Annual report 2018-19

1 Annual Report 2018-19 Contents

Performance report Foreword Overview About us Our vision Our values Our Clinical Commissioning Groups Clinically led Our CQC rating SASH+ - transforming care Research – improving care for patients Our governors and members SASH Charity

Our plans Our strategy Our strategic vision Our strategic objectives Our annual priorities STP – working in partnership Patient experience What our patients say Care opinion Patient Advice and Liaison Service (PALS) Supporting carers Open visiting Compliments – saying thank you Making it better - responding to complaints Performance Activity - the numbers A&E: four-hour standard Cancer waiting times

2 Annual Report 2018-19 Contents

Referral to treatment standard Activity - the numbers Digital conversations Our people Who are we Gender profile Staff survey Staff Family and Friends Test SASH Star Awards -recognising achievement Developing our staff Staff engagement Equality diversity and human rights Surrey Choices Black, Asian, Minority ethnic (BAME) network Health and wellbeing Occupational health SASH Active Our volunteers Work experience students Apprentices Friends of East Surrey Hospital Our environment Sustainability Recycling Energy efficiency Accountability report Our governance and assurance Our Board of directors, board and sub committees Annual governance statement; including key risks and issues Remuneration and staff report Conclusion pages Putting people first Keep in touch Finances

3 Annual Report 2018-19 Contents

Our finances

Karen Beadle, senior library assistant

4 Annual Report 2018-19 Performance report

Welcome to the Surrey and Sussex Healthcare NHS Trust Annual Report 2018-19, where you can find out more about our plans, our performance and our achievements. eW are also happy to have this opportunity to reflect on the positive difference our people continue to make to our patients.

Foreword

Dr Richard Shaw Michael Wilson CBE During the past eight years Chair Chief executive SASH has been on an incredible improvement are pleased to be able to share a specialist dentist in special journey and we were some of the highlights of the care dentistry. As a consultant absolutely thrilled that the last year. in special care dentistry Mili accumulation of all of this cares for vulnerable patients hard work was recognised In January 2019 the Trust was including those with dementia last year when we were rated also rated “Outstanding” for and severe learning difficulties Outstanding by the Care Use of Resources by NHS as well as people with severe Quality Commission, the Improvement and the CQC, medical conditions. More highest rating given by the in addition to being rated recently, at SASH, Mili initiated independent health regulator. “Outstanding” in respect of and led the introduction of Quality. Mouth Care Matters, a Health This rating is due to the Education England Kent, commitment of everyone SASH also delivered a financial Surrey and Sussex training at SASH to making patient surplus for the third consecutive initiative to improve the oral care the best it can be, and financial year, meeting its health of hospitalised adult the impact of continued planned savings target. In the patients. Following a successful improvement through the current climate this is a notable pilot at East Surrey Hospital, in SASH+ work we do, supported achievement, allowing the Trust 2016-17 Mouth Care Matters by our partnership with the to invest in additional capital was rolled out to 12 NHS trusts Virginia Mason Institute. This works during the year and to in Surrey, Sussex and Kent. partnership has helped move significantly improve its working SASH from a very difficult capital position. Richard Burford, chairman of place to being an Outstanding the Friends’ of East Surrey organisation. However, we do Mili Doshi, consultant in special Hospital was awarded a BEM acknowledge that to remain care dentistry was awarded (British Empire Medal) in the an Outstanding organisation a MBE (Member of the Order New Year Honours for services we must always learn and of the British Empire) for to veterans and the community challenge ourselves and services to dentistry in The in Surrey. This recognition continue to make incremental Queen’s Birthday Honours. comes after many years improvements to the way we This recognition comes after 17 volunteering that, as well as work and the care we provide. years of service to the NHS as some 14 years as chairman Through this annual report we a dentist and over ten years as for the Friends’ of East Surrey

5 Annual Report 2018-19 Foreword

Hospital, has included 28 years stimulating sounds and colours possible by their hard work, as chairman for the Federation and areas of reminiscence, commitment and compassion. of Old Comrades Association; walls of recall to help evoke 25 years for SSAFA, The memories and conversations Thank you. Armed Forces Charity, the among patients living with oldest military charity, alongside dementia. 23 years with The Honourable Artillery Company, formerly We believe that our success is known as the Territorial Army, attributable to all our fantastic Richard Shaw where he rose through the staff and to having a clear Chair ranks to become Colonel. improvement methodology that really encourages them In March 2019, SASH Charity to make the improvements welcomed guests to the themselves. opening of our dementia friendly garden, Camomile Looking forward into the Michael Wilson CBE Courtyard at East Surrey next year, we will continue to Chief executive Hospital. The garden was build on our success and to opened by special guest develop the hospital; with the Dame Judi Dench and is a new neonatal unit build and purpose-built garden area for development of our dental unit patients living with dementia and women’s’ outpatients. that provides an alternative We want to thank all of our space to the hospital wards in SASH people, clinicians, staff a safe outdoor environment and volunteers because we with impressive outdoor know that every achievement features, such as; nature areas, and success is only made

Godstone Ward team

6 Annual Report 2018-19 Overview - About us

Surrey and Sussex

Healthcare NHS Trust (SASH) Population of provides acute and complex 535,000 services at East Surrey 4,453 Hospital in Redhill alongside staff East Surrey Hospital a range of outpatient, Redhill diagnostic and planned care 735 Caterham Dene Hospital beds at Caterham Dene Hospital, Oxted Health Centre The Earlswood Centre and 14 Earlswood Centre Oxted Health Centre in operating Crawley Hospital theatres Surrey and at Crawley and Horsham Hospital Horsham Hospitals in West Sussex. in partnership with the major serve. Serving a growing population trauma centres at St George’s of over 535,000 we care for University Hospitals NHS The Trust is an Associated people living, working and Foundation Trust, Tooting, and University Hospital of Brighton visiting east Surrey, north- Royal Sussex County Hospital, and Sussex Medical School east West Sussex, and south Brighton. East Surrey Hospital and we are part of educating Croydon, including the towns of has 735 beds and ten operating cohorts of final year medical Crawley; Horsham; Reigate and theatres, along with four more students from the school each Redhill. theatres at Crawley Hospital in year under the supervision of East Surrey Hospital is the a day surgery unit. one of our consultants. Our designated hospital for Gatwick involvement supports the Airport and sections of the We are a major local employer, medical workforce of the future M25 and M23 motorways. It with a diverse workforce of and the delivery of high-quality has a trauma unit, which cares over 4,453 providing healthcare patient care. for seriously injured patients services to the communities we

Croydon

M20 Woking M25 Caterham Dene Hospital

Oxted Health Centre Guilford Earlswood East Surrey Hospital

Tonbridge

Crawley Hospital Tunbridge M23 Wells Horsham Hospital

7 Annual Report 2018-19 Overview - About us

Our vision The services we provide are commissioned by local clinical NHS Surrey Downs We will pursue perfection in the CCG: has 31 GP practices delivery of safe, high quality commissioning groups (CCGs) as well as NHS England. serving a population of healthcare that puts the people over 305,000 people living in our community first. in Mole Valley, Epsom and Our clinical Ewell, Banstead and east Our values commissioning Elmbridge Dignity and respect: we value each person as an individual groups (CCGs) and will challenge disrespectful The services we provide are and inappropriate behaviour. commissioned by local clinical NHS Horsham and Mid commissioning groups (CCGs) Sussex CCG: has 23 GP as well as NHS England. practices covering the Dignity and respect: northern part of Horsham In 2018-19, we held contracts District and Mid Sussex we value each person with 11 CCGs; of which our District with a population of as an individual and will co-ordinating commissioner is nearly 240,000 people challenge disrespectful and NHS Horsham and Mid Sussex inappropriate behaviour. CCG with ten associates.

The Trust has a contract with Clinically led One team: NHS England, who commission We are a clinically led specialised services and organisation, focused on putting we work together and have secondary care dental. The people first. Our services are a can-do approach to all Trust also has a contract with led and managed through four that we do, recognising that Sussex Musculoskeletal (MSK) divisions: we all add value with equal which is a partnership hosted worth. by a limited company. The Cancer and diagnostics majority of our services are commissioned by: Dr Tony Newman- Compassion: Saunders Chief (Dr Edward Cetti until 11 March 2019) we respond with humanity NHS East Surrey CCG: and kindness and search has 17 GP practices Jane Griffiths (Alison Associate for things we can do, James from 29 covering the districts director however small; we do not of Tandridge, Redhill, October 2018) wait to be asked, because Reigate and Horley with Divisional Victoria Daley we care. a population of 185,000 chief nurse (Deputy chief nurse) people Safety and quality:

we take responsibility for NHS Crawley CCG: has our actions decisions and 12 GP practices covering behaviours in delivering the Crawley district with a safe, high quality care. population of over 120,000 people

8 Annual Report 2018-19 Overview - About us

Medicine

Chief Dr Ben Mearns Cynthia Quainoo Associate (Alison James until 28 director October 2018)

Divisional Nicola Shopland chief nurse

Surgery Mr Ian Maheswaran (Dr Barbara Bray Chief until 3 May 2018)

Associate Natasha Hare director

Divisional Jamie Moore chief nurse

Women and children Miss Karen Jermy (Ms Zara Nadim Chief (until 30 November 2018)

Associate Bill Kilvington director

Divisional Michelle Cudjoe chief nurse (Head of midwifery)

Key strategic and cross divisional themes are also led by Clinical Chiefs

Chief Informatics Officer Dr Tony Newman Sanders, also chief of cancer and diagnostics Chief of Education Dr Sarah Rafferty Chief of Innovation Dr Des Holden from Jan 2019 Mr Ian Maheswaren, chief of surgery

9 Annual Report 2018-19 Our CQC rating

SASH rated outstanding 18 January 2019

SASH is one of the eight non-specialist acute trusts in England to be rated We observed many staff in different Outstanding. roles interact with patients in a kind, The CQC report highlighted respectful and considerate way. the success of SASH+ and the positive impact this is having on CQC inspector 2018 the people we care for. 10 Annual Report 2018-19 Our CQC rating

Announcement to staff of CQC rating

Media coverage after CQC announcement

11 Annual Report 2018-19 Our CQC rating

facilities and increased The Trust provided care Unmistakeable capacity that resulted and treatment in in enhanced accordance with evidence of effectiveness and evidence-based sustained responsiveness. This guidance. Evidence- was due to a firmly- based systems were improvement. embedded and positive used for treating very CQC inspector 2018 culture of openness and sick patients. Staff were transparency, supported aware of clinical guidance The CQC outlined in their report by a skilled, stable for patients with specific that our rating had improved to leadership and clear needs or diseases. outstanding because: systems of control and Staff provided care Patient safety and governance. and treatment based on the patient experience national guidance. were the dominant Speciality clinics thread running through Staff involved operating within the the Trust strategy and patients and outpatient department service delivery. followed relevant national those close guidance and participated The service had enough to them in in national and local staff with the right audits. qualifications, skills, decisions about Care was delivered training and experience their care and by staff that were to keep people safe from competent, trained and avoidable harm and treatment. supported by their abuse and to provide the CQC inspector 2018 managers, to provide right care and treatment. safe and effective care. There was an Staff understood how The service provided exceptional culture to protect patients from regular training and of data-driven continuous abuse. Staff had training development improvement and on how to recognise and opportunities for staff. transformation at the report abuse and they There were established Trust, and this was knew how to apply it. developmental career supported by a The Trust facilities and pathways for different comprehensive meeting premises were roles. structure and detailed accessible to patients Patients were treated with performance reporting and clearly signposted. compassion, kindness, processes. The Trust’s Where there were dignity and respect, when risk management limitations on space receiving care. policy, processes and within waiting areas staff Feedback from people tools were well designed. acted to mitigate risk and who used the service, The CQC saw the Trust was working to those who were close to unmistakable evidence improve the environment. them and stakeholders of sustained Signposting within the was positive about the improvement hospital had improved way staff treated people. achieved through since the previous Staff felt confident investment in new inspection. they could raise

12 Annual Report 2018-19 Our CQC rating

concerns and report further improvement. increase the Friends incidents, which were and Family Test regularly reviewed to In Urgent and response rate for aid learning. Lessons Emergency Care: surgery. learned were effectively The Trust should shared and we saw consider: Outpatients: changes implemented all staff are aware ensuring all staff are within the wards as the of the Trust policy aware of the consent result of investigations. for monitoring patients processes for patients Staff at all levels clearly who have received rapid undergoing minor and passionately tranquilisation. surgical procedures described how they met all staff are aware of the within the outpatient patients’ needs and Trust policy for the department so that they demonstrated a good storage of that are in line with best awareness of protected prescription pads. practice. characteristics including staff are aware of the a formal cleaning race, sexuality, and Trust policy for the safe schedule in place for disability. Staff were well storage of Substances toys within outpatient supported by the mental Hazardous to Health areas. health liaison team and regulations 2002. how it identifies issues the frailty and interface introducing an audit impacting on the team. process to monitor regular checks of The way the Trust patient records and emergency equipment supported and risk assessments during and act to address this. encouraged innovation the transition to between The Trust should was a real strength. systems. consider it reviews The Trust overall score how to provide the use of personal for the National NHS consultant presence 16 protective equipment Staff Survey was in the hours a day at weekends within the phlebotomy top 20% for the three in line with the Royal department in line with years preceding College of Emergency trust policy. the inspection. In some Medicine’s reviewing the space scores this ranked in the recommendations. within the outpatient top four organisations Medicine: department so that all nationally. a review of mandatory staff are aware of The Trust engaged well training compliance. and have access to with patients, staff, the Surgery: space for private public and local ambient temperature conversations with organisations to plan monitors are introduced patients and relatives, and manage appropriate in clinic rooms should be particularly where these services, and monitored and recorded. related to the delivery of collaborated with partner whether the 80% target bad news. organisations effectively. for mandatory training is sufficient. CQC also gave 14 sharing good practice recommendations around areas across all departments the Trust should consider for and wards in order to

13 Annual Report 2018-19 SASH+ transforming care

SASH+ to become one of the safest to ward’ are undertaking a and highest rated hospital variety of SASH+ training and transforming care organisations in the USA. development programmes.

In March 2015, the NHS Our aim at SASH is to pursue Sharing our work Trust Development perfection, putting our patients This year we have held four Authority, now part of at the forefront of everything quarterly open days and hosted NHS Improvement, invited we do, improving safety and a number of additional visits expressions of interest quality by reducing variation which have provided a wide from NHS trusts to be part and waste in every process. variety of stakeholders with of a five-year development Our SASH+ work supports an the opportunity to see and partnership, which aims to accelerated transformation in experience, first-hand, the fundamentally improve the quality by providing us with a SASH+ transformation work quality, performance and structured approach to continue that is taking place. They have financial sustainability of our improvement journey and been hugely impressed by the the organisations selected has helped to take us from high levels of staff engagement to take part as well as share being rated ‘Good’ by the CQC and commitment to the work learning with others. to becoming an Outstanding and the positive benefits the organisation. transformation programme is Over the last three and a bringing to patients across the half years SASH, along with Our kaizen promotion Trust. four other trusts have been office (KPO) team lead the working in partnership with the transformation programme; We are very proud of the Virginia Mason Institute (VMI) providing the structure, significant and sustainable in Seattle, USA who have methods and rigor behind the developed a transformational successful implementation management system - the of the SASH+ improvement Virginia Mason Production methodology, alongside training System, which is based on lean and developing staff from methodological improvement across the organisation to lead techniques adopted and using the new methods. adapted from the Toyota car manufacturing factory in Japan. Education and training To share and embed a Over the last 19 years the sustainable culture of Virginia Mason Production continuous improvement across System has enabled them the Trust, staff from ‘Board

14 Annual Report 2018-19 SASH+ transforming care

transformation changes we have successfully made and look forward to continuing to improve the high quality of care we provide to local people. This is reflected in the recent CQC report:

“The SASH+ quality improvement programme has empowered staff by equipping them with the lean tools, methods and a structured process which has very successfully built a culture of continuous improvement across the whole Trust. Investment in improvement and training has been a priority and this had resulted in a culture where staff at all grades and from all disciplines felt involved and enthused by the work streams and the idea that they could make a real different to patient safety and the patient experience” (CQC inspection report 2019) We are also proud of the empowering impact involvement in making change has on individuals and teams and feel that this is reflected in how our staff rank the organisation in the national NHS Staff Survey.

Sue Jenkins, director of kaizen

15 AnnualGastro / hepatology Report 2018-19Cardiology

Research Cross organisational Anaesthesia (Patients) Stroke

Dermatology Research – to the2018-19 evidence base of in research is again reflected Respiratory healthcare both nationally in a significant increase in the improving clinical and internationally. number of patients recruited treatments, care during 2018-19.Diabetes For the second Most of the national and year running, we recruited well and outcomes for international1,791 patients multi-centre agreed over 1000 patients to one of our patients studiesto take whichpart in we research invite our our high quality, NHS ethically patientsin 68 different to participate studies in are approved,Elderly research care studies Reproductive health Innovation in patient care National Institute of Health as part of their clinical care. is a Trust priority and Research (NIHR) studies. Against a target of 1009 recruits involvement in clinical Participation in these multi- we were able to offer research researchPaediatrics demonstrates site research studies gives participation to 1791 of our Ophthalmology our Trust’s commitment to our patients access to the patientsEmergency, into one injuries of the 62 improving clinical treatments, latest drugs and treatments in researchand critical projects care which have development and also helps to run across the Trust in different care and outcomes for our Urology ensure that our staff can offer disease areas or specialties. patients. By supporting Orthopaedics (Inc. bladder cancer) research, our staff are the best care available. This is a 66% increase since actively working to improve last year and our highest the drugs and treatments Recruitment performance achievement to date. offered to their patients and and targets to improve healthcare in the Our strategic Oncologyaim is to and We continue to perform well future. Asking important encourage greaterpalliative research care in respect of recruitment to research questions helps engagementRheumatology and increase research studies and in meeting us to improve the quality of research activity across our national performance targets care we offer and contributes Trust. Our strong performance set for research. Our research

Total participant recruitment and studies opened over last five financial years 2018/19 2017/18 2016/17 2015/16 2014/15

patient participants 1791 1077 817 449 771

staff participants 100 788 112 0 0

number of recruiting studies per year 62 60 54 50 45 16 Annual Report 2018-19 Research

department supported the for studies and have maintained proud to receive an award from set-up of 19 new studies this our 100% success record for the National Institute for Health year, allowing us to offer new recruiting to time and target for Research (NIHR) Clinical research opportunities to more commercial clinical trials which Research Network (CRN) Kent, of our patients. We continue to finished recruiting in 2018-19. Surrey and Sussex, recognising be amongst the top recruiting our achievement in meeting sites regionally and nationally In February 2019 we were very recruitment targets.

Patient recruitment - NIHR research studies

Gastro / hepatology Cardiology

Cross organisational Anaesthesia (Patients) Stroke

Dermatology 2018-19 Respiratory

Diabetes

1,791 patients agreed to take part in research in 68 different studies Elderly care Reproductive health

Paediatrics Ophthalmology Emergency, injuries and critical care Urology Orthopaedics (Inc. bladder cancer)

Oncology and palliative care Rheumatology

17

Total participant recruitment and studies opened over last five financial years 2018/19 2017/18 2016/17 2015/16 2014/15

patient participants 1791 1077 817 449 771

staff participants 100 788 112 0 0

number of recruiting studies per year 62 60 54 50 45 Annual Report 2018-19 Research

Patient experience

Involvement in clinical research I can’t thank the staff enough, I is one way we can deliver felt so well cared for in the trial, excellent patient experiences and outcomes. A large number knowing that the Consultants of our clinical specialities are were available to me and that engaged in research because we want to offer patients the research nurse responded research opportunities as immediately when I called. part of their care and believe Research patient participant that research activity helps to improve the effectiveness of our services.

We have a dedicated infrastructure for the support and development of research at SASH. Our specialised research delivery teams consisting of research nurses; co-ordinators and research administrators support clinical teams in discussing research study participation with patients and managing patient care on follow up and continued treatment after they enter a study.

In 2018-19 1791 patients volunteered to take part in one of the 62 research studies running at the Trust (66 % increase on 2017-18) The research team

18 Annual Report 2018-19 Our governors and members

Governors provide valuable September.* decision to recruit patient and insight and feedback public members and elect a from the members they The Trust has around 10,200 council of governors as part of represent. They work with, members, 6,000 from its patient its final stages of preparation represent and are conduits and public constituencies on the aspirant foundation to the members of their and 4,200 from its staff. The Trust pipeline. The Council of constituencies, helping the membership constituencies are: Governors remains constituted Trust to understand the Reigate and Banstead and active however it does not needs and experience of Tandridge have equivalent responsibilities patients and local people; Crawley to a similar body for a in effect, by making sure Horsham Foundation Trust. ‘patients are always in Mole Valley the room’ when services Mid Sussex Our Governors: are being discussed and Croydon (electoral Have input into Trust decisions made. wards: Purley; strategy development Coulsdon East; Have an active role in Our governors make a Coulsdon West; the improvement work valuable contribution to how Kenley; Sanderstead) for the Trust we deliver services and make Patients from outside Support the Trust in a difference to the future health the catchment area public consultations and wellbeing of local people. SASH staff Are members of We consider our governors key patient focused a trusted group of critical This year our governors have working groups friends who make an important played an active and important Are fundraising contribution to how we deliver role in: champions care and services at SASH. Annual environmental Continue to be a assessments resource and sounding The governors are elected by Wayfinding hospital board for the Trust members of the constituency signage project of which they are a member Hand hygiene and which they represent. The awareness days Council of Governors include Ward and departmental elected public governors and visits staff governors and nominated Organ donation governors from partner committee organisations. Our governors Development of are volunteers and unpaid, and our patient and public Council of Governors meetings engagement strategy are held four times a year. Patient Information development Governors are also members of Being consulted by the sub-group meetings, on specific CQC as part of their issues, for example patient formal inspection experience and community programme engagement events as well Developing a governor being part of our annual general newsletter meeting which is held each The Trust Board made the

19 Annual Report 2018-19 SASH Charity

SASH Charity raises money In addition, many individuals, The courtyard has been to enhance the patient care including members of Trust completely transformed, to provided at Surrey staff supported the campaign, create a fantastic new space for and Sussex Healthcare NHS by making donations, or patients, families, visitors and Trust. The charity does this fundraising. The courtyard was staff. It incorporates features by investing in state-of-the- officially opened by Dame Judi such as; step free access from art equipment; improving Dench on 8 March 2019. the wards and hospital corridor, the hospital environment; Other fundraising highlights non-slip flooring, raised flower supporting ground-breaking included: beds incorporating plants health research and specifically chosen for their providing specialist training. A fundraising tea sensory qualities, 1960s ‘wall of party to celebrate the recall’ images and a traditional In 2018-19, the charity’s income 70th anniversary of the red post box to stimulate totalled £163k and it spent NHS; ‘The NHS big memories and conversations, £354k in year. The closing 7-tea’ as well as a table tennis table balance, as at 31 March 2018, which also functions for playing was £682k. A raffle of FA Cup a dementia friendly game. tickets, kindly donated The Charity Commission by Redhill Football The launch event in March deadline for the submission of Club 2019 brought together the charitable fund accounts for patients, staff, individuals the year ended 31 March 2019 A team of Trust staff and organisations who had is 31 January 2020. Therefore, walking the Surrey supported the fundraising the accounts have not been three peaks campaign. Dame Judi Dench finalised at this stage. spent time meeting people, Being an official including visiting the adjoining Fundraising activity partner of the Run wards. The courtyard is a great Support for SASH Charity Reigate half marathon example of the difference a included fantastic community trust charity can make. support for the Camomile Making a difference Courtyard appeal (detailed In March 2019, the charitably below) which received support funded Camomile Courtyard from a huge range of local at East Surrey Hospital was organisations, including local officially opened by Dame Judi businesses, community groups, Dench. churches, schools and colleges.

20 Annual Report 2018-19 SASH Charity

Dame Judi Dench opens the Camomile Coutyard in March 2019

21 Annual Report 2018-19 Our plans

Our strategy work with our patients to design their healthcare and the need to Caring use innovative IT. The revised Our strategy was reviewed Develop the care we provide strategic objectives are: and refreshed for 2018-19. in partnership with patients, During our review we were staff, families, carers and confident that the strategy Safe community services; deliver was still in line with the it with compassion needs of our patients, public Deliver standardised, safe, and partners. Our strategy on high quality care which Responsive a page outlines our vision, pursues perfection and is in values, strategic objectives the top 25% of our peers Be the hospital of choice for and current (previously our community delivering annual) priorities. services in response to the needs of our population Our strategic objectives Effective The strategic objectives were refreshed for 2018-19. They As a teaching hospital, Well-led were amended to reflect deliver effective and sustainable clinical services To be a high quality employer the changing environment; that focuses on staff health the need to move towards which focus on outcomes, innovation and technology and wellbeing and delivers integrated healthcare systems patient centred, clinically led, and partnerships; the need to efficieint services 22 Annual Report 2018-19 Our plans

Our Current around improved discharge Well led: Improve staff health, planning which has specifically wellbeing and working lives priorities focused on establishing The health and well-being of accurate expected dates for our staff has continued to be We reviewed our current discharge during the year as the key area of focus within priorities and agreed that the well as improving the process our well led objective. During annual delivery objectives and timeliness of medication the year there have been were still appropriate with preparation for patients being various initiatives to support some minor adjustments. discharged. the health and wellbeing of our These are outlined below staff including, fitness classes, along with some of the Caring: Create best a health and well-being open highlights of what has been environment for patients day, increased security and delivered in year: 2018-19 has seen a vast the implementation of body array of improvements for cameras for our security guards Safe: Reduce avoidable harm patients including adjustments and parking attendants to Our priority to reduce avoidable made to outpatient waiting minimise abuse and violence, harm was translated into environments, clearer signage initiatives to encourage annual deliverables. The focus and sectioning within the exercise and smoking for 2018-19 would see the main hospital, overall décor, cessation. Whilst there continue introduction of a new SASH+ ward refurbishments, a to be a significant number of value stream to increase new dementia garden, new initiatives aimed at improving the incidence reporting and dementia friendly bright yellow lives for our staff there is still speedier treatment of sepsis toilet doors, a changing places more to do as reflected in our and increase the focus and area, suitable for people and staff survey and as such this spread of plans to reduce the carers with disabilities. will remain a high-profile area number of falls. Mid-year, due for us in 2019-20. to an increase in the incidence Responsive: Timely access of pressure damage, this was to services The areas described above also considered to be an added During 2018-19 the responsive give a flavour of the delivery of deliverable for the reducing priority was changed from the Trust’s strategy and current avoidable harm priority. improve efficiency of elective priorities but there is so much care to timely access more that permeates through Effective: Improve discharge to services. This was in the organisation. All staff teams planning recognition of the fact that all of review the Trust’s priorities and During the year we our services had an opportunity translate these at team level at implemented our electronic to be more responsive. During the beginning of the year. patient tracking system to the year responsiveness has Each team and ward area support proactive and timely been achieved through delivery proudly present their team management of patients and of key performance targets, level objectives somewhere beds empowering our staff improvements in timeliness, visible for all to see and local to care for patients in the reductions in the amount of production boards oversee most appropriate setting; this time ambulances wait on delivery of the objectives. has resulted in a sustained site to hand over patients, These will be specific for reduction in length of stay. improvements in theatre and the team for example, timely outpatients productivity, and access to services for the This was also supported by speedier management of pathology team might be our SASH+ value stream complaints. around reporting turnaround

23 Annual Report 2018-19 Our plans

Timely access to services

Anouska Adamson-Parks, director of strategy

24 Annual Report 2018-19 Our plans

times of a sample but it might supporting even more with rising activity and be length of time for a request extensive use of our acuity levels to recruit to new staff member SASH+ methodology The development of being in post for Human Ongoing delivery of a mental health Resources. During the year services rated as the strategy which teams were provided with a most efficient has increased the wide range of data to support services in the country focus on the need to the development and ongoing (Model Hospital) deliver seamlessly review of the team priorities to Participation and integrated physical and ensure a focus on continuous successful delivery mental healthcare improvement. of service improvements from Achieved an outstanding CQC Other deliverables achieved the national Getting rating as a Trust through the in year include: it Right First Time dedication and commitment of (GIRFT); of particular our staff The key developments note are the delivered through the annual achievements STP – working in partnership plan in 2018-19 are: within trauma an orthopaedics and The SASH geography and the Achieved an general surgery make-up of local Integrated outstanding CQC Delivery of seven-day Care Systems (ICS) means rating as a Trust services requirements that whilst SASH is governed through the dedication Set a strategic within the Sussex and East and commitment of our direction for Surrey ICS it has a critical role staff outpatients resulting to play in the Surrey Heartlands A new Workforce and in reductions in ICS. As such the Trust has Organisational did not attends, a strategic interest in both Development five-year cancellations and sets of plans and aligns itself strategy with annual improved patient accordingly. The plans that are delivery plans experience currently set out are described The development of a Extended our below: leadership programme discharge team so Successful recruitment that all wards have Sussex and East Surrey of nursing workforce dedicated complex ICS (STP) - The Sussex and reducing reliance on discharge support East Surrey ICS has spent agency A new ward to support much of 2018-19 reviewing the Implementation of system capacity issues population demographics and fast track through the winter formulating a view on the key physiotherapy to as well as support the priorities within the health and improve access for ongoing ward social care system. Alongside staff refurbishment this has been the development New End of Life Care programme moving of a set of shared priorities for strategy forward the ICS and its component Successful recruitment Increased paediatric organisations. To date this has and training to SASH+ staffing to enhance not been translated at place lean for leaders and medical support for level. The shared priorities are taster sessions this busy department outlined on the next page:

25 Annual Report 2018-19 Our plans

Our shared goals

1 Improved health outcomes 2. Improved quality, access and 3. Improved financial sustainability 4. Reforming the health and care system in 5. Developing a sustainable and experience for patients and operational performance of services and performance Sussex and East Surrey workforce and culture population health

Our shared 2019/20 priorities

1. Prevent ill health and manage population health Embed population health management approaches and whole population stratification Fully implement agreed pathways for angina, atrial fibrillation and falls prevention

2. Strengthen primary and community care Support primary care development, increasing resilience and improving access Build and support the ongoing development of effective intergrated primary care networks

3. Improve urgent and emergency care Fully implement the new intergrated Urgent Care model, incl NHS111 CAS and UTC models ED redesign including implementing Same Day Emergency Care and Acute Frailty services Implementation of a new model of step up/down community care

4. Improve planned care Implement agreed STP wide plan to reduce unwarrented variation in MSK services Redesign planned care services to reduce the number of people waiting for treatment Transformation of outpatient services Pathology capacity development and laboratory information management system

5. Improve mental health care Improve the prevention of mental health Improve the mental health provision and support in primary care networks and in A&E

6. Improve treatment, care and support for people with learning disabilities and autism Reduce reliance on patient care, supporting more people to live in the community Reduce inequalities by increasing uptake of annual health checks

7. Improve cancer care Improve the early detection and diagnosis of cancer Improve mental and physical health services for children New service models and improved care quality 8. Improve maternal and child health Improve maternity and neonatal services Improve mental and physical health services for children

26 Annual Report 2018-19 Our plans

Our shared goals

1 Improved health outcomes 2. Improved quality, access and 3. Improved financial sustainability 4. Reforming the health and care system in 5. Developing a sustainable and experience for patients and operational performance of services and performance Sussex and East Surrey workforce and culture population health

Our shared 2019/20 priorities

1. Prevent ill health and manage population health Implement Surrex and East Surrey system reform programme Embed population health management approaches and whole population stratification Support Primary Care Network development Fully implement agreed pathways for angina, atrial fibrillation and falls prevention Develop emerging Intergrated Care Partnerships Implementing commisioning system reform 2. Strengthen primary and community care Support the evolution of the SES ICS Support primary care development, increasing resilience and improving access Continue to develop clinical networks Build and support the ongoing development of effective intergrated primary care networks Develop research and education

3. Improve urgent and emergency care Digital transformation Fully implement the new intergrated Urgent Care model, incl NHS111 CAS and UTC models Full provider digitisation ED redesign including implementing Same Day Emergency Care and Acute Frailty services Developing a connected health and care system Implementation of a new model of step up/down community care Better use of data for planning population health Transformed digital services for the public 4. Improve planned care Implement agreed STP wide plan to reduce unwarrented variation in MSK services Workforce planning and transformation Redesign planned care services to reduce the number of people waiting for treatment Collaborative approaches to reduce temp staffing Transformation of outpatient services Improved productivity and transformation through new roles/new ways of working Pathology capacity development and laboratory information management system Improving workforce efficiency Finalise and implementation of workforce strategy 5. Improve mental health care Improve the prevention of mental health Estate planning and redesign Improve the mental health provision and support in primary care networks and in A&E Changes to the estate to facilitate delivery of the new models of care required in the system 6. Improve treatment, care and support for people with learning disabilities and autism Maintenance and change to the existing estate to maintian its integrity, improve its Reduce reliance on patient care, supporting more people to live in the community efficiency and improve how services are delivered Reduce inequalities by increasing uptake of annual health checks

7. Improve cancer care Improve the early detection and diagnosis of cancer Improve mental and physical health services for children

8. Improve maternal and child health Improve maternity and neonatal services

Improve mental and physical health services for children wide enabling programmes System reform and STP

27 Annual Report 2018-19 Our plans

Priority areas of focus

Helping people in Surrey lead healthy lives

1 1.1 Working to reduce obesity and excess weight rates 1.2 Enabling prevention and treatment of increasing risk and harmful drinking 1.3 Ensuring that everyone lives in good and appropriate housing 1.4 Promoting prvention to decrease incidence of serious conditions and diseases 1.5 Helping people to live independently for as long as possible and to die well

Supporting the emotional wellbeing

2 2.1 Enabling children, young people, adults and elderly with mental health to access the right help and resources 2.2 Enableing emotional wellbeing of mothers throughout their pregnancy 2.3 Preventing isolation and enabling support for those who do feel isolated

Supporting people in Surrey to fulfil their potential

3 3.1 Enabling children to develop skills for life 3.2 Enabling adults to succeed professionally

Surrey Heartlands ICS - being translated into outcome During 2018/19 Surrey measures and KPI ambitions. Heartlands has commenced To date this has not yet been its devolution journey by translated at place level. considering the needs of the population and developing a 5-10-year strategic plan (summarised below in terms of priority areas and the target populations). Whilst plans are at a high level this is now

28 Annual Report 2018-19 Our plans

Target population cohorts a General population b Children with SEND and adults with learning disbilities and/or autism c Young and adult carers in Surrey d People who need support to live with illness, live independently, or to die well e Deprived or vulnerable people

29 Annual Report 2018-19 Patient experience

What our patients say

Since the Trust has launched its bespoke patient experience platform in March 2017, it has gone from strength to strength. The Meridian system allows information to be filtered to different niche specialities, wards and services. It was recognised that other trusts have improved the amount of completed surveys with the support of volunteers and by using electronic tablets. Our volunteers can now request patients, who are ready for discharge, to complete our surveys electronically and anonymously whilst still in the hospital.

Your care matters The cards (pictured left) are produced in different colours for different specialities and divisions. The cards provide details of Freephone numbers and specific website links to ease the process for patients to complete the surveys.

Care opinion The care opinion website that is independent provides reassurance to patients that their concerns are listened to. Each clinical area has Patient Advice Liason Service Contacts are made via walk- designated staff who are (PALS) ins, telephone, letters and responsible for responding On average PALS have just emails. PALS intervene so that to comments when they are over 350 contacts per month potential reasons to complain posted and this continues whilst continuing to diffuse can be managed proactively. to be very helpful for the many situations. PALS offer organisation. practical solutions and a The aim is for the PALS teams listening ear in real time. to become further integrated

30 Annual Report 2018-19 Patient experience

within our divisions and to Carer’s Passport and their carers’. The café is an attend governance meetings in The carers’ passport is opportunity to remove isolation order to share learning which recognised throughout the trust and bring this target group has already started. to provide carers of patients’ together. The Trust have the discounts on parking, meals in Camomile Courtyard dedicated The PALS team consists of our restaurant, signposting to to Dementia patients. four part time officers who our carer support organisations are overseen by the Patient and refreshments on ward Clinical staffs wear yellow name Experience Lead. The whole drinks rounds. Divisions are badges which are dementia team are based in the PALS reminded regularly at the friendly. The emergency office. The office has been patient experience committee to department is planning to make redesigned to provide a more share the benefits of advocating four of the bays dementia comforting space for patients this passport to their team friendly. The Dementia Steering and their relatives, with the members. Group consists of a multi- service operating Monday to disciplinary of professionals Friday 9.30am to 4.30pm. The Open visiting who work on strategies to previous advice and information improve the dementia patient database has been updated Wayfinding- We now have experience and journey. to DATIX, which will now colourful vinyl to inform the synchronise with the rest of the public of the zone they are Patient Stories - Each PALS cases reported. entering and are in, which patient experience committee PALS have a monthly coordinates with our hospital meeting has a patient story team meeting where other site maps. The list of services that is rotated for the divisions departments are invited; this and also the provision of to share. The stories form is working to build a much decision boards enable patients an extremely powerful and better understanding of building to quickly decide which way meaningful way to focus relationships within the Trust. they need to turn at junctions, on what is important to our PALS main objective is eases the patient journey. Plans patients. We use patient stories to resolve situations from for 2020 will be to replace the across the Trust at training and becoming complaints where outside signage. staff meetings and we intend to possible. further develop this initiative by Noise at Night - This is a forming a group to establish if Supporting carers topic that is often highlighted we can capture patient stories Our carers steering group in patient feedback. The in a more impactful way. This will be relaunching to meet divisional chief nurses and may be by recording the patient again bi-monthly. The steering Patient Experience Lead are in telling their story and making group allows us to focus and discussion of finding solutions a podcast or filming patients improve work in identifying how to best combat the matter telling their stories so they can and supporting carers in a in a feasible system. be accessed more readily by consistent and effective way. all. Patient stories are also Carers Support Group is Dementia - Every last shared at our Trust Public located in the PALS office every Wednesday of the month, from Board meetings. Tuesday afternoon, which 3pm to 4pm the Trust have a allows direct referrals and this Dementia Café which is located Compliments – saying is reassuring for the patient and in the Three Arches Restaurant, thank you. The Trust are their carers. East Surrey Hospital and always receiving numerous dedicated to dementia patients compliments through our

31 Annual Report 2018-19 Patient experience

senSASHtional feedback, from Your Care Matters, through our express feedback online forms and through letters, cards and Fast and efficient donations to SASH Charity, A&E Department. given as a way of expressing thanks.

The patient experience team also receive telephone calls I had wonderful care from all the from patients wishing to extend staff on the birth unit, delivery their thanks and gratitude to the trust teams. suite and eventually theatre. We felt supported throughout Compliments received in PALS are always passed onto the and all the staff were caring and relevant department to share professional. I was extremely with staff.(See examples illustrated on the right). impressed with your service.

Once again I was seen at the exact time of my appointment.

Making it better- responding be resolved and patients or of staff are reported and shared to complaints their carers may choose to at the Patient Experience One of our strategic formally complain, they can Committee so that good objectives is to develop the do this by contacting our practice is shared Trust- wide. compassionate care we complaints team or the Patient provide using feedback from Advice and Liaison Service The two main themes our patients. Issues raised (PALS). Our complaints process identified were in the within complaints help us is integral to the improvement categories of care to understand the needs of of our services. implementation and attitude/ patients and where service courtesy of staff in 2018-19. improvements can be made. In In 2018-19 the Trust received These were: the first instance we encourage 601 formal complaints an our patients to discuss their increase from 2017-18 (542). Care Implementation: problems concerns directly with our staff We share key learning relating to diagnosis and and emphasise the value of a points with staff individually, general nursing and medical swift and empathetic response within ward teams and at the care featured in 135 complaints to patient concerns. divisional monthly governance in the 12-month period. This is meetings. Improvements in a very broad category and is However, if a situation cannot practice, policy and education therefore the main theme within

32 Annual Report 2018-19 Patient experience

actively solicit feedback on the complaints process from patients or carers who The communications were have had cause to use it. handled compassionately and (See examples of positive feedback illustrated on the I wasn’t made to feel like a left). nuisance. The timescales were very reasonable. The online form gave the opportunity to be descriptive and detailed.

The friendly manner in which I was dealt with. At no time was I made to feel I was being a nuisance, I was also assured that my issue would be rectified. My sincere thanks to the staff who spoke to me.

our complaints. The complaints team continue to provide a personal and Each complaint is thoroughly responsive service to investigated and scrutinised complainants. The Trust before feedback is given to the expects to acknowledge all complainant. We offer each complaints within three working complainant a choice of how days. In 2018-19 the complaints to receive this feedback; most team achieved this target in complainants choose to receive 100% of cases. We aim to a letter, but where the complaint respond to all complaints within is complex, a meeting is often the timescales agreed with the preferred. Working together complainant. Over the course the Trust aims to restore the of the year this was achieved in confidence of patients or over 90% of cases. carers, who have had cause to complain. The complaints team 33 Annual Report 2018-19 Performance

Working together, our teams are focused on delivering %age of patients readmitted within 28 days of discharge high quality services to the Standard 2017-18 2018-19 people we care for. Many of the key areas for delivery ED 95% in 4 hours - 95% 95% 96% are measured by national LAEDB Performance standards and we have listed ED 95% in 4 hours - 95% 92% 93% these together with our Trust Performance performance (shown right). Patients Waiting in 0 0 0 ED for over 12 hours Activity – the numbers following DTA This year continued to be a challenging one for both Cancer - TWR 93% 93% 94% emergency and elective care services across the Cancer - 62 day 85% 87% 82% Trust with unprecedented Referral to Treatment numbers of people attending Standard our emergency department RTT Incomplete 92% 89% 91% (ED) or being admitted as an Pathways - % waiting emergency. less than 18 weeks We also saw increases in the RTT Patients over 52 0 19 9 number of patients choosing weeks on incomplete SASH as their secondary pathways care provider of choice within Table: Performance against key national standards the catchment population for elective care services (outpatients and elective %age of patients readmitted within 28 days of operations). This growth discharge continued to put pressure on 2017-18 2018-19 Change %change the capacity of the Trust across beds, clinics and diagnostics. Emergency 99,071 105,325 6,254 6.31% attendances The table shows the Trust’s Outpatient 374,006 395,526 21,520 5.75% performance against key appointments national standards which Non-elective 36,276 38,398 2,122 5.85% reflects the pressures from admissions the increased activity as well Births 4,516 4,499 -17 -0.38% as a number of other factors described in the following Elective 48,569 52,419 3,850 7.93% sections. admissions Table: Activity numbers

34 Annual Report 2018-19 Performance

Q1 Q2 Q3 Q4

Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar- 18 18 18 18 18 18 18 18 18 19 19 19 ED 95% in 4 hours - 97.6% 98.7% 98.3% 97.4% 97.0% 97.6% 97.6% 96.3% 93.7% 90.6% 93.2% 95.9% LAEDB performance ED 95% in 4 hours - 95.5% 97.9% 97.1% 95.5% 97.6% 95.6% 93.1% 92.6% 88.8% 83.2% 88.0% 93.1% Trust performance Patients waiting in 0 0 0 0 0 0 0 0 0 0 0 0 ED for over 12 hours following DTA Ambulance 26 0 1 5 3 0 26 7 78 164 8 6 turnaround - number iver 60 mins Cancer - TWR 93.0% 93.1% 93.2% 94.1% 93.1% 93.0% 93.6% 93.4% 95.2% 93.2% 94.2% 93.0%

Cancer - 62 day 84.0% 81.2% 80.8% 81.5% 79.6% 87.7% 86.3% 87.9% 85.7% 74.9% 78.0% 81.1% referral to treatment standard RTT incomplete 89.9% 90.7% 90.0% 90.0% 89.4% 89.1% 89.5% 90.2% 89.3% 90.0% 90.2% 90.6% pathways - % waiting less than 8 weeks RTT patients over 52 16 15 8 10 16 16 13 9 10 13 11 9 weeks on incomplete pathways Percentage of 0.2% 0.1% 0.4% 0.4% 0.7% 0.1% 0.1% 0.5% 0.7% 1.3% 0.9% 1.1% patients waiting 6 weeks or more for diagnostic No of operations 0 1 5 2 0 0 1 3 6 8 TBC TBC cancelled on the day not treated within 28 days Table: Access to services

35 Annual Report 2018-19 Performance

Emergency a number of other pieces of We continue to work to improve improvement work including pathways to support the department: four- embedding a digital patient flow implementation of the national hour standard / command centre system. cancer strategy, and our The Trust has continued to internal and joint work as part of The emergency department work as part of the LAEDB the Surrey and Sussex Cancer four-hour standard (patients to deliver the best access Alliance will continue to focus attending an A&E department to emergency services for on improving outcomes for our must be seen, treated, and our local population. This is patients. admitted or discharged in under the forum where all partners four hours) continued to be a across the health and social Referral to treatment/ significant challenge across the care system work together diagnostics standard country throughout 2018-19 to undertake the assurance The 18-week referral to and the delivery of the standard of service delivery and treatment/diagnostics standard continues to be a key priority for performance for emergency (where patients start consultant- the Trust and the local health care. led treatment within a maximum system. of 18 weeks from referral for Cancer waiting times non-urgent conditions) has As a local system, we delivered Cancer access targets have been challenging throughout the standard with performance remained a significant focus the year with the impact of of 96% across the year, but with for us this year, during which emergency pressures, on- some challenges in the winter we have seen a number of going recruitment challenges months, and improved on the challenges including ongoing and capacity shortfalls in key 2017-18 performance of 95%. growth in cancer referrals. specialities. Performance for the East Despite this growth, the Trust Surrey Hospital Emergency successfully achieved the two While the Trust has not Department also improved week rule (TWR) standard in all achieved the incomplete in 2018-19 with performance quarters of 2018/19 and overall target since November 2016, of 93%, but with similar for the year we saw an increase there has been significant challenges over the winter in performance from 93% to improvement during the year months. 94%. with a reduction in the overall waiting list, a 50% reduction At both Local Accident and However, the 62 Day Standard in patients waiting over 52 Emergency Delivery Board saw a number of issues across weeks to start treatment and (LAEDB) and Hospital level the year which resulted in the for 7 months of the year, our performance significantly standard only being achieved performance against the exceeded the national average in Q3 of 2018-19 and overall incomplete standard has been and was consistently one of performance of 82% for the over 90%, well above the the top performers across the year compared to 87% in 2017- national average. country. 18. We had planned to achieve In 2018-19 we continued to Like emergency care, cancer the incomplete standard embed the Ambulatory Care has been a challenge nationally during Q3 of 2018-19 and Unit and Frailty Unit which have and many of the local issues made significant progress on a had a significant positive impact are also a reflection of national number of specialties, notably on the emergency care value challenges e.g. diagnostic neurology and dermatology, stream. We also undertook capacity. but further challenges around 36 Annual Report 2018-19 Performance

referral growth and internal capacity meant this ambition was not achieved in 2018-19 and now forms a key objective for 2019-20.

The six-week diagnostic standard (where patients waiting for a diagnostic test should have been waiting less than six weeks from referral) was achieved for ten of the 12 months of the year.

In January and March 2019 performance fell below expected levels when we saw un-precedented demand for Endoscopy as well as an MRI scanner breakdown.

Emergency department

Michael Wilson CBE Chief executive Date: 29 May 2019

37 Annual Report 2018-19 Performance

Digital conversations Twitter We continue to see a steady @sashnhs rise in visitors and traffic to our website and social media channels. Digital March 2018: March 2019: communications continues to be central to the delivery of Followers 11,256 11,928 communications activities at SASH and externally. 672 new followers in the past year Our website provides clear information which is easy to access and find, to our patients, visitors and staff. Our social media channels encourage LinkedIn www.linkedin.com/company/surrey-&-sussex- conversation among our social healthcare-nhs-trust media audience, promoting positive engagement. March 2018: March 2019: Our social media channels also Followers 1,904 2,473 raise the profile of the Trust and positively promote its work and reputation. 569 new followers in the past year The number of people engaging with SASH through our social media platforms continues to grow. You Tube www.youtube.com/user/sashnhs Website

1,176,773 page views (page March 2018: March 2019: views are the total number of pages viewed. Repeated Subscribers 209 313 views of a single page are counted). 27,911 views in the last year 71,925 minutes 295,554 users to the site, Most watched video: Your Operation at East Surrey Hospital 471,742 sessions (a session 9,986 views is defined as a group of interactions one user takes within a given time frame on the website. Google Analytics defaults that time frame to 30 minutes, meaning whatever a

38 Annual Report 2018-19 Performance

user does on your website (e.g. Facebook browses pages, downloads www.facebook.com/sash.nhs resources) before they leave, equals one session. March 2018: March 2019: 5,778 sessions came via Followers 2,461 3,156 social media (1.22% of sessions) 3,082 new likes in the past year Facebook 4,183 sessions 72.40% 695 new followers in the past year Twitter 1,241 sessions 21.48%

Instagram LinkedIn @sashnhs 326 sessions 5.64%

Instagram March 2018: March 2019: 12 sessions 0.21% Followers 684 1,098 414 YouTube new followers in the last year 3 sessions 0.05%

Other* 13 sessions 0.22% *Pinterest, Blogger, Weebly, Yammer

Pareeta Nayee, digital communications manager

39 Annual Report 2018-19 Our people

Who we are Who are we We have a workforce of over % of 4,200 people in a broad Staff group Headcount % female % male range of clinically registered workforce professions and support roles Add Prof and value everyone for the Scientific and 124 2.79 79.84 20.16 part they play in delivering Technic high quality care to our Additional patients through our one team Clinical 816 18.37 78.43 21.57 approach. Services Administrative Staff survey 885 19.93 83.84 16.16 National NHS Staff Survey and Clerical We received a fantastic Allied Health 213 4.80 84.04 15.96 response to the 2018 National Professionals NHS Staff Survey – over 64% Estates and of staff completed the survey 379 8.53 48.28 51.72 and our results were equally ancillary impressive. Whilst there have Healthcare 83 1.87 68.67 31.33 been amendments to the Scientists way the results have been reported, of the Key Findings Medical and 649 14.61 49.00 51.00 that are still comparable with Dental the 2017 survey, SASH scored Nursing and a ‘significant increase’ in 7 of Midwifery 1291 29.07 89.78 10.22 these and also a ‘significant Registered increase’ in staff engagement. Compared directly to other Students 1 .002 100 0.00 Acute Trusts, SASH were the top ranked for five of the key findings and in the top five Grand total 4,441 for 17 of the key findings. As well as being second highest nationally for staff engagement. the organisation reporting good We were third nationally for as a place to work communication between staff recommending SASH as or receive treatment senior management and a place to work and receive Percentage agreeing staff treatment. We continue to use that their role makes Percentage able the feedback from the survey to a difference to patients to contribute towards deliver improvements for staff. and service users improvements at Staff motivation at work work Where we are in the top five Recognition and value Staff satisfaction with Acute Trusts nationally of staff by managers and level of responsibility and Staff have fed back positively in the organisation involvement the following areas: Percentage of staff Quality of appraisals Staff recommendation of 40 Annual Report 2018-19 Our people

Staff satisfaction with relevant action. Overall FFT Scores 2018-19 resourcing and support Over the financial year our Percentage of staff Following the 2017 survey, Friends and Family tests score satisfied with we have already began work has been consistently over the opportunities with teams, particularly in the 93%. for flexible working Emergency Department, where patterns incidents occur more frequently Percentage of staff so we can understand how feeling unwell due incidents occur and what to work related stress in actions can be taken to Once again our last 12 months minimise these. The overall key national staff Percentage of staff finding scores have improved, feeling pressure to but we will continue our work survey scores attend work when feeling to ensure all of our staff have show how well unwell a safe environment in which Organisation and to work, without fear of abuse engaged staff management interest from service users, relatives are with the in and action on health and the public. and wellbeing organisation Percentage believing The data is used by the and that their the organisation Survey Coordination Centre provides equal (Picker Institute) in the NHS commitment, opportunities for career Benchmark Report, which dedication progression / promotion presents the data under Percentage of staff the four staff pledges and and support reporting their three additional themes of drives our on- most recent experience equality and diversity, errors of harassment, bullying and incidents and patient going journey or abuse experience measures. of continuous Fairness and effectiveness of Staff Friends and Family Test improvement procedures for The NHS Friends and Family Michael Wilson CBE reporting errors, near Test (FFT) are used widely Chief executive misses and incidents throughout the trust as a Staff feeling there is the measurement of patient effective use of patient feedback. FFT provide an and service user excellent learning tool for the feedback Trust to recognise issues that need to be addressed. Whilst this provides a positive overview, there is still work to All FFT results are provided do in relation to staff facing to divisions prior to monthly abuse, both physical and patient experience committee verbal from patients, relatives meetings; so that issues and and ensuring this is reported trends are discussed to seek so the Trust provides support solutions. appropriately and takes

41 Annual Report 2018-19 Our people

Overall FFT Scores 2018-19 Innovation and service development Over the financial year our improvement programmes Friends and Family tests score has been consistently over SASH values embracing new roles, 93%. for example, nursing Frontline employee of associate and the year advanced clinical practitioner Behind the scenes employee of the year leadership development One team - frontline team of the year developing internal educators and mentor SASH Star Awards – One team - behind the capacity recognising achievement scenes team of the The SASH Star Awards have year Our key areas of work / become a key date in the SASH successes aligned to strategic calendar and every year they Apprentice of the year objectives include: become bigger and better. Volunteer of the year Education and training policy 2018 marked our largest award development and establishing ceremony with over 210 staff NHS Lifetime the mandatory training group attending. The Awards are a Achievement to involve key stakeholders in real celebration of our staff and a programme of continuous the amazing contribution they Developing our staff improvement. make on a daily basis. We have been progressing work streams to support the Increased and maintained The quality and diversity of the implementation of the education mandatory training compliance nominations is a real testament and development strategy and exceeding the Trust KPI of to our staff. operational plan which was 80%. This has been achieved approved by the Trust Board in through a range of strategies To celebrate the NHS 70th January 2018. such as streamlining internal Birthday, we added an provision, increased reminders additional award for lifetime Five education objectives and closer working with key achievement. Our awards provide the framework for stakeholders. showcase and recognise the the underpinning operational excellent work SASH staff delivery plan aligned with Exceeded the Trust continuously delivers. Awards SASH’s strategic objectives. achievement review (appraisal) were presented for: Key work streams include: target of 90% and quality of appraisal is ranked as the Improving patient strengthening the highest for acute Trusts in the experience education governance 2018 national staff survey. structure Supporting diversity in Over 60 apprentice learners the workplace increasing engagement enrolled providing development for apprenticeship opportunities to existing staff.

42 Annual Report 2018-19 Our people

Booking and patient experience team

Deep cleaning team

43 Annual Report 2018-19 Our people

Programmes are offered over a consistent approach to external short courses and a diverse range of areas, for developing advanced practice academic programmes to example painting, hospitality, roles, applicable across all support continuing professional healthcare science, pharmacy professions. SASH has been development to support support, team leading and able to appoint a part time service delivery and specialist management, trainee nursing project lead for 12 months to development pathways. associates from levels 2 – 7. lead a project focusing current This is significant progress and future workforce needs, We facilitated access to from the previous year and education pathways and over 150 work experience enables the Trust to utilise governance to ensure patient placements for school the apprentice levy to support safety. students and charities seeking professional and career opportunities for people with development and create Developed SASH leadership learning disabilities. pipelines of talent. development framework and career development tool. SASH hosts a range of students Established trainee nursing Through working with a trusted on placements as part of their associate apprenticeship external partner and internal formal undergraduate training programme with 32 internal pilot groups we have developed with the majority in nursing and staff recruited onto programme a leadership framework at midwifery. Students who have between March 2018 and four different levels aligned to good placement experiences February 2019. The Trust has the trust values. The career and live locally often take up led work with partners across development tools provide roles at the hospital the STP to establish a Nursing current and aspirant leaders Associate Consortium working a means of self-assessing Our practice development with HEE and the training against the leadership team provides education and delivery partner the University framework and reflect on their training for nursing and support of Brighton. Trainees will readiness and development staff, covering clinical skills, complete a foundation degree needs for future roles. preceptorship, revalidation, and inter- organisational overseas recruitment, career placements across a range Increased participation development and the national of healthcare settings. On in personal development Care Certificate programme. successful completion staff programmes across a range of will be eligible to join the topic areas including customer Off-payroll engagements - NMC register in the new care, resilience and conflict Sometimes, it is necessary for role of Nursing Associate. resolution and we launched a the Trust to make use of the This role bridges the gap new foundation coaching skills skills of external contractors between nursing assistant and programme. rather than employed staff. At registered nurse and will play these times, we ensure that the a key role in providing direct Successful uptake of train the arrangements comply with our care. trainer workshops and mentor standing financial instructions training through academic and offer good value for money. Scoped and commenced modules and internal updates We also ensure that our project to develop a strategy to support development of our contracts require contractors for development and education internal faculty of educators to comply with the relevant of Advanced Clinical Practice and work-based supervisors. tax and national insurance roles. HEE has developed requirements. a new framework to provide We funded staff to complete

44 Annual Report 2018-19 Our people

In 2018-19, no members Mean hourly Male Female Diff% of staff were on off-payroll rate engagements for more than £245 per day and more than six AFC £13.82 £14.94 -8% months, (0 in 2017-18).

Staff engagement Staff engagement is key to Medical £34.52 £27.76 20% SASH being able to deliver high class quality and safe care to our patients. It is known that engaged and motivated staff Median Male Female Diff% improve patient outcomes. hourly rate

Our staff engagement score in AFC £11.83 £13.63 -15% the 2018 national staff survey improved from the 2017 survey and we were the second highest ranked acute trust Medical £34.68 £26.47 24% nationally for this.

We have a well-established network of different forums and work is a legal requirement that all mediums to engage with staff Divisionally-led organisations with over 250 or including: briefings and team more employees publish data meetings about their gender pay gap on TeamTalk briefings an annual basis. As well as hosted by the chief Freedom To Speak reporting via the Government’s executive Up Guardian and FSUG online reporting portal, SASH Ambassadors also publish this data on their Chief executive’s website. weekly message Guardian of Safe Working The gender pay gap shows the Annual NHS Staff difference in the average pay Survey: The response Our established staff between all men and women rate for the Trust engagement strategy supports in a workforce. If a workforce was 64% in 2018, ongoing work to ensure that has a particularly high gender which was the 4th all our staff maintain a strong pay gap, this can indicate there highest nationally connection with the vision and may be a number of issues to values of the organisation. deal with, and the individual Quarterly Staff Friends calculations may help to identify and Family Test Addressing the gender pay what those issues are. gap Regular meetings with Gender pay gap reporting The gender pay gap shows the trade union colleagues came into effect from 6 April difference between the average 2017, with the data being (mean and median) earnings SASH+ improvement published from April 2018. It of men and women. This is 45 Annual Report 2018-19 Our people

expressed as a percentage of The Trust is developing actions men’s earnings. to reduce the pay gap (e.g. supporting female medical and Our gender split by pay-band dental staff applications for shows that the significant excellence awards). We will majority of band 2 to 8a’s are also be looking more widely at female while the split is more the pay gap for other protected even at higher bands: characteristics.

46 Annual Report 2018-19 Our people

Imaging and diagnostics

47 Annual Report 2018-19 Our people

Equality, diversity and human strategy based on feedback rights from staff, service users, and During 2018-19 we finalised other groups as appropriate to and launched the SASH One supports the delivery of this. Team Inclusion Strategy. This We have also met our Public sets out our vision to ensure Sector Equalities Duties. that inclusion is central to everything that we do. Freedom to Speak Up The Francis Inquiry report and We have set up an executive subsequent reports including Catherine Sharpe level Inclusion Steering Group, the Freedom to Speak Freedom to speak up (ISG), which is chaired by Up review highlighted the guardian the SASH Director of Kaizen. need for organisational culture This ISG meets monthly and change across the NHS. of doctors in training in relation its purpose is to oversee the to their working hours, work on-going development of a In light of the recommendations, intensity, ability to have fully inclusive environment SASH has an independent adequate rest breaks during and culture at SASH. This Freedom to Speak up their working hours, and to will provide a framework for Guardian and Safer Working ensure that they are able inclusion for our staff, our Guardian. The role of the to attend their educational patients and service users, and Freedom to Speak up Guardian activities unimpeded. While the wider community. is to encourage and support the Guardian is accessible staff to raise concerns and at anytime when needed, We held our first Trust- ensure that the voice of the formal channel of wide inclusion conference our people is heard clearly communicating the difficulties in February 2018, which at a senior level within the that arise is through the usage celebrated inclusion at SASH. organisation. They have a clear of 'exception reporting' which is This event included internal and remit from the chief executive done electronically. external speakers as well as and the Trust Board to act performances from the Include freely, with complete autonomy Once submitted, there is a Choir. from the management team, clear pathway by which the From the 2018 Staff Survey as an alternative route for issues arisen are attended results, 74% said that the issues of concern to be raised to by the supervisors of the organisation made adequate at the highest level. The trainees involved and a well adjustments to enable them to Trust also has an established laid out escalation options. do their job (which is above the Safer Working Guardian who The Guardian reports directly national average). oversees the wellbeing of our to the Trust Board but also junior doctors. have access to the Chiefs and We have a duty to ensure executives when needed. we provide equal access Guardian for Safer Working and opportunity to all of our In accordance to the Junior The Guardian is required to people, whether they are our Doctors Contract 2016, the provide a formal report to staff, patients or the public and Trust appointed Dr Virach the Trust Quarterly and the regardless of whether they Phongsathorn as our Guardian Guardian's Board Reports have a protected for Safe Working Hours in are embedded on the Board characteristic. We will continue June 2016. The Guardian's Agenda which is accessible by to develop our inclusion role is to oversee the welfare the general public.

48 Annual Report 2018-19 Our people

Freedom to speak up The speaking up process

49 Annual Report 2018-19 Our people

Surrey Choices We continue to work in partnership with Surrey Choices to offer work experience to young adults with disabilities.

The aim is to equip young disabled people with the skills and confidence they need in order to live independent and fulfilling lives and to be able to gain paid employment. Work experience is a key element of this process giving students the opportunity to experience the work place and develop their communication and job- related skills. A small number of students have benefitted from this opportunity.

The Trust has also offered work experience to a mature student seeking to develop confidence and skills to secure employment after a period of mental health illness.

We remain committed to Lesley Copus, occupational health supporting all members of our community to have equal access to employment. Black, Asian, minority ethnic staff network (BAME)

50 Annual Report 2018-19 Our people

Black, Asian, minority ethnic especially at senior level and set-up a steering staff network (BAME) Ensure that all minority group (currently seven groups have a voice and members) The role of the Black, Asian, feel supported and Promoted the network minority ethnic (BAME) staff valued trust-wide and increased network is to be an independent Assist and influence membership including voice for staff from a black, policy and decision dedicated section on Asian and minority ethnic making reflective of SASHnet backgrounds. It is also to equality, diversity and Confirmed CEO board ensure the NHS delivers on inclusion champion the NHS England workforce To provide opportunities Contributed to the race equality standard and for diverse individuals to recruitment of Freedom to support SASH to meet its come together, support to Speak Up statutory duty to promote each other and share Ambassadors (FSUA) racial equality, eliminate ideas now included five staff discrimination and promote To continue to improve from BAME backgrounds inclusion. outcomes and the Participated and gave experience for BAME feedback in the BAME The BAME network is an patients treated within focus group as part of inclusive staff network, open our organisation the recent CQC to all including non BAME inspection members who are interested As well as creating better Input in the development promoting race equality and opportunities for BAME staff of the Trusts One Team inclusion. The SASH BAME within the Trust, the network Inclusion Strategy staff network was launched in gives members of the network Facilitated a BAME 2017-2018 and now has over access to a forum for support, session with Mental 60+ active members. support policy development and Wellbeing and build relationships with different Resilience workshop The objectives of the BAME groups within the organisation. Celebrated Black History network are to: Month Achievements of the network Circulate training, Improve the in 2018/19 development representation of BAME Re-launched the opportunities to network staff within the Trust network members

51 Annual Report 2018-19 Our people

Finance team #CelebratingDiversity at SASH during Black Histoty Month

52 Annual Report 2018-19 Our people

‘The BAME vision is to be an following up all work-related Read with our book independent and effective staff absences and incidents to club voice for BAME staff, patients, create a safe and supportive Receive the flu service users and carers to environment for our staff; vaccination ensure SASH delivers on its developing and expanding statutory duties regarding race our training programmes Our Volunteers equality.’ has improved reporting and Volunteers continue to play an compliance of health and safety important role in supporting Gillian Francis- Musanu incidents. our staff and patients and as Director of corporate affairs and part of the NHS long term Company Secretary plan, the Trust will continue and Chair of the BAME staff to build on our successes of network steering group working with volunteers.

Accessing hard to reach Wellbeing and SASH active The volunteer workforce is We are keen that staff take care groups a loyal and highly dedicated Patient experience lead is of their wellbeing and we have group, many of whom have working closely with the promoted regular wellbeing worked at SASH for many Engagement and Partnership activities through our SASH years, six having worked Officer from Surrey County Active campaign. The wellbeing at the hospital for over 25 Council, to build relationships day that was delivered in years, making an invaluable with the hard to reach groups. September 2018 was the most contribution to the local The target groups are successful to date, with some community. Disability, End of Life, Travellers 52 exhibitors and more than and BAME. The aim is to 800 attendees. Volunteers are a valuable understand and find ways asset whether their work that the Trust can be more As part of our commitment involves sitting with an accessible to these groups. to staff wellbeing we have anxious patient, providing Occupational health, safety and continued to develop our SASH reassurance, cutting up a wellbeing Active programme, which patient’s food or providing Occupational Health continues provides opportunities for staff reception support in the to take a proactive approach to engage in a wide range of evenings. towards staff health, wellbeing activities which support both and safety. This year the mental and physical wellbeing. Key areas of focus in 2018- department has supported the We offer staff the opportunity 19, included a programme recruitment of staff, (processing to: of training for all volunteers 2587 pre-employment requests and the development of for all types of staff); providing Sing in the SASH NHS new roles. Dementia, basic clinics and consultations, Community Choir life support, statutory and (which are delivered by a Take part in circuit mandatory and feeding specialist team of nurses and training training have been delivered. a visiting doctor); contributing Have a massage and New roles have included towards staff safety by more other complementary hospital hosts, mealtime than doubling the number therapies at reduced support, speech and language of immunisations and blood rates support, and providing tests undertaken in year, (eg. Walk with Colleagues at assistance with physiotherapy for measles, MRSA and TB); lunchtime and Mouthcare Matters.

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The Trust works closely with of information and support partner organisations to provide Our volunteers volunteers, therapists and volunteering opportunities are a key asset activity teachers, and the and this year there have been service continues to offer several success stories with to SASH, and crucial support to those affected volunteers transitioning into year on year by cancer. paid employment within the hospital. our volunteer Work experience students programme and career events The volunteer trolley service The Trust recognises the continues to be a popular continues to importance of offering work service and provides snacks grow. The range experience opportunities to and drinks to patients and their young people to encourage visitors at the bedside. The and scope of a career in healthcare. We scope of the trolley service has volunteering is aim to provide insight into been increased to three days a chosen career which may a week and there are plans fantastic to see assist young students in the to further extend the hours and I thank all of decision to pursue a specific of operation. Funds raised career. Placements are highly from the service have allowed our volunteers sought after and we offered 176 volunteer uniforms to be for their time and placements during 2018-19. purchased, volunteer marketing It is a great way to encourage material to be developed and dedication to future generations and put several events to be hosted supporting the students on a career path to for volunteers celebrating their becoming NHS staff of the work and contribution. Trust deliver first future. class care Radio Redhill has 70 volunteers The Trust’s many professional who visit the hospital wards Richard Shaw groups represented their talking to patients, collecting Chair chosen discipline at local their 8000 music requests every career events. Two events were year and then playing them on Mayor of Reigate and Banstead hosted by SASH: Meet the the daily request programmes. for her service to hospital radio. Practitioner and our Health and Radio Redhill can be heard on Social Care Autumn career fair ward headsets and on personal The Macmillan Cancer Support which we both hugely popular radios on 1431AM and online. Centre is open to anyone and successful. Practitioners affected by cancer and offers reported a high level of interest Highlights over the past year holistic care in a relaxed, and informed questions and include winning a Gold Award quiet space. The centre offers welcomed the event as an in the 2018 Hospital Radio support and information, opportunity to share their Association Awards for our as well as complementary passion for their profession. entry covering the visit of therapies, psychological and the Flying Scotsman to the emotional care, activity groups, Apprentices Bluebell Railway. Sian Wallis, a for example yoga and art, and Apprenticeships align with committee member and trustee various courses and groups. the widening access agenda of Radio Redhill, received a Led by the Centre Manager, to aid the recruitment of staff Volunteers Award from the there is an increasing team from our local community and

54 Annual Report 2018-19 Our people

provide our substantive staff associates, SASH currently has the opportunity to undertake staff enrolled on programmes in vocational learning to enhance the following subject areas: their career development. The landscape of business administration apprenticeships is team leading changing and this year health and social care saw the introduction of the pharmacy services apprenticeship levy which food production and requires employers with an cleaning annual wage bill of over £3m to contribute 0.5% into During National Apprenticeship a levy account which is then Week we were delighted to ring fenced to spend on celebrate the achievements of apprenticeship training. 16 colleagues who successfully achieved their apprenticeship The introduction of the levy has qualification in subjects ranging provided opportunity for new from cleaning and hospitality to schemes such as the nursing business administration, team associate apprenticeship leading and management. programme that we are Other healthcare specific running in conjunction with the apprenticeship development University of Brighton. programmes we are hoping to introduce in the coming year Eleven SASH trainee nursing include: assistants have been successfully selected on to this Healthcare support programme as part of a cohort worker levels 2 and 3 of over thirty trainees together Healthcare science with six NHS partners across levels 2,4 and 6 the region. Once qualified, Assistant practitioner nursing associates will deliver level 5 care with a wider skill set Advanced clinical enhancing their overall scope practitioner level 7 of practice, and complementing the work of registered nurses. The Trust also plans to introduce management This will ultimately enhance the apprenticeship development way patient care is provided programmes from level 3 and increase capacity within the upwards. healthcare professions. The apprenticeship levy provides a great opportunity for the Trust to offer a wide range of apprenticeship development programme for existing staff. In addition to the trainee nursing

55 Annual Report 2018-19 Our people

The Friends of East Surrey Hospital The aim of The Friends of East Surrey Hospital* charity is to supplement the service provided by the hospital for the comfort and welfare of patients, staff and visitors, by the provision of equipment and amenities and by supporting the voluntary work of the hospital.

The Friends of East Surrey Hospital run a coffee shop in the east entrance of East Surrey Hospital. This is the main source of income for the charity and is run entirely by volunteers.

The Friends of East Surrey Hospital have donated nearly £4.0m to the Hospital since 1990.

In 2018, the Friends of East

Surrey Hospital made 23 grants Richard Burford BEM, chair The Friends to SASH totalling £236,000 of East Surrey Hospital including: chairs for the Sunshine for the Front Desk at the £76,000 for a Liver Nursery Main Entrance Fibroscanner £1,700 for four CD The Sunshine Nursery’s £50,000 for a Specialist players for Radio Redhill annual outing echocardiograph Other grants were made Christmas gifts for the £11,000 for 15 Z beds for to support; wards and departments Palliative Care The Hospital gardens £4,000 for tables and Floral arrangements *charity number 287535

56 Annual Report 2018-19 Our environment

Sustainability at SASH (Care Without Carbon) Our vision to pursue perfection in the delivery of safe, high quality healthcare that puts the people in our community first is intrinsically linked to developing a truly sustainable approach healthcare. With this as a guiding principle, we are working towards three key aims:

long term financial sustainability minimising our impact and even having a positive impact on the environment supporting staff wellbeing to enable a healthy, happy, productive workforce

We have set out how we will achieve these aims in our Sustainable Development Management Plan (SDMP) called Care Without Carbon framework for sustainable expertise at the Trust. (CWC) at SASH. CWC sets healthcare, with work streams Key highlights from 2018-19 out the actions we need to take covering seven different across seven elements of the elements. See SASH’s seven Highlights from our organisation to ensure a co- elements of sustainable sustainability programme ordinated approach. healthcare illustrated above. this year include: The seven elements are The Trust’s director of driving change designed to integrate information and facilities is our across our Sussex sustainable thinking and executive lead for sustainability, and Surrey planning, into core operational and each of the seven elements Sustainability activities so that it becomes part has a senior lead within the and Transformation of business as usual and key to Trust. Responsibility for delivery Partnership (STP) the way the Trust functions. of each element sits with this senior lead, who is also area through a joint Energy Delivering more sustainable tasked with ensuring that this Performance Contract healthcare through our seven sustainability programme aligns (EPC). This will elements with any strategic goals and deliver new energy Our SDMP adopts the CWC priorities within their area of

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saving infrastructure to our main hospital site, saving the Trust money and cutting our carbon footprint over 15 years

working with local NHS trusts to deliver a joint waste tender, bringing cost savings and setting stringent KPIs for our contractors to help us deliver against targets set in our SDMP

launching a new staff engagement programme, Dare to Care, to support delivery of our SDMP

cutting our plastic use within the Trust through switching to compostable cups in our restaurant, and launching a staff pledge to use #oneless piece of plastic

transferring onto a renewable energy contract on 1 April of waste. We also transport our absolute carbon footprint 2018 Trust staff, patients and goods, by over 2,238 tonnes CO2e and purchase a large range of (24%). We are very close to securing £500,000 in medical and other equipment our in-year target for 2018-19, funding for LED and services. All of these marking our trajectory towards lighting from the activities generate carbon a 2020-21 target of 34% Department of Health dioxide (CO2) emissions, reduction, in line with national which are linked to climate NHS requirements (see SASH Environmental impact change, and can be collectively carbon emissions to 2020-21 Our carbon footprint summarised as our carbon diagram, shown right). In delivering our services footprint. we consume a significant Note: Figures relate to our amount of energy and water Since our baseline year of primary site, East Surrey and produce a large volume 2014-15 we have reduced Hospital only. Due to the date of

58 Annual Report 2018-19 Our environment

SASH carbon emissions to 2020-21 CO2e is the standard unit for measuring carbon footprints. It reflects the impact of all six greenhouse gases that cause global warming including carbon dioxide and methane. This is important as some of the gases have a greater warming effect than carbon dioxide.

CO2e from our buildings.

Our progress: The energy we use to heat, publication of the annual report, of the seven elements of the cool and power our buildings is we have estimated some of the SDMP. This year we are in the most significant contributor data reported here. Scope 3 the progress of reviewing our to our Trust’s carbon footprint. emissions for waste disposal SDMP with a view to revising it We have reduced absolute and procurement (supply chain) in line with the NHS Long Term CO2e from building related are not currently included in our Plan 2025 requirements. This energy consumption by 24% carbon footprint due to lack of commits NHS trusts to 2025 between 2014-15 and 2018-19 reliable conversion factors. Climate Change Act targets (2,240 tonnes CO2e in total). of 51% reduction in carbon Key highlights and projects for Progress against our seven emissions, as well as including the year ahead include: elements targets around travel and air successfully progressing pollution. our STP-wide EPC Leadership: project and aiming Leading the way for sustainable Over 2019-20 our key priorities to appoint a contractor healthcare policy and practice. will be to: towards the end of publish an updated 2019-20 moving to 2020 target: publish an annual SDMP to reflect these a new utilities sustainability report tracking requirements oversee management database progress against the SDMP delivery of this SDMP to improve operational Care Without Carbon at SASH. through our sustainability energy management and In particular showing how the steering group and emissions reporting key SDMP targets are being report to Board regularly securing £500,000 in met. through a set of funding for new LED sustainability KPIs lighting from the Our progress: Department of Health We have expanded the Buildings: providing the a key project for 2019- reporting on sustainability within workspace for low carbon care 20 will be to update the Trust’s Annual Report to delivery with wellbeing in mind. our carbon targets cover progress against each 2020 target: 34% reduction on to 2025 in line with

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the NHS Long Term Plan working with STP disposed of via an commitment of 51% partners to implement energy from waste plant, reduction by 2025 most relevant which generates recommendations from electricity and road The Trust moved onto a the Courier Services aggregate renewable electricity contract Review working with local on the 1 April 2018 and we developing our approach NHS partners to are currently investigating a to sustainable travel and successfully delivery a better way to reflect this in set targets to cut the joint waste tender. New our reporting of emissions mileage associated contractors are now in associated with electricity. As with delivery of our place, saving the trust a result of this procurement services in line with NHS money and introducing decision emissions from our Long Term Plan KPIs to support the consumption when using requirements delivery of this SDMP contract-specific emissions developing achieving zero waste factors was 0 tonnes CO2e, measurement and to landfill across all whilst when applying the grid reporting processes to our waste streams, factor they were 3,469 tonnes track progress against including of CO2e. our Travel Plan targets implementation of a new scheme Journeys: Circular economy: this year diverting maximising the health benefits creating and supporting an all of our offensive of our travel and transport ethical and resource efficient waste to a local activity whilst minimising supply chain. energy from waste environmental impacts. plant. This has cut our 2020 target: 34% reduction in 2020 target: waste to landfill, saved all measurable travel CO2e. engage suppliers in reducing the Trust money and impact on the environment reduced the Our progress: environmental impact The NHS accounts for five Our progress: of the waste through percent of all road traffic We’ve made significant cutting the emissions in England and travel is progress this year towards associated with responsible for 13 percent our targets of zero waste to waste collections of the NHS carbon footprint landfill and 75% recycling – reviewing the options around 350,000 miles each as well as moving towards for implementation of year with associated cost and taking a broader approach reusable sharps next carbon impacts. to procurement and circular year, as well as a economy. In particular: food waste stream During 2019-20 our specific increasing our offensive next year we will be areas of interest are: waste by 60% since working with our developing a business 2017-18 (reducing use of procurement department case for investment in clinical waste) to develop our approach electric vehicle we no longer send any to circular economy in charging points for staff, domestic waste to more detail reintroducing the cycle to landfill, all of the work scheme and general waste we Culture: introducing car sharing. generate is now informing, empowering and

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motivating people to take suffered work related stress and procurement, working with the ownership of sustainable increase the percentage of staff Carbon and Energy Fund to healthcare. participating in physical activity support carbon and cost savings during the working day, including across the STP system through 2020 target: active travel to work. energy improvements 100% of Trust staff to receive training on sustainability on Our progress: Joint waste procurement healthcare, including carbon Through the Dare to Care with four local NHS trusts, reduction and climate change engagement programme we have working with new adaptation, as appropriate to introduced several dares that contractors to deliver their role. have a wellbeing focus, including against stringent new ‘take a walk’ and ‘drink every KPIs Our progress: drop’. These dares have the After an initial piece of work benefit of improving wellbeing, For 2019-20 our priority will to to establish staff views on but also of reducing our impact further develop our work around sustainable healthcare we on the environment. climate change adaptation, in launched Dare to Care, an In January/February 2019 particular through an STP wide ongoing staff engagement we launched the ‘Step Up climate change risk assessment programme to support delivery Challenge’, inviting staff to walk to understand the impact climate of CWC. The programme allows a virtual route over 12 weeks change will have on our buildings staff to take an active part in which supports 10,000 steps per and delivery of our services. creating a more sustainable day. The challenge ran across 3 healthcare service. trusts enabling us to benchmark against other NHS organisations. Dare to Care launched in Results are still being processed November 2018 with a selection at the time of going to print. of 11 dares (a dare is a small pledge to do something Future: differently) focused on reducing supporting a strong local health our impact on the environment, economy to serve our economy and improving wellbeing. A now and in the future key aspect of our engagement 2020 target: annual climate methodology is to link healthy change adaptation assessment behaviours with sustainable undertaken as routine component behaviours, an approach tried of resilience and business and tested by SCFT over the past continuity procedures. four years. To date 445 dares have been taken by 81 staff. Our progress: Our aim is to have 500 dares by Working with our STP partners November 2019. to develop joint sustainability projects to support our own Wellbeing: Trust sustainability goals, and to creating a better working life for broaden our impact across the our people. region by working together. 2020 target: reduce sickness rate to 3.5%, reduce the percentage Projects include: of staff reporting that they have • STP-wide joint EPC

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Our governance director (non-voting) necessary financial, human and The chief executive and physical resources are in place and assurance accountable officer to enable the Trust to meet We remain committed to Chief finance officer and its priorities and objectives ensuring that our governance deputy chief executive and periodically reviewing systems and arrangements are Chief operating officer management performance cohesive and ensure that our Medical director approach is co-ordinated and Chief nurse ensuring that the Trust combined. Our directors’ report Director of information complies with these rules follows: and facilities (non-voting) of procedure; Director of corporate standing orders; Our Board of directors affairs and company standing financial Our Board of Directors consists secretary (non-voting) Instructions; scheme of five voting executive directors Director of people of delegation and and six non- executive directors and organisational statutory obligations at (including the chair) and development (non- all times meets every month in public. voting) The minutes and papers are Board members: statement of made freely available and this Other senior employees attend director responsibilities and includes publishing them on our as the Board of Directors declarations of interest website: www.surreyandsussex. considers appropriate. The nhs.uk/boardpapers Board of Directors provides Non-executive directors assurance and leadership (NEDs): Non-executive There are two additional non- of the Trust towards the directors have a wide variety executive directors and three achievement of corporate of experience in the voluntary, additional executive directors objectives and oversight of the public and private sectors. who are non-voting. Voting framework of sound internal They are all part-time. Their rights apply should the Board controls, risk management and declarations of interest for be unable to reach a consensus governance in place to support 2018-19 are: on a specific issue. their achievement. Richard Shaw, chair (from Members of the Board and The Board of Directors is 01.11.18) chair of safety additional Directors also responsible for: and quality committee (until meet for Board development setting the Trust’s 30.11.18) seminars strategic aims on a regular basis. setting the Trust’s values Governor of Brooklands and standards College of Further Membership of the Board of the safety and quality of Education directors services Alan McCarthy, chair A non-executive chair holding the organisation (until 30.09.18) with a second and to account for the Chair of Charity casting vote if necessary delivery of the strategy Commissioning Five non-executive and through seeking Performance for Sick directors assurance that systems Festival Designate non-executive of internal control are Trustee of Brighton director (non-voting) robust and reliable Dome and Festival Associate non-executive ensuring that the Board

62 Annual Report 2018-19 Accountability

Vice-chair Brighton Owner/director – David Programme Aldridge Community Sadler Advisory Ltd Academy Director Coach Paul Simpson, chief finance Trustee of Albion in the Associates Ltd officer and deputy chief Community Daphnee Pushparajah, executive Expert advisor to (Associate non-voting Interim Chair of NHS London Borough of until 30.11.18) STP Finance Group Camden on Chalcots Director of Vaneal Trustee of Gamble Estate Review Ltd Associate Director Aware of Engagement Richard Durban, vice chair and - UCB (global Dr Ed Cetti, medical director interim chair (from 01.10.18 – biopharmaceutical (from 01.01.19) 31.10.18) company) No declarations Magistrate (Justice of the Peace) on Surrey Bench Executive directors Dr Des Holden, medical director Paul Biddle, chair of The executive directors are (until 31.12.19) audit and assurance all full-time employees of Medical director of Kent, committee the Trust. Details of their Surrey and Sussex Non-executive director remuneration can be found in Academic Health W&J Linney Ltd the remuneration report section Science Network (one Trustee, Macfarlane of this report. day per week) Trust Non-executive director Pauline Lambert, senior Michael Wilson CBE, chief (NED) of South East independent non- executive Health Technology executive director Special Advisor for the Alliance Part-time Clinical Care Quality Paediatric Safeguarding Commission (CQC) Jane Dickson, chief nurse (from Named Nurse at Honorary President 01.04.18) Queen Victoria Hospital of the East Surrey Director of Mull Moments NHS Foundation Trust Branch of the NHS Ltd Caroline Warner, chair Retirement Fellowship of charitable funds CEO representative Fiona Allsop, chief nurse (until committee and chair of on the Programme 01.04.18) safety and quality Board for Health Specialist advisor, Care committee from Education England Quality Commission 01.01.19) Chair South East Coast (CQC) Councillor Tandridge Regional Talent Board District Council (until Visiting Professor at Angela Stevenson, chief October 2017) Surrey University operating officer Member Consumer Member of the Health Shareholder in Kate Council for Water Education England Tele- Grimes Ltd, Executive Member Fairchildes enhanced Learning Life Coaching Academy Community Programme Trust Member of the Gillian Francis-Musanu, director National Trust Guiding of corporate affairs (non-voting David Sadler, chair of finance Board – Virginia member) and workforce committee Mason Institute Home Office Authorised

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Person (Marriage Registrar): committee sets out the remit of scrutiny of the processes London Borough of Hounslow responsibility delegated by the implemented in relation to and City of Westminster Board of directors and sets out governance, risk and internal Member of Hillingdon the information requirements of control and reviews and Hospital NHS the considers the work of internal Foundation Trust committee, how it should and external audit. interact with the information it Mark Preston, director of receives and use this to reach The committee shall also people and organisational a conclusion about assurance. review and challenge the development (non-voting Where assurance cannot be Trust’s information assurance member) robustly established the chair framework to ensure that there No declarations of the committee reports this to are appropriate controls in the Board of directors. relation to data quality. Ian Mackenzie, director of estates and facilities (non- The Board of directors receives Nomination and remuneration voting member) a report from each chair at committee Member of Frimley every public board meeting. On To appoint and, if necessary, Health NHS Foundation receiving a report that identifies dismiss executive directors, Trust a lack of assurance in relation establish and monitor the Member of Royal Surrey to an aspect of the business the level and structure of the total County NHS Foundation Board of directors can either reward for executive directors, Trust hold the chief executive to ensuring transparency, fairness, Member of Surrey and account (managerial aspects) consistency and succession Borders NHS Foundation or seek independent assurance planning. Trust by referring the matter to its audit and assurance committee. The committee shall receive Our clinical chiefs of service reports from the chair of are members of the executive Core Board sub-committee the Board of directors on committee to ensure the right structure the annual appraisal of the clinical balance of decision The key functions of the Board chief executive; and from making. sub-committees are: the chief executive on the annual appraisals of executive Key committees Audit and assurance directors, as part of determining The Board of directors has committee their remuneration. The authorised a number of Meets a minimum of five committee meets at the request committees to scrutinise times a year to conclude upon of the chair of the Board and at aspects of the work of the Trust. the adequacy and effective least twice per year. Each committee is chaired by operation of the Trust’s overall a non-executive director with internal control system which Safety and quality committee a membership that (apart from includes financial and clinical meets monthly and has charitable funds and the audit assurance. It is the role of delegated authority to ensure and assurance committee the executive to implement the on-going development which is a non-executive a sound system of internal and delivery of the Trust’s membership) always includes control agreed by the Board safety and quality strategy the chief executive. of directors. The audit and and that this drives the Trust’s assurance committee provides overall strategy. The duties of The terms of reference of each independent monitoring and the committee shall ensure

64 Annual Report 2018-19 Accountability

the implementation, delivery to consider, on a rolling basis, then discussed and challenged and monitoring of the Trust’s managerial delivery of the at the Trust Board prior to its quality and clinical strategies. Board of directors’ strategy, acceptance. The BAF and The committee shall also be quality of services provided significant risk register are responsible for managing the and the effectiveness of risk presented at each public Board safety of patients through management, the delivery and meeting. ensuring compliance and the management of all performance implementation of effective and the management of each Accountability internal controls. clinical division. Each director confirms that they have taken all the steps that Finance and workforce Five executive sub-committees ought to be taken as a director committe have been formed to both in order to make them aware meets monthly to assist the guide management decisions of any relevant information Board of Directors in exercising and provide assurance for that should be shared with the its governance in delivering safety; responsiveness; Board and its auditors. one of the Trusts five strategic clinical effectiveness; patient objectives, namely Well Led. experience and workforce. The directors are required The following areas are the under the National Health constituent parts of the Well Board assurance framework Service Act 2006 to prepare Led objective within the remit The Board Assurance accounts for each financial of the Committee: finance and Framework is a key element of year. The Secretary of State, use of resources; workforce; the Trust’s system of internal with the approval of HM estates; IT; productivity and control. It provides a clear Treasury, directs that these procurement. The Committee methodology for the focused accounts give a true and fair will review five processes of management of risks in the view of the state of affairs of Well Led, namely: assurance; delivery of the Trust’s strategic the Trust and of the income and performance; planning; strategy objectives. expenditure, recognised gains preparation and implementation and losses and cash flows for and investment decisions. The executive team oversees the year. In preparing those and reviews the assurance accounts, the directors are Charitable funds committee framework, which is then required to: Meets three times a year discussed and challenged to oversee the generation, at the Trust Board prior to its apply on a consistent management, investment and acceptance. The assurance basis accounting policies disbursement of charitable framework and the Significant laid down by the funds (SASH Charity) within Risk Register are presented Secretary of State with the regulations provided by the monthly to the public Board. the approval of the Charities Commission. Significant risk register Treasury; Details all risks on the Trust make judgements and The executive committee risk register system that are estimates which are and executive committee for recorded as significant and reasonable and prudent; quality and risk link to the Board assurance state whether applicable The executive committee meets framework (BAF). The accounting standards weekly and a twice monthly executive committee oversees have been followed, executive committee for quality (through the head of corporate subject to any material and risk which is supported governance) the maintenance departures disclosed and by series of subcommittees and review of the BAF. It is explained in the

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accounts. *As Accountable Officer, the Chief Executive has an open The directors are responsible invitation to attend each Board for keeping proper accounting sub- committee. records which disclose with reasonable accuracy at any Signed: time the financial position of the Trust and to enable them to ensure that the accounts comply with requirements outlined in the above mentioned direction of the Secretary of State. They are also responsible for safeguarding Michael Wilson CBE the assets of the Trust and Chief executive hence for taking reasonable steps for the prevention and Date: 29th May 2019 detection of fraud and other irregularities.

The directors confirm to the best of their knowledge and belief they have complied with the above requirements in preparing the accounts.

The directors confirm that the annual report and accounts, taken as a whole, is fair, balanced and understandable and provides the information necessary for patients, regulators and stakeholders to assess the NHS Trust’s performance, business model and strategy.

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Directors’ membership of Board sub-committees

Audit and Nomination and Safety and Finance and Charitable assurance remuneration quality workforce funds committee committee committee committee committee

Chair Chair Chair Chair Chair Paul Biddle Richard Shaw Caroline Warner David Sadler Caroline Warner (from 01.11.18) (from 01.01.19) Richard Durban Richard Shaw (01.10.18 until (until 31.11.18) 31.10.18) Alan McCarthy (until 30.09.18)

Members* Members* Members* Members* Members* David Sadler All NEDs Alan McCarthy Paul Biddle Pauline Lambert (from 01.10.18) (until 30.09.18) David Sadler Paul Biddle Chief (Caroline Warner Pauline Lambert Richard Durban finance officer from 01.11.18) Caroline Warner Daphnee Chief nurse Richard Durban (until 31.12.18) Pushparajah Director of (until 30.09.18) Richard Durban (until 31.11.18) corporate affairs Richard Shaw (from 01.10.18) Chief finance Director of (until 01.11.18) Chief nurse officer information and Medical director Director of facilities Chief operating people and officer organisational In attendance Chief finance development Chief finance In attendance officer Clinical Director of officer Director of Chief executive chiefs information and corporate affairs director of facilities Director people and of corporate Other members organisational affairs of the executive development Chief nurse Chief and non- operating officer executive team are invited to attend as and when required

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Annual governance on pay rates and market rates. Pay rates for other senior statement managers are determined in (to be included) accordance with Agenda for Change job evaluations and central NHS review body pay Remuneration awards. Pay rates for the chair and non-executive directors and staff report of the Trust are determined including payroll by the Secretary of State and outlined in NHS Improvement statement guidelines. This report includes details regarding senior managers’ We do not operate any system remuneration in accordance of performance related pay. The with Section 234b and performance of non- executive Schedule 7a of the Companies directors is appraised by the Act. We have an established chair. The performance of the Nomination and Remuneration chief executive is appraised Committee to advise and by the chair. The performance assist the Board in meeting of Trust executive directors our responsibilities to ensure is appraised by the chief appropriate remuneration, executive. allowances and terms of service for the chief executive The chief executive and all and directors. Membership of directors are on permanent the Committee comprises of the contracts as at 31 March 2019 Trust chair and non-executive and subject to six months’ directors. The chief executive notice period. Termination or the other executive directors arrangements are applied can be invited to attend in an in accordance with statutory advisory capacity (except in regulations as modified by relation to their own terms and national NHS conditions conditions). of service agreements and the NHS pension scheme. The director of people and Tables attached show details organisational development of salaries, allowances and attends the committee as any other remuneration and adviser and is responsible pension entitlements of senior for taking minutes of the managers. No significant meetings. The chief executive awards have been made in the and directors’ remuneration past year to senior managers. is determined on the basis of reports to the remuneration The sections below are subject committee taking account of to audit. any independent evaluation of the post, national guidance

68 Annual Report 2018-19 Accountability

Dr Martin Dachsel, acute medicine consultant

69 Annual Report 2018-19 Accountability

Salaries and allowances 2018-19 Name Title (a) (b) (c) (d) (e) (f) Salary Expense Performance Long term All pension-related TOTAL (a to and fees payments pay and performance pay benefits (bands of e) (bands of (bands of (taxable) bonuses (bands and bonuses (bands £2,500) £5,000) £5,000) total to of £5,000 of £5,000) nearest £100 Executive Directors Cetti Edward Medical Director 20-25 0-5 25-27.5 50-55 Dickson Jane 115-120 1 247.5-250 365-370 Chief Nurse Francis-Musanu, Mrs. Gillian Director of Corporate Affairs 95-100 52.5-55 150-155 Josephine Holden, Mr Desmond Medical Director 100-105 10-15 0 115-120 Philip

Mackenzie, Mr Ian Duncan Director of Information and 105-110 0 105-110 Facilities

Preston, Mr Mark Director of Organisation 110-115 30-32.5 145-150 Development and People

Simpson, Mr. Paul Fraser Chief Financial Officer 140-145 5-10 35-37.5 190-195

Stevenson, Mrs Angela Chief Operating Officer 130-135 1 67.5-70 195-200

Wilson, Mr. Michael Anthony Chief Executive 195-200 1 0 195-200

Non-Executive Directors

Biddle, Mr. Paul Non-Executive Director 5-10 3 5-10

Durban, Mr. Richard Don Non-Executive Director 5-10 3 5-10

Lambert, Ms. Pauline Non-Executive Director 5-10 3 5-10

McCarthy, Mr. Alan Roy Chairman 15-20 3 15-20 Sadler, Mr. David Non-Executive Director 5-10 1 5-10 Shaw, Mr. Richard Oliver Chairman 15-20 2 15-20 Warner, Mrs. Caroline Non-Executive Director 5-10 2 5-10

Band of Highest Paid 195-200 Director’s Total Remuneration (£’000)

Mid Point of the Banded Total £197,500 Remuneration of Highest Paid Director (£’000) Median Total Remuneration £26,220

Ratio 7.53

70 Annual Report 2018-19 Accountability

Salaries and allowances 2017-18 Name Title (a) (b) (c) (d) (e) (f) Salary Expense Performance Long term All pension-related TOTAL (a to and fees payments pay and performance pay benefits (bands of e) (bands of (bands of (taxable) bonuses (bands and bonuses (bands £2,500) £5,000) £5,000) total to of £5,000 of £5,000) nearest £100 Executive Directors Cetti Edward Medical Director Dickson Jane Chief Nurse Francis-Musanu, Mrs. Gillian Director of Corporate Affairs **90-95 32.5-35 125-130 Josephine Holden, Mr Desmond Medical Director 135-140 10-15 0 150-155 Philip

Mackenzie, Mr Ian Duncan Director of Information and 100-105 17.5-20 120-125 Facilities

Preston, Mr Mark Director of Organisation 105-110 27.5-30 130-135 Development and People

Simpson, Mr. Paul Fraser Chief Financial Officer 135-140 20-22.5 155-160

Stevenson, Mrs Angela Chief Operating Officer 120-125 1 30-32.5 150-155

Wilson, Mr. Michael Anthony Chief Executive *200-205 1 0 200-205

Non-Executive Directors

Biddle, Mr. Paul Non-Executive Director 5-10 4 5-10

Durban, Mr. Richard Don Non-Executive Director 5-10 3 5-10

Lambert, Ms. Pauline Non-Executive Director 5-10 3 5-10

McCarthy, Mr. Alan Roy Chairman 30-35 4 35-40 Sadler, Mr. David Non-Executive Director 5-10 5-10 Shaw, Mr. Richard Oliver Chairman 5-10 2 5-10 Warner, Mrs. Caroline Non-Executive Director 5-10 1 5-10

Band of Highest Paid 200-205 Notes Director’s Total Remuneration (£’000) * In the salary figure there is a payment of £5,000.01 that relates to 16/17 pension adjustments amended in 2017/18 Mid Point of the Banded Total £202,500 Remuneration of Highest Paid ** In the salary figure there has been a deduction of £2,903.23 that relates to unpaid A/L taken in Director (£’000) the 16/17 financial Year amended in 2017/18 Median Total Remuneration £25,551

Ratio 7.93

71 Annual Report 2018-19 Accountability

Pension benefits 2018-19 Name Title (a) (b) (c) (d) (e) (f) (g) Cash (h) (i) Real Real Total Lump sum Cash Real Equivalent Employer’s Total pension Increase in increase Accrued at pension Equivalent increase Transfer contribution entitlem ent at 31 pension at in pension Pension at age Transfer in Cash Value at 31 to stakeholder March 2019 pension age lump sum pension related to Value at 1 Equivalent March 2019 pension (bands of (bands of at age at 31 accrued April 2017 Transfer £5,000) £2,500) pension March 2019 pension Value £000 age (bands of at 31 £000 (bands of £5,000) March £000 £2,500) £000 2019 £000 £000 £000 (bands of £000 £5000) £000

Cetti, Medical 0-2.5 0 30-35 65-70 403 15 447 0 30-35 Edward Director

Jane Chief Nurse 10-12.5 32.5-35 40-45 130-135 618 299 934 0 40-45 Dickson

Stevenson, Chief 147 924 0 50-55 Mrs Angela Operating 2.5-5 2.5-5 50-55 125-130 758 Officer Francis- Musanu Director of 120 879 0 35-40 Mrs Gillian Corporate 2.5-5 2.5-5 35-40 115-120 746 Josephine Affairs

Mackenzie, Director of 76 1,042 0 40-45 Mr Ian Information 0 0 40-45 130-135 952 Duncan and Facilities

Chief Simpson, Financial 95 735 0 30-35 Mr. Paul Officer 0-2.5 5-7.5 30-35 90-95 618 Fraser

Preston, Mr Director of 87 644 0 30-35 Mark Organisational 0-2.5 2.5-5 30-35 75-80 540 Development and People

NHSLA 1.03 3.00% publication - Disclosure of Senior Managers Rem uneration (Greenbury) 2018

72 Annual Report 2018-19 Accountability

Remuneration Notes * £25,551). equivalent transfer value of Reporting bodies are required to pensions. disclose the relationship between The Number of Employees based the remuneration of the highest on the average number of WTE Please note that the sections paid director in their organisation (whole time equivalent including below are not subject to audit. and the median remuneration of temporary staff) at the trust rose the organisations workforce. from 4,161 in 2017-18 to 4,376 in 2018-19. The banded remuneration of the highest paid director within the Total remuneration includes Trust in the financial year 2018- salary, non-consolidated 19 is £195,000-£200,000. This performance-related pay, approximates to 7.53 (2017-18 benefits-in-kind as well as 7.93 times) times the median severance payments. It does remuneration of the workforce, not include employer pension which is £26,220 (2017-18 contributions or the cash

2018/19 2018/19 2018/19 other 2017/18 2017/18 2017/18 other total permanently total total permanently total £000 employed £000 £000 employed £000 £000 £000 Salaries and wages 160,455 137,849 22,606 149,105 134,979 14,126 Social security costs 16,059 14,233 1,826 15,380 14,195 1,185

Apprenticship levy 778 778 0 731 731 Pension cost - employer contributions to NHS 18,333 18,333 0 15,785 15,785 pension scheme Temporary staff - agency/contracts staff 19,269 0 19,269 17,656 17,656

Total gross staff costs 214,894 171,193 43,701 198,657 165,690 32,967

Recoveries from DHSC Group bodies in respect of (2,831) (2,831) 0 (712) (712) staff cost netted off expenditure Total staff costs 212,063 168,362 43,701 197,945 164,978 32,967

2018/19 2018/19 2018/19 other 2018/19 2018/19 2018/19 other total permanently total total permanently total £000 employed £000 £000 employed £000 Included within: £000 £000 Costs capitalised as part of assets 350 172 178 250 250

Operating expenditure analysed as:

Employee expenses - staff and executive 210,099 166,576 43,523 196,865 163,898 32,967 directors Research and develoment 588 588 0 558 558

Education and training 1,026 1,026 0 272 272

Total employee benefits excl. capitalised costs 212,063 168,362 43,701 197,945 164,978 32,967

73 Annual Report 2018-19 Accountability

Staff numbers and costs

Average Staff Total 2018/19 Permanently Other Total 2017/18 Permanent Other 2017/18 Numbers No. 2018/19 2018/19 No. 2017/18 No. No. No. No. Medical and 615 562 89 612 565 47 dental

Ambulance staff 0 0 0 0

Administration 879 767 112 838 721 117 and estates

Healthcare 920 796 124 889 769 120 assistants and other support staff Nursing, 1,418 1,121 297 1,333 1,051 282 midwifery and health visiting staff Nursing, 0 0 0 0 midwifery and health visiting learners

Scientific, 424 384 40 405 374 31 therapeutic and technical staff Social Care Staff 0 0 0 0

Healthcare 84 84 0 84 Science Staff

Other 0 0 0 0

TOTAL 4,376 3,714 662 4,161 3,564 597

Of which: 5 3 2 4 4

Number of employees (WTE) engaged on capital projects Early retirements due to ill health No of early 2018/19 2018/19 2017/18 2017/18 retirements on £000 No 2 £000 No 2 the grounds of ill health 195 101

Staff sickness absence 2018/19 No. 2017/18 No. Total days lost 29,428 27,219 Total staff years 3,723 3,752 Average working 8 7 days lost (per WTE) 74 Annual Report 2018-19 Accountability

Reporting of other compensation schemes - exit packages 2018-19

Exit package cost band Number of Cost of Number Cost of Total Total cost Number of Cost of Compulsory Other (including any special compulsory compulsory of other other number of exit departures special redundancies departures payment element) redundancies redundancies departures departures of exit packages where special payment average cost average cost agreed agreed packages payments element have been included made in exit packages

2018/19 2018/19 2018/19 2018/19 2018/19 2018/19 2018/19 2018/19 No. £000 No. £000 No. £000 No. £000 £000 £000 Less than £10,000 1 10 1 10 10

£10,000 - £25,000 0 0

£25,001 - £50,000 0 0

£50,001 - £100,000 0 0

£100,001 - £150,000 0 0

£150,001 - £200,000 0 0

>£200,000 0 0

Total 1 10 1 10 0 0 0 0

Reporting of other compensation schemes - exit packages 2017-18

Exit package cost band Number of Cost of Number Cost of Total Total cost Number of Cost of Compulsory Other (including any special compulsory compulsory of other other number of exit departures special redundancies departures payment element) redundancies redundancies departures departures of exit packages where special payment average cost average cost agreed agreed packages payments element have been included made in exit packages

2017/18 2017/18 2017/18 2017/18 2017/18 2017/18 2017/18 2017/18 No. £000 No. £000 No. £000 No. £000 £000 £000 Less than £10,000 0 0

£10,000 - £25,000 0 0

£25,001 - £50,000 0 0

£50,001 - £100,000 1 51 1 51 51

£100,001 - £150,000 0 0

£150,001 - £200,000 0 0

>£200,000 0 0

Total 0 0 1 51 1 51 0 0 51

75 Annual Report 2018-19 Accountability

Exit packages: other non compulsory departure payment

Payments Total value of Payments Total value of agreed 2018/19 agreements agreed agreements 2018/19 2018/19 2018/19

No. £000 No. £000

Voluntary redundancies including early retirement contractual costs

Mutually adreed resignations (MARS) contractual costs

Early retirements in the efficiency of the service contractual costs

Contractual payments in lieu of notice

Exit payments following employment tribunals of court orders 1 10 1 51

Non contractual payments requiring HMT approval (special severance payments)*

Total 1 10 1 51

76 Annual Report 2018-19 Conclusion

Stay in touch Oxted Health Centre 10 Gresham Road Oxted Surrey and Sussex Healthcare RH8 0BQ NHS Trust 01883 734000 Trust Headquarters Canada Avenue Redhill The Earlswood Centre Surrey RH1 5RH Royal Earlswood Park 01737 768511 1 Anderson Court Redhill [email protected] Surrey RH1 6TP www.surreyandsussex.nhs.uk 01737 768511 Twitter: @SASHnhs Need help or advice? Surrey and Sussex Healthcare The Patient Advice and Liaison NHS Trust provides emergency Service (PALS) focuses on and non-emergency services at: improving services for NHS patients. It aims to: advise and support patients, East Surrey Hospital their families and carers provide Redhill information on NHS services Surrey listen to concerns, suggestions or RH1 5RH queries from our patients and the 01737 768511 people we care for help sort out problems quickly on their behalf Surrey and Sussex Healthcare NHS Trust provides non- Contact PALS: emergency services at Crawley 01737 768511 x1958 (for all Hospital which is managed by sites) NHS Property Services. [email protected] PALS, East Surrey Hospital, Crawley Hospital Redhill, Surrey, RH1 5RH Crawley West Sussex RH11 7DH You can ask a member of staff to 01293 600300 contact PALS on your behalf This information is available in We also provide a number of other languages and formats services at four community sites: including audio tape, la rge print and braille. For further Caterham Dene Hospital information please contact PALS Church Road Caterham Surrey (Patient Advisory Liaison Service) CR3 5RA 01883 837500 on 01737 231958 or email: sash. [email protected] Horsham Hospital Hurst Road Horsham West Sussex RH12 2DR 01403 227000

77 Annual Report 2018-19 Conclusion

Finances working capital position. trust. These values represent improvement on 2016-17 Stayed within its External and describe strong value for The year in context Financing Limit (EFL). money. The Trust’s 2018-19 reference cost index and WAC The Trust ended 2018-19 Stayed within its Capital will be notified to the Trust in with a surplus of £11.2m Resource Limit (CRL), the later part of 2019. (after technical adjustments). with a capital spend of In the current climate this £18.0m This performance is against a is a notable achievement, Delivered its Better context of significant deficits in allowing the Trust to invest Payment Practice acute trusts across the country, in additional capital works Code (BPPC) target of and continued activity pressure during the year and to 95% of bills paid within nationally and locally. For the significantly improve it 30 days (the first time Trust, emergency attendances working capital position. the Trust has achieved rose, again, to their highest that) ever levels in 2018-19. Although In January 2019 the Trust was the Trust’s new internal also rated “Outstanding” for The Trust was not able to fully pathways (introduced with the Use of Resources by NHS achieve the £16.1m surplus help of commissioners, and Improvement and the CQC, financial control total assigned now including an ambulatory in addition to being rated to it by NHS Improvement, care unit - Kingsfold) helped “Outstanding” in respect of and consequently agreed a to constrain the number of Quality. revised forecast outturn during emergency admissions to the 2018-19 financial year of Trust beds we still did not have In summary, the Trust: £7.3m. The surplus delivered sufficient bed capacity to treat matches the final expected the expected level of planned Has delivered a financial position plus a further £3.9m of care (elective) patients referred surplus for the third Provider Sustainability Funding to us. consecutive financial awarded to the Trust by NHS year; Improvement and notified on 18 Local Clinical Commissioning April 2019. Groups (CCGs), who formed Achieved £4.8m of the Sussex and East Surrey savings (meeting The cost per weighted activity Alliance during the year (taking its planned savings unit (WAU) is a unit cost in East Sussex CCGs and target); measure introduced as part Coastal West Sussex) again of Lord Carter’s and NHS agreed an end year financial Received £9.9m of non- Improvement’s Operational settlement that provided recurrent Provider Productivity work and recorded certainty in year and a fair final Sustainability Funding in the “Model Hospital” data position for both organisations. (PSF) from NHS portal. The Trust’s 2017-18 Improvement. Excluding (most recent numbers) cost per Within that settlement CCGs this non-recurrent WAU is the lowest for any acute have provided a one-off funding the Trusthad trust nationally (£2,903 per payment that partially covered a £1.3m underlying WAU). Our 2017-18 reference the impact of part of the cost of surplus position. cost index (where 100 is the emergency admissions (there index level) was 83 – again the is a “Marginal Rate Emergency Significantly improved its lowest in England for an acute Tariff” [MRET] which otherwise

78 Annual Report 2018-19 Conclusion

reduces the payment the Trust gets to 70% of the tariff for the number of patients above 2008 levels). The compromise over the MRET settlement was the main driver behind not delivering the original control total, and the subsequent loss of £3.2m of Provider Sustainability Funding (PSF).

Income and expenditure performance is described in the chart below, which provides a view back to the creation of the Trust in 1998-99. The £14.0m surplus planned for 2019- report can be accessed via the operates, and the Trust 20 (to meet the control total CQC website (https://www.cqc. performs strongly on clinical assigned to the Trust by NHS org.uk/provider/RTP) and its services, outperforming Improvement) includes £6.6m summary includes the following most trusts in England for non-recurrent PSF. points: the delivery of constitutional standards. The Trust also a Using 2017-18 data benchmarks well against Trust financial performance the Trust has the lowest total several clinical services from its creation in 1998-99 cost per Weighted Activity metrics linked to efficiency (see graph above right). Unit (WAU) in the country such as pre-procedure bed and performs well across the days (preparation prior to Use of Resources: inspected specific “Use of Resources” operations) and readmissions and rated “outstanding” Model Hospital metrics. Please (we have a very low The Use of Resources rating for see “Reference costs and proportion of people having the Trust is completed by NHS cost per weighted activity unit” to come back to hospital after Improvement and published section later - the Trust also a procedure) and has seen by the CQC alongside their performs well generally across improvement in others such other trust-level ratings. All six most aspects covered by the as Delayed Transfer of Care trust-level ratings for the Trust’s Model Hospital portal; (DTOC) and Did Not Attend key questions (safe, effective, (DNA) rates to better or near caring, responsive, well-led, use b There is visible evidence the national median; of resources) are aggregated of a clear commitment to yield the trust’s combined to continuously improve d The Trust benchmarks rating, which, overall was also productivity and quality of well on its efficiency measures “Outstanding”. care, particularly through the for pathology, imaging Trust wide SASH+ programme and pharmacy services This Trust, at the time of (referred to elsewhere in this and corporate services drafting this annual report, is annual report); (Finance, Human Resources one of only half a dozen in the [Organisational Development country rated outstanding for c Use of resources is and People], Information Use of Resources. The full about how an organisation Management and Technology) 79 Annual Report 2018-19 Conclusion

compared to other trusts; table below, with the 2017-18 figure at just under 83 (rounding e The Trust has delivered masks the improvement). This surpluses in recent years describes cost management and has improved its liquidity over a long period as well as position to the point where it the granular reporting of work now has good cash balances done, and suggests that we allowing it to repay past debt; have managed the investment in services without increasing f The Trust can evidence our unit costs. The Trust’s how it uses information reference costs were audited from the Model Hospital, in 2015-16 on behalf of the the Getting It Right First Department of Health and the Time (GIRFT) programme Trust was found to be materially (we have a “Model Hospital compliant in its reference cost Group” chaired by the CEO) processes and calculation. and other initiatives to drive service improvement and The Lord Carter work on productivity gains alongside trust operational productivity the SASH+ programme; and efficiency has used the reference cost to create a The report did identify areas cost per weighted activity for improvement, and the unit measure. This is a value report noted that spend on describing the cost to deliver agency staff remains high the treatments carried out (including as a proportion for patients, as adjusted and to the total pay bill), there weighted for complexity of are delays in the delivery treatment that can be compared of anticipated savings of with the average unit cost the pathology network across the country. The Trust the Trust is part of due to has a cost per weighted activity configuration issues and there unit of £2,903, the lowest unit are opportunities to improve cost in England for an acute productivity on procurement. trust.

(See above right, Trust Reference costs and cost per priductivity metrics). weighted activity unit The 2017-18 NHS reference costs (the most recent) are translated into an index to allow comparison between trusts, where the national average is an index of 100.

The Trust’s index score has changed as described in the

80 Annual Report 2018-19 Conclusion

Chart shows ranking position The original loan and the The current position on the loan for all trusts with data reported statutory breakeven duty is described below, with £2.8m in thte Model Hospital - colour Surrey and Sussex Healthcare left outstanding. The Trust is bandings reflect quartile - NHS Trust secured its £56.0m now making the scheduled darker green (left) is the best working capital loan at the end payments required by its quartile and daker red (right is of 2006-07 to cover debts from 25year loan agreement against the worst quartile) its poor financial performance that balance. up to that time.

81 Annual Report 2018-19 Conclusion

The loan repayment plan breakeven duty in April 2018 separate loans. There is £6.2m had been acting as a proxy and the format of reporting left to repay (in total) on these for meeting the statutory changed in last year’s the loans at 31 March 2019. breakeven duty, which the accounts (at note 52), with Trust has been in breach of the start point being changed since 2007-08. The statutory to 2009-10. This is because Looking forward – breakeven duty is set out in 2009-10 was the first year sustainability: financial strategy Schedule 5 of the NHS Act of International Financial overview 2006 and case law states Reporting Standards (IFRS) Last year (in 2018-19) that a surplus of an equal implementation and NHS the Trust delivered on its size to any past deficits Improvement, apparently, previous short term financial needs to be accumulated in regard that as a more suitable strategy objectives (which a period of (maximum) five point from which the breakeven were: “stabilising the Trust’s years after the deficit was duty should now be assessed. clinical services in the face of recorded. However as this increasing emergency demand does not take account of Other cash borrowing to provide sufficient capacity any loan arrangement and As mentioned above the Trust’s to deliver clinical and financial the repayment the Trust has cash position improved with its plans”, and; “recover the achieved, the Trust is still move into surplus, however the normalised [financial] position”). technically in breach. Trust still has a working capital facility (rather like an overdraft). For 2019-20 onwards we The external auditors of NHS At the end of 2018-19 that have reviewed our strategy trusts have responsibilities stands at £3.0m. and updated it, and also to under section 30 of the Local recognise the requirements of Audit and Accountability Act In order to manage its cash the NHS Long Term Plan. 2014 to report on unlawful flow (partly from our historical matters by issuing a referral position, partly from the deficit The refreshed financial to the Secretary of State. in 2015-16 and 2014-15 but strategy is as follows: Previously this was described also because of delays in under Section 19 of the Audit payments since then) the Trust Build on the recurrent Commission Act 1998. The secured a £19.8m working surplus achieved in Trust’s Auditor did so in a capital facility during 2015-16. 2018-19 and sustain Section 19 letter at the start That “overdraft facility” (this is recurrent balance; of the 2011-12 financial year not a loan like the £56.0m one and issued another letter, above) has now been largely use non-recurrent at the request of the Audit paid off but will remain in place sustainability funding Commission, with the 2013- as the Trust moves into 2019- to replenish the balance 14 financial accounts. As the 20 as it is prudent to maintain sheet and maintain a Trust’s breach is a technical the flexibility provided by the positive cash balance; one, there is no impact on the facility. Trust, beyond explaining the cover the costs of above and the auditors will not Finally, the Trust has also activity demand while issue another letter advising borrowed cash to support its striving for greater anything further on this matter. capital programme (for building productivity and works and equipment) over the efficiency; NHS Improvement issued years. Overall it has borrowed guidance in respect of the £13.5m since 2010-11 in three agree financial

82 Annual Report 2018-19 Conclusion

mechanisms with CCGs (at extra cost) to ensure the longer than a day has started that support pathway elective referral to treatment to flatten, despite the very and model of care standards are met. great increase in attendances changes, and do to the emergency department whatever the Trust can The operational plan saw we have seen. Increasing (without jeopardising additional capacity for elective same day emergency care is a the items above) to activity created in 2015- priority in the NHS Long Term support local CCG 16 (an additional elective plan. financial positions. ward, an additional theatre, and additional day case Further to that, in the winter become part of a capacity) and we opened of 2018-19 the Trust opened financially sustainable the Surgery Day Unit at East Horley Ward (built with integrated care Surrey Hospital at the end of funding provided by NHS partnership with other summer 2017-18 (reproviding Improvement), which is local providers that our day case capacity). intended as a “decant” ward delivers continuous However, initially the growth in in the summer (ie: moving operational efficiency, emergency demand continued patients into it so that we can improves health to prevent the effective use of close other wards occasionally, outcomes and this capacity, requiring us to eg for refurbishment work) and works in fuller and more implement further significant as extra capacity in the winter. effective partnership with infrastructure and significant other local stakeholders; changes to the model of care In 2018-19 theses measures for people that would otherwise helped provide more capacity be visiting the emergency for elective work and although The financial plan connection to department. the Trust did not quite meet the operational plan the referral to treatment The financial plan is supported In October 2017-18 Kingsfold standard, it halved the number by an operational plan (and opened as an ambulatory of patients waiting over 52 vice versa), describing how care unit (a very different weeks and reduced its waiting the Trust delivers its access model of care for emergency list significantly. Indeed, the and clinical standards. A key attendances) and along with performance was better than component in that is about the work around the emergency most other trusts in England. managing emergency demand department (including changes and maintaining capacity to to how ambulances queue, and Of course, the position is do elective work. Although providing a canopy), changes very fluid, and the Trust saw simplistic, this aspect has a to ways of working in other serious peaks in ambulance widespread (direct and indirect) wards (eg “cohorting” long conveyances during January impact on how the Trust stay patients on Tandridge) 2019 and there is a long performs financially. Too much and the introduction of standing problem with very long emergency activity does not fit primary care streaming (GP’s stay emergency patients (called into the capacity and requires in the ED) that has further “super-stranded patients”) additional resource to manage helped manage emergency whose number has stayed it while disrupting a wide range activity volumes. This has around 120 for much of the of other services which restricts seen a significant increase in year because it is problematic elective income while we still “same day emergency care” to find them places out of have fixed costs to service and treatments and the number hospital. Dealing with this group we have to do additional work of patients admitted that stay of patients provides a central

83 Annual Report 2018-19 Conclusion

theme not just for the Trust’s Waste Reduction right) combines multiple metrics operational plan in 2019-20 but Plan (WRP – savings to try to give an overall picture also for that of the whole health of £6.0m)) and additional of each trust’s performance system. cost reductions by against others. Divisions of £4.0m – total The position of each trust is 2019-20 budget £10.0m – with the plotted by: The 2019-20 revenue budget MRET the saving has been constructed to required is challenging surplus or deficit as a facilitate delivery of the £14.0m at about 4.5% of % of operating I and E control total surplus. turnover; expenditure (y axis) The control total has been set cost per WAU, which by NHS Improvement and the d £2.0m financial represents overall Board confirmed its acceptance contingency against cost relative productive in the Trust’s Plan submission pressures; efficiency (x axis) in April 2019. The colour of each e Expenditure through a bubble reflects the CQC The reason for this large “quality reserve” segment for that trust surplus target is because the budgeted at £1.0m. Trust will be paid a £5.2m refund of the previously unpaid As can be seen in the chart, the marginal rate emergency 2019-20 Savings and Trust ranks very well against tariff (“MRET” - which was the productivity others, and the chart also subject of the compromise deal In addition to the data about providers a flavour of how other with CCGs in 2018-19) and, if it the Trust’s cost per weighted trusts are performing. delivers the quarterly financial activity unit referred to targets, £6.6m of provider above, NHS Improvement In terms of the detail within sustainability funding. The has established a broad the Model Hospital, the underlying surplus the Trust range of work streams with Trust benchmarks well in the must deliver is £2.2m. benchmarking and other data majority of categories (the set out on a web-based portal portal is very extensive [this The revenue budget was called the Model Hospital. list is not all exhaustive] but approved by the Board in includes data on staff, non-pay, March 2019 and includes: Within the Trust the CEO chairs nursing, pathology services, a “Model Hospital Group” which medicines management, back a Receipt of £6.6m methodically reviews data office, estates and facilities, provider sustainability from the portal with clinical procurement and detail Getting funding (PSF); specialties and administrative It Right First Time programme departments in the Trust. information for many clinical b Receipt of £5.2m MRET The outputs provide inputs specialties). refund and its application to the waste reduction plan, directly to the surplus – productivity plans and clinical The Model Hospital data shows as this funding should improvement plans. that the Trust has one of the actually be set against lowest overall productivity gains the cost of emergency Chart: Model Hospital Quality, to achieve when benchmarked activity this is a saving; Efficiency, Deficit (QED) chart against other English trusts. c The combined core This chart (opposite above This reduces the opportunity

84 Annual Report 2018-19 Conclusion

for further cost improvements, Waste reduction and cost is set out elsewhere in this however the Trust continues to improvements are modelled Annual Report and summarised look at what it can do to reduce to come from all areas of the above in the “brief financial its costs while maintaining and Trust but major on agency history” section, describing our improving its services. In 2019- reduction, procurement, SASH+ programme and other 20 the core waste reduction usage of consumables, drugs, initiatives. plan (WRP) is set at £6.0m, and additional duty costs. with an additional £4.0m to Efficiencies contributing to gain from Divisional spend the productivity gain flow from Analysis of financial data reductions. Add to that the need outpatient demand and capacity The key financial statements to deliver a surplus against the work, reducing length of stay from the 2018-19 accounts are £5.2m of MRET funding paid as for non-elective patients and in the appendix. part of the Control Total regime, theatre efficiency. The table below provides a and the total cash releasing fuller summary of our income benefit required is £15.2m, Further information on the and expenditure performance about 4.5% this is a very Trust’s approach to improving since 2009-10, using the challenging target. its productivity and efficiency EBITDA* presentation.

85 Annual Report 2018-19 Conclusion

Detail of overall income and expenditure performance since 2009-10.

Income 2019-20 – looking forward In 2019-20 our income is forecast to total £357.0m, taking into account £6.6m of Provider Sustainability Funding and £5.2m of MRET funding (both paid as part of the sign up to the control total, with the former conditional on performance).

Costs 2019-20 – looking forward Costs in 2018-19 are forecast to total £343.0m, split as described in the table and chart (bottom right).

86 Annual Report 2018-19 Conclusion

In 2018-19 the Trust spent as follows: The Trust structures its £18.0m on capital investment programme to ensure that (buildings, IT and equipment) Item £m maintenance and refurbishment and stayed within our Capital is completed, that we invest in Resource Limit (CRL). improving patient areas and support the Trust strategy to The funding to pay for the Horley Ward, a 4.4 ensure patients are treated in a programme included a number decant ward in the safe, high-quality environment, of additional elements (on top summer (moving and which is welcoming and of the core capital resource limit patients into it convenient for them and their generated from depreciation), so that we can families. The programme is as follows: close other wards successfully transforming the occasionally, eg estate and has reduced the £2.5m of capital for refurbishment cost of maintenance as we resource limit awarded work) and as extra modernise the hospital in respect of good capacity in the financial performance in winter. 2017-18; Dental and 2.8 Neo-natal unit refurbishment Obstetrics/ and redesign £3.9m of NHS Gynaecology The Trust’s biggest project is Improvement capital for Outpatients (stage the refurbishment and redesign urgent and emergency 1 of our neo natal of the neonatal unit, where we care services (to pay for build – reproviding don’t have enough space for Horley Ward); for services whose our cots. That spreads over two accommodation years. £3.2m of capital funded needed to be altered from cash reserves in the project) A part of that work is well generated from the Trust EPR (electronic 1.4 underway [in April 2019] on surplus, and; patient record - the Dental and Obstetrics/ hardware) Gynaecology outpatients areas £0.7m provided that need to be reprovided and by the Sussex and IT other than EPR 0.9 this is scheduled to complete at East Surrey the end of May. The existing Sustainability and outpatient facilities will then Transformation move into the new build and Radiology 0.5 Partnership to fund work will then commence on Equipment hardware for our the neonatal refurbishment and electronic patient record. expansion. This will finish by Backlog 1.9 the end of 2019. A wide-range of different Maintenance projects were delivered in-year, Electronic patient record over 100, with the principle Digitise focus being investment in Although the business case and estate to improve how the Trust loan were approved by NHS works and improve care for Improvement, funding for the patients. The principal areas of next stage of the enhancement large item spend (>£0.3m) were of our Electronic Patient

87 Annual Report 2018-19 Conclusion

Records System (EPR Digitise and electronic prescribing and medicines administration) was not forthcoming from the Department of Health in 2017-18, and neither was it forthcoming in 2018-19.

As a result, the Trust is having to split the Digitise project into component parts and match used £0.7m of Trust capital capital to each from whichever alongside an award of £0.7m of sources it can. In 2018-19 we STP funding to buy hardware. used £0.7m of Trust capital As we move into 2019-20 it alongside an award of £0.7m of was hoped that the central STP funding to buy hardware. funding of electronic prescribing As we move into 2019-20 it and medicines administration was hoped that the central (EPMA) would have been funding of electronic prescribing announced by March, but again and medicines administration the award of funding has been (EPMA) would have been postponed. We will continue announced by March, but again to review and work through the award of funding has been how we manage this important postponed. We will continue upgrade to our electronic to review and work through patient record systems. how we manage this important upgrade to our electronic Signed: patient record systems.

Although the business case and loan were approved by NHS Improvement, funding for the next stage of the enhancement of our Electronic Patient Michael Wilson CBE Records System (EPR Digitise Chief executive and electronic prescribing and medicines administration) was not forthcoming from Date: 29th May 2019 the Department of Health in 2017-18, and neither was it forthcoming in 2018-19.

As a result, the Trust is having to split the Digitise project into component parts and match capital to each from whichever sources it can. In 2018-19 we

88 Annual Report 2018-19 Conclusion

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