Medway NHS Foundation Trust Annual Report and Accounts 2016/17 Presented to Parliament Pursuant to Schedule 7, Paragraph 25 (4) (a) of the National Health Service Act 2006 © Medway NHS Foundation Trust Contents Performance report 8 Accountability report 40 Quality report 114 Annual accounts 177 Contents 9 12 14 Introduction About Medway NHS Key developments from the Chief Foundation Trust Executive 18 Performance analysis 40 57 67 Accountability Governors report Staff report report 114 119 Quality report Priorities 177 Annual accounts Foreword from the Chairman There have been changes to our Board with the appointment of two new non- executive directors, Jon Billings and Mark Spragg, both of whom bring a wealth of experience. They have replaced me in my NED role, now that I have become Chair, and Martin Jamieson whose term of office came to an end in December 2016. The Council of Governors have continued to support the Trust and provide challenge to the Board. During the last 12 months, the Governors have further engaged with our communities with a series of drop-in Stephen Clark, Chairman coffee mornings and membership 2016/17 has been a fantastic year for recruitment events. Medway and I feel very fortunate to have stepped into the role of Chairman at such I would like to thank the League of Friends a positive time. for the invaluable support they have provided to the Trust. We deeply value our As you will be aware, the Care Quality longstanding relationship with the Friends Commission published its report in mid- and the equipment that they help to fund March, in which the Trust’s rating makes a huge difference to our patients. improved considerably. At the same time, NHS Improvement removed the Trust from On behalf of the Board, I would like to special measures, which had been thank all our staff and volunteers for their imposed on Medway in 2013. passion and commitment in providing the very best of care to our patients and their This is great news for our staff who are so families. committed to the continued improvement of quality and safety at the hospital. But The future is bright for Medway, and I look most importantly, it is great news for our forward to being a part of it. patients. Of course, we know we still need to do more, and we are now focused on addressing points raised in the report, and on taking this Trust from ‘better’ to ‘best’ Stephen Clark and on to ‘brilliant’. In May we launched Chairman phase three of our improvement plan, which sets out some specific areas we will be concentrating on to ensure we maintain momentum. This will be aligned with the Sustainability and Transformation Partnership (STP), the Kent and Medway- wide overview of how health and social care services will need to be delivered across the whole of Kent and Medway in future. 7 Performance report 8 Overview Introduction from the Chief Executive Patient safety is the number one priority for any healthcare provider and building on the progress we have already made in this area has continued to be a key theme for us in 2016/17. I’m pleased to say that our mortality rates have continued to fall and are now in line with national averages; our high mortality rates were one of the main reasons the Trust was placed into special measures in 2013. Our patient safety improvements include better Lesley Dwyer, Chief Executive systems for recognising and responding to patients whose condition has deteriorated, It has been a momentous year at Medway improved governance processes and and I would like to take this opportunity to better shared learning from safety reflect on the challenges and the incidents. In addition, corridors in our numerous achievements of the last 12 Emergency Department are no longer months. used for treating patients. Without doubt the most important moment We continue to make great strides in for the Trust this year was NHS improving the Medway experience for our Improvement’s decision to remove us from patients. Our care is now more responsive the special measures regime. I am so and effective; our patients see fewer pleased that the improvements that we doctors, enabling them to receive more are all so proud of have been recognised. consistent treatment, and are discharged This is a great tribute to our dedicated sooner. Thanks to the new Home First staff and the fantastic job they do day in, initiative with our partners Medway day out. They really are the best of Community Healthcare and Medway people, working hard to deliver the best of Council, patients who require further care. support at home can have their needs met sooner, allowing them to get back to the “I’m absolutely delighted that comfort of their own home. This is better Medway has exited special for our patients and means that as a Trust measures – and I want to pay we have fewer patients on our wards who don’t need to be there, freeing up beds for tribute to the outstanding staff the acutely ill. We have also begun work there who have always sought on a new community engagement strategy to put patients first” that will ensure that the people of Medway and Swale are more involved in decisions Jeremy Hunt about the services provided at the Secretary of State for Health hospital. March 2017 9 I’m pleased to say that the hospital went Developing new and better ways to smoke-free in October 2016; this has support our staff is something that will resulted in a much better and healthier forever be ongoing and we still have a lot environment for all users of our site. This to do, but I’m delighted to say that much was a major milestone for the Trust and I improved feedback from the 2016 Staff would like to thank everyone who has Survey indicates that staff feel we are been involved in helping us to achieve moving in the right direction. I would like to this. We have had fantastic support from pay tribute to all our staff for the staff, patients and visitors for which we are compassionate care they provide for our very grateful. patients and for their hard work and commitment to improving the hospital. However, 2016/17 has not been without challenge. The period immediately following Christmas was a time of very significant pressure for the Emergency Department and the hospital more widely. This meant that our performance against some of the key national targets was not what we would like it to be. We have since introduced new processes that have improved flow and we will continue to work with our healthcare partners to ensure only the patients that need to come to hospital do so, and that patients are discharged efficiently. This will be greatly aided by the completion of the final We were delighted to launch our new phase of our Emergency Department Trust vision this year which was created redevelopment in 2017. following feedback from more than 500 We continue to work hard to ensure that staff. The vision ‘Best of Care, Best of we have the right staffing levels at the People’ represents our aspiration to hospital. In 2016/17 we launched a new provide the highest quality of care for our Trust recruitment campaign featuring our community with highly-skilled staff. The own staff and we have been proud to values that underpin this vision, Bold, welcome many new people to our team. Every Person Counts, Sharing and Open, and Together, embody the behaviours of Our other significant challenge is our our staff in their work every day. financial position. We have to be realistic and recognise that improving our financial I always say that without the staff a position and eliminating our deficit will hospital is just bricks and mortar. They are take some time and cannot be done in a the beating heart of everything that we do. few weeks or months. We have developed We have worked hard this year to improve a financial recovery plan which aims to the working environment for our staff; take us to a sustainable financial or break ensuring they have better support from even position in three to five years. This leadership, more training and will involve achieving greater efficiencies development opportunities and do not and productivity from our existing suffer from unacceptable practices such services, prioritising the recruitment of as bullying and harassment. We are permanent staff to reduce dependency on particularly proud of the fantastic agency workers and improving our MediLead programme which offers procurement and contract management. leadership development for junior doctors We will also work closely with our partners aspiring to be leaders of the future. 10 across Kent to look at how we can deliver services more efficiently, through the Kent and Medway Sustainability and Transformation Partnership. It has been a fantastic year for the Trust but we know we still have much to do if we are to consistently provide the level of care that the people of Medway and Swale deserve. This is why in 2017/18, we will work hard to deliver the next phase of our improvement plan and continue our journey of recovery. Lesley Dwyer Chief Executive 11 About Medway NHS Foundation Trust Purpose, activities and history Medway Maritime Hospital was originally a Royal Naval Hospital, opened by King Edward VII in 1905. The hospital cost £800,000 and boasted a main corridor of nearly 1000 feet in length. Our volunteers perform an important role The hospital is made up of three clinical directorates – Acute and Continuing Care, Co-ordinated Surgical, and Families and Clinical Support Services– supported by The hospital as it looked in its early days corporate functions.