Barnsley Hospital NHS Foundation Trust Annual Report and Accounts 1 April 2019 to 31 March 2020 Presented to Parliament Pursuant to Schedule 7, Paragraph 25(4) (a) of the National Health Service Act 2006 © 2020 Barnsley Hospital NHS Foundation Trust Contents Performance Report 1 Accountability Report 44 Director’s Report 44 Remuneration Report 61 Staff Report 72 Governance Report 104 Statement of Accounting Officer’s Responsibilities 133 Annual Governance Statement 135 Financial Statements 149 1 Performance Report The purpose of this section of the report is to provide a short summary of Barnsley hospital NHS Foundation Trust, our purpose, the key risks to achievement of our objectives and how The Trust has performed during the reporting period. About Barnsley Hospital Barnsley Hospital NHS Foundation Trust is a district general hospital built in the 1970s and serving a population of approximately a quarter of a million people within the areas served by Barnsley Metropolitan Borough Council. The hospital provides a full range of district hospital services to the local community and surrounding area. These services include emergency and intensive care, medical and surgical care, elderly care, paediatric and maternity services, along with diagnostic and clinical support. The Trust provides a number of specialised services, such as cancer and surgical services in partnership with other NHS organisations. The Trust also provides national assistive technology services. Barnsley Assistive Technology is a nationally recognised specialised service that works with other professionals in local teams to provide electronic assistive technology. The service works with a wide range of electronic assistive technologies and with a wide range of individuals with severe disabilities. The Trust’s principal commissioner is Barnsley Clinical Commissioning Group (CCG), which is responsible for commissioning health services for the population of Barnsley. Operationally, the Trust has three Clinical Business Units (CBUs) and a Corporate Services Unit. Each CBU is led by a team made up of a Clinical Director, an Associate Director of Nursing/Midwifery and an Associate Director of Operations, who are supported by a Matron, Clinical Lead and Service Manager together with human resources, finance and data analyst teams. The CBU operational structure in 2019-20 comprised Medicine; Surgery & Critical Care; and Women’s, Children‘s and Clinical Support Services, supported by the Corporate Services Unit. Our 4,064 whole time equivalent employees (Trust and BFS staff as of 31 March 2019) are supported by a People Strategy which focus on the physical health and emotional wellbeing of staff, as well as a dedicated learning and development programme and a fully equipped Education Centre. 2 3 Local Health and Care Community The health of people in Barnsley is affected by local deprivation factors. Barnsley is the 38th most deprived local authority of the 317 in England (2019 data). Premature death from chronic diseases such as cancer, cardiovascular disease and lung disease is strongly linked to deprivation. The resident population is shown below. 4 Our Vision Our Trust vision is “to provide outstanding, integrated care”. Our Values and Behaviours It is important people are aware of our values, the things we stand for and the way we like to operate. We care about how people think and feel about us, so every time we present ourselves it is important that we make the right impression – whenever and wherever this may be. Our values and associated behaviours are: Our Value Our Behaviours Respect: We treat people Respect, courtesy, professionalism How we would like to be treated Kindness, compassion, dignity ourselves Clear, honest and responsible communication Teamwork: We work together We share the same goal to provide the best quality care We treat people fairly and equally We share and develop together Diversity: We focus on your Personalised care individual and diverse needs Involve people in decisions Listen to others In July 2019, the Trust celebrated the NHS values and those of the hospital by participating in national NHS Values Week. 5 We have developed a series of leadership behaviours and competencies to support our values and behaviours: 6 Chairman and Chief Executive’s Report Trevor Lake, Chairman Dr Richard Jenkins, Chief Executive Our Performance in 2019-20 Operational Performance We are pleased to report strong clinical and operational performance during 2019-20 despite substantial growth in the elective referrals and emergency attendances. Excellent patient access was delivered as demonstrated by achievement of the mandated standards of 18 week treatment for elective care, 62 day treatment for cancer care, and 6 week access to diagnostic services. The Trust was on course to achieve the four hour emergency care standard until early onset of winter caused a reduction in performance which was then compounded by the impact of Covid-19 at the end of the year. Emergency Care The four hour emergency access standard was not delivered in 2019-20 with performance of 91.5% against the standard of 95% of patients being admitted or discharged within four hours. Strong performance was maintained until November despite growth of around 5% in Emergency Department attendances and non-elective admissions. Despite not achieving the standard, Barnsley Hospital was consistently one of the top ten trusts in England including being the highest performing trust in October 2019. The early onset of winter made achievement of the target particularly challenging and the Trust’s ability to recover was compromised by the impact of Covid-19. The Trust commenced the implementation of plans to improve the patient experience in the Emergency Department and provide increased capacity and resilience. Medical and nurse staffing was reviewed the teams were expanded to reflect the growth in the number of patient attendances. Work also started on a new Paediatric Emergency Department and Children’s Assessment Unit which is planned to be completed in 2020- 21 and will provide expanded and purpose designed facilities and enable improved care. 7 Cancelled Operations The number of cancelled operations in 2019-20 was low. The Trust’s required standard of less than 0.8% of operations being cancelled was met in all four quarters despite the challenges arising from the loss of an operating theatre for almost the whole year due to the replacement of the operating theatre air handling unit. 18-Week Referral to Treatment (RTT) Patient Pathway The RTT waiting time standard was achieved for the year as a whole with performance of 93.6% against the standard of 92%. The standard was met every month during 2019- 20 other than in March 2020 when most elective surgery had to be cancelled as a result of the Covid-19 pandemic. Despite substantial growth in referrals, the Trust’s performance demonstrated an effective approach to ensuring timely access by patients to initial assessment, diagnostic tests, and treatment. Barnsley Hospital was in the top eight performing trusts in England throughout the year. Cancer Access Target: Urgent GP referrals seen within two weeks The Trust fell fractionally short of achieving this target in 2019-20 with 92.8% of patients seen within two weeks against the target of 93%. This level of performance was despite a 5% increase in referrals, with referral growth being particularly pronounced for suspected lower-gastrointestinal cancer and breast cancer. In response to this referral growth additional medical posts were established in colorectal surgery and breast surgery and the colorectal nurse specialist team was also increased. Straight to test pathways were implemented over the course of the year for lower-gastrointestinal, upper gastrointestinal, lung, and urology referrals. This reduced waiting times for patients and the number of outpatient appointments required. Forecasting tools were used in a number of specialties to inform capacity planning and ensure sufficient clinic appointments were available during periods of peak demand. Cancer Access Target: Treatment within 62 days of an urgent referral The Trust achieved the 62 day standard with 85.2% of patients commencing treatment within 62 days. This demonstrated effective coordination of complex patient pathways in order to reduce the time to cancer treatment. The Trust’s performance was the fifth best in England out of 128 trusts. In addition to the implementation of straight to test approaches, improvements were made to urology patient pathways to reduce waiting times for biopsies and for decisions at multi-disciplinary team meetings. A pathway for high risk prostate patient was introduced enabling investigations to be undertaken on a single visit to hospital. A streamlined head and neck lump pathway was also agreed. 8 Cancer Access Target: First treatment within 31 days This target was achieved consistently through the year. Increased staffing of tumour site teams helped improve the coordination of complex pathways and reduced waiting times for treatment. Diagnostic Tests The Trust maintained excellent access to diagnostic tests achieving the six weeks target for tests in every month during 2019-20. The proportion of tests not provided within six weeks did not exceed 0.5% in any month. 9 Coronavirus (Covid-19) In quarter 4 of 2019-20 the Trust, along with the NHS nationally, had to work differently at all levels to be able to care for patients with and protect staff and the public from Coronavirus (Covid-19).