2014Annual Report & Summary Financial -15 Statements

Exceptional healthcare, personally delivered 2014–15 2014–15 Annual Report & Summary Financial Statements Annual Report & Summary Financial Statements 01

Trust profile Contents

North Bristol NHS Trust (NBT) is a centre of excellence for health care 02 Introduction by chairman and chief executive in the South West region in a number of fields as well as one of the 05 Review of the year largest hospital trusts in the UK with an annual turnover of around 10 Listening to and working with £550million. our patients 16 How we’re performing In May 2014 the vast majority of the neonatal intensive care as the centre for Trust’s inpatient services were centralised major trauma for the Severn region 24 Redevelopment of our facilities at Southmead Hospital Bristol when the • Our Children’s Community Health brand new Brunel building opened its Partnership (CCHP) provides all 28 Sustainability doors. Services from Frenchay Hospital community child health and child and Last year we treated: were moved across during the month. adolescent mental health services for 34 Making NBT a great place Last year we treated over 51,000 Bristol and South Gloucestershire. over inpatients, including to work inpatients, including day patients, as well At any one time we have employed 51,000 day patients as caring for over 85,000 people in our around 9,500 staff. 40 World leading research Emergency Departments. More than The Trust has a single equality scheme, 6,000 babies were born at Southmead, 43 Charitable activity available on our website, covering all Cossham, at home or elsewhere in protected characteristics. We have a major the community and we carried out over incident plan which has been ‘desktop’ people in our 46 Finance approximately 295,000 outpatient tested in exercises and is fully compliant 85,000 Emergency Departments appointments. We conducted 7.9 million with requirements and guidance. pathology tests and treated 860 major 61 Annual Governance Statement trauma cases. During the year we carried How to contact us: out 430,000 imaging exams. babies were born at Southmead Hospital over Southmead, Cossham, Numbers of beds have fluctuated but Westbury-on-Trym 6,000 at home or elsewhere we have had around 1,000 over the Bristol in the community year and have provided inpatient care BS10 5NB from Frenchay (until May 2014) and Telephone: 0117 950 5050 Southmead Hospitals as well as in Thornbury and the Riverside Unit, based approx. outpatient near Blackberry Hill Hospital. We also Cossham Hospital 295,000 appointments provide a wide range of outpatient, Lodge Road midwifery and diagnostic services from Kingswood Cossham Hospital in Kingswood. BS15 1LF The Trust provides a range of acute and Telephone: 0117 340 8400 community services. These have included: 7.9 pathology tests million • General medical and surgical care as well as maternity services for a local population of nearly a million people in the Bristol, South Gloucestershire and North Somerset area 860 major trauma cases • Regional and specialist care for people living in the greater Bristol area as well as Somerset, Gloucestershire, Wiltshire and further afield for services such as neurosciences, orthopaedics, pathology, plastic surgery, renal and 430,000 imaging exams transplant services, urology and 2014–15 2014–15 02 Annual Report & Summary Financial Statements Annual Report & Summary Financial Statements 03

Introduction by Chairman and Chief Executive

No hospital has ever been through as much change as we have over the last year. In May 2014 the doors to the Brunel building at Southmead finally opened, on time and on budget, after years of planning and construction. Over a two week period, 540 patients were safely and successfully transferred into the new facilities from existing wards and departments at Southmead and Frenchay.

Our staff have settled into their new A challenging winter We are particularly pleased that the CQC surroundings, and are delivering high described our maternity service in Cossham Like many other NHS trusts, we had a difficult quality, safe care. There were problems in Hospital and our community services for winter. The particular pressure for us has the first months following the move into the children and young people as “outstanding”. been around emergency medical care for Brunel, most notably in theatres, but staff frail and elderly patients, where we have Among the changes made to address have pulled together to turn things around. experienced an eight per cent increase matters raised is the more rapid assessment This was always going to be a challenging over the last 12 months. These pressures of patients when they arrive in ED, the time but we are very grateful and proud have at times resulted in overcrowding the opening of a new GP Assessment Area and of the way our staff worked to adapt to Emergency Department. the introduction of four additional cubicles the changes. for initial assessment to reduce pressure. We understand that in some cases the Care Quality We are confident that, with our action plans patient experience has not been what we Commission report already progressing and having now settled would strive for during this time, but we In February, the Care Quality Commission in to our new hospital, we can expect to see would like to assure our patients that we (CQC) published its report into our services further benefits that will enable us to provide are working hard to improve things and the and rated the Trust overall as “requires quality care that achieves the best possible evidence suggests we are succeeding. improvement”. Every single service was rated outcomes for all our patients. The Brunel building offers state-of-the-art as being “good” in the context of caring and While the Trust aspires to being significantly facilities that have been designed to meet the staff were described as being “committed better than average its current CQC Trust needs of 21st century healthcare and we are and passionate”. rating is average for the NHS as a whole. now seizing the benefits the building offers. The CQC were concerned about the impact Passionate about safety Around three-quarters of beds are in single overcrowding was having in the Emergency rooms with their own bathroom. This has led Department (ED) and as a result rated This Trust has always been at the forefront to a reduction in hospital acquired infections this particular service as “inadequate” but of patient safety initiatives and during this and has almost eliminated the need to acknowledged that improving discharge year we became one of the first 12 NHS close wards due to outbreaks of norovirus. processes for patients was something organisations in England to sign up to a The environment is designed to be healing, that required close working with other three-year Government-led campaign that with access to light and plenty of views onto partners. Internal improvements include the aims to make the NHS the safest healthcare gardens. One of the biggest benefits that we recruitment of additional consultants and system in the world. Sign up to Safety hear about is that patients sleep well in the nurses, better triage of patients upon arrival, requires NHS organisations to listen to single rooms, aiding their recovery. improved privacy and dignity within the patients, carers and staff, learn from what they say when things go wrong and take Work continues on the second phase of corridor area and ensuring that observation action to improve patients’ safety. the hospital development which includes from the reception area is more welcoming a new patient and visitor car park – located and effective. More widely we are working right next to the main entrance, more staff closely with partners across the local health parking and landscaped gardens. This will be and social care system to ensure a safe and complete in 2016. well managed discharge once patients are well enough to leave the hospital. 2014–15 2014–15 04 Annual Report & Summary Financial Statements Annual Report & Summary Financial Statements 05

Introduction by Chairman and Chief Executive (continued) Review of the year

One of the first steps is the development Our volunteers of a plan that describes what we will do No annual report would be complete to reduce harm and save lives by working without a thank you to our fantastic army to reduce the potential causes of harm – a of volunteers and supporters. These include preventative approach. our amazing Move Makers, initially taken on Plans are built around five core pledges: to help people during the first few weeks Peter Rilett, putting safety first, continually learning, after the new hospital opened but who being honest and transparent, taking a proved so successful, we decided to keep Chairman leading role in collaborative learning and them on permanently. They do an absolutely supporting people to understand why things brilliant job and we have rolled them out have gone wrong and how to put them right. to Cossham Hospital and our Maternity North Bristol NHS Trust’s action plan builds on Unit. The hundreds of people , including existing practices and new measures. the League of Friends for Southmead and Andrea Young, Cossham, who give up their time for us are an Chief Executive inspiration and we are extremely thankful for their support and hard work. 2014–15 2014–15 06 Annual Report & Summary Financial Statements Annual Report & Summary Financial Statements 07

Review of the year (continued)

April 2014 Bristol’s first Macmillan Wellbeing Centre opens at Beaufort House, Southmead. The centre, which provides advice and support to Renal access nurse Wilfredo Manuel is honoured at the British Journal people with cancer, their friends and relatives, is a partnership of Nursing 2014 awards. He is named IV (intravenous) Therapy Nurse between Macmillan Cancer Support and North Bristol NHS Trust. It is of the Year at the awards ceremony in London. Wilfredo, who has a resource for people living with, and beyond, a cancer diagnosis, worked for the Trust for 11 years, was involved in bringing a nurse-led helping them access financial support, information about their line insertion and management service to Southmead’s renal unit. condition and treatment along with details of support groups. It also Ahead of the move into the new Brunel building, staff are given offers complementary therapies, sessions with dieticians and a the chance to acquaint themselves with their new ward areas. walking group. Special sessions are organised to give clinical staff training in how to use equipment in the wards before patients start to move in. In addition, more than 200 local people take up the opportunity to visit the new facilities as part of public tours. Patients (past and present), their families and staff gather at the Barbara Russell Children’s Unit at Frenchay Hospital for a special The Accident and Emergency Department successfully moves local area before drawing pictures inspired by their routes to the farewell party before the service is transferred to the Bristol Children’s overnight on May 19 from Frenchay and is immediately operational school. Their drawings of road signs, trees, houses, a post box and Hospital in May. The specialist unit for neurosciences, plastics and at Southmead from 2am. The Brunel building is fully open on May a cat were then transferred on to the final work using enamel on burns and trauma opened in 2000 and treated around 30,000 28 and the local media broadcast live from the atrium to mark copper. Their finished artwork now hangs in the public atrium on the children from across the South West and beyond. the occasion. ground floor. June 2014 August 2014 The first patients are seen in the new Bristol Breast Care Centre at The last episode of One Born Every Minute is broadcast on Channel 4. Southmead. Staff from the centre move into their new Beaufort The 20 part series proved exceptionally popular and the Trust’s social House home. Work on the refurbishment of the historic building media channels lit up each week with positive comments about nears completion ready to bring all breast care services for the Bristol our staff. area together under one roof. The Bristol Breast Care Centre has been The wards and corridors of Southmead Hospital are filled with the designed to make it a sensitive and comfortable environment for The popular Move Maker volunteers are asked to stay on indefinitely sound of music with Welsh harpist and soprano singer Joy Cornock patients. The centre fully opened in September. after proving such a success. The friendly volunteers were initially coming to perform for patients. The visit is part of the Trust’s Fresh recruited for a month to help patients and visitors find their way Arts music programme which has seen a variety of musicians and The Trust is one of the first 12 NHS organisations in England to sign around during the move into the new hospital. The team, who are performers coming into the hospital to play for patients. Patient Daisy up to an ambitious three-year Government-led campaign with identified by their brightly-coloured T-shirts, greet patients and Thomas from Staple Hill is serenaded with a Welsh folk song and a the aim of making the NHS the safest healthcare system in the visitors as they come into the new hospital, help them check-in hymn when Joy comes to play for her. She even gets to try playing world. Sign up to Safety, which launches this month, requires NHS for their appointments, answer queries, direct people around the the harp herself! organisations to: Listen to patients, carers and staff, learn from what building and arrange wheelchairs for people with mobility issues. they say when things go wrong and take action to improve patients’ October 2014 safety. September 2014 North Bristol NHS Trust becomes the first NHS organisation to be July 2014 honoured with the Work Experience Quality Standard. The Chief May 2014 Executive of charity Fair Train – which is behind the National Work Staff and patients begin to move into the new Brunel building. To mark National Transplant Week, the atrium of the Brunel building Experience Quality Standard – Beth Gardner, visits Southmead In total more than 540 patients move into their new single rooms and provides the backdrop for a performance from Bristol theatre group to present the award to Chief Executive Andrea Young. The Work four-bed bays from the old buildings at Frenchay and Southmead, Misfits. The group, made up of people with learning difficulties, is Experience Quality Standard is a national accreditation designed to including a number of critically ill patients from intensive care units at invited to the new hospital to highlight the work that goes on in recognise organisations with exemplary work experience provision; both sites. Our staff are supported by colleagues from the ambulance NBT to support people with learning difficulties to undergo kidney and also as a framework for development to help organisations plan, service and the military. transplants. The renal transplant team is leading the way in delivering run and evaluate effective work experience programmes. a patient pathway tailored to people with learning difficulties and With the first patients moved into the new Brunel building, an complex needs who might not otherwise be able to undergo the A ceremony to mark the official opening of Cossham Birth Centre army of volunteers starts welcoming people through the doors. life-changing procedure. takes place this month. The local area’s first midwife-led birth Taking inspiration from the Games Makers of the London 2012 centre at the Kingswood hospital opened its doors in January 2013. Olympics, the Move makers are a team who have been recruited to Pupils from Horfield CEVC Primary School visit the Brunel building Professor Lesley Page from the Royal College of Midwives unveils a meet and greet patients and visitors coming into the new hospital to see their art work on the walls. The group of Year 5 pupils worked plaque to commemorate the occasion. and to guide them through the building. with artist Rachel Davis on the project about the geography of the 2014–15 2014–15 08 Annual Report & Summary Financial Statements Annual Report & Summary Financial Statements 09

Review of the year (continued)

A new specialist arterial centre, providing state of the art planned December 2014 February 2015 to buy fairly traded products and also for the good work of the and emergency inpatient care, opens at Southmead. The centre will catering team in terms of raising awareness amongst staff about £50,000 of charity donations is shared by wards and departments at The Care Quality Commission (CQC) published its report into services specialise in the management of vascular diseases and disorders the products on sale which include bananas, tea, coffee, fruit juice Southmead Hospital and across NHS community teams as part of at North Bristol NHS Trust and rated us as “requires improvement” of the arteries, veins and lymphatic system. Patients with vascular and chocolate. the Trust’s annual Christmas Cracker campaign. Southmead Hospital overall. Every single service was rated as being “good” in the context disorders will be cared for by dedicated specialist vascular teams with Charity distributes the money raised to 18 teams and departments of caring and Trust staff were described by the CQC as being a consultant-led service providing 24/7 vascular surgery. who have put forward bids to buy specialist equipment for their “committed and passionate”. The CQC did criticise overcrowding in services. The funds have been collected from donations made the Emergency Department (ED) and as a result rated this service as by the patients and their families, local groups and companies “inadequate” but acknowledged that improving discharge processes throughout the year, including a generous £10,000 donation from for patients is not something the Trust can fix on its own. This will the Southmead Hospital League of Friends. need the Trust to continue to work with local commissioners and local authorities to resolve. An Emergency Department nurse at Southmead Hospital Bristol receives an award for her work on domestic abuse. Anna Bell, a March 2015 sister in the department, set up the domestic violence service in the A&E – then at Frenchay Hospital – two years ago. Staff have been trained in the questions to ask patients who they think might be at risk of domestic abuse. There are also now two full-time Independent Domestic Violence Advisors working in the department. Dementia patients benefit from colourful comforters after staff, patients and volunteers got knitting with gusto. A pile of Southmead Hospital benefits from a £250,000 donation towards its “Twiddlemuffs” is given to the Dementia Team to provide comfort helipad. The donation comes from the County Air Ambulance Trust, and activity to patients. The knitted muffs feature buttons, different which has made donations totalling £832,500 towards significant air textures, accessories and even small toys to provide stimulation for ambulance and helipad installation projects in Bristol. The installation restless hands. Holding the “Twiddlemuffs” and playing with the will significantly speed up transfer times for critically ill and injured different elements attached to them can be relaxing and reassuring patients being air lifted to hospital for emergency care. for people with dementia.

November 2014 A colourful and imaginative mural created by children from St The Bristol Urological Institute (BUI) is awarded £1.2 million to lead a Stephen’s Junior School in Kingswood is unveiled at Cossham major three year national multi-centre trial to evaluate the use of laser Hospital. Working with artists, nine children from the school (which technology for benign prostate surgery. This funding is allowing us to is located close by the hospital) visited Cossham in the autumn to trial a new type of laser called Thulium which cuts and vaporises the find out more about the rich history of the hospital building and its prostate and has shown promising results. This is an easier technique founder, local MP and benefactor, Handel Cossham. Their findings for surgeons to do than previous lasers and there is some evidence were incorporated into the mural. to indicate that patients may benefit from reduced blood loss and a January 2015 Southmead Hospital’s staff restaurant, The Vu, was one of the winners faster return to home after their operation. A Multiple Sclerosis (MS) physiotherapy programme based at the announced at the South West Fairtrade Business Awards. The Trust The Trust is awarded the Skills for Health Quality Mark for the Bristol County Ground could be rolled out across Europe after was presented with a silver award in recognition of its commitment standard of its education and training. NBT is one of just 16 achieving ground-breaking results. The fitness sessions at the BS7 organisations across the UK to receive the endorsement for delivering Gym have helped people with the condition regain balance and high quality training and the first hospital trust in the South West to movement skills and provided them with a forum to share their achieve the standard. The National Skills Academy Skills for Health experiences. The findings from the BrAMS (Bristol and Avon Multiple Quality Mark provides a framework that defines and endorses Sclerosis) scheme gained recognition when presented at an MS Community children’s health teams in South Gloucestershire are superior learning and training standards that health care employers conference in Norway and to the UK’s National Chartered Society awarded Young People Friendly status. The staff involved were need in order to cultivate a world-class workforce. of Physiotherapists and has now received interest from Italy, Spain invited to a celebratory afternoon tea hosted by North Bristol and Germany. Patients and staff celebrate the 20th anniversary of the Lung Exercise NHS Trust’s Community Children’s Health Partnership (CCHP) with and Education Programme (LEEP). More than 2,000 patients with The Trust appoints three new non-executive directors to its Board Barnardo’s to acknowledge their efforts. They were also presented chronic respiratory disease have benefitted from taking part in the - Andrew Willis, Liz Redfern CBE and Professor Nishan Canagarajah. with a certificate featuring art work produced by young people in programme which was launched at Frenchay Hospital in 1994 and All three bring a wealth of experience from the NHS, academia and Bristol and South Gloucestershire. moved across to Southmead in May this year. LEEP helps patients the business sector. improve their quality of life and self-manage their condition. 2014–15 2014–15 10 Annual Report & Summary Financial Statements Annual Report & Summary Financial Statements 11

Listening to and working with our patients

Friends and Family Test Positive comments During 2015/16 we will be increasing the range of methods by which patients, During the last year we have continued to • Staff carers and relatives can feedback to us. gain feedback from our patients through • General quality of care This approach will mean that staff can view the Friends and Family Test. Inpatient, • Food/catering the results almost instantly which will help emergency department and maternity • Facilities them to act on the feedback very quickly. services have been involved and we recently Expanding the methods will allow us to became an early adopter rolling the test out • Cleanliness survey patients at various points through to outpatients. Negative comments their time with us and also to focus on Previously we used a score called the Net • Food/catering specific topics. Promoter Score but since October our scores • Waiting/delays Inpatient Areas have been expressed as the percentage of • Provision of television facilities patients who would recommend our services During the year wards achieved more than • Staffing levels to their family and friends if they needed the 90 percent of patients recommending service and those who would not. Interestingly many of the aspects reported their services. We have worked towards on positively also appear in the negative increasing the number of responses to our Theme reports from the comments made in comments. During 2015/16 we will be survey because we know this improves the the survey are collated on a quarterly basis exploring these aspects more fully to information about what we do well and what and examined for areas that have improved understand and improve wherever possible. we can improve. During March we trialled and those that we can continue to improve. Televisions have been provided to ward the use of electronic devices in some of our During the last quarter of the year the key quiet rooms for use by patients and a plan wards with positive increases in the number themes have been: has been made for the provision of a patient of surveys completed. entertainment system at every bed.

Inpatient areas (Friends & Family Test) Emergency Department (Friends & Family Test) 2014–15 2014–15 12 Annual Report & Summary Financial Statements Annual Report & Summary Financial Statements 13

Listening to and working with our patients (continued)

Outpatient services Emergency Department Support for carers in Representation of carers at a The Patient Affairs (Bereavement Services) Following a week when HealthWatch set up team provides Southmead Hospital with the a stall in the Brunel atrium the organisation From April 1 2015 all outpatient services During 2014 a national survey was carried the hospital strategic level expertise to manage the legal and practical presented its findings from talking to visitors. across the country will be starting to survey out of patients who had used an NHS The Carers Support Scheme continues to The Trust’s Carers Charter, a joint charter requirements following a death in hospital. Key themes included: their patients. At North Bristol NHS Trust we accident and emergency department be promoted and developed. The scheme with the University Hospitals Bristol NHS Working closely with doctors, the wards started surveying outpatients during 2014 during January, February or March 2014. • Parking, distance from Beaufort car park involves the early identification of carers Foundation Trust, is being updated to reflect and the mortuary, they manage the release as an early adopter of the system. We have 279 patients (34 percent) who had used the to Brunel for patients with mobility issues, through an initial documented conversation. the latest legislation (Care Act 2014). of the deceased from the hospital to the recently started a text survey for outpatients department at North Bristol during that time lack of knowledge about shuttle bus Carers also access discounted car parking, appropriate people. based on the system used to remind patients responded. The survey is made up of eight The Hospital Carer Liaison manager is extended visiting times in all patient areas engaged in setting up a joint carers reference • Administration of letters and booking of about their appointments. sections and each question scored out of ten. and can now access the staff canteen. Improving patient experience appointments malfunctioning in terms of Our Emergency Department scored 8.3 in group representing carers from both NBT 2014/15 was a year of significant changes for incorrect dates Maternity Services terms of the overall experience. Carers can also access a Hospital Carers and UH Bristol. The North Bristol Trust Patient patients culminating in the move of services • Patient entertainment Maternity services have performed well Liaison Worker from the Carers Support Experience group meets quarterly, with a to the Brunel building. This brought about over the year with over 90 percent of their Cancer Services Centre. The Liaison Worker can provide carers membership of users of the Trust’s services, • Isolation of older people in single rooms many benefits for patients but also a number patients who would recommend the service. NBT takes part in the annual National Cancer with information and sign posting, liaise with patients and carers as well as various hospital and confusion on way finding in Brunel. departments. In addition to this strong links of challenges. In addition, during the year a Whilst this graph is based on the total Patient Experience Survey. Our results for hospital staff and support them around the The organisation also presented a report have been developed with the new Head of new role, Head of Patient Experience, was number of surveys, the data is collected at 2014 showed significant improvement over discharge process. The Carers Liaison Service on discharge processes and key feedback Patient Experience. created to bring an enhanced strategic and four points through the antenatal, perinatal those for 2013, with the Trust being in the top has received and supported 274 referrals over included; the lack of voluntary and practical focus to improvement work. and postnatal episodes. ten of the most improving trusts. This reflects the past year with the aid of the Trust, who Carers’ feedback and activity is regularly community sector support post discharge, the emerging impact of NBT’s strategies to provided office space and IT access within provided through quarterly reporting, whilst The Trust continues to engage with the discharge process taking too long and National Surveys improve the care for patients diagnosed the Sanctuary offices. issues from carers are also fed in to the CCG patients, carers and the public through a greater need to have a follow up check-up and treated for cancer, as well as those living number of groups and forums through the following discharge. Both reports helped us Inpatient Survey Awareness of carers’ rights and End of life steering group. 850 people who were inpatients at with and beyond cancer. The Trust showed Patient Experience Group and the Patient target improvements. improved performance over 2013 on 47 of identification of carers in the Trust Chaplaincy and Partnership Panel. These provide a valuable Southmead during June 2014 were included In order to achieve better feedback from the 62 scored questions in 2014. The work of the Carer Liaison Worker has contribution to making improvements in in the national survey. They were sent a Bereavement Services patient and carers we have piloted various extended across the Trust, with referrals patient experience. survey by an external organisation that The Chaplaincy provides religious, spiritual methods in the Trust including electronic manages this on our behalf according to the being made either directly from the carer or and pastoral care to patients, visitors and staff The Patient Experience Group tablets, video kiosk and text messaging. requirements set out nationally. The results from the ward nursing staff, administration or of all faiths or no faith. were due at the time of writing this report allied health professional staff. Stronger links The Patient Experience Group is chaired Work of the Trust’s Patient Panel have been developed with MacMillan Chaplaincy remains a valued part of by the Director of Nursing & Quality and and will be acted upon when received. The long standing Patient Panel has Wellbeing Centre, the Alzheimer’s Society patient care within Southmead Hospital. its membership includes patient and carer continued to meet during the year. and the NBT Dementia Team. The Carers Working alongside colleagues, chaplains representation, the Carers Support Centre, The panel’s membership is a majority of lay Liaison Worker regularly attends the memory help support those at some of the most HealthWatch, the Trust’s Patient Experience members who give freely of their time to help café at Gate 28. distressing and challenging times of their Leads, the Patient and Community the Trust. Staff from the Clinical Governance lives. For those whose faith is important we Engagement Manager and the Head of The Trust’s website has been updated to Directorate attend the panel on a regular also provide religious support. Patient Experience. It meets bi-monthly Maternity services (Friends & Family Test) include a section for carers. Carer awareness basis. Members contribute by participating in to receive and discuss the results of the displays take place six times a year within The hospital has its own team of chaplains quality, care and environmental audits, proof Friends and Family Test and other national the public space in the hospital. The Carers and volunteer pastoral visitors. The chaplains reading patient information leaflets and patient surveys in addition to ideas and Liaison Worker meets with new hospital are from various Christian denominations. sitting on various committees. proposals from the Trust. This year the group social workers to inform them about The wider team of volunteers also includes had the opportunity to discuss the Care the service and the referral pathway. Buddhist, Hindu and Muslim representatives. Quality Commission’s inspection report in Carer awareness training is provided to All members of the chaplaincy are happy addition to contributing to thinking about staff via mandatory training and inductions to work with those of different traditions the Trust’s Strategic vision for the future. for new staff. A new version of the Trust’s and faiths. It was instrumental in identifying the Quality admission paperwork is being developed The chaplains regularly visit the wards and Account priorities for this year. to ensure carers are identified at the are always happy to see patients or visitors, earliest opportunity. to offer a ‘listening ear’. They are also available to pray with a patient or offer the appropriate religious support in an emergency. 2014–15 2014–15 14 Annual Report & Summary Financial Statements Annual Report & Summary Financial Statements 15

Listening to and working with our patients (continued)

Involvement of Members • Patients and visitors’ ability to Learning lessons Ombudsman Referrals justified and seven dismissed. The Trust was reduce all overdue complaint responses communicate directly with the area of the asked to extend apologies for all the justified/ by the end of July 2015 and processes are Over the last year we have worked hard The Trust embraces the ethos of learning If after attempts at local resolution Trust they wish to contact is still below partially justified cases and asked to pay being redesigned to ensure greater control to develop and engage our potential from all complaints and concerns where a complainant remains dissatisfied, levels we would expect and numbers compensation in two cases and for one case by directorate rather than the Advice and Foundation Trust member base. possible. During the year some significant they may ask the Parliamentary Health of reported issues have continued to outstanding from 2013/14. Complaints team and mutual agreement As of April 2015 we have just under lessons have been learned and examples of Service Ombudsman to consider their cause concerns with complainants on timescales. 16,000 public members representing changes made to procedures and practices case. During 2014/15, the Trust is aware Principles for Remedy the four constituencies of Bristol, South • The pressures on the complaints process are given below: of 20 complainants who contacted the The Trust has accepted the Principles for Compliments Gloucestershire, North Somerset and the rest over the last 12 months have caused a Ombudsman where they subsequently • New food stocks have been provided in Remedy set out by the Parliamentary and Over the year, the Advice and Complaints of England and Wales. re-evaluation of the processes. To address decided to review the actions of the Trust and the medi-rooms for post-op patients Health Service Ombudsman and plans are in Team recorded 4,396 compliments - some the overdue cases, the reasons for the call for the complaints file. Of these cases, Our members have participated in various place to ensure that the Trust complies with examples are listed below: backlogs and also to ensure improvements • New comfort rounds have been 12 have been closed by the Ombudsman surveys and focus groups, including giving them by the end of 2015/16. In particular, are made during 2015/16 a programme introduced for the medi-rooms to assist and eight remain open. One complaint was us their views of the art work around the an action plan is being implemented to of support and training for the central waiting patients, the temperature will also wholly upheld, four were found to be partly hospital and their opinions of the hospital and directorate complaint teams has be more closely monitored (the nursing for our quality account. They have received been introduced. staff will engage with elderly patients and regular updates on the areas that interest Communication issues continue to be a offer them blankets as required) them and have been invited to various factor in many complaints. The increase • Discharge letters are now faxed to GPs events and forums. continues to be tackled by the Trust’s iCARE who do not have electronic links to avoid To find out more about Foundation Trust initiative, which is designed to make staff discharge delays We waited about three hours in A&E which is fine…attended by a young doctor on duty, who membership or to sign up as a member, consider their approach and communication • Communications between pharmacy and did a brilliant job of stitching eye lid. Good doctor visit www.nbt.nhs.uk/ft or drop us a line at from the patients’ perspective. This delivered wards have been made to improve the with brilliant people skills...just wanted to say [email protected]. a reduction in the trend over the final quarter turnaround for ‘tablets to take away’ and so I had an angioplasty procedure at the hospital thank you. of the year. improve patients’ discharge experience on 12th November 2014, which proved a long Complaints activity over the and complicated case. The perseverance of the last year Informal complaints (concerns) received • A new discharge lounge is being created in 2014/15 increased by 12.8 percent. for the Imaging Department, following surgeon and his team was first class, and the The views of our patients, relatives and carers This reflects the increase in lower level patient feedback about the current professionalism and attention of the nurses are very important to us and feedback from complaints such as infrastructure and parking waiting area before and after was exceptional. complaints has been effective in influencing issues, most of which directly resulted from • Waiting list co-ordinators will consider the change and improving practice in all clinical the impact of the construction works on the patients ages when devising the booking I realise the stress you and your staff areas. The total number of formal complaints Southmead site. The plan is to deliver the order of consultants lists. have undergone at this time as a result received during 2014/15 was 1,010 – an permanent parking facilities in Phase Two of of moving from Frenchay. It is very much increase of 253 from last year. Key messages Second Stage Reviews the development in 2016. I was not expecting such a slick experience…how to your credit that the work of your from the past 12 months are: Local Resolution Meetings (LRMs) are wrong I was. I went to the new Southmead Hospital hospital and its treatment and care, have • Formal complaint numbers have risen, Returns non-confrontational and are aimed at on level 2 Gate 18…The whole event was handled maintained and excellent standard. reflecting the challenges faced following If a complaint or concern is not satisfactorily allowing the complainant and the Trust and everyone in the department could not have the move to the new Brunel building and answered, the complainant is always invited to explore issues in a more dynamic way been more professional…Thank you all for helping the closure of Frenchay. It is, therefore, not to contact the Advice and Complaints Team than can be achieved via correspondence. me get back my life. clear if the underlying trend goes against to ensure their further concerns can be fully Complainants are welcome to attend with the nationally reported overall increase addressed. These “returned” issues are logged a friend or family for support and the Trust will ensure that senior staff are present to in numbers and the reasons recorded. Both my husband and I have spent time allow their concerns to be addressed and any I would just like to say a big thank you to all the staff from Gate 20 • As a consequence of the increase in in Frenchay and then in Southmead Overall returns decreased by 3.7 percent agreed actions/outcomes are taken forward. at the Brunel building for their care, kindness and support, during complaints, concerns and enquiries the Hospital and the meals were excellent. 103 (107) but those concerns that were due A digital recording of the meeting is provided and after my husband’s surgery yesterday. We have nothing but large clinical directorates and the facilities We were given a menu each day with a to unaddressed or unresolved issues, and as confirmation of the discussions and the praise for the whole team…under the circumstances we are really related directorates struggled to return great selection of food. therefore could be considered as avoidable, agreed actions. During the year LRMs were grateful for everything they did for us. cases within the negotiated timescales increased by one to 22 cases or 21.3 percent arranged and held for 75 cases, an increase of of all returns. ten on 2013/14.

I had to visit A&E this morning at 7.30am. I was treated with care, kindness, compassion and professionalism. At each stage each member of staff treated me as a human rather that a statistic and listened to me, taking on-board any qualms I had no matter how trivial. I was reassured and comforted by being given information that was relevant. 2014–15 2014–15 16 Annual Report & Summary Financial Statements Annual Report & Summary Financial Statements 17

How we’re performing

Priorities for Improvement As a result, over 180 patients and members of How did we get on with the public completed the survey. The results Every year the Trust manages a wide range of these priorities? were analysed and ranked according to quality improvement targets and measures, importance as rated by patients and carers. Improve Theatre Safety set by the Board, Commissioners, NHS These were discussed by the Trust’s Quality The first job of all health care professionals England and the Department of Health Committee to agree the final priorities prior is to keep patients safe. NBT is committed to – as well as those that are as a result of to final approval by the Trust Board. providing services of exemplary quality and requirements of specialist national reviews safety, giving the patient the best possible and recommendations from national Our Priorities for experience and outcome. It is known that NHS related organisations such as NICE, the way teams work together contributes Royal Colleges, Care Quality Commission Improvement for 2014/15 significantly to protecting patients from and others. 1. Improve theatre safety – ensuring that surgical teams work safely and harm. It is the responsibility of everyone These are included as part of our overall ensure high quality care through effective involved in the perioperative care of the quality strategy under the headings of communication and rigorous procedures patient to: patient safety, clinical effectiveness and before, during and after each operation • Work and communicate as part of a team patient experience. The connection between good performance and high quality care, 2. Improve discharge information to • Have the courage to protect patients and and the range of issues that remain priorities GPs – providing timely and accurate colleagues by speaking out if they have include falls, pressure ulcers, nutrition, information when patients leave hospital any concerns regarding patient safety medicines safety, infection prevention to ensure that their GP is fully aware of • Receive challenge from a colleague in and control. In addition to all the other their clinical condition and can continue a positive and professional manner, quality and safety targets, each year trusts safe and effective care giving the concerns others may have are asked to choose up to five priorities 3. Improve management of sepsis – due consideration. for improvement which are chosen in developing a deeper understanding of the The five ‘steps to safer surgery,’ which consultation with patients, public and staff. main causes of sepsis in patients, where incorporates the World Health Organisation Involving the public in this most frequently occurs and delivering (WHO) Checklist must be used in all patients effective treatment in a timely way undergoing invasive procedures in NBT and identifying these priorities are listed as: 4. Improve cancer patient experience We asked our clinical teams to make – supporting patients diagnosed with • STEP 1: Team brief suggestions for priorities to improve cancer in a timely and effective way to patient care. This list was then discussed • STEP 2: Sign in provide the best treatment with care, with Patient Panel and Patient Experience • STEP 3: Time out dignity and in supportive partnership with Group members. national charities and peers. • STEP 4: Sign out These topics were then compiled into a • STEP 5: Team de-brief survey for patient and public consultation NBT currently monitors compliance against which was distributed to Foundation Trust every patient with a 2014/15 performance members who wish to take part in surveys. of 87.4 percent for Safer Surgery Compliance Presentations, including the shortlist, and 95.2 percent WHO Compliance against were made to Local Authority Health a target of 100 percent. The chart overleaf Scrutiny Committees. illustrates the strong improvements made in the five steps to safer surgery during the year and the more gradual improvements made in WHO compliance. 2014–15 2014–15 18 Annual Report & Summary Financial Statements Annual Report & Summary Financial Statements 19

How we’re performing (continued)

The Head of Nursing for Core Clinical In 2015/16 this will continue as a Quality Information gathering has shown that most In the next year, this work needs to be built Our Priorities for Assurances on Quality from Services, supported by the Theatre Matron, Account priority and is also a local CQUIN patients with severe sepsis are initially cared on in terms of increasing staff awareness of Improvement for 2015/16 the Trust Board is examining the key factors influencing the (commissioning contract) incentive for in the Emergency Department (ED) or the sepsis, education of its management and remaining areas of non-compliance with which focusses on timeliness of discharge Acute Admissions Unit (AAU). Systems have audit of performance. We will continue to improve the quality of Review of Services the WHO checklist to ensure continued summaries and the development of these been put in place to enable these patients care for patients as set out in our contract, The Trust reviews data and information improvement in 2015/16. as summary care plans to be given to the to be tracked and their outcomes measured. Improve cancer including prevention of deterioration, related to the quality of its services through patient for the following specialties: Original research conducted in the Trust patient experience continuing to reduce pressure ulcers, reduce regular reports to the Trust Board and the Improve discharge falls, infection prevention and control and has shown that Early Warning Scores (EWS) NBT has continued to lead nationally on Trust’s governance committees. Each clinical • Respiratory improving nutrition and the management of information to GPs are predictive of outcomes in blood stream cancer survivorship during 2014/2015 service undergoes monthly Executive • Diabetes sepsis. In addition, through our consultation, The Trust achieved just over 78 percent of infection – a form of severe sepsis – and by building expertise and capacity in review in which performance against we have agreed with patients and staff to discharge summaries sent within 24 hours • Cardiology sequential audits carried out in AAU over the implementing alternative approaches to standards of quality and safety are reviewed. address the following priorities: in April 2014 but performance then dipped • Renal winter of 2014/15 have provided baseline cancer aftercare. We are in the process These reviews discuss with clinical teams data on sepsis management in terms of the and managers any areas of concern and to just over 74 percent at the time of the Improve management of bringing about a service redesign in 1. Improving care for patients with dementia hospital move in May 2014. Since then six interventions required within an hour of the approach to care and support for continuous quality improvement. The Trust 2. Improve our patients’ overall experience performance has improved aided by, of sepsis the diagnosis of severe sepsis. people affected by cancer. This involves has therefore reviewed 100 percent of the in hospital data available to them on the quality of care for example, a new discharge summary In 2014/15 a committee to advance the Improvements in the proportion of patients implementing an integrated model of in all its services. launched for Medical Day care which is management of sepsis was set up and met receiving oxygen (3-fold increase); lactate survivorship into the care pathway for 3. Improving the recognition, diagnosis and shorter and much easier to use. Similarly, a monthly to discuss strategies to gather data measurement (3/4- fold increase); blood everyone diagnosed and treated for cancer, treatment of Acute Kidney Injury (AKI) Examples of data and information reviewed tailored discharge summary is being worked with a greater focus on recovery, health and on sepsis incidence and the management of cultures (2-fold increase); antibiotics (3/4-fold 4. Improving the quality and timeliness have been: on for hip fractures that will be easier and wellbeing after treatment. Evaluations of our patients with sepsis within the Trust. increase) have been observed. Many staff of information provided to GPs when quicker to complete. programmes indicate high levels of patient • Mortality on which the Trust has a Initially there was very little information groups have targeted education on sepsis patients go home to ensure there is safe satisfaction and improved patient experience good record collected on the numbers of patients with with simulation training in the ward areas handover to primary care. and outcomes. • Patient Reported Outcome Measures – severe sepsis, where they were located and being delivered to the multidisciplinary team. The acute oncology team has delivered How we will measure a national survey of all patients having managed within the Trust or on compliance A key milestone in our strategy was the hip or knee replacements, varicose vein with consensus guidelines for the teaching on neutropenic sepsis and opening of the NGS Macmillan Wellbeing progress with these priorities introduced a screening tool to the admission surgery or groin hernia surgery management of sepsis (“Sepsis 6”). Centre. The centre is staffed by a centre Improvement measures will be set for each team which has increased the proportion of • Readmission to hospital manager, cancer support workers and priority and the data will be collected and patients with neutropenia being treated with volunteers and is a hub for the provision of analysed to track progress. This will be • Venous Thromboembolism – numbers antibiotics within an hour of presentation. advice, support and information to anyone monitored closely by the Trust’s Quality of patients risk assessed on admission living with or after a cancer diagnosis Committee chaired by the Medical Director. • Reducing harm from infection – there were or anyone concerned about cancer. Its membership includes the Director of no cases of MRSA in 2014/15 and Equipped with meeting rooms for education, Nursing and Director of Operations as well as a considerable reduction in C Diff cases one-to one support, complementary Clinical Directors, Chairs of quality and safety • Patient safety incidents – the Trust reports therapies, nutritional and exercise sessions, committees and other key staff involved a higher than average number of incidents WHO and five steps to safer surgery - as well as financial and back-to-work in monitoring or progressing quality and but mainly in the low to moderate degree compliance rates 2014/15 Discharge summaries sent within 24 hours advice, the centre provides cancer-related safety priorities. of harm information in a variety of media and formats to a steadily increasing number of patents, Reporting on a wide range of quality • National survey on Emergency relatives and staff from both hospital and measures is made to the Board every month Departments – carried out prior to the community settings. as part of an Integrated Board Report and opening of Brunel but the Trust improved includes measurements of progress against in many areas and deteriorated in only one. set improvement trajectories. This report is included in the public session of the Trust Board and is published on the Trust’s external website as part of the papers. In addition the information is reported via the Quality Sub Group to local clinical commissioning groups and NHS England.

WHO Checklist compliance 5 Steps to Safer Surgery 2014–15 2014–15 20 Annual Report & Summary Financial Statements Annual Report & Summary Financial Statements 21

How we’re performing (continued)

Improving quality and safety All inpatients within the Trust have their Safeguarding Children The CQC rated this service as outstanding Safety and Quality General Wards Work physiological observations (respiratory rate, and CCHP was described as having a child of patient care The definition of a child is anyone under Improvement work streams Stream – Falls levels of oxygen, pulse, blood pressure, and young person centred culture with the age of 18, but young people aged iCARE level of consciousness and temperature) children and young people being full NBT is one of the 12 Pathfinder NHS Serious falls can result in fractures, increased 16-18 years are usually treated in adult The iCARE programme was launched in measured and recorded according to our partners in their care. organisations to the national Sign Up to length of stay in hospital and, in severe cases, services. All clinical staff undertake Level 2 September 2014 in order to build upon Observations Policy. Safety campaign. We are seeking to utilise the death of a patient, so preventing and safeguarding children training and all staff Children are also seen in a range of other our strengths in caring for patients and the depth and breadth of our existing quality reducing the incidence of falls – especially This early recognition and management of Level 1. settings throughout NBT such as minor supporting colleagues, by recognising and improvement and safety experience through serious falls – is an important priority. patient observations may prevent avoidable injuries and outpatient clinics but the Trust’s spreading best practice. The CQC inspection in November 2014 found the former Safer Patients Initiative and the Not all falls are preventable but many can patient admissions to the Intensive Care Unit inpatient paediatric services transferred to that robust safeguarding procedures were in South West Quality and Safety Programme to be avoided with good risk assessment, iCARE stands for: (ICU) and help prevent avoidable cardiac University Hospitals Bristol in May 2014. place with clear lines of reporting. Also that make a significant change to our approach to preventative interventions and the right arrests and the need for cardiopulmonary I take responsibility for staff were aware of these procedures and Our Maternity services provide care harm reduction. training and support of staff. resuscitation (CPR). Communication that’s effective their own responsibilities to safeguard for mothers and babies, with some The Sign Up to Safety campaign provides What we did last year: Attitude that’s positive There is evidence to show that patients will children and young people. mothers under the age of 18 themselves. an opportunity to introduce a single Respect for patients, carers and colleagues often present with signs of deterioration prior Maternity services have developed a • Launch a new falls prevention bundle Safeguarding training compliance is systems wide approach to reducing harm. Environment that’s conducive to care. to suffering a cardiac arrest. Using cardiac safeguarding team, consisting of three • New falls risk tool monitored through the Safeguarding After extensive discussion the Trust identified arrest rates we can demonstrate that by using full time staff, with further development Approximately 4,500 staff have attended Children Operational Group; the figures 4 key areas for targeted improvement work, • Falls risk alert sticker the Early Warning System our staff have the planned of perinatal health and bereavement an iCARE session including all new staff at are reported quarterly to Bristol and South which are: • New intentional rounding tool tools to help recognise these signs and in support. Babies requiring specialist care are induction and bespoke sessions for staff Gloucestershire Safeguarding Children doing so potentially prevent the arrest. treated in the Neonatal Intensive Care Unit. 1. In-Patient Falls • Enhanced observation working in various environments, including Boards. Significant changes to the training There is a 24 hour on call service provided • A new falls prevention care plan. receptionists in the Emergency Department, requirement have been made as a result 2. Pressure Ulcers Safeguarding by the Designated Supervisor of Midwifery the Sterile Services Department, Facilities, the of the revised Intercollegiate Document The falls rate has increased by 9.6 percent to ensure there is safeguarding support for 3. Sepsis IT Service Desk and Switchboard, Volunteer vulnerable people (2014). The named nurses have worked despite these interventions being clinical staff at all times. Services and the Acute Assessment Unit. The Trust has a Safeguarding Committee, with the training department to develop 4. Acute Kidney Injury implemented. Other hospitals in the country chaired by the Director of Nursing that which have moved to buildings with It has enabled people who work directly with an electronic knowledge based assessment Safeguarding The approach also takes account of the oversees reporting structures and monitors high numbers of single rooms have also patients to reflect on how they work together to be completed three months post Level 1 significant and historic changes following the the safeguarding agenda in all of the Vulnerable Adults experienced increases in their falls rates (of to provide an environment conducive to and Level 2 training to provide some quality combination of acute services on to a single Trust’s services. As an organisation we The safeguarding of vulnerable adults up to 50 percent in some cases). care and helped staff who work in support assurance on whether learning outcomes are site and into a brand new hospital building. are committed to making safeguarding a remains a high priority for the Trust. This area areas to see how their work enables others to being achieved. The majority of the increased serious injury high priority for all members of the Trust. of practice requires collaborative working Learning achieved through discussions with provide high quality care. falls occurred soon after the MOVE to the Safeguarding standards are reported Lessons learnt from all serious case reviews with other health providers, health and social our frontline teams, patient representatives new hospital. The number of serious falls, Each month the iCARE Moments award has annually to the Clinical Commissioning and serious incidents are included in current care commissioners and the local authority and the quality improvement and safety however, has now been decreasing for the been an opportunity to highlight a moment Groups and performance activities are training packages. Formal child protection and the police. experts within the organisation has been last five months. when an individual or team did something reported quarterly to the Commissioners and supervision is provided for all staff with applied to create the Safety Improvement Over the last year the Trust has seen an that made a big difference to patients. the Local Safeguarding Children Boards. a child protection caseload. In addition, Plan and develop the Quality and Safety increase from 100 to 214 in the number reflective practice and peer review relating Improvement Faculty which was initiated at a Preventing The Safeguarding Committee has of referrals. The Trust has received three to safeguarding children is increasing workshop at the end of January 2015. deterioration responsibility for setting and monitoring the throughout clinical directorates. notifications of Serious Case Reviews but delivery of the Trust’s strategic priorities for these have not reported to date. The Trust Patients who are deteriorating often show safeguarding and providing assurance to the The Trust provides care to children and has also been involved in three Domestic signs and symptoms indicating their Board. The Committee is supported by two young people, via the Community Child Homicide Reviews and is delivering on the worsening state. Early Warning Scores (EWS) operational groups who carry out the work in Health Partnership (CCHP) for Bristol and resulting action plans. calculate a score based on the patient’s key relation to safeguarding: South Gloucestershire. These services measurements and provides an indicator include community paediatrics, health The Trust has maintained its focus on of how sick a patient is, thus enabling the • Children (child protection) visiting, school health nursing, allied health safeguarding adults, Mental Capacity Act recognition and escalation of care of patients • Vulnerable adults - including people with professionals and Child and Adolescent (including deprivation of liberty) training whose condition is worsening. dementia, adults with learning disabilities Mental Health. Within CCHP we provide which now includes PREVENT awareness, and mental health. 24 hour Consultant Community Paediatric domestic abuse and violence and female cover for child protection cases including genital mutilation, as well as human sexual abuse. trafficking awareness. 2014–15 2014–15 22 Annual Report & Summary Financial Statements Annual Report & Summary Financial Statements 23

How we’re performing (continued)

Ongoing work 2015/2016 Local Clinical Audit Reports What other organisations say Overcrowding in the Emergency Department Actions taken and National peer review is one of the symptoms of pressure across • Using technology. We are testing the use Each local clinical audit is reviewed in about the Trust future plans of Severn Major accordance with the Clinical Audit Policy the health and social care system. The Trust of bed and chair sensor alarms in the single As required by the CQC’s inspection process, which states that every clinical audit Care Quality Commission (CQC) frequently has large numbers of patients Trauma Network rooms with the aim of reducing falls in a detailed action plan was submitted in project must produce a report in the Trust By law all trusts must be registered with the who are fit to be discharged from hospital Our major trauma service was subjected patients who may not remember to call for March 2015 with many actions already standardised format with an accompanying CQC for each of the regulated activities they but who can’t go home because their to a national peer review in March 2015. assistance when they want to mobilise delivered. Pending its review of these action plan. These are reviewed by senior provide at every one of their locations. community care support isn’t ready. This in The chairman of the panel summarised the • Falls prevention training to all medical, turn makes it challenging to free up beds actions and a further spot check within the findings by commending the improvement members of the Quality Improvement The Trust has not taken part in any special nursing, pharmacy and therapy staff. and move patients from ED into the main Emergency Department, the warning notice in trauma mortality outcomes against a and Clinical Audit Department before the reviews or investigations by the CQC but Falls is one of the themes of our Sign Up hospital. The CQC has acknowledged that remains in place as at 31 March 2015. background of huge infrastructure change. clinical audit project is formally marked as under its routine inspection programme to Safety Programme and training forms a improving discharge processes for patients completed. 114 Local Clinical Audit Reports we were visited in November 2014, just a We are working closely with partners across The network is currently sixth out of the 23 substantial part of these plans is not something the Trust can fix on its were reviewed in this way during 2014/15. few months after the move into the new the local health and social care system to networks for mortality and NBT is ranked • Moving and handling equipment to be own and we are continuing to work with hospital. The CQC had never before inspected ensure a safe and well managed discharge first for mortality out of the 23 major trauma purchased for all wards to encourage safe Trust Data Quality local commissioners and local authorities to a hospital so soon after such a big move but once patients are well enough to leave centres. The network was also commended transfer of patients with poor mobility on resolve these challenges. Hospital episode statistics paid credit to the Trust for its smooth nature. the hospital. Delivery of all actions will be for leadership, the presence of 24-hour and off the toilet The Trust submits a wealth of information Despite some well documented problems, closely monitored by the Trust Board and consultant team leaders, damage control • A campaign to ensure all inpatients wear and monitoring data centrally to our which are being dealt with, patients are now also by the CQC and our commissioners to surgery training and the development and safe footwear commissioners and the Department of reaping some important benefits from the ensure that they are properly implemented delivery of high quality patient pathways in • Developing an Enhanced Care Nursing Health. The accuracy of this data is of vital new hospital such as very low infection rates and sustained. rib fracture fixation and spinal cord injury. Team for patients with confusion importance to the Trust and the NHS to and improved dignity and privacy. who are at risk of falls, to provide ensure high quality clinical care and accurate Within the final report, every single service increased observations financial reimbursement. was rated as being “good” in the context of • Working with the Dementia Team to Our robust data quality reporting, controls caring and Trust staff were described by the ensure all wards have activities for and feedback mechanisms are routinely CQC as being “committed and passionate.” patients with cognitive problems and a audited and help us monitor and maintain Some areas were rated as providing safe environment. high quality data. outstanding services but overall the Trust Audit and Data Quality received a ‘requires improvement’ rating. Clinical coding accuracy Copies of the full reports for the Trust and Participation in clinical audits Accurate clinical coding is an essential each individual location inspected by the NBT participated in all 32 of the 43 (74 element of the Trust’s ability to understand CQC are available publicly on its website: percent) national clinical audits that its clinical activity, in terms of audit and www.cqc.org.uk covered services we provide and all four of mortality statistics and to ensure accurate the National Confidential Enquiries It also reimbursement for care provided. The CQC did raise concerns about participated in 12 other national clinical overcrowding in the Emergency Department The department’s clinical coding auditor (ED) and issued a warning notice on audits and seven national registries that are has continued to run an extensive inpatient not included in the Department of Health December 16 2014 and rated this service as activity audit programme in 2014/15. “inadequate” within the full inspection report (DoH) list of audits for inclusion in the The audits continue to reflect accurate Quality Account. received in February 2015. In addition, nine coding and good practice in comparison to compliance actions were made. The Clinical Audit Committee reviewed our peers. reports of 27 national clinical audits between April 2014 and March 2015 and NBT will take actions on them all to improve the quality of health care provided. 2014–15 2014–15 24 Annual Report & Summary Financial Statements Annual Report & Summary Financial Statements 25

Redevelopment of our facilities

The big move On May 8 hundreds of staff from Frenchay weeks, the Move Makers have been so – many of whom worked at the hospital successful, they are now based here on a 2014/15 was a year of unprecedented for their entire careers – gathered at the permanent basis. change for North Bristol NHS Trust’s staff Redwood Restaurant for a celebration event and patients. which included the burial of a time capsule A&E moves and services transfer After many years of planning and in the grounds by children from the local from Frenchay construction the new Brunel building primary school which will be unearthed in Perhaps one of the most anticipated was officially handed over to the Trust by 50 years. elements of the move was the transfer of the developers Carillion on March 26. Accident and Emergency (A&E) department Patients move into the Brunel from Frenchay to Southmead. This took place Over the next two months a massive The first patients started moving into the at exactly 2am on Monday, May 19 when operation was undertaken which saw the Brunel during the week commencing May 12. the Frenchay department closed its doors Trust equip the building and thousands of and the Southmead unit opened to patients. The first patients were moved from C ward, staff take part in training and familiarisation Before the department closed a poignant the acute respiratory unit. They were wheeled tours before staff and patients began to blessing was held by one of the hospital through a tented walkway erected by a team move in during an unforgettable two weeks chaplains and staff released balloons into the from Royal Marines Reserve Bristol and into in May. night sky. the new building by porters. The Brunel building saw services from Juliette Hughes, Matron, said: “We are really Nurses from the Trust’s Learning & Research Southmead and Frenchay centralised on one pleased with how the night has gone. Centre were back in scrubs to help with site for the first time. We have been planning for this move the transfer of patients, with support from for a long time and everything went as it Specialist children’s services and administrators from the department. should have.” remembering Frenchay They were joined by volunteer retired Frenchay always had a strong history of nurses who used to work for the trust and The new department is much bigger with children’s neurosciences and burns. One of were involved in escorting patients into the larger cubicles and better access to scanning the first big milestones was the move of new building. and X-ray facilities, including a CT scanner these services and associated staff to the actually located in the unit which is used for The team were involved in a combination Bristol Children’s Hospital which would see, trauma and stoke patients. There is also a of taking patients from the ward, helping for the first time, all local hospital services helipad right outside. with final checks and then taking them over (including accident and emergency) for to the Brunel and settling them in to their Once A&E moved, staff and patients from the children under one roof. new rooms. other wards and departments at Frenchay On April 28 a special party was held at the began the journey across the city. This started Among the first patients to move across Barbara Russell Children’s Ward ahead of its with the transfer of the intensive care unit to the Brunel building was Sally Limb. big move on May 7. when 19 patients were transported by the Once she had settled into her new room in RAF’s large ambulance vehicle, which is Staff and patients (past and present) the Brunel Sally said she was impressed with known as a ‘jumbulance’. attended including 17-year-old Kray Mundy the facilities. who was a patient at the unit in 2008 for She said: “I love the private toilet and shower The Brunel: a bright future several months after he suffered a serious and I love that I can hang things up in a By May 28 all services, teams and stroke. His mum, Soniya said: “It’s a wonderful wardrobe. It is so airy and light with the air departments were in place. In total 540 place and is like a second home to us. coming in, which is particularly good when patients were successfully and safely moved It is home, my bubble. The staff here are you have respiratory problems. I think we are into the building over the course of the two so wonderful.” all excited to be here.” week period. Dr Amber Young, Lead for Specialist Once the first patients were settled in, our And in October we became the specialist Paediatrics, said: “This is the end of a very fantastic team of Move Makers started work. major arterial centre for patients in Bristol, long journey. I will miss the Barbara Russell These are volunteers who are based near Bath & North East Somerset, South Unit hugely but I am extremely excited about the main entrance who can help people Gloucestershire and some parts of Wiltshire moving such a high quality specialist service get checked in for their appointments and and Somerset. to a nationally-renowned children’s hospital.” guide people to where they need to be. The transfer of vascular surgery means Originally meant to be in place for a few that Southmead Hospital is now delivering 2014–15 2014–15 26 Annual Report & Summary Financial Statements Annual Report & Summary Financial Statements 27

Redevelopment of our facilities (continued)

24/7 multidisciplinary specialist vascular Frenchay site Payroll and Employment Services moved care inside the Brunel for both elective into the refurbished Burden Centre – now After the majority of services and and emergency patients. This has led to a called Frenchay Beckspool Building. Two of departments moved from Frenchay to reduction in the time it takes for urgent cases the three remaining onsite clinical services – Southmead in May 2014, work began to access theatre and patients spending less Headway and the Head Injury Therapy Unit, on decommissioning the buildings in time in hospital after they have undergone moved into the ground floor. preparation for demolition. This has now their procedure. been completed and demolition is scheduled The Brain Injury Rehabilitation Unit (BIRU) Despite some well documented issues and to start from late summer/autumn 2015. – operated by the Huntercombe Group – problems which have been dealt with, the remains in its accommodation on site. The Trust Board has signed off decisions Brunel building really is revolutionising how surrounding the future of the site. Having had we care for patients who are now reaping Learning & an encouraging response from the market many important benefits such as very and started discussions with a preferred Research extension low infection rates and improved dignity bidder, we are hoping to complete the sale of The extension to the Learning & Research and privacy. the site by the end of 2015. building was completed and handed Southmead Hospital over to the Trust in the summer of 2014. At this time we are progressing due diligence This development has been taken forward in redevelopment Phase Two on the bid and an indicative programme of partnership with the University of Bristol and The final phase of the Southmead site work is being drawn up. the building provides accommodation for redevelopment is now underway. The former The site has planning permission for housing, university laboratory-based research teams. hospital buildings were demolished during a primary school and a health and social In addition, more learning and development the winter/spring of 2014/15. care centre (plans for which are being facilities are now provided from the building When Phase Two is complete one of the progressed by South Gloucestershire Clinical – including an additional clinical skills biggest improvements will be around on- Commissioning Group). A portion of land laboratory and an expansion of the library. site parking for patients, visitors and staff will be transferred to Winterbourne Parish The building also provides accommodation – bringing the total number of spaces up to Council for use as a town and village green. for the Regional Quality Control Laboratory. 2,700. The bidder we are working with is solely In early 2015, the ground floor of the A brand new multi-storey car park specifically focused on the housing aspect. extension was equipped and now houses for patients and visitors will be created right In spring 2015, the last administrative staff Trust Headquarters. next door to the main entrance, enabling left Frenchay Park House (formerly Trust people to directly access the Brunel building Headquarters) and this is being sold to a under cover. local family. Bristol Breast Care Centre and • Modern, bright and comfortable at specially adapted premises at Cribbs Also included in the basement of the new Macmillan Wellbeing Centre environment making the most of natural Causeway in spring 2014. The centre light and views of the outside includes prosthetics, orthotics services and multi-storey will be an on-site sterile services The new Bristol Breast Care Centre which • Dedicated exits through courtyards for environmental controls. department. As an interim measure, the provides screening, diagnosis and after- patients following consultations to enable Trust has been renting a facility in nearby care support for cancer patients opened in Severn Pathology – Almondsbury until this is ready. greater privacy summer 2014 at the Beaufort House building Phase Two at Southmead. • The centre is divided into separate areas allowing direct access to the two main Work continues on Phase Two of the Severn Alongside the Bristol Breast Care Centre is clinical areas without patients having to Pathology building. It will provide an extra a new Macmillan Wellbeing Centre which pass through one area to reach another 5,000 extra square metres of space with two provides emotional, practical and financial linking bridges connecting to the existing • Both screening and symptomatic areas support for people affected by any type pathology sciences building which opened have their own dedicated waiting and of cancer, their families, friends and carers. in 2009. reception areas. This opened in autumn 2014. The new extension will house cellular The new Bristol Breast Care Centre provides Bristol Centre for Enablement pathology, neuropathology, genetics and all breast services for Bristol including The Disablement Services Centre, microbiology services and Public Health screening, diagnoses and follow-up Wheelchair and Special Seating and Bristol England’s pathology services. appointments. Key features of the Breast Care Communication Aids Service moved to Centre include: the new Bristol Centre for Enablement 2014–15 2014–15 28 Annual Report & Summary Financial Statements Annual Report & Summary Financial Statements 29

Sustainability

Over the past year the sustainability team has Whilst six monthly assessments against The assessment tool comprises been adapting to life within the new Brunel the Good Corporate Citizen criteria have eight sections: building. We have embarked on an ambitious been made, the Sustainable Development • Travel plan to introduce the environmental Management Plan has not been updated in management system ISO14001 to the recent years. This is now in progress and the • Procurement Facilities directorate. We have established Plan will incorporate the additional objectives • Facilities management a Trust-wide Sustainable Development and targets that will be set as part of the • Workforce Momentum Group to drive forward progress introduction of ISO14001. • Community engagement with our sustainability plans and we have been shortlisted and have won a number of Progress during 2014/15 • Buildings significant awards for our work. Good Corporate Citizen • Adaptation (to climate change) In addition to ISO14001 which will be used The Good Corporate Citizen assessment • Models of care to monitor environmental progress within model was developed for Trusts to Under each section there are six questions Facilities, the Trust uses two key methods benchmark progress on sustainable and for each question, three categories of to assess and manage performance on development, not just by measuring fuel performance: getting started, getting there sustainable development: bills or waste but by evaluating sustainability and excellent. The more questions the Trust across the board in financial, social and can answer yes to, the more points are • Good Corporate Citizen (GCC) – an environmental terms. It allows Trusts to accumulated. The graph below demonstrates assessment model used to help set and measure how well their activities support the percentage of points the Trust has measure progress against sustainable sustainability both inside the organisation scored on the questions under that section. development criteria and outside in the community. Assessment Every section and the majority of questions • Sustainable Development Management against the model was introduced as an within the section include reference to Plan (SDMP) – a board-approved plan obligation for all Trusts by the NHS Carbon reducing carbon emissions. By now the Trust incorporating the GCC criteria together Reduction Strategy. should be achieving a score of 50 percent in with other areas where the Trust can each area and by 2020 a score of 75 percent improve its sustainability. in each area. The assessment for 2014 highlights that the Trust has to make progress in a number of areas - our next assessment is due in June 2015. Sustainable Development Management Plan In line with the requirements of the NHS Carbon Reduction Strategy 2009, the Good corporate citizen assessment criteria headings Trust created a Sustainable Development Management Plan (SDMP) which was approved in March 2010. The Plan has been refined over time and is now in its third revision. It reflects the criteria within the Good Corporate Citizen model and suggested actions from the Carbon Reduction strategy together with internal Trust targets. We are in the process of developing an improved system for ensuring that responsibility for the actions in the Plan are assigned, monitored and reported back centrally. 2014–15 2014–15 30 Annual Report & Summary Financial Statements Annual Report & Summary Financial Statements 31

Sustainability (continued)

Carbon Once our infectious waste has been treated We will be trialling a reusable sharps bin The work the Trust did with clearance Overall consumption has slightly increased The Brunel building has a dedicated Building (autoclaved), it is shredded and sent by our system in 2015. This will reduce sharps specialist Benji and Co. on the waste over the year (electricity, gas and oil) by Management System (BMS) which enables us The Trust has not been monitoring its overall contractor for use as a feedstock for cement injuries, cost and the environmental impacts generated through vacating buildings at two percent. Although there has been a to control heating, lighting and operational carbon footprint due to a lack of data for kilns. Our domestic waste stream (everything of burning vast quantities of plastic sharps Frenchay and Southmead before the move noticeable increase in electrical consumption consumption of the building. We will key areas such as procurement. In line with that doesn’t go into a recycling bin) is taken bins. We will also be investigating the into the new hospital building has resulted across the estate there has also been a interrogate available energy data to compare our policy commitments, however, we will to a mechanical biological treatment plant in benefits of an inhaler recycling scheme in us being shortlisted for the Healthcare noticeable reduction in gas consumption specific areas of the building and its energy establish systems to monitor and reduce our Avonmouth where recyclables are extracted, (rather than incineration) and the use of Recycler of the Year category of the National leading to the overall net increase of usage, and see how policy, monitoring and carbon emissions during this financial year. the organic fraction removed for onwards devices which reduce the volume of liquid Recycling Awards. two percent. The closure of Frenchay has measurement effects consumption. Similarly, Waste processing and the remainder is burnt to clinical waste. resulted in offsite properties taking on the Trust will also look to utilise the existing derive energy. Energy some of the specialist services that are BMS system monitoring the additional Trust In line with our Environmental Policy the At the time of producing this report we In line with our Environmental Policy, the currently not provided at the Southmead buildings to identify areas for potential Trust is committed to monitoring and The Trust regularly reviews the waste streams had not received annual data from all of Trust is committed to monitoring and site until Phase Two of the Southmead energy saving. reducing the environmental impact of the being produced and how these can be better our waste contractors. Graphs following on reducing our environmental impact of our Redevelopment Scheme. waste we produce. managed. The items collected for recycling/ from last year’s report can be found below, 100 percent of half hourly electricity provided energy use. recovery/reuse include paper, cans/tins/foil, however, an updated version once all data With the opening of the Brunel building, by our supplier is renewable and comes from We produce a significant quantity of batteries, waste furniture and many more. has been received will be made available on This year has seen significant changes to the we are working closely with The Hospital a mixture of wind and solar power. Likewise, waste and its treatment and disposal has a Food waste passes through three waste the Trust’s Sustainable Development internet whole of the NBT estate culminating in the Company, Southmead, in identifying an additional 20 percent of our energy supply negative impact on the environment, with digesters containing enzymes which break pages. The waste streams which are missing transition of services into the new Brunel opportunities to assist in reducing the overall to the Brunel Building is renewable and is a large proportion of waste being treated it down into grey water which leaves site via or for which we have incomplete data building at Southmead. energy consumption of the Trust. An Energy supplied by our biomass boiler. (incinerated/autoclaved) or sent to landfill. the sewer system. This avoids greenhouse are: scrap metal, waste catering oil, waste Policy and Strategy will be developed to This has resulted in the reduction of energy We have also installed a new 84kWh solar Waste minimisation, re-use and recycling all gases which would otherwise be generated electrical equipment, ink/toner cartridges, assist in the overall management of energy consumption on other areas of the existing photovoltaic system on the roof of the have environmental benefits by reducing the from transporting it off-site for composting plaster waste, linen, chemicals and batteries. across the Trust. estate, in particular the Frenchay site, Learning & Research building to contribute consumption of raw materials, saving energy or treating it at sewage treatment plants. The graphs this year show an increase in where the majority of services over the towards our renewable energy generation. and limiting both landfill and incineration. We have introduced the tiger bag stream for some waste disposal routes. This is due year were transferred away. Overall energy We are currently reviewing the internal and non-infectious patient waste from certain to the move into the new Brunel building consumption across the total estate has external lighting provision across our sites areas such as maternity, Saplings nursery and where a large number of clear-outs have increased slightly over the previous year, with to save energy by switching to lower energy Trust toilets currently divert 15 percent down occurred, even post-move. This is expected a subsequent rise in CO e emissions (scopes 2 LEDs where possible. We are also improving this route. We will be rolling this out into to settle over the next year. The missing data 1,2) over the 2013/14 period. The reported roof insulation in various buildings across suitable areas during 2015 and are hoping is expected to boost our recycling figures so CO e emission figures are for electricity, gas, 2 the Southmead site to further improve to achieve closer to 30 percent segregation. that they are closer to the tonnages seen in biomass and oil consumed. energy efficiency. This waste goes to deep landfill rather 2013/14. than autoclaving.

Waste Disposal Routes & Tonnages 2008-14 Energy consumption Carbon emissions 2014–15 2014–15 32 Annual Report & Summary Financial Statements Annual Report & Summary Financial Statements 33

Sustainability (continued)

Water Travel In conjunction with the new Car Parking The Trust is also supporting the Bristol electric To achieve the Gold Award, we need to Climate change adaptation Policy, the Trust has been promoting vehicle network through the provision of a increase our percentage spend on organic The Trust is committed to monitoring and We have adopted a new Travel Plan (2013 to and mitigation alternative travel options to support rapid electric vehicle charging point on site (15 percent), free range, Fairtrade and locally reducing the environmental impact of the 2018) to increase the use of alternative travel staff choosing to travel to work by more at Southmead Hospital. Two further electric produced ingredients. The Trust’s Environmental Policy commits amount of water we consume. options here at the Trust. sustainable modes of transport. points will be available to staff and visitors on us to adopt climate change adaptation and In February 2015, we won the Silver Fairtrade We consume a significant volume of The aims and objectives of our new Travel completion of Phase Two works. mitigation measures to deliver a resilient The Trust actively promotes cycling Business Award for our work promoting water from sinks, showers, toilets, hydro- Plan are: healthcare service for the future. to members of staff as a sustainable In order to promote the sustainable travel Fairtrade products in our staff restaurant pools, autoclaving, cleaning and for • To reduce the number of single occupancy travel option. options available, a dedicated Travel Team at Southmead. Awards were presented to As a Trust, we must first reduce our carbon irrigation to maintain our green spaces. We vehicle journeys made to the hospital by exists to further encourage staff and visitors organisations in the South West who have footprint to mitigate the effects of climate monitor our water consumption closely Our latest staff travel survey undertaken in private car to adopt sustainable methods of travel. demonstrated commitment to promoting change. By adopting sustainable models of through our online metering systems. autumn 2014 found that 20% of staff are now The team provide information for staff Fairtrade products and raising awareness care and shifting the emphasis of patient Working closely with Bristol Water, we review • To improve travel choices and make them cycling to work, an increase of five percent and the public on a wide variety of forms amongst staff on the social, ethical and care closer to home to improve the patient our consumption levels regularly and if we safe and accessible to all since 2012. It is hoped the continued planned of transport. environmental reasons behind Fairtrade. experience, we will reduce the need to travel notice any increase in water consumption or • To encourage healthy, environmentally expansion of cycling facilities and secure and the emission of greenhouse gases in the water pressure, we will work to identify any sustainable travel choices. cycle storage will further increase numbers Travel West hold regular travel roadshows Further recognition of the good work we first instance. potential leaks or issues and resolve them as A number of measures have already been of cyclists. raising awareness of the alternative options have done to reduce the environmental We will be preparing for and adapting a priority. The new Brunel building includes taken to change how people travel to available for staff. In addition, the Travel Team impact of the food we provide was receiving The Trust is working with local authorities and to climate change by planning for the water efficient appliances, a grey water Trust sites, with particular emphasis on always attend the fortnightly Corporate the NHS Sustainability Award for Food in bus companies to improve and increase the vulnerabilities of our healthcare service, our recycling system and a green roof which reducing single occupancy vehicle travel and Induction meetings for new members of April 2015. bus network that services our sites including staff and our patients to climate impact risks. reduces surface water runoff. increasing the number of cyclists, walkers staff and can provide personal travel plans discounted bus tickets for staff. This is critical We are working with Emergency Planning to and public transport users. on request. Engaging the local There has been a significant reduction in to helping staff with their journeys to work, community on sustainability ensure business continuity, severe weather water consumed across the Trust in the Our Car Parking Policy has been instrumental but will also enable visitors and patients to In an effort to reduce travelling altogether and resilience planning to review how our The Trust is committed to engage staff, previous year. We are able to attribute in encouraging changes in the way that staff have a viable option other than bringing their the Trust encourages and has seen good health care service will become resilient patients, visitors, stakeholders, partners, significant areas of this reduction to the travel to work. The Policy included a new car to site. take-up of the use of teleconferencing and to localised climate change impacts such contractors and the wider local community decommissioning of Frenchay Hospital, staff parking permit scheme, enforcement videoconferencing facilities provided at the as extreme weather events, and potential For the public the Trust has a website that on sustainability and the links to health and hand in hand with the opening of the and terms and conditions of parking with the Frenchay and Southmead sites. shortages of fuel, water and food. gives travel information on how to get to our wellbeing. We held our first Sustainability Brunel building. Through the removal of old aim of controlling parking and regulating the sites by various means. There are hyperlinks Fair in the new Brunel building to mark water systems/pipework at both Frenchay number of staff bringing a car to site. With the Food Future plans to useful external sites such as Traveline, First the annual NHS Sustainability Day on and Southmead, we have been able to Board in full support of the permit scheme, In line with our Environmental Policy The Environmental Management buses, Wessex Connect and various others. 26 March 2015. identify and eliminate historic and often the Trust is able to determine the eligibility commitment to reduce the environmental System (EMS) will continue to drive undetected areas of the sites that had leaking of applicants by establishing a set of criteria Information leaflets that include site maps impact of the food we serve to patients and There are numerous public health co- forward continuous environmental water systems. based on distance from site and certain work are also sent out with appointments that give staff, the Trust has committed to source local, benefits from climate change adaptation improvement across the Trust in line with needs based issues. a variety of information. organic, seasonal and Fairly Traded food and mitigation measures, making health our Environmental Policy commitments wherever we can. The Trust promotes car sharing through the and wellbeing crucial to the delivery of outlined above. sustainable development within North Bristol Liftshare scheme which members of staff can Each day around 2,500 patient meals are The EMS will achieve this through setting NHS Trust. The mutual benefits realised Water consumption in cubic metres join free of charge and through regular Car prepared fresh on-site by our chefs and objectives and targets in line with our from a healthy workforce combined with Share Café’s. Our link with Liftshare provides much of the food comes from the local area Policy commitments, identifying and our objectives to reduce our impact on the a search engine for staff looking to car-share – reducing the Trust’s carbon footprint and managing our significant environmental local environment will combine to deliver a with other commuters going the same way. supporting local businesses. aspects and impacts, setting action plans sustainable healthcare system. Another facility provided is in the form of Co- We proudly continue to hold the Soil and undertaking internal audits which Wheels and City Car Club cars. This popular Association Food for Life Catering Mark will be externally verified to the ISO14001 resource is available to all who need to use a Silver Award for patient meals and plans are certification mark. From 2016, we will report vehicle as part of their work but who either underway to identify the necessary steps our sustainability and environmental data do not have a car or do not want to drive to apply for the Gold Award and achieve against our policy objectives and targets. to work in order to have a vehicle to use for the Soil Association accreditation in our work purposes. staff restaurant. 2014–15 2014–15 34 Annual Report & Summary Financial Statements Annual Report & Summary Financial Statements 35

Making NBT a great place to work

The Trust’s approach to workforce planning sustainable workforce plan for 2015/16. The recruitment team has reviewed all of its has focused on integrating business planning The focus will then move to achieving the internal processes and increased its capacity process with the resources required to deliver efficiencies made possible by the Brunel to recruit higher volumes of new starters in a our quality, safety, performance and financial building and working on a single site. shorter time period during the coming year objectives ensuring the right people have the in response to the needs of the organisation. The last year saw the wider implementation right skills and are in the right place to deliver of electronic rostering across a number of Following full evaluation the Trust has agreed our activity plan for 2015/16. areas including portering, catering, domestics the full rollout of Value Based Recruitment Workforce planning has been focused and theatre nursing. The Trust now has over for all vacancies which is scheduled to start in on reviewing and refining the staffing 4,000 staff on e-rostering, 3,000 of which are June 2015. The evaluation has demonstrated requirements which can be flexed to the paid electronically. The Trust is aiming to have that Value Based Recruitment manages needs of the Trust following the move to the all 4,000 staff paid electronically by summer new starter’s expectations of roles and new Brunel building. These requirements 2015. The process of electronic payroll as a result has reduced staff turnover by have been characterised either by new roles, replaces the reliance on paper generated around 19 percent. The rollout will initially different numbers of staff or different ways processing and thereby reducing pay errors include all non-medical posts, however, this of working. and the overall cost of administration. will be extended to include consultants, The next phase of e-rostering will be to junior doctors and senior recruitment over Planning has been led by clinicians and ensure it is embedded as part of the Trust’s the coming year. The work the Trust has service managers in each area to ensure that workforce management strategy. done around Value Based Recruitment has quality, safety, performance and affordability achieved national profile and the team has requirements are met. The extent of the The Trust has also implemented SafeCare, been asked to talk about its work at a number changes and consequent movement of a software system that enables us to of national events. staff has been unprecedented and resulted understand the nurse staffing levels required in very close working between clinical and on each inpatient ward in the context NBT eXtra, the Trust’s temporary staffing corporate teams. of patient need. This then means that service, has continued to deliver a high evidence-based staffing decisions can be quality service to the Trust managing an In addition there have also been a number made on each shift and reviews of funded unprecedented demand for temporary of services transferring in and out of the establishments can easily be conducted for staff. In the past year the service has taken Trust. This has included community specialist the Trust Board’s assurance that we maintain on the management of all the temporary children’s services at Church House and safe staffing levels. In achieving this we are staffing needs of the Facilities Management specialist paediatrics services transferring to complying with expectations set out by the Directorate providing over 370,000 hours of UH Bristol with Breast Care Services including National Quality Board. ancillary staff. all planned surgery, associated outpatient appointments and breast screening services Recruiting a Listening to and engaging transferring to the Trust last year. flexible workforce our staff Urology Services also moved to NBT which Over the past year the Human Resources The Trust received the results of the 2014 includes complex surgery and simple recruitment team has processed an national annual staff survey in early day case operations with outpatient unprecedented volume of applicants - 28,000 2015. Disappointingly, the response rate appointments offered at Southmead, job applications with over 2,000 new medical was significantly lower than in previous Cossham and Thornbury Hospitals, and non-medical staff appointed. The team years, 25 percent. There was a change Portishead, Bristol Royal Infirmary, is now deploying robust recruitment to the methodology last year, with most South Bristol Community Hospital, and approaches to address recruitment shortfalls. staff receiving the survey electronically Clevedon Hospital. This has included the recruitment of a cohort as opposed to hard copy. The response The development of these service changes of Spanish nurses who have been welcomed rate may also have been affected by the were led from the start by our senior doctors to the Trust. implementation in 2014 of the Staff Friends and nurses and involved patients, carers and and Family Test. the wider public in their design The People and Organisation Health directorate continued to work closely with clinical directorates and finance to ensure the workforce and finance planning process achieved an affordable and operationally 2014–15 2014–15 36 Annual Report & Summary Financial Statements Annual Report & Summary Financial Statements 37

Making NBT a great place to work (continued)

Our top ranking scores were: Quarterly staff surveys encourage staff wellbeing website which includes a • We created a sustainable website for to respond to the questions: ‘Would you directory of wellbeing services and cashback and discounts on purchases that • The percentage of staff receiving job recommend NBT as a place to be treated?’ support covering free monthly money create revenue from brand commission to relevant training, learning or development and ‘Would you recommend NBT as a place advice sessions, breathing space spend on staff benefit development, by in the last 12 months to work?’ meditation classes, clubs and fitness partnering with MyTrustBenefits • The percentage of staff able to contribute sessions such as the Trust’s football team, Detailed analysis of survey feedback over • Reward briefings for staff working in towards improvements at work walk to run club, onsite adult ballet and 2014 has provided an understanding of the community locations • Our bottom ranking scores were: zumba classes main themes arising from staff comments, • Development of a five year pay and • The percentage of staff agreeing that the which has formed the basis for the ‘2014 Staff • Collaboration and promotion of reward strategy. feedback from patients/service users is Experience Report’ detailing staff feedback community links and health support, used to make informed decisions in their and enabling a ‘You said; we did & are doing’ including the Happiness Project Developing our staff directorate/department approach. • Staff wellbeing events, including stress In March 2014 the Learning and • The percentage of staff reporting errors, awareness and back care week Development team were awarded the Skills The Staff Wellbeing Strategy, designed during near misses or incidents witnessed in the for Health Quality Mark in recognition of their 2014, has a proactive and preventative • Tailor made free wellbeing workshops, last month excellent delivery of teaching and learning. focus, recognising that it is too late to wait at manager’s request, supporting both • The percentage of staff suffering work until staff go out sick before action is taken. mental and physical wellbeing The Quality Mark endorses the quality of related stress in the last 12 months. It supports staff in taking responsibility for • A huddles pilot, leading the way in the delivery of training and learning and its In addition, the Trust implemented the Staff their own health as well as promoting health staff wellbeing and communication on suitability for the health sector. Friends and Family Test in accordance with and wellbeing and providing prevention, the wards The assessors said of the Trust’s training team the national guidance. Staff were asked intervention and rehabilitation services • Launch of ‘MyTrustBenefits’ discount that they “deliver teaching and learning to a two questions and the results are provided through five strategic objectives which cover: brochure and website, offering a wide very high standard and are passionate about below. All staff were surveyed in all quarters. • An enhanced experience of working at the range of national discounts along with what they do and all team members strive to There was no survey in Quarter 3 as the Trust to improve staff health and wellbeing discounts to over 100 local business. ensure that the learner experience is of high questions were covered in the National Staff quality, fit for purpose and enjoyable.” Attitude Survey. • Stronger individual ownership of personal Rewarding our staff health and wellbeing As part of improving staff experience, Further, they identified that in NBT we really • How likely are you to recommend North Bristol NHS Trust to friends and family In addition, staff were able to provide reasons • More effective staff contribution to particular focus was given to the support our home grown staff. if they needed care or treatment? (the results of which are shown below). for their responses. The main themes workplace improvement development and communication of the emerging were: We are actively promoting the quality of • Fit-for-purpose health and wellbeing staff reward package, based on survey education as a reason for working in NBT. Quarter 1 Quarter 2 Quarter 4 • Access to work - parking and travel services for staff at the Trust evidence that awareness of the reward We are targeting all potential sources of package was low amongst staff. Response rate 8% 23% 19% • Staff engagement - morale, • Reduction in sickness absence levels. future employees from school, college, job centre, marketing via NHS jobs, out turn Likely/Extremely likely 61% 60% 66% communication, culture The strategy set out a five year vision to Activities included: from university and wider marketing, with Neither likely nor unlikely 19% 22% 19% • Leadership and management deliver a working environment that will • Creating a central web page with links to specific targeted work for young people enable staff to be Happy, Healthy and Unlikely/Extremely unlikely 19% 16% 14% • Staffing levels all elements of the reward package to meet future workforce needs, and also Here. The annual strategic goals have been • Working environment • In October 2014 we launched total reward encourage diversity of opportunities for Don’t know 1% 1% 1% organised into three areas of ownership, • Career progression and job security statements for all staff to access their our wider and potential workforce for the • How likely are you to recommend North Bristol NHS Trust to friends and family Trust, Managerial and Individual, to reflect personal benefits statements online future. We are committed to developing our Over the last year, a key focus has been on the understanding that staff wellbeing is as a place to work? (the results of which are shown below) staff and providing learning opportunities improving staff experience to help make the everyone’s responsibility. • We negotiated 100+ discounts with local Trust a great place to work businesses to be included in a new staff to support development at all levels. Quarter 1 Quarter 2 Quarter 4 The actions undertaken to improve staff discount brochure. This was launched in The national Learning and Development Response rate 8% 22% 19% Staff wellbeing experience, engagement and wellbeing over November 2014 Agreement, with Health Education England, the last year included: sets out how we work in partnership with our Likely/Extremely likely 38% 39% 46% The Trust recognises the importance of staff universities and colleges in the support of our engagement and wellbeing as a key enabler • The introduction of a wellbeing session at Neither likely nor unlikely 19% 22% 22% undergraduate and post-graduate students - in helping create a positive organisational Corporate Induction Unlikely/Extremely unlikely 41% 35% 31% our future workforce. climate which ensures NBT achieves its • The creation of a wellbeing champions Don’t know 1% 1% 1% overall business strategy. network which so far includes We have valuable local schools partnerships 300 members which continue to grow with our work experience programme, offering over 100 • A quarterly staff experience newsletter students a year work experience, taster promoting ‘Zest4Life’ the Trust’s staff 2014–15 2014–15 38 Annual Report & Summary Financial Statements Annual Report & Summary Financial Statements 39

Making NBT a great place to work (continued)

sessions and support at schools and colleges sure they have support to make the transition through to bespoke directorate sessions • Set up a Disabled Staff Development Health and Safety In addition, training was provided to support and careers events which offer insights from student to staff nurse. whilst aligning this to the work being group that has identified areas that NBT organisational change and a new skills A number of health and safety procedures into a range of career options. This is ably undertaken on the novice to expert pathways need to look at and members have been programme introduced to help managers We are supporting nurses to return to their and issues have been reviewed and supported by our ambassadors, people of and the role of the advanced practitioner. invited to be assessors at the valued based manage sickness absence. profession and regain registration through implemented during the year and all walks of life in the NHS who are keen to recruitment sessions. A disabled member our Return to Practice programme which has During 2014 we continued to see a drop these include: support and inspire our future workforce. of staff now chairs this group Medical revalidation yielded 12 registered nurses. in the numbers of patients who have had • The appointment of responsible and In the last year the Trust has increased We are keen to grow our own talented a cardiac arrest and remain well below the • Improved the quantity and quality of staff During 2014 we have further developed deputy responsible persons under engagement with medical appraisal and at workforce, working with the support of national average (NCAA 2014). We also receiving equality and diversity training. our education partnerships with our local the Control of Asbestos Regulations, year end 92 percent of medical appraisals national and local programmes, utilising provided resuscitation training to 4,156 3,125 staff (an increase of 44 percent universities and further education colleges particularly important during a period of took place on time with the remaining eight apprenticeships, widening participation staff as part of their mandatory training from 2013) received this training through to ensure that we have access to a range of large scale demolitions percent having three months within which to strategies, and attraction programmes such programme, which is an increase on the Corporate Induction, completing the accredited training for our multidisciplinary complete and still maintain compliance with as work experience. previous year. Trust’s e-learning training or participating • Systems to control contractors’ safety workforce. Our key programmes include in specific equality and diversity procedures with 90 percent of contractors the NHS England requirement for appraisal. In October 2014, we were awarded the Fair leadership development with the NHS Following another excellent outcome of the training courses trained in hospital environment risks The Trust has further supported appraisers Train Quality Standard for the quality of our Leadership Academy UWE Business School NHS Library Quality Assurance Framework • The Two Ticks Disability symbol was • Transfer from the Health and Safety through appraiser professional development work experience in NBT. We are the first NHS and Exeter Consulting, in the delivery for Peer Review for library service provision, reviewed by Job Centreplus and awarded Department to a Trust Technical events with two full day workshops taking organisation to be recognised in this way. the second year of our successful regional we continue to deliver core knowledge for a further year Compliance Lead of assurance on the PFI place and a further two planned in 2015. leadership for Improving Frontline Talent, management and library resource We have run pre nursing courses, which contractor’s control of its risks The events were well received with some (on behalf of the South West region), our services for NBT and other NHS and public • Promoted and held equality events has given ten health care assistants the very positive feedback from attendees. professional development modules with health organisations. throughout the year to raise awareness • Ratification of more than a dozen health opportunity to have support in applying The Trust has developed its process of UWE and University of Bristol in delivering and promote understanding of race, and safety policies for university. We have a vibrant multidisciplinary and quality assurance of appraisal and will be master degree level modules, our supervisory disability (including mental health), In addition the management processes multi-professional environment and we strive implementing processes designed this year Our successful partnership with Job Centre sister programme accredited by UWE, and sex, sexual orientation, gender identity. for Health and Safety in the Trust were to ensure that all staff have access to our that will further support appraisers in their Plus goes from strength to strength with our valued Further Education Colleges, Chinese New Year and World Mental audited by the British Safety Council and facilities and have the appropriate support role but also ensure appraisees receive a high results in supporting people into work. Weston College, South Gloucestershire Health Day were also marked the department was pleased to receive the to help them with their induction or their quality appraisal. and Stroud College (SGS), North Somerset • Produced and widely distributed an highest standard of five stars. We continue to feature in nominations further studies, as well as direct support for Enterprise and Technology College, and City Equality newsletter In working closely with clinical governance and places at awards and celebrations clinical teams. of Bristol College, for example. Our policies Human Resource’s reporting on supporting both for the education we provide and • Provided support for staff though the We continue to work in partnership with information for appraisal for medical staff for our individual learners, at local and The Post-Graduate Medical Education Quality Ensuring equality and harassment and bullying advice live. staff to develop and update new key policies, has improved with the revalidation team regional levels. Improvement (QI) programme continues to diversity for all staff which clearly set out management and staff providing four supporting information grow and now incorporates senior medical Building on our successful apprenticeship In driving our commitment to enable the responsibilities. Some of the policies and reports (clinical audit, complaints, incidents trainees. Following a successful bid to the programmes is important to us, with delivery Trust to be a high performing, healthy practices updated and introduced over the and fitness to practice concerns) for every Regional Innovation Fund we have trained through the NBT centre for Health, Business organisation considerable focus and energy last year include: doctor. The team has been preparing a further 15 mentors and will be running Administration, and Functional Skills (literacy has been given to promoting an equal and throughout the year to achieve independent another mentor day in June. • Terms and Conditions Handbook and numeracy) and, through our South West diverse workforce, tackling discrimination verification of its processes for medical Apprenticeship Training Provider Partnership, We have recently appointed a Simulation when and wherever it occurs. The Trust is • Rostering Policy revalidation from NHS England and the we continue to lead the way in delivering Education Fellow (HESW funded) for an initial recognised for its positive reputation for • Professional Registration Policy assessment day will take place in summer equality work and often provides advice and traineeships, not just in the NHS, but across one year contract who will be responsible • Recruitment and Selection Policy 2015. Independent verification will be all sectors. for developing a programme of simulation guidance to other NHS bodies, public and required every five years and this is NBT’s • Uniform and Dress Code Policy and human factors based training to multi- private sector organisations. first time since revalidation was enacted in We have supported access to nurse training disciplinary teams in the ward/department • Equality and Diversity Policy December 2012. for our experienced assistant practitioners In particular, over the last year we have: environment. This post will support the • Harassment and Bullying Policy and health care assistants who want to Trust’s Sign Up to Safety initiative by targeting • Undertaken black and minority ethnic progress onto registered nurse, recognising • Disciplinary Policy areas of known risk and specific incidents staff career development work including their contribution and potential as staff identified through RCAs. matching NBT board members and • No Smoking Policy nurses in the future. We are welcoming senior managers as mentors, offering • Study Leave Policy our newly qualified staff nurses by making In addition to this, patient safety and quality recruitment training and the opportunity • Appraisal Policy the recruitment more straightforward and remains a core element of all training and to assess applicants for HCA posts through actively encouraging them to come and now includes human factors and we plan valued based recruitment sessions. A BME work for NBT while considering their future to introduce this in all our programmes member of staff now chairs this group careers and once employed by NBT, making ranging from corporate and clinical induction 2014–15 2014–15 40 Annual Report & Summary Financial Statements Annual Report & Summary Financial Statements 41

World leading research

The Trust has a significant and growing 3: Embed a research culture in clinical service In addition, NBT is also an integral member research portfolio with more than 280 delivery - develop a culture across NBT of the West of England Academic Health researchers delivering around 450 research in which research and innovation are Science Network (WEAHSN), whose core studies in the past year, including 48 embedded in and aligned with routine work streams are: commercial trials. clinical services, leading to significant • Improving patient safety – building on the health gains and efficiency improvements Established research strengths in successful South West programme in health services delivery musculoskeletal, infection and immunology, • Quality improvement – supporting neurosciences, diabetes, respiratory 4: Increase research income - increase the the spread of good practice to realise medicine and urology continue to be income from research and innovation service improvements supported alongside emerging strengths in and use that income in support of our • Enterprise and Translation- supporting anaesthetics, obstetrics and gynaecology and strategic aims. adoption of new technologies and stroke research. Collaborating across the city solutions to benefit patients We continue to deliver our three existing Since 2012 a formal collaboration, Bristol • Connecting patient data across the system highly prestigious National Institute for Health Partners, exists between the city’s for increased patient benefit Health Research (NIHR) programme grants, three NHS trusts (Avon and Wiltshire Mental The WEAHSN was accredited in 2013 for each worth £2 million alongside ten other Health Partnership NHS Trust, North Bristol five years. NIHR research grants worth an additional NHS Trust and University Hospitals Bristol £8.5million. NBT is a partner in the National Institute for NHS Foundation Trust), the three local Health Research (NIHR) Collaboration for In 2014 we were awarded five new NIHR clinical commissioning groups (Bristol, South Leadership in Applied Health Research and grants, four of these from the NIHR Research Gloucestershire and North Somerset CCGs) Care (CLAHRC) West working to conduct for Patient Benefit funding stream in the the two universities (University of Bristol and applied health research and implement areas of musculoskeletal disease, respiratory the University of the West of England) and research evidence, to improve health and disease and microbiology. The fifth is from Bristol City Council. health care across the West of England. the highly prestigious NIHR Programme Bristol Health Partners aims to improve the NBT is leading two projects into chronic renal Grants for Applied Research funding stream health of those who live in and around Bristol disease and equity of care. which aims to investigate better post- and to improve the delivery of the services operative prevention and management for NBT is leading the way for joint working on which they rely and to act as a mechanism chronic pain after total knee replacement, across the West of England region with key for change in the local health and care worth £1.9m. partnership NHS Trusts and the Clinical community and city region. Its shared vision Research Network: West of England (CRN In addition to NIHR funding, NBT has secured is for those who live in and around Bristol to WofE). An exciting collaboration around a €3.9m funding as part of an EU consortium enjoy the highest possible quality of life and clinical trial in maternity services has set best bid focused on combatting bacterial experience of care, helping Bristol and its practise examples for large scale trial delivery resistance in Europe. health and care system to be known for: across the region. Our research aims and priorities over the next • Equality of access, experience five years continue to be: and outcome 1: Be world-leading - actively participate • Excellence in research in Bristol Health Partners, in which • Promotion of innovation world-class clinical services, research and • Connectedness and collaboration innovation and teaching are strategically NBT is leading the integration work in the and operationally integrated across the city areas of musculoskeletal disease, Parkinson’s 2: Deliver high quality research of direct and movement disorders, chronic kidney patient benefit - support our staff to disease and dementia. deliver high quality translational and applied health services research of direct patient benefit 2014–15 2014–15 42 Annual Report & Summary Financial Statements Annual Report & Summary Financial Statements 43

World leading research (continued) Charitable activity

Building a strong Innovation • Continue to embed an innovation culture across the organisation by working with research infrastructure Over the last 12 months we have been individuals and teams to understand the supporting teams in their transition to the The Clinical Research Centre (CRC) at benefits of innovation and transformation new hospital and evaluating our current Southmead Hospital has been open for just and to develop their ideas under a year now and is a key part of clinical position as an innovator and stakeholder in • Strengthen the innovation delivery research delivery at NBT. The first patient the local health community. platform with clear processes, resources appointment took place in May 2014 and We’ve put considerable effort into and rewards working across the since then around 2,000 patients have been strengthening our external innovation organisation to connect innovators to seen. The CRC brings together researchers network, whilst simultaneously evaluating funding and support networks from all disciplines from across the Trust our own efforts internally and developing • Deliver high impact innovations in enabling them to work together more new models of sustainable working. We are our specialist services to optimise the closely to share best practice and encourage far better placed this year to capitalise output of our resources and enhance our collaboration. The centre ensures our patients upon the intellectual property assets of the reputation as a leader in patient centred are given the best possible experience of organisation to deliver outstanding care and care and health care innovations and taking part in a research study whilst being value to the health economy. given additional advice and support relevant transformational leadership. Our specialist to the study and their diagnosis. Our aims around innovation are as follows: services are: neurosciences, orthopaedics, children’s burns, plastic surgery, renal • Actively participate in local and regional The second phase of the Learning & Research & transplant, trauma, HIV and CCHP health networks (like Bristol Health building is finished and now houses clinical (Community Children’s Health Partnership) sciences researchers from the University of Partners and the West of England • Deliver the high impact innovations Bristol in addition to NBT researchers. Academic Health Science Network) to leverage improvements in care pathways, defined in innovation health and wealth The dedicated neuroscience clinical research diagnostics and in which world-class that are relevant to NBT. facility at Southmead is due to open mid- clinical services, research, innovation, 2015 and is the final part of the restructuring education, training and informatics are work to bring together research across NBT strategically and operationally integrated into one hub. The NBT Science Quarter was officially launched in spring 2015 to celebrate this new hub for health research. This is providing an excellent opportunity to advance clinical research supporting NBT’s aim of enhancing our reputation as one of the UK’s leading NHS organisations in research and innovation. NBT has worked hard to sustain and grow a strong research infrastructure of professionals including over 100 research nurses, midwives and allied health professionals, to work on developing new and delivering existing research studies. Through the efforts of this research workforce nearly 3,000 patients have been able to participate in nationally recognised clinical research studies at NBT during 2014, along with many more involved in more local research. 2014–15 2014–15 44 Annual Report & Summary Financial Statements Annual Report & Summary Financial Statements 45

Charitable activity (continued) Patient activity

The past 12 months have been Our partnership with Bristol Rotary and We were awarded a grant of £225,000 to Inpatient Activity incredibly exciting for the Trust’s charity. the Prostate Cancer Care campaign support the build of the new helipad at After consulting with staff, our Foundation continued with the ninth annual Run for the the Southmead Hospital site. As the major ElectIP NonElectIP DayCase Trust public members and other Future event. trauma centre for the South West region stakeholders, the charity took on a brand developing the helipad to ensure we are 2014/15 12644 60481 40413 The charity also received great support new identity as Southmead Hospital Charity. able to accommodate the full range of air from the Move Makers, volunteers and staff 2013/14 14530 58895 41669 This is to reflect the transfer of services from ambulances, means we can support the to help develop its next community wide Frenchay and that the majority of services are largest number of trauma patients. fundraising campaign “Do Something Super Outpatient Activity all on one site. for Southmead” – which aims to engage the The grant will also be able to support Our two main campaigns to complete the community with the many ‘heroes’ in our the building of a covered walkway to New FollowUp Total Bristol Breast Care centre and establish hospitals saving and transforming lives on a make it easier to treat patients in adverse 2014/15 145435 266082 411517 the new Neuroscience Clinical Research daily basis. weather conditions. Centre have been successfully done and 2013/14 190217 283190 473407 our community fundraising has gone from Fresh Arts Bristol Breast Care centre strength to strength. The charity supported a range of projects The new Breast Care Centre became fully A&E activity 14/15 under the Fresh Arts programme. operational in summer 2014. The fundraising The main aim for the team over the next These events use visual and performing appeal to support the centre continued six months is to put Southmead Hospital New Follow Up Total arts to support patients and staff across a until the end of the financial year. Charity firmly on the map – working hard wide range of conditions; the therapeutic Including existing charitable funds and the A&E 75364 379 75753 with local business, community associations, and social benefits for patients undertaking hard work undertaken by BUST the appeal schools and amenity groups to establish the Southmead 9554 56 9611 activities such as painting, dancing, singing raised over £500,000 for the new one-stop charity as a hub of social support in the wider and knitting are now well documented and service for the entire South West region. Frenchay 84918 435 85364 Bristol community. wider support from the charity has enabled Fundraising to support the extension of 13/14 101886 1316 103219 this programme to develop more widely Community Support training rooms and research will continue to across the Trust. The support given by our patient and family be part of the charity’s fundraising portfolio. groups has once again been tremendous. Major Trauma The campaign to continue research into brain Neuroscience Clinical Southmead Hospital Charity received its cancer gained international support via one Research Centre largest ever grant in 2014/15 from the family’s social media campaign raising more County Air Ambulance Trust – Help Appeal. To be locally known as the BRAIN Centre, the than £80,000. new neuroscience clinical research centre will be open to patients in May 2015. It will be the only facility undertaking research for and treating Alzheimer’s, Parkinson’s, dementia and multiple sclerosis. Over £1 million was raised through fundraising and voluntary donations. We are looking forward to working with BRACE as a new charity partner within the centre. Thank you also to… We receive support and donations from thousands of people, companies and community associations – unfortunately we have insufficient space to thank everyone individually but we would like to give a special mention to: SITEC, The Clarkes foundation, Louis and Anna Brooks and Shaun McCarthy. 2014–15 2014–15 46 Annual Report & Summary Financial Statements Annual Report & Summary Financial Statements 47

Finance

Financial statements resource limit (CRL) are presented separately Financial duties and financial in the consolidated accounts and it is the The financial statements have been prepared performance Trust’s results as an entity that are used in in accordance with the NHS Trusts Manual The Trust has three key financial duties: measuring its performance in year. for Accounts issued by the Department of • To break-even on income and expenditure Health. The Manual contains accounting Full accounts are available on request from: taking one year with another policies which comply with International Director of Finance, North Bristol NHS Trust, • Not to overspend its capital resource Financial Reporting Standards to the extent Christopher Hancock Building, Southmead limit (a limit on capital expenditure set that they are meaningful and appropriate to Hospital, Westbury-on-Trym, Bristol, to an agreed plan with the Department the NHS, as determined by HM Treasury. BS10 5NB. of Health) Group financial statements Financial review • To achieve its external financing limit (a The Trust is required to prepare consolidated Funding cash limit set by the Department of Health) accounts, incorporating the results of the The Trust’s main source of finance is from The table below sets out the Trust’s Trust’s linked charity, the North Bristol NHS contracts with other public sector bodies, performance against these targets in 2014/15 Trust Charitable Funds. The requirement to in particular NHS commissioning bodies. In and in the previous four years of the Trust. consolidate arises as a result of the Trust’s addition, the Trust also receives funding in ability to control the Charity as defined in the form of Public Dividend Capital (PDC) IAS 27 Consolidated and separate financial and credit arrangements including loans. statements. Consequently the accounts The most significant credit arrangement is present financial information for the Trust as currently the liability in respect of the new a stand-alone entity, and where required ‘the Private Finance Initiative (PFI) hospital. The Group’ which includes financial information Trust also received net additional funding for the Charity. through PDC from the Department of Health It is important to emphasise that the (DH) of £27.5m during the year in support of consolidation of the Charity has no impact capital schemes. Temporary cash support of on the results of the Trust as a stand-alone £8.5m was received and repaid in the year entity. These results and the measurement of in order to alleviate its short term cash flow the Trust’s performance against its breakeven pressures. Details of credit arrangements are duty, external financing limit (EFL) and capital disclosed in note 26 to the accounts.

2010-11 2011-12 2012-13 2013-14 2014-15 £m £m £m £m £m Break-even in year position 7.9 9.0 7.0 5.6 (19.7) Break-even cumulative position (17.5) (8.5) (1.5) 4.1 (15.6) External financing limit Achieved Achieved Achieved Achieved Achieved Capital resource limit Achieved Achieved Achieved Achieved Achieved The break-even performance excludes impairments, accounting for donated assets and the effect of accounting for PFI. The following table reconciles the retained deficit in the accounts to the deficit recorded for break-even purposes reported above, and this shows that the Trust achieved the target agreed with the Trust Development Authority (TDA) of (£19.7m). 2014–15 2014–15 48 Annual Report & Summary Financial Statements Annual Report & Summary Financial Statements 49

Statement of comprehensive income Finance (continued) For year ended 31 March 2015

Trust Trust results £m 2014–15 2013–14 Retained deficit for the year (27.4) £’000s £’000s Add back: Gross employee benefits (346,110) (346,613) Impairments 17.3 Other operating costs (201,280) (350,776) Less: Revenue from patient care activities 457,645 459,322 Reversal of impairments (9.4) Other operating revenue 95,266 82,054 Donated assets (0.2) Operating surplus/(deficit) 5,521 (156,013) Surplus recorded for break-even purposes (19.7) Notes: Investment revenue 76 103 1. Impairments and reversals arose following a revaluation of the Trust’s land and buildings by the district valuer (see below); Finance costs (32,893) (2,091) 2. The adjustment in respect of donated assets removes the net impact of depreciation on assets previously donated to the Trust and income from donations received in the year. Deficit for the financial year (27,296) (158,001) Public dividend capital dividends payable (81) (1,386) Retained deficit for the year (27,377) (159,387) Notwithstanding the achievement of the Forward look to 2015/16 The Trust has developed and approved financial targets agreed with the TDA, a recovery plan aimed at delivering a The Trust’s financial forecast for 2015/16 the Trust’s financial position remained recurring breakeven position by the end shows a deficit (as measured for break-even Other comprehensive income challenging during the year. In order to of 2017/18. The Trust Board considers duty purposes) of £26.0m, with a further Net gain/(loss) on revaluation of property, plant & equipment 24,492 8,876 achieve the target agreed of £19.7m the Trust that whilst this represents a significant deficit of £13m forecast for 2016/17. These delivered the planned £27.6m efficiency challenge, it is reasonable to expect Total comprehensive income for the year (2,885) (150,511) deficits are after assuming delivery of savings savings. The Trust also needed temporary that the Trust has adequate resources to in 2015/16 of £41.2m and a further £34.3m in cash support of £8.5m during the year to continue in operational existence for the 2016/17. Financial performance for the year help with short term cash flow issues which foreseeable future. was repaid in March 2015. For 2015/16, the majority of the assumed Retained deficit for the year (27,377) (159,387) savings have been identified and plans Summary Capital expenditure for the year was £59.8m are in place to meet the full targeted level and £27.5m PDC was received as part of financial statements IFRIC adjustment (including IFRIC 12 impairments) (9,382) 143,343 of savings. agreed support to the capital programme. Reproduced below is an extract from Impairments (excluding IFRIC 12 impairments) 17,286 20,050 the financial statements, of the Trust as Major areas of capital expenditure in the The forecast deficits, combined with the Adjustments in respect of donated assets (267) 1,599 year included £14m on the new Pathology Trust’s capital expenditure plans and debt an individual entity from the full annual Adjusted retained surplus/(deficit) (19,740) 5,605 building, £8.7m on medical equipment and repayments mean that the Trust had a cash accounts. The Trust’s external auditors issued £9.2m on IT investment. shortfall from April 2015 for which financing an unqualified audit report on the Financial from the TDA has been received. The Trust Statements on 4 June 2015. has secured assurances from the TDA that it Full copies of the Annual Report and Financial will make sufficient cash financing available Statements can be obtained from The over the next 12 months to enable the Trust Director of Finance North Bristol NHS Trust, to meet its liabilities as they fall due. Southmead Hospital, Bristol, BS10 5NB. 2014–15 2014–15 50 Annual Report & Summary Financial Statements Annual Report & Summary Financial Statements 51

Statement of financial position Statement of changes in taxpayers’ equity As at 31 March 2015 For the year ended 31 March 2015

Trust Trust 2014–15 2013–14 Public Retained Revaluation Total £’000s £’000s Dividend earings reserve reserves Capital Non-current assets: £’000s £’000s £’000s £’000s Property, plant and equipment 508,331 480,399 Balance at 1 April 2014 213,810 (242,871) 55,687 26,626 Intangible assets 433 833 Changes in taxpayer’s equity for 2014-15 Total non-current assets 508,764 481,232 Retained surplus/(deficit) for the year (27,377) (27,377) Current assets: Net gain/(loss) on revalution of property, plant, equipment 24,492 24,492 Inventories 7,919 6,273 Transfers between reserves 0 686 (686) 0 Trade and other receivables 41,055 35,270 Reclassification adjustments Cash and cash equivalents 1,041 43,958 New temporary and permanent PDC received – cash 35,995 35,995 Sub-total current assets 50,015 85,501 New temporary and permanent PDC repaid in year (8,500) (8,500) Non-current assets held for sale 31,705 0 Net recognised revenue/(expense for the year 27,495 (26,691) 23,806 24,610 Total current assets 81,720 85,501 Balance at 31 March 2015 241,305 (269,562) 79,493 51,236 Total assets 580,484 566,733 Current liabilities Trade and other payables (78,820) (73,003) Other liabilities (77) (77) Provisions (5,459) (5,607) Borrowings (10,486) (6,970) DH revenue support loan (900) (900) DH capital loan (520) (520) Total current liabilities (96,262) (87,077) Net current assets/(liabilities) (14,542) (1,576) Total assets less current liabilities 494,222 479,656 Non-currentliabilities Trade and other payables (3,701) (4,055) Other liabilities (2,281) (2,358) Provisions (1,412) (1,683) Borrowings (416,082) (424,004) DH revenue support loan (9,890) (10,790) DH capital loan (9,620) (10,140) Total non-current liabilities (442,986) (453,030) Total assets employed: 51,236 26,626 Fiananced by: Public Dividend Capital 241,305 213,810 Retained earnings (269,562) (242,871) Revalution reserve 79,493 55,687 Total taxpayer’s equity: 51,236 26,626 2014–15 2014–15 52 Annual Report & Summary Financial Statements Annual Report & Summary Financial Statements 53

Statement of cash flows For the year ended 31 March 2015 Finance - Directors’ Report

Trust Directors 2014–15 2013–14 Non-Executives Executives £’000s £’000s Mr Peter Rilett, Chairman Ms Andrea Young, Chief Executive Cash flows from operating activities Prof Nishan Canagarajah Dr Chris Burton, Medical Director Operating surplus/(deficit) 5,521 (156,013) Mr Ken Guy Ms Kate Hannam, Director of Operations Depreciation and amortisation 17,341 21,076 Mr Mark Lawton Ms Sue Jones, Director of Nursing Impairments and reversals 7,486 163,393 Mr Robert Mould Ms Catherine Phillips, Director of Finance Donated assets received credited to revenue but non-cash 0 (178) Ms Liz Redfern Interest paid (29,851) (1,069) Mr Andrew Willis Dividend paid (303) (793) * The register of interests of these members can be found at: www.nbt.nhs.uk/sites/default/files/attachments/Trust%20Board%20Papers%20March%202015.pdf (Increase)/decrease in inventories (1,646) 1,875 Fraud Increase in trade and other receivables (5,628) (13,231) Public Sector Payment Policy – External auditors’ remuneration Better Payments Practice Code The Trust’s auditors are Grant Thornton. The Trust has a Counter Fraud policy Increase/(decrease) in trade and other payables (3,407) 15,906 In accordance with the Better Payments During the financial year they were paid approved by the Audit Committee in Increase/(decrease) in other current liabilities (77) 0 Practice Code and government accounting £108,000 for statutory audit services to the 2013 that sets out the arrangements for Provisions utilised (2,116) (1,554) rules, the Trust’s payment policy is to pay Group (£104,000 for the Trust). A further deterring, preventing, detecting and £10,000 of non-audit work has been investigating instances of fraud, corruption Increase in movement in non cash provisions 1,570 3,767 creditors within 30 days of the receipt of the goods or a valid invoice (whichever is the undertaken in 2014/15 in relation to the or bribery against the Trust or the wider NHS. Net cash inflow/(outflow) from operating activities (11,110) 33,179 later) unless other terms have been agreed. Trust’s quality accounts. In implementing this policy the Trust has contracted with Audit South West to provide The Trust paid 86% of non-NHS invoices Cost allocation and charges for counter fraud services. Cash flows from investing activities within 30 days compared with 92% in the information Interest received 76 103 previous year. Further details of compliance The Trust complies with HM Treasury’s Emergency Preparedness The Trust has in place plans that are fully Payments for property, plant and equipment (53,552) (29,440) with the Code are contained in note 10 to the guidance on setting charges for information Annual Accounts. The Trust is committed to where appropriate. compliant with the requirements of the Payments for intangible assets 0 (181) NHS Commissioning Board Emergency the Prompt Payment Code. Personal Data Proceeds of disposal of assets held for sale (PPE) 0 450 Preparedness Framework 2013. There have been no incidents regarding data Net Cash inflow/(ottflow) (53,476) (29,068) loss or confidentiality breaches in 2014/15. Off Payroll Arrangements As part of the ‘Review of Tax Arrangements of Net cash inflow/(outflow) before financing (64,586) 4,111 Public Sector Appointees’ the Trust is required to disclose the number of non-payroll arrangements which existed at 31 March Cash flows from financing activities 2015 and what action has been taken in Gross temporary and permanent PDC received 35,995 2,093 regard to their tax status since that date. Gross temporary and permanent PDC repaid (8,500) (27) At 31 March 2015 the Trust had 9 such Loans repaid to DH - capital investment loans repayment of principal (520) (520) arrangements which required disclosure. Of these 5 have ended since that date, and Loans repaid to DH - working capital loans/revenue support loans (900) (900) 4 have continued without any changes Capital elements of payment in respect of finance leases and on-SoFP PFI (4,406) 0 to their contractual clauses. None of the Capital grants and other capital receipts (excluding donated/government granted cash receipts) 0 0 arrangements have been re-negotiated Net cash inflow from financing activities 21,669 646 to include contractual clauses allowing the Trust to seek assurance from the individuals concerned as to payment of their Net increased/(decrease) in cash and cash equivalents (42,917) 4,757 tax obligations.

Cash and cash equivalents (and bank overdraft) at beginning of the period 43,958 39,201 Cash and cash equivalents (and bank overdraft) at year end 1,041 43,958 2014–15 2014–15 54 Annual Report & Summary Financial Statements Annual Report & Summary Financial Statements 55

Financial information for inclusion in the Remuneration Report Finance - Directors’ Report (continued) Salary and Pensions entitlements of senior managers 2014/15

Existing off-payroll arrangements as of 31 March 2015, for more than £220 per day and that last longer than Remuneration of senior managers (audited)

6 months 2014-15 2013-14 Number Expense All pension Expense All pension payments realted payments realted Number of existing engagements as of 31 March 2015 9 (taxable) benefits (taxable) benefits Of which the number that have existed for: Salary (taxable) Total Salary (taxable) Total (to the (to the Less than one year at the time of reporting 1 (Bands of nearest (Bands of (Bands of (Bands of nearest (Bands of (Bands of £5,000) £100) £2,500) £5,000) £5,000) £100) £2,500) £5,000) Between one and two years at the time of reporting 5 Name and title £’000 £’00 £’000 £’000 £’000 £’000 £’000 £’000 Between two and three years at the time of reporting 0 Non-Executive Directors Between three and four years at the time of reporting 1 Peter Rilett – Chairman 20-25 – – 20-25 20-25 – – 20-25 Four or more years at the time of reporting 2 Nick Patel – Non Exective Director Left 31/12/14 0-5 – – 0-5 5-10 – – 5-10 New off-payroll arrangements between 1 April 2014 and 31 March 2015, for more than £220 per day and that last Avril Waterman-Pearson – Non Exective Director longer than 6 months Left 31/12/14 0-5 – – 0-5 5-10 – – 5-10

Number Elizabeth Redfern – Non Exective Director Started 01/12/14 0-5 – – 0-5 – – – – Number of new engagements, or those that reached six months duration, between 1 April 2014 and 31 March 2015 5 Ken Guy – Non Exective Director 5-10 – – 0-5 5-10 – – 5-10 Number of new engagements which include contractual clauses giving North Bristol NHS Trust the right to request assurance in relation to income tax and National Insurance obligations 0 Robert Mould – Non Exective Director 5-10 – – 5-10 5-10 – – 5-10 Mark Lawton – Non Exective Director 5-10 – – 5-10 5-10 – – 5-10 Number for whom assurance has been requested 0 Sue Sundstorm – Non Exective Director Of which Started 25/11/13, Left 31/03/14 – – – – 0-5 – – 0-5 Assurance has been received 0 Nishan Canagarajah – Non Exective Director Assurance has not been received 0 Started 12/02/15 0-5 – – 0-5 – – – – Engagements terminated as a result of assurance not being received 0 Andrew Willis – Non Exective Director Number of off-payroll engagements of board members, and/or senior officers with significant financial responsibility, during the Started 01/12/14 0-5 – – 0-5 – – – – year 0 Executive Directors Number of individuals that have been deemed “board members and/or senior officers with significant financial Andrea Young – Chief Executive Started 02/09/13 185-190 – 15-17.5 205-210 110-125 – 10-12.5 120-125 responsibility during the financial year. This figure includes both off-payroll and on-payroll engagements. (See note below). 18 Sue Jones – Director of Nursing 110-115 – 22.5-25 135-140 125-130 – 42.5-45 165-170 The Trust has identified the need for changes to procedures for off-payroll engagements. This is currently being reviewed, with actions logged Chris Burton – Medical Director (see note) 130-135 – 15-17.5 140-150 130-135 – 40-42.5 170-175 as required to be led by the Associate Director Human Resources and Development and progress to be monitored by the Audit Committee. Catherine Phillips – Director of Finance Note: Started 03/06/13 140-145 – 12.5-15 150-155 115-120 – 102.5-105 215-220 The number of individuals that have been deemed “board members and/or senior officers with significant responsibility during the financial year, both on and off payroll, has been calculated as per the Kate Hannam – Director of Operations Started members listed on the Remuneration Report. 15/12/14 35-40 – 10-12.5 45-50 – – – – Sickness Absence Data and Pension Liabilities Marie-Noelle Orzel – Chief Executive , Left 09/10/13 – – – – 70-75 – 7.5-10 80-85 Bill Boa – Interim Director of Finance Sickness absence data and pension liabilities Within the Remuneration Report salary and • The officers have taken all the steps that Started 07/01/13, Left 02/06/13 – – – – 65-70 – – 65-70 are detailed within the accounts under Note pension entitlements of senior managers has they should have taken as directors in 9. The policy note for pensions is presented been provided. order to make him/herself aware of any Jeremy Tozer – Interim Director of Operations Start under note 9.6 detailing how pension relevant audit information and to establish 19/09/14, Left 28/12/14 140-145 – – 140-145 – – – – liabilities are treated in the accounts and how Directors Statement that the Trusts’ auditors is aware of Corporate Directors to obtain the NHS Pensions accounts. Further The Directors state that at the date that this that information; Harry Hayer – Director of HR 120-125 2 5-7.5 125-130 120-125 – 20-22.5 140-145 report is signed: policies notes are included under note 1.5 • “Relevant audit information” means Simon Wood – Director of Facilities 110-115 1 125-127.5 235-240 95-100 – 15-17.5 110-115 within the accounts relating to pensions and • So far as the directors are aware, there is information needed by the Trusts’ auditor Sasha Karakusevic – Chief Operating Officer until early retirements. no relevant audit information of which the in connection with preparing his report; the 15/12/14. New Title Director of Strategy and Trusts’ auditors is unaware; and Transformation from 16/12/14 125-130 – – 125-130 125-130 – 130-132.5 255-260 Michael Coupe – Director of Stratey and Planning 5-10 – – 5-10 105-110 – 130-132.5 235-240 2014–15 2014–15 56 Annual Report & Summary Financial Statements Annual Report & Summary Financial Statements 57

Financial information for inclusion in the Remuneration Report (continued) Salary and Pensions entitlements of senior managers 2014/15

The cost for the Director of Nursing in Pay Multiples The banded remuneration of the highest Cash Equivalent Transfer Values benefits that the individual has accrued as a Real Increase CETV 2013/14 includes recharges from Yeovil NHS paid director in the organisation in the consequence of their total membership of Reporting bodies are required to disclose A Cash Equivalent Transfer Value (CETV) This reflects the increase in CETV effectively Foundation Trust totalling £94,231. These financial year 2014-15 was £185-£190k the pension scheme, not just their service the relationship between the remuneration is the actuarially assessed capital value of funded by the employer. It takes account are for the provision of her services for the (2013-14: £190-£195k). This was 6.5 times in a senior capacity to which disclosure of the highest-paid Director in their the pension scheme benefits accrued by of the increase in accrued pension due first 9 months of the year when she was (2013-14 6.6 times) the median remuneration applies. The CETV figures and the other organisation and the median remuneration a member at a particular point in time. to inflation, contributions paid by the employed at that trust. of the workforce, which was £29,156 (2013- pension details include the value of any of the organisation’s workforce. The benefits valued are the member’s employee (including the value of any 14 £29,003). pension benefits in another scheme or The Medical Director was seconded to Dorset accrued benefits and any contingent benefits transferred from another scheme Total remuneration includes salary, arrangement which the individual has CCG from 1 April 2013 to 31 March 2015 for In 2014-15, 4 employees (2013-14 3 spouse’s pension payable from the scheme. or arrangement) and uses common market non-consolidated performance-related transferred to the NHS pension scheme. 2.5 days per month. His full salary in 2014/15 employees) received remuneration A CETV is a payment made by a pension valuation factors for the start and end of pay, benefits-in-kind, but not severance They also include any additional pension falls within the band £150-155k (2013/14 in excess of the highest-paid director. scheme or arrangement to secure pension the period. payments. It does not include employer benefit accrued to the member as a result of £150-155k). Remuneration ranged from £14,294 to benefits in another pension scheme or pension contributions and the cash their purchasing additional years of pension £212,545 (2013-14: £14,153 to £234,113). arrangement when the member leaves No directors are paid any bonuses, benefits in equivalent transfer value of pensions. service in the scheme at their own cost. a scheme and chooses to transfer the kind or other remuneration. CETVs are calculated within the guidelines benefits accrued in their former scheme. and framework prescribed by the Institute The pension figures shown relate to the Pension entitlements of senior managers (audited) and Faculty of Actuaries.

Lump sum Total at age 60 Real accrued related to Real increase in pension at accrued increase in pension age 60 at pension at Cash Cash Real pension at lump sum 31 March 31 March Equivalent Equivalent Increase in Employers age 60 at aged 60 2015 2015 Transfer Transfer Cash Contribution to Value at Value at Equivalent Stakeholder (Bands of (Bands of (Bands of (Bands of 31 March 31 March Transfer Pension £2,500) £2,500) £5,000) £5,000) 2015 2014 Value To nearest Name and title £’000 £’000 £’000 £’000 £’000 £’000 £’000 £100 Executive Directors Andera Young – Chief Executive 0-2.5 5-7.5 55-60 170-175 1,225 1,122 72 N/A Sue Jones – Director of Nursing 0-2.5 5-7.5 45-50 140-145 883 806 56 N/A Chris Burton – Medical Director 0-2.5 2-5.5 45-50 145-150 924 846 55 N/A Catherine Phillips – Director of Finance 0-2.5 2-5.5 40-45 125-130 664 606 41 N/A Kate Hannam – Director of Operations 0-2.5 2-5.5 25-30 80-85 400 343 14

Corporate Directors Harry Hayer – Director of HR 0-2.5 0-2.5 10-15 30-35 184 161 19 N/A Simon Wood – Director of Facilities 5-7.5 17.5-20 45-50 140-145 970 802 146 N/A Sasha Karakusevic – Chief Operating Officer 0-2.5 0-2.5 40-45 120-125 725 681 26 N/A Past and present employees of the Trust are covered by the NHS Pension Scheme, details of this scheme are provided at note 9 within the full accounts. The tables of salary and pension entitlements of senior managers, including supporting notes, and the narrative notes relating to pay multiples have been audited. As non-executive members do not receive pensionable remuneration, there will be no entries in respect of pensions for non- executive members. 2014–15 2014–15 58 Annual Report & Summary Financial Statements Annual Report & Summary Financial Statements 59

2014/15 Annual Accounts of North Bristol NHS Trust Statement of the Chief Executive’s 2014/15 Annual Accounts of North Bristol NHS Trust responsibilities as the Accountable Officer Statement of Directors’ responsibilities in of the Trust respect of the accounts

The Chief Executive of the NHS Trust Development Authority has designated that the Chief Executive should be the Accountable Officer to the The directors are required under the National Health Service Act 2006 to prepare accounts for each financial year. The Secretary of State, with trust. The relevant responsibilities of Accountable Officers are set out in the Accountable Officers Memorandum issued by the Chief Executive the approval of the Treasury, directs that these accounts give a true and fair view of the state of affairs of the trust and of the income and of the NHS Trust Development Authority. These include ensuring that: expenditure, recognised gains and losses and cash flows for the year. In preparing those accounts, directors are required to: • there are effective management systems in place to safeguard public funds and assets and assist in the implementation of • apply on a consistent basis accounting policies laid down by the Secretary of State with the approval of the Treasury; corporate governance; • make judgements and estimates which are reasonable and prudent; • value for money is achieved from the resources available to the trust; • state whether applicable accounting standards have been followed, subject to any material departures disclosed and explained in • the expenditure and income of the trust has been applied to the purposes intended by Parliament and conform to the authorities which the accounts. govern them; The directors are responsible for keeping proper accounting records which disclose with reasonable accuracy at any time the financial position • effective and sound financial management systems are in place; and of the trust and to enable them to ensure that the accounts comply with requirements outlined in the above mentioned direction of the • annual statutory accounts are prepared in a format directed by the Secretary of State with the approval of the Treasury to give a true and fair Secretary of State. They are also responsible for safeguarding the assets of the trust and hence for taking reasonable steps for the prevention view of the state of affairs as at the end of the financial year and the income and expenditure, recognised gains and losses and cash flows for and detection of fraud and other irregularities. the year The directors confirm to the best of their knowledge and belief they have complied with the above requirements in preparing the accounts. To the best of my knowledge and belief, I have properly discharged the responsibilities set out in my letter of appointment as an Accountable Officer. By order of the Board

Signed

Andrea Young 4th June 2015 Chief Executive ...... Date ...... Andrea Young 4th June 2015 Chief Executive ...... Date ......

Catherine Phillips 4th June 2015 Finance Director ...... Date ...... 2014–15 2014–15 60 Annual Report & Summary Financial Statements Annual Report & Summary Financial Statements 61

2014/15 Annual Accounts of North Bristol NHS Trust Year ended 31 March 2015 Summarisation Schedules (TRUs) for North Bristol NHS Trust Annual Governance Statement

Summarisation schedules numbered TRU01 to TRU98H plus Freetext are attached. Director of Finance Certificate I certify that the attach summarisation schedules have been compiled from and are in accordance with the financial records maintained by the trust with the accounting standards and policies for the NHS approved by the Secretary of State.

Catherine Phillips 4th June 2015 Finance Director ...... Date ...... Chief Executive Certificate I acknowledge the attached summarisation schedules, which have been prepared and certified by the Director of Finance, as the summarisation schedules which the trust is required to submit to the Secretary of State.

Andrea Young 4th June 2015 Chief Executive ...... Date ...... 2014–15 2014–15 62 Annual Report & Summary Financial Statements Annual Report & Summary Financial Statements 63

Annual governance statement (continued) Annual governance statement 2014/15

1. Introduction • Value for money is achieved from the commissioners (NHS England, South 3. Governance Framework for all aspects of delivery. Other areas of risk it resources available to the Trust. Gloucestershire, Bristol and North Somerset addressed were:- The NHS Trust Development Authority Chief of the Organisation Clinical Commissioning Groups) to Executive, in his capacity as an Accounting • The expenditure and income of the • The Accountable Officer being exposed review quality, financial and operational Corporate Governance Officer for NHS Trusts in the Department Trust has been applied to the purposes to a risk that the key risks and control performance. The trust has also contributed The Trust Board maintains overall of Health, requires the Accountable Officer intended by Parliament and conform to systems within the Trust are not being to overview and scrutiny processes in South accountability for the effectiveness of (AO) for the North Bristol NHS Trust to give the authorities which govern them. managed effectively; Gloucestershire, Bristol and North Somerset, the system of internal control. As a large him assurance about the stewardship of • Effective and sound financial management in particular for transfers relating to Cellular and complex organisation a supporting • A lack of awareness of some quality and his organisation. systems are in place. Pathology, Urology, Breast Care and Vascular infrastructure is required to fulfil these other issues by the TMT; For the North Bristol NHS Trust the • Annual statutory accounts are prepared in Services and the disposal of the former responsibilities effectively. Authority is • A lack of clarity on how information flows Accountable Officer is Ms Andrea Young, a format directed by the Secretary of State Frenchay Hospital site. delegated by the Board to various board from Ward to Board and vice versa across Chief Executive. with the approval of the Treasury to give committees and the role and terms of the whole spectrum of information a true and fair view of the state of affairs reference of these were reviewed in 2014/15 • Insufficient focus on business planning 2. Scope of Responsibility as at the end of the financial year and the with the aim of clarifying how all aspects The Board approved terms of reference The Board of Directors is accountable for income and expenditure, recognised gains of the Trust’s business were delivered. for each of the committees in the revised internal control and as Chief Executive and losses and cash flows for the year. The revised approach separated the Trust’s structure. A review of the Trust’s Standing and Accountable Officer of the Trust In addition I have responsibility for; delivery and assurance functions and Orders also took place which incorporated my responsibilities are set out in the ensured the entirety of the Trust’s business • Maintaining a sound system of internal most of the current arrangements but Accountable Officers’ Memorandum issued was transacted in a clear and open structure. control that supports the achievement of needed minor amendments to take account by the Department of Health. These include The rationale for the change was the the Trust’s policies, aims and objectives. of the Board’s final changes to its committee ensuring that; mitigation of a number of risks including structure. These changes were approved • Ensuring the services provided by the Trust a lack of comprehensive oversight of the • There are effective management systems by the Board in April 2015. The Committee are of exemplary quality and safety, giving organisation by the Trust Management Team in place to safeguard public funds and structure of the Trust is shown below: patients the best possible experience. (TMT) now charged as the leadership group assets and assist in the implementation of The Trust meets regularly with the Trust corporate governance. Development Authority (TDA) and

Trust Board

Charitable Funds Remuneration Trust Finance & Quality and Risk Audit Committee Committee & Nominations Management Performance Management Committee Committee Committee Committee

TMT sub‑structure 2014–15 2014–15 64 Annual Report & Summary Financial Statements Annual Report & Summary Financial Statements 65

Annual governance statement (continued) Annual governance statement 2014/15

The key committees in terms of supporting the system of internal control are; Committee Member Attendance Records

Committee Functions Member Trust Board Audit Committee Quality & Risk Finance & Performance Management Committee Trust Board • The Trust Board maintains overall accountability for the effectiveness of internal control. It primarily discharges this responsibility through the receipt and review of; 2013/4 2014/5 2013/4 2014/5 2013/4 2014/5 2013/4 2014/5 • Quarterly reports on the Assurance Framework to ensure key risks are identified and controls or assurance gaps are being addressed with more detailed reporting to each meeting of the Quality and Risk Management Committee B Boa • An Integrated Performance Report providing internal assurances at monthly intervals on quality, finance, activity and workforce measures and (interim Dir. of Fin. – left Jun. 2013) 3/3 – 2/2 – 1/1 – 1/1 – other quarterly and six monthly measures on quality and safety and commissioning and clinical governance. • External assurance sources, including the External Auditors review of the Trust’s Quality Account and financial year end accounts and VFM C Burton 11/13 11/11 – – 6/6 6/6 – – opinion and reports from the Care Quality Commission and other external regulators as appropriate according to their risk impact and actions required. N Canagarajah (NED joined Feb. 2015) – 1/2 – – – – – – Audit Committee • The Audit Committee provides independent and objective scrutiny of Trust activities through its membership, which consists of three Non- M Coupe (Dir. of Strategy – left Jan. 2014) 8/10 – – – 3/4 – – – Executive directors. Executive Directors, senior managers, Internal and External auditors attend and provide input. • It is responsible for ensuring there are arrangements for the establishment and maintenance of an effective system of integrated governance, K Guy 13/13 10/11 4/4 5/5 1 – – 5 risk management and internal control, across the whole of the organisation’s activities (both clinical and non-clinical). • This supports the achievement of the organisation’s objectives and ensures compliance with regulatory, legal and code of K Hannam (Dir. of Ops. – joined Dec. 2014) – 3/3 – – – – – 3/3 conduct requirements. • In carrying out this work the Committee primarily utilises the work of Internal Audit, External Audit and other assurance functions, as well as H Hayer 12/13 10/11 – – 3/4 2/3 – - seeking reports and assurances from directors and managers as appropriate. Quality and Risk Management • The Quality and Risk Management Committee (Q&RMC) is the assurance committee responsible for overseeing the management of S Hughes 2/2 – – – – – – – Committee (Q&RMC) Risk, Governance and Assurance for the Trust on quality issues and the development of the Trust’s Risk and Assurance Register prior to Board approval. S Jones 11/13 10/11 – – 5/6 6/6 – – • It comprises two non-executives (one of them as chair) and five of the executives and is responsible for ensuring that effective quality governance, risk management and regulatory compliance systems are in place and that effective actions are taken to identify and address S Karakusevic 9/13 10/11 – – 5/6 5/6 6/8 3/5 deficiencies should they arise. • This also includes overseeing the system of control around directorates’ clinical and non-clinical risk registers including escalation to the Trust M Lawton 11/13 8/11 3/4 4/5 – – 8/8 10/10 risk register as informed by the Risk and Compliance Committee. • Furthermore, it is responsible for identifying all the cross cutting themes arising from executive and non-executive walk arounds (the latter R Mould 11/13 11/11 – – 6/6 6/6 – – having been instigated in year). • Other sources of assurance are reports and presentations from specialist staff as requested by the Committee in ‘deep dives’, approval of policies M-N Orzel 5/5 – 1 – 3/3 – 0/2 – and procedures, performance of systems against key performance indicators, progress against action plans to address identified gaps and internal or external audit reports. N Patel (NED – left Dec. 2014) 13/13 8/8 4/4 4/4 – – – – Finance & Performance Committee • The Finance and Performance Committee (F&PC) is the assurance committee responsible for overseeing the management of the Trust’s finance C Phillips 9/10 10/11 2/2 5/5 1/3 – 7/7 9/10 (F&PC) and performance in the context of the Trust’s strategy. • It comprises the chairman of the Trust, two non-executives and three of the executives and is responsible for ensuring the Trust’s mechanisms E Redfern (NED – joined Jan. 2015) – 2/3 – – – 1/2 – – for monitoring its finance and performance are robust and integrated. • Responsibilities include the review of the long term financial plan to seek assurance that the annual budgets are aligned with it and that it P Rilett 12/13 11/11 – – – 1 7/8 8/10 informs the annual business planning cycle • It also considers the risks to achieving forecast positions, maintains an overview of the activity and workforce models and that the measures S Sundstrom 4/4 – – – – 1/1 – – within the Integrated Performance Report meet the requirements of external stakeholders Trust Management • All delivery groups report through the TMT to the Trust Board. It focusses on: J Tozer (interim Dir. of Ops – left Dec. 2014) – 3/3 – – – 1/1 – 3/3 Committee (TMT) A Waterman-Pearson Business Planning; Quality; Performance Management; Health & Safety; (NED – left Dec. 2014) 11/13 7/8 – – – 2/2 – – Recovery & CRES Delivery, IM&T; (finance); Programme Management; A Willis (NED – joined Jan. 2015) – 3/3 – – – – – 3/3 Capital; Workforce; It comprises all the executive directors and all the clinical directors of the Trust S Wood 11/13 10/11 – – 5/6 3/5 – 1 A Programme Management Office (PMO) was established early in 2013 to ensure there was appropriate overview and scrutiny of clinical and A Young 7/7 9/11 – – 3/3 – 6/6 10/10 corporate key deliverables and oversight of projects relating to the hospital move. In 2014, a Move & Transformation Board was established to provide a simple overview of all related projects, a single critical path, a single Go/No Go list, overseen by a single Senior Responsible Officer (SRO). This responded in full to Office of Government Commerce recommendations. The Move Board was disbanded in 2014 following the successful transition of services into the Brunel Building but the PMO has maintained overview of reports from workstreams aiming to achieve the transformation of services that will provide the means for financial recovery and sustainability over the next three years. The PMO now reports through the Finance and Performance Committee and oversees the production of the Trust Board’s integrated performance report. 2014–15 2014–15 66 Annual Report & Summary Financial Statements Annual Report & Summary Financial Statements 67

Annual governance statement (continued) Annual governance statement 2014/15

Board and Principal Committee Reports Board and Principal Committee Reports continued The Audit Committee and Quality and Risk Management Committee are the key independent risk management and assurance committees underpinning the Trust Board’s overall responsibility for internal control in 2014/15. The Finance and Performance Committee deals with risks Committee Functions within its own remit. The Board and committees have received reports on: Quality and Risk Management • Policy on management of external reviews • Deep dives of specific services Committee (Q&RMC) • CQC inspection reports • Serious incident and complaint themes • Annual report • Quality strategy development and safety improvement plan Committee Functions • Terms of reference • Work plan Board • Integrated Performance Report (IPR) • Inpatient survey results • Patient confidentiality breach response • Various service annual reports • Committee and Service Annual Reports and meeting reports • Financial Sustainability updates • Risk management process assurance • Elimination of 52 week waiters plan • Southmead Redevelopment • Business plan • Moderation of high score risks • Cancer experience survey and peer review update • Frenchay Disposal Strategy • Staff Friends and Family Test results • Specific service risks and action plans • Guidance on FFT • Revised Standing Orders and Standing Financial Instructions • Safe staffing • CQC registration changes • Clinical audit update • Research and Innovation strategies • Whistleblowing Incident • CQC assurance development plan • Serious complaint investigation, governance implications and • Quality Account • Capital programme • Inpatient survey results and action plan action plan • Accountability Framework and TDA statements (within IPR) • Long Term Financial Model • Sub committee governance arrangements and reports • Legal claims policy and assurance • Trust Objectives • Project updates • Organ donation committee annual report • A&E survey • Annual Governance Statement • Contract approvals • Leadership walkaround themes • Complaints improvement plan • Medical Revalidation and Appraisal annual report • PFI variations • Patient Confidentiality – ICO report and action plan • External review update • Year-end Financial Accounts • CQC Reports and action plans • Deep dive approach • Committee effectiveness • Corporate governance arrangements • Business cases • Specific service reports • Clinical Excellence Awards Board Development existing Integrated Business Plan and Long experiences felt by patients and their families • Patient Administration System procurement • Board Risk and Assurance Register There were five changes to the personnel Term Financial Model could be achieved sometimes in their own words, which • Budget • Staff Attitude Survey results of the Board in 2014/15. Three non- with the available resource and capacity. has helped to maintain a focus of Board • Safeguarding serious case reviews • Strategy and Vision development executives, including the University of Bristol Work has been ongoing to develop a robust discussions and deliberations on achieving Audit Committee • Clinical audit assurance • Reference cost assurance strategic plan with fully reviewed business the best possible outcomes for patients. (Independent assurance) representative, came to the end of their • Safeguarding Policy and Governance • PBR data assurance framework and financial plans throughout the rest of the • Financial resilience review • Procurement strategy and business plan terms of office and have been replaced by The Board has also continued to refine an year. The Board met in specific workshops to • the counter fraud work plan • Audit fee letter 2014/15 two members with strong experience of Integrated Performance Report capturing discuss strategy twice by itself and once with • Standing orders/Standing financial instructions • Patient Administration System governance the NHS and one of the current Pro Vice- all the key factors of quality, operational, /Detailed scheme of delegation • Clinical audit annual report senior managers. Consultation was held with Chancellors from the University of Bristol. financial, human resource and regulatory • The strategic and operational internal audit plans • Internal audit and counter fraud annual reports staff and patients over the Summer and the There were changes to the portfolios of the issues. This gives it an informed view across • The 2013/14 Financial Accounts • Charitable funds accounts 2013/14 Board met with the South Gloucestershire • Trust Annual Report executives to align them better with the its whole range of services rather than • Information governance CCG Board to discuss the development • Annual Governance Statement • Quality Account audit 2013/14 Trust objectives. The most significant of these concentrating on a particular issue and of their respective strategies. As part of a • Gifts and hospitality register • Annual Audit letter was the creation of the role of a Director of allows easier access to themes that may be financial and operational recovery plan Finance and Performance • Integrated performance report • Financial sustainability workstream reviews Strategy and Transformation. The incumbent affecting more than one area. Committee (F&PC) • RTT recovery plans and progress updates • Long term financial model Chief Operations Officer took on this role submission to the TDA the Integrated • Valuation update • ITFF application and was replaced temporarily by an interim Business Plan was updated in September. The Board recognised during the year • Year end outturn • Tender approvals post holder and then by a permanent The original timetable for publication of the need to engage an independent • Commercial disputes • Committee governance and cycle of business appointment as Director of Operations and a the strategic plan was agreed to be delayed development partner to help its • Outline and full business cases • PFI contract issues until the Summer of 2015. A number of progression over the next year. The Trust • Financial sustainability plan updates • Financial review process of building contractors voting member of the Board. The NHS Trust other board development sessions were ran a competitive tendering process • Intensive Support Team report and action plan • Draft 2015/16 budget and cash flow forecast Development Authority supported the Board • Reference costs plan and update • CCG contract performance report with all Board level appointments during undertaken during 2014, focusing on and appointed Co Company as its Board • Service Line Reporting implementation and update • Deep dive process the year. Appropriate due diligence was areas such as financial recovery, quality Development partner for 2015/16. The first • Cancer services recovery plan and progress report • Business case approvals process undertaken on all appointments including governance and board governance. part of the plan is to run a diagnostic phase • ED four hour action plan • Bank and agency staffing improvement plans to build an understanding of the Trust with consideration of the Fit and Proper Persons The Board continued its strengthening of its • Review of CIP process • Capacity and demand planning a view to being presented to the Board • Spinal services plan • Draft 2015/16 business plan Test requirements which came into force connection with the quality of patient care early in 2015/16. This will be followed by the • Five year capital plan • Contract management governance during 2014. with direct examples of introduced patient development of a plan for the remainder • Cellular pathology service transfer • Committee effectiveness stories at the beginning of each Board In accordance with the TDA accountability of 2015/16 which will be informed by the meeting in public. Since January 2013 the framework the Board submitted a two year outcomes from the diagnostic. operational plan in April 2014 and a five Director of Nursing has, with the agreement year strategic plan in June 2015. Given the of a patient and his or her family, read out the Compliance with the Corporate focus required to move services from two experience of being treated and cared for Governance Code hospitals, Frenchay and Southmead, into one by NBT staff. The Board has been exposed, The Trust does not comply with the UK it was clear that only a refreshment of the therefore, to both positive and negative Corporate Governance Code. It has, however, 2014–15 2014–15 68 Annual Report & Summary Financial Statements Annual Report & Summary Financial Statements 69

Annual governance statement (continued) Annual governance statement 2014/15

reported on its Corporate Governance required, are escalated to the Quality and Risk 5. Risk Assessment All clinical and corporate directorates have Risk register entries are collected, reviewed Reports of these RCA’s and action plans arrangements by drawing upon best practice Management Committee for review. Q&RMC a risk lead responsible for ensuring risks and updated electronically. This facilitates are considered at the Clinical Risk and The Board Risk and Assurance Register available, including those aspects of the UK has oversight of the entire escalation process are recorded onto the RiskWeb system and risk moderation and escalation more Trust Health and Safety Committees. (BR&AR) defines and assesses the principle Corporate Governance Code considered to for all risks originally scored as extreme. the clinical directorates and the majority efficiently and is driving greater transparency The Q&RMC receives an incident report and strategic and operational risks to the Trust’s be relevant to the Trust. The Finance and Performance Committee of corporate directorates have a forum and appreciation of risks at all levels of the dashboard on a quarterly basis. The Trust objectives and sets out the controls and oversee risks to performance. Risks regarding where risk is discussed. This is either a organisation. This system has matured Board receives a monthly report in public assurances in place to mitigate these. Statutory Functions the move of services from two hospitals specific risk group or it is part of another during 2014/15. During the year the Q&RMC session to report transparently of new The Register was developed in 2012/13 from The Quality and Risk Management continued to be brought together at Trust group as a standing agenda item e.g. has reviewed the highest risks and tracked serious incidents and progress of actions the former board assurance framework and Committee (renamed from Governance Board in monthly highlight reports and at Clinical Governance or Health and Safety progress on them at each meeting and, of previous serious incidents through its operational and project risks are fed into a and Risk in 2013) oversees all statutory the Move and Transformation Board until Group. At these groups the directorate where necessary, has reviewed with clinical Integrated Performance Report. All patient software system by a network of risk leads in compliance functions. This is facilitated the successful completion in the Summer identifies risks and reviews incidents, taking directors and general managers the reasons safety incidents are reported electronically each directorate. through its Risk and Compliance sub- of 2014. action to minimise risk and learn lessons for scoring of specific risks. to the NHS Commissioning Board via the committee and monitoring of external Strategic Risks from incidents. Risk assessments are used at National Reporting & Learning Scheme agency reviews. Leadership given to the risk Incident reporting The BR&AR provides the mechanism for all levels of the Trust, from service planning (NRLS). Serious incidents are also reported to management process The Trust has a comprehensive single identifying potential risks against the Trust’s to assessing day-to-day risks. The Risk the Trust Development Authority and Clinical 4. Risk and incident reporting system which is well The overall responsibility for managing strategic priorities. For 2014/15 they were Management Strategy/Policy gives guidance Commissioning Groups. The Local Area Team established in the organisation. Reports from Control Framework risk rests with the Chief Executive and set against the ‘Big 5’ Trust objectives, as on scoring risks. and the CCGs have agreed on a standard incidents are provided to the directorates The system of internal control is designed assurance to the Board is provided through approved by the Board and identified within understanding of which incidents need Risk assessments can be clinical and and specific Trust committees as an aid to manage risk to a reasonable level rather the Quality and Risk Management (Q&RMC) the Integrated Business Plan. The Register reporting at national level. Incidents meeting non-clinical. Risks that cannot be to planning future improvements and than to eliminate all risk of failure to achieve and Finance and Performance Committees considers the key strategic risks against the criteria of the Reporting of Injuries, controlled adequately at local level are thus preventing similar incidents from policies, aims and objectives; it can therefore chaired by non-executives. Reports from each of the objectives and considers Diseases and Dangerous Occurrence escalated to directorate level and used re-occurring. Incidents are reviewed and only provide reasonable and not absolute these Committees, which include six of the the current controls and assurances in Regulations 1995 (RIDDOR) are reported to to populate their directorate risk register. investigated accordingly and for those that assurance of effectiveness. The system of Executive Directors and four of the Non- place to mitigate the risks occurring. the Incident Contact Centre. Directorate risk registers are reviewed at are graded serious, a Root Cause Analysis internal control is based on an ongoing Executive Directors of the Trust, are made Further controls and assurances are then Directorate governance meetings and are (RCA) is undertaken. Organisational Risk Profile process designed to: to the Board at its next available meeting. identified which are translated into actions. also used to inform/prioritise the budget During the 2014/15 financial year the Risk management receives significant The BR&AR is reviewed by the board in • Identify and prioritise the risks to the setting process. following high strategic risks have been attention at Board level and this is cascaded an ongoing quarterly cycle with key risk achievement of the organisation’s policies, identified for Board or Committee review throughout the organisation. changes highlighted. aims and objectives through the Board Risk and Assurance The Board maintains oversight of the risk • Evaluate the likelihood of those risks being Project and Directorate Risks Register and managed as outlined below; management system and reviews risk reports realised and the impact should they be on a quarterly basis. Q&RMC, in particular, Programmes and projects are expected realised and to manage them efficiently, reviews the top scoring risks at each of its to manage risks within the context effectively and economically. meetings and the Trust Management Team of their objectives and deliverables. Risk management is embedded throughout now monitors the work of its supporting Overall risks to the organisation arising from the Trust through a risk management committees on a quarterly basis with reports key programmes and projects are considered framework that is made up of committee for inclusion within the Trust’s Risk register, High Potential Risks Key Actions to Reduce Risk Risk Mitigated at Year End? including an assessment of the risks within (pre-mitigation actions) structures, risk staff leads familiar with their remit. RiskWeb. patient safety and risk management and The risk that the Trust’s 1) Recovery Plan agreed with NTDA for A&E 4 hour performance. Weekly Operational Group • Risk mitigation plans in place and performance could degrade, established, chaired by Medical Director with clinical, managerial and executive leaders to oversee updated throughout year including risk management tools e.g. the risk register and fail to meet its national action delivery. Revised improvement trajectory to hit target after new hospital has opened. 2) further support from outside Risk Web system. The Trust’s risk strategy access and outcome targets System wide patient flow review work with partners across Bristol to direct Winter pressures monies agencies and regular monitoring to priority areas and co-ordinate transfers of care more efficiently. 3) Specific operational focus by TDA. Performance remained and objectives are to ensure a pro-active on managing Urology service performance which is impacting across a number of performance below national standards but approach to risk management by engaging targets. Progress tracked through Directorate Executive Review Meetings (ERMs). 4) Action plan to became close to national average staff at all levels, in efforts to resolve risk drive Referral to Treatment (RTT) improvements (Urology & Orthopaedics) in place covering both by year end. operational and IMT factors. NHS Intensive Support Team engaged to review systems and suggest locally wherever possible. Formal escalation areas of improvement. 5) Addressing long waits for Spinal patients - focusing on releasing additional and moderation systems at a more senior internal capacity. 6) Links between Patient Advisory Group and ERMs standardised. level of management are in place where Continued failure addressed by 1) Direct operational controls for ED flow & Patient Discharge: necessary. All extreme risks, identified at 2) Continued implementation of ED recovery plan, with revised trajectory in light of post Move experience. 3) Routine tracking using ‘Leaving Hospital Database’ system. 4) Strengthened focus on directorate level, are primarily escalated to effective Board Rounds, definition and use of Estimated Discharge Dates (EDD). 5) Establishment one of three Trust-wide risk committees; of Operations Centre and review of Exec lead responsibilities. 6) Performance trajectories for all Clinical Risk, Health and Safety and Risk underperforming targets. 7) System urgent care action plan. 8) Spinal >52 week wait action plan. 9) Revised performance management framework in place 10) Weekly PTL meetings established to and Compliance committees and, where monitor 18 week performance 2014–15 2014–15 70 Annual Report & Summary Financial Statements Annual Report & Summary Financial Statements 71

Annual governance statement (continued) Annual governance statement 2014/15

Organisational Risk Profile (continued) 6. Review of Effectiveness consistently. However, some weakness in • Each month the Board reviews the Monitor the design and/or inconsistent application Provider Licence Compliance Statements High Potential Risks Key Actions to Reduce Risk Risk Mitigated at Year End? of risk management and (pre-mitigation actions) of controls put the achievement of and Board Compliance Statements internal control Inability to accommodate Active planning with services to speed up programme across all schemes to free up as much old site • Risk mitigation plans in place and first particular objectives at risk.” This is a sound that are submitted to the TDA. It has all services at Southmead as feasible. Also working with contractors (e.g. pathology and Breast Centre) to look at all facets of year target achieved As Accountable Officer, I have reviewed assurance opinion, at the same level consistently agreed positive responses to enable timely Phase programme - construction, decommissioning and commissioning of new building to reduce time in the effectiveness of the system of internal achieved for the past eight years. to all statements with the exception of 2 site handover to each phase. Carillion. This would incur control. Firstly, I can confirm that the system • The BR&AR itself provides me with its ability to be satisfied that its plans Work with Carillion to speed up decommissioning and thus mitigate the possible cascade risk. financial penalties. of internal control has been in place in North evidence that the effectiveness of controls are sufficiently robust enough to ensure Work with Vinci to address emerging potential delays to Pathology Phase 2 Bristol NHS Trust for the full year ended that manage the risks to the organisation ongoing compliance with existing targets. Efficiency target for the Trust 1) Directorate workforce plans to be further refined to detailed level and ensure alignment with staff • Risk mitigation plans in place and 31 March 2015 and up to the date of approval achieving its principal objectives have The Board has responded negatively to is 19%, or £92m, over the costing outputs reflected in budget. Changes reflected within revised submissions to NTDA in line with handover achieved on time to end of the Annual Report and Accounts. this for eight months and awaits evidence next three years; non delivery prescribed timescales. 2) Finalisation of documented Cost Improvement Plans, including Quality Impact of year been reviewed. that the implementation of its plans are would put Trust viability Assessments concluded with all directorates, with Trust Management Team engagement by end of The detail of my review is informed in a • The Trust’s Quality Account is subject at risk. May 2014. on trajectory. number of ways, as follows; to review by a formal External Auditor’s Board to Board with the TDA to test focus on understanding of sustainability plans and documentation opinion; the outcome of which is reported of project plans in place for all schemes • Executive directors and managers within to the Audit Committee. The external audit Trust is reducing its workforce Directorate workforce plans to be refined to detailed level and ensure alignment with staff costing • Risk mitigation plans in place the organisation who have responsibility is also reported to the Quality Committee. & intends to change to outputs reflected in budget. Changes reflected within revised submissions to NTDA in line with for the development and maintenance of more flexible working prescribed timescales. Ongoing assurance on performance and the system of internal control provide me arrangements. There is a risk data quality against the Trust’s aims for that the Trust will not be Directorate workforce plans to be further refined and aligned with two year business plan submitted with assurance. able to affordably implement to TDA Quality Improvement is obtained through these plans • The Head of Internal Audit provides me their inclusion in the monthly Integrated Failure to address the A recovery plan was agreed with the NTDA early in the year for improving ED waiting times with actions • Risk ongoing and remains very with an opinion (the ‘HoIAO’) on the overall Performance Report. This information difficulties in improving the as noted above. Hospital ‘re-boots’ were planned and implemented (a week of intensive challenge closely monitored and acted upon arrangements for gaining assurance is also reviewed at the Trust’s Quality flow of patients through the of reasons for patients occupying beds past their expected discharge date). Bed availability and hospital’s services. Pressure management revised. Referrals to the Trust from GPs being actively managed prior to the patient being through the Board Risk and Assurance Committee with Clinical Directors and on beds is not helped by sent to attend the hospital. Register and on the controls reviewed as forms part of directorate performance inconsistent delivery of part of the internal audit plan. The draft effective discharge process, Continued failure addressed by further Trustwide action plan with Board level of approval/monitoring reviews with the executive team in the and rising numbers of and policies on Escalation, Full Capacity and Bed and Patient Flow. Daily breach review and weekly in HoIAO states that “Significant assurance monthly Executive Review meetings. attendees in the Emergency depth breach review to establish pressures and resolve. BNSSG wide Policy for escalation produced. can be given that there is a generally Root Cause Analysis undertaken after each time Black escalation declared and wide range of actions Department needing to be sound system of internal control, designed admitted. These pressures developed internally, externally and strategically, to ensure patients leave hospital when clinically ready have knock on effects to do so. to meet the organisation’s objectives, and on delivery of referral to that controls are generally being applied treatment (RTT) targets. Scale, pace and complexity of 1) Workforce & OD Strategy to be developed. 2) Hotspots within Staff Survey result tackled by • Mitigating actions in place. change and/or staff turnover directorate, area or issue driven through Health & Wellbeing Group. 3) NBT Values Strategy linked to Type Assurance Source at the Trust causes uncertainty iCARE rollout plan. 4) Senior Leaders engagement events. 5) Recruitment of additional clinical staff to fill External Assurancess • External Audit reports on the Trusts annual financial accounts, which were unqualified for 2013/14. and/or excessive work vacancies in identified ‘hotspot’ areas. 6) Workforce dashboard developed and considered at Workforce pressure with consequent Committee. 7) Workforce Committee established. 8) Hot spot identification and action planning. 9) • SAS 70 report on the operations run by Shared Business Services Ltd impact on staff morale, stress Comprehensive workforce plan to TMT and Board in April. • SAS 70 report on the Electronic Staff Records system (ESR) levels and performance • Annual patients’ survey and delivery of action plan • Annual staff survey improved results and delivery of action plan Information Governance • Care Quality Commission – planned review programme reports received for all in and outpatient facilities. A warning notice was placed on the • As Accountable Officer I receive comprehensive and reliable assurance from a range of sources including managers, internal audit and Emergency Department but no other enforcement actions requested periodic external audits that information governance risks are being managed effectively. • Peer review visits • Local Authorities – Health Overview and Scrutiny Committees • There has been no reported lapse of data security in 2014/15 • National Clinical Audit reports • In all other aspects I can confirm that the Trust is compliant with the NHS Information Governance Toolkit self-assessment requirements • Medicines and Healthcare Products Agency • Joint Advisory Group in achieving a satisfactory grade with Level 2 achieved against all 45 requirements at 31st March 2015, as validated by the Trust’s • Management Systems Organisations accreditation reviews, such as the British Standards Institute internal auditors. • Intensive Care Support Team reports to Board • Patient Stories 2014–15 2014–15 72 Annual Report & Summary Financial Statements Annual Report & Summary Financial Statements 73

Annual governance statement (continued) Annual governance statement 2014/15

Type Assurance Source Referral to Treatment and Cancer Severe staffing shortages following the move The opening of the Brunel building, the into Brunel led to the extension of waiting new hospital at Southmead, was a major Internal Assurances • Reports received from internal audit and Diagnostic Waiting Times • Clinical audit reports Whilst the Trust has in many month’s times for echocardiograms, urodynamics and opportunity to implement transformational • Clinical Audit Assurance report to Audit Committee achieved the RTT waiting time targets cystoscopies which have yet to be resolved changes in both the quality and efficiency • Annual Clinical Audit Report to Audit Committee overall there have been persistent breaches with no other local providers able to provide of services. Working with TDA oversight and • Achievement of financial targets for 2014/15 in individual specialties. This has applied at sufficient capacity to reduce the backlog in conjunction with local commissioners, • (Integrated) Performance Management reports to the Trust Board incorporating Patient Experience and Friends and Family patient and of patients. the Trust is actively reviewing the operating staff results some time to Orthopaedics, Neurosurgery, assumptions that drive longer term • Financial Sustainability reports to the Trust Board General Surgery, Neurology, Medicine Serious Incidents – ‘Never Events’ • Programme & Project Management reports to the Trust board (e.g.Move and Redevelopment programmes) and Pain Management. The first four have affordability and planning the changes The Department of Health lists serious, • Annual Quality Account impacted on elective and cancer waiting needed to improve the financial position. preventable patient safety incidents that • Safer Staffing reports to Trust Board times. The NHS Intensive Support Team • Quality & Risk Management Committee Assurance reports to Board ideally should not occur. These are called To support the delivery of the return was invited in to review systems and make • Audit Committee reports to Board ‘never events’. If they do occur a report is to a breakeven position, the Trust has recommendations for improvement. • Finance and Performance Committee reports to Board provided to the following Trust Board giving developed a five year Sustainability Plan. Orthopaedics waiting times reflect the issues • Medical Staff appraisal progress reports to Trust Board further details of the incident, the actions The development of the plan was supported • Annual Equality Report around spinal surgery where demand is far taken and learning applied to try and prevent by a Turnaround Director who worked with outstripping supply in a specialty where future recurrence. the Trust during 2014 to identify savings 7. Significant Issues poor levels of performance in relation to actions in March 2015 achieved very good national capacity is not adequate. The year schemes which would deliver the required the national standard. ED attendances have results including one day with 100% of ED Three ‘never events’ were reported in the Taking the guidance provided on the began with 50 patients waiting over a year productivity and efficiency changes. continued to increase year on year although attendances being admitted, treated or Trust during 2014/15; two wrong site surgery disclosure of ‘significant issues’ within the for spinal surgery and an expectation that The Trust’s Programme Management not by the same amount as in 2013/14 but discharged within four hours. Other recent and one removal of wrong skin lesion. ‘2014/15 annual governance statement this would increase without action being Office (PMO) continues to provide project the number of admissions from the ED has actions include the ‘Discharge to Assess’ Each patient was fully informed, a detailed guidance’ letter issued by David Flory, TDA taken. Following discussion with the CCGs, management support for the delivery of increased by 4%. The root cause of long and a Better Board Round Project. Since the root cause analysis investigation carried out Chief Executive on 2 February 2015, the NHS England and the TDA the Board made schemes and reporting of delivery through waiting times in ED was identified as the CQC inspection in November (referenced with lessons learned for the specialty and Trust has outlined below information where the decision to close the service to all new the Trust Management Team, Finance & lack of flow of patients through the hospital. separately) all the organisations in the the wider directorate. None of these ‘Never this applies. referrals after September for spinal surgery Performance Committee and the Trust Board. Both before and after the move into the BNSSG area have agreed actions within an except for very urgent cases. The overall Events’ resulted in significant or permanent Emergency Department new facilities the availability of beds became Urgent Care Recovery Plan with the Trust number of patients waiting longer than a harm to the patient. The Trust Board also recognised that it should Performance the main reason for patients waiting in ED Development Authority and CQC to improve year peaked at 245 and the plan is to have no consider whether there were any lessons Future Financial Risks to be learnt following the deterioration in The target of patients waiting no more than for admission. A large factor in this was the the ED patient experience and the aim is to such patients by February 2016. The Trust delivered its financial performance the deficit position for 2014/15. The Trust four hours in the Emergency Department lack of speed in discharging patients when consistently deliver the national standard Capacity pressures in Urology have been for 2014/15 to its planned year end deficit Board commissioned an independent (ED) prior to either admission or discharge medically fit, particularly those needing from July 2015 onwards. a significant factor in the breaches of a (subject to external audit outcome) of governance review from DAC Beachcrofts to has been achieved in only two weeks of the complex social support. number of cancer targets throughout the £19.6m including the receipt of non- consider whether the Board was sufficiently year. In order to help test and refine the Trust’s Plans to improve patient experience when year, particularly the 62 day and 31 day recurrent income of £14m from the TDA. sighted on the issues which resulted in the response to this performance challenge attending the ED were revised more than secondary surgery and treatment from The projected financial position for 2015/16 deteriorating position. The draft report was the Trust has sought external support and once during the year and the overall situation diagnosis targets. Work on shortening and beyond, however, remains a significant received towards the end of 2014/15 and to this end has been visited by staff from in the BNSSG area became the subject of the patient pathway and adding theatre issue for the Trust. The Income & Expenditure will be considered by the Trust Board in the Department of Health (Emergency action plans for all the organisations involved. lists began to improve the positions from plan for 2015/16 shows a deficit of £26m April 2015. Care Intensive Support Team), the Trust These included the Trust setting up an September 2014. Following the move into with a CRES target of £41m. This means Development Authority, NHS England and Operational Control Centre and the TDA and Brunel, theatre functionality, theatre kit and the Trust will not achieve its statutory duty the Clinical Commissioning Groups. NHS England reviewing the whole urgent missing notes impacted on theatre capacity to breakeven and will require temporary Recovery plans, developed jointly with care system particularly following NBT’s and increased the number of cancelled financing to bolster its cash position early in commissioners and local authorities have performance deterioration in May and June operations. The first of these factors lasted 2015/16. Detailed work is underway to bring been implemented and refined during 2014. Performance remained well below the for some months impacting on the Trust’s this back to balance by the end of 2016/17. the year. Prior to the move into the Brunel national target levels during the Summer but overall theatre activity which did not recover Building a ‘re-boot’ week was undertaken whilst it declined nationally during the late its pre-move levels. Because of an increase in to identify the reasons for delays in patient Autumn and Winter, NBT’s deteriorated no demand for breast care and a much higher care and there was a reduction in long stay further and over the Christmas, New Year and number of patients exerting their choice of patients which, unfortunately was sustained January periods was comparable with other care and appointment times the two week for only a month. Comparison with local large EDs. A week long ‘Onwards Together’ urgent referral target was also not met in the providers shows that there is continued initiative involving all partner organisations last quarter. pressure on the local system as a whole and during which staff were urged and facilitated to implement potential improvement 2014–15 2014–15 74 Annual Report & Summary Financial Statements Annual Report & Summary Financial Statements 75

Annual governance statement (continued) Annual governance statement 2014/15

Post Move Issues organisations to improve the situation on a The transfer of over 500 patients, including sustainable basis. 24 critically ill, all the direct care and many Along with its partner organisations an other staff from two hospitals into one action plan was produced and a number of over a two week period was undertaken in actions have been completed by the end May. This was one of the NHS’s largest ever of the financial year with others due to be exercises and was completed successfully implemented up to the end of 2015. The key and safely. As with any new building and issues were to implement full recruitment to new ways of working there were initial issues the department, embed new practices and which impacted significantly on the Trust’s improve flow from the ED to the rest of the overall capacity in outpatient clinics and hospital. To ensure actions are implemented, theatres. This had an inevitable effect on the a fortnightly operational review group will Trust’s ability to achieve its waiting list and meet and the Board will track the delivery of referral to treatment targets and on staff actions monthly. The Trust Board considered confidence in their own ability to provide an its compliance with the regulations at its efficient service. Combined with shortages meeting in March 2015 and confirmed that it of skilled theatre staff, theatres were never considered that the Trust was now compliant able to achieve the same level of activity with the regulations as of 1 April 2015. as before the Move. The remedies for the building issues and the costs involved in the Electronic Patient Record Trust’s inability to fully utilise the facilities for Implementation a period were negotiated over a two month The Trust agreed the purchase and period with the private finance contractors implementation of a replacement system and a settlement is expected in April. for Cerner as the provider of an electronic patient record. A comprehensive review of Care Quality Commission Inspection the project was undertaken in January 2015 As part of the CQC’s planned programme and changes to the approach (including of inspections the Trust was inspected a revised project initiation document and between 5 and 7 November 2014 with an splitting the programme into three projects) unannounced second visit on 17 November and governance of the programme were 2014. The overall rating was ‘Requires approved by the Board in February 2015. Improvement’ and it was acknowledged The go-live date for the physical changeover that the inspection had taken place during of systems was postponed from July to a period of staff embedding into a new October 2015. environment, and unprecedented demand for hospital services. Despite this the CQC rated the services as good overall for caring. No significantly new issues were identified through the inspection report and some outstandingly good practices were found in Signed ...... some areas. Actions were already in place for the majority of the issues identified, however, there was some inconsistency in application Andrea Young of the required actions. Chief Executive North Bristol NHS Trust The Emergency Department, however, was identified as an area of focus to improve safety and responsiveness and 4th June 2015 Date: ...... the CQC issued a Warning Notice with enforcement actions. It was acknowledged that many actions were required of partner If you require a summary of this information in another language or format please contact: Nick Stibbs, Corporate Services Manager

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