be Osteoporotic (thinning of bones).
Osteoporosis is estimated to affect half of
women and one in five men over 50 years old. It is
a disease that makes the bone weak and brittle and
is often referred to as the ‘silent disease’, as it has
no signs or symptoms.
The Trust is extremely grateful to the League of
Friends, without whom this screening service
would not be possible. The League has generously
bought the Trust its own peripheral DEXA (Dual
Energy X-Ray Absorptiometry) scanner, which had
previously been loaned to the Trust by the
manufacturers, Merck Sharp & Dohme (MSD).
Read more about the League of Friends and their
sterling work on page 10.
15
Extending roles saves
time for all
All patients who have undergone a
total knee replacement come back
for a course of physiotherapy as
outpatients. Previously, the
patients were also coming back at
eight weeks and, occasionally, at
12 weeks to be ‘signed off’ by
their consultant.
Staff in the physiotherapy
department recognised the
additional workload this put on
consultants, as well as the fact that
patients were having to make an
unnecessary visit. So they
proposed a solution.
As autonomous practitioners,
physiotherapists are competent
and fully qualified to sign off a
patient (conclude their treatment).
With the backing of two
orthopaedic consultants and a
Clinical Director, the
physiotherapists piloted a scheme
to sign off patients at the
conclusion of their physiotherapy,
without the need for them to
revisit the consultant.
During the five-month pilot,
85 patients were discharged from
their ‘episode of care’ by a
physiotherapist and six were
referred back to their consultant
for additional treatment, saving a
total of 144 outpatient slots in five
months.
The new approach has now been
integrated as a standard part of
the service, with all four of the
Trust’s orthopaedic consultants
supporting it.
Direct access to
physiotherapy
Our Physiotherapy Department is
also working closely with a
number of local GP practices to
provide patients with direct access
to physiotherapists, reducing
unnecessary GP appointments.
This new approach was piloted
at Atherstone GP surgery
between November 2004 and
February 2005.
Posters and leaflets were
provided in the GP surgery
detailing suitable criteria for
patients to self-refer directly to
the physiotherapist.
During this four-month trial,
89 patients referred themselves
directly, with 95.5% found to be
appropriate referrals. This
effectively freed up 85
unnecessary GP appointments.
A physiotherapist from the
George Eliot is based at
Atherstone for eight sessions per
week (four mornings and four
afternoons) and the service has
now begun at Arley surgery too.
The spreading of this good
practice also supports the NHS
Plan to free up consultant and GP
time and ensure that, where
appropriate, allied health
professionals (AHPs) become the
first point of contact for patients.
MARCH 2006
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16
Diabetes
Trail-blazing with
award-winning
diabetes care
Our dedicated diabetes care team
based in the Outpatients
Department have yet again been
breaking new ground with their
award-winning developments for
patients and professionals.
Some diabetes sufferers may be
more likely to develop a number
of other conditions associated
with diabetes, including angina or
heart failure, non fatal stroke,
cataracts, and retinal problems/
blindness.
In extreme cases diabetes can
lead to necessary amputation,
renal failure and even death.
Thankfully, many of these
conditions can be managed to
minimise any risks.
As part of the National Service
Framework for Diabetes and the
national drive to improve care for
people with ‘long-term
conditions’, the local diabetes
team are working tirelessly to
improve care for people with
diabetes.
The team aims not only to
enhance patients’ access to
services but also to provide an
integrated approach to prevention
that minimises patients’ risk of
suffering from associated
complications.
One of the ways the team is
doing this is through their awardwinning Alphabet Strategy.
Led by Drs Vinod Patel and John
Morrissey, the diabetes team won
last year’s Medical Management
Team of the Year award from the
British Association of Medical
Award Winning Ways
The Diabetes Care team at George Eliot has a proven track record
in clinical research, based mainly around implementation of evidencebased practice in Diabetes Care. We have devised various models of
care that are patient-centred but involve the whole multi-professional
team from senior clinical staff to administrators. We have published
and presented extensively, with our work being awarded the
following main prizes:
l British Association of Medical Managers Top Team Award 2004
l West Midlands NHS Innovation Award First Prize 2005
l Diabetes UK Award for most significant contribution to Diabetes
Care
l Health and Social Care awards Runner Up 2005
The Diabetes Team and
their BAMM award
Managers (BAMM) for their
work on the Alphabet
Strategy.
BAMM judges rated entries
against criteria that included
creativity, innovation, patient
needs, patient involvement,
crossing boundaries, working
across the service and use of
multi-disciplinary resources.
Dr Morrissey said: “We
were able to demonstrate
that good management is
essentially all about doing
simple things, but properly.
And real success - as
illustrated by this award - is all
down to good team work.”
Facts and figures
l It is estimated that 1.8 million people in the UK have diabetes mellitus.
- Up to 1.25 million have type 2 diabetes
- 0.15 million have type 1 diabetes
l There may be as many as one million undiagnosed cases in the UK
alone.
l The estimated cost of NHS expenditure on diabetes is around 5% of
total NHS budget, approximately £5.2 billion
This is equivalent to: £99,717,567 a week
£14,245,367 a day
£593,560 an hour
£9,893 a minute
£165 a second
17
At a Glance - the Alphabet
Strategy explained
Advice
Advice and education to patients on
diet, medication, smoking cessation,
exercise, weight reduction
Blood pressure
Strict control of blood pressure levels
can help reduce diabetes-related
illnesses including heart failure, stroke,
vision deterioration and even death.
Innovation award
UK could prevent an estimated 1,500
new cases of blindness. The Diabetes
NSF guarantees that 80% of people
with diabetes will be screened by 2006,
rising to 100% by the end of 2007.
Cholesterol
Cholesterol can be a major contributor
to Coronary Heart Disease. Diabetes
sufferers can be at a greater risk of
developing CHD.
Feet
examination
Emphasises the
importance of an
annual foot
examination by
podiatrist, GP,
practice nurse,
or diabetes
nurse.
Diabetes control
Careful control of glucose (blood
sugar) levels can alleviate many of the
associated problems of diabetes and
significantly reduce the risk of diabetesrelated complications.
Guardian drugs
Recommends preventative medication
against complications and associated
illnesses, such as prescription of aspirin
to suitable patients at risk of cardiovascular ‘events’.
Eye examination
Diabetic
retinopathy is the
most common
cause of blindness
under the age of
65 in the western
world. Yearly
screening in the
Heart disease risk
Recommends a long-term, sustained
approach to care, aimed at multiple
risk factors in patients with type 2
diabetes. Evidence suggests this
approach can reduce the risk of
cardiovascular and microvascular
‘events’ by about 50%.
In March 2005, another project by the
Diabetes Care team, led by Dr
Lakshminarayanan Varadhan and
Dr Vinod Patel, won first prize for the
best Innovative Health Care Delivery
Project for the year 2005 from
MidTECH, the West Midlands NHS
Innovation Hub awards.
The awards aim to encourage and
promote innovation within the NHS.
The i-DREAM project, developed by
Dr Lakshminarayanan Varadhan and
the team, is an interactive computer
based tool that prompts clinicians to
incorporate research evidence into
clinical practice and helps them to
make evidence-based decisions, as well
as providing recommended
management plans for particular
conditions.
The programme has links to hospital
protocols and contains details about
landmark trials in diabetes.
The Award, which included a trophy,
a certificate and a cheque for £3,000,
was presented by Ms Gisela Stuart,
Member of Parliament for Edgbaston,
and Mr Alan Wenban-Smith, Chairman
of MidTech, to the winning team at a
function held at Millennium Point,
Birmingham, on 11th April, 2005.
Dr Varadhan and Dr Patel
with Ms Gisela Stuart, MP
APRIL 2006
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18
Sooner, faster, better....
Day Procedures
Patients are realising the benefits of
day case care as hundreds of
unnecessary overnight hospital
stays are eliminated.
The George Eliot’s Day
Procedures Unit was opened in
June 2003 and is speeding up care
for the vast majority of patients
attending the Eliot for elective
(planned) surgical procedures and
Endoscopy.
The DPU has gone from strength
to strength. Of the 20,676 elective
patients we see each year, 15,825
are day cases and the remaining
4,581 are inpatients.
DPU acting manager, Sister
Croft, said: “The DPU is having a
dramatic improvement on the
patient’s experience. Some
patients still find it surprising that
they can come into hospital for a
procedure and be back home
before the end of the day. But
that’s exactly what happens.
“The NICE guidelines ensure
patients are prepared. This enables
them to recover quickly in the unit.
Evidence suggests that most
patients recover far better in the
home environment, so if we can
cut out an overnight stay, the
patients are generally far happier.”
A patient from Nuneaton,
Mrs H, said: “I recently attended
the outpatient department for a
consultation. That afternoon I
underwent a minor operation at
the ‘Day Procedure Unit’… What
an excellent service I received… I
was overwhelmed by the
professional, caring and extremely
well organised ‘Tenby Unit’. This
praise extends from the calm,
pleasant receptionist through to
the highest level of nursing staff and
theatre staff.”
Facts and figures
l The drive to increase the number of patients attending as a day
case, rather than an inpatient, is part of a national commitment to
improve the patient experience.
l The NHS Plan outlines that, by 2008, 75% of all operations
should be performed as day cases.
l The George Eliot is pleased to be well ahead of this target,
performing 76% as day cases three years early. However, the
DPU has now put plans together to increase activity to 84% over
the next two years, thus giving more patients the opportunity to
go home the same day.
Day Procedures Unit
19
Radiology
refurbishments
Reduced waits, a sparkling new
environment and state of the
art equipment are now an
everyday reality for patients
requiring a scan.
The Trust’s ‘cross sectional’
imaging suite is now open
following the completion of
building works and the delivery
of a brand new, static MRI
(magnetic-resonance imaging)
scanner. The scanner was
delivered in April 2005 and
became fully operational,
following set-up and training,
from May 2005.
Until its arrival, the Trust had
relied on a mobile scanner that
was shared between the
George Eliot site and South
Warwickshire Hospitals,
supported by ad hoc sessions
provided by the Department of
Our new MRI scanner arrives - just like moving your fridge,
the MRI had to wait for its gases to settle before use.
The George Eliot’s new MRI room
Health, to help reduce waiting
times.
Demands for MRI scans have
been growing steadily over the
years. In 2003, the Trust made
a bid for Department of Health
funding for the new MRI
scanner, as well as a new
‘multi-slice’ CT (Computerised
Tomography) scanner, due to
be delivered in July 2005.
Waits for radiological
procedures are often referred
to nationally as ‘hidden waits’
in the system.
The Eliot has not been alone
in struggling with the rising
demands for scans but,
thankfully, with the new MRI
fully operational and additional
investment from the Trust to
provide increased staffing,
routine waits for an MRI scan
have already dropped
significantly in just a few
months and are set to fall far
further. It is important to
highlight that urgent requests
for scans are always met within
two weeks.
MAY 2006
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20
Connecting for Health
Connecting for Health (formerly
the NHS Information Authority) is
running the National Programme
for IT (NPfIT), which aims to
revolutionise the NHS by bringing
our IT systems into the 21st
century.
It is a mammoth programme of
work which is planned to be
implemented over a period of 10
years. Ultimately, this will ensure
the establishment of electronic
health records - all of our medical
history held on-line and available
to authorised clinicians on
demand.
There is a long way to go before
we reach this and there are many
different aspects that make up the
‘umbrella’ of NPfIT.
Over the past year, George Eliot
has been preparing for the
introduction of an entirely new
Patient Administration System
(PAS), which is likely to be
implemented during 2006.
In the meantime, the Trust has
also been maintaining its
reputation as a leading light in
piloting new and emerging
technologies. Here are just some
of the examples:
PACS pilot
Over the next three years, every
acute NHS hospital trust in
England is mandated by NHS
Connecting for Health to change
from conventional film-based
radiology to a Picture Archiving
and Communications System
(PACS).
The George Eliot took the
initiative to explore this
PACS
pilot
technology earlier than most by
installing a PACS pilot within the
Trust. Although the Trust will
not receive its official PACS for
another year or so, the feedback
from the pilot was extremely
encouraging and should result in a
swifter transfer to the new
technology when it is fully
installed.
The PACS pilot, focused in A&E
and Radiology, allowed staff to
experience an entirely digital
process. Instead of printing films,
Radiographers simply scanned a
CR (Computed Radiography)
plate, eliminating expensive film
and chemical costs. The digital
images were then instantly
available in A&E for immediate
review.
Normally, the introduction of
CR plate scanning is a difficult
hurdle when deploying PACS but,
as Linda Neale commented: “The
pilot has not had a negative impact
on the way we work. In fact, the
introduction has been relatively
seamless. Radiographers who have
never dealt with digital imaging
technology had little or no trouble
at all in using the equipment.”
The ultimate benefit, even in a
pilot situation, has been the care
of George Eliot patients.
Immediate access to images that
can be manipulated helps ensure
that A&E staff make faster, more
informed decisions.
Mobility pilot
Clinical colleagues across the
Trust have also been piloting a
project to improve access to
patient information through
wireless technology.
The ‘mobility pilot’ has seen 20
‘tablet’ laptop-type devices
provided in key areas such as
EMU (Emergency Medical Unit),
A&E and outpatients.
A number of clinical colleagues
were also provided with devices
for their ward rounds. It is early
days yet but the project has
proved a positive benefit in
providing up to the minute patient
information electronically, rather
than that information having to be
delivered manually.
The pilot is part of the wider
‘Connecting for Health’ national
initiative and could be spread to
other Trusts if successful here.
Sharon King, Senior Nurse for
EMU, was impressed with the new
technology. She said: “It’s changed
the way I work because I’ve been
able to stay at the patient’s
bedside, do a round with the
consultants and actually get the
results that they need next to the
patient. This means we can
discuss the results with the patient
instead of disappearing for ten or
fifteen minutes to get them.”
Dr Thulasiharan, Senior House
Officer at the Trust, has also
found the pilot beneficial, saying:
“I spend less time on admin.
Rather than just waiting for
somebody to leave the ward
computer until I could log on, I
can get results immediately. I now
spend more time on the patients,
so it’s very helpful.”
One of the outputs from the
pilot is the production of Return
on Investment (ROI) data, which to
date looks extremely encouraging
in its portrayal of significant cost
savings and efficiency gains - again
translating to better patient care.
21
Air tubes
Whilst not a part of the national
programme, George Eliot took
the decision earlier in the year to
improve its own connections
across the site by installing a
pneumatically powered air tube
system that went live in
September 2004.
The system links the pharmacy
and pathology departments with
wards and other departments
across the George Eliot Hospital,
via a network of tubes.
Items are sent in sealed, leakresistant carriers that are
transported through the tubes at
5 metres per second by a current
of air generated by large fans.
Most wards and departments have
a ‘send-receive station’ reasonably
close by.
Each station includes a despatch
tube, a keypad and a locked
cupboard into which returned
carriers fall.
When a carrier arrives at a
station, an audible alarm briefly
sounds and an arrival light flashes
on the ward concerned, informing
staff that they have a carrier to
collect.
Ward and departmental staff
send carriers by entering the four
digit code for the destination
required into the station’s keypad,
then inserting the carrier into the
station’s despatch tube.
Red carriers are used for
pathology specimens. Blue carriers
are used for prescriptions and
medicines.
The system is used to transport
specimens to pathology,
prescriptions to pharmacy and
dispensed medicines from
pharmacy to wards and
departments.
With 180mm diameter carriers
used on the system, it means the
majority of dispensed discharge
prescriptions can be sent via the
air tube.
Every month, the system delivers
around 3,500 carriers containing
specimens to pathology and 1,500
carriers containing prescriptions
to pharmacy.
A carrier sent from Lydgate
ward to the main pharmacy
department in maternity takes
around one minute to travel
across the site.
The benefits are clear: transit
times have been reduced and
portering time saved.
A recent survey within the Trust
demonstrated that a majority of
ward and department staff
regularly used the system.
Seventy eight per cent of staff
who completed the survey felt
that the system had improved
patient care by facilitating the
process for sending prescriptions
and pathology specimens.
The system is now perceived as
an essential element of the Trust’s
communications system.
Pharmacy manager Paul Mills - deputy chief pharmacist,
checks on the air-tube installation on Elizabeth Ward
with clerical support worker Jackie Probyn.
JUNE 2006
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22
Our Greatest Asset
Our Greatest Asset
Whilst 2004-05 was a challenging
year for the Trust, patients
continued to receive good quality
care thanks to the unwavering
dedication of our staff who
operate at some of the most costefficient rates in the NHS. The
work of every colleague has an
impact on patient care and that’s
why the Trust is working hard to
give something back to staff by
improving their working lives.
Agenda for Change
Agenda for Change is the biggest
ever change to pay structures the
NHS has experienced. Designed
to ensure fair pay and conditions
for NHS staff, it aims to improve
career opportunities and offer
greater rewards for those who
take on more demanding roles.
Agenda for Change will apply to
staff directly employed by the
NHS, excluding doctors, dentists
and top senior managers. The
new system means that all
relevant staff must have had their
role ‘job matched’ to national
outlines and assimilated against
national criteria in order to be
assigned a specific pay band.
The Department of Health has
stipulated that all relevant staff
must have been assimilated by
30th September 2005. By the end
of March 2005, 60% of staff
employed by the Eliot had been
matched and assimilated on to the
new pay bands, with the remaining
The numbers
40% to be matched over the
remaining few months.
Staff survey
Between October and December
2004, over 217,000 staff from 572
NHS Trusts and 26 strategic
health authorities (SHAs) in
England took part in the second
national NHS staff survey,
conducted by the Healthcare
Commission.
A total of 795 members of staff
at the George Eliot were selected
randomly, of whom 395 returned
a completed questionnaire.
Whilst the response represents
only about a fifth of the staff here,
it did provide a useful indicator
from which we can develop our
approach to improving staff
satisfaction. Some of the key
actions to improve staff morale
are being addressed through
improved communication,
support, training, improving worklife balance and minimising stress.
Improving Working
Lives (IWL)
A key step in addressing staff
satisfaction is through Improving
Working Lives accreditation, the
‘kite mark’ for NHS employers
and employees to measure Human
Resources management.
Staff from all areas across the
Trust have been working together
to help the George Eliot reach the
second stage of the Improving
Working Lives accreditation –
Practice Plus. IWL looks at all
aspects of staff experience. Some
of the key areas of work currently
being undertaken involve
improving the way we
communicate with staff, the way
we support them and the ways in
which we can minimise stress.
The Trust offers staff many
working benefits under the
umbrella of IWL, including child
care vouchers to help with the
cost of child care, an on-site
nursery newly opened last year,
the possibility of flexible working
and family friendly hours, subject
to negotiation, and a range of
discounts at local and national
retailers.
23
Our Greatest Asset
Equality statement
The George Eliot Hospital NHS
Trust is committed to building a
workforce which is valued and
whose diversity reflects the
communities it serves, enabling it
to deliver the best possible
healthcare service to the
community.
The Trust will seek to ensure
that it is a fair employer achieving
equality of opportunity and
outcomes in the workplace; and
to ensure that the Trust uses its
influence and resources as one of
the biggest employers in the area
to make a difference to the life,
opportunities and health of the
local community.
Everyone has a duty, both
morally and legally, not to
discriminate. The Trust will not
accept discrimination by any of its
employees and will work to
eradicate discrimination on the
basis of age, disability, race,
nationality, ethnic or national
origin, gender, religion, beliefs,
sexual orientation, domestic
circumstances, social and
employment status, HIV status,
gender reassignment or political
affiliation or trade union
membership.
The Trust has also adopted a
Race Equality Scheme (RES) in
accordance with the
Government’s commitment to
eliminate the potential for
discrimination in the public sector.
A Race Equality Audit has been
developed to enable the Trust to
monitor the service goals as set
out in our RES.
The Trust has a robust policy for
working with employees with
disabilities as part of the Equality
and Diversity agenda. The Trust
was accredited the ‘two ticks’
disability symbol by the Job
Centre Plus in March 2005 in
recognition of our work in this
area.
Occupational health
The George Eliot’s occupational
health service is currently
provided on site by North
Warwickshire PCT and is
accessible to all staff. The service
supports the Trust in managing
sickness absence and rehabilitation
into work through return to work
policies, and provides full health
screening for all relevant roles, as
directed by the Trust’s policies.
Investing in staff
The Trust’s training department
also offers a range of training and
development opportunities,
including NVQs (National
Vocational Qualifications), for
Health Care Support Workers
and any staff member who does
not hold a professional
qualification for the role that they
perform.
Training and Education Centre
All staff without such a
qualification are entitled to an
Individual Learning Account through
which they can develop
professionally.
NVQs that are provided by the
inhouse Training Department
include administration levels 2 and
3, care levels 2, customer services,
cleaning and support services,
catering and hospitality, operating
department level 2 and
diagnostic/therapeutic support
level 3.
which has led to an increase in the
number of medical students at
George Eliot.”
We are confident that the
GETEC will enable the Trust to
build on this reputation, and
develop a centre of excellence for
health training in the region.
The centre has been designed to
improve the quality of education
and training facilities for students,
staff and patients in the North
Warwickshire Community.
Facilities will include:
Investing in the
future
l Lecture Theatre
l Seven Seminar Rooms
l Clinical Skills and Resuscitation
l Skills Wards
l Clinical Skills Laboratory
l Library
l On-site catering
l Office Accommodation for
Education, Research and
Training
After more than two years of
planning, we received approval to
start building work on the new
George Eliot Training and
Education Centre (GETEC).
Funded by the Department of
Health and the Strategic Health
Authority, the new £5.5m centre
will provide the Trust with a
state-of-the-art venue packed with
facilities.
Commented Dr Neeta Manek,
Clinical Director for Education
and Consultant Microbiologist:
“The training and education teams
have an excellent reputation for
providing high quality teaching,
The GETEC will take
approximately 60 weeks to
complete and is due to open in
late August 2006. From January
2007 all courses, including
inductions, resuscitation training,
professional training and manual
handling, will be staged in the new
centre.
JULY 2006
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30 31
24
Money matters: summary financial information
Finance Director’s
Report
I am pleased to present my first
report as Director of Finance,
having taken over the reins in
September 2004 from my
predecessor Terry Hueck, who
retired last year.
I could not have joined the Trust
at a more challenging time both
operationally and financially.
Having been faced with a potential
£5.2m deficit in October, the
Trust weathered a number of
further financial pressures and
ended the year with a deficit of
£786k, which was below 1% of
turnover.
Despite the significant
improvement in our financial
position in the second half of the
financial year, this outturn does
mean that the Trust failed to meet
the first of its key financial targets,
i.e., to break even on its income
and expenditure account.
The Trust did, however,
successfully deliver its other key
financial targets, namely:
l To manage cash flows and
balances within the limits set
for the Trust by the
Department of Health.
l To manage capital expenditure
within limits set by the
Department of Health.
l To pay a dividend back to the
Department of Health,
equivalent to 3.5% of our
assets.
Reflections on the
Year
The Trust faced a very difficult
year in 2004/05 financially. There
was an initial financial savings
target of £4.5m at the start of the
year, which increased to £5.2m
part way through the year as
further financial pressures
crystallised. After six months the
Trust was £2.6m overspent.
Working closely with the West
Midlands South Strategic Health
Authority and the North
Warwickshire Primary Care Trust,
the Eliot developed an in-year
financial recovery plan, which
included tight controls over
recruitment and non-pay
expenditure.
In addition, patient activity
significantly over-performed
compared to initial plans and the
Trust was able to secure £2m in
additional income to support this
activity. The Trust also secured
non-recurrent income of £2.6m to
support service and operational
pressures, which closed the
financial gap to £786k at year-end,
being within 1% of turnover.
The Trust’s Reference Costs
Index is a guide to how efficient a
hospital is for patient services in
comparison to the rest of the
NHS. Our rating for 2003/04 was
79, meaning that the Trust is 21%
more cost-efficient than average
for the patient services we
provide. This demonstrates the
exceptional value for money of
services that are provided to local
people and is a testament to the
way our staff manage within the
resources available to them.
Future Financial
Challenge
In 2005/06 the Trust faces
perhaps its biggest ever financial
challenge. Despite an
unprecedented growth in NHS
resources at a national level, the
Trusts is faced with challenging
service and efficiency targets, the
impact of pay reforms and the
impact of significant non-recurrent
income in previous years
unwinding. The financial gap to be
closed as we start the new
financial year is £10.7m.
The Trust is currently working
with the Strategic Health
Authority and local
Commissioners to prepare a
balanced and financial plan. At the
current time, there remains a
minimum £4m gap, which will
require a solution to be identified
in-year.
In the longer term, it is
recognised that health care
providers throughout Coventry
and Warwickshire will need to
work even more closely together
to drive through lasting efficiency
gains and deliver long-term
financial stability.
Payment by Results
(PBR)
PBR is the Government’s
proposed system that will ensure
most acute NHS hospital services
across England are paid for by
local commissioners at a set
national tariff. Whilst this was
planned for full implementation
during 2005/06, the full
programme has now been
deferred and will be introduced
gradually over the next four
financial years.
The Government’s decision to
defer full implementation of
payment by results will continue
to impact on the George Eliot’s
income because we currently
provide many of our services at a
much cheaper rate than the
national average.
Work completed during
November 2004 indicates that,
once it is fully implemented, the
Eliot may gain by up to £12m.
However, under current guidance
operational in 2005/06, the Eliot
income will increase by £316k.
A further rebasing review of this
position will be conducted during
the autumn of 2005.
Acknowledgements
I would like to recognise the
achievements of the staff of the
George Eliot in maintaining
services and the care to our
patients broadly within the
resources available during a year
that has seen unprecedented
levels of emergency activity and
service pressure.
I would also like to thank the
dedicated members of the Finance
team who have completed once
again the annual accounts for the
Trust.
Karl Simkins
Director of Finance
25
Income and expenditure
INCOME SPLIT 2004/05
The following pages show an abridged summary of some of the key information in the
Trust’s annual accounts. If you would like a free copy of our full accounts, you can view
them on www.geh.nhs.uk or you can request a copy by contacting the Finance Directorate
on 02476 351351. Alternatively, email [email protected]
Income and Expenditure Account for the Year ended 31 March 2005
Income
Income from healthcare activities
Income from other activities
Operating expenses:
OPERATING SURPLUS
2004/05
£000
2003/04
£000
84,487
70,129
14,358
(82,937)
1,550
75,930
63,968
11,962
(73,727)
2,203
0
(49)
1,550
133
0
0
1,683
(2,469)
(786)
2,154
187
0
0
2,341
(2,333)
8
(Loss)/profit on disposal of fixed assets
SURPLUS BEFORE INTEREST
Interest receivable
Interest payable
Other finance costs
SURPLUS FOR THE FINANCIAL YEAR
Public Dividend Capital dividends payable
RETAINED SURPLUS/(DEFICIT) FOR THE YEAR
EXPENDITURE SPLIT 2004/05
Financial Performance
Year
Turnover
£000
44,433
48,176
52,331
56,785
1997/98
1998/99
1999/2000
2000/01
Surplus/
(Deficit)
£000
229
(182)
(1,265)
349
Year
Surplus/
(Deficit)
£000
7
909
8
(786)
Turnover
£000
62,790
71,643
75,930
84,487
2001/02
2002/03
2003/04
2004/05
AUGUST 2006
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26
BALANCE SHEET AS AT 31 MARCH 2005
31.3.05
£m
31.3.04
£m
75.1
67.6
6.6
5.5
(6.2)
(6.5)
0.0
0.0
LESS PROVISIONS FOR LIABILITIES
AND CHARGES
Provisions set aside for future payments
(0.4)
(0.3)
TOTAL NET ASSETS
75.1
66.3
FIXED ASSETS
Land, buildings and equipment
CURRENT ASSETS
Stocks, money owed to the Trust and cash
LESS CREDITORS <1 YEAR
LESS CREDITORS > YEAR
Money owed by the Trust in more than one years time
FINANCED BY
PUBLIC DIVIDEND CAPITAL
Capital Provided by the government
45.0
42.0
REVALUATION RESERVE
Increase in the value of fixed assets
29.5
23.7
Statement of Total Recognised Gains and Losses
for the Year Ended 31 March 2005
£000
2003/04
£000
1,683
2,341
0
0
Unrealised surplus on fixed asset revaluations/indexation
6,587
5,165
Increases in the donated asset and government grant
reserve due to receipt of donated and government grant
financed assets
104
299
(191)
(163)
0
0
8,183
7,642
0
0
8,183
7,642
Surplus for the financial year before dividend payments
Fixed asset impairment losses
Reductions in the donated asset and government grant
reserve due to the the depreciation, impairment and disposal
of donated and government grant financed assets
Additions/(reductions) in “other reserves”
Total recognised gains and losses for the financial year
Prior period adjustment
DONATION RESERVE
Value of donated fixed assets
1.1
1.1
Cumulative income and expenditure deficits from
previous years
(0.5)
(0.5)
TOTAL NET ASSETS
75.1
66.3
INCOME AND EXPENDITURE RESERVE
The Better Payment Practice Code requires the Trust to pay all valid non-NHS
invoices within 30 days of receipt of goods or a valid invoice, whichever is later.
Performance in 2004/05 was:
Better Payment Practice Code - measure of
compliance
Number
£000
Total bills paid in the year
23,987
Total bills paid within target
20,472
Percentage of bills paid within target 85.35%
16,490
14,282
86.61%
2003/04
Number
£000
23,706
20,780
87.66%
15,650
13,774
88.01%
Total gains and losses recognised in the financial year
This table shows how the cash was used in the year that ended 31 March 2005 and
the total change in the amount of cash we held.
Audit Committee
The Audit Committee
members in 2004/05
comprised: Carol Gibson,
Kishor Pala, Julie Jackson,
Frank McCarney, John
Beaumont and Ann Garratt.
Capital cost
absorption rate
The Trust is required to
absorb the cost of capital at a
rate of 3.5% of average
relevant net assets. The rate
is calculated as the percentage
that dividends paid on Public
Dividend Capital, totalling
£2,469,000, bears to the
average relevant net assets of
£68,574,000, that is 3.6%.
The variance from 3.5% is
within the Department of
Health materiality range of
3.0% to 4.0%.
CASH FLOW FOR THE YEAR ENDED
31 MARCH 2005
31.3.05
£m
31.3.04
£m
Cash from Operating Activities
Interest received
Sale of Fixed Asset
New Public Dividend Capital
4.0
0.1
0.0
3.0
4.6
0.2
0.0
2.0
TOTAL
7.1
6.8
31.3.05
£m
Capital Expenditure
Dividend Payments
Interest Paid
Increase in Cash Balances
31.3.04
£m
4.7
2.4
0.0
0.0
4.5
2.3
0.0
0.0
7.1
6.8
27
INDEPENDENT AUDITORS’ REPORT TO DIRECTORS
OF GEORGE ELIOT HOSPITAL NHS TRUST ON THE
SUMMARY FINANCIAL STATEMENTS
Board Members’ Remuneration
The remuneration of non-executive directors is determined nationally, and the remuneration of executive directors is
determined by the Board’s Remuneration Committee in line with national guidelines.
Respective Responsibilities of Directors and Auditors
The directors are responsible for preparing the Annual Report. Our responsibility is to
report to you our opinion on the consistency of the summary financial statements with
the statutory financial statements. We also read the other information contained in the
annual report and consider the implications for our report if we become aware of any
misstatements or material inconsistencies with the summary financial statements.
Basis of audit opinion
We conducted our work in accordance with Bulletin 1999/6 ‘The auditor’s statement
on the summary financial statements’ issued by the Auditing Practices Board for use in
the United Kingdom.
Opinion
In our opinion the summary financial statements are consistent with the statutory
financial statements of the George Eliot Hospital NHS Trust for the year ended 31
March 2005 on which we have issued an unqualified opinion.
19 August 2005
Date: ………………….
Signature: …………………………………..
Cornwall Court, 19 Cornwall St,
Address: ……………………………………
PricewaterhouseCoopers
LLP
Birmingham, B3 2DT
Name: …………………………….… ………………………………………………
Management Pay
Pay rises for senior managers in 2004/2005 did not exceed a pay envelope of 3.225%
Management Costs
Management costs
Income
£000
2003/04
£000
3,390
83,820
3,094
74,896
The Trust achieved its own management cost target of £3,409,994.
Management costs were 4.04% of Income (compared with 4.13% last year).
(bands of
£5000)
£000
2004-05
Other
Remuneration
(bands of
£5000)
£000
Benefits
in Kind
Rounded to the
nearest £100
(bands of
£5000)
£000
2003-04
Other
Remuneration
(bands of
£5000)
£000
Benefits in
kind
Rounded to
the nearest
£100
15-20
0
0
15-20
0
0
105-110
0
0
40-45
0
0
70-75
0
0
75-80
0
0
N/A
N/A
N/A
30-35
0
0
N/A
N/A
N/A
20-25
0
0
N/A
N/A
N/A
45-50
0
0
N/A
N/A
N/A
10-15
120-125
6,700
10-15
100-105
0
70-75
0
0
70-75
0
0
50-55
0
0
60-65
0
0
25-30
0
0
70-75
0
0
55-60
0
0
80-85
0
0
75-80
0
0
70-75
0
0
N/A
N/A
N/A
5-10
0
0
5-10
0
0
5-10
0
0
5-10
0
0
5-10
0
0
5-10
0
0
0-5
0
0
5-10
0
0
5-10
0
0
5-10
0
0
Salary
We have examined the summary financial statements set out on pages 25 to 30.
Name and Title
Cllr Frank McCarney
Chairman
Tucson Dunn
Chief Executive from 5/10/03
Duncan Alexander Phimister
from 30/6/03 to 4/10/03
Deputy Chief Executive
from 5/10/03 to 15/8/04
and from 1/12/04 to 31/3/05
David Lingwood
Acting Chief Executive to 27/6/03
Terry Alan Hueck
Director of Finance to 31/3/04
Edmund Mark Knight-Jones
Acting Director of Finance
from 1/4/04 to 5/9/04
Karl Simkins
Director of Finance From 6/9/04
Peter Handslip
Medical Director
Jane Taylor
Director of Nursing
Julie Whittaker
Director of Operations to 30/11/04
Simon Freeman
Director of Information
from 6/10/03 to 31/8/04
Ruth Tyrrell
Director of Human Resources
Sandra Jane Chittenden
Director of Strategic Development
to 31/3/05
Shaun Mountford
Chief Executive Intern - Modernisation
Carol Ann Gibson
Non Executive Director
Julie Jackson
John Brian Beaumont
Ann Garratt
Non Executive Director to 31/10/04
Kishor Pala
Salary
Consent withheld
Consent withheld
28
Board Members’ Remuneration
The remuneration of non-executive directors is determined nationally, and the remuneration of executive directors is
determined by the Board’s Remuneration Committee in line with national guidelines.
Name and Title
Cllr Frank McCarney
Chairman
Tucson Dunn
Chief Executive from 5/10/03
Duncan Alexander Phimister
from 30/6/03 to 4/10/03
from 5/10/03 to 15/8/04
and from 1/12/04 to 31/3/05
Edmund Mark Knight-Jones
from 1/4/04 to 5/9/04
Karl Simkins
Director of Finance from 6/9/04
Peter Handslip
Medical Director
Jane Taylor
Director of Nursing
Julie Whittaker
Director of Operations to 30/11/04
Simon Freeman
Director of Information
from 6/10/03 to 31/8/04
Ruth Tyrrell
Director of Human Resources
Sandra Jane Chittenden
Director of Strategic Development
to 31/3/05
Shaun Mountford
Carol Ann Gibson
Julie Jackson
John Brian Beaumont
Ann Garratt
Non Executive Director to 31/10/04
Kishor Pala
Real
Total accrued Cash Equivalent
Cash
Real Increase Employers
increase in
pension and
Transfer Value
Equivalent
in Cash
Contribution
pension and
related lump at 31 March 05
Transfer
Equivalent
to
related lump sum at age 60
Value at
Transfer
Stakeholder
sum at age 60 at 31 March 05
31 March 05
Value
Pension
(bands of
(bands of
£2500)
£5000)
To nearest
£000
£000
£000
£000
£000
£100
0
0
0
0
0
0
5-7.5
5-10
25
7
17
0
10-12.5
145-150
606
532
59
0
0-2.5
20-25
53
45
7
0
17.5-20
75-80
231
164
63
0
47.5-50
200-205
823
597
210
0
0-2.5
90-95
275
257
12
0
22.5-25
90-95
352
246
98
0
2.5-5
5-10
16
4
11
0
2.5-5
40-45
125
97
25
0
2.5-5
35-40
115
101
12
0
15-17.5
50-55
141
89
49
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
A Cash Equivalent Transfer Value (CETV) is the actuarially assessed capital value of the pension scheme benefits
accrued by a member at a particular point in time. The benefits valued are the member’s accrued benefits and any
contingent spouse’s pension payable from the scheme. A CETV is a payment made by a pension scheme, or
arrangement to secure pension benefits in another pension scheme or arrangement when the member leaves a
scheme and chooses to transfer the benefits accrued in their former scheme. The pension figures shown relate to
the benefits that the individual has accrued as a consequence of their total membership of the pension scheme,
not just their service in a senior capacity to which the disclosure applies. The CETV figures, and from 2004-05
the other pension details, include the value of any pension benefits in another scheme or arrangement which the
individual has transferred to the NHS pension scheme. They also include any additional pension benefit accrued
to the member as a result of their purchasing additional years of pension service in the scheme at their own cost.
CETVs are calculated within the guidelines and framework prescribed
Real Increase in CETV - This reflects the increase in CETV effectively funded by the employer. It takes account
of the increase in accrued pension due to inflation, contributions paid by the employee (including the value of any
benefits transferred from another pension scheme or arrangement) and uses common market valuation factors for
the start and end of the period.
Remuneration Committee
The remuneration and terms of service of Executive Directors of the Trust are determined by the
Remuneration Committee, which comprises solely the Chairman and Non-Executive Directors of the Trust.
The committee reviews the salaries of Executive Directors each year and agrees with the Chief Executive at the
commencement of the year performance criteria against which all Executive Directors will be measured.
The Chief Executive and the Executive Directors are appointed under open competition. An appointment
Panel comprising Non Executive Directors and external assessors appoints to Director positions. The
performance of the Chief Executive is monitored by the Chairman. Executive Directors’ performance is
monitored by the Chief Executive. The Chief Executive and Executive Directors are subject to the Trust’s
disciplinary procedure.
External auditors
The Trust's external auditors are PricewaterhouseCoopers LLP and the total charge for work undertaken in
2004/05 was £144,000 (inclusive of VAT).
The work included: Statutory audit and services carried out in relation to the statutory audit of the Trust's
accounts; Department of Health mandatory audit work on: Acute Hospital Portfolio; Data Quality and; Spot
Check Review.
The work on the Acute Hospital Portfolio comprised a review and assessment of performance in the areas of
therapy and dietetics, pathology, information and records and facilities management. The work on data quality
comprised a review and assessment on the quality of data provided by the Trust.
All audit work is managed, monitored and reported through the Trust's Audit Committee as part of the
governance arrangements in place within the Trust. This ensures that audit is independent of the management
process within the Trust.
Significant accounting policies
The Trust has provided £223,504 within expenditure for the estimated cost of the assimilation of staff under
Agenda for Change. This is a national initiative to modernise the pay system within the NHS whereby all staff
groups other than doctors, consultants and directors are assimilated into a modern pay structure from 1st
October 2004. Because of the complexity of implementing the new scheme, not all staff groups have yet been
assimilated. The provision (including back pay to 1st October 2004) represents the Trust's best estimates of the
likely additional costs of the remaining groups to be assimilated, mainly administration and clerical staff, scientific
therapeutic and technical staff.
29
Statement of the Chief Executive’s responsibilities
as the Accountable Officer of the Trust
The Secretary of State has directed that the Chief Executive should be the
Accountable Officer to the Trust. The relevant responsibilities of
Accountable Officers, including their responsibility for the propriety and
regularity of the public finances for which they are answerable, and for the
keeping of proper records, are set out in the Accountable Officers’
Memorandum issued by the Department of Health.
To the best of my knowledge and belief, I have properly discharged the
responsibilities set out in my letter of appointment as accountable officer.
Duncan Phimister Acting Chief Executive
The Directors are responsible for keeping proper accounting
records which disclose with reasonable accuracy at any time the
financial position of the Trust and to enable them to ensure that
Date: 12 July 2005
Statement on Internal Control 2004/05
1. Scope of responsibility
The Board is accountable for internal
control. As Accountable Officer, and
Chief Executive of this Board, I have
responsibility for maintaining a sound
system of internal control that supports
the achievement of the organisation’s
policies, aims and objectives. I also have
responsibility for safeguarding the public
funds and the organisation’s assets for
which I am personally responsible as set
out in the Accountable Officer
Memorandum.
The West Midlands South Strategic
Health Authority monitors the
performance of the George Eliot
Hospital NHS Trust through a quarterly
review process. The Trust is part of a
network of acute and primary care
trust’s in the local economy, which
regularly meet on a formal basis to
develop partnerships in improving
health care for the local community.
Statement of Directors’ Responsibilities in respect of the Accounts
The Directors are required under the National Health Services Act
1977 to prepare accounts for each financial year. The Secretary of
State, with the approval of the Treasury, directs that these
accounts give a true and fair view of the state of the Trust and of
the income and expenditure of the Trust for that period. In
preparing those accounts, the Directors are required to:
- apply on a consistent basis accounting policies laid down by the
Secretary of State with the approval of the Treasury
- make judgements and estimates which are reasonable and
prudent
- state whether applicable accounting standards have been
followed, subject to any material departures disclosed and
explained in the accounts.
2. The purpose of the system of
internal control
The system of internal control is
designed to manage risk to a reasonable
level rather than to eliminate all risk of
failure to achieve policies, aims and
objectives; it can therefore only provide
reasonable and not absolute assurance
of effectiveness. The system of internal
control is based on an ongoing process
designed to:
l identify and prioritise the risks to
the achievement of the organisation’s
policies, aims and objectives;
l evaluate the likelihood of those risks
being realised and the impact should
they be realised, and to manage them
efficiently, effectively and economically.
The system of internal control has been in
place in the George Eliot Hospital for the
year ended 31 March 2005 and up to the
date of approval of the annual report and
accounts.
3. Capacity to handle risk
The Trust’s Risk Management Policy
sets out the following direction and
intent with respect to risk management:
l The Trust will seek to reduce risk
to patients, employees and others by
appropriate management control,
accepting that some risk will always be
inherent and identified accordingly.
l The Trust will adopt a pro-active
approach with a programme of risk
management, which aims to preserve its
assets and reputation and to provide
protection against preventable injury
and loss to employees, patients and the
general public.
l Risk management is a fundamental
part of the trust’s ethos and total
approach to quality, corporate and
clinical governance and the Trust’s
controls assurance programme.
Leadership in delivering the risk
management strategy comes from:
l The Trust Board is responsible for
reviewing the effectiveness of internal
the accounts comply with requirement outlined in the above
mentioned direction of the Secretary of State. They are also
responsible for safeguarding the assets of the Trust and hence for
taking reasonable steps for the prevention and detection of fraud
and other irregularities.
The Directors confirm to the best of their knowledge and belief
they have complied with the above requirements in preparing the
accounts.
By order of the Board
Duncan Phimister - Acting Chief
Executive, 12 July 2005
Karl Simkin - Director of Finance,
12 July 2005
controls - financial, organisational and
clinical.
l The Chief Executive has ultimate
responsibility for having an effective risk
management system in place and overall
responsibility for controls assurance and
the management of risk throughout the
Trust.
l The Director of Nursing has
delegated responsibility for managing
the strategic development and
implementation of risk management and
controls assurance.
l The Director of Finance has
responsibility for managing the strategic
development and implementation of
financial risk management.
Risk awareness training is provided to
all new employees as part of the Trust’s
induction programme and updated
annually as part of mandatory training.
Risk management training is also
available as part of the Trust’s internal
training programme.
Departments are required to
nominate staff who are trained to
complete risk assessments for the areas
where they work and a system is in
place to document risks identified as
part of this process and to ensure that
action is taken to remedy any issues.
Information for all staff is available on
the Trust’s intranet.
The Trust is informed of the Audit
Commission’s new Code of Audit
Practice effective from 2005-06. This
requires a change in audit work, were
there are now two key focus, namely:
l Accounts including a review of the
Statement of Internal Control
l Use of resources
The Trust is currently reviewing its
governance arrangements to meet the
requirements of the new code, which
will include an internal assessment
covering the following areas:
l Financial Reporting
l Financial Management
l Financial Standing
l Internal Control
30
Statement on Internal Control 2004/05 - continued
l Value for money (economy,
efficiency and effectiveness)
4. The risk and control framework
The key elements of the risk strategy
are:
l Directors, managers and staff all
have responsibility for the management
of risk;
l risks are identified and reported
through an incident reporting system:
significant risks are reported in a risk
register and referred to the
Governance Committee and Trust
Board;
l a controls assurance framework is
established;
l Committees including Governance,
Clinical Risk, Health and Safety,
Infection Control and Drugs and
Therapeutics meet on a regular basis to
manage the risk control process.
Risk management is an integral part of
the Trust’s culture. The Trust Board is
committed to ensuring that risk
management forms an integral part of
its philosophy, practices and business
plans rather than viewed or practised as
a separate programme and that
responsibility for implementation is
accepted at all levels of the
organisation.
Trust Board approved a Controls
Assurance Framework in March 2004.
The Directors of the Trust following a
workshop facilitated by the Trust’s
external and internal auditors
developed the framework. The key
elements of the framework are:
l corporate assessment of risks
covering all aspects of the Trust
business;
l identification of key controls in
respect of each potential risk;
l assessment of assurances on
controls in place to manage the risks;
l identification of any gaps in controls
and assurances;
l an action plan to address these gaps.
Internal Audit’s review of the
organisation’s overall arrangements for
gaining assurance has concluded that:
‘An Assurance Framework has been
established which is designed and operating
to meet the requirements of the 2004/05
SIC and provide reasonable assurance that
there is an effective system of internal
control to manage the principal risk
identified by the organisation’
Trust Board reviewed and updated
the framework in March 2005 to ensure
compliance with standards for better
health, alignment with current business
plans and corporate risks and the
overall process for greater participation
of directorates.
The initial controls assurance
framework identified some minor gaps
in controls and assurances within the
Trust in the following areas:
l financial information and costing
systems;
l risk register;
l discharge of patients;
l information and IT support.
l access to national and local training
initiatives;
During 2004-05 action has been taken
to remedy these gaps with progress
reported to Trust Board in March 2005
and part of the review, The Board has
agreed an updated action plan which
will continue to be monitored by the
Trust’s Audit and Clinical Governance
Committees.
The Trust involves stakeholders by
informing and consulting on the
management of any significant risks.
Stakeholder involvement is sort
through:
l presentation at open Board meetings
and explicit references in the Trust’s
Annual Reports;
l the wide range of communication
and consultation mechanisms, which
already exist with relevant stakeholders,
both internal and external;
l consultation on all future policy
documents; stakeholders have the
opportunity to comment on the risk
elements.
5. Review of effectiveness
As Accountable Officer, I have
responsibility for reviewing the
effectiveness of the system of internal
control. My review is informed in a
number of ways. The head of internal
audit provides me with an opinion on
the overall arrangements for gaining
assurance through the Assurance
Framework and on the controls
reviewed as part of the internal audit
work. Executive managers within the
organisation who have responsibility for
the development and maintenance of
the system of internal control provide
me with assurance. The Assurance
Framework itself provides me with
evidence that the effectiveness of
controls that manage the risks to the
organisation achieving its principal
objectives have been reviewed. My
review is also informed by:
l the opinion of both Internal Audit
and External Audit, given in reports to
the Audit Committee;
l reports presented to the Clinical
Governance Committee.
The Trust Board, Audit and Clinical
Governance Committees have advised
me on the implications of the result of
my review of the effectiveness of the
system of internal control. A plan to
address weaknesses and ensure
continuous improvement of the system
is in place.
The process that has been applied to
maintain and review the effectiveness of
the system of internal control is as
follows:
The Trust’s Audit Committee
approves an annual internal audit
programme and receives all internal
audit reports. The Committee
monitors the Assurance Framework
action plan and the purpose of the
Audit Committee is as follows:
‘The Board has responsibility for
ensuring that effective internal financial
control operates within the Trust, and
as corporate trustee, within charitable
funds. The Audit Committee will
contribute to the achievement of these
objectives by providing a means of
independent and objective review of:
a) Financial and budgetary control
systems for the Trust and charitable
funds
b) Financial and management
information used by the Trust
c) Compliance with law, guidance, and
best practice
d) The performance of the internal and
external audit functions of the Trust
e) The implementation of guidance
issued by the Directorate of Counter
Fraud Services
The Audit Committee will serve to reduce
the risk of illegal or improper acts,
reinforce the importance and independence
of the audit function, ensure that the
overall audit cost to the Trust represents
value for money, and increase confidence
in the objectivity, integrity of financial, and
management reporting’.
The Trust’s Clinical Governance
Committee monitors standards of
clinical performance through the
Assurance Framework, receiving regular
reports from committees including,
Clinical Risk, Health and Safety and
Infection Control. The purpose of the
Clinical Governance Committee is as
follows:
‘To ensure that policies, procedures,
systems and processes are in place to
effect clinical governance’
The Trust incurred an income and
expenditure deficit in 2004-05, albeit
within 1% of turnover; this highlights
one of the key risks identified in the
assurance framework in March 2004.
During the year the Trust has taken
action to address any control and
assurance gaps, which were identified at
the start of the year, which may impact
on the financial performance. However,
income and expenditure plans for 200506 present the Trust with a very
challenging financial position, which will
require careful management and active
support from the Strategic Health
Authority and local NHS organisations
to redress the position.
Signed on behalf of the Trust Board:
Date: 12 July 2005
31
George Eliot Board - Register of Interests for 2004/05
Name
Frank McCarney
Chairman
Tucson Dunn
Chief Executive
Edmund Knight-Jones
Karl Simkins
Director of Finance
Dr Simon Freeman
Chief Information Officer
Duncan Phimister
Dr Peter Handslip
Medical Director
Dr Sam Chittenden
Chief Executive Intern - Strategy
Shaun Mountford
Julie Whittaker
Chief Executive Intern - Operations
Ruth Tyrrell
Director Human Resources
Jane Taylor
Director of Nursing
Dr Neeta Manek
Director of Clinical Education
Dr Vinod Patel
Director of Audit, Research & Evidence
Based Practice
Mrs Ann Garratt
Non-Executive Director
Miss Carol Gibson
Mrs Julie Jackson
Mr Kishor Pala
Mr Beaumont
Interest
None
None
None
None
None
None
Paid academic lectures per year x3-4, 2 to 3 overseas meetings
per year, to attend approved academic meetings
Chair of Nuneaton & Bedworth Healthy Living Network
None
None
None
None
Non-Executive Director of CDS Development Services
Lectures to healthcare professionals some attracting fees and
expenses
None
None
Nuneaton & Bedworth Borough Councillor
None
Director Bulkington Village Centre, Director Furnace Fields
Parents Centre. Spouse - Manager, DIAL Nuneaton & Bedworth
In a nutshell
Mission
The George Eliot Hospital NHS Trust’s
mission is to provide Better Care Without
Delay for all our patients.
Our vision is for the George Eliot to become
a ‘no wait’ hospital.
We aim to achieve our mission and vision
through our core values:
l Patient Satisfaction
l Our People and their Development
l Quality and Service Improvement
l Financial Responsibility
Governance
The Trust has been working towards
developing a fully integrated Governance
strategy including a new Governance
structure and framework. Significant changes
have included the appointment of a new
manual handling trainer and a Head of
Governance, due to commence shortly, to
assist the Trust in implementing good
practice across all areas of governance corporate and clinical.
The new Governance framework has been
developed on the basis of recommendations
and advice, following routine inspections by
the Health and Safety Executive (HSE) and
the West Midlands South Strategic Health
Authority.
The Trust continues to work
collaboratively with external agencies
including the HSE, the National Patients
Safety Agency, the Healthcare Commission
and Health Protection Agency to further
improve the patient environment, quality of
care and working lives for staff.
Clinical Governance is the system adopted
by the NHS to ensure that patients receive
the highest possible quality of care, ensuring
high standards, safety and improvement in
patient services. The Trust’s Clinical
Governance Committee ensures patient
safety and quality of care are prioritised
throughout the organisation as part of the
overarching strategy to achieve Standards for
Better Health. For further information on
Standards for Better Health, visit the
Healthcare Commission’s web site
www.healthcarecommission.org.uk.
Performance and waiting times
The Trust received one star in the 2004/05
performance ratings by the Healthcare
Commission.
l 96% inpatients waited 6 months
of less (England average - 95%)
l 92% outpatients waited 13 weeks
or less (England average - 83%)
l 86% A&E attenders seen within
4 hours (England average - 97%)
l 100% of Breast cancer diagnoses
treated within one month
(England average 99.5%)
To see the full performance ratings visit
www.healthcarecommission.org.uk.
The Trust has been working closely with
the Health and Safety Executive to
implement improvements for staff and
patients following mandatory inspections that
took place at the beginning of March 2004.
Improvement notices were issued on five key
areas that the Trust has since been
addressing rigorously. Further information
on the improvement notices can be found on
www.hse.gov.uk.
Major incidents
The Trust has in place a major incident plan
which is fully compliant with “Handling Major
Incidents: An Operational Doctrine” and
accompanying NHS guidance on major
incident preparedness and planning.
Contact us
George Eliot Hospital
NHS Trust
Head Office - Lewes House
College Street
Nuneaton
Warwickshire
CV10 7DJ
Email: [email protected]
Useful numbers
Switchboard:
Patient Advice and Liaison Service (PALS):
PALS freephone:
Multi-lingual co-workers:
024 7635 1351
024 7686 5550
0800 0407 194
024 7637 0028

2004/05 - George Eliot Hospital

Transcription

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