Annual Report and Accounts 2018-19
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Annual Report and Accounts 2018-19 Norfolk and Norwich University Hospitals NHS Foundation Trust Annual Report and Accounts 2018-19 Presented to Parliament pursuant to Schedule 7, paragraph 25(4) (a) of the National Health Service Act 2006. ©2019 Norfolk and Norwich University Hospitals NHS Foundation Trust Table of Contents 1 Performance Report Chairman’s Statement 8 Chief Executive’s Statement 11 1a Overview of Performance Purpose and Activities 14 Brief History 14 Key Issues and Risks 15 Strategy 15 Going Concern Statement 17 1b Performance Analysis How we measure performance 19 Integrated Performance Analysis 20 KPIs, Risk and Uncertainty 20 Long term trend analysis 25 Development and performance 31 Performance against key health targets 34 Our Financial Performance 44 Social and Community Report 46 Anti-bribery legislation 53 2 Accountability Report 55 2a Directors’ report Board of Directors 56 Statement as to disclosure of the auditors 61 Council of Governors 69 Principle for Cost Allocation 74 Political and charitable donations 74 5 2b Remuneration Report 75 2c Staff Report 84 Analysis of staff numbers 84 Analysis of staff costs 85 Staff survey results 89 Off payroll engagements 92 2d Single Oversight Framework 102 2e Statement of the responsibilities 104 of the Accounting Officer 2f Annual Governance Statement 106 Quality Report 122 Chief Executive’s statement 123 Priorities for improvement 125 Progress against our 2018/19 priorities 129 Board Assurance Statements 150 Local clinical audit 161 Care Quality Commission Reviews 170 Reporting against core indicators 180 Other information (patient safety, patient experience) 186 Annexe 1 - Statements from CCGs and others 197 Annexe 2 – Statement of Director’s responsibilities 204 Annexe 3 – Independent Auditor Report 210 Annexe 4 – Mandatory performance indicators 213 Appendix 1 – CQC action plan April 2019 221 Financial statements 1-47 6 Performance Report 7 Mark Davies, Chief Executive (left) and John Fry Chairman. Chairman’s Statement During my time as Chairman cancer referrals have increased by two thirds, representing I have been Chairman for the last six years an increase of over 10% each and will step down just after the end of my year. Emergency ambulance arrivals have second term in June 2019. The new increased by a similar amount. chairman David White is very experienced having been chairman of East Suffolk and The vital ingredient in keeping pace with North Essex NHS Foundation Trust and a these trends has been our outstanding staff former CEO of Norfolk County Council. This who ensure we deliver safe and appropriate makes me confident that I am leaving our care to our patients. Their commitment in hospitals with an experienced chairman who the face of service pressures and the can build on our achievements. fantastic support they give to our patients is second to none. We are a major employer in The last six years have been eventful as the Norfolk and have seen our workforce grow NHS has been under growing pressure from about 6,000 when I joined the Trust to during this time from an increasing over 8,000 now. population and an ageing one, nowhere is this trend more marked than in Norfolk. 8 We are also exceptionally fortunate to be NIHR is the clinical research delivery arm of supported by over 800 volunteers, incredibly the NHS, and every year it is responsible for hard working Governors, fantastic charities, helping thousands of patients take part in committed partners and of course our strong research studies that contribute towards local community. improving treatments for the future. We have always been rated highly as a In terms of capacity, our Emergency caring institution and our patients have Department has expanded its footprint reinforced this position with consistently high significantly in recent years as demand has scores on the friends and family test which grown from 60,000 attendances per year measures patient satisfaction. I am pleased when the hospital opened in 2001 to over to say that our CQC rating has been uplifted 130,000 attendances during 2018/19. In to ‘requires improvement’ thanks to an winter 2018, we added a temporary building organisation-wide quality improvement plan, to give us extra capacity for our ambulance led by the chief nurse and medical director, arrivals for our Rapid Assessment and which has helped us to make improvements Treatment service. The previous year, we across the board and reinforce a culture of tripled the size of the paediatric emergency constant improvement. department and opened the UK’s first Older People’s Emergency Department offering The footprint of the N&N hospital has increased dramatically over six years and specialist care for older people. Despite all there has been an ongoing programme of this investment we are still experiencing an training and developing staff and investment increase in ambulance arrivals and this trend to upgrade and expand our facilities. Having looks set to continue. cranes and construction work on site is the Part of our winter preparations for 2018/19 sign of a thriving and growing organisation included the addition of a new discharge which is certainly true of our hospitals. Over the last few years, we have seen the Bob suite in a modular building to give us more Champion Research and Education Building capacity and smooth the pathway for opened as a joint venture with UEA. It discharging patients. houses researchers finding new treatments Cromer Hospital is the jewel in our crown for diseases affecting ageing populations and I am delighted to say that we have and a unique bio-bank facility to store DNA and tissue samples, as well as formed a partnership with Macmillan Cancer undergraduate and postgraduate education. Support to develop a new cancer centre on the site benefitting the population of North The Quadram Institute (QI) opened in 2018 Norfolk. in which we run one of the largest endoscopy units in Europe and the Clinical Research More recently, we have started work on Facility. We are one of four partners in the plans to expand our interventional radiology QI, a world class research centre bringing and cardiology services with an extension on together food science, gut biology, human top of the east wing of the N&N health and disease and capitalising on the Hospital. The new unit will quadruple the world-class bioscience cluster based at the number of interventional suites, placing Norwich Research Park. I am very proud to NNUH among the biggest centres in the UK have been a part of this development which for interventional radiology. The project will will have a major impact on research in the also double the cardiology procedure rooms future. at the hospital. The development will help meet increasing demand on services, reduce We continue to put a lot of focus on research waiting times for patients and enable NNUH and one of the big steps in establishing staff to offer new services in the future such ourselves in this area was to be appointed as as stroke thrombectomy where blood clots one of just 15 NHS Trusts in England to run are directly mechanically removed from the a regional branch of the National Institute for brain following a stroke. Health Research (NIHR) Clinical Research Networks. 9 Following a further inspection in January Chief Executive’s Statement 2019 the CQC published its report in May I have been hugely impressed by the 2019 which saw a significant improvement commitment of our staff to improve the care as our rating rose from ‘inadequate’ to we deliver for patients. The Improvement ‘requires improvement’. Programme which launched in September 2018 has been led by the Chief Nurse and We welcomed the CQC’s most recent report Medical Director and is producing excellent which recognised the significant results and ensuring that our staff are fully improvements we have made in many areas involved in developing and improving their across the Trust. own services. The effort and attention to I would like to thank every one of our detail is impressive and makes me proud of amazing staff who have been working so the care our teams deliver. hard to deliver the Trust’s clear, comprehensive improvement programme. It We know that in many respects our clinical is their dedication, commitment and hard outcomes are extremely good, but there is a work mainly through the winter months which need for greater consistency and a more has helped to improve our ratings in such a robust framework around this. We have short period of time. We are now well on our seen a very substantial increase in the way on our five year journey to outstanding. number of patients coming to hospital on an emergency basis – especially by ambulance The CQC recognised a number of examples and this has placed extreme pressure on the of outstanding practice here at the trust NNUH hospital and its staff. The response of including leading the way in the East of our staff has been tremendous and we England in the use of robotic surgery, remain focussed on patient safety especially improving the safety culture through human when particularly busy. factors training and the plans we have to increase capacity at the NNUH particularly in We continue to operate in an environment interventional radiology and endoscopy in where demand is rising driven by an the newly opened Quadram Institute. increasing population and an ageing one. The latest statistics show that 23.9% of It is also recognised that the hospital has people in Norfolk are over the age of 65 some of the lowest infection and mortality compared with 17.9% nationally. Some older rates in the country. people are living very well but others live with increasing frailty.