Annual Report and Accounts Her Royal Highness The Countess of Wessex GCVO officially opened the Trust’s new £44m women and children’s development at The Royal Oldham Hospital on Thursday 13 June 2013.

The Countess, accompanied by the Lord-Lieutenant of Greater Manchester, Mr Warren Smith KStJ JP DLitt LLD, was greeted by the Trust Chairman, John Jesky, before being shown around the new children’s wards, maternity unit and neonatal intensive care unit (NICU) where she met staff and patients.

The new women and children’s supercentre fully opened to patients on 3 December 2012. It is now one of three specialist regional neonatal centres providing the highest level of intensive care to the smallest and most vulnerable babies.

Trust Chairman, John Jesky, said: “The Royal visit was a great privilege for all of our staff, particularly those who work on the units, and those who have been involved in developing this marvellous new facility. I know our staff are extremely proud of this new unit where we can provide excellent standards of care for our patients and their families from across Oldham, Rochdale and other parts of Greater Manchester.” Contents

About the Trust...... 2 The communities we serve...... 3 Top Ten Facts ...... 3 Chairman and Chief Executive’s Report...... 4 Mission Statement and Our Values...... 7 Corporate Objectives ...... 8 Looking to the Future...... 11 Risks...... 12 Quality Accounts Report 2012/13...... 13 • Statement on Quality on Behalf of the Board ...... 13 • Introduction...... 16 • Commissioned services...... 16 • Quality & Performance Standards ...... 16 • Quality of Care ...... 17 • Review of Quality Performance...... 18 • Quality Aspirations...... 49 • Our Priorities for Improvement in 2013/14...... 51 • Research and Innovation ...... 52 • Participation in Clinical Audit...... 54 • Participation in CQUINS...... 62 • Data Quality ...... 65 • Information Governance Toolkit attainment levels ...... 66 • Clinical coding error rate ...... 66 • The Care Quality Commission (CQC) Statement ...... 66 • Care, Compassion and Transparency ...... 69 • Francis Inquiry Report ...... 70 • Quality Improvement...... 73 • Service Developments ...... 88 • Advice, Liaison and Complaints...... 92 • What others say about the Trust ...... 94 • Annexe...... 94 Personal data...... 103 Sustainability...... 104 Emergency preparedness...... 108 Valuing People...... 111 Staff feedback ...... 113 NHS Constitution...... 116 Foundation Trust update...... 117 Annual Accounts ...... 119 Remuneration...... 162 Finance Glossary...... 165 Charitable Funds...... 168 Trust Board...... 170 Contacting the Trust...... 173

Annual Report and Accounts 2012/2013 1 About the Trust

The Pennine Acute Hospitals The Trust runs North Rochdale and also with East NHS Trust is one of the Manchester General Hospital, Lancashire to plan, develop and largest in the North West and The Royal Oldham Hospital, commission healthcare services largest non-teaching hospital Fairfield General Hospital in Bury for local people. Trust in England. and Rochdale Infirmary. We also Our clinical services are provide a range of community We employ over 8,000 staff organised within four services for North Manchester. and provide high quality general divisions: surgery, medicine and specialist hospital services The Trust has an annual and community, women and to around 820,000 residents operating budget of over half children, and diagnostic and across the north east of Greater a billion pounds. We work clinical support, which work Manchester in Bury, Prestwich, with our new local Clinical together to provide integrated North Manchester, Middleton, Commissioning Groups (CCGs) care across all of our services. Heywood, Oldham and Rochdale in Manchester, Bury, Oldham Specialist clinical areas within and parts of East Lancashire. and Heywood, Middleton and each division are overseen by one of 22 consultants who are senior doctors appointed as clinical directors responsible for managing their own services.

A range of support services, such as human resources, education and training, IT and communications, research and development, finance, governance, facilities, estates and catering, are all essential for our hospitals to run smoothly and effectively.

Annual Report and Accounts 2012/2013 2 The communities we serve

The communities we serve Rates of obesity, smoking, cancer pneumonia, asthma, bronchitis are diverse in their make- and heart disease related to poor and emphysema. up. Many areas suffer high general health and poor nutrition Other issues facing our levels of deprivation and are significantly higher than communities include are generally less healthy the national average, whilst life proportionately larger numbers when compared with the rest expectancy at birth in some of of younger and older people, of England, with a higher the areas we serve is one of the large and growing ethnic proportion of people who lowest in England. minority populations whose have a long term illness. Common themes of ill health health and access to healthcare Where there are high rates and death include vascular have been poor, and heavy of unemployment and and circulatory diseases such reliance on public transport deprivation, there tends to be as coronary heart disease and and low levels of personal car poorer health and a greater stroke, diabetes, cancer, and ownership. demand for health and social respiratory diseases such as care services.

Top Ten Facts In 2012/13 the Trust:

1) spent over half a billion pounds (about 7) delivered over 9,800 babies. £1.5m per day) on providing healthcare 8) issued over 1 million items from pharmacy services for local people. to inpatients, outpatients, patient discharges 2) invested £38 million on capital programmes and ward stocks. and in maintaining and improving the 9) re-processed/sterilised 230,369 instrument physical estate and on smaller projects to tray sets and 156,626 single instruments. develop frontline clinical services. 10) provided over 1.4 million (1,417,528) meals 3) spent £6.6 million on medical and scientific to patients. equipment to support front line clinical services.

4) saw 329,358 Type 1,2 and 3 A&E (urgent care) cases.

5) saw 690,147 outpatients, 235,385 total inpatients and 75,258 day cases.

6) made 112,000 visits to patients in their own homes to provide treatment and care.

Annual Report and Accounts 2012/2013 3 Chairman and Chief Executive’s Report

Two major issues have Locally, the work being carried new actions to reinvigorate our dominated the agenda out across Greater Manchester work in this area. for this Trust over the past by the Healthier Together The opening of the new twelve months. Nationally, programme has started to define £44m Women and Children’s preparation for and then what the future of healthcare supercentre at The Royal reaction to the Francis provision might look like across Oldham Hospital in November report into the events at the conurbation. While the final 2012 marked the successful Mid-Staffordshire Trust, with picture has not yet emerged, we conclusion of the Greater its key themes of care and have worked throughout the Manchester “Making it Better” compassion have been a year to influence the strategy, reconfiguration programme. This touchstone throughout the and to prepare the Trust for combined with the completion year. The events and failures what might come once the full on the “Healthy Futures” detailed in the reports have intentions are revealed later in reconfiguration programme in been a reminder to the whole 2013/14. 2011 has delivered two of the of the NHS that we must These two key themes have been most significant clinical services always focus on the needs the cornerstones of the Trust’s change programmes in the of individual patients. The corporate objectives for the last country. This Trust has played Francis report was a wake-up two years and all staff have been a major part in the redesign of call to the NHS as a whole mandated to include at least clinical services in the north-east and this Trust put renewed one objective related to patient sector of Greater Manchester focus on the work already safety and one objective related and beyond, and many of the underway to improve patient to patient experience in their service models developed serve safety and improve the own personal objectives. We as worthy examples for other patient experience. have seen progress in these areas health systems and networks, – hospital acquired infections both near and far, to follow. have dropped significantly in the The Trust Board has devoted year – we have almost eradicated more time during 2012/13 to MRSA bacteraemia and we have setting the vision, direction and seen a 76% reduction in the strategy for the Trust and intends number of Clostridium Difficile to finalise our strategy during cases over the last six years. 2013/14 taking into account the Hospital cleaning standards have emerging proposals from the improved, we have seen positive Healthier Together programme. progress in a number of areas as One of the key emerging evidenced by the results of the features for the future will be national impatient survey and integrated care, taking a stage we have maintained our CQC further how we link together registration with no conditions. all elements of care to support Our good progress on reducing people in their own homes, mortality ratios over the last two prevent un-necessary admission years reached a plateau towards to hospitals, support people the end of 2012. The Trust to return home as quickly as Board has spent considerable they can and to make sure that time investigating the cause of primary, secondary, community this and has agreed a range of

Annual Report and Accounts 2012/2013 4 Chairman and Chief Executive’s Report

and social care services all changes. Launched in June harmonise their important 2012 the “Listening into Action” roles around the needs of programme has set out to bring individuals. This Trust has together small committed and already made positive progress enthusiastic groups of staff and in the north of the city of give them the power to change Manchester where, in addition services for the better in their to being the main provider of own local areas. The first wave acute hospitals services for local saw ten staff teams grasp this people, the Trust also provides opportunity and effect change in the community services. This their service. The next wave of provides the Trust with an twenty staff teams started work important opportunity, working in March 2013. During 2013/14 alongside general practitioners we will see more waves of staff and the City Council, to deliver engaged in this process until it services focused around patient becomes a way of working. We needs. We believe that the work see this handing back of control achieved in this area is a model to local staff in local areas as for others to follow and we are an important means by which keen that our experience and we will effect change driven by the benefits we have realised can the people who know what is be extended to other patients needed and how to deliver it. served by the Trust. The Trust met all of the main Working and engaging with national access targets in the others have been themes which year, and in relation to the have run through many areas emergency care four hour target of our development this year. was one of the few Trusts in the We have had the opportunity country to consistently meet this to develop new and strong standard all year. We know from relationships with the newly the national inpatient survey that formed Clinical Commissioning while we have improved in some Groups which from 1 April areas we lost ground in others 2013 took responsibility for and we need to focus on those commissioning services for their in the year ahead. The overall local populations. We are also staff survey score showed a building relationships with the marginal improvement in 2012, National Trust Development but not enough to claim success. Agency which has taken over The work described in “Listening many of the responsibilities of into Action” will be our key the former Strategic Health means of engaging and involving Authority. staff in everything that we do.

It is, however, perhaps in This year has been another engaging with our staff where where set against the national we have seen the most dramatic economic downturn the Trust

Annual Report and Accounts 2012/2013 5 achieved significant savings departments over the course of a 10 years of service as a Non- and ended the year in financial year and the whole Board visits a Executive Director and Sally balance. During 2013/14 and range of wards and departments Bradley left her post as Medical beyond we know that we have each month before and after its Director to emigrate to Australia. to make strategic change to the Board meetings which are now Shauna Dixon joined as a new way in which we provide our held in rotation on every site. Non-Executive Director, Brian services – the emerging strategy We could not provide the high Steven took up post as Deputy and the work on integrated quality of service in our hospitals Chief Executive / Director of care referenced earlier will be and our community services Finance and IM&T and Christina key elements of enabling us to without our 1,000 volunteers Kenny became Acting Medical achieve this. and the many fundraisers who Director. add so much to the life of the Transformation must continue as Finally, our thanks go to all of Trust. To all of them we owe a must work to eliminate variation our staff who have yet again great debt of gratitude. During in the way we provide services achieved so much during the the year we reached our target where this is in the best interest year. This report is a record of to recruit 10,000 local people of patients. We must continue their achievements as we all as Foundation Trust members. to reinvent the way we provide continue to strive “to provide That so many people have said care, and we must continually the very best care for each they wish to be a part of shaping keep people informed about patient on every occasion”. We the future of the Trust as we what we are doing and why. commend this annual report move towards Foundation Trust as a demonstration of how all The Non-Executive Directors status in 2015 has been truly of our staff have contributed carry out regular visits to wards, heartening. to delivering on our mission the Executive Directors carry out There were several changes in statement this year and how we 100 unannounced Patient Safety the Trust Board in the year. Tim all intend to continue to do so in Walk-rounds on wards and Pickstone stepped down after the future.

John Jesky John Saxby Chairman Chief Executive 4 June 2013 4 June 2013

Annual Report and Accounts 2012/2013 6 Mission Statement and Our Values

Mission statement

The Trust’s mission statement is a statement of purpose of what our patients can expect from our staff across our hospitals and community services. “To provide the very best care, for each patient, on every occasion.” Our mission statement is enshrined within our organisational values:

The Trust’s values are:

■ Patient care is at the centre of everything we do. We work together to deliver a high quality service to provide the best possible outcome for our patients

■ Accountability, honesty and integrity are keys to our success both individually and across the Trust

■ Treating everyone with respect and promoting good working relationships will support individuals in reaching their full potential

Trust Chairman, John Jesky

Annual Report and Accounts 2012/2013 7 Corporate Objectives

The Trust produces a business plan each year. It sets out key priorities for the financial year and contains corporate and divisional objectives against which it judges its performance for the year to achieve its overarching strategic aims.

The objectives cover a wide range of different aspects of what we do. In order to monitor the Trust’s progress against the objectives, the Trust Board receives a quarterly report outlining developments against each standard.

The Trust’s corporate objectives for 2012/13 are set out in the table below, together with the Trust’s achievements against each objective.

Area for improvement We said we would How did we do? Improving Patient Reduce hospital standardised Maintained rolling standardised Safety mortality mortality at 99 or less using Risk Adjusted Mortality Index (RAMI). Reduce the number of hospital Achieved. acquired pressure sores Reduce the number of falls in Achieved; overall there has been a hospital 9.6% improvement on 2011/12. Reduce hospital acquired VTE Achieved. (venous thromboembolism) - over 95% of adult admissions to have VTE assessment Have No Never Events Two Never Events recorded in the year. Improving the patient Reduce healthcare acquired Achieved. Only 3 MRSA and 86 C Diff experience infections – not more than 4 MRSA cases recorded. & no more than 100 CDiff cases Comply with all NICE Guidelines Overall the Trust achieved 87% compliance. Maintain clean hospitals. Achieved. Improve the experience of patients Achieved improvement in the internal within the Trust patient survey results. Allow patients to be treated in an Achieved. Compliant with the environment where their dignity is regulations. not compromised. Respond to concerns from patients Marginally missed the target with about the services they receive 88% of complaints responded to within 25 working days. Reduce the number of patients Achieved 2% reduction in emergency admitted to hospital medical admissions. Carry out regular Non-Executive Achieved. Director patient experience walk rounds across all sites

Annual Report and Accounts 2012/2013 8 Area for improvement We said we would How did we do? Improving the patient Achieve the national Referral to Achieved a Trust level and for almost experience (cont’d) Treatment (RTT) Standards (18 every speciality. weeks) Meet the national urgent care Achieved. standards for treating patients Improve patient experience and Achieved. theatre productivity by minimising operations being cancelled on the day of admission Reduce the number of outpatient Achieved. cancellations by min of 3% year on year Achieve national cancer targets Achieved. including the 62 day referral to treatment target for cancer Deliver CQUINs (Commissioning for Did not achieve due to missing the Quality and Innovation) payments target for timeliness of outpatient and discharge letters. Agree Key Performance Indicators Achieved. (KPIs) for Community Services. Workforce Improve the overall staff satisfaction Achieved. rating in the national NHS staff survey Bank and agency spend to be less Achieved. than 10% of monthly bill Complete Personal Development Achieved. Reviews for 90% of staff by 31 March Achieve 95% staff attendance for 95% staff attendance achieved for the the year year. Achieve improvement in statutory Achieved. Increase in staff compliance and mandatory staff training from last year. compliance Achieve planned reductions in staff Not achieved. numbers as outlined in business plan Improve efficiency and performance Achieved. in the staff recruitment process Reduce the incidence of workplace Not achieved due to one former violence and aggression by 5% on patient who made multiple recorded previous year assaults on staff.

Annual Report and Accounts 2012/2013 9 Area for improvement We said we would How did we do? Financial Performance Deliver planned surplus Achieved. The SHA agreed to adjust the Trust’s control total from £5.7m surplus to break-even. Achieve External Finance Limit (EFL) Achieved. The Trust met all key financial duties. Achieve 3.5% return on capital Achieved. The Trust met all key employed financial duties. Achieve Capital Resource Limit Achieved. (CRL); not exceed limit. Meet Level 2 Information Achieved. Governance framework Maintaining our Maintain unqualified Care Quality Achieved. regulatory obligations Commission (CQC) registration Achieve CNST registration Achieved. Meet all recommendations from the Did not achieve in Q4 due to another Cancer Peer review Trust unable to provide consultant for Multi-disciplinary Teams. Foundation Trust Achieve Foundation Trust status in In discussion with NTDA on revised Application 2011/12 submission timetable. Play our part in the Work with local commissioners Achieved. We participate in the wider community (PCTs) and other stakeholders to Manchester Health & Wellbeing Board reduce the burden of ill health on and have actively sought membership the community involvement and joint working with Bury, Oldham and Rochdale HWBBs. Achieve Foundation Trust public Achieved membership of 10,000. Environment & Meet or exceed national carbon Achieved. On target for 10% Sustainability reduction profile target reduction by 2015. Improvement to the North Achieved. Manchester General Hospital estate condition Equality Increase in the numbers of patients Achieved. involved in engagement activity Achieve 100% of Service Impact Achieved. Assessments completed Equality Training as mandatory for Achieved. all staff every three years.

Annual Report and Accounts 2012/2013 10 Looking to the Future

The forthcoming year During 2013/14 we will ■ Strategy - Develop a strategy (2013/14) will be characterised redefine our services and set that delivers long term by setting out how we will out our strategy to meet the sustainability transform and reinvent the significant challenges which ■ Finance - Maintain a Trust as we move forwards still face the public sector. Financially Sustainable Trust on our journey to achieving There will be a major focus ■ Productivity - Improve Foundation Trust status. on setting out our strategy Productivity and Reduce for the future, taking into A new vision for the Trust is Variation account the emerging thinking being developed. This is the ■ Leadership and Personal from the Greater Manchester- foundation phase of work Responsibility - Deliver wide ‘Healthier Together’ resulting from the Trust Board’s and embed leadership and review of health services. commitment to a whole personal responsibility across Having already successfully organisation transformation the Trust delivered major clinically-led programme. Our new vision service reconfiguration and ■ Foundation Trust - Achieve all will determine our strategic improvements in the north-east Milestones on the FT Timeline objectives and, in turn, provide sector of Greater Manchester, a coherent framework for all the These major objectives are this Trust is well positioned to individual strategies required to supported by a number of influence and respond to any deliver them, ensuring they are supporting objectives and by recommendations or proposals both aligned with one another a larger number of “business from the Healthier Together and take account of their inter- as usual” objectives to support review. We will, of course, also dependencies for success. delivery of care across all of our be developing our own clinical hospital and community services. strategy to set out how we believe services should be best All of our aspirations, plans delivered for the population we and objectives for 2013/14 will serve. be set in the context of the national economic backdrop Our key objectives for 2013/14 and a significant cost saving will again emphasise patient programme required of the Trust. safety, patient experience, During the year, we will also have financial and workforce to react positively to any further imperatives. Our corporate service decommissioning and to objectives for 2013/14 are: the strategic implications and ■ Quality Improvement - Patient financial impact of integrated Safety - Reduce Mortality care. ■ Quality Improvement - Patient Experience - Deliver Personal, Compassionate Care ■ Quality Improvement - Clinical Effectiveness - Reduce Hospital Readmissions

Annual Report and Accounts 2012/2013 11 Risks

The management and mitigation of risk is one of the key responsibilities of the Trust Board and of staff at all levels. The key risks which the Trust faced in the year were:

■ Reputational damage ■ Never Events ■ Poor care leading to ■ An Engagement Strategy ■ There were two never events regulatory involvement was developed and in 2012/13 and following ■ There was no significant during the year the Trust thorough investigations regulatory involvement during has made considerable a common factor was the year. progress towards improving identified of failure to follow ■ Staff engagement, poor relationships with a number established procedures. staff attitude and the of stakeholders, particularly Relevant procedures were risk of poor care being local commissioners and amended or reinforced and provided as a result involvement of our staff. followed up with additional staff training. ■ The Trust joined 10 other NHS ■ The lack of an overarching bodies from across England to business strategy ■ Mortality implement the “Listening into ■ The Trust Board has devoted ■ The previous reductions in Action” staff engagement time in developing strategic mortality evidenced by the programme within the intentions for the Trust RAMI standardised mortality Trust. There are some early alongside the emerging ratio reached a plateau during signs that this programme is thinking from the Healthier the year. Other indicators beginning to make a positive Together programme. This – the Dr Foster HSMR and impact on staff engagement. will continue to be a major the national SHMI mortality ■ Achievement of feature of work during ratios - demonstrated slight Foundation Trust status 2013/14. increases in Trust mortality ratios during the year. The ■ The Trust did not meet ■ Delivery of commissioned Trust Board commissioned the Tripartite Agreement levels of activity and has monitored date for submission of the ■ The Trust did not fully achieve implementation of a Mortality application to the Strategic planned activity levels during Reduction Strategy to address Health Authority. Discussions the year and this will be this. continued throughout the a major area of focus for year with the Strategic 2013/14 in order to match ■ Achievement of national Health Authority and capacity to demand. targets subsequently the National ■ The Trust level urgent care Trust Development Authority ■ Achieving financial balance access target, cancer and on a revised timescale for ■ The Trust ended the financial referral to treatment targets submission of an application. year in balance (neither a were achieved throughout surplus or deficit) and there the year. were discussions throughout the year with commissioners to plan a sustainable financial position for future years.

Annual Report and Accounts 2012/2013 12 Quality Accounts Report 2012/13

1 Statement on Quality on Behalf of the Board

This Quality Accounts Report hospitals as an inpatient, an of the few Trusts in Greater sets out our performance outpatient or day-case surgery Manchester to achieve the and progress over the past patient, or by our staff in our 95% 4 hour unscheduled care year and our priorities for community services. standard last year in our efforts quality improvement for the to ensure our patients are seen, During 2012/13 we have made forthcoming year. treated, discharged or admitted significant progress in meeting in a timely manner. We continue The report offers the Trust all of our key national clinical to work with our local GPs and the opportunity to report performance standards. These Clinical Commissioning Groups and demonstrate how our include all national cancer (CCGs), community and social staff across our hospitals and targets, further reductions in our care services to sustain this community services have strived healthcare acquired infections performance. to provide and have successfully and pressure ulcers, a reduction delivered high quality services to in our hospital crude mortality We have also made further our patients, met key national rate, improvements in our 18 improvements in reducing standards and developed ways weeks (RTT) surgery waiting healthcare acquired infections to improve patient care and the times and meeting emergency across all our hospitals. We patient experience. access care standards including are pleased to report that we the national 4 hour unscheduled achieved our nationally-set The Trust Board and our staff care target. threshold targets for the number are committed to providing safe of cases of patients with hospital services and high quality of care We are proud to report that acquired MRSA and Clostridium for patients. This means focusing thanks to the commitment and Difficile (C Diff) infections. on providing services that are hard work of our clinical and Our staff work hard to tackle safe, effective, and are of a high non-clinical staff, not only by these infections with good standard, ensuring our patients A&E teams but wards and other hygiene practice and a range of and carers have an excellent teams across our hospitals, infection control measures. It experience of care and receive the Trust achieved the national is encouraging to note that we outstanding service and best unscheduled care standards for have successfully reduced the clinical outcomes. every quarter of 2012/13 and for number of MRSA bacteraemia the year as a whole. Quality of care is at the cases by 97% over the past six cornerstone of everything we Despite the unprecedented years, from 105 cases in 2006/7 do and everything the Trust demand on our services and a to three cases in 2012/13. And and our staff believe in. Quality challenging winter, this Trust for C Diff infections, the Trust encompasses patient care, was one of the best performing has also successfully reduced the patient safety and a good patient Trusts in Greater Manchester number of cases year on year, experience. in meeting the national achieving a 76% reduction in the four hour emergency access number of cases reported over All of our patients rightfully standard across our three A&E the past five years, from 356 expect high standards of care departments and our Urgent cases in 2008/09 to 86 cases in and a good experience, whether Care Centre. We were one 2012/13. they receive care in one of our

Annual Report and Accounts 2012/2013 13 Patient safety and reducing the number of healthcare acquired infections remains a top priority. The Trust is continuing to seek ways to reduce the number of hospital acquired infections further by setting itself challenging targets and ensuring the ongoing training of its staff and by adopting new technologies wherever possible.

The Trust has set the challenge for 2013/14 of Zero MRSA bacteraemia cases and to reduce C Diff infections by a further 20% to no more than 69 cases.

We have a large, highly trained and committed workforce and developments and quality improvements reflected in this Quality Accounts report are their success. Our annual staff awards provide us with an opportunity to recognise and celebrate the very best of quality of patient care, skill and innovation among our staff. But we also know that our patients show their appreciation day-in, day-out through innumerable cards, letters and kind words to those who care for them when they are at their most vulnerable.

In December 2012 the final transfer and investment of services under Healthy Futures and Making it Better (MiB) marked the end of these six year reconfiguration programmes of clinical services across Greater Manchester. The opening of our new £44m women and children’s facilities at The Royal Oldham Hospital and the transfer of ophthalmology services from Birch Hill Hospital to our new

Annual Report and Accounts 2012/2013 14 Eye Unit at Rochdale Infirmary engagement with our staff, our of care and compassion we marked the final chapters of commissioners, our patients and provide across all our services. It Making it Better and Healthy the general public. Engagement is important we continue to talk Futures respectively. These with our staff and our patients with and listen to staff and our two major programmes have and their families continues to be patients and families. resulted in over £100m capital an important area we have been We will not compromise patient investment in new buildings and focusing on. During 2013/14 we safety or quality of care as we facilities and dramatic shifts and will be inviting views, comments continue to work with our local improvements in the way we and ideas from our staff, patients commissioners on the financial deliver services. and partner agencies as we challenges facing not only this shape and develop a long-term But populations continue to Trust but the local and national clinical strategy for the Trust change (especially in relation health and social care system. designed to deliver sustainable to the numbers of people with services in the future. Many staff have been involved in long-term conditions and the developing this Quality Accounts numbers of very old people); The publication of the Francis report. Our colleagues and new ways of delivering care Report into the quality of care community partners have also in new settings are constantly provided at Mid Staffordshire had an opportunity to comment pioneered; new technologies are NHS Foundation Trust in on the content. Their comments continually developed and, of February 2013 reminds us of are printed in full within these course, there has been a world the importance and the need pages and I would particularly banking crisis and, in the UK, for us to remain focused on encourage readers to take a recession and a public sector the quality of care, compassion the opportunity to read what spending squeeze. and competence we provide for others say about the services each of our patients on every The Trust is now formulating we provide. These are their occasion. The recommendations a strategy development words, not ours. They help us outlined in the Report have been programme to create a long- reach the view that we have had considered and integrated into term plan for the next five another year of progress and our Long Term Quality Plan as years and beyond. This process development. we develop and look at ways will involve conversations and to further improve the quality

John Saxby Chief Executive 4th June 2013

Annual Report and Accounts 2012/2013 15 2 Introduction Quality Accounts are annual Dental; Urology and local populations. In the case of reports for the public from NHS Gastroenterology. NHS Manchester, our services providers about the quality of ■ Women and Children, including acute secondary and services they provide. They are comprising: Gynaecology; community services relate to the required by Government to Obstetrics; Community north of the city only. help NHS Trusts maintain focus Midwifery and Paediatric care. The Trust has three NHS and improve the quality of care ■ Community Services contracts for acute, community for patients. This report is the in North Manchester; and specialist services, fourth Quality Accounts report comprising: Active Case which detail commissioning published by The Pennine Acute Management, Community requirements in terms of finance, Hospitals NHS Trust. Nutrition, Continence, District activity, performance and quality. The Trust runs North Manchester Nursing, Falls and Navigator, In addition, a number of General Hospital, Fairfield Funded Nursing Care, Home specialist services previously General Hospital in Bury, The Enteral Feeding, Intermediate included in the acute contract Royal Oldham Hospital and Care, Macmillan Nursing continue to be migrated into Rochdale Infirmary. We also & Therapy, Physiotherapy, the Trust’s contract with the provide a range of community Podiatry/Vascular Triage, North West North of England service across the north part of Stroke, Tissue Viability/Leg Specialised Commissioning the city of Manchester. Ulcer Service. Group. The Trust provides services in the We employ around 9,000 As part of the NHS reforms, from following principle specialties: staff and serve a population of approximately 820,000 people, April 2013 PCTs will be replaced ■ Accident & Emergency; and principally the communities by local Clinical Commissioning Urgent Care. in Prestwich, Bury, North Groups (CCGs). These will be ■ Diagnostics, comprising: Manchester, Oldham, Heywood, organisations made up of local Anaesthetics; Pathology; Middleton, Rochdale and parts family doctors who will be Radiology; Critical Care and of East Lancashire. responsible for deciding what Clinical and Allied Healthcare services are commissioned Professions (AHPs). As the largest acute non- and how local taxpayers’ ■ Medicine, comprising: teaching Trust in the country, it is money is spent on healthcare Cardiology, Elderly Care, our responsibility to develop and services. This will include areas Endocrinology and deliver high quality healthcare including: cancer, respiratory Diabetes, General Medicine, services around the needs of our disease (breathing), mental Infectious disease, Oncology, patients, their families and the health, hospital operations and Palliative Care, Respiratory, communities we serve. prescribing of drugs. Rheumatology and sexual health. 3 Commissioned 4 Quality & ■ Specialist services, services Performance comprising: HIV/ AIDS, renal The Trust provides secondary care Standards care and HPB (liver surgery). acute services on behalf of four The Trust continuously and ■ Surgery, comprising: local Primary Care Trusts (PCTs) routinely reviews data related Ear, Nose and Throat - NHS Oldham, NHS Heywood to the quality of its services Surgery, General Middleton & Rochdale, NHS Bury to ensure we are meeting Surgery; Ophthalmology, and NHS Manchester - which high standards. The Trust uses Orthopaedics; Specialist commission services for their

Annual Report and Accounts 2012/2013 16 its integrated Performance These include standards that we statement, we have four key Scorecard to demonstrate this. understand are important factors areas within our strategic for patients and their families corporate objectives which Monthly reports to the Trust who choose to be treated place quality of care and clinical Board, the Trust’s Clinical and cared for in our hospitals, improvement as a key priority Governance and Quality including A&E waiting times, throughout the Trust. Committee and the Trust’s cancer and surgery appointment ■ To improve clinical Performance Management targets, reducing healthcare effectiveness and safety Group all include performance acquired infections. data and information relating to ■ To reduce mortality the quality of services. An important area that we have ■ To reduce harm focused on over the last year, ■ To improve the patient The Trust has reviewed all the but recognise needs much more experience data available on the quality of improvement, are discharge care in all of these NHS services letters being sent to a patient’s The Trust’s annual corporate over the past year. The income local family General Practitioner objectives set the overall generated by the NHS services (GP) in a timely manner. direction for the Trust, both in reviewed in 2012/13 represents terms of how our services our all (100%) of the total income We send over 8,000 patient delivered and the expectations generated from the provision discharge letters a week. on our staff. of NHS services by The Pennine Currently, 80 per cent of the Acute Hospitals NHS Trust for discharge letters are sent Quality of care is the cornerstone 2012/13. within 24 hours of the patient’s of everything we do and discharge. We have a robust everything the Trust and our staff We strive to ensure we continue system that tracks every patient believe in. to look at ways to improve the discharge and monitors when quality of our services we provide Our vision is for everyone, from the letter is sent. Over the past for our patients. This is achieved frontline staff, including nursing year we have improved our through our doctors, nurses and and medical staff and staff performance in this regard and healthcare staff working hard to employed through an external our staff continue to work hard reduce inefficiencies and reduce contractor, to members of the towards meeting the national and eliminate variation in clinical Trust Board, to place quality of contract standard of 100 per procedures, healthcare delivery care at the heart of our service cent of letters being sent within and improving patient outcomes delivery. And, importantly, we 24 hours. and the patient experience, aspire for quality to be everyone’s whilst maintaining our focus on concern and responsibility. patient safety and quality. 5 Quality of Care Particular attention is given to: The Trust’s mission statement is Over the past year, we have “to provide the very best care to ■ Quality Assurance - meeting looked to redesign and transform each patient on every occasion.” standards and targets our services by working closely that are expected from with our commissioners, local Our staff understand the regulatory bodies through GPs and partner agencies to importance of this pledge and safe and reliable systems and improving patient pathways and work hard to ensure this is processes. delivered every day to every the outcomes of patients. ■ Quality Improvement - patient that we care for. It where the quality of care In addition, we continue to focus underpins everything we do. exceeds the minimum on meeting and, where possible, requirements and compares exceeding locally and nationally To continue to support with the best in its class. determined standards of care. the delivery of this mission

Annual Report and Accounts 2012/2013 17 Our vision is driven by not changed substantially from urinary catheter will have a three key values: year to year as there is still work care plan that reflects current to be done and are very much in best practice and NICE Patient care is at the centre line with national standards and guidance. of everything we do. We work priorities in relation to patient ■ Delivery of the North together to deliver a high safety, patient experience and West Advancing Quality quality service to provide the clinical effectiveness. Programme and clinical best possible outcome for our processes pertaining to patients. Patient Safety Heart Failure, AMI, Stroke, Accountability, honesty and ■ Each month 95% of all adult Pneumonia and Hip and Knee integrity are keys to our success inpatients will have had a procedures. both individually and across the Venous Thromboembolism Trust. (VTE) risk assessment on 6.1 Patient Safety admission to hospital using Patient safety continues to be Treating everyone with the clinical criteria of the the Trust’s top priority. We are respect and promoting good national tool. committed to improving patient working relationships will ■ Reduce rate of adults safety and we aim to have support individuals in reaching developing grades 2, 3 and no avoidable deaths and no their full potential. 4 pressure ulcers whilst avoidable harm across all our receiving care in our hospitals The Trust’s vision of quality hospitals and services. of care is delivered in to ≤50 per 1000. partnership with our partner ■ Meet the target threshold 6.1.1 Executive agencies and particularly our of no more than 4 hospital local commissioners (PCTs) attributed MRSA cases across Director (Patient who purchase our services all our hospitals. Safety) Walk- from us and with whom we ■ Meet the target threshold rounds agree each year areas of of no more than 100 Each month members of the quality improvement under hospital attributed cases of Executive Management Team, the contracting for quality Clostridium Difficile (CDT) our Executive Directors, conduct a process. These areas of quality across all our hospital sites. schedule of unannounced visits to improvement payments are wards and clinical areas to meet known as Commissioning Patient Experience with staff to discuss and receive for Quality and Innovation or ■ Patient and/or carer feedback direct feedback on issues relating CQUINs. on patient experience will be to patient care, patient safety and introduced to 4 new services the patient experience. This is an per year and used as basis 6 Review opportunity for frontline staff and for an action plan to address of Quality managers to discuss any issues issues as they arise. Performance or concerns, or raise any ideas to ■ Each Provider Board meeting improve the quality of care we Building on the eight key will start with a patient provide to our patients. priorities for improvement set story that will shape further out in last year’s Quality Account improvement actions. Detailed analysis and feedback (2011/12) which are listed below, is provided to staff through the the following section includes Clinical Effectiveness Trust’s divisional management a report on the progress and ■ 95% of adults who have had teams to ensure any necessary improvement we have made. a risk assessment at the time actions are implemented. The priorities themselves have of inserting an indwelling

Annual Report and Accounts 2012/2013 18 In 2012-13, Greater Manchester commissioners included a new Commissioning for Quality and Innovation (CQUIN) payment target called “leadership for harm free care” which promotes patient safety.

The CQUIN requires a minimum of 10 walk-rounds per Executive Director to have been undertaken during the year with a walk-round being completed every month by a minimum of three Executive Directors. The Executive walk-rounds are useful and effective opportunities to give ‘ward to Board’ feedback and give assurance that improvements being undertaken are appropriate.

6.1.2 Venous Thrombo-Embolism The Trust monitor its data which quantifies the numbers and proportion of adult hospital admissions – aged 18 and over - who are being risk assessed for Venous Thromboembolism (VTE) to allow for the administering of appropriate prophylaxis based on national guidance from the National Institute for Health and Clinical Excellence (NICE).

The Pennine Acute Hospitals NHS Trust considers that the data, presented below, is as described for the following reasons:

■ The data is extracted electronically from patient systems and a full audit trail is available if required.

■ Due to the time lag between admission (entered onto Patient Admission System PAS) and discharge (coders collating the VTE risk assessment compliance) if the patients are in hospital for a long period or re-admitted, coders cannot collate the data for that month as the notes are in the clinical area. It appears therefore as if a patient has been admitted but not had an assessment. This will in turn lead to less than 100% even if all assessments are carried out. ■ There is no structure for adding this data retrospectively following the prescribed submission date.

The Pennine Acute Hospitals NHS Trust intends or has taken the following actions to improve this: ■ Previous % VTE risk assessments completion level of 92%. ■ Problem identified in coding reviewing all physical notes, even though assessments completed.

Annual Report and Accounts 2012/2013 19 ■ Developed VTE field into the damaged. In very serious cases, mean a longer stay in hospital. Automated Letter System the muscle and bone can also be Making regular and frequent (ALS) discharge summary. damaged. changes to a patient’s position is ■ Coders can now see one of the most effective ways Pressure ulcers are caused by electronically if assessment of preventing pressure ulcers. pressure as the weight of the is completed even if notes Regular inspection of high risk body presses down on the skin; are not available due to re- pressure areas is also important to when layers of the skin are admission or long stay. detect early signs of any ulcers. forced to slide over one another, ■ Raised clinician awareness for example, when you slide Many patients are admitted of the changes and that the down in a bed or a chair; or to hospital with a pressure ALS discharge summaries are through friction. Rubbing the ulcer acquired at home or in monitored for compliance. skin can increase the risk of a community residential or ■ VTE will shortly be connected pressure ulcers developing. nursing home. Some patients, into Health-views and the particularly those who are frail, Pressure ulcers are a widespread assessment therefore will be sick, bed ridden or have limited and often underestimated linked electronically. mobility, are more susceptible health problem. In the UK, it is ■ VTE risk assessment to developing ulcers whilst estimated that between 4% and compliance is at 95-96% in hospital without corrected 10% of all patients admitted to month on month and the intervention. hospital will develop at least one Trust constantly meets related pressure ulcer. For elderly people CQUIN targets. Improvements with mobility problems, the During the last 12 months, we figure can be as high as 70%. 6.1.3 Pressure have continued to work hard to Ulcers Most pressure ulcers that develop prevent patients from acquiring avoidable pressure ulcers in our Pressure ulcers (or bed sores in the NHS are preventable and care. We have developed smarter as they are more commonly preventing them happening systems to provide frontline staff known) occur when the skin and improves the care for vulnerable with the support and advice they the tissue beneath it becomes patients as they cause long term pain and distress and can also need to care for our vulnerable patients. %of admitted patients risk-assessed for VTE Quarter 2 2012/13 score Our doctors and nursing staff are being encouraged and National Average Value 93.8 empowered to make pressure Minimum value for peers 80.9 ulcer prevention a key priority Maximum value for peers 100 as part of the Trust’s patient safety agenda, resulting in a real PENNINE ACUTE HOSPITALS NHS TRUST value 95.8 change in attitude in this area.

The ways in which pressure %of admitted patients risk-assessed for VTE ulcers are reported and the Quarter 3 2012/13 score standards of reporting vary National Average Value 94.1 hugely from Trust to Trust. Minimum value for peers 84.6 However, at this Trust we have made significant progress in the Maximum value for peers 100 last year to ensure we have a PENNINE ACUTE HOSPITALS NHS TRUST value 96 common approach to dealing with press ulcers, particularly

Annual Report and Accounts 2012/2013 20 with our record keeping and tissue depth. The Trust is required superficial in nature (stage 2). In risk assessments. Through to report all stage 2 and above 2012/2013, 2 new categories greater awareness and improved pressure ulcers as a clinical (unstageable and suspected deep training, our staff are now better incident. Figure 1 demonstrates tissue injury) were introduced at identifying, reporting and the significant improvements to improve the accuracy of our managing pressure ulcers. we have made over the last 12 documentation. months in reducing the number of Reduction in the number hospital acquired pressure ulcers. Improving skin of pressure ulcer assessment skills Figure 2 below illustrates incidents It was acknowledged that that the majority of pressure Pressure ulcers are classified practitioners needed greater ulcers reported in our Trust are according to their estimated guidance and education around

Figure 1. Numbers of clinical incidents relating to pressure ulcers acquired in hospital for 2011/2012 and 2012/2013.

160 140 2011/2012 120 2012/2013 100 80 60 40 20 0 Mar Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb

Figure 2. Severity of pressure ulcers as reported in clinical incidents for 2011/2012 and 2012/2013

600 2011/2012 500 2012/2013 400 300 200 100 0 Stage 2 Stage 3 Stage 4 Unstageable Deep tissue (depth injury unknown) (depth unknown)

Annual Report and Accounts 2012/2013 21 assessing skin and understanding identified and reported. This ulcers. Moving forward, we how to differentiate pressure allows them to validate or have equipped our wards with ulcers from other skin lesions. verify the tissue damage additional heel off loading aids. Ongoing training is provided (providing confirmation of the In total, 320 aids have been at the bedside resulting in cause and severity of the skin purchased this year, equating to more effective prevention and damage) working alongside an investment of £13,000. This treatment outcomes for the frontline staff. For the patient, equipment allows the patient’s patient. this means the right treatment heel to be free of any pressure can be provided in a timely and is a well recognised strategy Pressure ulcer validation manner and for the Trust, it for preventing pressure ulcers. In response to the need for means we have much greater accurate pressure ulcer data confidence in the accuracy of our Clinical assessment tool reporting, the Tissue Viability pressure ulcer figures. We have introduced a new Specialist Nurses have adopted pressure ulcer clinical reference new ways of working. They Removing the pressure tool which staff use at the receive an electronic notification We recognise that the heel is patient’s bedside to help correctly as soon as a new hospital an area of the body at greater grade pressure ulcers and to acquired pressure ulcer is risk of developing pressure describe the severity or potential

Carol’s story

Carol Faust was admitted to The Royal Nuala said: “Patients on trauma and orthopaedic Oldham Hospital following a fall in her wards are known to be at greater risk of pressure kitchen. ulcers as they are often confined to bed and unable to move. After a head to toe inspection Tissue viability equipment co-ordinator Nuala looking for any clinical signs which would O’Brien visited her and the staff on our vascular indicate the skin was vulnerable to breakdown, T7 ward, to advise on how they could prevent ward staff implemented a regular turning regime Carol from developing pressure ulcers as she was for Carol on a special alternating pressure immobile, lying on her back due to the injury she mattress. These mattresses are made up of a had sustained. series of air cells which continually inflate and deflate at regular intervals to provide pressure “Pressure ulcer prevention is not a new relief to each part of the body.” priority for the Trust. Over the last two years we have stepped up our efforts to reduce pressure ulcers across our hospitals. Our tissue viability team has been working closely with staff at all levels of the organisation to raise awareness of the importance of identifying and managing pressure ulcers correctly.”

Judy Harker, the Trust’s nurse consultant for tissue viability

Annual Report and Accounts 2012/2013 22 depth of tissue damage. It care in relation to pressure ulcers. 6.1.4 Reducing provides greater accuracy to Both campaigns were run in pressure ulcer reporting and partnership with the national Healthcare documentation processes. Your Turn campaign. Acquired Infections Communicating the severity of Our efforts to reduce the The Trust has introduced an pressure ulcers is essential for number of patients with Health innovative risk assessment tool high quality care. Pocket guides Acquired Infections (HAIs), such aimed at patients who are at have been developed for relevant as MRSA (Methicillin Resistant risk of pressure damage from frontline staff, allowing for better Staphlococcus Aureus) and orthopaedic devices such as assessment of skin damage as Clostridium Difficile (CDT), across plaster of Paris. This work has they can be used at the bedside. our hospitals continue to be a been shared at a national wound top priority. SKIN bundle care conference. We continue to reduce HAIs by The SKIN Bundle (an acronym We have also produced a patient improving our use of antibiotics for Surface, Keep moving, information leaflet on preventing and by creating an environment Incontinence, Nutrition) is an pressure ulcers. This is used and culture whereby our staff assessment tool to help staff widely across the Trust and is understand the importance of focus on key interventions also available on our website ensuring wards and patient to prevent pressure ulcers. It in addition to a talking leaflet areas are clean and that we all prompts staff to remember which has been updated for practice good infection control elements of good pressure area patients for whom English is not and hygiene when caring for our care in a reliable way. The tool their first language. was rolled out across the Trust patients. two years ago and has now Clinical Engagement All staff, both clinical and become firmly embedded into The last twelve months has seen non-clinical, must complete clinical practice and patient care. the development of new support mandatory hand washing groups, led and facilitated by Education & Awareness training every year. Our staff are our clinical matrons, specifically encouraged to be vigilant and The Trust continues to proactively designed to work closely report cleanliness issues. We take part and lead in staff with frontline staff. These routinely ask patients and visitors education and local public initiatives have enabled more to use the hand gel provided awareness campaigns to raise the effective dissemination of new when coming onto the wards. profile of press ulcer pr evention developments and changes and treatment. Last year, events within the field of pressure All relevant elective (planned included International Stop ulcer care. They provide an surgery) and emergency Pressure Ulcer Day in November opportunity for education and patients are screened for and an education event for sharing of best practice. Group MRSA, MMSA (Meticillin healthcare professionals held in members act as Pressure Ulcer Sensitive Staphylococcus April at our hospital at Fairfield. champions, helping the Trust Aureus) bacteraemia and Ecoli The event brought together to drive forward excellence bacteraemia as required by the staff from local nursing homes, within skin care prevention Department of Health. hospital wards, community and treatment and challenging nursing teams, podiatry and outdated practices and cultures. tissue viability services. The theme was achieving harm-free

Annual Report and Accounts 2012/2013 23 Improvements According to national figures, we are among the top performing NHS Trusts across the country who has managed to significantly reduce the number of patients with MRSA bacteraemia since 2006. The Trust has successfully reduced the number of MRSA bacteraemia (hospital acquired) by 97% in six years from 105 in 2006/07 to 3 in 2012/13.

MRSA bacteraemia and CDT cases are reported via the Health Apr - 12 May - 12 Jun - 12ProtectionJul - 12 AgencyAug -(HPA). 12 SeptIn 2012/13, - 12 Oct the - 12 TrustNov met - 12 and Decexceeded - 12 Jan - 13 Feb - 13 Mar - 13 Cum. Trajectory 0 0 1 1 1 2 2 2 3 3 3 4 Cum. Actual 0 1 its 1targets for1 the reduction1 of MRSA1 and CDT.1 This is1 a sustained1 2 3 3 improvement, with year on year reductions in HAI cases as can be seen in the graphs below.

MRSA Cumulative Actual vs Cumulative Set Objective 2012-2013 4 Cum. Trajectory Cum. Actual 3

2

No. of points 1 Apr - 12 May - 12 Jun - 12 Jul - 12 Aug - 12 Sept - 12 Oct - 12 Nov - 12 Dec - 12 Jan - 13 Feb - 13 Mar - 13 Cum. Trajectory 6 12 20 26 32 40 48 56 67 79 91 100 Cum. Actual 17 27 34 42 47 52 56 60 63 71 77 86 0 Apr - 12 May - 12 Jun - 12 Jul - 12 Aug - 12 Sept - 12 Oct - 12 Nov - 12 Dec - 12 Jan - 13 Feb - 13 Mar - 13

CDT Cumulative Actual vs Cumulative Set Objective 2012-2013 100 Cum. Trajectory Cum. Actual 75 2009-10 2010-11 2011-12 2012-13 Hospital 398 362 149 100 attributed CDI 50 cases Required 262 160 125 86

No. of points target 25

0 Apr - 12 May - 12 Jun - 12 Jul - 12 Aug - 12 Sept - 12 Oct - 12 Nov - 12 Dec - 12 Jan - 13 Feb - 13 Mar - 13

Annual reported hospital attributed CDI cases vs set targets: 2009-2013 400 Hospital attributed CDI cases Required target 300

200

100

0 2009-10 2010-11 2011-12 2012-13

Annual Report and Accounts 2012/2013 24 We carry out in-depth during care of invasive urinary ■ Wards identified with cases of investigations of all MRSA devices. CDT undergo a full clean and bacteraemia and CDT cases, ■ Ongoing staff education disinfection. including collaboration with staff and assessment for ANTT ■ Hand hygiene audits carried from partner agencies who work (aseptic non-touch technique) out through random checks. in the community teams. The aim and aseptic wound care ■ Commode audits carried out is to continue to learn lessons standards. through random checks. across the whole health economy ■ Routine audit of observations ■ Cleaning issues escalated in an effort to reduce cases, with of clinical practice among immediately to cleaning robust action plans implemented staff to assess compliance supervisors. where necessary. with standards of practice ■ Increased cleaning resources, for hand hygiene, care of A series of actions to support such as sporicidal wipes are intravenous (IV) and urinary the continued reduction of both supplied to areas identified as catheter devices. MRSA and CDT continue to be high risk for CDT. implemented. These are listed ■ Ongoing audit of compliance ■ Ongoing promotion of below. The Trust will continue to with the integrated nursing antibiotic stewardship among aim to deliver quality healthcare care plan for MRSA and CDT medical staff. services safely with infection patients, including correct ■ Audits of antibiotic prevention at its core. isolation nursing practices. prescribing and ■ Review of MRSA screening administration carried out by MRSA and decontamination the pharmacy department The Trust’s MRSA bacteraemia protocols. and the Trust’s infection target for 2012/13 was no prevention team. more than 4 hospital attributed Clostridium Difficile (post 48hr) cases across all our (CDT) ■ Targeted antibiotic ward rounds by our consultant hospital sites. This has been The Trust reported a total of microbiologist for areas an exceptionally challenging 86 hospital attributed cases, identified as high risk for CDT; target; a maximum of 1 hospital- achieving a rate below the training provided to medical acquired MRSA bacteraemia required threshold of no more staff. every three months. However, than 100 in the year. Although with a range of measures in this is extremely positive, the ■ Project with local Primary place and commitment from challenge will be to sustain Care Trusts (PCTs) to review staff, the Trust achieved this these reductions at a time when care of urinary catheters in target with three reported cases the type and complexity of the community and within and is in a good position to illnesses seen in patients in acute the Trust. This will help move forward to meet the much hospitals continues to increase. reduce required antibiotic tougher target of no avoidable treatment for catheter related MRSA bacteraemias in 2013/14. For 2013/14 the Trust’s urinary tract infections, which Clostridium Difficile (CDT) is no have been identified as high We have implemented a number more than 77 hospital attributed risk of CDT infection. of actions across the Trust over cases (post 72hr) across all our the last year to reduce MRSA hospital sites. cases further. These include: We have implemented a number ■ Standardised nursing of actions across the Trust over care plans and patient the last year to reduce CDT cases care pathways, including further. These include: protecting against infection

Annual Report and Accounts 2012/2013 25 Rate (per 100,000 bed days) cases of Rate per “Year on year we are Clostridium Difficile 100,000 bed successfully reducing April 2011 - March 2012 days the numbers of patients National Average Value 21.8 with healthcare acquired Minimum value for peers 0.0 infections…. Our staff Maximum value for peers 51.6 are encouraged to be vigilant and report PENNINE ACUTE HOSPITALS NHS TRUST value 25.6 cleanliness issues and we routinely ask Rate (per 100,000 bed days) cases of Rate per patients and visitors Clostridium Difficile 100,000 bed April 2010 - March 2011 days to wash their hands and to use the hand gel National Average Value 29.6 provided when coming Minimum value for peers 0.0 onto the wards.” Maximum value for peers 71.8 Marian Carroll, PENNINE ACUTE HOSPITALS NHS TRUST value 32.8 Director of Nursing

Annual Report and Accounts 2012/2013 26 Case studies

Reducing C Diff through Antimicrobial stewardship During 2012, the reduction or prevention of infection with training, supervision and in Clostridium Difficile (CDT) with minimal unintended prescribing. Supported by the hospital acquired infections consequences to the patient Antimicrobial Management has been supported with including emergence of Team, the pharmacists have stringent antimicrobial resistance, adverse drug events, developed credit-card sized stewardship programme. and cost. aide memoires for medical staff. These information cards Antimicrobial stewardship To support this programme, carry abbreviated versions involves the optimal selection, additional antibiotic pharmacists of the Trust’s antimicrobial dose and duration of an have been appointed to formulary to support prudent antibiotic resulting in the cure support ward-based staff antimicrobial prescribing.

Norovirus Norovirus, often known as and prevent the spread of the Our staff worked hard to deal the winter vomiting bug, is virus which had come into the with the outbreak at North the most common stomach hospital from the community. Manchester General and a virus in the UK, causing We believe this was the right couple of wards at Fairfield vomiting and diarrhoea and decision and as part of our General Hospital in December affects millions of people of responsibility to protect our and January by isolating all ages. patients, particularly our elderly infected patients and carrying and more vulnerable patients. out a thorough clean. The illness, which is highly infectious, is generally mild According to the Health “The priority is to and people usually recover Protection Agency (HPA), the fully within 2-3 days. Infections number of confirmed cases of protect our patients can occur at any age because Norovirus in England and Wales and staff. Our staff immunity does not last. was over 80% higher than the work extremely previous year. In December 2012, just days hard to deal with before Christmas, the Trust Like other hospitals across an outbreak of took the precautionary decision the region, the outbreak of Norovirus. The to close every ward at North Norovirus led to a greater decision to restrict Manchester General Hospital demand on our A&E to patient visitors following departments and affected some visiting was a significant outbreak of the of our staffing and inpatient necessary to help Norovirus in a small number of bed capacity. The public were prevent the spread wards. advised not to attend hospital of the infection and unless they were seriously sick The decision to close all wards ensure safe patient or injured and were encouraged to visitors was made to ensure to wash their hands with soap care.” that the hospital could return and water to reduce the spread to normal as soon as possible Marian Carroll, of the virus. Director of Nursing

Annual Report and Accounts 2012/2013 27 Cleanliness “We’re confident that beds. More than 550 staff Every patient that we care and G4S will deliver the who have been working at the Trust for a number of years are treat should be cared for with essential services compassion and dignity in a expected to transfer across to necessary for the clean and safe environment. G4S under TUPE employment The Trust employs a specialist smooth running of all our regulations. The company contractor to provide domestic premises to the highest services 25 other main hospitals. cleaning services across our standards. We look PEAT inspections hospitals, in both clinical and forward to working with non-clinical areas. Although The NHS Health and Social Care domestic cleaning staff are them to deliver a clean Information Centre requires employed by a contractor, they and safe environment NHS Trusts to carry out Patient are an integral and important for patients, staff and Environment Action Teams (PEAT) inspections each year. part of the hospital workforce visitors across all our and the ward team. Unannounced PEAT inspection hospital sites.” teams review NHS hospitals Wards are routinely monitored Pam Miller, in England for their standards and checked to ensure they Associate Director of Facilities in areas such as cleanliness, are cleaned to high standards. hand hygiene, quality of Cleaning spot checks are also accommodation and food from undertaken by the Trust Director cleanliness remains high on the perspective of the patient. of Facilities, the Associate all wards. The internal web PEAT inspections took place Director of Facilities and the page contains The Health Act across the Trust in January and Associate Director of Nursing. regulation 12, National Cleaning February 2012. The findings are reported to the documents, the Trust Cleaning Trust Board every three months. Manual, Trust cleaning policy, Patient representatives visited The Trust’s Infection Prevention cleaning method statements and and were involved in each and Control Committee receives nurses cleaning schedules. of the inspections. The Trust a bi-monthly report on all also received an independent All of our hospital sites have cleaning issues. The contractor validation check from exceeded the required cleanliness is required to meet an overall independent NHS managers target month on month. Since performance score of 85.5% and a representative from the April 2012, the Trust has not over a 13 week assessment Department of Health. period. Financial penalties for reported any areas as rated ‘red’ poor performance are imposed. which means immediate action The Health and Social Care required. This is a significant Information Centre confirmed Ward staff are encouraged and improvement compared to the the results from our 2012 PEAT empowered to report cleaning previous year. assessments in May 2012. The issues to senior management outcomes of these inspections From May 2013, a new external should standards fall below those highlighted some excellent contractor will be responsible for expected. standards across our hospitals, providing healthcare cleaning particularly where all our Improvements services across our hospitals. G4S hospitals received an excellent Integrated Services has been Last year the Trust rolled out a rating for food (see table on next awarded a five-year contract new online tool for staff on the page). Trust internal website which with staff responsible for over houses all the documentation 184,000 square metres of staff require for ensuring premises and 1,960 in-patient

Annual Report and Accounts 2012/2013 28 Privacy & Dignity Site Name Environment Score Food Score Score FAIRFIELD GENERAL HOSPITAL 5 Excellent 5 Excellent 5 Excellent NORTH MANCHESTER 4 Good 5 Excellent 4 Good THE ROYAL OLDHAM HOSPITAL 4 Good 5 Excellent 4 Good ROCHDALE INFIRMARY 4 Good 5 Excellent 5 Excellent BIRCH HILL HOSPITAL 5 Excellent 5 Excellent 5 Excellent

There has been another The assessments will take our hospital mortality rates. improvement on our PEAT place every year, and results Mortality is closely monitored inspection from last year. All our will be reported publicly to and discussed every month as staff, from cleaners, porters and help drive improvements in the part of the Medical Director’s chefs to nurses and doctors, care environment. The results patient safety report which is work hard to ensure that our will show how hospitals are presented at our public Trust patients’ stay is as comfortable as performing nationally and locally. Board meetings. These reports possible and their experience at are also available on our website. Our PLACE assessment will take our hospitals is a positive one. place between April and June There are different ways in PLACE 2013. We will receive six week’s which hospital mortality can notice of a week within which be measured. For a number of From April 2013, the NHS will an assessment must be carried years the Trust has used the see the introduction of PLACE, out. Each PLACE assessment will CHKS (Comparative Health which is the new system for generate a score of four separate Knowledge Systems) Risk assessing the quality of the assessment areas of cleanliness, Adjusted Mortality (RAMI) as its patient environment. PLACE is food, privacy and dignity, and benchmarking model to allow based on a visual assessment. general maintenance and décor for the monitoring of mortality This new system will replace of the hospital environment. rates among our patients and the former Patient Environment the tracking of outcomes with The Trust expects to be notified Action Team (PEAT) inspections. specific clinical conditions. CHKS of the preliminary results in The assessments will apply to is an independent provider of July 2013, with final national all hospitals, hospices and day healthcare intelligence and publication in September treatment centres providing NHS quality improvement services. 2013. The results must then funded care. be published locally – likely to Adjusted mortality enables The assessments will see local be reported through our Trust the organisation to focus people go into hospitals as part Board public meeting – with on key indicators, driving of teams to assess how the an accompanying action plan down poor performance with environment supports patient’s that sets out how we expect other nationally recognised privacy and dignity, food, to improve services or any benchmarking tools such as Dr cleanliness and general building specific areas before the next Foster Intelligence’s Hospital maintenance. It will focus entirely assessment. Standardised Mortality Ratio on the care environment but (HSMR) and the Summary does not cover clinical care 6.1.5 Mortality Hospital Level Mortality Indicator provision or how well staff are (SHMI). We use a variety of data doing their job. indicators, analysis and methods The Hospital Standardised to carefully and actively monitor Mortality Ratio (HSMR) is an

Annual Report and Accounts 2012/2013 29 indicator of healthcare quality. by applying this methodology to of comparative healthcare This is a complex area but helps all 56 diagnosis groups in the Dr information - has annually compare an NHS Trust’s actual Foster Intelligence model. published its Hospital Guide. This number of deaths to its expected national report includes rankings HSMR looks at all deaths that or predicted number of deaths. of NHS Acute Trust’s perceived occur prior to discharge from HSMR is a statistical number relative performance with respect the NHS hospital system – i.e. that enables the comparison to patient safety and clinical deaths while under the care of of mortality rates between effectiveness. HSMR is routinely the NHS. The logic here is that hospitals. This prediction takes included in its performance the point of discharge is clinically account of factors such as indicators. determined – either you are well the age and sex of patients, enough to be discharger or you The Dr Foster Intelligence 11th their primary diagnosis and are dead. The difficulty is that it Hospital Guide was published in complicating factors, and their misses those patient transferred December 2012. Using Dr Foster length of stay in hospital. to die in a different environment methodology the Trust’s Hospital Standardisation of mortality rates outside the NHS – at home, Standardised Mortality Ratio allows comparison between in a nursing care home or in a (HSMR) was recorded as 102 different hospitals, serving hospice. This distortion has been covering the period from April different communities. relatively small in the past but 2011 – March 2012. This was HSMR is based on the likelihood has increased in some instances within the expected range. This of a patient dying of the condition recently. figure compares with the figure with which they were admitted to of 100 as reported in last year’s Also noting is that Dr Foster hospital (i.e. the patient’s recorded Dr Foster Hospital Guide 2011 Intelligence produces HSMR primary diagnosis). This means this and in 2010 the Trust’s HSMR data in which deaths are methodology relies on accurate was 110. Our latest published attributed to any hospital that diagnosis and record-keeping by year to date figures for HSMR for treated a patient. If a patient is doctors, and appropriate data the period April 2012 to January treated in hospital A and then coding. 2013 was 103. transferred to hospital B where If a Trust has an HSMR of 100, they die, the death counts as SHMI this means that the number of a death for both hospital A’s The ‘Summary Hospital-level patients who died is exactly as patient and hospital B’s. Mortality Indicator (SHMI)’ is would be expected. Values above As well as an individual patient’s another mortality measure and is 100, suggest a higher than diagnosis, HSMR is also also published as part of the Dr expected mortality and those influenced by a number of other Foster report. below as within an acceptable factors including the patient’s range. HSMR is an important SHMI looks at factors such age, the method of admission indicator that acts as a smoke as the patient’s age, method (e.g. elective/planned surgery alarm for potential problems of admission and underlying or emergency), any underlying with the quality of care. It is a medical conditions. The SHMI is health problems the patient trigger for investigation a ratio of the observed deaths may have, and the level of social over a period of time divided by The chance of dying from each deprivation or health standards the expected number given the condition is calculated by looking for that area in which the patient characteristics of patients treated at all the patients diagnosed lives. by that Trust. with that condition and then all those who died from it, in all Dr Foster The data used to calculate hospitals, over the course of a Since November 2001, Dr the SHMI includes all deaths year. A Trust’s HSMR is calculated Foster Intelligence – a provider in hospital, plus those deaths

Annual Report and Accounts 2012/2013 30 occurring within 30 days after discharge from hospital. Worth Percentage of admissions noting is that “after discharge” is a random moment in time and with palliative care coding responsibility for deaths that occur between discharge and 30 days The SHMI makes no adjustments later are harder to determine. The SHMI only attributes a death to for palliative care. This is an the hospital which last treated the patient prior to death. SHMI does indicator designed to accompany not adjust for palliative care because of the unreliability of coding. So the SHMI and gives a measure some hospitals may appear to have a worse SHMI than they should of the palliative care provided because no allowance has been made for patients admitted for care by each provider reported in the in the last days of life. SHMI. The Trust’s reported SHMI for 2011/12 was 1.05. The latest In a recent review by the Trust, published data for SHMI (Published April 13) for the period Oct 11 to we have since revised and September 12 is1.08. approved a policy which outlines SHMI April 2011 - March 2012 SHMI Value how any patient case note is to be highlighted with the use of National Average Value 1.0000 a stamp and sticker system to Minimum value for peers 0.7102 identify that the patient has had Maximum value for peers 1.2475 some level of Specialist Palliative PENNINE ACUTE HOSPITALS NHS TRUST value 1.0458 Care from either the Consultant on-site or the Macmillan Nurse Service. This Policy has been SHMI July 2011 – June 2012 SHMI Value re-published to all staff involved National Average Value 1.0000 with the emphasis being firmly Minimum value for peers 0.7108 on the importance of making it Maximum value for peers 1.2559 very clear and concise within the case note that the patient has PENNINE ACUTE HOSPITALS NHS TRUST value 1.0733 received Specialist Palliative Care.

Annual Report and Accounts 2012/2013 31 It is hoped that we will begin to see an increase in the Palliative Care The Trust is in a transition phase coding and this will be routinely monitored in the coming months to moving from using CHKS - monitor progress. Risk Adjusted Mortality Index (RAMI) to using the HSMR Percentage of admissions with palliative Diagnosis which is referred to in national care coded • April 2011 – March 2012 Rate publications and in the Dr Foster National average value 1 Hospital Guide. A decision Minimum value for peers 0 to move to HSMR was made Maximum value for peers 3.3 because CHKS is essentially limited to comparing our Trust PENNINE ACUTE HOSPITALS NHS TRUST value 0.6 with a ‘peer group’ of other similar Trusts. HSMR allows us to Percentage of admissions with palliative Diagnosis be compared against every Trust care coded • July 2011 – June 2012 Rate in the country. National average value 1 We recognise we have a great Minimum value for peers 0 deal of work to do to improve Maximum value for peers 3.3 the recording of our patient’s PENNINE ACUTE HOSPITALS NHS TRUST value 0.6 initial diagnosis by our doctors. If that diagnosis is not checked Improvements and verified by a senior clinician Mortality across our hospitals has decreased every year since 2005. during admission and if the initial According to recent figures by any indicator, including Dr Foster and diagnosis is less severe than CHKS, we have maintained steady improvement in our risk adjusted reality (e.g. an initial diagnosis hospital mortality rate. of pneumonia that should be bronchopneumonia) then this The Trusts rolling Risk Adjusted Mortality (2011 methodology) shows would lead to an incorrect the previous twelve months each month and provides evidence of diagnosis which could also result reduction over the last 12 months avoiding month on month variation. in a much higher HSMR being The Crude Mortality (number of deaths as a percentage of inpatient recorded. spells) continues to fall. Real Time Monitoring The number of deaths as a percentage of inpatient spells across our We have recently acquired the hospitals continues to decrease. This is encouraging. However, because Dr Foster Intelligence Real Time mortality measures compare a Trust’s mortality performance with other Monitoring (RTM) Tool to drive Trusts, unless our crude death rate decreases faster than our peers’, our work and to help us identify our mortality ratio will statistically increase. ways we can improve clinical There are three key factors that affect mortality ratios – the accuracy care and the primary diagnosis of patient records, diagnosis and coding, and, most importantly, the coding in relation to mortality. care we provide to our patients. The RTM is a web-based solution During the last year we have established a Trust Mortality Review that monitors and identifies Group which is chaired by the Medical Director and comprises a potential process, clinical and number of our senior hospital doctors. A Mortality Action Plan is coding problems around key being implemented to eliminate variation in the delivery of clinical indicators of clinical quality, care and improve our doctor’s coding of primary diagnosis. This will including mortality (HSMRs), ultimately improve patient outcomes across all our hospitals and length of stay, readmission rates clinical services. and patient safety. This is proving

Annual Report and Accounts 2012/2013 32 extremely informative and is Time Monitoring (RTM) tool which will allow us to look more closely highlighting different areas for us at mortality rates by diagnoses and specifically the expected deaths to focus on. For example, many resulting from primary diagnosis. The Trust will continue to review of the primary diagnosis listed on all mortality indicators, driving down poor performance with other our patient’s records is a medical nationally recognised benchmarking tools such as the Summary term called Syncope which may Hospital Level Mortality Indicator (SHMI). refer to a temporary loss of The Trust continues to work with other hospital Trusts as part of consciousness or a common form the North West Reducing Mortality Collaborative. The collaborative of fainting. This is not a diagnosis comprises nine NHS Trusts across the region and is supported by but more of a symptom and AQuA, the Advancing Quality Alliance. The collaborative was set up to therefore can and should not be improve clinical practice and understanding among clinicians to reduce recorded as a possible condition avoidable deaths. that could link to a patient dying. We have to look into this area more closely. 6.1.6 Patient Safety Incidents Patient safety incidents are reported to the National Reporting and Our doctors, however, Learning Service (NRLS) by provider organisations must exercise caution when documenting a definitive Reported Patient Safety Incidents per 100 primary diagnosis before they admissions • April 11 - September 11 Score have all the clinical evidence, National Average Value 5.99 but it is important that accurate Minimum value for peers 2.13 recording and coding is part of Maximum value for peers 19.25 a patient’s clinical treatment and PENNINE ACUTE HOSPITALS NHS TRUST value 5.10 reviewed routinely. Reported Patient Safety Incidents per 100 Another important factor which admission • October 2011 - March 2012 Score can explain why we are marginally National Average Value No Data higher than our peers is that our Minimum value for peers 0.94 hospitals predominantly deal with communities that generally Maximum value for peers 21.71 have health inequalities and PENNINE ACUTE HOSPITALS NHS TRUST value 5.22 long-standing chronic health Patient safety incidents resulting in severe harm or death are reported to the problems such chest, heart and National Reporting and Learning Service (NRLS) by provider organisations lung disease. Whilst there are differences in the way mortality Reported Patient Safety Incidents resulting Severe is calculated and variances in Harm or Death • April 11 - September 11 Score primary diagnosis and appropriate National Average Value 4.67 coding, the most important thing Minimum value for peers 0 is that we continue to focus on Maximum value for peers 0.34 ensuring our services are safe for PENNINE ACUTE HOSPITALS NHS TRUST value 0.15 our patients.

We will continue to focus on Reported Patient Safety Incidents resulting Severe Harm or Death • October 2011 – March 2012 Score further improving our hospital mortality rate by improving National Average Value No Data and standardising the way Minimum value for peers 0 we code primary diagnosis. Maximum value for peers 0.31 We will use the Dr Foster Real PENNINE ACUTE HOSPITALS NHS TRUST value 0.02

Annual Report and Accounts 2012/2013 33 6.1.7 Never Events ■ In-hospital maternal The Trust has revised its death from post-partum procedures for the insertion, The National Reporting and haemorrhage after elective management and removal Learning Service is a division caesarean section of intravenous devices. Ward of the National Patient Safety ■ Falls from unrestricted areas where certain intravenous Agency (NPSA). Never Events windows devices are inserted now include are defined by the NPSA as guidance for staff as part of the serious, largely preventable, The Trust reported two ‘Never ward based induction. We have patient safety incidents that Events’ in 2012/13 which were also revised our guidelines for should not occur if the available in relation to a retained guide checking of swabs, sharps and preventative measures have been wire following the fitting of implemented. a line and a retained swab instruments. during surgery. The Trust The World Health Organisation Our local commissioners - Board fully recognises that (WHO) Safe Surgery Saves Lives Primary Care Trusts (PCTs) these events are unacceptable Checklist remains a crucial part and from April 2013, Clinical and should not happen. Both of improving communication Commissioning Groups (CCGS) were fully investigated and the between our staff across clinical - are required to monitor the findings subject to our new teams in introducing safer surgery occurrence of ‘Never Events’ internal High Level Review within the services they Incident Review Panel which is practices to reduce patient harm commission and publicly report chaired by the Trust’s Medical and surgical complications. The them on an annual basis. Director. Importantly, our GP Trust has achieved compliance commissioners are invited to with the checklist and aims The list of 25 Never Events sit on these panels to open for continued growth. This is nationally includes incidents in the investigation reports and monitored through the Trust’s relation to: externally scrutinise the findings. Patient Safety Committee. ■ Wrong site surgery A key part of our commitment ■ Retained instrument post- Improvements in promoting harm-free care operation As a result of the routine but through investigations to Never and reducing the prevalence ■ Wrong route administration Events, the Trust has made a and risk of Never Events has of chemotherapy number of changes in order that been to ensure lessons can be ■ Misplaced naso or orogastric improvements can be made to learned from such incidents, tube not detected prior to use ensure patient safety, particularly improvements made and ■ Inpatient suicide using non- in relation to retained swabs and that these are shared widely collapsible rails instrument post-operation. throughout the Trust.

Investigation and management Issues/events identified of incident/event Incident, claims, complaints and other sources Investigation, action planning, improvements, monitoring and reporting Patients and Staff

Share lessons learning Identifying lessons learned All types of communications, to the right Risk management and data analysis, staff in a timely manner action plans, reports

Annual Report and Accounts 2012/2013 34 The Trust is developing a Lessons safety issues managed through a A Patient Experience Programme Learned Framework. The national reporting system. for our Non–Executive Directors purpose of this framework is started in October 2010. The We have a robust risk to ensure there is a clear and programme allows the Trust management system with agreed approach to notifying, Board members to meet and talk policies and systems in place investigating, managing and with patients, the public and across our hospitals for staff learning from incidents/events staff. It creates opportunities to report and record safety and importantly that lessons for our Non Executive Directors incidents, alerts, and in taking learned from a variety of sources to gain direct feedback from necessary action to address any reach target audiences. patients of their experiences of issues or concerns. All patient current or previous care they The framework defines ways in safety alerts are scrutinised by have received from the Trust. which sharing lessons learned the Trust’s Clinical Governance Board members can explore the can improve quality, reduce risks and Quality Committee. experiences with patients and and recurrence through: In April 2013, the Trust had no gain insight into the patient’s a) Standardised Trust processes alerts outstanding. journey. for the identification of Patients and staff continue to potential lessons learned. 6.2 Patient welcome the opportunity to b) Standardisation of the way Experience speak to Board members and offer their opinions, identify that that lessons learned are A key objective of reporting good practice and highlight any summarised, disseminated our patients’ experiences is issues or areas for improvement. and made available to staff. to assure the Trust Board, our In the coming year Non-Executive commissioners and the public It also sets out the routes that Directors of the local CCG’s will that those experiences have lessons learned are cascaded, be invited to join these visits. been listened to, acted upon the mechanisms required to and have influenced change proactively and systematically and improvement in services. 6.2.2 Patient capture key lessons for sharing Delivering the best quality care Trust wide so that they reach the stories for people at the right time right staff, in a timely manner Every month the Trust Board and in the right place depends and in the right format. receives a presentation, usually upon listening to feedback and given by a Clinical Matron or learning from experience. The framework will be further the Director of Nursing, about developed and rolled out in a patient’s experience who has 2013/14. 6.2.1 Non– been treated and cared for Executive Director at one of our hospitals. The 6.1.8 NPSA alerts patient’s story is presented to Patient Experience The National Patient Safety Board members in a variety of Agency (NPSA) helps the NHS Programme different ways including either understand why, what and how The Trust has six Non-Executive a written account or a recorded patient safety incidents happen, Directors who sit on the Trust interview with the patient played learn from these experiences, Board and hold to account in audio. The aim is to examine and take action to prevent future the work of the Trust and the and discuss the experience of a harm to patients. The NPSA Executive Management Team patient in detail and learn from issues alerts to Trusts across in providing quality healthcare any emergent issues. the country derived from the services for patients and the The Trust Board acknowledges reporting and analysis of patient communities we serve. the importance of hearing

Annual Report and Accounts 2012/2013 35 the patients’ stories directly The national inpatient survey is used to compare patients’ experience through the quoted extracts and perceptions across the NHS. The data is used in performance and the lessons learned and tables and quality indicators (CQUINs). actions taken. Improving the The Trust received some very positive results from the 2012 national links between wards and the inpatient survey and improved its scores in 35 out of the 59 questions Board was one of the key asked. The key area’s of improvement have been around the care and recommendations in the first treatment. The Trust will continue to work with the Divisions to make Francis Inquiry Report into Mid- improvements in the overall inpatient experience. Staffordshire NHS Foundation Trust. The Board recognises that not every perception held by Stayed Section heading Worse the same Improved a patient, or every complaint made, will necessarily be upheld. The emergency / A&E Nevertheless it remains important department, answered by 1 0 1 to understand how patients or emergency patients only their relatives have seen matters Waiting lists and planned even though Trust staff may admissions, (answered by those 0 0 2 have viewed the same situation referred to hospital) differently. Waiting to get to a bed on a ward 0 0 1

A patient story is a now regular The hospital and ward 4 1 6 feature of the Board’s agenda. Doctors 2 0 1 Details of the patient’s story and experience, good and bad, are Nurses 0 0 4 feedback to staff in ward teams. Care and treatment 1 2 6 Operations and procedures 6.2.3 National (answered by patients who had 0 0 6 Inpatient Survey an operation or procedure) Leaving hospital 4 7 6 Care Responsiveness to Patients Needs Overall views and experiences 1 1 2 Patient experience is a key TOTAL 13 11 35 measure of the quality of care. The NHS, including this Trust, The results of the 2012 inpatient survey were published in May continually strives to be more 2013 and are currently being shared with staff across our divisions. responsive to the needs of those Action plans are in development with the Divisions are will start to using services, including needs be implemented in August 2013, focusing on the lowest scoring for privacy, information and questions and areas where improvements were not achieved. Progress involvement in decisions. on action plans are monitored by the Trust’s Patient Experience and Equality and Diversity Committee quarterly and reports to the Clinical The NHS Outcomes Framework Governance and Quality Committee. for 2012/13 includes an organisation’s responsiveness to patients needs as a key indication of the quality of patient experience. This domain score is based on the mean a number of questions from the National Inpatient Survey 2012.

Annual Report and Accounts 2012/2013 36 National Inpatient Survey questions relating to CQUINs Responsiveness to the personal needs of patients 2011 2012 Were you involved as much as you wanted to be in 68 70 decisions about your care? Did you find someone in the hospital to talk about 59 59 your worries and fears? Were you given enough privacy when discussing 82 84 your condition and treatment? Did a member of hospital staff tell you about medication side effects to watch for when you 44 46 went home? Did hospital staff tell you who to contact if you were worried about your treatment or condition 68 71 when you went home?

Examples of other responses in the National Inpatient Survey Questions 2011 2012 How do you feel about the length of time you were on the waiting list? 7.8 8.7 Did you feel threatened during your stay in hospital by other patients or visitors? 9.7 9.9 How clean were the toilets and bathrooms that you used in hospital? 8.2 8.6 Did you have confidence and trust in the nurses treating you 8.6 9.0 In your opinion, were there enough nurses on duty to care for you in hospital? 7.4 8.1

Annual Report and Accounts 2012/2013 37 The Care Quality Commission (CQC) has also undertaken further analysis of results and identified scores for each of the sections out of ten. These results show how the Trust compares per section and overall to other Acute NHS Trusts across the country.

Based on patients’ responses to the survey, this Trust scored:

How this score compares with 2011 2012 other trusts For questions about the emergency / A&E department, answered 7.6/10 8.6/10 As expected by emergency patients only For questions about waiting lists and planned admissions, answered 6.4/10 9.0/10 As expected by those referred to hospital For questions about waiting to get to a bed on a ward 7.5/10 8.0/10 As expected For questions about the hospital and ward 8.2/10 8.4/10 As expected For questions about doctors 8.3/10 8.4/10 As expected For questions about nurses 8.4/10 8.6/10 As expected For questions about care and treatment 7.4/10 7.7/10 As expected For questions about operations and procedures, answered by 7.8/10 8.2/10 As expected patients who had an operation or procedure For questions about leaving hospital 6.6/10 6.9/10 As expected For questions about overall views and experiences 5.7/10 5.0/10 As expected

In addition the Trust participated in a further four national surveys two of which will be reported in the 2013/14 Quality Accounts:

SURVEY TITLE REPORT DATE National Cancer Survey - Patient Experience Summer 2013 National Chemotherapy Survey – Patient Experience Summer 2013 National Accident and Emergency Survey December 2012 National Day Surgery Survey – Pilot Scheme November 2012

6.2.4 Real Time Patient Experience Capture In addition to the national surveys that we carry out, Collecting and using patient real time feedback which include inpatient and outpatient services, helps us to: maternity and Accident and Emergency care, ■ understand any problems and develop quality we continue to collect ‘real time’ feedback from improvements to address them patients about their experience. ■ monitor the impact of quality improvement Collecting and using patient feedback and good initiatives complaint handling is vital in ensuring our patients ■ improve communication between patients and are listened to and that we learn from patient staff experience – good or bad. ■ provide accessible and responsive services based on people’s needs

Annual Report and Accounts 2012/2013 38 Local Survey National Inpatient 2009 Survey National Inpatient 2010 Survey National Inpatient 2011 Survey April 2012 May 2012 June 2012 July 2012 August 2012 September 2012 October 2012 November 2012 December 2012 January 2013 February 2013 2013 March Numbers of usable surveys 367 362 377 379 372 264 279 320 251 350 345 207 325 245 157 completed

6.2.5 Discharge Board, our commissioners and benchmarking and development is shared with directly with of services to be achieved. These Surveys our staff to ensure feedback is surveys were undertaken in the Our Trust volunteers routinely received by the wards or service, last 12 months in areas such visit our wards each week day and allow changes to be made to as Medical and Surgical wards, and sit with patients who are improve patient experience. Intensive Care Unit Community due to be discharged from Services and Maternity Postnatal The results to date have shown hospital. Our patients are asked Care. to complete a questionnaire that the patient experience in directly onto a tablet computer real time is significantly better 6.2.7 Advancing with the assistance of the than the retrospective account of volunteer if this is needed. The activity that occurs as part of the Quality Patient questionnaire is anonymous. national Inpatient Survey. Experience Volunteers are used rather than The Advancing Quality (AQ) hospital staff to avoid bias and 6.2.6 Service Led programme continues to support fear of discrimination. Surveys the improvement of patient care The numbers of usable surveys Ad hoc surveys are also and patient experience in NHS undertaken over the last 12 undertaken across the Trust using hospitals across the North West. months are shown above. This the real –time electronic capture Over the past 12 months the survey data informs the Trust devices to enable service reviews, Trust has developed a number of programmes to capture

Annual Report and Accounts 2012/2013 39 patient experience for the areas NHS patients undergoing patient on the particular day they of Hip and Knee Replacement, elective (planned) Hip or Knee are completing the questionnaire Pneumonia, Heart Failure and replacements, Groin Hernia to assess their own stat of health Myocardial Infarction. surgery or Varicose Vein rated from 0 (worse imaginable procedures. health 5 up to 100 (best possible The continuation of collecting imaginable health state). patient experience for these PROMS are short, self-completed major health conditions and questionnaires, which measure Oxford Hip / Knee replacement clinical pathways links to data the patient’s health status or and the Aberdeen Varicose Vein collected from the patient’s health-related quality of life at scores are used as an additional case notes. By carrying out a single point in time. The first measure to assessing health and this work we are able to questionnaire is given at time of overall outcomes of surgery. reduce re-admissions, reduce pre-operative assessment or on Provisional Key Results – 1st April complications, reduce costs and the day of admission. A second to 30th September 2012l decrease the length of stay in questionnaire is sent out six hospital for patients. months from date of surgery for During this six month time hip or knee replacements and for frame the Trust had an overall A key change to the programme varicose vein and groin hernia total of 1099 eligible hospital in 2012/13 was to ask patients procedures the survey is sent out procedures and 915 pre- only one question prior to three months following surgery. operative questionnaires were discharge from hospital (see returned – a participation rate table at the bottom of page). PROMs provides the Trust with of 83.3% for this time period. the means of gaining an insight The Trust has achieved an overall Nationally there were 118,368 into the way patients perceive response rate of 12.5% and eligible procedures carried out in their health and the impact that increase of 4% from last year. hospitals; 85,965 pre-operative treatments or adjustments to We are continuing to improve questionnaires returned so far, lifestyle have on their quality of the response rate by encouraging a headline participation rate of life. all patients to complete the 72.6% (69.9% for 2010-11). questionnaire and raising Definitions Of the 915 pre-operative awareness amongst our clinical The date from the pre- questionnaires completed a staff of the importance of patient operative questionnaire to the total of 363 have been sent feedback to help us improve our questionnaire sent out post out on behalf of the trust quality of care. operatively link to specific sets (39.7%). Overall of the 85,965 of questions that are recognised pre-operative questionnaires 6.2.8 Patient nationally as follows: returned, 31,687 post-operative Reported Outcome EQ-5D – Health Status which questionnaires were sent out, Measures (PROMs) include living arrangements, of which 10,534 have been mobility, able to self care, daily returned so far - a return rate of NHS Trusts are still required activities and mental status. 33.2%3 (81.0% for 2010-11) to report on patient-reported Nationally. outcome measures (PROMs). EQ-VAS – this is a visual analogue scale that asks the Information is collected on If an * is in a column signifies that wither the numbers currently are too small to support Benchmark Benchmark Benchmark the data or questionnaires have score 2010 score 2011 score 2012 not been linked at the time this Did you get the care that 85.7 90.7 89.5 data was available. mattered to you?’

Annual Report and Accounts 2012/2013 40 The following table compares pre- and post-operative ‘EQ-5D Index’ scores (a combination of five key criteria concerning patients’ self-reported general health), an increase in general health was recorded for:

EQ-5D Index Groin Hernia Hip Replacement Knee Replacement Varicose Veins National 51.4% 89.8% 79.4% 51.7% Lowest 39.4% * 53.8% * This Trust 42.9% 75.0% 75.0% 63.6% Highest 59.1% 100% 94.1% 50.0%

This table compares pre- and post-operative ‘EQ-VAS’ values (the current state of the patient’s self-reported general health), an increase in general health was recorded for:

EQ-5D Visual Analogue Score Groin Hernia Hip Replacement Knee Replacement Varicose Veins National 38.8% 65.2% 55.0% 41.6% Lowest 28.8% 39.4% * * This Trust 31.7% * * 50.0% Highest 52.3% 40.7% 37.9% 22.2%

This table compares pre-post operative responses to condition-specific questions, improvements in patients’ conditions were recorded for:

Oxford Hip / Knee Scores National Lowest This Trust Highest Hip Replacement 96.3% * 90.9% 100% Knee Replacement 92.4% * 78.6% 83.3%

Oxford Hip / Knee Scores National Lowest This Trust Highest Varicose Veins 83.4% * 100% 77.8%

Please note there is no condition The Pennine Acute Hospitals ■ Supporting patients to gain a scoring for groin hernia. NHS Trust intends to take the better understanding of what following actions to improve this PROMs means to them. The Pennine Acute Hospitals NHS score and so the quality of its ■ Ensuring Patients expectations Trust considers that this data is services, by: do not exceed the best as described for the following ■ Aiming to recruit 90% possible outcome of the reasons: of patients in 2013/14 surgery. ■ Lower numbers of completing the 1st respondents to the questionnaire pre-operatively. questionnaire than desired ■ Reviewing the current ■ Higher than attainable patient health gains of surgery and expectations from surgery identifying how these can be ■ Low numbers of patients maximised in order to achieve understanding PROMs standard.

Annual Report and Accounts 2012/2013 41 6.2.9 Carer The strategy sets outs key throughout the week to liaise objectives for the next three with ward staff, social services Developments years. These objectives include: and carer agencies to provide It is estimated that around six education of staff about carers, support for carers and allow the million carers in the UK provide raising awareness of carer’s effective transition from hospital unpaid care by looking after issues, supporting carers in the to home for patients. an ill, frail or disabled family hospital and supporting our staff member, friend or partner. carers with the development of a Carers Outreach at Around 2.3 million people staff carer’s network. Fairfield General Hospital become carers every year. Almost The Trust, in partnership with The The Trust has pledged to help three quarters of carers suffer Princess Royal Trust Bury Carers identify and support staff financially as a result of caring, Centre, opened a new Carers and patients with a caring with many having to give up Information Point at Fairfield responsibility. We have also their jobs. General Hospital in September committed to helping signpost 2012. The centre is situated The Trust launched its Carers carers to appropriate support and opposite the general office at the Strategy in 2009 in conjunction include them as partners in care. Broadoak Hospital entrance. with local carer’s groups and our A Carer Coordinator post four local councils and Primary The Carers’ drop-in centre commenced in the Trust during Care Trusts. The strategy sets out is open access for staff March 2012, to support carers the Trust’s commitment to carers and patients with a caring across our hospitals and provide - either staff who work for the responsibility, and provides support and advice to staff. Trust or carers of patients who information, help and advice. This member of staff is available use hospital services. Volunteers visit wards daily to

Annual Report and Accounts 2012/2013 42 identify carers and encourage ensure that we are following Over the past year we have been them to make appointments at the Information Standards encouraging many of our staff the outreach to get support and and our system in producing to become dignity champions, advice or just simply have a drink patient information is robust and we have held training and some respite. The facility is and evidence based. After the events, provided newsletters jointly staffed by the Trust and visit the Trust was congratulated and updates and celebrated our The Princess Royal Trust Bury by the accreditation body and champions. Carers Centre. certification was given for a Dignity Champions are able to further 3 years with annual This is the second carer’s raise any concerns they may reviews. information resource centre the have about the treatment of Trust has committed to following Our Patient Information Review individuals or practices across the the opening of the Carer Centre Group continues to meet Trust, and can gain support to do at North Manchester General regularly to ensure that our this by contacting the dignity and Hospital in October 2010. services meet the Department of quality breach line. Health guidance when producing They also have opportunities to written patient information. 6.2.10 Information share good practice with other The group includes medical colleagues and encourage their Standard and nursing staff and, most colleagues to use these practices People use our printed material importantly, involves patient in their daily routines. Over 700 and patient leaflets at all representatives to ensure all of our staff have come forward stages of their care, from first written information is clear, voluntarily to become dignity attendance at hospital, during accurate and easy to understand. champions. These champions their stay and after discharge. All our patient information are active across the Trust and This includes communication leaflets are also available on the supporting privacy and dignity in such as appointment letters and Trust’s website. patient information leaflets and all wards and departments. guidelines to support them in 6.2.11 Dignity making decisions about their 6.2.12 Public Champions health. and Patient Treating people with dignity and The Information Standard respect is expected of all our Engagement is a certification scheme for staff. It is not only a commitment The involvement of patients and organisations that produce set out in the NHS Constitution the public is core to the delivery written health and social care as one of the NHS values, but it of high quality healthcare information for patients and is a key pledge in our own Trust services and the implementation the public. Organisations values. of ‘‘a patient led NHS”. As a that meet the criteria of The healthcare provider we know Information Standard are entitled In May 2011 we launched our we need to listen, understand to place a quality mark on their Dignity campaign. The campaign and respond to patient and information materials so that raised awareness and supported public needs, expectations and people searching for health changes in the way we as an perceptions. We recognise and social care information can organisation think of dignity in that effective engagement easily identify it as coming from care. It aims to make sure that and actively involving patients, a reliable, trustworthy source. everyone treated in one of our patient representatives and This year the Trust underwent hospitals is receiving the best the wider public in service a two day accreditation audit possible care with the dignity development, leads to increased review by The Royal Society and respect they expect. patient satisfaction, more for Public Health (RSPH) to

Annual Report and Accounts 2012/2013 43 positive outcomes and improved the forum does not deal with electronically via handheld or patient/professional relationships. complaints or matters relating fixed survey machine before to an individual patient’s issues, leaving the department. Patients currently communicate it creates a genuine opportunity their opinions, good and bad, Some slight changes are being to assist the Trust in addressing regarding the quality of services made to the process following issues that affect many patients, and their experience of the Trust the pilot, but all wards and A/E consider new developments, and through a variety of means. This departments across the Trust will undertake policy reviews. The includes formal channels such as be equipped and start asking the forum is now looking to expand the Trust’s Patient, Advice and question by the end of February to meetings at North Manchester Liaison Service (PALS), through 2013. General Hospital. satisfaction questionnaires and It is proposed that Trust, site and experience surveys. We also have ward-level data collected from patient/user representation on 6.2.14 Friends and patients will then be published a number of our committees. Family Test (from April 2013) via the local In addition, patients and carers From 1st April 2013, Patients profiles on NHS Choices and have the opportunity to provide across the UK who are being individual ward data will be feedback online via NHS Choices discharged will be asked whether displayed on ward notice boards. or the Patient Opinion web sites, they would want their friends or via the Trust’s own public web or family to be treated at their site. hospital. 6.3 Clinical Effectiveness We work in partnership with Ministers are trying to improve patients and service users so they standards after warnings from 6.3.1 Indwelling can contribute to the planning, watchdogs that too many monitoring and evaluation of our patients, especially the elderly, Catheter Care services. We run a programme experience poor standards of Catheterisation places patients of engagement activities and basic care, including insanitary at risk of acquiring a urinary tract meetings with local community conditions and inadequate infection. The risk of infection is often associated with the and patient groups throughout nutrition. It has been suggested insertion method, the duration the year. that publishing the responses to of catheterisation, and the this “Friends and Family Test” quality of the catheter used. question will allow members the 6.2.13 Pennine Catheter associated urinary tract public to compare healthcare Patient Forum infection is the most common services and clearly identify the In addition to the Trust’s Health Care Associated Infection best performers from a patient Patient Experience and Equality (HCAI) in hospitals, accounting perspective. Committee, we also run a Patient for up to 40% of all infections. Forum Group. This is a voluntary The Trust piloted the system on Some of these infections can be group of patients that act on wards and in the A/E department serious and lead to significant morbidity and mortality. In behalf of ad represent other at Fairfield over Christmas and order to improve the safety and patients treated and cared for New Year 2012 and has seen effectiveness of our catheter across our services. some positive results. The wards care the Trust set as one of its asked the question of patients The group was set up in 2012 priorities to ensure that 95% on discharge, by giving them a and meets bi-monthly with staff of adults who have had a risk postcard to fill in, that was then and other patients at The Royal assessment at the time of posted into a comment box at Oldham Hospital. Meetings inserting an indwelling urinary the end of the ward. A/E patient are informative and although catheter have a care plan that were asked to fill in the question

Annual Report and Accounts 2012/2013 44 reflects best practice and NICE ensures the quality and safety of Advancing Quality continues Guidance. care is maintained. to improve the quality of care offered across the region with The Trust has reviewed its The Trust audits undertakes the ultimate goal that patients previous guidance for catheter monthly audit of urinary admitted to hospitals within management and a new insertion catheter care. This has shown the North West will received and management of urinary that for throughout the year consistent high quality care. catheters policy was launched 95% of adults who have had a in November 2012. The policy risk assessment at the time of The five clinical pathways the incorporated a new integrated inserting an indwelling urinary Trust is currently measured care pathway (ICP) for catheters. catheter have a care plan in against are: place. Work will continue to ■ Acute Myocadrial Infarction The ICP superseded all previous ensure further improvements are (AMI) - heart attacks documentation relating to made and full compliance with catheters. ■ Heart Failure the care plan is achieved. ■ Community-Acquired One of the main features of Pneumonia (CAP) the improvement, as well as 6.3.2 Advancing ■ Hip and knee replacement making sure risk assessment and Quality ongoing care remains safe and ■ Stroke services evidence based is that the ICP is The North West Advancing Stroke services as a new clinical a collaborative document that Quality (AQ) programme pathway was introduced to the remains with the patient and measures how well 23 NHS AQ programme as a shadow which is followed by all those Hospital Trusts across the North measure and is reported in who are providing care for the West perform against a number 2012/13 for the first time. whole time the catheter is in of specific evidence-based clinical pathways and enables Trusts to place. This means that if a patient Improvements is discharged with an indwelling measure and benchmark patient During the year we have urinary catheter the document outcomes against one another. continued to bring about will go home with the patient The programme is a clinical improvements in these areas so that carers in the community quality improvement programme through the implementation (district nurses/nursing homes etc) which aims to stimulate of specific action plans, careful can use it too. Furthermore this innovation, spread best practice data collection and recording means that patients who come to and improve the quality of care and focusing on delivering high hospital with a catheter will also offered across the region in the quality care for patients with have this with them as it will be treatment of a number of major these conditions. commenced by community carers. health conditions and health The main feature of the ICP is services. The Trust has improved its that it specifically focuses on performance within the seven reasons for Catheterisation The programme has been running programme in all of the clinical and ensures that they are only for four years, of which this Trust pathways. The Trust reported used when necessary. It also has played an active participating figures for the year are as features a daily care section that role since October 2008. follows:

Composite Quality Score Clinical Pathway/Condition Year 1 Year 2 Year 3 Year 4 Acute Myocardial Infarction (AMI) 92.4% 96.94% 97.44% 98.96% Heart Failure 50.35% 56.96% 59.57% 70.49% Community-Acquired Pneumonia (CAP) 82.56% 83.14% 84.03% 81.68% Hip and knee replacement 86.93% 83.79% 87.54 95.70% Stroke - - - 87.40%

Annual Report and Accounts 2012/2013 45 In 2013/14 the Trust will focus ■ Coding reviewed of patients to help the NHS monitor success on the following actions: seen by heart failure specialist in avoiding (or reducing to ■ To continue to raise nurse. a minimum) readmission of awareness of the AQ ■ Validation of coding will lead patients following discharge measures to all staff across to removal of inappropriate from hospital. Not all emergency the Trust and share best patients from heart failure readmissions are likely to be practice. measures and inclusion of part of the originally planned appropriate patients. treatment and some may ■ To expand prospective data be potentially avoidable. collection. ■ Review of echocardiogram referral form to ensure The NHS may be helped to ■ To increase capture of echocardiograms are accessed prevent potentially avoidable measure information using within two weeks and the readmissions by seeing existing IT systems. echocardiogram department comparative figures and learning ■ To continue to improve is aware of priority for heart lessons from organisations with performance in relation to failure patients. low readmission rates. the provision of smoking ■ Failed Left Ventricular Failure The indicators presented below cessation advice and (LVF) assessment reported measure emergency admissions discharge information. monthly to our cardio- to hospitals in England occurring ■ To continue to monitor local respiratory department. within 28 days of the last, performance against the previous discharge from hospital. pathway criteria and update Hip & Knee action plans. Every month this standard has There are five emergency been met cumulatively. There is readmissions indicators: fractured an action plan in place that is in Heart Failure proximal femur; hip replacement the process of being reviewed We have seen an overall surgery; hysterectomy; stroke to ensure that the shadow sustained improvement in our and ‘all readmissions’. performance in how we treat measure currently in place will be and manage patients with Heart adhered to when this becomes a The Trust has set up a requirement in 2013/14. Failure from 37.29% in April readmissions improvement group to determine the reasons for 2012 to 45.51% in October Each of our hospital sites has a the Trust’s readmissions rate. 2012, following a number of dedicated clinical lead for AQ actions and programmes which is and they clinically validate every The group meets monthly with ongoing. These include: failed measure to ensure that clinical directors and clinical leads to review the Trust’s ■ Awareness raising among the information has firstly been readmissions and formulate plans staff by our heart failure captured correctly and secondly, to reduce readmission rates. specialist nurses, clinical to ensure processes are in place It has identified key areas for directors and ward managers, to prevent reoccurrence and in investigation, and clinical audits particularly in medical not meeting the high standards are being carried out to identify assessment units. expected. areas for improvement. The ■ A new discharge leaflet for Trust is also looking to redesign all patients with any degree 6.3.4 Emergency care pathways with partner of heart failure and Left readmissions to health agencies. Ventricular Failure (LVF). Hospital within 28 ■ All heart failure patients referred for specialist review days of discharge by cardiologist or heart failure These emergency readmission specialist nurse. indicators provide information

Annual Report and Accounts 2012/2013 46 Emergency readmissions to hospital within 28 days of discharge : indirectly standardised percent, 16+ years, annual trend, P % of Data for 2010/11 standardised to persons 2006/07 Patients National Average Value 11.42 Minimum value for peers 6.31 Maximum value for peers 15.33 PENNINE ACUTE HOSPITALS NHS TRUST value 12.48

Emergency readmissions to hospital within 28 days of discharge : indirectly standardised percent, 16+ years, annual trend, P % of Data for 2009/10 standardised to persons 2006/07 Patients National Average Value 11.16 Minimum value for peers 5.06 Maximum value for peers 15.13 PENNINE ACUTE HOSPITALS NHS TRUST value 11.37

Emergency readmissions to hospital within 28 days of discharge : indirectly standardised percent, <16 years, annual trend, P % of Data for 2010/11 standardised to persons 2006/07 Patients National Average Value 10.15 Minimum value for peers 3.19 Maximum value for peers 16.06 PENNINE ACUTE HOSPITALS NHS TRUST value 10.08

Emergency readmissions to hospital within 28 days of discharge : indirectly standardised percent, <16 years, annual trend, P % of Data for 2009/10 standardised to persons 2006/07 Patients National Average Value 10.18 Minimum value for peers 2.47 Maximum value for peers 49.28 PENNINE ACUTE HOSPITALS NHS TRUST value 9.64

6.3.5 Staff Engagement We recognise that effective patient care and customer service improve how we communicate communication and engagement and, in turn, on the reputation of and engage with our patients, is fundamental to the success and the Trust. public, commissioners and outcomes of any organisation. external stakeholders and, most During 2012/13 we started Effective internal communication importantly, with our staff. to implement the Trust’s and staff engagement not only Stakeholder Engagement contributes to increased morale National Staff Survey Strategy which was approved by and staff engagement, but has a The annual national survey the Board in October 2013. The positive knock-on effect on the of NHS staff in England is strategy aims to develop ways to performance of staff, improved undertaken independently by

Annual Report and Accounts 2012/2013 47 the Picker Institute. The survey is starting to make a small but ■ Staff feeling supported by was distributed to 850 randomly significant positive impact on their managers selected staff across this Trust staff feeling more engaged and ■ 7% increase in staff feeling last year. The results of last year’s empowered. The survey also able to contribute to annual national survey of NHS shows, however, areas where improvements at work staff in England were published we need to focus and make in December 2012. improvements. These include Staff Recommending to appraisals/reviews that do not Friends and Family The return rate for the Trust was help staff to improve how they How members of staff rate 44%, which is below average for do their job and encouraging the care that their employer NHS acute Trusts in England, and senior managers to involve staff in organisation provides can be compares with a response rate important decisions. a meaningful indication of the of 46% in this Trust in the 2011 quality of care and a helpful survey. Improvements measure of improvement over The Trust’s overall staff The national staff survey showed time. The NHS staff survey also engagement score for 2012 was improvements in the following includes the following statement: 3.50 (out of a possible score areas: “If a friend or relative needed of 5.0 which would represent ■ Staff feeling more engaged treatment, I would be happy highly engaged staff). Whilst and empowered with the standard of care this score is in the worst 20% ■ 5% increase in the provided by this Trust” and when compared with trusts of a percentage of staff feeling asks staff whether they strongly similar type, it represents a small satisfied with the quality of agree, agree, neither agree nor improvement from the Trust’s work and patient care they disagree, disagree, or strongly 2011 score of 3.48. are able to deliver disagree”. ■ Staff feeling less pressured at The results of the national staff work The tables below and above survey show early indications that ■ Percentage of staff receiving right show the Trust’s results in our Listening into Action (LiA) relevant training relation to this question: staff engagement programme

National NHS Staff Survey 2012 Score National Average Value 3.07 Minimum value for peers 2.76 Maximum value for peers 3.34 PENNINE ACUTE HOSPITALS NHS TRUST value 3.07

National NHS Staff Survey 2011 Score National Average Value 3.81 Minimum value for peers 3.57 Maximum value for peers 4.01 PENNINE ACUTE HOSPITALS NHS TRUST value 3.71

Our action plan in response forward those things which are follows: to the survey aims to address demonstrating a positive impact ■ Continue to embed the those areas where our scores on our results. ‘Listening Into Action’ (LiA) are in the bottom 20% of acute staff programme Our action plan for 2013/14 is as trusts and to continue to take ■ Extend LiA programme to 20

Annual Report and Accounts 2012/2013 48 new teams/20 quality projects Through cultural change and side representatives to build on ■ Hold engagement events for transformation across the Trust, the real improvements we have staff on quality improvements our objective is that all staff at all made. levels understand and recognise ■ Continue to embed Team the importance and opportunity Talk as new staff briefing and 7 Quality for active involvement in engagement method engagement activities, whether Aspirations ■ Continue to hold the Trust’s formally through Listening into Since November 2012, the Trust annual Staff Awards Action (LiA) or through team has been planning our long term quality aspirations for the next Benchmark results to enhance or one-to-one conversations, five years. We have called this action plans: or through other two-way mechanisms. our Long Term Quality Plan. ■ Benchmark results against a clearly identified peer group As a Trust Board we know We have carried out a series of ■ Triangulate other data we have more work to do to discussions and conversations sources including patient create a culture where staff with the Trust Board and survey results, complaints feel more involved, valued and our frontline staff including and care indicators to supported. Our Listening into our doctors, nurses, allied improve understanding and Action (LiA) staff engagement health professionals, senior strengthen the action plans. programme will continue to consultants and clinical directors, provide opportunities for staff divisional directors and senior Values and behaviours: to engage in conversations management. ■ Develop common standards about the things which matter In addition, we have also of behaviour linked to our most to them and ways we can involved our local GP quality strategy and targets improve services and ensure this commissioners (Clinical ■ is a great Trust to work. We will Develop customer service Commissioning Groups), our continue to work closely with training programme for partner agencies, the public, our our staff, Trades Unions and staff patient facing frontline staff patients and their carers.

There are multiple drivers behind the quality imperative ... Increasing quality Main driver for Richard Francis Complaints and National Quality data available to commissioners QC’s report on concerns Board’s report ‘Quality patients is outcomes for Mid Staffordshire in the new health patients and NHS Foundation system’ populations Trust including quality outcomes Quality as the driver Quality as a source Quality concerns Regulatory Quality surveillance for patient choice of income for the Trust, e.g. requirements groups from 1 mortality April 2013: “will Revalidation: tests Organisational Developing Advances in bring together agreed standards development: quality and clinical practice, commissioners, for all consultants; taking a pride in maintaining medicines and regulators and other demands evidence working for the safety whilst technologies bodies, in a virtual of individuals’ Trust saving money team, to share effectiveness; information and requires colleague intelligence about and patient input quality across the system”

Annual Report and Accounts 2012/2013 49 The Quality Governance Framework

• Quality should drive the • The Board should have the necessary Trust’s strategy leadership, skills and knowledge to ensure delivery of the quality agenda • The Board should be sufficiently aware of potential risks to quality • The Board should promote a quality-focussed culture throughout the Trust

Strategy Capabilities and culture

Quality Governance Framework

Processes and structure Measurement

• There should be clear roles and • The appropriate quality information accountabilities in relation to should be analysed and challenged quality governance • The Board should be assured of • There should be clearly defined, the robustness of the quality information well understood processes for escalating and resolving issuesand managing • Quality information must be quality performance used effectively • The board should actively engage with patients, staff and other key stakeholders and quality

Annual Report and Accounts 2012/2013 50 8 Our Priorities As these priorities are also Local, provided across the NHS Trust Regional or National CQUINs sector; all the evidence suggests for Improvement in (Commissioning for Quality it would also make the way we 2013/14 and Innovation targets), there deliver care more efficient. We have set the following is a contract measuring and We have identified below five top priorities for quality monitoring process in place key areas where there is a improvement for 2013/14. These which reports to the monthly significant variation from the are performance-managed by North East Sector Quality Leads top performers in the NHS and exception and progress will Meeting which meets monthly. have set out our improvement be reported to the Clinical Tackling variation in the quality priorities and plans to bridge that Governance and Quality of care provided by Trusts in the gap and improve quality in the Committee to the Trust Board. NHS, including ours, won’t just coming year. lead to improvements in care

Number Improvement Priority Improvement Plan 1 Mortality - Reduce mortality to above Roll out Dr Foster Real Time monitoring tool average performance as measured by Identify and implement care bundles HSMR - below 99 on the 2013/14 base. Improve mortality reporting at Divisional level Implement retrospective review of primary diagnosis for patients with a low risk of dying Improve coding of co-morbidities. 2 Clostridium Difficile – Reduce hospital Rigorously follow the CDT action plan and attributed CDT cases further by exceeding monitor progress the national improvement trajectory by Ensure robust antimicrobial prescribing and 10% ensuring we remain within top ten closely monitor practice performing Trusts. Increase focus on hospital cleaning Reduce contamination on high risk wards 3 Readmissions - Work with Clinical Analyse data using the Dr Foster Tool Commissioning Groups (CCGs) to agree Identify the top 3 outliers joint plans, actions, timescales and quality Produce / agree action plans with robust impact. timescales for each of the identified outliers to reduce / bring the re-admission rate within the top 25th percentile 4 Staff Sickness and Absence - Reduce staff Revise absence policy and triggers sickness and absence to 3.5% over two Implement mandatory self care course for staff years with health issues Implement fact track access to physiotherapy Reduce average days lost per employee to and psychological treatment <10.7 5 Staff Survey - Achieve improvement in Implement Trust’s Listening into Action (LiA) national staff survey to above average staff engagement programme promoting a performance positive team culture, supportive management, positive contributions and participation and involvement

Annual Report and Accounts 2012/2013 51 “It shows what can be done with a committed 9 Research and and driven Board. The excellent this year. Indeed, 445 Trust has made excellent Trust patients diagnosed with Innovation cancer have participated in a Only by carrying out research progress, which will high quality NIHR CRN study. into “what works” can we undoubtedly embed This level of participation in continually improve treatment for further into their clinical cancer research means that patients, and understand how to services over time”. approximately 1 out of every 4 focus NHS resources where they of our patients diagnosed with will be most effective. Dr Jonathan Sheffield, cancer took part in a high quality Chief Executive of the National study. Patient participation in We view research as a core part Institute for Health Research cancer research has increased of the NHS. We are committed to Clinical Research Network enormously within the Trust over research as a driver for improving recent years. Over the past four the quality of care we provide or sub-contracted by the Trust years we have experienced a and the patient experience. It between 1st April 2012 – 31st 5-fold increase. enables our staff and the wider March 2013 that were recruited NHS, nationally and regionally, to during that period to participate In addition to improvements in improve the current and future in NIHR CRN studies approved by cancer research participation, the health of the people we serve. a research ethics committee was Trust has worked hard to develop research across other health ‘Clinical research’ means research 1414. This level of participation disciplines. Our level of research which has received a favourable in clinical research demonstrates within paediatrics (children’s opinion from a research ethics the Trusts commitment to services) has grown considerably committee within the National improving the quality of care this year. During 2011/12 only Research Ethics Service (NRES). we offer and to making our 11 children participated in a Information about clinical contribution to wider health high quality research study, research involving patients is kept improvement. whereas this year 160 children routinely as part of a patient’s participated in a high quality records. The Trust uses national Improvements study. This reflects a 14-fold systems to manage research in In 2012, the Trust was highly increase and highlights the proportion to risk. commended at The Health commitment shown by the staff Service Journal (HSJ) Awards in our Women and Children’s The Trust currently supports for developing a progressive Division. 379 research studies that have research culture. The Trust was received a favourable opinion particularly commended for Participation in high quality from a National Research the Trust Board’s commitment diabetes research has also Ethics Service. Of these to increasing opportunities for grown considerably over the studies, 112 are clinical trials patients to participate in high past 12 months. Indeed, involving medicinal products. quality studies that are adopted during 2012/13, 105 patients Our engagement with clinical by the National Institute for participated in a high quality research demonstrates the Health Research Clinical Research diabetes study, which Trust’s commitment to testing Network (NIHR CRN). represents a 3-fold increase in and offering the latest medical comparison to the previous year. treatments and techniques. The Trust is committed to Furthermore, in comparison to providing patients with the last year, the number of patients The Trust currently supports opportunity to take part in high participating in cardiovascular 91 NIHR CRN clinical research quality cancer research studies. research studies has increased by studies. The number of patients Cancer research performance almost 600%. receiving NHS services provided across the Trust has been

Annual Report and Accounts 2012/2013 52 Case study

The Trust has led the way in recruiting have been recruited through movement the first three patients in Europe to a disorder clinics within the Trust. We started it randomised placebo-controlled clinical pain initially at Fairfield and then branched out to relief disease study for Parkinson’s. Rochdale and Oldham.”

As the first major international study Patients who volunteer to take part in the targeting patients with Parkinson’s Disease, trial must have severe pain according to a the trial aims to assess the effectiveness of seven day pain diary which they fill in during a medication for pain associated with the their screening period. If they are suitable condition. then they are monitored at the programmed investigations unit (PIU) at Fairfield over Dr Jason Raw, consultant physician at a period of months and assessed for their Fairfield General Hospital, enrolled the levels of pain. Other symptoms of their first three patients early last year. He Parkinson’s Disease are also evaluated. said: “Parkinson’s Disease is a progressive neurological condition which affects about 127,000 people in the UK. The disease is associated with all manner of physical symptoms, including pain. This may be musculoskeletal or neuropathic, but it’s known to be one of the worst symptoms from the patient’s point of view. People also find that their movements become slower, they have tremors and rigidity. The patients

Throughout 2012/13, the Trust the art research trials. The Parkinson’s Disease, has actively engaged with extent to which our Infectious gastroenterology, surgery and commercial partners in order Diseases research unit at North podiatry. to provide our patients with an Manchester General Hospital Our clinical staff stay abreast opportunity to participate in engages with commercial of the latest possible treatment the highest quality commercial research partners is particularly possibilities and active funded research trials. This significant. For example, during participation in research leads engagement is successfully 2012/13, this unit participated in to successful patient outcomes. reflected by the fact that we 21 commercial research trials. The Trust currently has 134 are recruiting more patients High quality research is also clinical staff acting as the lead to NIHR commercial trials than being conducted within other investigator on research studies ever before, thus providing clinical fields. For example, the approved by a research ethics patients with an opportunity Trust has considerable research committee. to participate in state of activity in stroke, rheumatology,

Annual Report and Accounts 2012/2013 53 10 Participation in Clinical Audit Clinical audit is a way of improving the quality of care we provide to patients.

National clinical audits are largely funded by the Department of Health and commissioned by the Healthcare Quality Improvement Partnership (HQIP) which manages the National Clinical Audit and Patients Outcome Programme (NCAPOP). Most other national audits are funded from subscriptions paid by NHS provider organisations. Priorities for the NCAPOP are set by the Department of Health with advice from the National Clinical Audit Advisory Group (NCAAG).

Involvement in the National Clinical Audit Programme is high on the Trust’s clinical audit agenda and we aim to participate in all applicable national clinical audits which form part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP).

During 2012/13, 38 NCAPOP audits and 6 national confidential enquiries covered NHS services provided by the Trust. The Trust participated in 100% of the national clinical audits and 100% of the national confidential enquiries which it was eligible to participate in.

The NCAPOP audits and national confidential enquiries that the Trust was eligible to participate in during 2012/13 are listed below alongside the number of cases submitted for each audit where data collection was completed within the period.

Data collection % cases completed submitted National Clinical Audit Trust Participation 12/13 12/13 National Neonatal Audit (NNAP) Yes Yes 100% Paediatric Pneumonia (BTS) Yes Yes 83% Paediatric Asthma (BTS) Yes Yes 90% Paediatric Fever (CEM) Yes Yes 100% Childhood Epilepsy (RCPH) Yes No N/A Paediatric intensive care (PICA Net) N/A - Do not perform N/A N/A Paediatric cardiac surgery (NICOR) N/A - Do not perform N/A N/A Diabetes (RCPH) Yes No N/A Emergency use of oxygen (BTS) Yes Yes 100% Adult community acquired pneumonia (BTS) Yes Yes 100% Non invasive ventilation (BTS) Yes Yes 100% Cardiac arrest (National Cardiac Arrest Audit) Yes Yes 76% NMGH & ROH Renal Colic (CEM) Yes Yes 100%, FGH 70% Adult critical care (Case Mix Programme) Yes Yes 100% Potential donor audit (NHS Blood & Yes Yes 100% Transplant) Fractured Neck of Femur (CEM) Yes Yes 100% National Diabetes Audit Yes No (Data deadline Sept 13) N/A Heavy menstrual bleeding (RCOG) Yes No N/A

Annual Report and Accounts 2012/2013 54 Data collection % cases completed submitted National Clinical Audit Trust Participation 12/13 12/13 Pain Database (National Pain Audit) Yes On-going N/A Ulcerative colitis & Crohn’s disease (IBD) Yes No (Data deadline Dec13) N/A Adult Asthma (BTS) Yes Yes 100% Bronchiectasis (BTS) Yes Yes 100% National Audit of Dementia Yes Yes 100% National Joint Registry Yes On-going N/A National PROMS Programme (Elective surgery) Yes On-going N/A Intra-thoracic transplantation (NHSBT UK N/A - Do not perform N/A N/A Transplant Registry) at the Trust Coronary angioplasty Yes No N/A Peripheral vascular surgery (VSGBI Vascular Yes On-going N/A Surgery Database) Carotid Intervention Audit Yes On-going N/A CABG and valvular surgery N/A - Do not perform N/A N/A Myocardial Infarction National Audit (MINAP) Yes Yes 100% National Heart Failure Audit Yes Yes 100% Acute stroke (SSNAP) Yes Yes 100% Cardiac Arrhythmia (Rhythm Management) Yes Yes 100% Audit N/A – Data submitted Pulmonary Hypertention Audit by specialist centres N/A N/A only N/A - Data submitted Renal replacement therapy (Renal Registry) N/A N/A by renal units only Renal transplantation (NHSBT) N/A - Do not perform N/A N/A National Lung Cancer Audit Yes Yes 100% National Bowel Cancer Audit Yes On-going N/A Head & Neck Cancer (DAHNO) Yes Yes UTD National Oesophago-Gastric Cancer Audit Yes On-going N/A National Hip fracture Database Yes On-going N/A Trauma Audit & Research Network Yes On-going N/A N/A - Mental Health Prescribing in Mental Health Services N/A N/A Trusts N/A - Mental Health National Audit of Schizophrenia N/A N/A Trusts National Comparative Audit of Blood Transfusion – Labelling of blood samples for Yes Yes 100% transfusion National Comparative Audit of Blood Yes Yes 100% Transfusion – Medical use of Red Cells Part 2

Annual Report and Accounts 2012/2013 55 The Trust also participated in a number of national audits that do not form part of NCAPOP. Information in relation to these audits can be found in the Trust Clinical Audit Annual Report.

National confidential enquiry is a form of national clinical audit and is a method of assessing the quality of care to help identify potentially avoidable factors associated with adverse outcomes.

National confidential enquiry Trust Participation Confidential Enquiry into Maternal and Child Health (CMACH) Yes National Review of Asthma Deaths Yes National Confidential Inquiry into Suicide and Homicide N/A – Mental Health Trusts NCEPOD Subarachnoid Haemorrhage 2012 027 Yes NCEPOD - Alcohol Related Liver Disease (ARLD) (Trust) 2011 255 Yes NCEPOD Tracheostomy Study (National) 2012 245 Yes

The reports of 21 NCAPOP audits were reviewed by the provider in 2012. We intend to take the following actions to improve the quality of healthcare provided.

National Audit Reported Improvements made, or to be, made as result of report in 2012 National Joint Registry As a result of the Trust submitting data to the National Joint Registry the following improvements have been made: n Improved data submission and completeness n Previous report data discussed at the Directorate meetings and Clinical Audit and Governance meetings n Awareness raised amongst clinical staff.

Operational Actions to date: n Report to Clinical Leads and Service Manager within the Directorate for review and discussion. n Findings of the 2012 report to be presented at March 2013 Clinical Audit & Governance meeting. n Additional actions will be agreed at this meeting. Bowel Cancer Prior to the published report was undertaken the Trust reviewed Stoma Care and Management to ensure that it was not a potential outlier within this area.

A review is currently underway of the results and an action plan is in the process of being developed. Head and Neck Oncology Results of the report demonstrate that Multi-disciplinary team (MDT) discussion has risen to 90.6% (97.5% of all cases with a recorded care plan) nationally and the Trust is comparative with this data.

The Trust is currently working on improved data submission and validation.

The MDT is reviewing the national report and in the process of developing a continuous action plan that links into the Peer Review process

Annual Report and Accounts 2012/2013 56 National Audit Reported Improvements made, or to be, made as result of report in 2012 Lung Cancer The action plan includes: n Use MDT meetings to capture all cases discussed. Try to record cases in real time or near real time. Liaise with pathology departments to correlate cases. Work with IT department to set up CSV file upload facility if information is collected on a third party system or identify resources to input data directly n Use proforma for data collection at MDT. Identify key person to QA data prior to submission. Data imputers understand clinical implications of data. Map and allocate responsibility along patient pathway. Agree protocols and submission routes for patients that are treated across different organisations n Refer to the documentation on the National Lung Cancer Audit Website and ensure that key fields are completed for all relevant cases. Assist MDT co-ordinator by chair ensuring that stage, performance status and other key fields are discussed and recorded for each patient n Ensure that Over 95 per cent of patients submitted to the audit are discussed at an MDT by liaising with cancer waiting times team to identify lung cancer referrals. Liaise with radiology department to identify all imaging suspicious of lung cancer or mesothelioma. Liaise with pathology department to identify cases n The proportion of patients receiving CT prior to bronchoscopy should exceed 90 per cent - Ensure that all CT / bronchoscopy data is submitted to the audit. Review diagnostics protocols if rate is below optimum n Over 80 per cent of patients are seen by a lung cancer specialist nurse - Review the specialist nurse service, ensuring all nursing posts are staffed and that clear referral pathways exist Oesophago-gastric cancer Results have been circulated to the directorate team. The Directorate is required to develop a local action plan in response to the audit findings. Myocardial Infarction Findings of the national report were discussed by the directorate. The (MINAP) Trust’s overall figures were very good. The Directorate acknowledged that not all patients were admitted to a cardiology ward, however there are systems in place to refer the patients as the majority of patients were seen by a cardiologist/member of the cardiology team. Heart Failure See “Advancing Quality”, Heart Failure Section of the report for details on actions taken to improve treatment received by Heart Failure patients.

Adult Diabetes Results have been received by the directorate team and they are required to develop a local action plan in response to the audit findings.

Annual Report and Accounts 2012/2013 57 National Audit Reported Improvements made, or to be, made as result of report in 2012 Irritable Bowel Disease (IBD) As a result of the Trust submitting data to the National IBD Audit the following improvements have been made: n Bone protection during steroid therapy n Stool samples for CDT and SST n Heparin prescribed on admission n Appropriate escalation of treatment

Re-audits are underway to assess overall compliance in these areas. Pain Database Results have been circulated to the directorate team. The Directorate is required to develop a local action plan in response to the audit findings. Falls and Bone Health The Trust has an on-going action plan in relation to falls. See the “Patient Falls” Section of the report under “Review of Quality Performance” for details on actions taken to improve the prevention and management of inpatient falls. Health Promotion The national report is with the Medical Director for Action Planning. Heavy Menstrual bleeding As a result of the Trust submitting data to the National IBD Audit following improvement plan was agreed: n Improve history taking at first outpatient appointment n Ensure that patients are given information that helps to support them making informed choices. n A re-audit is planned for April 2013 to assess compliance in these areas. Neonatal Intensive and Actions taken forward locally in response to the audit findings include: special care n All admission notes to be entered onto the Badger Database and copy printed off and placed in case notes. This should improve the overall capture of data. Nursing staff to be empowered to enter data. n Raising awareness of the importance of record keeping on the Badger Database. n Cross checking information with the maternity database to confirm that antenatal steroids are given. n Raising awareness amongst health care professionals and mothers of the values, and health benefits of giving mother’s own milk to premature babies. n Increasing the level of exclusive breastfeeding (or giving of breast milk) amongst premature infants particularly those below 33 weeks gestation, in line with national standards. n Developing and enhancing the current mechanisms around a special follow-up clinic for babies who require 2 year developmental follow up. Pain in Children Results have been circulated to the directorate team. The Directorate is required to develop a local action plan in response to the audit findings.

Annual Report and Accounts 2012/2013 58 National Audit Reported Improvements made, or to be, made as result of report in 2012 Sepsis/Septic Shock Sepsis is now been regularly audited and there is a Sepsis decision maker on Symphony. COPD Discharge Results have been circulated to the directorate team. The Directorate is required to develop a local action plan in response to the audit findings. Emergency Oxygen Results have been discussed by the directorate team and the following actions have been agreed: n All junior doctors to complete e-learning as part of induction n Non-training grades to complete oxygen training n Increase uptake of training by nurses & health care assistants n To look at areas where there has been good uptake of training and see if this has translated into improved signature/titration Adult NIV Results have been discussed by the directorate team and the following actions have been agreed: n Future data collection to look at ARAS referrals n To re-launch and amend COPD template discharge letter to include NIV information. n Increased liaison with ICU at FGH around patients who would benefit from intubation. n As much NIV is started out of hours need to ensure wide staff group familiar with protocol. Re-circulation of protocol link to A&E and all medical registrars. (to circulate and to continue education sessions) n Improved use of NIV prescription charts. ( wards) n To review uptake of oxygen training and use of oxygen alert cards and giving patients their venturi masks on discharge. Adult Community Acquired Results have been circulated to the directorate team. The Directorate is Pneumonia required to develop a local action plan in response to the audit findings. Adult Asthma Audit Results have been discussed by the directorate team. It was noted that the admission and re-admission data compared very favourably with the national picture. The following actions have been agreed: n Audit results to be presented to A&E and medicine. n Feedback to audit on the patients coded inappropriately as asthma to identify how coding derived and what changes may need to be made to recording to improve coding n Audit and action plan to be shared with CCGs. n Asthma ALS template based on the A&E pathway letter to be introduced. n Wards to be reminded – how to order asthma plans and asked to record when given. n A&E asthma pathway to be re-invigorated at NMGH and FGH sites.

Annual Report and Accounts 2012/2013 59 10.1 Local Clinical practice in relation to infection ■ Changes to cleaning prevention. Any ward that does schedules in areas where Audit not achieve 85% is immediately issues identified. The Trust also undertakes a escalated back to the ward ■ Removal of inappropriate programme of local clinical manager and Divisional Nurse sinks for “tea making audit activity. The results Manager (DNM). An action plan stations” in open ward areas. of approximately 150 – 200 is formulated and reviewed by ■ Commode cleaning spot completed local clinical audits both the IPT and DNM. checks by Matrons and were reviewed by the Trust in DNMs. 2012/13. Actions planned and Any domestic cleaning ■ Additional cleaning services undertaken in response to the issues identified are reported to Laundry facilities. audit findings will be detailed in immediately to the ISS site the Trust’s 2012/13 Clinical Audit manager and monitoring ■ Change of clinic rooms in Annual Report. A number of officer with immediate action outpatients at ROH to allow clean and dirty utility rooms examples are highlighted below: requested. These actions are to be appropriately used. reviewed by the Trust Cleaning 10.1.1 Infection Committee. This is achieving ■ Change of equipment Control Audits: a positive impact on the focus cleaning regimes in high risk of standards of hygiene within areas such as ITU/NICU. The Infection Prevention Team the Trust. Key actions from the (IPT) audit ward and patient areas 10.1.2 Record on a rolling annual programme. 2012/13 audits include: The audits measure compliance ■ Improvement programme Keeping Audits: with standards of environmental to have all flexible scopes Annual record keeping audits hygiene and standards of clinical reprocessed centrally. are undertaken in all specialties

Annual Report and Accounts 2012/2013 60 throughout the Trust. The aim Documents in Casenotes Task ■ Improved quality of care and of these audits is to review and Finish Group: The group is safety of patients. the current standard of record working on the implementation ■ Has had positive cost keeping within the selected of an action plan which aims implications for the Trust. specialties and to compare this to improve patient safety and with national and local standards care by streamlining documents ■ Resulted in clear in order to: in use in our patient casenotes. improvements in ■ Maximise patient safety and Increase efficiency and reduce documentation. quality of care. costs by eliminating duplicated ■ ■ Support professional best information in casenotes. All clinicians now practice. documenting withdrawal Other groups are planned for the symptoms in same document ■ Comply with Information near future. Governance and NHS ■ User friendly document Litigation Authority Risk 10.1.3 Alcohol allowing clinical staff to score Management Standards. the symptoms therefore Withdrawal Audit all clinicians involved with In response to the audit findings and NHSLA Risk Management and Re-audit: patient can identify what Standards the Trust is in the An initial audit was undertaken signs and symptoms the process of updating it’s Record in the Accident & Emergency patient has been portraying Keeping Policy. In addition Department at NMGH. The a number of Task and Finish audit aimed to measure current 10.1.4 Re-audit of Groups have been set up to practice in relation to the the use of biologics focus on improving specific areas treatment of patients with The audit was undertaken to as identified below. alcohol withdrawal. ensure that our local service has Casenote Condition and As a result of the findings of implemented and is complying Filing Task and Finish Group: the initial audit an Alcohol with the NICE technological The group is working on the Withdrawal Policy and Integrated appraisals for the treatment of implementation of an action plan Care Pathway (ICP), based on rheumatoid arthritis, psoriatic which aims to: NICE Guidance, were introduced. arthritis & ankylosing spondylitis. ■ Improve the condition of The audit has previously been casenote folders - reducing A re-audit showed that the undertaken in 2009 and 2010 the number that are tightly introduction of the new Policy packed with worn and torn and ICP has: - and the re-audit will measure covers. whether changes in practice ■ Decreased admission time made as a result of the previous ■ Improve the quality of filing purely for detoxification. audits have resulted in improved within casenotes - reduce This will allow patients a compliance with the National loose and disorganised filing. better chance of completing Guidance. ■ Reduce loose filing of detoxification as an inpatient. pathology reports. The main change since the last ■ ■ Reaffirm process for using Decreased the amount audit is that there are now 2 PAS to identify the relevant of medication used for Biologics specialist nurses in post. casenotes when multiple sets detoxification. The re-audit results showed that of casenotes exist for one ■ Supported more personalised in Psoriatic Arthritis , Ankylosing patient. care to stop people being spondylitis and Rheumatoid ■ Reduce backlog filing and over or under medicated. arthritis the starting criteria for incomplete casenotes. biologics are being met.

Annual Report and Accounts 2012/2013 61 In comparison to previous audits: appointing a dedicated paediatric focus on these standards and ■ There is now 100% liaison nurse within The Royal determine how they can be recording of DAS 28 scores Oldham ED. addressed. before patients are seen in rheumatology clinic, this is in 10.1.6 Medicines 10.1.7 Blood comparison to 25% in 2009. Storage Re-audit Transfusion ■ In 2009 for PsA patients all A necessity for all healthcare The Blood Transfusion Team but 1 case had a record of providers is compliance with the have been involved in a number tender and swollen joints, Care Quality Commission (CQC) of audits in 2012/13. Actions and trial on more than 1 Outcome 9 Management of include: DMARD including MTx. In this Medicines. A visit by the CQC ■ Modification/Update to the current audit this was 100%. highlighted several areas for current trust policy for the ■ In AS in 2009 60% of review regarding this outcome Administration of Blood & cases had formal disease and since July 2012 an action Blood Products (EDC 006) assessment on 1 occasion plan has been implemented to – To comply with NHSLA only currently it is 100%. address these issues. Actions Standards 2012/13, including include: stepwise instructions for 10.1.5 A re-audit the administration of Blood ■ The Trust guidelines for Products. of Safeguarding storing, ordering and of Intoxicated administration of controlled ■ Issue of a new Transfusion drugs have been updated. Record for prescribing Blood Children Attending Products which incorporates Emergency ■ Estates have fixed all a Transfusion Checklist - medication cupboards and Department Compliant with NHSLA fridges that have been Standards 2012/13 It is Trust policy to generate an reported as having issues with ■ Colour change (Lilac Wash) Information Sharing Form when locks. to the current Traceability a child attends the Emergency Label to make it more visible Department or Urgent Care This re-audit determined that to staff and potentially Centre with alcohol intoxication. overall compliance with the audit help prevent labels from This information is then shared standards throughout the trust being mislaid / inadvertently with the School Health Advisor. is 91%. The November 2011 safe storage of medicines audit discarded The audit aims to measure measured compliance as 74%. ■ Education and Awareness of compliance with the Trust This increase in compliance is Staff - Link Nurse Study Day Child Protection Policy a consequence of the ongoing (NCWC001). efforts throughout the trust with 11 Participation in regards safe storage of medicines There were a number of and is reflective of the ongoing CQUINS recommendations from the successful implementation of NHS Trusts (providers of initial audit which have now CQC Outcome 9 Management services) are required to been implemented within the of Medicines action plan. make a proportion of their Trust. These include; training income conditional on quality to promote the use of a new Although the results of this audit and innovation, through the form and an alcohol awareness are extremely positive they do Commissioning for Quality and week being held in all ED/UCC’s. highlight some areas of non- Innovation (CQUIN) payment The greatest demonstration compliance throughout the framework. of change has come from trust. Our efforts now need to

Annual Report and Accounts 2012/2013 62 A proportion of the Trust’s to support and reinforce other contract CQUINs made up of contracted income for 2012/13 elements of the approach on 6 nationally defined indicators, was conditional on achieving quality and existing work in the 6 regionally defined indicators, quality improvement and NHS by embedding the focus 28 NHS Greater Manchester innovation goals agreed on improved quality of care in (GM) defined indicators and between the provider and its commissioning and contract 14 locally agreed indicators commissioners (local Primary discussions. with an associated value of Care Trusts) through the CQUIN approximately £12m. These payment framework. CQUINs encourage and reward indicators and the percentage organisations that focus on weighting assigned to each one The CQUIN framework forms quality improvement and and the approximate financial one part of the overall approach innovation in commissioning value associated is detailed in the on quality, which includes: discussions to improve quality for table below. defining and measuring patients and innovate. CQUINs quality, publishing information, build on, but not replace, existing As a result of participation in recognising and rewarding the CQUIN framework the Trust initiatives such as the Advancing quality, improving quality, continues to make significant Quality (AQ) programme. safeguarding quality and improvements to both patient staying ahead. It is intended For 2012/13 there are 54 acute experience and outcomes.

CQUIN Indicator CQUIN % Approx Value National VTE Risk Assessment (90%) 5.00% £601,281 National Composite indicator on responsiveness to personal needs 5.00% £601,281 National Dementia - Screening 1.67% £200,427 National Dementia - Risk Assessment 1.67% £200,427 National Dementia - Referral for Specialist Diagnosis 1.67% £200,427 National NHS Safety Thermometer 5.00% £601,281 Regional Advancing Quality (AQ) - AMI 0.83% £100,214 Regional Advancing Quality (AQ) - Heart Failure 0.83% £100,214 Regional Advancing Quality (AQ) - Hip & Knee Replacement 0.83% £100,214 Regional Advancing Quality (AQ) - Pneumonia 0.83% £100,214 Regional Advancing Quality (AQ) - Stroke 0.83% £100,214 Regional Advancing Quality (AQ) - Patient Experience 0.83% £100,214 NHS GM Dementia - Patient Experience 1.00% £120,256 NHS GM Dementia - Reduction in Length of Stay 1.25% £150,320 NHS GM Dementia - Action plan 1.50% £180,384 NHS GM Dementia - Antipsychotic Prescribing 1.25% £150,320 NHS GM Harm Free Care - VTE Risk Assessment (95%) 0.85% £101,928 NHS GM Harm Free Care - VTE Incidences 0.85% £101,928 NHS GM Harm Free Care - Pressure Ulcer Incidences 0.42% £50,964 NHS GM Harm Free Care - Tissue Viability Risk Assessment 0.42% £50,964

Annual Report and Accounts 2012/2013 63 CQUIN Indicator CQUIN % Approx Value NHS GM Harm Free Care - Pressure Ulcer Care Plan 0.42% £50,964 NHS GM Harm Free Care - Pressure Ulcer RCA 0.42% £50,964 NHS GM Harm Free Care - Falls Incidences 0.42% £50,964 NHS GM Harm Free Care - Falls Risk Assessment 0.42% £50,964 NHS GM Harm Free Care - Falls Care Plan 0.42% £50,964 NHS GM Harm Free Care - Falls RCA 0.42% £50,964 NHS GM Harm Free Care - Catheter Induced Urinary Tract Infections 0.42% £50,964 NHS GM Harm Free Care - Catheter Risk Assessment 0.42% £50,964 NHS GM Harm Free Care - Catheter Care Plan 0.42% £50,964 NHS GM Harm Free Care - Catheter Induced Urinary Tract Infections 0.42% £50,964 RCA NHS GM Harm Free Care - Leadership for Harm Free Care 0.67% £80,000 NHS GM Harm Free Care - Patient Stories 0.05% £6,500 NHS GM Harm Free Care - Bonus Payment Harm Free Care 7.50% £901,922 NHS GM Health Inequalities - Training (Dementia) 0.56% £66,809 NHS GM Health Inequalities - Breastfeeding Initiation 1.67% £200,427 NHS GM Health Inequalities - Smoking Status 0.56% £66,809 NHS GM Health Inequalities - Smoking Cessation Support 0.56% £66,809 NHS GM Health Inequalities - Alcohol Abuse Identification 0.56% £66,809 NHS GM Health Inequalities - Alcohol Advice 0.56% £66,809 NHS GM Health Inequalities - Fuel Poverty 0.56% £66,809 Local Safeguarding - Domestic Abuse 1.00% £120,256 Local Safeguarding - Alcohol (a) 1.00% £120,256 Local Safeguarding - Alcohol (b) 1.50% £180,384 Local Safeguarding - Competency Training 2.00% £240,512 Local Safeguarding - Privacy & Dignity Young People 0.50% £60,128 Local Safeguarding - Learning Disabilities 1.00% £120,256 Local Dementia - Respect Dignity & Appropriate Care 2.00% £240,512 Local Dementia - Assessment & Admission Processes 3.00% £360,769 Local Dementia - Actively Managed Discharge Processes 2.00% £240,512 Local Dementia - Environment 2.00% £240,512 Local Dementia - Contribution of Volunteers 1.00% £120,256 Local Dementia - Quality of Care at the End of Life 3.00% £360,769 Local Dementia - Screening 2.00% £240,512 Local Safe & Seamless Handover - the quality of information 28.00% £3,367,174 Total 100.00% £12,025,620

Annual Report and Accounts 2012/2013 64 12 Data Quality Good quality information assurance on data quality. We healthcare data hub for inclusion underpins sound decision recognise the need to have in the Hospital Episode Statistics making within the Trust and regular dialogue with our local (HES). The latest published data contributes to the improvement commissioners and data quality is included in the table below. of healthcare. The Trust is is discussed on a regular basis The current published figures committed to improving data with them as part of the contract for Missing NHS Numbers quality and has an Information challenge programme for for Admitted Patient Care, Quality Assurance Group in payment by results. Outpatients and A&E place to review related reports The Trust submits regular data to attendances are shown below: and provide assessment and the Secondary Uses Service (SUS)

Activity Type Pennine Acute % National % Admitted Patient Care 98.8%* 99.1% Outpatient 99.8% 99.3% A&E 98.2% 94.9%

* The Trust is slightly below the national average for admitted care as it anonymises HIV/ Infectious Diseases APC episodes, for which the Trust is a regional specialist centre, and also Termination of Pregnancies episodes.

Annual Report and Accounts 2012/2013 65 The Trust complies with the within a more supportive undertakes a rigorous annual recommendations outlined by environment which has resulted cycle of self assessment, evidence connecting for health regarding in more timely, quality assured production and assurance submission timescales, formats data being produced. against the quality standards. and content. The data quality The CQC carries out a routine dashboards provided by SUS 15 The Care formal review of services every are used extensively both within year to audit and review service the Trust and shared with our Quality Commission outcomes against the essential commissioners to monitor (CQC) Statement standards for each service performance. The Care Quality Commission location. The review includes (CQC) is an independent national unannounced visits to the Trust body responsible for regulating 13 Information premises so that teams of CQC the quality of care provided by Governance Toolkit Inspectors can speak with and NHS trusts, social services and observe the interactions between attainment levels independent care providers. The patients and staff and the quality Information Governance is Trust is required to register with of care being provided. The CQC about how NHS and social care the CQC under section10 of the has never taken any enforcement organisations and individuals Health and Social Care Act 2008. action against The Pennine Acute handle information. This can At the end of the reporting Hospitals NHS Trust since its be personal/patient, sensitive period the Trust is registered inception. and corporate information. The with the CQC with no conditions Trust’s Information Governance attached to registration. During 2012/13 the CQC Assessment Report score overall undertook visits on all four Trust The CQC continually monitors for the year April 2012 to March sites in July and August 2012, whether The Pennine Acute 2013 was 75% and was graded and on each occasion Inspectors Hospitals NHS Trust, and other “satisfactory” (green). spoke with many patients, care providers, are meeting their relatives and members of our essential standards of quality and staff. 14 Clinical coding patient safety. Their particular error rate focus is on patient outcomes in Rochdale Infirmary was The Trust has seen significant terms of the delivery of a quality visited in August 2012 and improvements within its coded experience of care. The CQC was found to be compliant in data throughout 2012/13 and pays particular attention to what respect of:- this has been demonstrated people say about the service. Outcome 2: Before people are within the latest external The intelligence which is used by given any examination, care, assurance audit report on behalf the CQC to make an assessment treatment or support, they of commissioners. The report upon the Trust’s performance should be asked if they agree to highlighted that our HRG error against the statutory standards is it rate for the March 2013 PbR obtained from external sources, Outcome 4: People should get audit was 5.2% of spells which including the National Patient safe and appropriate care that would be 3.8% below the Safety Agency, the Parliamentary meets their needs and supports national average error rate. Health Service Ombudsman, their rights Following a service review service users through a dedicated Outcome 6: People should get in 2010, the service was web site, mortality alerts, safe and coordinated care when redesigned and restructured national inpatient and staff they move between different in line with national coding surveys and through LINks, services recommendations. This change local charities and voluntary Outcome 9: People should be has seen the staff team working organisations. The Trust also

Annual Report and Accounts 2012/2013 66 given the medicines they need they need when they need them should be given the medicines when they need them and in a and in a safe way, the site was they need when they need them safe way found to be non-compliant; and in a safe way, was found Outcome 12: People should the CQC judged that this had a to be non-compliant; the CQC be cared for by staff who are minor impact on people using judged that this had a moderate properly qualified and able to do the service. impact on people using the their job service. North Manchester General Outcome 16: The service should Hospital was visited in Fairfield General Hospital was have quality checking systems July 2012 and found to be visited in July 2012 and found to manage risk and assure the compliant in:- to be compliant in:- health, welfare and safety of Outcome 1: People should be Outcome 2: Before people are people who receive care. treated with respect, involved in given any examination, care, The Royal Oldham Hospital discussions about their care and treatment or support, they should was visited in August treatment and able to influence be asked if they agree to it 2012 and was found to be how the service is run. Outcome 4: People should get compliant in:- Outcome 2: Before people are safe and appropriate care that Outcome 1: People should be given any examination, care, meets their needs and supports treated with respect, involved in treatment or support, they should their rights discussions about their care and be asked if they agree to it Outcome 6: People should get treatment and able to influence Outcome 4: People should get safe and coordinated care when how the service is run. safe and appropriate care that they move between different Outcome 4: People should get meets their needs and supports services safe and appropriate care that their rights Outcome 12: People should meets their needs and supports Outcome 6: People should get be cared for by staff who are their rights. safe and coordinated care when properly qualified and able to do Outcome 5: Food and drink they move between different their job should meet people’s individual services Outcome 16: The service should dietary needs Outcome 12: People should have quality checking systems Outcome 6: People should get be cared for by staff who are to manage risk and assure the safe and coordinated care when properly qualified and able to do health, welfare and safety of they move between different their job people who receive care services Outcome 16: The service should During the inspection at Fairfield have quality checking systems Outcome 12: People should General Hospital, in respect of to manage risk and assure the be cared for by staff who are Outcome 9, people should be health, welfare and safety of properly qualified and able to do given the medicines they need people who receive care their job when they need them and in Outcome 16: The service should During the inspection at North a safe way, the site was found have quality checking systems Manchester General Hospital, to be non-compliant; the CQC to manage risk and assure the in respect of Outcome 5, Food judged that this had a moderate health, welfare and safety of and drink should meet people’s impact on people using the people who receive care individual dietary needs, the site service. was found to be non-compliant; During the inspection at the The Trust was delighted that it the CQC judged that this had a Royal Oldham Hospital, in was compliant with the majority minor impact on people using respect to Outcome 9, People of outcome areas inspected on the service. Outcome 9, People should be given the medicines most sites. Where pockets of

Annual Report and Accounts 2012/2013 67 non-compliance were noted, on track to meet its completion provided very positive comments detailed action plans were timescale of compliance by 31 to the Inspectors about their developed and submitted March 2013. experiences on the Maternity to the CQC, with regular Unit. updates, demonstrating what The CQC inspected the improvements were being made Maternity Service at the Royal The comments included within to ensure the Trust met the Oldham Hospital on 21 March the CQC reports demonstrate the essential standards. The Trust 2013 in respect of Outcome 13, efforts made by the Trust staff. has declared itself compliant Staffing. The CQC has provided Our ambition is to continue to with Outcome 5, Meeting feedback that the Trust was build on our success to deliver Nutritional Needs and Outcome compliant with the essential even better outcomes for our 9, Medicines Management, is standards. In addition, patients patients in the coming year.

Comments included in the CQC Report on the Trust

Fairfield General Hospital “A lovely hospital, staff are so helpful from the minute you come in and I am very well cared for and feel safe”

North Manchester General Hospital – A&E “Staff can’t do enough for you, they are lovely and Every time I come in they look after me very well, I have no complaints”

Rochdale Infirmary “They are very good here, better than (another hospital in the area) and staff are very good”

The Royal Oldham Hospital “Staff are friendly, helpful and respectful. Everyone is much nicer than I could have expected.”

Annual Report and Accounts 2012/2013 68 “The Charter outlines a commitment for us as an organisation to 16 Care, use of comparable patient care measures. work more effectively Compassion and ■ Focuses on care outcomes to create a just culture Transparency and enables professionals to which is open, honest The Trust aims to create an NHS drive improvement. and transparent. A organisation where quality of just culture ensures care, clinical improvement and Improvements patient safety underpins all of In addition to our annual Quality individuals are fully our services through strong Accounts Reports, a variety supported to report leadership, innovation and a of monthly patient safety and concerns and safety culture of care, compassion, performance reports are routinely issues. Staff should feel openness and transparency. presented and discussed at the Trust’s public Board meetings. free to raise concerns Our patients and the public These cover a variety of key and issues at every level we serve have a right to performance areas such as the of the organisation. Any information about the quality of Trust’s mortality rate, healthcare care provided by our staff. This employee which does acquired infections, cleanliness requires us to adopt an open and this should be treated of hospital sites, and standards transparent culture alongside related to emergency care access, fairly and with empathy a commitment to measure and 18 week operations (Referral and consideration.” publish information on what To Treatment) and cancer. All matters to patients and staff – John Jesky, Trust Board papers including clinical outcomes and patient Trust Chairman the monthly performance and experience. patient safety reports are made A transparent culture: available on the Trust’s public- facing website. which has been launched by ■ Builds public confidence in the NHS Employers organisation the nursing care patients Speaking-Up Charter which represents employers in receive. In October 2012 the Trust signed the NHS, supporting them to put ■ Gives patients access to the up to the ‘Speaking Up Charter’, patients first. information they need to make meaningful choices about their care. ■ Informs the availability of patient choice and holds public servants to account. ■ Ensures organisational accountability. ■ Drives improvements in care through the

Annual Report and Accounts 2012/2013 69 The Charter outlines a October Board meeting. He was The Trust Board discussed the commitment by NHS employers, joined by Joanne Heyworth, Staff main themes of the Francis regulators, health unions, Side’s Deputy Secretary, Roger Report at its public Board professional associations and Pickering, Executive Director meeting in February where the bodies to work together to of Human Resources and John Trust’s response to the report was support staff when they raise a Saxby, Chief Executive, who all outlined along with proposals concern. signed the Charter. for action to be implemented as part of our Long Term Quality The Charter has six Plan which we had already commitments which a number 17 Francis Inquiry of organisations, including this Report started planning for some months before the Francis Report Trust, have signed up to: On 6th February 2013, Robert was published. Subsequent ■ To work in partnership Francis QC published his long- discussions were held in March with other organisations to anticipated report into the and April not only about the develop a positive culture role of the commissioning, significance of the findings of by promoting openness, supervisory and regulatory bodies the report but in exploring and transparency, fairness, in the delivery and monitoring developing aspirations for quality reporting and learning as an of services provided by Mid improvement across our services important and integral part of Staffordshire NHS Foundation and our hospitals. providing safer patient care. Trust. ■ To adhere to the principles of The Francis Report reminds us His report shows how the NHS this Charter to foster a culture of the importance and the need system and culture allowed of openness which supports for us to remain focused on poor quality of care to take staff to raise concerns. the quality of care, compassion place, raising concerns about ■ To share expertise to create and competence we provide for management, regulation and effective ways of breaking each of our patients on every quality assurance. down barriers to reporting occasion. The recommendations incidents and concerns early This is an important report for outlined in the Francis Report on. the whole of the NHS, including have been considered and ■ To exchange information, this Trust. The full report runs to integrated into our Long Term where it is appropriate and almost 2,000 pages with 290 Quality Plan. lawful to do so, in the interest recommendations. The report of patient and public safety. addresses a wide range of issues 17.1 Safeguarding ■ To signpost individuals to in relation to the quality of care Adults & Children support and guidance to provided at Mid Staffordshire Ensuring all our patients are safe ensure that they are fully NHS Foundation Trust, but is our top priority. Our specialist aware of and understand fundamentally comments wider Safeguarding Team provides their protected rights under on culture change that is needed advice, support, supervision the Public Interest Disclosure at all levels of the NHS. Act 1998 (PIDA). and training to our staff on all ■ To seek to highlight issues The Secretary of State for matters relating to the protection where current law or Health, Jeremy Hunt, and Chief of adults and children at risk. Executive of the NHS, Sir David regulations may restrict those The team develops standardised Nicholson, immediately wrote to who wish to raise a concern policy, practice guidelines and about a human error. all NHS Chief Executives asking procedures for staff and works Trust Boards to reflect upon at a strategic level to ensure Trust Chairman John Jesky signed the findings of the report and that the Trust’s obligations the Speaking-up Charter on discuss and consider carefully the under legislation, national behalf of the Trust Board at our recommendations.

Annual Report and Accounts 2012/2013 70 and local standards are met. practices relating to vulnerable Mental Capacity Act Representatives from the people, particularly in relation Seminars Trust sit on multi-agency Local to safeguarding, access to The Safeguarding Adult Safeguarding Children’s and patients (included that afforded Group has established a Adults Boards and attend local to volunteers or celebrities) and Mental Capacity Act (MCA) Community Learning Disability listening to and acting on patient Implementation Group. This Partnership forums. concerns.” group has launched a series of In addition to the day to day The Trust immediately carried seminars aimed at staff. This is work of safeguarding adults and out a review and concluded in response to audit findings, children at risk, a lot of work has that our procedures were robust national and organisational, been undertaken over the past and congruent with national highlighting a need to raise year to address concerns arising requirements and guidelines. awareness of the application from local and national enquiries There is evidence that shows of ‘best interest’ principles including the high profile Savile procedures are followed and for people who lack (mental) allegations and the Child Sexual that patient’s and relatives capacity. Exploitation cases uncovered in concerns are heard. However, Privacy and Dignity Rochdale. it is important to recognise that walkrounds: children and there is little certainty in the field young people Child Sexual Exploitation of safeguarding. Predatory sex The widespread nature of offenders are often skilled at Over the past year, our child sexual exploitation (CSE) ‘grooming’ those who work with safeguarding team has carried is becoming more apparent them, as well as their victims. out a series of ‘walkrounds’ following the Rochdale Local There will always be cases across our hospitals observing Authority enquires and those where such individuals will be different environments where that have followed since in other successful in perpetrating abuse children are seen and treated, parts of the country. We have and never being ‘found out’. both as inpatients, in A&E and as responded to this by ensuring Whilst we can never obliterate outpatients. The team take the our staff are made aware of the the risk to our patients, our staff opportunity to speak with staff problem and trained in how training, procedures, policies and about the need to protect the signs might be recognised and safeguarding infrastructure will privacy and dignity of children acted upon during day-to-day ensure it is minimised. and young people. care and treatment of patients. The findings of this important Online information Child sexual exploitation is work have been extremely sharing included within our safeguarding positive and provide assurance children (level 3) training. Study Following the introduction of that staff are aware of how sessions for staff have been our online information and to protect children and young delivered on each of our hospital referral forms for children at people when their privacy sites (two per month) reaching risk, our health and social care and dignity is threatened. This over 700 staff. colleagues in the community includes in environments where have reported that the quality space is challenged and separate Savile allegations of information included on the areas for children are not In November 2012, in light forms to be much improved and available. Meetings have been of the issues surrounding the has helped multi-agency working arranged with members from the Jimmy Savile revelations into and information sharing. Work local Youth Councils to discuss child exploitation, all NHS is now underway to develop the the findings in relation to their Trusts were required to “… same innovative system form for expectations and experiences of review arrangements and our adults and maternity services. accessing hospital services.

Annual Report and Accounts 2012/2013 71 Learning Disabilities Female Genital Mutilation, training are delivered in The Safeguarding Team have Domestic Abuse, Fabricated and environments which are collated three patient/carer Induced Illness, and Discharge conducive to learning, led by stories highlighting areas of policy for children who are qualified and experienced staff, strength and areas in need Looked After or where there are fit for purpose and tailored to of improvement in hospital child protection concerns. the needs of the individual. services. Two of the stories The purpose of the Trust- Medical Education are from carers of people with wide Alcohol Steering Group The Trust is the Lead Employer learning disabilities and are is to develop a standardised providing recruitment and especially important to capture and systematic approach to employment services to specialty in the light of findings from the delivering alcohol harm reduction doctors in training and their ‘Winterbourne Hospital’ Serious across the Trust. The aim is to host trusts located within the Case Review. reduce harm caused by alcohol North Western Deanery. All are misuse to patients attending The Trust wide Learning Disability employed and supported by our hospitals and community Steering Group is in the process the Trust for the duration of the services. The group has been of refining a ‘What Good Looks training programme. Like’ pathway for people with instrumental in securing funding learning disabilities who are to pull together alcohol services Within Pennine, the Foundation admitted to hospital based on across the Trust and introduce Programme for doctor training accounts from carers provided in new posts that will intervene is delivered across our hospital patient stories. The intention is to reduce alcohol admissions sites. We have 99 Foundation to improve the quality of patient to hospital. Potentially these Year 1 (FY1) trainees and 99 care and experience for people reductions could reach 5% a Foundation Year 2 (FY2) trainees. with learning disabilities. year. Our programme enables trainee doctors to gain competencies Training & Policies 17.2 Training & in core clinical skills, as well as The Safeguarding Team has Development other professional skills such as successfully introduced a new teamwork and communication. Our aim is to enable our staff training strategy the content of Trainees are assessed throughout to provide high quality services which has been approved by the two-year period to explicit and optimum levels of patient colleagues in the community. It standards, which are set out care. We believe this can be was launched last Summer and in the Curriculum for the achieved by providing learning has already resulted in nearly Foundation Years in Postgraduate opportunities and training which double the number of staff Education and Training. Quality are effective, flexible and fair to receiving safeguarding children assurance is carried out by the meet the needs of our staff. and adult training. The impact North Western Deanery on of this has been particularly We are committed to behalf of the General Medical prevalent in adult services where equal opportunities and an Council (GMC). there has been a demonstrable organisational culture which Alongside medical craft increase in the numbers of supports and promotes lifelong education, the Trust focuses safeguarding adult referrals to learning through the ethos on providing a solid grounding the local authorities. of a learning organisation. in professional behaviour and We recognise the crucial part New and updated strategies, responsibilities, probity, health, education can play in improving policies and guidelines this year ethics and career management. the working lives of staff. have included: Alcohol Strategy, Delivering high quality medical Learning Disability Strategy, Learning opportunities and education across the Trust

Annual Report and Accounts 2012/2013 72 enhances the Trust reputation as of training prepares our doctors 18 Quality a centre for learning and attracts and nurses for the future work increasing numbers of both environment allowing practice Improvement undergraduate and postgraduate of clinical skills in a safe but The Trust aims to create an NHS learners. realistic environment. In future, organisation where quality of this type of training will be care, clinical improvement and Simulation Training offered to our partner agencies patient safety underpins all of In December 2012, the Trust and colleagues in the wider our services. The Trust continues opened its new simulation healthcare community across to work with stakeholders to training and education suite Greater Manchester. review and improve the quality at North Manchester General of our services through strong Hospital. The facilities support a Mandatory Training leadership, innovation and a multi disciplinary training area, Our first responsibility is culture of care, compassion, encompassing all grades of staff/ the safety of our patients. openness and transparency. students within the Trust, with Mandatory training for all the aim of promoting a more our staff is important in areas 18.1 Patient Safety effective and safe team approach such as hand hygiene, health to patient care. and safety, fire awareness and 18.1.1 Safer information governance. All staff Surgery Simulation training is already must complete their mandatory All NHS Trusts in England, undertaken by the medical training every year to ensure we including our Trust, now use the staff in training and is being are all aware and familiar with WHO Surgical Safety Checklist introduced to the wider hospital Trust policies and procedures that for hospitals in order to provide community (cadets, student affect the smooth running of our safer surgical care. Whether a nurses and preceptees). This type services.

Annual Report and Accounts 2012/2013 73 patient is in A&E, attending an We are keen to continue to Prevention Care Plan for patients outpatient clinic or diagnostic improve areas of patient safety to who have had a fall or are at risk test, as an inpatient on one of ensure our patients are receiving of falls, is more sensitive. Along our wards or undergoing surgery the best care, based on the with risk of other harms, the in theatre or at a day surgery best current practice. Through patient’s individualised risk of falls unit, we are committed to our involvement in the national continue to be presented at the ensuring our services are as safe Safety Express programme and bedside by a traffic light system to as possible. by supporting and using this ensure that all staff are aware of campaign locally to promote the risks to patients following an Following the introduction of patient safety, we are determined assessment. This system has now the WHO Safe Surgery Saves to ensure our key practices and been extended into our accident Lives Checklist into the Trust in high standards are embedded and emergency departments. 2010, communication between into all our services our staff and clinical teams in Following an extensive review theatres has improved. The within the Trust, we have checklist has been crucial 18.1.2 Patient Falls committed to providing patients in introducing safer surgery Patient Falls are the most with appropriate suitable solid practices to reduce patient harm common patient safety incident sole footwear for those who do and surgical complications. reported by the National Patient not have them. This has led to a Safety Agency (NPSA). Falls in significant reduction in patient In September 2012, the Trust hospitals tend to occur among falls of up to 38% within our publicly announced that our elderly patients. ward areas. surgeons, doctors and nurses working across our hospitals There has been great emphasis In order to ensure essential care were all supporting Safer Surgery on ensuring we continue to put is provide to those who may Week - a national patient safety the patient at the centre of all suffer a fall, a Post Op Falls campaign to promote safer our decisions. Various practical Protocol is being actively used by surgery. The campaign was measures have been embedded staff across the Trust to ensure led nationally by Patient Safety to help patients, relatives and all critical care is provided to the First and the Clinical Board for clinical staff prevent our patients patient’s so that they make a Surgical Safety to help improve falling whilst in hospital. making a full recovery. the quality and reliability of local The Trust’s Strategic Group for implementation of the Five Steps Improvements the Prevention of Falls continues to Safer Surgery guidance across A key example is ‘The to support frontline staff to hospitals. Rounding Log’. This, alongside our Dementia Awareness implement best practice for The Safer Surgery Week programme, has been the prevention of falls. Staff campaign helped reaffirm and instrumental for staff in ensuring are routinely reminded of the focus staff in improving the that our patients’ basic needs importance of falls prevention quality and reliability of the are met at the hospital bedside through poster presentations, Five Steps to Safer Surgery that on a regular basis. This is proving training and continued form part of the WHO Safety particularly effective for those monitoring and feedback to Checklist. The guide is designed patients identified at risk of falls clinical areas on compliance with for use by team members or confusion. Falls Risk Assessment through involved in implementing monthly nursing quality indicators the Surgical Safety Checklist, The Trust has also embedded carried out on every ward. including briefing and debriefing the Falls Risk Assessment Tool These quality measures have our doctors and theatre staff. to ensure the trigger for the implementation of a Falls led to a significant reduction

Annual Report and Accounts 2012/2013 74 Case study - Forget-me-not

In February 2013, the Trust launched its more importantly, support of a new patient identification how to provide scheme to help support patients with support to those living dementia. with the condition whilst they are in hospital The Forget-Me-Not scheme is part of a wider drive by the government and Department of Led by the Alzheimer’s Society, the scheme Health to raise awareness of dementia and aims to make everyday life better for those change the way that people think about it. suffering with dementia by changing the way that people think, talk and act. It also Our staff attended awareness sessions to aims to get as many people as possible find out more about dementia and what it’s to register as Dementia Champions. The like to suffer from the condition. They were government is hoping that 1 million people also taught how to spot the symptoms and will register on the scheme by 2015.

Staff that choose to be “Dementia “Dementia can be a disorientating champions” are awarded a forget-me- and isolating condition and patients not badge to show that they know about can often feel lonely, confused and dementia. The same forget-me-not symbol will also be used to recognise organisations cut off. The Pennine Acute Trust’s and communities that are dementia friendly. dementia champions will be trained to spot the symptoms as staff have a really important role to play and can help us provide the best quality of care and support to our patients.”

Adele Doherty, Clinical Manager at Fairfield General Hospital

in the number of avoidable Falls Awareness programme by number with the condition is falls. The quality measures introducing a simulation ‘suit’ expected to double over the next implemented within the Trust that will allow staff’s to explore 30 years. have led to a 22% reduction of the physical and emotional Dementia is a term which falls in 2012/13 in comparison to challenges of the older person describes a syndrome which 2011/12 achievements. This far faces may be caused by a number of exceeds local and national NPSA illnesses. It results in progressive expectations (18% reduction). 18.2 Patient decline in multiple areas of As we move into 2013/14 the Experience function, including memory focus of our staff is on delivering function, communication and the a candid and compassionate 18.2.1 Dementia ability to carry out daily activities. commitment to harm free care According to the National Audit The two most common forms of by aiming for a 30% reduction Office, one quarter of people dementia are Alzheimer’s disease in falls within the Trust. We are accessing acute hospitals are and vascular dementia. excited at extending our Trust likely to have dementia and the

Annual Report and Accounts 2012/2013 75 We recognise the vulnerability of Improvements patients, as recommended by patients with dementia, delirium Dementia staff training and the Department of Health and and physical frailty and through awareness is a key part of our the National Institute for Clinical our Dementia Strategy we are dementia strategy. Over the past Excellence (NICE). beginning to take action and year we have developed a range A clinical decision that the develop ways we can improve of training materials and courses patient is dying is made by the the hospital experience for these for our staff, particularly those doctors and nurses caring for groups of patients and their who are responsible for patient the patient when deterioration carers. care and are based on wards and occurs with no response to all Early diagnosis of dementia and in clinical areas. appropriate treatments and interventions are key priorities We are committed to listening interventions. The assessment is for the Trust. Several other to our patients, their families repeated, including the clinical objectives of the strategy include and their carers. Working decision in relation to nutrition improving the quality of care for with and involving carers and and hydration. All decisions are people with dementia in general patients enables us to design made in the best interest of the wards; of particular importance care pathways that better meet patient and regular assessments are the objectives for defining the needs and expectations of throughout the day and night care pathways and ensuring the patients with dementia and their are undertaken to help maintain workforce has necessary skills to families. We continue to work the comfort and dignity of the offer the best quality of care by closely with the Alzheimer’s patient, which is paramount. providing training. Society, Local Involvement This care pathway would be Other actions include: Networks (LINks)/Healthwatch discontinued for the patient and local voluntary organisations, ■ Increasing the numbers of if, following reassessment, which will support us in this patients who are assessed for their condition indicated work. the possibility of dementia on improvement. The LCP provides admission to hospital staff with a guide to provide 18.2.2 Liverpool good quality care during the ■ Including dementia training in time the patient is on the LCP. staff inductions Care Pathway Medicines for symptom control ■ Staff inductions include an The Liverpool Care Pathway (LCP) will only be given if necessary, at element to cover dementia is an integrated care pathway the right time and no more than care and our aim is to expand that is used at the bedside of is needed to help the symptom. this to staff annual training patients to drive up sustained programmes and to provide quality of the dying in the last In May 2012, the Trust, enhanced dementia training hours and days of life. The in partnership with NHS for a core group of clinicians LCP has been implemented Manchester, organised our to ensure at least one nurse into hospitals, care homes, in third annual Pennine Palliative per shift is available with this individual’s own home and in the Care conference in Manchester. level of knowledge community and into hospices Organised as part of national across the country. ■ Having a clear treatment plan Dying Matters Awareness Week, the conference invited medical, for those patients assessed Last year, issues surrounding the nursing and care services staff and identified as ‘at risk’ Liverpool Care Pathway (LCP) from local and primary and ■ Raising the profile of the generated extensive local and secondary care organisations, dementia care pathway and national media coverage. The local nursing and residential care the standard of care provision Trust uses the Liverpool Care homes. Pathway (LCP) as a model of care to appropriately care for dying

Annual Report and Accounts 2012/2013 76 Delegates took the opportunity support from our Nutrition to come together to stimulate and Dietetic service which debate, obtain information is made up of dietitians, and share best practice on nutritionists, food workers, a end of life care, palliative care food development officer and and dying matters topics. The dietetic assistants. The team event helped staff discuss areas work within our hospitals where improvements can be and across the community in made to ensure patients in various settings. their last days are cared for with dignity, respect and with Improvements the appropriate care that is A revised menu for patients needed. with dysphagia (difficulty swallowing) has been Keynote speakers included Dr introduced by the Trust. Our Iain Lawrie, consultant and catering staff, speech therapists honorary clinical senior lecturer and dietitians worked alongside in palliative medicine at the food manufactures to revise Trust, Tony Bonser from the the menu. This included National Council for Palliative numerous tasting sessions Care, Kim Wrigley, End of suggesting changes to products Life Care Lead and Dr Petula where needed, ward trials of Chatterjee, medical director heating of food to ensure the (primary care) for the Greater products were suitable for the Manchester and Cheshire catering systems in place, a Cancer Network. nutritional analysis of the food provided and involvement of 18.2.3 Nutrition patients on the stroke units to Adequate food and drink is provide feedback on the new vital for good health. Ensuring meals. that our patients are properly The format of the menu was fed and hydrated is not only also updated into an A la carte the responsibility of our format allowing patients more catering staff, but a key role of choice at each meal time, our nursing staff. including smaller options for Nurse are expected to ensure patients who may be unable patents are comfortable and to eat larger meals. Patient positioned appropriately in information was also printed preparation for mealtimes, on the back explaining to regularly checking patients patients and their carers why while eating and drinking, they may require a modified and conducting ongoing texture diet. assessment to identify those The new menu was launched who require assistance with across the Trust in December their meals. 2012 and has now been Our nursing staff also rely on rolled out fully across the the professional advice and

Annual Report and Accounts 2012/2013 77 Trust. Regular ward meal attractively can help to improve dignity when they are often at time observations by catering a patient’s nutritional intake their most vulnerable. managers, Speech and Language and therefore overall nutritional We are proud to confirm that therapists and dietitians have status, and also reduce mixed sex accommodation has been conducted as part of the unnecessary food wastage. been virtually eliminated across review. The finger food menu can also our hospitals. Patients who are Improving the food offered to benefit other patients, as it can admitted to any of our hospitals our patients with dysphagia be offered as an alternative to should only share the room through increased choice, meals the main hospital menu. It is where they sleep with members that are safe in texture and particularly suitable for those of the same sex, and same sex nutritionally adequate increases with small appetites who are toilets and bathrooms will be the likelihood of patients being easily over faced by larger meals, close to their bed area. Sharing able to eat more, improving their long stay patients suffering from with members of the opposite nutritional status, recovery time taste fatigue, those with arthritic sex will only happen by exception and overall wellbeing. hands or conditions resulting in based on clinical need, for severe tremors. example where patients need to A finger foods menu primarily be cared for in critical care areas, aimed at patients with dementia Giving alternatives to the main such our as Intensive Care or has also been introduced as part hospital menu in this way High Dependency Units. of the initiatives of the Trust’s increases patient choice, offers Food and Nutrition Group. individualised care and improves We monitor patient experience Patients with dementia often the patient’s experience. This in relation to Single Sex suffer from poor hand to eye style of eating can easily be Accommodation (SSA) through coordination which can make replicated at home by carers daily monitoring by hospital cutlery difficult to use. Some after discharge if there has been management teams and on a patients are often find it difficult a positive impact on a patient’s monthly basis through a specific to sit down at mealtimes. The appetite with this approach in Patient Satisfaction Survey menu is suitable for patients who hospital. that includes questions on would normally chose meals single sex accommodation and Following successful pilots across from the main hospital menu environmental cleanliness. All a number of our wards last who do not have swallowing responses are presented to the year, the finger foods menu has problems. Patient Experience and Equality been launched across the Trust Committee and reports are Providing finger foods and will be regularly evaluated submitted to the Performance encourages patients with through regular ward reviews Management Group. dementia to maintain their and patient feedback. independence in eating. A loss The schedule of LINk visits has of independence in eating puts 18.2.4 Same Sex continued during the quarter and older people at increased risk feedback from the visits has been of under nutrition which has a Accommodation positive. Local Commissioners serious impact on their overall Every patient deserves the right have joined the visits and they health, wellbeing and quality of to receive high quality care that are supportive of the cross life. Preventing under-nutrition is safe, effective and respects borough review which allows has been shown to decrease their privacy and dignity. The all LINks to identify the different length of stay in hospital, reduce Trust is committed to providing provision and challenges in the risk of developing infections every patient with same sex meeting compliance across our and other complications. A accommodation because it helps hospitals. range of finger foods presented to safeguard their privacy and

Annual Report and Accounts 2012/2013 78 In 2012/13 the Trust was Care Access Standard requires Last year the Department of able to confirm that we are at least 95% of patients to Health introduced a range of new compliant with the Government’s be seen, treated, admitted, A&E clinical quality indicators requirement to provide single-sex transferred or discharged within as part of the NHS Outcomes accommodation. This declaration four hours of attendance at an Framework 2011/2012, of compliance by the Director A&E department, urgent care developed by the Department of of Nursing is publicly available centre or NHS walk-in centre. We Health in conjunction with the on our website. The number understand how important this College of Emergency Medicine. of mixed sex accommodation standard is because our patients These A&E clinical quality breaches per 1000 Finished deserve to be seen as quickly as indicators have been designed Consultant Episodes (FCEs) takes possible and this focus prevents to present a comprehensive account of the relative size of patients having to experience and balanced view of the care Trusts enabling performance to unnecessary delays in A&E and delivered by A&E departments, be benchmarked. In 2012/13, also encourages our staff in and accurately reflect the we have reported zero sleeping wards and other areas of the experience and safety of patients accommodation breaches. hospital to help inpatients recover and the effectiveness of the care and receive rehabilitation and they receive. The new indicators prevent unnecessary delays in 18.3 Clinical were introduced to provide their discharge home or in the clinicians with better information Effectiveness community. to encourage continuous 18.3.1 A&E 4 hour In 2012/13 the Trust saw 322,040 improvement, leading to better Emergency Access patients in our A&E departments and safer patient care, and to Standard and achieved the 95% national provide information that is easier 4 hour standard for the year and for patients to understand. Emergency and urgent care for each quarter of the year. This The eight indicators have applied services are available to people cumulative performance means to A&E departments since 1 April who need medical advice, that over the year over 307,777 2011 and now form part of the diagnosis and treatment quickly of our patients were seen, Department of Health’s Acute and unexpectedly. There are over treated, admitted, transferred or Trust performance framework. 21 million attendances at A&E discharged within four hours of The Trust’s monthly performance departments across the country coming to our hospitals. each year. for each of our sites across all We are one of the best A&E quality indicators are publicly We work hard to ensure our performing Trusts in the region available on our website under patients are seen as quickly as in relation to our A&E waiting quality and performance at www. possible across our three Accident times. This has been as a result pat.nhs.uk. & Emergency departments at of hard work and commitment The table below shows North Manchester General from our staff and a reflection of performance for the Trust by Hospital, Fairfield General the improvements we have made quarter and cumulative year Hospital and The Royal Oldham in ensuring patients are either to date up to the end of each Hospital, as well as our Urgent treated, moved to appropriate quarter. Care Centre (UCC) at Rochdale wards or discharged out of Infirmary. hospital in a timely manner when The Department of Health’s they are medically fit to do so. national 4-hour Emergency

Annual Report and Accounts 2012/2013 79 4 hour Emergency Access Standard Q1 Q2 Q3 Q4 Year Attends 83,607 79,777 81,027 77,629 322,040 Breaches 2,841 2,464 3,362 3,569 12,263 % Within 4 hrs 96.6% 96.9% 95.9% 95.4% 96.2%

The chart below shows the cumulative year to date (2012/13) performance against the 95% target.

97.5% 97.0% 96.5% 96.0% % winthin 4hrs 95.5% Target % 95.0% 94.5% 94.0% Q1 Q2 Q3 Q4 Year

Demand on services some patients having to wait pound capital investment Like most other hospital trusts longer to be treated. Figures programme to expand and across the country, our A&E suggest that every day up to improve facilities at both A&E departments continue to be 50 people who visit our A&E departments at Fairfield General extremely busy every day treating departments at North Manchester Hospital and at The Royal and dealing with all kinds of General and The Royal Oldham Oldham Hospital. patients. In December 2012, the Hospitals could be treated more Building work started in Trust narrowly missed the 95% quickly and more appropriately November on the £2.25 million national standard (94.06%) for by a pharmacist or another local expansion of Fairfield’s A&E. the month due to experiencing primary or community health The development will create very heavy demand whilst the service. dedicated A&E facilities for outbreak of Norovirus reduced children. The expansion will our inpatient bed capacity for A&E teams are routinely being also separate minor and major a couple of weeks during the faced with having to deal with cases, meaning those with minor winter. ‘run-of-the-mill’ minor cases such injuries are separated from more as coughs and colds, backache, critically ill patients who are The Trust continues to support toothache, feet problems and and promote the NHS Choose brought in by ambulance. upset stomachs on a daily basis Well campaign in efforts to – conditions that could be dealt Fairfield’s A&E was originally educate and encourage local with through a trip to the high designed to accommodate people to access and choose street chemist or by visiting other 45,000 patients. Last year the the right local health service and local services. department saw over 65,000 avoid unnecessary visits to A&E. patients. The expansion of Unnecessary visits to A&E Improvements clinical treatment space and the departments are wasting valuable In May 2012, the Trust improved physical layout of the NHS resources and could mean announced a huge multi-million whole department will improve

Annual Report and Accounts 2012/2013 80 “We often find ourselves dealing with patients who turn up to A&E throughout the contract period. department will help staffs The completion is planned for develop and provide high with minor illness and November 2013. standards of clinical care in a complaints who could modern spacious facility. It will Similarly, the £3.75 million have been seen and help improve the way services are capital investment of the delivered and benefit patients, treated elsewhere. On A&E department at The Royal particularly children who will average 30-50 patients Oldham Hospital will see the have dedicated facilities. The development of separate per day could and developments will also enable dedicated A&E facilities for should be dealt with in staff to plan and deliver better children and young people, and a primary care service urgent care in partnership with the expansion of the emergency our local GPs, GP commissioners such as a local pharmacy department to increase space and other partner agencies. The or community service. and capacity which will improve development is being built in waiting times and the patient These unnecessary phases and is expected to be experience. visits to A&E are a completed by summer 2014. drain on valuable and The development forms an limited resources. We integral part of the Healthy GP involvement have one NHS budget Futures and Making it Better Last year we appointed a local reconfiguration programmes General Practitioner (GP) to join which we all have a which have seen a number of our A&E department at North responsibility to look specialist services transferred, Manchester General Hospital in after. By choosing and centralised and developed at a brand new position to help using the right services, the hospital over the past year improve and develop future patients can expect to including the vascular unit, emergency and urgent care trauma and orthopaedic unit, services. We are seeking to be seen or treated more and haematology unit. appoint a GP for similar roles quickly, whilst keeping across our other hospitals. These The expansion of the A&E emergency services free unique roles - the first of their facilities will support and kind across Greater Manchester for those with serious accommodate the increased - will provide primary care clinical and life threatening number of acutely ill patients leadership in the transformation now being brought by illnesses.” and development of urgent care ambulance from the Rochdale services to better meet the health Dr Jimmy Stuart, borough area and support needs of local people across A&E consultant and clinical the development of obstetric, Oldham, Bury, Rochdale and director at North Manchester children’s and neonatal services North Manchester. General Hospital on the site. As part of the Trust’s senior The A&E department currently management team, the GPs will patient flow and have a positive sees on average 280 patients work closely with our doctors, impact on patients’ experience. per day; around 94,000 patients nurses and senior managers to a year. Of these, around 70 The project involves two improve services and ensure children aged under 16 are seen extensions followed by they are safe and to a high per day. The A&E team comprises substantial internal alterations standard. They will also assist in of 11 consultants in emergency that will have to be carried out in building good links with local medicine and 85 nursing staff. phases to ensure the department GPs, colleagues in social care can continue to function Once complete, the new A&E and mental health services,

Annual Report and Accounts 2012/2013 81 Case study

Giving the best care to cancer patients 24/7 The Trust has boosted its care for cancer and timely care for cancer patients. They patients with the introduction of a new also actively educate other members of staff Macmillan Acute Oncology Service (AOS). in promoting effective and safe care delivery to this group of patients. The service, launched in October 2012, has been set up to help deliver optimal urgent The Trust has also devised a patient flagging cancer care for those patients who present at system which allows patients who have been any of the Trust’s hospitals as an emergency diagnosed with a primary or reoccurrence admission, with complications from their of cancer to be identified as soon as they cancer, or its treatment. Patients who have turn up at hospital. The ‘flag’ is put on the a new or suspected cancer diagnosis are also electronic patient record and generates supported by the service. an alert in the A&E and MEU computer system to highlight to staff that the patient A report by the National Chemotherapy is an oncology patient. Once the alert is Action Group recommended the activated, an automatic email will be sent establishment of acute oncology teams to the AOS which will allow them to contact within acute hospitals to work with A&E the department where the patient is and and medical emergency units (MEU). Co- ascertain if the patient needs input from the ordinated by the Greater Manchester Cancer service. Network, the new AOS teams have now been set up in all of the ten hospital Trusts within the Greater Manchester area.

Our team comprises three Macmillan acute oncology nurses and three acute oncology co-ordinators who now work with A&E, MEU and ward based teams, as well as specialist palliative care staff to promote the optimal

local councils and the voluntary each of our four hospitals. This Trust’s bi-monthly Pennine Acute sector. We believe this joint includes palliative care services. Cancer Committee. working with primary care Each tumour group has an The Trust has a detailed services will help bring primary established multi-disciplinary cancer performance action care and secondary care clinical team (MDT), comprising doctors, plan which covers actions to expertise more closely together specialist nurses and other health achieve compliance with the with shared goals and a shared professionals from different health national cancer waiting times strategic direction. disciplines. Each MDT meets and compliance with the weekly and has a lead clinician, a national peer review cancer dedicated MDT co-ordinator and 18.3.2 Cancer measures. This action plan is a dedicated cancer tracker. Services updated monthly by directorate The Trust provides cancer The Trust’s lead clinician for managers across all specialities services for all of the main Cancer Services is the Deputy and is then widely circulated cancer tumour groups across Medical Director who chairs the to all cancer MDT members,

Annual Report and Accounts 2012/2013 82 divisional directors, directorate Improvements services for patients needing managers, lead cancer clinician The Trust’s Cancer Services major breast surgery as a day and the director of operations. have achieved a number case or one night stay. The Performance is reported through of developments this year, Trust has introduced a new the Trust’s Clinical Governance including: way of working and 23 hour and Quality Committee and the discharge; patients now have ■ Ward F11 at The Royal Trust Board. The Trust achieved a reduced hospital stay. pic Oldham Hospital and all national cancer standards the Macmillan Cancer ■ A Cancer & You event was each month during the year. Information and Support held by the Trust’s Macmillan Information Service. Over the past year the Trust Centre at North Manchester has been heavily involved in General Hospital were both ■ Pennine Cancer Patient supporting and leading local awarded the Macmillan User Partnership working and national cancer awareness Environmental Quality Mark. with Trust and Macmillan to campaigns. This has included ■ The Trust became designated implement a buddy scheme promoting and being involved as a shared care Teenage for patients and trained in public campaigns highlighting and Young Adults Oncology potential “buddies” to offer Ovarian and Cervical Cancers, service. support. Lung Cancer, Mouth Cancer ■ The Trust’s colorectal team ■ The Trust increased and Breast Cancer awareness. launched a new colorectal participation in research trials This included publicity and cancer support group. to over 1000 cancer patients. information events for staff and ■ The Trust’s Breast Service ■ The Trust implemented the the public. won a national NHS award Information prescriptions. for improving breast cancer

Annual Report and Accounts 2012/2013 83 ■ EBUS - Endobronchial In effort to sustain a high level appointments without Ultrasound started for Lung of performance and improve cancelling or rearranging their Cancer patients patient flow, the Trust’s plan is to appointment. ensure every patient has a clinical ■ The Trust launched a new ■ Elective Surgery Long Length management plan. Acute Oncology Service and of Stay (Adjusted Rate) - this flagging system. applies across all surgery 18.3.4 Clinical specialities and shows we The Trust met all national Cancer Efficiency kept on average elective performance standards (waiting Dr Foster Intelligence in its 2012 patients in for longer than times) Hospital Guide (published in other hospital Trusts. In December 2012), for the first addition, our day case surgery 18.3.3 Referral time, looked at the relationship rate is lower (i.e. not as to Treatment (18 between clinical efficiency and efficient) than other Trusts. weeks) quality by comparing mortality ■ Excess Bed Days (Elective ratios with an index of 13 Crude Rate) - this is the National and local NHS standards separate measures of efficiency. percentage of inpatient days require patients to be admitted spent in hospital that are in for surgery or scheduled The Trust performed particularly excess of the typical length (elective) services within 18 well on a shorter length of stay of stay in respect of Elective weeks of referral by their GP. This in hospital for elderly patients. procedures. To put it simply, standard is known as 18 weeks The Trust underperformed on the our patients stay longer in Referral To Treatment (RTT). following measures: hospital than in most other Significant progress has been Trusts. ■ 28 Day Emergency made over the last two years in Readmissions (Adjusted Rate) ■ Admissions Where Procedure reducing the backlog of patients - a greater percentage of Not Performed (Crude Rate) – awaiting elective surgery and emergency admissions were shows that we admit patients improvements have been made readmitted within 28 days as both emergencies and in our 18 week RTT waiting after discharge. electives. Patients are mostly list figures. Since June 2012, admitted as emergencies but ■ 7 Day Emergency the Trust has achieved all the no procedure is recorded as Readmissions (Crude Rate) national RTT standards. being performed. - a greater percentage of The Trust continues to face emergency admissions were Improvements challenges in ensuring patients readmitted within 7 days. admitted in a few clinical Our staff within the division of ■ Day Case Rate (from BADS specialities meet the 18 weeks surgery have established several basket of procedures) - standard. This includes trauma projects led by our doctors against the British Association & orthopaedics, general surgery and nurses to look at quality of Day Surgery basket of (colorectal, vascular, and general improvements and improved procedures we carried out surgery), and oral surgery. patient pathways in several of fewer procedures on a day Senior consultants and our the areas highlighted within the case basis. This also applies clinical directors are leading on report. These include conversion when all day case procedures developing improving patient of patients who previously would are included. pathways Performance continues be referred as inpatients to undergo an elective procedure to be closely monitored and is ■ DNA Rate (Crude Rate) - a and sty in hospital overnight to reported every month at the greater number of our a day case procedure instead. Trust Board. patients “Did Not Attend” We believe this will lead to an (DNA) for their outpatient

Annual Report and Accounts 2012/2013 84 improvement in our day case visiting other centres to focus a 26% of children do not attend rates but also an improved plan on the introduction of this appointments. This causes delays patient experience. specifically for Hips at The Royal for other patients who could Oldham Hospital. have used that slot and causes We are looking at a reducing frustration and extra work for the average length of stay of We have recently introduced staff who have to arrange repeat patients in our hospitals that have a new Physiotherapy tool that appointments. It also costs undergone a surgical procedure has been devised at North the Trust over £9 million of lost across all surgical specialties. This Manchester General Hospital income. will be achieved by ensuring a which has significantly reduced patient pathway is developed the time a patient has to wait A major new IT system which working across divisions from surgery to receiving we rolled out in January 2013 which include Allied Health rehabilitation. This will be rolled we believe will help us reduce Professional (AHP) services such as out shortly to The Royal Oldham the number of patients who fail physiotherapy to ensure patients Hospital site. to turn up for appointments. are treated and discharged from Our new free appointment We are also looking at how we hospital quicker. This will lead to reminder system will see patients can reduce the length of time a reduction in the length of stay receive messages sent to them, our patients stay in hospital for and the number of inpatient bed either by a phone call or by a surgery. A large proportion of days needed, therefore improving new text message system. The our planned surgery is carried our efficiency as an organisation. reminders will be sent out seven out as day surgery which days before their scheduled Further service improvement work means patients do not need to appointment. is also being undertaken looking stay overnight in hospital. We at the efficiency of use of our average around 72% of all our By introducing this reminder operating theatres, pre-operative planned surgery as day case system, it is hoped that the services and cancellation rates. surgery but we still need to do number of patients who fail to Process mapping of the patient’s more to reach the national best turn up for appointments will journey has been undertaken to rate of around 82%. This is a be drastically reduced. The new highlight where improvements good example of how we can system will be an innovative and can be made. Our clinical services improve quality of care while at cost effective way of reducing are looking at ways to improve the same time reducing cost. inconvenience, frustration and closing working with pre-operative waste. services. Within our endoscopy Appointment Reminder services this is being picked up via System 18.3.5 Stroke the NHS Improvement Endoscopy We have several projects led Project of which the Trust is by our doctors to look at how Services actively involved. we can improve how quickly The Trust’s Stroke Unit at Fairfield and efficiently we can treat and General Hospital is one of two A new Enhanced Recovery discharge patients through our specialist Primary Care Stroke service is currently being trialled hospitals. One of the major areas Centres which form a co- at Fairfield General Hospital for improvement is to reduce the ordinated approach to stroke for patients needing knee number of patients who do not care across Greater Manchester. replacements. We plan to roll this attend for appointments. Together with Salford Royal programme out to cover patient NHS Foundation Trust (the needing hip replacements in the The Trust sees on average over Comprehensive Stroke Centre), coming months. We also have 791,000 outpatients per year the two PSCs offer the very a “Hip champion” and “Knee but in certain clinics 13% of specialist elements of stroke care champion” who have been adult patients do not attend and such as thrombolysis treatments.

Annual Report and Accounts 2012/2013 85 This is one of the biggest average, 89% were better service and ‘one-stop’ clinics advances in minimising disability compared with 72% national across its four hospital sites. At caused by stroke. The Trust also average, 3% were worse these clinics patients undergo provides District Stroke Centres compared with the national a Carotid Doppler investigation on two of its other sites at North average of 5%, 1% were dead and are seen by a Consultant Manchester General Hospital and compared with 5% national Stroke Physician. They leave The Royal Oldham Hospital. average clinic with a diagnosis and a treatment plan. Introducing From 1 April 2011 until 31 It is essential within a Primary clinics across our four hospital March 2012 the PSC treated an Stroke Centre that all staff who sites enables us the opportunity average of 1000 patients who assess and treat stroke patients of offering patients a choice of were brought to the centre with for both acute stroke, TIA and where they want to be seen. clinical symptoms of stroke (FAST thrombolysis are specialist positive). On average 50% trained. We currently run stroke To date, the Trust has consistently were confirmed stroke, 25% thrombolysis training days at over achieved this target and were diagnosed as a TIA and 25 Fairfield three times per year. This continues to work towards % were false positives. During is a standard training package reducing the timescales involved this period we thrombolysed 90 run with the Greater Manchester even further for the benefit of its patients at a 18% thrombolysis Stroke and Cardiac Network. This patients. The Trust prides itself in rate during PSC service hours. is aimed at consultants, doctors being able to offer these patients and nurses who deal with acute choice and a high quality service From 1st April 2012 to 31st stroke assessment. In addition, in a timely manner. March 2013 during PSC working all our stroke staff are NIHSS t hours of 7am to7pm Monday The Trust recognises that and STAT trained (Stroke and to Friday, 1164 patients were much has been achieved TIA Assessment Training). This is brought to the centre. Of these throughout the year and also an approved course by the UK 42% were confirmed stroke, our responsibility to continuously Stroke Forum and Stroke Specific 17% were diagnosed as TIA develop and improve the Educational Framework. and 41% were false positives quality of services it provides. (i.e. other diagnosed conditions Transient Ischaemic Therefore whilst five key areas not related to stroke). During Attack Services for improvement have been set this period we thrombolysed we have identified the following The Trust has a robust and 80 patients at a 16.5 % more specific areas for quality proactive approach to treating thrombolysis rate. improvement which we will work patients referred with a on for 2012/13. The average door to needle time suspected Transient Ischaemic is 40 minutes compared to the Attack (TIA). The National Vital Patient Safety national average of 70 minutes, Signs Standard from 2011/12 ■ Reduce patient falls and the stroke onset to needle being was that 60% of high risk TIA associated harm, using a 110 minutes compared to the patients should be seen by robust falls care bundle and national average of 154 minutes a Consultant Physician and intentional rounding. and the door to CT scan being commenced on treatment within ■ Eliminate all avoidable 16 minutes compared to the 24 hours of them first presenting hospital acquired pressure national average of 25 minutes. to any healthcare professional. Low risk patients should be seen ulcers (also known as bed The patient outcomes at seven and treated within 7 days. In sores) using intentional days during this period are order to achieve this, the Trust rounding and safety in keeping with the national introduced a centralised booking walkabouts.

Annual Report and Accounts 2012/2013 86 ■ Reduce the incidence of provide advice about what to that capture key performance hospital acquired Venous do if they are. metrics and use these to Thrombo-Embolism (VTE) by ■ Promote and support women drive improvements in ensuring every patient has a to have a normal birth practice. Reports, which will VTE assessment on admission and deliver safe, evidence be presented and discussed and is given appropriate based care in the antenatal, at Trust Board meetings, will prophylaxis if required. be analysed and discussed at intrapartum and postnatal every level with associated ■ Improve the nutrition and period. hydration status of our monitoring of improvement ■ Ensure that where children patients through thorough measures. are not treated in a dedicated screening and providing ■ Review and revise all nursing paediatric area, our non- interventions where documentation to ensure it is RSCN (Registered Sick necessary. Use the expertise standardised across the Trust. Children’s Nurse) nurses have of specialist nurses to train other nurses on the ward. the appropriate knowledge to Patient Experience care for them appropriately. ■ Protect our vulnerable ■ Continue to include a patient patients, whether they are ■ Develop safe and efficient story at each Trust Board adults or children, and, in care pathways with (public) meeting that helps a timely manner, raise any other members of the shape further improvement concerns to the relevant multidisciplinary team (MDT) actions and feedback to the authorities and/or investigate and colleagues in partner staff within the relevant ward as appropriate. This includes NHS organisations across the and/or clinical department. patients with dementia. local health economy. ■ Roll-out the national Friends ■ Always discuss side effects of ■ Implement Nursing and and Family Test (FFT) across medications with patients and Midwifery Quality Indicators all our hospital sites for

Annual Report and Accounts 2012/2013 87 capturing all inpatients and ■ Generate an improvement and redesign the way health patients that attend A&E cycle of nursing care services in the North East of departments. delivered, in the prevention of Greater Manchester are provided ■ Continue to develop ways falls, VTE, catheter-acquired by centralising the skills and we can support patients with urinary tract infections resources of our doctors and dementia and their carers and pressure ulcers, while nurses into fewer larger specialist through staff awareness and positively impacting on the centres. training, early diagnosis, experience of patients and Healthy Futures focused on interventions, and appropriate staff. redesigning a range of adult standards of care. To measure improvement we healthcare services, both primary Clinical Effectiveness will: and secondary care. Two major, ■ Use the Trust’s monthly emergency receiving hospitals ■ Reduce and eliminate clinical Safety Thermometer reports were created at The Royal variation in healthcare to show a decline in the Oldham and North Manchester procedures and services. number of hospital acquired General Hospitals, with high ■ Improve efficiency of service falls, pressure ulcers, catheter quality emergency and elective provision. associated urinary tract services available at Fairfield ■ Deliver the Advancing Quality infections and VTEs. General Hospital and Rochdale Programme and clinical Infirmary. ■ Use the Nursing and processes in relation to Midwifery Quality Indicators The Making it Better programme Heart Failure, AMI, Stroke, Dashboard to demonstrate involved significant investment Pneumonia and Hip and Knee continuous improvement. and changes to NHS services procedures. ■ Use incident reporting to for pregnant women, newborn This will require us to: demonstrate an overall babies and children and ■ Develop Nursing and reduction of incidents and young people across Greater Midwife Care Indicators that any associated harm. Manchester. Improvements in demonstrate the impact of ■ Monitor the number of community services to bring nursing interventions on complaints, concerns and routine care closer to home was patient outcomes. Patient Advice Liaison Service accompanied by the development of new, better staffed maternity, ■ Publish outcomes that fairly (PALS) queries, identifying the neonatal and children’s units at reflect the level of nursing themes and trends. North Manchester General and care provided. The Royal Oldham Hospitals. ■ Test the feasibility of using a 19 Service Overnight maternity care ceased range of nursing, experience Developments at Fairfield General Hospital and and safety indicators to During the year we have Rochdale Infirmary, but antenal demonstrate that nursing successfully completed and clinics remained on all hospital intervention drives quality opened a number of new sites. improvement and reduces specialist facilities across our harm. hospital sites as part of the last Both reconfiguration ■ Note the impact of safe stages of the Healthy Futures and programmes have been led by effective nursing care Making it Better programmes. our doctors and nurses. Our intervention and subsequent new facilities have included patient and staff experience These two programmes, both our new multi-million pound created, in order to build formally approved in 2007 by Cardiology Silver Heart Unit at momentum for change. the then Secretary of State for Fairfield General Hospital, our Health, set out to transform new Women and Children’s

Annual Report and Accounts 2012/2013 88 development at The Royal Our investment in new equipment increased from 45 to 111 whole Oldham Hospital, and our new and improved staffing will ensure time equivalent staff and a new Rheumatology and Eye Units at that treatment is delivered in a dedicated neonatal pharmacist Rochdale Infirmary. more modern and comfortable has also been recruited. These environment and will help ensure changes mean the unit is now Women & Children the best possible care for children, able to provide a much more Services babies and families across personal and specialised service In November 2012, we proudly Oldham, Rochdale and other for women at the time when opened our new £44 million parts of Greater Manchester. they and their baby need it most. purpose-built Women and Approximately 5,300 babies are The maternity units at The Royal Children’s development at The expected to be born per year Oldham and North Manchester Royal Oldham Hospital after at the new maternity unit. The sites have in the past year many years of careful planning. Royal Oldham Hospital is now developed Midwife led Birth The new facility involves a major one of three specialist regional centres alongside the existing new purpose-built four storey neonatal centres providing the Consultant led Labour wards. building, new antenatal wards, highest level of intensive care to Each Birth centre consists of 14 new labour delivery rooms all the smallest and most vulnerable 4 rooms and offer a relaxed, with ensuite, obstetric theatres, babies. The NICU consists of 37 home from home setting with a midwife-led birth centre, cots with 9 intensive care, 9 high care provided by highly trained postnatal rooms with 29 beds, a dependency and 19 special care midwives and high quality children’s unit and a brand new cots. obstetric services close by if Level 3 Neonatal Intensive Care they are required. The units are The number of medical and Unit (NICU). staffed by a small core team nursing staff on the unit has also

Annual Report and Accounts 2012/2013 89 of midwives and community new Birth centre opened on 3 The Opthalmology Service midwives, which enables December 2012 as part of the transferred from Birch Hill provision of an integrated and Trust’s new purpose-built women Hospital in January 2013, promotes continuity of care. and children’s development had marking the completion of the 66 births in its first month. Healthy Futures and the closure Prior to the birth centres of Birch Hill Hospital. opening, the choice of place of Recent surveys have birth was limited to home or demonstrated that the Our new Pennine Rheumatology hospital, with the vast majority experience is very positive for Centre opened in April 2012 of births taking place in the families and highly valued and offers specialist enhanced consultant led units. The Birth by women. Both units have outpatient and day case facilities. place Study published in 2010 received some of the highest The service is based on an demonstrated that for low risk ratings in Greater Manchester existing ward at the Infirmary. women, giving birth in a midwife and performed above the Patients with a number of led unit was as safe as giving national average in patient conditions such as rheumatoid birth in a consultant led Labour experience in the Post Making arthritis, psoriatic arthritis, lupus, ward and women are less likely it Better user survey, with many osteoarthritis and osteoporosis to have intervention, thereby women indicating that they will benefit from the new service. preserving birth as a normal would reuse the service and They will be able to receive process. Low risk women attend would want to give birth in a care from a multidisciplinary the Birth centre when in labour Birth centre next time where a team including a consultant, where they have the opportunity Birth centre was present. specialist nurse, physiotherapist, to use birthing pools, balls and occupational therapist and slings during the labour and Rochdale Infirmary podiatrist, all at one location and are also encouraged to remain The Trust has invested £1.8 in the shortest possible time. mobile and adopt alternative million to develop a brand new The centre will allow us to focus positions to encourage normal specialist Eye unit at Rochdale intensively on those patients birth. The new family are then Infirmary. The new Eye Unit who are experiencing a flare up encouraged to return home once includes two co-located theatres, in their condition. It will create the baby has fed and care is refurbished outpatient and a central hub of rheumatology continued with the community support accommodation and expertise and research which midwife. provides a comprehensive will not only benefit our own ophthalmology service for both Benefits to birth centres also patients, but which we hope planned and emergency eye extend to the woman’s family will allow us to transform the care. The day-case unit has three as well. Partners have found the way we provide rheumatology wards, two for adults plus a experience to be equally positive treatment for patients and dedicated children’s ward, where and the philosophy of the Birth become leaders in rheumatology a variety of surgical procedures centre promotes family bonding services across Greater can be carried out. and a positive family dynamic Manchester. with inclusion of fathers in the A lot of thought has gone into birth process. how patients will move around Cardiology Services the unit, which will enhance Our new specialist cardiology The birth centre at North patient flow and productivity service opened in August 2012 Manchester General Hospital, but, most importantly provide at Fairfield General Hospital after called Blue Bell centre, opened safe, high quality care to all receiving around £2 million of on 1st January 2012 with just patients who are to undergo an investment. The new service under 800 births in the first year. ophthalmology procedure. included two new state-of-the- The Royal Oldham Hospital’s

Annual Report and Accounts 2012/2013 90 Dr Foster’s analysis clearly reinforces the need for changes in specialist clinics continue to be With the larger space now the way some services provided at Rochdale infirmary available within nuclear are designed to ensure where patients can see either a medicine, dedicated areas within the highest standards consultant or nurse specialist. the department have been identified for specific procedures. of quality and safety Nuclear Medicine The myocardial perfusion including moving Last year we opened our newly imaging service (MPI) which towards centres of expanded Nuclear Medicine provides high quality cardiac excellence for high risk department at North Manchester imaging to help in the initial procedures and the use General Hospital after a diagnosis of coronary artery £600,000 investment (plus disease, now has separate stress of hospital networks. building costs) by the Trust. The and recovery areas away from Department of Health department has benefited from the general areas which allow purpose-built accommodation, the general work to continue art Cardiac Catheterisation Labs which provides more room for without any restrictions. equipment and larger areas for located in a dedicated unit at the Patients can also now wait in patients to be examined in. hospital and refurbishment of comfort between their injection existing wards. Nuclear medicine is a form and scan time in a dedicated The Silver Heart Unit at Fairfield of diagnostic imaging which waiting room, and not to be left now provides a range of complex involves the injection of a slightly out, children are benefiting from diagnostic and enhanced radioactive tracer into the body their own paediatric waiting specialist interventional to show various systems within room. The department performs cardiology procedures for the body. The tests look at the around 120 scans per week patients. The unit is supported function of the body organs for both our inpatients and by a new 28 bed Integrated and can scan the lungs, kidneys, outpatients. Cardiology Unit which comprises bones, parathyroid and thyroid Breast Service two cardiology wards for acutely glands to look for infection, ill and high dependency patients, cancer and lymph nodes. The Last year our Breast Service and the general cardiology results then help the patient’s scooped a national NHS award ward for inpatient and day-case consultant to plan their various for improving breast cancer patients. forms of treatment. services for patients. Awarded as part of the NHS Improvement’s Our patients now benefit from The Silver Heart Unit transferred agenda on delivering major a brand new gamma camera from Rochdale Infirmary to breast surgery as a day case or installed in the department, Fairfield as part of the redesign one night stay, hospitals within plus an upgrade to our existing and improvements to cardiology cancer clinical networks were machine. The camera detects and Stroke services across the asked to demonstrate how their the radioactivity from an injection North East part of Greater team had made improvements given to the patient and forms Manchester. Rochdale Infirmary to breast cancer services in their an image so that we can find out continues to have a consultant area. cardiologist present on the site what is wrong with them. The Monday to Friday and provides new equipment now allows us The Trust has implemented a a full range of outpatient to provide quicker and improved new way of working whereby cardiology services. scans which has increased our patients have a reduced length throughput of patients and is of stay in hospital. Anyone The majority of cardiology helping to keep our waiting lists needing breast surgery can outpatient services including down to a minimum. attend outpatient clinics at North diagnostic and follow-up and

Annual Report and Accounts 2012/2013 91 Manchester General and The and integrated experience. By rate for 2012/13 (12.31%) is less Royal Oldham Hospitals, but sharing resources and expertise, than the average for last year undergo their surgery at North it is hoped that this integration 2011/12 (12.73%). Every month Manchester. will help make better use of this year with the exception of financial resources and improve July 2012 was below last year’s Patient acceptability, safety the overall patient experience average. and satisfaction were identified by speeding up the discharge as the key factors in planning and readmissions process and “This is a marvellous the change in the Service. We ultimately by aiding the patient’s example of how partner used to have an average post recovery and rehabilitation, surgery inpatient length of stay agencies can come whether at home or in the of 4.2 days. However, with a together to overcome community. total change of pathway for any barriers for those breast surgery patients, the total The service has introduced better members of our length of stay is now two days ways of tracking and monitoring community with the for mastectomy and 0.6 days for patients, from the time they breast conservation patients. are admitted, right through to most complex health discharge and follow on care. and social care needs.” Patients are initially seen by This new way of working is our breast care nurses who will John Saxby, already starting to demonstrate assess their suitability to go on Trust Chief Executive good results. Figures show that the new 23 hour pathway. Most since the unit was formed, the patients are very happy to be number of patients staying 20 Advice, Liaison treated as a day case or go home over 15 days in hospital has and Complaints after one overnight stay as they been reduced by 46%, with want to get back to their normal The NHS Complaints system is a a reduction of over 83% for life. powerful and useful mechanism patients staying over 100 days. for improving the quality of Integrated Health and Following the co-location of care and the patient experience, Social Care health and social care teams the both for individual complainants In January 2013 the Trust and length of stay (LOS) for patients and for the wider NHS, thus Manchester City Council opened at North Manchester General creating a culture of learning a new, integrated health and Hospital has seen an impressive from mistakes and putting things social care discharge unit at decrease: right. North Manchester General April 2011- November 2012 Complaints about the NHS are a Hospital. The new unit brings valuable way of identifying issues ■ 46.39% reduction in together teams from the Trust, in the service where change is 15 days LOS Manchester, Bury and Rochdale needed. Acknowledging these Councils, North Manchester ■ 51.92% reduction in issues and taking steps to rectify Clinical Commissioning Group 30 days LOS any problems identified is vital (CCG) and voluntary sector to ■ 69.57% reduction in to create an open and honest form a new, integrated team. 60 days LOS NHS. Complaints are welcomed The service aims to provide ■ 83.33% reduction in with a positive attitude by the better support and care for 100 days LOS Trust Board and are valued as patients with long term or feedback on service performance Together with the reduction in complex care needs by providing in the search for improvement. length of stay the readmission a more streamlined, seamless rate as not increased the overall The Trust has adopted the

Annual Report and Accounts 2012/2013 92 principles of good complaints Parliamentary and Health Service Board is to receive assurance handling set out by the Ombudsman and the number of that necessary action has been Parliamentary and Health complaints the Ombudsman has taken, not only on an individual Services Ombudsman, which also investigated. complaint but across the Trust, address the principles for remedy. where themes have been The Trust Board acknowledges These principles are reflected in identified. the importance of hearing the Trust’s complaints handling the patients’ stories directly During 2012/13, 819 formal policy are:- through the quoted extracts complaints have been received. ■ Getting it right and the lessons learned and The Complaints Department ■ Being customer focused actions taken. Improving the report monthly on response ■ Being open and accountable links between wards and the performance within 25 working ■ Acting fairly and Board was one of the key days or within the agreed proportionately recommendations in the Mid- timescale – the cumulative total Staffordshire NHS Foundation being 88%. The Patient Advice ■ Putting things right Trust Report. The Board and Liaison Service (PALS) dealt ■ Seeking continuous recognises that not every with 1911 enquiries in the year improvement perception held by a patient, to date. Reducing complaints and or every complaint made, Complainants have the right improving the patients’ will necessarily be upheld. to take their complaint to the experience is the aim of all Trust Nevertheless it remains important Ombudsman if they remain staff. Patients, their relatives to understand how patients or dissatisfied with the Trust’s and carers are encouraged to their relatives have seen matters response. During the year 29 communicate any concerns to even though Trust staff may Complainants referred their staff in a supported environment have viewed the same situation complaint to the Ombudsman with the aim of providing prompt differently. and the Ombudsman decided and clear explanations of the Without effective arrangements to investigate two of these treatment given. to ensure lessons are learned complaints. Ensuring that the Trust Board following complaints and The Trust complies with the receives comments directly from incidents, there is a risk that Treasury’s Managing Public patients and their relatives/carers quality and service improvements Money guidance in setting about their NHS experiences and may not be identified and charges for information, for their perceptions of the quality of implemented and that the cause example Freedom of Information service provided has continued of the complaint may not be (FOI) requests and access to to be one of the main areas of rectified, resulting in further health records requests. focus. complaints.

Key phrases taken verbatim from The Trust PALS/Complaints complaints received are grouped Department ensures that into themes and associated individual concerns or complaints sub-themes and included in are addressed effectively and quarterly reports to the Trust lessons learned and individual Board. Each quarter one theme actions are taken by suitable is analysed and presented staff and are implemented and alongside statistical information discussed at ward meetings. detailing the complaints upheld, Lessons learned are detailed in lessons learned and actions the quarterly report to the Trust taken, complaints referred to the Board. The main issue for the

Annual Report and Accounts 2012/2013 93 improvements in that area during as it will be fundamental to Annexe the first six months of 2013/14. understanding and enhancing The report also acknowledges the experience of and outcomes 21 What others say the changes that need to be for the patients on whose behalf about the Trust made and sustained to ensure we commission care. that the centrality of the quality 21.1 NHS and safety of the care provided 21.2 NHS East Oldham Clinical is further embedded into the culture of the organization. Lancashire Clinical Commissioning The CCGs will be actively Commissioning Group monitoring the progress of the Group Trust in delivering these changes, The NE Sector Clinical We would like to thank you for using a variety of assurance Commissioning Groups (CCGs) forwarding a draft copy of the methodologies. (Bury, Oldham, Heywood Pennine Acute Hospitals NHS Middleton and Rochdale and The Quality Account also Trust Quality Account 2012- North Manchester) welcome the articulates the Trust’s 2013 in accordance with the publication of the Pennine Acute commitment to safeguarding requirements of the Health Act Hospitals NHS Trust Quality the most vulnerable patients 2009 and the National Health Account. The Account provides accessing their services, and Service (Quality Accounts) a comprehensive review of the there are also specific areas for Regulations 2010. We are approach that the Trust takes development for the Trust in pleased to provide the response to maintaining and improving terms of people with protected from East Lancashire CCG as co- the quality and safety of the characteristics and other groups, commissioner with regard to this services that it is commissioned for instance carers, and the document. to provide. enhancement of relationships We recognise the amount of with external stakeholders to The NE Sector CCGs work work involved in producing the support this work that the CCGs closely with Pennine Acute Quality Account and anticipate will expect progress with during Hospital Trust, meeting formally that the following provides 2013/14. on a monthly basis, but also concise and comprehensive undertaking walkarounds and It is the belief of the quality feedback including assessment of supporting the high level review leadership within the CCGs that the accuracy of the report. of serious untoward incidents, Pennine Acute Hospitals Trust to assure the quality of services should be commended for the Quality Account 2012- provided and understand improvements made in the way 2013 Statement collectively the opportunities for that the investigate and learn East Lancashire CCG welcomes change and improvement. from serious untoward incidents. the opportunity to appraise the The Quality Account correctly The transparency that they content of the Quality Account identifies key areas that the operate with in terms of the for 2012-2013 and are pleased Trust needs to focus on in outcomes of investigations with to acknowledge that there is a order to improve the quality of the CCGs leads is exemplary. clear focus on the key quality services that it provides, indeed The develop of a Lessons Learnt elements and Pennine Acute the quality and timeliness of Framework during 2013/14 to Hospitals NHS Trust has clearly discharge communication from further support the identification referenced its organisational the organization is a continued of change and improvement objectives, focusing on the three cause of concern for the opportunities from a range key dimensions of quality as CCGs, and we expect major of information sources about outlined within ‘High Quality quality and safety is welcomed Care For All’ (DH, 2008):

Annual Report and Accounts 2012/2013 94 ■ To improve clinical good practice in this area and easily understood by patients effectiveness and safety consideration should be given and the public and in addition ■ To reduce mortality to the length, content and the inclusion of a patient story is complexity of Pennine Acute noted as exemplar and is to be ■ To reduce harm Hospitals NHS Trust’s Quality applauded. ■ To improve the patient Account given the target experience HCAI audience. According to national figures, The Quality Account is well- Pennine Acute Hospitals NHS presented and reflects the new Quality Initiatives to be Trusts are among the top requirements to benchmark progressed 2013/14 performing NHS Trusts across the against peers. As such it has East Lancashire CCG is pleased country and whilst C difficile has received a positive response to note that mortality reduction also reduced and the incidence from East Lancashire CCG. In is a priority for 2013/14 and look is 86 against a target of no more addition the CCG commends forward to receiving compliance than 100 both commissioners Pennine Acute Hospitals data with a target of below 99 in and provider agree that there NHS Trust for identifying its the next iteration of the Quality needs to be continued focus on priority areas where there are Account. We are unable to reduction. significant variations from the comment fully on current HSMR top performers in the NHS. This and SCHMI data as this has not Clinical Audit is challenging and will require yet been included and signed off Pennine Acute Hospitals NHS long term commitment to by the Chief Executive for your Trust continues to participate improvement goals and as such Quality Account. in 100% of National Clinical we would like to commend Audits and 100% of National Pennine Acute Hospitals NHS Review of Quality Confidential Enquiries and Trust’s approach to developing a Performance achieved this is a clear indication of an Long Term Quality Plan covering Patient Safety organisation with a commitment the next five years. Of significant note and to delivery of evidence based commendation is Pennine and safe care. However, However, East Lancashire CCG Acute Hospitals NHS Trust’s it is unclear if any clinical note that that many of the commitment to participation audits have been developed quality initiatives identified in the Patient Safety Walk collaboratively between by Pennine Acute Hospitals rounds. However, it is not clear provider and commissioner NHS Trust are subject to local, if these include a commissioner and East Lancashire CCG regional and national CQUIN representative and if not, would encourage the lead targets or referenced in the East Lancashire CCG would commissioner to include this quality schedule and East encourage both provider and recommendation in the Quality Lancashire CCG would welcome lead commissioner to explore this Account for 2013/14. the identification of additional as an option. quality initiatives. In addition Information Governance as patients and the public are Pressure ulcers East Lancashire CCG notes the primary audience for the East Lancashire CCG note that Pennine Acute Hospitals published Quality Accounts we the use of simple graphs to NHS Trust has scored green would welcome the inclusion evidence a sustained reduction against the requirements of of visual representation against in pressure ulcers from 2011/12 the Information Governance performance and would to 2012/13 and also the severity Toolkit but would find it helpful recommend review of East when they occur. The graphs to know if any serious breaches Lancashire Hospitals Quality are uncomplicated and it is in data security have been Account as an example of anticipated that these would be recorded in order for the Trust

Annual Report and Accounts 2012/2013 95 to provide further assurance to It is reassuring to note that the Rossendale locality thanks you the CCG and the public that recommendations of the Francis for the opportunity to make the that data held is stored, used Report are seen as an important above comments. and transferred securely and area of discussion throughout East Lancashire CCG trusts that confidentially. the Trust and in particular at you will find our observations in board level. Furthermore that the Clinical Coding Error Rate relation to your Quality Account Francis report recommendations East Lancashire CCG is unable to for 2012/13 pertinent and of have been considered and comment as the error rate is yet value and we confirm the data integrated into the Pennine to be included. underpinning the measures Acute long terms planning of performance and quality Staff survey process. reported in the Quality Report East Lancashire CCG notes the The quality aspiration and are robust and reliable. staff survey score is in the worst priorities for improvement are 20% and are pleased to see a We look forward to continuing clearly stated and represent the number of initiatives planned to work closely with Pennine aspects of healthcare that we by Pennine Acute Hospitals NHS Acute Hospitals Trust in the would expect a service provider Trust and look forward to an coming year and to seeing like Pennine Acute to be tackling. increase in the staff survey score the improvements to the There also seems to be a good for 2013/14. quality of services provided as recognition and focus on patient outlined in this year’s Trust’s consultation. East Lancashire Clinical Quality Account. We trust Commissioning Group, However there were a number of East Lancashire Hospitals NHS Rossendale locality areas listed below that we would Trust will continue to strive for commentary:- have liked to have seen but did excellence to successfully deliver As a new Commissioner, we not appear in the document,- the priorities identified for the strive to ensure that the services ■ A target for sending OP forthcoming year. We are happy provided for our population letters to GPs (discharge to discuss any of the above in are of the highest quality and letters are covered, but OP more detail if required. we recognise the developing letters are often important systems and processes as well and can take weeks to be 21.3 Health as improvements that Pennine typed and sent) Acute have made to drive up the Overview ■ Numbers of patients sent quality of services it provides. to A&E rather than a ward, & Scrutiny It has been useful for the Trust resulting from a GP request to Committee to clarify the services currently admit when there are no beds Joint Health Overview and provided by Pennine Acute as (often seems to happen with Scrutiny Committee (JHOSC) the Rossendale GP’s have been FGH medical admissions) commentary on the Pennine aware of a number of changes ■ Numbers of OP appointments Acute NHS Trust Quality Account and tried to keep informed. especially follow-ups 2012/13 There has been an overall activity rearranged by the Trust The Joint Health Overview shift between the Pennine ■ A statement regarding and Scrutiny Committee was Acute Trust and East Lancashire whistleblowing policies and established as a result of the Hospitals Trust that is partially gagging clauses Health and Social Care Act attributable to a lack of clarity 2001. This Act made Local around current services. East Lancashire Clinical Commissioning Group, Authorities with health and social

Annual Report and Accounts 2012/2013 96 care responsibility, responsible that much more improvement Review of Quality for reviewing and scrutinising is needed to reach the national Performance health services in their local area. contract standard. The JHOSC is pleased to see Consequently, it was decided the improvements in hospital Priorities for that a Joint Health Overview mortality rates but recognises Improvement in 2013/14 and Scrutiny Committee would that this is a very complex be established to scrutinise the The JHOSC has noted the Trust’s area. Whilst accepting and work of the Pennine Acute NHS priorities for improvement in appreciating the need for correct Trust. The JHOSC was established 2013/14. During 2012/13 coding and recording, the JHOSC jointly by Bury, Manchester, the JHOSC has scrutinised the would wish to see a greater Oldham and Rochdale councils partnership working in Oldham, emphasis on reducing mortality to consider issues affecting the aimed at reducing readmissions, rates by providing the best care health of local people and to and will be monitoring this possible. call the Pennine Acute NHS Trust area for improvement during into account on behalf of the 2013/14. The success of the focus on local communities. The JHOSC avoiding patient falls, linked to The Listening into Action staff comprises of 3 elected members dementia awareness raising, engagement programme is also from each of the constituent is welcomed by the JHOSC. an ongoing area of scrutiny by authorities. In particular, the provision of the JHOSC and the Committee suitable solid sole footwear for The JHOSC has met on seven is pleased that the Trust has patients is a simple but effective occasions during 2012/13 recognised that there is work measure which the JHOSC hopes to scrutinise the work of the to do to create a culture where will continue. Pennine Acute NHS Hospitals staff feel more involved, valued Trust. Further information and supported and is addressing A & E 4 hour Emergency about the JHOSC can be found issues around staff morale within Access Standard at http://www.bury.gov.uk/ the Trust. Whilst acknowledging that index.aspx?articleid=5278. The many people who turn up to Patient Safety following comments, on the A & E with minor illnesses and Quality Account, reflect the work Following concerns raised by complaints could be seen and that has been undertaken by the a Member of the Committee treated elsewhere, the JHOSC JHOSC during 2012/13. and the findings of the CQC, feels that, until other services, the JHOSC is pleased to see the such as GP appointments, Quality and Performance Trust’s focus on nutrition and are readily available, people Standards hydration of patients as a priority will continue to attend A & E The JHOSC is pleased to for patient safety. departments. The work that commend the partnership has been done in Bury, to Patient Experience working to improve patient promote the right choice to pathways and the outcomes of The JHOSC has been impressed people, has had some success. patients. The JHOSC sees this as with the Trust’s initiative to Partnership working in the a vital way forward in improving improve the care of patients other areas covered by the Trust the quality of care and the suffering from dementia and could learn from the work that patient experience. is pleased to learn that it will has been done in Bury. The be continuing. The JHOSC Whilst the JHOSC commends the JHOSC has been pleased to see hopes that this initiative will focus on discharge letters being the investment in the A & E be sustainable in terms of the sent to a patient’s GP in a timely departments at both the Royal investment and staff time that it manner, it agrees with the Trust Oldham Hospital and Fairfield will require. General Hospital.

Annual Report and Accounts 2012/2013 97 Referral to Treatment (18 patient appointments and hopes looks to both the Trust and weeks) that this request will be included the commissioners to establish The JHOSC is currently in its work to reduce the number whether transport problems are monitoring waiting lists as part of patients not attending out contributing to this. of its scrutiny programme. The patients appointments. Conclusion Committee has been pleased Stroke Services to see the action taken by the The JHOSC has worked closely Trust to reduce waiting times to The JHOSC is pleased to with the Pennine Acute NHS within the 18 week standard. It commend the continuing Hospitals Trust over the last will continue to monitor waiting improvement to and focus on year and has found a greater lists as the new commissioning stroke services within the Trust. involvement with clinical staff arrangements come into place to be beneficial. The Committee Dignity Champions and as further cost savings are hopes to work more closely with required within the NHS. The JHOSC has followed the the Trust Board to develop an progress on the introduction of open, honest and transparent Clinical Efficiency dignity champions within the relationship over the next, The JHOSC will be interested Trust and has been pleased to challenging year, enabling the to see the outcomes of the see over 700 members of staff JHOSC to undertake its role as Readmissions Improvement across the Trust supporting a ‘critical friend’ to the Trust Group, having undertaken some privacy and dignity in all wards and for the Trust to have a scrutiny of readmissions to the and departments. ‘sounding board’ for its plans Royal Oldham Hospital, during and proposals. Dementia the last year. 20th May 2013. Given the number of patients The JHOSC was interested suffering from dementia and the Changes made to the Quality to learn that the Trust was expected increase in sufferers in Account Report after receipt of underperforming on the number the future, the JHOSC welcomes statements. of patients not attending out the Trust’s approach to raising patient appointments, without awareness with staff, training Following and on account of cancelling or rearranging the staff to support patients with feedback received the Trust has appointment. This has been an dementia and the recruitment of made changes to the format area of concern for the JHOSC Dementia Champions. and presentation of some data in areas where the location contained within the report. of services has moved. The Cardiology Services We will continue to review and JHOSC has been concerned that The JHOSC visited the new Silver make any further changes we transport issues affect patients’ Heart Unit at Fairfield General can in order to further improve attendance, especially where Hospital and was extremely our future reports. The Trust services have moved further impressed by the facilities there. is producing a film for access away and patients have further However, it has expressed its by the public and external to travel. The JHOSC has asked concerns about the number stakeholders about our Quality the Trust to monitor patients’ of patients not attending out Account report 2012/13. reasons for not attending out patient appointments and

Annual Report and Accounts 2012/2013 98 Statement of directors’ responsibilities In respect of the Quality Account The directors are required under the Health Act 2009 to prepare a Quality Account for each financial year. The Department of Health has issued guidance on the form and content of annual Quality Accounts (which incorporates the legal requirements in the Health Act 2009 and the National Health Service (Quality Accounts) Regulations 2010 (as amended by the National Health Service (Quality Accounts) Amendment Regulations 2011).

In preparing the Quality Account, directors are required to take steps to satisfy themselves that:

■ the Quality Accounts presents a balanced picture of the trust’s performance over the period covered;

■ the performance information reported in the Quality Account is reliable and accurate;

■ there are proper internal controls over the collection and reporting of the measures of performance included in the Quality Account, and these controls are subject to review to confirm that they are working effectively in practice;

■ the data underpinning the measures of performance reported in the Quality Account is robust and reliable, conforms to specified data quality standards and prescribed definitions, and is subject to appropriate scrutiny and review; and

■ the Quality Account has been prepared in accordance with Department of Health guidance.

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

By order of the Board

Annual Report and Accounts 2012/2013 99 Independent Auditors’ Limited Assurance Report to the Directors of Pennine Acute Hospitals NHS Trust on the Annual Quality Account We are required by the Audit Respective ■ the Quality Account has Commission to perform responsibilities of been prepared in accordance an independent assurance Directors and auditors with Department of Health engagement in respect of The Directors are required under guidance. Pennine Acute Hospitals NHS the Health Act 2009 to prepare The Directors are required to Trust’s Quality Account for the a Quality Account for each confirm compliance with these year ended 31 March 2013 financial year. The Department requirements in a statement of (“the Quality Account”) and of Health has issued guidance directors’ responsibilities within certain performance indicators on the form and content the contained therein as part of of annual Quality Accounts our work under section 5(1)(e) (which incorporates the legal Quality Account. of the Audit Commission Act requirements in the Health Act Our responsibility is to form a 1998 (“the Act”). NHS trusts 2009 and the Regulations). conclusion, based on limited are required by section 8 of assurance procedures, on the Health Act 2009 to publish In preparing the Quality Account, whether anything has come to a quality account which must the Directors are required to take our attention that causes us to include prescribed information steps to satisfy themselves that: believe that: set out in The National Health ■ the Quality Account presents Service (Quality Account) a balanced picture of the ■ the Quality Account is not Regulations 2010, the National trust’s performance over the prepared in all material Health Service (Quality Account) period covered; respects in line with the criteria set out in the Amendment Regulations 2011 ■ the performance information Regulations; and the National Health Service reported in the Quality (Quality Account) Amendment Account is reliable and ■ the Quality Account is not Regulations 2012 (“the accurate; consistent in all material Regulations”). respects with the sources ■ there are proper internal specified in the NHS Quality controls over the collection Scope and subject matter Accounts Auditor Guidance and reporting of the The indicators for the year 2012/13 issued by the Audit measures of performance ended 31 March 2013 subject to Commission on 25 March included in the Quality limited assurance consist of the 2013 (“the Guidance”); and Account, and these controls following indicators: are subject to review to ■ the indicators in the Quality ■ Percentage of patient safety confirm that they are working Account identified as having incidents that resulted in effectively in practice; been the subject of limited severe harm or death; and assurance in the Quality ■ the data underpinning the Account are not reasonably ■ Emergency readmissions measures of performance stated in all material respects within 28 days of discharge reported in the Quality in accordance with the from hospital. Account is robust and Regulations and the six reliable, conforms to specified We refer to these two indicators dimensions of data quality set data quality standards and collectively as “the indicators”. out in the Guidance. prescribed definitions, and is subject to appropriate We read the Quality Account and scrutiny and review; and conclude whether it is consistent

Annual Report and Accounts 2012/2013 100 with the requirements of the ■ the annual governance expressly agreed and with our Regulations and to consider the statement dated May 2013; prior consent in writing. implications for our report if we ■ Care Quality Commission become aware of any material quality and risk profiles dated Assurance work omissions. 31 May 2013; and performed We conducted this limited We read the other information ■ the results of the Payment by assurance engagement under the contained in the Quality Account Results coding review. terms of the Audit Commission and consider whether it is We consider the implications for Act 1998 and in accordance materially inconsistent with: our report if we become aware with the Guidance. Our limited ■ Board minutes for the period of any apparent misstatements assurance procedures included: April 2012 to May 2013; or material inconsistencies with ■ evaluating the design and ■ papers relating to the Quality these documents (collectively implementation of the key Account reported to the the “documents”). Our processes and controls for Board over the period April responsibilities do not extend to managing and reporting the 2012 to May 2013; any other information. indicators; ■ feedback from the This report, including the ■ making enquiries of Commissioners dated May conclusion, is made solely to the management; 2013 Board of Directors of Pennine ■ testing key management ■ feedback from Local Acute Hospitals NHS Trust in controls; Healthwatch was requested accordance with Part II of the ■ limited testing, on a selective but all organisations were not Audit Commission Act 1998 basis, of the data used to currently in am position to and for no other purpose, as calculate the indicator back to comment due to the timing set out in paragraph 45 of the supporting documentation; of their transition from LINks. Statement of Responsibilities ■ comparing the content ■ the trust’s complaints report of Auditors and Audited of the Quality Account to published under regulation Bodies published by the Audit the requirements of the of the Local Authority, Social Commission in March 2010. Regulations; and Services and Complaints We permit the disclosure of ■ reading the documents. (England) Regulations 2009, this report to enable the Board dated May 2013; of Directors to demonstrate A limited assurance engagement ■ feedback from Health that they have discharged their is narrower in scope than Overview and Scrutiny governance responsibilities by a reasonable assurance Committee dated May 2013; commissioning an independent engagement. The nature, timing assurance report in connection ■ the latest national patient and extent of procedures for with the indicators. To the survey dated 2012; gathering sufficient appropriate fullest extent permissible by law, evidence are deliberately limited ■ the latest national staff survey we do not accept or assume relative to a reasonable assurance dated 2012; responsibility to anyone other engagement. ■ the Head of Internal Audit’s than the Board of Directors as annual opinion over the a body Pennine Acute Hospitals Limitations trust’s control environment NHS Trust for our work or this Non-financial performance dated May 2013; report save where terms are information is subject to more

Annual Report and Accounts 2012/2013 101 inherent limitations than In addition the scope of our to limited assurance have financial information, given the assurance work has not included not been reasonably stated characteristics of the subject governance over quality or non in all material respects matter and the methods used for mandated indicators which have in accordance with the determining such information. cooperative. All rights reserved. Regulations and the six This document is confidential dimensions of data quality set The absence of a significant body and its circulation and use are out in the Guidance. of established practice on which restricted. The KPMG name, logo to draw allows for the selection and ‘cutting through complexity’ of different but acceptable are registered trademarks of measurement techniques which KPMG International Cooperative can result in materially different (KPMG International) addition, KPMG LLP measurements and can impact non-been determined locally by Manchester comparability. The precision Pennine Acute Hospitals NHS 4 June 2013 of different measurement Trust. techniques may also vary. Furthermore, the nature and Conclusion methods used to determine Based on the results of our such information, as well as the procedures, nothing has come to measurement criteria and the our attention that causes us to precision thereof, may change believe that, for the year ended over time. It is important to 31 March 2013: read the Quality Account in the ■ the Quality Account is not context of the criteria set out in prepared in all material the Regulations. respects in line with the The nature, form and content criteria set out in the required of Quality Accounts are Regulations; determined by the Department ■ the Quality Account is not of Health. This may result in the consistent in all material omission of information relevant respects with the sources to other users, for example specified in the Guidance; for the purpose of comparing and the results of different NHS ■ the indicators in the organisations. Quality Account subject

Annual Report and Accounts 2012/2013 102 Personal data

The Trust regards information During 2012/13, the following Summary of serious untoward security as a very high priority incidents were reported which incidents involving personal data and has a series of safeguards involved the loss of potentially- as reported to the Information in place. identifiable personal data. Commissioner in April 2012 - March 2013

Number of people Date of Nature of potentially incident incident Nature of Data involved affected Notification steps

September Confidentiality Member of staff reported that 1 ICO informed. 2012 breach manager had breached their confidentiality.

October Subject Access A late response was made to a 1 ICO informed. 2012 Request Subject Access Request.

October Subject Access Failure to follow Trust procedure 1 ICO informed. 2012 Request in response to a Subject Access Request.

February Subject Access A late response was made to a 1 ICO informed. 2013 Request Subject Access Request.

March 2013 Data Loss The Pennine Acute NHS Hospitals 16 ICO informed medical paediatric handover sheet and reported via was found in the street by a member StEIS to the NHS of the public in Liverpool. It is highly Strategic Executive unlikely patients could be identified Information System from the limited information on the (formerly Strategic page. Health Authority).

Annual Report and Accounts 2012/2013 103 Sustainability

The Trust is committed Actions to date to implement Other initiatives, including energy to supporting the carbon the Carbon Reduction and carbon saving advice on the reduction and sustainable Strategy are: Trust’s intranet, have resulted development agenda of ■ The Trust Board approved in some positive feedback the NHS and in reducing the Sustainable Development from staff. By improving the the Trust’s carbon footprint. Strategy and Management awareness of staff on sustainable John Wilkes, Director of Plan in 2010. issues, we aim to encourage their Facilities, is the Board lead support with energy and carbon ■ The Trust Board approved for sustainability. This role reduction measures. purchase 100% of its at Board level ensures that electricity from renewable There are now 30 initiatives sustainability issues have sources in August 2011. programmed for delivery with visibility and ownership ■ A carbon footprint report identified annual savings of 1459 at the highest level of the was submitted in March tonnes of carbon. Additional organisation. 2011 to comply with the initiatives are being prepared for The current target of the Carbon requirements of the Carbon the April 2013 – March 2014 Reduction Strategy is to achieve Reduction Commitment and financial year that would, if a 10% reduction from the 2007 Energy Efficiency Scheme approved for delivery, provide carbon footprint of the NHS by operated by the Environment an additional reduction of 5000 2015. Significant progress has Agency on behalf of the UK tonnes per year from 2014 already been made in realising Government. onwards. these objectives. ■ The scheme to install a gas The completion of our new main at the Fairfield General The Trust is registered as a Women and Children’s facilities Hospital site as enabling work participant in the Government’s at The Royal Oldham Hospital, prior to replacing the energy Carbon Reduction Commitment which opened to patients in plant with lower carbon scheme. During 2011, the December 2012, has increased emitting equipment is nearing Trust established a baseline fuel the size of the Trust’s estate. To completion. consumption against which any maintain the drive to reduce future targets can be measured. The Sustainable Development our energy and carbon activity, Management Plan shows that the Trust needs to offset The Trust continues to use the of the 71 carbon reduction these additions by pursuing good corporate citizenship initiatives identified, 44 have corresponding reductions by toolkit for reviewing our carbon been completed. These are decommissioning underutilised footprint and sustainability. programmed to deliver a buildings wherever possible. This This toolkit enables the Trust to minimum saving of 1790 tonnes has already taken place with the evaluate its progress in improving of carbon in each full year. closure and sale of the Birch Hill its sustainability and informing Clock Tower site. stakeholders.

Annual Report and Accounts 2012/2013 104 Energy Costs Total Energy costs The NHS aims to reduce its 8 carbon footprint by 10% 7 between 2009 and 2015.Year 2008-09 2009-10 2010-11 2011-12 2012-13 6 Reducing the amountElec 35048 34468 35460 35851 35400 of energy used in ourSteam 12254 5 11561 13204 13751 14897 organisation contributesCoal 15938 4 15737 18435 14514 15538 Gas 72925 67156 66138 61139 66184 to this goal. There is also a 3

Oil 14 Cost - £m 78 77 421 1036 financial benefit which comes 2 from reducing our energy 1 bill. Our energy costs have 0 increased by 11% in 2012/13 2007/8 2008/9 2009/10 2010/11 2011/12 2012/13 – the equivalent of 98 hip operations. Energy usage Energy 150000 Year 2008-09 2009-10 2010-11 2011-12 2012-13 125000 ConsumptionElec 18,386 18,082 18,602 18,807 18,571 Our total energy consumptionSteam 0 0 0 0 0 100000 Oil has risen during the yearCoal from 5,299 5,233 6,130 4,826 5,166 Gas 125,676 to 133,055 MWh.Gas 13,389 12,33075000 12,143 11,225 12,151 Coal due to the increase inOil Estate 4 22 21 117 289 Steam 50000 Elec size by the Women & Children unit and the increased heating 25000 Energy used in MW/h requirement created by the 0 cold temperatures during 2008-09 2009-10 2010-11 2011-12 2012-13 2012/13. Our relative energy consumption has changed Carbon emissions during the year from 0.47 to 40,000 0.496 MWh/square metre.

30,000 Carbon Emissions Oil We have put plans in place to Gas 20,000 Coal reduce carbon emissions and Steam improve our environmental Elec 10,000 sustainability. Over the next

two years we expect to save Carbon Emissions - tonnes 0 £200,000 as a result of these 2008-09 2009-10 2010-11 2011-12 2012-13 measures. The higer cost of energy, consumption and emissions in 2012/13 are due to the following:- Our measure carbon gas 1) 11% inrease in energy prices from suppliers 2) A 24% increase in the number of Degree Days over and above the 2011/12 figure emissions have increased by (This is a measure of the coldness of the weather for the year) 1201 tonnes this year. An 3) The increase in estate size brought about by the opening of the new woman & children unit at The Royal Oldham Hospital

Annual Report and Accounts 2012/2013 105 2008-09 2009-10 2010-11 2011-12 2012-13 Region 1 436000 465000 464500 438500 498525

private sector organisations. Water usage Our expenditure on Carbon allowances to comply with the scheme for 2012/13 will be 500000 lower due to recent changes in the scheme that have yet to be 450000 confirmed by the Environment 2010-11 2011-12 2012-13 Agency. Clinical Waste £ 618210 542040 537901 400000 Other Waste £ 24253 20538 21242 Renewable Energy Confidential Waste £ 24594 23725 17315 Renewable energy purchased Domestic Waste £ 158420350000 124252 135371 from our electricity provider represents 25% of our total

Water usage - Cubic meters Water 300000 energy use. In addition, we 2008-09 2009-10 2010-11 2011-12 2012-13 generate 4.7% of our electricity on site.

Waste cost by type Water Consumption 1000000 Our water consumption has increased by 60,025 cubic metres 800000 in the last financial year. In

600000 2012/13 we spent £1,424,830 on water. 400000

Waste cost - £ Waste Waste 200000 Our expenditure on waste in the

0 last three years was incurred as 2010-11 2011-12 2012-13 shown in the chart left.

Clinical Waste £ Other Waste £ Confidential Waste £ Domestic Waste £ Waste Recovery & Recycling We recover or recycle 2943 increase of 3.4% (taking into account the increased estate size and tonnes of waste, which is 80% Degree Days this represents a reduction in like for like emissions). of the total we produce. We do not currently collect data on our annual Scope 3 emissions which cover indirect emissions from non energy activity such as the Sustainable purchasing of goods and services. Development Energy Efficiency Schemes Management Plan During 2011/12 our gross expenditure on the CRC Energy Efficiency The Trust has an up to date Scheme was £363,436. This is a mandatory scheme aimed at Sustainable Development improving energy efficiency and cutting emissions in large public and Management Plan. This enables

Annual Report and Accounts 2012/2013 106 us to ensure that as an NHS is therefore appropriate that we set out within our policies on organisation we are fully consider it when planning how sustainable procurement. We committed to conducting all we will best serve patients in the have started work on calculating aspects of our activities with due future. the carbon emissions associated consideration to sustainability, with the goods and services we Sustainability issues are included whilst providing high quality procure. in our analysis of risk facing the patient care. The NHS Carbon Trust. NHS organisations have We also have a Sustainable Reduction Strategy asks for the a statutory duty to assess the Transport Plan. The NHS boards of all NHS organisations risks posed by climate change. places a substantial burden on to approve such a plan. Risk assessment, including the the transport infrastructure, We consider the potential need quantification and prioritisation whether through patient, to adapt the organisation’s of risk, is an important clinician or other business buildings and estates as a result part of managing complex activity. This generates an of climate change, but not the organisations. impact on air quality and potential need to adapt the greenhouse gas emissions. It In addition to our focus on organisation’s activities. is therefore important that carbon, we are also committed we consider what steps are Adaptation to climate change to reducing wider environmental appropriate to reduce or change will pose a challenge to and social impacts associated travel patterns. both service delivery and with the procurement of infrastructure in the future. It goods and services. This is

Annual Report and Accounts 2012/2013 107 Emergency preparedness

Major Incident Plans Emergency Preparedness, All of our plans were revised manager, Allan Cordwell, at an Resilience and Response (EPRR) in 2012 to take into account international conference in Tel is led by the Executive Director service reconfiguration, the Aviv. The interest in the Trust was of Facilities who Chairs the Trust revised roles in emergency primarily the development of Resilience Forum. capacity at Rochdale Infirmary our CBRNE/Hazmat model and and Fairfield General Hospital how it has been used to mitigate The Trust Accountable and the adoption of a phased, potential incidents which the Emergency Officer is responsible proportional response in Trust has had to respond to. for Emergency planning and activating the Major Incident This includes the delivery of business continuity management Plan. specialist training including risk and is a required appointment assessments and a system of by NHS England in every NHS The management of Chemical, early incident recognition. Trust. The Resilience Forum Biological, Radiological, reports to the Risk Management Nuclear and Explosives (CBRNE) The Emergency Preparedness, Committee of the Trust Board. incidents is part of the Trust’s Resilience and Response Major Incident Plans. The Trust Annual Report sets out the The Trust’s Emergency and is obligated under the C.C.A. key requirements for the Trust Service Continuity plans are (2004) to provide a C.B.R.N.E. in 2013/14 to ensure that essential as they enable the response in relation to either an arrangements are in place to Trust’s hospitals to fulfil their accidental or deliberate release of manage incidents and events responsibilities as Category hazardous substances. A series of while maintaining services to 1 responders under the Civil staff training programmes have patients. Contingencies Act of 2004. been held during the year and Effective plans must be available NHS England has placed to date 82% of A&E staff have when needed to support the particular emphasis on the completed the two day training Trust’s response to an external following areas: course. emergency and the continued • Comply with category one delivery of essential services in The Trust has recently invested provider status as described the event of a serious disruption in and installed a new in statute (Civil Contingencies to normal operations. decontamination unit at the A&E Act 2004) department at North Manchester Our Major Incident Plans for • Comply with EPRR NHS General Hospital which can each of our four hospitals and England requirements as process 72 casualties per hour if community services comply detailed in the Emergency needed. This is the first unit in with the Civil Contingency Act Preparedness Framework the North of England of its type. 2004 and the NHS Emergency 2013 Planning Guidance 2005 and In September 2012, the Trust • Comply with the NHS all associated guidance. These hosted a training course at England business continuity plans are exercised and tested Fairfield General Hospital for framework 2013 each year and are reviewed and members of the Netherlands • Align with the 2012 updated as appropriate. Specific CBRNE Academy. Delegates International Standard for planning was held in advance of contacted the Trust after Business Continuity (ISO the Olympic Games last year. watching a presentation made by 22301) the Trust’s emergency planning

Annual Report and Accounts 2012/2013 108 Seasonal Flu Repsonse

Staff vaccinated against flu vaccinated this year – a take up rate of 60%. Each year, the Trust is committed to offering all This was a 4% increase on last year and included staff the seasonal ‘flu vaccination for free. The 50% of our frontline clinical staff. Staff who Trust’s annual staff seasonal ‘flu vaccination received their vaccination included our doctors, programme was launched on 1st October by the nurses, physiotherapists, community health Trust’s Director of Nursing, Marian Carroll, in an care professionals, support staff, receptionists, effort to vaccinate as many of our 9,000 staff as managers, catering and clerical staff and Trust possible. volunteers.

In just seven weeks, using link nurses in many In March 2013, the Trust’s occupational health wards and departments and staff drop-in team was shortlisted down to the last five from clinics, over half of our staff had voluntarily over 44 teams throughout the country for the received their seasonal ‘flu vaccination in efforts ‘Best Flu Fighter Team’, an award from the Social to protect our patients, themselves and their Partnership Forum that recognises the efforts of families in preparation for winter. In total, over teams to vaccinate frontline staff against the flu 5,300 of our clinical and non-clinical staff were virus.

“Influenza is dangerous, highly contagious and largely preventable. As NHS staff, I believe it is our collective responsibility to ensure our patients are safe. We have a crucial role to play in preventing a serious flu outbreak and helping to ensure that everyone understands the importance of the flu vaccination programme. As clinical NHS staff I believe we all play an important role in promoting the need for both our colleagues and those in our care to get vaccinated.” Marian Carroll, Director of Nursing

Norovirus to accept any new admissions, visitors following a significant NHS staff going off sick and outbreak of the Norovirus winter During winter in addition to the appointments being postponed. vomiting bug. In order to ensure Trust supporting the national The Trust urged people to stay patient safety and that the ‘Flu Fighter’ campaign, the Trust away from hospital if they were hospital could return to normal took an active role in informing struck with it and reminded that as soon as possible, the decision and advising patients and the they needed to drink plenty of was made to close all wards to public about the symptoms of fluids and wash hands regularly. visitors for at least 48 hours. Norovirus. The public was advised and In late December 2012, the Trust Norovirus, and the similar kept informed through regular took the precautionary decision Rotavirus, are spread quickly updates via the local media, to close every ward at North and if they get into hospitals it social media and the Trust’s Manchester General Hospital to can lead to wards being unable public website.

Annual Report and Accounts 2012/2013 109 Choose Well campaign A senior A&E consultant at the valuable NHS resources and or another local primary or Trust appeared on the BBC’s The could mean some patients are community health service. One Show in December 2012 as having to wait longer to be The Trust’s continues to work part of a feature looking at the treated. closely with local commissioners demand pressures facing A&E Figures suggest that every day and partner healthcare agencies departments. up to 50 people who visit the in urging the public to speak Dr Jimmy Stuart, the Trust’s A&E departments at North with their local pharmacy and A&E clinical director at North Manchester General Hospital and consider the full range of NHS Manchester General Hospital, The Royal Oldham Hospitals run services available to them by was keen to explain that by Pennine Acute Trust could be visiting online at www.nhs.uk unnecessary visits to A&E treated more quickly and more or for telephone advice call NHS departments are wasting appropriately by a pharmacist Direct 0845 46 47 or 111.

Annual Report and Accounts 2012/2013 110 Valuing People

Staff Awards 2012 In June, TV presenter, journalist or Technical Worker of the and Alzheimer’s campaigner Year Award for her work Fiona Phillips hosted the Trust’s raising awareness of mouth third annual Staff Awards cancer and championing the event at the Manchester City importance of oral health and FC Etihad Stadium. the impact that this has on the “It’s been an absolute privilege quality of life for patients. to attend The Pennine The Awards consist of 13 Acute Hospital Trust Staff categories which recognise Children’s divisional nurse the very best of patient care, manager, Yvonne Tunstall, was Awards where I met scores of dedication and innovation awarded Manager of the Year, inspirational NHS workers. I felt among staff. recognising her lead role in really proud to be presenting the safe transfer of inpatient the awards and to be among so Staff from an acute medical maternity and paediatric many dedicated and fantastic ward at Fairfield General services from Fairfield General people. I was really impressed Hospital (Ward six) were named Hospital to North Manchester with the level of commitment Frontline Team of the Year and General Hospital in March last and hard work of many Dr Sethi, a consultant in elderly year as part of the Greater care medicine at Fairfield, was individuals and teams including Manchester wide ‘Making It recognised for his innovative doctors, nurses, support Better’ programme. Yvonne work to pilot and secure workers and managers. was also instrumental in funding for a nursing home preparing The Royal Oldham “All the award winners truly outreach service. Hospital’s new neonatal unit deserve recognition and should Nurse ward manager Sr Gillian so that it could successfully be congratulated. NHS staff do Fogarty was honoured with the develop into a Level 3 unit a brilliant job caring for people. title of Nurse of the Year whilst which opened in December I love the NHS!” Dr Jeyagopal, a consultant and will greatly benefit Fiona Phillips radiologist based at The Royal vulnerable babies born in the Oldham Hospital, scooped Pennine area. Hospital Doctor of the Year. A vascular nurse specialist Personal assistant Cath based at The Royal Oldham Norbury based at Trust Hospital was recognised for “It is important to recognise headquarters was awarded the her outstanding contribution and celebrate the extraordinary Administrative or Secretarial to patient care and patient efforts and good work of teams Worker of the Year Award, safety. Debbie Ruff established and individuals across the whilst Anthony Douglas, a a group of healthcare Trust. Our annual Staff Awards professionals to develop a porter at North Manchester provide the opportunity to policy to support VTE (venous General Hospital, celebrated thank staff formally with the thromboembolism) prevention after scooping Support Worker recognition and applaud they of the Year. Specialist oral within the Trust and helped deserve.” health practitioner Emma Riley standardise anti-embolitic was awarded the Professional stockings which patients wear John Saxby, Chief Executive

Annual Report and Accounts 2012/2013 111 to speed up the circulation of Equality and developed and reviewed in line blood in the veins, making blood with the Equality Act 2010. clots less likely. Diversity The Trust is committed to The Trust recognises the value The Awards event was fully paid ensuring that its staff and service of a diverse workforce and is for and supported by a number users enjoy the benefits of an committed to implementing of external sponsors including: organisation that respects and policies and procedures that Vinci Construction UK; NG upholds individuals’ rights and will assist in eliminating Bailey; Weightmans; Mitie; APS freedoms. Equality and human discrimination and encouraging Group; Philips; G2 Speech; NHS rights are at the core of the diversity amongst its workforce. Discounts, Corporate Design Trust’s mission statement: ‘to The Trust’s aim is that its Company and iSOFT. provide the best care for each workforce is fully representative patient on every occasion’ of all sections of society and Long Service and is a prominent feature of that each member of staff Awards the coming year’s corporate feels respected. We strive to objectives. Staff who had worked at the ensure that individuals are Trust for over 40 years were also The Trust has an equality treated equally and fairly and acknowledged and thanked at and diversity strategy that is that decisions on recruitment, the annual staff awards for their supported by a Single Equality selection, training, promotion, loyalty and dedication. Those Scheme, identifying how staff career management and receiving an award were invited and patients from different provision of other benefits are to attend the event with a guest equality groups are supported based solely on objective and job and presented with a certificate and included in the Trust related criteria. by the Trust Chairman, John priorities and activities. The The Trust is committed to ensure Jesky, to mark the occasion. Single Equality Scheme and that the talents and resources Action Plan were developed of employees are utilised to Staff consultation during 2010, in conjunction with the full and that no applicant and negotiation local communities, including or employee receives less people with disabilities, of The Trust has two major forums favourable treatment on the different age groups, sexes and to inform and consult with staff grounds of sex, marital status, ethnic backgrounds. representatives – the Central sexual orientation, pregnancy, Joint Negotiating Committee The Trust has extensive policies ethnicity, religion, disability, age, and Joint Local Negotiating and procedures in place that gender re-assignment, caring Committee. Both of these support all staff to access responsibilities or any other committees have met regularly training and development and defining characteristic. throughout the year and provide equal opportunity within All managers are supported continue to play an important the workplace. A specific equal by Human Resources when role in ensuring staff views and opportunity policy is in place dealing with the requirements of feedback are listened to and in the Trust to support and disabled people and any people acted upon. inform staff of their rights and with specific requirements action to take should they feel to ensure that their working discrimination has occurred. All conditions are no less favourable current policy and practices are than any other employees.

Annual Report and Accounts 2012/2013 112 Staff feedback

Listening into and for the Trust. It empowers The first team was the Booking teams and groups of staff to and Scheduling Team based at Action drive forward positive change Rochdale Infirmary who have Listening into Action (LiA) is and improve culture and style of tackled problems of an ENT the Trust’s staff engagement leadership in their local areas and (ears, nose & throat) outpatient programme which was launched clinical and non-clinical services. clinic at Fairfield. The other in June 2012. The Pennine Acute Teams are supported by a Trust teams have included: the Trust is one of ten NHS Trusts Sponsor Group, chaired by the Unscheduled Care Teams at across the country to adopt the Chief Executive. North Manchester, Fairfield and LiA way of working. Rochdale, the Paediatric Team In March 2013 the first ten and Anaesthetic Teams from LiA is a systematic approach teams involved in the LiA North Manchester, the Trust to engage and empower all programme presented their Pathology Team, Ward six at staff around organisational and stories and the work they have Fairfield, the Clinical Assessment service challenges in an open been doing to staff colleagues Unit (CAU) at Rochdale Infirmary, and transparent way. It is about at two LiA ‘Pass it On events’ at and the Theatre Team at North mobilising and leveraging the North Manchester and Fairfield Manchester. full potential of staff to improve General Hospitals. The aim was outcomes for patients, staff to share best practice.

The First Ten Teams (LiA) Executive Team Members Mentors Links Missions Julie Archibald/ Jeanette John Customer Care & Staff Attitude Claire Hitchen Broome Wilkes Introduction of 5 point telephone answering standard. Smile Week. Mystery Shopper. Dr M. Gopi & Howard Marian Allergy Clinic Karen Hulley Cartledge Carroll Identify place / staff /training. Obtain equipment. Advertisement to GPS. Len Fielding Trudy Rob Gillies Pathology laboratory processes Cornick Refresh the recipe book IT - Provide longer log in times at the Path lab. Provide weekend phlebotomy service without funding. Moira Smith David Dr Tina Improve ENT Clinics. Gordon Kenny Amend guide to clinic templates. Audit of start & finish clinic times plus escalation process. Revise ENT Clinics templates. Ann Pogson & Louisa Hugh Review documentation. Dr Jason Raw Harkness Mullen Review documentation. Devise joint document for MAU and A&E

Annual Report and Accounts 2012/2013 113 The First Ten Teams (LiA) Executive Team Members Mentors Links Missions Jenny Brown Julie Owen Rob Gillies Direct Admission to Cardio respiratory ward. Identify resources for respiratory ward. Training needs analysis. Staff conversation to implement change. Julie Barber & Karen Dr Sally Patient Pathway Urology James Taylor Hughes Bradley Introduction of procedure specific consent forms. Multiple use of consent forms. Introduction of consent being taken in pre op as standard. Dr Simon Dr Tina Dr Tina Training Chadwick Kenny Kenny Training needs analysis to train HCSW to do cannulation. Adapt Rochdale HCSW training package and identify mentors. Ann McIlwraith Vanessa Brian Bureaucracy free ward Kenny Steven Direct booking of bank staff. Direct non stock ordering. Merging of AHP referral forms. Cath Collier & Roger Roger Dementia Care Jeanette Taylor Pickering Pickering Obtain plans for unit. Visit other units for ideas. Arrange patient and carer conversation.

The next 20 teams have been selected and are fully involved in the LiA staff engagement programme to make positive changes to their service.

Staff “Pulse Checks” are designed to become part of the fabric of our Trust, a Trust that listens to staff. They are a way of checking in with staff who may be affected by a change. Pulse checks can be used before, during or after a change. We are using Pulse Checks to monitor the internal wellbeing, or climate of our Trust. We will be able to track trends in the way staff view the Trust. The Pulse Checks are anonymous, short and easy to complete.

Annual Report and Accounts 2012/2013 114 Staff Survey 2012 The annual national survey training, learning or ■ Senior managers do not of NHS staff in England is development needs always involve staff in undertaken independently by important decisions ■ Staff know how to report the Picker Institute. The survey fraud, malpractice or ■ Staff would not always was distributed to 850 randomly wrongdoing recommend the Trust as a selected staff across this Trust in place to work October 2012. Our top five improvements since our 2011 survey are that The Trust Board acknowledges The results show early staff have experienced: that the Trust has more work to indications that our Listening do to create a culture where staff ■ More training in how to into Action (LiA) programme feel more involved, valued and deliver a good patient/service is starting to make a small but supported. Our LiA programme user experience significant positive impact on will continue to develop and ■ More equality and diversity staff feeling more engaged and provide opportunities for staff to training empowered. The survey also engage in conversations about shows, however, areas where ■ Better communication the things which matter most to we need to focus and make between senior managers them and ways we can improve improvements. We need to and staff services and ensure this is a great improve the effectiveness of how ■ More staff know who their Trust to work. We will continue we carry out staff appraisals and senior managers are to work closely with our staff Personal Development Reviews ■ More staff are able to do their and staff side representatives to (PDRS), and encourage senior job to a standard they are build on the real improvements managers to better involve staff pleased with we have made. in important decisions. However, there are areas The information provided by Our results for 2012 show where we have to focus on: the survey is informing the that compared to other Trusts: current work focused on the ■ Appraisals/performance development of the integrated ■ Fewer experiences of reviews do not leave staff engagement strategy. Leadership harassment, bullying and feeling their work is valued abuse have gone unreported development will feature as an ■ More staff have come to ongoing priority to make the ■ Fewer staff felt pressure from work despite not feeling well necessary improvements and colleagues to come to work enough to perform their then sustain them over the long despite not feeling well duties term. ■ More staff had an appraisal/ ■ Appraisals/reviews do not review and these identify help staff to improve how they do their job

Annual Report and Accounts 2012/2013 115 NHS Constitution

The Trust is fully committed As well as patients, the In March 2013, the Government in taking account of the Constitution also ensures that also published a revised NHS rights and pledges of staff the NHS provides a high quality Constitution following a and patients set out in the working environment for staff. recent public consultation. NHS Constitution. Published It brings together their legal It is likely there will be a in January 2009, the NHS rights, and pledges to provide further consultation later in Constitution gives patients staff with rewarding jobs that the year on further changes the legal rights to access make a difference to patients to the constitution, with the NHS services; drugs and and communities, support and aim of incorporating further treatments approved by opportunities to maintain their recommendations made by NICE; choice about where own health and well-being and Robert Francis QC in his report they receive their care; the opportunity to give their of the Mid Staffordshire NHS and to be treated with view on decisions that affect Foundation Trust Public Inquiry. dignity and respect. The them and the services they Constitution also sets out provide. clear expectations about the behaviours and values for all organisations providing NHS care.

Annual Report and Accounts 2012/2013 116 Foundation Trust update

The Government aims to turn at 31 March 2013, we have culturally diverse communities all NHS Trusts into Foundation recruited a total of 10,505 public we serve. Trusts over the next few years. members. Our membership is important to Foundation Trusts are still We have actively promoted us now and most importantly firmly part of the NHS, but the our plans to become an NHS in the future. We are very keen key difference is that they are Foundation Trust at venues that members of the public, in more accountable to the local and events across the local particular our patients are given communities they serve rather areas served by our hospitals every opportunity to be members than central government. and signed up people who of the Trust. Listening to and Listening to and working with are interested in the Trust and working with local people and local people and our staff is our services. We have recently our staff is important in making important in making sure our updated our membership sure our services are fit for the services are fit for the future. database and will be targeting future. Membership specific groups that are not well represented including young Medicine for Our membership has continued people and people from black to grow over the last year and and ethnic minority communities, Member Events we achieved our ambitious target to ensure we have a balanced Over the past twelve months we of signing up 10,000 public membership which is truly have held eighteen ‘Medicine members by August 2012. As representative of the local and for Members’ events including;

= 200 members

Rochdale Infirmary

Fairfield General 2554

2207

Royal Oldham 2889

1665

North Manchester General Rest of England 1204 members

Bury Heywood, Middleton & Rochdale Oldham North Sector of Manchester

Annual Report and Accounts 2012/2013 117 a ‘behind the scene’ tour of One of our most successful Governors’ Update the new cardiology Silver Heart member events was held in Last summer we held four open Unit at Fairfield General Hospital October when we invited Governor Information sessions in August where members members and the public for an for those interested in being a received a presentation from exclusive ‘walk-about’ tour of Governor of the Trust, we were our consultant cardiologists and our new children’s wards at The really pleased with the amount were shown around the new unit Royal Oldham Hospital. Over 650 of interest and the number which includes two new state-of- people attended the preview of people who attended the the-art Cardiac Catheterisation tour and met some of our staff sessions. The sessions were Labs. prior to the new facility opening hosted by the Trust Chairman, to patients in November 2013. Similar events were held at John Jesky, and provided an the Endoscopy Unit at The During the year we have opportunity to explain the role of Royal Oldham Hospital where also invited our members governors. We will be looking members were shown around and the public to talks and to recruiting nominations for the refurbished unit on G3 presentations on health related potential Governors in Winter and the new decontamination topics including; Breast Cancer 2013 with elections to be held in unit. The new Rheumatology Awareness, Orthopaedic 2014. Unit at Rochdale Infirmary gave Services, Dementia and Vascular To be eligible to stand for members the opportunity to Awareness. election you should be over 16 meet staff and view the facilities A special heritage event was years of age and be a Foundation at the unit. In January 2013, held at Fairfield General Hospital Trust member. You don’t members and the general public in February 2013 involving a need qualifications or specific were invited to view the facilities Workhouse Talk and heritage experience but you will need at the Trust’s new Eye Unit exhibition. Ninety people commitment, spare time and which transferred from Birch Hill came to learn more about the a genuine interest in working Hospital to Rochdale Infirmary. complicated and emotive history with the Trust. If you would like of workhouses and what life was further information please call really like in the workhouse. us on 01706 517302 or email [email protected]

Annual Report and Accounts 2012/2013 118 Annual Accounts

Financial overview 2013. Impairment charges and Trust’s estate during the year. the impact of accounting for As stated above, impairment a 2012/13 donated assets are not taken into charges are not taken into The Trust’s audited annual account when measuring NHS account when measuring NHS accounts outline the financial Trusts’ financial performance Trusts’ financial performance performance of the Trust for or performance against the or performance against the 2012/13 and are included, in full, breakeven duty (see notes 1.10, breakeven duty. at the end of this chapter. The 1.11 and 29.1). note references in this overview The planned deficit is in line with refer to the notes in the annual In 2012/13 the Trust met all key the Trust’s plan submitted to accounts. Please note a glossary financial duties: the National Trust Development Authority (NTDA). Despite of terms is included at the end ■ Breakeven taking one year submitting a deficit plan, the of the accounts for ease of with another (excluding Trust is making every effort to reference. impairments and accounting break even for the year. The Trust has achieved break for donated assets) (note even with a modest surplus of 29.1) The planned surplus takes into account the requirements of £25k (before impairment charges ➢■ Remain within approved the NHS Operating Framework and the impact of accounting external financing limit (note and local circumstances. The for donated assets) and a deficit 29.3) of £25.416m (after impairment NHS, overall, must continue to charges and the impact of ➢■ Maintain capital expenditure make efficiency savings every accounting for donated assets) within approved limits (note year until 2015/16 as part of the for the year 2012/13. 29.4) Government’s £20bn savings programme. The plan for Operating expenses includes ➢■ Achieve a 3.5% return on 2013/14 takes into a number of an impairment charge (relating capital employed (note 29.2) factors, including pay and non to the valuation of buildings) pay inflation, a reduction in tariff ➢■ Achieve 95% compliance of £25.273m. The impairment prices (the price we are paid for with Better Payments Practice charge to operating expenses services) and the cost savings Code (note 11.1) relates to the fall in value of targets required. The scale of buildings declared surplus b 2013/14 the saving challenge is such that during the year, fall in value The Trust is planning to make the Trust needs to transform the of newly constructed assets a deficit of £4.7m for 2013/14 way services are provided rather brought into use (Royal Oldham before impairments and than simply trimming costs Hospital phase 3 development) accounting for donated assets department by department. The and downward revaluations and a deficit of £11.35m after Trust also needs to achieve a step of buildings (to the extent the impairments and accounting for change in productivity which, by downward revaluation is not donated assets. An impairment way of example, as shown in the covered by an associated gain charge of £6.65m is included Dr Foster report published at the from previous years) as part in the 2013/14 plan relating to end of last year, is below that of of review of building values the changes in the value of the other comparable Trusts. undertaken at the end of March

Annual Report and Accounts 2012/2013 119 The total cost savings required by this Trust is; be compromised; the care the Trust provides to £29.9m this is equivalent to 5.2% of costs. This patients must not suffer as the Trust works smarter is made up of changes to national funding and more cost effectively. and the shortfall in last year’s savings. The The main financial risks for 2013/14 are: the Trust’s Transforming for Excellence (TfE) quality delivery of efficiency savings (cost improvements improvement and efficiency programme is the - CIPs) whilst maintaining or improving quality; channel through which we aim to make the the delivery of cost reductions linked to capacity necessary savings while providing safe, high reductions arising from de-commissioning; the quality, reliable and sustainable services through achievement of contracted activity levels and the this economic downturn and beyond. TfE is loss of income as a result of contractual financial implemented through work streams with clinical penalties. staff across all divisions and departments. Patient safety and performance should not and will not

STATEMENT OF COMPREHENSIVE INCOME 2012/13 Revenue Total revenue in 2012/13 amounted to £569.8m, of which, revenue from patient care activities was £523.4m with other operating revenue of £46.4m. Overall, total revenue has reduced by £8.3m (1.4%) between years. This is mainly due to the reduction in tariff (the price we are paid for services) of 4% relating to national efficiency targets offset by an increase in tariff for inflation (2.2%).

The vast majority of revenue comes from Primary Care Trusts – £517.9m (91%) Operating expenses Operating expenses (before impairment) amounted to £559.2m and the largest element of this is the pay bill for our staff of £368.1m (66%). Overall, operating expenses have reduced by £4.9m (0.9%). This reduction is mainly the result of cost improvements achieved during the year (£19.9m) offset by inflationary increases and other pressures not funded by tariff income of £15.0m. Comprehensive income Other comprehensive income shows gains and losses that are not credited or charged to revenue or expenses. Impairments of £13.5m were charged to the revaluation reserve relating to the decrease in value of the Trust’s buildings. These are charged to revaluation reserve to the extent that there is a credit held in the reserve from previous upward valuations. Together with the deficit for the year of £25.4m the total position was a loss in 2012/13 of £38.9m which represents the total change (reduction) in taxpayers’ equity.

Annual Report and Accounts 2012/2013 120 CAPITAL EXPENDITURE 2012/13 In 2012/13 the Trust spent £37.8m on buildings, equipment and information technology, as follows :

£000 Phase 3 development, ROH 17,092 Ophthalmology transfer to Rochdale Infirmary 1,716 A&E, ROH 481 A&E Fairfield 381 Medical and Scientific Equipment (incl donated assets) 6,612 Information Technology 5,247 Other building & estate schemes 6,227

The new £44.25m Women’s and Children’s development at Royal Oldham (ROH) started during 2010/11 and the main phase was completed and ready for use in December 2012.

REGISTER OF DECLARED INTERESTS A register of declared interests is company directorships held by directors maintained by the Trust and is available of the Trust with companies who are for inspection on application to Mr J likely to, or are seeking to, conduct Saxby, Chief Executive. There are no business directly with the Trust.

EXTERNAL AUDITORS The Trust’s Auditors are KPMG. The Auditing standards require the Directors cost of work performed by the auditor to provide the external auditors with in respect of the 2012/13 reporting representations on certain matters period was £167k (KPMG fee £177k material to their audit opinion. The less Audit Commission rebate £10k). Directors have confirmed to KPMG such This relates to audit services and the representations as necessary to the best requirements of the Audit Commission’s of their knowledge and belief, having Code of Practice, ie the statutory audit made appropriate enquiries of other and services carried out in relation to Directors and officers of the Trust. the statutory audit eg reports to the Department of Health.

Annual Report and Accounts 2012/2013 121 Governance Assurance Statement (formerly Statement of Internal Control)

The Trust Board is accountable for internal control. As Accountable Officer, the chief executive of the Board has responsibility for maintaining a sound system of internal control that supports the achievement of the trust’s policies, aims and objectives. The chief executive also has responsibility for safeguarding the public funds and the trust’s assets for which he is personally responsible, as set out in the Accountable Officer Memorandum.

As a large Acute Trust with a number of constituent stakeholder organisations, various arrangements and agreements are in place through which the Trust’s performance is monitored. These are set out in the full Governance Assurance Statement (included with the Annual Accounts) along with an explanation of the purpose of the system of internal control, information on the capacity to handle risk, the risk and control framework and review of effectiveness.

The Trust’s Annual Accounts for 2012/13 is set out on pages 132 to 163. In addition it should be noted that to comply with legislation governing charities, a separate set of Annual Accounts is maintained for funds held on trust. A full set of these accounts is also available on request.

B Steven 4th June 2013 Deputy Chief Executive/Director of Finance The Pennine Acute Hospitals NHS Trust Headquarters, North Manchester General Hospital Delaunays Road, Manchester M8 5RB

Annual Report and Accounts 2012/2013 122 Statement of Directors’ Responsibilities in respect of the Accounts The directors are required under the National Health Service Act 2006 to prepare accounts for each financial year. The Secretary of State, with the approval of the Treasury, directs that these accounts give a true and fair view of the state of affairs of the trust and of the income and expenditure, recognised gains and losses and cash flows for the year. In preparing those accounts, directors are required to:

■ apply on a consistent basis accounting policies laid down by the Secretary of State with the approval of the Treasury;

■ make judgements and estimates which are reasonable and prudent;

■ state whether applicable accounting standards have been followed, subject to any material departures disclosed and explained in the accounts.

The directors are responsible for keeping proper accounting records which disclose with reasonable accuracy at any 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 the assets of the trust and hence for taking reasonable steps for the prevention and 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.

By order of the Board

John Saxby Brian Steven Chief Executive 4th June 2013 Deputy Chief Executive/Director of Finance 4th June 2013

Annual Report and Accounts 2012/2013 123 Independent Auditor’s Report to the Board of Directors of Pennine Acute Hospitals NHS Trust We have audited the financial responsible for the preparation Opinion on financial statements of Pennine Acute of financial statements which statements Hospitals NHS Trust for the give a true and fair view. In our opinion the financial year ended 31 March 2013 Our responsibility is to audit, statements: which comprise the Statement and express an opinion on, ■ give a true and fair view of Comprehensive Income, the financial statements in of the financial position of Statement of Financial Position, accordance with applicable law Pennine Acute Hospitals NHS Statement of Changes in and International Standards on Trust as at 31 March 2013 Taxpayers’ Equity, Statement Auditing (UK and Ireland). Those and of its expenditure and of Cash Flows and Notes to standards require us to comply income for the year then the Accounts. These financial with the Auditing Practices ended; and statements have been prepared Board’s Ethical Standards for ■ have been prepared properly under applicable law and the Auditors. accounting policies directed in accordance with the by the Secretary of State with Scope of the audit of the accounting policies directed the consent of the Treasury as financial statements by the Secretary of State with the consent of the Treasury relevant to the National Health An audit involves obtaining as relevant to the National Service in England. We have evidence about the amounts ‘Health Service in England. also audited the information in and disclosures in the financial the Remuneration Report that is statements sufficient to give subject to audit. Opinion on other matters ‘reasonable assurance that the prescribed by the Code of This report is made solely to the financial statements are free Audit Practice 2010 for Board of Directors of Pennine from material misstatement, local NHS bodies whether caused by fraud or Acute Hospitals NHS Trust, as a In our opinion: body, in accordance with Part error. This includes an assessment ■ the part of the Remuneration 1/ of the Audit Commission Act of: whether the accounting Report subject to audit has 1998. Our audit work has been policies are appropriate to been properly prepared undertaken so that we might the Trust’s circumstances and in accordance with the state to the Board of the Trust, have been consistently applied accounting policies directed as a body, those matters we are and adequately disclosed; the by the Secretary of State with required to state to them in an reasonableness of significant the consent of the Treasury auditor’s report and for no other accounting estimates made by purpose. To the fullest extent the Directors; and the overall as relevant to the National permitted by law, we do not presentation of the financial Health Service in England; accept or assume responsibility statements. In addition, we and to anyone other than the Board read all the financial and non- ■ the information given in of the Trust, as a body, for our financial information in the the director’s report for the audit work, for this report or for annual report to identify material financial year for which the the opinions we have formed. inconsistencies with the audited financial statements are financial statements. If we prepared is consistent with Respective become aware of any apparent the financial statements. responsibilities of material misstatements or Directors and auditor inconsistencies we consider the Matters on which we are As explained more fully in implications for our report. required to report by the Statement of Directors’ exception Responsibilities, the Directors are We have nothing to report in

Annual Report and Accounts 2012/2013 124 respect of the following matters relating to proper arrangements, We planned and performed our where the Code of Audit Practice having regard to relevant work in accordance with the 2010 for local NHS bodies criteria specified by the Audit Code of Audit Practice 2010 requires us to report to you if: Commission. for local NHS bodies. Based ■ in our opinion, the on our risk assessment, we We report if significant matters Governance Statement does undertook such work as we have come to our attention not reflect compliance with considered necessary to form a which prevent us from the Department of Health’s view on whether, in all material concluding that the Trust has put requirements; respects, the Trust had put in in place proper arrangements place proper arrangements ■ any referrals to the Secretary for securing economy, efficiency to secure economy, efficiency of State have been made and effectiveness in its use of and effectiveness in its use of under section 19 of the Audit resources. We are not required resources. Commission Act 1998; or to consider, nor have we ■ any matters have been considered, whether all aspects Conclusion reported in the public interest of the Trust’s arrangements for On the basis of our work, having under the Audit Commission securing economy, efficiency regard to the guidance on the Act 1998 in the course of, or and effectiveness in its use specified criteria published by the at the end of the audit. of resources are operating Audit Commission in November effectively. 2012, we are satisfied that, in Conclusion on the all material respects, Pennine Trust’s arrangements Basis of conclusion Acute Hospitals NHS Trust put for securing economy, We have undertaken our work in place proper arrangements efficiency and in accordance with the Code to secure economy, efficiency effectiveness in the use of Audit Practice 2010 for local and effectiveness in its use of of resources NHS bodies, having regard to resources for the year ending 31 the guidance on the specified Trust’s responsibilities March 2013. criteria, published by the Audit The Trust is responsible Commission in November 2012, Certificate for putting in place proper as to whether the Trust has We certify that we have arrangements to secure proper arrangements for: completed the audit of economy, efficiency and the accounts of Pennine effectiveness in its use of ■ securing financial resilience; Acute Hospitals NHS Trust resources, to ensure proper and in accordance with the stewardship and governance, ■ challenging how it secures requirements of the Audit and to review regularly the economy, efficiency and Commission Act 1998 and the adequacy and effectiveness of effectiveness. Code of Audit Practice 2010 for these arrangements. The Audit Commission has local NHS bodies issued by the Auditor’s responsibilities determined these two criteria Audit Commission. We are required under Section as those necessary for us to 5 of the Audit Commission consider under the Code of Act 1998 to satisfy ourselves Audit Practice 2010 for local NHS that the Trust has made bodies in satisfying ourselves proper arrangements for whether the Trust put in place Timothy Cutler for and on behalf securing economy, efficiency proper arrangements for of KPMG LLP, Statutory Auditor and effectiveness in its use of securing economy, efficiency resources. The Code of Audit and effectiveness in its use of Chartered Accountants Practice 2010 for local NHS resources for the year ended 31 St James’ Square bodies issued by the Audit March 2013. Manchester Commission requires us to M26DS report to you our conclusion 4 June 2013

Annual Report and Accounts 2012/2013 125 The Pennine Acute Hospitals NHS Trust Annual Governance Statement 2012/13

Scope of responsibility responsibilities for monitoring Committee and Clinical The Board is accountable for and reporting on key aspects of Governance and Quality internal control. As Accountable the Trust’s business. The Trust Committee at each meeting and Officer, and Chief Executive of Board receives a report on the receives an annual assurance this Board, I have responsibility work of each sub-committee statement from both committees for maintaining a sound system after each meeting. Board and the Finance Committee to of internal control that supports members sit on a number of sub- confirm the extent to which the achievement of the Trust’s committees and there is a good each committee has discharged policies, aims and objectives. spread of cross sub-committee its responsibilities according to I also have responsibility for membership, thus helping to its Terms of Reference during safeguarding the public funds ensure an integrated approach the year. The Audit Committee and the Trust’s assets for which I to governance. Attendance at provides an annual report to the am personally responsible as set the Board and sub-committees is Trust Board. high and is reported elsewhere out in the Accountable Officer The Board agenda is formed in the annual report. A clear Memorandum. around matters relating to reporting cycle for the Board and Patient Safety, Strategy and Governance framework of its sub-committees ensures that Assurance with a clear annual the Trust an appropriate range of reports cycle of items to be considered The Trust Board comprising Non- are provided to the Board or and approved by the Board. The Executive and Executive Directors each sub-committee in a timely Board reserves the assurance is collectively responsible for manner and the actions taken role on performance matters setting out the values, strategy, are monitored by each sub- for itself, with operational direction and policy of the Trust committee and reported to the enactment taken forward and holding the executive to Board through the submission of through the Executive account for delivering against sub-committee minutes. management team, the Strategic these. There is a clear division The Audit Committee has Management Group and the of responsibilities at the head established arrangements for Divisional management teams. of the Trust between the oversight of the work of Internal running of the Board and the The Board has continued to and External Audit services executive responsibility for the devote more time to setting the and for advising the Board on Trust’s business. The Chairman vision, direction and strategy for these arrangements. The Audit leads the Board while the Chief the Trust during 2012/13. The Committee is responsible for Executive manages the Trust. strategic intentions for the Trust ensuring the establishment and have started to evolve during The integrated governance maintenance of an effective the year and take account of arrangements for the Trust system of integrated governance, the emerging thinking from the are described in the Standing risk management and internal Healthier Together programme Orders and Standing Financial control, across the whole of the for Greater Manchester. The Instructions which set out the organisation’s activities (both Board has continued to decisions reserved to the Board clinical and non-clinical) that develop its quality governance and those delegated through supports the achievement of the arrangements during the year the line management structure. organisation’s objectives. The and has started to consider the The Board sub-committees Audit Committee reviews the implications for the Trust arising have specific governance work of the Risk Management from the public inquiry into Mid

Annual Report and Accounts 2012/2013 126 Staffordshire NHS Foundation Board responsibility for financial Key risks facing the Trust in the Trust (Francis report). management and financial risk. year were: The Director of Human Resources ■ Risk Assessment Reputational damage, with is the Senior Information a resulting loss of patient The system of internal control Risk Officer with Board level confidence or referral of is designed to manage risk to responsibility for information patients elsewhere. This was a reasonable level rather than risk. The Director of Operations considered to be a significant to eliminate all risk of failure has Board level responsibility for risk in last year’s Annual to achieve policies, aims and operational risk. Governance Statement. The objectives; it can therefore Trust has made considerable only provide reasonable and Management of the Risk Register progress towards improving not absolute assurance of and Assurance Framework is relationships with a number effectiveness. The system of directly linked to review of the of stakeholders, particularly internal control is based on the Corporate Objectives and annual commissioners, during the Trust’s ongoing process designed business plans and regular year such that while this still to: reviews are embedded in the remains a risk for the Trust, routine work of management ■ identify and prioritise the it is no longer a “significant” teams across the Trust. The main risks to the achievement of risk. focus of the Trust’s corporate the Trust’s policies, aims and objectives are improving patient ■ The lack of an overarching objectives, safety, improving the patient business strategy with the ■ evaluate the likelihood of experience, developing the potential for patients to be those risks being realised and workforce and maintaining referred elsewhere leading the impact should they be financial viability. A process to a financial impact on the realised, and to manage them is in place to directly link the Trust. The Trust Board has efficiently, effectively and individual objectives for members devoted time to developing economically. of staff to the Trust corporate strategic intentions for the Trust alongside the emerging The system of internal control objectives. An internal audit thinking from the Healthier has been in place in The Pennine carried out during 2012 found Together programme. Acute Hospitals NHS Trust for the that the process was well year ended 31 March 2013 and embedded within the Trust. ■ Delivery of commissioned up to the date of approval of the levels of activity and A standard risk assessment annual report and accounts. consequential impact both process is used across the on patient experience and Trust and staff are trained in Board level responsibility the financial position of the the process at induction and and leadership for the risk Trust. The Trust did not fully then through the Governance, management process lies with achieve planned activity Risk Management and Health the Chief Executive who is levels during the year due to and Safety elements of the supported by a Governance fewer than expected patients mandatory training cycle for all Director. The Governance being referred. While this staff in the Trust. Director has operational had an impact on some responsibility for governance and The overall risk profile of the Divisions and Directorates, the the development and monitoring Trust relates to how it is viewed overall impact was managed of risk against specific objectives both internally and externally, across the Trust to achieve a and assessment criteria. the delivery of key operational balanced financial position. The Medical Director has Board objectives, financial challenges ■ Achieving financial responsibility for clinical risk. and progress towards Foundation balance in 2012/13 and The Director of Finance has Trust status. ensuring ongoing financial

Annual Report and Accounts 2012/2013 127 sustainability in light of the Good progress was made at on a revised timescale for current economic climate and hospital and specialty level submission of an application. further decommissioning of with plans in place to achieve Risks to data security are some of the Trust’s services. during 2013/14. managed through policies and This was managed during the ■ Poor care leading to procedures and mandatory year to achieve a balanced regulatory involvement. training. Arrangements are in budget and there were There was no significant place to protect confidential discussions throughout the regulatory involvement information, whilst ensuring year with commissioners to during the year and the that information is released to plan a sustainable financial Trust’s systems and processes those who have a right to access. position could be planned for to continually monitor These arrangements include future years. performance and patient continual review of information ■ Never Events. There were experience were enhanced security, policy changes and two never events in 2012/13, to improve early warning of improvements recommended a common factor being potential issues. within the information failure to follow established ■ Staff engagement, poor governance structure, and procedures. Each Never Event staff attitude and the risk of a dedicated Information was fully investigated through poor care being provided as Governance Team. The Director a Higher level Review Panel a result. The Trust joined 10 of Human Resources is the and relevant procedures were other NHS bodies from across Senior Information Risk Officer amended or reinforced and England to implement the and chairs the Information followed up with additional “Listening into Action” staff Governance Group which staff training. engagement programme oversees the policy arrangements ■ Mortality. The previous within the Trust. There are and reports to the Risk reductions in mortality some early signs that this Management Committee. There evidenced by the RAMI programme is beginning were five serious untoward data standardised mortality ratio to make a positive impact security incidents in the year. reached a plateau during on staff engagement. the year. This prompted The 2012 staff survey The risk and control the Board to examine other results demonstrate that framework indicators – the Dr Foster while overall the Trust has The risk and control framework HSMR and the national maintained its position is made up of the following key SHMI mortality ratios. against the 2011 staff survey, elements: Both of these indicators there are a number of specific ■ The Governance structure demonstrated slight increases areas where significant outlined above, of which risk in Trust mortality ratios further work is required. management is an integral during the year. The Trust ■ Achievement of Foundation part. Board commissioned and has Trust status. The Trust did not ■ The Assurance Framework in monitored implementation of meet the Tripartite Agreement which risks are linked to the a Mortality Reduction strategy date for submission of the Trust’s Corporate objectives. to address this issue. application to the Strategic ■ Board, Executive Director ■ Achievement of national Health Authority. Discussions and Director Divisional risk targets. The Trust level continued throughout the registers which are regularly urgent care access target, year with the Strategic reviewed at the Trust Board, cancer and referral to Health Authority and Executive Directors’ Group or treatment targets were subsequently the National Divisional Management Team. achieved throughout the year. Trust Development Authority

Annual Report and Accounts 2012/2013 128 ■ The Care Quality Commission initiatives and publicises and reviewed services, business Registration successful prosecutions as a plans, strategies, policies, deterrent effect. procedures and functions. This The Trust’s Risk Management ensures that the principles of Strategy and Policy are reviewed The Trust meets NHSLA Risk equality, diversity and respect for annually. The Trust’s risk Management Standards at Level human rights are at the core of management and assurance 1 for both the general standards our business planning processes framework process effectively and the maternity standard. and the implementation of places the management of risk The Trust has remained service delivery. alongside achievement of the registered with the Care Quality Trust’s corporate objectives Commission without conditions As an employer with staff and therefore ensures that risk and in compliance with the entitled to membership of the is managed on a day to day essential standards of quality and NHS Pension Scheme, control basis as part of the operational safety. measures are in place to management of the Trust, rather ensure all employer obligations The Quality Account, which than being the preserve of contained within the Scheme this Trust has chosen to fully specialist staff or committees. regulations are complied integrate into the Annual Report, The process is managed through with. This includes ensuring is the responsibility of the the line management structure that deductions from salary, Director of Nursing. The control and assured through the Trust’s employers’ contributions and framework comprises a task governance Committees. payments in to the Scheme are group to oversee the production. in accordance with Scheme The Assurance Framework is The task group reports to the rules, and that member Pension aligned to the Trust’s Corporate Clinical Governance and Quality Scheme records are accurately Objectives and is cross referenced Committee which in turn updated in accordance with to the Risk Register. The provides clinical input into the the timescales detailed in the Assurance Framework brings direction and development of Regulations. together all of the evidence the Quality Account. A draft of required to support the Annual the Quality Account is reviewed The Trust has undertaken a Governance Statement. The by the Audit Committee as part climate change risk assessment Assurance Framework identifies of the Annual Report and final and developed an Adaptation some gaps in controls and approval is given by the Trust Plan, to support its emergency assurance measures. There are Board. Data quality is assured preparedness and civil documented actions to address through the Trust’s data quality contingency requirements, these gaps. The review of governance structures, with as based on the UK Climate the Assurance Framework by Board Directors confirming a Projections 2009 (UKCP09), Internal Audit and the Internal statement of compliance with to ensure that this Trust’s Audit Opinion confirms that responsibilities in completing the obligations under the Climate there is high assurance that Quality Account. Change Act are met. during 2012/13 the Assurance Control measures are in place Framework fulfilled its role. Review of effectiveness to ensure that all the Trust’s As Accountable Officer, I have Strong internal processes and obligations under equality, responsibility for reviewing the procedures and comprehensive diversity and human rights effectiveness of the system of policies are a major element legislation are complied with. internal control. My review is in deterring risks from arising. Mitigation of risks to equality informed in a number of ways. The Trust has clear counter is integrated into core Trust The Head of Internal Audit fraud and prevention of bribery business by undertaking equality provides me with an opinion arrangements, supports national impact assessments on all new on the overall arrangements

Annual Report and Accounts 2012/2013 129 for gaining assurance through ■ prejudice the achievement of arising from that. The Trust’s the Assurance Framework and the business plan strategy is a key component of on the controls reviewed as part ■ undermine the integrity or the Foundation Trust application of Internal Audit’s work. The reputation of the Trust, and any delay in this could lead to Head of Internal Audit Opinion slippage against the FT timetable. ■ place delivery of the standards for 2012/13 gave significant The uncertainty around the expected of the Accountable assurance. Executive managers Healthier Together strategy, the Officer at risk, within the Trust who have implications for commissioners, ■ make it harder to resist fraud responsibility for the development the implications for development or other misuse of resources, and maintenance of the system of the Trust’s own strategy of internal control provide me ■ put a significant programme and the implications for the FT with assurance. The Assurance or project at risk, timetable could prejudice the Framework itself provides me with ■ divert resources from another achievement of the business plan evidence that the effectiveness significant aspect of the Trust’s and undermine the reputation of of controls that manage the risks business the Trust and therefore I consider to the Trust achieving its principal ■ have a material impact on the this risk to be “significant” in objectives have been reviewed. accounts terms of the definitions for the My review is also informed by the Annual Governance Statement. ■ put national security or data following:- To mitigate against this risk the integrity at risk. ■ Care Quality Commission Trust will work closely with staff Registration Although the Trust has already and commissioners and will, achieved major reconfiguration subject to pre-consultation and ■ NHSLA Risk Management and consolidation of secondary consultation, finalise a strategy Standards Assessment care services across the North- to meet the challenges posed ■ Data Accreditation / East sector of Greater Manchester and to ensure that viable and Information Governance further change will take place sustainable services can be Toolkit over the next few years arising delivered from within and across ■ External Audit Reports from the Greater Manchester sustainable organisations. The ■ Reports provided to the Trust wide Healthier Together Trust will seek to mitigate the Board and its sub-committees programme and the impact of the prospect of any delay to the FT wider economic situation on the timetable by agreeing a suitable The Trust’s Audit Committee need to ensure a sustainable Trust timetable and arrangements with continues to work closely with structure. Although the extent of the National Trust Development the Risk Management Committee service change already achieved in Authority during the first quarter and the Clinical Governance and the North East sector led initially of 2013/14. Quality Committee to ensure to a view within the Trust that that the Trust continuously The Trust faces further risks in there would not be a significant improves its management of risk. managing the financial demands impact on the Trust, the initial The Head of Internal Audit in of the current economic climate, papers from the Healthier providing his Opinion Statement reductions in activity and further Together programme suggest that provides further assurance of the decommissioning of services. The there may be a material impact on processes in place. Trust has further strengthened its the Trust’s services, although the relationships with commissioners This Annual Governance full impact is unlikely to be known during the year and there is clear Statement requires me to consider until later in 2013/14. Finalising understanding of the need for a whether there are any significant the Trust’s strategy is largely significant but reducing level of issues facing the Trust. These may dependent on the outcome of transitional support over the next be issues which could the Healthier Together strategy few years to enable the Trust to and commissioning intentions

Annual Report and Accounts 2012/2013 130 make the necessary changes to a significant risk. Continued the definitions for the Annual services to arrive at a clinically discussions with commissioners, Governance Statement. While viable and financially sustainable the Local Area Team and the it is a risk facing the Trust, if position. I have considered National Trust Development managed appropriately and with whether this risk is “significant” Authority are in place in order to the support of commissioners it in terms of the definitions for the mitigate this risk. will not be a significant risk. Annual Governance Statement. The previous reductions in Given the Trust’s track record to Conclusion mortality show signs of reaching date in successfully implementing There have been no significant a plateau or increasing slightly. large scale change, if the Trust control issues and my review There is a significant risk receives the required levels of confirms that The Pennine during 2013/14 that changes transitional support then the Acute Hospitals NHS Trust has to the method of funding and risk is not significant. However, a generally sound system of recording short stay patients if the Trust does not receive the internal control that supports the will have a one off, adverse but necessary level of transitional achievement of its policies, aims entirely statistical impact on the support then this will prejudice and objectives. Trust’s mortality ratio. This risk the achievement of the business has the potential to undermine plan, undermine the reputation public confidence in the service of the Trust, place delivery but will be mitigated by clear of clinical, performance and communication and evidence of financial standards at risk, divert work across a range of patient resources from other aspects of John Saxby care areas to reduce mortality. I the Trust’s business and have a Chief Executive have considered whether this material impact on the accounts 4 June 2013 risk is “significant” in terms of and will therefore constitute

Annual Report and Accounts 2012/2013 131 STATEMENT OF COMPREHENSIVE INCOME for the year ended 31 March 2013 2012-13 2011-12 NOTE £000 £000 Revenue Revenue from patient care activities 5 523,448 533,610 Other operating revenue 6 46,392 44,480 Total Revenue 569,840 578,090

Employee Costs (368,116) (380,202) Other Costs (216,363) (193,108) Operating expenses 8 (584,479) (573,310)

Operating surplus/(deficit) (14,639) 4,780

Finance costs: Investment revenue 12 141 125 Other gains and (losses) 13 109 (53) Finance costs 14 (2,491) (2,119)

Surplus/(deficit) for the financial year (16,880) 2,733

Public dividend capital dividends payable (8,536) (8,981)

Retained surplus/(deficit) for the year (25,416) (6,248)

Other comprehensive income Impairments and reversals taken to the revaluation reserve (13,519) (4,267) Gains on revaluations taken to the revaluation reserve 0 22,816 Total comprehensive income for the year (38,935) 12,301

Reported NHS financial performance position

Retained surplus/(deficit) for the year (25,416) (6,248) Impairments 25,273 9,165 Donated Assets adjustment (depreciation greater than the value of assets received) 168 636 Reported NHS financial performance position - surplus 25 3,553

A Trust’s Reported NHS financial performance position is derived from its Retained surplus/(Deficit), but adjusted for the following that are not part of the Trust’s financial performance:- - Impairments to Property, plant and equipment. - The net effect of donated assets. In 2011/12 the Department of Health changed the accounting treatment for Donated Assets. Prior to 2011/12 other operating revenue included a credit equal to the amount for donated asset depreciation charged to operating expenses. From 2011/12 the amount credited to other operating revenue is the value of donated assets received and not a credit for depreciation. The value of donated assets received is different from the cost of depreciation (either more or less) and results in an adjustment for financial performance purposes. At the same time, the Donated Asset Reserve has been eliminated with the balance credited to the revaluation reserve or retained earnings.

Annual Report and Accounts 2012/2013 132 STATEMENT OF FINANCIAL POSITION as at 31 March 2013

31 March 2013 31 March 2012 NOTE £000 £000 Non-current assets Property, plant and equipment 15 316,781 342,325 Intangible assets 15 6,174 3,865 Trade and other receivables 19 3,430 3,823 Total non-current assets 326,385 350,013

Current assets Inventories 18 8,645 8,126 Trade and other receivables 19 29,105 24,627 Cash and cash equivalents 20 16,011 24,580 Total current assets 53,761 57,333

Total assets 380,146 407,346

Current liabilities Trade and other payables/liabilities 21 (42,646) (41,400) Borrowings 22 (3,138) (2,646) Provisions 25 (11,123) (13,224) Total current liabilities (56,907) (57,270) Net current assets/(liabilities) (3,146) 63

Total assets less current liabilities 323,239 350,076

Non-current liabilities Borrowings 22 (64,835) (53,289) Provisions 25 (9,772) (9,220) Total assets employed 248,632 287,567

Financed by taxpayers’ equity: Public dividend capital 205,289 205,289 Retained earnings (14,963) 2,107 Revaluation reserve 58,306 80,171 Total taxpayers’ equity 248,632 287,567

John Saxby Chief Executive 4th June 2013

Annual Report and Accounts 2012/2013 133 STATEMENT OF CHANGES IN TAXPAYERS’ EQUITY for the year ended 31 March 2013

Public dividend Retained Reval’n Total capital earnings reserve (PDC) £000 £000 £000 £000 Opening balance at 1 April 2011 205,289 (1,549) 71,526 275,266

Changes in taxpayers’ equity for 2011-12 Retained surplus/(deficit) for the year (6,248) (6,248) Transfers between reserves 9,904 (9,904) 0 Downward revaluation of land (impairment) (1,226) (1,226) Downward revaluation of buildings (impairment) (3,041) (3,041) Upward revaluation of buildings/dwellings 18,700 18,700 Upward revaluation (indexation) of equipment 4,116 4,116 Balance at 31 March 2012 205,289 2,107 80,171 287,567

Changes in taxpayers’ equity for 2012-13 Retained surplus/(deficit) for the year (25,416) (25,416) Transfers between reserves 8,346 (8,346) 0 Downward revaluation of land (impairment) 0 0 Downward revaluation of buildings (impairment) (13,519) (13,519) Upward revaluation of buildings/dwellings 0 0 Upward revaluation (indexation) of equipment * Balance at 31 March 2013 205,289 (14,963) 58,306 248,632

For 2012-13 the amount of the transfer from the revaluation reserve to retained earnings relating to impairments is: 4,781 (4,781)

* From 2012-13 equipment is no longer indexed.

Annual Report and Accounts 2012/2013 134 STATEMENT OF CHANGES IN TAXPAYERS’ EQUITY for the year ended 31 March 2013

Public dividend Retained Reval’n Total capital earnings reserve (PDC) £000 £000 £000 £000 Opening balance at 1 April 2011 205,289 (1,549) 71,526 275,266

Changes in taxpayers’ equity for 2011-12 Retained surplus/(deficit) for the year (6,248) (6,248) Transfers between reserves 9,904 (9,904) 0 Downward revaluation of land (impairment) (1,226) (1,226) Downward revaluation of buildings (impairment) (3,041) (3,041) Upward revaluation of buildings/dwellings 18,700 18,700 Upward revaluation (indexation) of equipment 4,116 4,116 Balance at 31 March 2012 205,289 2,107 80,171 287,567

Changes in taxpayers’ equity for 2012-13 Retained surplus/(deficit) for the year (25,416) (25,416) Transfers between reserves 8,346 (8,346) 0 Downward revaluation of land (impairment) 0 0 Downward revaluation of buildings (impairment) (13,519) (13,519) Upward revaluation of buildings/dwellings 0 0 Upward revaluation (indexation) of equipment * Balance at 31 March 2013 205,289 (14,963) 58,306 248,632

For 2012-13 the amount of the transfer from the revaluation reserve to retained earnings relating to impairments is: 4,781 (4,781)

* From 2012-13 equipment is no longer indexed.

Annual Report and Accounts 2012/2013 135 STATEMENT OF CASH FLOWS for the year ended 31 March 2013

2012-13 2011-12 NOTE £000 £000 Cash flows from operating activities Operating surplus/(deficit) (14,639) 4,780 Depreciation and amortisation (non cash) 22,043 21,191 Impairments and reversals (non cash) 25,273 9,165 Donated Assets received credited to revenue (non cash) (322) (382) Interest paid (2,220) (1,844) Dividends paid (8,268) (9,340) (Increase)/decrease in inventories (519) 1,275 (Increase)/decrease in trade and other receivables (4,319) (3,501) Increase/(decrease) in trade and other payables/other liabilities (2,069) (3,881) Provisions utilised (3,758) (1,579) Increase/(decrease) in non cash provisions 1,938 12,020 Net cash inflow/(outflow) from operating activities a 13,140 27,904

Cash flows from investing activities Interest received 139 124 (Payments) for property, plant, equipment and intangibles (34,153) (36,108) Proceeds from disposal of plant, property and equipment 266 330 Net cash inflow/(outflow) from investing activities b (33,748) (35,654)

Net cash inflow/(outflow) before financing a+b (20,608) (7,750)

Cash flows from financing activities Loans received from the DH 15,000 18,000 Loans repaid to the DH (2,780) (2,092) Capital element of finance lease (181) (163) Net cash inflow/(outflow) from financing c 12,039 15,745

Net increase/(decrease) in cash and cash equivalents a+b+c (8,569) 7,995

Cash/cash equivalents at the start of the financial year 24,580 16,585

Cash/cash equivalents at the end of the financial year 20 16,011 24,580

Annual Report and Accounts 2012/2013 136 NOTES TO THE ACCOUNTS by use of absorption accounting in line with the Treasury FReM. The FReM does not require 1.0 Accounting Policies retrospective adoption, so prior year transactions The Secretary of State for Health has directed that (which have been accounted for under merger the financial statements of NHS Trusts shall meet accounting) have not been restated. Absorption the accounting requirements of the NHS Trusts accounting requires that entities account for their Manual for Accounts, which shall be agreed with transactions in the period in which they took place, HM Treasury. Consequently, the following financial with no restatement of performance required statements have been prepared in accordance when functions transfer within the public sector. with the 2011/12 NHS Trusts Manual for Accounts Where assets and liabilities transfer, the gain or issued by the Department of Health. The loss resulting is recognised in the SOCNE, and is accounting policies contained in that manual follow disclosed separately from operating costs. International Financial Reporting Standards (IFRS) to From the 1 April 2011, the trust took over the extent that they are meaningful and appropriate responsibility for community services in the North to the NHS, as determined by HM Treasury, which is Manchester area from the provider arm of NHS advised by the Financial Reporting Advisory Board. Manchester (PCT). No assets and liabilities were Where the NHS Trusts Manual for Accounts permits transferred between organisations. Approximately a choice of accounting policy, the accounting 235 staff transferred on the 1 April 2011. Income policy which is judged to be most appropriate to for the service is approximately £13m. the particular circumstances of the trust for the purpose of giving a true and fair view has been 1.4 Critical accounting judgements selected. The particular policies adopted by the and key sources of estimation trust are described below. They have been applied uncertainty consistently in dealing with items considered In the application of the Trust’s accounting policies, material in relation to the accounts. management is required to make judgements, 1.1 Accounting convention estimates and assumptions about the carrying amounts of assets and liabilities that are not readily These accounts have been prepared under the apparent from other sources. The estimates and historical cost convention modified to account for associated assumptions are based on historical the revaluation of property, plant and equipment, experience and other factors that are considered intangible assets, inventories and certain financial to be relevant. Actual results may differ from assets and financial liabilities those estimates and the estimates and underlying 1.2 Acquisitions and discontinued assumptions are continually reviewed. Revisions to operations accounting estimates are recognised in the period in Activities are considered to be ‘acquired’ only if which the estimate is revised if the revision affects they are taken on from outside the public sector. only that period or in the period of the revision and Activities are considered to be ‘discontinued’ only future periods if the revision affects both current if they cease entirely. They are not considered to and future periods. be ‘discontinued’ if they transfer from one public Management has applied accounting policies as sector body to another. outlined in note 1.0 according to the NHS Trust 1.3 Transforming Community Services Manual for Accounts and has not made any critical (TCS) transactions judgements about the application of accounting policies that could have a significant effect on the Under the TCS initiative, services historically amounts recognised in the financial statements. provided by PCTs have transferred to other providers - notably NHS Trusts and NHS Foundation There are no key assumptions, other than asset Trusts. Such transfers fall to be accounted for values and lives (see note 1.7), concerning the

Annual Report and Accounts 2012/2013 137 future or key sources of estimation uncertainty the extent that employees are permitted to carry at the end of the reporting period, that have a forward leave into the following period. significant risk of causing a material adjustment to the carrying amounts of assets and liabilities within 1.6.2 Retirement benefit costs the next financial year. Past and present employees are covered by the provisions of the NHS Pensions Scheme. The Other less significant areas of judgement and scheme is an unfunded, defined benefit scheme estimation techniques (e.g. depreciation) have been that covers NHS employers, General Practices and disclosed in the Trust’s accounting policies and in other bodies, allowed under the direction of the the notes to the financial statements, as required by Secretary of State, in England and Wales. The IFRS. scheme is not designed to be run in a way that 1.5 Revenue would enable NHS bodies to identify their share of the underlying scheme assets and liabilities. Revenue in respect of services provided is Therefore, the scheme is accounted for as if it were recognised when, and to the extent that, a defined contribution scheme: the cost to the NHS performance occurs, and is measured at the body of participating in the scheme is taken as fair value of the consideration receivable. The equal to the contributions payable to the scheme main source of revenue for the trust is from for the accounting period. commissioners for healthcare services. Revenue relating to patient care spells that are part- For early retirements other than those due to ill completed at the year end are apportioned across health the additional pension liabilities are not the financial years on the basis of length of stay funded by the scheme. The full amount of the at the end of the reporting period compared to liability for the additional costs is charged to expected total length of stay. expenditure at the time the Trust commits itself to the retirement, regardless of the method of Where income is received for a specific activity that payment. is to be delivered in the following year, that income is deferred. 1.7 Other expenses Other operating expenses for goods or services are The Trust receives income under the NHS Injury Cost recognised when, and to the extent that, they have Recovery Scheme, designed to reclaim the cost of been received. They are measured at the fair value treating injured individuals to whom personal injury of the consideration payable. compensation has subsequently been paid e.g. by an insurer. The Trust recognises the income when it 1.8 Property, plant and equipment receives notification from the Department of Work 1.8.1 Recognition and Pension’s Compensation Recovery Unit that Property, plant and equipment is capitalised if: the individual has lodged a compensation claim. The income is measured at the agreed tariff for the ■ it is held for use in delivering services or for treatments provided to the injured individual, less a administrative purposes; provision for unsuccessful compensation claims and ■ it is probable that future economic benefits will doubtful debts. flow to, or service potential will be supplied to, the trust; 1.6 Employee Benefits ■ it is expected to be used for more than one 1.6.1 Short-term employee benefits financial year; Salaries, wages and employment-related payments ■ the cost of the item can be measured reliably; are recognised in the period in which the service is and received from employees. The cost of leave earned ■ the item has cost of at least £5,000; or but not taken by employees at the end of the period is recognised in the financial statements to ■ Collectively, a number of items have a cost

Annual Report and Accounts 2012/2013 138 of at least £5,000 and individually have a the service being provided, an alternative site can cost of more than £250, where the assets are be valued. functionally interdependent, they had broadly A full revaluation of land and buildings was simultaneous purchase dates, are anticipated to undertaken during 2011/12 by the District Valuer have simultaneous disposal dates and are under with an effective revaluation date of 30 September single managerial control; or 2011. The previous full revaluation was undertaken ■ Items form part of the initial equipping and at the end of 2009. The building cost index and setting-up cost of a new building, ward or unit, associated location factor has fallen since that date irrespective of their individual or collective cost. by 8%. Building values have been adjusted to Where a large asset, for example a building, reflect this at the end of March 2013 resulting in a includes a number of components with significantly reduction in building values of £16.5m. Land values different asset lives, the components are treated have remained steady and have not been adjusted. as separate assets and depreciated over their own Properties in the course of construction for service useful economic lives. or administration purposes are carried at cost, less 1.8.2 Valuation any impairment loss. Cost includes professional fees but not borrowing costs, which are recognised All property, plant and equipment are measured as expenses immediately, as allowed by IAS 23 for initially at cost, representing the cost directly assets held at fair value. Assets are revalued and attributable to acquiring or constructing the asset depreciation commences when they are brought and bringing it to the location and condition into use. necessary for it to be capable of operating in the manner intended by management. All assets are Plant and machinery, fixtures and other equipment measured subsequently at fair value. is written off over their remaining useful lives or carried at their historic cost as this is not considered Land and buildings used for the trust’s services to be materially different from fair value. or for administrative purposes are stated in the statement of financial position at their revalued An increase arising on revaluation is taken to the amounts, being the fair value at the date of revaluation reserve except when it reverses an revaluation less any subsequent accumulated impairment for the same asset previously recognised depreciation and impairment losses. Revaluations in expenditure, in which case it is credited to are performed with sufficient regularity to ensure expenditure to the extent of the decrease previously that carrying amounts are not materially different charged there. A revaluation decrease that does from those that would be determined at the end of not result from a loss of economic value or service the reporting period. Fair values are determined as potential is recognised as an impairment charged follows: to the revaluation reserve to the extent that there ■ Land and non-specialised buildings – market is a balance on the reserve for the asset and, value for existing use thereafter, to expenditure. Impairment losses ■ Specialised buildings – depreciated replacement that arise from a clear consumption of economic cost benefit are taken to expenditure. Gains and losses recognised in the revaluation reserve are reported Until 31 March 2008, the depreciated replacement as other comprehensive income in the Statement of cost of specialised buildings has been estimated Comprehensive Income. for an exact replacement of the asset in its present location. HM Treasury has adopted a standard 1.8.3 Subsequent expenditure approach to depreciated replacement cost Where subsequent expenditure enhances an valuations based on modern equivalent assets and, asset beyond its original specification, the directly where it would meet the location requirements of attributable cost is capitalised. Where subsequent

Annual Report and Accounts 2012/2013 139 expenditure restores the asset to its original generated intangible assets is the sum of the specification, the expenditure is capitalised and expenditure incurred from the date when the any existing carrying value of the item replaced is criteria above are initially met. Where no internally- written-out and charged to operating expenses. generated intangible asset can be recognised, the expenditure is recognised in the period in which it is 1.9 Intangible assets incurred. 1.9.1 Recognition Intangible assets are non-monetary assets without 1.10 Depreciation, amortisation and physical substance, which are capable of sale impairments separately from the rest of the trust’s business or Freehold land and properties under construction are which arise from contractual or other legal rights. not depreciated. They are recognised only when it is probable that Otherwise, depreciation and amortisation are future economic benefits will flow to, or service charged to write off the costs or valuation of potential be provided to, the trust; where the cost property, plant and equipment and intangible non- of the asset can be measured reliably, and where current assets, less any residual value, over their the cost is at least £5000. estimated useful lives, in a manner that reflects Intangible assets acquired separately are initially the consumption of economic benefits or service recognised at fair value. Software that is integral potential of the assets. The estimated useful life of to the operating of hardware, for example an an asset is the period over which the Trust expects operating system, is capitalised as part of the to obtain economic benefits or service potential relevant item of property, plant and equipment. from the asset. This is specific to the Trust and Software that is not integral to the operation of may be shorter than the physical life of the asset hardware, for example application software, is itself. Estimated useful lives and residual values capitalised as an intangible asset. Expenditure are reviewed each year end, with the effect of any on research is not capitalised: it is recognised as changes recognised on a prospective basis. Assets an operating expense in the period in which it is held under finance leases are depreciated over their incurred. Internally-generated assets are recognised estimated useful lives. if, and only if, all of the following have been At each reporting period end, the trust checks demonstrated: whether there is any indication that any of its ■ the technical feasibility of completing the tangible or intangible non-current assets have intangible asset so that it will be available for suffered an impairment loss. If there is indication of use an impairment loss, the recoverable amount of the ■ the intention to complete the intangible asset asset is estimated to determine whether there has and use it been a loss and, if so, its amount. Intangible assets ■ the ability to sell or use the intangible asset not yet available for use are tested for impairment annually. ■ how the intangible asset will generate probable future economic benefits or service potential A revaluation decrease that does not result from ■ the availability of adequate technical, financial a loss of economic value or service potential is and other resources to complete the intangible recognised as an impairment charged to the asset and sell or use it revaluation reserve to the extent that there is a ■ the ability to measure reliably the expenditure balance on the reserve for the asset and, thereafter, attributable to the intangible asset during its to expenditure. Impairment losses that arise from development a clear consumption of economic benefit are taken to expenditure. Where an impairment loss 1.9.2 Measurement subsequently reverses, the carrying amount of the The amount initially recognised for internally- asset is increased to the revised estimate of the

Annual Report and Accounts 2012/2013 140 recoverable amount but capped at the amount 1.13 Non-current assets held for sale that would have been determined had there been Non-current assets are classified as held for sale if no initial impairment loss. The reversal of the their carrying amount will be recovered principally impairment loss is credited to expenditure to the through a sale transaction rather than through extent of the decrease previously charged there and continuing use. This condition is regarded as thereafter to the revaluation reserve. met when the sale is highly probable, the asset is Impairments are analysed between Departmental available for immediate sale in its present condition Expenditure Limits (DEL) and Annually Managed and management is committed to the sale, which is Expenditure (AME) from 2011-12. This is necessary expected to qualify for recognition as a completed to comply with Treasury’s budgeting guidance. sale within one year from the date of classification. DEL limits are set in the Spending Review and Non-current assets held for sale are measured at Departments (eg the Department of Health) may the lower of their previous carrying amount and fair not exceed the limits that they have been set. AME value less costs to sell. Fair value is open market budgets are set by Treasury and may be reviewed value including alternative uses. with departments in the run up to the Budget. The profit or loss arising on disposal of an asset is Departments need to monitor AME closely and the difference between the sale proceeds and the inform Treasury if they expect AME spending to carrying amount and is recognised in the Statement rise above forecast. Whilst Treasury accepts that of Comprehensive Income. On disposal, the in some areas of AME inherent volatility may mean balance for the asset on the revaluation reserve is departments do not have the ability to manage transferred to retained earnings. the spending within budgets in that financial year, any expected increases in AME require Treasury Property, plant and equipment that is to be approval. scrapped or demolished does not qualify for recognition as held for sale. Instead, it is retained 1.11 Donated Assets as an operational asset and its economic life is Following the accounting policy change outlined adjusted. The asset is de-recognised when it is the Treasury FREM for 2011-12, a donated asset scrapped or demolished. reserve is no longer maintained. Donated non- current assets are capitalised at their fair value on 1.14 Leases receipt, with a matching credit to income. They Leases are classified and accounted for as finance are valued, depreciated and impaired as described leases when substantially all the risks and rewards above for purchased assets. Gains and losses on of ownership are transferred to the lessee and the revaluations, impairments and sales are as described value of the asset is greater than £50,000. All other above for purchased assets. Deferred income is leases are classified as operating leases. only recognised where conditions attached to the Property, plant and equipment held under finance donation preclude immediate recognition of the leases are initially recognised, at the inception gain. of the lease, at fair value, or, if lower, at the 1.12 Government Grants present value of the minimum lease payments, Following the accounting policy change outlined with a matching liability for the lease obligation the Treasury FREM for 2011-12, a government to the lessor. Lease payments are apportioned grant reserve is no longer maintained. The value of between finance charges and reduction of the assets received by means of a government grant are lease obligation so as to achieve a constant rate of credited directly to income. Deferred income is only interest on the remaining balance of the liability. recognised where conditions attached to the grant Finance charges are recognised in calculating the preclude immediate recognition of the gain. trust’s surplus/deficit.

Operating lease payments are recognised as an expense on a straight line basis over the lease term.

Annual Report and Accounts 2012/2013 141 Lease incentives are recognised initially as a liability required to settle the obligation at the end of the and subsequently as a reduction of rentals on a reporting period, taking into account the risks and straight line basis over the lease term. uncertainties. Where a provision is measured using the cash flows estimated to settle the obligation, its 1.15 Inventories carrying amount is the present value of those cash Inventories are valued at the lower of cost and flows using HM Treasury’s discount rates - 2.2% in net realisable value using either the first-in first- real terms for general provisions (no change from out (manually recorded inventories) or weighted 2011/12) and 2.35% for pensions related liabilities average (computerised inventories) cost formula. (2.8% in 2011/12). This is considered to be a reasonable approximation to fair value due to the high turnover of inventories. When some or all of the economic benefits required to settle a provision are expected to be recovered Manually recorded inventories are counted once a from a third party, the receivable is recognised as an year. Computerised inventories are the subject of asset if it is virtually certain that reimbursements will rolling counts during the year. Certain inventories be received and the amount of the receivable can on wards and departments (including sterile be measured reliably. supplies) are covered by a materials management topping up system. The level of materials Present obligations arising under onerous contracts management inventories held by wards and are recognised and measured as a provision. An departments are estimated using a formula agreed onerous contract is considered to exist where the by external audit. Likewise, the value of ward/ Trust has a contract under which the unavoidable department drug inventories are estimated using a costs of meeting the obligations under the contract formula agreed with external audit. From 2009/10, exceed the economic benefits expected to be other ward and department inventories with a value received under it. less than £10,500 (per ward/department) are not A restructuring provision is recognised when the included in the inventories balance. Trust has developed a detailed formal plan for the 1.16 Cash and cash equivalents restructuring and has raised a valid expectation in those affected that it will carry out the restructuring Cash is cash in hand and deposits with any financial by starting to implement the plan or announcing institution repayable without penalty on notice its main features to those affected by it. The of not more than 24 hours. Cash equivalents measurement of a restructuring provision includes are investments that mature in 3 months or less only the direct expenditures arsing from the from the date of acquisition and that are readily restructuring, which are those amounts that are convertible to known amounts of cash with both necessarily entailed by the restructuring and insignificant risk of change in value. not associated with ongoing activities of the entity. In the Statement of Cash Flows, cash and cash equivalents are shown net of bank overdrafts that 1.18 Clinical negligence costs are repayable on demand and that form an integral The NHS Litigation Authority (NHSLA) operates a part of the Trust’s cash management. risk pooling scheme under which the trust pays an annual contribution to the NHSLA which in 1.17 Provisions return settles all clinical negligence claims. The Provisions are recognised when the Trust has contribution is charged to expenditure. Although a present legal or constructive obligation as a the NHSLA is administratively responsible for all result of a past event, it is probable that the Trust clinical negligence cases the legal liability remains will be required to settle the obligation, and a with the trust. The total value of clinical negligence reliable estimate can be made of the amount provisions carried by the NHSLA on behalf of the of the obligation. The amount recognised as a trust is disclosed at note 25. provision is the best estimate of the expenditure

Annual Report and Accounts 2012/2013 142 1.19 Non-clinical risk pooling 1.22 Financial assets The Trust participates in the Property Expenses Financial assets are recognised when the Trust Scheme and the Liabilities to Third Parties Scheme. becomes party to the financial instrument contract Both are risk pooling schemes under which the trust or, in the case of trade receivables, when the goods pays an annual contribution to the NHS Litigation or services have been delivered. Financial assets Authority and, in return, receives assistance with are derecognised when the contractual rights have the costs of claims arising. The annual membership expired or the asset has been transferred. contributions, and any excesses payable in respect Financial assets are initially recognised at fair value. of particular claims are charged to operating expenses as and when they become due. Financial assets are classified into the following 1.20 EU Emissions Trading Scheme categories: financial assets at fair value through profit and loss; held to maturity investments; EU Emission Trading Scheme allowances are available for sale financial assets, and loans and accounted for as government grant funded receivables. The classification depends on the intangible assets if they are not expected to be nature and purpose of the financial assets and is realised within twelve months, and otherwise as determined at the time of initial recognition. other current assets. They are valued at open market value. As the NHS body makes emissions, a Other than NHS trade receivables, non NHS trade provision is recognised with an offsetting transfer receivables and other receivables (relating to the from the government grant reserve. The provision injury cost recovery scheme) the Trust does not have is settled on surrender of the allowances. The asset, any other financial assets. provision and government grant reserve are valued at fair value at the end of the reporting period. 1.23 Financial liabilities Financial liabilities are recognised on the statement 1.21 Contingencies of financial position when the trust becomes A contingent liability is a possible obligation that party to the contractual provisions of the financial arises from past events and whose existence will instrument or, in the case of trade payables, when be confirmed only by the occurrence or non- the goods or services have been received. Financial occurrence of one or more uncertain future liabilities are de-recognised when the liability has events not wholly within the control of the trust, been discharged, that is, the liability has been paid or a present obligation that is not recognised or has expired. because it is not probable that a payment will be Loans from the Department of Health are required to settle the obligation or the amount recognised at historical cost. Otherwise, financial of the obligation cannot be measured sufficiently liabilities are initially recognised at fair value. reliably. A contingent liability is disclosed unless the possibility of a payment is remote. Other than NHS payables, non NHS payables and provisions, the Trust does not have any other A contingent asset is a possible asset that arises financial liabilities. from past events and whose existence will be confirmed by the occurrence or non-occurrence 1.24 Value Added Tax of one or more uncertain future events not wholly Most of the activities of the trust are outside the within the control of the trust. A contingent asset scope of VAT and, in general, output tax does not is disclosed where an inflow of economic benefits is apply and input tax on purchases is not recoverable. probable. Irrecoverable VAT is charged to the relevant Where the time value of money is material, expenditure category or included in the capitalised contingencies are disclosed at their present value. purchase cost of fixed assets. Where output tax is charged or input VAT is recoverable, the amounts are stated net of VAT.

Annual Report and Accounts 2012/2013 143 1.25 Foreign currencies different categories, which govern the way that The Trust’s functional currency and presentational individual cases are handled. currency is sterling. Transactions denominated Losses and special payments are charged to the in a foreign currency are translated into sterling relevant functional headings in expenditure on an at the exchange rate ruling on the dates of the accruals basis, including losses which would have transactions. At the end of the reporting period, been made good through insurance cover had monetary items denominated in foreign currencies NHS trusts not been bearing their own risks (with are retranslated at the spot exchange rate on 31 insurance premiums then being included as normal March. Resulting exchange gains and losses for revenue expenditure). either of these are recognised in the trust’s surplus/ deficit in the period in which they arise. 1.29 Subsidiaries Material entities over which the Trust has the power 1.26 Third party assets to exercise control so as to obtain economic or Assets belonging to third parties (such as money other benefits are classified as subsidiaries and are held on behalf of patients) are not recognised in the consolidated. Their income and expenses; gains accounts since the trust has no beneficial interest in and losses; assets, liabilities and reserves; and cash them. Details of third party assets are given in note flows are consolidated in full into the appropriate 31 to the accounts. financial statement lines. Appropriate adjustments 1.27 Public Dividend Capital (PDC) and are made on consolidation where the subsidiary’s PDC dividend accounting policies are not aligned with the Trust’s or where the subsidiary’s accounting date is before Public dividend capital represents taxpayers’ equity 1 January or after 30 June. in the NHS trust. At any time the Secretary of State can issue new PDC to, and require repayments of Subsidiaries that are classified as ‘held for sale’ are PDC from, the trust. PDC is recorded at the value measured at the lower of their carrying amount or received. As PDC is issued under legislation rather ‘fair value less costs to sell’ than under contract, it is not treated as an equity financial instrument. For 2010/11 and 2011/12, in accordance with the directed accounting policy from the Secretary An annual charge, reflecting the cost of capital of State, the Trust does not consolidate the NHS utilised by the trust, is payable to the Department charitable funds for which it is the corporate of Health as public dividend capital dividend. The trustee. charge is calculated at the real rate set by HM Treasury (3.5%) on the average carrying amount of 2 Accounting Standards issued all assets less liabilities, except for donated assets but not yet adopted. and cash balances with the Office of the Paymaster The Treasury FREM does not require the following General. The average carrying amount of assets Standards and Interpretations to be applied in is calculated as a simple average of opening and 2012-13. The application of the Standards as closing relevant net assets. revised would not have a material impact on the 1.28 Losses and Special Payments accounts for 2012-13, were they applied in that year: Losses and special payments are items that Parliament would not have contemplated when IAS 27 Separate Financial Statements – it agreed funds for the health service or passed subject to consultation legislation. By their nature they are items that IAS 28 Investments in Associates and Joint Ventures – ideally should not arise. They are therefore subject subject to consultation to special control procedures compared with the IFRS 9 Financial Instruments – generality of payments. They are divided into subject to consultation

Annual Report and Accounts 2012/2013 144 IFRS 10 Consolidated Financial Statements – financial position of the trust as a whole in their subject to consultation decision making process, rather than individual IFRS 11 Joint Arrangements – components included in the totals, in terms of subject to consultation allocating resources. This process again implies a IFRS 12 Disclosure of Interest in Other entities – single operating segment under IFRS8. subject to consultation The finance report considered monthly by the trust IFRS 13 Fair Value Measurement – board contains summary figures for the whole subject to consultation trust together with divisional budgets and their IPSAS 32 Service Concession Arrangement – cost improvement positions. The statement of subject to consultation financial positions (balance sheet), statement of comprehensive income (I&E), cash flow statement 3. Operating Segments and cash flow forecasts are considered for the All of the trust’s activities are in the provision whole trust in total only. The board as chief of healthcare, which is an aggregate of all the operating decision maker, therefore, only considers individual specialty components included therein, one segment of healthcare in its decision making and the large majority of the trust’s revenue process. originates with the UK Government. The majority of expenses incurred are payroll expenditure on staff The single segment of ‘healthcare’ has been involved in the delivery or support of healthcare identified as consistent with the core principles activities generally across the trust together with the of IFRS8 which is to enable users of financial related supplies and overheads needed to establish statements to evaluate the nature and financial the delivery of healthcare. The activities which earn effects of business activities and economic revenue and incur expenses are, therefore, of one environments. broad combined nature and, therefore, on this basis one segment of ‘healthcare’ is deemed appropriate. 4. Income generation activities The trust undertakes income generation activities The operating results of the trust are reviewed with an aim of achieving profit, which is then used monthly or more frequently by the trust’s chief in patient care. The following provides details operating decision maker which is the overall trust of income generation activities whose full cost board and which includes senior professional non- exceeded £1m or was otherwise material. executive directors. The trust board review the

Car Parking Charges Catering 2012/13 2011/12 2012/13 2011/12 £000 £000 £000 £000 Income 2,226 2,020 1,837 1,572 Full cost 2,216 1,837 2,033 1,814 Surplus/(deficit) 10 183 (196) (242)

Occupational Health 2012/13 2011/12 £000 £000 Income 1,016 1,051 Full cost 996 1,043 Surplus/(deficit) 20 8

Annual Report and Accounts 2012/2013 145 5. Revenue from patient care activities 2012/13 2011/12 £000 £000 Primary care trusts 517,885 527,649 Non-NHS: Private patients 276 303 Overseas patients (non-reciprocal) 484 377 Injury costs recovery 4,507 4,938 Other 296 343 523,448 533,610

Injury cost recovery income is subject to a provision for impairment of receivables of 12.6% to reflect expected rates of collection. 6. Other operating revenue 2012/13 2011/12 £000 £000 Education, training and research 19,711 20,242 Charitable and other contributions to expenditure 0 2 Donated assets (SOFP equipment) 322 382 Non-patient care services to other bodies 13,669 13,557 Income generation 7,447 7,149 Other revenue 5,243 3,148 46,392 44,480

7. Revenue From rendering of services 568,003 576,634 From sale of goods 1,837 1,456 569,840 578,090

Annual Report and Accounts 2012/2013 146 8. Operating expenses 8.1 Operating expenses (excluding employee benefits) 2012/13 2011/12 £000 £000 Services from other NHS trusts 948 861 Services from PCTs 2,354 2,450 Services from other NHS bodies 3,245 3,210 Services from foundation trusts 2,670 3,020 Purchase of healthcare from non NHS bodies 3,095 2,727 Trust chair and non executive directors 61 63 Supplies and services - clinical 85,422 82,563 Supplies and services - general 15,141 14,316 Consultancy services 1,053 2,793 Establishment 9,100 8,351 Transport 1,002 1,020 Premises 20,372 19,460 Provision for impairment of receivables 662 411 Inventories write down 26 54 Depreciation 21,032 20,313 Amortisation 1,011 878 Impairments and reversals of property, plant and equipment 25,273 9,165 Audit fees 167 291 Other auditor’s remuneration 0 18 Clinical negligence 13,813 12,805 Education and Training 1,107 861 Security Services 1,479 1,545 Interpreter Fees 215 153 Clinical waste 538 542 Insurance 572 495 Legal Fees 410 368 Employers Liability and Injury Benefit 1,233 867 Premature Retirement Provision 260 211 Professional Fees 875 831 Other 3,227 2,466 216,363 193,108

8.2 Employee Benefits Employee Benefits excluding Board Members 366,829 378,863 Board Members 1,287 1,339 Total employee benefits 368,116 380,202

Total Operating Expenses 584,479 573,310

Annual Report and Accounts 2012/2013 147 9. Operating leases 9.1 As lessee 2012/13 2011/12 £000 £000 Payments recognised as an expense Minimum lease payments 2,632 2,527 Total future minimum lease payments Payable: Not later than one year 2,304 2,791 Between one and five years 1,873 1,478 After 5 years 0 0 Total 4,177 4,269

9.2 As lessor The trust does not have any significant operating leases as lessor

10. Employee costs and numbers 10.1 Employee costs 2012/13 2011/12 Permanently Permanently Total Other Total Other Employed Employed £000 £000 £000 £000 £000 £000 Salaries and wages 306,400 279,711 26,689 313,347 290,103 23,244 Social Security Costs 22,923 22,092 831 22,775 22,039 736 Employer contributions to NHS Pension scheme 33,785 32,561 1,224 34,407 33,295 1,112 Termination benefits 5,091 5,091 0 9,730 9,730 0 Employee benefits expense 368,199 339,455 28,744 380,259 355,167 25,092

Of the total above: Charged to capital 83 57 Employee benefits charged to revenue 368,116 380,202 368,199 380,259

10.2 Average number of people employed 2012/13 2011/12 Permanently Permanently Total Other Total Other Employed Employed Number Number Number Number Number Number Medical and dental 1,099 999 100 1,097 1,000 97 Administration and estates 1,952 1,872 80 2,007 1,956 51 Healthcare assistants and other support staff 653 645 8 669 663 6 Nursing, midwifery and health visiting staff 3,890 3,607 283 4,033 3,827 206 Nursing, midwifery and health visiting learners 47 47 0 47 47 0 Scientific, therapeutic and technical staff 1,123 1,112 11 1,129 1,117 12 Other 7 7 0 7 7 0 Total 8,771 8,289 482 8,989 8,617 372

Of the above: No.of staff (WTE) engaged on capital projects 3 2

Annual Report and Accounts 2012/2013 148 10.3 Staff sickness absence 2012 2011 Number Number Total days lost 101,809 101,540 Total staff years 10,095 10,370 Average working days lost 10.1 9.8

In line with Department of Health guidance, the above data relates to the calendar year. Figures include doctors for whom Pennine Acute is the lead employer of on behalf of the North West Deanery. 10.4 Exit Packages agreed in year 2012/13 2011/12 Total Total Compulsory Other by cost Compulsory Other by cost Redundancies Departures band Redundancies Departures band Exit package cost band Number Number Number Number Number Number Less than £10,000 2 18 20 0 70 70 £10,001-£25,000 2 13 15 0 23 23 £25,001-£50,000 27 27 0 12 12 £50,001-£100,000 15 15 0 1 1 £101,000-£150,000 4 4 0 0 0 £150,001-£200,000 0 0 0 0 Total number of exit packages by type 4 77 81 0 106 106 Total resource cost (£000s) 50 2,843 2,893 1,177 1,177

All the costs in this note are accounted for in full in the year of departure with the exception of 1 in 2011- 12 for £31k that was charged to 2012-13. The exit packages agreed in 2011-12 relate to a voluntary severance scheme initiated by the Trust during the year. Other departures in 2012-13 relate to voluntary redundancy or individually agreed arrangements. Ill health retirement costs are met by the NHS pensions scheme and are not included in the exit costs table or trust costs for the year.

10.5 Ill Health Retirements 2012/13 2011/12 No. of persons retired on ill health grounds 20 19 Total additional pension liabilities accrued in year £000s 969 1,623

10.6 Pension costs Past and present employees are covered by the provisions of the NHS Pensions Scheme. Details of the benefits payable under these provisions can be found on the NHS Pensions website at www.nhsbsa.nhs.uk/ pensions. The scheme is an unfunded, defined benefit scheme that covers NHS employers, GP practices and other bodies, allowed under the direction of the Secretary of State, in England and Wales. The scheme is not designed to be run in a way that would enable NHS bodies to identify their share of the underlying scheme assets and liabilities. Therefore, the scheme is accounted for as if it were a defined contribution scheme: the cost to the NHS Body of participating in the scheme is taken as equal to the contributions payable to the scheme for the accounting period.

In order that the defined benefit obligations recognised in the financial statements do not differ materially from those that would be determined at the reporting date by a formal actuarial valuation, the FReM requires that “the period between formal valuations shall be four years, with approximate assessments in intervening years”. An outline of these follows:

Annual Report and Accounts 2012/2013 149 a) Accounting valuation The next formal valuation to be used for funding A valuation of the scheme liability is carried out purposes will be carried out at as at March 2012 annually by the scheme actuary as at the end of and will be used to inform the contribution rates to the reporting period. Actuarial assessments are be used from 1 April 2015. undertaken in intervening years between formal c) Scheme provisions valuations using updated membership data and The NHS Pension Scheme provided defined are accepted as providing suitably robust figures benefits, which are summarised below. This list is for financial reporting purposes. The valuation of an illustrative guide only, and is not intended to the scheme liability as at 31 March 2013, is based detail all the benefits provided by the Scheme or the on the valuation data as 31 March 2012, updated specific conditions that must be met before these to 31 March 2013 with summary global member benefits can be obtained: and accounting data. In undertaking this actuarial assessment, the methodology prescribed in IAS 19, The Scheme is a “final salary” scheme. Annual relevant FReM interpretations, and the discount rate pensions are normally based on 1/80th for the prescribed by HM Treasury have also been used. 1995 section and of the best of the last three years pensionable pay for each year of service, and 1/60th The latest assessment of the liabilities of the scheme for the 2008 section of reckonable pay per year is contained in the scheme actuary report, which of membership. Members who are practitioners forms part of the annual NHS Pension Scheme as defined by the Scheme Regulations have their (England and Wales) Pension Accounts, published annual pensions based upon total pensionable annually. These accounts can be viewed on the NHS earnings over the relevant pensionable service. Pensions website. Copies can also be obtained from The Stationery Office. With effect from 1 April 2008 members can choose to give up some of their annual pension for an b) Full actuarial (funding) valuation additional tax free lump sum, up to a maximum The purpose of this valuation is to assess the level amount permitted under HMRC rules. This new of liability in respect of the benefits due under the provision is known as “pension commutation”. scheme (taking into account its recent demographic experience), and to recommend the contribution Annual increases are applied to pension payments rates. at rates defined by the Pensions (Increase) Act 1971, and are based on changes in retail prices in the The last published actuarial valuation undertaken twelve months ending 30 September in the previous for the NHS Pension Scheme was completed for the calendar year. year ending 31 March 2004. Consequently, a formal actuarial valuation would have been due for the year Early payment of a pension, with enhancement, ending 31 March 2008. However, formal actuarial is available to members of the scheme who are valuations for unfunded public service schemes permanently incapable of fulfilling their duties were suspended by HM Treasury on value for money effectively through illness or infirmity. A death grounds while consideration is given to recent gratuity of twice final year’s pensionable pay for changes to public service pensions, and while future death in service, and five times their annual pension scheme terms are developed as part of the reforms for death after retirement is payable to public service pension provision due in 2015. For early retirements other than those due to ill The Scheme Regulations were changed to allow health the additional pension liabilities are not contribution rates to be set by the Secretary of funded by the scheme. The full amount of the State for Health, with the consent of HM Treasury, liability for the additional costs is charged to the and consideration of the advice of the Scheme employer. Actuary and appropriate employee and employer Members can purchase additional service in the representatives as deemed appropriate. NHS Scheme and contribute to money purchase

Annual Report and Accounts 2012/2013 150 AVC’s run by the Scheme’s approved providers or by other Free Standing Additional Voluntary Contributions (FSAVC) providers. 11. Better Payment Practice Code 11.1 Better Payment Practice Code - measure of compliance 2012-13 2010-11 Number £000 Number £000 Total Non-NHS trade invoices paid in the year 113,409 179,005 112,758 180,761 Total Non NHS trade invoices paid within target 109,331 173,801 108,522 175,334 Percentage of Non-NHS trade invoices paid within target 96% 97% 96% 97%

Total NHS trade invoices paid in the year 5,703 42,297 5,359 40,363 Total NHS trade invoices paid within target 5,580 42,144 5,328 39,329 Percentage of NHS trade invoices paid within target 98% 99% 99% 97%

The Better Payment Practice Code requires the Trust to aim to pay all undisputed invoices by the due date or within 30 days of receipt of goods or a valid invoice, whichever is later.

In addition to the Better Payment Practice Policy, the Trust signed up to the Prompt Payment Code (PPC) in March 2010. The Prompt Payment Code is a payment initiative developed in 2009 by Government with The Institute of Credit Management (ICM) to “tackle the crucial issue of late payment and help small businesses.” Details of the code can be found at www.promptpaymentcode.org.uk. 11.2 The Late Payment of Commercial Debts (Interest) Act 1998 The trust has not incurred any interest charges as a result of the late payment of commercial debts 12. Investment revenue 2012-13 2011-12 £000 £000 Interest revenue: Bank accounts 141 125 13. Other gains and losses 2012-13 2011-12 £000 £000 Gain/(loss) on disposal of property, plant and equipment 109 (53) 14. Finance Costs 2012-13 2011-12 £000 £000 Interest on loans 2,202 1,808 Interest on obligations under finance lease 18 36 Unwinding of discount factor (provisions) 271 275 Total 2,491 2,119

Annual Report and Accounts 2012/2013 151 152

15. Property, plant and equipment (PPE)/Intangibles

Buildings Computer AUC and Plant and Transport Information Furniture 2012-13 Land excluding Dwellings Total PPE Software - POA* machinery equipment technology & fittings dwellings purchased £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 Cost or valuation at 1 April 2012 48,033 285,069 466 26,658 89,944 1,310 27,180 2,031 480,691 8,997 Additions purchased 18,753 3,468 8,742 50 2,025 1,077 34,115 3,320 Additions donated 287 28 7 322 0 Reclassifications 25,513 (25,589) 57 19 0 0 Disposals (4,889) (716) (2,748) (8,353) (953) Revaluation/indexation loss (13,486) (33) (13,519) 0 Impairments 0 0 At 31 March 2013 48,033 315,849 433 4,537 94,141 672 26,464 3,127 493,256 11,364 Annual Reportand Accounts 2012/2013

Depreciation ** at 1 April 2012 0 69,461 37 0 52,314 957 14,588 1,009 138,366 5,132 Disposals (4,732) (716) (2,748) (8,196) (953) Impairments 25,273 25,273 0 Charged during the year 8,643 11 8,836 49 3,299 194 21,032 1,011 Depreciation at 31 March 2013 0 103,377 48 0 56,418 290 15,139 1,203 176,475 5,190

Net book value Purchased 46,783 210,963 385 4,537 36,255 354 11,319 1,921 312,517 6,174 Donated 1,250 1,259 0 0 1,218 28 6 3 3,764 0 Government granted 0 250 0 0 250 0 0 0 500 0 Total at 31 March 2013 48,033 212,472 385 4,537 37,723 382 11,325 1,924 316,781 6,174

Asset financing Owned 48,033 212,472 385 4,537 37,597 382 11,325 1,924 316,655 6,174 Finance leased 0 0 0 0 126 0 0 0 126 0 Private finance initiative 0 0 0 0 0 0 0 0 0 0 Total 31 March 2013 48,033 212,472 385 4,537 37,723 382 11,325 1,924 316,781 6,174 15.1 Revaluation reserve balance for property, plant & equipment Buildings AUC and Plant and Transport Information Furniture 2012-13 Land excluding Dwellings Total PPE POA* machinery equipment technology & fittings dwellings £000 £000 £000 £000 £000 £000 £000 £000 £000 At 1 April 2012 25,762 48,700 284 n/a 5,253 39 0 133 80,171 Movements 151 (21,191) (58) n/a (727) (27) 0 (13) (21,865) At 31 March 2013 25,913 27,509 226 n/a 4,526 12 0 120 58,306 * AUC - assets under construction, POA - payments on account. ** amortisation for intangible assets The net book value of PPE disposals during the year was £157k (Cost £8,353k less depreciation £8,196k). 15.1 Property, plant and equipment (cont.) Donated Assets During the year The Pennine Acute Hospitals Charity has donated equipment purchased at a cost of £322,000.

Asset Revaluations A full revaluation of land and buildings was performed during 2011/12 by the District Valuer with an effective date of 30 September 2011. The building cost index and associated location factor has fallen since that date by 8%. Building values have been adjusted to reflect this at the end of March 2013 resulting in a reduction in building value of £16.5m. Land values have remained steady and have not been adjusted.

Asset Lives There have been no changes during the year in the lives applied to the Trust assets Life applied Min Max Buildings exc Dwellings 5 58 Dwellings 29 34 Plant & Machinery 3 15 Transport Equipment 5 10 Information Technology 5 8 Furniture and Fittings 5 15

There has been no compensation from third parties for assets impaired included in the trust’s surplus.

The Trust has no temporary idle assets

The gross carrying amount of fully depreciated assets still in use is £32.9m (2011-12 £36.6m). 15.2 Intangible assets Asset Revaluations There have been no revaluations to intangible assets during the year and there are no revaluation balances held for intangibles.

For all purchased software the trust applies a finite life of between 5 and 9 years.

The trust still has fully amortised purchased software in use with a replacement cost of £1.6m (2011-12 £2.3m) 16. Impairments The District Valuer has reviewed newly contructed buildings/enhancements and assets declared surplus. This has resulted in an impairment charge of £22.2m which, together with the amount of downward revaluations for existing assets that cannot be absorbed by previous upward valuations held in the revaluation reserve (£3.1m), results in an impairment charge of £25.3m to operating expenses. Impairments charged to operating expenses do not affect the financial performance of the Trust. Such impairments are managed overall by the Department of Health on an annual basis as part of Annually Managed Expenditure totals (AME).

Annual Report and Accounts 2012/2013 153 17. Capital commitments Contracted capital commitments at 31 March not otherwise included in these financial statements:

31 March 2013 31 March 2012 £000 £000 Property, plant and equipment 9,505 15,437 Intangible Assets 62 0 18. Inventories 18.1 Inventories 31 March 2013 31 March 2012 £000 £000 Drugs 2,460 2,392 Consumables 5,865 5,364 Energy 320 370 Total 8,645 8,126 18.2 Inventories recognised in expenses 31 March 2013 31 March 2012 £000 £000 Inventories recognised as an expense in the period 34,817 44,415 Write-down of inventories (including losses) 26 54 19. Trade and other receivables 19.1 Trade and other receivables Current Non-current Current Non-current 31 March 31 March 31 March 31 March 2013 2013 2012 2012 £000 £000 £000 £000 NHS receivables-revenue 18,446 0 9,818 0 NHS receivables-capital 0 0 0 0 Non-NHS receivables-revenue 132 0 190 0 Non-NHS receivables-capital 0 0 3,242 0 Provision for the impairment of receivables (1,220) (1,117) (975) (918) Non NHS prepayments and accrued income 3,753 0 3,591 0 VAT 956 0 1,448 0 Other receivables 7,038 4,547 7,313 4,741 Total 29,105 3,430 24,627 3,823

The great majority of trade is with Primary Care Trusts, as commissioners for NHS patient care services. As Primary Care Trusts are funded by Government to buy NHS patient care services, no credit scoring of them is considered necessary.

The trust is the lead employer for doctors in training on behalf of the North West Deanery. The trust is responsible for the employment and payment of almost 2000 doctors in training under the lead employer contract with an annual value of approximately £117m (11/12 £115m). The costs are recharged to the relevant NHS organisation (22) throughout the North West (including Pennine Acute). Only the costs and associated numbers of the Deanery doctors in training to Pennine Acute (approximately 12%) are shown in Pennine Acute’s expenditure account and workforce numbers. NHS receivables includes £9.7m debt (11/12 £4.5m) relating to outstanding recharges to other organisations.

Annual Report and Accounts 2012/2013 154 19.2 Receivables past their due date but not impaired

31 March 2013 31 March 2012 £000 £000 By up to three months 590 304 By three to six months 212 313 By more than six months 299 314 Total 1,101 931 19.3 Provision for impairment of receivables 31 March 2013 31 March 2012 £000 £000 Balance at 1 April (1,893) (1,627) Amount written off during the year 219 145 Amount recovered during the year 209 169 (Increase)/decrease in receivables impaired (872) (580) Balance at 31 March (2,337) (1,893)

The provision mainly relates to overseas visitors and injury cost recovery receivables 20. Cash and cash equivalents 31 March 2013 31 March 2012 £000 £000 Balance at 1 April 24,580 16,585 Net change in year (8,569) 7,995 Balance at 31 March 16,011 24,580 Made up of Cash with Government Banking Services 15,988 24,456 Commercial banks and cash in hand 23 124 Cash/cash equivalents in statement of financial position 16,011 24,580 Cash/cash equivalents as in statement of cash flows 16,011 24,580 21. Trade and other payables Current 31 March 2013 31 March 2012 £000 £000 NHS payables-revenue 3,189 5,042 Non NHS trade payables - revenue 2,239 1,368 Non NHS trade payables - capital 9,001 5,720 Non NHS accruals and deferred income 26,122 23,769 Social security costs 703 4,670 Tax 476 269 NHS Pensions 156 0 Other 760 562 Total 42,646 41,40

A proportion of the tax and social security creditors in total relates to the trust’s contract as lead employer for doctors in training for the North West Deanery (see also note 19.1)

Annual Report and Accounts 2012/2013 155 21.1 Deferred Income Current 31 March 2013 31 March 2012 £000 £000 Opening balance at 1 April 4,995 7,242 Deferred income addition 1,032 3,205 Transfer of deferred income (3,416) (5,452) Deferred income at 31 March 2,611 4,995 22. Borrowings Current Non-current 31 March 31 March 31 March 31 March 2013 2012 2013 2012 £000 £000 £000 £000 Loans from: Department of Health 3,104 2,464 64,798 53,218 Finance lease liabilities 34 182 37 71 Total 3,138 2,646 64,835 53,289

Total current and non current 67,973 55,935

In 2009-10, the trust secured a loan of £42.050m over 25 years from the Department of Health to support the Womens & Children development at North Manchester General Hospital and the additional capacity development (above Radiotherapy) at the Royal Oldham Hospital. This was drawn down in 2009-10 and 2010-11. In 2011-12 the trust secured a loan of £36m to support Womens & Children development at the Royal Oldham Hospital. £18m of this loan was drawn down in 2011-12, £15m drawn in 2012/13 and £3m will be drawn in 2013/14.

Loans - repayment of principal falling due in: 31 March 2013 DoH Other Total £000 £000 £000 0-1 years 3,104 34 3,138 1-2 years 3,104 37 3,141 2-5 years 9,312 0 9,312 > 5 years 52,382 0 52,382 67,902 71 67,973

Annual Report and Accounts 2012/2013 156 24. Finance lease obligations Amounts payable under finance leases: Minimum Present value Minimum Present value lease of minimum lease of minimum payments lease payments payments lease payments 31 March 31 March 31 March 31 March 2013 2013 2012 2012 £000 £000 £000 £000 Within one year 39 34 200 182 Between one and five years 39 37 78 71 After five years 0 0 0 0 Less future finance charges (7) (25) Present value of minimum lease payments 71 71 253 253

Included in: Current borrowings 34 182 Non-current borrowings 37 71 71 253

The finance lease relates to analyser equipment supplied as part of a managed service contract in Pathology. The lease started 1 April 2010 and expires in 2014/15. 25. Provisions Current Non-current Current Non-current 31 March 31 March 31 March 31 March 2013 2013 2012 2012 £000 £000 £000 £000 Pensions relating to other staff 323 3,110 306 3,242 Legal claims 283 141 284 142 Restructurings 101 1,834 91 1,744 Redundancy 5,777 0 8,594 0 Other 4,639 4,687 3,949 4,092 Total 11,123 9,772 13,224 9,220

Pensions Employers & relating to Public Liability Restruc- Redun- other staff Legal Claims turings dancy Other Total £000 £000 £000 £000 £000 £000 At 1 April 2012 3,548 426 1,835 8,594 8,041 22,444 Arising during the year 183 306 95 5,060 2,596 8,240 Used during the year (292) (264) (132) (2,420) (650) (3,758) Reversed unused (200) (44) (5,457) (1,035) (6,736) Change of discount rate 94 86 254 434 Unwinding of discount 100 51 120 271 At 31 March 2013 3,433 424 1,935 5,777 9,326 20,895

Expected timing of cash flows: Within one year 323 283 101 5,777 4,639 11,123 Between one and five years 1,291 141 404 912 2,748 After five years 1,819 1,430 3,775 7,024

Annual Report and Accounts 2012/2013 157 Pensions relating to other staff refer to pre 1995 early retirements. The restructurings provision relates to the costs of restructuring associated with the creation of Pennine Acute Hospitals NHS Trust from the four predecessor Trusts in April 2002 (Bury, Rochdale, Oldham and North Manchester). Other provisions relate mainly to permanent injury benefits payable, contract issues and changes to pay.

£102.9m is included in the provisions of the NHS Litigation Authority in respect of clinical negligence liabilities of the trust (31/03/12 £107.2m).

26. Contingencies 26.1 Contingent liabilities 2012/13 2011/12 £000 £000 The trust’s liability to third parties (public and employers) under the (217) (186) scheme operated by the NHSLA 26.2 Contingent assets The trust does not have any contingent assets. 27 Financial risk management Financial reporting standard IFRS 7 requires disclosure of the role that financial instruments have had during the period in creating or changing the risks a body faces in undertaking its activities. Because of the continuing service provider relationship that the NHS trust has with primary care trusts and the way those primary care trusts are financed, the NHS trust is not exposed to the degree of financial risk faced by business entities. Also financial instruments play a much more limited role in creating or changing risk than would be typical of listed companies, to which the financial reporting standards mainly apply. The NHS trust has limited powers to borrow or invest surplus funds and financial assets and liabilities are generated by day-to-day operational activities rather than being held to change the risks facing the NHS trust in undertaking its activities.

The trust’s treasury management operations are carried out by the finance department, within parameters defined formally within the trust’s standing financial instructions and policies agreed by the board of directors. Trust treasury activity is subject to audit by the trust’s internal auditors.

Currency risk The trust is principally a domestic organisation with the great majority of transactions, assets and liabilities being in the UK and sterling based. The trust has no overseas operations. The trust therefore has low exposure to currency rate fluctuations.

Interest rate risk The trust borrows from government for capital expenditure, subject to affordability as confirmed by the strategic health authority. The borrowings are for 1 – 25 years, in line with the life of the associated assets, and interest is charged at the National Loans Fund rate, fixed for the life of the loan. The trust therefore has low exposure to interest rate fluctuations.

Credit risk Because the majority of the trust’s income comes from contracts with other public sector bodies, the trust has low exposure to credit risk. The maximum exposures as at 31 March 2013 are in receivables from customers, as disclosed in the Trade and other receivables note.

Annual Report and Accounts 2012/2013 158 Liquidity risk The trust’s operating costs are incurred under contracts with primary care trusts, which are financed from resources voted annually by Parliament . The trust funds its capital expenditure from funds obtained within its prudential borrowing limit. The trust is not, therefore, exposed to significant liquidity risks.

28 Events after the reporting period There are no events after the reporting period to report.

29. Financial performance targets International Financial Reporting Standards (IFRS) were introduced in 2009-10. The figures given for periods prior to 2009/10 are on a UK GAAP basis as that is the basis on which the targets were set for those years. 29.1 Breakeven Performance Restated 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 £000 £000 £000 £000 £000 £000 Turnover 499,444 513,531 557,760 557,007 578,090 569,840 Retained surplus/(deficit) for the 9,472 48 (22,252) (12,642) (6,248) (25,416) year Adjustments for Impairments 197 22,872 12,610 9,165 25,273 Adjustments for donated assets 291 636 168 Break-even in-year position 9,472 245 620 259 3,553 25 Break-even cumulative position 1,992 2,237 2,857 3,116 6,669 6,694 Materiality test (i.e. is it equal to or less than 0.5%): % % % % % % In-year position as a %tage of 1.9 0.0 0.1 0.0 0.6 0.0 turnover Cumulative as a %tage of 0.4 0.4 0.5 0.6 1.2 1.2 turnover

The trust achieved a surplus of 0.6% in 2011-12 as part of a strategy to improve liquidity year on year in line with the trust’s application to become a foundation trust. The Trust achieved a small surplus in 2012- 13. 29.2 Capital cost absorption rate Until 2008/09 the trust was required to absorb the cost of capital at a rate of 3.5% of forecast average relevant net assets. The rate is calculated as the percentage that dividends paid on public dividend capital bears to the actual average relevant net assets.

From 2009/10 the dividend payable on public dividend capital is based on 3.5% of the actual (rather than forecast) average relevant net assets and, therefore, the actual capital cost absorption rate is automatically 3.5%.

Annual Report and Accounts 2012/2013 159 29.3 External financing The trust is given an external financing limit which it is permitted to undershoot. 2012/13 2011/12 £000 £000 External financing limit 20,641 14,551 Cash flow financing 20,608 7,750 Finance leases taken out in the year 0 0 Other capital receipts 0 0 External financing requirement 20,608 7,750

Undershoot/(overshoot) 33 6,801

In 2011-12 the undershoot has arisen due to a combination of delays in the Trust’s reconfiguration schemes and revised cash flows for the Royal Oldham scheme. This continued to be the case in 2012-13. 29.4 Capital Resource Limit The trust is given a capital resource limit which it is not permitted to exceed. 2012/13 2011/12 £000 £000 Gross capital expenditure 37,756 36,108 Less: book value of assets disposed of (156) (383) Plus: loss on disposal of donated assets 0 0 Less: capital grants 0 0 Less: donations towards the acquisition of non-current assets (322) (382) Charge against the capital resource limit 37,278 35,343 Capital resource limit 38,317 42,351 (Over)/Underspend against the capital resource limit 1,039 7,008 30. Related party transactions During the year no trust board members or members of the key management staff, or parties related to any of them, has undertaken any material transactions with The Pennine Acute Hospitals NHS Trust. The Department of Health is regarded as a related party. During the year The Pennine Acute Hospitals NHS Trust has had a significant number of material transactions with the Department, and with other entities for which the Department is regarded as the parent Department. The main transactions and balances in each category are shown below: Amounts Amounts Related Party Expenditure Revenue owed to owed from £000s £000s £000s £000s Heywood, Middleton & Rochdale PCT 132,978 2,324 Oldham PCT 124,352 Manchester PCT 1,682 117,396 1,680 NHS Bury PCT 94,033 NHS North West 20,051 East Lancashire PCT 9,887 Salford PCT 12,514 Tameside & Glossop PCT 6,868 Pennine Care NHS FT 799 5,210 23 621 Manchester Mental Health Trust 176 3,426 711

Annual Report and Accounts 2012/2013 160 Amounts Amounts Related Party Expenditure Revenue owed to owed from £000s £000s £000s £000s NHS Litigation Authority 14,277 Central Manchester NHS FT 2,019 39 3,720 Salford Royal NHS FT 417 136 957 Christie Hospitals NHS FT 911 92 490 South Manchester University NHS FT 15 2,116 Lancashire Teaching NHS FT 242 20 Northumbria NHS FT 61 East Lancashire NHS Trust 1,529

In addition, the trust has had a number of material transactions with other government departments and other central and local government bodies. Most of these transactions have been with HMRC, Bury MBC, Oldham MBC, Rochdale MBC and Manchester City Council.

The trust has also received revenue and capital payments from a number of charitable funds, which include the Pennine Acute Hospitals Charity. The Trust Board is the corporate trustee of the charity.

31. Third party assets The Trust held £1,000 cash and cash equivalents at 31 March 2013 (£4,000 at 31 March 2012) which relates to monies held by the NHS Trust on behalf of patients. This has been excluded from the cash and cash equivalents figure reported in the accounts.

32. Intra-Government and other balances Current Non-cur- Current Non-cur- receiv- rent re- pay- rent ables ceivables ables payables £000 £000 £000 £000 Balances with other central government bodies 5,213 0 2,601 0 Balances with local authorities 0 0 0 0 Balances with bodies outside the departmental group 14 0 26 0 Balances with NHS trusts and foundation trusts 13,219 0 562 0 Balances with public corporations and trading funds 0 0 0 0 Intra government balances 18,446 0 3,189 0 Balances with bodies external to government 10,659 3,430 39,457 0 At 31 March 2013 29,105 3,430 42,646 0

Balances with other central government bodies 4,782 0 9,100 0 Balances with local authorities 0 0 0 0 Balances with NHS trusts and foundation trusts 6,484 0 881 0 Balances with public corporations and trading funds 0 0 0 0 Intra government balances 11,266 0 9,981 0 Balances with bodies external to government 13,361 3,823 31,419 0 At 31 March 2012 24,627 3,823 41,400 0 33. Losses and special payments In 2012-13 there were 402 cases of losses and special payments (2011-12: 326 cases) totalling £1,492,658 (2011-12: £1,064,162).

Annual Report and Accounts 2012/2013 161 Remuneration

The membership of the Trust’s Remuneration The executive directors are employed on permanent Committee comprises the chairman and non- contracts. The chief executive is required to give six executive directors with the chief executive months notice of termination of employment and attending as required. The committee determines the other executive directors three months. on behalf of the Board the remuneration and terms There are no special guaranteed termination of service arrangements of the chief executive, payments or compensation payments for early executive directors and other senior employees, termination of executives. Executives are subject ensuring they are fairly rewarded for their only to the same redundancy rights as all other contribution to the Trust. The chairman undertook employees of the Trust. an assessment of the chief executive measured against achievement of the corporate objectives. The chief executive undertook similar assessments with the other executive directors.

A) Remuneration 2012-13 2011-12 Other Re- Benefits Other Re- Benefits Salary muneration in Kind Salary muneration in Kind (bands (bands of (bands of of (bands of Name and Title £5000) £5000) £000 £5000) £5000) £000 J Saxby, Chief Executive 180-185 5 180-185 5 RB Steven, Deputy Chief Executive/Director of Finance 130-135 - commenced 12/7/12 B Herring, Acting Director of Finance & IMT to 11/7/12 35-40 60-65 S Bradley, Medical Director left 3/2/13 120-122 80-85 C Kenny, Acting Medical Director commenced 4/2/13 20-25 - M Carroll, Director of Nursing 115-120 115-120 R Pickering, Director of Human Resources 140-145 140-145 J Wilkes, Director of Facilities 105-110 105-110 H Mullen, Director of Operations 140-145 140-145 J Jesky, Chairman 20-25 20-25 TD Pickstone, Non Executive Director left 31/12/12 0-5 5-10 E Ahmad, Non Executive Director 5-10 5-10 C Mayer, Non Executive Director 5-10 5-10 M Holly, Non Executive Director 5-10 5-10 C Guereca, Non Executive Director 5-10 5-10 M Ollerenshaw, Non Executive Director 5-10 0-5 S Dixon, Non Executive Direcor commenced 1/3/13 0-5

Annual Report and Accounts 2012/2013 162 B) Pension Benefits

Name and title Real Real Total Lump sum Cash Cash Real Employers increase increase accrued at aged 60 Equivalent Equivalent Increase Contribution in in lump pension related to Transfer Transfer in Cash to pension sum at at age accrued Value at Value at Equivalent Stakeholder at age 60 age 60 60 at 31 pension at 31 March 31 March Transfer Pension March 31 March 2013 2012 Value 2013 2013 (bands of (bands of (bands of (bands of £2500) £2500) £5000) £5000) £000 £000 £000 £000 £000 £000 £000 £000 J Saxby, Chief Executive * ------RB Steven, Deputy Chief Executive/Director of Finance 0.0 - 2.5 5.0 - 7.5 30 - 35 100 - 105 736 626 65 commenced 12/7/12 B Herring, Acting Director of (0.0 - 2.5) (0.0 - 2.5) 45 - 50 140 - 145 994 953 11 Finance & IMT to 11/7/12 S Bradley, Medical Director left 10.0 - 2.5 - 5.0 45 - 50 135 - 140 0 712 (734) 3/2/13 12.5 M Carroll, Director of Nursing (0.0 - 2.5) (5.0 - 7.5) 55 - 60 175 - 180 1,341 1,304 (3) R Pickering, Director of 0.0 - 2.5 2.5 - 5.0 10 - 15 35 - 40 249 203 39 Human Resources J Wilkes, Director of Facilities 0.0 - 2.5 0.0 - 2.5 30 - 35 100 - 105 698 651 27 H Mullen, Director of 47.5 - 160.0 - 50 - 55 160 - 165 1,027 57 968 Operations 50.0 162.5 H Mullen, Director of 0-2.5 - 0-5.0 - 57 23 33 Operations

* J Saxby, Chief Executive no longer contributes into the NHS Pension scheme

As Non-Executive members do not receive CETV figures, and the other pension details, include pensionable remuneration, there will be no entries the value of any pension benefits in another scheme in respect of pensions for Non-Executive members. or arrangement which the individual has transferred to the NHS pension scheme. They also include any A Cash Equivalent Transfer Value (CETV) is the additional pension benefit accrued to the member actuarially assessed capital value of the pension as a result of their purchasing additional years of scheme benefits accrued by a member at a pension service in the scheme at their own cost. particular point in time. The benefits valued are CETVs are calculated within the guidelines and the member’s accrued benefits and any contingent framework prescribed by the Institute and Faculty of spouse’s pension payable from the scheme. A Actuaries. CETV is a payment made by a pension scheme, or arrangement to secure pension benefits in another Real Increase in CETV - This reflects the increase in pension scheme or arrangement when the member CETV effectively funded by the employer. It takes leaves a scheme and chooses to transfer the benefits account of the increase in accrued pension due accrued in their former scheme. The pension figures to inflation, contributions paid by the employee shown relate to the benefits that the individual has (including the value of any benefits transferred from accrued as a consequence of their total membership another pension scheme or arrangement) and uses of the pension scheme, not just their service in a common market valuation factors for the start and senior capacity to which the disclosure applies. The end of the period.

Annual Report and Accounts 2012/2013 163 Pension Benefits common market valuation factors for the start and As Non-Executive members do not receive end of the period. pensionable remuneration, there will be no entries in respect of pensions for Non-Executive members. Pay Multiples From 2011-12 reporting bodies are required to A Cash Equivalent Transfer Value (CETV) is the disclose the relationship between the remuneration actuarially assessed capital value of the pension of the highest-paid director in their organisation scheme benefits accrued by a member at a and the median remuneration of the organisation’s particular point in time. The benefits valued are workforce. the member’s accrued benefits and any contingent spouse’s pension payable from the scheme. A The banded remuneration of the highest paid CETV is a payment made by a pension scheme, or director in the trust (Chief Executive) in the financial arrangement to secure pension benefits in another year 2012-13 was £187,500 (2011-12, £187,500). pension scheme or arrangement when the member This was 7.3 times (2011-12, 7.3 times) the median leaves a scheme and chooses to transfer the benefits remuneration of the workforce, which was £25,528 accrued in their former scheme. The pension figures (2011-12, £25,528). There has been no change shown relate to the benefits that the individual has between years. accrued as a consequence of their total membership In 2012-13 2 employees received remuneration in of the pension scheme, not just their service in a excess of the highest-paid director. Remuneration senior capacity to which the disclosure applies. The ranged from £192,100 to £193,300. In 2011-12 no CETV figures, and the other pension details, include employee received remuneration in excess of the the value of any pension benefits in another scheme highest-paid director. or arrangement which the individual has transferred to the NHS pension scheme. They also include any Total remuneration includes salary, non-consolidated additional pension benefit accrued to the member performance-related pay (eg clinical excellence as a result of their purchasing additional years of awards), benefits-in-kind as well as severance pension service in the scheme at their own cost. payments. For the purposes of reporting pay CETVs are calculated within the guidelines and multiples remuneration does not include variable framework prescribed by the Institute and Faculty of aspects of pay such as overtime, enhancements or Actuaries. additional waiting list payments. Remuneration does not include employer pension contributions Real Increase in CETV - This reflects the increase in and the cash equivalent transfer value of pensions. CETV effectively funded by the employer. It takes The median remuneration for the workforce as a account of the increase in accrued pension due whole has been derived from permanent employees to inflation, contributions paid by the employee only and annualised for the year for the effect of (including the value of any benefits transferred from starters and part time staff. another pension scheme or arrangement) and uses

Annual Report and Accounts 2012/2013 164 Finance Glossary

Accruals equipment and vehicles, etc. In Depreciation the NHS, expenditure on an item accounting The measure of the wearing is classified as capital if it is in out, consumption or other Accruals accounting recognises excess of £5,000. loss of value of property, assets or liabilities when goods plant or equipment whether or services are provided or arising from use, passage of received - whether or not cash Capital Charges Capital charges are a way time or obsolescence through changes hands at the same of recognising the costs of technology, and market changes. time. Also known as ‘the ownership and use of capital matching concept’, this form of assets and comprise depreciation accounting ensures that income External Financing and interest/target return on and expenditure is scored in the capital. Limits (EFLs) accounting period when the The External Financing Limit (EFL) ‘benefit’ derived from services is is a fundamental element of the received or when supplied goods Capital Resource NHS trusts financial regime. It is are ‘consumed’, rather than Limit (CRL) a cash based public expenditure when payment is made. A control set by DoH onto NHS control set by DoH and a trust’s organisations to limit the level of access to all sources of external Amortisation capital expenditure that may be finance. The EFL represents The process of charging the cost incurred in year. the excess of its approved of an asset over its useful life as level of capital spending over opposed to recording its cost as Cost of Capital the cash a trust can generate a single entry in the income and A charge on the value of assets internally (mainly surpluses expenditure account. Usually tied up in an organisation, as and depreciation), essentially refers to intangible assets eg a measure of the cost to the controlling the amount of computer software. Similar in economy. “externally” generated funding. effect to depreciation. Commissioners Foundation Trust Breakeven Commissioners is a term used NHS foundation trusts are Breakeven is the term used to to cover those organisations not-for-profit, public benefit indicate that an organsiation who commission services from corporations. They are part has balanced its income with its NHS trusts or other providers of the NHS and provide over expenditure. (eg private sector). Primary half of all NHS hospital and Care Trusts (PCTs) are the main mental health services. NHS Capital (Property, commissioners in the NHS. foundation trusts are a result plant and of the Government’s drive to Current Assets devolve decision making from equipment) Receivables (debtors), inventories central to local organisations and Expenditure on the acquisition (stocks), cash or similar, whose communities. They provide and of land and premises, value is either, or can be develop healthcare according to individual works for the converted into cash within the core NHS principles - free care, provision, adaptation, renewal, next twelve months. based on need and not ability to replacement and demolition of pay. buildings, items or groups of

Annual Report and Accounts 2012/2013 165 Foundation trusts are regulated and staff pay (including years. The expense is matched by by Monitor. For more London weighting). MFF is a balance sheet provision entry information see the website paid by commissioners as a showing the potential liability of www.monitor-nhsft.gov.uk percentage add-on to the the organisation. national tariff. This helps to even Impairments out the purchasing power of Prudential Impairments generally relate to commissioners of NHS services Borrowing Code property, plant and equipment (mainly primary care trusts) and and represent the loss of value allows the use of a national tariff (PBC) of property, plant and equipment across the country. A framework that allows NHS below that recorded in the trusts to manage their capital accounts of the organisation. Payment by Results positions within their ability to Impairment occurs because (PbR) service the resulting financial something has happened to the obligations. The PBC is based Payment by results (PbR) is the property, plant or equipment upon a series of financial tests, system by which trusts are paid itself or to the economic which determine prudent for the majority of the work they environment in which it is used. capital positions relative to their do. The system is managed by revenues and costs. the Department of Health. Indexation Prudential A process of adjusting the value, Primary Care Trust normally of property, plant Borrowing Limit (PCT) and equipment to account for (PBL) inflation. A Primary Care Trust is responsible for commissioning The PBL is calculated by reference to the rules contained Intangible asset health services for its population and receives its resources in the PBC and represents the Software licence or some annually from the Department total borrowing (from all sources) other right, which although of Health. A PCT may also that an NHS trust can service invisible provides value to the provide some services itself eg based on its current financial organisation from its use. More community nursing. performance. commonly includes goodwill or brand values in the private sector. Provisions Public Dividend International Provisions are made when an Capital (PDC) expense is probable but there is PDC is similar to company share Financial Reporting uncertainty about how much or capital. It represents the value of Standards (IFRS) when payment will be required, the assets employed by a Trust From 2009/10 all public bodies, e.g. estimates for employers at its formation plus any further including the NHS, prepare their or public liability. Provisions issue or repayment of capital in accounts under International are included in the accounts subsequent years from/to the Financial Reporting Standards to comply with the accounting Department of Health. (IFRS). principle of prudence. An estimate of the likely expense Statement of Market Forces is charged to the income & expenditure account as soon comprehensive Factor (MFF) as the issue comes to light, income MFF is a composite index of although actual cash payment The statement of comprehensive geographical cost variations may not be made for many income is the IFRS equivalent in land, buildings, equipment

Annual Report and Accounts 2012/2013 166 of the income and expenditure account/ statement of totals gains and losses (UK GAAP).

Statement of financial position The statement of financial position is the IFRS equivalent of the balance sheet (UK GAAP).

Tariff The tariff is the unit price the trust is paid for the activity it delivers. For the majority of work a national mandatory tariff is used throughout the NHS. The Department also issues non mandatory tariffs for some activity. Some activity is not covered by either a mandatory or non mandatory tariff in which case a local tariff can be negotiated with commissioners.

Working Capital Working capital is the current assets and liabilities (receivables, inventories, cash and payables) required to facilitate the operation of an organisation.

Annual Report and Accounts 2012/2013 167 Charitable Funds

The Trust operates a covers all of our hospitals – are able to provide across the registered charity called The Fairfield General, Birch Hill, Trust. Pennine Acute Hospitals Rochdale Infirmary, North More information about Charity and other related Manchester General and The charitable funds and activities, charities (Charity Commission Royal Oldham for any charitable as well as making donations registration no 1050197). purpose relating to the NHS. on-line, is available on the Trust’s The public, our staff and The charity received income website at www.pat.nhs.uk. organisations make donations to of £710,000 in 2012/13, Gift Aid enables potential donors the Trust’s charity funds for many comprising: to maximise the income to the different reasons. Sometimes it is Donations £262,000 charity. The taxman adds 25p to mark gratitude for treatment, Legacies £302,000 in the pound for every pound sometimes it is to support the Investment Income £146,000 donated by UK taxpayers. Gift service generally and sometimes Aid information and envelopes it is to help remember a family The majority of expenditure has are now available on all wards member who worked for the been on medical equipment for a as well as the Cashiers offices at Trust. range of wards and departments across all hospitals. In addition, each site. These donations range from the hospital arts project is funded Donations to The Pennine Acute donations of a few pounds up by charitable funds. Hospitals Charity and other to six figure sums, but they are related charities can be received all equally welcome – and they The trustees of the Pennine at any of the hospitals’ cashiers’ are all put to good use. Last Acute Hospitals Charity would office, or more information is year the charity spent £826,000 like to express their sincere available from Trust’s Charitable during the year on medical thanks for all the generous Fundraising office on 0161 908 equipment, patients’ amenities, donations received over the last 4497. staff education and welfare and year and the charitable work undertaken by all individuals research. A full copy of the charity’s annual and organisations. Charitable report and accounts will be The charity has the Trust Board donations contribute greatly in available on the Trust’s website in as the corporate trustee and enhancing the services that we Autumn 2013.

In your Hands Appeal

Annual Report and Accounts 2012/2013 168 In Your Hands Appeal In THE first anniversary of the launch of The The money your Trust’s In Your Hands Appeal was marked by has funded the unveiling of a giant banner at The Royal an incubator, hands Oldham Hospital in February 2012. a ventilator, a appeal multisensory room and Visible from the front of the hospital, the banner equipment for monitoring which measures 20 metres x 13 metres, had been children. installed by Vinci Construction UK on the outside of the second floor level of the main hospital. A major aspect to the Appeal this year has been scanning people’s hands (both staff and the The banner advertises the Appeal which is public) for a small £1 donation. Since March last raising money for the new women and children’s year over two thousand digital hand scans have development currently being built at the hospital. been used and incorporated into a giant piece It aims to raise £200,000. Money raised will go of artwork which flows from the entrance of the towards additional equipment to enhance the new women and children’s building to the new new women and children’s unit at The Royal wards. Oldham Hospital which fully opened in December 2012. So far, the In Your Hands Appeal has raised just over £120,000 through fundraising and pledges. The In Your Hands Appeal was launched last year on 8 February 2011 by ITV Coronation Street’s To find out more about how you can help raise Jennie McAlpine who plays Fiz. Since then, money for the In Your Hands Appeal, or to make fundraising for the appeal has been going well a donation, go online to www.pat.nhs.uk, text thanks to the support of members of staff, local ‘Hand12’ to 70070 or ring on 0161 918 4497. businesses, individuals and families.

In February 2012, children’s charity “By scanning hundreds of people’s MedEquip4Kids who worked with Vinci hands we get this amazing variety of Construction presented a cheque for the Appeal individuals, shapes, sizes and colours after raising a staggering £50,000 in partnership – these then combine together as life with Vinci Construction and their sub-contractors. size images, overlapping one to the next, like the leaves of a tree. The artwork is “On behalf of the Trust Board, the literally made up of all the people who staff who work at the hospital, and on have given money as part of the appeal. behalf of the local communities we This is your chance to put your mark serve, I would like to sincerely thank literally on the new unit and offer your MedEquip4Kids and Vinci for this hand in support.” amazing donation and fundraising effort. Their contribution is invaluable; Artist Rob Vale from Lime Arts I know this new equipment and the & arts coordinator for The Trust multisensory room in particular will help and benefit the children that we care for in the unit. The support of MedEquip4kids is truly appreciated. Thank you and well done.”

John Jesky, Trust Chairman

Annual Report and Accounts 2012/2013 169 Trust Board

Non- Executive Directors Hugh Mullen, Director of ■ Monitors compliance with John Jesky, Chairman Operations standing orders and Standing Financial Instructions (SFIs). Edward Ahmad, Non Roger Pickering, Director of Executive Director Human Resources ■ Receives and approves annual accounts. Shauna Dixon, Non Executive Brian Steven, Deputy Chief Executive / Director of Finance Director (from 1 March 2013) Membership: and IM&T (from July 2012) Camilla Guereca, Non Michael Holly (Chair) Executive Director John Wilkes, Director of Edward Ahmad Facilities Michael Holly, Non Executive Chris Mayer Director The Trust Board had 12 The Finance Committee Chris Mayer, Non Executive meetings in 2012/13 with ■ Provides assurance to the Director attendance figures as noted Trust Board with regard to the in the tables at the bottom of Margaret Ollerenshaw, Non Trust’s financial standing Executive Director the page ■ Identifies issues that the Trust Tim Pickstone, Non Executive Board Sub-Committees Director (to December 2012) Board needs to be made The Board has six sub- aware of and investigates Executive Directors committees. matters as requested by the Trust Board John Saxby, Chief Executive The Audit Committee Dr Sally Bradley, Medical ■ Reviews reports from internal Membership: Director (to February 2013) and external audit. Barbara Herring (Chair to June 2012) Marian Carroll, Director of ■ Reviews compliance with Brian Steven Nursing Secretary of State directives (Chair from July 2012) Barbara Herring, Acting for countering fraud and Edward Ahmad Director of Finance and IM&T bribery. Michael Holly (to July 2012) ■ Reviews the system of Margaret Ollerenshaw Dr Christina Kenny, Acting integrated risk, governance Hugh Mullen Medical Director (from and internal control. February 2012) John Wilkes

Trust Board Attendance 2012/13 Non- Executive Directors Edward Shauna Camilla Michael Chris Margaret Tim John Jesky Ahmad Dixon Guereca Holly Mayer Ollerenshaw Pickstone 11/12 12/12 1/1 12/12 11/12 10/12 10/12 6/9

Executive Directors John Dr Sally Marian Barbara Dr Christina Hugh Roger Brian John Saxby Bradley Carroll Herring Kenny Mullen Pickering Steven Wilkes 10/12 10/10 11/12 3/3 2/2 12/12 12/12 9/9 11/12

Annual Report and Accounts 2011/2012 170 The Clinical Governance and Quality Committee ■ Gives direction to and agrees clinical governance policies ■ Agrees systems and processes to ensure quality in clinical care

Membership: John Saxby (Chair) Dr Sally Bradley (to January 2013) Marian Carroll Camilla Guereca Dr Christina Kenny (As Deputy Medical Director and then as Acting Medical Director from February 2013) Chris Mayer Roger Pickering

The Risk Management Committee ■ Oversees the design and effective operation of risk management processes across the Trust, including management and production of the assurance framework.

Membership: John Saxby (Chair) Camilla Guereca Barbara Herring (to June 2012) Margaret Ollerenshaw Hugh Mullen Brian Steven (from July 2012) John Wilkes

The Remuneration Committee ■ Determines on behalf of the Board appropriate remuneration and terms

Annual Report and Accounts 2011/2012 171 of service for the chief to the Codes of Conduct and coaching and facilitation executive, executive accountability. The interests Consultancy, The Slynn directors and other senior declared were: Foundation employees. J Jesky Director, C & D Mayer Consultancy Limited ■ Reviews arrangements Chair of North West for termination of Committee and Trustee of S Dixon employment and other Music in Hospitals. Managing Director, Shauna contractual terms. E Ahmad Dixon Consulting Limited Membership: Director - E & M Associates Trustee, Broughton House John Jesky (Chair) Limited – Consultancy and Home for ex Servicemen and Edward Ahmad Counselling. Women. Shauna Dixon Director - Silver Street Centre J Saxby (from 1 March 2013) – dormant limited company Camilla Guereca NHS Confederation Trustee - Beam International: representative on national Michael Holly Charity. Serious Hazards of Transfusion Chris Mayer Director and Trustee - Healing (SHOT) Steering Group. Margaret Ollerenshaw House Network – Counselling. Tim Pickstone Dr C Kenny (to December 2012) M Ollerenshaw Locum GP, Parkside Medical Head of Learning and Centre, Milton Keynes. The Endowment Development, Co-operative Committee Group ■ Ensures operation of the Governor, St Martin’s School, charity within the terms of Fitton Hill, Oldham. its governing documents C Guereca ■ Reviews and approves charitable funds and Chief Executive - Oldham accounts for the year. Personal Advocacy Ltd Vice Chair - Voluntary Action Membership: Oldham. John Jesky (Chair) John Saxby M Holly Dr Sally Bradley Councillor - South Middleton - (to February 2013) Rochdale MBC Barbara Herring (to July 2012) Deputy Chair and Trustee/ Dr Christina Kenny Director – AQA Limited (from February 2013) Governor – Cardinal Langley Brian Steven (from July 2012) High School, Middleton Declaration of Interests Governor – Little Heaton CE Primary School, Middleton The interests declared by Trust Board members at April 2013 C Mayer was submitted and noted. Associate, G4S All Board members had Associate, Fiona Macneill reconfirmed they subscribed Associates – consultancy,

Annual Report and Accounts 2012/2013 172 Contacting the Trust

The Trust welcomes feedback from patients Supporting your local hospitals – about its services. There are a number of Become a Foundation Trust member different ways in which you can contact us or The Pennine Acute Hospitals NHS Trust is an give us your views. aspirant Foundation Trust. Please support the Trust If you have an issue which you wish to raise about by becoming a member. Visit our website at www. your care then you should initially discuss this with pat.nhs.uk, email [email protected] or call the ward or departmental staff in the area you are 01706 517302 for more information. being cared for. Local staff are usually best placed to be able to answer questions about your own Find us on YouTube care, or those of your relatives.

We recognise that in some circumstances patients or relatives may prefer to discuss the matter with someone not directly involved in their care. In those circumstances you can also contact the Patient Advice and Liaison Service (PALS) on 0161 604 5897. You can also email: [email protected]

Twitter You can follow the Trust and its news and events on Twitter @pennineacutenhs

Sharing your feedback The Trust welcomes all comments on its services. Patients and their families can use the hospital feedback section of the NHS Choices website at www.nhs.uk, or the feedback sections of the Trust’s own website at www.pat.nhs.uk

Useful Contacts Switchboard 0161 624 0420 Volunteers co-ordinator 0161 778 5114 Charity 0161 918 4497 • [email protected]

Annual Report and Accounts 2012/2013 173 Annual Report and Accounts 2012/2013 174 Annual Report and Accounts 2012/2013 175 Midwives and patients celebrate the first year anniversary of the Bluebell Birth Centre at North Manchester General Hospital which saw the arrival of 766 babies in the centre’s first year.

Annual Report and Accounts 2012/2013 176 your comments We welcome comments on this Annual Report or about services provided by the Trust in general.

We also welcome enquiries about becoming a Foundation Trust member, a volunteer or donating or fundraising for our Pennine Acute Hospitals Charity.

Comments on this report Copies of this report, including different formats, are available from the Communication Department on tel. 0161 918 4284. It is also available online at www.pat.nhs.uk

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Annual Report and Accounts 2012/2013 178

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