South Warwickshire NHS Foundation Trust Annual Report and Accounts

South Warwickshire NHS Foundation Trust

Annual Report and Accounts for 2014/15

South Warwickshire NHS Foundation Trust Annual Report and Accounts for 2014/15 Presented to Parliament pursuant to Schedule 7, paragraph 25 (4) (a) of the National Health Service Act 2006

Content Introduction: pages 3-5 Section 2: Directors’ Report pages 69-90 Chief Executive’s message Chairman’s message - Directors’ Statement - Appointments and Roles Section 1: Strategic Report pages 6-68 - Board Profiles and Register of Interest - About the Trust - Executive Leadership Structure - Trust Structure - Disclosure of Corporate Governance Arrangements - Service Profile / Principal - Board Statements Activities - Board Committees - Strategy - Board and Committee - 2014/15 objectives Membership - Business Review - Directors’ Remuneration and  Review of 2014/15 Pension Benefits objectives  Trust performance Section 3: Council of Governors and against national Membership pages 91-112 targets  Quality - Council of Governors Structure - Governor Profiles  Key Developments in - Map of Constituencies 2013/14 - Meetings of the Council of  Financial Performance Governors Review - Sub-committees of the Council of - Risks and Uncertainties Governors - Trends and Factors affecting the - Trust Membership

Trust - Partnerships, Stakeholders and Section 4: Quality Report pages 113- Key Strategic Relationships 218 - Corporate  Activity Data Part 1: Statement on Quality Part 2: Priorities for Improvement and  Serious Untoward Assurance Statements Incidents Part 3: Review of Quality Performance  Information Governance Section 5: Statement of Accounting  Patient Experience Officers’ Responsibilities and Annual  Workforce Governance Statement pages 219-  Social, Community and 233 Human Rights  Current Developments Section 6: Summary of Financial  Environmental and Statements & Auditor’s Statement Sustainability pages 234-242

Chief Executive’s Message

The end of another financial year provides an opportunity to reflect and to re- focus. In many ways 2014/15 saw the realisation of a number of key strategic aims. The official opening of the Central England Rehabilitation Unit (CERU) provided formal recognition of what will be a fantastic facility for the people of Warwickshire and beyond for many years to come. Whilst this January saw its official opening, the facility has been open long enough to make a significant impact on the pathway for major trauma patients and as a consequence has already received excellent reviews from national experts.

We have also commenced the build of a new ward block at Warwick Hospital and what will be a fantastic new hospital in Stratford. I am old enough to remember the history of the Stratford site quite well, so I know how much it means to local people that the Trust are investing in the town and ensuring that the local population has access to vital services on their doorstep. Following the very generous donation from the Rigby Foundation towards our fundraising appeal we now look forward to opening the building with additional enhancements at the end of next year.

The NHS has featured heavily in the media, particularly over the winter. From our own perspective, we benefitted from a number of improvements to our processes which led to us meeting the Accident and Emergency (A&E) four hour target quite comfortably for the first half of the year. However, from December we saw major increases in admissions of frail older patients, much more than in previous years, and did not meet the target in the second half of the year. Whilst hitting the targets is important, our focus always has to be on patients and our staff and therefore I am pleased to see that feedback continues to place us in the very top group of Trusts nationally. Particular high points for me this year have been the Staff Survey, where we were the 6th best performing acute trust in the entire country, the A&E patient Survey where we came out in 10th place nationally and our Children’s Community Nursing Team being awarded the Child Heath Award in the prestigious Nursing Standard Awards. It is great to now see the Trust consistently highlighted as one of the country’s best providers, particularly in the context of the NHS being recognised as one of the best healthcare systems in the world.

This past year has also seen large deficits emerge across the provider sector in the NHS. We have so far managed to avoid this trend and I also put this down to the engagement and commitment of our staff. Getting things right first time for our patients reduces waste and duplication, being innovative helps us to deliver care in better ways and to develop new services and new approaches. The contribution of our arms- length company SWFT Clinical Services has been critical in this area. As well as reducing the cost of delivering pharmacy services, we are developing new services and now have established a successful training arm. This offers expertise to colleagues in primary care and other healthcare providers as well as stimulating and developing our staff.

Employing the best staff and continuing to develop them throughout their careers is key to being the best that we can be. It is therefore reassuring that we continue to attract the best staff who are drawn to the values and culture of the Trust.

I have been Chief Executive at the Trust for nearly nine years and throughout this period I have worked under the guidance of our Chairman Graham Murrell. You will see from his report that he stood down at the end of May. As I write this report I do not know who Graham’s successor will be but I can only hope that we can be as successful in the future as we have been during this period and I would like to go on record to thank him personally, and on behalf of the Board for his considerable contribution to the Trust.

Glen Burley, Chief Executive Date: 21st May 2015 4

Chairman’s message

This Annual Report presents a review of the past year’s activities in South Warwickshire NHS Foundation Trust. It provides a formal record, and I think it also conveys the real story of the Trust’s work and its achievements in the year. I am proud to present the report, and I recommend it to all who take an interest in our services.

A highlight of the year was the official opening, by HRH The Princess Royal, of the Central England Rehabilitation Unit at Leamington Spa Hospital. The presence of HRH The Princess Royal was a fitting tribute to the outstanding team who created this superb facility. The year has also seen the start of two major new investments; the building of a new ward block at Warwick Hospital and the first phase of redevelopment of Stratford Hospital. Both these projects are designed to accommodate the continuing development of our services and to meet the growing needs of our local population for the years ahead.

Some of our services have been under great pressure from unexpected activity levels this year, especially during the exceptionally difficult winter period, and our performance on some indicators has fallen short of our targets. Despite this the Trust has continued to show year-on-year improvements in the quality of patient care, for example in the prevention of infections and pressure sores and in terms of mortality rates.

The Trust pays careful attention to the feedback from patients on their experience of care, which gives us pointers for improvement but also huge encouragement at how much our services are appreciated. The quality of care depends above all on the ethos of the organisation and the commitment of our people, so it was very pleasing to see the staff survey again this year showing an outstanding level of staff engagement and job satisfaction despite the huge pressure everybody is under.

The positive feedback from both patients and staff reflects the outstanding work of our executive team, led by Glen Burley, and the skills and dedication of our staff across the organisation. I offer my thanks to all our staff for their hard work and loyalty, and I congratulate them on what has been accomplished this year.

The Trust’s Non-Executive directors bring independence and a range of special expertise to the work of the Board, and I would like to thank them for their support and for their distinctive contribution.

As a Foundation Trust the organisation is governed by the community it serves, and operates at arms’ length from the hierarchy of the NHS. Accountability to the community is exercised through the Council of Governors, comprising representatives of staff and public members as well as of key local bodies. Our governors have continued to fulfil their role in a conscientious and enthusiastic way, overseeing the performance of the Trust and holding the Board of Directors to account.

The Trust has continued to grow its membership base, and communicates regularly with members through the Pulse newsletter. The governors have arranged public meetings in various locations around the area, with presentations on clinical or organisational topics and opportunities to take questions and first-hand comments from members. The engagement of the Trust with governors and members is both stimulating and challenging, and we are continually seeking ways to build on these relationships to promote the success of the Trust for the benefit of the community.

The volunteers of the Hospital Patients Forum have continued their valuable work of reviewing and inspecting aspects of the Trust’s services, as an independent group of ‘expert patients’. The Forum is also now working closely with the Council of Governors, to which its work will make a valuable contribution.

The Trust and its patients continue to benefit from the efforts of local fund-raisers and the generosity of donors. We have seen continuing support for the Central England Rehabilitation Unit, and successfully launched the Stratford Hospital Cancer and Eye Appeal. The superb quality of all the facilities we are

5 developing owes much to the contributions of our supporters. I would like to pay particular tribute to the marvellous work of the respective Leagues of Friends of our hospitals, who raise funds year-in year-out and provides a great variety of large and small items for the benefit of patients.

The generosity of members of our community is also marked by the many volunteers who give their time in our hospitals, assisting and supporting patients and visitors. Their work makes a real difference to people’s experience of our services, and it is greatly appreciated.

This is the tenth of the Trust’s annual reports for which I have written the introductory message. By the time this report is published I will have retired from office. It has been a huge privilege, and a thoroughly enjoyable and rewarding experience, to serve in this role. I would like to record my sincere thanks to everyone I have worked with during my time in office, and to offer my very best wishes to my successor.

Graham Murrell, Chairman Date: 20th May 2015

Strategic Report

The Board of Directors has prepared this annual report to provide a fair, balanced and understandable analysis of the Trust. This includes the Strategic Report which identifies the strategy moving forward as well as a review of last year’s progress.

After making enquiries, the directors have a reasonable expectation that the 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.

The accounts have been prepared under a direction issued by Monitor under the National Health Service Act 2006.

Approved by the Board of Directors and signed on their behalf:

Glen Burley, Chief Executive Date: 21st May 2015

About the Trust This Annual Report covers a twelve month period ending 31 March 2015. The Trust employs 4,107 members of staff and provides services from a number of buildings across the county. The Trust provides community services to a population of over half a million people covering the whole of Warwickshire and acute services to South Warwickshire.

Warwick Hospital – This site houses the majority of the Trust’s acute services including; Accident and Emergency services, Diagnostic and Pathology departments, Maternity and Special Care Baby Unit, Main and Day Surgery Theatres together with an Intensive Care Unit and Coronary Care Unit.

Stratford-upon-Avon Hospital – This is one of the Trust’s community hospitals and it includes a Minor Injuries Unit, Outpatients Department, Radiology Department and an Intermediate Care Ward. This hospital is undergoing major development work, more information on page 63.

Leamington Spa Hospital – This site offers rehabilitation services to adults, as well as a number of outpatient services. This hospital houses the Central England Rehabilitation Unit (CERU). This unit has 42 beds over two wards, Campion and Chadwick and offers specialist neuro-rehabilitation for patients with acquired brain injuries.

Ellen Badger Hospital – This community hospital has inpatient beds and a Day Hospital, offering continued rehabilitation and help with medicines management and reduced mobility. Due to its rural location, some out-patient appointments are also offered.

Community Services teams operate out of a number of clinics, some of the larger ones include; Cape Road Clinic, Camp Hill Clinic and the Orchard Centre.

Vision

“Our vision is to provide high quality, clinically and cost effective NHS healthcare services that meet the needs of our patients and the population that we serve.”

Values

Safe - We put safety above everything else Compassionate - We offer compassionate  Keep patients, service users and staff safe care to everyone  Take personal responsibility  Friendly, helpful and courteous  Deliver high quality care  Sensitive to individual needs  Listen, value and support our staff  Respect privacy, dignity, diversity and choice Effective - We will do the right thing at the  Offer care we would want for ourselves right time and our loved ones  Proactively seek to make improvements  Work in partnership Trusted - We will be open and honest  Deliver evidence based care  Treat everyone with openness, honesty  Engage and involve and respect  Decisions driven by our local communities and a public service ethos  Commitment to excellence  Maintain professional standards

Trust Structure

The Trust provides acute and community NHS health services across the whole of Warwickshire. The Trust is the main provider of acute services for South Warwickshire, with Warwick Hospital offering the majority of the Trust’s services. In 2011, the Trust was awarded the contract to provide all of Warwickshire's community services.

The Trust was authorised as a Foundation Trust (FT) on 1 March 2010. As an FT, the Trust continues to be part of the NHS and treats patients in accordance with NHS principles. However, FT status has allowed the Trust to make a number of significant changes to the way the Trust operates. These changes include;

 greater freedom to manage our own affairs as an independent legal entity, called a public benefit corporation;

 freedom from central government, Department of Health and Strategic Health Authority control;

 freedom in the way the organisation plans and makes decisions; and

 no longer subject to the directions of the Secretary of State for Health

We are also more directly accountable to local people through our Membership, drawn from both the local population and staff. We have a Council of Governors, who are elected by the Membership, to whom the Board of Directors is accountable.

As a FT the Trust is regulated by a separate independent regulator called Monitor, who awarded the Trust a licence to operate as a FT, under terms of authorisation which outline the core services the Trust provides. They also regularly check the Trust is meeting all its commitments.

The Trust has a Board of Directors which comprises of a Chairman, 6 Non-Executives and 6 Executive Directors. Further information on the Board of Directors can be found on pages 71-76 and details about the Council of Governors on pages 91-112.

After being authorised as a Foundation Trust, in 2011 the Trust set up subsidiary company, SWFT Clinical Services Ltd. This was one of the very first NHS subsidiary companies to be set up in the UK. SWFT Clinical Services Ltd is a social enterprise, with the mission to improve care for patients by generating profits for the Trust to reinvest back into health services. The arm's length company is an innovative way for the Trust to generate profit, which is then reinvested, and protects front line services. It has a separate board that comprises of; Jayne Blacklay, Chair, Tony Boorman, Director, Kim Li, Director, Ann Pope, Director, Alison Williams, Director, Meg Lambert, Company Secretary.

Service Profile/Principal Activities South Warwickshire NHS Foundation Trust encompasses both acute services in South Warwickshire and community services across the whole of Warwickshire. The Trust’s aim is to reduce the overlap between hospital and community services and as a result services have been developed to ensure patients are being treated in the most appropriate setting. A range of the services provided are shown below.

Elective Care Integrated Care Emergency Care Support Services Division Division Division Division Acquired Brain Injury Adult Community Teams A&E Back Track Services Birth to Three Portage Ambulatory Care Chaplains Corner Acute & Chronic Pain Care of the elderly Cardiology Clinical Psychology Services Child Development Gynaecology and Dietetic Service Anaesthetics Child and Adolescent Obstetrics Electro-Biomedical Audiology Community Cardiac Nurse Maternity Engineering (EBME) Cancer Services Specialist Radiology Facilities Critical Care Community Children’s Resuscitation Service Occupational Therapy Dental Nursing Paediatrics Outpatients Dermatology Community Diabetes Nurse Acute Medicine Physiotherapy Endoscopy Specialist Respiratory Specialities Podiatry Orthopaedics Community Emergency Medical Measurement Speech & Language Pre-operative Response Team Therapy - Warwick Assessments Community Neuro- Hospital Theatres Rehabilitation Stoma and Internal Urology Community Paediatricians Pouch Care Gastroenterology Community Tissue Viability Wheelchair Services Continence Pharmacy District Nursing Diabetes Endocrinology Family Nurse Partnership Falls Service GUM (Genito-Urinary Medicine) Health Visiting Integrated Health and Intermediate Care Neighbourhood Teams Paediatric Occupational Therapy Paediatric Physiotherapy Palliative Care Nurse Specialists Parkinson Disease Nurse Specialists Rheumatology Safeguarding Children School Nursing Sexual Health Social Care Speech and Language Therapy Stroke Outreach Virtual Wards

Strategy The Trust revised their five year strategy for 2014-2019 at the Board of Directors and Council of Governor meetings in March 2014 and it focuses on the following five key areas: Service Profile As part of our vision to deliver as much care as possible closer to home, the Trust will increase and improve capacity at Stratford Hospital. This will improve access for patients, meeting the health needs of the expanding population in the Stratford District and surrounding areas. In turn this will allow for more capacity at Warwick Hospital where we will increase our bed numbers to meet the demands of a larger population. This will also include the further growth and repatriation of ambulatory cancer services onto both sites.

The Central England Rehabilitation Unit (CERU) will expand further to utilise the ground floor of the new building and will be further recognised as a national centre of excellence, through its reputation for quality and extensive research and development in the treatment for patients with acquired brain injuries.

Community hospitals will feature as part of our approach to managing patient care as close to home as possible. These small but local facilities will be GP-led and will offer ‘step up’ from home care as well as step-down and intensive rehabilitation from hospital.

The Trust’s Elective services will continue to be seen as national exemplars of productivity and patient satisfaction. Through this the Trust will grow the catchment population for Orthopaedics, Ophthalmology, Dermatology and General Surgery.

Our growing population will increase the number of frail elderly patients who will need to access our ‘Discharge to Assess’ pathways in the community and our specialist assessment process in the hospital setting.

Workforce As one of Warwickshire’s biggest employers we will aim to be the employer of choice in our sector as demonstrated by our NHS Staff Survey results which will continue to be in the top 20% of trusts.

The Trust will invest in leadership development in clinical and non-clinical areas and we will appoint the best staff who will demonstrate that they will uphold the Trust’s values. We will also ensure that our workforce profile supports the delivery of safe care.

Career opportunities for Health Care Assistants will be expanded and the roles of Nurses and Allied Health Professionals extended.

The Trust will be recognised as a centre of excellence for training including Nursing and Medical Students recording excellent ratings for their placements and demonstrating this by choosing to return to work for us substantively.

Local terms and conditions will be developed for staff which reward quality.

Quality

The quality and safety of our services is the Trust’s primary focus. The Trust will therefore aim to have a strong reputation for compliance with regulators and will continue to perform in the top 20% of trusts on the Friends and Family Test and will have a similar standing on NHS Choices.

The environment in which we deliver care will be improved, with more side rooms and amenities which meet patient expectations. This will include significant improvements to the environments in our maternity and orthopaedic departments.

The Trust’s values will underpin all that we do and will be recognised by our patients and service users as a guarantee for high quality NHS care.

We will ensure that patients have sufficient information to allow them to properly exercise choice in accessing our services and we will place as much information in the public domain to demonstrate the transparency in which we operate as a publicly financed Foundation Trust. This transparency will extend to the way in which the organisation responds to and learns from mistakes.

Clinicians will use hand held devices to deliver care in a range of settings. This will ensure that clinical data is recorded at the point of care, supporting safety and productivity. We will also encourage our clinicians to innovate and to provide best practice standards of care.

Inpatients will receive a daily senior clinical review which will be supported by rapid access to diagnostic support. Through this we will ensure that patients receive fast and effective treatment and are transferred back to their home at the earliest point and provided with suitable aftercare and support.

Sustainability Our strategy will be to continuously operate within national tariff and to maintain a Monitor continuity of

service rating of at least 3.

Through incremental and strategic growth we will have increased our organisational critical mass to be greater than £300m in annual turnover.

The Trust will continue to explore new markets and service offers including the provision of clinical services to non-NHS patients where this demonstrably improves our ability to offer excellent NHS care.

We will continue to exploit opportunities to use our existing organisational capability and skills to generate alternative sources of income. We will do this using the flexibility offered by our arm’s-length company, SWFT Clinical Services Ltd to quickly put these ideas into practice.

The range of NHS contracts will be expanded, so that we are less dependent on a single commissioner. We will also seek new and innovative sources of capital. High levels of productivity based on the right first time approach will be maintained and through the implementation of best practice both inside and outside of the public sector. Our carbon reduction targets will be met through a range of energy saving initiatives, delivering care locally to patients and working in a paper-light fashion.

Integration

Successful integration will be founded on the necessary enablers being in place across the local health and care system. Best practice models will be used to ensure that our resources are used in the best way to deliver safe, effective and compassionate care for our patients and service users.

Patients will be encouraged to manage their own care. This will be supported by technology and backed-up by clinical expertise and first class acute and community services working in partnership with primary care.

The Trust will harness technology to offer ‘virtual’ clinics, avoiding unnecessary travel to hospital. Through such technology we will also have more direct dialogue between local GPs and our specialists.

Technology will facilitate better on-call cover through virtual rotas and will allow smaller hospitals like ours to create more resilience through sharing scarce clinical skills. The Trust intends to be at the forefront of demonstrating that technology can support a more local, more dispersed, patient centred, paper-light delivery model.

Our vision is that patients and service users across Warwickshire will benefit from services which are seamless at the point of delivery and which share appropriate information, reducing duplication.

Patients will be able to easily navigate their way through our services which will offer more alternatives to hospital admission through very close working with colleagues in primary care.

Pathways into urgent care services will be more streamlined and we will seek to work collaboratively with primary care to offer better GP Out of Hours Services which combine the capacity of our A&E service with the skills of primary care.

The Trust will fully integrate services in the areas where we are in a position to provide the community and acute elements, reducing admission rates and length of stay. We will also develop innovative contracting models with our commissioners and work closely with key partners including not for profit organisations.

In the south of the county, the integration of services is at a more mature stage of development and as a consequence we will see some of the lowest non-elective admissions per head in the UK as well as low levels of attendance at A&E. Virtual teams spanning hospital, community, social and primary care services will work together to provide proactive interventions and support targeted at the more vulnerable and clinically appropriate patents.

The Trust will use simple, effective technological support to ensure that we keep in touch with at risk patients identified through risk stratification. Health and social care staff will use a single trusted assessment process and will share this through a single care record.

In the Coventry and Warwickshire health economy University Hospitals Coventry and Warwickshire NHS Trust (UHCW) will continue to be the primary providers of tertiary (specialist) services to our patients. Effective partnership working between the Trust and UHCW will ensure that Warwickshire patients have the best possible access to tertiary services with as many of these services as possible being delivered locally.

2015/16 Objectives

E very year the Trust sets a number of key objectives. These key objectives are based on local and national priorities and they are promoted internally so that all staff are aware of the Trust’s focus for the year. Managers are also asked to use these key objectives when setting their team’s annual objectives.

Provide High Quality Care

Achieve a ‘good’ or above rating in the CQC inspection

Further develop nurse staffing level measures in the community

Achieve paperless working in all outpatient areas

Implement electronic radiology and pathology requesting

Implement new food delivery system at Warwick Hospital

Create a specialist multidisciplinary team to improve care for patients with a dementia

Further embed new complaints procedure and ensure learning is shared within departments

Develop our Services

Improve capacity by opening the new ward block at Warwick Hospital

Agree maternity strategy to include provision for a midwife led unit

Agree plan for the next phase of Stratford Hospital

Improve theatre and diagnostic capacity

Integrate our Services

As part of implementing the ‘Better Care Fund’ deliver more integrated reablement services

Work with our staff to deliver more GP focused services

Capitalise on new models of care to maximise integration opportunities

Develop our People

Implement clinical workforce strategy:  Develop apprenticeship scheme in theatres  Increase the support, development and supervision for specialist and newly qualified nurses  Respond to recruitment challenge of expanding Care of Elderly team

Work with senior clinicians in A&E /Medical Assessment Unit to further develop 7 day services

Develop the leadership potential of senior clinicians

Make health and wellbeing a priority for our workforce and through our staff raise awareness with our local communities

Provide a Sustainable Future

Work with local providers to deliver a sustainable health economy

Realise the financial benefits available through the use of SWFT Clinical Services Ltd

Develop opportunities to increase non-NHS income

Embed service line management within the organisation

Review our information structure to ensure we provide a responsive service for internal stakeholders

Agree new carbon plan for the organisation

Business Review

Review of 2014/15 Objectives Develop our Services

Commence the building of phase 1 of the Achieved - Project on plan new Stratford Hospital

Commence the building of additional Achieved - New ward block will open Q3 15/16 ‘Right ward capacity at Warwick Hospital sizing’ of ward capacity exercise underway

Fully commission the phase 1 capacity of Partially Achieved - Phase 1 capacity is fully open, CERU and agree plans for phase 2 plans for Phase 2 are currently being finalised

Increase our elective capacity to meet Partially Achieved - Delivered through productivity demand improvement and temporary theatre capacity, however there has been significant increases in referrals

Increase MRI capacity to meet demand Achieved - In-year capacity increases delivered, Board and improve Radiology reporting times approval of full business case

Develop our People

Agree a clinical workforce strategy Achieved - Approved by the Board

Respond to the recruitment challenges in Partially Achieved - A Task and Finish Group has been Care of the Elderly and Theatres established, chaired by the Medical Director, to consider options related to the Care of the Elderly workforce

Reduce agency Nursing usage Partially Achieved - The demand for temporary staff was particularly high in the second half of the year with additional capacity regularly open and requiring additional staff. Need to maintain focus on staff sickness management

Further embed the Trust values Achieved - Evidenced through values based recruitment and Staff Survey results

Implement new staff communications Achieved - ‘Let’s Talk’ to be further refined strategy (Let’s Talk)

Engage more doctors in training in Achieved - Junior Doctors quality improvement group quality and service improvement established, attendance by Directors at Junior Doctors initiatives Forum

Use hand held technology to increase Achieved - Widespread community use of iPads using patient and service user contact time with GAP tool Clinicians

Provide High Quality Care

Improve patient experience with our Achieved - Action plan implemented and latest survey booking processes showing high levels of patient satisfaction

Implement the Trust’s EPR strategy and Achieved increase the speed and availability of access to medical records

Improve patient meal experience Achieved - Satisfaction levels improved in inpatient survey. Major improvements to meal service now being implemented

Use the Patient Care Committee to drive Achieved - Full work programme in place user engagement

Work with primary care to increase the Achieved - A care planning process that can move with level and quality of end of life care the patient between primary care, community and advanced planning between hospital and acute has been developed and implementation community settings continues. Working with CCG to increase the Palliative Care Consultant capacity

Provide more comprehensive 7 day Achieved - 100% of emergency admissions have a full services, increasing the availability of clinical assessment plan within 4 hrs. 100% have a senior decision making clinicians consultant review within 14 hours

Make our performance data more Not Achieved - We are in the process of agreeing how publicly available information should be presented to ensure ease of understanding

Provide a Sustainable Future

Explore opportunities to generate non- Achieved - ‘Guiding Principles’ agreed with Governors, NHS income and provide patients with a Development of amenity beds, Central England wider choice of services Rehabilitation Unit and Stratford Clinic

Commence a programme to replace our Achieved - Effective Lorenzo implementation, focus PAS systems with Lorenzo now switches to benefits realisation and paperless clinic objective

Respond to the George Eliot N/A - We are currently awaiting the next steps from procurement process George Eliot Hospital and the Trust Development Authority

Further reduce our carbon emissions Partially Achieved - There has been additional electrical loading due to the temporary theatre, however gas consumption has decreased significantly

Maximise productivity through the Not Achieved - Whilst SLR system has been implementation of Service Line Reporting implemented further work is needed to maximise (SLR) productivity through its use

Secure additional sources of income Achieved - Contributions agreed in both Warwick and including Community Infrastructure Levy Stratford District planning areas

Contribute to the development of a Achieved - Chief Executive engaged in all system strategy for a sustainable health discussions in addition to discussions with other Trusts. economy Despite this, other organisations in the health economy continue to struggle to demonstrate financial sustainability

Integrate our Services

Implement a new pathway for stroke Not Achieved - Working with commissioners to secure services including more community system wide agreement based rehabilitation

Fully embed frail elderly pathways Achieved - The Trust has agreed to take over the including Discharge to Assess capacity commissioning and funding of these beds in 2015/16

Submit a successful tender for GP Out of N/A - There has been no tender exercise during Hours Services 2014/15

Liaise with commissioners to agree a Achieved - Awaiting next steps in procurement process specification for integrated community from Clinical Commissioning Groups, work to further services improve GP and patient satisfaction has commenced

Introduce a single point of access for Achieved - iSPA (integrated single point of access) community based care improving user implemented and being refined experience

Revise team structures to increase Achieved - New structures in place and linked to iSPA clinical time improvements

Work with commissioners to plan the Achieved - Trust will be a full member of the ‘Better implementation of the Better Care Fund Together’; Board which will oversee the implementation of the Health and Wellbeing Strategy

Trust Performance against National Targets

18 Weeks target Not Achieved – Admitted 89%

Achieved – Non-Admitted 96%

A&E target Not Achieved – 94%

31-Day ‘Diagnosis to Achieved – 96% treatment’ target for patients with diagnosed cancer

62-Day ‘Referral to treatment’ Not achieved – 84% target for patients with suspected cancer

Reduction in C.Difficile cases Achieved

Reduction in hospital Achieved acquired MRSA cases

18 Weeks target – Admitted – Despite establishing additional capacity through a temporary theatre on site for six months we were unfortunately unable to meet the increase in demand and just missed the 90% target.

A&E target - Whilst we did achieve the A&E target for all of last year and until December of this year, we were unfortunately unable to sustain performance at the end of quarter 3 and into quarter 4. This was disappointing, however it was understandable due to the major increase in admissions we experienced throughout December 2014 and continuing into January 2015, in line with the experience of most of the NHS. We performed better than the national performance but narrowly missed the 95% target for the year.

62-Day ‘Referral to treatment’ target for patients with suspected cancer - Unfortunately this target was just missed by 1%. During quarter 1 we experienced issues with our referral tracking system which contributed significantly to not meeting the target during this period. This has now been fully resolved and we did achieve the target for quarter 3 and 4.

Quality

Infection Prevention and Control

The Trust continues to be proud of its strong commitment to reducing harm to patients, through both reducing rates of healthcare associated infections and improving outcomes for those patients who have infections.

This has been clearly demonstrated by our extremely low rates of hospital-attributed infection during 2014/15. Of particular note, has been our success in reducing the rates of Clostridium difficile (C.Diff) and eradicating deaths attributed to C.diff.

A target of a maximum of 24 cases of C.diff was set for the Trust in 2014/15. We are proud to report that this was successfully achieved with a total of only 1 “avoidable” hospital-attributed case of C.diff identified across both Community and Acute Trust services. In addition, there were no C.diff associated deaths. This is a fantastic achievement and one which all our staff are extremely proud of.

The zero-tolerance approach to MRSA bacteraemias continues to be applied nationwide by the Department of Health and we are pleased to report that there were no MRSA bacteraemias attributed to care at the Trust in 2014/15.

The Root Cause Analysis (RCA) process has continued to be rigorously applied by the Infection Prevention Team and their clinical colleagues throughout 2014/15, for the investigation of cases of MRSA bacteraemia, C.diff, C.Diff outbreaks, deaths where C. Diff has been certified as a leading cause of death, Methicillin Staphylococcus Aureus (MSSA) and other outbreaks of infection. We are grateful to our Infection Control colleagues from the Clinical Commissioning Group (CCG), who have assisted in this process and whose scrutiny has helped us ensure we continue to improve the care we deliver to our patients.

Nationally, during this winter season, it was noted that the seasonal Influenza vaccine was largely ineffective due to a mismatch between the strains of virus covered by the vaccine and those circulating across the country. Consequently, many patients and members of staff had little immunity to Influenza during the winter, which has posed a particular challenge to all healthcare providers, including ourselves. This resulted in two outbreaks of Influenza occurring on our wards.

During 2014/15, a group of healthcare professionals with a special interest in care of intravenous devices (IV) initiated two major projects; the introduction of needle-free extension sets, which prevent multiple complications associated with cannulas, and the development of the Vessel Health Preservation tool. This work has continued and developed into 2014/15 with an emphasis on education of staff and promoting the use of the Vessel Health Preservation Tool. This work is key in reducing IV-related infection, improvements in the patient’s experience and promoting the best chance of IV therapy success.

You can find out more about our performance in relation to infection control in the Quality Report (pages 113-215).

To reinforce the importance of hand washing before entering and leaving clinical areas the Trust implemented a new hand washing campaign in November 2014. The aim of the campaign was to help limit the spread of infections.

The visual campaign saw stickers, posters, flyers and floor graphics located around the Trust sites. The campaign targeted patients, visitors and staff, focussing on the message that germs are not always visible and therefore it is important to practice good hand hygiene when entering and leaving any clinical area.

Quality Governance

Quality and patient care is at the core of the organisation. To ensure we deliver services with quality we have quality governance processes in place. The day-to-day management of quality governance is the responsibility of everyone in our organisation. The identification and management of it requires the active engagement and involvement of staff at all levels. Our staff are best placed to understand the quality governance relevant to their areas of work, and must manage it, within a structured framework. The Trust recognises that quality governance cannot be simply attributed to one person but is an integral part of the normal management processes.

The Board of Directors are ultimately responsible for managing the organisational quality, using risk management processes to monitor it. The Board of Directors utilise the Board Assurance Framework (BAF) and the Trust Risk Register provide additional evidence that the appropriate quality governance arrangements and risk management policies are operating effectively. The Board of Directors are responsible for determining the governance arrangements of the Trust, including risk management and agreeing the necessary policy framework and for monitoring performance within these areas. The Audit Committee is responsible for providing independent assurance on the robustness of governance and risk management, including internal controls, in the Trust to the Board of Directors. The Committee primarily utilises the work of Internal Audit and External Audit but are not limited to these audit functions. It will also seek reports and assurances from Directors and Managers, as appropriate, concentrating on the over- arching systems of integrated governance, risk management and internal control, including evidence that the BAF is effective.

The Clinical Governance Committee, chaired by a Non-Executive Director, provides assurance to the Board of Directors that the Trust is fulfilling its statutory duties, and complying with national standards and achieving its own objectives in respect of the provision of clinical care. It takes into account national best practice guidelines, including National Service Frameworks and associated improvement strategies, The National Institute for Health and Care Excellence (NICE) and National Patient Safety Agency (NPSA) guidance. The Committee also consider the implications arising out of national reports and enquiries, including the National Confidential Enquiries (NCE), and consider the outcome of national audits. The Committee is responsible for implementing the governance agenda to ensure that there is continuous and measurable improvement in the quality of the services and for providing assurance to the Board of Directors that the risks identified are appropriately managed. An operational structure alongside a medical leadership structure is also in place to strengthen the quality governance for the organisation.

Please refer to the annual Quality Report where quality governance is discussed in more detail.

Care Quality Commission

South Warwickshire NHS Foundation Trust is required to register with the Care Quality Commission (CQC) and is registered without conditions. During 2014/15 the Trust has not been subject to any enforcement action or special reviews by the CQC. The Quality Report details more information about this registration and inspections carried out in 2014/15.

Commissioning for Quality and Innovation (CQUIN)

The purposes of CQUIN schemes are to endorse innovation and be a driver for quality improvement. Similar to last year for 2014/15 the Trust agreed a number of CQUIN schemes with our lead commissioners, South Warwickshire Clinical Commission Group. The Trust has made significant achievements with agreed CQUINs. For more details please see the Quality Report.

Key Developments in 2014/15

Central England Rehabilitation Unit (CERU) official opening

Her Royal Highness the Princess Royal officially opened the Central England Rehabilitation Unit (CERU) at Leamington Spa Hospital on Wednesday 29 January 2015.

CERU is a level 1 nationally accredited specialist rehabilitation facility which offers exceptional standards of care to patients with acquired brain injuries. The unit treated its first patient in November 2013 following development work which doubled capacity from 21 to 42 beds. The development work has enhanced the environment for patients to recover in and offers state- of-the-art facilities.

During the day The Princess Royal was given a guided tour by CERU’s Clinical Lead Derar Badwan and Sue Bleasdale, General Manager for the unit. The event was also an opportunity for HRH to meet patients and their families. The Princess Royal met with patients from Warwick, Nuneaton and Northampton and heard first-hand how the unit has helped them.

Integrated Single Point of Access (iSPA)

To access all of the adult community health teams the Trust introduced an Integrated Single Point of Access (iSPA) in May 2014. The iSPA was implemented to take all referrals and enquiries, as the previous service provided by West Midlands Ambulance Service ended. The service is available between 8:30 and 10pm and covers all localities across Warwickshire (Stratford, Warwick, Rugby, Nuneaton, Bedworth and rural North Warwickshire) and can be accessed via the phone or email.

Work starting on Stratford Hospital

Work on the new Stratford Hospital is underway with the main contractor, Speller Metcalfe, starting on site in December 2014. The new hospital is being built separately to the existing one and all current services will be maintained throughout the build.

The site will be approximately twice the size of the current one and will have appropriate car parking available. We will also be supporting this development with an energy centre. The car park and energy centre are the first elements to be built and when this work is complete the space will be released to start work on the main hospital building in June 2015.

More information on this development can be read on page 63.

Project 2020 - Lorenzo

Project 2020 is the Trust’s vision for achieving Electronic Patient Records (EPR). In February 2015 the Trust successfully went live with Lorenzo, a key component of our Project 2020 paperless vision.

This was a big organisational change so the Trust supported staff with a team of trained Lorenzo experts, a dedicated help desk and an online support tool. More information on Project 2020 can be found on page 63.

Fellows of the Institute of Health Visiting in England

Eight of the Trust’s Health Visitors have been awarded Fellowships of the Institute of Health Visiting (FiHV).

Launched in May 2014, the Fellowship scheme set out to identify and acknowledge 150 exceptional health visitors who have made a real difference to health outcomes for children and families in England.

Each Fellow needed to demonstrate excellence in practice and also their leadership potential. Since being accepted, all Fellows have undertaken a special four-day leadership development programme before the conferment ceremony. During this they were acknowledged as “expert and confident” health visitor leaders who are ready to become local ambassadors for health visiting, as well as for the Institute of Health Visiting.

Food for Life Partnership

The Trust is one of three trusts across England, piloting the Food for Life Partnership (FFL) in hospitals. FFL is a partnership of five charities working to transform food culture in the UK.

One of the projects that is being implemented under Food for Life is the re-introducing of tables onto wards so patients can eat together rather than by their beds.

Top 100 places to Work

In September 2014 NHS Employers teamed up with the Health Service Journal (HSJ) to compile a list of the best places to work in the NHS. The Trust was named in the top 100, one of only five trusts from the West Midlands.

The list was judged against the following areas:

- Leadership and planning - Corporate culture and communications - Role satisfaction - Work environment - Relationship with supervisor - Training and Development - Employee engagement and employee satisfaction

Top A&E Departments

In December 2014 the CQC published the results of a large national survey of patients attending Accident and Emergency Departments. The results of this survey were extremely positive and showed Warwick Hospital’s A&E Department rated as number 10 in the country. A further key finding of the survey was that 93% of patients answered yes when asked ‘Overall, did you feel you were treated with respect and dignity while you were in the A&E Department?’ This result placed the Trust as one of the best performing trust’s nationally.

New Recruitment Website

The Trust has launched a website to showcase the benefits of working at South Warwickshire NHS Foundation Trust: www.irecommendswft.com

The website offers job seekers an insight in to what it is like working at the Trust, including; information on the support they can expect, details of specific roles they are recruiting to and an opportunity to find out about the local area. The website also features a video, where prospective employees can find out first hand from staff what it is like working at the Trust.

Alcester Antenatal Clinic

The Trust launched an Obstetric Antenatal Clinic at Alcester Health Centre in October 2014. The new clinic supports the Trust’s Midwifery Service to deliver care closer to home for women living in Alcester and the surrounding areas. Before the introduction of the clinic local women would have to travel to Warwick Hospital if they needed to see a Consultant Obstetrician.

The new Antenatal clinic was the result of the Trust looking at ways to improve their services and make them more accessible for women in South Warwickshire. In addition to having an Obstetric Consultant, the clinic at Alcester Health Centre has a Midwife and there are also facilities for women to have Ultrasound Scans on site.

Data Quality Awards

Throughout 2014/15 the Trust continued their monthly Data Quality Awards. These awards recognise teams or individuals within the Trust that have shown best practice in data quality improvement. Their actions are then shared across the Trust to support improvements in other areas. They receive acknowledgement from Glen Burley, Chief Executive and Nicky Lloyd, Director of Finance and Chair of the Data Quality Committee. The Data Quality Awards highlight the Trust’s commitment throughout 2014/15 to improving data quality across the organisation. Embedding this new focus on data quality supported the successful implementation of Lorenzo.

Annual Clinical Conference

In October 2014 the Trust held its third Annual Clinical Conference, for nurses, midwives and allied health professionals at Warwickshire University.

The theme of the event was Communication, one of the 6Cs, with Courage, Compassion, Commitment, Care and Competency being the other key values. On the day delegates were able to learn all about body language, tone of voice and how to influence behaviour from the key note speaker Graeme Hall. During his corporate career Graeme spent 20 years working as an Operation Manager. Using his experience of working with a wide range of people, Graeme has since become a motivational speaker and developed a Dog Training business; The Dog Father.

Teams from across the Trust also shared how they are using communication to improve patient care. There were also inspiring talks from patients and relatives, as well as students and apprentices sharing their experiences about how good communication has supported their development.

CHKS Top 40 Hospitals

The Trust has been recognised as a ‘Top 40 Hospital’ for the fifth consecutive year in May 2014. The CHKS Top 40 Hospital award is based on 23 key performance indicators of clinical effectiveness, health outcomes, efficiency, patient experience and quality of care.

Smoke Free Sites Policy

The Trust marked National No Smoking Day by launching their Smoke Free Sites campaign on Wednesday 11 March 2015. The purpose of this campaign is to support our staff, patients and members of the public to quit smoking.

This campaign is leading up to all Trust sites going smoke free from 1 January 2016. As part of this work an updated Smoking policy has been drafted and circulated to all staff.

Annual GEM Awards

Previously known as the Star Awards, the Going the Extra Mile (GEM) GEM Awards allow staff as well as patients to nominate staff who they believe has gone above and beyond in their role. The awards are judged in three categories which are:

 GEM Award for clinical staff  GEM Award for non-clinical staff  GEM Award for teams

In September 2014, at the Trust’s Annual Meeting, the first annual Going the Extra Mile (GEM) winners were announced. This is where all of the GEM winners from the previous year are automatically nominated to win the annual award, which is judged against the Trust’s values – Trust, Safe, Effective and Compassionate.

Data Quality is recognised in leading awards

In December 2014 the Trust won the HMFA Governance Award 2014, which was awarded by the Healthcare Finance Managers Association at their Annual Conference.

The Trust won this prestigious national award for the on-going and systematic improvements that large numbers of staff have delivered to the timeliness of data capture across inpatient, outpatient and Community settings. This, alongside the transformation work to help the flow of patients through our services, has helped us to improve our responsiveness to deliver care to patients.

Third Integrated Care Conference

In May 2014 the Trust hosted the 3rd Integrated Care Conference at the Trident Centre, Warwick, in partnership with Arden Commissioning Support and Warwickshire County Council. The day was an opportunity for others to learn more about the successful integrated emergency and elderly care model that has been developed and implemented in Warwickshire. On the day 74 delegates attended from 34 different organisations, including acute hospitals, Clinical Commissioning Groups and local government.

Financial Performance Review

The Trust earned income of £237.6m in 2014/15, a rise of £10.8m (or 4.8%) compared to the previous year (2013/14, £226.8m). Of this, £217.7m arose from patient care activities, with the remaining £19.9m generated as other operating income. The Trust continues to derive the majority (£176.5m or 81%) of its income from Clinical Commissioning Groups. The Trust delivered a surplus of £0.226m in 2014/15, 89% lower than the 2013/14 surplus of £2.1m. The Trust had planned for a lower surplus in 2014/15 to take account of replacing the Patient Administration System.

The Trust has achieved a Continuity of Service Risk Rating (COSRR) rating for the period of 3, in line with our plan and forecast outturn.

Balance Sheet (Statement of Financial Position)

Over the course of the year the Trust has decreased its net assets by £1.656m, or 1.6% from £101m to £99.4m; the net decrease consists of the following:

 £2.061m revaluation loss, reflecting the outcome of the 5 yearly whole estate revaluation by the District Valuer  £0.226m operating surplus for the year

Income by Source

The Trust has continued in 2014/15 with the majority of its income sourced from its main commissioner, South Warwickshire Clinical Commissioning Group. (SWCCG). The chart below shows the split of income by main source:

Warwickshire CCG's Other CCG's NHS England NCA's other

The Trust can confirm that its income from the provision of goods and services for the purposes of the health service in England is greater than its income from the provision of goods and services for any other purpose.

Operating Expenses

The Trust incurred operating expenses of £234.7m in 2014/15, a rise of £11.9m (or 5%) compared to the previous year (2013/14, £222.7m). Pay costs continue to account for the majority of expenditure, with £156.6m (or 67%) in 2014/15 (2013/14, £148m and 67%).

Operating Expenses 2014/15

Pay

Services from other NHS Bodies Purchase of healthcare from Non NHS Bodies Clinical Supplies

General Supplies

Premises (Inc Depreciation/Impairments) CNST

Other

Audit Costs

Capital Expenditure

The Trust planned £11.5m of capital expenditure for 2014/15, however actual spend was £9.9m, with the remainder carried forward to 2015/16. The main items of spend were £4m on the new ward accommodation at Warwick, £3m on the Stratford upon Avon expansion, £1.15m on medical equipment, as well as £0.63m on essential refurbishments and replacements.

The 2015/16 capital program is for £22.4m of expenditure, of which £7.8m will be funded from internally generated resources and £14.6m is to be funded by a loan from the Foundation Trust Financing Facility. The main schemes are £5.6m on new ward accommodation at Warwick and £9.0m on the Stratford upon Avon expansion.

Pension Scheme

Past and present employees are covered by the provisions of the NHS Pensions Scheme. The Scheme is an unfunded, defined benefit scheme that covers NHS employers, General Practices and other bodies, allowed under the direction of the Secretary of State, in England & Wales. The Scheme is not designed to be run in a way that would enable NHS bodies to identify their share of the underlying Scheme assets and liabilities. Therefore, the Scheme is accounted for as if it were a defined contribution scheme: the cost of the NHS body of participating in the Scheme is taken as equal to the contributions payable to the Scheme for the accounting period.

Financial Viability

The Trust continued to experience deflation in prices in 2014/15 as the National Tariff (which governs the prices at which the Trust and all other providers sell their services to commissioners) continued with year on year deflation. This is set against rising costs due to pay and non-pay inflation. The growth in emergency activity, which has been paid for at only 30% of Tariff, has continued to put pressure on the

Trust finances, as not only does the income not generate margin, but the outlying of emergency patients into elective beds can lead to cancellations of full tariff elective activity, which then has to be rescheduled using premium rate, out of hours capacity.

As experienced elsewhere in the NHS, the Trust has seen a reduction in the retained surplus year on year, however, importantly, and unlike many other NHS organisations, it has continued to generate a surplus and plans to generate a further surplus again in 2015/16. The widely reported challenges to NHS finances continue to require a focus on reducing waste, waiting and variation in service delivery and the securing of acceptable contractual arrangements with commissioners.

Reference Cost Index

Each June/July, every NHS Trust and Foundation Trust is required to calculate and submit the unit cost of each activity to the Department of Health (DoH). Costs must be reconciled to the annual Financial Statements. The DoH uses this data to calculate a national average Reference Cost Index. This index informs the Payment by Results (PbR) National Tariff, to determine how much Trusts are paid for carrying out their services. The national Reference Cost Index (RCI) is published each autumn (usually November) by the Department of Health. An RCI of 100 is the national average. Our acute services have consistently been 10% lower than national average for several years, implying that we are a relatively financially efficient provider. The chart below shows the Trust’s RCI performance over the last 4 years (from 2010/11 onwards, Community Services joined the Trust).

120 SWFT RCI 2010/11 - 2013/14 115

110

105 SWFT 100 NHSW (Community 95 services until 2011/12)

90 National Average

80 2010/11 2011/12 2012/13 2013/14

Various work streams and projects continue to run to redesign services for patients to reduce waste, waiting and variation, which in turn lead to reduced costs. The Trust has continued to deliver surpluses, achieved at the planned level, and invest in improvements to facilities, against this challenging backdrop.

Cost Improvement Programme The Cost Improvement Programme (CIP) for 2014/15 was set at £8.7m (2013/14, £7.5m), and of this, £7.71m (or 89%) was achieved recurrently (2013/14 £6.3m achieved). The CIP for 2015/16 is set at £7m.

The deployment of Service Line Reporting and Patient Level Costing has begun, which is starting to further improve engagement with clinicians across the Trust, and assist in reducing waste, waiting and variations in patient care. The Directors can confirm that they have a reasonable expectation that the Trust has adequate resources to continue in operational existence for the foreseeable future, therefore the Board of Directors continue to adopt the ‘going concern’ basis in preparing the accounts. The Directors can also confirm that the income from the provision of goods and services for the National Health Services is greater than income from the provision of services to non NHS areas.

Procurement

Collaborative Procurement is an integral part of our philosophy. The Trust is a member of various collaborative groups, including Health Trust Europe (HTE) Consortium and West Midlands Heads of Procurement Group, and works closely with national procurement organisations such as NHS Supply Chain and Crown Commercial Services. The degree of collaboration and contractual compliance is outlined in the chart below which uses a breakdown of the £27m+ spent with the top 60 procurement suppliers (excluding Pharmacy, Estates & Capital and Healthcare Procurement)

Price Benchmarking

The NHS has recently commenced mandatory benchmarking in the form of the ‘Procurement Atlas of Variation’ which examines the prices paid for a large range of medical and general consumables. The Trust has previously participated in a number of voluntary benchmarking exercises and has been placed in the highest achievement quartile in all three of the new national mandatory exercises. This shows the extent to which the Trust already achieves relatively low prices on buying the most frequently purchased items in the NHS.

Pioneer Savings Group

During 2014/15 the Trust established the Pioneer Savings Group (PSG). This group acts as a strategic forum to analyse any Trust expenditure which does not pass through the trust payroll, with a view to identify opportunities and reduce whole life unit costs, delivering savings while maintaining or improving quality. Chaired by the Director of Finance, PSG has representatives from different areas of the organisation, including IT, Pharmacy, Estates, Procurement and Capital spend, working tirelessly to identify and to reduce Waste, Waiting and Variation. Working closely with the national Procurement expertise and support of the Department of Health, some of the early successes include standardising examination gloves, changing energy broker, and identifying further opportunities for pharmaceutical supply savings. Further work programmes continue and the group has already targeted savings of in excess of £1.2m so far for 2015/16.

E-Procurement Strategy

The Trust has implemented certain elements of a full e-procurement system. The majority of high usage departments use the Trust’s E-Financials (E-Procurement) system to requisition items electronically and 90% of all Orders emanating from the Purchasing Department are sent electronically to suppliers. There is a Trust specific catalogue of 5,000+ products maintained on the system together with an additional 11,000 lines available via the NHS Supplychain web based catalogue. The Trust will shortly have in place a GS1 (Product Coding) and Peppol (Electronic Document) implementation strategy.

The Head of Procurement is Chartered Institute of Purchasing and Supply (CIPS) qualified.

Risks and Uncertainties

There are a number of risks moving forward for the organisation and some of these have also impacted on 2014/15. These include:

 There are a number of trusts that are in difficulties and changes to other local health economies could pose risks to the Trust. Following the decision to stop the procurement process for George Eliot Hospital NHS Trust (GEH) in March 2014 there are still a number of uncertainties around GEH’s financial position and future sustainability. Located close to the Trust’s catchment area is Worcestershire. There has been a review in to the viability of a single acute provider organisation for the county, Worcestershire Acute Services NHS Trust. If this did occur it could lead to reduced functionality at the Alexandra Hospital in Redditch, which is the closest site to South Warwickshire and could impact on our patient flow. The uncertain future of both these hospitals could directly impact the local health economy.

 The above concerns are heightened in the context of the recent approved amendments to the Social Care Bill. These amendments provide the facility for the Trust Special Administrator to impose service reconfiguration solutions into a whole health economy if one party is in financial distress.

 The General Election in May 2015 could result in national and local government changes, which could impact on the way services are delivered nationally and within the local health economy.

 There are national problems for recruiting trained Nursing staff; this is particularly difficult for positions in specialist areas. This issue is felt across the whole of the NHS, as demand is greater than the number of Nurses available. To position the Trust as a strong employer in the local market the Trust has implemented a new marketing campaign. This focuses on engagement with prospective employees and local agents to promote roles. The campaign launched in September 2014 and will continue to support the Trust’s recruitment programme. However, if there continues to be a lack of trained Nurses it will become an increasing risk nationally.

 The Trust continues to work closely with Public Health and District Council planning teams to assess the impact proposed new property developments in Warwick and Stratford that could impact on our health services. The Trust foresees that population growth in these locations, as a result of new housing, will lead to increased demand for our services. To ensure that this will not negatively affect the standard of care we can provide to patients, the Trust is requesting financial contributions from developers to make the necessary capacity to meet demand. In 2014/15 the Trust successfully secured 11 contributions for health services in different localities; however there is a risk that future developments may not contribute to mitigate the impact on health services.

 The creation of the Better Care Fund (BCF) was announced as part of the 2014/15 Operating Framework. BCF requires local areas to formulate a joint plan for integrated health and social care and to set out how a single pooled Better Care Fund budget will be implemented to facilitate closer working between health and social care services. The fund will come into operation from the start of 2015/16. As part of the new framework CCGs will be able to choose one additional indicator that will contribute to the payment-for-performance element of the fund. South Warwickshire CCG recommended to the Health and Wellbeing Board that they use the percentage of people dying in their place of choice as a local measure. Access to the funding will be linked to performance on the national and local outcomes.

 The Trust has opted to introduce the alternative ‘voluntary’ tariff option proposed by NHS England and Monitor in 2015/16. This will continue to pose a financial risk to the Trust as well as an affordability challenge to our main commissioner, South Warwickshire CCG. The main variation in

this tariff is a reduction of the efficiency requirement from 3.8% to 3.5% and a further movement on the marginal rate for emergency admissions which increases the rate to 70% (from 30%) of tariff for all admissions since the ‘baseline’ year of 2008/09. Whilst the Trust has agreed a rebasing of activity above the baseline year, this it still at a lower level than 2014/15 outturn. In addition to this, as the CCG has found the total contract unaffordable the Trust has agreed to pick up the cost of community-based Discharge to Assess beds during 2015/16.

Trends and Factors Affecting the Trust

The elderly population in South Warwickshire is increasing at a greater rate than it is nationally. To support this, the Trust has worked alongside patients, clinicians and partners to develop a plan that has transformed the way care is delivered to older people. This has included introducing new community teams to care for patients in their own homes, re-designed community hospital care to increase productivity and invested in old age specialists within acute hospitals to care for elderly patients. As this increase is expected to continue it is important that the Trust continues to address their needs.

There is set to be an increase in housing within areas of South Warwickshire, particularly in the Stratford District locality. This factor will inevitably have an impact on population growth. Between 2008 and 2012, Stratford District’s GP practices’ list sizes have increased by 1.7% to about 135,000 and it is expected that the Stratford District population will grow between 5-10% over the next ten years. This anticipated population growth will have a direct impact on demand for the Trust’s services. We are addressing this with the development of Stratford Hospital, further details on this project can be found on page 63. The number of patients with long term and complex conditions is growing which in turn impacts on the demand for our services. The Trust must continue to seek new technologies to help this group of patients manage these conditions themselves at home. This is in line with providing care in the most appropriate setting and will help reduce the number of admissions required.

During December 2014 and January 2015 the Trust experienced extremely high demand for services. The national picture showed that some A&E providers were treating patients that could have used alternative services, whereas the majority of our patients were medically unwell and required admission. This trend suggested that some of our patients were leaving symptoms to develop, rather than being treated by GPs, Pharmacists and other health providers, resulting in the need for acute medical care. The Trust continues to work with partner health organisations to educate members of the public about preventative measures and alternatives to A&E. This not only reduces the demand for our services but also ensures that people access the right treatment.

Going forward we are working with Health and Social Care colleagues to gain a greater understanding of the impact that winter pressures had on our teams and we can improve our services to support these pressures in the future.

Partnership/Stakeholders/Key Strategic Relationships

The Trust has close relationships with a variety of stakeholders in order to ensure high- quality care is delivered to the population that the Trust serves. Some of these partnerships, stakeholders and key strategic relationships are from 2014/15 and moving forward into 2015/16 includes:

 The Trust will be developing a strong relationship with the South Warwickshire GP Federation which was developed in December 2014. The Trust very much welcomes this new organisation and will be looking to work together in 2015/16. The Trust would also like to work as closely with General Practitioners (GPs) in North Warwickshire and Rugby going forward.

 One of the key strategic relationships the Trust has is with Warwickshire County Council (WCC). The Trust and WCC are currently working together to explore a more integrated model of delivery for some services; in particular, WCC's Reablement Services and the Trust’s Intermediate Care and Community Emergency Response Team Services.

 There are a number of network arrangements that continue across Coventry and Warwickshire including the Pathology Network and Arden Cancer Network.

 The Trust also continues to build relationships with FT Members by hosting local events in order to ensure the community is represented in the Trust’s decisions. The Trust’s Governors also attend these events so they are able to gather views from Members in order to feedback into the Trust’s future plans.

 The Governors continue to attend a variety of the Trust’s meetings, as well as the quarterly Council of Governors Meeting. During 2014/15 the Governors have been involved in important strategic projects, with Governors sitting on the Stratford Project Board and the Electronic Patient Record Programme Board. For more information on the Trust’s Council of Governors and Membership please see pages 91-112.

 SWFT Clinical Services Ltd is a wholly owned subsidiary of South Warwickshire NHS Foundation Trust which provides the Trust’s dispensing pharmacy services.

 The Trust continues to work closely alongside the three Clinical Commissioning Groups (CCGs) in the area. Our main commissioners are the South Warwickshire Clinical Commissioning Group (SWCCG), the Coventry/Rugby CCG and the North Warwickshire CCG.

 The Trust also works closely with specialist commissioners, including; The National Commissioning Board who provide income, for Acquired Brain Injury inpatient care, cancer services and neonatal critical care. We also work with Children’s Services, Warwickshire County Council, Health Education West Midlands (for the provision of education and training), and other NHS providers (for support services and medical staff recharges).

 We continue to work closely with our Social Care colleagues to ensure patients are receiving care in the most appropriate setting.

 iWantGreatCare (A company providing a patient experience measurement tool) has been working alongside the Trust to collate and analyse patient responses to the NHS Friends and Family test. More information about this can be found in the Quality Report on pages 113-215.

 The Chief Executive attends the Health Overview and Scrutiny Committee to provide updates on developments of the Trust and this is a key relationship moving forward with regards to the Stratford Hospital Development.

 Warwickshire County Council is creating a Better Together Strategic Board which our Chief Executive will be a full member of. This is an opportunity to provide knowledge and contribute to decisions regarding the implementation and review of the Health and Wellbeing strategy for Warwickshire

 The Chief Executive attends Warwickshire County Council’s Health and Wellbeing Board to provide updates on developments of the Trust and gain a greater understand of Health and Wellbeing issues across the whole of Warwickshire.

 Amey are the Trust’s hotel services provider, providing catering, cleaning, portering and security services. From 1 December 2014 Amey started providing Hotel Services to some of the Trust's community sites as well as Warwick and Stratford Hospitals. Amey took on the catering, portering and domestic services for Leamington Spa and Ellen Badger Hospitals. They also started working in some of the Trust's clinics across Warwickshire to deliver domestic services.

 In February 2015 we implemented our new patient administration system, Lorenzo. Computer Systems Contractor (CSC) is the provider of this system and therefore going forward into 2015/16 we will continue our commercial relationship with them.

 We continue to work closely with Warwickshire County Council, promoting public health messages and campaigns, for example; hand washing messages and promoting flu vaccinations.

 We have strong relationships with other local providers, including University Hospitals Coventry and Warwickshire, George Eliot Hospital and the Coventry and Warwickshire Partnership Trust. Going forward the Trust will continue to work closely with other local providers to develop a solution that will provide a sustainable health economy across Warwickshire.

Corporate Activity for the Trust over the last 3 years

Activity 2014/15 2013/14 2012/13

A&E Attendance 66,107 63,563 62,359

First Outpatient Attendances 70,988 67,000 67,046

Follow-up Outpatients 155,675 155,531 153,878 Attendances Non-elective 40,400 35,711 34,349 (Emergency) Admissions Elective (Planned) Inpatient 5,307 4,864 4,209 Admissions Elective (Planned) Day Cases 26,190 25,776 24,945

Births 2,643 2,724 2,975 Community Contacts – Adult 565,268 n/a n/a and Children Services Community Contact - 140,937 n/a n/a Therapies

During 2014/15 the Trust implemented two new systems to record community data, these systems were GAP, a scheduling tool and Lorenzo, a patient administration system. This has impacted on the recording of community contacts and therefore we are unable to show comparable year-on-year figures. Within the 2015/16 annual report we will show comparable data.

The Outpatient numbers below exclude Physiotherapy, Occupational therapy and Dietetics; however these numbers are shown below:

Activity 2014/15 2013/14 2012/13

Therapy - First Outpatient 25,166 22,969 18,640 Appointment

Therapy – Follow up 74,102 66,910 50,118 Outpatient Appointment

Monitor’s Risk rating for the Trust 2014/15

Annual Plan Q1 Q2 Q3 Q4 2014/15 2014/15 2014/15 2014/15 2014/15

Continuity of 3 3 3 3 3 Service Risk (provisional) Rating (from Q3)

Governance Green Green Green Green Green Risk Rating (provisional)

Monitor’s Risk rating for the Trust 2013/14

Annual Plan Q1 Q2 Q3 Q4 2013/14 2013/14 2013/14 2013/14 2013/14 Financial 3 3 3 Risk Rating

- - - 3 3 Continuity of Service Risk Rating (from Q3)

Governance Amber/red Red Narrative Green Green Risk Rating Declared at Failed A&E Monitor was Failed Failed Cancer Risk – A&E target investigating Cancer 62- 62 day (GP target and governance day (GP referral) and RTT target concerns at referral) cancer 2 week the Trust, wait (breast triggered by symptoms) multiple breaches of the A&E target.

Failed - Cancer 62- day (GP referral target, Cancer 2WW Breast, RTT admitted

Serious Untoward Incidents

Since the introduction of electronic incident reporting in November 2012, there has been an overall increase in incident reporting, which has resulted in an increase in reported serious incidents. There have been 167 serious incidents reported to date in the financial year 2014/15. Following investigation, 41 of these incidents were downgraded. The table below illustrates the categories of reported incidents.

When an incident is identified as a potential serious incident, a round table meeting is held with key clinicians and senior managers. This meeting discusses the incident, actions that need to be taken immediately and the level of investigation required. The meeting will also record the information that is given to the patient and their carer’s in line with Duty of Candour requirements. An investigation lead is appointed who will then produce a report once the investigation has been completed. The report focuses on root causes, actions taken as a result of the incident and lessons learnt. The actions are monitored by the Patient Safety team. The root cause analysis report is presented for closure at the relevant assuring committee and the investigation lead is invited to present the report and answer any questions.

The Patient Safety team have made significant achievements over the year and have raised the staff and patient awareness in relation to patient safety. An example of this is the release of a comprehensive monthly patient safety report, accompanied by a newsletter which is made available to all staff on a bi- monthly basis. This includes individual anonymised case studies of incidents where there is learning which may be shared across all specialties. These are also included in the reports to the Divisional Audit and Operational Governance Groups.

Information Governance

Information Governance covers personal and sensitive information relating to patients, service users and employees and also corporate information such as financial and accounting records. As a custodian of confidential information, the Trust is mindful of the need to ensure that there are controls in place to ensure that this information is used, stored and managed in a safe and secure manner and, because the Trust regards information security as a very high priority, it has a series of safeguards in place to enable this.

The Trust utilises the Information Governance Toolkit which is a performance tool produced by the Department of Health (DH) and hosted by the Health and Social Care Information Centre (HSCIC). This Toolkit draws together legislation and central guidance and presents them as a set of standards and information governance requirements against which health and social care organisations must self-assess. The areas covered are:

 Information Governance Management  Confidentiality/Data Protection  Information Security  Clinical Information  Secondary Use Information  Corporate Information

NHS organisations are required to achieve a minimum Level 2 in all requirements in order to gain an overall score of ‘satisfactory’. For the 2014/15 submission (as at 31 March 2015) the Trust is pleased to report that it achieved a satisfactory rating.

In addition, all NHS Organisations are also required to report serious breaches of confidentiality to the Information Commissioner’s Office (ICO), who has the authority to take enforcement action and impose monetary penalties on organisations (of up to £500,000 per breach) for serious breaches of the Data Protection Act 1998.

The Department of Health issued guidance in June 2013: Checklist Guidance for Reporting, Managing and Investigating Information Governance Serious Incidents Requiring Investigation (IG SIRI). It was felt to be essential that all IG SIRIs occurring in Health, Public Health and Adult Social Care services were reported appropriately and handled effectively and, as a consequence, from that date organisations were required to report IG SIRIs to the DH via the IG Toolkit Incident Reporting Tool. As a guide, this meant the reporting of:

• any incident involving the actual or potential failure to meet the requirements of the Data Protection Act 1998 and/or the Common Law of Confidentiality; • the unlawful disclosure or misuse of confidential data, recording or sharing of inaccurate data, information security breaches and inappropriate invasion of people’s privacy; • such personal data breaches which could lead to identity fraud or have other significant impact on individuals; and will • apply irrespective of the media involved and includes both electronic media and paper records.

This IG Incident Reporting Tool was enhanced in October 2014 and the main enhancement enabled organisations, through new functionality, to assess the severity of an incident prior to it being notified to the Information Commissioner’s Office, Department of Health and NHS England. This functionality relates to incidents that appear initially to be classified as a Level 2 (of note, the severity of an incident will be determined by a scale, that is, the number of data subjects affected, and sensitivity factors), but which may not be so classified once the investigation has been concluded. This takes account of the fact that there is no simple definition of a serious incident and what may at first appear to be of a minor importance may, on further investigation, be found to be serious and vice versa. The Trust is pleased to report that no level 2 information governance incidents were reported in 2014/2015.

Freedom of Information (FOI) requests

Total FOIs 13/14 = 359 Total FOIs 14/15 = 421 (This figure represents a 17% increase on the previous year’s requests.)

Subject Access Requests (SARs)

Total SARs 13/14 = 877 (including requests from solicitors, insurance companies, third parties (for children, adults and deceased patients) and other health professionals. Total SARs 14/15 = 1020 (including requests from solicitors, insurance companies, third parties (for children, adults and deceased patients) and other health professionals. During both years, Department of Work & Pensions’ requests have been received, these requests are predominantly requests for medical reports, which are undertaken by the clinician involved in the care of the patient and are not classed as SARs.

This figure represents a 34% increase in the number of requests from the previous year and there continues to be a large number of requests from third parties (either relatives or professionals) and these must be thoroughly checked to ensure that the Trust is compliant with the Data Protection Act 1998 in that it needs to be satisfied that the third party making the request is entitled to act on behalf of the individual and this can include the written consent of the individual concerned or an appropriate Power of Attorney.

Information Governance Successes

The Trust continues to analyse and review the methods by which it provides Information Governance training opportunities for staff, including an off-line Workbook (and Test of Knowledge), onsite face-to-face training and on-line/e-learning across the whole of Warwickshire.

The Information Governance team continue to respond to more Freedom of Information requests and to Subject Access/Access to Health records requests (including requests from patients, relatives/carers, insurance companies, police, other health professionals and solicitors) and requests from the Department of Work & Pensions (DWP) for medical reports.

It is pleasing to note that the Trust has maintained a low level of incidents; nonetheless, the Trust believes that all incidents should be investigated using the principles of the Root Cause Analysis tool in order to understand what the root cause of the incident is and to address that root cause so that future, similar incidents are avoided and, in a number of incidents, to use the Tool as a whole.

IG took the opportunity to share the learning from reported IG-related incidents via the Patient Safety Newsletter, which was launched in Spring 2014. The message communicated generally was one of clarifying that we can all learn from those incidents and near misses as a Trust - whether we need to change our processes to improve our approach to Information Governance, Data Protection and Information Security; whether we need to understand our gaps and vulnerabilities or whether this information will help us formulate IG-related risks for the Trust’s risk registers.

Prompt Payment Code and the Better Payment Practice Code

The Department of Health requires that Trusts pay their non-NHS trade creditors in accordance with the CBI (Confederation of British Industry) Prompt Payment Code and Government Accounting Rules. The Trust’s payment policy is consistent with the CBI Prompt Payment Code and Government Accounting Rules and its measure of compliance is:

2014/15 2013/14 Categories Number £,000 Number £,000

Total Non-NHS trade 52,647 85,836 48,872 72,365 invoices paid in the year

Total Non-NHS trade 43,751 70,657 42,666 60,152 invoices paid within target

Percentage of Non-NHS 83% 82% 87% 83% trade invoices paid within target

Total NHS trade invoices 1,090 19,404 895 16,873 paid in the year

Total NHS trade invoices 847 16,774 720 11,352 paid within target

Percentage of NHS trade 78% 86% 80% 67% invoices paid within target

The Better Payment Practice Code requires the Trust to aim to pay all undisputed invoices by the due date or within 30 days of the receipt of goods or valid invoice, whichever is later. In March 2010 the Trust signed up to the Prompt Payment Code where the Trust will try and ensure that all suppliers are paid within agreed terms.

Payroll Engagements

In 2012/13 the Government highlighted the tax requirements on individuals who had off payroll engagements with an organisation. As a statutory public sector body we are asked to highlight in this report any arrangements we have of this manner and these can be seen in the table below:

Table 1: For all off-payroll engagements as of 31 March 2015, for more than £220 per day and that last for longer than six months No. of existing engagements as of 31 March 2015 0 Of which... No. that have existed for less than one year at time of reporting. 0 No. that have existed for between one and two years at time of reporting. 0 No. that have existed for between two and three years at time of reporting. 0 No. that have existed for between three and four years at time of reporting. 0 No. that have existed for four or more years at time of reporting. 0

Table 2: For all new off-payroll engagements, or those that reached six months in duration, between 1 April 2014 and 31 March 2015, for more than £220 per day and that last for longer than six months

No. of new engagements, or those that reached six months in duration, between 1 April 2014 and 31 March 2015 0 No. of the above which include contractual clauses giving the trust the right to request assurance in relation to income tax and National Insurance obligations 0 No. for whom assurance has been requested 0 Of which... 0 No. for whom assurance has been received 0 No. for whom assurance has not been received 0 No. that have been terminated as a result of assurance not being received. 0

Table 3: For any off-payroll engagements of board members, and/or, senior officials with significant financial responsibility, between 1 April 2014 and 31 March 2015

No. of off-payroll engagements of board members, and/or, senior officials with significant financial responsibility, during the financial 0 year.

Patient Experience Whilst no formal consultation with local groups and other organisations was held in the year, the Trust has continued to seek the views of local groups through a variety of methods. This includes working with the Patient Forum (page 48) together with our Governors and Members (pages 91-112). Staff also work with patients and their families on a local level within their ward/department to make continuous improvements. Evidence of this can be seen in the feedback from the Trust quality inspections that are detailed in the Quality Report (pages 113-215).

Patient Safety and Risk Management

Patient safety is fundamental to the services provided by the Trust and is critical for ensuring patients receive safe and quality care. To ensure Patient safety is monitored closely, the Trust’s Patient Safety Surveillance Group has continued through 2014/15. The group co-ordinates, supports and monitors the implementation of the work programmes and initiatives focussed on the improvement of patient safety. The group also monitors the implementation of patient safety alerts and provides assurance to the Clinical Governance Committee that necessary actions have been taken.

The Trust has developed its patient safety programme and implemented a vast array of initiatives pertinent to patient safety and to drive up standards of quality. The Trust has in place a dedicated ‘patient safety team’ who have responsibility for the delivery and monitoring of patient safety initiatives, which have focussed on incident management, reducing the number of hospital acquired pressure ulcers, reducing the number of falls. The team has continued to review medical records on a twice monthly basis using Global Trigger Tool methodology. This method identifies triggers during a patient’s hospital stay (e.g. blood transfusion). Once the reviewer has recognised a trigger, they then determine if this trigger has caused the patient any harm. The harm events range from temporary harm, to contributing to patient’s death.

The team also coordinate the mortality reviews undertaken by consultants, noting any comments made and identify any trends or patterns that may arise. The team also conduct mortality reviews in relation to any outliers from statistics produced by CQC and Dr Foster. For further information on the Trust patient Safety initiatives, these have been detailed in the Quality Report section which can be found on pages 113-218. Please also refer to the Annual Governance statement on pages 221-234, which gives further assurance around the management of risk across the Trust.

Emergency Planning

NHS Core Standards for Emergency Preparedness, Resilience & Response (EPRR) The NHS Core Standards for Emergency Preparedness, Resilience and response were introduced in September 2013 and all Trusts were required to complete a self-assessment and with documentary evidence attached to ensure compliance. This was completed in July 2014 and results and resulting action plan for addressing areas requiring further work was presented to the Board of Directors in October 2014. All actions will be to be completed by September 2015.

Emergency Preparedness Policy

The Emergency Preparedness Policy is being developed and will provide a strategic framework for the management of emergency preparedness and business continuity at the Trust. It will act as a framework to support the procedures and plans which form the operational measures for the Trust’s emergency response, which include plans for management of Major Incident, Business Continuity, Chemical, Biological, Radiation and Nuclear Plan, Heat wave response, and Pandemic Flu.

Training and exercises

Training during the past year included sessions for executive team, senior managers, on-call managers, medical and nursing staff including students. An e-learning programme is also in development for the coming year. Exercises were held to test business continuity plans and these will be repeated for different staff groups in the coming year.

Managing claims against the Trust

The Trust is committed to managing all clinical and non-clinical claims in accordance with NHS Litigation Authority (NHSLA) requirements.

The NHSLA schemes relevant to the Trust are:

 the Clinical Negligence Scheme for Trusts (CNST) covers clinical negligence claims; and  the Liabilities to Third Parties Scheme (LTPS) and the Property Expenses Scheme (PES) - known collectively as the Risk Pooling Schemes for Trusts (RPST) – cover non clinical risks.

The Trust’s Legal Services Co-ordinator submits monthly reports to the Trust’s Audit and Operational Governance Groups and Risk, Health and Safety Groups detailing new claims, settled or withdrawn claims, and on-going claims. These monthly reports include Lessons Learnt from settled or withdrawn claims. Lessons Learnt from clinical negligence claims are also reported to the Patient Safety Surveillance Committee.

The Trust’s Legal Services Co-ordinator submits an annual report to the confidential section of the Board of Directors' meeting. As well as detailing new claims, settled or withdrawn claims, on-going claims and any Lessons Learnt, this report also provides details of associated costs.

NHSLA Red Amber Green (RAG) ratings for CNST claims

The NHSLA first introduced RAG ratings in 2014/15 to help Trusts understand their claims profiles and the impact their past and current claims experience would have on their scheme contributions.

The RAG ratings compare a Trust's CNST claims experience against other CNST members providing similar care. The comparisons are risk-weighted to allow for the size and activity levels of each member.

Red, Amber or Green ratings are assigned based on the value of claims recently paid, the number of claims recently reported, the total value of known claims including Periodic Payment Orders (PPOs) and the Trust's five year contribution gap (i.e., the difference between the amount paid into the scheme and the amount paid out over five years).

In December 2014 the Trust was rated as follows:

 Value of claims paid: Green  Number of claims reported: Green  Known claims including PPOs: Green  Five year contribution gap: Green

Feedback

The Trust values the feedback of patients and visitors and continues to use patient feedback websites to understand their views, make improvements and celebrate success. The Trust is committed to responding to all patient feedback on the NHS Choices and Patient Opinion websites, as well as ensuring all comments are forwarded to the manager of the appropriate team. The Trust’s Board of Directors and Council of Governors also monitor the comments on these websites.

As a Foundation Trust, we continue to engage with the local community in order to use their views to develop our services and improve patient care. Every year the Trust sends a questionnaire to the Membership base to ask for their views on what the Trust should focus on in the upcoming year. In addition to this, when the Trust is planning larger developments then Members Events are arranged in the local area. During 2014/15, the Trust held a number of Members’ Events including a dedicated event on Stratford-upon-Avon Hospital’s development programme.

The Trust has significantly improved and developed its patient feedback mechanisms and has significantly developed its partnership with iWantGreatCare, who is supporting the Trust to collate and analyse patient responses to the NHS Friends and Family test. The Friends and Family Test asks patients ‘How likely are you to recommend our ward to friends and family if they needed similar care and treatment?’ Patients can either complete a survey card or visit the Trust’s unique iWantGreatCare website to leave feedback on the care they received. The pilot of the project began in the A&E Department and Inpatient wards and as per requirements stipulated by Department of Health, the survey project was rolled out across maternity services and community hospitals. iWantGreatCare provide a monthly report to all ward managers in order for them to monitor their responses and make improvements. The responses are also reported nationally. The survey has enabled the Trust to capture invaluable patient feedback and been a key to improving patients experience during their time at South Warwickshire NHS Foundation Trust. The feedback has driven a number of improvements across the wards and the organisation. Further information detailing the patient experience work and initiatives at the Trust; please see the Quality Report section pages 113-215.

The Trust has been operating community services across Warwickshire for over three years and in October 2014 started a detailed piece of work to understand more about how our key stakeholders feel about these services. We commissioned an independent research company to complete 300 telephone surveys with our community services users and the majority of services scored over 75% for satisfaction levels.

We also surveyed all GPs across Warwickshire to gather feedback on where we could make improvements to our services. A series of staff workshops were then held to discuss this feedback and look at ways to make improvements. As a result of this a range of work stream projects have been set up to move some of the suggestions forward to implementation stage including; partnership working and simplification of services.

The work from these projects will be reported to a new programme board called ‘New Models of Care’. This has been set up to include partners such as the GP federation (please see page 35 for further information about this partnership) to look at new ways of delivering care in the community and will be chaired by Glen Burley, Chief Executive.

Survey Results

National Inpatients Survey Results

The National Inpatient Survey was undertaken by Quality Health for South Warwickshire NHS Foundation Trust between September 2014 and January 2015.

The survey required a sample of 850 inpatients to be drawn from those patients being discharged during June, July, or August 2014 who had had a stay of at least one night in hospital. There were a number of categories of patients excluded from the survey e.g. psychiatric patients and maternity patients.

The target response rate for the survey set nationally was to achieve at least 60% from the usable sample, and the number of usable responses should be at least 500. For the Trust there were 413 completed questionnaires returned from the sample of 850. The final response rate for the Trust was 51% (413 usable responses from a final sample of 810).

Responses to the Trust’s 2014 survey were very positive, with improvements shown in many areas following the results of the 2013 survey. Based on our patients responses, this year the Trust was placed in the top (best) 20% of all participating Trusts for 16 Key areas. These included positive scores for;

 Privacy and dignity in A&E and whilst in hospital  Patients getting assistance to eat at mealtimes  Patients getting understandable answers from Doctors and Nurses  Patients having confidence and trust in Nurses  Staff taking the patients home situation into account when planning discharge  Carers felt they were given enough information to care for their patient

The survey also identified some areas where patients were less satisfied. From this feedback the Trust has identified a number of actions which will be monitored by the Patient Experience group.

We will continue to triangulate the organisation’s staff and patient survey data with that from the Inpatient Survey to identify whether there are any common themes relating to patient experience and quality of care concerns.

For further details on the findings and actions being taken by the Trust, please see the Quality Report pages 113-215.

Friends and Family Test (FFT)

The Friends and Family Test (FFT) aims to provide a simple headline metric which can be a driver in recognising good practice and improvements in the provision of quality care received by NHS patients and service users. Since April 2013, patients have been asked ‘How likely would you recommend hospital wards and A&E departments to their friends and family if they needed similar care or treatment’.

This means every patient in these wards and departments is able to give feedback on the quality of the care they receive, giving hospitals a better understanding of the needs of their patients and enabling improvements. The implementation of the FFT across all NHS services is an integral part of Putting Patients First, NHS England’s Business Plan for 2013/14 – 2015/16, and is designed to help service users, commissioners and practitioners. The Trust was proactive in its implementation programme and successfully rolled out to all areas ahead of the timescales outlined by NHS England. This vital tool enables the Trust to capture patient views and experiences from all services.

From 1 April 2014 to 31 March 2015, a staggering 27,741 patients have participated in the FFT and provided feedback on their experience and 96.5% of those patients would recommend South Warwickshire NHS Foundation Trust. Whilst this is a resounding achievement, the Trust is constantly striving to engage with patients and make necessary improvements from their feedback.

For further details on the Friends and Family Test and actions being taken by the Trust, please see the Quality Report pages 113-215.

Patient Advice Liaison Service (PALS)

PALS is an independent and confidential advice and support service for patients and their relatives/friends. It offers the opportunity to provide information and if appropriate, signposting to other agencies for further help and support. It also offers the opportunity to raise concerns enabling appropriate intervention at an early stage. The service works closely with patients, relatives and staff to identify where the Trust can improve the patient experience.

Patient Information

The Trust holds a monthly ‘Patient Information Group’ meeting to ensure that the information provided to patients, families and carers is written and formatted in a suitable style. The group consists of a range of clinical and non-clinical members of staff, as well as a member of the public who is part of the Patient’s Forum. The patient leaflet is reviewed at this meeting and then reviewed again on a three year basis unless there are any significant changes and then it would be reviewed midway through the period.

During 2014/15 the Patient Information Group was combined with the Clinical Practices Group as they have similar membership and remit.

Complaints

The Trust continues its proactive approach to encourage our patients that we want to hear about their experience as a patient at the Trust. This year the Trust has introduced a new Complaints Policy which is more patient focussed and encourages direct liaison between patients and their families and staff. The Trust feels it is particularly important that the patient can speak to the right member of staff, who knows about the particular service the patient has received. The new policy will ensure that there is effective negotiation of timelines, explanations given when there is delay but most of all that the priority is to provide a satisfactory resolution of complaints made to this Trust. For a full analysis of the Trust’s process and performance in 2014/15, please see the Quality Report pages 113-215.

Patient Forum The Patient Forum has been established for seven years and acts as an independent body of the Trust. The Forum has 15 Members and is always open to new members.

Each member of the Forum is linked with a particular ward so they are a familiar face to the staff on that ward. Some of the Forum’s projects involve carrying out cleanliness inspections, food audits, patient surveys, interviews and observations.

Members of the Forum attend the following Trust meetings:

• Patient Information Group • Patient Safety Surveillance Group

• Patient Experience Group • Car Park Group • Community and Hospital Information Exchange Forum • Amey quarterly meetings • End of Life Strategy meetings • Patient Care Committee • Ethnicity and Diversity Group • Smoke-Free Site Policy Implementation Group

This year the Forum has been involved in the Patient Led Assessment of the Care Environment (PLACE) inspections, the Outpatient Booking surveys and the Council of Governors new Patient Care Committee, to ensure that the Governors are aware of the work of the Forum.

The Chair and Vice Chair of the Forum also meet with Trust Directors on a monthly basis to exchange information and updates on projects.

Volunteers

The Trust’s volunteers continue to play an influential part in all of the Trusts’ hospitals. Warwick Hospital’s volunteers’ scheme sees people aged 18+ assisting in the functioning of the hospital. Whether it is by escorting patients to the correct ward or department, or being a ward volunteer where you talk to patients to help alleviate boredom and loneliness, as well as reading books and magazines with them. We also ask ward volunteers to assist patients with choosing meals, making them drinks or participating in activities with patients. Leamington Spa Hospital also has a volunteer programme. Volunteers hold a variety of roles; including, being part of a ‘buddying scheme’ to speak and play games with patients, as well as maintaining the hospital’s gardens so that patients can go outside during the summer months. Volunteers also assist Leamington Spa Hospital, Ellen Badger Hospital and Stratford-upon-Avon Hospital. For more information on volunteering for the Trust please see our website www.swft.nhs.uk.

Further opportunities are available for students through Kissing it Better. Kissing it Better is a charitable organisation that works with local community members to make a difference to the care of patients.

Community Hospital Information Experience Forum (CHIEF)

As part of the Patient Forum, CHIEF was established which aims to inform other local organisations including Councils and Charities on any developments or services that the Trust is undertaking. The CHIEF meetings have been a significant success with community leaders from local councils and voluntary organisations attending regularly. If you would like to attend these meetings please contact the Membership Officer on 0800 0852471.

Radio Warneford

Radio Warneford is Warwick Hospital’s radio station which broadcasts to the hospital’s inpatients.

League of Friends

Each of our hospitals; Warwick Hospital, Stratford-upon-Avon Hospital, Leamington Spa Hospital and the Ellen Badger Hospital has a League of Friends. The four groups of League of Friends support their hospital by organising fundraising activities to raise additional funds. Over the years, all four of the League of

Friends has raised a significant amount of money which has enabled our hospitals to purchase equipment and resources to enhance the care that patients receive. Fundraising

Fundraising systems are established to enable groups and individuals, who are raising funds for us, to receive support from the Trust. This includes; help with publicising their activities and the appropriate documentation to demonstrate they are legitimately fundraising for a charitable cause and are acting in compliance with the Charities Act. There is also a fundraising presence on the Trust’s website.

The many local fundraisers who give up their time to raise funds for the Trust are making an invaluable difference to the lives of patients. Together with our generous donors, they are helping to provide those special items and equipment that make such a difference to the lives of patients that the NHS is unable to provide.

We are celebrating the success of fundraising and raising the profile of the Trust in this capacity across the local community with the help of local and regional media.

We continue to raise funds for the Central England Rehabilitation Unit (CERU), a new state-of-the-art neuro-rehabilitation facility at Leamington Spa Hospital. The funds raised continue to provide enhancements for CERU. There has been great support for the appeal from members of the public, members of staff and the local media.

The visit in January by HRH The Princess Royal was a great day to show off how fundraising makes a difference. Some of our key fundraisers enjoyed talking to HRH about their involvement and how their fundraising donations have been spent.

In March there was an official opening of the Therapy Garden at Leamington Spa Hospital. Local garden centres and businesses donated items for this project and were invited to take part in a celebration event to mark its opening.

The Stratford Hospital Cancer and Eye Appeal launched in February 2014 to support a new hospital development in Stratford upon Avon. The fundraising appeal aims to raise £1 million to pay for world class facilities and enhancements for new Cancer and Ophthalmology services that have not previously been available in Stratford-upon-Avon.

The appeal has raised £370 000 to date. Our main donation has come from the Rigby Foundation who donated £250 000 to the appeal, enabling the cancer unit at Stratford to be forever known as ‘The Rigby Unit’. A special Stratford Appeal website has been launched (www.stratfordhospital.co.uk).

Thank you to all our supporters who have helped us during the year. All donations are making such a difference to patients and staff. For further information on fundraising please email [email protected]. Workforce

NHS Staff Survey

The national staff survey was released in February 2015 and the results showed that the Trust made further improvements on last year’s already impressive results.

The results show that the Trust are in the top 20% of all trusts nationally for 19 out of 29 categories. The survey which is produced annually by the Department of Health asks NHS staff a variety of questions about their opinions on the Trust they are employed by.

The Trust significantly exceeded the national average for overall staff engagement and in the following areas:  Staff recommendation of the Trust as a place to work or receive treatment  Staff agreeing that their role makes a difference to patients  Job satisfaction and staff motivation at work  Good communication between senior management and staff  Staff agreeing that they are able to contribute towards improvements at work

Response Rate

The Trust’s response rate for the Staff Survey 2014 was 51% which is in the highest 20% of trusts in England.

Top 5 Ranking Scores

2014/15 2013/14 Question Trust National Trust National Trust Average Average improvement/ deterioration Percentage of staff witnessing 29% 34% 26% 33% -3% (the lower potentially the percentage harmful errors, the better) near misses or incidents in last month

Staff job 3.72 3.60 3.71 3.60 +0.01 satisfaction Percentage of staff believing 96% 87% 93% 88% +3% the trust provides equal opportunities for career progression or promotion Percentage of staff reporting 95% 90% 88% 90% +7% errors, near misses or incidents witnessed in the last month Work pressure felt by staff 2.92 3.60 2.91 3.06 +1% (the lower the percentage the better)

Bottom 5 Ranking Scores 2014/15 2013/14 Question Trust National Trust National Trust Action Average Average improvement/ deterioration

Percentage of Continue to raise staff appraised 85% 85% 81% 84% 4% appraisal compliance in last 12 with improved months monitoring systems.

Continue to support line managers with training and coaching in delivering well- structured high quality appraisals that value staff contributions. Percentage of Enhanced analysis of staff agreeing 46% 56% N/A N/A N/A patient feedback now that feedback This was the available. Strategy in from first year this place to implement patients/service question was across the Trust and users is used to asked. through divisional make informed decisions in teams. their directorate/depa Senior operational rtment managers to develop a system of regular feedback review and learning from patient/service users at team meetings.

Explore through staff engagement sessions. Percentage of Investigate sources of staff feeling 28% 26% 21% 28% +7% (the lower pressures within pressure in last the percentage divisions. 3 months to the better) attend work Continue with when feeling centralised unwell recruitment campaign to eliminate vacancies.

Percentage of Rating has improved staff having 65% 63% 58% 60% +7% since last year and is equality and above national diversity training average. E&D in last 12 training recently months reviewed and also now widely available as e-learning. Percentage of Continue to measure staff feeling 78% 77% 82% 79% -4% staffing levels on a satisfied with shift by shift basis to the quality of ensure appropriate work and levels of support. patient care they are able to Explore through 2015 deliver staff engagement sessions.

Action plans

The staff survey report contains a detailed breakdown of each of the key findings by division and occupational staff group. This allows us to produce targeted action plans to address areas of concern. Actions in response to this report will be incorporated into the Trust’s Workforce Action Plan, specific actions for the bottom ranking scores can be found on pages 53-54.

Summary of Performance

The following two grids show the Trust’s Top 5 and Bottom 5 ranking scores in the 2014 survey. The grids also identify the Trust’s improvement/deterioration against last year’s responses.

The Trust scored in the highest category nationally for all five of its Top 5 ranking scores. For 4 of its Bottom 5 ranking scores, the results were above or very close to the national average.

Leadership

The Trust has continued to roll out its internally designed leadership programmes to ensure the embedding of key leadership messages across all staff groups and at all levels of leadership.

By continuing to focus on the Leadership Charter and engaging leadership culture we believe we have succeeded in broadening our leaders' understanding of their crucial role in demonstrating the leadership behaviours needed to engage and motivate their teams to deliver high quality safe effective and compassionate care in line with the Trust Values. In 2014/15 the leadership workshops were extended to include a wider range of clinical and some non-clinical leaders at ward sister and team leader level to further embed the leadership culture across all disciplines. Our leadership results in the 2014 staff survey indicate that this approach has been successful, as staff responses in all areas had improved again, building on our excellent results in 2012 and 2013.

The Trust continues to develop its medical leadership team, ensuring regular opportunities for the wider team to meet to discuss key learning topics and themes. A development programme to support our senior operational leaders has also been put in place which includes 360 appraisals. We have also supported our leaders to participate in key regional and national NHS leadership programmes and initiatives.

Appraisals

Continued improvement in appraisal compliance is recognised in our staff survey results. In particular the Trust was recognised in the 2014 survey for having well-structured appraisals and providing equal opportunity for career progression or promotion. This latter rating was the highest in the country for acute Trusts. The on-going training programme now reflects the importance of Trust values and is endorsed by the Chief Executive in a short video.

Work Experience

Work experience requests have been from Year 10 students, A Level and University students or people wanting career changes. Over 173 work experience placements were offered at South Warwickshire NHS Foundation Trust between 1 April 2013 and 31 March 2015. These included clinical and administration placements within the hospital for Year 10/11 students. This number also included placements for Year 12 and older students. For these students placements are more intense and are catered to their future NHS career choice. The top choice for work experience is shadowing doctors and a ward placement shadowing clinical staff. The department also organised taster days where students that are interested in Pathology and Speech and Language as a career had access to learn simple clinical skills and were given the opportunity to talk to clinical staff about their careers. There were also 19 visits to local schools for career fairs, and career assemblies. We have also organised a Nursing Only Seminar and Midwifery Workshop for aspiring Nurses and Midwives. We have been working closely with the Prince’s Trust to provide an exciting 4 week project for young unemployed people in the local area, 23 candidates have had the opportunity to develop their skills in interviewing, application completion and gain qualifications in First Aid at Work. They also had two week’s work experience in a mixture of clinical and non- clinical departments. The co- ordinator has worked closely with the recruitment team on the HCA assessment day and advised those candidates that were not successful to partake in the Princes Trust scheme.

Apprenticeships

To date the Trust has supported over 130 apprenticeships in clinical and non-clinical areas. This is acknowledged as a valuable means of developing and ‘growing’ a sustainable workforce for the future. There have been a number of successful appointments into permanent roles during the year with post holders now on identified career pathways. We will continue to invest in and support apprentices through on-going structured programmes.

Partnership working within the local health economy

With a commissioned piece of work from Warwickshire South CCG, the Trust has designed and is delivering a ‘look out’ programme in residential and nursing homes. The programme includes a number of key clinical signs to look out for and actions to take in order to reduce the risk of deterioration in residents’ health. The Trust has continued to meet with the Warwickshire Overview and Scrutiny Committee during the year.

Increasing our support of undergraduate and postgraduate students

The Trust has continued to increase its student placements to support our local higher educational institutions, significantly for student nurses. We also continue to provide a wide range of placements including medical students, physiotherapists, occupational therapists, pharmacists, podiatrists, speech and language therapists, dieticians, midwives, radiographers, audiologists, and operating department assistants. Nursing staff that wish to develop into more specialist roles are seconded, for example into health visiting, district nursing and school nursing. We also continue to train over 100 junior doctors in all medical specialties to provide the necessary experience for entry into higher training and general practice.

Internal Communications and Staff Engagement

A weekly e-bulletin (epulse) is sent to all staff and is generated with latest news, developments and events. This is an effective way to communicate messages to all staff in both our hospital and community settings. To compliment this tool, screensavers are developed by the Communications Team to send short messages to staff. The Communications Team have the ability to target screensavers to specific locations and this tool is particularly useful when sending messages to staff that are not computer based.

'Let's Talk' sessions are an opportunity for all staff to have open discussions with the Executive Team. They are hosted by one of the Executive Directors and held monthly; teams are also able to request that 'Let's Talk' is brought to one of their own team meetings. They are held in sites across the whole of Warwickshire and provide staff with an overview of what's happening across the organisation as well as an open forum for conversations about what is affecting teams on a day to day basis. The Rumour Mill is a popular communications tool amongst staff. It allows staff to ask anonymous questions to the Board of Directors. We also send out a quarterly magazine, Pulse to both staff and Members. Internal communications also support a number of patient safety initiatives, health and wellbeing campaigns and business change projects.

In 2014/15,as part of the Trust’s Project 2020 vision there was an internal communications plan to support the engagement of staff and promoting the implementation of Lorenzo. This included; facilitating awareness sessions, communicating key dates and technical information and promoting training. In May 2014 we also launched a ‘Communications Champion’ scheme. This involved recruiting members of our community teams to become a Communications Champion for their base or area. These individuals are responsible for feeding back important information to their colleagues, who can often be in hard to reach areas, and also making the Trust’s Communications Team aware of any activities or messages they need communicating to the organisation.

The Trust also has a corporate Twitter account @nhsswft which staff are encouraged to follow to find out about the Trust’s latest news and developments. Glen Burley, Chief Executive, is an active Twitter user and uses the Trust’s corporate account to personally tweet using #SWFTceo to identify his messages. The following departments within the Trust also have a Twitter account:@swftsustain – updates from the Sustainability Team, @SWFTrecruit – latest job updates, @practiceEdTeam – clinical and educational support to healthcare staff, @SWFT_MedSchool – aimed at the Trust’s medics. In June 2014 the Trust launched a new Twitter profile, @Strathospital – this is specifically to promote the developments at Stratford Hospital and the £1million fundraising appeal.

Recognition Group

The Recognition Group which includes community staff and hospital staff, meet on a monthly basis to promote staff achievements within the Trust. This group facilitate and manage the GEM Awards (Going the Extra Mile). These are where members of the public as well as members of staff to make nominations. All nominations are then reviewed by the Recognition Group and scored against the Trust Values. Each month there are potentially three winners, from the following categories:

 Non-Clinical GEM Award (e.g. Administration staff etc)  Clinical GEM Award (e.g. Nurses, Doctors, AHPs etc)  Team GEM Award (e.g. Nursing team, administrative team etc)

The group were also responsible for organising the Long Service Event which was held in October 2014 and congratulated staff who had worked in the Trust for 20, 25, 30 and 40 years.

The Woods Nurse of the Year 2014 was awarded to Sue Haskins, Cardiology Nurse, for being an essential member of the team who is knowledgeable, caring and friendly to staff and patients alike. Nursing Team of the Year 2014 was presented to Integrated Health Team 9 whose communication and team working has

enabled them to implement a new clinical pathway.

Social, Community and Human Rights

Health and Wellbeing

The Trust takes the health and wellbeing of its staff very seriously. Our health and wellbeing priorities are agreed and delivered in partnership with staff side and members of the Health and Wellbeing Group. The main focus of this group is to;

• Improve staff engagement • Reduce sickness absence • Encourage staff to make healthy life choices • Support clinical staff to act as health champions by communicating Public health priorities

The group develops and supports the implementation of all Health and Well-being related policies, strategies and guidelines as well monitoring and analysing workforce data to ensure resources are targeted effectively. The group have recently signed up to the Department of Health’s national health and well-being pledges which are covered under the Responsibility Deal scheme.

Over the past year, a range of events and campaigns have taken place, supported by internal and external stakeholders including: Public Health; Food for Life Partnership, Master Gardeners, Occupational Health; Learning and Development, the Communications Team; the Chaplaincy Team; our Staff Counselling Service; as well as our Trade Unions. The campaigns were delivered over a 12 month period and were seasonally themed and aligned to national campaigns. They included; • Cycle to Work Scheme • Back care at work and work station workouts campaign • Stop smoking campaign • Health checks for cholesterol, diabetes, blood pressure and BMI • Promotional days where we encouraged healthily eating and drinking • Training to support staff on how to deal with stress • Harvest Days where staff share extra produce they have grown

Smoke free site

A smoke free project group has been established. The group are responsible for agreeing and developing a time specific project plan to support the implementation of the Smoke Free Sites Policy. The implementation will be supported by Warwickshire Public Health, who, alongside the Trust, is working towards a county wide smoke free NHS.

We are looking at promoting screening days in conjunction with existing health and awareness days. For example during Cancer Prevention week in May, we will be sign posting breast screening for eligible staff.

Promoting Equality and Diversity

Over the last 12 months the Trust has continued to work in partnership with key stakeholders in the public and voluntary sector to engage communities across Warwickshire about how we improve patient experience and accessibility to local services. This has included organising a Warwickshire wide Carers Conference in Rugby which was delivered in partnership with Warwickshire County Council. The conference was well attended and raised awareness of the challenges facing carers and highlighted what support and services are available. The event included a number of real life case studies, demonstrating the importance of supporting carers.

As a result of feedback from the event, a number of actions were identified which included; reviewing staff awareness and training, reviewing the Carers Strategy and Carers guidelines to ensure that they are culturally appropriate, accessible and address the concerns of the Carers in our local communities.

Local Special Interest Panel

The Trust’s Local Specialist Interest Panel is made up of key stakeholders and partners from the local community, workforce and the public and voluntary sector. The panel meets each year to independently review and scrutinise the organisation’s progress and performance against its locally developed equality delivery action plan. A new plan is developed each year with actions identified. These actions are aimed at improving patient experience and developing an organisational culture that delivers accessible and culturally appropriate services that are responsive to the needs of the individual.

Promoting Equality and Diversity

Promoting equality and diversity are at the heart of the Trust’s values. We ensure that fairness is exercised in all that we do whether that is in our employment practices or the services we deliver. We will not discriminate on grounds of gender, race, ethnic origin, nationality, national origin, disability, sexual orientation, religion or age. Our patients, their carer’s and our staff deserve the very best we can give them in an environment in which all feel respected, valued and empowered. This includes supporting our staff to focus on delivering high quality accessible services that are responsive to each individual’s needs.

What we have done with our staff….

• The Trust provides annual training to staff which highlights the importance of recognising and appropriately addressing stereotyping, direct and indirect discriminatory behaviour, as well as acknowledging and valuing difference. • Staff are being provided with information through a staff handbook about what support is available to them; including how to access the confidential self-referral counselling service for staff. • The Trust continues to develop local policies, procedures and guidelines for staff in partnership with the local trade unions. • The Trust continues to raise awareness amongst staff on ‘Dignity at Work’ issues and the ‘Whistle Blowing Policy’ through internal communication channels and training sessions. • The Trust, in partnership with external specialists, advice regular audits its main sites to identify how to improve accessibility and remove barriers to those providing and using.

A summary of the Trust’s equality and Diversity data can be seen below:

Reporting Staff Group 2014/15 % 2013/14 % Consultants 134 3.21 132 3.14 Other medical Staff 185 4.44 182 4.33 Qualified Nursing and Midwifery 1478 35.44 1454 34.56 Unqualified Nursing Staff 655 15.71 662 15.74 Qualified Scientific, Therapeutic &Technical Staff 637 15.28 624 14.83 Support Staff - Non Nursing 161 3.86 234 5.56 Managers and Senior Managers 79 1.89 76 1.81 Admin and Estates 796 19.09 783 18.61 All other Staff 45 1.08 60 1.43 Total 4107 4207

Age Band 2014/15 % 2013/14 % 16-24 234 6 205 4.87 25-44 1854 44 1857 44.14 45-64 2001 48 2050 48.73 65+ 81 2 95 2.26

Ethnicity 2014/15 % 2013/14 % White 3550 85.13 3578 85.05 Mixed 58 1.39 53 1.26 Asian or Asian British 328 7.87 357 8.49 Black or Black British 100 2.40 89 2.12 Chinese or other ethnic group 46 1.10 46 1.09 Not disclosed 88 2.11 84 2.00

Gender 2014/15 % 2013/14 %

Female 3583 86 3594 85.43

Male 587 14 613 14.57

Disabled 2014/15 % 2013/14 % No 2893 70 2903 69.00 Not Declared 1179 28 1213 28.83 Yes 98 2 91 2.16

Gender Male Female Executive Directors 2 5 Senior Managers* 14 36 *Senior Managers are classified as any members of staff on Bands 8B, 8C and 8D or on local terms and conditions. Disability Status of Candidates

In the recruitment process, candidates have the opportunity to declare a disability on the application form. During the period of April 2014 to March 2015 we had 14,500 applications for positions and 4% of the applicants declared a disability on their application form, 4% of shortlisted candidates had declared a disability and 4% of those appointed had declared a disability.

The Trust is committed to the ‘Two Ticks’ interview guarantee scheme whereby those applicants who declare that they have a disability and meet the minimum criteria on the person specification are guaranteed an interview for the post.

The Trust has a sickness absence management policy which refers to how we support our employees who have or acquire a disability. We also have a study leave policy and a learning development team who can discuss with employees any additional training they may require to undertake their role within the organisation. Our training policies are equality impact assessed to ensure that no staff group is disadvantaged.

Early retirement on ill health

During 2014/15 there were 0 retirements from the Trust on the grounds of ill health.

Policies

The Trust has a rolling programme for review of its Human Resources policies, in partnership with staff side, through the Joint Negotiation and Consultation Committee Policy Sub Group. All Human Resources policies include a section related to monitoring and compliance. The Joint Negotiation and Consultation Committee receives a twice-yearly report on the application of the Disciplinary, Grievance, Performance and Capability, Sickness Absence Management and Dignity at Work policies.

Sickness Data

7.00

6.00 South Warwickshire NHS Foundation Trust Corporate Division 5.00 Elective Care

4.00 Emergency Care

3.00 Integrated Care Support 2.00

1.00

0.00

We will continue to monitor sickness levels across the Trust by department through the Finance and Performance Executive. Between October 2014 and February 2015, there was a noticeable increase in the numbers of staff who were absent from work because of colds/flu and gastrointestinal problems. This reflects the outbreaks of influenza and norovirus within the Trust during the same period, and which affected staff as well as patients.

During the year, the Trust has continued to develop its plan of health and wellbeing initiatives to support staff in maintaining their own health and wellbeing.

Health and Safety

During 2014/15 the Trust has been actively involved in reviewing its Health and Safety Management system. This has included ensuring appropriate governance arrangements are in place to assure the Trust Board that legal requirements are being met and good health and safety standards for the protection of staff and others are adhered to.

Reporting has continued on the compliance with “Statutory Standards” via the Estates Team being tabled and discussed via the Trust’s Risk Management and Health and Safety Committees. This has helped formulate more work on compliance with controlling the potential for bacterial growth (Legionella) within the Trust’s hot and cold water storage and distribution systems. Lack of adequate control may have serious health effects on vulnerable patients and some staff groups alike. This has been achieved with the input and hard work of the Estates Team and more work is underway to review compliance for other statutory requirements.

Divisional Managers have continued reporting into the Health and Safety Committee on a range of issues, including monitoring of their Division’s health and safety performance.

Further work has also been undertaken with regard to the introduction of recent legislation; Health and Safety (Sharp Instruments in Healthcare) Regulations 2013. This required the Trust to review risk assessments and practices across the Trust. As well as considering the implementation of safer sharps devices incorporating guards or other safety mechanisms for prevention of injury. The Trust continued this through the work of the Safer Needle Action Group (SNAG) led by the Matron of Infection Prevention and Control and the Trust’s Lead Health and Safety Adviser. Much work has been undertaken by members of the group in order for the Trust to assess and consider its approach to the use of safer devices. This work will continue into 2015/16.

Tackling Fraud The Trust’s Local Counter Fraud Specialist (LCFS) works with staff across the Trust to deter, prevent, detect and investigate fraud as appropriate. Close links are maintained with other departments within the Trust, with advice and assistance being provided as necessary. The LCFS has continued to participate in the Trust's induction programme, meeting with new staff to explain his role and make staff aware of how they can share (in confidence) any concerns that they may have about possible fraud or related issues. In addition, publicity material has been distributed throughout the Trust to help raise staff awareness of the role of LCFS and how to contact them. Any issues that the LCFS has become aware of have been looked into, and action taken as appropriate.

The Trust is also participating in the bi-annual National Fraud Initiative (NFI), run by the Audit Commission. This is a large scale data matching exercise that runs across the public sector, and seeks to identify potential fraud and overpayment issues in both central and local government, and in the NHS.

The Trust's anti-fraud arrangements are also subject to external review by NHS Protect, the NHS body that provides strategic leadership and guidance to health bodies in respect of anti-fraud and security management work. An inspection was carried out during the year, and it was felt that robust arrangements were in place within the Trust to prevent, detect and address any fraud or related issues.

Current and Future Developments

Stratford Hospital Work on the new £22 million Stratford Hospital started in December 2014. The build of the new hospital will be done in 2 phases. This first phase will house a cancer services unit on the top floor. This will include 12 chemotherapy treatment chairs, 2 emergency treatment rooms and a range of facilities to support patients such as a complimentary therapy room. It will also include an eye unit on the first floor with 8 outpatient consulting rooms, 3 treatment rooms with associated investigation rooms as well as a dedicated area for children to wait. During this initial phase the ground floor of the new building will be an empty shell initially, however we hope as part of the phase 2 development, to place some diagnostics at Stratford Hospital, for example a new MRI scanner.

Alongside the development work a £1million fundraising appeal has been launched to enhance the environment and services that will be delivered from the new hospital. You can read more about the fundraising appeal on page 50.

Project 2020

Project 2020 is the Trust’s vision for achieving Electronic Patient Records (EPR). The aim is that by 2020 we will have access to integrated electronic health care records wherever and whenever they are required. A key component of Project 2020 is the introduction of Lorenzo, our new patient administration system.

In February 2015 the Trust successfully went live with Lorenzo. Whilst this initial implementation phase was a replacement of the existing patient administration system, there will be more clinical functionality introduced over the next year that will support our paperless vision.

Joint working with Warwickshire County Council (WCC)

Work with Warwickshire County Council (WCC) is underway to develop a joint integrated model of delivery for some services including WCC's Reablement Services and the Trust’s Intermediate Care and Community Emergency Response Team Services. The purpose of this project is to move beyond organisational boundaries, so that staff can work effectively to support patients’ to maintain independence for longer and improve patients’ and carers’ experience by streamlining the services across Warwickshire. The first step for this work has been to recruit a Manager to work between the Trust and WCC to oversee the implementation of the integration project.

New Ward Block at Warwick Hospital

To meet the demand for our services a new ward block is being built at Warwick Hospital. Work on this new three storey building started in August 2014; it is progressing well and is due to be completed in October 2015. To facilitate the new ward block there has been a site reconfiguration, which includes a new office block on Lakin Road. The ground floor will be beds for Trauma Orthopaedics, the first floor will be Elective Orthopaedics and finally the top floor will have a number of single rooms.

Maternity A successful bid for NHS funding for Improving Maternity Care Settings meant that the Trust was able to begin the refurbishment of the Labour Ward at Warwick Hospital. So far we have refurbished the high risk delivery room giving it a home from home feel whilst maintaining the clinical integrity of the facility. The second phase of the refurbishment is now underway with all labour ward corridors being upgraded with new staff bases, utility rooms being refurbished and the creation of an office room. This work is expected to complete in June 2015.

A&E As part of an on-going development of our A&E Department at Warwick Hospital we are upgrading one of the cubicles within the department to provide an anteroom to allow for the treatment of infectious patients and a shower facility for patients within the Department. The upgrade will also relocate the current relatives’ room and provide much needed storage for the department. The plans for this work have now been agreed and costing of the project is underway.

Psychology The success of our Clinical Psychology Department at Warwick Hospital has meant that they have outgrown their current accommodation. Relocation of our IT training room has allowed us to create a space to house three additional clinical rooms within the Clinical Psychology Department and provide a larger, lighter waiting room and refurbished kitchen and toilet for the use of the Department. Once the building work is completed the rest of the Department is to be decorated. The building work is due to complete in April 2015.

Environment and Sustainability

South Warwickshire NHS Foundation Trust recognises our environmental obligations and we are committed to minimising our impact on the local environment and helping to improve it. We are taking significant action to achieve our aims, investing in spend to save schemes and collaborating with local partners to ensure our services and team are fit for the future.

Progress this year

A newly formed Carbon Management Engagement Team manages Sustainability Champions, along with a blog and Twitter feed, engaging Trust staff in new ways. We have run a number of successful awareness campaigns, Bike Week in June and NHS Sustainability Day in March. We offer regular energy saving advice workshops for staff with our solar panel partners Community Energy Warwickshire.

2014 saw a further 60kW of solar panels installed on the roofs of Leamington Spa Hospital and the new Support Services Building at Warwick Hospital, as part of the Solar Powered Hospitals project.

Sustainable Travel Plans have been produced for Warwick, Stratford and Leamington Spa Hospitals. The Travel Plans will help the Trust better manage its fleet, reduce carbon emissions and congestion caused by transport, and help to reduce car parking pressures. As part of this work, we successfully produced over 2504 personalised travel plans to staff and will continue to offer this into 2015/16. These plans also offer car sharing information offered by the Trust’s SWFT Liftshare website to help staff consider alternative travel options.

Carbon Saving Projects 2015/16

2014/15 saw a review of our Carbon Management Plan and its associated carbon saving projects. Following the review, workshops have been held to develop a new Carbon Management Plan to run from 2015/16 to 2020/21. A number of these projects will commence in 2015/16 such as the widespread implementation of LED lighting upgrades.

Project Aim PC Power Management Reduce electricity consumption from IT use Electricity AMR Measure energy use to enable better management installation Display Energy Report energy use Certificates ISO 140001 International accreditation for our environmental management system Lighting Upgrades LED lighting upgrades across our sites Fleet Electrification Review of fleet vehicle use and adding electric vehicles where appropriate. Solar panels on Warwick Reduce grid electricity demand by supplementing with Three Storey Ward cheaper renewable energy development.

Sustainability Strategy

A Sustainable Development Management Plan overarches our sustainability efforts. Our Strategy is underpinned by the five key principles of sustainable development: • living within environmental limits • ensuring a strong, healthy and just society • achieving a sustainable economy • promoting good governance • using sound science responsibly As a significant employer in the region with over 4,000 staff and an estate comprising of four hospitals and several community clinics and health centres, the Trust can make a significant contribution towards the NHS sustainable development agenda. How we deliver our services, manage our facilities and consume resources all impact on the local economy, society and the environment. The attitudes and values of our people also have an important bearing on our performance, reputation and ability to meet targets.

Sustainability Projects completed 2014/15

Project Aim Environmental Encourage better understanding and awareness of how day Sustainability Training to day activity impacts our local environment. Dedicated Car Share Bays Incentive staff to car share to our sites.

Future Projects 2015/16

Project Aim Ensure the goods and services we buy are good not only Procurement Policy for cost benefit analysis but better for society and the environment e.g. using local suppliers for catering. Water management and Manage our water consumption at building level to improve metering our water efficiency

Staff Training – e-learning Ensure staff are aware of their own responsibility to help the Trust achieve sustainability goals and empower staff to make changes for the better. Growing Gardens and Allocate green spaces for staff recreation, food growing and Green Spaces education and promote outdoor activity.

Emissions Report Area Type Financial Year Non-Financial Financial Information Information Greenhouse Gas Scope 1 (Direct) 2754 (Tonnes CO2) Emissions GHG Emissions 14,886,994 (KwH) 2014/15 £529,499 3047 (tonnes CO2)

16,595,073 (kWh) 2013/14 £592,485 Scope 2 (Energy 4127 (tonnes CO2) Indirect) Emissions 8,350,723 (kWh) 2014/15 £929,068 4431(tonnes CO2)

2013/14 8,190.516 (kWh) £842,000 Scope 3 Official Business Travel 2014/15 Not available Not available Emissions 2013/14 Not available Not available Finite Resources Water consumption including licences 2014/15 80,532 (cubic meters) £194,479

2013/14 79,133 (cubic meters) £199,634 Fuel Oil 2014/15 48 tonnes Not available

2013/14 35 tonnes Not available Onsite Energy CHP Generation 2014/15 Not available Not available (kWh) 2013/14 Not available Not available Solar PV 2014/15 93,819 (kWh) Not available 2013/14

59,819 (kWh) Not available

Directors’ Report

Statement of Disclosure to the Auditor

Each of the individuals that were a director at the date of this report has confirmed that:

So far as the director is aware, there is no relevant audit information of which the NHS Foundation Trust’s auditor is unaware; and the 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 and to establish that the NHS foundation trust’s auditor is aware of that information.

Board Composition

Strategic Report Summary

The Strategic Report provides a comprehensive review of the Trust’s development and performance during 2014/15. The purpose of the Strategic Report is to inform readers of the accounts and to help them to assess how the Trust has performed during the year. The report includes information on any important events that have affected the Trust (pages 23-27). It also includes an indication of any future developments which could impact on the Trust (page 63-64), information relating to communicating and consulting with employees (page 56) and an Emissions Report detailing Greenhouse Gas Emissions, Finite Resources, Onsite Energy Generation and Waste Minimisation and Management (page 67).

Board Composition

The Board of Directors comprises a Non-Executive Chairman, six other Non-Executive Directors and six Executive Directors all with voting rights, one of whom is the Chief Executive.

In attendance at Board meetings, without voting rights, were the Director of Human Resources and the Trust Secretary.

Appointment and Roles

The key Non-Executive roles within the Board are as follows:

• Chairman – Graham Murrell (extended from 1 March 2014 to 31 May 2015) • Vice-Chairman and Senior Independent Director – Alan Harrison (appointed for a further 12-month term to November 2015) • Audit Committee Chair – Rosemary Hyde (appointed for a 3-year term to 31 December 2016)

Board Statements

The Board considers its board statements on a quarterly basis in association with the relevant quarter return and certifies these statements or not as appropriate.

Board Member Profiles

Graham Murrell - Chairman Glen Burley - Chief Executive Graham was appointed Chair of Glen began his NHS career in 1983 as South Warwickshire General a finance trainee, qualifying as a Hospitals NHS Trust in 2006, and Chartered Public Finance Accountant became the first Chair of the in 1990. After reaching the position of Foundation Trust in 2010. Director of Finance for South After working initially in scientific Warwickshire Mental Health Services research, he pursued a career in business for 30 NHS Trust, he moved into an acute operational role years. He held senior management positions with when he became Director of Operations for the Boots The Chemists and Halfords, gaining Surgical Division of University Hospitals Coventry and specialist expertise in supply chain management, Warwickshire NHS Trust. In 2003 he was appointed business systems and project management. He as Deputy Chief Executive to Worcestershire Acute was a member of Halfords’ executive board and Hospitals NHS Trust and joined South Warwickshire in strategic planning team. 2006, initially as interim Chief Executive. Since his Graham became an independent business formal appointment in 2008 the Trust has developed consultant in 2004. He is vice chairman and a its local and national reputation moving through trustee of a voluntary-sector residential centre for financial turnaround, achieving Foundation Trust disabled people status in 2010, and in 2011 completing the successful acquisition of Warwickshire Community Services. Term of Appointment: From 1 March 2011 to 31 May 2015 Declared Interests: No personal interests. Spouse Declared Interests: Director and Vice-Chair of is Governor at Myton School and Practice Nurse at Trustees at Castel Froma Ltd (Honorary) and Rother House, Medical Centre Non-Executive Director of Acorns Children’s Hospice Trading Ltd (Honorary).

Dr Mandeep Mudhar - Non-Executive Director Tony Boorman - Non-Executive Director Mandeep is a qualified pharmacist and has been a Tony is currently Chief Ombudsman lecturer at Aston University in and Chief Executive at the Financial Pharmacy Practice. Mandeep also Ombudsman, appearing has a PhD research degree looking regularly on TV and radio at Pharmacy Education and Pre- programmes dealing with consumer registration Training in the UK. and financial issues. Prior to joining Mandeep got his PhD in 1998 and the Ombudsman Service in 2000 then joined AAH Pharmaceuticals Tony was Managing Director of in 1998 as Professional services Ofgem. Tony was previously a commissioner for manager. Mandeep’s most recent judicial appointments overseeing the process used to role has been at The Co-operative Pharmacy appoint judges across England and Wales. Tony where he was a board director as Head of joined the Trust as a Non- Executive Director in 2007. Business development. Mandeep left the Co-op in June 2013 and is now a consultant to the Term of Appointment: until 31 November 2015 pharmaceutical industry. Mandeep joined the Trust Declared Interests: Director of SWFT Clinical Services as a Non-Executive Director in January 2014. Ltd, a wholly owned subsidiary of South Warwickshire NHS Foundation Trust. Term of Appointment: until 31 December 2017 Spouse is a partner in Thinkvivid & Talking Declared Interests: Director of Marketing for Matters Ltd and a Governor of Warwickshire Numark. Assistant Director of the Pharmacists college Defence Association.

Dr Angela Brady Rosemary Hyde Non-Executive Director Non-Executive Director Angela is a GP and brings clinical Rosemary is a Chartered expertise to the board. Angela also Accountant, and a former partner has a master’s degree in Medical with PricewaterhouseCoopers. She Leadership, as well as extensive left the partnership in 2001, since knowledge regarding patient safety then she had built up a portfolio and improving local services. career, combining community roles Angela joined the Trust as a Non- with part time finance director and Executive Director in January 2014. consulting assignments, and non Executive roles. Rosemary joined the Term of Appointment: until 31 December 2017 Trust as a Non- Executive Director in January 2014. Declared Interests: County Councillor for Term of Appointment: until 31 December 2017 Warwick South (under the name of Angela Declared Interests: Director and Shareholder of Warner), Chair of the Smokefree Warwickshire RPR Consultants Ltd, Trustee of Stratford upon Alliance, Member of the Conservative Party, Avon Arts House Trust, Director of Stratford upon Employed GP at Budbrooke Medical Centre, Avon Arts House (Trading) Ltd. Part-owner of Lisle Court Medical Centre, Spouse is Director and Shareholder of Brian Hyde Spouse is a GP partner at Croft Medical Centre. Ltd, Spouse is Director of RPR Consultants Ltd, Spouse is a Board Member of Homes and Communities Agency.

Dr Alan Harrison Bruce Paxton Non-Executive Director Non-Executive Director Alan was appointed as a Non- Executive Director in December Bruce graduated from Bristol University 2007 and Vice-Chair of the Trust with a BSc (Hons) in engineering in in 2010. He is currently Chairman 1975 and joined Unilever’s packaging of the Staffordshire and West business in the UK. After several jobs Midlands with the ice cream business and head Probation Trust having overseen offices, he moved to a leadership role with United the merger of the two probation areas and their Biscuits. His first factory manager role was running a successful bid for Trust status. Alan became the microbiologically secure chocolate refinery, followed first Chief Executive of England Athletics, and was by an operations development remit across five responsible for setting up the new governing body factories in four European countries. After time as a for the sport. He has also worked closely with business unit general manager and in a strategic disabled people and a range of charitable development role, Bruce joined PepsiCo’s snacks organisations. He spent his early career with business in the UK, Walkers. This rapidly expanded in Courtaulds plc as a research scientist and an operations role across more than a dozen following a succession of senior management countries, adding facilities and capacity with a team roles, set up Courtaulds Specialty Fibres with its based in five countries. focus on the medical sector. He has managed a number of business turnarounds and led a More recently, Bruce has been managing director of a worldwide business improvement programme for machinery business supplying the pharmaceutical, Courtaulds Fibres. food and healthcare devices sectors. He retired from full-time business late in 2011, and now supplies Term of Appointment: until 30 November 2015 strategic advice part-time to sectors such as packaged Declared Interests: Director of the Albatross goods, technology development and engineering. Arts Project Ltd, Chairman of Fry Housing Trust and Justice of the Peace. Term of Appointment: until 31 January 2016 Declared Interests: Spouse is an employee of the Trust, lay member on the Admissions Steering Group at Warwick Medical School.

Jayne Blacklay Jane Ives Director of Development and Director of Operations Deputy Chief Executive Jane trained as a registered general Jayne trained as a pharmacist and nurse and gained clinical experience on worked at Warwick Hospital for a a renal unit as well as general medicine number of years before moving to and intensive care. Jane has held the post of Performance Manager director roles at City Hospital in in 2000. Birmingham and at the Royal She took over as Acting Director of Orthopaedic Hospital in Birmingham Modernisation and Performance Management in and has been Director of Nursing at this 2002 and then moved on to be Director of Service Trust since 2003 taking responsibility Development and Performance Management in for the operations portfolio from 2005. Since 2011 2003. Jayne also took twelve months sabbatical Jane has been Director of Operations. leave in 2004 to undertake voluntary work in Ghana. Declared Interests: Company Secretary, Wiper Blades Ltd. Declared Interests: Director of SWFT Clinical Services Ltd, a wholly owned subsidiary of South Warwickshire NHS Foundation Trust. Spouse is a partner of Warwick Surgical Partners. Helen Lancaster Director of Nursing Dr Charles Ashton Helen was appointed as the new Director of Medical Director Nursing for South Warwickshire Charles joined the Trust from NHS Foundation Trust on 1 Worcester Acute Hospitals NHS January 2011. Helen has worked Trust, where he held the post of in the Trust for over 8 years. Medical Director for 14 years. From Previously the Associate Director a clinical perspective Dr Ashton was of Nursing, Helen also recently a Consultant Physician with a worked at the Department of special interest in care of the elderly, Health as the development lead stroke and clinical pharmacology. As for ‘patient and service user well as the acute sector he has experience’. Helen started in the NHS as a student worked in stroke rehabilitation at Evesham community nurse and later trained as a midwife at University hospital and has also worked closely with primary care Hospitals of Leicester. She has held a number of providing clinics at local health centres. Board level positions across the Midlands. Helen is Declared Interests: Member of the Solihull CCG the Trust’s lead for a number of areas including Governing Body. single sex accommodation, safeguarding children and adults, privacy and dignity, quality of care and clinical governance, infection prevention and control, and patient experience.

Declared Interests: No personal interests. Spouse was a Director of Lighting Plus (previous contractor to the Trust) and is now a Business Development Executive for Danlers Lighting Controls.

Nicky Lloyd Director of Finance Nicky qualified with Touche Ross in Birmingham and is a Fellow of the Institute of Chartered Accountants in England and Wales. She was chosen to join the fast track Strategic Exchange Program with Deloitte and Touche in Philadelphia, USA, where she qualified as a Certified Public Accountant. On returning to the UK, Nicky joined Rover Group, with senior roles in Internal Audit, Manufacturing Finance and as Director of Finance at Rover Group Belux, based in Brussels. She has held a variety of senior NHS roles, including Chair of Good Hope Hospital, Non-Executive Director of Birmingham East and North Primary Care Trust and Associate Director of Finance at Walsall Healthcare NHS Trust.

Declared Interests: Chair of Governors and Charity Trustee at Sutton Coldfield Grammar School for Girls, Brother-in-law works for 3M Healthcare.

The Register of Interests is available on the Trust’s website or by writing to the Trust Secretary.

**Please note that Nicky Lloyd, Director of Finance resigned from her post in May 2015. David Harding has taken the role of interim Director of Finance.

Mandeep Mudhar also resigned from his post as Non-Executive Director in May 2015.

Executive Structure 2014/15

Meg Lambert Trust Secretary Glen Burley, Chief Executive Danny Roberts Chief Technology Officer

Jayne Blacklay Ann Pope Nicky Lloyd Helen Lancaster Director of Development Jane Ives Charles Ashton Director of Human Director of Finance Director of Nursing and Deputy Chief Director of Operations Medical Director Executive Resources

Associate Directors of HR Management Operations Financial Management Matrons Organisational Business Planning Estates & Facilities Financial Services Infection Prevention & Development Service Improvement Associate Medical Control Information & Computer Occupational Health Information & Technology Directors (x8) Contracting Supplies Capital Planning Risk Management Equality & Diversity Caldicott Guardian Marketing & Business Senior Informaton Risk Internal and External Clinical Governance Officer Training & Education Audit Development Patient Experience Payroll Communications

Anne Coyle Claire Hinds Rosemary Garner Simon Illingworth Associate Director of Associate Director of Associate Director of Operations- Associate Director of Operations - Integrated Operations - Support Emergency Care Operations - Elective Care Care Services

Foundation Trust Code of Governance – Disclosure of Corporate Governance Arrangements The NHS Foundation Trust Code of Governance is issued by Monitor as best practice advice for Foundations Trusts, under the principle of ‘comply or explain’. Trusts are therefore expected to comply with its provisions unless there are justifiable reasons not to.

South Warwickshire 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.

Statutory Requirements

The Code of Governance contains a number of statutory requirements, which the Trust is complaint with and do not require disclosure statements in the Annual report.

Provisions Requiring a Supporting Explanation

The Code of Governance contains a number of provisions that requires the Trust to give a supporting explanation whether the Trust is complaint or not. The relevant disclosure statements are detailed below.

Balance, Completeness and Appropriateness of the Board of Directors

As previously stated the Board of Directors comprises both Non-Executive and Executive Directors. The Executive Directors comprise the Chief Executive, Director of Finance, Medical Director, Director of Development/Deputy Chief Executive, Director of Operations and Director of Nursing.

The Non-Executive Directors comprise two appointments with financial expertise: one of whom is a qualified Accountant, three with business expertise, and one who is a Registered GP and local councillor. The Chairman has a private sector management background.

Taking the wide range of experience of the Board of Directors as a whole, the balance and completeness of the Board is felt to be appropriate.

Statement of Operation of the Board of Directors and Council of Governors

The primary role of the Board of Directors is to lead the Trust within the context of its Strategy, whilst ensuring successful financial stewardship of the organisation. In order to achieve this, the Board receives regular reports on all aspects of its business to enable appropriate decisions to be taken. In addition the Board has a schedule of reserved decisions, which lists out those decisions which only the Board can make and a scheme of delegation which details those areas of responsibility delegated to committees and individual Directors/Managers.

One of the key roles of the Council of Governors is to oversee the work of the Board. The Board and Council have therefore agreed a statement that defines how each will operate and how any disagreements will be resolved.

Independence of the Non-Executive Directors

The Board reviewed the independence of the Non-Executive Directors (including the Chair) at its meeting on 25 March 2015 and took the view that 5 out of the seven Non-Executive Directors (including the

Chairman) could be deemed independent. Bruce Paxton (Non-Executive Director) was deemed not to be fully independent; as his partner is a Consultant at the Trust. Dr Angela Brady (Non-Executive Director) was deemed not to be fully independent as she is a County Councillor (under the name of Angela Warner) and the Trust has a material business relationship with Warwickshire County Council. Both these interests are declared in the Directors’ Register of Interests and should any conflict arise both parties would be excluded from any discussion and decision relating to the matter in question.

As for all Board Members, Non-Executive Directors declare their interests in the Register of Directors’ Interests, which is available on the Trust’s website and in paper form from the Trust Secretary. Any conflicts arising would be handled as above.

Board of Directors Meetings and attendance

From 1 April 2014 to 31 March 2015, the Board of Directors met in both private and public sessions on a monthly basis (except in December 2014). An attendance record of the Board meetings can be found on pages 85-86.

Meetings of the Non-Executive Directors

In accordance with the Foundation Trust Code of Governance, the Chair and Non-Executive Directors have continued to meet outside of the normal Board meetings during 2014/15, with the Chief Executive in attendance as requested.

Appointment and Removal of Non-Executive Directors

In accordance with the Trust’s Constitution, the Council of Governors has the power to appoint and remove the Chair and Non-Executive Directors of the Trust. Although authority for the final decision cannot be delegated, much of the business of appointment or removal is carried out by the Council’s Nominations and Remuneration Committee.

The process for the appointment of the Chair and Non-Executive Directors has recently been revised by the Nominations and Remuneration Committee and Council of Governors. In accordance with the Foundation Trust Code of Governance, incumbents are offered the opportunity to stand for two 3-year terms provided their performance is good, following which positions are subject to open recruitment.

Trust Secretary

Meg Lambert was appointed as Trust Secretary in August 2007 and is also Secretary to the Council of Governors. Meg is a chartered secretary, holds a Masters in Public Administration (MPA) from the University of Warwick and is an Associate Member of the Institute of Chartered Secretaries and Administrators.

Significant Commitments of the Trust Chairman

Mr Graham Murrell, Trust Chairman, had no other significant commitments other than to the Foundation Trust.

Constitution

During the year the Board and Council of Governors reviewed and amended the Trust’s Constitution, including a general update, an expansion of the public constituency areas, and an update of the membership categories. The Constitution can be found on the Trust’s website.

Directors’ Remuneration

The Appointments and Remuneration Committee of the Board of Directors is responsible for setting the remuneration of the Executive Directors. Full details of the Directors’ remuneration are set out on page 87. The Nominations and Remuneration Committee of the Council of Governors is responsible for setting the remuneration of the Chairman and Non-Executive Directors.

Performance Evaluation of the Board, Directors and Committees

The Chairman is responsible for the appraisal of the Non-Executive Directors and the Senior Independent Director is responsible for the appraisal of the chairman in association with the Council of Governors. The Chief Executive is responsible for the appraisal of the Executive Directors, with the Chairman appraising the Chief Executive and these appraisals are reported to the Appointments and Remuneration Committee.

During the year a preliminary assessment against Monitor’s ‘Well Led’ Framework was undertaken by the Trust’s internal auditors and the Board felt it appropriate to use this assessment as the basis for the review of Board effectiveness in 2014/15.

Board Effectiveness

The above review provided the Board with valuable assurance of high standards of governance overall, with numerous examples of good practice. It also identified several areas where improved arrangements could further strengthen board effectiveness. The latter include some useful new pointers as well as some that have been noted by the Board from previous reviews, which are currently being progressed.

The Audit Committee has also undertaken a self-assessment of its performance in line with the provisions of the latest NHS Audit Committee Handbook.

Council of Governors – Directors’ Attendance

The Chief Executive, Director of Finance, Director of Operations and Director of Nursing attend all Council of Governors meetings, and other Executive Directors of the Trust attend Council meetings as required. At each Council meeting one of the Non-Executive Directors is invited to introduce themselves and talk about their role. There is an open invitation for the other Non-Executive Directors to attend.

During 2014/15 the Governors have not exercised their power under paragraph 10C of Schedule 7 to the NHS Act 2006 to formally require one or more of the Directors to attend a governors’ meeting for the purpose of obtaining information about the Trust’s performance of its functions or the Directors’ performance of their duties.

Board Communication with Governors

During the year the Board and in particular the Non-Executive Directors, have ensured that they are aware of the views of the Governors and Members through a number of activities, including:

• Two round table meetings between the Board of Directors and the Council of Governors • Attendance by the Non-Executive Directors and Executive Directors at Council meetings • Attendance by Board Members at the Members’ events, held throughout Warwickshire • Attendance by Governors at the Board of Directors meetings, including an opportunity to ask questions • Consideration of reports from Council meetings at Board meeting • Non-Executive Director attendance at the Governors Finance and Performance Committee • Informal meetings between the Governors, Chair and Non-Executive Directors before each Board of Directors meeting. • Establishment of time limited Governor engagement groups on key topics that would benefit from more detailed Governor consideration and discussion, led by the Director of Development.

Accounts 2014/15

The accounts for the accounting period 1 April 2014 to 31 March 2015 have been prepared by South Warwickshire NHS Foundation Trust in accordance with paragraphs 24 and 25 of Schedule 7 of the National Health Services Act 2006 in the form which the Independent Regulator of NHS Foundation Trusts (Monitor) has, with the approval of the treasury, directed.

Quality Governance

A description of the Trust’s arrangements in relation to Quality Governance is included in the Strategic Report on page 22.

Financial Instruments

The Trust’s use of financial instruments is in note 31 of the Annual Accounts.

Board Committees

The Board has three Committees: the Audit Committee, Clinical Governance Committee and the Appointments and Remuneration Committee.

Audit Committee

Remit - The Audit Committee provides the Board with assurance on the establishment and maintenance of an effective system of integrated governance, risk management and internal control. It is advised and supported by representatives from Deloitte (the Trust’s external auditor), CW Audit Services (the trust’s internal auditor), a representative from CW Counter Fraud Services (the Trust’s Local Counter Fraud Specialist) and the Director of Finance and Trust Secretary.

The Audit Committee has considered two broad areas of risk during the year, concerning; financial systems that underpin the financial processing and reporting of the organisation and also work driven largely by the principal risk areas identified in the Board Assurance Framework (BAF), as follows:

 financial management (budget setting and financial reporting and delivery) – significant assurance  budget setting and CIP – significant assurance  creditors – significant assurance  income and debtors – significant assurance  treasury management – significant assurance  contracted out payroll – significant assurance  charitable funds – significant assurance  asset management – significant assurance  project health check – new wards – significant assurance  project health check – Stratford – significant assurance  project health check – SLR – significant assurance  whistle blowing – significant assurance  safeguarding – significant assurance  car parking – significant assurance  medicines management – significant assurance  maternity activity data quality – significant assurance

Action plans have been agreed as appropriate and the implementation of these plans will continue to be monitored by the internal auditors over the coming months. In addition all outstanding audit actions are reported at each meeting of the Audit Committee and the Committee takes a proactive approach to monitoring the outstanding actions and requesting follow up audits where there are areas of concern.

In light of the above the Internal Auditors reported to the Audit Committee on 8 April 2015 that significant assurance could be given that the Trust had a general sound system of internal control.

External Audit - External Audit Services are provided by Deloitte, who were appointed by the Council of Governors, following a full competitive tender exercise, in April/May 2012. The tender process was led by a working group, comprising Audit Committee members, Governors and members of Trust staff, who agreed the audit specification, and evaluated all submitted tenders. The group also interviewed each tenderer in order to further test their suitability to the Trust. The group’s recommendation to appoint Deloitte was presented to the Council of Governors who made the final decision.

The Audit Committee assesses the effectiveness of the external audit process through the progress reports they submit to each Committee meeting and through key performance indicators. Deloitte has provided the Trust with tax advice as a non-audit service in 2014/15.

The Auditor’s fee for the period 1 April 2014 – 31 March 2015 was a total of £61,000. This includes the work for the external audit and the work on the Quality Accounts.

Internal Audit - The Trust has an internal audit function which is provided by CW Audit Services. The Audit Committee, advised by the Director of Finance, agrees a plan of work for internal audit, with a defined number of days’ work. As the year progresses internal audit present their findings of the audits into each of the areas listed in the plan. Audit Committee monitors management response to the recommendations and actively reviews outstanding actions.

Committee Membership - Membership and attendance of the Audit Committee during 2014/15 is indicated in table below.

Member No. of meetings No. of attendances

Bruce Paxton 7 7 Tony Boorman 7 6 Rosemary Hyde (Chair) 7 7

Mandeep Mudhar 7 7

Clinical Governance Committee

Remit - The Clinical Governance Committee provides the Board with assurance on clinical governance and compliance with related national standards and local objectives. Membership and attendance during 2013/14 of the Committee is indicated in the table below. Member No. of meetings No. of attendances

Alan Harrison 12 10

Bruce Paxton (Chair) 12 10

Dr Angela Brady 12 10

Appointments and Remuneration Committee

Remit - This committee advises the Board on the remuneration and terms of service of the Chief Executive and Executive Directors, and monitors and evaluates their performance. It is also responsible for the appointment of the Chief Executive in conjunction with the Council or Governors. The Trust Secretary provides advice in relation to governance and administrative support to the committee. The Director of Human Resources provides professional HR support and advice, and the Chief Executive also attends this committee. Information to support discussion and decisions around Senior Managers (i.e. Executives) pay is taken from benchmarking exercises undertaken by NHS Providers. This data looks at roles in relation to headcount and turnover of Foundation Trusts. The committee uses data from Trusts of a similar size as a benchmark for these discussions.

The remuneration for the most senior managers within the organisation is also considered. No performance related payments were made during the year and all Executive Directors are on substantive contracts with a 3 month notice period. There have been no termination payments but contracts do allow for notice to be paid in lieu.

During 2014/15 there have been no significant awards made to past senior managers. There are no plans for Directors remuneration policy changes in 2015/16. . Membership and attendance at the committee is indicated in the table below.

Member No. of meetings No. of attendances Bruce Paxton 3 3 Tony Boorman 3 1 Alan Harrison 3 3 Graham Murrell (Chair) 3 3 Angela Brady 3 1 Mandeep Mudhar 3 2 Rosemary Hyde 3 2

Terms of Reference

The Board of Directors has approved all Committee terms of reference, and these are reviewed on a regular basis, and amended as and when required.

Provisions Requiring Supporting Information to be made Publicly Available

The Trust is required to make the following information available to the public and does so either on its website or by request:

 Objectives of the Trust – on the website

 A description of each Director’s expertise and experience – contained in the Board profile section and on the Trust’s website

 Clear statement of the Board’s balance, completeness and appropriateness – contained in this chapter

 Main role of the Appointments and Remuneration Committee and the Nominations and Remuneration Committee – contained in this chapter and in the chapter on the Council of Governors. Terms of reference, available on request.

 Membership Strategy – available of the website and on request.

 Contact arrangements for Directors and Governors – available on the website Provisions Requiring Supporting Information to be made Available to Governors

The Trust is required to make the following information available to Governors and does so through the Nominations and Remuneration Committee:  For any Non-Executive Director seeking re-appointment a report from the Chairman confirming the effectiveness of their performance and their commitment to the role.

Provisions Requiring Supporting Information to be made Available to Members

The Trust is required to make the following information available to Members and does so in the voting packs issued to Members during the course of the election process for any elected Governor position:  Biographical details and other relevant information of those members submitting themselves for election/re-election.

Other Provisions For the other provisions of the Code of Governance there are no special disclosure requirements and the Trust is required to ‘comply’ or ‘explain’. The Board therefore reviewed these provisions of the Code at its meeting on 29 April 2015 and has confirmed its compliance, with the following exceptions, for which an explanation is provided:

Provision B.1.2 - At least half the Board of Directors, excluding the Chairman, should comprise non- executive directors determined by the Board to be independent. At the Board meeting on 25 March 2015, the Board reviewed the independence status of the Non- Executive Directors (NEDs) and agreed that of the six (excluding the Chair), four were independent and two were not, as follows:

Mr Bruce Paxton – not independent, as his wife is a senior employee (Consultant) of the Trust, and Dr Angela Brady – not independent, as Dr Brady is a County Councillor (under the name of Angela Warner) and the Trust does have a material business relationship with Warwickshire County Council.

Should any conflict of interest arise during Board business, this would be managed in the usual way through withdrawal from any relevant discussions, in accordance with the Trust’s Constitution.

Board and Committee Membership

Members Audit Clinical Appointments No. of No. of Board Committee Governance and Board of of Directors remuneration Directors meetings committee meetings attended

Graham Murrell ✓Chair 11 10 Chairman

Tony Boorman ✓ ✓ ✓ 11 10 Non Executive Director

Alan Harrison ✓ ✓ 11 10 Non Executive Director

Bruce Paxton ✓ ✓Chair ✓ 11 10 Non Executive Director

Rosemary Hyde ✓Chair ✓ 11 10 Non Executive Director

Dr Angela Brady ✓ ✓ 11 11 Non Executive Director

Dr Mandeep ✓ ✓ 11 8 Mudhar Non Executive Director

Glen Burley ✓ 11 11 Chief Executive

Jayne Blacklay 11 10 Director of Development/ Deputy Chief Executive Helen Lancaster ✓ 11 9 Director of Nursing Jane Ives ✓ 11 10 Director of Operations

Dr Charles ✓ 11 10 Ashton Medical Director

Nicky Lloyd ✓ 11 10 Director of Finance Please note: No Board of Directors was held during August 2014. Also in attendance at the Board meetings during 2014/15 were Ann Pope, Director of Human Resources and Meg Lambert (previously Meg Mold), Trust Secretary.

Directors’ Remuneration The disclosures detailed below that form part of Section 2 are subject to audit

2014/15 2013/14 Name and Title Salary Other Benefits Restated Other Benefits in (bands of remuneration in kind salary remuneration kind £5000) (bands of £5000) (rounded to (bands of £5000) (bands of £5000) (Rounded to the nearest the nearest £,000 £,000 £100) £,000 £,000 £100)

Glen Burley, 160-165 150-155 Chief Executive Nicky Lloyd Director of Finance 125-130 120-125 Jayne Blacklay, Director of Development/Deputy Chief 105-110 100-105 Executive Dr Charles Ashton, 50-55 100-105 35-40 10-15 25-30 Medical Director Jane Ives 100-105 100-105 Director of Operations Ann Pope 90-95 85-90 Director of Human Resources Helen Lancaster 100-105 90-95 Director of Nursing Graham Murrell, 35-40 35-40 Chairman Alan Harrison 10-15 5-10 Non-Executive Director Tony Boorman 5-10 5-10 Non-Executive Director Bruce Paxton 5-10 5-10 Non-Executive Director Rosemary Hyde 10-15 0-5 Non-Executive Director (from 1 January 2014) Dr Angela Brady 10-15 0-5 Non-Executive Director (from 1 January 2014) Dr Mandeep Mudhar 10-15 0-5 Non-Executive Director (from 1 January 2014)

Glen Burley, Chief Executive Date: 21st May 2015

The Register of Interests is available on the Trust’s website or by writing to the Trust Secretary.

Accounting policies for pensions is set out in note 10.4 to the accounts and retirement benefits are set out in note 1.5 to the accounts and that details of senior employees’ remuneration can be found in note 41 of the annual accounts.

The Trust’s Appointments and Remuneration Committee which consists of the Chairman and all the Non- Executive Directors considers all annual adjustments to Executive Directors’ salaries and travel reimbursement costs based on NHS guidance and national surveys of earnings for directors in the Health Service.

The Chief Executive and Executive Directors have standard NHS managerial contracts with the Chief Executive on 6 months’ notice and the Executive Directors on 3 months notice. The Chief Executive and the Executive Directors have no provision for performance related pay in their contracts. Please note the remuneration and pension information is subject to audit. The banded remuneration of the highest-paid director in South Warwickshire Foundation Trust in the financial year 2014-15 was £195k-£200k (2013- 14, £195k-£200k).

This was 7 times (2013-14, 7.1) the median remuneration of the workforce, which was £28,178 (2013-14, £27,900). In 2014-15, nil (2013-14, nil) employees received remuneration in excess of the highest paid director.

Remuneration ranged from £5k to £200k ((2013-14 £5k to £200k)). Total remuneration includes salary, non-consolidated, benefits-in-kind as well as severance payments. It does not include employer pension contributions and the cash equivalent transfer value of pensions. There have been no significant changes to the calculation of the ratio between 2012-13 and 2013-14. It has not been possible to include the whole time equivalent annualised cost of agency as the data is not held in a format that allows this detail of analysis.

There is no performance related pay for the Directors of the Trust, this includes performance related bonuses.

The NHS foundation trust has complied with the cost allocation and charging guidance issued by HM Treasury.

Directors Expenses 2014/15

Name and Title Expenses £

Glen Burley, Chief Executive 0

Nicky Lloyd, Director of Finance 0

Jayne Blacklay, Director of Development/ Deputy Chief Executive 0

Dr Charles Ashton, Medical Director 202

Jane Ives, Director of Operations 0

Helen Lancaster, Director of Nursing 0

Ann Pope, Director of Human Resources 0

Graham Murrell, Chairman 318

Alan Harrison, Non-Executive Director 810

Tony Boorman, Non-Executive Director 0

Bruce Paxton, Non-Executive Director 305

Rosemary Hyde, Non-Executive Director 0

Dr Angela Brady, Non-Executive Director 0

Dr Mandeep Mudhar, Non-Executive Director 410

Any travel by rail booked via rail warrants is paid directly by the Trust and is therefore excluded from the table above; all other rail travel submitted as an expense is included above.

Executive Directors receive an allowance for expenses which is included within their salary.

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Glen Burley, 2.5-5-0 10-12.5 60-65 185-190 1,122 979 92 147 Chief Executive

Nicky Lloyd, 2.5-5.0 -25-27.50 10-15 0 161 144 10 79 Director of Finance

Jayne -2.5-0 -2.5-0 30-35 100-105 615 577 8 27 Blacklay, Director of Development /Deputy Chief Executive

Ann Pope 0-2.5 5-7.5 25-30 75-80 501 418 61 82 Director of Human Resources

Jane Ives 0-2.5 0-2.5 35-40 110-115 719 650 35 61 Director of Operations

Helen 2.5-5.0 7.5-10 30-35 100-105 607 513 67 102 Lancaster Director of Nursing

Dr Charles 0-2.5 0-2.5 50-55 160-165 1,155 1,064 36 66 Ashton, Medical Director

Council of Governors and Membership

Council of Governors

Structure and Members

The Council of Governors comprises a total of 31 members. 16 of these members are duly elected to represent public constituencies, 7 members are elected as staff representatives, and 8 members are appointed from key local stakeholders and partners.

The Council started the year after the second full election of the Council of Governors. The Council of Governors, identified below, was active from the 1 March 2014. In accordance with the Constitution, Public and Staff Governors were elected through a formal election process and Appointed Governors were nominated by their respective organisations.

The role of a Governor is an important one, providing a direct link between the Trust, local communities and staff. Governors engage with their Members to gather feedback and views to ensure their voice is heard by the Trust. They have the opportunity, as part of the Council of Governors, to work with the Board of Directors to help shape the Trust’s plans for the future.

Key aspects of the Governors’ role include:

 Engaging with the local community and staff and representing their views  Contribution to the development of the Trust’s Annual Plan  Appointing Non-Executive Directors and Chair of the Trust and setting their terms and conditions  Overseeing the work of the Trust  Contributing thoughts, views and opinions at the Council of Governors meetings

Name Constituency

Cllr Susan Adams Appointed (Stratford District Council) Mrs Jean Arrowsmith Warwick District and Borders

Mr Jon Bolger West Stratford and Borders

Cllr Felicity Bunker Appointed (Warwick District Council) Anna Hargrave Appointed (Commissioner rep SWCCG) Mr Norman Byrne Warwick and Leamington Towns

Mr Michael Coker Warwick District and Borders Mr Roger Copping Warwick and Leamington Towns Mrs Ruth Cowan Warwick and Leamington Towns

Carol Credgington Staff (Clinical Support) Dr Terence Gasper West Stratford and Borders Mr David Gee East Stratford and Borders

Dr Richard Grimes Warwick District and Borders Dr Cally Harrison Northern Warwickshire and Rugby

Paul Leeman East Stratford and Borders

Mrs Mary Malloy West Stratford and Borders Mrs Lara McCarthy Appointed (University of Warwick) Mr Geoffrey Mitchell Staff (Non-Clinical Support)

Dr Adrian Parsons Appointed Governor (GP rep SWCCG) Cllr Clive Rickhards Appointed (Warwickshire County Council) Dr Jeremy Shearman Staff (Medical and Dental)

Mrs Sara Shoreman Staff (Nursing and Midwifery Community – previously Community) Mrs Ann Smith East Stratford and Borders Mrs Julie Smith Staff (Nursing and Midwifery Acute – previously Nursing and Midwifery) Mr Matthew Statham Warwick and Leamington Towns Cllr Bob Stevens Appointed (Warwickshire County Council)

Mrs Katherine Warwick Staff (Nursing and Midwifery Acute – previously Nursing and Midwifery) Vacant Northern Warwickshire and Rugby Vacant Warwick District and Borders

Vacant Staff (Nursing and Midwifery Community – previously

Community)

During the year there have been a number of changes to the Membership of the Council of Governors arising from resignations and by-elections. The Council currently has three vacant positions: an elected Staff Governor for the Nursing and Midwifery Community Constituency; an elected Public Governor for the Northern Warwickshire and Rugby Constituency and an elected Public Governor for the Warwick District and Borders Constituency.

Changes due to resignations and by-elections are identified in the table below:

Constituency Governor New/Replacement Standing Down Governor

Public – Warwick District Richard Seymour-Mead Vacancy and Borders

Public – West Stratford Vacancy Terence Gasper and Borders

Public – Warwick and Vacancy Norman Byrne Leamington Towns

The members of the Council of Governors (CoG) who served during the 2014/15 are as follows:

Public Governors No. Name Number of Expenses Attendances 2014/15 at 4 CoG meetings between 1 April 2014 - 31 March 2015

East Stratford and Borders 3 Mr David Gee 4 £319.02

Mr Paul Leeman 4

Mrs Ann Smith 4 £528.56

Warwick and Leamington Towns 4 Mr Norman Byrne 3 (from 17 April 2014 therefore eligible to attend 4 meetings)

Cllr Roger 2 £42.27 Copping

Mrs Ruth Cowan 4

Mr Matthew 3 Statham

Warwick District and Borders 4 Mrs Jean 4 £129.78 Arrowsmith

Mr Michael Coker 4

Dr Richard 4 Grimes

Mr Richard 1 Seymour-Mead (up until 15 July 2014 therefore eligible to attend 1 meeting)

West Stratford and Borders 3 Mr Jon Bolger 2

Dr Terence 2 Gasper (from 17 April 2014 therefore eligible to attend 4 meetings)

Mrs Mary Malloy 4 £213.18

Northern Warwickshire and Rugby 1 Dr Georgia (Cally) 4 £301.81 Harrison

Staff Governors No. Name Number of Expenses Attendances 2014/15 at 4 CoG meetings between 1 April 2014 - 31 March 2015

Nursing and Midwifery Acute 2 Mrs Katherine 3 Warwick

Mrs Julie Smith 3

Non-Clinical Support 1 Mr Geoffrey 0 Mitchell

Clinical Support 1 Mrs Carol 2 Credgington

Medical and Dental 1 Dr Jeremy 4 Shearman

Nursing and Midwifery Community 1 Mrs Sara 1 Shoreman

Appointed Governors No. Name Number of Expenses Attendances 2014/15 at 4 CoG meetings between 1 April 2014 - 31 March 2015

Stratford District Council 1 Cllr Susan Adams 2

Warwick District Council 1 Cllr Felicity 4 £53.10 Bunker

University of Warwick 1 Mrs Lara 4 £83.92 McCarthy

South Warwickshire Clinical 1 Anna Hargrave 3 Commissioning Group (nee. Burns)

GP Consortium 1 Dr Adrian 1 Parsons

Warwickshire County Council 2 Cllr Robert 3 1 Stevens

Cllr Clive 3 Rickhards

Director Attendance at Council of Governors

Members No. of No. of meetings attended meetings

Graham Murrell 4 4 Chairman

Tony Boorman 4 2 Non Executive Director

Alan Harrison 4 4 Non Executive Director

Bruce Paxton 4 4 Non Executive Director

Rosemary Hyde 4 3 Non Executive Director

Dr Angela Brady 4 1 Non Executive Director

Dr Mandeep Mudhar 4 1 Non Executive Director

Glen Burley 4 2 Chief Executive

Jayne Blacklay 4 3 Director of Development/ Deputy Chief Executive Helen Lancaster 4 2 Director of Nursing

Jane Ives 4 2 Director of Operations

Dr Charles Ashton 4 1 Medical Director

Nicky Lloyd 4 3 Director of Finance

Constituency Boundary Extension

The Council of Governors approved an extension to the Trust’s Constituency boundaries at its 20 November 2014 Council meeting. This increased the number of residents within the Trust constituency who were eligible for Trust Membership. Membership recruitment efforts have been and will continue to be run across the whole constituency, and in partnership with Trusts that already cover new areas.

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Elected Governors

The profiles of the Governors that have served on the Council of Governors from 1 April 2014 until 31 March 2015 are detailed below. The Governors have been divided into the constituencies that they represent.

Please note that the previously titled “Staff: Nursing and Midwifery” and “Staff: Community” Governors have now been combined and split as below, following at its 20 November 2014 Council meeting:

1) Nursing and Midwifery Acute – 2 Governors, and 2) Nursing and Midwifery Community – 2 Governors (1 vacant).

Public: Warwick and Leamington Towns

Norman Byrne – is delighted to have been elected to serve as a governor to the Trust, representing the public in Warwick and Leamington and intends to honestly and conscientiously represent local people. Even with forty years of business life behind him he knows that he faces a very steep learning curve to fit the role of Governor but hopes to go on to make a positive contribution to the governorship of the Trust. His strong belief and support for the fundamental values underpinning the NHS will not prevent him from embracing change but will guard against any dilution of those key values.

Roger Copping – is a Chartered Physiotherapist, now retired and was latterly a lecturer in physiotherapy at Coventry University. Roger has lived in Leamington for over 30 years and has been a local Councillor for 18 years. He is a member of Warwickshire Health Watch and has undertaken hospital PEAT inspections and “Enter & View” visits at local Care Homes. Dignity for all is Roger’s top priority, especially for the old, frail & vulnerable. He hopes to do all he can to support the Trust through the challenges of the new “Modernised” NHS.

Ruth Cowan - is a Chartered Physiotherapist and has worked not only in the NHS but also in Education and the private sector. Her motivation as a Governor is to help reflect the voice of the public. Ruth feels that having a Foundation Trust is a great opportunity for South Warwickshire to have a first class health service both for patients and providers.

Matthew Statham (Lead Governor) - Matthew has lived in the Leamington/Warwick area for most of his life. He is married with two children and likes to take an active role in the community. As a Governor he brings a fresh perspective, with 20 years industry experience from outside the healthcare profession.

Public: Warwick District and Borders

Jean Arrowsmith - has trained as a nurse at Warwick Hospital and worked in a variety of roles for 15 years. She believes that the knowledge and experience gained both in a hospital and community setting will assist her with achieving the full potential of being a Governor. Her clinical experience will also help in gaining the respect of clinicians, important in developing the credibility around the role of Governor.

Michael Coker - has a close association with the Warwick area, having worked in the area for many years. Through his previous roles as Councillor for Kenilworth Town Council and Warwick District Council, he has had close contact with the general public and is aware of the difficulties and benefits of the local NHS. He feels that his close association with the local community, both personally and professionally, gives him the experience to fill the role as a Governor of the Trust.

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Richard Grimes - as an Outpatient and Day Surgery Patient over a number of years, Richard has seen many improvements at Warwick Hospital. He became a Governor because he wanted to see the Trust continue to build upon these improvements. He is passionate about maintaining the principles upon which the NHS was founded and, as a Governor, ensures that the Trust is held to those principles and that the Trust’s actions are to the benefit of the community.

Richard Seymour Mead – (Governor until 15 July 2014) wishes to contribute to the on-going success of the Trust in the provision of excellent hospital and community services. Richard has worked as a full time NHS GP in Warwickshire for 33 years until retirement 3 years ago. The experience and knowledge gained in his long career in the NHS will be of use as a Governor particularly as the provider role to the new Clinical Commissioning Groups becomes established.

As Warwickshire hospitals and community services have cared for Richard, his parents and for his children as well as for very many of his patients, he hopes to be able to positively influence provision of these services for all members of our Warwickshire communities for years to come.

Public: West Stratford and Borders

Jon Bolger – strongly believes that his commercial and operational background in providing procurement services to large and often complex organisations will be of value in the role of Governor. His contact with the Trust has been as a patient and he is passionate about the benefits the NHS brings to the whole community and has the desire to help how the Trust can continue to deliver these in times of austerity.

Terence Gasper – during Terry’s 32 year career as a GP in Stratford on Avon, and prior to that as a junior hospital doctor at Warwick and Stratford hospitals, he has experienced the challenges involved in trying to deliver the best possible health care to the population of South Warwickshire in a constantly changing system. The ethos of the Foundation Trust is for the provision of care to be influenced, monitored and to a certain degree directed by the population it serves through its members and elected governors. As your representative he will strive to make your views on the care you receive and on the future strategies and developments known to the Trust and to help review the Trust’s safety, efficiency and effectiveness.

Mary Ann Malloy – has 37 years NHS experience as a clinician and a manager. She was a hospital pharmacist for 20 years before moving into primary care as a Pharmaceutical Adviser and Head of Medicines Management. Her experience in primary and community care includes professional advice, strategy, commissioning, service redesign, partnership working and governance. She was an inspector of nursing homes and has a special interest in the care of older people. She is a Trustee of Warwickshire Care Services. Mary is passionate about maintaining the principles of the NHS and became a Governor to use her experience to support the NHS locally in providing best quality services.

Public: East Stratford and Borders

David Gee – was actively involved in representing the interests of patients throughout South Warwickshire for a number of years and is now a member of the Warwickshire LINks (Local Involvement Networks). He will use this experience to ensure that the Trust continues to deliver an improving healthcare service.

Paul Leeman – (Governor from 30 December 2013) is a retired Environmental Health Officer in local government, his work focused on ensuring a safe healthy environment in which people can live, work and enjoy their leisure and has developed skills which enable him to communicate easily with all levels; managers, elected Members and the public. Paul’s 12 years as a Parish Councillor, 8 as Chairman, have taught him the value of listening to, evaluating and progressing constituents’ concerns, for the benefit of those constituents.

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In these times of an evolving and changing health service, Paul’s aims are to liaise, on behalf of the Members, with fellow Governors and health care professionals across all of the trust sites, addressing both patient and public concerns and needs regarding appointments, waiting times, catering, quality of care and safety within the hospital environment. As well as forging strong links with GP practices and community nursing services across the area.

Ann Smith – has worked in the NHS for over 32 years as a SRN, Ward Sister, District Nurse and Health Visitor. Patient Care and Clinical competence has always been a priority of hers. Ann lives in Shipston-on- Stour and became a Governor to use her experience to ensure best practice in healthcare, and to be a voice for public ideas, concerns and views in the community.

Public: Northern Warwickshire and Rugby

Cally Harrison – Having a clinical, academic and managerial background and a lengthy experience in the NHS, after working for different Trusts around the country, Cally felt that one of the best ways to contribute to improving and maintaining high standards of care locally is to become a Governor. As it has been shown by many national and international think tanks, quality should be the organising principle of any credible healthcare organisation; hence she would like to use her knowledge and expertise to ensure that the local NHS continues to successfully serve its patients.

Staff: Medical and Dental

Jeremy Shearman - has been a consultant in the Trust for eleven years. His clinical specialty of Gastroenterology is one that is anchored in traditional general hospital medicine, and he has worked hard with colleagues to ensure the very best care for local patients. As a Governor he strives to ensure that teamwork and integration become fundamental parts of the Foundation Trust and that local patient needs are understood by all.

Staff: Nursing and Midwifery Acute (previously Nursing and Midwifery)

Julie Smith - joined the health service in 1976 and, after a short career break to bring up her two sons, she joined Warwick Hospital in 1992 as a Bank Nurse and has stayed ever since. She is now the Clinical Lead for the Patient Experience Team. Julie became a Governor in order to inject the challenges and issues from the ‘shop floor’ and also to support the Trust in moving forward to meet the needs of the local community.

Katherine Warwick – joined the Health Service in 1974 as a nursing student and has worked at Warwick Hospital for a long time. She had a break when raising her family but always worked on the nursing "bank" on all the wards around the hospital and in Community services. She is now the Ward Manager on the Coronary Care Unit/ Cardiology Unit and deeply cares about delivering the highest standards of nursing care in the organisation and has an expertise and experience that she hopes will make a contribution to the development of services to our local community.

Staff: Clinical Support (including Scientific, Technical and Therapeutic Groups)

Carol Credgington – (Governor from 29 November 2013) has worked in the Trust as a Physiotherapist for over 30 years. During this time she has experienced many changes in the environment, the staffing and ways of working both professionally and within the Trust. Being part of the Physiotherapy team she is in a position to have some insight into the different Trust Departments and Teams, as the team work across most clinical areas within the Trust. Her managerial role has enhanced this further working on several different projects and with staff of all levels and from a cross section of teams. Carol believes the opportunity to be a Staff Governor will enable her to use her extended knowledge to ensure that the Trust continues to provide a quality service to meet the needs of the patients and support the staff to enable them to do so.

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Staff: Non-Clinical Support (including Managerial and Administrative Staff)

Geoffrey Mitchell –has worked in the Estates Department of the NHS for 36 years. He liaises with people at all levels, from Porters to the Chief Executive so is confident that he has a sound knowledge of how the Trust operates. Geoffrey believe he has the capacity to listen and be part of a successful team that can put forward recommendations that will benefit staff and patients to improve healthcare for everyone in the future.

Staff: Nursing and Midwifery Community (previously Community)

Sara Shoreman - is an experienced registered nurse and nurse prescriber with 32 years’ experience in a variety of health settings. She is committed to delivering excellent high quality care to patients and in supporting others to deliver the same. Sara is also committed to representing community services and feels that she is well placed to understand the challenges, pressures and rewards that working as a Governor brings.

Appointed Governors

The Trust also has a number of Appointed Governors, who represent local stakeholder organisations and put forward the views of their organisations at the Council of Governors meetings. The Trust’s Appointed Governors for 2013/14 are detailed in the list below, which also includes the date of any appointments and resignations that happened during 2013/14.

 Susan Adams – Stratford District Council  Felicity Bunker – Warwick District Council  Lara McCarthy– University of Warwick  Anna Hargrave (nee. Burns) – South Warwickshire Clinical Commissioning Group  Adrian Parsons – GP Consortium  Bob Stevens - Warwickshire County Council  Clive Rickhards – Warwickshire County Council

Contact Details

Governors can be contacted in the following ways: Call: 0800 085 2471 Post: Freepost RRUR-BBAH-CAJA Email: [email protected]

To access the Governors’ Register of Interests please visit www.swft.nhs.uk or alternatively contact the Trust Secretary at Warwick Hospital on 01926 495 321 ext 8040.

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Meetings of the Council of Governors

During the period 1 April 2014 to 31 March 2015 the Council of Governors has met on five occasions including the Annual General Meeting. A summary of its business is outlined below. A record of the number of attendances by each Governor at these meetings is included in the table on pages 95-97

22 May 2014

 At this meeting the Council received the forward planning elements of the Annual Plan for 2014/15. The Council also received the Finance Report and Quarterly Status Report.

 The Council nominated and appointed a Lead Governor for the year.

 The Council reviewed the Terms of Reference for one Committee, the Finance and Performance Committee. The Council also received Reports from other Committees, including the Patient Care Committee.

 The Council received the Self Assessment of the Council of Governors.

 This meeting was also attended by the Chairman, Chief Executive, Trust Secretary, Director of Finance, Director of Nursing, Director of Operations and two of Non-Executive Directors.

21 August 2014

 At this meeting the Council received the Annual Report and Accounts for 2013/14 and the External Auditor’s Annual Governance Report 2013/14. The Council also received the Finance Report and Monitor Compliance Measures Report.

 The Council approved extension of the External Auditors contract.

 The Council received Reports from Committees including the Finance and Performance Committee and the Patient Care Committee.

 This meeting was also attended by the Chairman, Trust Secretary, Director of Development, Director of Finance, Director of Operations, Medical Director, five Non-Executive Directors, and the Head of Governance.

11 September 2014 (Annual General Meeting)

 The Council of Governors met for the 2014 Annual Meeting in Warwick, which was attended by members of the public. The meeting received presentations on the Annual Report Summary Accounts and Auditor’s Statement for 2013/14.

 The Council presented the Annual Report of the Council of Governors 2013/14.

 The Council received a presentation on Orthopaedics at the Trust and the Woods' Nursing Awards and GEM Awards Presentations.

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20 November 2014

 At this meeting the Council received the Finance Report, Quarterly Status Report and Monitor Compliance Measures Report. The Council also received the Audit Committee Annual Report.

 The Council agreed the Calendar of Meetings for 2015/16.

 The Council approved amendments to the Trust Constitution, particularly the extension of Trust constituency boundaries.

 The Council received Reports from Committees including the Finance and Performance Committee, Membership Development and Patient Care Committee.

 This meeting was also attended by the Chairman, Chief Executive, Trust Secretary, Director of Development, Director of Finance, Director of Operations, five Non-Executive Directors, the Trust Assurance Manager and Senior Finance Manager.

19 February 2015

 At this meeting the Council received an update on Pressure Ulcers and Response to Urgent Care Pressures. The Council also received the Finance Report, Quarterly Status Report and Monitor Compliance Measures Report. Presentation from the Director of Nursing on the requirements for the Annual Quality Report, the Council agreed that the Patient Care Committee would carry out the work required for the Annual Report on behalf of the Council and the completed document would be shared with the full Council.

 The Council approved the Schedule of Business for 2015/16.

 The Council received a presentation on Membership at the Trust and recruitment and engagement plans.

 The Council received Reports from Committees including the Finance and Performance Committee, Membership Development and Patient Care Committee.

 Under Confidential Business the Council approved the Chair Appraisal 2014 and also received and update on the Appointment of the new Trust Chair.

 This meeting was also attended by the Chairman, Trust Secretary, Director of Development, Director of Nursing, three Non-Executive Directors, Senior Finance Manager and Associate Director of Operations – Emergency Division.

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Sub-Committees of the Council of Governors

At the inaugural meeting on 4 March 2010, the Council of Governors appointed three sub-committees to help the Council discharge its functions. These Committees were reappointed at the inaugural meeting of the new Council of Governors on 7 March 2013. Details of all committees are as follows.

Nominations and Remuneration Committee

The Nominations and Remuneration Committee makes recommendations to the Council of Governors on the appointment or re-appointment of the Chairman and Non-Executive Directors, and on the terms of appointment and remuneration for these positions. This Committee has met on seven occasions during the period of 2014/15 and made recommendations to the Council of Governors on the appointment of the new Chair, and approved the appraisals of the Chairman and Non-Executive Directors.

For the period April 2014 – March 2015 the Chair of the Committee was:

 Michael Coker (Public Governor: Warwick District and Borders).

Other members of the Committee included:

 Jean Arrowsmith (Public Governor: Warwick District and Borders)  Felicity Bunker (Appointed Governor: Warwick District Council)  David Gee (Public Governor: East Stratford and Borders)  Mary Malloy (Public Governor: West Stratford and Border)  Richard Seymour Mead (Public Governor: West Stratford and Borders) – until 15 July 2014  Jeremy Shearman (Staff Governor: Medical and Dental)  Matthew Statham (Public Governor: Warwick and Leamington Towns)

The Committee is advised by the Director of Human Resources, Trust Secretary and Trust Chairman who attend the meetings but are not members of the Committee.

Membership Development Committee

The Membership Development Committee is responsible for overseeing the recruitment and engagement of both public and staff Members. In recognition of both the Trust’s and the Council’s responsibilities regarding membership, this Committee has been convened as a joint Committee, with a combined Trust/Governor membership. This Committee has met four times during the period 2014/2015 and has reviewed the Membership Strategy, proposing updates and amendments to the Council of Governors. It has also reviewed and further developed project plans to recruit new Members in the Northern Warwickshire and Rugby constituency and to improve the recruitment of younger Members. The Committee has also been responsible for coordinating a series of public events aimed at engaging with Members and raising awareness of the work of the Trust with members of the public.

For the period April 2014 – March 2015 the Chair of this Committee was:  Richard Grimes (Public Governor: Warwick District and Borders).

Other Members of the Committee include:

 Susan Adams (Appointed Governor: Stratford District Council)  Sophie Gilkes (Associate Director of Communications)

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 Alan Harrison (Non-Executive Director)  Emma Jeavons (Membership and Engagement Officer) – from 16 June 2014  Nahida Kausar (Membership Officer) – up until 13 June 2014  Geoff Mitchell (Staff Governor: Non Clinical Support)  Meg Lambert (Trust Secretary)  Ann Pope (Director of Human Resources)  Ann Smith (Public Governor: East Stratford and Borders)  Julie Smith (Staff Governor: Nursing and Midwifery Acute)

General Purposes Committee

The General Purposes Committee is responsible for overseeing the arrangements for the conduct of business of the Council of Governors. The Committee has agreed to meet at least three weeks before a Council of Governors’ meeting, to review the business conducted at the last Council meeting and to consider and agree the agenda items for the next meeting. The Committee also considers the format and content of reports received by the Council and the Council agreed that the membership of its Committees would be agreed by the General Purposes Committee.

For the period April 2014 – March 2015 the Chair of this Committee was:

 Matthew Statham (Lead Governor and Public Governor: Warwick and Leamington Towns).

Other Members of this Committee include:

 Roger Copping (Public Governor: Warwick and Leamington Towns)  David Gee (Public Governor: East Stratford and Borders)  Richard Grimes (Public Governor: Warwick District and Borders)  Cally Harrison (Public Governor: Northern Warwickshire and Rugby)  Mary Malloy (Public Governor: West Stratford and Borders)  Lara McCarthy (Appointed Governor: University of Warwick)

The Chairman and Trust Secretary also attend these meetings but are not Members of the Committee.

Patient Care Committee

The Patient Care Committee has been established by the Council of Governors to scrutinise patient care, quality and dignity within the Trust. Representatives of the Patient Forum and the Trust’s senior nursing team are also members of the Committee.

The Chair of this Committee is:

 Jean Arrowsmith (Public Governor: Warwick District and Border)

Other Members of this Committee include:

 Ruth Cowan (Public Governor: Warwick District and Borders)  Carol Credgington (Staff Governor: Clinical Support)  Ronald Grant (Patient Forum Member)  William Hall (Patient Forum Member)

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 Charles Hart (Patient Forum Member)  Helen Lancaster (Director of Nursing)  Mary Malloy (Public Governor: West Stratford and Borders)  Bruce Paxton (Non-Executive Director)  Richard Seymour Mead (Public Governor: West Stratford and Borders) – up until 15 July 2014  Geoff Raine (Patient Forum Member)  Sara Shoreman (Staff Governor: Nursing and Midwifery Community)  Ann Smith (Public Governor: East Stratford and Borders)  Bob Stevens (Appointed Governor: Warwickshire County Council)

The Chairman (up until 23 July 2014) and Trust Secretary also attend these meetings but are not Members of the Committee.

Finance and Performance Committee

The Finance and Performance Committee has been established by the Council of Governors to receive assurance from the Trust in relation to performance and financial issues. In particular the Committee is to review in year performance and finances against previously agreed Trust objectives, outcome measures and key performance indicators. The Chair of this Committee is:

 Lara McCarthy (Appointed Governor: University of Warwick)

Other Members of this Committee include:

 Jon Bolger (Public Governor: West Stratford and Borders)  Matthew Statham (Lead Governor and Public Governor: Warwick and Leamington Towns)  Cally Harrison (Public Governor: Northern Warwickshire and Rugby)  Clive Rickhards (Appointed Governor: Warwickshire County Council)

The Director of Finance, the Director of Operations, the Chairman and Trust Secretary support these meetings but are not Members of the Committee.

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Trust Membership

The Trust’s Membership is split into two categories – staff Membership and public Membership. Membership is open to anyone aged 16 or over who lives within the public constituency areas or is an employee of the Trust, providing none of the exclusions in the Constitution apply.

Staff Membership

In the case of staff Membership, the following staff are eligible to become Members:

 Staff on a permanent contract  Staff on a fixed-term contract of 12 months or more  Staff who have been employed continuously for 12 months, and  Staff employed by an independent contractor working on the Trust’s behalf who have done so for 12 months or more

All eligible Trust staff automatically become Members unless they actively decide to opt out. For those staff acting on the Trust’s behalf but who are not employees of the Trust, including contractors’ staff and registered volunteers, they are invited to become Members through an ‘opt-in’ arrangement.

At 31 March 2015, only 2 members of eligible staff had chosen to opt out of Membership.

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Public Membership and Constituencies

The Trust Membership is made up of five public constituencies:  East Stratford and Borders;  Northern Warwickshire and Rugby, and  Warwick and Leamington Towns;  Warwick District and Borders;  West Stratford and Borders.

Public Membership has increased from 6111 at the beginning of April 2014 to 6145 at 31 March 2015. Public Membership analysis as at 31 March 2015 is as follows:

Age Group Total Membership (Public) As at 31 March 2015

16-24 285

25-44 817

45-64 1559

65+ 3480

Unknown 4

Total 6145

Gender Total Membership (Public) As at 31 March 2015

Male 2551

Female 3591

Unknown 3

Total 6145

Ethnicity Total Membership (Public) As at 31 March 2015

White 5556

Mixed 51

Asian or Asian British 309

Black or Black British 33

Chinese or Other Ethnic Group 29

Not supplied 167

Total 6145

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Constituency As at 31 March 2015

East Stratford and Borders 1036

Northern Warwickshire and Rugby 379

Warwick and Leamington Towns 1882

Warwick District and Borders 1488

West Stratford and Borders 1360

Unknown 0

Sub-Total 6145

Staff (incl. opt-in Staff)* 4170

Total 10315

Membership and Engagement Strategy

The Membership and Engagement Strategy was approved by the Council of Governors at its meeting on 2 December 2010 and reviewed and accepted by the new Council of Governors at its meeting on 7 March 2013. A further review to update the strategy was undertaken by the Membership Development Committee and approved by the Council on 8 August 2013. The strategy was developed through the Membership Development Committee who are keen to focus on developing a more engaged Membership. The overall objectives of the strategy are to:

 Build and maintain an engaged public Membership base that takes an active interest in the affairs of the Trust, and that is broadly representative of the population served by the Trust in terms of numbers, geographical distribution, demographic profile and ethnic diversity.  Develop staff Membership as a meaningful opportunity for participation in the governance and future direction of the Trust and not merely as the default status for employees.  Educate and inform Members so that they are equipped to act as critical friends of the Trust, to provide feedback on the Trust’s activities and to help evaluate development proposals.  Encourage Members to act as ambassadors for the Trust and the NHS within the community, to help promote the Trust’s reputation and the loyalty of patients, and to promote fund-raising and volunteering.  Embed the Trust firmly in the community through Members’ connections with the diverse and overlapping networks of local people and organisations.  Enhance the governance of the Trust, for the benefit of the communities it serves, through effective oversight by a well-balanced and suitably-equipped Council of Governors.  These objectives are in alignment with the values and vision of the Trust as set out in the Trust’s overall strategy.

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Membership Engagement

Since authorisation, the Trust has focused its attention on developing an engaged Membership base, rather than recruiting a lot more Members. To support this The Membership Office in conjunction with Governors have held a number of events for Members and potential new Members. These have included a series of medical presentations, such as on Diabetes, A&E and Maternity. This year, the Governors have also put on events to inform the Members about major development work taking place within the Trust, such as the Stratford Hospital Development plans. Feedback from these events has been excellent with Members saying they have enjoyed the presentations and are keen to learn about further development work within the Trust. The events have also provided the opportunity to sign up some new Members. During 2015/16 the Governors plan to continue these events offering more opportunities for them to engage with Members. The Trust has utilised Social Media tools, such as Facebook and Twitter, to raise awareness of the events and increase attendance. The Trust continues to adapt events and communication in response to Member feedback, including introducing events at different times of day.

The Membership Development Committee has considered several tools to help Governors improve their engagement skills and ensure all Governors are able to communicate effectively with Members, including Governor business cards and “What is a Governor?” information leaflets. The Committee has approved a Membership Champion role that will work closely with the Membership Office to further promote engagement with existing and prospective Members.

Membership Recruitment

The Trust continues to work on projects to increase the level of Public Membership in all constituencies to reflect at least 1% of population. The Membership Office has held Membership stalls in Health Centres, local healthcare Events, and in local shopping centres to recruit new Members.

The Trust has also continued the initiative to include a Membership application form with appointment letters sent out by Warwick Hospital and some community settings, and is now sending out approximately 16,500 letters a month to generate new Members. Information on Membership will now also be included in staff New Starter Packs, and also in leaver and retiree information to give these groups the opportunity to sign up as Public Members. Membership application forms can in addition be found at various Trust sites and volunteer-manned helpdesks.

Trust Governors have been actively encouraged to recruit from within their own social and community groups to further increase numbers and engagement with all areas of the Trust constituency.

If Members wish to communicate with Governors and/or Directors they can do so by contacting the Trust’s Membership Office on 0800 085 2471.

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Quality Report

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What Patients say about us…

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Part 1: Statement on Quality As another financial year closes I am delighted to introduce our Quality Report for the year ended 31 March 2015. The challenge for all NHS organisations is to provide the most care, to the highest standards within the constraints of the financial resources that we command. What is remarkable about the performance of SWFT over the past year is that we have delivered much more care and many improvements in quality whilst remaining as one of a very small number of acute providers to return a small operating surplus.

Infection control performance improved further last year with no hospital acquired MRSA bacteraemia and only 2 hospital acquired cases of C Difficile. We have also seen a number of quality focussed developments in the Trust led by our talented clinicians and supported by our Governors and the proactive work of our patients’ forum. In addition the Board gains strong assurance from the valuable work of our Clinical Governance Committee where evidence can be closely examined and which helps to drive our culture of continuous improvement.

Our exceptional National Staff Survey results have improved again over the past year leading to the Trust being widely recognised as one of the best employers in the NHS. The evidenced motivation and commitment of our workforce is reflected in the way that they deliver care to patients and service users. An example of this was our position in the national top 10 for A&E patient satisfaction as well as the many letters of appreciation that I receive every week. A survey we carried out last year also showed a very high level of user satisfaction regarding our community-based services. The work that we have done to ensure a seamless transition for our patients between hospital and non-hospital settings has also received much positive national recognition in the past year and is now being copied by other systems.

Despite the continued development of measures to improve urgent care flow in hospital and community settings, like the rest of the NHS we came under extreme pressure during the winter. It has been reassuring to see that A&E performance has now returned to the positive position that we saw in the first half of the year. The importance of this measure was evidenced through our previous work with the Health Foundation which demonstrated that good flow reduces risk to patients. In this regard it has also been reassuring to see our mortality rates continue to improve.

It has also been encouraging to see reductions in our caesarean section rate and a strong performance against CQUIN measures, all of which has been affirmed through external audit review and the commentaries of CCG and local Health Watch.

I hereby state that to the best of my knowledge the information contained within the Quality Report is accurate.

Glen Burley, Chief Executive Date: 21st May 2015

Declaration There are a number of inherent limitations in the preparation of Quality Accounts which may impact the reliability or accuracy of the data reported. These include: • Data is derived from a large number of different systems and processes. Only some of these are subject to external assurance, or included in internal audits programme of work each year. • Data is collected by a large number of teams across the trust alongside their main responsibilities, which may lead to differences in how policies are applied or interpreted. In many cases, data reported reflects clinical judgement about individual cases, where another clinician might have reasonably have classified a case differently. • National data definitions do not necessarily cover all circumstances, and local interpretations may differ. • Data collection practices and data definitions are evolving, which may lead to differences over time, both within and between years. The volume of data means that, where changes are made, it is usually not practical to reanalyse historic data. The Trust and its Board have sought to take all reasonable steps and exercise appropriate due diligence to ensure the accuracy of the data reported, but recognises that it is nonetheless subject to the inherent limitations noted above. Following these steps, to my knowledge, the information in the document is accurate.

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Looking ahead… Part 2: Priorities for Improvement

The Trust has 5 strategic goals listed below on the left. Each year the Trusts annual objectives are set and within these objectives, we have agreed a selection of priorities for Quality improvement for next year w h i c h are detailed below. We will report on their progress in our Quality Report next year.

Patient Outcomes • Continue to improve systems to further reduce mortality rates Provide High Quality care • To improve the identification and early treatment of patients with acute kidney injury and sepsis • Create a specialist multidisciplinary team to improve care for Develop our Services patients with a dementia

Patient Experience Develop our People • Improve End of Life care for Patients and carers – through providing information and seeking feedback from them • Further embed the management of Complaints to resolve 90% Provide a Sustainable Future complaints within the agreed timescales • Improving patient feedback methods and empowering ward staff to improve and learn from patient feedback

Integrate our services Patient Safety • Reduce the rate of patient falls with harm • Continue to reduce the number of avoidable pressure ulcers • Reduce the rate of patient medication incidents resulting in harm How these priorities were decided and why they are our priorities

 We have sought the views of clinicians and managers about what quality looks like, how it should be measured and how to improve quality. We have run a series of workshops on this subject during a leadership development programme for senior clinicians and managers at the Trust. There is a consensus that we should measure the three dimensions of quality - patient safety, clinical effectiveness and patient experience.

 A number of engagement events have taken place including feedback from Members, a SWOT(Strengths, Weaknesses, Opportunities and Threats) and PEST (Political, Economic, Social, Technology) analysis, workshops and a Governors Round table event. From this feedback the Chief Executive and the Executive Team agreed a long list of priorities for quality improvement based on what our staff patients and stakeholders have told us. This list was developed into a questionnaire and was sent to 3,000 stakeholders of the Trust. They were asked to vote on their top three priorities in the three dimensions of Quality.

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 The stakeholder’s included the Board of Directors, Council of Governors, Management Board, Patient Forum, all staff and members of the Trust. A number of the initiatives identified are on- going from the previous year as they remain high priorities for the Trust.

How we measure, monitor and report Quality  Our Board of Directors receives a monthly Integrated Quality Dashboard, Standards and Targets report from the Director of Nursing and Director of Operations that contain a broad range of performance measures including progress against the annual objectives and the quality priorities.  The Board Assurance Framework provides assurance to the Board for delivery of all key objectives inclusive of our quality priorities. Each objective has a Lead Director that is accountable for the delivery of that objective. Our management and governance structure provide a mechanism for reporting progress against the priorities, for implementing change and assurance on risk.

 As part of strengthening quality and visibility of the Board at ward and department level, the ‘Board to Ward’ initiatives have continued throughout the year.

 The executive team has adopted ward areas to visit on a regular basis to improve communication from Board to Ward. Many of the executive team visit ward and department areas on a regular basis that this is not recorded in the formal Board to Ward activity.

 As part of these walkabouts patient safety, incidents, complaints and issues that impact on the quality of care are discussed. As a result of these discussions, action is taken by either the executive team or by the ward and department managers to ensure the quality of care.

 We have introduced quality dashboards at board, divisional and service levels in the Trust with sets of key quality indicators as identified by the Services. These incorporate time-trend graphs and RAG (red, amber, green) ratings against benchmarked standards.

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High Level Committees

Chief Executive Board of Directors Officer

Risk Clinical Audit Management Management Governance Committee Board Committee Board

Divisional Audit & Operational Divisional Finance & Governance Risk Performance Groups Managemen Executive Drugs & t Groups Therapeutics Health & Information Committee Safety Governance Infection Committee Steering Prevention Board Group

Mortality Surveillance Committee Patient Experience Group Patient Safety Group

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Information

Direct Report Direct

Committee

Health & Safety HealthSafety &

Health & Safety Risks HealthSafety &

SafetyGroup

Safety Group

Governance GroupGovernance

Support Services Audit& Operational SupportServices

Maternity Risk, Health & Safety Group Health Risk, &Safety Maternity

CorporateGroup & Health Risk, Safety

Emergency & Elective Care Risk, & Health & Emergency Elective

Integrated & Care Community Risk, Health Risk, & IntegratedCommunity & Care

Risk Management Board Risk

Committee

Operational

Clinical Risks Clinical

Divisional Audit & Divisional

Clinical Governance Clinical Governance GroupsGovernance

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Statements of Assurance from the Trust

Review of Services During 2014/15 South Warwickshire NHS Foundation Trust provided and/or sub-contracted 61 NHS services. The South Warwickshire NHS Foundation Trust has reviewed all the data available to them on the quality of care in 100 per cent of these NHS services.

The income generated by the NHS services reviewed in 2014/15 represents 91per cent of the total income generated from the provision of NHS services by the South Warwickshire NHS Foundation Trust for 2014/15

Participation in Clinical Audits During 2014-15, 28 national clinical audits and 4 national confidential enquiries covered services that South Warwickshire NHS Foundation Trust provides. During that period South Warwickshire NHS Foundation Trust participated in 27 (96%) national clinical audits and 4 (100%) national confidential enquiries of the national clinical audits and national confidential enquiries which it was eligible to participate in.

South Warwickshire NHS Foundation Trust’s clinical activity; The national clinical audits and national confidential enquiries that South Warwickshire NHS Foundation Trust was eligible to participate in during 2014/15 and The national clinical audits and national confidential enquiries that South Warwickshire NHS Foundation Trust participated in during 2014/15 are in table 1. The national clinical audits and national confidential enquiries that South Warwickshire NHS Foundation Trust participated in, and for which data collection was completed during 2014/15 are listed 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. (See table 1)

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Clinical Audits activity (table 1)

National Clinical Audits that National Clinical Audits that National Clinical Audits that the Trust South Warwickshire Foundation South Warwickshire participated in and for which data Trust is eligible to participate in Foundation Trust were eligible collection completed, % completion

2014-15 for and participated in 2014-15

Children

Neonatal Intensive and Special  100% Care

Epilepsy 12 Audit (RCPH National  100% Childhood Epilepsy Audit)

Diabetes (RCPH National  100% Paediatric Diabetes Audit)

Fitting Child (Royal College of 100%  Emergency Medicine Audit)

Acute Care

Adult community acquired pneumonia (British Thoracic  Data collection in progress Society)

Cardiac Arrest (National Cardiac  100% Arrest Audit)

Case Mix Programme (CMP)  100%

National Emergency Laparotomy  100% Audit (NELA)

Pleural Procedures Audit  100%

Long Term Conditions

Diabetes (National Adult Diabetes Audit) includes National 100% Pregnancy in Diabetes Audit  Data collection in progress for the (NPID) and Diabetes Foot Care Diabetes Foot Care audit Audit (DFA)

Rheumatoid and early  100% inflammatory arthritis

Inflammatory Bowel  100% Disease(National IBD Audit)

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2014-15 for and participated in 2014-15

Chronic Obstructive Pulmonary  100% Disease (COPD)

Elective Procedures

Elective surgery (National PROM’s  100% Programme)

National Joint Registry  100%

Heart

Acute Myocardial Infarction and N/A The Trust is not currently other ACS (MINAP) x participating. Data collection is due to recommence in 2015-16

Heart Failure (Heart Failure Audit)  100%

Cardiac arrhythmia (Cardiac  100% Rhythm Management Audit)

Cancer

Lung cancer (National Lung cancer  100% Audit)

Bowel cancer (National Bowel  100% Cancer Audit)

Oesophago-gastric cancer  100% (National O-G CancerAudit)

Prostate cancer  100%

Older People

Falls and Fragility Fractures Programme (includes National  100% Hip Fracture Database and National Audit of Inpatient Falls)

Sentinel Stroke National Audit 100%  Programme (SSNAP)

Older People (Care in Emergency 100% Departments) (Royal College of  Emergency Medicine Audit)

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2014-15 for and participated in 2014-15

Mental Health

Mental Health(care in Emergency departments)(Royal College of  100% Emergency Medicine Audit)

Blood Transfusion

National Comparative Audit of Blood Transfusion Programme (includes audit of patient  100% information and consent and audit of transfusion in children and adults with sickle cell disease)

Other

National Intermediate Care Audit  100%

National Confidential Enquiries National Confidential Enquiries National Confidential Enquiries that that the Trust was eligible to that the Trust was eligible for The Trust participated in and for participate in 2014-15 and participated in 2014-15 which data collection completed, % completion

Sepsis  100%

Gastrointestinal Haemorrhage  100%

Lower Limb Amputation  100%

Tracheostomy Care  100%

The reports of 8 national clinical audits were reviewed by the provider in 2014/15 and South Warwickshire NHS Foundation Trust is taking the following actions to improve the quality of healthcare provided.

Pleural Procedures Audit Actions being taken following audit  Providing documentation guidance sheet for use in clinical areas

 Providing a proforma for use in patient notes, similar to Community Acquired Pneumonia / Acute Kidney Injury bundles

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Community Acquired Pneumonia 2013 Actions being taken following audit  Implementing Pneumonia Care Bundle  Developing a pneumonia scorecard  Educating junior medical staff – through Induction, teaching and Grand rounds programme

National Cardiac Arrest Audit (NCAA) Actions being taken following audit  Investigating the provision of an accredited course for healthcare assistants  Investing in equipment and identifying space for simulation training  Presenting local data and reports from the NCAA to both the Patient Safety committee and Deteriorating patient committee, as this data becomes available  Continuing to liaise with Information Technology with regard to electronic prompts to capture Cerebral Performance Category data  Making annual cardiac arrest data available to all staff on the Intranet.  Undertaking multi-disciplinary case note review of unexpected non survivors and when data inputting to NCAA, ensure any significant co morbidities are recorded

National Audit of Seizures in Hospital (NASH 2) Actions being taken following audit  Discussing at the A & E teaching programme  Ensuring seizures protocol on intranet and A & E shop floor

Asthma (Children) (Royal College of Emergency Medicine Audit) Actions being taken following audit  Introducing an asthma pathway that can guide doctors and nurses for the management of asthma attack in children

Severe sepsis and septic shock (adults) (Royal College of Emergency Medicine Audit) Actions being taken following audit  Including sepsis on the A & E departmental teaching programme. This is to encourage clear documentation, more awareness of Sepsis 6 and use of the Severe Sepsis Audit Sheet.

Paracetamol Overdose (adults) (Royal College of Emergency Medicine Audit) Actions being taken following audit  New guidelines to be included in the departmental teaching programme  Ensuring guidelines are on the intranet and A & E shop floor

Sentinel Stroke National Audit Programme (SSNAP) Actions being taken following audit  Improving performance in mood screening and subsequent patient care by implementing a universal mood screening programme  Providing nutrition screening training for staff on Victoria and Feldon wards.

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The reports of 2 National Confidential Enquiries were reviewed by the provider in 2014-15 and South Warwickshire NHS Foundation Trust is taking the following actions to improve the quality of healthcare provided.

Alcohol Related Liver Disease Actions being taken following audit  Establishing a formal multidisciplinary Alcohol Care Group  Piloting the British Association for the Study of the Liver/British Society of Gastroenterologists endorsed cirrhosis care bundle with the ultimate aim of implementation  Liaising with Recovery Partnership to increase Alcohol Specialist Nurse sessions

Subarachnoid Haemorrhage Actions being taken following audit  Formalising the network of care provided between UHCW and South Warwickshire Foundation Trust for subarachnoid haemorrhage patients.

The reports of 84 local clinical audits were reviewed by the provider in 2014/15. A selection of actions from the local audits that will have a beneficial outcome on patient care is described below:  Promoting the use of and implementing Care bundles for Acute Kidney Injury, Severe Sepsis, and Community Acquired Pneumonia to prompt the early recognition and treatment of these conditions  Providing education on the need for appropriate administration of IV fluids both intra and post – operatively  Installing soundproofing in the Endoscopy prep room to provide patient privacy when receiving their diagnosis  Establishing an Antimicrobial Stewardship Management Team (ASMT) at the Trust with the ultimate aim of improving antimicrobial prescribing and reducing antimicrobial resistance  Reviewing the training of paediatric junior doctors on the management of food challenges to improve allergy diagnosis  Maintaining temperatures in Theatre, Recovery room, Labour ward and Swan wards at or above 25° C to prevent hypothermia  Updating the Trust’s anticoagulation chart with clear guidance on new oral anticoagulants  Conducting a patient satisfaction survey for patients receiving Intrathecal Chemotherapy to identify improvements from patient feedback  Improving referral prioritisation system for Speech and Language patients to ensure high priority patients are seen sooner  Providing on-going awareness and training on the needs of looked after children and the importance of their health assessments

 Rewriting the ‘Prescribed Oral Nutritional Supplements in the Community’ guidelines to include processes for dietitians to follow when considering and requesting Oral Nutritional Supplements on prescription.

The outcomes of audits are reported to the relevant divisional Audit Operational Governance Groups (AOGGs) where action plans and progress is monitored. Quarterly progress is reported to the trusts Clinical Governance Committee.

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Participation in Clinical Research

The number of patients receiving NHS Services provided or sub-contracted by South Warwickshire NHS Foundation Trust between April 2014 and March 2015 that were recruited during that period to participate in research approved by a Research Ethics Committee was 903. Participation in clinical research demonstrates the Trusts commitment to improving the quality of care we offer and to making our contribution to wider health improvement.

South Warwickshire NHS Foundation Trust was involved in conducting 112 clinical research studies during 2014/15. Of these, 83 were supported by the National Institute for Health Research (NIHR) through its research networks. 100% were given permission by an authorised person within 5 days from receipt of a valid completion.

NIHR Portfolio Studies Number of Studies Percentage of Total Number of Speciality Patients Recruited Oncology 37 45.6 Neurology and Stroke 8 9.8 Musculoskeletal 7 8.6 Reproductive Health and Childbirth 5 6.2 Blood (Non-malignant haematology) 5 6.2 Diabetes 4 5 Paediatrics 4 5 Gastroenterology 4 5 Dermatology 2 2.5 ENT and Eyes 2 2.5 Congenital Disorders 1 1.2 Infectious Diseases and 1 1.2 Microbiology Cardiovascular 1 1.2

Non- Portfolio Studies Number of Studies Percentage of Total Number of Speciality Patients Recruited Educational (PhD, MSc etc.) 14 41.2 Other 11 32.4 Trust 6 17.6 Commercial 3 8.8

The Trust continues to partake in multi-centred studies supporting high quality research for the benefit of our patients. Our involvement in research has resulted in over 20 publications in the past 3 years, helping to improve patient outcomes and experience across the NHS.

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Goals Agreed with Commissioners A proportion of South Warwickshire NHS Foundation Trust’s income in 2014/15 was conditional on achieving quality improvement and innovation goals agreed between South Warwickshire NHS Foundation Trust and NHS Warwickshire, through the Commissioning for Quality and Innovation payment framework (CQUINs). The value of income in 2014/15 conditional upon achieving quality improvement and innovation goals was £3,220,962. The value of income for the associated payment in 2013/14 is £3,888,962.

Further details of the agreed goals for 2014/15 can be found via this link http://www.england.nhs.uk/wp-content/uploads/2014/02/sc-cquin-guid.pdf

Care Quality Commission

South Warwickshire NHS Foundation Trust is required to register with the Care Quality Commission (CQC) and is registered without conditions. Registration confirms that the Trust meets all regulations and standards stipulated by the CQC. It also confirms that the Trust is authorised to provide all registered services across all locations registered under South Warwickshire NHS Foundation Trust. The CQC has not taken any enforcement action against South Warwickshire NHS Foundation Trust during the period of 01/04/2014 to 31/03/2015. South Warwickshire NHS Foundation Trust has not been subject to any special reviews or any form of inspections by the CQC.

Source: CQC public website

Data Quality South Warwickshire NHS Foundation Trust submitted records during 2014/15 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 the patient's valid NHS Number was:

Admitted patient care 99.8% Outpatient care 99.9% Accident and emergency care 98.7%

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The percentage of records in the published data which included the patient's valid General Practitioner Registration Code was

Admitted patient care 100% Outpatient care 100% Accident and emergency care 100%

Clinical coding During 2014/15 South Warwickshire NHS Foundation Trust was subject to a Payment by Results inpatient coding audit carried out by CAPITA on behalf of the Audit Commission. Two hundred hospital provider spells were audited, half focused on accuracy of complications and co-morbidities for non-trauma orthopaedic procedures and the remaining half were emergency paediatric admissions with zero length of stay. A random sample was taken for the audit.

Audit Findings – Non-Trauma Orthopaedic Procedures The performance of the Trust, measured against the proportion of spells with an incorrect payment would place the trust better than average based on last year’s national performance Provider Spells tested in sample 103

% spells changing payment 4% Pre audit commissioner payment £274,692 Post audit commissioner payment £274,764 Net change in payment – undercharge £72

Audit Findings – Emergency Paediatric Admissions with zero length of stay The performance of the Trust, measured against the proportion of spells with an incorrect payment would place the trust better than average based on last year’s national performance.

Provider spells tested in sample 100 % spells changing price 6% Pre audit commissioner payment £60,009 Post audit commissioner payment £59,633 Net change in payment – overcharge £1,768

The final audit report made 3 recommendations to the trust: 1. Refresher training for complication and co-morbidity coding 2. Consistency in use of source documentation when coding, specifically the discharge letter that supports the coder to capture all relevant information for the current episode 3. Use all relevant clinical information when coding

These recommendations have been agreed and put into action by the trust.

Information Governance – annual mandatory inpatient clinical coding audit NHS Information Governance requires an annual assessment of clinical coding based on methodology developed by the NHS Classifications Service. During 2014/15 external clinical coding auditors undertook an audit of a random mix of 200 hospital provider spells across 3 chosen specialties: gastroenterology, cardiology, trauma and orthopaedics. Although the final audit report has not yet been received and approved, the initial audit results with regard to accuracy of primary diagnosis, secondary co-morbidities, primary procedure and secondary procedures are shown below. Last year’s results are also shown for comparison.

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During 2014/15 South Warwickshire NHS Foundation Trust was subject to a Payment by Results inpatient coding audit during the period by the Audit Commission and the error rates reported in the latest published for that period diagnoses and treatment coding were as follows;

Initial Audit Results Information Governance Information Governance Clinical Coding External Audit 12/13 Clinical Coding External Audit 13/14

Primary Diagnosis 94.5% accuracy 97% accuracy

Secondary Diagnoses 96.7% accuracy 96% accuracy

Primary Procedure 97.8% accuracy 97% accuracy

Secondary Procedures 98.1% accuracy 100% accuracy

The latest results confirm the consistency in the accuracy of clinical coding and the trust has maintained the highest level of attainment for the 2nd consecutive year for this Information Governance requirement.

Information Governance Information Governance is the way organisations ‘process’ or handle information. It covers personal information, i.e. that relating to patients/service users and employees, and corporate information, e.g. financial and accounting records. The Information Governance Toolkit is a performance tool produced by the Department of Health. It draws together legal rules and central guidance and presents them in one place as a set of information governance standards/requirements. Each Trust must undertake an annual assessment to identify and evidence its current level of compliance against these standards/requirements to see whether information is handled correctly and protected from unauthorised access, loss, damage and destruction; and, for this Trust, there were 45 standards/requirements in total (based on the law and central guidance). South Warwickshire NHS Foundation Trust Information Governance Assessment Report overall score for 2014/15 is graded satisfactory (green) by the Information Governance Toolkit Grading Scheme.

Reporting against core indicators Since 2012/13 NHS foundation trusts have been required to report performance against a core set of indicators using data made available to the trust by the Health and Social Care Information Centre (HSCIC).

For each indicator the number, percentage, value, score or rate (as applicable) for at least the last two reporting periods should be presented in a table. In addition, where the required data is made available by the HSCIC, a comparison should be made of the numbers, percentages, values, scores or rates of each of the NHS foundation trust’s indicators with:  the national average for the same and  those NHS trusts and NHS foundation trusts with the highest and lowest for the same. Please page 214 of the report for the Trusts performance against these indicators

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Part 3: Review of Quality Performance We agreed 9 priorities for quality improvement for 2014/15 and these are detailed below;

In this section of the report we review performance against the priorities for quality improvement we agreed for 2014/15. As an integrated Trust providing both acute hospital based services and community services, this report covers progress across the Trust, unless specifically identified as either Acute or Community.

Patient Patient Patient Safety Experience Outcomes

Introduce a single point of Improve systems and access for community based Improve patient meal processes to further experience care improving user reduce mortality rates experience Work with primary care to Improve patients increase the level and Reduce agency Nursing experience with our quality of End of Life care usage booking processes advance planning Provide more Use the Patient Care comprehensive 7 day services, increasing the Revise team structures to Committee to drive user increase clinical time availability of senior engagement decision making clinicians

Progress against achieving these Quality priorities can be found on the page numbers indicated below each priority. If we have achieved the Quality priority, a will be displayed. If a priority has not been achieved, a will be displayed.

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Patient Safety

Patient safety concerns everyone in the NHS, whether you work in a clinical or a non-clinical role. Every day more than a million people are treated safely and successfully in the NHS, but the evidence tells us that in complex healthcare systems things will and do go wrong, no matter how dedicated and professional the Staff. We also know that when things go wrong, patients are at risk of harm. The effects of harming a patient are widespread. There can be devastating emotional and physical consequences for patients and their families. For the staff involved too, incidents can be distressing, while members of their clinical teams can become demoralised and disaffected. Safety incidents also incur costs through litigation and extra treatment.

Patient safety is a broad subject incorporating the latest technology such as electronic prescribing and redesigning hospitals and services to washing hands correctly and being a team player. Many of the features of patient safety do not involve financial resources; rather, they involve commitment of individuals to practise safely. Individual doctors and nurses can improve patient safety by engaging with patients and their families, checking procedures, learning from errors and communicating effectively with the healthcare team.

Safety Culture A safety culture is one where safety is embedded in all activities, and where staff have a constant and active awareness of the potential for failure. At South Warwickshire NHS foundation Trust staff are able to acknowledge their mistakes, learn from them and take action to put things right.

The Trust also recognises the importance of encouraging a climate of openness in which all employees and other workers within the Trust can freely express their concerns without any fear of reprisal. This can contribute constructively to the development and continuous improvement of the Trusts services. As a result if a member of staff raises such a concern the matter will be dealt with positively, quickly and reasonably.

As part of an open and transparent working which is stipulated in a Whistle blowing policy, staff are encouraged to report incidents on the Trusts electronic systems which permits both an effective risk management mechanism and also empowers staff to report any malpractice they have evidenced. There will be no adverse consequences for a member of staff who raises a concern in accordance with this Policy unless the concern was raised with malicious intent. The Public Interest Disclosure Act 1998 (‘the Act’) makes it unlawful to dismiss, discipline or victimise a worker who ‘blows the whistle’ on criminal behaviour or other malpractice. The protection afforded by the act applies to workers who follow the specific procedures laid down in the legislation in disclosing specific categories of malpractice. By following this policy staff will be eligible for the protection set out in the act.

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Patient Safety Initiatives Patient Safety Newsletter The patient safety team has continued to compile a bi-monthly newsletter which is published electronically and made available to all staff. It includes examples of good practice, lessons learnt and changes in practice that occur as the result of an incident investigation. It will contribute to the feedback that staff receives from incident reporting, and demonstrate that reporting incidents does result in changes in practice for the benefit of patients.

Quality improvement visits The Trust has successfully introduced a programme of quality improvement visits to cover all of its wards and services across acute and community services. These quality visits have seen way to a robust and un-biased assurance process comprising of comprehensive programme of internal visits to all sites to assess compliance with local and national quality standards. Inspections have enabled the identification of good practice but more significantly to highlight areas where improvements are required.

Intelligence from the 'shop floor'

Areas of Emerging malpractice or themes in

breaches raised Patient

nationally or Experience

regionally Quality feedback Improvement Visit

Performance Risks identified by the CQC in their outliers across intelligence the Trust monitoring reports

Assurance process and reporting of assessment  Following a visit, findings are reported to the patient experience group who will have oversight of the findings and will recommend ab appropriate course of action to the Patient Safety Surveillance group as required.

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 The Director of Nursing provides an overview report to Finance and Performance Executive Committee, in accordance with an agreed reporting schedule. This will include the summary results of any ward inspections conducted. This report will provide assurance that any actions to improve quality of care and safety are being progressed.  The Clinical Governance Committee receives a quarterly report to inform the committee of the Trust’s compliance with the quality and safety standards and assure the committee that appropriate actions and services improvements have been made or are in progress to ensure safe and high quality services are in place.

Quality visit team  The Director of Nursing selects an inspection team, who will be independent of the area under review to carry out the visit, allocating a team leader.  Where possible inspection teams are multi-disciplinary, with ‘experts’ in the specific areas under review drafted onto the team if necessary.  Non-clinical staff are utilised to seek feedback from patients and to consider the environmental aspects of the visit.  The team leader allocates roles to the team.

Internal mock inspections have been conducted at a selection of wards across Acute and Community settings. Below is a selection of good practice observed through the quality improvement visits;

Squire Ward Ward was clean, well-organised, calm and uncluttered. Red table for dementia care was in use with patients taking an interest in the books Dress for Dignity campaign being encouraged and families informed and involved in this. The nurse leadership on the ward was excellent demonstrating a firm but fair approach to staff. Staff knew the expectations of them and their role, felt supported to do training and education and to develop themselves and able to raise concerns or challenge each other when needed. Good communication and team working evident. A&E Staff engagement across the Clinical Team, evidence of good communication. Team develop a newsletter to share information across the field. Few incidents, but good process in place where incidents occur so everyone can learn. Working and sharing good practices regionally and nationally. Guy Ward Leadership in the unit is excellent, staffs are clear in their roles, able to raise concerns and challenge practice. Staff commented on how well they felt supported by the Ward Manager. Nursing and medical Staff felt they could escalate issues to the Consultant on-call if required. End of Life care planning was thorough and personalised to ensure the best outcomes for patients. ITU The unit was clean, well-organised, calm, uncluttered and well led. Medicines Management and safe storage of medicines was excellent with staff able to demonstrate a safe system. Ellen Badger All staff engaged with, would recommend the hospital for care and treatment. Good environment, patient focussed and caring. All patients observed to be treated with privacy and dignity. Holistic care approach and initiatives such as horticultural therapy in the day unit and church service. Both enabling patient well-being and mobilisation.

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Exhall Grange Good leadership in place with a very innovative team in place. Ellipads used for feedback on patient experience. The team also won three national awards recently. Play specialist presented to national conference, at which the session was evaluated as ‘outstanding’. Excellent relationship with child, family and agencies. Flexibility with child and families. Child and family included in care planning. No complaints raised by children or families or agencies. Fairfax Ward Leadership was considered as excellent by the inspection team and that consequently the ward was well managed, well led, organised and safe. Innovative practice noted with the card system when a patients notes are taken off the ward or away from the clinical area so that the team know where the notes are, which we should share across the hospital as an excellent example of good team work and a means of maintaining patient safety. Chadwick Ward was clean, well organised, calm and uncluttered. Ward Red table for dementia care was in use with patients taking an interest in the books Dress for Dignity campaign being encouraged and families informed and involved in this. Good induction for all staff including bank and agency All patient assessments and care plans up to date Staff felt they received excellent handover information that prepared them for caring for their patients Patients were weighed every Sunday Finger foods available and accessed for dementia patients. Campion Ward Leadership was considered as excellent by the inspection team and that consequently the ward was well managed, well led, organised and safe. The unit was clean, well- organised, calm, uncluttered Drug round included photographic proofs of patients to ensure the correct medication was given to the correct patient

Safety culture apparent with the team knowing about recent incidents and the learning Feldon Ward from these, the board round in practice, the walk round report, staff felt supported to raise concerns and issues. Staff knew how to report faulty equipment and fault reported in log book. Clear and effective End of Life care planning was in place, with compassion being a central element.

All patient assessments and care plans up to date. Nutrition and hydration was a fundamental element of the care plan and were well adhered to. It was stated by all staff who were questioned that the Ward Manager made it a rule to ensure all patients were assisted with their food. All patients that were asked were complimentary of the food provisions.

Victoria Ward Overall we were very impressed with the quality of care and as individuals would be very happy for us or our families to be patients on the ward and patient feedback was very positive. We also noted good practice with regard to patients in palliative care and communication with relatives.

Knowledge with regards to risk reporting safeguarding and capacity was of a high standard.

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Cardiology Staff had been bought personal alarms to use in CCU when there are only two nurses including CCU, on duty and they feel vulnerable or need assistance. This innovative practice had been Malins ward implemented after recent incidents. and Cath. lab. The staff education and information campaign on pressure ulcer prevention and the diabetes education board demonstrate excellent practice in staff engagement and education.

Main Theatres Care of deteriorating patient, escalating sick patient and timely interventions, accurate documentation of vital observations and safety checks, WHO checks lists, VTE checks, all medical devices were in date, resus checks up to date Knowledge of palliative care and bereavement arrangements provided where needed . Stratford Excellent Well led teams –clear vision,-proactive, enthusiastic team, positive attitude, Health Visitors encouraged to be innovative. Creative, reactive to change, supportive. Staff said “They and School loved their job”. Staff encouraged expanding their knowledge and skills. Staff stated nurses that resources were assessable and good. Evidence of skills mix with competencies. Always looking to improve their services Post-registration student school nurses were welcomed and supported Newly qualified health visitors were welcomed and supported through preceptorship. Staff displayed a caring and compassionate manner. Worked very closely with other agencies.

Ophthalmology The department has a robust clinical induction programme ensuring that medical Department devices/ clinical interventions are only used or operated by staff assessed in that competency. The department works well with external organisations “Warwickshire Visual Support Service” were present in the department on the day of the visit. All staff spoken to describe how they are responsive to patients needs particularly those patients with learning disabilities and visual impairment. Avon ward Excellent attention to detail paid by staff to dietary needs and nutrition. The nursing documentation was completed to good standards with nutritional assessments competed clearly and appropriately. Good incident reporting and management of patient safety concerns. Staff also shared that there was debriefing following patient safety incidents McGregor Excellent Well led teams – clear vision, proactive, enthusiastic team, positive attitude. Ward Staff said “they love their job, have worked there for many years”. Evidence of skills mix with competencies. Retention of staff is good and no problems with recruitment. Responsive to the needs of their families and their staff. Families spoke highly of the service and the relationship between staff and families was excellent

Evaluation of our inspections Further to the initial mock inspections conducted, there has been positive uptake from the nominated inspectors and also the ward managers/staff where inspections have been conducted. In light of this, the mock inspections will continue across the organisation with continual evaluation of their effectiveness and outcomes. The findings of the inspections will continue to be reported directly to the management team of each respective ward/service and reported to the Patient Experience group for monitoring. The Clinical Governance Committee will receive a quarterly assurance report of the findings and updates against any improvement plans.

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Striving to improve patient safety

Monitoring patient safety To ensure patient safety is at the core of the Trusts business, the following processes are in place at the Trust;

 Data is triangulated to all appropriate committees or groups as part of the reporting structure.  National data regarding patient safety is validated by cross-checking against data released in the public domain by any governing health body.  Board reports depict ward level performance where required to facilitate data and performance monitoring.  Ward to board dashboards have been introduced across the organisation which depicts ward performance against a multitude of quality and safety measures.  Dashboards comprise of validated data and benchmarked against any national targets or Trust agreed targets.

The Safety Thermometer The Safety Thermometer is a tool for analysing and reducing harm to patients. The Safety Thermometer survey records any harms which patients in a ward or team have suffered and is carried out on a specific date, every month. This focuses on four key areas, which have been identified by the Department of Health as areas of preventable harm; Falls – Records the severity of any fall that the patient has experienced within the previous 72 hours Pressure ulcers - Records the patients WORST old pressure ulcer and WORST new pressure ulcer Catheter-acquired urinary tract infection (UTI) – Records information about any UTI acquired whether the patient had a urinary catheterisation or a urinary catheter in place Venous thromboembolism (VTE) assessment, prophylaxis and treatment – Records whether the patient has had a VTE assessment completed and if applicable, the patient is receiving treatment The Safety Thermometer was introduced into the Trust during February 2012.The overall aim is to provide data from every patient on a given day each month, to include any patient in a hospital bed and any patient seen by a trained nurse within the community setting. The data is then collated in a central database and returned to the NHS Information Centre.

The Patient Safety Team, Compliance Team and the Matrons have provided training to ward managers and professional Team Leaders throughout the year and have assisted with the data collection. Each area receives a copy of their data and are asked to complete an action plan to address areas where there are areas of concern. Each area must analyse their data, share with colleagues and develop interventions to improve their rate of harm-free care. The data is published monthly and available to the public. The Trust set a quality improvement measure to achieve 95% harm free care in the Safety Thermometer.

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Over the past 12 months the largest rate of harm was in connection with. Those Pressure ulcers that are acquired from outside of the Trust. Patients may not be in receipt of healthcare provided by the Trust. Our performance is in line with the national performance and a notable improvement in performance can be evidenced. The safety thermometer has been successfully embedded across the Trust and its importance has been further evidenced by the continuous achievement of 95% harm free care using the safety thermometer. Patient Safety Incidents

What is a patient safety incident? A patient safety incident is any unintended or unexpected incident, which could have or did lead to harm for one or more patients receiving NHS care. Definition from the NPSA (National Patient Safety Agency)

The Trusts Patient Safety Group has continued through 2014/15, and changed its title to the Patient Safety Surveillance Group. This group co-ordinates, supports and monitors the implementation of the associated work-streams. The group also monitors the implementation of patient safety alerts and provides assurance to the Clinical Governance Committee through the quarterly quality reports.

Incident Reporting The overall aim is to reduce incidents with harm and increase incident reporting in a fair blame culture. As per requirements stipulated by the NPSA, NHS organisations should have a centralised system for collecting data on patient safety incidents. This will help to analyse the type, frequency and severity of the incidents, and to use this information to improve systems and clinical care. For such systems to be effective, organisations need to encourage and support staff to report patient safety incidents. There are three types of incidents that should be reported: • Incidents that have occurred; • Incidents that have been prevented (also known as near misses); • Incidents that might happen.

Information from all these incidents and from risk assessments can flag up problem areas and lead to preventative strategies to protect patients. In line with NPSA requirements to have a centralised system for collecting data on patient safety incidents, the Trusts electronic incident reporting system, ‘Datix’ continues to be the single reporting system across the organisation since its implementation in November 2012. This electronic system enables real-time monitoring of incidents and prompt action.

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Monthly reports are presented to each of the divisional audit and operational governance groups, and a monthly Patient Safety report summarises the data collected and is presented to the patient safety surveillance Group

Serious Incidents A serious incident requiring investigation is defined as an incident that occurred in relation to NHS funded services and care resulting in:  the unexpected or avoidable death of one or more patients, staff, visitors or members of the public  permanent harm to one or more patients, staff, visitors or members of the public or where the outcome requires life-saving intervention or major surgical/medical intervention, or will shorten life expectancy (this includes incidents graded under the NPSA definition of severe harm)  a scenario that prevents or threatens to prevent a provider organisation’s ability to continue to deliver health care services, for example, actual or potential loss or damage to property, reputation or the environment  a person suffering from abuse  adverse media coverage or public concern for the organisation or the wider NHS

Serious incidents in healthcare are relatively uncommon, but when they do occur the NHS has a responsibility to ensure that there are systemic measures in place for safeguarding of people, property, NHS resources and reputation. This includes the responsibility to learn from these incidents in order to minimise the risk of them happening again. During 2014/15 the reporting of Serious Incidents was as follows;

Pressure Ulcers – this table shows the total number of grade 3 and grade 4 Pressure ulcers. Only once they are thoroughly investigated as per Trust policy, they are then categorised as avoidable or unavoidable. Following a thorough investigation of all serious Incidents, it may be deemed that the cause of the incident is not as initially recorded or reported, therefore the incident is then downgraded. For example; an incident initially reported as a pressure ulcer, may be downgraded to a moisture lesion following investigation.

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Once the incident has been closed by the assuring Committee (Clinical Governance Committee), the lessons learnt are included in the governance report for each of the audit and perational governance groups. Themes are monitored by the Patient Safety Team.

The actions arising from serious incidents are monitored by the Patient Safety team, and a quarterly report is reviewed by the Clinical Governance Group to ensure that actions are completed.

Duty of Candour The Trust is required to demonstrate that a duty of candour has been applied to all serious incidents reported from April 2013. The Trust reports against the Duty of Candour for service users and their families and is part of our governance process and being open policy. Families should be informed by the Trust within 10 working days of a severe harm or death to a service user. This information has been made mandatory for all patient safety incidents.

Duty of candour Performance Target

Patient /Next of kin/carers were informed 100% 100% Relationship to patient was documented 100% 100% Person informing patient and / or NOK 100% 100% Method of informing patient / NOK: - Face to face 100% 100% - Not recorded 0% 0% Details of information given recorded 100% 100%

Never Events Never events are serious, largely preventable patient safety incidents that should not occur if the available preventative measures have been implemented. Once an incident is categorised as a Never event, the Trust follows a formal thorough investigation process to understand the root causes and to put actions in place to prevent it happening again in the future. During 2014/15, South Warwickshire NHS Foundation Trust has reported two never events.

Following thorough investigations into the never events, the lessons learnt and actions required have been listed below;

Never event Lessons learnt Progress

Wrong product When a product is questioned by a member of All actions completed inserted into the the team the surgery should be stopped if safe abdomen during an to do so and clarification of product emergency caesarean established. section requiring All members of the team to be kept informed All actions completed return to theatre for (including night co-ordinators) of changes to removal products used within obstetric theatres Improve signs in Labour Ward theatre All actions completed informing where absorbable Haemostat is found.

Clear written guidance regarding the use and All actions completed checking procedure absorbable haemostat

Review the trust procurement process and All actions completed ensure that the generic names of products are used and not brand (trade) names

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Ensure all Midwives and Obstetricians are All actions completed aware of the updated guidelines Wrong site surgery Re circulate Interpreting and translation All actions completed guidance and ensure it is easy to access

Develop a modified WHO (World Health All actions completed Organisation) checklist for minor procedures

Review of Smartcard policy at next Medical All actions completed Records team meeting Review of signage in Women’s unit All actions completed

Global Trigger Tool The Patient Safety team review medical records on a twice a month basis using the Global Trigger Tool methodology. This method identifies triggers during a patient’s hospital stay (e.g. blood transfusion).Once the reviewer has recognised a trigger, they then determine if this trigger has caused the patient any harm. The harm events range from temporary harm to contributing to patient’s death. See Categories below;

From our reviews harm events are predominantly in the first two categories E & F. This would appear to impact on the length of the hospital stay. The rate of harm identified through the note reviews ranges from 0% to 3.7%. The summary of triggers / harm events is as follows;

The majority of triggers relate to General care: - Readmission of patients within 30 days - Failure to respond to early warning score

Whilst the triggers relate to two specific areas, the Trust has developed work streams to address these specific areas. The Trust recently conducted a readmission audit in conjunction with a GP as a representative of the CCG. The findings of the audit were very positive denoting that where the readmissions occurred, these were not due lapses in care or the result of suboptimal care. The audit also outlined that whilst readmissions occurred, these could have been prevented by improving partnership working across the region.

NHS Litigation Authority Risk Management Standards (NHSLA) NHSLA manages negligence and other claims against the NHS. The NHSLA helps to resolve disputes fairly, shares learning about risks and standards in the NHS and also helps to improve safety for patients and staff. Participating NHS Trusts are assessed against the NHSLA Risk Management Standards. These are as follows;

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Level Requirement South Warwickshire NHS Foundation Trust’s position Level 1 NHS Trusts are expected to have the process for managing risk described and documented in approved  Achieved policies Level 2 NHS Trusts are expected to evidence the process for managing risk is as described in the approved policies  Achieved Level 3 NHS Trusts are expected to demonstrate the process for The NHSLA are currently managing risk is working across the whole organisation. reviewing their Assessment process and assessments of all organisations have ceased until further notice.

South Warwickshire NHS Foundation Trust has successfully achieved and retained its Level 2 accreditation from the NHSLA for both acute standards and maternity CNST (Clinical Negligence Scheme for Trusts). There have been no failures or breaches in compliance with the NHSLA standards in any other area.

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Pressure Ulcers

Committed to our patients The Trust has continued in our determination to reduce the number of pressure ulcers that occur within the Trust. We have developed the following awards to issue to our Wards to celebrate their success;

BRONZE SILVER GOLD PLATINUM 50 days pressure 100 days pressure 365 days pressure 2 years pressure ulcer free ulcer free ulcer free ulcer free

We are pleased to announce that 20 nursing teams have achieved platinum awards and 7 teams have achieved a Gold award this year. The team are planning an awards ceremony to be held in conjunction with the annual Pressure Ulcer Prevention Week.

A pressure ulcer (also known as 'bed sores', 'pressure sores' and 'decubitus ulcers') is an ulcerated area of skin caused by irritation and continuous pressure on part of the body. Pressure ulcers are more common over bony prominences (places where your bones are close to your skin) such as your heels, the lower part of your back and your bottom. There are various things that can increase your risk of developing a pressure ulcer - in particular, if your mobility is reduced for some reason and you are spending long periods lying in bed or sitting in a chair.

Reducing avoidable harm to patients has been an on-going priority for the Trust in particular the reduction of avoidable pressure ulcers.

In April 2012 the Trust signed up to the Harm Free Care initiative and implemented the Safety Express which included rolling out the Safety Thermometer across the Trust in both acute and community settings. In June 2012 the Trust began the Stop the Pressure Campaign - to eliminate all avoidable pressure ulcers by December 2012. In July 2012 a peer review was undertaken and the Trust received excellent feedback in relation to the on-going work to reduce avoidable pressure ulcers.

In November 2012 the Datix incident reporting system was implemented across the community as their previous reporting system licence came to an end. In November 2013, Datix web was implemented across the whole Trust. As part of Stop the Pressure Campaign, several changes in the way pressure ulcers were reported across the NHS were implemented, including the criteria and national guidance on grading pressure ulcers and deeming whether they were avoidable or not.

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Unavoidable Examples:  Patients in critical care where, haemodynamic or spinal instability may preclude turning or repositioning and lead to unavoidable pressure ulcers;  Patients who refuse to be repositioned may also develop unavoidable pressure ulcers;  The condition of skin failure does exist;  Patients at end of life may not be able to tolerate repositioning as frequently as their skin may require. In these cases, pressure damage may be an unavoidable consequence of their terminal status;  Has not been seen by a healthcare professional or has not been on a healthcare professional’s caseload for over 72hrs;  Refused assessment and/or has not complied with the agreed plan of care and has mental capacity, and  On initial assessment the patient has existing signs of pressure damage.

Unavoidable damage would also be possible where the patient is known to a health care professional but an acute/critical event occurs affecting mobility or the ability to reposition. This may include the patient being discovered following: • a fall, and • loss of consciousness due to, for example unexpected collapse; drug misuse, alcohol misuse.

A further category was also introduced SCALE (Skin Changes At Life’s End.) End of life skin changes stem from ineffective skin and underlying soft tissue perfusion, increased vulnerability to external insults such as minimal pressure, build-up of metabolic waste, and local tissue factors. At end of life a person may develop a skin breakdown despite multiple appropriate interventions and optimal care, as it may be impossible to shield the skin from insult and injury in its compromised state.

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What does the data tell us?

Acute Pressure Ulcers Year on year comparison

Total Avoidable

28 30

8 2

2012/13 2013/14 2014/15

Chart 2

Community Pressure Ulcers Year on year comparison Total Avoidable 434

343

232

11 (3.2%) 7 (3%) 13 (2.9 %)

2012/13 2013/14 2014/15

Chart 3

Charts 2 & 3 show the number of avoidable pressure ulcers for 2013/14 and 2014/15 across the Acute and Community settings, categorisation of avoidable and unavoidable was not fully embedded across the Trust until the end of 2012.

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It is also important to put into context the numbers of pressure ulcers against the 350,000 patients that are seen in the acute setting, and particularly for the community setting, the number of contacts that are seen equating to approximately 22,000 contacts per month

Number of days since last Avoidable Pressure Sore (Acute) Postion as of 31 March 2015

1094 1094 1094 1094 1094 1094 1030 1059 991

791 778

607 558 515 500 438 395 354 297 224 185 195 83 25

Chart 4

Number of days since last Avoidable Pressure Sore (Community) Position as of 31 March 2015

973 973 973 973 973 973 973 973

790

517

304

154 183 91 61 61 0

Community team

Chart 5

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Charts 4 & 5 show the numbers of days since the last avoidable pressure ulcer across the inpatient wards and the community teams. Once an avoidable pressure ulcer is attributed to an area or team the days free goes to zero. There is variance across the Trust and this relates to either an avoidable pressure ulcer being attributed to the area or when the ‘Stop the Pressure’ campaign was fully embedded in the area.

Overview of Initiatives and actions taken There has been significant investment in equipment; all of our foam mattresses are of a high specification and can be used for patients at risk of pressure ulcer development. We have upgraded 25% of our foam mattresses to Premier active (these are foam mattresses with air cells that we can flex up with a pump to make a higher specification). Dynamic mattresses amount to 70% of our mattress fleet.

All of our chairs have been replaced so each chair has an integrated pressure relieving seat. We use Repose heel boots, heel troughs, aderma heel pads to offload pressure. District Nursing Teams have access to repose mattress and cushions 24/7 whilst they wait for equipment to be delivered from our contractor. There are 22,680 pieces of pressure relieving equipment provided to patients in the community.

A Root Cause Analysis (RCA) is carried out for all pressure ulcers. A mini RCA is carried out on all grade 2 pressure ulcers. All grade 3 & 4 pressure ulcers are reported as Serious Incidents and follow the Serious Incident reporting process. They are all reviewed monthly in the Pressure Ulcer Review Group that is chaired by the Director of Nursing. Teams are asked to present their investigation to state what lessons have been learnt, and using the national criteria, whether the pressure ulcer is identified as either avoidable or unavoidable.

A new assessment tool has been developed for allied health professionals - the pressure ulcer risk assessment tool (PURA).

In February 2015 a new patient education booklet was launched called the ‘Skin booklet’. This provides carers and patients with information and advice on all aspects of pressure ulcer prevention, recognition and treatment, and is given to all patients on the community caseloads as well as care homes.

Nurse care indicators are monitored monthly against the required documentation and assessments for patients are undertaken, including the Waterlow assessment action plan, reassess weekly reassessments and SKIN bundle.

Other initiatives include: • Increased training has been developed for care homes; • Annual Pressure Ulcer Prevention week; • Annual Regional Link Nurse Event; • SKIN Bundle in the Community and Care Record for Pressure Ulcer prevention and falls (intentional rounding charts); • An extensive programme in the form of e-learning and face-to-face Learning has been developed for all staff; • the Continence Project launched as part of the SKIN bundle to promote continence and review products we use, e.g. Tena® Wash and pads; • Certificates for days free of avoidable pressure ulcers and annual presentation by the Director of Nursing; • Videos made by staff are available on http://your-turn.org.uk/ • Monthly Tissue Viability newsletter with new initiatives and lessons learnt

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Screening Tool It has been recognised throughout the health economy that every contact with patients are an opportunity to provide health education. The team are in the final stages of developing a Traffic Light screening tool and referral pathway to detect and target non inpatients at risk of pressure ulcer development. The tool has been developed with the Multi-disciplinary team (MDT) to assist them in identifying at risk patients and referring them to the most appropriate health care professional.

Education Tissue viability and pressure ulcer prevention training is mandatory for all clinical staff. This mandatory training encompasses pressure ulcer prevention, risk assessment, documentation and the use of pressure relieving equipment. The team have developed an E Learning training package for pressure ulcer prevention that has been uploaded onto the Trusts Electronic training system. This system is available to all Trust staff and can be accessed at home as well as within the Trust. The team receive quarterly reports regarding the uptake of this training.

SKIN Bundle (Surface, Skin inspection, Keep me moving, Incontinence, Nutrition) Prior to Ambition 1 being launched the Trust had already begun to develop a SKIN (acute) and SSKIN (community) bundle to improve the quality of care provided to our patients. The bundles focus on the essential care required to prevent pressure ulcers. As part of a documentation review within the Trust, it was decided to combine the falls Challenge and intentional rounding with the SKIN bundle into one simple-to-use tool. In the acute setting a dedicated SKIN bundle implementation nurse was employed to support clinical areas in introducing the tool. In the community, due to overlap of community services a regional booklet was developed. The purpose of this booklet is to provide patients and carers with essential information to prevent pressure ulcers and provide contact details for support.

In summary With all new initiatives and high profiling of issues comes the increased awareness and increased reporting. What has been demonstrated through a review of the data is that there is some double counting, which is inevitable as staff are encouraged to report any break in the skin that they find, pressure ulcers are acquired outside of the Trust but may be attributed to another health care setting not managed by the Trust. Many pressure ulcers reported in the first instance when validated through the RCA process are either not a pressure ulcer or are externally acquired or are unavoidable. Since 2012 considerable work has been on-going across the Trust to reduce avoidable pressure ulcers. The data demonstrates a reassuring picture that there is robust incident reporting and that the teams are committed to reducing avoidable pressure ulcers. As demonstrated in areas that have been avoidable pressure ulcer free with many areas for 1, 2 and 3 years. The Tissue Viability Team will continue to work and to develop initiatives to further reduce the numbers of avoidable pressure ulcers across the Trust.

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Infection Prevention The Trust is proud of its strong commitment to reducing harm to patients, through both reducing rates of healthcare associated infections, and improving outcomes for those patients who have infections. The Root Cause Analysis (RCA) process is rigorously applied by the Infection Prevention Team and their clinical colleagues, for the investigation of cases of Methicillin-Resistant Staphylococcus Aureus (MRSA) blood infections, Clostridium Difficile (C.Diff) outbreaks, deaths where C. Diff has been certified as a leading cause of death and other outbreaks of infection. In addition, in 2014/15, we commenced a programme of formal RCA into every case of Trust-attributed C.diff and Methicillin-Sensitive Staphylococcus Aureus (MSSA) blood infections. All such RCA findings and recommendations are presented to the Infection Prevention Board by the patient’s clinical teams.

Clostridium Difficile (C.Diff) Over the last 8 years, we have learnt many lessons about sources of infection, root causes and the processes required to reduce C.diff related infections. The Department of Health recognises that patients may still develop or acquire C.diff infection, as antibiotics and other interventions are required in order to treat certain underlying conditions. Therefore, an emphasis has now been set on identifying if care was appropriate for these patients and did any lapses of care lead to the development of C.diff infection. In essence, was this infection avoidable? Each case of C.diff identified more than 2 days after admission to the Trust was thoroughly investigated in conjunction with Infection Prevention experts from the Clinical Commissioning Group (CCG). A target of a maximum of 24 “avoidable” C.diff cases was set for the Trust in 14/15 and we are proud to report that this was successfully achieved with a total of only 2 hospital-attributed avoidable cases of C.diff identified Trust-wide. This is an amazing achievement and we are delighted to be able to assure our patients that all is being done at the Trust to protect them from infection, whilst under our care.

MRSA bacteraemia Methicillin-Resistant Staphylococcus Aureus (MRSA) is a bacterium responsible for several difficult-to- treat infections in humans. The Department of Health continues to drive a “Zero-tolerance” approach to MRSA bacteraemia. This means that any “avoidable” MRSA bacteraemias are deemed unacceptable. We are pleased to report that zero Trust-attributed MRSA bacteraemias were identified in 2014/15 (compared to 1 case in 13/14).

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Methicillin-Sensitive Staphylococcus Aureus (MSSA) Surveillance and monitoring of Methicillin-Sensitive Staphylococcus Aureus (MSSA) bacteraemias Rates of these remain low when compared nationally, however a total of 9 hospital-attributed MSSA bacteraemias were identified in 2014/15 compared to 11 in 2013/14. As with MRSA and C.diff, each case of MSSA bacteraemia was investigated and analysed.

E.coli bacteraemias Thirty Trust-attributed E.coli bacteraemias were identified in 14/15, compared to 29 E.coli bacteraemias in 13/14. E.coli bacteraemias are quite common and usually associated with infections of the urinary tract. Actions to reduce avoidable E.coli bacteraemias are mainly associated with a reduction in the numbers of short-term urinary catheters and excellent urinary catheter care.

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Medication Safety

A very successful medication safety week took place during January 2015. During this week the medication policy and handbook was officially launched with a staff competency self-assessment process and a reminder of key safety messages. We saw excellent practices were reported and witnessed. Some themes for on-going improvements in practice were also identified and these will be discuss and addressed through the Patient Safety Medication working group. Mock CQC inspections are also being undertaken in all clinical areas where medication safety practices are also being challenged.

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Achievements to improve medication safety this year Improving Medicines Safety has been an ongoing priority for the Trust over several years. During the course of this year, the following achievements have been made;  The electronic incident reporting form has been improved to enable accurate reporting and analysis of medication incidents  Medicines policy and audit schedule revised  Development of the sepsis care bundle and implementation across the acute sector  Revised critical drug list and flow chart across acute and community settings to support nursing staff to know where and how to get critical drugs out of hours.  Improve the care; be diabetes aware’ Campaign has been launched.  Revised and re-launched the good TTO (to take out) guide  Audit of completion of good TTO guide has been undertaken  A review of the transfer checklist and policy to ensure patient drugs are included  An audit of the contents of the lockers has been devised  A revision of the bed space checklist to include lockers to ensure patient safety  The percentage of admitted patients having a full medicines reconciliation done by a Pharmacist and Pharmacy Technician (Medicines Manager) has increased to over 90%  The Trust has increased non medical prescriber numbers this year,  A transcribing policy has been developed

The Trust continues to practise evidence based medicine, implementing national quality standards and guidelines within 90 days of their publication, and maintaining a limited list of medicines approved for use in the Trust. We now achieve over 95% compliance with a formulary (preferred prescribing list) for medicines which are used in both primary and secondary care, up from a base of 75% the previous year, and compared to a target of 85% compliance.

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Nurse Care Indicators (NCI) The monthly NCI audits are a key element of measuring quality across the clinical wards. Over the last 12 months improvements continued across the Trust and by March 2015 overall compliance reached 96.7%, with all divisions exceeding the Trust target of 95%

The elective division and the Integrated division continued to perform more favourably throughout the year having reached 97.1% and 98.8% respectively in February 2014. For the entire period from February 2014 to February 2015 the integrated division achieved in excess of 95%, and the elective division only dropped below 95% once which was in August 2014. The matrons continue to work with the emergency division managers, because progress in this area has been slower. However, steady improvements have still been achieved and the most recent scores were 95.8% compared with 93.4% for the same period last year.

Nursing Care Indicators Overall Trust Compliance

97.3% 97.7% 97.3% 97.6% 96.7% 96.8% 96.9% 97.0% 96.7% 96.1% 95.4% 94.4%

Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15

The revised nursing documentation which was distributed at the beginning of February 2013, with all the current and relevant assessment tools and associated care plans in one booklet is well embedded in practice now and the ward managers continue to receive their results directly from the Compliance department on a monthly basis. The quality compliance department and matrons continue to monitor performance and discuss results regularly with the ward teams with the continued overall aim of maintaining good quality and safe outcomes for our patients.

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Reducing Patient Falls in Hospital

The causes of falls are complex and hospital patients are particularly vulnerable to falls. This is due to many factors, such as: medical conditions, including delirium, cardiac, neurological or musculoskeletal; side effects from medication; problems with balance, strength, mobility, and vision; and inappropriate footwear.

As with many Trusts across the country, we experienced an increased admission rate of increasingly frail, elderly and confused patients. This group of patients are the most vulnerable for experiencing falls and injuries. Overall, however, our rate has been descreasing over the last five years (Table 1). During 2014/15, despite continuing increased efforts, and new initiatives, to meet our target of a 5% reduction in falls with injury rate, our rate remained relatively constant.

Table 1

2010 - 2015: Falls with injuries - rates per 1000 bed days 3

2.5

1.5

0.5

0 2010/11 2011/12 2012/13 2013/14 2014/15

The falls prevention agenda was given even greater priority, in 2014/15, by the employment of an additional Falls Prevention Lead. This increased emphasis on falls prevention helped to improve the reporting rate and quality of falls reporting, and, therefore, also may have contributed to the higher injury rate. The improved reporting, and increased profile given to falls prevention, started in June 2014, which may account for the increased rate in Quarter 2. Also, many areas were experiencing problems with temporary staffing over the holiday period.

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Falls Rate with Injury per 1000 Bed Days 2014/15

2.1 2 1.8

1.4

Quarter 1 Quarter 2 Quarter 3 Quarter 4

Included in the falls with injury are those falls which resulted in permanent harm for the patients. There were 15 falls with permanent harm in 2014/15 – the majority of which were patients who sustained a fractured hip. All of these incidents had in depth investigations. Generally, the findings of the investigations were that many of the falls were unavoidable. However, any learning from the investigations has been followed up with the individuals concerned and has influenced the falls prevention agenda for 2014/15 and plans for 2015/16, as detailed below.

During 2014/15 we have:

• Employed an additional Falls Prevention Lead • Relaunched the Trusts Falls Prevention Group and strategy • Completed partnership working with Art students from Warwick College Visual Communication Course who designed a falls prevention logo, pictograms and posters to raise awareness with staff and patients on falls risk factors • The Trust Participated in the National Audit of Inpatient Falls by the Royal College of Physicians • Improved the consistency of the investigations procedures and root cause analysis, following serious injury, leading to greater shared learning • Made improvements to the reporting of falls on the electronic incident reporting system DATIX, leading to prompts for prevention of further falls • Focused senior nurse falls prevention interventions on high rate wards • Reviewed staffing levels on high rate wards • Included falls awareness training into the Trust’s newly qualified nurses’ training programme • Substantially increased our supply of falls prevention alarms, which was kindly funded by Warwick Hospital League of Friends • Worked to improve our compliance with NICE Clinical Guidelines stipulating The Assessment and Prevention of Falls in Older People, June 2013 – through drafting a patient information leaflet • Implemented a new bedrail assessment process to improve our assurance of a thorough assessment • Continued to ensure that dementia initiatives are promoted in relation to falls prevention.

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Falls prevention logo, pictograms and posters to raise awareness with staff and patients on falls risk factors, designed by Art students from Warwick College Visual Communication Course

Next year to reduce patients who fall and suffer harm, we will:  Review falls risk assessment and care plan procedures following the outcome of the National Audit of Inpatient Falls and local audit programmes of falls documentation and Root Cause Analysis  Develop a falls awareness e-learning programme for inpatient and community staff  Start a falls prevention awareness campaign across the Trust, with monthly topics  Provide high rate wards and divisions with a tailored quarterly report detailing analysis of local falls incidents  Relaunch the Falls Prevention Link Nurse programme, to help to cascade falls prevention information and projects to the ward staff.

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Quality Priority 2014/15 - Single point of Access Introduce a single point of access for community based care, improving user experience

To access all of the adult community health teams the Trust introduced an Integrated Single Point of Access (iSPA) in May 2014.

The iSPA was implemented to take all referrals and enquiries, as the previous service provided by West Midlands Ambulance Service ended. The service is available between 8:30 and 10pm and covers all localities across Warwickshire (Stratford, Warwick, Rugby, Nuneaton, Bedworth and rural North Warwickshire) and can be accessed via the phone or email.

The call logging system for patient search has been developed as a web application and sits on the Global Assessment Platform (GAP). The telephony system allows call be answered via the computer giving instant live access to call volumes and waiting times. This allows for great efficiency when answering, triaging and logging a call and it creates a database in incoming calls as well as peak times for referral management which in turn delivers a more responsive and efficient service.

A mobile scheduling solution has been developed for use by the iSPA staff to log a new referral, allocate the work and manage the workload in the Integrated Health Teams. A mobile version of the scheduling tool on iPads allows staff to receive their schedule of work, sign off visits that have taken place, or rebook or discharge patients whilst out in the field.

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Patient Experience 96.5% of Inpatients would recommend South Warwickshire NHS Foundation Trust Our aim is to continually improve the patient experience within the Trust. The Director of Nursing chairs the Patient Experience Group (PEG) and through this group a range of work is overseen, in all departments across the Trust. The PEG holds clinicians and managers to account for the patient experience in their area through direct reporting to the group. Each manager/clinician is expected to provide actions plans for improvement.

Friends and Family Test The Friends and Family Test (FFT) aims to provide a simple headline metric which can be a driver in recognising good practice and improvements in the provision of quality care received by NHS patients and service users.

The implementation of the FFT across all NHS services is an integral part of Putting Patients First, NHS England’s Business Plan for 2013/14 – 2015/16, and is designed to help service users, commissioners and practitioners.

Since April 2013, patients have been asked ‘How likely would you recommend hospital wards and A&E departments to their friends and family if they needed similar care or treatment’. This means every patient in these wards and departments is able to give feedback on the quality of the care they receive, giving hospitals a better understanding of the needs of their patients and enabling improvements.

Performance this year From 1st April 2014 to 31st March 2015, a staggering 27,741 patients have participated in the FFT and provided feedback on their experience and 96.5% of those patients would recommend South Warwickshire NHS Foundation Trust. Whilst this is a resounding achievement, the Trust is constantly striving to engage with patients and make necessary improvements from their feedback.

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Breakdown of responses Of the 27,741 patients who have participated since April 2014 the Percentage of patients who would recommend the Trust was as follows;

% of patients who would Area of Care recommend the ward or area

96.9% A&E

Antenatal 96.8%

Children Therapy 100.0%

Community Nursing 94.8%

Community Postnatal 95.7%

Community Specialist Services 97.2%

Community Therapy Services 98.9%

Day Surgery 97.5%

Home Birth 100.0%

Inpatient 93.7%

Labour 95.2%

MIU 94.0%

Outpatient 90.6%

Paediatric Outpatient 92.7%

Postnatal 94.4%

Overall percentage who would recommend the Trust 96.5%

The FFT data is a powerful dataset available in the public domain and enables public and patients to compare services across the healthcare economy, identify those who are performing well and drive others to take steps to improve. Data evidences that since the introduction of the FFT in April 2013 at South Warwickshire NHS Foundation Trust, a substantial proportion of our patients have participated in the FFT and provided valuable feedback on their experience.

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What some of our patients say about us…

‘I was treated with such respect and love. ‘Nurses could not do the nurses could not do enough for me’ enough for me (Castle ward) (Fairfax Ward)

‘ My family were kept informed and the consultant was clear when explaining things to me ’ (CCU)

‘long wait but there were some 'I've never been so serious cases here. i was seen and cared for!' (Nicol unit) treated very well’ (A&E)

Emerging themes The free text comments are analysed by the Trusts FFT Lead and the emerging trends since implementation have been summarised below;

Top 5 Positive themes:  Patients receive clear explanations of their condition  Cleanliness of wards/ bed areas  Effective and promptness of staff  Attentiveness to care  Excellent atmosphere, friendliness of staff.

Top 5 Negative themes:  Slow to respond to call bells on ward  Noise levels, especially at night  Being moved around at night  Communication between staff  A&E waiting time – no real-time waiting time updates available

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Actions to address Negative themes Whilst there highest proportion of comments received from partaking patients is positive feedback of their experience, the negative feedback received as resulted in actions to be taken. This comprises of;

• Reinforcing the Night charter: The Night Charter campaign led by extremely proactive Trust staff, has seen some success during the Year. The campaign aims to focus staff’s attention on improving patient experience You said, overnight, by reducing noise and disturbance in clinical areas and promoting We did a restful night’s sleep to assist recovery and improve patient outcomes. The matrons are also addressing the FFT feedback with the Night charter team to review individual feedback received and to review the adherence to the Charter in those specific ward areas.

• Standard of call bells: As result of the call bells issue, a standard has been You said, implemented to ensure calls bells are answered within a specified We did timeframe. This will ensure a standardised approach and also allow monitoring of compliance.

• A&E to update waiting time board: Whilst there are boards in place to You said, provide waiting patients with waiting time indications, as result of feedback We did A&E staff have been informed to ensure that all information boards are updated to keep patients better informed.

Monitoring Patient feedback and improvements Each manager or clinician is expected to provide actions plans for improvement. All comments from the FFT are distributed to each respective ward and each ward team is debriefed with performance at local meetings. Patient satisfaction performance is accessible to all patients with the aid of display board on wards. Performance of Patient experience measures is reported from ward to Board level through an integrated Quality dashboard, on a monthly basis.

The Friends and Family Test data is available in the public domain and enables the public and patients to compare services across the healthcare economy, identify those who are performing well and drive others to take steps to improve. The FFT for acute in-patients and patients discharged from A&E became mandatory on 1 April 2013. In order to meet this national mandatory requirement, and to deliver the FFT survey requirements the Trust has contracted a third party patient organisation – iWantGreatCare (iWGC). The third party organisation has worked collaboratively with the Department of Health to ensure the methodology and reporting processes comply with requirements and legislations.

As part of our agreement with iWGC, the Trust receives a monthly management and ward reports:  Trust level report: this comprises include a summary of volume and feedback scores by ward by month, and easily identify top performers and outliers;  Ward level report: This encompasses comparative scores across wards. Ward reports includes all free text comments provided by patients.

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National Inpatient Survey 2014

Summary of findings The National Inpatient Survey was undertaken by Quality Health for South Warwickshire NHS Foundation Trust between September 2014 and January 2015.

The survey required a sample of 850 inpatients to be drawn from those patients being discharged during June, July, or August 2014 who stayed at least one night in hospital. There were a number of categories of patients excluded from the survey e.g. psychiatric patients and maternity patients.

The target response rate for the survey set nationally was to achieve at least 60% from the usable sample, and the number of usable responses should be at least 500. 413 completed questionnaires were returned from the sample of 850 from South Warwickshire NHS Foundation Trust. The final response rate for the Trust was 51% (413 usable responses from a final sample of 810).

Based on patient responses, South Warwickshire NHS Trust was placed amongst the top 20% of NHS Trusts for the following areas;

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he survey also identified some areas where patients were less satisfied. The trust has identified

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The following actions which will be monitored by the Patient Experience group

The Hospital and Ward- We will continue to assess cleaning standards in light of poor scores for cleanliness in both wards and bathroom facilities and ensure that there is a clear line of responsibility for this.

As part of our service improvements we will continue to challenge our contracted service providers to review food quality, choice, temperature, timing of food arriving and the operation of the catering contract.

Leaving hospital The main reason for delays in discharge was patients having to wait for medication to take home. We are constantly reviewing medication safety and will strive to reduce delays or improving efficiency of the process.

Overall - Actions Whilst we have a multitude of patient feedback methods, we will continue to improve patient feedback methods and process. This will ensure as many patients as possible are asked about their views on the quality of their care.

Whilst staff are up to date on complaints procedures and able to explain and easily communicate this to patients, we will ensure that information about how to complain is available for patients in hospital.

We will continue to triangulate the organisation’s staff and patient survey data with that from the Inpatient survey to identify whether there are any common themes relating to patient experience or quality of care concerns.

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Privacy and Dignity Privacy and dignity remain high priorities for the Trust. In 2007 we introduced 7 dignity promises in response to themes from patient surveys and complaints. As the promises were 5 years old and there had been a lot of change in the Trust a further review was held in 2012 and changes were made as detailed in the promises below. This was important as the promises needed to apply to all of our patients.

We promise:

 Not to allow language or other communications issues to become a barrier to understanding  You will be introduced to the staff that are caring for you  You will be called by a name of your choosing  To respond to your questions promptly, or find someone who can  Your privacy and modesty will be maintained at all times  You will be treated in a courteous manner that respects equality, diversity and your human rights  Our staff will deliver the highest standard of safe care and customer service

The Promises are presented to all new staff at corporate induction sessions held monthly and are displayed in all of our clinical areas. The training is delivered by the Matron team and explains the Trusts expectations and standards in relation to privacy and dignity.

We review the training we deliver to our staff yearly and are currently reviewing our communication training, this will enable us to deliver consistent excellent customer service. The training focuses on attitudes and behaviour whilst at work. The Practice development team deliver communications and customer service training to all newly qualified practitioners based on principles learnt from the British Olympic Games makers training. This new training is underpinned by the new National Nursing and Midwifery Strategy Compassion in Practice which focuses on the 6 C’s –

 Care  Compassion  Competence  Communication  Courage  Commitment

The matron team co-ordinate and lead an annual audit to ensure national privacy and dignity standards are achieved and maintained. An action plan has been developed and is currently being implemented. The audit confirmed that public and patient areas are consistently clean and well maintained and in addition, separate male and female toilet and washing facilities are clearly labelled and accessible. However, the main issue identified at this year’s audit was the inconsistent quality of curtains around patient bed areas. This finding was also supported by the Essence of Care benchmark reported by ward staff and where a problem has been identified, these curtains are currently being replaced.

Ensuring all patients are treated with dignity and respect underpins the work of the Trust. The principles are embedded across our working practices from the board to ward and can be demonstrated in the success we have achieved in our compliance to the single sex accommodation standards, delivering excellence in dementia care, our continued work with ‘Kissing it Better’. Our Friends and Family Test results and National Inpatient survey results. Many of our achievements are detailed later in this section.

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In October 2014 we held the third Annual Nursing, Midwives and Allied Health Professionals Clinical Conference for South Warwickshire NHS Foundation Trust which was such a huge success.

The event saw colleagues coming together from across the Trust to share truly inspirational stories and experiences. The event was opened by a patient with their story that challenged us to think differently about the care we provide. Throughout the day we heard presentations from staff and patients alike that were both thought provoking and inspirational.

Presentations, speakers and posters were all of an exceptional standard interlinking the themes of gold standard, the 6Cs and personalised care in order to ensure that we continue to put compassion into practice. The staff were provided with plenty of thoughts and reflections to work and motivate them throughout the year, this event wouldn’t have been the same without the patients and staff’s involvement, determination and drive to succeed.

What our patients told us in the National inpatient Survey 2014 Based on patient responses, South Warwickshire NHS Trust was placed amongst the top 20% of NHS Trusts for the following areas related to Privacy & Dignity;

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Staff Experience

Our full staff survey results were published by the Department of Health on 24 February 2015. This report enables us to compare how we are doing in comparison with other NHS trusts nationally and with our own results in previous years. As you will probably be aware, the Trust has performed really well in the national staff surveys every year since the combined Trust of acute and community services was formed in 2011, and the 2014 survey was no exception, maintaining the high performance levels in some key areas and making notable improvements from last year in others. This year the Trust achieved the best possible ratings for 19 out of the 29 key measures in the survey and was rated above average in a further 5 of these measures. (This compares to 10 key measures in the best ratings category and 7 that were above average in the 2013 survey). It was also encouraging that the areas where we had focused our action plan from the 2013 staff survey had all improved in the 2014 survey. As last year, the Trust was in the best rated category for staff recommending the Trust as a place to work or receive treatment. Once again the Trust achieved a very high overall Staff Engagement score, which remains in the top 20% for all trusts, as it has been each year since 2011. This year, we scored 3.86 out of a possible 5.00, compared to 3.84 in 2013 and 3.90 in 2012. The national average for all trusts in 2014 was 3.74. 3.95 3.9 3.85 3.8 3.75 3.7 SWFT 3.65 3.6 NHS Average 3.55 3.5 3.45 2011 2012 2013 2014 SWFT Staff engagement scores

Staff motivation and job satisfaction also remained high and staff reported very positive support from their line managers. We also improved on providing opportunities for staff to contribute ideas and improvements at work (an area which we have been focusing on since last year’s survey). Appraisal rates within the Trust improved and 85% of staff reported they had an appraisal within the last 12 months, bringing us in line with the national average for the first time in recent years. The Trust also performed in the best 20% for the percentage of staff suffering work-related stress in the last 12 months for the fourth year running. However, the percentage of staff reporting that they felt pressure to attend work in the last 3 months when feeling unwell had increased and we need to address this over the coming year. There was also an improvement in the reporting of errors and near misses and staff stated that they would feel secure in raising concerns about unsafe clinical practice. The Trust remained in the top 20% of acute trusts for staff reporting they believe that the Trust provides equal opportunities for career progression or promotion, as it has been since 2011, and with 96% of staff reporting that this was the case, we have the best (or equal best) score for acute trusts in 2014. An additional theme about patient experience was added to the 2014 staff survey for the first time and this has proven to be an area in which the Trust has performed less well. Only 46% of Trust staff reported that feedback from patients and service users is used to make informed decisions in their work areas. As always, the Trust will now put into place an action plan to address areas of lower performance and it is likely that this will focus on the use of feedback from patient experience and supporting staff health and well-being in the workplace.

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Complaints The Trust is proactive in encouraging patient feedback, recognising that service user feedback, comments and complaints are effective measures of services delivered, what is needed to improve those services, changing trends/demands and necessary learning. The information assists the Trust to:  Recognise standards of service delivery and continue to ensure service improvement  Understand the patient experience, perspective and expectations  Identify any problematic areas  Identify actions needed Managing formal complaints effectively – Case Study The Trust upheld this complaint and whilst we could not change the outcome for this particular family, the Trust could however demonstrate learning and recommendations as a result of the complaint made. By outlining the issues and the complaints management procedure that was followed and being prepared to accept responsibility, this ensured a satisfactory resolution of the complaint. Our case study shows is that early resolution is not always the best thing, it is more important to respond correctly.

Background A formal complaint was received from the daughter of a 54yr old man who had been diagnosed with terminal cancer, given only a few days to live and who went on to pass away at home. The family were very unhappy with the services received - specifically from their perspective, about one member of the District Nursing staff. It is worth noting that there were other issues related to the overall service provision which on investigation became clear and some of these related to other service providers.

The complaint initially was submitted by email and gave a description of events and issues the family were unhappy with, which covered their experience from a series of visits by a member of the District Nursing staff.

The main issues within the complaint were:  Unarranged visits  Poor and inappropriate communication  Giving of incorrect contact number, (particularly relevant in this case as urgent contact needed & the when the family tried the number given it was incorrect)  Staff attitude  Failure to identify information and making assumptions  Incorrect and incomplete documentation  Failure to provide cream as promised to assist in the prevention of pressure sores and given incorrect advice on alternative for short-term application  Inappropriate comments made in front of the patient  Inappropriate visit following death to fetch equipment, patient still in the home at the time.

Effective Handling The complaint was passed to an appropriate lead and the complainant advised and there were a few anxious emails initially but this was handled by the PEO (Patient Experience Office). The complainant sent in a number of separate email requests for copies of various procedures and patient notes, which were given to the complainant as requested. There was an exchange of information on a reasonably regular basis between the complainant and the PEO – at all times the complainant was reassured that the Trust would do everything they could to respond to the family and to offer support during this process.

The family were offered to meet with relevant members of staff to discuss the findings. The complainant was pleased to be offered the choice of how to receive the response information and initially requested a formal response, before considering meeting with staff and therefore a response was sent from the Chief Executive (CEO).

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The complainant contacted the PEO stating their dissatisfaction with the investigative findings and to ask how quickly they needed to write to the Trust with their remaining concerns. The PEO advised that the Trust was well aware that these were difficult times for the family and that they could take their time to contact the Trust again, and the complaint would remain open. It is worth noting that this was over the Christmas period.

Sometime later the family came back to the PEO with their outstanding concerns and the PEO requested a review of the investigation made from an independent senior nurse (i.e. employee of the Trust, not previously involved with the case). Following this, the family were contacted to meet at their convenience to talk through their letters and the findings of the investigation. With support from the PEO, agreed to meet and decided they would prefer the meeting to be held at Warwick Hospital rather than at their home.

Outcome The family members met with Trust staff and the meeting went extremely well, the family felt they had the opportunity to talk about how they felt about what had happened, including some elements of the response information they did not understand or felt were not quite right. The staff felt that the overall investigation had highlighted a number of issues about the services this family had received, not just about the District Nurse’s visits. The complaint investigation upheld the complaint and identified a number of actions and recommendations as a result. These were discussed with the family and also that the senior nurse felt there were other issues which needed to be looked into and recommendations made, which would improve service provision for families in such circumstances in the future. Without giving specific information relating to the complaint and the patient, in total there were 12 lessons learnt that were acted on which included the to change/amendment to current process/procedures

The family reported they felt happy to have had the opportunity to choose how to receive the feedback information. By being able to read the formal response, consider the information they had been given and then to meet with the staff to discuss it all gave them time to digest everything and to reassure them they were being listened to. The complainant stated that the Trust was flexible and listened to the family; they were treated with respect and discretion. They were reassured that they were being listened to. Then to be able to meet with staff, by which time they were calmer, they were reassured that they were meeting with staff who were prepared to listen, to understand how difficult this was for them and be flexible.

The Trust upheld their complaint and could not change the outcome for this particular family, the trust could however demonstrate learning and recommendations as a result of the complaint made. By showing all of the above and being prepared to accept responsibility, this ensured a satisfactory resolution of the complaint.

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The year at a glance

186 formal

Complaints

recieved

37 Upheld by

SWFT

8 referred to the

Parliamentary Ombudsman by complainant

1 investigated then part-upheld

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There were 186 complaints received in 2014/15. The complaint process for community and the acute hospital has been fully embedded and is an integrated process. There were 8 complaints referred to the Parliamentary Health Service Ombudsman (PHSO) in 2014/15. Following its initial review, 1 investigated and part-upheld. The final outcome of the others has not yet been communicated to the Trust. The Trust has worked very closely with the PHSO this year and responded immediately to any initial requests made or subsequent advice given. The Trust feels that external advice can at times be invaluable in assisting towards achieving a satisfactory local resolution. The process for reporting of complaints is continuing to monitor that where delays are occurring, there is a valid reason, that a comprehensive response is issued and all efforts are made to bring a successful local resolution. The Trust has this year increased its resources within the Patient Experience Team, which consists of the Patient Advice Liaison Service, Formal Complaints and the Bereavement Service. The Trust recently introduced a new model of working to ensure that the Team work more comprehensively together, providing cover in times of absence and enabling the team members to provide a comprehensive and holistic approach to Patient Experience Services. A review of services is currently in process.

Complaints by Division

Others: Emergency Division Complaints Beaumont ward (4) Castle ward (4) Charlecote ward (4) MacGregor ward (4) Radiology (4) Dugdale ward (3) Fracture clinic (3) Hatton ward (3) Others 52 A&E 50 Machen Eye Unit (3) Victoria ward (3) CCU (2) ITU (2) Catheter Suite Paediatrics (5) MAU/Fairfax 23 Dental Farries ward (5) Discharge Co-ordinators Gynaecology Discharge Lounge Mary ward Medical Measurement (5) Maternity 15 Medical Secretaries Malins ward (6) Obstetrics Respiratory service Squire ward Pharmacy (7) Nicholas Stratford MIU Avon ward (9) ward (10) Swan ward

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Others: Elective Division Complaints Anaesthetics (2) Dermatology (2) DVT Clinic (2) Gastroenterology (2) Haematology (2) Others 12 Cancer Services Orthopaedics 14 Willoughby ward ENT 3 Urology 3 Named Clinicians 12 Oncology 3 Oken ward 3

Audiology 3 23 hour ward 4 Guy ward 6 Day Surgery 4 Aylesford Unit 4

Others: Integrated & Community Division Complaints Arden Court Brunswick HLC Community Midwifery Continence Service District Dental, RLSRH Nursing 5 Diabetes Family Planning, Arden ward, Stratford Other 13 RLSRH 2 Intermediate care Macmillan nursing Nicol Unit, Stratford Riversley Park CC Ellen Badger 2 SaLT Therapy services Health Visiting 2 Support Services Division Complaints

Podiatry 1 OT 1

Outpatient Booking 1 Physiotherapy 5 Estates / G4S 2 Outpatients 3

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Lessons learnt from Complaints The following are a selection of lessons learned that’s have been implemented in response to the complaint received by the Trust which the investigation showed the complaint to be upheld and lessons learnt identified in the form of an action plan.

• Ensure corporate and mandatory training includes the Attitude impact of personal behaviours on patient experience • Ensure all staff wear name badges and implement "hello my name is.." approach across the Trust

• ‘Care Round’ principle to be reinforced in A&E to ensure regular communication with waiting patients & relatives. • A senior nurse to answer telephone calls from patients with concerns, and the nurse will triage the patients Communication appropriately. The nurse will document what advice is given or what action is taken.

• A patient information leaflet will be developed regarding bubble ECG and this will be sent to the patient with the appointment letter.

• Discharging doctor to ensure changes are highlighted on drugs and discharge summary so GP is alerted as well as Clinical care / ward staff & family. service changes • A review of the interpreting service has been carried out by the Trust, and a new provider for interpreting has been identified.

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Patient Advice Liaison Service (PALS)

PALS is an independent and confidential advice and support service for patients and their relatives/friends. It offers the opportunity to raise concerns enabling appropriate intervention at an early stage. The service works closely with patients, relatives and staff to identify where the Trust can improve the patient experience. The public expects a high level of service and where there is any concern this is not being delivered PALS can offer advice and support.

Top Five PALS Contact Topics

2012-13 412

260 PALS can be 239 contacted on 181 01926 600 054 114

Clinical care decision Communication Property Outpatients Appts Discharge/transfer (lost/found)

Examples of where PALS has supported and improved patient experience:  Where a concern is highlighted to staff, particularly where there has been a misunderstanding or miscommunication, encouraging small changes in individual practice to improve future patient care  Liaison with appropriate staff to expedite appointment dates or follow up for diagnostic procedures where appropriate  Assistance and support regarding discharge arrangements  Assistance with housing/benefit claims  Signposting to external agencies when additional help is required

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Non-Clinical Ward Moves The monitoring and analysis of non-clinical ward moves for patients continue with data being reported to the Patient Experience Group monthly. This reporting mechanism also includes a more detailed analysis of a sample of patients experiencing more than three moves on a quarterly basis. Patients are randomly selected from the higher numbers of moves and the healthcare records are reviewed to explore the indications, the times and the issues that arise from patients’ moves.

The matron team have continued to work with ward managers, their teams and the bed management team in an attempt to minimise the number of moves a patient experiences, which can result in disruption to communication and continuity of care. The concept of outlying patients within the Trust still exists due to pressures on capacity and an increase in demand however the developments of the Community Emergency Response Team (CERT) and the implementation of ‘Discharge to Assess’ (D2A) beds in nursing and residential homes has had a positive impact on length of stay and the need to transfer patients at their end of medical episode awaiting social or community health care to free up acute bed capacity. This year has seen a reduction of 1.3% of patients being moved more than 3 times. The average for the year is 3% however there was a dip in September 2014 to 2.4% and a more significant dip to 1.8% in December 201414.

This data is still analysed and reported to the Patient Experience Group (PEG) on a monthly basis. The quarterly patient story often reveals clinically indicated moves and moves in and out of the community hospitals. In the past 12 months the patient moves stories had not involved patients with a dementia and the most recent story illustrates that all ward transfers took place in line with the Night Charter principles.

Night Charter The Night Charter has been a successful campaign led by extremely proactive Trust staff, that aims to focus staff’s attention on improving patient experience overnight, by reducing noise and disturbance in clinical areas and promoting a restful night’s sleep to assist recovery and improve patient outcomes. In response to the national patient survey for the Trust (2010-2011), where noise at night had been identified as an issue for our patients, two night co-ordinators addressed the challenge with the support of a network of champions to improve experience overnight by raising awareness, reducing noise, minimising patient ward moves overnight, promoting good environmental maintenance and fostering a culture of supportive sleep for patients.

A working party was established back in February 2012 which saw the launch of the Night Charter; a set of simple principles informing staff of how to achieve an improved service delivery overnight. This encompassed good housekeeping, clinical management systems and good practice quality standards. The working party continues to meet quarterly to review the application of the charter, challenge incidents raised overnight regarding patient experience and put into place actions to raise awareness and address specific issues. Their work is linked closely to the Friends and Family Test data analysis, the smiley face feedback processes, complaints and the national inpatient survey.

Some of the actions and quick fixes revolve around installation of silent closing bins in patient areas, enforcing the professional presentation policy, of rubber soled shoes, mobile telephone devices to prevent phones ringing unanswered for long periods disrupting patients sleep, challenging behaviours, ensuring hushed tones and minimising patient moves overnight.

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Same Sex Accommodation During the year the Trust has made a significant improvement in eliminating the numbers of patients who experienced mixed sex accommodation we are able to report there have been no single sex breaches during 2014/15

PLACE (Patient Led Assessment for the Care Environment) The programme is an annual self-assessment process. Assessments would have normally been carried out in February 2013 for this Trust; however the process is changing for this year. It will now be known as PLACE (Patient Led Assessment for the Care Environment). The assessment calendar will now run from April to June and results will be issued in September/October time. We will be given six weeks’ notice of the week we have to hold the assessment in and scores will be reported the following week to the Information Centre. The scoring system has changed and will now be either a Pass, Qualified Pass or Fail for each area visited. Our team must be made up of at least 50% patient representation to staff ratio and a separate summary sheet will be completed by our patient representatives.

The actions and recommendations that came out of last year’s assessment have been implemented to ensure patient safety is not compromised.

The recent confirmed PLACE scores for 2014/15 This year’s PLACE assessment programme was carried out between April and June 2013, in which all 4 hospitals were assessed including the ward at Arden Court. The whole format for the assessment has changed with greater participation from our Patient Representatives/Governor, more in depth paperwork and a change to the scoring system. On all counts, if there was debate about the grade to be given on any area our patient representatives had the final decision. Trust staff including a Matron and Hotel Services staff together with the chair of our Patient and Public Forum attended a half day training session in Birmingham, then we trained all other members that were to take part in the assessments. This was well received and meant that everyone had a clear understanding of what was required on the day. This year there were 35 people involved over the 4 hospitals: 2 teams consisting of 2 patient representatives and 2 Trust members of staff for Stratford, Ellen Badger and Royal Leamington Spa Rehabilitation Hospitals including Arden Court and 5 teams for Warwick Hospital. We also placed an additional neutral person in each team to act as the scriber. Fundamentally the content was the same as in previous years with cleanliness, condition/appearance and maintenance (Environment) privacy and dignity, hand hygiene, staff appearance, internal areas, external areas and food but each section was more in depth with more elements having to be answered. A set of organisational question on food, procurement, buildings and facilities, privacy and dignity and first impressions a) (as you walk on to the ward) and b) (when you had finished the assessment) had to be answered. The question on first impressions definitely made the team aware of the environment that they were walking into and fits with the 15 steps survey that the Trust are now carrying out. Once the assessment had been completed and before leaving each site our Patients Reps were required to complete a summary paper to confirm that it was true reflection of the day and that Trust team members had not pressurised the outcome of the scoring. Action plans have been put together, some areas have already been visited where a fail was scored to see if any interim work could be carried out and these areas have been discussed with the Director of Nursing. Action plans have been distributed for the appropriate person to action and report back to Hotel Services. All plans will be rated by priority and will updated as work is complete, for any areas that will need a larger amount of money than we can fund through our PLACE monies these will be taken forward through other channels such as the capital committee.

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Summary of Scores Below is an overview of all scores for each hospital. Overall some 3000 elements were checked during this round of assessments. This year the official scoring system from the Health and Social Care Information Centre has been show in a thermometer format and that there is no pass or fail mark. This % is calculated by reference to the score achieved expressed as a % of the maximum score possible.

Royal Warwick Stratford Leamington Spa Ellen Badger Hospital Hospital Rehabilitation Hospital Hospital

Cleaning Cleaning Cleaning Cleaning 94.19% 97.30% 97.15% 99.25% Food and Food and Food and Nutrition Food and Nutrition Nutrition Nutrition 79.72% 85.7% 92.36% 91.61% Privacy and Privacy and Privacy and Dignity Privacy and Dignity Dignity Dignity 90.45% 79.16% 85.05% 90.94% Condition Condition Condition Condition appearance appearance apearance apearance maintainance maintainance maintainance maintainance 89.19% 93.85% 92.16% 93.40%

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Nutrition and Hydration Quality Priority 2014/15 - Patient food Improve the patient experience of food service

The Trust continues to encourage staff, friends and relatives, and volunteers to actively participate in enhancing the patient’s experience with regards to nutrition and hydration.

In addition ‘Let’s do Lunch’ and ‘Tea for Two’ continue to be promoted across the Trust. Visiting times across the Trust have been expanded to include meal times to support ‘Let’s do Lunch’ and encourage relatives and visitors to participate in mealtimes. Hotel Services and food service providers are working closely with nursing teams to look at alternate catering options with a view to delivering an improved patient service by the end of the year. The Trust also participates in a week long Nutrition and Hydration Awareness event, where the importance of good nutrition and hydration is highlighted by a series of events and activities across both acute and community hospitals. Nutrition is at heart of good health. To help us improve our food service, Patient surveys were carried out during the course of the year, to ascertain patient experience of the food at our hospitals. Surveys were distributed and completed by inpatients randomly selected across all wards.  At all hospitals, choices on the patient menus have been changed to reflect comments received either after discussion with patients, from patient surveys or from discussions with ward staff.  All of our hospitals have also retained the Gold Award for Food Hygiene and Safety awarded by Warwick District Council.

Catering, domestic, portering and security services are outsourced to an external service provider. These providers must ensure they meet our Trusts requirements and to ensure an excellent patient experience whilst in the care at any of our hospitals. The service provider until February 2014 was G4S, who are an established service provider and have achieved the British Standards UK accreditation - BSI 22000 for Food Safety and Hygiene last year. From February 2014 the chosen supplier was AMEY.

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Warwick and Stratford Hospitals On average 86% of in-patients felt the service they received was either excellent or good.

For the period April 1st 2014 to March 2015, the chart below highlights the results for the catering surveys carried out at Warwick and Stratford Hospitals. In total 1000 responses were received within this period.

Percentage of patients who stated that the food service they received was EXCELLENT or GOOD 86 88 86 87 87

84 84 81 80 83 82

July

May

June

April

March

August

January

October

February

December

November September

Leamington Spa, Ellen Badger Hospitals and Arden Court On average 95% of in-patients felt the service they received was either excellent or good.

For the period April 1st 2014 to March 2015, the chart below highlights the results for the catering surveys carried out at Leamington Spa Hospital, Ellen Badger Hospital and Arden Court.

In total 379 responses were received within this period.

Percentage of patients who stated that the food service they received was EXCELLENT or GOOD

96 97 96 100 97 98 90 89 91

85 83 87

July

May

June

April

March

August

January

October

February

December November September

The Trusts Hotel Services Team and Matrons continue to focus on improving the overall patient meal experience. At Warwick Hospital the emphasise has been particularly around food temperatures with the focus on the meal trolleys after the meals have been loaded just prior to the trolley leaving the Catering department. This process has shown a heat retention benefit of around 4 -5C. We continue to monitor

179 portion sizes and the quality of food provided to patients and we are working closely with Ward Managers and staff to improve the meal service delivery at ward level. Community hospitals introduced the use of the patient diet strips and notice boards and all staff including catering assistants received training on these. The boards were not successful on Campion ward or for Chadwick Ward as different methods of communicating dietary needs are in place. Re -training for all healthcare cleaning staff in the use of the patient diet strips and notice boards above the patient’s beds was reviewed again during the year. Competent checks are carried out by the Contract Managers and Supervisors on an on-going basis. At all hospitals, some of the choices on the patient menus have been changed to reflect comments received either after discussion with patients, from patient surveys or from discussions with ward staff. The Nicol Unit at Stratford hospital is now using the same 3 week menu cycle as at Ellen badger and Leamington Spa Hospitals. This menu includes seasonal food changes.

Screening and Management of Malnutrition Dietetic and Nursing staff continue to actively support the Warwickshire Nutrition Pathway for hospitals and the community for patients who are malnourished or at risk of malnutrition. The pathway is based on the British Association for Parenteral and Enteral Nutrition (BAPEN) Commissioning toolkit - Malnutrition Matters: Meeting Quality Standards in Nutritional Care – A Toolkit for Commissioners and Providers in England. Key areas of work  Malnutrition Universal Screening Tool (‘MUST’) embedded across all wards and community teams in Warwickshire  Oral Nutritional Supplement prescribing pathway in the hospitals continues  Countywide referral criteria for dietetic services  Nutrition screening and assessment training – cascade training at ward level.  Auditing nutrition screening to meet requirements for nurse care indicators and Care quality commission standards

Objectives for the next 12 months:

 To improve training compliance for MUST as figures are currently 78.8% community staff and 89.6% acute staff  To improve the compliance of MUST assessment and the correct implementation of care plans for ‘at risk’ patients, especially in the acute Trust.

Following the latest audit conducted by the quality compliance department, there were some other learning needs identified and it was recommended that the results from this audit should be shared with the ward managers and Nutrition Steering Committees as appropriate, who can feedback the results to the nursing staff.

Summary of audit results Average % compliance NCI In-Patients 2014/15 Elective Emergency Integrated Is there a completed Nutritional Assessment (signed and dated) 93% 87% 98% If the patient is 'at risk' has a Care Plan, demonstrating nutritional support interventions, been completed? 57% 62.5% 91%

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Community Teams Community Nutrition KPI Audit (April 2014-March 2015) All patients who receive planned sequence of care should be Average score: 95% assessed for their risk using a recognised evidence based tools for developing a pressure ulcer, dehydration and malnourishment and falls

Food for Life Partnership The Trust is one of three trusts across England, piloting the Food for Life Partnership (FFL) in hospitals. FFL is a partnership of 5 charities working to transform food culture in the UK.

The project is to identify how we can provide healthy and sustainable food to patients, staff and visitors, bearing in mind that the food required by some patients will be different to that required by staff and visitors. One of the projects that is being implemented under Food for Life is the re-introducing of tables onto wards so patients can eat together rather than by their beds.

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Working with others to improve Patient Experience

Quality Priority 2014/15 - Use the patient Care Committee to drive user engagement

Our core purpose is to provide high quality NHS healthcare services that meet the needs of our patients and the population that we serve. In order to help us improve quality, we work with stakeholders and partake in various initiatives.

Patient Care Committee The Patient Care Committee (PCC) is a subcommittee of the Governing Council and as such reports to the Governors at their meetings. The PCC is chaired by a governor and meets approximately every six weeks. It is charged to review and keep under review all aspects of patient care. Three of our members represent the Forum on this committee although only two can attend each meeting. At each meeting one of the representatives will report on work the forum is undertaking and the PCC suggest to us areas they wish us to consider for our annual work plan.

At each meeting the PCC considers the Integrated Quality Dashboard which contains various statistics concerning the work of the hospital and its effects on patients. This report can highlight areas where it is felt improvements could be made as well as areas of good performance.

As members of this committee the forum provide valuable insight to it from our contacts with both patients and staff, mainly arising from our regular ward visits.

Annual Report of the South Warwickshire Foundation Trust Patient Forum for 2014/15 The Patient Forum has been established for seven years and acts as an independent body of the Trust. The Forum has 15 Members and is always open to new members. Each member of the Forum is linked with a particular ward so they are a familiar face to the staff on that ward. Some of the Forum’s projects involve carrying out cleanliness inspections, food audits, patient surveys, interviews and observations. Members of the forum attend the following Trust meetings: • Patient Information Group • Patient Safety Surveillance Group • Patient Experience Group • Car Park Group • Community and Hospital Information Exchange Forum • Amey quarterly meetings • End of Life Strategy meetings • Patient Care Committee • Ethnicity and Diversity Group • Smoke-Free Site Policy Implementation Group

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One key programme is the work with the Stratford and Warwick Hospitals patient Forum. It is now four years since the Patient Forum was established as an independent body by the trust with the vision to improve the patient experience at our hospitals. The role of this independent Patient forum is to: - Monitor and review the services provided by the Trust for patients - Ascertain the views of patients, users and carers - Prepare and carry out a published Work Plan for each year - Make regular reports and recommendations to the Trust based on the work plan and the views of patients and the public.

The forum begins each year with a Work Plan and we strive to achieve our aims as resources and the vagaries of hospital life allow. Some projects have been reserved for the future in order to deal with urgent requests from managers and governors.

Continuing Projects

Cleanliness and PLACE Inspections Since the last AGM in March we have carried out cleanliness inspections in 10 wards consisting of Beaumont, Avon, A&E, Fairfax, Swan and Dugdale, Malins and Charlecote, 23 hour ward Castle. In addition the forum has taken part in the annual PLACE inspections at all the Trust acute sites and a number of follow-up mini-PLACEs. (PLACE represents the Patient Lead Assessments of the Patient Environment). These inspections showed that the situation on all wards was good or very good and we were satisfied that the issues found were generally dealt with quickly. However we consider that there are a few items such as damaged walls, furniture units and floors which are taking longer to resolve.

Food Matters This has been a very busy year. Forum members have carried out over 70 food audits in the last 12 months which means that every ward has been audited for all three mealtimes. The results have largely been very good and any found wanting have been monitored and revisited.

This year has seen a change in the food service provider, with G4S being replaced by Amey. Whilst first impressions were really good it would be fair to say they did have a few hiccups before they settled down. Happily things have now begun to bed down and we have seen some real improvements in both the presentation and the quality of the food being served, not only on the wards but also in the restaurant. Unfortunately service has been bugged with a large number of breakdowns with the food delivery trolleys. Asbestos was also discovered in the kitchen which has delayed the introduction of the Ward Hostess Trolley service which is now planned to be launched in mid-June 2015. At the same time the Trust will introduce electronic food ordering, which will make the system much less prone to mistakes and eventually will mean that if a patient moves wards their food will follow them.

In April 2014 the Trust was invited to take part, along with Bart’s Hospital in London and the Huddersfield General, to take part in a Pilot Programme on the Food for Life Programme (FFLP). This programme (which is already well established in schools and some other places), is designed to encourage healthy eating not only on the wards but also among the staff and visitors in the Trust. Already the Forum has assisted with amending the menus and making sure that the restaurant serves a good selection of the healthy option food. The vending machines have been restocked and contents now provide 66% of healthy products.

We are pleased that a trial is now being carried out to assess the need for supplying discharge food packs for vulnerable patients.

We once again thank the members of staff of Hotel Services, the ward staff and the catering staff, who have always made it their business to make sure that we are always able to carry out these audits.

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Inform visitors and patients about the Forum We have kept this information on notice boards and the website up to date and a new group photograph was taken.

Liaison with all wards Most of our members have adopted one or more wards and have made themselves known to ward managers and regularly visit allocated wards. Members have been welcomed on visits to the wards and any comments have been well received and acted upon.

CHIEF (Community and Hospital Information Exchange Forum) This programme of two-hour meetings every other month has continued with one topic chosen in the meeting and one by the Trust. Topics for the year included maternity, developments at Stratford hospital, community services, dementia, out-patient appointments, dietetics and private health care.

Stratford Hospital, Leamington Spa Hospital, Central England Rehabilitation Unit (CERU) and Ellen Badger Hospital We have continued to monitor patient experience in the same way that we deal with Warwick Hospital. We are also tracking the redevelopment plan at Stratford and are pleased with the plans to avoid disruption of the normal work of the wards and clinics. We were particularly pleased to see the progress with CERU which is an outstanding resource for Warwickshire and a wider area. We have continued to monitor this valued resource and were pleased to note that six beds were made available to relieve the pressure on Warwick from the demands of A & E.

Out-Patient Appointments We have assisted in the roll out of a survey of the experiences of patients with the appointments system. This will continue with a larger population of patients

Services in the Community The Trust has continued to ask us to be involved with these services. We clearly appreciate their value to patients and in releasing patients from hospitals. However we have not yet identified any specific projects with community services.

Establish a relationship between the Forum, the Trust and Healthwatch. One of our members is also a member of Healthwatch Warwickshire and continues to pursue ways we can all work together. Len Mackin, an officer of Healthwatch, came to one of our patient forum meetings and explained the purpose and function of Healthwatch

Phlebotomy (not a service provided by the Trust) The survey into the Phlebotomy service resulted in improvements in waiting times and perhaps more importantly giving patients information.

Usage of TVs and bedside comforts We were aware that the system for the provision of TVs at beds had failed. We responded to a request from managers and rapidly carried out a survey of the views of patients in every ward.

George Eliot Hospital We have recently opened up a working relationship with our opposite numbers at George Eliot Hospital so that we can share knowledge and experience.

Amey Meetings On approximately a quarterly basis a meeting is held between the contractors and hospital representatives to review the work being carried out suggest improvements and highlight any concerns. The contractors provide these meetings with figures showing performance for the previous three months which can show either good or poor performance. Their remit covers three main areas, namely, catering, cleaning and security/portering. The Forum has one member responsible for attending these meetings where we can bring forward concerns about the service we have been made aware of following ward visits.

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Patient Safety Surveillance The Patient Safety Surveillance Committee meets monthly. Its remit encompasses all aspects of patient safety, both within the hospital and the community. Each meeting reviews statistics gathered on a monthly basis from the Trust's Datix computer base so as to identify trends in the incidence of adverse events involving patients such as falls, skin lesions or embolisms which are potentially avoidable. Very few of these events lead to serious harm, but root cause analysis is conducted so as to characterise weaknesses in patient care procedures and hence implement improvements. To follow up one such case, the Forum was asked to redesign a poster used throughout the hospital offering advice on the scope and limitations of cardiopulmonary resuscitation. The outcome of this small but important project was approved by the Patient Information Group and the new poster is now displayed in every ward.

Car Parking Members of the Forum are also participating in a series of stakeholder discussions devised to develop a ten year strategy for improving car parking facilities at all of the Trust's properties. Adequate parking for staff is the major concern, but Forum members are anxious that the needs of hospital visitors - both fit and disabled - are properly considered.

Equality and Diversity We have continued to attend meetings of this group and we are pleased with progress in a number of ways. This has included comments on a new booklet about end of life care, proper support for carers, providing online training and a handbook for staff. Other topics which have been reviewed include the rehabilitation services at Leamington, induction of new staff, monitoring of recruitment processes.

End of Life Care We have attended meetings of this group which was established to provide a regime to replace the Liverpool Pathway. We are satisfied that appropriate procedures are being put in place and training for all relevant staff will be provided.

Smoke Free Site Implementation Group One of our members has joined this new group to represent the views of patients.

Meetings with Directors Two members of our chair group have met with the directors Jayne Blacklay, Jane Ives and Helen Lancaster on a monthly basis. These meetings give us the opportunity to raise concerns and to learn about planned developments and discuss our work. We thank them for their time.

‘Kissing it Better’ is about sharing simple healthcare ideas. It is also about harnessing the energy of the most dynamic groups in a local community and inviting them to use their specialist skills to make a difference to the care of patients and their carers within hospitals and care homes

We have been working with ‘Kissing it Better’ for the past year, the scheme has involved harnessing the energy of the local schools and colleges and inviting them to use their specialist skills to make a difference to the care of patients. By making small changes we can create a positive patients experience in hospital. This year we have had students from a number of schools and colleges visiting the hospital and making a difference. Hair and beauty students visit once a week and provide a pampering session for our older patients. We have some students that sing popular songs when they visit the wards and departments; we recognise that music therapy is especially beneficial for people living with a dementia. Patients also really enjoy having short stories and poems read to them. Health and Social care students have started a voluntary long term placements with us, this enables them to obtain valuable work experience but also gives an opportunity for the students to talk to patients and take part in Tea for Two, a scheme where we encourage our staff to sit and enjoy a cup of tea and a chat with a patient that may not be having any visitors.

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Quality Priority 2014/15 - Booking appointments Implement an improved appointment process

We have developed a project to integrate our in-patient and out-patient booking teams based around specialties – so that the team can meet the needs of patients and clinicians as a ‘one stop shop’. Improving the patients experience is an aim of this work and will be monitored through Trust patient surveys.

81% of our patients said their appointment have not been changed against a national benchmark of 78% (source: OPD Survey)

Outpatient Department Survey 2014 This survey was designed by the Patient Forum to gain patient feedback regarding their booking experiences. The questionnaire asked 8 questions and included boxes at the end of the survey for any additional comments.

Summary of findings

Out of the 100 surveys distributed 51 were returned. While only a small sample, initial findings indicate their experience was positive with overall 82% of patients where either very satisfied or satisfied with their experiences. The least positive responses indicated that although a majority of patients were happy with their appointment date and time, 82% had not chosen it, further supported by patients were generally sent a letter with this information as opposed to being contacted by telephone or partial booking letter.

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Responses included comments on either their appointment and/or experience of Outpatients. A resounding proportion of patients provided some very positive feedback, comments which included:

Further information regarding appointment; • Very attentive when booking • This was an appointment made at short notice, I have had no hassle, very easy • My first time very satisfied

Comments about Outpatient experience; • Very comprehensive • Quick and efficient • Online booking system is very good, quick and easy to use

82%

Very Satisfied or satisfied with their experience

80%

Happy with their appointment time and date

82%

Didn’t choose their appointment

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Q1: Is this your first appointment for your condition?

Yes No

Q2: If 'no' is this a follow up especially arranged after a previous appointment?

Yes No

Q3: Which clinic are you attending today?

Rheumatology 18% 21% Endocrinology Dermatology Gynaecology 4% Orthopaedics 4% 4% Gastroenterology 2% Neurosurgery 4% Paediatrics

2% Respiratory 4% 35% ENT 2% Blank

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Q4: Were you given an appointment Q5: Did you choose your appointment date and time that was convenient to date and time? you?

blank 2% Blank 2%

No Yes 18% 16%

Yes 80% No 82%

Q6: What system was used to book your appointment?

61%

15.5% 13.5% 10%

Other

hospital

appointment

Chooseand Book

telling of your you

A letter A fromhospital

askingyouring to

A letter A fromthe hospital A telephone A call from the

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Q7: Did you get a text reminder? 27

Yes No Blank

Q8: Overall how satisfied were you with the process to book your appointment today?

4% Very satisfied 12% Satisfied Neither satisfied or dissatisfied Dissatisfied Blank

Very satisfied, 51%

31%

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39% responses included comments on either their appointment and/or experience of Outpatients. These comments included:

Further information regarding appointment; • Very attentive when booking • Appointment too early • I failed to attend my previous appointment and did not wish to change time despite the fact it was 2 hours after the bus • This appointment was made 6 months instead of 3 months after last appointment • It's annoying to have an appointment date and time for it to be changed at last minute • This was an appointment made at short notice, I have had no hassle , very easy • Previous appointment was cancelled without letting me know • I would like to be able to choose time of appointment as work is funny about time off • would like to have been offered an appointment after school • My first time very satisfied

Comments about Outpatient experience; • Always pleasant and obliging with smiles! • Very comprehensive • Extremely helpful • Quick and efficient • Excellent Service • Online booking system is very good, quick and easy to use • Not clear exactly where the appointment was • Pleased with service given • All staff very good • Administration has been poor, we always have to follow up an appointment • Most outpatient experiences have been satisfactory or good • We have been asking our GP for this appointment for approximately 2 years • This appointment was made 3 months ago for my daughter, it wasn’t changed either date or time which was very refreshing

Next Steps  Increase sample size, reordering some further questionnaires to hand out  Look at areas that could be improved upon especially the use of the partial booking system

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Patient Outcomes Hospital Mortality Rates Quality Priority 2014/15 - Mortality To improve systems to further reduce mortality rates

In the last year, our overall mortality rates remain within the average range for NHS Trusts in England. A variety of mortality indicators have been developed, which use different methods to adjust for differences in age, gender, time range and palliative care coding. Trends for the Trust are similar on all these measures. Overall, rates are downward. Mortality rates have been described as, “A smoke alarm” which should always be checked even if the site of the problem is thought to be already known. A variety of mortality indicators have been developed, which take in to account patient factors such as whether an admission was emergency or elective, age, gender, diagnosis when first admitted to hospital, important co-morbidities, whether receiving palliative care, and the relative affluence of the area where the patient lived. Trends for the Trust are similar on all these measures and the overall trend for these rates is downward. In the last year, our overall mortality rates remain within the average range for NHS Trusts in England.

What we have done We monitor trends in overall mortality, and discuss contributing factors at our monthly Mortality Surveillance Committee. The Committee is chaired by the Trust’s Medical Director, and has external representation from the local Clinical Commissioning Group and the Local Area Team. The Committee initiates work relating to patient mortality. For example, it has commissioned a report to look at whether mortality rates are higher in patients admitted at the weekend and found that there is no increase. We also monitor mortality rates within specialties at the Mortality Surveillance Committee. We compare well in most areas. Reports on the mortality within each speciality are produced and each month, the speciality lead presents a response to the Committee. Where mortality rates for specialties are high compared to the previous year or with peers, we have undertaken specialty mortality reviews, and developed comprehensive action plans, leading to reductions in mortality rates. The Trust also receives monthly data from CHKS which compares mortality rates by condition with other similar sized organisations. If the Trust is identified as having a higher mortality rate for a specific condition, a further review of this group of notes is conducted to ensure that appropriate treatment was given. Mortality data is discussed monthly at the Trust Mortality Surveillance Committee,

Mortality reviews The Trust sets a standard for all individual deaths to be reviewed and we have introduced new systems to support compliance with this standard, as well as making participation in mortality reviews part of Consultant job plans and an essential requirement for revalidation. Any areas where patient care may be improved identified by these reviews are widely shared within the Trust and actions taken. We have strengthened oversight of mortality reviews though our Audit and Operational Governance Groups which report monthly to the Mortality Surveillance Committee. The Audit and Operational Governance Groups and the Mortality Surveillance Committee report to the Clinical Governance Committee on a quarterly basis, which reports to the Trust Board of Directors. Mortality figures are reported to Trust board on a monthly basis in the Integrated Quality dashboard.

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Summary Hospital-Level Mortality Indicator (SHMI) SHMI is the ratio between the actual number of patients who die following a treatment 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.

It covers all deaths reported of patients who were admitted to acute, non-specialist trusts and either die while in hospital or within 30 days of discharge.

The data used to produce the SHMI is generated from data the Trust submits to the Secondary Uses Services (SUS) linked with data from the Office for National Statistics (ONS) death registrations to enable capturing of deaths which occur outside of hospitals. Additional contextual indicators are also published alongside the SHMI to add some context to the interpretation of the SHMI.

South Warwickshire NHS Foundation Trust’s latest SHMI value for the latest 12 months is 1.02 which is “as expected”.

How to use the SHMI The SHMI requires careful interpretation, and should not be taken in isolation as a headline figure of trust performance. The SHMI is an indication of whether individual trusts are conforming to the national baseline of hospital-related mortality. Mortality within a trust is described as being either “as expected”, “lower than expected” or “higher than expected”. All trusts are encouraged to explore and understand the activity which underlies their SHMI from their own data collection sources.

Care of Patients with a Dementia During 2014/15 much focus has been placed on embedding the evidence based care bundle derived from ‘The Delivering Excellence in Dementia Care in Acute Hospitals’ project based on the composite module of New Cross Hospital, Royal Wolverhampton NHS Trust and the annual National Audit of Dementia Care and Anti-psychotic Prescribing, providing support and signposting for cares and relatives of people living with dementia and measuring their experience of the support they have received and also securing funding to enhance the inpatient environments on the Warwick site to improve signage and identification of areas to support people living with dementia whilst they are in hospital.

The project team called the Dementia and Elderly Care Action Alliance (DECAA) led by the Trust’s clinical lead for dementia, has been instrumental in the implementation of the care bundle, supported in practice by the dementia champion network. The care bundle supports the use of the getting to know the person concept, utilising the Alzheimer’s Society’s ‘This is me’ document, adopting the ‘Butterfly Scheme ©’ endorsed by the Department of Health (DH) which aims to support a person with dementia in an unfamiliar environment by the recognition and application of a specific care response from all Trust staff. It also empathises the need for nutrition and falls assessment and appropriate care planning and the expectation to review any established anti-psychotic medication and prescribe with caution under specialist advice.

Establishing engagement with the person living with dementia and their family onto the Butterfly Scheme© provides the opportunity to support carers and signpost them to dementia literature, services and websites or portals As part of this year’s Commissioning for Quality & Innovation (CQUIN) schedule, we have established a system for measuring the support the cares have experienced, working collaboratively with the DH to measure cares support and the success of the care bundle. The number of responses has been low, since we launched the postal survey in November 2013 but the detail of information allows us to review our processes and practices, celebrate success and address areas of concern. ,

The focus on dementia awareness training and been maintained and is delivered across many forums including our contract staff, with our greatest success having achieved the recognition of the mandatory requirement for all Trust staff to have dementia awareness training. It is now an integral element of the training programme for annual mandatory training.

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Following this year’s Patient Led Assessment of the Care Environment (PLACE) inspections, we have secured some funding to improve some of the inpatient areas within the acute site. We have worked with a nationally accredited, dementia friendly signage company and are in the process of modifying 5 of our acute wards to become more dementia friendly, with clear, pictorial signs, for bays and bathrooms, orientation boards and floor graphics to support safe mobilisation.

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Quality Priority 2014/15 - End of Life care Work with primary care to increase the level and quality of End of Life care advance planning Whilst we achieved significant success, a care planning process that can move with the patient between primary care, community and acute has been developed and implementation continues.

Improving the quality of end of life care was identified as one of the Trust’s key objectives for 2014/15 with the overall aim of supporting people to be cared for and to die in the place of their choice. To enable this to happen a number of end of life care initiatives have been implemented across the Trust over the past few months. An outline of these initiatives and progress against them is outlined below:

Amber Care Bundle The Amber Care Bundle was launched at Warwick Hospital following the appointment of a facilitator in July 2014. This is an approach used in hospitals to manage the care of patients where clinicians feel recovery is uncertain and are concerned that they may only have a few months left to live. It supports healthcare professionals to continue with treatment in the hope of recovery while recognising the need to initiate conversations with patients and their families about their future treatment and care and preferences related to these. Therefore, supporting improved planning of care.

Since July 2014 a total of 251 clinical staff across 15 wards have undergone training in the use of the amber care bundle with further implementation planned over the next few months. On-going review of the effectiveness of this initiative will continue to be monitored as part of the Trust End of Life Care Audit Plan.

Care of the Dying Evaluation (CODETM) The Care of the Dying Evaluation (CODETM) is a post bereavement survey that assesses the quality of care and level of support provided to individuals and their families in the last days and hours of life. The Trust is currently piloting the use of this survey to capture the experience of relatives of patients who died in Warwick Hospital in order to identify where any changes or improvements can be made and to share areas of good practice.

End of Life Care Clinical Champions – Quality End of Life Care for all (QELCA) Training Over the past 12 months a total of 20 End of Life Care Clinical Champions have been identified across wards at Warwick Hospital and Community Hospitals following completion of the QELCA training programme at Myton Hospice. This training has enabled the hospital nurses to work alongside those from the Hospice, giving them first-hand experience of working with and observing experienced palliative care nurses in delivering expert care to patients and their families at the end of life. Combined with classroom discussion, reflection and on-going action learning sets, each nurse is then enabled to return to their team / ward equipped to lead and support on-going improvements in end of life care for patients and their families.

Rapid Discharge Home to Die Process The rapid discharge home to die process aims to support the timely discharge of patients at the end of life to enable them to die at home / in their place of choice. This process is now in place across Warwick Hospital and community hospitals and a training package developed to support ward teams in planning discharges at the end of life. To monitor the effectiveness of the end of life care initiatives implemented across the Trust an End of Life Care audit report has now been developed. The main objectives of this report are:

 To capture evidence that advance care planning discussions are taking place to enable patients to achieve their wishes at the end of life

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 To review current outcomes for patients at the end of life and identify future outcomes in line with national and local best practice and guidance , supporting development of a dashboard where appropriate  To identify areas of good practice in end of life care  To identify where more work needs to be developed - identifying areas of particular focus

Warwickshire Macmillan Palliative Care Project The Warwickshire Macmillan Palliative Care Project is a programme of change and redesign that spans hospital and community services. This Macmillan funded project which is hosted by the Trust is being supported by multiple partners and service users who are all working together to improve the experience of palliative and end of life care and so ensure that services are responsive to the needs of patients and their families. A summary of two of the project’s key initiatives is included below:

(i)Seven Day Specialist Palliative Care Nursing Service One of the main aims of the project is to enable implementation of a Warwickshire wide seven day specialist palliative care nursing service in line with national guidance. To inform the requirements for this the Macmillan Specialist Palliative Care Team piloted a seven day service in North Warwickshire during the month of March which included community patients and George Eliot Hospital. Outcomes from this pilot are currently being evaluated and it is planned for a Warwickshire wide seven day service to be fully implemented later this year.

(ii)Experience Based Design As part of the Macmillan palliative care project we want to work with patients and their families to identify how we can improve services that support people with palliative care needs and what the priorities for improvement need to be. To do this we are using an approach called Experience Based Design (EBD). This focuses on how patients and their families experience different services and how those experiences made them feel. Once these have been captured we plan to work with patients, families and staff to co- design improvements that address the issues raised during this process. This aims to ensure that any changes and improvements made to services are aligned with patient experience and are meeting the needs of the people that access them.

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Quality Priority 2014/15 - Provide more comprehensive 7 day services, increasing the avialbility of senior descion making clinicans

And

Quality Priority 2014/15 - Revise team structures to increase clinical time

What we have achieved…

Assess before admission  We have developed an ambulatory emergency care clinic 7 days a week which is located alongside our medical assessment unit. Patients are referred to the clinic by GP’s or by the A&E department if they are safe to be cared for in a non-bedded environment.  GP’s have access to discuss patients with a consultant acute physician 7 days a week.  Our Community emergency response team (CERT) provides a 2 hour response to any patients in the community who is referred to them – 7 days a week.

Early Access to Senior Clinicians  We have invested in our A&E consultant staff so that they are on site 7 days a week and provide on-call cover 24/7  We have invested in our team of consultant acute physicians so that they are now on site 7 days a week providing consultant led care for all emergency patients  We have developed a specialist frailty assessment unit for older patients admitted as an emergency with care provided by a multi-disciplinary team of old age specialists  There is on the day access to all our specialist teams on weekdays

Standardised care process is hospital wards  All medical wards now have a consultant of the week model to ensure continuity of patient care  We have set a standard that all diagnostic tests will be completed within 24 hours of request  We have implemented standardised board and ward rounds in all our wards and set expected date of discharge with patients so they can plan for going home with their families.  We have implemented nurse-led discharge for patients with specific diagnoses or after surgery

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Discharge to Assess  We have developed three ‘discharge to assess’ pathways for patients who cannot be discharged home without support – so that no patients should have to stay in hospital for assessment of their on-going needs. These pathways support patients at home, in community hospitals and in temporary residential and nursing homes  There is a ‘trusted assessment’ process in place so that hospital staff can restart packages of care for patients and refer to reablement services without a social worker needing to be involved

 Over 150 patients a month are now seen in the ambulatory emergency clinic and 75% are discharged home on the same day  We have avoided the admission of over 20 patients a week through the CERT team response to patients at home  Nearly 50% of patients admitted as an emergency are now discharged home within 48 hours  Over 95% of patients referred for a specialist opinion or diagnostic test are seen within 24 hours of referral  Length of stay for patients admitted as an emergency has reduced by over 1 day  The Trust had met the A&E target for admitting or discharging 95% within 4 hours

Improving the Discharge Pathway

The discharge planning team continues to utilise the dedicated database for the sole purpose of monitoring and recording all complex patient discharges. Subsequently, this database has now also been implemented into the community hospitals in the South of the county. This allows the Trust to identify trends and local delays, whether internally or externally by other organisations. Twice weekly meetings between health and social care occur, to discuss the most complex patient cases at Warwick Hospital and the community hospitals. Actions and solutions are agreed in order for the discharges to be safely expedited. These meetings were previously weekly, but have increased so that outcomes can be fed back at the second meeting, to determine if progress has been made, time frames achieved, and for action plans to be amended if necessary. On a daily basis, (Monday to Friday) senior Trust managers and the bed management team are informed of all complex patient discharges.

Education and Training continues to be provided to Trust staff through a variety of formats, such as the ‘Essentials for Nursing Day’, which occurs annually on the Warwick Hospital site, as well as taking training directly to ‘frontline’ staff within their own clinical areas. This approach has been developed following feedback, as ward staff feel it is difficult to be released from ward commitments to attend specific training sessions. A member of the team presents on the Trust’s Stroke training and ‘Safeguarding Vulnerable Adults’.

Following on from the successful implementation of the ‘restarts in care packages’, for patients in hospital no longer than 10 days that require the same level of support on discharge as they did prior to admission; this has been carefully devolved to ward staff by the discharge team. This enables and encourages ward staff to take ownership, and to date this has proved very successful without any issues being highlighted by social care. For the discharge team, there has been a steady increase in the number of patients following the completion of the screening tool - NHS Continuing Healthcare Checklist (CHC) – requiring a full MDT assessment for consideration of Continuing Healthcare eligibility. In order to address this, the team has had to reorganise and adapt to meet the additional workload. Although only approximately 25-30% of the assessments result in eligibility for CHC funding, the increase in referrals for a full CHC assessment is

198 expected to continue to rise. This is partly due to the local ageing, frail population with multiple ongoing health and social care needs, but also due to the Department of Health intentionally setting the Checklist stage of the process low, in order to ensure that all those who require a full consideration of their needs have this opportunity.

Joint working between the Trust and Warwickshire County Council (WCC) in relation to assessment and information sharing has progressed considerably well, as a supportive tool has been developed that promotes shared assessment and reduces duplicate professional assessments taking place in hospital. This has reduced the overstatement of needs that often occurs when a patient is assessed in an unfamiliar environment, when they are often at their most vulnerable. In addition to reducing a prolonged length of stay in hospital, this will minimise the number of patients being required to make long term decisions about their care while still in hospital; unless in exceptional and appropriate circumstances. This tool is part of a much larger project by the Trust, WCC and the CCG, which aims to explore 3 different patient discharge pathways under the ‘Discharge to Assess’ philosophy.

The supportive tool is known as the ‘eCAT’ (electronic Common Assessment Tool). This enables an initial assessment of a patient’s needs and a referral to the appropriate pathway for their level of care/situation. The eCAT has initially started with Pathway 1, as the goal for the majority of patients within hospital is to return home. Over an 8 week period, the discharge team has piloted this tool, and has referred approximately 160 patients. This is a ‘trusted assessment’ between health and social care practitioners and allows a referral to go directly to the receiving service, such as Intermediate Care (The Community Emergency response Team/ CERT) or Reablement.

Nurse led patient discharges continued to increase in 2014/15, through the increased number of nurse practitioners, introduction of new ambulatory care pathways and increasing numbers of community nurses administering intravenous therapy to patients at home. Improved communication about patients’ expected discharge dates. This has been achieved through an increase in the consistency and regularity of Consultant ward rounds.

Transformation Programme What is the Transformation Programme and why was it developed? Following the integration of Community Services with the Trust in April 2011 and collaborative working in the North of the County, the Trust aims to reduce the overlap between hospital and community services and strengthen collaborative working with Primary Care.

The vision of integration is to deliver quality locality based community health services, responsive to patients needs through a skilled workforce productively serving the local population with dignity and care. There are currently eight areas being reviewed and developed within the Transformation Programme as detailed overleaf:

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What has the Transformation Programme achieved and what are the benefits to patients? The information shown in the chart gives a flavour of some of the transformational work taking place under the Programme.

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Care of Older People - What are our goals?  To develop Integrated Health Teams to include Urgent Response to enable us to support patients in crisis at home and prevent admissions to hospital where possible.  To arrange an assessment and on-going support for patients at home in the immediate period following a hospital stay to promote earlier discharges.  Provision of a Comprehensive Geriatric Assessment undertaken within 24 hours of patient arriving at Warwick Hospital, 7 days per week.

What are the benefits to patients? What have we done so far? Next steps Where appropriate, patients’ health In the North of the County - needs supported by Community Through the introduction of the CERT Team, George Eliot Review of Services at Services allowing them to remain in Hospital saw a reduction of the length of stay for patients, Ellen Badger Hospital their usual place of residence thereby cutting at least 1 day off their average. and scoping based on maintaining their independence. the Nicol Unit and Community Services Teams were enlarged to be able to Arden Ward model. Where admission to hospital is receive more referrals to ensure patients can be treated in necessary, clinical teams will ensure their own home rather than staying in hospital (Increase of Development of a patients are supported to return home 133% to Intermediate Care Services, 30% to Virtual Ward) CERT response in the at the earliest possible opportunity East of the county in thereby reducing their length of stay in In the South of the County - conjunction with hospital. On the Nicol Unit: UHCW, Rugby St Cross Refurbishment to Nicol Unit has delivered an enhanced Hospital and Coventry Reduced likelihood of readmission to healing environment with positive feedback received from Community Services. hospital. patients and staff.

Partnership working will ensure that More patients are being seen, on average an increase of patients receive quality, seamless care. 32% and the average length of stay has reduced from 28 days to 19 days. Improved patient experience and clinical outcomes. An audit on the use of sedatives prescribed on has seen much less use of sedatives and anti-psychotic drugs. Patients receiving these reduced from 60% of patients to 25%.

South CERT: Direct referrals from GPs to CERT Team has seen a dramatic increase, these means that significantly more patients are cared for at home rather than having to be admitted to hospital. This has helped by freeing up capacity for patients who are in need of a hospital stay.

Arden Court: In March 2014, the decision was taken to relocate this service within the main hospital site. to meet the needs of the patients who require some additional support prior to going home following a hospital stay, or require a little more support than can be provided in their own home so that they do not need to be admitted to an acute hospital setting.

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Long Term Conditions - What are our goals?

 To develop services for patients with a long term condition (e.g. Diabetes, Respiratory Disease, Heart Conditions) to help them to have healthy active lives and reduce the need to come in to hospital.  We are currently scoping the work that is required across a numbers of organisations including health, social care, mental health and voluntary and private sector organisations to make this a truly joined up system. Musculoskeletal – What are our Goals?

 To make it easier to access Orthopaedic services and to make the way that the patient travels through the system more consistent.

What are the benefits to patients? What have we done so far? Next Steps

Patients access the right treatment, The Knee, Shoulder, and Foot and Auditing that the new pathways are in the right place, at the right time Ankle Pathways have been jointly being used. reviewed and redesigned by Review to make sure that duplication Reducing duplication in the system, Consultants, GPs and Clinicians and of diagnostics and unnecessary including diagnostics. have been agreed. These have been follow-up appointments are reduced. Improved patient experience and communicated through a number of Patient feedback to be collected to clinical outcomes. forums to ensure that everyone is ensure changes have delivered an using them to make the process the improved patient experience. same whoever you see.

There has been a review of the Orthotics Service. A robust triage, review and discharge process has been implemented to ensure that patients receive the service closer to home in community settings and where possible a shift from bespoke insoles to off the shelf insoles and creating a “one stop shop” for patients.

Stroke Services - What are our goals?

 To enhance the quality of care along the pathway to ensure care is delivered to meet or exceed nationally recommended standards  To work with partners in acute, community, social care and voluntary sectors to develop an Integrated Hospital and Community Service that is consistent, effective, seamless and communicated.

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What are the benefits to What have we done so far? Next steps patients?

Patients receive the right A National Stroke Service review is being carried out, so Strategic Stroke review care, in the right place, at we are working closely with the Midlands and East lead to completed and the right time. ensure that the pathway redesign aligns with local and .communicated national requirements. Care delivered closer to Business Case finalised to home. A number of working groups have been set up to review develop Stroke services and redesign patient flow along the pathway, service including an enhanced Reduced lengths of stay in delivery models, staffing and resource, communication team in the community to hospital. and strategic impacts. support patients to be discharged more safely Better clinical outcomes. The organisation is developing a business case based on earlier and to develop the local review and ensuring that this aligns with the longer term rehabilitation Ability to self-manage recommendations of regional review and service needs in the community. health conditions thereby specification for Stroke Services. increasing independence. Confirmation of resource required to deliver agreed pathways of care.

Ambulatory Care Pathways – What are our Goals?  To be able to see patients in an emergency clinic to assess them to reduce unnecessary hospital admissions  To be able to treat patients with identified conditions i.e. cellulitis, blood clots in a clinic or community setting or their own home rather than them having to stay in hospital. Follow-up Reduction Plan - What are our goals?  To remodel our outpatient services to deliver a more efficient appointment booking system  To meet the targets to see patients within the national guidelines of 18 weeks What are the benefits to patients? What have we done so far? Next steps The provision of a quality and On-going review of long waiters to Whole system change to needs driven outpatient service. understand why patients are Outpatient services to improve Outpatient appointments available waiting a long time for their access and waiting times within the required timescales appointments Capacity to see new patients within The ability to be fast-tracked back Identification by specialty of the 18 week target due to released in to the system if appropriate. pathway changes to improve the capacity system and meet the needs of the patient and organisation. The changes to patient pathways through the transformation work undertaken so far have created different requirements for community and hospital based staff. The aim of the Workforce Integration projects is to develop community services to deliver care that is universal, integrated and easier to access through ‘Integrated Teams’

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Integrated Health Teams: ‘right care, right place, right time, first time’ Elements that will make up an integrated team

Long Term Conditions Team Long term condition teams have now been integrated into all teams throughout Warwickshire. The focus remains managing patients with one or multiple long term conditions in the community through an integrated health care pathway. The main aim of this element of the team is to prevent unnecessary hospital admissions but also work with colleagues to promote a safe and timely discharge for patients from acute hospitals. The teams are engaged in the development of a self-care model of health supporting and teaching patients about their individual conditions. This allows individuals to monitor their own health care status, however, when there is significant exacerbation of the symptoms the long term conditions element of the team are able to respond quickly to provide a clinical management plan to treat patients in their own homes. Surveys have suggested this leads to better outcomes for patients, increasing quality of life outcomes in terms of their own management of their long term conditions.

Urgent Response –Community Emergency response Team (CERT) Urgent response is available in all Integrated Health Teams .It provides a rapid response rehabilitation service at short notice including nursing and therapy to enable people to stabilise from an acute episode that might otherwise have resulted in an acute hospital stay (step up care) or following acute hospital treatment (step down care). This element of the service helps prevent unnecessary hospital admission and also assist to facilitate safe early discharge from a hospital environment.

Urgent response sits within the Intermediate Care element of the team and can undertake assessment of need within 2 hours of initial referral. This consists of a range of Intermediate Care components such as enabling, rehabilitative and treatment services in community and residential settings to improve a patient’s independence. The patient is then transferred to the appropriate service within 72 hours.

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Urgent Response (CERT) flowchart

Intermediate Care Element of an Integrated Team Intermediate Care is available within each integrated team across the county. This consists of community based multi-disciplinary rehabilitation team providing a range of service responses for a maximum of 6 weeks. The aim of this element of the team is to facilitate the transition to functional independence so that patients can return to or remain in their usual place of residence. This can avoid unnecessary admission to hospital, and support discharge from hospital allowing patients to complete their rehabilitation and recovery at home or within a defined residential setting.

Nursing Element of an Integrated Health Team Community Nursing is a key element in the Integrated Health Team and deliver a wide range to support within patients own homes and clinic bases. They deliver wound care, palliative and end of life care, continence and skin care. Also intravenous anti biotic therapy can now be delivered in a community setting. Leg Ulcer clinics have also been developed which are locality based within community settings

The Community Children’s Nursing Team (CCNT) The service continues to grow as it responds to the increased need for delivery of skilled complex/technological nursing care in any setting outside of the hospital. Our objectives continue to focus on reducing hospital admissions, facilitating early discharge from hospital for children with life changing and life limiting conditions, ensuring high quality safe care for children with complex care needs and ensuring that the views of the children, young people and their families are continually used to shape our service. Over the past few months a number of surveys have been carried out using the EleLites secured by children’s services. All feedback has been very positive from users.

Through successful partnership working with Coventry universities research department, funding has been secured for three years to run focus groups and explore patient experience. Three focus groups have been

205 run so far and have been very successful. A second Christmas party for the children in both Coventry and Warwickshire CCNT services is planned following the excellent evaluation last year. Again, through excellent partnership working across Coventry and Warwickshire our Consultant Nurse, the Clinical Education Lead along with her counterpart in Coventry launched e-competencies in April 2012. They are now being used nationally and have transformed teaching of all grades of staff in the care and management of children and young people with complex healthcare needs.

2012 has been a very busy year for paediatric palliative across both Coventry and Warwickshire, our lead nurse and consultant have continued to raise the profile through updating the national Together for Short Lives care pathways. Both CCNT’s were successful in becoming one of only four areas across England collecting palliative care data for the Department of Health. The aim of this national project is to gather data which will enable better understanding of the resources and costs of children and young people’s palliative care across England. This information will help to inform the Department of Health on the development of a classification that categorises and costs the different levels of support needed, creating a national funding system based on a per –patient tariff.

Partnership working continues with our colleagues in the local authority Integrated Disability Service (IDS). Following the successful funding in 2010 of two of our band 3 support workers, the IDS have funded a further support worker to work alongside their staff, to deliver a short break service to children and young people across Warwickshire. Funding for this very valuable service has been secured for a further year. In a recent local authority Ofsted report the staff from our service were highly commended.

Community Nursing This service is available across the county and provides nursing care to people within their own home (including residential care) or within specialist community clinics. This service is predominantly for patients who are housebound. Community nurses are currently assigned to work with specified GP Practices or work within identified geographical boundaries. The service delivers:  End of life care  Tissue viability  Bladder and bowel management  Nutritional support  Long term conditions support  IV Therapy in the Community setting  All Band 6 and 7 Community Nurses who hold a caseload have been trained in the delivery of Telehealth following a successful pilot of this tool in the North Virtual Ward who now 19% of their patients using Telehealth as part of their planned care.

Family Nurse Partnership (FNP) The Family Nurse Partnership (FNP) is a preventative programme offered to first time young mothers, aged 13-19 years. The same family nurse works with families from early pregnancy up until the child is two. The programme's primary focus is the future health and wellbeing of the child and mother. Family nurses have background in midwifery and health visiting and they receive supplementary training to equip them for their new role.

There have been a total of 108 clients enrolled to the service and caseloads are now full. Occasionally spaces arise in case loads due to attrition and we target the youngest and most vulnerable to these places wherever possible. During the recruitment phase of the programme, the target was to enrol 75% of eligible clients and the team achieved 76%.

90% of clients have additional needs such as mental health problems, leaving care, unstable living arrangements and learning difficulties. So far 9 clients have left the programme – 5 have moved out of the area and 4 have become inactive (decided to leave the programme). The fidelity goal for attrition is 40%; Warwickshire’s attrition rate is 9%. All the Family Nurses are fully resourced and have completed the

206 pregnancy and infancy training, motivational interviewing techniques and post natal depression training. There is one further training day in March, 2012.

Learning from FNP has been shared with other services such as health visiting and school nursing; and client and agency feedback about the service has been good.

School Nursing In March this year we held a conference for school nursing at Dunchurch Park Conference Centre in Rugby, called “Celebrating Success”. Wendy Nicholson, Professional Officer for the Department of Health (DH) attended. It was timely that she came as the document “Getting it right for children, young people and families” was launched. She was impressed with the work going on in Warwickshire. She invited us to send in examples of good practise as she is collating examples from across the country. All these examples if chosen will go on the DH school nurse site and C4EO site.

We have a nurse working with Wendy at the DH looking at a young carers’ pathway for school nurses. One of our practice teachers from the south of the county was chosen by Wolverhampton University to be in a promotional film about school nursing as a career. We introduced a child protection health assessment last year following findings from a serious case review in Gateshead. School Nurses now see the child or young person who is subject to a child protection case conference to search for health needs. It is now embedded in practice. Many school health leads from around the region have been interested in using the assessment.

We secured funding for two members of staff to develop their teaching interests further and become practice teachers. They have just completed the course. In school nursing now we have four practice teachers.

School Nurse Assistants offer smoking cessation to young people in schools. They have seen many young people over the year. We now receive payment from the quit smoking service which will go towards resources for the teams. Staff attended training put on for them specifically from the quit smoking service around advocacy and promotional branding. Due to the fantastic work that the team provide all year round, staff have been invited to attend briefings on next year’s quit smoking campaign. We were very fortunate to secure bespoke training from the Family Planning Association for staff who deliver sex and relationship education in schools. Partners from Respect Yourself have paid for two groups to go on the training which can be accredited from Staffordshire University.

Productive Community Services continues in school nursing teams. All bases will have had 5’s training and will have applied that to their areas. We have set up a focus group to look at projects that can be standardised across the county.

Health Visiting (HV) The Health Visiting Service in Warwickshire has continued to improve and embed changes as detailed in the Health Visitor Implementation Plan (DH, 2011). As an Early Implementer Site in taking this vision forward we are now in a position of helping other trusts to follow suit.

As a service we are now offering the new core offer to all families to include: Community, Universal, Universal Plus and Universal Partnership Plus. This is outlined in our new leaflet for parents and includes the 'Healthy Child Programme (DH, 2009). We will have full coverage of this programme by April 2015 as the number of Health Visitors increases and the caseload numbers reduce. We continue to closely audit antenatal visits to parents and are collecting case studies to demonstrate the difference these are making to families.

Strengthening the ‘Partnership Agreement’ between Midwives and Health Visitors across the health economy aims to improve communication and this is a key piece of work for the Trust. Strengthening further elements of the Healthy Child Programme (HCP) has also been a focus during this last year. We are currently undertaking two pilots. One to improve the two to two and a half review working with partners, specifically at incorporating the Early Years Foundation Stage summary. This project is being led by the Department for Education and Department of Health and Warwickshire is a project partner. We have been

207 awarded £9,000 by the Department of Health to support the project development. A second pilot is looking at the nine month review in introducing the Ages and Stages Social and Emotional tool to identify babies with any attachment/speech and language difficulties early. We have celebrated 150 years of Health Visiting in 2012, with the format of a conference attended by well regarded national speakers, families, health visitors and partners. This was very well evaluated.

The service has received a 'rapid appraisal' from Sustain (commissioned by the Cluster SHA) this November. The three day review involved staff members from all levels being interviewed, the final report showed no areas of concerns and some areas of note to which progress has already been made. The report was described as “exceptional”.

We are working closely with our commissioners in ensuring the growth of Health Visitors is reached as outlined in the Operating Framework. We have increased the number of Health Visitor students by 900%. In 2012 we have 49 students in training in Warwickshire. We employed an additional 11 Health Visitors in Sept 2012 (7 in the North) to increase capacity and meet the requirements as set out in the above plan. We plan to employ an additional 12 Health Visitors this Sept 2013 and subsequently until we reach our target of 42.5WTE additional Health Visitors by April 2015. We have implemented a new model within Warwickshire with our Community Practice Teachers in ensuring that quality is maintained as much as possible with the increase in educational commissions. Health Visitors have risen to the challenge in undertaking new roles as mentors to the students.

The Public Health Department is currently updating our geographical model to ensure Health Visitors are placed where the need is within the county.

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Indicator Performance of two reporting National average Highest score and periods lowest score The value and banding of the summary Average SHMI Not traceable on NHSIC Not traceable on hospital-level mortality indicator (‘SHMI’) for 2013/14 – 1.05 NHSIC the trust for the reporting period; and 2014/15 – 0.96 The percentage of patient deaths with palliative care coded at either diagnosis or specialty level for the trust for the reporting The Trust considers that this data is as described for the following reasons: period. -The Trust acknowledges that these percentages are within the expected range. The Trust has taken the following actions to improve these percentages, and so the quality of its services by: -Working closely with the specialist palliative care team. -Improving access to the expertise of the palliative care team and recording their input accurately.

The trust’s patient reported outcome 2013/14 Not available on NHSIC Not available on measures scores for: a) 0.097 NHSIC a) groin hernia surgery b) 0.046 b) varicose vein surgery c) 0.294 c) hip replacement surgery and d) 0.259 d) knee replacement surgery during the reporting period. 2014/15 a) 0.093 b) 0.042 c) 0.301 d) 0.249

The Trust considers that this data is as described for the following reasons: -The Trust acknowledges the results vary across the four procedures;. With regards to Groin Hernia we have noted that 93% of patients said that their problems are better now when compared to before the operation and 85% of patients describe the results of their operation as excellent, very good or good. The Trust has taken the following actions to improve these scores, and so the quality

of its services by:

-The Trust regularly monitors and audits the pre- and postoperative healthcare of all

patients. Surgical operative outcomes are consistently of high quality and safety, with excellent patient satisfaction for these procedures. The health gains that PROMs measure are of a more generic nature and are not exclusively linked to secondary healthcare provision and will need the consideration of a health economy-wide group to influence.

Not available on NHSIC Not available on The percentage of patients aged: 2013/14 - 5.5% NHSIC 0 to 15 and 2014/15 – 5.9%

(ii) 16 or over

209 readmitted to a hospital which forms part of The Trust considers that this data is as described for the following reasons: the trust within 28 days of being discharged -Since the national published figures (across) are considerably historical, we have from a hospital which forms part of the trust looked at our recent data the overall Trust average for all ages groups is comparable to during the reporting period. our peer group of similar hospitals of 6% (from CHKS). Trust intends to take the following actions to reduce this percentage, and so the quality of its services by: -Continuing to expand and develop the Acute Medicine and Acute Surgery service by employing more senior decision makers in the initial assessment units, for longer, some unnecessary/avoidable admissions are prevented Continuing to develop the community virtual ward service. More proactive, risk based management of virtual ward patients is already having an effect on avoidable admission reduction

The trust’s responsiveness to the personal 2013 – 57% 2014 - 57.8% Not aviable on needs of its patients during the reporting 2014 – 59.4% NHSIC period.

. The Trust considers that this data is as described for the following reasons: Performance is on-par with national data published and is as expected. The Trust is pleased to note that it is above the national average when the National inpatient Survey has been conducted. The Trust has taken the following actions to improve these scores, and so the quality of its services by: The survey identified some areas where patients were less satisfied. The trust has compiled these into an action plan and these will be monitored quarterly by the Patient Experience group

The percentage of staff employed by, or under 2014/15 – 85% 69% 90% contract to, the trust during the reporting period who would recommend the trust as a The survey was introduced as a provider of care to their family or friends. requirement by NHS England in 2014/15. No previous years data available.

The Trust considers that this data is as described for the following reasons: As part of the FFT rollout programme, NHSE (NHS England) has stipulated a Staff FFT survey to be conducted during the course of the year. Organisations can choose their own data collection methodology and may select a range of different methods to encourage participation from all staff groups. The Trust has taken the following actions to improve these scores, and so the quality of its services by: The staff survey report contains a detailed breakdown of each of the Key Findings by Division and occupational staff group, which will allow us to produce targeted action plans to address areas of concern. It will be incorporated into the Trust’s Workforce Action Plan. Clearly the Trust will be focusing on its lowest ranking scores, in particular the patient experience measures. The percentage of patients who were admitted Average rate during; Not available on NHSIC Not available on to hospital and who were risk assessed for 2013/14 – 95.1% NHSIC venous thromboembolism during the reporting 2014/15 – 97% period. The Trust considers that this data is as described for the following reasons: Performance is on-par with national data published and is as expected. The Trust is pleased to note that it is above the national average in undertaking these risk assessments. The Trust has taken the following actions to improve these scores, and so the quality of its services by: Continuing the educational sessions with each junior doctor intake Continuing with a variety of promotional activities to staff and patients. Implementing the use of technology to assist in the recording of the risk

The rate per 100,000 bed days of cases of 2013/14 - 10.724 Not available on NHSIC Not available on C.difficile infection reported within the trust 2014/15 – 9.0127 NHSIC amongst patients aged 2 or over during the

210 reporting period. The Trust considers that this data is as described for the following reasons: Please refer to Infection control section of the Quality report on page 214

The Trust has taken the following actions to improve these scores, and so the quality of its services by: Please refer to Infection control section of the Quality report The number and, where available, rate of patient 2013/14: Not available on NHSIC Not available on safety incidents reported within the trust during Total of 6183 incidents, NHSIC the reporting period, and the number and Of which; 1.7% Resulted in severe percentage of such patient safety incidents that harm/death resulted in severe harm or death. 2014/15: Total of 6185 incidents of which; 1.5% resulted in severe hard/death

The Trust considers that this data is as described for the following reasons: As organisations that report more incidents usually have a better and more effective safety culture, the Trust is pleased to note it has higher than average reporting rates for one of the reporting periods specified. The Trust has taken the following actions to improve these scores, and so the quality of its services by: - Continual raising of awareness of what constitutes as an incident and how to report. -Continual improvement of quality investigations and learning. -Reviewing the severity coding of all incidents to ensure accuracy and consistency of reporting. Please refer to the Patient safety section of the Quality report for reporting rates and the initiatives taken to encourage reporting.

Trust Performance against National Targets- Not Achieved – Admitted 89% 18 Weeks target Achieved – Non-Admitted 96% Not Achieved – 94% A&E target 31-Day ‘Diagnosis to Achieved – 94% treatment’ target for patients with diagnosed cancer 62-Day ‘Referral to treatment’ Not achieved – 84% target for patients with suspected cancer Reduction in C.Difficile cases Achieved Reduction in hospital Achieved acquired MRSA cases 18 Weeks target – Admitted – Despite establishing additional capacity through a temporary theatre on site for 6 months we were unfortunately unable to meet the increase in demand and just missed the 90% target. A&E target - Whilst we did achieve the A&E target for all of last year and until December of this year, we were unfortunately unable to sustain performance at the end of quarter 3 and into quarter 4. This was disappointing, however it was understandable due to the major increase in admissions we experienced throughout December 2014 and continuing into January 2015, in line with the experience of most of the NHS. We performed better than the national performance but narrowly missed the 95% target for the year. 62-Day ‘Referral to treatment’ target for patients with suspected cancer - Unfortunately this target was just missed by 1%. During quarter 1 we experienced issues with our referral tracking system which contributed significantly to not meeting the target during this period. This has now been fully resolved we did achieve the target for quarter 3 and 4.

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Glossary AHP Allied Health Professional BAPEN British Association for Parenteral and Enteral Nutrition BFI Baby Friendly Initiative BSI British Standards Institution CARE Care, Attitude, Responsiveness and Environment CCG Clinical Commissioning Group CCNT Community Children’s Nursing C.Diff Clostridium Difficile CERT Community Emergency Response Team CHC Continuing Healthcare Checklist CHKS Caspe Healthcare Knowledge System CQC Care Quality Commission DECAA Dementia and Elderly Care Action Alliance DoH Department of Health eCAT electronic Common Assessment Tool E.Coli Escheria Coli EOL End of Life FNP Family Nurse Partnership HCA Healthcare Assistant HCAI Healthcare Associated Infection HCP Healthy Child Programme HIA Higher Impact Action HV Health Visiting LTC Long Term Condition MDT Multi-Disciplinary Team MRSA Methicillin-Resistant Staphylococcus Aureus MSSA Methicillin-Sensitive Staphylococcus Aureus MUST Malnutrition Universal Screening Tool NICE National Institute for Health and Care Excellence NIHR National Institute for Health Research

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NHLSA National Health Service Litigation Authority NPSA National Patient Safety Agency PALS Patient Advice Liaison Service PEAT Patient Environment Action Team PEG Patient Experience Group PHSO Parliamentary Healthy Service Ombudsman PLACE Patient Led Assessment for the Care Environment RCA Root Cause Analysis SHA Strategic Health Authority SHMI Summary Hospital-Level Mortality Indicator SSKIN Surface, Keep Moving, Incontinence, Nutrition/Surface, Skin Inspection, Incontinence, Nutrition SSI Surgical Site Infection STEIS Strategic Executive Information System SWFT South Warwickshire NHS Foundation Trust UHCW University Hospitals Coventry and Warwickshire UTI Urinary Tract Infection VW Virtual Ward WCC Warwickshire County Council

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Stakeholder Comments As part of stakeholder engagement, the trust must provide a copy of the draft quality accounts/report to the clinical commissioning group which has responsibility for the largest number of people to whom the trust has provided relevant health services during the reporting period for comment prior to publication and should include any comments made in its published report. NHS foundation trusts must also send draft copies of their quality accounts/ report to their local Healthwatch organisation and overview and scrutiny committee (OSC) for comment prior to publication, and should include any comments made in their final published report. The commissioners have a legal obligation to review and comment, while local Healthwatch organisations and OSCs will be offered the opportunity to comment on a voluntary basis.

Statement from NHS South Warwickshire Clinical Commissioning Group (mandatory)

Following our review of the South Warwickshire NHS Foundation Trust Quality Account we are pleased to state that this provides an honest representation of the work the Trust has undertaken to improve the quality of its services during 2014/15.

NHS South Warwickshire Clinical Commissioning Group (as lead commissioner for the South Warwickshire NHS Foundation Trust contract) continues to work in partnership with the Trust with the aim of ensuring that service users, carers and their families receive excellent quality of care and treatment throughout their healthcare experience, whether this is in the acute sector or in community services. During 2014/15 the Trust has continued its focus on emergency care pathways, with a particular emphasis on developing more ambulatory care pathways that aim to reduce avoidable admissions to hospital, as well as on reducing waiting times for patients waiting for elective operations.

Inpatient experience of care continues to be high during 2014/15, as demonstrated by the national inpatient survey and Friends and Family test results. In A&E, whilst patient satisfaction is also good, response rates for the Friends and Family test continue to be a challenge, and these dropped during the winter months, in particular. As a result, the Trust has implemented actions aimed at increasing patient participation in the survey. During 2014/15 the Friends and Family test was rolled out to all outpatient departments and clinics, community teams, community nursing teams and specialist services with further roll-out planned, following the pilot stage, to Children’s services from April 2015. The Staff Friends and Family test was successfully launched in the Trust during 2014/15 with very positive feedback achieved against the two questions: how likely are you to recommend your organisation to your friends and family as a place to work?; and how likely are you to recommend your organisation to your friends and family if they need care or treatment?

Whilst performance against A&E and Referral to Treatment (RTT) Targets was largely good during the majority of the year (A&E performance being amongst the best in the country up until the end of Quarter 3), challenges over the winter period through bed pressures had a significant impact on the year end position. At the end of Q4 there was under-delivery on both the A&E and RTT targets. Norovirus affected a number of wards and bays, closing them for significant periods of time with an associated impact on pathways for both emergency and elective patients. As a result, the management of Norovirus remains a priority to be further tackled during 2015/16. The RTT target has also suffered a reduction in performance during Q4 as a result of data issues, as a consequence of the Trust implementing the Lorenzo information system during Q4. These are being actively addressed by the Trust.

In respect of other infection control targets, the Trust continues to perform well against the key national targets for MRSA and the C Difficile. E Coli bacteraemias have increased in number during 2014/15, and the CCG will be working with the Trust to ensure best practice continence and catheter care is employed in a bid to reduce the number of patients affected.

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We are pleased to note further improvements in performance against stroke targets. Whilst an improvement in performance against national cancer targets was seen during Quarter 3; unfortunately, this was not maintained during the Q4 winter period. The CCG continues to attend Cancer Services meetings with the Trust in order to ensure that the agreed cancer services action plan is appropriately implemented and effects the required changes. All cancer breaches are robustly reviewed and learning is disseminated within both primary and secondary care in order to achieve improvements in performance.

We are pleased to note that Caesarean section rates, which were higher than we would have liked during 2013/14 and the early part of 2014/15, have reduced significantly since summer 2014 and are being maintained at a lower level. This appears to be the result of a clinical audit into the reasons for C-sections and an action plan developed specifically to promote normal birth.

Delivery of some of the national and local CQUIN schemes have proven to be challenging for the Trust at times during 2014/15, particularly those on dementia and the A&E Friends and Family response rates. In view of the local priority of these they will be further prioritised for delivery in 2015/16. It is pleasing to note, however, that the local CQUIN focused on nutrition and food quality has been successful in improving patient nutritional status and satisfaction with meals at Warwick Hospital.

Patient Safety remains a joint priority. The CCG reviewed Serious Incident reporting and management procedures at the Trust during 2013 and, while we were happy with the governance and systems in place, there were a few developmental actions identified. The Trust completed these during 2014/15 and is now planning to undertake a further review of its systems and processes in light of new national guidance on serious incident management.

To conclude, we are content that the information in this account is accurate and has been discussed in detail during our monthly Clinical Quality Review meetings. There is robust evidence that the vast majority of patients are happy with the services they receive and feel able to raise matters of concern with the Trust, if required. The Trust continues to aim to deliver high quality services and its priorities of continued improvement in patient outcomes, patient experience and the volume of patient safety incidents are welcomed by the CCG.

We look forward to a further year of collaboration to drive forward our shared aim of improving the quality of services for our local population.

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2014/15 Statement of Directors Responsibilities in Respect of the Quality Report

The directors are required under the Health Act 2009 and the National Health Service (Quality Accounts) Regulations 2010 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 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 are subject to review to confirm that requirements set out in the NHS Foundation they are working effectively in practice; Trust Annual Reporting Manual 2014/15 and that the content of the Quality Report is not  The data underpinning the measures inconsistent with internal and external sources of of performance reported in the information including: Quality Report is robust and reliable, conforms to specified data quality  Board minutes and papers for the standards and prescribed 106 period April 2013 to March 2014 definitions, is subject to appropriate scrutiny and review and the Quality  Papers relating to Quality reported to Report has been prepared in the Board over the period April 2013 to accordance with Monitor's annual March 2014 reporting guidance (which  Feedback from the commissioners incorporates the Quality Accounts dated 11/05/2015 regulations) (published at

 Feedback from Governors dated www.monitornhsft.gov.uk annual 13/05/2015 reporting manual) as well as the standards to support data quality for the preparation of the Quality Report  The trust's complaints report (available at published under regulation 18 of the Local Authority Social Services and www.monitornhsft.gov.uk/annualrepo NHS Complaints Regulations 2009, rtingmanual). dated 11/05/2015 The directors confirm to the best of their  The National outpatients survey 2014/15 knowledge and belief they have complied

 The National inpatients survey 2014/15 with the above requirements in preparing the Quality Report - By order of the Board  The National staff survey 2014/15

 The Head of Internal Audit's annual opinion over the trust's control environment dated 22 May 2014 Signed: (Director of Finance, South  CQC quality and risk profiles 2014/15 Warwickshire NHS Foundation Trust)

 The Quality Report presents a st balanced picture of the NHS Date: 21 May 2015 Foundation Trust's performance over the period covered; Signed:  The performance information reported (Chief Executive, South Warwickshire NHS Foundation Trust) in the Quality Report is reliable and accurate; Date: 21st May 2015  There are proper internal controls over the collection and reporting of the measures of performance included in the Quality Report, and these controls

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Limited Assurance certificate to the Board of Governors and Board of Directors of South Warwickshire NHS Foundation Trust

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Statement of Accounting Officers’

Responsibilities and Annual

Governance Statement

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Statement of the chief executive's responsibilities as the accounting officer of South Warwickshire 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 South Warwickshire 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 South Warwickshire 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.

To the best of my knowledge and belief, I have properly discharged the responsibilities set out in Monitor's NHS Foundation Trust Accounting Officer Memorandum.

Glen Burley, Chief Executive Date: 21st May 2015

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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 NHS Foundation 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 NHS Foundation 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 on-going process designed to identify and prioritise the risks to the achievement of the policies, aims and objectives of South Warwickshire NHS Foundation 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 South Warwickshire NHS Foundation Trust for the year ended 31 March 2015 and up to the date of approval of the annual report and accounts.

Capacity to handle risk

As Accounting Officer I have overall responsibility for risk management and am accountable for the effective implementation of risk management and the internal control processes.

The capacity of the Trust to handle risk is achieved through the delegated responsibilities in place as defined in the Trust’s Risk Management Strategy. The Strategy sets out the Trust’s approach to risk, the accountability arrangements including responsibilities of the Board and its sub-committees, Directors, specialist leads and individual employees. It defines the risk management process including risk identification, analysis and evaluation, which will be undertaken to ensure delivery of the Strategy and the capacity to handle risk across the Trust.

Risk management training is mandatory for all new starters band 5 and above and is also provided for existing staff with designated responsibility for undertaking risk assessments. The training is designed to provide an awareness and understanding of the risk management strategy, process and practical experience of completing the risk assessment paperwork.

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The Board and Senior Managers participated in risk management training which was facilitated by Browne Jacobson Solicitors, this training provided an update on the statutory Duty of Candour and the rules and regulations of Coroners courts. Additional training has been provided, to all levels of staff, covering areas such as fire safety, health & safety, moving and handling, resuscitation and first aid. The Trust continues to provide the Institution of Occupational Safety and Health (IOSH) Managing Safely course to staff, Band 7 and above. All staff receive information on risk management and incident reporting during the Trust induction process.

The Trust has a number of measures in place to disseminate learning from good practice. There is an Annual Clinical Conference that provides information on best practice in areas of clinical practice for example, tissue viability and communication skills. There is also a regular ‘Grand Round’ for doctors to discuss specific topics highlighting best practice. Best practice is also discussed at Board of Directors level and a monthly patient story focuses on what went well and what could be improved.

The risk and control framework

The NHS Litigation Authority (NHSLA) Risk Management Standards for Trusts and the Maternity Clinical Risk Management Standards required the Trust to have two separate Risk Management Strategies. From April 2014, the NHS Litigation Authority (NHSLA) has ceased assessing trusts against their Risk Management Standards; therefore the Trust has taken the opportunity to merge the separate Risk Management Strategies into a single document. In June the new Risk Management Strategy 2015-18 will be presented at Risk Management Board for approval and Board of Directors for ratification. The Strategy explains how risks are identified, evaluated, scored and monitored within the organisation. The Trust has in place a risk matrix, which is used to evaluate all risks, both clinical and non-clinical, as well as incidents and complaints within the organisation. All risks are included in the Organisational Risk Registers and monitored by the relevant Divisional Risk Management Group in accordance with the Strategy. In addition, all risks with a score of 8-12 (dark amber) and 15-25 (red) are presented, quarterly, to the Risk Management Board (which is an executive committee) and risks scoring 15-25 (red) are presented to the Board of Directors on a quarterly basis.

In the autumn and spring of each year the Board of Directors hold a ‘Round Table’ event with the Council of Governors which ensures that the Trust’s annual plan meets national and local priorities and which also provides an opportunity to determine the organisation’s risk appetite relevant to strategic challenges. The Board of Directors has rated its overall risk appetite as 15; therefore any risk of 15-25 (red) is reported to the Board. In relation to the Board Assurance Framework (BAF), the Board has requested sight of those risks rated 8-12 (dark amber) and 15-25 (red), these risks are submitted quarterly for consideration.

The Organisational Risk Register and BAF were subject to quarterly review by the Board to consider any gaps in either the assurance or controls. Where required, further action was taken by managers to mitigate the risk.

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Extreme risks (risks scoring 15-25) listed on the Trust’s Risk Register during 2014-15 are outlined below:-

 Lack of Band 5 qualified nurses, for the specialist service, due to a 40% increase in capacity resulting in loss of income if level 1 status is not maintained. End of year score was 16;

 Service disruption due to obsolete equipment (air handling plant, generators, washers) resulting in a compromised Endoscopy Service. End of year score was 16;

 Failure of the single high voltage (HV) supply cable to the main site due to the obsolete high voltage switchgear and or the inability to connect temporary generators to the electrical system in the event of a loss of supply resulting in loss of clinical services. End of year score was 15; and

 Failure of power supply (Support Services side of Lakin Road site) due to insufficient capacity of the backup generator resulting in loss of clinical services. End of year score was 15.

Extreme risks (risks scoring 15-25) on the Trust’s Risk Register, which were opened and closed during 2014-15 are detailed below:-

 Elective Care Non-achievement of Trust Cost Improvement Plan (CIP) targets 2014/15 because of non-delivery of schemes which could affect the Trusts ability to achieve planned financial surplus and hence the affordability of new developments. Opened May 2014. Closed December 2014.

The Executive Team identify future corporate risks, which will be managed and mitigated as part of the Board Assurance Framework (BAF) process. Measures to assess whether the outcomes have been achieved have been linked to the organisational strategic objectives and the Quality Improvement Priorities.

Areas of risk identified to date are predominantly linked to the changing age profile of the population across Warwickshire. The demographic distribution is resulting in an increasingly elderly and frail population living with Long Term Conditions and Dementia. As a result the Trust is committed to developing different staffing solutions and introducing nurse staffing level measures within the community, by reviewing the skill mix and the development of further Assistant Practitioner roles.

The risks associated with these are based on systems, processes, financial frameworks and the skills of the workforce to meet this increasing demand. Underpinning the identified risks it is identified that the current IT infrastructure requires further development to support real time data capture to optimise Trust productivity and service developments.

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The 2014-15 BAF has been updated, by the Executive Team and reviewed on a quarterly basis by the Risk Management Board and Board of Directors. The Audit Committee was responsible for providing independent assurance on the robustness of governance and risk management in the Trust. The BAF was the key process used by the Board to ensure that all principal risks were controlled, that the effectiveness of those key controls was assured and that there was sufficient evidence to support the Annual Governance Statement.

Internal Audit have undertaken both an Interim and Final Review of the BAF 2014-15, which reported that the Trust has a BAF in place that clearly links the organisational objectives/aims through to principal risks, controls and assurances. The design and construction of the BAF document is compliant with the Department of Health guidance. Internal Audit’s testing, by sample, confirmed that the controls on which the Board rely are in place.

The Trust has in place, a Programme Management Office (PMO) function and Programme Delivery Board (PDB) to oversee programmes/projects and manage programme/project risks. The PDB is a monthly meeting, administered by the PMO and chaired by the Chief Executive. The PDB monitors the progress of all programmes/projects across the Trust including Cost Improvement Plans and ensures alignment to Trust Objectives. This forum provides the opportunity to constantly evaluate programmes/projects, in particular any risks impacting on the delivery of the required outcomes and benefits.

During the year this included a focus on the need to control occupancy and demand levels due to the potential detrimental effect on waiting times and HCAI performance. As a result the Board continues to develop the measures which will help to provide greater insight into the quality of patient care which will be reported as part of our Annual Quality Report.

Risk management is embedded into the Trust and this includes being open with patients, relatives and carers when patients are exposed to harmful events. All patient safety incidents are reported nationally through the National Reporting Learning System and compared nationally with similar organisations. There have been working groups developed to reduce patient falls and medication errors. The work programmes are monitored by the Patient Safety Surveillance Committee.

The Care Quality Commission reported in their Intelligent Monitoring Report that staff reporting of errors, near misses and incidents is as expected and comparable with similar Trusts. All patient safety and non- clinical incidents are reviewed by the relevant manager, investigated where necessary and improvements implemented as required. The Board is assured that all incidents are reported and managed in a timely manner via the Trust’s electronic incident reporting system and the internal governance committee structure.

The Trust has an independent Patient Forum which works with the Trust’s Council of Governors on patient related issues. Two members of the Forum sit on the Council of Governor’s Patient Care committee to ensure the work of both bodies is aligned. Where possible the Trust proactively works with all stakeholders.

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As a Foundation Trust, the organisation operates under a licence, issued on 1 April 2014 by Monitor, the independent regulator of Foundation Trusts. The existing control and reporting mechanisms described in this Annual Governance Statement are used to ensure that the Trust is compliant with the terms of its licence.

With respect to condition FT4 (NHS Foundation Trust governance arrangements) the Board reviews the terms of reference of its committees on an annual basis to ensure their effectiveness. In addition, the Audit Committee undertakes an annual self-assessment of its own effectiveness using a proforma from the NHS Audit Committee handbook, which is reported to the Board. The Audit Committee also submits an Annual Report to the Council of Governors. The terms of reference also serve to define the responsibilities, accountabilities and reporting lines of each Committee. The Board receives a report following each Committee meeting, written by the Non-Executive Director Chair, and is therefore able to both receive assurance but also challenge any of the decisions made. The responsibilities of the Board and its Directors are defined in the Trust’s Constitution.

The Board has a detailed schedule of business, agreed annually, which defines when reports will be submitted, ensuring the Board can operate timely and effective scrutiny of its operations. Key performance reports covering quality of care, nurse staffing, finance and operational performance are received on a monthly basis to ensure sufficient rigour is applied. Internal Audit was commissioned to undertake a preliminary review of the Trust’s/Board’s performance against Monitor’s ‘Well-Led’ framework, as the Board’s review of effectiveness in 2014-15. The report provided valuable assurance of high standards of governance overall, with numerous examples of good practice. It also identified several areas where improved arrangements could further strengthen board effectiveness. The latter included some useful new pointers as well as some that have been noted by the Board from previous reviews.

The Trust is required to submit to Monitor a certified Corporate Governance Statement, as part of the new annual planning arrangements. The Board will be testing the various elements of that statement against the reports and submissions both the Board and its Committees have considered during the year, in order to provide the necessary assurances on the validity of the statement. This testing and the resulting report is undertaken by the Trust Secretary and is a system that provided the Board with sufficient assurances under previous arrangements.

CQC Compliance

The Trust is fully compliant with the requirements of registration with the Care Quality Commission.

The Trust is required to register with the Care Quality Commission (CQC) and is registered without conditions. Registration confirms that the Trust meets all regulations and standards stipulated by the CQC. It also confirms that the Trust is authorised to provide all registered services across all locations registered under the Trust.

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As part of the CQC registration the Trust is subject to periodic inspections conducted by the CQC to satisfy the regulatory body that the Trust is fulfilling regulations and requirements. The Trust has not been subject to any inspections or any enforcement actions set by the CQC during the period of April 2014 to March 2015.

To monitor and maintain compliance, an internal governance arrangement is embedded at the Trust. The Trust has developed its current embedded process of self-assessments of compliance and has successfully introduced an internal compliance inspection programme, which resembles the approach adopted by the CQC. Quality Improvement Visits have facilitated a robust and un-biased assurance process comprising of a comprehensive schedule to visit all services, including those in the community, and assess compliance with the CQC standards. Inspections conducted to date, have enabled the identification of good practice but more significantly highlight areas where improvements are required.

Assurance Process and Reporting of Assessment  All Inspection reports are reported to the Patient Experience Group who have oversight of the findings and recommend appropriate courses of action to the Patient Safety Surveillance Committee as required.  Corporate Leads update the CQC Compliance Self-assessment document and provide the completed assessments to the Governance Team, in accordance with an agreed reporting schedule, for review and validation.  A compliance overview report is presented to the Finance and Performance Executive and at Board, in accordance with an agreed reporting schedule. This includes the summary results of any ward inspections conducted. This report will provide assurance that any actions to improve compliance are being progressed.  The Clinical Governance Committee receives a quarterly report to inform the Committee of the Trust’s compliance with the CQC standards and provides assurance to the Committee that appropriate actions and service improvements have been made or are in progress to ensure safe and high quality services are in place.

Evidence is reviewed to assess compliance with the CQC standards and regulations. Where there is insufficient evidence or there is performance data to suggest a potential breach in compliance, a monitoring and improvement plan is devised by the Compliance Unit and the outcome lead. These plans are monitored and reported to the aforementioned committees and compliance status is subject to review until there is satisfactory evidence or data to provide assurance of compliance with the CQC standards and regulations.

The Clinical Governance Committee, in particular, reviews all aspects of the Trust’s Clinical Governance arrangements, including CQC compliance, on behalf of the Board. The Non-Executive Chair of the Committee provides each Board meeting with a written report on the Committee’s business, providing assurance and also highlighting issues of concern for the Board’s attention.

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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 into 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 all the organisation’s obligations under equality, diversity and human rights legislation 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 Adaptation Reporting requirements are complied with.

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

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, and the executive managers within the Trust who have responsibility for the development and maintenance of the internal control framework. I have drawn on the content of the Quality Report contained within 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 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 Committee and Risk Management Board, and a plan to address weaknesses and ensure continuous improvement of the system is in place.

The Trust employs a number of processes to deliver economy, efficiency and effectiveness of the use of its resources. The Board of Directors sets the standards and has specified within the Standing Financial Instructions and Scheme of Delegation the appropriate delegated authority levels throughout the Trust. Executive Directors and managers therefore have responsibility for the effective management and deployment of their staff and other resources to optimise the efficiency of their division/department.

The Board receives performance and financial reports at each of its meetings and receives reports from the chairs of its committees to which it has delegated powers and responsibilities.

A Non-Executive Director of the Board chairs the Audit Committee with regular attendance by representatives from the Trust’s internal and external auditors. The Committee has reviewed and agreed audit plans for both the internal and external auditors during the year (which has informed this accounting period), progress against which is regularly reviewed by the Audit Committee.

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McKesson Shared Services (MSS) currently provides the Trust’s payroll services from their Sheffield office. This contract has been in place, and managed through an agreed Service Level Agreement, since 1 July 2013. The internal auditors of MSS issued a qualified opinion for the period 1 April 2014 to 28 February 2015, on the basis that deficiencies were identified with the operating effectiveness of three of MSS’s stated controls: the input and changes to permanent and temporary payroll data. Our Internal Auditors and External Auditors have undertaken further substantive testing of transactions that McKesson process on behalf of the Trust. No significant concerns were raised.

Information Governance

Risks to data security are managed and controlled as part of the risk management process. The Trust has an Information Security Policy which supports the Information Governance Strategy. The Trust participates in the Health & Social Care Information Centre (HSCIC) Information Governance Toolkit (IGT) and achieved a Level 2 (or above) in all of the 45 Requirements. The IGT is a performance tool which allows NHS organisations and partners to assess themselves against Department of Health (DH) Information Governance policies and standards. The purpose of the assessment is to enable organisations to measure their compliance against the law and central guidance and to see whether information is handled correctly and protected from unauthorised access, loss, damage and destruction. The ultimate aim is to demonstrate the organisation can be trusted to maintain the confidentiality and security of personal information and this, in turn, increases public confidence that the NHS and its partners can be trusted with personal data.

In addition, the IGT requires organisations to report Serious Information Governance incidents against the Department of Health’s (DH) IG Incident Reporting Tool (enhanced in October 2014). These enhancements followed the initial publication of the DH’s Checklist Guidance for Reporting, Managing and Investigating Information Governance Serious Incidents Requiring Investigation (IG SIRI), on 1st June 2013. This Guidance confirmed all IG SIRIs occurring in Health, Public Health and Adult Social Care services were to be reported appropriately and handled effectively and, as a consequence, from that date organisations were required to report IG SIRIs to the Department of Health via the IG Toolkit Incident Reporting Tool. The Tool is very useful in enabling organisations, through new functionality, to assess the severity of an incident prior to it being notified to the Information Commissioner’s Office, Department of Health and NHS England. This functionality relates to incidents that appear to be Level 2.

The Trust reported one incident against the DH IG Incident Reporting Tool. A level 1 incident was reported on 28 October 2014 and was managed locally in line with the IG SIRI 1 June 2013: version 2.0. This incident related to unauthorised disclosure, involving limited patient information on a ward handover sheet with no adverse outcome.

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A level 2 incident was reported on the IG national reporting tool on 21 November 2014 and on 24 November 2014 this was amended to state it was a near miss and the national incident grading altered to 0, given the information was recovered on 22 November 2014 securely, intact and there was no evidence of any unauthorised disclosure. This incident was reported in line with IG SIRI 1 November 2014: version 4.0.

Future incidents will be managed and graded using the IG SIRI 27 February 2015: version 5.0.

Of note, during 2014-15, the Trust is pleased to report that it has not had to report any Level 2 IG SIRIs.

The Information Governance team has taken the opportunity to share the learning from reported IG-related incidents via the Patient Safety Newsletter, which was launched in spring 2014. The message communicated generally was one of clarifying lessons that can be learnt from those incidents and near misses as a Trust - whether processes need to be changed to improve the Trust’s approach to Information Governance, Data Protection and Information Security; whether the Trust needs to understand any gaps and/or vulnerabilities and how this information can help formulate IG-related risks for the Trust’s risk registers.

In July 2014 HSCIC approached organisations to understand how prepared they would be in the face of potential cyber-attacks. Earlier in the year HSCIC had been asked by the Secretary of State for Health to take on an enhanced role to help ensure data security across the care system and, as part of this role, there was a requirement to gather information on organisations’ ‘Cyber Preparedness’. This information gathering was in the form of a survey and questions covered organisations’ readiness for cyber-attacks via testing and monitoring systems and processes, organisations’ approach in terms of cyber risk management, training and raising awareness and where responsibility lay within the organisation for this. The Trust provided a positive response to the survey in terms of its cyber preparedness.

In addition, the Department of Health’s (DH) IG Incident Reporting Tool (in terms of functionality, content and guidance) was further enhanced to cover cyber incidents; the aim of which is to facilitate the reporting of significant cyber security related serious incidents requiring investigation. As a result of this development HSCIC published its updated Guidance in February 2015 covering Information Governance and Cyber Security Serious Incidents, applicable to all organisations processing Health, Public Health and Adult Social Care personal data.

Annual Quality Report

The Directors are required under the Health Act 2009 and the National Health Service (Quality Accounts) Regulations 2010 (as amended) 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 in the NHS Foundation Trust Annual Reporting Manual.

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The Quality Report (QR) 2014-15 represents a balanced declaration of the quality of services, risk management and governance processes that underpin the Trust. The QR demonstrates that the Trust has a systematic application of policies, procedures and practices that establishes the context. The report provides insight and assurance into the monitoring, communication and improvement of quality, risk and patient safety. The Executive lead for the QR is the Trust’s Director of Nursing.

The Board is assured that appropriate controls are in place to ensure that the data included in the QR is accurate and balanced through the structure of committees and groups which have key roles in the delivery of the risk management agenda. Each committee and group focuses on specific areas of activity and provides assurance the Board requires that all areas of risk are being adequately managed. The Board has ultimate responsibility for determining the governance arrangements of the Trust, agreeing the necessary policy framework and for monitoring performance within these areas. The Board manages governance affairs efficiently and effectively through the implementation of internal controls.

Further assurance is provided through our main commissioners, South Warwickshire Clinical Commissioning Group and the Health Overview and Scrutiny Committee of Warwickshire County Council, who are both given the opportunity to comment on the QR and their statements are included in the report prior to publication. For the review of the 2014-15 stakeholder engagement process, a dedicated task and finish group was convened by Warwickshire County Council with representation from HealthWatch to provide stakeholders with a method of gaining assurance of delivery against the Trusts Quality objectives and to have insight into the Trusts strategies, systems and processes to deliver high quality services over the coming year.

The final draft QR is reviewed and amended by the Audit Committee before final sign off by the Board and publication.

We have presented our QR as part of our Annual Report and Accounts based on a range of quality metrics, which are routinely reported internally and externally through the Integrated Performance Dashboard and Quarterly Patient Experience Report.

The quality metrics are reported on a monthly basis and performance is compared to previous month’s performance with any exceptions supported by validated data and performance improvement plans.

The Board is satisfied that the content of the report reflects the regular information received throughout the year. The Council of Governors has reviewed the QR and felt that it was representative of the quality, risk and governance agenda.

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The Board has taken assurance on quality of data included in the report from the following sources:

• External audit testing and certification, which encompasses - reviewing the content of the Quality Report against the requirements set out in the NHS Foundation Trust Annual Reporting Manual, - reviewing the content of the Quality Report for consistency against the other internal and external information sources, - a signed limited assurance report by the External Auditors on whether anything has come to the attention of the auditor that leads them to believe that the Quality Report has not been prepared in line with the requirements set out in the NHS Foundation Trust Annual Reporting Manual and is not consistent with the other internal and external information sources. • Internal audit reports. • The Audit Commission Reports on Payment by Results – where data quality and governance were assessed. • The Information Governance Toolkit assessment. • The National NHS Information centre

In addition to the above, data has also been subjected to scrutiny by commissioners and the Commissioning Support Unit (CSU) on their behalf.

The Trust also has a Data Quality Committee that governs quality assurance. There has also been a drive to improve data quality led by the Director of Finance who is working with the information team to identify and reward good practice in the Trust. The information team also provide training on data quality to support the quality assurance process.

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 Trust who have responsibility for the development and maintenance of the internal control framework. I have drawn on the content of the quality report attached to 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 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 Committee, Risk Management Board, Clinical Governance Committee, Divisional Audit and Operational Governance Groups and the Divisional Risk Management Groups. A plan to address weaknesses and ensure continuous improvement of the system is in place.

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During the year the Board regularly reviewed progress against a number of action plans including the BAF to ensure that identified actions were implemented in a timely manner. The Audit Committee received regular reports on assessments undertaken by the Trust’s internal and external auditors, and the Trust’s Finance and Performance Executive monitored the Trust’s system of financial control. The annual report produced by the Trust’s internal auditors identified that significant assurance could be given and that there is a generally sound system of internal control, designed to meet the organisation’s objectives, and that controls are generally being applied consistently. A separate report provided assurance regarding the work of the internal audit function regarding Counter Fraud Activities.

There have continued to be improvements made to urgent care flows in acute and community services including the discharge to assess capacity in local nursing and residential homes. Whilst we were unable to maintain A&E performance throughout the whole winter period due to acuity of admissions and capacity restrictions due to flu and norovirus outbreaks, performance has stayed above the national average for the whole year and was well above average in the first half of the year.

Preventing and controlling healthcare associated infections has continued to be a key governance priority for the Trust. In order to keep the Hand Hygiene message fresh, a new campaign was launched trust-wide throughout 2014-15. The threat of Norovirus outbreaks is a constant one, throughout the winter period 2014-15 saw several wards affected by Norovirus, in line with a high prevalence of Norovirus nationally. A further significant reduction has been achieved in MRSA bacteraemia and Clostridium difficile associated infections, with extremely low levels of infection noted.

The implementation of Lorenzo in February 2015 has caused some operational challenges. Outpatients remains the highest risk area and specifically it has not yet been possible to obtain a fully accurate outpatient waiting list (Outpatient PTL). This has led to an apparent increase in the number of long waiters without a date and later notice appointments being offered to patients which has affected the outpatient DNA rate. More positive progress has been made with regards to Inpatients and the Outpatient PTL for this group of patients is now accurate. Performance against the Referral to Treatment Time (RTT) measures has also dipped in January, February and March 2015 due to demand increases and failing the admitted target, but with the open and non-admitted targets both being met each month in 2014-15.

The Trust achieved all the cancer standards during the period October-December 2014 and all standards except the 31 day subsequent treatment standard in January to March 2015.

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The process that has been applied in maintaining and reviewing the effectiveness of the system of internal control is summarised below:  The Board oversees risk and governance assessments regularly;  The Audit Committee ensures that systems and processes are in place;  The Risk Management Board and assuring committees review and manage risk on a routine basis;  Directors/Managers lead on defined areas of risk; and  Internal Audit provides an opinion on the system of internal control and the BAF.

Regular reports regarding clinical and non-clinical incidents, complaints, legal claims and other risks identified were submitted to the Clinical Governance Committee and the Health and Safety Committee (which reports to the Risk Management Board), which monitored progress and suggested action to be taken as appropriate. Directors and senior managers of the Trust have specific responsibilities for reviewing the risks and controls for which they are responsible and for maintaining internal control systems.

The Trust received significant assurance on all reviews carried out by Internal Audit. We have agreed action plans with management and will continue to monitor the implementation of these plans over the coming months. All outstanding Audit actions are reported at each meeting of the Audit Committee which takes a proactive approach to monitoring the outstanding actions and requesting follow up audits where there are areas of concern.

The Trust will continue to monitor its governance processes and make any appropriate changes to strengthen process.

Conclusion

No significant internal control issues have been identified.

Chief Executive Date: 21st May 2015

234

Summary of Financial

Statements & Auditor’s

Statement

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Statement of Comprehensive Income This statement provides a summary of the income we have received for providing healthcare, education and research services and expenditure we have incurred in delivering these services.

Total Total All numbers are in £ thousands 2014/15 2013/14

Income from activities 217,728 208,068 Other operating revenue 19,914 18,766 Operating expenses -234,676 -222,741 OPERATING SURPLUS 2,966 4,093 Profit on disposal of fixed assets 0 0 SURPLUS BEFORE INTEREST 2,966 4,093 Finance income - Interest receivable 60 56 Finance costs - interest payable -51 0 Other finance costs-unwinding discount -71 -112 SURPLUS FOR THE FINANCIAL YEAR 2,904 4,037 Public dividend capital dividends payable -2,765 -1,928 Gain from transfer by Absorption 87 0 RETAINED SURPLUS 226 2,109

Other comprehensive income Impairments and reversals Gain from transfer by absorption from demising bodies 19,150 Gains / (Losses) on revaluations -2,061 5,518 Reduction in the donated asset reserve Total comprehensive income for the year -1,835 26,777

236

Statement of Financial Position This statement provides a summary view of the net worth of the Trust represented by its assets and liabilities and how this worth is represented in terms of taxpayers’ equity.

All numbers are in £ thousands Mar-15 Mar-14 Non-current assets Property, plant and equipment 106,556 102,493 Intangible assets 2,615 2,726 Investments in associates 250 250 Trade and other receivables 501 581 Total non-current assets 109,922 106,050 Current assets Inventories 2,860 2,901 Trade and other receivables 14,310 13,762 Cash and cash equivalents 9,877 9,126 Total current assets 27,047 25,789

Total assets 136,969 131,839 Creditors falling due within one year -29,540 -28,925 Net current assets/(liabilities) -2,493 -3,136 Creditors falling due > one year -6,548 -240 Provisions for liabilities and charges -1,443 -1,581 Total assets employed 99,438 101,093 Financed by taxpayers' equity: Public dividend capital 64,082 63,902 Revaluation reserve 13,328 14,369 Retained earnings 22,028 22,822 Total Taxpayers' Equity 99,438 101,093

Date: 21st May 2015 Glen Burley, Chief Executive

South Warwickshire NHS Foundation Trust has complied with the cost allocation and charging requirements set out in HM Treasury and Office of Public Sector guidance.

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Statement of Cash Flows This statement provides a summary view of how the Trust has made use of the cash it has received and how it has sought additional and repaid existing capital.

All numbers are in £ thousands Mar-15 Mar-14 Cash flows from operating activities 2,966 4,093 Depreciation and amortisation 4,291 3,949 Impairments and reversals 0 0 Non Cash Donations / Grants credited to Income -80 -371 Tax paid 0 0 Dividends paid 0 0 (Increase)/decrease in inventories 41 -476 (Increase)/decrease in trade and other receivables -436 -8,685 Increase/(decrease) in trade and other payables 123 -208 Increase/(decrease) in other current liabilities 1,156 -1,023 Increase/(decrease) in provisions -178 -340 Other movements in operating cash flow -14 10 Net cash inflow/(outflow) from operating activities 7,869 -3,051 Cash flows from investing activities Interest received 60 56 (Payments) for property, plant and equipment -10,277 -7,721 Proceeds from disposal of plant, property and equipment 0 38 (Payments) for intangible assets -348 -862 (Payments) for other investments 0 0 Proceeds from disposal of other financial assets 0 0 Net cash inflow/(outflow) from investing activities -10,565 -8,489 Net cash inflow/(outflow) before financing -2,696 -11,540 Cash flows from financing activities Public dividend capital received 180 290 Public dividend capital dividend paid -2,894 -1,662 Interest paid -51 0 Loans Received 6,404 385 Loans repaid -192 -239 Capital element of finance leases and PFI 0 -51 Net cash inflow/(outflow) from financing 3,447 -1,277 Net increase/(decrease) in cash and cash equivalents 751 -12,817 Cash (and) cash equivalents at the beginning of the financial year 9,126 21,943 Cash (and) cash equivalents at the end of the financial year 9,877 9,126

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INDEPENDENT AUDITOR’S REPORT TO THE BOARD OF GOVERNORS OF SOUTH WARWICKSHIRE NHS FOUNDATION TRUST

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South Warwickshire NHS Foundation Trust Warwick Hospital Lakin Road Warwick CV34 5BW Phone : 01926 495321 Fax : 01926 482603 www.swft.nhs.uk

To obtain a printed copy of the Annual Report please email [email protected]

1998/99 Trust Accounts pro-forma Data entered below will be used throughout the workbook:

Trust name: South Warwickshire NHS Foundation Trust This year 1 April 2014 to 31 March 2015 Last year 2013/14 This year ended 31 March 2015 Last year ended 31 March 2014 This year commencing: 1 April 2014

Intro South Warwickshire NHS Foundation Trust - Annual Accounts 1 April 2014 to 31 March 2015

Annual Accounts for the Period 1 April 2014 to 31 March 2015 Foreword to the Accounts

These accounts for the 12 month period ended 31 March 2015 have been prepared by the South Warwickshire NHS Foundation Trust in accordance with paragraphs 24 and 25 of Schedule 7 to the National Health Service Act 2006 in the form which Monitor has, with the approval of the Treasury, directed.

Page 1 South Warwickshire NHS Foundation Trust - Annual Accounts 1 April 2014 to 31 March 2015

STATEMENT OF COMPREHENSIVE INCOME FOR THE YEAR ENDED 31 MARCH 2015

2015 2014

NOTE £000 £000 Revenue Operating Income 4,5 & 6 237,642 226,834 Operating Expenses 8 (234,676) (222,741) Operating surplus 2,966 4,093 Finance costs: Finance income 13 60 56 Finance expense - financial liabilities 15 (51) 0 Finance expense - unwinding of discount on provisions (71) (112) PDC Dividends payable (2,765) (1,928) Net Finance Costs (2,827) (1,984) Share of Profit / (Loss) of Associates/Joint Ventures accounted for using the equity method 0 0 Corporation tax expense 0 0 Gain from transfer by Absorption 87 0 Retained surplus for the year 226 2,109

Other comprehensive income Gain / (Loss) from transfer by absorption from demising bodies 0 19,150 Revaluation gains/(losses) and impairment losses property, plant and equipment (2,061) 5,518

Total comprehensive income for the year (1,835) 26,777

The notes on pages 6 to 43 form part of these accounts.

All income and expenditure is derived form continuing operations. There are no minority interests in the Trust. Therefore the surplus for the year of £226,295 (2013/14 surplus of £2,109,000) and total comprehensive expense for the year of £1,835,000 (2013/14 £26,777,000 comprehensive income) is wholly attributable to the Trust.

Page 2 South Warwickshire NHS Foundation Trust - Annual Accounts 1 April 2014 to 31 March 2015

STATEMENT OF FINANCIAL POSITION AS AT 31 MARCH 2015 31 March 31 March 2015 2014 Non-current assets NOTE £000 £000 Intangible assets 17 2,615 2,726 Property, plant and equipment 16 106,556 102,493 Investment Property 0 0 Investment in subsidiary 39 250 250 Other Investments 0 0 Trade and other receivables 21 501 581 Other Financial assets 22 0 0 Other assets 0 0 Total non-current assets 109,922 106,050 Current assets Inventories 20 2,860 2,901 Trade and other receivables 21 14,310 13,762 Other financial assets 22 0 0 Non-current assets for sale and assets in disposal groups 0 0 Cash and cash equivalents 24 9,877 9,126 Total current assets 27,047 25,789 Total assets 136,969 131,839 Current liabilities Trade and other payables 25 (25,752) (26,202) Borrowings 26 (96) (218) Other financial liabilities 34 0 0 Provisions 29 (380) (349) Other liabilities 27 (3,312) (2,156) Liabilities in disposal groups 0 0 Total Current Liabilities (29,540) (28,925) Total assets less current liabilities 107,429 102,914 Non-current liabilities Trade and other payables 25 0 0 Borrowings 26 (6,548) (240) Other financial liabilities 27 0 0 Provisions 29 (1,443) (1,581) Other liabilities 27 0 0 Total Non Current Liabilities (7,991) (1,821)

Total assets employed 99,438 101,093

Financed by taxpayers' equity: Public Dividend Capital 64,082 63,902 Revaluation reserve 13,328 14,369 Available for sale investments reserve 0 0 Other reserves 0 0 Merger reserve 0 0 Retained Earnings 22,028 22,822 Total Taxpayers' Equity 99,438 101,093

The financial statements on pages 2 to 5 were approved by the Board and authorised for issue on 20 May 2015 and signed on its behalf by:

Signed: …………………………………(Chief Executive) Date: ……………………

Page 3 South Warwickshire NHS Foundation Trust - Annual Accounts 1 April 2014 to 31 March 2015

STATEMENT OF CHANGES IN TAXPAYERS' EQUITY

Public Retained Revaluation Other Total Dividend earnings reserve reserves Capital (PDC) £000 £000 £000 £000 £000 Changes in taxpayers’ equity for 2014/15 Opening Balance at 1 April 2014 63,902 22,822 14,369 0 101,093 Prior Period Adjustment 0 0 0 0 0 Revised Balance at 1 April 2014 63,902 22,822 14,369 0 101,093 Total Comprehensive Income for the year Retained surplus/(deficit) for the year 0 226 0 0 226 Transfers by Normal absorption: transfers between reserves 0 (2) 2 0 0 Transfers between reserves 0 0 0 0 0 Impairments and reversals 0 0 0 0 0 Net loss on revaluation of property, plant and equipment 0 0 (2,061) 0 (2,061) New PDC received 180 0 0 0 180 PDC repaid in year 0 0 0 0 0 PDC written off 0 0 0 0 0 Other reserves movements 0 (1,018) 1,018 0 0 Balance at 31 March 2015 64,082 22,028 13,328 0 99,438

Opening Balance at 1 April 2013 63,612 1,798 8,616 0 74,026 Prior Period Adjustment 0 0 0 0 0 Revised Balance at 1 April 2013 63,612 1,798 8,616 0 74,026 Total Comprehensive Income for the year Retained surplus/(deficit) for the year 0 2,109 0 0 2,109 Transfers by MODIFIED absorption: Gains/(losses) on 1 April transfers from demising bodies. 0 19,150 0 0 19,150 Transfers by MODIFIED absorption: transfers between reserves 0 (235) 235 0 0 Transfers between reserves 0 0 0 0 0 Impairments and reversals 0 0 0 0 0 Net gain on revaluation of property, plant and equipment 0 0 5,518 0 5,518 New PDC received 195 0 0 0 195 PDC repaid in year 0 0 0 0 0 PDC written off 0 0 0 0 0 PDC adjustment for cash impact of payables / receivables transferred from legacy teams 95 0 0 0 95 Other movements in PDC in year 0 0 0 0 0 Balance at 31 March 2014 63,902 22,822 14,369 0 101,093

Page 4 South Warwickshire NHS Foundation Trust - Annual Accounts 1 April 2014 to 31 March 2015

STATEMENT OF CASH FLOWS FOR THE YEAR ENDED 31 March 2015 2,015 2,014 NOTE £000 £000 Cash flows from operating activities Operating surplus 2,966 4,093 Depreciation and amortisation 16, 17 4,291 3,949 Impairments and reversals 16, 17 0 0 Non Cash Donations / Grants credited to income (80) (371) Decrease /(Increase) in inventories 41 (476) (Increase)/Decrease in trade and other receivables (436) (8,685) (Increase)/decrease in other current assets 0 0 Increase/(Decrease) in trade and other payables 123 (208) Increase/(Decrease) in other current liabilities 1,156 (1,023) (Decrease) in provisions 29 (178) (340) Other movements in operating cash flows (14) 10 Net cash inflow from operating activities 7,869 (3,051)

Cash flows from investing activities Interest received 60 56 Payments for property, plant and equipment 16 (10,277) (7,721) Proceeds from disposal of plant, property and equipment 0 38 Payments for intangible assets 17 (348) (862) Proceeds from disposal of intangible assets 0 0 Payments for financial assets 0 0 Proceeds from disposal of financial assets 0 0 Revenue rental income 0 0 Net cash outflow from investing activities (10,565) (8,489) Net cash inflow before financing (2,696) (11,540)

Cash flows from financing activities Public dividend capital received 180 290 Public dividend capital repaid 0 0 Loans received 6,404 385 Loans repaid (192) (239) PDC Dividend Paid (2,894) (1,662) Interest Paid (51) 0 Capital element of finance leases and PFI 0 (51) Net cash outflow from financing 3,447 (1,277)

Net increase in cash and cash equivalents 751 (12,817) Cash and cash equivalents (and bank overdrafts) at the beginning of the financial year 9,126 21,943

Cash and cash equivalents (and bank overdrafts) at the end of the financial year 24 9,877 9,126

Page 5 South Warwickshire NHS Foundation Trust - Annual Accounts 1 April 2014 to 31 March 201

NOTES TO THE ACCOUNTS

1. Accounting Policies Monitor has directed that the financial statements of NHS Foundation Trusts shall meet the accounting requirements of the Foundation Trust Annual Reporting Manual (FT ARM) which has been agreed with HM Treasury. Consequently, the following financial statements have been prepared in accordance with the FT ARM 2014/15 issued by Monitor. The accounting policies contained in that 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 NHS Foundation Trusts. The accounting policies have been applied consistently in dealing with items considered material in relation to the accounts.

1.1 Accounting convention These accounts have been prepared under the historical cost convention modified to account for the revaluation of property, plant and equipment and intangible assets. 1.2 Acquisitions and discontinued operations Activities are considered to be ‘acquired’ only if they are taken on from outside the public sector. Activities are considered to be ‘discontinued’ only if they cease entirely. They are not considered to be ‘discontinued’ if they transfer from one public sector body to another.

1.3 Critical accounting judgements and key sources of estimation uncertainty In the application of the Trust’s accounting policies, management is required to make judgements, estimates and assumptions about the carrying amounts of assets and liabilities that are not readily apparent from other sources. The estimates and associated assumptions are based on historical experience and other factors that are considered to be relevant. Actual results may differ from those estimates. The estimates and underlying assumptions are continually reviewed. Revisions to accounting estimates are recognised in the period in which the estimate is revised if the revision affects only that period, or in the period of the revision and future periods if the revision affects both current and future periods.

1.3.1 Critical judgements in applying accounting policies

The Trust took on the provision of community healthcare and associated healthcare services for Warwickshire (then known as "Warwickshire Community Services") on 1 April 2011.

1.3.2 Key sources of estimation uncertainty 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:

Provisions include an estimate of future liabilities based on information available when the accounts are approved (see note 29). Provision is made for the impairment of receivables based on the information available when the accounts are approved (see note 21.3). Income includes an estimate of the value of partially complete spells of patient activity at 31 March 2015 and estimates for activity data for overperformance. The annual leave accrual is calculated on annual leave balances as at the time of the production of the accounts.

Page 6 South Warwickshire NHS Foundation Trust - Annual Accounts 1 April 2014 to 31 March 2015

Notes to the Accounts - 1. Accounting Policies (Continued)

Our accounting policies for property, plant and equipment are described in section 1.7. Land and buildings are held at a valuation, which inevitably creates estimation uncertainty. However, the bases of valuation used are consistent with current accounting standards and sector best practice and involve the appropriate use of experts. The bases of valuation are set out in more detail in notes 1.7 and 16.

1.4 Income 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. The main source of income for the Trust is through contracts with 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.

Income relating to patient care spells that are part-completed at the year end are apportioned across the financial years on the basis of length of stay at the Statement of Financial Position date compared to expected total length of stay. 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.

Interest income is accrued on a time basis, by reference to the principal outstanding and interest rate applicable.

1.5 Employee Benefits 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. Retirement benefit costs Past and present employees are covered by the provisions of the NHS Pensions Scheme. The Scheme is an unfunded, defined benefit scheme that covers NHS employers, General Practices and other bodies, allowed under the direction of the Secretary of State, in England and Wales. It is not possible for the NHS Foundation Trust to identify its share of the underlying scheme liabilities. Therefore, the scheme is accounted for as a defined contribution scheme. Employer's pension cost contributions are charged to operating expenses as and when they become due.

Additional pension liabilities arising from early retirements are not funded by the scheme except where the retirement is due to ill-health. The full amount of the liability for the additional costs is charged to the operating expenses at the time the Trust commits itself to the retirement, regardless of the method of payment. The Trust has no employees that are members of other pension schemes in relation to their employment at the Trust.

1.6 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.

Page 7 South Warwickshire NHS Foundation Trust - Annual Accounts 1 April 2014 to 31 March 2015

Notes to the Accounts - 1. Accounting Policies (Continued)

1.7 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 • it individually has a cost of at least £5,000; or

• it collectively has a cost of at least £5,000 and individually has a cost of more than £250, where the assets are functionally interdependent, the individual items had broadly simultaneous purchase dates, are anticipated to have simultaneous disposal dates and are under single managerial control; or • it forms part of the initial equipping and setting-up cost of a new building, ward or unit irrespective of their individual or collective cost. Expenditure on IT equipment such as desktop or laptop computers and associated peripherals is not capitalised and is instead charged as revenue expenditure as it is incurred, as these assets have a value below £5,000 individually and are not considered to be functionally interdependent or under single managerial control. 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 an item will flow to the Trust and 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 recognised above. The carrying amount of the part replaced is derecognised. 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.

Valuation All property, plant and equipment are measured initially at cost, representing the cost 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 fair value.

Land and buildings used for the Trust’s services or for administrative purposes are stated in the Statement of Financial Position at their revalued amounts, being the fair value at the date of revaluation less any subsequent accumulated depreciation and impairment losses. Revaluations are performed with sufficient regularity to ensure that carrying amounts are not materially different from those that would be determined at the Statement of Financial Position date. Fair values are

Land and non specialised buildings – market value for existing use Specialised buildings – depreciated replacement cost

Properties in the course of construction for service or administration purposes are carried at cost, less any impairment loss. Cost includes professional fees but not borrowing costs, which are recognised as expenses immediately, as allowed by IAS 23 for assets held at fair value. Assets are revalued and depreciation commences when they are brought into use.

Plant and Machinery, Transport equipment, Information Technology and Fixtures and Fittings are held at depreciated historic costs as this is not considered to be materially different from fair value. 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".

Page 8 South Warwickshire NHS Foundation Trust - Annual Accounts 1 April 2014 to 31 March 2015

Notes to the Accounts - 1. Accounting Policies (Continued)

Component Accounting - Buildings

The Trust applies component accounting to buildings as follows. Buildings are held on the fixed asset register in components with separate asset values for Structure, Engineering, External Works (where appropriate) and Fixtures and Fittings. The values and asset lives for each of these components are derived from the latest valuation of the estate and from subsequent enhancement expenditure, depreciation or impairment. Each of these components is divided in the valuer's calculations into a number of lower-value components. Our valuers values the appropriate lower-value components and calculate the asset lives of Structure, Engineering, External Works and Fixtures and fittings based on the weighted average of asset lives of the appropriate lower-value components. The Trust does not record and account for these lower-level components separately as there will be no material difference between the capital accounting entries derived from component accounting at this more detailed level and component accounting at the level of Structure, Engineering, External Works and Fixtures and Fittings.

1.8 Intangible assets

Recognition Intangible assets are non-monetary assets without physical substance, which are capable of sale separately from the rest of the Trust’s business or which arise from contractual or other legal rights. They are recognised only when it is probable that future economic benefits will flow to, or service potential be provided to, the Trust; where the cost of the asset can be measured reliably, and where the cost is at least £5,000.

Intangible assets acquired separately are initially recognised at fair value. Software that is integral to the operating of hardware, for example an operating system, is capitalised as part of the relevant item of property, plant and equipment. Software that is not integral to the operation of hardware, for example application software, is capitalised as an intangible asset. Expenditure on research is not capitalised: it is recognised as an operating expense in the period in which it is incurred. Internally-generated assets are recognised if, and only if, all of the following have been demonstrated: ● the technical feasibility of completing the intangible asset so that it will be available for use; ● the intention to complete the intangible asset and use it; ● the ability to sell or use the intangible asset; ● how the intangible asset will generate probable future economic benefits or service potential; ● the availability of adequate technical, financial and other resources to complete the intangible asset and use it; and ● the ability to measure reliably the expenditure attributable to the intangible asset during its development.

Measurement The amount initially recognised for internally-generated intangible assets is the sum of the expenditure incurred from the date when the criteria above are initially met. Where no internally-generated intangible asset can be recognised, the expenditure is charged to the Statement of Comprehensive Income in the period in which it is incurred.

Following initial recognition, intangible assets are carried at fair value by reference to an active market, or, where no active market exists, at amortised replacement cost (modern equivalent assets basis). In preparing these accounts, we have continued to hold all intangible assets at amortised cost as this is not considered to be materially different from fair value. Internally-developed software is held at historic cost to reflect the opposite effects of development costs and technological advances.

1.9 Depreciation and impairments

Freehold land and properties under construction are not depreciated. Assets in the course of construction are not depreciated until the asset is available for use.

Page 9 South Warwickshire NHS Foundation Trust - Annual Accounts 1 April 2014 to 31 March 2015

Notes to the Accounts - 1. Accounting Policies (Continued)

Otherwise, depreciation and amortisation are charged on a straight line basis to write off the costs or valuation of tangible and intangible non-current assets, less any residual value, over their estimated useful lives. The estimated useful economic life of an asset is the period over which the Trust expects to obtain economic benefits or service potential from the asset. This is specific to the Trust and may be shorter than the physical life of the asset itself. The estimated useful lives and residual values are reviewed each year end, with the effect of any changes recognised on a prospective basis. Assets held under finance leases are depreciated over their estimated useful lives or, where shorter, the lease term.

At each Statement of Financial Position date, the Trust checks whether there is any indication that any of its tangible or intangible non-current assets have suffered an impairment loss. If there is indication of an impairment loss, the recoverable amount of the asset is estimated to determine whether there has been a loss and, if so, its amount. Intangible assets not yet available for use are tested for impairment annually.

In accordance with the FT ARM, impairments that are due to a loss of economic benefits or 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 arising from a loss of economic benefit or 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 revalution 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.

1.10 Borrowing costs Borrowing costs are recognised as expenses as they are incurred.

1.11 Donated non-current assets Donated property, plant and equipment assets are capitalised at their fair value on receipt. The donation is credited to income at the same time, unless the donor has imposed a condition that the future economic benefits embodied in the donation are to be consumed in a manner specified by the donor, in which case the donation 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.

1.12 Government grants

Government grants are grants from Government bodies other than income from Clinical Commissioning Groups (CCGs) or NHS Trusts for the provision of services. Grants from the Department of Health are accounted for as Government grants as are grants from the Big Lottery Fund. These are accounted for in the same manner as Donated Non Current Assets - as per note 1.11 above.

Page 10 South Warwickshire NHS Foundation Trust - Annual Accounts 1 April 2014 to 31 March 2015

Notes to the Accounts - 1. Accounting Policies (Continued)

1.13 Non-current assets held for sale Non-current assets are classified as held for sale if their carrying amount will be recovered principally through a sale transaction rather than through continuing use. This condition is regarded as met when the sale is highly probable, the asset is available for immediate sale in its present condition and management is committed to the sale, which is expected to qualify for recognition as a completed sale within one year from the date of classification. Non-current assets held for sale are measured at the lower of their previous carrying amount and fair value less costs to sell. Fair value is open market value including alternative uses.

The profit or loss arising on disposal of an asset is the difference between the sale proceeds and the carrying amount and is recognised in the Statement of Comprehensive Income. On disposal, the balance for the asset on the revaluation reserve, donated asset reserve or government grant reserve is transferred to retained earnings. For donated and government-granted assets, a transfer is made to or from the relevant reserve to the profit/loss on disposal account so that no profit or loss is recognised in income or expenses. The remaining surplus or deficit in the donated asset or government grant reserve is then transferred to related earnings.

Property, plant or equipment that is to be scrapped or demolished does not qualify for recognition as held for sale. Instead, it is retained as an operational asset and its economic life is adjusted. The asset is de-recognised when it is scrapped or demolished.

1.14 Leases Leases are classified as finance leases when substantially all the risks and rewards of ownership are transferred to the lessee. All other leases are classified as operating leases.

1.14.1 The Trust as lessee

Property, plant and equipment held under finance leases is initially recognised, at the inception of the lease, at fair value or, if lower, at the present value of the minimum lease payments, with a matching liability for the lease obligation to the lessor. Lease payments are apportioned between finance charges and reduction of the lease obligation so as to achieve a constant rate on interest on the remaining balance of the liability. Finance charges are recognised in calculating the Trust’s surplus / deficit.

The asset and liability are recognised at the inception of the lease, and are de-recognised when the liability is discharged, cancelled or expires.

Operating lease payments are recognised as an expense on a straight-line basis over the lease term. Lease incentives are recognised initially as a liability and subsequently as a reduction of rentals on a straight-line basis over the lease term.

Contingent rentals are recognised as an expense in the period in which they are incurred.

Where a lease is for land and buildings, the land and buildings components are separated. Leased land is considered separately and not automatically treated as an operating lease. Leased buildings are assessed as to whether they are operating or finance leases.

1.14.2 The Trust as lessor Amounts due from lessees under finance leases are recorded as receivables at the amount of the Trust’s net investment in the leases. Finance lease income is allocated to accounting periods so as to reflect a constant periodic rate of return on the Trust’s net investment outstanding in respect of the leases.

Rental income from operating leases is recognised on a straight-line basis over the term of the lease. Initial direct costs incurred in negotiating and arranging an operating lease are added to the carrying amount of the leased asset and recognised on a straight-line basis over the lease term.

Page 11 South Warwickshire NHS Foundation Trust - Annual Accounts 1 April 2013 to 31 March 2014

Notes to the Accounts - 1. Accounting Policies (Continued)

1.15 Inventories Inventories are valued at the lower of cost and net realisable value using the 'first in, first out' (FIFO) cost formula. This is considered to be a reasonable approximation to fair value due to the high turnover of stocks.

1.16 Cash and cash equivalents Cash is cash in hand and deposits with any financial institution repayable without penalty on notice of not more than 24 hours. Cash equivalents are investments that mature in 3 months or less from the date of acquisition and that are readily convertible to known amounts of cash with insignificant risk of change in value.

1.17 Provisions

Provisions are recognised when the Trust has a present legal or constructive obligation as a result of a past event, it is probable that the Trust will be required to settle the obligation, and a reliable estimate can be made of the amount of the obligation. The amount recognised as a provision is the best estimate of the expenditure required to settle the obligation at the Statement of Financial Position date, taking into account the risks and uncertainties. Where the effect of the time value of money is significant, the estimated risk- adjusted cash flows are discounted using the discount rates published and mandated by HM Treasury.

When some or all of the economic benefits required to settle a provision are expected to be recovered from a third party, the receivable is recognised as an asset if it is virtually certain that reimbursements will be received and the amount of the receivable can be measured reliably.

Present obligations arising under onerous contracts are recognised and measured as a provision. An onerous contract is considered to exist where the Trust has a contract under which the unavoidable costs of meeting the obligations under the contract exceed the economic benefits expected to be received under it.

A restructuring provision is recognised when the Trust has developed a detailed formal plan for the restructuring and has raised a valid expectation in those affected that it will carry out the restructuring by starting to implement the plan or announcing its main features to those affected by it. The measurement of a restructuring provision includes only the direct expenditures arising from the restructuring, which are those amounts that are both necessarily entailed by the restructuring and not associated with ongoing activities of the entity.

1.18 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. The contribution is charged to the Statement of Comprehensive Income. 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 Trust is disclosed at note 29 but is not recognised in the NHS Foundation Trust's accounts.

1.19 Non-clinical risk pooling The NHS Foundation 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 as and when the liability arises.

Page 12 South Warwickshire NHS Foundation Trust - Annual Accounts 1 April 2014 to 31 March 2015

Notes to the Accounts - 1. Accounting Policies (Continued)

1.20 EU Emissions Trading Scheme EU Emission Trading Scheme allowances are accounted for as Government grant funded current financial assets, valued at open market value. The Trust does not have any of these allowances.

1.21 Contingencies A contingent liability is a possible obligation that arises from past events and whose existence will be confirmed only by the occurrence or non-occurrence of one or more future events not wholly within the control of the Trust, or a present obligation that is not recognised because it is not probable that a payment will be required to settle the obligation or the amount of the obligation cannot be measured sufficiently reliably. A contingent liability is not recognised, but is disclosed unless the possibility of a payment is remote.

A contingent asset is a possible asset that arises from past events and whose existence will be confirmed by the occurrence or non-occurrence of one or more uncertain future events not wholly within the control of the Trust. A contingent asset is disclosed where an inflow of economic benefits is probable.

Where the time value of money is material, contingencies are disclosed at their present value.

1.22 Financial assets Financial assets are recognised on the Statement of Financial Position when the Trust becomes party to the financial instrument contract or, in the case of trade receivables, when the goods or services have been delivered. Financial assets are derecognised when the contractual rights have expired or the asset has been transferred.

Financial assets are initially recognised at fair value.

Financial assets are classified into the following categories: financial assets ‘at fair value through profit and loss’; ‘held to maturity investments’; ‘available for sale’ financial assets, and ‘loans and receivables’. The classification depends on the nature and purpose of the financial assets and is determined at the time of initial recognition.

Fair value is determined by reference to quoted market prices where possible, otherwise by valuation techniques. The Trust has no financial assets held at a valuation, as the cost represents fair value.

The effective interest rate is the rate that exactly discounts estimated future cash receipts through the expected life of the financial asset, to the net carrying amount of the financial asset.

At the Statement of Financial Position date, the Trust assesses whether any financial assets other than those held at ‘fair value through profit and loss’ are impaired. Financial assets are impaired and impairment losses 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 have an impact on the estimated future cash flows of the asset.

For financial assets carried at amortised cost, the amount of the impairment loss is measured as the difference between the asset’s carrying amount and the present value of the revised future cash flows discounted at the asset’s original effective interest rate. The loss is recognised in the Statement of Comprehensive Income and the carrying amount of the asset is reduced directly, or through a provision for impairment of receivables.

Page 13 South Warwickshire NHS Foundation Trust - Annual Accounts 1 April 2014 to 31 March 2015

Notes to the Accounts - 1. Accounting Policies (Continued)

If, in a subsequent period, the amount of the impairment loss decreases and the decrease can be related objectively to an event occurring after the impairment was recognised, the previously recognised impairment loss is reversed through the Statement of Comprehensive Income to the extent that the carrying amount of the receivable at the date of the impairment is reversed does not exceed what the amortised cost would have been had the impairment not been recognised.

1.23 Financial liabilities Financial liabilities are recognised on the Statement of Financial Position when the Trust becomes party to the contractual provisions of the financial instrument or, in the case of trade payables, when the goods or services have been received. Financial liabilities are de-recognised when the liability has been discharged, that is, the liability has been paid or has expired.

Financial liabilities are initially recognised at fair value.

Financial liabilities are classified as either financial liabilities ‘at fair value through profit and loss’ or other financial liabilities.

After initial recognition, financial liabilities are measured at amortised cost using the effective interest method. The effective interest rate is the rate that exactly discounts estimated future cash payments through the life of the asset, to the net carrying amount of the financial liability. Interest is recognised using the effective interest method.

1.24 Value Added Tax Most of the activities of the NHS Foundation 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 Fixed Assets. Where output tax is charged or input VAT is recoverable, the amounts are stated net of VAT.

1.25 Foreign currencies

Transactions 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. At the Statement of Financial Position date, monetary items denominated in foreign currencies are retranslated at the rates prevailing at the Statement of Financial Position date. These are taken to the Statement of Comprehensive Income.

1.26 Third party assets Assets belonging to third parties (such as money held on behalf of patients) are not recognised in the accounts since the Trust has no beneficial interest in them. However, they are disclosed in Note 35 to the accounts in accordance with the requirements of HM Treasury's FReM.

1.27 Public Dividend Capital (PDC) and PDC dividend 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 forecast cost of capital utilised by the NHS Foundation Trust, is payable as PDC 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, (ii) average daily cash balances 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 of the audit of the annual accounts.

Page 14 South Warwickshire NHS Foundation Trust - Annual Accounts 1 April 2014 to 31 March 2015

Notes to the Accounts - 1. Accounting Policies (Continued)

1.28 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 each individual case is handled. Losses and special payments are charged to the relevant functional heading in expenditure on an accruals basis, including losses which would have been made good through insurance cover had NHS Trusts not been bearing their own risks (with insurance premiums then being included as normal revenue expenditure).

However the losses and special payments (note 36) are compiled directly from the losses and compensations register which reports on an accrual basis with the exception of provisions for future losses.

1.29 Subsidiaries The Trust has a wholly owned subsidiary, named SWFT Clinical Services Ltd., incorporated in the United Kingdom. This company, which began trading on 3 May 2011, provides outpatient pharmacy services and chemotherapy drugs to NHS patients from Warwick Hospital and, training to NHS and other healthcare related organisations, and commencing during 2014/15, the operation of a private treatment centre at Stratford and the continence service. The accounts of this company can be obtained from the Trust. The Trust's investment in this company is £250,000 of share capital. The Trust will account for any dividends receivable from this subsidiary as income in the year in which they are declared. As at 31 March 2015, the net assets of SWFT Clinical Services Ltd were £333,000 (31 March 2014 £322,000) and profit is £11,000 (31 March 2014 £4,000) as shown in note 39.1.

The Trust is the corporate trustee to South Warwickshire NHS Charitable Fund. 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 beneftis through its power over the fund. (Note 39.2)

Neither the Company nor the Charitable Fund are material to the Trust's accounts, and therefore have not been consolidated in the Trust's financial statements.

1.30 Associates

Associate entities are those over which the Trust has the power to exercise significant influence. Associate entities are recognised in the Trust’s financial statements using the equity method. The investment is initially recognised at cost. It is increased or decreased subsequently to reflect the Trust’s share of the entity’s profit/loss or other gains/losses following acquisition. It is also reduced when any distribution e.g. share dividends are received by the Trust from the associate. Associates which are classified as “held for sale” are measured at the lower of their carrying amount of fair value less costs to sell.

1.31 Joint operations Joint operations are activities which are carried on with one or more other parties but which are not performed through a separate entity. The Trust includes within its financial statements its share of the activities, assets and liabilities.

Joint operations are activities undertaken by the Trust in conjunction with one or more other parties but which are not performed through a separate entity. The Trust records its share of the income and expenditure, gains and losses, assets and liabilities and cash flows.

1.32 Transfer of assets relating to rehabilitation and community services

The ownership of the land and buildings at Royal Leamington Spa Rehabilitation Hospital and Ellen Badger Hospital, Shipston, transferred to the Trust on 1 April 2013. This transfer, which was accounted for under Modified Absorption Accounting, relates to rehabilitation and community services which transferred to the Trust on 1 April 2011. The land and buildings transferred had a net book value of approximately £16 million. This includes the value of enhancements made in 2012/13 at the point of transfer.

Page 15 South Warwickshire NHS Foundation Trust - Annual Accounts 1 April 2013 to 31 March 2014

Notes to the Accounts - 1. Accounting Policies (Continued)

1.33 Corporation Tax

The current nature of the Trust's business does not give rise to a Corporation Tax liability.

1.34 Going Concern

The Trust maintains both a 5-year plan and a detailed annual business plan. After making enquiries that includes examining the period of at least one year from the date of the approval of the accounts, the Directors have a reasonable expectation that the 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 these accounts.

1.35 Standards and interpretations in issue not yet adopted

The following accounting standards, amendments and interpretations have been issued by the IASB and IFRIC but are not yet required to be adopted by the European Union (EU):

Change Published Published Financial year for which the by IASB change first applies

IFRS 9 Financial Instruments: Financial Assets Jul-2014 Not yet EU adopted. Expected Financial Liabilities to be effective from 2018/19 Effective from 2015/16 but not Annual Improvements 2012 Dec-2013 yet EU adopted Effective from 2015/16 but not Annual Improvements 2013 Dec-2013 yet EU adopted EU adopted in June 2014 but not yet adopted by HM IFRIC 21 Levies May-2013 Treasury Adoption delayed by HM Treasury. To be adopted from IFRS 13 Fair Value Measurement May-2011 2015/16

Not yet EU adopted. Expected IFRS 15 Revenue from contracts with customers May-2014 to be effective from 2018/19 IAS 19 (amendment) - employer contributions to defined benefit Effective from 2015/16 but not pension schemes Nov-2013 yet EU adopted IAS 36 (amendment) - recoverable amount disclosures Financial To be adopted from 2015/16 Statements: amendment "offsetting financial assets and liabilities" May-2013 (aligned to IFRS 13 adoption)

The above accounting standards are not expected to have a material impact on the Trust's financial statements.

Page 16 South Warwickshire NHS Foundation Trust - Annual Accounts 1 April 2014 to 31 March 2015

Notes to the Accounts

2. Operating segments

The Trust has just one operating segment, namely Healthcare Provision.

The "Chief Operating Decision Maker" is deemed to be the Trust's Board of Directors. The Board currently receives only high level financial reporting information and does not therefore review information or allocate resources in any way that could be perceived to represent operating segments. This will be reviewed during the course of 2015/16 dependent upon the information received by the Chief Operating Decision Maker.

Healthcare Healthcare Provision Provision

2015 2014 £000 £000

Income 237,642 226,834

Surplus

Common costs 237,503 224,725 Surplus before interest 139 2,109

Net Assets: Segment net assets 99,438 101,093

3. Income generation activities

The Trust undertakes income generation activities with an aim of achieving a surplus, which is then used in patient care. There were no income generation activities whose full cost exceeded £1m.

Page 17 South Warwickshire NHS Foundation Trust - Annual Accounts 1 April 2014 to 31 March 2015

Notes to the Accounts

4. Revenue

Revenue is almost totally from the supply of services. Revenue from the sale of goods is immaterial.

2015 2014 £000 £000 Income from Activities 217,728 208,068 Other Operating Income 19,914 18,766 237,642 226,834

5. Revenue from Patient Care Activities

5.1 Income from Activities by Source 2015 2014 £000 £000 Commissioner Requested Services NHS Foundation Trusts 48 0 NHS Trusts 124 151 CCG's and NHS England 211,234 202,151 Local Authorities 5,436 5,106 Non Commissioner Requested Services NHS Other 0 0 Non NHS: Private patients 112 86 Non-NHS: Overseas patients (non-reciprocal) 54 53 NHS injury cost recovery scheme (was RTA) 709 377 Non NHS: Other 11 144 217,728 208,068

Injury cost recovery income is subject to a provision for doubtful debts of 18.9% (2013/14 15.8%) to reflect expected rates of collection. In addition the Trust has chosen to provide 100% for all receivables older than 31 March 2011 (2013/14, 31 March 2010).

The Trust's Terms of Authorisation set out the mandatory goods and services that the Trust is required to provide. For the twelve month period to 31 March 2015 the income from activities is split as follows:

2015 2014 £000 £000 Income relating to mandatory services 216,842 207,408 Income from non mandatory services 886 660 217,728 208,068

6. Other Operating Revenue

2015 2014 £000 £000

Research and development 121 214 Education and training 9,733 9,606 Charitable and other contributions to expenditure 104 0 Non Cash Donations (physical assets) from NHS Charity 80 0 Cash Donations (purchase of capital assets) from NHS Charity 37 0 Non-patient care services to other bodies 4,532 3,243 Other Revenue 5,307 5,703 19,914 18,766

The other revenue total above £5,307,000 (2013/14 £5,703,000) consists of staff and patient car parking income £1,307,502 (2013/14 £1,167,614), recharges for IT shared services £221,757 (2013/14 £827,211), Speech and Language Therapy Income £436,684 (2013/14 £467,238), accommodation rentals £173,435 (2013/14 £173,361), South Warwickshire Lorenzo Incentive Fund income £325,000 (2013/14 £200,000) and other smaller items.

Page 18 South Warwickshire NHS Foundation Trust - Annual Accounts 1 April 2014 to 31 March 2015

Notes to the Accounts

Note 6. Other Operating Revenue (continued)

The Trust's Terms of Authorisation set out the education and training that the Trust is required to provide. For the twelve month period to 31 March 2015 the income from activities is split as follows:

2015 2014 £000 £000 Income relating to mandatory education and training 8,888 8,961 Income from non mandatory education and training 845 645 9,733 9,606

7. Private Patient Income

Note Deleted.

8. Operating Expenses 2015 2014 £000 £000

Services from NHS Foundation Trusts 267 443 Services from NHS Trusts 4,293 4,198 Services from all other NHS Bodies 234 300 Purchase of healthcare from non NHS bodies 994 873 Employee Expenses - Executive directors 1,121 1,236 Employee Expenses - Non-Executive directors 108 101 Employee Expenses - Staff 155,385 147,148 Drug costs 21,658 19,168 Supplies and services - clinical (excluding drug costs) 20,492 19,065 Supplies and services - general 6,511 6,551 Establishment 1,845 3,785 Transport 1,916 791 Premises 8,495 7,339 Increase in bad debt provision 411 1,023 Depreciation on property, plant and equipment 3,832 3,713 Amortisation on intangible assets 459 236 Impairments of property, plant and equipment 0 0 Impairments of intangible assets 0 0 Audit fees audit services- statutory audit 61 62 audit services -regulatory reporting 0 0 Other auditors remuneration other services 0 23 Clinical negligence 3,014 3,112 Loss on disposal of other property, plant and equipment 0 0 Legal fees 95 199 Consultancy costs 418 1,029 Training, courses and conferences 1,006 786 Car Parking and Security 622 310 Patient Travel 15 21 Hospitality 63 54 Insurance 66 65 Other services, eg external payroll 201 152 Other 1,094 958 234,676 222,741

The Trust's contract with its external auditors, Deloitte LLP, provides for a limitation of the auditors liability of one million (£1,000,000) pounds sterling.

Page 19 South Warwickshire NHS Foundation Trust - Annual Accounts 1 April 2014 to 31 March 2015

Notes to the Accounts

9. Operating leases

9.1 As lessee Payments recognised as an expense 2015 2014 £000 £000

Minimum lease payments 0 0 Contingent rents 0 0 Sub-lease payments 0 0 0 0

Total future minimum lease payments 2015 2014 £000 £000

Payable: Not later than one year 0 0 Between one and five years 0 0 After 5 years 0 0 Total 0 0

9.2 As lessor Rental Revenue 2015 2014 £000 £000

Rents recognised as income in the period 66 51 Total rental revenue 66 51

Total future minimum lease payments 2015 2014 £000 £000 Receivable: Not later than one year 65 52 Between one and five years 202 30 Total 267 82

Page 20 South Warwickshire NHS Foundation Trust - Annual Accounts 1 April 2014 to 31 March 2015

Notes to the Accounts

10. Employee costs and numbers

10.1 Employee costs 2015 2014

Total Permanently Other Total Permanently Other Employed Employed

£000 £000 £000 £000 £000 £000

Salaries and wages 125,940 114,867 11,073 113,901 113,901 0 Social Security Costs 8,158 8,158 0 8,504 8,504 0 Employer contributions to NHS Pension scheme 14,537 14,537 0 14,244 14,244 0 Other pension costs 0 0 0 0 0 0 Termination benefits 0 0 0 0 0 0 Agency/Contract Staff 7,871 0 7,871 11,735 0 11,735 Employee benefits expense 156,506 137,562 18,944 148,384 136,649 11,735

10.2 Average number of people employed 2015 2014 Total Permanently Other Total Permanently Other Employed Employed Number Number Number Number Number Number

Medical and dental 296 296 0 294 294 0 Administration and estates 724 724 0 693 693 0 Healthcare assistants and other support staff 676 676 0 699 699 0 Nursing, midwifery and health visiting staff 1,198 1,198 0 1,187 1,187 0 Nursing, midwifery and health visiting learners 44 44 0 54 54 0 Scientific, therapeutic and technical staff 503 503 0 480 480 0 Bank and agency staff 483 0 483 315 0 315 Other 10 10 0 8 8 0 Total 3,934 3,451 483 3,730 3,415 315

Page 21 South Warwickshire NHS Foundation Trust - Annual Accounts 1 April 2014 to 31 March 2015

Notes to the Accounts

10.3 Pension costs

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

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

a) Accounting valuation

A valuation of the scheme liability is carried out annually by the scheme actuary as at the end of the reporting period. Actuarial assessments are undertaken in intervening years between formal valuations using updated membership data and are accepted as providing suitably robust figures for financial reporting purposes. The valuation of the scheme liability as at 31 March 2015, is based on the valuation data as 31 March 2014, updated to 31 March 2015 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.

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, published annually. These accounts can be viewed on the NHS Pensions website. 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 scheme (taking into account its recent demographic experience), and to recommend the contribution rates.

The last published actuarial valuation undertaken for the NHS Pension Scheme was completed for the year ended 31 March 2012.

The Scheme Regulations allow contribution rates to be set 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) will be used to replace 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.

Page 22 South Warwickshire NHS Foundation Trust - Annual Accounts 1 April 2014 to 31 March 2015

Notes to the Accounts

11. Retirements due to ill-health

During the full financial year 2014/15 there were Nil (2013/14, 2) early retirements from the NHS Foundation Trust agreed on the grounds of ill-health. The estimated additional pension liabilities of these ill-health retirements will be £Nil (2013/14: £71,616). The cost of these ill-health retirements will be borne by the NHS Business Services Authority - Pensions Division.

12. Better Payment Practice Code

12.1 Better Payment Practice Code - measure of compliance

2015 2014 Number £000 Number £000

Total Non-NHS trade invoices paid in the year 52,647 85,836 48,872 72,365 Total Non-NHS trade invoices paid within target 43,751 70,657 42,666 60,152 Percentage of Non-NHS trade invoices paid within target 83% 82% 87% 83%

Total NHS trade invoices paid in the year 1,090 19,404 895 16,873 Total NHS trade invoices paid within target 847 16,774 720 11,352 Percentage of NHS trade invoices paid within target 78% 86% 80% 67%

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

12.2 The Late Payment of Commercial Debts (Interest) Act 1998 2015 2014 £000 £000

Amounts included in finance costs from claims made under this legislation 0 0 Compensation paid to cover debt recovery costs under this legislation 0 0 Total 0 0

There were no late payments of commercial debts for 2014/15 (2013/14 £Nil).

Page 23 South Warwickshire NHS Foundation Trust - Annual Accounts 1 April 2014 to 31 March 2015

Notes to the Accounts

13. Finance Income 2015 2014 £000 £000

Interest on Bank Accounts 60 56 Other 0 0 Total 60 56

14. Other gains and losses 2015 2014 £000 £000

(Loss) on disposal of property, plant and equipment 0 0 Total 0 0

15. Finance Costs - Interest Expense 2015 2014 £000 £000

Loans from Independent Trust Financing Facility 51 0 Commercial loans 0 0 Overdrafts 0 0 Finance leases 0 0

51 0

Page 24 South Warwickshire NHS Foundation Trust - Annual Accounts 1 April 2014 to 31 March 2015

Notes to the Accounts

16. Property, plant and equipment Land Buildings Dwellings Assets under Plant and Transport Information Furniture & Total excluding construction machinery equipment technology fittings dwellings and POA

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

Cost or valuation at 1 April 2014 17,874 77,903 1,681 1,857 17,846 0 3,287 954 121,402 Transfer by Absorption 0 87 0 0 0 0 0 0 87 Additions - purchased 0 939 0 7,253 1,638 0 0 (29) 9,801 Additions - donated 0 0 0 0 80 0 0 0 80 Impairments charged to revaluation reserve 0 0 0 0 0 0 0 0 0 Reclassifications 0 2,363 0 (2,363) 0 0 0 0 0 Revaluation / indexation gains 510 (8,345) 109 0 0 0 0 (402) (8,128) Disposals 0 0 0 0 (256) 0 0 0 (256) At 31 March 2015 18,384 72,947 1,790 6,747 19,308 0 3,287 523 122,986

Depreciation at 1 April 2014 0 3,769 49 (21) 11,854 0 3,029 229 18,909 Reclassifications 0 0 0 0 0 0 0 0 0 Disposals 0 0 0 0 (244) 0 0 0 (244) Revaluation/indexation gains 0 (6,067) 0 0 0 0 0 0 (6,067) Impairments 0 0 0 0 0 0 0 0 0 Reversal of Impairments 0 0 0 0 0 0 0 0 0 Charged during the year 0 2,298 50 0 1,229 0 122 133 3,832 Depreciation at 31 March 2015 0 0 99 (21) 12,839 0 3,151 362 16,430

Purchased/Donated Classification Purchased 18,336 71,134 1,524 6,768 5,827 0 124 161 103,874 Donated 48 1,813 167 0 642 0 12 0 2,682 NBV Total at 31 March 2015 18,384 72,947 1,691 6,768 6,469 0 136 161 106,556

Asset financing Classification Owned 18,384 72,947 1,691 6,768 6,469 0 136 161 106,556 Finance Leased 0 0 0 0 0 0 0 0 0 NBV Total 31 March 2015 18,384 72,947 1,691 6,768 6,469 0 136 161 106,556

Page 25 South Warwickshire NHS Foundation Trust - Annual Accounts 1 April 2014 to 31 March 2015

Notes to the Accounts

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

Opening balance at 1 April 2013 10,744 56,064 1,626 474 16,918 0 3,270 335 89,431 Transfer by Absorption 6,725 11,537 0 0 737 1 16 235 19,251 Additions - purchased 0 3,714 0 3,498 970 0 (29) 0 8,153 Additions - donated 0 13 0 0 274 0 0 24 311 Impairments charged to revaluation reserve 0 0 0 0 0 0 0 0 0 Reclassifications 0 1,517 0 (2,109) 186 (1) 30 360 (17) Revaluation / indexation gains 405 5,058 55 0 0 0 0 0 5,518 Disposals 0 0 0 (6) (1,239) 0 0 0 (1,245) Cost or valuation at 31 March 2014 17,874 77,903 1,681 1,857 17,846 0 3,287 954 121,402

Accumulated depreciation at 1 April 2013 0 1,686 0 (16) 11,717 0 2,895 121 16,403 Reclassifications 0 (49) 0 (5) 43 0 4 7 0 Disposals 0 0 0 0 (1,207) 0 0 0 (1,207) Revaluation/indexation gains 0 0 0 0 0 0 0 0 0 Impairments 0 0 0 0 0 0 0 0 0 Reversal of Impairments 0 0 0 0 0 0 0 0 0 Charged during the year 0 2,132 49 0 1,301 0 130 101 3,713 Accumulated depreciation at 31 March 2014 0 3,769 49 (21) 11,854 0 3,029 229 18,909

Purchased/Donated Classification Purchased 17,874 70,522 1,473 1,878 5,992 0 258 725 98,722 Donated 0 3,612 159 0 0 0 0 0 3,771 NBV total at 31 March 2014 17,874 74,134 1,632 1,878 5,992 0 258 725 102,493

Asset financing Classification Owned 17,874 74,134 1,632 1,878 5,992 0 258 725 102,493 Finance Leased 0 0 0 0 0 0 0 0 0 Total 31 March 2014 17,874 74,134 1,632 1,878 5,992 0 258 725 102,493

Page 26 South Warwickshire NHS Foundation Trust - Annual Accounts 1 April 2014 to 31 March 2015

Notes to the Accounts

16. Property, plant and equipment (continued)

During the current and prior year assets were donated by the Trust’s League of Friends and South Warwickshire NHS Foundation Trust Charitable Funds.

The estimated lives of the fixed assets are as follows: Buildings excluding Dwellings From 5 years (minimum life of fixtures and fittings) to 106 years (maximum life of substructure) Dwellings 21 to 52 years Plant and Machinery 1 to 34 years Information Technology 4 to 10 years Furniture and Fittings 3 to 15 years

We have obtained Modern Equivalent Asset valuations for all of our land and buildings as at 31 March 2015, and these are reflected in these accounts. The values of assets covered by various methods of valuation as at 31 March 2014 and 31 March 2015 are set out in the table below.

Method of valuation Opening balance covered by Closing balance covered by method (£m), 1 April 2014 method (£m), 31 March 2015 Modern Equivalent Asset Valuation 90.7 93.2

We have not obtained open market values for our land and buildings as we have no plans to sell them at present. We are therefore unable to disclose whether the net book value of our assets is significantly different from open market value.

Page 27 South Warwickshire NHS Foundation Trust - Annual Accounts 1 April 2014 to 31 March 2015

Notes to the Accounts

17. Intangible assets Computer Development Total software - expenditure purchased (internally generated) £000 £000 £000 Gross cost at 1 April 2014 3,614 108 3,722 Transfers by absorption - Normal 0 0 0 Additions purchased / internally generated 348 0 348 Additions donated 0 0 0 Reclassifications 0 0 0 Disposals other than by sale 0 0 0 Revaluation/indexation 0 0 0 Impairments 0 0 0 Reversals of impairments 0 0 0 Gross cost at 31 March 2015 3,962 108 4,070

Amortisation at 1 April 2014 888 108 996 Reclassifications 0 0 0 Disposals other than by sale 0 0 0 Revaluation 0 0 0 Impairments 0 0 0 Reversal of impairments 0 0 0 Charged during the year 459 0 459 Amortisation at 31 March 2015 1,347 108 1,455

Net book value Purchased 2,567 0 2,567 Donated 48 0 48 Total at 31 March 2015 2,615 0 2,615

Page 28 South Warwickshire NHS Foundation Trust - Annual Accounts 1 April 2014 to 31 March 2015

Notes to the Accounts

17. Intangible assets

Development Computer expenditure Total Software - (internally Purchased generated) £000 £000 £000

Gross cost at 1 April 2013 2,675 108 2,783 Additions Purchased / Internally Generated 862 0 862 Additions donated 60 0 60 Reclassifications 17 0 17 Disposals other than by sale 0 0 0 Revaluation / Indexation 0 0 0 Impairments 0 0 0 Reversal of impairments 0 0 0 Gross Cost at 31 March 2014 3,614 108 3,722

Amortisation at 1 April 2013 652 108 760 Reclassifications 0 0 0 Disposals other than by sale 0 0 0 Revaluation 0 0 0 Impairments 0 0 0 Reversal of impairments 0 0 0 Charged during the year 236 0 236 Amortisation at 31 March 2014 888 108 996

Net book value Purchased 2,726 0 2,726 Donated 0 0 0 NBV total at 31 March 2014 2,726 0 2,726

Page 29 South Warwickshire NHS Foundation Trust - Annual Accounts 1 April 2014 to 31 March 2015

Notes to the Accounts

17. Intangible assets (continued)

We hold all our intangible assets at amortised historical cost as we consider that there will be no material difference between this value and a current valuation.

Our purchased intangible assets consist mostly of software licences and have estimated useful lives of three to five years. Our internally generated intangible assets are development costs which are considered to have an indefinite useful life. This is because the human resources developments to which they relate have an ongoing benefit to the Trust. Internally generated intangible assets are assessed for impairment on an annual basis.

18. Revaluation and Impairments

18.1 Revaluation reserves movement on land and buildings

2015 2014 £000 £000

Revaluation reserve at 1 April 14,369 8,616 Impairments 0 0 Transfers by Absorption - Modified 2 235 Revaluations (2,061) 5,518 Asset disposals 0 0 Other reserve movement 1,018 0 Revaluation reserve at 31 March 13,328 14,369

During the current and prior year there were no impairments or reversals of previous impairments in relation to Land and Building recognised in the Statement of Comprehensive Income.

18.2 Impairments on other fixed assets recognised in the Statement of Comprehensive Income

Assets £000 Plant and machinery 0 Information technology 0 Development assets 0 Total 0

The Trust reviews its property plant and equipment for indicators of impairment each year. During 2014/15 impairments of £2,061,000 were identified (2013/14, £180,000).

Page 30 South Warwickshire NHS Foundation Trust - Annual Accounts 1 April 2014 to 31 March 2015

Notes to the Accounts

19. Capital commitments Contracted capital commitments as at 31 March not otherwise included in these financial statements: 2015 2014

£000 £000

Property, plant and equipment 20,570 2,186 Intangible assets 0 254 Total 20,570 2,440

20. Inventories

20.1. Inventories 2015 2014

£000 £000

Drugs 1,274 1,013 Consumables 1,557 1,861 Energy 29 27 Total Inventories 2,860 2,901

20.2 Inventories recognised in expenses

There were no write-downs of inventories recognised in expenses (2013/14 Nil).

21. Trade and other receivables

21.1 Trade and other receivables Current Non-current Current Non-current

2015 2015 2014 2014

£000 £000 £000 £000

NHS Receivables 10,431 0 11,781 0 Provision for impaired receivables (1,944) 0 (3,193) 0 Prepayments 1,433 77 1,967 83 Accrued income 773 0 225 0 PDC receivable 32 0 0 0 VAT receivables 415 0 249 0 Other receivables 3,170 424 2,733 498 Total 14,310 501 13,762 581

The great majority of trade is with Clinical Commissioning Groups, as commissioners for NHS patient care services. As Clinical Commissioning Groups are funded by Government to buy NHS patient care services, no credit scoring of them is considered necessary. The majority of trade undertaken with non NHS bodies, is mainly linked to formal written agreements and the Trust routinely provides in part for any debt greater than 30 days.

21.2 Receivables past their due date but not impaired 2015 2014 £000 £000

By up to three months 3,428 512 By three to six months 772 107 By more than six months 1,599 33 Total 5,799 652

Page 31 South Warwickshire NHS Foundation Trust - Annual Accounts 1 April 2014 to 31 March 2015

Notes to the Accounts

21.3 Provision for impairment of receivables 2015 2014 £000 £000

Balance at 1 April 3,193 2,194 Increase in provision 411 1,962 Amounts utilised (1,660) (24) Unused amounts reversed 0 (939) Balance at 31 March 1,944 3,193

This includes £440,000 (2013/14 £440,000) in respect of invoice raised to non NHS customers, and £333,000 (2013/14 £243,000) provision for bad debt relating to the injury cost recovery scheme.

22. Other financial assets

The Trust has nil other financial assets for 2014/15 (2013/14 £nil)

23. Other current assets

The Trust has nil other current assets for 2014/15 (2013/14 £nil)

Page 32 South Warwickshire NHS Foundation Trust - Annual Accounts 1 April 2014 to 31 March 2015

Notes to the Accounts

24. Cash and cash equivalents 2015 2014

£000 £000

Opening Balance 9,126 21,965 Net change in year 751 (12,839) Balance at 31 March 9,877 9,126

Made up of Cash at commercial banks and in hand 152 107 Cash with the Government Banking Service 9,725 9,019 Deposits with the National Loans Fund 0 0 Other current investments 0 0 Cash and cash equivalents as in Statement of Financial Position 9,877 9,126

Cash and cash equivalents as in Statement of Financial Position 9,877 9,126 Bank overdraft 0 0 Cash and cash equivalents as in statement of cash flows 9,877 9,126

25. Trade and other payables Current Non-current Current Non-current 2015 2013 2014 2012 £000 £000 £000 £000

NHS payables 5,920 0 5,201 0 Trade payables - capital 440 0 750 0 Other trade payables 5,176 0 8,565 0 Social Security Costs 1,431 0 1,396 0 Other Taxes Payable 1,788 1,364 Other payables 2,090 0 2,023 0 Accruals 8,907 0 6,806 0 PDC payable 0 0 97 0 Total 25,752 0 26,202 0

Page 33 South Warwickshire NHS Foundation Trust - Annual Accounts 1 April 2014 to 31 March 2015

Notes to the Accounts

26. Borrowings Current Non-current Current Non-current 2015 2015 2014 2014 £000 £000 £000 £000

Bank overdrafts 0 0 0 0 Drawdown in committed facility 0 0 0 0 Loans from Foundation Trust Financing Facility 0 6,404 0 0 Other Loans 96 144 192 240 Obligations under finance leases 0 0 26 0 Total 96 6,548 218 240

27. Other liabilities Current Non-current Current Non-current 2015 2015 2014 2014 £000 £000 £000 £000

Other - deferred income 3,312 0 2,156 0 Total 3,312 0 2,156 0

Page 34 South Warwickshire NHS Foundation Trust - Annual Accounts 1 April 2014 to 31 March 2015

Notes to the Accounts

28. Finance lease obligations

The Trust had one lease agreement for medical equipment remaining with Siemens. This contract was for a fixed period of time, unless extended by written agreement signed by the lessee and the lessor. At any time, the Trust has the option to terminate the contracts with the lessor's prior written consent, but would be required to pay a termination sum equal to all rental due to the lessor from date of termination to the end of the contract, discounted, plus compensation for the residual value in the event of total loss. The contract did not allow the Trust to modify, replace or alter the equipment without the lessor’s consent, to use the goods as security, or to interfere with the lessor’s ownership or other rights.

Termination Sum: All rental due to the lessor (date of termination to the end of the contract) discounted at the discount percentage rate, plus in the event of total loss the Trust shall pay the lessor the amount of residual value discounted from the end of the contract. All annual lease payments are for fixed amounts and hence there are no contingent rents.

Restrictions. The Trust: shall not modify, replace or alter the goods without the lessor's consent; shall not use the goods as security; shall not do anything which interferes with the lessor's ownership of or other rights in the goods; and shall not claim capital allowances for the goods.

This lease has now terminated during 2014/15 and there are no ongoing commitments.

Total future minimum lease payments at the end of 31 March 2015 is £Nil (2013/14 £26,000) and their total present value is £Nil (2013/14 £26,000).

Amounts payable under finance leases: Minimum lease Present value of Minimum lease Present value of payments minimum lease payments minimum lease payments payments 2015 2015 2014 2014 Gross lease liabilities £000 £000 £000 £000 of which liabilities are due: - not later than one year 0 0 26 26 - later than one year and not later than five years 0 0 0 0 - later than five years 0 0 0 0 Finance charges allocated to future periods 0 0 0 0 Net lease liabilities 0 0 26 26

Included in: Current borrowings 0 0 26 26 Non-current borrowings 0 0 0 0 0 0 26 26

Page 35 South Warwickshire NHS Foundation Trust - Annual Accounts 1 April 2014 to 31 March 2015

Notes to the Accounts

29. Provisions Current Non-current Current Non-current 2015 2015 2014 2014 £000 £000 £000 £000

Pensions relating to other staff 155 768 153 911 Other legal claims 174 0 146 0 Other 51 675 50 670 Total 380 1,443 349 1,581

Detailed Information for Period Ended 31 March 2014 Pensions - former Pensions - Other legal directors other staff claims Other Total £000 £000 £000 £000 £000

At 1 April 2014 0 1,064 146 720 1,930 Change in the discount rate 0 0 0 0 0 Arising during the year 0 0 128 0 128 Utilised during the year 0 (155) (21) (51) (227) Reclassified to liabilities held in disposal groups in year 0 0 0 0 0 Reversed unused 0 0 (79) 0 (79) Unwinding of discount 0 14 0 57 71 At 31 March 2015 0 923 174 726 1,823

Expected timing of cash flows: - not later than one year 0 155 174 51 380 - later than one yr and not later than five years 0 620 0 205 825 - later than five years 0 148 0 470 618 Total 0 923 174 726 1,823

Legal claims includes the amount informed by the NHS Litigation Authority with respect to employer's and public liability together with any specific provision made by the Trust for known events.

Other relates to injury benefits which are notified to the Trust by the NHS Pensions Agency.

In addition to the above, the NHS Litigation Authority holds provisions to the value of £770,733 in relation to the Employer's Liability Scheme and £11,506,460 in relation to the Clinical Negligence Sheme for Trusts at 31 March 2015 (£766,601 and £18,425,173 respectively at 31 March 2014).

Page 36 South Warwickshire NHS Foundation Trust - Annual Accounts 1 April 2014 to 31 March 2015

Notes to the Accounts

30. Contingencies

30.1 Contingent liabilities 2015 2014 £000 £000

Gross value of contingent liabilities 49 38 Amounts recoverable against liabilities 0 0 Total 49 38

30.2 Contingent assets

The Trust has no contingent assets in relation to the current or prior year.

31. Financial instruments

31.1 Financial assets At fair value Loans and Total Loans and Total through profit receivables receivables and loss

2015 2015 2014 2014 £000 £000 £000 £000 £000

Receivables 0 13,301 13,301 12,293 12,293 Cash at bank and in hand 0 9,877 9,877 9,126 9,126 Total at 31 March 0 23,178 23,178 21,419 21,419

31.2 Financial liabilities At fair value Other Total Other Total through profit and loss 2015 2015 2014 2014 £000 £000 £000 £000 £000

Payables 0 25,752 25,752 26,202 26,202 PFI and finance lease obligations 0 0 0 26 26 Other borrowings 0 6,644 6,644 432 432 Provisions under Contract 0 1,784 1,784 1,784 1,784 Total at 31 March 0 34,180 34,180 28,444 28,444

The carrying value of financial assets and liabilities is equivalent to fair value.

Page 37 South Warwickshire NHS Foundation Trust - Annual Accounts 1 April 2014 to 31 March 2015

Notes to the Accounts

32. Financial risk management

Financial reporting standard IFRS 7 requires disclosure of the role that financial instruments have had during the period in creating or changing the risks a body faces in undertaking its activities. Because of the continuing service provider relationship that the NHS Foundation Trust has with Clinical Commissioning Groups (CCGs) and the way the CCGs are financed, the NHS Foundation Trust is not exposed to the degree of financial risk faced by business entities. Also financial instruments play a much more limited role in creating or changing risk than would be typical of listed companies, to which the financial reporting standards mainly apply. The NHS FoundationTrust has limited powers to borrow or invest surplus funds and financial assets and liabilities are generated by day-to-day operational activities rather than being held to change the risks facing the NHS Foundation Trust in undertaking its activities.

The Trust’s treasury management operations are carried out by the finance department, within parameters defined formally within the Trust’s standing financial instructions and policies agreed by the board of directors. Trust treasury activity is subject to review by the Trust’s internal auditors and has received a "significant assurance" opinion during the 2014/15 review.

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

Interest rate risk The Trust has borrowed from the Foundation Trust Financing Facility for the major capital projects at Warwick and Stratford. The borrowings are for a fixed period of 25 years, in line with the life of the associated assets, and interest is charged at the National Loans Fund rate, fixed for the life of the loan, at 3.19%. The Trust therefore has low exposure to interest rate fluctuations.

Credit risk Because the majority of the Trust’s income comes from contracts with other public sector bodies, the Trust has low exposure to credit risk. The maximum exposures as at 31 March 2015 are in receivables from customers, as disclosed in the Trade and other receivables note.

Liquidity risk

The Trust’s operating costs are incurred under contracts with Clinical Commissioning Groups, Local Authorities and NHS Area Team which are financed from resources voted annually by Parliament. The Trust has a Continuity of Services Risk Rating of 3 and holds large cash balances. The Trust is not currently exposed to any significant liquidity risk associated with inability to pay creditors.

Page 38 South Warwickshire NHS Foundation Trust - Annual Accounts 1 April 2014 to 31 March 2015

Notes to the Accounts

33. Events after the reporting period

There are no events after the reporting period.

34. Related party transactions

During the year none of the Board Members or members of the key management staff or parties related to them has undertaken any material transactions with South Warwickshire NHS Foundation Trust.

The Department of Health is regarded as a related party. South Warwickshire NHS Foundation Trust has had a significant number of material transactions with the Department of Health, and with other entities for which the Department is regarded as the parent Department. These entities are listed below:

2015 2014 Income Expenditure Receivables Payables Income Expenditure Receivables Payables £000 £000 £000 £000 £000 £000 £000 £000 Central Government Departments Department of Health 0 2,768 32 0 0 1,928 0 97

Clinical Commissioning Groups (CCG's) NHS South Warwickshire CCG 143,502 1,481 3,440 1,481 137,500 2,919 3,186 1,447 NHS Warwickshire North CCG 15,365 1,210 1,277 1,210 14,198 626 586 596 NHS Coventry and Rugby CCG 13,768 748 630 748 13,568 584 440 556

NHS Trusts University Hospitals Coventry and Warwickshire NHS Trust 1,362 4,886 685 760 1,548 4,964 478 1,328 West Midlands Ambulance Service NHS Foundation Trust 11 390 19 90 10 485 10 51 George Eliot NHS Trust 594 237 170 44 725 212 164 54

Other Bodies The NHS Litigation Authority 0 3,014 0 0 0 3,112 0 0 The NHS Pension Agency 0 14,537 0 2,030 0 14,244 0 1,969 SWFT Clinical Services Ltd 177 4,247 136 58 532 3,769 74 317 Castel Froma Ltd 37 117 4 0 37 859 2 0 Acorns Children's Hospice Trading Ltd 0 0 0 0 0 0 0 0

35. Third party assets The Trust held £866 (2013/14 £871) cash and cash equivalents at 31 March 2015 which relates to monies held by South Warwickshire NHS Foundation Trust on behalf of patients. This has been excluded from the cash and cash equivalents figure reported in the accounts.

Page 39 South Warwickshire NHS Foundation Trust - Annual Accounts 1 April 2014 to 31 March 2015

Notes to the Accounts

36. Losses and special payments

There were 137 cases (2013/14 62 cases) of losses and special payments totalling £293,611 (2013/14 £73,516) during 2014/15. These payments are reported on an accruals basis but excluding provisions for future losses. Amount Number £000 Cash Losses 0 0 Fruitless Payments and Constructive Losses 0 0 Bad Debts and Claims abandoned 50 103 Stores Losses 244 34 294 137 The value of Cash Losses and Fruitless Payments is less than £1,000.

37. Pathology service

South Warwickshire General Hospitals NHS Trust (now South Warwickshire NHS Foundation Trust), University Hospitals Coventry and Warwickshire NHS Trust and George Eliot Hospital NHS Trust formed a single Pathology Service at 1 April 2008. The service is hosted by University Hospitals Coventry and Warwickshire NHS Trust and there is an agreement approved by the Trusts, with this Trust's share being 20.11%. Payments for the service are made in accordance with a service level agreement.

The Pathology Service accounts reported by University Hospital Coventry and Warwickshire NHS Trust were:

Reported by University Hospitals South Warwickshire NHS Coventry and Warwickshire NHS Foundation Trust's Share Trust 2015 2014 2015 2014 £000 £000 £000 £000 Revenue from Patient Care Activities 1,251 1,222 252 246 Other Operating Revenue 30,361 28,753 6,106 5,782 Operating Expenses (31,612) (30,025) (6,358) (6,038) Operating Deficit 0 (50) 0 (10)

University Hospitals Coventry and Warwickshire NHS Trust reported a breakeven position of £Nil in their accounts for the pathology service in 2014/15 (2013/14 - £49,767), the South Warwickshire NHS Foundation Trust's share was £Nil (2013/14 -£10,008).

Reported by University Hospitals South Warwickshire NHS Coventry and Warwickshire NHS Foundation Trust's Share Trust

2015 2014 2015 2014

£000 £000 £000 £000 Non current assets 27 1,664 5 335 Current assets Stocks and work in progress 730 715 147 144 Debtors-due within 1 year 1,184 1,450 238 291 1,914 2,165 385 435 Current liabilities (2,933) (4,042) (418) (641) Net current liabilities (1,019) (1,877) (33) (206) Total assets less current liabilities (992) (213) (28) 129

Non current liabilities 0 (779) 0 (157)

Total assets employed (992) (992) (28) (28) Financed by: Tax payers' equity Public dividend capital 434 434 259 259 Retained earnings (1,426) (1,426) (287) (287)

Total tax payer's equity (992) (992) (28) (28)

University Hospitals Coventry and Warwickshire NHS Trust reported net liabilities of £992,000 (2013/14 net liabilities of £992,000) in their accounts for the pathology services; South Warwickshire NHS Foundation Trust's share was net liabilities of £28,000 (2013/14 £28,000).

Page 40 South Warwickshire NHS Foundation Trust - Annual Accounts 1 April 2014 to 31 March 2015

Notes to the Accounts

38. Directors Remuneration

2014/15 Benefits in Other Bonus Kind Remuneration Payments (rounded to Salary (bands of (bands of (bands of the nearest Total (bands Name and Title £5000) £5000) £5000) £00) of £5,000)

Mr G Burley Chief Executive 160-165 160-165 Mrs N Lloyd Director of Finance 125-130 125-130 Mrs J Blacklay Director of Development 105-110 105-110 Dr C Ashton Medical Director 50-55 100-105 35-40 185-190 Mrs J Ives Director of Operations 100-105 100-105 Mrs H Lancaster Director of Nursing 100-105 100-105 Mrs A Pope Director of Human Resources 90-95 90-95 Mr G Murrell Chairman 35-40 35-40 Mr A Harrison Non Executive Director 10-15 10-15 Mrs R Hyde Non Executive Director 10-15 10-15 Mr T Boorman Non Executive Director 5-10 5-10 Mr B Paxton Non Executive Director 5-10 5-10 Dr M Mudhar Non Executive Director 5-10 5-10 Dr A Brady Non Executive Director 5-10 5-10

7 Executive Directors were members of a defined benefit pension scheme during 2014/15.

Band of Highest Paid Director's Total 195-200 Median Total Remuneration 28,178 Ratio 7.0 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 remuneration of the highest-paid director in South Warwickshire Foundation Trust in the financial year 2014/15 was £195k-£200k (2013/14, £195k-£200k). This was 7 times (2014/15, 7.1) the median remuneration of the workforce, which was £28,178 (2013/14, £27,900). In 2014/15, nil (2013-14, nil) employees received remuneration in excess of the highest-paid director. Remuneration ranged from £5k to £200k (2013/14 £5k to £200k). Total remuneration includes salary, non-consolidated performance-related pay, benefits-in-kind as well as severance payments. It does not include employer pension contributions and the cash equivalent transfer value of pensions. There have been no significant changes to the calculation of the ratio between 2013/14 and 2014/15. It has not been possible to include the whole time equivalent annualised cost of agency as the data is not held in a format that allows this detail of analysis.

Page 41 South Warwickshire NHS Foundation Trust - Annual Accounts 1 April 2014 to 31 March 2015

Notes to the Accounts

38. Directors Remuneration continued

Pensions Benefits

pensionat age 60 (bandsof £2,500) Real increasein pensionlump sum at age60 (bands of £2,500) Total accrued pension(at age 60) at 31March 2015 Lumpsum (at age 60) relatedto accrued pensionat 31 March 2015(bands of £5000) CashEquivalent TransferValue at 31 March2015 Cashequivalent TransferValue at 31 March2014 Real increasein equivalentTransfer ValueAfter Inflation Fund Employer Increaseto Cash EquivalentTransfer Value Name and Title Real increasein £000 £000 £000 £000 £000 £000 £000 £000 Mr G Burley Chief Executive 2.5-5.0 10-12.5 60-65 185-190 1122 979 92 147 Mrs N Lloyd Director of Finance 2.5-5.0 25-27.5 10-15 0 161 144 10 79 Mrs J Blacklay Director of Development -2.5-0 -2.5-0 30-35 100-105 615 577 8 27 Mrs J Ives Director of Operations 0-2.5 0-2.5 35-40 110-115 719 650 35 61 Mrs H Lancaster Director of Nursing 2.5-5.0 7.5-10 30-35 100-105 607 513 67 102 Mrs A Pope Director of Human Resources 0-2.5 5-7.5 25-30 75-80 501 418 61 82 Dr C Ashton Medical Director 0-2.5 0-2.5 50-55 160-165 1155 1064 36 66

Exit Packages

There were no exit packages for senior management (2013/14 Nil).

39. Subsidiary relationships

39.1 SWFT Clinical Services Ltd

In applying the principles of IAS 27 (Consolidated and Separate Financial Statements) the Trust has a subsidiary relationship with SWFT Clinical Services Ltd (CS Ltd). The net assets of CS Ltd are not deemed material to the Trust's position, and therefore are not consolidated into group accounts and group accounts are not prepared. The following table sets out the net assets of CS Ltd in relation to the Trust's suplus and CS Ltd's net profit results.

2015 2014 £000 £000

CS Ltd net assets 333 322 SWFT NHS Trust net assets 99,438 101,036 % 0.33% 0.32%

CS Ltd net profit 11 4 SWFT NHS Trust net profit 226 2,109 % 4.87% 0.19%

The company was incorporated in the United Kingdom on 24 February 2011 and began trading on 3 May 2011. The Trust's investment in this company is £250,000 of share capital.

Page 42 South Warwickshire NHS Foundation Trust - Annual Accounts 1 April 2014 to 31 March 2015

Notes to the Accounts

39. Subsidiary relationships continued

39.2 Charitable Funds

The Trust is the Corporate Trustee for the South Warwickshire Foundation Trust Charitable Fund, registered charity number 1056424

In applying the principles of IAS 27 (revised) (Consolidated and Separate Financial Statements) the charity would be considered a subsidiary. However the charity balance and in year transactions are not significant for 2014/15 and therefore a decision was taken not to consolidate the funds. Details of the charity can be obtained from the Trust.

Page 43