Royal Berkshire NHS Foundation Trust Annual Report and Financial

Royal Berkshire NHS Foundation Trust

Annual Report and Financial Statements for the year ended 31 March 2016

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

Royal Berkshire NHS Foundation Trust

Annual Report and Financial Statements for the year ended 31 March 2016

Contents Page No

Chairman’s and Chief Executive’s Introduction 5

Performance Report

Overview of performance 8 Performance analysis 8

Accountability Report

Directors’ Report 13 Statement as to disclosure to auditors Income disclosures Enhanced quality governance reporting Governance arrangements

Remuneration Report 35 Annual statement on remuneration Senior managers’ remuneration policy Annual report on remuneration

Staff Report 46 Introductory paragraph Staff survey Expenditure of consultancy/off payroll

NHS Code of Governance 52

Regulatory Ratings 56

Statements of Accounting Officer’s Responsibilities 57

Annual Governance Statement 59

Quality Account 67

Annual Accounts 140

Chairman’s Report

I am delighted to be part of the Royal Berkshire NHS Foundation Trust. I began with the organisation in August 2015 and wish to thank Janet Rutherford who acted as Chair for five months prior to my arrival.

I would also like to acknowledge the Non-Executive Directors, Executives and Governors all of whom have through their various roles in driving the Trust forward and, for supporting me as I gain an understanding of the complexity surrounding the NHS.

It has been a year of continual change and challenge. Like many trusts we continue to see unprecedented levels of demand on our Emergency Department as well as significant pressure on other services in all our locations.

The Trust has continued to make steady progress in so many areas throughout the year. Achieving our forecast financial position, achieving the 18 week Referral To Treatment standard and improving our data quality are just a few of the significant achievements made; an unannounced inspection of our maternity services noted it ‘a very different place’.

We have continued to develop our Trust strategy and are working closely with partners to plan for the development of an Accountable Care System in West Berkshire. This is all very exciting and enables an agreement that allows us and our partners to set priorities, agree how we will work together and create a more joined up view of the service we need to provide to the Berkshire public, long term. This will be so much better for all our patients.

All our team members across the Trust, all our volunteers and the charities that support us have all made a tremendous contribution to the Trust this year and I thank them all deeply. We could not do what we do without you. Likewise I am proud to lead a Board that only has our patients and staff in mind as we drive our future.

The year ahead sees further challenges but I am confident we have the right skills to take us into the future. I look forward to 2016/17 and working with you all to ensure the Trust achieves its vision in providing high quality healthcare to our entire community.

Chief Executive’s Report

The past year has seen the Royal Berkshire NHS Foundation Trust improve its performance in a number of areas.

Despite increasing numbers attending the Emergency Department (ED), we achieved the ED access standard for three of the four quarters but due to the pressure in Quarter 4 with high attendances and admissions, despite best efforts we could not meet the standard. We achieved the planned trajectory to improve the 18 week Referral To Treatment (RTT) standard and have met this standard since October 2015.

Achieving the Cancer standards remains challenging particularly due to increased demand and the national recruitment difficulties in securing Dermatology and Gastroenterology consultants. Significant progress has been made on our quality priorities. It has been pleasing to see increased incident reporting but lower levels of harm.

The national Friends and Family survey results place us as one of the best performing acute trusts in the country. The Trust was also named as the best performing Cardiology and Hyper Acute Stroke Unit (HASU) in the country.

We were delighted that the Care Quality Commission (CQC) found significant improvements in our Maternity services following an unannounced inspection in November 2015. Three areas were rated as “good” and two as “requires improvement” in their report of April 2016.

The total number of Clostridium Difficile (C.Diff.) cases reported for 2015/16 was 31 against a full year target of 27. 13 cases demonstrated no lapses in care.

Pleasingly we have achieved our forecast financial deficit and we will be working to create a surplus in 2016/17.

In September 2015 we held the first Staff Excellence Awards in the Trust for three years. It was a chance to celebrate and recognise our staff. Our Head Porter, Jose Cabrera-Abreu, went on to be shortlisted for a Regional Leadership Award for his work. Long Service Awards were also reintroduced by the Trust and it has been humbling to see the long standing commitment of many of our staff.

Information Management and Technology has been a key issue for the Trust, but we can now see evidence of our strategy being implemented and progress being made. Specifically, over the past year, data quality has been improved. The Data Assurance Team has been restructured with more senior leadership and our old, undocumented data warehouse replaced. A contract with Cerner was signed in September 2015 which provides new Electronic Patient Record (EPR) hardware and introduction of several products to help improve operational running. The main implementation is “Order Communications” which is the electronic ordering of Radiology and Pathology tests. Work has also started to go “paperless at the point of patient” contact by 2018. The Trust also offered all patients free WiFi during the year.

The “#hellomynameis” work started last year has further developed, and is something that was noted by Healthwatch locally. This powerful message has also been recognised by patients who write in or comment on NHS Choices.

The Trust improved its NHS Choices rating. This medium is to be one way that NHS England measures patient satisfaction. The 4.5 star is one we are proud of, and includes a number of 5 star ratings from patients. Where we receive less favourable feedback, we act on it and, where necessary, seek to improve our patients’ experience. 6

The Trust continued to improve services throughout the year. We refurbished the relatives room for bereaved relatives in the ED. We added new information screens and staff in the department sought meaningful feedback via ‘Quality Time’ to shape behaviour and improve patient experience. We also increased the amount of time geriatricians spend on ED to ensure our older patients get early expert assessment.

Establishment of a virtual fracture clinic has been successful; our endoscopy unit received accreditation and a new Lucentis room at Prince Charles Eye Unit opened in March 2016.

The Trust successfully tackled a reduction in its maintenance backlog, reducing outstanding jobs from over 500 to less than 50. This has improved the standard of the facilities we operate and helped to improve patient care.

Our award winning Portering team has increased productivity and generated savings of £147K from the introduction of the Task Management System (TMS). An additional 23,774 portering tasks were carried out compared to the year before with 79% of the 197,273 jobs completed on target.

Work continues on creating the Berkshire Surrey Pathology Partnership and all of our pathology laboratories have been accredited by Clinical Pathology Accreditation (CPA) UK.

Over 1,000 staff were trained on mental health including caring for patients with dementia and we improved our “home early settled and safe” programme to ensure vulnerable people return home early in the day.

In July a major incident was caused by an unplanned power loss in Battle and part of North Block caused by a mains water leak and a subsequent small but contained fire in the Cardiac Care Unit (CCU). Whilst service was disrupted, actions were taken immediately and throughout the ensuing few days to mitigate the immediate impact of these events and maintain patient and staff safety, and to minimise the impact of the incident. Temporary generators and lighting were quickly installed and full operations were reinstated within four days. Plans were carefully developed over the following days to restore the mains power supply and generator backup whilst successfully ensuring minimal disruption to services. Our staff did a fantastic job in keeping services going.

Our relationships with our partner organisations have continued to progress and we are creating a more integrated way of working which will help us manage the demands as a system. The Trust, Berkshire Healthcare NHS Foundation Trust and Berkshire West Clinical Commissioning Groups (CCGs) signed a Memorandum of Understanding for the Accountable Care System (ACS) in order to explore new and integrated ways of working across the local area.

Individual staff have made contributions too numerous to mention and a number of services have received accolades for their high performance. These include Stroke, Cardiology, and End of Life Care. The progress we have made is down to our staff, our partner organisations, our large team of volunteers and the charities that support us.

Thank you to our governors for their on-going commitment to the Trust and to the Board and senior management team for working so hard over the past year. 2016/17 will be no less challenging but we are in a good position to make even more achievements in the coming year.

Performance report

Overview We have been an NHS foundation trust since June 2006 and we are pleased that the freedoms and responsibilities that this brings enables us to work with our members through our Council of Governors to shape our direction of travel, and that working with commissioners we can develop the services and facilities that are needed by our local communities.

This year has been another challenging year for the Trust. The issues facing us are largely reflected across the NHS as the system continues to balance delivering high quality care against increasing demand and reducing financial resources. To tackle issues being faced in our access standards we have set up a number of improvement groups with the sole task of driving improvement through innovation, change and recognition of good practice. Action plans linked to data quality, allocation of resource, patient flow and the construction of pathways have been developed for the key workstreams impacting performance with each plan being managed by a well-represented senior group reporting into an over-arching executive led quality group.

We have seen good progress against the Referral To Treatment (RTT) standards achieving compliance against the new standards and addressing data quality issues. Whilst we are disappointed that performance in the ED fell short, this was directly linked to a rise in attendances and admissions over the winter which were significantly higher than predicted. Although Cancer Standards are not yet fully compliant we are making progress and seeing improvements in respect of the 2 Week Wait (2WW) and some reduction in the waiting list for 62 day pathways.

Taken together we are confident that the range of work across all access standards undertaken through 2015/16 will have a positive impact on future performance and that our short and medium term plans will deliver compliance through 2016/17. Risks requiring attention within 2016/17 to secure this compliance include potential investment in ED (capital and revenue) and also diagnostic capacity for CT and Gastroenterology in order to secure a long term sustainable position.

Overview: Going concern After making enquiries, the directors have a reasonable expectation that the Royal Berkshire NHS Foundation Trust has adequate resources to continue in operational existence for the foreseeable future. For this reason, they continue to adopt the going concern basis in preparing the accounts.

Performance analysis In-year changes at a national level relating to the application of RTT rules and performance reporting have been adopted and compliance achieved for 2015/16. We commenced development of a management and reporting portal to enable a higher level of scrutiny into our data quality following the 2014/15 reporting break. This system was fully deployed through the mid part of the year with a number of processes being adapted to allow a more pro-active approach to the management of data quality, enhanced audit routines and ability to manage the RTT incomplete waiting list. Work will continue into 2016/17 with further technological enhancements being planned and supported by a detailed training package for all staff involved.

Cancer performance remains a significant concern for the Trust with many of the standards not achieving compliance throughout 2015/16. As a result of the sustained under- performance we have launched a monthly Cancer Taskforce where senior figures within the Trust’s management, clinical teams and commissioning bodies are brought together to drive 8

forward the Trust’s Cancer Recovery Action Plan. We have worked closely with commissioners (CCGs) and the Intensive Support Team (IST) to develop robust and sustainable plans for recovery of the Two Week Wait and 62 Day standards with the expectation being that improvement specific to these two standards will impact all cancer standards. These plans have been scrutinised heavily by our own executive groups and our regulators (Monitor and NHS England). Upon agreement of recovery trajectories the Trust has set up a further Cancer Action Group to manage the delivery of actions required to enable compliant cancer pathways and ultimately compliant performance.

Whilst diagnostic demand continues to pressurise the Trust’s capacity we have ensured patients are not waiting beyond six weeks for tests.

The ED has remained under significant pressure throughout 2015/16. Performance was maintained for three consecutive quarters however unprecedented attendance numbers complicated by a high level of acuity through Quarter 4 has caused the Trust to fall below the 95% standard for 2015/16. ED attendance numbers through the latter part of the year have been in excess of 300 per day, peaking at 370 per day and admissions from the department have increased by 11% over previous years. Despite the increased pressure the Trust’s performance remains high at a regional and national level. During 2015/16 a number of data quality measures were reviewed and new processes implemented to address any concerns. In November 2015 these processes were subjected to audit and proved to be effective.

National RBFT RBFT RBFT Standards 2013/14 2014/15 2015/16 % of Incomplete Pathways within 18 weeks 92% N/A 91.56% 93.02% from referral Referral to % of Admitted Pathways treated within 18 90% N/A 77.45% N/A Treatment (RTT) weeks from referral % of Non-Admitted Pathways treated within 95% N/A 96.30% N/A 18 weeks from referral Diagnostic % of service users waiting less than 6 99% 96.9% 91.3% 99.24% Monitoring weeks from referral for a diagnostic test (DM01) Emergency % of ED attendances admitted or 95% 92.10% 94.44% 94.16% Department (ED) discharged within 4 hours of arrival % of service users referred with suspected 93% 93.6% 90.7% 77.5% cancer from a GP waiting no more than two weeks for first appointment % of service users referred urgently with 93% 93.9% 91.5% 84.5% breast symptoms (where cancer is not initially suspected) waiting no more than two weeks for first appointment % of service users waiting no more than 96% 98.1% 97.2% 96.8% one month (31 days) from decision to treat Cancer to treatment for all cancers % of service users referred with suspected 85% 86.2% 80.7% 74.2% cancer from a GP waiting no more than two months (62 days) from referral to first definitive treatment for cancer. % of service users waiting no more than 90% 91.7% 88.6% 88.7% two months (62 days) from referral from an NHS screening service to first definitive treatment for cancer % of service users waiting no more than one month (31 days) – Anti-Cancer Drug 98% - - 99.2% Cancer – % of service users waiting no more than 94% - - 94.2% Subsequent one month (31 days) – Surgery Treatments % of service users waiting no more than 94% - - 95.8% one month (31 days) – Radiotherapy % of service users waiting no more than 94% - - 100% one month (31 days) – Other

Financial Performance The Trust group, which comprises the Trust, the Trust’s wholly owned subsidiary and the Trust’s charity, made a deficit of £9.7m in 2015/16 compared to the deficit of £9.2m in 2014/15.

In 2015/16 we continued to see growth in activity and in income. The Trust worked hard to reduce costs and delivered £17.3m of savings in 2015/16. However, this was only sufficient to offset the reduction in income due to reduced prices set by Monitor (NHS Improvement from 1 April 2016), and the increase in cost due to pay and non-pay inflation. As a result the Trust’s deficit remained broadly the same as in 2014/15.

The pay bill rose by £6.2m in 2015/16, with the largest increases in medical staff pay, £3.2m, and nursing staff pay, £2.3m. Ensuring our pay is controlled remains a key priority.

The non-pay bill rose by £12.7m in 2015/16. The largest increases were in drugs costs, which grew by £7.6m, of which £7.0m was recharged onwards to commissioners, and contribution to the NHS Litigation Authority, to cover clinical negligence claim costs, which grew by £4.5m.

The Trust plans to return to financial stability in 2016/17 and has planned for a surplus of £4.8m, underpinned by a £9.9m contribution from the national Sustainability Fund and further savings from the Trust’s cost savings initiatives.

Summary Financial Results – comparison to prior year:

Year on Year 2015/16 2014/15 variance £m Income 373.28 355.11 18.17

Pay (215.77) (209.59) (6.18) Non-pay including impairment (143.63) (130.88) (12.74) Expenses (359.39) (340.47) (18.92)

EBITDA 13.88 14.64 (0.75)

Depreciation / profit or loss on disposal (17.68) (17.63) (0.05) PDC Dividend (4.66) (4.99) 0.34 Net Interest payable (0.99) (1.11) 0.11 Other non-operating expenses (0.27) (0.14) (0.13) Reported (deficit) for the period (9.71) (9.23) (0.49)

Capital Expenditure The Trust spent £12.7m on capital expenditure in 2015/16, of which £1.7m was financed through leases. The focus of the Trust’s capital expenditure plan was on medical equipment, IT, and investment in Engineering Compliance and Fire safety projects.

Cashflow and Balance Sheet The Trust continued to hold a strong Statement of Financial Position mainly consisting of land and buildings owned by the Trust from which the Trust provides services to patients. The liquidity of the Trust declined in 2015/16, largely as a result of the lower trading results, and at the end of the year the Trust had cash or cash equivalent assets of £15.4m.

The Trust has three loan facilities, totalling £27m, from the Independent Trust Financing Facility (ITFF), two to finance the development of the Royal Berkshire Bracknell Clinic and one to finance the Trust’s Cerner Electronic Patient Record (EPR) system. All of these loans have been fully drawn down and are being repaid.

The Trust has a £10m working capital facility with the ITFF, but has not had cause to draw down on it.

The Trust manages its cash position closely.

Monitoring Trust Financial Performance The Trust’s financial performance is reviewed through the weekly Executive meetings as well as at the monthly meeting of the full Trust Board, which takes a strategic view on the month’s and annual financial results.

Monitor assesses financial performance based on four criteria, debt cover, liquidity, income and expenditure margin and income and expenditure variance from plan. Overall the Trust achieved a financial services risk rating of 2 at the end of the year, within the range of one to four where four is the best performance.

Overseas operations The Trust has no overseas operations

Environmental, social, community and human rights issues A full report on our environmental impact is included below. The Trust is keen to engage with the local community and does this in several ways. The main route is via the Trust membership which offers the local community the chance to attend Trust membership events and find out more about how we work. Each of our policies has an equality impact assessment to assess its impact on service users and staff.

Sustainability Report The following table summarises the impact of the Trust’s business on the environment. The figures include effect of the on-going operation of the Combined Heat and Power (CHP) unit at the Royal Berkshire Hospital site. This unit generates a significant proportion of the electricity used by the hospital, and utilises the waste heat from the generation process to provide heating and hot water to the larger buildings on this site.

Trust Sustainability Performance Greenhouse Gas Emissions Scope 1: Energy Direct Emissions Imported Natural Gas: For heating only: 3,041 tonnes CO2 For electricity generation: 8,100 tonnes CO2 11,141 tonnes CO2 Total cost: £1,395k

Scope 2: Energy Indirect Emissions

Imported Electricity 3,224 tonnes CO2

Total cost: £808k

Scope 3: Official Travel Emissions Business Travel by Clinicians and Staff Mileage claimed 505,111miles

Total cost: £268k

Waste Minimisation and Management Waste Streams Clinical waste for incineration: 291 tonnes Clinical waste for treatment 572 tonnes General waste for energy 738 tonnes Recycled waste 498 tonnes 2,098 tonnes

Total cost: £582k

Finite Resources Water Consumption Water drawn from abstraction borehole: 87,747 cubic metres Water drawn from mains supplies 149,826 cubic metres 237,573 cubic metres

Total cost: £433k

Achievements within the year  Increased use of electric pool cars for official travel  Increase in the proportion of self-generated electricity using the CHP installation.  Better waste segregation to reduce clinical waste incineration and increase recycling rates.

Accountability report

Directors’ report

Political or charitable donations The Trust did not make any political or charitable donations during the period 1 April 2015 to 31 March 2016.

Private Finance Initiative Contracts The Trust had no involvement in any Private Finance Initiative Contracts during the period 1 April 2015 to 31 March 2016.

Charitable Funds The Trust is supported by a number of charities. The Trust’s Charity is the Royal Berkshire NHS Foundation Trust Charity, which makes charitable grants to the Trust, often to contribute to capital projects.

Under IAS 27 the Trust, as the Corporate Trust of the Charity, consolidates the financial statement of the Charity into these Financial Statements.

The Royal Berkshire NHS Foundation Trust Charity does prepare its own financial statements, which are submitted to the Charity Commission.

Better Payment Practice Code – measure of compliance Currently, the Trust is required to pay all its trade creditors in accordance with the Better Payment Practice Code. The target is to pay all trade creditors within 30 days of receipt of goods or a valid invoice (whichever is the latter) unless other payment terms have been agreed with the supplier. Currently the percentage number of invoices the Trust pays within 30 days is 71% (77% were paid within 30 days in 2014/15).

Statement as to disclosure to auditors (s418) Each board director at the time that this report is approved does confirm that:

 so far as each director is aware, that there is no relevant audit information, defined as information needed by the NHS foundation trust’s auditor in connection with preparing their report, of which the NHS foundation trust’s auditor is unaware of; and

 each director has taken all the steps that they ought to have taken as a director in order to make themselves aware of any relevant audit information including:

o making such enquiries of his/her fellow directors and of the Trust’s auditors for that purpose; and o have taken such steps as are required by his/her duty as a director of the Trust to exercise reasonable care, skill and diligence.

External auditor details The Trust’s External Auditors for 2015/16 were:

KPMG LLP 15 Canada Square London E14 5GL

Over the course of the year our external auditors have delivered a range of reports to the Committee.

These include:

 The Audit Plan for the period  Progress update reports on the delivery of our audit work  Technical update reports highlighting NHS FT and health sector issues of relevance for the Committee  ISA 260 Audit Highlights Memorandum reports following our audit of the Group financial statements, and the financial statements of HFMS Limited and the Royal Berks Charity and  The clean assurance opinion on the content of the Trust’s Quality Account and an adverse opinion on the Quality Report indicators.

KPMG’s remuneration was £223k including VAT (£210k including VAT in 2014/15) for the period 1 April 2015 to 31 March 2016.

The liability limits have been agreed as:

Audit Liability – unlimited All other work – up to £1m limit

Internal auditor details The Trust’s Internal Auditors for 2015/16 were:

Price Waterhouse Coopers LLP Docklands 161 Marsh Wall London E14 9SQ

PwC’s remuneration was £262,860 (£814,780 2014/15) for the period 1 April 2015 to 31 March 2016.

The above 2014/15 fees (£512,982) included support provided by PwC to a Clinical Admin and Strategic Cost Reduction Programme.

Income disclosures required by Section 43(2A) of the NHS Act 2006 This information can be found in the performance analysis section.

Identifying potential financial risks The Trust has effective mechanisms in place to manage risk, in accordance with its risk management policy and strategy, supported by the Audit and Risk Committee, which has Board accountability.

The Trust has low exposure to market risk being the risk that the fair value or cash flows of a financial instrument will fluctuate because of changes in market prices. In particular, the Trust is not exposed to price risk or credit risk and its exposure to interest risk is small because, with the exception of cash, its financial assets and liabilities are either at nil or fixed interest. The Trust’s exposure to liquidity risk is only as a result of exposure to its challenging cost improvement programme.

 Market risk This is the risk that the fair value or cash flows of a financial instrument will fluctuate because of changes in market prices.

 Interest Rate risk All the Trust's financial assets and liabilities, with the exception of cash held in UK banks, carry a nil or fixed rate of interest. The Trust is not, therefore, exposed to significant interest rate risks.

 Price risk The Trust does not deal with financial instruments other than loans with fixed interest rates and low value operating or finance leases. As a result the Trust is not exposed to a price risk.

 Credit risk The Trust is not exposed to credit risk.

 Liquidity / cash flow risk The Trust’s exposure to liquidity / cashflow risk in relation to funding provided by the Commissioners is limited as it is government backed. In the event that the Trust does not deliver against the 2016/17 plan, and beyond, its cash will continue to deteriorate creating a heightened pressure on liquidity.

Enhanced quality governance reporting The Board is committed to quality governance and ensures that the combination of structures and processes at Board level and below support quality performance throughout the Trust. In 2015/16 the Board undertook a further self-assessment of Monitor’s Quality Governance Framework and identified evidence in support of the four key areas underpinning it i.e. strategy, capabilities and culture, processes and structures and measurement to ensure that the required standards are achieved, action is taken on below standard performance, continuous improvement is planned and taken forward, best practice is identified, shared and delivered and risks to quality of care are identified and managed. This is managed through various mechanisms including the Trust’s Board Assurance Framework. Further details of the approach to quality governance within the Trust and the processes adopted to achieve high quality safe patient care may be found in the Annual Governance Statement on page 59 and the Quality Report on page 67.

Governance Arrangements The Trust became a foundation trust in 2006. Foundation trusts are public benefit corporations. They remain part of the NHS and the public sector. The Trust was required to demonstrate excellence in a number of areas to be granted foundation trust status. The benefits of foundation status include greater freedom to manage and control the Trust outside of national and regional NHS structures as well as operational benefits like being able to retain surpluses for future investment and borrow money for expansion of services.

The staff and public members of the Trust elect governors to the Council. Other governors are appointed by key partners such as local authorities and our clinical commissioning group. The Council of Governors hold the Board of Directors to account and represent the views of the membership. The Board of Directors comprises both Non-Executive and Executive Directors and leads the organisation taking and managing the key financial and strategic issues. On behalf of the Board the Chief Executive and other senior staff manage the Trust on a day to day basis.

The majority of governors on the Council are publicly elected by public members of the Trust. The Council appoints the Non-Executive Directors who have a voting majority on the Board. All Board members and governors meet the ‘fit and proper person test’ as described in our provider licence.

Further details on foundation trusts can be found on the regulator’s website: www.monitor- nhsft.gov.uk

Board of Directors The Board of Directors of the Trust is a combined board, meaning that it comprises both Executive (paid staff) and Non-Executive (appointed external) Directors. Collectively, it has responsibility for:

 providing leadership to the organisation within a framework of prudent and effective controls  sponsoring the appropriate culture, setting strategic direction, ensuring management capacity and capability, and monitoring and managing performance  safeguarding values and ensuring the organisation’s obligations to its key stakeholders are met  facilitating the understanding on the part of governors of the role of the Board and the systems supporting its oversight of the Trust  taking account of the NHS Constitution in all aspects of its work.

The Board carries out the role envisaged within the Monitor Code of Governance, namely that its role is to provide active leadership of the Trust within a framework of prudent and effective controls which enables risk to be assessed and managed.

As such, the Board:  is responsible for ensuring compliance with the terms of authorisation, constitution, mandatory guidance issued by Monitor, relevant statutory requirements and contractual obligations  sets the strategic aims, taking into consideration the views of the Council of Governors, ensuring that the necessary financial and human resources are in place for the trust to meet its objectives and review management performance  as a whole is responsible for ensuring the quality and safety of healthcare services, education, training and research delivered by the Trust and applying the principles and standards of clinical governance set out by the Department of Health, the Care Quality Commission, and other relevant NHS bodies. The Board ensures that the Trust exercises its functions effectively, efficiently and economically  sets the Trust’s overall culture, its values and standards of conduct and ensures that its obligations to the public, its members, patients and other stakeholders are understood and met.

The Trust has a code of conduct for Board Directors based on the values of the NHS.

Board engagement with the Council and Members The Board takes active steps to ensure it interacts appropriately with the Council of Governors. The Board has agreed protocols in respect of communication with the Council and to help discharge its statutory duties. Non-Executive Directors are required to attend Council of Governors meetings and two Non-Executive Directors are assigned to each Council sub-committee. There is also a joint meeting between the Board and the Council which is held twice a year.

Direct engagement with members takes place at the Trust’s Annual Members’ Meeting where reviews of the year and forward plans are delivered and there is an open question and answer session.

The register of Board directors at 31 March 2016 is as follows. For the latest register please see the Trust’s website.

Name Designation

Jean O’Callaghan Executive Director (Chief Executive) Graham Sims Non-Executive Director (Chairman) (Appointed in August 2015) Caroline Ainslie Executive Director (Director of Nursing) Craig Anderson Executive Director (Director of Finance) Lindsey Barker Executive Director (Medical Director) Mary Sherry Executive Director (Chief Operating Officer) (Appointed in June 2015) Julian Dixon Non-Executive Director Brian Hendon Non-Executive Director (Senior Independent Director) Alison Hill Non-Executive Director Sue Hunt Non-Executive Director (Deputy Chair)

The following were also Board directors during the year:

Paul Beal – Director of Workforce and Organisational Development Bernie Bluhm – Interim Chief Operating Officer Alistair Flowerdew – Medical Director Janet Rutherford – Non-Executive director and Acting Chair

During 2015/16 Janet Rutherford was appointed as Acting Chair from 27 February 2015 until 23 August 2015. Sue Hunt was appointed Deputy Chair and Brian Hendon Senior Independent Director. Graham Sims was appointed as Chair on 24 August 2015. All Non- Executive Directors are considered independent.

The Trust's Constitution specifies that Non-Executive Directors are appointed for three year terms of office. Appointments can be terminated in accordance with Monitor's Code of Governance.

Declarations of interest made by Board members are available on the Trust’s website. Changes to the Board during the year are set out on page 31.

Graham Sims has declared that he is a Director of Quantilis Limited and a Director of HKS Holdings Limited.

Directors’ statement In the case of each of the persons who are directors at the time the report is approved:

a) so far as the director is aware, there is no relevant audit information of which the company’s auditor is unaware, and b) they have taken all the steps that they ought to have taken as a director in order to make themselves aware of any relevant audit information and to establish that the company’s auditor is aware of that information.

Biographies Chief Executive Officer: Jean O’Callaghan, joined the Trust in August 2014. She was previously at Dorset County Hospital NHS Foundation Trust where she was Chief Executive from 2010 until August 2014. Jean joined Dorset at a difficult time where it was facing both quality of care and financial challenges and in breach of licence. Over the four year period it returned to financial balance and good performance. Prior to Dorset, Jean was Chief Executive at Bedford Hospital NHS Trust and before that she was Chief Executive of the Canterbury District Health Board in New Zealand. Jean is a nurse by background and has spent her career in health services in New Zealand, Australia and the UK.

Chairman: Graham Sims, joined the Trust in August 2015, bringing a wealth of chair and corporate experience and knowledge in strategy, investment, operations and leadership. He has held roles as Chairman and various directorships within large and small corporate businesses including BP, Mobil, Compass, the Home Office, Little Chef and a number of PE backed businesses in the UK and internationally. Graham is also involved with a number of charity boards.

Director of Nursing: Caroline Ainslie, who joined the Trust in June 2012, has held a number of senior roles, including Divisional Head of Nursing and Professions at Southampton, before moving to take on a strategic role as Deputy Chief Nurse at South Central Strategic Health Authority. Caroline worked initially as a Trauma and Orthopaedic nurse in Bournemouth, Southampton and other trusts before progressing into nurse management.

Director of Finance: Craig Anderson joined the Trust in July 2011, having previously worked for Partnerships UK as Finance Director and has worked closely with a number of central government departments, such as the Department for Education, on the implementation of major infrastructure programmes. Prior to that Craig spent nine years with Thames Water, his last two years as Managing Director of Commercial Operations across the UK and Ireland. He has held a number of other finance positions in Europe and the UK including with Unisys.

Medical Director: Dr Lindsey Barker, was appointed Medical Director on the 1 May 2015. Lindsey joined the trust in 1990. She is a Consultant Nephrologist and Physician, trained in Bristol and Oxford. She has worked in medical managerial roles since 2008, most recently Divisional Director of Medicine and Care Group Director. She has been instrumental in the redesign of several medical services and specifically the growth of the Reading Renal Unit.

Chief Operating Officer: Mary Sherry joined the Trust in June 2015 as Chief Operating Officer and Deputy Chief Executive. Mary was previously Chief Operating Officer at Moorfields Eye Hospital, a 23 site networked specialist hospital where she led operational delivery and developed a challenging transformation programme. Mary has six years Board level experience in Acute general hospital care, often across several sites. She is known for working collaboratively with clinical and non clinical teams to deliver a broad agenda across quality, performance and finance – key roles being at Poole Hospital, Portsmouth, Surrey and Sussex and St George’s Teaching Hospital. Mary is a non clinical manager with a HR background, Lean and Systems Thinking trained. She is experienced in supporting staff to deliver high quality services and has been successful in doing so including in financially challenged Trusts.

Non-Executive Director: Julian Dixon, joined the Trust in December 2014. He has worked in leadership roles in the academic, healthcare and commercial sectors. He worked for more than twenty years in global healthcare companies, most recently at GSK where he held a number of senior roles leading teams developing and launching new health technologies. He went on to become Chief Operating Officer at UCLPartners, an Academic Health Science 18 partnership. He is now Managing Director at Strategic Health Connections, a consultancy which helps organisations to translate innovation into improved health and wealth outcomes.

Non-Executive Director: Brian Hendon who joined the Trust in August 2012, is a Chartered Accountant and an experienced Executive and Non-Executive Board Member. His 25 year senior executive career has been extensive holding roles as Executive Chairman, Managing Director and Finance Director with private sector companies in manufacturing, retail services and fmcg sectors. His non-executive posts include Thames Valley Housing Association and previously NHS Berkshire East and NHS Berkshire PCT from which he stepped down when appointed to his post at the Royal Berkshire NHS Foundation Trust.

Non-Executive Director: Alison Hill, who joined the Trust in December 2013, has wide experience in the health service – both at a national level in senior management and as a GP working in the community. For many years she worked as a GP in Nettlebed, Oxfordshire, before pursuing a career in policy development and implementation in a series of health service and academic posts. She served as Professional Policy Advisor to the Department of Health NHS Genetics Team and Director of Effective Practice Programme at the King’s Fund. Her management roles have included Medical Director for NHS London where she was responsible for the performance of over a quarter of the GPs, dentists, optometrists and community pharmacists in the capital.

Non-Executive Director: Sue Hunt, who joined the Trust in November 2014, is a Chartered Accountant whose long and varied career at KPMG spanned audit, mergers and acquisitions and healthcare consultancy. She led the team contracted by the Department of Health to advise Trusts on all aspects of their Foundation Trust application and also provided due diligence services on potential investments in the independent healthcare sector. Sue is an experienced Non-Executive Director in the health, education, housing and space technologies sectors with current roles at Notting Hill Housing Group, CfBT Education Trust and The Satellite Applications Catapult Ltd. She was also a Non-Executive Director and then Acting Chair of NHS Direct until its disestablishment in 2014.

Review of Board performance Every three years the Board commissions an external evaluation in line with good practice. Deloitte carried out a review of our governance arrangements in line with the Well Led Framework (WLF) between January and March 2016. The Trust self-assessed against the WLF in relation to its strengths and areas for further development. Recommendations for improvement highlighted by the review will be implemented and monitored by the Board during 2016.

Executive Board members are also appraised on an individual basis.

Following a tendering process for external auditors, the Audit and Risk Committee recommended the appointment of Deloitte LLP to the Council of Governors for a period of three years from 1 April 2016. The Council of Governors approved this appointment in January 2016.

Board attendances – April 2015 to March 2016

Governors Audit and Audit Remuneration and Performance Performance Nominations Nominations Finance and Finance Governance

Operational Operational

Resources Council of of Council Clinical Clinical Charity Board

Finance* and

Risk

*****

Graham Sims 0/0 6/6 2/2 6/6 4/6 2/2

Janet Rutherford 1/1 (NED/Acting 6/6 3/3 1/1 5/7 5/6 2/2 Chair) Jean O’Callaghan 11/11 1/1 11/11 5/6 3/3 9/11 4/4 *** Caroline Ainslie 8/11 1/1 10/11 5/6 1/4 **** Craig Anderson 1/1 11/11 3/3 9/11 3/4

Lindsey Barker ** 1/1 Acting Medical 10/11 9/10 3/6 4/4 Director/Medical **** Director) Paul Beal 1/1 5/5 2/2

Suzanne 0/0 1/1 0/0 Emerson-Dam Alistair 0/0 0/0 0/0 0/1 0/0 Flowerdew Bernie Bluhm 1/1 3/3 0/1 0/1 Mary Sherry 0/0 8/8 3/5 2/4 0/3

Julian Dixon 1/1 11/11 5/6 11/11 1/1 4/4

Brian Hendon 1/1 10/11 10/11 10/11 5/5 2/4

Alison Hill 1/1 11/11 6/6 11/11 5/5 4/4

Sue Hunt 1/1 10/11 10/11 11/11 4/4 3/4

* The Operational Performance and Finance Committee was disbanded in April 2015 and the Finance and Resources Committee took on its responsibilities ** Acting Medical Director from November 2014. Medical Director from 1 May 2015 *** For nominations business only **** Either Medical Director or Director of Nursing required to attend ***** Executive Directors attend only upon request

The formal committee structure of the Board is shown below.

Trust Board

Finance and Audit and Risk Clinical Governance Charity Nominations Resources Committee Committee Committee and Committee Remuneration Exec lead Exec leads Caroline Exec lead Exec lead Craig Ainslie/ Lindsey Craig Exec lead Craig Anderson Anderson Barker Anderson Suzanne Emerson-Dam

The main roles of each committee and group are as follows:

Audit and Risk Committee The Committee reviews the effectiveness of financial systems for internal control and reporting and report to the Board of Directors on the levels of assurance. It also now co- ordinates and prioritises non-clinical governance and non clinical risk issues. It is responsible for ensuring and monitoring the regular review of risks identified against the board assurance framework and corporate risk register in order to embed risk management within the organisation.

Charity Committee The Royal Berkshire Charity (Royal Berkshire NHS Foundation Trust Charity Fund Registration Number 1052720) is governed by trustees acting through the Charity Committee. They are responsible for the overall management of charitable funds.

Clinical Governance Committee The Committee provides assurance to the Board that appropriate clinical governance mechanisms are in place and effective throughout the organisation

Nominations and Remuneration Committee The Committee oversees a formal, rigorous and transparent procedure for the appointment of the Chief Executive and the other Board Executive Directors. It advises and makes recommendations to the Board on Executive and senior management remuneration and remuneration policy. See the Board remuneration report on page 39.

Finance and Resources Committee The Committee gives detailed consideration to operational, finance, estates, investment, IT and workforce issues. It advises the Executive and Board on issues to achieve the best value for money and use of resources. It seeks to ensure that agreed strategies for finance, estates and IT are developed, implemented, monitored and reviewed.

Audit and Risk Committee

Composition The Audit and Risk Committee comprises Non-Executive Directors.

Discharging its responsibilities The Committee discharges the responsibilities delegated to it by the Board in the following ways: - the Committee has Board approved terms of reference - the Committee submits an annual programme of work to the Board for its approval - minutes of meetings are submitted to the Board - the Chairman of the Committee gives regular verbal updates at the Board meetings. - The Committee prepares an annual report for the Board. The terms of reference of the Committee are reviewed annually by the Board to ensure their appropriateness and that they incorporate best practice as it develops. The work of the external auditors and the Committee has been carried out within a framework set by Monitor. The focus of this framework has been on the final accounts and the Statement of Internal Control. Over the course of the year our external auditors have delivered a range of reports to the Committee. These include:

 the ISA260 report outlining the findings of the 2014/15 audit of the Trust’s Group 2014/15 financial statements, and report following the audit for the Quality Accounts Management Letter for 2014/15

 regular progress updates on the delivery of the audit and technical updates to members of the Audit Committee

 the ISA260 report outlining the findings of the 2014/15 audit of the Royal Berkshire NHS Foundation Trust Charity

 the ISA260 report outlining the findings of the 2014/15 audit of Healthcare Facilities Management Services Limited

 External Audit plan for 2015/16 also presented.

Responsibility for appointment of external auditors rests with the Council of Governors.

The contract with KPMG, our current auditors, ends at the conclusion of the audits for 31 March 2016. Following a tendering process the Committee recommended the appointment of Deloitte LLP to the Council of Governors for a period of three years from 1 April 2016. The Council of Governors approved this appointment in January 2016.

The Committee’s key focus was on follow up of internal audit recommendations and it has also extended into a broader role beyond its historic technical remit and has received updates on progress against the Quality Improvement Project Plans and IT at a number of its meetings.

Ensuring external auditors’ independence The Trust has a policy in place for the engagement of the external auditors for non-audit work. This policy complies with all relevant auditing standards and follows industry practice

22 in terms of defining prohibited work and setting out the approval and notification processes all non-audit work should be subject to. The policy is reviewed annually by the Audit and Risk Committee and they receive confirmation through KPMG progress reports presented to each of their meetings that it has been complied with.

The Audit and Risk Committee believes that in this way the external auditors’ independence is ensured.

It is the combined responsibility of the directors to prepare the annual financial statements and report. It is the auditors’ responsibility to report on whether the financial statements and Annual Report give a true and fair view.

Auditors’ statement on reporting responsibilities It is the external auditors’ responsibility on completion of their audit to issue:  an opinion on financial statements: this confirms the accounts present a true and fair view of operations; and  a conclusion on the Trust’s use of resources: this confirms that no evidence has been identified to suggest resources are not being used effectively to deliver healthcare and other objectives.

External auditors are also required to confirm aspects of the Quality Account Report, including a sample of indicators have been correctly prepared and presented.

External auditors are required to report the findings of their audit to those charged with governance - for the Trust this is the Audit and Risk Committee. The FT Code of Governance states that this report must be sent to Monitor by the Trust.

Chair of the Audit and Risk Committee report The Trust Board have delegated authority to the Audit and Risk Committee, a Non-Executive Committee of the Trust Board, to review the establishment and maintenance of an effective system of integrated governance, risk management and financial and non-financial non- clinical internal controls, which supports the achievement of the Trust’s objectives.

The Committee has no executive powers. It is authorised to seek any information it requires from any employee and all employees are directed to co-operate with any request made by the Committee.

In addition, the Committee is required to satisfy itself that the Trust has adequate arrangements for countering fraud, for managing security of resources and has to review arrangements by which staff of the Trust may raise concerns via the Trust’s Whistle Blowing policy.

The Audit and Risk Committee consists of three Non-Executive Directors members supported by professional advisors with Trust attendance provided by the Chief Executive Officer and the Director of Finance.

The Committee meets privately on a regular basis with the Trust’s Internal and External Auditors.

During 2015/16 the Audit and Risk Committee has satisfied itself that the findings of assurance reports and other studies relating to the Trust, as drawn to its attention by the Board or by management, have been reviewed and the implications to the governance of the organisation considered. These reports include reports instigated by Monitor and Care Quality Commission and other professional bodies with responsibility for the performance of 23 staff or functions (e.g. Royal Colleges, accreditation bodies, etc).

The Committee conducts an annual review of its effectiveness with its terms of reference and submits any findings and proposals for changes to the Board of Directors for consideration and once a year prepares an annual report. Both the review and the annual report are presented to the Board. No matters of concern were raised in the 2015/16 review.

Financial reporting The Committee reviewed the Trust’s accounts and Annual Governance Statement and how these are positioned within the wider Annual Report. To assist this review the Committee considered reports from management and from the internal and external auditors to assist the consideration of:

 the quality and acceptability of accounting policies, including their compliance with accounting standards  key judgements made in preparation of the financial statements  compliance with legal and regulatory requirements  the clarity of disclosures and their compliance with relevant reporting requirements  whether the Annual Report as a whole is fair, balanced and understandable and provides the information necessary to assess the Trust’s performance and strategy.

The Committee reviewed the content of the Annual Report and accounts and advised the Board that, in its view, taken as a whole:  it is fair, balanced and understandable and provides the information necessary for stakeholders to assess the Trust’s performance, business model and strategy  it is consistent with the draft Annual Governance Statement, Head of Internal Audit Opinion and feedback received from the external auditors.

Significant financial judgments and reporting for 2015/16 The Committee considered a number of areas where significant financial judgments were taken which have influenced the financial statements.

The Committee identified through discussion with both management and the external auditor the key risks of misstatement within the Trust’s financial statements. The Committee discussed these risks with the external auditor at the time the external auditor’s audit plan was reviewed and at the conclusion of the audit. The Committee also discussed these risks with management during the year and received a paper from management in advance of the year end. Set out below is a summary of how the Committee satisfied itself that these risks of misstatement had been appropriately addressed.

 Valuation of land, buildings and dwellings and intangible assets: We reviewed reports from management which explained the basis of valuation and the consideration of the need to recognise any impairment. We also considered the auditors’ views on the accounting treatment of these assets. We are satisfied that the valuation of these assets within the financial statements is consistent with management intention and is in line with accepted accounting standards

 Recognition of NHS Income: We received assurances from management in relation to the application of a consistent methodology for the recognition of income and provisioning of aged NHS debt. We also reviewed the outcomes from the Agreement of Balances exercise across the NHS as part of our consideration of the external auditor’s report, to confirm that we had appropriately recognised income within the accounts  The adequacy of provisions; for example in relation to debtor balances and contractual disputes.

External audit KPMG has provided External Audit services since the 1 April 2008. Audit and non-audit fees are set, monitored and reviewed throughout the year and are included in note 3.1 of the accounts. KPMG also provides some non-audit services to the Trust, during the year this included the provision of tax advisory and tax compliance services. The Committee receives a report of all non-audit services provided by KPMG at each meeting and have considered whether these services might result in any impairment of the auditor objectivity and independence. For all non-audit services delivered the Committee has concluded there is no risk of impairment of auditor objectivity and independence.

During the Audit and Risk Committee meeting on the 20 January 2016 the Committee reviewed and approved the external audit plan for the 2015/16 period. As part of the discussion at this meeting the Committee reviewed key risk areas highlighted by external audit in relation to the valuation of assets and recognition of NHS income.

During the Audit and Risk Committee meeting on the 17 May 2016 the Committee reviewed the 2015/16 financial statements and KPMG’s ISA260 Audit Highlights memorandum prepared as part of its audit of the Group and Trust financial statements. Following this, the Committee recommended to the Board that it approve the Annual Report and Financial Statements for the period ending 31 March 2016.

Internal audit and counter fraud services The Board uses external parties to deliver the internal audit and counter-fraud services.

PwC has provided the Trust’s internal audit service since March 2011. This service covers both financial and non-financial audits according to a risk-based plan agreed with the Audit Committee. During the year internal audit issued 8 reports which resulted in a total of 24 findings (5 high risk findings, 13 medium risk findings and 6 low risk findings). At each meeting the Committee receives a report from Management confirming the status of internal audit recommendations.

Internal controls Through the internal audit plan the Committee reviews the financial and risk controls operating in the Trust, through and during the year also looked at the controls relating to data quality, estate and the patient environment, information governance and private patient activity. Action plans were put in place to address minor issues in operating processes.

Fraud detection processes and whistle-blowing arrangements The Trust’s counter fraud service is provided by TIAA, who provide fraud awareness training, carry out reviews of areas at risk of fraud and investigate any reported frauds.

The Committee reviewed the levels of fraud and theft reported and detected and the arrangements in place to prevent minimise and detect fraud and bribery. No significant fraud was uncovered in the past year.

Other areas reviewed In addition to the above areas of work the Committee has received reports on losses and special payments incurred by the Trust and considered the overall work of the risk management processes during the 2015/16 period.

External Audit, Internal Audit and Counter Fraud Service Contracts A tender process for all three services took place in 2015/16 to identify and appoint appropriate service contracts from 1 April 2016.

The current incumbents for internal audit services, PwC, and counter fraud services, TIAA, were reappointed.

A recommendation was submitted to the Council of Governors in January 2016 for the external auditor’s contract for the Trust. The Council of Governors approved the appointment of Deloitte LLP.

Nominations and Remuneration Committees There are two Nominations and Remuneration Committees – one established by the Board of Directors for the appointment of Executive Directors and one established by the Council of Governors for the appointment of Non-Executive Directors.

Board Nominations and Remuneration Committee This consists of all Non-Executive Directors and the Chief Executive (for nominations business only). Further information on the Board Nominations and Remuneration Committee can be found on p36.

Council of Governors Nominations and Remuneration Committee The Committee consists of governors and is chaired by the Lead Governor. The Committee makes recommendations to the Council regarding the appointment of and remuneration for Non-Executive Directors.

Responsibilities The Committee oversees the development, implementation and review of the policy for Non- Executive Directors and the policy for governors. The Committee leads the process for the identification of Non-Executive Directors.

Remuneration Duties The Committee will make recommendations to the Council of Governors on the following:

 To develop, seeking the advice and recommendations of the Chief Executive, mechanisms to ensure that the Committee and the Council is informed of the up to date position on Non-Executive Director remuneration, in particular the practice in Foundation Trusts  To recommend an overall remuneration and terms of service policy for the Non- Executive Directors  To recommend levels and terms of service for individual Non-Executive Directors, taking into account the overall policy established by the Trust.

Nomination Duties  To establish and keep under annual review a policy for the composition of the Non- Executive Directors, which takes account of the strategic needs of the Trust and the balance of the Board, and membership strategy  To consider the skills and experience required in any Non-Executive Director appointment  To identify appropriate candidates for appointment as Non-Executive Directors  To establish and keep under annual review a policy for the composition of the Council of Governors, which takes account of the membership strategy  To oversee the process for the appraisal of the Chairman and Non-Executive Directors as set out in the protocol agreed between the Board of Directors and Council of Governors  To keep under review the protocol for the appraisal of the Chairman and Non- Executive Directors  Act on behalf of the Council in the arrangements agreed with the Board for the appointment of a Chief Executive  Keep under review the protocol for the appointment of a Chief Executive.

The Committee reviews these terms of reference annually, making recommendations to the Council of Governors as appropriate.

Board re-appointment process The process agreed by the Council of Governors, with the support of the Board of Directors, for the re-appointment of Non-Executive Directors is as follows:

a) The reappointment of a Non-Executive Director is considered by the Council’s Nominations Committee, which will make a recommendation to the full Council

b) The following information is submitted to the meeting at which the re-appointment is considered:  A summary of the individual’s last three years’ appraisals, submitted by the Chairman of the Trust. In the case of the re-appointment of the chairman, this information will be submitted to the Committee by the senior independent director

 A summary of the individual’s attendance at Board and committee meetings since their appointment

 An assessment, provided by the Chairman (or senior independent director in the case of the re-appointment of the chairman), of the balance of skills of the Non- Executive team on the Board and the individual’s contribution to this

 As background information to the discussion, the Committee will be provided with the Charter of Expectations, which sets out the skills required from, and the expectations of, Board members, and any employment advice from the Director of Workforce and Organisational Development

 A statement by the individual seeking reappointment.

c) The Nominations Committee will be entitled to request any further information that it deems necessary to be able to make a recommendation to the Board.

Council of Governors The Council of Governors have two key duties which are:  To hold the Non-Executive Directors to account for the performance of the Board  Representing the interests of members and the public.

Other duties include:  Approving the appointment of the Chief Executive  Appointing and if appropriate, removing the Chair and Non-Executive Directors  Appointing the Trust’s auditors  Approving amendments to the Trust’s Constitution.

The Register of Governors as at 31 March 2016 is set on the next page and also shows the constituency that each represents. For the latest register please see the Trust’s website.

Register of Governors The following is the register of governors of the Royal Berkshire NHS Foundation Trust. It is maintained by the Trust Secretary. Contact details for governors are on the Trust’s external website or can be obtained via the Trust Secretary.

Attendance at Name Constituency Term of office Council meetings Ms. Deborah Sander Reading 2018 4/4

Mr. Martyn Cooper Reading 2016 1/4

Mr. Dave Dymond Reading 2017 3/4

Mr. Jon Andrews Reading 2017 4/4

Mr. David Cooper Reading 2017 4/4 (Lead Governor) Vacant Wokingham 2016

Mr. Tony Lloyd Wokingham 2017 4/4

Mr. Paul Gupta Wokingham 2018 2/2

Mr Jeremy Butler East Berkshire and 2017 4/4 Borders Vacant East Berkshire and 2018 Borders Vacant East Berkshire and 2016 Borders Mrs. Gwen Mason West Berkshire and 2018 2/2 Borders Mr. Colin Lee West Berkshire and 2016 2/4 Borders Vacant West Berkshire and 2017 Borders Mrs. Caroline Southern Oxfordshire 2018 2/2 Bowder Mr. Ian Clay Volunteer Governor 2016 2/4

Vacant Staff: Health Care 2018 Assistant/Ancillary Mr. Steve Sellwood Staff: 2018 0/2 Admin/Management Mr. Charles Staff: Medical/Dental 2017 3/4 McKenna Mr. Hiten Patel Staff: Allied Health 2017 1/2 Professionals/Scientific Ms. Anne-Marie Staff: Nursing/Midwifery 2018 4/4 Probert Ms. Wendy Bower Appointed by Berkshire 2016 4/4 West Federation of CCGs Ms. Jennie Ford Appointed by Berkshire 2016 4/4 East Federation of CCGs

Mr. Sanusi Koroma Appointed by Reading 2016 0/4 Council for Racial Equality Mr. Peter Dooley Appointed by Berkshire 2016 2/4 Carers Service Councillor Bet Appointed by Reading 2016 3/4 Tickner Borough Council Councillor Bob Pitts Appointed by 2016 2/4 Wokingham Borough Council Councillor Gordon Appointed by West 2016 1/4 Lundie Berkshire Council Vacant Youth rep appointed by 2016 Wokingham Borough Council

* Governors are elected by members of the relevant constituency unless stated otherwise.

Declarations of interest made by governors are available on the Trust website.

Changes to the Council during the year are set out on page 32.

Governors work to influence the Trust and have an impact in several informal and formal ways. The formal ‘committee structure’ of the Council is shown below.

Council of Governors

Membership Nominations and Clinical Strategy Business Committee Remuneration Assurance Committee Assurance Committee Committee Committee Non Non Executive Non Executive Executive Non Executive Lead Leads Leads Leads Graham Sims Julian Dixon Graham Sims Brian Hendon Alison Hill Sue Hunt

The main roles of each group are as follows:

Clinical Assurance Committee

 The Committee will review the clinical assurance information submitted to the Board, and bring significant matters of interest or concern, and the Board’s response, to the attention of the Council of Governors  The Committee will satisfy itself that the Board is reviewing, in a timely manner, appropriate clinical information to ensure compliance with the Terms of Authorisation  The Committee will keep under review a range of assurance information submitted to the Board.

Business Assurance Committee

 The Committee will review the financial and business performance monitoring information submitted to the Board, and bring significant matters of interest or concern, and the Board’s response, to the attention of the Council of Governors  The Committee will satisfy itself that the Board is reviewing, in a timely manner, financial and performance information to ensure compliance with its Provider Licence  The Committee will keep under review a range of assurance information submitted to the Board.

Membership Committee

 To develop a policy, implement agreed proposals and keep under review the Trust approach to engaging with the membership community  To recommend appropriate relationships and methods of communicating between Governors and the membership  To develop, implement and review, annually, a membership strategy for the Trust

 To keep under review the membership of the Trust to ensure that the actual membership is representative of those eligible to be members of each constituency  To oversee preparations for the Annual Members’ Open Day  To prepare an annual report for the Council and the annual members meeting with regard to the steps taken to secure representative membership, the progress of the membership strategy and any changes to the membership strategy

Strategy Committee

 To recommend objectives to the Council of Governors which are achievable and within the resources available  To keep under review the implementation of the objectives  To oversee the annual evaluation of the Council and its performance and to recommend any subsequent action  To make recommendations on areas that could improve the Council's capability to achieve its objectives  To monitor the effectiveness of the Council, its committees and groups and to submit proposals for improvement  To recommend a governor training and annual development programme.

The Nominations and Remuneration Committees consider the salaries and appointments of the Non-Executive Directors of the Board.

Board attendance at Council of Governor meetings can be found on p20.

Changes to the Board and Council of Governors The following were also Board Directors during the year:

The following were also governors during the year:

John McKenzie – Public Governor Tony Skuse – Public Governor David Mihell – Public Governor Carol Bolderson – Public Governor David Rowark – Public Governor Thomas Bune – Public Governor Mark Goff – Staff Governor Jonathan Mason – Staff Governor Pamela Simmons – Staff Governor Maria Walker-Reeves – Staff Governor

Our membership This section sets out who is eligible to become a member of the Trust, our current membership numbers and our strategy and targets for recruiting new members.

Our members can stand as governors, and are responsible for electing our governors. They get involved in the Trust through our membership newsletters, events, annual members 32 meeting and as issues or topics arise that could be of interest such as consultation on services.

Eligibility Membership is open to two main groups:

(a) Public, including patients and carers - people living within the five constituencies - people aged 16 and over.

(b) Staff employed by the Trust - all staff on a permanent contract or a contract of 12 months or more - all staff who are not already public members.

Categories of staff membership:

- medical and dental staff - nursing and midwifery staff - allied health professions and scientific and technical staff - healthcare support workers (all disciplines) and ancillary staff - administrative, clerical and management staff.

Boundaries of public membership

Reading - All the electoral wards in Reading Borough Council (unitary authority) area.

West Berkshire and borders  All the electoral wards in West Berkshire Council (unitary authority) area.  The following electoral wards from the Basingstoke and Deane Borough Council area of North Hampshire: Baughurst, Burghclere, Calleva, East Woodhay, Highclere and Bourne, Kingsclere, Pamber, Tadley North and Tadley South.  The following electoral ward from the Test Valley Borough Council area of North Hampshire: Bourne Valley.

East Berkshire and borders  All the electoral wards in Bracknell Forest Borough Council (unitary authority) area.  All the electoral wards in Slough Borough Council (unitary authority) area.  All the electoral wards in the Royal Borough of Windsor and Maidenhead (unitary authority) area.  The following electoral wards from South Bucks District Council area: Burnham, Beeches, Burnham Church, Burnham Lent Rise, Dorney and Burnham South, Farnham, Royal, Iver Heath, Iver Village and Rickings Park, Stoke Poges, Taplow, Wexham and Iver West.

Southern Oxfordshire  The following electoral wards from South Oxfordshire District Council area: Chiltern Woods, Cholsey and Wallingford South, Crowmarsh, Didcot All Saints, Didcot Ladygrove, Didcot Northbourne, Didcot Park, Goring, Hagbourne, Henley North, Henley South, Shiplake, Sonning Common, Wallingford North and Woodcote.

Wokingham  All electoral wards in Wokingham Borough Council (unitary authority) area.

About our current membership

At 31 March 2016 our public membership stood at 17,135 and our total membership at 22,596.The membership remains under represented in the younger age groups – and the imbalance exists until we reach the 30+ age groups. The 60-74 age category remain the highest represented. However the Council of Governors agreed to maintain the membership at its current level for the year – the Trust membership remains significantly higher than the average foundation trust membership.

Constituency Public % of public membership

East Berkshire and Borders 4,927 29% Reading 4,843 28% Southern Oxfordshire 982 6% West Berkshire and Borders 3,077 18% Wokingham 3,306 19% Other 0 0% Total 17,135

Get in touch If you would like to contact our governors or directors, or to find out more about how you might get involved, please contact our membership office:

Foundation Trust Membership Office Corporate Governance Physiotherapy East Craven Road Reading RG1 5AN Tel: 0118 322 7405 or: [email protected] or visit our website www.royalberkshire.nhs.uk

Remuneration report

Annual statement on remuneration The Medical Director was appointed in May 2015. The appointment was ratified by the Nominations and Remuneration Committee on 28 April 2015.

The Chief Operating Officer started in post in June 2015. The appointment of the Chief Operating Officer was ratified by the Nominations and Remuneration Committee on 30 March 2015.

The Nominations and Remuneration Committee met on 29 January 2015 in order to decide the remuneration of the Chief Executive and the other Executive Directors for the 2015/16 financial year.

There were no changes to the remuneration of the Chief Executive, or the Executive Directors, during the year.

Senior managers’ remuneration policy Attracting and retaining talented directors and senior managers is essential for the successful delivery of the Trust’s strategy and objectives within an increasingly competitive market place. The remuneration policy is designed with that in mind.

The table on page 39 shows the remuneration package for senior managers (Executive Directors) including pension related benefits. The remuneration package for senior managers is decided in line with Trust policy. The salary paid is inclusive of any overtime or allowances. The table shows the salary/fees paid to Non-Executive Directors. No additional fees or other items, that could be considered to be remuneration in nature, are paid to the Non-Executive Directors. The Trust is satisfied that the salaries of its executives, including those earning above £142,500 per annum, are in line with trusts of a similar size.

The definition of “senior managers” is ‘those persons in senior positions having authority or responsibility for directing or controlling the major activities of the NHS Foundation Trust’. For the purpose of reporting senior manager’s remuneration in the table (below) and the pension benefits table this has taken to mean those Executive Directors holding voting rights on the board and also the Trust’s Non-Executive Directors.

The senior manager’s salary is payment for delivering the Executive Director role and for delivering the short and long-term strategic objectives of the Trust. Each Executive Director post is paid on a spot salary. The salaries are reviewed on an annual basis when a decision is made whether to implement a pay award.

There have been no new components added to the remuneration package or any changes to the existing components in this period therefore senior managers have not been consulted regarding their remuneration policy.

There are no provisions for the recovery of sums paid to directors or for withholding payments to senior managers.

Service Contracts Obligations A contract for service is in place for any senior managers obtained via temporary, agency or contractor arrangements. The contract for service details the standard terms of business. The Trust will outline separately any specific obligations e.g. key deliverables.

Policy on payment for loss of office The Executive Director contract has been subject to a full review during 2015/16. The notice period for Executive Directors remains at six months with a month being classed as 4 weeks. The notice period for senior managers is three months.

Payment for loss of office (redundancy) would be in line with national terms and conditions of employment (Agenda for Change).

Payment for any other type of loss of office would be made in line with contractual requirements and appropriate authorisation would be obtained as outlined in the Trust’s Severance Protocol. The main components of the payment for loss of office would be unused annual leave and payment in lieu of notice.

Statement of consideration of employment conditions elsewhere in the Foundation Trust The majority of Trust employees are employed on national terms and conditions of employment. Any pay awards given to staff on national terms and conditions are taken into account when setting the remuneration levels for staff on Trust salaries.

In 2011 the Trust did consult with staff regarding the implementation of Trust salaries with the two levels of developing and achieving. The consultation was part of the wider management restructure. The Trust did undertake benchmarking when determining the appropriate salary levels.

Annual report on remuneration

Service Contracts

Name Designation Date Appointed End of Term of Office Mr Brian Hendon Non-Executive Director April 2012 July 2016 Dr Alison Hill Non-Executive Director December 2013 December 2016 Mr Julian Dixon Non-Executive Director October 2014 October 2017 Ms Sue Hunt Non-Executive Director October 2014 October 2017 Mr Graham Sims Chairman August 2015 August 2018

The notice period for Non-Executive Directors is one month.

Remuneration Committee The Nominations and Remuneration Committee is responsible for agreeing, on behalf of the Board, the Trust’s remuneration policy for directors and for determining the total individual remuneration package for these directors and senior staff earning over £75,000 per annum. Other staff employed in the Trust are on national terms and conditions of employment and are therefore determined at a national level.

The Nominations and Remuneration Committee consists of all Non-Executive Directors and the Chief Executive attends for nominations business only. The number of Nominations and Remuneration Committee meetings and individuals’ attendance at each meeting can be found on p20.

The Director of Workforce and Organisational Development provides advice or services to the Remuneration Committee.

The Nominations and Remuneration Committee uses the following survey guidance: - Health and Social Care Information Centre - Salary surveys conducted by NHS Providers

Disclosures required by Health and Social Care Act

Fair Pay multiple

The ‘Fair Pay Disclosure’ section of this annual report has been subject to audit.

Year to 31 March 2016 Year to 31 March 2015

Band of Highest Paid 275 - 280 275 - 280 Director’s Total Remuneration - £000

Median Total Remuneration 29,234 28,791

Ratio 9.49 9.64

Reporting bodies are required to disclose the relationship between the remuneration of the highest-paid director in their organisation and the median remuneration of the organisation’s workforce

The banded annualised remuneration of the highest-paid director in Trust in the financial year 2015/16 was £275,000 - £280,000 (2014/15, £275,000 - £280,000). This was 9.49 times (2014/15 - 9.64) the median remuneration of the workforce including medical consultants remuneration, which was £29,234 (2014/15 - £28,791). The increase applied to the directors pay in 2015/16 was in line with all other staff.

In 2015/16, no employees (2014/15 one employee with an annualised remuneration banding of £295,000 - £300,000) received remuneration, on an annualised basis, in excess of the annualised remuneration of the highest-paid director.

Total remuneration includes salary, non-consolidated performance-related pay and benefits-in-kind. It does not include employer pension contributions, termination payments and cash equivalent transfer value of pensions

Expenses paid to Directors and Governors

The expenses paid to Directors and Governors section of this Report has been subject to audit.

The table below lists the total of re-imbursive expenses paid to Directors and Governors

Year to 31 March 2016 Year to 31 March 2015

Directors 6,380 14,441

Governors 227 1,212

Of the amount stated in respect of Directors’ expenses £4,309 was paid to Non-Executive Directors (2014/15 £3,210).

During the year, inclusive of Non-Executives, there were 15 Directors in post (2014/15,18). Of these, 5 received expenses payments (2014/15, 7)

Additionally there were 33 governors in post during the year (2014/15, 33) of which 2 were paid expenses (2015/16, 4)

Definition of “senior managers”

The definition of “senior managers” is ‘those persons in senior positions having authority or responsibility for directing or controlling the major activities of the NHS Foundation Trust’. For the purpose of reporting senior manager's remuneration in the table(below) and the pension benefits table(Table C) this has been taken to mean those Executive Directors holding voting rights on the Board and also the Trusts' Non-Executive Directors

The ‘Remuneration’ section of this report has been subject to audit.

The pension related benefits for those Directors who have been in post for only part of the year have been calculated on a pro-rated basis to reflect that periodicity.

Year to 31 March 2016

Payments-in- Performance Salary and lieu of notice Pension related Name and Title related Total fees and unpaid 7 benefits bonuses annual leave

Bands of Bands of Bands of £5,000 Bands of £5,000 Bands of £2,500 £5,000 £5,000

£000 £000 £000 £000 £000 EXECUTIVE DIRECTORS

Jean O'Callaghan 180 - 185 N/A 0 47.5 - 50.0 230 - 235

Chief Executive Officer

Lindsey Barker (Interim to 16 Apr 2015 then permanent) 175 - 180 N/A 5 - 10 207.5 - 210.0 390 - 395 Medical Director

Alistair Flowerdew (To 24 Apr 15 ) 1 10 - 15 N/A 0 0 10 - 15 Medical Director

Craig Anderson 2 130 - 135 N/A 0 27.5 - 30.0 155 - 160 Director of Finance

Caroline Ainslie 125 - 130 N/A 0 170.0 - 172.5 300 - 305 Director of Nursing

Mary Sherry (From 01 Jun 3 115 - 120 115.0 - 117.5 235 - 240 15) N/A 0 Chief Operating Officer

Bernie Bluhm (To 02 Jun 4 40 - 45 N/A 0 0 40 - 45 15) Interim Chief Operating officer

Paul Beal (To 31 Jul 15)6 50 - 55 27.5 - 30.0 125 - 130 40 - 45 0 Director of Workforce and

Organisational Development

Suzanne Emerson-Dam (From 01 Aug 15 to 28 Sep 10 - 15 N/A 0 12.5 - 15.0 25 - 30 15) 6 Interim Director of Workforce and Organisational

Development

NON-EXECUTIVE DIRECTORS Graham Sims - Chairman (From 24 Aug 15) 30 - 35 N/A 0 0 30 - 35

Janet Rutherford (Acting Chair - To 23 Aug 15) 15 - 20 N/A 0 0 15 - 20 Janet Rutherford (Deputy Chair - From 24 Aug 15 to 30 Sep 15) 0 - 5 N/A 0 0 0 - 5 Brian Hendon 15 - 20 N/A 0 0 15 - 20 Alison Hill 15 - 20 N/A 0 0 15 - 20 Susan Hunt 15 - 20 N/A 0 0 15 - 20 Julian Dixon 15 - 20 N/A 0 0 15 - 20

Notes 1 Alistair Flowerdew remained contracted in post as Medical Director (from 01 Apr 2015 to 24 Apr 2015) after standing down although Lindsey Barker was appointed to cover this role. (Made permanent from 17 April 2015).

2 Effective from 18th January 2014 Craig Anderson was appointed to the role of interim Deputy Chief Executive Officer in addition to his role as Finance Director. This interim role ceased on the appointment of Mary Sherry.

3 On appointment to the post of Chief Operating Officer from 1st June Mary Sherry also became Deputy Chief Executive Officer.

4 Interim Chief Operating Officer (Bernie Bluhm) was employed "off-payroll". The values shown above exclude VAT and an average agency mark-up charge, from that billed.

5 Paul Beal received 4.5 month’s pay in lieu of notice. This was in line with his contract of employment.

6 From 29th September 2015 the position of Director of Workforce and Organisational Development was removed from the Board.

None of the directors received any benefits in kind. 7 "Performance related bonuses" relates to the awarding of Clinical Excellence Awards by NHS England. No "long-term performance-related bonuses" were paid.

Posts occupied by more than one person From To during the year

Medical Director Alistair Flowerdew 01 Apr 15 24 Apr 15 Lindsey Barker 01 Apr 15 31 Mar 16

Director of Workforce and Organisational Development Paul Beal 01 Apr 15 31 Jul 15 Suzanne Emerson-Dam (Acting) 01 Aug 15 28 Sep 15

Chairman/Chair Graham Sims 24 Aug 15 31 Mar 16 Janet Rutherford (Acting) 01 Apr 15 23 Aug 15

Year to 31 March 2015

Performanc Pension related Name and Title Salary and fees e related Total 7 benefits bonuses

Bands of Bands of Bands of Bands of

£5,000 £5,000 £2,500 £5,000

£000 £000 £000 £000 EXECUTIVE DIRECTORS 3 Jean O'Callaghan (From 01 Aug 14) 120 - 125 0 - 120 - 125 Chief Executive Officer

Alistair Flowerdew (From 18 Jan 14 to 31 Jul 80 - 85 14) 80 - 85 0 0 Interim Chief Executive Officer

Alistair Flowerdew (From 01 Aug 14 to 31 Mar 15) 5 130 - 135 0 0 130 - 135 Medical Director

6 Brian Reid (To 31 Jul 14) 55 - 60 5 - 10 0 60 - 65 Interim Medical Director

Lindsey Barker (From 10 Nov 14 to 31 Mar 15) 5 60 - 65 5 - 10 7.5 - 10.0 80 - 85 Interim Medical Director

Craig Anderson 2 130 - 135 0 20.0 - 22.5 150 - 155 Director of Finance

Caroline Ainslie 110 - 115 0 22.5 - 25.0 135 - 140 Director of Nursing

3 Paul Beal (From 17 Dec 14) 30 - 35 0 - 30 - 35 Director of Workforce and Organisational

Development

Bernie Bluhm (From 17 Dec 14) 4 75 - 80 0 0 75 - 80

Interim Chief Operating Officer

Peter Malone (To 30 Jun 14) 35 - 40 5 - 10 0 45 - 50

Care Group Director 1

Sue Edees (From 01 Jul 14 to 17 Dec 14) 60 - 65 5 - 10 12.5 - 15.0 80 - 85

Care Group Director 1

NON-EXECUTIVE DIRECTORS

Stephen Billingham - Chairman (To 27 Feb 15) 30 - 35 0 0 30 - 35

Janet Rutherford (Acting Chair from 01 Mar 2015) 25 - 30 0 0 25 - 30 John Barrett 15 - 20 0 0 15 - 20 Brian Hendon 15 - 20 0 0 15 - 20 Jane May (To 26 Nov 14) 10 - 15 0 0 10 - 15 Alison Hill 15 - 20 0 0 15 - 20 Susan Hunt ( From 29 Oct 14) 5 - 10 0 0 5 - 10 Julian Dixon (From 26 Nov 14) 5 - 10 0 0 5 - 10

Notes 1 The appointment of Care Group Directors to the Board was rotated every 6 months between the three Care Group leads, until 17 December 2014 when their Board role ceased.

2 Effective from 18th January 2014 Craig Anderson was appointed to the role of interim Deputy Chief Executive Officer in addition to his role as Finance Director.

3 At the time of finalising the 2014/2015 pension disclosures the Trust was awaiting updated prior year information from the Pensions Agency relating to Jean O'Callaghan (joined Trust August 2014) and Paul Beal (joined Trust October 2014). The Trust has therefore not been able to make a meaningful calculation of in- year "Pension related benefits" for the year ending March 2015, for either of them.

4 Interim Chief Operating Officer (Bernie Bluhm) is employed "off-payroll". The values shown above exclude VAT and an average agency mark-up charge, from that billed. 5 Alistair Flowerdew remained contracted in post as Medical Director (from 10 Nov 2014 to 31 Mar 2015) after standing down although Lindsey Barker was appointed to cover this role on an interim basis.

6 Brian Reid (Interim Medical Director) opted out of the NHS Pension scheme with effect from 1st April 2014

Chief Executive Officer

Alistair Flowerdew (Interim) 01 Apr 14 31 Jul 14

Jean O'Callaghan 01 Aug 14 31 Mar 15

Medical Director

Brian Reid (Interim) 01 Apr 14 31 Jul 14

Alistair Flowerdew 01 Aug 14 31 Mar 15

Lindsey Barker (Interim) 10 Nov 14 31 Mar 15

Chairman/Chair

Stephen Billingham 01 Apr 14 27 Feb 15

Janet Rutherford (Interim) 01 Mar 15 31 Mar 15

Total pension entitlement

The "Pension Benefits" section of this report has been subject to audit.

Total Total Real accrued Lump Cash Real accrued Lump Real increase pension sum at Cash equivale increase pension sum at increase in at age age 60 equivalent nt in at age age 60 at in cash Name and pension 60 at 31 at 31 transfer transfer pension 60 at 31 31 March equivale Title lump sum March March value at value at at age 60 March 2016 nt at age 60 2016 2015 31 March 31 Bands of 2015 Bands of transfer Bands of Bands Bands 2016 March £2500 Bands £5000 value £2500 of of £5000 2015 of £5000 £5000

£000 £000 £000 £000 £000 £000 £000 £000 £000

Executive

Directors

Jean O'Callaghan 1 2.5 - 5.0 7.5 - 10.0 20 - 25 15 - 20 65 - 70 55 - 60 0 0 0 Chief Executive Officer Alistair Flowerdew 1,2 0 0 85 - 90 80 - 85 255 - 260 250 - 255 0 0 0 Medical Director Lindsey Barker 1 10.0 - 12.5 30.0 - 32.5 70 - 75 60 - 65 215 - 220 185 - 190 0 1,422 0 Medical Director Craig Anderson 0 - 2.5 0 5 - 10 5 - 10 0 0 131 101 28 Chief Finance Officer Caroline Ainslie 7.5 - 10.0 22.5 - 25.0 45 - 50 35 - 40 140 - 145 115 - 120 814 659 148 Nursing Director Mary Sherry 3 5.0 - 7.5 15.0 - 17.5 45 - 50 35 - 40 135 - 140 110 - 115 1,035 859 138 Chief Operating Officer

Paul Beal 4 0 - 2.5 2.5 - 5.0 25 - 30 20 - 25 80 - 85 65 - 70 497 415 26 Director of Workforce and Organisational Development Suzanne Emerson- Dam 5 0 - 2.5 0 - 2.5 25 - 30 20 - 25 75 - 80 65 - 70 395 321 11 Interim Director of Workforce and Organisational Development

Notes

1.As a result of age related factors Jean O'Callaghan, Alistair Flowerdew and Lindsey Barker's pensions have no cash equivalent transfer value as at 31st March 2016.

2. Alistair Flowerdew was in post as Medical Director from 1st April 2015 to 24th April 2015. During this period no increase was accrued in respect of "Real increase in pension at age 60", or "Real increase in pension lump sum at age 60".

3. Mary Sherry was in post as Chief Operating Officer from 1st June 2015 to 31st March 2016. Figures shown for "Real increase in pension at age 60", "Real increase in pension lump sum at age 60" and "Real increase in CETV" have been calculated on a pro rata basis between these two dates.

4. Paul Beal was in post as Director of Workforce and Organisational Development from 1st March 2015 to 31st July 2015. Figures shown for "Real increase in pension at age 60", "Real increase in pension lump sum at age 60" and "Real increase in CETV" have been calculated on a pro rata basis between these two dates.

5. Suzanne Emerson-Dam was in post as Interim Director of Workforce and Organisational Development from 1st August 2015 to 28th September 2015. Figures shown for "Real increase in pension at age 60", "Real increase in pension lump sum at age 60" and "Real increase in CETV" have been calculated on a pro rata basis between these two dates.

Bernie Bluhm (Interim Chief Operating Officer) was employed "Off-payroll" and therefore had no NHS pension to be declared.

On 16 March 2016, the Chancellor of the Exchequer announced a change in the Superannuation Contributions Adjusted for Past Experience (SCAPE) discount rate from 3.0% to 2.8%. This rate affects the calculation of CETV figures in this report. Due to the lead time required to perform calculations and prepare annual reports, the CETV figures quoted in this report for members of the NHS Pension scheme are based on the previous discount rate and have not been recalculated.

Payments for loss of office

The "Severance Payments" section of this report has been subject to audit.

Number of Total number of compulsory Number of other exit packages by Exit package cost band redundancies departures agreed cost band <£10,000 17 17 £10,000 - £25,000 2 2 £25,001 - £50,000 3 1 4 £50,001 - £100,000 2 2 £100,000 - £150,000 0 £150,001 - £200,000

Total number of exit packages by type 7 18 25 Total resource cost £272,038 £102,021 £374,059

Staff report

Fixed Term Permanent Temp Administration and Estates 781.87 52.74 Healthcare assistants and other support staff 1065.05 26.26 Medical and dental 312.16 324.55 Nursing, midwifery and health visiting learners 5.05 1.86 Nursing, midwifery and health visiting staff 1523.51 31.95 Scientific, therapeutic and technical staff 523.71 34.26

Status Female Male Director 5.00 1.00 Employee 3543.70 1096.06 Senior Manager 23.53 24.00 Grand Total 3572.23 1121.06

Cumulative Cumulative % Abs Rate Cumulative Abs (FTE) Avail (FTE) (FTE)

44,453 1,431,655 3.10%

The Trust’s expenditure on consultancy during 2015/16 was £603k.

In 2015, the overall measure of staff engagement at the RBFT dropped slightly, however our overall position on this measure is consistent with the 2015 National Average for Acute Trusts.

In the key component element of staff engagement - staff motivation at work - the Trust maintained its position and is again consistent with NHS averages on this measure.

As a Trust we will look to pursue our agenda to further enhance staff engagement with renewed vigour– focussing on the key enablers of staff engagement in areas including staff health and wellbeing, effective management and leadership and communication. Our new Organisational Development Strategy will provide a coherent framework for delivering improvements in a range of areas in the staff experience in 2016/17.

On a number of key areas - including staff agreeing that care of patients is our organisations top priority and staff agreeing that if a friend or relative needed treatment, they would be happy with the standard of care provided by this organisation – we have shown in year improvements and score higher than the acute trust average in 2015 on these measures.

The Trust has a HR Local Counter Fraud Policy which was reviewed in April 2016.

Summary of Performance

Response Rate

2014/15 2015/16 Trust Improvement/Deterioration Trust National Trust National Despite a reported 7.7% drop in response Average Average rate, only 51 fewer surveys were returned Response in 2015 relative to 2014 (1981 in 2015 Rates compared 2032 in 2014). The disproportionate drop in % response rate is due to the nature of the statistical methodology used by the NHS Staff 45 42 37.3 41 Survey co-ordination centre in relation to how some ineligible surveys in 2014 were categorised and excluded as part of the denominator for the overall response rate for 2014.

Top 4 Ranked Scores

2014 2015 Trust Top 4 Ranking Scores Trust National Trust National Improvement or Average Average Deterioration since 2014. KF22: % of staff experiencing 14% 14% 14% 14% No change physical violence from patients, relatives or the public in the last 12 months KF28: % of staff witnessing 32% 34% 30% 31% 2% improvement potentially harmful errors, near misses or incidents in the last month KF32: Effective use of patient Measure not 3.73 3.70 (0 – ineffective or service user feedback comparable use of feedback; 5 – effective use of feedback) KF15: % of staff satisfied with Not Measured 50% 49% New Key finding the opportunities for flexible for 2015 working patterns

Bottom 4 Ranked Scores

2014 2015 Bottom 4 Ranking Scores Trust National Trust National Trust Average Average Improvement or Deterioration since 2014. KF29: % of staff reporting 88% 90% 84% 90% 4% deterioration errors, near misses or incidents witnessed in the last month KF20: % of staff experiencing 13% 11% 14% 10% 1% deterioration discrimination at work in the

47 last 12 months KF27: % of staff reporting Measure not 23% 37% New Key finding most recent experience of comparable for 2015 harassment, bullying or abuse KF19: Organisation and Not measured 3.46 3.57 New Key finding management interest in and for 2015 action on health and wellbeing

Action plans to address areas of concerns The 2015 survey does highlight a number of areas where we need to focus our efforts into the future and an action plan for 2016/17, addressing key themes from the survey has been developed. The action plans focuses on improvements in the following domains:

 Staff Engagement – involvement, recognition and job satisfaction and improving recommendation of the RBFT as a place to work.  Senior Management - visibility and communication  Raising Concerns – increasing reporting and improving confidence and awareness of actions taken  Equality and Diversity – discrimination from patients and reporting issues  Appraisals – quality and quantity  Staff Health and Wellbeing.

Commentary and Future Priorities and Targets Our operating environment continues to be very challenging and in many respects our survey findings are a reflection of the significance of the challenges we face.

Staff continue to agree that care of patients is our organisations top priority and staff agree that if a friend or relative needed treatment, they would be happy with the standard of care provided by this organisation. Our performance on these two areas has improved and we continue to perform better than the acute trust average in 2015 on these measures. However, staff recommendation of the Trust as a place to work has declined and it is this umbrella measure that is the key focus for improvement.

In 2016/17 we will focus on returning to our previously held position of being a top 20% employer on measures of staff engagement and recommendation as a place to work.

Our new Organisational Development strategy sets out our bold aspirations for improvements in our organisational culture, how we develop staff and nurture talent, how we will enhance staff health and wellbeing and promote inclusivity and how we engage with the workforce on key areas such as our values and strategic vision.

We will continue to work hard to meet our significant capacity challenges, focussing on recruitment and retention and exploring new models of delivering services to enable staff to work smarter rather than harder.

We will use the frameworks provided by the Equality Delivery System 2 (EDS2) and the Workforce Race Equality Standard (WRES) to drive improvements in inclusivity and eliminate discrimination at work. We will work even harder to ensure staff understand their responsibilities in terms of raising and reporting issues and will communicate clearly and coherently, changes and improvements we’ve made.

Monitoring of the 16/17 action plan will be undertaken quarterly through the Trust Education and Workforce Board and other committees such as the Finance and Resources Committee, Joint Staff Side Committee and the Staff and Patient Experience Committee.

Equality reporting 2015/16 saw the introduction of two new national equality standards across the NHS. The overarching aim of these new standards is to provide an impetus to the equality agenda; to challenge organisations to improve their performance in relation to Equality and Diversity. The new standards were the WRES and the EDS2.

Our work in delivering the WRES highlighted some of the challenges we, like many NHS organisations, face. At the Trust, black and minority ethnic (BME) staff are under- represented in senior management and board positions and are less likely to access non mandatory training opportunities as well as being less likely to believe the Trust acts fairly with regard to career progression. On a range of other staff survey measures however, the experience of BME staff at work is more positive than the workforce average as a whole. Our WRES Improvement plan (2016-18) sets a clear vision for improvement and sets out our commitments for the years ahead to improve the experience and opportunity of BME staff.

In delivering EDS2, a range of areas emerged as opportunities for improvement and development. The majority of our 18 outcomes were collectively assessed by our stakeholders as ‘developing’, indicating that many, but not all protected groups fare well relative to the wider population groups. The collective process of discussing our performance and agreeing grading with our partners and patients has enabled us to identify priorities for future action and to inform our equality objectives.

EDS2 and WRES have provided a coherent framework for assessing and developing our equality and diversity agenda, whilst also shining a spotlight on many achievements and innovations we have delivered in 2015/16 across the Equality and Diversity agenda, including:

 UNICEF Baby Friendly Accreditation – Our Maternity Department celebrated achieving ‘Baby Friendly' status – part of a global accreditation programme from UNICEF and the World Health Organisation designed to support breastfeeding and to strengthen mother-baby and family relationships

 Project SEARCH – Our ground breaking programme supporting young people with learning disabilities into employment through structured work experience placements celebrated its 4th year at the Trust. 59% of all students who have participated in the programme have secured paid, substantive employment at the Trust

 Pioneering healthcare in the community – Our viral hepatitis testing and pathways to treatment in ‘hard to reach’ communities has grown both in strength and in its reach. Our mobile chemotherapy unit continues to offer improved opportunities for access

 Stonewall Diversity Champion and ‘Two ticks’ employer- The Trust was again proud to continue to be a Stonewall Diversity Champion and also to maintain our ‘Two Ticks - Positive about Disability’ Employer status

 Patient Information and Translation Services – Growth in our patient information services and translation provision continues to meet the needs and demands of our culturally diverse population groups

 Equality Impact Assessments – Our process for assessing the equality impacts of our policies and strategies has been refreshed and bolstered to provide stronger assurance that potential equality impacts are identified and mitigated.

Reporting high paid off-payroll arrangements The Trust monitors, on a monthly basis, the reliance on off-payroll engagements by reviewing engagement costs more than £220 per day.

Off-payroll engagements as of 31 March 2016, for more than £220 per day and that last longer than six months

No. of existing arrangements as of 31 March 2016 33 Of which: No. that have existed for less than one year at time of 20 reporting No. that have existed for between one and two years at time of 10 reporting No. that have existed for between two and three years at time 1 of reporting No. that have existed for between three and four years at time 2 of reporting No. that have existed for four or more years at time of 0 reporting

The Trust can confirm that all existing off-payroll engagements, outlined above, have at some point been subject to a risk-based assessment as to whether assurance is required that the individual pays the right amount of tax and, where necessary, that assurance is being sought.

All new off-payroll engagements or those that reached six months duration, between 1 April 2015 and 31 March 2016, for more than £220 per day and that last longer than 6 months

All new off-payroll engagements or those that reached six 23 months in duration, between 1 April 2015 and 31 March 2016, for more than £220 per day and that last longer than six months No. of the above which include contractual clauses giving the 23 Trust the right to request assurance in relation to income tax and National Insurance obligations No. of whom assurance has been requested 23 Of which: No. for whom assurance has been received 20 No. for whom assurance has been requested but not been 3 received No. that have been terminated as a result of assurance not 0 being received

The Trust has not engaged any individual without including contractual clauses allowing the Trust to see assurance as to their tax obligations.

Any off-payroll engagement of board members and/or senior officials with significant financial responsibility, between 1 April 2015 and 31 March 2016

Any off-payroll engagements of board members and/or senior 1 officials with significant financial responsibility, between 1 April 2015 and 31 March 2015 No. of individuals that have been deemed “board members 15 and/or senior officials with significant financial responsibility” during the financial year. This figure should include both off- payroll and on-payroll engagements.

NHS Foundation Trust Code of Governance

The Royal Berkshire NHS Foundation Trust has applied the principles of the NHS Foundation

Trust Code of Governance on a comply or explain basis. The NHS Foundation Trust Code of

Governance, most recently revised in July 2014, is based on the principles of the UK

Corporate Governance Code issued in 2012.

The Board declares that, with the exception of the statement below, the Trust has met the requirements of the Monitor Code of Governance for the year 2015/16.

Non-compliance is reported as follows:

Code Provision

B.7.4 Non-Executive Directors, including the Chairperson should be appointed by the Council of Governors for the specified terms subject to re-appointment thereafter at intervals of no more than three years and subject to the 2006 Act provisions relating to removal of a director.

One Non-Executive Director was appointed for a term of office of four years in 2012. The Authorised Constitution of the Trust was updated in 2013 and now stipulates that Non- Executive Directors are appointed for a term of office of three years so any further appointments will be made for a period of three years.

Mandatory Disclosures

Code Requirement Location in Annual provision Report A.1.1 The schedule of matters reserved for the board of This is located in the directors should include a clear statement detailing the Trust’s Standing roles and responsibilities of the council of governors. This Financial Instructions statement should also describe how any disagreements between the council of governors and the board of directors will be resolved. The annual report should Board Committees and include this schedule of matters or a summary statement Council of Governors of how the board of directors and the council of Pages 21 and 31 governors operate, including a summary of the types of decisions to be taken by each of the boards and which are delegated to the executive management of the board of directors. A.1.2 The annual report should identify the chairperson, the Directors’ Report deputy chairperson (where there is one), the chief Page 17 executive, the senior independent director (see A.4.1) and the chairperson and members of the nominations, audit and remuneration15 committees. It should also set out the number of meetings of the board and those committees and individual attendance by directors.

A.5.3 The annual report should identify the members of the Directors’ Report council of governors, including a description of the Page 29 constituency or organisation that they represent, whether they were elected or appointed, and the duration of their appointments. The annual report should also identify the nominated lead governor. FT ARM The annual report should include a statement about the Directors’ Report number of meetings of the council of governors and Pages 20 and 29 individual attendance by governors and directors. 52

B.1.1 The board of directors should identify in the annual report Directors’ Report each non-executive director it considers to be Page 17 independent, with reasons where necessary. B.1.4 The board of directors should include in its annual report Directors’ Report a description of each director’s skills, expertise and Page 18 experience. Alongside this, in the annual report, the board should make a clear statement about its own balance, completeness and appropriateness to the requirements of the NHS foundation trust. FT ARM The annual report should include a brief description of Directors’ Report the length of appointments of the non-executive directors, Page 17 and how they may be terminated B.2.10 A separate section of the annual report should describe Directors’ Report the work of the nominations committee(s), including the Pages 26 and 36 process it has used in relation to board appointments. FT ARM The disclosure in the annual report on the work of the Not applicable. Open nominations committee should include an explanation if advertising has been neither an external search consultancy nor open used for Non-Executive advertising has been used in the appointment of a chair appointments during the or non-executive director. year B.3.1 A chairperson’s other significant commitments should be Directors’ Report disclosed to the council of governors before appointment Page 17 and included in the annual report. Changes to such commitments should be reported to the council of governors as they arise, and included in the next annual report. B.5.6 Governors should canvass the opinion of the trust’s The Trust’s strategic members and the public, and for appointed governors the planning process body they represent, on the NHS foundation trust’s includes formal forward plan, including its objectives, priorities and dissemination of the strategy, and their views should be communicated to the forward plan to board of directors. The annual report should contain a governors. Governor statement as to how this requirement has been representation of undertaken and satisfied. members’ views is discussed at the governors’ Strategy Committee, which includes attendance from the NEDs. The 2016/17 Operational Plan was submitted to and discussed at the Strategy Committee in April 2016 and governors’ feedback was reported to the Board prior to approval and submission of the Operational Plan.

FT ARM If, during the financial year, the Governors have This power has not exercised their power* under paragraph 10C** of been exercised in schedule 7 of the NHS Act 2006, then information on this 2015/16 must be included in the annual report. B.6.1 The board of directors should state in the annual report Directors’ Report how performance evaluation of the board, its committees, Page 19 and its directors, including the chairperson, has been conducted. B.6.2 Where there has been external evaluation of the board Directors’ Report

and/or governance of the trust, the external facilitator Page 19 should be identified in the annual report and a statement made as to whether they have any other connection to the trust. C.1.1 The directors should explain in the annual report their Annual Governance responsibility for preparing the annual report and Statement accounts, and state that they consider the annual report Page 59 and accounts, taken as a whole, are fair, balanced and understandable and provide the information necessary for patients, regulators and other stakeholders to assess the NHS foundation trust’s performance, business model and strategy. Directors should also explain their approach to quality governance in the Annual Governance Statement (within the annual report). C.2.1 The annual report should contain a statement that the Annual Governance board has conducted a review of the effectiveness of its Statement system of internal controls. Page 59

C.2.2 A trust should disclose in the annual report: Directors’ Report (a) if it has an internal audit function, how the function is Page 14 structured and what role it performs; or Annual Governance (b) if it does not have an internal audit function, that fact Statement and the processes it employs for evaluating and Page 59 continually improving the effectiveness of its risk management and internal control processes. C.3.5 If the council of governors does not accept the audit N/A committee’s recommendation on the appointment, reappointment or removal of an external auditor, the board of directors should include in the annual report a statement from the audit committee explaining the recommendation and should set out reasons why the council of governors has taken a different position. C.3.9 A separate section of the annual report should describe Directors’ Report the work of the audit committee in discharging its Page 22 responsibilities. The report should include:  the significant issues that the committee considered in relation to financial statements, operations and compliance, and how these issues were addressed;  an explanation of how it has assessed the effectiveness of the external audit process and the approach taken to the appointment or re-appointment of the external auditor, the value of external audit services and information on the length of tenure of the current audit firm and when a tender was last conducted; and  if the external auditor provides non-audit services, the value of the non-audit services provided and an explanation of how auditor objectivity and independence are safeguarded. D.1.3 Where an NHS foundation trust releases an executive Not applicable. director, for example to serve as a non-executive director elsewhere, the remuneration disclosures of the annual report should include a statement of whether or not the director will retain such earnings. E.1.4 Contact procedures for members who wish to Directors’ Report communicate with governors and/or directors should be Page 29 made clearly available to members on the NHS foundation trust's website and in the annual report. E.1.5 The board of directors should state in the annual report Directors’ Report the steps they have taken to ensure that the members of Page 16 54

the board, and in particular the non-executive directors, develop an understanding of the views of governors and members about the NHS foundation trust, for example through attendance at meetings of the council of governors, direct face-to-face contact, surveys of members’ opinions and consultations. E.1.6 The board of directors should monitor how representative Directors’ Report the NHS foundation trust's membership is and the level Page 34 and effectiveness of member engagement and report on this in the annual report. FT ARM The annual report should include: Directors’ Report  a brief description of the eligibility requirements for Page 29 joining different membership constituencies, including the boundaries for public membership;  information on the number of members and the number of members in each constituency; and  a summary of the membership strategy, an assessment of the membership and a description of any steps taken during the year to ensure a representative membership [see also E.1.6 above], including progress towards any recruitment targets for members. FT ARM The annual report should disclose details of company Directors’ Report directorships or other material interests in companies Pages 17 and 30 held by governors and/or directors where those companies or related parties are likely to do business, or are possibly seeking to do business, with the NHS foundation trust. As each NHS foundation trust must have registers of governors’ and directors’ interests which are available to the public, an alternative disclosure is for the annual report to simply state how members of the public can gain access to the registers instead of listing all the interests in the annual report.

Regulatory ratings

As a foundation trust our activities are overseen by Monitor the independent regulator of Foundation Trusts. Monitor uses the Trust’s Annual Plan and its in-year quarterly submissions to assign a risk rating for finance and governance for the Trust. Monitor uses these ratings to assess the risk of compliance with the Trust’s Terms of Authorisation (to be a foundation trust), to guide the intensity of its monitoring and to signal its degree of concern with the specific issues identified and evaluated.

With the change in regulatory regime in 2013/14 following the enactment of the NHS Act 2012, foundation trusts method of assessment was changed from the Financial Risk Rating to the Continuity of Service Risk Rating under the Risk Assessment Framework. This assessment method was replaced in August 2015 by the Financial Sustainability Risk Rating. This change took place at the end of Q1 2015/16.

The risk ratings achieved by the Trust for 2014/15 and 2015/16 are summarised in the tables below.

By Continuity of Service Risk Rating assessment

Annual Q1 2014/15 Q2 2014/15 Q3 2014/15 Q4 2014/15 Plan 2014/15 Continuity of service 3 2 2 2 2 rating

Governance Green Green Under Red Red rating review

Annual Q1 2015/16 Q2 2015/16 Q3 2015/16 Q4 2015/16 Plan 2015/16 Continuity of 2 1 N/A N/A N/A service rating

Governance Red Red N/A N/A N/A rating

By Financial Sustainability Risk Rating assessment

Annual Plan Q1 2015/16 Q2 2015/16 Q3 2015/16 Q4 2015/16 2015/16 Financial N/A N/A 2 2 2 Sustainability Risk Rating

Governance Red Red Red Red Red rating

Financial Sustainability Risk Rating

The Trust’s Annual Plan for 2015/16 had a Financial Sustainability Risk Rating of 1 in the first quarter, rising to 2 by the end of the year.

During the year Monitor changed its rating calculation by adding additional metrics to the calculation, which it renamed Financial Sustainability Risk Rating. The new rating calculation generates a score of 1, 2, 3 or 4, with a 4 being the top of the range and 1 being the bottom of the range.

Under the new rating the Trust’s Annual Plan scored a 1 in Quarter 2, Quarter 3 and Quarter 4. The Trust’s actual risk rating in those periods was a 2.

The Trust Board is committed to return the Trust to financial stability and expects to do so by the end of 2016/17.

Statement of the Chief Executive's responsibilities as the Accounting Officer of Royal Berkshire NHS Foundation Trust

The NHS Act 2006 states that the Chief Executive is the 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 for which they are answerable, and for the keeping of proper accounts, are set out in the NHS Foundation Trust Accounting Officer Memorandum issued by Monitor.

Under the NHS Act 2006, Monitor has directed Royal Berkshire NHS Foundation Trust to prepare for each financial year a statement of accounts in the form and on the basis set out in the Accounts Direction. The accounts are prepared on an accruals basis and must give a true and fair view of the state of affairs of the Royal Berkshire NHS Foundation Trust and of its income and expenditure, total recognised gains and losses and cash flows for the financial year.

In preparing the accounts, the Accounting Officer is required to comply with the requirements of the NHS Foundation Trust Annual Reporting Manual and in particular to:

 observe the Accounts Direction issued by Monitor, including the relevant accounting and disclosure requirements, and apply suitable accounting policies on a consistent basis  make judgements and estimates on a reasonable basis  state whether applicable accounting standards as set out in the NHS Foundation Trust Annual Reporting Manual have been followed, and disclose and explain any material departures in the financial statements  ensure that the use of public funds complies with the relevant legislation, delegated authorities and guidance and  prepare the financial statements on a going concern basis.

The accounting officer is responsible for keeping proper accounting records which disclose with reasonable accuracy at any time the financial position of the NHS foundation trust and to enable him/her to ensure that the accounts comply with requirements outlined in the above mentioned Act. The Accounting Officer is also responsible for safeguarding the assets of the NHS foundation trust and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities.

Annual governance statement

Scope of responsibility

As Accounting Officer, I have responsibility for maintaining a sound system of internal control that supports the achievement of the Trust’s policies, aims and objectives, whilst safeguarding the public funds and departmental assets for which I am personally responsible, in accordance with the responsibilities assigned to me. I am also responsible for ensuring that the Trust is administered prudently and economically and that resources are applied efficiently and effectively. I also acknowledge my responsibilities as set out in the NHS Foundation Trust Accounting Officer Memorandum.

The purpose of the system of internal control

The system of internal control is designed to manage risk to a reasonable level rather than to eliminate all risk of failure to achieve policies, aims and objectives; it can therefore only provide reasonable and not absolute assurance of effectiveness. The system of internal control is based on an ongoing process designed to identify and prioritise the risks to the achievement of the policies, aims and objectives of the Trust, to evaluate the likelihood of those risks being realised and the impact should they be realised, and to manage them efficiently, effectively and economically. The system of internal control has been in place in the Trust for the year ended 31 March 2016 and up to the date of approval of the annual report and accounts.

Capacity to handle risk

The Board of Directors has overall responsibility for the management of risk within the Trust, and there have been a number of changes in the Boards composition in the last 12 months, including the appointment of a new Chairman and resignation of the Director of Workforce and Organisational Development.

The Quality Improvement and the Clinical Quality Assurance Departments merged in March 2016, with the purpose via the new structure to improve and integrate the Trust’s governance, patient safety and risk management with the ultimate aim of improving quality and safety outcomes.

As Chief Executive, I am directly accountable to the Board of Directors in relation to the performance of the Trust. The authority within risk management is, however, delegated to individual Executive Directors who are supported in this, by their own teams.  Director of Finance – financial, purchasing, business development and health and safety  Medical Director – clinical governance  Chief Operating Officer – Clinical services and objectives delivery  Executive Director of Nursing – patient safety, safeguarding, assurance, litigation and for the development and oversight of the Trust’s strategic risk management processes, with support being provided by the Head of Risk for the Corporate Risk Register and the Trust Secretary and Director of Strategy for the Board Assurance Framework Document.

The Risk Management Policy identifies further role responsibilities for risk management through the Care Groups and corporate equivalent directorates who have the responsibility for leadership in risk management for their own areas of responsibility.

Structures and systems are in place to support the delivery of integrated risk management across the Trust, which includes the following provision of training in 2015/16 –  The members of the Trust Board received an information and training session regarding risk and assurance processes at the June Board development session 2015  The three Care Boards (Urgent, Planned and Networked) received presentations and information on the revised risk management process, risk registers and the use of the Centralised risk management system – Datix  Risk assessment and risk register entry and management training has been provided to over 135 members of staff since June 2015. Training sessions are supported by a ‘how to’ guidance booklet  Risk management and incident reporting is now incorporated in the Trust’s Induction and clinical refresher mandatory training programmes.

The risk and control framework

There are many ways that the organisation seeks to learn. This includes from good practice, guidance, incident reporting and investigation, complaints, claims, and risk assessments. This information is filtered to frontline staff via the intranet, Committees and newsletters.

The Trust encourages incident reporting, with staff receiving information and training on their induction and refresher training days.

The Trust’s risk management framework is designed to identify and then manage risks to an acceptable level (treat rather than terminate) all risks.

Within the framework the Risk Management Policy sets out the roles and responsibilities of Trust employees, identifies that risk can come from various sources - clinical, financial, regulatory, strategic etc and the process for assessing, escalating and de-escalating risks. The Risk Management Policy was reviewed and approved in June 2015, and is held in the Trust’s document management system on the intranet.

The Trust’s risk appetite statement and risk management strategy were reviewed in June 2014, and now it is time to refresh these documents, - with draft versions presently being produced and presented to the Audit and Risk Committee ahead of being adopted by the Trust Board during 2016.

The Trust’s Risk Appetite Statement will indicate how much, or how little the Board of Directors wish to commit in terms of risk when reviewing service changes, capital investment etc.

Risks are managed through departmental, service, care group and corporate risk registers. The Trust is in the process of improving the quality of information contained within risk entries and centralising all risk registers onto the Trusts’ Datix system. This will allow for consistency of risk identification and entry information and allow for clear oversight by the Board and develop themed reporting and risk identification. All risks now have to have an owner, remedial action/treatment plan and a target deadline for completion, and where risks are escalated these need to be sponsored by a member of the committee which is escalating the risk. This allows for ownership and accountability to be ingrained within the risk management culture of the organisation.

The Trust at the time of producing this statement has identified at total of 434 risks of which-  181 risks have been identified at the department level

 111 risks have been identified at the service level  122 risks have been identified at the care group/ directorate level and  20 risks have been identified at the corporate level.

As the awareness and risk culture matures within the Trust, it is expected that this number should increase considerably especially at the departmental and service level.

The revised Risk Management Policy sets out a transparent ‘ward to board’ escalation and de-escalation process which ensures only ‘challenged and validated’ high level risks are reported on the Corporate Risk Register, which identifies the major risks to the whole organisation and is reviewed by the Integrated Risk Management Committee who report to the Audit and Risk Committee.

The Audit and Risk Committee function is as a sub-committee of the Board – which are in place to both ensure the effective governance of operational and strategic processes and systems and to provide suitable assurance that risk is effectively managed. The Audit and Risk Committee, along with the Board reviews the Corporate Risk Register and the Board Assurance Framework quarterly.

Corporate Risk Register

The most significant - highest scoring risks from the corporate risk register at the time of producing this statement, are identified below. There are plans to address each risk within their register entry.

 Inadequate data quality  Failure to meet ED Clinical standards including 4 hour standard of 95% seen and discharge/transfer out  Inability to recruit to, and retain substantive nursing, midwifery and medical vacancies  Theatre Utilisation  Healthcare Records Management  Compliance to Cancer targets  The Effectiveness of Clinical Admin Teams.

The Board Assurance Framework

The Board Assurance Framework provides the mechanism for the Board to monitor risks, controls and the assurances that controls are effective. The Board recognises the importance of the Board Assurance Framework in mitigating the Trust’s strategic risks and is currently in the process of enhancing the document. The Board have identified and agreed the following strategic risks –

 Principal risk 1 – Failure to maintain and improve quality of care and access standards  Principal risk 2 – Failure to maintain governance standards required to maintain license to operate and to deliver quality patient care  Principal risk 3 – Failure to sustainably achieve financial targets and CIPS  Principal risk 4 – Failure to maintain compliance and develop an estate fit for the future  Principal risk 5 – Scale of IT implementation impacts negatively on functioning of Trust and on clinical care  Principal risk 6 – Failure to ensure there are the right staff (numbers, skills and capability) in the right place

 Principal risk 7 – Failure to develop the organisation to support the delivery of the Trusts’ vision  Principal risk 8 – Failure to maintain engagement with stakeholder groups  Principal risk 9 – Failure to respond to changes in the external environment impacts on the viability of the Trust.

An internal audit was undertaken on the Trusts risk management processes in 2015, to which an action plan was produced and completed, to implement the audits recommendations.

As part of its mandatory requirements the Trust has commissioned in 2016, an external review of its compliance to the ‘well led framework’ which includes risk management. The Trust is fully compliant with the registration requirements of the Care Quality Commission.

As an employer with staff entitled to membership of the NHS Pension Scheme, control measures are in place to ensure all employer obligations contained within the Scheme regulations are complied with. This includes ensuring that deductions from salary, employer’s contributions and payments in to the Scheme are in accordance with the Scheme rules, and that member Pension Scheme records are accurately updated in accordance with the timescales detailed in the Regulations.

Control measures are in place to ensure that the organisation’s obligations under equality, diversity and human rights are complied with.

The Trust has undertaken risk assessments and Carbon Reduction Delivery plans are in place in accordance with emergency preparedness and civil contingency requirements, as based on UKCIP 2009 weather projects, to ensure that this organisation’s obligations under the Climate Change Act and the Adaption Reporting requirements are complied with.

Review of economy, efficiency, and effectiveness of the use of resources

Data security

Data Communications:

The Trust has put in place appropriate measures to ensure the security of data and to ensure the risk of data loss is minimised. This is achieved in the following ways:

Access to data:  All applications are password controlled, the password policy issued by IT details the password requirements and the need to change passwords, and this is further enforced through forced password changes after 90 days on key applications  Remote connectivity to the Trusts applications is strictly controlled and only achieved by two factor authentication - user name / password plus RSA (Remote secure access) token with a 60 second refresh time  Third party access is only available under the terms laid out in the Information Governance Statement of Compliance issued by the NHS. This has been fully documented in the Access Control policy.

Backup of data:  The systems managed by IT have a daily, weekly, monthly backup cycle that is managed by the operations team in line with their operating procedures

 Tape back-ups are stored in a fireproof safe, critical systems and monthly tapes are stored for a period of one year should the need arise to retrieve historical data  These back-up tapes would be used if there is a need to recover in the event of a disaster.

Threat intrusion:  All PCs and servers have antivirus software installed and in addition a three-layer firewall is in place to reduce the risk of intrusion  The latest version of anti-virus software is distributed through an automated software deployment tool, and supplier notice boards are monitored regularly to ensure that newly identified threats are dealt with  Following a serious virus attack in late Quarter 4 2015/16, the Trust has strengthened and updated its Antivirus on its residual vulnerable hardware. IT has also accelerated its program to replace this hardware and its dated Windows XP/2003 operating system.

Disposal of equipment:  Disposal of equipment: any computer equipment or media that is replaced either through end of life refresh or due to a fault that cannot be repaired has the hard drive removed and granulated.

Encryption / removable media: In addition, the following policies are in the process of being implemented:

 Encryption Policy - all new laptops will be delivered with encryption software pre- loaded, this cannot be removed. All existing laptops are now encrypted  Removable Media Policy - this policy is in place and the Trust is planning to lock out any non-encrypted media devices such as memory sticks to ensure that if any patient data is copied it is secured.

IT Controls Improvement: In February 2015 , the Director of Information Management and Technology (IM and T) instigated an IT controls improvement programme to give a fuller overview of the current risks associated with the IT applications and support mechanisms . The wider objectives of this programme include actions from the PwC internal audit on IT controls carried out in September 2015.

The programme objectives that were completed by the end of March 2016 include:

- Confirmation of the priority of the Trust’s most critical 250 IT systems - Definition, agreement and implementation of an IT Governance document which sets out the management of IT controls and the operational running of and access to the IT Applications and Infrastructure of the Trust - A review of the IT controls of the top 40 Trust priority IT systems (the programme is reviewing 40 at a time) - Mitigation of the most serious threats and weaknesses - A review of the next 40 priority systems - A review of resources needed to continue to execute the programme.

Early feedback relating to the recent PwC follow up internal audit on IT controls indicates good progress has been made and the Trust will again incorporate any findings from this audit into the on-going programme.

Information governance

During 2015/16 there were seven information governance incidents recorded by the Trust as ‘serious incidents’. These were recorded at level 2 or above requiring the Trust to notify the Information Commissioner’s Office. In 2014/15 there were seven incidents.

The Trust has a commitment to encourage staff to report and investigate all relevant issues, even where the loss is considered minor. In each instance issues are investigated and actions taken where appropriate to mitigate against further occurrences.

Governance structures

Risk is managed on behalf of the Board through the Trust’s governance structure. The committee structure was last reviewed in 2014/15 and risk is managed through the following Board committees:  Audit and Risk Committee  Clinical Governance Committee  Finance and Resources Committee.

The Audit and Risk Committee oversees the delivery of effective risk management arrangements in the Trust. The key aims and objectives for risk management include:  complying with legal and statutory requirements and meeting the requirements of external regulators and other relevant bodies  providing guidance to assist with proactive risk management and risk reduction  supporting the organisation in its approach to ensuring the safety of staff, patient and visitors.

The Clinical Governance Committee enables the Board of Directors to obtain assurance that high standards of care are provided by the Trust and in particular that adequate and appropriate clinical governance structures, processes and controls are in place throughout the Trust. The key responsibilities of the CGC are:

 to ensure compliance with CQC essential standards and NICE guidance  to be assured that risks to clinical quality are proactively identified, prioritised and managed  to ensure effective learning is embedded from serious incidents, complaints and patient feedback  to oversee the Trust’s quality strategy, quality account and quality governance framework.

The Quality Assurance and Learning Committee which reports to the Clinical Governance Committee was introduced during 2014/15. Care Group Governance Committees now report to this committee, which has strengthened an integrated approach to the management of risk and shared learning across the organisation.

Review of effectiveness

As Accounting Officer, I have responsibility for reviewing the effectiveness of the system of internal control. My review of the effectiveness of the system of internal control is informed by the work of the internal auditors, clinical audit and the Executive managers and clinical leads within the NHS Trust who have responsibility for the development and maintenance of the internal control framework. I have drawn on the content of the Quality Account Report included in this Annual Report and other performance information available to me. My review is also informed by comments made by the external auditors in their management letter and

64 other reports. I have been advised on the implications of the result of my review of the effectiveness of the system of internal control by the Board, the Audit and Risk Committee (and clinical governance/ quality committee, if appropriate) and a plan to address weaknesses and ensure continuous improvement of the system is in place.

I have been specifically informed on the effectiveness of the system of internal control and the validity of the Corporate Governance Statement by the:  Trust Board: through the regular review, adoption and approval of the Trust Corporate Risk Register, the ‘Quality and Patient Safety reports’ and the ‘Integrated Performance reports’  Audit and Risk Committee: through internal and external audit, reviewing the adequacy of internal control systems designed to minimise risk. Also, ensuring overall co-ordination of risk management and monitoring of the action plans to address the risks identified in the Trust Corporate Risk Register  Clinical Governance Committee: ensuring the effective working of clinical governance, both corporately and at care group level, including clinical audit and risk management. It also reviews reports on the quality assurance process and Quality Accounts data requirements demonstrating effectiveness and improvements in the quality and safety of our care for patients.

A review of our governance arrangements against the Monitor Well Led Framework was carried out by Deloitte from January to March 2016. Recommendations from the review will be considered during 2016/17 to further strengthen the Board Committee structure.

A number of factors have contributed to form the Head of Internal Audit opinion for the year. The Trust has been working on its programme of IT systems transformation over the last three years, as highlighted in prior year Annual Reports, and significant progress has been made this year, in particular with a key programme of review and improvement in controls over the Trust’s highest priority systems. However, until this work is complete there remain shortcomings in the IT control environment.

Also, the Trust has identified significant concerns in relation to the quality of some of its underlying performance data. To address this the Trust has implemented a new data warehouse and has commenced a data assurance programme to assess data quality arrangements and to provide clear levels of confidence in reported information.

Progress on both the IT systems transformation and the data quality programme is being monitored by the Audit and Risk Committee.

The Trust is in the middle of a major multi-year programme to review the Trust’s systems to assess the design and operation of key general controls (such as user access and change management), implementing improvements in control where required, to close the gap in controls that was a key reason behind poor Head of Internal Audit opinion in previous years. During the year the Trust completed its review of the 40 highest priority systems and is now working its way through the next highest priority systems.

As a result, whilst noting the progress made in the year, the Head of Internal Audit has reached an opinion of “major improvement required” on the Trust’s overall system of controls, effectiveness and use of resources.

Chief Executive’s Quality Statement

Jean O’Callaghan

Our 2015/16 Quality Account focussed on six priorities chosen in consultation with our patients, staff and stakeholders. They all contribute to the Trust’s strategic objectives of improving quality of care, achieving quality standards and improving governance arrangements.

They aim to keep our patients safe from harm, provide clinically effective treatment and ensure a positive experience whilst in our care.

Under patient safety, we said a priority was to improve the safety of our maternity service. We have improved our facilities and worked hard to increase staffing, but this remains a challenge. Great progress was made in improving leadership and the culture within the service.

Also under patient safety we wanted to improve reporting of patient safety incidents and our systems for learning from them.

The priority has been achieved with increased reporting compared to last year. A ‘raising concerns’ confidential email has been set up encouraging staff to raise concerns in a confidential manner; a patient safety star of the month began in June 2015 to celebrate the staff member who has reported the most incidents.

Under clinical effectiveness we aimed to improve the availability and quality of medical records and reduce waiting times to ensure treatments were received at the right time. Both require further work in 2016/17, but progress has been made. There is now automated requesting of patient records, a streamlined referral process, and we have commenced Trustwide records management training.

We also made progress in National Standards, but improvements are still needed to fully achieve our cancer targets and this remains a priority in 2016/17.

The 18 week pathway standard we are required to report on has been consistently achieved over the past year.

Emergency Department waiting times were achieved for the first three quarters of the year but significant increases in attendance over the winter meant we were unable to sustain this performance.

The Ward Accreditation Scheme was launched in October 2014. In the last quarter of the year, Trueta ward became the first to apply for and succeed in gaining their ward accreditation, pending formal interview and presentation to the Board. They completed their portfolio and met agreed indicators, maintaining these standards for six months prior to applying for Accreditation.

Our Patient Leadership Programme is now on its fifth cohort of patient leaders with approximately 26 volunteers trained. These patient leaders provide invaluable insight into patient experience and help drive many quality improvement initiatives across the Trust as well as sitting on interview panels for nurses and consultants.

Glossary of Technical Terms

CAT Clinical Administration Team The 14 administrative support teams in the Trust CCG Clinical Commissioning Group CCGs are clinically-led statutory NHS bodies responsible for the planning and commissioning of health care services for their local area. CDS Commissioning Data Sets CDS form the basis of data on activity carried out by NHS Trusts reported centrally for monitoring and payment purposes. Clinical Senate Clinical Senates have been established to be a source of independent, strategic advice and guidance to commissioners and other stakeholders to assist them to make the best decisions about healthcare for the populations they represent. CQC Care Quality Commission The independent regulator of health and adult social care in England. CQUIN Commissioning for Quality and Innovation A scheme designed to encourage NHS Trusts to improve quality and patient safety by setting targets and rewarding achievements of those targets through financial payments. These targets are set nationally and locally. Cubescribe An outsourced audiotyping software used by the Trust to have clinic letters typed Delayed Transfers Patients who are medically fit to be discharged but are unable to be of Care so due to issues with the onward patient pathway Dr Foster An organisation used by the Trust to provide analysis of mortality and morbidity data and comparisons with other healthcare providers. Duty of Candour A legal regulation to ensure that providers are open and transparent with people who use services and other 'relevant persons' (people acting lawfully on their behalf) in general in relation to care and treatment. It also sets out some specific requirements that providers must follow when things go wrong with care and treatment, including informing people about the incident, providing reasonable support, providing truthful information and an apology. EPR Electronic Patient Record The electronic system used by the Trust to record patient information FFT Friends and Family Test A survey which asks patients who have received NHS care whether they would recommend the Trust to their friends and family if they needed similar care and treatment. There is also a staff FFT which surveys NHS staff and asks whether staff would recommend the Trust as a provider of care to their friends and family. FP10s Prescription forms HES Hospital Episode Statistics A data warehouse containing details of all admissions outpatient appointments and ED attendances at NHS hospitals in England. HSCIC Health & Social Care Information Centre The national provider of information, data and IT systems for health and social care “John’s A campaign for carers of patients with dementia to be given the right Campaign” to stay by the bedside as long as they wish to do so http://johnscampaign.org.uk/#/

MUST Malnutrition Universal Screening Tool A five-step screening tool to identify adults who are malnourished, at risk of malnutrition, or obese NEWS National Early Warning Score A screening tool designed to assess the degree of illness of a patient based on 6 vital signs NHS Intensive An organisation providing short or medium term support to NHS Support Team organisations with management expertise, focusing on improving performance, quality assurance and programme enhancement NICE National Institute for Health and Care Excellence An independent national organisation commissioned to develop guidance and quality standards in health and social care NOMADs Monitored dosage device/ aid for helping patients to manage their daily medications NRLS National Reporting and Learning System A central database of patient safety incident reports which is used to analyse hazards risks and opportunities to improve patient care. Perinatal mortality Deaths of babies between 22 weeks gestation and up to 7 days after birth PROMS Patient Reported Outcome Measures Pre- and post- operative surveys used to assess the quality of care delivered to NHS patients from the patient perspective by calculating the health gains after surgical treatment. PTL Patient Tracking Lists A system used by NHS organisations to monitor patients on “Referal to Treatment” pathways RTT Referral to Treatment Targets set by the government of the maximum waiting times patients should experience when waiting for treatment SHMI Summary Hospital-level Mortality Indicator An indicator which reports on mortality at trust level across the NHS in England. It is the ratio between the actual number of patients who die following hospitalisation at the Trust and the number that would be expected to die on the basis of average England figures, given the characteristics of the patients treated there. SIRI Serious Incident Requiring Investigation An incident in healthcare which had serious consequences for patients, family, or the delivery of healthcare services; or for which there is large potential for learning. These are required to be reported to the Trust’s commissioners. SUS Secondary Uses Service The single, comprehensive repository for healthcare data in England which enables a range of reporting and analyses to support the NHS in the delivery of healthcare services. Thames Valley A local Academy for NHS funded organisations in the Thames Valley Leadership and Wessex area to support the development leaders at all levels Academy Thames Valley An organisation working across Thames Valley to share best Strategic Clinical practice, provide guidance on variation and promote the work of peer Network organisations as a vehicle to improve ways of working and patient outcomes. Thrombolysis A treatment to dissolve dangerous blood clots by pharmacological means known as “clot busting”

PART 1: Introduction

What is a Quality Account?

Since 2009, all NHS hospitals must publish a Quality Account. The Quality Account is an annual report to the public by NHS providers of the quality of the services provided. Its purpose is to ensure NHS trusts demonstrate their commitment to delivering high quality care, openness and candour and to invite the stakeholders to contribute to determining the standards of care they desire and expect.

This document is Royal Berkshire NHS Foundation Trust (the Trust)’s Quality Account for 2015-16 and it is divided into four sections:

Part 1: A statement from the Chief Executive on quality. We have also set out an introduction to the Trust and what quality means to us.

Part 2: An outline of our quality improvement priorities for 2016/17. This includes how we have chosen those priorities through consultation.

Part 3: Mandated statements of assurance from the Board on clinical audit, research, CQUIN payments, CQC registration and data quality.

Part 4: We review 2015/16 and comment on our performance against our priorities for the year. We have also included highlights of other areas of quality improvement that have been important to us and to our patients. This includes information on national and mandated core indicators for 2015/16, including benchmarking.

About the Royal Berkshire NHS Foundation Trust

The Royal Berkshire NHS Foundation Trust provides high quality acute medical and surgical services for our local communities for over 500,000 people in Reading, Wokingham, West Berkshire and surrounding areas. We also provide specialist services to a population of one million across Berkshire and its borders. With just over 4,500 staff we are one of the largest employers in the Reading area.

Our specialist centre is the Royal Berkshire Hospital in Reading, a large district general hospital with the expertise to treat patients requiring urgent or hyper-acute care.

Additionally we have a number of community sites where we deliver ambulatory care and diagnostics. We continue to develop the range of services offered in the community to take a greater proportion and range of care nearer to, or in, patients’ homes.

We provide services from the following bases:

. Royal Berkshire Hospital, Reading with just under 700 beds and capacity for over 200 day patients

. The Prince Charles Eye Unit, Windsor, provides eye services to the patients of East Berkshire

. Dialysis services at a dedicated unit in Windsor

. West Berkshire Community Hospital - day surgery unit and the acute outpatients department

. Royal Berkshire Bracknell Healthspace – cancer, renal and outpatient services

. Townland’s Hospital, Henley – outpatient services

We have been an NHS foundation trust since June 2006 and we are pleased with the freedom and responsibilities that this brings. It enables us to work with our members through our Council of Governors to shape our direction of travel. Working with Commissioners we can develop the services and facilities required by our local communities.

We are a designated specialist centre in cancer, bariatric care, heart attack and stroke. We also provide specialist care as part of a care network through a local neonatal unit, an interventional radiology unit and a trauma unit. We are part of the critical care and vascular care networks.

Our Approach to Quality

Our commitment to quality is summarised in our vision:

“Seamless delivery and excellence in healthcare and outcomes”

In support of this vision we have a 5 year Quality Strategy in place, containing our quality objectives and plans around 4 simple aims. These are:

1. Caring Culture: Development of our Organisational Development Strategy to align all the components of our organisation that define us, our culture and how we approach quality of care 2. Safer Environment: Reducing avoidable harm through initiatives such as the Sign up to Safety campaign; improving the sharing of learning from incidents; and improving risk management structures. 3. Improving Outcomes: Reviewing mortality indicators; improving clinical documentation; and reviewing and improving clinical audit and governance processes. 4. Better Experience: Improving communication with patients; improving waiting times; reviewing the complaints processes.

How do we know we are delivering quality care?

The Trust Board is accountable for the systems of assurance, internal control and risk management and regularly monitors and reviews these at Trust Board level and via its committees. The Chief Executive is ultimately responsible for ensuring the Trust delivers a high quality service for all patients and for compliance with quality and performance targets. This responsibility is delegated to members of the Executive, such as the Medical Director, the Executive Director of Nursing, and to the Director of Finance for financial targets.

The Executive Team and the Care Groups meet every month to discuss and monitor progress against our quality indicators. A dashboard is used to help the Trust monitor performance which focuses attention on those areas that require further work. The Quality Governance Committee reviews progress against actions bi-monthly and the Trust’s quality performance is reported and discussed at the Trust Board every month.

The Board is actively engaged in reviewing the quality of our services. The Chief Executive, Chairman and the Executive Director of Nursing take part in regular ward visits to meet staff and talk with patients. Throughout the year, we hold monthly Patient Safety and Patient Experience departmental visits. Teams consisting of executive directors, non-executive directors, senior nurses, estates and facilities, corporate and operational managers and patient leaders visit all our sites to assess safety, the environment, and patient experience, speaking with both staff and patients.

The Trust Board gains assurance on quality through a number of reports including:

. The monthly Integrated Performance Report (key performance indicator dashboard) . Periodic quality and safety reports . Regulatory assurance including compliance with external regulators and Commissioners . Patient experience/patient feedback . Board visits to wards and departments . Patient complaints . Safeguarding . Thematic learning from incidents The Trust also monitors progress against CQUIN targets. Commissioning for Quality and Innovation (CQUIN) is a scheme designed to encourage NHS Trusts to improve quality and patient safety by setting targets and rewarding achievements of those targets through financial payments. These targets are set nationally and locally.

Our Quality Improvement Journey 2012 – 2017

We know our ability to learn from the past is critical to our ability to improve in the future. Therefore, we have reflected on how we have achieved success in sustaining and growing improvement over the last 5 years. This helps us to reflect on those areas that are a greater challenge and that may warrant an increased profile and attention over a period longer than 12 months.

2012/13 2013/14 2014/15 2015/16 2016/17

Reducing Improving Ensuring we have Reducing the Reducing and numbers of number of preventing reporting of and the right numbers patients who pressure C.difficile learning from of staff with the develop C. ulcers infections Patient Safety right skills to meet difficile Incidents. our patients' needs Improving Improving the Reducing Harm Free safety of our Reducing harm from harm from Care: falls, maternity Sepsis Patient Safety Patient sepsis UTI, pressure services ulcers, VTE

Ensuring Understanding Improve the timely and and reducing Reducing waiting times to ensure treatments appointments informed weekend received at right time system mortality discharge

Improving availability and quality of medical records

Improving Antimicrobial ClinicalEffectiveness Stewardship

Improving our courtesy, communication and behaviours

Improving Improving safe Improving care for the Reducing and timely patients with outpatient cancellations discharge for dementia and experience patients support for carers

Improving administration systems to improve booking processes,reduce cancellations inc. Patient Experience Patient improving access to hospital

Quality Improvement Priorities Diagram 2012-17

PART 2: Priorities for Improvement 2016-17

How did we choose our priorities for 2016-17?

Our high level Trust objectives are to ensure that patients are safe from harm, they receive clinically effective treatment and they have a positive experience whilst in our care. This year we have chosen 7 priorities for improvement that fall within these three high level groups.

The Quality Account priorities form a key element of the Trust’s Quality Strategy. It is our aim to align our priorities with those of our Commissioners, our patients and our staff to ensure that we have the supporting strategies that will underpin successful delivery. As a result, we are confident that these priorities will be meaningful and relevant to our key stakeholders, whilst ensuring that we continue to give appropriate focus to other priorities over a longer period.

In order to develop our priorities this year we have reviewed progress against last year’s objectives; reviewed the themes arising from our internal quality indicators such as incidents, complaints and clinical audit / outcomes data; and undertaken consultation with key stakeholders:

. Listening to our patients: the Trust is committed to ensuring patients’ views are heard and used to inform our service development. We therefore held a conference with our patient partners to develop suggestions for quality priorities and have consulted with our Governors in finalising these choices.

. Listening to our staff: our staff are responsible for delivering the care and services our Trust provides on the frontline, day in, day out. They have unique insight into what matters to patients, what aspects of care we excel in, and what aspects of care could be improved. All staff were therefore given the opportunity to give suggestions and vote for the quality priorities they felt should be included in the forward plan for 2016-17.

. External stakeholder engagement: the long-list of quality objectives was shared with our Commissioners, Healthwatch and Health and Wellbeing Boards.

Patient Safety Priority 1: Ensuring we have the right numbers of staff with the right skills to meet our patients’ needs

Why is this important? Ensuring our hospital is staffed with the appropriate number and skill mix of clinical professionals is vital to the delivery of quality care and keeping patients safe from avoidable harm. Vacancy rates are a challenge across all staff groups and cause financial pressures with increased agency staff spending and pressures in providing continuity of care for our patients. In March 2016 we had an overall vacancy rate of 5.7%.

What work has been completed so far? The Trust has an active strategy for recruitment and retention which has included: . revision of the interview process for Health Care Assistants (HCAs) and nurse recruitment . re-launch of the ‘refer a friend’ scheme . use of social media – LinkedIn, Twitter and Facebook accounts – to promote recruitment . three overseas nursing recruitment campaigns to Portugal and Italy resulting in the successful recruitment of 40 nurses . recruitment open days held for nursing, midwifery and therapies . recent leavers written to and encouraged to return . development of bespoke rotation programmes for student nurses; support offered with interview techniques and practice; and the benefits and job opportunities at the Trust outlined to all of our students . delivery of a training programme for NHS Professionals staffing agency (NHSP) for new HCAs to encourage them to work at the Trust when they finish their training

Plans for Improvement 2016-17 In 2016-17 we plan to: . continue recruitment open days for nursing and midwifery . offer ‘Golden Hello’ payments of £2000 to new staff in two very hard to recruit areas: orthopaedics and elderly care . undertake further overseas recruitment campaigns . promote our relocation package to attract those based further afield . offer a skills development programme for nurses . continue rotation programmes for student nurses so different opportunities can be promoted . introduce a clinical support worker development programme in partnership with NHSP

Key Quality Performance Measures: . A reduction in our overall vacancy rate . Reduction in our rolling 12 month workforce turnover . Maintenance of >90% fill rate of planned Registered Nurse shifts

Patient Safety Priority 2: The Timely Identification and Treatment of Sepsis

Why is this important? Severe sepsis accounts for approx. 32,000 deaths annually in England. Some estimates suggest that up to 34% of these deaths are potentially preventable. If recognised and treated in a timely manner the chances of patient survival significantly increase. What work has been completed so far?

Sepsis has been high on the Trust’s agenda for nearly 10 years now, and an ongoing collaborative, trust wide, multi-professional approach has continued to transform our improvement capability, capacity and resilience in trying to make a significant difference to those patients with a diagnosis of sepsis. Our learning and collaboration extended across the local health economy, where we are now working together across primary, secondary and community care using a common sepsis language and methodologies such as NEWS and sepsis screening tools.

This has been a collaborative team approach working across a wide range of work streams all resulting in the aggregation of marginal improvement gains across the range of different drivers. There is never just one solution to a problem with such a wide scope, but a transparent and open culture has enabled us to start exploring the root causes and identify potential areas for change across our trust and in primary care.

Plans for improvement 2016-17

The publication of the National Confidential Enquiry into Patient Death and Outcome “Just say sepsis” report in November 2015 has given us a clear template to work from in order to benchmark ourselves against “gold standard practice”. We are already hard at work to map our existing processes / tools against the recommendations made. This will provide a clear picture of what actions needs to be taken over the next year to ensure all processes are solidly embedded into our daily practice. This work will also be supported by the 2016/2017 national sepsis CQUIN that will again include the “front door” admissions, but will for the first time also focus on inpatients developing sepsis on the ward.

Internationally, new updated sepsis criteria were published in February 2016. This is a significant development as all screening criteria will now change, which will require renewed education across both primary and secondary care. In addition new NICE guidance due for publication in July 2016 will provide us with clear guidelines to benchmark against and work towards.

Key Quality Performance Measures: . Improvement in percentage of patients who were screened for sepsis (ED and inpatient areas)

. Improvement in the percentage of patients with sepsis who were given intravenous antibiotics within 1 hour (ED) or 1.5 hours (inpatient areas)

Clinical Effectiveness Priority 3: Reducing waiting times to ensure treatment is received at the right time for patients with cancer

Why is this important?

Ensuring patients receive timely diagnosis and treatment for cancer is a high priority to ensure our patients achieve the best possible clinical outcomes and to minimise the psychological impact of waiting for diagnoses and treatments. Meeting cancer waiting time targets was part of the quality priority to reduce waiting times in 2015-16, which unfortunately the Trust has not been able to meet due to increasing capacity pressures. We have therefore decided to continue this work stream as a priority for 2016-17.

What work has been completed so far?

In 2015-16 we:

. developed a nationally agreed action plan to recover performance and implemented a joint Cancer Task Force with the CCGs and Clinical Senate . agreed a backstop policy for all patients not treated by day 104 on their pathways to be clinically reviewed . worked with the NHS Intensive Support Team to improve our cancer services . redesigned pathways to include appropriate escalation triggers . agreed to additional doctors for breast surgery, gastroenterology, colorectal surgery and dermatology . created an additional endoscopy treatment room . developed “one-stop” services in gynaecology, urology and head & neck . improved access to information, transparency and accountability for actions on cancer pathways . reduced our ‘active patient’ list by 20%. This has been achieved through improved scrutiny of patient lists, greater senior leadership involvement, additional staffing capacity on a temporary basis, and specialty-level improvements in capacity and process . expanded our cancer pathway tracking and escalation team

Plans for improvement 2016-17

A tripartite agreed action plan is in place focussing on improving our performance, supported by a high level Cancer Task Force. Actions include:

. developing robust capacity and demand models with the Intensive Support Team . continuing to reduce our active patient list . expanding our “one-stop” services starting with urology . reducing waiting times for suspected cancer first appointments to 7 days . providing increased real time, visual information to clinical teams . review of current cancer system as fit for purpose and integration with our main hospital administration system

Key Quality Performance Measures: . 85% of patients should receive their first definitive treatment within 62 days of an urgent GP referral for suspected cancer (by Q3&4 in line with CCG agreed improvement trajectory)

. 100% of patients waiting longer than 104 days with a confirmed diagnosis of cancer should have a clinical harm review 79

Clinical Effectiveness Priority 4: Improving the Availability and Quality of Medical Records

Why is this important?

The medical record is vitally important in supporting the clinical pathway and in the provision of safe and effective patient care. This was a quality priority for 2015-16 which unfortunately was not fully achieved largely due to the impact of the administrative review project during its implementation phase. We have therefore decided to continue this as a quality priority for 2016-17.

What work has been completed so far?

In 2015-16 we:

. automated requesting of inpatient records on admission to bed board, reducing the need for staff to request records . reduced the number of patient “record volumes” transported around the Trust by delivering the last two volumes only, helping with storage and keeping records safe and tidy . streamlined our retrieval process across the Trust to reduce interruptions to admin team members . commenced with Trust-wide records management training programme to all admin staff . reviewed and changed our service level agreements with our off-site records management service provider . introduced monthly audits of the content and quality of clinical documentation in patient records in all relevant inpatient areas, with regular feedback and discussion of issues at clinical governance meetings . reviewed and amended tracking locations within the Clinical Admin Teams

Plans for improvement 2016-17

We plan to: . complete Trust-wide records management training programme for all admin staff and clinical staff . reduce temporary records within the Trust by increased records tracking, awareness, and monitoring departmental records management performance . introduce improved intranet communications and monthly Health Records newsletter . redesign the Health Records department to offer more on-site support to admin areas to manage records on a daily basis . introduce an electronic tagging system, using a passive radio frequency Identification (RFID) infrastructure for all hard copy Health Records to further increase record availability . commence a project to introduce “Paperless”/”paper light” encounters to be fully implemented by the end of 2018 . review the content of the healthcare records quality audit to include more quality measures; design healthcare records audits for daycase/ outpatient areas; and continue to raise awareness of record keeping standards on a monthly basis through specialty clinical governance meetings

Key Quality Performance Measures: . Maintain 98% availability of notes available to the clinical staff by the time of the clinic appointment . Improve compliance with basic record keeping standards from 85% to 90% 80

Clinical Effectiveness Priority 5: Improving Antimicrobial Stewardship

Why is this important?

Antimicrobial resistance has risen significantly over the last 40 years which poses a serious risk to public health. Inappropriate and overuse of antimicrobials is a key driver. Improving antimicrobial stewardship is therefore an important national priority for clinical effectiveness and safety.

What work has been completed so far?

We have: . completed our antibiotic consumption data validation with Public Health England . benchmarked our antibiotic stewardship programme against NICE best practice guidance . developed an antibiotic stewardship improvement programme for 2016-17 . reviewed our antibiotic policies, protocols and guidelines and made them accessible via an app on mobile devices for greater accessibility to prescribers at the point of care . provided education and training on antibiotic prescribing and stewardship . as part of the wider medicines optimisation initiative, promoted and increased medication incident reporting and learning, ensured a process for medicines reconciliation is in place, and implemented a patient-centred approach to medicines management.

Plans for improvement 2016-17

We plan to:

. develop a local antibiotic consumption vs. antibiotic resistance monitoring system . develop an antibiotic stewardship programme e.g. regular and more frequent antibiotic prescribing audit with real-time feedback to prescribers, implementation period and re- audit . ensure rapid turnover time (≤ 2hours from sampling to result) of emergency and urgent microbiology tests to support acute patient pathway e.g. sepsis and pneumonia . support education and training for all staff on antibiotic resistance and stewardship and also on antibiotic prescribing for medical and non-medical independent prescribers . improve medicines reconciliations within 24 hours of admission in all areas through increased resources and technicians . develop IT systems to support e-prescribing

Key Quality Performance Measures: . 1% Reduction in overall antibiotic consumption per 1000 admissions . Increase in antibiotic prescriptions reviewed within 72 hours to 90% (by Q4 in line with national CQUIN trajectory)

Patient Experience Priority 6: Improving our Administration Systems

Why is this important?

Improvement of our administration systems was chosen as a quality priority for 2015-16. However, this involved a large-scale reorganisation of the infrastructure of the hospital and will take more than a year to fully embed and realise the benefits of the restructure. It has therefore been agreed this should continue as a quality priority for 2016-17.

What work has been completed so far?

. a single contact point for patients and GPs in each CAT . an extension of administrative cover to core hours of 8am – 6pm to improve accessibility for patients . an outsourced audio-typing software “Cubescribe” has been introduced to improve efficiency and clinic letter turnaround times . greater cross-cover for administrative teams and roles to ensure there are no single points of failure

Plans for improvement 2016-17

A detailed development programme is being led by the Chief Operating Officer. The programme encompasses improvement work streams focussing on telephony, estates, staffing and recruitment, technology, information and training. Plans include:

 improving the ‘Netcall’ telephone system across all areas  providing additional office space for full establishment of admin staff  ensuring Cubescribe is implemented in every area  procuring a digital dictation system  focusing on improved recruitment and retention of staff  closely monitoring key indicators through a performance dashboard

A Programme Board has been established which meets monthly and reports into both the Executive and Board to monitor progress.

Key Quality Performance Measures: . A reduction in the time taken to issue clinic letters to patients . Reduction in the abandoned call rate . Improvement in % outpatient GP letters despatched within 7 working days . A 25% reduction in complaints related to administration compared to 2015-16

Patient Experience Priority 7: Improving the Care of Patients with Dementia and Support for Carers

Why is this important?

There are 850,000 people living with dementia in the UK today with approximately 700,000 informal carers supporting their loved ones. Dementia is the leading cause of death for women and third highest for men. The Trust is in the process of reviewing its dementia and carer strategy and, in light of the above statistics, ensuring this is fully implemented is important in improving our patient experience.

What work has been completed so far?

. dementia friendly wards – introduction of colour-themed wards, improvements to flooring and a cinema room . introduction of ‘Twiddlemuffs’ – double thickness hand muffs with bits and bobs attached inside and out which provide a stimulation activity for restless hands of patients suffering from dementia . activities care crew – care team who organise activities for dementia patients who are particularly agitated and provide distractions for them and help to run reminiscence groups . collaboration with the Alzheimer’s Society visiting elderly care wards . a programme of dementia training for staff . events run during ‘dementia awareness week’ to raise awareness . a “forget me not” sign above the beds to indicate patients with cognitive problems who need help with communication (whether that be because of dementia or a delirium)

Plans for improvement 2016-17

. finalising the Trust Dementia Strategy with sections on: patient care, the hospital environment, training and research, carers’ support and collaboration with other care providers, in order to provide a framework for quality improvement . extending open visiting across the Trust supported by a Visitors’ Charter in response to ‘John’s Campaign’ . improving communication and collaboration with carers through the ‘information about me’ booklets . improving involvement of carers in the discharge process . undertaking our dementia carers’ survey and responding to the feedback . continuing to work in a collaborative basis with the Alzheimer’s Society to provide specialist support for carers . extending the links with community providers . participating in the National Audit of Dementia . starting a project to improve night care and sleep for dementia patients

Key Quality Performance Measures: . Improvement in key measure on dementia carers’ survey: o Leaving hospital: were you given information about where you are able to get further help and support? . Ensure 80% of all clinical staff have received specific dementia training

PART 3: Statements of Assurance from the Board

Review of Our Services

During 2015-16 the Royal Berkshire NHS Foundation Trust provided and/ or sub-contracted 33 NHS services.

The Royal Berkshire NHS Foundation Trust has reviewed all the data available to them on the quality of care in 33 of these NHS services.

The income generated by the NHS services reviewed in 2015-16 represents 100% of the total income generated from the provision of NHS services by the Royal Berkshire NHS Foundation Trust for 2015-16.

Participation in National Clinical Audits and National Confidential Enquiries

National clinical audit provides assurance that the care being delivered by our services is of the highest quality in terms of clinical effectiveness, patient outcomes and patient experience, compared to both national best practice standards and other service providers nation-wide. Where the care being delivered does not meet these standards, it provides a stimulus for improvement in the quality of treatment and care. National clinical audit also provides a measure for organisations to be compared with other care providers across the country. National confidential enquiries are national reviews of high risk medical or surgical conditions which produce recommendations to be implemented to improve the quality of care being delivered to patients.

During 2015/16 36 national clinical audits and 3 national confidential enquiries covered relevant health services that the Royal Berkshire NHS Foundation Trust provides.

During 2015/16 the Trust participated in 94% national clinical audits (34/36) and 100% of national confidential enquiries of the national clinical audits and national confidential enquiries which it was eligible to participate in.

The national clinical audits and national confidential enquiries that the Royal Berkshire NHS Foundation Trust was eligible to participate in during 2015-16 are as follows.

The national clinical audits and national confidential enquiries that the Royal Berkshire NHS Foundation Trust participated in, and for which data collection was completed during 2015- 16, are listed below alongside the number of cases submitted to each audit or enquiry as a percentage of the number of registered cases required by the terms of that audit or enquiry.

Title Participation Rate National Clinical Audits 1. Falls and Fragility Fractures Audit 100% Programme (FFFAP), National Hip Fracture Database (NHFD) 2. Falls and Fragility Fractures Audit 0%* Programme (FFFAP), Inpatient Falls audit *The Trust’s organisational data was included in the national analysis but the clinical data was excluded as data collection was not carried out on mandated day. 3. National Parkinson’s Audit 111 cases submitted; denominator data unavailable 4. National Comparative Audit of Blood 100% 84

Transfusion programme - Audit of Patient Blood Management in Scheduled Surgery 5. National Comparative Audit of Blood 100% Transfusion programme - Audit of the use of blood in Lower GI bleeding 6. National Comparative Audit of Blood 100% Transfusion programme - Audit of the use of blood in Haematology 7. Renal Replacement Therapy (UK Renal 100% Registry) 8. Rheumatoid and early inflammatory 14 cases submitted – denominator arthritis unknown 9. Emergency Laparotomy (NELA) 100% 10. Patient Reported Outcome Measures Groin Hernia – 40.8% (PROMS) Hip Replacement – 56.4% Knee Replacement – 55.8% Varicose Vein – 33.9% Data only available up to Feb 2016 11. Bowel Cancer National Audit (NBOCAP) 100% 12. Oesophago-Gastric Cancer Audit Estimated participation in range 34 – 44 (NOGCA) % 13. Lung Cancer Audit (NLCA) 168 cases submitted June 2015 (2014 data) Transition to monthly data collection. 14. Prostate Cancer 95% 15. National Joint Registry 100% 16. Trauma Audit and Research Network 100% (TARN) 17. Acute Coronary Syndrome (MINAP) 100% 18. Cardiac Rhythm Management 100% 19. Coronary Angioplasty 100% 20. National Heart Failure Audit Data collection ongoing 21. Procedural Sedation in Adults (CEM) 50 cases submitted – denominator unavailable 22. Vital Signs in Children (CEM) 100 cases submitted – denominator unavailable 23. VTE risk in lower limb mobilisation (CEM) 34 cases submitted – denominator unavailable 24. Adult Critical Care ICNARC 100% 25. Emergency Use of Oxygen 37 cases submitted, denominator unavailable 26. Adult Community Acquired Pneumonia 17% - Minimum sample size of 30 (BTS) cases achieved 27. National Neonatal Audit Programme 100% (NNAP) 28. National Pregnancy in Diabetes Audit 100% (NPID) 29. National Paediatric Diabetes Audit 100% 30. Diabetes (Adult) - Inpatients (NADIA) 98% 31. National Cardiac Arrest Audit 100% 32. Sentinel Stroke National Audit Programme 100% (SSNAP) 33. Pulmonary Rehab 100% 34. Paediatric Asthma 65% - Minimum sample of 20 cases achieved National Confidential Enquiries 85

1. NCEPOD – Acute Pancreatitis 100% 2. NCEPOD – Provision of Mental Health in 100% Acute Hospitals 3. Maternal, infant and perinatal mortality 100% (confidential enquiry) National Clinical Audits and Confidential Enquiries not participated in: National Diabetes Audit – Adult Only partially relevant to the RBH National Audit of Intermediate Care Only partially relevant to the RBH Inflammatory Bowel Disease The Trust will be submitting data of the IBD Registry which replaces this audit.

Results of National Clinical Audits and National Confidential Enquiries

The reports of 10 National Clinical Audits and 1 National Confidential Enquiry were reviewed by the provider in 2015/16 and the Royal Berkshire NHS Foundation Trust intends to take the following actions to improve the quality of healthcare provided:

. Findings from the Epilepsy 12 National Audit (published November 2014) highlighted the need for a specialist Paediatric Epilepsy Nurse. Funding was arranged and this post has now been recruited. . Findings from the Head & Neck Cancer audit (published July 2014) prompted the multidisciplinary team to monitor waiting times for treatment. . A review of findings from Mothers & Babies: Reducing Risk through Audit & Confidential Enquiries across the UK (MBRRACE-UK) Saving Lives, Improving Mother’s Care 2014 (published December 2014) report identified the need for the following actions: o A business case for funding pre pregnancy counselling with input from an Obstetric Physician o Support for the provision of a dedicated higher monitoring area on delivery suite

In addition to being a driver for quality improvement work, national audit also provides assurance about the quality of care being delivered where the Trust is already performing to the highest standard, or where significant improvements have been made year on year. In some cases, the Trust is one of the highest performers in the country. Some of the highlights of our national audit performance are given below:

Sentinel Stroke National Audit Programme (SSNAP)

SSNAP Standard National RBFT

Proportion of eligible patients given thrombolysis 83.3% 94.4%

Proportion of patients who were thrombolysed within 57.7% 94.9% 1 hour

Median time between clock start and thrombolysis 55mins 25mins

Quarter 1 (April – June 2015) SSNAP data

For April - June 2015 the Trust’s Hyper-Acute Stroke Unit (HASU) was the best performing Thrombolysis stroke service in the country, providing lifesaving treatment to patients in the fastest time, with 94.9% of eligible patients receiving thrombolysis within the 1 86 hour golden standard, and on average receiving this treatment in just 25 minutes. The annual figures put the HASU in the top ten nationally for the service.

National Neonatal Audit Programme (published October 2015) Findings showed 100% of babies admitted to the Neonatal Unit (NNU) had their temperature taken within 1 hour of birth, in comparison to 94% nationally. The standard ‘Mothers receiving antenatal steroids’ was 87% compared to 85% nationally and a significant improvement on previous years where the Trust had scored 66% for this standard.

National Hip Fracture Audit (published September 2015)

. NHFD Dashboard Data from Jan-Dec 2014 (published September 2015)

The Trust was in the top quartile of participating trusts for the recording of mental test score (99.5%) on admission and peri-operative assessment (98.1%). In addition all patients had their pressure ulcer status recorded placing the Trust in the top quartile of trusts and improvement was seen in surgery on day of, or day after, admission and patients returning to their original residence within 30 days.

Results of Local Clinical Audits and Quality Improvement Projects

Local-level clinical audit and quality improvement projects tend to be more specialised and smaller in scope than the national audit projects, but have the advantage of rapid cycles of data collection and quality improvement work; this means patients can experience the benefits of the changes implemented more quickly.

The reports of 26 local clinical audit and quality improvement projects were reviewed by the provider in 2015/16 and the Royal Berkshire NHS Foundation Trust intends to take the following actions to improve the quality of healthcare provided:

Healthcare Records Audit In 2015-16 the methodology of the healthcare records audit was redesigned so that each clinical specialty audited 5 sets of notes per month, with the results fed back into clinical governance meetings for discussion and awareness-raising on a monthly basis. Overall, the Trust saw an improvement in 6 out of the 10 basic standards for records keeping with an average compliance rate of 85%. In 2016-17 improving the quality of medical records will continue as a quality priority for the Trust. Actions include: reviewing the content of the 87 healthcare records quality audit to include more quality measures; designing a healthcare records audit for daycase/ outpatient areas; and continuing to raise awareness of record keeping standards on a monthly basis through specialty clinical governance meetings. It is our aim to raise compliance with the basic record keeping standards from 85% to 90%.

Reducing the overuse of βhCG measurements in the emergency gynaecology clinic This quality improvement project identified that patients from the emergency gynaecology clinic were being over tested for βhcg in cases of possible pregnancy of unknown location, in contrast to best practice guidance published by NICE. Actions put in place included an education campaign and the development of “50% Cards” to act as a visual reminder to staff of the NICE discharge criteria. Re-audit results have shown significant reduction in unnecessary βhcg tests over 3.5 months resulting in better patient experience as well as having efficiency benefits for the Hospital. Dementia CQUIN Project This audit reviewed standards on staff training rates, undertaking of dementia assessments, and how the Trust supported carers. As a result of this work the following actions were implemented: . introduction of ‘Twiddlemuffs’ . collaboration with the Alzheimer’s Society visiting elderly care wards to provide specialist support for carers . a programme of dementia training for staff . events run during ‘dementia awareness week’ to raise awareness . drafting of a dementia strategy This work will be continuing as a quality priority for the Trust in 2016-17.

Timely prescription of ‘to take out’ (TTO) medications for discharge CQUIN Project This project was undertaken to improve the timely prescribing and dispensing of TTOs to facilitate faster discharge of patients. The following actions were undertaken: . discharges for the next day were discussed and planned at a 14:30 discharge board round . implementation of an Enhanced Recovery checklist . pharmacy staff implemented a review of all TTOs required for the next day on elderly care wards at 15:00 The Trust was nominated for a Health and Safety Journal (HSJ) Value in Healthcare Award for the work completed.

Plans for Clinical Audit and Quality Improvement 2016-17

The Clinical Audit and Improvement Programme for 2016-17 has been developed from trend data from analysis of complaints, incidents, audits and mortality reviews; alignment to the Trust’s identified Quality Priorities for 2016-17; and feedback from clinical governance leads and specialties.

In order to support the delivery of this programme the Trust intends to take the following actions:

. Trustwide training programme on clinical audit and quality improvement methodologies . Annual poster competition event for clinical audit and quality improvement projects . Increased promotion of clinical audit and quality improvement projects and shared learning through intranet, communications and newsletters

. Closer partnership working with clinical leadership programme (nursing) and the Project Management Office (PMO)

Participation in Clinical Research

The number of patients receiving NHS services provided or sub-contracted by the Royal Berkshire NHS Foundation Trust in 2015-16 that were recruited during that period to participate in research approved by a research ethics committee was in excess of 5089 (as of 8 May 2016).

The Trust continues to uphold its commitment to ensuring that National Institute for Health Research (NIHR) portfolio adopted studies are accessible for patients, relatives and staff to participate in.

We are involved in conducting single and multi-centre research studies across the majority of clinical specialities. We have an established infrastructure whereby clinical research runs effectively alongside clinical services and we have a workforce model that supports flexible working whilst maintaining the high quality and standards of research conduct expected within the NHS.

There are 198 active studies and an additional 64 studies in the participant follow up phase (as of 31 March 2016). Thirteen of the studies have been initiated by investigators at the Trust. Over time, there has been a slow increase in the number and complexity of investigator initiated studies. Last year the Trust acted as the sole Research Sponsor for its very first multicentre, NIHR adopted, investigator initiated study called the “POEM study”. POEM (Prescription of Analgesia in Emergency Medicine), is a retrospective multicentre observational study that aims to assess the adequacy of pain management (according to the College of Emergency Medicine - CEM) in consecutive patients with confirmed long bone fracture or dislocations isolated to a single limb, presenting to Emergency Departments (EDs). Twelve sites are anticipated to have taken part when the study concludes at the end of the year

In 2015-16 we opened our second multicentre NIHR adopted study where we are the lead site. The Lipocalin and other biomarkers in the Emergency Department for the diagnosis of Acute Kidney Injury study (LEAK) is a multicentre prospective cohort study in consecutive adult patients admitted from 4 EDs which will aim to determine the diagnostic accuracy of plasma neutrophil gelatinase-associated lipocalin (NGAL) and Cystatin C for acute kidney injury compared to creatinine-based RIFLE (Risk, Injury, Failure, Loss, End stage renal disease) and AKIN (Acute Kidney Injury Network) criteria at 24-48 hours from admission.

Having embraced the challenge of the government’s commitment to working with the life sciences industry to deliver first class clinical research in the NHS we once again exceeded our target for increasing the number of commercially funded studies by opening a further 7 more of these studies during this year.

Our research activity and infrastructure demonstrates our commitment to transparency and desire to improve patient outcomes and experience across the NHS. A number of our studies require additional monitoring and assessments and this contributes to keeping people well and out of hospital.

Clinical research highlights our commitment to improving the quality, relevance, and focus of research, whilst adding value and offering the latest medical treatments and techniques to our local patient population. 89

In the Guardian League Tables published on 21 October 2015 (for activity in 2014/15) The Trust was listed 21 out of 161 acute trusts recruiting into research studies and recognised as the 2nd highest recruiting district general hospital.

CQUIN Payment Framework

A proportion of the Royal Berkshire NHS Foundation Trust’s income in 2015-16 was conditional on achieving quality improvement and innovation goals agreed between the Royal Berkshire NHS Foundation Trust and any person or body they entered into a contract, agreement or arrangement with for the provision of NHS services, through the Commissioning for Quality and Innovation payment framework.

Further details of the agreed goals for 2015-16 and for the following 12 month period will be available electronically at www.royalberkshire.nhs.uk

*At the time of writing, the final CQUIN achievement for 2015-16 was bieng finalised with the Trust’s commissioners. Full details will be uploaded to the Trust’s website once agreed.

CQUINS 2015-16:

% % Weighting Weighting CQUIN Value (£) Achieved* Description of Indicator (Contract (CQUIN Value) Scheme) Acute Kidney 0.25% 10% £552,322 8% This CQUIN focused on Injury AKI diagnosis and treatment in hospital and the plan of care to monitor kidney function after discharge. Sepsis - 0.25% 10% £552,322 4% This CQUIN focused on Screening patients arriving in the hospital via the Emergency Department Sepsis - (ED) or by direct Antibiotic emergency admission to Administration any other unit (e.g. Medical Assessment Unit) or acute ward.

It sought to incentivise providers to screen for sepsis all those patients for whom sepsis screening is appropriate, and to rapidly initiate intravenous antibiotics, within 1 hour of presentation, for those patients who have suspected severe sepsis, Red Flag Sepsis or septic shock.

Dementia and 0.15% 6% £331,393 4.8% This CQUIN focused on Delirium - Find, assessment and Assess, discharge planning for Investigate, patients with dementia; Refer and ensuring that appropriate Inform (FAIRI) dementia training was Dementia - Staff 0.025% 1% £55,232 1% available to staff; and Training ensuring that carers of Dementia - 0.075% 3% £165,697 3% people with dementia felt Supporting adequately supported Carers UEC: Improving 0.5% 20% £1,104,6 20% This CQUIN focused on Recording of 44 improving diagnosis Diagnoses in recording in the ED. ED Documented 0.3125% 12.5% £690,403 12.5% Locally agreed priority: Consultant Increased involvement of Obstetrician Obstetric Consultant to involvement in ensure appropriateness decision for of all emergency emergency Caesarean sections Caesarean section Seven Day 0.3125% 12.5% £690,403 0% Locally agreed priority: Working Non-elective admission patients who are discharged at the weekend or a bank holiday. Safe and 0.3125% 12.5% £690,403 11.25% Locally agreed priority: effective To improve decision Intravenous making and timely (IV) fluid administration of IV fluid hydration on MAU Medications on 0.3125% 12.5% £690,403 12.5% Locally agreed priority: Discharge Timely prescribing and dispensing of medication *Subject to final approval of evidence by Commissioners

In addition, NHS England informatics reporting CQUIN for 2015-16 was 100% achieved.

In 2014/15 the Trust achieved 80.01% of its national CQUIN targets and 92.5% of its locally agreed CQUIN targets. This resulted in an income payment of £6.24 million.

CQC Registration Compliance

The Royal Berkshire NHS Foundation Trust is required to register with the Care Quality Commission and its current registration status is “Registered without conditions” at its 5 registered locations.

The Care Quality Commission has not taken enforcement action against the Royal Berkshire NHS Foundation Trust during 2015-16.

The Royal Berkshire NHS Foundation Trust has not participated in special reviews or investigations by the Care Quality Commission during 2015-16.

CQC Visits

During 2015/16 the Royal Berkshire NHS Foundation Trust has been subject to the following visits by the CQC:

. November 2015 an unannounced CQC inspection of the Trust’s maternity and gynaecology services. The Trust was rated “Good” in three out of five areas in Maternity and Gynaecology: Effectiveness, Caring and Leadership. Safety and Responsiveness have improved, but still need further improvement. Overall the Maternity and Gynaecology service was rated “Requires Improvement”.

Noted areas of outstanding practice included: . Breast feeding was encouraged and the Midwifery services had achieved UNICEF ‘Baby Friendly’ status . A pink patient wrist-band system had recently been introduced for patients who had undergone surgery and had a vaginal pack in situ. This was to ensure the pack was subsequently removed . Significant improvements had been made to the staffing of the maternity wards . Issues were escalated appropriately . The Trust achieved a care level rate of 100% between April – July 2015, 98% in August 2015 and 99% in September 2015.

The Trust has already made improvements in the areas Inspectors have highlighted as needing improvements such as reviewing medicines management practices to ensure medicines are stored at the appropriate temperatures.

. The Trust participated in an Ofsted-led inspection of West Berkshire Local Authority services for children in need and of safeguarding provision between 3 and 25 March 2015. Children’s services were rated as inadequate and the Local Safeguarding Children’s Board as requires improvement. Within the inspection report, effective partner working was noted. Actions arising from the inspection will be monitored by the Improvement Board.

. The Trust also participated in an Ofsted-led inspection of Wokingham Local Authority services and Local Safeguarding Children’s Board for children in need and of safeguarding provision between 12 October and 5 November 2015. Children’s services and the Wokingham Safeguarding Children’s Board were rated as requiring improvement. There were several areas of practice identified that reflected effective partnership working between the Trust and its partners. Actions will be monitored through the Safeguarding Children’s Board Business Plan.

CQC Peer Review

In January 2015, the Trust started a programme of internal peer review visits, the objective of which is to provide assurance that the issues identified by the Care Quality Commission (CQC) in its March 2014 Inspection of the Trust had been resolved and to celebrate areas of good practice.

A team of 30 clinical and administrative staff (including junior doctors) visit wards and outpatient areas on an unannounced basis each month and make observations and speak to staff about their knowledge of specific areas of practice. During 2015/16, a total of 73 92 inpatient wards and outpatient areas were visited, sometimes more than once, with the following themes being the focus of each visit:

. Sharps practice . Ward based IT provision . Medical equipment provision, servicing and training . Patient information and access to translation services . Patient documentation in medical notes and security . Care of outlying patients . Signage survey for patients . Medical device management compliance . Compliance with resuscitation checks and documentation . Medicines management compliance . Compliance with administration processes within the Clinical Administration Teams

The results from each visit are fed back to ward staff and management teams and any Trust- wide action required as a result of the visits, identified at the monthly Peer Review Steering Group chaired by the Executive Director of Nursing.

In June 2015, a team from the Royal Bournemouth & Christchurch Hospitals NHS Foundation Trust (RBCH) spent a day in the Trust undertaking a peer review visit within 10 Wards and departments. The team identified some areas of outstanding leadership, innovation and patient care. It found staff to be proud to work at the hospital and have a positive approach to quality, improvement and patient safety.

CQC Outliers

On 17 June 2015, the Trust received a maternity outlier alert relating to an apparent sharp rise in the rate of perinatal mortality within the Trust during the period July 2014 – January 2015. The issue had been recognised within the Trust prior to receipt of the alert and a review of the individual cases had been started in May 2015. The investigation identified some coding issues which were resolved from mid-May 2015 and the data was refreshed during May 2015 to correct errors for the period 1 April 2014 – 31 March 2015, but taking these into account the still-birth rate remained higher than predicted for the period in question. The outcome of the review concluded that there was no systemic reason for the increased still-birth rate or any underlying themes. However, the analysis demonstrated some learning issues which have required the Trust to take action. These were:

 Review of the Trust guideline on monitoring fetal movements  Implementation of Monitoring of Intrauterine growth restriction (IUGR) babies Oxford Academic Health science network guideline  Greater involvement of consultant delivered care in complex pregnancy cases  Continued monitoring at Perinatal Mortality and Morbidity Meetings

Since January 2015, the Trust’s perinatal mortality rate has been within national norms. On 3 February 2016, the Trust was informed by the CQC that the outlier alert had been formally closed.

Data Quality

Throughout 2015-16 the Trust has continuously monitored and reviewed its data quality processes and procedures. In the spring of 2015, the Trust undertook an internal audit 93 review focusing on ED 4 hour waits and cancer 18 week RTT reporting. The results published in October 2015 indicated some data discrepancies as a result of underlying process issues. These process issues were fully resolved as of November 2015 following the implementation of the recommendations of the review which included: redesigning processes for recording data in ED; extensive work to review data quality across the Trust; and education and awareness-raising for staff around coding issues for 18 week RTT pathways. A re-audit in December 2015 indicated that significant improvements have been made and that the key issues had been resolved, although recommending the ongoing improvements should continue to be pursued. The action plan on this is progressing well, along with further development work on RTT and Cancer data quality.

In addition, the Trust has taken the following actions to improve data quality in 2015/16:

. The Trust successfully implemented a new data warehouse and began making SUS Commissioning Data Set submissions from this new installation, this has significantly improved the quality of data held in SUS, HES and Dr Foster. . The Trust resumed regular batch tracing against the spine, this has resulted in improved GP data available on EPR and data submitted externally to SUS . With the support of an external auditing organisation the Trust has also undertaken a review of the clinical coding department in order to better understand and address concerns with quality and depth of coding. . The Trust has restructured both its informatics and data quality teams in order to ensure that they are best placed to provide an effective service to the organisation . The Trust started a trial data quality programme working closely with an external consultancy firm to develop a data assurance programme and framework for Cancer and Radiology.

The Trust will be taking the following actions to improve data quality in 2016/17:

. The Trust will look to further expand its newly implemented data warehouse so it holds more key Trust datasets extracted from non EPR systems. This will ensure that the new data warehouse serves as a centralised source of Trust information. This in turn will increase visibility of Trust data as well as support timely and efficient tracking of data quality issues across multiple datasets and sources. . The Trust will expand the data assurance programme to cover more key Trust datasets and will develop a robust data assurance framework to ensure visibility and consistency in data quality. The Trust will also implement appropriate data quality steering groups and reporting/governance structures to ensure that key data quality items are tracked and escalated appropriately with clear lines of ownership and responsibilities . The Trust will develop and implement an effective action plan to address findings from the clinical coding review . Clinical engagement with the coding team is necessary for increasing the quality of coded information. In 2016/17 the Coding Department will work closely with the Informatics Department to develop an intuitive clinical coding dashboard for consultants. This will offer clinicians better access to their data as well as allow for queries on coded information to be raised and more effectively managed. . The Coding Department will continue to work closely with the Informatics Department to track key coding quality indicators in near real time. This approach to data quality is expected to increase the efficiency of the clinical coding audit process and will

allow the Trust to identify, review and correct coding errors before external submissions are made. . The Trust will continue to work towards improving the content of its medical records. The Medical Records Improvement Programme has been implemented to coordinate and drive improvements. . The Trust will continue to engage in a joint programme of work with our local CCG (Clinical Commissioning Group) to triangulate and improve our data quality. This will involve reconciling Secondary Uses Services (SUS) submissions with billing (SLAM) to identify areas of missing or conflicting data.

NHS Number and General Medical Practice Code Validity

The Royal Berkshire NHS Foundation Trust submitted records during 2015-16 to the Secondary Uses service for inclusion in the Hospital Episode Statistics which are included in the latest published data. The percentage of records in the published data which included a valid NHS number and valid General Medical Practice Code are as follows:

Valid General Medical Valid NHS Number Practice Code Admitted Patient Care 99.53% 100% Outpatient Care 99.79% 99.98% Accident and Emergency 98.11% 100% (ED) Care

Information Governance Toolkit Attainment Levels

The Information Governance Toolkit (IGT) provides an overall measure of the quality of data systems, standards and processes. The score a trust achieves is therefore indicative of how well they have followed guidance and good practice. The Trust Information Governance Assessment Report overall score for 2015/16 was 69% (2014/15 was 80%) and the grading was red due to two assessment areas scoring 1. These requirements will be addressed as a data flow mapping plan has been developed and will be implemented during 2016/17.

Clinical Coding Error Rate

The Royal Berkshire NHS Foundation Trust was not subject to the Payment by Results clinical coding audit during 2015-16 by the Audit Commission.

PART 4: Our Quality Performance 2015-16

Review against our 2015-16 Quality Priorities

In 2015-16 we prioritised six initiatives for improvement:

Domain Priority Progress

Patient Safety 1: To improve the safety of our maternity service Partially Achieved 2: To improve reporting of patient safety incidents Achieved and our systems for learning from them Clinical 3: To improve the availability and quality of medical Carried Effectiveness records forward 2016- 17 4: To reduce waiting times to ensure treatments Carried received at the right time forward 2016- 17 Patient 5: To improve the safe and timely discharge of Partially Experience patients Achieved 6: To improve administration systems to improve Carried booking processes, reduce cancellations and forward 2016- improve access to hospital 17

Below we have summarised our performance against these indicators. Progress has been monitored by the Trust Board throughout the year and where we have identified further scope for improvement this has been carried forward to 2016-17 as we recognise that some of our priorities will take several years to fully implement.

Priority 1: To improve the safety of our maternity service

During 2014 a CQC inspection identified our maternity services as “in need of improvement”. The Trust commissioned an external review from the Royal College of Obstetricians and Gynaecologists and the resulting recommendations from this review were incorporated into a comprehensive action plan with immediate, medium and long-term objectives.

What did we do in 2015-16?

Estates and Facilities: we upgraded our ventilation systems on the Delivery Suite to ensure Entonox levels are within safe limits and to improve the temperature regulation. Four birthing rooms on the Delivery Suite have also been refurbished to provide a more homely feel.

Staffing: we have increased consultant hours with the appointment of 2 new locums. Discussions are underway regarding the integration of the obstetrics and gynaecology services to strengthen consultant cover in these areas. There is budget provision to achieve 1:28 midwife to birth ratio; however, recruitment of midwives to achieve this remains an ongoing challenge. There has been an increase use of nurses to support midwives on post natal wards to free midwives to provide 1:1 care in labour, and midwifery roles and skill mix have been reviewed.

Leadership and Strategy: daily multi-disciplinary operational staffing meetings have been introduced to ensure that key areas are safe. “Meet the managers” walkabouts have been introduced to improve visibility and communication between the leadership team and frontline staff. Reporting has been improved so that the Executive Board have oversight of key performance indicators and there are monthly meetings which include the whole multidisciplinary team. The Thames Valley Leadership Academy also provided support to the senior multi-disciplinary team in further developing team cohesion.

Culture and Quality Improvement: communication workshops have taken place and there have been improvements made to the morning and evening handovers. There has been an increase in social / charity events, for example, the production of the “Berkshire Born and Bred” 1950s style charity calendar which to date has raised over £1,500 for the refurbishment of the birthing rooms. Many staff have also been on the “Investment in Excellence” training course which looks at ways for individuals and teams to maximise their potential. Other quality improvement projects have included a restructure of the community midwife team, midwifery care assistant and support worker roles and deployment have been reviewed, redesign of the induction of labour pathway, triage review, strategic and operational reviews of the Midwife-Led Unit, and a home birth service review.

Overall, the staff have delivered significant progress against the quality priorities using the improvement programme as a framework and monitoring tool. The senior team are well positioned to lead the service and are keen to maintain momentum to fully realise the benefits of the work to date for patients and staff.

Did we achieve our targets?

Our key indicators were:

1) Percentage of unexpected admissions >37 weeks to NICU

8 7.5 7

6.5 6

NICU 5.5 5

% ofUnexpected% 4.5

Admissions (>37wks) to (>37wks)Admissions 4

Our percentage of unexpected admissions >37 weeks to the Neonatal Intensive Care Unit (NICU) has shown a steadily decreasing trend over the year. In Q1 the average was 7%, decreasing to 6.1% in Q2, 6% in Q3 and 5.7% in Q4. The monthly target set by our commissioners was 6% or less. It can be seen that with the exception of January 2016, this has been consistently achieved from August 2015.

2) Midwife to birth ratio This has proven to be a challenging indicator to improve despite best efforts. The quarterly figures show that our ratios for the year have been:

Q1 1:30 Q2 1:33 Q3 1:33 Q4: 1.33

In order to mitigate the risk of the midwifery staffing numbers the following actions have been implemented to ensure the safety of the mothers and babies in our care:

. Daily staffing review to redeploy staff to ensure 1:1 care in labour. This has been achieved consistently in 99-100% of cases. . 8 Agency midwives on ‘lines of work’ . Flexible working policy implemented with 6 monthly review . Recruitment plan in place. Meeting held with international recruitment agency who are doing some exploratory work with regards to midwifery recruitment. . A recruitment campaign aimed at recent leavers has resulted in 4 midwives being re- employed on zero hours and permanent contracts.

Priority 2: To improve reporting of patient safety incidents and our systems for learning from them

Incident reporting gives us an opportunity to learn from past events and near misses and to ensure that steps are taken to minimise recurrence. Research has shown the more incidents that are reported, the more information is available about any issues, and the more action can be taken to make healthcare safer for our patients.

What did we do in 2015-16?

Theatres Incident Reporting Feedback Project A 3 month project was undertaken in Theatres in August – October 2015 where all incident handling managers were required to give written feedback to incident reporters regarding the investigation and actions taken following the incident report. The idea was that this would help to share learning, as well as enable staff reporting incidents to see how this was making a difference to patient safety and to be an encouragement to report more in future. The feedback received from this project was that incident reporters felt more appreciated; they were more engaged in the incident reporting and investigation process; and it promoted greater co-operation and collaboration between reporters and managers in finding solutions to issues and problems which were raised. This project will continue in Theatres and there are plans for this to be rolled out across the Trust in 2016-17.

“Patient Safety Star of the Month” Initiative In order to positively promote incident reporting, a “Patient Safety Star of the Month” initiative began in June 2015. The purpose of this is to celebrate the staff member who has reported the most incidents each month. The staff member is rewarded with a certificate and a mention in the “Patient Safety and Quality Newsletter” and weekly Trustwide “Round-up” newsletter.

Raising Patient Safety Concerns confidential email account In order to encourage the reporting of concerns which staff do not feel able to raise through their line manager, a ‘raising concerns’ confidential email account has been set up. This enables staff to email patient safety concerns to the Quality Governance Team in the hospital in the knowledge that this issue will be reviewed and appropriate action taken in a confidential manner.

Sharing learning through the Patient Safety and Quality Newsletter and Patient Safety Hot Topics In order to share learning from incidents a monthly “Patient Safety and Quality” newsletter is published which includes key learning arising from serious incidents and local investigations as well as highlighting articles on patient safety and quality issues. This is widely disseminated to clinical staff across the Trust and discussed at specialty level clinical governance meetings. Any issues considered to require particular highlight are turned into “Patient Safety Hot Topics” and slides are disseminated for presentation and discussion across the Trust. An archive of the newsletters and hot topics are available as a resource on the Trust’s intranet pages.

Did we achieve our targets? Our aims were to: . Improve the reporting of incidents . Improve sharing of incidents and outcomes to relevant parties

. Drive a culture which encourages staff to speak up and speak out

In 2015 – 16 we reported a total of 9555 patient safety incidents to the National Reporting and Learning System (NRLS), with a reporting rate per 100 admissions of 10.1%. In 2014- 15 we reported 8418 total incidents and had a reporting rate per 100 admissions of 9.2%. Therefore, compared with the same period last year, the Trust has seen an increase of 13.5% in total incidents reported and a 0.9% improvement in its reporting rate per 100 admissions.

1000 800 600 400 200 0 Incidents Reported Incidents No. of Patient Safety Safety Patient No. of

2014-15 2015-16 Month

* Trust data used rather than published NRLS data due to NRLS data being 6 months in arrears. Trust figures are subject to data validation processes and may be revised slightly before final NRLS submission.

Shared Learning Case Study: Information Governance Breaches

In order to provide high quality treatment for patients, the Trust holds a large amount of personal and sometime sensitive data about individuals under our care. Ensuring the security of this data is extremely important and where incidents occur regarding potential breaches of information security they are taken very seriously.

Between April and June 2015 there was 1 information governance breach serious incident reported to our commissioners. Between July and September 2015 there were 5 more of these serious incidents, making information governance breaches the highest serious incident type for that quarter.

The majority of these incidents were dropped ‘handover sheets’ found by staff or patients inside and out of the hospital grounds. Handover sheets give details of patients in a ward area with notes for clinical staff about their care needs. These handover sheets are used for communication of essential patient information between staff but should be securely disposed of at the end of each shift. In order to address this, a Trustwide communication campaign took place including:

. an email from the Chief Executive to all staff . communication from each care group requiring all staff to print handover sheets on yellow paper to make them less easy to lose . posters put up at the exits of all wards areas reminding staff to dispose of handover sheets securely . communication of shared learning via patient safety and quality newsletter and patient safety ‘hot topics’ to clinical governance meetings

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The effectiveness of this shared learning is evidenced by the fact that there were 0 information governance breach serious incidents relating to breaches in staff or patient confidentiality reported to our commissioners following this campaign between October 2015 and March 2016*.

There is now a widespread awareness of these incidents and the need to be careful with handover sheets at ward level, tested via spotchecks at the bi-monthly patient safety executive walkarounds.

* Nb there was one cyber security incident in February 2016 relating to a computer virus affecting the IT systems in the hospital. This was reportable to the Information Commissioner’s Office as a “cyber security incident”.

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Priority 3: To improve the availability and quality of medical records

The medical record is vitally important in supporting the clinical pathway and in the provision of safe patient care. This was carried forward as a priority from 2014/15 recognising that there was still work to be done to improve the availability and quality of patients’ medical records.

What did we do in 2015-16?

We have:

. Automated requesting of inpatient records on admission to bed board, reducing the need for staff to request records . Reduced the volume of patient “record volumes” transported around the Trust by delivering the last two volumes only, helping with storage and keeping records safe and tidy . Streamlined our retrieval process across the Trust to reduce interruptions to admin team members . Commenced with Trust-wide records management training programme to all admin staff . Reviewed and changed our off-site records management service provider’s service level agreement . Introduced monthly audits of the content and quality of clinical documentation in patient records in all relevant inpatient areas, with regular feedback and discussion of issues at clinical governance meetings . Reviewed and amended tracking locations within the Clinical Admin Teams

Did we achieve our targets?

1) Increase the availability of notes available to the clinical staff by the time of the clinic appointment from 97.8% to 99%.

Partial: We have increased the percentage of records available to clinical staff by the time of the clinic appointment from 97.8% to 98.6%

2) Increase the number of inpatient cases coded from notes to 80%

Not achieved: Over the last year we have failed to meet this target. The average percentage of notes received by the Coding Department has been 59% for 2015-16*. This measure reflects the volume of patient records collected by the Coding Department from wards post-discharge (though does not include additional records subsequently retrieved from the wards and administrative areas by Medical Records and delivered to Coding). As noted under priority 6 below, the implementation of the admin restructure led to delays in the flow of patient notes around the hospital. Against this background, further improvement work on this has not been possible to pursue whilst the changes in structures and processes were taking place. There has been a slight improvement since September 2015 and further work to address the issue is planned for 2016-17.

*N.b. the % of patient notes received by the Clinical Coding Department has been used as a proxy indicator for cases coded from notes as this data is currently unavailable. Work is ongoing to improve the systems in place to record and monitor this data.

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3) Improve the content of medical records through regular audit and improvement activity Partial: A monthly healthcare records audit is now in place in all relevant inpatient areas. The results demonstrate an overall improvement in the content of the medical record since last year. There are 10 basic record keeping standards included of which 6 saw improvement, 1 remained the same and 3 showed a slight decrease. Overall the Trust was over 85% compliant with these standards. There were 5 additional quality standards this year including documentation of diagnosis, clinical findings and clinical management plans. For these standards the Trust was over 95% compliant with 3 of the standards and over 80% compliant with the other 2. Work to raise awareness of record keeping standards and embed these in practice will continue in 2016-17.

Basic Record Keeping Standards 2014-15/ 2015-16

Patient location Addressograph on both sides of page All entries accountable Contact number

Chronological order

All entries timed Allergy status recorded Legibility

All entries dated All entries in blue/black ink

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

2015-16 2014-15

Quality Record Keeping Standards 2015-16

Documented evidence of discharge planning 81.30%

Date patient last seen by a consultant documented 85.40%

Documented evidence of examination/ clinical 96.60% findings

Clear documentation of current issues/ diagnosis 97.30%

Clearly documented management plan 97.60%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

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Plans for improvement 2016-17

As this priority was partially achieved in 2015-16 this workstream will be continuing as a priority for improvement in 2016-17. Our plans for this are outlined in part 2 above.

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Priority 4: To reduce waiting times to ensure treatments received at the right time

Patients have a right to be diagnosed and start treatment as soon as possible and therefore national standards for waiting times have been set. In 2014/15 we were failing to meet our 18 week referral to treatment, cancer 62 day waits for first treatment, and our ED 4 hour wait target.

What did we do in 2015-16?

Cancer Targets

. Developed a nationally agreed action plan to recover performance and implemented a joint Cancer Task Force with the CCGs and Clinical Senate . Agreed a backstop policy for all patients not treated by day 104 on pathway to be clinically reviewed . Worked with the NHS Intensive Support Team to review our cancer services . Redesigned pathways to ensure appropriate escalation triggers were in place . Additional doctors provided for breast surgery, gastroenterology, colorectal surgery and dermatology . Created an additional endoscopy treatment room . Developed “one-stop” services in gynaecology, urology and head & neck . Improved cancer tracking systems to improve access to information, transparency and accountability for actions. . Reduced our ‘active patient’ list by 20%. This has been achieved through improved scrutiny of patient lists, greater senior leadership involvement, additional staffing capacity on a temporary basis, and specialty-level improvements in capacity and process.

Referral to Treatment (RTT) 18 Week Standards

. Data Quality – investigations have been made into a system solution for the identification and management of RTT pathways. . The Trust’s Information Team have rolled out the in-house developed TIPs system for the management and reporting of RTT. . Agency resource employed to assist the reporting and tracking processes. . Weekly Patient Tracking List (PTL) meetings implemented for the planning and management of both long wait pathways and proactive management of the waiting list. . To support the education and training of staff, task specific training guides hosted in an online training and quick reference portal have been developed. . Trust Access Policy has been reviewed and updated . Specialty action plans were developed and implemented

ED Waiting Times

We made robust winter plans to improve resilience, worked with the ambulance services and other health partners to try to control arrival and discharge flows. We have also continued the establishment of dual front door model – the Surgical Admissions and GP Assessment Units added additional space in ED - with a new observation area and a mental health assessment room. The Trust continues to focus on the medically fit list and complex clinical discharge list in order to try to create flow.

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Alongside these efforts there have also been improvements made to the data quality processes for ED 4 hour wait recording and 18 week RTT pathways following the implementation of recommendations from our internal audit in November 2015.

Did we achieve our targets?

National 2014/15 2015/16 Indicator Target Q4 Q1 Q2 Q3 Q4 RTT 18 weeks 92% 90.3% 93.0% 93.4% 92.7% 93.0% (incomplete pathways) ED Waits < 4 hours (type 95% 92.4% 96.0% 95.7% 95.0% 90.2% 1&2) Cancer 62 day waits 85% 80.4% 81.8% 76.4% 70.9% 70.8% (Urgent GP referral) We have achieved the 92% national targets for RTT 18 weeks incomplete pathways for all 4 quarters of 2015-16.

We managed to achieve the ED <4hour targets for Q1-3 of 2015-16 which, against a backdrop of increased demand and a nationally decreasing trend, is a great achievement. Unfortunately, in January 2016 our ED attendances were up by 15% compared to the same month last year, much higher than the national average of a 10.1% increase. In the face of these capacity pressures we did not manage to achieve the 95% target for Q4.

Despite the work completed to date and improvements seen in some areas (such as the 2 week breast symptomatic targets which we are now meeting), we are still failing to meet our 62 day waits for cancer treatment. This is due to pressures in referral numbers, national issues in recruiting dermatologists and radiologists and the subsequent impact this has on our clinical and diagnostic services. This workstream will be continuing as a priority for improvement in 2016-17. Our plans for this are outlined in part 2 above.

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Priority 5: To improve the safe and timely discharge of patients

From admission it is important that we are effectively planning patient pathways to ensure a safe and seamless transition from the hospital and to avoid unnecessary delays. This helps to improve patient outcomes and to give a better patient experience.

What did we do in 2015-16?

Discharge planning for complex patients

To improve the safe and timely discharge of patients, matrons have been working with the wards in a more structured way to improve the discharge planning process for patients with complex discharge needs. This has included allocating specific discharge leads where required for individual patients who may move around the hospital. Matrons then escalate any to the weekly patient flow meetings attended by the Care Group Directors of Nursing and Chief Operating Officer to be taken forward at the highest level to ensure a joined up and streamlined discharge process.

Home Early Settled and Safe Campaign

This campaign was aimed at discharging patients earlier in the day so that they were home ‘settled and safe’ before dark. This included liaising with Care Homes and Carers; having electronic discharge letters (EDLs) written and ‘to take out’ (TTO) drugs dispensed the day before discharge; and ensuring hot meals are available in the Discharge Lounge so patients can be discharged sooner to this area. Not only is this better for discharged patients’ experience, it also improves the patient flow for new patients being admitted.

In addition, there have been trials of occupational therapists going home with patients to ensure their home environments are prepared and patients are settled before they leave. A new discharge information envelope has also been designed to contain all of the information collected by patients whilst in hospital to help with communication on discharge. This is currently being piloted on a few wards before roll out across the Trust.

Did we achieve our targets?

Time of Discharge

Time of Discharge 100.0% 80.0% 60.0% 40.0% 20.0% 0.0%

% Discharges 08:00 - 11:59 % Discharges 12:00 - 20:59 % Discharges 21:00 - 07:59

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We aimed to reduce the number of discharges after 21:00 and increase the number of discharges before 12:00. Unfortunately, the figures show that the time of discharge has remained fairly static across the year and therefore we have not achieved this target. However, the vast majority of our discharges do take place between 08:00 – 21:00 (on average 92.1% in 2015-16). Of the patients who are discharged after 9pm, one third are maternity patients and 80% are under 60 years old.

Reduce delayed transfers of care

Delayed Transfers of Care 7.0% 6.0% 5.0% 4.0% 3.0% 2.0% 1.0% 0.0%

The delayed transfers of care figures have also remained fairly constant throughout the year.

Whilst we have not seen much progress in the specific indicators set in last year’s Quality Accounts, the work which has been completed around patient flow and having EDLs and TTOs completed the day before discharge has seen improvement.

Prior to 2015-16, TTOs and EDLs were inconsistently completed the day before discharge.

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This led to patients having to wait around for TTOs before they could go home once discharged. In April 2015 we implemented planning of next day discharges at the 14:30 discharge board rounds, use of an enhanced recovery checklist, and pharmacy introduced a 15:00 medication ward check on 5 elderly care wards. All of which resulted in an increase to an average of 67% (Q1), 63% (Q2), 70% (Q3) and 68%* (Q4) TTOs and EDLs completed 1 day before discharge. The Trust has been nominated for a Health & Safety Journal Award for this work.

*The Q4 CQUIN data is being finalised with the commissioners therefore this figure is subject to CCG validation.

The ‘home early settled and safe’ campaign and discharge work will continue in 2016-17 to improve on these results.

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Priority 6: To improve administration systems to improve booking processes, reduce cancellations and improve access to hospital

Administration issues were one of the top complaint themes for the Trust in 2014/15. Improving our administration processes was considered a priority in order to improve the patient journey and overall patient experience.

What we did 2015-16

A review and reorganisation of our administrative support service was undertaken in June 2015. This restructured the administrative teams into 14 Clinical Administrative Teams (CATs), each with a standardised staffing structure of: a Patient Pathway Manager, Patient Pathway Co-ordinator, Assistant Patient Pathway Co-ordinator, and Patient Pathway Support.

This has achieved:

. A single contact point for patients and GPs in each CAT . Administrative cover has been extended to core hours of 8am – 6pm to improve accessibility for patients . An outsourced audio-typing software “Cubescribe” has been introduced to improve efficiency and clinic letter turnaround times . Greater cross-cover for administrative teams and roles to ensure there are no single points of failure

Did we achieve our targets?

The administrative review was a major overhaul of the infrastructure of the hospital. It took several months to make the required changes which had an impact on the quality of our administrative service for a time. This was not a ‘quick-fix’ solution and may take a further 12 months to fully embed and realise the benefits of the new ways of working. Progress with the administrative review has been kept under constant scrutiny and an initial evaluation of the project was undertaken after 3 months to seek feedback from staff. Following this, a dedicated work programme has been introduced with key performance indicators being monitored on a regular basis at Executive Board level.

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Complaints relating to administration:

12 10 10 9

8 8 7 6 6 5 4 4 4

Administration 3 2 2 2 No. of Complaints related to related Complaints of No. 0 0

In 2014/15 there were 58 administration complaints raised, an average of 4.8 per month. In 2015/16 there were 60 administration complaints raised, an average of 5 per month. The graph shows clearly that during the CAT implementation period (June – September 2015) complaints were significantly raised as new processes and staff were embedding. In the period October 2015 – March 2016 there were a total of 22 complaints with an average of 3.7 per month. This shows that post-implementation, complaints relating to administration have decreased, and are on average better than 2014-15. It is hoped that with the continuing work on the new admin systems these will continue to decrease.

‘Did Not Attend’ (DNA) Rates

DNA Rates 14.0% 12.0% 10.0% 8.0% 6.0% 4.0% 2.0% 0.0%

We had aimed to reduce our DNA rates through improving our administration systems. The graph demonstrates the DNA rates have remained fairly constant over the last year. The reasons for patients not attending clinics or scheduled operations are multi-factorial. Work has taken place to improve administration systems since the implementation of the administrative services review, for example, to improve theatre scheduling to give a greater time period between pre-op assessment and theatre for patient optimisation. This work will

111 continue for 2016-17 alongside a programme to look at improving DNA rates for outpatient clinics.

The improvement of our administration systems will continue as a quality priority for 2016- 17. However, as DNA rates are partially based on factors outside of the Trust’s control, more direct performance measures have been chosen to measure this priority in 2016-17.

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Other Achievements and Improvements made in 2015-16

Duty of Candour: Openness and honesty when things go wrong

We are committed to promoting candour, openness and honesty as an integral part of a patient safety-focused culture. In order to implement the new Duty of Candour regulations we have added the following processes to our incident reporting and learning framework.

All patient-safety related incidents: all staff are encouraged to inform patients (or their advocate/ carers) when things have gone wrong with their care, offer an apology, and to document this in the patient’s healthcare record. This is reinforced by a “saying sorry” mandatory prompt on the incident reporting form.

Moderate/ severe harm patient safety related incidents: where patients have suffered moderate or severe harm as a result of an incident which has been identified as requiring further investigation, the patient (or their advocate/carer) is apologised to and informed that an incident investigation will be taking place – in person where possible. This is followed up in writing by a letter from the Chief Executive to: offer an apology; inform the patient of the scope and timescales for the investigation; and to give the patient an opportunity to contribute to the investigation and ask any questions they want answered. The patient is also given a named liaison with contact details at this stage. Once the report has been written, the patient is invited to review, discuss with a clinical member of the team, and feed in any comments they may have to the final report.

Plans for 2016-17: in order to ensure these processes are fully embedded in practice, ‘Duty of Candour’ is included as a topic on our Clinical Audit and Improvement forward plan for 2016-17. We are planning to audit documentation in healthcare records, the timeliness of patient contact following a decision to investigate an incident, and to seek patient feedback on their perceptions of how well the Trust is doing with this.

In addition, we will be providing education and training to support frontline staff to undertake duty of candour, acknowledging that this can be a challenging and sensitive area.

The Trust was one of the first 12 hospitals in the country to join the ‘Sign up to Safety’ national campaign. The vision of this campaign is to improve safety across the NHS by reducing ‘avoidable’ harm by 50% in 3 years and save up to 6,000 lives annually.

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A detailed action plan is in place to underpin this work. Key achievements to date include:

 An 83% reduction in never events (6 never events recorded in 2014, reduced to 1 for 2015)  Implementation of the Theatre Safety Strategy including patient safety debriefs and improvements of shared learning and feedback from incidents  Development of a new Acute Kidney Injury Care Bundle  Improvements in medication error incident reporting rates  Redesign of the Trust drug chart  Improvements in neonatal chlorhexidine procedures and sharing of learning nationally

NHS Staff Survey Results 2014 2015 Trust Best Worst Staff Survey Key change score for score for National National Finding Trust Trust since acute acute Average Average 2014 trusts trusts 1. Percentage of staff experiencing harassment, 23% 26% 16% 42% bullying or abuse from 23% 27% -4% staff in the last 12 months 2. Percentage of staff believing that the organisation provides 87% 87% 96% 70% equal opportunities for 85% 82% -3% career progression or promotion

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The NHS staff survey is an annual survey of staff feedback. Our results are compared nationally and the results used to drive local service improvement. The results of two of the key indicators are given below with details of the actions in place to address the issues identified.

1. Percentage of staff experiencing harassment, bullying or abuse

A key priority area responding to the levels of harassment and bullying experienced by staff will be the development of a clear behavioural framework that sets unequivocal standards on how we expect staff to behave in a manner that is consistent with our organisational values. This will be supported by a number of planned interventions, including: . Locally developed Trust wide signage - zero tolerance of discrimination and bullying at work . Enhancing awareness of support available to staff following incidents at work . Regular senior management communications reinforcing zero tolerance of bullying and harassment . Campaign to internally reinvigorate awareness of Trust policies (e.g. Violence and Aggression Policy; Incident Reporting) to improve reporting of incidents.

2. Percentage of staff believing there are equal opportunities for career progression

Inclusivity and talent management are two key strands of our new Organisational Development Framework, and through delivery of this framework and the actions below, we will look to address the slightly worse than national average result for this indicator:

. Establish regular internal Career Development Workshops: One for aspiring BME (black and minority ethnic) senior managers, one for BME staff bands 1-4 – identify career pathways and access to opportunities . Introduce charter of behaviour for managers – with equality a key theme . Monitor promotions across the Trust and identify areas requiring focus . Refresh recruitment and selection training to ensure greater focus on unconscious bias in recruitment and selection

CQC Ratings Grid

The overall rating for the Trust following the CQC’s comprehensive inspection in March 2014 was ‘requires improvement’. The high level ratings of this review are given below:

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The specific ratings were given to the core services inspected as per the table below:

Accident and emergency Good

Medical care (including older people’s care) Requires Improvement

Surgery Requires Improvement

Intensive/critical care Requires Improvement

Maternity and family planning Requires Improvement

Services for children and young people Good

End of life care Good

Outpatients Requires Improvement

In response to the findings of the inspection, the Trust developed an action plan, which addresses how it will meet the requirements of the 7 compliance actions and 27 ‘must’ and ‘should-do’ actions specified by the CQC. Progress of the actions within the plan is reviewed monthly by the Senior Management Team, at the Quality Assurance & Learning Committee and bi-monthly at the Trust Board Clinical Governance Committee. Externally the Berkshire West Clinical Commissioning Group has responsibility for monitoring of the plan, which is reviewed by the CQC at regularly quarterly monitoring meetings with the Trust.

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Quality Governance Review

In October – November 2015 a review of the quality governance teams and structures in the Trust took place. The previously separate Clinical Quality Assurance and Quality Improvement Teams were brought together to provide an integrated and cohesive Quality Governance Team. This new team has been strengthened to ensure that sufficient resource and support is available for patient safety, clinical effectiveness and risk management structures and initiatives across the Trust.

Creating a unified, integrated Quality Governance Team will:

. focus the Quality work undertaken by the Trust to ensure all projects are aligned to the Trust’s identified quality aims and priorities for 2016-17 . pool expertise into one team which will be simpler and more accessible for clinical staff seeking support . provide a greater resource for education, training and promotion of patient safety, risk, clinical audit and quality improvement . enable the development of IT software systems to support a robust risk assessment framework, real-time analysis and bespoke dashboard reporting of incident data. Executive Leads: Executive Director of Nursing & Medical Director

Deputy Director of Nursing & Governance

Quality Head of Governance & Head of Governance Head of Risk Head of Patient Safety Improvement Compliance Team Assistant

Clinical Audit & Informatics Health, Safety Datix Systems Patient Safety Improvement Facilitator & Risk Advisor Manager Managers x2 Lead

Clinical Audit Admin & Datix Assistant / Improvement Assistant Clerk x2 Facilitators x2

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Patient Safety Thermometer The Patient Safety Thermometer is a measurement tool for a programme of work to support patient safety improvement. It is a monthly snapshot audit used to record patient harms at the frontline, and to provide immediate information and analyses for frontline teams to monitor their performance in delivering harm free care with regards to:  pressure ulcers  falls  urinary tract infections (UTIs) in patients with a catheter  new venous thromboembolisms (VTEs)

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As the graphs above illustrate, over the last 4 years the Trust has improved in the reduction of pressure ulcers, falls with harm and VTEs. The Trust benchmarks favourably against the national average in all of these standards. Overall, the Trust has delivered ‘harm free care’ (new harm) consistently for over 98% of patients.

Acute Hip Fracture Unit In February 2015 a new dedicated 24-bed Acute Hip Fracture Unit (AHU) was opened. Patients with suspected hip fractures can now be directly admitted from ED under an Orthogeriatrician to a dedicated ward where a specialist multidisciplinary team works 7 days a week to provide a high standard of care. This has resulted in: prompt preoperative optimization and discussion with Trauma and Anaesthetic consultants about individual patients; improved communication with next of kin; closer post-operative monitoring to prevent complications; and early mobilization and proactive discharge planning. All of which has enhanced the care of the patients with a significant reduction in the length of stay.

In the year since the AHU began there has been:

 39.4 % improvement in the average time from ED to admission to an orthopaedic ward: 10.4 hrs to 6.3 hrs

 27.2% improvement in the percentage of patients mobilized on the first post-operative day: 53.4% to 80.6%

 21.2% improvement in average length of stay from: 19.3 days to 15.2 days – significantly below the national average of 19.2 days

Nutrition and Hydration

Malnutrition is a common problem affecting around one third of patients admitted to hospital and is increasingly recognised as a cause and consequence of illness and injury. Thus, promoting safety in nutritional care so that malnourishment is prevented where possible and treated when it does occur, is a key imperative at the Trust. Over the last year we have done a considerable amount of work to increase the profile of nutrition and hydration to ensure that our staff understand its importance. We have increased our compliance with nutritional assessments (‘MUST’ screening) for all patients admitted to hospital. In December 2015 this had reached: 91% MUST completed within 24 hours, 98% MUST completed within 48 hours and 93% reassessed in 7 days, which is a great achievement.

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We have a nutrition and hydration training programme for staff to ensure we meet the nutritional needs of our patients; a very active group of multi-professional nutrition champions who undertake education and learning activities for staff; as well as a large number of lay and non-clinical staff volunteers who have undergone specific training to enable them to safely assist patients with eating and drinking on the wards. Additional work undertaken has included: . A ‘feed me up’ campaign to ensure patients having enteral feeding are nursed at 30˚ which has led to a significant reduction in aspiration pneumonia; . The ‘hydration matters’ working group which has reviewed the acute kidney injury care bundle, fluid balance monitoring chart and documentation, electrolyte review, and timely administration of intravenous fluids; . Nutritional health promotion for staff with the implementation of the ‘Health and Wellbeing Strategy’; . Special menus developed for patients from differing cultures, religions and with special dietary requirements including gluten-free, vegan and patients who need encouragement to eat fresh food.

We have developed a Food and Drink Strategy outlining our strategic intentions to continue and extend this work to provide high quality, nutritious and responsibly sourced food and drink to our patients, staff and visitors over the next 3 years.

Integrated Pain and Spinal Service (IPASS)

The IPASS was set up in September 2015 in partnership with community providers to provide fast access and high quality community based assessment and treatment for patients with spinal and persistent pain which has not responded to standard medical treatments. The goal is to support the delivery of multidisciplinary and self-management tools. This service has been a great success, receiving very positive comments from our patients, and resulting in the Rheumatology Team winning the British Society for Rheumatology (BSR) 2016 Emerging Best Practice Award.

“Ready Steady Go” Initiative

In December 2014, a Lead Nurse for Transition was appointed at the Trust, to carry out a 12 month pilot of the nationally recognised transition programme ‘Ready Steady Go’ (RSG) in 2 cohorts of patients; diabetes and neuro-disability. The post was funded by the Thames Valley Strategic Clinical Network (TVSCN) and formed part of a Thames Valley wide project to develop transition services for young people with long term conditions. ‘Ready Steady Go’ is a structured, but where necessary adaptable, transition programme which can be used across all sub-specialties. A key principle throughout RSG is ‘empowering’ the young person to take control of their lives and equipping them with the necessary skills and knowledge to manage their own healthcare confidently and successfully in both paediatric and adult services. The pilot has now been evaluated and the clinicians involved all believe the programme has the potential to have positive health outcomes for young people. Phase 2 of the project will begin in March 2016, with the aim of rolling out the programme to all paediatric specialties within the Trust.

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Patient Experience and Involvement

The Patient Leadership Programme is now on its fifth cohort of patient leaders with approximately 26 volunteers trained. These patient leaders provide invaluable insight into patient experience and help drive many quality improvement initiatives across the Trust. This year one of our patient leaders reviewed our ‘Care Crew’ who provide activities for patients on our elderly care wards and as a result a new activity room was introduced for our patients. Patient leaders are also routinely invited to interview panels for ward sisters and specialist nursing roles. We are also the first Trust in the country to now have patient leaders on interview panels for new consultants.

In response to ‘John’s Campaign’, the right of carers to stay with patients with dementia, the Trust has agreed a standardised flexible visiting hours guide to increase the number of wards allowing open visiting across the Trust. This allows carers/families to support their loved ones as and when necessary. We have developed a ‘Visitors’ Charter’ alongside this to provide guidelines to ensure the practicalities of running a ward can be maintained whilst ensuring a positive experience for visitors and patients.

Patient Story Library: patients and carers who have experienced problems or inadequate care in the hospital are being invited to write an account of their experiences. These stories will be published in booklet form to be used as powerful training and teaching materials for our staff to share learning and hopefully ensure such incidents do not recur.

User Ratings: we are very proud that in the national “Friends and Family Test” (FFT) survey, 99% of our inpatients would recommend the Trust to their friends and family. This resulted in the Trust being shortlisted for the national FFT Awards 2016 for the “FFT Champions of the Year” category. We have also achieved a 4.5 star rating on NHS Choices with many positive and encouraging comments about the quality of care and treatment our patients are receiving on a daily basis.

Whitley Day Unit

The new day unit on Whitley ward allows patients with symptoms of severe fluid retention resulting from heart failure to return home after each daily course of treatment, rather than be admitted to hospital for several days. This improves the quality of life for patients and patient outcomes by reducing the risk of complications associated with lack of mobility and sleep deprivation, which are often associated with long hospital stays.

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Mandated Performance Indicators 2015-16

The mandated performance indicators required in Trust Quality Accounts are given below. Where available, the data has been drawn from the Health and Social Care Information Centre (HSCIC).

Summary Hospital-Level Mortality Indicator (SHMI) The SHMI value is a ratio between the actual number of patient deaths in hospital or within 30 days of discharge, and the ‘expected’ number of deaths based on an England average, adjusted to take account of the characteristics of the patient population.

. The SHMI Banding ratings are 1=higher than expected; 2=as expected; 3=lower than expected. . The percentage of deaths of patients whose treatment included palliative care is given as a contextual indicator.

Oct ‘14 – National NHS NHS Indicator 2013-14 2014-15 Sep ‘15* Average Best Worst Summary of Hospital Level 1.0624 1.016 0.981 1.00 0.652 1.177 Mortality Indicator (SHMI) Banding 2 2 2 2 3 1 SHMI percentage of deaths of patients 23.4% 42.0% 45.0% 26.6% N/A N/A coded with palliative care * SHMI data is published 6 months in arrears therefore Oct14 – Sep15 is the latest data available The Royal Berkshire NHS Foundation Trust considers that this data is as described for the following reasons: the data is provided by the HSCIC.

The Royal Berkshire NHS Foundation Trust has taken the following actions to improve this indicator, and so the quality of its services, by having in place a 2-stage mortality review process. This involves: . undertaking regular reviews of its mortality data in order to identify and address any data quality and coding issues. . undertaking clinical mortality reviews to identify clinical care issues. Any issues raised are addressed and lessons learned shared at the Clinical Outcomes and Effectiveness Committee chaired by the Medical Director. The Trust’s SHMI has decreased every year since 2013 and is currently better than the national average.

Patient Reported Outcome Measures (PROMS) – Adjusted Health Gain Scores National NHS NHS Indicator 2013-14 2014-15 2015-16 Average** Best** Worst** Groin Hernia *Not yet 0.114 0.080 0.084 0.154 0 Surgery available Varicose Vein N/A N/A N/A 0.095 0.154 -0.002 Hip *Not yet Replacement 0.434 0.462 0.437 0.524 0.33 available (Primary)

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Knee *Not yet Replacement 0.307 0.299 0.315 0.418 0.204 available (Primary) *PROMS data is published 6 months in arrears and therefore at the time of writing was available for April – September 2015 only. However, the Trust had insufficient modelled records at this stage to have adjusted health gain scores calculated (>30). This data will be reported in the Quality Report 2016-17

**these figures have been quoted for 2014-15 rather than Apr-Sep 2015-16 to enable comparison to the available RBH data.

The Royal Berkshire NHS Foundation Trust considers that this data is as described for the following reasons: data is collected by a contracted external organisation and then provided to the HSCIC.

The Royal Berkshire NHS Foundation Trust has taken the following actions to improve these scores, and so the quality of its services, by reviewing the care of individual patients as case studies at the General Surgical Clinical Governance meetings for groin hernia surgery and monitoring the hip and knee PROMs within the Orthopaedic Clinical Governance and business meetings for hip and knee replacement surgery.

Emergency Readmissions to Hospital within 28 Days of Discharge* Indicator 2013-14 2014-15 2015-16 Paediatrics (0- 7.2 % 5.11% 2.68% 15 yr olds) Adults 6.7% 4.29% 9.78% (16+ yr olds) *There is no HSCIC Data for this indicator therefore national comparative data is unavailable *For 2015-16 daycases were not included in the emergency readmission data. In previous years this has been included which accounts for the difference in the 2014/15 and 2015/16 values.

The Royal Berkshire NHS Foundation Trust considers that this data is as described for the following reasons: the Trust has completed readmission activity reconciliations with both the CCG and the national SUS readmission data extracts and has found its data to be in line with these external readmission sources.

The Royal Berkshire NHS Foundation Trust has taken the following actions to improve these percentages, and so the quality of its services, by regularly reviewing the emergency readmissions that appear to be related to the previous admission and ensuring that the care and treatment of these patients is reviewed by the relevant clinical team.

The Trust’s Responsiveness to the Personal Needs of Patients This indicator is based on a composite score of 5 questions from the national inpatient survey  Were you involved as much as you wanted to be in decisions about your care and treatment?  Did you find someone on the hospital staff to talk to about your worries and fears?  Were you given enough privacy when discussing your condition or treatment?

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 Did a member of staff tell you about medication side effects to watch for when you went home?  Did hospital staff tell you who to contact if you were worried about your condition or treatment after you left hospital?

National NHS NHS Indicator 2012 2013 2014 2015 Average Best Worst (2014) The Trust’s responsiveness Not yet to the personal 76.8 77 76.8 76.6 87.4 67.4 available* needs of patients * HSCIC data for 2015 due to be published “May 2016” but unavailable at time of writing The Royal Berkshire NHS Foundation Trust considers that this data is as described for the following reasons the data are collected by a contracted external organisation and provided to the HSCIC.

The Royal Berkshire NHS Foundation Trust intends to take the following actions to improve this percentage, and so the quality of its services, by updating and promoting the Trust Consent Policy and undertaking an audit of informed consent to improve patient involvement in decisions about care and treatment. In addition, the ongoing work to improve discharge information and communication to patients (outlined above) will help to improve this indicator.

Staff Recommendation Rate National NHS Best NHS Worst Q4 2014- Q1 2015- Q2 2015- Average Indicator Q2 2015- Q2 2015- 15 16 16* Q2 2015- 16 16 16 If a friend or relative needed treatment, I would be happy with 83% 84% 82% 79% 100% 48% the standard of care provided by this organisation * Jul-Sep 2015 is the most recent data available on HSCIC as Q3 data is not collected.

The Royal Berkshire NHS Foundation Trust considers that this data is as described for the following reasons the data are collected by a contracted external organisation and provided to the HSCIC.

The Royal Berkshire NHS Foundation Trust intends to take the following actions to improve this percentage, and so the quality of its services, by implementing the action plans to

124 improve the quality of our care and services outlined in this report. We will actively engage staff with these quality priorities and improvement workstreams and improve communication of our quality achievements with all staff.

Patient Recommendation Rate The ‘Friends and Family Test’ (FFT) records the percentage of patients who would recommend the Trust to their friends and family. The Trust inpatient and ED recommendation rates are given in comparison to the national averages in the graph below:

ED and Inpatient FFT Results 2015-16

100 98 96 94 92 RBH Inpatient 90 National Inpatient 88 RBH ED 86 84 National ED 82

Rate % Recommendation

Jul-15 Jan-16 Jun-15 Oct-15 Apr-15 Feb-16 Sep-15 Dec-15 Aug-15 Nov-15 Mar-16 May-15

National NHS NHS Indicator Jan-16 Feb-16 Mar-16 Average Best Worst Mar-16 Mar-16 Mar-16 Inpatient FFT Recommendation 99.2% 99.3% 99.0% 95.7% 100% 72.0% Rate ED FFT Recommendation 94.7% 95.2% 95.6% 84.0% 98.9% 49.3% Rate

The Royal Berkshire NHS Foundation Trust considers that this data is as described for the following reasons: the data are collected by a contracted external organisation and provided to the HSCIC.

The Royal Berkshire NHS Foundation Trust has taken the following actions to improve these percentages, and so the quality of its services, by encouraging patients to complete the FFT and incentivising the ward staff to strive to improve on their scores through the ward accreditation scheme.

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Venous Thromboembolism (VTE) Risk Assessment National NHS Best NHS Q2 2015- Q3 2015- Q4 2015- Average Indicator Q3 2015- Worst Q3 16 16 16 Q3 2015- 16 2015-16 16* Percentage of patients risk 95.8% 95.3% 95.4% 95.5% 100% 61.5% assessed for VTE *National Q4 data published by NHS England is 2 months in arrears therefore the Q4 data is unavailable at the time of writing. The Royal Berkshire NHS Foundation Trust considers that this data is as described for the following reasons: it is collected electronically and monitored on a monthly basis by the Board.

The Royal Berkshire NHS Foundation Trust has taken the following actions to improve this percentage, and so the quality of its services, by involving key clinical staff to train others in the importance of risk assessment, collecting the risk assessment data electronically, and monitoring the indicator in the monthly Board performance reports.

Clostriduim Difficile (C.diff) National NHS Best NHS Worst Indicator 2013-14 2014-15 2015-16* Average 2014-15 2014-15 2014-15 Rate of C.diff per 100,000 bed days (patients 18.1 14.1 12.50 15.1 0 62.2 aged 2+) Trust apportioned cases only *Trust data supplied as HSCIC data unavailable at time of writing The Royal Berkshire NHS Foundation Trust considers that this data is as described for the following reasons: all positive results are reviewed and verified by the Infection Control Team and a root cause analysis investigation undertaken to identify the contributory factors and actions for improvement.

The Royal Berkshire NHS Foundation Trust has taken the following actions to improve this indicator, and so the quality of its services, by implementing actions focused on appropriate stool sampling, improved microbial prescribing, environmental cleaning, hand hygiene and prompt isolation of affected patients. In addition, the Chief Executive chairs the C.diff Investigation meeting to review the RCA reports completed for each incidence of C.diff, identifying lapses in care and actions for improvement.

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Patient Safety Incidents Acute non- NHS Apr- Oct14- Apr15- NHS Best Indicator specialist Worst Apr- Sep14* Mar15* Sep15** Apr-Sep15 Trust (all) Sep15 Apr-Sep15 Number of patient safety 3965 4362 5174 632,050 12,080 1,559 incidents reported Rate per 1000 bed 38.25 39.35 41.87 50.59 74.67 18.07 days (median)

Number of patient safety incidents 11 8 13 2717 2 89 which resulted in severe harm/ death Percentage of patient safety incidents 0.1% 0.1% 0.25% 0.43% 0.07% 2.92% which resulted in severe harm or death *Data supplied from the National Reporting and Learning System (NRLS) **NRLS data is published six months in arrears therefore Apr-Sept 2015 is the latest data available

The Royal Berkshire NHS Foundation Trust considers that this data is as described for the following reasons: the Trust encourages an open reporting patient safety culture. All incidents reported are reviewed and validated by the Quality Governance Team prior to upload to the NRLS.

The Royal Berkshire NHS Foundation Trust has taken the following actions to improve these indicators, and so the quality of its services, by encouraging the reporting of patient safety incidents as a Quality Priority. All severe harm/ death patient safety incidents are subject to potential Serious Incident Requiring Investigation (SIRI). Those meeting the criteria have a thorough root cause analysis investigation undertaken and an action plan developed to put mitigation in place to prevent the incident happening again and to share lessons learned across the Trust.

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Performance against relevant indicators and performance thresholds set out in the Monitor Risk Assessment Framework

Indicator Benchmark 2014-15 2015-16 Maximum 18 weeks from RTT 92% 91.56% 93.02% (Incomplete pathways) ED: 4 hour wait 95% 94.44% 94.16% All cancers: 62 day wait urgent GP referral:

Urgent GP referral 85% 81.7% 74.2% NHS Cancer Screening Referral 90% 90.1% 88.7% All cancers: 31-day wait for second or subsequent treatment: Surgery 94% 95.4% 94.2% Anti-cancer treatments 98% 99.4% 99.2% Radiotherapy 94% 97.5% 95.8% All cancers: 31 day wait from 96% 97.9% 96.8% diagnosis to first treatment Cancer: two-week wait referral to date first seen Urgent Referrals 93% 90.9% 77.5% Symptomatic Breast Patients 93% 91.3% 84.5%

We have achieved the national benchmark standard for 5 out of 10 standards. The standards which have not been achieved are the ED 4 hour waits and cancer 2 week and 62 day waits. The ED 4 hour wait targets have been discussed above. The Trust recognises that further work is required to improve compliance with the cancer waiting time standards and is therefore taking this forward as a quality priority for 2016-17 through the Cancer Task Force and action plan.

The Trust has carried out extensive data quality improvement work in 2015-16, in order to address data quality concerns identified during spring 2015 in respect of key performance indicators presented above, including ED 4 hour waits and 18 week RTT reporting. Further details and improvement activities undertaken are provided in the Data Quality review section.

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Annex 1: Statements from Commissioners, Local Healthwatch Organisations and Overview and Scrutiny Committees

Wokingham Health Overview and Scrutiny Committee

Members of the Wokingham Health Overview and Scrutiny Committee reviewed the draft Quality Account 2015-2016 for Royal Berkshire NHS Foundation Trust:

. We welcome the priorities for the forthcoming year. It is positive that a number of priorities for the previous year which were not fully achieved, for a number of reasons, are being taken forward as priorities for 2016-17. . We are pleased to note the work undertaken so far with regards to recruitment and retention and the further plans for improvement in this area. . Whilst it is disappointing that the ED target for Q4 will not be achieved, we are pleased to note that the target was achieved for Q1-3 of 2015-16 despite increased demand. . We note that a behavioural framework setting unequivocal standards on how staff are expected to behave in a manner consistent with the organisational values, will be developed. . It is positive that 99% of inpatients completing the Friends and Family Test survey would recommend the Trust to their friends and relatives.

Healthwatch West Berkshire

Healthwatch West Berkshire, though only delivering the contract for just under a year now, are passionate about the quality of care our West Berkshire residents receive from the Royal Berkshire NHS Foundation Trust and other providers.

We have this year appreciated the opportunity to meet CEO Jean O’Callaghan and the commitment to 6 monthly meetings with the Thames Valley Network of Healthwatches. It is also good to be recognised as key partners in feeding back as independent organisations the experiences of RBH FT patients and the opportunity to identify and make recommendations of services.

Healthwatch West Berkshire has previously raised concern regarding appointment processes and more specifically appointment letters relating to the West Berkshire Community Hospital locality, we are pleased to see in the report that Royal Berkshire NHS Foundation Trust acknowledges there is still significant progress to be made and continuing its commitment ‘Improving our Administration Systems’ as a key quality priority. Even recently we are still finding errors with the administration system that can cause delay and worry for patients.

We have the belief that the DNA (did not attend) results would see some improvement particularly in the West Berks community Hospital (WBCH) locality once we start to see those administration systems move forward and as a local Healthwatch we will be monitoring the public’s experiences of these systems closely over the next 3-6 months.

There appears to be some issues around discharges from the hospital which we have raised with Royal Berkshire to address with their partner organisations.

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We acknowledge the priorities for improvement for 2016-17 and in line with our own local Healthwatch Workplan priorities will be keen to see the outcomes in particular of

 Clinical Effectiveness Priority 3: Reduce waiting times to ensure treatment is received at the right time for patients with Cancer

 Clinical Effectiveness Priority 4: Improving the Availability and Quality of Medical Records

 Patient Experience Priority 6: Improving our Administration Systems

Berkshire East and Berkshire West Clinical Commissioning Groups (CCGs) Joint Statement

Executive Summary

Berkshire West Clinical Commissioning Group (CCG) Federation has reviewed the Royal Berkshire NHS Foundation Trust Quality Account and is providing a joint response on behalf of Newbury and District CCG, South Reading CCG, North and West Reading CCG, Wokingham CCG, Slough CCG, Bracknell and Ascot CCG and Windsor Ascot and Maidenhead CCG. The Quality Account 2015/16 provides information across a wide range of quality measures and gives a comprehensive view of quality of care provided by the Trust. There is evidence that the Trust has relied on both internal and external assurance mechanisms.

The CCGs are satisfied with the accuracy of the data and information contained in the Account and also that the Trusts 2015/16 Quality Account Priorities are those that are in line with the Trusts Vision and Strategic Objectives and five year plan. The CCGs agree that the seven key priorities identified by the Trust are appropriate and a true reflection of findings and discussions we have had with them throughout the year.

History

The Royal Berkshire NHS Foundation Trust is one of the largest general Hospital Foundation Trusts in the country. They provide acute medical and surgical services to Reading, Wokingham and West Berkshire and specialist services to a wider population across Berkshire and its borders. Underneath their “Vision” sits their strategic objectives and their five year plan which details how they aim to achieve their objectives. The Trust very much values the partnership working across the local health economy, and with their patients and the public. Berkshire West CCGs are pleased to continue working in partnership with them.

Quality Account 2015/16

The Quality Account for 2015/16 clearly identified their successes to date and also areas for further improvement and continuing focus. The CCG’s support the Trust’s openness and transparency and is committed to working with the Trust to achieve further progression and successes in the areas identified within the Quality Account. This will be carried out through a number of both proactive and reactive mechanisms and collaborative, integral and multi- agency working. 130

Patient Safety Priority 1: Ensuring we have the right numbers of clinical staff with the right skills to meet our patients’ needs

We are pleased that the Trust has remained committed to ensuring that the hospital is staffed with the appropriate number and skill mix of clinical professionals to enhance the delivery of quality care and keep patients safe from avoidable harm. We recognise that vacancy rates have been a challenge across all staffing groups which have the associated financial pressures associated with increased agency staff spending and ongoing pressures to provide continuity of care for the patients. We welcome the Trusts recruitment strategy and acknowledge the many mechanisms they have employed in order to increase recruitment and sustain retention. We welcome the further development and actions highlighted for 2016/17.

Patient Safety Priority 2: The Timely Identification and Treatment of Sepsis

The Trust has worked hard in 2015/16 to continue to transform the improvement capability, capacity and resilience in trying to make a significant difference to those patients with a diagnosis of sepsis. This priority has further been enhanced by learning and collaboration extended across the local health economy. It is noted that the Trust is now working together across primary, secondary and community care using a common sepsis language and methodologies such as NEWS and sepsis screening tools. It is to note that this was a National CQUIN initiative for 15/16, which the Trust were have fully committed to and although were disappointed to not have achieved the required target in quarter 3, have nonetheless made significant progress. This national CQUIN has been extended to 16/17 which further supports the Trusts aims and objectives within this area.

Clinical Effectiveness Priority 3: Reducing waiting times to ensure treatment is received at the right time for patients with cancer

The CCGs have been concerned over the past 12 months in relation to the trusts performance against key cancer and RTT standards and we know the trust shared these concerns and has been working hard to make improvements. We therefore welcome the acknowledgement that the quality priority to reduce waiting times in 2015-16 to meet the constitutional standards was not met due to increasing capacity pressures and staffing issues and subsequently needs to continue to be a focus in this year’s quality priorities. That said, the CCGs acknowledge the effort and focus the Trust has dedicated to improving their performance across all cancer targets and welcome the improvements that have been made in 2015/16. We further recognise that the Trust is aspirational in development and monitoring of key pathways and it is welcomed that the Trust has decided to continue this work stream as a priority through 2016-17. The CCG look forward to a further improvement in performance outcomes as a result of continuing this work, as well as developing robust capacity and demand models with the Intensive Support Team following a review of the current cancer system to ensure it is fit for purpose and integration with the main hospital administration system.

Clinical Effectiveness Priority 4: Improving the Availability and Quality of Medical Records

This was a quality priority for 2015-16 which unfortunately was not fully achieved largely due to the impact of the administrative review project during its implementation phase. This was 131 disappointing and the CCGs feel this remains a key quality improvement area of focus and therefore welcome the trusts decision to continue its effort in improving the quality of medical records in 2016-17. The CCG has had assurance of progress towards various work streams which contribute to the success of this project and the overarching aims. It is recognised that while a number of positive elements have been achieved, there remains a significant amount of work to be completed in order to attain the achievement of the internal KPI’s as stated.

Clinical Effectiveness Priority 5: Improving Antimicrobial Stewardship

We recognise that the Trust has made positive steps in reducing the number of Trust acquired C.Difficile avoidable infections throughout 15/16 and also recognise the further priorities that have been outlined in order to continue with improvement plans throughout 16/17. The CCGs acknowledge the benefits and importance of the development of the Berkshire West Infection Prevention Control Committee in 2015/16, ensuring learning across the system relating to all aspects of infection control and welcome this committee being further developed to have Executive involvement in 2016/17.

Patient Experience Priority 6: Improving our Administration Systems

Improvement of the Trust administration systems was chosen as a quality priority for 2015- 16. However, the Trust acknowledges that this involved a large-scale reorganisation of the infrastructure of the hospital and has the recognition that this programme will take more than a year to fully embed and realise the benefits of the restructure. Therefore the CCG agree that it should continue as a quality priority for 2016-17. We especially welcome the priorities regarding clinic letters as this has been a theme from GP colleagues when continuing the clinical management of the patient within the primary care setting.

Patient Experience Priority 7: Improving the Care of Patients with Dementia and Support for Carers.

The CCG recognises the various steps taken in order to maintain the safety of patients with Dementia within the Trust. These developments have been further increased by the National CQUIN in 15/16 which the CCG have been assured regarding training plans, assessment of patients and development of carers questionnaires. Quality assurance visits have also highlighted the number of ward based initiatives that have been implemented and welcome the further improvement stated throughout 16/17.

Overall

We are pleased that the Trust has chosen to focus their priorities on areas affecting patient safety, clinical effectiveness and patient experience. The CCG recognises that a vast amount of work has been undertaken over the past year, however supports the trust in their recognition of the areas where there is still work to be undertaken. This is echoed within the Quality Account by the Trust regarding the rollover and continued progression of workstreams within medical records, administration systems, sepsis and cancer waiting times.

The CCGs also acknowledge the work that the Trust has undertaken in improving the quality of maternity services in 2015/16 and welcome working further with the Trust in 2016/17 on beginning to implement the recommendations of the National Maternity Review 2016, agreeing a timeline for priorities, particularly focussing on further improving patient choice. 132

We support the Trust in its continuing focus on the positive results from 2015/16 priorities and their continuing work to further those improvement and strengthen priorities over the coming financial year. Overall, there have been many positive highlights for the Trust and the CCG has gained assurance via a number of forums and by the undertaking of quality assurance visits. The CCGs therefore remain positive that the Trust are committed to offering high quality and safe care to our patients.

The Council of Governors’ Statement

The Council of Governors has been fully engaged in the process for the preparation of the Quality Account Report 2015/16 and has had the opportunity to comment on the priorities for the year and their ranking. The Council has also been able to seek the views of members on priorities for 2016/17 through consultation through our membership engagement programme.

The Council of Governors commends the progress made with the quality priorities for 2015- 16, notably the improvement in learning from incidents, the improvements made by the maternity team, and the discharge initiatives. The Council notes that there were several quality priorities which were not fully achieved last year and looks forward to seeing the progress against these priorities carried forward for 2016-17.

The Council of Governors fully supports the quality priorities identified for 2016/17. The Council considers that they reflect key quality issues affecting the Trust and the selection aligns with the other quality initiatives in the Trust such as the National CQUINs. The Council endorses the reasoning behind the selection of each of the priorities.

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Annex 2: Limited Assurance by External Auditors

INDEPENDENT AUDITOR’S REPORT TO THE COUNCIL OF GOVERNORS OF ROYAL BERKSHIRE NHS FOUNDATION TRUST ON THE QUALITY REPORT

We have been engaged by the Council of Governors of Royal Berkshire NHS Foundation Trust to perform an independent assurance engagement in respect of Royal Berkshire NHS Foundation Trust’s Quality Report for the year ended 31 March 2016 (the ‘Quality Report’) and certain performance indicators contained therein.

Scope and subject matter

The indicators for the year ended 31 March 2016 subject to limited assurance consist of the following two national priority indicators (the indicators):

 percentage of incomplete pathways within 18 weeks for patients on incomplete pathways at the end of the reporting period; and

 A&E: maximum waiting time of four hours from arrival to admission/transfer/discharge.

Respective responsibilities of the directors and auditors

The directors are responsible for the content and the preparation of the Quality Report in accordance with the criteria set out in the NHS Foundation Trust Annual Reporting Manual issued by Monitor.

Our responsibility is to form a conclusion, based on limited assurance procedures, on whether anything has come to our attention that causes us to believe that:

 the Quality Report is not prepared in all material respects in line with the criteria set out in the NHS Foundation Trust Annual Reporting Manual;

 the Quality Report is not consistent in all material respects with the sources specified in the Detailed Guidance for External Assurance on Quality Reports 2015/16 (‘the Guidance’); and

 the indicator in the Quality Report identified as having been the subject of limited assurance in the Quality Report are not reasonably stated in all material respects in accordance with the NHS Foundation Trust Annual Reporting Manual and the six dimensions of data quality set out in the Guidance.

We read the Quality Report and consider whether it addresses the content requirements of the NHS Foundation Trust Annual Reporting Manual and consider the implications for our report if we become aware of any material omissions.

We read the other information contained in the Quality Report and consider whether it is materially inconsistent with:

 board minutes and papers for the period April 2015 to May 2016;

 papers relating to quality reported to the board over the period April 2015 to May 2016;

 feedback from commissioners, dated 04/05/2016;

 feedback from governors, dated 19/05/2016;

 feedback from local Healthwatch organisations, dated 05/05/2016; 134

 feedback from Overview and Scrutiny Committee, dated 22/04/2016;

 the trust’s complaints report published under regulation 18 of the Local Authority Social Services and NHS Complaints Regulations 2009, dated 07/03/2016;

 the latest national patient survey, dated May 2015;

 the latest national staff survey, dated 22/03/2016;

 the 2015/16 Head of Internal Audit’s annual opinion over the trust’s control environment, dated 18/05/2016; and

 the latest CQC Intelligent Monitoring Report, dated May 2015.

We consider the implications for our report if we become aware of any apparent misstatements or material inconsistencies with those documents (collectively, the ‘documents’). Our responsibilities do not extend to any other information.

We are in compliance with the applicable independence and competency requirements of the Institute of Chartered Accountants in England and Wales (ICAEW) Code of Ethics. Our team comprised assurance practitioners and relevant subject matter experts.

This report, including the conclusion, has been prepared solely for the Council of Governors of Royal Berkshire NHS Foundation Trust as a body, to assist the Council of Governors in reporting the NHS Foundation Trust’s quality agenda, performance and activities. We permit the disclosure of this report within the Annual Report for the year ended 31 March 2016, to enable the Council of Governors to demonstrate they have discharged their governance responsibilities by commissioning an independent assurance report in connection with the indicator. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the Council of Governors as a body and Royal Berkshire NHS Foundation Trust for our work or this report, except where terms are expressly agreed and with our prior consent in writing.

Assurance work performed

We conducted this limited assurance engagement in accordance with International Standard on Assurance Engagements 3000 (Revised) – ‘Assurance Engagements other than Audits or Reviews of Historical Financial Information’, issued by the International Auditing and Assurance Standards Board (‘ISAE 3000’). Our limited assurance procedures included:

 evaluating the design and implementation of the key processes and controls for managing and reporting the indicator;

 making enquiries of management;

 testing key management controls;

 limited testing, on a selective basis, of the data used to calculate the indicator back to supporting documentation;

 comparing the content requirements of the NHS Foundation Trust Annual Reporting Manual to the categories reported in the Quality Report; and

 reading the documents.

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A limited assurance engagement is smaller in scope than a reasonable assurance engagement. The nature, timing and extent of procedures for gathering sufficient appropriate evidence are deliberately limited relative to a reasonable assurance engagement.

Non-financial performance information is subject to more inherent limitations than financial information, given the characteristics of the subject matter and the methods used for determining such information.

The absence of a significant body of established practice on which to draw allows for the selection of different, but acceptable measurement techniques which can result in materially different measurements and can affect comparability. The precision of different measurement techniques may also vary. Furthermore, the nature and methods used to determine such information, as well as the measurement criteria and the precision of these criteria, may change over time. It is important to read the quality report in the context of the criteria set out in the NHS Foundation Trust Annual Reporting Manual.

The scope of our assurance work has not included governance over quality or the non- mandated indicator, which was determined locally by Royal Berkshire NHS Foundation Trust.

Basis for adverse conclusion – Four Hour A&E Wait Time

As set out elsewhere in the Quality Accounts, the Trust has experienced performance reporting issues during the first eight months of 2015/16. These findings were highlighted by an internal audit review of data quality carried out in November 2015 and included concerns in respect of validation and accuracy of data recorded.

Through our testing of this indicator for the 2015/16 period we have confirmed the following findings:

 Accuracy of data – sample testing evidences cases where the Trust have recorded pathways as non-breaches of the four hour limit, where supporting documentation evidences that these may have been breaches of the limit.

 Validity of data – some commentary noted to support data recorded was only stored in the data recording system for 72 hours prior to November 2015, thus there is no audit trail to evidence where breaches have been validated to non-breaches.

Following the internal auditor’s initial review of A&E activity in November 2015, the Trust has since taken positive steps to rectify these inconsistencies, including implementation of revised operating and validation procedures. A follow-up audit was completed in December 2015 to ensure that issues had been rectified. The conclusions of this audit evidenced that the Trust has implemented successful procedures to limit errors in A&E data, and the results of our testing of cases from December 2015 onwards confirm that discrepancies were only noted prior to this revision of procedures.

As a result of the overall issues identified through our work we are unable to conclude that the data reported by the Trust for the four hour A&E waiting time target is presented in line with national guidance for the full year ended 31 March 2016.

Basis for adverse conclusion – 18 Week Referral-to-Treatment Indicator – incomplete pathways

Following the reporting holiday granted by Monitor during 2014/15, the Trust have undertaken a comprehensive validation exercise during 2015/16 and continue to make 136

Annex 3: Statement of Directors’ Responsibilities for the Quality Report

The Directors are required under the Health Act 2009 and the National Health Service (Quality Accounts) Regulations to prepare Quality Accounts for each financial year.

Monitor has issued guidance to NHS foundation trust boards on the form and content of annual quality reports (which incorporate the above legal requirements) and on the arrangements that NHS foundation trust boards should put in place to support the data quality for the preparation of the quality report.

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

. the content of the Quality Report meets the requirements set out in the NHS Foundation Trust Annual Reporting Manual 2015/16 and supporting guidance;

. the content of the Quality Report is not inconsistent with internal and external sources of information including:

. board minutes and papers for the period April 2015 to the date of this statement

. papers relating to quality reported to the board over the period April 2015 to the date of this statement

. feedback from commissioners dated 04/05/2016

. feedback from local Healthwatch organisations dated 05/05/2016

. feedback from Overview and Scrutiny Committee dated 22/04/2016

. feedback from Governors, dated 19/05/2016

. the Trust’s complaints report published under regulation 18 of the Local Authority Social Services and NHS Complaints Regulations 2009, dated 07/03/2016;

. the latest national patient survey May 2015

. the latest national staff survey 22/03/2016

. the Head of Internal Audit’s annual opinion over the trust’s control environment dated 18/05/2016

. the Quality Report presents a balanced picture of the NHS foundation trust’s performance over the period covered;

. the performance information reported in the Quality Report is reliable and accurate;

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

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

Royal Berkshire NHS Foundation Trust

Consolidated Financial Statements for the year ended 31 March 2016

CONTENTS Page No.

Contents 2 Independent Auditor's Report 3 Forward to the Consolidated Financial Statements 8 Statement of Comprehensive Income 9 Statement of Financial Position 10 Statements of Changes in Taxpayers' Equity 11 Statement of Cash Flows 13 Notes to the Accounts 1 Accounting Policies……………………………………………………………… 14 2 Income from Continuing Operations…………………………………………… 26 3 Operating Expenses…………………………………………………………….. 29 4 Staff Costs and Numbers……………………………………………………….. 31 5 Late Payment of Commercial Debts…………………………………………… 33 6 Finance Income and Expenses………………………………………………… 33 7 Intangible Non-current assets………………………………………………….. 34 8 Property, Plant and Equipment………………………………………………… 36 9 Investments………………………………………………………………………. 40 10 Inventories……………………………………………………………………….. 41 11 Trade and Other Receivables………………………………………………….. 41 12 Cash and Cash Equivalents……………………………………………………. 42 13 Trade and other payables………………………………………………………. 43 14 Provision for Liabilities and Charges…………………………………………... 44 15 Notes to the Statement of Cash Flows………………………………………… 45 16 Capital Commitments……………………………………………………………. 45 17 Events after the Reporting Period……………………………………………… 45 18 Contingencies……………………………………………………………………. 45 19 Related Party Transactions…………………………………………………….. 46 20 Private Finance Transactions………………………………………………….. 46 21 Pooled Budget Projects………………………………………………………… 46 22 Financial Instruments…………………………………………………………… 46 23 Third Party Assets………………………………………………………………. 48 24 Losses and special payments………………………………………………….. 48 25 Charity summary disclosure……………………………………………………. 50 26 HFMS summary disclosure…………………………………………………….. 51

INDEPENDENT AUDITOR’S REPORT TO THE COUNCIL OF GOVERNORS OF ROYAL BERKSHIRE NHS FOUNDATION TRUST ONLY Opinions and conclusions arising from our audit 1 Our opinion on the financial statements is unmodified We have audited the financial statements of Royal Berkshire NHS Foundation Trust for the year ended 31 March 2016 set out on pages 10 to 52. In our opinion: • the financial statements give a true and fair view of the state of the Group’s and the Trust’s affairs as at 31 March 2016 and of the Group’s and the Trust’s income and expenditure for the year then ended; and • the financial statements have been properly prepared in accordance with the NHS Foundation Trust Annual Reporting Manual 2015/16. 2 Our assessment of risks of material misstatement In arriving at our audit opinion above on the financial statements the risks of material misstatement that had the greatest effect on our audit have been set out as follows. Valuation, completeness and existence of Non-Current Assets – £174.4 million (2014/15 £181.4m) risk level is  (consistent) year on year Refer to the Audit Committee Report within the Trust’s Annual Report, Note 1.5 (accounting policy), within the Statement of Financial position as at 31 March 2016 and Note 8 within the financial statements. The risk: The Trust’s land and buildings (excluding dwellings) are required to be maintained at up to date estimates for year-end market value in existing use (EUV) for non-specialised property assets in operational use, and, for specialised assets where no market value is readily ascertainable, the depreciated replacement cost of a modern equivalent asset that has the same service potential as the existing property (DRC). The Trust last obtained a full external valuation of these assets at 31 March 2013, and has held assets at this valuation since that date. There is a risk that the carrying value of land, buildings (excluding dwellings) and dwellings shown within the 2015-16 financial statements does not reflect changes in the market valuation of these assets in the period since 31 March 2013, or changes in the condition of these assets that may have given rise to an impairment in their carrying value. In 2015/16 the Directors undertook a limited interim “desk-top” revaluation exercise that was subject to review by a sub-committee of the Board of Directors. This exercise incorporated consideration of the value of all the Trust’s Property, Plant and Equipment at the closing balance sheet date, but did not involve the physical inspection of the assets covered by the valuation. The review was carried out by the Trust and was supported by a review by the Trusts property advisors GVA Grimley. The risk relating to the valuation of land and buildings has not changed since our audit of the financial statements for the year ended 31 March 2015. The Trust owns 100% of the share capital of Healthcare Facilities Management Services Limited (HFMS Ltd). Investments in subsidiaries are subject to annual impairment reviews under paragraph 9 of IAS 36 ‘Impairment of Assets’. An impairment loss is recognised when the carrying value of an asset is greater than its recoverable amount, which is higher of its fair value less costs of disposal and its value in use. Value in use is the present value of future cash flows expected to derive from the asset or cash generating unit. In 2015/16 the Directors undertook an assessment of impairment indicators as defined in IAS 36. This exercise identified that those criteria set out under paragraph 9 of IAS 36 were met, namely that an indication for impairment existed based on the expected discounted future cash flows to be derived from the subsidiary The Directors also undertook an assessment of the present value of future cash flows expected to be derived from the operation of HFMS Ltd by discounting future cash flows using a discount rate that reflected the Directors current market assessments of the time value of money and the risks specific to the investment in HFMS Ltd. The valuation risk for the 100% owned subsidiary HFMS Ltd in the Trust’s accounts has been added for the year ended 31 March 2016, following management’s decision to review this valuation, given the indicators for impairment that existed to suggest the carrying value of the investment had been over-stated.

Our Response: In this area our audit procedures included reviewing those fixed assets acquired or constructed during the year (which were not subject to a full valuation) to assess whether the costs capitalised by the Trust were directly attributable to bringing these assets into use and whether there was any evidence that carrying value of these assets was materially different from their fair/current value. This review, incorporating both additions and transfers from assets under construction, was designed to assess the completeness and accuracy of the balance of fixed assets. We assessed the objectivity, independence and competence of the valuer to perform the desk top valuation. We also challenged the appropriateness of the indices used in relation to the current market value of assets subject to the “desk-top” revaluation exercise. We considered separately whether any physical or market indicators for impairment existed. Our procedures for the existence of fixed assets included physical verifications of assets as per the asset register, as well as confirmation that disposals of equipment had been appropriately reflected in the year end valuation of property, plant and equipment. We reviewed the impairment indicator assessment made by the Directors of the Trust of HFMS Ltd and the subsequent valuation made by the Directors of the present value of future cash flows, to assess whether they are reasonable such that the Trust can conclude on the value in use of the Trust’s investment in HFMS Ltd. Specifically, we assessed the inputs used in the valuation model to confirm validity of the assumptions used in this calculation and tested the sensitivity of the cash flow model to changes in these assumptions. NHS Income Recognition - £339.8 million (2014/15 - £323.8m) risk level is  (consistent) year on year Refer to the Audit Committee Report within the Trust’s Annual Report, Notes 1.2 and 1.26 (accounting policy), the Statement of Comprehensive Income for the year ended 31 March 2016, and Note 2 as at 31 March 2016 within the financial statements. The risk: The main source of income for the Trust is the provision of healthcare services to the public under contracts with NHS Clinical Commissioning Groups and NHS England, which make up 74% of Group income from continuing operations. The Trust participates in the agreement of balances exercise for the purpose of ensuring that intra-NHS balances are eliminated on the consolidation of the Department of Health’s resource accounts. This exercise identifies mismatches between income and expenditure and receivable and payable balances recognised by the Trust and its counterparties. Miss-matches can occur for a number of reasons, but the most significant risks at this Trust relate to: • the completeness and existence of income and activity recorded at the period end which has not been subject to validation and confirmation processes by the counterparties; and • the completeness and existence of income and activity recorded in the financial statements where there are disputes with counter-parties in relation to validated activity. Our response: In this area our audit procedures included a review of the arrangements in place to manage the Trust’s contracts with commissioning bodies, incorporating contract monitoring and accounts receivable processes. For the largest Clinical Commissioning Groups (CCGs) and NHS England, we agreed income received during to the period to amounts invoiced and subsequent cash amounts received by the Trust. We confirmed that the contract agreements with a sample of the Trust’s main CCGs for 2015/16 had been signed by both the Trust and the CCG. As part of our review of the Agreement of Balances exercise, we challenged and validated with the Trust all mis-matches over £250K highlighted through the exercise to confirm the basis of the figures reported by the Trust. Where disputed balances existed we challenged the reasonableness of the Trust’s assumptions relating to these by inspecting a sample of the Trust’s records on the quality and timeliness of the activities in dispute and reviewing correspondence with commissioners. Valuation of provisions for debtors - £ 1.8 million as at 31 March 2016 (£0.8m as at 31 March 2015) risk level is  (increased) year on year Refer to the Audit Committee Report within the Trust’s Annual Report, Note 1.12 (accounting policy), the Statement of Comprehensive Income for the year ended 31 March 2016, and Note 14 as at 31 March 2016 within the financial statements.

The risk: The Trust has been required to achieve delivery of £17.8m of savings programmes against a target of £16.7m and faces ongoing pressure to manage cash flows. The effective collection of the Trust’s debtors is therefore an important tool to secure the cash position. The provision for debtors is an indicator of the ability of the Trust to recover outstanding debt. This is a new risk identified for our external audit of the financial statements for the year ended 31 March 2016. This has been raised as a result of the continued pressure on the Trust’s working capital position, as well as due to increased regulator focus on NHS providers’ working capital and Statement of Financial Position management. Our response: In this area our audit procedures included confirmation of the basis upon which any provisions for contract income have been made. Where confirmation had been received from the third party as to the disputed amount, we confirmed that amounts provided for were in line with this confirmation. We reviewed controls in place for balance disputes and contract monitoring, to confirm whether provisions had been identified by the Trust in a timely manner. We did not specifically assess provisions against the actual reduction in contract income realised, due to ongoing negotiation between the Trust and its commissioners. 3. Our application of materiality and an overview of the scope of our audit The materiality for the Group financial statements was set at £7.4 million (2014/15: £6.9 million), determined with reference to a benchmark of income from operations (of which it represents 2%, the same as the prior year). We consider income from operations to be more stable than a surplus-related benchmark. We report to the audit committee any corrected and uncorrected identified misstatements exceeding £250K (2014/15: £250K), in addition to other identified misstatements that warrant reporting on qualitative grounds. The Group has two reporting components: Healthcare Facilities Management Services Limited and the Royal Berkshire NHS Foundation Trust Charity. Both of these components are subject to audits for group reporting purposes performed by the Group audit team based at Royal Berkshire Hospital in Reading. These audits cover 100% of group income, the surplus for the year and total assets. The audits performed for group reporting purposes are all performed to the level of materiality agreed for the Group audit. Our separate audits of the Trust’s reporting components will be undertaken applying a lower level of materiality, between £80k and £7,400K (2014/15: £85K and £6,900K), and are all performed at the Trust’s Prince’s House office in Reading. 4 Our opinion on other matters prescribed by the Code of Audit Practice is unmodified In our opinion: • the parts of the Remuneration and Staff Reports to be audited have been properly prepared in accordance with the NHS Foundation Trust Annual Reporting Manual 2015/16; and • the information given in the Annual Report for the financial year for which the financial statements are prepared is consistent with the financial statements. 5 We have nothing to report in respect of the following matters on which we are required to report by exception Under ISAs (UK&I) we are required to report to you if, based on the knowledge we acquired during our audit, we have identified other information in the Annual Report that contains a material inconsistency with either that knowledge or the financial statements, a material misstatement of fact, or that is otherwise misleading. In particular, we are required to report to you if: • we have identified material inconsistencies between the knowledge we acquired during our audit and the directors’ statement that they consider that the Annual Report and Accounts taken as a whole is fair, balanced and understandable and provides the information necessary for patients, regulators and other stakeholders to assess the Trust’s performance, business model and strategy; or • the audit and risk committee terms of reference does not appropriately address matters communicated by us to the audit committee. Under the Code of Audit Practice we are required to report to you if in our opinion:

• the Annual Governance Statement does not reflect the disclosure requirements set out in the NHS Foundation Trust Annual Reporting Manual 2015/16, is misleading or is not consistent with our knowledge of the Trust and other information of which we are aware from our audit of the financial statements. In addition we are required to report to you if: • any reports to the regulator have been made under Schedule 10(6) of the National Health Service Act 2006. • any matters have been reported in the public interest under Schedule 10(3) of the National Health Service Act 2006 in the course of, or at the end of the audit. We have nothing to report in respect of the above responsibilities. 6 Other matters on which we report by exception - adequacy of arrangements to secure value for money Under the Code of Audit Practice we are required to report by exception if we conclude that we are not satisfied that the Trust has put in place proper arrangements to secure value for money in the use of resources for the relevant period. As part of our audit work we have completed our review of the Quality Report produced by the Trust. This has included work to seek to provide a limited assurance opinion on A&E waiting times and the referral to treatment target performance at the Trust. We have reported adverse conclusions on the presentation of data associated with both of these indicators. Management have reflected the wider context of the internal improvement programme and other reviews and assurance they have received over the indicators within their commentary in the Quality Report (see page 28). This work has involved the Trust investing resources in process improvement to their patient record keeping and validation processes, which through management review and independence challenge from internal audit have shown improved performance over the course of the year. The Trust, as in 2014/15, is subject to enforcement actions that have been agreed with Monitor (now NHS Improvement) following the receipt of formal notification from Monitor on 12 December 2014 that it had ‘reasonable grounds to suspect that the Licensee (Royal Berkshire NHS Foundation Trust) has provided and is providing healthcare services for the purposes of the NHS in breach of the following conditions of its licence: FT (4), FT4 (5) (a)-(c)(e) and (f), FT4 (6) (a)-(d) and (f), FT4 (7). These conditions relate to the establishment of effective governance procedures, in particular in relation to compliance with healthcare standards set by regulators; data quality to provide information on quality of care; and compliance with the duty to operate efficiently, economically and effectively. Significant work has been performed by the Trust to address these concerns and it is expected during 2016/17 complete its work to address these enforcement actions. As a result of these issues we are not able to conclude that the Trust has effectively used performance information to support informed decision making and performance management throughout the 2015/16 period. Except for the matters referred to above we are satisfied that that the Trust put in place proper arrangements to secure economy, efficiency and effectiveness in its use of resources for the year ended 31 March 2016. Certificate of audit completion We certify that we have completed the audit of the accounts of Royal Berkshire NHS Foundation Trust in accordance with the requirements of Schedule 10 of the National Health Service Act 2006 and the Code of Audit Practice issued by the National Audit Office. Respective responsibilities of the accounting officer and auditor As described more fully in the Statement of Accounting Officer’s Responsibilities on page 56 of the Annual Report, the accounting officer is responsible for the preparation of financial statements which give a true and fair view. Our responsibility is to audit, and express an opinion on, the financial statements in accordance with applicable law and International Standards on Auditing (UK and Ireland). Those standards require us to comply with the UK Ethical Standards for Auditors. Scope of an audit of financial statements performed in accordance with ISAs (UK and Ireland)

Scope of an audit of financial statements performed in accordance with ISAs (UK and Ireland) A description of the scope of an audit of financial statements is provided on our website at www.kpmg.com/uk/auditscopeother2014. This report is made subject to important explanations regarding our responsibilities, as published on that website, which are incorporated into this report as if set out in full and should be read to provide an understanding of the purpose of this report, the work we have undertaken and the basis of our opinions.

Respective responsibilities of the Trust and auditor in respect of arrangements for securing economy, efficiency and effectiveness in the use of resources The Trust is responsible for putting in place proper arrangements to secure economy, efficiency and effectiveness in its use of resources, to ensure proper stewardship and governance, and to review regularly the adequacy and effectiveness of these arrangements. Under Section 62(1) and Schedule 10 paragraph 1(d), of the National Health Service Act 2006 we have a duty to satisfy ourselves that the Trust has made proper arrangements for securing economy, efficiency and effectiveness in its use of resources. We are not required to consider, nor have we considered, whether all aspects of the Trust‟s arrangements for securing economy, efficiency and effectiveness in its use of resources are operating effectively.

Scope of the review of arrangements for securing economy, efficiency and effectiveness in the use of resources We have undertaken our review in accordance with the Code of Audit Practice, having regard to the guidance on the specified criterion issued by the Comptroller and Auditor General (C&AG), as to whether the Trust has proper arrangements to ensure it took properly informed decisions and deployed resources to achieve planned and sustainable outcomes for taxpayers and local people. The C&AG determined this criterion as necessary for us to consider under the Code of Audit Practice in satisfying ourselves whether the Trust put in place proper arrangements for securing economy, efficiency and effectiveness in its use of resources for the year ended 31 March 2016. We planned our work in accordance with the Code of Audit Practice. Based on our risk assessment, we undertook such work as we considered necessary to form a view on whether, in all significant respects, the Trust had put in place proper arrangements to secure economy, efficiency and effectiveness in its use of resources.

The purpose of our audit work and to whom we owe our responsibilities This report is made solely to the Council of Governors of the Trust, as a body, in accordance with Schedule 10 of the National Health Service Act 2006. Our audit work has been undertaken so that we might state to the Council of Governors of the Trust, as a body, those matters we are required to state to them in an auditor‟s report and for no other purpose. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the Council of Governors of the Trust, as a body, for our audit work, for this report or for the opinions we have formed.

Neil Thomas, Partner for and on behalf of KPMG LLP, Statutory Auditor Chartered Accountants 15 Canada Square London E14 5GL

May 2016 7

Royal Berkshire NHS Foundation Trust – Consolidated Financial Statements for the year ended 31 March 2016

FOREWORD TO THE CONSOLIDATED FINANCIAL STATEMENTS

These consolidated financial statements for the year ending 31 March 2016 have been prepared by Royal Berkshire NHS Foundation Trust in accordance with Paragraphs 24 and 25 of Schedule 7 of the National Health Service Act 2006 and are presented to Parliament pursuant to Schedule 7, paragraph 25 (4) of the National Health Service Act 2006.

Jean O'Callaghan

Chief Executive Officer 24 May 2016

Royal Berkshire NHS Foundation Trust – Consolidated Financial Statements for the year ended 31 March 2016

STATEMENT OF COMPREHENSIVE INCOME

Trust Group Trust Group 2015/16 2015/16 2014/15 2014/15

Notes £000 £000 £000 £000

Income from continuing operations 2 373,958 373,279 356,108 355,110

Operating expenses of continuing operations 3 (382,111) (377,074) (359,570) (358,099)

OPERATING DEFICIT (8,153) (3,795) (3,462) (2,989)

Finance costs Finance income 6 800 67 834 79 Finance expenses 6 (1,060) (1,060) (1,190) (1,190) Finance expenses - unwinding of discount 2 2 (60) (60) Other tax movements 1.17 0 (270) 0 (82) PDC Dividends payable (4,656) (4,656) (4,992) (4,992)

NET FINANCE COSTS (4,914) (5,917) (5,408) (6,245)

DEFICIT FOR THE YEAR (13,067) (9,712) (8,870) (9,234)

Other income:

Other reserve movements 0 0 0 0

Assets acquired through absorption 0 0 0 0

Other recognised gains and losses 0 0 (6) (5)

TOTAL COMPREHENSIVE INCOME / (EXPENSE) FOR THE PERIOD (13,067) (9,712) (8,876) (9,239)

Royal Berkshire NHS Foundation Trust – Consolidated Financial Statements for the year ended 31 March 2016

STATEMENT OF FINANCIAL POSITION At 31 March 2016 Trust Group Trust Group 31 March 2016 31 March 2016 31 March 2015 31 March 2015 Notes £000 £000 £000 £000 NON-CURRENT ASSETS Intangible non-current assets 7 9,696 9,703 9,593 9,631 Property, Plant and Equipment 8 158,570 174,416 164,800 181,359 Investments 9 10,600 12 15,000 12 Deferred Tax 0 62 0 42 Trade and other receivables 11 15,783 613 16,269 746

TOTAL NON-CURRENT ASSETS 194,649 184,806 205,662 191,790

CURRENT ASSETS Inventories 10 5,692 5,692 5,202 5,202 Trade and other receivables 11 20,328 18,353 27,077 17,684 Assets held for sale 8 1,240 1,240 2,000 2,000 Cash and cash equivalents 12 10,432 15,362 10,883 17,724

TOTAL CURRENT ASSETS 37,692 40,647 45,162 42,610 TOTAL ASSETS 232,341 225,453 250,824 234,400

CURRENT LIABILITIES Trade and other payables 13 (39,861) (41,562) (42,219) (37,741) Borrowings 13 (3,960) (3,960) (3,994) (3,994) Provisions 14 (1,804) (1,804) (773) (773) Tax payable (4,020) (4,020) (3,955) (3,955)

TOTAL CURRENT LIABILITIES 13 (49,645) (51,346) (50,941) (46,463)

TOTAL ASSETS LESS CURRENT LIABILITIES 182,696 174,107 199,883 187,937

NON-CURRENT LIABILITIES

Borrowings 13 (23,236) (23,236) (26,906) (26,906) Other Long Term payables 13 0 0 (443) (443) Deferred Tax Liability 0 (2) 0 0 Provisions 14 (274) (274) (315) (315) TOTAL NON CURRENT LIABILITIES 13 (23,510) (23,512) (27,664) (27,664)

TOTAL ASSETS EMPLOYED 159,186 150,595 172,219 160,273

TAXPAYERS' EQUITY Public Dividend Capital 157,511 157,511 157,477 157,477 Revaluation Reserve 23,237 23,237 24,288 24,288 Charitable funds 0 3,460 0 4,073 Income and Expenditure Reserve (21,562) (33,613) (9,546) (25,565)

TOTAL TAXPAYERS' EQUITY 159,186 150,595 172,219 160,273

The notes on pages 14 to 51 form part of these accounts. The Financial Statements on pages 9 to 13 were approved by the Board on 24 May 2016 and signed on its behalf by:

Jean O'Callaghan, Chief Executive Officer 26 May 2015

Royal Berkshire NHS Foundation Trust – Consolidated Financial Statements for the year ended 31 March 2016

GROUP STATEMENT OF CHANGES IN TAXPAYERS' EQUITY

Public Charitable Income and Revaluation Dividend Funds Expenditure Total Reserve Capital Reserve Reserve £000 £000 £000 £000 £000

Taxpayers' equity at 1 April 2015 24,288 157,477 4,073 (25,565) 160,273

Total comprehensive income / (expense) for the year 0 0 (613) (9,099) (9,712)

Transfer of excess of current cost depreciation to the Income and Expenditure Reserve (627) 0 0 627 0

Transfer of retained reserve on disposal of assets (424) 0 0 424 0

Public Dividend Capital received 0 34 0 0 34

Taxpayers' equity at 31 March 2016 23,237 157,511 3,460 (33,613) 150,595

Taxpayers' equity at 1 April 2014 25,060 157,047 4,353 (17,379) 169,081

Total comprehensive income / (expense) for the year 0 0 (280) (8,959) (9,239)

Other Reserve movements 1 0 0 0 1

Transfer of excess of current cost depreciation to the Income and Expenditure Reserve (773) 0 0 773 0

Public Dividend Capital received 0 430 0 0 430

Taxpayers' equity at 31 March 2015 24,288 157,477 4,073 (25,565) 160,273

Royal Berkshire NHS Foundation Trust – Consolidated Financial Statements for the year ended 31 March 2016

TRUST STATEMENT OF CHANGES IN TAXPAYERS' EQUITY

Public Income and Revaluation Dividend Expenditure Total Reserve Capital Reserve £000 £000 £000 £000

Taxpayers' equity at 1 April 2015 24,288 157,477 (9,546) 172,219

Total comprehensive income / (expense) for the year 0 0 (13,067) (13,067)

Transfer of excess of current cost depreciation to the Income and Expenditure Reserve (627) 0 627 0

Transfer of retained reserve on disposal of assets (424) 0 424 0

Public Dividend Capital received 0 34 0 34

Taxpayers' equity at 31 March 2016 23,237 157,511 (21,562) 159,186

Taxpayers' equity at 1 April 2014 25,060 157,047 (1,443) 180,664

Total comprehensive income / (expense) for the year 0 0 (8,876) (8,876)

Transfer on disposal of fixed assets 1 0 0 1

Transfer of excess of current cost depreciation to the Income and Expenditure Reserve (773) 0 773 0

Public Dividend Capital received 0 430 0 430

Taxpayers' equity at 31 March 2015 24,288 157,477 (9,546) 172,219

Royal Berkshire NHS Foundation Trust – Consolidated Financial Statements for the year ended 31 March 2016

STATEMENT OF CASH FLOWS

Trust Group Trust Group 2015/16 2015/16 2014/15 2014/15

Notes £000 £000 £000 £000 CASH FLOWS FROM OPERATING ACTIVITIES Net cash generated from operations 15 18,699 17,686 14,924 13,171

CASH FLOWS FROM INVESTING ACTIVITIES Interest received 800 67 834 79 Payments to acquire tangible non-current assets (9,651) (9,816) (9,954) (9,954) Proceeds from sale of tangible non-current assets 742 742 322 322 Purchases of financial current assets 2,000 2,000 8,000 8,000 Payments to acquire intangible non-current assets (1,654) (1,654) (2,093) (2,093)

Net cash generated from/(used in) investing activities (7,763) (8,661) (2,891) (3,646)

CASH FLOWS FROM FINANCING ACTIVITIES

Loans repaid to Foundation Trust Financing Facility (3,669) (3,669) (3,707) (3,707) Interest paid (1,096) (1,096) (1,190) (1,190) PDC Capital received 34 34 430 430 PDC Dividends paid (4,656) (4,656) (4,992) (4,992)

Net cash generated from/(used in) financing activities (9,387) (9,387) (9,459) (9,459)

Increase/(decrease) in cash and cash equivalents 1,549 (362) 2,574 66

Cash at 01 April 1,883 8,724 (691) 8,658

Cash at 31 March 12 3,432 8,362 1,883 8,724

Royal Berkshire NHS Foundation Trust – Consolidated Financial Statements for the year ended 31 March 2016

NOTES TO THE ACCOUNTS

1 Accounting Policies

Monitor is responsible for issuing an accounts direction to NHS Foundation Trusts under the NHS Act 2006. Monitor has directed that the financial statements of the Trust shall meet the accounting requirements of the NHS Foundation Trust Annual Reporting Manual (FT ARM) which shall be agreed with the Secretary of State. Consequently, the following Consolidated Financial Statements have been prepared in accordance with the 2015/16 FT ARM issued by Monitor.

The accounting policies contained in the above manual follow International Financial Reporting Standards (IFRS) and HM Treasury‟s Financial Reporting Manual (FReM) to the extent that they are meaningful and appropriate to the Trust. The accounting policies have been applied consistently in dealing with items considered material in relation to the accounts.

Accounting convention

These accounts have been prepared under the historical cost convention modified to account for the revaluation of property, plant and equipment, intangible assets, inventories and certain financial assets and financial liabilities.

1.1 Consolidated Financial Statements

These consolidated financial statements have been prepared incorporating the accounts of Healthcare Facilities Management Services Ltd (HFMS), a wholly owned subsidiary of Royal Berkshire NHS Foundation Trust, and Royal Berkshire NHS Foundation Trust Charity (The Charity).

Subsidiary entities are those over which the Trust has the power to exercise control or a dominant influence so as to gain economic or other benefits. The income, expenses, assets, liabilities, equity and reserves of subsidiaries are consolidated in full into the appropriate financial statement lines.

HFMS provides fully managed healthcare facilities to the healthcare community. The Company has two principal assets which are the Bracknell Clinic at Brants Bridge in Bracknell and Princes House in Reading.

The Trust is the corporate trustee to The Charity. The Trust has assessed its relationship to the charitable fund and determined it to be a subsidiary because the Trust is exposed to, or has rights to, variable returns and other benefits for itself, patients and staff from its involvement with the charitable fund and has the ability to affect those returns and other benefits through its power over the fund.

The charitable fund‟s statutory accounts are prepared to 31 March in accordance with the UK Charities Statement of Recommended Practice (SORP) which is based on Financial Reporting Standard (FRS102). On consolidation, necessary adjustments are made to the charity‟s assets, liabilities and transactions to:

- recognise and measure them in accordance with the Trust‟s accounting policies; and

- eliminate intra-group transactions, balances, gains and losses.

The amounts consolidated are based on the unaudited 2015/16 financial statements of the subsidiaries.

1.2 Income Recognition

Income in respect of services provided is recognised when, and to the extent that, performance occurs and is measured at the fair value of the consideration receivable in the normal course of business. The main source of income for the Trust is under contracts from commissioners in respect of healthcare services. Where income is received for a specific activity which is to be delivered in the following financial year, that income is deferred.

Partially completed contracts for patient services are not accounted for as work-in-progress but are treated as accrued income. The value of partially completed spells of healthcare at the end of the financial year (or period) is treated as accrued income where it is certain that the Trust will receive the income under the contracting arrangements subsisting with its commissioners at the Statement of Financial Position date.

Income from the sale of non-current assets is recognised only when all material conditions of sale have been met, and is measured as the sums due under the sale contract.

Royal Berkshire NHS Foundation Trust – Consolidated Financial Statements for the year ended 31 March 2016

1.3 Expenditure on other goods and services

Expenditure on goods and services is recognised when, and to the extent, that they have been received, and is measured at the fair value of those goods and services. Expenditure is recognised in operating expenses except where it results in the creation of a non-current asset such as property, plant and equipment.

1.4 Employee benefits

IAS 19 sets out the requirements for accounting for short-term employee benefits, post-employment benefits and termination benefits. The „Employee benefits expense‟ includes all three of these costs.

Short-Term employee benefits

Salaries, wages and employment related payments are recognised in the period in which the service is received from employees. The cost of annual leave entitlement earned but not taken by employees at the end of the period is recognised in the financial statements to the extent that employees are permitted to carry forward leave into the following period.

Termination benefits

Termination benefits are recognised as an expense when the Trust is committed demonstrably, without realistic possibility of withdrawal, to a formal detailed plan to either terminate employment before the normal retirement age, or to provide termination benefits as result of an offer made to encourage voluntary resignations. Termination benefits for voluntary resignations are recognised as an expense if the Trust has made an offer of voluntary resignation, it is probable that the offer will be accepted, and the number of acceptances can be estimated reliably. If the benefits are payable more than twelve months after the reporting period, then they are discounted to their present value.

Pension costs

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

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

a) Accounting valuation

A valuation of scheme liability is carried out annually by the scheme actuary (currently the Government Actuary‟s Department) as at the end of the reporting period. This utilises an actuarial assessment for the previous accounting period in conjunction with updated membership and financial data for the current reporting period, and are accepted as providing suitably robust figures for financial reporting purposes. The valuation of scheme liability as at 31 March 2016, is based on valuation data as 31 March 2015, updated to 31 March 2016 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.

Royal Berkshire NHS Foundation Trust – Consolidated Financial Statements for the year ended 31 March 2016

The latest assessment of the liabilities of the scheme is contained in the scheme actuary report, which forms part of the annual NHS Pension Scheme (England and Wales) Pension Accounts. These accounts can be viewed on the NHS Pensions website and are published annually. Copies can also be obtained from The Stationery Office.

b) Full actuarial (funding) valuation

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 payable by employees and employers.

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 Secretary of State for Health, with the consent of HM Treasury, and consideration of the advice of the Scheme Actuary and appropriate employee and employer representatives as deemed appropriate.

c) Scheme provisions

The NHS Pension Scheme provided defined benefits, which are summarised below. This list is an illustrative guide only, and is not intended to detail all the benefits provided by the Scheme or the specific conditions that must be met before these benefits can be obtained:

The Scheme is a “final salary” scheme. Annual pensions are normally based on 1/80th for the 1995 section and of the best of the last three years pensionable pay for each year of service, and 1/60th for the 2008 section of reckonable pay per year of membership. Members who are practitioners as defined by the Scheme Regulations have their annual pensions based upon total pensionable earnings over the relevant pensionable service.

With effect from 1 April 2008 members can choose to give up some of their annual pension for an additional tax free lump sum, up to a maximum amount permitted under HMRC rules. This new provision is known as “pension commutation”.

Annual increases are applied to pension payments at rates defined by the Pensions (Increase) Act 1971, and are based on changes in retail prices in the twelve months ending 30 September in the previous calendar year. From 2011-12 the Consumer Price Index (CPI) has been used which replaced the Retail Prices Index (RPI). Early payment of a pension, with enhancement, is available to members of the scheme who are permanently incapable of fulfilling their duties effectively through illness or infirmity. A death gratuity of twice final year‟s pensionable pay for death in service, and five times their annual pension for death after retirement is payable.

For early retirements other than those due to ill health the additional pension liabilities are not funded by the scheme. The full amount of the liability for the additional costs is charged to the employer.

Members can purchase additional service in the NHS Scheme and contribute to money purchase AVC‟s run by the Scheme‟s approved providers or by other Free Standing Additional Voluntary Contributions (FSAVC) providers.

Royal Berkshire NHS Foundation Trust – Consolidated Financial Statements for the year ended 31 March 2016

1.5 Property, Plant and Equipment

Capitalisation

Property, plant and equipment is capitalised where:

- it is held for use in delivering services or for administrative purposes;

- it is probable that future economic benefits will flow to, or service potential be provided to, the trust;

- it is expected to be used for more than one financial year;

- the cost of the item can be measured reliably and

• individually have a cost of at least £5,000; or • which form a group of assets which individually have a cost of more than £250, collectively have a cost of at least £5,000, where the assets are functionally interdependent, they had broadly simultaneous purchase dates, are anticipated to have simultaneous disposal dates and are under single managerial control; or • form part of the initial setting-up cost of a new building or refurbishment of a ward or unit, irrespective of their individual or collective cost; or • comprise a set of assets with a value in excess of £5,000, each of which costs over £250, and where such assets are managed as a single trust-wide set of assets under common managerial control and are replaced under a single trust-wide replacement policy.

Where a large asset, for example, a building, includes a number of components with significantly different asset lives, e.g. plant and equipment, then these components are treated as separate assets and depreciated over their own useful economic lives.

Valuation

All property, plant and equipment assets are measured initially at cost, representing the costs directly attributable to acquiring or constructing the asset and bringing it to the location and condition necessary for it to be capable of operating in the manner intended by management.

All assets are measured subsequently at valuation. Property, plant and equipment assets are stated at the lower of replacement cost or recoverable amount. The carrying values of property, plant and equipment assets are reviewed for impairment in periods if events or changes in circumstances indicate the carrying value may not be recoverable. The costs arising from financing the construction of the property, plant and equipment assets are not capitalised but are charged to the Statement of Comprehensive Income in the year to which they relate.

- All land and buildings are revalued using professional valuers in accordance with IAS 16. A three year interim valuation is also carried out. All specialist buildings were independently revalued by professionally qualified valuers under the Modern Equivalent Asset basis. - Valuations are carried out by professionally qualified valuers in accordance with the Royal Institution of Chartered Surveyors (RICS) Appraisal and Valuation Manual. The last full asset valuations were undertaken in March 2013 and the revaluation undertaken at that date was accounted for on 31 March 2013. - Additional alternative open market value figures have only been supplied for operational assets scheduled for imminent closure and subsequent disposal. - Assets in the course of construction are valued at cost and are valued by professional valuers as part of the five or three-yearly valuation or when they are brought into use.

An item of property, plant and equipment which is surplus with no plan to bring it back into use is valued at fair value under IFRS 13, if it does not meet the requirements of IAS40 of IFRS 5.

Subsequent Expenditure

Subsequent expenditure relating to an item of property, plant and equipment is recognised as an increase in the carrying amount of the asset when it is probable that additional future economic benefits or service potential deriving from the cost incurred to replace a component of such item will flow to the enterprise and

Royal Berkshire NHS Foundation Trust – Consolidated Financial Statements for the year ended 31 March 2016

the cost of the item can be determined reliably. Where a component of an asset is replaced, the cost of the replacement is capitalised if it meets the criteria for recognition above. The carrying amount of the part replaced is de-recognised. Other expenditure that does not generate additional future economic benefits or service potential, such as repairs and maintenance is charged to the Statement of Comprehensive Income in the period in which it is incurred.

Depreciation

Items of property, plant and equipment are depreciated over their remaining useful economic lives in a manner consistent with the consumption of economic or service delivery benefits. Freehold land is considered to have an infinite life and is not depreciated.

Property, plant and equipment which has been reclassified as „Held for Sale‟ ceases to be depreciated upon the reclassification. Assets in the course of construction and residual interests in off-Statement of Financial Position PFI contract assets are not depreciated until the asset is brought into use or reverts to the Trust, respectively.

Revaluation gains and losses

Revaluation gains are recognised in the revaluation reserve, except where, and to the extent that, they reverse a revaluation decrease that has previously been recognised in operating expenses, in which case they are recognised in operating income.

Revaluation losses are charged to the revaluation reserve to the extent that there is an available balance for the asset concerned, and thereafter are charged to operating expenses.

Gains and losses recognised in the revaluation reserve are reported in the Statement of Comprehensive Income as an item of “other comprehensive income”.

Economic life of property, plant and equipment Min Life Max Life

Years Years

Buildings and Dwellings 20 100

Plant & Machinery, Furniture & Fittings, Transport Equipment and Information 3 20 Technology

Impairments

In accordance with the FT ARM, impairments that arise from a clear consumption of economic benefits or of service potential in the asset are charged to operating expenses. A compensating transfer is made from the revaluation reserve to the income and expenditure reserve of an amount equal to the lower of (i) the impairment charged to operating expenses; and (ii) the balance in the revaluation reserve attributable to that asset before the impairment.

An impairment that arises from a clear consumption of economic benefit or of service potential is reversed when, and to the extent that, the circumstances that gave rise to the loss is reversed. Reversals are recognised in operating income to the extent that the asset is restored to the carrying amount it would have had if the impairment had never been recognised. Any remaining reversal is recognised in the revaluation reserve. Where, at the time of the original impairment, a transfer was made from the revaluation reserve to the income and expenditure reserve, an amount is transferred back to the revaluation reserve when the impairment reversal is recognised.

Other impairments are treated as revaluation losses. Reversals of „other impairments‟ are treated as revaluation gains.

De-recognition of Non-current assets

Assets intended for disposal is reclassified as „Held for Sale‟ once both of the following criteria are met:

Royal Berkshire NHS Foundation Trust – Consolidated Financial Statements for the year ended 31 March 2016

- the asset is available for immediate sale in its present condition subject only to terms which are usual and customary for such sales; - the sale must be highly probable i.e. ; • management are committed to a plan to sell the asset • an active programme has begun to find a buyer and complete the sale • the asset is being actively marketed at a reasonable price • the sale is expected to be completed within 12 months of the date of classification as „Held for Sale‟; and • the actions needed to complete the plan indicate it is unlikely that the plan will be dropped or significant changes made to it.

Following reclassification, the assets are measured at the lower of their existing carrying amount and their “fair value less costs to sell”. Depreciation ceases to be charged. Assets are de-recognised when all material sale contract conditions have been met.

Property, plant and equipment which is to be scrapped or demolished does not qualify for recognition as “Held for Sale” and instead is retained as an operational asset and the asset‟s economic life is adjusted. The asset is de-recognised when scrapping or demolition occurs.

Donated, government grant and other grant funded assets

Donated and grant funded property, plant and equipment assets are capitalised at their fair value on receipt. The donation/grant is credited to income at the same time, unless the donor has imposed a condition that the future economic benefits embodied in the grant are to be consumed in a manner specified by the donor, in which case, the donation/grant is deferred within liabilities and is carried forward to future financial years to the extent that the condition has not yet been met.

The donated and grant funded assets are subsequently accounted for in the same manner as other items of property, plant and equipment.

1.6 Intangible assets

Recognition

Intangible assets are non-monetary assets without physical substance which are capable of being sold separately from the rest of the Trust‟s business or which arise from contractual or other legal rights. They are recognised only where it is probable that future economic benefits will flow to, or service potential be provided to, the Trust and where the cost of the asset can be measured reliably.

Intangible non-current assets are capitalised when they are capable of being used in Trust's activities for more than one year, they can be valued, and they have a cost of at least £5,000.

Internally generated intangible assets

Internally generated goodwill, brands, mastheads, publishing titles, customer lists and similar items are not capitalised as intangible assets.

Expenditure on research is not capitalised.

Software

Software which is integral to the operation of hardware, e.g., an operating system, is capitalised as part of the relevant item of property, plant and equipment. Software which is not integral to the operation of hardware, e.g., application software, is capitalised as an intangible asset.

Measurement

Intangible assets are recognised initially at cost, comprising all directly attributable costs needed to create, produce and prepare the asset to the point that it is capable of operating in the manner intended by management.

Subsequently intangible assets are measured at current value in existing use. Where no active market exists, intangible assets are valued at the lower of depreciated replacement cost and the value in use where

Royal Berkshire NHS Foundation Trust – Consolidated Financial Statements for the year ended 31 March 2016

the asset is income generating. Revaluations gains and losses and impairments are treated in the same manner as for Property, Plant and Equipment. An intangible asset which is surplus with no plan to bring it back into use is valued at fair value under IFRS 13, if it does not meet the requirements of IAS 40 of IFRS 5. Intangible assets held for sale are measured at the lower of their carrying amount or “fair value less costs to sell”."

Amortisation

Intangible assets are amortised over their expected useful economic lives in a manner consistent with the consumption of economic or service delivery benefits.

1.7 Investments

Investments in subsidiary undertakings, associates and joint ventures are treated as non-current asset investments and valued at market value. Non-current asset investments are reviewed annually for impairments. Deposits and other investments that are readily convertible into known amounts of cash at or close to their carrying amounts are treated as liquid resources in the Statement of Cash Flows. These assets, and other current assets, are valued at cost less any amounts written off to represent any impairment in value. They are reviewed annually for impairments.

1.8 Revenue government and other grants

Government grants are grants from Government bodies other than income from NHS Commissioners for the provision of services. Where a grant is used for funding revenue expenditure, including research and development, it is taken to the Statement of Comprehensive Income to match that expenditure. It is recognised at the point that the Trust is entitled to the grant income unless the grantor has imposed a condition that permits the income to be recognised in a later period at which point it is held as deferred income and released to the Statement of Comprehensive Income once the grantor's conditions are met.

1.9 Inventories

Inventories are valued on the following bases:

- Prosthetics and drugs are valued on a first-in, first out (FIFO) basis.

This is considered to be a close approximation to the lower of cost and net realisable value due to the high turnover of the various types of inventories. Consignment inventory is not valued.

1.10 Cash, bank and overdrafts

Cash, bank and overdraft balances are recorded at the current values of these balances in the Trust‟s cash book. These balances exclude monies held in the Trust‟s bank account belonging to patients (see “third party assets” below). Account balances are only set off where a formal agreement has been made with the bank to do so. In all other cases overdrafts are disclosed within payables. Interest earned on bank accounts and interest charged on overdrafts is recorded as, respectively, “interest receivable” and “interest payable” in the periods to which they relate. Bank charges are recorded as operating expenditure in the periods to which they relate.

1.11 Research and development

Expenditure on research is not capitalised. Expenditure on development is capitalised if it meets the following criteria:

- there is a clearly defined project - the related expenditure is separately identifiable - the outcome of the project has been assessed with reasonable certainty as to its technical feasibility and its resulting in a product or services that will eventually be brought into use; and - adequate resources exist, or are reasonably expected to be available, to enable the project to be completed and to provide any consequential increases in working capital.

Expenditure so deferred is limited to the value of future benefits granted by the R&D funding organisation and is amortised through the Statement of Comprehensive Income on a systematic basis over the period expected to benefit from the project. It is re-valued on the basis of current cost. Expenditure which does not

Royal Berkshire NHS Foundation Trust – Consolidated Financial Statements for the year ended 31 March 2016

meet the criteria for capitalisation is treated as an operating cost in the year in which it is incurred. Where possible, the Trust discloses the total amount of research and development expenditure charged in the Statement of Comprehensive Income separately. However, where research and development activity cannot be separated from patient care activity it cannot be identified and is therefore not separately disclosed.

Non-current assets acquired for use in research and development are amortised over the life of the associated project.

1.12 Provisions

The Trust provides for legal or constructive obligations that are of uncertain timing or amount at the Statement of Financial Position date on the basis of the best estimate of the expenditure required to settle the obligation. Where the effect of the time value of money is significant, the estimated risk-adjusted cash flows are discounted using HM Treasury‟s discount rate of 3.60% in real terms, except for early retirement provisions and injury benefit provisions which both use the HM Treasury's pension discount rate of 1.37% in real terms.

1.13 Contingencies

Contingent assets (that is, assets arising from past events whose existence will only be confirmed by one or more future events not wholly within the entity‟s control) are not recognised as assets, but are disclosed in the Notes to the Accounts where an inflow of economic benefits is probable.

Contingent liabilities are provided for where a transfer of economic benefits is probable. Otherwise, they are not recognised but are disclosed unless the probability of a transfer of economic benefits is remote. Contingent liabilities are defined as:

a) possible obligations arising from past events whose existence will be confirmed only by the occurrence of one or more uncertain future events not wholly within the entity‟s control; or

b) present obligations arising from past events but for which it is not probable that a transfer of economic benefits will arise or for which the amount of the obligation cannot be measured with sufficient reliability.

1.14 Clinical negligence costs

The NHS Litigation Authority (NHSLA) operates a risk pooling scheme under which the NHS foundation trust pays an annual contribution to the NHSLA, which, in return, settles all clinical negligence claims. Although the NHSLA is administratively responsible for all clinical negligence cases, the legal liability remains with the NHS foundation trust. The total value of clinical negligence provisions carried by the NHSLA on behalf of the NHS foundation trust is disclosed at note 14.0 but is not recognised in the Trust's accounts.

1.15 Non-clinical risk pooling

The Trust participates in the Property Expenses Scheme and the Liabilities to Third Parties Scheme. Both are risk pooling schemes under which the Trust pays an annual contribution to the NHS Litigation Authority and in return receives assistance with the costs of claims arising. The annual membership contributions and any „excesses‟ payable in respect of particular claims are charged to operating expenses when the liability arises.

1.16 Value Added Tax

Most of the activities of the Trust are outside the scope of VAT and, in general, output tax does not apply and input tax on purchases is not recoverable. Irrecoverable VAT is charged to the relevant expenditure category or included in the capitalised purchase cost of non-current assets. Where output tax is charged or input VAT is recoverable, the amounts are stated net of VAT.

1.17 Corporation Tax

Section 148 of the Finance Act 2004 amended S519A of the Income and Corporation Taxes Act 1988 to provide power to the Treasury to make certain non-core activities of Foundation Trusts potentially subject to corporation tax. This legislation became effective in the 2005/06 financial year.

Royal Berkshire NHS Foundation Trust – Consolidated Financial Statements for the year ended 31 March 2016

In determining whether or not an activity is likely to be taxable a three-stage test may be employed:

- The provision of goods and services for purposes related to the provision of healthcare authorised under Section 14(1) of the Health and Social Care Act 2003 (HSCA) is not treated as a commercial activity and is therefore tax exempt; - Trading activities undertaken in house which are ancillary to core healthcare activities are not entrepreneurial in nature and not subject to tax. A trading activity that is capable of being in competition with the wider private sector will be subject to tax; - Only significant trading activity is subject to tax. Significant is defined as annual taxable profits of £50,000 per trading activity.

The majority of the Trust's activities are related to core healthcare and are not subject to tax. However, the Trust's subsidiary, Healthcare Facilities Management Services Ltd, incurred corporation tax of £62k during 2015/16 (2014/15 £224k).

Deferred tax asset relates to the Corporation Tax asset for the Trust's subsidiary (HFMS). £290k relates to £62k 2014/15 asset and £228 tax accruals for 2015/16 (2013/14 £42k asset) the value of which was not determined until after signing the 2014/15 Group Financial Statements. There was deferred tax income of £20k during 2014/15 (2013/14 £142k income)

Trust Group Trust Group 2015/16 2015/16 2014/15 2014/15 £000 £000 £000 £000 Deferred Tax 0 20 0 142 Corporation tax 0 (290) 0 (224) Tax movements 0 (270) 0 (82)

1.18 Losses and Special Payments

Losses and Special Payments are items that Parliament would not have contemplated when it agreed funds for the health service or passed legislation. By their nature they are items that ideally should not arise. They are therefore subject to special control procedures compared with the generality of payments. They are divided into different categories, which govern the way that individual cases are handled. Losses and special payments are charged to the relevant functional headings in expenditure on an accruals basis, including losses which would have been made good through insurance cover had NHS foundation trusts not been bearing their own risks (with insurance premiums then being included as normal revenue expenditure).

However the losses and special payments note is compiled directly from the losses and compensations register which reports on an accrual basis with the exception of provisions for future losses.

1.19 Foreign exchange

Transactions that are denominated in a foreign currency are translated into sterling at the exchange rate ruling on the dates of the transactions. Resulting exchange gains and losses are taken to the Statement of Comprehensive Income.

1.20 Third party assets

Assets belonging to third parties (such as money held on behalf of patients) are not recognised in the accounts since the NHS Foundation Trust has no beneficial interest in them. However, they are disclosed in a separate note to the accounts in accordance with the requirements of the HM Treasury Financial Reporting Manual.

1.21 Leases

Finance Leases

Where substantially all risks and rewards of ownership of a leased asset are borne by the NHS foundation trust, the asset is recorded as property, plant and equipment and a corresponding liability is recorded. The value at which both are recognised is the lower of the fair value of the asset or the present value of the minimum lease payments, discounted using the interest rate implicit in the lease.

Royal Berkshire NHS Foundation Trust – Consolidated Financial Statements for the year ended 31 March 2016

The asset and liability are recognised at the commencement of the lease. Thereafter the asset is accounted for an item of property plant and equipment.

The annual rental is split between the repayment of the liability and a finance cost so as to achieve a constant rate of finance over the life of the lease. The annual finance cost is charged to Finance Costs in the Statement of Comprehensive Income. The lease liability is de-recognised when the liability is discharged, cancelled or expires.

Operating Leases

Other leases are regarded as operating leases and the rentals are charged to operating expenses on a straight-line basis over the term of the lease. Operating lease incentives received are added to the lease rentals and charged to operating expenses over the life of the lease.

1.22 Public dividend capital

Public dividend capital (PDC) is a type of public sector equity finance based on the excess of assets over liabilities at the time of establishment of the predecessor NHS trust. HM Treasury has determined that PDC is not a financial instrument within the meaning of IAS 32.

A charge, reflecting the cost of capital utilised by the NHS foundation trust, is payable as public dividend capital dividend. The charge is calculated at the rate set by HM Treasury (currently 3.5%) on the average relevant net assets of the NHS foundation trust during the financial year. Relevant net assets are calculated as the value of all assets less the value of all liabilities, except for (i) donated assets (including lottery funded assets), (ii) average daily cash balances held with the Government Banking Services (GBS) and National Loans Fund (NLF) deposits, excluding cash balances held in GBS accounts that relate to a short-term working capital facility, and (iii) any PDC dividend balance receivable or payable. In accordance with the requirements laid down by the Department of Health (as the issuer of PDC), the dividend for the year is calculated on the actual average relevant net assets as set out in the “pre-audit” version of the annual accounts. The dividend thus calculated is not revised should any adjustment to net assets occur as a result the audit of the annual accounts.

1.23 Financial instruments and financial liabilities

Recognition

Loans and receivables are non-derivative financial assets with fixed or determinable payments which are not quoted in an active market. They are included in current assets. The Trust's loans and receivables comprise current investments, cash and cash equivalents, NHS receivables, accrued income and 'other receivables'.

All other financial assets and financial liabilities are recognised when the trust becomes a party to the contractual provisions of the instrument.

De-recognition

All financial assets are de-recognised when the rights to receive cash flows from the assets have expired or the trust has transferred substantially all of the risks and rewards of ownership.

Financial liabilities are de-recognised when the obligation is discharged, cancelled or expires.

Impairment of financial assets

At the Statement of Financial Position date, the Trust assesses whether any financial assets, other than those held at fair value through income and expenditure, are impaired. Financial assets are impaired and impairment losses are recognised if there is objective evidence of impairment as a result of one or more events which occurred after the initial recognition of the asset and which has an impact on the estimated future cash flows of the asset.

Loans and receivables

Loans and receivables are non-derivative financial assets with fixed or determinable payments which are not quoted in an active market. They are included in current assets. 23

Royal Berkshire NHS Foundation Trust – Consolidated Financial Statements for the year ended 31 March 2016

The Trust‟s loans and receivables comprise: current investments, cash and cash equivalents, NHS receivables, accrued income and “other receivables".

Loans and receivables are recognised initially at fair value, net of transactions costs, and are measured subsequently at amortised cost, using the effective interest method. The effective interest rate is the rate that discounts exactly estimated future cash receipts through the expected life of the financial asset or, when appropriate, a shorter period, to the net carrying amount of the financial asset.

Interest on loans and receivables is calculated using the effective interest method and credited to the Statement of Comprehensive Income." Loans from the Department of Health are not held for trading and are measured at historic cost with any unpaid interest accrued separately

Determination of fair value

Book values of the Trust's and Group's financial assets and liabilities are the same as their Fair values and consequently the Fair values have not been disclosed separately.

1.24 Accounting standards that have been issued but have not yet been adopted

The following accounting standards, amendments and interpretations have been issued by the IASB and IFRIC but are not yet required to be adopted:

Effective for future financial years:

- IFRS 9 Financial instruments (expected to be effective from 1 April 2018 but not yet EU adopted) - IFRS 10 (amendment) and IAS 28 (amendment) – Sale or contribution to assets (expected to be effective from 1 April 2016 but not yet EU adopted) - IFRS 10 (amendment) and IAS 28 (amendment) – Investment entities applying the consolidation exception (expected to be effective from 1 April 2016 but not yet EU adopted) - IFRS 11 (amendment) – Acquisition of an interest in a joint operation (expected to be effective 1 April 2016 but not yet EU adopted) - IFRS 15 Revenue from contracts with customers (expected to be effective from 1 April 2017 but not yet EU adopted) - IAS 1 (amendment) – Disclosure initiative (expected to be effective 1 April 2016 but not yet EU adopted) - IAS 16 (amendment) and IAS 38 (amendment) – Depreciation and amortisation (expected to be effective 1 April 2016 but not yet EU adopted) - IAS 16 (amendment) and IAS 41 (amendment) – Bearer plants (expected to be effective 1 April 2016 but not yet EU adopted) - IAS 27 (amendment) – Equity method in separate financial statements (expected to be effective 1 April 2016 but not yet EU adopted) - Annual Improvements to IFRS 2012-15 cycle (expected to be effective from 1 April 2017 but not yet EU adopted)

The Trust has considered the above new standards, interpretations and amendments to published standards that are not yet effective and concluded that they are either not relevant to the Trust or that they would not have a significant impact on the Trust's financial statements, apart from some additional disclosures.

1.25 Accounting standards, amendments and interpretations issued that have been adopted early

The Trust has not early adopted any new accounting standards, amendments or interpretations.

1.26 Key sources of judgement and estimation of uncertainty

The management have determined that the following are the key assumptions concerning the future, and other key sources of estimation uncertainty at the Statement of Financial Position date, that have a significant risk of causing a material adjustment to the carrying amounts of assets and liabilities within the next financial year.

The Trust makes four significant estimates at the Statement of Financial Position date and these are detailed below.

Royal Berkshire NHS Foundation Trust – Consolidated Financial Statements for the year ended 31 March 2016

- The majority of the income in 2015/16 was earned from NHS commissioners, principally Clinical Commissioning Groups (CCGs), with approximately 70% being from our lead federation of commissioners, Berkshire West CCGs. An income provision has been included in the accounts at the end of the year totalling £1.8m, the value of which has been based upon discussions with our commissioners on contract deductions and reflects the year end contract closure agreement in principal that has been concluded with Berkshire West CCG federation. The outstanding issues will be concluded with the commissioners in the new-year following agreement on the final contract reports for 2015/16.

- As stated in section 1.5 the Trust undertakes a full asset valuation exercise on a regular basis. The last full valuation review was undertaken in March 2013 by independent qualified valuers GVA Grimley LLP.

During March 2016 an interim asset valuation was undertaken for land, buildings, IT equipment and medical equipment. As part of this exercise it is necessary for the GVA Grimley LLP to assess the current market environment in relation to the value of land and buildings and estimate the value of the Trust's land / building assets based on this assessment. Following the review it was determined that there is no change in values that need to be disclosed in these financial statements. The values which consisted of both increases and decreases in asset values determined for IT and medical equipment by the valuation assessment have been recognised within these financial statements.

- In line with other estimates, revisions to accounting estimates are recognised in the year in which the estimate is revised. For accrued annual leave benefits (2015/16 £437k, 2014/15 £630k), revisions to estimates are made at the accounting year end and the effect of the revision will be reflected in the period being closed. This means that any changes to estimated values at 31 March 2016 will be accounted for in the next financial year, and will be affected by a revised estimation at the next accounting period end. These year-end estimation revisions are not expected to provide material differences from one period end to the next and therefore will have a minimal effect on the Statement of Comprehensive Income.

- Under Income and Expenditure Recognition principles, the Trust has reflected the estimated values notified to other NHS bodies for work in progress at the year end, that is, partially completed spells. (2015/16 £2.08m, 2014/15 £1.99m).

1.27 Carbon Reduction Commitment (CRC) Energy Efficiency Scheme

The CRC scheme is a mandatory cap and trade scheme for non-transport CO2 emissions. Where NHS foundation trusts are registered with the CRC scheme, they are required to surrender to the government an allowance for every tonne of CO2 they emit during the financial year. Therefore, registered NHS foundation trusts should recognise a liability (and related expense) in respect of this obligation as CO2 emissions are made.

Royal Berkshire NHS Foundation Trust – Consolidated Financial Statements for the year ended 31 March 2016

Trust Group Trust Group 2015/16 2015/16 2014/15 2014/15 2 Income from continuing operations

£000 £000 £000 £000 NHS Foundation Trusts 892 892 754 754 NHS Trusts 1 1 27 27 Clinical Commissioning Groups (CCGs) 276,920 276,920 267,007 267,007 NHS England 61,773 61,773 55,843 55,843 Local Authorities 3,178 3,178 3,480 3,480 NHS Other 179 179 139 139 Non NHS: - Private Patients 3,301 3,301 2,307 2,307 - Overseas Patients (non-reciprocal) 588 588 317 317 - NHS Injury Scheme (previously Road Traffic Act) 804 804 848 848 - Other 1,109 1,109 619 619 Income from activities 348,745 348,745 331,341 331,341

Research and Development 1,422 1,422 1,268 1,268 Education and training - non CCG 10,529 10,529 11,159 11,159 Non-patient care services to other bodies 464 464 347 347 Net Charitable Funds 0 (631) 0 (298) Other income 12,798 12,750 11,993 11,293 25,213 24,534 24,767 23,769

Total income from continuing operations 373,958 373,279 356,108 355,110

Other income includes the following balances: clinical excellence awards £411k (2014/15 £388k), Non-NHS clinical services £2,305k (2014/15 £2,817k), car parking £1,462k (2014/15 £1,391k) and catering £600k (2014/15 £633k).

Income from the Compensation Recovery Unit in relation the recovery of costs of road traffic accidents is subject to an impairment for doubtful receivables to reflect expected rates of collection. This provision is included within impaired receivables (see note 11).

Royal Berkshire NHS Foundation Trust – Consolidated Financial Statements for the year ended 31 March 2016

2.1 Income from Activities by type Trust Group Trust Group 2015/16 2015/16 2014/15 2014/15 £000 £000 £000 £000

Elective Income 59,045 59,045 59,425 59,425 Non Elective Income 83,269 83,269 76,211 76,211 Outpatient Income 69,328 69,328 63,657 63,657 Other NHS Clinical Income 117,794 117,794 116,029 116,029 A&E Income 15,420 15,420 13,396 13,396 Private Patient Income 3,889 3,889 2,623 2,623 Other income 25,213 24,534 24,767 23,769

Total 373,958 373,279 356,108 355,110

2.2 Overseas visitors (relating to patients charged directly by the Trust)

Trust Group Trust Group 2015/16 2015/16 2014/15 2014/15 £000 £000 £000 £000 Income recognised this year 588 588 317 317 Cash payments received in-year 353 353 132 132 Amounts added to provision for impairment of receivables 211 211 141 141 Amounts written off in-year 72 72 339 339

2.3 Commissioner Requested Services (CRS) Trust Group Trust Group 2015/16 2015/16 2014/15 2014/15 £000 £000 £000 £000

Commissioner Requested Services 338,693 338,693 322,850 322,850 Non-Commissioner Requested Services 35,265 34,586 33,258 32,260

Total income from continuing operations 373,958 373,279 356,108 355,110

Consistent with 2014/15 all CCG and NHS England services have been designated as CRS for 2015/16. During 2015/16 the Trust‟s commissioners have completed an exercise to define CRS for 2016/17 onwards. The changes are not expected to have a material impact on this disclosure.

Royal Berkshire NHS Foundation Trust – Consolidated Financial Statements for the year ended 31 March 2016

2.4 Group Segmental reporting of income

160,000

140,000

120,000

100,000

80,000 2015/16 Income 60,000 2015/16 Expenditure 40,000

20,000

0 Urgent Care Planned Care Network Care * Other

Urgent Planned Network * Other Total Service area Care Care Care £000 £000 £000 £000 £000 2015/16 Income 120,548 139,367 97,072 16,292 373,279 Expenditure (84,319) (118,598) (83,232) (90,925) (377,074) Operating Surplus/(Deficit) 36,229 20,769 13,840 (74,633) (3,795) 2014/15 Income 111,753 138,778 93,169 11,410 355,110 Expenditure (82,456) (112,026) (76,887) (86,730) (358,099) Operating Surplus/(Deficit) 29,297 26,752 16,282 (75,320) (2,989) * Other includes Corporate, Estates & Facilities, the Royal Berkshire NHS Foundation Trust Charity and Healthcare Facilities Management Services

Royal Berkshire NHS Foundation Trust – Consolidated Financial Statements for the year ended 31 March 2016

3 Operating Expenses

Trust Group Trust Group 3.1 Operating expenses comprise: 2015/16 2015/16 2014/15 2014/15

£000 £000 £000 £000

Executive directors' costs 988 988 981 981 Non-executive directors' costs 128 128 143 143 Staff costs 214,652 214,652 208,467 208,467 Total staff costs 215,768 215,768 209,591 209,591

Drug costs 43,095 43,095 35,507 35,507 Supplies and services - clinical 44,113 44,450 43,375 43,651 Supplies and services - general 6,550 6,562 6,135 6,149 Establishment 3,553 3,586 3,789 3,821 Transport 520 517 228 227 Premises 27,395 25,414 28,328 25,944 Bad debts 634 634 363 363 Depreciation and amortisation 16,772 17,680 16,710 17,625 Audit Fees - Statutory Audit 64 64 84 84 Other auditor's remuneration - KPMG non-audit 99 122 65 91 Accounting & Consultancy fees - other 28 28 175 175 Internal Audit and Local Counter Fraud Service 202 202 205 205 Clinical negligence 12,962 12,962 8,454 8,454 Redundancy costs 272 272 126 126 (Profit)/Loss on disposal of non-current assets 184 184 0 0 Other 5,500 5,534 6,185 5,836 161,943 161,306 149,729 148,258

Total expenses 377,711 377,074 359,320 357,849

Impairment 4,400 0 250 250 Operating expenses of continuing operations 382,111 377,074 359,570 358,099

The impairment expense of £4.4m shown in 2015/16 Trust expenditure relates to the valuation of the Trust’s investment in the 100% owned subsidiary HFMS Limited. Management have estimated a revised valuation of this investment at 31 March 2016, based on a discounted cashflow model (see Note 9). The assets held by the subsidiary are two properties, valued in the Group accounts on a Modern Equivalent Asset basis and a fair value basis respectively. No goodwill is recognised in the Group accounts in respect of this investment, and as such the impairment made to the Trust’s investment is removed on consolidation.

*Other expenses includes the following balances: Management Consultancy Services £603k (2014/15 £501k), Other Professional Advice £51k (2014/15 £359k), Trust Legal Costs £351k (2014/15 £601k) and Course Fees £622k (2014/15 £696k).

Royal Berkshire NHS Foundation Trust – Consolidated Financial Statements for the year ended 31 March 2016

Trust Group Trust Group 2015/16 2015/16 2014/15 2014/15 Fees paid and payable to the Trust’s external auditor, KPMG £000 £000 £000 £000 Audit Services - Statutory Audit 64 64 84 84

Other Non Statutory Services - 1. the auditing of accounts of any associate of the Trust 0 15 0 15 2. audit-related assurance services 0 0 0 0 3. taxation compliance services 80 80 47 47 4. all taxation advisory service not falling within item 3 above; 0 8 0 11 5. internal audit services; 0 0 0 0 6. all assurance services not falling within items 1 to 5; 0 0 0 0 7. corporate finance transaction services not falling within items 1 to 6 above; and 0 0 0 0 8. all other non-audit services not falling within items 2 to 7 above. 19 19 18 18 Other Non Statutory Services sub total: 99 122 65 91

Total fees paid and payable to the Trust's external auditor: 163 186 149 175 VAT payable 32 37 30 35 Total fees paid and payable to the Trust's external auditor including VAT: 195 223 179 210 The Statutory Audit liability limits are: - Audit Liability – unlimited - All other work – £1m limit

All assets disposed of during 2014/15 and 2013/14 were unprotected assets.

3.2 Arrangements containing an operating leases Trust Group Trust Group 2015/16 2015/16 2014/15 2014/15 £000 £000 £000 £000

Other operating lease rentals 1,430 1,430 1,148 1,148

1,430 1,430 1,148 1,148

Royal Berkshire NHS Foundation Trust – Consolidated Financial Statements for the year ended 31 March 2016

3.2.1 Total future minimum operating lease payments

Other Other Other Other leases leases leases leases

Trust Group Trust Group 2015/16 2015/16 2014/15 2014/15

£000 £000 £000 £000

Operating leases payments which are payable:

Within 1 year 1,544 1,544 1,311 1,311 Between 1 and 5 years 4,694 4,694 4,283 4,283 After 5 years 1,123 1,123 1,289 1,289

7,361 7,361 6,883 6,883 The Trust has short term operating leases for various types of equipment and the payments for these are included in the minimum lease payments for the financial year.

4. Staff costs and numbers

4.1 Staff costs

Trust Group Trust Group 2015/16 2015/16 2014/15 2014/15

£000 £000 £000 £000

Salaries and wages 169,060 169,060 166,855 166,855 Social security costs 12,778 12,778 12,513 12,513 Employer contributions to NHSPA 20,023 20,023 19,467 19,467 Agency staff 13,779 13,779 10,613 10,613 Redundancy costs 272 272 126 126 215,912 215,912 209,574 209,574

The figures above exclude non-executive directors' costs. 2014/15 comparatives adjusted in the Agency (£15,768k reduced to £10,613k) and Salaries and Wages (£161,700k increased to £166,855k) categories to reflect the inclusion of all bank and locum staff with contracts being treated as payroll staff. Note - the movement in both categories was £5,155k and has no impact on the total staff costs.

Royal Berkshire NHS Foundation Trust – Consolidated Financial Statements for the year ended 31 March 2016

4. Staff costs and numbers cont'd

4.2 Average number of persons employed

Trust Group Trust Group 2015/16 2015/16 2014/15 2014/15

Number Number Number Number

Medical and dental 638 638 606 606 Administration and estates 837 837 859 859 Healthcare assistants & other support staff 1,093 1,093 1,056 1,056 Nursing, midwifery & health visiting staff 1,554 1,554 1,584 1,584 Nursing, midwifery & health visiting staff - learners 7 7 7 7 Scientific, therapeutic and technical staff 558 558 557 557 Bank & agency staff 231 231 177 177 Other 0 0 0 0 Total 4,918 4,918 4,846 4,846 The average number of employees is calculated as the whole time equivalent number of employees under contract of service in each month, divided by the number of months in a year.

Agency staff numbers are based on time worked per actual invoices converted to WTE‟s.

4.3 Employee benefits

Employee benefits paid in 2015/16 – nil (2014/15 – nil)

4.4 Retirements due to ill-health

During the year to 31 March 2016 there were 4 early retirements from the Trust agreed on the grounds of ill- health (4 in the year to 31 March 2015). The estimated additional pension liabilities of these ill-health retirements are £236k (£326k in the year to 31 March 2015). This information has been supplied by NHS Pensions Agency.

4.5 Salary and pension entitlements of senior managers

Total remuneration paid to directors for the year ended 31 March 2016 (in their capacity as directors) totalled £988k (year ended 31 March 2015 £981k). No other remuneration was paid to directors in their capacity as directors. There were no advances or guarantees entered into on behalf of directors by the Trust. Employer contributions to the NHS Pension Scheme for Executive Directors for the year ended 31 March 2016 totalled £129k (for year ended 31 March 2015 £155k). The total number of directors to whom benefits are accruing under the NHS defined benefit scheme (the NHS Pension Scheme) was 8 (31/3/15 – 8).

4.6 Restructuring costs

Restructuring costs which are made up of compulsory redundancy, voluntary redundancy and mutually agreed resignation (MARS) amounted to £272k in respect of 7 members of staff (2014/15 – 9 members of staff incurring payments of £307k) are included within the table below which shows the total cost of staff exit packages during the year. There were no exits by way of voluntary redundancy or mutually agreed resignation.

Royal Berkshire NHS Foundation Trust – Consolidated Financial Statements for the year ended 31 March 2016

Total no. of exit No. of compulsory No. of other packages by cost Exit package cost by band redundancies departures agreed band

£ <10,000 0 17 17 10,000 - 25,000 2 0 2 25,000 - 50,000 3 1 4 50,000 - 100,000 2 0 2 100,000 - 150,000 0 0 0 150,000 - 200,000 0 0 0

Total number of exit packages by type 7 18 25

Total cost (£000) £272 £102 £374

5.0 Late Payment of Commercial Debts (Interest) act 1998

Amounts included within Interest Payable arising from claims under this legislation - £3k (2014/15 - £5k). Compensation paid to cover debt recovery costs arising under this legislation – nil (2014/15 – nil).

6.0 Finance income and expenses

6.1 Finance income

Finance income includes interest receivable

Interest income

In the year to 31 March 2015 interest of £67k (31 March 2015 - £79k) was received by the Group. This included an amount of £67k (31 March 2015 - £79k) which was earned from working capital balances in interest bearing bank accounts and from investments in National Loan Funds.

6.2 Finances expenses

In the year to 31 March 2015 interest charges of £1,060k (2014/15 £1,190k) were payable by the Group.

Royal Berkshire NHS Foundation Trust – Consolidated Financial Statements for the year ended 31 March 2016

7.0 Group Intangible Non-current Assets

Intangible Non-current Assets at the Statement of Financial Position date 31 March 2016 comprise the following elements:

At 31 March 2016 At 31 March 2015 Software Assets Software Assets & under Total & under Total Licences Construction Licences Construction

£000 £000 £000 £000 £000 £000

Gross cost at 1 April 16,086 1,052 17,138 14,972 37 15,009 Reclassifications 907 (907) 0 36 0 36 Additions - purchased 1,393 261 1,654 1,078 1,015 2,093 Additions - purchased by the Charity 0 0 0 0 0 0 Impairments 0 0 0 0 0 0 Disposals 0 0 0 0 0 0 Gross cost at 31 March 18,386 406 18,792 16,086 1,052 17,138

Accumulated amortisation at 1 April 7,507 0 7,507 5,705 0 5,705 Provided during the year 1,582 0 1,582 1,802 0 1,802 Impairments 0 0 0 0 0 0 Disposals 0 0 0 0 0 0 Accumulated amortisation at 31 March 9,089 0 9,089 7,507 0 7,507

Net book value Purchased at 31 March 9,229 406 9,635 8,511 1,052 9,563 Donated at 31 March 68 0 68 68 0 68 Total at 31 March 9,297 406 9,703 8,579 1,052 9,631

Royal Berkshire NHS Foundation Trust – Consolidated Financial Statements for the year ended 31 March 2016

7.0 Trust Intangible Non-current Assets

Intangible Non-current Assets at the Statement of Financial Position date 31 March 2016 comprise the following elements:

At 31 March 2016 At 31 March 2015 Software Assets Software Assets & under Total & under Total Licences Construction Licences Construction

£000 £000 £000 £000 £000 £000

Gross cost at 1 April 15,932 1,052 16,984 14,818 37 14,855 Reclassifications 907 (907) 0 36 0 36 Additions - purchased 1,377 261 1,638 1,056 1,015 2,071 Additions - donated 16 0 16 22 0 22 Impairments 0 0 0 0 0 0 Disposals 0 0 0 0 0 0 Gross cost at 31 March 18,232 406 18,638 15,932 1,052 16,984

Accumulated amortisation at 1 April 7,391 0 7,391 5,620 0 5,620 Provided during the year 1,551 0 1,551 1,771 0 1,771 Impairments 0 0 0 0 0 0 Disposal 0 0 0 0 0 0 Accumulated amortisation at 31 March 8,942 0 8,942 7,391 0 7,391

Net book value Purchased at 31 March 9,222 406 9,628 8,473 1,052 9,525 Donated at 31 March 68 0 68 68 0 68 Total at 31 March 9,290 406 9,696 8,541 1,052 9,593

Royal Berkshire NHS Foundation Trust – Consolidated Financial Statements for the year ended 31 March 2016

8 Property Plant and Equipment

8.1 Group Property, Plant and Equipment assets at the Statement of Financial Position date 31 March 2016 comprise the following elements: Assets under Buildings construction & Plant & Transport Furniture & Land excluding Dwellings I.T. Total payments on Machinery Equipment fittings dwellings account Cost or valuation: £000 £000 £000 £000 £000 £000 £000 £000 £000 At 1 April 2015 24,870 148,941 222 4,940 46,269 107 20,566 3,232 249,147 Additions - purchased 0 2,703 0 2,365 2,961 0 1,070 10 9,109 Additions - purchased by the Charity 0 108 0 0 105 0 0 0 213 * Reclassifications 0 1,209 0 (1,700) 388 0 91 12 0 Disposals 0 0 0 (162) (593) 0 0 0 (755) At 31 March 2016 24,870 152,961 222 5,443 49,130 107 21,727 3,254 257,714 Accumulated depreciation: At 1 April 2015 0 16,218 152 0 32,438 33 16,220 2,727 67,788 Charged during the period 0 9,145 25 0 3,609 15 3,175 129 16,098 Disposals 0 0 0 0 (588) 0 0 0 (588) Depreciation at 31 March 2016 0 25,363 177 0 35,459 48 19,395 2,856 83,298

Net book value 31 March 2015 - Purchased at 31 March 2015 24,870 132,705 70 4,898 12,641 74 4,333 505 180,096 - Purchased by the Charity at 31 March 2015 0 18 0 42 1,190 0 13 0 1,263 Total at 31 March 2015 24,870 132,723 70 4,940 13,831 74 4,346 505 181,359

Net book value 31 March 2016 - Purchased at 31 March 2016 24,870 127,333 45 5,443 12,078 59 2,196 398 172,422 - Purchased by the Charity at 31 March 2016 0 265 0 0 1,593 0 136 0 1,994 Total at 31 March 2016 24,870 127,598 45 5,443 13,671 59 2,332 398 174,416

*Transfer of software licences to Non-current Assets.

Of the totals at 31 March 2016, £4,554,000 (31 March 2015 £4,554,000) related to land valued at open market value, £2,145,000 (31 March 2015 - £2,214,000) to buildings value at open market value and £50,000 (31 March 2015 - £75,000) to dwellings valued at open market value. No land is leased by the Trust. 36

Royal Berkshire NHS Foundation Trust – Consolidated Financial Statements for the year ended 31 March 2016

8 Property Plant and Equipment cont'd

8.1 Trust Property, Plant and Equipment assets at the Statement of Financial Position date 31 March 2016 comprise the following elements: Assets under Buildings construction & Plant & Transport Furniture & Land excluding Dwellings I.T. Total payments on Machinery Equipment fittings dwellings account Cost or valuation: £000 £000 £000 £000 £000 £000 £000 £000 £000 At 1 April 2015 23,399 133,498 222 4,942 44,633 0 20,427 3,232 230,353 Additions - purchased 0 2,546 0 2,237 2,299 0 944 10 8,036 Additions - donated 0 242 0 0 753 0 126 0 1,121 * Reclassifications 0 1,209 0 (1,700) 387 0 91 12 (1) Disposals 0 0 0 (162) (591) 0 0 0 (753) At 31 March 2016 23,399 137,495 222 5,317 47,481 0 21,588 3,254 238,756 Accumulated depreciation: At 1 April 2015 0 15,008 152 0 31,562 0 16,104 2,727 65,553 Charged during the period 0 8,540 25 0 3,375 0 3,152 129 15,221 Disposals 0 0 0 0 (588) 0 0 0 (588) Depreciation at 31 March 2016 0 23,548 177 0 34,349 0 19,256 2,856 80,186

Net book value 31 March 2015 - Purchased at 31 March 2015 23,399 118,472 70 4,900 11,881 0 4,310 505 163,537 - Donated at 31 March 2015 0 18 0 42 1,190 0 13 0 1,263 Total at 31 March 2015 23,399 118,490 70 4,942 13,071 0 4,323 505 164,800

Net book value 31 March 2016 - Purchased at 31 March 2016 23,399 113,688 45 5,317 11,539 0 2,196 398 156,582 - Donated at 31 March 2016 0 259 0 0 1,593 0 136 0 1,988 Total at 31 March 2016 23,399 113,947 45 5,317 13,132 0 2,332 398 158,570

*Transfer of software licences to Non-current Assets.

Of the totals at 31 March 2016, £3,843,000 (31 March 2015 £3,843,000) related to land valued at open market value, £203,000 (31 March 2015 - £216,000) to buildings value at open market value and £50,000 (31 March 2015 - £75,000) to dwellings valued at open market value. No land is leased by the Trust. 37

Royal Berkshire NHS Foundation Trust – Consolidated Financial Statements for the year ended 31 March 2016

8 Property Plant and Equipment

8.1 Group Property, Plant and Equipment assets at the Statement of Financial Position date 31 March 2015 comprise the following elements: Assets under Buildings construction & Plant & Transport Furniture & Land excluding Dwellings I.T. Total payments on Machinery Equipment fittings dwellings account Cost or valuation: £000 £000 £000 £000 £000 £000 £000 £000 £000 At 1 April 2014 24,870 144,810 217 3,897 46,207 107 19,295 3,011 242,414 Additions - purchased 0 533 5 4,941 2,579 0 1,139 80 9,277 Additions - purchased by the Charity 0 18 0 0 73 0 0 0 91 * Reclassifications 0 3,580 0 (3,891) 2 0 132 141 (36) Disposals 0 0 0 (7) (2,592) 0 0 0 (2,599) At 31 March 2015 24,870 148,941 222 4,940 46,269 107 20,566 3,232 249,147 Accumulated depreciation: At 1 April 2014 0 8,152 79 0 30,452 18 12,973 2,563 54,237 Charged during the period 0 8,066 73 0 4,258 15 3,247 164 15,823 Disposals 0 0 0 0 (2,272) 0 0 0 (2,272) Depreciation at 31 March 2015 0 16,218 152 0 32,438 33 16,220 2,727 67,788

Net book value 31 March 2013 - Purchased at 31 March 2013 22,970 137,103 215 4,654 15,388 101 8,031 550 189,012 - Finance Lease at 31 March 2013 0 0 0 0 0 0 0 0 0 - Donated at 31 March 2013 0 754 0 0 1,090 0 0 0 1,844 Total at 31 March 2013 22,970 137,857 215 4,654 16,478 101 8,031 550 190,856

Net book value 31 March 2014 - Purchased at 31 March 2014 24,870 136,658 138 3,897 14,581 89 6,316 448 186,997 - Purchased by the Charity at 31 March 2014 0 0 0 0 1,174 0 6 0 1,180 Total at 31 March 2014 24,870 136,658 138 3,897 15,755 89 6,322 448 188,177

Royal Berkshire NHS Foundation Trust – Consolidated Financial Statements for the year ended 31 March 2016

8 Property Plant and Equipment cont'd

8.1 Trust Property, Plant and Equipment assets at the Statement of Financial Position date 31 March 2015 comprise the following elements: Assets under Buildings construction & Plant & Furniture & Land excluding Dwellings I.T. Total payments on Machinery fittings dwellings account Cost or valuation: £000 £000 £000 £000 £000 £000 £000 £000 At 1 April 2014 23,399 129,364 217 3,899 44,572 19,156 3,011 223,618 Additions - purchased 0 533 5 4,899 2,232 1,129 80 8,878 Additions - donated 0 18 0 42 420 10 0 490 * Reclassifications 0 3,583 0 (3,891) (1) 132 141 (36) Disposals 0 0 0 (7) (2,590) 0 0 (2,597) At 31 March 2015 23,399 133,498 222 4,942 44,633 20,427 3,232 230,353 Accumulated depreciation: At 1 April 2014 0 7,547 79 0 29,809 12,888 2,563 52,886 Charged during the period 0 7,461 73 0 4,025 3,216 164 14,939 Disposals 0 0 0 0 (2,272) 0 0 (2,272) Depreciation at 31 March 2015 0 15,008 152 0 31,562 16,104 2,727 65,553

Net book value 31 March 2014 - Purchased at 31 March 2014 23,399 121,817 138 3,899 13,589 6,262 448 169,552 - Donated at 31 March 2014 0 0 0 0 1,174 6 0 1,180 Total at 31 March 2014 23,399 121,817 138 3,899 14,763 6,268 448 170,732

Net book value 31 March 2015 - Purchased at 31 March 2015 23,399 118,472 70 4,900 11,881 4,310 505 163,537 - Donated at 31 March 2015 0 18 0 42 1,190 13 0 1,263 Total at 31 March 2015 23,399 118,490 70 4,942 13,071 4,323 505 164,800

*Transfer of software licences to Non-current Assets.

Royal Berkshire NHS Foundation Trust – Consolidated Financial Statements for the year ended 31 March 2016

8 Property, Plant and Equipment cont'd

8.2 The net book value of land, buildings and dwellings comprises:

At 31 March 2016 At 31 March 2015 Trust Group Trust Group £000 £000 £000 £000

Freehold 137,391 152,513 141,959 157,663 Total 137,391 152,513 141,959 157,663

8.3 Profit/(Loss) on Disposal/ Derecognition of Non-current Assets

Profit on the disposal/ derecognition of non-current assets is made up as follows: Trust Group Trust Group 2015/16 2015/16 2014/15 2014/15 £000 £000 £000 £000

Profit/(Loss) on disposal/ derecognition of other Non-current assets (184) (184) (6) (6)

9.0 Investments

At 31 March 2016 At 31 March 2015 Trust Group Trust Group £000 £000 £000 £000

Investment in subsidiary - HFMS 10,600 0 15,000 0 Charity Investments - Chariguard Fund 0 12 0 12

Total 10,600 12 15,000 12

The carrying value of the Trust‟s investment in the subsidiary HFMS is reviewed by the Trust on an annual basis by considering the forward financial projections of the company and the open market value of the company‟s non- current assets. The 2015/16 review identified that the forward financial projections resulted in an impairment of the investment in HFMS totalling £4.4m, using a discounted cash flows model. The impairment has been reflected in the Trust‟s current year financial statements reducing the value of the investment from £15.0m to £10.6m.

Ordinary shares of £1.00 each held by the Trust in Healthcare 31 March 31 March Facilities Management Services Limited (HFMS) 2016 2015

- Number of ordinary shares of £1.00 each held by the Trust 15,000,100 15,000,100

£000 £000 - Value of ordinary shares held 15,000 15,000

Royal Berkshire NHS Foundation Trust – Consolidated Financial Statements for the year ended 31 March 2016

10.0 Inventories Trust Group Trust Group

At 31 March 2016 At 31 March 2015 £000 £000 £000 £000

Raw materials and consumables 5,692 5,692 5,202 5,202

Total inventories 5,692 5,692 5,202 5,202

11.0 Trade and other receivables Trust Group Trust Group At 31 March 2016 At 31 March 2015 £000 £000 £000 £000

NHS receivables 5,251 5,302 5,587 5,587 Prepayments 2,146 2,163 2,439 2,389 Accrued income 6,974 6,776 6,532 5,437 Other receivables 7,099 5,254 13,157 4,909 Total 21,470 19,495 27,715 18,322

Provision for impaired receivables (1,142) (1,142) (638) (638)

Total trade and other current receivables 20,328 18,353 27,077 17,684

Non-current receivables

Other receivables 15,956 786 16,443 920 Provision for impaired receivables (173) (173) (174) (174)

Total trade and other non-current receivables 15,783 613 16,269 746

Total trade and other receivables 36,111 18,966 43,346 18,430 Other receivables (falling due after more than one year) represents costs that the Group is claiming from insurance companies for treating injuries from road traffic accidents, via the Compensation Recovery Unit and £786k (31 March 2015 - £919k) is expected to be recovered after 12 months.

Provision for impairment of receivables Trust Group Trust Group At 31 March 2016 At 31 March 2015 £000 £000 £000 £000

At 1 April 812 812 834 834 Increase / (decrease) in provision 634 634 363 363 Amounts utilised (131) (131) (385) (385) Total 1,315 1,315 812 812

Royal Berkshire NHS Foundation Trust – Consolidated Financial Statements for the year ended 31 March 2016

Ageing of impaired receivables Up to three months 33 33 50 50 In three to six months 55 55 54 54 Over six months 1,227 1,227 708 708 Total 1,315 1,315 812 812

Ageing of non-impaired receivables past their due date Up to three months 1,318 1,318 1,505 1,505 In three to six months 2,331 2,331 1,543 1,543 Over six months 3,060 3,060 449 449 Total 6,709 6,709 3,497 3,497

12.0 Cash and cash equivalents Trust Group Trust Group At 31 March 2016 At 31 March 2015

Cash £000 £000 £000 £000

Bank accounts 3,432 6,784 1,883 7,157

Total 3,432 6,784 1,883 7,157

Current asset investments

Short-term National Loan Fund investments 7,000 7,000 9,000 9,000 Scottish Widows 90 day notice account 0 1,578 0 1,567

7,000 8,578 9,000 10,567

At 1 April 10,883 17,724 16,309 25,659

Net change in year (451) (2,362) (5,426) (7,935)

Total Cash and cash equivalents 10,432 15,362 10,883 17,724

Broken down into: Cash at commercial banks and in hand 275 2,733 196 1,301 Cash with the Government Banking Service 3,157 4,051 1,687 5,856 Other investments 7,000 8,578 9,000 10,567

Cash and cash equivalents as in Statement of Financial Position 10,432 15,362 10,883 17,724 42

Royal Berkshire NHS Foundation Trust – Consolidated Financial Statements for the year ended 31 March 2016

13.0 Trade and other Payables

13.1 Payables at the Statement of Financial Position date comprise: Trust Group Trust Group

At 31 March 2016 At 31 March 2015 £000 £000 £000 £000 Current payables:

Payments received on account 2,636 2,636 2,667 2,667 NHS payables 1,681 1,681 1,204 1,204 Capital payables 1,460 1,460 1,954 1,954 Deferred Income 885 885 1,372 1,383 Other payables 10,257 11,446 17,397 13,447 Accruals 22,942 23,454 17,625 17,086

Total Trade and other payables 39,861 41,562 42,219 37,741

Loans - capital repayment 3,670 3,670 3,669 3,669 Loans - interest payable 290 290 325 325 Total Borrowings 3,960 3,960 3,994 3,994

Tax and social security costs 4,020 4,020 3,955 3,955 Provisions 1,804 1,804 773 773

Total Current Payables 49,645 51,346 50,941 46,463 Non-current payables: Loans 23,236 23,236 26,906 26,906 Other Long Term payables 0 0 443 443 Deferred Tax 0 2 0 0 Total Borrowings 23,236 23,238 27,349 27,349

Provisions 274 274 315 315 Total 23,510 23,512 27,664 27,664

Total Payables 73,155 74,858 78,605 74,127

13.2 Loans and other long-term financial liabilities

At 31 March 2016 At 31 March 2015 Loans - Payment of principal falling due: £000 £000 £000 £000

Within one year 3,670 3,670 3,669 3,669 Between one and two years 3,003 3,003 3,670 3,670 Between two and five years 9,007 9,007 9,007 9,007 After five years 11,226 11,226 14,229 14,229

TOTAL 26,906 26,906 30,575 30,575

Royal Berkshire NHS Foundation Trust – Consolidated Financial Statements for the year ended 31 March 2016

14.0 Provisions for liabilities and charges Trust Group Trust Group At 31 March 2016 At 31 March 2015 Current Pensions relating to staff 45 45 45 45 Other 1,759 1,759 728 728 Total Current 1,804 1,804 773 773 Non-current Pensions relating to staff 274 274 315 315 Other 0 0 0 0 Total Non-Current 274 274 315 315 Total Provisions 2,078 2,078 1,088 1,088

Pensions Other At 31 March At 31 March Group and Trust relating to Provisions 2016 2015 staff £000 £000 £000 £000 At 1 April 2015 360 728 1,088 3,609 Arising during the year 0 10,196 10,196 6,593 Utilised during the year (39) (9,165) (9,204) (9,174) Unwinding discount and reversed unused (2) 0 (2) 60 Total 319 1,759 2,078 1,088

Expected timing of cash flows: Within 1 year 45 1,759 1,804 773 1 - 5 years 144 0 144 146 Over 5 years 130 0 130 169 Total 319 1,759 2,078 1,088

All provisions relate to the Trust and there are none in the subsidiaries. The category of other provisions is comprised fully of contract income.

In addition to the above provisions, £275,575,057 was included in the provisions in the accounts of the NHS Litigation Authority for clinical negligence liabilities of the Trust at 31 March 2016 (31 March 2015 - £113,050,000).

This provision for liabilities is calculated by NHS Litigation Authority and reflects total claims and settlements outstanding, as discounted by HM Treasury published discount rates. In December 2015 HM Treasury updated the discount rates and there was a substantial change in the long term discount rate, to which this provision is sensitive. As a result the provision at 31 March 2016 shows an increase of £140m on the same time last year, of which approximately £118m is attributable to the change in discount rate.

Royal Berkshire NHS Foundation Trust – Consolidated Financial Statements for the year ended 31 March 2016

15.0 Notes to the Statement of Cash Flows

15.1 Reconciliation of operating surplus to cash flow from operating activities

Trust Group Trust Group

At 31 March 2015 At 31 March 2014

£000 £000 £000 £000

Operating deficit - including impairment (8,153) (3,795) (3,462) (2,989) Reversal of revaluation gains/(losses) and impairment losses of property, plant and equipment 0 0 250 250 Derecognition of property, plant & equipment 184 184 0 0 Impairment losses of investments 4,400 0 0 0 Depreciation and amortisation 16,772 17,680 16,710 17,625 Corporation Tax 0 (270) 0 (82) Shares purchased in HFMS 0 0 0 0 (Increase)/decrease in inventories (490) (490) 5 5 (Increase)/decrease in receivables 7,235 (556) (3,904) (1,735) Increase/(decrease) in current payables (1,798) 4,382 7,962 2,834 Increase/(decrease) in non-current payables (443) (441) (56) (156) Increase/(decrease) in provisions for liabilities and charges 992 992 (2,581) (2,581)

Cash flows from operating activities 18,699 17,686 14,924 13,171

15.2 Reconciliation of net cash flow to movement in net debt

There was £34,000 PDC capital debt received for the year to 31 March 2016 (31 March 2015 £430,000)

16.0 Capital Commitments

Commitments under capital expenditure contracts at the balance sheet date were £970,000 (£1,340,000 at 31 March 2015).

17.0 Events after the reporting period

There were no material events after the reporting period (at 31 March 2015 - none reported).

18.0 Contingencies

The Trust recognises a contingent liability in respect of litigation brought against the Trust by the Health and Safety Executive, in relation to an incident in 2011. The case is due to be heard at Reading Crown Court on 27th May 2016. Management have taken and are continuing to take legal advice on this matter. The amount and timing of any future cash outflows as a result of this litigation remain inherently uncertain at reporting date and cannot be estimated reliably by the Trust or its legal advisors. Any future cash outflows are likely to be in the form of a fine and as such are not recoverable under the Trust‟s insurances.

Royal Berkshire NHS Foundation Trust – Consolidated Financial Statements for the year ended 31 March 2016

19.0 Related Party Transactions

Royal Berkshire NHS Foundation Trust is an independent body not controlled by the Secretary of State. It is therefore considered that Government departments and agencies are not related parties. However, the Trust has material dealings with the following NHS bodies: 2015/16 At 31 March 2016 Expenditure Income Accounts Accounts (Supplies & (Services Receivable Payable Services Provided) balance balance purchased) £000 £000

NHS Blood and Transplant 0 1,547 0 9 Berkshire Healthcare NHS Foundation Trust 2,154 3,803 315 1,039 Frimley Health NHS Foundation Trust 1,280 808 644 695 Oxford University Hospitals NHS Trust 1,633 2,249 660 415 NHS Bracknell and Ascot CCG 13,039 0 856 120 NHS Chiltern CCG 2,392 0 150 6 Newbury and District CCG 39,888 0 2,204 333 NHS Litigation Authority 0 12,962 0 0 NHS North and West Reading CCG 55,335 0 1,776 508 NHS Oxfordshire CCG 19,757 0 1,076 107 NHS Slough CCG 4,742 0 (30) 0 NHS South Reading CCG 59,858 0 13 791 NHS Windsor, Ascot and Maidenhead CCG 6,247 0 (671) 40 NHS Wokingham CCG 71,160 0 1,755 569 NHS England 61,773 0 2,745 14

The Group also has dealings with the following charities:

Reading and District Hospitals Charity (RDHC) 129 0 33 0 The Trust has received donations and revenue receipts from a number of charitable bodies.

During the year none of the Trust Board members or members of the key management staff or parties related to them has undertaken any material transactions with Royal Berkshire NHS Foundation Trust.

During the year none of the Trust Board members or members of the key management staff received any form of short-term employee benefits; post-employment benefits; other long term benefits; termination benefits or share- based payments.

Staff of the Royal Berkshire NHS Foundation Trust form part of the board of Healthcare Facilities Management Services Ltd and the Charity Committees of Royal Berkshire NHS Foundation Trust Charity and Reading and District Hospitals Charity. None of these staff receive any form of remuneration for these positions.

20.0 Private Finance Transactions

The Trust had no involvement in any Private Finance Initiative contracts during the year 2015/16 or 2014/15.

21.0 Pooled Budget Projects

The Trust did not enter into any pooled budget arrangements during the year to 31 March 2016 or the year to 31 March 2015

22.0 Financial Instruments

A financial instrument is defined in IAS 32 as a 'contract that gives rise to a financial asset of one entity and a financial liability or equity instrument of another entity.' NHS Foundation Trusts could have financial instruments 46

Royal Berkshire NHS Foundation Trust – Consolidated Financial Statements for the year ended 31 March 2016

under any area of the following Statement of Financial Position categories - investments, trade receivables (but not prepayments), cash at bank and in hand, trade payables (but not deferred income), loans and provisions.

Once financial assets and liabilities have been identified and recognised, they are initially and subsequently measured at fair value through income and expenditure. Fair value is the amount at which an asset can be exchanged, or liability settled, between knowledgeable, willing parties in an arms-length transaction.

IFRS 7 requires a disclosure relating to the risks associated with financial instruments. These are defined below

Market risk

This is the risk that the fair value or cash flows of a financial instrument will fluctuate because of changes in market prices. The Trust is exposed to minimal market risks.

Interest Rate Risk

All the Trust's financial assets and liabilities, with the exception of cash held in UK banks, carry a nil or fixed rate of interest. The Trust is not, therefore, exposed to significant interest rate risks. The following tables show the interest profiles of the Trust's assets and liabilities.

22.1 Financial Assets Trust Group Trust Group 31 March 2016 31 March 2015 £000 £000 £000 £000

Trade and other receivables excluding non financial assets 33,965 16,803 40,907 16,041 Other Financial Assets 0 0 0 0 Investments 10,600 12 15,000 12 Cash and cash equivalents (at bank and in hand) 10,432 15,362 10,883 17,724

Total 54,997 32,177 66,790 33,777

All financial assets are fixed rate. Other Financial Assets for 2014/15 which was cash on deposit with the National Loans Funds have been transferred for consistency to Cash and Cash Equivalents (at bank and in hand).

22 Financial Instruments cont'd

22.2 Financial Liabilities Trust Group Trust Group

At 31 March 2016 At 31 March 2015 £000 £000 £000 £000

Borrowings excluding finance lease and PFI liabilities 26,906 26,906 30,575 30,575 Obligations under finance leases 0 0 0 0 Trade and other payables excluding non financial assets 40,151 41,852 42,987 38,509 Provisions under contract 2,078 2,078 1,088 1,088

Total 69,135 70,836 74,650 70,172

All financial liabilities are fixed rate.

Royal Berkshire NHS Foundation Trust – Consolidated Financial Statements for the year ended 31 March 2016

Under IAS 32 and IAS 39 Public Dividend Capital is not a financial instrument. It continues to be classified within 'Taxpayers' Equity'.

The Trust had negligible foreign currency income or expenditure.

The Trust knows of no other specific risks relating to individual instruments.

Liquidity risk

The Group's operating income is predominantly from contracts with local Clinical Commissioning Groups, which are financed from resources voted annually by Parliament. The Group has minimised its exposure to any liquidity risks.

Credit risk

This is the risk that one party to a financial instrument will cause financial loss to another party by failing to discharge an obligation.

The majority of the financial contracts entered into by the Group are with other NHS bodies. These are bound by the Better Payment Practice Code and funded by taxpayer's equity, which significantly reduces the risk of non-payment.

22.3 Fair Values

Book values of the Trust's and Group's financial assets and liabilities are the same as their Fair values and consequently the Fair values have not been disclosed separately

23.0 Third Party Assets

The Trust held £55.00 at bank and in hand at 31 March 2016 (Nil as at 31 March 2015) on behalf of patients.

24.0 Losses and Special Payments

These payments are charged to the Statement of Comprehensive Income and are recorded in the losses and special payments register on an accruals basis.

Clinical negligence cases are managed by the National Health Service Litigation Authority and transactions relating to such cases are held in their accounts. The Trust pays a premium for their services and excesses on some cases. Therefore, these cases have not been accounted for in the Trust's accounts.

During the reporting period there were 428 cases of losses and special payments totalling £559k (168 cases totalling £841k for the year ending 31 March 2015). Within this total there were a number of debts written off totalling £132k (£352k 31 March 2015). This amount is incorporated in the provision for impairment of receivables figure reported in Note 3, Operating Expenses. The losses figures also includes obsolete stock write offs from 7 areas totalling £9K (31 March 2015 - 5 cases totalling £5k).

Losses 2015/16 2014/15 Number Value Number Value £000 £000

Bad debts and claims abandoned 374 133 101 352 Obsolete stock written off 7 9 5 5 Total Losses 381 142 106 357

Royal Berkshire NHS Foundation Trust – Consolidated Financial Statements for the year ended 31 March 2016

Special payments 2015/16 2014/15 Number Value Number Value £000 £000

Compensation payments 12 22 19 54 Employment related payments 27 392 24 419 Ex gratia payments 8 3 19 11 Total Special payments 47 417 62 484

Total Losses and Special Payments 428 559 168 841

Royal Berkshire NHS Foundation Trust – Consolidated Financial Statements for the year ended 31 March 2016

25.0 Charity summary disclosure

Royal Berkshire NHS Foundation Trust Charity Summary Statement of Financial Activities

Total Total 2015/16 2014/15 £000 £000

Total incoming resources 1,212 850

Total cost of generating funds (229) (235) Charitable activities including support costs (1,596) (896)

Total resources expended (1,825) (1,131)

Net incoming/(outgoing) resources before other recognised gains and losses (613) (281) Other recognised gains and losses: 0 1

Net movement in funds (613) (280)

Reconciliation of Funds: Total funds brought forward form previous year 4,073 4,353 Net movement in funds (613) (280) Total Fund balances carried forward 3,460 4,073

Royal Berkshire NHS Foundation Trust Charity Summary Balance Sheet at Year End

31 March 31 March 2016 2015 £000 £000

Total Non-current Assets 12 12

Total Current Assets 3,853 4,236 Current Liabilities (405) (175)

Net Current Assets/(Liabilities) 3,448 4,061

Total Assets less Current Liabilities 3,460 4,073

Net Assets 3,460 4,073

The Funds of the Charity: Restricted Income Fund 161 161 Unrestricted Income Fund 3,262 3,875 Endowment Funds 37 37

Total Charity Funds 3,460 4,073 50

Royal Berkshire NHS Foundation Trust – Consolidated Financial Statements for the year ended 31 March 2016

26.0 HFMS summary disclosure

HFMS Summary Statement of Financial Activities

Total Total 2015/16 2014/15 £000 £000

Operating income 3,804 3,638

Operating Expenditure (3,967) (3,638) Corporation Tax Expenditure (270) (82)

Profit/(Loss for the year) (433) (82)

HFMS Summary Balance Sheet at Year End 31 March 31 March 2016 2015 £000 £000

Total Non-current Assets 15,919 16,644

Total Current Assets 698 8,328 Current Liabilities (3,246) (10,817)

Net Current Assets/(Liabilities) (2,548) (2,489)

Total Assets less Current Liabilities 13,371 14,155

Non Current Liabilities (14,819) (15,170)

Net Assets (1,448) (1,015)

Called up Shareholder capital 15,000 15,000 Profit and Loss (Prior Year) (16,015) (15,933) Profit and Loss (Current year) (433) (82)

Total Shareholders' Equity (1,448) (1,015) As shown in note 9.0 the Trust has a £10.6m investment in HFMS. The carrying value of this investment is reviewed by the Trust on an annual basis by considering the forward financial projections of the company and the open market value of the company‟s non-current assets. The 2015/16 review identified that the forward financial projections result in an impairment of the investment in HFMS. The impairment (£4.4m) has been reflected in these Trust financial statements reducing the value of the investment from £15.0m to £10.6m.

The non-current assets within the summary disclosure are valued in accordance with IAS16 in accordance with Monitor‟s ARM. In producing the Trust‟s Group Accounts a consolidation adjustment is required from the HFMS accounts submitted separately to Companies House in relation to the valuation for the investment property assets held by the company. In the HFMS accounts this valuation is based upon the long term income projections resulting from legally binding rent agreements (which, in turn, are based on the market value of the freehold interest as at 31 March 2014).