Fundusz NHS, Szpitale rejonu Mid Yorkshire Sprawozdanie roczne
Transcription
Fundusz NHS, Szpitale rejonu Mid Yorkshire Sprawozdanie roczne
Fundusz NHS, Szpitale rejonu Mid Yorkshire Sprawozdanie roczne 2012/13 2012/13 2012/13 2 MY ANNUAL REPORT 2012/13 What’s inside Page Chairman and Chief Executive statements 4 More about us 6 The highlights of 2012/13 8 Patients 17 Partners and community 24 Staff 29 Board report 35 Looking ahead 45 Annual Governance Statement 47 Financial report 57 Glossary 70 The Mid Yorkshire Hospitals NHS Trust 3 Chairman’s statement Chairman’s statement When I joined the Trust midway through the year, my expectation was that this was an organisation with limited prospects and that my role would be to oversee a process to take the organisation into merger or acquisition by another organisation. Since then I have spent a lot of time out and about in the organisation. I have met some fantastic, dedicated staff and experienced the passionate loyalty local people have for their hospitals and community services. It’s therefore no surprise that six months on – the Trust has a real opportunity to move forward as a successful organisation. At the start of 2013/14, we launched a programme to promote and energise delivery of our Trust values: Caring, Respect, Improving and High Standards. These values were developed with our staff, service users and partner organisations and over the course of the year ahead, we will be working with teams throughout the organisation to ensure they underpin everything we do from recruiting and developing staff to responding to patient concerns. We have used these values as the headings for sections of this report to remind people of why they are important to us and how we can demonstrate them in the way we deliver care day to day. I have to thank my predecessor David Stone CBE who stepped in as acting Chairman in March 2012 and provided leadership and direction to the Board during a very challenging period. During the year, we have recruited a new team of Non-Executive Directors who bring a wealth of experience to their role and have strengthened the Executive Director team. Although we are not a Foundation Trust, the Board has committed to adopt the standards that apply to Foundation Trusts – sound systems for ensuring high quality services, rigorous attention to financial and service performance and effective engagement with staff and the wider public. These are the building blocks that will move us to being one of the best performing organisations – and some examples of how we are already moving in that direction are described in this report. 4 Jules Preston MBE Chairman MY ANNUAL REPORT 2012/13 Chief Executive’s foreword Chief Executive’s foreword* It is difficult to sum up in a few words the achievements of the 12 months from April 2012 to March 2013, which is the period covered by this report. 2012/13 was an incredible year for the Trust; a year in which we moved from being amongst the worst performing Trusts to being recognised for the positive progress we are making. At the start of the year, we launched a programme of work under the banner of Making it Better Together to harness the energy and initiative of staff to deliver the standards of safe, high quality care that people in our communities expect and deserve. There is no doubt that improvement on the scale we have achieved would not have been possible without a huge collective effort and everyone in the organisation should be proud of what we have achieved. My foreword provides a snapshot of the improvements we have achieved that are covered in detail throughout the report. • Our hospital mortality rate came down so that we now compare well with similar organisations. • In 2011/12 the Trust met only half of the national performance targets. This year we met 89% • In spite of continued rising demand, we were one of a very small number of Trusts nationwide who succeeded in delivering the four hour standard for treatment in A&E • The majority of people referred to us for treatment were seen and treated within 18 weeks and we met this target as a Trust – although there is still work to do to get on track in some specialties • We made major improvements to our outpatient booking system – which had been a huge frustration for many people due to inability to book a local appointment and repeated cancellations • We have continued to improve our discharge planning processes so that arrangements are in place to allow people to go home as soon as they are well enough • The number of people who contracted infections while in our care reduced compared to previous years. The Mid Yorkshire Hospitals NHS Trust Throughout the report you will see examples of the excellent care delivered by our staff and the army of volunteers who work in our hospitals and in people’s homes. The report also details how we have invested in improving our services – not only through investment in equipment and buildings but also by developing the skills of our staff and by acting on the feedback we receive from people who use our services. The report also reflects on some of the challenges we have faced through the year. Change on the scale we have delivered has meant tough decisions about how we provide care, organise our staff and spend public money. We have also undertaken a major programme of work to put together proposals for the way hospital services will be delivered in the future, which were formally consulted upon between March and May this year. The Annual Report is an opportunity to celebrate what we have achieved and thank staff for their hard work and commitment. I am delighted to say that we have moved a long way towards our stated aim of being amongst the top ten Trusts in the country by 2015 and I am confident that we will continue to build on that success. Stephen Eames Chief Executive Stephen Eames was Interim Chief Executive from 1 March 2012. * He was appointed substantively to the post with effect from 2 September 2013. 5 More about us Bradford Fact file M621 income of l a u n n a n d We have a million an 0 6 4 £ n a f. h more t 8,000 staf n a h t e r o employ m M606 Cleckheaton Halifax M62 Batley Heckmondwike Brighouse Mirfield Dewsbury and District Hospital Huddersfield More about us 6 Around half a million people living in the Wakefield and North Kirklees districts of West Yorkshire use our services in our three main hospitals – Pinderfields in Wakefield, Dewsbury and District Hospital and Pontefract - and in the community as well. People also travel from other areas to use our services as part of patient choice. care to people who have been discharged from hospital but need extra support, care and rehabilitation before they go home. When our Trust was established in April 2002, we provided mainly hospital services but in 2010 we also started providing community therapy services and intermediate care services. These services provide short-term specialist Our services are provided from three hospital sites and in a range of community settings such as health centres, clinics, GP surgeries, family centres and in people’s own homes. In April 2011, we expanded to provide community health services for the Wakefield district to include Adult Community Nursing and Children’s and Families’ Health. MY ANNUAL REPORT 2012/13 More about us Leeds Rothwell Castleford M62 Normanton Pinderfields Hospital (Wakefield) Featherstone Pontefract Hospital A1(M) M1 Dewsbury to Pinderfields 8.5 miles Hemsworth Pinderfields to Pontefract 10.7 miles Pontefract to Dewsbury 17.6 miles Barnsley The Mid Yorkshire Hospitals NHS Trust South Elmsall Every day on average during 2012/13… • • • • • • • • More than 600 people attended our emergency departments About 218 patients were admitted as an emergency We carried out more than 260 planned procedures, such as operations We saw around 1,850 people in our outpatient departments 19 babies were delivered in our maternity units We provided community services to more than 308 patients Our district nurses made more than 1,060 patient visits Our health visitors saw more than 17 new babies. 7 The highlights of 2012/13 The highlights of 2012/13 This annual report is an opportunity to celebrate some of the great work, achievements and improvements delivered by our staff, supporters and partners. Here’s just a snapshot … 8 MY ANNUAL REPORT 2012/13 The highlights of 2012/13 Caring Ensuring quality of care is at the heart of everything we do. Arts@Pinders: A world of new creative opportunities was opened up to spinal injury patients at a new Arts Club launched with the help of our Trust. Arts@Pinders gives people being treated at the Spinal Injuries Centre at Pinderfields Hospital the chance to use art and crafts as a means of therapy, self-expression – and fun! The club was launched by four former patients from the Spinal injuries Unit - Steven ‘Harry’ Harrison, John Clayton, Belinda Noda and David Wilders. National award for support: Supporting carers and parents: A specialist advice line is now supporting parents and carers across the district to provide the best possible care for children and young people with diabetes. The service, operating every day of the year, has been extended to cover children attending the Dewsbury diabetes clinic. It puts young people, parents and carers in direct contact with a team of specialists who can provide expert advice and support on all aspects of managing the condition. The Mid Yorkshire Hospitals NHS Trust Our Childcare and Carers’ Support Service scooped a national award in May in recognition of its support to working parents and carers. The team won the ‘Most effective benefits strategy for working parents and carers’ award at the national ‘Employee Benefits’ 2012 awards. The service won the award for their work in developing ways of working for staff with childcare and carer responsibilities as well as benefits and support available for all staff. 9 The highlights of 2012/13 Pledging high quality care: Nurses from our Trust pledged their commitment to providing high quality patient care at our first Nursing and Midwifery conference. It was on the theme of ‘Energise for Excellence’ (E4E), and saw staff come together to share ideas and best practice. The conference saw the launch of the Trust’s Nursing and Midwifery Strategy and provided an opportunity to showcase the good work and innovative practice that is being undertaken across both hospital and community services. Sharing experiences: Patients and their families shared their personal experiences with staff at our Trust in a bid to improve standards of care. The annual Patient and Family Experience Summit gave clinical staff a personal insight into what it’s like to be cared for at our hospitals. The event, in its third year, uses real life stories to help staff see things from the patients’ perspective. Both positive and negative experiences were talked about to highlight what things the Trust does well and what could be done better. 10 MY ANNUAL REPORT 2012/13 The highlights of 2012/13 Respect Showing value and respect for everyone and treating others as we would wish to be treated. Valuing our heroes: Staff who provide exceptional care at the Trust were recognised by a national awards scheme. Nine members of staff from across our three hospitals and community services were named NHS Heroes. The scheme was set up as part of the NHS’s 64th birthday celebrations to honour those who go the extra mile in their work to make sure that every patient receives the best care. It’s the first time that both patients and colleagues have had the chance to celebrate their heroes and recognise their efforts. They were: James Carr, Volunteer Guide; Tao Carey, Midwife; Fran Lofthouse, Health Care Assistant; Martin West and Helen Chadwick, Design and Print; Heinz Schulenburg, Consultant Anaesthetist; Heather Angilley, Senior Specialist Physiotherapist; Lorraine Hughes, Senior Midwife; and Liz Lynagh, Health Visitor at Crofton Health Centre. The Mid Yorkshire Hospitals NHS Trust 11 The highlights of 2012/13 Valuing your voice: People with a passion for healthcare were invited to represent their community on our new Stakeholder Forum which we set up in 2013.The forum enables local people to have a strong voice in the development of health services across Wakefield, Pontefract and North Kirklees. Jules Preston MBE, Chairman of the Trust, said: “Not only do we need to make sure we provide the right services, we also need to listen to the public and take on board their views to identify the most effective ways of delivering them.” Tackling bad behaviour: A local Police Community Support Officer (PCSO) started working with hospital staff to tackle crime and anti-social behaviour at Pinderfields Hospital. PCSO Glen Kilduff of West Yorkshire Police started a dedicated three-month pilot to support Trust staff. The aim was to ensure the hospital site offers a safe and pleasant environment for patients, staff and visitors. His role will include working with security staff to deal with criminal incidents and anti-social behaviour. PCSO Kilduff said: “The Police and the Trust already have a strong relationship and the hospital has good facilities and security, but being on the site means we can work even more closely together to deal with incidents quickly and effectively.” 12 Satisfaction survey: Our Physiotherapy Service was highly rated in a patient satisfaction survey carried out in 2012. The audit showed that 98% of patients were satisfied or very satisfied with the service, and 82% of patients had seen a significant improvement in their condition following assessment and treatment. The survey was part of a continued commitment by us to listen to what patients have to say. Patients’ views were sought about their involvement in the planning of their treatment, whether they were treated with dignity and respect, how informed they were of their progress, and whether staff were helpful. MY ANNUAL REPORT 2012/13 The highlights of 2012/13 High standards Taking responsibility for providing the best services and patient experience. New hi-tech equipment: A £500,000 piece of equipment, called a lithotripter, was installed in the Urology Investigations Unit at Pinderfields Hospital in January 2013 and is helping to provide quicker and better treatment for patients with kidney stones. It is being used to treat over 20 patients a week using a procedure called extracorporeal shock wave lithotripsy where intense high-frequency sound waves are used to target and crush kidney or gallstones. It means that emergency patients can be treated quickly and without the need for invasive surgery and non-emergency patients require fewer courses of treatment, meaning fewer trips to the hospital. Clinics closer to home: Investing in the future: Our purpose-built, hospital education centre at Pinderfields was officially opened in May. The centre was designed to complement a similar facility at Dewsbury and District Hospital in providing modern facilities for staff for learning and study. It houses clinical skills rooms, mock ward areas, training rooms for resuscitation, the staff library and a large lecture theatre. State-of-the-art virtual reality simulators allow junior doctors to carry out surgical procedures on virtual reality ‘patients.’ A specialist team of hospital diabetes nurses and doctors started to hold clinics in GP practices across the Wakefield District for patients who would benefit from specialist advice and treatment. The team works alongside GPs and practice staff. This means that patients can be seen in their community by the most skilled person at the right time, which helps to better manage the patient’s condition outside of hospital. This also helps patients avoid long-term complications such as heart, feet and eye conditions and reduce hospital visits. The Mid Yorkshire Hospitals NHS Trust 13 The highlights of 2012/13 New screening service: The first patient in our area to be successfully treated for a potentially fatal condition discovered by a new screening programme urged others to go for screening. Mr John Watson, 65, of Methley, had a successful operation at Pinderfields Hospital in Wakefield to repair a large abdominal aortic aneurysm (AAA), which was detected when he attended for screening at his local GP surgery. The Abdominal Aortic Aneurysm Screening Programme was introduced in Wakefield and North Kirklees in 2012 and is being introduced gradually across England. Screening is offered at local GP surgeries and is free of charge to all men in the year they turn 65. It is a simple ultrasound test to detect potential abdominal aortic aneurysms. Women are much less commonly affected and are not included in the screening programme. Eye care changes: Changes to ophthalmology (eye care) services led to more patients being seen at Pontefract Hospital. Glaucoma, medical retina and cataract services at Pinderfields Hospital moved to Pontefract to make better use of the space there. Before the move outpatient clinic rooms at Pontefract were underused and, although theatre sessions were being well used, there was significant room for improvement in terms of the number of patients accessing the theatre unit. Since the changes in September 2012 there’s been a significant increase in the number of patients undergoing planned surgery at Pontefract. Hitting the standard: We were delighted to achieve the four-hour emergency care standard for 2012/13 – especially against a background of an 8% increase in activity. Across the year we saw, admitted, treated or discharged 96.1% of our patients in four hours against a target of 95%. Chief Operating Officer Carole Langrick said: “This is a fantastic accolade and it is all thanks to our staff for their continued dedication and hard work. It has been a very demanding year for all of our people, and particularly those working in emergency care services.” 14 MY ANNUAL REPORT 2012/13 The highlights of 2012/13 Improving We always look for ways to improve what we do. We encourage involvement, value contributions and listen to and positively act on feedback. More operations at Pontefract: Work to improve the way state-of-the-art facilities at Pontefract Hospital were used for local residents is reaping results. A project to improve the way the hospital is used was launched in December and there have been increased patients attending fracture clinics and more operations carried out in the hospital’s theatres. Listening to you: Cancer waits fall: Waiting times for cancer patients at our Trust had dramatically improved according to figures we reported in April 2013. Improvements to the service meant more patients were receiving their treatment locally than ever before and we were one of the best trusts in the region for ensuring that patients with suspected cancer referred by their GP were seen within two weeks. Dr Nick Spencer, lead clinician for cancer services, said: “Thanks to the dedication of all our clinical and support staff, more patients with suspected cancer are being assessed and investigated faster than ever before.” The Mid Yorkshire Hospitals NHS Trust The Friends and Family Test, a national initiative to gather feedback from patients, was launched at our hospitals in March 2013. It gives patients the chance to feed back their views of the care or treatment they have received in hospital. The feedback helps us celebrate areas of good practice and target areas for improvement. On discharge from hospital, each patient is given a survey form with the question: “How likely are you to recommend our ward / A&E Department to friends and family if they needed similar care or treatment?” Every patient is invited to respond by choosing one of six different options, ranging from “extremely likely” to “extremely unlikely”. They can also add further comments if they wish to do so. 15 The highlights of 2012/13 Results on the up: Improvements in A&E services: An annual audit in 2012 showed stroke services at the Trust were improving. The sentinel stroke national audit programme measures hospital trusts against national clinical guidelines for stroke and gives an indication of how they are doing compared to other trusts. The audit was carried out by the lead clinician for stroke at the Trust and the results showed significant improvements had been made since the last audit in 2010. An independent patient survey said our A&E services had improved significantly. The Picker Institute conducted the survey on our behalf and patients were selected at random. They had attended A&E departments at Pinderfields, Pontefract or Dewsbury and District Hospitals between January and March 2012. The 275 people who took part were asked questions on a range of topics including arrival, waiting, care and treatment, tests and environment and facilities. 98% of patients said the department was clean or very clean, 93% praised doctors and nurses for working well together and 90% rated reception staff as excellent, very good or good (90%). The results show the Trust has made significant improvements in cleanliness and privacy since the last survey which was in 2008. Getting IT right: IT services at our Trust were recognised at the 2012 E-Health insider awards, which reward excellence in healthcare IT. Our Trust, along with supplier MongooseIT, beat off stiff competition from four other finalists to win the Healthcare IT product innovation category for ‘Healthview’. Healthview is a search engine which enables staff to find clinical information from the Trust’s electronic patient record systems in a very quick and simple way. The system took 10 months to develop and was designed with clinicians, for clinicians. 16 MY ANNUAL REPORT 2012/13 Patients Patients Every year our staff care for thousands and thousands of people in our hospitals, in clinics in our community and in patients’ own homes. Our vision for the future has been shaped by listening to the opinions and experiences of our patients and those close to them, along with the views and priorities of our staff and key stakeholders. We strive to ensure continuous improvement in the quality of our services for our patients. Did you know? were meeting the The UK food safety regulator confirmed we safety in March 2013. very highest standards of food hygiene and years – the highest We have held a five star rating for over five s Agency. accreditation given out by the Food Standard The Mid Yorkshire Hospitals NHS Trust 17 Patients What the survey said Every year the health regulator, the Care Quality Commission, publishes the results of its inpatient survey, carried out with a sample of hospital inpatients. More than 800 patients in each of the 156 Trusts were asked for their views on their hospital stay in areas such as their experience in A&E, waiting times, the hospital and ward, doctors, nurses, care and treatment, operations and procedures and discharge. In our Trust 397 patients returned their completed survey. The results showed that in the majority of areas, the Trust compared well with others across the country. The Trust was reported as being among the best performers nationally in key areas such as not re-arranging a patient’s admission date and in providing support for patients in eating their meals. The report did however flag up significant areas where the Trust did not compare favourably including people’s experience, the perception of enough nurses being on duty and in providing patients with clear information on medicines. Stephen Eames, Chief Executive of The Mid Yorkshire Hospitals NHS Trust, said: “This survey is one of the ways that we gather feedback about how our patients feel about our services. I’m pleased that the majority of patients who took part in the survey felt that we are doing well in some really key areas such as not changing their hospital admission date. “I’m also pleased that in the main, we are also maintaining our performance on last year and compare well with other Trusts in the majority of areas. “However, the survey highlights some really significant areas that we need to review and act upon. I’m disappointed that when asked about their overall experience, patients responded less favourably than in 2011 and this means that nationally we don’t compare well. This is simply not good enough. “Our patients deserve nothing but the best care. While more recent feedback and performance reports over the last year are positive, the inpatient survey flags up that we need to do much more and we will review the results and take action in response to this feedback from our patients.” The full CQC inpatient survey results are available at: www.cqc.org.uk 18 Investing in your care Nearly £16 million worth of investment in healthcare equipment and facilities took place in 2012/13. We invested across our hospitals and community services including buying new medical and IT equipment and improving buildings. Below are just some of the investments made during 2012/13: • The installation of a pharmacy robotic dispensing system – an automated robotic arm and storage unit which quickly locates and accesses the correct medicines for dispensing • Medical simulation equipment including new urology simulators, which help in training for surgical operations • A new stress echo machine which uses ultrasound to create images of the heart to help determine whether any chest pain or associated symptoms are related to heart disease • New ophthalmic (specialist eye care) equipment – a new specialist microscope and a retina imaging scanner and a specialist camera which can take detailed photos of the interior of the eye • A machine which uses a laser to treat patients who have problems with an enlarged prostate • A machine which takes x-rays of the upper and lower jaw and teeth. In addition, investment has been made across all our hospital sites including new surgical equipment, a new and improved patient administration system that will go live in 2013 and an upgrade to the electronic system which organises staff rotas. MY ANNUAL REPORT 2012/13 Patients Listening and helping When our patients need help, advice or support or need to raise a concern they can turn to our Patient Advice and Liaison Service (PALS). PALS operates across our Trust and the central Patient Liaison Team works with key members of staff to provide the best possible service for our patients. We always aim to provide the best possible care for our patients but occasionally things can go wrong. We take complaints very seriously and investigate them fully. If there are issues identified, we work with the patient and their family to address them and learn from them for the future. But we are also happy to report that we received many compliments throughout the year from patients and their relatives – thanking staff for their care, hard work and dedication. Just a few are summarised here: The main role of the PALS team is to: • Advise and support our patients, their families and carers • Provide information on NHS services • Listen to concerns, suggestions or queries • Help sort out problems quickly on behalf of our patients, carers and relatives. y Clinic, To Rheumatology Da Pontefract a five star “I felt as if I was in a taxi was hotel – help getting eshment given, a parting refr is the best offered, making th outing for weeks.” To the Midwife-led Un it, Pontefract “Really relaxed enviro nment; staff were attentive, calm and helpful. I’m really glad we chose the midwife-led unit and would recom mend it.” To the Community Nu rsing team at Homestead Medical Ce ntre, Wakefield “The nurses were exce llent and my saviours on more than one occasion. They were always th ere for me, making me feel safe, secure and in good hands.” ity Nurses, To Commun tre Medical Cen k r a P d o o Outw e on ho visited m w s e rs u n badly e “Th spital with a o h m ro f e nd in discharg d promptly a e it is v m r a le broken ging schedu n a h c r u o h otice. fitting in wit mes short n ti e m o s , s a d, at what w xception, kin e t u o h it w , al and They are d profession n a le b a h c approa ample to up as an ex ld e h e b ld shou the NHS.” fields 3, Pinder 4 e t a G rs, 11 and the docto To Gate k n a h t o or like t t staff f r o p “I would p u s e. nd ward wards m o t nurses a n w o h all dness s spect at their kin e r h it w ated s fully I was tre ment wa nts.” t a e r t y dm onsulta times an by the c e m o t explained The Mid Yorkshire Hospitals NHS Trust , royd Centre th o o B e th To Dewsbury e to thank “I would lik d f who acte all the staf ly, and caring lly a n io s s e f pro what was and made oa tressful int potentially s e.” e experienc very positiv To the Colpos copy Clinic, Pontefract “At each vis it I have found the ca re given to me excepti onal. Their dedica tion and professionalis m cannot be faulted.” To short stay and thea tres staff at Pontefract “I have just come out of a short stay ward at Pontefract an d I cannot speak too highly of th e kindness, tact and humour of al l staff on the ward and in thea tre to a very nervous patient.” 19 Patients To A&E, MAU and SA U at Dewsbury “I feel moved to tell yo u of the wonderful nursing my sister received at Dewsbury. She was ad mitted to A&E, then MAU and finally SAU. Nothing was too much trouble for the nursing staff. She received and I witn essed, first class professional caring se cond to none.” To staff on ward 20 at Pinderfields and the Macmillan team “Can I take the opportunity to thank all the staff on ward 20 after looking after my mother in her final days. The level of care shown was above and beyond the call of duty. May I also thank the Macmillan team for their support and empathy.” To Breast Care nurse and s consultants at Pinderfield d “When I was diagnose with breast cancer my en world fell apart. But wh the Breast Care nurses talked to me I started to get my head around it. It was nice to know you were a phone call away and that was smashing.” To PALS (P atient Advice an d Liaison Service) “I am very impressed with PALS ! What a great serv ice you provide.” and other To Ward 12 wsbury staff at De five day “During my ed what I stay I receiv be the best considered to m eatment fro care and tr al, nursing all the medic y staff. and ancillar n ot have bee They could n , helpful and more caring friendly.” To staff in Emergency Department, CCU and Chaplaincy at Dewsbury “I am writing to tell you about the excellent treatment I received from all the staff who were involved in my care. Nothing was too much trouble for them and I just wanted to show my gratitude and appreciation for the wonderful work done by staff at Dewsbury and District Hospital. I would also like to thank members of the Chaplaincy team who were also very supportive.” 20 2011/12 2012/13 Number of compliments 3,090 1,999 Number of formal complaints received 1,341 1,417 % acknowledged within three working days (target 100%) 81% 99% % responded to within the agreed timeframe (target 85%) 63% 66% 10 (1 upheld) 16 (1 upheld) 2,400 2,700 Number of referrals to the Ombudsman Number of PALS enquiries During 2012/13, as a result of feedback from our patients, carers and relatives, we made some key changes including: • Improvements to the environment and admission procedures for day surgery patients attending Gate 40 at Pinderfields • Improvements to the Appointment Centre at Pinderfields to address problems being experienced by patients • The introduction of arrangements within ophthalmology to offer routine review appointments for Wakefield district residents at local health centres. Our philosophy for handling complaints The Trust policy on dealing with formal and informal complaints was reviewed in September 2011. The Policy outlines our philosophy for handling complaints and describes how this is underpinned by the Ombudsman’s Principles of Good Administration, Principles for Remedy and Principles of Good Complaint Handling. A particular focus for our Trust is the application of the Principles: • • • • • • Getting it right Being customer focused Being open and accountable Acting fairly and proportionately Putting things right Seeking continuous improvement. MY ANNUAL REPORT 2012/13 Patients The quality of your care A Quality Account is an annual report from a provider of NHS healthcare about the quality of services they deliver. Here is a snapshot of the 2012/13 report but if you would like to find out more you can find the full document on the NHS Choices website or at www.midyorks.nhs.uk How we did in 2012/13 Quality priority Improve systems and processes to further reduce mortality rates Achieved? The Hospital Standardised Mortality rate (HSMR) for the Trust in 2011/12 was 108.2 which was significantly higher than the expected rate. We undertook a lot of work to understand why the HSMR was high and found that the main reason was that we had under-reported the proportion of patients who were having palliative care. We were only reporting about 60% of the rates that the average Trust reported. Dr Foster confirmed that this was the main factor. Yes During 2012/13, we did a lot of work to improve our mortality rates by focussing on the quality of care, on the types of patients coming into hospital and on ensuring we were coding properly. During the year we have seen a progressive fall in the HSMR so that the rebased level is now below the national average at 96. Improve patient safety by implementing the Safety Thermometer The Safety Thermometer focuses on the provision of ‘harm free’ care. The definition of ‘harm free’ care means that patients are not subjected to the following: •• Pressure ulcers (hospital acquired) •• Falls with harm •• Catheters and urinary tract infection (UTI) •• Venous thromboembolism (VTE). Yes We have seen an increase in “harm-free” care and reductions in falls and pressure sores/ulcers. Improve the diagnosis and care of patients with dementia We have signed up to the national register of Dementia Friendly Hospitals and committed to be an active member of the multi-agency dementia board, working with the local authority, mental health trust and other agencies to agree priorities and action plans. Yes We have recently participated fully in the second National Dementia Audit, and the results show we have made significant progress in developing policies and developing ward level Dementia Champions. Our training programme on dementia is in place and staff now have the opportunity to gain additional knowledge and skills to care for patients with dementia. We screen patients over the age of 75 years for dementia and have guidance for staff in place to investigate and support those identified. Improve compliance with best practice guidelines and prevent healthcare acquired infection* The Trust failed to achieve its MRSA bacteraemia target in 2012/13 but achieved a 27% reduction in MRSA bacteraemia on the previous year’s performance. (Target seven – eight recorded) No (8 cases against a target of 7) We achieved the C Difficile target by a reduction of 61% in reported infections. Yes Improve outpatient scheduling, bookings and communications with patients We have developed a performance framework for the management of second and third time cancellations at specialty level, setting standards about who was authorised to cancel booked clinics and reminding doctors and specialist nurses about the rules for booking planned absence. No (5.7% of appointments cancelled against a target of 5%) The Mid Yorkshire Hospitals NHS Trust 21 Patients Quality of care is at the heart of what we do and we are committed to ensuring the safety of all our services and providing a consistently first class patient experience. In support of our quality priorities we will also be developing and then implementing a quality strategy in 2013/14. How we performed in key areas Compliance monitoring Our quality priorities for 2013/14 are as follows: 1 2 22 To reduce methicillin sensitive staphylococcus aureus (MSSA) blood infections by a third compared with 2012/13 To maintain mortality rates below the national average 3 To improve patient reported outcome measures (PROMS) for joint replacements 4 To increase incident reporting rates to that of the top 25% of Trusts 5 To reduce harm from falls by 25% compared with 2012/13 Annual target 2012/13 95% 96.1% 7 8 78 39 Referral to treatment waiting times - admitted 90% 90.7% Referral to treatment waiting times - non admitted 95% 96.3% Referral to treatment waiting times - patients on an incomplete pathway 92% 93.1% Diagnostic test waiting times <1% 0.7% Maximum wait of 2 weeks for urgent cancer referral 93% 97.9% Two week GP referral to first outpatient - breast symptoms 93% 97.4% All cancers - 31 days wait for second or subsequent treatment - surgery 94% 99.8% All cancers - 31 days wait for second or subsequent treatment - drugs or treatment 98% 100% All cancers - 31 days from diagnosis to first treatment 96% 99.4% All cancers - 62 days from screening to treatment 90% 94.4% All cancers - 62 days from urgent referral to treatment 85% 86.2% Delays in transfer of care 3.5% 2.9% Single sex accommodation breaches 0 4 Venous thromboembolism risk assessment 90% 97.9% Measure A&E - Total time in A&E MRSA Clostridium difficile MY ANNUAL REPORT 2012/13 Patients Information Governance Preventing and controlling infection We have a team dedicated to fighting infection across our hospital wards and departments. They work with staff, patients and visitors to help reduce the chances of an infection and keep our hospitals clean and safe. In 2012/13 there were eight MRSA bacteraemia (bloodstream infections) cases compared to 11 the previous year and there were 39 cases of Clostridium difficile compared to 101 the year before. While this is movement in the right direction we believe that every infection is one too many and the work continues to bring down the numbers by partnership working across our hospitals and in the community. The infection prevention and control committee is chaired by our Chief Executive and over the year we have recruited a new member of staff to focus on hand hygiene and provided extra training for staff – all part of our efforts to tackle infections. We are committed to ensuring that all paper-based and electronic patient health and staff records are handled in accordance with the Data Protection Act 1998 and other related legislation. In the NHS, the term used to describe the set of controls for assuring that personal information is handled in a secure and confidential manner is ‘information governance’. Every year we assess our compliance with information governance standards through the NHS information governance toolkit and every year we continue to make sustained positive progress. The information governance toolkit was updated during 2012/13 and set even higher and more challenging standards to be achieved by NHS Trusts. At the end of 2012/13 we achieved a very successful score of 81% which was classified as satisfactory as we achieved a level 2 or above score in all the 45 requirements. Plans are already in place to continue to improve this score for the 2013/14 Version 11 IG Toolkit. The Trust reported one serious untoward incident related to an information governance breech. Every patient, every time The Mid Yorkshire Hospitals NHS Trust 23 Partners and community Partners and community We are a major employer in Wakefield and North Kirklees, provide services to hundreds of thousands of people and have significant buildings and land in the districts. We are part of our community and have a responsibility to our community. 24 MY ANNUAL REPORT 2012/13 Partners and community Working together We work closely with many organisations including our two local authorities, Kirklees and Wakefield Councils, Local Involvement Networks (LINks) – which have now been replaced with local Healthwatch organisations - and our NHS commissioners (who plan and buy health services for local people). In 2012/13 our main commissioners were the primary care trusts in Wakefield and Kirklees. From April 2013 these have been replaced by the new clinical commissioning groups for Wakefield and North Kirklees. We are represented on many local boards and are committed to working with our partners for the benefit of our community. These roles are important – we need to work together to safeguard our community wherever possible and plan for the future. The proposals to reorganise hospital services which the Trust has been consulting on, referred to elsewhere in this report, have been developed through a partnership group which includes representatives of commissioners, social care and community and mental health services. The priority has been to develop a shared view about how services need to change and develop to make sure health and social care organisations develop plans that work together to meet the needs of the population. Work to develop integrated health and social care services is being taken forward through a multi-agency task force involving partners in social care, community health and mental health services as well as the Trust. part in surveys and focus groups. We have also recruited to a public stakeholder forum to help us develop stronger links into communities. The forum was recruited through newspaper advertising and direct contact with existing user groups. Its role mirrors the role of public members of a Foundation Trust council of governors and members will engage with the Trust in a strategic and advisory role and act as guardians of the public interest, providing a user perspective to the Trust Board on future plans and supporting the Trust to engage and communicate with the public more effectively. A generous community The generosity of our local community continues year on year with individuals, teams and organisations supporting the work we do with generous gifts to our Trust. Many people raise funds as a way of saying thank you for the treatment and care they or a family member has received. Their efforts make a real difference to both patient care and staff experience. We have a dedicated Charitable Funds Committee which manages the money that is donated to us and makes sure that it is spent in the best way. You can read the fund’s financial statement on pages 68 and 69 of this report. We have also been linking with other providers of acute hospital services and tertiary services to look at how we might be able to work more closely to deliver services more effectively and to explore the potential to save costs by sharing some non-clinical support services. In addition to our work with other providers of services, the Trust has met regularly with the Joint Health Overview and Scrutiny Committee for Kirklees and Wakefield to discuss the proposed service changes and has provided regular briefing information to the chairs of both individual committees. The proposals for hospital services have been the major topic of discussion with the LINKs but they have also played a vital role in helping us to improve services, for example by supporting a review of the way outpatient services are organised to address frustrations and concerns expressed by many people who have used our services. As part of our plans to develop new approaches to engaging with the public, we have worked with colleagues in the clinical commissioning groups to develop a database of people who are interested in getting more involved by taking The Mid Yorkshire Hospitals NHS Trust 25 Partners and community Preparing for emergencies As a major organisation with a vital role in our local community we have to make sure we are prepared for the worst. Our Major Incident Planning is fully compliant with the requirements of the NHS Emergency Planning Guidance 2005. We work closely with all our partners and regularly carry out exercises to test our readiness in the event of an emergency or major incident. In the last year we have worked with other organisations, such as the ambulance service and local authorities, and have been involved in 10 exercises. The Civil Contingencies Act (2004) sets out very clear responsibilities for organisations like ours. One of those is that we have a major incident plan, which sets out our actions in the event of a major incident. We tested this plan in an exercise run by the Health Protection Agency in September 2012. We also have a winter plan for the Trust, which is approved annually by the Board. We work closely with other organisations to ensure we can deal with any problems caused by winter weather. Sustainability Report As with all NHS organisations, we have an energy and environmental policy in place as part of our ongoing commitment to minimise our impact on the environment. During 2012/13 the Trust has continued to progress the sustainable development agenda and to build on the good work that has taken place in previous years. Sustainable Development action plan The Trust has further developed a revised Sustainable Development Plan which will be presented to the Board for approval in 2013, key highlights of the plan include: • Establishing a director lead to drive and manage the sustainability agenda • Commitment to acting as a Good Corporate Citizen • Progress towards a sustainable health system • To comply with all relevant legislation • To ensure new builds incorporate sustainability measures • To further progress the Trust’s Carbon Management Plan. The plan will be a living document and will be revised annually to reflect any impacts which may occur within the Trust estate. The Trust has a Carbon Management Plan to support achievement of carbon reduction targets in line with the NHS Carbon Reduction Strategy, which requires the carbon footprint to reduce by 10% between 2007 and 2015. Work that has already taken place include a new centralised energy efficient boiler, a new site wide building management system incorporating variable speed drives and extensive metering arrangements and the removal of steam plant. These schemes have saved 1,497 tonnes of carbon. Detailed below are some of the key elements that have been achieved in the 2012-13 financial year. 26 MY ANNUAL REPORT 2012/13 Partners and community Summary of Key Achievements in 2012/13 We are making use of new technology designed to minimise energy and carbon usage. For example, installing solar panels on some building roofs which saves energy and reduces carbon emissions. During the 2012/13 period the Trust trialled a form of renewable energy on the estate with the installation of photovoltaic panels being fitted to the Learning Development Unit at the Dewsbury site. The Trust’s Transport Service in 2012/13 has made a further improvement to our carbon reduction strategy. We have continued to provide a shuttle bus service which substantially reduces the amount of carbon produced by individual journeys for inter site travel between our three hospital sites. Shuttle bus services supported the journeys of 148 thousand staff and moved 25,000 items of post, parcels and medical notes including x-rays and urgent items of medical supplies for wards and theatres. Using the Carbon Trust calculator for the 369,000 miles travelled by the Trust’s shuttle service a net Co2 saving of 520 tons has been achieved. The scheme has reduced the Trust’s carbon footprint by 6.2 tonnes of carbon/annum and has provided a reduction in utility cost of £2,422 a year. Various lighting projects within the Trust have been clear winners with the new high energy efficient lighting being fitted to the Staincliffe Wing corridors at Dewsbury. The intention is for this type of energy efficient lighting to be incorporated into all our new build and refurbishment schemes. The new energy efficient modules have given a saving of £5,780 per annum with a carbon saving of 15 tons a year. The Trust installed night-watchman, a computer based system which turns off computers that are not in use. The electrical savings are monitored on an ongoing basis, to identify any additional opportunities for further savings, as computer systems are developed or modified. We have an ongoing partnership with transport providers to support our Trust’s Travel and Transport strategy. In a joint project with the Local Authority and METRO, the local commissioners of public transport, the Trust was able to re-establish the dedicated bus service to Pinderfields Hospital from Wakefield Bus Station in 2012. The new 111 service operates runs every 20 minutes at peak times and provides a much needed service for visitors, outpatients and staff. The new service contributes to the Trust Healthy Travel Plan by further reducing the organisation’s reliance on car travel. The Trust has also initiated a cycle scheme where staff can purchase a reduced cost bicycle to travel to and from work, cutting the impact on the environment. The cost of the cycles is spread over three years and a number of staff have taken up the cycle scheme option with cycle trains starting up in many areas. Savings to date, in the first year of operation, have shown a reduction in carbon of 361 tonnes and revenue saving of £69,334. Further development of our Transport and Travel strategy to reduce carbon emissions and fuel consumption has included: • Developing our policies for fleet vehicles to ensure that they are both fuel efficient and have the lowest carbon emissions for their vehicle size • Making greater use of our staff shuttle bus service to transport staff as well as post and packages between sites, including medical records and instruments. The Mid Yorkshire Hospitals NHS Trust 27 Partners and community Becoming greener Plans and visions for the future: • An organisational structure that puts sustainability at the heart of its activities • A sustainable NHS can only be achieved by all staff and managers’ efforts • Localised groups to be set up to identify potential sustainability initiatives • Staff to be informed and embrace sustainability issues • Staff to continue to increase their use of cross site travel arrangements • Continue to provide staff with the opprtunity to take up the salary sacrifice scheme relating to cycle to work initiative • Continue to undertake Sustainabilty Promotion Days. Trust Carbon Footprint The Trust is committed to continuing to promote the Sustainability Agenda throughout its business and to keep the principles of this agenda at the core of all its activities. The Trust’s base CO2 assessment for reporting year 2007/08 was 23,206 tonnes of carbon. From that period to 2010/11, the Trust has gone through some significant redevelopments on two of its main sites which have dramatically improved its carbon footprint. After completion of the Pinderfields and Pontefract Hospitals and implementation of the carbon initiatives undertaken, the Trust’s carbon footprint in 2011/12 was 21,607 tonnes, which is a reduction of 1,655 tonnes from the 2007/08 base line assessment and equates to 7%. During 2012/13 adverse weather increased the energy consumption, resulting in an increased carbon footprint of 23,262 tonnes. Although there has been an in year increase in the Trust’s carbon footprint, previous initiatives have continued to limit the extent of this adverse effect. Partnerships and working groups The Trust continues to be an active member within the following working groups and organisations: • The Climate Change Management Group Yorkshire and Humberside • The Sustainable Development Unit • Local Authority • The Wakefield Council Environmental Group • Royal Institute of Public Health • Northern Energy Group. 28 MY ANNUAL REPORT 2012/13 Staff Staff Buildings, technology and facilities are all important to your care – but nothing is more important than the people who provide it, from the people you never see – working hard behind the scenes to keep everything running as smoothly as possible – to the people at the frontline delivering your care. Staff headcount 208 Additional Professional Scientific and Technical 1,496 Additional Clinical Services 1,465 Administrative and Clerical 533 Allied Health Professionals 964 Estates and Ancillary The Trust has faced some significant challenges in relation to staff during the year as it undertakes a major redesign of workforce. This has manifested in industrial action and staff survey results which show there are areas of low staff morale. Sickness absence has also been higher than the national average and work has been ongoing to address this. 196 Healthcare Scientists 755 Medical and Dental The Trust has put in place a programme of work to address workforce challenges. This includes introduction of leadership development programmes and a Top 100 academy to encourage and develop people with potential, a comprehensive staff engagement plan and revised policies for staff management. 30 Students The Mid Yorkshire Hospitals NHS Trust 2,413 Registered Nursing and Midwifery 8,060Total 29 Staff Celebrating our staff We celebrated the dedication and achievements of our staff who have gone the extra mile to make a difference to local health services at our annual Celebrating Success event in July. Delighted winners walked away with coveted awards which mark their commitment to going beyond the call of duty in areas such as patient care, new and innovative ways to provide services, leadership and lifetime achievement. The overall winner of the Chairman’s Award for Outstanding Achievement and the Excellence in Service Improvement Award were the urology team for their work to improve the management of prostate cancer. Consultant plastic surgeon Mr Oliver Michael Fenton was awarded an MBE for services to paediatric plastic surgery in the New Year’s Honours list. Mr Fenton was nominated by his anaesthetic colleague, Keith Judkins, who accompanies him on his numerous trips to Romania and India where they perform operations on children with cleft lips and palates. Stephen Eames, our Chief Executive, said: “These awards are a humbling reminder that our staff have the drive and determination to meet challenges head on. Our staff go the extra mile, they strive to be better and make a difference to the lives of our patients and I would like to thank them all.” Dr Kate Granger was one of the winners in the Yorkshire Evening Post’s Best of Health Awards. Kate was the winner of the Judges’ Award – an award designed to recognise an individual or team who has made an outstanding and inspiring contribution in the field of health. The awards were launched by the local paper to recognise local healthcare workers who go above and beyond the call of duty. Midwife Pauline Daley and MY Rosewood Centre Team at Dewsbury were also nominated for awards. 30 MY ANNUAL REPORT 2012/13 Staff Supporting and developing our staff “Ensuring the safety of our patients and our staff through innovative, yet less time consuming training, is often a difficult task. However, this year the organisational development team has focussed heavily on developing and promoting our e-learning provision so that our staff have more choice about how and when they complete their mandatory training.” Ian Ward, Associate Director of Organisational Development. Our valued volunteers Just under 1,000 people volunteer at our Trust and make a valuable contribution to the day-to-day running of our hospitals – and bring real benefits to our patients. Mandatory training is essential to protect our staff and patients and covers issues such as infection control, medicines management and fire safety. This year’s new approach has made a great impact. Through a combined effort of more choice in the method of training, a more effective reporting system and through the hard work and support of all the training leads, the Trust actually doubled its percentage compliance rate in all of the core subjects during 2012. Other achievements for 2012/13 included: Their work varies from helping guide patients and visitors around our hospitals, running coffee shops, helping out in our wards and departments and helping to gather important feedback from our patients. They come from all walks of life and are all ages. Some give a few hours each week and some are able to volunteer for more. Not only do they give their valuable time, they are also great fundraisers for our Trust and in 2012/13 raised £101,000. From this money one of the largest donations was for the benefit of intensive care patients at Dewsbury and District Hospital with more than £26,000 for new medical equipment. The unit was presented with a new ventilator, fibre optic bronchoscope and a dressings trolley. Our volunteers do a fantastic job and we would like to say “thank you” to them all. • The highly successful Clinical Leadership Development programme, a series of workshops for our clinical heads of service, aimed at providing this group with the skills and knowledge to address the range of leadership and management situations that arise in today’s healthcare environment • We continued with our Institute of Leadership (ILM) programmes for Band 3-7 leaders, providing them with a sound start in their leadership careers, in addition to helping them meet those important management tasks through our “Licensed to Manage” programme. During 2012/13 we also trained over 40 apprentices in roles such as healthcare assistants and technicians. As a Trust, we recognised and understood that during difficult economic times, with the need to meet stringent targets, staff engagement and motivation can often be put under serious pressure. This led to the design of a new Staff Engagement and Organisational Development framework for 2013, with a range of development initiatives to engage and empower our staff. This includes a new appraisal process focussed on quality, the launch of a coaching scheme to provide support for our management and the introduction of a behavioural framework, derived from the Trust’s core values, which will give confidence to our managers in dealing with behaviours that work against our desired culture. The Mid Yorkshire Hospitals NHS Trust 31 Staff Childcare support Our Childcare and Carers Support Service supports all staff to help them to balance their work and family commitments. Affordable childcare is an important issue for many employees. During 2012/13 we introduced a voluntary salary sacrifice scheme available to all staff using the onsite nursery facilities. The scheme enables members of staff to sacrifice the whole of their annual childcare costs and receive Tax, National Insurance and pension exemption on the amount sacrificed. Our onsite holiday club was awarded the top award by a national charity in recognition of the high quality service and continual support for children with additional needs. The benefit road shows continued to promote a range of benefits, health and wellbeing services and support offered by the Trust, our Cyclescheme is now open all year round to Trust employees and we increased the number of discounts from local organisations available to staff. Equality and diversity We are committed to promoting equality and diversity in our day to day treatment of all staff, patients and visitors regardless of race, ethnic origin, gender, gender identity, marital status, mental or physical disability, religion or belief, sexual orientation, age or social class. We have a long-standing Equal Opportunities Policy which was put together in accordance with the Government Acts on disability, sex discrimination and age discrimination. Our policy aims to outline our clear commitment to equal opportunities and the action we aim to take as an employer. Together with our Equality and Diversity statement, our Equal Opportunities Policy outlines the principles and behaviour we would expect from all our managers and staff. We carry out Equality Impact Assessments (EIAs) on proposed policies, service developments or functions to identify any adverse or positive effect it has on differing groups in the Trust and communities. As a major local employer we have been focusing on addressing recruitment and retention issues. This involves understanding the make-up of our local population and the barriers, often multiple, facing potential future employees. We are involved in both local and national initiatives: • Get Britain Working: In partnership with Job Centre Plus we create opportunities under some of the Get Britain Working measures. We provide voluntary work experience for unemployed people aged 16-24 to put themselves forward for work placements lasting between two and eight weeks and between 25-30 hours per week. Young people who have spent up to eight weeks in a work experience opportunity can have their placement extended by four weeks where an offer of an apprenticeship exists. We are also involved in Work Together, a nationwide initiative to encourage all unemployed people to consider unpaid work placements as a way of improving their employment prospects while they are looking for work • Work Programme: This focuses on the longer-term unemployed and will support a wide range of people from Jobseekers Allowance recipients who have been out of work for some time, to individuals who may previously have been receiving incapacity benefits for many years • Exemplar Employer Framework: This is led by Wakefield Council and is an agreement amongst public sector organisations to support those with severe and enduring learning difficulties and mental health problems into employment. 32 MY ANNUAL REPORT 2012/13 Staff During 2012 the Occupational Health Service underwent a significant review, resulting in changes to the model of service delivery, staffing structure and skill mix. We aim to support staff in reaching, maintaining and sustaining wellness and key stakeholders within the organisation will have opportunity to assist and play a role in developing this wellness culture through a new Organisation Health and Wellbeing Group. Our staff’s health and wellbeing There has been a major focus on managing sickness absence over the course of the year. This has involved improving support for staff to tackle some of the underlying causes of ill health, reviewing staff who have repeated episodes of absence and supporting staff to return to work after periods of ill health. Reducing sickness absence saved the Trust almost £100,000 in cover costs and lost productivity and also has a major impact on patient care and staff morale by reducing the frequency with which staff have to cover for unexpected absence. The chart below shows how we have improved. In 2012/13: • We have introduced workplace health champions • We launched mental health and resilience training opportunities for staff • We provided fast-track access to appropriate treatment and on-line self assessment forms for staff with musculoskeletal disorders • We ran a flu campaign which led to 54% of clinical staff being vaccinated compared to 42% in the previous year. Looking after the health and wellbeing of staff directly contributes to the delivery of quality patient care. Poor workforce health has high and far reaching costs to our organisation and ultimately our patients. Sickness absence 5.5% 5.0% 4.5% 4.0% 3.5% 3.0% APR MAY JUN JUL AUG SEP OCT NOV DEC JAN 2011/12 with BBW 2011/12 without BBW 2012/13 with BBW 2012/13 without BBW FEB MAR * Balfour Beatty Workplace (BBW) is the Trust’s PFI partner responsible for provision of some non-clinical services. These staff are managed by BBW on behalf of the Trust. The Mid Yorkshire Hospitals NHS Trust 33 Staff Working with our staff Our staff need to know what is happening across the organisation, as well as in their own service or department, and have the chance to influence the future of the Trust. Keeping our staff informed and opening up routes for them to communicate with senior managers and other colleagues is vitally important. Our staff survey The results for our Trust in 2012 showed an overall improvement from 2011 and showed that we are doing well in areas such as our staff feeling safe at work and the Trust provision of opportunities for career progression or promotion. We use a variety of tools – face to face meetings and team briefings, traditional newsletters and online versions and blogs from the Chief Executive. Our directors visit wards and departments to speak to staff and listen to their views and concerns. However, there were some significant findings where the Trust remains in the bottom 20% for acute trusts. These included staff recommendation of the Trust as a place to work or receive treatment; staff motivation at work; staff reporting errors, near misses or incidents and agreeing that incident reporting procedures are fair and effective; and staff having well-structured appraisals. There are regular opportunities to “Ask Stephen” and gain the ear of the Chief Executive Stephen Eames. There is also the “Tell Stephen” email address which provides a failsafe route by which staff can quickly alert him if they feel they are encountering blockages to sort a problem out. Our Chief Executive Stephen Eames said: “While this year’s results showed that we have improved in some areas it is very clear that we need to do much more and take wideranging action to build on the improvements that we have already put in place over the last year.” We work with our Joint Consultative and Negotiating Committee (JCNC) and involve the committee in developing and revising our employment policies and managing change. The committee is made up of management and union representatives. We also carried out our own local survey with staff to find out what changes and improvements they would like to see, and have developed an action plan to address the National Staff Survey results which takes account of this feedback from staff. Our Medical Staff Committee provides a forum for our senior medical staff and also safeguards the terms and conditions of service of all medical staff employed by our Trust. Examples of actions taken during 2012/13 as a result of Staff Survey outcomes: • Introduction of Employee Assistance Programme, giving all staff access to professional counselling advice • Training delivered to support a mentally healthier working environment to reduce work related stress • Working with West Yorkshire Police to provide on-site Police Community Support Officer to assist staff in difficult situations • Series of open staff meetings to engage with staff regarding future direction of the Trust. The full results of the national survey are available to view at www.nhsstaffsurveys.com/cms 34 MY ANNUAL REPORT 2012/13 Board report Board report Our Trust Board is legally responsible for the leadership, direction, control and risk management of our services. This includes setting our strategic aims and ensuring that the right financial and human resources are in place for us to meet our objectives. The Board meets in public and the meetings are open to anyone who wants to attend. Details, including agendas and papers, are available on our website at www.midyorks.nhs.uk The Board is made up of six Non-Executive Directors, including the Chairman, and five Executive Directors, including the Chief Executive, and each member brings a variety of individual skills and experience. The Trust also has two associate Non-Executive Directors who do not have voting rights. Non-Executive Directors are not employees of the Trust and are appointed to provide independent support and challenge to the Board. The independent regulator of Foundation Trusts, Monitor, requires that Non-Executive directors should be able to act independently and should not: • Have been an employee of the NHS [aspirant] foundation trust within the last five years; • Have or have had within the last three years, a material business relationship with the NHS [aspirant] foundation trust either directly, or as a partner, shareholder, director or senior employee of a body that has such a relationship with the NHS [aspirant] foundation trust; The Mid Yorkshire Hospitals NHS Trust • Have received or receive additional remuneration from the NHS [aspirant] foundation trust apart from a director’s fee, participates in the NHS [aspirant] foundation trust’s performance-related pay scheme, or is a member of the NHS [aspirant] foundation trust’s pension scheme; • Have close family ties with any of the NHS [aspirant] foundation trust’s advisers, directors or senior employees; • Hold cross-directorships or have significant links with other directors through involvement in other companies or bodies; • Have served on the Board for more than nine years from the date of their first election; • Be an appointed representative of the NHS [aspirant] foundation trust’s university medical or dental school. All of the Trust’s Non-Executive Directors meet Monitor’s requirements in terms of independence. 35 Board report Our Board of Directors as at March 31, 2013 During 2012/13 there were a number of changes to The Mid Yorkshire Hospitals NHS Trust Board, following the resignation of the four Non-Executive Directors who were in post in June 2012. Non Executive Directors Jules Preston MBE, Chairman Mr Preston joined the Trust in October 2012, bringing with him extensive experience in the NHS, having served as Chairman of the Northumberland, Tyne and Wear NHS Foundation Trust, one of the largest mental health and learning disability Trusts in the country, since its establishment in April 2006. He has previously been a Non-Executive Director of other NHS organisations including the former Sunderland Health Authority and the then Northumberland, Tyne and Wear Strategic Health Authority. Terry Carter, Non-Executive Director Mr Carter joined the Trust Board in October 2012 and was previously a Head of Operations for the Audit Commission and a District Auditor with the Audit Commission for a range of health and local government bodies. Terry is interested in good governance and service improvements of health and local government. Trevor Lake, Non-Executive Director Mr Lake joined the Trust Board in July 2012 and has a background at Senior Executive and Director level in the Hotel and Hospitality industry and now specialises in consultancy across that sector. He is also an Independent Member of the West Yorkshire Police Authority (since 2005) and a Non-Executive Associate with NHS Calderdale, Kirklees and Wakefield District. Louise Scott, Non-Executive Director Ms Scott joined the Trust Board in March 2013 and brings experience of providing advice and support to people from a wide range of backgrounds with a career in company and commercial law spanning more than 25 years. Her latest position was head of the legal department of Croda International PLC, a FTSE 100 global speciality chemical company with more than 3,000 staff and a turnover of £1billion. Added to her legal work, Louise is a registered volunteer for ShelterBox, an international disaster relief charity that provides emergency shelter, warmth and dignity to people affected by disaster worldwide. David Hicks (Associate Non-Executive Director) Dr Hicks joined the Trust Board in March 2013 and has a passion for patient safety and patient experience, and acts as an Inspector for the Care Quality Commission, giving him an insight into the importance of how organisations appear from the perspective of the general public. In a previous role, Dr Hicks has been Medical Director at Barnsley Hospital Foundation Trust, where he was also Acting Chief Executive for 12 months. David Sheard (Associate Non-Executive Director) Councillor Sheard joined the Trust Board in January 2013 and is the Deputy Leader of Kirklees Council. He was first elected to represent the Heckmondwike Ward in 1982 and has chaired major committees across the council. He was appointed as a Member of the Dewsbury Bench in 1982 and served until going onto the supplementary list in 2012. He has a degree in Business Studies and graduated as a member of the IWSP. He worked at BBA Cleckheaton before joining the RAF. On leaving the RAF he worked for Kirklees Council and the West Yorkshire Passenger Transport Authority. Executive Directors 36 Stephen Eames, Chief Executive Mr Eames has 20 years’ experience as a Chief Executive. He has substantial experience in merger and acquisition, PFI and public/private sector partnerships and hospital turnaround. Stephen is also experienced in top level leadership activities and in partnership working with NHS institutions, local authorities, the private sector and a variety of other agencies. He is a trained coach and mentor, and regular contributor to the Health Service Journal. He is a member of the Editorial Board for the Journal of Marketing and Management in Healthcare. Richard Jenkins, Medical Director Dr Jenkins was appointed as Interim Medical Director in August 2012 and was substantively appointed in November 2012. He is a Consultant in Diabetes and Endocrinology and has been with the Trust since 2002 after completing his training in South Yorkshire. He has held a number of medical leadership roles in the Trust since 2004, most recently as the Divisional Clinical Director for Medicine. He works clinically at all three Trust sites and in the community. MY ANNUAL REPORT 2012/13 Board report Helen Thomson, Interim Chief Nurse Mrs Thomson holds an MA in Leading Innovation and Change from York University and a BA (Hons) in Management from Leeds University. She is a registered nurse and midwife and holds the Advanced Diploma in Midwifery and the Midwife Teachers Diploma. She became the Director of Nursing and Midwifery and Deputy General Manager at Huddersfield Royal Infirmary from 1991and in April 2001 was appointed Executive Director of Nursing for the Calderdale and Huddersfield NHS Trust where she also held the post of deputy chief executive since January 2006. She joined The Mid Yorkshire Hospitals NHS Trust as Interim Part-Time Director of Nursing and Quality from October 2012 to April 2013 when she returned full time to her substantive position as Director of Nursing for Calderdale and Huddersfield NHS Foundation Trust. Robert Chadwick, Finance Director Mr Chadwick joined the Trust in October 2011. He was previously Director of Finance at The Pennine Acute Hospitals NHS Trust from April 2002 and was Acting Chief Executive at the Trust from May 2006 to June 2007 and Director of Finance at North Manchester Healthcare NHS Trust. Carole Langrick, Chief Operation Officer and Deputy Chief Executive Mrs Langrick joined the Trust in June 2012 as Chief Operating Officer and Deputy Chief Executive. She started her health service career as a nurse and since then has held a variety of clinical, managerial and leadership roles in hospital and community services, as well as in Commissioning and, more latterly, with Strategic Health Authorities. During his career Bob has provided leadership to large complex organisations, achieving key financial and performance targets. As QIPP lead for Pennine Acute, Bob designed and lead the project ‘Transforming for Excellence’ which provided for a sound financial foundation based on the transformation of service provision. Prior to joining the Trust, Carole was Director of Strategic Development and Deputy Chief Executive at North Tees and Hartlepool NHS Foundation Trust. Directors appointed to the Trust Board since April 2013 Prew Lumley, Non-Executive Director Prew Lumley joined the Trust Board in April 2013. Prew is a partner at the leading law firm Squire Sanders (formerly Hammonds) which specialises in Commercial Property. Charlotte Sweeney, Non-Executive Director Charlotte Sweeney has worked at a strategic human resources and development level for more than 15 years, reporting to the Boards at a number of global, blue chip financial services firms. She is a leading expert in equality, diversity and inclusion and has advised a number of Government bodies on their strategies and focus. She is the founder and Director of Charlotte Sweeney Associates, a consultancy firm specialising in change management strategy, including diversity, wellbeing, inclusion and employee engagement. She is an active member of Leeds Chamber of Commerce. In 2010/11 she sat on the Strategic Housing and Land Availability Assessment Committee for Leeds and has recently been appointed to the Leeds Chamber of Commerce Economic and Retail Infrastructure Committee. She is also involved in the Squire Sanders charitable committee and is a member of the Squire Sanders Social Committee. Charlotte is currently Leadership Group Member of Employers for Careers Executive Committee and President of European Professional Women’s Network in London. In addition, she is an Equalities Advisory Board Member (external) of the Department of Business, Innovation and Skills and an Advisory Board Member for Women on Boards UK, a Non-Executive Director with responsibility for Diversity & Inclusion for the City HR Association and a Co-opted Trustee for the Equality and Diversity Forum. Sally Napper, Chief Nurse Sally Napper joined the Trust Board in May 2013. She is an experienced director having been Chief Nurse at Bradford Teaching Hospitals NHS Foundation Trust since 2008 where she was also Chief Operating Officer. Sally has led on improving patient experience and quality of care at Board level. She is a Registered Nurse and Registered Nurse for Sick Children and worked at Great Ormond Street Hospital early in her career. Directors are required to declare any interests relating to themselves or their spouse which may affect their impartiality. The Declaration is overleaf. The Mid Yorkshire Hospitals NHS Trust 37 Board report Declaration of Interests Directors in post at 31 March 2013 Name and title Interest Mr Jules Preston, Chairman Chairman/NED, Assessment North East Ltd Sunderland (unpaid) Chairman/Trustee, Grace House North East Children’s Hospice Appeal (unpaid) Trustee Pinetree Centre (unpaid) 38 Mr Terry Carter, Non-Executive Director Nothing to declare Mr Trevor Lake, Non-Executive Director Director, Six Degrees Consultancy Ltd Ms Louise Scott, Non-Executive Director Nothing to declare Dr David Hicks, Associate Non-Executive Director Chairman, Barnsley Premier Leisure (registered charity) Councillor Mr David Sheard, Associate Non-Executive Director Nothing to declare Mr Stephen Eames, Interim Chief Executive Nothing to declare Mrs Carole Langrick, Chief Operating Officer / Deputy Chief Executive Nothing to declare Mr Robert Chadwick, Director of Finance Nothing to declare Dr Richard Jenkins, Medical Director Trustee of Diabetes Charity Ms Helen Thomson, Interim Chief Nurse Chief Nurse, Calderdale & Huddersfield NHS Foundation Trust Mr Graham Briggs, Director of Human Resources & Organisational Development Nothing to declare Mrs Caroline Griffiths, Interim Director of Corporate Planning & Projects Nothing to declare Specialist Inspector, Care Quality Commission MY ANNUAL REPORT 2012/13 Board report Director who joined the trust since April 2013 Name and title Interest Prew Lumley, Non-Executive Director Partner, Squire Sanders (UK) LLP Charlotte Sweeney, Non-Executive Director Director, City HR Association Owner, Charlotte Sweeney Associates Ltd Leadership Group Member, Employers for Careers Sally Napper, Chief Nurse Spouse: Partner, Wellington House Surgery, Batley/Birstall Sister: Associate specialising in personal injury/medical negligence, Irwin Mitchell Solicitors, Leeds Note: For details of directors throughout 2012/13 and more information about our Board please see our Governance Statement from page 47 Arrangements for performance review of Board members The Chairman’s objectives were set on appointment in October 2012 and reviewed at the end of the year by the chairman of the Strategic Health Authority. This responsibility passed to the chairman of the national Trust Development Authority in April. The Chairman conducts a quarterly performance appraisal of all Non-Executive Directors. The annual objectives of the Chief Executive reflect the priorities of the organisation set by the Trust Board and are agreed with the Chairman. The Chairman reviews the Chief Executive’s performance against these objectives and provides a formal report to the Remuneration and Terms of Service Committee. Each Executive Director agrees objectives with the Chief Executive which reflect their contribution to delivery of the organisation’s priorities. The Chief Executive conducts a quarterly performance appraisal for each director and an annual appraisal which is reported to the Remuneration and Terms of Service Committee. The Mid Yorkshire Hospitals NHS Trust 39 Board report Key Trust Board Attendance Attended û Apologies Not applicable 1 April 2012 to 31 March 2013 private only Name David Stone private only private only 3 May 2012 24 May 2012 31 May 2012 21 June 2012 25 July 2012 14 Sept 2012 27 Sept 2012 û Jules Preston 25 Oct 2012 29 Nov 2012 31 Jan 2013 28 Feb 2013 Totals 6/7 5/5 12/12 Stephen Eames Prof Tim Hendra 5/5 Tracey McErlainBurns 5/5 Dr Richard Jenkins Robert Chadwick 7/7 12/12 û 4/5 Helen Thomson Adrian Griffiths û Carole Langrick 2/3 û 8/9 10/12 Graham Briggs û û Ruth Unwin 5/5 Caroline Griffiths Kate Harper û 6/7 2/2 Iain Wilkinson û 3/4 David Longstaff û û 2/4 Jack Kershaw Dr Margaret Faull 4/4 Anita Fatchett û 3/4 1/1 Pat Garbutt û Rosie Valerio Trevor Lake 8/8 5/5 1/1 3/3 1/1 Terry Carter David Sheard David Hicks 6/7 6/6 Louise Scott 40 28 March 2013 MY ANNUAL REPORT 2012/13 Board report Remuneration report Salary and pension entitlements of senior managers A) Remuneration Benefits in kind £000 2012/13 Salary (bands of £5000) £000 Other remuneration (bands of £5000) £000 Benefits in kind £000 0 0 0 0 0 0-5 0 0 15-20 0 0 0 0 0 15-20 0 0 Anita Fatchett, Non-Executive Director to 2 July 2012 5-10 0 0 0-5 0 0 Dr Margaret Faull, Non-Executive Director to 2 July 2012 5-10 0 0 0-5 0 0 David Longstaff, Non-Executive Director to 2 July 2012 5-10 0 0 0-5 0 0 Iain Wilkinson, Non-Executive Director to 2 July 2012 5-10 0 0 0-5 0 0 Jack Kershaw, Non-Executive Director to 23 May 2012 5-10 0 0 0-5 0 0 Terry Carter, Non-Executive Director from 1 October 2012 0 0 0 0-5 0 0 Trevor Lake, Non-Executive Director from 12 July 2012 0 0 0 0-5 0 0 Patricia Garbutt, Non-Executive Director from 12 July 2012 to 19 March 2013 0 0 0 0-5 0 0 Rosie Valerio, Non-Executive Director from 12 July 2012 to 4 February 2013 0 0 0 0-5 0 0 Louise Scott, Non-Executive Director from 1 March 2013 0 0 0 0-5 0 0 Cllr David Sheard, Associate NonExecutive Director from 1 January 2013 0 0 0 0-5 0 0 Dr David Hicks, Associate Non-Executive Director from 1 March 2013 0 0 0 0-5 0 0 Name and title 2011/12 Salary (bands of £5000) £000 Other remuneration (bands of £5000) £000 35-40 Non-executive directors Ed Anderson, Chairman to 2 March 2012 David Stone, Interim Chairman from 3 March 2012 to 30 September 2012 Jules Preston, Chairman from 1 October 2012 The Mid Yorkshire Hospitals NHS Trust 41 Board report (A) Salary and associated costs are recharged by the organisations which employ them substantively and it is the total recharge which is reported. (B) Other remuneration includes Medical Director payment, Clinical Excellence Award, on-call allowance and Additional Programmed Activity (APA). (C) Other remuneration includes Medical Director Payment, Clinical Excellence Award, on-call allowance and Additional Programmed Activity (APA). (D) Interim executive directors who were not paid via the Trust’s payroll. A) Remuneration Name and title 2011/12 Salary (bands of £5000) £000 Other remuneration (bands of £5000) £000 Executive directors Julia Squire, Chief Executive to 31 January 2012 Benefits in kind £000 2012/13 Salary (bands of £5000) £000 Other remuneration (bands of £5000) £000 Benefits in kind £000 155-160 0 0 0 0 0 Stephen Eames, Interim Chief Executive from 1 March 2012 (A) 0 25-30 0 0 300-305 0 Professor Tim Hendra, Medical Director to 5 August 2012 (B) 95-100 110-115 0 30-35 35-40 0 0 0 0 55-60 70-75 0 120-125 0 0 40-45 0 0 Dr Richard Jenkins, Acting Medical Director 6 August 2012, Substantive from 23 November 2012 (C) Tracey McErlain-Burns, Chief Nurse and Director of Patient Experience to 31 July 2012 (Acting Chief Executive 19 December 2011 to 29 February 2012) Kate Harper, Acting Chief Nurse and Director of Patient Experience 6 January 2012 to 29 February 2012 and Acting Director of Nursing and Quality 1 August 2012 to 14 October 2012 10-15 0 0 15-20 0 0 Helen Thomson, Interim Chief Nurse, from 15 October 2012 (A) 0 0 0 0 50-55 0 Caroline Griffiths, Interim Director of Corporate Planning & Projects, from 20 August 2012 (A) 0 0 0 0 90-95 0 Vince Doherty, Interim Finance Director 4 January 2011 to 30 September 2011 (D) 0 90-95 0 0 0 0 Robert Chadwick, Finance Director from 1 October 2011 70-75 0 0 145-150 0 0 John Watts, Interim HR Director until 31 October 2011 (D) 0 140-145 0 0 0 0 Graham Briggs, Director of Human Resources and Organisational Development from 1 November 2011 45-50 0 0 115-120 0 0 Angie Watson, Chief Operating Officer to 30 November 2011 90-95 0 0 0 0 0 Adrian Griffiths, Interim Chief Operating Officer from 1 December 2011 to 1 June 2012 (D) 0 70-75 0 0 25-30 0 Carole Langrick, Chief Operating Officer/ Deputy Chief Executive from 1 June 2012 105-110 0 0 130-135 0 0 Ruth Unwin, Director of Development, from 1 October 2010. Director of Communications and Engagement from 20 August 2012 105-110 0 0 105-110 0 0 The figure for interim directors reflects the amount reimbursed to their employer organisation rather than actual salary. 42 MY ANNUAL REPORT 2012/13 Board report Salary and pension entitlements of senior managers B) Pension benefits Name and title Real increase in pension and related lump sum at age 60 Real increase in lump sum at aged 60 Total accrued pension and related lump sum at age 60 at 31 March 2013 (bands of £2500) (bands of £2500) (bands of £5000) (bands of £5000) £000 £000 £000 Lump sum at aged 60 related to accrued pension at 31 March 2013 Cash equivalent transfer value at 31 March 2013 Cash equivalent transfer value at 31 March 2012 Real increase in cash equivalent transfer value Employers contribution to stakeholder pension £000 £000 £000 £000 £000 Executive directors Professor Tim Hendra, Medical Director 0 0 285-290 210-215 1,522 1,595 0 Dr Richard Jenkins, Acting Medical Director 6 August 2012, Substantive from 23 November 2012 2.5-5 7.5-10 155-160 115-120 628 543 56 Tracey McErlain-Burns, Chief Nurse and Director of Patient Experience to 31 July 2012 (Acting Chief Executive 19 December 2011 to 29 February 2012) 0 0 190-195 140-145 827 778 9 Kate Harper, Acting Chief Nurse and Director of Patient Experience 6 January 2012 to 29 February 2012 and Acting Director of Nursing and Quality 1 August 2012 to 14 October 2012 2.5-5 10-12.5 150-155 115-120 744 623 89 Robert Chadwick, Finance Director from 1 October 2011 0-2.5 0-2.5 255-260 190-195 1,337 1,233 40 Graham Briggs, Director of Human Resources and Organisational Development from 1 November 2011 3.5-4 11.5-12 185-190 135-140 933 789 103 Carole Langrick, Chief Operating Officer/ Deputy Chief Executive from 1 June 2012 35-37.5 25-27.5 230-235 170-175 1,036 782 176 0 0 110-115 80-85 468 435 11 Ruth Unwin, Director of Development, from 1 October 2010. Director of Communications and Engagement from 20 August 2012 The Mid Yorkshire Hospitals NHS Trust 43 Board report Pay Multiple Statement Highest paid Director’s total remuneration Median total remuneration Ratio 2012/13 2011/12 £245,000 - £250.000 £205,000 - £210.000 £25,000 - £30.000 £20,000 - £25.000 9.6 8.13 All NHS Trusts are required to disclose the relationship between the remuneration of the highest paid director in their organisation and the median remuneration of the organisation’s workforce. Total remuneration includes salary, non consolidated performance related pay, benefits in kind as well as severance payments. The median total remuneration above is the total remuneration of the staff member lying in the middle of the linear distribution of the total staff in the Trust, excluding the highest paid director. This is based on the annualised full time equivalent remuneration as at the reporting period date. The increase to the remuneration of the highest paid director reflects the changes in Trust Board personnel in 2012/13. The remuneration of the highest paid director excludes the associated charges for pension and other costs of employment which are required to be included in the remuneration report. In 2012/13 one employee received remuneration in excess of the highest paid director (three in 2011/12) and their remuneration was in the range of £245,000 to £250,000 (£205,000 to £235,000 in 2011/12). 44 MY ANNUAL REPORT 2012/13 Looking ahead Looking ahead The Mid Yorkshire Hospitals NHS Trust is putting together plans to progress towards becoming a Foundation Trust following major improvements in service and financial performance achieved during the last year. The national Trust Development Authority which regulates and supports Trusts that are not yet authorised as Foundation Trusts has categorised The Mid Yorkshire Hospitals as one of 42 organisations nationally where further work is needed to achieve sustainability and are expected to be able to achieve Foundation Trust status within three to four years. The Trust has put in place a programme of work with the aim of achieving Foundation Trust status. The Mid Yorkshire Hospitals NHS Trust 45 Looking ahead Meeting the challenge A major consultation started in March 2013 on plans to ensure our hospital services are able to provide high quality care well into the future, with results for patients becoming amongst the best in the country. The decision to go ahead with public consultation was announced by the Board of NHS Calderdale, Kirklees and Wakefield District in January. The decision was made on the basis that the chosen option would: • • • • • Help save more lives Improve outcomes of care Keep as many services local as possible Provide a first class experience for patients Contribute to financial improvement. The decision marked the culmination of an intense period of engagement work carried out in 2012 to explain the challenges to our local NHS to our wider communities. From these conversations, we were made aware of key areas of concern, such as outpatient appointments and transport. More details about the consultation, the proposals and the reasons behind them can be found on our dedicated website www.meetingthechallenge.co.uk The proposals in summary: Emergency care • Pinderfields will continue to provide consultantdelivered emergency care with full resuscitation facilities and deal with critically ill and injured patients • Both Dewsbury and Pontefract Hospitals will deliver emergency care via a mix of doctors and advanced nurse practitioners. There would also be consultants during the day and on-call as well as full resuscitation facilities available • The three hospitals will operate as an emergency care network incorporating accident and emergency departments and emergency day care services. Maternity care • Consultant-led maternity care will be centralised at Pinderfields Hospital, with midwife-led units at Dewsbury, Pontefract and Pinderfields • Antenatal (before the birth) and postnatal care (after the baby has been born) will still be provided locally at all three hospitals and in GP practices and community clinics • Neo-natal services (for very poorly and premature babies) will be located with consultant-led maternity care at Pinderfields. Paediatric care • Inpatient services for children will be centralised at Pinderfields Hospital. This includes surgery for children, which is already centralised at Pinderfields, and inpatient medical care • Dewsbury will have a short stay unit for children who may need to be observed by a clinical team for a few hours. Surgical care • Complex, emergency and major surgery (generally requiring the backup of critical care) will take place in Pinderfields • Dewsbury Hospital will provide an increased range of planned inpatient surgery (including orthopaedics from the Dewsbury area) but there will be no emergency or complex surgery • Pontefract Hospital will offer planned orthopaedic operations, including those requiring an inpatient stay and some short stay surgery from other surgical specialties. 46 MY ANNUAL REPORT 2012/13 Annual Governance Statement Annual Governance Statement All NHS provider organisations are required to produce a statement setting out the arrangements that are in place to ensure the delivery of safe services and to manage risks. The Annual Governance Statement of The Mid Yorkshire Hospitals NHS Trust is overleaf. The Mid Yorkshire Hospitals NHS Trust 47 Annual Governance Statement Scope of responsibility The Chief Executive is the Accountable Officer for the Trust and is responsible for maintaining a sound system of internal control that supports the achievement of the organisation’s policies, aims and objectives, whilst safeguarding public funds. As Accountable Officer, it is my responsibility to ensure probity and transparency in the running of the organisation in accordance with the responsibilities set out in the Accountable Officer’s Memorandum. I am personally accountable for ensuring the Trust is administered economically and that the public funds entrusted in me are deployed efficiently and effectively. The section below describes the systems that were in place during the year from April 2012 to the end of May 2013 to support decision making and manage risks. The statement is designed to provide an accurate assessment of the effectiveness of control systems which have been developed and enhanced over the course of the 12 month period. The governance framework of the organisation The Trust is governed by a Trust Board comprising six Non-Executive Directors, including the Chairman, and five Executive Directors, including the Chief Executive. In addition, the Director of Human Resources and Organisational Development attends the Trust Board in a non-voting capacity and the Director of Communications and Engagement attends public sessions of the Trust Board. The Trust Board also has two associate Non-Executive Directors who attend the Board in a non-voting capacity. The Trust Board has overall responsibility for determining the future direction of the Trust and ensuring delivery of safe and effective services in accordance with legislation and principles of the NHS. The Trust Board must also ensure the organisation complies with relevant regulatory standards. Non-Executive Directors of NHS Trusts were appointed by the Appointments Commission, which is an independent body. (This function has now been taken over by the national trust Development Authority). They are not employees of the Trust but receive remuneration for their role which is agreed nationally. Executive Directors are employees of the Trust. Details of directors’ remuneration is set out on page 42 of the Annual Report. 48 During the year there were a number of new appointments to the Trust Board. This includes the appointment of an experienced NHS Foundation Trust Chairman and Chief Operating Officer as well as recruitment of Non Executive Directors with a wide range of experience. The Trust Board members during 2012/13 were: • David Stone, Chairman until September 30th 2012 • Jules Preston, Chairman from October 1st 2012 • Terry Carter, Non-Executive Director from October 1st 2012 • Trevor Lake, Non-Executive Director from July 12th 2012 • Patricia Garbutt, Non-Executive Director from July 12th 2012 to March 31st 2013 • Rosie Valerio, Non-Executive Director from July 12th 2012 to February 4th 2013 • David Sheard, Associate Non-Executive Director from January 1st 2013 • Louise Scott, Non-Executive Director from March 1st 2013 • David Hicks, Associate Non-Executive Director from March 1st 2013 • Iain Wilkinson, Non-Executive Director to July 2nd 2012 • Jack Kershaw, Non-Executive Director to May 23rd 2012 • David Longstaff, Non-Executive Director to July 2nd 2012 • Anita Fatchett, Non-Executive Director to July 2nd 2012 • Margaret Faull, Non-Executive Director to July 2nd 2012 • Adrian Griffiths, Acting Chief Operating Officer to May 31st 2012 • Stephen Eames, Interim Chief Executive from March 1st 2012 • Carole Langrick, Chief Operating Officer/Deputy Chief Executive from June 1st 2012 • Tim Hendra, Medical Director until July 31st 2012 • Richard Jenkins, Interim Medical Director from August 6th 2012. Substantively appointed as Medical Director from November 23rd 2012 • Tracey McErlain Burns, Chief Nurse & Director of Patient Experience to July 31st 2012 • Kate Harper, Acting Director of Nursing and Quality from August 1st 2012 to October 14th 2012 • Helen Thomson, Acting Director of Nursing from October 15th 2012 • Caroline Griffiths, Interim Director of Corporate Planning and Projects from August 20th 2012. The Trust Board met 12 times during the year. MY ANNUAL REPORT 2012/13 Annual Governance Statement External review of governance An external review of governance arrangements was commissioned by the Trust in March 2012. Its recommendations included a comprehensive review of committee structures, Board development – including changes to the composition of the Board, quality of Board reports, and administration, review of arrangements for commissioning internal and clinical audit, refinement of the serious untoward incident management processes, review of processes for management of the Assurance Framework and risk register and the interface with clinical risk registers and review of policies. A comprehensive action plan was put in place to address the recommendations. Progress in delivering these actions is reflected in this statement. A detailed review of arrangements for quality governance was commissioned in January 2012 and changes to the processes for delivery, performance management and Board assurance will be introduced during 2013. Trust Board committees This section describes the committee structure which was established following the external review of governance. This structure will be streamlined as a result of the changes recommended following the review of Quality Governance. There were six committees in place during 2012/13 which carried out functions delegated to them by the Trust Board and seek assurance on behalf of the Board. These committees report directly to the Trust Board. The role of the committees and a summary of issues considered by the committees are detailed below: The Audit Committee The Audit Committee reviews and provides assurance on the systems of internal control, including financial controls. The Audit Committee membership is made up of NonExecutive Directors. Executive Directors attend the committee to present information. The Audit Committee met 5 times during the year. Issues considered by the committee included: • • • • • Internal audit plan and progress reports Internal audit reports and recommendations External audit updates External audit reports and recommendations Counter Fraud policy and legislation and investigations • Accounting procedures and issues • Governance developments and the system of internal control The Mid Yorkshire Hospitals NHS Trust • Process for developing the Assurance Framework and risk register • Tender exceptions • Losses and special payments. The Finance Committee The Finance Committee provides assurance on the development and delivery of the financial plans, including cost improvements. The Finance Committee is chaired by a Non-Executive Director and its membership includes NonExecutive and Executive Directors. The Finance Committee met 10 times during the year. The major focus of the committee during the year has been to provide oversight to the development and delivery of cost improvement plans. In addition the committee also considered plans for capital investment, property disposal, performance against contract and delivery of CQUIN targets and the on-going operational management of the PFI agreement. The committee has also been involved in reviewing the development of financial plans for 2013/14. The Quality and Clinical Governance Committee The Quality and Clinical Governance Committee provides assurance on matters relating to quality, clinical safety and patient experience as well as the adequacy of systems for governing quality and risk. The Quality and Clinical Governance Committee is chaired by a Non-Executive Director and its membership includes Non-Executive and Executive Directors and is attended by the divisional clinical directors and the governance leads of the three clinical divisions. The frequency of Quality and Clinical Governance committee meetings was increased in response to the governance review and the committee met 9 times during the year. The committee routinely considers matters relating to quality and patient safety, including performance against quality account priorities, relevant strategies and policies, clinical incidents, complaints and patient experience reports, safeguarding issues, morbidity and mortality rates and compliance with mandatory training requirements. In addition, the committee has received assurance in relation to the following issues: • Progress in delivering improved hospital mortality rates • Medicines safety • Trust response to risks associated with hip implants • Improvements in the outpatient booking system to address risks to patient safety and patient experience. 49 Annual Governance Statement The Remuneration and Terms of Service Committee The Remuneration and Terms of Service Committee approves the appointment of Executive Directors. The committee also sets remuneration and terms of services for Executive Directors and agrees the framework for remuneration of other senior staff and clinicians. Membership of the Remuneration and Terms of Service Committee is made up exclusively of Non-Executive Directors and Executive Directors have no involvement in determining their own remuneration. The Remuneration and Terms of Service Committee met 6 times during the year and considered the following matters: • • • • Directors’ Appraisals and remuneration Mutually Agreed Resignation Scheme applications Review of the Executive Director structure Appointment of Executive Directors. The Risk Management Committee The Risk Management Committee was established in July 2012 and is an executive committee chaired by the Chief Executive. Its principal role is to oversee delivery of the risk management strategy, to take an overview of the risk management agenda and ensure a strategic approach to the management and mitigation of corporate and clinical risks and ensure effective coordination and performance management. The Risk Management Committee reviews the content of the risk register and Assurance Framework and agrees follow up action. The committee has reviewed arrangements for updating the clinical, directorate and corporate risk registers The Workforce and Organisational Wellbeing Committee The Workforce and Organisational Wellbeing committee was established in December 2012 as a result of review of internal controls which gaps in control to support delivery of key objectives in the Assurance Framework. The Clinical Executive Group The Clinical Executive Group is the key executive body responsible for implementing the strategic direction set by the Trust Board and for ensuring clinical, service and financial performance in line with local and national standards. The Clinical Executive Group is chaired by the Chief Executive and met monthly. Its membership included the Medical Director, the Chief Nurse, the Chief Operating Officer, the Finance Director, the Director of Human Resources, the Director of Corporate Planning and Projects, the Director of Commissioning, Performance and Informatics, the Director of Communications, the Divisional Clinical Directors, and Associate Directors of Operations for the Clinical Service Groups whose role is set out below. The Clinical Divisions are responsible for the operational delivery of services, ensuring service and financial performance standards specific to their service are delivered. The Clinical Service Groups are led by a Divisional Clinical Director, an Associate Director of Operations and an Associate Director of Nursing. The divisional structure has been reviewed during 2012/13 and there are now three Clinical Divisions responsible for integrated care, medicine and surgery. A mapping exercise was undertaken with support of Internal Audit to review the groups which support operational delivery and performance monitoring and their reporting arrangements and further work is planned to review and clarify performance management and assurance arrangements following the independent review referred to above. The Charitable Funds Committee In addition to the formal committees of the Board referred to above, the Trust Board acts as Trustee to the Charitable Funds for the organisation and has established a Charitable Funds Committee with delegated authority to manage the charitable funds on its behalf. The committee is chaired by a Non-Executive Director and its membership is made up of Executive Directors and staff with responsibility for workforce development and wellbeing. The role of the committee is approve key workforce strategies and policies on behalf of the Trust Board and provide assurance to the Trust Board in relation to workforce, organisational wellbeing and organisational development and the governance of key workforce risks. 50 MY ANNUAL REPORT 2012/13 Annual Governance Statement Compliance with the Code of Governance The Board is bound by the Code of Governance which requires NHS Trust Boards to exercise the same standards of governance that apply to all private and public sector organisations. This means that Trust Board members must work together and take collective responsibility for the performance of the organisation, including financial, service and clinical performance. Not all of the agreed objectives were fully delivered in-year, indicating a need to improve the effectiveness of the process for setting deliverable objectives and the controls that are in place for monitoring delivery. The Trust Board operates as a unitary Board. This means that all Board members work as equals to act in the best interests of the organisation. Board administration has been reviewed during the year and new arrangements have been put in place for preparing and distributing agenda and papers, maintaining a comprehensive record of meetings and decisions, ensuring appropriate referral of matters between the Board and committees and ensuring decisions. The presentation and content of papers is generally good. Corporate objectives The Trust Board agreed that the priorities for the year were: • • • • • The Trust Board has exercised its duty to monitor delivery against these objectives and the overall performance of the Trust through the integrated performance reports that it receives at each meeting. • • • • The Trust Board has maintained a strong focus on clinical governance, ensuring that clinical safety has not been compromised by the financial pressures facing the organisation and has applied a range of mechanisms to assess clinical quality and patient experience, including developing a patient safety dashboard to supplement other reports on quality indicators, service performance, patient experience and introducing director led clinical safety walk rounds. • The Trust Board meets the criteria set out in the Code of Governance in relation to independence of Non-Executive Directors. Board members have confirmed their commitment to abide by the Standards of Business Conduct for NHS Directors. A Board development programme is in place and has included induction and orientation of new members, facilitated workshops on the role of the unitary board, Quality Governance, development of the Trust’s response to the Francis report and development of the corporate objectives and annual plan. Board members have also attended external events linked to individual development needs. A 360 degree appraisal process has been undertaken by all Board members to support the development programme. There are clear committee structures and the responsibilities of individual committees are set out in their terms of reference and the Scheme of Delegation. The Standing Orders follow the model standing orders for NHS Trusts and are complied with. The Mid Yorkshire Hospitals NHS Trust To improve clinical effectiveness and safety To improve patient experience To achieve national and local access targets To be the employer of choice and maintain a skilled and motivated workforce To meet planned financial performance targets and deliver value for money To meet regulatory standards To determine the strategic direction of the Trust To ensure our communities receive better healthcare To invest in buildings that meet the best environmental and sustainability standards To ensure our culture and practice aligns with public sector equality legislation. The risk and control framework The system for managing and mitigating risk is set out in the Trust’s risk management policy and strategy which was refreshed in July 2012. The strategy provides a systematic approach to the anticipation, prevention, mitigation and management of risk across all areas of the Trust’s business. It is based upon the principles laid down in legislation, government guidance and industry best practice. The systems of control are designed to offer assurance to the Trust Board and external bodies that risks are being managed effectively. Risk is identified through a variety of mechanisms. A comprehensive system is being rolled out to report, record and analyse incidents. In addition the Trust uses performance reports, data analysis and patient feedback to assess and anticipate risks. Work has taken place to improve the performance management regime and the timeliness and quality of performance data in the Trust during the year. 51 Annual Governance Statement Risk registers are held at clinical service group and corporate directorate level and work has continued with support from the Trust’s Internal Auditors to develop arrangements for feeding risks identified at an operational level into a Trust wide corporate risk register. The process for ensuring effective interface between the clinical and divisional risk registers, the corporate risk register and the Board Assurance Framework is coordinated through the Risk Management Committee. The corporate risk register identifying the key risks to delivery of the Trust’s objectives has been revised during the year. The Assurance Framework and Risk Register are reviewed by the Trust Board at regular intervals throughout the year. The Assurance Framework identifies potential risks to delivery of the Trust’s strategic objectives, internal and independent sources of assurance and gaps in control and assurance. Throughout the year Internal Audit has liaised closely with the Trust with regard to its Assurance Framework and has concluded that the methodology surrounding the design and operation of the framework is sound and that the process is well embedded within the organisation. The Trust Board takes assurance and advice on risk avoidance from external sources including the Care Quality Commission, NHS Litigation Authority and the West Yorkshire Internal Audit Consortium and Counter Fraud services. Public stakeholders are able to provide feedback on the Trust’s services in a variety of ways. The Trust seeks feedback from service users through surveys, patient involvement groups and public involvement activities. Representatives of the Trust also meet regularly with MPs, representatives of Kirklees and Wakefield Local Involvement Networks (LINKs) and Overview and Scrutiny Committees (OSC) and with local authority members. The Trust takes a proactive approach to communications and holds regular briefings with the media. There has also been a comprehensive programme of engagement with the public to support the development of a strategy for reconfiguration of clinical services as well as a formal engagement exercise overseen by the joint OSC to seek views on proposed changes to the organisation of ophthalmology, orthopaedic surgery and neuro-rehabilitation services. Risk assessment Analysis of risks is carried out using a recognised tool which assesses the likelihood and potential impact of a risk manifesting and the key controls in place to manage and mitigate risk. A number of risks were identified during the year. These are recorded on the Trust’s risk register which reflects the following risks and mitigating action: 52 • The absence of a clearly articulated vision for the future of the organisation which is being addressed through a comprehensive approach to financial and performance recovery, work to determine the future configuration of services, development of supporting strategies and regular dialogue with the National Trust Development Authority. Formal consultation took place from March to May on proposed changes to clinical service configuration which will be reflected in the strategic plan concluded in May 2013 • Maintaining safe services and compliance with regulatory requirements: action plans have been developed to ensure compliance with CQC and NHSLA standards and these are complemented by routine checks and safety walk rounds, standard operating procedures and escalation arrangements • Ability to deliver cost improvements and identify further cost improvements for 2013/14, mitigated by a robust financial planning regime including granular, quality assured CIP plans for 2012/13 which have been delivered and development of plans using a similar process for 2013/14 • Competing pressures in the system affecting quality and patient experience mitigated through review of the systems and processes to ensure quality governance, review of arrangements for dealing with and learning from complaints and robust arrangements for following up on CQC visits • Ability to develop a clinically and financially sustainable model of service which is being addressed through a comprehensive review of configuration of hospital services supported by a joint health and social care programme to strengthen models of care closer to home • Fitness of IT systems, which is being addressed through the implementation of an IM&T strategy, overseen by a senior level steering group • Ability to secure public confidence in services, which is being addressed through a communication strategy jointly delivered with NHS commissioners, to support clinical service reconfiguration, communications plans associated with specific issues, regular media briefing and through development of a staff engagement strategy • Ability to recruit and retain a workforce with the necessary capacity and capability and to maintain motivation through a period of significant change. This is being addressed through a workforce plan, application of agreed arrangements for managing change, strengthened monitoring of workforce targets, action plans to address issues identified through the staff survey, and policy review • Absence of a strategic estates plan, mitigated by a review of estates and facilities functions, review of arrangements for reviewing and reporting environmental risks and development of a prioritised plan for estates development and maintenance. MY ANNUAL REPORT 2012/13 Annual Governance Statement Review of the effectiveness of risk management and internal control • Discharge Management: Internal Audit was commissioned to review the Trust’s Discharge Management processes. The main issue related to the need to use the expected date of “medically fit for discharge” as a key driver in the discharge process. A programme of work is being developed to address this. The Trust has worked closely with Internal Audit in developing the risk management framework. The Head of Internal Audit has concluded that the system of internal control in place during 2012/13 offered significant assurance. This is based on the range of work undertaken as part of the annual Internal Audit plan, including assessment of the Board Assurance Framework and an assessment of the range of individual opinions arising from risk-based audit assignments, contained within Internal Audit reports throughout the year. This assessment takes account of the relative materiality of these areas and the improved performance in terms of addressing identified weaknesses in control. • Car Park Follow Up: Internal Audit was commissioned to follow up previous recommendations made in relation to ensuring that all staff employed by third party organisations were paying for their car parking permits. The audit found that the Trust had taken steps to identify all third party staff with Trust car parking permits. Invoices had been sent to third party organisations to recover back payments. However, there appeared to have been a lack of agreement with third party organisations regarding the Trust’s intention to raise charges for permits and the amounts to be charged. As a result, a significant proportion of payments were in dispute. Internal audit issued 8 limited assurance reports during the year. These related to: • Business Continuity: Internal audit acknowledged that Business Continuity arrangements were being redeveloped at the Trust but noted that the newly formed Resilience Forum (RF) had not yet established a formal work plan and clear reporting lines for reporting progress against this work plan to the Clinical Executive Group. Internal audit also recommended that the Resilience Forum needed to take a robust hold on Business Continuity matters and ensure that divisional and directorate plans were developed and were reviewed to ensure compatibility and consistency. • Locum Doctors: this was a follow up to a previous report relating to booking of locum doctors and preappointment checks. Whilst there was evidence of improvement, issues remained regarding recording of identity checks and local induction. Weekly checks to ensure compliance with policy were introduced in November and Internal Audit have confirmed this checking process is now embedded. • Clinical Risk: this audit was undertaken at a time when the Trust’s risk management processes were under review. Significant work had been undertaken to improve corporate and divisional governance structures and processes were still being refined. The limited assurance related to the need for the Quality and Clinical Governance Committee to ensure its assurance requirements. This has now been actioned. • Auto Enrolment Pension Scheme: Internal Audit found that the Trust had developed a project group and liaised with staff groups to assess the impact of the Pensions Act 2008 ahead of the April 2013 implementation date. The lmited assurance opinion was based on the absence of a project plan identifying the remaining tasks to be done and responsibility for delivering these. A plan has now been developed. • Lease Cars: a limited assurance opinion was issued relating to the need for more robust contract management arrangements with South West Yorkshire Partnerships NHS Foundation Trust in relation to the administration of the car leasing and salary sacrifice scheme. The Mid Yorkshire Hospitals NHS Trust • CQC Compliance: Internal audit recommended that the arrangements for senior management oversight of CQC related issues at the Trust required greater clarity and that a formal framework should be put in place to set out the assurance requirements required by the Board via QCGC and to assess how the QCGC will obtain these assurances. The Audit Committee has also sought assurance on the Trust’s clinical audit arrangements, which are being reviewed as part of the broader programme to refine Quality Governance arrangements. The strategic position of the Trust has been strengthened through the work done to develop a proposal for service configuration that is clinically and financially sustainable and through delivery of recovery plans for financial and service performance. The improvements in relation to financial and service performance and Hospital Standardised Mortality Rates (HSMR) reflect the strengthened controls that have been put in place and their effectiveness. 96.1% of people attending the Trust’s A&E departments during the year were seen within four hours. The Trust also achieved the 18 week for complete pathways (90.7% against a target of 90% for admitted patients and 96.3% 53 Annual Governance Statement against a target of 95% for non-admitted pathways). The trust also achieved all targets in relation to referral to treatment for cancer and incomplete pathways for the year. The Trust is working towards achievement of level one in relation to the NHSLA risk management standards. In the period April 2012 – March 2013 the Care Quality Commission (CQC) carried out ten inspections at the Trust. Dewsbury Hospital 10 April 2012 – follow up visit to check improvements had been made following previous visits in 2011 and 2012 in relation to: • Care and welfare of people who use services – compliance action required in relation to maternity and midwifery services • Staffing – standard being met. CQC confirmed action to address compliance notice issued in February 2012 had been taken • Assessing and monitoring the quality of service provision – standard being met. Dewsbury Hospital 3 July 2012 – follow up visit to check improvements had been made following previous visits in 2011 and 2012 in relation to: • Respecting and involving people who use services – enforcement action taken • Care and welfare of people who use services – standard being met • Cooperating with other providers – standard being met • Staffing – compliance action required to ensure sufficient qualified and experienced staff to meet people’s needs • Complaints – compliance action required based on evidence that the standard had not been met over the year although action to address this was noted. Dewsbury Hospital 12 November 2012 – confirmed compliance with all core standards. 54 Pinderfields Hospital 5 September 2012 – inspection of the day surgical ward when used as extra capacity during periods of high demand. • Respecting and involving people who use services – compliance action required • Care and welfare of people who use services – standard being met • Cleanliness and infection control – compliance action required • Safety and suitability of premises – enforcement action taken to ensure compliance with this standard in relation to. Pinderfields Hospital 12 and 13 November 2012 • Respecting and involving people who use services – standard being met • Care and welfare of people who use services – compliance action required • Cooperating with other providers – standard being met • Cleanliness and infection control – standard being met • Safety and suitability of premises – standard being met • Staffing – standard being met • Assessing and monitoring the quality of service provision – standard being met • Complaints – standard being met. Pontefract Hospital 12 November 2012 • Respecting and involving people who use services – standard being met • Care and welfare of people who use services – standard being met • Cooperating with other providers – standard being met • Cleanliness and infection control – standard being met • Staffing – standard being met • Assessing and monitoring the quality of service provision – standard being met • Complaints – standard being met. Dewsbury Hospital 21 and 28 February 2013 • Assessing and monitoring the quality of service provision action required. Subsequent visit confirmed the Trust had taken satisfactory action to address this. Queen Elizabeth House, Wakefield (intermediate care service) – fully compliant. Pinderfields Hospital 4 July 2012 • Respecting and involving people who use services – standard being met • Care and welfare of people who use services – standard being met • Staffing – standard being met • Complaints – compliance action required to meet this standard. Where issues were identified by the CQC, the Trust has put in place robust action plans to ensure compliance and that learning is disseminated to other areas. For each of the 16 essential outcomes there is a lead who will review the compliance with the relevant standard and develop actions if required. An internal CQC self assessment tool has been developed and this is used to undertake CQC style inspections on inpatient wards. The CQC internal inspections are led by the associate directors of nursing and the findings reported to the divisional boards. MY ANNUAL REPORT 2012/13 Annual Governance Statement Gaps in assurance identified in the Assurance Framework Quality Governance and Quality Accounts The Assurance Framework identified some areas where there were gaps in control or where the Board had not received adequate assurance. Issues not covered elsewhere in this statement included: An independent assessment of Quality Governance arrangements was commissioned by the Trust and concluded in April 2013. This has identified potential areas for improvement and actions have been taken to address the issues identified. A further assessment has been postponed and will take place as part of the Trust’s wider programme of work to develop governance systems that are consistent with the approach adopted by Foundation Trusts. • Delays in responding to complaints and lack of focus on learning lessons • Issues regarding demand management in ophthalmology • Lack of evidence of the positive impact of demand management initiatives in the wider health and social care system • Failure to achieve the national target for MRSA due to 8 cases being reported against a target of 7. This was an improvement on the previous year when there were 11 cases of MRSA. There have been 8 serious untoward incidents reported to the Strategic Health Authority compared with 11 in 2011/12 and no ‘never events’. The main categories of serious incidents during 2012/13 were slips, trips and falls, pressure ulcers, staffing levels, administration or supply of medication; and ‘Other’. Incident data, themes and trends are routinely reviewed by the Quality and Clinical Governance Committee. A weekly Patient Safety Panel has been established to focus on avoidance of incidents and review of lessons learned. There have been 54 data protection incidents compared with 55 in the previous year. The Trust is achieving level two compliance with the Information Governance Toolkit. The Mid Yorkshire Hospitals NHS Trust The Trust identified five priorities in the 2012/13 Quality Accounts: • Improve systems and processes to further reduce mortality rates: nationally validated data on mortality levels shows that of the three main measures in use, the Trust is better than average on two measures and average on the third. The Trust’s Hospital Standardised Mortality Rate was 96 compared with 108 the previous year • Improve patient safety by implementing the safety thermometer: objectives in relation to the safety thermometer were set in the quality account for the 2012/13 period. The Trust achieved 85% harm free care. Falls reduced by 1.07% and pressure ulcers reduced by 3.18% • Improve the diagnosis and care of patients with dementia: the Trust is actively engaged in multi agency arrangements to develop pathways for dementia. This includes screening of patients, staff training, development of patient held records for use by all agencies and participation in the national dementia audit. The Trust was able to demonstrate improvement in the national dementia audits and dementia care remains a priority for 2013/14 • Improve compliance with best practice guidelines and prevent hospital acquired infections: the Trust achieved 100% compliance with its target to screen all elective patients but failed to achieve 100% screening of non-elective patients. The Trust failed to achieve the national target for hospital acquired MRSA but has maintained above average performance in relation to management of C Difficile with 39 cases against a target of 78 • Improve outpatient scheduling, bookings and communications with patients: as a result of actions implemented through the Outpatient Improvement Programme, significant improvements against an agreed set of indicators. However, the target was not achieved as the proportion of cancelled appointments was 5.7% against a target of 5%. 55 Annual Governance Statement Significant issues The Trust is driving a major hospital service reconfiguration programme designed to secure clinically and financially sustainable services. This will include development of Pinderfields Hospital as the major acute site with Dewsbury and Pontefract Hospitals providing a wide range of local services for people with less acute or complex health needs and being developed as centres of excellence for planned care and rehabilitation. The Trust ended the year with a deficit of £21.8m against a planned deficit of £26m. This was in line with the Trust’s agreement with NHS North of England. During 2012/13 the Trust received £12.5m cash support from the Department of Health as part of its agreed 2012/13 financial plan. This cash support enabled the Trust to maintain its payments to staff and suppliers and ensured that the Trust was able to meet the Department of Health’s target that at least 95% of all suppliers are paid by the invoice due date or within 30 days of receipt of an invoice. The Department of Health set a national target in 2011 that all NHS Trusts must achieve Foundation Trust status by 2014. At the time it was anticipated that those organisations that were unable to achieve this were likely to be merged or acquired by existing Foundation Trusts. The Trust has been working with the Department of Health and latterly with the national Trust Development Authority to assess the future direction of the organisation, having confirmed that Foundation Trust authorisation by 2014 was not achievable. A decision is expected on whether the Trust can progress to Foundation Trust within an extended timescale. The Trust has submitted a comprehensive operating plan to the Trust Development Authority setting out its priorities for 2013/14. Internal audit opinion The Head of Internal Audit has issued an opinion giving significant assurance in relation to the risk and control systems in place during 2012/13. The Trust has experienced three episodes of industrial action relating to the major workforce re-profiling exercise that is underway. There is also evidence that this is impacting on staff morale and motivation as evidenced in the 2012/13 staff opinion survey which placed the Trust in the bottom 20% nationally in relation to staff recommending the Trust as a place to work or receive treatment, motivation at work, staff reporting errors, near misses or incidents and agreeing that incident reporting procedures are fair and effective, staff having well structured appraisals. The scale of the challenges facing the Trust require on-going effort to manage the reputational impact and secure staff and public confidence. The Trust launched its Making it Better Together programme in 2012 to encourage staff to identify opportunities for efficiency improvement. Further work being developed under the ‘Making it Better’ banner includes development of a behaviours framework to ensure staff throughout the organisation promote the Trust’s vision and values, tackling underlying cultural causes of underperformance and unsatisfactory patient experience. The Trust also launched the Friends and Family test in March – one month ahead of the national launch and has established a public stakeholder forum to act in an advisory capacity to the Trust Board, providing a direct interface between the organisation and the communities it serves. A similar forum is planned for staff representatives. 56 MY ANNUAL REPORT 2012/13 Financial report Financial report The Mid Yorkshire Hospitals NHS Trust 57 Financial report Financial Overview 2012/13 We achieved three of our four Statutory Financial Duties: • We managed our capital expenditure within approved limits • We managed our cash within approved limits • We achieved a 3.5% on capital employed. In 2012/13 we agreed a financial plan with the Strategic Health Authority which provided for a deficit of £26m. The plan took into account our financial position brought forward from 2011/12, and the requirements of the 2012/13 NHS Operating Framework. Within our plan we provided for a cost reduction programme of £23.2m which covered the 4% national cost efficiency requirement that all Trusts were required to deliver and 1.4% to cover local pressures and reduce the impact of the financial challenge brought forward from 2011/12. Looking forward to 2013/14 We also secured £10m of transitional support from the local health economy. Our plan also identified a requirement for cash support from the Department of Health to ensure that payments to our staff and our suppliers could be maintained. Our financial challenge will continue into 2013/14 and we have agreed a financial plan with NHS Trust Development Authority which provides for a deficit of £20.7m for 2013/14. At the end of 2012/13 we have: • Delivered an in year deficit of £21.839m, an improvement against our plan of £4.161m. The £21.839m is after agreed Department of Health technical accounting adjustments charged to our operating expenses and the impact of a change in accounting treatment for donated assets. Excluding these adjustments the deficit is £36.855m. The Department of Health measures the Trust against the £21.839m. This improved position is due to the tight financial controls implemented in 2012/13 and some under spending against additional monies provided to the Trust in year • Delivered in year savings of £23.435m, an improvement against our plan of £0.235m • Our work force has reduced from 6,823.29 whole time equivalents on 1st April 2012 to 6,518.40 whole time equivalent staff on 31st March 2013. The reduction also includes a number of vacancies some of which will be recruited to during 2013/14 • We received cash support of £12.5m from the Department of Health and we maintained our payments, fully achieving the Department of Health’s target that 95% of our suppliers are paid by the invoice due date or within 30 days of receipt of the invoice. 58 The impact of our planned deficit was that we failed the financial duty of breaking even taking one year with another. In agreeing our financial plan, it was recognised by the Strategic Health Authority and Department of Health that we would not achieve this financial duty in 2012/13. Our forecast deficit takes into account our financial position brought forward from 2012/13 and the requirements of the 2013/14 NHS Operating Framework. Within our forecast we have plans to reduce our costs by £25.3m. These plans are to cover the 4% national cost efficiency requirement that all Trusts are required to deliver and to reduce the impact of the financial challenge brought forward from 2012/13. All of our savings schemes will be assessed for the impact on patient safety and patient experience by our Medical Director and Chief Nurse. In our 2013/14 plan we have identified that we will require £28m of cash support to from the Department of Health enable us to maintain our payments to staff and suppliers. We have also secured £3.9m of transitional support from the local health economy and NHS England. Recognising the financial challenge that we have faced in 2012/13 and face again in 2013/14 we are continuing to work closely with our commissioners and the NHS Trust Development Authority to develop a financial plan for our Trust which supports the future provision of sustainable clinical services. MY ANNUAL REPORT 2012/13 Financial report Statement of Comprehensive Income 2012/13 Capital Expenditure 2012/13 In 2012/13 we invested £15.588m in our healthcare facilities and equipment. This can be found on page 62. Revenue Total revenue in 2012/13 amounted to £461m, of which, revenue from patient care activities was £422m with other operating revenue of £28.5m and £10m in respect of transitional support. The majority of our revenue comes from Primary Care Trusts - £431m (94%). Following the reconfiguration of the NHS on 1st April 2013, this income in future will be contracted from Clinical Commissioning Groups, NHS England and Local Authorities. Expenses Our operating expenses excluding financing costs were £483m and the largest element of this is the pay bill for our staff of £301m (62%). Also included within the operating expenses was a charge of £14.9m for the impairment of the value during the year that Clayton Hospital and Pontefract Southside were being held in our accounts at. This reflects the impact of these sites being closed in year and being accounted for as non operational. The Department of Health classes impairments as a technical item and adjusts for them when calculating the Trust’s financial performance for the year. Financing costs We incurred financing costs of £15m, £11m of which is derived from the PFI unitary payment under the PFI accounting requirements and £3m is the Public Dividend Capital Dividend which is paid to the Department of Health. £4.417m was invested in maintaining and improving our facilities, £2.621m in replacing our Information Technology equipment and developing our systems and £8.550m in new medical equipment. This investment was made across all three of our hospital sites and our community services. £0.140m of the investment in new medical equipment was from charitable sources. In 2013/14 we plan to spend £13.664m on maintaining, replacing and developing our healthcare facilities and equipment. We anticipate that £0.5m of this expenditure will be funded through donations and the remainder will be funded internally. Pages 57 to 69 record the summarised financial statements for the financial year 2012/13. A full set of the accounts is available on the Trust’s website at www.midyorks.nhs.uk or by writing to us at the address on the back page of this report. Please note a glossary of terms is included at the end of the summarised financial statements for ease of reference. External Auditors Grant Thornton UK LLP was the Trust’s external auditors in 2012/13. The cost of the work undertaken by Grant Thornton UK LLP was £124,763 (net of VAT). This was for audit services in relation to the statutory audit and the quality accounts. Auditing standards require the directors to provide the external auditors with representations on certain matters material to their audit opinion. The board has confirmed and provided assurance via a statement of representation to its auditors that there is no information relevant to the audit that they are aware of that has not been made available to the auditors. Directors have taken all steps necessary to make themselves aware of any relevant audit information and established that the auditors are aware of that information. Robert Chadwick Director of Finance 24 May 2013 The Mid Yorkshire Hospitals NHS Trust 59 Financial report Statement of Representation Independent Auditors’ Report We have examined the summary financial statement for the year ended 31 March 2013 the Statement of Comprehensive Income, the Statement of Financial Position, the Statement of Changes in Taxpayers’ Equity and the Statement of Cash Flows. This report is made solely to the Board of Directors of The Mid Yorkshire Hospitals NHS Trust in accordance with Part II of the Audit Commission Act 1998 and for no other purpose, as set out in paragraph 45 of the Statement of Responsibilities of Auditors and Audited Bodies published by the Audit Commission in March 2010. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the Trust’s directors and the Trust as a body, for our audit work, for this report, or for opinions we have formed. Respective responsibilities of directors and auditor 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 statement within the Annual Report 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 statement. We conducted our work in accordance with Bulletin 2008/03 “The auditor’s statement on the summary financial statement in the United Kingdom” issued by the Auditing Practices Board. Our report on the statutory financial statements describes the basis of our opinion on those financial statements. Opinion In our opinion the summary financial statement is consistent with the statutory financial statements of The Mid Yorkshire Hospitals NHS Trust for the year ended 31 March 2013. We have not considered the effects of any events between the date on which we signed our report on the statutory financial statements 24 May 2013 and the date of this statement. Paul Dossett Senior Statutory Auditor, for and on behalf of Grant Thornton UK LLP No 1 Whitehall Riverside Whitehall Road Leeds LS1 4BN 9 September 2013 60 MY ANNUAL REPORT 2012/13 Financial report Chief Executive’s responsibilities The Chief Executive of the NHS has designated that the Chief Executive should be the Accountable Officer to the Trust. The relevant responsibilities of Accountable Officers are set out in the Accountable Officers Memorandum issued by the Department of Health. These include ensuring that: • there are effective management systems in place to safeguard public funds and assets and assist in the implementation of corporate governance; • value for money is achieved from the resources available to the Trust; • the expenditure and income of the Trust has been applied to the purposes intended by Parliament and conform to the authorities which govern them; • effective and sound financial management systems are in place; and • annual statutory accounts are prepared in a format directed by the Secretary of State with the approval of the Treasury to give a true and fair view of the state of affairs as at the end of the financial year and the income and expenditure, recognised gains and losses and cash flows for the year. To the best of my knowledge and belief, I have properly discharged the responsibilities set out in my letter of appointment as an Accountable Officer. Stephen Eames Chief Executive 24 May 2013 The Mid Yorkshire Hospitals NHS Trust 61 Financial report Statement of Comprehensive Income for the year ended 31 March 2013 2012/13 £000 2011/12 £000 422,270 412,444 Income in respect of transitional support 10,000 14,000 Other operating revenue 28,522 29,510 0 1,000 Gross employee benefits (301,145) (291,802) Other costs (166,995) (168,803) Impairments (14,870) 18,816 Operating surplus/(deficit) (22,218) 15,165 78 88 (27) (145) Finance costs (11,555) (11,582) Surplus/(deficit) for the year (33,722) 3,526 Public dividend capital dividends payable (3,133) (3,129) Retained surplus/(deficit) for the year (36,855) 397 0 (13,355) 9,273 6,832 (27,582) (6,126) (36,855) 397 0 (21,607) 14,870 2,082 146 (89) (21,839) (19,217) 66 (220) Revenue from patient care activities Income in respect of PFI transitional support Investment revenue Other gains and (losses) Other comprehensive income Impairments and reversals Net gain/(loss) on revaluation of property, plant & equipment Total comprehensive income for the year Financial performance for the year Retained surplus/(deficit) for the year 2011/12 - IFRIC 12 adjustment including IFRIC12 impairments Impairments (excluding IFRIC12 in 2011/12) Adjustments for donated/government grant reserve elimination Adjusted retained surplus/(deficit) PDC dividend: balance receivable/(payable) at 31 March A NHS Trust’s reported NHS financial performance position is derived from its retained surplus/(deficit), but adjusted to take into account items which the Department of Health do not consider to be part of the organisation’s financial performance. In 2012/13 the Trust was required to adjust for the impairment of £14.870m and the impact of the donated/government grant reserve elimination of £0.146m. In 2011/12 the Trust was also required to adjust for the revenue benefit of accounting for the Trust’s PFI assets on the balance sheet (required under International Financial Reporting Standards). This adjustment is not required from 2012/13 onwards. 62 MY ANNUAL REPORT 2012/13 Financial report Statement of Financial Position as at 31 March 2013 31 March 2013 £000 31 March 2012 £000 442,182 456,743 3,084 1,447 0 226 445,266 458,416 8,717 8,336 16,029 17,300 Non-current assets: Property, plant and equipment Intangible assets Trade and other receivables Total non-current assets Current assets Inventories Trade and other receivables 2,587 3,506 27,333 29,142 3,233 1,138 30,566 30,280 475,832 488,696 (36,655) (30,882) Provisions (9,208) (5,304) Borrowings (7,452) (7,192) Capital loan from Department of Health (1,000) (1,000) Total current assets/(liabilities) (54,315) (44,378) Net current assets/(liabilities) (23,749) (14,098) Non-current assets plus/less net current assets/liabilities 421,517 444,318 0 (237) (6,305) (6,499) (320,488) (326,776) (11,500) (12,500) (338,293) (346,012) 83,224 98,306 Cash and cash equivalents Total current assets Non-current assets held for sale Total current assets Total assets Current liabilities Trade and other payables Non-current liabilities Trade and other payables Provisions Borrowings Capital loan from Department of Health Total non-current liabilities Total Assets Employed: Financed by taxpayers' equity: Public Dividend Capital Retained earnings Revaluation reserve Other reserves Total Taxpayers' Equity: The Mid Yorkshire Hospitals NHS Trust 146,490 133,990 (127,086) (103,421) 61,135 65,052 2,685 2,685 83,224 98,306 63 Financial report Statement of changes in taxpayers’ equity for the year ended 31 March 2013 Public Dividend Capital Retained earnings Revaluation reserve Other reserves Total reserves £000 £000 £000 £000 £000 133,990 (103,421) 65,052 2,685 98,306 Retained surplus/(deficit) for the year 0 (36,855) 0 0 (36,855) Net gain/(loss) on revaluation of property, plant & equipment 0 0 9,273 0 9,273 Impairments and reversals 0 0 0 0 0 Transfers between reserves 0 13,190 (13,190) 0 0 New PDC received 19,500 0 0 0 19,500 PDC repaid in year (7,000) 0 0 0 (7,000) Net recognised revenue/(expense) for the year 12,500 (23,665) (3,917) 0 (15,082) 146,490 (127,086) 61,135 2,685 83,224 11,605 (11,605) 133,990 (106,578) 74,335 2,685 104,432 Retained surplus/(deficit) for the year 0 397 0 0 397 Net gain/(loss) on revaluation of property, plant & equipment 0 0 6,832 0 6,832 Impairments and reversals 0 0 (13,355) 0 (13,355) Movements in other reserves 0 0 0 0 0 Transfers between reserves 0 2,760 (2,760) 0 0 Net recognised revenue/(expense) for the year 0 3,157 (9,283) 0 (6,126) 133,990 (103,421) 65,052 2,685 98,306 0 0 Changes in taxpayers’ equity for the year ended 31 March 2013 Balance at 1 April 2012 Balance at 31 March 2013 Included above: Transfer from revaluation reserve to retained earnings in repect of impairments 0 Changes in taxpayers’ equity for the year ended 31 March 2012 Balance at 1 April 2011 Balance at 31 March 2012 Included above: Transfer from revaluation reserve to retained earnings in repect of impairments 64 0 MY ANNUAL REPORT 2012/13 Financial report Cash Flow Statement for the year ended 31 March 2013 2012/13 £000 2011/12 £000 (22,218) 15,165 Cash flows from operating activities Operating Surplus/(Deficit) Depreciation and Amortisation 19,817 19,595 Impairments and Reversals 14,870 (18,816) 0 (235) (11,559) (11,562) (3,419) (2,788) (Increase)/Decrease in Inventories (381) (401) (Increase)/Decrease in Trade and Other Receivables 1,563 1,704 Increase/(Decrease) in Trade and Other Payables 4,423 (2,427) (1,974) (1,828) Donated Assets received credited to revenue but non-cash Interest Paid Dividend (Paid)/Refunded Provisions Utilised Increase/(Decrease) in Provisions 5,534 3,652 Net Cash Inflow/(Outflow) from Operating Activities 6,656 2,059 78 87 (12,008) (6,303) (664) (67) 977 486 (11,617) (5,797) (4,961) (3,738) Public Dividend Capital Received 19,500 10,400 Public Dividend Capital Repaid (7,000) (10,400) Loans repaid to DH - Capital Investment Loans Repayment of Principal (1,000) (1,000) Capital Element of Payments in Respect of Finance Leases and On-SoFP PFI (7,458) (7,157) 0 234 Net Cash Inflow/(Outflow) from Financing Activities 4,042 (7,923) Net Increase/(Decrease) in Cash and Cash Equivalents (919) (11,661) Cash and Cash Equivalents (and Bank Overdraft) at beginning of the period 3,506 15,167 Cash and Cash Equivalents (and Bank Overdraft) at year end 2,587 3,506 Cash flows from investing activities Interest Received (Payments) for Property, Plant and Equipment (Payments) for Intangible Assets Proceeds of disposal of assets held for sale (PPE) Net Cash Inflow/(Outflow) from Investing Activities Net cash inflow/(outflow) before financing Cash flows from financing activities Capital grants and other capital receipts The Mid Yorkshire Hospitals NHS Trust 65 Financial report Staff Sickness absence Total days lost Total staff years Average working days lost 2012/13 number 2011/12 number 76,683 77,417 7,062 6,450 11 12 Better Payment Practice Code – Measure of compliance 2012/13 number 2012/13 £000 2011/11 number 2011/12 £000 Total Non-NHS Trade Invoices Paid in the Year 71,547 126,206 76,494 124,400 Total Non-NHS Trade Invoices Paid Within Target 68,003 121,415 72,854 119,363 Percentage of Non-NHS Trade Invoices Paid Within Target 95.0% 96.2% 95.2% 96.0% Total NHS Trade Invoices Paid in the Year 2,950 38,859 2,921 32,884 Total NHS Trade Invoices Paid Within Target 2,865 38,764 2,826 32,610 97.1% 99.8% 96.7% 99.2% Non-NHS Payables NHS Payables Percentage of NHS Trade Invoices Paid Within Target The Better Payment Practice Code requires the Trust to aim to pay all valid invoices by the due date or within 30 days of receipt of a valid invoice, whichever is later. 66 MY ANNUAL REPORT 2012/13 Financial report Exit Packages agreed in 2012/13 2012/13 2011/12 Number of compulsory redundancies Number of other departures agreed Total number of exit packages by cost band Number Number Number Number of compulsory redundancies Number of other departures agreed Total number of exit packages by cost band Number Number Number Exit package cost band (including any special payment element) Less than £10,000 1 67 68 2 1 3 £10,001 - £25,000 2 95 97 2 0 2 £25,001 - £50,000 3 45 48 1 0 1 £50,001 - £100,000 7 10 17 0 0 0 £100,001 - £150,000 4 1 5 0 0 0 £150,001 - £200,000 1 0 1 0 0 0 Total number of exit packages by type 18 218 236 5 1 6 1,402 4,413 5,815 95 3 98 Total resource cost (£000s) This note provides an analysis of Exit Packages agreed during the year. Redundancy and other departure costs have been paid in accordance with the provisions of the NHS Scheme. Where the Trust has agreed early retirements, the additional costs are met by the Trust and not by the NHS Pensions scheme. Ill-health retirement costs are met by the NHS Pensions scheme and are not included in the table. As part of the Workforce Transformation Programme the Trust has run two MARs schemes in 2012/13 which have been fully approved by the Strategic Health Authority. Of the 236 exit packages agreed, 197 are as a result of these schemes. This disclosure reports the number and value of exit packages taken by staff leaving in the year. Note: The expense associated with these departures may have been recognised in part or in full in a previous period. The Mid Yorkshire Hospitals NHS Trust 67 Financial report Accounts of our Charitable Fund Statement of financial activities for the year ended 31 March 2013 Unrestricted funds £000 Restricted funds £000 Endowment funds £000 Total funds 2012/13 £000 Total funds 2011/12 £000 153 81 234 18 26 278 24 24 11 35 - 153 105 258 18 37 313 204 561 765 20 50 14 849 1 1 - - 1 1 - Charitable activities: Land and buildings Purchase of medical equipment Refurbishment 33 216 - 263 - - 33 479 - 39 336 51 Staff education and welfare Patient welfare and Amenities 40 145 4 2 - 44 147 113 109 Sub total direct charitable expenditure 434 269 - 703 648 Governance costs Total resources expended 13 448 4 273 - 17 721 20 668 (170) (238) - (408) 181 - - - - (170) (238) - (408) 181 Incoming resources Incoming resources from generated funds: Voluntary income: Donations Legacies Sub total voluntary income: Fundraising events Investment income Other incoming resources Total incoming resources Resources expended Costs of generating funds: Fundraising costs Sub total costs of generating funds Sub total: Net (outgoing) / incoming resources before transfers and other recognised gains and losses Transfers: Gross transfers between funds Net (outgoing) / incoming resources before other recognised gains and losses Other recognised gains and losses: Realised and unrealised gains/ (losses) on investment assets 79 30 - 109 132 (91) (208) - (299) 313 Total Funds brought forward 2,040 842 5 2,887 Total Funds carried forward 1,949 634 5 2,588 2,574 2,887 Net Movement in funds Reconciliation of Funds 68 MY ANNUAL REPORT 2012/13 Financial report Charitable Fund balance sheet as at 31 March 2013 Unrestricted funds £000 Restricted funds £000 Endowment funds £000 Total funds at 31 March 2013 £000 Total funds at 31 March 2012 £000 Investments 1,012 384 - 1,396 1,287 Total Fixed Assets 1,012 384 - 1,396 1,287 17 3 - 20 55 1,183 461 5 1,649 1,449 97 37 - 134 607 1,297 501 5 1,803 2,111 (37) (4) - (41) (201) Net Current assets 1,260 497 5 1,762 1,910 Total assets less current liabilities 2,272 881 5 3,158 3,197 Provisions for liabilities and charges (323) (247) - (570) (310) Net assets 1,949 634 5 2,588 2,887 Permanent Endowment funds - - 5 5 5 Restricted income funds - 634 - 634 842 Unrestricted income funds: 1,949 - - 1,949 Total charity funds 1,949 634 5 2,588 2,040 2,887 Fixed assets: Current assets: Debtors Short term investments and deposits Cash at bank and in hand Total Current Assets Liabilities: Creditors falling due within one year The funds of the charity: The Mid Yorkshire Hospitals NHS Trust 69 Glossary Glossary Capital NHS North of England Land, premises and equipment. The regional Strategic Health Authorities are the main link between the Department of Health and the NHS. They are responsible for ensuring that all NHS organisations work together to deliver modern, high quality patient-centred services. Capital expenditure Spending on land, premises and equipment. This includes works to provide, adapt, renew, replace or demolish buildings, items or groups of equipment and vehicles. In the NHS, any spending which is more than £5,000 and where the item has a life of more than one year is classified as capital. Depreciation The measure of the wearing out, consumption or other loss of value of property, plant or equipment whether arising from use, passage of time or obsolescence through technology and market changes. External Financial Limit The External Financing Limit (EFL) is a fundamental element of the NHS Trust’s financial regime. It is a cash based public expenditure control set by the Department of Health and a Trust’s access to all sources of external finance. The EFL represents the excess of its approved level of capital spending over the cash that a Trust can generate internally (mainly surpluses and depreciation). Private Finance Initiative (PFI) The use of private finance in capital projects, particularly in relation to the design, construction and operation of buildings and support services. Commissioners Commissioners is a term used to cover those organisations who commission services from NHS Trusts or other providers. Primary Care Trusts (PCTs) were the main commissioners in the NHS in 2012/13. Statement of Comprehensive Income The statement of comprehensive income is the International Financial Reporting Standards (from 2009/10 all public bodies including NHS prepare their accounts using these) equivalent of the income and expenditure account/statement of total gains and losses (UK GAAP). Impairments Statement of Financial Position Impairments generally relate to property, plant and equipment and represent the loss of value of these below that recorded in the accounts of an organisation. Impairment occurs because something has happened to the property, plant or equipment itself or to the economic environment in which it is used. The statement of financial position is the International Financial Reporting Standards equivalent of the balance sheet (UK GAAP). A previous impairment may reverse when an asset which has previously fallen in value and been impaired is now valued at a value higher than that recorded in the accounts. The Department of Health does not count an impairment or reversal of impairment against NHS Trust’s financial performance and classes these as technical in nature. 70 MY ANNUAL REPORT 2012/13 Notes The Mid Yorkshire Hospitals NHS Trust 71 Telephone 0844 811 8110 If you need this annual report in a different language, large print or braille please contact us on 01924 543635 and we will make arrangements for you. This report is also available to download at www.midyorks.nhs.uk ents to the pati Thank you who were ies and famil d or gave interviewe r their pictures fo permission r this Report, as fo to be used any members m e th who well as shire staff rk o Y id M uction. of g its prod n ri u d d e help Jeżeli potrzebują Państwo kopi tego sprawozdania rocznego w innym języku, wydrukowanej dużym drukiem lub w alfabecie Breille’a, prosimy skontaktować się z nami dzwoniąc na numer: 01924 543635, przygotujemy dla Państwa taką kopię. 01924 543635 01924 543635 Design: MY design – The Mid Yorkshire Hospitals NHS Trust | MYd 78674 The Mid Yorkshire Hospitals NHS Trust Pinderfields Hospital Aberford Road Wakefield WF1 4DG