Annual report and accounts 2014/15

Transcription

Annual Report and Accounts
for the year ended 31 March 2015
Basildon and Thurrock University Hospitals NHS Foundation Trust
Annual Report and Accounts for the year ended 31 March 2015
Presented to Parliament pursuant to Schedule 7, paragraph
25(4)(a) of the National Health Service Act 2006.
Contents
Section
Content
Page
1
Chairman and Chief Executive’s Statement
2
Strategic Report
13
Trust Profile and history
13
Our Services
13
The environment we operate in
14
Operating Review
14
Managing our performance
14
Achieving national standards
14
Principles risks and uncertainties
16
Underlying trends
18
Financial performance
18
Our Staff
21
Staff Survey
27
Sustainability Report
30
Strategic Plan 2014/15 – 2018/19
31
Going Concern
32
Director’s Report
35
Board of Directors
35
How our Foundation Trust is run
40
Role of the Board of Directors
41
Ensuring high standards of governance
41
How the Board operates
42
Board Committee Structure
43
How we evaluate performance of the Board and its Committees
50
3
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Section
4
Content
Page
The Council of Governors
53
The role of the Council of Governors
53
Composition of the Council of Governors
55
Meetings of the Council
58
Making appointments
59
Keeping governors informed and involved
60
Membership
63
The role of Members
63
Building our membership
63
Improvements for Patients and Staff
71
Listening and Responding to Stakeholders
71
Stakeholder relations
72
Health and Safety
73
Countering Fraud and Corruption
74
7
Foundation Trust Code of Governance
77
8
Background Information
79
Accounting Policies
79
Prompt Payment for Suppliers
79
Internal Auditors
80
External Auditors
80
Fixed Assets
80
Political and Charitable Donations
80
Cost allocation and charging requirements
80
Post balance sheet events
80
Financial instruments
81
Pensions and Retirement Benefits
81
Director’s Register of Interests
81
Remuneration report
83
Regulatory Report
95
5
6
9
10
Section
10
Content
Quality Report 2013/14
Page
97
Appendix 1: Statement from Directors
144
Appendix 2: Statement from Stakeholders
146
Appendix 3: External Auditors Report to Council of Governors of BTUH on
Annual Quality Report
161
11
Statement of Accounting Officer’s Responsibility
165
12
Annual Governance Statement
167
13
Accounts for Year ended 31 March 2015
183
Foreword to the Accounts
185
Independent auditor’s report to the Board of Governors of
186
Statement of Comprehensive Income
193
Statement of Financial Position
194
Statement of Changes in Taxpayers Equity
195
Statement of Cash Flows
196
Notes to the Accounts
197
1 Chairman and Chief Executive’s statement
It is interesting to note that, of the more than
130 hospital inspections that the CQC has
undertaken since the new inspection regime
started at the end of 2013, around a third have
been graded as good or outstanding, with the
majority requiring improvement or inadequate.
This gives a clear picture of the distance we
have travelled relative to our peers in recent
years, and reflects the hard work of everyone
who works in the Trust. We would like to thank
them all for their collective efforts in helping us
achieve this result.
It has been a year of mixed fortunes for the
Trust, with good news about the quality of
services we provide but, in common with the
majority of other acute trusts in the country,
increasing demand for our emergency services
and an escalating financial challenge to be
addressed, not just today but also in future
years.
Improving quality of services
Last year’s Annual Report highlighted the
progress that was being made throughout the
Trust in improving the quality of our services to
patients, although at the time we were in special
measures and awaiting the outcome of a full
inspection by the Care Quality Commission
(CQC) that had taken place in March 2014. The
CQC finalised their report in June 2014 and
graded the Trust as ‘good’ overall. This grading
reflects the fact that we were not perfect, with
further work needed in certain areas. But they
also recognised that in other areas we were
performing exceptionally well, with our maternity
services being graded as ‘outstanding’. Overall,
the review confirmed the progress the Trust has
made, and we were delighted with the result.
Increasing demand for emergency
services
While the quality of our services has been
improving, this has come at a cost. The number
of people working at the Trust has increased in
the last two years. This increase is partly the
result of a review of the level of nursing staff
we employed which indicated that more nurses
were required to help address our quality
issues. The extra staff also reflects the cost of
meeting increasing demand for our services,
particularly in the area of emergency treatment,
which grew by 4.1% in 2014/15, following an
increase of 5.6% the previous year. We also
opened two new wards over this period to meet
demand.
The outcome of the inspection meant that the
Trust was released from special measures
shortly thereafter, the first Trust placed in
special measures in 2013 to have their
improvement recognised in this way. The CQC
returned in March 2015 to follow-up on areas
that they had identified required improvement
and, at the time of writing, we await their report.
The seasonally higher level of emergency
demand we see in winter did not decrease
much during summer 2014 and, like the
majority of acute trusts across the country,
our hospital services were under considerable
pressure in the first months of 2015. A key part
of coping with this demand is not just our ability
to see people promptly when they first arrive
at A&E, but finding a bed for those who need
to be admitted. Considerable effort goes into
ensuring timely discharges from hospital to free
up bed spaces, but more needs to be done, not
As an example of our improvement, our
mortality indicator, SHMI, has improved from
1.17 in October 2012 to 1.03 in the year to
September 2014, the most recent period for
which published figures are available. This
shows that we have moved from being a
significant outlier to being within expected limits.
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just by ourselves, but also in collaboration with
the wider health sector in our part of the county.
We would like to pay tribute to the front-line
staff, who have kept the hospital operating at
the high standards we expect at this time of
unprecedented demand.
These factors alone cost us around £8million.
Added to this was the failure to achieve all the
cost reduction initiatives we set ourselves for
the year, although we did achieve 75% of our
planned savings - £13million. We were unable
to reduce the proportion of staff employed
on agency contracts by as much as we had
planned due to supply issues for medical staff
and delays in registering nurses recruited from
overseas. Finally, there were a number of oneoff costs last year that were not foreseen at the
time the budget was prepared.
Worsening financial position
We had expected to incur an operating deficit
in 2014/15 of around £6.5million when we
prepared our budget in March last year. But
as the year progressed it became increasingly
obvious not only that our result was going to
be significantly worse than this, but also that
our cash reserves, which had started the year
at £20.6million, would run out in March 2015.
In the end, our final result for the year was a
deficit of £23.8million and we ended the year
with cash balances of £10.7million, but only
after we had received a loan of £10.6million
from the Department of Health.
The consequence of our unplanned deficit and
our need for financial support within the year
was that Monitor launched an investigation into
our financial position towards the end of 2014,
following which they found us to be in breach
of our licence in February 2015. In response to
this finding, we have given Monitor a number
of undertakings. They include the delivery
of our financial forecast for 2015/16 and an
agreement to commission two reviews, the
first of our financial governance arrangements
and the second of what would need to change
for the Trust to return to a position of long
term financial sustainability. The Trust has
been actively engaged in meeting all of its
undertakings.
There are several reasons why our position
was worse than planned but a major factor is
that we have had to react to significant changes
in the demand for our services that were not
anticipated. They included:
z a higher demand for emergency services,
where our incremental income does not cover
the extra costs we incur in providing the
services;
Looking to the future
Our financial forecast for 2015/16 indicates
that an even larger deficit of £38million is
likely on present trends and that further
additional funding will be required. The
financial governance review, undertaken by
the professional services company, Grant
Thornton, is being finalised and changes in our
internal arrangements recommended by this
review are being actioned. The sustainability
review is underway and will report shortly. This
z a consequent reduction in planned
admissions to ensure we had beds available
for emergency admissions, with the loss of
income from those planned admissions;
z the cost of outsourcing some work to meet
target times for referral to treatment and
government waiting list initiatives, costs
which we were not fully reimbursed to us by
our commissioners.
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of Directors, not least in the appointment of
Clare Panniker as Chief Executive. He won the
confidence of stakeholders, helping to lay the
ground for the Trust’s improving reputation as it
addressed its quality issues, and strengthened
the engagement between the Board and the
Trust’s Governors, making the Council of
Governors more effective as it took on new
responsibilities for holding the Board to account.
On behalf of everyone involved with the Trust,
we pay tribute to his achievements and thank
him for all he has done.
is a key piece of work which aims to identify
what we can improve ourserves by being more
efficient, what improvements we can achieve
in collaboration with others in the local health
economy, and to what extent there is now a
structural element in our deficit beyond that
which can be fixed by the first two areas. All of
these issues will need to be addressed to bring
the increasing deficit under control.
We have not waited for the outcome of the
sustainability review before addressing
opportunities in the wider system. October
2014 saw the start of a joint venture between
the Trust, Southend University Hospital NHS
Foundation Trust and an independent sector
partner, iPP (Integrated Pathology Partnerships)
which is now running the pathology services
that the two Trusts used to run in-house. While
the change was cost-neutral in 2014/15, it
will bring benefits in future years, both from
efficiency savings within the joint venture and
from the opportunity for it to win more business
elsewhere in the region.
We are delighted to welcome Nigel Beverley as
our new Chairman who joined the Trust in May
2015 and will take up position on a substantive
basis at the beginning of July.
In February 2015, Anne-Marie Carrie resigned
as a Non-Executive Director on being appointed
to a new role in the health sector. Anne-Marie
had been a director for three years and with
her background in children’s services, made
a valuable contribution as a member of the
Quality and Patient Safety Committee. We wish
her well in her new role.
We will be looking for opportunities with our
neighbouring acute trusts to improve services
for patients across the sector.
Changes to the Board of Directors
June 2015 marks the end of Bob Holmes’ term
of office as a Non-Executive Director, a time
which concluded with Bob taking on the role of
Acting Chairman until Ian Luder’s successor
could be appointed. The Board would like
to acknowledge the tremendous personal
contribution Bob Holmes has made for more
than eight years as a Non-Executive Director
and more recently as acting Chair.
For most of the year under review, Ian Luder
was Chairman of the Trust. Ian stepped down
from that role in January 2015 on announcing
his intention to stand for election to Parliament.
In the time since his appointment in 2012,
Ian played a key role in reshaping the Board
There were also a number of changes to the
Executive Director team during 2014/15, which
are detailed in the Directors section of in this
report and the board would like to thank them
for their service to the Trust and wish them well
for the future.
Finally, we are alert to the opportunities to
work more closely with community providers to
improve pathways of care as well as avoiding
expensive delays by treating people on a timely
basis in the most appropriate setting.
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With the changes to the Executive and
Non-Executive Director teams, a number of
responsibilities have been reallocated to other
directors and the Board will therefore operate
with two fewer directors in future.
This report showcases a very busy, but
rewarding, year where we have been
recognised for significant improvements to the
services we deliver to our patients. We look
forward to building on this hard work in the
year ahead, as we work towards improving the
Trust’s financial position in the context of the
findings from the Sustainability Review and
system-wide initiatives.
Bob Holmes
Acting Trust Chairman
27 May 2015
Clare Panniker
Chief Executive
27 May 2015
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2 Strategic report
The Annual Report and Accounts 2014/15 have been prepared under the direction issued by
Monitor under the National Health Service Act 2006.
Our services
Introduction to the Trust
We provide an extensive range of acute
healthcare services at Basildon and Orsett
Hospitals, plus x-ray and blood testing facilities
at the St Andrew’s Centre in Billericay.
Trust profile and history
In April 2004, the Trust was authorised as
one of the first ten NHS foundation trusts in
the country. Foundation status gives us more
control over how we spend our money and plan
our services. We remain firmly part of the NHS
and are subject to NHS standards, performance
ratings and inspections.
We primarily serve the 410,000 population
of south-west Essex covering Basildon and
Thurrock, together with parts of Brentwood
and Castle Point. We also continue to provide
dermatology services from seven sites across
the south Essex area.
The Trust has a Council of Governors with
local, elected public and staff governors and
appointed stakeholder governors. The Council
of Governors is responsible for holding the
Board of Directors to account through the NonExecutive Directors and for the appointment
of the Chairman and Non-Executive Directors.
The Trust has a duty to consult and involve
the governors in the strategic plans of
the organisation. The governors act as a
communications channel for our foundation
trust members, ensuring their views are
represented when important decisions are
taken about services and the future direction of
the organisation.
The Essex Cardiothoracic Centre is part of the
Trust and provides a full range of specialist
cardiothoracic services for the whole county
and further afield.
With a budget of over £293million, in 2014/15
the Trust treated 88,000 inpatients and day
cases, provided nearly 325,000 outpatient
consultations and attended to 126,900 A&E
patients.
The extensive programme of investment
in hospital services has continued during
2014/15, with changes to a number of facilities
designed to improve patient flow through
the hospital, particularly for those attending
as emergencies. These have included the
relocation of the discharge lounge to a larger
area, work to establish a medical day unit and
the development of a paediatric assessment
unit co-located with the children’s emergency
department.
The Trust is regulated and licensed by Monitor,
the independent regulator of foundation
trusts and is registered with the Care Quality
Commission (CQC) for the services we provide.
The Trust’s main purpose continues to be the
provision of healthcare. There have been no
significant changes in the range of services
provided during 2014/15, but many quality
improvements have been made which are
detailed in the Quality Report (see page 97).
During the year we also established a
pathology joint venture, with Southend Hospital
and iPP. The new organisation, Pathology First
will secure a modernised pathology service for
south Essex, providing high quality diagnostic
and interventional care.
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The environment we operate in
3. Deliver a balanced mix of planned and
emergency services – with an initial focus
on reducing waiting times in areas such as
orthopaedics, and improving services for
local people.
NHS Basildon and Brentwood Clinical
Commissioning Group and NHS Thurrock
Clinical Commissioning Group were the
Trust’s main commissioners of services during
2014/15, with cardiothoracic services and
renal dialysis commissioned by specialist
commissioners, hosted by NHS England.
4. Work with other providers and
commissioners to provide effective
care and strengthen our role in the local
community.
Operating Review
5. Be an excellent employer that recruits
and develops excellent staff and leaders
– with an initial focus on seven day services,
developing knowledge and skills and finding
solutions to the hard to recruit specialities.
This section reviews how we have performed
over the past year, and highlights the risks and
uncertainties facing the Trust.
Managing our performance
6. Provide value for the taxpayer by
continuously improving productivity –
with an initial focus on the full use of Orsett
Hospital and the effective use of technology
to enhance patient care.
Every year, the Board of Directors agrees
objectives and how it will be measured to
review Trust performance. These measures
are developed into key performance indicators
and monitored monthly throughout the
year. In setting these measures, the Board
takes account of the views of the governors,
staff, regulators and the priorities of both
commissioners and NHS England, and sets
indicators that best fit these priorities.
In addition, a suite of local measures were
agreed for reporting against other key areas,
including staffing matters, environmental
matters and finance.
Achieving national standards
Local and national priorities and measures:
The Trust is committed to achieving the national
standard requirements each year as set out
in our contract with the clinical commissioning
groups (CCGs). These replicate the
requirements from Monitor and NHS England
and apply to all providers of health services.
More information on these is provided in the
Quality Report, page 97.
The Board of Directors agreed six key
objectives with measures for monitoring
progress for 2014/15:
1. Deliver high quality acute care – with
an initial focus on developing seven day
services and putting patients on the best
treatment pathway through early clinical
assessment
2. Provide more services out of hospital –
with an initial focus on reducing the need for
hospital admissions and reducing length of
stay for frail, elderly and respiratory patients.
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needed a short hospital admission, on an
outpatient or ambulatory care basis may have
artificially increased length of stay slightly.
Targets achieved
There were some areas of significant
improvement in 2014/15:
z Performance against the national cancer
targets has been generally good all year.
A root cause analysis is completed for
each breach of these standards in order
to determine the cause and what remedial
action could be taken. In most cases, the
patient has declined to be treated within the
timescales and, as this is their choice, the
Trust is limited in what action can be taken.
The number of patients referred to be seen
within two weeks has risen to unprecedented
levels, which has been challenging to
manage. The Trust is working with partner
organisations to identify the cause and
solutions to this.
z Crude mortality has remained below the
expected rate for the year as a whole.
z The two nationally recognised mortality
indicators remained within normal limits
throughout the year.
z There has been a 16% reduction in the
number of complaints received during the
year, possible as a result of the introduction
of duty of candour during the complaint
process.
z The introduction of the Electronic Patient
Record (EPR), reported last year has
embedded well and all initial concerns have
been resolved. Work is now on-going to
implement additional modules which will
support clinical decision-making in the Trust,
e.g. Order Communications).
z Performance against the Quality Indicators
for Accident and Emergency has not been
as good this year as previously. The Trust
did not achieve the target of 95% of patients
seen and admitted or discharged within four
hours, caused by the significant increase
in both A&E attendances and emergency
admissions.
Targets not achieved
z Six cases of MRSA bacteraemia have been
attributed to the Trust in the year and two of
these have been agreed as contaminants.
z The Trust’s financial performance has not
been as good as expected. We have ended
the year in deficit of £23.8million, despite
making savings of over £13million. Further
details of the financial performance are
provided later in this section and can also be
found in the Annual Accounts at page 183.
z There were 36 cases of Clostridium Difficile
against a target of 18 cases. All cases were
reviewed with the CCG and no lapses of care
were identified.
z Staff turnover has increased to 14.9% for
the year. It should be noted that this includes
staff who have transferred under TUPE
arrangements to other organisations.
z Reductions in length of stay for both elective
and non-elective patients were not achieved
again this year, although it is recognised that,
treating patients who previously would have
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have been undertaken to help mitigate this
risk but recruitment remains challenging,
with persistent vacancies in some hard to
recruit to specialties. The Trust is working
with Anglia Ruskin Univeristy to establish
new roles which may help to reduce these
vacancies with different staff.
Principal risks and uncertainties
At the beginning of each financial year, the
Board of Directors agrees, in consultation
with staff and governors, the key objectives
and priorities for the year. Through the Board
Assurance Framework (BAF), the Trust then
identifies the highest risks that might prevent
the achievement of the key service priorities
or disrupt service continuity. The Board
of Directors reviews these risks regularly
throughout the year and amendments and
additions made when necessary.
Looking forward to 2015/16, the Trust is aware
of a number of uncertainties which may impact
on the delivery of services in a safe, effective
and economic way. These include:
z The Trust’s financial situation at the end of
the year, ending with a larger than planned
deficit and the assumptions the annual plan,
require the achievement of a significant
level of cost improvement plans (over 6% of
budget each year) and increased efficiency
and productivity. To deliver this level of
savings while protecting the quality of care
provided to patients, the Trust needs to look
to innovative and more cost effective ways of
providing care. This may lead to opportunities
to expand services or, conversely, service
reduction.
During 2014/15, the principal risks identified
through the BAF have included:
z The potential impact of increasing emergency
activity and demand on our ability to deliver
consistent, high quality and safe services
to patients. This risk was mitigated by
opening an additional 14 inpatient beds,
further changing the way Basildon University
Hospital is managed in the evening and at
weekends and by working closely with our
partners in social care and the community to
provide streamlined care across the services.
z The national strategy to implement new
models of healthcare provision may offer
opportunities not previously considered by
the Trust.
z The deteriorating financial position during
the year following significant investment in
schemes designed to improve the quality
of care provided at our hospitals, including
additional staff, equipment and changes
in clinical practice. A cost improvement
programme was developed which resulted in
a high level of savings but was not sufficient
to offset the overspend.
There were also three areas that we considered
to be high-risk activities during 2014/15, based
on the previous year’s performance. These
were emergency care, financial performance
and achievement of the 18-week referral to
treatment standards. The following paragraphs
describe how we have improved the care and
treatment provided to patients, and pathways of
care.
z The potential impact on our ability to provide
high quality care caused by difficulties in
recruiting staff to key clinical areas in the
Trust, including the emergency and critical
care departments. Targeted recruitment
events and innovative recruiting practices
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z Increasing the number of conditions that
could be treated on a day case or ambulatory
basis, reducing the need for hospital
admission.
Emergency Care performance
The Trust continued to experience exceptional
growth in demand for emergency services
during the year, with attendances to A&E
increasing at a rate of over 7% and emergency
admissions rising to in excess of 28,600. This
has placed considerable pressure on Trust
services and has necessitated increasingly
innovative ways of managing demand.
z Implementing a number of best practice
treatment programmes for patients.
Examples of this include the management of
acute kidney injury and sepsis and severe
sepsis.
Evidence of the improvement made is now
available in the standard hospital mortality rates
(SHMI), which is 1.03 and within expected limits
for the 12 months to September 2014 (the most
recent published data).
Despite the increase in bed capacity at
Basildon Hospital in 2013/14, we needed to
increase and re-align our bed capacity again
this year to respond to demand. To that end, a
further 14 beds were commissioned in October
2014. The discharge lounge has been relocated
to allow for the development of ambulatory care
and improved assessment of children in the
emergency department, and work continues on
the frail elderly ward and the medical day unit.
Referral to Treatment (RTT) performance
The past year was challenging for delivery
against the 18 week RTT standard. Nationally,
there was a change in guidance and
approaches to reducing ‘backlog’ which meant
that there was a national “planned” breach
of these standards in order to treat as many
patients who had waited over 18 weeks as soon
as possible. This change was challenging for
frontline staff, especially the medical teams.
Despite this, the Trust has made steady
progress during the year and average waiting
times have reduced. Data integrity has greatly
improved with a lot of effort made in ensuring
that our data is accurate. 2015/16 will see
further improvements with a move towards
speciality level compliance meaning that all of
our specialities will be delivering to the national
18 week standard.
These last two changes have been greatly
delayed due to the need to maintain a higher
number of hospital beds to safely manage
the increased number of patients requiring
admission to hospital. However, completion
and use of these areas is anticipated to now
take place in 2015.
It was recognised that merely providing
additional beds would not be sufficient to meet
the increased demand for services and so the
clinical management teams made a number of
changes to streamline the movement of patients
through the hospital to discharge home. These
have included:
z Changing the shift patterns of nursing staff to
improve continuity of care.
z Increasing the numbers of medical staff in
key specialities.
z Increasing the number of services providing
care on a 24/7 basis.
17
In 16 of the 19 clinical speciality areas provided
by the hospital, length of stay is above the
national average.
Underlying trends affecting the delivery
of health services
The local health economy context in south west
Essex is challenging. Basildon and Brentwood
CCG and the Trust have a deficit for 2014/15,
are predicting deficits for 2015/16 and have
challenging cost improvement plans for the next
two years. This may negatively impact on the
ability of both organisations to invest to improve
patient services.
In response to these trends, the Trust
has a clinical strategy, which will drive
the development needed in local services
to respond to the predicted changes in
demographics and increases in demand.
The key focus of this strategy is to develop
and deliver high quality healthcare services,
which are available 24/7 and which are able
to respond flexibly to local demand. It focuses
on the those areas where the Trust is known to
be outside of national averages and plans to
establish alternative pathways for patients, not
all of which will be in hospital.
Locally there is a higher than average
prevalence of chronic obstructive pulmonary
disease (COPD), asthma, and obesity, whilst
social deprivation indicators including low levels
of academic attainment are worse than the
national average and surrounding areas. In
common with many parts of the country, the
increasing health and social care needs of an
ageing population are highlighting a lack of
system integration across the area.
Financial performance 2014/15
The Trust experienced a very difficult year,
posting a deficit of £23.8million on a turnover
of £294million. The original plan for the year
was a deficit of £6.5million, but by mid-year it
became apparent that the financial plan had
not made sufficient provision for the challenging
operational environment; excessive increases
in emergency demand, growing waiting lists,
reductions in elective work and a hardening
labour market. Each of these factors pushed
the Trust finances to the limit.
The needs of an ageing population continue to
influence Trust development and performance.
As in many areas of the country, the proportion
and number of elderly residents in our area
continues to have a significant impact on
demand for our services.
Population forecasts indicate that the health
economy can expect a 13% increase in the
number of people aged over 75 years by 2018
– a real term increase of 4,000 people. The
underlying demand for health and social care
services is predicted to rise by 10-15% over
the next five years, with an increasing number
of older people, and more frail patients with
multiple co-morbidities. In 2014/15, 28% of
all emergency admissions were people aged
over 78 years and admissions for pneumonia,
influenza and chronic obstructive pulmonary
disease (COPD) were in the top 25% nationally
with higher than average standardised deaths.
As the scale of the problem became apparent
during the autumn of 2014, improved controls
were introduced to seeks to curb revenue
spending and discretionary capital expenditure
deferred to minimise cash outflow. As a result
of the deteriorating position, the Trust was
investigated and deemed by the regulator to be
in breach of its licence. It was also necessary
for the Trust to apply for a £10.6million revolving
working capital facility from the Department
of Health in March 2015 to support the cash
position.
18
£15.2million. After allowing for interest payable
and other financing costs of £6.9million, down
from £7.2million, the overall deficit increased to
£23.8million.
During 2013, the Board of Directors had made
a conscious decision to commit significant
investment in the quality of care it provided to
patients and capacity. Since 2013, the Trust
has invested in more than 400 new staff and
over 100 inpatient beds, including escalation
areas. As a direct result of this investment and
management action the Trust was the first of
the 11 ‘Keogh trusts’ to emerge from special
measures in June 2014. This heavy investment
has flowed through to the current year but
without a proportionate increase in income.
The savings planned through the Trust’s cost
improvement programme (CIP) were £17million
of which £13million was delivered. Not all of
these savings were cashable.
Capital expenditure amounted to £8.6million.
This was £3million lower than the original plan
due to cost avoidance and slippage because of
delays in building works (as wards were being
used to increase capacity).
The need to meet core targets, specifically the
referral to treatment (RTT) targets, meant that
significant activity was either outsourced to
the independent sector or additional payments
were made to staff to undertake work outside
normal hours.
The cash balance at 31 March 2015 was
£10.7million, (£20.6million on 31 March 2014).
The balance this year includes £10.6million
working capital support received from the
Department of Health in March 2015. Therefore
the underlying cash position represents a
reduction of £20.5million (100%) from a year
earlier.
In summary, the 2014/15 deficit was driven by
the following main factors:
z previous investment in quality and safety
z agency staffing premium costs
As a consequence of the deterioration in
financial performance in 2014/15 the Trust
finished the year with a Continuity of Services
Risk Rating (CoSRR) of ‘1’ at 31 March 2015.
For an explanation on CoSRRR, see Section
10.
z RTT targets – outsourcing and additional
payment to staff
z cost improvement slippage
z unfunded activity and income challenges by
commissioners
Licence breach – enforcement
undertakings
Income from operations for the year was
£294.4million, up £6million (2%) on 2013/14,
reflecting the increase in the number of patients
treated, offset by a reduction in the tariff the
Trust receives for each patient seen.
In November 2014 Monitor undertook an
investigation into the Trust and concluded that
there were reasonable grounds to suspect that
the Trust was in breach of its provider licence
in respect of its sustainability and financial
governance, namely, an unplanned financial
deficit, an unplanned CoSRR 1 and the
requirement for distressed funding.
Related expenses including depreciation
were higher at £311.4million, up £21.2million
(7.3%) due to the reasons outlined above. This
caused an operating deficit of £17million in the
year, compared with a deficit of £1.8million in
2013/14, an adverse swing, year-on-year, of
19
Monitor was prepared to accept enforcement
undertakings (section 106 of the Health &
Social Care Act 2012) from the Trust to secure
a return to compliance with the relevant licence
conditions.
The report will be considered by the Board of
Directors and an action plan will be developed
and agreed with Monitor for implementation.
Monitor’s Provider Regulation Executive met
on 11 February 2015 to agree the enforcement
undertakings. These were signed by the acting
Chair on 18 February and by Monitor’s Chief
Executive on 24 February. The undertakings
were published on 27 February. Monitor’s
Enforcement Undertakings cover five main
areas:
Looking forward to 2015/16 the Trust has
submitted, to Monitor, a financial plan for an
income and expenditure deficit of £38million, on
a turnover of £289million.
Looking forward to 2015/16
Monitor will assess the impact of the financial
plan on both revenue and capital resources
to determine the level of section 42 interim
support, i.e. cash loans, that the Trust will
require. Monitor will apply to the Department of
Health for the interim support, on behalf of the
Trust.
z Sustainability
z Financial governance
z Distressed funding
The 2015/16 plan is underpinned by a cost
improvement programme of £12million. The
underlying run rate coming into the financial
year was a deficit of more than £2million
per month. After allowing for the impact in
the reduction to the tariff (income), pay and
price inflation, pay increments and other cost
pressures such as the premium for the clinical
negligence scheme for trusts (CNST), the
financial challenge is significant.
z Reporting
z General (governance)
Financial Governance Review
The Enforcement Undertakings required the
commissioning by the Trust of a Financial
Governance Review in accordance with scope
agreed by Monitor.
The review, which commenced in March 2015,
examined the following areas:
In April 2015, Monitor commenced a
10-week sustainability review, to examine both
the clinical and financial sustainability of the
Trust. This is one of the requirements of the
Enforcement Undertakings as a result of the
licence breach.
z Financial reporting arrangements including
forecasting, cash flow reporting and Board
and sub-committee financial information
z Financial management including working
capital management
The finance team has been strengthened and
financial management and control processes
across the Trust are being improved to
ensure the financial plan is achieved, without
compromising quality and safety of services.
z Internal control procedures
z Financial planning procedures including
the appropriateness and adequacy of the
2015/16 planning process
z Board and organisational financial awareness
20
information that is expected to be of interest
and relevance to the workforce.
The Trust has a dedicated programme
management office to support and monitor key
aspects of CIP delivery and ensure no adverse
impact on quality.
The Trust has continued to enjoy a healthy
and productive relationship with Trade Union
representatives, and open and transparent
communication has been instrumental in
achieving this. It is clearly recognised that the
Trust management and Trade Unions share a
common objective in ensuring the continuing
efficiency and quality of the services provided to
patients and their relatives, and our staff.
Our staff
This section explains our key policies and
activities to support and develop our staff and
promote diversity.
Communication and involvement
Ensuring that we listen to our staff and take
their views on board is pivotal in delivering
better outcomes for patients and their care.
Significant efforts were made over the year
to improve the quality and effectiveness of
employee communications.
The Joint Negotiating Committee brings
together Union and Trust representatives, and
continues to be well established in the routine
running of the Trust with active participation at
each meeting.
The Staff Council, with membership from
employees and representatives from across
all disciplines in the Trust, has played an
important role in representing as wide a range
of staff views as possible when contributing to
discussions on a variety of agendas.
Monthly blogs by the Chief Executive alongside
‘all user’ emails from Executive Directors when
required, have ensured that employees are fully
abreast of developments within the Trust. The
monthly Chief Executive’s open forum meetings
have continued to provide all staff with the
opportunity to be directly informed by, and raise
concerns with, the Chief Executive. A weekly
‘next week’ diary, sent on a Friday to ‘all email
users’ informs staff what is happening in the
Trust in the following week. Daily ‘Stepping Up
Now’ meetings were introduced last year. Led
by the Executive Directors in turn, the meetings,
which are held every weekday morning, update
staff on the ‘alert’ status of the Trust, provide
a daily opportunity for staff to raise issues
regarding patient safety and the opportunity to
share Trust-wide issues. Those attending the
meetings feed back to their departments the
issues raised.
On a monthly basis, through the Staff Council
and the Joint Negotiating Committee, staff are
provided with a platform to air their views. In
addition, informal but scheduled discussions
take place with the Trade Union representatives
on a monthly basis to ensure that all concerns
are addressed promptly.
Absence
The Trust has typically maintained levels of
absence below 4% averaged over the
12 month period. This has been possible
through rigorous management of absence,
including monthly review of Bradford scores
with department managers, return to work
interviews and timely referral to Occupational
Health for advice to support a return to work.
Based on feedback from staff representatives,
noticeboards were placed by staff hand
scanners and are regularly updated with
21
Despite these actions, absence levels in the
Trust increased noticeably in November and
December 2014, as they have done in the
previous two years, reaching a peak of 4.64%.
Since then, with the continued programme
of weekly reviews and monitoring, levels of
absence have declined again and were at
3.90% in March 2015.
Fig.1: Year on year staff sickness comparison
addition, the Trust provides support resources.
A virtual learning environment, ‘ULearn’ has
been developed, and support is provided to
students undertaking clinical placements as
part of their undergraduate studies.
Education, Training and Development
The Trust is committed to supporting every
member of staff to fulfil their potential
through targeted learning and development
activities. The learning and development
priorities for 2014/15 were developed from the
organisational strategy.
1. Leadership
Leadership development is accessible to
all Trust staff. As part of the Trust induction
process, all new staff attend the Trust’s
‘Working at the Heart of Care’ programme
which reinforces organisational values and
Learning and development embraces
leadership, core and mandatory skills, preprofessional education and training and
continuing professional development. In
22
as an exchange network between sectors
that support middle, senior and strategic/
executive leadership. It is planned to
develop a local CSLE in the coming year
to encourage cross-sector collaboration
on service priorities.
expectations of all staff working for the Trust.
Mentorship and coaching is available for all
staff undertaking development programmes
as well as for staff with particular needs
arising from appraisal and other processes.
These underpin the more senior
programmes outlined below.
z Consultant Development Programme.
The pilot programme has now been
completed and is currently being
evaluated to ensure alignment to the
Basildon Transformational Leadership
Programme for 2015/16.
z The Senior Leadership Transformational
Programme.
The Trust, in collaboration with University
College London Partners (UCLP) and
Professor Richard Bohmer (Harvard
Business School) developed and delivered
a modular leadership programme for over
60 senior clinical leaders from across
the organisation. The success of the
programme and the subsequent work
arising from it, has led to the planning of a
further programme to be delivered to the
next tier of senior staff in 2015/16.
2. Core and mandatory skills
Core skills is defined as training that applies
to significant numbers of employees in order
for them to fulfil the requirements of their
role, whereas mandatory training is training
which is required by all staff.
The majority of mandatory and core skills
training is delivered through ULearn
and comprises over 25 different training
programmes, all tailored to the requirements
of the organisation. In 2014/15 a compliance
target of 80% was set for these areas of
training and this target was met or exceeded
in both core and mandatory skills.
z NHS Leadership Academy Programmes.
The Trust has increased its support for the
NHS National Leadership Programmes
during 2014/15, principally at the junior
levels. All newly appointed staff in Bands
4-6 are encouraged to undertake the
Edward Jenner programme (a foundation
leadership programme).
3. Pre-professional training
Pre-professional training embraces support
staff in NHS pay-bands 1-4, most notably
Health Care Support Workers (HCSW), also
known as Health Care Assistants (HCA).
During the last year we have:
z The Cross Sector Leadership Programme
‘Leading into the Future’.
The Cross Sector Leadership Exchange
(CSLE) is a consortium of senior leaders
from public sector organisations that
are responsible at a national level for
the development of leaders within their
organisations. Ours is the only NHS Trust
to work on the development and delivery
of this programme within this national
forum. Its overarching purpose is to act
z Delivered an HCA Foundation
Programme, which will feed into the now
required Health Care Certificate to ensure
support workers are provided with the
necessary skills and knowledge to deliver
high quality, safe care.
23
z Provided support to staff wishing to
progress into professional training through
the work-based learning opportunities
provided by Health Education East of
England.
including patient safety, equality and
diversity and dementia awareness, as
well as profession-specific learning areas.
Ulearn is a vehicle to deliver important
messages about patients’ experiences
through the recording of patient stories
which are then available for staff to access
24/7.
z Delivered a number of apprenticeships,
particularly in midwifery.
z Managed the process by which staff
are able to access foundation degrees.
This will be further enhanced with the
commissioning of a Health Science
Foundation Degree as a pre-cursor for
staff wishing to enter nurse training.
z Our library service offers a wide range
of traditional and innovative support for
staff and students. This includes a clinical
librarian service where our librarians act as
an information searching resource during
clinical ward rounds. The service achieved
a 98% score in the 2014/15 Library Quality
Assessment Framework; the highest score
recorded in the east of England.
4. Continuing Professional Development
In addition to a full range of education
and training activity commissioned from
our partner higher education institutions,
a special project was commissioned with
Anglia Ruskin University to support the
Trust’s dementia strategy which is designed
to make us a ‘dementia friendly’ organisation
by 2016.
z The medical training support team were
commended for outstanding performance
when hosting MRCS, PACES RCS Site
and MBBS medical student examinations.
z Our local higher education partner has
recently graded our standard of mentorship
for nursing students as ‘excellent’.
During 2014/15 the process for identifying
training needs has been thoroughly
overhauled to ensure that commissioned
training fits organisational service
objectives and achieves maximum return
on investment. The financial allocation for
non-medical education was fully utilised,
our Trust being one of a small number in
the east of England to achieve its target
expenditure.
6. Education quality
The quality of education provided by the
Trust was subjected to a major triennial
(multi-profession) inspection by Health
Education East of England during 2014/15.
The Quality Performance Framework (QIPF)
visit/report concluded that there were no
areas of immediate concern, that the quality
domains were met without conditions
and that there were a number of areas of
good practice. Subsequent visits by Royal
Colleges and Higher Education Institutes
to a number of specialties have upheld that
view.
5. Learning support
z ULearn is not only an e-learning
repository, but a medium for continuous
learning. It hosts a number of ‘learning
zones’ covering a wide range of subjects
24
We are fully aware of our legal responsibilities
and obligations in respect of eliminating unfair
and unlawful discrimination, promoting equality
of opportunity and good relations between all
and involving our staff and members of the
community in the development of our action
plans.
Addressing inequalities
The Trust is committed to providing equality of
opportunity and freedom from discrimination, as
well as dealing effectively with any proven act of
discrimination, abuse or harassment to patients
and staff.
The Trust’s equality commitment communicates
its approach to equality and diversity, conveying
how patients and employees should be treated
with respect and dignity at all times. Significant
work was undertaken over the course of the
year to ensure that agreed outcomes against
the equality delivery system were being
achieved.
The gender make-up of the Board of Directors
was at 31 March 2015:
Male:
Female:
The Trust has a robust policy framework which
supports the recruitment, retention, promotion
and development of staff with disabilities.
These policies reflect the legal requirements
of employers. The policies include making
reasonable adjustments to support staff to
remain in work or to return to work following
a disability, all of which are applied following
an assessment of individual need and
circumstances. Examples of where such
policies have supported staff include:
z The purchase and use of specific software
packages to support staff with dyslexia.
z The installation of digital hearing loops in
main meeting rooms, to support staff who are
hard of hearing.
z Fully disabled accessible site for wheelchair
users.
z Adjusted or flexible working patterns to fit
around individual needs.
25
10 members, 59% of the Board
7 members, 41% of the Board
Fig.2: Age band ratio, all Trust staff, March 2015
Fig.3: Gender ratio, all Trust staff, March 2015
Fig.4: Ethnic origin ratio, all Trust staff, March 2015
26
Staff Survey
National Staff Survey
The Trust has sought over the course of the
year to engage with staff at all levels, through
a number of forums and mediums. These have
been initiated with a view to encouraging staff
to share views and raise any concerns. In
addition, quarterly mini surveys have been
undertaken throughout the year to gauge staff
perceptions on an on-going basis. The mini
survey asks 14 questions (a sub-set of the
national survey plus two ‘Friends and Family’
mandatory questions) that relate to the Trust’s
key aims and objectives for 2014/15.
The Trust in 2014, as in 2013, undertook a full
census survey. The response rate of 29% was
lower than hoped for; however, in real terms
this was far more representative of the views of
the workforce than a sample. The Trust results
in 2014 were generally the same as the results
in 2013; with 14 results being worse than the
NHS average, 10 better than average, and
5 average.
The key outcomes from the National Staff
Survey can be seen in the Figs.5-7.
On ‘overall staff engagement’ the Trust score
remained the same as last year however at
3.71 this is marginally worse than the national
average of 3.74.
27
Fig.5: Area with notable improvement at a local level
Indicator
Trust
2013
Trust
2014
47%
58%
Trust
2013
Trust
2014
National
average
2014
90%
89%
85%
24%
34%
30%
2.97
3.01
3.07
68%
69%
71%
82%
80%
77%
Trust
2013
Trust
2014
National
average
2014
4%
4%
3%
13%
14%
11%
78%
76%
81%
36%
36%
34%
31%
29%
26%
KF26. Percentage of staff having equality and diversity
training in the last 12 months
Fig.6: Top five ranking scores
Indicator
KF7. Percentage of staff appraised in last
12 months
KF21. Percentage of staff reporting
good communication between senior
management and staff
KF3. Work pressure felt by staff
KF5. Percentage of staff working extra
hours
KF1. Percentage of staff feeling satisfied
with the quality of work and patient care
they are able to deliver
Fig.7: Bottom five ranking scores
Indicator
KF17. Percentage of staff experiencing
physical violence from staff in last 12
months
KF28. Percentage of staff experiencing
discrimination at work in last 12 months
KF6. Percentage of staff receiving jobrelevant training, learning or development
in last 12 months
KF12. Percentage of staff witnessing
potentially harmful errors, near misses or
incidents in last month
KF20. Percentage of staff feeling pressure
in last 3 months to attend work when
feeling unwell
28
The introduction and implementation of sevenday working will be a further area of work in
the year ahead. There is the need to build
increased resilience within the workforce to
allow for service expansion and extended
working, through a review of working patterns
and increased flexibility in the workforce. The
aim is to meet service needs while delivering
the quality of care that the Trust aspires to
provide.
Survey action plans
The workforce department is working closely
with the clinical divisions and staff to support
the development of action plans and improve
levels of engagement. The areas that have
contributed to the top and bottom five ranking
scores have been identified to enable the
sharing of good practice from the best and
development plans for the worst.
Divisions are discussing the results of the
national and mini surveys at their weekly and
monthly performance meetings to ensure that
the results are widely disseminated and that
action planning is robust. The action plans,
and updates will continue to be reported at
divisional and senior management group
meetings. The mini survey questions for
2015/16 will be targeted at identifying if the
agreed development plans are having the
desired impact.
We believe that a satisfied and motivated
workforce will deliver better outcomes for
patients. Working collaboratively with our
staff on improving perceptions about the
organisation, as evidenced through surveys and
discussions, and providing them with the levers
to enable change will also be a key priority for
the year.
Note: This strategic report does not include any
information on the social, community or human
rights issues within the Trust, as this information
has not been collected during the year.
Priorities for 2015/16
We will develop a skilled and motivated
workforce and we will improve patient and
staff satisfaction.
Embedding the Trust values and behaviours
will be a key focus area in 2015/16. This will
be through continuing to improve recruitment
and selection processes and targeted training
including bespoke leadership development
programmes, and developing mentor and
coaching networks. There will be on-going
work to develop a comprehensive clinical
skills framework to ensure that the core
competencies and skills of all staff are
reinforced to support the delivery of Keogh’s
Ten Clinical Standards.
29
Sustainability report
However, increased inpatient activity must have
a greater impact on electricity consumption
as the use of equipment and technology
ramps up correspondingly. It is therefore very
encouraging to reflect that whilst there has
been a 94.35% increase in patient procedures
between 2005/6 and 2014/15 electricity
consumption has only increased by 49.97%.
As for a number of years, the Trust’s focus
during 2014/15 in terms of sustainability has
been on containing its consumption of the main
utilities, gas and electricity and through doing
this controlling costs and carbon emissions.
The graphs below set out consumption for
both gas and electricity over a number of years
however, that can only be properly understood
in the context of activity within the hospital
which has changed dramatically.
When the Trust is procuring goods and
services environmental factors are taken into
consideration alongside the quality and cost
of the goods/service. Each supplier is asked
to demonstrate their policies and procedures
with regard to complying with applicable
environmental laws and regulations and how
they deliver sustainable options.
Gas consumption can be expected to increase
in relation to inpatient activity though heating
a space is has a fixed cost irrespective of the
numbers of people passing through it.
Fig.8: Gas consumption
30
Fig.9: Electricity consumption
“The Trust’s vision is to be an excellent provider
of high quality, safe care for our community”
Trust Strategic plan 2014/15 - 2018/19
During 2013/14, the Board of Directors
reviewed and revitalised the Trust’s
Strategic Plan. The items below highlight the
underpinning vision
on and values of the Strategic
Plan with the overarching
rarching aims.
The Trust’s values are listed in the six circles
below:
31
The Trust’s aims in 2014/15 were:
6. Provide value for the taxpayer by
continuously improving our productivity –
fully utilise Orsett Hospital, and the effective
use of technology to enhance patient care.
z Deliver increasingly high quality, safe,
compassionate patient-centred services.
z Work together with our patients to improve
their experience and achieve the best
outcome.
To support the overarching direction of travel,
a number of enabling strategies have been
developed: clinical, estates, human resources
and strategic change. The implementation of
these strategies is designed to support the
achievement of the overarching strategic plan
and will be monitored by the Board.
z Deliver care by skilled and caring staff
who feel valued by the Trust in a culture of
openness.
z Work with health and social care partners for
the benefit of all patients.
Going concern
z Provide services that are sustainable and
deliver value for money.
The Trust incurred a substantial deficit in
2014/15, which led to a requirement for interim
financial support from the Department of Health
in March 2015.
To support these aims, our six objectives are to:
1. Deliver high quality hospital care –
developing seven-day services and putting
patients on the best treatment pathway
through early clinical assessment.
The Trust will incur a further sizeable financial
deficit in 2015/16 in order to deliver the full
range of services to meet anticipated local
health care demands. The Board of Directors
anticipates that it may take some years before
the Trust can achieve financial balance on a
sustainable basis. The regulator, Monitor is
undertaking a sustainability review in the first
quarter of the new financial year.
2. Provide more services out of hospital –
reducing the need for admissions to hospital
and reducing length of stay for frail, elderly
and respiratory patients.
3. Deliver a balanced mix of planned and
emergency services – reducing waiting times
in areas such as orthopaedics, improving
services for the local population.
The Board of Directors has carefully considered
the principle of ‘Going Concern’ and the
Directors have concluded that there are
material uncertainties related to the financial
sustainability (profitability and liquidity) of the
Trust which may cast significant doubt about
the ability of the Trust to continue as a going
concern.
4. Work with other care providers and
commissioners to provide effective care and
strengthen our role in the health economy.
5. Be an excellent employer that recruits
and develops excellent staff and leaders –
seven-day services, developing knowledge
and skills, particularly in hard-to-recruit
specialties.
Nevertheless, the going concern basis remains
appropriate. This is because the Board of
Directors has a reasonable expectation that the
32
Trust will have access to adequate resources
in the form of financial support from the
Department of Health (NHS Act 2006, section
42a) to continue to deliver the full range of
mandatory services for the foreseeable future.
Clare Panniker
Chief Executive
27 May 2015
33
Fast action saves stroke patient
Gillian Longman, 60, arrived at Basildon
Hospital’s A&E department with a suspected
stroke. She was assessed five minutes later
by a specialist stroke nurse. A scan showed
that her stroke was caused by clot on the
brain and she was given a ‘clot-busting’ drug,
known as thrombolysis.
She began to feel better within an hour of
receiving thrombolysis. She was moved to the
hyper acute stroke unit for hourly monitoring,
then to the acute stroke unit, and went home
just three days after she had the stroke.
The Trust’s hyper acute stroke unit is among
the best performing in the East of England
according to data from the Royal College of
Physicians. Patients receive rapid access to
scanning equipment and the best available
drugs, have a better chance of surviving and
are more likely to return home than go into
care.
The stroke service, covering south Essex,
provides access to specialist stroke
consultants, nurses and therapists 24 hours a
day, seven days a week. It also provides some
of the best physiotherapy and occupational
therapy services, helping patients retain their
independence after suffering a stroke.
Basildon and Brentwood Clinical
Commissioning Group (CCG) and Thurrock
CCG have invested an additional £1million
investment in stroke services at the Trust.
The Trust extended consultant cover to seven
days a week, increased the number of beds
on the hyper acute stroke unit and recruited
additional staff.
Gillian Longman, patient with members of the stroke team
34
3 Directors’ report
This section provides information on the way the Trust is run and improvements made to
services during the year.
The Board of Directors
The people who have served on the Board
of Directors during the year are listed below,
together with a brief biography, their term of
office and membership of Trust Committees.
The Directors’ Register of Interests, which is
updated annually, is available on the Trust
website.
Clare Panniker, Chief Executive
Ian Luder, Chairman
(to January 2015)
Clare has worked in the NHS for more than
20 years, leading change and improving the
quality of healthcare. A registered nurse with
a business degree, Clare has worked with
a range of front line specialties and has a
detailed understanding of how to improve
services that focus on giving patients the best
possible experience. Prior to joining the Trust in
September 2012, she was Chief Executive at
North Middlesex Hospital where she is credited
with radically transforming the organisation’s
performance and culture.
Appointed as a Non-Executive Director (NED)
in April 2012, Ian was Sheriff of the City of
London for 2007/08 and Lord Mayor in 2008/09
and was a NED of Homerton University
Hospital for six years, where he helped steer it
to Foundation Trust status, when he became
Deputy Chairman.
A chartered accountant and former partner at
Grant Thornton, he has also been a NED of
Barndoc Healthcare Ltd and an Independent
Member of the Audit Committee for the House
of Lords.
Clare mentors other aspiring NHS leaders,
from both clinical and management
backgrounds. She was also the Chief Executive
Representative on the national ‘High Quality
Care for all’ Advisory Panel, chaired by Lord
Darzi and David Nicholson in 2009.
Membership of Committees*: QPS, FRC, RN
The Chief Executive is the Accounting Officer
for the Trust and carries full responsibility for
the Trust’s performance, forward planning and
leadership of the Executive Team and Clinical
Directors.
Membership of Committees: QPS, FRC
* For key to committees, please see Fig.10 on page 44
35
Nigel Kee, Chief Operating Officer
(from July 2014)
Mark Magrath, Commercial Director
Mark has worked in healthcare for more than
30 years, previously in Southend, Bromley,
Croydon and a short spell in the USA.
Nigel Kee joined the Trust in July 2014 as Chief
Operating Officer, providing executive-level
leadership for the clinical divisions.
He became Director of Planning and Service
Development in 2002. Previous NHS senior
management experience includes planning,
performance management, informatics, general
management, contracting and marketing.
Nigel is a trained nurse and has extensive
operational, clinical and board level experience.
He has also worked at a national level as
sponsoring director for the Department of
Health’s cleaner hospitals and single sex
accommodation programmes.
He has a professional clinical background in
pathology/medical science.
Mark left the Trust at the end of April 2015.
............................................................................
Membership of Committees: FRC
Hannah Coffey, Chief Operating Officer
(to May 2014)
............................................................................
Diane Sarkar, Director of Nursing
Hannah joined the NHS in 1997 as an NHS
Graduate Management Trainee, and worked in
a number of roles across primary, community
and hospital care, including a 3-month
elective working in mental health services in
the townships of Cape Town. Hannah has
worked in a variety of settings, both within
commissioning organisations and acute
hospitals before joining the Trust in January
2011 as Chief Operating Officer. Hannah left
the Trust during May 2014 to join Guy’s and St
Thomas’ as their Director of Operations.
Diane’s experience spans the NHS and
private healthcare. After training at The Royal
Free Hospital in London, she worked in a
number of London’s large acute hospitals
and progressed through several operational
and corporate management positions. In
1996, Diane worked in the private sector
at the Wellington Hospital, setting up new
governance frameworks and leading on the
quality agenda. Having completed a Master’s
degree, Diane returned to the NHS in 2001 at
Southend Hospital, as Associate Director of
Operations for Medicine and then Associate
Director of Nursing. Appointed in 2010, her
focus has been particularly around developing
the nursing workforce, as well as leading on a
number of corporate agendas, including quality
improvement and the patient safety and patient
experience agenda.
Membership of Committees: QPS
36
Adam Sewell-Jones, Deputy Chief
Executive / Acting Chief Operating Officer
(May to July 2014)
Rick Tazzini, Director of Finance
(from November 2014)
Rick was appointed as Director of Finance in
2014. He is a CIPFA qualified accountant with
an MBA and 29 years’ experience across the
NHS, police and local government.
After university, Adam Sewell-Jones joined the
Trust as a finance trainee. He stayed here for
four years, from 1992-96, before going to work
as an accountant at Redbridge Healthcare
NHS Trust. He returned to Basildon to work as
Medicine Directorate General Manager from
2000 to 2002, spent two years at University
College London Hospitals NHS Trust, then,
in 2004, returned to the Trust to be Deputy
Director of Finance.
Rick joined the Trust from North Essex
Partnership University NHS Foundation Trust,
where he was the director of resources;
responsible for finance, performance,
contracting, ICT, information, estates and
procurement. Prior to this Rick was director of
finance and administration with Essex Police.
Adam was appointed as Director of Finance
in September 2007. In January 2013,
Adam became responsible for the Trust’s
Transformation Programme and moved away
from his Director of Finance role. He was
appointed Deputy Chief Executive in October
2013.
............................................................................
Andy Morris, Interim Director of Finance
(to September 2014)
Andy is a director of Integrity Addition
Consulting Ltd and provides consultancy and
financial management services to the NHS.
Andy’s appointment finished at the end of
September 2014.
Membership of Committees: FRC, QPS
............................................................................
Celia Skinner, Medical Director
Celia obtained her Fellowship from the
Royal College of Physicians in 2001 and
has specialised in genito-urinary medicine,
particularly the treatment of HIV/Aids. She was
previously deputy medical director at Barts
Health where she had worked since 1995,
having previously been associate medical
director and a divisional director.
............................................................................
Zoe Asensio-Sanchez (nee Smith),
Director of Estates and Facilities
(non-voting)
Zoe joined the Trust as Director of Estates and
Facilities in October 2013.
A member of the Royal Institute of British
Architects, she began her career as an architect
in the public sector, progressing into estates
management for a large private education
provider maintaining 28 sites across the
country.
Celia is passionate about improving clinical
care and sees the job of Medical Director here
as an opportunity to build on her achievements
at Barts.
Membership of Committee: QPS, FRC
37
Danny Hariram, Director of Workforce and
Organisational Development
(non-voting)
Anne Marie Carrie, Non-Executive Director
(to February 2015)
Appointed as a NED in April 2012, Anne Marie
is a Government commissioner on social
mobility and child poverty.
Danny joined the Trust in March 2015.
Danny has worked in NHS human resources for
more than 17 years, in acute, mental health and
community services. Most recently he was at
Ashford and St Peter’s Hospitals, where he was
acting director of human resources.
As the former hief Executive of the UK’s largest
children’s charity, Anne Marie has experience
of working with services for children, young
people and families, and a proven track record
of managing large complex organisations.
............................................................................
Anne Marie resigned from her post with effect
from the end of February 2015.
Nigel Taylor, Director of Workforce and
(non-voting) (to November 2014)
Membership of Committees: QPS, RN,
Maternity Liaison Committee
............................................................................
Nigel joined the Trust in August 2003,
having worked in the NHS in both hospital
management and personnel since 1980,
including four years as human resources
director at Kings Lynn and Wisbech Hospitals
from 1999. He has extensive experience of
personnel management and was chairman of
the Essex NHS Employers’ Network.
John Govett, Non-Executive Director
John is Group Chief Executive of Ixion Holdings
(Contracts) Ltd (Anglia Ruskin University) and
Chairman of Paragon Concord Ltd.
He has led company-wide root and branch
reviews for organisations including P&O Ferries
(as UK & Worldwide Commercial & Marketing
Director) and Surrey County Council (as acting
Deputy CEO). A former Head of Marketing at
Tesco, John has held various non-executive
director and governance roles.
Nigel took early retirement in November 2014.
............................................................................
Stephanie Lawton, Acting Director of
Workforce and Organisational Development
(November 2014 to February 2015)
John was initially appointed in April 2012 for
a three-year term, and was successfully reappointed to March 2018.
Stephanie has more than 23 years’ experience
in the NHS and joined the Trust in 2004 as
Deputy Director of Workforce. During her time
with the Trust Stephanie was seconded into the
role of deputy Chief Operating Officer.
Membership of Committees: FRC (Chair),
AC, RN
Following Nigel’s retirement Stephanie took on
the directorship in an acting role. Stephanie
has subsequently been formally seconded to
Princess Alexandra Hospital as chief operating
officer from March 2015.
38
Barbara Riddell, Non-Executive Director
Bob Holmes, Non-Executive Director,
Deputy Chairman and Acting Chairman
(from January 2015)
Appointed in April 2012 for a four year term
(until 2016), Barbara was director of resources
at London Fire Brigade, where she was
responsible for finance, HR, procurement and
property from 2001-10. A civil servant working
in central government and then the Property
Services Agency/English Partnerships for
two decades, she was also head of corporate
services for the Metropolitan Police. Barbara
has served as a non-executive director on
boards in the public and not-for-profit sectors
and is chairman of Housing for Women. She
was awarded an OBE in 2008.
Bob is a chartered accountant with many years’
experience as a finance director for a range
of organisations including Stena Line, Prism
Rail and Seawheel Ltd. Since 2003, he has run
his own consultancy practice specialising in
working with owner managed businesses. Bob
was also a non-executive director of the Dover
Harbour Board, where he continues to chair the
Board of Pension Trustees.
Bob has experience of running large
commercial enterprises, providing services to
the public. His role with Dover Harbour Board
has given him an understanding of how a public
sector board is accountable to its stakeholders
and local community.
Membership of Committees: AC, FRC, CF
(Chair), RN, Joint Negotiating Committee
(Chair), Staff Council
............................................................................
Bob joined the Board in December 2006
Following the resignation of the Chairman,
Bob’s term of office was extended to the end
of June 2015 and he covered the role of Acting
Chairman.
Peter Sheldrake, Non-Executive Director,
Senior Independent Director
After graduating with an honours degree in
sociology, Peter joined the police and spent
his entire 31-year career with the Essex
force. He rose through the ranks becoming
divisional commander of Braintree District in
1999, and two years later was appointed Chief
Superintendent and divisional commander of
Basildon District.
Membership of Committees: AC (Chair until
January 2015), FRC, QPS, RN
............................................................................
David Hulbert, Non-Executive Director
Appointed in April 2012 and reappointed in
April 2015 for a further three-year term, David
is a Director of Ravensbeck, a media-oriented
deal, management and advisory firm and was
previously President of Walt Disney Television International.
Following his retirement from the police force
in 2006, Peter joined the Board of the Essex
Probation Service, where he continued to serve
until September 2011.
Appointed as a Non-Executive Director in
December 2007, his term runs until March
2016.
A Cambridge graduate, with an MBA from
Stanford Business School, David has built a
successful career working for major blue-chip
companies across the globe.
Membership of Committees: AC, QPS, CF, RN
Membership of Committees: AC, QPS (Chair),
FRC, RN
39
and delivery of services, by the independent
regulator of foundation trusts, Monitor, and
locally by the Council of Governors. The Board
of Directors is held to account for quality of
services by the Care Quality Commission
(CQC).
Elaine Maxwell, Non-Executive Director
Elaine Maxwell was appointed as a
Non-Executive Director in April 2014. Elaine is
a registered nurse and worked in hospitals and
as a health visitor before moving into quality
management. She was executive director
of nursing at Dorset County Hospital NHS
Foundation Trust from 1999 to 2003 and at
Barking Havering and Redbridge University
Hospitals NHS Trust from 2004 to 2007 before
undertaking her PhD and moving into academic
roles. Elaine is currently principal lecturer in
Leadership at London South Bank University.
The Trust can hold contracts in its own name
and act as a corporate trustee. In the latter role,
it is accountable to the Charity Commission for
those funds deemed to be charitable.
Leadership
The Chairman is responsible for leadership
of both the Board of Directors and the
Council of Governors. The Chairman, Ian
Luder, had significant external commitments
during 2014/15 and these were declared on
appointment and contained within the Register
of Interests. Ian stepped down as Chairman in
January 2015 to pursue a political career.
Elaine is also a trustee of the Florence
Nightingale Foundation, a trustee of Island
Health Trust and a member of the editorial
board of the Journal of Research in Nursing.
Membership of Committees: QPSC, AC, CF, RN
............................................................................
As Chairman of the Board of Directors,
the Chairman is responsible for ensuring
the Board’s effectiveness and setting its
agenda. The Chairman facilitates the effective
contribution and performance of all Board
members who collectively are responsible for
the Trust’s long-term success and sustainability.
He also ensures that there is sufficient and
effective communication with stakeholders to
understand their issues and concerns.
Composition and completeness of
the Board of Directors
The Board of Directors considered its
composition, skills, balance, and completeness
and was satisfied that its composition was
appropriate for the leadership of the Trust
during 2014/15.
How our Foundation Trust is run
As Chairman of the Council of Governors,
the Chairman provides a pivotal link between
governors and directors especially the nonexecutive directors (NEDs). Listening to the
governors is one of the ways the Chairman can
hear the views of the local community, local
people and local stakeholders. The Chairman
regularly provides feedback to the Board of
Directors on the views of the governors and
local community.
This section explains how we make decisions
and manage the services we provide to our
local community.
The Trust is run by the Board of Directors,
which is collectively responsible for the
quality of healthcare delivery and financial
performance. The Board of Directors is held
to account for stewardship of public money
40
leadership of the executive team. She
recommends to the Board any investment or
new business opportunities which meet this
strategy. She also ensures that the Trust’s risks
are adequately addressed and appropriate
internal controls are in place. The Trust seeks
the views of the Council of Governors when
developing its annual plan.
The governors routinely invite the Chief
Executive to their meetings and invite
attendance by other executive and nonexecutive directors as required. In these
meetings governors, members and the
public may raise questions of the Chairman
or his deputy or any other director present
at the meeting about the affairs of the Trust.
The executive directors attend meetings of
the Council of Governors when the agenda
includes business where they are well placed to
contribute.
Providing support to directors
New directors receive a full, formal and tailored
induction on joining the Board of Directors.
The Board of Directors ensures that directors,
especially NEDs, have access to independent
professional advice, at the Trust’s expense,
where they judge it necessary to discharge
their responsibilities as directors or to provide
additional assurance on areas of challenge.
The corporate secretary facilitates such events.
The role of the Board of Directors
The Foundation Trust is led by a Board of
Directors, which is collectively responsible for
the exercise of the powers and the performance
of the Foundation Trust. The Board sets the
strategic direction of the Foundation Trust
ensuring that the necessary financial and
human resources are in place to meet its
priorities and objectives. It operates within
a framework of processes, procedures and
controls which allows performance and
progress to be monitored and its risks carefully
assessed and managed.
Directors also have access, at the Trust’s
expense, to training courses and/or materials
that are consistent with their individual and
collective development programme. The
availability of independent external sources of
advice is made clear at the time of appointment.
Directors, governors and members are
supported by a full-time Corporate Secretary
and team, comprising a full-time Deputy
Corporate Secretary, a full-time Board
Secretary and Assistant Board Secretary and a
part-time Membership Officer.
The Board of Directors is responsible for
ensuring compliance with the Licence granted
by Monitor (formerly the terms of authorisation),
its constitution, mandatory guidance issued by
Monitor, relevant statutory requirements and
contractual obligations.
The Board of Directors is responsible for
promoting effective dialogue between the
organisation and the local community on its
plans and performance, ensuring that the plans
are responsive to the community’s needs.
Ensuring the Board of Directors
maintains high standards of
governance
The Board of Directors recognises the
importance of the principles of good corporate
governance and is committed to improving
the standards of corporate governance within
the organisation. In March 2015, following a
The Chief Executive is responsible for
executing the strategy agreed by the Board
and developing the Trust’s objectives through
41
How the Board of Directors operates
requirement of the undertakings provided to
Monitor, the Trust commissioned an external
Financial Governance Review, with the scope
agreed by Monitor. The findings of this review
are nearing completion and will be presented
to the Board of Directors. Following this, action
will be taken to address any recommendations
within the review.
The Trust has maintained its support of the
Nolan principles of public life and has continued
to make the majority of its decisions at Board
meetings held in public. To support this, there
is the Directors Responsibilities and Code of
Conduct, which applies to all directors and has
been adopted by all Board members. This Code
of Conduct builds on the NHS Code of Conduct
and includes the Nolan principles of public life.
To support its governance arrangements, in
2013/14 operations risk management and
quality governance were all strengthened and
these arrangements continued in 2014/15. The
Trust developed clear information for directors
and governors highlighting key performance
indicators in the form of a performance report
which is published monthly. In addition, a
monthly joint quality report, written by the
medical and nursing directors, provides an
increased level of detail on the quality, safety
and effectiveness measures, progress and
remedial actions taken, where appropriate.
The Trust held nine formal meetings of the
Board during 2014/15, with a part of each
meeting held in public. Though parts of
most meetings were held in private, this was
because the items being considered were either
commercially or patient sensitive. The Board
had a number of strategic away-days and
seminars. The majority of the Board’s decisions
and discussions were held in public.
In September 2014, the Board agreed to a
revised meeting schedule with six formal
(public) meetings each year. This revised
timetable will be in place for 2015/16. In
recognition that this may hinder the Council
of Governors in their role, the Board has
appointed two Governor Observers on the
following Board sub-committees:
The Board of Directors and Council of
Governors have a number of guidance
documents which were jointly agreed: standing
orders for Council of Governors and Board of
Directors meetings, Directors and Governors
Responsibilities and Code of Conduct and an
Engagement (Disputes) Policy, detailing how
any disagreements between the Council and
Board are resolved.
z Audit Committee
z Quality and Patient Safety Committee
In 2014/15, the Trust purchased additional
Directors and Officers Liability Insurance
to cover the risk of legal action against its
directors.
z Finance and Resources Committee
z Charitable Funds Committee
The Council of Governors also receives the
agendas and minutes of all meetings held in
private.
42
The Board of Directors also has powers to
delegate and make arrangements to exercise
any of its functions through a committee,
sub-committee or joint committee. The
Board of Directors keeps the performance
of its committees under regular review and
requires that each committee considers its
performance and effectiveness during the year.
These assessments, together with committee
meetings, are used for determining individual
and collective professional development
programmes for directors, relevant to their
duties as Board members.
The Board of Directors introduced clinical
visits whereby executive and non-executive
directors pair-up to visit clinical areas on the
day of the board meeting. Governors continue
to participate in these visits and find them
worthwhile.
The Constitution details how disagreements
between the Board of Directors and the Council
of Governors will be resolved. Alongside this,
a specific Engagement (Disputes) Policy was
approved and introduced in 2013. This policy
has not been used in 2014/15.
The Scheme of Reservation and Decision
details what types of decisions are to be taken
by the Board, and which decisions are to be
delegated to management by the Board of
Directors. These were reviewed in 2014.
During 2014/15, the Trust’s board committee
structure was as set out below:
Council of Governors
Board of Directors
Audit Committee
Internal Audit
Charitable
Funds
Committee
Remuneration
and
Nomination
Committee
Finance
and
Resources
Committee
Quality
and
Patient Safety
Committee
External Audit
Reports from
other Assurance
Committees
43
Directors attendance
Membership and attendance at Board
of Directors and Committee meetings is
summarised in Fig.10 below. The values
shown are the number of attendances against
number of meetings held during the year that
the director was eligible to attend. Where there
is no entry, this means the director is not a
member of that Committee.
Fig.10: Directors’ attendance at meetings
Committee
BoD
AC
QPS
FRC
CF
RN
Chair
IL/BH
BH
DH
JG
BR
IL/BH
2/4
8/9
4/4
10/12
4/4
Ian Luder (to Jan 2015)
6/7
Bob Holmes
9/9
4/4
6/6
Peter Sheldrake
8/9
5/5
5/6
David Hulbert
9/9
5/5
5/6
John Govett
7/9
Barbara Riddell
8/9
Anne Marie Carrie (to Feb 2015)
8/8
Elaine Maxwell
7/8
Clare Panniker
8/9
Mark Magrath
8/9
11/12
Andy Morris (to Oct 2014)
5/6
5/6
Diane Sarkar
8/9
3/6
Adam Sewell-Jones
8/9
4/6
Nigel Taylor (to Aug 2014)
6/6
4/4
Hannah Coffey (to May 2014)
1/1
1/1
Celia Skinner
8/9
Rick Tazzini (from Nov 2014)
4/4
8/8
Stephanie Lawton
(from Sept 2014 to Feb 2015)
4/4
6/7
Nigel Kee (from July 2014)
6/6
Zoe Asensio-Sanchez
9/9
9/12
Danny Hariram (from Mar 2015)
1/1
1/1
4/4
3/4
8/12
4/4
4/5
10/12
3/4
4/5
12/12
4/4
5/6
5/5
5/6
3/5
Key:
(BoD) Board of Directors
(CF) Charitable Funds Committee
(RN) Remuneration and Nominations Committee
44
3/4
5/6
5/6
4/4
2/3
4/4
10/12
11/12
5/8
8/12
(AC) Audit Committee
(QPS) Quality and Patient Safety Committee
(FRC) Finance and Resources Committee
Directors’ additional activities
advisor to the Committee is appointed, that
person is not a member of the Committee.
No Executive Directors were appointed as a
Non-Executive Director in another organisation
during the year, and no Board Director is a
Governor or Director of another Foundation
Trust.
The Committee has undertaken two recruitment
processes for executive directors within the
year: the Director of Finance and the Director
of Workforce and Organisational Development.
Both were supported by a third party
recruitment agency; however, the selection and
appointments were considered solely by the
Committee. The third party recruiters were not
members of the Committee, and therefore did
not materially assist the Committee.
All Board Directors meet the ‘fit and proper
persons’ test as described in the provider
license.
Remuneration and Nominations
Committee
The Committee reviewed the composition,
balance and skills of the Board in September
2014. A recommendation was made to the
Council of Governors, NED and Chairman
Appointments Committee that a NED with a
recent and relevant financial experience would
be required when Mr Bob Holmes left the Board
at the end of his term of office in March 2015.
The Remuneration and Nominations Committee
serves a number of purposes:
z Determine the remuneration and terms of
service of the Trust’s Chief Executive and
executive directors.
z Consider the payment conditions of any
termination arrangements.
met four times during 2014/15. The Committee
convened in July, September, October and
December 2014 and:
z Appoint executive directors (including the
Chief Executive) following a formal, rigorous,
open and transparent process.
z Advise the Council of Governors on the skills
and experience required for non-executive
director appointments.
z Agreed the recruitment process and
remuneration for the Director of Finance.
z Agreed the recruitment process and
remuneration for the Director of Workforce
and Organisational Development.
The Committee is comprised of the nonexecutive directors and is chaired by the Trust
Chairman. Its terms of reference are compliant
with all Code Provisions relating to it in the
Code of Governance 2010 (revised 2013).
Membership of the Committee is shown in
Fig.10.
z Approved the Succession Plan 2014/15.
z Reviewed the objectives agreed for Executive
Directors, including the Chief Executive.
z Reviewed the objectives agreed for NonExecutive Directors, including the Chairman.
The Chief Executive and Director of Workforce
and Organisational Development are invited to
attend the Committee when relevant. Neither
will attend any meeting at which the terms
of office or remuneration of their posts are
being considered. In the event that an external
z Reviewed and agreed the executives’
salaries.
45
Charitable Funds Committee
Key activities in 2014/15 included:
The Charitable Funds Committee ensures the
Trust complies with its responsibilities as a
corporate trustee and reviews the performance
of charitable funds. Membership of the
Committee is shown in Fig.10.
z Review and approval of the internal audit
strategy, operational plan and more detailed
programme of work, ensuring that this was
consistent with the audit needs of the Trust
as identified in the Assurance Framework.
z Consideration of the major findings of
internal audit work, the appropriateness of
management responses, and the timeliness
of completion of agreed actions.
Audit Committee
The Board has a well-established Audit
Committee composed of NEDs. In 2014/15,
membership of the committee consisted of
five NEDs and excluded the Chairman. Two
members of the Committee have recent and
relevant financial experience. Membership of
the Committee is shown in Fig.10.
z Review and approval of the external audit
strategy, operational plan and more detailed
programme of work.
z Review of all External Audit reports, including
the annual governance report to the
Committee and the annual audit letter to the
Council of Governors and any work carried
outside the annual audit plan.
The function of the Audit Committee is to
assess the adequacy and effective operation of
the Trust’s overall systems of risk management
and internal control. It focuses mainly on
the framework of risks, controls and related
assurances that underpin delivery of the Trust’s
operational objectives.
z Review of the Trust’s Annual Report and
Financial Statements before approval by
the Board of Directors including the Annual
Governance Statement and changes in, and
compliance with, accounting policies and
practices.
The Audit Committee reviews arrangements
for Trust staff to raise, in confidence, concerns
about possible improprieties in matters of
financial reporting and control, clinical quality,
patient safety or other matters (the Trust
Whistleblowing Policy).
z Review of all work related to counter fraud
and security as required by NHS Protect.
z Review of the work of other committees
of the Board of Directors whose work can
provide relevant assurance on the Trust’s
overall system of governance.
In focusing on the framework of risks, controls
and related assurances that underpin the
delivery of the organisation’s objectives (the
Board Assurance Framework), the Committee
takes a particular interest in the processes,
which underpin the organisation’s key
disclosure statements, including the Annual
Governance Statement in the Annual Report
and Accounts.
The Committee also received regular reports
on:
z Losses and compensation payments.
z Waiver of tendering process and competitive
quotations.
z Any allegation of suspected fraud notified to
the Trust.
46
z In reviewing the reports from the External
Auditors to the Committee and the Council
of Governors, and taking into account the
Committee’s private discussions with the
External Auditors, the Committee considered,
along with comments from management,
whether the Trust had received, in the
Committee’s opinion, an effective audit. The
Committee recommended to the Council of
Governors the continuing engagement of
BDO, by way of an extension to its contract,
as auditors for the 2014/15 financial year. The
External Auditors’ fee was fixed by reference
to the contract under which they were first
appointed, and the Committee received
confirmation of the fees to be charged for the
2014/15 audit when considering the external
audit plan for the year. The External Auditors
did not undertake any additional work outside
of the audit plan during the year.
In addition, the Committee carried out the
following activities during the year:
z Provided an Annual Committee Report to the
Council of Governors in July.
z Received a report on the Audit of the
Charitable Fund Accounts.
z Considered the timing of the tender process
for the provision of Internal and External Audit
services over the next 18 months and agreed
a plan for both.
z Received and approved Standing Financial
Instructions, Schemes of Reservation
and Delegation and other elements of the
Corporate Governance Manual.
z Received the NHS Protect Audit Report and
Action Plan relating to the Local Security
Management Service.
z Appointed two Governor Observers to the
Committee to assist them in their statutory
duty to hold the Board to account via the
Non-Executive Directors.
z The Committee revised and approved its
Terms of Reference and Annual Work Plan
2015/16 to take account of the changes to
the Code of Governance (2014) and the
NHS Audit Committee Handbook (2014). In
particular, the items revised include:
In line with the Code of Governance (2014), the
Committee has the following items to report to
the Board.
The requirement for the Committee to
receive third party reports (e.g. CQC,
Royal Colleges) in order to assess their
implications on the integrated governance
arrangements of the Trust.
z The Committee undertook a forensic review
of the financial statements prepared for the
Annual Report and Accounts 2013/14. The
Annual Report and Accounts were consistent
with the information provided to the
Committee throughout the year, and with the
information provided from external assurance
reports (e.g. Care Quality Commission
reports). The same process took place in May
2015, prior to the Board of Directors receiving
the financial, operation and compliance
statements within the 2014/15 Annual Report
and Accounts.
The requirement for the Committee to
review the policies for ensuring compliance
with relevant regulatory, legal and code
of conduct requirements and any related
report and self-declarations.
47
z In preparation for reviewing the 2014/15
financial statements, operations and
compliance, the Committee spent
considerable time assessing the Trust’s
Going Concern declaration.
assurance committees. The aim is to ensure
in-depth scrutiny and additional assurance on
internal control in these areas.
In the light of Monitor finding the Trust to
be in breach of its licence as a result of the
deteriorating financial position during the
year, the Committee has agreed to review
its oversight of the financial governance
arrangements and oversee the implementation
of the action plan developed following receipt
of the Financial Governance Review. This
review has been commissioned as part of the
undertakings provided to Monitor and has been
completed by Grant Thornton.
The Trust’s umbrella clinical governance
committee is the Quality and Patient Safety
Committee. It is responsible to the Board of
Directors for monitoring implementation of
strategic priorities and assuring compliance
with regulatory requirements and patient safety
and quality improvement best practice. Quality
governance and quality are discussed in more
detail in the Annual Governance Statement
(page 167) and Quality Report (page 97)
respectively. Membership of the Committee is
shown in Fig.10.
Quality and Patient Safety Committee
The Trust ensures that the External Auditor’s
independence has not been compromised
where work outside the audit code has been
commissioned by referring all such work to the
Council of Governors for approval.
In 2014/15, the Quality and Patient Safety
Committee met every two months. The focus
on quality improvement and outcomes was
maintained by the presentation of a detailed
joint quality report from the Medical Director and
Director of Nursing to the Board of Directors
each meeting.
The Audit Committee is supported by two
assurance committees of the Board; the
Quality and Patient Safety Committee and
the Finance and Resources Committee. Each
committee consists of directors, supported by
appropriate officers. The number of NEDs on
each Committee varies but a NED chairs both
During 2014/15, the quality governance
arrangements relating to quality improvement
and clinical governance are as set out below.
Divisional Governance Meetings
Risk and Compliance
Patient Safety
Patient Experience
Senior Management Group
Quality and Patient Safety
Audit Committee
Committee
Board of Directors
48
Two Governor Observers on the Committee
have provided regular feedback on the work
of the Committee at Council of Governors
meetings during 2014/15.
z Regular reviewing of financial forecasts,
including cash flow forecasts.
Key activities during 2014/15 included:
z Review and updating of Managing Operating
Cash Policy.
z Regular review of the workforce plan and
investigation of any variation to that plan.
z Maintaining a focus on the mortality reduction
programme, and monitoring outcomes of this
work.
z Oversight of action plans developed in
response to external service reviews and
compliance visits.
During the course of the year, when it became
apparent that the Trust’s financial position
was deteriorating significantly, the Committee
diverted considerable time and scrutiny to the
root causes and remedial actions required to:
z Monitoring and reviewing areas of poor
performance against quality metrics and Key
Performance Indicators (KPIs).
z Understand the cause of the deterioration
and identify what remedial action could be
taken.
z Approving the Clinical Audit Annual
Programme and provided oversight of the
progress and outcomes of the programme.
z Strengthen the Standing Financial
Instructions and associate financial
authorities, including the introduction of a ‘no
purchase order, no pay’ policy.
z An evaluation of clinical audit against the
Healthcare Quality Improvement partnership’s
publication Clinical Audit: A simple guide for
NHS Boards as part of the Annual Report of
Clinical Audit 2014/15.
z Review the discretionary spend limits and
policy.
z Commission a review of all large contracts
and negotiate improved terms.
z Communicate the root causes of this position
to staff, commissioners and regulators.
Finance and Resources Committee
The Committee’s work predominantly focuses
on the review of effective financial management
throughout the Trust. The Committee has a
significant role to play in reviewing the Trust’s
financial plans and performance.
In addition to the planned activity, the
Committee also:
z Reviewed the capital programme in light of
the deteriorating financial position, reducing
the commitment in-year.
Key activities for 2014/15 included:
z Scrutinised the cash position, with the aim
of gaining clarity on the ‘going concern’
statement required by the Annual Report.
z Considering in detail the Trust’s financial
performance including achievement of
efficiency savings and cash management by
reference to the Annual Plan.
z Agreed the decision to apply to Monitor for
distressed Trust funding for 2014/15 and
2015/16 to support the cash position.
z Monitoring financial risks and controls and
management’s actions to mitigate their effect.
49
z Reviewed the Trust’s banking arrangements
going forward.
commissioned a Quality Governance Review in
2013/14 which provided some insight into areas
of improvement. This was reassessed in 2014,
and the Trust was found to have improved its
quality governance arrangements.
z Reviewed the development of the Cost
Improvement Plan for 2014/15 and 2015/16
and monitored their delivery.
The annual appraisal/performance evaluation of
the Chairman is led by the Senior Independent
Director, with input from the Council of
Governors, Board members and with support
from the Corporate Secretary. The outcome of
the appraisal and agreed objectives are shared
with the Council of Governors in July each
year. The Chairman in turn, with input from the
Council of Governors, undertakes the annual
appraisals or performance evaluations of the
Non-Executive Directors. The Non-Executive
Directors’ objectives agreed as part of this
process are also shared with the Council of
Governors in July each year.
z Agreed the annual plan(s) for submission to
Monitor.
z Whole Board review of proposed Annual Plan
submission took place at the March meeting,
and all planned agenda items moved
accordingly.
z Agreed the Enforcement Undertakings as
determined by Monitor.
z Agreed the terms of reference of the
Financial Governance Review, on behalf of
the Board of Directors.
z Agreed a revised budget setting process for
2015/16, following a review of the lessons
learned from 2014/15.
The Chief Executive leads the annual appraisal
of the Executive Directors. She is supported
in this by the Non-Executive Directors,
particularly in relation to the performance of the
Executive as corporate Board members. The
Remuneration and Nominations Committee
reviews the outcome of the appraisal and
objectives agreed each year.
How we evaluate the performance
of the Board of Directors and its
committees
The Trust is committed to ensuring governance
best practice, and has adopted a mixture of
regulator-driven evaluation and self-assessment
to evaluate the performance of the Board of
Directors.
Evaluation of the Committees is scheduled
to be completed in March and April each
year and is usually undertaken as a selfassessment exercise. The Audit Committee
conducted a self-appraisal of its performance
using the framework in the Audit Committee
Handbook 2014. This covered the Committee’s
composition, establishment and duties,
compliance with the law and regulations,
corporate governance, financial and internal
control, risk management, internal and external
audit, clinical and quality governance and
administration.
The past five years have been particularly
challenging for the Trust, with a number of
changes to the Board’s membership and a
significant level of external scrutiny of both
the Board’s performance and its governance
arrangements.
The Board of Directors conducted an appraisal
process in 2014/15, which included feedback
from Governors. In addition, the Trust
50
The Quality and Patient Safety Committee also
reviewed its performance for the year, using a
similar methodology to the Audit Committee.
The Finance and Resources Committee will
use the outcome of the Financial Governance
Review to assess its effectiveness and review
its terms of reference and work plan for
2015/16.
Finally, the Chairman and NEDs meet privately
as required to review performance of the Board.
51
Links with hospice benefit patients with liver disease
Patients with long term liver disease are
benefitting from improved care, thanks to
joint working between the Trust and St Luke’s
Hospice.
Sarah Tarff, Liver Nurse Specialist, explains:
“This project is about making sure patients
with long term liver diseases get the support
they need and optimise their quality of life.”
As the first known partnership of its kind in
Essex, patients with different liver diseases
at various stages of treatment have been
referred to St Luke’s Hospice for assessment,
ongoing care and support.
One of the symptoms of chronic liver disease
is a build-up of fluid called ascites in the
abdomen, which the body cannot get rid
of and needs to be drained. Normally that
would require admission to hospital. Instead
St Luke’s are able to schedule more regular
appointments to drain the fluid, which means
the patient benefits from a shorter stay in their
day unit, which is a less clinical and more
comfortable setting.
The hospice provides a wide range of services
to patients who have end of life care needs,
including, support groups, holistic care,
complimentary therapies, physiotherapy and
counselling. Those services are also available
for patients with long term health conditions,
other than cancer.
Sarah Tarff, liver nurse specialist; Virginia Campbell, specialist nurse practitioner,
St Luke’s Hospice
52
4 The Council of Governors
All governors sign a declaration on election
that indicates that they meet the ‘fit and proper
persons’ test as described in the provider
license. No governor is a director or governor in
another NHS Foundation Trust.
Appointed governors represent their
organisation and connect the Trust and their
appointing organisations, so their position within
that organisation is not considered as a material
interest.
Elected governors are subject to re-election by
the members of their constituency at regular
intervals not exceeding three years and subject
to a maximum term of office. The names of
governors submitted for election or re-election
are accompanied by biographical details
and any other relevant information to enable
members to take an informed decision on their
election. For governors seeking re-election this
includes the number of Council of Governors
meetings attended during the previous year.
The role of the Council of Governors
The Council of Governors links the Foundation
Trust to its members and community to ensure
local people are engaged and involved in our
services.
The Council of Governors is responsible for
representing the interests of NHS Foundation
Trust members, the public and partner
organisations in the local health economy in
the governance of the Trust. It also holds the
Board of Directors to account for the Trust’s
performance, through the Non-Executive
Directors. This includes ensuring the Board of
Directors acts so that the Trust does not breach
the terms of its Licence (formerly its terms of
authorisation).
The Council of Governors holds formal
meetings in public to make decisions and to
ensure the views and priorities of local people
inform the Trust’s decisions on strategy. In
addition, governors hold meetings without
officers present to discuss matters amongst
themselves and attend informal meetings with
directors to develop their own knowledge of the
services the Trust provides and discuss issues
as they arise. Governors produce a newsletter,
three editions in 2014/15, and use the Trust
website to communicate with members. During
2014/15, governors attended a number of
community engagement events.
The roles and responsibilities of the Council of
Governors are set out in the Trust Constitution
and detailed in the Governors Governance
Handbook. This handbook includes the relevant
policies applicable to the Council of Governors,
e.g. policy to be used in the event of a governor
persistently failing to attend meetings, conflict of
interest, etc.
A number of committees and working groups
of the Council of Governors have been
formed and, although responsibility for all
decisions is retained by the full Council of
Governors, the in-depth work carried out by the
committees is greatly valued. The committees
of the Council of Governors consider the
Trust Constitution and recommend changes,
review the remuneration and terms of office
of the Chairman and Non-Executive Directors
The majority of the governors have no external
directorships or interests that are relevant and
material to NHS business matters. Membership
of political parties and declarations that may
be material are recorded and updated in the
Register of Governors’ Interests retained by
the Corporate Secretary. The full Register of
Interests is available on request (01268 524900
ext. 3943).
53
(NEDs), appoint and re-appoint the Chairman
and NEDs and recruit members. In addition,
governors work with Trust staff to contribute
to improvements in the look and feel of the
hospital environment, for example by choosing
artwork for display, and adding their voice to
how the landscape of the hospital should look.
Importantly they contribute to a small number
of operational groups and are represented
on the Trust Board Committees, the Patient
Safety Group, Nutrition and Hydration Steering
Group, Patient-led Assessment of the Care
Environment (PLACE) (environmental) Steering
Group and the Organ Donation Committee.
roles and responsibilities of governors and an
overview of the key work and developments
of the Council of Governors during the year,
demonstrating how governors met their
statutory requirements. This information will
be shared with Foundation Trust members at
the Annual Members Meeting in September
2015, and given to newly elected governors at
induction for information.
Lead Governor
Ron Capes, Public Governor Basildon, was
elected as the Lead Governor for a third year at
the Council of Governors meeting in May 2014.
To help the Chairman and NEDs gain a greater
understanding of the view of governors and
the Trust’s membership, they regularly discuss
the affairs of the NHS Foundation Trust with
governors at frequent, formal and informal
meetings. NEDs are invited to attend meetings
with governors and there is an expectation of
attendance should governor’s request this. In
2014/15, NEDs attended a number of Council
of Governors Committee and working group
meetings.
Simon Hooker, was also re-elected as the
Deputy Lead Governor, he is a Public Governor
for Basildon.
On joining the Trust, each new governor
receives an induction and on-going training in
the business of the Trust. Re-elected governors
are also invited to attend an induction session
as a ‘refresher’ if they so wish. Governors
discuss and have the opportunity to comment
on the quality goals set each year, which are
included in the Quality Report.
The Council of Governors Annual Review
2014/15 provides information about the duties,
54
Composition of the Council of Governors
The composition of the Council of Governors comprises 30 Governors for 2014/15, as per details
in Fig.11.
Fig.11: Composition of Council of Governors
Group
Partnership
Organisations
Anglia Ruskin University
South Essex College
Basildon, Thurrock and Brentwood CVS
representative
Total
Staff
Staff employed by BTUH
Total
Local Authority
Thurrock Borough Council
Essex County Council
Total
University
Royal Free and University College
Medical School
Total
Total Representative Governors
Public/Patients
Basildon
Thurrock
Brentwood
The rest of England
Total Public/Patient Governors
Total
Number of
Governors
1
1
1
3
5
5
1
1
2
1
1
11
8
6
3
2
19
30
The names of the members of the Council of Governors that served during the year are in Fig.12
below.
55
Fig.12: Council of Governors Members
Class
Name
Date
elected/
appointed
Date reelected
Term of
office
Date of
retirement/
resignation
Meetings
attended
Declaration
of Interest
summary
Political
party
Public Thurrock
Reg Sweeting
Apr 2007
Apr 2013
3 years
Mar 2016
5/6
None
None
Public Thurrock
Tony Coughlin
Apr 2014
3 years
Mar 2017
Public Thurrock
Karen Boyles
Apr 2014
3 years
Mar 2017
Public Thurrock
Dennis John
Apr 2014
2 years
Mar 2016
Public Thurrock
Peter Glover
Apr 2012
3 years
May 2014
1/6
None
None
Public Thurrock
Russ Allen
Apr 2012
3 years
Mar 2015
4/6
None
None
Public Basildon
Brian Levett
Apr 2009
Apr 2010
3 years
Mar 2016
6/6
None
None
Public Basildon
Ron Capes
Apr 2010
Apr 2013
3 years
Mar 2016
5/6
Magistrate for
Essex – Chair
Billericay Royal
British Legion,
Vice-chair
Billericay Design
Statement
None
Assoc, Member
of Patient
Participation Grp
Public Basildon
Marlene
Moura
Apr 2010
Public Basildon
Dr V N
Srivastava
Public Basildon
Apr 2013
3 years
Mar 2016
5/6
Trustee of St
Luke’s Hospice
None
Apr 2012
3 years
Mar 2015
4/6
None
None
Alan
McFadden
Apr 2012
3 years
Mar 2015
5/6
None
Labour
Public Basildon
Andrew
Schrader
Apr 2013
3 years
Mar 2016
2/6
Partner
employed by the
Trust, Elected
Councillor
Conservative
Public Basildon
Simon Hooker
April 2013
3 years
Mar 2016
5/6
Parish Councillor
for Great
Burstead &
Sth, Green
None
56
Class
Name
Date
elected/
appointed
Date reelected
Term of
office
Date of
retirement/
resignation
Meetings
attended
Public Basildon
Brian Wellman
Apr 2008
Apr 2014
2 years
Mar 2016
5/6
None
None
Public Brentwood
David
Anderson
Apr 2006
Apr 2012
3 years
Aug 2014
4/6
None
None
Public –
Brentwood
Eric Watts
Apr 2013
3 years
Mar 2016
6/6
None
National
Health Action
Party, Labour
Public –
Brentwood
Paul Barrell
Apr 2013
2 years
Mar 2015
6/6
None
None
Public –
Rest of
England
Andy Halls
Apr 2013
Apr 2014
3 years
Mar 2015
4/6
Two members
of immediate
family work at the
hospital
None
Public –
Rest of
England
Roy Rutter
Apr 2006
Apr 2012
3 years
Mar 2015
6/6
Son works at the
hospital
None
Staff Basildon
Danny Day
Apr 2013
Apr 2014
3 years
Mar 2017
6/6
Wife works for
the Trust
None
Staff Basildon
Stephen
Hartman
Apr 2012
3 years
Mar 2017
5/6
None
None
Staff Basildon
Ray Best
Apr 2011
1 year
Mar 2015
2/6
None
Labour
Staff Basildon
Elizabeth
Carpenter
Apr 2014
2 years
Mar 2016
3/6
None
None
Staff
Stephen
Lewis
Apr 2014
2 years
Mar 2016
0/2
None
None
South Essex
College
Wendy
Barnes
Oct 2011
Jan 2015
3 years
Oct 2017
2/6
None
None
Partner
Organisation
- UCL
Medical
School
Dr Aroon Lal
Jul 2008
Jul 2011
Jul 2014
3 years
Jul 2017
0/6
None
None
Partner
Organisation
- Anglia
Ruskin
University
Ruth Jackson
Nov 2009
Nov 2012
3 years
Oct 2015
2/6
None
None
Local
Authority
– Thurrock
Council
Cllr Wendy
Curtis
Jan 2014
1 year
Jan 2015
0/1
None
Labour
Apr 2014
57
Declaration
of Interest
summary
Political
party
Class
Name
Date
elected/
appointed
Local
Authority
– Essex
County
Council
Cllr Kay
Twitchen
Jul 2013
Voluntary Brentwood,
Basildon
and
Thurrock
CVS
Ken Wright
Apr 2012
Date reelected
Apr 2014
Term of
office
Date of
retirement/
resignation
Meetings
attended
Declaration
of Interest
summary
3 years
May 2015
2/4
Elected member
ECC. Basildon
Youth Strategy
Board, Vice
president
Synergie
Conservative
1 years
Mar 2015
6/6
None
Conservative
Meetings of the Council of Governors
During 2014/15, there were five formal
meetings of the Council of Governors, including
the Annual Members Meeting. Governors
are encouraged to attend by varying the
times of meetings and the venues across
constituencies. Travelling expenses to and
from meetings are reimbursed.
The number of attendances by Directors
at meetings of the Council of Governors is
recorded and is shown in Fig.13.
58
Political
party
Fig.13: Directors’ attendance at Council of Governors meetings
Board of Directors member
Ian Luder – Chairman (to Jan 2015)
Bob Holmes - Non-Executive Director
Elaine Maxwell - Non-Executive Director
Peter Sheldrake - Non-Executive Director
Barbara Riddell - Non-Executive Director
John Govett - Non-Executive Director
David Hulbert - Non-Executive Director
Anne Marie Carrie – Non-Executive Director (to Feb 2015)
Mark Magrath – Commercial Director
Celia Skinner – Medical Director
Adam Sewell-Jones – Deputy Chief Executive
Nigel Taylor - Director of Personnel and Organisational Development (to Aug 2014)
Diane Sarkar – Director of Nursing
Nigel Kee – Chief Operating Officer (from July 2014)
Andy Morris, Interim Director of Finance (to Sept 2014)
Zoe Asensio-Sanchez, Director of Estates and Capital Development
Rick Tazzini (from Nov 2014)
Stephanie Lawton - Director of Workforce and Organisational Development (acting)
(Sept 2014-Feb 2015)
Danny Hariram - Director of Workforce and Organisational Development
(from Mar 2015)
Meetings
attended
3/4
4/5
2/5
5/5
3/5
1/5
1/5
0/4
2/5
0/5
5/5
0/2
3/5
0/4
4/5
1/3
0/5
2/2
0/2
1/1
Making appointments
Holmes became the Acting Chairman, and
will remain as such until June 2015 to give a
handover period for the incoming Chairman.
Two existing NEDs completing their first term
of office sought re-appointment. These reappointments were approved by the Council
of Governors in November 2014. The agreed
process was followed for the appointment of a
replacement Chairman and NED.
It is the role of the Council of Governors to
appoint, re-appoint or remove the Chairman
and NEDs. An appointment process was
agreed by the Council of Governors in 2014, in
consultation with the Trust’s Remuneration and
Nominations Committee.
The Chairman and one Non-Executive Director
were scheduled to retire at 31 March 2015.
Ian Luder, Chairman resigned from the Trust in
January 2015 and the Deputy Chairman Bob
59
During 2014/15, the Council of Governors did
not consider exercising its power to remove the
Chairman or any other NED.
The Board of Directors Remuneration and
Nominations Committee considered the skills
and experience of current Board members
before making a formal recommendation to
the Council of Governors, NED and Chairman
Remuneration and Appointment Committee
(NEDRAC) on the skills required for both
new appointments. The Remuneration and
Nominations Committee considered that it
would be in the best interest of the Trust for
the NED to have a recent and relevant finance
background. The NEDRAC and the Council of
Governors agreed with this view.
The Governors, Chairman and Non-Executive
Directors Remuneration and Appointment
Committee (NEDRAC) annually reviews the
remuneration paid to NEDs. To inform this,
the governors review the NHS Providers
breakdown of all foundation trust remuneration
rates for NEDs. This provides governors with a
benchmark to help in reviewing and determining
any change to remuneration for Trust NEDs.
When considering the remuneration of the Trust
Chairman, the Senior Independent Director
provides support to the governors.
The NEDRAC membership was comprised of
governors with the Trust Chairman or where
relevant, the Senior Independent Director in
attendance. The Council of Governors resolved
that all categories of governor i.e. public,
staff and appointed, should be represented
on the NEDCRC Appointment Panel, with
public governors in the majority. Following
due process, which included advertisements
in newspapers and professional journals, in
regards to the NED appointment.
All NEDs are considered independent in
character and judgement using the criteria for
independence listed within the NHS Foundation
Trust Code of Governance (2013) (see section
8 on Code Compliance). The Chairman
was considered to be independent upon
appointment in 2012.
Keeping governors informed and
involved
An Appointments Panel solely drawn from
NEDRAC members, plus the Trust Chairman,
was established and appropriate recruitment
and selection training for these governors was
provided.
It is the Chairman’s role to lead the Council
of Governors. To support him in this, Barbara
Riddell, Non-Executive Director has undertaken
the role of governor liaison, and has worked
closely with the governors throughout the year.
Third party recruitment specialists were
commissioned to recruit for the Chairman
position and, to widen the pool of NED
candidates, it was agreed to extend the search
for candidates for the NED position to be
included in that contract. The process to recruit
a Chair concluded in April 2015. Mr Nigel
Beverley joined the Trust 1 May 2015 and will
take up his Chair position in early July.
Governors receive the agenda, all papers and
minutes for Board of Directors meetings held in
public and are able to be present for the public
session of these meetings. Since May 2013,
governors have also received the agenda and
minutes of any Board session held in private.
Governors are also invited to participate in the
Board of Directors monthly clinical visits.
60
Visits to different areas across the Trust provide
Board members and governors with assurance
of the quality of clinical care and areas for
improvement both from the patient experience
and staff perspective.
communications department, and at informal
meetings between governors and directors.
They have also been involved in site
inspections by regulators, and have had the
opportunity to meet in private with regulators.
Peter Sheldrake is the Trust’s Senior
Independent Director. The Senior Independent
Director is available to members and governors
through the Corporate Secretary if they have
concerns that contact through the normal
channels of Chairman, Chief Executive or
Director of Finance has failed to resolve or for
which such contact is inappropriate.
Governors took part in one national and
additional local PLACE Lite (Patient-Led
Assessment of the Care Environment)
assessments during 2014/15. These looked
at the current hospital environment and an
action plan was produced to address areas of
improvement. A governor is a representative on
the PLACE Advisory Group.
Members of the Board of Directors attend
meetings of the Council of Governors to provide
information on the Trust’s performance, update
them on strategy and key operational issues
and to ensure that the governors have access
to Directors when required.
There are two Governor Observers on each of
the Board sub-committees and they provide
regular reports to the Council of Governors on
the activities of those committees.
The Governor and NED discussion forum
continued during 2014/15. The forum meets
three times a year, providing governors with
an opportunity to question and challenge the
NEDs on the performance of the Trust, share
the views of the public and the Council of
Governors and exchange information about ongoing issues. This forum helps to develop the
relationship between the governors and NEDs
in response to changes in the Health and Social
Care Act 2012.
Governors have been kept informed about
stakeholder and regulatory scrutiny through
briefings sent by the Chairman, the Chief
Executive, the Corporate Secretary, the
61
Open day at the Trust
In the dermatology department visitors learned
about the treatment of skin cancer and other
conditions, and the medical equipment
management service opened their workshop
to show their highly specialised skills in
maintaining the complex technology that is
essential for patient care and treatment.
Hundreds of visitors attending an open day
were given a behind-the-scenes view of
Basildon University Hospital.
Basildon and Pitsea carnival queen Gemma
Bell and her two princesses, Beth and Chloe,
delighted young patients when they dropped
into the children’s ward.
Hospital staff ran dozens of stalls around the
hospital, offering health checks, competitions,
games and information about specialised
services. Non-clinical departments on hand
to explain their role to visitors included fundraising, hospital radio, volunteers, governors,
Trust membership, patient advice and liaison
service, chaplaincy, catering and cleaning.
The estates department showed visitors how
vital services are maintained for patients in the
hidden depths of the hospital, where miles of
pipes carry water, steam and medical gases to
wards and departments, along with cables for
electricity and computers.
Another popular attraction was a tour of the
cardiac cath lab in The Essex Cardiothoracic
Centre where visitors saw high-tech
equipment used by cardiologists.
Basildon and Pitsea carnival cast visit the children’s ward
62
5 Membership
Fig.14: Current Public membership by
constituencies
The role of members
There are two categories of membership –
public and staff.
Area
Basildon
Brentwood
Thurrock
Rest of England
Total
Public members are individuals who live in one
of the four constituencies – Basildon, Thurrock,
Brentwood and the Rest of England – are aged
12 and above and have registered to become
members.
Staff members are employees, including
contract staff where the contract with the Trust
extends beyond 12 months, and volunteers.
Staff members are ‘opted in’ to membership.
Although retaining the right to opt out of
membership, in practice very few have over
the eleven years since the foundation trust
was established. There is one staff group ‘Staff
employed by BTUH’.
Members
5,991
659
3,564
2,187
12,401
A key objective for 2014/15 was to maintain
the overall level of membership as at 31 March
2014, replacing members that left during the
year with members from under-represented
areas and hard to reach groups, increasing
representation in these areas.
The Membership Framework 2014/15 detailed
four areas to focus on:
Building our membership
1. Engaging with younger people
(up to 22 years).
The Council of Governors Annual Members’
Meeting (AMM) and Membership Strategy
Working Group reviewed the Trust Membership
Strategy in 2014 and updated it in line with
the membership target set for the year. The
Membership Strategy provides the framework
for the continued targeted development of
membership recruitment, engagement and
retention, in line with statutory requirements.
This strategy describes the involvement of
members, patients, clients and the local
community.
2. Demographic representation:
z to increase Brentwood by 5%
z to increase male membership
z to increase Thurrock by 10%
3. Demographic representation with ethnic and
hard to reach groups.
4. Maintaining an active membership.
The current public membership by constituency
is shown in Fig.14.
63
Membership numbers
The Trust’s membership for 2014/15 and the planned membership for 2015/16 are shown in
Fig.15.
Fig.15: Membership size and movements
2014/15
Plan
2014/15
Actual
2015/16
Planned
Public constituency:
At year start (April 1)
New members
Members leaving
At year end (31 March)
Minimum required under Annex 1 of Constitution
Staff constituency:
At year start (April 1)
New members
Members leaving
At year end (31 March)
Minimum required under Annex 2 of Constitution
12,402
800
(250)
12,952
40
4,115
830
(571)
4,374
10
12,402
1,023
(362)
13,063
40
4,374
565
(830)
4,109
10
13,063
900
(400)
13,563
40
4,109
tbc
(tbc)
4,109
10
During 2014/15 membership of the public
constituency increased by 8.25% and
membership of the staff constituency
decreased by 6%.
The planned figures for the staff constituency
are based on average turnover and expected
workforce changes.
64
Fig.16: Analysis of membership at 31 March 2015
Public constituency:
Age group:
0-16
17-21
22+
Total
Ethnicity:
White
Mixed
Asian or Asian British
Black or Black British
Other
Total
SocioABC1
economic
C2
groupings: D
E
Total
Gender:
Male
Female
Total
2013/14
Number of
members
120
468
11,814
12,402
10,434
137
304
447
1,053
12,375
3,496
3,547
2,824
2,439
12,306
4,279
8,031
12,310
2014/15
Number of
members
140
506
12,417
13,063
10,932
148
343
501
294
12,218+
3,647
3,764
2,949
2,548
12,908*
4,448
8,530
12,978**
%
Eligible
membership
Not available
Not available
Not available
89%
1%
3%
4%
3%
100.0
28%
29%
23%
20%
100.0
34%
66%
100.0
1,685,199
35,135
76,263
71,355
9,837
1,877,789
680,214
572,470
285,895
320,908
1,812,039
908,903
968,886
1,877,789
Note: Ethnicity Essex County population, whereas the Socio-economic population is based on
Essex County Postcode population. The population data for the age-group and gender is sourced
from the census data.
+ 845 were detailed as ‘not stated’
*155 were detailed as ‘Unclassified’
**85 were detailed as ‘Unclassified’
65
z Attended the St Luke’s Hospice fete in June
2014.
Staff constituency
Membership of the staff constituency is open
to any individual who is employed by the Trust
under a contract of employment. They may
become, or continue as, a member of the Trust
provided they:
z A display stand at the Brentwood Council
for Voluntary Service (CVS) lunch in June
2014 and their Community Funding Fair in
September 2014.
z A promotional stand in the main reception at
Basildon Hospital at the Trust Open Day, with
an opportunity for governors to undertake
engagement with the public.
z are employed by the Trust under a contract of
employment which has no fixed term or has a
fixed term of at least 12 months; or
z have been continuously employed by the
Trust under a contract of employment for at
least 12 months.
z Engaged with people at the South Ockendon
Community Forum.
Those individuals who are eligible for
membership of the Trust are referred to
collectively as the staff constituency.
z Two governors spent the morning talking to
women about their experiences of the women
and children’s services.
The staff constituency is based on an opt-in
arrangement. All staff eligible for membership
are contacted on joining the Trust to confirm
their membership and they are given the
opportunity to opt out. No staff members opted
out in 2014/15.
z An opportunity to meet public governors was
held at Billericay Library during a local health
event.
Contact cards are sent out to patients with first
outpatient appointment letters, who provide
name and contact details and post back to us.
This is followed up by a telephone call from
the Membership Office, for signing up as a
new member. Nearly 750 members have been
signed up since the system started.
Work to recruit new members
A number of initiatives were put in place
to maintain membership during 2014/15,
particularly targeting the under-represented
areas. Governors attended a number of events
within their constituencies to engage with the
public, and to support and encourage Trust
membership. These events included:
Communication with members
A dedicated foundation trust email address and
telephone number is available providing contact
details for member queries and comments.
Members who wish to contact a governor can
do this through the Trust website.
z A stand at the community Strawberry Fair in
Brentwood, in June 2014.
z Promotion at local parish council meetings.
Members and the public can attend Board of
Directors public meetings, Council of Governor
meetings and the Annual Members’ Meeting.
z Attended two Fresher’s Fairs at South Essex
College, where more than 100 new young
members were recruited.
z Supported the Big Lunch community event in
Thurrock.
66
These are advertised in advance in The
Foundation Times newsletter, on the Trust
website, and a press release is sent to local
media.
public and listen to their views about Trust
services. A quarterly Governor Engagement
Activity form was introduced and outcomes are
reported to the Council of Governors.
During 2014/15, members were emailed with
details of various events including details of
local consultations and communications from
local partners and stakeholders.
Many governors supported the monthly visits to
different areas in the Trust with Directors.
A Governors Training and Development
Plan was in place for 2014/15 to help ensure
governors are equipped with the necessary
skills and knowledge they need to discharge
their duties appropriately. This was reviewed in
March 2015.
Governors’ achievements 2014/15
This year the Trust celebrated 10 years of being
a Foundation Trust, with an afternoon tea party
for the Council of Governors. This showcased
the work and value that the Council has had
over the years and Governors, past and
present, attended. Executive Directors were
available to provide up-to-date information to
those governors who had questions.
A handbook, outlining the statutory role and
responsibilities of governors, was updated to
support the governor induction programme.
Future membership – actions for
2015/16
Three issues of The Foundation Times, our
members newsletter and one Annual Review
were published and circulated to all members
during the year. Governors play a significant
part in contributing to these publications.
During 2015/16 the Trust will endeavour to
build on the work already undertaken and
identify new opportunities to maintain existing
membership. The objectives set in the
Membership Strategy are:
In the March 2015 election, 12 Members put
themselves forward for election with 10 Council
of Governors positions available, commencing
in post on 1 April 2015. There was active
promotion internally and in the community
leading up to and during the election, which
included media coverage and community
newsletters. Governors were involved with
researching online voting which was introduced
as another available option to posting ballot
papers in 2015.
Building the membership
1. To increase the number of active, informed
members who are representative of
patients and local communities, by a
variety of methods including working with
local partnership agencies to undertake
recruitment.
Managing active membership
2. To ensure electoral processes are in place
and elections appropriately advertised to
encourage more members to stand for
election to the Council of Governors or vote
for others who they would like to represent
them.
During 2014/15, governors attended a number
of local community events including seven
‘Here 2 Hear’ listening events. These were
held in Basildon and Orsett hospitals and were
an opportunity for governors to meet with the
67
3. To review socio-economic membership
activity, to provide a focus on underrepresented groups and communities for
future recruitment.
4. To provide performance reports on the
analysis of current membership to meet
regulatory requirements to the Board of
Directors.
5. To support elected governors to fulfil their
designated roles and responsibilities to
facilitate their participation in setting policy
and influencing decisions.
Communicating with members
6. To ensure members receive appropriate
communications to promote a better
understanding and have a say in healthcare
services the Trust provides.
7. To maximise opportunities to participate
in recruitment and engagement events by
targeting local communities, with governor
support provided to Trust officers.
Membership engagement
8. The Annual Members’ Meeting (AMM) and
Membership Strategy Working Group is
the overarching sub group of the Council of
Governors that monitors the effectiveness of
the Membership Strategy ensuring that:
z it remains a relevant and meaningful
document;
z action is taken in growing a representative
membership as this is a key element of
the Trust’s governance arrangements and
reporting on the progress at the Annual
Members Meeting.
The Council and Board of Directors approved
the revised Trust Membership Strategy in 2014.
68
Caring for patients with dementia
Areas the dementia project will be
concentrating on include:
Each year in our hospitals we care for
hundreds of patients with dementia. To
provide a focus for improving their care the
Trust established the Dementia Project, which
was officially launched with the opening of a
new reminiscence room at Basildon Hospital.
z Creating dementia friends, linking with
the Alzheimer’s Society. Dementia friends
learn a little bit more about what it’s like
to live with dementia and then turn that
understanding into action. Anyone of any
age can be a dementia friend
The 50s-themed room includes a kitchen and
living room area, old-fashioned furnishings
and a TV, giving a familiar background to
activities for patients with dementia, for whom
the hospital environment can seem extremely
daunting.
z Identifying dementia champions on each
ward
z Developing a dementia ‘care bundle’, which
is a set of documents that describe the care
to be provided
The room’s transformation was made possible
thanks to a generous donation from the
Basildon Hospital League of Friends.
z Setting up a carers forum
z Ensuring there is high quality staff
education, training and support
L-R (standing) Jane Gilby, project leard nurse; Richard Ernest, REMPODS; Diane Sarkar, director
of nursing; Karen Fashanu, matron; (seated) Sylvia Blake, Basildon Hospital League of Friends
69
70
6 Improvements for patients and staff
z Implemented a new way of completing ward
rounds in The Essex Cardiothoracic Centre.
The new model supports nurses and medical
staff to work together to improve patient
safety and reduce unnecessary time in
hospital.
Listening to our stakeholders
Our status as an NHS foundation trust means
we have much greater interaction with the
public through our governors. The 19 public,
five staff and six stakeholder governors work
hard to ensure the Trust is aware of the views of
local people and communities through attending
local events, membership recruitment days and
contributing to workshops and meetings. This
informs our plans for the future.
z Made changes to the shift patterns for
nursing staff to improve continuity of care for
patients during the day.
Our staff work hard to help people and
on occasions this can be in unique ways.
Examples in 2014/15 include arranging for a
patient’s dog to come into the hospital so she
could see him, arranging a birthday party for a
long-term patient in the children’s department
and helping to arrange a wedding for a
terminally-ill patient.
Governors have provided honest and
constructive comments as have patients,
public, staff and partners, regulators and
commissioners and the Trust has been able to
make positive changes as a result. Examples of
service improvements include:
z Taking steps to improve the care of dementia
patients across the Trust, including opening a
reminiscence room on Kingswood Ward and
changing staff name badges making it easier
for patients to see quickly the name of the
staff looking after them.
The Trust has continued to build on the
improvements to the way it engages with staff,
patients and the public and how it listens to
their views and ideas. Examples of this during
2014/15 include:
z Strengthened our commitment to our older
population by pledging to become ‘dementia
friendly’. The Board of Directors are all
dementia friends, having undertaken training
in February 2015.
z Executive listening surgeries held each
month, where staff, patients and the public
can talk face to face to members of the
Executive Team to share their ideas and
concerns.
z Opened 20 additional beds in Basildon
Hospital to help ease expected pressures
over the winter period.
z Patient stories have continued at the Board
of Directors meetings, with the Board hearing
first-hand what patients and carers think of
the care they received.
z Undertook a transformation event ‘The
Perfect Ward’, to test new clinical and
administrative practices designed to reduce
the length of time patients spend in hospital.
z The Executive and Non-Executive Directors,
with governors, undertake visits to clinical
areas on the day of each Board meeting.
Each month is themed, to enable the Board
to receive feedback from patients, carers
and staff about key issues. The results of
these visits are reported in the public Board
meetings.
z Joined the national domestic abuse specialist
project (DASP), which aims to provide
support, advice and practical help to people
suffering from domestic violence.
71
z The Emergency Department participated in a
Tweetathon (using Twitter social media site)
to share with the public what happens during
an average day for them.
Throughout the year, we have maintained
regular contact with senior officers from
Monitor and the CQC. There is a regular flow of
information detailing the actions being taken by
the Trust to ensure it returns to compliance with
the conditions of its Licence (formerly its Terms
of Authorisation).
z The monthly quality report to the Board of
Directors, produced by the medical and
nursing directors, includes the views of
patients as posted on the NHS Choices
website.
The Trust maintains strong relationships with a
number of partner organisations, some of which
have representatives appointed to the Council
of Governors. These include:
z The Chief Executive holds a monthly staff
forum, where she provides contemporary
information about what is happening across
the Trust. This is then shared with all staff
through a cascaded briefing.
z Councils for Voluntary Services (CVS).
z Local authorities – recognising the interface
between health and social care services.
z The Director of Nursing holds regular
meetings with ward sisters to share new
information and hear what is happening on
the wards.
z South Essex College – for staff training and
shared facilities.
Stakeholder relations
z Essex County Council Health Overview and
Scrutiny Committee and Thurrock Council
Health and Wellbeing Overview and Scrutiny
Committee – to consider progress being
made at the hospital following external
reviews, any proposals to change services,
vary plans or assess compliance with
healthcare core standards.
z Anglia Ruskin and Essex Universities – for
nursing and midwifery training.
The Trust depends significantly on income
generated by delivering services commissioned,
in the main, by NHS Basildon and Brentwood
and NHS Thurrock Clinical Commissioning
Groups. Services are delivered through legally
binding contracts, which reflect the national
standards set by the Department of Health.
z South Essex Partnership NHS Foundation
Trust – to liaise on service delivery and
shared facilities.
The Trust signed a one-year contract for
2014/15 with Basildon and Brentwood Clinical
Commissioning Group acting on behalf of all
Essex commissioners apart from specialist
commissioning.
z University College London and Royal Free
Medical School – for undergraduate training
to medical students, and recognition of the
Trust as a university hospital.
The Trust must also satisfy Monitor, the
independent regulator of foundation trusts,
that it adheres to high standards of financial
management, governance and service delivery;
and the Care Quality Commission (CQC) that it
complies with the essential standards of quality
and safety.
z Southend University Hospital NHS
Foundation Trust – a strategic partnership
to develop models of networked services
to address some shared issues for our
organisations such as specialist skills, critical
mass and resource utilisation.
72
z Anglia Ruskin Health Partners (ARHP) and
University College London Partners (UCLP)
academic/health partnership that facilitate
shared learning and research.
against health and safety legislation, approved
code of practice, and health and safety
guidance, but also CQC essential standards.
The source of the reports will continue to be
health and safety related external inspections
and formal regulatory audits, but will now also
include the new health and safety compliance
audit reports. Such audits are scheduled
throughout the year and are fed directly into the
framework.
Health and Safety
The Trust accepts its responsibility to ensure
that a healthy and safe environment is
provided for all staff, patients and visitors,
and continues to deliver a quality service with
proven commitment in achieving its moral and
legislative duties.
The triggers for undertaking additional audits in
the health and safety and assurance framework
can now also be changes in legislation,
identification of accident and incident trends,
safety executive prosecution and enforcement
notices, and any other areas that require close
attention as and when they are identified. An
example of such an audit is the forthcoming
anchor point and ligature audit.
The health and safety governance structure
is well embedded within the Trust and allows
direct reporting to the Board. The Health and
Safety Management Group has representation
from all parts of the Trust and reports to
the Senior Management Group. One of its
many roles is to monitor and progress health
and safety in line with the key performance
indicators, the Health and Safety Assurance
Framework and the Health and Safety Work
Plan.
The areas of manual handling and slips, trips
and falls have received significant focus this
year as they are issues of high frequency
nationally. Incidents continue to be monitored
via bi-monthly and quarterly reports, with any
remedial action identified being actioned and
monitored. In addition, in response to Trust
specific incidents, inappropriate waste incidents
are also being monitored via bi-monthly and
quarterly reports, with any remedial action
identified being taken and monitored.
Work has continued throughout 2014/15 to
minimise the likelihood of workplace accidents,
ill-health and near-misses. The focus of this
work has been on those areas of high risk.
Monitoring of mandatory health and safety
related training within the Trust has continued
throughout the year, with low risk manual
handling e-learning and fire e-learning
continuing to maintain above 80% compliance.
Improvements in fire safety arrangements at
the Trust have been given significant focus
this year. The responsibility for overseeing this
sits with the Fire Safety Committee, led by the
Director of Estates and Facilities. Improvements
in this area include; two new members of staff
with responsibility for fire safety, improved
compliance with face to face fire training and
changes to the Trust estate to strengthen the
fire management arrangements.
The health and safety and assurance
framework is fully integrated into the Trust’s
new peer compliance audit system which is
managed by the Health and Safety department.
This enables the areas of inherently high risk
which are captured in the health and safety and
assurance framework to be reviewed not only
73
We have firm counter fraud policies, which are
promoted widely through formal and informal
awareness sessions. The Trust policies are
reviewed on a regular basis by the LCFS and
the Trust.
Throughout the year, 15 incidents were
reportable under the Reporting of Injuries,
Diseases and Dangerous Occurrences
Regulations 1995 (RIDDOR). These were
attributed to those incident types that are
known to be highly reported nationally, including
manual handling injuries and slips, trips
and falls. Actions are taken to minimise the
likelihood of reoccurrence of such incidents.
Our occupational health service is an integral
part of the Trust, focussing on maintaining
and improving staff health and wellbeing and
providing support and advice for staff who are
experiencing health difficulties.
A comprehensive occupational health
programme is provided, including preappointment health checks for all new
employees and a vaccination programme to
tackle seasonal flu and other communicable
diseases, in particular ensuring our staff are
protected against MMR. The occupational
health service has led on a health and
wellbeing strategy and involves Trust staff in
health improvement events, such as smoking
cessation, healthy weight loss and fitness
challenges.
Countering fraud and corruption
The Trust places strong emphasis on
countering fraud and corruption and follows the
NHS Protect Standards for Providers to ensure
that public funds are protected.
The Trust has an annual work plan, which is
agreed with our Local Counter Fraud Specialist
(LCFS) to ensure that appropriate coverage is
provided and maintained.
74
New lifeline for patients
The project has improved patient safety with
the installation of 28 new valves to the oxygen
main. This means that if a technical problem
occurs in one area of the hospital, this can
be isolated and the supply of oxygen can
be maintained to all other wards. Back-up
cylinders are used to ensure there is oxygen
for patients in affected areas.
Much of the important work to improve patient
care in hospitals goes on behind the scenes.
A highly specialised £136,000 project in the
basement of Basildon Hospital has provided a
more reliable oxygen supply for patients.
Oxygen is one of the most commonly
used medicines in hospitals, particularly in
emergencies. It may also be used for patients
with respiratory conditions or for therapies, to
relieve pain, for example. Last year, the Trust
used 12 million litres of oxygen at a cost of
£195,000.
The existing copper pipe, much of it 40 years
old, was removed and recycled to partly offset
the cost of the upgrade.
A new 550 metre copper main pipe was
installed under the main corridor, connecting
two large oxygen tanks at either end of the
hospital site.
Zoe Asensio-Sanchez, director of estates and facilities, with members of the estates team
75
76
7 Foundation Trust Code of Governance
Basildon and Thurrock University Hospitals
NHS Foundation Trust has applied the
principles of the NHS Foundation Trust Code of
Governance on a comply or explain basis. The
NHS Foundation Trust Code of Governance,
most recently revised in July 2014, is based on
the principles of the UK Corporate Governance
Code issued in 2012.
The rationale for compliance with this element
of the Code is detailed below:
Provision B.1.1 states that:
The Board of Directors should identify in the
annual report each Non-Executive Director it
considers to be independent. The Board should
determine whether the director is independent
in character and judgement and whether there
are relationships or circumstances which are
likely to affect, or could appear to affect, the
director’s judgement. The Board of Directors
should state its reasons if it determines that a
director is independent despite the existence
of relationships or circumstances, which may
appear relevant to its determination, including if
the director:
The Board of Directors reviews its compliance
with the Code of Governance provisions
annually and where it does not comply it
considers the risks associated with noncompliance and mitigates those risks as far as
possible.
All disclosures required by the Board of
Directors and its Committee can be found in the
Director’s Report at Section 3.
z has been an employee of the NHS foundation
trust within the last five years;
All disclosures required by the Council of
Governors about its activities can be found in
the Council of Governors at Section 4.
z has, or has had within the last three years,
a material business relationship with the
NHS foundation trust either directly, or as
a partner, shareholder, director or senior
employee of a body that has such a
relationship with the NHS foundation trust;
All disclosures required in relation to
remuneration can be found in the Director’s
Remuneration Report at Section 9.
All declarations required in relation to
Nominations can be found at Section 3 for
Executive Directors and Section 4 for
Non-Executive Directors.
z has received or receives additional
remuneration from the NHS foundation trust
apart from a director’s fee, participates in the
NHS foundation trust’s performance-related
pay scheme, or is a member of the NHS
foundation trust’s pension scheme;
The Code of Governance was revised in 2014
and the Board reviewed its compliance against
the revised Code in March 2014. Following
this review, the Board of Directors agreed the
Trust complied with all the main and supporting
provisions of the Code, where they were
applicable. However, Code Provision B.1.1
requires the Board to provide a rationale in the
event that a Non-Executive Director is found
to be independent despite the existence of
circumstances which may appear relevant to its
determination.
z has close family ties with any of the NHS
foundation trust’s advisers, directors or senior
employees;
z holds cross-directorships or has significant
links with other directors through involvement
in other companies or bodies;
z has served on the board of the NHS
foundation trust for more than six years from
the date of their first appointment; or
77
z is an appointed representative of the NHS
foundation trust’s university medical or dental
school.
2. The only one of the seven criteria for
independence under Provision B.1.1 that the
two NEDs do not meet is the length of time
that they have served on the Board, which is
a legacy of the Council of Governors’ original
decision regarding the length of the term for
which NEDs would be appointed. Both NEDs
are independent using the other six criteria.
Explanation:
Until 2013, all NEDs, including the Chairman,
were appointed by the Council of Governors for
specified terms of up to four years, and with an
opportunity to seek re-appointment for a further
term of office. Therefore, it was possible for a
NED to serve eight years on the Board. This
term of office was non-compliant with the Code
and was explained each year.
3. Both NEDs’ terms of office were confirmed
at the time they were re-appointed in March
2011 and March 2012 respectively and the
Council of Governors had not expressed
any reservations about their ability to remain
independent in re-appointing them for this
period.
To address this, in 2013, the Council of
Governors agreed that the terms of office
for future NEDs should be changed and
reduced the terms of office to three years and
for two terms only. This means that all new
appointments made from 2013 will be in full
compliance with this provision. The Trust’s
Constitution (July 2013) reflects this change.
5. The Senior Independent Director, must, by
definition remain independent to remain
effective in this role. The Council of
Governors expressed no concern about his
level of independence and continues to refer
to him as a source of advice.
In making this decision, the Board also
complies with Code Provision B.1.2, which
requires half of the Board of Directors to
be independent (seven NEDs and seven
voting Executive Directors) and Provision
C.3.1 relating to the membership of the Audit
Committee.
Two NEDs who served during 2014/15 had
been in post for more than six years. One of
these NEDs had been due to finish his term of
office in March 2015; however, he is currently
the Acting Chairman until a substantive
appointment is made. However, the Board
considered the two NEDs concerned in 2013/14
and determined that they would remain
independent until the end of their terms of office
for the following reasons:
One NED resigned in year and has not been
replaced. One Executive Director left the
Trust on 30 April 2015 when the composition
of the Board returned to seven NEDs and six
Executive Directors.
1. Independence is an attitude of mind that
is best evidenced by the actions of the
NED concerned. The Board of Directors
considered that the two NEDs have
continued to exert the same level of
constructive challenge to executive directors
that they have shown since first being
appointed to the Board.
78
8 Background information
This section includes items of information
which we are required to include in our
annual report.
The Better Payment Practice Code was
replaced by The Prompt Payment Code in
2009. The Trust is registered with this Code.
It applies the following principles to payment
practices.
Accounting policies
The accounting policies for the Trust are
shown on page 197 and include policies on
pensions and other retirement benefits. Details
of senior employees’ remuneration are set out
in the Remuneration Report on page 83. The
Trust’s external auditor and details of their
remuneration and fees are set out in note 5 in
the accounts.
z Pay suppliers on time.
z Give clear guidance to suppliers.
z Encourage good practice.
Fig.17: Public Sector Payment Policy
Performance
2014/15
Prompt Payment for suppliers
As a measure of performance the Trust aims to
pay at least 95% of its invoices in accordance
with these obligations. Its performance is
summarised in Fig.17.
Performance
2013/14
By
value
By
volume
By
value
By
volume
93.0%
93.7%
94.7%
94.9%
There has been a slight reduction in the
performance compared to last year. This is as
a result of the introduction of stringent financial
controls which caused some minor delays in
payments while the controls were bedding in.
The Trust supported The Better Payment
Practice Code that was established in 1998 by
business and government, to help improve the
payment culture amongst organisations trading
in the UK. The Code is supported by public as
well as private sector organisations. Collectively
they represent about 20% of the UK’s gross
domestic product.
The Trust was not required to make any
payments of interest under the Late Payment of
Commercial Debts (Interest) Act 1998.
This simple code sets out the following
obligations of a business to its suppliers:
Internal Auditors
The Internal Audit function is provided by
TIAA Ltd, an independent business assurance
provider. Internal Audit reports to the Audit
Committee and follow a work plan of audits as
agreed by the Committee.
z Agree payment terms at the outset of a deal
and stick to them.
z Explain your payment procedures to
suppliers.
z Pay bills in accordance with any contract
agreed with the supplier or as required by
law.
The contract with Tiaa Ltd runs through to
March 2016.
z Tell suppliers without delay when an invoice
is contested, and settle disputes quickly.
79
Due to changes in prices the net revaluation
was an increase of £16.9million; land values
increased by £6.8million, buildings and
dwellings increased by £10.1million.
External Auditors
The external auditors appointed with effect from
1 April 2011 were PKF. On 28 March 2013, PKF
(UK) LLP merged its business into BDO LLP
and the Trust has novated the contract for the
supply of statutory audit services to the merged
firm. Accordingly, the auditor’s report is in the
name of the merged firm.
There are no property, plant and equipment
assets where, in the directors’ opinion, the
market values are significantly different from the
values shown in the accounts.
The Council of Governors were informed of the
merger in January 2013 and they approved a
recommendation to appoint BDO as the Trust’s
external auditors.
Political and charitable donations
As an NHS foundation trust, we make no
political or charitable donations. The Trust
continues to benefit from charitable donations
received and is grateful for the efforts of
fundraising organisations and members of the
public for their continued support.
As far as the directors are aware there is no
relevant information of which the auditors are
unaware. The directors have taken all of the
required steps to make themselves aware of
any relevant audit information, and to establish
that the auditors are aware of it.
Cost allocation and charging
requirements
External Evaluation of Governance
The Trust has complied with the cost allocation
and charging requirements as set out in
HM Treasury and Office of Public Sector
Information guidance.
An independent financial governance review
was undertaken by the professional service
company, Grant Thornton UK LLP. They do not
have any other connection to the Trust.
Post balance sheet events
Fixed assets
Details of any post balance sheet events are
provided in note 23 to the accounts.
As stated in note 1.7 to the accounts, property,
plant and equipment are stated at the lower
of replacement cost and recoverable amount.
DTZ carried out the last complete re-valuation
of land, buildings and dwellings as at 31
March 2015. The next full revaluation is due in
2016/17.
Financial instruments
The Trust does not have any significant
exposure to interest rate or exchange rate risks
and therefore does not hold any complicated
financial instruments to hedge against
such risks. Details of the Trust’s Financial
Instruments are shown in note 29 to the
accounts.
80
Pensions and retirement benefits
The accounting policies for pensions and other
retirement benefits are set out in note 31 to the
accounts and details of the senior employees
remuneration can be found in page 91 of the
remuneration report.
Directors Register of Interests
The Directors Register of Interests, which
provides detail of all company directorships
and other significant interests can be found on
the Trust website. The Register of Interests for
Governors, providing the same detail, can be
accessed via the Corporate Secretary (01268
524900 ext. 3943).
81
Self-care makes life easier for kidney patients
Dialysis nurses at Basildon and Orsett
hospitals encourage patients to manage their
own dialysis, either at home, if it is suitable
for them, or in the renal unit, so they can fit
treatments around their own schedules.
So far 40 patients have been trained to
operate dialysis equipment. One of these
is Colin Ashburn, who is now able to fit his
treatment round his full time work. He was
diagnosed with kidney failure three years ago
and now needs four sessions of dialysis a
week.
Dialysis is a treatment that replicates many
of the kidney’s functions, filtering the blood
to get rid of harmful waste, extra salt and
water. About 20,000 people in Britain receive
dialysis, most of them over the age of 65.
Colin, 46, said: “My employers are very
accommodating about my condition, but the
job involves a lot of meetings and planning
ahead, and that had to be fitted around the
appointments in the renal centre, and what
times the nurses have available.
“Being able to come into the renal unit and
operate the equipment myself at times to suit
me makes life a lot easier.”
Santhy Gopalan, sister on the renal unit,
said: “Colin is a wonderful patient, like all
our patients. He is learning very quickly, but
of course we will take time to teach anyone
to do self-care, if they want to do it and are
suitable.”
Colin Ashburn, patient; Santhy Gopalan, sister
82
9 Remuneration report
The remuneration package and conditions of
service for executive directors is agreed by the
Remuneration and Nominations Committee, a
Committee of the Board of Directors consisting
of all the NEDs, including the Chairman of the
Trust. In setting the remuneration for directors,
the Committee takes account the following:
Annual Statement from the Chair of
the Remuneration and Nominations
Committee
During the year the Remuneration Committee
received a report from the Chief Executive on
the remuneration of the Executive directors.
It agreed to increase the salary of the Deputy
Chief Executive to maintain an appropriate
differential between this post and the newly
appointed Chief Operating Officer and Director
of Finance. The Committee also agreed to
increase the salary of the Chief Executive, the
Medical Director and the Director of Nursing
in recognition of the achievement of their
stretch objectives agreed at the beginning of
the year, and in the case of the Director of
Nursing, to also ensure that her salary was at
an appropriate level relative to more recently
appointed executives. No other executive
director received an increase in their salary in
2014/15.
z Market value of similar posts in similar size
organisations.
z The benchmarking information provided by
the Foundation Trust Network.
z The pay rates for those staff reporting to the
director in question.
The remuneration for executive directors
does not include any performance-related
bonuses and none of the executives receives
personal pension contributions other than their
entitlement under the NHS pension scheme.
The components parts of the remuneration
package for senior managers are detailed in
Fig.18:
Senior Managers’ Remuneration
Policy
The Trust’s remuneration policy states that
Agenda for Change applies to all directly
employed staff except very senior managers
(directors) and those covered by the Doctors’
and Dentists’ Pay Review Body. The Knowledge
and Skills Framework has been adopted to
assess performance of those staff subject to
Agenda for Change and a system of appraisal
and personal development planning has been
adopted for all staff. There are, at the current
time, no plans to change this policy.
83
Fig.18: Remuneration package components for senior managers
Basic salary
Pension
Bonus
Benefits
Each year, the
Remuneration
and Nominations
Committee considers
the contribution of each
director against the
functions of the post as
defined in the current
job description and as
foreseen for the future.
This is carried out in
parallel with a review of
the individual’s career
development and
potential opportunities
for progression.
The Executive Directors
are able to join the
standard NHS pension
scheme that is available
to all NHS staff.
Bonuses are not given
to staff, including senior
managers. The Medical
Director, however,
received a clinical
excellence award (CEA)
during 2014/15.
The Trust operates
a number of salary
sacrifice schemes,
including child care
vouchers and a car lease
scheme. This is open to
all permanent members
of staff.
Clinical Excellence
Awards recognise and
reward NHS consultants
and academic GPs
who perform ‘over and
above’ the standard
expected of their role.
Awards are given for
quality and excellence,
acknowledging
exceptional personal
contributions. This is a
national initiative.
The executive directors all hold permanent
contracts. The notice period for executive
directors is six months and there are no
additional arrangements for enhanced
termination payments or compensation for early
termination of contract. The Trust does not use
confidentiality agreements, unless related to
patient identifiable information.
The individual forgoes
an element of their
basic pay in return for a
defined benefit.
The Council of Governors NED Remuneration
and Appointments Committee met on one
occasion to consider NED remuneration and
recommended that, in line with the national
pay award, and after reviewing the comparison
information provided by the Foundation Trust
Network, the NEDs, including the Chairman,
would receive a 1% pay increase commencing
1 April 2014.
The executive directors each have objectives
set by the Remuneration Committee that are in
line with the strategic objectives of the Trust.
The Trust is not liable for any compensation
payments to former senior managers or
amounts payable to third parties for the
permanent services of a senior manager.
These are then reviewed as part of an on-going
appraisal system.
NEDs contracts are based on a fixed fee as
detailed in Fig.21a. Additional fees are payable
for the role of Deputy Chairman, and Senior
Independent director and Chair of the Audit
Committee as detailed in Fig.21a.
There are no amounts to be recovered or
payments to be withheld from the executive
directors.
The Trust does not consult with employees
when preparing the seniors managers’
remuneration policy.
NEDs contracts are summarised in Fig.19.
84
Annual report on Remuneration
Information not subject to audit.
Service Contracts
The term of office for non-executive directors
is three years with the possible renewal for a
further term to a maximum of six years. The
termination of a non-executive director contract
would be the responsibility of the Council of
Governors.
Fig.19 below details the current contracts that
are in place.
Fig.19: Non-Executive Directors Contracts
Name
Appointment
date
Start of
End of current
current term
term
Bob Holmes
December 2006
April 2011
March 2015*
Peter Sheldrake
December 2007
April 2007
March 2016
Ian Luder (resigned January 2015)
April 2012
April 2012
March 2015
Anne Marie Carrie
(resigned February 2015)
April 2012
April 2012
March 2016
John Govett
April 2012
April 2015
March 2018
David Hulbert
April 2012
April 2015
March 2018
Barbara Riddell
April 2012
April 2012
March 2016
Elaine Maxwell
April 2014
April 2014
March 2017
* Mr Holmes has been the Deputy Chair for a number of years. He stepped up to the role of Chair
in January 2015 and is therefore still in post. He will complete his term of office at the end of June
2015.
85
Remuneration Committee
is responsible for remuneration of the senior
managers for the Trust. Full details of the
committee can be found on page 45.
Fig.10 (page 44) details the committee
members and their attendance at meetings
throughout the year .
Expenses
Expenses have been paid to both directors and
governors during the year in Figs. 20a and 20b.
Fig.20a: Directors and Governors expenses
2014/15
2014/15
Total in Office
Directors
Governors
21
30
51
Total Receiving
Expenses
11
13
24
Total Expenses
£
12,247
3,293
15,540
Total Receiving
Expenses
13
12
25
Total Expenses
£
13,038
3,119
16,157
Fig.20b: Directors and Governors expenses
2013/14
2013/14
Total in Office
Directors
Governors
18
41
59
Note: The number includes all Directors or
Governors who served for any part of the
financial year.
86
Personal Service Contracts
For all off-payroll engagements as of 31 March
2015, for more than £220 per day and that last
longer than six months:
The Trust is obliged to disclose all off-payroll
engagements. This places a requirement
upon the Trust to establish the employment
status of workers and to obtain evidence about
the tax and National Insurance Contribution
obligations of workers engaged by or seconded
from a company (including personal services
companies).
Number of existing engagements as at
31st March 2015
Of which:
Number that have existed for less than
one year at the time of reporting
Number that have existed for between
one and two years at the time of reporting
two and three years at the time of
reporting
three and four years at the time of
reporting
Number that have existed for more than
four years at the time of reporting
When interim staff are appointed by the Trust
the individuals are asked to sign a personal
service contract with the Trust. The contract
includes clauses within it that state:
z The temporary contractor is liable to be taxed
in the UK and shall at all times comply with
income Tax (Earnings and Pensions) Act
2003 and all other statutes and regulations
relating to income tax.
z The temporary contractor is liable to National
Insurance Contributions (NICs) in respect of
consideration received under the contract
with the Trust and shall at all times comply
with the Social Security Contributions and
Benefits Act 1992 and all other statutes and
regulations relating to NICs.
Number that have been terminated as a
result of assurance not being received
20
10
6
0
0
4
0
All of the above engagements have a personal
service contract in place and have, at some
point been asked to provide evidence of
compliance with the Income Tax and NICs
regulations.
z The Trust may request evidence that the
temporary contractor has complied with these
regulations.
z The Trust may supply any information it
receives to Her Majesty’s Revenue and
Customs (HMRC) for further investigation.
The Trust requests evidence of compliance
from all contractors on a personal service
contract once their contract extends beyond a
six month period.
87
Andy Morris was in post as interim Director of
Finance from September 2013 to September
2014 due to problems in recruiting. Rick Tazzini
joined the Trust on a substantive contract as
Director of Finance in November 2014. There
are no longer any board members or senior
officials with significant financial responsibility
operating through a personal service contract.
For all new off-payroll engagements, or those
that reached six months in duration, between
1 April 2014 and 31 March 2015, for more than
£220 per day and that last for longer than six
months:
Number of new engagements, or those
that reached six months in duration,
between 1 April 2013 and 31 March 2014
Number of the above which include
contractual clauses giving the Trust the
right to request assurance in relation
to income tax and National Insurance
obligations
Number for whom assurance has been
requested
Of which:
Number for whom assurance has been
received
Number for whom assurance has not
been received
10
10
10
10
For any off-payroll engagements of board
members, and/or, senior officials with significant
financial responsibility, between 1 April 2013
and 31 March 2014:
Number of off-payroll engagements of
board members, and/or, senior officials
with significant financial responsibility,
during the financial year
Number of individuals that have been
deemed ‘board members and/or
senior officials with significant financial
responsibility’, during the financial year.
This figure includes both off-payroll and
on-payroll engagements
1
21
88
Information subject to audit.
Directors’ remuneration
Fig.21a: Directors’ Remuneration 2014/15
Salary
and
Fees
Pension
Related
Benefits
Bonus
Benefits
*
**
(bands of
£5,000)
(bands of
£2,500)
(bands of
£5,000)
(bands of
£5,000)
(bands of
£5,000)
£’000
£’000
£’000
£’000
£’000
Ian Luder
Chairman (to January 2015)
30 - 35
-
-
-
30 - 35
Bob Holmes
Non-Executive (to January 2015)
Acting Chair (from January 2015)
20 - 25
-
-
-
20 - 25
10 - 15
-
-
-
10 - 15
10 - 15
-
-
-
10 - 15
10 - 15
-
-
-
10 - 15
Elaine Maxwell, Non-Executive Director
10 - 15
-
-
-
10 - 15
10 - 15
-
-
-
10 - 15
Peter Sheldrake, Non-Executive Director
15 - 20
-
-
-
15 - 20
185 - 190
47.5 - 50.0
-
0-5
235 - 240
Zoe Asensio-Sanchez, Director of Estates and
Capital Development
100 - 105
20.0 - 22.5
-
-
125 - 130
Hannah Coffey, Chief Operating Officer (to
May 2014)
10 - 15
0 - 2.5
-
-
10 - 15
Danny Hariram, Director of Workforce and
Organisational Development (from March
2015)
5 - 10
12.5 - 15.0
-
-
20 - 25
Nigel Kee, Chief Operating Officer (from July
2014)
85 - 90
77.5 - 80.0
-
-
165 - 170
Stephanie Lawton, Acting Director of
Workforce and Organisational Development
(November 2014 to February 2015)
35 - 40
2.5 - 5.0
-
0-5
40 - 45
105 - 110
-
-
-
90 - 95
Andy Morris, Interim Director of Finance (to
September 2014)
95 - 100
-
-
-
95 - 100
120 - 125
80.0 - 82.5
-
-
200 - 205
Adam Sewell-Jones, Deputy Chief Executive
125 - 130
22.5 - 25.0
-
5 - 10
155 - 160
Dr Celia Skinner, Medical Director
145 - 150
12.5 - 15.0
35 - 40
-
195 - 200
Nigel Taylor, Director of Personnel and
Organisational Development (to November
2014)
55 - 60
-
-
-
45 - 50
Rick Tazzini, Director of Finance (from
November 2014)
50 - 55
37.5 - 40.0
-
0-5
90 - 95
Name and Title
Total
Chairman
Non-Executive Directors
Executive Directors
89
Fig.21b: Directors’ Remuneration 2013/14
Salary
and
Fees
Pension
Related
Benefits
Bonus
Benefits
*
**
(bands of
£2,5000)
(bands of
£5,000)
(bands of
£5,000)
(bands of
£5,000)
(bands of
£5,000)
£’000
£’000
£’000
£’000
£’000
40 - 45
-
-
-
40 - 45
Trevor Parks, Non-Executive Director
10 - 15
-
-
-
10 - 15
Bob Holmes, Non-Executive Director
10 - 15
-
-
-
10 - 15
Name and Title
Total
Chairman
Ian Luder
Non-Exec (from April 2012)
Chairman (from July 2012)
Non-Executive Directors
Peter Sheldrake, Non-Executive Director
10 - 15
-
-
-
10 - 15
10 - 15
-
-
-
10 - 15
10 - 15
-
-
-
10 - 15
10 - 15
-
-
-
10 -15
10 - 15
-
-
-
10 -15
(from September 2012)
175 - 180
82.5 - 85.0
-
0-5
260 - 265
Hannah Coffey, Chief Operating Officer
105 - 110
30.0 - 32.5
-
-
135 - 140
105 - 110
(2.5 - 5.0)
-
-
100 - 105
130 - 135***
-
-
-
130 - 135
45 - 50
10.0 - 12.5
-
-
55 - 60
Dr Celia Skinner, Medical Director
(from February 2013)
145 - 150
120 - 122.5
35 - 40
-
300 - 305
105 - 110
35.0 - 37.5
-
-
140 - 145
Adam Sewell-Jones, Deputy Chief
Executive
130 - 135
32.5 - 35.0
-
5 - 10
170 - 175
Nigel Taylor, Director of Personnel &
100 - 105
(2.5 - 5.0)
-
-
95 - 100
45 - 50
0 - 2.5
-
-
50 - 55
Executive Directors
Andy Morris, Interim Director of Finance
(from September 2013)
Andy Ray, Acting Director of Finance
(February 2013 to September 2013)
Zoe Asensio-Sanchez (nee Smith),
Director of Estates and Capital Development
(from October 2013)
*
In accordance with the HM Treasury ARM, payments of Clinical Excellence Awards have been shown as
bonuses
** Benefits in kind is the taxable value of benefits provided, the values are calculated in accordance with
Inland Revenue rules and relates to the salary sacrifice schemes
*** In the table above one of the Executive directors, Andy Morris, from Integrity Addition Consulting Limited,
is working in an interim capacity. The total remuneration shown for this individual is not comparable with
the other executive directors as there is no entitlement to pension, annual leave, public holiday, sick
leave or any other similar entitlements for substantive staff.
90
91
0.0 - 2.5
2.5 - 5.0
0.0 - 2.5
0.0 - 2.5
2.5 - 5.0
0.0 - 2.5
0.0 - 2.5
Danny Hariram,
Director of Workforce and Organisational Development (from
March 2015)
Nigel Kee,
Chief Operating Officer (from July 2014)
Stephanie Lawton,
Acting Director of Workforce and Organisational
Development (from November 2014 to February 2015)
Mark Magrath,
Commercial Director
Diane Sarkar,
Director of Nursing
Adam Sewell-Jones,
Deputy Chief Executive
Dr Celia Skinner,
Medical Director
Rick Tazzini,
Director of Finance (from November 2014)
0.0 - 2.5
-
0.0 - 2.5
Hannah Coffey,
Chief Operating Officer (to May 2014)
Nigel Taylor,
Director of Personnel and Organisational Development
(to November 2014)
0.0 - 2.5
Zoe Asensio-Sanchez,
Director of Estates and Capital Development
-
-
5.0 - 7.5
5.0 - 7.5
12.5 - 15.0
0.0 - 2.5
0.0 - 2.5
10 - 12.5
0.0 - 2.5
0.0 - 2.5
-
7.5 - 10.0
£’000
£’000
2.5 - 5.0
Real
increase
in pension
lump sum
at age 60
(bands of
£2,500)
Real
increase
in pension
at age 60
(bands of
£2,500)
Clare Panniker,
Chief Executive
Name and Title
Fig.22: Directors’ pension benefits
Directors’ pension benefits
65 - 70
40 - 45
60 - 65
35 - 40
30 - 35
45 - 50
25 - 30
20 - 25
20 - 25
20 - 25
0-5
55 - 60
£’000
-
130 - 135
185 - 190
105 - 110
95 - 100
140 - 145
80 - 85
70 - 75
65 - 70
65 - 70
-
165 - 170
£’000
726
-
1,164
551
533
937
377
440
337
289
27
952
£’000
33
-
65
42
83
29
8
71
10
2
18
80
£’000
628
859
1,071
495
438
884
342
334
210
264
8
849
£’000
Cash
Real
Cash
Lump sum
Total
at age 60 Equivalent Increase Equivalent
accrued
Transfer
in Cash
Transfer
pension at related to
Value at
Equivalent
Value at
accrued
age 60 at
31 March
Transfer
31 March pension at 31 March
2014
Value
2015
31 March
2015
2015
(bands of
(bands of
£5,000)
£5,000)
7
215
26
18
17
15
5
12
1
1
15
26
£’000
Employer
contribution
to
stakeholder
pension
Notes to Fig. 22
As Non-Executive members do not receive
pensionable remuneration, there will be no
entries in respect of pensions for Non-Executive
members.
Real Increase in CETV – this reflects the
increase in CETV effectively funded by the
employer. It takes account of the increase in
accrued pension due to inflation, contributions
paid by the employee (including the value of
any benefits transferred from another pension
scheme or arrangement) and uses common
market valuation factors for the start and end of
the period.
A Cash Equivalent Transfer Value (CETV) is
the actuarially assessed capital value of the
pension scheme benefits accrued by a member
at a particular point in time. The benefits valued
are the member’s accrued benefits and any
contingent spouse’s pension payable from
the scheme. A CETV is a payment made by
a pension scheme, or arrangement to secure
pension benefits in another pension scheme
or arrangement when the member leaves a
scheme and chooses to transfer the benefits
accrued in their former scheme. The pension
figures shown relate to the benefits that the
individual has accrued as a consequence of
their total membership of the pension scheme,
not just their service in a senior capacity to
which the disclosure applies. The CETV figures,
and from 2004/05 the other pension details,
include the value of any pension benefits in
another scheme or arrangement which the
individual has transferred to the NHS pension
scheme. They also include any additional
pension benefit accrued to the member as a
result of their purchasing additional years of
pension service in the scheme at their own cost.
CETVs are calculated within the guidelines
and framework prescribed by the Institute and
Faculty of Actuaries. For senior managers that
join the Trust during the year the opening CETV
is estimated by the Trust based on the closing
CETV and the movements realised from other
senior managers based on length of service
and age.
The Trust has not made any contributions to
stakeholder pensions for senior managers
during the year.
92
Last year, the highest paid director was the
interim Director of Finance who was paid via an
off-payroll engagement. As the interim director
of finance completed his assignment with the
Trust in September 2014 he does not feature
in this calculation. This has resulted in a large
reduction in the highest paid director.
Fair Pay Multiple
Foundation 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.
The annualised remuneration of the highestpaid director in the Trust in the financial year
2014/15 was £180,000 – £185,000 (2013/14,
£215,000 – £220,000). This was 7.6 times
(2013/14, 8.8) the median remuneration of
the workforce, which was £24,000 (2013/14,
£25,000).
The median remuneration has dropped but
this is to be expected. The Trust has invested
significantly in additional staffing, particularly in
newly qualified nursing staff, along with the full
impact of the change in on-call arrangement
whereby overtime is no longer paid as it is
built into the basic remuneration. The full year
impact of this has been seen in 2014/15.
Total remuneration includes salary, nonconsolidated performance-related pay, benefitsin-kind as well as severance payments. It does
not include employer pension contributions or
the cash equivalent transfer value of pensions.
The median remuneration for all employees
is based on employees with a permanent
contract with the Trust as at 31 March 2015
and earnings have been adjusted for part
time staff with any overtime or other additional
hours excluded. Agency staff working at the
year-end have also been included in the
median calculation, with the cost reduced by
an estimation for the amount of commission
included in the cost.
These, combined, have the impact of
decreasing the ratio to 7.6 for 2014/15.
Clare Panniker
Chief Executive
Fig.23: Highest and median
remuneration
Band of Highest
Paid Directors Total
Remuneration
Median Total
Remuneration
Ratio
2014/15
£’000
2013/14
£’000
180-185
215-220
24
25
7.6
8.8
93
27 May 2015
94
10 Regulatory report
As a foundation trust and provider of hospital
services, and a significant employer in the
area, the Trust is accountable to a number of
regulators. The main regulators in respect of
the hospital services are Monitor and the Care
Quality Commission.
These regulators rate the performance of the
Trust and the Trust’s performance against its
plan is shown in the figures below.
Fig.24: Regulatory Ratings
Q1
Q2
Annual
2013/14
2013/14
Plan
2013/14
Under Compliance Framework
Financial Risk Rating
3
3
3
Governance Risk Rating
Red
Red
Red
Under Risk Assessment Framework
Continuity of Services Rating
N/A
N/A
N/A
Governance Rating
N/A
N/A
N/A
Continuity of Services Rating
Governance Rating
Annual
Plan
2014/15
3
Red
Q3
2013/14
Q4
2013/14
N/A
N/A
N/A
N/A
3
Red
2
Red
Q1
2014/15
Q2
2014/15
Q3
2014/15
Q4
2014/15
2
Red
1
Green
1
Green
1
Red
95
At the end of 2014/15, the Trust was ranked
as ‘good’ by the Care Quality Commission but
with one outstanding compliance action. Further
details of this can be found in the Annual
Governance Statement on page 167.
The regulatory ratings in Fig.24 were assessed
by Monitor in accordance with the Compliance
Framework until October 2013, following
which the Risk Assessment Framework (RAF)
became the regulatory assessment framework.
Compliance with both frameworks is therefore
included for the previous year.
Section 43 (2A) of the NHS Act 2006 (as
amended by the Health and Social Care
Act 2012) requires that the income from
the provision of goods and services for the
purposes of the health service in England must
be greater than its income from the provision of
goods and services for any other purposes. Of
the £294.4 million of income generated during
2014/15 £265.7 million (90.3%) relates directly
to the provision of NHS health care.
The financial risk rating ranges from 1 (worst)
to 4 (best). A rating of 3 indicates that there are
some concerns in one or more components but
that a significant breach is not likely, a score of
4 indicates that there are no concerns. Under
the RAF, the continuity of services rating is a
combination of two measures; liquidity and
capital service coverage. A rating is given to
each element and aggregated to an overall
Continuity of Services rating. Any overall score
of below 4 may trigger increased scrutiny from
Monitor.
The deterioration in the RAF rating for finance
is explained further in the Strategic Report,
Section 2 and the Annual Accounts, Section 16.
A governance risk rating of green indicates
that there are no concerns with plans for
ensuring compliance with the Trust’s terms
of authorisation. A rating of amber indicates
that there are some concerns and a rating of
red indicates that there are concerns that the
Trust may be in serious breach of its licence
(previously terms of authorisation).
In February 2015, Monitor, the independent
regulator of foundation trusts, found the
Trust to be in breach of its Licence following
the significant deterioration of the financial
position from that planned at the beginning of
the year. In response, the Trust has provided
the Regulator with Undertakings, the detail of
which can be found in the Annual Governance
Statement (page 167).
96
11 Quality report
Foundation Trusts are required to produce
an annual quality report published within the
Annual Report, providing information about the
quality of services delivered and priorities for
improvement.
How we produced the quality report
As a provider of healthcare, the Trust’s priority
is to ensure our patients receive high quality,
safe care.
The Trust is committed to making ongoing improvements, and each year we set
challenging quality improvement goals with the
aim of becoming one of the safest organisations
in the NHS.
The quality report provides a good opportunity
to show how well we have performed and
where we could make improvements. It shows
the data we use to monitor improvement in
patient safety, clinical effectiveness and patient
experience.
In developing this year’s quality report, the Trust
has ensured that governors, local HealthWatch,
staff and other stakeholders including the local
Clinical Commissioning Groups (CCGs), have
had an opportunity to comment on the quality
priorities for the Trust.
This is the sixth quality report produced by the
Trust.
The quality report is set out in three sections:
Part 1: A statement on quality from the Chief
Executive, Clare Panniker
A variety of methods were used to collect
feedback and views, including face-toface meetings, presentations and written
correspondence. A dedicated email account
was also set up to help a wider audience
participate in decisions about the Trust’s quality
goals for the coming year.
Part 2: Priorities for improvement
In this section the Trust sets out key
commitments for improving the quality
of services provided. We look back at
our quality aims for last year and look
forward as we set out priorities for the
year ahead.
We asked our stakeholders to comment on
key quality goals that will support care that is
safer, offers better clinical outcomes, improves
reliability and delivers better patient experience
under the following headings:
Included in this section are statements
about the organisation which are
intended to help people compare
different health organisations.
Care that is safer:
Part 3: Review of quality performance
This demonstrates how the organisation
has performed to date.
z Reducing harm from hospital acquired
pressure ulcers.
z Reducing harm from injurious falls.
97
z Patient experience
Care that is reliable:
Quality of care includes quality of caring.
This means how personal care is delivered
and the compassion, dignity and respect
with which patients are treated. It can only
be improved by analysing and understanding
patient satisfaction with their experience of
NHS services.
z Further reduce hospital mortality (measured
through Hospital Standardised Mortality
Ratio, (HSMR) and Summary Hospitallevel Mortality Indicator (SHMI) and crude
mortality).
z Reducing harm from deterioration by
reducing our cardiac arrest rate.
z Clinical effectiveness
Care that is personal:
This means understanding success rates
from different treatments for different
conditions. Assessing this will include clinical
measures such as mortality or survival rates,
complication rates and measures of clinical
improvement. Clinical effectiveness may also
extend to people’s wellbeing and ability to
live independent lives.
z Improve both the response rate and
recommender score for the Friends and
Family Test.
We also looked at our internal clinical quality
performance information and national indicators
to reach our decision on what the quality
priorities for the Trust should be in 2015/16.
The goals will be monitored through the
Trust’s quality governance processes. These
include performance reports at monthly Board
meetings, corporate quality governance
meetings for safety, patient experience and risk
and compliance, Divisional governance groups,
clinical support unit performance meetings and,
where relevant, for public display on wards and
in departments.
What is quality in healthcare?
High quality healthcare is safe and effective
care that is delivered in a compassionate
way, treating patients with respect. Quality in
healthcare can be described through three
domains:
z Patient safety
The first domain of quality must be that we
do no harm to patients. This means ensuring
the environment is safe and clean, reducing
avoidable harm such as drug errors or rates
of healthcare associated infections.
98
The year has not been without its challenges.
Increasing patient expectations, national
financial constraints and patients who are living
longer with more complicated health needs
mean the NHS has been under unprecedented
pressure and needs to find ways to change in
order to meet the new demands. We spent the
year looking at different ways of working to see
how we can improve our services at the same
time as becoming more efficient.
Part 1 - Chief Executive’s Statement
on Quality
This is the third quality report I have overseen
for the Trust. The quality of our services has
improved significantly during 2014/15 and I
know from the messages I receive, patients are
more satisfied than they ever have been.
The Care Quality Commission (CQC) published
its report in June 2014 into our services
following their inspection of the Trust in March
2014. We achieved an overall rating of ‘good’
and on the advice of Professor Sir Mike
Richards, chief inspector of hospitals, the Trust
was removed from special measures. I am
particularly proud of our maternity services that
were rated as ‘outstanding’ with an open culture
and strong focus on patient experience, safety
and risk management.
In particular this year, in common with many
acute Trusts, we have experienced an
unprecedented high demand for emergency
inpatient services, which has meant bed
capacity has been stretched. This has required
an intense focus on how we manage the flow
of patients through our hospitals; it has placed
additional pressure on our staff and created
challenges to maintaining the quality of care
and positive experience of patients.
To quote the CQC ‘“Excellent leadership” has
changed the culture and behaviour of staff at
NHS Foundation Trust – and the CQC reported
“outstanding care and treatment” as well as
“innovation and good practice”.
I cannot pretend this has not been difficult, but
I do think the staff in our hospitals and those
working for other organisations that support our
hospitals have been incredible at keeping the
health system in south west Essex going during
such difficult times.
My response has been a simple one; we
couldn’t have done any of this without the
extraordinary hard work, dedication and
commitment of staff.
I am very proud of what has been achieved and
look forward to another year of putting care and
compassion at the heart of everything we do.
We have developed a positive culture, putting
patients first. We will continue to be open and
transparent, we will learn from our mistakes
and we will listen to our patients and respond
to their concerns. We have made it a priority to
encourage people to speak out if they think any
activity is jeopardising patient safety.
I can confirm to the best of my knowledge the
information contained within this document is
accurate and has received the full approval of
the Trust Board.
We recognise that this is not the end of our
journey. The CQC report did identify areas
where we need to improve and we have been
developing plans to address their concerns.
Clare Panniker
Chief Executive
99
Date: 27 May 2015
Part 2 - Priorities for Improvement
In this section of the quality report we look back at our quality goals for last year and look forward
as we set out the goals for the year ahead.
This section also includes statements about the organisation, which are intended to help people
compare different health organisations.
Looking back: priorities for improvement
in 2014/15
All of the goals identified in last year’s
quality account were important to the safe
and effective delivery of patient care. While
some continue to be priorities for this year
with additional resources allocated to make
further improvements, others have become
routine measures for the Trust on how well the
organisation is performing.
Fig.25 is a summary of the Trust’s performance
against the quality goals for 2014/15.
Fig.25: Performance against quality goals 2014/15
Patient Safety
Clinical
Effectiveness
Patient
Experience
Priority
Key objective
Measure
Rating
Improving patient safety:
Providing harm free care
to our patients both in and
out of hospital
Improving quality
and reliability of care:
Delivering excellent
outcomes for our patients
by implementing best
practice
Improving patient
and staff experience:
Providing our patients
and their carers with the
best possible experience
while they are using our
services and those of our
partners
To reduce patient
harm events
Process and
Outcome
Mostly
Achieved
To reduce harm
from deterioration
Outcome
Achieved
To improve score
for the Friends and
Family Test
Process and
Outcome
Mostly
Achieved
Red Quality priority not achieved
Amber Quality priority partially/mostly achieved
Green Quality priority achieved
100
Patient Safety Priorities 2014/15
Care that is safer:
The activities undertaken to achieve the quality goals in 2014/15 are described in further detail
below.
Fig 26: Improving patient safety
Quality
improvement goal
Aim
Achieved/
Not achieved
2013/14
2014/15 National
average
Source
Improving patient safety: Providing harm-free care to our patients both in and out of hospital.
Goal to reduce patient harm events.
Percentage of
patients with harm
free care
On or above
national average by
end of Q4
Improvement made
target not achieved
92.6%
93.8%
94.8%
HSCIC
Harm from injurious 20% reduction by
falls
end of Q4
Improvement made
target not achieved
8
1
N/A
Internal
Pressure ulcer
incidence
0.25 per 1,000 bed
days by end of Q4
Achieved
0.261
0.176
N/A
Internal
Reduction in Never
Events *
Zero
Not achieved
3
2
N/A
Internal
Reduction in
avoidable VTE
events **
20% based on Q1 & Achieved
2 outturn
14
8
N/A
Internal
* Cumulative for the year
** 14 events for the period March 2014 to September 2014 and 8 events for the period
October 2014 to March 2015
Percentage of patients with harm free care
The Trust measures harm free care through the
national benchmarking tool the Patient Safety
Thermometer. Developed by the NHS the
Safety Thermometer provides a ‘temperature
check’ on harm.
The results below reflect the work that has
been on-going throughout the year to improve
awareness of patient harm events and the
work to learn from when things go wrong and
change practices to reduce the risk of harm in
the future.
Staff in the hospital carry out a survey once
a month on the wards looking at harm events
including:
z Pressure ulcers
z Falls
z Catheter associated urine infections (UTI)
z Venous thromboembolism (VTE) events
There has been an improvement in the rate
of harm free care in 2014/15 when compared
to 2013/14, although performance is not yet
consistently on or above the national average
which was the goal set by the Trust last year.
101
dedicated time to work with staff to embed
knowledge and skills in reducing the number of
falls that result in serious injury.
The improvement made was supported by
the establishment of a Patient Harm Scrutiny
Group to ensure peer review of patient harm
events and to promote rapid sharing of any
learning from a harm event. The group’s main
achievements have been through:
Reducing harm from avoidable pressure
ulcers
z Engagement from matrons, senior sisters and
charge nurses, developing the ‘not on my
ward’ zero tolerance attitude to patient harm.
z Improved holding to account.
z Commissioner attendance and participation
ensuring transparency and openness to
tackling harm.
Reducing harm from falls
Accidental falls are the most commonly
reported patient safety incidents in NHS
hospitals. More than 200,000 hospital falls are
reported in English trusts each year, though
the actual figure is thought to be much higher.
Falls can lead to injury including fractures and
head injuries, impaired confidence, anxiety and
poor rehabilitation, and are a frequent factor
in patients needing long-term care. However,
there is evidence that the risk of falling in
hospital can be reduced and that these often
simple interventions can be missed.
This year the Trust has been involved in the
FallSafe project, which is a key initiative to
reduce harm from falls. The FallSafe project
facilitates improved knowledge and skills
among key ward staff and implements the use
of care bundles - important tasks that reduce
the risk of fall - and key visual prompts for staff
to help ensure that are aware of the risks to
their patients.
A major initiative this year was the appointment
of the Quality Improvement Fellow with
The incidence of pressure ulcers is a good
measure of the quality of care a patient
receives. If the fundamental elements of care
are in place, such as feeding and hydration,
and if patients are assessed correctly and
appropriate pressure relieving techniques are
used, then pressure ulcers should be a rare
occurrence. The Trust had a quality goal in
2014/15 to sustain a level of avoidable pressure
ulcers below 0.25 per 1,000 bed days and an
ambition to get to zero avoidable pressure
ulcers.
Successes include:
z Reduce from 0.5 to 0.25 per 1,000 bed days
avoidable pressure ulcers 13/14.
z Reduce from 0.25 to 1.9 per 1,000 bed days
avoidable pressure ulcers 14/15.
The main work this year centred on targeted
support to clinical areas experiencing the
highest number of pressure ulcers. A business
case for additional Tissue Viability Nurses
was successfully submitted in 2014/15,
and the additional staff will support further
improvements in 2015/16.
Never events
Never events are serious and largely
preventable. An updated list of never events is
published by the Department of Health each
year. This list includes a number of safetyrelated incidents that should not occur if best
practice guidance is followed.
102
When a never event occurs it is essential to
ensure that learning takes place to mitigate any
risk of a similar event occurring again. This
action goes hand in hand with fully working in
partnership with the Clinical Commissioning
Group and ensuring that the patient and/
or family affected is kept fully informed and
supported through the process, in line with Duty
of Candour.
The Trust declared two never events during
2014/15. In response to these particular
incidents extensive improvement work has
been undertaken involving:
z Review of the compliance with the World
Health Organisation surgical checklist.
z Ensuring that local standard operating
procedures are reviewed to address the root
causes and contributory factors for these
events occurring.
z Providing additional training and education to
specific staff groups involved.
The Trust declared three never events during
2013/14.
Reducing harm from VTE
One of the Trust quality goals in 2014/15 was
to reduce the number of avoidable venous
thromboembolism (VTE) events that affect our
patients. These are blood clots that can occur
as a result of an episode of hospital care when
patients are less mobile or following surgery.
The improvement milestones we chose were:
z Quarter 1 and 2 set the baseline, we had four
events reported.
z Our improvement trajectory was to reduce by
20% and measure again in Quarter 3 and 4.
z Number of events in Quarter 3 and 4 was
three, the source of the data was from the
incident reporting system.
z The number of reported hospital associated
VTE events may be below the number of
actual events that occur. The Trust will be
working towards ensuring all VTE events are
incident reported and investigated in 2015/16.
z Initiatives that took place in 2014/15 included
an awareness campaign on the correct
prescription of thromboprophylaxis to reduce
the risk of blood clots occurring while patients
are in hospital.
103
Clinical Effectiveness Priorities 2014/15
Care that is effective:
below.
Fig 27: Improving quality and reliability of care
Quality
improvement goal
Aim
Achieved/
Not achieved
2013/14
2014/15 National
average
Source
Improving quality and reliability of care: Delivering excellent outcomes for our patients by
implementing best practice
Goal: to reduce harm from deterioration
Reduction in
cardiac arrests
Median per 1,000
admissions
Improvement made
target not achieved
4.2
N/A
N/A
Internal
Crude mortality
On or below 1.9%
Achieved
1.8
1.8
N/A
Internal
HSMR
Below 95
Achieved
88.48
88.57
100
HSCIC
SHMI*
< 1.05
Achieved
1.04
1.03
1
HSCIC
* SHMI – Summary Hospital-level Mortality Indicator
The SHMI is the ratio between the actual number of patients who die following treatment at the Trust and the
number that would be expected to die on the basis of average England figures, given the characteristics of the
patients treated.
Reducing cardiac arrests
Nationally it has been shown that two thirds
of all cardiac arrests are predictable while
one third are avoidable. A recent review into
deaths across England showed there was
often a failure to recognise deterioration and
so the Trust chose reducing cardiac arrests as
a priority in 2014/15. Unfortunately, despite
improvements, we were unable to reduce the
rate to the national median of 1.56 per 1,000
admissions. We believe we can still improve
the recognition and response to these patients
and dramatically reduce cardiac arrests. Since
April 2013 a set of quality improvements
have been implemented and have reduced
the number of cardiac arrests by a third. We
will continue to make changes to our care of
the patients at risk of deterioration and have
included this within a work stream of the ‘Sign
up to Safety’ initiative.
Crude mortality
The Trust’s rolling 12 month average for crude
mortality was 1.83%, below the 1.9% trajectory
with significant seasonal variation. This was in
line with nationally published data. Enhanced
surveillance of deaths in the winter period did
not show any clinical care concerns. Crude
mortality was chosen as a quality goal in
2014/15 and work will continue through the
deteriorating patient workstream in ‘Sign up
to Safety’ in 2015/16 to improve performance
further.
Hospital standardised mortality ratio (HSMR)
104
The hospital standardised mortality ratio
(HSMR) measures whether the number of
people who die in hospital is higher or lower
than would be expected.
the illness and issues such as whether they live
in a deprived area.
Groups of patients with conditions that
commonly result in death, such as heart attacks
or strokes, are assessed to see how many,
on average in England, survive their stay in
hospital. Rates of death take account their age,
This chart shows how the hospital mortality ratio
varies in relation to the national average of 100.
The information gives hospitals an indicator of
whether their mortality rates are above average
and need further investigation.
Fig.28: HMSR quarterly figures (Dr Foster)
Patient Experience Priorities 2014/15
Source of data: Health and Social Care Information Centre
105
below.
Fig.29: Activities undertaken to achieve quality goals 2014/15
Quality
improvement goal
Aim
Achieved/
Not achieved
2013/14
2014/15 National
average
Source
Improving patient and staff experience: Providing our patients and their carers with the best possible
experience while they are using our services and those of our partners
Goal: to go above and beyond the friends and family test
Patient Friends and On median
Achieved
Family test *
Response rate
Achieved
inpatient: 40% Q4 in
inpatient areas
N/A
Staff Friends and
Family Test **
N/A
Establish baseline
in Q4 for proportion
of staff uptake and
staff recommender
score
Improvement made
target not achieved
Patient Reported
Median or better
Outcome Measures
***
Data not available
Cancer survey
Not achieved
Median or better
91%
56.2%
95%
HSCIC
44.9%
HSCIC
Suppressed due to
small numbers
86%
86%
89%
HSCIC
Quality
Health
* See Part 2, vi
** See Part 2, v
*** See Part 2, ii
Cancer survey
The 2014 National Cancer Patient Experience
Survey Programme questionnaire included
three sections where patients could make
comments in their own words about the cancer
care they had received. The comments were
under the following headings:
z Was there anything particularly good about
your NHS cancer care?
z Was there anything that could have been
improved?
z Any other comments?
The Cancer Patient Experience Survey 2014
follows on from previous years, designed to
monitor national progress on cancer care. The
survey includes 70 questions and is collected
against different tumour sites.
The Trust did not reach the goal of being at the
median or better for every relevant question.
The survey would be difficult to summarise
succinctly within the body of this report.
However one question offers an overview
of what patients think about their care; Q70
-Patient`s rating of care `excellent`/ `very good`.
The 2014 score for the trust was 86%
compared to the national average of 89%.
106
There were other areas of good performance
in the 2014 survey and areas that require
improvement. A detailed improvement plan is
being implemented.
Full details of the survey method are in
the National Report of the Cancer Patient
Experience Survey 2014, are available at
www.quality-health.co.uk
National staff survey
For the third year running, the national NHS
staff survey shows an increase in the number
of staff who would be happy with the standard
of care at the Trust if a relative or friend needed
treatment here.
National patient survey
The Care Quality Commission uses national
surveys to find out about the experience of
patients when receiving care and treatment
from healthcare organisations.
Accident and Emergency survey
During the summer 2014, a questionnaire was
sent to all patient aged 16 years or over who
attended A&E in February 2014. Responses
were received from 244 (30%) patients.
Fig.30 provides a summary of the survey and
how the scores compare to other trusts (the full
survey is available at www.cqc.org.uk)
In 2014, 64% of our staff would be happy
with the standard of care provided by this
organisation compared to the national average
of 65%.
In addition nearly three quarters of staff said
that patient care is the Trust’s top priority; in
the latest survey, 74% said they agreed with
this statement. The annual survey asks NHS
staff to give their views anonymously about
their experiences at work, including reporting
incidents, training and stress.
The 2014 survey also showed that nine out of
ten staff agree their role makes a difference to
patients and 80 per cent are satisfied with the
quality of work and patient care they are able to
deliver (both above the national average).
However there was a slight decrease in the
number of respondents who would recommend
the Trust as a place to work, from 56% in 2013
to 54% in 2014.
Improvements needed include job relevant
training for staff and supporting staff to raise
concerns. Action plans for improvements are
being prepared by the relevant divisions.
107
Fig 30: Summary of Accident and Emergency Survey 2014
Section
How this score
compares with other
Trusts
Score
Arrival at A&E
8.1/10
Worse
About
the
same
Better
Waiting times
6.1/10
Worse
About
the
same
Better
Doctors and nurses
8.4/10
Worse
About
the
same
Better
Care and treatment
7.8/10
Worse
About
the
same
Better
Tests
8.3/10
Worse
About
the
same
Better
Hospital environment and facilities
8.4/10
Worse
About
the
same
Better
Leaving A&E
6.1/10
Worse
About
the
same
Better
Experience overall
8.4/10
Worse
About
the
same
Better
The survey shows that the Trust ranks similar to other Trusts
Looking forward: priorities for improvement in 2015/16
Setting the quality agenda
The Trust aims to provide a safe environment
for patients. We understand that treatments
have inherent risks associated with them but
we want to ensure that we are continuously
working towards reducing harm and learning
when things do go wrong. We promote and
encourage an open and transparent culture,
and Trust staff are actively supported and
encouraged to report and speak up when they
identify a risk or something has gone wrong.
The Trust has made a huge improvement in
this area and we are now in the top 10% in
England for reporting such incidents. Our aim is
to develop a culture of safety, which anticipates
safety risks and shows preparedness to
respond.
Following consultation with stakeholders,
the areas listed below will form the core of
our quality improvement work for 2015/16,
supporting the clinical strategy strategic
objective ‘deliver high quality care wherever
needed’.
Care that is safer:
z Reducing harm from hospital acquired
pressure ulcers
z Reducing harm from injurious falls
108
Organisations and individuals who sign up to
the campaign commit to setting out actions they
will undertake in response to the following five
pledges:
Care that is reliable:
z Further reduce hospital mortality (measured
through Hospital Standardised Mortality
Ratio, (HSMR) and Summary Hospitallevel Mortality Indicator (SHMI) and crude
mortality)
z Put safety first
Commit to reduce avoidable harm in the NHS
by half and make public the goals and plans
developed locally.
z Reducing harm from deterioration by
reducing our cardiac arrest rate
z Continually learn
Make their organisations more resilient to
risks, by acting on the feedback from patients
and by constantly measuring and monitoring
how safe their services are.
z Improve both the response rate and
recommender score for the Friends and
Family Test
We aim to do this within the framework
provided through the national ‘Sign up to Safety’
campaign.
The ‘Sign up to Safety’ campaign is designed
to help realise the ambition of making the
NHS the safest healthcare system in the world
by creating a system devoted to continuous
learning and improvement. This ambition is
bigger than any individual or organisation and
achieving it requires us all to unite behind this
common purpose. We need to give patients
confidence that we are doing all we can to
ensure that the care they receive will be safe
and effective at all times.
‘Sign up to Safety’ aims to deliver harm-free
care for every patient, every time, everywhere.
It champions openness and honesty and
supports everyone to improve patient safety.
z Honesty
Be transparent with people about their
progress to tackle patient safety issues and
support staff to be candid with patients and
their families if something goes wrong.
z Collaborate
Take a leading role in supporting local
collaborative learning, so that improvements
are made across all of the local services that
patients use.
z Support
Help people understand why things go wrong
and how to put them right. Give staff the time
and support to improve and celebrate the
progress.
The Trust has completed a Safety Improvement
Plan, which sets out the organisation’s plans
for the next 3-5 years in relation to quality and
safety.
109
Developing quality improvement
capacity and capability
The quality goals identified above were not the
only improvements we made to our services.
The following are a few examples of good
practice that we are proud to report in our
quality report.
A key aim has been to increase the capacity
of our workforce to deliver care that is
compassionate as well as safe and effective.
Professor Bohmer Programme
We have been working with Professor Bohmer
(Harvard Business School) to transform the
Trust into a truly clinically-led organisation. The
programme commenced in April 2014, when
65 senior clinical leaders attended monthly
sessions to learn more about how to approach
whole system re-design.
Staff worked in teams while being mentored by
Professor Bohmer on a range of projects, with
the aim of improving the services we provide.
Schwartz Rounds
The aims of the programme are:
Working in healthcare can be stressful to a
degree rarely seen in other professions. Our
staff make decisions that have life and death
implications and so need to develop strategies
to deal with this. In a culture envisaged as
‘don’t moan’ and ‘don’t hesitate to cope’, NHS
workers are generally not good at talking to
each other about how they are feeling.
z To define the Trust’s approach to improving
quality across the whole system for defined
populations
Schwartz Rounds were developed in the United
States about 20 years ago by the Schwartz
Centre for Compassionate Healthcare. The
founder, Ken Schwartz, was a healthcare
attorney who at the age of 40 developed
terminal lung cancer. During the 10 months
up to his death he wrote movingly about his
experience.
z To develop a core group of clinicians who
lead improvement programmes each year
Schwartz Rounds are structured meetings
for all members of clinical and non-clinical
staff. They consist of brief presentations from
three or four staff members about a particular
experience followed by a facilitated discussion
on the emotional aspects of caring in that
situation. Everything that is said during the
meeting is regarded as confidential.
z To develop the capabilities of senior leaders
within the organisation
z To demonstrate clear improvements in care
for defined populations
In putting this into practice, clinical teams work
with patients to understand and define what
they value most about their care. They are then
expected to take a critical look at the current
operating system and propose a new model of
care, including how patient experience will be
measured. This encourages clinicians to be
outward-looking, to identify who is delivering
new models of care as well as encouraging
internal and local innovation.
In 2015/16 a second cohort will go through
the programme to ensure sustainability and to
develop further capacity and capabilities.
We have held six rounds at the Trust, all of
which have been well attended and evaluated
by our staff.
110
Improvement advisor role
Sepsis six care bundle
The Trust has an ambition to become one
of the safest organisations in the NHS. We
knew that we could improve but we needed
to build capacity within our clinical teams to
make the changes necessary to ensure reliable
compliance with best practice. One of the ways
we achieved this was to introduce the role of
improvement advisor, to:
A number of serious incident investigations
highlighted a delay in recognising and treating
sepsis. Research evidence shows that the
sepsis six care bundle (a series of tasks and
interventions that should take place if sepsis
is suspected) is proven to reduce deaths and
complications related to sepsis. The sepsis
care bundle had already been implemented
across the Trust but there was wide variation
in its use and few measures to demonstrate
its effectiveness, so it was time for a new
approach.
z Develop the ‘introduction to Quality
Improvement’ (QI) course and train members
of staff to deliver the course independently
z Support the existing clinical effectiveness
team to adopt a QI approach to bring about
change in practice
z Support the clinical effectiveness team in
their advisory role with individual projects
z Coach individual staff on quality based
projects
z Lead the adoption of the QI approach within
existing Trust improvement teams, planning
and testing change related to patients at risk
of deterioration
z Raise patient safety issues when highlighted
through QI work
As well as improving our capacity to make care
safer and more effective, they did targeted work
to:
z Reduce harm from falls
z Improve compliance with the sepsis care
bundles (a tool that helps staff to treat
infections earlier and more effectively)
z Ensure fewer errors in blood sampling
Our aim was to halve the number of deaths
from sepsis within one year, ensure reliable
recognition and use of the sepsis care bundle
and delivery of the highest quality care for the
patient, every time.
An improvement advisor from UCLPartners
worked with us to facilitate the quality
improvement approach in our accident and
emergency department. They identified a
sepsis champion within the department and
trained them to develop staff capabilities and
deliver sustainable results. Several small
changes were introduced alongside a cultural
shift to collect and act upon real-time data,
which is fed back to frontline staff.
Our results show a 58% sustained reduction
in sepsis related mortality, and improvements
in the consistency of care delivered. It
demonstrates that through relentless regular
measurement and using data for improvement,
patient care can improve in quality, safety,
experience and productivity with a reduced
length of stay.
z Reduce cardiac arrests
111
Commissioners have invested an additional
£1million for stroke services at Basildon
Hospital to bring them up to the highest
standards. A long term decision on the
organisation of stroke services in south Essex
has yet to be made, but the extra funding will
ensure patients receive high quality stroke care.
Improving stroke care
The care and treatment of stroke patients at
Basildon University Hospital has improved
significantly over the last three years, according
to the latest figures from the National Stroke
Strategy.
During the first half of 2014, the care of stroke
patients exceeded the required level for four out
of five key standards:
z Patients with suspected stroke who are
scanned within an hour of arriving at hospital
– 75%, compared to 31% in 2011.
z Patients receiving clot-busting medication, if
appropriate, within three hours of arrival at
hospital -15%, compared to 4% in 2011.
z Patients with transient ischaemic attack (mini
stroke) not admitted but treated within
24 hours – 66%, compared to 55% in 2011.
z Proportion of stroke patients admitted to
hospital who spend 90% of their stay on a
specialist stroke ward – 89%, compared to
76% in 2011.
The standard that the Trust did not meet relates
to the time taken to settle the patient on the
stroke unit once a decision has been made to
admit them. The national standard requires
that 90% of patients should go to the stroke
unit within four hours. The Trust achieved this
for 80% of patients, which is short of the target
but a significant improvement since 2011, when
just 41% of patients were placed on the stroke
unit within the time limit. Action has been taken
to address the shortfall, including an improved
triage and assessment system to help nurses
identify patients arriving at A&E who are not
showing obvious signs of stroke.
So far, the Trust has used some of the extra
funding to extend consultant cover to seven
days a week and for additional staff including
a consultant, eight nurses to care for stroke
patients, six occupational therapists, six
physiotherapists, a speech therapists and a
psychological support worker.
Extending radiology hours for CT and MRI
scans
Patients and staff are feeling the benefit of
reduced waiting times following the extension
of the radiology hours for routine CT and MRI
scans.
In the past only clinically urgent scans would be
carried out between 5pm and 9am. This meant
that routine inpatient scans might need to wait
until the next day if there weren’t enough slots
to meet demand, and that any patient admitted
or seen after 5pm would have to wait until the
next day.
Since January 2015, there has been a
radiologist on site seven days a week. Routine
inpatient scans are carried out 9am to 8pm
Monday-Friday, and 9am to 4pm at weekends,
(with a radiologist available 4pm to 8pm from
home). Outside these hours there is an on-call
radiologist to report on urgent scans, which is
provided on an outsourced basis.
112
The number of patients now waiting for scans
at the beginning of each day has reduced
from 20 to less than five. With careful planning
outpatients can also be scanned in the evening,
which has a direct impact on both the
two-week cancer pathway and 18-week referral
to treatment pathway. Extending the scanning
day also makes more effective and productive
use of the scanners.
The dementia project was officially launched
with the opening of a new reminiscence room at
Basildon University Hospital. The 50’s-themed
room includes a kitchen and living room area,
old-fashioned furnishings and a TV, giving a
familiar background to activities for patients with
dementia, for who the hospital environment can
seem extremely daunting.
Award-winning cancer services
Dementia project
It is estimated that there are 850,000 people
with dementia in the UK, and that 1 in 14 people
over the age of 65 has dementia.
Each year in our hospitals we care for hundreds
of patients with dementia. They will be in
hospital for many reasons, but we also need to
ensure that we meet any additional needs they
have due to their dementia.
To provide a focus to improving care for patients
with dementia, the Trust has established the
Dementia Project.
Areas the dementia project is concentrating on
include:
z Creating dementia friends, linking with the
Alzheimer’s Society. Dementia friends learn
about what it’s like to live with dementia and
then turn that understanding into action.
z Identifying dementia champions on each
ward.
z Developing a dementia ‘care bundle’, which
is a set of documents that describe the care
to be provided.
z Setting up a carers forum.
z Ensuring there is high quality staff education,
training and support.
The team at Basildon University Hospital who
care for people with cancer won the Cancer
Team of the Year award in the national Quality
in Care Programme which recognises and
rewards good practice in the NHS. The staff
were commended for their work to integrate
cancer care in hospital and for improving care
for patients by co-ordinating their services
effectively.
The cancer service at Basildon University
Hospital is exceptional in that it co-ordinates
three teams – Acute Oncology, Cancer of
Unknown Primary and Specialist Palliative
Care.
The acute oncology service offers prompt
assessment and advice, seven days a week,
for people with cancer that suffer side effects
or complications, as a result of their condition,
or because of the cancer treatment they are
receiving. These side effects are most likely
to occur within six weeks of cancer treatment,
and may include nausea and vomiting, or more
serious conditions such as neutropenic sepsis,
an infection which requires rapid treatment
with antibiotics. When cancer patients come
to the accident and emergency department
for treatment, or are admitted to other wards
in hospital, they are assessed by a specialist
acute oncology nurse, to ensure that they
receive timely and quality care.
113
The Cancer of Unknown Primary service (CUP)
is the only one of its kind in south Essex, and
was established last year. It provides care for
patients who have advanced cancer but the
exact type cannot be identified. In England and
Wales, more than 10,000 cases of CUP occur
annually and it is the fourth most common
cause of cancer death.
The Macmillan Specialist Palliative Care
Service also provides a seven day a week
service at Basildon University Hospital, from
9am to 5pm. Telephone advice and face-to-face
assessments are available for patients with
specialist palliative care needs.
Statements of assurance
In this section of the quality report the Trust
must include certain statements, in common
with other Trusts, to enable comparisons to be
made between organisations.
Statements from Directors
The Statements from Directors confirm that the
information in the quality report is an accurate
reflection of quality in the organisation.
Please see appendix 1.
Parents praise care for youngest patients
The care provided to babies at Basildon
University Hospital received praise in a recent
survey carried out among parents in the
neonatal intensive care unit, which shows an
extremely high level of satisfaction with the
service for premature and seriously ill babies.
Parents were asked 24 questions about the
care and communication they received on the
unit. The response was 100 per cent positive to
11 questions, and over 90 per cent positive to a
further 10 questions.
Parents commented on how friendly and
helpful they found the staff, and said that they
were given useful advice about feeding and
equipment.
114
Reporting against core indicators
The following indicators are mandated in all
quality reports and so help stakeholders and
the public compare the Trust’s performance with
other organisations providing health care.
i) Summary Hospital-Level Mortality
Indicator
NHS England has created a method for
measuring hospital death rates. This
measure is known as SHMI - summary
hospital-level mortality indicator.
The SHMI measure is based on national
data, which calculates for each hospital
how many deaths would be expected to
occur if they were conforming to the national
average. The measure takes into account
factors such as differences in age, sex,
diagnosis, type of admission and other
diseases (co-morbidity). This figure is
compared with the number of deaths that
did occur in the hospital and the SHMI is the
ratio between the two. If the same number
of deaths occurred as expected the ratio will
be one. A SHMI of greater than one implies
more deaths occurred than predicted by the
measure.
Figs. 31a, 31b and 32 show the values for
SHMI for the Trust for the reporting period.
Fig.31a: Our latest SHMI result for the period to September 2014 is 1.03.
The banding is 2 (banding is a rating score from 1 to 3 with 1 being the best)
Publication
Reporting period
Date
Jan 2015 Jul 2013 - Jun 2014
Apr 2015
Oct 2013 - Sep 2014
1.040
National
Average
1.0
National
Lowest
0.893
National
Highest
1.119
1.030
1.0
0.597
1.107
BTUH value
Fig.31b: SHMI for period July 2012 to September 2014
Fig.32: The percentage of patient deaths with palliative care coded at either diagnosis or
speciality level for the Trust is 27.7%
Publication
Reporting period
Date
Jan 2015 Jul 2013 - Jun 2014
Apr 2015
Oct 2013 - Sep 2014
28.1%
National
Average
24.6%
National
Lowest
7.4%
National
Highest
49.0%
27.8%
25.4%
7.5%
49.4%
BTUH value
Source of data: Health and Social Care Information Centre
115
The Trust considers that this data is as
described for the following reasons: the
data is reported and monitored externally to
the Trust, and is based on data published
by the Health and Social Care Information
Centre, the Trust also uses a proxy measure
to calculate hospital mortality which helps
assess the validity of all mortality data.
effectively and ensuring a senior clinical
review within 12 hours of admission and then
daily.
ii) Patient Reported Outcome Measures
(PROMs)
PROMs calculate the health benefits for
patients after surgical treatment using
pre- and post-operative surveys. Figs. 33
to 36 set out key statistics on patients’ selfreported health before undergoing four
common elective surgical procedures. It
includes analysis of questionnaires that all
NHS hospitals asked to collect from all willing
patients. A higher number indicates a more
positive response.
Reducing SHMI continues to be a quality
priority for the Trust in 2015/16. The Trust
intends to take the following actions to
improve the SHMI, and so the quality of its
services, by continuing the work streams
to reduce patient harm from deterioration,
avoidable cardiac arrests, avoiding harm
from sepsis; treating acute kidney injury
Fig.33: Groin hernia surgery
Publication
Reporting period
Date
February April 2013 to
EQ-5D Index
2015
March 2014
EQ VAS
February
2015
EQ-5D Index
April 2014 to
September 2014
EQ VAS
(provisional)
BTUH value
0.067
-0.918
Suppressed
due to small
numbers of
questionnaires
returned
National
Average
0.085
-1.053
0.081
National
Lowest
0.008
-5.791
0.009
National
Highest
0.139
2.864
0.125
-0.397
-4.070
3.237
National
Average
0.436
11.487
21.340
National
Lowest
0.342
7.005
17.634
National
Highest
0.545
17.189
24.444
0.442
0.350
0.501
12.162
5.380
16.537
21.922
18.357
25.418
Fig.34: Hip replacement surgery
Publication
Reporting period
Date
EQ-5D Index
2015
March 2014
EQ VAS
February
2015
Oxford Hip
Score
EQ-5D Index
April 2014 to
September 2014
EQ VAS
(provisional)
Oxford Hip
Score
BTUH value
0.447
10.711
21.661
Suppressed
due to small
numbers of
questionnaires
returned
116
Fig.35: Knee replacement surgery
Publication
Reporting period
Date
EQ-5D Index
2015
March 2014
EQ VAS
Oxford Knee
Score
EQ-5D Index
2015
September 2014
EQ VAS
(provisional)
Oxford Knee
Score
BTUH value
0.275
3.788
15.893
Suppressed
due to small
numbers of
questionnaires
returned
National
Average
0.323
5.640
16.248
National
Lowest
0.215
-1.547
12.049
National
Highest
0.416
15.401
19.762
0.328
0.249
0.394
6.369
-0.665
12.508
16.702
14.416
20.440
National
Average
0.093
-0.553
-8.698
National
Lowest
0.023
-7.677
-16.849
National
Highest
0.150
4.093
11.292
0.100
0.054
0.142
-0.465
-2.799
3.955
-9.479
-16.762
-4.567
Fig.36: Varicose vein surgery
Publication
Reporting period
Date
EQ-5D Index
2015
March 2014
EQ VAS
February
2015
Aberdeen
Questionnaire
EQ-5D Index
April 2014 to
September 2014
EQ VAS
(provisional)
BTUH value
Suppressed
due to small
numbers of
questionnaires
returned
Aberdeen
Questionnaire
Data source: Health and Social Care Information Centre
quality of its services, by changing elective
service provision in the following ways:
described for the following reasons: The data
is collected independently of the Trust by an
approved provider and analysed and published
by the Health and Social Care Information
Centre. Unfortunately some of the sample sizes
were too small to analyse.
z Musculoskeletal hub referring into hip and
knee subspecialty clinics
The Trust intends to take the following actions
to improve the PROMs scores, and so the
z New procedure to create a ‘ring-fenced’
orthopaedic only ward – Horndon Ward
z Ensuring a specified number of consultants
performing the procedures
z All post-op patients receiving physiotherapy
from Trust services.
117
(This data has not been published nationally
since 2011, however it is a requirement within
the Quality Account reporting guidelines)
iii) Emergency readmissions to hospital
within 28 days
Emergency readmission indicators help
the NHS monitor success in avoiding
(or reducing to a minimum) readmission
following discharge from hospital.
The Trust considers that the data published
in 2013 is as described for the following
reasons the data is collated nationally and
is published by the Health and Social Care
information centre.
Not all emergency readmissions are likely to
be part of the originally planned treatment
and some may be avoidable. To prevent
avoidable readmissions it may help to
compare figures with and learn lessons from
organisations with low readmission rates.
The national highest and lowest figures
are for comparable medium acute trusts
as defined in the report, while the national
average is across all trusts.
The Trust intends to take the following
actions to improve the emergency
readmission rates within 28 days, and so
the quality of its services: undertaking audits
of the reason for readmission to ensure
that any relevant learning can be shared
within the Trust to where possible prevent
unnecessary readmissions.
Comparison of emergency readmissions to hospital within 28 days of discharge: indirectly
standardised percentage (2003/04 to 2011/12) .
Fig.37: All emergency readmissions (16+ yrs)
Publication
Date
December
2013
December
2013
9.18%
National
Average
11.43%
National
Lowest
4.88%
National
Highest
17.15%
9.05%
11.45%
6.67%
17.10%
National
Lowest
3.75%
National
Highest
14.94%
4.04%
16.05%
Reporting period
BTUH value
March 2010 to April
2011
March 2011 to April
2012
Fig.38: All emergency readmissions (0-15 yrs)
Publication
Date
December
2013
December
2013
Reporting period
BTUH value
March 2011 to April
2012
March 2010 to April
2011
7.25
National
Average
10.01%
8.61
10.01%
Data source: Health and Social Care Information Centre
118
described for the following reasons: it is
collected independently from the Trust and
published by the Care Quality Commission.
iv) Trust responsiveness to patient needs
Patient experience is a key measure of the
quality of care. The NHS should continually
strive to be more responsive to the needs of
those using its services, including the need
for privacy, information and involvement in
decisions.
actions to improve the staff responsiveness
to patients needs and so the quality of its
services, by implementing the following
patient experience improvement programme:
Improving hospitals’ responsiveness to
personal needs is a key indication of the
quality of patient experience. This score is
based on the average of answers to five
questions from the National Inpatient Survey
(figs. 39 to 43):
z See vi) Friends and Family Test
Fig.39: Q32: Were you involved as much as you wanted to be in decisions about your care
and treatment?
Publication
Reporting period
Date
May 2014 September 2013 to
January 2014
January 2015
6.9
National
Average
n/a
National
Lowest
5.9
National
Highest
8.6
7.2
n/a
6.1
9.2
BTUH value
Fig.40: Q34: Did you find someone on the hospital staff to talk to about your worries and
fears?
Publication
Reporting period
Date
January 2014
January 2015
5.6
National
Average
n/a
National
Lowest
3.9
National
Highest
8.1
8.0
n/a
7.0
9.5
BTUH value
119
Fig.41: Q36: Were you given enough privacy when discussing your condition or treatment?
Publication
Reporting period
Date
January 2014
January 2015
8.5
National
Average
n/a
National
Lowest
7.6
National
Highest
9.2
7.3
n/a
5.7
9.0
BTUH value
Fig.42: Q56: Did a member of staff tell you about medication side effects to watch for when
you went home?
Publication
Reporting period
Date
January 2014
January 2015
4.0
National
Average
n/a
National
Lowest
3.6
National
Highest
7.4
8.1
n/a
7.3
9.7
BTUH value
Fig.43: Q63: Did hospital staff tell you who to contact if you were worried about your
condition or treatment after you left hospital?
Publication
Reporting period
Date
January 2014
January 2015
7.4
National
Average
n/a
National
Lowest
6.2
National
Highest
9.7
7.7
n/a
6.4
9.7
BTUH value
Data source: Care Quality Commission
120
described for the following reason; it is
collected and analysed independently of the
Trust.
v) Staff recommender score
The staff recommender score below is taken
from the national Staff Survey. In April 2014,
NHS England introduced the Staff Friends
and Family Test (FFT) in all NHS trusts
providing acute, community, ambulance and
mental health services in England.
NHS England’s vision is that all staff should
have the opportunity to feedback their views
on their organisation at least once per year.
It is hoped that Staff FFT will help to promote
a big cultural shift in the NHS, where staff
have further opportunity and confidence to
speak up, and where the views of staff are
increasingly heard and are acted upon.
The data in Fig.44 is taken from the national
Staff Survey carried out in 2014. It shows that
the recommender score has improved since
last year and is now close to the national
average for acute trusts.
actions to improve the staff recommender
score and so the quality of its services,
by: continuing to engage with and listen
to staff views about working for the Trust;
maintaining the quarterly mini staff survey to
help facilitate rapid intervention when staff
identify problems and issues affecting care;
to continue to hold open forum sessions with
staff to listen to their views and through the
‘Stepping Up’ meetings help each morning
to listen to staff feedback on the issues that
may impact on their ability to deliver care that
is safe and effective.
Fig.44: Staff recommender score improvement
Publication
Reporting period
Date
February September 2013
2014
February September 2014
2015
3.63
National
Average
3.66
National
Lowest
2.78
National
Highest
4.25
3.65
3.67
3.00
4.20
BTUH value
Data source: National NHS Staff Survey 2014 – acute trusts Health and Social Care Information Centre
121
vi) Friends and Family Test – Patient
recommender score
The NHS Friends and Family Test (FFT)
provides feedback on the services provided
by the Trust and includes inpatient areas and
the Accident and Emergency Department.
Feedback is used to help The Trust to
improve services for everyone.
Please note there is not a comparable score
for response rates for 2013/14 as the scoring
system changed during 2014.
Fig.45: Inpatients - % recommended
Publication
Reporting period
Date
April 2015 February 2015
May 2015 March 2015
94%
National
Average
95%
National
Lowest
82%
National
Highest
100%
91%
95%
78%
100%
BTUH value
Response rates for March 2015 were 56.2% with a national average of 44.9%.
described for the following reason: it is analysed
independently of the Trust.
to improve the staff recommender score and so
the quality of its services:
z Involve people who have made a complaint in
service redesign and improvement
z Develop an experience-sharing learning
method ‘see it my way’ where members of
staff and patients get together to share their
experiences and discuss together ways to
improve services
z Develop a Trust patient experience video to
train staff.
z Introduce an inpatient information booklet,
and amenity packs for emergency admissions
122
vii) VTE assessment
VTE assessment is a national patient safety
initiative to reduce avoidable deaths from blood
clots that may develop as a result of admission
to hospital. When patients are assessed and
treated appropriately, it can significantly reduce
rates of mortality associated with this condition.
The Trust met the target for 2014/15 to ensure
that risk assessments are recorded for 95% or
above of all patients admitted to the Trust.
Fig.46: VTE assessment
Publication
Reporting period
Date
March 2015 February 2015
April 2015
100%
National
Average
95%
National
Lowest
N/A
National
Highest
N/A
100%
95%
N/A
N/A
BTUH value
March 2015
Data source: VTE assessment daily recording on electronic patient record system (EPR)
described for the following reasons:
z We measure VTE assessment electronically
daily to make sure that we can sustain our
performance. We also carry out a monthly
audit of a sample of patient notes to see if
when a risk is identified, the correct treatment
plan is put in place.
123
actions to improve the VTE risk assessment
scores, and so the quality of its services, by:
introducing a new thrombosis improvement
plan in 2015/16 with the aim of continuing
improvements in compliance with assessment
and effective prophylaxis and by undertaking
root cause analysis on all hospital associated
VTE events.
vii) Rate per 100,000 bed days Clostridium
difficile
Upon notification, all cases of Clostridium
difficile (C.difficile) are reported to a national
Public Health England data capture system.
A root cause analysis (RCA) is instigated
by the Trust for all cases identified 72 hours
after admission.
The total number of cases of C. difficile
attributed to the Trust since April 2014 is
37 against a trajectory of 18. The number
of cases per month has reduced since an
increase in June – August 2014. Much work
has been undertaken by all staff to reduce
the number of cases including managing
patients identified as carriers in the same
way as those with C. difficile infection.
Due to the number of cases of C. difficile,
Public Health England (PHE) were
invited to undertake a peer review, this
included scrutiny of the RCAs undertaken
and ward visits where there had been
a higher number of cases, to identify
any additional areas for concern and
make recommendations for change or
improvement that may not have previously
been considered. Further work with PHE’s
regional epidemiology unit and the wider
local health economy continues to be
undertaken during 2015/16 to identify areas
which may impact on reduction of cases.
The threshold for 2015/16 has been set at
31 cases.
described for the following reasons: The
data is reported nationally and although
higher than last year is within expected
limits.
actions to improve the rate of Clostridium
difficile and so the quality of its services, by
continuing to apply and embed practice in
accordance with Trust infection prevention
and control policies.
Fig.47: Clostridium difficile - bed days (rate per 100,000)
Publication
Reporting period
Date
July 2014
April 2012 to March
2013
July 2014
April 2013 to March
2014
13.3
National
Average
17.4
National
Lowest
0.0
National
Highest
31.2
8.8
14.7
0.0
37.1
BTUH value
Data source: Public Health England Report
124
Clinical Governance and Risk Department,
and subsequently presented to the
Executive Directors for final ratification.
All serious incidents are shared with
the Clinical Commissioning Group, who
externally review all serious incident
investigations to provide an external
independent assurance function.
viii) Rate of patient safety incidents
Trust staff are actively supported and
encouraged to report incidents and near
misses as part of a culture that puts a high
priority on patient safety. Some incidents
that occur in the NHS are defined as
serious incidents (SIs). Serious incidents in
healthcare are uncommon but when they
occur NHS trusts have a responsibility to
ensure these are thoroughly investigated
so that action can be taken, and lessons
learned to mitigate the risk of similar
incidents occurring in the future.
The Trust promotes a ‘fair and just’ culture,
which encourages staff confidence to report
any concerns. The purpose of investigation
is to encourage openness, learning is
shared widely and quality improvement is
positively endorsed, so that care provided
to patients is continually improved. In
addition, continuous analysis of incidents
and serious incidents is undertaken and
shared widely across the organisation.
Where any areas of concern are identified,
then specific actions are taken to undertake
a deeper level of investigation, so that
potential risks are mitigated.
When a serious incident occurs, the Trust
appoints a trained investigating officer to
ensure that the circumstances surrounding
the incident are investigated in accordance
with Root Cause Analysis best practice.
They are also responsible for making
recommendations that are implemented
by the relevant department. Evidence
to support that these actions have been
completed is reviewed by the corporate
Fig.48: Rate of patient safety incidents
Publication Reporting
Date
period
April 2015
April 2015
October 2013 to
March 2014
April 2014 to
September 2014
Number of patient
safety incidents
% resulting in severe
harm or death
Number of patient
safety incidents
% resulting in severe
harm or death
Data source: National Reporting and Learning Service
125
BTUH
value
4,517
National
Average
3,083
National
Lowest
1,048
National
Highest
5,495
1.1%
0.7%
0%
2.3%
5,662
4,196
35
12,020
0.2%
0.5%
0%
82.9%
During 2014/15 further development work
has been focussed on the improvements
already seen in 2013/14, which have
included:
z Data is reported from ward to board on a
monthly basis, outlining trend analysis and
evidence of compliance against internal and
external Key Performance Indicators
z Falls prevention
z This data are supported through externally
verified sources, including NHS England and
the National Reporting and Learning Service
(NRLS). The Clinical Governance and Risk
team have a robust process for the daily
upload of data to the NRLS which includes
a weekly reconciliation between internal
submitted incident reports and externally
uploaded reports to NRLS. If a discrepancy
rate is identified the team undertake analysis
and review to identify any potential errors.
z Pressure ulcer prevention
z Identification and management of the
deteriorating patient
The Trust has ensured that incident
reporting and risk assessment has become
mandatory training for all staff (clinical and
non-clinical). Further bespoke training
sessions are provided for those staff who
have the responsibility of investigating
incidents, and managing risk in their areas
of responsibility.
The evidence of improvement related to
incident reporting can be evidenced as the
number of incidents reported during April
2014 to September 2014 was 5,662. This is
a 25% increase on October 2013 to March
2014. Out of the 5,662 incidents reported
in April 2014 to September 2014, 0.2%
resulted in severe harm or death. This is a
significant improvement on 1.1% reported
for the previous period.
This is a strong indicator that the increase
in reporting, supported by the marked
reduction in the percentage of harm
resulting in severe harm or death, shows
that patient safety remains the highest
priority for all staff working at the Trust.
described for the following reasons:
z The Clinical Governance and Risk team
review every individual reported patient
safety incident as part of an internal daily
safety briefing process.
z NRLS summary reports are reported
internally to the Trust Board and analysis
includes a review of the Trust’s national
benchmark position.
to improve the incidents resulting in severe
harm or death and so the quality of its services,
by:
z Continuing to undertake robust serious
incident investigations into all incidents that
evidence moderate harm or greater, and also
for those incidents that pose a significant risk
to patient safety.
z Continuing to undertake chief executive
chaired scrutiny panels whenever a trend is
identified that poses a risk to patient safety.
z Utilising incident data as a means by which
‘near miss’ incidents are reviewed to predict
any future risk to patient experience, patient
safety, by closely working with any location/
profession/specialty based ‘hot spot’.
126
z Continuing to improve the levels of support
and information sharing with patients and
families affected by serious incidents through
the Duty of Candour. Openly investigating
all severe harm or death incidents using
a comprehensive root cause analysis
investigation as part of the serious incident
process.
Participation in Clinical Audits
National Clinical Audits
z Continuous development of systems and
processes to support cross-divisional learning
from all reported incidents.
z Robust processes to assure key
recommendations and actions from serious
incident investigations lead to genuine
improvement in care pathways for patients
Review of services
During the reporting period 2014/15 Basildon
and Thurrock University Hospitals NHS
Foundation Trust provided and/or subcontracted
36 relevant health services.
The national clinical audits and national
confidential enquires that Basildon and
Thurrock University Hospitals NHS Foundation
Trust participated in, and for which data
collection was completed during 2014/15, are
listed in Fig.49 overpage alongside the number
of cases submitted to each audit or enquiry as
a percentage of the number of registered cases
required by the terms of that audit or enquiry
(Fig.50).
During that period the Trust participated in
100% (41/41) national clinical audits and
100% (4) national confidential enquiries of the
national clinical audits and national confidential
enquiries which it was eligible to participate in.
NHS Foundation Trust has reviewed all the data
available to them on the quality of care in 36 of
these relevant health services.
The income generated by the relevant health
services reviewed in reporting period 2014/15
represents 90.3% per cent of the total income
generated from the provision of relevant
services by Basildon and Thurrock University
Hospitals NHS Foundation Trust for reporting
period 2014/15.
127
Fig.49: Data collection/participation for National Clinical Audit 2014/15
Target
sample size
Cases
submitted
(%)
Adult Cardiac Surgery (SCTS)
All cases
100%
Adult community acquired pneumonia
All cases
In progress
BCIS Cardiovascular Intervention (Coronary Angioplasty) 2014
All cases
100%
BTS Pleural procedures Audit
All cases
100%
Case Mix Programme (ICNARC)
All cases
100%
CEM Fitting child (care in emergency departments)
Max of 50
100%
CEM Mental health (care in emergency departments)
Max of 50
100%
CEM Older people (care in emergency departments)
Max of 100
100%
Congenital Heart Disease (Paediatric cardiac surgery)
All cases
100%
DAHNO National Head & Neck Cancer Audit
All cases
100%
Epilepsy 12 (Childhood epilepsy)
All cases
100%
Falls & Fragility Fractures Audit Programme (FFFAP) (National Hip
Fracture Database & Audit of falls & bone health NAFBH)
All cases
100%
IBD Inflammatory bowel disease Audit
All cases
In progress
IBD Inflammatory bowel disease Biologics
All cases
100%
Maternal, Newborn & Infant Clinical Outcome Review Programme
(MBRRACE-UK)
All cases
100%
MINAP Myocardial Infarction National Audit
All cases
100%
National Audit of Dementia (care in general hospitals) Pilot
All cases
In progress
National Bowel Cancer Audit 2014
All cases
In progress
National Cardiac Arrest Audit (NCAA)
All cases
100%
National Cardiac Rhythm Audit (Cardiac arrhythmia)
All cases
In progress
National Comparative Audits of Blood Transfusion Programme
All cases
100%
National Diabetes Core Audit (NDA)
All cases
100%
National Diabetes Foot Care Audit NDFA
All cases
In progress
National Diabetes Inpatient Audit (NADIA) 2014
All cases
100%
National Emergency Laparotomy Audit (NELA)
All cases
In progress
National Clinical Audit
128
Target
sample size
Cases
submitted
(%)
National Heart Failure Audit
All cases
100%
National Joint Registry 2014
All cases
100%
National Lung Cancer Audit 2013
All cases
In progress
National Neonatal intensive & Special care (NNAP) Audit
All cases
100%
National Oesophago-gastric Audit (NAOGC)
All cases
100%
National Paediatric Diabetes Audit (NPDA)
All cases
100%
National Pregnancy in Diabetes Audit
All cases
100%
National Rheumatoid & Early Inflammatory Arthritis Audit
All cases
In progress
National Vascular Registry – Carotid Endarterectomy
Interventions Audit
All cases
100%
National Vascular Registry – Peripheral Arterial Disease
All cases
In progress
National Vascular Registry – Abdominal Aortic Aneurysms
All cases
100%
Patient Reported Outcome Measures for Elective Surgery 2014
All cases
100%
Prostate Cancer Audit
All cases
In progress
Renal replacement therapy (Renal Registry)
All cases
100%
Sentinel Stroke National Audit Programme (SSNAP)
All cases
100%
Severe Trauma Audit & Research Network (TARN)
All cases
100%
National Clinical Audit
Fig.50: National confidential enquiries 2014/15
Cases
included
Clinical
questionnaire
returned
Case notes
returned
Organisational
questionnaire
returned
NCEPOD – Sepsis
5
2
4
1
NCEPOD – Gastrointestinal Haemorrhage
3
0
0
1
NCEPOD – Lower Limb Amputation
6
5
5
1
NCEPOD – Tracheostomy Care
19
19
4
1
National Confidential Enquiries (3)
129
In 2014/15 the Trust also submitted data to 10 other national clinical audit projects.
Fig.51: Other national projects
Target
sample size
Cases
submitted
(%)
Urological surgery BAUS Cancer registry nephrectomy
All cases
100%
NHFD Anaesthetic Sprint Audit Project
All cases
100%
All cases
100%
All cases
100%
All cases
In progress
Surgical Site Infection Surveillance (Large Bowel Surgery)
All cases
In progress
ESCP pan-European right hemicolectomy / ileocaecal resection
audit
All cases
In progress
National Surgical Site Surveillance (Orthopaedics)
All cases
100%
10
100%
All cases
In progress
Other National Projects (10)
Breast Cancer Clinical Outcome Measures Project (BCCOM)
2014
Determining Universal Processes related to best outcome in
Emergency Abdominal Surgery
Orchestra audit- Orchidopexy - Does earlier surgery affect
testicular atrophy
BAD Non Melanoma Skin Cancer Audit 2014 (1st round)
SCTC Thoracic Surgery Dataset 2014/15
130
Published National Clinical Audit and
Confidential Enquiry Reports during 2014/15
The reports of 28 national clinical audits and
four confidential enquiries were reviewed by the
provider in 2014/15 and Basildon and Thurrock
University Hospitals NHS Foundation Trust
intends to take the following actions to improve
the quality of healthcare provided.
Trust-wide
z National Cardiac Arrest Audit 2013/14
The report was reviewed by the Resuscitation
Group. The Trust is reported as having
a higher than national average cardiac
arrest rate per 1000 admissions. The Trust
Deteriorating Patient Board is overseeing a
programme of improvement work to reduce
avoidable cardiac arrests rate by 50% with a
stretch target of 75% which is a rate of less
than 1.0/1000 admissions.
z National Cancer Patient Experience
Survey 2013/14
The report was presented and reviewed
at the Medicine Audit Meeting and there is
an ongoing, routinely updated action plan.
There are ongoing meetings to provide clear
improvement strategies incorporated within
each tumour sites’ work plan. Key areas for
improvement are around communication,
provision of information and pain control.
The Macmillan Value Based Standards
pilot project continues to be rolled out and
there is a continuing robust Palliative Care
Educational Programme run by the team,
which is accessible to all disciplines.
General Medicine
z UK Renal Registry
The report was presented to the Renal
Services User Group and three areas for
improvement were identified; referral rates
for renal transplant, reducing infection rates
with methicillin sensitive staphylococcus
aureus and improving achievement of target
haemoglobin levels.
z Sentinel Stroke National Audit Programme
(SSNAP) Quarterly Reports
The reports are presented and reviewed at
the monthly Stroke Service Group and the
ongoing stroke action plan is updated. Key
areas for improvement are the provision of
ring fenced stroke beds, resources for speech
and language therapy and improvements in
documentation by the multidisciplinary team.
z British Thoracic Society (BTS) Adult
Emergency Oxygen Audit 2013
The report was presented to the Respiratory
MDT meeting. A local audit is being carried
out to ensure that the nursing teaching
programme carried out in 2013 has had an
effect on improved practice in titrating oxygen
to meet target saturation ranges.
z British Thoracic Society (BTS) National
Pleural Procedures Audit 2014
at the Medicine Audit Meeting. In keeping
with national guidance all chest drains were
inserted by trained staff or under adequate
supervision. The service plans to: introduce
a pre-procedure checklist which will ensure
written consent is taken; train all Respiratory
Specialist Registrars to Level 1 competency
for inserting chest drains under ultrasound
guidance; and purchase drain fix dressings to
prevent drain migration, kinking and fall out.
131
z Royal College of Physicians (RCP) and
British Thoracic Society (BTS) Chronic
Obstructive Pulmonary Disease (COPD)
2013/14
The report was presented and reviewed at
the Respiratory MDT Team meeting. Work
is currently ongoing to reduce length of stay
and improve acute non-invasive ventilation
capacity with a business case being
submitted for weekend working specialist
nurses.
z Inflammatory Bowel Disease (IBD)
Biologics Audit & Organisational Audit
2013
the IBD Multi-disciplinary Group. A review will
be undertaken of concomitant medication for
patients with Crohn’s disease on biologics,
improved collection of quality of life scores
and ensuring patients with IBD have a named
dietitian.
z National Lung Cancer Audit 2013
both the weekly cancer MDT meetings and
the Essex Lung Cancer Network Meeting.
Since the 2013 report, we now have more
lung cancer clinical nurse specialists (CNS) in
post and more patients with a new diagnosis
of lung cancer will be seen by the CNSs.
Surgical Services
z Inflammatory Bowel Disease (IBD)
Inpatient Care & Experience Reports
2013/14
at the Gastroenterology Service meeting.
We comply with all areas but there are
further improvements required. More
robust documentation in healthcare records
and outpatient clinic letters is required,
prescription of calcium and vitamin D
supplements for patients on steroids for
bone protection needs to be reinforced and
a new pathway for anaemia is already being
implemented.
z National Emergency Laparotomy Audit
(NELA) Organisational Report
The organisational report was presented
and reviewed at the Surgical Divisional Audit
Meeting. Critical care and outreach services
need to be staffed at adequate levels to
ensure 24-hour specialist input and work is
currently in progress to address this.
z Anaesthetic Sprint Audit of Practice
(ASAP)
The report was presented at the Anaesthetic
Clinical Audit Meeting. Further education and
training of anaesthetists is being provided
to ensure peri-operative nerve blocks are
offered to all patients with hip fracture,
to reduce the incidence of hypotension
with spinal anaesthesia and reduce bone
cement implantation syndrome. A quality
improvement project is also in progress to
extend the use of nerve blocks and spinal
anaesthesia.
132
z Intensive Care National Audit and
Research Centre (ICNARC)
the critical care departmental meeting and
shows notable practice compared with similar
units. Work is being undertaken to address
documentation issues affecting mortality
figures and these include improved data
quality to ensure relevant risk factors and
co-morbidities are captured. Consultant job
plans have been re-configured to improve
admission and discharge processes.
z National Bowel Cancer Audit Annual
Report 2014
the colorectal multi-disciplinary meeting.
The method of data capture and upload will
be reviewed due to inconsistencies. More
recently data has been uploaded using the
Somerset system, so it is expected that the
majority of the issues will be resolved.
z Falls & Fragility Fractures Audit 2013/14
(National Hip Fracture Database)
at the monthly Hip Fracture Programme
meeting. We offer an excellent orthogeriatric
programme, with a consistently low mortality
rate. However, actions will be taken to
initiate a programme of audit centred on the
NICE quality standard including reviewing
drivers to improve time to theatre, access to
orthogeriatric care, examine the provision
of fracture liaison nurses and on-site DEXA
scan facilities.
z National Vascular Registry (NVR) Carotid
Endarterectomy Interventions Round 6
the Surgical Division Governance meeting.
All three vascular surgeons perform carotid
surgery within accepted safety margins.
Actions are being taken to ensure earlier
completion of pre-operative investigations.
Women and Children Services
z British Thoracic Society (BTS) Paediatric
Asthma Report 2013
The report was presented and reviewed by
the Paediatric Governance Meeting. Use
of a written asthma plan and discharge
information leaflet before discharge will be
implemented.
z National Neonatal Audit Programme
(NNAP) 2013
at the Neonatal Audit meeting. Action will
be taken to inform the obstetric team of
the results for babies receiving antenatal
steroids. The service is carrying out a quality
improvement project to improve the number
of babies receiving first retinopathy screening
and further training will be provided to staff to
increase the proportion of babies receiving
any of their mother’s milk when discharged
from the unit.
z Epilepsy 12 Round 2 2013
the Paediatric Governance Meeting. A model
has been agreed to implement a transition
clinic once numbers of patients have been
identified, an epilepsy database is being
implemented and work is underway to secure
a further contract for the Epilepsy Nurse
Specialist.
133
z National Paediatric Diabetes Audit (NPDA)
2012/13
at both the Paediatric Diabetes MDT
meeting and East of England Paediatric
Diabetes Network. There are no specific
recommendations following the audit,
although there is an ongoing work plan in
place to improve care outcomes.
z National Diabetes in Pregnancy (NPID)
Audit 2013
by both the Maternity Clinical Governance
Group and Divisional Governance Group.
Actions in response to the report, currently
being undertaken are: meeting with
commissioners and primary care teams to
develop and implement a strategic plan and
to increase consultant cover to cope with
increased demand in capacity for pregnant
diabetic women.
z National Comparative Audits of Blood
Transfusion 2013 – Anti D Blood
both the Trust’s Transfusion Committee and
Maternity Audit meeting. The audit identified
four women who did not have a discussion
and were never offered anti-D. Since the
audit a failsafe officer has been appointed
working in conjunction with the antenatal
screening midwife. We can confirm that since
the failsafe officer was appointed there have
no further reported cases. A local re-audit is
currently in progress to provide continued
assurance. The midwifery management
team will be incorporating anti-D prophylaxis
into the mandatory training programme for
relevant staff.
The reports of the following National Clinical
Audit were reviewed by the Trust and no
improvements were required
z National Head and Neck Cancer Audit
(DAHNO) 9th Report
This is a network based audit and the
network came first in multiple parameters.
The report was presented and reviewed in
the Head and Neck Clinical Governance
meeting.
z National Vascular Registry (NVR)
Abdominal Aortic Aneurysm Round 3
the Surgical Division Governance meeting.
AAA outcomes are within nationally accepted
limits and therefore no specific local actions
in response to the report are currently
identified.
z Prostate Cancer Organisational Audit
The report was presented and reviewed by
the Trust’s Cancer Board. After reviewing
report recommendations no specific local
actions in response to the report are currently
identified.
z National Institute for Cardiovascular
Outcomes Research (NICOR) National
Cardiac Rhythm Audit 2012
the monthly CTC Electrophysiology meetings.
After reviewing the report recommendations
no specific local actions in response to the
report are currently identified.
134
z Royal College of Physicians National
Review of Asthma Deaths 2014
The report was reviewed by the Respiratory
Team and the need for improved
psychological support for patients with
asthma was identified and this will be
explored.
z British Cardiovascular Interventional
Society (BCIS) Coronary Angioplasty
National Audit 2013
the MINAP and PPCI meeting. The data is
consistent with previous years. No anomalies
were noted last year and no further action is
required beyond our current processes as
we are performing better than our predicted
complication rate.
z Myocardial Infarction National Audit
Project (MINAP)
The report was presented and reviewed at the
monthly cardiology meeting. Standards have
generally improved and no specific local actions
in response to the report are currently identified.
The reports of the following National
Confidential Enquiries were reviewed by the
Trust.
z Maternal, Newborn & Infant Clinical
Outcome Review Programme: MBRRACE
Mortality report
the Maternity Clinical Governance & Risk
Management Committee. In response to
report recommendations, local actions
include:
Writing a guideline for sepsis in maternity.
Sepsis and a guideline for Maternity Early
Warning Score has been included in
mandatory multidisciplinary skills and drills
training.
Sepsis six campaign was launched in
maternity in November 2014, raising the
profile of sepsis recognition.
The epilepsy guideline has been approved
by the Maternity Policy Steering Group.
z National Confidential Enquiries into
Patient Outcome and Death (NCEPOD) –
Tracheostomy Care 2014
The report was reviewed by the anaesthetic
services. Actions for improvement include
staff training and competencies, improved
documentation, review of equipment and
availability and agreement of formal policies.
Local Clinical Audits
The Corporate Clinical Audit Programme links
with the Trust Quality Strategy and Quality
Goals and provides evidence and measures for
a number of projects.
The reports of 14 local clinical audits were
reviewed in 2014/15 and Basildon and Thurrock
intends to take the following actions to improve
the quality of healthcare provided:
Goal 1: Improving Patient Safety
Fewer avoidable pressure ulcers, fewer patients
harmed from falls and no never events.
z Pressure Ulcer Documentation (SSKIN
bundle)
Compliance with the pressure ulcer risk
assessment (Waterlow assessment) is
audited monthly and every quarter a more
detailed clinical audit is carried out. The
results are disseminated to senior sisters
and head of nursing for any remedial action
required on specified wards.
There have been discussions for a Trust
care pathway for women with headaches.
135
z Falls Prevention Pathway (Fallsafe)
Compliance with the falls risk assessment
document is audited monthly and compliance
has been maintained above 95%. The
Fallsafe project collects more detailed
measures for elements of falls prevention
and the results are examined by the Fallsafe
group and improvement actions developed.
z Hydration audit
Compliance with fluid balance chart
completion is monitored monthly. Following
lower than expected audit results the
organisation updated and re-issued the
essential standards of care for hydration to
all nursing staff and delivered training to all
ward-based nursing staff.
z VTE Prevention - appropriate prophylaxis
The administration of VTE prophylaxis is
audited monthly. During the year the results
fell outside expected limits and a number of
actions were taken to improve awareness
and compliance with good practice in
reducing the risk of VTE. These included a
staff presentation, messages in the Trust ‘Hot
Spots’ bulletin and posters were displayed
in clinical areas. Following these actions the
results increased to within normal limits.
z WHO Surgical Checklist (including Main
Theatres, Dermatology, Colposcopy,
Endoscopy, Radiology, Interventional
Cardiology and Cardiac Surgery)
The quarterly World Health Organisation
(WHO) surgical checklist audit carried out
in main theatres demonstrated sustained
improvement. The audit was extended during
the year to cover a number of other areas.
Improvements were made to the availability
of and use of surgical checklists in these
areas and quarterly audits are continuing to
improve compliance with the process.
z Quality of Discharge Summaries
The aim of this audit was to provide baseline
data on compliance with the standards
for completing a discharge summary
and focused on the quality of information
provided. Following the audit a quality
improvement project group has been
established that will take forward ideas for
improvement using quality improvement
methodologies such as frequent data
collection and testing changes using plan, do,
study, act (PDSA) cycles.
Goal 2: Improving the Quality and Reliability
of Care
Fewer cardiac arrests, patients treated earlier
for signs of deterioration and better use of the
sepsis care bundle.
z Management of Sepsis
Data from this quality improvement project
is reviewed monthly by the Sepsis Board to
determine areas for further improvement. Key
actions for 2015/16 are to improve reliable
delivery of the care bundle and to implement
the sepsis care bundle within the Acute
Medical Assessment Unit and in maternity.
z Urinary Tract Infection (UTI) Pathway
The outcome of the audit was presented to
the Right Place Right Time Board in May
2014. Improvement actions agreed were to
incorporate information relating to UTI into
the sepsis care bundle and junior doctor
induction training and to update the empirical
antibiotic policy.
136
z Treatment Escalation Plans
Compliance with the completion of treatment
escalation plans (TEP) is reviewed monthly
by the Divisions. Compliance within the
medical wards has improved over the
year. The TEP group plans to discuss the
requirement for the use of TEP forms for
surgical patients and for medical patients
admitted to surgical wards.
z Audit of clinical observations
A monthly audit is conducted which includes
ensuring there is a plan for the frequency of
observations, observations are completed
and patients escalated appropriately.
Results are discussed within the divisional
performance meetings and improvements
were made during the year to ensure
staff are fully aware of the standards and
expectations.
z Do not attempt cardiopulmonary
resuscitation (DNACPR)
The DNACPR audit is conducted to ensure
that records are completed and discussion
with patients, family / carers is documented.
The outcome of the audits are reviewed
by the Resuscitation Group and divisions
and any remedial actions are developed to
address any gaps highlighted.
z Pneumonia Care Bundle
A Quality Improvement project to reduce
mortality from pneumonia is in progress. A
new community-acquired pneumonia care
bundle has been developed and tested to
ensure that essential components of care
for patients with pneumonia are carried
out. The care bundle is being implemented
within the emergency department and acute
assessment units and ongoing monitoring
and improvement cycles will continue.
z Acute Kidney Injury
A Quality Improvement project to reduce
mortality and complications from acute kidney
injury (AKI) is in progress. A new AKI care
bundle is being developed and tested to
ensure that essential components of care for
patients with AKI are carried out and ongoing
monitoring and improvement cycles will
continue.
Goal 3: Improving patient and staff
experience
Providing our patients and their carers with the
best possible experience:
z Dementia (assessment and onward
referral) and carers survey - CQUIN
related
Results from the dementia audit and carer’s
survey are reviewed monthly by the Dementia
Strategy Group. Improvements were made
during the year to the process for ensuring
that a dementia assessment is completed on
admission for relevant patients and this has
resulted in sustained improvement exceeding
90%.
z Participation in clinical research
Clinical research is a central part of the NHS,
as it is through research that the NHS is able
to offer new treatments and improve people’s
health. Organisations that take part in clinical
research are actively working to improve the
drugs and treatments offered to patients.
The statement below shows the number
of patients who were recruited to take part
in clinical research and being treated by
the Trust. Participation in clinical research
gives patients access to the latest drugs and
treatments in development.
137
NHS Foundation Trust is a partner in the
National Institute for Health Research (NIHR)
Clinical Research Network: North Thames
and works closely with the core team to
maximise funding to support the delivery of
high quality research.
Participation in clinical research demonstrates
our commitment to improving the quality of
care we offer and to making our contribution
to wider health improvement. Our clinical
staff stay abreast of the latest treatment
possibilities and active participation in
research leads to successful patient
outcomes.
The number of patients receiving relevant
health services provided or sub-contracted
by the Trust in 2014/15 that were recruited to
participate in research approved by a NHS
research ethics committee was 1,927. 1,578
recruits were to NIHR portfolio studies with
the remaining 349 to studies that have not
been adopted
We believe that patients should have access
to good quality, ethically-approved research
and that whether or not someone participants
in a research study they should receive
nothing less than the NHS gold standard.
Of the newly recruited patients, 404 (21%)
were enrolled to interventional clinical trials;
these are complex and time-consuming
studies. The remaining 1,506 participants
(79%) were enrolled in observational studies.
We were involved in 177 active clinical
research studies, of which 100 remain actively
recruiting patients, 44 following-up patients
and 33 that have closed within the year.
These studies took place across 22 clinical
specialties. Cardiology, diabetes and cancer
are the top recruiting specialties.
z Use of the Commissioning for Quality and
Innovation (CQUIN) Payment Framework
The CQUIN payment framework was
introduced with the aim of making care
quality the core value of NHS providers. The
framework makes a proportion of provider
income conditional on locally agreed quality
and innovation goals.
During the reporting period seven Adverse
Events, eight Serious Adverse Events and
0 Suspected Unexpected Serious Adverse
Reactions were reported. A total of two
research participants died and the incidence
of death was unrelated to the research in all
cases.
A proportion of the Trust’s income in
2014/15 was conditional on achieving quality
improvement and innovation goals agreed
between the Trust and any person or body
they entered into a contract, agreement or
arrangement with for the provision of relevant
health services, through the Commissioning
for Quality and Innovation payment
framework.
The monetary total for income in 2013/14,
conditional upon achieving quality
improvement and innovation goals was:
£288.4million (this represents the total income
for the Trust and not just the CQUIN portion of
payment).
The Trust continues to support educational
research and provide training and advice
to staff requiring support for academic
qualifications and to external students.
138
The CQUIN Schemes agreed with the Trust’s main commissioner for 2014/15 are:
Fig.51: Agreed CQUIN schemes
CQUIN scheme
Friends and Family Test – Implementation of staff FFT - NHS Trusts Only
Friends and Family Test - Early Implementation in outpatient and daycase
Friends and Family Test - Increased or maintained response rate
Friends and Family Test - Increased response rate in acute inpatient services
NHS Safety Thermometer - Improvement Goal Specification
Dementia - Find, Assess, Investigate and Refer
Dementia - Clinical Leadership
Dementia - Supporting Carers of People with Dementia
Co-ordinated End of Life
Implementation of SystmOne
Sepsis
Improved Management of Frail Individuals
Ambulatory Emergency Care
Improved Discharge
Hearing Loss / Dementia
Introduction of a Blueteq system
Expected Value
CQUINs 2014/15 = 2.5%
(Currently payment for CQUINS is part of an arbitration process to agree a final settlement of
Trust income from commissioners)
Further information about locally agreed CQUIN goals is available from the Trust on request
(01268 524900 ext. 3943).
139
The maternity unit received an outstanding
rating. Some of the things the CQC highlighted
included exceptional care and treatment, open
culture with strong focus on patient safety and
risk management. The service continuously
reviews and acts on feedback from patients
and relatives, and patients said they felt safe
in the hands of staff. Leadership encourages
cooperative, supportive relationships among
staff and compassion towards patients.
What the regulators said about the Trust
The Care Quality Commission
The Care Quality Commission (CQC) is the
independent regulator of health and adult
social care in England. The CQC make sure
that the care provided by hospitals, dentists,
ambulances, care homes and home-care
agencies meets government standards of
quality and safety. They also protect the
interests of vulnerable people, including those
whose rights are restricted under the Mental
Health Act.
The ratings for services provided by the Trust
are:
The Trust is required to register with the CQC
and has no conditions on registration.
The Trust is currently registered to carry out the
following legally regulated services:
At Basildon University Hospital: Maternity and
midwifery services, termination of pregnancies,
treatment of disease, disorder or injury,
surgical procedures, diagnostic and screening
procedures, management of supply of blood
and blood derived products, assessment or
medical treatment for persons detained under
the Mental Health Act 1983 and family planning.
At Orsett Hospital: Termination of pregnancies,
treatment of disease, disorder or injury;
surgical procedures, diagnostic and screening
procedures and family planning.
For further information about the CQC’s
new acute regulatory model and inspection
framework please visit: www.cqc.org.uk
Basildon University Hospital was inspected
by the CQC utilising a ‘Wave 2’ inspection
approach, the review took place over two days
– 19 to 20 March 2014.
The Trust has not participated in any special
reviews or investigations by the CQC during the
reporting period.
CQC report Celebrating Good Care
The Trust is particularly pleased to be
referenced in the CQC Celebrating Good
Care Report in March 2015. This reflects the
transformational improvement journey the Trust
has gone through over the last few years.
The report references the work undertaken
to improve good governance processes in
particular to support responsiveness to patients
and the public. A copy of the report is available
at the following web address:
www.cqc.org.uk/content/celebrating-good-carechampioning-outstanding-care-1
Basildon University Hospital was awarded an
overall rating of ‘good’ with very few areas
requiring improvement.
140
Data Quality
Clinicians and managers are dependent on
good quality data from clinical systems to
ensure that they are delivering appropriate
services to patients. This data must be accurate
and accessible when needed to ensure it
effectively supports the delivery of patient
services.
Secondary Uses Service (SUS) Submissions
The Trust submitted records during 2014/15 to
the Secondary Uses Service for inclusion in the
Hospital Episode Statistics which are included
in the latest published data. The percentage
of records in the published data is shown in
Fig.53:
Fig.53: Percentage of records published in Hospital Episode Statistics
2013/14
2014/15
% for admitted patient care
99.6%
99.7%
% for outpatient care:
99.7%
99.8%
% for accident and emergency care:
98.5%
98.7%
Which included the patient’s valid NHS number was:
Which included the patient’s valid General Medical Practice Code was:
% for admitted patient care:
100%
100%
% for outpatient care:
100%
100%
% for accident and emergency care
100%
99.9%
141
Information Governance toolkit attainment
rates
The Trust Information Governance Assessment
Report for the period 2014/15 was 71% and
was graded as green, satisfactory.
By comparison the Trust Information
Governance Assessment Report for the period
2013/14 was 71% and was graded as green,
satisfactory.
Clinical coding error rate
The Trust was not subject to the Payment by
Results clinical coding audit during 2014/15 or
2013/14 by the Audit Commission.
The Trust has taken the following actions to
improve data quality:
z An independent audit of information
governance arrangements
142
Part 3 - Review of quality performance
The Trust uses a wide range of information to monitor performance and the quality of services. The
Trust board have reviewed the indicators required for the quality strategy and as a result a number
of indicators are no longer referenced in the quality report. Each of the three indicators for patient
safety, clinical effectveness and patient experience monitired in 2014/15 has been discussed in
detail with historical and benchmarked data in Section 2.
Fig.54 below shows summary of indicators, with a comparison of performance over the past four
quarters and the arithmetic average as part of the Monitor risk assessment framework (RAF).
Further information is included in Appendix 3 that including locally defined measures and targets.
Fig.54: Summary of indicators
Target
YTD
Q1
Q2
Q3
Q4
2014/15
average
90%
77.3%
76.9%
82.4%
83.7%
82.8%
95%
93.1%
88.4%
89.0%
88.2%
91.3%
92%
82.7%
85.4%
90.5%
87.8%
88.9%
95%
95.9%
95.0%
94.7%
88.8%
94.4%
85%
81.5%
77.8%
82.2%
76.0%
79.5%
90%
91.7%
100.0%
60.0%
92.3%
91.2%
94%
100.0%
100.0%
100.0%
100.0%
100.0%
98%
100.0%
100.0%
100.0%
100.0%
100.0%
96%
100.0%
99.2%
100.0%
100.0%
99.6%
Cancer 2 week (all cancers)
93%
95.1%
94.9%
95.6%
96.4%
95.3%
Cancer 2 week (breast symptoms)
93%
95.4%
96.2%
100.0%
93.7%
95.3%
18
10
23
30
37
37
CQUIN scheme
*Referral to treatment time, 18 weeks
in aggregate, admitted patients
in aggregate, non-admitted patients
in aggregate, incomplete pathways
A&E Clinical Quality- Total Time in
A&E under 4 hours
Cancer 62 Day Waits for first
treatment (from urgent GP referral)
Cancer 62 Day Waits for first
treatment (from NHS Cancer
Screening Service referral)
Cancer 31 day wait for second or
subsequent treatment - surgery
Cancer 31 day wait for second
or subsequent treatment - drug
treatments
Cancer 31 day wait from diagnosis to
first treatment
Cumulative total C.diff (including:
cases deemed not to be due to lapse
in care and cases under review)
* RTT for the quarter is reported as the performance for the worst month of the quarter
143
The Trust’s complaints report published
under regulation 18 of the Local Authority
Social Services and NHS Complaints
Regulations 2009 dated 12 November
2014, 11 February 2015, 27 May 2015
Appendix 1 – Statement from Directors
The following is a statement of directors’
responsibilities in respect of the quality report
and is required by the Foundation Trust
regulator Monitor.
The Directors are required under the Health Act
2009 and the National Health Service Quality
Accounts Regulations 2010 to prepare Quality
Accounts for each financial year. Monitor has
issued guidance to NHS foundation trust boards
on the form and content of annual quality
reports (which incorporate the above legal
requirements) and on the arrangements that
NHS foundation trust boards should put in place
to support the data quality for the preparation of
the quality report.
In preparing the quality report, directors are
required to take steps to satisfy themselves
that:
z the content of the quality report meets the
requirements set out in the NHS Foundation
Trust Annual Reporting Manual 2014/15
z the content of the Quality Report is not
inconsistent with internal and external
sources of information including:
Board minutes and papers for the period
April 2014 to April 2015
Papers relating to Quality reported to the
Board over the period April 2014 to April
2015
Feedback from the commissioners dated
8 May 2015
Feedback from the governors
Feedback from local Healthwatch
organisations dated 8 May 2015
The national patient survey dated March
2015
The national staff survey May 2015
The Head of Internal Audits annual
opinion over the Trust’s control
environment dated 22 May 2015
CQC Intelligent Monitoring Report dated
December 2014
z the Quality Report presents a balanced
picture of the NHS foundation trust’s
performance over the period covered;
z the performance information reported in the
Quality Report is reliable and accurate;
z there are proper internal controls over the
collection and reporting of the measures of
performance included in the Quality Report,
and these controls are subject to review to
confirm that they are working effectively in
practice;
z the data underpinning the measures of
performance reported in the Quality Report
is robust and reliable, conforms to specified
data quality standards and prescribed
definitions, is subject to appropriate scrutiny
and review; and the Quality Report has been
prepared in accordance with Monitor’s annual
reporting guidance (which incorporates the
Quality Accounts Regulations) as well as
the standards to support data quality for the
preparations of the quality report.
144
The directors confirm to the best of their
knowledge and belief they have complied with
the above requirements in preparing the Quality
Report.
By order of the Board
Bob Holmes
Acting Trust Chairman
27 May 2015
Clare Panniker
Chief Executive
27 May 2015
145
Appendix 2 – Statement from
Stakeholders
Commissioners
z Basildon and Brentwood Clinical
Commissioning Group
Basildon and Brentwood Clinical
Commissioning Group welcomes the
opportunity to comment on the Quality Annual
Account prepared by Basildon and Thurrock
(BTUH).
As a primary commissioner of services,
Basildon and Brentwood has the following
statement to make for inclusion in the BTUH
Quality Account. This commentary is also
made on behalf of Thurrock CCG.
This is of course at a time when the
future sustainability of the NHS has to be
addressed; it is of note that BTUH is keen
to be at the forefront of system re-design
alongside the CCG and other health care
providers.
The CCG agree with and support the key
quality goals that the Trust has described
and we have the sight of a number of other
metrics to ensure further breadth and depth
of assurances of additional initiatives and
plans to continually improve patient safety
and quality of care.
There have been a number of further
improvements to help embed the divisional
governance structure to improve patient
safety and quality:
To the best of the CCGs knowledge, the
information contained in the account is
accurate and reflects a true and balanced
description of the quality of the provision of
services
The Trust has signed up for the ‘Sign Up
To Safety’ campaign.
Staff are supported in a number of different
and innovative ways – such as the
‘Schwartz Rounds’ which acknowledge the
stressful environment staff work within and
offers a method of support to all staff at all
levels who wish to participate.
This year has seen vast improvements for
patient safety and quality of care at BTUH
throughout 2014/15, with the ‘good’ rating
by the CQC and the removal of special
measures by Monitor.
The ‘Bohmer’ programme has developed
a progressive move towards improved
clinical leadership with the aim of
improving quality and enabling clinicians to
better understand their role in leading the
organisation.
These achievements are a reflection of the
dedication and hard work of all staff at the
Trust, from the impressive leaders to those
who deliver hands on care and the functions
behind the scenes. The Trust should be
proud of its achievements.
The introduction of a Quality Improvement
advisor role.
Continued drive and improvement is still
required; but this is achievable due to the
positive, open and transparent culture, and
an organisation who have demonstrated that
they have become a learning organisation.
146
focus our attention to gain the required
assurance about standards of care. This
team provides valuable independent
assurance to the Trust Board about
standards of care.
Assurance
The CCG formally monitors and gains
assurances about the standards of practice
within the Trust through the Clinical Quality
Review Group. This group meets monthly
and consists of executives from the provider
and the CCG, plus other senior members
of each team. The overarching purpose
of the group is to provide assurance to
the CCG regarding the delivery of clinical
quality at BTUH, by having an overarching
view of quality standards within the Trust. It
examines and reviews all quality indicators,
including the Trust’s Clinical Quality
Performance Report, which details level of
compliance, and reason for any failure to
meet the quality indicators and information
requirements contained within the contract.
Mortality Rates (including care of the
deteriorating patient)
The Standard Hospital Mortality Indices
(SHMI) value for Basildon Hospital has
been improving for consecutive quarters
since June 2012. The latest SHMI data
shows the value to be within the expected
limits, meaning the number of people who
die following treatment is within the range
that would be expected to die.
In 2014/15 the Trust identified and committed
to 13 sub-sets of three over-arching goals for
quality. Of those 13:
Care of the Deteriorating Patient Methodologies to improve the escalation
and care of the deteriorating patient have
been another key focus this year. The key
improvements have included:
six were achieved
- Implementation of a new National Early
Warning System (NEWS)
four although target was not achieved,
improvements were made
- The development of the Critical Care
Outreach Team
three were not achieved (reduction in
Never Events, improved PROMs, improved
cancer care survey)
- Introduction of key care bundles
Areas of note within the Trust
- Extension of senior medical working
hours
The Trust has its own internal
Compliance Team who regularly
undertake unannounced compliance
visits within the Trust, co-opting specialist
support in to the team when required
to assess compliance against expected
standards. The CCG works closely
with team, feeding them each other’s
intelligence as to where we should both
- Improvements to the Hospital at Night
Service
- Extension of diagnostic working hours
All of these ensure improved monitoring,
communication and escalation when
patients begin to deteriorate.
147
Workforce – numbers and satisfaction
Nurses - The Trust continues to close the
nursing vacancy gap with substantively
recruited staff, however, this remains a
challenge. In response to that challenge,
the Trust has developed a number of
recruitment initiatives which includes:
Learning culture
Incidents - Incident reporting by the
Trust remains at a consistent level,
having previously risen from being in the
lowest quartile of reporters nationally
to the highest quartile of reporters, with
evidence of good management at local
levels. Incident trends are analysed and
information triangulated with complaints,
staffing levels etc to ensure learning is
identified and embedded in practice.
- work based learning enabling HCAs to
enrol with Essex University on a work
based nursing degree programme
- Partnership work with Anglia Ruskin
University to facilitate the ‘Return to
practice’ course which will develop a
small but consistent supply of nurses
who wish to re-join the workforce
The CCG is pleased to see the continued
high reporting of all incidents, including
serious incidents, as this demonstrates
that the organisation is open and honest.
In addition, there is good evidence that the
Trust is a learning organisation.
- Overseas recruitment from Spain,
Portugal and the Philippines
Specific elements of care – falls,
pressure ulcers VTE, IPC, EMSA.
- In-house recruitment event for student
nurses
The Trust continues to take measures to
ensure that all newly recruited staff have
their competencies checked and signed off
as part of the Trust’s induction programme
and their commitment to ensuring staff are
competent and safe to practice.
Medical - Recruitment to specialist areas
such as A&E and CCU continue to be a
challenge, as does the need to recruit to
meet the 7 day requirements.
Staff Satisfaction - The 2014 National
Staff Survey highlighted that for the third
consecutive year, BTUH has seen an
improvement in the number of staff who
would be happy with the standard of care
at the Trust, if a relative or friend needed
treatment at the Trust.
Falls - BTUH have adopted a number of
schemes to reduce the number of falls:
- The ‘FallsSafe’ project, a proven
methodology to reduce falls. The
project involves formal education and
training and recruitment of ‘champions’
who can scrutinise audit data, cascade
learning and skills to empower their ward
colleagues and the multi-disciplinary
teams to implement high quality falls
related care. Since adoption of the
methodology, BTUH have seen an 8%
reduction in falls, improvement in risk
assessing and general falls management.
- The monthly Trust Falls Prevention
Group which is attended by the CCG and
looks at themes and trends as well as
the weekly Harm Free Care Group where
individual cases are peer reviewed to
assess avoidability and learning.
148
- All falls with harm are reported as serious
incidents, the Root Cause Analysis
investigations carried out by BTUH are
scrutinised and signed off by the CCG.
-
Re organisation of the falls team.
-
Application to become part of ‘Sign
up to Safety’, a national campaign to
reduce avoidable harm.
Pressure Ulcers
For 2014/15, the Trust had the reduction of
avoidable pressure ulcers, grades 2, 3 and
4 to below 0.25 per 1000 bed days as a
quality goal; this has been achieved in 9 of
the 11 months from April 2014.
In order to work towards their ambition of
zero pressure ulcer days, the Trust has
undertaken the following:
Infection Prevention and Control
The challenge to reduce Hospital Acquired
Infections (HCAIs) continues.
- MRSA bacteraemia - whilst a zero
tolerance for MRSA bacteraemia
continues; there have been two
contaminates and five actual cases
in 2014/15. These cases have
been for patients with multiple,
serious co-morbidities, with minimal
recommendations from the Post Infection
Review for improvements in infection
prevention and control practices. The
challenge for MRSA in 2015-16 remains
at zero.
- Clostridium difficile - robust systems
are in place to review all HCAI’s and
the CCG infection Prevention & Control
Team attend multidisciplinary meetings
to ensure there are no lapses in patient
care.
- Establishment of the Harm Free Care
weekly peer review meetings which the
CCG attends.
- Re-launch of SSKIN care bundles.
- Heels up campaign which included
providing staff with a mirror and supported
leaflets.
- Increased capacity with the tissue
viability team.
Fig.55 below shows the number of cases
across the CCG.
Fig.55: Clostridium difficile cases
across CCG
C.diff figures
- ‘Sign up to Safety’ campaign
BTUH
Venous Thromboembolism (VTE)
Following last year’s fall in performance
around VTE; BTUH took actions to
improve awareness and compliance with
good prescribing and administration of
prophylaxis. As a result, their internal
monthly audits have shown an improving
picture over the last six months.
149
Actuals
Trajectory
37
18
Eliminating Mixed Sex Accommodation
(EMSA)
BTUH have had a number of breaches with
regards to EMSA. Apart from two, these
were all in relation to CCU patients. The
CCG has worked with the Trust to revise
their policy to ensure they are not unfairly
judging their compliance to this standard
for this particular group of patients, who
arguably would have a clinical reason for
not moving promptly from CCU.
Patient experience
- Friends and Family Test (FFT)
BTUH have steadily improved their
FFT response rates in both A&E and
inpatients.
For A&E April to February 2015, a
mean average of 74% of respondents
recommended the service.
From April 2014, the Staff FFT was
introduced, staff were asked to respond
to two questions:
z how likely they are to recommend the
NHS services they work in to friends
and family as a place for care?
z how likely they would be to recommend
the NHS service they work in to friends
and family as a place to work?
The Staff FFT is conducted on a quarterly
basis, for Quarter 1, 56% recommended
BTUH as a place to work and 66% as a
place for care. Quarter 2 saw improved
results with 57% of staff stating that they
would recommend BTUH as a place to
work, and 73% as a place for care.
Patient Advisory Liaison Service (PALS)
This service was previously criticised
by CQC and during the Keogh review –
following that feedback a senior clinical
post was created and the office has now
moved to the front of the hospital. The
development of the Patient Advice and
Liaison Service has assisted in directing
patients and relatives to have the ability to
find an early remedy to many issues that
with good communication can often be
rectified at ward level, without the need to
escalate further.
For inpatients April to February 2015, a
mean average of 95% of respondents
For CTC, 98% April to February 2015,
a mean average of respondents
For Maternity birth and antenatal, April to
February 2015, a mean average of 100%
and 98% respectively.
In October 2014 FFT was implemented in
main outpatient departments at Basildon
and Orsett, CTC and fracture clinic. Of
those who responded, 93% of the said
they would recommend the Trust.
At the end of the Friends and Family test
survey BTUH pose two questions asking
patients to state what they thought BTUH
did well and what we could do better. Key
issues raised in 2014/15 were around
waiting times in A&E, care staff and food
for inpatients.
150
Patient Engagement
The Trust has joined the Patient Leaders
programme with the CCG. They hold
listening surgeries, have good links with
Healthwatch and now have patient stories
at Board.
Children’s safeguarding
Previous concerns around child
safeguarding have been vastly reduced.
The structure for safeguarding has been
improved as has the relationship with
the two Child Safeguarding Boards for
Thurrock and Essex.
In order to improve the ease of understanding
of the issues faced by the Trust a high level
assurance document has been developed to
assist the Trust and others to track on-going
improvements. This document will scrutinise the
following areas:
CIP review
The National Quality Board: HOW TO:
Quality Impact Assess Provider Cost
Improvement Plans guidance recommends
a multi-disciplinary approach to the
assessment and sign off of provider
CIPs through the development of a ‘Star
Chamber’. Although the CCG have not
adopted the ‘Star Chamber’ approach in its
entirety, the guiding principles, promoting
systematic exploration of quantitative and
qualitative intelligence and encourages
the orderly triangulation of information to
help assess the quality impact of our main
provider’s CIPs.
Legionella
This past year has seen a year of
sustained improvements. The joint
Steering Group have passed ongoing
monitoring to the CCG.
Monthly review meeting continue, when
detailed discussions around the Key
Performance Indicators are discussed and
reviewed.
There have been a number of challenges
around maintaining water temperatures
and achieving the required levels of
silver and copper in the water system,
despite this there has been a consistent
achievement of nil/minimal positive
Legionella results on the Basildon Hospital
site.
The CCG have continued to have quarterly
meetings with BTUH to gain assurance on
the quality impact of the CIPS.
Major work is needed in the coming year
on the old block to improve hot water
return temperature.
151
z Thurrock Clinical Commissioning Group
Thurrock CCG welcomes the opportunity to
comment on the annual Quality Account of
NHS Foundation Trust for 2014/15.
The infection control incidences relating to
CDiff, MRSA and IGAS have been monitored
consistently by the Trust and CCG’s Infection
Control Teams. The CCG consider that this
significant work to reduce harm from these
incidents will need to continue for 2015/16.
The CCG notes the summary of the Trust’s
Performance for 2014/15. Whilst some
quality goals have been achieved it is
recognised that there is still some work to
do to improve harm free care although the
Trust has enhanced its incident reporting
processes. From a national perspective this
is demonstrated by the improvement in the
Trust performance which is now in the top
10% of hospitals for reporting harm.
The CCG welcomes the development of
key priorities for quality improvement during
2015/16 and will continue to provide support
and guidance. It is recognised that the
Trust is experiencing significant financial
challenges and assurances will be sought to
ensure that the quality and safety of patients
is not compromised. The rigour of quality
assurance monitoring will continue.
The CCG is pleased to note the work to
improve quality through the Schwartz
Round processes and the work with Harvard
Business School implementing the Bohmer
Programme to ensure sustainability.
The CCG is also pleased that the Trust is
referenced in the Care Quality Commission
Celebrating Good Care Report published in
March 2015, reflecting its transformational
improvement and removal from special
measures.
The further measures to improve quality
through the recognition and treatment of
sepsis are also noted, together with the work
with UCL Partners. It is anticipated that this
will reduce mortality through sepsis during
2015/16.
The CCG note that some cancer and other
quality targets have been challenging and not
achieved during 2014/15. The CCG would
welcome information on actions being taken
to optimise performance.
152
z Healthwatch Essex
Healthwatch Essex is an independent
organisation with a vision to be a voice
for the people of Essex, helping to shape
and improve local health and social care
services. We believe that people who use
health and social care services and their lived
experience should be at the heart of the NHS
and social care services.
We recognise that Quality Account reports
are an important way for local NHS services
to report on what services are working well,
as well as where there may be scope for
improvements. The quality of the services
is measured by looking at patient safety,
the effectiveness of treatments that patients
receive and patient feedback about the
care provided. We welcome the opportunity
to provide a critical, but constructive,
perspective on the Quality Accounts for
BTUH, and we will comment where we
believe we have evidence – grounded in
people’s voice and lived experience – that is
relevant to the quality of services delivered
by BTUH.
It is commendable that the Trust has
focused on patient experience as one of
their priorities over the past year, and it
has achieved the goal of increasing the
response rate and recommender score in
their Friends and Family tests (although data
is not entirely clear cut). In the priorities for
2015/16, BTUH is keeping a focus on these.
Healthwatch Essex supports the Trust in
these endeavours, but would encourage
the Trust to think about how other methods
can be used to capture qualitative insights
of people’s lived experiences of care, and to
use this to continue to drive improvement.
The Trust has also improved its performance
on complaints and compliments, which is
encouraging. In 2014/15, BTUH had a 16%
reduction in complaints received, and a 66%
increase in the number of positive comments,
with a total of 478 in 2014/15 compared to
288 in the previous year.
In this account, BTUH outline the actions
being taken to help further improve the
experience of patients. These actions include
involving people who have made a complaint
in service redesign and improvement,
introducing an inpatient information booklet,
amenity packs for emergency admissions, an
experience sharing learning method ‘see it
my way’ where members of staff and patients
share their experiences and discuss ways to
improve services, and the development of
Trust patient experience video to train staff.
Over the past year, the Trust has seen
improvements, after receiving a rating of
‘good’ by the CQC and being removed from
special measures. However, the Trust has
also begun to experience financial difficulties
in 2014/15 – a fact that the Trust recognises
it has in common with many other acute
Trusts. This coincides with other common
factors that are placing an additional burden
on the Trust’s resources, such as bed
capacity and high demand for services. It is
important to remain vigilant to the impact this
could have on patient and carer experience
at BTUH.
Healthwatch Essex believes that lived
experience should be at the heart of services,
and believes that listening to the voice and
lived experience of patients, service users,
carers, and the wider population, is a vital
component of providing good quality care.
We will continue to support the work of BTUH
in this regard.
153
Group (CCG), is instigated. This review
identifies contributory factors, non-optimal
practice and lessons learned from the case
to improve future practice. It also identifies
the organisation best placed to ensure these
lessons are acted upon and the organisation
to which the case is assigned.
Appendix 3 – Supplementary
Performance Information
In addition to the information provided in the
main part of the report with regard to quality
improvement and performance delivery, this
section describes other quality measures that
the Trust seeks to achieve.
There have been six cases of MRSA
bacteraemia during 2014/15; four cases
were assigned to the Trust. Two cases were
agreed contaminants.
z Infection prevention and control
The Trust Infection Prevention and Control
team work closely with staff across the Trust
to embed robust infection prevention and
control processes, to ensure high quality,
safe, patient care.
The MRSA threshold will remain as zero for
2015/16.
z Delayed transfer of care
The ambition is to maintain the lowest
possible rate of delayed transfers of care.
Good performance is demonstrated by a
consistently low rate over time, and/or by a
decreasing rate.
z MRSA bacteraemia
The national guidance on the reporting and
monitoring and post infection review (PIR)
process for MRSA bloodstream infections
(BSI) was implemented in April 2013 as part
of a strategy for achieving a zero tolerance to
Healthcare Associated Infection (HCAI).
Following laboratory identification, each case
of MRSA BSI is reported immediately to a
national Public Health England data capture
system, and a multi-disciplinary post infection
review, which includes a representative
from the local Clinical Commissioning
Performance throughout the year, as shown
on the chart below, has been variable and is
affected by the complexity of patient needs.
Our aim is to ensure that discharges are safe
and meet the needs of patients while still
being undertaken in a timely way.
Fig.56: Delayed transfer of care April 2013 to March 2015
Source of data: Trust internal report
154
z Complaints
The Trust received a 16% reduction in
complaints in 2014/15. We use information
from complaints and from PALS to take
immediate action when people using our
services identify a problem that needs to be
resolved.
Fig.57: Complaints received 2014/15
Total complaints
2011/12
2012/13
2013/14
2014/15
484
633
833
700
Source of data: Internal complaints report
The key themes and trends are reported
monthly to the Board of Directors within the
performance report and within each division
to ensure a local response to any problems
identified.
Fig.58: Top three complaints themes 2011-2015
2011/12
1
2
3
2012/13
2013/14
Medical judgement/
diagnosis (120)
Medical care/
treatment (159)
Medical care/
treatment (103)
Nursing care/
treatment (64)
Medical judgement/
diagnosis (95)
Nursing care/
treatment (85)
Source of data: Trust risk management database, Ulysses
155
Medical care/
treatment
(186)
Medical judgement/
diagnosis (115)
Nursing care/
treatment (114)
2014/15
Medical care/
treatment (170)
Communication
(103)
Medial judgment
diagnosis (84)
z Responding to our public
The Trust uses a variety of sources of
information to assess how we could do things
differently to improve patient experience.
Comment cards have always been a rich
source of capturing feedback.
From March 2014, the ‘Get It Right’ cards
and leaflets were replaced with a refreshed
version ‘We’re Listening’, to coincide with the
relocation of the PALS office.
z Dementia friendly hospitals
Hospitals play an important role in people’s
journey through dementia. Up to 25%
of patients in hospital can be living with
dementia and they are at greater risk of
dehydration, malnutrition and harm from falls.
It is important that the Trust has staff with the
right skills and knowledge to care for people
with dementia and that we help identify those
with people with signs of dementia as early
as possible.
Fig.59: Comment Cards 2011-2014
Year
Qtr 1
Qtr 2
Qtr 3
Atr 4
2011/12
89
107
113
57
2012/13
61
63
64
63
2013/14
75
94
170
132
2014/15
39
64
78
35
Early diagnosis
(Abbreviated Mental Test Score)
The Trust undertakes an assessment of
all patients over the age of 75 to test their
cognitive performance. The aim is to help
identify any potential problems and then
refer the patient on for a more detailed
assessment. Following implementation of
a new method for collecting the data our
performance has been good.
The Trust also captures feedback from the
NHS Choices website, which is scrutinised by
our external regulators for comments relating
to the Trust. In 2014/15, a feedback email
address was set up to capture comments to
help shape and develop services provided
by the Trust. Comments are acknowledged
where possible, and if further investigation is
required or a concern raised about a current
inpatient, advice is given to contact the PALS
team or speak with the senior ward staff.
The Trust has experienced a significant
increase (66%) in the number of positive
comments in the form of formal plaudits, with
a total of 478 logged in 2014/15 compared to
288 in 2013/14. These are in addition to the
expressions of thanks received and displayed
in wards/departments.
156
Fig.60: Dementia screening April 2013 to March 2015
Source of data: Internal Trust documentation audit
Fig.61: Nursing documentation audit April 2013 to March 2015
Source of data: Internal Trust documentation audit
157
Improving staff awareness of dementia
All Trust staff are required to undertake an
awareness session in dementia. We believe
this benefits our patients and will help
support our local community by reducing
stigma associated with this condition and
encouraging people to get involved and be
more supportive to people with dementia.
This is a new quality measure at which our
performance has been good.
Fig.62: Improving staff awareness
(tier 1 training)
Source of data: Internal training data
158
z Eliminating mixed-sex accommodation
There is a commitment across the NHS to
reduce and, where possible, eliminate mixedsex accommodation. The Trust is committed
to eliminating mixed-sex accommodation
and to maximise privacy and dignity for our
patients.
The graph below shows that some incidents
of mixed-sex accommodation still occur.
These are all related to two areas in the Trust,
the critical care unit (CCU) and endoscopy
department. In CCU the incidents occurred
when patients were deemed fit for transfer
out of the unit but a bed was not available
on a ward within 12 hours. In endoscopy,
the Trust normally runs lists of same gender
patients, however on a few occasions it was
necessary to add someone of the opposite
gender to a list because an investigation was
urgent. While this was in the best interests
of the patient, it was not necessarily in the
best interest of other patients in the unit and
so was regarded as a breach of the rules
governing mixed-sex accommodation.
Fig.63: Eliminating mixed-sex accommdation April 2013 to March 2015
Source of data: Trust internal report
159
New foot clinic means better experience for diabetes
patients
Nicola Lewis, lead diabetes nurse, said:
“The purpose of the early access foot clinic
is to make sure the wounds are treated and
prevent amputations, which is a possibility in
the most extreme of cases.”
Diabetic patients are benefitting from a better
experience thanks to the opening of the new
foot clinic. Foot care is important for patients
with type 1 or 2 diabetes, because glucose
levels affect the circulatory system, causing
problems to blood flow. Any ulcers that form
have great difficulty in healing due to the
reduced blood supply.
The newly refurbished clinic room in the
outpatient department is purpose-built to allow
for the debridement of diabetic foot wounds.
Debridement speeds up the healing process
for ulcers, by removing the affected tissue
from the wound.
“Around 50 patients a week attend the foot
clinic,” explains Nicola. “Previously we were
in a side room on a ward, where space
was much more limited. The new clinic
room is more spacious and has the latest
air-exchange system which is important
for infection control. As it is located in the
outpatient department, closer to the car park,
it is easier for patients to access.”
Diabetes team
160
Independent auditors report to the Council of Governors
of Basildon and Thurrock University Hospitals NHS
Foundation Trust on the Quality Report
We have been engaged by the Council of
Governors of Basildon and Thurrock University
Hospitals NHS Foundation Trust to perform an
independent assurance engagement in respect
of Basildon and Thurrock University Hospitals
NHS Foundation Trust’s Quality Report for
the year ended 31 March 2015 (the ‘Quality
Report’) and certain performance indicators
contained therein.
out in the NHS Foundation Trust Annual
Reporting Manual;
z the Quality Report is not consistent in all
material respects with the sources specified
below; and
z the indicators in the Quality Report identified
as having been the subject of limited
assurance in the Quality Report are not
reasonably stated in all material respects
in accordance with the NHS Foundation
Trust Annual Reporting Manual and the six
dimensions of data quality set out in the
Detailed Guidance for External Assurance on
Quality Reports.
Scope and subject matter
The indicators for the year ended 31 March
2015 subject to limited assurance consist of
the national priority indicators as mandated by
Monitor:
z Percentage of incomplete pathways within
18 weeks for patients on incomplete
pathways
z Maximum waiting time of 62 days from urgent
GP referral to first treatment for all cancers
We refer to these national priority indicators
collectively as ‘the indicators’.
We read the other information contained in
the Quality Report and consider whether it is
materially inconsistent with:
Respective responsibilities of the
directors and auditors
z board minutes for the period April 2014 to
March 2015;
The directors are responsible for the content
and the preparation of the Quality Report in
accordance with the criteria set out in the NHS
Foundation Trust Annual Reporting Manual
issued by Monitor.
z papers relating to quality reported to the
Board over the period April 2014 to April
2015;
Our responsibility is to form a conclusion, based
on limited assurance procedures, on whether
anything has come to our attention that causes
us to believe that:
z the Quality Report is not prepared in all
material respects in line with the criteria set
We read the Quality Report and consider
whether it addresses the content requirements
of the NHS Foundation Trust Annual Reporting
Manual, and consider the implications for our
report if we become aware of any material
omissions.
z feedback from the commissioners, dated May
2015;
z feedback from Healthwatch Organisations,
dated May 2015;
z the latest national patient survey, dated 2014;
z the latest national staff survey, dated 2014;
161
z Care Quality Commission intelligent
monitoring report dated December 2014; and
Assurance work performed
We conducted this limited assurance
engagement in accordance with International
Standard on Assurance Engagements 3000
(Revised) – ‘Assurance Engagements other
than Audits or Reviews of Historical Financial
Information’, issued by the International Auditing
and Assurance Standards Board (‘ISAE 3000’).
Our limited assurance procedures included:
z the Head of Internal Audit’s annual opinion
over the Trust’s control environment for
2014/15.
We consider the implications for our report if we
become aware of any apparent misstatements
or material inconsistencies with those
documents (collectively, ‘the documents’). Our
responsibilities do not extend to any other
information.
z evaluating the design and implementation of
the key processes and controls for managing
and reporting the indicators
We are in compliance with the applicable
independence and competency requirements
of the Institute of Chartered Accountants in
England and Wales (ICAEW) Code of Ethics.
Our team comprised assurance practitioners
and relevant subject matter experts.
z making enquiries of management
z testing key management controls
This report, including the conclusion, has been
prepared solely for the Council of Governors
NHS Foundation Trust as a body, to assist the
Council of Governors in reporting Basildon and
Trust’s quality agenda, performance and
activities. We permit the disclosure of this report
within the Annual Report for the year ended 31
March 2015, to enable the Council of Governors
to demonstrate they have discharged their
governance responsibilities by commissioning
an independent assurance report in connection
with the indicators. To the fullest extent
permitted by law, we do not accept or assume
responsibility to anyone other than the Council
of Governors as a body and Basildon and
Trust for our work or this report, except where
terms are expressly agreed and with our prior
consent in writing.
z limited testing, on a selective basis, of the
data used to calculate the indicator back to
supporting documentation
z comparing the content requirements of the
NHS Foundation Trust Annual Reporting
Manual to the categories reported in the
Quality Report
z reading the documents.
A limited assurance engagement is smaller
in scope than a reasonable assurance
engagement. The nature, timing and extent of
procedures for gathering sufficient appropriate
evidence are deliberately limited relative to a
reasonable assurance engagement.
Limitations
Non-financial performance information is
subject to more inherent limitations than
financial information, given the characteristics
of the subject matter and the methods used for
determining such information.
162
The absence of a significant body of
established practice on which to draw allows
for the selection of different, but acceptable,
measurement techniques which can result in
materially different measurements and can
affect comparability. The precision of different
measurement techniques may also vary.
Furthermore, the nature and methods used
to determine such information, as well as the
measurement criteria and the precision of these
criteria, may change over time. It is important
to read the Quality Report in the context of the
criteria set out in the NHS Foundation Trust
Annual Reporting Manual.
The scope of our assurance work has not
included governance over quality or nonmandated indicators, which have been
determined locally by Basildon and Thurrock
University Hospitals NHS Foundation Trust.
Basis of conclusion in respect of
indicators – 62 days from urgent
GP referral to first treatment for all
cancers
From our testing we found two cases where the
data recorded on the Somerset system was not
consistent with the information recorded on the
GP referral form. One of these had an impact
on the Trust’s reported performance.
We tested a further sample and found one
further case where the referral form had not
been scanned on the system and could not be
located in paper form. On further investigation,
it was established that the form had been
destroyed as it was thought to be already
scanned on the system. As a result we were
unable to verify whether this case had been
accurately recorded on the system.
Conclusion
Based on the results of our procedures, nothing
has come to our attention that causes us to
believe that, for the year ended 31 March 2015:
z the Quality Report is not prepared in all
material respects in line with the criteria set
out in the NHS Foundation Trust Annual
Reporting Manual;
z the Quality Report is not consistent in all
material respects with the sources specified
above;
z with the exception of the 62 days from urgent
GP referral to first treatment for all cancers
indicator referred to in the paragraph above,
the indicators in the quality report subject
to limited assurance have been reasonably
stated in all material respects in accordance
with the ‘NHS foundation trust annual
reporting manual’.
David Eagles
For and on behalf of BDO LLP
Ipswich, UK
28 May 2015
163
164
11 Statement of Accounting Officer’s Responsibility
Statement of the Chief Executive’s
responsibilities as the accounting officer of
NHS Foundation Trust.
The NHS Act 2006 states that the Chief
Executive is the accounting officer of the NHS
foundation trust. The relevant responsibilities
of the accounting officer, including their
responsibility for the propriety and regularity of
public finances for which they are answerable,
and for the keeping of proper accounts, are set
out in the NHS Foundation Trust Accounting
Officer Memorandum issued by Monitor.
Under the NHS Act 2006, Monitor has directed
NHS Foundation Trust to prepare for each
financial year a statement of accounts in the
form and on the basis set out in the Accounts
Direction. The accounts are prepared on an
accruals basis and must give a true and fair
view of the state of affairs of Basildon and
Trust and of its income and expenditure, total
recognised gains and losses and cash flows for
the financial year.
In preparing the accounts, the Accounting
Officer is required to comply with the
requirements of the NHS Foundation Trust
Annual Reporting Manual and in particular to:
z state whether applicable accounting
standards as set out in the NHS Foundation
Trust Annual Reporting Manual have
been followed, and disclose and explain
any material departures in the financial
statements;
z ensure that the use of public funds complies
with the relevant legislation, delegated
authorities and guidance; and
z prepare the financial statements on a going
concern basis.
The accounting officer is responsible for
keeping proper accounting records, which
disclose with reasonable accuracy at any time
the financial position of the NHS foundation
trust and to enable him/her to ensure that the
accounts comply with requirements outlined
in the above mentioned Act. The Accounting
Officer is also responsible for safeguarding the
assets of the NHS foundation trust and hence
for taking reasonable steps for the prevention
and detection of fraud and other irregularities.
To the best of my knowledge and belief, I have
properly discharged the responsibilities set out
in Monitor’s NHS Foundation Trust Accounting
Officer Memorandum.
z observe the Accounts Direction issued by
Monitor, including the relevant accounting
and disclosure requirements, and apply
suitable accounting policies on a consistent
basis;
z make judgements and estimates on a
reasonable basis;
Clare Panniker
Chief Executive
165
Date: 27 May 2015
166
12 Annual Governance Statement
Scope of responsibility
Capacity to handle risk
As Accounting Officer, I have responsibility
for maintaining a sound system of internal
control that supports the achievement of the
NHS Foundation Trust’s policies, aims and
objectives, whilst safeguarding the public
funds and departmental assets for which I
am personally responsible, in accordance
with the responsibilities assigned to me. I am
also responsible for ensuring that the NHS
Foundation Trust is administered prudently
and economically and that resources are
applied efficiently and effectively. I also
acknowledge my responsibilities as set out in
the NHS Foundation Trust Accounting Officer
Memorandum.
The Board of Directors has the authority
and responsibility for the establishment,
maintenance, support and evaluation of the
Trust’s Risk Management Strategy.
Leadership is provided by the Board, through
myself as Chief Executive and the executive
and divisional clinical directors. Clinical and
corporate directors are accountable for risk
management within their Directorates and
Divisions.
Executive Directors’ roles and functions are
formally reviewed each year to ensure that
there are no gaps or overlaps in the corporate
management structure of the organisation.
The purpose of the system of internal
control
The system of internal control is designed to
manage risk to a reasonable level rather than
to eliminate all risk of failure to achieve policies,
aims and objectives; it can therefore only
provide reasonable and not absolute assurance
of effectiveness. The system of internal control
is based on an ongoing process designed
to identify and prioritise the risks to the
achievement of policies, aims and objectives
NHS Foundation Trust, to evaluate the
likelihood of those risks being realised and the
impact should they be realised, and to manage
them efficiently, effectively and economically.
The system of internal control has been in place
in Basildon and Thurrock University Hospitals
NHS Foundation Trust for the year ended
31 March 2015 and up to the date of approval
of the annual report and accounts.
In 2014/15, the review resulted in one change
of responsibility, with the Director of Estates and
Capital Development taking on responsibility
for facilities from the Chief Operating Officer. All
other director portfolios remain unchanged.
The role of each director is clarified through the
agreement of comprehensive job descriptions,
and key priorities are determined by and
aligned to the objectives documented in the
Annual Plan. Training needs are identified and
provided through personal development plans.
Performance against objectives is assessed
throughout the year at individual and executive
team level, and formal annual appraisals are
undertaken, the results of which are presented
to the Trust Remuneration and Nominations
Committee. The structure of the Executive
Team ensures that appropriate focus is placed
on managing the key risks faced by the Trust,
and sound management of its financial, human
and property resources.
167
Operational day-to-day management of
NHS Foundation Trust is delegated to
the Senior Management Group (SMG).
Membership of this Group comprises the nine
executive directors, five divisional clinical
directors, deputy chief operating officer, clinical
leads for pathology and radiology, senior
risk and patient safety managers, director of
post-graduate education and clinical leads for
cancer services and clinical effectiveness. The
associate medical director for patient safety
attends the Senior Management Group as
required. Each divisional clinical director is a
practicing medical specialist and is supported
professionally and managerially by a general
manager and head of nursing and quality. The
SMG implements the strategies and decisions
of the Board of Directors and has responsibility
for operational decision-making and the
management of all risks. All Divisions are subdivided into Clinical Service Units (CSU); each
Unit is managed by a clinical service unit lead
(a practicing medical specialist), a service unit
manager and a lead nurse. This triumvirate has
delegated responsibility for the professional and
managerial performance of the CSU, reporting
to the divisional clinical director and general
manager.
Risk specialists/advisors are appointed where
appropriate throughout the Trust and each
maintains the relevant qualifications and
experience sufficient to ensure that competent
advice is available to managers. A list of all
advisors is available in the Risk Management
Strategy and includes professionals in patient
safety, medicines management, fire safety,
security, health and safety, clinical risk,
business continuity and emergency planning.
Together with local clinical and non-clinical
leads and advisors, these specialists support
the creation, implementation and monitoring of
policies, procedures, protocols and guidelines
for the effective control of risk. Where
responsibilities are assigned to individuals
within the Risk Management Strategy, the Trust
reviews their training needs regularly to ensure
that competence is sufficient for the discharge
of their duties.
All employees have an important role to play
in identifying, assessing and managing risk.
To support employees in this role, the Trust
provides a comprehensive suite of policies,
strategies, procedures, protocols and guidelines
together with information at levels that are
relevant to an individual’s role. The Trust aims
to ensure that employees have the knowledge,
skills, support and access to expert advice
necessary to manage risk effectively and
efficiently. Counselling, support and training
are provided in line with the risk management
training needs analysis, which identifies the
level of training appropriate for an individual’s
authority and duties. The Trust has a clear
policy for staff completion of mandatory and
core training aimed at managing risk. The
policy is clear that managers are responsible
for ensuring staff attendance and compliance
is monitored regularly and reported to a
committee of the Board.
Learning from good practice is encouraged, as
is learning from mistakes in order to continually
strive for better outcomes for patients. Learning
is shared internally through team, professional
and divisional meetings where practice
changes following incidents and complaints
are discussed and corporate meetings where
risk recommendations from solicitors following
inquests and claims are shared. In addition,
during 2014/15, the Trust has maintained
168
a number of previously implemented
communication methods, which have proved to
be very popular with staff:
and a significant employer. It clearly sets out
accountabilities for risk management at each
level in the organisation and aims to ensure
a comprehensive system of internal control
without compromising flexibility, innovation and
best practice.
z The ‘Hot Spots’ weekly messages following
incidents and Top Spots highlighting good
practice.
z The daily ‘Stepping Up Now’ patient safety
meeting.
z Weekly messages displayed in screen savers
and on the Trust intranet.
z Divisional patient safety briefings.
z #PassItOn messages from the Senior
Management Group to the wider Trust.
z Weekly ‘Next Week @ BTUH’ diary email.
Learning is shared externally by reporting
to organisations such as the Care Quality
Commission (CQC), the National Reporting
and Learning System (NRLS), Medical and
Healthcare Products Regulatory Agency
(MHRA), NHS Protect, the local Commissioners
and the Local Area Team. The risk register is
a single document where risk and governance
leads can view how others identify, manage and
control common risks.
The risk and control framework
The Risk Management Strategy is one of the
seven designated policies that must be agreed
and endorsed by the Board of Directors. It
details the Trust’s approach to risk management
and describes it as both a statutory requirement
and an indispensable element of good
management. It is a fundamental part of the
total approach to quality, corporate and clinical
governance and is essential to the Trust’s
ability to discharge its functions as a partner
in the local health and social care system, as
a Public Benefit Corporation and provider of
health services, a custodian of public funds
The strategy and its associated policies and
procedures set out the processes for identifying,
assessing, communicating, documenting,
escalating, managing and reviewing risks.
Risks or changes in risk are identified in a
number of ways, including recommendations
from external reports, major organisational
failures and high profile failures to more
local methods of risk profiling, incidents,
claims, complaints, receipt of alerts and risk
assessment of work related activities. Risks
are assessed using an agreed risk assessment
template, controlled in ways to reduce the effect
or the likelihood of occurrence and recorded
on the Trust Risk Register, which is a single
repository for all the risks identified from all
sources across the Trust.
Each Division is responsible for its own risk
register, which is reviewed by senior managers
and risk leads monthly. The Board of Directors
receives a significant risk report monthly,
the corporate risk register quarterly and the
board assurance framework (BAF) at least six
monthly. The BAF ensures that the Board of
Directors is aware of the highest risks to the
achievement of its objectives and the controls
necessary to ensure the risk is maintained
at an acceptable level. The appetite for risk
is determined for individual circumstances or
events and the Board will request additional
controls where it wishes to reduce the likelihood
or impact.
169
The Finance and Resources Committee and
the Quality and Patient Safety Committee
regularly review relevant significant risks and
incidents relating to its area of responsibility.
The Audit Committee independently monitors,
reviews and reports to the Board of Directors
on the extent to which the Trust has in
place an effective system of governance,
risk management and internal control. This
Committee also reviews the BAF, which
documents the risks, controls and related
assurances that underpin the delivery of the
organisation’s key objectives.
The key elements of quality governance in
place during 2014/15 were:
z Strategy
The Trust has communicated its quality
priorities and goals for the year across the
organisation and designed its performance
information to support the monitoring of
progress with these goals.
A Trust-wide Clinical Strategy has
been consulted on and agreed during
the year, supported by a number of
enabling strategies. These have been
communicated to staff across the hospital
and have formed the basis of the business
planning activities.
Quality governance arrangements
In 2013/14, as part of the Undertakings
provided to Monitor for being in breach
of the conditions of our license, the Trust
commissioned an external Quality Governance
Review, the scope and method of which were
agreed with Monitor in advance. McKinsey
undertook this review in September and
October 2013, and the findings were reported to
the Board and Monitor in October 2013.
The Governance Review provided an overall
rating of 4.5, with green ratings in three areas,
amber-green in five areas and amber-red in two
areas. In May 2014, this was re-assessed; at
this time, the Trust’s overall score was 2.5, an
improvement and evidence that the Trust had
implemented the findings of the original review.
Specific and challenging Trust objectives
were agreed for the period 2013/14 to
2017/18 that include key performance
indicators (KPIs), milestones and
trajectories. These objectives are
monitored monthly through the
Performance Report, with supporting
benchmark data (where available) and
improvement trajectories.
Development of the existing performance
management framework for the Divisions
and the formal inclusion of this within
the job description of the Deputy Chief
Executive.
The findings, recommendations and action
plans have been reported regularly to the Board
via the Quality and Patient Safety Committee.
The key findings, with actions taken are detailed
below.
z Capability and Culture
Processes are in place to ensure that
the Board of Directors has the suitable
skills, knowledge and capacity to deliver
the organisation’s objectives. In 2014/15,
this information provided the basis of the
preferred skills required in the appointment
of a new non-executive director and
influenced the process for seeking new
executive directors.
170
The Trust has in place an executive-led and
clinically-supported programme of quality
improvements, with the overarching aim of
re-focusing the culture of the Trust to one of
patient safety first.
the Senior Management Group and the
Trust’s Executive Team. Quality impact
assessments are signed off by the medical
director and director of nursing and are
retrospectively reviewed at six-monthly
intervals.
The Trust has developed, implemented
and delivered a strategic cost improvement
programme 2014/15 amounting to just over
£13m and has established the programme
for 2015/16. This aims to deliver £12.7m
savings in year, delivery of which will be
overseen by the Programme Management
Office.
Maintained communications with staff
through chief executive briefings and
blogs, director of nursing briefings and
blogs, frequent executive ‘walkabouts’
during the daytime and night,
unannounced observational clinical
visits, regular Board and governors visits
to clinical areas and weekly Divisional
performance reviews against key metrics
including measures of service quality.
z Processes and Structure
The Internal Quality Assurance and
Compliance team has been strengthened
and has conducted a significant number
of clinical reviews, using the Care Quality
Commission prompts in order to determine
the level of on-going compliance with the
essential standards.
The Trust’s Data Quality Policy mandates
the undertaking of regular data quality
audits (externally commissioned) during
the year, and these provide assurance
on the accuracy of data within the Trust.
During 2014/15, two additional data
quality audits have been completed, both
providing substantial assurance, looking at
the accuracy of cancer data, following high
profile national failings in this area.
The ongoing programme of unannounced
clinical visits provides valuable intelligence
on the level of compliance with essential
and professional standards.
Key assurance committees of the Board
focus on quality and safety supported
by three management groups (Patient
Experience, Patient Safety and the Risk
and Compliance Group) each led by the
accountable executive. Each has a work
programme that reflects the expectations
and performance of directorates and
corporate activities.
There is a formal process to consider
and document the potential impact cost
improvement plans on the quality of patient
care and other significant decisions. This
process ensures that the cost improvement
plans are agreed by divisional clinical
directors, divisional general managers,
z Measurement
A robust Clinical Audit Plan exists which
has developed systems and processes
to reflect the process used in financial
audit. As reliance upon clinical audit for
appropriate assurance has increased, the
clinical audit plan has evolved to become
more risk-based providing consistent
coverage across the Trust’s activities and
using patient feedback to drive audit.
171
The graphical information provided within
the performance reports (reported at the
public Board meetings and Council of
Governors meetings) incorporates the
Regulatory Interventions
Trust’s internal targets and standards and
where appropriate, benchmarking data
in order to provide clear and transparent
information on the Trust performance.
Where variances exist, narrative is
provided to give assurance that remedial
action is being taken to bring performance
back within expected limits.
Benchmarking, wherever possible,
against other Trusts and through the
use of national data sets, such as Dr
Foster Intelligence, Summary Hospital
Mortality Indicator (SHMI), Care Quality
Commission (CQC), National Reporting
and Learning System (NRLS) of the
National Patient Safety Association and the
Quality Observatory data.
z Monitor
The Board submits quarterly declarations
to Monitor to confirm that the Trust meets
the standards set in the Quality Governance
Framework. During 2014/15 the Trust
successfully came out of the special
measures programme, after a positive
CQC inspection, following which it was
rated as ‘good’ overall (more information on
Compliance with CQC standards section).
Challenge by Board members, particularly
the non-executive directors, of the data
presented and requests for more detailed
underlying information in order to identify
the root cause of potential issues of
concern. Board challenge of this nature
is documented in Board minutes and
captured in any subsequent action plans.
Executives note sources of information on
Board reports, and ensure independent
validation to strengthen assurance,
wherever possible.
However, in November 2014, as a result of
the serious deterioration the Trust’s financial
position, Monitor undertook an investigation,
following which, in February 2015, the
Trust was determined to be in breach of its
Licence; specifically the following conditions:
Continuity of Services 3(1)(a) and
(b) – relating to standards of corporate
governance and financial management
and in particular, those standards
necessary to provide Commissioner
Requested Services and providing
reasonable safeguards to ensure the Trust
is able to operate as a going concern.
Documentation of the systems and controls
used to produce data for non-financial
reports to the board and the sources of
assurance over the completeness and
accuracy of the information produced.
Where appropriate, the Board has
implemented additional assurance
processes such as tailored internal audit
reviews or externally commissioned
reviews.
Foundation Trust 4(2) – relating to
the Foundation Trust’s Governance
Arrangements, in particular, that the
Foundation Trust apply those principles,
systems and standards of good corporate
governance which reasonably would be
regarded as appropriate for a supplier of
health care services to the NHS.
Foundation Trust 4(5)(a),(d), (e) and (f).–
relating to the expectation that the Trust
will establish and effectively implement
systems and/or processes:
(a) to ensure compliance with the
Licensee’s duty to operate efficiently,
economically and effectively;
172
(d) for effective financial decision-making,
management and control (including but not
restricted to appropriate systems and/or
processes to ensure the Licensee’s ability
to continue as a going concern);
(e) to obtain and disseminate accurate,
comprehensive, timely and up to date
information for Board and Committee
decision-making;
z Compliance with CQC standards
The Trust is registered with the CQC for
the provision of regulated services on two
sites: Basildon University Hospital and
Orsett Hospital. At the time of writing (April
2015) the Trust is not fully compliant with the
registration requirements of the Care Quality
Commission.
In March 2014, the CQC undertook a
planned review of the Trust, using a revised
methodology with the new Chief Inspector of
Hospitals. This comprehensive visit, which
took place over three days and involved over
30 inspectors was positive. The Trust was
rated as ‘good’ overall with one area rated
as ‘requires improvement’ (surgical services)
and one compliance action, relating to the
management of medicines.
(f) to identify and manage (including but
not restricted to manage through forward
plans) material risks to compliance with
the Conditions of its Licence;
Monitor accepted a number of Undertakings
from the Trust designed to address the
causes of the License breach, which are:
The Trust will develop and deliver a
recovery plan
An action plan was developed following this
review which was overseen by the Senior
Management Group and Quality and Patient
Safety Committee.
The Trust will participate in a Sustainability
Review, to be undertaken by Monitor, with
the scope to be determined by Monitor
The Trust will commission a Financial
Governance Review, the scope of which
will be approved by Monitor.
In March 2015, the CQC returned to the
Trust to test compliance with management of
medicines and to review the one area which
had required improvement previously. At the
time of writing, the report of this visit had not
been received.
Actions are underway to comply with these
undertakings. The Financial Governance
Review, commissioned from Grant Thornton
is being finalised and will be reported to the
Board of Directors. An action plan will be
developed to address any recommendations
made. In addition, the Sustainability Review
has commenced, but the timescale for
completion is not yet confirmed.
As in previous years, during 2014/15 the
Trust has continued to receive visits, reports
or correspondence from Monitor, the Care
Quality Commission, the Health and Safety
Executive, the Clinical Commissioning
Groups, the Local Area Team, the Nursing
and Midwifery Council and East of England
and London Deaneries.
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Data security risks
sensitivity factor, it provides an overall score
which details how an incident should be
investigated. Only IG incidents which score
at level 2 are reportable on the IGT Incident
Reporting Tool.
Data security risks are managed and controlled
through the implementation of the Information
Security Policy. All reasonable organisational
and technical measures are taken to ensure
that the personal information the Trust holds
will be kept secure and used only for fair and
lawful purposes. All staff are conversant with
and comply with all relevant policies and
guidance on information security and are
trained to a level appropriate to their role and
responsibilities.
At the time of writing, 10 information
governance incidents have been reported
using this methology:
April 2014 – a referral letter was faxed to
an external third party instead of to a GP
practice.
August 2014 – a handover sheet containing
patient details was found outside A&E by a
member of staff.
The Trust has an executive director, Mark
Magrath, commercial director designated as
the Senior Information Risk Owner (SIRO) who
provides a detailed report to the chief executive
to inform the Annual Governance Statement.
The SIRO has completed the SIRO training and
the IOSH accredited course, ‘Safety for Senior
Executives’.
April 2014 – information requested by
and sent to an insurance company were
sent to the wrong recipient. The insurance
company had provided an incorrect
address.
An Information Governance Group is in place
which reports to the Board of Directors annually.
The Information Governance Toolkit (IGT) has
been completed for 2014/15 and a compliant
position obtained. TIAA, the Internal Auditors,
audited the evidence for this in February 2015.
The Trust has a Data Security and
Confidentiality Undertaking, which outlines the
expectations of third parties when handling/
transferring Patient Identifiable Data to ensure
compliance with Data Protection legislation and
Trust policies.
April 2014 – clinical information sent to
the wrong address as the patient had
moved and the address not updated on the
system.
May 2014 – information relating to a patient
was sent in error to a third party, who then
sent it to the patient.
June 2014 – a handover sheet was found in
a public staircase by a member of staff.
z Information Governance Serious Incidents
The Health and Social Care Information
Centre (HSCIC) issued new guidance and
a checklist (February 2015) for reporting
information Governance (IG) Incidents.
The checklist comprised a baseline scale
dependent on the level of individuals
involved (ranked from 0-3). Together with a
174
September 2014 – records of one patient
found in the records of another following a
requested for Access to Medical Records.
The records were returned.
November 2014 – discharge letter sent
home with the wrong patient. The letter was
returned to the Trust by a family member.
November 2014 – a handover sheet was
found in a public staircase by a member of
Trust staff.
December 2014 – letter sent to incorrect
GP.
The Trust has continued to work to reduce
mortality rates and has been able to reduce
the number of patients who die in hospital.
The Summary Hospital Mortality Indicator
(SHMI) has reduced to 1.03 (January 2015
publication) and is within expected limits. The
Trust anticipates that this will continue to fall
over the next two publications. This work is
sponsored by the Medical Director.
The Information Commissioner contacted
the Trust and has issued an undertaking
in respect of two of these incidents. An
Information Risk Review was undertaken
in March 2015 by the Information
Commissioners Office (ICO).
z Other Risks
Other risks, which were in evidence during
2014/15 were:
Recruitment to specialist medical posts has
improved but remains a risk. The Trust is
working with Anglia Ruskin University to
develop new nursing posts to support those
areas of greatest clinical need.
Sustained increases in emergency demand
throughout the year and the impact on the
balance of elective and emergency activity
within the hospital.
The principal risks to compliance with the
NHS Foundation Trust condition 4 (FT
governance) for the coming year are:
The on-going difficulties in recruiting to
certain clinical areas and the need to
increase staffing across the professions.
Failure to deliver the action plan following
the Financial Governance Review will
result in a potential unsustainable financial
position and loss of confidence by the
regulators.
The financial position deteriorated during
the year from that expected when the
Annual Plan was submitted resulting in
a worsening of the Monitor Continuity of
Services Rating to 1.
During 2014/15, emergency activity continued
to rise, with the accident and emergency
department seeing 126,000 patients, up from
103,000 in 2013/14. The pressure within the
system has been consistent all year. The
Board of Directors agreed to commission
an additional 20 beds on site, which opened
in December 2014. The additional capacity,
and changes to the management of patients
during times of peak demand, however, did
not mitigate this risk and performance was
such that the Trust failed to achieve the
four-hour standard for the year.
175
The Trust’s financial position at the end
of 2014/15, combined with planning
assumptions in the annual plan, require a
significant level of cost improvements over
two years. Failure to deliver on these plans
would be a risk to maintaining compliance
with the condition to operate efficiently,
economically and effectively.
To support the Trust to be compliant with
this condition, the Trust has an established
Board and Committee structure, with
clear accountability for the Board and its
Committees and the staff reporting to it.
The Board and its Committees have a
scheme rules, and that member Pension
Scheme records are accurately updated in
accordance with the timescales detailed in the
regulations.
schedule of matters to be reviewed at each
meeting, and the meetings have been set
at times to ensure that the information they
receive is timely. Each Committee reviews
its effectiveness annually and revises its
terms of reference to take account of any
changes of priorities during the year. The
Board meets in public every two months when
it scrutinises the information provided by the
Executive team on all areas of performance.
This includes financial, quality, safety and
effectiveness measures.
Control measures are in place to ensure
that all the organisation’s obligations under
equality, diversity and human rights legislation
are complied with.
The Trust has undertaken risk assessments
and Carbon Reduction Delivery Plans are
in place in accordance with emergency
preparedness and civil contingency
requirements, as based on UKCIP 2009
weather projects, to ensure that the Trust’s
obligations under the Climate Change Act and
the Adaptation Reporting requirements are
complied with.
This structure is underpinned by an
operational structure, with clinically led
Divisions, providing enhanced accountability
for services. The responsibilities of the
Directors and Board Committees are detailed
in the Annual Report (section 3).
Risk management is something almost all
staff practice every day, in different ways
at different times. Risk management is
embedded within the Trust in the form of
processes such as adherence to Trust
policies, procedures and guidelines,
Trust-wide incident reporting, project risk
assessment, process risk assessment,
compliance self-assessment with CQC
essential standards, performance
management and updating and reviewing risk
registers. The identification of risk is openly
encouraged with clear methods and routes for
escalation where required.
As an employer with staff entitled to
membership of the NHS Pension Scheme,
control measures are in place to ensure all
employer obligations contained within the
scheme regulations are complied with. This
includes ensuring that deductions from salary,
employer’s contributions and payments in
to the scheme are in accordance with the
Review of economy, efficiency and
effectiveness of the use of resources
In addition to the financial review of resources
by the Board of Directors, the Audit Committee
and the Finance and Resources Committee,
the quarterly returns to Monitor and the weekly
and monthly financial information provided to
all budget holders, the processes that have
been applied to ensure resources are used
economically, efficiently and effectively include:
z Internal audit
Internal audit has reviewed selected systems
and processes in place during the year and
published reports detailing the required
actions within specific areas to ensure
economy, efficiency and effectiveness of the
use of resources is maintained. Progress with
actions is reviewed at each meeting of the
Audit Committee.
176
The Senior Management Group is
responsible for ensuring that the clinical
risks and priorities of the Trust are
understood, assessed and mitigated and
actioned.
z Financial efficiencies
Divisional-level performance monitoring of
service lines to provide information on the
contribution of individual services.
Individual approval of capital expenditure
projects and oversight by the Finance and
Resources Committee.
Divisional Management Boards and
Governance Committees are responsible
for ensuring that the Divisions are managed
efficiently and effectively and that evidence
is available to support that assessment.
z The maintenance of a Clinical
Effectiveness Unit
to oversee the implementation of
the National Institute for Health and
Care Excellence (NICE) guidance,
National Service Frameworks (NSFs)
and recommendations from National
Confidential Enquiries.
The Medicines Safety Group oversees
the maintenance of a local drug formulary
to ensure clinically appropriate and cost
effective use of medicines.
Annual Quality Report
to monitor the introduction of new
techniques and research and development
projects ensuring patient safety, clinical and
cost effectiveness of new treatments as
well as the appropriate training of clinicians.
to support clinical audit within the Trust,
ensuring that the Board receives assurance
that key clinical risks are being audited as
robustly as financial risks.
to promote evidence-based health care
through training and education to nurses
and as part of the Foundation Programme
for doctors.
to share good practice through
collaborative working with primary care,
secondary care, mental health and public
health providers in the south Essex area.
The use of management groups charged with
monitoring efficiency and effectiveness as
part of their terms of reference:
The directors are required under the Health Act
2009 and the National Health Service (Quality
Accounts) Regulations 2010 (as amended) to
prepare Quality Accounts each financial year.
Monitor has issued guidance to NHS foundation
trust boards on the form and content of the
annual Quality Reports which incorporate
the above legal requirements in the NHS
Foundation Trust Annual Reporting Manual.
The content of the Quality Report and the
selection of the key quality priorities is a
decision taken by the Board of Directors based
on national and local priorities and with input
from a range of local stakeholders.
The production of the Quality Report is the
responsibility of the Quality, Innovation and
Patient Safety Directorate. This corporate team
is drawn mainly from clinical backgrounds
with experience of working in areas that
affect patient safety, clinical effectiveness and
patient experience. In preparing this report, the
priorities agreed the previous year are reviewed
and the data used within the quality report is
177
extracted from the Trust Performance Report
which is scrutinised by the Quality and Patient
Safety Committee, Senior Management Group
and the Board of Directors.
Review of effectiveness
Additional data is gathered through the Trust’s
annual clinical audit programme. Additional
assurance has been provided through limited
external audit of data sources.
The accuracy and quality of elective waiting list
information receives regular scrutiny throughout
the year. This is because, failure to record
accurate data may lead to patients experiencing
prolonged waits for treatment and the Trust
being unable to appropriately track and manage
its waiting lists.
In order to provide assurance that the systems
used are robust, the Trust has a number of
mechanisms to monitor this, which are both
internal and external:
z CCG Access Board which scrutinises the
waiting list data monthly.
z Internal Patient Access Steering Group which
meets weekly to the Patient Target Lists to
monitor waiting times and take action where
necessary.
z There is a team of validators whose role is to
ensure all elective patients are on the correct
pathway and to validate all pathways.
z RTT is reviewed by the Internal Auditors as
part of their regular programme of activities.
As Accounting Officer, I have responsibility for
reviewing the effectiveness of the system of
internal control. My review of the effectiveness
of the system of internal control is informed by
the work of the internal auditors, clinical audit
and the executive managers and clinical leads
within the Trust who have responsibility for the
development and maintenance of the internal
control framework. I have drawn on the content
of the quality report attached to this annual
report and other performance information
available to me. My review is also informed
by comments made by external auditors in
their management letter and other reports. I
have been advised on the implications of the
result of my review of the effectiveness of the
system of internal control by the Board, the
Audit Committee, the Quality and Patient Safety
Committee, and the Finance & Resources
Committee and a plan to address weaknesses
and ensure continuous improvement of the
system is in place.
The process that has been applied in reviewing
the effectiveness of the system of internal
control includes the on-going work of and
reports from:
z The Board of Directors which monitors the
effectiveness of the system of internal control
through clear accountability arrangements.
z The Audit Committee, which is a Committee
of the Board of Directors and is accountable
to the Board for reviewing the establishment
and maintenance of an effective system of
internal control and risk management. The
Committee meets at least five times each
year. The Audit Committee approves the
annual audit plans and activities for internal
178
audit and external audit and ensures a
programme of clinical audits associated with
the highest clinical risks is overseen by the
Quality and Patient Safety Committee. It
ensures that recommendations to improve
weaknesses in the systems of control arising
from audits are actioned by management.
The Audit Committee reviews the Board
Assurance Framework and ensures that
the Board committees work cohesively and
efficiently.
Additional areas of work that may support
the opinion will be determined locally but
are not required for Department of Health
purposes e.g. any reliance that is being
placed upon Third Party Assurances.
3. During the course of the year four limited
assurance opinion reports have been
issued. There were:
z Financial Management and Budgetary
control, pharmacy stock management,
procurement and data leakage.
z The Quality and Patient Safety Committee
and Finance and Resources Committee
which have advised me on the arrangements
for clinical governance, clinical risk
management, internal clinical effectiveness
and patient safety, health and safety and
financial performance respectively.
The key issues highlighted were:
Financial Reporting and Budgetary
Control – The key issues raised were:
z The Head of Internal Audit who has provided
me with an opinion that limited assurance
can be given this year. This opinion takes into
consideration the following:
1. An assessment of the design and
operation of the underpinning Assurance
Framework and supporting processes; and
2. An assessment of the range of individual
opinions arising from risk-based audit
assignments, contained within internal
audit risk-based plans reported throughout
the year. The assessment has taken
account of the relative materiality
of these areas and management’s
progress in respect of addressing control
weaknesses. All recommendations due
for implementation, prior to the end of the
financial year, had been implemented.
- The forecast deficit of £6.5m at the
beginning of the financial year was
dependent on the run rate slowing
down and the CIP becoming more
cash releasing. Whilst the CIP has
been over-achieving, this has predominantly been used to offset
the level of productivity and overperformance. Consequently, the
forecast deficit has increased from
£6.5m to £23.7m.
- The use of temporary staffing is
beyond sustainable levels and more
work needs to be done internally to
work more efficiently.
- The Trust has submitted a revised
financial recovery plan to Monitor,
and are subject to an investigation by
Monitor over their finances.
179
Pharmacy Stock Management
Arrangements – The key issues raised
were:
- Adequate records need to be
maintained by the Trust and GWE, at
each relevant stage, of all IT assets
undergoing data destruction or
disposal.
- Sample stock counts at the Basildon
Dispensary provide an average
accuracy rate of 73%.
- A formal comprehensive Service
Contract needs to be put in place
and signed by both parties for
data destruction and disposal of IT
equipment.
- Value of stock adjustments made due
to stock count differentials are not
regularly reported or monitored.
- There are no segregation of duties
on pharmaceutical orders below
£20,000.
- The Trust needs to test the
effectiveness of the data wiping
service provided by GWE by seeking
independent certification from a
reputable data recovery specialist.
Procurement – The key issues raised
were:
- The Trust’s SFI/SO was not complied
with in 2/5 contracts tested.
In order to address these weaknesses, some
of which have also been highlighted in the
Financial Governance Review, the following
actions are being taken:
- Despite a central procurement
function in operation, they were not
involved in the procurement of 2/5
contracts, the same two contracts
where non-compliance was observed.
Instead, contracts were procured
locally by the relevant department.
1 The recommendations of the
Financial Governance Review will be
implemented in full, which will address
the weaknesses in the Finance and
Budgetary Control and Procurement
audits.
- In the instance where the services
could not be tendered, an appropriate
tender waiver form citing the
circumstances for the waiver, was
not processed for the selected
contractors.
2 Each limited assurance audit has an
action plan, signed off the responsible
Executive Director and reported to the
Audit Committee until it is completed.
This will ensure that the necessary
actions are taken in respect of the Data
Leakage Arrangement and Pharmacy
Stock Levels audits.
Data Leakage Arrangement – The key
issues raised were:
- The Trust needs to ensure that
the methods used by GreenWorld
Electronics Ltd (GWE) for the
physical destruction of different
categories of IT assets, including
USB sticks and solid states
devices, are in line with government
standards.
z The Financial Governance Review has
identified a number of areas of weakness
with the financial controls in place, which will
be the focus of activity in the coming year.
180
z Both the Senior Information Risk Owner and
Caldicott Guardian are accountable to me
and responsible for ensuring all reasonable
steps are taken to confirm that the Trust’s
data is accurate and secure, and complies
with the Data Protection Act 1998 and
Caldicott principles.
The Foundation Trust is not fully compliant
with the registration requirements of the Care
Quality Commission and continues to have
License conditions as a result of deteriorating
finances. It is no longer in special measures.
The Board has responded to (and will
continue to respond to) all the reports and
correspondence, has developed action
plans with measurable outcomes and clear
accountabilities and has strengthened the
Board, revised executive accountabilities and
strengthened management arrangements.
z The Director of Infection Prevention and
Control is accountable to me and responsible
for ensuring that systems and processes
are in place to reduce healthcare associated
infections with particular emphasis on MRSA
bacteraemias and Clostridium Difficile.
I recognise that this is an on-going process and
believe this is a balanced statement of the risks
and controls within the Trust during 2014/15.
z Clinical Audit activity within the Trust is
reported to the Quality and Patient Safety
Committee as an annual programme, with
resulting actions and changes in service.
Signed
z Executive Directors and senior managers
within the organisation, who have
responsibility for the development and
maintenance of the system of internal
control, provide me with assurance. They
are accountable for setting service unit,
division and team objectives to ensure
the achievement of the Trust’s strategic
objectives and for implementing agreed
strategies, policies and procedures.
Clare Panniker
Chief Executive
Conclusion
The Trust has continued to face challenges
during 2014/15, but while there is evidence that
the level of compliance with expected standards
and license provisions are being addressed,
it is clear that the systems of internal control,
particularly in relation to financial management
require additional focus and activity during
2015/16 to provide the Board with assurance
the system of internal control is robust and
supports the delivery of the outcomes required.
181
Date: 27 May 2015
182
Accounts for the Year ended 31 March 2015
183
184
Foreword to the Accounts
BASILDON AND THURROCK UNIVERSITY HOSPITALS NHS FOUNDATION TRUST
Basildon and Thurrock University Hospitals NHS Foundation Trust (“the Trust”) is required to
“keep accounts in such form as Monitor may with the approval of Treasury direct” (paragraph
24(1), Schedule 7 of the National Health Services Act 2006 (“the 2006 Act”). The Trust is required
to “prepare in respect of each financial year annual accounts in such form as Monitor may with
the approval of Treasury direct” paragraph 25(1), Schedule 7 to the 2006 Act). In preparing their
annual accounts, the Trust must comply with any directions given by Monitor, with the approval of
Treasury, as to the methods and principles according to which the accounts are to be prepared and
the information to be given in the accounts (paragraph 25(2), Schedule 7 to the 2006 Act).
In determining the form and content of the annual accounts Monitor must aim to ensure that the
accounts present a true and fair view (paragraph 25(3), Schedule 7 to the 2006 Act)
Clare Panniker
Chief Executive
27 May 2015
185
186
Independent auditor’s report to the Council of
Hospitals NHS Foundation Trust
the Trust on a going concern basis, although
the Directors have concluded that there are
material uncertainties related to the financial
sustainability (profitability and liquidity) of the
Trust which may cast significant doubt about
the ability of the Trust to continue as a going
concern. Our opinion is not qualified in respect
of this matter.
We have audited the financial statements of
NHS Foundation Trust for the year ended 31
March 2015 which comprise the Statement
of Comprehensive Income, the Statement of
Financial Position, the Statement of Changes
in Taxpayers’ Equity, the Statement of Cash
Flows and the related notes. The financial
reporting framework that has been applied in
their preparation is applicable law and NHS
2014/15 issued by the Independent Regulator
of NHS Foundation Trusts (‘Monitor’).
Respective responsibilities of the
Accounting Officer and auditor
Opinion on financial statements
In our opinion the financial statements:
z give a true and fair view of the state of affairs
NHS Foundation Trust NHS Foundation
Trust’s affairs as at 31 March 2015 and of
its income and expenditure for the year then
ended
z have been properly prepared in accordance
with NHS Foundation Trust Annual Reporting
Manual 2014/15
z have been prepared in accordance with the
National Health Service Act 2006.
Emphasis of matter
We draw attention to note 1.28 to the financial
statements which sets out the basis on which
the accounts have been prepared. Specifically,
it sets out the Directors’ assessment of the
financial position of the Trust in the context
of the National Health Service framework in
which it operates and their conclusion that
it is appropriate to prepare the accounts of
As explained more fully in the Statement of
the Chief Executive’s Responsibilities as the
Accounting Officer, the Accounting Officer is
responsible for the preparation of the financial
statements and for being satisfied that they
give a true and fair view. Our responsibility is to
audit and express an opinion on the financial
statements in accordance with applicable law
and International Standards on Auditing (UK
and Ireland). Those standards require us to
comply with the Financial Reporting Council’s
(FRC’s) Ethical Standards for Auditors.
This report is made solely to the Council of
Hospitals NHS Foundation Trust, as a body,
in accordance with paragraph 5.2 of Audit
Code for NHS Foundation Trusts 2014. Our
audit work has been undertaken so that we
might state to the Council of Governors of
NHS Foundation Trust those matters we are
required to state to it in an auditor’s report
and for no other purpose. To the fullest extent
permitted by law, we do not accept or assume
responsibility to anyone other than he NHS
Foundation Trust as a body for our audit work,
for this report or for the opinions we have
formed.
187
Scope of our audit of the financial
statements
An audit involves obtaining evidence about
the amounts and disclosures in the financial
statements sufficient to give reasonable
assurance that the financial statements are free
from material misstatement, whether caused by
fraud or error. This includes an assessment of:
whether the accounting policies are appropriate
to Basildon and Thurrock University Hospitals
NHS Foundation Trust NHS Foundation Trust’s
circumstances and have been consistently
applied and adequately disclosed; the
reasonableness of significant accounting
estimates made by the Accounting Officer;
and the overall presentation of the financial
statements.
In addition, we read all the financial and nonfinancial information in the Annual Report
to identify material inconsistencies with the
audited financial statements and to identify
any information that is apparently materially
incorrect based on, or materially inconsistent
with, the knowledge acquired by us in the
course of performing the audit. If we become
aware of any apparent material misstatements
or inconsistencies we consider the implications
for our report.
Our assessment of risks of material misstatement
In arriving at our opinion on the financial statements, the risks of material misstatement that had
the greatest effect on our audit, and the principal procedures we applied to address them, were as
set out below.
Risk
A significant proportion
of the Trust’s income is
received through service
level agreements with
organisations responsible
for the commissioning
of healthcare services,
which are based on
planned levels of patient
activity. There is a risk of
fraud, due to pressure on
management to achieve
financial targets, in
recognising this revenue
through inappropriate use
of accounting policies,
failure to apply the Trust’s
stated accounting policies
or inappropriate use of
estimates in calculating
this revenue.
How the scope of our audit responded to the risk
In responding to this risk, our audit procedures included:
z Consideration of the accounting policies applied by the Trust in
the recognition of income
z Reviewing the design and implementation of controls in place for
the revenue system covering both NHS and non-NHS income
z Investigation of differences identified as a result of the NHS
“agreement of balances” and transactions exercise which is
a mandated and formal process run on a national basis and
which aims to ensure agreement of balances and transactions
between NHS bodies (for example, between the Trust and clinical
commissioning groups), and also with other government bodies
z Agreeing a sample of components of income recognised with
clinical commission groups to agreed service level agreements
z Reviewing estimates used in calculation NHS contract provisions,
which reflect residual uncertainty in income due as at the year
end because final agreements had not yet been reached, to
ensure the methods and judgements used were appropriate
z Ensuring that all income items tested were accounted for in line
with the revenue recognition policy adopted by the Trust.
188
Risk
The calculation of the
fair value of land and
buildings is subject to a
high level of estimation
uncertainty. There is a risk
of material misstatement if
inappropriate or inaccurate
estimates or assumptions
are used in the calculation
of these fair values.
z We considered the independence, expertise and qualifications of
the management expert (valuer)
z We confirmed the basis of valuation for assets valued in year was
appropriate based on their usage and, where relevant, specialist
nature
z We reviewed indices and price movements for classes of assets
against the percentage assumptions used by the Trust to ensure
that the valuations attributed to assets were reasonable
z We challenged the indices and assumptions adopted by the Trust
in valuing their assets.
A joint arrangement has
been developed between
the Trust and Southend
Hospital for the provision
of Pathology services
which came into effect
from 1 October 2014. The
accounting treatment is not
complex, but the standards
which determine which
accounting treatment
should be applied
are. There is a risk of
material misstatement if
the arrangement is not
accounted for in line with
IFRS 10, 11 and 12.
z Discussing with management the process adopted for determining
that a joint arrangement was in place
z Scrutinising management’s assessment of the contract agreement
and their conclusion that the arrangement is a joint venture as per
IFRS 11
z Agreeing the method used for accounting for this joint venture in
the Trust’s financial statements.
189
Risk
The Trust has faced
increasing financial
challenges during the year
and is currently regarded
as being at a material
level of financial risk in
respect of the continuity
of services. There is also
an increased risk that the
financial pressures arising
from this situation will lead
to management bias in
accounting estimates and
material misstatement in
the financial statements.
In responding to this risk, key audit procedures included:
z Heightened scepticism was applied throughout all of our
testing, particularly around accounting estimates and significant
judgements applied
z Scrutinising the going concern assessment completed by
management and those charged with governance
z Challenging forecasts and assumptions used in the Trust’s future
financial plans and cash flow models
z Considering relevant findings of Internal Audit arising from their
work relating to the financial position of the Trust and its financial
management arrangements, and the overall Head of Internal Audit
opinion
z Discussions with Monitor in relation to the reviews that the Trust
has been subject to as a result of their breach in their terms of
authorisation
z Discussions with Management on the plans in place to address
the financial challenges.
Our application of materiality
We define materiality as the magnitude of
misstatement in the financial statements that
makes it probable that the economic decisions
of a reasonably knowledgeable person would
be changed or influenced. We use materiality
in both planning the scope of our audit and in
evaluation the results of our work.
The materiality for the financial statements as a
whole was set at £4.6m million. This has been
determined by reference to the benchmark of
gross expenditure (of which it represents 1.5%)
which we consider to be one of the principal
considerations for the Council of Governors
in assessing the financial performance of the
Trust.
We agreed with the Audit Committee to report
to it all material corrected misstatements
and all uncorrected misstatements we
identified through our audit with a value in
excess of £92,000, in addition to other audit
misstatements below that threshold that we
believe warranted reporting on qualitative
grounds.
Opinion on other matters on which
we are required to report
In our opinion the:
z the part of the remuneration report identified
as subject to audit in the Annual Report
has been properly prepared in accordance
with the Foundation Trust Annual Reporting
Manual
190
z the information given in the strategic report
and directors’ report for the financial year for
which the financial statements are prepared
is consistent with the financial statements.
Matter on which we report by
exception
The Audit Code for NHS Foundation Trusts
requires us to report to you if we are not
satisfied that the Trust has made proper
arrangements for securing economy, efficiency
and effectiveness in its use of resources.
NHS Foundation Trust has a general duty
under paragraph 63 of Chapter 5 of the
National Service Act 2006 to exercise the
functions of the Trust effectively, efficiently and
economically. Paragraph 1 of Schedule 10 of
the National Health Service Act 2006 and the
Audit Code for NHS Foundation Trusts require
that we satisfy ourselves that the Foundation
Trust has made proper arrangements for
securing economy, efficiency and effectiveness
in its use of resources.
For the year ended 31 March 2015 the Trust
has reported a deficit of £23.8m. Prior to the
end of the financial year, the Trust received
distress funding from the Independent Trust
Financing Facility (ITFF) of £10.6m in order to
support the ongoing operating expenses.
As a result, the Trust has commissioned an
external review of its financial governance
arrangements. Monitor is completing a review
to assess the sustainability of the organisation
and its long term plans for the provision of
healthcare services.
The Trust is currently predicting a deficit of
£38m for 2015/16 and it is expected that the
Trust will require further distress funding in
October 2015, although a funding plan and
timetable has not yet been formalised.
As a result of the matters discussed above,
we have been unable to satisfy ourselves
that Basildon and Thurrock University
Hospitals NHS Foundation Trust made proper
arrangements for securing economy, efficiency
and effectiveness in its use of resources for the
year ended 31 March 2015.
Other matters on which we report by
exception
We have nothing to report in respect of the
following:
Under the NHS Foundation Trust Annual
Reporting Manual, we report to you if, in our
opinion, information in the Annual Report is:
z materially inconsistent with the information in
the audited financial statements, or
In February 2015 Monitor found the Trust to be
in breach of its licence and issued enforcement
action on the following grounds:
z apparently materially incorrect based on, or
materially inconsistent with, our knowledge
of the NHS Foundation Trust acquired in the
course of performing our audit; or
z Sustainability of the financial plan
z otherwise misleading.
z Financial governance (Continuity of Service
Risk Rating of 1)
In particular, we consider whether we have
identified any inconsistencies between our
knowledge acquired during the audit and
the directors’ statement that they consider
z Requirement for significant distress funding
191
the Annual Report is fair, balanced and
understandable and whether the annual report
appropriately discloses those matters that we
communicated to the Audit Committee which
we consider should have been disclosed.
Qualified certificate
We certify that we have completed the audit
of the financial statements of Basildon and
Trust in accordance with the requirements
of Chapter 5 of Part 2 of the National Health
Service Act 2006 and the Audit Code for NHS
Foundation Trusts 2014 issued by Monitor
except that, as noted above, we have been
unable to satisfy ourselves that Basildon and
Trust has made proper arrangements for
securing economy, efficiency and effectiveness
in its use of resources.
We also have nothing to report in respect of the
following:
Under the Audit Code for NHS Foundation
Trusts 2014 we are required to report to you if
we have been unable to satisfy ourselves that:
z proper practices have been observed in the
compilation of the financial statements; or
z the annual governance statement meets the
disclosure requirements set out in the NHS
and is not misleading or inconsistent with
other information that is forthcoming from the
audit; or
z the Quality Report has been prepared in
accordance with the detailed guidance issued
by Monitor.
David Eagles (senior statutory auditor)
For and on behalf of BDO LLP
Ipswich, UK
28 May 2015
192
Basildon and Thurrock University Hospitals NHS Foundation Trust - Annual Accounts 2014/15
STATEMENT OF COMPREHENSIVE INCOME
FOR THE YEAR ENDED 31 MARCH 2015
2014/15
NOTE
£000
2013/14
£000
£000
£000
Continuing Operations
Operating income from activities
3
268,148
263,091
Other operating income
Reversal of Impairments
4
9
25,560
666
25,265
-
Operating expenses
General
Impairments
5-6
(310,596)
(765)
9
OPERATING (DEFICIT)/ SURPLUS
Interest receivable
Interest payable
PDC Dividends payable
8
7-8
10
(311,361)
(290,153)
(16,987)
(1,797)
100
(1,111)
(5,829)
122
(1,065)
(6,206)
(10)
(31)
Other finance costs - unwinding of discount
NET FINANCE COSTS
Share of profit/(loss) of Joint ventures
accounted for using the equity method
(289,877)
(276)
32
(LOSS)/PROFIT BEFORE INCOME TAX
Income Tax expense
(Deficit)/Surplus from continuing operations
Surplus/(deficit) of discontinued operations
and the gain/(loss) on disposal of
discontinued operations
(DEFICIT)/SURPLUS FOR THE YEAR
Other Comprehensive Income
Revaluation on property, plant and
equipment
Impairment losses on property, plant and
equipment
(6,850)
(7,180)
-
-
(23,837)
(8,977)
-
-
(23,837)
(8,977)
-
-
(23,837)
(8,977)
16,837
355
-
(408)
TOTAL OTHER COMPREHENSIVE (EXPENDITURE)/ INCOME
FOR THE YEAR
16,837
(53)
TOTAL COMPREHENSIVE (EXPENDITURE)/INCOME FOR THE
YEAR
(7,000)
(9,030)
The notes on pages 197 to 225 are an integral part of these accounts.
Page 193
STATEMENT OF FINANCIAL POSITION
AS AT 31 MARCH 2015
NOTE
NON-CURRENT ASSETS
Intangible assets
Property, plant and equipment
Trade and other receivables
12
13
16
31 March 2015
31 March 2014
£000
£000
8,914
229,605
2,306
8,412
214,339
1,720
240,825
224,471
6,427
19,318
10,749
6,096
11,818
20,637
36,494
38,551
(38,827)
(1,836)
(5,444)
(32,669)
(1,095)
(1,442)
Total Current Liabilities
(46,107)
(35,206)
TOTAL ASSETS LESS CURRENT LIABILITIES
231,212
227,816
(35,688)
(1,014)
(25,274)
(1,032)
Total Non-Current Liabilities
(36,702)
(26,306)
TOTAL ASSETS EMPLOYED
194,510
201,510
114,176
78,038
2,296
114,176
61,746
25,588
194,510
201,510
Total non-current assets
CURRENT ASSETS
Inventories
Cash and cash equivalents
15
16
17
Total Current Assets
CURRENT LIABILITIES
Trade and other payables
Borrowings
Provisions
18
19
20
NON-CURRENT LIABILITIES
Borrowings
Provisions
18
19
20
TAXPAYERS' EQUITY
Public Dividend Capital
Revaluation Reserve
Income and Expenditure Reserve
21
TOTAL TAXPAYERS' EQUITY
Signed:
(Chief Executive)
Date:
Page 194
STATEMENT OF CHANGES IN TAXPAYERS' EQUITY
Total
Public
Dividend
Capital
£000
£000
210,540
(8,977)
114,176
-
63,543
-
32,821
(8,977)
-
-
(1,744)
1,744
(408)
-
(408)
-
355
-
355
-
Taxpayers' Equity at 31 March 2014
201,510
114,176
61,746
25,588
Taxpayers' Equity at 1 April 2014
201,510
114,176
61,746
25,588
Surplus/(deficit) for the year
(23,837)
-
-
(23,837)
Transfers between reserves
-
-
(545)
545
16,837
-
16,837
-
194,510
114,176
78,038
2,296
Taxpayers' Equity at 1 April 2013
Surplus/(deficit) for the year
Transfers between reserves
Impairments
Revaluation gains/(losses) on property, plant
and equipment
Revaluation gains/(losses) - property, plant
and equipment
Taxpayers' Equity at 31 March 2015
Page 195
Income and
Revaluation
Expenditure
Reserve
Reserve
£000
£000
STATEMENT OF CASH FLOWS
NOTE
CASH FLOWS FROM OPERATING ACTIVITIES
Cash generated from operations
25
2014/15
2013/14
£000
£000
(5,017)
7,984
Net cash generated from operating activities
(5,017)
7,984
CASH FLOWS FROM INVESTING ACTIVITIES
Interest received
Purchase of intangible assets
Purchase of property, plant and equipment and Investment Property
Sales of property, plant and equipment and Investment Property
110
(2,120)
(7,557)
181
201
(4,595)
(13,493)
-
Net cash used in investing activities
(9,386)
(17,887)
CASH FLOWS FROM FINANCING ACTIVITIES
Loans received from the Foundation Trust Financing Facility
Loan instalments repaid to the Foundation Trust Financing Facility
Interest paid
PDC Dividend paid
12,250
(1,095)
(1,097)
(5,543)
4,650
(1,095)
(1,065)
(6,349)
4,515
(3,859)
NET DECREASE IN CASH AND CASH EQUIVALENTS
(9,888)
(13,762)
Cash and cash equivalents as at beginning of year
20,637
34,399
CASH AND CASH EQUIVALENTS AS AT END OF YEAR
10,749
20,637
Net cash used in financing activities
Page 196
NOTES TO THE ACCOUNTS
1.
ACCOUNTING POLICIES
Monitor has directed that the financial statements of NHS Foundation Trusts shall meet the accounting
requirements of the NHS Foundation Trust Annual Reporting Manual (FT ARM) which shall be agreed with
HM Treasury. Consequently, the following financial statements have been prepared in accordance with the
FT ARM issued by Monitor. The accounting policies contained in that manual follow International Financial
Reporting Standards (IFRS) and HM Treasury‟s Financial Reporting Manual to the extent that they are
meaningful and appropriate to NHS Foundation Trusts. The accounting policies have been applied
consistently in dealing with items considered material in relation to the accounts.
1.1
Accounting Convention
These accounts have been prepared under the historical cost convention modified to account for the
revaluation of property, plant and equipment, intangible assets, inventories and certain financial assets and
liabilities at fair value to the business. NHS Foundation Trusts, in compliance with HM Treasury's Financial
Reporting Manual , are not required to comply with the International Accounting Standard (IAS) 33
requirements to report 'earnings per share' or historical profits and losses.
1.2
Critical Judgements and Estimation Uncertainty
The preparation of financial statements, in conformity with IFRS, requires the use of certain critical
accounting estimates and the exercise of management judgement in applying accounting policies. The
estimates and associated assumptions are based on historical experience and other factors that are
considered to be relevant. Actual results may differ from those estimates and the estimates and underlying
assumptions are continually reviewed.
The following are the key areas of critical accounting estimates:
Depreciation
The purpose of depreciation is to reduce the net book value of assets to their residual values over their
useful economic lives. The useful economic life of each category of fixed asset is assessed when acquired
by the Trust. A degree of estimation is used in assessing the useful economic lives of assets. See note 1.7
for further details.
Accruals
When preparing accruals, historical experience and known factors are taken into account.
Provisions
Provisions are recognised when the Trust has a present legal or constructive obligation as a result of a past
event, it is probable that the Trust will be required to settle the obligation, and a reliable estimate can be
made of the amount of the obligation. See note 1.14 for further details.
Fair Value of Land and Buildings
Valuations are carried out in accordance with the Royal Institute of Chartered Surveyors (RICS) Appraisal
and Valuation Manual. See note 1.7 for further details.
Partially Completed Spells
Income for an inpatient stay can be recognised from the day of admission, but cannot be precisely calculated
until after the patient is discharged. The period from admission to discharge is known as a spell. For
patients occupying beds as at 31 March, the estimated income from partially completed patient spells is
included in income.
1.3
Expenditure on Other Goods and Services
Expenditure on goods and services is recognised when, and to the extent that they have been received, and
is measured at the fair value of those goods and services. Expenditure is recognised in operating expenses
except where it results in the creation of a non-current asset such as property, plant and equipment.
Page 197
1.4 Acquisitions and Discontinued Operations
Activities are considered to be "acquired" whether or not they are acquired from outside the public sector.
Activities are considered to be "discontinued" where they meet all of the following conditions:
a. the sale (this may be at nil consideration for activities transferred to another public sector body) or
termination is completed either in the period or before the earlier of three months after the commencement
of the subsequent period and the date on which the financial statements are approved;
b. if a termination, the former activities have ceased permanently;
c. the sale or termination has a material effect on the nature and focus of the reporting NHS Foundation
Trust's operations and represents a material reduction in its operating facilities resulting either from its
withdrawal from a particular activity or from a material reduction in income in the NHS Foundation Trust's
continuing operations; and
d. the assets, liabilities, results of operations and activities are clearly distinguishable, physically,
operationally and for financial reporting purposes.
Operations not satisfying all these conditions are classified as continuing.
1.5 Revenue Recognition
Income is accounted for by applying the accruals convention. The main source of income for the Trust is
under contracts from commissioners in respect of healthcare services. Income is recognised in the year in
which services are provided, where these services are partially completed during the year an appropriate
proportion of the total income due for that service is accrued. Where income is received for a specific activity
which is to be delivered in the following financial year, that income is deferred for example, maternity partially
completed spells.
1.6 Losses and Special Payments
Losses and special payments are included on a cash basis when they arise. Details for the payments made
are included in note 11 in these accounts. Guidance on the definitions of losses and special payments can be
found in HM Treasury's Managing Public Money .
1.7 Intangible Assets
Intangible assets are non-monetary assets without physical substance which are capable of being sold
separately from the rest of the Trust‟s business or which arise from contractual or other legal rights. They are
recognised only where it is probable that future economic benefits will flow to, or service potential be provided
to, the Trust and where the cost of the asset can be measured reliably and is at least £5,000 or form a group
of assets which individually have a cost of more the £250 and collectively have a cost of at least £5,000 and
where the assets are functionally interdependent.
Internally generated goodwill, brands, mastheads, publishing titles, customer lists and similar items are not
capitalised as intangible assets.
Expenditure on research is not capitalised.
Software which is integral to the operation of hardware e.g. an operating system, is capitalised as part of the
relevant item of property, plant and equipment. Software which is not integral to the operation of hardware
e.g. application software, is capitalised as an intangible asset.
Measurement
Intangible assets are recognised initially at cost, comprising all directly attributable costs needed to create,
produce and prepare the asset to the point that it is capable of operating in the manner intended by
management.
Subsequently intangible assets are measured at fair value. Increases in asset values arising from
revaluations are recognised in the revaluation reserve, except where, and to the extent that, they reverse an
impairment previously recognised in operating expenses, in which case they are recognised in operating
income. Decreases in asset values and impairments are charged to the revaluation reserve to the extent that
there is an available balance for the asset concerned, and thereafter are charged to operating expenses.
Gains and losses recognised in the revaluation reserve are reported in the Statement of Comprehensive
Income as an item of „other comprehensive income‟.
Amortisation
Intangible assets are amortised over their expected useful economic lives in a manner consistent with the
consumption of economic or service delivery benefits. This is normally assumed to be a minimum of 5 years.
Page 198
1.8 Property, Plant and Equipment
Capitalisation
Property, plant and equipment are capitalised where the item:
• is held for use in delivering services or for administrative purposes;
• it is probable that future economic benefits will flow to, or service potential be provided to, the Trust;
• is expected to be used for more than one financial year; and
• the cost of the item can be measured reliably.
In addition, the cost of each asset must meet the following criteria:
• individually has a cost of at least £5,000; or,
• form a group of assets which individually have a cost of more than £250, collectively have a cost of at
least £5,000, where the assets are functionally interdependent, they had broadly simultaneous purchase
dates, are anticipated to have simultaneous disposal dates and are under single managerial control; or,
• form part of the initial setting-up cost of a new building, or refurbishment of a ward or unit, irrespective of
their individual or collective cost.
Where a large asset, for example, a building, includes a number of components with significantly different
asset lives e.g. plant and equipment, then these components are treated as separate assets and depreciated
over their own useful economic lives.
Valuation
All property, plant and equipment assets are measured initially at cost, representing the costs directly
attributable to acquiring or constructing the asset and bringing it to the location and condition necessary for it
to be capable of operating in the manner intended by management. The carrying values of tangible fixed
assets are reviewed for impairment in periods if events or changes in circumstances indicate the carrying
value may not be recoverable. The costs arising from financing the construction of the fixed assets are not
capitalised but are charged to the income and expenditure account in the year to which they relate.
IAS 16 requires valuations to be undertaken with sufficient frequency that the book value isn't materially
different to the fair value. All land and buildings are restated to current value using professional valuations
every five years. A three yearly interim valuation is also carried out. The valuation was carried out in March
2015 and valued as at 31 March 2015.
The valuations are carried out primarily on the basis of modern equivalent assets for specialised operational
property and existing use value for non-specialised operational property. The land value for existing use
purpose is assessed at existing use value. For non-operational properties including surplus land, the
valuations are carried out at open market value.
Additional alternative open market figures will only be supplied for operational assets scheduled for imminent
closure and subsequent disposal.
Assets in the course of construction are included at cost to date and are valued by professional valuers when
they are brought into use.
Plant and equipment is valued at depreciated purchase cost.
Subsequent Expenditure
Where subsequent expenditure enhances an asset beyond its original specification, the directly attributable
cost is added to the asset‟s carrying value. Where subsequent expenditure is simply restoring the asset to
the specification assumed by its economic useful life then the expenditure is charged to operating expenses.
Depreciation, Amortisation and Impairments
Items of property, plant and equipment are depreciated over their remaining useful economic lives in a
manner consistent with the consumption of economic or service delivery benefits. Freehold land is
considered to have an infinite life and is not depreciated.
Buildings, installations and fittings are depreciated on their current value over the estimated remaining life of
the asset as assessed by the Trust's professional valuers. Leaseholds are depreciated over the primary
lease term.
Page 199
1.8
Property, Plant and Equipment (cont.)
Revaluation Gains and Losses
Revaluation gains are recognised in the revaluation reserve, except where, and to the extent that, they reverse a
revaluation decrease that has previously been recognised in operating expenses, in which case they are
recognised in operating income.
Revaluation losses are charged to the revaluation reserve to the extent that there is an available balance for the
asset concerned, and thereafter are charged to operating expenses.
Gains and losses recognised in the revaluation reserve are reported in the Statement of Comprehensive Income
as an item of „other comprehensive income‟.
Impairments
In accordance with the FT ARM, impairments that are due to a loss of economic benefits or service potential in
the asset are charged to operating expenses. A compensating transfer is made from the revaluation reserve to
the income and expenditure reserve of an amount equal to the lower of (i) the impairment charged to operating
expenses; and (ii) the balance in the revaluation reserve attributable to that asset before the impairment.
An impairment arising from a loss of economic benefit or service potential is reversed when, and to the extent
that, the circumstances that gave rise to the loss is reversed. Reversals are recognised in operating income to
the extent that the asset is restored to the carrying amount it would have had if the impairment had never been
recognised. Any remaining reversal is recognised in the revaluation reserve. Where, at the time of the original
impairment, a transfer was made from the revaluation reserve to the income and expenditure reserve, an
amount is transferred back to the revaluation reserve when the impairment reversal is recognised.
Other impairments are treated as revaluation losses. Reversals of other impairments are treated as revaluation
gains.
Gains and losses recognised in the revaluation reserve are reported in the Statement of Comprehensive Income
as an item of „other comprehensive income‟.
Useful Economic Lives
The following table details the useful economic lives for the main classes of property, plant and equipment and,
where applicable, sub-categories, within each class.
Main Asset Class
Buildings (including Dwellings)
Plant and Machinery
Sub-Category
Structural
Engineering
Short Term
Medium Term
Long Term
Information Technology
Furniture and Fittings
Transport Equipment
Useful Economic Life (Years)
115 (max)
25
5
6-10
11-15
5
10
7
The above lives are used prior to the professional valuers' assessment. Following assessment by the
professional valuer, the useful economic lives are adjusted on an asset-by-asset basis.
De-Recognition
Property, plant and equipment which is to be scrapped or demolished does not qualify for recognition as „Held
for Sale‟ and instead is retained as an operational asset and the asset‟s economic life is adjusted. The asset is
de-recognised when scrapping or demolition occurs.
1.9
Investments
The Trust did not hold any non-current asset or current asset investments during the year.
Page 200
1.10 Donated, Government Grant and Other Grant Funded Assets
Donated and grant funded property, plant and equipment assets are capitalised at their fair value on receipt.
The donation/grant is credited to income at the same time, unless the donor has imposed a condition that the
future economic benefits embodied in the grant are to be consumed in a manner specified by the donor, in
which case, the donation/grant is deferred within liabilities and is carried forward to future financial years to the
extent that the condition has not yet been met.
The donated and grant funded assets are subsequently accounted for in the same manner as other items of
property, plant and equipment or intangible assets.
1.11 Revenue Government and Other Grants
Government grants are grants from Government bodies other than income from clinical commissioning
groups, NHS England and NHS trusts for the provision of services. Where a grant is used to fund revenue
expenditure it is taken to the Statement of Comprehensive Income to match that expenditure.
1.12 Inventories
Inventories are valued at current cost which, whilst not consistent with IAS2, is considered to be a close
approximation to the lower of cost or net realisable value and will not lead to a materially mis-stated amount
for the value of inventories.
1.13 Cash, Bank and Overdrafts
Cash, bank and overdraft balances are recorded at the current values of these balances in the Trust's cash
book. These balances exclude monies held in the Trust's bank accounts belonging to patients (see note 30).
Account balances are only set off where a formal agreement has been made with the bank to do so. In all
other cases overdrafts are disclosed within current liabilities. Interest earned on bank accounts and interest
charged on overdrafts are recorded as, respectively, 'interest receivable' and 'interest payable' in the periods
to which they relate. Bank charges are recorded as 'operating expenditure' in the periods to which they relate.
1.14 Research and Development
Expenditure on research is not capitalised. Expenditure on development is capitalised if it meets the following
criteria:
•
•
•
•
there is a clearly defined project;
the related expenditure is separately identifiable;
the outcome of the project has been assessed with reasonable certainty as to:
• its technical feasibility;
• it results in a product or service which will eventually be brought into use; and
adequate resources exist, or are reasonably expected to be available, to enable the project to be
completed and to provide any consequential increases in working capital.
Expenditure so deferred is limited to the value of future benefits expected and is amortised through the
Statement of Comprehensive Income on a systematic basis over the period expected to benefit from the
project. It is revalued on the basis of current cost. Expenditure which does not meet the criteria for
capitalisation is treated as an operating cost in the year in which it is incurred. Where possible, the Trust will
disclose the total amount of research and development expenditure charged in the Statement of
Comprehensive Income separately. However, where research and development activity cannot be separated
from patient care activity it cannot be identified and is therefore not separately disclosed.
Fixed assets acquired for use in research and development are amortised over the life of the associated
project.
1.15 Provisions
The Trust provides for legal or constructive obligations that are of uncertain timing or amount at the Statement
of Financial Position date on the basis of the best estimate of the expenditure required to settle the obligation.
Where the effect of the time value of money is significant, the estimated risk-adjusted cash flows are
discounted using HM Treasury‟s discount rate of 1.3% in real terms.
Page 201
1.16 Contingencies
Contingent assets (that is, assets arising from past events whose existence will only be confirmed by one or
more future events not wholly within the Trust's control) will not be recognised as assets, but will be disclosed
in note 24 where an inflow of economic benefits is probable.
Contingent liabilities will be provided for where a transfer of economic benefits is probable. Otherwise, they will
not be recognised, but will be disclosed in note 24 unless the probability of a transfer of economic benefits is
remote. Contingent liabilities are defined as:
• possible obligations arising from past events whose existence will be confirmed only by the occurrence of one
or more uncertain future events not wholly within the Trust's control; or,
• present obligations arising from past events but for which it is not probable that a transfer of economic benefits
will arise or which the amount of the obligation cannot be measured with sufficient reliability.
1.17 Clinical Negligence Costs
The NHS Litigation Authority (NHSLA) operates a risk pooling scheme under which the Trust pays an annual
contribution to it, which, in return settles all clinical negligence claims. Although the NHSLA is administratively
responsible for all clinical negligence cases, the legal liability remains with the Trust. The total value of clinical
negligence provisions carried by the NHSLA on behalf of the Trust is disclosed at note 20 but is not
recognised in the Trust's accounts.
The total value of clinical negligence provisions carried by the NHSLA on behalf of the Trust is disclosed at
note 20 but is not recognised in the Trust's accounts.
1.18 Non-Clinical Risk Pooling
The Trust participates in the Property Expenses Scheme and the Liabilities to Third Parties Scheme. Both are
risk pooling schemes under which the Trust pays an annual contribution to the NHSLA and, in return, receives
assistance with the costs of claims arising. The annual membership contributions, and any 'excesses' payable
in respect of particular claims, are charged to operating expenses when the liability arises.
1.19 Pension Costs
Past and present employees are covered by the provisions of the NHS Pensions Scheme. Details of the
benefits payable under these provisions can be found on the NHS Pensions website at
www.nhsbsa.nhs.uk/pensions. The scheme is an unfunded, defined benefit scheme that covers NHS
employers, GP practices and other bodies, allowed under the direction of the Secretary of State, in England
and Wales. The scheme is not designed to be run in a way that would enable NHS bodies to identify their
share of the underlying scheme assets and liabilities. Therefore, the scheme is accounted for as if it were a
defined contribution scheme: the cost to the NHS Body of participating in the scheme is taken as equal to the
contributions payable to the scheme for the accounting period.
Employers' pension cost contributions are charged to operating expenses as and when they become due.
Additional pension liabilities arising from early retirements are not funded by the scheme except where the
retirement is due to ill-health. The full amount of the liability for the additional costs is charged to the operating
expenses at the time the trust commits itself to the retirement, regardless of the method of payment.
Further information can be found in Note 31
1.20 Value Added Tax
Most of the activities of the Trust are outside the scope of VAT and, in general, output tax does not apply and
input tax on purchases is not recoverable. Irrecoverable VAT is charged to the relevant expenditure category
or included in the capitalised purchase cost of assets. Where output tax is charged or input VAT is
recoverable, the amounts are stated net of VAT.
1.21 Third Party Assets
Assets belonging to third parties (such as money held on behalf of patients) are not recognised in the accounts
since the Trust has no beneficial interest in them. However, they are disclosed in a separate note to the
accounts in accordance with the requirements of the HM Treasury Financial Reporting Manual .
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1.22 Leases
Finance Leases (Where Trust is Lessee)
Where substantially all risks and rewards of ownership of a leased asset are borne by the Trust, the asset is
recorded as property, plant and equipment and a corresponding liability is recorded. The value at which both are
recognised is the lower of the fair value of the asset or the present value of the minimum lease payments,
discounted using the interest rate implicit in the lease. The implicit interest rate is that which produces a constant
periodic rate of interest on the outstanding liability.
The asset and liability are recognised at the inception of the lease, and are de-recognised when the liability is
discharged, cancelled or expires. The annual rental is split between the repayment of the liability and a finance
cost. The annual finance cost is calculated by applying the implicit interest rate to the outstanding liability and is
charged to Finance Costs in the Statement of Comprehensive Income.
Operating Leases
Other leases are regarded as operating leases and the rentals are charged to operating expenses on a straightline basis over the term of the lease. Operating lease incentives received are added to the lease rentals and
charged to operating expenses over the life of the lease.
Leases of Land and Buildings
Where a lease is for land and buildings, the land component is separated from the building component and the
classification for each is assessed separately. Leased land is treated as an operating lease unless title passes to
the lessee at the end of the lease term.
1.23 Public Dividend Capital (PDC) and PDC Dividend
Public Dividend Capital (PDC) is a type of public sector equity finance based on the excess of assets over
liabilities at the time of establishment of the predecessor NHS trust. HM Treasury has determined that PDC is
not a financial instrument within the meaning of IAS 32.
A charge, reflecting the cost of capital utilised by the Trust, is payable as PDC dividend. The charge is calculated
at the rate set by HM Treasury (currently 3.5%) on the average relevant net assets of the Trust during the
financial year. Relevant net assets are calculated as the value of all assets less the value of all liabilities, except
for:
(i)
donated assets (including lottery funded assets),
(ii)
average daily cash balances held with the Government Banking Services (GBS) and National Loans Fund
(NLF) deposits, excluding cash balances held in GBS accounts that relate to a short-term working capital
facility,
any PDC dividend balance receivable or payable. In accordance with the requirements laid down by the
Department of Health (as the issuer of PDC), the dividend for the year is calculated on the actual average
relevant net assets as set out in the „pre-audit‟ version of the annual accounts.
(iii)
The dividend thus calculated is not revised should any adjustment to net assets occur as a result the audit of the
annual accounts.
1.24 Foreign Exchange
The functional and presentational currencies of the Trust are sterling.
A transaction which is denominated in a foreign currency is translated into the functional currency at the spot
exchange rate on the date of the transaction.
Where the Trust has assets or liabilities denominated in a foreign currency at the Statement of Financial Position
date:
•
monetary items (other than financial instruments measured at „fair value through income and expenditure‟)
are translated at the spot exchange rate on 31 March;
•
non-monetary assets and liabilities measured at historical cost are translated using the spot exchange rate
at the date of the transaction; and,
•
non-monetary assets and liabilities measured at fair value are translated using the spot exchange rate at
the date the fair value was determined.
Exchange gains or losses on monetary items (arising on settlement of the transaction or on re-translation at the
Statement of Financial Position date) are recognised in income or expense in the period in which they arise.
Exchange gains or losses on non-monetary assets and liabilities are recognised in the same manner as other
gains and losses on these items.
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1.25 Financial Assets and Financial Liabilities
Recognition
Financial assets and financial liabilities which arise from contracts for the purchase or sale of nonfinancial items (such as goods or services), which are entered into in accordance with the Trust‟s normal
purchase, sale or usage requirements, are recognised when, and to the extent which, performance
occurs i.e. when receipt or delivery of the goods or services is made.
Financial assets or financial liabilities in respect of assets acquired or disposed of through finance leases
are recognised and measured in accordance with the accounting policy for leases described in note
1.21.
Regular purchases or sales are recognised and de-recognised, as applicable, using the trade date - the
date on which the trust commits to purchase or sell the asset.
All other financial assets and financial liabilities are recognised when the Trust becomes a party to the
contractual provisions of the instrument.
De-Recognition
All financial assets are de-recognised when the rights to receive cashflows from the assets have expired
or the Trust has transferred substantially all of the risks and rewards of ownership.
Financial liabilities are de-recognised when the obligation is discharged, cancelled or expires.
Classification and Measurement
Financial assets are categorised as loans and receivables. Financial liabilities are classified as „Other
Financial liabilities‟.
Loans and Receivables
Loans and receivables are non-derivative financial assets with fixed or determinable payments
which are not quoted in an active market. They are included in current assets.
The Trust‟s loans and receivables comprise: cash and cash equivalents, NHS debtors, accrued
income and other debtors.
Loans and receivables are recognised initially at fair value, net of transactions costs, and are
measured subsequently at amortised cost, using the effective interest method. The effective
interest rate is the rate that discounts estimate future cash receipts through the expected life of the
financial asset or, when appropriate, a shorter period, to the net carrying amount of the financial
asset.
Interest on loans and receivables is calculated using the effective interest method and credited to
the Statement of Comprehensive Income.
Other Financial Liabilities
All other financial liabilities are recognised initially at fair value, net of transaction costs incurred,
and measured subsequently at amortised cost using the effective interest method. The effective
interest rate is the rate that discounts estimate future cash payments through the expected life of
the financial liability or, when appropriate, a shorter period, to the net carrying amount of the
financial liability.
They are included in current liabilities except for amounts payable more than 12 months after the
Statement of Financial Position date, which are classified as long-term liabilities.
Interest on financial liabilities carried at amortised cost is calculated using the effective interest
method and charged to Finance Costs. Interest on financial liabilities taken out to finance property,
plant and equipment or intangible assets is not capitalised as part of the cost of those assets.
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1.26 Financial Assets and Financial Liabilities (cont)
Impairment of Financial Assets
At the Statement of Financial Position date, the Trust assesses whether any financial assets, other than
those held at „fair value through income and expenditure‟ are impaired. Financial assets are impaired and
impairment losses are recognised if, and only if, there is objective evidence of impairment as a result of
one or more events which occurred after the initial recognition of the asset and which has an impact on
the estimated future cashflows of the asset.
For financial assets carried at amortised cost, the amount of the impairment loss is measured as the
difference between the asset‟s carrying amount and the present value of the revised future cash flows
discounted at the asset‟s original effective interest rate. The loss is recognised in the Statement of
Comprehensive Income and the carrying amount of the asset is reduced through the use of a bad debt
provision.
1.27 Corporation Tax
The activities of the Trust are limited to healthcare or the provision of services associated with healthcare
and therefore the Trust has determined that it has no liability to corporation tax.
1.28 Going Concern
The Trust incurred a substantial deficit in 2014/15, which led to a requirement for interim financial support
from the Department of Heath in March 2015.
The Trust will incur a further sizeable financial deficit in 2015/16 in order to deliver the full range of
services to meet anticipated local health care demands. The Board of Directors anticipates that it may
take some years before the Trust can achieve financial balance on a sustainable basis. The regulator,
Monitor, is undertaking a sustainability review in the first quarter of the new financial year.
The Board of Directors has carefully considered the principle of 'Going Concern' and the Directors have
concluded that there are material uncertainties related to the financial sustainability (profitability and
liquidity) of the Trust which may cast significant doubt about the ability of the Trust to continue as a going
concern.
Nevertheless, the going concern basis remains appropriate. This is because the Board of Directors has
a reasonable expectation that the Trust will have access to adequate resources in the form of financial
support from the Department of Health (NHS Act 2006, section 42a) to continue to deliver the full range
of mandatory services for the foreseeable future.
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1.29 Accounting Standards and Amendments Issued But Not Yet Adopted
The following standards and interpretations issued by the International Accounting Standards Board have not yet
been adopted. None of them impacted upon the Trust's financial statements.
IFRS 9
Financial Instruments
IFRS 13
Fair Value Measurement
IAS 19
Employer contributions to defined benefit pension schemes
IAS 36
Recoverable amount disclosures
IFRIC 21
Levies
IFRS 15
Revenue from contracts with customers
Annual Improvements 2012
Annual Improvements 2013
2.
Segmental Analysis
The Trust reports its performance to the Board on a monthly basis. The main source of income for the Trust is
from commissioners in respect of healthcare services from Clinical Commissioning Groups and NHS England who
are under common control and classified as a single customer. Net assets are not reported to the Board so
therefore have been excluded for the purpose of this note.
The Trust report's to the Board by directorate down to an Operating Contribution. All further costs are shown on a
corporate level so have been excluded in the analysis.
2.1
Operating Segments
Surgical
Services
£000
Women's
and
Children's
Services
£000
Cardiothoracic
Centre
£000
Integrated
Core
Services
£000
Acute
Medicine
General
Medicine
Corporate
Total
£000
£000
£000
£000
2014/15
Income
Expenditure
Contribution
64,941
(54,341)
10,600
38,581
(26,169)
12,412
46,736
(37,162)
9,574
28,043
(58,254)
(30,211)
15,144
(18,381)
(3,237)
85,255
(59,960)
25,295
14,882
(56,302)
(41,420)
293,582
(310,569)
(16,987)
2013/14
Income
Expenditure
Contribution
64,354
(51,935)
12,419
35,774
(24,174)
11,600
47,511
(34,950)
12,561
25,681
(53,292)
(27,611)
12,111
(16,671)
(4,560)
82,845
(55,884)
26,961
20,080
(53,215)
(33,135)
288,356
(290,121)
(1,765)
Page 206
3.
Income from Activities
2014/15
£000
2013/14
£000
3.1.1 Provision of Healthcare Services
Elective income
Non-elective income
Outpatient income
Other types of activity income
A&E income
Income from protected activities
Private patient income
Other non-protected clinical income
47,126
86,863
45,772
73,227
12,737
265,725
401
2,022
47,365
87,161
42,059
74,369
10,045
260,999
384
1,708
Total income from activities
268,148
263,091
265,725
2,423
196,217
66,874
268,148
263,091
3.1.2 Commissioner Requested Services
Commissioner Requested Services
Non-Commissioner Requested Services
4.
Other Operating Income
2014/15
£000
Research and development
Education and training
Charitable and other contributions to expenditure
Pharmacy sales
Car park
Catering
Commercial property rentals, supplies and services
Accommodation charges
Non-patient care services to other bodies
Non-patient care services to private healthcare providers
Reversal of Impairment
Other
4a.
Overseas visitors
1,060
6,140
127
531
1,684
1,353
1,094
838
8,222
2,615
666
1,896
1,311
7,084
124
515
1,512
1,309
976
826
7,950
2,433
1,225
26,226
25,265
2014/15
£000
Income recognised this year
Cash payments received in year
Amounts added to provision for impairment of receivables
Amounts written off in year
Page 207
2013/14
£000
186
68
39
79
2013/14
£000
248
98
107
42
5.
Operating Expenses
2014/15
£000
2013/14
£000
4,301
523
151
13,269
1,842
195,758
18,212
3,637
952
195
5,150
1,573
185,664
17,943
2,790
5,663
1,205
628
11,499
665
176
31,579
9,512
10
2,395
6,763
2,191
921
11,759
(292)
204
29,310
8,742
3
58
816
6,265
5,674
56
3
7
1,877
5,857
4,967
310,596
289,877
5.1 Operating Expenses Comprise:
5.1.1 General
Services from Foundation Trusts
Services from other NHS Trusts
Services from other NHS bodies
Purchase of healthcare from non-NHS bodies
Directors' costs
Staff costs
Drug costs
Supplies and services
- Clinical (excluding drug costs)
- General
Establishment
Transport
Premises
Bad debts
Inventories write down
Inventories consumed
Depreciation and amortisation
Loss on disposal of other property, plant and equipment
Audit fees
- statutory audit
- other assurance services
- taxation advisory services
Consultancy
Clinical negligence
Other
'Other' includes the new and reversed unused movements on provisions (note 20).
5.1.2 Impairments
On new construction when asset brought into use
Changes in market price
765
276
765
276
311,361
5.2
Operating Leases
2014/15
£000
290,153
2013/14
£000
5.2.1 Operating Expenses Include the following cost in respect of operating leases:
Minimum lease payments
5.2.2 Annual Commitments Under Operating Leases are:
542
501
542
501
2014/15
£000
2013/14
£000
The Trust has some plant and equipment under operating leases. Some of these leases are cancellable
and all are based on an original period not exceeding three years.
The future aggregate minimum lease payments under the operating leases are:
No later than 1 year
Later than 1 year and no later than 5 years
Page 208
636
628
435
346
1,264
781
5.3 Limitation on Auditor's Liability
The auditor limits liability in respect of the audit of these financial statements to £0.58m.
6.
Staff Costs and Numbers
2014/15
£000
2013/14
£000
Staff costs and numbers includes all staff employed by the Trust and agency staff. It specifically excludes
non-executive directors and staff charges in relation to services from other trusts unless it is not a simple
recharge or sharing of costs.
6.1 Staff Costs
Executive Directors
Salaries and wages
Social Security Costs
Employer contributions to NHS Pensions Authority
Agency/Contract staff
Other Staff
Salaries and wages
Social Security Costs
Employer contributions to NHS Pensions Authority
Termination costs
Agency/Contract staff
1,093
132
360
116
1,009
124
141
156
1,701
1,430
142,971
11,761
15,754
374
27,566
139,516
11,551
15,676
(406)
22,741
198,426
189,078
Past and present employees are covered by the provisions of the NHS Pensions Scheme and details of this
can be found in Note 31.
6.2 Average Number of Persons Employed
Permanently
Employed
Agency,
Temporary
and contract
staff
2014/15
2013/14
WTE
WTE
WTE
WTE
Medical and dental
Administration and estates
Healthcare assistants and other support staff
Nursing, midwifery and health visiting staff
Scientific, therapeutic and technical staff
Other
474
1,002
967
1,395
216
4
81
76
102
150
38
-
555
1,078
1,069
1,545
254
4
524
1,263
1,109
1,545
358
4
Total
4,058
447
4,505
4,803
Permanently employed staff includes staff on an employment contract who provide services on a casual
basis. The average number is based on whole time equivalent staff (WTE) rather than headcount and based
on contracted hours rather than worked hours.
Temporary staff WTEs are calcualated on annual averages based on the payments made and recorded on
the finance system for all agency and temporary staff.
On 1 October 2014, 147 WTE were transferred to the Pathology Joint Venture under TUPE arrangements.
6.3 Employee Benefits
The total taxable value of benefits for the year is £556,607 (2013/14: £450,358). The value of benefits is
based on the taxable value of the benefit less any contribution made by the employee. There were no
payments made for staff benefits that were linked to an incentive scheme and exceeded £100,000 in the
year.
6.4 Retirements Due to Ill-Health
During 2014/15 there were 3 (2013/14 - six) early retirements from the Trust agreed on the grounds of illhealth. The estimated additional pension liabilities of these ill-health retirements will be £127,497
(£217,674). The cost of these ill-health retirement will be borne by the NHS Pensions Agency.
Page 209
6.
Staff Costs and Numbers
6.5 Staff Exit Packages
Exit package cost band
2014/15
Number of
Compulsory
redundancies
<£10,000
£10,000-£25,000
£25,001-£50,000
£50,001-£100,000
£100,001-£150,000
£150,001-£200,000
£200,000 +
Total number by type
Total resource cost (£000)
2013/14
Number of
other
departures
agreed
Total
number
Number of
Compulsory
redundancies
Number of
other
departures
agreed
Total
number
(10)
1
1
1
-
-
(10)
1
1
1
-
10
(18)
1
-
10
(18)
1
(7)
-
(7)
(7)
-
(7)
374
-
374
(406)
-
(406)
The anticipated redundancies provided for in 2013/14 were not required and therefore the provision was released
in 2014/15 creating a credit for that year.
7.
The Late Payment of Commercial Debts (Interest) Act 1998
2014/15
£000
2013/14
£000
There were no payments included within interest payable (note 8) that arose from claims made by small
businesses under this legislation.
8.
Finance Income and Costs
2014/15
£000
Finance Income
Interest on loans and receivables
Finance Costs
Loans from the Foundation Trust Financing Facility
Net Finance Income
9.
Impairment of assets
100
122
100
122
(1,111)
(1,065)
(1,111)
(1,065)
(1,011)
(943)
2014/15
£000
Changes in asset value charged to revaluation reserve
Changes in asset value charged to comprehensive income
Changes in asset value charged to operating expenses
Reversal of impairments
Page 210
2013/14
£000
2013/14
£000
765
(666)
(408)
(276)
-
99
(684)
10.
Public Dividend Capital Dividends
2014/15
£000
Opening Net Relevant Assets
Closing Net Relevant Assets
Average Net Relevant Assets
Daily Average Cash Balance
Adjusted Average Net Relevant Assets
200,246
192,716
196,481
29,943
166,538
Dividend Charge
Dividend Rate
11.
5,829
3.5%
Losses and Special Payments
Number
2013/14
£000
209,203
200,222
204,713
27,358
177,355
6,206
3.5%
£000
2014/15
Cash losses
Fruitless payments and constructive losses
Bad debts and claims abandoned
Damage to buildings, property including stores losses
Compensation under legal obligation
Extra contractual to contractors
Ex gratia payments
Special Severance payments
Extra statutory and regulatory
581
5
3
39
-
568
176
24
146
-
Total Losses and Special Payments
628
914
2013/14
Cash losses
Fruitless payments and constructive losses
Bad debts and claims abandoned
Damage to buildings, property including stores losses
Compensation under legal obligation
Extra contractual to contractors
Ex gratia payments
Special Severance payments
Extra statutory and regulatory
2
509
8
1
33
-
7
497
204
29
80
-
Total Losses and Special Payments
553
817
There were no cases where the net payment exceeded £300,000.
Note: Cash Losses and Serverance Payments amounted to under £500.
There were no cases where the net payment exceeded £300,000.
12.
Intangible Assets
Gross cost at 1 April 2014
Reclassifications
Additions purchased
Disposals
Gross cost at 31 March 2015
Software
licences
£000
2014/15
Total
£000
2013/14
Total
£000
11,375
123
2,038
(42)
13,494
11,375
123
2,038
(42)
13,494
7,276
476
4,703
(1,080)
11,375
Amortisation at 1 April 2014
Provided during the year
Reclassifications
Disposals
Amortisation at 31 March 2015
2,963
1,655
4
(42)
4,580
2,963
1,655
4
(42)
4,580
2,693
1,350
(1,080)
2,963
Net book value
- Purchased at 1 April 2014
- Donated at 1 April 2014
- Total at 1 April 2014
8,412
8,412
8,412
8,412
4,575
8
4,583
- Purchased at 31 March 2015
- Donated at 31 March 2015
- Total at 31 March 2015
8,914
8,914
8,914
8,914
8,412
8,412
The Trust has no trademarks or patents.
Page 211
13. Property, Plant and Equipment
13.1 Property, Plant and Equipment at the balance sheet date comprise the following elements:
Land
Buildings
excluding
dwellings
Dwellings
AUC *
Plant and
Machinery
Transport
Equipment
Information
Technology
Furniture &
fittings
Total
£000
£000
£000
£000
£000
£000
£000
£000
£000
Cost or valuation at 1 April 2014
Additions - purchased
Additions - donated
Reclassifications
Revaluations
Disposals
At 31 March 2015
36,004
6,881
42,885
153,712
1,839
3,374
1,379
(641)
159,663
5,104
211
345
(38)
5,622
2,382
2,557
(1,847)
3,092
47,626
1,016
110
(2,495)
(3,341)
42,916
179
7
186
23,151
915
(12)
(14,342)
9,712
5,221
23
17
512
(1,735)
4,038
273,379
6,568
127
(123)
8,222
(20,059)
268,114
Depreciation at 1 April 2014
Impairments
Reversal of impairments
Reclassifications
Revaluations
Disposals
Depreciation at 31 March 2015
-
5,172
2,979
765
(666)
620
(8,250)
(620)
-
226
117
22
(365)
-
(18)
(18)
32,217
3,113
(1,014)
(3,184)
31,132
109
19
128
18,276
1,274
38
(14,340)
5,248
3,040
355
348
(1,724)
2,019
59,040
7,857
765
(666)
(4)
(8,615)
(19,868)
38,509
Net book value
- Finance Leased at 31 March 2014
- Government granted at 31 March 2014
Total at 31 March 2014
36,004
36,004
147,976
564
148,540
4,878
4,878
2,382
2,382
14,754
655
15,409
70
70
4,867
8
4,875
2,152
29
2,181
213,083
1,256
214,339
42,885
42,885
159,042
621
159,663
5,622
5,622
3,110
3,110
11,235
6
543
11,784
58
58
4,464
4,464
1,978
41
2,019
228,394
6
1,205
229,605
* Assets under construction and payments on account
Page 212
13. Property, Plant and Equipment
13.1Property, Plant and Equipment at the balance sheet date comprise the following elements:
Land
Buildings
excluding
dwellings
Dwellings
AUC *
Plant and
Machinery
Transport
Equipment
Information
Technology
Furniture &
fittings
Total
£000
£000
£000
£000
£000
£000
£000
£000
£000
Cost or valuation at 1 April 2013
Additions - purchased
Additions - donated
Impairments
Reclassifications
Revaluations
Disposals
At 31 March 2014
36,004
36,004
146,214
7,560
(684)
267
355
153,712
5,104
5,104
1,864
1,004
(486)
2,382
46,197
2,268
124
(257)
(706)
47,626
159
20
179
21,279
2,327
(455)
23,151
5,123
101
(3)
5,221
261,944
13,280
124
(684)
(476)
355
(1,164)
273,379
Depreciation at 1 April 2013
Disposals
Depreciation at 31 March 2014
-
2,429
2,743
5,172
113
113
226
-
29,849
3,074
(706)
32,217
92
17
109
17,619
1,112
(455)
18,276
2,707
333
3,040
52,809
7,392
(1,161)
59,040
Net book value
36,004
36,004
143,213
572
143,785
4,991
4,991
1,864
1,864
15,623
725
16,348
67
67
3,653
7
3,660
2,383
33
2,416
207,798
1,337
209,135
36,004
36,004
147,976
564
148,540
4,878
4,878
2,382
2,382
14,754
655
15,409
70
70
4,867
8
4,875
2,152
29
2,181
213,083
1,256
214,339
* Assets under construction and payments on account
Page 213
13.2 The net book value of land, buildings and dwellings at 31 March 2015 comprises:
Used in
Provision of
Commissioner
Requested
Services
Used in the
Provision of
Non
Commissioner
Requested
Services
£000
£000
31 March
2015
31 March
2014
Total
£000
Total
£000
Freehold
208,170
-
208,170
189,423
TOTAL
208,170
-
208,170
189,423
The Trust's land and buildings were last revalued by an independent valuer during 2014 with an effective
valuation date of 31 March 2015. Any revaluation surplus is transferred to the revaluation reserve. Any
downward revaluation is charged against the revaluation reserve to the extent that it relates to the land or
building concerned. Any additional deficit is charged to the Statement of Comprehensive Income.
The Trust does not revalue any properties held under finance leases during the last five years of the lease.
14.
Investments
The Trust held no fixed or current asset investments at either 31 March 2015 or 31 March 2014.
15.
31 March
2015
£000
Inventories
Raw materials and consumables
Work-in-progress
Finished goods
TOTAL
31 March
2014
£000
6,427
6,096
-
-
6,427
6,096
The cost of inventories recognised as an expense and included in operating expenses was £49,791K (2013/14:
£47,253K)
No inventories were written down at the year end. Certain inventories were written off during the year due to
normal breakages or expiry of shelf life. The amount of write-off during the year was £176K (2013/14: £204K)
and is included in operating expenses.
Page 214
16.
31 March
2015
£000
Trade and Other Receivables
31 March
2014
£000
16.1 Current
NHS Trade Receivables
Receivables due from NHS charities – Revenue
Provision for doubtful debts
Other prepayments and accrued income
Interest Receivable
VAT Receivable
PDC Receivable
Other Receivables
Sub Total
15,368
10
(895)
2,192
4
484
15
2,140
19,318
6,574
86
(707)
1,487
14
2,158
301
1,905
11,818
Provision for doubtful debts
Other Receivables
(246)
2,552
(314)
2,034
Sub Total
2,306
1,720
21,624
13,538
16.2 Non-Current
TOTAL
Most of the income for the Trust arises from income generated from government agencies and no
credit scoring is carried out for these customers. For other income from activities, income is obtained
in advance where possible or is secured by service level agreements or contracts. Other operating
income comes from various sources, including Government agencies. Before accepting new
customers, other than Government agencies, for other operating income the Trust uses an external
scoring system to assess the potential customer's credit quality and defines credit limits by customer.
The increase in 2014-15 NHS Trade Receivables relates to the raising of contract income invoice for
£7.7m relating to 2015-16 in March 2015. This was to guarantee payment on 1 April to improve the
Trust cash flow. This has been adjusted as part of Deferred Income in Note 18.1.
16.3 Movement in Provision for Impaired Trade and Other Receivables
Opening Balance
Impairment losses recognised
Amounts written off as uncollectable
Impairment losses reversed
Closing Balance
31 March
2015
£000
1,021
2,501
(545)
(1,836)
31 March
2014
£000
1,784
2,157
(471)
(2,449)
1,141
1,021
The Trust provides for impairment of trade receivables based on past payment experience of various
debtor types and also takes into account any change in payment practices by individual or groups of
customers. Provision is made in full for outstanding amounts for each class of debt, the gross amount
outstanding by each debtor is shown in the table below.
Up to 30 days
30 to 60 days
60 to 90 days
90 to 180 days
Over 180 days
31 March 2015
£000
£000
Trade
Other
11
42
9
44
246
68
39
682
327
Page 215
814
31 March 2014
£000
£000
Trade
Other
30
64
7
1
31
203
117
32
536
300
721
16.4
Past due date but not impaired
receivables
Up to 30 days
30 to 60 days
60 to 90 days
90 to 180 days
Over 180 days
31 March 2015
Trade
Other
£000
£000
31 March 2014
Trade
Other
£000
£000
8,980
132
42
16
194
336
327
168
586
2,138
51
434
276
387
-
462
324
131
489
1,975
9,364
3,555
1,148
3,381
As explained earlier, provision for doubtful debts is made on the basis of past experience. As a result not all
debts that are past their due date are provided in full. The Trust does not hold any collateral or other credit
enhancements over these balances, nor does it have any right of offset against any amounts owed by the
Trust to the customer.
An analysis of the age of trade receivables past due but not impaired is provided in the table above.
None of the provision for doubtful debts includes receivables from companies which have been placed in
liquidation.
The directors consider that the carrying amount of trade and other receivables is approximately equal to
their fair value.
The maximum exposure to credit risk at the reporting date is the carrying value of each class of trade
receivable.
31 March
2015
£000
17. Cash and cash equivalents
Cash at commercial banks and in hand
Cash with the Government Banking Service
Cash and cash equivalents as in Statement of Financial
Position
288
10,461
411
20,226
10,749
20,637
31 March
2015
£000
18. Trade and Other Payables
31 March
2014
£000
31 March
2014
£000
18.1 Current
Deferred Income
NHS Payables
Non - NHS Trade Payables - revenue - other
Non - NHS Trade Payables - capital
Tax and social security costs
Other Payables
Accruals
9,794
2,774
5,971
1,777
3,384
3,459
11,668
1,635
5,545
5,183
2,848
3,447
3,479
10,532
Total Current
38,827
32,669
Deferred Income includes £7.7m of contract income that relates to April 2015 refer to note 16.2.
Page 216
31 March
2015
£000
19. Borrowings
19.1 Current
Loans from the Independent Trust Financing Facility
19.2 Non-Current
Loans from the Independent Trust Financing Facility
Total Borrowings
31 March
2014
£000
1,836
1,095
1,836
1,095
35,688
25,274
35,688
25,274
37,524
26,369
19.3 Bank Overdrafts
The Trust did not use its commercial overdraft facility.
19.4 Loans from Independent Trust Financing Facility
Loans from the Independent Trust Financing Facility have been made available and are at a fixed interest
rate. Details of each loan are given below.
4.7% loan of £1.6m repayable by instalments every six
months commencing March 2007
4.9% loan of £8.4m repayable by instalments every six
months commencing July 2008
4.49% loan of £16m total facility repayable by instalments
every six months commencing March 2012
1.90% loan of £6.3m total facility repayable by instalments
every six months commencing September 2015
3.5% revolving working capital facility of £10.6m repayable
March 2020
Page 217
25 Years
1,056
1,120
25 Years
5,954
6,303
25 Years
13,614
14,296
10 Years
6,300
4,650
5 Years
10,600
-
37,524
26,369
31 March
2015
£000
19.5 Finance Lease Liabilities
31 March
2014
£000
The Trust had no Finance Leases as at 31 March 2015 or 31 March 2014.
20. Provisions for Liabilities and Charges
At 1 April 2014
Change in discount rate
Arising during the year
Utilised during the year
Reversed unused
Unwinding of discount
At 31 March 2015
Expected timing of cashflows:
Within one year
Between one and five years
After five years
Pensions
relating to
other staff
£000
Legal claims
Other
Total
£000
£000
£000
1,139
128
(157)
(4)
10
1,116
155
144
(67)
(145)
87
1,180
4,791
(716)
5,255
2,474
5,063
(224)
(865)
10
6,458
102
403
611
1,116
87
87
5,255
5,255
5,444
403
611
6,458
31 March
2015
£000
20.1 Provisions for Liabilities and Charges
Current
Non-Current
5,444
1,014
6,458
31 March
2014
£000
1,442
1,032
2,474
Provisions for legal claims represents the gross estimated liability from employer and public liability
cases and other outstanding legal claims based on contractual or employment liabilities. Employer and
public liability cases are managed by NHS Litigation Authority through the Liabilities to Third Party
scheme and the NHS Litigation Authority share of the provision is included in its accounts.
There were no pension provisions relating to former directors.
Included within provisions is £2.6m for contract income challenges and £1.6m for employment tribunals.
£72,783K is included in the provisions of the NHS Litigation Authority at 31 March 2015 in respect of
clinical negligence liabilities of the Trust (31 March 2014 £57,448K).
Page 218
21.
Revaluation Reserve
All of the balance on the revaluation reserve relates to property, plant and equipment.
22.
Capital Commitments
Commitments under capital expenditure contracts at the balance sheet date were £2,589K (31 March 2014
£2,135K).
23.
Post Balance Sheet Events
There are no post balance sheet events.
24.
Contingencies
There were no contingencies at either 31 March 2015 or 31 March 2014.
25.
Notes to Statement of Cash Flows
2014/15
£000
25.1
Reconciliation of Operating Surplus to Net Cash Flow from Operating Activities
2013/14
£000
Operating surplus/(deficit) from continuing operations
(16,987)
(1,797)
Operating deficit
Adjustment for non-cash items:
Depreciation and amortisation
Impairments
Reversals of impairments
Loss on Disposal
Non-cash donations/grants credited to income
Changes in Working Capital:
Decrease/(Increase) in Trade and Other Receivables
Decrease in Inventories
Increase/(Decrease) in Trade and Other Payables
(Decrease)/Increase in Provisions
Other movements in operating cash flows
(16,987)
(1,797)
9,512
765
(666)
10
(127)
8,742
276
3
(124)
(8,382)
(331)
7,229
3,974
(14)
240
955
4,002
(4,313)
-
(5,017)
7,984
Net cash inflow from operating activities
Page 219
26. Related Party Transactions
The Trust is a corporate body established by the Secretary of State. The Independent Regulator of NHS
Foundation Trusts ('Monitor') and other Foundation Trusts are considered related parties. The Department of
Health is regarded as a related party as it exerts influence over a number of financial and operating policies of
the Trust. The Trust had a significant number of transactions with the Department of Health and with entities for
which the Department of Health is regarded as the parent department.
In addition, the Trust has had a number of material transactions with other Government Departments and other
central and local Government bodies.
The Trust has also received revenue and capital payments from Basildon and Thurrock University Hospitals
Charitable Trust. The Trust is Corporate Trustee of this charity and therefore it is considered a related party.
The related party transactions described above are summarised in the table below. Where individual trusts or
Government Departments transactions are not material these have been grouped together.
During the year none of the Board Members, Governors or members of the key management staff or parties
related to them has undertaken any material transactions with the Trust other than compensation as disclosed in
this note.
2014/15
Foundation Trusts
Southend University Hospital NHS FT
South Essex Partnership NHS FT
North East London NHS FT
Other
English NHS Trusts
Barts Health NHS Trust
Mid Essex Hospital Services NHS Trust
Imperial College Healthcare NHS Trust
Other
Clinical Commissioning Groups (inc. NHS
NHS Barking and Dagenham CCG
NHS Basildon and Brentwood CCG
NHS Castle Point and Rochford CCG
NHS East and North East Hertfordshire CCG
NHS England
NHS Havering CCG
NHS Mid Essex CCG
NHS Newham CCG
NHS North East Essex CCG
NHS Southend CCG
NHS Thurrock CCG
NHS West Essex CCG
Other
Public Health England
Health Education England
NDPBs
Other
Other DH bodies
Other
WGA Special Health Authorities
NHS Litigation
Other
Other WGA Bodies
NHS Blood and Transport
HM Revenue and Customs
NHS Pension Scheme
NHS Professionals
Other
Charitable Trust
Other Local or Central Government Bodies
Department of Health
Expenditure
with
Related
Party
£000
Income
from
Related
Party
£000
Amounts
owed to
Related
Party
£000
Amounts due
from Related
Party
£000
1,716
68
1,925
979
342
1,557
1,645
92
350
10
356
190
15
326
85
95
116
293
55
78
949
146
(52)
26
76
17
47
27
58
587
109,962
8,549
981
53,266
2,362
3,471
260
2,085
3,325
80,776
1,705
2,662
7,033
628
367
44
219
53
588
22
29
-
3
4
136
3
92
-
57
-
6,460
-
-
-
2,156
11,893
16,114
210
28
-
43
3,384
2,197
2,208
1
1,209
35
50
246
2,687
161
372
87
127
274
9,581
622
555
-
1
1
10
10
289
-
-
Details of the transactions with the Trust's Joint Venture Partner can be found in note 32 of these accounts.
Page 220
484
1
3
21
15
26. Related Party Transactions (cont.)
2013/14
Expenditure
with Related
Party
£000
Foundation Trusts
South Essex Partnership University NHS FT
Southend University Hospital NHS FT
North East London NHS FT
Oxford Health NHS FT
Other
English NHS Trusts
Barts Health Trust
Mid Essex Hospital Services NHS Trust
Imperial College Healthcare NHS Trust
Other
Clinical Commissioning Groups (inc. NHS
England)
NHS Barking and Dagenham CCG
NHS Basildon and Brentwood CCG
NHS Castlepoint and Rochford CCG
NHS East and North East Hertfordshire CCG
NHS England
NHS Havering CCG
NHS Mid Essex CCG
NHS Newham CCG
NHS North East Essex CCG
NHS Southend CCG
NHS Thurrock CCG
NHS Waltham Forest CCG
NHS West Essex CCG
Other
Public Health England
Health Education England
WGA Special Health Authorities
NHS Litigation Authority
Other
Other WGA Bodies
NHS Blood and Transport
Income
from
Related
Party
£000
Amounts
owed to
Related
Party
£000
Amounts
due from
Related
Party
£000
115
1,644
1,211
181
947
1,509
302
2,077
99
13
668
222
12
331
164
497
434
45
177
294
531
272
946
117
7
143
28
36
178
83
273
4
157
520
105,693
7,823
575
53,105
2,551
3,736
289
2,049
3,090
75,503
169
1,515
2,452
389
7,690
26
2,851
4
257
77
125
29
595
63
263
38
20
-
4
17
141
4
16
312
1,111
13
448
2,268
200
632
6,064
149
-
-
2,014
-
-
-
11,675
-
3,447
2,158
15,817
-
2,133
-
393
173
-
1,888
5
-
14
-
86
-
1,336
60
265
-
-
2
-
HM Revenue and Customs
NHS Pension Scheme
NHS Professionals
Other
Charitable Trust
Other Local or Central Government Bodies
Department of Health
6
0
2
22
301
The Health and Social Care Act 2012 has led to a restructuring of the NHS resulting in the demise of the Trust's
main commissioner, South West Essex PCT. With effect from 1 April 2013 responsibility for related nonspecialist commissioning has transferred to NHS Basildon and Brentwood Clinical Commissioning Group and
NHS Thurrock Clinical Commissioning Group. This change does not have an impact on the financial results
reported for the year ended 31 March 2014.
Page 221
26. Related Party Transactions (cont.)
2014/15
£000
2013/14
£000
Key Management Compensation
Key management includes all those individuals or entities controlled by them that have been identified as
Senior Management. Full remuneration details are included in the Remuneration Report. The payables
arise as a result of normal trading credit and are due within one month of receipt and bear no interest.
Compensation Payable
Short Term employment benefits
Post Employment Benefits
1,315
360
1,675
1,271
141
1,412
There were no amounts due to or from key management personnel as at 31 March 2015 or 31 March
2014.
27. Private Finance Transactions
The Trust has not entered into any Private Finance Transactions.
28. Pooled Budget Projects
The Trust has not entered into any Pooled Budget Projects.
29. Financial Instruments
Financial Risk Management
The Trust's activities expose it to a variety of financial risks: market risk (including financial markets), credit
risk and liquidity risk. The Trust's overall risk management programme focuses on credit risk.
Market risk for the Trust is low as there are no significant foreign exchange transactions (although some
suppliers prices are affected by foreign exchange fluctuations) and price risk is low as the Trust does not
hold investments. Liquidity risk is minimised by regular cash flow forecasting and maintaining a working
capital facility.
Credit risk primarily arises from two sources; cash deposits with banks and financial institutions and credit
exposures to customers and other debtors.
Cash deposits with financial institutions are controlled by the Trust's Managing Operating Cash policy and
this is regularly monitored by the Finance and Resources committee. The policy provides that deposits
may only be made with 'A' rated institutions, or Government Banking services, and in addition operates
additional single deposit, banking group and concentration limits.
The majority of the Trust's customers are Clinical Commissioning Groups. As such, credit risk in this area
is considered to be limited to disputes over activity rather than the customers' ability to pay. Other
customers have an appropriate credit check or settle via cash or using major credit cards before any
activity is undertaken. Where debtors exceed any agreed credit terms appropriate provision is made
against that class of debt; full details of these provisions are given in note 16.
Liquidity risk
The Trust's net operating costs are incurred under contracts with local Clinical Commissioning Groups and
NHS England, which are financed from resources voted annually by Parliament. The Trust mainly
finances its capital expenditure from funds made available from Government under an agreed borrowing
limit. The Trust is not, therefore, exposed to significant liquidity risks.
Interest-Rate Risk
Where the Trust's Financial Assets and Liabilities are subject to floating interest rates these are all based
on the prevailing Base Rate. The Trust is not, therefore, exposed to material interest-rate risk.
The book value of financial instruments is considered to be the same as the fair value.
Page 222
29. Financial Instruments
31 March
2015
£000
Analysis by category
31 March
2014
£000
All Financial Assets are Loans and Receivables
Cash and cash equivalents
16,461
10,749
7,458
20,637
Total
27,210
28,095
All Financial Liabilities are Other Financial Liabilities
Borrowings
37,524
11,784
26,369
14,922
Total
49,308
41,291
30. Third Party Assets
The Trust held £60 cash at bank and in hand at 31 March 2015 (31 March 2014: £629) which relates to
monies held by the Trust on behalf of patients. This has been excluded from the cash at bank and in hand
figure reported in the accounts.
31. Pension Costs
Past and present employees are covered by the provisions of the NHS Pensions Scheme. Details of the
benefits payable under these provisions can be found on the NHS Pensions website at
www.nhsbsa.nhs.uk/pensions. The scheme is an unfunded, defined benefit scheme that covers NHS
employers, GP practices and other bodies, allowed under the direction of the Secretary of State, in England
and Wales. The scheme is not designed to be run in a way that would enable NHS bodies to identify their
share of the underlying scheme assets and liabilities. Therefore, the scheme is accounted for as if it were a
defined contribution scheme: the cost to the NHS Body of participating in the scheme is taken as equal to the
contributions payable to the scheme for the accounting period.
In order that the defined benefit obligations recognised in the financial statements do not differ materially
from those that would be determined at the reporting date by a formal actuarial valuation, the FReM requires
that "the period between formal valuations shall be four years, with approximate assessments in intervening
years". An outline of these follows:
Accounting valuation
A valuation of the scheme liability is carried out annually by the scheme actuary as at the end of the reporting
period. This utilises an actuarial assessment for the previous accounting period in conjunction with updated
membership and financial data for the current reporting period, and are accepted as providing suitably robust
figures for financial reporting purposes. The valuation of the scheme liability as at 31 March 2015, is based
on valuation data as 31 March 2014, updated to 31 March 2015 with summary global member and
accounting data. In undertaking this actuarial assessment, the methodology prescribed in IAS 19, relevant
FReM interpretations, and the discount rate prescribed by HM Treasury have also been used.
The latest assessment of the liabilities of the scheme is contained in the scheme actuary report, which forms
part of the annual NHS Pension Scheme (England and Wales) Pension Accounts, published annually. These
accounts can be viewed on the NHS Pensions website. Copies can also be obtained from The Stationery
Office.
Page 223
31. Pension Costs (cont)
Full actuarial (funding) valuation
The purpose of this valuation is to assess the level of liability in respect of the benefits due under the scheme
(taking into account its recent demographic experience), and to recommend the contribution rates.
The last published actuarial valuation undertaken for the NHS Pension Scheme was completed for the year
ending 31 March 2012.
The Scheme Regulations allow contribution rates to be set by the Secretary of State for Health, with the consent
of HM Treasury, and consideration of the advice of the Scheme Actuary and appropriate employee and
employer representatives as deemed appropriate.
Scheme provisions
The NHS Pension Scheme provided defined benefits, which are summarised below. This list is an illustrative
guide only, and is not intended to detail all the benefits provided by the Scheme or the specific conditions that
must be met before these benefits can be obtained:
The Scheme is a "final salary" scheme. Annual pensions are normally based on 1/80th for the 1995 section and
of the best of the last three years pensionable pay for each year of service, and 1/60th for the 2008 section of
reckonable pay per year of membership. Members who are practitioners as defined by the Scheme Regulations
have their annual pensions based upon total pensionable earnings over the relevant pensionable service.
With effect from 1 April 2008 members can choose to give up some of their annual pension for an additional tax
free lump sum, up to a maximum amount permitted under HMRC rules. This new provision is known as
“pension commutation”.
Annual increases are applied to pension payments at rates defined by the Pensions (Increase) Act 1971, and
are based on changes in retail prices in the twelve months ending 30 September in the previous calendar year.
From 2011-12 the Consumer Price Index (CPI) has been used and replaced the Retail Prices Index (RPI).
Early payment of a pension, with enhancement, is available to members of the scheme who are permanently
incapable of fulfilling their duties effectively through illness or infirmity. A death gratuity of twice final year‟s
pensionable pay for death in service, and five times their annual pension for death after retirement is payable.
For early retirements other than those due to ill health the additional pension liabilities are not funded by the
scheme. The full amount of the liability for the additional costs is charged to the employer.
Members can purchase additional service in the NHS Scheme and contribute to money purchase AVC‟s run by
the Scheme‟s approved providers or by other Free Standing Additional Voluntary Contributions (FSAVC)
providers.
Page 224
32.
Joint Venture and Subsidiaries
32.1 Joint Venture Performance
The Trust holds a 25.5% share of each of Facilities First LLP and Pathology First LLP. These entities are jointly
controlled by the Trust, Southend University Hospital NHS Foundation Trust and Integrated Pathology
Partnerships (iPP). The arrangements are treated as a joint venture and are accounted for using equity
accounting, such that 25.5% of the surplus/(deficit) made is include in the Trust's Statement of Comprehensive
Income and 25.5% of the net assets of the Joint Venture are included in the Statement of Financial Position of
the Trust
Group statements have not been prepared as the initial consideration in the Joint Venture is nil. The amounts to
be included under entity accounting is also nil. As such there are no material changes to the statement.
Profit and Loss Account
Turnover
Cost of sales
Facilities
First
Pathology
First
Combined
2014/15
£000
2014/15
£000
2014/15
£000
7,616
(7,616)
4,836
(4,836)
12,452
(12,452)
Gross Profit
-
-
-
Operating expenditure
-
-
-
Profit/(Loss) before tax
-
-
-
Trust's share of profit/(loss) in Statement of Comprehensive Income
-
-
-
59
36
95
(59)
(36)
(95)
Net Assets/(Liabilities)
-
-
-
Net Assets/(Liabilities)
-
-
-
Share of net assets/(liabilities) recognised in the Statement of
Financial Position
-
Statement of Financial Position
Current assets
Payables - amounts due within one year
-
32.2 Subsidiaries
The Trust has not consolidated the charity accounts of Basildon and Thurrock University Hospitals Charitable
Trust due to materiality.
Page 225
-
Nethermayne
Basildon
Essex SS16 5NL
01268 524900
Minicom
01268 593190
Patient Advice and Liaison Service (PALS)
01268 394440
[email protected]
www.basildonandthurrock.nhs.uk

Annual report and accounts 2014/15

Transcription

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