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Annual Report and Accounts 2020-2021

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Annual Report and Accounts 2020-2021 Annual Report and Accounts 2020-2021 © Northern Health and Social Care Trust copyright 2021. This information is licensed under the Open Government Licence v3.0 To view this licence visit: www.nationalarchives.gov.uk/doc/opengovernment‐licence/version/3/ Any enquiries regarding this publication should be sent to [email protected] or 028 2766 1293 Northern Health and Social Care Trust Annual Report and Accounts for the year ended 31 March 2021 Laid before the Northern Ireland Assembly under Article 90 (5) of the Health and Personal Social Services (NI) Order 1972 (as amended by the Audit and Accountability Order 2003) by the Department of Health On 7 July 2021 Annual Report 2020/21 Contents Foreword from the Chairman 1 Performance Report Performance Overview 2 Performance Analysis 30 Accountability Report Corporate Governance Report Overview 45 Non-Executive Directors’ Report 46 Directors’ Report 47 Statement of Accounting Officer’s Responsibilities 49 Governance Statement 50 Remuneration and Staff Report 88 Assembly Accountability and Audit Report 102 Financial Statements Consolidated Accounts 114 Notes to the Accounts 122 Accounts of monies held on behalf of patients and residents 162 Glossary 167 Foreword from the Chairman I am pleased to present the Northern Health and Social Care Trust (the Trust) Annual Report and Accounts for the year ended 31 March 2021. The 2020/21 year has been a year like no other. The global COVID-19 pandemic changed priorities considerably as the Trust necessarily shifted its focus to dealing with the considerable pressures posed by often very ill patients whilst at the same time trying to maintain as many health and social care services as possible. That collective effort has been exceptional and I pay tribute to staff at all levels and in all roles for their dedication and resilience throughout the past year, often in the face of seemingly insurmountable challenges. Many staff have been redeployed into unfamiliar roles to meet urgent demand. The Trust successfully launched in a very short time, a new Nightingale facility on behalf of the region on the Whiteabbey Hospital site, to meet the intensive rehabilitation requirements of recovering COVID-19 patients. A Mass Vaccination Centre in Ballymena for staff and members of the public was also quickly established and continues to operate. This has been backed up by mobile teams, with vaccines being administered to care home residents and staff, the housebound and the homeless. In my Foreword to the 2019/20 Annual Report, I alluded to the creative and innovative ways of working that were beginning to emerge even in the early days of the pandemic. Service delivery and the way people work will see many positive changes. The Trust has also participated in the roll-out of some of the components of the Minister for Health’s ‘No More Silos’ programme and that process of transformation will continue over the coming year. I have no doubt that staff are physically and mentally exhausted after such a monumental effort and need time to recover. It is our hope that the vaccination programme, careful decision making by those in key positions and people continuing to adhere to the guidelines will prevent further surges and see some return to normality as we all knew it. That will allow us to continue the process of rebuilding those health and social care services upon which the population of the Northern area depends. Finally, in commending this report, I once again thank the Chief Executive, her senior management team and all staff throughout the Trust. Their considerable input and personal sacrifice in the face of adversity have been inspirational. Mr Bob McCann - Chairman 24 June 2021 1 PERFORMANCE REPORT PERFORMANCE OVERVIEW Purpose This section of the report presents the Chief Executive’s perspective on the Trust’s performance over the period 2020/21. It also summarises the purpose and activities of the Trust and provides a brief description of the business model and operating environment, organisational structure, objectives and strategies. Key issues and risks that could affect the organisation in delivering against its objectives are identified and the section concludes with an outline of performance over the reporting period. Chief Executive’s Statement This report reflects the challenges of what has been a very different year for health and social care systems not just here in Northern Ireland but across the world. It has been a year dominated by the COVID-19 pandemic and in common with other Trusts, normal business in a lot of areas in the Northern Trust was put on hold, with the required focus being the response to the emergency that unfolded over the course of the year. The safety of our patients, service users and staff has been paramount. In spite of the fact that many of our services had to be suspended or reduced to allow us to protect emergency and urgent services, Trust staff went to great lengths to ensure that, where possible, services were sustained. Regional surge planning arrangements were put in place in relation to critical care, respiratory care and elective care, in order to ensure capacity was maximised to treat COVID-19 patients on a system-wide basis, regardless of place of residence. This saw Antrim Area Hospital ICU scale up from a baseline of seven beds to 14 beds in line with the regional Critical Care Network Northern Ireland (CCaNNI) Surge Plan. Resourcing this increase in ICU beds was one of many reasons why staff had to redeploy throughout the course of the year to meet demand in priority areas. Although we were forced to stop all elective activity in Antrim, I am pleased to say that we were able to continue to provide much of the required surgery for priority red- flag patients from across the Trust area in Causeway Hospital. In recognition of an emerging potential crisis in care homes, we set up a Partner Hub during the first surge to provide advice, support and vital PPE to independent sector homes. Over of the course of the year, we also provided in-reach, multi-disciplinary staff support to several homes for older people and those with a learning disability. In late 2020 we successfully piloted the ‘Phone First’ telephone triage and assessment service, which is one of the ten elements of ‘No More Silos’, the DoH’s Urgent and Emergency Care Action. Over the coming year, this service will be rolled out by all Trusts, using a single regional number. Urgent Care Centres will be developed across the region and new direct referral pathways to services in primary, secondary and community settings will be developed. 2 PERFORMANCE REPORT As I have previously acknowledged, even before the pandemic many of our services were already facing significant strategic and demographic challenges. Unfortunately one of the long lasting consequences of the COVID-19 pandemic will be ever-growing waiting lists. However, a regional focus will help to ensure that we prioritise resources for those most in need. The mental health of many of our population – young and old – has undoubtedly been significantly impacted by the pandemic and we will need to ensure that our services can respond to that need. Adult in-patient services regularly see bed occupancy rates over 100% and heightened acuity levels, including a threefold increase in special observations and doubling of the proportion of detained patients. Community mental health services are also reporting increasing levels of low level anxiety and depression. A similar positon is reflected in our younger population with referrals to Child and Adolescent Mental Health Services (CAMHS) continuing to increase. The higher level of acuity has resulted in the regional inpatient unit operating to capacity and young people being admitted to our adult inpatient services. The Eating Disorder service has experienced particular pressures with a fourfold increase in admission rates. Similarly, as COVID-19 has placed additional stress on already vulnerable families, the number of children in care has increased by 11%. We really value the important contribution of extended families, foster carers and residential social workers who have provided such good care to all our children and young people. We fully expect the impact of COVID-19 on families will continue to place pressure on all our children’s services. The integrated care prototype, which we led in partnership with general practitioners in our geographical area, has delivered the blueprint for a new integrated model for planning and commissioning services which is now being developed regionally. Working across primary, secondary and community care interfaces, this is a vital component of the necessary health and social care service transformation that needs to take place. There are many examples of how services within the Trust have adapted to meet the challenge of the pandemic, providing innovative ways to ensure our service users continued to receive care throughout this period. These include widespread adoption of telephone triage, virtual clinics and video calls. We now have the opportunity to harness such innovation and to review, reform and potentially reconfigure in order to build better services. We are committed to providing a carefully considered, balanced and evidence-based response to rebuilding services and we will continue to work innovatively with our primary care/community partners and our clinical leaders to maximise the rapid scale and spread of technology. Throughout the pandemic and in developing our rebuild plans, the Trust has been keen to promote the health and wellbeing and recovery of our staff. Staff across a range of service areas, including human resources, occupational health, psychology, infection control and health improvement, have worked collaboratively to pool their expertise and resources to draw together a comprehensive package of practical support.
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