South Tyneside NHS Foundation Trust

SOUTH TYNESIDE NHS FOUNDATION TRUST
ANNUAL REPORT AND ACCOUNTS
1 APRIL 2014 – 31 MARCH 2015
SOUTH TYNESIDE NHS FOUNDATION TRUST
ANNUAL REPORT AND ACCOUNTS
1 APRIL 2014 – 31 MARCH 2015
Presented to Parliament pursuant to Schedule 7, paragraph 25 (4) (a) of the
National Health Service Act 2006
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A word from the chairman and the chief executive
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CHAIRMAN AND CHIEF EXECUTIVE REPORT
CHAIRMAN’S INTRODUCTION
I am delighted to introduce this year’s Annual Report. In this, our tenth year as an
NHS Foundation Trust, I can look back with pride at the wonderful achievements of
our staff and the great strides we have made in service improvement. I have
however, been Chairman of local health services in excess of 19 years and have
been part of many changes together with my senior colleagues. In that time we have
seen major investment in people, facilities, equipment and technology. We have
changed our shape and range of services, developed clinical partnerships and done
all we can to deliver high quality local care and support for our patients.
In this my final year as Chairman of the Trust, I am filled with a deep appreciation of
all that my NHS colleagues do. Day in day out they strive for excellence but most
importantly they do so with care and compassion. Whether it be front line staff
involved in the direct care of patients at home or in our hospitals, or staff who work
behind the scenes to ensure that all of the patient care services can run smoothly, I
see immense dedication every single day.
It is never easy, but it has never been as tough and challenging as this last few
years. One thing is certain, it is not going to get easier and as we move forward the
challenge of doing more for less, meeting increasingly difficult targets and ensuring
safe and sustainable services will be a major priority for the Board.
I am certain that the only way to do this will be to do things differently. The key will
be in partnership working to ensure that all of our services are integrated across the
public sector to improve co-ordination and communication and to reduce duplication
and waste.
I know our new leadership team moving into 2016 will have this at the very top of the
agenda and I wish them every success in this exciting and challenging time.
On a personal level it has been my great pleasure to be part of the public sector in a
Non-Executive capacity. I have worked with so many excellent Executive Director
and Non-Executive Director colleagues over the years and I have highly valued their
support and the dedication and commitment they have shown.
I have been very fortunate to work with some great Boards of Directors and Council
of Governors during my 18 years' tenure as Chair. We have had a number of
changes over the years but each and every Executive and Non-Executive and
Governor has been passionate in their commitment to delivering the best possible
safe and quality care, with compassion, to the people in the communities we serve.
I have received wonderful support, advice and when necessary challenge but always
in a constructive and non-adversarial manner and with the patients interest in mind.
In her Chief Executive Report and throughout this review of last year, Lorraine
highlights our many successes, challenges and achievements, so in view of my
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forthcoming retirement I wish to reflect and thank those colleagues and partners I
have worked closely with.
The most important decision I made in my role as Chair was the appointment of
Lorraine Lambert as Chief Executive. Within days of receiving my letter of
appointment from the then Secretary of State, I was informed by the then CEO, Mr
Brian Aisbitt, that he was retiring forthwith. Thankfully, I was able to turn to such
eminent people as Sir Liam Donaldson and David Flory to find a successor. We
appointed Lorraine as Chief Executive and fairly soon after that a new Finance
Director, Mike Robson. My critics will probably say that they are the only things I got
right but we've never looked back since.
Lorraine and I have worked very closely together and like all relationships we have
from time to time thought differently about things but that has always been about the
'how' not the 'what'. We have shared a common goal of continually improving and
developing services. My role is to lead the Board, Lorraine has lead the Trust and
the, now, 5000 colleagues who directly and indirectly deliver our services.
Lorraine's inspiration, commitment and motivation has got us to where we are today
as one of the top performing Trusts in the NHS, consistently delivering our financial,
contractual, performance, quality and safety targets. These last 12 months have
been particularly difficult, for us and all NHS Providers but in in this difficult climate,
we have still continued to strive for innovation and improvement.
The highlight of my term of office was to be one of the first to achieve Foundation
Trust status, despite at that time being one of the smallest Acute Trusts in England.
If anything that has been our strength, as we have a warm successful nonhierarchical culture and behaviour in both clinical and non-clinical areas. This
achievement is closely followed by the successful integration within the Trust of
Community Health Services in Gateshead, South Tyneside and Sunderland. This
became the basis of our future vision to be the best provider of Integrated Health and
Social Care and Wellbeing Services.
I have so many colleagues I wish to thank and acknowledge but space does not
permit so please forgive me if I particularly mention my longstanding friend and
colleague David Fleetwood. I have known Dave, through business for many years in
his position as a Senior Officer at Sunderland Council. I was delighted when he was
appointed a Non-Executive Director, 10 years ago. He retired at the end of this year
and I wish to publicly acknowledge the support, advice and guidance I have received
from him, latterly in his position as Deputy Chair and Chair of the Audit Committee.
He shared our commitment, values and ethics and had been a trusted friend and
advisor even putting up with my derogatory comments about accountants!
The Council of Governors has appointed Keith Tallintire as Dave's successor as
Chair of Audit and he brings a wealth of experience from the private business sector
and has served as a Non Executive Director of Durham Dales, Easington and
Sedgefield Clinical Commissioning Group, is currently Finance Director and Deputy
CEO of Derwentside Homes and very much involved in the Third Sector.
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Our Council of Governors has done a terrific amount of work this year, particularly
bearing in mind that this is a voluntary, unpaid role. There has been a heavy
workload in the light of recent developments and Governors continue to sit on Board
Sub Committees as observers, contribute to Task and Finish Groups on matters
such as Communications, play an active role in a wide range of service
developments such as our Energy Centre, play a lead role in quality assessments
through the PLACE inspections and participate in our Board Visits. Thank you all for
your commitment and contribution.
I do get frustrated, with the media coverage regarding the NHS, which does not
recognise the increasing demand for our services at a time when we and all of the
public sector are having to find more and more financial savings and still deliver
service improvement. I do not recognise the NHS they describe when I see our
committed and caring colleagues be they doctors, nurses, other clinical staff or our
teams behind the scenes in Estates and Facilities, Finance, HR, and many others
working both out in the community and our hospitals. They genuinely come to work
every day to their best and their best is something special.
I have also been really humbled by the support of the local communities we serve
who hold their NHS services dear and of course our wonderful volunteers who day in
day out give their precious time to support us in many ways.
I have enjoyed every day, well almost every day, of my involvement with the Trust
and working with colleagues in other NHS organisations and the close working
relationships that have developed with the Third Sector, Local Authorities and
particularly the political and executive leadership at South Tyneside Council. I will
miss my colleagues in the Trust, those working in the communities and the hospital
and hospice and chatting with colleagues, patients and visitors on my daily
walkabouts particularly in Alexander's Cafe.
The organisation is in good shape, the future is both challenging and exciting and I
will continue to use the fantastic services we have available locally and support the
great people who provide them. Best wishes to you all.
Peter Davidson
Chairman
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CHIEF EXECUTIVE’S REPORT
I am filled with mixed emotions as I write this, my last Chief Executive Report for
South Tyneside NHS Foundation Trust. It has been a privilege and a pleasure to
serve this organisation and I will be very sad to leave it when I stand down from my
role in September 2015. In the 36 years I have worked for the NHS I have remained
passionate about this being the finest institution in the world and have been proud of
the NHS staff and its services every single day.
It is of course a very different NHS today to the one I joined on 8 th November 1979.
Back then a wait of two to three years was not uncommon for hip surgery, patient
choice did not really exist and traditional mixed sex nightingale wards were the norm.
That’s not to say there were not some fantastic ground breaking services and
compassionate care at that time but the advances which have been made are
phenomenal.
In today’s NHS we expect choice, privacy and dignity, safe care and compassion,
and so we should. These are the measures by which we are judged and which sets
the NHS apart as a fantastic public service.
The theme of this year’s Annual Report is a celebration of our first ten years as an
NHS Foundation Trust. This has been a remarkable period in the development of
local services. The shape of our organisation and the range of services we provide
has changed several times both before and after becoming an NHS Foundation
Trust. What has been constant throughout is the excellent staff who have remained
committed to delivering their best for the people we serve.
I hope you will enjoy both reading about the journey we have travelled over the past
ten years and the account of our performance over the past year. We also take a
look forward to the future we see ahead and our ambitions for service development
and new ways of working.
Our operational services have continued to see investment and development with a
full refurbishment of our IT department, ensuring our refrigeration units in the
Catering department and mortuary are fully compliant with current legislation, an
expansion of our Paediatric A&E department to facilitate the transfer of paediatric
day case patients from ward 12 into this area, the enabling aspects for a new boiler
house and combined heating and power (CHP) facility, plus all the necessary
preparatory works for the commencement of the new Integrated Care Hub which I
will mention later.
At the same time we have seen a number of service pressures. Like many other
organisations across the country, this has been a year of unprecedented demand for
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emergency care. For the first time at the year-end we did not meet our A&E target of
95%, which was bitterly disappointing.
What we are seeing however, is an increasing demand on hospital and community
services. We have growing numbers of frail elderly people who need support on an
ongoing basis and at times of acute illness. The whole health and social care
system has found it challenging to meet this level of demand and we will be keeping
our focus on solving this as the year progresses.
We like many other organisations have found this level of demand to be
unprecedented. This is not the standard we would wish to achieve for our patients,
however, I must pay tribute to our staff who have done a remarkable job in working
intensively to ensure that all patients receive safe, high-quality care despite these
pressures, and they have shown real determination and true grit in the face of
adversity. I pay tribute to them all and we are grateful to them for the sustained effort
that they have made over what is now more than a six-month period of ongoing
intensive demand.
As this year progresses we will need to look closely at the reasons for this shift in the
pattern of winter pressures. We normally use that term in respect of the surge in
demand over the winter months but this year demand has continued through the
whole year. For that reason, we had to create extra capacity on the District Hospital
site and to do so had to move our beloved Primrose Hospital beds and staff to open
a bigger ward so that we could accommodate more elderly frail patients and support
them adequately with expert staff.
Again I pay tribute to Dr Rodgers and the whole Primrose team who made a sterling
effort with minimum fuss to ensure that this transfer did not adversely affect any
patients. They simply rose to the challenge with the greatest commitment and
consideration possible for the welfare of our elderly population. They regularly
receive very well deserved positive compliments about the service they provide we
owe them our gratitude for their outstanding work at a difficult time.
This pressure extended throughout the whole service. The knock-on effect of very
intense demand at the front door of the hospital inevitably creates demand on our
back of house services and wards across the whole Trust were extremely busy
throughout the whole period. Important clinical supporting services such as
radiology, pathology, physiotherapy, occupational therapy and pharmacy , to name
but a few , also had to rise to the challenge. Services outside hospital played a very
major role in managing the demand on hospital services and our excellent
community services were stretched to meet the needs of patients day in and day out
They did a wonderful job and we received many letters of compliment not just from
patients but from other professionals in our Clinical Commissioning Groups, from
General Practitioners and from colleagues in neighbouring Trusts. Without the input
of our back of house services, our non clinical support services teams and our staff
working in the community, this would have been a very difficult winter to manage.
We saw day in day out the complete dedication of our teams to doing their very best
for our patients and it is when this kind of difficulty emerges that we see the NHS,
our finest institution, at its very best. Colleagues from the ambulance service through
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to primary care to community services and our hospital teams worked as one,
making sure that everything they did was in the best interests of our patients.
It has also been a very challenging year financially. Despite achieving a very
significant cost reduction programme amounting £13,297k, we still ended the year
with a small deficit position of £3,223k against our annual income of £208,235k. The
year ahead will be equally challenging with similar levels of savings required and we
are working hard both internally and with partners to look at driving down cost whilst
improving efficiency, effectiveness and quality.
On a more positive note we were delighted in the year to progress not only as one of
14 national pilots for integrated care working with local health and social care
partners in South Tyneside but to also be a part of successful “vanguard”
programmes with partners in Gateshead and Sunderland. These are important
milestones in our development of integrated care delivery across health and social
care boundaries.
Further we were pleased during the year to be selected by South Tyneside Local
Authority to develop an Integrated Care Hub for elderly people with dementia, a
major new ground breaking facility which will be entirely different to previous services
in this important area.
Due to open in 2016 at a cost of £9 million, the Hub will be a template for other
similar schemes we hope to develop going forward.
You will see in the magazine section of our report a whole range of service
developments and improvements which I hope you will enjoy reading. We are not
complacent and have not stood still. Our service improvement programme continues
to go from strength to strength and it is a pleasure to be able to share some of these
enhancements with you.
Some highlights include investment in additional surgical teams who have brought
new skills and new expertise to enhance care for our local population. New
anaesthetists and orthopaedic surgeons with special interest areas will also bring
benefit to the current range of services we provide. In our community services we
have continued to make excellent progress in the development of integrated care
teams, making sure that the patient is at the centre of what we do and that services
are tailored around the individual not around the organisation. We have worked
closely with colleagues in Clinical Commissioning Groups to work on new models of
community services delivery and we are already reaping the benefits of those new
ways of working. Our patients will see real change in the responsiveness and the
coordination of essential care which we will enhance this during the course of this
year with the development of shared information systems with our General Practice
colleagues. This will be a major step forward in service integration and a very worthy
investment in partnership with Clinical Commissioning Groups.
Looking ahead, we see integrated care as a very major element of our future service
profile, building on the integrated care hub to develop our plans for further integrated
care delivery across Gateshead, South Tyneside and Sunderland. This will be not
only involve integrated staff teams but the provision of integrated care across the
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whole spectrum of public sector services outside hospital. We see this as the most
cost effective and efficient way to deliver care to the population we serve, working
with our principal commissioners and Local Authority partners. This will require us to
look at radical new ways of working, new models of care delivery and some new
organisational arrangements to be able to deliver those models. To support this we
will develop a whole new range of extremely important partnerships so that we can
build confidence in an integrated care model that is successful for the future.
In addition to these important future plans to integrate services, we have a number of
planned investments in both hospital and community care.
Within our hospital services, we intend to develop a surgical treatment centre
designed to provide excellent fast-track surgical care in a dedicated area. Further,
we anticipate moving to new models of maternity care where new mothers can go
home on the day of delivery should they wish to do so with appropriate supported
home care. This is the modern way of delivering maternity care and it is what our
patients tell us is their preference. Again this will require some service redesign and
the close involvement and participation of our staff and patients as we reshape
services going forward.
Within our medical services, we have just opened a new cardiac catheter lab. This
builds on the investment in new pacemaker technology and in exercise testing
equipment to assess whether patients are fit for surgery. Also under development
are new models of diabetes care, of thyroid services and enhancements have also
taken place in a range of specialisms in the past year
We are always looking at opportunities to do better for our patients and this year we
challenged ourselves to look closely at how we deliver services every day looking to
make rapid improvements for immediate implementation wherever possible.
To do this, we worked with PricewaterhouseCoopers LLP on the introduction of a
methodology called PERFORM which we use to look at how each has gone that day
and to solve any problems for the next day.
We do this every day, in a rapid system which allows field staff to not only identify
what could have been done better, but also put together a solution and have the
power to implement that solution themselves. This has been very well received
across the organisation and has improved our performance in a number of areas
during the course of this year. We will be extending the use of the PERFORM
methodology to our community services and support services staff to ensure the
most efficient and effective use of their time when trying to provide essential services
across a large geographical area. This is an exciting development which takes
intensive effort from the staff concerned and I have been extremely pleased to see
the level of commitment and enthusiasm amongst the clinical teams who have
delivered the first phases of the programme. They have shaped the model that will
be our way of working for future years to come and they deserve great credit for
doing so.
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It has therefore been an exciting year, never easy and always filled with challenge. I
have been deeply impressed by the way our staff have risen to that challenge and by
their unstinting dedication and commitment.
In the 36 years I have worked in the NHS I have been proud of what it stands for ,
proud of the people who work within it and proud of the care we give to our patients.
This final year has been no exception.
It has been an absolute privilege to work with my Executive Director colleagues who
show every single day a passion for what we do and strive to do all they can to
ensure our patients get the very best care. Two new Directors joined us in the year.
Steve Williamson, Chief Operating Officer and Bob Brown, Executive Director of
Nursing and Patient Safety. They have made an immediate and excellent
contribution to our work and I am confident that we made an excellent choice in
asking them to join our team. Ian Frame, Executive Director of Personnel and
Development continues as always to ensure that the way we value our staff
demonstrates the appreciation we have of the outstanding care and compassion
they show to our patients. His leadership of cultural change throughout the
organisation has been exemplary. Alan Rodgers, Medical Director has shown not
only exceptional leadership to our professional staff but has been the champion of
safe and effective care always ensuring the Board is sighted on this in its decision
making. Last but by no means least, Mike Robson, Executive Director of Finance
and Corporate Governance and Deputy Chief Executive has continued to provide
excellent leadership and ensure the highest standards of probity and governance.
They have, each one, provided me with unstinting personal and professional
support. They have given myself, the Board and the Trust as a whole their absolute
commitment and will continue to do so. It has been my pleasure to work with them all
and I deeply appreciate and I am humbled by being part of such an excellent team.
No organisation can function well without excellent leadership and our Board as a
whole has demonstrated its capability and commitment even at the most challenging
of times .Our Non-Executive Director colleagues have shown real diligence in their
commitment and passion for excellence and I have been immensely grateful to work
with such professional and caring people.
It has been a pleasure to work for the past 25 years with Chris Morgan, Private
Office Manager, whose support and humour has been invaluable and over the past 7
years with Steve Jamieson who I refer to as ‘Minister without Portfolio’ who simply,
over and above his day job, steps up to the mark and supports myself, Peter and the
Executive team in whatever needs to be done. I am grateful to them both.
In particular Peter Davidson, Chairman, and I have been at the helm together now
for some 18 years. This in itself is unusual but even more so when you consider that
I am completely ignorant about football and Peter has tolerated this failing for so
long. It has been my honour to work with someone who genuinely cares about the
community we serve, who wants our patients to receive the very best care and our
staff to want to work with us because they enjoy doing so. Peter has been a great
mentor and friend not only to myself but to many others over the years and when he
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himself steps down from office later this year he will be a difficult act to follow and I
wish him well.
Finally it would be remiss of me not to mention the person who has endured the task
of organising me and keeping me on track for all of the 18 years I have worked at the
Trust as Chief Executive. Yvonne Ward has been much more than my Personal
Assistant, she has been the little voice that keeps me right , the force to be reckoned
with when it is wrong and above all the rock on which I have always been able to
depend. Her loyalty and care has undoubtedly been the constant that has kept me
on track and my gratitude to and affection for her is beyond words.
In closing I will just add my very best wishes to the Trust and all its staff for the
future. We have reached a really important watershed with a new leadership team
soon to be in place, a challenging and exciting strategy which will change the overall
shape and range of what we do and a major financial and service development
challenge in the next few exciting years. As I stand down I know I am leaving the
organisation in safe hands, the hands of every member of staff who cares about
what we do and wants our patients to receive the very best care and support. If that
essential compassion and commitment is right, the rest follows.
I am proud of our staff, proud of South Tyneside NHS Foundation Trust, proud of the
NHS and above all humbled to have had chance to work with such caring and
dedicated people throughout my career.
Lorraine B Lambert
Chief Executive
Date: 21 May 2015
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HIGHLIGHTS OF THE YEAR
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New beginning for new arrivals
Our new Special Care Baby Unit at South Tyneside District Hospital, which looks
after some of the Borough’s youngest, most vulnerable patients, was officially
opened in a ceremony conducted by Chief Executive Lorraine Lambert.
The unit is now situated adjacent to the Delivery Suite on the ground floor of the
maternity block, making it easier for babies to be taken there after birth and for
mothers to be with them.
Mrs Lambert said: “I am delighted that we have been able to relocate our Special
Care Baby Unit in a place in the hospital which is more convenient for families. Its
ultra-modern facilities and comfortable surroundings enable our highly trained staff to
give them the very best care and support at what it is a very difficult and stressful
time for them.”
The relocation of the unit, which looks after babies who need a high degree of care,
most of whom are premature or require observation following a difficult delivery, was
made possible following an award of almost £267,000 from a government fund to
improve and upgrade maternity units.
Trust scores highly with patients
A survey of patients’ views of their care and treatment produced very positive results,
with some scores up with the very best in the country.
South Tyneside NHS Foundation Trust was one of 156 acute and specialist NHS
trusts which took part in the survey, aimed at helping to improve the quality of
services that the NHS delivers. Responses were scored on a scale from 0 to 10, with
10 being the best possible.
We scored a 9.7 for patients being given enough privacy when being examined or
treated. For the question ‘Overall, did you feel you were treated with respect and
dignity?’, the score was 9.3. Regarding having confidence and trust in the doctors
and nurses, the scores were 9.2 and 9 respectively. We were among the very best
performers in relation to the hospital specialist being given all the necessary
information about the patient’s condition or illness by the person referring them,
scoring 9.6, and for staff discussing with patients whether additional equipment or
adaptations were needed in their home after leaving hospital, scoring 9.2. Chief
Executive Lorraine Lambert said: “We are delighted with the results of this latest
survey, which are very encouraging for patients and staff. We need to know from
people when we are doing things right and, also, when we have got it wrong so we
can make plans to put it right, not only for them but for lots of other patients.”
Leading the way in thrombosis prevention
We retained our status as an Exemplar Centre, providing national leadership in the
prevention of blood clots or thrombosis.
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Our Trust has been at the forefront in this field for over a decade, introducing
standardised, preventative measures many years before this became a national,
mandatory requirement in 2010. In 2008 we were one of an initial group of six Trusts
to be nationally recognised as a centre of excellence with the award of Venous
Thromboembolism (VTE) Exemplar status. That status has now been revalidated by
the National VTE Prevention Programme.
Trust Chief Executive Lorraine Lambert said: “Our work in this area has already
greatly improved outcomes for inpatients at South Tyneside District Hospital by
reducing the incidence of potentially life-threatening thrombosis. We are absolutely
delighted that, following a revalidation process, we have been shown to be achieving
the standards expected of those in a leadership role in relation to delivering high
quality VTE prevention.”
Celebrating Nurses’ Day
We marked International Nurses’ Day on May 12 th – the date of Florence
Nightingale’s birth – with displays highlighting the diverse, innovative work of our
nurses. We employ nurses in hospital services in South Tyneside and community
health services, including district nursing, health visiting, school nursing and
palliative care, in Gateshead, South Tyneside and Sunderland. The events, held in
each of the three localities, celebrated their achievements and information was also
available on careers in nursing, the experience of patients and the important issue of
infection control.
Louise Burn, Acting Director of Nursing and Patient Safety, said: “Our nurses do a
fantastic job in a wide variety of roles and are constantly looking at how they can
make services better. They are dedicated to ensuring that each and every patient
receives care that is as safe as possible and to making a difference to patients and
their families, from the moment a new life begins, to saying goodbye to a loved one,
and all the stages in between.”
Patients reap the benefits of focus on research
South Tyneside NHS Foundation Trust’s growing reputation as a leader in
healthcare research was highlighted on International Clinical Trials Day on May 20th.
Members of the research team had a stand in Alexander’s Restaurant at South
Tyneside District Hospital, where they encouraged patients, visitors and staff to find
out more about the exciting developments and opportunities in research which have
enabled local patients to get involved and receive the very latest treatments.
Professor Colin Rees, Clinical Director of Research and Development, said:
“Involvement in high quality research is important as it allows us to offer our patients
the very latest treatment options and we can learn from it how to improve healthcare
for the future. We have developed a culture where research is a core activity,
creating an environment for it to flourish.”
Our research, once restricted to a limited number of clinical specialties, now covers a
wide range. In 2008/9, we participated in less than 10 trials but by 2013/14 this had
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grown to over 70 across a wide range of specialities, including gastroenterology,
respiratory, cancer, stroke, reproductive health and community services.
We are a partner organisation in the National Institute for Health Research’s (NIHR)
Clinical Research Network: North East and North Cumbria, which provides funding
and support to help us to develop a dedicated research team.
Research in respiratory medicine has developed rapidly, with the team securing
three industry drug trials and consistently achieving recruitment targets and industry
funding is being used to provide a dedicated respiratory research nurse to further
develop this field of research.
South Tyneside Respiratory Consultant Dr Liz Fuller, Clinical Research Speciality
Lead in Respiratory for the NIHR Clinical Research Network: North East and North
Cumbria, said: “We are pleased to be able to offer patients the opportunity to take
part in trials at their local hospital, giving them access to the latest treatment options
and enabling the patient to take an active role in their healthcare.”
We are one of the most active Trusts in the UK in bowel cancer screening research
and have one of the most active gastrointestinal research departments nationally.
We spearheaded a study involving patients recruited from six hospitals in the region.
The trial, funded by NIHR’s Research for Patient Benefit Programme, was led by
Professor Rees, who is Speciality Group Lead in Gastroenterology for the NIHR
Clinical Research Network: North East and North Cumbria, and his research team.
The aim of the study was to assess the accuracy of different forms of technology in
characterising colonic polyps found at colonoscopy examinations of the large bowel
and comparing this with the traditional laboratory analysis. A total of 1,700 patients
were recruited over 19 months, more than 300 of those at South Tyneside’s hospital.
Durham University is the Trust’s main academic partner in research.
Don’t ignore stroke symptoms
In Action on Stroke Month in May, health staff at South Tyneside District Hospital
urged people not to dismiss warning signs of stroke as ‘just a funny turn’. Staff
provided health and lifestyle advice and blood pressure checks at stalls in the
hospital.
Each year, at least 46,000 people in the UK have a mini-stroke - also known as a
TIA or Transient Ischaemic Attack - for the first time, of which around 500 occur in
South Tyneside, which is nearly double the national average.
Dr Jon Scott, Consultant Physician for Stroke Services at South Tyneside District
Hospital, said: “A TIA is a warning sign that a person may be at a high risk of a
stroke. That risk is greatest in the first few days, with one in 12 people who have a
TIA going on to suffer a full-blown stroke within a week. The symptoms can pass
very quickly and are often mistaken for tiredness or other conditions, such as
migraine.
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“Every second counts when it comes to successfully treating a patient with a
suspected stroke and improving their chances of a full recovery: a delay in getting
help can result in death or long-term disabilities. Urgent investigation and treatment
for some people who have a TIA could reduce their risk of having another stroke by
80 per cent. Rapid access (within 24 hours, seven days a week) to specialist
assessment, investigation and treatment is still important even if the symptoms have
stopped as it can reduce the risk of someone having another TIA or a disabling
stroke.”
Dr Scott added: “We are constantly amazed at what our patients achieve through
their sheer courage and determination but to have a fighting chance of living a near
normal life, it is absolutely vital that, at the first symptom of a stroke, they call 999.”
Our multi-disciplinary Stroke Unit team, led by Dr Scott, includes nurses,
physiotherapists, occupational therapists, speech and language therapists, social
workers and a clinical psychologist. Stroke and TIA patients are able to receive fast
access to expert assessment as a result of a collaborative Consultant rota between
South Tyneside NHS Foundation Trust, Gateshead Health NHS Foundation Trust
and City Hospitals Sunderland NHS Foundation Trust, which was introduced in
2011. The rota ensures that a specialist stroke consultant is on call at all times, 24
hours a day, seven days a week.
Through ‘telehealth’ technology, consultants can log on to their computer at work or
at home to both see and talk to patients through a video link to the bedside. This,
along with access to the patient’s scan results, allows a rapid decision on the best
treatment for them.
Doctors’ cycling challenge
Two South Tyneside District Hospital doctors geared up for GastroCycle 2014 to
raise money to help fight diseases of the digestive system.
Neither Dr Laura Neilson nor Dr Roisin Bevan were previously regular cyclists but
both were determined to complete the four-day, 290-mile ride from London to
Manchester in aid of the charity Core, which supports research across all areas of
gastroenterology and provides practical information to patients, their families and
carers.
Gastroenterology Registrar Dr Neilson said: “One in eight deaths in the UK is linked
to these conditions so most people will know of someone who has been affected by
them.”
Dr Bevan, Gastroenterology Research Registrar, added: “Working in research has
made me more aware of the work being done and the difficulties in getting funding
for these projects. Raising this money for Core will help support a broad range of
gastroenterology research. Getting fit and enjoying the North East countryside on the
bikes has been a nice, side benefit.”
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Keep smiling
Oral health promoters put a smile on the faces of both young and old during National
Smile Month (May 19th-June 19th).
The team from South Tyneside NHS Foundation Trust, who cover Gateshead, South
Tyneside and Sunderland, went in to secondary schools and care homes to raise
awareness of the importance of oral health. Research suggests there is a link
between poor oral health and conditions such as dementia, pneumonia, colon
cancer, heart attacks, strokes and complications during pregnancy. Regular visits to
the dentist - as often as they recommend - can help to nip problems in the bud.
Award shortlist hat-trick
South Tyneside NHS Foundation Trust was a finalist in no fewer than three
categories of the national Patient Safety and Care Awards 2014.
Chief Executive Lorraine Lambert said: “To have three finalists out of hundreds of
entries from all over the country is a fantastic achievement and I am incredibly proud
of all the staff involved. Patient safety is at the very heart of all we do and our
shortlistings for these awards recognise our commitment to ensuring our patients
receive the safest, most effective care of the highest standard.”
Our Sunderland Community Child & Adolescent Mental Health Service was
eventually judged the winner in the ‘Mental Health’ category for its ‘Fun Friends’ pilot
- a group programme for children aged four to seven with anxiety-related issues.
This involved play-based activities, underpinned by cognitive behavioural therapy.
Preliminary results from the pilot scheme were very positive, indicating reduced
anxiety in all six children who took part.
The entry for the ‘Patient Safety in Hospital Care’ award was for a system for
identifying levels of patient dependency to support decision-making about patient
care, enabling the right level of care for those who need it, quick discharge home in
some cases, and, where appropriate, referral to other services.
Our community falls service in Sunderland was a finalist in the ‘Patient Safety in
Care of Older People’ category for its innovative work in greatly reducing the number
of falls. To measure whether they were making a difference, the team carried out an
audit and, among 142 patients who completed their rehabilitation programme, the
number of falls was lowered from 629 before taking part to 117 afterwards (81 per
cent). Six months after discharge, 69 per cent of those who had completed the
programme had not experienced a fall. The team were also among the finalists in the
Quality Improvement (QI) Awards 2014.
Improving the lives of diabetes patients
Our staff highlighted people’s positive experiences of controlling and living with
diabetes in Diabetes Week in June.
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The theme was 'i Can', with charity Diabetes UK focusing on the progress made
since its inception in 1934 by encouraging people to share their stories of courage
and hope on Facebook, Twitter and Instagram. Our diabetes service encouraged
local patients to join in.
An innovative service for South Tyneside patients with type 2 diabetes is reducing
waiting times and ensuring that patients are seen by the most appropriate healthcare
professional. It involves an integrated approach by Consultant Diabetologists at the
District Hospital, a GP with a special interest in diabetes and our diabetes specialist
nurses.
Patients with routine type 2 diabetes are still managed by their GP but the
intermediate service means that those who require some specialist input but who do
not need to go to hospital for their treatment can be seen in clinics in the community.
Referrals into the service from GPs and practice nurses are reviewed within one
working day by a Consultant Diabetologist who decides if the patient should be seen
in one of the clinics or in the hospital service.
We also offer a specialist service for women with diabetes in South Tyneside who
are thinking of having a baby. By helping them to improve control of their diabetes
prior to pregnancy, they are able to ensure the best possible chance of a successful
pregnancy for mother and baby. Patients can be referred to the specialist preconception service by their GP or practice nurse.
In addition, education programmes are available for patients. DESMOND (Diabetes
Education and Self Management for Ongoing and Newly-Diagnosed) helps people
with type 2 diabetes to self-manage their condition effectively by changing their
lifestyle through diet and exercise. Our trained DESMOND educators offer monthly
sessions for the newly-diagnosed at community health venues in South Tyneside
and Sunderland.
DAISY (Diet And Insulin to Suit Yourself) is a group education programme for people
with type 1 diabetes who are on multiple, daily injections and is based on
carbohydrate counting and equipping them with essential skills to manage their
condition more effectively. DAISY 2 is for people with type 2 diabetes who are on
multiple, daily injections. Both courses are available to patients under the care of a
diabetes Consultant at South Tyneside.
Help for lung disease sufferers
Shoppers in Gateshead’s Trinity Square were able to find out more about a free
programme to help local people with lung disease to improve their quality of life from
our community pulmonary rehabilitation team, which is led by occupational
therapists.
The team’s rehabilitation programme for people with Chronic Obstructive Pulmonary
Disease (COPD) is available at five leisure centres across the borough. It is tailored
to each individual’s needs and abilities and is aimed at increasing fitness and
tolerance to exercise and promoting people’s self-management of their condition
through exercise and education.
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Following on from the programme, the team review individual progress and there is
also an opportunity for people to continue to work towards their goals with the same
exercise instructors.
Improving treatment for thyroid patients
The innovative ways in which patients with thyroid disorders are being treated at
South Tyneside District Hospital was highlighted when Consultants Dr Jeevan
Mettayil and Dr Khaled Dukhan addressed a South Tyneside NHS Foundation Trust
Medicine for Members meeting.
One of the main functions of the thyroid gland is to produce hormones that help
regulate the body's growth and metabolism. If it does not function properly, this can
affect health in many ways, including increasing the risk of obesity, heart disease,
depression, anxiety, hair loss, sexual dysfunction and infertility, so it is important that
thyroid disorders are diagnosed and successfully treated.
Dr Mettayil and Dr Dukhan have led the development of a number of improvements
in the treatment pathway for thyroid patients to make it easier for them to receive
‘joined-up’ care. As part of this streamlining, waiting times for clinic appointments for
underactive and overactive thyroid patients are among the shortest in the North East.
A new, multi-disciplinary meeting was also introduced, where complex cases of
thyroid nodules are discussed to arrive at a treatment plan incorporating wideranging views.
There are plans to develop a ‘one stop’ thyroid nodule clinic, which would be one of
the first of its kind in the region, where patients would be seen and, if necessary,
have a biopsy. This would have the twin advantages of shortening waiting times and
speeding up the process when the need for investigations is indicated.
New Chief Operating Officer
Steve Williamson joined South Tyneside NHS Foundation Trust as its new Chief
Operating Officer.
Mr Williamson has significant experience in transforming and improving health
services and a passion for providing the very best possible care and experience to
patients, families and carers using hospital and other health services.
He said: “I am delighted at the opportunity to work with everyone at South Tyneside
NHS Foundation Trust. Our public services across health and local government are
facing an exceptional financial challenge and I know things are very tough for
everyone involved in their delivery. However, I believe the Trust is uniquely placed,
with its mix of hospital services in South Tyneside and community services in
Gateshead, Sunderland and South Tyneside, to go from strength to strength.
“The passion I have seen for delivering the very best experience for the people we
serve is a fantastic asset and I believe we can build on this passion and experience
to further develop our services and make a dramatic impact on improving the health
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of our local population. Whilst many hospital and community services may struggle
financially in the future, I think we have great potential to expand our current services
and take a key role in the future of healthcare provision in the North of England.”
Chief Executive Lorraine Lambert said: “We are delighted to welcome Steve to our
Executive team. He was an outstanding candidate and I am sure his vast experience
will prove invaluable as we push ahead with our programme to transform services,
whilst ensuring local people have access to local services, now and in the future.”
Mr Williamson joined South Tyneside from University Hospital Southampton NHS
Foundation Trust, where he was Divisional Director for Trauma and Specialist
Services. At Southampton, he led the creation of the Wessex Major Trauma Centre
and the integration and improvement of stroke services across South East
Hampshire and he directed significant local and specialist health services across the
Wessex region, serving a population of three million.
Previously, he was Associate Chief Operating Officer at Portsmouth Hospitals NHS
Trust, ran the regional Wessex Renal and Transplant Service, worked in local
government at Associate Director level and also led the creation of a new
government organisation, Her Majesty’s Courts Service, in Hampshire and Isle of
Wight.
His new post meant a return to the North East for Mr Williamson, who was brought
up in Ashington.
Keeping pace with technology
South Tyneside heart patients were among the first in the North East to be given a
new type of pacemaker which allows doctors to monitor them remotely at all times,
anywhere in the world.
Consultant Cardiologist Dr Mickey Jachuck said: “We are delighted that South
Tyneside NHS Foundation Trust is able to offer patients the benefit of this latest
technology. With a traditional pacemaker, the patient has to attend for regular checkups to allow us to retrieve the information on it and check how well the pacemaker
and the patient’s heart is working.
“With the new pacemaker, all of the information collected is continuously transmitted
wirelessly via a small device, which the patient keeps with them, and we can do the
routine checks without them having to come to the department. Crucially, by sending
alerts, it also allows us to detect any problems early - well before the patients
themselves may be aware of anything being wrong.”
Pacemakers are most commonly used to treat slow heart rhythms but Dr Jachuck
said the Trust would be looking into the possibility of using the wireless pacemaker
to pick up other hearth rhythm problems.
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Birthday celebrations for volunteer group
Our Hospital Volunteer Service, which improves the experience of patients at South
Tyneside District Hospital, celebrated its first anniversary.
Since its launch in June 2013, the service, which is a partnership between South
Tyneside NHS Foundation Trust and South Tyneside Council for Voluntary Service
(CVS), has gone from strength to strength. The volunteers were initially introduced
on the elderly care wards and then the Stroke Unit. They now cover a variety of
wards and more are beginning their training.
The service was set up to allow volunteers to have more direct contact with patients
to improve their experience in hospital whilst, at the same time, releasing nursing
staff from non-nursing tasks. As well as supplying companionship, they help patients
at mealtimes and with their hobbies and interests, and perform personal tasks, such
as hairstyling and applying hand cream. They also help on the wards, doing errands
to assist the ward team so that they can concentrate on caring for patients.
Trust Chief Executive Lorraine Lambert said: “We have a fantastic tradition of
volunteer support and we are delighted that this newest group is making such a
positive contribution. I know that the small, personal touches they provide mean so
much to our patients and make their stay in hospital, which can be quite a daunting
experience, more pleasant. At the same time, by taking on some of the non-nursing,
non-clinical duties which are important in terms of patient care but which can easily
and appropriately be carried out by non-nursing staff, they are freeing up valuable
nursing time.”
Vicky Fleming, Hospital Volunteer Service Co-ordinator, said: “I am so pleased with
how the project is progressing. We have a great team of volunteers, all of whom are
dedicated to making the patients’ stay in hospital a little more comfortable. The CVS
would also like to thank the staff at South Tyneside District Hospital for their
continued support for the volunteers during the past year.”
Karlie is the charity champ
Auxiliary nurse Karlie Davies raised a knockout £3,200 for a South Tyneside cancer
charity.
She took part in FTC (Fight the Cancer) 3 at Rainton Meadows Arena, Houghton-leSpring - the third in a series of boxing events in aid of Cancer Connections. Although
her bout was awarded to her opponent following a split decision, she was still a
winner, being awarded a trophy on the night for raising the most money.
Karlie, of South Shields, who works at the District Hospital, thanked all the staff,
including doctors, nurses and domestic workers, and patients and their relatives,
who sponsored her, as well as Westoe Taxis, who were her initial sponsors.
She said: “I’ve been overwhelmed by the support I’ve received. I only set out to raise
£300 and the final total is amazing.”
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Families’ £1,000 thank you to hospital
A bumper cheque for £1,000 was handed over to say thank you to nurses and
doctors at South Tyneside District Hospital for the care they provide.
Rob Mackins, of South Shields, presented the donation to elderly care staff on Ward
19, where his father, Tom, was frequently a patient. Mr Mackins Senior, also of
South Shields, who died in April, 2012, at Primrose Hill Hospital in Jarrow, aged 84,
suffered from a number of health problems, including dementia, and his son
estimated that in the last three or four years of his life, his father was admitted to the
District Hospital about 30 times, often to Ward 19, where is still remembered with
great fondness.
He said: “The staff on Ward 19 were so lovely, considerate and genuinely caring.
They have a difficult, busy job to do but they always had time for him. When he was
in a side ward, they moved his chair so he was sitting facing the door and could see
people going past. That sounds like just a small thing but it had a huge impact on
him because it meant he didn’t feel lonely or isolated. Not only was the care he
received there outstanding, but they also supported us as a family. My mother,
Joyce, died, aged 79 in May 2011 and we were still grieving but they saw we were
struggling and they were able to prepare us for his passing.”
Mr Mackins and his family and friends raised about £800 and a donation of £200
from the grateful family of another patient, Marion Nolan, boosted the total to £1,000.
New nursing chief for Trust
Dr Bob Brown joined South Tyneside NHS Foundation Trust as Executive Director,
Nursing and Patient Safety.
Chief Executive Lorraine Lambert said: “We interviewed a very strong field of
candidates and Bob greatly impressed us. With his considerable knowledge and
experience from working at a senior level in various roles in the NHS, he will be a
fantastic asset in our continuous drive to ensure that our patients in hospital in South
Tyneside and in the community in Gateshead, Sunderland and South Tyneside get
the safest, best possible care.”
Dr Brown said: “I am delighted to have commenced in South Tyneside NHS
Foundation Trust, an organisation with a strong reputation for high quality care and
one that continually seeks to work with a range of partners to help improve health
and care throughout our communities. This is a very important time for nursing and
for health and care, generally: a time to focus on implementing the recommendations
of the Francis report into the failings of Mid-Staffordshire NHS Foundation Trust and
those in several other key documents published in 2013.
“It is crucial that we work together to demonstrate the qualities of our organisation
and, where necessary, continue to seek to improve safety and experience for
patients and the public. As a ‘Pioneer’ organisation in South Tyneside, we also have
a responsibility to develop integrated care, working with the local Council,
commissioning groups, voluntary sector and our community at every level to test and
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evaluate ways of improving population health. This is an exciting time for the Trust
and I look forward to working with colleagues at every level to achieve our aims.”
Dr Brown was previously Director of Nursing and Professional Practice at Torbay
and Southern Devon Health and Care NHS Trust. Before that, he worked for South
Eastern Health and Social Care Trust in Northern Ireland, where he was an Assistant
Director of Nursing and Primary Care with managerial and professional responsibility
for a range of services including community hospitals, mental health services for
older people, GP Out of Hours and Minor Injury Units, and nursing in the community.
Other roles in his career have included: planning and commissioning nurse with
Southern Health and Social Services Board; Senior Professional Officer with
Northern Ireland Practice and Education Council for Nurses, Midwives and Health
Visitors and Lead Nurse (Practice Development) and Lecturer/Research Practitioner
in Nursing with Newry and Mourne Health and Social Services Trust and University
of Ulster (joint appointment). Dr Brown gained his Doctor in Nursing Science degree
in 2007 through undertaking a research study on the experience of loneliness among
people with life-limiting illness.
Providing Quality care for older people
South Tyneside District Hospital received recognition for its support for older people
with the award of the Elder Friendly Quality Mark.
Ward 19 was one of 12 wards acknowledged in the second wave of Quality Mark
presentations, becoming one of only 17 in the country to now be acknowledged in
this way.
The Quality Mark is run by the Royal College of Psychiatrists and was developed in
partnership with organisations including Royal College of Physicians, Royal College
of Nursing and British Geriatrics Society. It was established to encourage hospital
wards to become involved in improving the quality of essential care of older people
and to recognise good care provision, as identified by patient feedback.
South Tyneside NHS Foundation Trust Chief Executive Lorraine Lambert said: “This
is a wonderful achievement and I am extremely proud of the team. It is particularly
important to us because, to achieve it, the views of patients themselves were taken
into consideration.
“Not only is it fantastic news for patients and their relatives and carers, who can be
assured that they are receiving the best care, but also for our staff, who do such a
wonderful job and are always willing to go the extra mile to provide that care.
“With increasing numbers of older people living longer, we are committed to
delivering the very best support for them that enables them to have the best quality
of life possible. The Quality Mark demonstrates that we are already doing that and
we plan, in the next few years, on building on the good work currently being
undertaken to further enhance and develop our facilities for this very important group
of patients. These plans include the development of a centre of excellence for the
care of older people at South Tyneside District Hospital.”
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The award is for three years with an interim review. Wards joining the Quality Mark
scheme commit to continuous focus on improving essential care based on feedback
from patients.
The day that the rain came
It started like any other day but, following the ‘Tuesday Torrent’, on July 8th, 2014,
staff at South Tyneside District Hospital found themselves in full incident response
mode by 9am.
In an early morning deluge, two weeks’ worth of rain fell in the space of just one hour
and the hospital site was at the epicentre of the storm. What followed in the next few
hours was a shining example of what can be achieved when everyone pulls together
in the face of adversity.
Accident & Emergency was among the areas hardest hit. Immediately, the
department managers moved the adult service into the unaffected paediatric area
and, virtually seamlessly, patients continued to be seen. Meanwhile, domestic and
clinical staff set to work together on the mopping-up operation, with other A&E
department members, who had initially been working elsewhere on the day, leaving
their tasks to join them. By 2pm, full service had been resumed and, by the end of
the day, 168 patients had been seen, all but one of whom had been treated within
four hours.
The Radiology department was also badly affected, however, temporary
administration accommodation was quickly earmarked and staff managed to
maintain an urgent x-ray service, using mobile equipment, and non-urgent patients
were offered alternative appointments.
In the operating theatres, the intense rainfall led to a ceiling collapse in reception.
Staff called upon colleagues in estates and on the domestic team to help with the
clear-up, once again ensuring minimal disruption. After the necessary safety checks
had been carried out, all operating lists were running to full capacity after a delay of
no more than an hour.
Elsewhere, the estates team worked flat out and all patient services were largely
back to normal well before the end of the main working day – a truly remarkable
achievement.
Chief Executive Lorraine Lambert said. “Amazingly, the majority of our patient
services were totally unaffected and care and safety were in no way compromised.
In the immediate aftermath, our top priority was ensuring that the premises were safe
to treat patients and, due to the urgent work undertaken by our infection control,
estates and domestic staff, we were able to assure ourselves of this.
“To back this up, everyone throughout the hospital, from doctors and nurses to
receptionists, literally rolled up their sleeves and mucked in. This was teamwork of
the highest order and the pride I feel in our fantastic workforce is indescribable.”
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Nurses help with embarrassing problem
People in Gateshead, South Tyneside and Sunderland with bladder and bowel
problems were reminded of the help available to them through a local specialist
nursing service.
Our nurses hold regular adult and children’s clinics in all three areas and their
expertise can often significantly improve continence problems. The clinics are open
access, which means appointments can be made direct without needing to go
through a GP or other health professional.
Specialist nurse, Julie Fawcett, who had an article published in the British Journal of
Community Nursing on the effective management of male urinary incontinence, said:
“Incontinence can have an impact on all aspects of life but it is still a taboo subject
for many people so they do not seek help and, instead, try to manage the problem
alone. The good news is that it is a largely preventable and treatable condition.
Treatment, which can range from lifestyle changes and exercises to medical devices
and medication, depends on severity and the underlying cause but, even if the cause
cannot be cured, there are ways to ease symptoms to make life more pleasant.
Effective assessment is key to effective management and that is what our service
offers. We can help to put people back in control of their bladder or bowel.”
Patients’ positive health report
Standards at South Tyneside NHS Foundation Trust’s hospitals in relation to
patients’ privacy and dignity, cleanliness, food and general building maintenance are
top notch, according to patients themselves.
Patient-led Assessments of the Care Environment (PLACE) take place every year in
NHS hospitals and hospices, with local people going in as part of teams to inspect.
The 2014 inspections, held between March and May, covered South Tyneside NHS
Foundation Trust wards, outpatients and emergency departments at South Tyneside
District Hospital, South Shields; Primrose Hill Hospital, Jarrow, and St Benedict’s
Hospice, Sunderland.
Out of 12 areas, 10 were given the highest score of A (very confident that the
environment supported good care) and the remaining two a B (confident that the
environment supported good care).
Chief Executive Lorraine Lambert said: “We always aim to ensure every single one
of our patients is cared for with compassion and dignity in a clean, safe environment
so these results are fantastic news. Recurring themes in the assessors’ comments
were the friendliness of the atmosphere and the high quality of the environment and
our staff in all departments can justifiably feel very proud.
“These assessments are particularly important because they give patients and the
public a voice and influence in the way their local health and care services are run.
Through them, we get unbiased, objective views and a clear message about what
we can do to improve even further. As well as much positive feedback this year, the
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assessors were able to identify some areas where they felt improvements could be
made in the care environment and we are already working to address these.”
Trust among best places to work
South Tyneside NHS Foundation Trust was named as one of the best places to work
in the NHS in England.
HSJ’s Best Places to Work, in association with NHS Employers, is a celebration of
the 100 best employers in the health service. To compile the list, NHS staff survey
findings were used to analyse each organisation across seven core areas:
leadership and planning; corporate culture and communications; role satisfaction;
work environment; relationship with supervisor; training and development and
employee engagement and satisfaction.
Chief Executive, Lorraine Lambert, said: “Working in the NHS has possibly never
been tougher than it is now and, locally, we have faced some difficult challenges, as
have many NHS organisations. It is extremely pleasing and reassuring that, despite
those difficulties, our fantastic staff, who demonstrate enthusiasm, compassion and
friendliness each and every day, remain positive about us as an employer.
“Our staff generally tell us that they feel we are an open and honest employer and
we try to do everything we can to show that we value them. For example, we have a
range of very good, family-friendly, flexible working practices and policies. We place
a great emphasis on providing training programmes and opportunities at all levels in
the organisation and we have introduced initiatives such as individual health
assessment checks for all staff at their workplace.
“We are not complacent and we understand that we will not get this right all of the
time so we are always looking to improve further but being named in the top 100
health employers is a real boost for our organisation and all the staff who work within
it.”
Introduction of gold standard test
South Tyneside patients are being given a new ‘gold standard’ test as part of their
pre-operative assessment.
Cardiopulmonary Exercise (CPEX) testing was introduced at South Tyneside District
Hospital for bowel cancer surgery patients and it was anticipated that, over time, it
would be offered to patients having other operations as well.
During the test, the patient exercises on a bike whilst wearing a mask and
measurements are taken which provide information about the lungs, heart, muscles
and peripheral circulation – the blood flow that reaches the upper and lower
extremities of the body and the surface of the skin. Staff, including consultant
anaesthetists and operating department practitioners, have been specially trained to
take the measurements.
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Consultant Anaesthetist Dr Naveen Venugopal said: “This is a very important
development which is great news for South Tyneside as it is the gold standard test
for comprehensive pre-operative assessment for patients undergoing major surgery.
It was originally used in the training of elite athletes to see whether they were
improving their fitness. In the hospital setting, it can help to determine a patient’s
fitness for surgery, as using the exercise bike mimics how the body will react postsurgery. It also provides information on the risks to the patient of having the
operation and can identify other disorders or diseases, which may require the
anaesthesia for the operation to be modified.”
Consultant Anaesthetist Dr Darshan Boregowda added: “The test is useful in terms
of planning patient care as it helps predict whether a patient would benefit from a
post-operative stay in the high dependency unit or the intensive care unit.”
National award for health staff
Health staff at South Tyneside NHS Foundation Trust celebrated a major national
award.
A project aimed at boosting the weight of older South Tyneside patients won the
‘Value and Improvement in Medicines Management’ category in the Health Service
Journal (HSJ) Value in Healthcare Awards, which recognise excellent use of
resources and improvement in outcomes in the NHS.
Trust Chief Executive Lorraine Lambert said: “This is wonderful news and I am so
proud of our nutrition and dietetics team. It is a fantastic achievement and it
demonstrates that they are leaders in their field.”
The winning entry was in response to the high, rising cost of the nutritional
supplements often prescribed for patients who become malnourished due to a
variety of reasons, including dementia and depression, or long-term medical
conditions which affect breathing or swallowing and make eating difficult.
The work involved assessing, reviewing and monitoring patients taking nutritional
supplements to ensure they were receiving the right, high quality care regarding their
diet. A training programme was also set up in local care homes, resulting in more
than 1,000 carers being trained in the course of a year in how to give residents a
high energy, high protein diet. As a result, 80 per cent of the patients seen by the
Dietitian showed an increase in their Body Mass Index (BMI) and there were
substantial savings on the cost of nutritional supplements.
The Trust was also a finalist in the ‘Value and Improvement in Telehealth’ category
of the awards. Telehealth technology is used to help patients in Gateshead,
Sunderland and South Tyneside to live independently at home for longer. For
example, the innovative ‘Florence Simple Telehealth’ personalised texting service
gives patients prompts to help them manage their health care needs at home. It is
also now being used to proactively prevent illness, as well as to manage a range of
long-term conditions.
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Nurse becomes ambassador
South Tyneside hospital nurse specialist Shelley Quantrill was honoured for her
outstanding work to promote thrombosis awareness and improve thrombosis care.
She was awarded ambassador status by the charity, Lifeblood, in acknowledgement
of her ‘exceptional commitment’ to helping improve the lives of patients at risk of, or
who have suffered from, thrombosis.
Ms Quantrill said: “This is a tremendous honour and I am absolutely thrilled. I am
very proud to be part of the team at South Tyneside NHS Foundation Trust which
has been at the national forefront in the prevention of thrombosis for over a decade.
Earlier this year, we discovered that we had retained our status as a centre of
excellence, providing national leadership in this field. Crucially, our work has already
greatly improved outcomes for local inpatients at South Tyneside District Hospital by
reducing the incidence of potentially life-threatening thrombosis.”
South Tyneside cancer patients receive best care
South Tyneside was the top hospital in the country for patient experience of cancer
care.
The District Hospital came first in a league table compiled by Macmillan Cancer
Support, based on research commissioned by NHS England.
South Tyneside NHS Foundation Trust Chief Executive Lorraine Lambert said: “This
is brilliant news for our patients and for our staff of doctors, nurses and cancer
management experts. I am very proud indeed of this achievement, which is
testament to the hard work of staff and demonstrates that we are not only giving
patients the best, most clinically effective treatment but also the support that they
need at a very stressful time in their lives.
“Positive patient experience, which includes being treated with dignity and respect
and being given the opportunity to discuss treatment choices, is as vital as treatment
to a cancer patient’s quality of life and is linked to improved outcomes.”
The league table compares the performance of hospitals across the country against
measures of patients’ experiences whilst being treated in hospital, such as: whether
their diagnosis and treatment options were explained clearly to them; whether they
felt supported in their care and whether they felt they were treated with respect.
Trusts were ranked according to the number of times they appeared in the highest
20% on the 61 scored questions, with the top ten being among the ten most often in
the ‘green’ top 20%.
Research reinforces importance of bowel cancer screening
Professor Colin Rees led new research which indicates that bowel cancer patients
may do better if diagnosed through screening.
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Professor Rees, who is one of the UK’s leading experts in endoscopy (a procedure
where the inside of the body is examined) and screening, said: “We know that bowel
screening saves lives: this research suggests that the way we diagnose some
patients seems to make a difference to how well those patients do. Even taking into
account differences in gender, location of tumour, underlying health and
backgrounds, patients with later-stage bowel cancer were more likely to survive the
disease if they were diagnosed through screening.”
The national bowel cancer screening programme is offered to people in England
aged 60 to 74, who are sent a stool testing kit every two years. The test looks for
blood in stool samples, allowing the disease to be detected before symptoms
become apparent. South Tyneside District Hospital was the first hospital in the
country to offer an additional test -‘Bowelscope’ screening - to men and women
around their 55th birthday. This involves using a small tube to look at the inside of
the lower bowel to find any small growths, or polyps, which may develop into bowel
cancer if left untreated. Removing the polyps reduces the likelihood of people getting
bowel cancer.
The latest study, which has been published in the British Journal of Cancer, follows
earlier research from the same team that suggested patients whose bowel cancers
were detected through screening could have a better chance of beating the disease
because screening, generally, picks up cancers at an earlier stage when treatment is
more likely to be effective.
Researchers from Durham and Leeds universities worked with colleagues in
hospitals across Tyneside to compare more than 300 screen-detected bowel
cancers with almost 200 same-stage cancers diagnosed in people who had a
negative bowel cancer screening test but then developed symptoms in the two-year
gap before their next test. Their findings, suggesting that patients with later-stage
cancers also do better if their disease is picked up through screening, indicate that
there may be other factors at play in addition to early diagnosis.
Professor Rees added: “Research is ongoing but, even though we do not yet have
all the answers, we know that bowel cancer screening saves lives. Cancer
diagnosed through screening is likely to be at an earlier stage making it easier to
treat but, even if diagnosed at a later stage, our research shows diagnosis through
screening seems to mean patients have a better chance of doing well. Unfortunately,
only around 58 per cent of people who are offered bowel screening in the UK
complete their testing kits so it is very important that everyone offered the test takes
it.
“It is also important to say that even if they have had a normal screening result they
should see a doctor if they notice any unusual changes in the body – such as
bleeding from the bottom or persistent changes in bowel habits. It may be something
much less serious but, if it is cancer, getting it diagnosed at an early stage can really
make a difference.”
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Hospital’s investment in advanced technology
Seriously ill patients at South Tyneside District Hospital are the first in the North East
to have the opportunity to benefit from state-of-the-art equipment which helps with
their breathing.
The critical care team introduced specialised ventilators, costing almost £240,000, in
the Intensive Therapy Unit (ITU). NAVA (Neurally Adjusted Ventilatory Assist)
technology uses the electrical signal which travels from the brain to the diaphragm –
the main breathing muscle – to synchronise the patient’s breathing efforts more
effectively.
Consultant Anaesthetist Dr Christian Frey said: “Many of our patients in ITU require
support with their breathing and we are delighted that we can now offer this
advanced technology. It demonstrates our commitment to investing in the best
equipment in the interests of the very best patient care.”
Mechanical ventilation was introduced in ITUs more than 50 years ago and treatment
has relied upon a clinician adjusting airway pressure, flow and volume. With NAVA,
the ventilator pressure is constantly adjusted by the patient’s own brain signals. The
electrical activity of the diaphragm is captured, fed to the ventilator and used to
assist the patient’s breathing.
Dr Frey added: “This allows a more precise and timely response from breath to
breath, improving patient comfort, and it is expected to lead to shorter dependency
on artificial ventilation.”
Food for thought for World Mental Health Day
Recipes for happiness were on the menu at an event in Sunderland City Library to
celebrate World Mental Health Day in October.
South Tyneside NHS Foundation Trust’s Community Child and Adolescent Mental
Health team organised a free, fun session, aimed primarily at young people and
families. The theme was food and healthy eating and there was an opportunity to
take part in various activities, involving food tasting and art. Advice was also
available on ‘Five a day for health and happiness’ – introducing small actions in daily
life to make you feel good, which is an important part of being healthy.
Training to ensure compassionate care
South Tyneside NHS Foundation Trust is leading the way in providing special
training for health and social care staff to ensure they have the right qualities and
skills to provide high quality, compassionate care.
The first cohort of new starters from the Trust and independent care providers in
South Tyneside embarked on the Care Certificate programme, which the Trust is
running along with partners including Tyne and Wear Care Alliance. It is anticipated
that in the coming months, all new care workers in England, including healthcare
assistants in hospitals and staff in care homes and who look after people in their own
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homes, will have to gain the certificate, which is being introduced in response to the
Francis Inquiry Report’s recommendations into the failings at Mid-Staffordshire NHS
Foundation Trust.
Dr Bob Brown, Executive Director, Nursing and Patient Safety, explained that, in the
interests of providing best care for people, it was keen to introduce the certificate as
soon as possible.
He said: “Safety, quality and experience are our bywords: ensuring patients and the
public feel safe using our services; that the service they receive is the highest quality
we can offer and that their experience throughout is a good one. We already have an
extremely good record for providing safe care but we are never complacent and aim
to improve even further so I am delighted that we have been able to introduce a Care
Certificate training programme so soon. It shows our continued commitment to
investing in our own future workforce, whilst ensuring staff in both health and social
care are equipped to deliver safe and competent care. It will give employers, patients
and people who receive care and support evidence that the health or social care
worker standing in front of them is providing safe, compassionate and high quality
care.”
Topics covered in the programme include infection control, dementia care and
patient dignity. All learners, in addition to gaining hands-on caring experience with
the support of a mentor, progress through a workbook and are actively encouraged
to learn through reflecting on their role.
Preventing the spread of infection
South Tyneside NHS Foundation Trust’s infection prevention and control team raised
awareness of their important role in patient safety during International Infection
Prevention Week in October.
They organised an information stand in Alexander’s restaurant at South Tyneside
District Hospital, giving the public and staff the opportunity to find out more about
their individual jobs, from healthcare assistant to specialist nurse. They also
promoted one of the simplest but most effective ways for members of the public to
prevent infection - good handwashing. For staff, they emphasised the importance of
following the Trust’s hand hygiene policy.
Nurses help to stop pressure ulcers
Nurses from South Tyneside NHS Foundation Trust organised a free study day to
mark Stop Pressure Ulcer Day on November 20 th.
The event, arranged by the Trust’s tissue viability team, was open to unpaid carers
of family and friends in Gateshead, South Tyneside and Sunderland, as well as
nurses and paid care staff.
Pressure ulcers, also known as bedsores, are caused when an area of skin is placed
under pressure, disrupting the flow of blood. They can affect anyone who is unwell
and confined to bed or sitting for prolonged periods of time. Older, frail people are
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especially vulnerable. It is estimated that just under half a million people in the UK
will develop at least one pressure ulcer in any given year and, usually, they will have
an underlying health condition. The study day was aimed at giving staff and carers
the knowledge and skills to identify the early signs and prevent pressure ulcer
development. The day consisted of a series of workshops highlighting the
importance of recognising the early signs of pressure damage, who to speak if you
need advice and the equipment available.
Call for lung disease patients for treatment study
South Tyneside lung disease patients were encouraged to join in a UK-wide study to
see if an old drug can help a relatively new drug work better as a treatment for a
common lung condition.
South Tyneside NHS Foundation Trust is one of only a handful of centres involved in
the vital research and it was looking for people with the lung disorder Chronic
Obstructive Pulmonary Disease (COPD), previously called chronic bronchitis and
emphysema, to take part.
COPD is the sixth leading cause of death in the UK, causing 28,000 deaths a year.
The condition causes narrowing of the airways which, in turn, causes breathing
problems, and often a persistent cough and chest infections. There is no cure for
COPD, which costs the NHS £1 billion per year, and it can be hard to treat.
Based on laboratory and pre-clinical work, the researchers are using low doses of a
drug called theophylline, in conjunction with the inhaled steroids already used today.
Theophylline used to be used to treat COPD on its own but its use at high dose as a
drug to open up airways has declined with the development of new, inhaled
treatments.
Consultant Respiratory Physician Dr Liz Fuller, who is leading the latest research at
South Tyneside District Hospital, said: “COPD is an unpleasant condition, which can
cause much suffering, and current treatments are limited. Inhaled steroids, like those
used to treat asthma, are used to tackle COPD but, unlike their effectiveness with
asthma, the airways of people with COPD are somewhat resistant to steroids and we
have been using relatively high doses as a result. We want to test the theory that low
doses of theophylline will act on the airways, helping the inhaled steroids already
used widely in COPD today to work far more effectively.”
Early indications are positive, she added. “So far, the patients who we have recruited
seem to have benefited from it. Several have reported feeling much better, although
we do not know yet which of them are receiving the placebo. Generally, however, I
think they welcome the extra support which comes with taking part in research.”
Raising awareness of mouth cancer
South Tyneside NHS Foundation Trust’s oral health promoters backed the British
Dental Health Foundation’s Mouth Cancer Action Month in November by offering
free mouth screening and advice and guidance on the risk factors for the disease, its
signs and symptoms and the importance of early detection.
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By knowing more about the risk factors, living healthier lifestyles and by learning
what to look for, people can help reduce their risk and lower the number of lives that
mouth cancer affects. Early detection could save your life so it is really important not
to ignore possible signs and that everyone has a regular check-up with their dentist
to increase the chances of mouth cancer being detected. The latest campaign was
all about taking action: don’t leave that ulcer unattended for more than three weeks
and don’t ignore that unusual lump or swelling or red and white patches in your
mouth.
Dentist’s brush with adventure
Dentist Sarah Kime had no problem extracting cash from friends and colleagues in
support of her latest adventure in aid of a charity which provides vital dental pain
relief and training for healthcare workers to deliver sustainable dentistry in the
developing world.
Miss Kime, a specialist in special care dentistry with South Tyneside NHS
Foundation Trust’s community dental team, raised £575 for Bridge2Aid by walking
80 kilometres along the Great Wall of China. This followed her feat in climbing Mount
Kilimanjaro, the highest mountain in West Africa, which raised more than £1,000 for
the same cause.
The community dental team is made up of highly trained staff who provide
specialised NHS dental services, not usually available in general dental practice, for
adults and children in South Tyneside, Sunderland and Gateshead who have been
referred by a doctor, a dentist, or other health or social care professional.
Helping patients to breathe easier
Patients with breathing problems can now travel lighter thanks to a generous
donation by the South Tyneside Breathe Easy support group.
The group supplied the Acute Respiratory Assessment Service (ARAS) at South
Tyneside District Hospital with five, portable nebulisers, costing a total of £850. The
small, lightweight devices make it more convenient for local patients with Chronic
Obstructive Pulmonary Disease (COPD) and other long-term conditions, who may
have to use a nebuliser up to four times a day to clear their lungs, to go on holiday.
Mums supporting mums to breastfeed
The first graduates of a new breastfeeding peer support training programme are
helping South Tyneside mums to breastfeed for longer.
The course was developed by South Tyneside NHS Foundation Trust health visitor
Jen Menzies and public health midwife Jane Harker. They based it in line with the
standards of the UK Baby Friendly initiative, which aims to support breastfeeding
and parent-infant relationships by working with public services to improve standards
of care.
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A dozen mums successfully completed the first training, which included
communication and support skills, and they work with the Trust’s health
professionals in ante-natal infant feeding workshops and the various breastfeeding
support groups, which are run by the Trust’s breastfeeding support worker team at
Children’s Centres within the borough.
Mrs Menzies said: “Our graduates had all had a positive breastfeeding experience
themselves. Now, they can give other mums and mums-to-be the benefit of that
experience and, hopefully, encourage them not only to breastfeed at birth but to
continue to do so, as breastfeeding reduces the risk of babies becoming ill and is
associated with a reduced risk of later childhood disease, as well as with protecting
the mother’s health.”
Model patients put on the style
South Tyneside patients took to the catwalk to demonstrate their stylish approach to
getting on with their lives.
A group of them were models in a fashion show, which was arranged on behalf of
nurse specialists from South Tyneside NHS Foundation Trust.
The stoma nurse specialists care for people who have had bladder or bowel cancer
or who suffer from inflammatory bowel disease conditions, such as Crohn’s Disease
or Ulcerative Colitis, and, as a result of their treatment, are living with a temporary or
permanent stoma – a surgically-created opening. Adapting to life with a stoma can
be difficult but it can also mean a better quality of life, enabling patients to leave the
house and get out and about more.
The event, held at the Quality Hotel, Boldon, was sponsored by ConvaTec and BCA
Direct, which respectively manufacture and deliver products for stoma patients. The
models paraded in front of an invited audience of family and friends, as well as other
patients. There was also an opportunity for patients and carers to chat informally with
the team from South Tyneside District Hospital, who receive 60 to 80 referrals a year
and who offer support and guidance on many topics, including stoma management
and nutrition.
Nurse specialist Jane Barnes said: “The fashion show was a way of demonstrating
that, post-surgery, patients can still look and feel good in High Street clothes. It was
a huge success and we’d like to thank everyone concerned who helped to organise it
and who supported it.”
Colour and style consultant Yvonne Frost, of Chester-le-Street-based Image-On,
styled the models from head-to-toe in clothes from casual to party wear in the luxury
of the personal styling suite in John Lewis, in Newcastle, and a hair stylist and makeup artist helped pamper them, completing their look.
She said: “A little bit of glitz and glamour can go a long way in boosting people’s
confidence and I hope other patients took heart from the show and realised they, too,
can still feel good about themselves.”
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£9 million hub for older people gets the green light
A state-of-the-art centre which will offer integrated health and social care services to
South Tyneside’s older people, their carers and families was given the green light in
December.
South Tyneside Council’s Planning Committee approved plans from South Tyneside
NHS Foundation Trust to build the £9 million facility – which is set to be the biggest
of its kind in the UK – on a site at South Tyneside District Hospital.
The Integrated Care Hub will provide high quality support for older people, who
currently represent 18 per cent of the Borough’s population, and particularly for those
with dementia.
Members heard that the new hub will provide 80 beds with around 30 older people
living on the site and others accessing beds for short breaks when their carers are
on holiday or before going back to live at home. The centre will provide information
and advice to older people and their carers as well as help to use technological aids
to support independent living. There will also be rooms for medical consultations and
assessments of people’s needs.
Trust Chief Operating Officer Steve Williamson said: “We are delighted that our
plans for the integrated care hub for older people and their families and carers have
been approved. We can now forge ahead with the development and realise our joint
vision with the Council and key health, social care and voluntary sector agencies of a
centre of excellence, providing joined-up care for South Tyneside’s growing ageing
population and increasing numbers of people with dementia.”
Councillor Mary Butler, Lead Member for Adult Social Care and Support Services at
South Tyneside Council, said: “This new facility will enable us to offer more support
to the Borough’s older population to enable them to live independently in their
community for as long as possible. By offering more joined-up services, we will be
able to enhance the quality of life for our older people and those who care for them.”
She added: “We know that South Tyneside will see a 50 per cent increase in cases
of dementia across all ages by 2030. This figure is predicted to increase to 138 per
cent for those over 90 so being able to meet this growing need is critical.”
The new hub is expected to open in 2016.
‘Hello, my name is…’
Staff at South Tyneside NHS Foundation Trust joined in a national campaign by
telling patients their name.
Dr Kate Granger, an elderly medicine consultant in Yorkshire who has terminal
cancer, started #hellomynameis on Twitter following her personal experience during
a hospital stay when a number of staff failed to introduce themselves to her before
delivering care.
South Tyneside NHS Foundation Trust Chief Executive Lorraine Lambert said: “We
know that the small, personal touches can mean so much to patients and can add to
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their experience. Dr Granger is an inspiration and her campaign serves as a
reminder of how the smallest actions can make a significant difference. Introducing
yourself is the first step to making a connection and beginning to build trust and,
whilst our staff are totally committed to providing compassionate care, sometimes
this simple act can get forgotten as they address the patient’s immediate needs. By
getting involved in #hellomynameis, hopefully, we can reinforce the importance of
the human touch.”
Health staff – and Collabro star - line up for flu vaccination
Collabro’s Jamie Lambert used his star power to promote uptake of the flu
vaccination among NHS staff and the public.
Jamie, who rocketed to fame when he and his fellow bandmates won Britain’s Got
Talent 2014, took the opportunity to get the jab on a visit to meet friends and former
colleagues at South Tyneside District Hospital, where he worked in the supplies
department on and off for six years before taking part in the talent show.
Jamie, of Washington, whose proud mother is South Tyneside NHS Foundation
Trust Chief Executive Lorraine Lambert, said: “I was going to have the jab anyway
before Collabro embarked upon a full UK tour as we all needed to be physically at
the top of our game so it seemed the perfect chance to get it when I was back at the
hospital to see some of my old friends, who have given me such wonderful support
over the last few months. I, in turn, am very happy to support the flu immunisation
campaign as I know from my personal experience of working in the NHS how
important it is.”
All health staff are encouraged to get immunised against flu to cut the risk of it
spreading to patients and colleagues during the winter.
Dr Bob Brown, South Tyneside NHS Foundation Trust’s Executive Director, Nursing
and Patient Safety, joined fellow ‘flu champions’ and the occupational health team in
giving the vaccination to Trust staff at special sessions at South Tyneside District
Hospital and at community health venues in Gateshead, South Tyneside and
Sunderland.
Dr Brown said: “Winter is the busiest time of the year for the NHS and it is extremely
important in the interests of patient care that our frontline healthcare workers such as
doctors, midwives and nurses, who are more likely to be exposed to the influenza
virus through their caring role, have the jab. By protecting themselves and their
vulnerable patients, they are also protecting their colleagues and their own families.
The vaccination is important for the rest of our staff, both clinical and non-clinical, as
it helps to reduce sickness absence so that they can continue to play their part in the
delivery of services, ensuring that our patients receive the best possible care.”
One-stop shop clinics to transform South Tyneside diabetes care
Diabetes care in South Tyneside is set to be transformed with the creation of new
one-stop-shop-style clinics in the borough.
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The service, which will be delivered by South Tyneside NHS Foundation Trust, has
been welcomed by local people with diabetes. The new facilities, which are funded
by NHS South Tyneside Clinical Commissioning Group (CCG), will bring together
nine separate annual health checks under one roof locally for the first time and will
mean better care, a more personal service and less hassle for patients. Instead of
three or more separate appointments at different times of the year, the centres will
provide the full range of tests together. As a result, GPs will be free to spend more
time with patients, planning their care together with the full set of results to hand
rather than delivering the tests themselves.
One-stop shop clinics will be provided at Flagg Court and Cleadon Park Primary
Care Centre, South Shields, and Glen Primary Care Centre, in Hebburn.
Patients who do not attend for the new service will be actively followed up, and close
joint working with GPs will reduce the risk of patients slipping through the net. Newlydiagnosed patients are referred to the retinal screening service, which automatically
registers them for the nine annual processes of care.
Groundbreaking bowel cancer research wins award
A regional research study sponsored by South Tyneside NHS Foundation Trust,
which could lead to improved diagnosis of bowel cancer, scooped an award.
Around 1,800 patients were recruited for the study to find out if using special
technology, Narrow Band Imaging (NBI), during a colonoscopy (camera test) may be
able to help doctors and nurses decide whether polyps - growths on the bowel wall are potentially pre-cancerous as accurately as examination in the laboratory. The
findings are being awaited worldwide as this is the first, large scale study of its kind.
Professor Colin Rees, who led the study, said: “If NBI is found to be as accurate, it
will allow us to provide results to patients regarding the nature of polyps immediately,
rather than having to wait for laboratory tests. It would also mean that polyps that are
unlikely to become cancerous will not need to be removed, meaning less risk for
patients.”
The patients involved were from South Tyneside District Hospital, Northumbria
Healthcare NHS Foundation Trust, University Hospital of North Tees & Hartlepool
NHS Foundation Trust, County Durham & Darlington NHS Foundation Trust, North
Cumbria University Hospitals NHS Foundation Trust and South Tees Hospitals NHS
Foundation Trust. The trial was judged the winner in the Chief Investigator/Study
Team of the Year category by the National Institute for Health Research North East
and North Cumbria Clinical Research Network.
Professor Rees said: “We are delighted with this award, which recognises the
commitment of the study team and the excellence of the collaborative working within
the North East and North Cumbria Clinical Research Network and with Durham
Clinical Trials Unit. We are particularly grateful to all patients who are prepared to
participate in studies: research is a very important way to improve patient care and
we couldn't do that without patient involvement in research."
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Opening up job opportunities for people with learning disabilities
South Tyneside NHS Foundation Trust welcomed a new member of staff,
demonstrating its continuing commitment to breaking down barriers for people with
learning disabilities wishing to enter the workplace.
David Johnson, of Jarrow, is part of the administration team for the Talking
Therapies service and loves his job. He said: “I had done work experience but this is
my first proper job. I am really enjoying the work and the tasks that I have been given
and I have already made some good friends in the team.”
According to the Foundation for People with Learning Disabilities, only seven per
cent of people with learning disabilities have a job, while 65 per cent want to work.
The Trust was among a group of South Tyneside employers who attended an
employment summit, organised by Equal People and Your Voice Counts on behalf of
the Learning Disabilities Partnership Board, to find out more about how people with
learning disabilities feel about work, what the barriers are to finding work and how
the situation can be improved.
Some years ago, the Trust changed its processes to make recruitment information
more accessible so that people with learning disabilities were able to apply for posts
and this was recognised as good practice with an award from the CIPD, the
professional body for HR and people development.
David is one of several people with learning disabilities working in the Trust. Others
include one who is employed as an assistant support worker promoting awareness
and understanding of learning disabilities in GP practices in Gateshead and Andrew
McWhirter, who has been part of the Learning Disability service, in the administration
and clerical team, for almost five years.
Andrew, who lives in Sunderland, said: “I am so pleased that I was given this
wonderful opportunity. It is a pleasure and an honour to be part of the staff and the
service and my colleagues have shown me great kindness and support.”
Tracey Peters, head of the Learning Disability service, said: “Andrew has a lot of
experience and skills and has proved a valuable member of the team. We have had
fantastic feedback from people outside the organisation with whom he has dealt
about his positive attitude and behaviour.”
Clinical Business Manager Mandy Bowler, who is in charge of both the Learning
Disabilities service and the Talking Therapies mental health team, added: “Andrew
has been a great success in his role and we had no hesitation in offering a similar
opportunity to David who, I am sure, will prove equally as effective a team member.”
Ian Frame, the Trust’s Executive Director, Personnel and Development, said: “We
are committed to providing equality of opportunity in our employment practices and
we are delighted to have staff of the calibre of Andrew and David on board.”
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Chief Executive to retire
After a long and dedicated career spanning 36 years in the NHS, Lorraine Lambert,
Chief Executive at South Tyneside NHS Foundation Trust, announced she would
retire in September 2015.
Mrs Lambert, who joined the NHS straight from university, has always worked in the
North East, spending periods in Gateshead and Sunderland and a total of 25 years
in South Tyneside, the last 18 years as Chief Executive at the Trust.
Chairman Peter Davidson said: “We will be immensely sad to see Lorraine leave us.
She has led the Trust with absolute commitment and dedication throughout her time
in post. She is a fierce advocate of the NHS and of high quality patient care. Her
support for NHS staff and services is renowned and she leaves an outstanding
legacy for her replacement.”
Mrs Lambert said: “I am very sad to be leaving what has been a lifelong and deeply
happy career doing a job that I love in an organisation of which I am incredibly proud.
Having decided that this is the right time to retire, I feel I can do so knowing that we
have had many outstanding achievements in the time I have been Chief Executive,
working alongside Peter as Chairman, and that we have well-developed plans for a
strong, successful and exciting future to hand on to the next generation of leaders.”
Change for the better
South Tyneside NHS Foundation Trust staff celebrated NHS Change Day on March
11th, 2015, with a staff event showcasing some of the innovation, improvements and
positive changes which had benefited patients over the past year.
Among the hospital and community health services highlighted were falls, pressure
ulcer damage, diabetes and health visiting. The Trust also used the day as a
platform to launch its ‘Change Agents’ programme to support its leaders in making
improvements and positive changes to their services and patient pathways through
specific projects.
Ian Frame, Executive Director, Personnel and Development, said: “We in the NHS
are passionate about helping people and NHS Change Day is about harnessing our
collective energy, creativity and ideas to effect change to improve the care and
wellbeing of those who use the NHS. Our Trust always seeks to promote positive
actions that can contribute to a changing and improving NHS and, as well as
reflecting on changes in the last year, we are encouraging staff to come up with
ideas for improvement and efficiency. These will be fed into our existing continuous
quality improvement activity and we will use any emerging themes to inform future
projects.”
Hospital volunteer still going strong at 90
Dorothy Robertson became a hospital volunteer in South Tyneside more than 70
years ago and, as she celebrated her 90th birthday in March 2015, she was still
volunteering - one of the band of greeters in South Tyneside District Hospital’s
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Outpatients department, welcoming patients and their families and carers and
helping them with enquiries.
As a girl during the Second World War, she had ambitions to be a nurse but, at just
17, she was too young. However, the matron at the Ingham Infirmary in South
Shields agreed to take her on as a volunteer in Outpatients and she became so
trusted that she was allowed to dress wounds.
“I was a general dogsbody but I loved it so much that I used to go in on my days off
from my office job,” she recalled.
Mrs Robertson, of South Shields, has a long history of service to her home town.
She maintained her links to her local hospital over the years through her involvement
in health bodies, such as the Community Health Council, of which she was vice
chairman, and the Alzheimer’s Society in South Tyneside, of which she was
chairman. She was a magistrate for more than 20 years and trained as a counsellor
for Relate.
She said: “I’m very proud to still be associated with South Tyneside District Hospital
which, as well as providing a great service, offers patients and visitors a friendly,
personal touch. I love the contact with the public which I get as a greeter.
Sometimes, people just want to chat and the staff don’t always have time for that but
we volunteers are more than happy to talk to them.”
Trust Chairman Peter Davidson said: “Dorothy is an inspiration. Her record of service
to her community, including her local hospital, is wonderful. At our regular meetings
of the voluntary organisations which support the Trust, she is always there to steer
me in the right direction and support our drive to improve hospital visiting for patients
and their families. We’re very glad that she is continuing as a volunteer with us –
we’re lucky to have her.”
Teatime is the right time for nutrition advice
The importance of food and drink in care was high on the menu when South
Tyneside health workers joined care home residents for the Worldwide Afternoon
Tea, organised as part of Nutrition and Hydration Week in March, 2015.
Michelle Swinburne, Prescribing Support Dietitian, and Lauren McDowell,
Community Nutrition Assistant, from South Tyneside NHS Foundation Trust, took the
opportunity to emphasise the need for good nutritional intake and hydration when
they went to support events in several homes in the borough. The nutrition and
dietetics staff have given special training to more than 1,000 care home staff in
South Tyneside over the last two years to help prevent and treat malnutrition and, as
a result, many of the homes have reported that their residents have put on weight.
The ongoing ‘Food First’ programme focuses on screening for malnutrition and
preventing and treating it by implementing a high energy/protein diet to boost weight.
A new programme, Nutrition in Dementia Training, has also been developed,
specifically in response to requests from the homes.
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Denise Horsley, the Trust’s Strategic Lead, Safer Care, said: “Food and drink are
essential to physical and mental well-being and high standards of nutrition and
hydration care are particularly important as people get older since they can lose their
appetite, or they may not eat properly because they have dementia, depression or a
long-term condition which affects their breathing or swallowing and makes eating
difficult. If they are malnourished and underweight then they are at a higher risk of
picking up infections, which can result in being admitted to hospital, where their stay
can be prolonged due to their weakened state.”
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STRATEGIC REPORT
45
STRATEGIC REPORT
Our history
South Tyneside NHS Foundation Trust was authorised as an NHS Foundation Trust
by Monitor, the Independent Regulator of Foundation Trusts, on 1 January 2005.
The principal purpose of the Trust is the provision of goods and services for the
purposes of the health service in England. This does not preclude the provision of
cross-border services to other parts of the United Kingdom. The Trust must comply
with the provider licence conditions, and non-compliance may result in enforcement
action by Monitor. The Trust must also act in accordance with the terms of its legally
binding contracts with commissioners.
On 1 July, 2011 the Community Health Services for the Gateshead, South Tyneside
and Sunderland Primary Care Trusts transferred to the Trust under the Transforming
Community Services initiative.
Our Purpose and Aims
Our vision is to be the North East’s premier combined hospital, community and wellbeing provider by 2020 through:
The provision of top class community-based health and well-being facilities and
services
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A thriving District general Hospital in the centre of community services in South
Tyneside and beyond
This will ensure STFT has a strong future, building on our purpose and aims, which
are:Purpose: to provide the best care for our patients, in the best place at the right time.
Aims:
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To deliver high quality and safe services to patients
To continuously improve services
To ensure financial performance is strong
To deliver excellent partnerships for the benefits of patients
To be an excellent employer
To always listen, learn and act
‘We Choose to go further to exceed our customers’ expectations’
And more specifically:
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We Choose to go further to improve patient care
We Choose to go further to show compassion to our patients
We Choose to go further to improve patient safety
46
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We Choose to go further to look after our staff
We Choose to go further to work in partnership
Principal activities
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General surgery
Trauma and orthopaedics
Urology
ENT
Ophthalmology
Oral surgery
Plastic surgery
Accident and Emergency (A&E)
Anaesthetics
General medicine
Haematology
Clinical pharmacology
Cardiology
Gastroenterology
Neurology
Paediatrics
Geriatric medicine
Obstetrics
Gynaecology
Radiology
Chemical pathology
Diabetic Medicine
Respiratory Medicine
GI Surgery
Speech and Language Therapy
Podiatry
Sexual Health
Community Learning Disability
Home Assessment and Therapy
Home Care Support
Our clinical services are integrated throughout the Trust and managed across the
following six streams of care:
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Acute and Urgent Care
Intermediate Care
Planned Care
Women, Children and Families
End of Life and Specialist Palliative Care
Learning Disabilities, Mental Health and Substances Misuse
47
The Context
2014/15 undoubtedly saw the toughest economic conditions that the Trust has faced
since becoming a Foundation Trust. Despite this we have implemented safe staffing
levels during the year and met the recommendations of the second Francis report as
well as those of regulators and professional bodies with no additional resources.
Agency expenditure due to national shortages of medical and qualified nursing staff
has been one of the biggest pressures faced by the Trust in the year.
The temptation within such an environment is to see delivery of “business as usual”
as an achievement, however, we cannot of course stand still and whilst delivering
the day job we are of course always looking towards new developments and areas
where we can grow our service portfolio.
We operate in a more and more complicated financial and commissioning
environment in which we will continue to develop strong partnerships to address
service transformation and meet the increasing demand for health and social care,
including addressing pressures in the delivery of both emergency and planned care.
We continue to see integrated care as a major element of our future service profile,
building on the Integrated Care Services Hub to develop our plans for further
integrated care delivery across Gateshead, South Tyneside and Sunderland. This
will not only involve integrated staff teams but the provision of integrated care across
the whole spectrum of public sector services outside hospital. We see this as the
most cost effective way to deliver care services to the population we serve, working
with our principal commissioners and Local Authority partners. This will require us to
look at radical new ways of working, new models of care delivery and some new
organisational arrangements to be able to deliver these models. To support this we
will develop a whole new range of extremely important partnerships so that we can
build confidence in an integrated care model that is successful for the future.
In addition to these important future plans to integrate services, we have a number of
planned investments in both hospital and community care to ensure we meet service
demands and ensure that patient safety, quality and experience remains at the
forefront of our work. In the next year we will build on our excellent record and
publish a 5 year Quality Strategy which will incorporate a 3 year Safety Improvement
Plan.
Looking ahead we are developing our future clinical strategy based on our own
service transformation programme with our work with Health and Wellbeing Boards
and key commissioners. Within our hospital services we see a number of potential
areas for change in the years to come and in particular will focus on ensuring that we
provide locally what we can do safely and sustainably whilst looking to partners to
support our patients with specialist input where required. Broadly, however, we see
there being a requirement for an ongoing provision of a full range of emergency
medical services locally with appropriate support facilities and enhanced by world
standard diagnostic services provision. We aspire to be a leading provider of
diagnostic and rehabilitation services to support this ambition. Within our surgical
specialties we envisage the continuation of high quality planned surgery locally in
partnership with other providers, primarily our colleagues in Sunderland, whilst
48
recognising that given the very small numbers involved, it is possible that emergency
surgery may need to be provided in a centralised model for the acute phase of care
with local services for diagnostic and rehabilitation aspects of care. Equally we will
review the model for the provision of stroke services and progress the
implementation of a Care of the Elderly Strategy. This will be essential to maintain
quality standards and expertise going forward and our clinicians are working hard
with colleagues elsewhere to develop models that give our patients and our expert
staff the very best opportunity to ensure the right quality and range of services.
Within community services we are working with commissioners to agree the scope
and pattern of care to be provided moving primarily to a model based on GP clusters
and Local Authority Boroughs. We share the aim of having comprehensive and
coterminous local teams as far as possible to enable integration with social care, a
seamless patient pathway and ensure the very best continuity of care. Some of this
work has been completed in the last year and will be helpful in shaping how we go
forward in these essential elements of our service portfolio. We are a partner in the
Vanguard project in Sunderland and chair the Provider Board which directs the
delivery of the 3 major transformation programmes which form the core of the
Vanguard model.
We are always looking at opportunities to do better for our patients and in the past
year we challenged ourselves to look closely at how we deliver services every day
looking to make rapid improvements for immediate implementation wherever
possible. To do this we worked with PricewaterhouseCoopers LLP (PwC) on the
introduction of a methodology called PERFORM which we use to look at how each
suggested improvement has gone that day and to solve any problems for the next
day whilst ensuring no adverse impact on quality of care.
The Trust develops and implements policies using its Scheme of Delegation and Sub
Committee structure to review and approve the policies required to support its
strategic and operational plans including policies in relation to environmental
matters, employee issues and social, community and human rights issues where
appropriate.
With regard to our workforce there is an urgent need to fill those established
Consultant posts, which are current being covered by expensive locum agency
doctors. There may also be a need to recruit a new Medical Director this year and
cover the clinical elements of his post in Elderly Medicine.
Significant additional investment was made in 2014/15 following an assessment of
ward based nurse staffing levels. Further work in 2014/15 identified recruitment
difficulties across the North East, with all Trusts trying to recruit from a seemingly
reduced supply of trained nurses. We have embarked on a national recruitment
strategy, attempting to use our unique combination of acute and community services
to attract nurses from other parts of the country. This will be supported by our first
international recruitment campaign.
49
Financial Commentary
Introduction
The supplementary financial information for the year ended 31 March 2015, are
shown on pages 209 to 213.
Financial Performance 2014/15
After a period of tariff price reductions plus reductions in contract income as a result
of procurement activity the Trust has been faced with significant levels of cost
improvement to achieve (7% in 2014/15 amounting to £13.85m). The Annual Plan
for 2014/15 approved by the Board of Directors in March 2014 included a target
surplus of £13.8m which included income related to the transfer of St. Benedict’s
Hospice of £13.3m. The planned surplus excluding this was £0.5m (0.25% of
turnover).
In addition to this, improvements to service delivery made by the Trust in the year
have, based upon the rules within the national tariff, resulted in reductions in income.
Expenditure pressures have occurred as the Trust has implemented Safe Staffing
levels and met the implications of the Francis, Keogh, Clwyd & Hart and Berwick
recommendations as well as those of regulators and professional bodies.
One of the more significant expenditure pressures faced by the Trust in the year has
been in relation to agency spend of £5.0m due to national shortages in medical staff
in some specialties.
The new commissioning arrangements have presented the Trust with further
challenges during the year. Local Clinical Commissioning Groups face increased
pressures to reduce their spend as a result of the prospect of reduced allocations
due to changes in national strategy. The Trust and our main Commissioner will have
to review future clinical strategy and in particular address loss making Acute services
that are uneconomical to operate on a national tariff basis from a smaller district
hospital. Local Authorities have continued with their review of commissioned
services which has resulted in further services provided by the Trust being either
tendered or ceased.
A key component of the Trust’s plans to deliver its cost improvement target is the
'Choose Change -Driving Transformation Forward' programme which has led to
some very important strategic reshaping of services. Over the past three years we
have looked at all aspects of how we deliver care, at how we organise our resources
to support that care delivery and at the business systems and processes that
underpin this important work. This has led to a new way of organising our staff
teams into pathways of care supported by new working arrangements.
A significant programme of work over the last 18 months has been the development
of a strategic partnership with PricewaterhouseCoopers LLP (PwC) to further
develop our approach to efficiency. We have adopted a methodology developed by
50
PwC called PERFORM as a fundamental strand of our approach to service
transformation and efficiency on a much wider scale. Having not had the opportunity
to test this in the health arena before, this also provided PwC with an opportunity to
refine the methodology with us as we tested its implementation over a number of
areas. We have recently won the national Management Consultancies Association
(MCA) award in partnership with PwC for the impact of PERFORM in achieving
performance improvement in the public sector. The MCA is the leading body
nationally for Management Consultants and this award is a great reflection of the
partnership we have had with PwC over the last 18 months. The award is a direct
result of the leadership, effort and determination of everyone involved in our
PERFORM approach.
The Trust delivered a total of £13.3m of cost improvement schemes during 2014/15.
The deficit for the year to 31 March 2015 (including one off exceptional items) was
£3,223k, compared to a deficit of £1,926k in 2013/14. Exceptional items included
within this deficit are detailed below:
 Net restructuring costs of £671k
 A charge of £55k relating to a reduction in the value of the Trust’s buildings
 Income from donated and government granted assets £456k
The underlying position for the year with exceptional items removed is a deficit of
£2,937k compared to a planned surplus of £500k. Key reasons for this variance
include: Fees of £660k in relation to Transformation schemes ahead of delivery of
benefits in 2015/16
 Non achievement of £600k of contract income related to South Tyneside CCG
 Increased costs of medical staffing to ensure appropriate levels of cover
throughout the year mainly due to national shortages in medical staff
 Loss of contribution from services retracted in year including Minor Injuries
Units, Substance Misuse and Health and Wellness teams.
 Delays in the achievement of income generation targets and other identified
PERFORM schemes
Overall income was higher than plan in the year, excluding the St. Benedict’s
Hospice transfer, by £6.3m, largely related to the following income streams:
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Additional income for A&E Winter Resilience £1.8m
£1.8m resilience funding for specific schemes
Readmission schemes amounting to £0.6m
Income from 4 GP practices (plan assumed only South Tyneside retained)
£1.2m
 Immunisation for flu and HPV £0.5m
 Additional rental income £0.5m
51
Further details are provided in the following sections.
Statement of Comprehensive Income
The Trust is reporting a deficit of £3,223k, however, excluding the one-off
adjustments outlined above the Trust would have reported a deficit of £2,937k for the
financial year. This is the adjusted deficit used by Monitor in deriving the Trust’s
overall Continuity of Services Risk Rating for the year. Further details are provided
in the regulatory ratings section of this report.
Net restructuring costs of £671k comprised gross redundancy costs most of which
related to changes to or retraction of services in the year.
In the 2013/14 accounts the Trust’s land and buildings were mostly valued on a
Modern Equivalent Asset (MEA) basis. This means rather than their value being the
cost of replacing them like for like the value represents the cost of replacing them
with modern equivalents (e.g. replacing old red brick building with one of steel frame
construction).
In 2014/15 the Trust has valued its estate based on the land and buildings that would
be needed to provide its current services (either on the same site or an alternative
site) as opposed to delivering them from the land and buildings it currently owns.
The fundamental principle is that the hypothetical buyer for a modern equivalent
asset would purchase the least expensive site that would be suitable and appropriate
for its proposed operations. It would not compete with more valuable alternative
uses, nor would it buy a site that was larger than required to accommodate a modern
equivalent development.
A full revaluation of the Trust’s property assets was undertaken by the District Valuer
in 2014/15 on a MEA alternative site basis. The change to valuation method was
treated in the accounts as a change to accounting estimates and was therefore
transacted in the year rather than as a prior period adjustment. However, in order to
establish the impact from the change a revaluation was carried out on this basis at 1
April 2014 with a further revaluation being carried out at a prospective date of 1 April
2015, and accounted for as at 31 March 2015.
The revaluation on an alternative site basis at 1 April 2014 resulted in an overall
decrease in the value of the Trusts land and buildings from £80,818k to £43,388k.
The subsequent revaluation carried out at 1 April 2015 saw a rise of £8,265k due to
increases in building costs. Of the net impact £29,109k was transacted to the
revaluation reserve, £2,224k was an impairment to Income & Expenditure and
£2,168k was a reversal of the impairment earlier in the year.
All assets held for sale at the beginning of the year related to dwellings that were
sold during the year.
Income from donated assets was £16k and government granted assets was £440k
which mainly comprised funding towards a Health and Social Care Interface
Exchange.
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Income
Income for the period to 31 March 2015 amounted to £208,235k and can be
analysed as £194,078k from activities and £14,157k other operating income
(including the reversal of impairments of £2,168k). £155,550k (80%) of income from
activities came from Clinical Commissioning Groups (CCGs) and covers planned
and emergency care, outpatient attendances and Accident and Emergency
attendances, as well as other patient care services such as district nursing.
Other operating income includes income for education and training, research and
development and for non-clinical services provided to other NHS bodies.
Charitable income of £9k was received from South Tyneside General Charitable
Fund for an upgrade to a bathroom at Primrose Hospital and £7k was received from
the League of Friends for a bladder scanner.
Other charitable income of £326k comprised £45k from the Saunders Gill Trust
towards the funding of a Stoma Care Nurse post, £146k from the St. Benedict’s
Hospice Charity towards the costs of fundraising staff employed at the hospice,
£100k from St. Benedict’s Hospice for a contribution towards the national nondomestic rates cost in year and £36k from McMillan Cancer Support for an Acute
Oncology Nurse.
CCGs commission services on behalf of their residents from the Trust under legally
binding contracts which include planned activity levels and indicative values. Some
services, predominantly community-based, are provided under block contracts, for
which a fixed sum is payable irrespective of activity levels. Most hospital services
are provided under cost per case arrangements, with the amount payable to the
Trust based on the actual activity during the year multiplied by the national tariff or
local price for each type of activity.
Commissioning of healthcare services for South Tyneside, Gateshead and
Sunderland CCGs for 2014/15 was carried out by North of England Commissioning
Support Unit acting on behalf of each statutory body. Agreement was reached with
South Tyneside CCG and Sunderland CCG regarding the income due for 2014/15,
based on a review of contracts, cost pressures and forecasts to the end of March
2015, however, no year-end agreement was made with Gateshead CCG.
Expenditure
Operating expenses amounted to £209,063k, of which £154,163k relates to pay
(73.7%). Included within operating expenses are the one-off costs relating to the
reduction in property asset values and redundancies as identified above.
The overall reduction in cost from 2013/14 is £4,910k. The main driver of the
reduction in pay, supplies and services and property rentals relates to services
retracted in the year. Following the revaluation to an alternative site approach
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depreciation has reduced in the year by £577k, however, this has been more than
offset by impairments of property, plant and equipment of £1,282k.
The reductions in cost have been delivered having also absorbed the estimated cost
of the pay award and incremental drift in year £1,801k and increases in CNST
premiums £301k.
Financing, Cash Balances and Capital Investment
Financing and cash balances
The Trust won the tender for an Integrated Care Services Hub commissioned by
South Tyneside Council in the year. The hub is a purpose built and innovatively
designed community resource for older people in South Tyneside which will be
located on the North Eastern boundary of the existing South Tyneside District
Hospital site. The Trust applied for a £9.5m loan over a 10 year period in the year to
finance the estimated cost of the build and equipment for the hub.
The loan is being drawn down on a quarterly basis in advance of expenditure and
Trust has drawn down £3,050k at 31 March 2015. The expenditure at 31 March
2015 was £445k and the main building work commenced on site on 27 April. The
facility is due to open in the Spring of 2016.
Closing cash amounted to £16.239m, an increase of £1.33m compared to the value
of £14.909m as at 31 March 2014.
The Trust earned interest of £42k in the year from cash balances held in
Government Banking Services (GBS) Accounts, which pay interest at 0.25% below
base rate.
Capital investment
Capital investment in improvements to buildings, new medical equipment and
information technology amounted to £5,698k in the year.
Investment in Estates and Facilities of £1,868k included the commencement of the
Integrated Care Services Hub, investment in ward enhancements and improvements
to clinical departments and refurbishment of non clinical areas. A number of other
smaller schemes made up the balance of spend.
£2,471k was invested in new medical equipment in the year. The main capital
expenditure in the year was within the radiology department. This comprised the
replacement of haemodynamic equipment in the interventional radiology room and
replacement of radiology equipment that was condemned following a flood caused
by adverse weather conditions. Other equipment purchased included ventilators for
ITU, endobronchial ultrasound equipment and Theatre tables.
Investments of £1,868k in information technology supported the implementation of eprescribing, medicines management and a community electronic patient record
system in the year.
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The Trust benefits from an active voluntary sector. Asset purchases from donated
funds totalled £16k and comprised an upgrade to a bathroom at Primrose Hospital
and a bladder scanner.
Financial Outlook 2015/16
As in previous years, the national tariff for 2015/16 includes an efficiency
requirement of 3.5% and there are also reductions in contract income as a result of
procurement activity as Clinical Commissioning Groups look to reduce their spend as
they face increased pressures and the prospect in the future of reduced allocations
due to changes in national allocations.
In addition a number of services have been transferred to Local Authority
commissioning responsibilities and the economic outlook for Local Authorities
inevitably means re-procurement or potential ceasing of many of these services. In
relation to services that have gone out to tender in most cases the Trust is
competing with private companies that are not restricted by Agenda for Change
terms and conditions. This has resulted in the loss of a number of services or
retention at reduced contract value.
Health Visiting is transferring to Local Authority commissioning responsibilities from 1
October 2015 and whilst this is currently protected the economic outlook for Local
Authorities inevitably means there is a risk of re-procurement for these services in
the future.
The establishment of the Better Care Fund creates both opportunities for increased
joint planning and joint working but also represents a financial risk. Sunderland CCG
have invested in integrated and recovery at home teams moving into 2015/16 to
prevent admissions to hospital. However, no investment has been made in
community teams in South Tyneside or Gateshead.
The Trust is planning for a deficit of £5m in 2015/16. In order to achieve this the CIP
target is £12.742m. Breaking even or making a surplus would have resulted in an
increased CIP that the Board considered to be unachievable. This will inevitably
impact on cash/liquidity, our ability to invest in capital and potentially the Continuity
of Service Risk Rating.
The Board has considered a range of financial risks and reviewed mitigating actions
in order to ensure key targets are met. The Finance Risk Management Group, which
is chaired by the Chief Executive and consists of all Executive Directors, reviews the
financial risk register which addresses risks to the overall financial strategy.
Major risks throughout 2014/2015 and present into the future are:
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Failure to meet financial targets due to continuing financial pressures and
delays in delivery of cost improvements. This is actively managed throughout
the year by the Board, the Finance Risk Management Group and the
Executive Board.
55
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Commissioning changes which may lead to significant loss of service
portfolio. We have continued to work closely with Clinical Commissioning
Groups, NHS England and Local Authorities to ensure we understand and
fully meet their needs.
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Failure to meet performance and quality targets leading to regulatory action or
penalties imposed through contracts. Particular risks are present in delivering
A & E 4 hour waiting times. Monthly integrated performance reporting to the
Board and associated action plans are designed to mitigate this risk.
The Trust has implemented a major programme of change and modernisation in
recent years. The Finance Risk Management Group reviews progress on the cost
improvement programme on a monthly basis. In addition to this, to ensure that the
programme does not have an adverse impact on quality of care, we have ensured
extensive clinical involvement in schemes throughout their development and
implementation.
As noted above we have adopted a methodology developed by PwC called
'PERFORM' as a fundamental strand of our approach to service transformation and
efficiency on a much wider scale.
Essentially, PERFORM optimises what managers in the Trust do, how they do it and
provides them with the a framework that helps them and their teams act and behave
differently and become equipped with capabilities and support needed to channel
resources effectively and efficiently towards securing the Trusts vision and strategic
objectives. Work carried out to date has demonstrated that PERFORM works and
provided some confidence that it can help the Trust release between 15 – 20% of its
capacity to be used to either generate additional income or reduce operating costs.
For these reasons, PERFORM will be at the heart of our approach to driving up
performance and quality of our services during 2015/16 and beyond.
Breakdown of number of employees at year end
Table 1 details the breakdown of the number of male and female employees at the
year end.
Directors
Other senior managers
Employee
Grand Total
Male
10
9
672
691
Table 1: Number of male and female employees
56
Female
3
3
4,013
4,019
Grand
Total
13
12
4,685
4,710
Accounts preparation
The Trust’s financial statements have been prepared in accordance with the
Directions made, under paragraphs 24 and 25 of Schedule 7 to the National Health
Service Act 2006, by Monitor, the Independent Regulator of NHS Foundation Trusts,
with the approval of the Treasury.
Going concern
After making enquiries, the Directors have a reasonable expectation that the Trust
has adequate resources to continue in operational existence for the foreseeable
future. For this reason, they have continued to adopt the going concern basis in
preparing the 2014/15 accounts.
In making such enquiries, the Directors considered the following:
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the impact on liquidity from planning for a £5m deficit in the year
the size of the initial cost improvement programme of £12.742m (6.7% of
turnover) for 2015/16; and
the financial risks identified within the report on the 2015/16 revenue budgets
presented to the Board meeting on 31 March 2015.
Whilst recognising the significant financial challenges facing the Trust, the Directors
have considered the history of achievement of financial targets, the partnership
working and relationships within the local health economy, and the level of cash
balances retained.
Another consideration is in relation to the interpretation of going concern in the HM
Treasury Financial Reporting Manual in relation to public bodies. Paragraph 2.215
states:
In applying paragraphs 25 to 46 of IAS 1, preparers of financial statements should be
aware of the following interpretations of Going Concern for the public sector context:
a) For non-trading entities in the public sector, the anticipated continuation of the
provision of a service in the future, as evidenced by inclusion of financial provision
for that service in published documents, is normally sufficient evidence of going
concern. However, a trading entity needs to consider whether it is appropriate to
continue to prepare its financial statements on a going concern basis where it is
being, or is likely to be, wound up;
b) Sponsored entities whose statements of financial position show total net liabilities
should prepare their financial statements on the going concern basis unless, after
discussion with their sponsors, the going concern basis is deemed inappropriate;
and
c) Where an entity ceases to exist, it should consider whether or not its services will
continue to be provided (using the same assets, by another public sector entity) in
determining whether to use the concept of going concern in its final set of financial
statements.
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The financial statements should therefore be prepared on a going concern basis
unless management either intends to apply to the Secretary of State for the
dissolution of the NHS Foundation Trust without the transfer of the services to
another entity, or has no realistic alternative but to do so.
Based upon the above the Directors have a reasonable expectation that the Trust
has adequate resources to continue in operational existence for the foreseeable
future. For this reason they continue to adopt the going concern basis in preparing
the accounts.
Approved on Behalf of the Board of Directors
L B Lambert
Chief Executive
Date: 21 May 2015
58
DIRECTORS’ REPORT
The principal activities of the Trust are outlined in the strategic report on page 44.
Details of likely future developments at the Trust are included within the section on
the context on pages 45 and 46.
The following were directors of South Tyneside NHS Foundation Trust during the
year:
Peter Davidson
David Fleetwood
Alan Clarke
Gordon Booth
Iain Malcolm
Allison Thompson
Pat Harle
Chairman
Vice Chairman/Independent Director (until 31 March, 2015)
Senior Independent Director
Independent Director
Independent Director
Independent Director
Independent Director
Lorraine Lambert
Mike Robson
Alan Rodgers
Ian Frame
Steve Williamson
Bob Brown
Chief Executive
Executive Director of Finance and Corporate Governance
Executive Medical Director
Executive Director of Personnel and Development
Chief Operating Officer (from 9th June, 2014)
Executive Director of Nursing and Patient Safety (from 14th July,
2014)
Executive Director of Nursing and Patient Safety (until 13 th April,
2014)
Bev Atkinson
PATIENT SAFETY, QUALITY AND EXPERIENCE - ANNUAL SUMMARY OF
ACHIEVEMENTS 2014/15
INTRODUCTION
Our vision as a provider of NHS health care services is to work as an integrated
organisation to provide a comprehensive range of high quality health and care
services to meet the needs of the local population and others who choose to make
use of our services.
The aims developed by the Trust to underpin this goal and ensure the long term
delivery of safe, high quality services, and best experience for people are:
Safe Care
 A patient safety culture which is integral to our service delivery
 Demonstrable leadership for patient safety
 Systems and processes are in place to deliver safe care
Effective Treatment
 Care and treatment will be based upon the best up to date evidence available
 A range of measures to monitor the safety and effectiveness of care and
treatments.
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
Care and treatment that focuses on outcomes for patients
Quality Services
 A workforce with relevant skills and knowledge to deliver safe, high quality care
 Transformation and modernisation of services to improve safety and quality
 Excellent patient care and experience
 Continuous monitoring of safety and service improvement
BACKGROUND INFORMATION
As an integrated acute and community organisation South Tyneside NHS
Foundation Trust provides a comprehensive range of services in hospitals, clinics
and in patients own homes across South Tyneside, Gateshead and Sunderland.
Ensuring patient safety, positive patient experience and best possible outcomes for
people accessing these services is the key priority for the Trust.
As an integrated Trust, patient safety, quality and experience (SQE) reporting
systems and processes have continued to be developed in alignment with national
and regional drivers to ensure that the broader organisation remains fit for purpose.
The first report of this type was received by the Board of Directors in April 2013 and
will continue to be reported in the same vein using the Monitor Quality Framework 1
to support the narrative, and through describing progress and achievements in
patient safety, quality and experience in 2014/15. The Monitor Framework identifies
six key criteria to report against, these are:
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Leadership
Staff Engagement
Guidelines and training
Safety Metrics
The Learning Cycle
Resourcing
Compliance with National Standards
In 2014/15 South Tyneside NHS Foundation Trust has been subject to a number of
inspections in line with national requirements.
 August 2014 – Care Quality Commission (CQC): Review of health services for
Looked after Children and Safeguarding in Gateshead. This was a focused
inspection which provided a narrative outcome report reflecting the
experiences of children and young people: making recommendations for
improvement rather than giving a rating.
In 2014/15 the Trust participated in peer reviews in the following services;
 Trauma – February 2015, after which an action plan has been developed and
is underway.
1
Monitor (2010), The Board Role in Patient Safety. London
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Awards
 Winner of Chief Investigator/Study Team of the Year category for a study on
Narrow Band Imaging during Colonoscopy: awarded by National Institute for
Health Research, North East and North Cumbria Clinical Research Network.
 Named top hospital in the country for Patient Experience of Cancer Care by
Macmillan Cancer support commissioned by NHS England.
 Elder Friendly Quality Mark awarded by Royal College Psychiatrists to Ward
19, South Tyneside District Hospital. The Quality Mark was developed in
partnership with Royal College of Physicians, Royal College of Nursing and
British Geriatric Society
 Winner of Health Service Journal (HSJ) Value in Healthcare Awards in the
category Value and Improvement in Medicines Management.
 Finalist in the HSJ Value in Healthcare Awards: Value and Improvement in
Telehealth category.
 Named one of the HSJ’s “Best Places to Work” in association with NHS
Employers.
 Winner of the Patient Safety and Care Awards in category for mental healthSunderland Community and Adolescent Mental Health Service, “Fun Friends”.
Finalists: Sunderland Community Falls team and Patient Safety Team.
 Retained “Exemplar status” for providing leadership in the prevention of
thrombosis
 Shortlisted in the British Medical Association (BMJ) Berwick National Patient
Safety Awards: Patient Safety Team leadership approach.
HOW WE MEET MONITOR’S PATIENT SAFETY CRITERIA
Leadership
South Tyneside NHS Foundation Trust (STFT) has made further progress to
reinforce our commitment to organisational leadership development from what was
already a strong position in 2013/14. In 2014 our Trust was named as one of the
best places to work in the NHS in England. HSJ’s Best Places to Work, in
association with NHS Employers, is a celebration of the 100 best employers in the
health service. To compile the list, NHS staff survey findings were used to analyse
each organisation across seven core areas: leadership and planning; corporate
culture and communications; role satisfaction; work environment; relationship with
supervisor; training and development and employee engagement and satisfaction. It
is especially pleasing to achieve this acknowledgement in a time of increasing
national and local pressures, both financial and reputational, knowing that working in
the NHS has never been tougher than it is now. Locally, we have faced some difficult
challenges, as have many NHS organisations and it is therefore extremely pleasing
and reassuring that, despite those difficulties, our
staff, who demonstrate
enthusiasm, compassion and friendliness each and every day, remain positive about
us as an employer.
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In January 2014 the “Choose to Lead” leadership strategy2 was approved by the
Board of Directors and continues to be embedded across the Trust. The strategy
encompasses national leadership development approaches and principles3 aligning
these to STFT’s unique character and culture. This distinctiveness is embodied in
our approach to leadership based on the belief that leadership is not restricted to
staff in designated management or leadership roles, but where leadership
behaviours are expected from everyone in the organisation. This model can be
described as shared or distributed leadership and recognises that everyone
contributes to the organisation’s success. Mandatory training in leadership skills is
being rolled out for all staff groups, a significant undertaking, which demonstrates the
commitment of the organisation to develop its overall leadership capability and
capacity.
Making safety an explicit and visible priority in the leadership agenda
Understanding the patient safety culture in the organisation helps to improve patient
safety and outcomes as every member of staff in the Trust has a role to play in
keeping patients safe and providing highest quality care. Evidence suggests that
organisations with a positive safety culture have open communication, a shared
importance about patient safety and managing risk and staff feel supported in their
work (Health Foundation, 2011)4. In early 2015 a team cultural assessment tool was
launched to give us further intelligence on the culture of our organisation by team.
This will add depth to the intelligence we collected as part of the organisation cultural
assessment undertaken in 2013 and can be triangulated with a range of safety,
quality and experience indicators to give organisational assurance on the quality of
care we give to our patients.
“Hello my name is…” is a national campaign instigated by Dr Kate Granger a
consultant in elderly medicine in Yorkshire who has cancer herself. Dr Granger
started this campaign on Twitter, the social media platform, after she became
frustrated with the number of staff who failed to introduce themselves to her when
she was in hospital. She describes this simple courtesy as 'the first rung on the
ladder to providing compassionate care' and as the start of making a vital human
connection, helping patients to relax, and building trust. South Tyneside NHS
Foundation Trust pledged its backing in 2014 to 'Hello my name is...', as an
important strand of enhancing our positive patient safety culture, by simply reminding
staff to go back to basics and properly introduce themselves to patients. In February
2015 the Trust reaffirmed our commitment to the movement with a formal launch of
the campaign led by the Trust Chairman and Chief Executive Officer. This level of
leadership commitment is essential in signalling the importance to all staff of acting
on what we know; that the smallest things can often make the biggest difference to
how our patients and their families experience their care. Our staff have embraced
the campaign which has now gathered huge momentum right across the Trust.
2
Choose to Lead- Leadership Strategy 2014-2016. BoD 28th January 2014
The NHS Leadership Framework; the NHS Constitution; Compassion in Practice (DH,2012), Nursing, Midwifery
and Care Staff: Our Vision and Strategy
4
The Health Foundation (2011) -Research scan: Does improving safety culture affect patient outcomes?
3
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Articulate a clear crisp plan to drive the patient safety agenda
The direction of patient safety in England is now supported by a number of national
initiatives. STFT has been an early adopter of these initiatives and frequently led the
way both locally and nationally. In 2012 we were the first Trust in the North East to
publish “Open and Honest Care” information to the public with regard to care in our
hospital settings. In November 2013 we were one of only five Trusts nationally who
were able to publish “Open and Honest care” information relating to care given by
our district nursing teams and in 2014 we began to publish safe staffing information
on our website in line with national requirements. We also include an “easy read”
version of staffing information to help members of the public best understand any
staffing challenges we have had and actions we have taken to support teams to
continue to deliver safe and effective care.
In November 2014 our Executive Director of Nursing and Patient Safety submitted a
funding proposal to the North East and North Cumbria Academic Health Science
Network, to develop and lead a North East Patient Safety Collaborative to reduce the
number of pressure ulcers by 50% in areas selected for intervention.
Earlier this year STFT signed up to join the national “Sign up to Safety” campaign.
“Sign up to Safety” aims to deliver harm free care for every patient, every time,
everywhere building on the transparency initiatives known as “Open and Honest
Care”. This government initiative champions openness and honesty and supports
everyone to improve the safety of patients. The three year objective is to reduce
avoidable harm by 50% and save 6,000 lives nationally. “Sign up to Safety” contains
five key pledges which all member organisations will commit to:





Putting safety first. Commit to reduce avoidable harm in the NHS by half
and make public our locally developed goals and plans
Continually learn. Make our organisation more resilient to risks, by acting on
the feedback from patients and staff and by constantly measuring and
monitoring how safe our services are
Being honest. Be transparent with people about our progress to tackle
patient safety issues and support staff to be candid with patients and their
families if something goes wrong
Collaborating. Take a lead role in supporting local collaborative learning, so
that improvements are made across all of the local services that patients use
Being supportive. Help people understand why things go wrong and how to
put them right. Give staff the time and support to improve and celebrate
progress.
STFT already has a track record of achieving against each of these pledges. “Sign
up for Safety” provides us with an opportunity to bring together all of the work we
already do onto one plan, including external initiatives, ensuring they add value to
our work and are not “add on” or isolated projects which can potentially distract from
important on-going work.
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The Patient Safety Priorities5 developed in 2014 for 2014 to 2017 will be reviewed
and priorities that remain current will be included on the organisational plan. A Safety
Improvement Plan from April 2015 to March 2017 is now in place.
Empower the clinical leadership
The staff appreciation strategy was approved by the Board of Directors in November
20136. This is a refresh of previous similar strategies updated to take into account
the size and scope of the integrated organisation. The aim of the strategy is to
reward, recognise and show appreciation for behaviour and performance which is
complementary to Trust aims and values and to increase overall staff morale, by
highlighting the contribution and role of each staff member in the success of our
Trust. The Strategy which went live in April 2014 has proved very popular with both
frontline staff and managers who nominate their colleagues for recognition of
achievement either as individuals or as members of a team.
The Trust has been working in partnership with PricewaterhouseCoopers LLP (PwC)
throughout 2014/15 to adapt an innovative reform methodology for health care
settings: the methodology is called “PERFORM”. PERFORM is described as an
operational excellence approach that rapidly delivers results through optimising what
managers do, how they do it, and the tools they use. PERFORM drives improved
performance through:
• Highlighting operational problems before they escalate
• Increasing Managers’ time spent on coaching
• Supporting effective delegation of work
• Encouraging best practice
• Making performance visible
• Providing clarity on what is required day-to-day
• Balancing workloads between teams
Wards and teams attend a two day “boot camp” which engages staff in the tools and
techniques used by PERFORM and encourages staff to think about the vision for
their service and how they can all play a part in delivering it. Teams then enter a 10
week interactive programme, with intensive coaching to help embed the tools and
techniques while driving new ways of working. A key component of the work is the
design and implementation of an information centre from which all staff can track
team performance on a daily basis. At daily meetings, known as “huddles”, teams
review performance from the previous day and identify today’s priorities. Leadership
of the huddle changes daily and is not hierarchical encouraging leadership
behaviours from all grades of staff. Staff are taught to “problem solve” and take
ownership of ward/ team performance. Teams feel empowered to make decisions
and solve problems they would previously have escalated to their managers
Throughout 2014/15 executive leaders and senior managers have continued to
regularly meet front line staff in a variety of clinical and professional fora to share
intelligence, experiences, developments and practice. The Patient Safety Senior
5
6
Patient Safety Priorities – 2014 to 2017 .Executive Board March 2014
Staff Appreciation Strategy – BoD November 2013
64
Team continue to regularly work alongside staff in wards, teams and services to
develop the open dialogue from “board to ward”. These clinical days for senior staff
are complementary to the more formal programme of Board visits.
Staff Engagement
At South Tyneside NHS Foundation Trust our aim is to deliver care that is genuinely
focused on the needs and wishes of individual patients, on each and every occasion.
This ambition requires a culture of genuine patient engagement and an
organisational approach to patient experience which is owned and valued by each
member of staff. Every interaction or contact with our services can reveal attitudes
and behaviours that either accelerate or impede a patient centred approach to care
delivery.
The Trust recognises that we need to engage with social media as an effective way
of communicating and engaging with our staff, patients and the public. In 2014 the
STFT Twitter account was established to allow a stream of tweets from members of
the Executive team, clinicians and senior managers reporting innovations,
celebrating success, commenting on work that is underway, reporting national and
local events and news. A Trust “App” is also being developed which contains
information on Trust services and our staff. The App will facilitate the collection of
staff “friends and family” survey data to ensure we reach as many staff as possible to
enable a timely and receptive response to their views.
In 2014, we also commenced the Staff friends and family surveys on a quality basis.
70% of staff indicated they were very satisfied or satisfied with STFT as an employer
and as a provider of healthcare.
Put in place measures to increase front line staff engagement
An important factor in relaying patient feedback to staff with the purpose of engaging
them to improve safety, quality or experience is time. The ability to reflect patient
feedback onto current care delivery makes both the message to frontline staff and
the opportunity to stimulate change much more powerful and immediate. With this in
mind in 2014 the Carer and Patient Involvement Team (CAPI) piloted ‘Real Time’
Patient Feedback within acute wards and departments. The proposal was to
complete the feedback cycle from patient interviews to report within an eight hour
timeframe. A CAPI facilitator visited the pilot wards once a fortnight over a six week
period to interview patients using a series of pre-set questions. The visits were
conducted at appropriate times either in the morning or afternoon. When the
afternoon time slot was selected visitors would also have the opportunity to share
their views and participate in an interview.
The pilot was successful with the feedback cycle completed within the allocated eight
hour timeframe. The pilot has proved very popular with ward staff, findings are
shared with all staff at daily ward huddles with actions for improvement identified and
implemented immediately when possible. The real time feedback initiative is now
being rolled out to all acute wards and departments. The development of a dedicated
telephone line and email address is now underway to provide patients and their
65
relatives an opportunity to tell us about their ‘Real Time’ experiences outside of the
planned visits to the Acute Wards and Inpatient Units.
Engage junior doctors and nurses on the patient safety agenda
In 2012 Guys and St Thomas’ NHS Foundation Trust launched Barbara’s story to
raise staff awareness of what it feels like to be a patient with dementia in unfamiliar
surroundings. The story follows the journey of an older lady called Barbara through
varied stages of her care pathway. The story is narrated by Barbara’s thoughts and
feelings to help staff understand what it feels like to be in the patient’s shoes, and
aimed at helping staff to reflect on how things might appear from the patient’s
perspective. The story highlights scenarios where Barbara is shown simple acts of
kindness and consideration but also more upsetting situations where she isn’t given
sufficient attention or care and the impact these two approaches have on Barbara’s
feelings.
Thanks to funding from the Burdett Trust Barbara’s story was launched across the
South Tyneside NHS Foundation Trust in June 2014 and to date 3901 staff have
joined Barbara on her journey. Staff are asked to tell us what they would do
differently as a result of seeing Barbara and their comments have been captured on
a short video to promote our commitment to compassion in practice. In
acknowledgement of the organisations commitment to Barbara’s story the
Alzheimer’s Society have recently endorsed our programme and will recognise all
staff who have completed Barbara’s journey as “Dementia Friends”.
Maximise opportunities for team work so as to improve staff allegiance
Our staff celebrated NHS Change Day on Wednesday March 11 th 2015, with an
event showcasing some of the innovation, improvements and positive changes
which have benefited our patients over the past year.
NHS Change day was the culmination of 30 days of change which ran from 10 th
February and involved the Continuous Quality Improvement (CQI) team revisiting
some of the key changes and positive improvement stories from the past year. The
day itself provided the opportunity for us to come together, harnessing our collective
energy, creativity and ideas to make change happen. Teams from all areas of the
Trust presented over 40 of their projects to their colleagues. There was a real “buzz”
in the room as staff understood the scale of the collective achievement and the real
difference they had helped to make to the care and wellbeing of our patients and
families.
NHS Change Day was used as a platform to launch the “change agents programme”
to support leaders make positive changes to their services or patient pathways
through specific improvement projects.
Guidelines and Training
The Trust recognises that well educated, skilled and knowledgeable staff are our
most valuable resource in achieving safe standards of patient care, improved patient
outcomes and excellent patient experience.
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The Francis 2 report7 and the Cavendish review 8 which followed led to a number of
national initiatives to address apparent national failings in recruitment of the right
people into caring roles and ensure that those who are recruited are appropriately
trained and valued as members of the team.
The Trust continues to take an active role in developing systems and processes to
ensure we recruit staff with the values aligned to the “6Cs” and the “Choose” values
of the Trust. We are continually developing new ways to ensure staff remain
supported to deliver their role with opportunities for development both personally and
professionally.
Give support to clinical area leaders in their deploying of key guidelines.
The Clinical Audit Team has developed a robust in-house database to monitor Trust
compliance with all NICE guidance and to support staff in deploying key guidelines
in their areas of practice. There are systems in place to download all new guidance
and the NICE Guidance Review Group then considers whether it is relevant with
regard to the services the organisation provides. Guidance would only be
considered not relevant at this point if the service is not provided as part of our
organisational portfolio. Any guidance considered relevant is then forwarded on to
identified leads, within the appropriate specialty. In the case of uncertainty the group
will refer to the lead clinician in the relevant specialty for advice.
The clinical leads then review the guidance using a baseline assessment tool or
NICE Guidance review template within 8 weeks. This review will establish whether
the Trust is compliant or non-compliant with the guidance, identify any implications
for implementation and in cases of non-compliance prepare an action plan. Noncompliance action plans/gap analyses are reviewed by the NICE Guidance Review
Group for assessment of the potential impact on care. The group then decides on a
Red, Amber or Green (RAG) rating for reporting purposes. The Executive Director of
Nursing and Patient Safety is advised of the reasons for any deviation or deficits
from recommended practice, the detail of which should have been outlined within
the response, action plan and gap analysis.
Since April 2012, 386 pieces of guidance have been logged on the database and
have been to the NICE Guidance Review Group. Currently as a Trust we are fully
compliant with 47% of relevant guidance with a further 41% still currently under
review. 12% of reviews are still outstanding and are reported by exception at each
NICE Guidance Review Group meeting.
Action plans are monitored within the appropriate Division with any deviation from
plan exception reported to the NICE Guidance Review Group.
7
Francis R, (2013), Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, chaired by Robert
Francis QC. http://www.midstaffspublicinquiry.com/report
8
Cavendish Review (2013)- An Independent Review into Healthcare Assistants and Support Workers in the
NHS and social care settings
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Prioritise resource efforts to improve the safety of systems and
across the organisation
processes
NHS organisations are required by statute (Civil Contingencies Act 2004) to plan for,
and respond to, a wide range of incidents and emergencies that could impact on
health or patient care. These could be anything from extreme weather conditions, to
an outbreak of an infectious disease, or a major transport accident. STFT major
incident plans were thoroughly reviewed in 2013 following new arrangements for
local health emergency preparedness, response and resilience (EPRR) which were
implemented on 1 April 2013. The refreshed plan reflects both the overall changes
in the structure of the NHS and commissioned changes to patient pathways for
children and for major trauma patients.
In order to ensure that our plans are fit for purpose and that staff understand their
role in any type of major incident it is vital to test out the plans. In June 2014 we
invited Public Health England to help us test our plan using the Emergo Training
System (ETS) which is considered by the Cabinet Office to be a cost effective
substitute for a live exercise.
The all-day exercise took place on 3rd June 2014 and over 50 staff from a range of
professional backgrounds and disciplines across the Trust took part in an exercise
based on a mass casualty incident caused by a multiple train crash. The day
evaluated well as the methodology is very interactive and engaging. These events
are designed to highlight areas of good practice as well as areas for improvement.
Lessons learned at the event were fed back to staff in a “hot debrief” which was
followed up by a written report. The major incident plan is constantly refreshed to
take account of improvements from lessons learned in both exercises and live
incidents.
Give direction for a review of patient safety training
The Care Certificate was developed in response to the Francis Inquiry and following
a review of non-registered staff working in caring roles which was undertaken by
Camilla Cavendish .The purpose of the Care Certificate is to provide clear evidence
to employers, patients and people who receive care and support that the health or
social care worker delivering care has been trained and developed to a specific set
of standards and has been assessed for the skills, knowledge and behaviours to
ensure that they provide compassionate and high quality care and support. All new
care workers in England, including healthcare assistants in hospitals and staff in care
homes, and those who look after people in their own homes, will have to gain the
certificate.
Locally STFT is leading the way in providing special training for health and social
care staff to ensure they have the right qualities and skills to provide high quality,
compassionate care. South Tyneside Foundation Trust was chosen as a test site to
develop the Care Certificate and was keen to take an integrated approach to piloting
this by developing a Care Certificate Programme and Workbook working in
partnership with partners in the Social Care Sector in South Tyneside. Members of
the STFT team worked with private providers in the residential and nursing care
sector as well as those working in domiciliary care or employed to deliver direct care
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by South Tyneside Council to develop a programme. The aim of the programme is to
provide all those newly employed to deliver care in hospital, care homes or the
homes of individuals in South Tyneside with the same Care Certificate Programme,
workbook and assessment. The STFT team sought to truly consider the challenges
and good practice already in place and to understand how the Care Certificate can
work both in a small domiciliary care provider to a large nursing home, and from an
NHS Trust to Council services. The team developed a unique and integrated
innovative approach; the only site nationally to build on the diverse range of
strengths that each of our partners brings to ensure we educate, prepare and equip
our care staff with the skills to deliver high quality care. Twenty new starters from the
Trust and independent care providers in South Tyneside embarked on the Care
Certificate programme in October 2014, which the Trust is running along with
partners including Tyne and Wear Care Alliance
Safety Metrics
The development of Trust-wide safety metrics is a key tenet of the patient safety
culture and although this was successfully achieved in 2013/14 it is an area of work
under constant development.
The Classic Safety Thermometer has been a national requirement since 2012
reporting on four harms: pressure ulcer, falls, catheter associated urinary tract
infection and venous thrombosis. Thirty one clinical teams are surveyed each month
which represents approximately 1600 patients.
The Maternity Safety Thermometer data collection commenced in August 2014 with
information from Ward 22 and Delivery Suite. The maternity safety thermometer
measures harms from:






Perennial and /or abdominal trauma.
Post-partum haemorrhage
Infection
Babies with an Apgar score of less than five at seven minutes
Those admitted to a neo natal unit
Psychology safety: 4 questions related to mothers being separated from their
babies.
Twenty four patients have been surveyed so far with an average of 5 per month.
In 2013 the Trust became involved in the national pilot developing a medicines
safety thermometer collecting data in three clinical areas. The pilot stage is now
complete and there is an expectation that NHS trusts will roll this out across acute
and community services. From November 2014 in STFT there has been a planned
rollout of the initiative across a number of clinical teams with only three ward areas
now outstanding: these wards will be joining the data collection in May. Our district
nursing teams have also been recruited with the intermediate care teams next to
join. The medicines management team have developed guidance and an intranet
information page to help support teams deliver the medicines safety thermometer.
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Agree a prioritised list of key metrics for the Board to monitor
In 2013/14 the Patient Safety, Quality and Risk Group (now named Choose Safer
Care Subcommittee) received a standard report from the Patient Safety Panel bimonthly. This report is currently in the process of being updated to contain a patient
safety, quality and experience (SQE) dashboard which has been developed by the
patient safety team. The dashboard, which will cover acute bedded areas in the first
instance, contains a range of safety, quality and risk indicators which can be
weighted and RAG rated. Areas of exception will be identified objectively using the
monthly Safer Care Panel analysis of the dashboard signalling the need for a
“deeper dive” into the current intelligence and decisions on further actions to support
teams made in partnership with operational management.
Ensure that the metrics are tailored to different levels of governance
The patient safety metrics have been refined so that they can be reported and
reviewed by ward/team, clinical business unit, division or cross organisation.
Assurance Matrons triangulate safety, quality and experience indicators by ward and
team every month. This information is shared with operational teams at ward
manager, clinical operational manager and clinical business manager level. This
meeting includes discussion of soft intelligence and any developments or
improvement initiatives. This opportunity for open dialogue is valuable in deciding
appropriate interventions to support clinical teams. The Strategic Lead for Safer Care
aligned to each Division has regular discussions with the Divisional Director with
regard to any areas of concerns. The Patient Safety Panel oversees the safety
metrics from an organisational point of view and reports by exception any areas of
concern to the Choose Safer Care Subcommittee.
Check that the metrics are delivered in conjunction with the staff
In 2014 a patient safety framework known as ‘ASSURED’ was developed by the
Continuous Quality Improvement (CQI) team to support improvement and practice
development at team level. When wards and teams need support to help them
improve patient safety, quality and experience it is important to ensure that the plans
for support are making a real and measurable difference. The ASSURED framework
provides a standard approach to establish performance baselines, undertake
measurement, re-measurement and evaluation which subsequently means we can
be “re ASSURED’” that improvement is sustained. The success of this ward/team
improvement model is dependent on effective, collaborative relationships between
multi-disciplinary teams and ultimately empowers ward and team leaders to make a
real difference and to sustain positive change over time.
The ASSURED model was presented at an NHS England event to celebrate nursing
innovations in November 2014; this generated interest from other Trusts who wish to
emulate our success.
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Publish the metrics widely and transparently across the organisation
A SharePoint site has been developed which holds all the patient safety metrics
available for each ward and team. This site undergoes regular development to
ensure that triangulation of information by ward/team is as simple as possible. The
SharePoint site is available on request to all staff to support involvement,
understanding and ownership of safer care.
In accordance with the National Quality Board guide (2013) to safe staffing capacity
and capability, safer staffing data is now displayed for patients and the public in all
bedded areas of the Trust and by community teams and a monthly report tabled at
Executive Board. The information is updated daily and includes the number of staff
planned to be on duty for each shift compared to the number who are actually
available. Many wards and teams display their patient safety, quality and experience
information and over the coming months this will be rolled out to all areas in a
standard format.
Publish metrics widely and transparently
South Tyneside NHS Foundation Trust was one of only five Trusts able to publish
community safety metrics on our website in line with the national time frame; this
now sits alongside the safety metrics for in patient areas. Since May 2014 we have
published our safer staffing board reports on the public area of our website.
Alongside this we provide an easy to read summary of areas where we have had
staffing levels below expected levels with explanations of how we have supported
those wards and teams to deliver safe and effective care.
The Learning Cycle
Continuous development as a learning organisation is a key objective for the Trust
and is underpinned by the Quality, Research & Audit and Continuous Quality
Improvement Programmes.
In 2014/15 the annual plan for continuous quality improvement (CQI) was fully
delivered. The team has delivered 17 continuous improvement events and a further
46 improvement projects. The CQI team have trained 384 staff in lean methodology
and have led 37 improvement events. The CQI team facilitates practice development
to all wards and teams across the Trust. The following is one example of practice
development designed to lead to a reduction in harm to our patients as a result of
pressure ulcers. A similar piece of work has also been undertaken to reduce falls
throughout the organisation by introducing the Fallsafe Care Bundle
SSKIN is an evidence based five step care bundle for pressure ulcer prevention. The
aim of the care bundle is to identify all patients who are at risk of developing
pressure ulcers and then reliably implement prevention strategies identified by NICE
(2005). SSKIN is an aide memoir for the following five strands of care:


Surface: make sure your patients have the right support
Skin inspection: early inspection means early detection. Show patients and
carers what to look for
71



Keep your patients moving
Incontinence/ moisture: your patients need to be clean and dry
Nutrition/ hydration: help patients have the right diet and plenty of fluids
Ward 10 was chosen to ‘pilot’ documentation which underpinned the new practice for
3 months. At the end of each month staff comments and suggestions were taken into
consideration and amendments made to the document to ensure it was fit for
purpose and increased staff engagement. A communication strategy was agreed
with the Ward Manager and rolled out to staff at team meetings. The CQI team
provided guidance notes to help staff to easily understand and complete the
documentation. One of the CQI facilitators visited the ward on regular occasions to
support staff through the change process and a member of Ward 10 team was given
the opportunity to lead the launch of the documentation with their colleagues.
The documentation has changed considerably throughout the 3 month pilot
reinforcing the importance of ‘testing’ documentation in practice before proceeding to
rolling it out. The form is now fit for purpose and there are plans to launch this Trust
wide through a phased approach. Evaluation over the coming months will ascertain
the success of this initiative in reducing pressure ulcers in our patients and will align
with the regional Pressure Ulcer Reduction Collaborative.
South Tyneside NHS Foundation Trust is a member organisation of the
Northumberland Tyne and Wear Comprehensive Local Research Network (NTW
CLRN). The CLRN allocate funding to the organisation to support the approval,
management and delivery of NIHR portfolio studies. The Trust has an active portfolio
of clinical research which reflects the organisations commitment to providing high
quality patient care and embeds a culture of innovation across the organisation.
During 2014/15 the research team have recruited 350 patients into a range of
studies including 5 commercial studies: STFT are the lead site for the national
Adenoma study. The team has achieved 100% of studies approved within the 15 day
target and 83% of studies recruited the first patient within 30 days which are
excellent results reflecting the commitment of the team.
In 2014/15 the research team has also expanded the Trust research portfolio
delivering studies in areas that have not had an active research profile in the past.
These new areas include anaesthetics, critical care and cardiology.
Proactively manage risk on the basis of robust interrogation of the data.
Incident reporting is a fundamental tool of risk management, the aim of which is to
collect information relating to adverse events, including near misses, which will aid
the Trust in focusing on improvements in safety. The STFT Risk and Compliance
Team receive and monitor all electronic incident forms completed across the Trust
which are stored in the Datixweb risk management information system. All patient
safety incidents are graded, recorded and uploaded to the National Reporting and
Learning System (NRLS) through Datix web. The Customer Services Team
maintains the complaints and claims database and report on themes and trends.
As part of the Datix web process, relevant managers receive immediate notification
when an incident is reported on the system. It is the managers’ responsibility to
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investigate the incident and advise the Risk and Compliance Team if the incident
needs reassigning to another manager. Notifications are also sent to the Risk and
Compliance Team as well as any specialist role, e.g. security related incident
notifications are sent to the Security Manager, pressure ulcers notifications are sent
to the Tissue Viability Team.
Most serious clinical incidents which are identified either through Datix reporting or
management escalation are investigated by the Assurance Matrons, the only regular
exception to this is the investigation of pressure ulcers .The Tissue Viability team
have a robust process for reviewing root cause analysis and learning from clinical
incidents.
The team of Assurance Matrons ensure that all serious incidents are investigated in
an objective and standard way: investigations and the development of action plans
are conducted in collaboration with operational teams. Assurance Matrons are
responsible for ensuring that all actions are completed and lead any necessary
changes in practice to support patient safety. One example of this was the
implementation across the Trust of yellow ID bands as a visual prompt for patients
with drug allergies. This initiative followed the investigation of a serious incident in
which a patient was administered an intravenous drug for which she had a known
allergy.
In 2014/15 the assurance matrons investigated 39 serious incidents. The final
reports are submitted to the respective Clinical Commissioning Group (CCG) and
lessons learned are reported to individual wards and teams as well as in divisional
and professional fora across the organisation. Where possible the relevant
Assurance Matron attends the CCG Serious Incident Panel to discuss their findings
with commissioners.
All serious incidents are reported to the Patient Safety Panel chaired by the
Executive Director of Nursing and Patient Safety. The Patient Safety Panel agrees to
close serious incidents following all actions being completed and signed off by the
CCG. In a recent innovation the Patient Safety Panel will log all lessons learned and
will maintain an audit trail of where these lessons have been shared.
Summary of lessons / outcomes / themes from Serious Incidents 2014/15
Incident
Category
Pressure Ulcers
Lessons / Outcome / Theme
Contributory factors:
 Delay in receiving equipment
 Patients choice in not using equipment
 No photograph to use to monitor progression of
ulcer
Improvements:
 Improved documentation
 Patient information
 Integration of printer with
development
73
IT
system
in
Incident
Category
Slips, trips, falls
Lessons / Outcome / Theme
Contributory factors:
 Patients who fall are often assessed as low risk
– review of falls policy needed in light of NICE
guidance
 Patients attempting to mobilise independently to
toilet against staff advice
 Physical presentation that may lead to fainting
 Risk assessment on admission changing during
stay and in between re-assessment
 Periods of agitation / restlessness
 Staffing on nightshift
Improvements:
 Falls risk assessment documentation to be used
in maternity documentation
 Significant increase in use of falls technology
 Improvements in documentation including
assessments of risk
 Visuals introduced in clinical areas
 Toilet posters
 Supervision of patients in bathrooms
Suicide / death Contributory factors:
of a patient
 Homelessness / secure accommodation on
release from prison
 Poor engagement with services
Medication
errors
Improvements:
 Multi-agency working and communication
Contributory factors:
 Distraction / preoccupation with other duties
 Time pressures – running late
 Stock not put away when not in use (increases
risk of mixing medicines up)
 Storage of medications (Penicillin v Non
Penicillin)
 Acknowledgement and Identification of allergies
Improvements:
 Review of all Patient Group Directives
 Tidying of clinical rooms following clinical
activity
 Implementation of coloured medicine allergy
bands
 Use of Extramed system to record allergies
 Medication chart reviewed – drug allergies to
appear on each page
 Visual identity of drug allergies implemented
 Introduction of medicine round audits
 Introduction of O2 carrying brackets for oxygen
cylinders
74
Resourcing
The national focus on staffing levels has continued to increase in intensity during
2014/15 following the Keogh review which highlighted staff shortages, especially in
nursing and midwifery, as an indicator of below standard delivery of care. From June
2014 NHS Trusts have been required to report monthly staffing information, by ward
and team, publishing board papers on the Trust website. There is also a requirement
for six monthly staffing reviews using evidence based tools to be presented to a
public Board meeting every six months.
Implement a staff allocation system to match staff levels and experience to
need, proactively and flexibly.
Throughout 2014/15 there has been a continuation of the phased roll out of
eRostering, completing inpatient services and specialist departments, and rolling out
to community services. Ward /team engagement with regard to this project has
remained broadly positive and receptive which is a tribute to our staff and reflects
their engagement with major change. Work continues with teams to ensure the
production of effective rotas. Key performance indicators have been produced for
clinical operational managers to drive improvement and to encourage a more
standard approach to rota production across all teams. There has been some
detailed work undertaken to ensure that planned levels of staffing are
commensurate with budgets and that bank staff requirements are met through the
eBank module. These changes have facilitated the national requirement to report
staffing fill rates, comparing planned with actual levels on both day and night duty.
Positive benefits continue to be the transparency of staffing levels across all the
wards and teams with the opportunity for managers to sign off effective rotas while
highlighting and addressing poor practice with rota makers in a timely fashion.
Invest in sufficient levels of appropriately trained staff to deliver safe patient
care
In June 2013 the Board of Directors agreed an investment of £1.8 million in nursing
staff to meet the staffing recommendations from the acute bed base review. This
second phase of this investment was released from reserves in August 2014 to
enable the completion of the recruitment process, which continues.
Prioritise resources to ensure an appropriate supporting infrastructure and
ring fence or invest in dedicated safety resources to drive projects in order to
help frontline staff to deliver safe patient care
The Executive Director of Nursing and Patient Safety utilised the Safer Care Nursing
Tool (SCNT9) to underpin our second staffing establishment review in September
2014. This methodology is very different from that used in the Trust 2013 staffing
review which was based on bed numbers. The SCNT is an evidence based tool that
enables nurses to assess patient acuity and dependency, incorporating a staffing
9
Safer Care Nursing Tool- Implementation Resource Pack, July 2013. The Shelford Group.
75
multiplier to ensure that nursing establishments reflect patient needs. The SCNT is
also an accredited staffing toolkit in alignment with NICE guidance for Safer Staffing
in Adult Inpatient Areas.
The analysis from data collected on every patient in South Tyneside District General
and Primrose Hospitals, along with St Benedict’s Hospice during September 2014,
indicated variation in registered nurse numbers across three shifts, and disparity in
patient acuity and dependency compared with budgeted and actual establishments
across wards. A second audit cycle has recently been completed in the same wards
using the same methodology in March 2015. Analysis of this latest dataset will be
reviewed alongside the September data and reported to the Board of Directors in
June 2015 along with any recommendations that the reviews suggest.
The use of the SCNT to review our nursing establishment will be refined over future
audit cycles which will take place twice per year in September and March. A key
strand of work will be to triangulate the data collected in terms of safety, quality and
experience indicators such as patient harms, staff and patient experience and “red
flags”, to better understand what safe staffing looks like on all our wards and teams
and identify areas for new or shifting investment or a different staffing model. NHS
England has recently published further guidance, “Safer Staffing: A Guide to Care
Contact Time (November 2014),” which focuses on the “value added” work of front
line nurses and carers with a view to maximising these aspects of their work, while
providing support for others, which will help drive improvements in care through ward
led modifications in practice. Some of the examples of good practice described
within the guidance will also be important to understand and may help reshape how
ward teams deliver care.
Our Quality Priorities for 2015/16
The following list of quality improvement priorities for 2015/16 has been developed
following consultation within and outside the Trust with key stakeholders. The priority
areas reflect national and local concerns and include representation from patients
and their carers through surveys, questionnaires and complaints analysis. To gain
the contribution of the wider public we discuss priorities with local Healthwatch
organisations, and the three local authority health oversight committees, and
particularly with the public members of our Council of Governors. Staff engagement
in developing priorities continues to come through consultation across the Safety,
Quality, and Experience (SQE) Assurance Team and Operational Management and
frontline teams, as well as staff side representatives. Increasingly we benefit from
staff participation in Choose Safer Care initiatives and the continuous learning
achieved through quality improvement activities.
In South Tyneside NHS Foundation Trust we recognise that it is absolutely right to
focus on the importance of having the right organisational culture to deliver high
quality, compassionate care; engaging all staff in a creating a person-centred culture
and being open and honest with our patients and their families. Throughout 2015/16
we will continue to implement an integrated action plan that incorporates the
recommendations from national review reports (Francis, Keogh, Clwyd & Hart, and
Berwick). Through utilising the culture survey and barometer tools we will focus
improvement initiatives in areas requiring specific support and as part of an
organisation wide approach to Continuous Quality Improvement (CQI). We will build
76
capability and capacity to lead on and undertake SQE improvement work across
frontline teams in hospitals and the community. To more inclusively engage with
patients, the public and staff we will establish a Patient & Public Participation Panel,
a Lessons Learned Committee that incorporates Duty of Candour requirements and
an enhanced framework to ensure we learn at every opportunity (at individual, team
and corporately) from clinical incidents and poor experience. Building on the
established Quality Surveillance Group process with local partners we will further
work to ensure learning and improvement is cascaded across the whole health and
care system in South Tyneside and beyond.
During 2015/16 we will publish a 5 year Quality Strategy to 2020, that will incorporate
a three year Safety Improvement Plan (SIP), the key areas of which will include Safe
Staffing in hospitals and community, mortality review across the full patient pathway
with CCGs and primary care and further developing the way we utilise indicators and
quality metrics to report from teams to Board. The SQE Leadership team will utilise a
CQI framework called Transforming Care at the Bedside (TCAB) to work with teams
in a facilitative approach that incorporates development work in the following ways:
1.
2.
3.
4.
Increasing safety and reliability
Building vitality and effective team working
Developing person-centred practice, a compassionate and caring culture
Improving effectiveness and efficiency
All of the above will be underpinned by progressing the Trust ‘Choose to Lead’ value
that recognises that every member of staff is a potential leader. We are committed to
providing all our staff with the leadership skills to perform in their current role, and
prepare for their next role. We will therefore, further implement the Trust Leadership
Strategy, and an evaluation framework that will demonstrate how investment in
leadership development is creating a pool of talent to help us achieve our ambition to
be the premier combined hospital, community and well-being provider in the NorthEast by 2020.
Priority 1 – To develop and publish a three year Safety Improvement Plan (SIP) as
part of a new five year Quality Strategy. This plan and strategy builds on
our current Safety, Quality and Experience plans and a strong
foundation of improvement work. The Trust has ‘Signed Up to Safety’, a
national campaign to reduce avoidable harm by half and save 6000 lives
over the next three years. Each participating organisation is required to
publish a Safety Improvement Plan.
Priority 2 – To create and roll out a Safety, Quality, Experience (SQE) training and
development programme that will facilitate front-line teams to utilise
improvement methods in their everyday practice. Building capability and
capacity to undertake continuous quality improvement (CQI) activities is
a national priority (Berwick Report, 2013) and the SQE programme
builds on a foundation of CQI activities across the organisation.
Priority 3 – To further develop our culture of learning from experience. New
regulations such as the Duty of Candour further emphasise the
importance of open and honest reporting, learning lessons and
demonstrating accountability in assurance around actions. The Trust has
77
a robust governance structure, is transparent and engaging with staff,
patients and the public – the challenge going forward is to ensure we
learn and improve at every opportunity, every day.
Priority 4 – To provide assurance to the Board and patients that we are continually
focussed on demonstrating safe staffing levels. Safe Staffing is a
National Quality Board, NHS England and CQC priority. There is an
increasing evidence-base that demonstrates the link between the
number, skills and mix of staff and the quality of care patients receive.
We already fulfil National Quality Board and NHS England requirements
to undertake twice yearly nursing establishment review and are reporting
nurse staffing alongside other indicators of quality to Board of Directors.
Consultation, Communication and Staff Involvement
We have a number of forums and mechanisms to ensure that we provide accurate
and timely information, and consult where appropriate, on matters affecting staff.
This would include the Joint Consultative Committee (JCC), The Health and Safety
Committee, Team brief, the intranet, staff e- bulletin, roadshows and exhibitions. We
also supplement these regular forums with more bespoke ways of addressing topic
specific issues of importance using special meetings, leaflets, roadshows etc.. In
2014/15 these topics included TUPE consultation on a number of service transfers
e.g. urgent care, healthy lives/nutrition service and also the new NHS Pension
arrangements.
These same forums, particularly JCC are used to involve staff in improving quality
and efficiency, but the most direct way of doing this is through the PERFORM
methodology, an efficiency tool developed with PricewaterhouseCoopers LLP, which
is being rolled out across the Trust.
All regular communications, and the Team Brief specifically, highlight the financial
and economic factors affecting the Trust.
Disability
Our policy relating to the employment and development of people with a disability,
and action plans, are incorporated in the overall Equality Delivery System. However,
specifically for disabled employees, we continued our policy of guaranteeing an
interview to any applicant who declares themselves to have a registered disability
provided that they meet the basic person specification requirements. We also
continued our successful return to work package which assists, among others, staff
who may have become disabled whilst with us. The Trust`s Fairness at Work Group
monitors applications, training, career development and promotions to ensure all
staff are treated fairly. In the late part of 2014/15 the Trust signed up to Project
Choice which will give work experience opportunities to young people with learning
disabilities.
78
Achieving our Targets
Our Board continues to place the achievement of key targets and the monitoring of
patient services, quality and performance at the heart of its agenda.
Our performance in 2014/15 against specific key performance indicators is
summarised in Table 2:
A&E attendances, including Walk in Centres
A&E 4-Hour Standard
Cancer Indicators
 14 day target
 31 day target (1st treatment)
 31 day target (subsequent treatment –
surgery)
 31 day target (subsequent treatment – drugs)
 62 day target (2 week wait referrals)
18 Week Referral to Treatment Waiting Times
 Admitted Patients
 Non Admitted Patients
 Incomplete pathways
 Waits > 36 weeks
Hospital Acquired Infections
 MRSA
 C.Difficile
Outpatient Attendances (all types)
Emergency and Non Elective Cases
Planned Inpatients and Day Cases
District Nursing Visits
Urgent Care Team Visits
Intermediate Care Team Visits
92,520
94.46%
95.9%
100%
100%
100%
88.9%
95.6%
98.7%
95.1%
0
1 (Threshold =0)
9 (Threshold =10)
83,513
15,252
12,319
664,969
23,959
59,091
Table 2: Performance against Targets and Indicators
Our Key Partnerships
We have continued our commitment to collaborative and partnership working whilst
supporting patient choice. Major strategic reshaping and transformation of services
continues to be embedded in our work with Foundation Trust partners to deliver
clinical networks that provide safe, sustainable, cost effective services. We work
particularly closely with our Local Authority and Clinical Commissioning Group
partners in South Tyneside in the development of integrated care and in our role
within the national Pioneer bid. The development of the Integrated Care Services
Hub on the South Tyneside District Hospital site is an excellent example of the
Trusts expanding role and partnership with others. In Gateshead and Sunderland we
are working in partnership with Clinical Commissioning Group colleagues and others
to deliver Vanguard models of care as part of the 5 Year Forward View. In
Sunderland as part of this work we are leading the Out of Hospital Provider Board.
We recognise the areas in which we can be market leader and are actively working
79
with health and Local Authority partners to accelerate commissioning of those areas
to consolidate and develop our market presence.
As a provider of both hospital and community services we are uniquely placed to
make a really meaningful contribution in this area. We see the integration of
services across health and social care as a major opportunity to improve care for our
population and to put in place the foundations of long term and sustainable change.
There is no doubt that the current economic climate combined with increased
pressure across public services means that integrated working and achieving the
best we can using our collective power and responsibility will be an essential factor
for the continued delivery of high quality services. We understand this and will
continue to play our full part and indeed lead some of these initiatives.
Of course we have other extremely important areas of partnership working. One of
these is with our colleagues who commission our services both in terms of our formal
contractual relationships and in terms of service development. We spend a great
deal of time building on these foundations and ensuring that we approach service
improvement and quality with a common agenda and based on an open culture and
sharing of information for the benefit of the patients we serve. In this way we have
seen several service developments and changes to the way services are provided
based on the first-hand experience of staff delivering services and of the users who
receive them.
We also have long standing and well established partnership working arrangements
in a number of clinical networks with other local provider Foundation Trusts. The
majority of our services are now closely linked with other providers to ensure that we
each meet high standards of care, that services are safe and sustainable and that
we work collaboratively to design care pathways for the future that are fit for purpose
and provide our patients with equity of access to services provided in the best place
to meet their needs by the right expert staff to achieve the best outcome for them.
National Inpatient Survey
The Trust was one of 78 organisations that commissioned Picker Institute to
undertake the 2014 National Inpatient Survey. A total of 850 patients from the Trust
were sent a questionnaire. 831 patients were eligible for the survey, of which 323
returned a completed questionnaire, giving a response rate of 39%. This is a 4%
increase in response rate compared to the 2013 survey. A total of 60 questions were
used in both the 2012 and 2013 surveys. This increased to 86 questions in the 2014
survey.
The survey results have indicated that we maintained good performance in
comparison with the previous year in the majority of areas, but have identified areas
for improvement in the information we provide to patients who are being discharged
from hospital, delays in hospital discharge and opportunities for people to rate the
quality of their experience and care. It is however very encouraging to note that we
performed significantly better than other organisations in nineteen of the indicators
people rated. These included privacy, respect and dignity, confidence in staff, trust
and involvement in decision-making about people’s treatment and care.
80
The next steps are to develop an action plan to promote improvement where needed
and to sustain the areas of excellent practice.
Customer Services
Our Customer Services team aims to provide an efficient and user friendly service to
assist in resolving queries and concerns in a supportive and helpful way.
In 2014/15, 210 individuals brought forward concerns and Table 3 provides
comparisons of these figures for years between 2010/11 and 2014/15
Q1
Q2
Q3
Q4
Total
2014/15
52
65
35
58
210
2013/14
60
73
42
46
221
2012/13
71
71
68
71
287
2011/12
64
57
55
71
247
2010/11
72
55
60
48
235
Table 3: Number of complaints received by STFT 2010-15
During 2014/15, a total of six complainants referred their complaints to the
parliamentary and Health Services Ombudsman. Of those, five reviews have been
concluded by the Ombudsmen: four with no case to answer and one with further
actions recommended over and above those already taken by the Trust.
Financial Instruments
The Trust has minimal exposure to price risk, credit risk, liquidity risk and cash flow
risk.
Directors’ statement on audit information
As far as the Directors are aware, there is no relevant audit information of which the
auditors are unaware, and the Directors have taken all of the steps that they ought to
have taken as Directors in order to make themselves aware of any relevant audit
information and to establish that the auditors are aware of that information.
Events after the reporting date
South Tyneside NHS Foundation Trust provides specialist palliative care to the
people of Sunderland and surrounding areas from St. Benedict’s Hospice. Prior to
the transfer of Community Services to the Trust in July 2011 the service was
provided by the former Gateshead Primary Care Trust from a facility in
Monkwearmouth, Sunderland which was owned by Northumbria, Tyne & Wear
Mental Health NHS Foundation Trust. However, at the time of the transfer of
community services to the Trust a new state of the art premises was in the process
of being built at a new site in Ryhope, Sunderland which had been funded and
commissioned by the former NHS South of Tyne and Wear on behalf of the PCT.
81
Consideration was given to the transfer of the ownership of the Hospice to the Trust
at the time of the closure of the PCTs under the property transfer scheme as the
Trust was 100% occupier. However, as the Hospice was not fully commissioned and
the mechanism within the property transfer scheme for the transfer of the
Contractors guarantees was not clear it was decided to defer the transfer to the Trust
until the defects liabilities period was complete. Practical completion occurred on 31
March 2013 and the property was subsequently transferred to NHS Property
Services when the PCT was dissolved. The facility opened in June 2013 and the
Trust transferred the service from Monkwearmouth at this time.
St Benedict’s Hospice and Centre for Specialist Palliative Care includes 14 in-patient
beds, day care and lymphoedema and outpatient services, as well as a number of
community nursing teams and an education centre. The estimated cost of the build
was £12m.
As the Trust fully occupied the premises it was proposed that the freehold be
transferred to the Trust when the defects liability period on the construction ends.
The transfer was therefore expected to happen in the first quarter of 2014/15 at the
revalued amount of £13.3m. However, the transfer has subsequently been tied up
with other unrelated property transfers so that one transfer can be made rather than
several which has caused a delay. The transfer is therefore now expected to
happen toward the end of the first quarter of 2015/16 at an estimated value of
£12.657m.
Since this is a statutory transfer nil consideration is payable and stamp duty is not
liable on the transfer. The transfer would therefore be transacted in the financial
statements in 2015/16 as income from government grants. The Trust has leased the
property from NHS Property Services from occupation in June 2013.
82
ANNUAL REPORT 2014/15
Council of Governors
The Council of Governors is responsible for reflecting the interests of the members
of the Foundation Trust and partner organisations in the local health economy
ensuring that the local community is directly involved in the governance of the Trust.
The main function of the Council of Governors is to work with the Board of Directors
to ensure the Trust acts in a way that is consistent with its objectives and the
conditions under which it is licensed. The Council of Governors also works with the
Board of Directors in setting the strategic direction of the Trust. The Council of
Governors is not involved in matters of day to day management such as budget
setting, staffing issues or other operational matters.
Composition of the Council of Governors
A full copy of the constitution is available on request from the Private Office, South
Tyneside District Hospital, Harton Lane, South Shields, NE34 0PL and on the
website www.stft.nhs.uk
COUNCIL OF GOVERNORS
Chairman
Public Governors
South Tyneside
Sunderland
Gateshead
1
Total
17
Staff Governors
Clinical
Non Clinical
4
2
Total
6
Appointed Governors
Clinical Commissioning Groups
South Tyneside Local Authority
Sunderland Local Authority
Gateshead Local Authority
Voluntary organisations
Higher Education
Total
1
1
1
1
3
1
8
9
4
4
CHAIRMAN
Board of Directors)
Overall total(also Chairman of the 32
83
PUBLIC GOVERNORS
The Public Constituency consists of people over the age of 16, living within the
boundaries of South Tyneside, Sunderland and Gateshead and includes patients
and their carers, as well as the general public.
STAFF GOVERNORS
The Staff Constituency includes all staff on a substantive contract, those working for
the Trust for a period of 12 months or more, and those, although not directly
employed by the Trust, who exercise functions for the Trust.
The staff constituency is divided into 2 groups:
 Clinical staff
 Non clinical staff
APPOINTED GOVERNORS
Appointed by partner organisations as per Section 2.1 of Annex 3 (Composition of
the Council of Governors) of the Trust’s Constitution.
Elected Public Governors
Gateshead
South Tyneside
Sunderland
Clinical
Non Clinical
Maria Barrell – until December 2014
Sophie Marchal
Tom Scott
Paul Watson
Mohammed Abuzahra
Patricia Anthony
Steven Burnell
Tom Defty
Graeme Hunt
Bashir Malik
James Perry
Elaine Richards
Nigel Thomas
Isabel Common - until December 2014
Diane Kirtley
Michael McDonnell
Sidney Mill – until October 2014
Elected Staff Governors
Rob Bolton
David Henderson
Denise Horsley – until December 2014
Carolyn Taylor – from December 2014
Mark Tull
Marion Langley
Kevin McBride
84
Meetings
Attended
2/2
3/4
3/4
1/4
2/4
4/4
3/4
3/4
3/4
2/4
0/4
4/4
4/4
1/2
0/4
2/4
0/2
3/4
2/4
1/2
1/2
4/4
3/4
4/4
Appointed Governors
Gateshead Local Authority
Gateshead Voluntary Sector
Clinical Commissioning Groups
South Tyneside Local Authority
South Tyneside Voluntary Sector
Sunderland Local Authority
Sunderland Voluntary Sector
Higher Education Sector
Vacant
Robert Buckley
Stephen Clark
Vacant
Allyson Stewart
John Kelly
Mark Foster
Professor Greg Rubin
–
resigned
0/4
3/4
4/4
0/4
0/4
0/2
January 2015
Council of Governors’ responsibilities include the appointment of auditors, review of
performance of the Chairman and Non Executive Directors, contributing to the
development of strategic and operational plans and review of quality priorities and
the annual quality report. These items are discussed at public meetings and are
supported by specific governor working groups who report back to the full Council.
The Chief Executive is invited to every meeting of the Council of Governors. In
addition both Executive and Non-Executive Directors attend meetings of the
Governors as appropriate to the matters under discussion. Governors and NonExecutive Directors also participate in visiting programmes to our services and
facilities. These visits provide an excellent opportunity not only to exchange views
but to meet patients, staff and volunteers.
It also provides a vehicle for
understanding how clinical and non-clinical services function and whether they are
responding to the needs of the local population.
Both Executive and Non-Executive Directors participate in the induction and ongoing
training programme for Governors and attend members meetings arranged to
consider specific health topics.
Election details
The public and staff governors are elected by secret ballot of the membership. In
respect of appointed governors, nominations were sought from local partner
organisations, namely the Clinical Commissioning Groups, Local Authorities, the
voluntary sector and higher education.
Elections took place in December 2014 for public governors in Gateshead, South
Tyneside and Sunderland and for staff governors in the Clinical staff group.
Constituency
December 2014
Public
Gateshead
South Tyneside
Sunderland
Staff
Clinical
No of
members
No of
seats
No of
contestants
5134
1
2
2
0
3
0
21.8%
3344
2
3
12.8%
85
Election turnout %
Terms of Office
Elected governors:
3 years with further 2 terms of office if re-elected, to a maximum of 9 years.
Appointed governors:
3 years after which they are eligible for reappointment.
Analysis of membership at 31 March 2015
Membership
Analysis of current membership
Public constituency
Number of members
Eligible membership
Public members
5,508
625,569
0-16
0
115,774
17-21
60
39,117
22+
5,204
470,678
Unknown
244
Age (years):
Ethnicity:
White
5,065
599,123
Mixed
21
4,661
Asian or Asian British
100
14,385
Black or Black British
23
2,774
Other
7
2,904
Unknown
292
Socio-economic groupings*:
AB
1,050
28,862
C1
1,468
59,158
C2
1,291
44,512
DE
1,687
68,240
Male
1,855
305,271
Female
3,602
320,297
Unknown
51
Staff constituency
4,550
Gender analysis
4,550
86
*definitions
AB- Higher managerial, administrative, professional intermediate managerial, administrative,
professional
C1- Supervisory, clerical, junior managerial
C2 - Skilled manual workers
DE- Semi-skilled and unskilled manual workers, casual labourers, pensioners, unemployed
Implementation of our membership strategy
Our strategy aims to ensure that our membership reflects the local community and
the local geography, socio-economic, racial and cultural diversity. In addition, it aims
to continue to grow the membership and to see a year on year increase in
membership.
Staff recruitment
Staff members are recruited automatically when joining the Trust on a substantive
contract or after 12 months employment on a temporary contract. Information on
membership is included within the staff handbook, given to new starters, and
includes information on the option to opt out of membership, if desired.
Public recruitment
The Annual Plan set a target for public membership of 5,616 before April 2015. Our
strategy for achieving our annual target has initially focused on those methods which
have proved successful in the past, although we are always keen to explore new
ways in which we could increase our membership base. Members of the Council of
Governors assist in membership recruitment by raising awareness of membership in
their communities. Benefits of membership have also been advertised in public
areas of the Trust as well as on the website.
We aim to ensure all patients and public involvement activity is of a high quality,
consistent and co-ordinated. We do this by working closely with our governors and
our membership.
Recruitment initiatives to date have included:






Offering special ‘Members Only” events and visits, including Medicine for
Members presentations.
Ongoing recruitment by Governors
Offering tangible benefits to encourage residents to become members of the
Foundation Trust, e.g. offering to members the same discount as staff in the
Staff Restaurant and in local shops and premises
Discounts for public members with a company called Health Service
Discounts (www.healthservicediscounts.com) You can register with them and
receive regular updates on the latest discounts on things such as holidays,
electrical goods, entertainment, insurance, etc.
‘Join Us’ link added to landing page of website.
Letters sent to patients on reverse of appointment letters.
87


Attendance at local engagement events across South Tyneside, Sunderland
and Gateshead.
Targeted press coverage in all local newspapers promoting membership.
Our public membership base and the development of the role of the Governors has
provided additional opportunities for more engagement with the people of
Gateshead, South Tyneside and Sunderland. The Governors play a key role in the
forward planning process and commented on our performance in relation to the Care
Quality Commission standards against which we are measured.
Communication with Members
All new members receive a Membership pack and Membership card, which provides
information on membership and governance arrangements. They will then receive
Membership Newsletters throughout the year.
Membership recruitment remains a high priority for us and we are delighted at the
enthusiasm and willingness of staff and members of the Council of Governors and
Board of Directors to become actively involved in this important work.
We aim to continue to strive not only to increase our membership numbers but to
make membership an interesting and worthwhile process for all concerned.
Anyone interested in becoming a member of the Foundation Trust can contact the
hospital by emailing [email protected], visiting www.stft.nhs.uk and
completing the online application form or by calling the Membership Office on 0191
2024121 24hour answerphone.
88
Board of Directors
The Board of Directors sets the Trust’s strategic aims, ensures that the necessary
finance and personnel are in place to deliver these aims and reviews management
performance. The Trust is chaired by Peter Davidson. The Chief Executive is
Lorraine Lambert and the rest of the Board of Directors is comprised of:Non-Executive Directors
Mr G Booth
Transferred to the Trust on 1 July 2011 as a non-voting lay person
Independent Director
appointed from 13 July 2012 until 12 July 2015
Mr A Clarke
Independent Director
appointed from 13 July 2012 until 12 July 2015
Mr D Fleetwood
Independent Director
appointed from 1 April 2005 until 31 March 2008
re-appointed from 1 April 2008 until 31 March 2011
re-appointed from 1 April 2011 until 31 March 2014
(extended until 31 March 2015 by Council of Governors meeting held
on 23 January 2014)
Mrs P Harle
Independent Director
Appointed from 1 November 2013 until 31 October 2016
Cllr I Malcolm
Independent Director
appointed 1 November 2012 until 31 October 2014
re-appointed 1 November 2014 until 31 October 2017
Mrs A Thompson
Independent Director
appointed from 1 November 2012 until 31 October 2015
Executive Directors
Ms B Atkinson
Executive Director of Nursing and Patient Safety
Until 14 April 2014
Dr R Brown
Executive Director of Nursing and Patient Safety
Appointed 14 July 2014
Mr I H Frame
Executive Director of Personnel and Development
Mr M P Robson
Executive Director of Finance and Corporate Governance
Deputy Chief Executive
Dr A Rodgers
Executive Medical Director
Mr S Williamson
Chief Operating Officer
Appointed 9 June 2014
In accordance with good governance, more than half of the Board comprises of Non
Executive Directors who are independent in character and judgement. The Board
89
has appointed an Independent Non Executive Director, Mr David Fleetwood to be
Vice Chair, until 31 March, 2015, and Mr Alan Clarke to be the Senior Independent
Director in accordance with the provisions of the Code of Governance. The
termination of the appointment of Non Executive Directors will be by the Council of
Governors in accordance with the terms of the Constitution. The Chairman and Non
Executive Directors are appointed on a three year contract and are eligible for
reappointment for up to two further terms of office, i.e. a maximum tenure of nine
years in total.
Peter Davidson Chairman. Peter Davidson is a senior business executive and was
Senior Vice President of Marsh, an international insurance and risk management
corporation. Peter has served as a Local Authority councillor and was a member of
the local Health Authority. Peter has no other significant commitments.
Lorraine Lambert – a Chief Executive since 1993, with over 30 years NHS
experience. She has a track record in transforming organisations and change
management with a strong reputation for delivering challenging objectives in short
timescales. Lorraine has been Governor of City of Sunderland College, member of
the Common Purposes Advisory Board, Wearside Business Education Council and
National Clinical Assessment Authority and currently Chairs the North East and
Cumbria Critical Care Network and the NHS North East Equality Leadership Board.
Bev Atkinson – Executive Director Nursing and Patient Safety. Bev was a Director
from 2002, originally in Sunderland Teaching Primary Care Trust and, in 2007, she
became Director of Nursing, Allied Health Professionals (AHPs) and Clinical
Services across Gateshead, South Tyneside and Sunderland. In 2009, she became
joint Managing Director of NHS South of Tyne and Wear Community Services. Prior
to these posts, Bev was Deputy Director of Nursing, AHPs and Midwifery in
Gateshead Health NHS Foundation Trust. She started her career as a nurse and has
worked in a diverse range of services. Bev holds an MBA (Durham University), BSc
(Hons) Degree in Nursing Science, is a Practice Development teacher and is a
Certified Leader for the North East Transformation System
Gordon Booth – Non Executive Director. Gordon's full time career was in delivering
services to people, face to face. As a manager he has worked in transport,
entertainment, advertising sales and marketing, personnel and training and
development, and pensions and finance. He spent ten years at Nissan where he
learned about the value of continuous improvement in making a company truly World
class. His non-executive roles in the NHS since 2007 have included working for the
Board of South of Tyne & Wear Primary Care Trust and Chairman of Community
Health Services, South of Tyne and Wear.
Bob Brown - Bob was previously Director of Nursing and Professional Practice at
Torbay and Southern Devon Health and Care NHS Trust. Before that, he worked for
South Eastern Health and Social Care Trust in Northern Ireland, where he was an
Assistant Director of Nursing and Primary Care, with managerial and professional
responsibility for a range of services, including community hospitals, mental health
services for older people, GP Out of Hours, Minor Injury Units and nursing in the
community. He is a Trustee and Council Member of the Queen’s Nursing Institute.
90
Alan Clarke – Non Executive Director. Resident of South Tyneside all of his
professional life since moving to the region in 1977 from his home city of Liverpool.
He has had a long career in local government, working for South Tyneside and
Newcastle City Councils before becoming Assistant Chief Executive at Sunderland
City Council in 1995 and Chief Executive of Northumberland County Council in 2000.
David Fleetwood – Non Executive Director. A qualified accountant with extensive
financial experience in local government. David was until recently Head of Strategic
Change Programme at the City of Sunderland and has a particular expertise in risk
management and management of commercial activities within the public sector.
Ian Frame – Executive Director of Personnel and Development is a senior personnel
professional with strengths in organisational development and strategic planning of
human resources working at local, regional and national level. He has been adviser
to Sunderland University and an Open University Tutor.
Pat Harle – Non Executive Director. Previously a Non Executive Director with NHS
Primary Care Trusts in South of Tyne and Wear Pat has held appointed Foundation
Trust Governor positions. Pat has also held a number of national offices, including
former president of the British Association of Dental Nurses, training advisory board
chairman and deputy chairman of an examining board. Pat was awarded an MBE in
2002 and a Lifetime Achievement Award from The Probe dental publication and she
was presented with the British Dental Association’s Medal of Distinction.
Iain Malcolm – Non Executive Director. Elected Local Authority councillor since
May 1988 and currently Leader of the Authority. Iain is also Chairman of the Local
Government Commission (LGA) Urban Commission. After leaving university, Iain
commenced work with a Member of the European Parliament and in 1998, was
appointed Chief of Staff to the Leader of the European Parliamentary Labour Party.
In January 2001 Iain was appointed Chief Executive of a Public Affairs Consultancy,
Sovereign Strategy
Mike Robson – Executive Director of Finance and Corporate Governance and
Deputy Chief Executive has previous experience running a major teaching hospital.
He has a depth of financial and business expertise as well as experience of PFI
schemes. He is a Vice President of St Oswald’s Hospice.
Alan Rodgers – Medical Director and highly respected practising clinician with
general management experience at senior level. Alan is an assessor for the Royal
College of Physicians and a reviewer for the British Geriatrics Society Journal ‘Age &
Ageing’ and holds a Masters Degree in Business Administration.
Allison Thompson – Non Executive Director. Allison is a positive, agile and results
driven Executive Director with a highly successful background. She has built her
career on solid, business, commercial and marketing foundations over a 24 year
period and latterly held Executive positions as Chief Operating Officer and HR
Director. Allison has a track record of significant commercial and restructuring
success throughout her career
91
Steve Williamson - Steve has significant experience in transforming and improving
health services and a passion for providing the very best possible care and
experience to patients, families and carers using hospital and other health services.
He joined South Tyneside from University Hospital Southampton NHS Foundation
Trust, where he was Divisional Director for Trauma and Specialist Services.
Previously, he was Associate Chief Operating Officer at Portsmouth Hospitals NHS
Trust, worked in local government at Associate Director level and also led the
creation of a new government organisation, Her Majesty's Courts Service, in
Hampshire and Isle of Wight.
On obtaining Foundation Trust status the Board produced a profile of the range of
skills and experience required by the Non Executive Directors to complement the
skills of the Executive Directors to ensure an effective and functioning Board. The
Non Executive Directors are drawn from a diversity of business and public sector
backgrounds bringing a broad range of views and experience to Trust deliberations.
Through a successful appointments process we have maintained the balance and
appropriateness of the membership of the Board.
The Board has carried out a self evaluation on an annual basis since the Foundation
Trust was established in January 2005. The main purpose of this review process is
to determine whether the Board and its committees, including the Council of
Governors, are functioning effectively.
The Trust holds a Register of Interests for both Directors and Governors, which
includes company directorships where the company is likely to do business or is
possibly seeking to do business with the Trust. These are available for public
inspection upon request to the Private Office, South Tyneside District Hospital,
Harton Lane, South Shields, NE34 0PL or by visiting the website www.stft.nhs.uk
No directors have any significant interests which may conflict with their management
responsibilities.
Salary and pension entitlements
Details of the remuneration of senior employees of the Trust and the relationship
between the highest paid director and the median are provided can be found on
pages 97-99. Information on these pages has been audited.
Accounting policies for pension and other retirement benefits are set out in the notes
1.5 and 5.5 of the financial statements.
Expenses paid to governors during the reporting period were as follows:
Total number of governors in office
Number of governors receiving expenses in the reporting period
Aggregate sum of expenses paid to governors (to the nearest
£00)
92
2014/15
32
7
£300
2013/14
32
5
£130
Expenses paid to Directors during the reporting period were as follows:
2014/15
13
1
£8,000
Total number of Directors in office
Number of Directors receiving expenses in the reporting period
Aggregate sum of expenses paid to Directors (to the nearest
£00)
2013/14
13
0
£0
Bob Brown, Executive Director of Nursing and Patient Safety, received £8,000
expenses in the year in relation to relocation costs.
Attendance of Meetings of Board of Directors
Choose Safer Care Sub
Committee – (from February 2015)
Transformation Board – (until
June 2014)
Patient Safety Quality and
Risk Group – (until November 2014)
Information Strategy Group
Charitable Funds
Audit Committee
Board
Meetings
Name
Gordon Booth
Alan Clarke
Peter Davidson
David Fleetwood
Pat Harle
Iain Malcolm
Allison Thompson
7/7
7/7
7/7
7/7
6/7
5/7
4/7
4/5
5/5
5/5
5/5
2/5
-
3/3
-
5/5
-
3/3
3/3
2/3
0/1
1/1
1/1
1/1
1/1
1/1
1/1
1/1
1/1
1/1
Bev Atkinson
1/1
-
-
-
-
-
-
4/5
-
2/2
3/4
2/2
-
1/1
7/7
3/7
7/7
7/7
5/5
5/5
-
3/3
3/3
2/3
2/2
4/5
5/5
2/5
3/4
3/3
3/3
2/3
3/3
1/2
1/1
1/1
1/1
0/1
-
1/1
1/1
1/1
1/1
0/1
(until 11 April 2014)
Bob Brown
(from 14 July 2014)
Ian Frame
Lorraine Lambert
Mike Robson
Alan Rodgers
Steve Williamson
(from 9 June 2014)
Details regarding the Remuneration Committee are included within the remuneration
report on page 94.
93
Audit Committee
The Audit Committee is comprised of Non-Executive Directors and was chaired by
Mr David Fleetwood until his tenure ended on 31 March 2015. Mr Keith Tallintire has
been appointed from 1 April 2015 and now chairs the Audit Committee. Its role is to
ensure that the Trust’s financial systems and controls are working effectively and to
monitor progress and assurance. Other members of the Committee are Mr Gordon
Booth, Mr Alan Clarke, Mrs Pat Harle and Cllr. Iain Malcolm.
Significant issues considered by the Audit Committee during the year included
overseeing the review of the Trust’s Standing Financial Instructions and Scheme of
Delegation and the introduction of an e-learning package to ensure that all managers
above supervisory role receive training on essential financial planning and
management. Proposed changes to the valuation method for specialised property
were considered by the Audit Committee prior to agreement by the Finance Risk
Management Group. Risks associated with management override of controls and
fraud in revenue recognition were also considered.
External Auditor
Following a standard procurement process in the year the Council of Governors
appointed Deloitte LLP in June 2014 as the Trust’s external auditor for the three
years from the year ended 31 March 2015 to the year ended 31 March 2017 with an
option to extend the contract for up to two years.
The Audit Committee assesses the performance of external audit by reference to
performance indicators including evidence of compliance with mandatory auditing
standards and professional standards and external quality assurance by a
recognised supervisory body. In addition information on achievement of planned
audit days, the quality of audit reports and consultation / liaison with management
will also be taken in to account.
In accordance with the Trust’s policy, the Audit Committee considered the objectivity
and independence of auditors in relation to the provision of non-audit services. The
Committee were satisfied that robust arrangements were in place within the firm to
ensure independence and objectivity. There were no non-audit services fees paid to
Deloitte LLP during the year.
The total remuneration paid to Deloitte LLP in respect of audit work in 2014/15 was
£36,990 excluding VAT and comprised the following:2014/15
£
30,000
6,990
36,990
Statutory Audit
Quality Report
Total
Table 4: Breakdown of payments to Auditors.
* Fees for 2013/14 relate to PricewaterhouseCoopers LLP
94
2013/14*
£
39,950
12,000
51,950
Internal Audit
Internal Audit provide the Accounting Officer, in an economical, efficient and timely
manner, with an objective evaluation of, and opinion on the overall adequacy and
effectiveness of the Trust's framework of governance, risk management and control.
An internal audit strategy is designed by the Head of Audit to detail the work
necessary to fulfil these requirements in accordance with the trusts Standing
Financial Instructions and the NHS Internal Audit Standards. The Head of Audit
opinion is a key element of the framework of assurance to assist the Board in the
completion of its Annual Governance Statement.
An Internal Audit Charter has been agreed by the Audit Committee which states that
if the Head of Audit or the Audit Committee considers that the level of Audit
resources in anyway limit the scope of internal audit or prejudice its ability to deliver
a service consistent with the definition of internal audit they will advise the Board
accordingly. The internal audit function is carried out under contract by Sunderland
Internal Audit Services.
Charitable Funds Committee
The Charitable Funds Committee, which manages all charitable activities of the
Trust, is chaired by Mr Peter Davidson.
Appointments and Review Committee
The Appointments and Review Committee is responsible for recommending the
appointment of Non Executive Directors following open advertising and the use of
recruitment agencies where required. Membership consists of selected Governors
and is chaired by Allyson Stewart (Lead Governor).
Choose Safer Care Sub Committee
The Patient Safety, Quality and Risk Group was renamed as the Choose Safer Care
Sub Committee in the year. The Committee is chaired by Mr Gordon Booth,
Independent Director and has delegated responsibility for reviewing and monitoring
the Board Assurance Framework and the Strategic Risk Register. It is responsible
for ensuring that appropriate systems and processes are in place across the Trust
for the management of risk, ensuring high standards of care are practiced and
appropriate measures are taken to address any deficiencies or gaps in the risk
assurance and patient safety systems and processes.
Information Strategy Group
The Information Strategy Group is chaired by Mr Alan Clarke. It ensures the
appropriate information systems, applications and processes are in place across the
Trust to support the effective and efficient delivery of services. The Group has
delegated responsibility for Information Governance and approves the submission of
the Information Governance Toolkit.
95
Statement of Directors’ responsibilities
The Directors of the Trust are responsible for maintaining proper accounting records
and preparing annual financial statements which give a true and fair view, and which
have been prepared on the basis set out in the Foundation Trust Annual Reporting
Manual and in particular to observe the Accounts Direction issued by Monitor. In
preparing those financial statements, the Directors are required, so far as is
consistent with the Accounts Directions made by Monitor, to:

Select suitable accounting policies and apply them consistently

Make judgements and estimates that are reasonable and prudent

State whether applicable accounting standards have been followed, subject to
any material departures disclosed in the financial statements

Prepare the financial statements on a going concern basis unless it is
inappropriate to assume that the Trust will continue in business
The Directors are responsible for keeping proper accounting records, in such form as
Monitor, with the approval of the Treasury, directs.
The directors are also under a duty to prepare an Annual Report for each financial
year complying in form and content with the requirements of Monitor.
Compliance with the NHS Foundation Trust Code of Governance
Monitor, the Independent Regulator of NHS Foundation Trust, has issued guidance
detailing best practice for governance of NHS Foundation Trusts, entitled The NHS
Foundation Trust Code of Governance.
South Tyneside 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 sections above demonstrate how the Trust has applied the main and supporting
principles of this Code throughout 2014/15.
The Board of Directors have reviewed the provisions of the Code and confirms that
in all material aspects the Trust complies with those provisions.
96
REMUNERATION REPORT
(Unaudited Section)
Annual Statement on Remuneration
A Remuneration Committee, comprising the Chairman and all Non-Executive
Directors, has been in place since the Trust was established. The Committee
advises the Board on appropriate remuneration and terms of service for the Chief
Executive, Executive Directors and other senior members of staff.
Attendance at Meetings of Remuneration Committee
Attendance
1/1
1/1
1/1
1/1
1/1
1/1
1/1
Peter Davidson, Chair
David Fleetwood
Gordon Booth
Alan Clarke
Pat Harle
Iain Malcolm
Allison Thompson
The Remuneration Committee is advised by the Executive Director of Personnel and
Development, who is not a member of the Committee.
The remuneration of Non-Executive Directors is determined by the Council of
Governors together with allowances and other terms and conditions of service. The
Council of Governors also has an established Appointment and Review SubCommittee.
An individual staff appraisal system operates for all staff, which assesses
performance against agreed objectives and/or standards.
Comparisons with other organisations are primarily through external assessments
and benchmarking exercises.
We do not operate a performance related pay system for any staff, though the
Agenda for Change pay system incorporates gateways, where staff can only
progress if they demonstrate acceptable performance and development.
There is an Executive Salary Framework. Progression from the minimum point to
the mid-point and maximum is based on satisfactory reports of good performance
and which show 2 years consecutive high performance against Trust objectives.
The Framework also includes an Excellence Award scheme for Executive Directors,
which comprises 2 additional discretionary salary awards for exceptional
performance.
The Chief Executive is employed on a 3 year fixed term rolling contract which may
be terminated by 6 months notice by either party unless terminated prematurely, in
97
which case she will be paid the unexpired portion of her contract up to a maximum of
6 months.
The remaining Executive Directors are employed on permanent contracts which may
be terminated by 3 months’ notice by either party unless terminated prematurely.
Director’s redundancy entitlements are in line with Agenda for Change Conditions of
Service, i.e. one month’s remuneration for each full year of service up to a maximum
of 24 months.
A revised salary scale was approved by the Remuneration Committee for
implementation from 1 April, 2013, following an external independent review of
Executive salaries compared with Trusts of a similar size and complexity. The
Trust’s Executive Directors and Senior managers employed on STFT Conditions of
Service agreed to stagger the recommended increases incrementally over a four
year period. During 2014/15, it was agreed to accelerate this progression for those
Senior Managers who took additional responsibilities whilst there was a vacancy for
the Chief Operating Officer post. These increases are reflected in the movement of
remuneration bandings and have an impact on pension-related benefits.
Details of service contracts, unexpired term, notice periods for senior
managers
L B Lambert, Chief Executive
Commenced
Rolling contract
Notice/Termination
M P Robson, Executive Director of Finance and
Corporate Governance, Deputy Chief Executive
Commenced
Open Contract
Notice/Termination
Commenced
Open Contract
Notice/Termination
Commenced
Open Contract
Notice termination
Commenced
Open contract
Notice /termination
Commenced
Open Contract
Notice/Termination
Commenced
Open Contract
Notice/Termination
Commenced
Open Contract
Notice/Termination
Commenced
Open Contract
Notice/Termination
Commenced
Open Contract
Notice/Termination
Commenced
Open Contract
Notice/Termination
I H Frame, Executive Director of Personnel and
Development
A Rodgers, Medical Director
S Williamson, Chief Operating Officer
B Atkinson, Executive Director of Nursing &
Patient Safety
B Brown, Executive Director of Nursing & Patient
Safety
S Jamieson, Director Service Reform and
Corporate Services
E Criddle, Divisional Director
I Stables, Divisional Director
C Bentham, Divisional Director
98
1.10.97
10.11.14 – 9.11.17
Unexpired
portion,
max 6 months
1.06.98
3 months
25.05.98
3 months
16. 08.01
3 months
9.6.14
3 months
01.03.12
Left 13.4.14
3 months
14.7.14
3 months
21.09.09
3 months
09.02.10
3 months
01.09.12
3 months
01.09.12
3 months
Dr R Cooper, Clinical Lead
Commenced
Open Contract
Notice/Termination
Commenced
Open Contract
Notice/Termination
Commenced
Open Contract
Notice/Termination
Commenced
Open Contract
Notice/Termination
Commenced
Open Contract
Notice/Termination
Commenced
Open Contract
Notice/Termination
Commenced
Open Contract
Notice/Termination
Commenced
Open Contract
Notice/Termination
Dr L Cope, Clinical Lead
Dr C Frey, Clinical Lead
Dr A Nasser, Clinical Lead
Dr J Scott, Clinical Lead
Dr S Wahid, Clinical Lead
Dr G Okugbeni, Clinical Lead
Mr K Wynne, Clinical Lead
01.06.06
3 months
6.05.98
3 months
1.11.08
3 months
1.02.03
3 months
1.11.07
3 months
01.08.09
3 months
01.10.11
3 months
22.08.11
3 months
Senior Managers’ Remuneration Policy
As indicated in the Annual Statement of Remuneration, there is a performancerelated element to Senior Managers’ remuneration, in that incremental progression is
subject to two years high performance, as evaluated through performance appraisal.
In general, our policy is to remunerate our Senior Managers within the mid- to upperquartile of salary scales of comparator Trusts, but with the opportunity for Executive
Directors to achieve a comparable salary to the highest paid comparator, through the
Executive Excellence Award Scheme. This is not routinely used and award winners
will have demonstrated several years high performance and recent evidence of
exceptional performance.
There are no current plans to revise this policy.
99
REMUNERATION REPORT
(Audited Section)
A) Remuneration
Taxable
Benefits *
(bands of
£5000)
£000
(bands of
£5000)
£000
(bands of
£5000)
£000
(bands of
£2,500)
£000
45-50
(Total
nearest
£100)
£
Nil
Nil
Nil
15-20
Nil
Nil
Nil
10-15
10-15
10-15
10-15
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Nil
10-15
185-190
45-50
Nil
Nil
Nil
130-135
B Atkinson - Executive Director of
Nursing & Patient Safety (Leaver 14 April
2014)
RJ Brown - Executive Director of Nursing
& Patient Safety (Commenced 14 July
2014)
LH Cope - Clinical Lead
A Nasser - Clinical Lead
R Cooper - Clinical Lead
J Scott - Clinical Lead
C Frey - Clinical Lead
S Wahid - Clinical Lead
K Wynne - Clinical Lead
GI Okugbeni - Clinical Lead
S Jamieson - Director of Service Reform
and Corporate Services
E Criddle - Divisional Director
I Stables - Divisional Director
C Bentham - Divisional Director
Full Year 2013-14
Annual
Long-term
PensionOther
Performance Performance
Related
Remuneration
Related
Related
Benefits***
Bonuses**
Bonuses**
Total
Salary &
Fees
Taxable
Benefits *
(bands of
£5,000)
£000
(bands of
£5,000)
£000
(bands of
£5000)
£000
(bands of
£5000)
£000
(bands of
£5000)
£000
(bands of
£2,500)
£000
(bands of
£5,000)
£000
(bands of
£5,000)
£000
Nil
Nil
45-50
45-50
(Total
nearest
£100)
£
Nil
Nil
Nil
Nil
Nil
45-50
Nil
Nil
Nil
15-20
15-20
Nil
Nil
Nil
Nil
Nil
15-20
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Nil
10-15
10-15
10-15
10-15
5-10
10-15
10-15
10-15
10-15
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Nil
5-10
10-15
10-15
10-15
10-15
Nil
Nil
Nil
Nil
Nil
25-30
Nil
Nil
Nil
Nil
Nil
60-65
10-15
185-190
135-140
5-10
185-190
50-55
Nil
1,400
Nil
Nil
Nil
Nil
Nil
Nil
35-40
Nil
Nil
Nil
Nil
Nil
100-105
5-10
185-190
190-195
Nil
Nil
Nil
Nil
Nil
130-135
120-125
2,700
Nil
Nil
60-62.5
Nil
185-190
100-105
600
Nil
Nil
30-32.5
Nil
135-140
95-100
400
Nil
Nil
37.5-40
Nil
135-140
Nil
Nil
Nil
Nil
Nil
Nil
Nil
110-115
4,100
Nil
Nil
80-82.5
Nil
195-200
85-90
500
Nil
Nil
117.5-120
Nil
205-210
Nil
Nil
Nil
Nil
Nil
Nil
Nil
0-5
Nil
Nil
Nil
Nil
Nil
0-5
100-105
6,900
Nil
Nil
Nil
Nil
110-115
70-75
5-10
5-10
Nil
5-10
5-10
5-10
5-10
5-10
Nil
Nil
Nil
Nil
3,000
Nil
Nil
Nil
4,100
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Nil
35-40
10-15
35-40
35-40
10-15
20-25
35-40
15-20
12.5-15
Nil
7.5-10
0-2.5
2.5-5
17.5-20
15-17.5
Nil
2.5-5
Nil
140-145
140-145
155-160
165-170
125-130
130-135
210-215
135-140
85-90
180-185
170-175
190-195
210-215
165-170
175-180
250-255
165-170
Nil
5-10
5-10
Nil
5-10
5-10
5-10
5-10
5-10
Nil
Nil
Nil
Nil
800
Nil
Nil
Nil
3,400
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Nil
35-40
10-15
35-40
35-40
5-10
20-25
35-40
15-20
Nil
10-12.5
57.5-60
90-92.5
0-2.5
12.5-15
40-42.5
2.5-5
47.5-50
Nil
130-135
140-145
140-145
160-165
120-125
120-125
195-200
140-145
Nil
185-190
220-225
265-270
200-205
155-160
190-195
240-245
215-220
90-95
90-95
95-100
85-90
5,200
1,800
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Nil
117.5-120
20-22.5
97.5-100
60-62.5
Nil
Nil
Nil
Nil
215-220
115-120
195-200
145-150
80-85
85-90
85-90
75-80
5,500
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Nil
55-57.5
65-67.5
57.5-60
107.5-110
Nil
Nil
Nil
Nil
140-145
150-155
145-150
185-190
Name and Title
P Davidson - Chairman
WD Fleetwood - Vice Chairman (leaver
31 March 2015)
A Brewster -Non Executive Director
(leaver 31 Oct 2013)
GL Booth - Non Executive Director
A Clarke - Non Executive Director
I Malcolm - Non Executive Director
AM Thompson - Non Executive Director
P Harle - Non Executive Director
(commenced 1 Nov 2013)
LB Lambert - Chief Executive
A Rodgers - Medical Director
MP Robson - Executive Director of
Finance and Corporate Governance
IH Frame - Executive Director of
Personnel & Development
H Ray - Chief Operating Officer (leaver 30
March 2014)
SM Williamson - Chief Operating Officer
(Commenced 9 June 2014)
Full Year 2014-15
Annual
Long-term
PensionOther
Performance Performance
Related
Remuneration
Related
Related
Benefits***
Bonuses**
Bonuses**
Salary &
Fees
100
Total
B) Pension Benefits
Name and title
Real Increase in
Pension at
Normal Pension
Age
Real Increase in
Lump Sum at
Normal Pension
Age
L B Lambert - Chief Executive
A Rodgers - Medical Director
M P Robson - Executive Director of Finance and Corporate Governance
(bands of £2500)
£000
Nil
Nil
Nil
(bands of £2500)
£000
Nil
Nil
Nil
(bands of £5000)
£000
Nil
Nil
Nil
(bands of £5000)
£000
Nil
Nil
Nil
(Nearest £1000)
£000
Nil
Nil
1,344
(Nearest £1000)
£000
Nil
Nil
Nil
(Nearest £1000)
£000
Nil
Nil
Nil
Nil
Nil
Nil
0-2.5
5-7.5
5-7.5
Nil
45-50
50-55
145-150
Nil
941
411
71
62
1,037
499
Nil
Nil
0-2.5
Nil
0-5
Nil
Nil
10
14
Nil
Nil
Nil
0-2.5
0-2.5
0-2.5
0-2.5
0-2.5
0-2.5
0-2.5
5-7.5
2.5-5
0-2.5
2.5-5
Nil
Nil
2.5-5
2.5-5
2.5-5
2.5-5
2.5-5
0-2.5
2.5-5
15-17.5
7.5-10
2.5-5
12.5-15
45-50
Nil
35-40
40-45
35-40
10-15
30-35
55-60
20-25
35-40
25-30
35-40
40-45
145-150
Nil
110-115
125-130
110-115
30-35
90-95
175-180
70-75
110-115
85-90
115-120
125-130
998
1,511
620
628
533
153
413
1,247
461
613
423
768
753
Nil
Nil
39
32
32
26
34
45
33
131
70
54
124
Nil
Nil
676
677
579
183
458
1,326
507
761
504
843
897
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Nil
I H Frame - Executive Director of Personnel and Development
SM Williamson - Chief Operating Officer (Commenced 9 June 2014)
RJ Brown - Executive Director of Nursing and Patient Safety (Commenced 14
July 2014)
B Atkinson - Executive Director of Nursing and Patient Safety (Leaver 14 April
2014)
LH Cope - Clinical Lead
A Nasser - Clinical Lead
R Cooper - Clinical Lead
J Scott - Clinical Lead
C Frey - Clinical Lead
S Wahid - Clinical Lead
K Wynne - Clinical Lead
G Okugbeni - Clinical Lead
S Jamieson - Director of Service Reform and Corporate Services
C Bentham - Divisional Director
E Criddle - Divisional Director
I Stables - Divisional Director
Total Accrued
Lump Sum at
Cash Equivalent Real Increase in Cash Equivalent
Pension at Normal Normal Pension Age Transfer Value at Cash Equivalent Transfer Value at
Pension Age as at related to accrued
1st April 2014
Transfer Value
31 March 2015
31st March 2015
pension as at 31st
2014-15
March 2015
Employer's
contribution to
stakeholder
pension
As Non Executive members do not receive pensionable remuneration, there are no entries in respect of pensions for Non Executive members.
A Cash Equivalent Transfer Value (CETV) is the actuarially assessed capitalised 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 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.
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.
101
Pay multiples (information in this section is audited)
Reporting bodies 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 banded remuneration of the highest-paid director in South Tyneside NHS
Foundation Trust in the financial year 2014/15 was £185k - £190k (£2013/14, £190k
– 195k). This was 6.63 times (2013/14, 6.98 times) the median remuneration of the
workforce, which was £28,181 (2013/14, £27,899).
In 2014/15, one (2013/14, two) employees received remuneration in excess of the
highest-paid director. Remuneration ranged from £5k to £190k (2013/14 £5k to
£227k)
Total remuneration includes salary, non-consolidated performance-related pay,
benefits in kind as well as severance payments. It does not include employers’
national insurance contributions, employers’ pension contributions and the cash
equivalent transfer value of pensions.
The main reason for the marginal change in the multiple (a reduction of c.0.44%) is
that median remuneration has increased slightly whilst the banded remuneration of
the highest paid director has remained unchanged.
In 2014/15 there was a flat rate pay award of 1% to all staff at the top of their band.
Staff that were due an increment only received the increment without inflation, which
will have increased overall remuneration levels. These factors contribute to the
marginal increase in median remuneration.
102
High paid off-payroll arrangements
The Trust has issued guidance to all staff to ensure that payments are not made
gross to any individuals who should be classed as employees. This note provides
details of the criteria used by HMRC to determine employment status. Any proposal
to make gross payments to an individual, on the basis of self-employment, must be
assessed against this checklist and then submitted to the Executive Director of
Finance and Corporate Governance and Executive Director of Personnel and
Development for approval before reaching any agreement with an individual. As a
result of this process there were no high off-payroll arrangements made directly by
the Trust.
The Trust implemented the use of STAFFflow in January 2013 with
PricewaterhouseCoopers LLP and Liaison. Liaison administer the recruitment
through agencies of temporary medical staff and process a payroll on behalf of the
Trust to make payments to them, making the necessary checks as required. Prior to
STAFFflow these staff would have been sought direct from agencies. National
shortages in medical staff have resulted in difficulties recruiting in the year which has
led to temporary staff being required for longer periods of time. There were 4
temporary medical staff that were paid through a Personal Service Company for
more than 6 months of the year. Details are included in the tables below.
For all off-payroll engagements as of 31 Mar 2015, for more than £220 per day
and that last for longer than six months
No. of existing engagements as of 31 Mar 2015
4
Of which:
Number that have existed for less than one year at the time of reporting
2
Number that have existed for between one and two years at the time of
2
reporting
Confirmation:
The Trust confirms that all existing off-payroll engagements, outlined above, have
at some point been subject to a risk based assessment as to whether assurance is
required that the individual is paying the right amount of tax and, where necessary,
that assurance has been sought.
For all new off-payroll engagements, or those that reached six months in
duration, between 1 Apr 2014 and 31 Mar 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
2
between 1 Apr 2014 and 31 Mar 2015
Number of the above which include contractual clauses giving the Trust the
right to request assurance in relation to income tax and national insurance
2
obligations
Number for whom assurance has been requested
2
Of which:
Number for whom assurance has been received
2
103
For any off-payroll engagements of board members, and/or senior officials
with significant financial responsibility, between 1 Apr 2014 and 31 Mar 2015
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". This figure includes
both off-payroll and on-payroll engagements.
LB Lambert
Chief Executive
Date: 21 May 2015
104
0
25
REGULATORY RATINGS
Overview
Since 1 April 2013 all NHS Foundation Trusts need a licence from Monitor, the
sector regulator for health services in England, stipulating specific conditions that
they must meet to operate. Key conditions among these are financial sustainability
and governance requirements.
The Risk Assessment Framework sets out the approach taken to oversee NHS
Foundation Trusts with the governance and continuity of services requirements of
their provider licence.
The aim of a Monitor assessment under the Risk Assessment Framework is to show
when there is:

a significant risk to the financial sustainability of a provider of key NHS
services which endangers the continuity of those services; and/or

poor governance at an NHS Foundation Trust.
These are assessed separately using new types of risk categories, each NHS
Foundation Trust will therefore be assigned two ratings.
The role of ratings is to indicate when there is a cause for concern at a provider, but
it is important to note that they will not automatically indicate a breach of its licence
or trigger regulatory action. Rather, they prompt Monitor to consider where a more
detailed investigation may be necessary to establish the scale and scope of any risk.
The continuity of services risk rating
The continuity of services risk rating states Monitor’s view of the risk facing a
provider of key NHS services. There are four rating categories ranging from 1, which
represents the most serious risk, to 4, representing the least risk. A low rating does
not necessarily represent a breach of the provider’s licence, it reflects the degree of
financial concern Monitor have about the provider and consequently the frequency
with which they will monitor it.
NHS Foundation Trust governance
NHS Foundation Trust condition 4 of the licence sets out the overall standards
Monitor set for different aspects of NHS Foundation Trust governance. Where there
is evidence that an NHS Foundation Trust may be failing to meet the requirements of
the condition, Monitor is likely to investigate whether a breach of the governance
condition may have occurred or is likely to occur and, if so, consider whether to take
regulatory action.
Monitor will primarily use a governance rating, incorporating information across a
number of areas. The following information will be considered regarding the Trust
and whether it is indicative of a potential breach of the governance condition:
105





performance against selected national access and outcomes standards
including A&E waiting times, referral to treatment targets and rates of
C.Difficile infection
outcomes of CQC inspections and assessments relating to the quality of care
provided
relevant information from third parties
a selection of information chosen to reflect organisational health at the
organisation
the degree of risk to continuity of services and other aspects of risk relating to
financial governance and
Monitor will use the information gathered under the five categories outlined above to
assess the strength of governance at an NHS Foundation Trust.
Monitor recommends that NHS Foundation Trusts carry out periodic in-depth and
independent reviews of their governance, ideally every three years. The primary
purpose of these reviews is to ensure a consistently effective level of governance
assurance. Where reviews identify material governance concerns, Monitor will
consider the Trust’s response to the review and what, if any, steps on are
appropriate.
The governance rating
There are three categories to the governance rating applicable to all NHS
Foundation Trusts as follows:

Green - no governance concern is evident or Monitor is not currently
undertaking a formal investigation

Where Monitor identify potential material causes for concern with the Trust’s
governance in one or more of the categories (requiring further information or
formal investigation), the Trust’s green rating will be replaced with ‘under
review’ and a description of the issue; or

Red rating if regulatory action is taken
Where a Trust breaches given targets, or certify breaches, Monitor will use the sum
of each metric’s weighting to calculate a service performance score. Where this
score is 4.0 or greater, this will represent a governance concern.
There are additional rules regarding application of the rating where the Trust
exceeds its C.Difficile target for the year and is above the de minimus limit set by
Monitor, where the Trust fails to meet the A&E target twice in any 2 quarters over a
12 month period or where there are 3 consecutive breaches of the same target in
successive quarters for cancer waiting times and Referral to Treatment waiting
times.
2014/15 performance
Table 5 compares the planned and actual performance of the Trust, as assessed by
Monitor, against these ratios for 2013/14 and 2014/15.
106
Risk rating
Annual
plan
2014/15
Q1
2014/15
Under the Risk Assessment Framework
Continuity of services
4
3
risk rating (COSRR)
Governance rating
Green
Green
Annual
plan
2013/14
Q1
2013/14
Under the Compliance Framework
Financial risk rating
3
2
(FRR)
Governance risk
Green
Amberrating
Red
Under the Risk Assessment Framework
Continuity of services
risk rating (COSRR)
Governance rating
Q2
2014/15
Q3
2014/15
Q4
2014/15
3
3
3
Green
Green
Q2
2013/14
Q3
2013/14
Green
(Draft)
Q4
2013/14
4
4
Green
Green
2
AmberRed
Table 5: Comparison of planned and actual performance of the Trust 2014/15 against 2013/14.
Note: the Q4 rating for 2014/15 is the Trust’s own assessment as the Monitor ratings had not been issued at the time of
submission of this report.
The continuity of services risk rating system used by Monitor allows adjustments for
one-off exceptional costs and income in some of the calculations. This is to enable
comparisons between organisations and financial periods to be made on a
consistent basis. The draft continuity of services risk rating for Q4 is therefore
calculated following adjustments for the impact of property asset impairments and
restructuring costs identified above.
Regulatory action
2013/14
The actual rating for the first quarter was 2 and the Trust was required to submit
monthly financial monitoring reports to Monitor from July 2013. The Trust reported
an unplanned FRR of 2 at quarter 2, which triggered consideration by Monitor for
further regulatory action. However, the shadow continuity of services rating for the
quarter under the new Risk Assessment Framework due to be implemented on
1 October 2013 was 4. Monitor decided not to open an investigation into whether
the Trust could be in breach of its licence at this stage, the Trust’s governance rating
was reflected as Green and the Trust was returned to quarterly monitoring.
As noted above, the new continuity of services risk rating (COSRR) is calculated
differently to the FRR. Whereas the FRR was intended to identify breaches of
Trusts’ terms of authorisation on financial grounds, the COSRR will identify the level
107
of risk to the on-going availability of key services. The COSRR is based upon two
metrics that are equally weighted as follows:

Liquidity: days of operating costs held in cash or cash equivalent forms,
including wholly committed lines of credit available for drawdown

Capital Servicing Capacity: the degree to which the organisation’s
generated income covers its financing obligations
As large cash balances were held during the year the change in calculation of the
rating has been of benefit to the Trust.
The Trust reported a continuity of services risk rating of 4 in the final two quarters of
the year.
2014/15
The Trust has retained a liquidity rating of 4 throughout the year due to large cash
balances. However, as a result of the deficit in the year, the capital servicing
capacity rating was 1 for the first 3 quarters and 2 at quarter 4. As the metrics are
equally weighted this gave the Trust a COSRR of 3 throughout the year compared
with the plan which was 4.
The Risk Assessment Framework was updated in March 2015 and under the new
framework if a Trust has an overall rating of 3 but either its liquidity or its capital
service capacity is rated 1, then they may subsequently investigate whether it is in
breach of the continuity of services licence conditions, or requires enhanced
monitoring.
As a result of exceptional winter emergency pressures experienced across all of the
NHS the Trust breached the A&E target in Q3 and Q4 of 2014/15. As noted above,
consecutive breaches in two quarters represents a governance concern. Monitor
and NHS England have met with South Tyneside System Resilience Group
members to understand the pressures over the winter period and the SRG’s plan to
support improvement. The governance rating for Q4 as a result of this concern is
still to be confirmed.
108
STAFF SURVEY
An annual staff survey is carried out nationally when, during October each year, all
staff are requested to complete a questionnaire from which a random sample of 800
is used to assess the results.
The survey covers 29 different factors such as job satisfaction, job safety and
training. The results are published each February and allow comparisons of
progress both within the Trust and with other Trusts.
Improvements since 2013/14
The overall survey results continued to be largely positive. Of the 29 factors, we
were reported as being in the best 20% of all Trusts for 12 of them.
Even our weaker areas were very close to the national average and in some cases
better than the national average.
Table 6 shows our top and bottom 4 ranked key indicators and how they compare
with 2013/14.
Future priorities and targets
Though very pleased with the results, we are in no way complacent and an action
plan has been agreed where we will focus on the five areas which we feel will make
the most significant difference to staff satisfaction. These are: stress prevention;
bullying and harassment; appraisal; mandatory training; and being clear about the
future direction of the Trust.
COMPARISONS AGAINST KEY INDICATORS 2013/14 AND 2014/15
2013/14
Trust
Response rate
35%
National
Average
49%
2014/15
Trust
44%
2013/14
Top 4 Ranking Scores
Staff
witnessing
harmful errors
National
Average
42%
Trust Improvement/
deterioration
Improvement of 9%
2014/15
Trust
National
Average
Trust
National
Average
18%
33%
20%
34%
Improvement of 2%
6%
15%
7%
14%
Deterioration of 1%
60%
70%
61%
71%
Deterioration of 1%
22%
29%
21%
29%
potentially
Staff
experiencing
physical
violence from public/patients
Staff working additional hours
Staff experiencing bullying or
abuse from patients/public
Improvement of 2%
109
Trust Improvement/
Deterioration
2013/14
Trust
National
Average
2014/15
Trust
89%
90%
87%
90%
Deterioration of 2%
Score for staff feeling motivated
at work
3.81
3.86
3.79
3.86
Deterioration of 0.2
Staff feeling able to contribute
towards improvements at work
69%
68%
66%
68%
Deterioration of 3%
Staff agreeing that their role
makes a difference to patients
92%
91%
90%
91%
Deterioration of 2%
Bottom 4 Ranking Scores
Staff reporting errors
National
Average
LISTENING TO WHAT PEOPLE THINK OF US
Communication with our staff
Our established methods of communicating with staff, and involving them in decision
making, include team briefing, Board visits, the open Annual General Meeting
roadshow, information boards, the monthly staff e-bulletin, the intranet and
Communication Zones.
We consult on a six-weekly basis with staff side organisations through the Joint
Consultative Committee, and the Negotiation Committee, the policy sub-group and
the quarterly Health and Safety Committee.
All of our communication and consultations forums have included regular information
on financial performance and other key Trust targets in 2014/15.
Consultations
In terms of staff consultation there were a number of contractual movements
requiring TUPE and other consultation discussions. These included discussion
around contracts involving staff working in the Sunderland Urgent Care Centre,
Health Trainers/Nutritional & Obesity Services
110
DISCLOSURES
INCOME
The Trust’s income from the provision of goods and services for the purposes of the
health service in England (“principal purpose income”) is 93% of total income, and is,
therefore, greater than its income from the provision of goods and services for any
other purposes (“non-principal purpose income”).
Non-principal purpose income (7% of total income) mainly relates to research and
development, education and training of medical and nursing staff, non-clinical
services provided to other NHS bodies, rental income, profit on disposal of property,
plant and equipment, reversal of impairments and income from services such as car
parking and catering which provide a contribution towards the provision of goods and
services for the purposes of the health service in England.
Equality & Diversity
South Tyneside NHS Foundation Trust is committed, and as a public sector
organisation statutorily required to ensure that equality, diversity and Human Rights
are embedded into all our functions and activities within the organisation.
In undertaking our functions we must have due regard to the need to:



eliminate unlawful discrimination, harassment and victimisation and any other
conduct prohibited by the Act;
advance equality of opportunity between people who share a protected
characteristic and people who do not share it;
and foster good relations between people who share a protected
characteristic and people who do not share it.
The Trust’s Equality Strategy details how we will meet these requirements by
reference to Equality Data for those people within the communities that we serve and
for our workforce.
Our Equality Objectives have been set based on the best available evidence at the
time when we completed our analysis. We do however recognise that there has not
always been good evidence available across all protected characteristics to inform
these objectives. Much of the work over the coming months/years will be on
improving the quality and quantity of the available monitoring data on staff and
service users and engaging with groups of staff and service users where monitoring
data will not be collected.
The Equality Delivery System (EDS) (Updated to EDS2)
The EDS is designed to support us to deliver better outcomes for patients and
communities and better environments for staff, which are personal, fair and
diverse. The EDS is all about making differences to healthy living and working lives.
111
At the heart of EDS is a set of agreed goals. These are:
Goal 1 – Better health outcomes for all
Goal 2 – Improved patient access and experience
Goal 3 – A representative and supported workforce
Goal 4 – Inclusive leadership
The EDS has formed part of the evidence that has helped us set our Equality
Objectives. We have also consulted with patients, carers, local interest groups as
well as Trade Union representatives and staff. We have agreed, for South Tyneside
NHS Foundation Trust, 2 Equality Objectives:
Equality Objective 1:Equality Objective2:-
Zero tolerance approach to bullying and
harassment in the workplace
Distributed leadership accountability for equality,
diversity and human rights within South Tyneside
NHS Foundation Trust
Priorities and Targets going forward
We aim to have undertaken and published a further four full Impact Assessments on
services, including full consultation with representatives from minority groups. We
also aim to have completed an evaluation of how effective our actions have been to
improve acute care for people with learning disabilities.
The following table details the age, ethnicity and gender mixes of our staff and our
membership:Staff
2013/14
%
Staff
2014/15
%
Membership
2013/14
%
Membership
2014/15
%
0-16
17-21
22+
0
68
4879
0
1.37
98.63
1
79
4630
0.02
1.68
98.30
2
147
5118
0.03
2.66
92.78
0
60
5,204
0
1.09
94.48
White
Mixed
Asian or Asian
British
Black or Black
British
Other
Gender
Male
Female
Transgender
Recorded
disability
4544
27
78
91.85 4317
0.55 25
1.58 81
91.66
0.53
1.72
5078
21
102
92.05
0.38
1.84
5,065
21
100
91.95
0.38
1.81
32
0.65
31
0.66
21
0.38
23
0.41
266
5.38
256
5.44
7
0.12
7
0.12
737
4310
0
98
14.90
85.10
0
1.98
14.67
83.33
0
2.03
1863
3604
0
1221
33.77
65.33
0
22.13
1,855
3,602
0
1201
33.67
65.39
0
21.80
Age
Ethnicity
691
4019
0
89
Table 7: age, ethnicity and gender mixes of our staff and our membership
112
Health and Safety Report 2014/15
Workplace Safety and Health for everyone
The Health, Safety and Wellbeing Department has continued its certification to the
internationally recognised BS OHSAS 18001 standard for our internal Occupational
Health and Safety Management System. We are in our second 3 year cycle for
certification with 6 monthly audits to ensure compliance.
The Health and Safety Team has recently been externally audited by Sunderland
Internal Audit Services on Standard A of the Workplace Health and Safety Standards
document from the NHS Health, Safety and Wellbeing Partnership Group, which was
revised in July 2013. The Health and Safety Team has also successfully achieved
compliance with CHAS (the Contractors Health and Safety Assessment Scheme) for
the Trust which is an on-going annual assessment of Health and Safety Compliance.
The Health and Safety Committee meets on a quarterly basis and successfully
provides a decision making forum for all Health and Safety issues, providing Board
Assurance, and incorporates reports from other specialist Teams within the Trust
including Security, Wellbeing, Environmental Management, Fire Safety, Estates and
Facilities.
There have been 19 incidents reported to the Health and Safety Executive over the
last year under RIDDOR (Reporting of Injuries, Diseases and Dangerous
Occurrences Regulations 1995), an increase of 8 reports from the previous financial
year. There have been no enforcement notices served on the Trust over 2014/15 by
the Health and Safety Executive, the Enforcement Authority for the Trust.
Of the 322 Health and Safety related incidents reported through DatixWeb over 90%
were rated no or minimal harm. Analysis of the incidents showed no significant ongoing trends apart from Slips, Trips and Falls which is a priority topic for the Trust.
The Health and Safety Team are continuously providing Managers with support,
guidance and advice for Health and Safety related issues.
183 Workplace Assessments have been carried out by the Health, Safety &
Wellbeing Teams since 1 April 2014 following self-referrals and referrals from
Managers. The reports and associated action plans benefitting teams and individuals
by identifying actions required to improve the working environment and workplace.
The Health Safety and Wellbeing Team has successfully carried out an
Organisational Stress Assessment actively supporting on-going events using the
European Health and Safety Week in October to further raise awareness of specific
and related issues.
Sustainability & Climate Change
Climate change is now recognised as one of the greatest threats facing the world
today and can be seen as one of the greatest societal challenges as global
communities join together to reduce its effects in the social, economic and
environmental arena.
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An NHS Foundation Trust must reduce emissions of greenhouse gases and manage
the impacts of climate change and we recognise our role in reducing carbon dioxide
emissions and the benefits of doing so.
We participate fully in the Carbon Reduction Commitment Energy Efficiency Scheme
and work with partners to identify evidence and reduce our emissions.
The NHS Carbon Reduction Strategy requires that by 2015 the NHS as a whole will
have reduced carbon emissions by 10% from a 2007 baseline. Targets set by the
Climate Change Act for future years are a 34% reduction by 2020, a 64% reduction
by 2030 and 80% reduction by 2050, all from a 1990 base line.
We recognise that our organisation needs to be a visible and effective public sector
contributor to sustainable development in general, and carbon reduction in particular.
To do this, we need to operate efficiently, conscious of our core role in delivering
safe and cost effective health care, whilst simultaneously operating economically and
ethically, recognising our broader obligations to the health of the population and the
planet as a good corporate citizen.
The photo voltaic cells affixed to the roof of St Benedicts Hospice generate around
40,000 kWh of electricity per annum which equates to a saving of £5000 per annum
and a carbon emissions reduction of 21 tonnes.
From the matrix shown below it can been seen that over the last three years there
has been a steady reduction in the consumption of gas and electricity and this has
been due not only to the overall higher year round temperatures, hence the need for
less heating, but also to the careful management of the Estates services with the
addition of more efficient lighting, greater control of space heating and ventilation.
Going forward we expect this control to be further strengthened.
The Trust for carbon emissions for 2014 -2015 have fallen by 529 tonnes which
equates to a saving of £8500 against 2013-2014 figures.
Alongside carbon reduction work, we have undertaken a major review of our waste
and how waste is disposed of. We have made waste management a key priority and
worked hard to introduce wider recycling for a wide variety of waste types and over
the course of the year and have achieved our target of over 75% of all our waste,
which was previously sent for landfill, now being recycled. With investment in new
equipment to reduce collections from our sites and new recycling bins with improved
labelling we aim to encourage patients and staff to increase our collective role in
recycling our waste.
This year has seen the continued work of the Trusts sustainability commitment with
the continued development and implementation of the Trust Sustainability
Development Management Plan with a focus on the Trust Green Travel Plan, a key
piece of work planned is the mapping of green travel options for patients and staff at
the South Tyneside General Hospital site.
During this year, we continued to celebrate our commitment to Sustainability with a
Staff Sustainability Event being held, this event was organised to promote South
Tyneside NHS Foundation Trusts approach, support, commitment and community
involvement in what the Trust is doing to meet the challenge of providing a
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sustainable workplace and what our employees can do both at work and home to
contribute toward the Trust aims. The event had advice on water conservation,
recycling, green energy options and staff engagement through the staff travel survey.
2012/13 to 2014/15 financial year comparisons
item
Area
Value
2012/13
High
temperature
waste disposal
(tonnes)
Non-burn
alternative
treatment
(tonnes)
Landfill
(tonnes)
101.98
54.27
44.086
£35,334
£19,428
£17486
96.98
94.49
183.19
£33,387
£33,827
£60,353
246.06
0
0
£93,346
£0
£0
N/A
£240
£240
£773
N/A
N/A
N/A
£1136
131.923
£37,783
£69361
£8386
£201,931
£122856
£153,280
WEE disposal
(items)
4.8
Waste
Minimisation
and
Management
Hazardous Chemicals
for disposal (items)
Waste sent for
recycling (tonnes)
Total cost of
all waste
disposal
Water &
Sewage
Finite
Resources
Value
Value
Cost
Cost
Cost
2013/2014 2014/2015 2012/13 2013/2014 2014/2015
407.4
Fixed price
contract.
Items
weight not
recorded
Fixed price
contract.
Items
weight not
recorded
100.51 +
Obrien’s
charge by
bin
84940 m3
87370m3
97636m3
£224,685
£241,101
£96,034
Electricity kWh
7,637,553
7,462,889
7,037,488
£704,649
£776,281
£760,568
Gas kWh
25,146,421
23,022871
21,641,216 £853,781
£797,036
£663,872
26581 L
25,861 L
£15,542
£9,586
Gas oil litres
22,119
£18,006
Table 8: Environmental footprint metrics 2012 – 2014/15
FRAUD AND CORRUPTION
The Trust’s contracts with commissioners for healthcare services include specific
clauses and schedules regarding counter fraud arrangements.
Local counter fraud specialist services are provided to the Trust by staff working for
Sunderland Internal Audit Services. Individuals appointed as Local Counter Fraud
Specialists (LCFS) have been approved as suitable for this role by NHS Protect and
have been accredited by the Counter Fraud Professional Accreditation Board. The
Lead LCFS for the Trust is Kathryn Wilson, Local Counter Fraud Specialist. An
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annual plan for counter fraud work on behalf of the Trust is presented to the Audit
Committee by the Lead LCFS.
The LCFS provides regular updates to the Audit Committee on counter fraud work
being undertaken, and produces an annual report for the Committee on the Trust’s
compliance with the counter fraud requirements in its contracts with commissioners
and on work performed in relation to the NHS Counter Fraud Strategy. The current
Fraud and Corruption Response policy is available to all staff via the Trust intranet.
The Local Security Management Specialist is Glenn Mattinson, who is an employee
of the Trust. Security policies and procedures are available to all staff via the Trust
intranet.
BETTER PAYMENT PRACTICE CODE
The government’s better payment practice code requires public sector bodies to pay
all trade creditors within 30 days. The performance of the Trust in 2014/15 against
the target of 95% of invoices by value and number is shown below.
The Trust is an approved signatory of the prompt payment code, which is hosted by
the Institute of Credit Management on behalf of the Department of Business
Innovation and Skills. Signatories to the Code commit to:


Pay suppliers within agreed terms
Ensure suppliers know how to invoice them
Encourage good practice
Better Payment Practice Code - measure of compliance
Number
Total bills paid in the year
Total bills paid within target
Percentage of bills paid within target
Value
£000
50,192
41,195
82.07%
40,017
35,072
87.64%
The Better Payment Practice Code requires the Trust to aim to pay all valid nonNHS invoices by the due date or within 30 days of receipt of goods or a valid
invoice, whichever is later.
During 2014/15 no interest was payable under the Late Payments of Commercial
Debts (Interest) Act 1998.
THE LATE PAYMENT OF COMMERCIAL DEBTS (INTEREST ACT) 1998
Amounts included within other interest payable arising
from claims made under this legislation
Compensation paid to cover debt recovery costs under this
legislation
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Year Ended
31.03.2015
£000
0
0
Year Ended
31.03.2014
£000
0
0
PENSION LIABILITIES
9 individuals retired early on ill-health grounds during the year with additional
pension liabilities of £614,556.
COST ALLOCATION
The Trust has complied with the cost allocation and charging requirements set out in
HM Treasury and Office of Public Sector Information guidance.
SICKNESS ABSENCE DATA
Sickness absence data, using the Cabinet Office calculations is based upon the
calendar year. These are summarised in Table 9:
2014
2013
Total FTE days lost due to sickness absence
48,338
45,673
Total number of FTE days a year available
861,191
872,325
Average number of days sickness absence per FTE
12.6
11.7
Table 9: Sickness absence data for 2014 compared to 2013
POTENTIAL DATA LOSS/CONFIDENTIALITY BREACHES
All potential data losses are reported to the Trust’s Caldicott Guardian and Senior
Information Risk Owner. Board level governance is delegated to the Information
Strategy Group, which is chaired by a Non-Executive Director. There were no
breaches that have resulted in a report to the Information Commissioners Office in
the year.
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South Tyneside NHS Foundation
Trust
“Choose High Quality Care”
Our Quality Report
2014/15
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1:
Statement from the Chief Executive
QUALITY REPORT
Part 1 – Chief Executive’s Statement
This year we have produced our sixth annual Quality Report which provides a
summary of our performance against a number of quality measures for 2014/15 and
our quality priorities for 2015/16. We continue to ensure that patient safety and
quality of care is at the forefront of our work. In 2014-15 we had several successful
inspections and accreditations of achievements at service and organisational level.
To help us with this we have selected challenging targets for the year ahead. We will
also report here on the progress we have made in the past twelve months against
the priorities we set ourselves in our last report.
Rates of hospital acquired infection and the performance of hospital A&E
departments are measures that are frequently in the public eye. Once again we have
performed at the highest level nationally in infection control, with only 1 case of
MRSA bacteraemia and 9 cases of Clostridium Difficile in the year. From November,
2014, through to March, 2015, like many other NHS Foundation Trusts, we
experienced significant pressures in the A&E Department, extending throughout the
hospital. Consequently, we failed to maintain the A&E performance above the target
of 95% for the year, achieving just below 92% for the year.
We successfully rolled out the Patient Friends and Family test from ward areas to
Outpatient Departments and Community settings and our results were consistently
high throughout the year, scoring 4.7 out of a possible 5.
From a service perspective we were successful in being awarded a tender by South
Tyneside Local Authority for the development of an Integrated Care Hub, working in
partnership with Age UK, which will provide an 80-bedded unit operating with four
different levels of care, from day attenders through to long-stay care for dementia
patients. This is an exciting opportunity for the Trust and the new unit will open its
doors in the Spring of 2016.
Our commitment to employing talented, caring staff, alongside effective leadership
from the Board and a culture of continuous improvement in safety will ensure that we
will continue to provide the best services for our patients.
There are a number of inherent limitations in the preparation of Quality Accounts
which may impact the reliability or accuracy of the data reported. These include:

Data is derived from a large number of different systems and processes. Only
some of these are subject to external assurance, or included in internal audits
programme of work each year.

Data is collected by a large number of teams across the Trust alongside their
main responsibilities, which may lead to differences in how policies are
applied or interpreted. In many cases, data reported reflects clinical
judgement about individual cases, where another clinician might have
reasonably have classified a case differently.
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
National data definitions do not necessarily cover all circumstances, and local
interpretations may differ.

Data collection practices and data definitions are evolving, which may lead to
differences over time, both within and between years. The volume of data
means that, where changes are made, it is usually not practical to reanalyse
historic data.
We have sought to take all reasonable steps and exercise appropriate due diligence
to ensure the accuracy of the data reported, but recognise that it is nonetheless
subject to the inherent limitations noted above. Following these steps, to my
knowledge, the information in the document is accurate with the exception of the
matters identified in respect of the 18 week referral to treatment incomplete pathway
indicator as described on page 178.
Lorraine B Lambert
Chief Executive
Date: 21 May 2015
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2:
Priorities for Improvement and Statements of Assurance from the Board
Foundation Trusts are required to publish quality accounts each year, as set out in
National Health Service (Quality Accounts) Regulations 2010 and National Health
Service (Quality Accounts) Amendment Regulations 2012. The quality report must be
included as part of the Trust’s annual report. In addition the report must be prepared in
accordance with annual reporting guidance provided by Monitor and the Department of
Health. Much of the text in the report is therefore both prescribed and mandatory.
In our 2013/14 Quality Report we explained the areas where we would focus attention
on quality improvements during 2014/15. Part 2 of this report highlights our
performance against the indicators we selected and sets out our priorities for 2015-16.
We will also provide statements of assurance from our Board of Directors and
commentary from a range of stakeholders.
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2.1
Progress Made Since Publication of the 2013/14 Quality Report
Our Patient Safety Priorities for 2014-15
Priority 1 Resourcing: Ensure optimum staffing capacity and capability
Rationale for Inclusion:
There is a nationally accepted and growing body of evidence that patient outcomes
are linked to whether are not organisations have the right people, with the right
skills, in the right place at the right time. Following the publication of the of the
report of the Mid-Staffordshire NHS Foundation Trust Public Inquiry and the Keogh
Reviews into 14 Trusts with higher than expected mortality levels, the importance
of NHS Trusts making the right decisions with regard to safe staffing levels is
coming under increasing scrutiny.
Target 2014/15:
We will implement standard processes including across the Trust to ensure
visibility of safe, consistent staffing levels.
Our Progress:
From June 2014 NHS Trusts have been required to report monthly staffing
information, by ward and team, publishing board papers on the Trust website.
There is also a requirement for six monthly staffing reviews using evidence based
tools to be presented to a public Board meeting every six months.
a) Implement a staff allocation system to match staff levels and experience
to need, proactively and flexibly.
Throughout 2014/15 there has been a continuation of the phased roll out of
eRostering, completing inpatient services and specialist departments, and rolling
out to community services. Work continues with teams to ensure the production of
effective rotas. Key performance indicators have been produced for clinical
operational managers to drive improvement and to encourage a more standard
approach to rota production across all teams. These changes have facilitated the
national requirement to report staffing fill rates, comparing planned with actual
levels on both day and night duty.
Positive benefits continue to be the transparency of staffing levels across all the
wards and teams with the opportunity for managers to sign off effective rotas while
highlighting and addressing poor practice with rota makers in a timely fashion.
b) Invest in sufficient levels of appropriately trained staff to deliver safe
patient care
In June 2013 the Board of Directors agreed an investment of £1.8 million in nursing
staff to meet the staffing recommendations from the acute bed base review. This
second phase of this investment was released from reserves in August 2014 to
enable the completion of the recruitment process.
c) Prioritise resources to ensure an appropriate supporting infrastructure
and ring fence or invest in dedicated safety resources to drive projects in
order to help frontline staff to deliver safe patient care
The Executive Director of Nursing and Patient Safety made a decision to use the
Safer Care Nursing Tool (SCNT) to underpin our second staffing establishment
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review in September 2014. This methodology is very different from that used in the
Trust 2013 Staffing Review which was based on bed numbers. The SCNT is an
evidence based tool that enables nurses to assess patient acuity and dependency,
incorporating a staffing multiplier to ensure that nursing establishments reflect
patient needs. The SCNT is also an accredited staffing toolkit in alignment with
NICE guidance for Safer Staffing in Adult Inpatient Areas. We are working to utilise
the 6-monthly establishment analysis using the SNCT to inform the e-roster
baseline and as a result of this the ward establishment. While the £1.8m
investment is in budget lines we continue to have a significant vacancy gap and
board has approved a plan to recruit from a wider catchment area nationally and
internationally. Our revised recruitment plan commences in June with a weekend
open day.
The analysis from data collected on every patient in South Tyneside District
General and Primrose Hospitals, along with St Benedict’s Hospice during
September 2014, indicated variation in registered nurse numbers across three
shifts, and disparity in patient acuity and dependency compared with budgeted and
actual establishments across wards. A second audit cycle was completed in March
2015 on the same wards using the same methodology. Analysis of this latest
dataset will be reviewed alongside the September data and reported to the Board
of Directors in June 2015 with any recommendations that the reviews suggest.
The use of the SCNT to review our nursing establishment will be refined over future
audit cycles which will take place twice per year in September and March. A key
strand of work will be to triangulate the data collected in terms of safety, quality and
experience indicators such as patient harms, staff and patient experience and “red
flags”, to better understand what safe staffing looks like on all our wards and teams
and identify areas for new or shifting investment or a different staffing model. NHS
England has recently published further guidance, “Safer Staffing: A Guide to Care
Contact Time (November 2014),” which focuses on the “value added” work of front
line nurses and carers with a view to maximising these aspects of their work, while
providing support for others, which will help drive improvements in care through
ward led modifications in practice. Some of the examples of good practice
described within the guidance will also be important to understand and may help
reshape how ward teams deliver care.
Priority 2 Leadership: Create a positive patient safety culture
Rationale for Inclusion:
Understanding the patient safety culture in the organisation helps to improve
patient safety and outcomes as every member of staff in the Trust has a role to
play in keeping patients safe and providing high quality care. Evidence suggests
that organisations with a positive safety culture have open communication, a
shared importance about patient safety and managing risk and staff feel supported
in their work.
Target 2014/15:
We will roll out cultural assessment across the trust at team level and above. This
will allow the patient safety team to examine the variation in culture between teams
and target those in need of intensive support and coaching to improve team
motivation.
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Our Progress:
South Tyneside NHS Foundation Trust (STFT) has made further progress to
reinforce our organisational leadership from what was already a strong position in
2013/14. In 2014 our Trust was named as one of the best places to work in the
NHS in England. HSJ’s Best Places to Work, in association with NHS Employers,
is a celebration of the 100 best employers in the health service. To compile the list,
NHS staff survey findings were used to analyse each organisation across seven
core areas: leadership and planning; corporate culture and communications; role
satisfaction; work environment; relationship with supervisor; training and
development and employee engagement and satisfaction. It is especially pleasing
to achieve this acknowledgement in a time of increasing national and local
pressures, both financial and reputational, knowing that working in the NHS has
never been tougher than it is now. Locally, we have faced some difficult
challenges, as have many NHS organisations and it is, therefore, extremely
pleasing and reassuring that, despite those difficulties, our staff, who demonstrate
enthusiasm, compassion and friendliness each and every day, remain positive
about us as an employer.
In January 2014 the “Choose to Lead” leadership strategy was approved by the
Board of Directors and continues to be embedded across the Trust. The strategy
encompasses national strategies and principles aligning these to STFT’s unique
character and culture. This distinctiveness is embodied in our approach to
leadership based on the belief that leadership is not restricted to staff in designated
management or leadership roles, but where leadership behaviours are expected
from everyone in the organisation. This model can be described as shared or
distributed leadership and recognises that everyone contributes to the
organisation’s success. Mandatory training in leadership is being rolled out for all
staff groups, a significant undertaking, which demonstrates the commitment of the
organisation to develop its overall leadership capacity.
In early 2015 a team cultural assessment tool was launched to give us further
intelligence on the culture of our organisation by team. This will add depth to the
intelligence we collected as part of the organisation cultural assessment
undertaken in 2013 and can be triangulated with a range of safety, quality and
experience indicators to give organisational assurance on the quality of care we
give to our patients. The cultural assessment was completed in April and will report
to board in June to include a plan for utilising the findings as part of service level
development plans.
“Hello my name is…” is a national campaign instigated by Dr Kate Granger a
consultant in elderly medicine in Yorkshire who has terminal cancer. Dr Granger
started this campaign on Twitter, the social media platform, after she became
frustrated with the number of staff who failed to introduce themselves to her when
she was in hospital. She describes this simple courtesy as 'the first rung on the
ladder to providing compassionate care' and as the start of making a vital human
connection, helping patients to relax, and building trust. South Tyneside NHS
Foundation Trust pledged its backing in 2014 to 'Hello my name is...', as an
important strand of enhancing our positive patient safety culture, by simply
reminding staff to go back to basics and properly introduce themselves to patients.
In February 2015 the Trust reaffirmed our commitment to the movement with a
formal launch of the campaign led by the Trust Chairman and Chief Executive
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Officer. This level of leadership commitment is essential in signalling the
importance to all staff of acting on what we know; that the smallest things can often
make the biggest difference to how our patients and their families experience their
care. Staff have embraced the campaign which has now gathered huge
momentum right across the Trust.
Priority 3 Safety Metrics: Deliver Open and Honest Care
Rationale for Inclusion:
The development of Trust-wide safety metrics is a key tenet of the patient safety
culture and has now been successfully achieved. The Trust first delivered the data
required by the classic safety thermometer in August 2012 and has been taking
part in Choose Safer Care (nationally known as Open and Honest Care) since
October 2012; we are only Trust in the North East to participate. The Patient
Safety Team has further refined the Trust’s suite of patient safety metrics during
2013/14 and identified a core set of metrics available for all wards/clinical
teams/clinical departments in the Trust.
Target 2014/15:
 We will implement competency frameworks for staff which include measures for
attitude and behaviour which will also form the cornerstone of evidence that
nurses will need to have in order to be revalidated, and therefore registered, from
2015.
 We will continue and expand the medicines safety thermometer across the Trust.
Our Progress:
The Classic Safety Thermometer has been a national requirement since 2012
reporting on four harms: pressure ulcer, falls, catheter associated urinary tract
infection and venous thrombosis. Thirty one clinical teams are surveyed each
month which represents approximately 1600 patients.
The Maternity Safety Thermometer data collection commenced in August 2014
with information from ward 22 and delivery suite.
The maternity safety
thermometer measures harms from:






Perennial and /or abdominal trauma.
Post-partum haemorrhage
Infection
Babies with an Apgar score of less than five at seven minutes
Those admitted to a neo natal unit
Psychology safety: 4 questions related to mothers being separated from
their babies.
Twenty four patients have been surveyed so far with an average of 5 per month.
In 2013 the Trust became involved in the national pilot developing a medicines
safety thermometer collecting data in three clinical areas. The pilot stage is now
complete and there is an expectation that NHS Trusts will roll this out across acute
and community services. From November 2014 in STFT there has been a planned
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rollout of the initiative across a number of clinical teams with only three ward areas
now outstanding: these wards will be joining the data collection in May. Our district
nursing teams have also been recruited with the intermediate care teams next to
join. The medicines management team have developed guidance an intranet
information page to help support the teams deliver the medicines safety
thermometer.
a)
Agree a prioritised list of key metrics for the Board to monitor
In 2013/14 the Patient Safety, Quality and Risk Group (now named Choose Safer
Care Subcommittee) received a standard report from the Patient Safety Panel bimonthly. This report is currently in the process of being updated to contain a
patient safety dashboard which has been developed by the patient safety team.
The dashboard, which will cover acute bedded areas in the first instance, contains
a range of safety, quality and risk indicators which can be weighted and RAG rated.
Areas of exception will be identified objectively using the dashboard signalling the
need for a “deeper dive” into the current intelligence and decisions on further
actions to support teams made in partnership with operational management.
b)
Ensure that the metrics are tailored to different levels of governance
The patient safety metrics have been refined so that they can be reported and
reviewed by ward/team, clinical business unit, division or by organisation.
Assurance matrons triangulate safety, quality and experience indicators by ward
and team every month. This information is shared with operational teams at ward
manager, clinical operational manager and clinical business manager level. This
meeting includes discussion of soft intelligence and any developments or
improvement initiatives. This opportunity for open dialogue is valuable in deciding
appropriate interventions to support clinical teams. The strategic lead safer aligned
to each division has regular discussions with the divisional director with regard to
any areas of concerns. The patient safety panel oversees the safety metrics from
an organisational point of view and reports by exception any areas of concern to
the Choose Safer Care Subcommittee.
c)
Check that the metrics are delivered in conjunction with the staff
In 2014 a patient safety framework known as ‘ASSURED’ was developed by the
continuous quality improvement team (CQI) to support improvement and practice
development at team level. When wards and teams need support to help them
improve patient safety, quality and experience it is important to ensure that the
plans for support are making a real and measurable difference. The ASSURED
framework provides a standard approach to establish performance baselines,
undertake re-measure and evaluation which subsequently means we can be “re
ASSURED’” that improvement is sustained. The success of this ward/team
improvement model is dependent on effective, collaborative relationships between
multi-disciplinary teams and ultimately empowers ward and team leaders to make a
real difference and to sustain positive change over time.
The ASSURED model was presented at an NHS England event to celebrate
nursing innovations in November 2014; this generated interest from other Trusts
who wish to emulate our success.
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Priority 4 Staff Engagement: Embed patient focused care
Rationale for Inclusion:
A measure of success for the organisation will be when everyone in the Trust sees
delivery of the best possible patient experience as their business and can quantify
their contribution to our success and be proud to be part of it. Staff engagement is
the key tenet to both delivering safe and effective patient care and excellent patient
experience.
Target 2014/15:
We will include staff in our Friends and Family Test
Our Progress:
The Staff Friends & Family test was introduced in April 2014 and is reported to the
Board of Directors each quarter. A number of new clinical areas were required to
begin using the Friends & Family Test during the year, including Maternity services
and some community services. We successfully achieved implementation in all
required areas and exceeded the response rates required in the national targets.
At South Tyneside NHS Foundation Trust our aim is to deliver care that is
genuinely focused on the needs and wishes of individual patients, on each and
every occasion. This ambition requires a culture of genuine patient engagement
and an organisational approach to patient experience which is owned and valued
by each member of staff. Every interaction or contact with our services can reveal
attitudes and behaviours that either accelerate or impede a patient centred
approach to care delivery.
The Trust recognises that we need to engage with social media as an effective way
of communicating and engaging with our staff, patients and the public. In 2014 the
STFT Twitter account was established to allow a stream of tweets from members
of the Executive team, clinicians and senior managers reporting innovations,
celebrating success, commenting on work that is underway, reporting national and
local events and news. A Trust “App” is also being developed which contains
information on Trust services and our staff. The App will facilitate the collection of
staff “friends and family” survey data to ensure we reach as many staff as possible
to enable a timely and receptive response to their views.
Engage junior doctors and nurses on the patient safety agenda
In 2012 Guys and St Thomas’ NHS Foundation Trust launched Barbara’s story to
raise staff awareness of what it feels like to be a patient with dementia in unfamiliar
surroundings. The story follows the journey of an older lady called Barbara through
varied stages of her care pathway. The story is narrated by Barbara’s thoughts
and feelings to help staff understand what it feels like to be in their patient’s shoes
helping staff to reflect on how things might appear from the patient’s perspective.
The story highlights scenarios where Barbara is shown simple acts of kindness and
consideration but also more upsetting situations where she isn’t given sufficient
attention or care and the impact these two approaches have on Barbara’s feelings.
Thanks to funding from the Burdett Trust Barbara’s story was launched across the
South Tyneside NHS Foundation Trust in June 2014 and to date 3,901 staff have
joined Barbara on her journey. Staff are asked to tell us what they would do
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differently as a result of seeing Barbara and their comments have been captured
on a short video to promote our commitment to compassion in practice.
In acknowledgement of the organisation’s commitment to Barbara’s story the
Alzheimer’s Society have recently endorsed our programme and will recognise all
staff who have completed Barbara’s journey as “Dementia Friends”.
Maximise opportunities for team work so as to improve staff allegiance
Our staff celebrated NHS Change Day on Wednesday 11 March 2015, with an
event showcasing some of the innovation, improvements and positive changes
which have benefited our patients over the past year.
NHS Change day was the culmination of 30 days of change which ran from 10
February 2015 and involved the CQI team revisiting some of the key changes and
positive improvement stories from the past year. The day itself provided the
opportunity for us to come together, harnessing our collective energy, creativity and
ideas to make change happen. Teams from all areas of the Trust presented over
40 of their projects to their colleagues. There was a real “buzz” in the room as staff
understood the scale of the collective achievement and the real difference they had
helped to make to the care and wellbeing of our patients and families.
NHS Change Day was used as a platform to launch the “change agents
programme” to support leaders make positive changes to their services or patient
pathways through specific improvement projects.
Priority 5
The Learning Cycle: Disseminating learning and
developing practice
Rationale for Inclusion:
Continuous quality improvement is already a key strength of our organisation,
supporting the transformation programme and ensuring that patients are central to
service improvements and best practice is embedded. Improvement events will take
place in 2014 focussed on reducing falls, pressure damage, venous
thromboembolisms and urinary tract infections in patients with indwelling catheters.
The Trust has committed to implementing ‘PERFORM’ in partnership with
PricewaterhouseCoopers LLP (PwC) to embed new ways of working in clinical
teams to increase productivity and effectiveness.
Target 2014/15:
 We will expand the implementation of PERFORM to additional services including
diagnostics, Obstetrics and Gynaecology, Pharmacy and selected community
services.
 We aim to continue to increase our involvement in national development during
2014-15
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Our Progress:
The Trust has been working in partnership with PricewaterhouseCoopers (PwC)
throughout 2014/15 to adapt an innovative reform methodology for health care
settings: the methodology is call PERFORM. PERFORM is described as an
operational excellence approach that rapidly delivers results through optimising what
managers do, how they do it, and the tools they use. PERFORM drives improved
performance through:
• Highlighting operational problems before they escalate
• Increasing Managers’ time spent on coaching
• Supporting effective delegation of work
• Encouraging best practice
• Making performance visible
• Providing clarity on what is required day-to-day
• Balancing workloads between teams
Wards and teams attend a two day “boot camp” which engages staff in the tools and
techniques used by PERFORM and encourages staff to think about the vision for
their service and how they can all play a part in delivering it. Teams then enter a 10
week interactive programme, with intensive coaching to help embed the tools and
techniques while driving new ways of working. A key component of the work is the
design and implementation of an information centre from which all staff can track
team performance on a daily basis. At daily meetings, known as “huddles”, teams
review performance from the previous day and identify today’s priorities. Leadership
of the huddle changes daily and is not hierarchical encouraging leadership
behaviours from all grades of staff. Staff are taught to “problem solve” and take
ownership of ward/ team performance. Teams feel empowered to make decisions
and solve problems they would previously have escalated to their managers.
PERFORM has been initiated in a number of phases. The planned programme
across diagnostics, obstetrics and gynaecology, pharmacy and selected community
services was achieved, although the main work in community services has now
begun in 2015/16.
In 2014/15 the annual plan for continuous quality improvement (CQI) was delivered
supported by the Continuous Quality Improvement Team. The team has delivered
17 continuous improvement events and a further 46 improvement projects. The CQI
team have trained 384 staff in lean methodology and have led 37 improvement
events. The CQI team facilitates practice development to all wards and teams
across the Trust. The following is one example of practice development designed to
lead to a reduction in harm to our patients as a result of pressure ulcers. A similar
piece of work has also been undertaken to reduce falls throughout the organisation
by introducing the Fallsafe Care Bundle. The Fallsafe Care Bundle has been
updated following a pilot on 4 wards. It will be implemented in all care of the elderly
and medical wards by the end of June 2015 and remaining wards (surgical) and St
Benedict’s by the end of July 2015.The intended outcome is to further reduce the
number of falls patients have in our care as a result of identifying all patients at risk
of a fall and ensuring strategies such as falls technology are in place to prevent a fall
occurring. To monitor the reduction and trends in falls the learning from RCA, data
from the NHS Safety Thermometer, Open and Honest Care data and the Safety
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Quality and Experience dashboard will be discussed at the falls operational meeting
to identify interventions needed to continuously reduce patient harm from falls.
SSKIN is an evidence based five step care bundle for pressure ulcer prevention.
The aim of the care bundle is to identify all patients who are at risk of developing
pressure ulcers and then reliably implement prevention strategies identified by NICE
(2005). SSKIN is an aide memoir for the following five strands of care:





Surface: make sure your patients have the right support
Skin inspection: early inspection means early detection. Show patients and
carers what to look for
Keep your patients moving
Incontinence/ moisture: your patients need to be clean and dry
Nutrition/ hydration: help patients have the right diet and plenty of fluids
Ward 10 was chosen to ‘pilot’ documentation which underpinned the new practice
for 3 months. At the end of each month staff comments and suggestions were taken
into consideration and amendment made to the document itself to ensure it was fit
for purpose and increase staff engagement. A communication strategy was agreed
with the Ward Manager and rolled out to staff at team meetings. The CQI team
provided guidance notes to help staff to easily understand and complete the
documentation. One of the CQI facilitators visited the ward on regular occasions to
support the staff through the change process and a member of Ward 10 team was
given the opportunity to lead the launch of the documentation with their colleagues.
To monitor the reduction and trends in pressure damage the learning from RCA,
data from the NHS Safety Thermometer, Open and Honest Care data and the Safety
Quality and Experience dashboard will be discussed at the pressure damage RCA
panel to identify interventions needed to continuously reduce patient harm from falls.
South Tyneside NHS Foundation Trust is a member organisation of the
Northumberland Tyne and Wear Comprehensive Local Research Network (NTW
CLRN). The CLRN allocate funding to the organisation to support of the approval,
management and delivery of NIHR portfolio studies. The Trust has an active
portfolio of clinical research which reflects the organisation’s commitment to
providing high quality patient care and embed a culture of innovation across the
organisation. During 2014/15 the research team have recruited 350 patients into a
range of studies including 5 commercial studies: STFT are the lead site for the
national Adenoma study. The team has achieved 100% of studies approved within
the 15 day target and 83% of studies recruited the first patient within 30 days which
are excellent results reflecting the commitment of the team.
In 2014/15 the research team has also expanded the Trust research portfolio
delivering studies in areas that have not had an active research profile in the past.
These new areas include anaesthetics, critical care and cardiology.
Incident reporting is a fundamental tool of risk management, the aim of which is to
collect information relating to adverse events, including near misses, which will aid
the Trust in focusing on improvements in safety. As part of the process, relevant
managers receive immediate notification when an incident is reported on the
Datixweb system. It is the managers’ responsibility to investigate the incident and
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advise the Risk and Compliance Team if the incident needs reassigning to another
manager. Notifications are also sent to the Risk and Compliance Team as well as
any specialist role, e.g. security related incident notifications are sent to the Security
Manager, pressure ulcers notifications are sent to the Tissue Viability Team, etc.
Most serious clinical incidents which are identified either through Datix reporting or
management escalation, are investigated by the Assurance Matrons. The only
regular exception to this is the investigation of pressure ulcers. The Tissue Viability
team have a robust process for reviewing root cause analysis and learning from
clinical incidents.
The team of assurance matrons ensure that all serious incidents are investigated in
an objective and standard way: investigations and the development of action plans
are conducted in collaboration with operational teams. The assurance matrons are
responsible for ensuring that all actions are completed and lead any necessary
changes in practice to support patient safety. One example of this was the
implementation across the Trust of yellow ID bands as a visual prompt for patients
with drug allergies. This initiative followed the investigation of a serious incident in
which a patient was administered an intravenous drug for which she had a known
allergy.
In 2014/15 the assurance matrons investigated 39 serious incidents. The final
reports are submitted to the Clinical Commissioning Groups (CCG) and lessons
learned are reported to individual wards and teams as well as in divisional and
professional for a across the organisation. Where possible the assurance matrons
attend the CCG serious incident panel to discuss their findings with commissioners.
All serious incidents are reported to the Patient Safety Panel chaired by the
Executive Director of Nursing and Patient Safety. The Patient Safety Panel agrees
to close serious incidents following all actions being completed and sign off by the
CCG. In a recent innovation the Patient Safety Panel will log all lessons learned
and keep an audit trail of where these lessons have been shared.
Summary of lessons / outcomes / themes from Serious Incidents 2014/15
Incident Category
Pressure Ulcers
Slips, trips, falls
Lessons / Outcome / Theme
Contributory factors:
 Delay in receiving equipment
 Patients choice in not using equipment
 No photograph to use to monitor progression of ulcer
Improvements:
 Improved documentation
 Patient information
 Integration of printer with IT system in development
Contributory factors:
 Patients who fall are often assessed as low risk –
review of falls policy needed in light of NICE
guidance
 Patients attempting to mobilise independently to
toilet against staff advice
 Physical presentation that may lead to fainting
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Suicide / death of a
patient
Medication errors
 Risk assessment on admission changing during stay
and in between re-assessment
 Periods of agitation / restlessness
 Staffing on nightshift
Improvements:
 Falls risk assessment documentation to be used in
maternity documentation
 Significant increase in use of falls technology
 Improvements in documentation including
assessments of risk
 Visuals introduced in clinical areas
 Toilet posters
 Supervision of patients in bathrooms
Contributory factors:
 Homelessness / secure accommodation on release
from prison
 Poor engagement with services
Improvements:
 Multi-agency working and communication
Contributory factors:
 Distraction / preoccupation with other duties
 Time pressures – running late
 Stock not put away when not in use (increases risk
of mixing medicines up)
 Storage of medications (Penicillin v non Penicillin)
 Acknowledgement and Identification of allergies
Improvements:
 Review of all PGDs
 Tidying of clinical rooms following clinical activity
 Implementation of coloured medicine allergy bands
 Use of Extramed system to record allergies
 Medication chart reviewed – drug allergies to appear
on each page
 Visual identity of drug allergies implemented
 Introduction of medicine round audits
 Introduction of 02 carrying brackets for oxygen
cylinders
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Priority 6
Guidelines and training: supporting staff to remain fit for purpose
and deliver evidenced based care
Rationale for Inclusion:
Well developed, skilled and knowledgeable staff are the most valuable resource in
any organisation. Ensuring staff remain fit for purpose is challenging to any Trust
due to the fast pace of change within the NHS as technologies develop and new
ways of working emerge. Revalidation for Medical staff has been implemented in the
Trust. Revalidation for nurses will become an NMC requirement by 2015 and there
will be a similar revalidation requirement for allied health professionals.
Target 2014-15:
To support nurses and allied health professionals to meet these requirements we will
develop core, specialist and advanced competency frameworks which will be rolled
out to all staff in 2014-15
Our Progress:
The Francis 2 report and the Cavendish review which followed led to a number of
national initiatives to address apparent national failings in recruitment of the right
people into caring roles and ensure that those who are recruited are appropriately
trained and valued as members of the team.
The Trust continues to take an active role in developing systems and processes to
ensure we recruit staff with the values aligned to the “6 Cs” and the “Choose” values
of the Trust. We are continually developing new ways of ensure staff remain
supported to deliver their role with opportunities for development both personally and
professionally.
Give support to clinical area leaders in their deploying of key guidelines.
The Clinical Audit Team has developed a robust in house data base to monitor Trust
compliance with all NICE guidance to support staff in deploying key guidelines in
their areas of practice. There are systems in place to download all new guidance
and the NICE Guidance Review Group then considers whether it is relevant with
regard to the services the organisation provides. Guidance would only be
considered not relevant at this point if the service is not provided as part of our
organisational portfolio. Any guidance considered relevant is then forwarded on to
identified leads, within the appropriate specialty. In the case of uncertainty the
group will refer to the lead clinician in the relevant specialty for advice.
The clinical leads then review the guidance using a baseline assessment tool or
NICE Guidance review template within 8 weeks. This review will establish whether
the Trust is compliant or non-compliant with the guidance, identify any implications
for implementation and in cases of non-compliance prepare an action plan. Noncompliance action plans/gap analyses are reviewed by the NICE Guidance Review
Group for assessment of the potential impact on care. The group then decides on a
Red, Amber or Green (RAG) rating for reporting purposes. The Executive Director
of Nursing and Patient Safety is advised of the reasons for any deviation or deficits
from recommended practice, the detail of which should have been outlined within
the response, action plan and gap analysis.
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Since April 2012 386 pieces of guidance have been logged on the database and
have been to the NICE Guidance Review Group. Currently as a Trust we are fully
compliant with 47% of relevant guidance with a further 41% still currently under
review. 12% of reviews are still outstanding and are reported by exception at each
NICE Guidance Review Group meeting.
Action plans are monitored within the appropriate Division with any deviation from
plan exception reported to the NICE Guidance Review Group.
Give direction for a review of patient safety training
The Care Certificate was developed in response to the Francis Inquiry and following
a review of non-registered staff working in caring roles which was undertaken by
Camilla Cavendish. The purpose of the Care Certificate is to provide clear evidence
to employers, patients and people who receive care and support, that the health or
social care worker delivering care has been trained and developed to a specific set
of standards and has been assessed for the skills, knowledge and behaviours to
ensure that they provide compassionate and high quality care and support. All new
care workers in England, including healthcare assistants in hospitals and staff in
care homes and who look after people in their own homes, will have to gain the
certificate.
Locally STFT is leading the way in providing special training for health and social
care staff to ensure they have the right qualities and skills to provide high quality,
compassionate care. South Tyneside Foundation Trust was chosen as a test site to
develop the Care Certificate and were keen to take an integrated approach to
piloting this by developing a Care Certificate Programme and Workbook working in
partnership with partners in the Social Care Sector in South Tyneside. Members of
the STFT team worked with private providers in the residential and nursing care
sector as well as those working in domiciliary care or employed to deliver direct care
by South Tyneside Council to develop a programme. The aim of the programme is
to provide all those newly employed to deliver care in hospital, care homes or the
homes of individuals in South Tyneside with the same Care Certificate Programme,
workbook and assessment. The STFT team sought to truly consider the challenges
and good practice already in place and to understand how the Care Certificate can
work both in a small domiciliary care provider to a large nursing home, and from an
NHS Trust to Council services. The team developed a unique and integrated
innovative approach; the only site nationally to build on the diverse range of
strengths that each of our partners bring, to ensure we educate, prepare and equip
our care staff with the skills to deliver high quality care.
About 20 new starters from the Trust and independent care providers in South
Tyneside have embarked on the Care Certificate programme, which the Trust is
running along with partners including Tyne and Wear Care Alliance
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Priority 7
To strengthen the links between patient feedback and
improvement
Rationale for Inclusion:
During 2014, the annual programme of patient experience studies conducted by the
Trust’s Carer and Patient Involvement Team will be repeated to ensure that the
patient experience in every clinical area across the Trust is conducted within the
year.
Target 2014/15:
 We will roll out our ‘Open and Honest’ point of prevalence patient harm survey to
our community services.
 We will expand the Friends and Family Test to our community teams.
Our Progress:
The direction of patient safety in England is now supported by a number of national
initiatives. STFT has been an early adopter of these initiatives and frequently led the
way both locally and nationally. In 2012 we were first in the north east to publish
“Open and Honest care” information to the public with regard to care in our hospital
settings. In November 2013 we were one of only five Trusts nationally who were
able to publish “Open and Honest care” information relating to care given by our
district nursing teams and in 2014 we began to publish safe staffing information on
our website in line with national requirements. We also include an “easy read”
version of staffing information to help members of the public best understand any
staffing challenges we have had and actions we have taken to support teams to
continue to deliver safe and effective care.
In November 2014 our Executive Director of Nursing and Patient Safety drafted a
proposal to develop and lead a North East Patient Safety Collaborative to reduce the
number of pressure ulcers by 50% in areas selected for intervention. This proposal
has now been accepted with the expectation that work will be completed in May
2016.
Earlier this year STFT signed up to join the national “Sign up to Safety” campaign.
“Sign up to Safety” aims to deliver harm free care for every patient, every time,
everywhere building on the transparency initiatives known as “Open and Honest
care”. This government initiative champions openness and honesty and supports
everyone to improve the safety of patients. The three year objective is to reduce
avoidable harm by 50% and save 6,000 lives.
“Sign up to Safety” contains five key pledges which all member organisations will
commit to:

Putting safety first. Commit to reduce avoidable harm in the NHS by half
and make public our locally developed goals and plans

Continually learn. Make our organisation more resilient to risks, by acting on
the feedback from patients and staff and by constantly measuring and
monitoring how safe our services are
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
Being honest. Be transparent with people about our progress to tackle
patient safety issues and support staff to be candid with patients and their
families if something goes wrong

Collaborating. Take a lead role in supporting local collaborative learning, so
that improvements are made across all of the local services that patients use

Being supportive. Help people understand why things go wrong and how to
put them right. Give staff the time and support to improve and celebrate
progress.
STFT already has a track record of achieving against each of these pledges. “Sign
up for Safety” provides us with an opportunity to bring together all of the work we
already do onto one plan, including external initiatives, ensuring they add value to
our work and are not “add on” or isolated projects which can potentially distract from
important on-going work.
The Patient Safety Priorities developed in 2014 for 2014 to 2017 will be reviewed
and priorities that remain current will be included on the organisational plan.
Priority 8
To develop assistive technology to facilitate the collection and
distribution of patient feedback
Rationale for Inclusion:
The use of hand held tablets will support wider spread collection of patient stories by
reducing administrative processes and allow more effective and efficient use of the
CAPI team. We will also develop assistive technology for patient areas. This will
allow patients to provide real-time feedback at the point of care. During 2014-15 we
will also develop a database to coordinate patient experiences from a wide range of
sources providing a holistic view of services from the patient’s perspective. This will
allow us to identify and focus on areas which patients and carers feel that we can
improve upon.
Target 2014/15:
We will introduce assistive technology to collect qualitative and quantitative patient
and carer feedback
.
Our Progress:
An important factor in relaying patient feedback to staff with the purpose of engaging
them to improve safety, quality or experience is time. The ability to reflect patient
feedback onto current care delivery makes both the message to frontline staff and
the opportunity to stimulate change much more powerful and immediate. With this in
mind in 2014 the Carer and Patient Involvement Team (CAPI) piloted ‘Real Time’
Patient Feedback within acute wards and departments. The proposal was to
complete the feedback cycle from patient interviews to report within an eight hour
timeframe. A CAPI facilitator visited the pilot wards once a fortnight over a six week
period to interview patients using a series of pre-set questions. The visits were
conducted at appropriate times either in the morning or afternoon. When the
afternoon time slot was selected visitors would also have the opportunity to share
their views and participate in an interview.
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The pilot was successful with the feedback cycle completed within the allocated
eight hour timeframe. The pilot has proved very popular with ward staff; findings are
shared with all staff at daily ward huddles with actions for improvement identified and
implemented immediately when possible. The real time feedback initiative is now
being rolled out to all acute wards and departments. The development of a
dedicated telephone line and email address is now underway to provide patients and
their relatives an opportunity to tell us about their ‘Real Time’ experiences outside of
the planned visits to the Acute Wards and Inpatient Units.
Priority 9
To raise staff awareness with regard to carers
Rationale for Inclusion:
Most people who need care rely on family members, friends and neighbours i.e.
informal care. Some estimates place the number of informal carers in the UK at 6.4
million. Since many people do not readily distinguish themselves as carers,
identification of carers continues to be a major issue for healthcare providers.
Target 2014/15:
We will develop and roll out training and awareness packages to ensure that our
staff are able to support our carers
Our Progress:
A Trust representative attends the Carers’ Strategy Groups in the three Local
Authority areas to network with other agencies. Specific issues are communicated
directly with clinical teams as appropriate, e.g. Young Carers items with services for
children.
A quarterly newsletter is produced by the Trust to update staff on developments to
support carers and share positive stories of where carers have been supported. All
newsletters are available on the intranet, cascaded to teams and noted in the Trust
Staff Briefing. Contact details for the local carers’ voluntary organisations are
included in the newsletter to enable clinical staff to refer people when required.
A member of the Carer and Patient Involvement Team attends the Trust Discharge
Strategy and Operational Groups to champion the role of carers in the discharge
process.
Where possible, carers’ views are listened to when patients’ experiences are
measured. This is included in the Friends and Family Test Plus, conducted monthly
in every service in the Trust and Real Time Feedback, rolled out in the Trust and
conducted in face to face interviews by the Carer and Patient Involvement Team.
The staff training and awareness has been placed on hold during 2014-15.
Previously, a package was developed and delivered to some Trust clinical teams.
Since then, partner Local Authorities have developed training schemes in
conjunction with the Strategy Groups, with the agreement that this will be the
preferred model in future. Updates are required to accommodate the changes
results from the Care Act and a designated member of the Carer and Patient
Involvement Team will roll out the new training in a planned way during 2015-16.
Meanwhile, facilitators in the Carer and Patient Involvement Team continue to
promote support for carers on an ad hoc basis in their routine work in clinical areas.
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To demonstrate to patients and families that their
feedback is important and we take action on receiving it
Rationale for Inclusion:
We want to demonstrate that the Trust is able to listen and respond to the views of
patients, their families and the local community and to use feedback constructively
and innovatively to inform local service improvements.
Priority 10
Target 2014/15:
We will develop visibility walls in patient/carer accessible areas. We will use the
visibility walls to show our patients and carers that we are continuously improving
our care on the basis of their feedback.
Our Progress:
A SharePoint site has been developed which holds all the patient safety metrics
available for each ward and team. This site undergoes regular development to
ensure that triangulation of information by ward/team is as simple as possible. The
SharePoint site is available on request to all staff to support involvement,
understanding and ownership of safer care.
Safer staffing data is now displayed for patients and the public in all bedded areas of
the Trust and by community teams. The information is updated daily and includes
the number of staff planned to be on duty for each shift compared to the number
who are actually available.
Many wards and teams display their patient safety, quality and experience
information and over the coming months this will be rolled out to all areas in a
standard format in the coming months.
South Tyneside NHS Foundation Trust was one of only five Trusts able to publish
community safety metrics on our website in line with the national time frame; this
now sits alongside the safety metrics for in patient areas.
Since May 2014 we have published our safer staffing board reports on the public
area of our website. Alongside this we provide an easy to read summary of areas
where we have had staffing levels below expected levels with explanations of how
we have supported those wards and teams to deliver safe and effective care.
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2.2 Our Priorities for 2015-16
The following list of priorities for improvement for 2015/16 has been developed following
wide consultation. Key areas are identified by our patients and their carers through
surveys, questionnaires and complaints. To gain the contribution of the wider public we
discuss priorities with local Healthwatch organisations, and the three local authority
health oversight committees, and particularly with the public members of our Council of
Governors. Staff engagement in developing priorities continues to come through the
staff side representatives, but increasingly we benefit from staff responses in Choose
Safer Care and through quality improvement activities.
In South Tyneside NHS Foundation Trust we recognise that it is absolutely right to focus
on the importance of having the right organisational culture to deliver high quality,
compassionate care; engaging all staff in a patient centred culture and being open and
honest with our patients and their families.
Priority 1 – Clinical
Effectiveness
To develop and publish a three year Safety
Improvement Plan (SIP) as part of a new 5-year Quality
Strategy
Rationale for Inclusion:
The Trust has ‘Signed Up To Safety’, a national campaign to reduce avoidable
harm by half and save 6000 lives over the next three years. Each participating
organisation is required to publish a Safety Improvement Plan.
Target 2015/16:
Publish Safety Improvement Plan by June 2015 and 2020 Quality Strategy by
December 2015 and deliver Year 1 objectives by March 2016.
Baseline:
This plan and strategy builds on our current Safety, Quality and Experience plans
and a strong foundation of improvement work
Priority 2 – Clinical
Effectiveness
To create and roll out a Safety, Quality, Experience
(SQE) programme that will train front-line teams to
utilise improvement methods in their everyday practice
Rationale for Inclusion:
Building capability and capacity to undertake continuous quality improvement (CQI)
activities is a national priority (Berwick Report, 2013)
Target 2015/16:
Design and implement Phase 1 of the SQE programme between October 2015 and
March 2016.
Baseline:
The SQE programme builds on a foundation of CQI activities across the
organisation.
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Priority 3 – Patient
To further develop our culture of learning from
Experience
experience
Rationale for Inclusion:
New regulations such as the Duty of Candour further emphasise the importance of
open and honest reporting, learning lessons and demonstrating accountability in
assurance around actions.
Target 2015/16:
To fully implement Duty of Candour requirements, put into place a Patient and
Public Involvement Panel and demonstrate confidence in our approach to systemwide learning and improvement.
Baseline:
The Trust has a robust governance structure, is transparent and engaging with
staff, patients and the public – the challenge going forward is to ensure we learn
and improve at every opportunity, every day.
Priority 4 – Patient
Safety
To provide assurance to the Board and patients that we
are continually focused on demonstrating safe staffing
levels
Rationale for Inclusion:
Safe Staffing is a National Quality Board, NHS England and CQC priority. There is
an increasing evidence-base that demonstrates the link between the number, skills
and mix of staff and the quality of care patients receive.
Target 2015/16:
We will implement NICE Guidance for Safe Staffing in hospitals and participate in
the development of guidance for nursing in the community.
Baseline:
We already fulfil National Quality Board and NHS England requirements to
undertake twice yearly nursing establishment review and are reporting nurse
staffing alongside other indicators of quality to Board of Directors.
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2.3
Statements of Assurance from the Board
During 2014/15 South Tyneside NHS Foundation Trust provided and sub-contracted
130 relevant health services. South Tyneside NHS Foundation Trust has reviewed all
the data available to it on the quality of care in all of these relevant health services.
The income generated by the relevant health services reviewed in 2014/15 represents
100 per cent of the total income generated from the provision of relevant health services
by South Tyneside NHS Foundation Trust for 2014/15.
The safety, effectiveness and patient experience of all of our clinical services is
reviewed on an on-going basis through a process of Board of Director and Executive
Board oversight. Performance against national and local contractual targets is reported
regularly to the Board of Directors. Patient safety and patient experience reports are
also scrutinised at the Choose Safer Care Subcommittee which is a Board delegated
committee chaired by a Non-Executive Director.
2.4 Clinical Audit and Research
Clinical Audit
Participation in audits and clinical research programmes helps us to review our
performance and standards across a wide range of areas. We participate in national
and local audits and implement a range of developments and changes as a result.
This Clinical Audit Quality Account covers the period from 1 April 2014 to 28 February
2015.
During 2014/15 33 national clinical audits and 5 national confidential enquiries covered
relevant health services that South Tyneside NHS Foundation Trust provides.
During 2014/15 South Tyneside NHS Foundation Trust participated in 94% (n=29)
national clinical audits and 80% (n=4) national confidential enquiries of the national
clinical audits and national confidential enquiries which we were eligible to take part in.
Of the 33 national clinical audits that the Trust was eligible to take part in, participation
was not applicable to 2 audits for the following reasons:
 National Non-Invasive Ventilation Audit (BTS) was postponed by BTS
 National Audit of Dementia Audit was a pilot only and STFT was not selected for the
pilot process.
Of the 31 remaining audits the Trust participated in 29 and did not participate in 2.
The national clinical audits and national confidential enquiries that South Tyneside NHS
Foundation Trust was eligible to participate in during 2014/15 are listed in the table
below.
The national clinical audits and national confidential enquiries that South Tyneside NHS
Foundation Trust participated in during 2014/15 are also listed in the table below.
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The national clinical audits and national confidential enquiries that South Tyneside NHS
Foundation Trust participated in and for which data collection was completed during
2014/15 are listed in the table below 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.
The reports of 35 national clinical audit reports were reviewed by the provider in
2014/15, and South Tyneside NHS Foundation Trust intends to take the following
actions to improve the quality of health care provided:



Ensuring the lead clinician produces an action plan
The action plan is signed off by the appropriate strategic group or committee
Progress is monitored through the appropriate committee.
The reports of 202 local clinical audits submitted in 2014/15 were reviewed by the
organisation and South Tyneside NHS Foundation Trust intends to take actions to
improve the quality of health care provided by ensuring all audit reports and action plans
are reported to the Clinical Audit Committee, and by exception these reports and action
plans are presented to the Board.
Due to the much varied submission/reporting deadlines for ongoing/continuous national
audits, the figures for such audits have been based upon the number of cases actually
submitted out of the number of identified cases from 1 April 2014 to 31 March 2015.
142
National Clinical Audits and Confidential Enquiries for inclusion in Quality Accounts Report 2014/2015
Eligible for participation
Participated
% pts submitted to audit
Adult critical care (ICNARC CMP)
Yes
Yes
Community Acquired Pneumonia (BTS)
Yes
Yes
100%
(n=299)
N/A
Data collection continuing into 2015/2016
CONFIDENTIAL ENQUIRY (NCEPOD)
Acute Pancreatitis
Yes
Yes
N/A
Data collection continuing into 2015/2016
CONFIDENTIAL ENQUIRY (NCEPOD)
Gastrointestinal Haemorrhage Study
Yes
Yes
80%
(n=4/5)
CONFIDENTIAL ENQUIRY (NCEPOD)
Sepsis Study
Yes
Yes
N/A
Data collection continuing into 2015/2016
National Emergency Laparotomy Audit (NELA)
Yes
Yes
National Joint Registry (NJR)
Yes
Yes
National Non-Invasive Ventilation Audit (BTS)
Yes
N/A
100%
(n=73)
(Year 1 Dec 2013 to Nov 2014)
Year 2 data collection continuing into
2015/2016
100%
(n=248)
N/A
Audit postponed by BTS.
Awaiting revised timelines.
Pleural Procedures Audit (BTS)
Yes
No
N/A
Trust unable to participate due to staff
shortage in Respiratory Medicine
Trauma (TARN)
Yes
Yes
86%
(n=138/161)
Acute Care
143
Eligible for participation
Participated
% pts submitted to audit
Patient Information and Informed Consent
Yes
Yes
100%
(n=24)
Audit of transfusion in children and adults with sickle cell
disease
Cancer
No
N/A
N/A
Bowel Cancer - National Bowel Cancer Audit Programme
(NBOCAP)
Yes
Yes
100%
(n=99)
Head and neck oncology (DAHNO)
Lung Cancer - National Lung Cancer Audit (NLCA)
No
Yes
N/A
Yes
Oesophago-gastric cancer (NAOGC)
Yes
Yes
N/A
100%
(n=135)
44%
(n=16/36)
Acute coronary syndrome or acute myocardial infarction
(MINAP)
Adult Cardiac Surgery (ACS)
Yes
Yes
No
N/A
Cardiac arrest (NCAA)
Yes
Yes
Cardiac arrhythmia (Cardiac Rhythm Management Audit)
HRM
Congenital Heart Disease – Paediatric Cardiac Surgery
(CHD)
Coronary Angioplasty
Yes
Yes
No
N/A
100%
(n=63)
100%
(n=99)
N/A
No
N/A
N/A
Heart Failure (HF)
Yes
Yes
Pulmonary Hypertension
Vascular Surgery Registry – VSGBI Vascular Surgery
Database (NVD)
No
No
N/A
N/A
117 patients entered to audit
Unable to determine participation rate as
number of identified patients not provided
by audit lead
N/A
N/A
Blood and Transplant
Heart
144
82%
(n=120/146)
N/A
Eligible for participation
Participated
% pts submitted to audit
Chronic Kidney Disease in primary care
No
N/A
N/A
Pulmonary Rehabilitation Audit
Yes
Yes
N/A
Data collection continuing into 2015/2016
Diabetes - Paediatric (NPDA)
Yes
Yes
National Diabetes Footcare Audit
Yes
Yes
N/A
Approximately 60 cases identified
2014/2015.
System not yet open for 2014/2015
submissions.
Deadline for submissions is not until
September 2015.
Unable to ascertain
Inflammatory Bowel Disease Programme:
Biologics Audit
Yes
Yes
100%
(n=8)
Renal Replacement Therapy
No
N/A
N/A
Rheumatoid and early inflammatory arthritis
No
N/A
N/A
Mental Health: Care in Emergency Departments
(College of Emergency Medicine)
Yes
Yes
100%
(n=50)
Prescribing Observatory for Mental Health (OMH-UK)
No
N/A
N/A
NATIONAL CONFIDENTIAL INQUIRY
Suicide and homicide in people with mental illness (NCISH)
Yes
N/A
N/A
No suitable cases identified for
submission
Long Term Conditions
Mental Health
145
Eligible for participation
Participated
% pts submitted to audit
Yes
Limited - pilot only
N/A
N/A
Sentinel Stroke National Audit Programme (SSNAP)
SSNAP Acute Organisational Audit
Yes
Yes
N/A
Sentinel Stroke National Audit Programme (SSNAP)
SSNAP Clinical Audit
Yes
Yes
Falls and Fragility Fractures Audit Programme:
National Hip Fracture Database
Yes
Yes
Yes
Yes
100%
(n=100)
Elective Surgery (National PROMS programme) – Hernia
Yes
Yes
Data handled by external agency
Elective Surgery (National PROMS programme) – Hips
Yes
Yes
Data handled by external agency
Elective Surgery (National PROMS programme) – Knees
Yes
Yes
Data handled by external agency
Elective Surgery (National PROMS programme) – Varicose
Veins
No
N/A
N/A
National Audit of Intermediate Care
Yes
No
N/A
National Ophthalmology Audit
No
N/A
N/A
Older People
National Audit of Dementia
Older People: Care in Emergency Departments
(College of Emergency Medicine)
Unable to ascertain
100%
(n=188)
Other
146
Eligible for participation
Participated
% pts submitted to audit
Child Health Programme (CHR-UK)
Yes
Yes
Data handled by external agency
Epilepsy 12 Audit (Childhood Epilepsy)
Yes
Yes
CONFIDENTIAL ENQUIRY:
Maternal, infant and newborn programme (MBRRACE-UK)
Yes
Yes
Fitting Child: Care in Emergency Departments
(College of Emergency Medicine)
Yes
Yes
100%
(n=3)
100%
(n=7) obstetric cases
Unable to ascertain neonatal cases
100%
(n=33)
Neonatal intensive and special care (NNAP)
Yes
Yes
99%
(n=105/106)
Paediatric Intensive Care (PICANet)
No
N/A
N/A
Women’s & Children’s Health
Table 1: National clinical audits & confidential enquiries 2013/2014
147
2.4
RESEARCH
South Tyneside NHS Foundation Trust recognises the numerous benefits of Research
to the organisation and more importantly for our patients. According to a consumer poll
conducted in 2013 commissioned by the National Institute for Health Research (NIHR),
87% of people would prefer to be treated in a hospital that does clinical research. Being
a research active Trust demonstrates a commitment to high quality patient care and
embeds a culture of quality and innovation across the organisation.
South Tyneside NHS Foundation Trust is committed to the promotion and conduct of
research. As a partner organisation of the North East and North Cumbria Local Clinical
Research Network (NENC LCRN) South Tyneside NHS Foundation Trust was awarded
approximately £470,555 to support and deliver NIHR Portfolio studies.
Research is underway in a number of clinical specialities, 504 patients had been
recruited to 39 NIHR Portfolio studies. The Trust had a target to recruit to 5 industry
trials in 2014/15 and have exceeded this target recruiting to 6 industry trials recruiting a
total of 52 patients to industry trials.
The table below outlines our recruitment by study to non-commercial portfolio studies
(recruitment data from the NIHR open data platform as at 10 th April 2015, full
recruitment numbers for 2014/15 will not be available till after April 24th 2015)
Topic/
Specialty Group
Study Title
Ageing
Reform – a randomised trial of a multifaceted
podiatry intervention for fall prevention in patients
over 65
Mental Health
Anaesthesia
SIPs Jr RCT
A Sprint National Anaesthesia Project (SNAP) to
survey patient reported outcome after
anaesthesia in UK Hospitals
Adenoma Trial
Advanced endoscopic imaging strategies for
colitis surveillance
Chemoprevention of premalignant intestinal
neoplasia (ChOPIN) incorporating inherited
predisposition of neoplasia (IPOD) analysis of
genomic DNA from AspECT and BOSS clinical
trial
The establishment of a new generation
azathioprine metabolite monitoring test based on
white cells
A randomised controlled trial of eicosapentaenoic
acid (EPA) and/or aspirin for colorectal adenoma
Gastroenterology
148
Total
Number of
Patients
Recruited
2014/15
79
84
36
58
7
5
5
2
Topic/
Specialty Group
Cancer
Cardiology
Dermatology
Health Services
Research
Hepatology
Injuries and
Emergencies
Primary Care
Study Title
Total
Number of
Patients
Recruited
2014/15
(or polyp) prevention during colonoscopic
surveillance in the NHS Bowel Cancer Screening
Programme: The seAFOod (Systematic
Evaluation of Aspirin and Fish Oil) polyp
prevention trial
Predicting serious drug side effects in
gastroenterology
Investigation of the clinical, serological and
genetic factors that determine primary nonresponse, loss of response and adverse drug
reactions to Anti-TNF drugs in patients with active
luminal Crohn's Disease
A Randomized Active-Controlled Double-Blind
and Open Extension Study to Evaluate the
Efficacy, Long-term Safety and Tolerability of
TP05 3.2 g/day for the Treatment of Active
Ulcerative Colitis (UC)
Lungcast
Stampede
Cantalk
GLORIA - AF: Global Registry on Long-Term Oral
Anti-thrombotic TReatment In Patients with Atrial
Fibrillation (Phase II/III – EU/EEA Member States)
Pressure 2
Early evaluation of the Integrated Care and
Support ‘Pioneers’ in the context of the Better
Care Fund and the Integrated Care Policy
Programme
Investigation of the Genetic and Molecular
Pathogenesis of Primary Biliary Cirrhosis
The Effect of Exercise on Liver Lipid in People
with Fatty Liver with Moderate Alcohol Intake
A UK Collaborative Study to Determine the
Genetic Basis of Primary Sclerosing Cholangitis
(UK-PSC)
Tranexamic Acid for the Treatment of
Gastrointestinal Haemorrhage: An International
Randomised, Double Blind Placebo Controlled
Trial
PCRN2761 COPD
FIRST STEPS: Randomised controlled trial of the
effectiveness of the Group Family Nurse
Partnership (gFNP) programme compared to
routine care in improving outcomes for high risk
mothers and preventing abuse
149
2
1
1
2
1
1
44
8
1
4
3
1
12
1
7
Topic/
Specialty Group
Study Title
Reproductive
Health
Effect of folic acid supplementation in pregnancy
on preeclampsia -Folic Acid Clinical Trial (FACT)
A randomized, double-blind, placebo-controlled,
Phase III, international multi-centre study of 4.0
mg of Folic Acid supplementation in pregnancy
for the prevention of preeclampsia
Spot protein creatinine ratio (SPCr) and spot
albumin creatinine ratio (SACr) in the assessment
of pre-eclampsia: A diagnostic accuracy study
with decision analytic model based economic
evaluation and acceptability analysis
Induction of labour versus expectant
management for nulliparous women over 35
years of age
A randomised, double blind, multi-center,
placebo-controlled study to evaluate the efficacy,
safety, and tolerability of NT100 in pregnant
women with a history of unexplained recurrent
pregnancy loss
A randomised, double-blind placebo controlled
trial of the effectiveness of low dose oral
theophylline as an adjunct to inhaled
corticosteroids in preventing exacerbations of
chronic obstructive pulmonary disease (TWICS)
A Multicenter, Randomized, Double-Blind,
Placebo-Controlled Study to Evaluate the Safety
and Efficacy of Pulmaquin® in the Management
of Chronic Lung Infections with Pseudomonas
aeruginosa in Subjects with Non-Cystic Fibrosis
Bronchiectasis, including 28 Day Open-Label
Extension and Pharmacokinetic Substudy (Orbit
3)
A multicentre non-blinded randomised controlled
trial to assess the impact of Regular Early
SPEcialist symptom Control Treatment on quality
of life in malignant Mesothelioma “ - RESPECTMeso”
A Phase IIa, Randomized, Double-blind, Placebocontrolled, Parallel Group Study to Assess the
Safety and Efficacy of 28 Day Oral Administration
of BAY 85-8501 in Patients with non-Cystic
Fibrosis Bronchiectasis
Extras
Respiratory
Stroke
Limbs Alive – Monitoring of Upper Limb
Rehabilitation
150
Total
Number of
Patients
Recruited
2014/15
19
5
2
1
20
4
2
1
13
3
Topic/
Specialty Group
Study Title
A Very Early Rehabilitation Trial - A Phase III,
multi-centre, randomised controlled trial of very
early rehabilitation after stroke
RATULS: Robot Assisted Training for the Upper
Limb after Stroke
Reading comprehension in aphasia: The develop
ment of a novel
assessment of reading comprehension
Total
Number of
Patients
Recruited
2014/15
1
1
1
The number of patient receiving relevant health services provided or subcontracted by
South Tyneside NHS Foundation Trust in 2014/15 that were recruited during that period
to participate in research approved by a research ethics committee 438.
151
Research Performance Metrics
In the 2011 ‘Plan for Growth’ the Government outlined the need for a dramatic and sustained improvement in the performance of
providers of NHS Services in initiating and delivering clinical research and outlined two benchmarks against which all NHS providers
would be measured
Performance in Initiating Clinical Trials
The performance in initiating clinical trials benchmark monitors 70 days from receipt of a valid research application to recr uitment of
the first participant in the trial. This data has to be submitted to the NIHR on a quarterly basis. The data outlined in the table below
outlines our performance in the first three quarters of 2014/15, during this time South Tyneside opened 8 clinical trials achieving the 70
day benchmark for 6 trials. The data for the last quarter will be submitted to the NIHR on 1 st May 2016.
Name of Trial
(FACT) Effect of folic acid
supplementation
in
pregnancy on preeclampsia
– Folic Acid Clinical Trial – A
randomised,
double-blind,
placebo-controlled, Phase III,
international
multi-centre
study of 0.4mg Folic Acid
supplementation
in
pregnancy
to
for
the
prevention of preeclampsia
(FIND-UC)
Endoscopic
tromdal
imaging
vs
chromoendoscopy
as
surveillance
strategy for
neoplasia in ulcerative colitis
(CRYSTAL) A prospective,
multi-centre,
12-week,
randomised open-label study
Date of
Receipt of
Valid
Research
Application
08/04/2014
Date of NHS
Permission
First Patient
Recruited?
Date of First
Patient
Recruited
Duration
between VRA
and NHS
Permission
Duration
between
VRA and
First Patient
Comments
14
Duration
between NHS
Permission
and First
Patient
35
22/04/2014
Yes
27/05/2014
49
Benchmark
achieved
28/04/2014
07/05/2014
Yes
27/05/2014
9
20
29
Benchmark
achieved
29/05/2014
03/06/2014
Yes
16/06/2014
5
13
18
Benchmark
achieved
152
Name of Trial
to evaluate the efficacy and
safety of glycopyrronium (50
mg od) in indacterol and
glycopyrronium
bromide
fixed-dose
combination
(110/50 mg od) regarding
symptoms and health status
in patients with moderate
chronic
obstructive
pulmonary disease (COPD)
switching from treatment with
any
standard
COPD
programme.
(RESPONSE) A randomised,
double-blind,
multi-centre,
placebo-controlled study to
evaluate the efficacy, safety,
and tolerability of NT100 in
pregnant women with a
history
of
unexplained
recurrent pregnancy loss
(RPL)
(RESPECT-MESO) A multicentre,
double-blind,
randomised controlled trial to
assess the impact of Regular
Early SPecialist Symptom
Control Treatment on quality
of
life
in
malignant
Mesothelioma
(ORBIT-3) A multi-centre,
randomised,
double-blind,
placebo-controlled study to
evaluate the safety and
efficacy of Pulmaquin® in the
Date of
Receipt of
Valid
Research
Application
Date of NHS
Permission
First Patient
Recruited?
Date of First
Patient
Recruited
Duration
between VRA
and NHS
Permission
Duration
between NHS
Permission
and First
Patient
Duration
between
VRA and
First Patient
Comments
16/06/2014
19/06/2014
Yes
24/06/2014
3
5
8
Benchmark
achieved
09/06/2014
18/06/2014
No
9
147
156
17/07/2014
22/07/2014
Yes
5
105
110
Benchmark
not
achieved –
no meso
patients
seen. 1st
patient
recruited
Benchmark
not
achieved –
patient
consented
31/07/2014
153
Name of Trial
management of chronic lung
infections with pseudomonas
aeruginosa in subjects with
non-cystic
fibrosis
bronchiectasis, including 28
day open-label extension
and pharmacokinetic substudy
SIPs Jnr RCT – Developing
and
evaluating
alcohol
screening and interventions
for
adolescents
in
emergency departments
ADENOMA
Study
–
Accuracy of Detection using
Endocuff Optimisation of
Mucosal Abnormalities
Date of
Receipt of
Valid
Research
Application
Date of NHS
Permission
First Patient
Recruited?
Date of First
Patient
Recruited
Duration
between VRA
and NHS
Permission
Duration
between NHS
Permission
and First
Patient
Duration
between
VRA and
First Patient
Comments
within 30
days but
subsequent
ly not
eligible.
14/10/2014
16/10/2014
Yes
31/10/2014
2
18/11/2014
24/11/2014
Yes
24/11/2014
6
154
15
17
Benchmark
achieved
6
Benchmark
achieved
Performance in Delivering Industry Trials
The performance in delivering clinical trials benchmark measures recruitment of the target number of patients within the agreed time
(recruitment to time and target) for all industry studies. South Tyneside recruited to 6 industry studies, 5 of which were new industry
studies. All trials are still actively recruiting so it is not yet possible to say if time and target was achieved. The data outlined in the
table below outlines our performance in the first three quarters of 2014/15 during which we opened three new industry studies.
Name of Trial
Target
number of
patients
available
Target
Number of
patients
Date Agreed
to recruit
target
number of
patients
Trial Status
8
Date Agreed
to recruit
target
number of
patients
available
Yes
A prospective, multi-centre, 12-week, randomised open-label study to
evaluate the efficacy and safety of glycopyrronium (50 mg od) in indacterol
and glycopyrronium bromide fixed-dose combination (110/50 mg od)
regarding symptoms and health status in patients with moderate chronic
obstructive pulmonary disease (COPD) switching from treatment with any
standard COPD programme (CRYSTAL).
A randomised, double-blind, multi-centre, placebo-controlled study to
evaluate the efficacy, safety, and tolerability of NT100 in pregnant women
with a history of unexplained recurrent pregnancy loss (RPL) (RESPONSE)
A multi-centre, randomised, double-blind, placebo-controlled study to
evaluate the safety and efficacy of Pulmaquin® in the management of
chronic lung infections with pseudomonas aeruginosa in subjects with noncystic fibrosis bronchiectasis, including 28 day open-label extension and
pharmacokinetic sub-study (ORBIT-3)
Yes
11/06/2015
Open
Yes
5
Yes
15/02/2015
Open
Yes
3
Yes
31/03/2015
Open
155
Research Management and Governance (approval targets)
The Research & Development Team have approved 25 portfolio studies in 2015/16, 23
studies (92%) achieved the 15 day approval target. In addition 4 non-portfolio studies
were approved and 6 service evaluations have been processed by the Research &
Development Team.
156
2.5 Commissioning for Quality and Innovation (CQUIN) Payment Framework
A proportion of South Tyneside NHS Foundation Trust’s income in 2014/15 was
conditional upon achieving quality improvement and innovation goals agreed
between South Tyneside NHS Foundation Trust and any person or body they
entered into a contract, agreement or arrangement with for the provision of NHS
services, through the Commissioning for Quality and Innovation (CQUIN) Payment
Framework.
Further details of the agreed goals for 2014/15 and for the following 12 month
period are available at: www.stft.nhs.uk
The monetary total for the amount of income in 2014/15 conditional upon achieving
quality improvement and innovation goals is £3,486,317. The monetary total for the
associated payment in 2013/14 was £4,151,425.
Final reconciliation shows that for the full year we will have achieved over 98% for
the scheme.
157
158
2.6
Information on Care Quality Commission (CQC) Registration
South Tyneside NHS Foundation Trust is required to register with the Care Quality
Commission and its current registration status is registration in full, with no conditions. The
Care Quality Commission has not taken any enforcement action against South Tyneside
NHS Foundation Trust during 2014/15.
Activities that the trust is registered to carry out:









Accommodation for persons who require nursing or personal care
Diagnostic and screening procedures
Family planning services
Maternity and midwifery services
Nursing care
Personal care
Surgical procedures
Termination of pregnancies
Treatment of disease, disorder or injury
The South Tyneside NHS Foundation Trust has participated in special reviews or
investigations by the Care Quality Commission relating to the following areas during 2014/15.
 Review of health services for Looked after Children and Safeguarding in
Gateshead. This was a focused inspection which provided a narrative outcome
report reflecting the experiences of children and young people: making
recommendations for improvement rather than giving a rating.
South Tyneside NHS Foundation trust intends to take the following action to address the
conclusions or requirements reported by CQC:
 Support the development of a multi-agency action plan
South Tyneside NHS Foundation trust has made the following progress by 31 st March 2015
in taking such action:
 The action plan is now in place.
Further information about our registration status can be found at www.cqc.org.uk
159
2.7 Customer Services
In 2014/15 a total of 210 people raised formal complaints with us as indicated below:
Q1
Q2
Q3
Q4
Total
2014/15
52
65
35
58
210
2013/14
60
73
42
46
221
2012/13
71
71
68
71
281
2011/12
64
57
55
71
247
2010/11
72
55
60
48
235
2009/10
70
77
60
70
277
During 2014/15 a total of 6 complainants referred their complaints to the Parliamentary and
Health Services Ombudsman.
To date, 5 reviews have been concluded by the Ombudsman, 4 with no case to answer and 1
with further actions recommended over and above those already taken by the Trust. These
actions are currently being carried out. We are awaiting the outcome of the one remaining
case.
2.8
Information on Data Quality
Good quality information underpins sound decision making at every level in the NHS and
contributes to the improvement of health care.
South Tyneside NHS Foundation 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 from months April 2014 to November 2014
are:
The percentage of records which included the patient’s valid NHS number was:



99.7% for admitted patient care;
99.9% for outpatient care and
99.2% for accident and emergency care
Valid General Practitioner Registration Code was:



100% for admitted patient care;
100% for outpatient care and
100% for accident and emergency care
During the year the Trust was selected along with over 40 other Trusts to be part of the
National Referral to Treatment Waiting List Data Validation Programme. This work identified
a number of recommendations for improvement nationally, as well as operational and training
issues within the Trust. The Programme identified a number of data quality issues,
particularly within the Patient Tracking List which the Trust acted upon towards the end of the
year.
160
2.9
Information Governance Assessment Report
South Tyneside NHS Foundation Trust Information Governance Assessment Report overall
score for 2014/15 was 79% and was graded green.
To facilitate our commitment to the better sharing of patient information, we have initiated two
new programmes of work which will run for most of the next three years. These programmes
will:

Deploy a new Electronic Patient Record (EPR) into community healthcare, based on
EMIS Web and including mobile working for staff such that Community and GP data
will be shared, and the quality of data captured will be driven up capture occurs at
point of treatment.

Deliver application integration across Health and Social Care in South Tyneside to
facilitate integrated ways of working with Council staff, as well as other HealthCare
organisations such as Northumberland Tyne and Wear NHS Foundation Trust.
In addition the Trust has continued to invest in delivering its Information Technology Strategy,
continuing to extend the use of electronic whiteboards and electronic discharge solution.
In progressing actions against the data quality plan we particularly expect to see further
progress from:

Extending the digital referral and reporting system to cover new services currently
requested on paper. This will have both an increase in the quality of service delivery
and in the quality of data gathered and recorded.

The Trust will invest in mobile technology for community nursing services, which in
conjunction with the community electronic patient record will allow patient care to be
recorded at time of the event even in the patient’s home.
2.10 Information on Clinical Coding
South Tyneside NHS Foundation Trust was not subject to the Payment by Results clinical
coding audit during 2014/15 by the Audit Commission.
Audits conducted during 2014/15 have been undertaken in accordance with the HSCIC
Clinical Classifications Service Clinical Coding Audit Methodology 2014/15 Version 8.0.
During the reporting period the error rates reported in the latest audit report for that period for
diagnoses and treatments coding (clinical coding) were:




Primary Diagnoses Incorrect
Secondary Diagnoses Incorrect
Primary Procedures Incorrect
Secondary Procedures Correct
161
10.00%
16.80%
6.87%
9.68%
All episodes within the audit sample were identified from:




Ambulatory Care discharges;
General Surgery specialty;
Trauma and Orthopaedics specialty; and
Where a sign or symptom code (R code) was a primary diagnosis
The results of the coding audits should not be extrapolated further than the actual sample
audited. South Tyneside NHS Foundation Trust will be taking the following actions to
improve data quality. We have developed an action plan on the basis of the
recommendations made in the audit report. Our plan supports continuous improvement in
the accuracy of our coding. We have begun work to improve the coding of patients in the St.
Benedict’s Hospice in Sunderland; this has been identified as a contributory factor to our
“SHMI” mortality rate, and we will mirror the assurance processes that are used in the coding
within the acute hospital.
162
2.11
Reporting Against Core Quality Indicators
The value and banding of the Summary Hospital-level
Mortality Indicator (SHMI) for the Trust
Measure:
Band 2 “as expected”
Jul 2013 – June
Apr 2013 – Mar
2014
2014
STFT Value:
STFT Value:
115.1
115.1
STFT without
STFT without
Hospice:
Hospice:
99.3
99.2
STFT Band:
STFT Band:
1
1
Highest National:
Highest National:
119.8
119.7
Lowest National:
Lowest National:
54.1
53.9
Target:
Oct 2013 – Sep
2014
STFT Value:
118.3
STFT without
Hospice:
Not Available
STFT Band:
1
Highest National:
119
Lowest National:
59.0
Jan 2013 – Dec
2013
STFT Value:
110.6
STFT without
Hospice:
95.9
STFT Band:
2
Highest National:
117.6
Lowest National:
62.4
SHMI is a ratio of the observed number of deaths to the expected number of deaths
for a provider. The observed number of deaths is the total number of patient
admissions to the hospital which resulted in a death either in hospital or within 30
days post discharge from the hospital.
South Tyneside NHS Foundation Trust considers that this data is as described for
the following reasons. The table above demonstrates our SHMI values and
bandings over several reporting periods. The data shows that until recently we
have consistently been banded at level 2 which suggested that our mortality rates
were ‘as expected’.
We have identified that the SHMI value for STFT is affected by the management of
St Benedict’s Hospice in Sunderland. If the data concerning those hospice patients
was removed from the SHMI calculation, the most recent data suggests that the
Trust SHMI value is ‘99’. The deterioration to a band 1 state has been discussed
with commissioners and NHS England, and can again be linked to St Benedict’s,
specifically the increase in the number of beds in a newly built facility, and the
reduction in admissions to the acute hospital.
South Tyneside NHS Foundation Trust intends to take the following actions to
improve this indicator, and so the quality of its services. Our Mortality Review
Group is responsible for scrutinising mortality and the work of individual
departmental mortality measures. Patient deaths are reviewed to identify any
concerns or areas where care could be improved in the future. The Mortality
Review Group also regularly audits the main mortality types included with the SHMI
calculation. These audits provide assurance and form the basis for further
investigations during the year by consultants in each area.
Data
Source

CHKS
https://indicators.ic.nhs.uk/webview/
163
Measure:
The percentage of patient deaths with palliative care
coded at either diagnosis or specialty level for the Trust
Band 2 “as expected”
Jul 2013 – June
Apr 2013 – Mar
Oct 2013 – Sep 2014
2014
2014
STFT Value:
STFT Value:
STFT Value:
Not Available
26.1
27.4
Highest National:
Highest National:
Highest National:
Not Available
49
48.5
Lowest National:
Lowest National:
Lowest National:
Not Available
0.0
0.0
Target:
Jan 2012 – Dec
2012
STFT Value:
26.6
Highest National:
46.9
Lowest National:
1.3
South Tyneside NHS Foundation Trust considers that this data is as described for
the following reasons. Some acute Trusts including ours provide specialist
palliative care inpatient services within designated wards, or within the community.
This potentially affects the SHMI value and means that it may be difficult to
compare one Trust with another.
The South Tyneside NHS Foundation Trust intends to take the following actions to
improve this indicator, and so the quality of its services:
Our Mortality Review Group is responsible for scrutinising mortality and the work of
individual departmental mortality measures. Patient deaths are reviewed by the
group to identify any concerns or areas where care could be improved in the future.
Our mortality data and SHMI rating is affected by the fact that our trust provides
specialist palliative care to the people of Sunderland and the surrounding areas at
St Benedict’s Hospice.
Data Source

CHKS

https://indicators.ic.nhs.uk/webview/
164
Measure
Patient Reported Outcome Measures (PROMS)
Value = EQ-5D
Varicose Vein
Surgery
Hip
Replacement
Surgery
Knee
Replacement
Surgery
Groin Hernia
Surgery
2014/15
2013/14
Trust Score:
N/A
N/A
National Average:
53.8
51.8
Trust Score:
Data Censored
82.9
National Average:
90.0
89.3
Trust Score:
Data Censored
77.9
National Average:
82.2
81.4
Trust Score:
47.1
56.3
National Average:
50.2
50.6
South Tyneside NHS Foundation Trust considers that this data is as described for
the following reasons. Varicose vein procedures is not a routine operation at STFT
and none were carried out during this reporting period. The number of hip and
knee replacement questionnaire pairs returned for STFT has been censored due to
small numbers. This is to protect patient confidentiality.
South Tyneside NHS Foundation Trust intends to take the following actions to
improve PROMs performance, and so the quality of its services. We will continue
to look specifically at the actual health gains from a pre-operative to post-operative
position. In an effort to mitigate the lack of feedback from the PROMs process the
orthopaedic department is committed to implementing the EQ-5D evaluation which
is the underpinning principle behind PROMs.
This is an integral part in the planned, “Enhanced Discharge Programme”
implemented within the Department during 2014-15. Patients throughout their
journey have their outcomes assessed using the EQ 5D principle, this is a live
process which will provide accurate feedback on the progress outcomes of patients
based on their feeling of their health.
Data
Source
HSCIC: http://www.hscic.gov.uk/proms
165
The percentage of patients aged:
- 0 to 15
- 16 or over
readmitted to a hospital which forms part of the Trust within 30
days of being discharged from a hospital which forms part of
the Trust.
Measure
Age 0 to 15
Age 16+
2013/14
2014/15
Readmission Rate
5.8%
5.8%
Peer Readmission Rate
8.4%
8.3%
Readmission Rate
5.7%
5.5%
Peer Readmission Rate
7.0%
6.9%
South Tyneside NHS Foundation Trust considers that this data is as described for the
following reasons. In order to demonstrate our performance for 30 day readmissions
against the national context, we have provided a comparison with data extracted from
the CHKS database. CHKS is a healthcare intelligence provider with whom a large
number of Trusts are registered nationally. The peer group shown in the table above
includes all registered CHKS Trusts.
South Tyneside NHS Foundation Trust has taken the following actions to improve this
readmission rate, and so the quality of its services, by showing that the data has been
provided for the last two reporting periods and demonstrates that our Trust compares
favourably with the peer group readmission rates in both age groups.
We continue to work with partner organisations in improving the resilience of the
systems across South Tyneside to reduce readmissions to hospital. A number of new
projects were implemented over the winter period, including enhancing rehabilitation
services.
It should be noted that the required core indicator within the Quality Accounts is
readmission within 28 days, however, the indicator that is currently reported to the
Board and Commissioners as above is 30 days and is based upon the National Tariff
Payment System definition. The 30 day indicator is calculated where the time between
discharge from the initial admission and readmission is equal or less than 30 days and
allows for additional exclusions that are not permitted under the Quality Accounts
definition. Performance in 2014/15 on 28 day readmissions is included on page 178.
Data Source
Data source: CHKS
166
Measure
Responsiveness to Patient Need
Survey of Adult Inpatients 2014 versus 2013
The South Tyneside NHS Foundation Trust considers that this data is as described for
the following reasons. The National Inpatient Survey is part of the NHS Patient Survey
Programme. The Trust was one of 78 organisations that commissioned Picker Institute
to undertake the 2014 National Inpatient Survey. A total of 850 patients from the Trust
were sent a questionnaire. 831 patients were eligible for the survey, of which 323
returned a completed questionnaire, giving a response rate of 39%. This is a 4%
increase in response rate compared to the 2013 survey. A total of 60 questions were
used in both the 2012 and 2013 surveys. This increased to 86 questions in the 2014
survey.
The survey results have indicated that we maintained good performance in
comparison with the previous year in the majority of areas, but have identified areas
for improvement in the information we provide to patients who are being discharged
from hospital, delays in hospital discharge and opportunities for people to rate the
quality of their experience and care. It is however very encouraging to note that we
performed significantly better than other organisations in nineteen of the indicators
people rated. These included privacy, respect and dignity, confidence in staff, trust
and involvement in decision-making about people’s treatment and care.
The South Tyneside NHS Foundation Trust intends to take the following actions to
improve this indicator, and so the quality of its services. We will continue to participate
in and measure our progress via the Annual Inpatient Survey. The next steps are to
develop an action plan to promote improvement where needed and to sustain the
areas of excellent practice. This process is now established as part of our standard
operational processes and going forward, assurance will be provided via reports to our
Executive Board.
Data Source
http://www.cqc.org.uk/provider/RE9/survey/3
167
Measure
The percentage of staff employed by, or under contract to, the trust
who would recommend the Trust as a provider of care to their family
or friends
South Tyneside NHS Foundation Trust considers that this data is as described for the
following reasons. The Annual National NHS Staff Survey asked all respondents
whether they would recommend our Trust to family and friends as a provider of care.
168
The results of the survey over the last two reporting periods demonstrate that we are
in line with the national average for this indicator. The results are reported as both
percentage scores and also as ‘scale summary’. Scale summary scores are
calculated by converting staff responses to particular questions into scores. For each
of these scale summary scores, the minimum score is always 1 and the maximum
score is 5.
South Tyneside NHS Foundation Trust intends to take the following actions to
improve this score, and so the quality of its services. We will continue to work as a
team to embed a culture of leadership which is founded upon compassionate, safe
and transparent care. In 2014 we launched our Choose to Lead Strategy. This sets
out South Tyneside NHS Foundation Trust’s (STFT) leadership development strategy
for 2014 to 2016 and incorporates the clinical leadership framework.
Data
Source
Measure
http://www.nhsstaffsurveys.com/Page/1019/Latest-Results/StaffSurvey-2014-Detailed-Spreadsheets/
The percentage of patients who were admitted to hospital and who
were risk assessed for venous thromboembolism
Value
2014/15
2013/14
Trust
Score
97.6%
95.01%
96%
96%
National
Average
South Tyneside NHS Foundation Trust considers that this data is as described for the
following reasons. All Trusts are required to report the proportion of documented VTE
risk assessments being conducted as a percentage of all admitted patients. The DH
national target requires that at least 90% of all admitted patients should receive a VTE
risk assessment. In 2014/15 we exceeded the national average.
South Tyneside NHS Foundation Trust intends to take the following actions to
improve this indicator/percentage and so the quality of its services. We intend to
continue to lead nationally in terms of VTE prevention through our Choose Safer Care
programme of work
Data
Source
http://www.england.nhs.uk/statistics/statistical-work-areas/vte/vte-riskassessment-2014-15/
169
Measure
The number, and where available, rate of patient safety incidents
reported within the Trust
01-10-14 to
31-03-15
01-04-14 to
30-09-14
01-10-13 to
31-03-14
01-04-13 to
30-09-13
Number (Rate
per 1,000 Bed
Days)
Number (Rate
per 1,000 Bed
Days)
Number (Rate
per 1,000 Bed
Days )
Number (Rate
per 100
Admissions)
Trust
Not Available
2,253 (38.52)
2,249 (37)
1,748 (9.39)
National
Average
Not Available
4,196 (35.9)*
2,185 (33.3)
2,052 (8.13)
Highest
Not Available
12,020 (74.96)
3,790 (74.9)
4,301 (17.1)
Lowest
Not Available
35 (0.24)
301 (5.8)
908 (3.9)
Period
n.b. Reported against Acute non-specialist hospitals. Data for 01/10/14 to 31/03/15
expected to be available September 2015
Measure
The number, and percentage of such patient safety incidents that
resulted in severe harm or death
Trust
Not Available
National
Average
Not Available
Highest
Lowest
10 (0.4%)
5 (0.2%)
7 (0.4%)
10.18 (0.60%)
7.64 (0.4%)
Not Available
74 (74.3%)
59 (7%)
56 (3.33%)
Not Available
0 (0%)
0 (0%)
0 (0%)
7.45 (0.40%)
South Tyneside NHS Foundation Trust considers that this data is as described for the
following reasons. The Trust actively promotes a culture in which the reporting of
incidents, errors and near misses is encouraged and used as a mechanism towards
improving the safety of our patients.
South Tyneside NHS Foundation Trust has taken the following actions to improve this
indicator, and so the quality of its services. All patient safety incidents are reported
electronically via the National Reporting and Learning System (NRLS) to the National
Patient Safety Agency (NPSA) which ensures that lessons from adverse incidents in
one locality are learned across the NHS as a whole. We believe and are committed
to the delivery of health care services of the highest quality where risks to patients,
staff and visitors are minimised.
Data
Source
http://www.nrls.npsa.nhs.uk/resources
170
Maximum Waiting Time of 62 days From Urgent GP Referral to
First Treatment for All Cancers
Measure
South Tyneside NHS Foundation Trust considers that this data is as described for
the following reasons. The chart above highlights our performance in 2014/15.
National guidance on improving outcomes indicates that over 85% of patients
should receive their first definitive treatment for cancer within two months (62-days)
of an urgent referral for suspected cancer. Our results for 2014-15 demonstrate
that we have reached or exceeded the 85% national target across the year.
The South Tyneside NHS Foundation Trust has taken the following actions to
improve this indicator, and so the quality of its services. In our previous quality
reports we have highlighted the challenge faced in terms of achieving this target.
This is largely due to the low numbers of patients through the Trust who count
towards the indicator, and the fact that we work collaboratively which means that
we would share a breach with the tertiary provider if a patient begins their journey
with the Trust. This in effect means that more than two breaches per month would
likely result in failure of this target.

Data
Source
Connecting for Health National Cancer Waiting Times Database:
http://www.connectingforhealth.nhs.uk/nhais/cancerwaiting

Open Exeter database
171
Measure
The rate per 100,000 bed days of cases of C. Difficile infection
reported within the Trust amongst patients aged 2 or over
Value
2014/15
2013/14
Trust Score:
National
Average:
Highest
National:
Lowest
National
7.8
12.2
Not Available
14.7
Not Available
37.1
Not Available
0
South Tyneside NHS Foundation Trust considers that this data is as described for
the following reasons. In 2014/15 we had 9 cases of Clostridium Difficile infection
against a target of 10. To set this in context, the above chart shows that the rate of
infection reported at South Tyneside NHS Foundation Trust compares extremely
favourably with the national average. The data demonstrates that we have
consistently reported below the national average of reported cases whilst also
ranking amongst the most effective healthcare providers for this indicator.
The chart below demonstrates our progress against our targets over several
reporting periods.
South Tyneside NHS Foundation Trust intends to take the following actions to
improve infection control rates, and so the quality of its services. Our Infection
Prevention and Control Team will continue to work alongside our hospital and
community teams to provide and monitor good practice in order to achieve the
targets set in all local patches.
Data
Source

https://www.gov.uk/government/statistics/clostridiumdifficile-infection-annual-data
172
3
An Overview of the Quality of Care
The data set below is included in our monthly performance report to the Trust Board. The indicators have been selected by ou r
board and key stakeholders on the basis that any non-compliance would adversely affect patient safety, clinical effectiveness and
patient experience. Many of these indicators are also either operational standards, or national or local quality requirements of the
NHS Standard Contract. Part three contains performance against national key priorities that have not already been reported in part
two.
3.1
Quality of Care Data
Patient Safety
Indicator 1
Fractured Neck
of FemurPatients
Operated on
Within 36 Hours
of Admission
Data Source
Internal
Integrated
Performance
Dashboard
Data Standard
Average
2013-14
Target
2014-15
Quarter 1
Average
Quarter 2
Average
Quarter 3
Average
Quarter 4
Average
Average
2014-15
75.6%
> 75%
73.2%
79.9%
76.4%
82.9%
78.1%
NICE CG124
As per 2014-15
NHS Standard
Contract
Average
National Hip
fracture
71.7%
Database
This is a quality requirement within the NHS Standard Contract. Fracture neck of femur (NOF) is associated
with significant morbidity and an estimated one-year mortality of 30%.
National Data
Reason for
Selection
173
Patient Safety
Indicator 2
Ambulance
Handover Time
in A&E (%
recorded using
handover
screens)
Reason for
Selection
Patient Safety
Indicator 3
Staff
Turnover
Stability of
Turnover
Relating to
Staff with >1
year of
Service.
Reason for
Selection
Data Source
Data Standard
Internal
Integrated
Performance
Dashboard
As per 2014-15
NHS Standard
Contract
Average
2013-14
Target
2014-15
Quarter 1
Average
Quarter 2
Average
Quarter 3
Average
Quarter 4
Average
Average
2014-15
76%
>90%
76.4%
75.3%
67.7%
60.8%
70.1%
This is a quality requirement within the NHS Standard Contract. In the majority of cases handovers happen
smoothly and are well managed, but it is recognised that there are still areas where dedicated work is
needed to reduce delays and improve the service offered to patients. Handover start time is defined as the
time of arrival of the ambulance at the accident and emergency department, with the end time defined as the
time of handover of the patient to the care of accident and emergency staff. The performance of the Trust
has been validated by the commissioners, and it is recognised that the number of non-NEAS ambulances
used to transport patients to our A&E department affects the maximum possible performance. We continue
to work with commissioners to understand where performance can be improved.
Data Source
Data Standard
Internal
Workforce
Performance
Dashboard
Local HR
Strategy
Average
2013-14
Target
2014-15
90.3%
90%
Average
2014-15
89.8%
This performance indicator is presented on a monthly basis to the Executive Board. There is a nationally
accepted and growing body of evidence that patient outcomes are linked to whether or not organisations have
the right people , with the right skills, in the right place at the right time. Following the publication of the report of
the Mid-Staffordshire NHS Foundation Trust Public Inquiry and the Keogh Reviews into 14 trusts with higher
than expected mortality levels, the importance of NHS Trusts making the right decisions with regard to safe
staffing levels is coming under increasing scrutiny. Staff turnover has a direct impact on staffing levels.
‘Turnover’ includes statistics on joiners to and leavers from the Trust within a specific time period based on
174
Patient Safety
Indicator 3
Clinical
Effectiveness
Indicator 1
Breastfeeding
Initiation
Reason for
Selection
Average
Target
Average
2013-14 2014-15
2014-15
headcount. There has again been a significant number of staff leave the Trust under TUPE legislation following
the loss of contracts to other providers i.e. Minor Injury Units in Sunderland, Substance Misuse in Gateshead.
The underlying stability is above target.
Data Source
Data Standard
Data Source
Data Standard
Average
2013-14
Target
2014-15
Quarter 1
Average
Quarter 2
Average
Quarter 3
Average
Quarter 4
Average
Average
2014-15
NHS England
Statistical Work
Areas / Maternity
& Breastfeeding
55.4%
>56.8
54.7%
48.4%
47.6%
52.1%
50.7%
Internal
Integrated
Performance
Dashboard /
Vital Signs
Monitoring
Report
Average
73.5%
Min
National Data
39.3%
Max
92.2%
This is a local quality requirement within the NHS Standard Contract. Breastfeeding has many health benefits
for both the mother and infant. To reduce infant mortality and ill health, WHO recommends that mothers first
provide breast milk to their infants within one hour of birth – referred to as “early initiation of breastfeeding”. This
ensures that the infant receives the colostrum (“first milk”), which is rich in protective factors. We continue to
work with mothers in both Maternity services and Health Visiting to improve initiation and maintenance of breast
feeding rates. South Tyneside Council have continued the funding of a Public Health Midwife into 2015/16 and
this will again contribute to identifying opportunities to improve practice.
175
Clinical
Effectiveness
Indicator 2
Improving
Access to
Psychological
Therapies –
Moving to
Recovery
Data Source
Data Standard
Average
2013-14
Target
2014-15
Quarter 1
Average
Quarter 2
Average
Quarter 3
Average
Quarter 4
Average
Average
2014-15
Internal
Integrated
Performance
Dashboard
http://www.hscic.
gov.uk/iapt
52%
50%
54.5%
53.5%
54.7%
55.4%
54.6%
Jan
45.1%
This is a local quality requirement within the NHS Standard contract. Improving Access to Psychological
Therapies (IAPT) is an NHS programme rolling out services across England offering interventions approved
by the National Institute of Health and Clinical Excellence (NICE) for treating people with depression and
anxiety disorders. The IAPT programme is designed to support the NHS in delivering a number of goals
including increased health and well-being, with at least 50% of those completing treatment moving to recovery
and most experiencing a meaningful improvement in their condition. The IAPT Data Standard constitutes a
framework through which patient recovery is recorded and monitored.
Performance in both of our services - Gateshead and South Tyneside - has exceeded national targets in
2014/15 and seen both recognised nationally. Targets for waiting times and access numbers has also
exceeded their respective national targets.
National Data
Reason for
Selection
Clinical
Effectiveness
Indicator 3
Health Visitor
Numbers –
Additional
Numbers
Employed
Reason for
Data Source
Data Standard
Average
2013-14
Target
2014-15
Quarter 1
Average
Quarter 2
Average
Quarter 3
Average
Quarter 4
Average
Average
2014-15
Health Visitors
Internal
Minimum Dataset
Integrated
(Health and
174.8
180.0
177.4
175.9
179.5
179.3
178.0
Performance
Social Care
Dashboard
Information
Centre)
The Health Visitors Minimum Data Set has been set up to help support the government's commitment to
176
Selection
Clinical
Effectiveness
Indicator 4
Proportion of
Patients Who
Spend More
than 90% of
Their In-patient
Stay on a Stroke
Unit.
Reason for
Selection
improve the health visiting service and recruit 4,200 more health visitors nationally by 2015. Our internal data
is submitted to the Health and Social Care Information Centre (HSCIC), via the Omnibus Survey. A registered
Health Visitor refers to a qualified nurse/midwife who is also registered on the third part of the register as a
Health Visitor.
The actual number of staff employed fluctuates as leavers and new starters occur each month. However the
underlying position was that we achieved the target.
Data Source
Data Standard
Average
2013-14
Target
2014-15
Quarter 1
Average
Quarter 2
Average
Quarter 3
Average
Quarter 4
Average
Average
2014-15
Internal
Integrated
Performance
Dashboard
National Stroke
Strategy
NICE QS2
VSMR Guidance
85%
80%
59%
73%
80%
58%
67%
Over the last 20 years evidence has accumulated which will allow more effective primary and secondary
prevention strategies for stroke patients. We are now more able to recognise people at the highest risk and
who are most in need of active intervention. There is also now good evidence to support interventions and
care processes in stroke rehabilitation. In the UK, the National Sentinel Stroke Audits have documented
changes in secondary care provision over the last 10 years, with increasing numbers of patients being treated
in stroke units, more evidence-based practice, and reduced mortality and length of hospital stay. In addition
to other measures, Trusts are assessed by the proportion of stroke patients who spend more than 90% of
their in-patient stay on a stroke unit.
Performance in quarter 4 was particularly affected by pressures on bed availability across the wider hospital.
This restricted the ability to ensure stroke patients moved directly to the unit from A&E.
The data above has been recalculated at the year end from a revised data set. The actual performance
against target may therefore differ to what was reported to the Board during the year.
177
Patient
Experience
Indicator 1
Data Source
Cancellation of
Elective
Operations
Internal
Integrated
Performance
Dashboard /
Unify2
Data
Standard
Total
2013-14
Target
2014-15
Quarter
1
Quarter
2
Quarter
3
Quarter
4
Total
2014-15
81
0
23
13
55
105
196
National
Standard
Department
of Health
(DH)
Average 123
Min 0
Max 648
This is a national operational standard requirement within the NHS Standard Contract. Cancelled operations
are a waste of resources and time. They bring the additional administrative burden of re-scheduling
appointments or a blank theatre slot. They are distressing and inconvenient for patients, and when the
patients themselves cancel operations, they can also be problematic for the hospital. Identifying the different
type of cancellations, understanding the reasons and then tackling them appropriately, improves the
throughput of patients along the patient pathway.
Department of Health (DH) guidelines say that patients who have their operation cancelled (for a non-clinical
reason) on the day of surgery should be readmitted within 28 days. If a patient has not been treated within 28
days of a cancellation then this is recorded as a breach of the standard and the patient should be offered
treatment at the time and hospital of their choice. There were no patients at STFT who were not offered an
alternative date within 28 days during this reporting period.
Performance in quarter 3 and quarter 4 was affected by emergency admission pressures on beds; this
restricted the number of beds available for elective operations. We will continue to work to improve our winter
resilience, in partnership with all other stakeholders in the urgent care pathways, and to improve our
emergency planning for winter.
National
Data
Reason for
Selection
178
Patient
Experience
Indicator 2
Percentage of
Women who
have Seen a
Midwife by 12
Weeks and 6
Days of
Pregnancy
Reason for
Selection
Data Source
Data
Standard
Average
2013-14
Target
2014-15
Quarter
1
Average
Quarter
2
Average
Quarter
3
Average
Quarter 4
Average
Average
2013-14
Internal
Integrated
Performance
National
90.1%
>90%
92.1%
89.6%
91.8%
89.6%
90.7%
Dashboard /
Standard
https://indicat
(DH)
ors.ic.nhs.uk/
webview/
94.2%
National Data
This is a local quality requirement within the NHS Standard contract. All women should access maternity
services for a full health and social care assessment of needs, risks and choices by 12 weeks and 6 days of
their pregnancy to give them the full benefit of personalised maternity care and improve outcomes and
experience for mother and baby. Reducing the percentage of women who access maternity services late
through targeted outreach work for vulnerable and socially excluded groups will provide a focus on reducing
the health inequalities these groups face whilst also guaranteeing choice to all pregnant women.
Patient
Experience
Indicator 3
Data Source
Choose and
Book Slot
Utilisation
Issues
Internal
Integrated
Performance
Dashboard/
Choose and Book
National System
and Reports
Reason for
Selection
This is a quality requirement within the NHS Standard Contract with a target of < 4%.
Patients should always be able to book an appointment at their chosen provider using the Choose and Book
system when the service is a directly bookable service. In order to support this the Trust has a target to
ensure sufficient appointment slots available on choose & book at least 96% of the time. Performance is
measured through data collection relating to slot utilisation issues against a 4% or less target.
Performance was adversely affected by availability of consultants in a small number of clinical specialties.
Additional clinics were put in place and recruitment of medical staff continued.
Data
Average
Standard 2013-14
Choose
and Book
Best
Practice
Guidance
5.2%
Target
2014-15
Quarter
1
Average
Quarter
2
Average
Quarter 3
Average
Quarter
4
Average
Average
2014-15
<4.0%
12.2%
21.3%
14.4%
6.2%
13.7%
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3.2
Key National Priorities 2014/15
The Risk Assessment Framework from Monitor includes key national targets and
thresholds for achievement. The Trust’s performance in 2014-15 against those not
covered elsewhere in this Quality Report is shown below.
Risk Assessment Framework Indicator
A&E: maximum waiting time of four hours from
arrival to admission/ transfer/ discharge
Maximum time of 18 weeks from point of referral
to treatment in aggregate - admitted
Maximum time of 18 weeks from point of referral
to treatment in aggregate – non admitted
Maximum time of 18 weeks from point of referral
to treatment in aggregate – patients on an
incomplete pathway
Cancer: 62-day wait for first treatment from NHS
Cancer Screening service referral
Cancer: 62-day wait for treatment from urgent
GP referral
Cancer:31-day wait for second or subsequent
treatment, comprising surgery
Cancer:31-day wait for second or subsequent
treatment, comprising anti-cancer drug
treatments
Cancer:31-day wait for second or subsequent
treatment, comprising radiotherapy
Cancer: 31-day wait from diagnosis to first
treatment
Cancer: two week wait from referral to date first
seen - all urgent cancer referrals (cancer
suspected)
Cancer: two week wait from referral to date first
seen – for symptomatic breast patients (cancer
not initially suspected)
Certification against compliance with
requirements regarding access to health care for
people with a learning disability
Data completeness: community services –
referral to treatment information
Data completeness: community services –
referral information
Data completeness: community services –
treatment activity information
Target
95%
Actual
94.5%
90%
95.6%
95%
98.7%
92%
95.1%
90%
Comments
See below
Not
Applicable
85%
88.9%
94%
100%
98%
100%
94%
Not
Applicable
96%
100%
93%
95.9%
93%
Not
Applicable
N/A
Compliant
50%
60.8%
50%
75.9%
50%
65.0%
As a result of exceptional winter emergency pressures experienced across all of the
NHS the Trust breached the A&E target in Q3 and Q4 of 2014/15. As a response to
this pressure, the Trust operated on a command and control basis for much of
January and February to ensure patient safety and experience was appropriately
180
maintained. The performance at the start of Q1 has significantly improved and the
Board is confident that the target will be met during 2015/16.
As noted in section 2.8 the National Referral to Treatment Waiting List Data
Validation Programme identified some data quality issues with Referral to Treatment
data. Whilst those identified have been addressed and not all will impact on the
above reported performance the Trust’s External Auditors are unable to provide
assurance on these figures.
The Trust’s performance in 2014-15 on other national indicators not covered
elsewhere in this Quality Report is shown below.
Other National Indicators
Emergency readmissions within 28 days of discharge from
hospital
Actual
12.76%
The above performance is based upon the Quality Accounts definition for emergency
readmissions within 28 days of discharge from hospital. This differs from the
indicator of 30 days reported monthly to the Board of Directors and Commissioners
included on page 163 which is based upon the National Tariff Payment System
definition. The National Tariff Payment System definition is calculated where the
time between discharge from the initial admission and readmission is equal or less
than 30 days and allows for additional exclusions that are not permitted under the
Quality Accounts definition.
181
Annex 1: Statements from commissioners, local Healthwatch
organisations and Oversight and Scrutiny Committees
Where 50% or more of the relevant health services that the NHS Foundation Trust
directly provides or sub-contracts during the reporting period are provided under
contracts, agreements or arrangements with NHS England, the Trust must provide a
draft copy of its quality accounts/report to NHS England for comment prior to
publication
Where this is not the case, a copy must be provided to the clinical commissioning
group (CCG) which has responsibility for the largest number of people to whom the
trust has provided relevant health services during the reporting period for comment
prior to publication and should include any comments made in its published report.
NHS foundation trusts must also send draft copies of their quality accounts/report to
their local Healthwatch organisation and oversight and scrutiny committee for
comment prior to publication.
The commissioners have a legal obligation to review and comment, while local
Healthwatch organisations and OSCs are offered the opportunity on a voluntary
basis.
South Tyneside NHS Foundation Trust made copies of its draft quality account
report available to South Tyneside CCG (as lead commissioner for local CCGs), and
to the OSCs and Healthwatch organisations in South Tyneside, Sunderland and
Gateshead.
182
Feedback on Our 2014/15 Quality Report
Statement from the Commissioners: South Tyneside Clinical Commissioning
Group, Sunderland Clinical Commissioning Group and Gateshead Clinical
Commissioning Group.
Thank you for sharing the Trust’s quality report. The Clinical Commissioning Groups
welcome the opportunity to review and provide commentary on the Quality Account
for 2014/15.
As commissioners, South Tyneside (STCCG), Gateshead (GCCG) and Sunderland
Clinical Commissioning Group (SCCG) are committed to commissioning high quality
services from South Tyneside Foundation Trust (STFT) and take seriously their
responsibility to ensure that patients’ needs are met by the provision of safe, high
quality services and that the views and expectations of patients and the public are
listened to and acted upon.
Throughout 2014/15, the CCGs held bi-monthly clinical quality review group
meetings with the Trust; these meetings were well attended and provided positive
engagement for the monitoring, review and discussion of quality issues. STCCG is
participating in the joint board visits with the Trust, to gain assurance on the quality
of services provided, and is working with the Trust to implement commissioner-led
unannounced assurance visits to monitor the quality of the services provided and to
encourage continuous quality improvement.
The report provides a comprehensive description of quality improvement work within
the Trust and an open account of where improvements in priorities have been made.
We appreciate the amount of work involved in producing this report however it is an
important step in improving public accountability in relation to quality.
The CCGs recognise the work the Trust has achieved to date in the delivery of the
2014/15 priorities and in the on-going delivery of the quality measures. We would like
to congratulate the Trust on its achievement in 2014 in being named as one of the
best places to work in the NHS by the Heath Service Journal, and its positive
leadership strategy in making leadership part of everyone’s role alongside the Board
recommitment to the ‘Hello my name is…’ campaign.
We would like to thank the Trust for working collaboratively with the CCGs regarding
mortality, and acknowledge their open and honest sharing of work carried out to
date, as well as on-going work streams.
The CCGs would like to draw attention to the innovative use of technology across
the Trust, for example the use of e-Rostering and the Safer Care Nursing Tool to
ensure optimum staffing and capability, improving visibility of staffing levels and the
implementation of Key Performance Indicators to ensure nursing establishment
reflects the patient’s needs in terms of acuity and dependency. In addition to this, we
note the investment and commitment by the Trust, to improve data quality and data
sharing between primary and community care as well as Health and Social Care.
183
We recognise the improvements in efforts to engage with staff using a variety of
social media and look forward to receiving further information around outcomes, as
this approach develops. In addition to this it is encouraging to see that staff have
been increasingly involved in the development and delivery of key metrics showing
that the Trust has adopted a ‘Board to Ward’ approach, as well as staff involvement
in Continuous Improvement projects with the resulting benefits shared across the
organisation.
The CCGs acknowledge the assurance provided by the Trust of the robust
processes in place for the investigation of serious incidents and sharing of lessons
learned at team, ward and organisational level, and recognise the improvements
made in key areas as a result of contributory factors in these incidents. It was
disappointing that the report did not also detail improvements made or lessons
learned as a result of patient feedback through complaints, which we note have seen
a year on year reduction since 2012/13.
We would like to congratulate the Trust on the work done to date to improve
transparency and availability of information in the public arena with the publication of
‘Open and Honest Care’, and the use of visibility walls to display safer staffing data
and patient safety metrics across the Trust. The CCGs look forward to receiving the
outcomes of the North East Patient Safety Collaborative initiative to decrease the
number of pressure ulcers by 50%.
The CCGs recognise the improvements made to increase patient engagement within
the Trust in an effort to gather feedback on services, with the introduction of the
CAPI facilitator, although it was disappointing that the report did not highlight any
outcomes or interventions as a result of patient feedback.
South Tyneside, Gateshead and Sunderland CCGs welcome the Trusts specific
priorities for 2015/16 and consider that these are appropriate areas to target for
continued improvements which link to the CCGs commissioning priorities. It was of
particular interest to note that these quality priorities reflect a focus on patient safety,
continuous improvement and transparency. It is also noted that the number of
priorities have been reduced to 4 compared to 10 in 2014/15, which will ensure that
resources will be more focused upon meaningful achievement. The CCGs are
assured that these priorities were developed in conjunction with key stakeholders,
including staff and patients.
Overall the report is well written and presented and is reflective of quality activity
across the organisation. As required under the Quality Report Regulations, staff
within the CCGs have checked the accuracy of data relevant to the contract. In so far
as we have been able to check the factual details, the CCGs view is that the report is
materially accurate. It is clearly presented in the format required by NHS England
and the information it contains accurately represents the Trust’s quality profile.
184
The CCGs look forward to continuing to work in partnership with the Trust to assure
the quality of services commissioned in 2015/16.
Yours sincerely
Ann Fox
Director of Nursing Quality and Safety
South Tyneside CCG
185
Response from Healthwatch Gateshead - 12-05-15
Healthwatch Gateshead – Response to South Tyneside NHS
Foundation Trust Quality Accounts 2014/15
Healthwatch Gateshead welcome the opportunity to comment on the Quality report
for South Tyneside NHS Foundation trust 2014/15.
As a consumer champion we are always looking to see how our local healthcare
providers can learn, improve and build upon patient experience. We are particularly
pleased to see and acknowledge the work undertaken to improve patient feedback
and how the trust is using that feedback to learn and improve its services, with a
clear emphasis on safety.
We acknowledge progress as reported by the trust under many of its priorities. We
are pleased to see that the trust has signed up to the ‘sign up to safety’ campaign
and reports a good track record already of achieving against the five key pledges.
We also acknowledge and support the work being undertaken under priority 10
where key information about safety quality and experience is shared across bedded
areas and community teams.
Overall we are pleased to see how the trust is clearly making good progress in
learning from the experience of their patients and that they have made a
commitment to fully implementing the Duty of Candour requirements under its
priorities for 2015/16
Healthwatch Gateshead
186
Response from Healthwatch South Tyneside 14-05-15
South Tyneside NHS Foundation Trust (the Trust) Quality Report 14/15
Healthwatch South Tyneside (HWST) Response
HWST has noted the introduction of e-rostering and the SCNT tool kit in relation to
safer staffing levels. HWST acknowledges the achievement of the Trust on being
identified as one of the best places to work in the NHS in 2014. HWST welcomes
that the Trust signed up to the “My Name is...” campaign and that its staff embraced
this initiative; HWST considers this will personalise and improve the patient
experience of provision.
HWST is pleased to note that the use of the Safety Thermometer is becoming further
embedded within the Trust’s clinical provision. HWST will be interested to see how
the patient safety dashboard develops and any outcomes from its implementation.
HWST notes the progress in terms of continuous improvement and the ASSURED
methodology that was shared with other Trusts as an NHS innovation.
HWST consider that the Trust investing in new technology will improve information
access for the public and look forward to downloading the Trust App. However
HWST hopes that there will still be “Friends and Family” alternatives available for
those people who are not comfortable with technology.
HWST applaud the inroads the Trust has made with improving staff awareness of
Dementia through “Barbara’s Story”. NHS Change Day sounds like a good
motivational tool and appears to have enhanced staff involvement and development.
HWST is pleased that the Trust has put in place the Fallsafe and SKKIN care
bundles to reduce falls and pressure ulcers respectively as these are highlighted in
the Serious Incidents. HWST hopes to see a corresponding reduction in these as
these become embedded in clinical culture.
HWST note that the Trust has introduced the Care Certificate training and that this
year 20 new starters have been trained.
HWST will be contacting the Trust’s Carer and Patient Involvement Team to look at
how we tie in with them in terms of patient and carer stories. We are also interested
in further looking at how and where the Trust uses assistive technology for patient
feedback.
HWST is disappointed that the training for staff around carer support and awareness
was put on hold this year, even though we appreciate that the LA are producing
training in relation to this.
We are pleased to see that the community safety metrics are now available to
people on line. HWST has noted the research and clinical trials data. The Trust
appears to have performed well against the CQUIN targets.
HWST is unable to comment on: rates of patient safety incidents and rates of patient
safety incidents that resulted in severe harm or death as the figures are not yet
available. The Trust appears to have performed above the key national priorities.
187
HWST looks forward to working with the Trust to continue to improve services for the
people of South Tyneside in 2015/16.
Jan Pyrke, Development Officer, 14th May 2015
188
Response from South Tyneside Council Oversight & Scrutiny Committee
Dear Lorraine
Thank you for giving us the opportunity to comment on your Quality report for
2014/15.
We realise that it has been an extremely difficult year for the Trust, in common with
many others around the country, in dealing with the high numbers of admissions
during the winter. The transfer of specialist palliative care to ward 22 to enable staff
to be seconded to help cope with an increase in emergency admissions illustrated
how difficult it has been to cope with rising demand in busy winter periods. We do
hope that temporary measures such as this do not become more frequent and a
more robust contingency is possible.
We are very excited about the construction of the Integrated Care Hub on the South
Tyneside General Hospital site. This will be a hugely needed focal point for the care
of older people in the Borough, particularly those with Dementia.
However, coupled with plans to move the Walk-in Centre from Jarrow to the General
Hospital site, we are concerned that the extra volume of cars on site will overwhelm
the sites car parks. We would welcome representation from the Trust to our People
Select Committee to explain how this issue is being addressed.
We continue to enjoy a very strong and honest relationship with South Tyneside
Foundation NHS Trust and hope that this continues in the future. In particular we
would like to thank yourself for the respect that you have shown for the democratic
process and wish you well in your future endeavours.
Cllr John McCabe
Response from Sunderland City Council Oversight & Scrutiny Committee
Thank you for the opportunity to comment on your 2014/15 Quality Report which
provides a good account of services and the performance achieved during the past
year.
The experience of Scrutiny Councillors is that the Trust demonstrates a strong
commitment to patient safety and high quality care.
Sunderland Scrutiny Councillors are happy to endorse the priorities set out for
2015/16 in the Trust’s draft Quality Report. In delivering those ambitions, Scrutiny
Members are keen to work with the Trust on areas of joint responsibility; particularly
where change will benefit Sunderland residents.
Overall, we would like to thank you for presenting your report and look forward to a
further year of quality and safety improvements
189
Response from Gateshead Council Oversight & Scrutiny Committee
Based on Gateshead Care, Health and Wellbeing OSC’s knowledge of the work of
the Trust during 2014-15 we feel able to comment as follows:Previously the OSC has sought reassurance that the Trust’s priorities are connected
to Gateshead JSNA and reflect local need and that they receive more information
about community services being provided for Gateshead residents.
The OSC acknowledges the efforts of the Trust to provide information to the OSC
about community services in Gateshead but is disappointed that the national
approach to the format and content of Quality Accounts focuses mainly on acute
services meaning that the account provides little comparative information regarding
the provision of community services in Gateshead and other localities covered by the
Trust.
The OSC is supportive of the overall Account and the priorities outlined for 2015-16.
The OSC is pleased to note that CQC has no compliance issues in regard to the
Trust.
190
Response from Governors
From: Pat Anthony [mailto:[email protected]]
Sent: 14 May 2015 16:39
To: Walker Malcolm
Subject: RE: Quality Account 2014/15
Dear Malcolm,
Thank you for your letter.
I confirm the contents to be an accurate account of our meeting. I confirm that
“Time on a Stroke Unit” is the 3rd Indicator chosen to be reviewed.
I would like to thank you for your detailed (and lengthy) explanation of the report, and
thank Mike for his contribution and explanations. It was all very informative, and
enjoyable to hear of the progress made since the last Quality Accounts/Report, and I
congratulate all those involved.
Kind Regards
Pat Anthony
From: GEORGE SCOTT [mailto:[email protected]]
Sent: 13 May 2015 23:30
To: Walker Malcolm
Cc: [email protected]; Burn Diane
Subject: Re: Quality Account 2014/15
Hi Malcolm,
Thank you for a very interesting and informative meeting today in which we went
through the Quality Account for 2014/15 in detail and with much discussion. Thank
you for receiving the comments made by Pat and myself with patience and for
adding to the document where necessary as a result of with those comments.
Following your explanation regarding the third indicator to be reviewed in the Quality
Account I can confirm our acceptance this should be the “Time on a Stroke Unit”
which is an important and challenging issue to address.
Regards, Tom Scott
191
Annex 2: Statement of Directors’ responsibilities for the quality
report
The Directors are required under the Health Act 2009 and the National Health
Service (Quality Accounts) Regulations 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:


the content of the Quality Report meets the requirements set out in the NHS
Foundation trust Annual Reporting Manual 2014/15 and supporting guidance
the content of the Quality Report is not inconsistent with internal and external
sources of information including:
o board minutes and papers for the period April 2014 to 21 st May 2015
o papers relating to Quality reported to the the board over the period
April 2014 to 21st May 2015
o feedback from commissioners dated 13/05/2015
o feedback from governors dated 13/05/2014
o feedback from local Healthwatch organisations dated 14/05/2015
o Feedback from Overview and Scrutiny Committee dated 14/05/2015
o The trusts complaints report published under regulation 18 of the Local
Authority Social Services and NHS Complaints Regulations 2009,
dated 04/06/2015
o The 2014 national patient survey 21/05/2015
o The 2014 national staff survey 16/04/2015
o The Head of Internal Audit’s annual opinion over the trust’s control
environment dated 21/05/2015
o CQC Intelligent Monitoring Report dated 25/11/2014
o The Quality Report presents a balanced picture of the NHS foundation
trust’s performance over the period covered
o The performance information reported in the Quality Report is reliable
and accurate
o 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
o The data underpinning the measures of performance reported in the
Quality report is robust and reliable, conforms to specified data quality
192
standards and prescribed definitions, is subject to appropriate scrutiny
and review and
o The Quality report has been prepared in accordance with Monitor’s
annual reporting guidance (which incorporates the Quality Accounts
regulations) (published at at www.monitor.gov.uk/annualreportingmanual)
as well as the standards to support data quality for the preparation of
the Quality Report (available at
www.monitor.gov.uk/annualreportingmanual).
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
P Davidson
Chairman
Date: 21 May 2015
L B Lambert
Chief Executive
Date: 21 May 2015
193
Glossary of Terms
Board of Directors
A board of directors is a body of elected or appointed members who jointly oversee
the activities of an organisation.
Care Quality Commission (CQC)
The CQC is the independent regulator of all health and adult social care in England.
The primary role of the CQC is to ensure that hospitals, care homes and care
services are meeting national standards.
Commissioning for Quality and Innovation (CQUIN)
The CQUIN framework is an incentive scheme which enables commissioners to
reward excellence by linking a proportion of English healthcare provider’s income to
achievement of local quality improvement goals.
Commissioners / Clinical Commissioning Groups (CCGs)
Clinical Commissioning Groups (CCGs) in each local area are made up of doctors,
nurses and other professionals coming together to use their knowledge of local
health needs to commission the best available services for patients. They have the
freedom to innovate and commission services for their local community from any
service provider which meets NHS standards and costs – these could be NHS
hospitals, social enterprises, voluntary organisations or private sector providers.
Clinical Audit
Clinical audit is a process that aims to improve patient care and outcomes through
systematic review of care against agreed standards implementation of identified
improvements.
Clostridium Difficile (C.Diff)
Clostridium Difficile is is a species of Gram-positive bacteria that occurs naturally in
the gut. Approximately two-thirds of children and 3% of adults test positive for C Diff.
The bacteria are harmless in healthy people but can cause severe diarrhoea and
other intestinal disease when competing bacteria in the gut flora have been wiped
out by antibiotics.
Datix
Datix is an electronic risk management software system which allows incident forms
to be completed electronically by all staff. The use of this technology allows greater
transparency and trend analysis in addition to improving access to the reporting
system
Department of Health (DH)
The Department of Health is a department of the UK government with responsibility
for government policy in England on health, social care and the NHS.
Foundation Trust (FT)
A Foundation Trust is a type of NHS organisation which have a significant amount of
managerial and financial freedom when compared to NHS hospital trusts. Although
194
still part of the wider NHS, they have greater level of autonomy in setting strategic
goals. Similar to the concept of ‘co-operatives’ local people, patients and staff can
become members and governors and hold the Trust to account.
Healthcare- acquired infection (HCAI)
This is an infection that occurs as a result of the healthcare that a person receives.
Meticillin- Resistant Staphylococcus Aureus (MRSA)
MRSA is a bacterium which has developed resistance to a range of antibiotics
including penicillin. MRSA is therefore responsible for several difficult to treat
infections in humans. MRSA is often associated with clinical care as patients with
invasive devices such as central lines, open wounds and reduced immunity are more
at risk of infection than the general public.
Monitor
Monitor is the independent regulator of NHS Foundation Trusts. It is independent of
central government and directly accountable to parliament.
National Institute for Health and Care Excellence (NICE)
Previously known as the National Institute for Health and Clinical Excellence,
following the Health and Social Care Act 2012, NICE was renamed the National
Institute for Health and Care Excellence on 1 April 2013 and changed from a special
health authority to a non-departmental public body. The primary role if NICE is to
provide guidance and quality standards. NICE makes recommendations to the NHS
on clinical treatments and medicines and also makes recommendations to the NHS,
local authorities and other organisations involved in healthcare on how to improve
people’s health and prevent illness.
National Patient Survey
The NHS patient survey programme systematically gathers the views of patients
about the care they have recently received because listening to patients' views is
essential to providing a patient-centred health service.
National Patient Safety Agency (NPSA)
The National Patient Safety Agency is an arm’s length body of the Department of
Health which promotes improved, safe patient care by informing, supporting and
influencing the health sector.
Overview and Scrutiny Committee
Overview and Scrutiny Committees are local authority bodies with statutory roles and
powers to review local health services. They help to plan services and implement
change to make the NHS more responsive to local communities.
Pressure Ulcers / Pressure Sores
Pressure ulcers are also known bed sores. They occur when the skin and underlying
tissue becomes damaged as a result of reduced mobility combined with pressure
applied to soft tissue so that blood flow to the soft tissue is completely or partially
obstructed. Most commonly pressure ulcers occur to the sacrum, coccyx, heels or
the hips, but other sites such as the elbows, knees, ankles or the back of the
cranium can also be affected.
195
Risk Assessment
This is a methodology used to protect patients and staff from harm. It is a systematic
examination of what could cause harm to allow us to weigh up if we have taken
enough precautions or should do more to prevent harm.
Root Cause Analysis (RCA)
RCA is a method used to solve problems by attempting to identify and correct the
root causes of events, as opposed to simply addressing their symptoms. RCA is
generally used in a learning culture to drive continuous improvement. By focusing
correction on root causes, problem recurrence can be prevented. Following RCA we
share learning with staff across the hospital to inform our practice and help prevent
further reoccurrence.
Safety Thermometer
The NHS Safety Thermometer is a local improvement tool for measuring, monitoring
and analysing patient harms and 'harm free' care. The tool provides a quick and
simple method for surveying patient harms and analysing results so that we can
measure and monitor local improvement and harm free care over time.
The “6C’s”
The Chief Nursing Officer's “6 Cs” are Care, Compassion, Competence,
Communication, Courage and Commitment
Venous Thromboembolism (VTE)
A venous thrombosis is a blood clot (thrombus) that forms within a vein. Thrombosis
is a term for a blood clot occurring inside a blood vessel. A typical venous
thrombosis is deep vein thrombosis (DVT), which can break off (or embolise), and
become a life-threatening pulmonary embolism (PE).
196
197
198
199
200
Statement of the Chief Executive's responsibilities as the Accounting Officer
of South Tyneside 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 South Tyneside 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 South
Tyneside NHS Foundation 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:





observe the Accounts Direction issued by Monitor, including the relevant
accounting and disclosure requirements, and apply suitable accounting
policies on a consistent basis;
make judgements and estimates on a reasonable basis;
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;
ensure that the use of public funds complies with the relevant legislation,
delegated authorities and guidance; and
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 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.
LB Lambert
Chief Executive
Date: 21 May 2015
201
Annual Governance Statement
Scope of responsibility
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 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 on-going process designed to identify
and prioritise the risks to the achievement of the policies, aims and objectives of
South Tyneside NHS Foundation Trust and 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 South Tyneside NHS Foundation Trust for the year ended 31 March 2015
and up to the date of approval of the annual report and accounts.
Capacity to handle risk
The Risk Management Strategy defines how risk management will be embedded at
both corporate and operational level and defines the leadership responsibilities of
each Director and lead officers for the management of key risks. The strategy was
approved by the Board of Directors on 28 May 2014.
I have responsibility for the overall organisation, management and staffing of the
Trust and for its procedures in financial and other matters. I ensure that financial
systems and procedures promote the efficient and economical conduct of business
and safeguard financial propriety and regularity throughout the Trust and reports to
the Board of Directors. I chair the Financial Risk Management Group which includes
all Executive Directors and which monitors the financial risks of the Trust. All serious
untoward incidents, clinical and non clinical, are reported to me regardless of time of
day.
During the year the Executive Director of Nursing and Patient Safety had day to day
responsibility for both clinical and non clinical risk management. All serious
untoward incidents are reported through this office and appropriate action initiated.
The Executive Director of Finance & Corporate Governance has responsibility for
ensuring appropriate controls are in existence for sound financial management and
202
is the lead officer for the Board Assurance Framework reporting to the Executive
Board and the Board of Directors.
The Chief Operating Officer will advise on both corporate and departmental risks
relating to a range of services under their direct control including areas of high risk
such as Hotel Services and Estates.
The Medical Director and Executive Director of Nursing & Patient Safety are
responsible for providing advice and identifying significant clinical risks and play a
key role in the Choose Safer Care Sub Committee, Clinical Incident Review Group
and Clinical Practice and Policy Group. These individuals lead on implementing
changes in practice or process arising from clinical incidents or near misses.
The Risk Management Strategy identifies resources, guidance and policies available
to support staff in fulfilling their roles including the incorporation of risk management
into competence based training for staff. Training needs analysis is carried out
annually and managers have specific responsibility for ensuring that staff attend
relevant training. All senior managers are required to complete specific e-learning
modules on Risk Management Awareness. The Risk Management Operational
Group, chaired by the Executive Director of Nursing & Patient Safety, supports the
implementation of the Risk Management Strategy.
The Board of Directors and its Sub Committees receives and reviews all publications
that may impact on the Trust, for example guidance from regulatory bodies and
public enquiries. Recommendations arising from the publications are reviewed and
where appropriate actions plans are identified to ensure shared learning from good
practice is implemented within the Trust.
The risk management strategy has been cascaded through briefing systems and
electronic communications.
The risk and control framework
Key elements of the Trust’s Risk Management Strategy are:

A statement of the philosophy underpinning the Trust’s approach to risk
management

The objectives of the strategy

A clear definition of the roles and responsibilities of managers within the risk
management process

A clear description of the roles and responsibilities within the risk
management structure of Sub Committees of the Board of Directors

The maintenance and review of the risk register

A description of the system of risk evaluation used throughout the Trust
203

A description of the existing policies/documents to which the strategy is linked

Ensuring risk management is incorporated in formal induction and training
programmes for Trust staff

The incorporation by managers of risk management in routine training needs
analysis

A review of risks associated with any material or significant transactions
Establishing the Trusts attitude to risk by assessing its desire, capacity and tolerance
for risk, remains with the Board of Directors as part of the overall Board Assurance
Framework.
The Board of Directors carries out as a minimum an annual review of its governance
arrangements. In addition as part of the development of the annual plan the Board
determines how each of its objectives including ensuring efficient, economic and
effective operations, compliance with standards, strong financial management and
control and the identification of risks and required mitigations will be managed within
the Board Assurance Framework. Reporting of progress and actions within the
Board Assurance Framework is actively scrutinised by the Board and its Sub
Committees.
There is a well developed system of annual review of corporate governance
standards in place including review of Monitor guidance to ensure the Trust
continues to comply with best practice. The Board of Directors receives guidance
issued by Monitor at its regular meetings and reviews compliance on at least an
annual basis.
The Trust's annual plan and supporting strategies including workforce are scrutinised
by the Board and its Sub Committees to ensure compliance with numbers and
standards to meet its objectives. The Board regularly reviews its own working
practices and that of its sub committees. In the last year a formal review of Board
working practices and agendas has been carried out along with a review of the terms
of reference for each sub committee and their supporting working groups.
During the year, the Remuneration Committee, which comprises the Chairman and
the Non Executive Directors, considered and put in place succession plans for the
Chief executive, who retires on 30 September 2015, and for the Chairman, whose
term of office concludes on 31 December 2015.
The Choose Safer Care Sub Committee (CSCSC), which is chaired by a Non
Executive Director, monitors the strategy and reviews the Strategic Risk Register
and Board Assurance Framework on behalf of the Board. CSCSC is also
responsible for considering and approving supporting policies designed to embed
risk management throughout the Trust.
Major risks throughout 2014/2015 and present into the future are:
204

Failure to meet financial targets due to continuing financial pressures and
delays in delivery of cost improvements. This is actively managed throughout
the year by the Board, the Finance Risk Management Group (FRMG) and the
Executive Board which receive regular monthly financial reports of
performance against plan. Performance against CIP plans to date and
forecast achievement to the year end is reviewed monthly by the FRMG.
FRMG also review forecast outturns on a monthly basis following the mid
year review.

Commissioning changes which may lead to significant loss of service
portfolio. We have continued to work closely with Clinical Commissioning
Groups, NHS England and Local Authorities to ensure we understand and
fully meet their needs. All tender opportunities are identified by the Business
Development team and are discussed with the Board and Chairman’s
Reference Group. The Chairman’s Reference Group are responsible for
monitoring the opportunities and reviewing tenders prior to submission. The
outcome of tenders is notified to the group as received.

Failure to meet performance and quality targets leading to regulatory action or
penalties imposed through contracts. Particular risks are present in delivering
A & E 4 hour waiting times. Daily capacity planning meetings are held as
required to identify and monitor actions required to deliver all urgent care
targets. The Board monitors delivery via monthly integrated performance
reports.
The report by Sir Robert Francis QC into the failings at Mid-Staffordshire NHS
Foundation Trust was published in February 2013. The Board of Directors and the
Council of Governors reviewed the 290 recommendations in 2013/14, considered the
base line position and identified new requirements and changes needed. The Board
of Directors agreed a focus for the implementation of the main changes in the
Francis Report and the Berwick Report and a task and finish group, led by the
Executive Director of Nursing and Patient Safety, was instrumental in providing the
framework for an integrated Francis, Keogh, Berwick Action Plan which has been
implemented and receives the oversight of the Choose Safer Care Sub-committee.
The Care Quality Commission (CQC) carried out a review of health services for
Looked after Children and Safeguarding in Gateshead in August 2014. This was a
focused inspection which provided a narrative outcome report reflecting the
experiences of children and young people, making recommendations for
improvement rather than giving a rating. A multi agency action plan is now in place.
The Trust participated in a peer review of Trauma Services in February 2015, after
which an action plan was developed and is being implemented.
The Director of Nursing and Patient Safety is responsible on behalf of the Board of
Directors for ensuring we meet the Care Quality Commissions registration
requirements for all of our facilities. The Foundation Trust is fully compliant with
those registration requirements.
205
The Information Strategy Group, which is a sub committee of the Board and is
chaired by a Non Executive Director, is responsible for Information Governance and
approves the annual Information Governance Toolkit submission and monitors the
resultant action plan. The Executive Director of Finance and Corporate Governance,
is the designated Senior Information Risk Owner. The Information Governance
Toolkit self-assessment produced a 79% compliance score, with all of the 45
standards assessed as achieving level 2 or greater. The Information Strategy Group
ensures that appropriate plans are in place and monitored to ensure that a minimum
of level 2 is maintained for all standards and is also responsible for approving and
ensuring the implementation of Trust policies for the management of Information
Assurance.
The Information Strategy Group is responsible for ensuring that a proactive
programme of data quality reviews is carried out utilising internal resources, Internal
Audit and external reviews to ensure the performance and quality data upon which
the Board places reliance in gaining assurance is reliable and fit for purpose.
The Information Security Group which is chaired by the Caldicott Guardian is a sub
group of the Information Strategy Group and is responsible for reviewing the
management of data security and other information security risks.
During the year the Trust was selected along with over 40 other Trusts to be part of
the National Referral to Treatment Waiting List Data Validation Programme. This
work identified a number of recommendations for improvement nationally, as well as
operational and training issues within the Trust. The Programme identified a number
of data quality issues, particularly within the Patient Tracking List which the Trust
acted upon towards the end of the year.
The Equality and Diversity Steering Group is responsible for ensuring that equality
impact assessments are undertaken and the Group manages the implementation of
a programme of review for services that require a full impact assessment. All new
and revised policies and planning and strategy documents presented to the Board of
Directors are equality impact assessed.
Since 1 April 2013 all NHS Foundation Trusts need a licence from Monitor, the
sector regulator for health services in England, stipulating specific conditions that
they must meet to operate. The Trust must comply with the provider licence
conditions, and non-compliance may result in enforcement action by Monitor. Key
conditions among these are financial sustainability and governance requirements.
The Risk Assessment Framework sets out the approach taken to oversee NHS
Foundation Trusts with the governance and continuity of services requirements of
their provider licence.
The Trust maintained a Continuity of Services Risk Rating of 3 throughout 2014/15.
The rating was largely due to a liquidity rating of 4 as large cash balances were held
during the year. The capital servicing capacity was 1 in the first 3 quarters and 2 in
quarter 4 as a result of the deficit.
206
The Risk Assessment Framework was updated in March 2015 and under the new
framework if a Trust has an overall rating of 3 but either its liquidity or its capital
service capacity is rated 1, then Monitor may subsequently investigate whether the
Trust is in breach of the continuity of services licence conditions, or requires
enhanced monitoring.
As a result of exceptional winter emergency pressures experienced across all of the
NHS the Trust breached the A&E target in Q3 and Q4 of 2014/15. A breach twice in
two quarters of this standard represents a governance concern. Monitor and NHS
England have met with South Tyneside System Resilience Group members to
understand the pressures over the winter period and the SRG’s plan to support
improvement. The governance rating for Q4 as a result of this concern is still to be
confirmed.
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 into the Scheme are in accordance
with the Scheme rules, and that member Pension Scheme records are accurately
updated in accordance with the timescales detailed in the Regulations.
We discuss priorities and are members of local CCG Partnership Boards and Health
& Wellbeing Boards, as well as attending the three local authority health oversight
committees to ensure that they are aware and involved in managing risks which
impact on the local health economies.
Control measures are in place to ensure that all the organisation’s obligations under
equality, diversity and human rights legislation are complied with.
The Foundation 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
this organisation’s obligations under the Climate Change Act and the Adaptation
Reporting requirements are complied with.
Review of economy, efficiency and effectiveness of the use of resources
The Board of Directors receives regular monthly financial and key performance
reports which include risk assessment of non delivery of targets. The Board reviews
compliance with national standards and targets agreed with commissioners, detailed
clinical and non clinical benchmarking data. The integrated performance report
includes detailed drill down into standards at risk of non delivery and the Board
receives regular reports on performance improvement plans designed to return
performance to plan.
The Finance Risk Management Group, which I chair, reports regularly to the Board
on progress on improving economy and efficiency utilising a risk based review in line
with the overall risk management strategy.
Performance improvement is
continuously monitored through corporate and clinical efficiency reviews which are
chaired by me. The annual internal audit and external audit plans, which are
207
monitored by the Audit Committee, includes reviews of economy, efficiency and
effectiveness, the outcome of which is incorporated within the internal audit opinion,
which is presented to the Board of Directors.
The Finance Risk Management Group, which I chair and comprises all Executive
Directors, is responsible along with the Board of Directors for overseeing the Trust’s
cost improvement and transformation programmes. Monitoring of these programmes
is through integrated reports produced by the Finance Department.
Attendance at Board meetings, the Information Strategy Group, Charitable Funds
Sub Committee, Audit Committee and the Choose Safer Care Sub Committee are
monitored during the year. A table disclosing attendance in the year by the Board of
Directors is included within the annual report.
The Board of Directors has assessed itself against the Corporate Governance Code
at its meeting on 21 May 2015 and considers that the Trust is compliant.
Annual Quality Report
The Directors are required under the Health Act 2009 and the National Health
Service (Quality Accounts) Regulations 2010 (as amended) 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 in the NHS Foundation Trust Annual Reporting
Manual.
The Board receives monthly reports on the quality of the services it delivers as well
as reviewing quality metrics, including those identified for development in the
previous year, within the integrated performance report. The Board has considered
and agreed an assurance framework for monitoring of quality using the framework
issued by Monitor.
The 2014/15 Quality Report which incorporates the views of the Council of
Governors, summarises information received by the Board throughout the year and
builds upon previous years reports. The data, which is presented to the Board and
upon which the Board places reliance, is subject to quality review by Internal Audit
during the audits completed as part of the Annual Internal Audit Plan, the findings of
which are monitored by Audit Committee.
The annual quality report is subject to a limited assurance review by the Trust’s
external auditors which is published alongside the report. The assurance work
undertaken by Deloitte LLP led to a qualified conclusion on the accuracy of the
reported 18 week Referral to Treatment incomplete pathway indicator. Their findings
indicate related issues with the admitted and non-admitted indicators. The Trust has
put in place an action plan in order to address the concerns identified. This plan
includes a review of processes and procedures based on the existing Patient
Administration System (PAS) and the implementation of recommendations arising
from the National RTT Waiting List Data Validation Programme.
208
Review of effectiveness
As Accounting Officer, I have the responsibility for reviewing the effectiveness of the
system of internal control. My review of effectiveness of the system of internal
control is informed by the work of the internal auditors, clinical audit and executive
managers and clinical leads within the NHS Foundation 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
and the Risk Management Assurance Group and a plan to address weaknesses and
ensure continuous improvement of the system is in place.
In accordance with good governance, more than half of the Board comprises of Non
Executive Directors who are independent in character and judgement. Non
Executive membership of the Board is monitored by the Council of Governor's
Appointments & Review Sub Committee whilst Executive Directors performance is
monitored by the Executive Appointments & Review Sub Committee of the Board of
Directors.
The Board continues to review the Trust’s Risk Management framework and
processes, and has agreed terms of reference for the Choose Safer Care Sub
Committee and its supporting committees. The Board Assurance Framework was
approved by the Board on 28 May 2014 and reviewed throughout the year. In
addition to formal Board meetings the Board holds monthly workshops to explore
specific issues in greater detail.
The Mortality Review Groups and the Clinical Incident Review Group, reports to the
Choose Safer Care Sub Committee which reports direct to the Board of Directors.
The governance arrangements for the Trust’s Information Assurance programme are
regularly reviewed during the year by the Information Strategy Group which reports
to the Board of Directors.
Regular reports on Clinical Governance and performance reports from service
specific groups are presented to the Executive Board and Board of Directors, along
with the work of the Finance Risk Management Group, the Capital Governance
Group and the minutes of the Board’s sub committees.
Participation in audits and clinical research programmes helps us to review our
performance and standards across a wide range of areas. We participate in national
and local audits and implement a range of developments and changes as a result.
The Audit Committee is comprised of Non Executive Directors. Its role is to ensure
that the Trust’s financial systems and controls are working effectively and to monitor
progress and assurance.
209
Internal Audit has carried out specific reviews of the Trust’s Board Assurance
Framework and overall governance framework. The outcome of reviews by internal
and external audit and the Counter Fraud and Security Management Service have
been considered throughout the year through regular reports to the Audit Committee
and the Board if required. Action plans are in place and monitored regularly to
address identified gaps in control arising from audit reviews.
On the basis of the work carried out by Internal Audit in accordance with the Annual
Internal Audit Plan significant assurance has been given that there is a generally
sound system of internal control, designed to meet the organisation’s objectives, and
that controls are generally being applied consistently. However, some weaknesses in
the design and/or inconsistent application of controls, put the achievement of
particular objectives at risk.
A key control issue during the year was the failure of the A&E 4 hour target in the
last 2 quarters of the year. As a response to this pressure, the Trust operated on a
command and control basis for much of January and February to ensure patient
safety and experience was appropriately maintained.
Conclusion
Whilst the achievement of the A&E target was a significant risk in year the
performance at the start of Q1 has significantly improved and the Board is confident
that the target will be met during 2015/16.
Given the size of the potential Cost Improvement Programme (CIP) for 2015/16 the
Board of Directors have agreed that the Trust will plan for a deficit of £5m in
2015/16. Whilst this will have an impact on liquidity during the year the Trust does
have available resources to sustain this in the short term. This will allow time during
2015/16 to progress the strategic agenda and develop robust CIP plans with
recurrent savings and in order to revert back to a surplus in 2016/17.
From the reviews undertaken no other significant control issues have been identified
during 2015/16.
L B Lambert
Chief Executive
Date: 21 May 2015
210
Supplementary Financial Information
The supplementary financial information which follows (pages 209-213) are an
extract from the full Financial Statements which can be obtained, free of charge,
from:Mr M P Robson
Executive Director of Finance and Corporate Governance
South Tyneside NHS Foundation Trust
Harton Wing
South Tyneside District Hospital
Harton Lane
South Shields
Tyne and Wear
NE34 0PL
211
STATEMENT OF COMPREHENSIVE INCOME FOR THE YEAR ENDED
31 MARCH 2015
Note
Year
Ended
31 Mar
2015
£000
Year
Ended
31 Mar
2014
£000
Operating income
3
208,235
214,762
Operating expenses
4
(209,063)
(213,973)
(828)
789
42
(9)
52
(5)
(17)
(2,411)
(2,395)
(24)
(2,738)
(2,715)
(3,223)
(1,926)
Other comprehensive income:
Impairments
Revaluations
(35,206)
6,097
(157)
3,442
TOTAL COMPREHENSIVE (EXPENSES)/INCOME FOR THE
YEAR *
(32,332)
1,359
Operating (deficit)/surplus
Finance costs
Finance income
Finance cost - financial liabilities
Finance cost - unwinding of discount and change in discount rate
on provisions
PDC dividends payable
Net finance costs
DEFICIT FOR THE YEAR
6
7
* Total comprehensive expenses for the year includes an impairment of £35,205,718 in relation to the
revaluation of land and buildings which was carried out on a Modern Equivalent Asset alternative site
basis.
212
STATEMENT OF FINANCIAL POSITION AS AT 31 MARCH 2015
Note
31 Mar
2015
£000
31 Mar
2014
£000
NON-CURRENT ASSETS
Intangible assets
Property, plant and equipment
Trade and other receivables
Total non-current assets
8
9
12.1
350
62,765
473
63,588
258
91,091
568
91,917
CURRENT ASSETS
Inventories
Trade and other receivables
Non-current assets held for sale
Cash and cash equivalents
Total current assets
11
12.1
10
20
2,163
10,593
0
16,239
28,995
2,100
8,466
332
14,909
25,807
CURRENT LIABILITIES
Trade and other payables
Borrowings
Provisions
Other liabilities
Total current liabilities
13.1
15
18
14
(16,701)
(4)
(238)
(2,289)
(19,232)
(14,692)
(9)
(284)
(990)
(15,975)
15
18
(3,050)
(572)
(3,622)
(4)
(587)
(591)
TOTAL ASSETS EMPLOYED
69,729
101,158
TAXPAYERS' EQUITY
Public dividend capital
Revaluation reserve
Income and expenditure reserve
43,584
8,140
18,005
42,681
37,900
20,577
TOTAL TAXPAYERS' EQUITY
69,729
101,158
NON-CURRENT LIABILITIES
Borrowings
Provisions
Total non-current liabilities
The financial statements on pages 1 to 49 were approved and authorised for issue by
the Board of Directors on 21 May 2015 and signed on their behalf by:
Signed:
(Chief Executive)
Date: 21 May 2015
213
STATEMENT OF CHANGES IN TAXPAYERS' EQUITY
Taxpayers' equity at 1 April 2014
Deficit for the year
Revaluations gains and losses - property, plant and equipment
Impairments*
Public Dividend Capital received
Asset disposals
Historic cost depreciation adjustment
Taxpayers' equity at 31 March 2015
Total
£000
Public
dividend
capital
£000
Revaluation
reserve
£000
Income and
expenditure
reserve
£000
101,158
(3,223)
6,097
(35,206)
903
0
0
42,681
0
0
0
903
0
0
37,900
0
6,097
(35,206)
0
(208)
(443)
20,577
(3,223)
0
0
0
208
443
69,729
43,584
8,140
18,005
* Impairments relate to a change in the accounting estimate for the measurement of fair value of property from a modern equivalent asset basis to a
modern equivalent asset basis based on an alternative site. Further details are provided in note 9.6.
** Other reserve movements relate to transfers between the revaluation and income and expenditure reserve, in respect of impairments, recognised in the
statement of comprehensive income, resulting from a loss of economic benefits (as opposed to a general fall in prices) where the property also had a
balance on the revaluation reserve.
214
STATEMENT OF CHANGES IN TAXPAYERS' EQUITY
Taxpayers' equity at 1 April 2013
Deficit for the year
Revaluations gains and losses - property, plant and equipment
Public Dividend Capital received
Asset disposals
Historic cost depreciation adjustment
Total
£000
Public dividend
capital
£000
Revaluation
reserve
£000
Income and
expenditure
reserve
£000
99,591
(1,926)
42,473
0
37,510
0
19,608
(1,926)
3,285
208
0
0
0
208
0
0
3,285
0
(379)
(1,350)
0
0
379
1,350
0
0
(1,166)
1,166
101,158
42,681
37,900
20,577
Other reserve movements *
Taxpayers' equity at 31 March 2014
* Other reserve movements relate to transfers between the revaluation and income and expenditure reserve, in respect of impairments, recognised in the
statement of comprehensive income, resulting from a loss of economic benefits (as opposed to a general fall in prices) where the property also had a
balance on the revaluation reserve.
215
STATEMENT OF CASH FLOWS FOR THE YEAR ENDED
31 MARCH 2015
Note
31 Mar
2015
£000
31 Mar
2014
£000
(828)
789
(828)
789
4,179
2,699
(2,168)
(550)
4,728
1,442
(16)
(2,090)
0
(2,939)
(73)
1,212
Cash flows from operating activities
Operating (deficit)/surplus
Operating (deficit)/surplus
Non-cash income and expense:
Depreciation and amortisation
Impairments
4.1
4.1
Reversals of impairments
Loss on disposal
4.1
9.5
Non-cash donations credited to income
(Increase) in trade and other receivables
Increase in inventories
Increase in trade and other payables
12.1
11.1
13.1
Increase/(decrease) in other liabilities
(Decrease)/increase in provisions
14
18
(63)
1,784
1,299
(69)
(10)
Other movements in operating cash flows
Net cash generated from operations
(540)
106
(279)
(2,535)
4,167
(9)
1,902
Interest received
Purchase of intangible assets
Purchase of property, plant and equipment
Sales of property, plant and equipment
42
(188)
(5,366)
996
52
(143)
(5,208)
619
Net cash used in investing activities
(4,516)
(4,680)
903
3,050
(9)
(7)
(2)
208
0
(8)
0
(5)
(2,256)
(2,779)
Net cash used in financing activities
1,679
(2,584)
Increase/(decrease) in cash and cash equivalents
1,330
(5,362)
Cash and cash equivalents at 1 April
14,909
20,271
Cash and cash equivalents at 31 March
16,239
14,909
Cash flows from investing activities
Cash flows from financing activities
Public dividend capital received
Loan received from the Independent Trust Financing Facility
Capital element of finance lease rental payments
Interest paid
Interest element of finance lease
PDC dividend paid
216
217
The supplementary financial information included within this Annual Report has been
approved by the Board of Directors at the Board Meeting on 21 May 2015.
The strategic report is only part of the Trust’s Annual Report and Financial
Statements.
The auditor’s report on the full Annual Report and Financial Statements was
unqualified and stated that the Strategic Report and Directors’ report were consistent
with the financial statements.
L B Lambert
Chief Executive
Date: 21 May 2015
218
Contact details
Members can contact Governors and Non Executive Directors via the Membership
Co-ordinator, Mrs Christine Morgan:
at the address below
via the membership line (0191) 2024121
via the website (www.stft.nhs.uk)
or via email [email protected]
Other languages
The text of this report can be made available in several languages or also tape. It is
also available on CD in PDF format which can be read in Adobe Acrobat. Contact
the Finance Department, at the address below for details.
South Tyneside NHS Foundation Trust
Harton Wing
South Tyneside District Hospital
Harton Lane
South Shields
Tyne and Wear
NE34 0PL
Tel: (0191) 404 1000
Fax: (0191) 427 9908
Web: www.stft.nhs.uk
219
COMPLIMENTS FROM THE PUBLIC
“A sincere and heartfelt thank you for all the care, consideration, and compassion
shown to dad during his stay on your ward. It has been a difficult time for us all but
knowing that you were all there for us has helped immensely. You really are a
special bunch”.
“To thank all the wonderful staff of Ward 19, for the excellent care given during our
father’s short illness. Special thanks go to Chris, Joanne, Pauline and Abbi for their
support and compassion to our family at this difficult time”.
“Hello, please can I pass on my appreciation for the top class service I received
today. Briefly, I presented at A & E with chest pain and was seen within minutes for
blood pressure and ECG. After a reasonable wait, I was seen by a doctor who took
a blood sample to see if it was cardio-related. This came back clear but because of
family history a second test was required. I was moved to an assessment ward and
a second test was taken. Everything was explained clearly, the staff were all polite
and professional and I honestly could not fault any part of my treatment. Thankfully I
got the all clear: at this point I felt like a timewaster but again it was impressed on me
if the same should happen again, then I should do exactly the same. It is staggering
how such a high standard of care can be maintained when the financial constraints
are more tighter than ever, Well Done Everyone!”
“On behalf of all of my family I would just like to say that we are really so grateful for
the help and support that we did receive from everyone on ward nine. It's been an
incredibly hard and sad 4-5 days. But it was heart-warming and always reassuring to
be amongst such caring people. I know that you will feel that the staff are 'doing
their job' and to an extent this is true. But the reality is that everyone did their job and
so much more. Nothing was too much trouble”,
“My Mam is not easy to please at times, but she has told so many people about the
fantastic service we did receive over an extended period. Everything possible was
done to make my Dad comfortable. He died with dignity and this was so precious to
us. Please pass my thanks to everyone”.
“Just a note to let you know that she was full of praise for the care she received and
the manner in which the staff coped, under what she described as difficult
circumstances. She was extremely happy and grateful for all the help she received”.
“Please can I register my thanks to all the staff in the stroke unit. For the past week
my father has been cared for in this unit. My father is almost 91 and each and every
time he is admitted it feels like he is part of their family. I can't praise them highly
enough for the care and dedication they give to him. It is due to this care that he
bounces back each time.
220
I would also like to thank the staff in A&E last Sunday for the care they gave to him
and the support they gave to me. Whilst the hospital has had lots or bad press
because of unmet targets, may I just say that people are more important that
statistics on a graph sheet and this is what this team does well.
Thank you to all concerned you should be very proud of your staff”.
“I’m currently on my last week of management placement at Riverview health centre
working within the zone 2 team and I just thought I would send you a little message
to highlight how brilliant this team is. I am ever so grateful to have had the
opportunity to work alongside a team of such dedicated nurses. The knowledge and
skills amongst this team truly is exceptional and they all work so well together. I have
not yet throughout my whole training came across such a supportive and
enthusiastic team and the relationships I have seen between themselves and
patients is second to none. They have supported me, educated me and taught me
some valuable lessons in which I will take with me throughout my own career as a
nurse and for that I am truly grateful. Both Andrea and Sandra are brilliant and lead
the team with so much respect which is so refreshing to see and be a part of. I
honestly could not fault this team at all and I have enjoyed my time here from start to
finish. I feel truly blessed to of had the opportunity to work alongside my co-mentor
Katy Aldridge and the rest of the girls and feel they all deserve a little recognition for
the dedication in which they all show daily. As front line staff they are a brilliant
reflection to the NHS”.
Patient’s mother rang this morning to compliment the hospital A&E department for
the excellent care they gave her son on his recent visit. Her son has epilepsy and
has visited on numerous occasions and his mother is an ex-nurse. She states both
the care her son received and the staff were excellent and she was very impressed
with the department and the improvement she has seen on recent visits culminating
in this latest one which prompted her telephone call.
“I would like to praise the staff in the stroke unit, ward 8. Over the last few years my
father has spent time on this unit, the latest this last week. From the domestic staff
through to consultants involved in his care the care they give him is exemplary.
Nothing is ever too much trouble to any of them. He is always treat with respect and
dignity to the extent that I am sure they would not or should I say could not treat their
own family any better. So thank you all. This hospital and the NHS should be very
proud to have such a dedicated team. Thank you so much”.
“I would like you to pass on my thanks and compliments to Keith from the Warfarin
Clinic. I attended the clinic today at 2pm with my father Keith took a great deal of
time to answer my many questions about dad's medication. Above all, I felt he was
very sympathetic and understanding of the impact of the medication in relation to my
dad's memory loss. I felt he was able to "read between the lines" and this meant my
dad felt quite at ease”.
221
“On behalf of the family of my late Aunt, who sadly passed away in ITU on the 13 th
December 2014, I would like to express how grateful we all were at the professional
and fantastic care that she received. The support shown to her husband, children
and the rest of the family was outstanding to say the least.
I would just like to make you aware that the whole staff team in ITU, Doctors, Nurses
and the Health Care Assistants were exceptional and I would like to express my
thanks and gratitude and behalf of the whole family, who have asked me to pass
their thanks. I would like to nominate them for Team of the month and year, it makes
me proud to be part of such an amazing organisation”.
“I would like to compliment Gateshead Council on the excellent service provided by
the Gateshead Equipment Service, the Gateshead Home Care team led by Ben
Meadows and Alison and also the District nurses. My father received the best of care
and attention from all these services during his last months and without that care he
would have been unable to remain at home. The equipment he needed was
delivered promptly by a team of very pleasant, friendly and helpful staff. All the
carers were sympathetic to him and took a great interest in making sure they did the
best they could to address all his needs and make him comfortable right up until the
day he died The District nurses paid him many visits at all times of the day and night
and always treated him with great patience and respect. He was very grateful for all
the help he received and didn't at all take it for granted. I would be failing in my duty
as his daughter not to let you know how much my father and his family appreciated
all this care and attention. Please pass on our thanks and appreciation to all those
services I have mentioned”.
“I recently had an arthroscopy knee operation at South Tyneside Hospital, although
this type of operation is somewhat tender I cannot praise Mr Al Dadah and the
hospital team enough for their precision and care, pre and post op. The operational
procedure to my knee has now improved my movement and reduced vastly the
painful symptoms I was feeling, which as enhancing my movement has also
enhanced my mood”.
222
Statement of the Chief Executive's responsibilities as the Accounting Officer
of South Tyneside 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 South Tyneside 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 South
Tyneside NHS Foundation 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:





observe the Accounts Direction issued by Monitor, including the relevant
accounting and disclosure requirements, and apply suitable accounting
policies on a consistent basis;
make judgements and estimates on a reasonable basis;
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;
ensure that the use of public funds complies with the relevant legislation,
delegated authorities and guidance; and
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 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.
LB Lambert
Chief Executive
Date: 21 May 2015
i
Annual Governance Statement
Scope of responsibility
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 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 on-going process designed to identify
and prioritise the risks to the achievement of the policies, aims and objectives of
South Tyneside NHS Foundation Trust and 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 South Tyneside NHS Foundation Trust for the year ended 31 March 2015
and up to the date of approval of the annual report and accounts.
Capacity to handle risk
The Risk Management Strategy defines how risk management will be embedded at
both corporate and operational level and defines the leadership responsibilities of
each Director and lead officers for the management of key risks. The strategy was
approved by the Board of Directors on 28 May 2014.
I have responsibility for the overall organisation, management and staffing of the
Trust and for its procedures in financial and other matters. I ensure that financial
systems and procedures promote the efficient and economical conduct of business
and safeguard financial propriety and regularity throughout the Trust and reports to
the Board of Directors. I chair the Financial Risk Management Group which includes
all Executive Directors and which monitors the financial risks of the Trust. All serious
untoward incidents, clinical and non clinical, are reported to me regardless of time of
day.
During the year the Executive Director of Nursing and Patient Safety had day to day
responsibility for both clinical and non clinical risk management. All serious
untoward incidents are reported through this office and appropriate action initiated.
The Executive Director of Finance & Corporate Governance has responsibility for
ensuring appropriate controls are in existence for sound financial management and
is the lead officer for the Board Assurance Framework reporting to the Executive
Board and the Board of Directors.
ii
The Chief Operating Officer will advise on both corporate and departmental risks
relating to a range of services under their direct control including areas of high risk
such as Hotel Services and Estates.
The Medical Director and Executive Director of Nursing & Patient Safety are
responsible for providing advice and identifying significant clinical risks and play a
key role in the Choose Safer Care Sub Committee, Clinical Incident Review Group
and Clinical Practice and Policy Group. These individuals lead on implementing
changes in practice or process arising from clinical incidents or near misses.
The Risk Management Strategy identifies resources, guidance and policies available
to support staff in fulfilling their roles including the incorporation of risk management
into competence based training for staff. Training needs analysis is carried out
annually and managers have specific responsibility for ensuring that staff attend
relevant training. All senior managers are required to complete specific e-learning
modules on Risk Management Awareness. The Risk Management Operational
Group, chaired by the Executive Director of Nursing & Patient Safety, supports the
implementation of the Risk Management Strategy.
The Board of Directors and its Sub Committees receives and reviews all publications
that may impact on the Trust, for example guidance from regulatory bodies and
public enquiries. Recommendations arising from the publications are reviewed and
where appropriate actions plans are identified to ensure shared learning from good
practice is implemented within the Trust.
The risk management strategy has been cascaded through briefing systems and
electronic communications.
The risk and control framework
Key elements of the Trust’s Risk Management Strategy are:

A statement of the philosophy underpinning the Trust’s approach to risk
management

The objectives of the strategy

A clear definition of the roles and responsibilities of managers within the risk
management process

A clear description of the roles and responsibilities within the risk
management structure of Sub Committees of the Board of Directors

The maintenance and review of the risk register

A description of the system of risk evaluation used throughout the Trust

A description of the existing policies/documents to which the strategy is linked
iii

Ensuring risk management is incorporated in formal induction and training
programmes for Trust staff

The incorporation by managers of risk management in routine training needs
analysis

A review of risks associated with any material or significant transactions
Establishing the Trusts attitude to risk by assessing its desire, capacity and tolerance
for risk, remains with the Board of Directors as part of the overall Board Assurance
Framework.
The Board of Directors carries out as a minimum an annual review of its governance
arrangements. In addition as part of the development of the annual plan the Board
determines how each of its objectives including ensuring efficient, economic and
effective operations, compliance with standards, strong financial management and
control and the identification of risks and required mitigations will be managed within
the Board Assurance Framework. Reporting of progress and actions within the
Board Assurance Framework is actively scrutinised by the Board and its Sub
Committees.
There is a well developed system of annual review of corporate governance
standards in place including review of Monitor guidance to ensure the Trust
continues to comply with best practice. The Board of Directors receives guidance
issued by Monitor at its regular meetings and reviews compliance on at least an
annual basis.
The Trust's annual plan and supporting strategies including workforce are scrutinised
by the Board and its Sub Committees to ensure compliance with numbers and
standards to meet its objectives. The Board regularly reviews its own working
practices and that of its sub committees. In the last year a formal review of Board
working practices and agendas has been carried out along with a review of the terms
of reference for each sub committee and their supporting working groups.
During the year, the Remuneration Committee, which comprises the Chairman and
the Non Executive Directors, considered and put in place succession plans for the
Chief executive, who retires on 30 September 2015, and for the Chairman, whose
term of office concludes on 31 December 2015.
The Choose Safer Care Sub Committee (CSCSC), which is chaired by a Non
Executive Director, monitors the strategy and reviews the Strategic Risk Register
and Board Assurance Framework on behalf of the Board. CSCSC is also
responsible for considering and approving supporting policies designed to embed
risk management throughout the Trust.
Major risks throughout 2014/2015 and present into the future are:

Failure to meet financial targets due to continuing financial pressures and
delays in delivery of cost improvements. This is actively managed throughout
the year by the Board, the Finance Risk Management Group (FRMG) and the
iv
Executive Board which receive regular monthly financial reports of
performance against plan. Performance against CIP plans to date and
forecast achievement to the year end is reviewed monthly by the FRMG.
FRMG also review forecast outturns on a monthly basis following the mid
year review.

Commissioning changes which may lead to significant loss of service
portfolio. We have continued to work closely with Clinical Commissioning
Groups, NHS England and Local Authorities to ensure we understand and
fully meet their needs. All tender opportunities are identified by the Business
Development team and are discussed with the Board and Chairman’s
Reference Group. The Chairman’s Reference Group are responsible for
monitoring the opportunities and reviewing tenders prior to submission. The
outcome of tenders is notified to the group as received.

Failure to meet performance and quality targets leading to regulatory action or
penalties imposed through contracts. Particular risks are present in delivering
A & E 4 hour waiting times. Daily capacity planning meetings are held as
required to identify and monitor actions required to deliver all urgent care
targets. The Board monitors delivery via monthly integrated performance
reports.
The report by Sir Robert Francis QC into the failings at Mid-Staffordshire NHS
Foundation Trust was published in February 2013. The Board of Directors and the
Council of Governors reviewed the 290 recommendations in 2013/14, considered the
base line position and identified new requirements and changes needed. The Board
of Directors agreed a focus for the implementation of the main changes in the
Francis Report and the Berwick Report and a task and finish group, led by the
Executive Director of Nursing and Patient Safety, was instrumental in providing the
framework for an integrated Francis, Keogh, Berwick Action Plan which has been
implemented and receives the oversight of the Choose Safer Care Sub-committee.
The Care Quality Commission (CQC) carried out a review of health services for
Looked after Children and Safeguarding in Gateshead in August 2014. This was a
focused inspection which provided a narrative outcome report reflecting the
experiences of children and young people, making recommendations for
improvement rather than giving a rating. A multi agency action plan is now in place.
The Trust participated in a peer review of Trauma Services in February 2015, after
which an action plan was developed and is being implemented.
The Director of Nursing and Patient Safety is responsible on behalf of the Board of
Directors for ensuring we meet the Care Quality Commissions registration
requirements for all of our facilities. The Foundation Trust is fully compliant with
those registration requirements.
The Information Strategy Group, which is a sub committee of the Board and is
chaired by a Non Executive Director, is responsible for Information Governance and
approves the annual Information Governance Toolkit submission and monitors the
resultant action plan. The Executive Director of Finance and Corporate Governance,
v
is the designated Senior Information Risk Owner. The Information Governance
Toolkit self-assessment produced a 79% compliance score, with all of the 45
standards assessed as achieving level 2 or greater. The Information Strategy Group
ensures that appropriate plans are in place and monitored to ensure that a minimum
of level 2 is maintained for all standards and is also responsible for approving and
ensuring the implementation of Trust policies for the management of Information
Assurance.
The Information Strategy Group is responsible for ensuring that a proactive
programme of data quality reviews is carried out utilising internal resources, Internal
Audit and external reviews to ensure the performance and quality data upon which
the Board places reliance in gaining assurance is reliable and fit for purpose.
The Information Security Group which is chaired by the Caldicott Guardian is a sub
group of the Information Strategy Group and is responsible for reviewing the
management of data security and other information security risks.
During the year the Trust was selected along with over 40 other Trusts to be part of
the National Referral to Treatment Waiting List Data Validation Programme. This
work identified a number of recommendations for improvement nationally, as well as
operational and training issues within the Trust. The Programme identified a number
of data quality issues, particularly within the Patient Tracking List which the Trust
acted upon towards the end of the year.
The Equality and Diversity Steering Group is responsible for ensuring that equality
impact assessments are undertaken and the Group manages the implementation of
a programme of review for services that require a full impact assessment. All new
and revised policies and planning and strategy documents presented to the Board of
Directors are equality impact assessed.
Since 1 April 2013 all NHS Foundation Trusts need a licence from Monitor, the
sector regulator for health services in England, stipulating specific conditions that
they must meet to operate. The Trust must comply with the provider licence
conditions, and non-compliance may result in enforcement action by Monitor. Key
conditions among these are financial sustainability and governance requirements.
The Risk Assessment Framework sets out the approach taken to oversee NHS
Foundation Trusts with the governance and continuity of services requirements of
their provider licence.
The Trust maintained a Continuity of Services Risk Rating of 3 throughout 2014/15.
The rating was largely due to a liquidity rating of 4 as large cash balances were held
during the year. The capital servicing capacity was 1 in the first 3 quarters and 2 in
quarter 4 as a result of the deficit.
The Risk Assessment Framework was updated in March 2015 and under the new
framework if a Trust has an overall rating of 3 but either its liquidity or its capital
service capacity is rated 1, then Monitor may subsequently investigate whether the
Trust is in breach of the continuity of services licence conditions, or requires
enhanced monitoring.
vi
As a result of exceptional winter emergency pressures experienced across all of the
NHS the Trust breached the A&E target in Q3 and Q4 of 2014/15. A breach twice in
two quarters of this standard represents a governance concern. Monitor and NHS
England have met with South Tyneside System Resilience Group members to
understand the pressures over the winter period and the SRG’s plan to support
improvement. The governance rating for Q4 as a result of this concern is still to be
confirmed.
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 into the Scheme are in accordance
with the Scheme rules, and that member Pension Scheme records are accurately
updated in accordance with the timescales detailed in the Regulations.
We discuss priorities and are members of local CCG Partnership Boards and Health
& Wellbeing Boards, as well as attending the three local authority health oversight
committees to ensure that they are aware and involved in managing risks which
impact on the local health economies.
Control measures are in place to ensure that all the organisation’s obligations under
equality, diversity and human rights legislation are complied with.
The Foundation 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
this organisation’s obligations under the Climate Change Act and the Adaptation
Reporting requirements are complied with.
Review of economy, efficiency and effectiveness of the use of resources
The Board of Directors receives regular monthly financial and key performance
reports which include risk assessment of non delivery of targets. The Board reviews
compliance with national standards and targets agreed with commissioners, detailed
clinical and non clinical benchmarking data. The integrated performance report
includes detailed drill down into standards at risk of non delivery and the Board
receives regular reports on performance improvement plans designed to return
performance to plan.
The Finance Risk Management Group, which I chair, reports regularly to the Board
on progress on improving economy and efficiency utilising a risk based review in line
with the overall risk management strategy.
Performance improvement is
continuously monitored through corporate and clinical efficiency reviews which are
chaired by me. The annual internal audit and external audit plans, which are
monitored by the Audit Committee, includes reviews of economy, efficiency and
effectiveness, the outcome of which is incorporated within the internal audit opinion,
which is presented to the Board of Directors.
vii
The Finance Risk Management Group, which I chair and comprises all Executive
Directors, is responsible along with the Board of Directors for overseeing the Trust’s
cost improvement and transformation programmes. Monitoring of these programmes
is through integrated reports produced by the Finance Department.
Attendance at Board meetings, the Information Strategy Group, Charitable Funds
Sub Committee, Audit Committee and the Choose Safer Care Sub Committee are
monitored during the year. A table disclosing attendance in the year by the Board of
Directors is included within the annual report.
The Board of Directors has assessed itself against the Corporate Governance Code
at its meeting on 21 May 2015 and considers that the Trust is compliant.
Annual Quality Report
The Directors are required under the Health Act 2009 and the National Health
Service (Quality Accounts) Regulations 2010 (as amended) 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 in the NHS Foundation Trust Annual Reporting
Manual.
The Board receives monthly reports on the quality of the services it delivers as well
as reviewing quality metrics, including those identified for development in the
previous year, within the integrated performance report. The Board has considered
and agreed an assurance framework for monitoring of quality using the framework
issued by Monitor.
The 2014/15 Quality Report which incorporates the views of the Council of
Governors, summarises information received by the Board throughout the year and
builds upon previous years reports. The data, which is presented to the Board and
upon which the Board places reliance, is subject to quality review by Internal Audit
during the audits completed as part of the Annual Internal Audit Plan, the findings of
which are monitored by Audit Committee.
The annual quality report is subject to a limited assurance review by the Trust’s
external auditors which is published alongside the report. The assurance work
undertaken by Deloitte LLP led to a qualified conclusion on the accuracy of the
reported 18 week Referral to Treatment incomplete pathway indicator. Their findings
indicate related issues with the admitted and non-admitted indicators. The Trust has
put in place an action plan in order to address the concerns identified. This plan
includes a review of processes and procedures based on the existing Patient
Administration System (PAS) and the implementation of recommendations arising
from the National RTT Waiting List Data Validation Programme.
Review of effectiveness
As Accounting Officer, I have the responsibility for reviewing the effectiveness of the
system of internal control. My review of effectiveness of the system of internal
viii
control is informed by the work of the internal auditors, clinical audit and executive
managers and clinical leads within the NHS Foundation 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
and the Risk Management Assurance Group and a plan to address weaknesses and
ensure continuous improvement of the system is in place.
In accordance with good governance, more than half of the Board comprises of Non
Executive Directors who are independent in character and judgement. Non
Executive membership of the Board is monitored by the Council of Governor's
Appointments & Review Sub Committee whilst Executive Directors performance is
monitored by the Executive Appointments & Review Sub Committee of the Board of
Directors.
The Board continues to review the Trust’s Risk Management framework and
processes, and has agreed terms of reference for the Choose Safer Care Sub
Committee and its supporting committees. The Board Assurance Framework was
approved by the Board on 28 May 2014 and reviewed throughout the year. In
addition to formal Board meetings the Board holds monthly workshops to explore
specific issues in greater detail.
The Mortality Review Groups and the Clinical Incident Review Group, reports to the
Choose Safer Care Sub Committee which reports direct to the Board of Directors.
The governance arrangements for the Trust’s Information Assurance programme are
regularly reviewed during the year by the Information Strategy Group which reports
to the Board of Directors.
Regular reports on Clinical Governance and performance reports from service
specific groups are presented to the Executive Board and Board of Directors, along
with the work of the Finance Risk Management Group, the Capital Governance
Group and the minutes of the Board’s sub committees.
Participation in audits and clinical research programmes helps us to review our
performance and standards across a wide range of areas. We participate in national
and local audits and implement a range of developments and changes as a result.
The Audit Committee is comprised of Non Executive Directors. Its role is to ensure
that the Trust’s financial systems and controls are working effectively and to monitor
progress and assurance.
Internal Audit has carried out specific reviews of the Trust’s Board Assurance
Framework and overall governance framework. The outcome of reviews by internal
and external audit and the Counter Fraud and Security Management Service have
been considered throughout the year through regular reports to the Audit Committee
ix
and the Board if required. Action plans are in place and monitored regularly to
address identified gaps in control arising from audit reviews.
On the basis of the work carried out by Internal Audit in accordance with the Annual
Internal Audit Plan significant assurance has been given that there is a generally
sound system of internal control, designed to meet the organisation’s objectives, and
that controls are generally being applied consistently. However, some weaknesses in
the design and/or inconsistent application of controls, put the achievement of
particular objectives at risk.
A key control issue during the year was the failure of the A&E 4 hour target in the
last 2 quarters of the year. As a response to this pressure, the Trust operated on a
command and control basis for much of January and February to ensure patient
safety and experience was appropriately maintained.
Conclusion
Whilst the achievement of the A&E target was a significant risk in year the
performance at the start of Q1 has significantly improved and the Board is confident
that the target will be met during 2015/16.
Given the size of the potential Cost Improvement Programme (CIP) for 2015/16 the
Board of Directors have agreed that the Trust will plan for a deficit of £5m in
2015/16. Whilst this will have an impact on liquidity during the year the Trust does
have available resources to sustain this in the short term. This will allow time during
2015/16 to progress the strategic agenda and develop robust CIP plans with
recurrent savings and in order to revert back to a surplus in 2016/17.
From the reviews undertaken no other significant control issues have been identified
during 2015/16.
L B Lambert
Chief Executive
Date: 21 May 2015
x
xi
xii
xiii
xiv
xv
xvi
FOREWORD TO THE FINANCIAL STATEMENTS
SOUTH TYNESIDE NHS FOUNDATION TRUST
These financial statements for the year ended 31 March 2015 have been prepared
by the South Tyneside NHS Foundation Trust under Schedule 7 of the National
Health Service Act 2006, paragraphs 24 and 25 and in accordance with directions
given by Monitor, the sector regulator for health services in England.
Foreword
STATEMENT OF COMPREHENSIVE INCOME FOR THE YEAR ENDED
31 MARCH 2015
Note
Year
Ended
31 Mar
2015
£000
Year
Ended
31 Mar
2014
£000
Operating income
3
208,235
214,762
Operating expenses
4
(209,063)
(213,973)
(828)
789
42
(9)
52
(5)
(17)
(2,411)
(2,395)
(24)
(2,738)
(2,715)
(3,223)
(1,926)
Other comprehensive income:
Impairments
Revaluations
(35,206)
6,097
(157)
3,442
TOTAL COMPREHENSIVE (EXPENSES)/INCOME FOR THE YEAR
*
(32,332)
1,359
Operating (deficit)/surplus
Finance costs
Finance income
Finance cost - financial liabilities
Finance cost - unwinding of discount and change in discount rate on
provisions
PDC dividends payable
Net finance costs
DEFICIT FOR THE YEAR
6
7
The notes on pages 6 to 49 form part of these financial statements.
* Total comprehensive expenses for the year includes an impairment of £35,205,718 in relation to the
revaluation of land and buildings which was carried out on a Modern Equivalent Asset alternative site
basis.
Page 1
STATEMENT OF FINANCIAL POSITION AS AT 31 MARCH 2015
Note
31 Mar
2015
£000
31 Mar
2014
£000
NON-CURRENT ASSETS
Intangible assets
Property, plant and equipment
Trade and other receivables
Total non-current assets
8
9
12.1
350
62,765
473
63,588
258
91,091
568
91,917
CURRENT ASSETS
Inventories
Trade and other receivables
Non-current assets held for sale
Cash and cash equivalents
Total current assets
11
12.1
10
20
2,163
10,593
0
16,239
28,995
2,100
8,466
332
14,909
25,807
CURRENT LIABILITIES
Trade and other payables
Borrowings
Provisions
Other liabilities
Total current liabilities
13.1
15
18
14
(16,701)
(4)
(238)
(2,289)
(19,232)
(14,692)
(9)
(284)
(990)
(15,975)
15
18
(3,050)
(572)
(3,622)
(4)
(587)
(591)
TOTAL ASSETS EMPLOYED
69,729
101,158
TAXPAYERS' EQUITY
Public dividend capital
Revaluation reserve
Income and expenditure reserve
43,584
8,140
18,005
42,681
37,900
20,577
TOTAL TAXPAYERS' EQUITY
69,729
101,158
NON-CURRENT LIABILITIES
Borrowings
Provisions
Total non-current liabilities
The financial statements on pages 1 to 49 were approved and authorised for issue by the Board of
Directors on 21 May 2015 and signed on their behalf by:
Signed:
(Chief Executive)
Date: 21 May 2015
Page 2
STATEMENT OF CHANGES IN TAXPAYERS' EQUITY
Taxpayers' equity at 1 April 2014
Deficit for the year
Revaluations gains and losses - property, plant and equipment
Impairments*
Public Dividend Capital received
Asset disposals
Historic cost depreciation adjustment
Taxpayers' equity at 31 March 2015
Total
£000
Public
dividend
capital
£000
Revaluation
reserve
£000
Income and
expenditure
reserve
£000
101,158
(3,223)
6,097
(35,206)
903
0
0
42,681
0
0
0
903
0
0
37,900
0
6,097
(35,206)
0
(208)
(443)
20,577
(3,223)
0
0
0
208
443
69,729
43,584
8,140
18,005
* Impairments relate to a change in the accounting estimate for the measurement of fair value of property from a modern equivalent asset basis to a
modern equivalent asset basis based on an alternative site. Further details are provided in note 9.6.
** Other reserve movements relate to transfers between the revaluation and income and expenditure reserve, in respect of impairments, recognised in the
statement of comprehensive income, resulting from a loss of economic benefits (as opposed to a general fall in prices) where the property also had a
balance on the revaluation reserve.
Page 3
STATEMENT OF CHANGES IN TAXPAYERS' EQUITY
Taxpayers' equity at 1 April 2013
Deficit for the year
Revaluations gains and losses - property, plant and equipment
Public Dividend Capital received
Asset disposals
Historic cost depreciation adjustment
Total
£000
Public dividend
capital
£000
Revaluation
reserve
£000
Income and
expenditure
reserve
£000
99,591
(1,926)
42,473
0
37,510
0
19,608
(1,926)
3,285
208
0
0
0
208
0
0
3,285
0
(379)
(1,350)
0
0
379
1,350
0
0
(1,166)
1,166
101,158
42,681
37,900
20,577
Other reserve movements *
Taxpayers' equity at 31 March 2014
* Other reserve movements relate to transfers between the revaluation and income and expenditure reserve, in respect of impairments, recognised in the
statement of comprehensive income, resulting from a loss of economic benefits (as opposed to a general fall in prices) where the property also had a
balance on the revaluation reserve.
Page 4
STATEMENT OF CASH FLOWS FOR THE YEAR ENDED
31 MARCH 2015
Note
31 Mar
2015
£000
31 Mar
2014
£000
(828)
789
(828)
789
4,179
2,699
(2,168)
(550)
4,728
1,442
(16)
(2,090)
0
(2,939)
(73)
1,212
Cash flows from operating activities
Operating (deficit)/surplus
Operating (deficit)/surplus
Non-cash income and expense:
Depreciation and amortisation
Impairments
4.1
4.1
Reversals of impairments
Loss on disposal
4.1
9.5
Non-cash donations credited to income
(Increase) in trade and other receivables
Increase in inventories
Increase in trade and other payables
12.1
11.1
13.1
Increase/(decrease) in other liabilities
(Decrease)/increase in provisions
14
18
(63)
1,784
1,299
(69)
(10)
Other movements in operating cash flows
Net cash generated from operations
(540)
106
(279)
(2,535)
4,167
(9)
1,902
Interest received
Purchase of intangible assets
Purchase of property, plant and equipment
Sales of property, plant and equipment
42
(188)
(5,366)
996
52
(143)
(5,208)
619
Net cash used in investing activities
(4,516)
(4,680)
903
3,050
(9)
(7)
(2)
208
0
(8)
0
(5)
(2,256)
(2,779)
Net cash used in financing activities
1,679
(2,584)
Increase/(decrease) in cash and cash equivalents
1,330
(5,362)
Cash and cash equivalents at 1 April
14,909
20,271
Cash and cash equivalents at 31 March
16,239
14,909
Cash flows from investing activities
Cash flows from financing activities
Public dividend capital received
Loan received from the Independent Trust Financing Facility
Capital element of finance lease rental payments
Interest paid
Interest element of finance lease
PDC dividend paid
Page 5
NOTES TO THE FINANCIAL STATEMENTS
1
Accounting policies and other information
Monitor has directed that the financial statements of NHS Foundation Trusts shall meet the
accounting requirements of the NHS Foundation Trust Annual Reporting Manual which shall be
agreed with HM Treasury. Consequently, the following financial statements have been prepared in
accordance with the NHS Foundation Trust Annual Reporting Manual (FT ARM) 2014-15 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 financial statements, except
where a new accounting policy has been adopted.
1.1
Accounting convention
These financial statements have been prepared on a going concern basis and under the historical
cost convention modified to account for the revaluation of property, plant and equipment.
1.2
Continuing and discontinued operations, mergers and acquisitions
An operation is classified as discontinued when either:(a) it is classified as held for sale; or
(b) the activities have ceased without transferring to another entity; or
(c) the activities have been transferred to an entity outside the boundary of Whole of Government
Accounts, such as the private or voluntary sectors.
Operations not satisfying all these conditions are classified as continuing.
Activities transferred to or from other bodies within the boundary of Whole of Government Accounts
are “machinery of government changes” and are treated as continuing operations and accounted
for as a transfer by absorption.
Activities acquired from outside the Whole of Government Accounts boundary are accounted for in
accordance with IFRS 3.
1.3
Consolidation
Subsidiaries
Subsidiary entities are those over which the Trust is exposed to, or has rights to, variable returns
from its involvement with the entity and has the ability to affect those returns through its power over
the entity. The income, expenses, assets, liabilities, equity and reserves of subsidiaries are
consolidated in full into the appropriate financial statement lines. The capital and reserves
attributable to minority interests are included as a separate item in the Statement of Financial
Position.
The amounts consolidated are drawn from the published financial statements of the subsidiaries for
the year. Where subsidiaries’ accounting policies are not aligned with those of the Trust (including
where they report under UK GAAP) then amounts are adjusted during consolidation where the
differences are material. Inter-entity balances, transactions and gains/losses are eliminated in full
on consolidation.
South Tyneside Foundation Trust is the sole shareholder of four limited companies. These were
registered with Companies House during 2014/15. These companies are STFT Holdings Limited,
South Tyneside Integrated Care Limited, Gateshead Integrated Care Limited and Sunderland
Integrated Care Limited. The Trust had one small financial transaction with STFT Holdings Limited
in the year. This has not been consolidated into the Trust's accounts on the grounds of materiality.
The remaining subsidiaries are yet to commence trading.
Page 6
1.3
Consolidation (continued)
South Tyneside NHS Foundation Trust is the corporate trustee to the South Tyneside NHS
Foundation Trust Charitable Fund. The Trust has assessed its relationship to the charitable fund and
determined it to be a subsidiary because the Trust is exposed to, or has rights to, variable returns
and other benefits for itself, patients and staff from its involvement with the charitable fund and has
the ability to affect those returns and other benefits through its power over the fund.
Prior to 2013-14, the FT ARM permitted the Trust not to consolidate the charitable fund. From 201314 the Trust is required to consolidate any material charitable funds which it determines to be
subsidiaries. The Trust did not consolidate the charitable fund in the 2013-14 financial statements on
the grounds of the fund not being material and has not consolidated in the 2014-15 financial
statements on the same basis.
The South Tyneside Trust General Charitable Fund is registered with the Charity Commission
(registered number 1059500). As at the 31 March 2014, the value of the funds was £1,517k. As at
31 March 2015 the value of the funds is estimated as £1,546k. This represents an estimated net
increase in value of £29k.
South Tyneside Trust General Charitable Fund's principal office is based at South Tyneside NHS
Foundation Trust, South Tyneside District Hospital, Harton Wing, Harton Lane, South Shields, NE34
0PL.
1.4
Income
Income in respect of services provided is recognised when, and to the extent that, performance
occurs and is measured at the fair value of the consideration receivable. The main source of income
for the Trust is contracts with commissioners in respect of healthcare services.
Where income is received for a specific activity which is to be delivered in the following financial
year, that income is deferred.
Income from the sale of non-current assets is recognised only when all material conditions of sale
have been met, and is measured as the sums due under the sale contract.
The Trust accounts for income due on partly completed spells of patient care. Income is accrued
based on length of stay using an average bed day rate for the appropriate specialty. Differences
between these accruals and the actual income due when the spell is completed are accounted for in
the period of completion.
The Payment by Results rules regarding maternity pathways changed in 2013-14. The commissioner
now makes one payment covering the whole of the maternity pathway at the point at which the
woman first presents for treatment. Where the pregnancy spans the year end the income relating to
the percentage of the services delivered in the year has been recognised in the financial statements
with the remainder being deferred into the future year.
1.5
Expenditure on employee benefits
Short-term employee benefits
Salaries, wages and employment-related payments are recognised in the period in which the service
is received from employees. The cost of annual leave entitlement earned but not taken by
employees at the end of the period is recognised in the financial statements to the extent that
employees are permitted to carry forward leave into the following period.
Page 7
1.5
Expenditure on employee benefits (continued)
Pension costs
NHS Pension Scheme
Past and present employees are covered by the provisions of the NHS Pensions Scheme. The
Scheme is an unfunded, defined benefit scheme that covers NHS employers, general practices
and other bodies, allowed under the direction of Secretary of State, in England and Wales. It is
not possible for the NHS Foundation Trust to identify its share of the underlying scheme
liabilities. Therefore, the scheme is accounted for as a defined contribution scheme.
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.
National Employment Savings Trust (NEST)
The Pensions Act 2008 (the Act) introduced a new requirement for employers to automatically
enrol any eligible job holders working for them into a workplace pension scheme that meets
certain requirements and provide a minimum employer contribution. The Trust implemented
auto-enrolment on 1 May 2013.
Where an employee is eligible to join the NHS Pension Scheme then they will be automatically
enrolled into this scheme, even if they have previously opted out.
However, where an
employee is not eligible to join the NHS Pension Scheme (e.g. flexible retiree employees) then
an alternative scheme must be made available by the Trust.
The Trust has chosen NEST as an alternative scheme. NEST is a defined contribution pension
scheme that was created as part of the government’s workplace pensions reforms under the
Pensions Act 2008.
Employers' pension cost contributions for both schemes are charged to operating expenses as
and when they become due.
Further details of the schemes are provided at Note 5.5 to the financial statements.
1.6
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.
1.7
Property, plant and equipment
Recognition
Expenditure on property, plant and equipment is capitalised
where:
• it 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;
• it is expected to be used for more than one financial year; and
• the cost of the item can be measured reliably.
Page 8
1.7
Property, plant and equipment (continued)
In order for expenditure on property, plant and equipment to be capitalised it must also:
• individually have 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.
Measurement
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 property, plant and equipment 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 property, plant and equipment asset are not capitalised but are
charged to the Statement of Comprehensive Income in the year to which they relate.
All assets are measured subsequently at fair value.
(a) Property assets
Land and buildings used for the Trust’s services or for administrative purposes are stated in the
statement of financial position at their revalued amounts, being the fair value at the date of
revaluation less any subsequent accumulated depreciation and impairment losses. Revaluations are
performed with sufficient regularity to ensure that carrying amounts are not materially different from
those that would be determined at the Statement of Financial Position date.
Fair values are determined as follows:
Land and non specialised buildings – market value for existing use
For non-operational properties including surplus land, the valuations are carried out at open market
value
Specialised buildings – depreciated replacement cost
HM Treasury has adopted a standard approach to depreciated replacement cost valuations based on
modern equivalent assets and, where it would meet the location requirements of the service being
provided, an alternative site can be valued.
The Trust initially complied with the above by undertaking a full Modern Equivalent Asset Valuation
(MEAV) of all land and buildings property, which was accounted for in 2010. This was undertaken by
professionally qualified valuers in accordance with the Royal Institute of Chartered Surveyors (RICS)
Appraisal and Valuation Manual. This valuation was carried out based on the existing site. In
2014/15 the Trust amended its approach and the land and buildings property was valued on an
alternative site basis. The Trust's external valuer is the District Valuer (North) based at the Durham
Valuation Office.
Page 9
1.7
Property, plant and equipment (continued)
IAS 16 requires that the carrying value of property is not materially different to fair value at the
Statement of Financial Position date. In order to meet this requirement the Trust contract with the
District Valuer (North) to provide a five year rolling programme of valuations following the initial
MEAV in 2010. This included a full revaluation in the first year and the fifth year, an interim
revaluation in the third year and a desktop update (including a physical inspection of any properties
where material capital expenditure had taken place) in the intervening years. As a result of the Trust
amending its approach and moving to an alternative site basis for 2014/15 two revaluations were
carried out during the year; the first to value the property on an alternative site basis at 1 April 2014
and the second to update these values for changes in value due to price increases and capital
expenditure at 31 March 2015.
Additional alternative open market value figures have only been supplied for operational assets
scheduled for imminent closure and subsequent disposal.
Properties in the course of construction for service or administration purposes are carried at cost,
less any impairment loss. Cost includes professional fees but not borrowing costs, which are
recognised as expenses immediately, as allowed by IAS 23 for assets held at fair value. Assets are
revalued and depreciation commences when they are brought into use.
(b) Non-property assets
Trusts may elect to adopt a depreciated historical cost basis as a proxy for fair value for assets that
have short useful lives or low values (or both). For depreciated historical cost to be considered as a
proxy for fair value, the useful life must be a realistic reflection of the life of the asset and the
depreciation method used must provide a realistic reflection of the consumption of that asset class.
Prior to the implementation of IFRS, operational equipment was valued at net current replacement
cost by the annual application of indices as agreed by the Directors. From 1 April 2009 indexation
ceased. The carrying value of existing assets at that date will be written off over their remaining
useful lives and new fixtures and equipment are carried at depreciated historic cost as this is not
considered to be materially different from fair value. Equipment surplus to requirements is valued at
net recoverable amount.
Subsequent expenditure
Subsequent expenditure relating to an item of property, plant and equipment is recognised as an
increase in the carrying amount of the asset when it is probable that additional future economic
benefits or service potential deriving from the cost incurred to replace a component of such item will
flow to the Trust and the cost of the item can be determined reliably. Where a component of an asset
is replaced, the cost of the replacement is capitalised if it meets the criteria for recognition above.
The carrying amount of the part replaced is de-recognised. Other expenditure that does not generate
additional future economic benefits or service potential, such as repairs and maintenance, is charged
to the Statement of Comprehensive Income in the period in which it is incurred.
Depreciation and amortisation
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.
Property, plant and equipment which has been reclassified as ‘Held for Sale’ ceases to be
depreciated upon the reclassification. Assets in the course of construction are not depreciated until
the asset is brought into use.
Buildings, installations and fittings are depreciated on their current value over the estimated
remaining life of the asset as assessed by the NHS Foundation Trust's professional valuers.
Leaseholds are depreciated over the primary lease term.
Page 10
1.7
Property, plant and equipment (continued)
Equipment is depreciated on current cost evenly over the estimated life. Estimated equipment lives are:
Plant and machinery
Transport equipment
Furniture and fittings
Information technology
5
7
7
5
- 15 years
years
- 10 years
- 8 years
Lives are initially set when equipment is first brought into use and are then re-assessed on a yearly basis.
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 that do not arise from a loss of economic benefit 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 arise from a clear consumption 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 clear consumption 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.
De-recognition
Assets intended for disposal are reclassified as ‘Held for Sale’ once all of the following criteria are met:
• the asset is available for immediate sale in its present condition subject only to terms which are
usual
• the sale must be highly probable i.e.:
- management are committed to a plan to sell the asset;
- an active programme has begun to find a buyer and complete the sale;
- the asset is being actively marketed at a reasonable price;
- the sale is expected to be completed within 12 months of the date of classification as ‘Held for
Sale’;
- the actions needed to complete the plan indicate it is unlikely that the plan will be dropped or
significant
Page 11
1.7
Property, plant and equipment (continued)
Following reclassification, the assets are measured at the lower of their existing carrying amount and
their ‘fair value less costs to sell’. Depreciation ceases to be charged and the assets are not
revalued, except where the ‘fair value less costs to sell’ falls below the carrying amount. Assets are
de-recognised when all material sale contract conditions have been met.
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.
1.8
Donated assets
Donated property, plant and equipment assets are capitalised at their fair value on receipt. The
donation is credited to income at the same time, unless the donor has imposed a condition that the
future economic benefits embodied in the donation are to be consumed in a manner specified by the
donor, in which case, the donation 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 assets are subsequently accounted for in the same manner as other items of property,
plant and equipment.
1.9
Intangible assets
Recognition
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.
Intangible assets are capitalised when they are capable of being used in a Trust's activities for more
than one year; they can be valued; and they have a cost of at least £5,000.
All intangible assets held by the Trust relate to software.
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.
Purchased computer software licences are capitalised as intangible assets where expenditure of at
least £5,000 is incurred and amortised over the shorter of the term of the licence and their useful
economic lives.
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 carried at depreciated historical cost as, due to the short useful
life of the asset, this is not considered to be materially different from fair value.
Amortisation
Intangible assets are amortised on a straight line basis over their expected useful economic lives in a
manner consistent with the consumption of economic or service delivery benefits.
The standard life for software intangible assets ranges from 3 – 5 years dependent upon the asset.
Page 12
1.10
Revenue, government and other grants
Government grants are grants from Government bodies other than income from NHS bodies 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.
Grant income relating to assets is recognised within income when the Trust becomes entitled to it,
unless the grantor imposes a condition that the future economic benefits embodied in the grant are to
be consumed as specified by the grantor and if it is not, the grant must be returned to the grantor.
Where such a condition exists, the grant is recognised as deferred income within liabilities and
carried forward to future financial years to the extent that the condition has not yet been met.
1.11
Inventories
Inventories are valued at the lower of cost and net realisable value. The cost of inventories is
measured using the First In, First Out (FIFO) method.
1.12
Cash and cash equivalents
Cash is cash in hand and deposits with any financial institution repayable without penalty on notice of
not more than 24 hours. Cash equivalents are investments that mature in 3 months or less from the
date of acquisition and that are readily convertible to known amounts of cash with insignificant risk of
change in value.
These balances exclude monies held in the NHS Foundation Trust's bank account belonging to
patients (see note 1.21 Third Party Assets).
1.13
Financial instruments 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 1.14.
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 cash flows 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'.
Page 13
1.13
Financial instruments and financial liabilities (continued)
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 receivables, accrued
income and other receivables.
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 exactly estimated 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.
As detailed in note 1.18 the calculation of the PDC Dividend changed in 2013-14. Average daily
cash balances held with the Government Banking Service (GBS) and National Loans Fund are now
deducted from average relevant net assets rather than the balance held with GBS at the year end.
As a result of this the Trust has not invested any funds outside of the Government Banking Service
in the year as it would have to earn interest in excess of 3.50% to be of benefit to the Trust.
Other financial liabilities
All 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 exactly estimated 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.
Impairment of financial assets
At the Statement of Financial Position date, the Trust assesses whether any financial assets 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 cash flows 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.
Page 14
1.13
Financial instruments and financial liabilities (continued)
Impairment losses on such assets are charged to the bad debt provision when there is an indication
that part or all of the debt may not be recoverable. The carrying value of the asset is only written off
once agreed by the Executive Director of Finance and Corporate Governance in line with delegated
limits. At that stage any amount charged to the bad debt provision in respect of that asset is written
off against the carrying value, with any difference being charged to the Statement of Comprehensive
Income.
1.14
Leases
The Trust as lessee
Finance leases
Where substantially all risks and rewards of ownership of a leased asset are borne by the NHS
Foundation 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 asset and liability are recognised at the commencement of the lease. Thereafter the asset is
accounted for as an item of property, plant and equipment.
The annual rental is split between the repayment of the liability and a finance cost by apportioning
each rental payment between a finance charge and a reduction of the lease obligation using the sum
of digits method. The annual finance cost is charged to Finance Costs in the Statement of
Comprehensive Income. The lease liability is de-recognised when the liability is discharged,
cancelled or expires.
Operating leases
Other leases are regarded as operating leases and the rentals are charged to operating expenses on
a straight-line 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.
The Trust as lessor
Operating leases
Rental income from operating leases is recognised on a straight line basis over the term of the lease.
Initial direct costs incurred in negotiating and arranging an operating lease are charged to income
and expenditure as incurred.
1.15
Provisions
The NHS Foundation Trust recognises a provision where it has a present legal or constructive
obligation of uncertain timing or amount, for which it is probable that there will be a future outflow of
cash or other resources, and a reliable estimate can be made of the amount. The amount
recognised in the Statement of Financial Position is the best estimate of the resources required to
settle the obligation. Where the effect of the time value of money is significant, the estimated riskadjusted cash flows are discounted using HM Treasury’s discount rate which varies from -1.50% to
2.20% in real terms dependent upon the time base of the cash outflow (2013-14, -1.90% to 2.20%).
The only exception to this is early retirement provisions and injury benefit provisions which both use
the HM Treasury’s pension discount rate of 1.60% (2013-14 - 1.8%) in real terms.
Page 15
1.15
Provisions (continued)
Clinical negligence costs
The NHS Litigation Authority (NHSLA) operates a risk pooling scheme under which the NHS
Foundation Trust pays an annual contribution to the NHSLA, 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 NHS Foundation Trust. The total value of clinical negligence
provisions carried by the NHSLA on behalf of the NHS Foundation Trust is disclosed in note 18 but it
is not recognised in the Trust’s financial statements.
Non-clinical risk pooling
The NHS Foundation 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 NHS Litigation Authority 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.
Redundancy
The NHS Foundation Trust makes provision for any redundancy costs in accordance with IAS 37
Provisions, Contingent Liabilities and Contingent Assets.
Agenda for Change
The NHS Foundation Trust makes provision for the cost of the outcome of reviews requested by staff
in respect of the review of Agenda for Change bandings of posts. As the NHS Foundation Trust no
longer has any outstanding reviews from staff the provision brought forward from 2013/14 was
reversed during 2014/15.
1.16
Contingent liabilities
Contingent liabilities are not recognised, but are disclosed in note 19, 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 entity’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 for which the amount of the obligation cannot be measured with
sufficient reliability.
1.17
Value Added Tax
Most of the activities of the NHS Foundation 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 property,
plant and equipment assets. Where output tax is charged or input VAT is recoverable, the amounts
are stated net of VAT.
1.18
Public dividend capital
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.
Page 16
1.18
Public dividend capital (continued)
A charge, reflecting the cost of capital utilised by the NHS Foundation Trust, is payable as public
dividend capital dividend. The charge is calculated at the rate set by HM Treasury (currently 3.50%)
on the average relevant net assets of the NHS Foundation Trust during the year. Relevant net assets
are calculated as the value of all assets less the value of all liabilities, except for i) donated assets, ii)
average daily cash balances held with the Government Banking Services (GBS) and National Loans
Fund, excluding cash balances held in GBS accounts that relate to a short-term working capital
facility, iii) for 2013/14 only, net assets and liabilities transferred from bodies which ceased to exist on
1st April 2013 and iv) 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 financial statements. The dividend thus calculated is not revised should any adjustment to net
assets occur as a result of the audit of the annual financial statements.
1.19
Corporation tax
A full review of the Foundation Trust's activities has been carried out in accordance with guidance
published by HM Revenue and Customs to establish any activities that are subject to Corporation
Tax. Based on this review there is no corporation tax liability in the year ended 31 March 2015.
1.20
Foreign exchange
The functional and presentation 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.
Exchange gains or losses on monetary items (arising on settlement of the transaction or on retranslation at the Statement of Financial Position date) are recognised in income or expense in the
period in which they arise.
The Trust had minimal monetary foreign exchange transactions and no non-monetary foreign
exchange transactions in the year.
1.21
Third party assets
Assets belonging to third parties (such as money held on behalf of patients) are not recognised in the
financial statements since the NHS Foundation Trust has no beneficial interest in them. However,
they are disclosed in a separate note to the financial statements in accordance with the requirements
of the HM Treasury’s Financial Reporting Manual.
1.22
Losses and special payments
Losses and special payments are items that Parliament would not have contemplated when it agreed
funds for the health service or passed legislation. By their nature they are items that ideally should
not arise. They are therefore subject to special control procedures compared with the generality of
payments. They are divided into different categories, which govern the way that individual cases are
handled. Losses and special payments are charged to the relevant functional headings in
expenditure on an accruals basis, including losses which would have been made good through
insurance cover had NHS Trusts not been bearing their own risks (with insurance premiums then
being included as normal revenue expenditure).
However, the losses and special payments note is compiled directly from the losses and
compensations register which reports on an accruals basis with the exception of provisions for future
losses.
Page 17
1.23
Accounting standards that have been issued but have not yet been adopted
The following accounting standards have been amended by the IASB and IFRIC but have not yet
been adopted because they are not yet required to be adopted:
Change published
1.24
IFRS 9 Financial Instruments
Published
by IASB
October 2010
Financial year for which the
change first applies
Uncertain. Not likely to be adopted
by the EU until the IASB has finished
the rest of its financial instruments
programme
IFRS 13 Fair Value Measurement
May 2011
IAS 36 (amendment) - recoverable amount
disclosures
May 2013
Annual Improvements 2012 and 2013
December
2013
Effective date of 2013-14 but not yet
adopted by HM Treasury
To be adopted from 2015-16 (aligned
to IFRS 13 adoption)
Effective from 2015-16 but not yet
EU-adopted
IAS 19 (amendment) - employer
contributions to defined benefit pension
schemes
November
2013
Effective from 2015-16 but not yet
EU-adopted
IFRIC 21 Levies
May 2013
Effective from 2014-15 but not yet
adopted by HM Treasury
Accounting standards issued that have been adopted early
There are no accounting standards that have been adopted early.
1.25
Critical accounting judgements and key sources of estimation uncertainty
In the application of the Trust’s accounting policies, management is required to make judgements,
estimates and assumptions about the carrying amounts of assets and liabilities that are not readily
apparent from other sources. 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 underlying assumptions are continually reviewed. Revisions to accounting estimates
are recognised in the period in which the estimate is revised if the revision affects only that period or
in the period of revision and future periods if the revision affects both current and future periods.
1.25.1
Critical judgements in applying accounting policies
The following are critical judgements, apart from those involving estimations (see 1.25.2) that
management has made in the process of applying the Trusts accounting policies and that have most
significant effect on the amounts recognised in the financial statements.
The Trust has made critical judgements, based on accounting standards, in the classification of
leases and arrangements containing a lease. The Trust assessed each contract potentially
incorporating a lease in accordance with IAS 17 - Leases and applied the appropriate accounting
treatment.
Page 18
1.25.2
Key sources of estimation uncertainty
The following are the key assumptions concerning the future, and other key sources of estimation
uncertainty at the end of the reporting period, that have a significant risk of causing a material
adjustment to the carrying amounts of assets and liabilities within the next financial year.
Under IAS 37, provisions totalling £809,134 were made for probable transfers of economic benefits
in respect of Redundancy Costs, risk pooling, pension costs of former employees and injury benefit
pensions.
In accordance with IAS 16 Property, Plant and Equipment the NHS Foundation Trust amended its
accounting estimates for property during 2014/15 and amended its approach to valuing land and
buildings property from a MEAV approach based on the existing site to a MEAV approach based on
an alternative site. Further details of this estimation are provided in note 9.6.
Page 19
2
Segmental analysis
IFRS 8 requires disclosures of the results of significant operating segments. The standard provides for
the information on income, expenses, surplus/deficit, assets and liabilities to be disclosed on the same
basis as that used for internal reporting to the Chief Operating Decision Maker (CODM). The CODM is
the Board of Directors.
Following the integration of community services, clinical services provided by the Trust have been
restructured. Clinical services consist of three divisions which have similar economic characteristics,
products, services and processes. They operate under the same regulatory framework and within the
core business of healthcare within the same economic environment i.e. the UK economy. Clinical
services is reported to the Board as one segment and the divisions are considered to meet the
aggregation tests under the standard. The Trust has therefore concluded that a single segment of
Healthcare should be reported in the financial statements.
The net surplus and total assets and liabilities for the single segment of Healthcare are therefore as
disclosed in the Statement of Comprehensive Income for the Trust.
2014-15
Healthcare
£000
2013-14
Healthcare
£000
194,078
14,157
202,722
12,040
208,235
214,762
Deficit per Statement of Comprehensive Income
(3,223)
(1,926)
Segment net assets
69,729
101,158
Income
Income from activities
Other Operating Income
Total Income
Deficit by segment
Operating Deficit as reported to the Board of Directors
The Trust's revenues derive mainly from healthcare services provided to patients under contracts with
commissioners within England. The main commissioners of services from the Trust, accounting for
over 86% of revenues, are South Tyneside Clinical Commissioning Group (48%), Sunderland Clinical
Commissioning Group (14%), Gateshead Clinical Commissioning Group (12%) and the Cumbria,
Northumberland and Tyne and Wear Local Area Team (12%). Details of total income received from
these commissioners during 2014-15 are shown in note 22.
Page 20
3
Income
Year
Ended
31 Mar
2015
£000
Year
Ended
31 Mar
2014
£000
3.1
Operating income
Acute income
Elective inpatient income
Non elective income
Outpatient income
Accident and emergency income
Other NHS clinical income **
11,512
30,639
9,590
5,028
32,519
13,699
30,393
9,862
5,030
33,355
Community income
Income from CCGs and NHS England
Income not from CCGs and NHS England
92,301
11,644
95,527
13,725
Other Trust income
Private patient income
Other non protected income **
23
822
36
1,095
Total income from activities
194,078
202,722
723
4,711
633
4,538
9
244
7
46
326
708
3,898
634
2,168
535
438
221
771
3,920
3
540
759
365
Total other operating income
14,157
12,040
TOTAL OPERATING INCOME
208,235
214,762
Income from activities
Other operating income
Research and development
Education and training
Received from NHS charities: Receipt of grants/donations
for capital acquisitions
Received from other bodies: Receipt of grants/donations for capital
acquisitions - Donation (i.e. receipt of donated asset)
Charitable and other contributions to expenditure
Non-patient care services to other bodies
Other ***
Profit on disposal of property, plant and equipment
Reversal of impairments of property, plant and equipment
Rental revenue from operating leases - minimum lease receipts
Income in respect of staff costs where accounted on gross basis
Income in respect of staff costs includes charges to other Foundation Trusts for sessions carried out
by Trust employed Consultants of £185,016 and charges to various organisations of other staff costs
of £253,754.
Page 21
3.1
Operating income (continued)
** Analysis of income from activities: other NHS clinical income
and other non-protected Income
Critical care
Ward attenders
Chemotherapy
Direct access
Community therapy
Specialist nursing
Community medical
Wheelchair services
Other clinical specialties
Urgent care service
NHS Injury Cost Recovery Scheme
Acutely sick and injured children's pathway
LIS funding
Excluded drugs and devices
Prescription charges
Ambulatory Care
Outpatient Diagnostics
Maternity Pathway
Other income
Total other clinical income (NHS and non-protected)
Year Ended
31 Mar 2015
£000
Year Ended
31 Mar 2014
£000
4,063
571
2,909
1,599
2,172
653
386
399
1,403
557
449
3,328
186
1,189
29
1,208
1,509
3,418
7,313
33,341
4,024
318
1,446
3,987
2,180
628
431
403
2,062
257
671
4,336
283
1,822
61
1,332
1,531
3,650
5,028
34,450
Other clinical specialties includes post discharge tariffs £450,360 (2013-14 £457,212), orthotics £336,888
(2013-14 £335,068), elderly consultant £52,833, long stay patients £265,041 (2013-14 £225,975),
community weight management £100,000 (2013-14 nil), drug & alcohol services £141,463 (2013-14
£108,888) and other income streams of £57,409 (2013-14 £165,057)
Other income includes Commissioning for Quality and Innovation (CQUIN) income for acute services
based upon 2.50% of actual contracted activity £1,824,182 (2013-14 £2,187,018), Winter Pressures
allocation £1,770,000 (2013-14 £800,000), Non Recurring Transition Support £2,041,397, Paediatric
Diabetes Funding £178,740 and other income streams totalling £1,499,356.
The total income relating to Commissioning for Quality and Innovation (CQUIN) for both acute and
community services is £3,688,439 (2013-14 £4,151,425), the income relating to Community Services
CQUIN of £1,864,257 (2013-14 £1,964,407) is included within Community Income from CCGs/NHS
England.
The NHS Injury scheme income is subject to a provision for doubtful debts to reflect expected rates of
collection. The Compensation Recovery Unit advise that there is a 18.9% (2013-14 15.8%) probability of
not receiving the income. Following a review of local information the Trust has included a provision of
20.2% (2013-14 24.60%) in the financial statements for the year ended 31 March 2015.
*** Analysis of Other Operating Income: Other
Car parking
Pharmacy sales
Catering
Property rentals
Clinical Service Level Agreements
Urology Income
Vascular
Bowel Cancer Screening
Neurology/Ophthalmology
Oral Surgery
Other income*
Total other income
£000
£000
510
13
655
170
52
787
73
344
67
327
900
3,898
389
7
636
172
51
772
68
367
74
257
1,127
3,920
*Other Income includes £182,800 (2013-14 £274,200) for facilities charges for dermatology services,
£85,899 (2013-14 £192,764) for Breast Surgery Services and £64,224 childcare subsidy (2013-14 nil)
Page 22
3.2
Private patient income
The statutory limitation on private patient income in section 44 of the 2006 Act was repealed with effect
from 1 October 2012 by the Health and Social Care Act 2012. The financial statements disclosures that
were provided previously are no longer required.
The income disclosures required by Section 43(2A) of the 2006 Act, as amended by the 2012 Act, are
included within the Trust’s Annual Report.
3.3
Overseas Visitors
Income recognised this year
Cash payments received in-year
Amounts added to provision for impairment of receivables
Amounts written off in-year
3.4
Year Ended
31 Mar 2015
£000
Year Ended
31 Mar 2014
£000
12
9
0
2
14
11
3
16
Income from activities arising from Commissioner Requested Services (CRS) and all other
services
Year Ended
31 Mar 2015
£000
Year Ended
31 Mar 2014
£000
Income arising from Commissioner-Requested Services
Income arising from non-Commissioner-Requested
Services
180,184
13,894
190,329
12,393
Total income from activities
194,078
202,722
Under the terms of its provider licence the Trust must provide specific healthcare services which are
requested by Commissioners.
3.5
Year Ended
31 Mar 2015
£000
Year Ended
31 Mar 2014
£000
Rents recognised as income in the period
TOTAL
535
535
759
759
Future minimum lease payments due
- not later than one year
- later than one year and not later than five years
TOTAL
295
14
309
354
25
379
Operating lease income
The main source of rental income from operating leases relates to property leased to Northumberland,
Tyne and Wear NHS Foundation Trust for the provision of Mental Health Services. These leases are on
a short term basis and require a 6 month notice period to terminate the contract.
The Trust also acts as a lessor to Ashfield Nursery. This lease is 15 years in duration and is due to
terminate at the end of March 2017.
Page 23
4
Operating expenses
4.1
Operating expenses by Type
Services from NHS Foundation Trusts
Services from NHS Trusts
Services from CCGs and NHS England
Services from other NHS Bodies
Purchase of healthcare from non NHS bodies
Employee Expenses - Executive directors
Employee Expenses - Non-executive directors
Employee Expenses - Staff
Supplies and services - clinical (excluding drug costs)
Supplies and services - general
Establishment
Research and development
Transport (business travel)
Transport (other)
Premises
Increase in provision for impairment of receivables
Increase in other provisions
Drug costs
Rentals under operating leases - minimum lease payments
Rentals under operating leases - sublease payments
Depreciation on property, plant and equipment
Amortisation of intangible assets
Impairments of property, plant and equipment
Impairments of assets held for sale
Audit fees
audit services - statutory audit
Other auditors' remuneration
other services
Clinical negligence
Loss on disposal of other property, plant and equipment
Legal fees
Consultancy costs
Training, courses and conferences
Patient travel
Redundancy
Early retirements
Hospitality
Insurance
Losses, ex gratia and special payments
Other
Total
Year Ended
31 Mar 2015
£000
Year Ended
31 Mar 2014
£000
5,292
5
526
528
47
763
132
153,268
11,930
1,869
1,683
454
1,022
366
6,129
(210)
0
6,179
5,860
0
4,083
96
2,699
0
6,636
16
638
558
6
825
133
154,461
13,546
1,969
1,813
283
2,182
209
5,824
291
67
6,117
7,221
(456)
4,660
68
1,417
25
37
52
0
2,795
84
133
1,199
541
2
665
45
0
221
112
508
209,063
639
2,494
109
141
507
369
2
573
30
1
239
60
248
213,973
Employers' pension contributions are included within employee expenses. Employee expenses for
Executive Directors includes £37,310 (2013-14 £61,419) in respect of employer pension contributions.
Expenditure within other operating expenses for the year ended 31 March 2015 includes £258,367
(2013-14 £161,013) services from Local Authorities, £32,243 (2013-14 £29,875) for crèche payments,
£101,733 (2013-14 £108,460) patient expenses, £27,558 funeral expenses and other expenditure
totalling £88,367 (2013-14 £(50,881)).
Page 24
4.2
Arrangements containing an operating lease
Minimum lease payments
Less sublease payments received
Total
Year Ended
31 Mar 2015
£000
Year Ended
31 Mar 2014
£000
5,860
0
5,860
7,221
(456)
6,765
The Trust has a large number of leases with various suppliers. Of the minimum lease payments,
£5,084,360 relates to building lease agreements, £626,370 relates to vehicles and £149,999 to
photocopiers.
4.3
Timing of minimum operating lease future payments
Future minimum lease payments due:
- not later than one year;
- later than one year and not later than five years;
Total
4.4
Year Ended
31 Mar 2015
£000
Year Ended
31 Mar 2014
£000
3,741
1,151
4,892
4,480
1,763
6,243
Auditor's remuneration
In March 2014, the Board of Governors appointed Deloitte LLP as the Trust’s external auditor for three
years from the year ended 31 March 2015 to the year ended 31 March 2017.
The audit fee for the statutory audit, including the assurance of the Quality accounts, was £36,990
(2013-14 £51,950) excluding VAT.
The engagement letter was signed on 4 December 2014.
There were no additional non-audit fees paid to Deloitte LLP during the year ending 31 March 2015.
Page 25
5
Employee expenses and numbers
5.1
Employee expenses
Total
£000
Permanently
employed
£000
Other
£000
Year
Ended
31 Mar
2014
£000
Salaries and wages
Social security costs
Pension costs - defined contribution plans
(Employers contributions to NHS Pensions)
Termination benefits
Agency/contract staff
125,730
9,735
15,074
124,262
9,623
14,901
1,468
112
173
128,107
9,696
15,157
710
4,290
710
0
0
4,290
603
2,807
Total
155,539
149,496
6,043
156,370
The total employer pension contribution payable in the period 1 April 2014 to 31 March 2015 was £14,666,575
(2013-14 £15,244,691). This differs from the figure above as the latter includes adjustments such as pension
costs for staff recharged by other bodies, and for annual leave accruals.
5.2
Average monthly number of employees (whole time equivalent basis)
Total
Number
Senior
manage
- ment
Number
Agency,
temporary
and
contract
Number
Other
Number
Year
Ended
31 Mar
2014
Number
240
780
1
9
50
25
189
746
247
814
Medical and dental
Administration and estates
Healthcare assistants and other
support staff
Nursing, midwifery and health visiting
staff
Nursing, midwifery and health visiting
learners
Scientific, therapeutic and technical staff
Other
261
0
27
234
254
2,060
0
96
1,964
2,156
37
555
7
0
0
0
0
15
0
37
540
7
35
531
7
Total
3,940
10
213
3,717
4,044
Page 26
5.3
Staff exit packages
There were 17 exit packages agreed in the year as follows:
Exit package cost and band
Number of
compulsory
redundancie
s
<£10,000
£10,000 - £25,000
£25,001 - £50,000
£50,001 - £100,000
Total number by exit packages by type
Total resource cost
1
4
5
3
Cost of
compulsory
redundancie
s
£
6,510
83,245
202,023
168,777
13
5,065
0
44,100
155,964
Total cost
of exit
packages
by cost
band
£
11,575
83,245
246,123
324,741
Year Ended
31 Mar
2014
£
23,408
223,205
304,380
197,810
205,129
665,684
30
748,803
Number of
other
departures
agreed
Cost of
other
departures
agreed
1
0
1
2
4
460,555
The compulsory redundancy costs arose as a consequence of cessation of services by Commissioners.
Included within the above figures are provisions made in the financial statements for redundancy costs within the Gateshead Sexual Health team and
Health and Lifestyle advisor teams. This totals £199,097 and relates to 6 employees.
Exit packages: non-compulsory departure payments
Number of
Payments
agreed
Voluntary redundancies including early retirement contractual costs
Early retirements in the efficiency of the service contractual costs
Contractual payments in lieu of notice
4
0
3
7
Total value
of
agreement
s
£
189,311
0
15,818
205,129
The number of payments agreed in the above note differs to that in the exit cost and package band note as a single exit package is made up of
several components.
Page 27
5.4
Early retirements due to ill health
During the year ended 31 March 2015 there were 9 early retirements from the Trust agreed on the
grounds of ill health at an additional cost of £614,556 (2013-14 - 9 early retirements at a cost of
£473,889).
5.5
Retirement benefits
NHS Pension Scheme
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 HM Treasury Financial Reporting Manual (FReM) requires that “the period between formal
valuations shall be four years, with approximate assessments in intervening years”. An outline of
these follows:
a) 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 is
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 at 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.
b) 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 2004. Consequently, a formal actuarial valuation would have been due for
the year ending 31 March 2008 and again on 31 March 2012. However, formal actuarial valuations
for unfunded public service schemes were suspended by HM Treasury on value for money grounds
while consideration was given to recent changes to public service pensions, and while future scheme
terms are developed as part of the reforms to public service pension provision due for
implementation in 2015.
Page 28
5.5
Retirement benefits (continued)
The Scheme Regulations were changed to 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.
c) 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
AVCs run by the Scheme’s approved providers or by other Free Standing Additional Voluntary
Contributions (FSAVC) providers.
National Employment Savings Trust (NEST)
Automatic enrolment is the term given to the legal obligation that the government has now placed
on employers to provide all ‘workers’ with access to a pension scheme. The staging date for the
Trust to implement automatic enrolment was 1 May 2013. As a result of this, with effect from that
date the Trust must:
• Provide a qualifying scheme for all workers;
• Automatically enrol all eligible jobholders onto the scheme; and
• Pay employer contribution for eligible jobholders to the scheme.
Where an employee is eligible to join the NHS Pension Scheme then they will be automatically
enrolled into this scheme, even if they have previously opted out. Where an employee is not
eligible to join the NHS Pension Scheme (e.g. flexible retiree employees) then an alternative
scheme must be made available by the Trust.
Page 29
5.5
Retirement benefits (continued)
NEST is a defined contribution pension scheme that was created as part of the government’s
workplace pensions reforms under the Pensions Act 2008. Details of the scheme can be found on
their web site www.nestpensions.org.uk.
Further details regarding NEST as an alternative provider are as follows:
• A member can take their money out of NEST at any age from at least 55 and up to and just
before their 75th birthday.
• Members who suffer from ill health may be able to take their money out of NEST before age 55.
• In the case of serious ill health, where a registered medical practitioner says the member has
less than a year to live, the member can be paid their retirement pot as a lump sum. This can
happen at any age before 75.
Employer contributions to the scheme are charged to the Statement of Comprehensive Income.
Other creditors includes £3,382 (2013-14 £2,331) in relation to employee and employer
contributions due to NEST at 31 March 2015. The total employers contributions for the year
totalled £19,435 (2013-14 £12,951)
5.6
Senior managers' remuneration
Year Ended
31 Mar 2015
£000
Year Ended
31 Mar
2014
£000
3,037
212
3,249
3,045
251
3,296
Total of key management personnel compensation
Short term employee benefits
Post-employment benefits
Total key management
compensation
No advances were made and no credits were granted by the Trust to directors during the year.
The Trust has not provided any guarantees on behalf of directors during the year.
Key management personnel comprises the Board of Directors and the Executive Board.
Remuneration details for individual senior managers are provided within the Trust's Annual
Report.
As explained in note 5.5, the NHS pension scheme is an unfunded defined benefit scheme but is
accounted for as if it were a defined contribution scheme.
The number of executive directors accruing benefits under the NHS Pension Scheme is 4 (201314 - 5). No directors accrue benefits under money purchase schemes.
No executive directors received remuneration from another company in the year. Details of
remuneration received by other senior managers from other organisations are disclosed in note
22 - Related Party Transactions.
During 2014-15 Mr Steve Williamson was appointed as Chief Operating Officer and Dr Bob
Brown was appointed as Director of Nursing and Patient Safety.
Page 30
6
Finance income
Interest on bank accounts
Total
7
Finance costs
7.1
Finance costs - interest expense
Finance leases
Loans from the Independent Trust Financing Facility
Total
Year Ended
31 Mar 2015
£000
Year Ended
31 Mar 2014
£000
42
42
52
52
Year Ended
31 Mar 2015
£000
Year Ended
31 Mar 2014
£000
2
7
9
5
0
5
During 2014/15 the Trust agreed a loan from the Independent Trust Financing Facility for £9.5m.
The loan is to fund the building of a new integrated care services hub on the Trust's site. The term
of the loan is 10 years and the interest rate is 1.47%. At 31 March 2015 £3.05m of the loan had
been drawn down.
7.2
Impairment of assets (property, plant and equipment and
intangibles)
Impairment due to change in market value where no revaluation
reserve exists
Impairment where the costs of upgrades to Trust property was
greater than the subsequent increase in value
Impairment due to damage to equipment as the result
of a flood
Impairment to Statement of Comprehensive
Income
£000
£000
1,631
25
593
1,417
475
0
2,699
1,442
Impairment due to change in market value taken from
revaluation reserve
Reversals of impairments
35,206
157
(2,168)
(540)
Total impairments
35,737
1,059
8
Intangible assets
8.1
Intangible assets 2014-15
Software
licences
(purchased
)
£000
Gross cost at 1 April 2014
Additions - purchased
Gross cost at 31 March 2015
402
188
590
Accumulated amortisation at 1 April 2014
Provided during the year
Accumulated amortisation at 31 March 2015
144
96
240
Net book value
Net book value - purchased at 31 March 2015
350
Page 31
Software
licences
(purchased)
8.2
Intangible assets 2013-14
£000
Gross cost at 1 April 2013
Additions - purchased
Gross cost at 31 March 2014
259
143
402
Accumulated amortisation at 1 April 2013
Provided during the year
Accumulated amortisation at 31 March 2014
76
68
144
Net book value
Net book value - purchased at 31 March 2014
258
Page 32
9
Property plant and equipment
Total
9.1
Property plant and equipment 2014-15
Buildings
excluding
dwellings
Land
Dwellings
Assets
under
construction
Plant and
machinery
Transport
equipment
Information
technology
Furniture
and
fittings
£000
£000
£000
£000
£000
£000
£000
£000
£000
Cost or valuation at 1 April 2014
Additions - purchased
Additions - donated
Impairments
Reversal of impairments
Revaluations
Reclassifications
Removal of accumulated depreciation following revaluation
Transfers to assets held for sale
Disposals
Cost or valuation at 31 March 2015
107,479
5,494
16
(37,430)
2,168
6,097
0
(1,731)
0
(3,795)
78,298
19,961
0
0
(16,590)
55
14
0
0
0
0
3,440
58,736
0
0
(20,314)
2,107
5,852
977
(1,677)
0
0
45,681
2,121
0
0
(526)
6
231
0
(54)
0
0
1,778
401
1,965
9
0
0
0
(977)
0
0
0
1,398
19,767
2,486
7
0
0
0
0
0
0
(3,376)
18,884
285
(4)
0
0
0
0
0
0
0
0
281
5,314
1,047
0
0
0
0
0
0
0
(380)
5,981
894
0
0
0
0
0
0
0
0
(39)
855
Accumulated depreciation at 1 April 2014 as restated
Provided during the year
Removal of accumulated depreciation following revaluation
Impairments
Disposals
Accumulated depreciation at 31 March 2015
16,388
4,083
(1,731)
475
(3,682)
15,533
0
0
0
0
0
0
0
1,677
(1,677)
0
0
0
0
54
(54)
0
0
0
0
0
0
0
0
0
12,642
1,519
0
475
(3,272)
11,364
155
16
0
0
0
171
3,013
768
0
0
(380)
3,401
578
49
0
0
(30)
597
Net book value
Net book value - owned at 31 March 2015
Net book value - finance lease at 31 March 2015
Net book value - government granted at 31 March 2015
Net book value - donated at 31 March 2015
Net book value total at 31 March 2015
61,419
0
52
1,294
62,765
3,440
0
0
0
3,440
44,681
0
52
948
45,681
1,778
0
0
0
1,778
1,398
0
0
0
1,398
7,270
0
0
250
7,520
73
0
0
37
110
2,580
0
0
0
2,580
199
0
0
59
258
9,219
0
0
0
0
7,579
132
1,354
154
Cost or valuation of assets held at zero net book value
at 31 March 2015
Page 33
Total
9.2
Property plant and equipment 2013-14
Buildings
excluding
dwellings
Land
Dwellings
Assets
under
construction
Plant and
machinery
Transport
equipment
Information
technology
Furniture
and
fittings
£000
£000
£000
£000
£000
£000
£000
£000
£000
Cost or valuation at 1 April 2013
Additions - purchased
Additions - donated
Impairments
Reversal of impairments
Revaluations
Reclassifications
Removal of accumulated depreciation following revaluation
Transfer to assets held for sale
Disposals
Cost or valuation at 31 March 2014
104,612
5,254
287
(1,574)
540
3,442
0
(2,502)
(722)
(1,858)
107,479
20,313
0
0
0
0
0
0
0
(352)
0
19,961
54,820
0
0
(1,369)
540
3,353
3,822
(2,430)
0
0
58,736
2,645
0
0
(205)
0
89
34
(72)
(370)
0
2,121
1,746
2,427
84
0
0
0
(3,856)
0
0
0
401
19,199
1,699
201
0
0
0
0
0
0
(1,332)
19,767
254
76
0
0
0
0
0
0
0
(45)
285
4,749
1,046
0
0
0
0
0
0
0
(481)
5,314
886
6
2
0
0
0
0
0
0
0
894
Accumulated depreciation at 1 April 2013
Provided during the year
Removal of accumulated depreciation following revaluation
Transfer to assets held for sale
Disposals
Accumulated depreciation at 31 March 2014
15,958
4,660
(2,502)
(20)
(1,708)
16,388
0
0
0
0
0
0
0
2,430
(2,430)
0
0
0
0
92
(72)
(20)
0
0
0
0
0
0
0
0
12,375
1,449
0
0
(1,182)
12,642
191
9
0
0
(45)
155
2,863
631
0
0
(481)
3,013
529
49
0
0
0
578
Net book value
Net book value - purchased at 31 March 2014
Net book value - finance lease at 31 March 2014
Net book value - government granted at 31 March 2014
Net book value - donated at 31 March 2014
Net book value total at 31 March 2014
89,185
3
92
1,811
91,091
19,961
0
0
0
19,961
57,321
0
92
1,323
58,736
2,121
0
0
0
2,121
401
0
0
0
401
6,774
3
0
348
7,125
130
0
0
0
130
2,230
0
0
71
2,301
247
0
0
69
316
9,437
0
0
0
0
7,531
132
1,627
147
Cost or valuation of assets held at zero net book value
at 31 March 2014
Page 34
9.3
Assets held at open market value:
Of the totals at 31 March 2015, £213,000 related to land valued at open market value and £313,000
related to buildings valued at open market value.
9.4
Economic life of property, plant and equipment
Land
Buildings excluding dwellings
Dwellings
Assets under Construction
Plant and Machinery
Transport Equipment
Information Technology
Furniture and Fittings
9.5
Minimum
life
n/a
4
8
0
1
5
3
5
Maximum
life
n/a
109
92
0
25
19
18
15
Property, plant and equipment disposals
There was a profit of £634,417 relating to disposal of property and equipment. The largest profit related
to the disposal of Radiology scanners which had previously been damaged due to a flood. Insurance
proceeds totalling £595,756 have been recognised in relation to this equipment. This profit is largely
offset by an impairment of these assets amounting to £474,960. These profits were partly offset by
losses on disposal totalling £84,128 the largest of which related to the sale of a washer-disinfector which
generated a loss of £61,422.
There were no disposals of land or buildings assets used in the provision of Commissioner Requested
Services during the year (2013-14 nil).
9.6
Property revaluation
As described in accounting policy 1.7, the Trust revised its accounting estimates during the year in
relation to the basis of valuing its land and buildings property. As a result of this the Trust carried out two
revaluations during 2014/15. The first of these was carried out at 1st April 2014 which resulted in
impairments totalling £36,836,594 as a result of changes in prices using the new accounting estimates.
The second revaluation was carried out at 31st March 2015. The impact of this was a revaluation gain of
£8,223,251 in relation to an increase in prices. This was offset in part by an impairment of £561,123
relating to the difference between capital expenditure on land and buildings and the subsequent
increase in their valuation as a result of this expenditure.
Page 35
10
Non-current assets held for sale
10.1
Non-current assets held for sale 2014-15
£000
Net book value non-current assets for sale at 1 April 2014
Plus assets classified as available for sale in the year
Less assets sold in year
Less impairment of assets held for sale
Net book value non-current assets for sale at 31 March 2015
332
0
(332)
0
0
10.2
Property,
plant and
Equipment
Non-current assets held for sale 2013-14
Net book value non-current assets for sale at 1 April 2013
Plus assets classified as available for sale in the year
Less assets sold in year
Less impairment of assets held for sale
Net book value non-current assets for sale at 31 March 2014
230
702
(575)
(25)
332
Non-current assets held for sale at 1 April 2014 comprised four residential properties that the Trust had
deemed surplus to requirements. All of these assets were sold within the year ended 31 March 2015.
11
Inventories
11.1
Inventories
Drugs
Equipment services
Pathology reagents
Wheelchair services
Prostheses
Other
Total inventories
11.2
Year
Ended
31 Mar
2015
£000
Year
Ended
31 Mar
2014
£000
727
420
0
123
115
778
2,163
730
386
29
140
94
721
2,100
17,574
31
17,605
19,003
33
19,036
Inventories recognised in expenses
Inventories recognised in expenses
Write-down of inventories recognised as an expense
Total Inventories recognised in expenses
Page 36
12
12.1
Trade receivables and other receivables
Trade receivables and other receivables
Current
NHS receivables - revenue
Other receivables with related parties - revenue
Provision for impaired receivables
Prepayments
Accrued income
PDC receivable
VAT receivable
Other receivables
Total current trade and other receivables
Non-current
Provision for impaired receivables
Other receivables
Total non-current trade and other receivables
Total
31 Mar 15
£000
Financial
assets
31 Mar 15
£000
Nonfinancial
assets
31 Mar 15
£000
4,943
1,601
(118)
1,287
832
0
106
1,942
4,943
1,601
(18)
0
832
0
0
1,398
10,593
Total
31 Mar 14
£000
Financial
assets
31 Mar 14
£000
Nonfinancial
assets
31 Mar 14
£000
0
0
(100)
1,287
0
0
106
544
5,125
1,113
(451)
981
52
58
129
1,459
5,125
1,113
(364)
0
52
0
0
944
0
0
(87)
981
0
58
129
515
8,756
1,837
8,466
6,870
1,596
(132)
605
0
0
(132)
605
(187)
755
0
0
(187)
755
473
0
473
568
0
568
Page 37
12.2
Provision for impairment of receivables
At 1 April
Increase in provision
Amounts utilised
Unused amounts reversed
At 31 March
12.3
31 Mar
2015
£000
31 Mar
2014
£000
638
226
(178)
(436)
250
370
291
(23)
0
638
31 Mar
2015
£000
31 Mar
2014
£000
0
0
0
1
250
251
321
4
13
8
292
638
31 Mar
2015
£000
31 Mar
2014
£000
668
393
524
1,453
409
3,447
822
1,235
762
480
194
3,493
Analysis of impaired receivables
Ageing of impaired receivables
0
- 30 days
30
- 60 days
60
- 90 days
90
- 180 days
180 - 360 days
Total
Ageing of non-impaired receivables past their due date
0
- 30 days
30
- 60 days
60
- 90 days
90
- 180 days
180 - 360 days
Total
Page 38
13
13.1
Trade and Other Payables
Trade and Other Payables
Total
31 Mar 15
£000
Financial
liabilities
31 Mar 15
£000
Nonfinancial
liabilities
31 Mar 15
£000
1,730
4,296
650
2,591
1,367
1,343
4,627
97
1,730
4,296
650
2,591
0
0
4,627
0
16,701
Current
NHS payables - revenue
Amounts due to other related parties - revenue
Other trade payables - capital
Other trade payables - revenue
Social Security costs
Other taxes payable
Accruals
PDC interest payable
Total current trade and other payables
13.2
Early retirements detail included in NHS payables above
- to buy out the liability for early retirements over 5 years
- number of cases involved
- outstanding pension contributions at 31 March 2015 (all employees)
Page 39
Total
31 Mar 14
£000
Financial
liabilities
31 Mar 14
£000
Nonfinancial
liabilities
31 Mar 14
£000
0
0
0
0
1,367
1,343
0
97
1,927
3,002
522
1,090
1,441
1,455
5,255
0
1,927
3,002
522
1,090
0
0
5,255
0
0
0
0
0
1,441
1,455
0
0
13,894
2,807
14,692
11,796
2,896
31 Mar 15
£000
31 Mar 15
Number
31 Mar 14
£000
31 Mar 14
Number
12
11
36
1,927
36
2,056
14
Other liabilities
31 Mar 2015
£000
31 Mar 2014
£000
2,289
990
31 Mar 2015
£000
31 Mar 2014
£000
4
9
3,050
0
3,050
0
4
4
Current
Other deferred income
15
Borrowings
Current
Obligations under finance leases
Non-current
Loan from the Independent Trust Financing Facility
Obligations under finance leases
Total non-current borrowings
During 2014-15 the Trust agreed a loan from the Independent Trust Financing Facility for £9.50m. The
loan is to fund the building of a new integrated care services hub on the Trust's site. To date £3.05m of
the funding has been drawn down. The term of the loan is 10 years and the interest rate is 1.47%
All borrowings under finance leases relate to franking machines and scales.
16
Prudential borrowing limit
The prudential borrowing limit requirements in section 41 of the NHS Act 2006 have been repealed with
effect from 1 April 2013 by the Health and Social Care Act 2012. The financial statements disclosures
that were provided previously are no longer required.
17
Finance lease obligations
31 Mar 2015
£000
31 Mar 2014
£000
Gross lease liabilities
of which liabilities are due
- not later than one year;
- later than one year and not later than five years;
Gross lease liabilities
4
0
4
11
4
15
Finance charges allocated to future periods
0
(2)
Net lease liabilities
4
13
4
0
4
9
4
13
of which liabilities are due
- not later than one year;
- later than one year and not later than five years;
Page 40
18
Provisions for liabilities and charges
Current
31 Mar
2015
£000
8
38
117
0
44
31
238
Pensions relating to former directors
Pensions relating to other staff
Other legal claims
Agenda for Change
Redundancy
Other
Total
Provision for liabilities and charges
At 1 April 2014
Change in the discount rate
Arising during the year
Utilised during the year
Reversed unused
Unwinding of discount
At 31 March 2015
Expected timing of cash flows:
- not later than one year;
- later than one year and not later than five
years;
- later than five years.
Total
31 Mar
2014
£000
8
39
109
3
95
30
284
Non-Current
31 Mar
31 Mar
2015
2014
£000
£000
90
88
256
259
0
0
0
0
0
0
226
240
572
587
Pensions
- former
directors
Pensions
- other
staff
Other
legal
claims
£000
96
0
9
(8)
0
1
98
£000
298
0
30
(38)
0
4
294
238
310
8
31
262
810
59
98
Total
£000
871
9
171
(192)
(57)
8
810
Page 41
£000
109
0
82
(20)
(54)
0
117
Agenda
for
Change
£000
3
0
0
0
(3)
0
0
Redundancy
£000
95
0
44
(95)
0
0
44
Other
£000
270
9
6
(31)
0
3
257
38
154
117
0
0
0
44
0
31
125
102
294
0
117
0
0
0
44
101
257
18
Provisions for liabilities and charges (continued)
Provisions relating to pensions are based on estimates of costs received from NHS Pensions. The
timing of cash flows is unlikely to vary significantly as long as the pensions concerned continue to be
drawn. The current discount rate is 1.30% (2013-14 - 1.80%). The impact of the change is shown in
the provisions for liabilities and charges note on the previous page.
The other legal claims against the Trust are expected to be largely settled in 2015-16. The total of
£117,050 relates exclusively to outstanding claims concerning the costs of risk pooling for nonclinical claims.
A provision of £43,892 has been included in the year for redundancy costs. These relate to the
retraction of the Weight Management and Health and Lifestyle Advice services.
The other provision relates to estimated costs for injury benefits amounting to £257,004. The
amounts due have been discounted to their present value using the pensions discount rate which is
currently 1.30% (2013-14 - 1.80%).
18.1
19
Clinical negligence liabilities
31 Mar
2015
£000
31 Mar
2014
£000
Amount included in provisions of the NHSLA at 31 March in respect
of clinical negligence liabilities of South Tyneside NHS Foundation
Trust
47,907
31,547
31 Mar
2015
£000
31 Mar
2014
£000
(112)
(112)
(110)
(110)
Contingent liabilities
Value of contingent liabilities Other
Net value of contingent liabilities
The Trust cannot accurately determine the eventual liability arising from risk pooling for non-clinical
claims, and therefore has included a contingent liability of £112,166.
Page 42
20
21
Cash and cash equivalents
31 Mar 2015
£000
31 Mar 2014
£000
At 1 April
Net change in year
At 31 March
14,909
1,330
16,239
20,271
(5,362)
14,909
Broken down into:
Cash at commercial banks and in hand
Cash with Government Banking Services
Cash and cash equivalents as in Statement of Financial
Position
27
16,212
16,239
23
14,886
14,909
Cash and cash equivalents as in statement of cash flows
16,239
14,909
Capital commitments
Commitments under capital expenditure contracts at the Statement of Financial Position date were
£495,675
£000
Material Projects Include:
Replacement of equipment in Radiology room 5
323,201
Ultrasound machine for Radiology
59,950
Endoscopy Reporting System
46,576
Extramed IT system for Theatres
50,850
22
Related party transactions
South Tyneside NHS Foundation Trust is a public benefit corporation authorised by the Independent
Regulator for Foundation Trusts ('Monitor') under section 35 of the National Health Service Act 2006.
During the period none of the Board Members, Governors or members of the key management staff or
parties related to them has undertaken any material transactions with South Tyneside NHS Foundation
Trust, with the exception of those listed below:
Helen Watson - Appointed Governor of South Tyneside NHS Foundation Trust is the Executive Director of
Children's Services at South Tyneside Council and Iain Malcolm, Non-Executive Director of South Tyneside
NHS Foundation Trust is the Leader of South Tyneside Council. The Trust had income in the year with
South Tyneside Council of £3,101,011 largely in relation to the commissioning of community services, and
expenditure of £985,247, largely in respect of property rates.
Councillor John Kelly - Appointed Governor of South Tyneside NHS Foundation Trust is a councillor of
Sunderland City Council. The Trust had income of £2,890,167 in the year with Sunderland City Council
largely relating to the provision of community services, and expenditure of £264,879 relating mainly to
salary costs of CAMHS staff and rates.
Professor Greg Rubin - Appointed Governor of South Tyneside NHS Foundation Trust for Durham
University – School of Medicine and Health – Wolfson Research Institute. The Trust had expenditure of
£54,607 in the year with Durham University relating to research projects.
The Department of Health is regarded as a related party. During the year South Tyneside NHS Foundation
Trust received income of £53,337 from the Department of Health. The Trust also had significant
transactions with other entities for which the Department is regarded as the parent Department. These
entities, along with the transactions and balances, are listed on the following page.
The Trust has also received revenue and capital payments from the South Tyneside Trust General
Charitable Fund, for which the Trust is a corporate trustee and members of the Board of Directors are
trustees. Revenue and capital payments made by the Charity in relation to the Trust amounted to £154,801
(2013-14 £243,740) and the Trust had a debtor balance with the charity of £1,259 (2013-14 £68,480) as at
31 March 2015.
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22
Related party transactions (continued)
22.1
Related party transactions and balances 2014-15
Income
£000
Related party
South Tyneside Clinical Commissioning Group
Sunderland Clinical Commissioning Group
Gateshead Clinical Commissioning Group
Durham Dales, Easington and Sedgefield Clinical Commissioning Group
North Durham Clinical Commissioning Group
Newcastle West Clinical Commissioning Group
Newcastle North & East Clinical Commissioning Group
North Tyneside Clinical Commissioning Group
Other Clinical Commissioning Groups
Other NHS Trusts
City Hospitals Sunderland NHS Foundation Trust
Gateshead Health NHS Foundation Trust
North East Ambulance NHS Foundation Trust
Northumberland Tyne and Wear NHS Foundation Trust
Northumbria Healthcare NHS Foundation Trust
The Newcastle upon Tyne Hospitals NHS Foundation Trust
County Durham and Darlington NHS Foundation Trust
Other Foundation Trusts
Department of Health
Cumbria, Northumberland and Tyne and Wear Local Area Team
NHS Litigation Authority
Public Health England
Health Education England
NHS Property Services Limited
Other NHS & DH bodies
NHS Blood and Transplant Authority
South Tyneside Council
Gateshead Council
Sunderland City Council
Other Local Government
NHS Pensions Agency
HMRC
Other Central Government
Totals
Expenditure Receivable
£000
£000
Payable
£000
100,720
28,935
24,819
270
159
52
59
142
394
0
0
0
1
0
0
0
0
0
530
1
1,071
158
217
55
39
19
43
72
121
0
552
0
0
0
0
0
0
0
0
1
1,400
2,141
15
740
17
803
183
4
1,975
3,211
3
2
112
321
135
94
259
861
0
95
5
54
16
4
738
390
0
241
4
221
25
30
53
26,081
0
6
4,517
303
10
16
3
0
2,960
4
0
4,982
84
533
0
1,822
0
2
32
353
0
0
97
0
0
1
0
2,352
81
2
3,101
4,013
2,890
223
0
0
0
985
11
265
0
15,039
9,725
0
620
57
471
97
0
106
1
1
0
1
1
1,939
2,710
0
202,066
40,976
6,650
9,387
The following, who are not employees of South Tyneside NHS Foundation Trust, are appointed to the Board of Governors to
represent their organisations:Stephen Clark, Director of Public Health, South Tyneside Clinical Commissioning Group
Helen Watson, Executive Director, Children's Services, South Tyneside Council - until 15 July 2014
Councillor John Kelly, Councillor, Sunderland City Council
Allyson Stewart, Voluntary Services - South Tyneside
Mark Foster , Voluntary Services - Sunderland
Robert Buckley , Voluntary Services - Gateshead
Professor Greg Rubin, Durham University – School of Medicine and Health – Wolfson Research Institute - until 5 January 2015
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Page 45
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23
Financial instruments
IFRS 7, Financial Instruments: Disclosures, requires disclosure of the role that financial instruments have
had during the period in creating or changing the risks an entity faces in undertaking its activities.
Financial instruments play a much more limited role in creating or changing risk than would be typical of
the listed companies to which IFRS 7 mainly applies.
Credit risk
Because of the continuing service provider relationship that the NHS Foundation Trust has with local
commissioning bodies and the way those bodies are financed, the NHS Foundation Trust is not exposed
to the degree of financial risk faced by other business entities.
The NHS Foundation Trust has the freedom to borrow funds and can invest surplus funds in accordance
with Monitor’s guidance on Managing Operating Cash. This includes strict criteria on permitted
institutions, including credit ratings from recognised agencies. Financial assets and liabilities are
generated by day-to-day operational activities rather than being held to manage the risks facing the NHS
Foundation Trust in undertaking its activities.
The NHS Foundation Trust fully expects that all non-impaired financial instruments are fully recoverable.
Liquidity risk
The NHS Foundation Trust's net operating costs are incurred under legally binding contracts with local
commissioning bodies, which are financed from resources voted annually by Parliament. The Trust has
financed capital expenditure from internally generated resources. South Tyneside NHS Foundation Trust
is not, therefore, exposed to significant liquidity risks.
The NHS Foundation Trust has included a planned deficit of £5,000,000 in its Annual Plan submission for
2015/16. As the Trust has significant cash resources it does not believe the planned deficit represents a
significant risk to liquidity.
Market risk
The main potential market risk to the Trust is interest rate risk. The Trust's financial liabilities carry nil or
fixed rates of interest. Cash balances are held in interest bearing accounts for which the interest rate is
linked to bank base rates and changes are notified to the Trust in advance. The Trust is not, therefore,
exposed to significant interest-rate risk.
23.1
Financial assets by category
Assets as per Statement of Financial Position
Loans and
receivables
£000
Trade and other receivables excluding non-financial assets (at 31 Mar
2015)
Cash and cash equivalents at bank and in hand (at 31 Mar 2015)
8,756
16,239
Total at 31 March 2015
24,995
Trade and other receivables excluding non-financial assets (at 31 Mar
2014)
Cash and cash equivalents at bank and in hand (at 31 Mar 2014)
6,870
14,909
Total at 31 March 2014
21,779
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23.2
Financial liabilities by category
Current
Other
financial
liabilities
£000
NonCurrent
Other
financial
liabilities
£000
Borrowings (31 March 2015)
Obligations under finance leases (31 Mar 2015)
Trade and other payables excluding non financial assets (31 Mar 2015)
Provisions under contract (at 31 Mar 2015)
0
4
13,894
120
3,050
0
0
572
Total at 31 March 2015
14,018
3,622
Obligations under finance leases (31 Mar 2014)
Trade and other payables excluding non financial assets (31 Mar 2014)
Provisions under contract (at 31 Mar 2014)
Total at 31 March 2014
9
11,796
175
11,980
4
0
587
591
Liabilities as per Statement of Financial Position
23.3
Fair values of financial assets and financial liabilities at 31 March 2015
There is no difference between the book value and fair value of the financial assets and financial
liabilities.
24
Losses and special payments
There were 121 cases of losses and special payments totalling £118,860 (2013-14 - 123 cases totalling
£84,458). These amounts are reported on an accruals basis.
Number
£000
Losses
Losses of cash
2
0
Bad Debts and claims abandoned (excluding those between the Trust
56
7
and other NHS bodies)
Stores Losses including damage to buildings and other properties as a
12
33
result of theft, criminal damage and neglect
70
40
Special Payments
Compensation under legal obligation
24
75
Ex gratia payments
27
4
51
79
Total
121
119
There were no clinical negligence cases where the net payment exceeded £100,000.
There were no fraud cases where the net payment exceeded £100,000.
There were no personal injury cases where the net payment exceeded £100,000.
There were no compensation under legal obligation cases where the net payment exceeded £100,000.
There were no fruitless payment cases where the net payment exceeded £100,000.
25
Third party assets
The Trust held £2,821 cash at bank and in hand at 31 March 2015 (2013-14 - £1,898) which relates to
monies held by the NHS Foundation Trust on behalf of patients. This has been excluded from cash at
bank and in hand figure reported in the financial statements.
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26
Carbon reduction commitment energy efficiency (CRC) scheme
The CRC scheme is a mandatory cap and trade scheme for non-transport CO2 emissions. Where NHS
Foundation Trusts are registered with the CRC scheme they are required to surrender to the government
an allowance for every tonne of CO2 emitted during the financial year. Therefore, registered NHS
Foundation Trusts should recognise a liability (and related expense) in respect of this obligation as CO2
emissions are made.
The carrying amount of the liability at 31 March 2015 will therefore reflect the CO2 emissions that have
been made during that financial year.
The liability is measured at the amount expected to be incurred in settling the obligation. This is the cost
of the number of allowances/tonnes required to settle the obligation, being £16 (2013-14 £12) per
allowance/tonne. The Trust has included an accrual in the financial statements at 31 March 2015 of
£133,854 in relation to this obligation.
27
Events after the reporting date
South Tyneside NHS Foundation Trust provides specialist palliative care to the people of Sunderland
and surrounding areas from St. Benedict’s Hospice. Prior to the transfer of Community Services to the
Trust in July 2011 the service was provided by the former Gateshead Primary Care Trust from a facility
in Monkwearmouth, Sunderland which was owned by Northumbria, Tyne & Wear Mental Health NHS
Foundation Trust. However, at the time of the transfer of community services to the Trust a new state of
the art premises was in the process of being built at a new site in Ryhope, Sunderland which had been
funded and commissioned by the former NHS South of Tyne and Wear on behalf of the PCT.
Consideration was given to the transfer of the ownership of the Hospice to the Trust at the time of the
closure of the PCTs under the property transfer scheme as the Trust was 100% occupier. However, as
the Hospice was not fully commissioned and the mechanism within the property transfer scheme for the
transfer of the Contractors guarantees was not clear it was decided to defer the transfer to the Trust until
the defects liabilities period was complete. Practical completion occurred on 31 March 2013 and the
property was subsequently transferred to NHS Property Services Limited when the PCT was dissolved.
The facility opened in June 2013 and the Trust transferred the service from Monkwearmouth at this time.
St Benedict’s Hospice and Centre for Specialist Palliative Care includes 14 in-patient beds, day care and
lymphoedema and outpatient services, as well as a number of community nursing teams and an
education centre. The estimated cost of the build was £12m although the Trust has been informed that
NHS Property Services are holding the property at a net book value of £12.657m at 31 March 2015.
As the Trust fully occupied the premises it was proposed that the freehold be transferred to the Trust
when the defects liability period on the construction ends. The transfer was expected to happen during
2014-15, however, due to the number of other properties being transferred by the Department of Health
in year the transfer was unable to be completed. The Trust have now been advised that the transfer
should be concluded in the first quarter of 2015-16. Since this is a statutory transfer nil consideration is
payable and stamp duty is not liable on the transfer. The transfer would therefore be transacted in the
financial statements in 2015-16 as income from government grants. The Trust have leased the property
from NHS Property Services Limited from occupation in June 2013.
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