ANNUAL REPORT & ACCOUNTS 2017/18 Aintree University Hospital NHS Foundation Trust

Annual Report and Accounts 2017/18

Presented to Parliament pursuant to Schedule 7, Paragraph 25 (4) (a) of the National Health Service Act 2006 Contents

Chairman’s Foreword 6  Quality Report 2017/18 66 3

Performance Report 8  1 Governance & Organisational n Overview 10 4 Arrangements 124 Aintree University Hospital NHS Foundation Trust 10 n Code of Governance 126 Chief Executive’s statement on Council of Governors 126 Aintree’s performance in 2017/18 14 • Nominations Committee 128 • Achievements in 2017/18 16 • Membership & Membership Committee 128 Key issues and risks in delivery Board of Directors 129 of Trust objectives 20 • Audit Committee 135 Going concern disclosure 21 • Remuneration & Nominations Committee 138 n Performance Analysis 22 n Head of Internal Audit Opinion 139 Operational Performance 22 Financial Performance 26 n Statement of the Chief Investing in the Estate Infrastructure 29 Executive’s responsibilities Corporate & Social Responsibility 30 as Accounting Officer 140 • Community Engagement 30 • Sustainability and Environmental Performance 31 n Independent Auditors’ Report 141 • Equality, Diversity & Inclusion 33 n Annual Governance Statement 2017/18 148

Accountability Report 34 2 n Directors’ Report 36 Accounts 2017/18 154 Board of Directors 36 5

Foreword to the Accounts 156 NHS Improvement’s Single Oversight Framework 37 Accounts for the 12 months Quality Governance 39 April 2017 to March 2018 157 Responding to Patients 40 Volunteers Service 42 Research & Development 43

n Staff Report 49 Staff Engagement & Well-being 49 • Education & Learning 50 • Staff Survey 51 • Improving Staff Health & Well-being 54 • Occupational Health 56 Off-payroll arrangements 57 Remuneration Report 62

© 2018 Aintree University Hospital NHS Foundation Trust Chairman’s Foreword

Welcome to our 2017/18 Annual Report where we share with you some of Aintree’s achievements and challenges over the past year in providing services to our communities across North Mersey.

of Cambridge in September 2017. the role of Transaction Integration We are acutely aware that the the inspection by the Care Quality ensuring that Aintree continues to This event gave us the opportunity Director to focus full-time on the NHS faces unprecedented demand Commission (CQC) in October 2017, provide the highest quality care and Our patients have remained at to showcase the £35m state-of-the- proposed merger with The Royal for its services, with all providers although we were delighted that the best possible experience for those art facilities, recognise the staff who the heart of all we do with our Liverpool & Broadgreen University under pressure to find new ways the inspection team found much who need it – deserve our praise and had worked on the development and staff consistently going beyond Hospitals Trust. Beth Weston joined of delivering services against for us to be proud of and rated the recognition. They continue to rise acknowledge the £1m contribution to the Board as the Trust’s Chief a backdrop of a tough climate overall care at Aintree as ‘good’; to the challenges that operational the call of duty to provide our the construction of the helipad by the Operating Officer and Sue Green, for public spending. Part of our and identified pharmacy as having pressures bring and demonstrate patients with outstanding care. HELP Appeal. Director of People & Corporate Affairs response to this challenge has been outstanding practice. We recognise their competence and compassion left the Trust on 31 March 2018. to take steps, in collaboration with there is still more to do and we are every single day. In March 2018, the Board decided our partners, to transform the working quickly on those areas where to invest £8m in improving our Life in the NHS continues to be The Board has continued to delivery of healthcare services. we need to improve the quality of services. Investments were made in challenging but also rewarding – meet with our staff through the through traditional and social media services for our patients. a number of critical areas including our patients have remained at the Aintree’s local population is an ‘Conversations with the Board’ and by and many people now follow us on nurse staffing, Accident & Emergency, heart of all we do with our staff increasingly ageing one with We have made significant visiting most areas of the Trust with Twitter and other media. medicine for the elderly, general consistently going beyond the call patients having many co-morbidities effort, working with our staff the Director Walk Rounds. The Board surgery and general medicine. The Council of Governors continues of duty to provide our patients with and, in common with other NHS and with external partners to Conversations in particular allowed us Although this would increase the to support the organisation to meet outstanding care. organisations, our hospital is make improvements in our A&E to hear the views of our staff about planned deficit for 2018/19, the the needs of patients and provides extremely busy with more patients performance. Although we did not patient safety as well as listening to We welcome the on-going support Board was unanimous in its view that constructive challenge to the Board in attending our Accident & Emergency achieve the 4-hour standard, we were their concerns and the impact on we receive from all our partners but, maintaining safe, responsive and line with its statutory duties. We said Department than ever before. Our identified as the most improved Trust them from the increased operational most importantly, we are grateful to effective patient services was more goodbye in July to those governors urgent care and emergency services through the winter period which the pressures. The role of the Board is our staff and our volunteers whose important. who had completed their term of came under significant pressure in Board has recognised as a significant to ensure we try and do something commitment to Aintree and our office and welcomed new governors 2017/18 but, throughout it all, we achievement. about those concerns where we can. We continue to benefit from working patients will help us to deliver the to the Council. Our volunteers play remained focused on delivering the closely with a range of local partners future they deserve. As ever, the motivation and We are proud of Aintree and, despite an important part in the life of our highest quality health care. If at times including MPs, NHS commissioners, dedication of our staff has been the financial pressures facing us, want hospital and I am honoured and we fall short of expectations, we local authorities, universities and truly magnificent. All of them - those to ensure that the hospital provides humbled by their unfailing support to make every endeavour to put things the third sector, plus other NHS on the frontline providing care or the right environment for treating our patients. right and learn from the experience organisations and employers to behind the scenes supporting clinical our patients and for staff to work in. Dr Neil Goodwin CBE to the benefit of our patients. ensure that we play an active part in We welcomed a new Medical Director, services and those who keep our We were delighted, therefore, after Chairman the life of the communities we serve Dr Tristan Cope, and a new Chief We were very disappointed to receive Trust functioning every day who three years of development, to have and further afield. We share stories Nurse, Dianne Brown, in April 2017. an overall rating for the Trust of patients might never meet but who, our Urgent Care & Trauma Centre about this collaborative working and During the year, our Deputy Chief ‘Requires Improvement’, following nevertheless, play a vital role in officially opened by the HRH Duke promote our service developments Executive, Angie Smithson took up

6 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 7 1

Performance Report What we do Aintree is a recognised centre for multi-disciplinary health research and education, enjoying close collaboration with On average we see over 421,000 outpatients, 168,000 the University of Liverpool, Edge Hill University, Liverpool Overview A&E / Walk In Centre attendances and admit over 93,000 John Moores University, the University of Chester and patients each year. other NHS Trusts. The training and education of staff The Trust is one of the largest local employers with over combined with our clinical research impacts positively on 4,900 staff working at Aintree and also delivering services the care we provide for our patients by helping to attract This section provides summary information about Aintree in the community. We are recognised for our support of the very best staff. University Hospital NHS Foundation Trust, our purpose, our staff through training (including our award winning At the end of 2017/18, the Trust had non-current assets of apprenticeship programme) and our engagement and over £186 million and an annual income in excess of £350 the key risks to the achievement of our objectives and staff development programmes. million. We contract with over 20 commissioning bodies, how the Trust has performed during the year. including those in North Wales and the Isle of Man.

Aintree University Hospital NHS Foundation Trust is a large 682,507 Patients seen per year teaching hospital in Liverpool 400 serving a population of around doctors 330,000 in North Liverpool, South Sefton and Kirkby. Our vision is: to be a leading provider of the 167,791 421,501 46,673 Visits to our A&E highest quality healthcare. 1,290 Outpatients Inpatients Department and the 4,900+ nurses Walk In Centres members of staff We became a NHS foundation trust on 1 August 2006 established as a public benefit corporation authorised under the National Health Service Act 2006. Aintree University Hospital NHS Foundation Trust is fully 690 compliant with the registration requirements of the allied health Care Quality Commission. Being a foundation trust professionals means that we have more control of how we manage our budgets and shape the services we provide to reflect the needs and priorities of our patients and local community. Our Council of Governors ensures that we listen to the views of our patients and those living locally, our staff and other interested parties so that we can make improvements to our services and £351m 789 beds the information about these services. turnover 3,000 Our common purpose of “getting it right for every patient Patients recruited for every time” is central to the quality of the services we 320+ Clinical trials and research studies in deliver and is wholeheartedly supported by our staff. studies typical year £11.6m The local population served by Aintree includes some of invested in building the most socially deprived communities in the country, and infrastructure with significantly lower than the England average life expectancy and high levels of morbidity. The population 13,600+ projects profile is also ageing rapidly with some neighbourhoods Foundation Trust having a projected growth of around 45% expected in members the over 75s. These factors combine to create significant demand for hospital-based care. We also work with our partners to provide a range The Trust is a teaching hospital of both the University of services in community settings including diabetes, of Liverpool and Edge Hill University. We provide high rheumatology, ophthalmology and alcohol services. Other 93% Confidence 67% quality elective and emergency care services to meet the tertiary services provided by the Trust to a much wider Inpatients who would in our services Staff who would recommend day-to-day needs of our local community. In addition, we population of around 1.5 million in Merseyside, Cheshire, recommend us to families and us to their family and friends also provide high quality specialist services including major South Lancashire and North Wales include respiratory Inpatient Survey friends needing treatment if they needed treatment trauma, hyper-acute stroke, complex obesity, regional medicine, rheumatology, maxillofacial and liver surgery. results and head and neck surgery, upper GI cancer, hepatobiliary and We are proud of our close partnerships with other NHS Staff FFT liver and specialist endocrine services. organisations and Local Authorities.

10 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 11 Highlights of 2017/18

Proud of Aintree Excellence Awards 2017 Duke of Cambridge – grand opening of Urgent Care and Trauma Centre

I donate campaign End PJ Paralysis campaign #EndPJparalysis ACE Award presentation - Ward 15 Nephrology Flu-Fighter Campaign

Frailty Unit – knitted cannula sleeves for dementia patients Chinese Doctors placement Organ Donation memorial garden

12 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 13 Chief Executive’s statement on Aintree’s 2017/18 performance

It has been a year of challenges but our staff remain true to our common purpose ‘to get it right for every patient every time’ and we have worked with our partners to transform the delivery of all our services.

Aintree, in common with the Improvement Plan will incorporate October 2017 at St George’s Hall and wider NHS, continues to face these actions and will be further a record number of staff attended. significant operational and developed in 2018/19 to include The Proud of Aintree award - which financial pressures and we have actions to improve quality more is decided by members of the public worked hard to ensure that we widely across the Trust. who nominate teams and individuals remain focused on delivering high they feel have made a real difference We are aware that some of our staff quality and safe services. We have to their care - was won by Paul Flynn, had been concerned that patient also moved closer to realising our Governance Lead for Surgery & safety was not at the forefront for strategic aim, to transform the Anaesthesia after being nominated the Trust. The Board explored this delivery of our services across the by a patient for his excellent work at length with representatives from local health economy through ethic, compassion and commitment Divisions in every Conversation increased collaborative working to improving patient safety. The with the Board held in 2017/18 and with partners. Physiotherapy Ventilation Team won concluded that this was not a widely an Outstanding Contribution to The Trust had a unprecedented held view in the Trust. The conclusion Safety Award for the development number of patients seeking care from was reinforced by the Board’s of an electronic tool to facilitate safe our services both at Aintree Hospital decision in March 2018 to invest £8m care from the moment of admission and the Walk In Centres at Kirkby in the Trust’s services and in its staff, for Home Ventilation users. Awards and Litherland. This reflects our with £1.8m to be used to increase were presented to 19 teams and reputation as a provider of choice but the number of nurses employed at individuals from across the hospital also requires us to work closely with Aintree. This investment was also during the ceremony including our commissioners and other key made to support our response to the Outstanding Contribution to Safety, partners to ensure that these higher shortages of qualified staff nationally Learner of the Year, Team of the Year, levels of activity can be managed and and locally and the need to consider Clinical Leader of the Year, Volunteer alternatives to hospital are in place, alternative staffing models. of the Year and Employee of the Year. wherever possible. We became the most improved Trust More of our staff completed the in Cheshire & Merseyside during the national NHS Survey in Autumn winter months for A&E performance. We became the most improved 2017 than in the previous year, We have made significant progress to placing us above the national Trust in Cheshire & Merseyside develop our proposals for a Health and average response rate. This invaluable during the winter months for Well-being Campus on our existing insight into what our staff feel about site which provides an opportunity to A&E performance. working at Aintree will form the greatly enhance health care facilities basis of a revised approach to staff to better meet the needs of our local engagement in 2018/19. The results We remained focused on our efforts population by creating a community suggested that, for some of our staff, to deliver the A&E 4 hour access aligned with the NHS heathy new it has been challenging to work at standard and were supported in town model. Using monies we Aintree and our position in several these endeavours by Ernst & Young to received from the One Public estate areas of the survey deteriorated. deliver a series of activities under the programme we have now commenced non-elective flow programme. We engagement with potential key We strongly believe that our strategic made some notable improvements stakeholders and received many vision is achievable - by continuing in year so that we became the positive expressions of interest. The on our journey of Reshaping most improved Trust in Cheshire proposal involves the redevelopment our Future we can overcome the & Merseyside during the winter of land, much of which is currently challenges we face in order to be months. We will continue to build on under-utilised and in some areas the leading provider of the highest these improvements in 2018/19. vacant, to deliver a high quality mixed quality health care. However, we can use development with sustainable only do this by ensuring our staff feel The inspection of our services by new homes and places of care. It will valued and part of an organisation the Care Quality Commission in create full time employment positions that actively listens to and acts on October 2017 received a ’Requires and has been identified by the their concerns not only through Improvement’ rating. Although this Department of Health as a priority the survey but also through other was disappointing, we recognised scheme for development. initiatives such as the Conversations that we needed to address the gaps with the Board, Ask the Board and identified and had already started We held our annual Proud of the Staff Friends & Family Test (FFT). work to do this. Our Aintree Quality Aintree Excellence Awards in

14 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 15 Achievements in 2017/18 with ward staff to identify and deliver Aintree has been using trained a bespoke improvement goal. The The wide range of tasks volunteers to enhance end of life team use quality improvements, care for patients and their families/ human factors and organisational our volunteers undertake carers since 2012. Our volunteers are tools to define, analyse and make and their desire to give up experienced and very dedicated and improvements. They will also their time freely is enormously provide a highly regarded service with complete a formal evaluation to appreciated by our patients, both local and national recognition, particularly for its positive Value each other gather learning and monitor the improvements. families and staff. contribution to the patient journey. They undertake an interactive training Despite our best efforts, we do at programme covering the principles times make mistakes. In 2017/18 of palliative care and symptom Strategic we reported seven never events in Our Department of Medicine control, communication skills, Vision the Division of Surgery (Trauma & for the Elderly has continued to • clinical governance, spirituality and Improve through learning and innovation Orthopaedics, and Ophthalmology) deliver high standards of care for To be a resilience. Volunteers who carry out since August 2017, and one never their patients and support to their leading provider of the this companionship service sit with event by the Division of Medicine staff which was reflected in their highest quality health care patients, organise activities for elderly (Cardiology). Clearly, never events response to the Staff Survey. The patients, act as dining companions for should never happen and the Trust staff exemplify the caring culture patients with dementia and generally Communicate openly and honestly has taken this very seriously as they of Aintree by arranging a series of • VALUES show understanding and compassion are highly unusual and concerning. events for their patients and families/ to the patients and their family/carer. Common Purpose In addition to the internal incident carers – this year, they held a ‘Play They do not replace the essential Getting it right for every patient every time investigations, both internal and Your Cards Right’ event in memory of VALUES medical and nursing care that patients external reviews of the safety Sir Bruce Forsyth. require in their final days and hours culture within Theatres have The hospital environment is also of life but supplement the quality Work as a team been commissioned. We are also • critical for delivering outstanding and quantity of support for patients Strategic Objectives taking part in a national review of care. We recently completed our and their families. The wide range investigation practices commissioned £35m Urgent Care and Trauma (UCAT) of tasks our volunteers undertake • Use resources wisely jointly by NHS Improvement and the Centre with the new £1m helipad, and their desire to give up their time Care Quality Commission. These will funded by the HELP Appeal. The freely is enormously appreciated by Deliver Achieve best Promote research Deliver sustainable Provide strong Be a well- report back in 2018/19. outstanding care patient outcomes & education healthcare to meet system leadership governed helipad will save vital minutes when our patients, families and staff. The by being a by providing by delivering the people’s needs by working together and clinically- transferring trauma patients from Volunteer Department also manages patient-centred effective treatment benefits of education, by delivering to support seamless led organisation air ambulance into the hospital. The organisation to achieve best research and efficient, cost pathways across by developing and one of the largest NHS Trust work that provides high possible patient innovation for our effective services all sectors supporting effective We were delighted to be classed UCAT Centre, which was formally experience schemes and works quality, safe and outcomes and patients and staff to ensure their leadership across the opened by HRH The Duke of closely with 121 Schools, Colleges and compassionate services promote quality long-term organisation to enable our as the best Trust in the country of life sustainability people to achieve our vision Cambridge in September 2017, was Universities across Merseyside. Deliver safe compassionate care for staff flu vaccinations. also named Project of the Year at the 2017 Health Estates and Facilities The programme was recognised Management Awards. this year when it was awarded silver accreditation by Fairtrain for Once again we focussed on infection Patient and family engagement providing excellent high quality work prevention and control through Reshaping our Future experience for all ages. The Fairtrain aiming to reduce the number of Through a variety of mechanisms, we quality mark is very much sought after patients contracting C.difficile, have continued to listen to what our and puts the Trust alongside blue-chip MRSA and MSSA. We are, however, patients and their families have had companies such as British Airways, finding it increasingly challenging to say about the services they receive Key areas of activity in 2017/18 which supported the Trust in delivering its objectives are highlighted below: Bentley Motors and Cisco UK. to achieve the IPC standards due and this will inform our Patient and Family Experience Strategy. It will Standards of Quality and Safety’ and to the more complex needs of our Deliver outstanding care underpin the work that is planned other key clinical indicators, helps patients. In 2017/18 there were 43 42 ward and department for 2018/19 as we strive to deliver the Achieve best patient All healthcareReshaping organisations strive to clinical leaders to understand our how Future patients with C.difficile – below the best possible experience to all those outcomes deliver high quality and appropriate they deliver care, identify what works assessments were completed last national performance objective of no who access our services. care to patients. The Trust has ensured well and where further improvements year with 12 wards achieving more than 46 cases – and we had one Aintree is a member of the Liverpool hospital-attributable MRSA case. We that its Quality Priority to deliver care are needed. Aintree Champions Excellence The Board of Directors listens to Diabetes Partnership which involves that is safe, clinically effective and were pleased to have achieved a 30% a patient, staff or volunteer story other NHS organisations in providing 42 ward and department assessments which provides a positive experience (ACE) status. reduction in the number of patients at the start of each of their formal care to those living with diabetes. were completed last year with 12 for patients and their families has with MSSA against the Trust objective board meetings. Hearing their stories Its aims are to provide care closer wards achieving Aintree Champions not been compromised despite the to reduce the number of cases by 15%. helps us understand the experience to home and to support patients Excellence (ACE) status. ACE is operational and financial pressures pride in the team, multi-disciplinary of being a patient – sometimes they in learning how to manage their awarded for wards achieving a We were delighted to be classed facing the NHS. team involvement in achieving ACE are read out; sometimes the patient condition; it also delivers training to ‘green’ rating on three consecutive as the best Trust in the country for status and individualised plans for shares their own story directly with us. staff to improve their understanding. Achieving and maintaining assessments and following a staff flu vaccinations. As a result, wards/departments for improving The latest survey of diabetic inpatients consistently high standards across all presentation to a panel of Executive we were shortlisted for the Most Whatever way we hear the stories, standards. It has also given the wider demonstrated higher than average ward/department areas is challenging and Non-Executive Directors and Innovative Flu Fighter Campaign they can have the power to inspire Trust the opportunity to recognise performance for those receiving care and measuring the quality of care Governors, explaining the journey to in the 2017/18 Flu Fighter Awards. and humanise us, to compel action and celebrate individual and team at Aintree. The diabetes care provided delivered by individuals and teams triple green and detailing plans to Our continued improvement on and to challenge our assumptions. hard work and achievement. During by teams at Aintree was rated is not an easy task. Aintree’s ensure they maintain high standards immunisation performance is a credit The stories provide us with insights the year, the Trust established a ‘outstanding’ following an assessment Assessment and Accreditation of care. to our staff as it not only protects we would not have by just looking Quality and Excellence Support Team by the National Clinical Director for (AAA) framework which is based on them and their families but also our at reports. (QuEST) which includes staff from the ‘Essence of Care’ benchmarks, the Working with AAA has also led to patients and visitors. Obesity & Diabetes at NHS England. the Corporate Nursing Team working Care Quality Commission’s ‘Essential team cohesion on the wards, a greater

16 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 17 Promote research Showcase Event keep everyone which have led to significant informed of achievements and help changes and improvements being and education foster a sense of pride amongst staff. made to practices and procedures. In 2017/18, Aintree, in a clinical The National Freedom to Speak Up academic collaboration with the Guardian visited Aintree in 2017/18 University of Liverpool, was awarded We continue to raise the and was impressed by the progress made by the Trust. £1.5m in grants for two multicentre awareness of the importance head and neck cancer studies, putting of clinical research trials with More than 400 people attended the patient at the centre of head and Aintree’s Apprenticeship Open Day in neck oncology research. Around 1,000 our patients, public and staff July 2017 to be offered careers advice people a year are referred to Aintree through supporting events for nursing, catering, administration, with head and neck cancers and, in pharmacy, physiotherapy, some areas of Liverpool, the incidence such as International Clinical Trials Day. occupational therapy, plumbing of head and neck cancer is twice the and joinery. The Trust recognises national average. The funding will that learning a new profession will help with two randomised controlled have a positive impact on people’s trials on the prevention of oral cancer This year the ‘Dragons’ approved lives and apprenticeships provide and the prevention of complications 14 bids from a wide range of staff the opportunity to study and earn in head and neck surgery, developed from frontline healthcare assistants, money. Since the Open Day, we have through NW Surgical Trials Centre, nurses, allied health professionals, successfully recruited to 30 apprentice part of Cancer Research UK’s consultants and senior leaders. Some roles across the Trust. Additionally, Liverpool Cancer Trials Unit. One of of the innovations approved for through talent management and Provide strong Be a well governed and have accepted our position and our the trials will also fund a PhD training funding were: succession planning, we have system leadership clinically-led organisation on-going plans to build towards a programme for a surgical trainee. supported 60 existing staff to sustainable future. • 3D technology for reconstructive gain new skills, knowledge and The Board believes that delivering The Care Quality Commission We continue to raise the awareness surgery to benefit maxillofacial Aintree University Hospital NHS qualifications through apprenticeships further efficiency savings cannot inspection undertaken in October of the importance of clinical research patients Foundation Trust is an identified trials with our patients, public and to support patient care. be done by Aintree on its own, but 2017 resulted in a disappointing Category 1 responder under the Civil • design for a bespoke gown for will require closer working with ‘Requires Improvement’ rating for staff through supporting events such Once again, for the third year Contingencies Act (CCA) 2004. This critical care patients to allow better our partners across all sectors. A the Trust. Although the inspection as International Clinical Trials Day. running, we hosted a seven week means that the Trust has a duty to access to lines tracheostomies, significant amount of work, led by team found much for us to be proud prepare for and effectively respond to We continued with our approach to observational placement by 11 ensuring better care and comfort clinicians, to re-align hospital- of, there were areas where we have emergency situations. In September supporting innovation through our Chinese Doctors who practice at for patients based services across the City of to improve the quality of our services 2017, the Trust was required to Dragons’ Den, where staff can bid consultant level in China. This is part Liverpool and South Sefton under and we are working quickly to do complete a self-assessment against for one-off funding of up to £25k • Folding bed chairs on wards for of a Chinese Government-funded the Healthy Liverpool Programme this through the implementation of a the NHS England (NHSE) Emergency to help them put innovative quality relatives/carers wishing to stay with programme across the North West, and Shaping Sefton, has been robust improvement plan. The areas Preparedness Resilience and improvement work in place without patients overnight in conjunction with Valette’s Business undertaken and the possible requiring particular focus included: Response (EPRR) Core Standards. impacting on departmental budgets. School Manchester. An extensive • staff exercise classes, such as Yoga organisational changes needed to The Trust achieved full compliance Trust Directors are our ‘Dragons’ programme of observational clinical • Safeguarding – we have and Ai Chi. make that happen explored. Aintree against the standards. In addition the and they allocate the £250k annual experience, meetings and external strengthened the team supporting has been working with the Royal Trust was assessed by representatives innovation fund to empower staff During 2017/18, the Trust has further visits to other NHS Trusts, including staff in clinical areas which, in turn, Liverpool & Broadgreen University of NHSE Cheshire & Merseyside and to implement changes to improve developed its approach to Freedom Liverpool Heart & Chest NHS FT was helped strengthen our procedures Hospitals NHS Trust (RLBUHT) with NHSE EPRR Regional Team who patient care and staff experience. to Speak Up against the National organised to provide as diverse an for the care of vulnerable patients the intention of consolidating our attended the hospital site. Based on Office’s 10 principles to support its experience as possible. The placement two organisations, as well as working The Dragons’ Den encourages • Governance – we have taken steps the visit the Trust achieved a rating of systems and processes, governance enabled the doctors to return home with other providers, to facilitate collaboration within individual to improve those processes which Outstanding. arrangements and policies. Specific with both clinical practice insights and the development of single, city-wide projects and departments but also support how we provide care at a programmes of work have been an understanding of the delivery of services delivered through centres In compliance with the consolidation across different staff groups and consistently good standard initiated within AED and Medicine healthcare in the NHS in England. of academic, clinical and service of offences relating to trafficking and divisions. Periodic updates and a • Medicines management systems – excellence to improve the health and slavery within the Modern Slavery we invested in the ward-based well-being of our community. Act 2015, the Trust works to current pharmacy team to further improve NHS Supply Chain (NHSSC) ethos and In January 2018, as a member of the practice in medicines management code of conduct which encompass Liverpool Health Partners (LHP), the across the hospital. greatly facilitated Aintree being cited to managing the Trust’s finances the Laws and Ethical standards when Deliver sustainable Board agreed LHP’s business plan, as the most improved Trust in Cheshire efficiently but without having a Following the Well-Led Governance transacting with or on behalf of the in support of its aim to be the lead health care to meet & Merseyside over the winter period. negative impact on the quality and Review completed in March 2017 NHS. Any breach of the obligations co-ordinator in linking businesses people’s needs The Trust maintained its investment safety of the care we provide our by Deloitte LLP, which identified a stipulated in this Supplier Code of and the NHS in the region, and to in the estate infrastructure with a patients. number of areas of good practice, Conduct is considered a material We are clear that achieving standards lead the development of strategies programme of works including the we implemented an action plan to breach of contract by the supplier. has a positive impact on patient We continued to implement our at the interface between the NHS refurbishment of the operating address those areas where there was experience and so considerable work Quality & Efficiency Programme in and Higher Education Institutions. Front line NHS staff are well placed theatres, the completion of the further scope for enhancement and was put in place to drive forward 2017/18 to deliver efficiency savings Following the review of research to be able to identify and report helipad and ward reorganisations development. Progress was reported improvements, most notably in whilst improving the quality of priorities of the University of any concerns they may have about as well as the purchase of medical to the Board throughout 2017/18 Emergency & Acute Care. We sought services and maintaining performance Liverpool, the intention was to create individual patients who present for equipment. and actions are now embedded into additional support in 2017/18 on the against operational standards. a joint research service across the treatment and modern slavery is business as usual for 2018/19. implementation of our Emergency & The Trust’s financial performance Reinforced by robust Quality Impact Research & Development departments part of the safeguarding agenda. Acute Care Programme to improve was closely monitored in 2017/18 to Assessment and Equality Assessment which would form the cornerstone of We continue to maintain a good A statement of the Trust’s actions is performance and patient flow ensure the financial (deficit) plan processes, this ensured that quality future bids for funding. relationship with our regulators available on the Trust website in line throughout the organisation. This was delivered. We remain committed was not compromised. and despite the performance and with the requirements of the Act. financial challenges in 2017/18, they

18 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 19 Going concern disclosure

Despite the projected deficit for and agreed principles, which mean after due consideration of a range of 2018/19, the Board of Directors that the Trust should be able to factors, including: does not have any evidence provide high quality healthcare • Pay awards and incremental indicating that the going concern within the resources available, increases basis of preparing the accounts provided the cost saving targets of the Trust, as detailed below, are achieved. • National Insurance and pension is not appropriate as the Trust contribution changes The Trust has a robust governance has not been informed by NHS structure which includes a Finance • Inflationary increases for insurance Improvement (NHSI)/Monitor & Performance Committee, a sub- premiums, drugs, utilities and that there is any prospect of Committee of the Board, which general non-pay intervention or dissolution within has the responsibility to monitor the next 12 months. • Financial consequences of both financial performance and oversee capital and revenue developments The directors approved the 2018/19 the necessary corrective action on Annual Plan submission to NHSI/ behalf of and in conjunction with the • Cost savings requirements Monitor. This plan shows an Income Board. The Trust recognises there is • Impact of activity levels and and Expenditure deficit in 2018/19 an urgent need to develop a wider commissioning intentions. amounting to £29.1 million which detailed programme for the delivery is above the control total set by of the continued cost savings and Cash flow projections take into NHSI. The plan does not include to derive benefits from local and account the planned deficit, capital Key issues and risks in delivery of Trust objectives any transitional support income. City Region health economy-wide expenditure, repayment of Public Achieving this plan will require transformational change. Dividend Capital, the drawdown interim revenue cash loans totalling of revenue / capital funds and The preparation of the income £22.5 million. The plan contains movements in working balances. and expenditure budgets and cash The key issues and risks facing the Trust in the delivery of its efficiency targets, including cost There is no certainty that further flow statements is predicated on improvement plans, amounting to cost savings will be identified many national and local factors objectives have been assessed and steps taken to mitigate these, £6.6 million (of which not all has from organisational and service and assumptions regarding both been planned in detail). Having reconfiguration or that additional which included identifying key drivers of change to support the income and expenditure and profiled regard to the significant efficiencies short-term funding will be obtained accordingly. successful delivery of our objectives. achieved over the recent past, this when required and this indicates the level of cost reduction is considered The anticipated level of activity existence of a material uncertainty undertaken for its commissioners, that may cast doubt about the The strategic risks are given below with the We fail to provide effective treatment that and therefore the level of income, is Trust’s ability to continue as a going mitigation identified: achieves best possible outcomes The preparation of the income derived after due consideration of a concern. However, notwithstanding In 2017/18, the Trust experienced eight never events – and expenditure budgets range of factors, including: the deficits referred to above, the We fail to ensure that the care provided for all in Trauma & Orthopaedics, Ophthalmology and Cardiology Trust does not have any evidence patients is high quality, safe and compassionate and cash flow statements • 2017/18 forecast outturn – for wrong site surgery, incorrect implant and wrong indicating that the going concern The Trust’s 3 Year Quality Strategy (2014-17) helped us site injection. In mitigation, the Trust has commissioned is predicated on many • Changes in activity resulting from basis is not appropriate or that deliver improvements in the quality of our clinical services. both internal and external reviews of the safety culture national and local factors and changes in demographic and there is any prospect of intervention This Strategy was refreshed for 2017/18 to ensure the in theatres starting in Q4 2017/18 and carrying on into assumptions regarding both demand or dissolution within 12 months delivery of the three elements of our definition of quality from the date of approval of these 2018/19. All incidents have been managed in accordance • National Payment by Results rules – care that is safe, care that is clinically effective and care income and expenditure and financial statements. In terms of the with agreed governance pathways with learning points and regulations that provides a positive experience for patients and their shared in the monthly Divisional Assurance Group profiled accordingly. sustainable provision of services, families. Our success in continuing to deliver this strategy meetings. The use of the World Health Organisation • Commissioning intentions there has been no indication from has meant that patients and families will always have: the Department of Health that (WHO) Surgical Safety Checklist continues to be revised • National tariff prices. to be challenging. If these levels the Trust will not continue to be a • confidence that we will use feedback from patients and refined as we learn from events in Theatres; we of efficiencies are not achieved, going concern. The directors have and families to improve our services have also raised awareness of the risk and reinforced the The day to day operations of the leadership within Theatres. the Trust would need to apply to Trust are funded from contracts with accordingly prepared the financial • access to high-quality, effective clinical services the Department of Health or other NHS commissioners. The uncertainty statements on a going concern basis. We fail to deliver the benefits of education, appropriate regulatory body for in the current economic climate • care provided in a clean and safe environment research and innovation for our patients and staff additional funding. The plan also has been mitigated by agreeing a • a guarantee that the Trust Board, senior clinical and The Trust continued to take a multi-disciplinary approach includes essential capital expenditure number of contracts with Clinical managerial leaders, and our governors will make to education and learning with a focus on improving of £18.3 million of which £15.2m Commissioning Groups, Local quality their top priority. will need to be funded by the Authorities and NHS England for capability and competence across all staff groups. During Department of Health. a further year and these payments Our aim is to create and sustain a culture of continuous 2017/18, we also reviewed and enhanced the provision of provide a reliable stream of funding improvement and to be a learning organisation in which our leadership and management programmes. Aintree The directors believe that this minimising the Trust’s exposure to Steve Warburton every member of staff understands their role in delivering continues to work with the Collaboration for Leadership forward plan provides a realistic liquidity and financing problems. Chief Executive this strategy and works towards that aim every day. The and Applied Health Research on a variety of research assessment of the Trust’s position. 23 May 2018 delivery of improvements was supported by a number of projects with the aim of delivering health, well-being and Income and expenditure budgets The anticipated level of expenditure enabling principles which we outlined within our Strategy quality of care across the region. In addition, we enhanced have been set on the basis of robust within the approved plan is derived and which relate to building capability and creating an our Aintree Quality Improvement System (AQUIS) to optimal environment for improvement. Work has begun include some joint working with the Royal Liverpool & on developing our Quality Strategy for 2018-2020. Broadgreen Hospitals NHS Trust to deliver a shared Quality Improvement Basic Training course.

20 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 21 Performance Analysis

Inpatients and Day Cases This section provides a detailed performance summary of how 100 2013/14 2014/15 2015/16 2016/17 2017/18 Aintree University Hospital NHS Foundation Trust measures Admissions its performance with more detailed integrated performance increased by 90 analysis and long-term trend analysis, where appropriate. 5.4% 80 70

60 Overall, the Trust’s performance was acceptable, despite significant 50 40

operational pressures and financial challenges. Episodes of care, 000's Total admissions increased by 5.4% 30 during 2017/18 (2016/17: 2.7%) to 93,215. Of these, 46,673 were 20 admitted for an elective procedure Operational Performance (2016/17: 49,068), of which 86% 10 were treated as day cases. 0 Non-elective episodes of care Elective IP Elective Daycase Non-Elective Total Admissions increased to 46,542 (2016/17: Waiting times 39,388). • narrowly missed the 18-week referral to treatment Chart 2: Inpatients and Day Cases 2013/14 – 2017/18 In 2017/18, the Trust: target (RTT) for incomplete pathways • over the whole year, treated admitted or discharged • narrowly missed the target that no more than 1.0% of 83% of patients within 4 hours. This was below the patients should wait more than 6 weeks for a diagnostic national Accident and Emergency standard of 95.0% test, reporting an average of 1.5% for the year.

Cancer Targets Outpatients 450 2013/14 2014/15 2015/16 2016/17 2017/18

Over the whole year, the Trust has met four of the eight cancer targets applicable in 2017/18. 400

Actual 2017/18 350 100% Target 2017/18 300 Patients attending outpatient clinics 250 decreased by 95% 1.2% 200 150

90% Outpatient Attendances, 000's 100

50 85% The total number of patients 0 attending outpatient clinics New Followup Outpatient Total decreased by 1.2% during Attend Attend Procedures Attendances 80% 2017/18 to 421,501 in total (2016/17: 426,686). Chart 3: Comparison of Outpatients’ Data 2013/14 – 2017/18 75% Cancer Cancer Cancer 62 day Subsequent Subsequent Breast Consultant 2 week 31 days 62 days screening 31 day 31 day symptomatic upgrades drugs surgery Chart 1: Cancer Targets 2017/18

22 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 23 Emergency Services Efficiency / Productivity Clinical Effectiveness 167,791 patients seeking urgent care were seen in The Trust manages its efficiency and productivity through • Mortality - mortality rates are a key quality indicator 2017/18, a 2.7% increase on last year. Of these, just monitoring a number of indicators which both improve for the hospital and the Trust compares its mortality with under half were Type 3 attendances delivered at Kirkby the patient experience and reduce our costs: the Dr Foster and national benchmarked data. Walk-in-Centre and at Litherland Walk-in-Centre. • Average Length of Stay (ALOS) – is the time on – Hospital Standardised Mortality Rate (HSMR) – Type 1 urgent care attendances at Aintree increased average that each patient admitted to the hospital would this shows that the mortality rate for the hospital is significantly by 5.3% to 87,612. stay in the hospital. It is variable as some patients stay in better than expected with an index rating of 91.2, The Trust was unable to meet the 4 hour access standard hospital much shorter times and others longer. Using Dr against a norm of 100 (lower score being better than throughout the year, although performance improved Foster data (Dr Foster is an independent healthcare data expected), and better than last year’s rating of 94.22. over the last quarter compared to the same period last provider), the ALOS at Aintree was 0.94 days more than – Summary Hospital Mortality Indicator (SHMI) – year, despite the increased pressures of winter. would be expected for the acuity of patients admitted to the latest report shows a SHMI of 102.85 lower than the hospital at 7.40 days. This is a marginal deterioration Delivery of the standard was affected by several factors the norm, but within expected control limits. The on last year when the ALOS was 0.85 days above expected including increased demand, lack of embedded processes rate is improved on the same period last year of levels at 7.45 days. The increase in ALOS coincides with across the Trust and an increase in the number of 107.26. The Trust will continue, through the Avoidable an increase in the number of patients who have finished ‘medically optimised’ (i.e. ready for discharge) patients Mortality Reduction Group, to review mortality rates their acute stay and are ready for discharge. The Trust is occupying acute beds. This position was reflected across across a broad spectrum and identify and address any working closely with community and primary care partners the health economy and nationally. underlying causes for outlying data, with appropriate within the health system and with local authorities to actions put in place where necessary. During the year, the Trust continued to roll out its reduce delays in discharging patients from hospital. comprehensive and robust Emergency and Acute Care – Crude Mortality – the trend in crude mortality, the Plan, covering Accident & Emergency, assessment areas number of deaths in the hospital as a % of discharges, and ward areas. Embedding the plan across all areas is the Improving productivity within theatres is a major at 3.56% for the year was higher than the average rate key focus internally for 2018/19, whilst externally the Local strand of the 2018/19 efficiency work stream for 2016/17 of 3.34%. Health Economy Accident & Emergency Delivery Board • Readmission – the readmission rate is the percentage continues to look at system-wide solutions to deliver and the Trust has established a working group to of patients who were readmitted to hospital as an the standard on a consistent basis. The Trust is an active identify a clear plan of actions that will improve emergency within 28 days of discharge. Using Dr Foster member of this body. performance to the target rate of 85.5%. data to compare the Trust’s performance against national This plan enabled the Trust to maintain a stable expectations, this shows that the rate of readmissions performance over winter, with a year on year reported of 9.65% was 0.25% higher than Dr Foster rates. improvement of 7.9% over the winter period. • Theatre Utilisation – in order to treat as many This compares to a gap of 0.48% in 2016/17. patients as possible who need surgery, the Trust is keen Nationally, all NHS providers have been set a target • Hospital Acquired Infections and Hospital to make the best use of our operating theatres. to deliver the 95% standard by March 2019. The Trust Cleanliness – improving hospital cleanliness and expects to meet this requirement. Elective theatre efficiency at our main theatres (AUH) reducing hospital acquired infections remains a top and within the Elective Care Centre (ECC) remains sub- priority for the Trust. optimal and showed little improvement year on year. For 2017/18, the target of no more than 46 cases of Improving productivity within theatres is a major strand C.Difficile was achieved with 43 cases reported that were of the 2018/19 efficiency work stream and the Trust has attributable to the Trust. Type 1 Attends established a working group to identify a clear plan of actions that will improve performance to the target rate One case of MRSA was reported during the year which Type 3 Attends of 85.5%. matches that reported in 2016/17, but above the standard to have no hospital acquired MRSA infections in any • Delayed Transfer of Care (DTOC) – the number of Admissions from A&E year. The Trust remains committed to eradicating MRSA beds affected by reportable delayed discharges in 2017/18 infections from the Trust, a position overseen by the 180 was 3.72% (equivalent to 28 beds), a decrease on that Quality Committee. reported in 2017/18 when 3.94% of beds were affected.

160 In addition to reportable DTOCs, the Trust consistently has around a further 100 patients on a daily basis who are 140 ready for discharge, but are awaiting packages of care or

placement. 120 • Day Case Rate – the Trust’s day case rate at the end of the year, as reported by Dr Foster Intelligence, was 100 1.1% better than expected at 84.7%. The proportion of procedures delivered as daycase also increased by 0.9% 80 from 83.8%.

Attendances, 000's • Cancellations – during the year, 256 operations 60 were cancelled for non-clinical reasons, representing 0.60% of all operations scheduled, a deterioration on 40 33,925 2016/17 when 183 operations were cancelled, 0.41% 26,642 27,397 22,008 26,140 of all operations. Disappointingly, three patients were 20 not readmitted within 28 days following cancellation. This compares to five patients during 2016/17. Hospital 0 outpatient cancellations for non-clinical reasons 2013/14 2014/15 2015/16 2016/17 2017/18 decreased to 5.58% from 6.0%.

Chart 4: Emergency Attendances and Admissions 2013/14 – 2017/18

24 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 25 The Trust incurred an exceptional charge of £23.4m Disclosure to Auditors Financial Performance during 2017/18 in relation to its statutory requirement to undertake an independent valuation of its estate As far as the Directors are aware, there is no relevant every 5 years. audit information of which the auditors are unaware. The The current year has seen continued strain on urgent STF was received on delivery of the underlying planned Directors have taken all of the steps that they ought to care services. Attendances at Aintree were up by 5.3% deficit, but not for achieving the access standards for A&E. have taken as Directors in order to make themselves aware which, coupled with the lack of capacity in out-of-hospital Financial Risk of any relevant audit information and to establish that the Our plan included the delivery of a stretching Quality, services/facilities, presented challenges in achieving patient auditors are aware of that information. Efficiency and Productivity (QEP) programme of £13.6m. Aintree continues to deliver strong financial performance flow through the hospital. On a daily basis, around 120 Despite significant in-year service pressures, the Trust in the context of the current operational services medically optimised patients, who are ready for discharge delivered its plan, with a reported deficit of -£3.5m, before pressures it and the wider NHS faces. However, the cost (RFD), occupied acute beds. Compliance with Income Sources exceptional items, which included STF of £10.6m (inclusive of delivering our services is no longer matched by the Restriction As well as the increase in overall numbers attending of a bonus of £4.4m for delivering the financial plan). income we receive, a position the Trust recognised a Aintree University Hospital NHS FT (AUHFT), the Trust number of years ago. Aintree University Hospital NHS Foundation Trust has Given the financial deficit, the Trust reported a Use of has also witnessed a steady increase in the acuity and complied with Section 43(2A) of the NHS Act 2006 (as Resources Rating of 4. Demand, particularly for urgent care services, continues to dependency of patients, which has not only led to grow and we responded to this rise by increasing capacity amended by the Health and Social Care Act 2012) which increases in the number of patients requiring admission, levels, alongside delivering productivity improvements and requires that the income from the provision of goods and but also a need to increase staffing levels to ensure that Income and Expenditure redesign of patient pathways. services for the purposes of the health service in England patients remain safe whilst under our care. must be greater than its income from the provision of Total income for 2017/18 was £351.0m (2016/17: £343.3m) NHS efficiency targets continue to be set at 2%, with goods and services for any other purposes. All these factors have put pressure on the financial and was generated in the following areas: productivity gains averaging around 1.3% to 1.8% per position of the Trust. annum. Further savings are becoming increasingly difficult Other income received by the Trust in 2017/18 has had Operational expenditure budgets totalled £349.5m, with a no adverse impact on the delivery of our services. The The Trust was set a control total of £6.8m, which included to deliver and, whilst Aintree will continue to drive out further £5.0m incurred to service loan interest and Public Trust is, therefore, compliant with Section 43(3A) of the receipt of Service and Transformation Funding (STF) of inefficiencies as appropriate, we believe it is only through Dividend Capital (PDC) Dividend. NHS Act 2006. £8.5m, giving an underlying planned deficit of -£15.3m. proactive action on prevention, investment in new care models, sustaining social care services and, over time, seeing a bigger share of the efficiency coming from wider system improvements, that a step change in the financial Capital Investment position will be achieved. During 2017/18 the Trust invested £11.6 million in a range of estate infrastructure, equipment and information technology assets. Non elective income £90.8m Demand, particularly for urgent care services, The capital programme was financed by a combination continues to grow and we responded to this of the Trust’s own internally generated resources, supplemented by approved loans organised with the Elective income rise by increasing capacity levels, alongside Department of Health. £45.5m delivering productivity improvements and redesign of patient pathways. £m

Other Increasingly, we are looking at how the demand for Theatre upgrade programme 1.7 income services and the growing expectation of the public can £18.5m Outpatient be met by delivering services in different ways and with Ward upgrades and 3.1 income broader organisational collaboration. Without significant other environmental changes £45.2m transformation schemes, the pressure on hospital-based services will continue to grow and the affordability of the Information Technology and 2.0 Non-patient local health and social care system will remain challenged. other equipment care services to Our vision for 2018/19 remains to be a leading provider other bodies A&E income of the highest quality health care, providing the right care Medical Equipment 3.2 £6.6m £13.8m for every patient every time. The safety of our patients Helipad 1.0 remains the cornerstone of our ethos. Nationally, the financial position for the provider sector Other 0.6 Education and continues to be challenged. In 2016/17 the ‘Provider’ sector training reported a deficit of £2.6bn excluding STF, the position for Total 11.6 £12.5m 2017/18 is likely to show a deterioration on this based on 2017/18 Q3 reported data. Table 1: Capital Investment 2017/18 Research & It is within this context that the Trust is working. Its future Development financial viability needs to be considered, not in isolation, £0.8m but as an element of a wider set of strategies in support Non PBR activity income of the Trust’s overall aims and the key deliverables set by £105.1m Private patient NHS England. income £1.6m Sustainability & Transformation Figure 1: Total Operational Funding Income 2017/18 £10.6m

26 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 27 20.000

18.000

16.000

14.000

12.000 £M 10.000

Working8.00 Capital0 Facility and Liquidity Proactive Treasury Management and the Foundation Trust’s ability to invest excess cash on the financial markets Investing in Estate Infrastructure The Trust has6.00 maintained0 stable levels of working capital (within the scope of an approved investment policy) during the financial year and achieved the generated £55k in interest which was reinvested in 4.000 cash levels required to support the annual plan. patient care. Current & Future Developments 2.000 During 2017/18 several significant projects have 20.000 0.000 been completed which have delivered a wide range Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 of benefits: 18.000 • Completion of Phase 2a of the extension and upgrade Actual Cash Balances Plan 16.000 of our Emergency Department as part of the Urgent Care & Trauma Centre (UCAT) development to create a 14.000 bespoke Frailty Assessment Unit • Completion of a new modern Critical Care Unit 12.000 as Phase 3 of our flagship UCAT development £M 10.000 • Delivery of a helicopter landing pad as part of our Major Trauma single receiving site status 8.000 • Adaptation of Emergency Department assessment area • Further refurbishment of six wards within the Tower for delivery of primary care streaming model Block as part of the plans for a single Orthopaedic 6.000 service with Royal Liverpool and Broadgreen Hospitals • Refurbishment and reconfiguration of five and as part of long term ward investment programme 4.000 operating theatres as part of a long term strategy to upgrade the oldest of the operating theatre complexes • Reconfiguration of on-site car parking management 2.000 improving the environment for staff and patients system to ensure fair and efficient charging systems are in place • Refurbishment to our Main A operating theatre 0.000 • Extension and replacement of the hospital pneumatic Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 recovery to provide upgraded fit for purpose facilities tube system used for the delivery of specimens • Reconfiguration and refurbishment of inpatient Chart 5: Cash Actual versus Plan 2017/18 • Conclusion of investment in our energy infrastructure Actual Cash Balances Plan surgical ward and assessment unit to allow for delivery of changes to models of care scheme to ensure the site can continue to meet the growing demands of a modern acute hospital and Events after the Accounting Policies Compliance with • Completion of the refurbishment and re-equipping of significantly reduce our carbon footprint our on-site Laundry with modern energy efficient and Reporting Period The Trust’s significant accounting HM Treasury Policy reliable equipment • Implementation of a new state of the art Electronic policies are set out in Note 1 in the Patient Record System as the first stage in creating There were no material events Aintree University Hospital NHS • Wide scale installation of LED lighting has been carried a single digital healthcare record across three of the between the report period and Notes to the Accounts on page 161 Foundation Trust has complied with of the full accounts included in this out across the hospital from 2015 through to 2017/18. City’s main hospital campuses. Alongside the iLinks submission of the final 2017/18 the cost allocation and charging programme, it will allow sharing of information report. Whilst there were only minor The Trust will continue to invest in the future of local accounts. requirements set out in HM across primary, secondary and tertiary care, enabling changes made to the essence of the health care provision to care for the community it serves Treasury and Office of Public Sector the transformation of clinical practice to deliver accounting policies, the governing through further developments during 2018/19 which will Information Guidance. better and integrated patient care pathways between Joint Ventures and document that they are derived from see further changes to the Aintree campus, namely: has changed from the Foundation health organisations, improving all levels of care Subsidiary Companies Trust Annual Reporting Manual (FT • Replacement of several patient lifts within the main across the City. Better Payment ward blocks In July 2007, the Trust established a ARM) to the Department of Health Practice Code wholly owned subsidiary company Group Accounting Manual (DH GAM). called Aintree Healthcare Limited. The Accounting policies for pensions and The Trust endeavours to pay its purpose of this company is to provide other retirement benefits are set suppliers on a timely basis and in community healthcare projects. As at out in a note to the accounts (Note accordance with the Better Payment 31 March 2018, the company had not 1.5) and details of senior employees’ Practice Code. In 2017/18, the Trust commenced trading. remuneration can be found on page paid 77.1% of its non-NHS supplier 62 of the Remuneration Report. invoices within 30 days of the receipt of a valid invoice.

28 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 29 Sustainability and action plan to support the delivery of its strategies and to improve its sustainability performance; this plan is environmental performance undergoing development against the Trust’s priorities. Aintree continues to contribute to improving the The Strategy will ensure that, by understanding and sustainability of the wider City region and the reduction exercising its corporate social responsibility, the Trust can in health inequalities. Over recent years, the Board of be confident that its actions will benefit rather than harm Directors has approved a Sustainability Strategy, Travel the environment in which we operate and this will be Plan, Carbon Reduction Plan and Capital Investment developed in parallel with our Social Values Strategy. Plan to provide a framework to support its objectives in this area. The Board of Directors is supportive of this agenda and will be engaged in ongoing review and implementation 2018/19 will see the Trust carrying out a comprehensive of the strategy, receiving updates on progress. review of its existing Sustainability Strategy and associated

Waste minimisation & Waste produced by the Trust Expenditure Management

2016/17* 2017/18 2016/17* 2017/18

1,751 tonnes 1,753 tonnes £322,631 £312,853

Methods of Disposal: High temperature incineration, heat treatment, WEEE and landfill. Corporate & Social Responsibility Finite Resources: The Trust’s total utilities usage and costs 2016/17 and 2017/18 Utility Units Usages Costs

2016/17* 2017/18 2016/17* 2017/18 Community Engagement Aintree and the Royal Liverpool and Broadgreen Hospitals into one single team to allow the service to be managed Water M3 212,343 216,326 £543,662 £482,319 The Trust aims to strengthen its engagement with its more effectively as well as providing better patient local community through consultation on and experience. The orthopaedics proposal is part of a wider Electricity GJ 37,039 43,000 £1,093,919 £1,348,856 participation in key projects. In 2017/18, we worked with Healthy Liverpool vision for transforming hospital services our Council of Governors to strengthen their role in this in the City. Gas GJ 194,302 173,983 £1,445,823 £1,231,565 engagement which included promoting membership at different locations within the hospital to engage members Aintree’s staff support a large number of awareness Oil GJ 4,800 3,655 £51,215 £61,760 and the general public. We also supported Governors campaigns each year. These offer both health advice to in developing their relationship with members of the the public, while also helping staff celebrate their service Total achievements. Information stands in the hospital, staffed Energy Get Involved with Aintree Group who had expressed an 236,141 220,638 £2,590,957 £2,642,181 interest in being involved in activities within the hospital. by frontline clinical teams, are complemented with social (excluding media activity using Aintree’s corporate communications water) Healthwatch representatives from Sefton, Liverpool and systems, along with local media coverage. Several national Knowsley attend the Trust’s Patient Experience Executive fundraising campaigns are also supported by staff, patients * All figures for 2016/17 have been corrected for non-trust consumption Led Group which strengthens patient insight into our and visitors. programme of work. Table 2: Carbon emissions: summary performance - 2016/17 & 2017/18 Among the awareness campaigns supported in 2017/18 We frequently engage with our community through our were: Artwork projects. The Trust’s Promoting Art in Aintree The Trust has experienced significant operational pressure Waste volumes remain stable this year; the cost of disposal (PARTIA) has a fully integrated arts programme which aims • April Falls Day across the estate during 2017/18. Against this ongoing has reduced slightly following improved agreements to improve the patient experience, enhance the hospital • Deaf Awareness Week pressure, the Trust has a number of initiatives to reduce with our waste disposal providers. An ‘at source recycling’ environment and provides social engagement both within both consumption and tariffs. Most notably, the delivery initiative was introduced in 2016/17 and this initiative the hospital and in the local community. PARTIA has raised • Dementia Drop-in Sessions for Carers of the Carbon Energy Fund (CEF) project due to be will be extended in 2018/19 to improve recycling levels, the profile of Arts in Health with an increased emphasis on • International Clinical Trials Day completed in 2018 will deliver significant energy savings reduce the Trust’s overall carbon footprint and improve performing arts being delivered on wards by volunteers and reductions in carbon emissions. engagement with staff. and students from local education establishments as well • Reserve Forces Day Our total finite energy consumption has been steady with Water usage has reduced by 10% over the last two years, as arranging Art Exhibitions. • Girl Guiding Merseyside a slight reduction; however, costs have risen due to the reversing the trend of the previous three years which saw The Trust continued to engage with local Overview • Organ Donation Week underlying increase in imported electricity. a 30% rise in water consumption. This continues to be an and Scrutiny Committees (OSC), attending meetings area of concern and further reduction initiatives will be Imported electricity consumption and expenditure have and circulating briefings of relevant Aintree news to • FAB NHS Change Week considered in the coming year. significantly increased again in 2017/18. This is due to the committee members. This included supporting • Workout at Work Day the non-availability of combined heat and power plant Use of fuel oil has remained high in order to facilitate the engagement work with the OSCs by the team leading during the extensive modernisation project. Gas demand clearing and subsequent upgrade of existing oil storage the public consultation on creating a single orthopaedic • Wellness on Wheels (smoking cessation) has reduced; however, there is a detrimental financial facilities and commissioning of several newly completed service for Liverpool. • World Kidney Day consequence seen overall. This situation will not be high care areas. The Liverpool Clinical Commissioning Group led on a • Therapies Open Event fully resolved until the end of the energy infrastructure public consultation in relation to the proposed changes investment project later in 2018/19. to hospital-based orthopaedic services across the City. • Nutrition & Hydration Week. The proposals included bringing the specialist teams from

30 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 31 To further reduce our carbon • Ongoing commitment for for those who work in the NHS. footprint, we are collaborating joint leadership of strategic In the last 12 months, the The Trust uses EDS2 to review its with partners: procurement at Liverpool Women’s equality performance and ensure Hospital and Liverpool Clinical Trust has continued to work it is fully compliant with the • Energy reduction – engagement Laboratories, demonstrating our on integrating and embedding Equality Act 2010 and Public Sector with the CEF as part of the commitment to collaborative Equality Duty. During the course of Liverpool Energy Collaborative equality, diversity and inclusion procurement. 2018/19, the Trust is undertaking with The Walton Centre into all areas of Trust business. a collaborative approach to EDS2 and Liverpool Women’s NHS Our achievements were recognised at working alongside local Trusts and Foundation Trusts to deliver the North West Excellence in Supply South Sefton Clinical Commissioning significant investment in energy Awards 2017 where we were finalists The Trust recognises that to attract, Group. The collaborative approach infrastructure renewal. This project with two Supplier Engagement develop and retain high calibre staff, will ensure services are efficient will deliver savings of £860k per nominations. the diversity of the workforce must and effective in meeting the annum and reduce our carbon Procurement in the NHS is under be respected and valued. Recruitment needs of our local population and footprint by 2,800 tonnes of CO2 significant pressure to realise future in all cases is objective and based in improving access and health • Procurement – working with savings and it is recognised that it on merit and the individual’s ability outcomes across the local health our STP partners, we have is no longer viable to be working to perform the job at the required economy. Our equality objectives negotiated a new model of energy in silos. The Trust is, therefore, standard. Appropriate procedures originally approved for 2014-18 will procurement committed to working with the are in place and the Trust is in the be updated during 2018/19 and will Department of Health and Social Care process of reviewing its Recruitment • Sustainability – we have and NHS Improvement to deliver the and Selection Policy to ensure that commenced participation in Future Operating Model. unfair discrimination does not occur. Our achievements were the Liverpool City Region Green The Trust has an Equality, Diversity recognised at the North West Energy project and anticipate wide and Human Rights Statement in all ranging opportunities as a result Equality, Diversity its policies which states that the Trust Excellence in Supply Awards • Travel and transport – the and Inclusion adheres to legal and performance 2017 where we were finalists Trust is working closely with requirements and will mainstream with two Supplier Engagement The Trust serves a diverse community Mersey Travel, refreshing and Equality, Diversity and Human nominations. updating the Travel Plan delivery and is committed to eliminating Rights principles through its policies, and exploring new and ongoing discrimination; promoting equality procedures, service development and initiatives such as cycle to work, of opportunity and providing an engagement processes. We are also car share and promoting electric environment which is inclusive for working collaboratively with other be based on results from EDS2, the vehicles. patients, carers, visitors and staff. local Trusts and Commissioners to Workforce Race Equality Standard, ensure that we are addressing the We aim to provide equality of access equality monitoring reports and from needs of service users with protected to services and to deliver healthcare engagement with our stakeholders characteristics, including disability, as Procurement that is sensitive to the needs of the including patients, staff and staff side defined by the Equality Act 2010. representatives. The Procurement and Supplies individual and communities. These Department is a key enabler in commitments are set out in the Trust’s In the last 12 months, the Trust has In 2017/18, we also enhanced our the delivery of the Trust’s strategic Equality and Diversity Policy and continued to work on integrating intranet and external-facing Equality vision to be a leading provider of underpinned by the Trust’s Equality and embedding equality, diversity and Diversity webpages and revised the highest quality health care. The Objectives for 2014-2018 to: and inclusion into all areas of Trust the Equality Impact Assessment business. Department supports the delivery of • increase the Trust’s capacity to toolkit. Our workplan for 2018/19 Aintree’s Quality Strategy and the is to take forward a number of identify discrimination, harassment The newly established Equality Trust’s strategic objectives by: initiatives that will continue to and victimisation by developing and Diversity Group reports to embed equality, diversity and • sourcing and delivering the right its workforce and patient data the Hospital Management Board inclusion within the Trust. products and services at the right systems to cover all groups that and ensures the Trust is compliant time to the right place to meet our sit within the nine protected with legislative and regulatory customers’ needs through efficient characteristics requirements relating to equality and diversity. This includes the procurement practices, innovation • improve, year on year, the reported completion and submission of and market knowledge patient experience of groups with the 2017 Workforce Race Equality • creating a positive customer protected characteristics where Standard (WRES) and accompanying experience evidence demonstrates that this is action plan, publication of Workforce Steve Warburton below average for all patients Chief Executive • ensuring that purchasing is and Patient Equality Monitoring data 23 May 2018 undertaken in an environmentally • provide information in a variety on the Trust’s website and continued sustainable manner of ways for patients whose first implementation of the Accessible language is not English, for those Information Standard (AIS). • achieving efficiency through who are hard of hearing and or The NHS Equality Delivery System continuous improvement of supply partially sighted or blind in order (EDS2) is a national toolkit to chain management. to improve their experience help NHS organisations improve Key achievements in 2017/18 were: • reduce health inequalities the services they provide for their • Delivery of over £1m savings for groups with protected local communities, consider health characteristics by improving inequalities in their locality and • Successful leadership of access to key services. provide better working environments collaborative procurement across the region which saw all Trusts involved collectively deliver £1.5m savings

32 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 33 2

Accountability Report Directors’ Report NHS Improvement’s Single Oversight Framework Board of Directors

The management of the Trust is overseen by the Board of Single Oversight Framework Segmentation Directors which, in line with the NHS Foundation Trust governance NHS Improvement’s Single Oversight Framework provides NHS Improvement has placed Aintree University Hospital the framework for overseeing providers and identifying NHS Foundation Trust in Segment 2. potential support needs. The framework looks at five requirements, is held to account by the Council of Governors to This segmentation information is the Trust’s position as themes: discharge the Trust’s accountability to the local population. at 23 May 2018. Current segmentation information for • Quality of care NHS trusts and foundation trusts is published on the NHS Improvement website. Clinical services are delivered through three clinical operating divisions. • Finance and use of resources • Operational performance A range of corporate functions support the operational activities. Finance and use of resources • Strategic change The finance and use of resources theme is based on • Leadership and improvement capability (well-led). the scoring of five measures from ‘1’ to ‘4’, where ‘1’ Based on information from these themes, providers reflects the strongest performance. These scores are then are segmented from 1 to 4, where ‘4’ reflects providers weighted to give an overall score. Given that finance and receiving the most support, and ‘1’ reflects providers with use of resources is only one of the five themes feeding Board of Council of maximum autonomy. A foundation trust will only be in into the Single Oversight Framework, the segmentation Directors Governors segments 3 or 4 where it has been found to be in breach of the Trust disclosed above might not be the same as the or suspected breach of its licence. overall finance score here.

Area Metric 2017/18 scores 2016/17 scores

Division Q4 Q3 Q2 Q1 Q4 Q3 Division Division of of Diagnostic Corporate of Surgery & Financial Capital service cover 4 4 4 4 3 4 Medicine & Support Services Anaesthesia sustainability Services Liquidity 4 4 4 4 4 4

Financial efficiency I&E margin 4 4 4 4 2 3

Financial controls Distance from 2 2 2 2 1 2 The Board of Directors comprises six The Board reviewed its performance managed. The Board also considered financial plan Non-Executive Directors, including the and effectiveness against the the report from the CQC Inspection in Chairman and up to five Executive standards in each of the four key 2017 to inform its learning and work Agency spend 4 4 3 3 4 3 Directors, including the Chief areas of the Monitor (NHSI) Quality is being taken forward in 2018/19 Executive (further details including Governance Framework (strategy, with Deloitte LLP to address this. Overall scoring 4 4 3 3 3 3 biographical information can be capabilities and culture, process and Further details relating to the systems found on pages 129 –132). The Board structures, and measurement), using of internal control are to be found in of Directors has overall responsibility the recommendations from the the Annual Governance Statement Table 3: Single Oversight Framework scores for strategic development, for independent Well-Led Governance (AGS) (page 148). ensuring the quality and safety of Review which took place in 2016/17 our services, education, training to inform its formal agenda and During 2017/18, the Board of and research delivered by the Trust; development discussions in 2017/18. Directors continued to reinforce its ensuring that Aintree is complying This built on the areas of strength stated principle that efficiency savings with its licence (an important element highlighted by the Review including cannot be realised to the detriment of which is its review of the risk the robust governance structure with of quality and patient safety. We management framework and the a clear focus on assurance reporting have had a good record of strong effectiveness of internal controls); and escalation, and good use of financial management and although ensuring the delivery of effective the Board Assurance Framework. we continue to face significant financial stewardship, high standards The latter, in conjunction with the financial pressures, we believe that, of clinical and corporate governance Corporate Risk Register, enables in conjunction with our exceptional and promoting effective relationships the Board to be assured that risks staff, we are able to continue to with our local community. to quality of care are identified and respond to the challenges facing us.

36 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 37 Directors’ interests Quality Governance

The Board of Directors annually The Board is committed to quality reviews its Register of Declared Members of the public can gain access to the Register of governance and ensures that the Interests. The Directors are required Directors’ Interests by writing, telephoning or emailing the combination of structures and to make known any interest in Trust Headquarters: processes at Board level and below relation to matters being discussed support quality performance Aintree University Hospital NHS Foundation Trust, at a meeting of the Board, and throughout the Trust. The Board’s Aintree Lodge, Lower Lane, Liverpool, L9 7AL. any changes to their declared Quality Committee ensures interests. The Register of Declared Telephone: 0151 529 4766, e-mail: [email protected] oversight of clinical risks and Interests for the Board of Directors provides assurance to the Board on Further details of Aintree’s Board of Directors are at pages 129–132. is held by the Director of Corporate the quality of clinical care. To do Governance/Board Secretary and is this, it reviews serious incidents and available for public inspection. receives assurances on the linkages with key areas such as complaints and claims. It also monitors compliance with CQC standards. The Trust uses the Datix system to ensure that risk management is embedded within the organisation and to register all incidents, complaints and claims. The system creates regular reports for key staff and for the groups responsible for governance and quality both divisionally and at Trust level. The Trust has appropriate policies and procedures in place to support quality governance. Appropriate training is provided both at induction and at regular planned intervals, depending on assessment of need, and in a targeted manner. All methods of feedback, whether they be incidents, complaints, claims, inquests, formal reviews or informal patient feedback are closely analysed Further assurance of our systems Significant developments have taken thematically by the Trust. This enables and processes has been gained from place with regards to Information the Trust to identify lessons that can internal assessments and internal Security in 2017/18 following the be learnt, change practice where audit. We produce an annual Quality “wannacry” Cyber-attack in May necessary and to improve controls Report, led by the Chief Nurse, which 2017. The Trust was successful in that are in place. This process is includes the quality objectives set to securing additional monies from enhanced by external benchmarking improve patient safety, experience NHS Digital to strengthen our cyber and participating in peer review. The and outcomes. security stance. Chief Nurse leads in ensuring that Work has commenced on ensuring learning is shared across Aintree from the Trust is compliant with the these activities including through a new General Data Protection number of staff fora. The Trust was successful Regulations (GDPR) which will The Estates & Facilities Directorate in securing additional come into force on 25 May 2018. develops, reviews and implements monies from NHS Digital The Trust’s Senior Information Risk the Trust’s health and safety policies to strengthen our cyber Owner, the Director of Finance, has and leads the Trust in meeting held regular bi-monthly meetings internal and external requirements security stance. with a key focus on Information set to keep patients, staff and visitors Governance and Information Security. safe. Monitoring of health and safety E-mail communications have also related non-clinical incidents was Further details of the approach to been issued to staff in relation to carried out throughout the year quality governance within the Trust information governance and cyber and identifiable trends as well as and the processes adopted to achieve security issues throughout the year. Reporting of Injuries, Diseases and high quality safe patient care may be The Trust has maintained its Dangerous Occurrences Regulations found in the Quality Report on page ‘satisfactory’ rating for the year in (RIDDOR) incidents investigated and 66 and the AGS on page 148. respect of the IG Toolkit. acted upon.

38 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 39 Quality Performance Group and Assessing the healthcare food, condition appearance & Responding to Patients Executive-Led Groups. Examples of maintenance, dementia (including quality innovation schemes include environment dementia friendly environment) reducing avoidable mortality from We value the input of our local and disability. An annual report on The Trust has a strong commitment to using patient feedback to Pneumonia, Acute Kidney Injury Healthwatch organisations and the Trust’s performance on PLACE (AKI) and Sepsis, improving holistic their contribution to the Patient inspections is provided to the Hospital improve the quality of its services and to ensure patient experience needs assessment and care planning Experience Executive-Led Group. Management Board. The outcome of for patients living with and beyond We also appreciate the benefit the 2017 inspections showed that the continues to improve. cancer and enhancing the provision of working with external expert Trust had improved in each domain of end of life care. organisations such as the Alzheimer’s on the previous year and against the national averages. Key improvement projects in Society and the Carers’ Organisation. 2017/18 included working with from patients, relatives and carers of how care should be delivered, Our Governors have been involved Improving the patient NHS Improvement on a pressure and a small reduction in receiving and provides a platform for in the patient-led assessment of the ulcer reduction programme and experience formal complaints. Feedback has identifying good practice and where care environment (PLACE) inspections falls reduction workstreams. These during the year which is reported to During 2017/18, patient feedback been extremely positive and the improvements are required in areas projects in which the Trust works the Health and Social Care Information has been obtained from a number positioning at the front of the of poor performance. alongside regulatory bodies are Centre. The domains covered as part of sources including patient stories hospital has encouraged patients and There was an unannounced visit from especially important as the risk profile of the assessments are cleanliness, and from national and local patient their families to access the team. the Care Quality Commission (CQC) in of the Trust’s patient cohort continues privacy, dignity and well-being, surveys. During 2018/19, we will October 2017, following which action to increase. continue this focus by launching plans were implemented to support our Patient and Family Experience improvement in identified key areas. Strategy which will focus on a Local monitoring of The Trust also took immediate action series of developments to enhance improvements in the quality to address the small number of patient and family experience of care in wards/departments specific concerns that were raised with the ambition of increasing during inspection by the CQC. our rating in the National In- is completed via the Aintree patient Survey. It is envisaged Assessment & Accreditation During 2017/18, the implementation that this strategy will assist our of Aintree’s Quality Strategy (2014- staff to provide the best possible (AAA) Framework. 17) was monitored by the Board experience of care to our patients, Committees and the Executive-Led families and carers. Groups through quarterly update reports. This has ensured that quality The PACT volunteers audit the Following on from an earlier remains at the forefront of the hospital clinical areas to ensure collaboration with NHS England, decision making process at the Trust. leaflets and posters are displayed Picker Institute Europe and the We also monitor against all relevant in each area to ensure that patient, Institute for Healthcare Improvement national and local targets to ensure carers, relatives have the opportunity (IHI) the Trust was invited to join a we are responding to the needs of to raise a concern/complaint. There further cohort of Trusts participating our patients appropriately. in Always Events. Having established is also a comments box outside the that our patients do not always PACT reception area for anyone know who is in charge of their care, wishing to raise a concern/complaint Our progress towards we are currently engaging with out of normal office hours. patients and staff to consider rolling local quality targets out the #hellomyname is campaign and other key quality How we monitor throughout the Trust. improvements improvements in the During 2017/18, the Patient Aintree’s Quality Schedule 2017/18 Information Booklets were updated quality of healthcare that and the local Commissioning for and distributed to the wards to we provide Quality & Innovation (CQUIN) provide information about the standards were developed in line Local monitoring of improvements hospital from admission through to with feedback through activities in the quality of care in wards/ discharge. such as the Friends and Family departments is completed via the Test and patient and carer surveys, Aintree Assessment & Accreditation through discussions with staff, senior (AAA) Framework. This process Learning from complaints clinicians, governors, foundation trust provides the Trust with assurance that Since the opening of the Patient members and in partnership with our the quality and safety of nursing care Advice and Complaints Team’s local Clinical Commissioning Groups. is being regularly monitored, and (PACT) reception area at the start of that action plans are in place where Progress towards achieving these 2017/18, there has been a significant standards are not met. In addition, key standards and milestones are increase in receiving concerns AAA supports local understanding monitored through the Clinical

40 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 41 Stakeholder Relations Research & Development

Aintree’s public and patient involvement activities The Research Department aims to have a diverse range of research studies available for patient participation. This includes both During 2017/18, there have End PJ Paralysis Patient Voices non-commercial and commercial partnerships, covering over 33 been a number of projects In October 2017, the Trust held a ‘Patient Voices’ allows patients to therapeutic clinical areas. where we engaged with and series of awareness events as part leave a recorded voice message on involved patients, carers and of the national #endpjparalysis their experience via the Friends & campaign which aims to get Family Test (FFT). In 2017/18, Aintree conducted Aintree to place commercial contracts Aintree was commissioned to relatives. These included: patients dressed and moving in their The facility to leave feedback via over 320 clinical research studies, with our successful delivery team. evaluate the Liverpool Diabetes own clothes, rather than hospital automated voice message or text achieved through clinical leadership Partnership. The outcome of the gowns or pyjamas to help combat Aintree has been working with the messaging was already established and a commitment from over 100 evaluation will be reported during Visiting Times Audit deconditioning - the process of Collaboration for Leadership and in Outpatients and the Emergency Principal Investigators across the 2018/19. The partnership between Applied Health Research in Care In July 2017, the Volunteers physical deterioration due to bed Trust. The Principal Investigators the Trust and CLAHRC was established (CLAHRC). The Trust has supported Department supported a survey rest - as for many patients wearing are supported by a record number with the Liverpool Commissioning this collaboration on a variety of of inpatients asking them about pyjamas reinforces feeling unwell of research nurses maintaining the Group to improve the service delivery The Board of Directors has research projects during 2017/18 their experiences of visiting times and can prevent a speedy recovery. research portfolio. of Diabetes across the region. described this mechanism as a with the aim of improving health, following the introduction of We continue to take this forward The Trust has a high number of well-being and quality of care across flexible visiting hours in 2016/17. and ask relatives, friends and carers powerful tool for ensuring that research studies open and recruiting the region. Aintree has contributed to help and support us by bringing in patient views are heard in their Our patients told us that they were although there has been a slight dip to the Cancer project, Managing patients’ own clothing to help them This facility has specialist happy with the flexible hours for own words. compared to previous years. This Complex Health Needs and Diabetes. visiting and during 2018/19 we will get out of bed. We also encourage dip is expected as research activity equipment and resources to The Cancer project is a partnership continue to work with the wards patients to ask about their condition, fluctuates year on year; however, the support the diverse portfolio of with the University of Liverpool to support staff in promoting the what needs to be done to enable Department and in February 2017 the overall aim is to increase the number looking at how doctors and nurses research studies conducted at Visitors’ Charter and Information them to go home and when they facility was expanded to incorporate of clinical trials, using the commercial communicate with their head and the Trust. Leaflet to patients and visitors. can be discharged. Each ward taking inpatients. The Board of Directors income revenue. part will have a nursing health care has described this mechanism as neck cancer patients. The aim is to assistant champion and therapy a powerful tool for ensuring that At present, the Trust has partnerships develop a tool to aid communication champion who will help develop patient views are heard in their own with over 40 commercial contract during the patient’s clinical pathway. The refurbished clinical research ideas to combat deconditioning and words. All positive and constructive organisations, generating comparable The Managing Complex Health Needs facility, within the Clinical Sciences encourage colleagues to implement feedback received via FFT is revenue levels from the previous is an Aintree collaboration with Alder Building for Research and Education, the agreed practice. disseminated to Divisional teams, year which supports research activity Hey Children’s NHS Foundation Trust is now fully operational. This who then develop action plans to across the Trust. The Trust is regularly and the University of Liverpool. The aim facility has specialist equipment address any issues. performing at 100% for the delivery of the project is to help patients when and resources to support the of its commercial trials and, as this they are moving from the Children’s diverse portfolio of research studies data is held within the public domain, Hospital to an adult hospital. conducted at the Trust. It also provides Volunteers Service commercial partners approach the opportunity to showcase to our commercial partners the excellent delivery capacity when they are 2017/18 has been another successful life companionship service continues scheme was recognised as one which considering research study placement year for Aintree Volunteers, who to make a significant impact on provides excellent high quality work within the North West Coast. continue to provide a highly the palliative care delivered within experience opportunities for all ages Genomics England, a company regarded service with both the Trust. The wide range of tasks and was given Silver accreditation wholly owned and funded by the local and national recognition, undertaken by volunteers and the with Fairtrain. The Fairtrain quality Department of Health, was set up to particularly for its positive genuine desire to give their time mark is a sought after accreditation sequence 100,000 whole genomes contribution to the patient journey freely and willingly to help others which Aintree now shares with British from NHS patients by 2017. Its four and the excellent relationship with continues to exceed all expectations Airways, Bentley Motors and Cisco UK. main aims are to bring benefit the local community. and is greatly appreciated by Future plans and aims for the service to patients; to set up a genomic patients, visitors and staff. A dedicated group of over 800 include embarking on a number of medicine service for the NHS; to volunteers between the ages of 16 The volunteer department also new volunteer initiatives to support enable new scientific discovery and and 88 offers invaluable support to manages one of the largest NHS Trust patients and their families in many of medical insights; and to kick start the Trust by enhancing the services work experience schemes and works areas of the Trust. Having excellent the development of a UK genomics delivered to patients in a variety of in close liaison with 121 Schools, relationships with the local community industry. ways, e.g. sitting and chatting with Colleges and Universities in the is a real advantage and guarantees a During 2017/18, Aintree has been patients, organising activities for Merseyside area. 585 work experience constant flow of kind hearted people actively recruiting patients with cancer elderly patients, acting as dining students attended the Trust during from all walks of life who are keen to into the Genome Project from breast, companions for patients with the year to gain invaluable experience give their time freely to help deliver an colorectal and head and neck cancer. dementia, providing complementary of working within a busy NHS excellent service to our patients. therapies etc. The volunteer end of environment. During the year, the

42 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 43 Research Strengths Performance – Measures

The Trust has world-leading academic infrastructure in the • During 2017/18, we continued to maintain the Trust’s • Time to Target (Performance in Commercial Activity excellent track record for the recruitment of patients Time to Target) – the figure associated with the high following areas: into studies, increase the breadth of studies and to level objectives and the Performance in Initiation and refine performance metrics. We also aimed to review: Delivery objective is 80%. The Trust has maintained this delivery target and is currently running between 90% Diabetes and Obesity Head and Neck Cancer Critical Care and Anaesthesia • Management and Governance of all Clinical Trials of and 100% for the Delivery of Commercial Clinical Trials Investigative Medicinal Products • Initiation in Clinical Research – the Trust has a very During 2017/18, the diabetes and Mersey Head and Neck Oncology The Aintree Critical Care and challenging target of a 70 day benchmark to recruit the endocrine team have been very active Group (MHNORG), currently Anaesthetic Group has been very first patient into the study. During 2017/18, the Trust with clinical research, publications comprising of 45 research staff and successful in bids to provide extra was running at approximately 80% for all activity. and starting new projects. They have primarily based between Aintree nurse support to the research team. published over 25 original papers and and the University of Liverpool, is the They have increased the numbers review articles in prestigious journals largest UK centre for postgraduate of patients recruited from 4 per Performance – Activity such as the Lancet, Diabetologia, research training in Head & Neck month to 11 per month and the Diabetes Care and Diabetes, Obesity (H&N) specialties. The team have a team have also been successful in and Metabolism. There are a number comprehensive portfolio of early and winning a national funding award of new studies due to open, namely: late-phase local and national clinical from the National Institute of During 2017/18, the Trust maintained a large number of studies downward trajectory, the pipeline of studies has been reviewed. trials. Central to the success of the Academic Anaesthesia. This award STRIVE – Aintree is one of four available to our patients, with over 320 studies conducted. Currently, the Trust is turning down approximately 20 studies group is the consented collection aims to evaluate a novel collaborative collaborative sites in the UK for this The figure is comparable to previous years as seen in Chart 6. per month. Given the patient population at Aintree, it was of tissue samples from surgical approach to teach emergency £1.6 million investigator-initiated However, the trajectory is on a downward trend; this is within recognised that this was not ideal and required a research nurse cases at Aintree for the purpose of cricothyroidotomy in emergency but study studying the effects of the normal range of studies as they are continually opening and infrastructure to support the portfolio but there is a proposal to translational research from more than difficult situations. weight loss medication liraglutide closing on a day to day basis. However, in response to the invest in a further two research nurses to address this issue. 1500 patients diagnosed with Head in people with severe and complex and Neck Squamous Cell Carcinoma obesity. (HNSCC) malignant or premalignant Respiratory Research Total Studies per year RESILIENT – this £1 million study lesions. In addition to the clinical The laboratory provides excellent will investigate the effects of two team the MHNORG have accrued a research opportunities for patients medicines for diabetes (dapagliflozin longitudinal, frozen and archival tissue with asthma, Chronic Obstructive 372 and exenatide MR) on appetite and and blood resource with funding Pulmonary Disease (COPD) and research 368 studies 327 body composition. from the Johnson Foundation and the Interstitial Pulmonary Fibrosis. The 322 315 research research studies research 320 University of Liverpool, along with research brings together expertise 302 research studies ENERGIZE – this £0.5 million studies studies research funding from Aintree for a Laboratory 290 research studies study has completed recruitment from Liverpool School of Tropical research studies 2015/2016 Manager who has populated the and follow up of the effects of Medicine, the University of Liverpool studies 2014/2015 laboratory in the Clinical Sciences 2010/2011 2016/2017 dapagliflozin on energy balance and the NHS with multiple external 2013/2014 Centre at Aintree that enables primary 2012/2013 2017/2018 in diabetes. The results will be collaborations. cell culture of tumour tissue on site 2011/2012 presented during the American and has resulted in the production of Diabetes Association meeting in numerous new HNSCC cell lines. Chart 6: Total Number of Research studies during 2017/18 June 2018. Musculoskeletal Diseases The Team are recognised national There are also a number of new The team has recently started to and international leaders in several commercial trials in obesity, diabetes recruit into an early phase trial study fields including: and diabetes complications that will looking at a novel drug formulation open in 2018. 1. HPV positive Oropharynx into osteoarthritis. This collaboration cancer, including epidemiology, involves both commercial Four MD/PhD students have diagnosis, risk-stratification and the partnerships and involvement and completed and been awarded their identification of novel, de-intensified support from Liverpool Clinical degrees. In April 2017, Dr Uazman Total Commercial Income £860k treatment strategies involving trans- Trials Unit based at the University £850k Alam started as a new Clinical Senior Commercial oral laser surgical approaches which of Liverpool. The team has recently Commercial Lecturer and Honorary Consultant in income income have been pioneered in Aintree. patented a new blood test to predict £641k Diabetes and Endocrinology. Dr Alam responses to high cost biological £600k Commercial will focus on a new area of research 2. Oral cavity cancer, including the drugs in rheumatoid arthritis. This income k Commercial 2016/2017 2017/2018 for the Trust on the complications identification, risk-stratification, has now been commercialised by the £450 income of diabetes, especially neuropathy. management of pre-malignant University of Liverpool and has the Commercial income 2015/2016 He has already been successful in oral lesions, facial reconstruction potential to save the NHS more than £252k obtaining grant funding and started post-surgical ablation and the 2014/2015 £12 million per year. Commercial some commercial research into new management of osteoradionecrosis. income 2013/2014 treatments for painful neuropathy 3. Health Related Quality of Life which affects many people with (HRQOL) and Surgical Outcomes. diabetes. 2012/2013 4. Early and late phase clinical trials in H&N cancer: notably, early phase, Chart 7: Commercial income generation during 2017/18 window-of-opportunity studies.

44 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 45 Funding Sustainability

The Trust has three main streams of funding for Research and Our ambition is to expand the research portfolio across contracts across the Trust. We believe that the proposed therapeutic areas and although this remains a challenge, merger with the Royal Liverpool Hospital will bring Development activities: we believe it is achievable with excellent communication excellent benefits for research staff, both in terms of and ongoing involvement with clinical colleagues. capacity and career development opportunities which, in turn, will bring increased benefits to patients. The Trust’s success with external collaborators and regional Commercial partnerships with NIHR Programme, Higher Education Institutes maintains our commercial Pharmaceutical companies Clinical Doctoral Research Fellowship The revenue generated from commercial contracts The Trust has been awarded a Clinical Doctoral Research reached an all-time high in 2016/17 and this has been Fellowship in Diabetes research led by an Aintree Governance maintained for 2017/18. This funding supported the physiotherapist. The Health Education England/NIHR Clinical growth of research activity and research staff across the Doctoral Research Fellowship (CDRF) Scheme is aimed Trust. However, commercial activity is vital to the support at registered non-medical healthcare professionals with of the growth of research activity across the Trust. To sufficient research experience or training to prepare them to The Trust has recently undergone a hosted site Medicines This activity is supported by Research & Development address this, the Trust gave a commitment in 2017/18 to undertake a PhD, and who wish to obtain a PhD by research and Healthcare Products Regulatory Agency (MHRA) oversight of the clinical trials. The Sponsoring organisation increasing the research workforce in order to generate an whilst continuing to develop their clinical skills. Inspection in collaboration with one of our commercial were extremely supportive and stated that the MHRA increase in commercial income. This fellowship will explore the effects of physical activity partners. The study was set up and risk assessments were Inspection and the Findings were ‘the most favourable Aintree continues to be involved with the development of on patients following bariatric surgery. Following bariatric commented upon by the MHRA. As a Trust, the MHRA they have ever been involved with’. This was a success an Industry Gateway Office (IGO), led by Liverpool Health surgery clinical guidelines recommend that patients complemented the Generic Research team for their record to be celebrated, between the collaborating Sponsor, Partners, and chaired by the Trust’s Chief Executive. The undergo regular exercise; however, research shows that and data management keeping, along with Standard Research and Development and Clinical Generic Team led IGO aims to promote Liverpool to external commercial levels of physical exercise remain low. There is evidence to Operating Procedure delivery for Trial Master Files and by Melanie Harrison, Senior Research Nurse. partners as a region with the capacity to deliver clinical show that physical exercise following surgery may have Clinical Oversight. trials and commercial contracts. long term outcomes, patients may achieve a greater initial weight loss and reduce the risk of regain. In addition to this, the body is able to use insulin which is important for Department of Health good blood sugar control in diabetes. Research Success at Aintree This funding flows through the National Institute for The research team, led by an Aintree physiotherapist, Health Research (NIHR) which has been reduced in the will develop work packages of exercise to provide North West Region as a whole. However, the funding support and guidance to Aintree patients following Cardiology Cancer allocations for 2018/19 have allowed Aintree to maintain bariatric surgery. There will be wide consultation with its funding allocation with a small uplift due to activity. patients, commissioners and clinical teams to evaluate the Aintree is playing a leading role in improving the diagnosis The research nurses and data manager at Aintree were This provides the opportunity to review our non- effectiveness of the work packages. of patients with coronary heart disease. The Trust is taking chosen to be the Cancer Research UK Clinical Drug commercial activity during the next financial year. part in a major European research trial called DISCHARGE to Development (CDD) Trial Heroes. In 2017/18, they won speed up the diagnosis of Aintree patients with chest pain the award from the CDD team “for all their hard work on and possible coronary heart disease. the AMG319 study. They are fantastic with their patients Grant Awards from national calls There is evidence to show that physical exercise and will go above and beyond to ensure that they can Aintree is playing a leading role in improving the diagnosis take part in the study. The whole team are extremely for research themes from Charitable following surgery may have long term outcomes, of patients with coronary heart disease. The Trust is taking conscientious and enter very high quality data and process Organisations and the Department part in a major European research trial called DISCHARGE patients may achieve a greater initial weight loss extremely complicated samples. They are a lovely team and to speed up the diagnosis of Aintree patients with chest of Health and reduce the risk of regain. are always extremely welcoming and accommodating on pain and possible coronary heart disease. During 2017/18, monitoring visits”. The team is led by Professor T Jones. Aintree patients will be recruited into the trial to determine NIHR Doctoral Research Fellowship if the use of CT scans would benefit patients in the diagnosis Once the study is evaluated, the findings will be shared of coronary heart disease. This work was first pioneered The Trust has been awarded a prestigious NIHR Doctoral with Aintree patients and the public through the Patient in Berlin and now our patients have the opportunity to be Research Fellowship during 2017/18. This study is led by and Public involvement group established here at Aintree. involved in this important clinical research study. a trainee surgeon with the aim of developing Principal This group consists of Aintree patients and participants This work was first pioneered in Berlin and now our patients Investigators and hence provides a sustainable research from a UK based charity specifically for people who have have the opportunity to be involved in this important clinical workforce for the future. The research is looking at the had or are considering the weight loss surgery. Therefore research study. effectiveness of Fibrin Sealant in reducing complications the results will be fed back to the very participants who in patients undergoing neck dissection for head and have helped shape the research here at Aintree. neck cancer. If this pilot study demonstrates that a future trial is deliverable, it is anticipated that it will commence Hepatology shortly after funding is secured. Fibrin Sealant could be During 2017/18, Aintree worked with a commercial implemented into routine surgical practice without delay partner, Vital Therapies, in ground breaking research for to our patients here at Aintree. As neck dissection is one liver disease. The Aintree hepatology research team were of the most commonly performed major head and neck flying the flag for the UK as they were the top recruiter operations, the result of the trial could have far reaching across Europe in this innovative device and drug trial. effects on patient care both nationally and internationally.

46 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 47 Clinical Research Studies across the Trust Staff Report

Presently, there are over 300 studies open and recruiting across 33 Our staff are an integral part to delivering our vision to be a therapeutic departments. leading provider of the highest quality health care and are the Number of Studies key enablers to delivery of all of our strategic objectives.

35 34 35 We continue to build on our commitment to staff engagement

30 and understand the importance of having all our people

25 25 focussed on ‘getting it right for every patient every time’. s 22 21 20 19 20

15 14 15 13 12 12 At the year end, the Trust employed 4,916 staff as follows (male: female ratio): Number of Studie 10 10 9 9 10

4 4 Staff Group Numbers Male: Female ratio 5 3 3 3 2 2 1 1 1 1 1 Directors 13 7 : 6 0 Senior Managers (ESR) 488 248 : 240

Other Employees 4,428 847:3,581

Table 4: Trust Employees

Chart 8: Research Active Departments Staff Engagement & Well-being On-going Developments within Research and Development As well as the Staff Survey and the Key achievements in 2017/18 were: • Raising concerns model – Staff Friends & Family Test, other this has continued to evolve with initiatives such as “Conversations • Conversations with the implementation of the Speak with the Board” and “Ask the these focussed on the out Safely Policy. The Freedom to We have seen progress in a number of areas, with many successful grant applications and publications such as: Board” have supported staff the Board – organisation prioritising patient care. Speak Up Guardian role has also engagement. Significant work has All Board members were involved in continued to evolve and a report is • Over 100 Publications in high impact scientific and medical journals also been undertaken on making it structured conversations with staff provided to the Board twice yearly easy, expected and safe for staff to at all levels from the Divisions and to highlight any themes. • Key member of Joint Research Office initiative raise concerns. Corporate Teams including Estates &

• Fully refurbished and operational Clinical Research Facility based in the Clinical Science Centre supported by a Facilities on how well they feel the • Directors Dragons’ Den – Summary of organisation prioritises patient care. dedicated Clinical Research Facilities Manager this has been led by the Chief These sessions have enabled staff Engagement Activity Executive with investment for a to feed back their experience and • A full review of the governance arrangements for Clinical Trials and a review of the Research Standard range of innovative schemes being The Trust has continued to for Board members to explore how Operating Procedures approved, including a Zappar App improve its engagement with staff improvements can be achieved. using Listening into Action (LIA) for education, for both staff and • Clinical Academic Programmes Leads with key stakeholders: Aintree involvement in Cancer, Infection & MSK, methodology which empowers staff patients to be able to provide Diabetes and Respiratory to address barriers getting in the way • Ask the Board – offers staff the the best possible care, improved of them doing the right thing and outside space for our patients • Strong commitment from both Research and Development offices to provide a unified research service across opportunity to put their questions improving the delivery of services recovering from strokes and other both Aintree and Royal Liverpool sites direct to the Board and for the provided for our patients. Board’s responses to be shared with neurological conditions and the all staff via our website. design of a new bespoke gown for • Model of service reconfiguration for research administration has been developed and agreed by the CEO at 2017/18 has seen LIA principles being our patients on critical care who Aintree and CEO at Royal Liverpool Hospital. deployed locally and corporately need very specialised care. within the organisation.

48 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 49 Education & Learning

During 2017/18, the Trust continued to drive its Education & Learning Strategy with a multi-disciplinary approach to education and learning with a focus on improving capability and competence across all staff groups. The Integrated Education & Learning Service supports the delivery of this approach.

Key achievements in 2017/18 include: • Improved ‘Carry the bleep’ teaching for 5th year medical students to prepare them for foundation years • Implementation of the core education teams and functions to support a multi-professional approach • Excellent feedback received for our undergraduate across medical and clinical education, as well as a education programme delivery for medical students learning organisation team. Delivering excellence in from the University of Liverpool National NHS Staff Survey 2017 education to meet the Trust’s common purpose • Improved feedback received from Health Education • Improved educational experience of our trainees by England (HEEN) for our Postgraduate Medical Education establishment of full day’s protected teaching once and removal of the Trust from General Medical Council The national NHS staff survey ran between September and December a fortnight for foundation trainees, with positive (GMC) Enhanced Monitoring evaluation 2017. The Trust used a mixed mode method and all staff were offered • Support for the development of a Mersey Apprentice • Developing the multi-professional workforce to strategy led by the Mersey teaching partnership the opportunity to complete the survey. Details of the key findings support changes in medical staffing to include further • Implementation of a multi-professional preceptorship development of advanced practice, physicians associates from the Survey are identified below: programme for newly qualified nurses and AHP’s and medical support worker roles (MSW) • Implementation of a new mandatory risk management • Continued implementation of the junior doctors’ training matrix and made significant improvement in contract Response rate compliance • Funding was received from the ‘Dragons’ Den’ initiative 2016/17 2017/18 Trust Improvement/ Deterioration • Continuation of undergraduate multi professional for several initiatives such as support for trainee doctors; simulation education (STABILISE) in collaboration with Trust Trust Benchmarking augmented reality app, innovative learning environment local Healthcare Environment Inspectorate (HEI) group (acute and state of the art simulation equipment trust) average • The creation of a Learning Zone which allows staff to • On-going provision of a clinical training hub in the acute drop in and practice their clinical skills. hospital, which provides staff with easy access to Clinical Response rate 43% 50% 45.5% The response rate for the Trust increased by 7% on Education the previous year and is also higher than average for acute trusts.

Table 5: Summary of performance – Response rates 2017 Leadership Development Largest local changes Our top 5 scores in 2017 where the Our bottom 5 scores in 2017 since the 2016 Survey Trust compared most favourably where the Trust compared least Developing leadership and management capability and capacity with other acute trusts: favourably with other acute trusts: Staff experience has improved • KF16 Percentage of staff working • KF4 Staff motivation at work across the Trust remains a key priority for Aintree. It is an integral part against the following key findings: extra hours • KF11 Percentage of staff appraised of our drive to improve the quality of patient care and the experience • KF10 Support from immediate • KF20 Percentage of staff in the last 12 months managers experiencing discrimination at work • KF23 Percentage of staff of patients, their families and friends. in the last 12 months • KF13 Quality of non-mandatory experiencing physical violence from training, learning or development • KF25 Percentage of staff staff in the last 12 months During 2017/18, Aintree reviewed the provision of • Implemented a team performance coaching programme experiencing harassment, bullying • KF15 Percentage of staff satisfied • KF18 Percentage of staff attending leadership and management programmes, including: for the senior leadership team or abuse from patients, relatives or with the opportunities for flexible work in the last 3 months despite the public in the last 12 months • The Institute of Leadership and Management (ILM) Level • A matron professional development programme has working patterns feeling unwell because they felt 2 Team Leader Award - a 3 day programme accredited by been undertaken. • KF30 Fairness and effectiveness of • KF26 Percentage of staff pressure from their manager, the ILM and aimed at Team Leaders and Supervisors procedures for reporting errors, experiencing harassment, bullying colleagues or themselves or abuse from staff in the last • Commissioned the development of a core management near misses and incidents • KF24 Percentage of staff / skills programme 12 months • KF9 Effective team working. colleagues reporting most recent • KF14 Staff satisfaction with experience of violence. resourcing and support.

50 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 51 Top 5 ranking scores Future priorities and targets The priorities for action arising from the 2017 survey Improvement work is already underway to ensure the 2016/17 2017/18 Trust Improvement/ Deterioration have been linked directly to delivery of the Trust vision Trust achieves the national average for staff engagement. Trust Trust Benchmarking and common purpose and link to the four high impact An improvement programme will also be developed to group (acute areas identified in the Trust’s Annual Business Plan: ensure consistent engagement across the organisation as trust) average • Culture part of the Trust’s cultural improvement programme.

KF16. Percentage of staff 70% 69% 72% Improved from 2016 and better than national • Capacity working extra hours acute average • Competence

KF20. Percentage of staff 10% 10% 12% Same as 2016 but lower than national acute • Communication. experiencing discrimination average at work in the last 12 months

KF25. Percentage of staff 26% 27% 28% Slightly worse than 2016 but still better than experiencing harassment, the national acute average Staff Friends & Family Test bullying or abuse from patients, relatives or the public in the last 12 months Feedback from the National Staff Friends and Family Test (FFT) was monitored quarterly during 2017/18, The Staff FFT poses two questions: KF26. Percentage of staff 23% 22% 25% Improvement from 2016 and better than with the exception of Quarter 3 as this coincided with experiencing harassment, national acute average the National Staff Survey period. • how likely are you to recommend this organisation to bullying or abuse from staff friends and family if they needed care or treatment? in the last 12 months • how likely are you to recommend this organisation to KF14. Staff satisfaction with 3.33 3.35 3.31 Improvement on 2016 and better than national friends and family as a place to work? resourcing and support acute average. The Trust’s results for 2017/18 are set out below demonstrating an improving trend in recommendation as a place to work. Table 6: Summary of Top 5 Ranking Scores

Trust Wide – 2017/18

Bottom 5 ranking scores Base % Score % Target Target Met 2016/17 2017/18 Trust Improvement/ Deterioration Question Q1 Q2 Q4 Q1 Q2 Q4 Q1 Q2 Q4 Q1 Q2 Q4 Trust Trust Benchmarking group (acute trust) average How likely are you KF4. Staff motivation 3.82 3.84 3.92 Improvement on 2016 but still below national to recommend this at work acute average organisation to 929 874 1039 83 85 81 67 67 67 friends and family if KF11 Percentage of staff 78% 78% 86% Same as 2016 they needed care or appraised in the last 12 months treatment?

KF23 Percentage of staff 2% 3% 2% Worse than 2016, however, figure is not experiencing physical statistically significant violence from staff in the last 12 months How likely are you to recommend this KF18 Percentage of staff 58% 56% 52% Improvement on 2016 but still worse than organisation to friends 926 872 1039 59 61 62 61 61 61 attending work in the last national acute average and family as a place 3 months despite feeling to work? unwell because they felt pressure from their manager, colleagues or themselves Table 8: Staff Friends & Family - Trust results 2017/18

KF24 Percentage of staff/ 60% 63% 66% Improvement on 2016 but still worse than colleagues reporting most the national acute average recent experience This feedback will build on the development work to improve staff engagement and the overall staff engagement score. of violence

Table 7: Summary of Bottom 5 Ranking Scores

52 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 53 Improving Staff Health & Well-being

The Trust is committed to maintaining high levels of attendance effectively and, to this end, seeks to proactively manage this area.

Throughout 2017/18, the Trust has supported managers and staff in improving their attendance and well-being under five High Impact Changes previously identified. These areas remain the focus for the 2017/18 People and Organisational Development Plan.

Improvement and Health and Well-being can tailor • Following our collaboration with the needs of the individual with the Merseyside Sports Partnership changes made in 2017/18 type of support required (MSP), the Trust launched an initiative whereby staff had access • The Health and Well-being Group • A successful Flu Campaign saw to gym bikes in their work areas. (HWG) is tasked with delivery of us vaccinating over 87% of our The purchase of these exercise bikes health and well-being actions in frontline staff. Once again, we by the Trust has enabled staff to line with the 2016-18 plan. This offered flexibility in appointments have access to them at their place plan is aligned to the Health and and locations covering a 24 hour of work. This innovation allows Well-being (HWB) CQUIN and the period to ensure that as many staff to spend a few minutes during initiatives within it ensure its ability staff as possible who wished to be their working day increasing their to deliver the CQUIN objectives vaccinated had the opportunity physical activity and reducing Trust focus for 2018/19 which were set out for 2017/18 to do so including ‘Flu to you’ sedentary behaviour with a proactive focus on the initiatives and ‘Jab at the Hut’. fast track management of MSK’s Our Flu team worked closely with • Specialist Nurses and our Effective Mental Health Support peer vaccinators to provide the Occupational Physio have The focus for Health and Well-being for 2018/19 is mapped to the and the encouragement of staff greatest accessibility. We have commenced the roll out of a series to increase their physical activity. been shortlisted for this year’s NHS of ‘health on the hoof’ sessions 2018/19 Health & Well-being CQUIN as well as being based on the Activities such as the NHS Games Employers Flu Fighters awards in targeting those hard to reach are again supported with Aintree the category of ‘Most innovative Flu patient facing staff who seldom five High Impact Areas of: continuing to chair these events Fighter campaign’ take part in the HWB events that which are designed to encourage are hosted throughout the year. • We have made further staff participation. Following a This initiative is fully supported by Developing local evidence-based Access to local, high-quality, accredited improvements to the online successful bid to the Dragons’ Den, senior leadership. the Occupational Health (OH) and management referral form to improvement plans occupational health services Well-being Service has been able to Occupational Health to expand Build on the HWG’s work to deliver the agreed annual Continued review of the occupational health service launch a series of exercise classes for the information provided at the plans. The Group is made up of representatives across all to ensure it is proactive and accredited to support the employees including Ai-Chi which point of referral resulting in more stakeholder groups to facilitate meaningful interventions system for staff and the organisation as well as look at take place in the therapies pool (of effective reports being generated. and initiatives aimed at providing employees with streamlined quality innovation which meets the health particular benefit to employees who This is now being shared as best information to support their informed lifestyle choices. and well-being needs of our staff and our organisation. have experienced MSK disorders); practice within the wider Cheshire & Mindful Yoga and Tai Chi classes Merseyside OH remit as the basis for streamlining our services Strong, visible leadership Encouragement and enablement of • The Employee Assistance Programme, which involves various • A programme for Mindfulness Ensure health and well-being initiatives are underpinned staff to take personal responsibility training has now been completed listening therapies including with strong leadership and visible support at Board level Build on the success of 2017/18 activities and expand by employees across the Trust counselling, provides greater with monthly progress reporting through the Workforce targeted initiatives for individuals to make informed which has enabled the cascade flexibility for both face to face and Executive-Led Group and Board. choices about health changes and/or improvement that of mindfulness as a tool that can phone counselling and support. It has a positive effect upon them and, in turn, assist in be used as a means of nurturing aims to support staff to remain in the nurturing of a resilient, engaged workforce through individual resilience. It is introduced work whilst receiving additional Improved management capacity ownership of their holistic health needs. This will be support. In terms of referrals, over at the commencement of Basic Ensure line management training plans for 2018/19 in supported by the delivery of the 3 year HWB plan 2016- 50% of staff accessed the service Life Support training to ensure the relation to the attendance management of their staff 2019 and as part of the relevant CQUIN. whilst still in work. The service widest reach across our workforce enables managers to be equipped with the tools to deliver which is hosted within Occupational fair and consistent management of employees. This will be evident in the newly constructed Core Management Training Programme.

54 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 55 Occupational Health (OH) and Well-being Service Off-payroll Arrangements Disclosures

The Trust has an in-house weight management assistance, internal and external customers. All Trust board-level appointments are included on the payroll. The Trust only uses off-payroll engagements where occupational health service which is smoking cessation and alcohol As part of its streamlining, the there is a genuine commercial requirement to allow the Trust to buy in specialist skills on a short term basis, for designed to maximise the physical, support services. OH and Well-being service has which no internal expert exists and for which the Trust would have no long term requirement. psychological and social health significantly improved its clearance Staff have access to a wide range and well-being of all employees of new starters in patient facing of proactive Health and Well-being This Service also delivers bespoke roles in order to benefit the time initiatives such as a garden allotment, effective occupation health to hire and on-boarding of new No. of existing engagements as of 31 March 2018 of which: exercise classes, the use of static delivery to a number of NHS Trusts employees. On average, the time exercise bikes in all work areas as and other organisations. to clear from contacting is now less No. that have existed for less than one year at the time of reporting 0 well as cycle and running clubs. As than four working days. The Service The establishment of the Head part of the proactive approach, the has recently completed its SEQOHS No. that have existed for between one and two years at the time of reporting 0 of Organisational Health and OH service offers ‘back on track reaccreditation which has been Effectiveness and the review of classes’ for employees as an effective awarded for a further 5 years. The No. that have existed for between two and three years at the time of reporting 0 the various processes for both means of preventing musculoskeletal comments of particular note from the pre-employment and management disorders by focusing on education, assessors stating: “The entire facility No. that have existed for between three and four years at the time of reporting 0 referral have had a positive impact on core stability and functional provides an exceptional clinical the delivery of a safe effective quality restoration. This programme is also environment for good occupational No. that have existed for four or more years at the time of reporting 0 service. offered to employees who want health delivery”. to improve their general fitness In addition to the core services of and functional capacity. The OH The ongoing development of the OH Table 9: For all off-payroll engagements as of 31 March 2018, for more than £245 per day and that last longer than six months new employee health assessments, and Well-being service has led the and Well-being internal and external management referrals/advice implementation of various fitness facing web pages has resulted in a and immunisation/vaccination All of the existing off-payroll engagements, as outlined in Table 9 above, have at some point been subject to a classes specifically for Aintree staff. simplified intuitive index of useful programmes, other services offered risk-based assessment as to whether assurance is required that the individual is paying the right amount of tax and, information and signposting for by OH and Well-being include fast The Service has continued to develop where necessary, that assurance has been sought. employees as well as showcasing track physiotherapy, a comprehensive its services in accordance with its Safe what we offer to prospective and Employee Assistance Programme Effective Quality Occupational Health existing clients. (EAP), lifestyle health assessments, Service (SEQOHS) accreditation, complimentary therapies, health working with an external provider promotion programmes aligned to for an EAP and is nearing completion No. of new engagements, or those that reached six months in duration, between 1 April 1 Public Health guidance including of electronic personal records for 2017 and 31 March 2018

Of which:

Number assessed as within the scope of IR35 0 Sickness absence during Counter Fraud Number assessed as not within the scope of IR35 1 2017/18 The Trust is committed to tackling Signed An attendance management target fraud within the organisation by Number engaged directly (via PSC contracted to trust) and are on the trust’s payroll 0 of 96% was set for 2017/18 and raising awareness of the issues and Number of engagements reassessed for consistency / assurance purposes during the year 0 reported to the Board on a monthly ensuring all employees are aware of basis. The Trust has maintained an the necessary reporting lines should Number of engagements that saw a change to IR35 status following the consistency review 0 average attendance rate of 95.77% they suspect fraud, corruption and/or across the year. Focussed work is bribery. All employees play a vital role Steve Warburton underway on reducing long term in helping reduce losses throughout Chief Executive, 23 May 2018 absences using a range of health and the NHS. Table 10: For all new off-payroll engagements, or those that reached six months duration, between 1 April 2017 and 31 March 2018, well-being initiatives. The Trust’s intranet contains for more than £245 per day and that last longer than six months information and guidance to staff on what they can do to report fraud including the contact details of the Trust’s Local Counter Fraud Specialist Number of off-payroll engagements of board members and/or senior officials with 0 and links to other relevant websites. significant financial responsibility, during the financial year The Trust has a suite of policies in relation to Counter Fraud, including  Number of individuals that have been deemed ‘board members and / or senior officials with 13 Anti-Fraud and Bribery and Standards significant financial responsibility’ during the financial year. This figure must include both of Personal and Business Conduct off-payroll and on-payroll engagements. for all employees, in addition to its Freedom to Speak Up policy. Table 11: For any off-payroll engagements of board members and/or senior officials with significant financial responsibility, between 1 April 2017 and 31 March 2018

56 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 57 Exit Packages (Tables) (Audited by PwC LLP)

1. Reporting of other compensation schemes – Number of Number of Total number exit packages 2017/18 compulsory other departures of exit packages 3. Exit packages: other (non-compulsory) departure 2017/18 2017/18 2016/17 2016/17 redundancies agreed payments – 2017/18

Exit package cost band Number Number Number Agreements Total value of Payments Total value of (including any special payment element) agreements agreed agreements

<£10,000 2 28 30 Number £000 Number £000 £10,001 - £25,000 1 1 Voluntary redundancies including early £25,001 - £50,000 2 3 5 retirement contractual costs

£50,001 - £100,000 2 2 Mutually agreed resignations (MARS) 1 49 7 233 contractual costs £100,001 - £150,000 0

£150,001 - £200,000 0 Early retirements in the efficiency of the service contractual costs >£200,000 0 Contractual payments in lieu of notice 30 171 38 224 Total number of exit packages by type 7 31 38 Exit payments following employment tribunals or Total resource cost £234,000 £220,000 £454,000 court orders

Non-contractual payments requiring HMT approval

Total 31 220 45 457

of which: 2. Reporting of other compensation schemes – Number of Number of Total number exit packages 2016/17 compulsory other departures of exit packages non-contractual payments requiring HMT approval redundancies agreed made to individuals where the payment value was more than 12 months’ of their annual salary Exit package cost band Number Number Number (including any special payment element)

<£10,000 1 37 38

£10,001 - £25,000 1 2 3

£25,001 - £50,000 1 4 5

£50,001 - £100,000 2 2

£100,001 - £150,000 0

£150,001 - £200,000 0

>£200,000 0

Total number of exit packages by type 3 45 48

Total resource cost £42,000 £457,000 £499,000

58 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 59 Analysis of Staff Costs (FT ARM 2.80): (Audited by PwC LLP)

2017/18 2017/18 2017/18 Permanently Other Total Employed £000 £000 £000

Salaries and wages (including bank and locum staff) 158,621 13,072 171,693

Social security costs 15,173 562 15,735

Apprenticeship Levy 769 0 769

Employer's contribution to NHS Pensions 17,303 661 17,964

Employer's contribution to National Employer 11 0 11 Savings Trust

Agency / contract staff 0 15,236 15,236

Total 191,877 29,531 221,408

Analysis of Staff Numbers (FT ARM 2.80): (Audited by PwC LLP)

2017/18 2017/18 2017/18 Permanently Other Total Employed

Medical and dental 566 25 591

Administration and estates 961 48 1,009

Healthcare assistants and other support staff 521 29 550

Nursing, midwifery and health visiting staff 1,596 418 2,014

Scientific, therapeutic and technical staff 766 16 782

Total 4,410 536 4,946

60 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 61 Remuneration Report Salary and Pension Entitlements of Senior Managers (Audited by PwC LLP)

Remuneration paid to Executive Directors is determined by the A ) Remuneration 2017/18 Remuneration and Nominations Committee, whose membership comprises the Trust Chairman and the Non-Executive Directors. Salary and All Taxable Annual Long Term All Pension Total Fees (bands Benefits Performance Performance Related (bands The annual statement from the Chair of the Remuneration of £5000) (Rounded Related Related Benefits of £5000) to the Bonuses Bonuses (bands Committee is to be found on page 138, together with details of nearest (in bands (in bands of £2500) attendance at and membership of the Committee. £100) of £5000) of £5000) £000 £000 £000 £000 £000 £000 Service contract The Trust’s Remuneration Committee The banded remuneration of the Goodwin N, 40-45 0 0 0 0 40-45 considered each of the proposed highest paid director in the Trust Chairman obligations salaries for the Executive Directors in the financial year 2017/18 was Appointments to Executive Director at the time of their appointment. £172,500 (2016/17, £222,500). This was Clague J, 10-15 0 0 0 0 10-15 posts are made in open competition The Trust can demonstrate that it 6.5 times (2016/17, 9.2) the median Non-Executive and can only be terminated by reviews remuneration on a regular remuneration of the workforce, which Director resolution of the Board other than basis and, where new appointments was £26,565 (2016/17, £24,262) as in cases of normal resignation. are to be made, takes into account audited by PwC LLP. Johnston T, 10-15 0 0 0 0 10-15 national benchmarking when setting Non-Executive Directors hold permanent contracts In 2017/18, 24 (2016/17, four) remuneration levels. Director with a standard six month period employees received remuneration in of notice. Non-Executive Directors The Trust does not have a excess of the highest-paid director. Wearne M, 10-15 0 0 0 0 10-15 are appointed for a period of three Performance Related Pay policy so Remuneration of these employees years and can only be removed in Non-Executive performance-related bonuses are not ranged from £171k to £289k (2016/17: Director accordance with Monitor’s Code of applicable, nor are recruitment and £235k – £309k). Total remuneration Governance. retention premia applied to senior includes salary and, if appropriate, Fillingham D, 10-15 0 0 0 0 10-15 management roles. would include non-consolidated Non-Executive performance-related pay and Director Loss of office benefits-in-kind. It does not include The Trust’s normal disciplinary policies Senior managers paid severance payments, employer Ryan K, 10-15 0 0 0 0 10-15 apply to Executive Directors, including more than £150,000 pension contributions and the cash Non-Executive the sanction of instant dismissal equivalent transfer value of pensions. Director for gross misconduct. The Trust’s Two of the Trust’s Executive Directors The fair pay multiple has moved to redundancy policy is consistent with are paid more than £150,000, the Warburton S, 170-175 0 0 0 50-52.5 220-225 6.5 in 2017/18 from 9.2 in 2016/17 NHS redundancy terms for all staff. In threshold considered a suitable Chief Executive mainly due to a reduction in salary the eventuality of a senior manager’s benchmark for NHS foundation trusts of the current highest paid director. loss of office, the Chief Executive (for – these are the Chief Executive and Jones I, 125-130 0 0 0 27.5-30 150-155 In the previous year, the highest paid executive directors) or the Chairman Medical Director. Director of Finance director was the Medical Director (for the Chief Executive) may alter, & Business Services For the Chief Executive and Medical who retired in March 2017. The postpone or disallow any individual Director, the salary levels applied highest paid director is now the Chief payment they deem appropriate. Cope T, 1 165-170 0 0 0 0-2.5 170-175 were benchmarked against the Executive who is in a pay bracket that These actions must be supported by Medical Director median range, using the Capita is £50k lower. the Remuneration Committee. NHS Foundation Trust Board Smithson A, 145-150 0 0 0 92.5-95 240-245 Remuneration Report February Deputy Chief 2014. The salary level of the Deputy Expenses Executive/ Remuneration Chief Executive/Integration Director 1/21 governors submitted expense Integration Director Details of remuneration are set out reflected the wider core role in terms claims in 2017/18. The total amount in the tables overleaf and have been of devolved responsibility from the of expenses paid to governors in Brown D, 110-115 0 0 0 50-52.5 165-170 subject to audit. The tables include Chief Executive for external areas 2017/18 was £126. 8/13 directors Chief Nurse the following: e.g. Healthy Liverpool, strategic transformation etc. It also reflected submitted expense claims in 2017/18. Green S, 105-110 0 0 0 25-27.5 135-140 • salaries and fees – annual basic pay the market rate at that time. The total amount of expenses paid to directors in 2017/18 was £8,703. Director of People • taxable benefits – additional Reporting bodies are required to & Corporate Affairs tax benefits disclose the relationship between • pension-related benefits – the remuneration of the highest Weston B, 60-65 0 0 0 30-32.5 90-95 the annual increase in pension paid director in their organisation Acting Chief entitlement, determined in and the median remuneration of the Operating Officer accordance with the HM organisations workforce. Revenue and Customs method. 1 The clinical element to T Cope’s role equates to £48k

62 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 63 B ) Remuneration 2016/17 (Audited by PwC LLP) C ) Pension Benefits (Audited by PwC LLP)

“As an employer with staff entitled to membership of the NHS Pension Scheme, control measures are in place to ensure all Salary and All Taxable Annual Long Term All Pension Total employer obligations contained within the Scheme regulations are complied with. This includes ensuring that deductions Fees (bands Benefits Performance Performance Related (bands from salary, employer’s contributions and payments in to the Scheme are in accordance with the Scheme rules, and that of £5000) (Rounded Related Related Benefits of £5000) member Pension Scheme records are accurately updated in accordance with the timescales detailed in the Regulations.” to the Bonuses Bonuses (bands nearest (in bands (in bands of £2500) Real Total Real Related Cash Cash Real Employers £100) of £5000) of £5000) Increase Accrued Increase lump Equivalent Equivalent Increase / Contribution £000 £000 £000 £000 £000 £000 in Pension in sum at Transfer Transfer (Decrease) to Pension at age related age 60 Value at Value at in Cash Stakeholder Goodwin N, 40-45 0 0 0 0 40-45 at age 60 at 31 lump at 31 31 March 31 March Equivalent Pension Chairman 60 March sum at March 2018 (To 2017 (To Transfer (To nearest (bands 2018 age 60 2018 nearest nearest Value (To £100) Clague J, 10-15 0 0 0 0 10-15 of (bands of (bands (bands £1000) £1000) nearest Non-Executive £2500) £5000) of of £1000) Director £2500) £5000)

Herzog J, 10-15 0 0 0 0 10-15 Non-Executive £000 £000 £000 £000 £000 £000 £000 £000 Director Warburton S, 2.5-5 55-60 2.5-5 150-155 1,082 998 84 0 Johnston T, 10-15 0 0 0 0 10-15 Chief Executive Non-Executive Director Jones I, 2.5-5 35-40 0-2.5 85-90 623 558 65 0 Director of Finance Wearne M, 0-5 0 0 0 0 0-5 & Business Services Non-Executive Director Cope T, 0-2.5 35-40 0 95-100 649 618 31 0 Medical Director Fillingham D, 10-15 0 0 0 0 10-15 Non-Executive Smithson A, 5-7.5 55-60 7.5-10 145-150 986 878 108 0 Director Deputy Chief Executive/ Ryan K, 10-15 0 0 0 0 10-15 Integration Director Non-Executive Director Brown D, 2.5-5 25-30 2.5-5 70-75 472 401 71 0 Chief Nurse Warburton S, 165-170 0 0 0 250-252.5 420-425 Chief Executive Green S, 0-2.5 10-15 0-2.5 25-30 210 177 33 0 Evans S, 220-225 0 0 0 0 220-225 Director of People & Medical Director Corporate Affairs

Jones I, 120-125 0 0 0 192.5-195 315-320 Weston B, 0-2.5 30-35 0-2.5 75-80 472 439 33 0 Director of Finance Acting Chief & Business Services Operating Officer

Smithson A, 145-150 0 0 0 42.5-45 190-195 Deputy Chief Executive/Chief As Non-Executive members do not accrued in their former scheme. The and framework prescribed by the Operating Officer receive pensionable remuneration, pension figures shown relate to Institute and Faculty of Actuaries. there are no entries in respect of the benefits that the individual has Firth N, 55-60 0 0 0 37.5-40 95-100 Real Increase in CETV - This reflects the pensions for Non-Executive members. accrued as a consequence of their Director of Nursing increase in CETV effectively funded total membership of the pension & Quality A Cash Equivalent Transfer Value by the employer. It takes account of scheme, not just their service in a (CETV) is the actuarially assessed the increase in accrued pension due Green S, senior capacity to which the disclosure 105-110 0 0 0 37.5-40 145-150 capitalised value of the pension to inflation, contributions paid by the Director of People & applies. The CETV figures, and the scheme benefits accrued by a employee (including the value of any Corporate Affairs other pension details, include the member at a particular point in benefits transferred from another value of any pension benefits in time. The benefits valued are the pension scheme or arrangement) and Thomas A, another scheme or arrangement which 50-55 0 0 0 125-127.5 175-180 member’s accumulated benefits and uses common market valuation factors Acting Director of the individual has transferred to the any contingent spouse’s pension for the start and end of the period. Nursing & Quality NHS pension scheme. payable from the scheme. A CETV Signed is a payment made by a pension They also include any additional scheme, or arrangement to secure pension benefit accrued to the Notes pension benefits in another pension member as a result of their purchasing D Brown commenced the role on 1 April 2017. S Green left the role on 31 March 2018. A Smithson relinquished the Chief Operating Officer post on 1 October 2017 but retained her Board position as Deputy Chief Executive to enable her to focus on the role of Integration scheme or arrangement when additional years of pension service in Director. B Weston commenced the role on 1 October 2017. A Thomas commenced in the acting role from 1 October 2016 to 31 March the member leaves a scheme and the scheme at their own cost. CETVs Steve Warburton 2017. N Firth left the role on 29 September 2016. S Evans left the Trust on 31 March 2017. J Herzog left the Trust on 31 March 2017. chooses to transfer the benefits are calculated within the guidelines Chief Executive, 23 May 2018

64 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 65 3

Quality Report 2017/18 Contents

What is a Quality Account Report? 70

Part 1: Statement on quality from the Chief Executive 71

Statement on quality from the Chief Executive of Aintree University Hospital 71

Part 2: Priorities for improvement and statements of assurance from the Board 73

2.1  Priorities for improvement Progress and priorities for improvement in the quality of relevant health services at Aintree University Hospital NHS Foundation Trust 78 2.2 Statements of assurance from the Board Statements of assurance as specified by the Quality Accounts Regulations 80 2.3 Reporting against core indicators Performance against a core set of indicators using data made available to the Trust by NHS Digital 92

Part 3: Other information 100

Performance data relevant to the quality of health services provided or sub-contracted by the Trust during 2017/18 3.1  Overview of the quality of care offered by the Trust based on performance in 2017/18 against indicators selected by the Board 100 3.2 Performance against relevant indicators and performance thresholds set out in oversight documents issued by NHS Improvement in 2017/18 109 3.3 Additional information 110

Annexes i. Statements from Commissioners and local Healthwatch organisations 111 ii. Statement of Directors’ responsibilities for the quality report 116 iii. Statement from Trust Governors 117 iv. Independent auditors’ report to the Council of Governors of Aintree University Hospital NHS Foundation Trust on the Quality Report 118 v. Clinical Audit Summary 120 vi. Glossary of Terms 122

68 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 69 Part 1 – Statement on quality from the Chief Executive

Quality has been Aintree’s watchword for many years and we have been ambitious in our quality improvement programmes under the umbrella of our Quality Strategy which we refreshed for 2017/18 to ensure we continued to embed our Quality Priorities to make care safer, more effective and improving the patient experience.

However, as with the wider NHS, Our plan to improve how we meet all • Patient and family engagement we are working in an increasingly of the required CQC standards will be – we continue to listen to what our more challenging environment delivered in the first half of 2018/19. patients and their families have to with greater numbers coming to say about the services they receive The key elements of our 2017/18 Aintree for treatment and also and this will inform our Patient and quality performance include: more patients requiring extra Family Experience Strategy. This support due to their complex • Patient Safety Thermometer – strategy will underpin the work health needs and increased frailty once again we have improved on that is planned for 2018/19 as we and dependency. As a result, we our position and are providing strive to deliver the best possible have found it difficult to fully harm-free care to over 97.7% of our experience to all those who access achieve our internal aspirational patients, better than the national our services. targets and, in certain instances, average Operational pressures continued national standards. • Major Trauma – thanks in no throughout 2017/18 which had an This report demonstrates what we small part to the contributions of impact on our ability to achieve a achieved last year and outlines our the HELP Appeal, Aintree and the number of our key performance plans for 2018/19, including our new Walton Centre NHS Foundation indicators including A&E, Referral to two-year Quality Strategy, which aims Trust opened our new helipad Treatment, Diagnostics and Cancer to evolve and enhance our quality which helps us continue to deliver standards. However, we have still improvement journey. excellent outcomes for patients made improvements wherever across Cheshire and Merseyside. possible so that our patients are not Our biggest disappointment last year, We remain ranked second in the adversely affected: however, was receiving a ‘Requires country outside London for clinical Improvement’ rating, following • A&E four-hour standard – outcomes What is a Quality Account Report? the inspection by the Care Quality the support provided to us by our Commission (CQC) in October 2017. • Infection Prevention & Control partners, the national Emergency Although the inspection team (IPC) – we remain vigilant in our Care Improvement Programme found much for us to be proud of, aim to reduce the number of and by Ernst & Young, has led to The Health Act of 2009 sets out guidance in relation to the production there were areas where we have to patients contracting C.difficile and improvements in our performance improve the quality of services for our MRSA and we were delighted to to treat 95% of patients within four of Quality Accounts. Each year the Trust reviews updated guidance patients and we are working quickly be classed as the best Trust in the hours in the Emergency Department to do this. These areas include: country for staff flu vaccinations. published by NHS Improvement regarding the content required in the • 18 week Referral to Treatment – We continue to work hard to ensure • Safeguarding – we have invested this standard was directly impacted all IPC standards are delivered in document. Aintree University Hospital’s Quality Account for 2017/18 further in a team to support staff by the national directive to cancel accordance with best practice in clinical areas, further enhancing elective operations due to winter takes into account the guidance published on February 2018. our procedures for the care of • Advancing Quality – we achieved pressures vulnerable patients the targets for all seven of the • Diagnostics – this was a Clinical Focus Areas we participated • Governance – we are improving challenging standard for us to The aim in reviewing and publishing performance Aintree recognises how important it is that the in and are currently ranked number those processes which support how achieve mainly due to workforce about quality is to enhance public accountability by information it provides about the quality of care is one in the North West for treating we provide care at a consistently capacity, particularly for provision listening to and involving the public, partner agencies accessible to all. As a report to the public, this Quality patients who present to our good standard, and ensure that of specialised investigations. and, most importantly, acting on feedback received by Account, and ‘easier read’ accessible versions of the hospital with Acute Kidney Injury, lessons are learnt and shared across The clinical teams have worked patients, staff, families and carers. Aintree produces Quality Account and the Trust’s Quality Reports, are Alcohol Related Liver Disease and the Trust hard to make improvements and quarterly Quality Reports on the Trust’s priorities to published on Aintree’s public website. Pneumonia the position has now improved show improvements to quality during the year. This • Medicines management systems significantly is so that Aintree can regularly inform people who – we are strengthening the ward- work for the Trust, people who use the Trust’s services, based pharmacy team to further carers, the public, commissioners of NHS services, improve practice in medicines and local scrutineers of our quality initiatives and to management across the hospital. encourage regular feedback.

70 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 71 Part 2 – Priorities for improvement and statements of assurance from the Board

Part 2.1(i) Summary of progress against our quality improvement priorities for 2017/18

Care that is The Trust’s three overarching Care that priorities for improvement in Clinically provides a Positive 2017/18 were set out in our Effective one-year Quality Strategy Experience for Patients and their (2017/18). These overarching Care that priorities aim to make care safer, families • Cancer – The Trust has worked • Falls prevention – Our aim was to reinforced by our staff who strive more effective and improve the is Safe closely with the Cancer Alliance, achieve a continued reduction in every day to achieve our common patient experience. NHS England and with the clinical inpatient falls and falls with harm. purpose of: teams in order to improve delivery We achieved a 1.7% improvement against required standards. As a in falls with harm against a 5% result of this work, performance improvement target and continue “getting it right for every against the required standards has work to improve all falls in the patient every time” continued to improve overarching 2018/19 action plan The delivery of these overarching performance. This process is used Quality Committee and available on • Inpatient Survey – although • Pressure ulcers – we set ourselves priorities is underpinned by a to hold our services to account for Aintree’s website. The indicators used the results of the 2017 Survey are improvement targets for 2017/18 I am proud of Aintree and our staff portfolio of key quality initiatives. the quality of care provided. Each to assess performance are the same as not yet available, as in previous for both Grade 2 and Grade 3+ – all those who work for us are our During 2017/18 we have embedded indicator is monitored on a monthly those used in the 2016/17 report and years, we will link any learning pressure ulcers but did not meet biggest asset and we do our utmost a rigorous monitoring process or quarterly basis, as applicable, some new key quality goals have also with the Staff Survey outcomes either. A number of initiatives to ensure they receive the support for measuring the quality of and performance is reported to the been introduced as indicated. and also incorporate them into the and work streams are in place to they need. In return, they give development and implementation address this Aintree and our patients their hard of our Patient and Family work and dedication. We are also • Mortality – the focus provided by Experience Strategy in 2018/19 fortunate in receiving invaluable our clinically-led mortality work assistance from our many supporters, • Staff Survey – more members of streams has led to us reducing including volunteers, support groups, staff engaged with this national mortality levels by further members and governors, who also survey in 2017 and we were developing care pathways and help us to deliver our vision. pleased that a higher number driving improvements to make care would recommend Aintree as a safer for our patients. As a result, I confirm that, to the best of place to work. We have improved we are now below expected levels my knowledge, the information in a number of areas although we for SHMI and HSMR and are within contained in this report is a true and recognise that there is still work to the expected range for accurate reflection of the services and do, for example acting on concerns crude mortality. outcomes that we have delivered. raised by patients/service users Despite the challenges we face, and the number and quality of we remain committed to quality appraisals undertaken. We fully and moving closer to realising our recognise that for the Trust to strategic vision: deliver the quality of patient care we aspire to, our staff need to feel valued and be motivated so we are Steve Warburton actively engaging with our staff to “to be a leading provider Chief Executive, May 2018 address their concerns of the highest quality • Incident reporting – to improve health care” our levels of patient safety incident reporting by the end of 2018-19, We reinforce our Trust values which we are focussing on targeted ensure that our behaviours underpin but supportive interventions our strong patient-centred culture using the National Reporting & at Aintree. Our vision and values are Learning System

72 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 73 Progress against our priorities for 2017/18 is set out below: Clinical Effectiveness – providing care and treatment to people who use services that improve their quality of life. Patient Safety – protecting people who use services from harm and injury and providing treatment in a safe environment Objective 2014/15 2015/16 2016/17 2017/18 Progress

Objective 2014/15 2015/16 2016/17 2017/18 Progress Nutrition and Hydration – Achieved 95% reliability in the completion of To reduce grade 2 pressure Requires the malnutrition universal screening 69 63 61 64 ulcers by 5% improvement tool (MUST). Requires 90.7% 90.12% 93.07% <95% Implemented updated fluid balance improvement To eliminate grade 3 and 4 Requires 3 5 6 7 guidance and a new fluid balance pressure ulcers improvement chart which is based on National best 1 ‘Moisture or practice and NICE guidance Pressure Tool’ Support the reduction of hospital To achieve the Advancing Quality Began Guidance Achieved acquired moisture lesions1 composite process score (CPS) of 90.3% June 15 71.8% 92.8% Achieved Sheet for patients with Acute Kidney Injury 50.2% introduced To achieve the Advancing Quality CPS¹ Began To reduce the number of all inpatient Requires 720 554 421 425 of 94.5% for patients with Alcohol Jan 15 50.6% 75.4% 94.9% Achieved falls with harm by 5% improvement Related Liver Disease 56.9% Reduce the number of inpatient falls To achieve the Advancing Quality CPS¹ leading to moderate harm and above 40 38 Achieved 33.1% 50.3% 58.2% 88.2% Achieved of 87.9% for patients with Diabetes by 5%1 To achieve the Advancing Quality To reduce the number of Clostridium Requires 41 35 27 43 CPS¹ of 78.4% for patients who have 2.2% 13.6% 21.8% 78.6% Achieved difficile infection (CDI) cases by 20% improvement fractured their hip Reduce to zero Trust apportioned Requires 2 2 1 1 To achieve the Advancing Quality CPS¹ MRSA bacteraemias improvement of 95% for patients receiving hip & 89.9% 99.2% 82.9% 96.8% Achieved To reduce MSSA bacteraemias by 15% 19 25 37 26 Achieved knee surgery To achieve the Advancing Quality CPS¹ To reduce the incidence of missed 78.1% 71.5% 75.6% 95.0% Achieved Review Making ➝ Requires of 95% for patients with pneumonia critical/high risk medication doses 7% Baseline progress improvement by 50% To achieve the Advancing Quality CPS¹ Hospital Acquired Thrombosis (HAT) – for 93% for patients diagnosed with 72.6% 79.3% 77.1% 93.2% Achieved improve our performance on VTE risk 93.1% 92.6% Achieved Sepsis. assessment in relevant patient groups¹ Achieve the standard: >90% of patients Ventilator Acquired Pneumonia diagnosed with Community Acquired Baseline data Making (VAP) – Achieve >95% reliability with >95% Achieved Pneumonia (CAP) to receive appropriate Requires collected progress 72.4% 78.1% 80.3% compliance against VAP care bundles1 antibiotics within 4 hours of arrival in improvement the Trust and achieved a downward The Deteriorating Patient – To reduce trend in pneumonia mortality Baseline Central Line Associated Blood Stream 25 17 Achieved taken Fully embed the elements of the Sepsis Making Making Making Infections by 10% Achieved Achieved 6 care bundle progress progress progress To achieve 95% compliance for Requires cardio-pulmonary resuscitation 52% 58% 84% 88.6% Improve the recognition and improvement training and practice management of Acute Kidney Injury Achieved Achieved Achieved Achieved (AKI) The Deteriorating Patient - Fully embedded all the elements of the Achieved Achieved Achieved Achieved Achieved Ensure that improvement in the Requires AMBER care bundle across the Trust 98.6% 96.3% monitoring and escalation of the improvement deteriorating patient are sustained 1 during 2017/18¹. New key quality goal for 2017/18

1 New key quality goal for 2017/18 Clinical effectiveness is one of our overarching priorities. care but some patients do not receive all the components This is because there is evidence of inconsistency in the of best practice care; this applies to both inpatient and delivery of clinical care; some patients receive the best outpatient services. Patient safety is one of our overarching priorities because At Aintree, everyone endeavours to provide the highest occasionally patients will stay longer in hospital, or need standard of care and we encourage our staff to voluntarily additional monitoring or treatment as a result of care that report any patient safety issues so that we can learn has fallen below our usual standards. Sometimes, despite from our mistakes. The progress report on our portfolio our best efforts, a patient may experience harm. of patient safety initiatives demonstrates that we have worked with patients and their families to reduce avoidable harm and improve outcomes.

74 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 75 The Institute for Healthcare Improvement has developed achieved through the work of the enhanced outreach the concept of “care bundles” to help health care support team and the avoidable mortality reduction providers deliver the best possible care for patients “work streams”. reliably. A care bundle is a defined list of (evidence based) For Advancing Quality a decision has been made by the interventions which if implemented should improve the Advancing Quality Alliance to use the Composite Process process of care and the patient outcome. The progress Score (CPS) as a means of measuring performance in report on our portfolio of patient safety initiatives 2017/18. Furthermore the Chronic Obstructive Pulmonary demonstrates that we have reduced mortality in a number Disease (COPD) clinical focus area was removed from the of clinical scenarios: this includes the deteriorating patient, programme during this year. acute kidney injury, sepsis and pneumonia. This has been

Patient Experience – ensuring that people who use services have a positive experience of their care and providing treatment with compassion, dignity and respect.

Objective 2014/15 2015/16 2016/17 2017/18 Progress

Maintain a position within the top 25% of participating Picker Institute Most Position Requires organisations measuring patient 2nd Quartile improved 2nd Quartile 26.5% Improvement experience via the 2017 National Acute Trust Inpatient Survey

A positive patient and family experience is of great As part of the development of the ‘Patient and Family importance to us. We understand that many of our Experience Strategy’ we asked staff, patients and families patients often undergo life changing diagnoses and for their views and these will be incorporated into the treatments, and it is our ambition to make their strategy and the delivery plan. The Strategy will drive experience the best that it can possibly be. improvements in Patient and Family Experience and will include a review of the methods used to monitor and Whilst the actions have been delivered from the patient evaluate patient experience within Trust services. The experience plan, the Trust has not maintained its ranking Strategy will be launched in 2018/19 and include key within the top 25% of Picker organisations in the milestones for monitoring implementation. National Inpatient Survey. This may, in part, be due to a change in data set used for 2017/18, and the number and breakdown of acute and specialist Trusts using Picker to undertake the National Inpatient Survey.

Enabling Initiatives

Objective 2014/15 2015/16 2016/17 2017/18 Progress

188 staff Progressed with staff training and trained, 110 uptake of projects via AQUIS (Aintree improvement Achieved Quality Improvement system) 1 projects ongoing

Successfully increase incident reporting Making Requires & align Trust incident reporting figures progress improvement to those of similar Trusts 1

There has been an increase in incident reporting during As part of the action to reduce the number of never 2017/18. However the Trust reporting figures remain events the Trust will: lower than those of similar Trusts. There has been a • Develop a new guideline document for the notable increase in never events in 2017/18 and; therefore implementation of National Safety Standards for this has been included as a priority area for action Invasive Procedures (NatSSIPs) and Local Safety and improvement in “Aintree Quality Improvement Standards for Invasive Procedures (LocSSIPs) Programme” (AQuIP). • Monitor the implementation of NatSSIPs and LocSSIPs • Design and present a NatSSIPs’ training package to key staff. These actions should be completed by September 2018.

76 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 77

Part 2.1(ii) Priorities for improvement in 2018/19 Care that is clinically effective

Topic Aim: By 31 March 2020 we will have…

The Trust’s Quality Strategy for 2018 – 2020 reinforces the three • Improved our consistency of triage overarching priorities for improving patient care. These overarching • Embedded effective ‘Pitstop’ of patients within majors department • Implemented the required actions following the demand and priorities aim to ensure that care delivered by the Trust is safer, more capacity review effective and provides a positive patient experience. • Implemented and embedded the SAFER flow bundle across all wards • Completed a review of the rota’s to maximise workforce skills to Urgent and emergency care pathways match demand in ED and assessment areas Priority 1: Care that is Safe The delivery of these priorities will be underpinned by a • Implemented direct transfer of appropriate patients to all portfolio of key quality goals as set out below. assessment areas We will focus on ensuring compliance with CQC Key Quality Goals: • Implemented agreed pathways in specialties to ensure ‘right patient fundamental standards of care. This will include to right bed’ safeguarding those patients who are the most vulnerable. • Care that is safe – CQC fundamental standards of care. • Embedded use of Medworxx and full utilisation of the SAFER metrics • Care that is safe – Safeguarding processes. dashboard to review performance. Priority 2: Care that is Clinically Effective • Care that is safe – Mental Health Act compliance. • Improved performance in the delivery of care bundles for patients We will focus on the delivery of timely, responsive on a non-elective care pathway • Care that is safe – Preventing and learning from harm. Responsiveness to the deteriorating patient and reliable care; particular emphasis will be given • Improved responsiveness to the deteriorating patient as monitored to our urgent and emergency care pathways and the • Care that is clinically effective – Acute and emergency via MEWS compliance. deteriorating patient. care pathways. • Care that is clinically effective – Responsiveness to the Priority 3: Care that provides a deteriorating patient. • Patient experience – Positive Patient and Family positive experience for patients and Patient experience experience and delivery of patient centred care through their families a focus on asking our patients “What Matters to you?” Topic Aim: By 31 March 2020 we will have… We will focus on improving the delivery of patient and Enablers family centred care. • Building Staff Capability The delivery of our key quality goals will be supported by Positive and family centred care • Delivery of Patient and Family Experience Strategy and key milestones promoting access and uptake of staff training on quality improvement knowledge and skills to bring about change in practice to embed continuous improvement.

Enabling Initiatives Care that is safe Topic Aim: By 31 March 2020 we will have… Topic Aim: By 31 March 2020 we will have…

• No regulatory concerns or warning notices in place Building Staff Capability • Progressed with staff training and uptake of projects via AQUIS • Reduced the number of outliers identified by the CQC in their (Aintree Quality Improvement System) CQC fundamental standards of care Insight data • Produced a biannual core service report identifying compliance with CQC fundamental standards

Safeguarding processes • To be compliant with Section 11 of the safeguarding audit. How progress to achieve the quality improvement • Staff and senior clinicians, for example through discussion priorities will be reported: at the Trust’s Divisional governance meetings. • Audited and monitored compliance against relevant Mental Health Mental Health Act compliance Act Standards The Trust’s Board of Directors will approve the Quality • Governors and Foundation Trust Members through Strategy for 2018 – 2020. Progress against this plan will • Had the policy, training and Service Level Agreement updated. Quality Account Meetings and the governor-led Quality be reported to the Quality Committee. It will also be of Care Committee. • Improved incident reporting so the Trust is in the highest quartile shared widely with governors, members, local groups and Preventing and learning from harm organisations as well as the public. • Commissioners of NHS services, through contract • Seen a reduction in serious incidents. negotiation and monitoring processes. How the views of patients, the wider public and • Local Healthwatch through feedback from visits to staff were taken into account: services, at quarterly informal meetings and via the The key quality goals were agreed by taking into account Patient Experience Executive-led Group. the views of: • Stakeholders and the wider public, for example through • People who use the Trust’s services and carers, for example activities such as Quality Priorities Engagement Events. through receipt of feedback through activities such as the Friends and Family Test, patient and carer surveys.

78 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 79

Part 2.2 Statements of Assurance from the Board Audit/Enquiry Number of cases submitted

Inflammatory Bowel Disease (IBD) Registry, Biological Therapies Audit. 136 (90.6%)

To assure the public that we are performing to essential Learning Disability Mortality Review Programme (LeDeR) 0% (No cases requested)

standards, providing high quality care, measuring clinical process Major Trauma Audit 834 (100%)

and are involved in initiatives to improve quality, we offer the Medical and Surgical Clinical Outcome Review Programme (NCEPOD) – 2 (100%) following statements: Acute Heart Failure Medical and Surgical Clinical Outcome Review Programme (NCEPOD) – 1 (100%) Cancer in Children, Teens and Young Adults Information on participation Common content for all Quality Accounts nationally Medical and Surgical Clinical Outcome Review Programme (NCEPOD) 11 (92%) is contained in a double line border like this. in clinical audits and national confidential enquiries Study remained open at Perioperative diabetes 31 March Information of the review of services During 2017/18, 38 national clinical audits and 4 Medical and Surgical Clinical Outcome Review Programme (NCEPOD) – 1 (100%) During 2017/18 Aintree University Hospital NHS national confidential enquiries covered relevant Pulmonary embolism Foundation Trust provided and/or sub contracted 39 health services that Aintree University Hospital NHS Myocardial Ischaemia National Audit Project (MINAP) 393 (100%) relevant health services. Aintree University Hospital Foundation Trust provides. These are listed in full NHS Foundation Trust has reviewed all the data in Annex v. During that period Aintree University National Audit of Breast Cancer in Older People (NABCOP) In progress available to them on the quality of care in 39 of Hospital NHS Foundation Trust participated in 92% National clinical audits and 100% National these relevant health services. The income generated National Bowel Cancer (NBOCA) 282 (100%) by the relevant health services reviewed in 2017/18 confidential enquiries of the national clinical audits and national confidential enquiries which it was represents 100% of the total income generated from eligible to participate in. National Cardiac Arrest Audit (NCAA) 81 (100%) the provision of relevant health services by Aintree University Hospital NHS Foundation Trust for 2017/18. The national clinical audits and national National Chronic Obstructive Pulmonary Disease (COPD) Audit programme – 13 (100%) confidential enquiries that Aintree University Pulmonary rehabilitation Hospital NHS Foundation Trust participated in, and for which data collection was completed during National Chronic Obstructive Pulmonary Disease (COPD) Audit programme – 904 (100%) 2017/18, are listed below alongside the number Secondary Care of cases submitted to each audit or enquiry as a percentage of the number of registered cases National Comparative Audit of Blood Transfusion programme – Re-audit of the 34 (100%) required by the terms of that audit or enquiry. 2016 audit of red cell and platelet transfusion in adult haematology patients

National Comparative Audit of Blood Transfusion programme – National 40 (100%) Comparative Audit of Transfusion Associated Circulatory Overload (TACO) Audit/Enquiry Number of cases submitted National Diabetes Audit – Foot Care Audit 102 (100%)

BAUS Urology Audits – Percutaneous Nephrolithotomy (PCNL) 10 (No requirement data) National Diabetes Audit – Inpatient Audit (NaDia) 99 (100%)

BAUS Urology Audits – Urethroplasty Audit 43 (65.6%) National Diabetes Audit – Core Diabetes Audit 1020 (100%)

Cardiac Rhythm Management (CRM) 208 (100%) National Emergency Laparotomy Audit (NELA) 180 (100%)

ICNARC Case Mix Programme (CMP) 1340 (100%) National Heart Failure Audit 750 (154%)

Elective Surgery (National PROMs Programme) National Joint Registry (NJR) 658 (100%) Pre-operative 629 (99.1%) National Lung Cancer Audit (NLCA) 281 (100%) Post-operative 626 (98.9%) National Oesophago-gastric Cancer (NOGCA) 60 (100%) Endocrine and Thyroid National Audit 416 (100%) National Ophthalmology Audit – Adult Cataract surgery 1623 (93.3%)

Falls and Fragility Fractures Audit programme (FFFAP) – Inpatient falls 30 (100%) National Prostate Cancer Audit 217 (100%)

Falls and Fragility Fractures Audit programme (FFFAP) – National Hip Fracture 301 (100%) Procedural Sedation in Adults (care in emergency departments) 8 (100%) Database Sentinel Stroke National Audit programme (SSNAP) 159 (100%) Fractured Neck of Femur (care in emergency departments) 50 (100%) Serious Hazards of Transfusion (SHOT): UK National haemovigilance scheme 12 (No requirement data) Head and Neck Cancer Audit (HANA) 1321 (100%) UK Parkinson’s Audit: (incorporating Occupational Therapy Speech and Language 25 (100%) Therapy, Physiotherapy Elderly care and neurology)

80 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 81 Actions arising as a result of national and local audits In addition, the reports of 192 local clinical audits were reviewed by the provider in 2017/18 and Aintree University Hospital NHS Foundation Trust intends to take the following actions to improve the quality of The Trust Board has delegated authority for clinical audit and Aintree University Hospital NHS Foundation Trust healthcare provided. to the Trust‘s Clinical Effectiveness Executive-led Group. intends to take actions listed in the table below to Through this delegation, the reports of 11 national improve the quality of healthcare provided. 3198 Documentation Audit 2015 • Local Area Matrix and Practitioner Summary Sheets clinical audits were reviewed by the provider in 2017/18 • Invite a member of Support Service to join the to be implemented in ARDU, Ward 10, Ward 17, Clinical Records Group Ward 19 and Critical Care • Present the findings of this audit to the Clinical • Those staff identified with the incorrect competency Records Group form to complete the correct rated risk form and 2643 National Anaesthetic Audit Project 5: 2826 Sentinel Stroke National Audit Programme - withdraw incorrect form Accidental Awareness under General Anaesthesia Includes SINAP (SSNAP) (OLP008) Long Term Set • To discuss and agree that an annual audit using the same methodology and standards is to be used in • To ensure that competency is reassessed and (AAGA) • Improved access to stroke beds – full protocol future Trust wide record keeping audits documented annually. To be communicated clearly • Internal department alert issued to all staff to developed. HSAU developed (ring-fenced) to all staff via “All About Aintree” asking them to address sedation and record keeping • Cascade results of audit to all relevant areas to make • Stroke Guidelines to be updated to include latest rectify any gaps in their documentation as soon as them aware of overall Trust performance (within 2656 National Sentinel Stroke National Audit Royal College of Physicians Guidance possible and line mangers are to enforce this each discipline) Programme - Includes SINAP • Stroke Business Case to be resubmitted to Board – • Divisional Directors of Nursing to share report with • Meeting between key discipline representatives to • Move stroke outliers with the same urgency as further bed modelling to be completed Matrons requesting that they advise their local AED patients be held and revised Clinical Records Management areas of shortfalls in medical device documentation. • Regular Review of SSNAP data Policy to be approved Matrons to monitor local area compliance. Issue to • NIHSS to be completed for all probable stroke be raised at Medical Devices Committee patients as soon as possible after admission/stroke 2919 National Ophthalmology Audit 3290 Documentation Audit 2016 diagnosis • Ensure all co-morbidities are documented in • Countersignature standard (re AHPs) to be reviewed • Communication to be sent to the Clinical Director Medisoft. Take time to review records and enter the and any changes agreed. Record Keeping Policy to of AED, Matron and Nominated member of staff • Aim is to scan 50% of stroke patients within one data electronically be updated and approved to reflect changes agreed requesting that action is taken to ensure that all hour competency statements are countersigned 3191 National Audit of Dementia • Nursing to add any areas for improvement to their • If there is only one bed on the unit and a stroke existing record keeping action plan • Medical Devices Safety Compliance Co-ordinator to patient requiring it they should be admitted • Meeting with the chief nurse to develop dementia review AED competency (the bed should not be reserved for potential champions. • IG Toolkit level within the Trust to be agreed against thrombolysis) • Development of dementia and delirium screening the standard – “A multi professional audit of clinical • Coronary Care Unit to update and include all risk records across all specialties has been undertaken” devices on their local area matrix • A “move list” /step down list should be developed in the new EPR system. and updated daily identifying patients who could 3241 College of Emergency Medicine: • Therapy section of audit tool to be revised • Ward 4 to implement the Medical Devices Policy move out of the stroke unit if required. This should training and competency evidence folder. Severe Sepsis and Septic Shock 3296 Medical Devices – Training be available for the ward and bed management • To implement a new sepsis proforma to ultimately 3454 A Retrospective Analysis of Missed VTE team during evenings and weekends when there is • Assessment and Rehabilitation Day Unit to have a improve sepsis management within our patients Assessments in April 2015 at Aintree University no consultant available designated Medical Devices folder containing all admitted to Aintree. their Medical Devices Policy compliance paperwork Hospital Trust; a re-audit of data 6 months post • Speech and Language Therapist to record initial intervention. 3345 National: Diabetes Foot care • Clinical Laboratories to train and competency assess swallow assessment • Trust to introduce new electronic system • Additional staffing resource has been identified (completing relevant documentation) all staff in the • To explore solution of Electronic Joint health and which will enable the service to provide more Fracture Clinic regarding the use of blood glucose • Improved education/audit /feedback for all social care assessment record. To look at Sigma emergency and new patients appointments for monitors clinical staff templates patients, as well as increasing flexibility of available • A communication to all consultant grade staff to • Standardised ward pro-forma required to be capacity to respond to service need. • If patients are not thrombolysed the reasons why be sent by the Medical Director advising them of introduced. We are awaiting result of pilot action. If need to be clearly stated on SSNAP 4889 RCR National Audit of the Provision of the requirement to document their medical devices the pilot is satisfactory the process is to be rolled out • The stroke clinician communication board needs to Imaging of the Severely Injured Patient training and competency across the Trust be clear on which patients are outliers and which • Improved percentage of provisional reports scanned • Email regarding medical devices compliance to be 4881 Audit to determine if patients have need follow-up only onto Clinical Radiology Information System (CRIS) sent to Divisional Medical Directors access to relatives and carers at a time when they need it • Team to meet bed management to discuss stroke • Review national results when available. Discuss • Future re-audit to include assessment of previous pathway further changes if our results significantly differ versions of competency forms that are currently in • To explore the feasibility of a standardised quiet from other major trauma centres. hour/ protected meal times across the organisation • All strokes and probable strokes to be moved to unit use as soon as possible after admission 5003 Re-Audit: College of Emergency Medicine: • To ensure that competency statements are fully • Patient experience team to offer education/ Severe Sepsis and Septic Shock supportive visits to each ward • Full protocol for 4 hour admission completed and to be communicated clearly to all • Implementation of a sepsis team in AED – Sepsis staff via “All About Aintree” asking them to rectify 2449 Clinical Audit of Malnutrition Universal • Ensure all stroke ward referrals are seen as soon as bay created. Pit-stop team (including Consultant/ any gaps in their documentation as soon as possible Screening Tool Assessment possible and with the same urgency as AED referrals middle grade) assesses the patient and puts plan of and line mangers are to enforce this support • Nutrition and Hydration improvements to be investigations and treatment in motion • If patient is a clear stroke patient then to move • Each training grade doctor to be trained and progressed with joint dietetic and nursing leads. urgently and not wait for consultation review 5062 National Audit of Emergency Laparotomies assessed as competent in the medical devices they Following updated NICE guidance this will culminate 2756 National: Lung Cancer 2016 are expected to use when undertaking their role. in a joint work stream aimed at improving the Trust All documentation evidencing this to be fully fluid balance guidance and developing a new chart • Implement Lung Cancer Nurse Specialist • Develop App based system for data entry and analysis completed and available for audit

82 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 83 2482 Re-audit Monthly Modified Early Warning 3140 Do Not Attempt Cardiopulmonary 4478 Surviving Sepsis 4924 Documentation of driving and compliance System (MEWS Audit) Resuscitation Decisions • Local education to take place with DVLA regulations in diabetes outpatient • Discussion currently in place in relation to changing • To re-educate junior doctors on putting into their clinic records • Sepsis trolleys to be relaunched Aintree’s MEWS to the NEWS scoring system management plans a ceiling of care or UDNACPR • Educate and encourage health care professionals (with discussion) • On-going education and relaunch of sepsis bundle. to discuss and document on hypoglycaemic • Ward managers to ensure all staff whom perform unawareness and driving related issues and document MEWS do so accurately and complete • To have a Box in the senior summary review that • New sepsis screening tool being developed to competency assessment states “ceiling of care?” or “UNDACPR” followed by encourage identification • Patient education programme on impaired “Has record of discussion of UDNACPR been made?” hypoglycaemia awareness – combined programme • Staff educated regarding the importance of • Re-audit after relaunch and education on AMU with Royal Liverpool Hospital checking all parameters • Discussions to be held about including the ‘ceiling of • Recommend the re-launching of the local sepsis care’ box to the ward round proformas • Diabetes and Driving leaflets to be updated • Ward feedback- importance of RN countersignature campaign bundle • Discuss with current junior doctors in teaching 4966 An audit to assess the appropriateness of • Ongoing dissemination of information via monthly • Improve availability of sepsis bundle stickers in the sessions and present audit to the new Foundation DNACPR decisions and quality of documentation e-mail with link to the individual audit results on aBI Accident and Emergency Department and Acute Year 1 students Medical Unit • All clinicians working on AMU to be notified of the 2848 Clinical Audit of the use of Gentamycin at 3201 Assessment and Management of ANCA results of this audit to improve their documentation Aintree University Hospital • Introduction of pit-stops and effective triage to Vasculitis According to NHS England and NICE of DNACPR decisions • Access to nurse handover sheets on the I-drive could identify sepsis early Guidelines • The audit will be discussed at the next Trust be obtained whereby pharmacists could request • Recording of patient data in UK-IVAS registry for 4494 An assessment of the current quality and rate Mortality Group meeting and an email will be levels to be taken for specific patients audit and research purposes. of compliance of the management of unprovoked subsequently circulated • Antibiotic guideline cards could be re-designed to Venous Thromboembolism (DVT & PE) beyond the • Urgent assessment of vasculitis patients in • Periodic reminders from senior AMU staff for emphasise the need for pharmacy contact when first 3 initial months at AUH outpatients/ triaging referrals and provision of hot/ clinicians to focus on the quality of their DNACPR prescribing gentamicin • Team to draft the new protocol and issue to urgent patient slot in consultant clinics – one slot/ documentation assurance group for approval and ratification. • An alert on JAC prescribing could be incorporated consultant during the on-call week. 5002 Sepsis Re-audit (Jan 2017) of compliance requesting prescribers to contact pharmacy when • Review of Clinic letters to be included in the next 3220 Expected Date of Discharge with the sepsis bundle they prescribe gentamycin audit to ensure change has been captured. • Develop and introduce an ‘Expected Date of • To allocate a dedicated area for initial assessment 2975 Antibiotic Prescribing in Neutropaenic Sepsis Discharge Policy’ for the Trust • Communication and monitoring process of all cases, and treatment of sepsis patients • Patient group directive (PGD) to be developed to to ensure that all reviews are fully documented • Through departmental meetings and during • Ideal Body Weight chart readily available in allow nurses to give the first dose of antibiotics induction of staff highlight the need for clear 4609 A re-audit of pain management following assessment areas to include AED/AMU/AEC without a prescription for this patient group. documentation on why an expected date of major trauma from the Emergency Department • Up to date proforma in line with NICE guidance • Teaching sessions on neutropenic sepsis to be discharge decision cannot be made at the early (ED) to Ward arranged stage of a patient’s admission to hospital • Implementation of Trauma Network Booklet with 3142 Regional Audit of Hydration at the End included pain score box for use in ED of Life • To train more nurses and AED nurses in the • Re-education of the AMU senior staff regarding techniques for taking a blood cultures the National Institute of Health Research and • Continuing education particularly focused on • Ensure staff trained in assessment of hydration- Department of Health guidelines, through introductory sessions for new Anaesthetists/Critical including in end of life care teaching 3082 Review of both completeness and knowledge departmental meetings and during induction of Care doctors/ED staff of anaesthetic Standard Operating Procedures • An updated multidisciplinary End of Life Care Plan staff within anaesthetic directorate 4656 Post-Operative Anaemia and Acute is planned for launch in the acute Trust. This will involve the development of an individual plan of • Locations of SOP files have been expanded to include 4468 Compliance with Enteral Feeding Kidney Injury care, concerning hydration and nutrition. Ongoing ALL areas where a general anaesthetic is administered Prescription Chart on Critical Care • Develop a protocol for iron transfusion in fracture review of this is planned • Changes to be made where documentation is kept neck of femur patients • Individuals in each area now have responsibility for within medical notes to aid compliance by nursing 4587 NHS Bowel Cancer Screening Programme updating the guidelines on an annual basis and it is • Liaise with the renal team and blood transfusion staff in documentation and signing the enteral (BCSP): qualitative and quantitative assurance included in the induction pack for all new staff nurse to develop a protocol for prevention and prescription chart to ensure patients receive correct audit of CT colonography practice management of AKI in emergency fracture neck of 3114 Falls NICE Guidance feed and reduce risk of wrong feed or wrong rate of femur patients • Improve bowel preparation: A new bowel • To consider the use of a validated assessment tool feed given to the patients preparation has been introduced, including 4736 Improving the medical assessment, and whether this can be incorporated into the 4474 Delayed / Lost to Follow Up in Medical citrafleet depending upon age and co-morbidities of documentation and management of inpatient falls baseline assessment. It is accepted that it is unlikely Retina patients that the Therapy team would have the capacity to through the development of an inpatient falls • Review the means of indicating the clinical priority • Reach 100% target for coding: All reporting CTC carry out this assessment at home for every patient proforma given to appointments on the booking system. radiologists to ensure all BCSP CTCs are coded with admitted with a fall but incorporating this tool into • Trust wide implementation of the proforma (Referral to Treatment (RTT) form being reviewed) summary and extra colonic codes. This information the inpatient assessment would allow for assessment • Distribution of the audit results at Grand Round has been disseminated to the department of risk and advice to be given to the patient and/or • Designated person (age-related macular their relatives or carers degeneration tracker) to regularly identify the • Development of an educational programme for • CTCs are an invasive study. At present only verbal number of patients currently awaiting follow- foundation doctors on assessing and managing consent is obtained. However, written consent • To review Therapy documentation to ensure that it is up in Medical Retina and confirm the capacity inpatient falls including use of the proforma forms are to be introduced to ensure patients are clearly documented when a home hazard assessment for outpatient appointments and any specialist aware of the risks and potential complications from has been complete. investigations undergoing a CTC • There has been education of Therapy staff on the • Prioritise reviews according to clinical need • Improve bowel distention: Change method of NICE guidelines for falls to increase awareness imaging from prone supine to lateral decubitus of their role and to focus their goal setting and • In case of longer absence of AMD tracker, ensure supine to improve distention treatment planning around falls. They have also had responsibility being delegated advice on stating clearly on the Aintree at Home referral if a home hazard assessment is required

84 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 85 Achievement CQUIN Target (provisional results) Improvement of staff health and well being Improving Staff Health Partial Healthy food for NHS Staff, visitors and patients and Well-being Achievement Improving the uptake of flu vaccinations for front line staff Timely identification of sepsis in emergency departments and acute inpatient settings

Reducing the Impact Timely treatment of sepsis in emergency departments and acute of Serious Infections inpatient settings (Antimicrobial Resistance Partial Assessment of clinical antibiotic review between 24-72 hours and Sepsis) Achievement of patients with sepsis who are still inpatients at 72 hours Reduction in antibiotic consumption per 1,000 admissions Reduce by 20% the number of attendance’s to A&E for patient’s Improving Services for within a selected cohort of frequent attender’s who would benefit People with Mental Health from mental health and psychosocial interventions Needs who Present to A&E Achieved Delivery milestones to be achieved Advice and guidance services operational for specialities covering Offering Advice at least 35% of total GP referrals and Guidance Achieved Delivery milestones to be achieved 100% of referrals to first outpatients services able to be received Partial NHS e-Referrals through e-RS. Achievement Delivery milestones to be achieved Submission of the new emergency care data set (ECDS) from 1st October 2017 Supporting Proactive and Safe Discharge 2.5% point increase in the number of patients aged 65+ discharged Partial to their usual place of residence within 3 – 7 days of admissions Achievement Delivery milestones to be achieved

Participation in clinical research Use of CQUIN framework Adult Critical Care Timely 60% of patients discharged from critical care within 4 hours of Achieved Discharge being clinically ready for discharge to a ward bed

Collection of baseline-data for the range of drug doses that are The number of patients receiving relevant health A proportion of Aintree University Hospital NHS to be standardised as agreed with the commissioner services provided or sub-contracted by Aintree Foundation Trust income in 2017/18 was conditional University Hospital NHS Foundation Trust in on achieving quality improvement and innovation Nationally Standardised Local Drugs & Therapeutics Committee have agreed and approved principles of dose standardisation and dose adjustments required 2017/18 that were recruited during that period to goals agreed between Aintree University Hospital Dose-banding for Adult Intravenous Anticancer Achieved participate in research approved by a research ethics NHS Foundation Trust and any person or body they Targets to be agreed for end of year achievement in relation to Therapy (SACT) committee was 3,300. entered into a contract, agreement or arrangement the % of doses standardised per drug with for the provision of relevant health services, Trust agreement and adoption of standard product descriptions through the Commissioning for Quality and for individual chemotherapy drugs Innovation payment framework. Further details of Participation in clinical research demonstrates Aintree’s Faster adoption of prioritised best value medicines as they become the agreed goals for 2017/18 and for the following available commitment to improving the quality of care we offer and 12 month period are available electronically at Hospital Medicines Improving drugs minimum data set data quality to making our contribution to wider health improvement. www.england.nhs.uk/nhs-standard-contract/cquin/ Optimisation Achieved Our clinical staff stay abreast of the latest possible cquin-17-19/ Cost effective dispensing routes treatment possibilities and active participation in research Improving data quality with outcome databases (SACT and leads to successful patient outcomes. During 2017/18 the total income associated with Intravenous Immunoglobulin Treatment) the achievement of quality improvement and Aintree was involved in conducting 327 clinical research innovation goals amounted to £5.9m. Aintree Initiation of hub and spoke network arrangements to review studies in 33 Clinical areas during 2017/18. There were treatment plans of specialised rheumatology patients University Hospital NHS Foundation Trust received Multi-system Auto-immune over 100 clinical staff participating in research approved £5.9m income for the associated payment in Rheumatic Diseases MDT All specialised rheumatology patients to be discussed by a Partial by a research ethics committee at Aintree during 2017/18. multi-disciplinary team and have an outcome recorded 2017/18. Clinics, Data collection and Achievement These staff participated in research covering 33 medical Policy Compliance Patients’ treatment plans to comply with national policies and specialities. clinical information is collected on national disease registries to determine the impacts of the network and commissioning policies As well, in the last three years, over 100 publications An overview of the initiatives and performance during have resulted from our involvement in National Institute 2017/18 is outlined in the table overleaf. Comparison of local data flows available from ‘Purple to Gold’ for Health Research, which shows our commitment to Agree and implement critical steps to facilitate use of ‘Purple transparency and desire to improve patient outcomes and Local Clinical Utilisation to Gold’ data Partial experience across the NHS. Review CQUIN Achievement Operationalising agreed software system Our engagement with clinical research also demonstrates Aintree’s commitment to testing and offering the latest Reporting of internal and external delay themese medical treatments and techniques. Staff health and well-being support Diabetic Eye Screening, Improving staff engagement Bowel Screening and Dental Achieved Services Deliver new integrated dental service pathways and patient centred care

86 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 87 Inadequate Requires Outstanding improvement

Are servicserviceess Safe ective Caring Responsive Well ledOverall Urgent and emergency services (A&E) Registration with the Care Quality Commission Saf e? Aintree University Hospital NHS Foundation • Regulation 13 HSCA (RA) Regulations 2014 TrustMedical is requiredcare (includin tog register with the Care Quality Safeguarding service users from abuse and Commissionolder people’s caandre) its current registration status improper treatment Aintree University Hospital NHS Foundation Aintree University Hospital NHS Foundation Trust has is Requires Improvement. Aintree University Trust is required to register with the Care Quality participated in an announced inspection between 3 • Regulation 18 HSCA (RA) Regulations 2014 Hospitalective NHS? Foundation Trust has the following Staffing. Commission and its current registration status is and 6 October 2017 and between 25 and 26 October conditionsSurgery on registration. Following a Care Quality Requires Improvement. 2017. The Trust has received a rating of Requires Commission announced inspection in October The Care Quality Commission has taken Improvement following this inspection and has The Care Quality Commission has taken enforcement 2017 the Trust requires improvement related to 5 enforcement action against Aintree University developed a comprehensive action plan to address action against Aintree University Hospital NHS regulations: Hospital NHS Foundation Trust during 2017/18. This the concerns that were identified. Intensive/critical care Foundation Trust during 2017/18. This relates to Caring? relates to Regulation 11 HSCA (RA) Regulations • Regulation 9 HSCA (RA) Regulations 2014 2014 Need for consent. Aintree University Hospital Regulation 11 HSCA (RA) Regulations 2014 Need Person-centred care for Consent. NHS Foundation Trust has not participated in any • EndRegulation of life care 10 HSCA (RA) Regulations 2014 special reviews or investigations by the Care Quality Dignity and respect Commission during the reporting period. Responsive?• Regulation 12 HSCA (RA) Regulations 2014 This action plan, the Aintree Quality Improvement Programme (AQuiP) will be monitored on a monthly basis to ensure Safe care and treatment that identified actions have been implemented and that these actions are having the required improvement affect. Outpatients There are 6 domains included within the AQuiP each of which includes a number of specific focus areas:

The table below shows the CQC ratings grid for the services provided at the Trust following the last full inspection Domain Focus Area in October 2017. The Trust is working with the CQC to implement a significant improvement plan that will evidence substantial changes in practice since the Trust was last inspected. Service Improvement Compliance against national standards including surgical checklists

Governance and process for internal control Records management Infection prevention and control Overall Requires Medicines management Inadequate Good Outstanding rating Improvment Equipment and facilities

Processes Overall InadequateeRReequirequiress Good Outstanding Safeguarding and Mental Capacity Act Safeguarding training rating improvement Patient access Acute and emergency care patient flow Safe Effective Caring Responsive Well led Overall Clinical assessment Medical care (including Requires Requires Requires Requires Requires End of life care Good Care Pathways older people’s care) improvement improvement improvement improvement improvement Dermatology

Asthma Urgent and emergency Requires Requires Requires Requires Safe ective Caring Responsive Well ledOverall Good Good improvement improvement improvement Are servicserviceess Stroke services (A&E) improvement Urgent and emergency Cardiology services (A&E) GoodGood NotNot raratted GGoodood GoGoodod GoGoodod GoGoodod Good Good Good Good Good Good Safe? GoodGood Risk assessment and mitigation Surgery Medical care (including Incident reporting GoodGood GoGoodod GoGoodod GoGoodod GoGoodod GoGoodod Preventing and Learning from harm older people’s care) Learning from harm Intensive/critical care Good Good Good Good Good Good Deteriorating patient ective? GoodGood Surgery RRequirequireses GoodGood GGoodood GGoodood GoGoodod GoGoodod imprimprovovemenementt Workforce capacity Requires Requires Requires End of life care Good Good Good Workforce Workforce capability improvement improvement improvement Intensive/critical care Workforce cultures Caring? GoodGood GoGoodod GoGoodod GoGoodGoodGoodod GoGoodod GoGoodod

Patient Experience Patient experience and dignity Outpatients Good Not rated Good Good Good Good End of life care GoodGood GoGoodod GoGoodod GoGoodod GoGoodod GoGoodod Responsive? GoodGood

Outpatients GoodGood NotNot raratted GGoodood GoGoodod GoGoodod GoGoodod W GoodGood ell led?

88 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 89 Information on the quality of data Clinical coding error rate Learning from Deaths NHS Number and General Medical Practice Code Validity Aintree University Hospital NHS Foundation Trust During 2017/18, 1,429 of Aintree University Hospital • Timely discharge remains a challenge which was not subject to the Payment by Results clinical Foundation Trust patients died. This comprised the requires a system wide solution. The Trust continues coding audit during April 2017 to March 2018 by Aintree University Hospital NHS Foundation Trust following number of deaths which occurred in each to work collaboratively with external agencies the Audit Commission. submitted records during 2017/18 to the Secondary quarter of that reporting period: and partners. Simultaneously there is an ongoing Uses service for inclusion in the Hospital Episode • 287 in the first quarter; work stream looking at improving the efficiency Statistics which are included in the latest published of internal patient management to minimise the • 322 in the second quarter; data. The percentage of records in the published delays in the discharge process which are caused data: Statement on relevance of data quality • 405 in the third quarter; within the Trust • 415 in the fourth quarter. • Which included the patient’s valid NHS and actions to improve data quality • When avoidable factors are identified which cut Number was: By 18 March 2018, 920 case record reviews and 10 across the NHS organisations, Aintree and other Good quality information underpins the effective delivery investigations have been carried out in relation to local provider Trusts utilise a cross-Trust mortality • 99.9% for admitted patient care; of the care of people who use NHS services and is essential 1,429 of the deaths. review process to request a mortality review in the • 99.9% for outpatient care; and if improvements in quality of care are to be made. other organisation In 10 cases a death was subjected to both a case • 98.2% for accident and emergency care record review and a serious incident investigation. The • The Trust has taken a decision to regard any • Which included the patient’s valid General Medical number of deaths in each quarter for which a case in-patient fall which results in fractured neck of Practice Code was: Aintree University Hospital NHS Foundation record review or an investigation was carried out was: femur (FNOF) as a potential ‘serious incident’. This Trust will be taking the following actions to is because in certain patient groups FNOF carries a • 2 in the first quarter; • 100% for admitted patient care; improve data quality: significant mortality risk; this risk can reasonably • 3 in the second quarter; be expected to be higher in a patient admitted • 100% for outpatient care; and • Data Quality Strategy and policies regularly • 2 in the third quarter; because of significant medical problems. This reviewed and kept up to date to ensure • 99.9% for accident and emergency care decision ensures that a thorough investigation is appropriate actions are undertaken to improve • 3 in the fourth quarter. undertaken for any falls leading to severe harm the quality of data recorded and reported Three representing 0.21% of 1,429 of the patients’ or death after a FNOF. There is a working group deaths during the reporting period are judged to be • Development and circulation of data quality on Falls Reduction as an area of focus for quality more likely than not to have been due to problems in Information Governance Toolkit reports to facilitate improvement improvement the care provided to the patient. attainment levels (Information • Routine audits undertaken to validate the quality • The serious review made recommendations on In relation to each quarter, this consisted of: Governance) of data improving the safety of care of patients with • 1 representing 0.35% for the first quarter; diabetes. • Regular coding audits undertaken to ensure • 1 representing 0.31% for the second quarter; robustness of clinical data An assessment of the impact of the actions described • 1 representing 0.25% for the third quarter; above include: Aintree University Hospital NHS Foundation Trust • The Trust has invested in a data quality team • 0 representing 0% for the fourth quarter • The internal work on avoiding unnecessary delays Information Governance Assessment Report overall with particular focus on validating and improving score for 2017/18 was 70% and was graded Green, in the discharge process has improved patient flow Electronic Patient Record data These numbers have been estimated using the and allowed the Trust to manage admissions better Satisfactory. Mortality Review System which runs on a monthly • Achievement of a minimum of level two than have been the case previously. The external basis. The system (database) includes demographics IG Toolkit limitations have not been resolved, but work is and other quality indicators which are used, along ongoing with the patients’ notes, to gain an informed view to see if any lessons can be learnt. • Joint mortality reviews have taken place with other provider Trusts; this has strengthened governance If there is an incident identified resulting in a death links between Trusts then an investigation will be carried out in line with • The Falls Reduction Working Group has achieved the Trust’s incident management and reporting a significant reduction in the numbers of falls with process. This process is led by the Clinical Governance harm. Using the serious incident process on FNOF Team along with the Divisional Teams and with the falls will bring strong actions into place with a support of the Consultant (who was leading on the formal implementation methodology. care) and their Team to determine lessons learnt. The final report is then submitted to the Safety & Risk 220 case record reviews and investigations completed Executive Led Group for review and discussions then after (31 March 2017) which related to deaths which shared widely throughout the Trust. took place before the start of the reporting period. During the financial year 2017/18 the following deaths Four representing 1.82% of the patient deaths before were reviewed and identified avoidable factors were: the reporting period are judged to be more likely than not to have been due to problems in the care provided • Prolonged delayed discharge from hospital waiting to the patient. These numbers have been estimated for nursing home placement resulting in hospital using the Mortality Review System which runs on acquired pneumonia a monthly basis. The system (database) includes • The importance of early recognition and demographics and other quality indicators which management of sepsis are used, along with the patients’ notes, to gain an • Falls resulting in harm in frail patients informed view to see if any lessons can be learnt. • One death was subject to a serious incident review. Seven representing 0.47% of the patients during Actions have been taken in response to these mortality 2016/17, are judged to be more likely than not to have review findings as follows; been due to problems in the care provided to the patient.

90 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 91

Part 2.3 – Reporting against core indicators Summary hospital-level mortality indicator (SHMI)

NHS Outcome Trust rate noted Top Worst Data Framework Indicator for reported National average Performer Performer Source Since 2012/13 NHS foundation trusts have been required to report Domain Indicator period

performance against a core set of indicators using data made (Oct 16 – Sept 17) available to Trusts by NHS Digital. SHMI value: SHMI value: 100 1.0222 Banding: 2 72.70 134 Banding: 2 (as expected) The following tables show our performance for a least two However, it is not always possible to provide the national Prevent people (as expected) reporting periods and, where the data is made available by average and best and worst performance for some SHMI value from dying NHS Digital, a comparison with the national average and indicators due to the way the data is provided. In addition and banding prematurely (Jul 16 – Jun 17 the highest and the lowest performing Trusts. the most recent national data is not always available for the most recent financial year. Where this is the case, the time SHMI SHMI value: 100 period used is noted. value:1.0285 Banding: 2 72.61 122.77 Banding: 2 (as expected) NHS Digital (as expected)

(Oct 16 – Sept 17) % of patient 31.5% 59.80% 11.50% deaths with Aintree value: Enhancing quality palliative care 52.7% of life for people coded at either with long term diagnosis or (Jul 16 – Jun 17) conditions specialty level Aintree value: 31.10% 58.60% 11.20% for the Trust 54.2%

The Aintree University Hospital NHS Foundation Trust considers that this data is as described for the following reasons; the data has been extracted from NHS Digital and the outputs are regularly reviewed and through the Trust’s executive led Trust Avoidable Mortality Reduction Group. The Trust has an ‘as expected’ mortality rate as measured by the Summary Hospital Level Mortality Indicator (SHMI) at 1.0222 for the period July 2016 – June 2017, as demonstrated in the table above. Unlike the Hospital Standardised Mortality Ratio (HSMR), the SHMI includes deaths 30 days after discharge and therefore patients, including those on palliative care end of life pathways, who are appropriately discharged from the hospital. The Aintree University Hospital NHS Foundation Trust has taken the following actions to improve this indicator and so the quality of its services, by a structured programme of work focused on the reduction of avoidable mortality: • An active Avoidable Mortality Reduction Group chaired by the Medical Director with representatives from all clinical divisions and with the involvement of clinical commissioners representatives • This is supported by structured review of data, benchmarking and trends related to in-hospital deaths as well as detailed clinical review at a local level • Mortality improvement work is also supported by work with external agencies such as AQuA, where the Trust is seen as delivering the best performance regionally on a range of quality and process measures related to conditions such as pneumonia and acute kidney injury which are known to contribute to in-hospital mortality. The Trust is seen to have a high rate of palliative care coding. As the Trust provides a number of regional and specialist services and is a provider of specialist palliative care, these levels are seen as appropriate for the organisation.

92 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 93

Readmission rates for children and adults Patient Experience

NHS Outcome NHS Outcome Trust rate Trust rate noted Framework National Top Worst Framework National Top Worst Data Indicator noted for Data Source Indicator for reported Domain average Performer Perfomer Domain average Performer Performer Source reported period period Indicator Indicator

(Apr 2011- (Apr 2016- % of patients readmitted Mar 2012)* Mar 2017) 68.1% 85.2% 60.0% Ensuring people Responsiveness to a hospital which forms 10.01% 5.10% 13.58% Aintree: 67% Aintree: 0 have a positive to the personal part of the Trust within 28 NHS Digital experience needs of its patients days of being discharged (Apr 2015- of care from a hospital which Mar 2016) 69.6% 86.2% 58.9% forms part of the Trust (Apr 2010- Aintree: 69.4% during the reporting Mar 2011) period The Aintree University Hospital NHS Foundation Trust considers that this data is as described for the following Aintree: 0 10.15% 5.85% 13.94% (i) Aged 0 to 15 reasons; the data has been extracted from NHS Digital and is derived from, the National Inpatient Survey. Helping people recover from Aintree is focused on improving the experience of patients. As per the data above, Aintree University Hospital NHS episodes of NHS Digital Foundation Trust performs in line with the national average in terms of responsiveness to the personal needs of ill health or its patients. The Aintree University Hospital NHS Foundation Trust has taken the following actions to improve this following injury % of patients readmitted (Apr 2011- indicator and so the quality of its services, by: to a hospital which forms Mar 2012)* • The introduction of a flexible visiting policy. A Visitors’ Charter had been developed in conjunction with local part of the Trust within 28 11.45% 8.96% 13.50% Aintree: 11.76% Healthwatch Groups and approved at Patient Experience Executive Led Group. Patients, Visitors and Staff have days of being discharged been given the opportunity to provide feedback on the core and flexible visiting times via a survey developed from a hospital which by a Volunteer. The results demonstrate that patients and visitors are satisfied with the visiting times and find forms part of the Trust them more convenient. Following feedback from staff, further engagement work is ongoing to support staff in during the reporting (Apr 2010- promoting the Visitors’ Charter. Further patient, visitor and staff satisfaction surveys will be undertaken during 2018 period Mar 2011) 11.42% 7.60% 12.94% • Aintree scores in the interquartile range of Trusts on the Picker patient experience survey (voluntary independent (ii) Aged 16 or over Aintree: 12.11% bi-annual patient feedback survey) and maintains a focus on identifying areas for improvement through this process • A patient and family shadowing and engagement project is in place to help understand patients’ experience of * Most recently available data the Trust and identify areas for improvement.

Aintree University Hospital NHS Foundation Trust considers that this data is as described for the following reason; the data has been extracted from NHS Digital. The readmission rate demonstrated for Aintree University Hospital NHS Foundation Trust is comparable to that

expected. The Aintree University Hospital NHS Foundation Trust has taken the following actions to improve this National Staff Survey indicator and so the quality of its services, by continuing to work with CCG teams, Accident and Emergency and local Mental Health providers to reduce readmissions and frequent Accident and Emergency attendee rate. NHS Outcome Framework Trust rate noted for National Top Worst Data Please note that this indicator was last updated in December 2013 and future releases have been temporarily Indicator suspended pending a methodology review Domain reported period average Performer Performer Source Indicator

(Apr 2016- Mar 2017) Ensuring people 42% 72% 29% % of staff who would Aintree: 48% have a positive recommend the Trust to NHS Digital experience of their family or friends (Apr 2015- Mar 2016) care 42% 75% 27% Aintree: 41%

The Aintree University Hospital NHS Foundation Trust considers that this data is as described for the following reason; the data has been extracted from NHS Digital and is taken from the National Inpatient Survey. Aintree University Hospital NHS Foundation Trust is performing in line with the national average. The Aintree University Hospital NHS Foundation Trust has taken the following actions to improve this indicator and so the quality of its services, by: • The Trust encourages staff to raise concerns in relation to the quality of care patients receive • The Trust has a formal establishment review process to provide regular review of staffing levels, incidents and patient acuity to help ensure that the right staffing levels are in place to deliver high quality care • There is continual focus on staff well-being along with an ongoing development of a self-care programme • Ongoing focus on improving appraisal and training compliance to ensure that staff are supported in the delivery of their roles • There is a continued focus on improving incident report and learning from mistakes.

94 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 95

Venous thromboembolism (VTE blood clot)

NHS Outcome Trust rate noted Framework National Top Worst Data Indicator for reported Domain average Performer Performer Source period Indicator

(Apr 2017- Treating and Dec 2017) end 95.25% 100% 76.08% caring for of Q3 Aintree: % of patients who were people in a safe 92.29% admitted to hospital and environment NHS Digital who were assessed for and protecting (Apr 2016- venous thromboembolism them from Mar 2017) 95.70% 100% 76.48% avoidable harm end of Q3* Aintree: 94.23%

The Aintree University Hospital NHS Foundation Trust considers that this data is as described for the following reason; the data has been extracted from NHS Digital. The Aintree University Hospital NHS Foundation Trust has taken the following actions to improve this indicator and so the quality of its services, by: • The Trust continues to provide comprehensive training in the completion of VTE Proformas • Every Breach in compliance is validated and contact made with Doctors when risk assessments are found to be incomplete.

Clostridium difficile (C.Diff) infection

NHS Outcome Trust rate noted Framework National Top Worst Data Indicator for reported Domain average Performer Performer Source period Indicator

Treating and (Apr 2017- Mar caring for 34 0 150 Crude count of cases of C. 2018) Aintree: 66 people in a safe difficile infection reported environment NHS Digital within the Trust amongst and protecting patients aged 2 or over (Apr 2016- Mar them from 30 0 116 2017) Aintree: 46 avoidable harm

* Most recently available data (crude cases only available from NHS Digital)

The Aintree University Hospital NHS Foundation Trust considers that this data is as described for the following reason; the data has been extracted from NHS Digital. The data shows an overall reduction in the total number of cases reported to Public Health England since March 2016. The Aintree University Hospital NHS Foundation Trust has taken the following actions to improve this indicator and so the quality of its services, by the following work which continues: • Annual Healthcare Associated Infections reduction delivery plan for 2018/19 has been developed and agreed. This includes actions to reduce CDI and other healthcare associated infections. The Delivery Plan is monitored at the IPC Group and Safety & Risk Executive Led Group. Latest un-validated data shows a marginal reduction in performance with total volume of C.Difficile infections reported to PHE increasing in 2017/18 • All cases of CDI are presented to the IPC Operational Group to enable themes to be monitored and agreement in terms of suitability for appeal • An internal audit regarding antimicrobial stewardship has been undertaken; reasonable assurance provided. Actions to be implemented and monitored via the Antibiotic Action Group • Joint review of antibiotic guidelines in progress with Liverpool Clinical Laboratories and the Royal Liverpool Hospital • The treatment for CDI is being reviewed to include the use of fidaxomicin for all patients.

96 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 97

Patient Reported Outcome Measures (PROMs) Rate of patient safety incidents and percentage resulting in severe harm or death

NHS Outcome NHS Outcome Trust rate noted Trust rate noted Framework National Top Worst Data Framework National Top Worst Data Indicator for reported Indicator for reported Domain average Performer Performer Source Domain average Performer Performer Source period period Indicator Indicator

(Apr 2017 – Sept 2017) 5,226 1,133 15,228 (Apr 2016- Number of patient Aintree: 3,768 Mar 2017) 0.086 0.135 0.006 safety incidents reported Aintree: 0.074 within the Trust (Oct 2016 – Patient reported outcome Mar 2017) 5,122 1,301 14,506 measure for: Aintree: 3,227 (i) Groin hernia surgery (Apr 2017 – (Apr 2015- Mar 2017) 42.84 23.47 111.69 Rate of patient safety Mar 2016) 0.088 0.157 0.0213 Aintree: 30.6 incidents reported Aintree: 0.081 Treating and within the Trust Helping people (Oct 2016 – caring for - per 1,000 bed days recover from Mar 2017) 41.1 23.13 68.97 people in a safe episodes of NHS Digital Aintree: 26.29 (Apr 2016- environment NHS Digital ill health or Patient reported outcome Mar 2017) 0.437 0.533 0.335 and protecting following injury measure for: (Apr 2017 – Aintree: 0.434 them from Sept 2017) 18.4 0 121 Number of such patient (ii) Hip replacement avoidable harm Aintree: 9 surgery (Apr 2015- safety incidents that resulted in severe harm Mar 2016) 0.438 0.510 0.320 (Oct 2016 – or death Aintree: 0.424 Mar 2017) 19 1 92 Aintree: 11 (Apr 2016- Patient reported outcome Mar 2017) 0.323 0.398 0.249 (Oct 2016 – measure for: Aintree: 0.316 Mar 2017) 0.4 0 2.0 Rate of such patient safety Aintree: 0.20 (iii) Knee replacement (Apr 2015- incidents that resulted in surgery severe harm or death Mar 2016) 0.320 0.398 0.198 (Oct 2016 – - per 1,000 bed days Aintree: 0.299 Mar 2017) 0.4 0 2.1 Aintree: 0.30 The Aintree University Hospital NHS Foundation Trust considers that this data is as described for the following reason; the data has been extracted from NHS Digital. The Aintree University Hospital NHS Foundation Trust considers that this data is as described for the following reason; PROMs measure patients’ health gains after surgery. The information is gathered from patients who complete a the data has been extracted from NHS Digital. questionnaire before and after surgery. From the data available, the case mix adjusted average health gain shows that the Trust is not an outlier when compared nationally. The Aintree University Hospital NHS Foundation Trust has taken the following actions to improve this indicator and The Aintree University NHS Hospital Foundation Trust has taken the following actions to improve this indicator and so so the quality of its services, by: the quality of its services, by: • Continuing to promote the reporting of incidents across the Trust Continuing the work within Orthopaedics and General Surgery to ensure that the best patient outcomes are achieved. • Identify a plan for greater sharing of lessons learnt and feedback following incident investigations, building on the good practice that is in place across the organisation • Develop enhanced systems for raising concerns.

98 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 99 Reducing Antibiotic Consumption • Incorporating an IV alert in the electronic prescribing Part 3: Other Information Antimicrobial resistance (AMR) has risen alarmingly over system which highlights all patients on critical the last 40 years. Reducing consumption of antibiotics medications including IV antibiotics and optimising prescribing practice by reducing the • Strong and effective multidisciplinary leadership indiscriminate or inappropriate use of antibiotics which is (champions) at all levels 3.1 An overview of the quality of care a key driver in the spread of antibiotic resistance. • Education and training of all clinical staff to ensure During 2017/18 Aintree has participated in a national documentation and appropriate use of antimicrobials CQUIN initiative to reduce antibiotic consumption by The following section provides an overview of the quality of focusing on antimicrobial stewardship and ensuring The latest results available demonstrate an 8.8% reduction antibiotic review within 72 hours. The aim was to reduce in Carbapenem antibiotic consumption and a 55% care offered by Aintree based on performance in 2017/18 against total antibiotic consumption and the consumption of two decrease in Tazocin antibiotic consumption. The large specific types of antibiotics (Carbapenems and Tazocins). decrease in Tazocin consumption is due to a national additional indicators selected by the Board in consultation with Activities to reduce antibiotic consumption have included: shortage in the availability of this type of antibiotic which has necessitated changes to make the Trust formulary stakeholders. These indicators have been selected to demonstrate • Reviewing guidelines and switching to narrow spectrum Tazocin sparing by introducing amoxicillin, gentamicin and our ongoing commitment to patient safety, clinical effectiveness agents where possible metronidazole. Therefore one agent has been replaced • Using pharmacist daily reviews and ward round by three resulting in an overall increase in antibiotic and enhancing the patient experience checklists to review all patients on antibiotics and to consumption. The robust antimicrobial stewardship switch patients from IV antibiotics to oral antibiotics in activities introduced by the Trust have mitigated the a timely and appropriate manner overall increase in antibiotic consumption has been limited Our Patient Safety Initiatives: to a 7.5% increase. • Using stickers in patients’ medical notes to highlight to all health professionals the rationale for continued use Aintree’s Flu-Fighter Campaign of Intravenous Antibiotics after 72 hours Aintree’s flu-fighter campaign for 2017/18 has been our most successful ever, exceeding the national target of 70% coverage of frontline staff in record time. More than 87% of staff had their flu jab which protects staff, families Four quarter rolling rate of piperacillin - and patients, Moreover 75% of our entire workforce had tazobactam prescribing per 1000 admissions; by acute trust their vaccination during this year’s campaign. Aintree was the top performing acute Trust for staff flu vaccination 400 Aintree for the majority of the reporting period. To achieve this success the Trust’s Occupational Health Department worked collaboratively with the Communications Team England to ensure that staff received positive messages about the effectiveness of flu vaccination. The Occupational Health Team also worked in partnership with Divisional Managers 200 to ensure that staff were given the opportunity to be staff, early morning vaccinations were available from vaccinated at their convenience with vaccinations being 7am and weekend vaccination sessions were facilitated Per 1000 available from pop-up clinics (‘Jab at the Hut’), walkabouts throughout the hospital. Aintree’s Flu Campaign has also (‘Flu to You’) and drop in sessions. Evening sessions were been shortlisted for the Most Innovative Flue Fighter facilitated within wards and departments to capture night Campaign in the Flu Fighter 2018 Awards. 0 2016/17 Q3 2016/17 Q4 2017/18 Q1 2017/18 Q2 2017/18 Q3

We wanted to ensure that it was easier than ever for our staff to get their flu jabs and thousands took advantage in the first few weeks. Thanks to everyone involved for all their hard work in making it so successful, and to everyone who had their jab, as without their willing participation the campaign would not be effective. Reduce antibiotic consumption per Reduce antibiotic consumption per Diane Haddock – Head of Organisational Health and Effectiveness 1000 admissions – Carbapenem > 2% 1000 admissions – Total antimicrobials > 2%

Q4 2016/17 Q2 2017/18 Q4 2016/17 Q2 2017/18 Number of Staff Vaccinated Work related stress referrals

2016 – 17 2017 – 2018 March 2017 March 2018 No of cases No of Cases 103.2 94.2 (8.8%) 4,381 4,711 (7.5%)

Data Source: PHE Fingertips Data Source: PHE Fingertips 84.2% 87.5% at M11 63% 51%

Data Source: Schedule 4 Quality Requirements KPI Return Data Source: Trust Workforce systems

100 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 101 Emergency and Acute Care Programme There is still a significant amount of work to do to The Trust has undertaken a programme of work spanning improve waiting times in the emergency department. There are between 20 to 50 homeless attending a Consequently in 2018/19 the emergency care programme the last 6 months in order to support achievement monthly clinic where diabetic patients can be seen of the 95% 4 – hour waiting time standard as well will focus on: by podiatrists and a Liverpool Diabetes Partnership as performance against key quality indicators in the • Continued work in the emergency department to emergency department. embed the changes implemented to support the results Diabetic Senior Nurse (DSN) The Emergency and Acute Care Programme has focused above on three workstreams; the emergency department, • Bed demand and capacity modelling to ensure that the patient assessment areas and patient flow through the Trust has the correct volume and split of beds to deliver Outreach Team to engage the Homeless and Hostel hospital. The team have used qualitative and quantitative non elective activity residence to attend for holistic Diabetes care. LDP information to determine a series of high impact change has worked with 20 hostels, in piloting an education areas and tested impact of these through a series of • Implementation of the SAFER patient flow bundle to programme which has now been delivered and has a rapid improvement events, building the learning and improve length of stay, volume of discharges and the roll out schedule agreed for 2018/19. There are monthly permanent changes back into the programme of work to time of these discharges on the base wards. joint clinics with the Homeless Outreach Team, visiting embed and sustain them. – S – Senior review. All patients will have a senior identified diabetics in Hostels or in the city centre review before midday by a clinician able to make Brownlow Group Practice. These high impact changes have included focusing Our Clinical Effectiveness Initiatives on patients who could be seen and treated without management and discharge decisions There are between 20 to 50 homeless attending a monthly admission, time to initial assessment, time to see first – A – All patients will have an expected discharge Improving Diabetes care – clinic where diabetic patients can be seen by podiatrists doctor and time to speciality review. Between 19th to 25th date and clinical criteria for discharge Liverpool Diabetes Partnership and a Liverpool Diabetes Partnership Diabetic Senior March 2018 the results have demonstrated: Nurse (DSN), there are also quarterly Eye Screen clinics The Liverpool Diabetes Partnership (LDP) was developed – F – Flow of patients will commence at the earliest which have up to five patients assessed, with DSN support, • 10% improvement in the percentage of patients in 2015 to promote collaborative working with Aintree opportunity from assessment units to inpatient and there are currently 10 homeless patients on intense receiving initial assessment within 15 minutes University Hospital NHS Foundation Trust, the Royal wards. Wards that routinely receive patients from management plans with the DSN. • 6% improvement in the percentage of patients assessment units will ensure the first patient arrives Liverpool and Broadgreen University Teaching Hospitals receiving first doctor review within 60 minutes on the ward by 10 am NHS Trust and Liverpool Community Health (LCH). In addition, the service has also helped to increase the knowledge and skills of GPs, practice nurses and Part of its remit was to develop community based services, • 5% improvement in non-admitted performance – E – Early discharge. 33% of patients will be community care health professionals who diagnose and for diabetic patients, and to encourage better holistic care discharged from base inpatient wards before midday treat people with diabetes. The CQC recently visited the • All of this has been achieved in the backdrop of an for them in their community, rather than having to attend team during a joint clinic and were pleased with the 8-10% increase in attendances between November – R – Review. A systematic multi-disciplinary team hospital outpatient appointments and alternatively A&E. work quoting “A great example of primary care working – February 2017/18 (and also in complexity) in review of patients with extended lengths of stay It was also tasked with reducing the numbers of diabetic together to reach are homeless population”, and they comparison to the same time period in 2016/17. (>7 days – ‘stranded patients’) with a clear ‘home patients attending A&E and the reduction in amputations. first’ mindset. have been rated as ‘Outstanding’ for diabetes care by the While making significant inroads into these aims, the LDP National Clinical Director for Obesity and Diabetes at NHS has also been working in partnership with other external England. organisations to improve the health and well-being of Latest performance figures from December 2017 show diabetic patients across the city. that amongst the diabetic population within Liverpool, 4 hour A&E waiting time standard Reduction in 12 hour trolley wait in AED Liverpool has approximately 750 homeless people in the the service is achieving a 20% reduction in sight and city including, rough sleepers, “sofa surfers” and hostel kidney related complications, 12% fewer strokes, and 22% dwellers and the team have worked collaboratively with less admissions to hospital for hypoglycaemia (low blood Feb 2017 Feb 2018 March 2017 March 2018 St Paul’s Eye Hospital, LCH Podiatry and the Homeless sugar levels).

86.4% 83.9% 0 0

Data Source: Hospital PAS Data Source: Hospital PAS Impaired vision from diabetes Transient Ischemic Attach (TIA)

2016/17 2017/18 2016/17 2017/18

6% change from -24% change -12% -18% target from target

Data Source: LDP outcome meeting Data Source: LDP outcome meeting

102 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 103 Performance data on the management of patients Mental Health CQUIN relating to Emotionally Unstable Personality Disorder with Sepsis indicates that performance against all three The mental health CQUIN, led by Dr Mark Griffiths (EUPD) and frequent attenders presenting with persistent indicators is improving during 2017/18. In addition, Consultant Lead Clinical Psychologist and Dr Elizabeth medical complaints, but where patterns of attendance the Trust currently takes part in the Advancing Quality MacCallum, AED Consultant, was introduced in April over the previous 12 months were strongly suggestive or programme with six other Trusts in the Region. This 2017 and its main objective was to reduce the number of mental health / psychological factors affecting medical programme monitors the percentage of measures from attendances to AED, for patients within a selected (and status. a care bundle (CPS) delivered and the percentage of identifiable) cohort of frequent attenders. They would be There have been pro-active care plans put in place patients receiving their appropriate care bundle (ACS). patients whose patterns of attendance were indicative providing psychologically-informed case management Currently Aintree have the third highest score and the of mental health factors influencing medical status, guidance across the various organisations, which seek to second highest percentage of patients receiving the care who could be identified as likely to benefit from mental ensure that when a patient attends either Trust they get bundle. Improvements brought about include: health and psychosocial interventions, (within their case the same consistent model of care, more effectively and • Sepsis training modules established including electronic management and under a pro-active care approach). efficiently. Following model implementation we have induction The CQUIN is a collaborative piece of work which means noticed that not only have the number of attendances, for these patients, dropped significantly (see below) but the • Clinical huddles, other clinical training (e.g. renal, the Aintree clinical team is working very closely with duration of their stay within the emergency department respiratory) various external organisations such as Mersey Care, the Royal Liverpool & Broadgreen University Hospitals, North has also reduced considerably. Not only has this been a • Regular education and training taking place. F1 and F2 West Ambulance Service, the Police and the voluntary triumph for the patients, in getting the most appropriate doctors have set training times with clinicians from SAU sector. treatment for them, but it has also helped the clinicians and MAU to raise awareness of Sepsis and the Sepsis in the emergency department manage patients more pathway. Introduction of Sepsis 6 trolleys in AED and The CQUIN cohort including, 2 primary patient groups; effectively and establish good collaborative working Aintree’s Sepsis Improvement Programme MAB/FAB clinical areas frequent attenders presenting with mental health needs across Trusts and external organisations. Aintree’s sepsis campaign for 2017/18 has seen some significant positive outcomes in our patient care with • Introduction of Sepsis boxes on inpatient wards. reported drops in our summary hospital-level mortality • Development and introduction of a sepsis screening (SHMI) for Sepsis 136.68 to 107.7. tool, guidance and clerking proforma. The use of these CQUIN attendance Improvements have been made through the is being audited and discussed to establish means of establishment of our Sepsis Improvement Group which improving usage. 50 includes multi professional members from Clinicians In addition the use of an orange antibiotic review band (doctors, surgeons, nurses, pharmacists) and support staff. is being proposed to highlight the need for antibiotic 40 The groups meet monthly to review our achievements review. A small trial has been undertaken in the against the national CQUIN for Sepsis and establish means MC attendances emergency department and a launch across the hospital is 30 of making improvements. The national CQUIN aims to being developed with a scheduled implementation during AUH reduce the impact of serious infections by: Q1 2018/2019. 20 MC trajectory

• Timely identification of sepsis in emergency No of attendances departments and acute inpatient settings AUH trajectory 10 • Timely treatment for sepsis in AED and acute inpatient Currently Aintree have the third highest score settings (antibiotics in 1 hr of diagnosis) and the second highest percentage of patients 0 • Clinical antibiotic review between 24-72 hours of receiving the care bundle. patients with sepsis. Jul 17 Jan 18 Jun 17 Oct 17 Feb 18 Sep 17 Apr 17 Dec 17 Nov 17 Mar 18 Aug 17 May 17

Month

Percentage of Septic patients screened Transient Ischemic Attach (TIA) AED attendances for Aintree Cohort AED attendances for Mersey Care cohort

2016/17 2017/18 2016/17 2017/18 April 2017 March 2018 April 2017 March 2018

98.6% 99.8% 39.8% 67.2% 15 5 25 10

Data Source: Aintree Business Intelligence Portal Data Source: Aintree Business Intelligence Portal Local Data Source Local Data source

104 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 105 Understanding the role of Bowel Cancer Screening Programmes and Advanced Bowel Cancer Multidisciplinary Teams (MDTs) Currently, advanced bowel cancer multi-disciplinary teams (MDTs) are not standard practice in the NHS. At Aintree, our team established the first advanced bowel cancer MDT in the UK in 2012. We provide a central referral point for all patients with advanced bowel cancer in Cheshire and Merseyside, North Wales and the Isle of Man. Health professionals are dealing with more people than ever before, and resources are stretched. However our experienced specialists have taken proactive steps to come together and develop this service. This team is made up of Our Patient Experience Initiatives healthcare professionals, all with specialities relevant to Stroke Relaxation Room the site of the cancer and they are very good at planning Terry said: “This is a great addition to the effective treatments for patients whose cancer is limited to The relaxation room on the Aintree Stroke Unit opened one organ, such as the bowel. in December 2017. The new relaxation room provides a stroke ward at Aintree and will really dedicated space to help combat some of the psychological However, in cases where bowel cancer has spread to other improve the experience of patients. I’m patients with the most effective treatment options. This effects of a stroke. The room, which is a converted office parts of the body such as the liver or lungs, we believe increases patients’ chances of quality survival. space, includes sensory lighting, relaxing music and incredibly proud of Danielle for having patients would significantly benefit from the input and essential oils which are known for their calming and the initiative to create this space with the advice of MDTs that specialise in treating advanced bowel In 2017 Bowel Cancer UK singled out teams at Aintree therapeutic properties. support of her colleagues. I’ve heard lots cancer. Consequently at Aintree we have combined these for praise after they led the way in caring for patients and other specialists into one team. From screening to with advanced bowel cancer. Our patients gave us the It is a great addition to the stroke ward at Aintree and about it, so it’s great to see it in the flesh diagnosis to treatment, our advanced bowel cancer MDT following feedback in relation to the Bowel Cancer really improves the experience of patients. Danielle and be here for the official opening.” will come to well informed decisions quickly and provide Screening experience they have had at Aintree... McDermott, Stroke Data and Quality Co-Ordinator, designed and furnished the room when she identified that Terry McDermott patients and their families often need a quiet space away from the clinical areas to relax. A stroke affects your brain, which is what controls your emotions and behaviours, so having the space to address any psychological issues alongside the medical care offered on our stroke unit is fantastic news for our patients and really enhances the

psychology services provided on the ward. My dignity was I could not have The room was officially opened on 23 February 2018 by I would like to maintained asked for better two ex-Liverpool Football Club players, Terry McDermott comment on how and David Johnson. through the much I appreciated staff to carry out whole process the friendly and this procedure. They professional support were not only very I received from all professional, but the staff from bowel were also caring and cancer screening understanding. I love sitting Thank you Our patients said... in this room it The room has a lovely It has allowed captures calming effect me to spend something we quality time with forget about my family in a in the clinical space that feels Adenoma Detection Rate following colonoscopy setting and that Bowel Cancer Screening Patients seen within more like home after positive screening test (Merseyside and is people’s 14 days of receiving an abnormal test than a hospital North Cheshire) well-being. Our patients and their families said... 2016 2017 2016 2017

100% 100% 61.55% 63.79%

Local Data Source Local Data source

106 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 107 Aintree Volunteer Companionship Service friends. They also act as a liaison between the patient/ The Aintree Volunteer scheme was established in 1997 and family and the nursing staff, communicating any concerns Part 3.2 Performance against relevant indicators and provides a well-respected service with local and National in a timely and appropriate manner. performance thresholds set by NHS Improvement recognition. It is now one of the largest NHS volunteer Volunteers providing this service have undergone a two services in the UK. Over 800 volunteers make a positive and a half day interactive training programme covering contribution to the Trust by enhancing the quality of life the principles of palliative care and symptom control, for patients, relatives and staff at Aintree. communication skills, clinical governance, spirituality and To include 18 weeks, A&E, 62 day cancer waits and Board and the Trust’s regulators throughout the year. In 2012 a new volunteer companionship role in end of resilience. C Difficile. Actions to address any areas of underperformance are put in place where necessary. These performance measures life care at Aintree was established. This is an innovative The volunteer companionship service was initially set up Aintree is required to report its performance with a list and outcomes help Aintree to monitor how it delivers its model of care using trained volunteers to support patients as a pilot within the Trust, and closely monitored. Focus of published key national priorities, against which the services. at end of life and their families. The role of the trained groups were formed with Ward Managers to discuss the Trust is judged. Aintree reports its performance to the volunteer is to provide a listening ear and a hand to hold progress of the service. for dying patients and comfort and support for family and

Performance against key national priorities from the Monitor Compliance Framework 2017/18

2017/18 It helped me to know Volunteer This is an excellent NHSI Apr 2017 – that if mum had no companions just service for families, Indicator Quarter 1 Quarter 2 Quarter 3 Quarter 4 visitors, a volunteer being there really can’t thank you Threshold March 2018 could sit with her works and is a enough. Keep up Maximum time of 18 until her visitors came great bonus the good work weeks from point of referral to treatment Relative Ward Sister Relative >=92% 93.13% 92.21% 91.73% 90.51% 91.90% (RTT) in aggregate – patients on an incomplete pathway (1)

A&E: maximum waiting time of four hours from >=95% 80.88% 82.31% 85.07% 83.54% 82.95% arrival to admission/ Regular support sessions take place with the Volunteer The service has received a number of National awards and transfer/discharge Manager, Assistant Clinical Psychologist and the promotion of the service has led to other acute hospitals Palliative care team, providing coping mechanisms and and hospices expressing an interest in setting up similar All cancers: 62-day enabling one to one discussions. As more volunteer services. To date, over 34 Trusts and Hospices have visited wait for first treatment companions trained up for the service, a mentorship Aintree to find out more about the service. from: – Urgent GP >=85% 84.4% 80.7% 86.3% 84.7% 84.1% support programme has been introduced using the more The volunteer companionship service does not replace the referral for suspected experience companions, which allowed a shadowing essential medical and nursing care that patients require in cancer system and further one to one support. their final days and hours of life, but aims to supplement NHS Cancer Screening To date eight training programmes have been completed the quality and quantity of support for patients and >=90% 91.7% 88.4% 84.9% 87.8% 89.7% enabling the service to go trust wide in 2013, recruitment their families. It is the first of its kind to be delivered in a Service referral for a ninth is currently underway. For the service hospital setting and Aintree Volunteers are proud to be Clostridium Difficile (C. to continue to be successful training must work in leading the way Nationally. 46 9 14 11 9 43 conjunction with close support and supervision along with diff) – Total cases psychological and peer support. Clostridium Difficile (C. diff) case variance from N/A -2.5 +2.4 -0.6 -2.3 -3.0 plan Staff Survey Responses Requests for companions from wards SHMI3 100 102.85

2016/17 2017/18 2016/17 2017/18 6 week diagnostics 1% 3.9% 2.22% 4.80% 1.38% 1.38% VTE 95% 91.4% 92.2% 92.3% 92.3% 92.1%

43.7% 45.5% 135 700

3 Latest position report in relation to SHMI (standardised hospital mortality index) is as reported above. This performance is a rolling 12 month position Local Data Source Local Data source updated on a quarterly basis and covers the period of the last 12 months, as per NHS Digital.

108 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 109 Part 3.3 Additional information for 2017/18 Annex i

Delivery of Seven Day Services Quality Account Statement – There are four priority standards for the delivery of The Trust is fully compliant with the four priority 7-day 7 day services: service standards within major trauma and critical care Aintree University Hospital NHS Foundation Trust and has made progress towards compliance with these • Consultant review within 14 hours of admission standards for both heart attack and stroke services. There • 7-day access to diagnostic tests are gaps for some specialised investigations, but this is improving. The Trust is not yet fully compliant for these • 24 hour access, seven days a week to key Consultant – priority standards within all specialties. At weekends directed interventions therefore, whilst new, sick and potential discharge • Daily Consultant reviews patients are seen there are a cohort of patients whose care may not be progressed. This means that the Trust is not always able to achieve the best possible length of stay for all patients. During 2018/19, the Trust will review compliance against the four priority standards in light of the merger plans with Royal Liverpool & Broadgreen University Hospitals NHS Trust. The Trust will also continue to take action and create change where possible within South Sefton, Liverpool and This Quality Account indicates the • For Care that provides Positive existing resources. Knowsley CCGs welcome the Trust’s commitment to improving Experiences for Patients and their opportunity to jointly comment the quality of the services it provides families, the Trust failed to reach on Aintree University Hospital with commissioners supporting the its ambition and this requires NHS Foundation Trust’s Quality key priorities outlined in the Quality improvement. Account for 2017/18. The CCGs Strategy (2017/18). Whilst it is These three areas of priority will have worked closely with the acknowledged that some indicators continue for 2018/19 in line with Trust throughout 2017/18 to gain were not achieved, progress the Trust’s Quality Strategy (2018 – assurances that the services has been made on last year’s 20) and will be underpinned by a delivered were safe, effective and account. The following identifies achievement and areas where portfolio of key quality goals: personalised to service users. The further work is required. CCGs share the fundamental aims • Care that is safe- CQC of the Trust and supports their • For Care that is Safe, fundamental standards of care strategy to deliver high quality, achievement was gained in the • Care that is safe – Safeguarding harm free care. following areas: pressure ulcers processes (grade 2}, in-patient falls, MSSA, It is noted that the Quality Account that is being reviewed is a draft VTE. Partial achievement or • Care that is safe – Mental Health version and the CCGs look forward further improvement is required Act compliance to receiving the finalised account. for pressure ulcers (grade 3 and 4}, C.difficile and MRSA cases and • Care that is safe – Preventing and The work the Trust has undertaken learning from harm and described within this Quality Cardio-Pulmonary-Resuscitation Account has helped to improve Training and Practice • Care that is clinically effective – patient safety and the quality of • For Care that is Clinically Acute and emergency care patient experience and endorses the Effective, achievement was pathways Trust’s commitment to the delivery gained in all the Advancing of world class care for all. • Care that is clinically effective – Quality composite processing Responsiveness to the The Commissioners welcome the scores, in embedding the AMBER deteriorating patient progress made on the 2017/18 care bundle across the Trust and accounts and the focus of work on in embedding the elements of • Patient experience – Positive and the three overarching priorities: the Sepsis 6 Care bundle. family centred care. • Care that is Safe Partial achievement was gained in using the MUST tool, • Care that is Clinically Effective in patients with Community • Care that provides Positive Acquired Pneumonia (CAP) Experiences for Patients and their receiving antibiotics within 4 families hours of arrival at the Trust and in improving the recognition and management of Acute Kidney Injury

110 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 111 The CCGs recognise the quality The Trust’s Quality Strategy for the It is felt that the priorities for Aintree University Hospital NHS Foundation Trust Quality Account challenges faced at the Trust with forthcoming year (2018/19) has quality improvement identified the recent CQC inspection rating taken into account and been agreed for the coming year are both 2017/18 Commentary of “requires improvement” and on the views from all stakeholders challenging and reflective of the

will look to support and work with including staff, commissioners current issues across the health Healthwatch Sefton would In looking at clinical effectiveness, Improvements to ‘end of life care the Trust on the action plan to and most importantly patients. economy. We therefore commend like to thank the Trust for the completion of the MUST screening has been an area which we have improve standards. The Trust has The monitoring of the Quality the Trust in taking account of opportunity to comment on the tool for nutrition and hydration is received local feedback on and it been particularly challenged with Improvement Plan, which all new opportunities to further draft Quality Account 2017/18. still only a partial achievement. This will be good to see the strategy a series of Surgical Never Events action plans will feed into, has a improve the delivery of excellent, We attended the Quality Priorities is an area we review yearly and it which the trust are to develop which will require work on review clear direction for reporting and compassionate and safe care for engagement event (16th March would be good to see this achieved which will hopefully look to embed of incidents, lessons learned and accountability. every patient, every time. 2018) which was interactive over the next 12 months. end of life care. change in practice supported by and engaging. Commissioners are aspiring through The Trust has continued to work In looking at CQUIN targets, the policy development and training On reading the draft account, our strategic objectives and 5 year Signed: in partnership with Healthwatch trust should be proud of their to mitigate risks to patients for all overall impression is that the style Sefton. We regularly attend the plans to develop an NHS that achievement to improve services serious incidents. and openness of the report is to Patient Experience Executive delivers positive outcomes, now for people with Mental Health The draft Quality Account is a and for future generations. This be commended. The way in which Led Group and we hold monthly objectives have been presented to needs presenting at A & E. Frequent comprehensive report that clearly means reflecting the government’s Fiona Taylor, Chief Officer engagement stands to gather both show progress year on year is really patient and visitor feedback. attendees at the department has demonstrates progress within objectives for the NHS set out in South Sefton and Southport easy to read. It would have been been an area for concern for a the Trust. It identifies where the their mandate to us, adding our & Formby CCGs helpful to see targets for the goals We are aware that over the past number of years. It would have organisation has done well, where own stretching ambitions for which have been set to be achieved 12 months opportunities for been beneficial to have seen what further improvement is required improving health and delivering by March 2020. volunteers to support and get 20% looks like (i.e. the number of and the ambitions moving forward. better services to go even further Signed: involved with patient experience people this related to). The report lacks information to tailor care to the local health From working with the Trust surveys have been limited. We however on what actions are economy. Providing high quality we are aware that during the understand that there have been With regard to staff training, needed to achieve these goals, in care and achieving excellent past 12 months, the biggest a number of leadership changes we found no real detail about line with their Quality Strategy. outcomes for our patients is the Dianne Johnson, disappointment was receiving a and that a revised ‘Patient mandatory training for staff in non- ‘Requires Improvement’ rating from central focus of work for the local Chief Executive Experience & Engagement strategy’ clinical areas. In particular, those We have reviewed the information the Care Quality Commission. In is being drafted. A Healthwatch system and is paramount to the Knowsley CCG staff who are telephone based provided within the Quality Account the draft we were surprised that representative attended the recent local system’s success. and/or on reception areas and any and checked the accuracy of data this outcome wasn’t referred to patient experience event and we other patient facing facilities. Staff within the account against the in detail (although the statement welcome this strategy. are often the primary contact for latest nationally published data from the Chief Executive was yet to many patients and this can have be included in the draft). In our last feedback report we where possible. highlighted a number of areas. considerable repercussions should it In looking at the priorities for Staff at the trust were described not be positive for a patient and/or patient safety, it was disappointing as ‘professional, fantastic and family member, carer or friend. to read how a number of key courteous’. It was therefore The work to progress 7 day priorities have not been met. For disheartening to see that only 41% services was noted and the need example, the increase in grade 3 of staff (lower than the national moving forward, to address the and 4 pressure ulcers (four more average) would recommend the gap for diagnostic testing and the than the previous year), however trust to their friends and family. it was good to see that there had impact this is having on potential been a 5% reduction in grade 2’s. One of the concerns related to discharge. discharge processes. It is good to Again an increase in Clostridium Healthwatch Sefton will continue difficile infections was seen with an see that there are a number of areas where the Trust is reviewing to work in partnership with the increase of eight from last year, this Trust to support the on-going work area requiring improvement. discharge. The plan to develop and introduce an ‘Expected Date to improve the overall care and Work to reduce both the number of Discharge Policy’ for the Trust is services provided to both patients of inpatient falls and inpatient falls welcomed. and their visitors, particularly those leading to moderate harm and areas of work/ strategies which are Another area identified was a above by 5% were achieved and to be developed in the next lack of communication regarding this reflects work undertaken by 12 months. the trust. medication and again we welcome the work to strengthen the ward based pharmacy teams.

112 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 113 Commentary on the Quality Account of Aintree University Hospital Healthwatch Liverpool Aintree Quality Account

NHS Foundation Trust by Healthwatch Knowsley 2017/18 Commentary

Healthwatch Knowsley welcomes Overall the Trust currently holds a It is felt a key concern that the Healthwatch Liverpool welcomes At our main Listening Event on 11th We are aware that the Trust has the opportunity to provide this patient experience rating of 4.5 out Quality Account does not begin to this opportunity to comment on July 2017 we spoke to 74 people, been doing some work around commentary in support of the of 5 stars (good/excellent) based acknowledge is around the Trust’s the Quality Account of 2017/18. many of whom praised the caring equality and diversity issues, Aintree University Hospital NHS on the 400 comments held on ability to respond to the challenges We base these comments on the approach of staff, but some people however we are keen to see further Foundation Trust Quality Account the Healthwatch Knowsley online of staff retention and recruitment. content of this Quality Account, did express concerns about staffing details about this. We welcome an for 2017/18. A draft copy of feedback centre. This rating has With the NHS facing well our ongoing engagement with numbers and the negative impact increased focus on both pressure the Account was provided to been collated through experience documented challenges relating the Trust and feedback received that this can have on patients’ ulcer prevention and end of life Healthwatch Knowsley in a timely feedback provided by patients to the recruitment and retention from patients and families. experiences of care. We are due to care. We are encouraged to see manner to allow for a response to and family members. Listening of key skills, it seems the quality hold a further Listening Event at the a focus on increasing staffing be produced. The past year has clearly been a Events at which we have spoken to account fails to provide a statement Trust this year. levels and also a commitment to patients and family members held about this and its impact on quality. challenging one for the Trust and Healthwatch Knowsley would improving patient experience. In within the Accident and Emergency We were also surprised to note this is borne out in the Quality Although there have been like to thank the Trust for terms of capacity, we feel that a department have also contributed that the priorities for the coming Account. challenges for the Trust this year their willingness to work with system-wide conversation is needed to this rating. The Trust has year do not address the proposed Healthwatch across the year, The CQC inspection report this year there have also been areas of proactively supported this work. merger with the Royal Liverpool around bed numbers and the including ongoing involvement has highlighted a mixed picture. progress. and Broadgreen University Hospitals staffing needed to sustain these. through the Patient Experience Whilst we understand that much Some areas, such as surgery and The work done around diabetes NHS Trust. Overall we are hopeful that the Executive Led Group and with of the text is mandated we found critical care, have scored very well, care has reduced the incidence of Trust can make the necessary pieces of work linked to the the layout and structure of the It is also clear to see the significant whereas others, such as medical diabetes-related complications and improvements and, together with redesign of the Bereavement Suite report made it very inaccessible to amount of achievement that has care, require improvement. there has also been progress around our neighbouring Healthwatch, and with the Catering and Nutrition the public. This could be improved been detailed throughout the sepsis screening and monitoring of Sub-Group. This collaborative The Trust have unfortunately missed we look forward to continuing to by consistency in the statistics and Quality Account for 2017/18 and deteriorating patients. working has been a consistent language used. the staff at the Trust must be a number of targets this year work closely with the Trust over the theme over many years now and is commended for this. Healthwatch including those around rates of Given the pressures on Accident forthcoming year. Concerns do also remain around very much appreciated. Knowsley wishes to place on Clostridium Difficile infection, CPR and Emergency services, we were aspects of patient safety, in record their appreciation of the training for staff, transfers out of encouraged to see the work particular, the Patient Safety Trust’s work on behalf of our local critical care, and completion of the priorities detailed around hospital being done around reducing A&E community. Malnutrition Universal Screening attendances for a specific group acquired pressure ulcers and Tool (MUST). infection control. Further to this, of patients with mental health pressure on staff and the capacity to Targets around waiting times in conditions. We are keen to see if deliver safe care may be reflected in Accident and Emergency have this progress can be maintained and the percentage of staff who would also been missed, although we perhaps rolled out to other groups readily recommend their Trust to acknowledge this has been a of patients. their friends and family. particular challenge across the We know from feedback that country and Aintree has seen an the Trust has a great deal of increased demand for these services support and loyalty from the local in excess of the national average. community. However, looking to the forthcoming year, there is clearly much for the Trust to do.

114 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 115 Annex ii Annex iii Statement of directors’ responsibilities for the quality report Statement from Trust Governors

The directors are required • feedback from governors dated • the data underpinning the and processes within the Trust. under the Health Act 2009 and 15/05/2018 measures of performance This training is an important part the National Health Service reported in the Quality Report is of the Governor programme as it • feedback from local Healthwatch (Quality Accounts) Regulations robust and reliable, conforms to deepens our knowledge and gives organisations, Healthwatch to prepare Quality Accounts for specified data quality standards us the opportunity to challenge the Sefton dated 11/05/2018, each financial year. and prescribed definitions, is quality agenda. Healthwatch Knowsley dated subject to appropriate scrutiny NHS Improvement has issued 21/05/2018 and Healthwatch At the Governor-led Quality of Care and review and the Quality guidance to NHS foundation Liverpool dated 15/05/2018 Committee, executive directors Report has been prepared trust boards on the form and and senior managers are asked • the Trust’s complaints report in accordance with NHS content of annual quality reports to provide information to assist published under regulation 18 Improvement’s annual reporting (which incorporate the above Governors in understanding, of the Local Authority Social manual and supporting guidance legal requirements) and on the supporting and engaging with the Services and NHS Complaints (which incorporates the Quality arrangements that NHS foundation three key elements of the Trust’s Regulations 2009, published Accounts regulations) as well as trust boards should put in place to Quality Strategy (i.e. care that is April 2017 to March 2018 the standards to support data support the data quality for the safe, care that is clinically effective quality for the preparation of preparation of the quality report. • the 2016 national patient survey and provides a positive experience the Quality Report. published January 2017 for patients and their families). In preparing the Quality Report, The directors confirm to the best At formal Council of Governors’ directors are required to take steps • the 2017 national staff survey of their knowledge and belief they meetings, Governors have the to satisfy themselves that: published March 2018 have complied with the above opportunity to challenge the • the content of the Quality • the Head of Internal Audit’s requirements in preparing the Governors have a key role in for example, the Patient- Non-Executive Directors and seek Report meets the requirements annual opinion of the trust’s Quality Report. ensuring that the voice of our Led Assessments of the Care assurance on quality, performance set out in the NHS foundation control environment dated patients, members and local Environment and the ever evolving and system issues. We also take

trust annual reporting manual 27/04/2018 community is at the heart of work on discharge planning part in the Director Walk Rounds By order of the board 2017/18 and supporting the Trust’s decision-making. including the Multi-Disciplinary which provide an opportunity for • Care Quality Commission guidance Date: 23 May 2018 This provides an opportunity Accelerated Discharge Event. Governors to observe how the Trust inspection reports dated for Governors to get involved Governors are also involved in is working and how the Quality • the content of the Quality 07/03/2018 and 16/03/2018 where appropriate in the quality other collaborative initiatives – for Strategy and its Quality Priorities Report is not inconsistent with initiatives and improvement work • the Quality Report presents a example, the Catering Food Quality are being delivered. internal and external sources of undertaken by the Trust during balanced picture of the NHS Group. More recently, Governors information including: the course of the year. Governors keep themselves abreast have supported the Bowel Cancer foundation trust’s performance Chairman of local and national developments Screening programme with one • board minutes for the period over the period covered One of the responsibilities of by attending local and regional of our Public Governors acting as April 2017 to 31 March 2018 the Council of Governors is to externally facilitated workshops • the performance information a champion for the promotion approve the local quality indicator and seminars, where appropriate, • papers relating to quality reported in the Quality Report is of this important health issue. Date: 23 May 2018 for the purpose of external audit enabling them to be more informed reported to the board over the reliable and accurate We participated in the Quality (as detailed on page 118 of the when reviewing Aintree’s Quality period April 2017 to April 2018 Conversation event with staff • there are proper internal controls detailed requirements for the Account which they do at the and stakeholders and took the • feedback from commissioners, over the collection and reporting external assurance for quality beginning of each financial year. opportunity to review the content joint response from South of the measures of performance reports 2017/18). Governors Governors also comment on the of the Quality Account at two Sefton, Liverpool and Knowsley included in the Quality Report, Chief Executive discussed this at a session in accessibility of the Quality Account sessions in March and April 2018. CCGs dated 22/05/2018 and these controls are subject to February 2018 and subsequently for members and wider stakeholder There has also been an opportunity review to confirm that they are ratified their decision at the formal groups. working effectively in practice Council of Governors’ meeting for Governors to be part of the in March 2018. At the same time Aintree Champions Excellence Signed on behalf of Aintree’s we, as Governors, were also able (ACE) Panel which assessed those Council of Governors to look back at the performance wards achieving three consecutive on our quality objectives over the Green ratings and their application

year, which are also reviewed by to achieve ACE status. We have the Governor-led Quality of Care also been provided with bespoke Committee on a quarterly basis. training sessions from executive directors and senior managers on Pamela Peel-Reade In 2017/18, Governors continued Finance, Safeguarding, Serious Lead Governor to support and contribute to Incidents and Complaints which improving the quality of care have provided Governors with that the Trust provides through, further insight into the systems

116 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 117 Our Independence and • reviewing the Quality Report for the Quality Report in the context of Annex iv Quality Control consistency against the documents the assessment criteria set out in the We applied the Institute of specified above; FT ARM and “Detailed requirements for quality reports for foundation Chartered Accountants in England • obtaining an understanding trusts 2017/18”and the Criteria and Wales (ICAEW) Code of Ethics, of the design and operation of Independent Auditor’s Limited Assurance Report to the referred to above. which includes independence and the controls in place in relation Council of Governors of Aintree University Hospital NHS other requirements founded on to the collation and reporting The nature, form and content fundamental principles of integrity, of the specified indicators, required of Quality Reports are Foundation Trust on the Annual Quality Report objectivity, professional competence including controls over third determined by NHSI. This may result and due care, confidentiality and party information (if applicable) in the omission of information professional behaviour. We have been engaged by the Council of Governors Scope and subject matter and performing walkthroughs to relevant to other users, for example confirm our understanding; for the purpose of comparing the of Aintree University Hospital NHS Foundation Trust to The indicators for the year ended 31 March 2018 subject We apply International Standard results of different NHS Foundation perform an independent assurance engagement in respect to limited assurance (the “specified indicators”) marked on Quality Control (UK) 1 and • based on our understanding, Trusts. of Aintree University Hospital NHS FoundationTrust’s with the symbol in the Quality Report, consist of the accordingly maintain a assessing the risks that the Quality Report for the year ended 31 March 2018 (the following national priority indicators as mandated by comprehensive system of quality performance against the specified In addition, the scope of our ‘Quality Report’) and specified performance indicators Monitor: control including documented indicators may be materially assurance work has not included contained therein. policies and procedures regarding misstated and determining the governance over quality or non- compliance with ethical nature, timing and extent of mandated indicators in the Quality requirements, professional standards further procedures; Report, which have been determined Specified Indicators Specified indicators criteria and applicable legal and regulatory locally by Aintree University Hospital (Monitor’s Detailed Guidance) • making enquiries of relevant requirements. NHS Foundation Trust. management, personnel and, Percentage of patients with a total In line with the definition included within NHS Improvement’s Use and distribution of the report where relevant, third parties; time in A&E of four hours or less from “Detailed requirements for external assurance for quality reports Conclusion arrival to admission, transfer of discharge for foundation trusts 2017/18” Annex C (page 24) This report, including the conclusion, • considering significant judgements Based on the results of our has been prepared solely for the made by the NHS Foundation Trust procedures, nothing has come to Percentage of incomplete pathways Council of Governors of Aintree In line with the definition included within NHS Improvement’s in preparation of the specified our attention that causes us to within 18 weeks for patients on incomplete University Hospital NHS Foundation “Detailed requirements for external assurance for quality reports indicators; believe that for the year ended 31 pathways at the end of the reporting Trust as a body, to assist the Council for foundation trusts 2017/18” Annex C (page 23) March 2018: period of Governors in reporting Aintree • performing limited testing, University Hospital NHS Foundation on a selective basis of evidence • The Quality Report does not Trust’s quality agenda, performance supporting the reported incorporate the matters required and activities. We permit the performance indicators, to be reported on as specified in and assessing the related the FT ARM and the “Detailed Respective responsibilities of the • The specified indicators have not 15/05/2018; disclosure of this report within the disclosures; and requirements for quality reports Directors and auditors been prepared in all material Annual Report for the year ended 31 • Feedback from Local Healthwatch for foundation trusts 2017/18”; respects in accordance with the March 2018, to enable the Council • reading the documents. The Directors are responsible for organisations, Healthwatch Sefton Criteria set out in the FT ARM of Governors to demonstrate they • The Quality Report is not the content and the preparation of dated 11/05/2018, Healthwatch A limited assurance engagement and the “Detailed requirements have discharged their governance consistent in all material respects the Quality Report in accordance Knowsley dated 21/05/2018 and is less in scope than a reasonable for external assurance for quality responsibilities by commissioning with the documents specified with the specified indicators criteria Healthwatch Liverpool dated assurance engagement. The nature, reports for foundation trusts an independent assurance report in above; and referred to on pages of the Quality 15/05/2018; 2017/18”. connection with the indicators. To the timing and extent of procedures Report as listed above (the “Criteria”). for gathering sufficient appropriate • The specified indicators have not • The Trust’s complaints report fullest extent permitted by law, we The Directors are also responsible We read the Quality Report and evidence are deliberately limited been prepared in all material published under regulation 18 of do not accept or assume responsibility for the conformity of their Criteria consider whether it addresses the relative to a reasonable assurance respects in accordance with the the Local Authority Social Services to anyone other than the Council with the assessment criteria set out content requirements of the FT ARM engagement. Criteria set out in the FT ARM and NHS Complaints Regulations of Governors as a body and Aintree in the NHS Foundation Trust Annual and the “Detailed requirements and the “Detailed requirements 2009, published April 2017 – March University Hospital NHS Foundation Reporting Manual (“FT ARM”) and for quality reports for foundation Limitations for external assurance for quality 2018; Trust for our work or this report save the “Detailed requirements for quality trusts 2017/18”; and consider the where terms are expressly agreed and Non-financial performance reports for foundation trusts reports for foundation trusts 2017/18” implications for our report if we • The 2016 national patient survey with our prior consent in writing. information is subject to more 2017/18”. issued by Monitor (operating as NHS become aware of any material published January 2017; inherent limitations than financial

Improvement) (“NHSI”). omissions. Assurance work performed information, given the characteristics • The 2017 national staff survey of the subject matter and the Our responsibility is to form a We read the other information published March 2018; We conducted this limited assurance conclusion, based on limited assurance contained in the Quality Report and engagement in accordance with methods used for determining such PricewaterhouseCoopers LLP • The Head of Internal Audit’s procedures, on whether anything has consider whether it is materially International Standard on Assurance information. Manchester annual opinion over the Trust’s 25 May 2018 come to our attention that causes us inconsistent with the following Engagements 3000 (Revised) The absence of a significant body control environment dated to believe that: documents: ‘Assurance Engagements other of established practice on which The maintenance and integrity of 27/04/2018; and than Audits or Reviews of Historical • The Quality Report does not • Board minutes for the period, April to draw allows for the selection Aintree University Hospital NHS • Care Quality Commission Financial Information’ issued by the incorporate the matters required 2017 to April 2018; of different but acceptable Foundation Trust‘s website is the inspection, dated 19/02/2018. International Auditing and Assurance to be reported on as specified in measurement techniques which responsibility of the directors; the • Papers relating to quality report Standards Board (‘ISAE 3000 can result in materially different work carried out by the assurance the FT ARM and the “Detailed We consider the implications for our reported to the Board over the (Revised)’). Our limited assurance measurements and can impact providers does not involve requirements for quality reports report if we become aware of any period April 2017 to April 2018; procedures included: comparability. The precision of consideration of these matters and, for foundation trusts 2017/18”; apparent misstatements or material different measurement techniques accordingly, the assurance providers • Feedback from the Commissioners, inconsistencies with those documents • reviewing the content of the • The Quality Report is not may also vary. Furthermore, the accept no responsibility for any joint response from South Sefton, (collectively, the “documents”). Our Quality Report against the consistent in all material respects nature and methods used to changes that may have occurred to Liverpool and Knowsley CCGs responsibilities do not extend to any requirements of the FT ARM and with the sources specified below; determine such information, as well the reported performance indicators dated 22/05/2018; other information. the “Detailed requirements for and quality reports for foundation as the measurement criteria and the or criteria since they were initially • Feedback from Governors dated trusts 2017/18”; precision thereof, may change over presented on the website. time. It is important to read

118 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 119 Annex v

The National Clinical Audits and National Confidential Enquiries The National Clinical Audits and National Confidential Enquiries that Aintree University Hospital NHS Foundation Trust was eligible that Aintree University Hospital NHS Foundation Trust participated to participate in during 2017/18 are: in during 2017/18 are:

• BAUS Urology Audits – • Medical and Surgical Clinical • National Comparative Audit of • BAUS Urology Audits – • Medical and Surgical Clinical • National Diabetes Audit – Foot Nephrectomy audit Outcome Review Programme Blood Transfusion programme – Percutaneous Nephrolithotomy Outcome Review Programme Care Audit (NCEPOD) – Cancer in Children, National Comparative Audit (PCNL) (NCEPOD) – Cancer in Children, • BAUS Urology Audits – • National Diabetes Audit – Teens and Young Adults of Transfusion Associated Teens and Young Adults Percutaneous Nephrolithotomy • BAUS Urology Audits – Inpatient Audit (NaDia) - Circulatory Overload (TACO) (PCNL) • Medical and Surgical Clinical Urethroplasty Audit • Medical and Surgical Clinical • National Diabetes Audit –Core Outcome Review Programme • National Diabetes Audit – Outcome Review Programme • BAUS Urology Audits – • Cardiac Rhythm Management Diabetes Audit (NCEPOD) – Perioperative Foot Care Audit (NCEPOD) – Perioperative Urethroplasty Audit (CRM) diabetes diabetes • National Emergency Laparotomy • National Diabetes Audit – • Cardiac Rhythm Management • Intensive Care National Audit Audit (NELA) • Medical and Surgical Clinical Inpatient Audit (NaDia) • Medical and Surgical Clinical (CRM) and Research Centre Case Mix Outcome Review Programme Outcome Review Programme • National Heart Failure Audit • National Diabetes Audit – Core Programme (CMP) • Case Mix Programme (CMP) (NCEPOD) – Pulmonary embolism (NCEPOD) – Pulmonary embolism Diabetes Audit • National Joint Registry (NJR) • Elective Surgery (National PROMs • Elective Surgery (National PROMs • Myocardial Ischaemia National • Myocardial Ischaemia National • National Emergency Laparotomy Programme) • National Lung Cancer Audit Programme) Audit Project (MINAP) Audit Project (MINAP) Audit (NELA) (NLCA) • Endocrine and Thyroid National • Endocrine and Thyroid National • National Audit of Breast Cancer • National Audit of Breast Cancer • National Heart Failure Audit Audit • National Oesophago-gastric Audit in Older People (NABCOP) in Older People (NABCOP) Cancer (NOGCA) • National Joint Registry (NJR) • Falls and Fragility Fractures Audit • Falls and Fragility Fractures Audit • National Audit of Dementia (in • National Bowel Cancer (NBOCA) programme (FFFAP) – Inpatient • National Ophthalmology Audit – programme (FFFAP) – Inpatient General Hospitals) • National Lung Cancer Audit Contract until March 2018. Falls Adult Cataract surgery Falls (NLCA) • National Bowel Cancer (NBOCA) • National Cardiac Arrest Audit • Falls and Fragility Fractures Audit • National Prostate Cancer Audit • Falls and Fragility Fractures Audit • National Oesophago-gastric (NCAA) • National Cardiac Arrest Audit programme (FFFAP) – National programme (FFFAP) – National Cancer (NOGCA) • Procedural Sedation in Adults (NCAA) Hip Fracture Database • National Chronic Obstructive Hip Fracture Database (care in emergency departments) • National Ophthalmology Audit – Pulmonary Disease (COPD) • National Chronic Obstructive • Fractured Neck of Femur (care in • Fractured Neck of Femur Adult Cataract surgery Audit programme – Pulmonary • Sentinel Stroke National Audit Pulmonary Disease (COPD) emergency departments) (care in emergency departments) rehabilitation programme (SSNAP) Audit programme – Pulmonary • National Prostate Cancer Audit • Head and Neck Cancer Audit • Head and Neck Cancer Audit rehabilitation • National Chronic Obstructive • Serious Hazards of Transfusion • Procedural Sedation in Adults • Inflammatory Bowel Disease Pulmonary Disease (COPD) Audit (SHOT): UK National • Inflammatory Bowel Disease • National Chronic Obstructive (care in emergency departments) (IBD) Registry, Biological programme – Secondary Care haemovigilance scheme (IBD) Registry, Biological Pulmonary Disease (COPD) Audit • Sentinel Stroke National Audit Therapies Audit. Therapies Audit. programme – Secondary Care • National Comparative Audit of • UK Parkinson’s Audit programme (SSNAP) • Learning Disability Mortality Blood Transfusion programme – • Learning Disability Mortality • National Clinical Audit of • Serious Hazards of Transfusion Review Programme (LeDeR) Re-audit of the 2016 audit of red Review Programme (LeDeR) Specialist Rehabilitation for (SHOT): UK National cell and platelet transfusion in Patients with Complex Needs • Major Trauma Audit • Major Trauma Audit haemovigilance scheme adult haematology patients following Major Injury (NCASRI) • Medical and Surgical Clinical • Medical and Surgical Clinical • UK Parkinson’s Audit • National Comparative Audit of • National Comparative Audit of Outcome Review Programme Outcome Review Programme Blood Transfusion programme – Blood Transfusion programme – (NCEPOD) – Acute Heart Failure (NCEPOD) – Acute Heart Failure National Comparative Audit Re-audit of the 2016 audit of red of Transfusion Associated cell and platelet transfusion in Circulatory Overload (TACO) adult haematology patients

120 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 121 Annex vi

Glossary of Terms

aBI Aintree Business Intelligence HAWD Hand Washing PbR Payment by Results SIGMA Hospital Patient Administration System ACE Part of the Aintree Assessment & HCAI Healthcare Acquired Infection RAG Red Amber Green (traffic light scoring system) SOP Standard Operating Procedure Accreditation process HLO High Level Objective R & D Research and Development SUI Serious Untoward Incident ACS Average Care Score HR Human Resources RCA Root Cause Analysis TARN Trauma Audit and Research Network AED Accident & Emergency Department HSCA Health and Social Care Act RN Registered Nurse Unify2 National Reporting Hub AKI Acute Kidney Injury HSMR Hospital Standardised Mortality Rate RTT Referral to Treatment Time UTI Urinary Tract Infection AMBER Assessment, Management, Best Practice, ICD-10 International Classification of Diseases SSNAP Sentinel Stroke National Audit Programme VTE Venous-Thromboembolism Engagement, Recovery Uncertain IPC Infection Prevention & Control SALT Speech and Language Therapy WCNN Walton Centre for Neurology and AMU Acute Medical Unit Neurosurgery IV Intravenous SHMI Summary Hospital Level Mortality Indicator AQ Advancing Quality WHO World Health Organisation Intentional Comfort rounds on wards SBAR Situation, Background, Assessment, AQuA Advancing Quality Alliance Rounding Recommendation YTD Year to date AQuIP Aintree Quality Improvement Plan JAC Electronic Prescribing System AQuIS Aintree Quality Improvement Schedule KPI Key Performance Indicator ARLD Alcohol Related Liver Disease LCH Liverpool Community Health AUH Aintree University Hospital NHS LDP Liverpool Diabetes Partnership BGM Blood Glucose Monitoring LOCSSIPS Local Safety Standards for Invasive CCG Clinical Commissioning Group Procedures C.Difficile Clostridium Difficile MAU Medical Assessment Unit CDI Clostridium Difficile Infection MDT Multi-Disciplinary Team CNS Clinical Nurse Specialist MET Medical Emergency Team COPD Chronic Obstructive Pulmonary Disease MEWS Modified Early Warning System CAP Community Acquired Pneumonia MRSA Methicillin-Resistant Staphylococcus Aureus CPS Composite Process Score MFU Maxillo Facial Unit CQC Care Quality Commission MSSA Methicillin Sensitive Staph Aureus CQUIN Commissioning for Quality and Innovation MUST Malnutrition Universal Screen Tool (payment framework) NATSSIPS National Safety Standards for Invasive CRIS Clinical Radiology Information System Procedures CRBSI Catheter Related Bloodstream Infection NCEPOD National Confidential Enquiry into Patient Outcome and Death CSP Co-ordinated Systems for gaining NHS Permission NEWS National Early Warning Score CRN Clinical Research Network NICE National Institute for Clinical Research CTC Computer Tomography Colonography NIHR National Institute for Health Research CXR Chest X Ray NIHSS National Institute of Health Stroke Score DNACPR Do Not Attempt Cardiopulmonary NPS National Patient Survey Resuscitation NWC CRN North West Coast Clinical Research Network DT Diabetes Team ORMIS Operating Room Management Information DVT Deep Vein Thrombosis System E4E Energise for Excellence OT Occupational Therapy ED Emergency Department PAS Patient Administration System EDS Equality Delivery System PDSA Plan, Do, Study, Act ENP Emergency Nurse Practitioner PE Pulmonary Embolism FFT Friends and Family Test PID Performance Information Delivery FNOF Fractured Neck of femur PLACE Patient Led Assessments of the Care Environment GP General Practitioner PROMS Patient Reported Outcomes HAT Hospital Acquired Thrombosis

122 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 123 4

Governance & Organisational Arrangements Governance & Organisational Arrangements Elected Governors

Public Governors Term of Office Expiry Date Attendance at Council of Governors’ Meetings Corporate governance relates to the processes, customs, policies, laws, and institutions which have an impact on the way an Tracey Barnes 3 years 31 July 2018 3/4 organisation is controlled. An important theme of corporate Sharon Bird 3 years 31 July 2018 3/4 governance is the nature and extent of accountability of people Mike Bowker 3 years 31 July 2020 0/4 in the business, and mechanisms that try to decrease the risks. Tony Byrne 3 years 31 July 2018 3/4 This section details the organisational arrangements in place to Elaine Carter 3 years 31 July 2020 3/3 deliver good corporate governance. Jennifer Ensor 3 years 31 July 2020 3/3

Jim Ford 3 years 31 July 2020 2/3

Code of Governance Ray Humphreys 3 years 31 July 2020 3/3

Tony Kneebone 3 years 31 July 2018 3/4 Aintree University Hospital NHS Foundation Trust The NHS Foundation Trust Code of Governance, most has applied the principles of the NHS Foundation Trust recently revised in July 2014, is based on the principles of Colin Maher 3 years 31 July 2020 1/3 Code of Governance on a comply or explain basis. the UK Corporate Governance Code issued in 2012. The Board confirms that the Trust complies with all Rose Milnes 3 years 31 July 2020 1/4 provisions of the Code of Governance. Council of Governors Julie Naybour 3 years 31 July 2018 1/4 Pamela Peel-Reade 3 years 31 July 2020 3/4

The Trust’s relationship with its During 2017/18, the Non-Executive partner organisations. This information Rosemary Urion 3 years 31 July 2018 3/4 Governors, and through them Directors continued with the practice impacts positively and materially on with its members, is constructive adopted since October 2015 of the preparation of the Trust’s Annual Elected Governors and useful. It provides valuable giving presentations to the Council Business Plan. Each year, the Governors public accountability for the work of Governors on the key issues and and members are presented with the Staff Governors Term of Office Expiry Date Attendance at Council of the Trust. assurance they have received on Annual Report and Accounts and the of Governors’ Meetings the Trust’s financial and operational Annual Plan at the annual members’ The Council of Governors and the performance, quality and safety and meeting. Governors are also involved Board of Directors have a clear Helen Frankland (Nursing) 3 years 31 July 2018 2/4 audit committee activity. Updates in reviewing the Quality Account understanding of the roles and are also provided at formal Council providing feedback on its content responsibilities of each party in Lorraine Heaton (AHP / Scientists) 1 year* 31 July 2018 3/4 meetings on the Trust’s strategic and contributing to the statement accordance with the Constitution. The direction and activity by the Chairman from the Lead Governor on governor Board of Directors’ role is to manage Kerry McManus (All Other Staff) 3 years 9 March 2021 4/4 and Chief Executive. This provides activity and involvement during the the business of the Trust and the Governors with the opportunity to year in support of the Trust’s quality Andrew Swift (Medical) 3 years 9 March 2021 1/4 Council of Governors is responsible for hold the NEDs to account for the improvements. representing the interests of public performance of the Board, and to and staff members, and local partner In addition to the Governor-Led Appointed Governors seek further advice and clarification, organisations in the governance of Membership Committee, a Governor- if required. This approach also assists the Trust. Amongst other statutory Led Quality of Care Committee acts Barbara Hunter-Douglas Governors in their appraisal of the 3 years 31 July 2018 1/4 duties, the Council of Governors as a central point for work involving (Edge Hill University) NEDs. Details of key issues discussed holds the non-executive directors to the care and safety of patients. It at each formal Council of Governors’ account for the performance of the also enables Governors to become Cllr Paul Cummins meeting are submitted to the Board 3 years 31 July 2018 2/4 Board of Directors and appoints the better informed on issues of concern (Sefton MBC) of Directors. Furthermore, the Chairman and Non-Executive Directors to members and the public. Chairman holds a feedback session (NEDs), and the Trust’s external Professor John Wilding with Governors on key matters arising The Council of Governors consists 3 years 31 July 2018 3/4 auditors. The Council of Governors (University of Liverpool) from the Board’s discussions at its of the Chairman of the Trust and 21 also approves the appointment of the formal meetings. The Governors, in elected and appointed Governors. Chief Executive, the remuneration Table 12: Composition of the Council of Governors turn, recognise their responsibility for All elected governors have a three * term extended for 12 months following resignation of elected candidate from this constituency and terms of office of the Chairman regularly feeding back information year term of office. Elections for and Non-Executive Directors, receives about the Trust, its vision and appointment as an elected governor the Trust’s annual report and accounts performance to their constituencies were undertaken during January and gives views and advice on the and partner organisations. to March 2018 with the successful Pamela Peel-Reade was re-appointed as Lead Governor with Aintree University Hospital NHS Foundation Trust, forward plans of the Trust. The Trust’s candidates taking up office with effect from 1 August 2017. Aintree Lodge, Lower Lane, Liverpool L9 7AL. Constitution details the process to The Governors have input into effect from 1 August 2018. The be adopted should there be any the Annual Business Plan through Members of the public can gain access to the Register of Telephone: 0151 529 4766 elections were administered by disagreement between the Council of discussions with the Trust on the Governors Interests by writing, telephoning or emailing the the Electoral Reform Society in E-mail: [email protected]. Governors and the Board of Directors priorities for development and Trust Headquarters: accordance with the model election and how this would be resolved. improvement of the organisation, rules in the Trust’s Constitution. as seen by their constituencies and

126 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 127 Nominations Committee Board of Directors

The Council of Governors Nominations Committee Members’ attendance was as follows: The Board of Directors comprises Executive Directors is evaluated by the and evaluation of their effectiveness. met on one occasion in 2017/18 and made six Non-Executive Directors, Chief Executive, and that of the Chief In December 2016 through to March recommendations to the Council of Governors in including the Chairman and up to Executive and Non-Executive Directors 2017, Deloitte LLP undertook a Well- Member Attendance relation to the re-appointment of a Non-Executive five Executive Directors, including by the Chairman, on an annual basis. Led Governance Review (WLGR) of Director (NED) and the extension of contract for the Chief Executive. The Board of the Trust and their final report was Neil Goodwin (Chair) 1/1 The Trust has a formal, rigorous another NED. Directors has overall responsibility submitted to the Board in April 2017. and transparent procedure for for strategic development, A number of areas of good practice The Trust’s approach to non-executive director appointments Paul Cummins 1/1 the appointment of directors, approving policy and monitoring were identified as well as areas with is to engage with key stakeholders via focus groups, both executive and non-executive. performance. This includes scope for further enhancement and followed by an interview with the Nominations Committee. Tony Kneebone 1/1 Appointments are made on ensuring the delivery of effective development. This subsequently led A formal recommendation is then taken to the Council merit, based on objective criteria. financial stewardship, high to an action plan being developed of Governors for approval. There were no external Pamela Peel-Reade 1/1 Assurances are sought from non- standards of clinical and corporate which identified how each of the appointments in 2017/18. executive director candidates that governance and promoting recommendations would be taken Rose Milnes 1/1 they have sufficient time to fulfil effective relations with the local forward and the Board received their duties. Appointments among community served by the Trust. quarterly updates on progress. non-executive directors are reviewed Table 13: Nominations Committee Member Attendance The Board has a formal schedule of annually and their terms of office are The WLGR and assessment of delivery matters reserved for Board decisions. staggered over three years to ensure of the Board Objectives provided the Some decisions are delegated to its an orderly succession to the Board. Board with the opportunity to discuss Board committees and these are Non-Executive Director appointments its performance and agree what clearly set out in those committees’ may be terminated on performance could be moved forward as business- Membership & Membership Committee terms of reference, which are grounds or for contravention of the as-usual and what required greater reviewed regularly by the Board. The qualification criteria set out in the focus in 2018/19 to further enhance Board has the following committees Constitution, with the approval of its on-going Board Development in place: three-quarters of the members of the Programme. The Trust aims to build a successful Membership and Chief Executive to promote the benefits of membership Council of Governors, or by mutual Scheme as an integral part of its vision to be a to new members of staff, as well as highlighting the role of • Audit During 2017/18, the Board continued consent for other reasons. The leading provider of the highest quality health the Staff Governor. • Quality with its Engagement Programme Trust uses either an external search care. The Council of Governors has a Membership • Finance & Performance which includes: In 2017/18, the number of FT public members increased consultancy or open advertising in Committee to lead the process of developing and • Remuneration and Nominations from 8,543 to 8,711. Membership figures are set out in the relation to board appointments. • Director Walk Rounds – Executive implementing the Membership Scheme and ensure • Charitable Funds. table below: Directors, Non-Executive Directors a representative membership. The Membership The Trust’s Executive Team provides All Directors have full and timely and Governors visit each of the Committee has adopted a strategy of membership organisational leadership and access to relevant information to wards and departments within the engagement as well as targeted recruitment, takes appropriate action to ensure FT members as of 31 March 2018, by constituency enable them to discharge their hospital to learn more about the predominantly aimed at low represented groups. that the Trust delivers its strategic responsibilities. The Board of daily challenges they face as well Public 8,711 and operational objectives. It The membership engagement strategy was approved Directors meets monthly and at as the improvements made and maintains arrangements for effective in 2015/16, with a view to encouraging more Governors each formal meeting reviews the achievements to date Allied Health Professionals/Scientists 695 governance throughout the to participate in membership engagement. To support Trust’s key performance information, organisation, monitors performance • Ask the Board – provides staff this, a toolkit was developed for Governors to use which including reports on quality and All Other Staff 2,523 in the delivery of planned results with the opportunity to ask includes template presentations and key information about safety, patient experience and care, and ensures that corrective action is questions on any subject matter the Trust. During 2017/18, the Membership Committee, operational activity, financial analyses Medical Staff 407 taken when necessary. The Hospital with answers provided each supported by the Trust, continued to develop relationships and strategic matters. Management Board (HMB) includes month via the intranet and with the Get Involved with Aintree Group of members Nursing Staff 1,291 The Board of Directors monitors senior managers and clinicians internal communications who have expressed an interest in being more involved compliance with the Trust’s objectives in its membership and supports in activities within the hospital. A calendar of Trust • Conversations with the Board – Staff total 4,916 and is responsible for approving the Chief Executive in providing events/activities is made available to the group who are provides an opportunity for the major capital investment and any assurance to the Board of Directors encouraged to get involved with support being provided by Board to hear the views of staff Total membership (public and staff) 13,627 borrowing. It meets with the Trust’s on the direction and operational Governors and the Trust to ensure that there is appropriate from each of the Divisions on key Council of Governors, senior clinicians management of the Trust. The HMB interaction. A number of Governors have taken the issues arising from the Staff Survey and divisional managers, and uses takes on the leadership of the Trust opportunity to use a membership stand in locations within Table 14: Membership Numbers (31 March 2018) and patient safety. external advisors to facilitate strategic in developing the overall strategy the hospital to engage with and obtain the views from discussion. and ensuring delivery of strategic Feedback mechanisms are in place members and the general public about the governor role objectives and mitigation of risk and, in conjunction with observations and the services provided by the hospital as well as recruit The Trust’s Constitution includes the eligibility requirements The Board of Directors considers through a focus on clinical quality, from the Well Led Governance new members through this interaction. for staff and identifies the boundaries for public that its composition is appropriate performance and delivery. Review, these will be taken forward membership. with a balanced spread of expertise Membership presentations continue at the Trust’s into further development of the to fulfil its function and terms of volunteers’ induction. As the Trust has no paediatric The Membership Strategy is available on request. Programme in 2018/19. authorisation, with the Chairman services and patients are generally older, this provides an Members of the public wishing to contact Governors can Board Leadership and Non-Executive Directors meeting Directors may seek individual opportunity to attract younger FT members. In line with the do so by writing, telephoning or emailing the Corporate the independence criteria laid down and Development professional advice or training at the aim of engaging more members through digital and social Governance Team: in the NHS Foundation Trust Code Trust’s expense in the furtherance media, an electronic version of the member newsletter The performance of the Board Aintree University Hospital NHS Foundation Trust, of Governance. The Trust continued of their duties. The Board has direct was circulated on a quarterly basis to the 1,000+ FT public Committees was kept under review Lower Lane, Liverpool, L9 7AL to ensure that all Board Directors access to the Director of Corporate members who have provided the Trust with an email through regular reports submitted to met the criteria of the Fit & Proper Governance/Board Secretary who address. Furthermore, a Staff Governor regularly attends Telephone: 0151 529 4766 the Board of Directors and through Persons Test. The performance of the advises on compliance with relevant the Trust’s monthly Corporate Induction with the Chairman e-mail: [email protected] a review of their terms of reference

128 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 129 regulations and ensures that Board and chief executive. The chairman with patients, members, clients, and Committee procedures are is responsible for the leadership staff and other stakeholders. It is Committee membership is indicated by the following symbols: followed. The proceedings at all of the Board of Directors and the chairman’s role to facilitate Audit Committee Quality Committee Board and Committee meetings Council of Governors, ensuring the effective contribution of all are fully recorded, enabling any their effectiveness individually, directors, ensuring that constructive Remuneration & Nominations Committee Charitable Funds Committee concerns of Directors to be minuted. collectively and mutually. The relationships exist between them Finance & Performance Committee The appointment or removal of the chairman is also responsible for and the Council of Governors. The Director of Corporate Governance/ ensuring that members of the chief executive is responsible for Board Secretary is a matter for the Board of Directors and Council of the performance of the executive Dr Neil Goodwin, CBE Dianne Brown Dr Tristan Cope Board as a whole. Governors receive accurate, timely directors, the day to day running Chairman Chief Nurse Medical Director and clear information appropriate of the Trust and implementing There is a clear division of for their respective duties and approved strategy and policy. responsibilities between the chairman for effective communication Neil is an experienced board chair, Dianne trained in the 1980s with Tristan was appointed Medical leadership academic and a former Wrightington, Wigan and Leigh NHS Director in April 2017. He graduated Board of Directors’ Pen Portraits chief executive in the NHS. He was Trust and then chose to specialise in from Aberdeen University in 1992 and appointed Chairman from October women’s health, working at Billinge subsequently trained in Anaesthesia 2014 having previously been a non- Hospital for seventeen years in all and Intensive Care Medicine in North Dr Neil Goodwin, Steve Warburton executive director of the Trust. Neil areas of women’s health including Wales and Merseyside. Board of Directors CBE also chairs the Board of Onward reproductive medicine, general He was appointed as a Consultant Homes Ltd (previously Symphony gynaecology and early pregnancy. in Anaesthesia and Critical Care Housing Group) and the Eastern An experienced Board Director, at Aintree in 2001, and has held & Central Cheshire Partnership Dianne joined Aintree in April positions as Clinical Director of Critical Board and has been interim chair 2017, following her previous role of Care, Clinical Director of Anaesthesia, of Liverpool Health Partners since Director of Nursing and Midwifery at Director of the Cheshire and Mersey November 2017. Liverpool Women’s NHS Foundation Simulation Centre, Clinical Head of Neil has been an NHS university Trust which she held for three years. Division of Surgery and most recently hospital and strategic health authority She has had a variety of leadership Deputy Medical Director. Tristan Dianne Brown Joanne Clague Dr Tristan Cope chief executive. As a leadership and managerial roles prior to her received a Master’s degree in Medical academic Neil was visiting professor successful appointment as Director of Leadership from Birkbeck, University of leadership studies at Manchester Nursing and Quality here at the Trust. of London. He has particular interests Business School for over ten years, in Human Factors and leadership Dianne is passionate about providing when he also consulted on strategy development. In addition to his duties safe, effective and compassionate and leadership development, and as Medical Director, Tristan continues care for all patients and their families undertook confidential inquiries into to work part time as a consultant in at Aintree University Hospital NHS board governance. He is the author Critical Care Medicine. Foundation Trust. of Leadership in Healthcare, the first book of its kind set in a European context. Neil holds postgraduate David Fillingham, CBE David Fillingham Tim Johnston Ian Jones Joanne Clague degrees from London and Manchester Non-Executive Director / Deputy Non-Executive Director Business Schools and in 2007 he was Chairman appointed CBE for services to the NHS. Joanne is Director of Operations in David was appointed as the first the Faculty of Biology, Medicine and Steve Warburton Chief Executive of AQuA (Advancing Health at the University of Manchester, Chief Executive Quality Alliance) in April 2010. AQuA having previously been the Chief is a membership funded improvement Operating Officer at the Academic organisation based in the North West Health Science Network. Prior to that Steve was appointed Chief Executive of England. Its mission is to support its she was Director of Operations for Kevan Ryan Angie Smithson Mandy Wearne in December 2015, having previously members to improve health and the the Faculty of Health and Life Sciences been Acting Chief Executive from 1 quality of healthcare. at the University of Liverpool. As a April 2015. Prior to that, Steve was member of the University of Liverpool’s David joined the NHS in 1989 from a Director of Finance & Business Services/ Senior Executive Group, Joanne career in manufacturing. He went on Deputy Chief Executive. Before joining provided leadership for the delivery to take a number of Chief Executive Aintree University Hospital in July of world-leading research excellence, posts including Wirral FHSA, St Helens 2006, he was the Director of Finance & a dynamic knowledge exchange and Knowsley Health Authority, North Performance/Deputy Chief Executive economy contribution, and a first-rate Staffordshire Hospitals NHS Trust, at South Sefton Primary Care Trust and staff and student experience. Having and Royal Bolton Hospital NHS FT. before that, Deputy Director of Finance undertaken her professional training From 2001 to 2004 David was Director at the Royal Liverpool Children’s NHS Sue Green Beth Weston with Deloitte, Joanne is a qualified of the NHS Modernisation Agency Trust. Steve joined the NHS in 1989 as a chartered accountant with 14 years developing new ways of working and Graduate Finance Trainee and qualified of post-qualification experience and promoting leadership development as an accountant in 1993. significant experience of leading across the NHS as a whole. He was transformational change. Joanne awarded the CBE for this work. David joined the Aintree Board in April 2015 is also a Visiting Senior Fellow at The and has previous experience as a Non- King’s Fund. He was appointed to the Executive Director and Chair of Finance Board in October 2013. Committee in both the charitable and independent school sectors.

130 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 131 Tim Johnston Angie Smithson Sue Green Non-Executive Director Deputy Chief Executive / Director of People & Date of Appointment Date of appointment Length of Appointment 4 Integration Director Corporate Affairs for 2nd term (if applicable)

Tim was appointed to the Board in Non-Executive Director January 2013 and became the Deputy Angie joined Aintree as Chief Sue was appointed as Director of Chairman in November 2013, a position Operating Officer in April 2014 People and Corporate Affairs on 1 Neil Goodwin April 2014 April 2017 3 years he relinquished in December 2014. and was appointed Deputy Chief August 2014. She started her career He is a graduate economist and a Executive in December 2015. Angie in 1986 when she joined Wirral Joanne Clague April 2015 April 2018 3 years Chartered Accountant. He is a major subsequently became Integration Council’s Personnel Department, shareholder and senior partner in Director in October 2017. She achieving Postgraduate CIPD in 1992. David Fillingham October 2013 October 2016 3 years AMION Consulting – an economics and was previously Chief Operating Sue moved into Higher Education in business planning consultancy. Tim Officer/Deputy Chief Executive at 2000 and held the position of Deputy Tim Johnston January 2013 January 2016 3 years was previously the National Partner Northern Lincolnshire & Goole NHS Director of Personnel at the University in KPMG with responsibility for its Foundation Trust, where she had of Liverpool before joining the NHS in Kevan Ryan November 2015 N/A 3 years Infrastructure and Government line of also held the posts of Director of 2003 as a Deputy Director of HR and business. He was also a leading partner Operations and Director of Service Project Director for the Foundation Mandy Wearne January 2017 April 2018 2 years in KPMG’s national regeneration and Business Development from 2008. Trust application and subsequently team. He is a non-executive Director Angie qualified from Cambridge & the Director of HR & Organisational of Network Space Holdings Ltd and Huntingdon School of Nursing in 1989 Development at Wirral University Network Space Developments Ltd and and held a variety of nursing posts in Teaching Hospital NHS Foundation Chairman and Director of Langtree London hospitals before moving into Trust for six years. Sue left the Trust in Title Date of Appointment Property Partners Ltd, a national general management roles, including March 2018. commercial property developer. He is a brief spell in the private sector. Executive Director also a Director of The Big Trust. During this period Angie received an MBA from Kingston University. Beth Weston Steve Warburton Chief Executive December 2015 Acting Chief Operating Officer Ian Jones (with effect from October 2017) 5 Dianne Brown Chief Nurse April 2017 Director of Finance & Mandy Wearne Business Services Non-Executive Director Tristan Cope Medical Director April 2017 Beth joined the Trust in April 2015 Sue Green Director of People & Corporate Affairs August 2014 1 and was appointed Acting Chief Ian was appointed Director of Finance Mandy set up her own independent Operating Officer in October 2017. Ian Jones Director of Finance & Business Services December 2015 & Business Services in December 2015, company, six years ago, to continue She previously worked at Central having previously been acting up in to inspire excellence in the quality of Manchester University Hospitals Angie Smithson Deputy Chief Executive/Integration Director April 2014 2 that role since April 2015. Ian was care experience. She has an extensive (CMFT) for 12 years as Director for a previously the Deputy Director of background in NHS leadership, number of hospitals, more latterly Beth Weston Acting Chief Operating Officer October 2017 3 Finance at Aintree. He is a qualified management, clinical practice and as Director of Trafford Hospital Chartered Accountant, having trained public health, working in a variety following its acquisition by CMFT with a major national firm, before of health care settings. She has in 2011. Beth joined the NHS in Table 15: Board Members’ Terms of Office moving into the NHS in 1993. held a number of executive director 1995 and graduated from the NHS roles, including health care strategy, Graduate Management Training performance, and provider and Scheme in 1997. During this period 1 Sue Green left the Trust with effect from 28 March 2018 Kevan Ryan market development, as well as being Beth also graduated from Manchester 2 Angie Smithson relinquished the Chief Operating Officer post in October 2017 but retained her Board position as Deputy Non-Executive Director policy advisor to the Department of University with a Masters in Managing Chief Executive to enable her to focus on the role of Integration Director Health (DH) on the development of Healthcare Organisations. 3 Beth Weston took on the role of Acting Chief Operating Officer for a period of twelve months. social value led provider models. As Kevan was appointed to the Board in the first regional director of service November 2015. He is an experienced experience in England in 2008, Non-Executive Directors are required to give the Trust three months’ notice of their intention to leave. solicitor and in his current role as the she led the DH Patient Experience The Trust’s Constitution also refers to the Council of Governors’ ability to remove the Chairman and other Director of Legal, Risk & Compliance Policy Programme working on the Non-Executive Directors should the need arise. at the University of Liverpool, he is development of national indicators Executive Board members are employed on a permanent basis and are required to work a notice period of responsible for providing strategic and a review of the national six months. legal advice to the University, as well survey architecture. Acclaimed as a as providing direction and oversight passionate and practical force for to the various risk and compliance change, she was nominated for the functions. He previously worked as NHS Inspiration Leadership Award a commercial solicitor with leading in 2010. Mandy is committed to national law firms, Eversheds and supporting NHS leadership and service Addleshaw Goddard and in-house experience improvement through with Royal Liver Assurance and Royal her role as an executive coach and & Sun Alliance. mentor to many aspiring and future leaders. She joined the Board as a Non-Executive Director in January 2017 and from April became the Chair of the Quality Committee.

4 Non-voting member 5 Non-voting member

132 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 133 Audit Committee Audit Committee Activities In discharging its duties, the Committee meets its The role of the Audit Committee is to provide to the Board responsibilities through utilising the work of Internal Audit, of Directors an independent and objective review over External Audit and other assurance functions, along with the establishment and maintenance of effective systems assurances from Trust officers (where required) and directing of integrated governance, risk management and internal and receiving reports from the auditors and fraud specialists. control across the organisation’s clinical and non-clinical activities. It also provides assurance on the independence Financial and effectiveness of both external and internal audit and The Audit Committee has played a key role in endorsing ensures that standards are set and compliance with them the accounting policies in operation at the Trust and in is monitored in the non-financial and non-clinical areas of reviewing both the annual accounts and the external the Trust that fall within the remit of the Committee. The audit review of the accounts. Audit Committee is significantly instrumental in reviewing the integrity of the Annual Accounts, and related External The Audit Committee reviewed the 2017/18 annual Auditor’s Reports. In addition, it reviews the Annual accounts at its meetings on 27 April 2018 and 18 May 2018 Governance Statement prepared by the Chief Executive and subsequently recommended their adoption to the in his role as the Accounting Officer along with related Board of Directors. internal audit reports. The Audit Committee takes a risk- based approach to its work with a continued focus on the Quality Account Board Assurance Framework. Whilst the Audit Committee is responsible for monitoring the process for production of the Quality Account, the Composition of the Audit Committee content of the Quality Account is the remit of the Quality The Audit Committee operates in accordance with the Committee. To that end, at its meeting on 27 April 2018, Terms of Reference agreed by the Board of Directors. It the Audit Committee noted the process undertaken by the has met on five occasions during the last financial year Trust to comply with the statutory requirements for the and details of each member’s attendance at meetings are 2017/18 Quality Account and recommended at its meeting provided below. The committee membership comprises on 18 May 2018, the adoption of the Quality Account to at least three Non-Executive Directors including one with the Board of Directors. “recent and relevant financial experience”. Data Quality and Governance The Audit Committee Members during 2017/18 were: During 2017/18, the Committee reviewed the progress Board & Board Committees made to implement the management actions arising Tim Johnston –– Chair of Committee from the audit of A&E Data Quality and was satisfied that Joanne Clague –– Member of Committee sufficient improvements had been made to the systems Committees and process in place, with some actions requiring further Kevan Ryan –– Member of Committee strengthening. Member Board of Audit Remuneration Quality Finance & Charitable Council of Annual The Committee also reviewed the audit of the data Directors & Nominations Committee Performance Funds Governors Members quality for 6-week diagnostics which had identified areas Committee Committee Meeting Member Actual/Possible for improvement particularly in respect of input into the SIGMA system. The Committee was content with the Neil Goodwin 7/8 4/5 3/4 1/1 Tim Johnston 5/5 action plan. The Trust had one reportable Information Governance Dianne Brown 7/8 7/11 5/11 1/1 1/1 Joanne Clague 4/5 breach during the year – see Annual Governance Statement for further details. Joanne Clague 7/8 4/5 4/5 11/11 3/4 1/1 Kevan Ryan 5/5 Cyber Security Tristan Cope 7/8 8/11 3/11 2/4 1/1 Table 17: Audit Committee Member Attendance The Committee maintained its focus on the Trust’s IT David Fillingham 7/8 4/5 7/11 6/11 2/4 0/1 security systems to combat cyber-attacks and continued to work closely with the Counter Fraud team to embed Sue Green 7/8 7/11 8/11 2/4 1/1 and raise awareness of cyber-crime with staff throughout the organisation. In light of the WannaCry cyber-attack Tim Johnston 8/8 5/5 5/5 10/11 4/4 3/4 1/1 In addition to the Committee members, standing in May 2017, the Committee undertook a “deep dive” invitations are extended to the Director of Finance & into the cyber security arrangements in place at the Ian Jones 7/8 7/11 10/11 4/4 2/4 1/1 Business Services, the Chief Nurse, the Chief Executive Trust and was advised on the level of activity to combat (for specific items), Internal Auditors, External Auditors, threats and the improvements made to protect from Mandy Wearne 8/8 10/11 2/4 1/1 Local Counter Fraud Specialist, Director of Corporate daily attacks. The Committee was also advised that two Governance/Board Secretary and the Head of Corporate separate audits on cyber security were undertaken by Kevan Ryan 8/8 5/5 4/5 11/11 4/4 4/4 1/1 Finance. Other officers of the Trust may be invited to the RSM and NHS Digital and, whilst a number of areas had Committee to answer any points which may arise. been highlighted for improvement, overall the Trust had Angie Smithson 8/8 3/6 5/7 1/4 1/1 good systems and controls in place. The majority of the A Board Committee Assurance Report is considered at issues identified in both audits had been addressed but Steve Warburton 8/8 9/11 10/11 3/4 1/1 the Board of Directors’ meetings following each Audit the long term programme in regard to replacement PCs Committee meeting and the Committee Chair brings any and operating systems would continue to be progressed Beth Weston 4/4 4/5 8/10 3/4 1/1 significant matters to the attention of the Board. during 2018/19. The Committee recognised that the cycle of learning, changing and improving systems was constant Table 16: Board & Board Committees Attendance and acknowledged the work completed and actions implemented to minimise the risk placed on the Trust in regard to its IT systems.

134 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 135 Clinical Audit The Committee undertook a deep dive into the Clinical Audit process with particular focus on the value of the work to improve the quality of patient care, the linkage to the risk registers and details of the type of Audit undertaken. The Committee was advised that the introduction of the Clinical Audit Management system (CAMs) had significantly increased the level of control and improved linkage with Divisions on planning and monitoring progress against audits. However, the Committee required the reporting of clinical audits to be strengthened throughout the governance framework. Internal Auditors would address this as part of their Phase 2 audit work and report back in 2018/19.

Corporate Governance The Audit Committee has gained assurance on all areas within its remit by reviewing: • the Annual Governance Statement • the process for managing the Board Assurance Framework (BAF) • the linkages between the strategic and operational risks and how the Board Assurance Framework dovetails with the Corporate Report of the Trust Risk Register • the Corporate Governance Framework Manual (including the Scheme of Delegation and Standing Financial Instructions) • regular reports from both Internal and External Audit in relation to the adequacy of the systems of internal control. The Audit Committee Chair consults with the Chair of the Quality Committee as appropriate to ensure that the process Internal Audit Fraud • An update review of Sickness Absence Management to of gaining assurance in non-financial matters is in line with Our Internal Audit service is provided by RSM Risk As with the Internal Audit Service, RSM is the service ensure that the actions taken provided assurance that the Audit Committee’s responsibility to discharge its duties Assurance Services LLP (RSM). Their role is to provide provider for the Local Counter Fraud Specialist (LCFS). The the controls and processes in place were fit for purpose. to the Board correctly. The Audit Committee Chair also an independent and objective internal audit service Committee is fully supportive of counter fraud work within Significant progress had been made to enhance and ensures that Internal Audit plans and reports that refer to providing an opinion to the Accounting Officer, the Board the Trust and regularly reviews the risk of fraud and work strengthen the management of long-term sickness, the matters of relevance to the Quality Committee are shared. of Directors and the Audit Committee on the degree to completed in accordance with Service Condition 24 of the implementation of the ESR self-service system and the establishment of Divisional workforce dashboards The Trust’s Annual Governance Statement was considered at which risk management, control and governance support Provider Contract. The Committee receives and approves the meeting held on 27 April 2018 and recommended to the the achievement of the organisation’s agreed objectives. an annual proactive work plan, regular progress reports • A review of the Safeguarding arrangements including against the work plan and a final annual report detailing Board of Directors for approval following the meeting on 18 The Internal Audit Plan was driven from the risks set out in the systems and processes in place which highlighted all proactive and reactive work undertaken by the LCFS. May 2018. the Trust’s own Board Assurance Framework (BAF) as well weaknesses in the control framework. The matter as areas specifically identified by Executive Directors for 2017/18 has witnessed a continued increase in staff was subsequently referred to the Board with the risks External Audit audit review and was subsequently approved by the Audit reporting fraud concerns and speaking with the LCFS and subsequent improvement plan continuing to be The provision of external audit services is currently Committee. during ward and department visits to gain assurance monitored by the Quality Committee reporting through delivered by PricewaterhouseCoopers LLP (PwC). Their and advice on fraud related matters. The LCFS has also to the Board During the course of the year, the Committee ensured that work focussed upon the audit and opinion on the financial completed an operational fraud risk assessment in 2017 regular progress reports were received on the delivery • The improvements that had been identified with ward statements. In January 2018, the Committee approved to identify the key fraud risk areas for future proactive of the Internal Audit Plan. The plan also included issues processes for patient flow as part of the Emergency & an External Audit Plan for the year to 31 March 2018 and exercises. This, together with ongoing joint work with identified by the Quality Committee. As part of this Acute Care programme. The Trust was receiving support has received regular updates on the progress of work. In the Corporate Governance Team on Declarations of process, the Committee has influenced changes to the plan from Ernst & Young on improving A&E performance and addition, reports and briefings (as appropriate) have been Interest to ensure the Trust is compliant with recent to direct work to risk areas identified during the course the outcome of that work would need to be assessed received from PwC in accordance with the requirements of changes to NHS guidance, ensures that the Trust is of the year. The Internal Audit annual report highlights before considering the recommendations from the audit. the Audit Code. targeting those key risk areas. certain areas for inclusion in the Annual Governance This would be followed up during Q1 2018/19 A draft unqualified opinion (and audit certificate) on the Statement and these have been reflected in that section of Liaison with Trust HR, NHS Counter Fraud Authority • The continued focus on improving compliance standards accounts of the Foundation Trust for 2017/18 was given to the report. (formerly NHS Protect), the Home Office, local authorities for Additional Clinical Activity Sessions which would be a the Trust on 18 May 2018. and neighbouring NHS organisations has continued The overall conclusion from the work undertaken in key focus as part of the follow up review in Q1 2018/19 throughout the year resulting in the assistance in third In addition to the audit of the annual accounts, PwC has 2017/18 is that the organisation has an adequate and party external investigations. • A review of the audit of Working Time Regulations also undertaken assurance work on the Trust’s Quality effective framework for risk management, governance which identified significant gaps in policy, procedures Account for 2017/18 in accordance with the guidelines set and internal control. This is based on testing undertaken. Other work of Audit Committee and guidance documentation. Some progress has been out by NHS Improvement in the Annual Reporting Manual However, the work undertaken has identified further The Committee also contributed to the following: made to address the issues but further review will be (ARM). On 18 May 2018, the auditors issued a draft limited enhancements to the framework for risk management, required during 2018/19. assurance report on the contents of the Quality Account governance and internal controls to ensure that it remains • A review of the management tracking system for audit and mandated indicators, and a report to Governors adequate and effective. actions revealed a number of outstanding actions that Tim Johnston covering external assurance on two mandated and one had not been addressed. The Committee requested that Chair, Audit Committee locally selected indicator. these actions be completed by end of Q1 2018/19 May 2018

136 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 137 Remuneration & Nominations Committee Head of Internal Audit Opinion

The purpose of the Remuneration & Nominations Annual Remuneration Statement In accordance with Public Sector Internal Audit Standards, Committee is to decide the pay and allowances and other terms and conditions of the executive directors. This statement refers to senior managers employed by the head of internal audit is required to provide an annual Membership of this Committee wholly comprises the Trust. Senior Managers are defined as the Chairman, of non-executive directors, who are viewed as the Chief Executive, Non-Executive Directors, Executive opinion, based upon and limited to the work performed, on independent. Directors and any person in a senior position having authority or responsibility for directing or controlling the the overall adequacy and effectiveness of the organisation’s The Committee is chaired by the Trust chairman with all major activities of the Trust i.e. those who influence the non-executive directors as members. Committee members decision of the Trust as a whole. risk management, control and governance processes. The have no financial interest in matters to be decided. The Chief Executive and Director of People & Corporate Affairs For the year 2017/18, the Remuneration Committee opinion should contribute to the organisation’s annual normally attend committee meetings in an advisory determined to apply the principle of the National Pay capacity and provide assistance to the Committee as Award irrespective of role/level whilst uplifting those governance statement. required, except where their own salaries are discussed. staff beneath the national minimum wage in line with The Committee met on five occasions during the year. The national requirements. It also supported a review of Remuneration Report is set out on page 62. those on spot salaries to identify where assimilation onto the national pay, terms and conditions was appropriate. The Committee approved the Policy for the Fit and For the 12 months ended 31 March 2018, the head of internal audit opinion for Proper Persons Test. It also reviewed its succession plans Aintree University Hospital NHS Foundation Trust is as follows: Member Actual/Possible and considered the framework to provide reasonable assurance for use in preparation for the merger and a Neil Goodwin (Chair) 4/5 potential new structure. Head of internal audit opinion 2017/18 From our follow up work, undertaken across the year, we Joanne Clague 4/5 During the year, the Committee reviewed its Board are able to confirm that management have continued to arrangements in light of the potential merger and “The organisation has an adequate and effective work on strengthening control where weaknesses have David Fillingham 4/5 agreed to the Deputy Chief Executive/Chief Operating framework for risk management, governance and been identified. We have also seen the audit committee Officer (COO) relinquishing her role as COO to enable internal control. However, our work has identified ask for management assurance around addressing internal Tim Johnston 5/5 full-time focus on the merger as Integration Programme further enhancements to the framework of risk audit actions, with updates from lead executives at audit Director. The role of Acting COO was to be undertaken management, governance and internal control to committee meetings. Kevan Ryan 4/5 by the Director of Operations. The Committee also ensure that it remains adequate and effective.” considered the potential for Directors of the Trust Mandy Wearne 4/5 providing Board level leadership at other Trusts but The formation of our opinion is achieved through a risk-based plan of work, agreed with management and agreed not to make any changes to the Constitutional We are able to confirm that management have arrangements at this time. approved by the audit committee, our opinion is subject to inherent limitations. continued to work on strengthening control Table 18: Remuneration & Nominations Committee The Committee also considered the Chief Executive’s where weaknesses have been identified. Member Attendance performance appraisal for 2016/17 and the report of the We have issued 20 reports during 2017/18, of which two Chief Executive on the summary of Executive Director have provided ‘no assurance’ on the areas audited – appraisals for 2016/17. Working Time Regulations and the Authorisation Process. In addition to this, we also issued seven ‘partial assurance’ reports in the following areas:

• Safeguarding Children

Neil Goodwin • NHS Supply Chain Invoices Chair, Remuneration Committee • Emergency & Acute Care Programme – May 2018 Ward Level Discharge Management • Decontamination (Fast Track) • Duty of Candour • Theatre Stock Controls • Shared Service Governance Arrangements.

138 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 139 Statement of the Chief Executive’s Responsibilities Independent Auditor’s Report to the Council of as the Accounting Officer of Aintree University Governors of Aintree University Hospital NHS Hospital NHS Foundation Trust Foundation Trust

The NHS Act 2006 states that the Chief Executive is the Report on the audit of the financial statements Accounting Officer of the NHS foundation trust. The relevant responsibilities of the Accounting Officer, including their responsibility for the propriety and regularity of public finances Opinion Material uncertainty relating In our opinion, Aintree University Hospital NHS Foundation to going concern for which they are answerable, and for the keeping of proper Trust’s financial statements: In forming our opinion on the financial statements, which accounts, are set out in the NHS Foundation Trust Accounting • give a true and fair view of the state of the Trust’s affairs is not modified, we have considered the adequacy of as at 31 March 2018 and of the Trust’s income and the disclosure made in note 1 (Accounting Policies) to Officer Memorandum issued by NHS Improvement. expenditure and cash flows for the year then ended the financial statements concerning the Trust’s ability to 31 March 2018; continue as a going concern. • have been properly prepared in accordance with the The Trust is forecasting a deficit and a cash shortfall Department of Health and Social Care Group Accounting for 2018/19 and anticipates that it will receive external Manual 2017/18. financial support to enable it to meet its liabilities as they fall due and provide ongoing healthcare services. We have audited the financial statements, included within However, the nature of any financial support, including NHS Improvement, in exercise of the powers conferred The Accounting Officer is responsible for keeping proper the Annual Report and Accounts (the “Annual Report”), on Monitor by the NHS Act 2006, has given Accounts accounting records which disclose with reasonable whether such support will be forthcoming or sufficient is which comprise: the Statement of Financial Position as at not yet known. Directions which require Aintree University Hospital accuracy at any time the financial position of the NHS 31 March 2018; the Statement of Comprehensive Income NHS Foundation Trust to prepare for each financial foundation trust and to enable him to ensure that the for the year then ended; the Statement of Cashflows These conditions, along with the other matters explained year a statement of accounts in the form and on the accounts comply with requirements outlined in the above for the year then ended; the Statement of Changes in in note 1 to the financial statements, indicate the existence basis required by those Directions. The accounts are mentioned Act. The Accounting Officer is also responsible Taxpayer’s Equity for the year then ended; and the notes of a material uncertainty which may cast significant doubt prepared on an accruals basis and must give a true and for safeguarding the assets of the NHS foundation trust to the financial statements, which include a description of about the Trust’s ability to continue as a going concern. fair view of the state of affairs of Aintree University and hence for taking reasonable steps for the prevention the significant accounting policies. The financial statements do not include the adjustments Hospital NHS Foundation Trust and of its income and and detection of fraud and other irregularities. that would result if the Trust were unable to continue as expenditure, total recognised gains and losses and cash To the best of my knowledge and belief, I have properly a going concern. flows for the financial year. discharged the responsibilities set out in the NHS Basis for opinion Explanation of material uncertainty In preparing the accounts, the Accounting Officer Foundation Trust Accounting Officer Memorandum. We conducted our audit in accordance with the National The Trust’s cash flow forecast for 2018/19 is predicated is required to comply with the requirements of the Health Service Act 2006, the Code of Audit Practice and on a Cost Improvement Plan (CIP) savings requirement of Department of Health Group Account Manual and in relevant guidance issued by the National Audit Office on £6.6m, not all of which has been planned in detail, and particular to: behalf of the Comptroller and Auditor General (the “Code relies on significant distress funding and a large capital of Audit Practice”), International Standards on Auditing • observe the Accounts Direction issued by NHS loan being received during the year, neither of which (UK) (“ISAs (UK)”) and applicable law. Our responsibilities Improvement, including the relevant accounting and have been agreed. Without this, the Trust forecasts show under ISAs (UK) are further described in the Auditors’ disclosure requirements, and apply suitable accounting that it will have a negative cash balance at the end of the responsibilities for the audit of the financial statements policies on a consistent basis; financial year 2018/19 and may require additional financial section of our report. We believe that the audit evidence Steve Warburton support, on top of the current planned support, in order • make judgements and estimates on a reasonable basis; we have obtained is sufficient and appropriate to provide Chief Executive to meet its liabilities as they fall due. However, the extent a basis for our opinion. • state whether applicable accounting standards as set 23 May 2018 and nature of any additional financial support, including out in the NHS Foundation Trust Annual Reporting whether such support will be forthcoming or sufficient is Manual (and the Department of Health Accounting not yet known. Manual) have been followed, and disclose and explain Independence any material departures in the financial statements; We remained independent of the Trust in accordance What audit work we performed • ensure that the use of public funds complies with with the ethical requirements that are relevant to our In considering the financial performance of the Trust we: audit of the financial statements in the UK, which includes the relevant legislation, delegated authorities and • Understood the Trust’s FY18/19 Annual Plan and cash the FRC’s Ethical Standard, and we have fulfilled our guidance; and flow forecasts, including the key assumptions within, for other ethical responsibilities in accordance with these example, underperformance against CIPs; • prepare the financial statements on a going requirements. concern basis. • Assessed the Trust’s ability to achieve its CIP/ efficiencies target through consideration of historical delivery of CIP/ efficiencies and, as above, the sensitivity of the FY18/19 Annual Plan to underperformance in this area; and • Assessed the potential need for additional financial support to enable the Trust to meet its liabilities as they fall due and understood whether any financial support included within forecasts has already been agreed upon.

140 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 141 Our audit approach

Context Overview Our audit for the year ended 31 March 2018 was planned and Overall materiality: executed having regard to the £7,020k which represents 2% fact that the Trust’s operations of total revenue. and financial stability were largely Materiality We performed our audit of the unchanged in nature from the financial information for the Trust previous year. In light of this, our at Aintree House which is where the approach to the audit in terms of Trust’s finance function is based. scoping and key audit matters was largely unchanged apart from one In establishing our overall approach, key audit matter that was new for we assessed the risks of material the financial year 2017/18, Risk of misstatement, taking into account WPA consolidation, which was a the nature, likelihood and potential required significant risk from our magnitude of any misstatement. Audit group auditors, the National Audit Following this assessment, we applied Scope Office (NAO). professional judgement to determine the extent of testing required over each balance in the annual accounts.

Our principal risks and key audit matters were: Our approach to the audit in Management override of control terms of scoping and key audit and the risks of fraud in revenue Key audit matters was largely unchanged recognition; matters apart from one Key audit Financial sustainability and going matters that was new for the concern; and financial year Valuation of Property, Plant and Equipment.

The scope of our audit Key audit matters

As part of designing our audit, we Key audit matters are those matters whole, and in forming our opinion determined materiality and assessed that, in the auditors’ professional thereon, and we do not provide a the risks of material misstatement in judgement, were of most significance separate opinion on these matters. the financial statements. In particular, in the audit of the financial In addition to financial sustainability we looked at where the directors statements of the current period and and going concern, described in made subjective judgements, for include the most significant assessed the Material Uncertainty relating example in respect of significant risks of material misstatement to going concern section above, we accounting estimates that involved (whether or not due to fraud) determined the matters described making assumptions and considering identified by the auditors, including below to be the key audit matters future events that are inherently those which had the greatest effect to be communicated in our report. uncertain. As in all of our audits on: the overall audit strategy; the This is not a complete list of all risks we also addressed the risk of allocation of resources in the audit; identified by our audit. management override of internal and directing the efforts of the controls, including evaluating engagement team. These matters, whether there was evidence of bias and any comments we make on the by the directors that represented a results of our procedures thereon, risk of material misstatement due were addressed in the context of our to fraud. audit of the financial statements as a

142 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 143 Key audit matter How our audit addressed the Key audit matter Key audit matter How our audit addressed the Key audit matter

Management override of control and the risks of Income Valuation of Property, Plant and Equipment As part of our work around valuation of property, plant fraud in revenue recognition and equipment we: For income/receivable transactions, we tested on a sample Management’s accounting policies, key judgements See note 1 to the financial statements for the basis that the transactions and the associated income had and use of experts relating to the valuation of the • Engaged our in-house valuation experts to consider the directors’ disclosures of the related accounting policies, been posted to the correct financial year by tracing them Trust’s estate are disclosed in Note 1 to the financial assumptions and estimates applied by management’s judgements and estimates relating to the recognition of to invoices or other documentary evidence. Our testing statements. expert during the course of the valuation. This exercise income and note 3 for further information. did not identify any items materially incorrectly recorded. considered whether key assumptions, and the valuation We focused on this area because Property, Plant and methodology used was reasonable and appropriate; We focused on this area because there is a heightened We tested a sample of items of contract revenue from Equipment (PPE) represents the largest balance in the risk due to the Trust being under increasing financial Clinical Commissioning Groups (“CCG”) and NHS England, Trust’s statement of financial position. The PPE balance • Tested a sample of the assets by verifying that the pressure. traced them to contract and to correspondence between at 31 March 2018 is £185.8m. input data used by the valuer was consistent with the the Trust and the CCG regarding over/ under performance. underlying estates and property asset information held Whilst the Trust is looking at ways to maximise revenue Land and buildings are measured at fair value based on We tested income back to invoices and cash receipts. Our by the Trust; and reduce costs, there is significant pressure to report periodic valuations. The valuations are carried out by a testing did not identify any items incorrectly recorded. results in line with its annual plan to attain set key professionally qualified valuer in accordance with the • Recalculated the revaluation/impairment arising from performance indicators which attracts bonuses and We tested a sample of income to invoices and subsequent Royal Institute of Chartered Surveyors (RICS) Appraisal the valuation exercise for a sample of assets and checked incentives. cash received (for NHS and non-NHS income) to check and Valuation Manual, and performed with sufficient that these had been appropriately reflected in the whether it had been correctly recorded, and this did not regularity to ensure that the carrying value financial statements; and As all Trusts are under pressure to achieve their identify any items requiring amendment in the financial is not materially different from fair value at the control totals there is a risk that the Trust could adopt • Physically inspected a sample of assets across land, statements. reporting date. accounting policies, make accounting judgements or buildings to check existence and to confirm they were estimates or treat income and expenditure transactions Intra-NHS balances In 2017/18, management have undertaken valuation in use. in such a way as to lead to material misstatement in the of the Trust’s estate. This led to an increase in the We obtained the Trust’s mismatch reports received from Our testing identified no matters that required reported deficit position. revaluation reserve of £9.5m. The overall charge to the NHS Improvement (“NHSI”), which identified balances amendment within the financial statements. Statement of Comprehensive Income during the year Given these incentives, we considered the risk of (debtor, creditor, income or expenditure balances) that was £23.4m. management manipulation in each of the key audit were different from those recognized by the counterparty. matters, which are: We checked that management had investigated disputed amounts above £300,000 (based on the National Audit • Recognition of revenue; Office’s reporting criteria), then discussed with them the • The inherent complexities in a number of contractual results of their investigation and the resolution, which we arrangements entered into by the Trust, for example traced to correspondence with the counterparty. We then How we tailored the audit scope Materiality intra-NHS transactions; considered the impact, if any, these disputes would have on We tailored the scope of our audit to ensure that we The scope of our audit was influenced by our application the value of income and expenditure recognised in 2017/18 • Manipulation through journal postings; and performed enough work to be able to give an opinion of materiality. We set certain quantitative thresholds and determined that there was no material impact. on the financial statements as a whole, taking into for materiality. These, together with qualitative • Management estimates. Manipulation through journal posting account the accounting processes and controls, and the considerations, helped us to determine the scope of environment in which the Trust operates. our audit and the nature, timing and extent of our audit We selected a sample of manual and automated journal procedures and to evaluate the effect of misstatements, transactions that had been recognised in revenue, focusing In establishing our overall approach we assessed the both individually and on the financial statements as in particular on those with unusual characteristics. We risks of material misstatement, taking into account a whole. performed other journal tests which were focused on the nature, likelihood and potential magnitude of any identifying unusual account combinations. misstatement. Following this assessment, we applied Based on our professional judgement, we determined professional judgement to determine the extent of testing materiality for the financial statements as a whole as We traced these journal entries to supporting required over each balance in the financial statements. follows: documentation to check that the transaction had a We performed most of our audit work at Aintree House, business case and was accounted for appropriately within which is where the finance function is based. the financial statements. Our testing identified no issues that required further investigation. Overall materiality £7,020k (2017: £6,865k) Management estimates We evaluated and tested management’s accounting How we determined it 2% of revenue (2017: 2% of revenue) estimates, focusing on: Rationale for benchmark applied Consistent with last year, we have applied this benchmark, a generally accepted • accruals; auditing practice, in the absence of indicators that an alternative benchmark • provisions; would be appropriate. • deferred income; and • Property, Plant and Equipment Valuation (see specific key audit matter below).

We tested reasonableness of the key accounting estimates We agreed with the Audit Committee that we would report to them misstatements identified during our audit above on which management’s estimates were based and the £300,000 (2017: £250,000) as well as misstatements below that amount that, in our view, warranted reporting for basis of their calculation on a sample basis by comparing qualitative reasons. the assumptions used by management in the calculation of their estimate with independent assumptions and investigating any differences. Our testing identified no matters that required amendment within the financial statements.

144 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 145 Reporting on other information Reasonable assurance is a high level of assurance, but is In light of the knowledge and understanding of the Trust Other matters on which we report by exception not a guarantee that an audit conducted in accordance and its environment obtained in the course of the audit, We are required to report to you if: The other information comprises all of the information in with ISAs (UK) will always detect a material misstatement we did not identify any material misstatements in the the Annual Report other than the financial statements and when it exists. Misstatements can arise from fraud or Performance Report or Accountability Report. • the statement given by the directors within the our auditors’ report thereon. The directors are responsible error and are considered material if, individually or in the Statement of the Chief Executive’s Responsibilities as In addition, the parts of the Remuneration and Staff for the other information. Our opinion on the financial aggregate, they could reasonably be expected to influence the Accounting Officer statements does not cover the other information and, reports to be audited have been properly prepared the economic decisions of users taken on the basis of these • the section of the Annual Report included within the accordingly, we do not express an audit opinion or, except in accordance with the NHS Foundation Trust Annual financial statements. Governance & Organisational Arrangements section, to the extent otherwise explicitly stated in this report, any Reporting Manual 2017/18. as required by provision C.3.9 of the NHS Foundation form of assurance thereon. A further description of our responsibilities for the audit of the financial statements is located on the FRC’s website Arrangements for securing economy, efficiency and Trust Code of Governance, describing the work of the In connection with our audit of the financial statements, at: www.frc.org.uk/auditorsresponsibilities. This description effectiveness in the use of resources Audit Committee does not appropriately address matters our responsibility is to read the other information and, forms part of our auditors’ report. Under the Code of Audit Practice we are required to communicated by us to the Audit Committee in doing so, consider whether the other information is report, by exception, if we conclude we are not satisfied • the Annual Governance Statement does not meet the materially inconsistent with the financial statements or our As part of an audit in accordance with ISAs (UK), that the Trust has put in place proper arrangements for disclosure requirements set out in the NHS Foundation knowledge obtained in the audit, or otherwise appears we exercise professional judgement and maintain securing economy, efficiency and effectiveness in its use of Trust Annual Reporting Manual 2017/18 or is misleading to be materially misstated. If we identify an apparent professional scepticism. resources for the year ended 31 March 2018. or inconsistent with our knowledge acquired in the material inconsistency or material misstatement, we are We are required under Schedule 10(1) of the National course of performing our audit. We have not considered required to perform procedures to conclude whether there We draw your attention to the Trust’s Annual Governance Health Service Act 2006 to satisfy ourselves that the Trust whether the Annual Governance Statement addresses all is a material misstatement of the financial statements or a Statement of the annual report which includes details on has made proper arrangements for securing economy, risks and controls or that risks are satisfactorily addressed material misstatement of the other information. If, based the overall result of the CQC inspection. efficiency and effectiveness in its use of resources and by internal controls on the work we have performed, we conclude that there is to report to you where we have not been able to satisfy We have nothing to report as a result of this requirement a material misstatement of this other information, we are ourselves that it has done so. We are not required to except for the matters detailed below, where we have • we have referred a matter to Monitor under Schedule 10 required to report that fact. We have nothing to report consider, nor have we considered, whether all aspects of been unable to satisfy ourselves that the Trust has made (6) of the National Health Service Act 2006 because we had based on these responsibilities. the Trust’s arrangements for securing economy, efficiency proper arrangements for securing effectiveness in its use of reason to believe that the Trust, or a director or officer of the Trust, was about to make, or had made, a decision which With respect to the Performance Report and the and effectiveness in its use of resources are operating resources for the year ended 31 March 2018. effectively. We have undertaken our work in accordance involved or would involve the incurring of expenditure that Accountability Report, we also considered whether the The Care Quality Commission (CQC) performed inspections with the Code of Audit Practice, having regard to the was unlawful, or was about to take, or had taken a course disclosures required by the NHS Foundation Trust Annual of the Trust during October 2017 and January 2018 and criterion determined by the Comptroller and Auditor of action which, if followed to its conclusion, would be Reporting Manual 2017/18 have been included. issued the inspection report with an overall rating for the General as to whether the Trust has proper arrangements unlawful and likely to cause a loss or deficiency Trust of ‘Requires Improvement’ and specifically, a rating Based on the responsibilities described above and our to ensure it took properly informed decisions and of ‘Requires Improvement’ for the ‘Are services effective?’ • we have issued a report in the public interest under work undertaken in the course of the audit, ISAs (UK) and deployed resources to achieve planned and sustainable domain. Schedule 10 (3) of the National Health Service Act 2006 the Code of Audit Practice require us also to report certain outcomes for taxpayers and local people. We planned our opinions and matters as described below. work in accordance with the Code of Audit Practice. Based Except for the matters noted above, we have no other • we have not received all the information and on our risk assessment, we undertook such work as we matters to report in relation to proper arrangements for explanations we require for our audit. considered necessary. securing economy, efficiency and effectiveness in the use We have no exceptions to report arising from this responsibility. Responsibilities for the financial of its resources for the year ended 31 March 2018. We will prepare an annual audit letter which will cover statements and the audit the Trust’s key risks in securing economy, efficiency and Responsibilities of the directors for the financial effectiveness in its use of resources, how these have been statements discharged by the Trust, and our actions to review these. The Trust is responsible for publishing this annual audit As explained more fully in the Accountability Report, letter, and ensuring that it is available to the public. Certificate the directors are responsible for the preparation of the financial statements in accordance with the Department of Use of this report We certify that we have completed the audit of the financial statements in accordance with the Health and Social Care Group Accounting Manual 2017/18, requirements of Chapter 5 of Part 2 to the National Health Service Act 2006 and the Code of Audit Practice. This report, including the opinions, has been prepared for and for being satisfied that they give a true and fair view. and only for the Council of Governors of Aintree University The directors are also responsible for such internal control Hospital NHS Foundation Trust as a body in accordance as they determine is necessary to enable the preparation with paragraph 24 of Schedule 7 of the National Health of financial statements that are free from material Service Act 2006 and for no other purpose. We do not, in misstatement, whether due to fraud or error. giving these opinions, accept or assume responsibility for In preparing the financial statements, the directors are any other purpose or to any other person to whom this responsible for assessing the Trust’s ability to continue as report is shown or into whose hands it may come save a going concern, disclosing as applicable, matters related where expressly agreed by our prior consent in writing. Rebecca Gissing (Senior Statutory Auditor) to going concern and using the going concern basis of for and on behalf of PricewaterhouseCoopers LLP accounting unless the directors either intend to liquidate Chartered Accountants and Statutory Auditors the Trust or to cease operations, or have no realistic Other required reporting Manchester alternative but to do so. 25 May 2018 Opinions on other matters prescribed by the The Trust is also responsible for putting in place proper Code of Audit Practice arrangements to secure economy, efficiency and effectiveness in its use of resources. Performance Report and Accountability Report In our opinion, based on the work undertaken in Auditors’ responsibilities for the audit of the the course of the audit, the information given in the financial statements Performance Report and Accountability Report for the Our objectives are to obtain reasonable assurance about year ended 31 March 2018 is consistent with the financial whether the financial statements as a whole are free from statements and has been prepared in accordance with material misstatement, whether due to fraud or error, applicable legal requirements. and to issue an auditors’ report that includes our opinion.

146 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 147 procedural documents to ensure on strategic decision making, and and received acceptable assurance on appropriate guidance is available for the Board receives regular updates the systems and processes in place to all staff. The Document Management on the status of those risks. The minimise the level of risk placed on Annual Governance Statement System provides staff with access to Board identified how the risk the Trust in regard to its IT systems. all approved Trust policies, procedures appetite would be applied through In 2017/18, a review was undertaken and guidance in one location on the the existing Trust risk management on the implementation of the intranet. Trust policies are cascaded framework and this is included in our management actions relating to data to all staff through Team Brief, the All Risk Management Strategy and the quality within A&E with the Audit Scope of responsibility responsibility for risk management. of the senior management team associated Policy. The Strategy also Committee satisfied that sufficient The key elements of the strategy to provide assurance in relation to contains an escalation process for the improvements had been made to As Accounting Officer, I have include a description of individual the development of local systems rapid identification and reporting the systems and controls in place. In responsibility for maintaining a and collective responsibilities of the of control. In 2017/18, the Audit The Trust continues to be a to the Board of emerging risks or addition, independent assurance is sound system of internal control that Board of Directors, its committees and Committee reviewed the new BAF member of the Advancing concerns around risk mitigation. provided by the Audit Commission’s supports the achievement of the NHS other groups within the Trust that are and considered the supporting Payment by Results (PbR) Data Quality Alliance (AQuA) and The BAF provides an effective focus foundation trust’s policies, aims and concerned with risk management. The systems and processes behind the Assurance Framework review and has been actively involved in on strategic and reputational risk objectives, whilst safeguarding the Strategy was revised in October 2017 Corporate Report of the Trust Risk internal audit reports. rather than operational issues, and public funds and departmental assets and is reinforced by the Assurance Register and its alignment to the BAF. sharing their collaborative work highlights any gaps in controls or The Trust is fully aware of its for which I am personally responsible, & Escalation Framework which and participating in specific Divisional governance arrangements assurances. It provides the Board requirements to comply with the in accordance with the responsibilities provides further assurance of the risk have been established to ensure programmes. of Directors with confidence that forthcoming introduction of the assigned to me. I am also responsible management processes in place in the effective risk management across all systems and processes in place are new General Data Protection for ensuring that the NHS foundation Trust. Divisions. This includes appropriate operating in a way that is safe and Regulations (GDPR) from May 2018. trust is administered prudently and About Aintree e-briefing and other The Trust has a governance structure identification and escalation of risk effective. It is a dynamic tool which A Working Group, chaired by the economically and that resources are line reporting mechanisms. applied efficiently and effectively. I in place that supports the process of to the Executive-Led Groups and the is regularly reviewed throughout the Senior Information Risk Officer (SIRO), also acknowledge my responsibilities risk escalation and management. The Hospital Management Board, and Good practice and lessons learned year by the Board Committees and has been established to provide as set out in the NHS Foundation Trust Board has a committee structure with the maintenance of Divisional Risk from a variety of local and national the Board of Directors and supports assurance that effective best practice Accounting Officer Memorandum. risk managed and monitored through Registers. Staff are trained to manage sources on incidents, complaints, me when completing this statement mechanisms are put in place as well as the following Board committees risk in a way that is appropriate concerns, claims and audits are shared at the end of each financial year. integrating the standards with other – Audit, Quality and Finance & through a range of methods including governance frameworks, strategies, Quality drives the Trust’s strategy Performance – with further assurance newsletters, service improvement work programmes and projects to The purpose of the and annual plan and the Board of being provided by the Hospital work, education and training ensure compliance with the new Directors is aware of potential risks system of Management Board which also has Divisional governance programmes, and through the legislation. In addition, Task & Finish to Quality via the process outlined internal control responsibility for the performance arrangements have been divisional governance arrangements. Groups have been set up and provide above. The Board commissioned management of the organisation. Lessons and shared learning are also regular progress reports to the The system of internal control established to ensure effective Deloitte LLP to undertake a Well Led The structure is based on the Care identified through the following Working Group identifying any areas is designed to manage risk to a risk management across all Governance Review which included Quality Commission’s domains reports - Practice Improvement requiring particular focus/attention to reasonable level rather than to self-assessment and evaluation of its of care quality, which enhances Divisions. and Lessons Learned (PILL), Patient ensure compliance is achieved. eliminate all risk of failure to achieve effectiveness and performance and clinical engagement, influence and Experience and Complaints & Concerns policies, aims and objectives; it can their final report was submitted to ownership of leadership actions. It Reports, all of which are considered therefore only provide reasonable the Board in April 2017. A number allows for discussions to take place to their authority and duties. This through the governance structure. Major Risks and not absolute assurance of of areas of good practice were within Executive-Led Groups on is supported by a robust training In addition, the Trust continues to be effectiveness. The system of internal identified as well as areas with The major risks, both in year and performance, risks and improvement programme on risk management a member of the Advancing Quality control is based on an ongoing scope for further enhancement and potential, are highlighted below. actions prior to scrutiny of progress from induction and including Alliance (AQuA) and has been actively process designed to identify and development. This subsequently led Controls and assurances which taking place in the relevant Board mandatory training. This is monitored involved in sharing their collaborative prioritise the risks to the achievement to an action plan being developed describe how the Trust manages Committees for assurance purposes. by the Workforce Executive-Led work and participating in specific of the policies, aims and objectives which identified how each of the and mitigates these risks to the It also enables us to learn from good Group. Both the induction and the programmes on reducing avoidable of Aintree University Hospital NHS recommendations would be taken achievement of its strategic objectives practice. mandatory training programmes are mortality, quality improvement and Foundation Trust, to evaluate the forward and the Board received and how outcomes will be assessed aligned to statutory requirements, patient safety. likelihood of those risks being The Board revised the Trust’s strategic quarterly updates on progress. are identified through the best practice and Trust policy. The realised and the impact should vision and its objectives to achieve BAF which is robustly monitored by training programmes are also Information Governance risks are they be realised, and to manage that in 2016/17. The Trust’s strategic the Board and the Board Committees. available to volunteers who work for The Risk and Control managed as part of the processes them efficiently, effectively and risks were principally monitored the Trust. described above and assessed using There is a risk that we fail to: economically. The system of internal through the Board Assurance Framework the Information Governance Toolkit. control has been in place in Aintree Framework (BAF) and the monthly Other risk management training is • ensure that the care provided for The Trust’s Risk Management Strategy The Risk Register is updated with the University Hospital NHS Foundation Corporate Performance Report, with provided both on a formal and on an all patients is high quality, safe and has been approved by the Board currently identified information risks. Trust for the year ended 31 March less significant risks being addressed ad hoc basis. This includes training and operational risk management compassionate 2018 and up to the date of approval through normal performance on risk management capability, risk Data quality and data security risks processes are embedded throughout • provide effective treatment that of the annual report and accounts. management arrangements. identification and scoring criteria, are managed and controlled via the the organisation. The level and nature achieves best Throughout the year, the Board investigation techniques (including risk management system. Risks to of operational risk information that possible outcomes received regular reports on the key root cause analysis) to review serious should be subject to Board scrutiny data quality and data security are Capacity to Handle Risk risks to compliance with the Trust’s incidents, health and safety incidents has been determined by the Board continuously assessed and added • deliver the benefits of education, research and innovation for our The Trust has a Risk Management licence and the action taken with as well as complaints investigations. of Directors within its Risk Appetite to the relevant section of the Risk patients and staff Strategy that sets out the role regard to the most significant risks It also covers the use of human Statement. This was reviewed in Register reviewed by the Information identified on the Trust Risk Register. factors techniques and other Governance & Data Quality Group and responsibilities of the Chief 2017/18 against risk appetite themes, • deliver efficient, cost-effective and investigation tools. Bespoke risk which reports through to the Executive, Executive Directors The Audit Committee has oversight all of which were considered critical sustainable services management training is provided Safety & Risk Executive-Led Group. and managerial roles key to the of the system of risk management in the achievement of the Trust’s annually for the Board. The Audit Committee undertook • provide sufficient strategic focus co-ordination of risk management and assurance, including the BAF, strategic objectives. The aim of the a deep dive on the Trust’s cyber and leadership to support seamless throughout the Trust. The strategy and has a cycle of business that The Trust continues to monitor the revised statement was to improve security arrangements in light of the pathways across health and social clearly states that all staff have a requires attendance by members system for managing its policies and risk sensitivity in Board discussions ‘WannaCry’ cyber-attack in May 2017 care systems

148 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 149 • be a well-governed and clinically- of activities under the non-elective the Trust in responding in a safe and speak to and, if possible, meet with Management Board. The outcome of to these findings. The Trust was led organisation to enable our flow programme. These activities efficient way. those who are affected. Feedback the 2017 inspections showed that the aware prior to the inspection that people to achieve the Trust’s have delivered improvements to the from these discussions is considered Trust had improved in each domain Safeguarding provision required Workforce: the Trust is acutely aware common purpose. extent that the Trust maintained a during the investigation and a on the previous year and against the significant attention and had begun of the significant issues nationally relatively good performance level copy of the final report is shared. national averages. to address this by making significant Major risks that were being within the NHS regarding shortages during the winter months when there This provides the opportunity for investment into the service and closely monitored in 2017/18 were of qualified staff which are being The risks to compliance with the was a 9% increase in attendances any comment on the report to be developing a recovery plan. At the Ophthalmology, Workforce and mirrored locally. We recognise the conditions of the Provider Licence over the previous year, and resulted included if appropriate. A review time of inspection, therefore, the Service Transformation. Major risks for negative impact this has on our staff are monitored through the Board in the Trust being recognised by of the process for the management Trust was able to provide the CQC 2018/19 include: as demand for our services increases Assurance Framework. This includes NHS England as the most improved of incidents was undertaken in with a comprehensive, phased and we continue to actively pursue compliance with Condition 4 – Safeguarding: the Trust underwent in Cheshire & Merseyside. However, 2017/18 with a view to investigations action plan. The CQC published their recruitment strategies and look at Foundation Trust Governance. The inspection by the Care Quality the Trust has recognised that further being dealt with more swiftly, the final report on 21 February 2018, alternative staffing models, where Board assessed compliance at its Commission (CQC) during October work is required in order to take its generation of high quality analysis giving the Trust an overall rating of clinically appropriate, to address meeting in May 2017 and believes 2017. The high level feedback performance to the next level and and stronger recommendations. The ‘Requires Improvement’. All issues the situation. A recent acuity and that effective systems and processes received during the inspection ensure that it is sustainable. Activities implementation of the proposals identified in the two inspections by dependency study highlighted specific are in place to maintain and monitor highlighted that the CQC had found have been identified to deliver will take place during 2018/19. The the CQC have been incorporated changes to nursing and health care the following conditions: evidence that Safeguarding, Mental this step change and the Finance Board’s appointment of a Freedom into an overarching improvement assistant requirements which will be Capacity Act (MCA) and Deprivation & Performance Committee and to Speak Up Guardian reinforces the • the effectiveness of governance plan which will be progressed during implemented during 2018/19. of Liberty (DoLs) processes had not the Board will continue to monitor Trust’s commitment to being open structures 2018/19 with monthly reporting been followed. In November 2017, progress during 2018/19. Service transformation: Aintree and transparent. During 2017/18, to and monitoring by the Quality • the responsibilities of Directors and the CQC wrote to the Trust issuing a has identified that in order to deliver there have been eight Never Events Committee and the Board of Clinical Risk: the most significant Board Committees Warning Notice in relation to both sustainable health care for the reported by the Trust which places Directors on progress. In addition, clinical risk the Trust is currently the provision and management of benefit of patients, transformational it as a significant outlier. In line with • reporting lines and accountability the Trust established a Hospital facing is our ability to maintain an organisational reform and service standard practice, the Trust has between the Board, its Committees Safeguarding Board reporting to effective flow of patients through change is required. To that end, conducted internal investigations and the Executive Team the Hospital Management Board the organisation through the winter Aintree continues to pursue an regarding these incidents to identify to provide greater focus and rigour period and beyond. This report • the submission of timely and The Trust is continuing to take organisational merger with the Royal immediate actions, root causes to our systems and processes on has alluded to a 6-9% increase in accurate information to assess Liverpool & Broadgreen University and associated learning. These Safeguarding. The CQC has indicated steps towards implementing attendances over winter 2017/18 risks to compliance with the Trust’s Hospitals NHS Trust as part of the investigations will be supplemented that the Trust will need to make the required improvements compared to last winter (2016/17) Licence, and Healthy Liverpool Programme and by an external review to provide some further progress in implementing the and this increase in workload and these will be overseen Shaping Sefton Programme. This is also thematic and cultural insight. • the degree and rigour of oversight improvements identified in respect showed little, and uncharacteristic, during 2018/19 by the aligned with the North Mersey Local the Board has over the Trust’s of Safeguarding before the warning sign of abating well into the Delivery System plans which form part performance. notice can be lifted. Hospital Safeguarding Board spring and continues beyond; this of the overall Cheshire & Merseyside and monitored by the Quality increase naturally leads to increased These conditions are detailed within Sustainability and Transformation Plan. admissions to the hospital and The outcome of the 2017 the Annual Governance Statement, Committee and the Board of The Trust, however, continues to focus Employer Obligations pressure on beds. inspections showed that the the validity of which is assured via the Directors. on the delivery of cost-effective health Audit Committee. As an employer with staff entitled care, ensuring that patient safety and Trust had improved in each An increase in acute medical to membership of the NHS Pension quality of service are not compromised. admissions necessitates the use of domain on the previous year Scheme, control measures are in place surgical beds for medical patients and against the national Care Quality Commission to ensure all employer obligations MCA and DoLs within the Trust. A rather than elective surgical admissions averages. Registration (CQC) contained within the Scheme follow-up inspection was undertaken which itself increases clinical risk for regulations are complied with. This by the CQC in January 2018 on those patients and impacts on the The Trust encourages its staff to The Trust is required to register with includes ensuring that deductions these specific areas to identify organisation’s ability to deliver its report incidents whether there the CQC and its current registration from salary, employer’s contributions whether there had been significant surgical workload. This inevitably leads Public stakeholders are involved in status is registered without and payments into the Scheme are improvement in relation to the to the unprecedented cancellation was any consequence resulting managing risks which impact on conditions for the Health and Social in accordance with the Scheme rules, warning notice they had issued. of operations which, in addition to from the incident or not. them. During 2017/18, they were Care Act 2008. The foundation and that member Pension Scheme The CQC published their report the inconvenience to patients, has engaged and involved in the Multi- trust is fully compliant with the records are accurately updated in in March 2018 and indicated that an impact on our ability to manage Disciplinary Accelerated Discharge registration requirements of the accordance with the timescales further progress is required before surgical demand and potential patient When things do go wrong, the Event (MADE) to support and Care Quality Commission. It monitors detailed in the Regulations. the warning notice can be lifted. safety implications. This is reflective of Trust encourages its staff to report expedite the discharge of suitable this compliance by mapping the The Trust is continuing to take steps the situation nationally. Additionally, incidents whether there was any patients providing feedback and fundamental standards/CQC domains towards implementing the required to meet the increasing acute demand consequence resulting from the observations on the process. The Trust through the Trust-wide Executive-Led Equality, Diversity & improvements and these will be we have had to open a large number incident or not. Anonymous reporting also undertakes monthly Patient-led Groups’ Terms of Reference, progress overseen during 2018/19 by the of escalation beds which stretches Human Rights is accepted to mitigate against Assessments of the Care Environment and audit reports providing assurance Hospital Safeguarding Board and our staffing resources. Our ability to any concerns the reporter of an (PLACE) with representation from and other methods such as the Control measures are in place to monitored by the Quality Committee manage such increases in workload incident may have. However, if the public stakeholders and Governors Aintree Assessment & Accreditation ensure that all the organisation’s and the Board of Directors. is impacted by an array of services, reporter of an incident identifies inspecting areas of the hospital under (AAA) Scheme. obligations under equality, diversity many of which are outside the Trust’s Emergency & Acute Care: whilst themselves, they receive feedback the domains of cleanliness, privacy & and human rights legislation are direct sphere of influence and control The Trust had an inspection of its the Trust has made significant for every incident they report. This dignity, food, condition appearance & complied with. but we are working very closely with core services by the Care Quality improvements to the systems and is to help demonstrate the value of maintenance, dementia and disability. all partners to try and alleviate the Commission (CQC) in October processes within the Emergency reporting, that we have learned from Observations from the assessments situation and facilitate discharges 2017 and January 2018. The CQC Department, it remained challenged that incident and that things have are collated and developed into an from the hospital. In response to this provided feedback during the initial in achieving sustained performance changed as a result, with the aim of action plan with clear timescales for unprecedented demand on our acute inspection that they had found against the 4-hour standard. During encouraging staff to report more completion. An annual report on services, we have implemented the evidence that Safeguarding processes 2017/18, the Trust received support incidents. When serious incidents are the Trust’s performance on PLACE ‘SAFER’ programme, a series of work had not been followed and issued from Ernst & Young to deliver a series investigated, members of the Trust inspections is provided to the Hospital streams which is designed to support an enforcement action in relation

150 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 151 Sustainability in the Quality Report is robust and to the Board of Directors and identify further enhancements to by September 2018 and 95% by The Trust has effective systems, reliable, conforms to specified data provides me with evidence that the framework of risk management, March 2019 and the Trust expects to The foundation trust has undertaken quality standards and prescribed the effectiveness of controls that governance and internal control meet this target. We continued to risk assessments and Carbon processes and mechanisms in definitions, is subject to appropriate manage the risks to the organisation to ensure that it remains adequate work closely with our partners, and Reduction Delivery Plans are in place to produce the Quality scrutiny and review and has been achieving its principal objectives and effective particularly those in as part of the A&E Delivery Board, to place in accordance with emergency Account and to ensure that it prepared in accordance with NHS have been reviewed. Internal Audit respect of Safeguarding, Discharge review system-wide solutions across preparedness and civil contingency is a general and balanced view Improvement’s annual reporting provides me with an opinion about Management, the authorisation the health economy. Operational requirements, as based on the UKCIP manual and supporting guidance the effectiveness of the assurance process for Additional Clinical pressures in 2017/18 had a negative 2009 weather projects, to ensure that and that appropriate internal (which incorporates the Quality framework of the internal controls Activity Sessions and Working impact on the 18 week referral to this organisation’s obligations under controls are in place to ensure Accounts regulations) as well as the reviewed as part of the Internal Time Regulations. Whilst the Audit treatment target for admitted and the Climate Change Act and the the accuracy of the data. standards to support data quality for Audit Plan. Work undertaken by Committee sought and gained non-admitted patients with the Trust Adaptation Reporting requirements the preparation of the Quality Report. Internal Audit is reviewed by the assurance that management actions narrowly missing the overall standard are complied with. Audit Committee with relevant to address these weaknesses would for the year. The Trust met four of The Executive Lead for the Quality reports also considered by the Quality be progressed, it also received the eight cancer targets applicable The Board of Directors approved containing personal identifiable data Account is the Chief Nurse. The Committee. The Quality Committee updates on further assurance from in 2017/18. The Trust reported eight the implementation of a significant sent unencrypted to NHS Digital content of the Quality Account is also responsible for receiving Executive leads on audits giving Never Events during 2017/18 and Carbon Reduction Scheme in 2016 under national reporting obligations. reflects the Trust’s overall Quality assurance on clinical audit to ensure ‘partial assurance’ and overdue undertook internal investigations and this continues to be carried out Technical fixes were put in place Strategy and the priorities included in that the Trust is delivering effective actions through the embedded of each incident and the learning through the Carbon Energy Fund and the Information Commissioner’s this document. evidence-based clinical care. My recommendation tracking process from them was shared across the during 2018/19. The infrastructure Office issued a ‘no further action The Trust has consulted with staff, review is also informed by External within the Trust. organisation. In addition, the Trust scheme, which is valued at around required’ response. The Trust has governors and external organisations Audit opinion, inspections carried has commissioned an external review £12.4m, will deliver annual revenue maintained its ‘satisfactory’ rating for The Trust continued to face a such as the Clinical Commissioning out by the Care Quality Commission, to provide some thematic and cultural savings in the order of £863k and an 2017/18 in respect of the Information significant number of challenges Groups, Local Authority Overview and NHS Resolution (previously the insight and the outcome of this report associated carbon reduction of 2789 Governance Toolkit. Notification during 2017/18, principally in relation Scrutiny/Health Select Committees NHS Litigation Authority) risk will be taken forward during 2018/19. tonnes of CO2 per annum. has been received from NHS Digital to the achievement of the 95% and the three Healthwatch management accreditation and other in regard to the new Data Security A&E standard. This was exacerbated organisations on the content of external inspections, accreditations and Protection Toolkit and the Trust by the difficulties experienced in the Quality Account and formal and reviews. Conclusion Review of Economy, will complete its registration process discharging patients and impeding statements from these external bodies during Q1 2018/19. The processes outlined below are flow throughout the hospital. My review confirms that Aintree Efficiency and are contained within the Annual well established and ensure the The Trust continued to implement University Hospital NHS Foundation Effectiveness of the The Trust has been preparing for the Report. The Council of Governors effectiveness of the systems of enhanced activities to the Emergency Trust has a generally sound system introduction of GDPR in 2017/18. were also consulted on the priorities Use of Resources internal control through: & Acute Care programme and the of internal control that supports the Internal Audit has looked at the for 2017/18 and determined which performance trajectory has seen achievement of its policies, aims and The Financial Plan is approved by the Trust’s state of readiness for GDPR of the local indicators was to be • Board review of the Board steady improvement particularly objectives. Board of Directors and submitted to and identified areas where the reviewed by external audit. Assurance Framework including risk over the winter months despite NHS Improvement (NHSI). The plan, control environment could be further registers and action plans There were some internal control increased attendances during this including forward projections, is strengthened; these actions have issues during 2017/18 that are • Audit Committee scrutiny of systems period. NHS providers have been set monitored in detail by the Finance & been progressed during the year. Review of Effectiveness identified in the body of the Annual a target to deliver 90% achievement Performance Committee on a monthly and controls in place Governance Statement for which the As Accounting Officer, I have basis with key performance indicators Trust developed and implemented responsibility for reviewing the • Review of serious incidents and and metrics reviewed by the Board Annual Quality Report learning by the Board Committees robust action plans. through the Corporate Performance effectiveness of the system of The directors are required under the and Safety & Risk and Clinical Report. The Trust’s resources are internal control. My review of the The Trust continued to Health Act 2009 and the National effectiveness of the system of internal Effectiveness Executive-Led Groups managed within the framework implement enhanced activities Signed Health Service (Quality Accounts) set by the Corporate Governance control is informed by the work of the • Review of progress in meeting the Regulations 2010 (as amended) to to the Emergency & Acute Framework Manual which includes internal auditors, clinical audit and CQC essential standards prepare Quality Accounts for each standing financial instructions. the executive managers and clinical Care programme and the financial year. NHS Improvement (in • Internal audit reviews of the Financial governance arrangements leads within the NHS foundation performance trajectory has seen exercise of the powers conferred on effectiveness of systems of are supported by internal and external trust who have responsibility for Monitor) has issued guidance to NHS internal control. steady improvement particularly audit to ensure economic, efficiency the development and maintenance foundation trust boards on the form over the winter months despite and effective use of resources. On of the internal control framework. In 2017/18, Internal Audit stated and content of annual Quality Reports the basis of the Trust’s Annual Plan, a I have drawn on the content of that the Trust had an adequate increased attendances during which incorporate the above legal Steve Warburton monthly report is submitted to NHSI the quality report attached to this and effective framework for risk this period. requirements in the NHS Foundation Chief Executive on its financial position, on which Annual report and other performance management, governance and Trust Annual Reporting Manual. 23 May 2018 feedback is received periodically and information available to me. My internal control. However, they did review is also informed by comments the Board advised. The Trust has effective systems, made by the external auditors in processes and mechanisms in place their management letter and other to produce the Quality Account and reports. I have been advised on the Information Governance to ensure that it is a general and implications of the result of my review balanced view and that appropriate The Information Governance & Data of the effectiveness of the system of internal controls are in place to Quality Group utilises ISO27001 internal control by the Board, the ensure the accuracy of the data, and standard as a benchmark for Audit Committee and the Quality the collection and reporting of the compliance monitoring of the Trust’s Committee and a plan to address measures of performance included in assets and supplier management. weaknesses and ensure continuous the Quality Report, and these controls improvement of the system is in place. In 2017/18, one information are subject to review to confirm governance incident was reported that they are working effectively in The Trust’s Assurance Framework / to the Information Commissioner’s practice. The data underpinning the Risk Register is reviewed quarterly Office (ICO) relating to a spreadsheet measures of performance reported by the Quality Committee reporting

152 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 153 5

Accounts 2017/18 Aintree University Hospital NHS Foundation Trust - Annual Accounts 2017/18 Statement of comprehensive income for the year ended 31 March 2018 STATEMENT OF COMPREHENSIVE INCOME FOR THE YEAR ENDED 31 MARCH 2018 Foreword to the Accounts

Note 2017/18 2016/17 £000 £000

Operating income 3.1 350,988 343,371

Aintree University Hospital NHS Foundation Trust Operating expenditure 4.1 (372,870) (336,047)

OPERATING (DEFICIT) / SURPLUS FOR THE YEAR (21,882) 7,324 These accounts for the year ended 31 March 2018 have been prepared by the Aintree University Hospital NHS Foundation Trust under Schedule 7 of the National Health Service Act 2006, paragraphs 24 and 25 and in accordance with directions given by NHS Improvement (in exercising power conferred on Monitor) the sector regulator for health services in England. FINANCE COSTS

Finance income 6.1 55 68 Signed Finance costs 6.2 (1,585) (1,660)

PDC dividends payable (3,513) (3,552)

NET FINANCE COSTS (5,043) (5,144)

Steve Warburton Chief Executive Gains on disposal of assets 0 1 23 May 2018

(DEFICIT) / SURPLUS FOR THE YEAR (26,925) 2,181

(Deficit) / Surplus for the year after exceptional items (26,925) 2,181

Net impairment of assets exceptional item 4.2 23,395 0

(Deficit) / Surplus for the year before exceptional items (3,530) 2,181

Other comprehensive income not affecting the (deficit) / surplus reported above:

Revaluations gains on purchased property, plant and equipment not charged to the Statement of Comprehensive Income 9,472 0

TOTAL COMPREHENSIVE (EXPENSE) / INCOME FOR THE YEAR (17,453) 2,181

The notes on Pages 161178 to 167183 form part of these accounts.

SoCI

156 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 157 Aintree University Hospital NHS Foundation Trust - Annual Accounts 2017/18 Aintree University Hospital NHS Foundation Trust - Annual Accounts 2017/18 Statement of financial position as at 31 March 2018 Statement of changes in taxpayers’ equity for the year ended 31 March 2018 STATEMENT OF FINANCIAL POSITION AS AT 31 MARCH 2018 STATEMENT OF CHANGES IN TAXPAYERS' EQUITY FOR THE YEAR ENDED 31 MARCH 2018

Note 31 March 2018 31 March 2017 Total Public Revaluation Income and £000 £000 Taxpayers' Dividend Reserve Expenditure NON-CURRENT ASSETS Equity Capital Reserve £000 £000 £000 £000 Intangible assets 8.1, 8.2 1,061 241 Property, plant and equipment 9.1, 9.2 185,799 194,212 Taxpayers' equity as at 1 April 2017 135,875 112,680 27,432 (4,237)

Total non-current assets 186,860 194,453 Deficit for the year ended 31 March 2018 (26,925) (26,925) CURRENT ASSETS

Inventories 10 2,223 2,193 Transfers between Reserves 0 (248) 248 Trade and other receivables 11.1 23,212 19,637 Cash and cash equivalents 15 11,193 9,961 Receipt of Public Dividend Capital 2,411 2,411

Total current assets 36,628 31,791 Revaluation of Property, Plant & Equipment 9,472 9,472 CURRENT LIABILITIES

Trade and other payables 12.1 (42,389) (32,340) Borrowings 13 (2,655) (2,423) Taxpayers' equity as at 31 March 2018 120,833 115,091 36,656 (30,914) Provisions 14.1 (469) (1,978) Other liabilities 12.2 (7,199) (6,263)

Total current liabilities (52,712) (43,004) £000 £000 £000 £000 TOTAL ASSETS LESS CURRENT LIABILITIES 170,776 183,240 Taxpayers' equity as at 1 April 2016 133,694 112,680 27,432 (6,418) NON-CURRENT LIABILITIES Surplus for the year ended 31 March 2017 2,181 2,181 Borrowings 13 (49,111) (45,966) Provisions 14.1 (557) (622) Other liabilities 12.2 (275) (777)

Total non-current liabilities (49,943) (47,365) Taxpayers' equity as at 31 March 2017 135,875 112,680 27,432 (4,237)

TOTAL ASSETS EMPLOYED 120,833 135,875 Description of each Reserve

FINANCED BY: Public Dividend Capital This reserve represents the balance of central capital funding provided to acquire the plant, property and equipment held by the Public Dividend Capital 115,091 112,680 Trust. Revaluation Reserve 36,656 27,432 Income and Expenditure Reserve (30,914) (4,237) Revaluation Reserve This reserve represents the balance of plant, property and equipment revaluations undertaken by the Trust. TOTAL TAXPAYERS' EQUITY 120,833 135,875

Income and Expenditure Reserve This reserve represents the balance of historic surpluses and deficits since the Trust was established. The financialfinancial statementsstatements from pagepage 157174 were approvedapproved onon 2323 MayMay 20182018 by bythe theBoardBoard of of Directors and areare signedsigned on on its its behalf behalf by: by:

Signed: …………………………………………………………………………………..Date: …………………………

Steve Warburton Chief Executive

SoFP SoCiTE 158 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 159 Aintree University Hospital NHS Foundation Trust - Annual Accounts 2017/18 Statement of cash flows for the year ended 31 March 2018 Notes to the Accounts STATEMENT OF CASH FLOWS FOR THE YEAR ENDED 31 MARCH 2018

Note 2017/18 2016/17 1. Accounting policies intervention or dissolution within the profiled accordingly. The anticipated £000 £000 next 12 months. level of activity undertaken for its and other information commissioners, and therefore the Cash flows from operating activities The directors approved the 2018/19 level of income, is derived after due Annual Plan submission to NHSI/ consideration of a range of factors, Operating (deficit) / surplus from continuing operations for the year (21,882) 7,324 Monitor. This plan shows an Income 1.1 Basis of preparation including: and Expenditure deficit in 2018/19 NHS Improvement, in exercising amounting to £29.1m which is above • 2017/18 forecast outturn Operating (deficit) / surplus for the year (21,882) 7,324 the statutory functions conferred the control total set by NHSI. The on Monitor, has directed that the • Changes in activity resulting from plan does not include any transitional Non cash income and expenses financial statements of the trust shall changes in demographic and support income. Achieving this meet the accounting requirements demand plan will require interim revenue of the Department of Health and Depreciation & Amortisation 4.1 5,264 5,340 cash loans totalling £22.5m. The • National Payment by Results rules Social Care Group Accounting Manual Asset Impairments 4.2 23,395 0 plan contains efficiency targets, and regulations (GAM), which shall be agreed with Donations for assets credited to income 3.1 (1,020) (56) including cost improvement plans, HM Treasury. Consequently, the • Commissioning intentions (Increase) in Trade and Other Receivables (3,584) (1,993) amounting to £6.6m (of which not all following financial statements have has been planned in detail). Having • National tariff prices. (Increase) in Inventories (30) (177) been prepared in accordance with regard to the significant efficiencies Increase / (Decrease) in Trade and Other Payables 5,585 (2,632) the GAM 2017/18 issued by the The day to day operations of the Trust achieved over the recent past, this Increase in Other Liabilities 434 251 Department of Health. are funded from contracts with NHS level of cost reduction is considered (Decrease) in Provisions (1,574) (1,249) commissioners. The uncertainty in the The accounting policies contained to be challenging. If these levels current economic climate has been in the GAM follow International of efficiencies are not achieved, mitigated by agreeing a number of Net cash generated from operations 6,588 6,808 Financial Reporting Standards to the Trust would need to apply to contracts with Clinical Commissioning the extent that they are meaningful the Department of Health or other Groups, Local Authorities and NHS Cash flows from investing activities: and appropriate to the NHS, as appropriate regulatory body for England for a further year and these determined by HM Treasury, which additional funding. The plan also payments provide a reliable stream is advised by the Financial Reporting includes essential capital expenditure Interest received 50 66 of funding minimising the Trust’s Advisory Board. Where GAM permits of £18.3m of which £15.2m will need Purchase of Property, Plant and Equipment (6,260) (10,385) exposure to liquidity and financing a choice of accounting policy, the to be funded by the Department Purchase of Intangible Assets (868) (241) problems. accounting policy that is judged to of Health. Receipt of cash donations to purchase capital assets 1,020 56 be most appropriate to the particular The anticipated level of expenditure The directors believe that this Sale of Property, Plant and Equipment 0 1 circumstances of the trust for the within the approved plan is derived forward plan provides a realistic purpose of giving a true and fair view after due consideration of a range of assessment of the Trust’s position. Net cash (used in) investing activities (6,058) (10,503) has been selected. The particular factors, including: Income and expenditure budgets policies adopted are described below. have been set on the basis of robust • Pay awards and incremental These have been applied consistently Cash flows from financing activities and agreed principles, which mean increases in dealing with items considered that the Trust should be able to material in relation to the accounts. Public Dividend Capital received 2,411 0 provide high quality healthcare • National Insurance and pension contribution changes Net Loans received / (paid) 3,377 (2,423) within the resources available, Capital element of finance lease rental payments 0 (15) 1.1.1 Accounting provided the cost saving targets • Inflationary increases for insurance are achieved. premiums, drugs, utilities and Interest paid (1,587) (1,672) convention Interest element of finance leases 0 (3) The Trust has a robust governance general non-pay Public Dividend Capital Dividend paid (3,499) (3,543) These accounts have been prepared structure which includes a Finance • Financial consequences of both under the historical cost convention & Performance Committee, a sub- capital and revenue developments modified to account for the Net cash generated from / (used in) financing activities 702 (7,656) Committee of the Board, which revaluation of property, plant and has the responsibility to monitor • Cost savings requirements equipment, intangible assets and financial performance and oversee Increase / (decrease) in cash and cash equivalents 1,232 (11,351) • Impact of activity levels and inventories. the necessary corrective action on commissioning intentions. behalf of and in conjunction with the Cash and cash equivalents at 1 April 2017 15 9,961 21,312 Board. The Trust recognises there is Cash flow projections take into 1.1.2 Going Concern Basis an urgent need to develop a wider account the planned deficit, capital Cash and cash equivalents at 31 March 2018 15 11,193 9,961 detailed programme for the delivery expenditure, repayment of Public These accounts have been prepared Dividend Capital, the drawdown on a going concern basis. Despite of the continued cost savings and to derive benefits from local and of revenue / capital funds and the projected deficit for 2018-19, movements in working balances. the Board of Directors does not City Region health economy-wide transformational change. There is no certainty that further have any evidence indicating that cost savings will be identified the going concern basis of preparing The preparation of the income from organisational and service the accounts of the Trust, as detailed and expenditure budgets and cash reconfiguration or that additional below, is not appropriate as the flow statements is predicated on short-term funding will be obtained Trust has not been informed by many national and local factors when required and this indicates the NHS Improvement (NHSI)/Monitor SoCF and assumptions regarding both existence of a material uncertainty that there is any prospect of income and expenditure and that may cast doubt about the

160 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 161 Trust’s ability to continue as a going 1.3 Consolidation Revenue grants and other 1.6 Expenditure on other components with significantly Where a component of an asset is concern. However, notwithstanding contributions to expenditure different asset lives e.g. plant and replaced, the cost of the replacement Following HM Treasury’s agreement goods and services the deficits referred to above, the Government grants from government equipment, then these components is capitalised if it meets the criteria to apply IAS27 to NHS Charities from Trust does not have any evidence bodies other than income from Expenditure on goods and services is are treated as separate assets and for recognition above. The carrying 1 April 2013, the Trust has established indicating that the going concern commissioners or trusts for the recognised when, and to the extent depreciated over their own useful amount of the part replaced is that as the Trust is the corporate basis is not appropriate or that provision of services. Where a grant that they have been received, and is economic lives. de-recognised. Other expenditure trustee of the linked NHS Charity there is any prospect of intervention is used to fund revenue expenditure measured at the fair value of those that does not generate additional ‘The Aintree University Hospital or dissolution within 12 months it is taken to the Statement of goods and services. Expenditure is future economic benefits or service Charitable Fund’, it effectively has from the date of approval of these Comprehensive Income to match that recognised in operating expenses 1.8.2 Measurement potential, such as repairs and the power to exercise control so as financial statements. In terms of the expenditure. except where it results in the creation maintenance, is charged to the Valuation sustainable provision of services, to obtain economic benefits. of a non-current asset such as Statement of Comprehensive Income there has been no indication from However, the transactions are The value of the benefit received property, plant and equipment. All property, plant and equipment in the period in which it is incurred. the Department of Health that immaterial in the context of the when accessing funds from the assets are measured initially at the Trust will not continue to be a Trust and transactions have not Government’s apprenticeship service cost, representing the costs directly Depreciation going concern. The directors have been consolidated. Details of the is recognised as income at the point 1.7 Exceptional Items attributable to acquiring or Items of property, plant and accordingly prepared the financial transactions with the charity are of receipt of the training service. constructing the asset and bringing equipment are depreciated over Exceptional Items are those items statements on a going concern basis. included in the related parties’ notes. Where these funds are paid directly it to the location and condition their remaining useful economic that, in the Trust’s view, are required to an accredited training provider, necessary for it to be capable of lives in a manner consistent with the to be disclosed separately in Notes the corresponding notional expense operating in the manner intended consumption of economic or service 3.1 and 4.1 by virtue of their 1.2 Critical judgements 1.4 Income is also recognised at the point of by management. All assets are delivery benefits. In order to ensure size or incidence to enable a full recognition for the benefit. measured subsequently at fair value. that each individual component in applying accounting Income in respect of services provided understanding of the Trust’s financial is recognised when, and to the Fair value is determined as the lower of the asset is appropriately policies performance. of replacement cost and recoverable extent that, performance occurs and 1.5 Expenditure on depreciated, each component is The following are the judgements, is measured at the fair value of the amount. An item of property, plant given an individual life which is apart from those involving consideration receivable. Employee Benefits 1.8 Property, and equipment which is surplus with then aggregated into a ‘weighted estimations (see below) that no plan to bring it back into use is average life’ and applied to the The main source of income for the management has made in the Short-term Employee Benefits Plant and Equipment valued at fair value under IFRS 13, if value of the asset. This ensures Trust is contracts with commissioners process of applying the trust Salaries, wages and employment- it does not meet the requirements of that individual components are in respect of healthcare services. accounting policies and that have related payments such as social IAS 40 or IFRS 5. depreciated appropriately. Freehold Where income is received for a 1.8.1 Recognition land is considered to have an infinite the most significant effect on the security costs and the apprenticeship All land and buildings are revalued specific activity which is to be life and is not depreciated. Property, amounts recognised in the financial levy are recognised in the period in Property, Plant and Equipment is using professionally qualified valuers delivered in a subsequent financial plant and equipment which has statements: which the service is received from capitalised where: (in accordance with IAS 16) at least year, that income is deferred. Income been reclassified as ‘Held for Sale’ employees. The cost of annual leave every five years. The valuations from the sale of non-current assets • it is held for use in delivering ceases to be depreciated upon the entitlement earned but not taken by are carried out primarily on the is recognised only when all material services or for administrative reclassification. Assets in the course 1.2.1 Sources of employees at the end of the period is basis of depreciated replacement conditions of sale have been met, and purposes of construction are not depreciated estimation uncertainty recognised in the financial statements cost, under the modern equivalent is measured as the sums due under until the asset is brought into use or to the extent that employees are • it is probable that future economic asset methodology, for specialised The following are assumptions about the sale contract. Accrued income reverts to the Trust, respectively. permitted to carry-forward leave into benefits will flow to, or service operational property and existing future and other major sources of relates to known 2017/18 revenue the following period. potential be provided to, the Trust use value for non-specialised estimation uncertainty that have that was not invoiced for as at 31 Revaluation gains and losses operational property. The value of a significant risk of resulting in a March 2018. Pension costs • the item is expected to be used land for existing use purposes is Revaluation gains are recognised material adjustment to the carrying – NHS Pension Scheme for more than one financial year The NHS Foundation Trust receives assessed at existing use value. For in the revaluation reserve, except amounts of assets and liabilities income under the NHS Injury Cost Past and present employees are • the cost of the item can be non-operational properties including where, and to the extent that, they within the next financial year. Recovery Scheme, designed to covered by the provisions of the NHS measured reliably surplus land, the valuations are reverse a revaluation decrease that has previously been recognised in The month 12 patient related reclaim the cost of treating injured Pension Scheme. The scheme is an carried out at open market value. • the cost of the item is at least operating expenses, in which case income includes estimates, based on individuals to whom personal injury unfunded, defined benefit scheme Assets in the course of construction £5,000, or they are recognised in operating an average income for the activity compensation has subsequently that covers NHS employers, general are valued at cost and are valued income. delivered in the month by each been paid e.g. by an insurer. The practices and other bodies, allowed • collectively, a number of items by professional valuers when under the direction of Secretary of speciality, for the small proportion NHS Foundation Trust recognises the have a cost of at least £5,000 and brought into operational use. Revaluation losses are charged to the State, in England and Wales. of episodes that did not have fully income when it receives notification individually have a cost of more All plant and machinery, transport revaluation reserve to the extent that coded Healthcare Resource Group from the Department of Work and The scheme is not designed in a way than £250, where: equipment, information technology there is an available balance for the (HRG) data available in time for the Pension’s Compensation Recovery and furniture and fittings are that would enable employers to - the items are functionally asset concerned, and thereafter are closure of the annual accounts. Unit (CRU) that the individual has treated as short-life assets with the identify their share of the underlying interdependent charged to operating expenses. lodged a compensation claim. The depreciated historical cost deemed The Trust has made a judgement to scheme assets and liabilities. income is measured at the agreed - the items have broadly a proxy for fair value. Gains and losses recognised in the defer some of the income received in Therefore, the scheme is accounted tariff for the treatments provided simultaneous purchase dates revaluation reserve are reported in 2017/18 (and previous years) where for as a defined contribution scheme. to the injured individual. However, and are anticipated to have Subsequent expenditure the Statement of Comprehensive that income has been received to a charge is recognised within Employer’s pension cost contributions simultaneous disposal dates Subsequent expenditure relating Income as an item of ‘other specifically fund an activity which will expenditure as a provision for are charged to operating expenses to an item of property, plant and comprehensive income’. occur in a future financial year. - the items are under single unsuccessful compensation claims as and when they become due. equipment is recognised as an managerial control, or Impairments The Trust has determined that the and doubtful debts. Additional pension liabilities arising increase in the carrying amount of from early retirements are not In accordance with the GAM, transactions of the Aintree University Sustainability and Transformation - the items form part of the initial the asset when it is probable that Hospital Charitable Fund, for which funded by the scheme except where setting-up cost of a new building additional future economic benefits impairments that arise from a clear Fund (STF) income is recognised the retirement is due to ill-health. consumption of economic benefit the Trust is the Corporate Trustee, are when the Trust has achieved financial or refurbishment of a ward or unit, or service potential deriving from the immaterial in the context of the Trust The full amount of the liability for irrespective of their individual or cost incurred to replace a component or service potential in the asset are and activity targets set by NHS the additional costs is charged to the charged to operating expenses. and the transactions have not been Improvement. STF Incentive and collective cost (i.e. grouped assets). of such item will flow to the Trust consolidated. operating expenses at the time the and the cost of the item can be A compensating transfer is made Bonus income is recognised once Where a large asset, for example trust commits itself to the retirement, determined reliably. from the revaluation reserve to the notified by NHS Improvement. regardless of the method of payment. a building, includes a number of

162 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 163 income and expenditure reserve of except where the ‘fair value less will result in an intangible asset for acquisition and that are readily transactions costs, and are measured recorded as property, plant and an amount equal to the lower of (i) costs to sell’ falls below the carrying sale or use; convertible to known amounts of subsequently at amortised cost, equipment and a corresponding the impairment charged to operating amount. Assets are de-recognised cash with insignificant risk of change using the effective interest method. liability is recorded. The value at • the Trust intends to complete the expenses; and (ii) the balance in the when all material sale contract in value. The effective interest rate is the rate which both are recognised is the asset and sell or use it; revaluation reserve attributable to conditions have been met. that discounts exactly estimated lower of the fair value of the asset In the Statement of Cash Flows, cash that asset before the impairment. • the Trust has the ability to sell or future cash receipts through the or the present value of the minimum Property, plant and equipment which and cash equivalents are shown net use the asset; expected life of the financial asset lease payments, discounted using the An impairment that arises from is to be scrapped or demolished does of bank overdrafts that are repayable or, when appropriate, a shorter interest rate implicit in the lease. a clear consumption of economic not qualify for recognition as ‘Held • how the intangible asset will on demand and that form an integral period, to the net carrying amount benefit or service potential is for Sale’ and instead is retained as generate probable future part of the Trust’s cash management. The asset and liability are recognised of the financial asset. Interest on reversed when, and to the extent an operational asset and the asset’s economic or service delivery Cash, bank and overdraft balances at the commencement of the lease. loans and receivables is calculated that, the circumstances that gave economic life is adjusted. The asset benefits e.g. the presence of a are recorded at current values. Thereafter the asset is accounted using the effective interest method rise to the loss is reversed. Reversals is de-recognised when scrapping or market for it or its output, or for as an item of property, plant and and credited to the Statement of are recognised in operating income demolition occurs. where it is to be used for internal equipment. Comprehensive Income. to the extent that the asset is use, the usefulness of the asset; 1.11 Financial instruments The annual rental is split between restored to the carrying amount it • adequate financial, technical and and financial liabilities Financial Liabilities the repayment of the liability and would have had if the impairment 1.8.4 Donated assets other resources are available to the All financial liabilities are recognised a finance cost so as to achieve a had never been recognised. Any Recognition Donated property, plant and Trust to complete the development initially at fair value, net of constant rate of finance over the life remaining reversal is recognised in equipment assets are capitalised and sell or use the asset; and Financial assets and financial liabilities transaction costs incurred, and of the lease. The annual finance cost the revaluation reserve. Where, at at their fair value on receipt. The which arise from contracts for the measured subsequently at amortised is charged to Finance Costs in the the time of the original impairment, • the Trust can measure reliably the donation is credited to income at purchase or sale of non-financial cost using the effective interest Statement of Comprehensive Income. a transfer was made from the expenses attributable to the asset the same time, unless the donor items (such as goods or services), method. The effective interest rate The lease liability, is de-recognised revaluation reserve to the income during development. has imposed a condition that the which are entered into in accordance is the rate that discounts exactly when the liability is discharged, and expenditure reserve, an amount future economic benefits embodied with the Trust’s normal purchase, estimated future cash payments cancelled or expires. is transferred back to the revaluation Software Licences in the grant are to be consumed in sale or usage requirements, are through the expected life of reserve when the impairment reversal Software which is integral to the a manner specified by the donor, in recognised when, and to the extent the financial liability or, when Operating leases is recognised. operation of hardware e.g. an which case, the donation is deferred which, performance occurs i.e. when appropriate, a shorter period, to the Other leases are regarded as operating system, is capitalised as Other impairments are treated within liabilities and is carried receipt or delivery of the goods or net carrying amount of the financial operating leases and the rentals are part of the relevant item of property, as revaluation losses. Reversals of forward to future financial years to services is made. liability. charged to operating expenses on a plant and equipment. Software which ‘other impairments’ are treated as the extent that the condition has not straight-line basis over the term of is not integral to the operation of Financial assets or financial liabilities They are included in current liabilities revaluation gains. yet been met. the lease. Operating lease incentives hardware, e.g. application software, in respect of assets acquired or except for amounts payable more received are added to the lease Donated assets are subsequently is capitalised as an intangible asset. disposed of through finance leases than 12 months after the Statement rentals and charged to operating accounted for in the same manner are recognised and measured in of Financial Position date, which are 1.8.3 De-recognition expenses over the life of the lease. as other items of property, plant and accordance with the accounting classified as non-current financial Assets intended for disposal are equipment. 1.9.2 Measurement policy for leases described below. liabilities. Interest on financial Operating lease income is received reclassified as ‘Held for Sale’ once all liabilities carried at amortised cost is for the lease of buildings or land Intangible assets are recognised All other financial assets and financial of the following criteria are met: calculated using the effective interest where the risks and rewards of initially at cost, comprising all directly liabilities are recognised when the 1.9 Intangible assets method and charged to Finance ownership of the leased asset are • the asset is available for immediate attributable costs needed to create, NHS Foundation Trust becomes a Costs. Interest on financial liabilities retained by the Trust. sale in its present condition subject produce and prepare the asset party to the contractual provisions of taken out to finance property, plant only to terms which are usual and to the point that it is capable of the instrument. 1.9.1 Recognition and equipment or intangible assets is Leases of land and buildings customary for such sales operating in the manner intended by De-recognition not capitalised as part of the cost of Where a lease is for land and Intangible assets are non-monetary management. • the sale must be highly probable assets without physical substance All financial assets are de-recognised those assets. buildings, the land component ie: which are capable of being sold Amortisation when the rights to receive cash flows is separated from the building Impairment of financial assets component and the classification for - management are committed to separately from the rest of the Intangible assets are amortised over from the assets have expired or the At the Statement of Financial Position each is assessed separately. Leased a plan to sell the asset; Trust’s business or which arise from their expected useful economic lives Trust has transferred substantially date, the Trust assesses whether land is treated as an operating lease. contractual or other legal rights. in a manner consistent with the all of the risks and rewards of - an active programme has begun any financial assets are impaired. They are recognised only where it consumption of economic or service ownership. Financial liabilities are to find a buyer and complete Financial assets are impaired and is probable that future economic delivery benefits. de-recognised when the obligation is the sale; benefits will flow to, or service discharged, cancelled or expires. recognised if, and only if, there is 1.12.2 The Trust as Lessor objective evidence of impairment as - the asset is being actively potential be provided to, the Trust a result of one or more events which Finance leases marketed at a reasonable price; and where the cost of the asset can 1.9 Inventories Classification and Measurement be measured reliably. Financial assets are categorised as occurred after the initial recognition Amounts due from leases under Inventories are valued at the lower of - the sale is expected to be loans and receivables. of the asset and which has an impact finance leases are recorded as completed within 12 months of Internally Generated cost and net realisable value. The cost on the estimated future cash flows of receivables at the amount of the the date of classification as Intangible Assets of inventories is measured using the Loans and receivables the asset. trust net investment in the leases. First In, First Out (FIFO) method less ‘Held for Sale’; and Internally generated goodwill, Loans and receivables are non- Finance lease income is allocated any provisions deemed necessary. to accounting periods to reflect - the actions needed to complete brands, mastheads, publishing titles, derivative financial assets with fixed 1.12 Leases a constant periodic rate of return the plan indicate it is unlikely customer lists and similar items are or determinable payments which on the Trust’s net investment that the plan will be dropped or not capitalised as intangible assets. are not quoted in an active market. 1.10 Cash and cash outstanding in respect of the leases. significant changes made to it. Expenditure on research is not They are included in current assets. 1.12.1 The Trust as Lessee equivalents The Trust’s loans and receivables Following reclassification, the capitalised. Expenditure on Operating leases development is capitalised only Cash is cash in hand and deposits with comprise: cash and cash equivalents, Finance leases assets are measured at the lower of NHS receivables, accrued income and Rental income from operating leases where all of the following can be any financial institution repayable Where substantially all risks their existing carrying amount and ‘other receivables’. is recognised on a straight line basis their ‘fair value less costs to sell’. demonstrated: without penalty on notice of not and rewards of ownership of a over the term of the lease. Initial more than 24 hours. Cash equivalents leased asset are borne by the Depreciation ceases to be charged • the project is technically feasible Loans and receivables are recognised direct costs incurred in negotiating are investments that mature in 3 NHS foundation trust, the asset is and the assets are not revalued, to the point of completion and initially at fair value, net of and arranging an operating lease months or less from the date of

164 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 165 are added to the carrying amount of • present obligations arising from 1.17 Corporation Tax the leased asset and recognised as an past events but for which it is expense on a straight-line basis over not probable that a transfer of Aintree University Hospital NHS the lease term. economic benefits will arise or Foundation Trust is a Health Service for which the amount of the body within the meaning of s519A obligation cannot be measured ICTA 1988 and accordingly is 1.13 Provisions with sufficient reliability. temporarily exempt from taxation in respect of income and capital The Trust recognises a provision where gains within categories covered it has a present legal or constructive 1.15 Public by this. There is a power for the obligation of uncertain timing or dividend capital Treasury to disapply the exemption amount; for which it is probable in relation to the specified activities that there will be a future outflow Public dividend capital (PDC) is a type of a Foundation Trust (s519A (3) of cash or other resources; and a of public sector equity finance based to (8) ICTA), accordingly, the Trust reliable estimate can be made of the on the excess of assets over liabilities is potentially within the scope amount. The amount recognised in at the time of establishment of the of Corporation Tax in respect of the Statement of Financial Position predecessor NHS organisation. HM activities which are not related is the best estimate of the resources Treasury has determined that PDC is to, or ancillary to, the provision of required to settle the obligation. not a financial instrument within the healthcare and where the profits Where the effect of the time value of meaning of IAS 32. exceed £50,000 per annum. However, money is significant, the estimated there is no tax liability in respect of At any time, the Secretary of State risk-adjusted cash flows are discounted the current financial year. using the discount rates published and can issue new PDC to, and require mandated by HM Treasury. repayments of PDC from, the Trust. PDC is recorded at the value received. Clinical negligence costs 1.18 Foreign Exchange A charge, reflecting the cost of capital The functional and presentational NHS Resolution operates a risk utilised by the Trust, is payable as PDC pooling scheme under which the currencies of the trust are sterling. A dividend. The charge is calculated at transaction which is denominated in Trust pays an annual contribution the rate set by HM Treasury (currently to NHS Resolution, which, in a foreign currency is translated into 3.5%) on the average relevant the functional currency at the spot return, settles all clinical negligence net assets of the Trust during the claims. Although NHS Resolution is exchange rate on the date of the financial year. Relevant net assets are transaction. administratively responsible for all calculated as the value of all assets less clinical negligence cases, the legal the value of all liabilities, except for (i) liability remains with the Trust. The donated assets, (ii) average daily cash 1.19 Third party assets total value of clinical negligence held with the Government Banking provisions carried by NHS Resolution Service (GBS) and National Loans Assets belonging to third parties being included as normal revenue and the government implementation 1.23 Segmental Analysis on behalf of the Trust is disclosed at Fund (NLF) deposits, excluding cash (such as money held on behalf of expenditure). date for IFRS16 still subject to HM note 14.2 but is not recognised in the balances held in GBS accounts that patients) are not recognised in the Treasury consideration. Operating segments are reported However the losses and special NHS Foundation Trust’s accounts. relate to a short-term working capital accounts since the Trust has no in a manner consistent with the payments note is compiled directly • IFRS9 Financial Instruments facility, and (iii) any PDC dividend beneficial interest in them. However, internal reporting provided to the Non-clinical risk pooling from the losses and compensations - Application required for balance receivable or payable. they are disclosed in a separate note chief operating decision-maker. The Trust participates in the Property to the accounts in accordance with register which reports on an accruals accounting periods beginning The chief operating decision maker, Expenses Scheme and the Liabilities In accordance with the requirements the requirements of HM Treasury’s basis with the exception of provisions on or after 1 January 2018, who is responsible for allocating to Third Parties Scheme. Both are risk laid down by the Department of Financial Reporting Manual. for future losses. not yet adopted by the FReM: resources and assessing performance pooling schemes under which the Health (as the issuer of PDC) the early adoption is not therefore of the operating segments, has been Trust pays an annual contribution to dividend for the year is calculated on permitted identified as the Board that makes the actual average relevant net assets 1.21 Gifts NHS Resolution and in return receives 1.20 Losses and Special • IFRS15 Revenue from contracts strategic decisions. A segmental as set out in the “pre-audit” version assistance with the costs of claims Gifts are items that are voluntarily with Customers - Application analysis is shown at Note 2. of the annual accounts. The dividend Payments arising. The annual membership donated, with no preconditions required for accounting periods thus calculated is not amended Losses and special payments are contributions, and any ‘excesses’ and without the expectation of any beginning on or after 1 January should any adjustment to net assets items that Parliament would not payable in respect of particular claims return. Gifts include all transactions 2018, but not yet adopted by occur as a result of the audit of the have contemplated when it agreed are charged to operating expenses economically equivalent to free and the FReM: early adoption is not annual accounts. funds for the health service or passed when the liability arises. unremunerated transfers, such as therefore permitted legislation. By their nature they are the loan of an asset for its expected items that ideally should not arise. • IFRS16 Leases - Application 1.16 Value Added Tax useful life, and the sale or lease of 1.14 Contingencies They are therefore subject to special assets below market value. required for accounting periods control procedures compared with beginning on or after 1 January Contingent liabilities are not Most of the activities of the Trust the generality of payments. They 2019, but not yet adopted by recognised, but are disclosed in Note are outside the scope of VAT and, in are divided into different categories, the FReM: early adoption is not 17, unless the probability of a transfer general, output tax does not apply 1.22 Standards issued but which govern the way that individual therefore permitted of economic benefits is remote. and input tax on purchases is not cases are handled. Losses and special not yet adopted Contingent liabilities are defined as: recoverable. Irrecoverable VAT is • IFRIC22 Foreign Currency payments are charged to the relevant charged to the relevant expenditure The DH GAM does not require Transactions and Advance • possible obligations arising from functional headings in expenditure category or included in the capitalised the following Standards and Consideration - Application past events whose existence will be on an accruals basis, including losses purchase cost of fixed assets. Where Interpretations to be applied in required for accounting periods confirmed only by the occurrence which would have been made good output tax is charged or input VAT is 2017/18. These standards are still beginning on or after 1 January of one or more uncertain future through insurance cover had NHS recoverable, the amounts are stated subject to HM Treasury FReM 2018. events not wholly within the net of VAT. trusts not been bearing their own adoption, with IFRS9 and IFRS15 entity’s control; or risks (with insurance premiums then being for implementation in 2018/19,

166 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 167 Aintree University Hospital NHS Foundation Trust - Annual Accounts 2017/18 Aintree University Hospital NHS Foundation Trust - Annual Accounts 2017/18 Aintree University Hospital NHS Foundation Trust - Annual Accounts 2017/18

2. Segmental Reporting 3.1 Operating Income 2017/18 2016/17 2. Segmental Reporting £000 £000 Income from Activities by nature* Medicine and MedicineEmergency and Surgery Total Emergency Surgery Total Care Elective income 45,492 49,915 Care Non elective income 90,818 82,306 2017/18 2016/17 2017/18 2016/17 2017/18 2016/17 Outpatient income 23,445 23,920 2017/18£000 2016/17£000 2017/18£000 2016/17£000 2017/18£000 2016/17£000 Follow up outpatient income 21,803 25,453 £000 £000 £000 £000 £000 £000 A & E income 13,834 12,319 Income * 135,750 127,408 138,126 143,346 273,876 270,754 High cost drug items from commissioners 21,455 19,955 Income * 135,750 127,408 138,126 143,346 273,876 270,754 Private patient income 1,618 1,681 Expenditure * Pay (77,920) (65,771) (78,643) (77,355) (156,563) (143,126) Other types of non-PBR NHS clinical income 83,536 84,699 Expenditure * Pay Non-Pay (77,920)(31,659) (65,771)(30,705) (78,643)(33,794) (77,355)(35,756) (156,563)(65,453) (143,126)(66,461) Non-PayTotal (31,659)(109,579) (30,705)(96,476) (33,794)(112,437) (35,756)(113,111) (65,453)(222,016) (66,461)(209,587) Total Income from Activities 302,001 300,248 Total (109,579) (96,476) (112,437) (113,111) (222,016) (209,587) Total Other Operating Income 48,987 43,123 Total Contribution 51,860 61,167 Total Contribution 51,860 61,167 Total Operating Income 350,988 343,371 Other Services ** (78,785) (58,986) Other Services ** (78,785) (58,986) * £296m (£293m in 2016/17) of the £302m (£300m in 2016/17) Total Income from Activities relates to Total (Deficit) / Surplus (26,925) 2,181 Commissioner Requested Services and £6m (£7m in 2016/17) is from non-Commissioner Requested Total (Deficit) / Surplus (26,925) 2,181 Services. 2017/18 2016/17 * The figures for both Medicine and Surgery include income from non-clinical services of: Income from Activities by source £000 £000 * The figures for both Medicine and Surgery include income from non-clinical services of: 2016/17 2017/18 NHS Foundation Trusts 518 468 2017/18 2016/17£000 £000 NHS Trusts 3,418 5,183 £000 £000 CCGs & NHS England 286,661 284,882 Surgery 3,968 4,087 Surgery 3,968 4,087 Local Authorities 653 761 Medicine 2,061 1,881 Department of Health 26 20 Medicine 2,061 1,881 NHS other 87 160 6,029 5,968 Non-NHS private patients 1,618 1,681 6,029 5,968 Non-NHS overseas visitors (chargeable to patient) 127 142 NHS Injury cost recovery scheme 2,408 2,136 ** "Other services" contains the following : Non-NHS other 6,485 4,815 ** "Other services" contains the following : Income of £77,167,000 Comprises Training and Education Levies, Direct Access Community Services, Service Level Agreements Total Income from Activities 302,001 300,248 Income(2016/17, of £77,167,000 £72,686,000) Compriseswith otherTrainingproviderand Educationorganisations,Levies,ResearchDirect Accessand DevelopmentCommunity Services,and incomeServicegeneratingLevel Agreementsactivities (e.g. (2016/17, £72,686,000) with Catering,other providerInjury Costsorganisations,RecoveryResearch(ICR) income,and Developmentetc.) and Sustainableand income& generatingTransformationalactivitiesFund(e.g.(STF) Catering,Income.Injury Costs Recovery (ICR) income, etc.) and Sustainable & Transformational Fund (STF) Other Operating Income Income. Expenditure of £155,952,000 Comprises Clinical Support Services (e.g. Radiology, Pathology, Physiotherapy, etc.), Central Support Research and development 783 922 Expenditure(2016/17, of £131,672,000)£155,952,000 ComprisesDepartmentsClinical(e.g.SupportEstatesServices& Maintenance,(e.g. Radiology,Hotel Services,Pathology,Finance,Physiotherapy,HR, etc.),etc.),accountingCentral chargesSupport for Education and training 12,494 12,882 (2016/17, £131,672,000) Departmentsdepreciation(e.g. andEstates the payment& Maintenance, of a Public DividendHotel Services, Capital dividend.Finance, HR, etc.), accounting charges for Notional income from Apprenticeship Fund 360 0 depreciation and the payment of a Public Dividend Capital dividend. Charitable contributions to expenditure (donated assets) 1,020 56 Non patient care services to other bodies 6,550 4,925 Sustainability and Transformation Fund income 10,591 10,284 The Trust does not report total assets attributable to each operating segment to the Board. Consequently, total assets attributable to each Catering income 3,004 2,697 The Trustoperatingdoes segmentnot report are totalnot disclosed.assets attributable to each operating segment to the Board. Consequently, total assets attributable to each Car park income 2,782 2,679 operating segment are not disclosed. Central funding for Consultant Clinical Excellence Awards 820 804 Income Generation schemes 1,099 1,086 The Trust considers the Board of Directors to be the Chief Operating Decision Maker (CODM) because it regularly reviews operating Other income ** 9,484 6,788 The results,Trust considers makes decisionsthe Board aboutof Directorswhere resourcesto be the areChief allocatedOperating as a resultDecision and assessesMaker (CODM) performance.because it regularly reviews operating results, makes decisions about where resources are allocated as a result and assesses performance. Total Other Operating Income 48,987 43,123 Income and expenditure arising from both the medicine and surgery departments are what is reported to the Board on a distinct and Incomeseparateand expenditure basis and thereforearising fromthey haveboth alsothe medicinebeen disclosedand surgery separatelydepartments in the accounts.are what is reported to the Board on a distinct and separate basis and therefore they have also been disclosed separately in the accounts. Total Operating Income 350,988 343,371 The majority of the Trust's revenue is generated from three NHS customers, with each amounting to more than 10% of the Trust's total The majorityincome. Theseof the Trust'scustomersrevenue generatedis generated income offrom £87.7m,three £78.6mNHS customers, and £41.5mwith andeach are includedamounting in allto ofmore the segmentsthan 10% reportedof the Trust's above.total ** Other income consists of a number of items (such as charges to organisations using the Trust's facilities, income. These customers generated income of £87.7m, £78.6m and £41.5m and are included in all of the segments reported above. income from various training courses) that, individually, total less than £1m.

3.2 Overseas visitors (relating to patients charged directly by the 2017/18 2016/17 Foundation Trust) £000 £000

Income recognised in-year 127 142 Cash payments received in-year (relating to current and prior years) 82 138 Amounts impaired in-year (relating to current or prior years) 0 12 Amounts written off in-year (relating to current and prior years) 23 9

Income

168 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 169 Aintree University Hospital NHS Foundation Trust - Annual Accounts 2017/18

4.1 Operating Expenditure 2017/18 2016/17 5.3 Pension Costs £000 £000 Past and present employees are covered by the provisions of the two NHS Pension Schemes. Details Clinical services from other NHS bodies 1,464 1,407 of the benefits payable and rules of the Schemes can be found on the NHS Pensions website at www. Purchases of healthcare from non-NHS bodies 1,192 3,170 nhsbsa.nhs.uk/pensions. Both are unfunded defined benefit schemes that cover NHS employers, GP Staff and Executive Directors Costs 221,408 208,269 practices and other bodies, allowed under the direction of the Secretary of State in England and Wales. Remuneration of Non-Executive Directors 116 121 They are not designed to be run in a way that would enable NHS bodies to identify their share of the Reversal of previously accrued potential redundancy costs (1,331) (684) underlying scheme assets and liabilities. Therefore, each scheme is accounted for as if it were a defined Drug costs 31,537 30,588 contribution scheme: the cost to the NHS Supplies and services - clinical (excluding drugs) 45,052 45,321 body of participating in each scheme is taken as equal to the contributions payable to that scheme for the Supplies and services - general 11,031 10,556 accounting period. Establishment costs 4,076 3,757 Notional expenditure from Apprenticeship Fund 360 0 In order that the defined benefit obligations recognised in the financial statements do not differ materially Transport costs 696 920 from those that would be determined at the reporting date by a formal actuarial valuation, the FReM Premises costs 16,249 15,868 requires that “the period between formal valuations shall be four years, with approximate assessments in Bad debt charge 705 725 intervening years”. Rentals under operating leases 3,140 3,085 Depreciation of property, plant and equipment 5,216 5,327 An outline of these follows: Amortisation of intangible non-current assets 48 13 Impairment of Assets 23,395 0 Internal Audit costs 102 101 a) Accounting valuation Audit fees relating to statutory audit 57 59 Audit assurance on the Quality Account 10 10 A valuation of scheme liability is carried out annually by the scheme actuary (currently the Government Other audit assurance work 4 4 Actuary’s Department) as at the end of the reporting period. This utilises an actuarial assessment for the Clinical negligence 6,703 6,118 previous accounting period in conjunction with updated membership and financial data for the current Other expenditure 1,640 1,312 reporting period, and is accepted as providing suitably robust figures for financial reporting purposes. The valuation of scheme liability as at 31 March 2018, is based on valuation data as at 31 March 2017, Total operating expenditure 372,870 336,047 updated to 31 March 2018 with summary global member and accounting data. In undertaking this actuarial assessment, the methodology prescribed in IAS 19, relevant FReM interpretations, and the discount rate prescribed by HM Treasury have also been used. 4.2 Impairment of Assets 2017/18 2016/17 £000 £000 The latest assessment of the liabilities of the scheme is contained in the report of the scheme actuary, which Impairments charged to operating deficit forms part of the annual NHS Pension Scheme Accounts. These accounts can be viewed on the NHS Pensions website and are published annually. Copies can also be obtained from The Stationery Office. Changes in market price following a full revaluation of the Trust's estate 23,395 0

Total impairments charged to operating deficit 23,395 0 b) Full actuarial (funding) valuation

Total impairments charged to Revaluation Reserve 0 0 The purpose of this valuation is to assess the level of liability in respect of the benefits due under the schemes (taking into account their recent demographic experience), and to recommend contribution rates Total impairments 23,395 0 payable by employees and employers.

4.3 Auditors Liability The last published actuarial valuation undertaken for the NHS Pension Scheme was completed for the year ending 31 March 2012. The Scheme Regulations allow for the level of contribution rates to be changed by The independent Auditors will accept liability to pay damages for losses arising as a direct result of breach of the Secretary of State for Health, with the consent of HM Treasury, and consideration of the advice of the contract or negligence on its part in respect of services provided. The limitation on the independent Auditors' Scheme Actuary and appropriate employee and employer representatives as deemed appropriate. liability was set at £1m in the 2017/18 engagement letter (£1m in 2016/17). The next actuarial valuation was to be carried out as at 31 March 2016, and is currently being prepared. The direction assumptions are published by HM Treasury which are used to complete the valuation calculations, 5.1 Employee Expenses 2017/18 2016/17 from which the final valuation report can be signed off by the scheme actuary. This will set the employer £000 £000 contribution rate payable from April 2019 and will consider the cost of the Scheme relative to the employer cost cap. There are provisions in the Public Service Pension Act 2013 to adjust member benefits or Salaries and wages (including bank and locum staff) 171,693 163,481 contribution rates if the cost of the Scheme changes by more than 2% of pay. Subject to this ‘employer cost Social security costs 15,735 15,018 cap’ assessment, any required revisions to member benefits or contribution rates will be determined by the Apprenticeship Levy 769 0 Secretary of State for Health after consultation Employer's contribution to NHS Pensions 17,964 16,468 with the relevant stakeholders Employer's contribution to National Employer Savings Trust 11 7 Agency / contract staff 15,236 13,295 National Employment Savings Scheme (NEST) Total 221,408 208,269 The Pensions Act 2008 introduced automatic enrolment of eligible workers into a qualifying workplace Senior staff salary and pension disclosures have been included within the Remuneration Report . pension scheme. The National Employment Savings Scheme (NEST) is a defined contribution pension scheme and the Trust has a duty to automatically enrol employees into the scheme, subject to certain 5.2 Early Retirements due to Ill Health criteria. However, the number of enrolments and the level of contributions are not material to the This note discloses the number and additional pension costs for individuals who retired early on ill-health grounds Trust’s Accounts. during the year, the costs of which are met by NHS Pensions. There was 1 early retirement on the grounds of ill health in 2017/18 at a cost of £60,000 (10 at a cost of £551,000 in 2016/17). This information was supplied by NHS Pensions.

Expend

170 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 171 Aintree University Hospital NHS Foundation Trust - Annual Accounts 2017/18 Aintree University Hospital NHS Foundation Trust - Annual Accounts 2017/18

6.1 Finance Income 2017/18 2016/17 8.1 Intangible Assets (Relates to software licenses.) Total £000 £000 £000

Interest on cash investments 0 36 Cost at 1 April 2017 1,921 Interest on bank deposits 55 32 Additions - purchased 868 Total 55 68 Correction of gross historical balances (nil net impact) (1,680)

Cost at 31 March 2018 1,109 6.2 Finance Costs 2017/18 2016/17 £000 £000 Accumulated amortisation at 1 April 2017 1,680

Interest on loans from the Department of Health 1,585 1,657 Provided during the year 48 Correction of gross historical balances (nil net impact) (1,680) Interest on Finance Leases 0 3

Accumulated amortisation at 31 March 2018 48 Total 1,585 1,660 Net book value total at 31 March 2018 1,061

7. Operating Leases 8.2 Intangible Assets 2016/17 £000 7.1 Aintree University Hospital NHS Foundation Trust as "Lessor" 2017/18 2016/17 Cost at 1 April 2016 1,828 Operating lease income £000 £000 Additions - purchased 241 Property rentals recognised as income in the year 55 91 Assets fully amortised and no longer in use (148)

Total 55 91 Cost at 31 March 2017 1,921

Future minimum lease payments due 2017/18 2016/17 Accumulated amortisation at 1 April 2016 1,815 £000 £000 Provided during the year 13 - not later than one year 39 32 Assets fully amortised and no longer in use (148)

Total 39 32 Accumulated amortisation at 31 March 2017 1,680

Net book value total 31 March 2017 241

7.2 Aintree University Hospital NHS Foundation Trust as "Lessee" The useful economic life for all reported intangible assets is 5 years (2016/17, 5 years). 2017/18 2016/17 Operating lease expenditure £000 £000

Minimum lease payments 3,140 3,085

Total 3,140 3,085

Future minimum lease payments due 2017/18 2016/17 £000 £000

- not later than one year 875 1,104 - later than one year and not later than five years 1,398 1,818 - later than five years 0 18 Intangibles Total 2,273 2,940

All operating lease expenditure refers to plant and equipment (medical equipment and lease cars).

Leases

172 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 173 Aintree University Hospital NHS Foundation Trust - Annual Accounts 2017/18 Aintree University Hospital NHS Foundation Trust - Annual Accounts 2017/18

9.1 Property, Plant and Equipment Total Land Buildings Dwellings Assets Plant & Transport Informatio Furniture & 10. Inventories 31 March 2018 31 March 2017 excluding under machinery Equipment n fittings £000 £000 dwellings construction technology Drugs 2,223 2,193 £000 £000 £000 £000 £000 £000 £000 £000 £000 Total Inventories 2,223 2,193 Cost at 1 April 2017 235,193 7,556 183,082 4,852 145 30,811 0 7,870 877 Drug costs recognised in expenses in 2017/18 were £31,537,000 (£30,588,000 in 2016/17) of which £31,492,000 Additions - purchased 9,706 0 2,247 51 2,826 3,078 18 1,428 58 Additions - donations of physical assets 1,020 0 900 0 0 120 0 0 0 were inventory items. The write down of inventories recognised as an expense for the year was £0 (£0 in 2016/17) Impairments charged to operating expenses (23,395) 0 (20,167) (3,228) 0 0 0 0 0 Revaluations (102) (2,500) 2,354 44 0 0 0 0 0 11.1 Trade and Other Receivables 31 March 2018 31 March 2017 Reclassifications 0 0 39 0 (39) 0 0 0 0 £000 £000 Disposal of assets with zero net book value (nil net impact) 0 0 0 0 (8,124) 0 (1,264) (226) (9,614) Current Cost at 31 March 2018 212,808 5,056 168,455 1,719 2,932 25,885 18 8,034 709 Trade receivables 9,884 10,742 Accumulated depreciation at 1 April 2017 40,981 0 9,144 502 0 23,809 0 6,933 593 Injury Costs Recovery Scheme (ICR) receivables 4,169 3,928 Provision for impaired receivables (1,598) (1,785) Provided during the year 5,216 0 2,730 40 0 2,042 0 318 86 Prepayments 3,033 2,274 Revaluations (9,574) 0 (9,073) (501) 0 0 0 0 0 Accrued income 7,270 4,010 Disposal of assets with zero net book value (nil net impact) (9,614) 0 0 0 0 (8,124) 0 (1,264) (226) PDC dividend receivable 454 468

Accumulated depreciation at 31 March 2018 27,009 0 2,801 41 0 17,727 0 5,987 453 Total Current Trade and Other Receivables 23,212 19,637

Of which £14.870,000 were current receivables from NHS and DHSC Group Bodies. Net book value and financing None of the receivable balances are secured. Amounts are generally due within 30 days and will be settled in NBV - Purchased at 31 March 2018 182,853 5,056 162,855 1,678 2,932 8,011 18 2,047 256 NBV - Donated at 31 March 2018 2,946 0 2,799 0 0 147 0 0 0 cash.

Net book value total at 31 March 2018 185,799 5,056 165,654 1,678 2,932 8,158 18 2,047 256 11.2 Provision for Impairment of Receivables 2017/18 2016/17 £000 £000

Aintree University Hospital NHS Foundation Trust - Annual Accounts 2017/18 As at 1 April 1,785 1,582

Increase in provision 730 916 Land Buildings Dwellings Assets Plant & Informatio Furniture & 9.2 Property, Plant and Equipment Total Amounts utilised (892) (522) excluding under machinery n fittings Unused amounts reversed (25) (191) dwellings construction technology

£000 £000 £000 £000 £000 £000 £000 £000 As at 31 March 1,598 1,785

Cost at 1 April 2016 223,739 7,556 161,058 4,819 13,138 29,058 7,441 669 11.3 Analysis of Impaired Receivables Additions - purchased 11,501 0 9,106 33 145 1,605 404 208 Receivables in this section only refer to outstanding aged debt for which invoices have been raised. They do not Additions - donations of physical assets 56 0 0 0 0 56 0 0 include debts that arise under statute, such as Injury Cost Recovery (ICR) claims, which comprise the majority of Reclassifications 0 0 12,918 0 (13,138) 195 25 0 the Trust's impaired debt. Assets fully depreciated and no longer in use (103) 0 0 0 0 (103) 0 0 2017/18 2016/17 Cost at 31 March 2017 235,193 7,556 183,082 4,852 145 30,811 7,870 877 £000 £000 Ageing of impaired receivables Accumulated depreciation at 1 April 2016 35,757 0 6,498 385 0 21,742 6,607 525 0 - 30 days 0 13 Provided during the year 5,327 0 2,646 117 0 2,170 326 68 31 - 60 days 0 6 Assets fully depreciated and no longer in use (103) 0 0 0 0 (103) 0 0 61 - 90 days 5 1 91 - 180 days 11 2 Accumulated depreciation at 31 March 2017 40,981 0 9,144 502 0 23,809 6,933 593 Over 180 days 48 70

Total 64 92 Net book value and financing 2017/18 2016/17 NBV - Purchased at 31 March 2017 192,696 7,556 172,496 4,350 145 6,928 937 284 Ageing of non-impaired receivables £000 £000 NBV - Donated at 31 March 2017 1,516 0 1,442 0 0 74 0 0 0 - 30 days 3,739 1,729 Net book value total at 31 March 2017 194,212 7,556 173,938 4,350 145 7,002 937 284 31 - 60 days 819 1,026 61 - 90 days 872 307 91 - 180 days 716 1,557 Over 180 days 1,832 1,591

Total 7,978 6,210 PPE1718 The majority of the NHS Foundation Trust's income is due from NHS commissioners and is subject to legally binding contracts which limits credit risk. Non-NHS customers form only a small proportion of total income and the majority of those customers are organisations that are unlikely to cease trading in the short term or default on payments (e.g. councils or universities).

Receivables

174 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 175

PPE1617 Aintree University Hospital NHS Foundation Trust - Annual Accounts 2017/18 Aintree University Hospital NHS Foundation Trust - Annual Accounts 2017/18

12.1 Trade and Other Payables 31 March 2018 31 March 2017 14.1 Provisions £000 £000 Total Pensions Other legal Other Current claims £000 £000 £000 £000 Trade payables 8,891 11,589 Capital payables 6,550 2,084 As at 1 April 2017 2,600 702 443 1,455 Accruals 22,758 14,598 Tax payable (income tax, national insurance and apprenticeship levy) 4,190 4,069 Arising during the year 252 19 233 0

Total Current Trade and Other Payables 42,389 32,340 Utilised during the year (159) (80) (79) 0

Of which £14,185,000 current payables were from NHS and DHSC Group bodies. Reversed unused (1,667) (4) (208) (1,455)

None of the payable balances are secured. Amounts are generally due within 30 days and will be settled in cash. As at 31 March 2018 1,026 637 389 0

12.2 Other Liabilities 31 March 2018 31 March 2017 £000 £000 Expected timings of cash flows: Current - not later than one year 469 80 389 0 Deferred income 7,199 6,263 - later than one year and not later than five years 267 267 0 0 Total Other Current Liabilities 7,199 6,263 - later than five years 290 290 0 0 31 March 2018 31 March 2017 Non-Current £000 £000 TOTAL 1,026 637 389 0

Deferred income falling due later than 1 year but less than 5 years 131 609 Deferred income falling due later than 5 years 144 168 "Pensions" include the likely cost of permanent injury and early retirement pension compensation settlements and the subsequent application of the appropriate value supplied by the Government's Actuary Department to assess the total Total Other Non-Current Liabilities 275 777 provision required for the anticipated duration of the liability. It does not include any provision relating to former Directors.

"Other legal claims" comprises provisions in respect of the Trust's employer and public legal liabilities. 13. Borrowings 31 March 2018 31 March 2017 £000 £000 Current 14.2 Clinical Negligence liabilities (see note 1.13 for further information) Total £000 Capital loans from the Department of Health (DoH) 2,655 2,423 Amount included in provisions of the NHS Resolution at 31 March 2018 in respect of clinical negligence Total Current Borrowing 2,655 2,423 liabilities of Aintree University Hospital NHS Foundation Trust 26,734

31 March 2018 31 March 2017 Non-Current £000 £000 Amount included in provisions of the NHS Resolution at 31 March 2017 in respect of clinical negligence liabilities of Aintree University Hospital NHS Foundation Trust 25,912 DoH loans falling due later than 1 year but less than 5 years 10,621 9,693 DoH loans falling due later than 5 years 38,490 36,273

Total Non-Current Borrowing 49,111 45,966

Analysis of DoH loans Interest rate Term (years)

Loan 1 - (Original value £24,000,000) Agreement Date 16 March 2010 4.27% 25 Loan 2 - (Original value £20,000,000) Agreement Date 19 March 2012 2.92% 25 Loan 3 - (Original value £15,000,000) Agreement Date 15 December 2014 2.62% 25 Loan 4 - (Original value £5,800,000) Agreement Date 6 February 2018 1.86% 25

Payables

Provisions

176 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 177 Aintree University Hospital NHS Foundation Trust - Annual Accounts 2017/18 Aintree University Hospital NHS Foundation Trust - Annual Accounts 2017/18 Aintree University Hospital NHS Foundation Trust - Annual Accounts 2017/18

18. Related Party Transactions 15. Cash and Cash Equivalents 31 March 2018 31 March 2017 18. Related Party Transactions £000 £000 TheThe Foundation Foundation Trust's Trust's parent parent entity entity is the is theDepartment Department of Healt of Health andh and Social Social Care. Care.

At 1 April 9,961 21,312 DuringDuringthetheyearyearreportedreportedin thesein theseaccounts,accounts,nonenoneof theof theBoardBoardMembers,Members,GovernorsGovernorsor keyor keymanagementmanagementstaffstaffhavehaveundertakenundertakenanyanymaterialmaterial transactionstransactionswithwithAintreeAintreeUniversityUniversityHospitalHospitalNHSNHSFoundationFoundationTrust.Trust.DetailsDetailsof Directors'of Directors'remunerationremunerationandandotherotherbenefitsbenefitsareareincludedincludedin thein the Net change in year 1,232 (11,351) AnnualAnnual Report's Report's Remuneration Remuneration Report. Report.

At 31 March 11,193 9,961 SomeSomestaffstaffandandGovernorsGovernorsof theof theTrustTrusthavehavean interestan interestin thein themanagementmanagementof Woodlandsof WoodlandsHospiceHospiceCharitableCharitableTrustTrust(a Hospice(a Hospicesitedsitedon onthetheTrustTrust grounds).grounds).However,However,thetheTrustTrustdoesdoesnotnotenterenterintointosignificantsignificantincomeincomeandandexpenditureexpendituretransactionstransactionswithwiththetheCharity,Charity,althoughalthoughit doesit doesundertakeundertake Cash at commercial banks and in hand 44 50 somesome transaction transaction processes processes on itson behalf,its behalf, such such as procurement.as procurement.

Cash with GBS (Government Banking Service) 11,149 9,911 MembersMembersof theof theBoardBoardof Directorsof DirectorsandandGovernorsGovernorsof theof theTrustTrustholdholdpositionspositionsat Universitiesat Universitiesbutbutarearenotnotin ainpositiona positionto materiallyto materiallyaffectaffect Cash and cash equivalents as in the Statement of Financial Position 11,193 9,961 transactionstransactionsbetweenbetweenthethetwotwoparties.parties.TheTheTrustTrusthashashadhada significanta significantnumbernumberof materialof materialtransactionstransactionswithwiththetheUniversitiesUniversitiesof Liverpoolof Liverpoolandand EdgeEdge Hill Hillas follows:-as follows:- Bank overdraft 0 0 Receivable Receivable Payable Expenditure Expenditure Income Income Receivable Receivable Payable Payable balance Expenditure Expenditure Income Income balance Payable balance balancebalance balance balancebalance Cash and cash equivalents as in the Statement of Cash Flows 11,193 9,961 2016/17 2016/17 31 March 2017 31 March 2017 2017/182017/18 2016/17 2017/182017/18 2016/17 31 March31 March 2018 2018 31 March 2017 31 March31 March 2018 2018 31 March 2017 £000 £000 £000 £000 £000£000 £000 £000£000 £000 £000£000 £000 £000£000 £000 University of Liverpool 1,719 276 82 20 University of Liverpool 1,8101,810 1,719 243 243 276 126 126 82 25 25 20 Edge Hill University 240 209 12 0 16. Contractual Capital Commitments Edge Hill University 273 273 240 225 225 209 22 22 12 12 12 0

Commitments under property, plant and equipment capital expenditure contracts, as at 31 March 2018, were £123,000 (£1,783,000 as at 31 March 2017). AintreeAintreeUniversityUniversityHospitalHospitalNHSNHSFoundationFoundationTrustTrusthashashadhada significanta significantnumbernumberof materialof materialtransactionstransactionswithwithSouthSouthSefton,Sefton,LiverpoolLiverpoolandand KnowlseyKnowlsey CCGs CCGs in 2017/18 in 2017/18 and and held held receivable receivable and and payable payable balan balancesces with with them them as atas 31 at March31 March 2018: 2018:

Receivable Receivable Payable 17. Contingent Liabilities 31 March 2018 31 March 2017 Expenditure Expenditure Income Income Receivable Receivable Payable Payable balance Expenditure Expenditure Income Income balance balance balance Payable balance £000 £000 balance balance balance 2017/18 2016/17 2017/18 2016/17 31 March 2018 31 March 2017 31 March 2018 31 March 2017 2017/18 2016/17 2017/18 2016/17 31 March 2018 31 March 2017 31 March 2018 31 March 2017 £000 £000 £000 £000 £000 £000 £000 £000 Contingent liabilities 10 16 £000 £000 £000 £000 £000 £000 £000 £000 South Sefton CCG 0 89,882 0 814 South Sefton CCG 0 0 0 90,13490,134 89,882 247 247 0 0 0 814 Liverpool CCG 0 17 84,782 83,112 152 113 3 17 10 16 Liverpool CCG 0 17 84,782 83,112 152 113 3 17 Knowsley CCG 0 32,704 14 0 Knowsley CCG 0 0 0 32,76832,768 32,704 21 21 14 83 83 0 The contingent liabilities recorded reflect amounts relating to employer liability legal cases not provided for in Note 14.1, as it is not considered probable that they will fall due. The amount recorded as a contingency is the difference between AintreeAintreeUniversityUniversityHospitalHospitalNHSNHSFoundationFoundationTrustTrusthashasalsoalsohadhada significanta significantnumbernumberof transactionsof transactionswithwithotherotherNHSNHSor Governmentor Governmentdepartmentsdepartments the amount provided in Note 14.1 and the agreed NHSLA excess level (i.e. the maximum which the Trust could be whichwhich are are all classedall classed as "relatedas "related parties" parties" to the to theTrust. Trust. Mater Material transactionsial transactions and/or and/or balances balances in excess in excess of £2m of £2m are are detailed detailed below: below: required to pay).

Receivable Receivable Payable Expenditure Expenditure Income Income Receivable Receivable Payable Payable balance Expenditure Expenditure Income Income balance Payable balance balancebalance balance balancebalance 2016/17 2016/17 31 March 2017 31 March 2017 2017/182017/18 2016/17 2017/182017/18 2016/17 31 March31 March 2018 2018 31 March 2017 31 March31 March 2018 2018 31 March 2017 £000 £000 £000 £000 £000£000 £000 £000£000 £000 £000£000 £000 £000£000 £000 Health Education England 0 13,620 48 6 Health Education England 3 3 0 13,41713,417 13,620 64 64 48 0 0 6 NHS England - Core (including NHS England - Core (including 0 10,284 3,753 0 0 0 0 12,61512,615 10,284 6,5336,533 3,753 0 0 0 STF)STF) NHS England Cheshire & NHS England Cheshire & 0 11,414 1,851 0 0 0 0 11,17211,172 11,414 434 434 1,851 0 0 0 MerseysideMerseyside Local Local Team Team NHS England North West NHS England North West 0 40,242 221 0 0 0 0 43,15343,153 40,242 823 823 221 18 18 0 CommissionCommission West Lancashire CCG 0 5,819 219 0 West Lancashire CCG 0 0 0 6,0636,063 5,819 219 219 219 5 5 0 St Helens CCG 0 2,809 0 0 St Helens CCG 0 0 0 2,5042,504 2,809 0 0 0 57 57 0 Southport & Formby CCG 0 8,764 867 0 Southport & Formby CCG 0 0 0 7,0737,073 8,764 45 45 867 0 0 0 Wirral CCG 0 2,994 57 0 Wirral CCG 0 0 0 2,7422,742 2,994 43 43 57 7 7 0 The Walton Centre NHS FT 173 3,333 1,247 90 The Walton Centre NHS FT 136 136 173 3,2553,255 3,333 1,5971,597 1,247 206 206 90 Liverpool Community Health NHS Liverpool Community Health NHS 2,329 1,143 112 55 1,1551,155 2,329 255 255 1,143 171 171 112 1,0001,000 55 TrustTrust Royal Liverpool & Broadgreen Royal Liverpool & Broadgreen 13,182 4,880 830 3,204 14,32214,322 13,182 5,8115,811 4,880 1,2591,259 830 4,3864,386 3,204 UniversityUniversity Hospitals Hospitals NHS NHS Trust Trust Betsi Cadwaladar University Local Betsi Cadwaladar University Local 0 3,242 0 0 0 0 0 3,6133,613 3,242 0 0 0 0 0 0 HealthHealth Board Board Isle of Man DoH and Social Care 0 2,130 0 0 Isle of Man DoH and Social Care 0 0 0 2,5742,574 2,130 0 0 0 0 0 0 NHS Resolution 6,118 0 0 0 NHS Resolution 6,7036,703 6,118 0 0 0 0 0 0 6 6 0 NHS Business Services Authority 16,103 0 0 325 NHS Business Services Authority 17,22017,220 16,103 0 0 0 0 0 0 0 0 325 National Insurance Fund 15,026 0 0 2,147 National Insurance Fund 15,74315,743 15,026 0 0 0 0 0 0 2,2462,246 2,147 NHS Pension Scheme 16,468 0 0 2,298 NHS Pension Scheme 17,96417,964 16,468 0 0 0 0 0 0 2,5412,541 2,298

All theAll thetransactions transactions referred referred to in to this in this note note were were on normalon normal commercial commercial terms. terms.

TheTheTrustTrustis theis thecorporatecorporatetrusteetrusteeof Theof TheAintreeAintreeUniversityUniversityHospitalHospitalCharitableCharitableFundFund(Regn(Regnno:no:1050542).1050542).TheTheCharitableCharitableFundFundAccountsAccountshavehave notnotbeenbeenconsolidatedconsolidatedintointothesetheseaccountsaccountsas theas thetransactionstransactionsareareconsideredconsideredimmaterialimmaterialin thein thecontextcontextof theof theTrust.Trust.TheTheprovisionalprovisionalturnoverturnoverof of thetheCharityCharityin 2017/18in 2017/18waswas£332,000£332,000(£174,000(£174,000in 2016/17)in 2016/17)andandits netits netassetsassetswerewere£1,022,000£1,022,000(£1,013,000(£1,013,000in 2016/17).in 2016/17).TheTheTrustTrustprovidesprovidesa a financialfinancial and and administration administration service service for forthe theCharity Charity for forwhich which the theCharity Charity paid paid £45,000 £45,000 in 2017/18 in 2017/18 (£44,000 (£44,000 in 2016/17). in 2016/17).

An AnAnnualAnnualReportReportandandAuditedAuditedAccountsAccountsof theof theTrust'sTrust'sCharityCharity(covering(coveringthetheyearyearreportedreportedin thesein theseAccounts)Accounts)willwillbe beavailableavailablefromfrom31 January31 January Cash 20192019 and and may may be accessedbe accessed via viathe theCharity Charity Commission Commission website website at www.charity-commission.gov.uk. at www.charity-commission.gov.uk.

178 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 179 RelatedRelated Parties Parties Aintree University Hospital NHS Foundation Trust - Annual Accounts 2017/18 Aintree University Hospital NHS Foundation Trust - Annual Accounts 2017/18

19. Financial Instruments 20. Third Party Assets

Although the NHS Foundation Trust does not hold or deal in complex financial instruments, it is required to comment upon its The Trust held £1,842 cash and cash equivalents as at 31 March 2018 (£2,691 as at 31 March 2017) which related to exposure to credit, liquidity and market risk and how those risks are managed. monies held by the Trust on behalf of patients. These figures have been excluded from cash and cash equivalents reported in the Accounts. 19.1 Exposure to Risk 21. Losses and Special Payments a) The majority of the NHS Foundation Trust's income is due from NHS commissioners and is subject to legally binding contracts which limits credit risk. Non-NHS customers form only a small proportion of total income and the majority of those customers are There were 436 cases of losses and special payments in 2017/18 (374 in 2016/17). These are accounted for on an organisations that are unlikely to cease trading in the short term or default on payments (e.g. councils, universities, Woodlands accruals basis and exclude provisions for future losses. As no individual losses exceeded £300,000, none require Hospice, etc.). analysing separately.

b) The NHS Foundation Trust is exposed to liquidity risk in that it needs to maintain sufficient cash balances to meet payable obligations in order to ensure continuity of service. However, that risk is mitigated by the regular monthly receipt of contractual 2017/18 2017/18 2016/17 2016/17 cash from NHS commissioners. Numbers Value Numbers Value £000 £000 Losses c) As the NHS Foundation Trust does not deal in currencies, invest cash over the long term, borrow at variable rates or hold any equity investments in companies (other than its own subsidiary) its exposure to market risk (either interest rate, currency or price) Overpayment of salaries 13 8 7 8 is limited. Injury Cost Recovery claims withdrawn 660 850 270 358 Private Patient debts 2 1 3 1 19.2 Managing Risk Overseas Visitor debts 11 23 5 9 Other bad debts and claims abandoned 28 16 16 4 a) To manage credit risk, the NHS Foundation Trust has documented debt collection procedures which are regularly reviewed and ensures that its credit control staff are adequately trained and resourced. Potential payment defaulters are identified at an 714 898 301 380 early stage and appropriate action is taken on a timely basis. (Also see measures to manage liquidity at (b)). Special Payments

b) The NHS Foundation Trust ensures that daily cash flows are examined and the investment of surplus cash is restricted to a Ex gratia payments in respect of loss of personal effects 23 5 18 3 term of three months. Cash investments are also restricted to highly rated, UK domiciled, financial institutions and the levels of Ex gratia payments in respect of loss of personal injury with advice 19 101 47 212 cash deposited in any individual institutions at any one time is restricted. Cash management is governed by a regularly reviewed Other ex gratia payments 9 5 8 3 Board Policy and departmental procedure notes. 51 111 73 218 c) Market risk is managed by limiting investments to fixed rate and fixed term with credit worthy institutions, based upon market knowledge as to the likely movements in interest rates. Total 765 1,009 374 598

19.3 Financial Assets by Category Loans and Loans and receivables receivables 31 March 2018 31 March 2017 Assets as per Statement of Financial Position £000 £000

Trade and other receivables (excluding non-financial assets) 14,990 12,158 Cash and cash equivalents 11,193 9,961 Total Financial Assets 22,656 22,119

Financial assets do not include receivables arising by statute (e.g. Injury Costs Recovery scheme receivables).

19.4 Financial Liabilities by Category Financial Financial liabilities liabilities 31 March 2018 31 March 2017 Liabilities as per Statement of Financial Position £000 £000

Borrowings (excluding finance leases) 51,766 48,389 Trade and other payables (excluding non-financial liabilities) 38,199 28,271 Total Financial Liabilities 87,903 76,660

19.5 Fair value of Financial Instruments

The Trust has 4 capital loans from the Department of Health which, in the main, are categorised as non-current financial liabilities. The carrying value of the liability is considered to approximate to fair value as the arrangement is of a fixed interest and equal instalment repayment nature and the interest rate is not materially different to the discount rate.

The carrying values of short term financial assets and financial liabilities are considered to approximate to fair value.

Losses

Fin Instruments 180 Aintree University Hospital NHS Foundation Trust Aintree University Hospital NHS Foundation Trust 181