QUALITY SAFETY Annual Report PEOPLE DELIVERY and Accounts 2013/14 ENVIRONMENT COST

Page Annual Report and Accounts 2013/14 1

Annual Report and Accounts 2013/14

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

Contents

Contents Page

Chairman’s and Chief Executive’s Statement 4

Hospital Highlights 9

Strategic Report Our Trust 17 Our Services 18 Our Performance On Delivering Our Plans in the following activities: Our Patients 19 Our Staff 24 Our Performance 41 Our Environment 52 Our Finances 56 Our Future Business Plans 67

Directors’ Report Profile of the Board 71

Board of Directors’ Report Management Commentary and Principle Activities 83 NHS Foundation Trust Code of Governance 88

Council of Governors Report 91

Membership Report 103

Audit Committee Report 109

Remuneration Committee Report 113

Nominations Committee Report 123

Quality Account Annex A 125

Statement of Directors’ Responsibilities in Respect of the Quality Report Annex B 207

External Auditor’s Limited Assurance on the Contents of the Quality Report Annex C 209

Statement of the Chief Executive’s Responsibilities as the Accounting Officer Annex D 212

Annual Governance Statement 2013/14 Annex E 213

Independent Auditor’s Report To The Council Of Governors Annex F 232

Accounts for the Period 1st April 2013 to 31st March 2014 Annex G i - xxxvi

Notice of the Trust’s Members and Annual Public Meeting 271

Page Annual Report and Accounts 2013/14 3 Chairman’s and Chief Executive’s Statement

The past 12 months has been a year of ongoing change within the organisation from new infrastructures to innovative improvements in care, treatments and services.

Quality and safety of patient multi-storey car park and care to ensure that the right care care has remained our key midwifery unit. This investment is given by the right person at priority and the publication of has not been confined to the right time. The pathways are the Keogh Report in the summer infrastructure, we have also strictly audited and in present ‘real highlighted a number of areas of undergone a major recruitment time’ feedback so we can address good practice, as well as areas for drive which has led to more than areas where we need to improve improvement. 180 new nurses and 45 doctors quickly. being employed by the Trust. We have seen a marked reduction We have recorded excellent in mortality, passed the year These have been embraced results from these initiatives, milestone for remaining MRSA through our Better Care Now the recent nationally released free, developed successful new Programme which sets the Summary Hospital Mortality clinical pathways, as well as highest possible standards of care, Index (SHMI) figures show a developed the Better Care Now focusing on clinical pathways, reduction from 126* to 117* Programme. waiting times and ensuring comparing March 2012 to March we have the right professional 2013 and our current calculation Blackpool Teaching Hospitals workforce with the right skills to shows a rolling 12 month figure has also undergone a major deliver high quality care. to April 2014 of 109*. For all investment programme mortality rates a comparison is with the opening of The pathways focus particularly made between the number of our new main entrance, on the first 24-36 hours of patient actual deaths for an individual population and the expected number of deaths for the hospital “Since the Keogh Review team visited population of England and the Trust we have been under intense Wales. A score of 100 is taken as the average. Given the actions monitoring, which we have welcomed underway we project a figure of 110.9 by the end of April 2014, and embraced as reassuring our patients which will be within the expected about the quality of service received at range for this Trust. Blackpool Teaching Hospitals...”

Page 4 Blackpool Teaching Hospitals NHS Foundation Trust Since the Keogh “We have met both the Independent Regulator Review Team visited the Trust we have of NHS Foundation Trusts, Monitor, and the Care been under intense monitoring which Quality Commission (CQC) on a monthly basis to we have welcomed report on progress and have demonstrated real and embraced as reassuring our patients improvements delivered at a rapid pace...” about the quality of service received at whilst the overall ratings for both cases. In 2006/07 there were Blackpool Teaching Hospitals. We Clifton Hospital and Fleetwood 49 cases of MRSA, therefore have met both the Independent Hospital were “good”. The the improvement is a great Regulator of NHS Foundation overall rating for the Trust was achievement which has been Trusts (Monitor) and the CQC “requires improvement”. As we accomplished by excellent on a monthly basis to report on would expect, the CQC identified infection prevention practices. progress and have demonstrated areas for improvement, many of The challenge now is to ensure real improvements delivered at a which we are already working we maintain our focus on all rapid pace. on and making progress. We Healthcare Acquired Infections must focus on those areas where and remain diligent and follow In January the CQC carried improvement is needed. Based best practice at all times. out an inspection of Blackpool on the progress we have already Teaching Hospitals using made, we are confident we can More than £16m has been invested their new hospital inspection tackle these issues and reach the in a new main entrance and multi- methodology which gives stage where all our ratings are storey car park at Blackpool Victoria possible ratings of; inadequate, at least “good”. The levels of care Hospital. The new entrance gives requires improvement, good and and commitment at the Trust us an impressive focal point for outstanding. The report shows are exceedingly high and both the hospital allowing patients a the majority of the areas they the hospital and the Trust overall better experience from arrival with looked at were rated as “good” received a “good” rating for care. a main reception, waiting areas, – of the 68 ratings given 42 were retail units and café. The building good, two were “outstanding”, We have also welcomed a new is linked to the new multi-storey 22 were “requires improvement” initiative to hold regular Quality car park which has secure parking and two areas were deemed Assurance Reviews from our CCG. for more than 1,000 cars. This new “inadequate”. The overall rating We had the first of these visits in infrastructure has also given the for Blackpool Victoria Hospital November with a team visiting Trust the opportunity to improve was “requires improvement” our Families Division which found the wayfinding signage around the substantial progress in all areas. site. The new structures are a major step forward in the provision of The Trust was delighted to high quality patient care, providing announce that it had been better access to the hospital for more than one year without any patients, visitors and staff. reported MRSA bacteraemia

Page Annual Report and Accounts 2013/14 5 In August 2013 we opened the latest facilities for health “More than £16m has a £680,000 state-of-the-art professionals to learn new midwifery-led unit, which offers skills in a simulated hospital been invested in a a home-from-home birthing environment without environment for expectant mums. compromising patient new main entrance The unit runs independently from safety. The realistic rooms and multi-storey car the existing delivery suite, but are equipped with the latest is situated just next door, giving medical technology and park at Blackpool mums the option of a less hospital equipment and are home Victoria Hospital...” intensive birthing experience but to a family of sophisticated with the safety of the consultant- life-sized manikins who are led facilities just feet away should programmed to replicate a Community Health Monitoring the need arise. This unit has number of conditions in unwell Team. Well done to all of them, an dramatically improved birthing adults, children and babies. amazing achievement. choices for women and their families who can now choose to During the year, six of our The accolades didn’t stop there have their baby at home, in the community nurses received – the Trust’s maternity team won delivery suite or in the new unit. one of the profession’s highest the Women’s Health Category accolades. The six members at the National Care Integration The Trust also officially unveiled of staff were given the title of Awards for their integrated care its new medical simulation Queen’s Nurse by the Queen’s pathway for pregnant women centre this year which offers Nursing Institute. The honour is who misuse substances. The only given to a small number of pathway resulted in a dramatic community nurses each year in reduction in the number of recognition of their outstanding babies requiring admission to contribution to quality of practice specialised neonatal care for the and attention management of withdrawal from “We believe care starts from the to client drugs. and patient first moment a patient meets care. Five of The Trust’s Human Resources team scooped a national Healthcare a health professional and a the nurses are from the People Management Award proper introduction is the first Blackpool for its coaching and personal Family Nurse development programme and step to providing compassion Partnership Blackpool Victoria Hospital’s and helps put patients at ease and the Clinical Research Centre beat off sixth nurse stiff competition from some of the while using our services...” is from the country’s biggest organisations to

Page 6 Blackpool Teaching Hospitals NHS Foundation Trust take bronze in the PharmaTimes first-hand how their feedback is Clinical Research Site of the Year driving improvements. Since the category. introduction of the Friends and Family Test, the Trust has scored Locally, more than 250 members better than the national average. of staff were honoured for Increasing the patient’s voice is their dedication, commitment fundamental to improving patient and loyalty at the annual Staff care and since the agenda was Achievement Awards and launched there has been a surge a record number of entries in the amount of feedback the were received this year in our Trust receives, both positive and Celebrating Success Awards. negative, enabling the Trust to provide better services and, as The NHS Friends and Family part of our patient experience Test was introduced to the Trust initiative, the Trust has also in April 2013 which is a major pledged its support for the new Ian Johnson Chairman step forward in giving patients a “hello my name is” campaign 21st May 2014 greater voice. Blackpool Teaching aimed at putting patients at ease Hospitals NHS Foundation with the member of staff who is Trust’s ‘Transforming the Patient caring for them. Experience Agenda’ has been instrumental in making the We believe care starts from the organisation more patient and first moment a patient meets a family centred in 2013, with a health professional and a proper comprehensive patient feedback introduction is the first step to system to ensure all service users providing compassion and helps needs are considered in every put patients at ease whilst using decision it makes locally, both at a our services. clinical and a policy level. This has made the organisation a lot more During the year there have been accessible and accountable to changes to the Board of Directors patients and their representatives. with Nicky Ingham appointed to From weekly ward spot surveys the post of Director of Workforce to patient panels and digital and Organisational Development first-person patient experiences, and Tim Bennett taking up the patients can now easily and role of Director of Finance. regularly tell us how they feel about their treatment and see Gary Doherty Chief Executive 21st May 2014 (*Please note SHMI data was taken from externally published information and internal calculations and RAMI data was taken from the CHKS website and both sets of data was the 12 month rolling average figure taken as at 18th May 2014.)

Page Annual Report and Accounts 2013/14 7 “Words cannot explain the treatment Mr Zacharias and his team have given me at the centre. Every member of staff I have come into contact with seems very positive, friendly and like they really want to help you and make you feel better. They’ve been wonderful.” Mrs A Iqbal, Leeds

Page 8 Blackpool Teaching Hospitals NHS Foundation Trust Hospital Highlights

Over the past 12 months there have been many new developments which have helped to improve quality of care, patient safety and the overall patient experience. Here are just some of the notable achievements we have made in the past year.

Highlights

Para-Olympian Shelly Woods officially opens new Haematology and Oncology Unit British Para-Olympian Shelly Woods officially opened the new Haematology and Oncology Day Unit at Blackpool Victoria Hospital.

The Unit opened thanks to funding from the Trust’s charity Blue Skies Hospitals Fund and the League of Friends of Blackpool Victoria Hospital.

The build cost around £500,000 in total to bring to fruition with Blue Skies Hospitals Fund putting £195,000 towards the costs and the League of Friends BVH providing a further £125,000. The Kay Kendall Leukaemia Fund also donated £21,373 towards the build which was spent on furniture and equipment for the Haematology Day Unit.

Page Annual Report and Accounts 2013/14 9 programme. The volunteers are largely provided by the local Healthwatch organisation.

PLACE previously the Patient Environment Action Team (PEAT) study, was changed to ensure it was an independent ‘patient led Assessment’ with the patient’s voice playing a significant role in the result of the survey.

Environment assessments are carried out at ward and departmental level, from a patient perspective with each PLACE visit generating a score in the four areas of cleanliness, food & Magical volunteers volunteers for their wonderful hydration, privacy, dignity and confidentiality and buildings & The Trust’s volunteers were efforts to improve the quality grounds. thanked for giving their time and of patient experience within effort at a special celebration Blackpool Teaching Hospitals. Nigel Fort, Assistant Director of evening. As part of the evening a number Clinical Support and Facilities Management at the Trust, One hundred and twenty of volunteers were awarded said: “The Trust has been volunteers from acute and certificates for completing more extremely fortunate in working in community care settings than 100 hours of service at the partnership with external patient attended the ‘Magic of Trust in a new scheme called assessors who have made this Volunteering’ event in May ‘Healthy Futures’. new process possible. With their 2013 at the De Vere Hotel, help we have achieved scores in Blackpool, which included a three PLACE Assessment all above areas that were higher course meal and spectacular The Trust has thanked volunteers than National Average.” entertainment from magician who helped assess local Paul Roberts and comedian Mick sites as part of the national Miller. Patient Led Assessment of the Care Environment (PLACE) The Trust volunteers, whose ages range from 16 to 94, perform a variety of duties which complement the work of our paid staff, including helping visitors to navigate their way through the hospital, assisting patients during meal times, collecting patient survey feedback, providing clerical support and working on hospital radio.

At the event they were all praised for their efforts by Volunteer and Community Engagement Officer, Jane Iceton, who thanked the

Page 10 Blackpool Teaching Hospitals NHS Foundation Trust but is also cardiac enabled to enable imaging of the heart on the coronary arteries. Further equipment includes mobile X-ray units, digital X-ray rooms, a new X-ray screening room and a new vascular intervention lab.

In addition to the new medical imaging equipment a new reporting system (PACS) has also been installed to allow more efficient reporting by the Consultant Radiologists. Several new offices have also been built to accommodate new consultant Medical simulation centre simulation training displays for appointments to manage the ever opens its doors both sepsis and post partum increasing demand for imaging of haemorrhage with the Sim adult patients. Blackpool Victoria Hospital has and maternity manikins. found new ways to ensure the The Trust has also refurbished five safety of its patients, with the of its x-ray rooms at Blackpool official unveiling of its Simulation Patients benefiting from £9m X-ray investment Victoria Hospital, two of which and Skills Suite. The suite are connected to the A&E offers state of the art facilities Patients across Blackpool and department, to ensure that for health professionals to try the Fylde are to benefit from a £9 instantly viewable, high quality out their skills in a simulated million investment in radiology digital x-rays are used where they hospital environment without equipment. The Trust has is in matter most. The new Imaging compromising patient safety. the process of installing more rooms can also undertake the full than 100 new pieces of state of range of Trauma examinations The realistic rooms are equipped the art radiology equipment. required by the referring clinicians with the latest medical These include a new CT Scanner, including the full range of technology, equipment and a housed within the cardiothoracic Orthopaedic examinations. family of sophisticated life sized unit providing general imaging manikins who are programmed to replicate a number of conditions in unwell adults, children and babies so clinicians can learn how to operate in a pressurised environment.

An open day was held to celebrate the opening and raise awareness to members of the community and staff on the advancements the hospital has made in the patient safety arena, while acknowledging the challenges that remain. Everyone who attended was given the chance to use the specialist training equipment for CPR and airway management, and watch

Page Annual Report and Accounts 2013/14 11 New car park and main area guided, where necessary, by and a multi-storey car park and entrance one of the Trust’s new band of has cost a total of £16.5m. The volunteer navigators. capital has been borrowed Blackpool Victoria Hospital has a from the Department of Health new look for 2014. The developments, which took a (DoH) and will be paid back from year to build, are both imaginative income generated through retail Patients, visitors and staff are and innovative and use space and parking charges. benefiting from an impressive and light to provide a clean and new entrance and multi-storey confident first impression of the car park. The new developments hospital. have solved two problems which historically affected people using The entrance hall currently the hospital – where to park and includes Costa Coffee, Marks and which entrance to use. Spencer and W H Smith retail outlets and has a reception area Visitors are now directed through and access to the first floor of the to the facility from the Trust’s hospital. The entrance hall is the new car park and can access the final stage of a scheme to provide majority of the hospital from the improved access to the hospital

Page 12 Blackpool Teaching Hospitals NHS Foundation Trust hygiene – the highest rating achievable nationally by the Food Standards Agency.

The hospital was assessed by Blackpool Borough Council who made an unannounced visit. An Environmental Health Officer checked the kitchen, looked at how food was prepared and cooked and the food hygiene systems and temperature records.

The award means patients can continue to have confidence in the standards of catering services £680,000 Midwifery Led medical intervention during they are receiving and that the Unit birth, making it a more normal Trust produces food in a safe experience for mums. manner. The kitchens produce Mums-to-be can now use the more than 3,000 meals every day new £680,000 Midwifery-led Water and movement are for inpatients, staff and external Unit which opened at Blackpool predominantly used for pain visitors. Victoria Hospital in summer 2013. relief although women are able to access whatever pain relief they The unit, which was officially require due to the close proximity opened by chief executive of the of the delivery suite next door. Royal College of Midwives, Cathy This unit provides choices that Warwick, offers state-of-the-art women on the Fylde coast have birthing facilities for mums who not previously had. The traditional are low-risk in pregnancy, with model, which is still available in four spacious en-suite birthing the hospital, involves transferring rooms, two with pools, and a mums and babies from the home-from-home environment delivery suite to the ward area making the birthing experience as until discharge. Mums delivering normal as possible. in the Midwifery Unit will stay for Excellence award about eight hours before being A building excellence award has The facility runs independently discharged home. been bestowed on Blackpool but is alongside the delivery suite Victoria’s £40m Surgical Centre. within the hospital’s Women and The development, which opened Children’s Unit. in March 2012, was praised It gives a homely environment Accreditations for its quality and complexity staffed by midwives with less at the awards organised by Five-star service Blackpool Borough Council For the third year running patients who praised the quality of the can be assured of the highest development, particularly in light standards of hygiene in their local of its complexity, also saying the hospital kitchen. construction site was the tidiest they had ever witnessed. Blackpool Teaching Hospitals NHS Foundation Trust kitchen staff The three-storey surgical unit, celebrated after being awarded which was opened by former a five star rating for their food Blackpool football manager Ian

Page Annual Report and Accounts 2013/14 13 Holloway, boasts 10 operating Staff in the Endoscopy Unit The newly-established ascites theatres, a day-case unit and 61 diagnose and treat disorders service at Blackpool Teaching inpatient beds in a bright and of the colon, stomach and Hospitals NHS Foundation Trust modern environment. Half of oesophagus in an environment allows liver patients to have excess the in-patient beds are in single dedicated to patient safety, fluid drained during a day visit rooms with en suite facilities. privacy and comfort. rather than being admitted to hospital for a three to four day Endoscopy department Human Resources team period. gets national seal of wins national award for its approval coaching programme The service has given patients their lives back and this Patients at Blackpool Victoria The Human Resources (HR) team shortlisting was a testament to Hospital’s Endoscopy Unit can be at Blackpool Teaching Hospitals the innovation and dedication of assured of the highest possible NHS Foundation Trust has won our staff. The scheme was devised quality of care after a national seal an award for its coaching and here and now helps more than of approval. personal development in the 40 patients on a regular basis and Healthcare People Management gives patients their independence The unit has achieved Association’s annual celebration to be able to visit the hospital for accreditation from the prestigious event. just an eight hour session rather Joint Advisory Group (JAG) on than have to be admitted for gastrointestinal endoscopy which The awards celebrate the best about four days. Its success has formally recognises that a high HR practices in all healthcare been to reduce the number of quality endoscopy service is organisations across the country. readmissions to hospital, reduce operating in the hospital. The Trust won the award for its the inpatient length of stay and project to introduce a leadership improve the patient’s experience. The stringent accreditation style that gave managers the means that patients attending skills to use a coaching style to for endoscopy can be assured of empower and engage their staff an excellent service delivered by to make decisions that mattered. a highly skilled and fully trained team. An evaluation of the scheme was 100% positive and the Achieving JAG Accreditation is organisation is now in the important not only because it is top 20% of Trusts for effective proof of a high quality endoscopy teams showing communication service at the hospital but is between managers and staff in also required for the delivery of the country. The judges said the the Lancashire Bowel Cancer project was a comprehensive Screening Service. programme based on research The accreditation, which is evidence and a clear case for undertaken by an independent change that achieved deep team, is important as it assures employee engagement with clear patients that the unit delivers measures of success. the highest quality of clinical care and gives our patients the Nurse-led service best experience it can. It also recognised in prestigious shows that we have a highly awards trained workforce and proves our commitment to delivering A revolutionary nurse-led service, full training packages to our staff which is giving patients their to make sure we have a team of lives back, was shortlisted for a highly skilled practitioners. prestigious British Medical Journal award.

Page 14 Blackpool Teaching Hospitals NHS Foundation Trust Page Annual Report and Accounts 2013/14 15 “To say that the operation changed my life would be a great understatement. Without all the fantastic staff at the Centre I would not be here, it’s as simple as that and I wanted to do something to thank all the fantastic NHS staff who have helped so much. “From the GP who referred me to the consultant who performed my operation and the staff who looked after me in the hospital and throughout my rehabilitation, I could not have asked for any more, it was truly remarkable.’’

Mr R Hudson, Blackpool

Page 16 Blackpool Teaching Hospitals NHS Foundation Trust Strategic Report

This section includes information about: • Our Trust Our Trust • Our Services This section also includes information Blackpool, Fylde and Wyre across the about our achievements on performance Hospitals NHS Foundation Trust community or on delivering our plans in the following was established on December staff bases from areas: 1st 2007 under the National a multitude of • Our Patients Health Service (NHS) Act 2006. locations including • Our Staff In October 2010, the Trust was 70 treatment • Our Performance awarded teaching hospitals centres and six status and changed its named to support facilities, • Our Environment Blackpool Teaching Hospitals NHS these locations are • Our Finances Foundation Trust in recognition of lease and freehold • Our Future Business Plans this. On 1st April 2012, the Trust properties provided merged with the Community by NHS Property Health Services of NHS Blackpool Services Ltd:- http://www. Fylde and Wyre Clinical and NHS North Lancashire. property.nhs.uk/ Commissioning Group (CCG Lancashire North Clinical The Trust comprises the following In addition to this school nursing Commissioning Group (CCG) main sites:- is provided from over 200 schools. Cheshire, Warrington and Wirral Area Team (for specialist areas) • Blackpool Victoria Hospital The Trust’s main commissioners Blackpool Council – Public Health • Clifton Hospital are:- Lancashire County Council – • Fleetwood Hospital Public Health • Rossall Hospital Rehabilitation Blackpool Clinical Commissioning National Commissioning Board – Unit Group (CCG) Local Area Team • Bispham Rehabilitation Unit • Blenheim House Child Development Centre • National Artificial Eye Service • Poulton Offices

The services at Bispham Rehabilitation Unit are provided by Spiral Health CIC http://www. spiralhealthcic.co.uk/aboutus.asp

The Trust also provides services

Page Annual Report and Accounts 2013/14 17 Our Services

As well as providing the full range 2012, the Trust also of district hospital services and now provides a wide “The Trust provides a community health services, such range of community comprehensive range of as, adult and children’s services, services to residents in health visiting, community Blackpool, Fylde, Wyre acute hospital services nursing, sexual health services and North Lancashire. and family planning, stop We employ 6,729 to the population of the smoking services and palliative staff (Headcount, had Fylde Coast, as well as the care, the Trust provides tertiary a turnover in excess cardiac and haematology services of £370m in 2013/14 millions of holidaymakers to a 1.6m population catchment and have a total of 912 that visit each year.” area covering Lancashire and beds. South Cumbria. Between 1st April 2013 and contacts was 1,229,933. Clinicians The Trust provides a 31st March 2014 we treated from Lancashire Teaching comprehensive range of acute approximately 94,355 day cases Hospitals NHS Foundation Trust hospital services to the population and inpatients (elective and non provide onsite services for renal, of the Fylde Coast, as well as the elective), 305,185 outpatients neurology and oncology services. millions of holidaymakers that and had 82,999 A&E attendances. We utilise assets to the value of visit each year. From 1st April The total number of community £192m to support our services.

Page 18 Blackpool Teaching Hospitals NHS Foundation Trust Our Patients

It is really important to us that we listen to our patients and make improvements to our services in response to their views.

Learning from Feedback

The Trust has many ways in which we can learn from our patients’ feedback; this could be positive or negative feedback. We feel that feedback is key to us being able to develop and enhance patient centred services.

We use the national friends and family test as an initial feedback mechanism. This has been used since April 2013 for all over 16 year olds who have been inpatients or those patients who attend our Emergency Department. Since October 2013 we have implemented this across our so care is enhanced immediately promoter score’ based on a Maternity Services. The feedback following their feedback. scoring system on plus 100 to from these tests enables wards to The friends and family feedback minus 100. implement changes in real time, is reported monthly in a ‘net

Emergency Trust Overall Inpatient Maternity Month Responses Department score Response Rate Response rates Response Rate April 72 453 19.7% 0.1% Not surveyed May 74 724 25.7% 1.5% Not surveyed June 76 877 32% 2.5% Not surveyed July 72 1021 37.7% 7.4% Not surveyed August 73 938 29.4% 4.1% Not surveyed September 76 814 25.60% 3.10% Not surveyed October 74 1128 30.70% 6.50% 9.7% November 70 1521 41.2% 13.4% 8.6% December 73 1816 44% 17.7% 9.8% January 14 66 2005 43.4% 21.7% 7.9% February 14 71 1611 41.8% 15.4% 12% March 14 72 1636 37% 14.1% 19.45%

Page Annual Report and Accounts 2013/14 19 Following the implementation of the Friends and Family test, we also revised the way we collect feedback from our patients in the local inpatient survey. This survey is now sent to people’s homes approximately two weeks following their discharge, and the information is used in a variety of ways to give our staff feedback and also to support service improvements initiatives.

In order to fully understand the care our patients are receiving we have recruited and trained a team of volunteers called ‘the listeners’ who go into patient care areas and ask individual patients a series of questions relating to their stay in that particular area. Again this information is fed back to the “All our learning is fed back to the Trust board clinical team so improvements can be made in a speedier time and also is placed on our internet site...” frame. All our learning is fed back to the You Said...We Did Trust board, placed around our hospital sites and on our web site We have started using this simple the patients experience in our so people can see the changes tool to highlight areas where care is enhanced. that we are making. patient have given us specific feedback so it is clear as to the Examples are shown in the table specific actions we have taken to below: ensure the issue is resolved and

You Said: We did: We are really cold on this ward, especially in Senior nursing staff contacted the estates team, who the night and are using extra blankets to warm checked the ward temperature and turned it up. It is ourselves up. now being monitored regularly by all ward staff.

You Said: We did: Bay based nursing is now being used on each shift, It would be nice if the nursing staff could spend so staff in their dedicated bays can spend more time some more time with us. with their patients.

You Said: We Did: A request was submitted to the estates team and There are no mirrors in the bathroom in this ward mirrors have now been fitted in every bathroom on making it difficult for us to shave. the ward.

Page 20 Blackpool Teaching Hospitals NHS Foundation Trust Enhancing Patient Safety

“All Patient Safety Patient Safety Walkabouts Walkabouts provide Patient safety remains a priority for all staff within the Trust and an opportunity for is led by the Board of Directors demonstrating their continued staff to discuss their commitment to improving concerns and issues patient safety. raised by patients...” The Executive Directors carry out adhoc Patient Safety Walkabouts on a weekly basis, averaging approximately 10 walkabouts per Shared Decision Patient Relations month. In addition all Executive Making Team Directors take ownership of a number of set wards which they This project has been run in visit regularly. This enables staff Learning from Patients partnership with the Advancing to seek Executive assistance if Quality Alliance (AQUA) to We encourage patients to give required and to have a named implement a shared decision tool. us feedback, both positive and Executive Director to call upon. This is aimed at ensuring patients negative, on their experiences of are wholly involved in their care our hospital services so that we Structured Patient Safety by giving greater information can learn from them and develop Walkabouts are carried out to one about the options that are our services in response to specified ward or department on a open to them during their care patients’ needs. monthly basis. All areas of the Trust, pathway. including those within Community During the financial year 1st April Health Services are included in Giving answers to three set 2013 to 31st March 2014 we the annual programme of Patient questions enables staff to received 4331 thank you letters Safety Walkabouts. The inclusion understand what is important to and tokens of appreciation from of Non Executive Directors the individual patient and also patients and their families, an and Governors of the Trust on helps the patient to make the best increase of 959 on the previous the Structured Patient Safety decision about their healthcare. year. Walkabout has enabled a wider assessment of the safety issues The three questions are: The number of formal complaints within the wards and departments. • What are my options? received by the Trust during the During these Walkabouts the • What are the pros and cons of same period was 498 this includes patient’s views are sought to each of these options for me? 402 written complaints registered ensure any areas where they feel • How do I get support to help via the Trust and 62 Community their experience could have been me make a decision that is right formal complaints. There were enhanced is shared with staff. for me? also 34 verbal complaints made. The overall numbers of formal All Patient Safety Walkabouts This tool has been implemented complaints show an increase of provide an opportunity for staff to within our maternity services 41 for the Trust figures, however, discuss their concerns and issues and also within the Heart Failure including the Community figures raised by patients. The Patient Safety Rehabilitation team within the show an overall reduction of 19 Walkabouts are also an opportunity Cardiac Centre, there are plans to compared to the previous year. for staff to showcase areas of good look at the use of this tool in other (Further details are contained in practice as well as areas where areas over 2014/15. the Quality Report at Annex A). improvements may be considered.

Page Annual Report and Accounts 2013/14 21 Serious Untoward Incidents death of a patient has risen and in Assurance that actions have and Lessons Learned 2013/14 there have been 10, which been completed and practice equates to 0.09% of the total. All changed is gained from evidence There has been a steady increase patient deaths are uploaded to the collection, audit findings and in the number of untoward National Reporting and Learning further monitoring of reported incidents reported over the past System (NRLS), where clinical staff incidents. A requirement for a risk five years. Patient Safety Incidents in the Patient Safety Division of assessment is considered within account for approximately the NHS Commissioning Board, the SUI process, in relation to the 76% of all reported untoward review all incidents with a degree contributory factors which led to incidents. In the year 2013/14, of patient harm of death or severe the SUI, which is monitored and there have been 14,414 untoward harm. When uploading data to the reviewed by the Divisions and the incidents reported (35% increase NRLS we need to be clear on the Board. from the previous year) and definitions of death or severe harm of these 10,957 were patient from patient safety incidents. It is It is essential that lessons are safety incidents and as such not always possible to say that a learned from SUI’s in order to were reported to the National death was or wasn’t attributed to a mitigate the risk of reoccurrence, Patient Safety Agency. The Trust patient safety incident. Where it is these lessons are fed-back to target for incident reporting reasonably clear at the outset that staff within the Divisions through within 24 hours of occurrence a death has occurred from natural training, ward/departmental is 95% and 72% of incidents causes, or natural progression of meetings, governance meetings that were graded at level 3-5 an illness, this is not reported as a and the Lessons Learnt Newsletter (serious, severe harm or death), death. A death is only reported to published Trust wide monthly. were reported within 24 hours. the NRLS where there is a degree Lessons learnt are also discussed In order to address this shortfall of harm or where an actual impact at the Learning from Incidents and all induction, clinical mandatory of long term harm has occurred Risk Incident (LIRC) Committee and specific incident reporting to the patient. All grade 4 and held monthly. The LIRC Committee and investigation training 5 patient safety incidents are has also initiated project group incorporates the importance of investigated within the Serious working to review and make contemporaneous reporting. The Untoward Incident (SUI) process. recommendations in relation message being communicated There have been a total number to the four key areas of concern is that if an incident has occurred of 89 SUI’s in the last financial year, for patient safety incidents, i.e. action needs to be taken which is an increase of 50 from last pressure sores, medication errors, promptly to prevent a recurrence year, of these 39 met the criteria of incorrect labelling of samples and especially if the incident has being externally reported on the patient falls. All completed SUI resulted in severe harm or death. Strategic Executive Information reports are published on the Trust All incidents graded at level 3-5 System (StEIS) and are monitored intranet site so that any member also automatically initiate a Root by the commissioners. Following of staff can access and use this Cause Analysis (RCA), which completion of the investigation documentation as a learning identifies immediate actions report the recommendations experience. Links with the Learning taken, recommendations for and action plan are monitored. and Development Team have improvement or change and been adopted so that training shared learning across the and development can be tailored organisation. around real life incidents and patient experiences. The Trust’s In 2013/14, there were 44 incidents (0.35% of all incidents reported) that were graded as “Links with the Learning and Development serious/severe harm/death. This is an increase on the 2012/13 figure Team have been adopted so that training of 25 incidents. and development can be tailored

The number of patient safety around real life incidents and patient incidents that resulted in the experiences...”

Page 22 Blackpool Teaching Hospitals NHS Foundation Trust Simulation Centre continues to 26 Lead Trainers that are now from previous versions except undertake training sessions where attached to areas of practice so where clarification has been made staff who were involved in the that they can help to support new around the definition of ‘Retained incident have the opportunity to TalkSafe practitioners in holding foreign object post procedure’. The re-enact the scenario, reflect on the the safety based conversations. never events list provides a lever events and evaluate what went There are both cultural and for those in the NHS to improve wrong and why. Feedback from practitioners sessions available patient safety through greater staff has been extremely positive, for all members of staff across the focus, scrutiny, transparency especially with those staff who Trust. and accountability when serious have been involved in an incident patient safety incidents occur It where a patient was severely Staff Trained in TalkSafe provides healthcare workers, harmed or died. Conversations clinicians, managers, board and 2011-12 2012-13 2013-14 accountable officers with clarity Engagement of the patient and about their responsibilities, in their relatives is very important 20 220 331 particular clear guidance on what not only to the Trust with an is expected in terms of preventing open and honest culture, but In order to help facilitate the never events and the response if as a healing tool. Patients and release of staff to undergo the they should occur. relatives are informed when an training, it has been reviewed incident has occurred and that an for 2014. These are now two Incidents are considered never investigation is to be undertaken. half day sessions available, one events if: In some cases, they are asked that explores the safety culture • The incident either resulted in for their versions of events and within the organisation and the severe harm or death or had the this is reflected within the report. other that allows staff to become potential to cause severe harm Following completion of the TalkSafe practitioners. or death. investigation report they are • There is evidence that the never given the opportunity to discuss Never Events event has occurred in the past the findings, recommendations Never Events are serious, and is a known source of risk for change and actions taken to largely preventable patient (for example through reports prevent further occurrence. safety incidents that should to the National Reporting and not occur if the available Learning System or other serious TalkSafe Initiative preventative measures have incident reporting system). TalkSafe aims to gain been implemented by health • There is existing national commitment to the behaviours care providers. None have been guidance or safety required to truly champion reported in the last financial year. recommendations, which if patient safety ensuring that the This is a measure of the concerted followed, would have prevented Trust has the highest possible effort and focus of those working the incident from occurring. patient and staff safety standards. within the Organisation towards • Occurrence of the never event The concept has been used in embedding patient safety. can be easily identified, defined industry in many years and has and measured on an ongoing clearly demonstrated an impact There was one ‘Never Event’ basis. on an organisation’s safety culture. incident reported by the Trust at There is very strong evidence that the end of the 2013/14 financial the safest companies in the world year, which is being investigated Quality - Our all use an approach emphasising under the Serious Untoward creation of a positive safety Incident investigation process. Patients culture through management leadership together with assisted New guidance was issued from A more detailed report in relation on the job risk assessments the Department of Health in to quality and safety in patient using the vehicle of personal December 2013, which details care is outlined in our Quality behavioural safety conversations. the criteria list of 25 never events. Report at Annex A. Across the Trust, we now have The document is unchanged

Page Annual Report and Accounts 2013/14 23 Our Staff

During 2013/14, the Trust had a number of key workforce initiatives under the Quality, Innovation, Productivity and Prevention programme order to deliver the Trust’s share of NHS efficiency savings requirement.

Our staff are an integral part of delivering our vision as an organisation to deliver top quality patient care, excellent education and world class research. Our aim is to deliver success through our people. We understand the importance of having all our people focused on excellent outcomes, staff who care, teach and research, managers who manage and leaders who lead. “Our staff are an integral part of delivering As an organisation we want to: our vision as an organisation to deliver top

• enable staff to deliver of their quality patient care, excellent education best and world class research...” • care for people who care • work in partnership to deliver focused, proven workforce This is the same as the previous Our staff engagement score is practices year and places us in the average 3.79 compared with a national • ensure our workforce is focused category for returns. Overall, average for acute trusts of on delivering excellent patient the responses to the survey 3.74. This engagement score is care. are very positive and show no calculated from 3 Key Findings: material change compared to We strive to be the Trust of choice the 2012 results. The survey was • KF22: staff ability to contribute for both our patients and our staff. undertaken between October towards improvements at work We are driven by our belief that an and December 2013, the results – highest (best) 20%. engaged and flexible workforce were formally published by the • KF24: staff recommendation of who are valued and supported Care Quality Commission in the trust as a place to work or deliver safe, effective and personal February 2014. The survey is receive treatment – average. healthcare for every patient, every an annual survey which seeks • KF25: staff motivation at work – time. the views of staff on a variety highest (best) 20%. of questions including their experiences of staff satisfaction, Out of 28 Key Findings the Trust training, line management, was found to be: Staff Survey appraisals, work related stress, violence and abusive behaviour • in the best 20% of Trusts What our staff said:- and making a difference to nationally for 13 out of the 28 In our 2013 survey we maintained patients. key findings, our response rate, achieving 49%. • above/better than average for

Page 24 Blackpool Teaching Hospitals NHS Foundation Trust seven out of the 28 findings, us to engage with more of and our employees via additional • average for eight out of the 28 paper based surveys plus our key findings. second year participating via an on-line version. The Trust “Picker, enabled The Trust did not have any elected therefore to undertake negative findings (i.e. were not a further 200 paper surveys us to engage in the worst 20% of acute Trusts, and 1000 on-line surveys. The with more of our were not worse than average, nor combined participation rate for significantly worse than 2012). 2013 was 47% with a total of employees via 938 completed surveys being additional paper Based upon the NHS England processed (478 paper and 460 on- requirements the Trust issued line). In 2012 a total of 981 surveys based surveys...” 800 paper surveys. However, our were completed (480 paper and Survey supplier, Picker, enabled 501 on-line).

2012/13 2013/14 Trust Improvement/ Survey Questions % % Deterioration National National Response Rate Trust Trust Average Average 49.9% 45.6% 47% 46.9% 2.9% Deterioration*

2012/13 2013/14 Trust Improvement/ Survey Questions % % Deterioration National National Top 5 Ranking Scores Trust Trust Average Average Percentage of staff experiencing discrimination at work in last 12 11% 11% 7% 11% 4% improvement months Percentage of staff working 64% 70% 62% 70% 2% improvement extra hours Percentage of staff agreeing that their role makes a difference to 91% 89% 94% 91% 3% improvement patient care Percentage of staff experiencing physical violence from staff in 2% 3% 1% 2% 1% improvement last 12 months Percentage of staff appraised in 93% 84% 92% 84% 1% deterioration last 12 months

NHS England base their participation rate on the paper *In 2013 the opportunity for all staff to participate in the survey, via the newly surveys only, and the Trust created HR portal was available. Take up achieved a participation rate of in 2013 was extremely low, however as 48.5% in 2013 which compared familiarisation with the Portal grows across favourably with the national acute the Trust, it is hoped that this will increase rate of 48.7%. in 2014.

Page Annual Report and Accounts 2013/14 25 Staff Survey Results Staff Survey Results Trust Improvement/ Survey Questions 2012/13 2013/14 Deterioration % % National National Bottom 5 Ranking Scores Trust Trust Average Average Percentage of staff reporting errors, near misses or incidents 91% 90% 90% 90% 1% deterioration witnessed in the last month Staff recommendation of the trust as a place to work or 3.65% 3.57% 3.65% 3.68% No change receive treatment Percentage of staff experiencing physical violence from patients, 15% 15% 15% 15% No change relatives or the public in last 12 months Percentage of staff experiencing harassment, bullying or abuse 27% 30% 29% 29% 2% deterioration from patients, relatives or the public in last 12 months Percentage of staff having well structured appraisals in last 12 36% 36% 38% 38% 2% deterioration months

Actions to Address Areas of Concerns It is extremely encouraging that the Trust has been able to achieve an overall position of above average. However in order to maintain and improve this position over the coming year it is essential that the Trust achieves ongoing improvements aligned to anticipated changes and challenges for the future. As such the priorities for • Continuously improve To support the priority actions, action for 2014/15 are as follows: knowledge and timely use of the Trust will introduce quarterly error and incident reporting surveys to measure staff • Continuing to engage and systems resulting in real time satisfaction which will incorporate involve staff at all levels to be organisational learning the nationally required Staff proud of the Trust, reflected in • Continue to support staff Friends and Families test. This data their willingness to recommend development, health and will also be used to support wider it as a place to work and receive wellbeing quality, safety and productivity care requirements and achievements.

Page 26 Blackpool Teaching Hospitals NHS Foundation Trust Engaging with our Staff

Blackpool Teaching Hospitals NHS Foundation Trust continues to engage with staff and has held a number of Big Conversations with staff across both community and hospital to develop refreshed Trust core values that will be launched in 2014/15 and integrated with our HR processes. Our aim is to be a high performing organisation delivering high quality and compassionate care and our values and behaviour framework has been developed and tested with staff throughout 2013. Staff survey results demonstrate that the trust scored better than average for staff engagement in 2013 with a score of 3.79 (which is comparable with the 2012 score) and the trust was in the top 20% for staff feeling that they could contribute to improvements at work and also feeling motivated. In 2014 we will work hard to ensure that more staff would recommend the trust as a place to work through focusing on our values and behaviours and a broad clinical “Our aims is to be a high performing engagement strategy. organisation delivering high quality We will continue to engage and compassionate care and our with our staff to seek feedback both corporately and also at a values and behaviour framework has local level, particularly around been developed and tested with staff ideas to improve quality, safety, innovation, productivity and throughout 2013...” prevention.

We have well-established partnership working with trade unions and professional organisations that play a key role in ensuring the future success of the Trust. We will continue to build on and strengthen partnership working going forward.

Page Annual Report and Accounts 2013/14 27 The coming year will see a service users Equality Delivery System major focus on how we can best • Improving support (EDS) public consultation and engage with staff across the mechanisms for people with engagement event in March Trust, including improving our learning difficulties when 2014 at venues in Blackpool and internal communication methods, attending hospital Lancaster. The report from the launching a series of listening • Introducing Health Passports consultation will be submitted events, delivery of appropriate for people with a learning later in the year around May. training to support improved difficulty The outcome of the EDS will engagement, creating a better • Understanding the needs continue to influence which of the experience for our staff and of minority/hard to reach equality objectives require further ultimately our patients. groups and making healthcare attention or adjustment. accessible Equality and Diversity The Trust continues to review Policies Promoting Equality how best to support all patients There are a number of policies and Diversity and service users, irrespective of that come under the equality and any protected characteristic they diversity heading, all of which Equality and Diversity (E&D) is may have to ensure we meet their are monitored and reviewed an important part of the Trust’s needs. on a regular basis. New policies overall work to improve service are introduced as required, for provision. The Trust’s Equality Equality Objectives example, a new policy written this Objectives are now part of the The Trust Equality Objectives year was ‘Gender Reassignment: overall business objectives, are monitored by the Trust’s Support in the Workplace’. The showing the commitment being Equality Diversity and Human adaptation of the Trusts Equality given to equality and diversity Rights Steering (ED&HRS) Analysis Procedure has been across the Trust. The Public Sector Group. Following the outcome very successful. The questions Equality Duty expects all public of the 2013 Equality Delivery in the initial assessment make sector organisations to promote System (EDS) public consultation staff think differently about the equality and diversity by: and engagement event the impact policies and procedures objectives were reduced from etc have across all the protected • eliminating discrimination, eight to two. The ED&HRS group characteristics. In turn this harassment and victimisation made the decision to focus on provides the Trust with continuing • advancing equality of two objectives that had been evidence on its work to reduce opportunity graded from achieving down to discrimination and increase • fostering good relations developing at the consultation. inclusion for both service users between people who share a By amending the equality and staff. protected characteristic and objectives it provides the ideal those who do not share it. opportunity for the Trust to focus The Trust operates the Two on areas perceived to require Ticks symbol whereby anyone Some of the ongoing work improvement. EDS continues who discloses a disability during includes: to assist the Trust to meet the application and meets the following requirements: essential criteria of the person • Butterfly Project to assist specification, is automatically patients with Dementia • Compliance with the Public shortlisted. The Trust does • Memory Wall and Boxes to Sector Equality Duty not monitor as a specific assist patients with Dementia • Deliver on the NHS Outcomes requirement the numbers of staff • Using yellow paper for Framework who become disabled during appointments assists people • NHS Constitution for Patients their employment. The Trust’s with sight impairments and Staff Equality and Diversity Lead • Larger font on correspondence • CQC Essential Standards assists in supporting staff by • Emailing correspondence working with managers and our to blind or visually impaired The Trust will hold its third Occupational Health to ensure

Page 28 Blackpool Teaching Hospitals NHS Foundation Trust we provide the right support all staff have an equal ability to held its fourth E&D conference and reasonable adjustment. We apply and be considered. in October 2013 and was again a use our capability/management resounding success bringing new of absence procedures along Equality Diversity and knowledge and perspectives of with reasonable adjustments Human Rights Training E&D issues to Trust staff. to ensure an employee who Equality and Diversity (E&D) becomes disabled can remain in continues to be part of the Table: Summary of employment. This would include Trust’s induction and mandatory Performance – Workforce the consideration of training for training programmes to maintain Statistics - Tina Daniels suitable alternative roles. The awareness and emphasise the Trust does not offer any specific From analysis carried out between importance of E&D in all aspects training for staff that may become data collated on the makeup of of employment and service disabled, but utilises the support the local community and that provision. The training includes: and advice of our Occupational of staff employed, the Trust is Health Service to introduce reflective of the community it • E-learning modules adjustments as recommended, serves. • Rolling programme of monthly facilitating an employee to remain workshops covering additional in employment. The advice of The table on the next page areas e.g. Learning Disabilities Access to Work is also sought and identifies the breakdown of staff and Sexual Orientation the recommendations from their groups for April 2013 to March including issues faced by older reports are implemented. 2014. people. • Deaf and Disability Awareness The Trust does not have a specific The results of the staff survey • Transgender issues policy on career development or showed that 90% of staff reported promotion for disabled people, having received E&D training Since its inception in February but by operating a positive or updates which is a further 2011 the Staff Equality and culture ensures we never unfairly improvement on our 2012 survey Diversity Network has trebled in discriminate and maintain this results. This is a key priority for membership. The enthusiasm ethos in all that we do. Career the Trust and E&D updates form of the group continues to reflect development / promotion part of mandatory training as well the importance that staff view opportunities are subject to our as being part of the Induction equality and diversity from both equal opportunities procedure Training. We expect to continue an employee and service user and required to be advertised so improving in this area year on perspective. The Staff E&D Group year.

“...by operating a positive culture ensures we never unfairly discriminate and maintain this ethos in all that we do...”

Page Annual Report and Accounts 2013/14 29 Full Time Organisation Ethnic Origin Equivalent Headcount (FTE) 0 White 8.90 11 4 Indian 5.20 6 5 Pakistani 2.00 2 7 Chinese 8.47 9 9 Not given 0.00 1 A White - British 4,850.32 5,714 B White - Irish 32.84 38 C White - Any other White background 90.96 98 C3 White Unspecified 0.51 1 CA White English 1.00 1 CB White Scottish 0.53 1 CFWhite Greek 1.00 1 CK White Italian 2.00 2 CP White Polish 7.09 7 CY White Other European 17.00 17 D Mixed - White & Black Caribbean 6.27 7 E Mixed - White & Black African 2.67 3 Blackpool F Mixed - White & Asian 9.41 11 Teaching G Mixed - Any other mixed background 7.80 9 Hospitals GC Mixed - Black & White 1.00 1 NHS Foundation GF Mixed - Other/Unspecified 1.60 2 Trust H Asian or Asian British - Indian 106.87 112 J Asian or Asian British - Pakistani 30.13 31 K Asian or Asian British - Bangladeshi 2.53 3 L Asian or Asian British - Any other Asian background 40.49 44 LA Asian Mixed 1.00 1 LE Asian Sri Lankan 1.00 1 LH Asian British 1.00 1 LK Asian Unspecified 2.00 2 M Black or Black British - Caribbean 6.00 6 N Black or Black British - African 15.78 17 P Black or Black British - Any other Black background 2.00 2 R Chinese 7.03 10 S Any Other Ethnic Group 53.62 58 SC Filipino 15.80 16 SD Malaysian 2.00 2 SE Other Specified 7.60 8 Undefined 17.85 183 Z Not Stated 203.39 251 Total 5,572.67 6,690

Page 30 Blackpool Teaching Hospitals NHS Foundation Trust The Trust’s Equality Diversity and medical positions but has made messages into on-boarding Human Rights Steering Group, steady progress in filling key material so there is a feeling of chaired by the Director of Human vacancies, however there is still consistency for the candidate Resources and Organisational much to do. We have extended throughout the employee life Development, has an inclusive our searches internationally and cycle. membership reflective of been successful in recruiting the protected characteristics qualified nurses from Spain There is still a great deal to do including representation from and Portugal. There has been in this regard as the NHS has Trust staff, partner organisations significant investment by the Trust similar challenges so we need to and patient groups. to increase Consultant numbers work on promoting the Trust as to the establishment and in the employer of choice and fully Priorities for 2014/15 include: support of this a recruitment express the opportunities for staff • Continued compliance with campaign was developed in in working within an integrated the Equality Act 2010 and NHS response to stakeholder feedback organisation offering many career Regulation Framework about the potential barriers to opportunities across acute and • A fifth Trust E&D conference for attracting individuals to work for community care. We need to 2014 the organisation. The ‘Change work with our current staff who • Progress area requiring Your Landscape’ campaign www. have committed their working development as highlighted in changeyourlandscape.co.uk lives to Blackpool and share their the 2014 EDS report has been designed to challenge experiences with prospective • Prepare for the third submission people’s thinking through images recruits. to the national Equality Delivery and words, as well as celebrate System (EDS) the significant investment the We need to focus our attention • Hold the third EDS public Trust has made to improve equally on the retention of our consultation and engagement delivery of services. It challenges staff to ensure we are providing event with service users what Blackpool is and what it the necessary support during • Continue to develop and isn’t and guides people to make their 'on-boarding' to the Trust expand the work undertaken connections between locality, but also through their transition for EDS lifestyle, personal aspirations and into their role. We launched an • Continue work to improve shaping patient care. electronic exit questionnaire working/service practices for during 2013/14 which has been staff and service users who are The campaign has resulted in well received and the completion hearing impaired a good number of applications rate has been high thus enabling • Continue working to develop in specialties where the Trust us to examine common trends practices for staff and service has historically struggled to and themes that we need to users who are sight impaired recruit to, and also increased the proactively respond to. • Review E&D training to number of applicants in other identify gaps in knowledge specialities providing more and understanding regarding choice for the organisation. It has protected characteristics also proved significant in raising Developing our Staff • Increase social value (ongoing) morale amongst existing staff, During the year we continued by improving links with local as it highlights the positives to to make improvements in the schools, Fire Service, Police working for and in Blackpool, and ways we support our integrated gives a valuable tool for others to workforce in learning and spread this message. continuous development, which we believe are key to delivering Recruiting and It is the intention to build on this quality patient centred care across further by using materials to Retaining the Best the Trust. We continued to offer a promote jobs internationally, and range of leadership development Staff use the imagery at Recruitment and learning opportunities to all Fairs. We are also keen to Blackpool has faced challenges staff at every level throughout incorporate the images and in recruiting to nursing and the organisation. Our clinical

Page Annual Report and Accounts 2013/14 31 improvements in individual participants performance, behaviours, self awareness, service improvements and levels of success • Improvements to confidence and wellbeing were also evident

We were very proud in 2013 to win the prestigious national HPMA award for our coaching culture, which we introduced to help embed our engagement strategy and improve performance through increased self-awareness, confidence and performance. Our in-house coaches are now able to complete an accredited programme in-house through “We need to focus our attention equally on CETAD and we have continued the retention of our staff to ensure we are to train line managers as coaches to help our staff maximise their providing the necessary support during potential and performance. their ‘on-boarding’ to the Trust but also During 2013, we launched our through their transition into their role.” Patient Experience Revolution ‘Compassionate Care through leadership programme aimed at programmes being accredited Compassionate Attitudes’ clinical and non-clinical leaders through Centre for Training & training programme across the is now in its fourth cycle and Development (CETAD) which is Trust. The overall purpose of has received excellent reviews. Lancaster University’s work based this programme is ‘To create the Leaders on the programme are learning arm. An evaluation study environment and commitment introduced to the latest thinking of the new and junior leadership for caring so that high quality on leadership practice, gain an development programme patient care can thrive in the Trust’. overview of their own leadership identified the following impacts: We were delighted when this styles and personality preferences, was highlighted as good practice and learn techniques to problem • 99% of delegates have from the Keogh review team who solve alongside techniques improved their knowledge and spent a week looking at patient to engage and motivate their skills in the workplace overall safety. We have trained 1,015 teams. The skills required to lead with 99% of delegates applying staff in 2013/14 and the results local and organisational change their learning back in the have been very positive with over programmes, manage projects, workplace 90% of those who attended the and lead service improvement • Key areas of improvement training using the skills either are equally high on the learning included motivating most or some of the time. Those agenda. others, influencing others, units who had a high number of communication styles, giving staff trained all report a higher In addition, the development of and receiving feedback, than peer average friends and team leaders, supervisors and empathy, emotional family test result. first line managers has been well intelligence and self awareness established with our in-house • Line managers cited

Page 32 Blackpool Teaching Hospitals NHS Foundation Trust The specific objectives centre on the three areas of Self, Team and Patient. To encourage and support your care of YOURSELF so that you can fulfil your dedication and vocation of caring for others • Develop your self-awareness and understand the need for caring for yourself Self • Understand a significant cause of stress and pressure • Enhance your capability to deal with stress and pressure • Increase your commitment to caring for yourself To encourage and support your care of MY TEAM so that you can fulfil your dedication and vocation of caring for others Team • Develop your understanding of what creates great teamwork • Enhance your capability to practice as a great team member • Increase your commitment to caring for your team To encourage and support your care of PATIENTS and their CARERS so that you can fulfil your dedication and vocation of caring for others Patient • Develop your understanding of what creates great patient care • Enhance your capability to practice as a great carer • Increase your commitment to caring for your patients

“Our evaluation of appraisals in 2013/14 has identified some top tips for the future and our training for 2014 will be targeted...”

Once again improving the uptake for 2014 will be targeted and was established this year and of appraisal has been a core will include advice to managers work will continue to ensure staff theme and we continue to work who have more than 12 staff to are able to complete training to achieve the target of 90%, but appraise in the window. requirements’ in a more timely our year end performance was and convenient way, allowing 82%. Our goal is to ensure that Mandatory training is also a key a more blended approach to not only are appraisals taking target which unfortunately we learning. place, but that they are of a good failed to achieve during 2013/14, standard. This needs to be our 79% were recorded as having Induction is a key time in the life focus going forward and we will undertaken all the required cycle of our employees as it helps continue to audit the quality of modules of mandatory training to welcome staff as well as embed appraisals that have taken place against a target of 90%. There our values and behaviours. and provide support where has been a review of mandatory Following a review of the content there is room for improvement. training to ensure a flexible and attendance, the team have Our evaluation of appraisals in approach which allows staff to improved induction compliance 2013/14 has identified some top access the training in a range of to 85% and will launch a revised tips for the future and our training ways including ELearning which programme in April aligned to Page Annual Report and Accounts 2013/14 33 “Our Practice Education team works closely with the universities and in practice, to ensure a high quality learning experience for student nurses...”

our revised values. We plan to We are accredited Investors in o achievement of a patient test effectiveness through focus People Gold and underwent a safety award groups of recent recruits on an diagnostic exercise with Investors o 90%+ VTE compliance ongoing basis. in People in November 2013. This o improvements in staff survey diagnostic exercise indicated scores We have been able to offer a that the broad principles of the o reductions in sickness range of education, training and Investors in People Framework are absence development opportunities being met. A number of positive o achievement of a Best that underpin workforce and features emerged from the review, Communications Team in the organisational development. not least the fact that: NHS Award These opportunities are available o achievement of a national to all staff groups often in • a significant amount of coaching award partnership with universities, progress has been made on o A&E performance that ranks colleges and other education the harmonisation of people amongst the best in the providers. Our Practice Education management processes across country team works closely with the all areas of the Trust o a score of excellent across all universities and in practice, to • staff perceive that there has areas in the PEAT inspection ensure a high quality learning been real progress in terms experience for student nurses. of the integration of the three These results are testimony Trusts to the effectiveness of people Current challenges demonstrate • Moreover, a key characteristic of management strategies, and that the Trust needs to increase high performance workplaces indeed to the knowledge, skills leadership and management is the achievement of and dedication of the workforce. capacity and competence in desired results. Through the The above outcomes are given order to improve organisational documentary submission, additional resonance given effectiveness and productivity presentations and interview that they have been achieved through the pursuit of an feedback a wide range of against a backdrop of significant engagement culture. It is fair to outcomes were highlighted challenges such as: say that more emphasis needs in relation to quality, safety, to be placed on accountability, people, delivery and • changes in senior leadership competency and performance environment. positions ensuring that everyone is clear • These included: • the Keogh Review on expectations and receives o improvements in National • financial pressures identified necessary support, Patient Survey scores • the ongoing integration project but, importantly understands the o lowest ever infection rates consequences of non-delivery. o Information Standard accreditation

Page 34 Blackpool Teaching Hospitals NHS Foundation Trust Knowledge and Library Services

The Blackpool Knowledge and Library Service continues to support effective patient care by ensuring access to information and evidence for clinical and managerial decision making, research and innovation, staff development, and clinical governance.

Building upon its current links with other organisations in the academic and healthcare services continue to support sectors, the Library has renewed evidence based practice and its Service Level Agreement clinical decision making in both with the University of Central an acute and community setting, Lancashire and has formed a thereby improving productivity, new partnership agreement “...the Library optimising resources, and with the Public Health domain of is working with supporting staff in the delivery of Blackpool Council. better care for our patients. community-based As part of its Learning and Development Agreement with teams to develop an the NHS North of England, the outreach function Staff Trust is required to submit an Communication annual self-assessment against that will provide the national standards contained remote access The Trust communicates, informs in the Library Quality Assurance and involves its staff on key issues Framework. The standards to services and such as quality, safety, finance are designed to help develop information skills and performance via a number of high quality knowledge and methods. library services that enable the training for staff...” entire workforce to access the Staff from across all areas of the evidence base and acquire to services and information skills Trust are invited to a face-to-face the skills to use, evaluate, and training for staff. Additionally, monthly Team Brief, where the implement evidence in clinical the Library is developing its links Chief Executive and members of and management decision with the Risk Management team the Executive Team brief staff on making. We are pleased to report and, going forward, will provide the key decisions that have been that in 2013 the service scored information regarding evidence made at the Board of Directors’ 94% following validation, which based practice to those areas meeting, and update staff on is above the regional average of within the organisation where developments within the six areas 91%. learning opportunities have of our vision – Quality, Safety, been identified through incident Delivery, People, Environment and In alignment with the Trust’s reporting. Cost. strategy for delivering integrated services, the Library is working We look forward to working with This meeting is podcast and with community-based teams our colleagues to ensure that made available to all staff who to develop an outreach function knowledge and information were unable to attend and is also that will provide remote access

Page Annual Report and Accounts 2013/14 35 available in a written document on the intranet and is emailed out to all staff within the organisation. Staff are given the opportunity to ask questions and give feedback “Occupational Health continues to offer on these issues. There is also a rumour board where staff can a variety of health initiatives to support raise questions anonymously if staff to be empowered to manage their they wish to. own health by accessing therapeutic interventions, healthy lifestyle checks, weight Sickness Absence management and exercise classes...” Work continues within the Trust to pro-actively manage and support early indication is that the service that are required. Divisions the absence process. has been well received and this continue to monitor absence will be evaluated towards the compliance on an ongoing basis Increased focus has been placed end of the initial 12 month period through monitoring of reports on the importance of entering to determine whether further and through regular meetings accurate absence reason codes funding for the service will be with line managers to guide and on both the E Rostering and web sought. Occupational Health support them in compliance to data entry systems to enable continues to offer a variety of the absence policy with support trend analysis and monitoring. We health initiatives to support staff as appropriate from Occupational are striving to improve the quality to be empowered to manage Health. Long term sickness cases of data input to enable more their own health by accessing are also monitored closely across detailed analysis of the reasons therapeutic interventions, all divisions and appropriate reported for absence to identify healthy lifestyle checks, weight supportive discussions and areas requiring closer scrutiny and management and exercise classes. actions are taken in a timely to identify targeted interventions Mindfulness taster sessions have manner. to reduce sickness absence. been introduced and all courses have been fully subscribed. Sickness absence for the year The Occupational Health 2013/14 ended slightly higher Department launched a new The Trust Sickness Absence policy than the previous year on 3.92% Physiotherapist service in has been reviewed and this was as detailed in the table below. February 2014 as a 12 month trialled within the Unscheduled However, it is envisaged that pilot for staff to ‘self refer’ into the Care division over the last six with concerted effort the Trust service. It is anticipated that this months of 2013. The evaluation will achieve or improve on the will help act as a preventative report was submitted to the new 3.5% target for 2014/15, treatment and support staff to JNCC meeting recently and helped by the introduction of remain in work through early it was agreed that the policy the harmonised Attendance intervention (who may have would be implemented Trust- Management policy across the previously gone off sick). The wide following some revisions Trust.

Overall Trust Sickness Absence Rates Year Sickness Absence Results 2009/2010 4.47% 2010/2011 4.23% 2011/2012 3.52% 2012/2013 3.85 % 2013/2014 3.92%

Page 36 Blackpool Teaching Hospitals NHS Foundation Trust The table below details national sickness absence data and the figures given are for the calendar year.

Statistics Produced by IC from ESR Data Figures Converted by DH to Best Estimates of Required Data Warehouse Items Quarterly Sickness Absence iView Staff in Post Publications National Average FTE-Days Lost to Average Sick Days of 12 Months (2013 Average FTE 2013 FTE-Days Available Sickness Absence per FTE Calendar Year) 4.24% 1,050,781 33,815,725 1,410,395 9.5 Improving the Health and Well- being of our Staff “As a core part of our staff wellbeing offer, A healthy energised workforce is good for the Trust and for we have continued to offer subsidised the care of our patients. We are committed to maintaining health activities including Zumba, Yoga and improving the health and and Slimming World...” wellbeing of our staff and run a variety of services and activities to encourage people to take As a core part of our staff in April 2013. The Professional responsibility for their own health wellbeing offer, we have Regulator, the General Medical and wellbeing. continued to offer subsidised Council (GMC) expects all doctors health activities including Zumba, working in the Trust will be The workplace health and Yoga and Slimming World. revalidated by March 2016. The wellbeing department retained Trust has made recommendations its Safe Effective Quality The department also offers for 20% of doctors in 2013/14. Occupational Health Services services to a number of external We are expected to make (SEQOHS) accreditation during organisations which provides recommendations for 40% of our 2013/14 which is put simply a additional income that is doctors in 2014/15 and 2015/16 quality assurance standard for reinvested into the service and the respectively and thereafter the Occupational Health providers. Trust for the benefit of our staff. process will continue as per Our seasonal flu campaign regulation. achieved an uptake of 71% and we were shortlisted by NHS Employers at the Flu Fighters Medical Revalidation awards. The team implemented an electronic management The process of revalidation is to referral process to ensure timely assure patients and the public, referrals and improvement of our employers and other healthcare service to managers. professionals that licensed doctors are up to date and practicing In order to improve services for to the appropriate professional our staff we have now introduced standards. The revalidation a physiotherapist to the team to process was approved by the support our staff with musculo- Secretary of State in December skeletal problems to facilitate 2012, and the local process of them to gain more timely access. implementation commenced

Page Annual Report and Accounts 2013/14 37 Breakdown of Staff place both to work and to receive the year; this is an excellent result treatment. The chart below shows bearing in mind additional activity As at year end the breakdown of how our performance is in relation and some bad weather which directors, other senior managers to slips, trips and falls incidents and increases the risk of falling during and employees by male and sharps / needlestick incidents. The the winter months 2013/14. The females categories is indicated in year has seen a slight increase in Trust dress-code policy was revised the table below:- the number of injuries related to to include guidance on suitable moving and handling. Together footwear and this has clearly been these make up the top three instrumental in the reduction of Breakdown of Staff as at 31st incidents reported annually. There this type of injury. March 2014 has been a decrease of 17% in Male Female needlestick injuries from 108 to 90. There is overall a slight increase Directors and on reporting of Health and Safety other senior 8 6 Moving and handling incidents incidents, this increase should managers* have shown an increase of 10%, be judged against the current Employees 1390 5325 an increase of 10 injuries over amount of staff employed within the previous year. The use of the Trust due to integration with * Directors and senior managers comprises better manual handling aids the Community Trusts (NHS Executive Directors and Non-Executive has helped keep the increase Blackpool and North Lancashire Directors in post at 31st March 2014 as to a low level, but this increase Primary Care Trust). Ongoing work disclosed in the Remuneration Report. must be judged against more continues to effectively reduce patients being treated, many with the number of incidents and drive mobility problems in the Trust, forward a pro-active health and Health and Safety and the decrease in the number safety culture across the Trust. – A Safe Working of bariatric patients being treated, which cause staff problems when The graph below details reported Environment having to move or assist them Health and Safety, Security and with their mobility. Violence and Abusive Incidents Over previous years, with continual 1st April 2013 to 31st March 2014 improvements being introduced, Slips, trips and falls have decreased compared with 1st April 2012 to the Trust has developed into a safe by 3.5%, down by 4 incidents over 31st March 2013.

Health and Safety, Security and Violence and Abusive Incidents April to March 2012/13 and 2013/14

201 Security Issues 200

373 Violent/Abusive Incidents 307

110 Moving and Handling Incidents 100 Categories

108 Slips, Trips and Falls 112

Clinical Sharp Injuries 112 136

2013/14 2012/13 0 50 100 150 200 250 300 350 400 Number of incidents

Page 38 Blackpool Teaching Hospitals NHS Foundation Trust Security Management The security of staff, service “Blackpool Teaching Hospitals NHS users, carers, relatives, visitors and property is a key Trust priority. Foundation Trust is committed to The delivery of high levels of safety and security is critical to the improving the environment and sense of delivery of the highest possible overall personal security for those who standards of clinical care and Blackpool Teaching Hospitals NHS access our services and for those who Foundation Trust is committed to provide those services...” improving the environment and sense of overall personal security for those who access our services and for those who provide those services. forward within the Trust, helping delivered without fear of violence to deliver an environment that is and aggression. One of the key areas of work for safe and secure for both patients the Local Security Management and staff. Constant development The number of verbal abuse and/ Specialists (LSMS) is working to in incident reporting, action or aggressive incidents reported reduce violence against NHS planning, risk assessment and between 1st April 2013 and 31st staff, and a key part of this is to ongoing monitoring ensures that March 2014 were 373, compared constantly measure the scale all safety risks within the Trust, to 307 reported incidents in the of the problem. All staff are including property assets, staff previous financial year, showing encouraged to report any incident and patient safety, are protected, an increase of 21.4%. The A&E to enable changes to be driven thereby allowing care to be Department accounted for 17%

Page Annual Report and Accounts 2013/14 39 (63 reported incidents) of all or damage to staff or patients’ alert is activated. We are delighted violence and aggression reported personal property. that the NHS lone worker service across the Trust. introduced into the Trust was a We are committed to ensuring winner at the National Personal Wherever possible the Trust seeks that Trust staff are properly Safety Awards 2010. This award to minimise risk by deterrence, all protected and appropriate recognises those who have security related incident reports training is received. Conflict helped people to stay safe from are reviewed by the LSMS on a Resolution Training, with the violence and aggression, and weekly basis and investigations addition of Breakaway Techniques demonstrated best practice in the instigated as appropriate and, if Training, and Security Awareness field. required, a review undertaken of Training is being rolled out to all any security measures in place for front line staff. Conflict Resolution The Trust CCTV working group effectiveness. theory is also included as part of continues to oversee and develop the Corporate Induction. the Closed Circuit Television The Trust employs a security team (CCTV) monitoring system, for for the Blackpool Victoria hospital The lone worker system the Blackpool Victoria, Clifton site. The team are trained to a high introduced within the Trust has and Fleetwood sites. There standard and form an integral part been continually financially have been some new camera of the Trusts deterrence strategy. supported by the Board of installations during the 2013/14 Directors. The lone worker period which were highlighted as The Trust has a focus on positive device enables staff to be better gaps by the CCTV Working group reporting, giving details of any protected by discreetly calling and they cover what would be security event; these consist of for assistance in a potentially considered critical assets to the physical and non physical assaults aggressive situation. Additionally, Trust. With the improvements against staff; theft or damage this ensures that staff are quickly to CCTV, throughout a number (including burglary, arson, and and accurately located and the of premises, it is anticipated that vandalism) to NHS property or whereabouts and movements of this will improve the chances of equipment issued to staff; theft lone workers obtained when an criminals being caught and act as a visual deterrent to people mindful of committing criminal offences. The security room both monitor and control some 150 cameras “We are committed to ensuring that Trust staff are properly protected and Security audits have been introduced within the Trust by appropriate training is recognised, the Local Security Management Specialists, (LSMS) where visits as a key factor Conflict Resolution to individual departments are Training with the addition of Breakaway conducted so any security/ safety issues can be addressed Techniques Training as well as Security and the LSMS can work with the Awareness Training being rolled out to department to produce its own individual Lockdown Action Card. all front line staff. Conflict Resolution theory is included as part of the Corporate Induction also...”

Page 40 Blackpool Teaching Hospitals NHS Foundation Trust Our Performance

Despite being an extremely busy and met the majority of national and challenging year, the Trust National Quality and local performance targets. delivered on the majority of Standards A summary of our performance national and local performance against key operational targets is targets and standards and has The Trust continued to given below. delivered on a number of strategic deliver excellent operational development initiatives. performance during 2013/14,

Quality Standard 2012/13 2013/14 Cancelled operations - Percentage of operations cancelled Achieved Failed Cancelled operations - Percentage of cancelled operations not treated Achieved Achieved within 28 days Reperfusion: Primary PCI waiting times Achieved Achieved A&E Achieved Failed 18 weeks Referral to Treatment (admitted pathway) Achieved Achieved 18 weeks Referral to Treatment (non-admitted pathway) Achieved Achieved Patient experience Achieved Achieved Cancer diagnosis to treatment waiting times Achieved Achieved Cancer diagnosis to treatment waiting times - Subsequent Surgery Achieved Achieved Cancer diagnosis to treatment waiting times - Subsequent Drugs Achieved Achieved Cancer urgent referral to first outpatient appointment waiting times - GP Achieved Achieved Cancer urgent referral to first outpatient appointment waiting times - Achieved Achieved Breast symptoms Cancer urgent referral to treatment waiting times – GP Achieved Achieved Cancer urgent referral to treatment waiting times - Screening Achieved Achieved Staff satisfaction Achieved Achieved

National Quality Standards Performance in more detail

A more detailed report on our performance is outlined below and in our Quality Report at Annex A.

Page Annual Report and Accounts 2013/14 41 Bowel Cancer Screening Centre The NHS Bowel Cancer Screening “We have established a new clinical Programme (NHS BCSP) in Lancashire has seen one of its and managerial structure within the most challenging years to date since its inception in April 2008, service to ensure we achieve roll with the commencement of out within expected timescales and a new Bowel Scope screening service for participants aged plan to increase publicity and health 55. The Lancashire Screening promotion activity once the initial Centre hosted by Blackpool Teaching Hospitals was successful lists are established...” in a bid to become a first wave Bowel Scope Programme and was the first centre in the North West to start a phased roll out in December 2013 with the first flexible sigmoidoscopy 74 completed its phased roll Since April 2008, we have procedure list being undertaken out in 2011 and has resulted in diagnosed 475 patients with in February 2014 on the increasingly complex patients cancer at an earlier stage. We have Endoscopy Unit at the Blackpool with co-morbidities being also seen an increase in the bowel Victoria Hospital site. assessed. polyps removed from patients who underwent a colonoscopy. The next phase of the roll out During our seven years in Last year, 46 % of patients had will commence in April 2014 operation, the Lancashire polyps removed and in 2013-14 with a further list to be rolled Screening Centre has also this has risen to 48%, therefore out on Thursday evenings at seen nearly 350,000 FOBt kits reducing the risk of cancer in the the Blackpool site. We have returned by participants to the future. established a new clinical and BCSP Regional Hub in Rugby, managerial structure within the Warwickshire. Following the Our clinical teams of Specialist service to ensure we achieve roll processing of these kits, the results Screening Practitioners and out within expected timescales showed that more than 5700 Screening Colonoscopists and plan to increase publicity and participants received a positive continue to participate in health promotion activity once cancer screening result. The joint meetings which are now the initial lists are established. service has continued to produce well established and ensure The service so far has proved quality outcomes in terms of the QA standards are met. The popular with participants and it health benefits for patients taking achievement of these standards is anticipated that we will be fully up the offer of screening within ensures we keep high quality operational across Lancashire our population, especially relating patient care at the forefront of our at Blackpool Fylde & Wyre, East to early detection and treatment service. This will also stand us in Lancashire and Preston sites of cancers. good stead for our forthcoming within 2 years. 3 yearly QA Visit from the North On commencement of the West Regional Quality Assurance In terms of our Faecal Occult programme in 2008, the cancer team, which is due in November Blood Test (FOBt) screening detection rate was seen to be 2014. programme more than 580,000 11% with the rate for 2013-14 at screening invitations have been a level of around 8.33%. This is an sent to GP registered populations. ongoing testament to the early The extended age range up detection and prevention ethos of to and including those aged the screening initiative.

Page 42 Blackpool Teaching Hospitals NHS Foundation Trust Emergency Access Targets

Performance against the 4 hour national standard was strong in Quarters 1 and 2, with performance at 96.4% and 96% respectively. However, in the second half of the year performance had been below the national standard, with performance at 94% in Quarter 3 and 90.67% for Quarter 4. Performance has deteriorated due to higher levels of bed occupancy, which has caused patients requiring an admission to a non- elective bed to wait for a longer period of time in the Emergency Department. An Improvement Plan is in place which is being “We have also approved plans to led by the Unscheduled Care Divisional Management Team. increase the number of doctors and This plan is focused on providing nurses in the Emergency Department more care in the community and reducing bed occupancy to provide timely, effective and to ensure there is adequate compassionate care to patients...” bed capacity available to meet peaks in demand. We have also standardised management and • Stroke approved plans to increase the delivery of patient care and, • Cardiac Chest Pain number of doctors and nurses as a result, improves patient • Acute Kidney Injury in the Emergency Department outcomes and can contribute to provide timely, effective and to a reduction in mortality, A work plan for 2014/15 agreed to compassionate care to patients. hospital complications and address other high mortality areas length of stay. One of the has been developed. reasons for this is they enhance Better Care communication between clinical Data is collected real time and fed staff and clinicians to patients back to clinicians and teams to Pathways by presenting clear plans that allow immediate improvements provide an understanding of to be made. All pathways The Better Care Now project - the treatment and care to be have seen an improvement in pathways stream, was launched in delivered. compliance with the mission August 2013 and links our quality critical points of the pathways, and safety initiatives under one The pathways identified and and there has been a downward umbrella. It has 3 workstreams: developed to date are ones that trend in mortality for pneumonia, impact most on our mortality and sepsis and stroke the first three • Pathways morbidity. Five pathways have pathways to be launched. (See • Waits been implemented to date: table 1 below). It is envisaged • Staffing that the other pathways will • Pneumonia demonstrate this trend when It has been proven that the use • Sepsis mortality figures are released. of clinical pathways supports

Page Annual Report and Accounts 2013/14 43 Table 1 - indicates downward trend in mortality for pneumonia, sepsis and stroke pathways.

Baseline Compliances of 12 month 12 month Launch compliance all mission critical Pathway rolling SHMI rolling SHMI Date of all mission points end Dec Dec 2012 Dec 2013 critical points 2013 Pneumonia 28.08.2013 0% 42.6% 117.57 104.63 Sepsis 25.09.2013 0% 30.34% 122.96 94.82 Stroke 23.10.2013 0% 31.76% 128.4 116.78 Cardiac Chest Pain 20.11.2013 N/A 74.73% 91.4 106.2 Acute Kidney Injury 06.01.2014 0% (1 we 6.1.14) 23.07% N/A N/A

COPD / Diabetes Fylde Coast. Key metrics have of information and data security Improving Diabetes been developed to monitor risks. The HIC is chaired by the Management: progress in COPD management Deputy Chief Executive who is The Trust continues to work across the health economy. The also the nominated Board Lead closely with commissioners and steering group has overseen for Information Governance and partners across the Fylde Coast to the introduction of specific care the Senior Information Risk Owner support the implementation of bundles for End stage COPD, End (SIRO) for the Trust. the new diabetes pathway. This of life care in COPD, Discharge includes drawing up a detailed Care and Early Supported The reporting and investigation model of diabetes care for the discharge. Work is now ongoing of incidents is an integral part of future which includes diabetes to embed these new care all employees’ duties. It applies to care at primary care level (in GP bundles. Acute management of ALL staff and all untoward events Practices), Intermediate care level COPD has been reviewed and a and near misses. Information (in neighbourhood team clinics) new acute care pathway will be Security Incidents are known and complex and specialist care launched in May/ June 2014. as an ‘Information Governance level within the Acute setting. related Serious Incident Requiring Work is underway to ensure Further information on Investigation’ (IG SIRI). As a guide that all appropriate patients performance improvements is this includes any incident which are discharged back to primary identified in the Quality Accounts involves actual or potential failure care management. Pilot sites for at Annex A. to meet the requirements of the intermediate care level clinics are Data Protection Act 1998 and/or the currently being identified. Common Law of Confidentiality. Information The diabetes foot care pathway Using information about the was launched successfully in 2013 Governance and context, scale and sensitivity and this has seen a significant Identifying / of what has occurred IG SIRI’s rise in referrals for review at are categorised into one of the the diabetes foot care multi- Managing Risks following levels: disciplinary team (MDT) clinic. As a result, diabetes foot care provision The Health Informatics Committee 0 - Near miss/non-event. will be reviewed in early 2014/15. (HIC) is responsible for all aspects 1 - Confirmed IG SIRI but no of Information Management, need to report to Information COPD Patients: Information Governance and Commissioner (ICO), The Trust is working in partnership Information Communications Department of Health (DoH) with commissioners and partners Technology throughout the Trust and other central bodies. in the implementation of the known collectively as Information 2 - Confirmed IG SIRI that must COPD pathway across the Management; this includes the be reported to ICO, DoH and identification and management other central bodies.

Page 44 Blackpool Teaching Hospitals NHS Foundation Trust During 2013/14 the Trust has place a detailed report would be Incidents classified at severity level incurred no incidents classified as included in the Trust’s Annual 1 are aggregated and reported in an IG SIRI severity level 2. Should Report. the table below. an incident of this level take

Table: Summary of Level 1 Personal Data Related Incidents 2013/14 Category Breach Type Total A Corruption or inability to recover electronic data 2 B Disclosed in Error 20 C Lost in Transit 6 D Lost or stolen hardware 4 E Lost or stolen paperwork 15 F Non-secure Disposal – hardware 0 G Non-secure Disposal – paperwork 0 H Uploaded to website in error 0 I Technical security failing (including hacking) 1 J Unauthorised access/disclosure 13 K Other 4

The Trust achieved Information 1) Legality of Constitution The Trust has a robust Governance Toolkit (IGT) internal The legality of the Constitution Membership Development assessment compliance score of remains, however, there have Strategy and in October 2012, 82% in 2013/14 compared to 84% been a number of changes/ in agreement with the Trust’s in 2012/13. The IGT submission amendments to the Constitution Council of Governors identified is subject to independent audit, in 2013/14. three key strategic objectives to the Trust’s auditors, KPMG enhance delivery of the strategy. have reviewed the evidence In summary, the amendments The objectives are:- provided as part of the Version relate to the public constituency, 11 submission and provided composition, tenure for • Objective 1:- To build and an overall Moderate Assurance Appointed Governors, conflicts maintain membership opinion in respect of our process of interests for Directors and numbers to ensure of Self Assessment. Governors, and mergers/ representation of the significant transactions. population the Trust serves • Objective 2:- Communicate effectively with all members 2) Growing Representative Eight Elements • Objective 3:- Engage with of Compliance Membership members and encourage Over the past year, the Trust has involvement within the Trust. with regards to seen its membership slighly Governance decrease. The Trust understands the importance of having an engaged Monitor uses the term The Trust understands the and active membership and has governance to describe importance of having a reflective focussed on ways of achieving this the effectiveness of an NHS and robust membership and throughout the year, as detailed in Foundation Trust's leadership. In continues to prudently maintain the Membership section. relation to the eight elements our database with regular of compliance with regards to cleansing, this can result in a loss governance the position is as of members following every follows: cleanse.

Page Annual Report and Accounts 2013/14 45 3) Appropriate Board Roles appointed as a Non- and Structures Executive Director on 1st September 2013. In October 2012, the Board • Following a rigorous commissioned a Quality recruitment process, Governance Review to be Nicky Ingham undertaken by KPMG. The review was appointed as commenced in January 2013 and Director of HR & OD the outcome was reported to the in July 2013 and Board in February 2013. During took up post on 1st 2013 the Board implemented November 2013. the recommendations from the • Jacqui Bate KPMG report and has monitored continued to work within the progress on a quarterly basis to • Any proposal or removal must HR & OD Department until she ensure compliance. be proposed by a Governor left the Trust on 19th December and seconded by no less than 2013. A subsequent review was 10 Governors, including at least • Following a rigorous undertaken by KPMG in September two elected Governors and two recruitment process, Tim 2013 in relation to Governance Appointed Governors Bennett was appointed as Arrangements and the overall • Written reasons for the Director of Finance in July report rating provided significant proposal shall be provided to 2013 and took up post on 25th assurance. Work is on-going to the Non-Executive Director in November 2013. implement the medium/low question, who shall be given • Feroz Patel was appointed priority recommendations outlined the opportunity to respond to Acting Director of Finance in the report, all of which were such reasons on 5th November 2012 and completed by 31st March 2014. • In making any decision to continued in that role until remove a Non-Executive Mr Bennett took up post in There were a number of changes Director, the Council of November 2013. to the membership of the Board Governors shall take into • Robert Bell, Director of of Directors during 2013/14 as account the annual appraisal Clinical Support & Facilities follows:- carried out by the Chairman Management, left the Trust on • If any proposal to remove a 22nd November 2013. • Gary Doherty took up his Non-Executive Director is not position as newly appointed approved at a meeting of The Board would like to place Chief Executive on 1st April the Council of Governors, no on record their sincere thanks to 2013. further proposal can be put Paul Olive and Robert Bell for all • Paul Olive resigned from the forward to remove such Non- of their hard work in taking the Trust with effect from 31st May Executive Director based upon Trust forward and driving quality 2013. the same reasons within 12 improvements over the past 11 • Jacqui Bate was appointed months of the meeting. years and 4½ years respectively. Interim Director of Human Resources & Organisational In the event of any changes to 4) Co-operation with NHS Development (HR & OD) on the Executive Directors of the bodies and local authorities 3rd June 2013 following the Board, appropriate deputising The Trust will continue to work resignation of Janet Benson, arrangements are in place to closely with key commissioners, Acting Director of HR & OD, on ensure continuity. stakeholders and Local 2nd June 2013. Authorities. Alliances have • Following the recruitment With regard to the termination been made with Blackpool process to find a replacement of Non-Executive Directors, and Lancashire Healthwatch NED and an additional NED, Jim removal is in accordance with the (formerly known as Blackpool Edney was appointed as a Non- procedures outlined in the Trust and Lancashire Local Involvement Executive Director on 1st June Constitution: Networks (LINks)) and Blackpool 2013 and Michele Ibbs was

Page 46 Blackpool Teaching Hospitals NHS Foundation Trust and Lancashire Health Overview and Scrutiny Committees. Regular meetings are held with our main commissioners, NHS Blackpool, Fylde and Wyre and NHS North Lancashire, in relation to the monitoring of in-year performance.

5) Clinical Quality The Trust has strengthened its performance management structure in relation to delivering the Care Quality Commission (CQC) quality and safety standards and has maintained progress to deliver top 10% performance for National Health Service In light of the Francis Report on clinical quality. Over the next 12 Litigation Authority (NHSLA) Mid Staffordshire Hospitals and months, the Trust will continue Risk Management Standards, the Trust being identified as to focus on the quality of services which is the highest level possible having high mortality rates, the that we are offering to our that can be achieved. We have Trust was selected as part of the patients and the implementation also successfully achieved review by a national advisory of our Clinical Quality Framework. compliance with Level 2 Clinical group set up by NHS Medical The Clinical Quality Framework Negligence Scheme for Trusts Director, Sir Bruce Keogh into 14 sets out the approach that this will (CNST) Maternity Standards hospitals which had higher than take and the measures that the demonstrating that we have expected mortality rates. Further Board of Directors have identified a high performing Maternity details are outlined in section 7. as being key to delivering quality service. The review took place from the care and how success in these 17th June 2013. Sir Bruce Keogh areas will be measured. In view of the Trust participating published his report summarising in the NHSLA Schemes this has the findings and actions the Trust 6) Service Performance enabled the Trust to demonstrate needed to take. From this, the against Healthcare Targets that we have aimed to achieve the Trust produced an action plan and Standards following: based on the findings of the The Trust is required to register Keogh review, and monitored, with the CQC and its current • Reduce the number and cost of and has now successfully registration status is compliant. claims implemented, the vast majority The CQC has not taken • Reduce the number and of the action plan matters. Those enforcement action against the severity of incidents actions which required ongoing Trust for the reporting period • Have a structured framework improvement, including the 2013/14 and remains registered for risk management systems Trust’s objective to continue to with no conditions. and processes reduce mortality rates, will be • Have a proactive approach to combined with the new CQC Further information is detailed in improvement in patient safety inspection action plan which will section 2.2.5 of the Quality Report and well-being of staff be formulated following the CQC at Annex A. • Empower staff within the visit in January 2014. organisation to manage their 7) Other Risk Management own risks Further details are outlined in • Embed risk management in Part 3 section 3.4.1 of the Quality Processes organisational culture Accounts which can be found in The Trust has maintained • Provide assurance to the Board Annex A. compliance with Level 3 of Directors and stakeholders

Page Annual Report and Accounts 2013/14 47 8) Provision of Mandatory the Annual Report can be found the quality and safety of patient Services in the Quality Report (Annex A) care. The organisations have and in the Annual Governance worked together to develop short There are no foreseeable service Statement (Annex E). and long-term plans for the local changes that threaten the delivery health economy that are aligned of mandatory services provided across primary, community and by the Trust, nor are there any Strategic secondary care. These plans issues of accreditation that include agreed pathways of care threaten the viability of a service Development that meet local and national in 2013/14. Relationship with quality and safety requirements, as well as being cost effective in order The Trust has developed a robust Commissioners and to meet the financial challenges set of business continuity and Stakeholders facing the NHS. Regular meetings contingency arrangements The Trust’s relationships with its are held between the Trust and the integrating Community Health stakeholders have been further local CCGs to review and, where Services over the last twelve developed during 2013/14, necessary, redesign care provision months. This ensures that services with representatives from the to better meet the needs of the can continue to be provided Trust’s Executive Directors population. during a catastrophic event that attending local groups such as the impacts upon patient services. Blackpool Overview and Scrutiny The Trust’s Board of Directors has These plans have been cascaded Committee. Cross-organisational participated in numerous Board- throughout the organisation and groups, such as the Fylde Coast to-Board sessions with local CCGs where appropriate have been fully Commissioning Advisory Board and acute Trusts, which provides tested. There are Major Incident which includes representatives a shared understanding of local and Pandemic Influenza Plans in from commissioners and service delivery and any plans for place, which dovetail with regional providers of health and social care, change. and other local arrangements. sets the local strategic direction These plans have been thoroughly as well as approving new ways of A sub-group of the Council of tested through six monthly working, monitoring the progress Governors was established to assist mandatory communication of agreed plans and initiatives, the Board of Directors in short- callouts, ‘live’ regional and other and ensuring alignment across term (2-year) and strategic (5-year) local desktop exercises. The various aspects of care provision. planning. This has provided the Trust also has arrangements for opportunity for early involvement decontaminating patients, which Our Executive Directors have by the Governors in discussions were enacted in September supported the newly established regarding the key challenges 2010, and are exercised every two Clinical Commissioning Groups facing the organisation; our months to ensure the departments (CCGs), and have continued to proposed plans relating to quality, keep staff up to date. work in partnership with these operations, workforce and finance; groups to identify strategies to Board assurance on these plans; Further information where promote and improve the health and longer-term strategic plans quality governance and quality of the local population, with an regarding models of care provision. are discussed in more detail in emphasis on improvements to

“The Trust’s Board of Directors has participated in numerous Board-to-Board sessions with local CCGs and acute Trusts, which provides a shared understanding of local service delivery and any plans for change...”

Page 48 Blackpool Teaching Hospitals NHS Foundation Trust Improving Patient undertaken. These include the the patient’s journey through Breast Service (Clinical Triage their inpatient stay will improve Care Project), Transcatheter aortic the quality of care we provide, valve implant and a referral to thereby improving the experience 100 Day Pathway discharge surgical event. This and outcomes for patients. The Scheduled Care Division has was with a focus on optimisation been working in collaboration with pre-operatively/pre-habilitation The Better Care Now: Waits local commissioners to standardise with enhanced recovery through project continues to target pathways for the majority of the inpatient journey and improvements in each of the patient referrals into the service. A expediting patient discharge to an highest wait areas to ensure that series of 100 day pathway events appropriate facility for on-going patients receive timely access have been run during the last 12 management. to services supporting earlier months, which have enabled all discharge from hospital and aspects of high volume pathways Better Care Now: Waits improved patient experience. to be agreed with Commissioners. The Trust’s Strategic Direction, as Clinicians from the whole health set out in the 2013/14 Strategic economy contributed to the Plan, identifies the aim of zero Disclosure of Public evolution and sign off of the delays for patients. Better Care Now: pathways of care, incorporating Waits, is a Trust wide improvement Interest many improvements. These programme to reduce delays for pathways commenced in GP inpatients supporting the delivery The Trust has held no public practices and incorporated the of this ambition. consultations between 1st April inpatient and discharge phase of 2013 – 31st March 2014 their management. The Waits project aims to improve the quality and safety of care Clinical referral templates have and the experience for patients Research and been worked up with primary through a reduction in the care colleagues and uploaded time patients spend waiting for Development into the EMIS GP system for the assessments and diagnostics, with first time. This will enable GPs to a standard referral to assessment Grant Successes use the templates to train more timescale of 24 hours or less. MASDA – Marker for Autism junior colleagues and contribute to Spectrum Disorders based on an improvement in the quality of The approach taken to establish EEG Analysis referrals. All pathways are available the top internal ‘waits’ has allowed for Autism Spectrum Disorders electronically to all clinicians. for targeted action to be taken to based on EEG Analysis improve access to these services. Dr Megan Thomas, Consultant Further pathway work has This work will mean that rather Paediatrician and Director of been undertaken to support than waiting a number of days Research and Development is the patients referred as an for services such as a CT scan or collaborating with Professor emergency to the hospital. an occupational therapy review, Aneta Stefanovska, a Bio-Physicist Alternative pathways are being patients can expect to be waiting and Professor Peter McClintock, devised to reduce admissions, less than 24 hours. To support Emeritus Professor of Physics, avoid readmissions and reduce this project, there has been the and colleagues from Lancaster the length of stay for those roll out of ‘Board Rounds’ across University to explore a potential patients who need an emergency the Trust. These daily ward based new biomarker for autism inpatient stay. meetings involve the full MDT spectrum disorder. briefly discussing each patient Diagnosis of autism spectrum Other projects have run as a to ensure their care is being disorders currently depends result of the success, which have progressed appropriately and on the clinical recognition of included reviews of various that patients do not experience significant problems with an services and highlighted potential delays in their inpatient stay. individual’s communication, improvements that can be This proactive management of social interaction and flexible

Page Annual Report and Accounts 2013/14 49 thought processes. There is no community by their family learning in a variety of clinical definitive test to confirm or rule doctor. Around 1 in 10 patients settings. The ultimate outcome out the diagnosis. Finding a way with this condition, who do not for this study will be a production of making the diagnosis before improve with simple treatment, of simulation based training symptoms are well established get referred to hospital. The aim packages. Dr Morris Gordon, may increase the impact of of this research is to evaluate Consultant Paediatrician, Mrs interventions. This study is looking commonly used interventions Helen Box, Associate Director of at an innovative technique based for management of the frozen Medical Education. on the nonlinear analysis of EEG shoulder in secondary care. It will waves measured from children look at the effectiveness and cost TAVI QL- Aortic stenosis diagnosed with this condition. In effectiveness of the more invasive (narrowing of the heart valve) is order to achieve this, brain waves and costly surgical interventions the most common valve disease of young children with a diagnosis that are most commonly of elderly people in the western of an autism spectrum disorder used in the NHS and compare world. Surgical valve replacement will be compared with the brain them with early structured has been the treatment choice waves of similar young children physiotherapy. The acceptability in symptomatic patients with who have no developmental of these interventions to patients severe aortic stenosis for decades. problems. This study has received and clinicians and important Approximately 30% of patients a research grant from the charity outcomes to patients will be are declined surgery as they Action Medical Research. explored. The study has been are high risk. Transcatheter nominated for funding from Aortic Valve Implantation (TAVI) the National Institute for Health has emerged as an alternative Research Health Technology treatment for high risk patients. Assessment Programme. This study aims to assess the quality of life of TAVI patients in Trust sponsoring locally the North West of England and developed studies will help in the future selection The sponsor of a research study of patients for TAVI. Dr David is responsible for ensuring that Roberts, Consultant Cardiologist, specific duties are performed, Dr Joanne Sanderson, Clinical properly distributed, allocated Psychologist and Dr Izhar Hashmi, and accepted by investigators Research Speciality Doctor in and their employing institutions Cardiology. and care organisations, and for the governance of the research Research Recognition – First study from conception to final Global Patient completion, including design, Recruiting the first global patient management, and finance. (first patient in the world to join United Kingdom Forzen a study) is a key performance Shoulder Trial (UK FroST) The Trust is now sponsoring a indicator for the pharmaceutical Mr Bambos Charalambous, number of studies including: industry in clinical research as it Consultant Orthopaedic Surgeon shows that the NHS can support is a co-applicant with Professor The TINSELS Trial – Simulated the rapid set-up of clinical trials on Amar Rangan, Clinical Professor learning is an established the international stage. at South Tees Hospitals NHS approach for skill acquisition. The Trust is pleased to report that Foundation Trust and colleagues It provides the opportunity for it has achieved first global patient on the UK FroST study. core knowledge and skills into in a clinical trial in liver failure Frozen shoulder is a painful the practical/work environment for Conatus Pharmaceuticals. and debilitating condition in a safe and effective way. The Dr Peter Isaacs, Consultant causing stiffness and disability study is designed to investigate Gastroenterologist and Associate in the affected shoulder and the design, applicability and Research and Development arm. Most patients with frozen effectiveness of simulated Director is the local investigator. shoulder are treated in the Page 50 Blackpool Teaching Hospitals NHS Foundation Trust The Trust was widely recognised are designed to provide hands-on Social and by the National Institute for Health practical support, learning from Research and commended by others’ experiences and offering Community Issues Conatus Pharmaceuticals for the relevant and timely strategies There are a number of health rapid set-up of this trial. for bringing about sustained challenges facing the population improvement in the Trust. of Blackpool, Fylde and Wyre.

Reduced life expectancy is the National Institute for major health inequality. It is an indicator of the population’s Health Research health and wellbeing. Low life expectancy is accompanied by a Research Team developing longer period spent in ill health. with the help from the Trust’s Organisation Development The Fylde Coast’s mortality and NIHR Leadership Support and Team life expectancy is a challenge Development Programme – The Research Team are being faced by local partners. An outline Easier and Faster Research: The supported by the Trust’s of some of the key approaches NIHR – Ashridge Development Organisational Development and future directions are detailed Process Team to take part in the Aston below:- The Government wants to make University Team based working health research easier and faster programme. This will allow us • secondary prevention for so that research findings can to examine the team and look at cardiovascular (CVD) events benefit patients more quickly ways to increase our effectiveness. • improving diabetes and we can make this country The team has already had an management a competitive location for life ‘away day’ to look at how they • treating CVD risk among science industry research. In felt we were working together, Chronic Obstructive Pulmonary recent years significant progress the impact of personality styles Disease (COPD) patients has been made on developing and developed team based • reducing smoking in research in the NHS. However, operating principles. The next pregnancy the NHS is not where it needs to stage will be to cascade the Aston • reducing harmful alcohol be if health research is to have organisational development team consumption providing stop the maximum impact on patient based working programme from smoking interventions care, and the NHS is to meet the the senior team to the operational • providing ‘flu vaccination for challenging national benchmarks team. for research initiation and delivery. those with existing health conditions and the elderly. The R&D function in NHS Trusts Thank you! is at the heart of the research This past year has been extremely Modelling the possible impact of process, and the leadership of busy and challenging in Research these interventions shows that, the R&D Director and R&D Senior and Development, but we would if fully implemented, they have Manager is critical. like to take the opportunity to the potential to improve health thank all of the patients who have and reduce deaths. Improving Dr Megan Thomas, Director of joined one of the clinical trials. life expectancy and reducing Research and Development Your contribution is very much inequalities across the Fylde Coast and Michelle Stephens, R&D appreciated. Manager were successful in being is a massive challenge. accepted on Cohort 2 of the NIHR / Ashridge Development in Spring 2012. This programme lasts for a year and includes workshops, one-to-one coaching, small group work, Master classes, and a conference. All these activities

Page Annual Report and Accounts 2013/14 51 Our Environment

Sustainability Reporting

The Trust is committed to providing sustainable healthcare to the people of the Fylde Coast and beyond. This sustainability report aims to satisfy requirements for Public Sector Sustainability Reporting and fulfil the Trust’s commitment to develop systems to place information relating to the environment into the public domain. “We have established a new clinical and We recognise that our operations managerial structure within the service have an environmental impact. These include, but are not limited to ensure we achieve roll out within to, waste production, the impacts of transport, energy and resource expected timescales...” use, discharges to water and emissions to air. In addition, we • Manage transport the Trust’s corporate objectives, acknowledge the significance requirements progress against these aims of the indirect impacts that we • Use energy, water and other and objectives is managed influence through procurement finite resources responsibly and through our existing Corporate and our choice of contractors and efficiently Governance structures. suppliers. • Reduce overall waste disposal, reduce the hazards from Policy and strategy are developed It is the Trust’s objective to act waste and increase reuse and and continuously reviewed by in a responsible manner to recovery of resources where the appropriate governance control and reduce any negative feasible committees. Public Governors are impacts on the environment • Prevent pollution resulting given the opportunity to attend whilst continuing to provide high from discharges to water or key decision making forums to quality patient care. In particular, emissions to air – including ensure that the views of patients, we aim to continue to ensure emissions of CO2 and other carers and the local community that our activities comply with, greenhouse gases are considered. or exceed, applicable regulation and we will work to meet any We will achieve these aims by Day to day responsibility for environmental targets imposed implementing a programme implementing the sustainability by the government. of continual improvement of agenda is delegated to the Estates environmental performance & Facilities Divisions. A quarterly We have, or are developing, and will set robust objectives Environmental and Sustainability appropriate strategies to ensure and targets and develop key Management Forum brings we reduce our environmental performance indicators to together key team members impact in four key areas. These will measure progress. throughout the Trust to ensure ensure that we continue to: performance and targets are As sustainability is included in delivered.

Page 52 Blackpool Teaching Hospitals NHS Foundation Trust Environmental Performance in Key Areas for 2012/13 and 2013/14

Table: Environmental Performance Non Financial Data Cost 2012/13 2013/14 2012/13 2013/14 Waste Arising (Total waste from all 1,490 1,506 £287,960 £302,342 sources) tonnes tonnes Clinical Waste (waste disposed of 631 tonnes 658 tonnes £213,909 £232,404 via high temperature incineration) Waste sent to landfill 89 tonnes 12 tonnes £9,315 £1,140 Waste Recycled waste 638 tonnes 660 tonnes £33,488 £34,642 Minimisation Non Hazardous Incineration 119 tonnes 169 tonnes £12,455 £16,055 (Energy from waste) Electrical and Electronic waste 7.62 tonnes 7 tonnes £1,100 £1,173 items Percentage of Waste subject to a 94% (43% 94% (54% n/a n/a recycling or recovery exercise Recycled) Recycled) Management of Finite Water 152,992 m3 161,208 m3 £501,133 £510,194 Resources Electricity - Imported 30,915 GJ 36,486 GJ £993,429 £1,172,819 Total Electricity – Imported + CHP 64,028 GJ 64,778 GJ £1,196,641 £1,352,936 generated Gas 223,909 GJ 206,625 GJ £1,851,567 £1,826,227 Other Energy – Heating Oil 1,232 GJ 1,214 GJ £23,162 £22,305 Fuel used in Blackpool Teaching 32,791 21589.75 £46,003 £29.761.84 Hospital Trust owned transport Litres litres Fuel used in ex North Lancashire 55,995 55,687 Primary Care Trust owned £87,310 £73,923.00 Litres litres transport Direct Green Direct emissions from the energy House 16,168 15,161 sources above only – excluding n/a n/a Gas (GHG) tonnes tonnes CHP generated electricity Emissions -Data published in 2012/13 has been corrected to best available data for the purposes of this report. -To bring this report in line with internal monthly reports waste costs (including those for 2012/13) are reported exclusive of VAT. All other costs are inclusive of VAT. -This figure represents a maximum based on in year purchases. The actual figure Explanatory consumed is likely to be slightly lower. notes -Above data excludes non-acute community sites -The information above is an extrapolation of the best available data at the time of compilation (January 2014). Actual year end figures may therefore differ slightly from those presented. In the event of any difference between this data in this report and that presented in our annual Estates Returns Information Collection (ERIC) return the ERIC figures are to be preferred.

The figures above represent the results of a year’s hard work in difficult conditions.

Page Annual Report and Accounts 2013/14 53 “The new multi-storey car park and main entrance has implemented LED lighting technology and an intelligent lighting control strategy to turn off un-necessary lighting if Lux-levels are sufficient or if no motion is detected. This strategy will save the Trust in the region of £32,000 per annum...”

A key achievement in 2013/14 plate heat exchangers, a 100kW Light-Emitting Diode (LED) saw the Estates Department CHP unit at Clifton Hospital and lamps are now installed as awarded £1.3million from the improvements to the central standard throughout the Trust. Department of Health to invest in steam distribution system, all A compatible bulb is available energy efficiency technologies. of which will generate annual for existing fittings when bulbs These technologies include the savings of £300,000 which will be reach their end of useful life. The replacement of ageing steam re-invested into patient care. new multi-storey car park and calorifiers with modern efficient main entrance has implemented LED lighting technology and an intelligent lighting control strategy to turn off un-necessary lighting if Lux-levels are sufficient or if no motion is detected. This strategy will save the Trust in the region of £32,000 per annum on running costs of the building compared to if standard fluorescent lights were fitted with no controls. Sustainability and life-cycle management were at the forefront of design for the new multi-storey car park and main entrance, as not only is LED lighting and controls utilised throughout, but also other energy efficient technologies including air source heat pumps linked to under floor heating in the main atrium, revolving doors to reduce heat loss and variable speed drives on motors and fans. This all reduces the environmental impact of the building and creates a welcoming and pleasant start to the patient experience.

2013/14 continues to see the financial benefits of the 1.2MW CHP onsite at Victoria Hospital.

Page 54 Blackpool Teaching Hospitals NHS Foundation Trust In the 1st quarter of 2014 initial auditing and trials took place to further improve Clinical Waste Compliance and Segregation. In partnership with Sharpsmart/ Clinisafe we will look at introducing re-usable sharps containers, improved packaging and a “bag to bed” system for the compliant segregation of all Clinical Waste. The new segregation system will improve the patient environment by removing all clinical waste to sluices/dirty utilities following treatments where possible, supply improved training and information on compliant Although there was a period of assessment and sorting of waste segregation via e-learning, one downtime during the months of streams along with the ability to to one training, information September and October, the CHP improve site wide collections of posters and labelling of waste has still achieved an annual net confidential waste, Batteries and bins. A new Waste Data Base is saving of £165,584 for the Trust Printer Cartridges. being established in partnership and prevented 1,892 tonnes CO2 with the Trust’s Information emissions being emitted into the The new Mill Size Cardboard Baler Management Team. This will atmosphere. will allow reductions in operator improve waste information time & storage plus increased gathering and will be linked into The Carbon Reduction revenue. The existing baler has the Trust Intranet along with Commitment Energy Efficiency been retained at a significant the e-learning suite provided by Scheme is in the third year of cost saving which will permit the Sharpsmart/ Clinisafe Project. reporting, with an estimated recovery and recycling of plastic liability under the scheme of which will supply another good Clinical Waste Pre Acceptance £212,000 for 2013/14. The cost revenue stream whilst reducing and Dangerous Goods Safety per tonne of CO2 is currently the cost and collection frequency Audits were completed by an £12, although this is forecast to of the current general waste independent contractor in the increase to £16 per tonne from compactor. 4th Quarter of 2013 and will be April 2014, highlighting the used to assist in improvements importance of energy efficiency Work is ongoing to improve in Clinical Waste and Transport and reducing consumption within compliance with regards to food Compliance during 2014 and the Trust. waste disposal and to that end reviewing policy and procedure. Catering/Waste Management 2013/14 has been a period of will be running a trial of food Going forwards into 2014/15, consolidation and investigation waste digesters in early 2014 in we are keen to begin integrating of current operations for Waste conjunction with W2O/Mechline. Environmental and Sustainability Management. Ongoing review of The trial will aim to confirm target performance data for the Non Clinical Waste Streams improvements in food waste the non-acute community sites has led to changes in contractor processing which will reduce costs into the combined Trust annual service resulting in reduced in Energy /Water consumption, reporting, and at present are collections via bulking with larger infrastructure maintenance and concentrating on ensuring all data containers and improved costs/ enable the current general waste collected is sufficient, accurate revenues. Additional manpower stream to be re classified as Dry and relevant to the requirements in the Waste Compound Mixed Recycling producing of our patients and staff. has allowed improved pre significant cost savings.

Page Annual Report and Accounts 2013/14 55 Our Finances

the Trust submit a reforecast for for the year, however taking Income and the remainder of the 2013/2014 into account a net loss on the Expenditure financial year. revaluation of assets £14.7m, net loss on disposal of assets of £0.2m, Performance Table 1 below, therefore, and net restructuring costs of compares performance against £0.9m, the deficit is £12.4m for the As a result of a detailed analysis the 2013/2014 reforecast year. of the Trust submitted Quarter 2 submitted in mid-December 2013/2014 Monitoring Return, the 2013. Full details of the Trust’s financial independent regulator, Monitor, performance are set out in the highlighted a material change to Before the reporting of accounts for 1st April 2013 to 31st the Trust’s financial projections exceptional items the Trust March 2014 that accompanies the and accordingly requested that achieved a surplus of £3.4m Annual Report in Annex G.

Table 1: compares the 2013-14 actual performance to the 2013-14 plan. Plan Actuals Variance £’m £’m £’m Total income 365.9 370.5 4.6 Expenses (350.9) (356.0) (5.1) EBITDA* 15.0 14.5 (0.5) Depreciation (6.2) (6.0) 0.2 Dividend** (4.5) (4.0) 0.5 Loss on asset disposal 0 (0.2) (0.2) Gain on Revaluation 0 (14.7) (14.7) Restructuring costs (0.8) (0.9) (0.1) Interest income 0.1 0.1 0.0 Interest expense (1.2) (1.2) 0.0 Surplus(Deficit) 2.4 (12.4) (14.8)

* Earnings before interest, tax, depreciation and amortisation. ** Public Dividend Capital

“...the Trust achieved a surplus of £3.4m for the year, however taking into account a net gain on the revaluation of assets £4.0m, net loss on disposal of assets of £3.1m, and net restructuring costs of £1.1m, the surplus is £3.2m for the year...”

Page 56 Blackpool Teaching Hospitals NHS Foundation Trust The Trust’s financial performance profile for the last five years is summarised in Chart 1 below.

Chart 1: Surplus Performance £5.0m

£0.0m £3.3m 3.2m (£5.4m) (£5.0m) (£12.4m) £m (£10.0m)

(£15.0m) (23.1m) (£20.0m)

(£25.0m) 2009/10 2010/11 2011/12 2012/13 2013/14

The financial performance prior to exceptional items was £0.8m above plan.

Chart 2: Completed Patient Spells 110,000

105,000

100,000

95,000

90,000

85,000 92,020 97,390 97,422 108,100 94,355 80,000 2009/10 2010/11 2011/12 2012/13 2013/14

Chart 3: Outpatient Attendances 310,000 305,000 300,000 295,000 290,000 285,000 280,000 275,000 270,000 265,000 285,731 276,442 287,014 296,917 305,185 260,000 2009/10 2010/11 2011/12 2012/13 2013/14

Page Annual Report and Accounts 2013/14 57 Chart 4: A&E Attendances 94,000 92,000 90,000 88,000 86,000 84,000 82,000 80,000 78,000 76,000 91,448 83,187 80,572 83,002 82,999 74,000 2009/10 2010/11 2011/12 2012/13 2013/14

Income from providing clinical is covered by contracts with the national contract published services to NHS patients, as below, Clinical Commissioning Groups by the DoH and priced using the represents the majority of the and other NHS commissioners. National Tariff or locally agreed Trust’s income (2013/14: £335.3m The terms of these contracts are prices as appropriate. or 91%; 2012/13: £325.7m or 90%). agreed locally between the Trust The provision of these services and commissioners based on

Chart 5: Clinical Income Recovery by Commissioners

£10.1m £11.4m Blackpool CCG £23.8m

£120.1m Fylde & Wyre CCG £61.1m Lancashire North CCG

NHS England - Specialist Commissioning NHS England - Other Commissioning

£15.1m Other Associate PCTs / CCGs

£93.7m Non-Contracted CCGs

In addition to the NHS Clinical A full asset revaluation was carried income described above, the out in March 2014 this resulted in Trust receives a number of other upward valuation of previously income streams. The trend in impaired assets as a result of a this income is summarised in combination of re use and change Chart 6 and performance in in indices. 2013/14 is summarised in Chart 7. Performance in 2013/14 is broadly in line with previous years “...Performance in 2013/14 is broadly with the most significant variation relating to predominately in line with previous years with the exceptional items as set out most significant variation relating to below. predominately exceptional items...”

Page 58 Blackpool Teaching Hospitals NHS Foundation Trust Chart 6: Non-NHS Clinical/Non-Clinical Income 2009/10 to 2013/14 £40.0m

£35.0m

£30.0m

£25.0m

£20.0m

£15.0m

£10.0m

£5.0m £30.3m £30.0m £33.0m £34.4m £37.9m £0.0m 2009/10 2010/11 2011/12 2012/13 2013/14

Chart 7: Non-NHS Clinical / Non-Clinical Income by Type

£2.6m £1.9m Private Patient Income £1.3m

£0.8m RTA Income

£5.0m £1.8m Other Non-Protected Clinical Income Research and Development

Education, Training and Research Non-Patient Care Services to Other Bodies £11.6m Sale of Goods and Services

These income streams equated services help reduce the cost of Act 2006 was repealed by the to £37.9m or 10.2% of the total patient related activities. Health and Social Care Act 2012. income earned for the year. Of Consequently the Trust is no this £26.0m or 7% relates to the With effect from 1st October 2012, longer required to disclose private provision of other services not the statutory limitation on private patient income against the base directly related to healthcare, patient income earned by NHS year (2002/03). including catering and car park Foundation Trusts under section income. Any surplus from these 44 of the National Health Service

Page Annual Report and Accounts 2013/14 59 Chart 8: Private Patient Income 2009/10 – 2013/14 £2.0m £1.8m £1.6m £1.4m £1.2m £1.0m £0.8m £0.6m £0.4m £0.2m £1.4m £1.3m £1.2m £1.4m £1.9m £0.0m 2009/10 2010/11 2011/12 2012/13 2013/14

The level of private patient income the improvement in waiting current economic climate. is decreasing as a proportion of times and the reduction in private total patient income, reflecting healthcare insurance in the

Chart 9: Expenditure for 2013/14 broken down by expenditure type

£28.8m Pay Costs £236.3m Drug Costs £96.3m Non Pay

Non Operating Costs

£24.2m

The above expenditure reflects Programme Management with the full £20.6m identified the higher than planned activity Office (PMO) to scrutinise During the year the Trust spent delivered, additional CCG funding QuIPP planning and delivery. In £5.3m on management costs for developments and winter, addition, the Trust is utilising which represents 1.45% of turnover. additional expenditure to meet external support to identify areas By comparison, in 2012/13, the Keogh Action Plan and the of improvement and develop/ management costs as a percentage achievement of £12.7m of Quality, implement action plans to deliver of turnover were 1.57%. Innovation, Productivity and the required efficiency. During Prevention (QuIPP). In addition, the last three years the Trust has The definition of management the Trust has also accounted for delivered savings of £15.5m in costs used by the Trust is any one in an impairment charge as a result 2011/12, £19.2m in 2012/13 and non-clinical posts at band 8b and of downward valuation of £17.2m £12.7m in 2013/14. above. which has a significant impact on non- operating costs. Significant progress has already Senior employees remuneration is been made in the identification and set out in the Remuneration Report The Trust has in place a delivery of efficiencies for 2014/15 section of this report.

Page 60 Blackpool Teaching Hospitals NHS Foundation Trust Cash Flow and Balance Sheet

The Trust’s cash balance at the deferred income above plan by Chart 10 summarises the Trust’s end of the financial year was £1.0m primarily relating to the year end cash balances across £25.3m against a reforecast North West Leadership Academy, the last five years. Note that this balance of £13.6m. The cash an increase in provisions above reflects the Trust’s ability, as a balance was £11.7m above the plan of £4.5m and active Foundation Trust, to retain cash reforecast primarily driven by management of working capital balances at year-end. capital cash slippage of £2.8m, balances £3.4m.

Chart 10: Year-end Cash Balances £30.0m

£25.0m

£20.0m

£15.0m

£10.0m

£5.0m £11.7m £15.4m £19.6m £27.4m £25.3m £0.0m 2009/10 2010/11 2011/12 2012/13 2013/14

As a Foundation Trust, the Trust sufficient cash and liquidity to undisputed invoices within 30 is required to ensure that it has support ongoing demands. days of receipt. The table below enough liquidity to support its summarises the performance for working capital requirements. The To comply with best practice the 2013/14. Trust has worked hard to maintain Trust is required to pay 95% of

Chart 11: Better Payment Practice Code Number £’000 Number £’000 Subject 2013/14 2013/14 2012/13 2012/13 Total Non-NHS trade invoices paid in the year 97,021 136,233 82,529 111,042 Total Non-NHS trade invoices paid within target 34,042 61,080 25,991 43,691 Percentage of Non-NHS trade invoices paid within target 35.1% 44.8% 31.5% 39.3% Total NHS trade invoices paid in the year 2,698 32,937 2,851 29,159 Total NHS trade invoices paid within target 1,183 18,302 1,140 16,046 Percentage of NHS trade invoices paid within target 43.8% 55.6% 40.0% 55.0%

The deterioration of payment The Trust is continuing to work with No interest was paid to suppliers performance in line with the its suppliers in a climate where a key under the late payment of Prompt Payment Code is reflective target is to preserve and improve Commercial Debts (Interest) Act of a planned slowdown in the cash balances following a period of 1998. payment of trade suppliers to intensive capital investment. improve cash balances.

Page Annual Report and Accounts 2013/14 61 The Trust invested over £18.8m in capital schemes during 2013/14. Expenditure during the period included the following investments; £m Main Entrance / Multi Storey Car Park 11.6 Stroke Unit 0.9 A&E upgrade 3.3 Other Schemes 3.0

Financial assistance for the 13/14 our-publications?id=932. A assessing financial risk, Monitor capital programme was sourced brief description of Monitor’s will assign quarterly and annual from the Independent Trust regulatory ratings is provided risk ratings using a system which Financing Facility (ITFF) (£6.1m) below. Monitor takes a looks at two common measures and Public Dividend Capital proportionate, risk based of financial robustness:- (PDC) drawdown of £2.6m, approach to regulation. The the remainder being internally assessment of risk by Foundation • Liquidity: funded. Trusts and by Monitor was - days of operating costs held articulated during 2013/14 by in cash or cash equivalent The Trust has a capital programme the application of two risk ratings forms, including wholly of £9.6m for 2014/15. A significant which are updated each quarter committed lines of credit element of this spend £5.6m in relation to: available for drawdown; relates to the on-going clinical and; equipment replacement • Continuity of Service Rating • Capital servicing capacity: programme which will be (COS) rated 1-5, where 1 - the degree to which the financed by ITFF loan drawdown. represents the highest risk and organisation’s generated The Women’s and Children’s and 5 the lowest); and income covers its financial Main entrance Multi Storey Car • Governance risk rating (rated obligations. Park schemes were completed red, amber-red, amber-green or and commissioned in 2013/14. green). The risk rating is forward-looking and is intended to reflect the As a NHS Foundation Trust, the These results are shown in the likelihood of an actual or potential Trust has greater freedoms to table below. financial breach of the Foundation borrow money in order to finance Trust’s Terms of Authorisation. The capital investment as described Financial Risk Rating Continuity of Service Risk Rating above. In August 2013 Monitor the system is on a scale of 1-4 as follows: independent regulator of Foundation Trust’s released the 1. Highest risk – For licence Performance Risk Assessment Framework holders demonstrating a 2013/14 which replaced the significant level of financial risk Against Monitor’s Compliance Framework 2013/14. and could result in Monitor Compliance The Risk Assessment Framework taking formal enforcement 2013/14 introduced a revised action. Framework financial risk rating the Continuity 2. Material level of financial risk of Services Risk Rating. and Monitor may subsequently Monitor is the Independent investigate whether the Regulator of Foundation Trusts. Continuity of Service Risk Ratings organisation is in breach of the Monitor has devised a system are allocated using a scorecard continuity of services licence of regulation described in which compares key financial which may result in further its Compliance Framework, information across all Foundation regulatory action including which is available from the Trusts. A rating of 4 reflects the monthly monitoring. Monitor web site: http://www. lowest level of financial risk and 3. Regulatory concerns in one or monitor-nhsft.gov.uk/home/ a rating of 1 the highest. When more components the licence

Page 62 Blackpool Teaching Hospitals NHS Foundation Trust holder may be asked to provide reflected in the risk ratings which • Red - Likely or actual a limited amount of financial they publish for each Trust: significant breach of Terms of information on a monthly basis, Authorisation 4. No regulatory concerns • Legality of constitution • Green - No material concerns • Growing a representative Governance Risk Rating membership Financial Performance Monitor uses the term • Appropriate board roles and Against Monitor’s governance to describe structures Compliance Framework • Cooperation with NHS bodies the effectiveness of an NHS Based on its 2013/14 Annual Foundation Trust’s leadership. and local authorities • Clinical quality Plan resubmission, the planned They use performance measures risk rating was assessed at such as whether Foundation • Service performance (healthcare targets and Continuity of Service Risk Trusts are meeting national Rating 3. Actual performance targets and standards, e.g. a standards) • Other risk management for 2013/14 is a Continuity of reduction in Clostridium Difficile Service Risk Rating of 3 and the rates, as an indication of this, processes • Provision of mandatory services table below summarises the together with a range of other Trust’s performance against the governance measures described Risk Assessment Framework below. Monitor consider these The Governance Risk rating system is on a scale of Red - Green (Continuity of Service Risk Ratings areas when assessing governance were not reported for 2012/13): risk at Foundation Trusts, as as follows:

Target 2013/14 2013/14 2012/13 (level 3 risk) plan Re-plan Annual Performance Liquidity ratio >-7 days -11 days -14 days -12 days Capital Service Cover >1.75% 2.18x 1.77x 1.80x

Governance Performance key to delivering quality care and actions are being implemented – Against Monitor’s how success in these areas will be to address any issues or Compliance Framework measured. concerns raised Monitor has rated Blackpool On a quarterly basis, the Further information regarding Teaching Hospitals NHS Trust is required to submit arrangements in place to govern Foundation Trust ‘Green’ for monitoring returns to service quality is outlined in governance risk throughout Monitor, as the regulator, for the Quality Report at Annex A 2013/14. The Trust has performance regarding finance and in the Annual Governance strengthened its performance and governance. A report is Statement at Annex E. management structure in relation submitted to the Board each to delivering the CQC quality quarter regarding the following and safety standards and has key purposes: maintained progress to deliver top 10% performance for clinical • to set out the Trust’s Monitor quality. Over the next 12 months, Governance Declaration, the Trust will continue to focus Governance Risk Rating and on the quality of services that supporting documentation in we are offering to our patients accordance with its Terms of and the implementation of Authorisation and the Monitor our Strategic Framework. The Risk Assessment Framework Strategic Framework sets out the requirements 2014/15 and; approach that this will take and • to provide information and the measures that the Board of assurance to the Board, and Directors have identified as being to Monitor, that the necessary

Page Annual Report and Accounts 2013/14 63 The tables below provide a year and a comparison to the regulatory risk rating performance summary of regulatory risk rating previous year. They also provide compared with expectations in performance throughout the a summary of the actual quarterly the annual plan.

Regulatory Ratings Report 2012/13 Annual Plan Subject Q1 2012/13 Q2 2012/13 Q3 2012/13 Q4 2012/13 2012/13 Financial Risk Rating 2 2 2 2 3 Governance Risk Rating Green Green Green Green Green

Regulatory Ratings Report 2013/14 Annual Plan Subject Q1 2013/14 Q2 2013/14 Q3 2013/14 Q4 2013/14 2013/14 Continuity of Service Rating 3 3 3 3 3 Governance Risk Rating Green Green Green Green Green

During 2013/14, the Trust has pensions, that are used to prepare greater than its income from the achieved a surplus before the accounts are set out in Annex provision of goods and services exceptional items of £3.4m (and a G to this report. Details of the for any other purposes. deficit of £12.4m after exceptional Directors’ remuneration is included items). The exceptional in the Remuneration Report. The Where Blackpool Teaching items impact relates to asset format of the accounts and the Hospitals NHS Foundation Trust impairments of £14.7m and supporting accounting policies has received income other than restructuring of £0.9m. were reviewed by the Trust’s Audit income from the provision Committee at its meeting on 30th of goods and services for the At its meeting of 26th March 2014, April 2013. purposes of the health service in the Finance Committee considered England, this other income and the budget for 2014/15 and going In the opinion of the Directors any associated expenditure has concern assessment. The budget there are no reportable events not had a detrimental impact is based on activity assumptions after the reporting period. on the provision of goods and that have been agreed with services for the purposes of commissioners, combined with Income Disclosures the health service in England expenditure budgets that have As per Section 43(2A) of the NHS and where appropriate has taken into account the likely Act 2006, the Board is not aware contributed to / supported the cost risks in this period and the of any circumstances where provision of goods and services requirement for efficiencies of market value of fixed assets is for the purposes of the health £20.6m. significantly different to carrying service in England. value as described in the Trust’s On the basis of these plans, “after financial statements. The Trust’s Financial making enquiries, the Directors auditors have provided an have a reasonable expectation opinion on our 2013/14 accounts, Instruments that the NHS Foundation Trust has which is outlined at Annex F. adequate resources to continue The Trust does not have any listed in operational existence for the Blackpool Teaching Hospitals capital instruments and is not a foreseeable future. For this reason, NHS Foundation Trust has met financial institution. Due to the they continue to adopt the going the requirement for the 2013/14 nature of the Trust's Financial concern basis in preparing the Financial Year that the income Assets/Financial Liabilities, book accounts.” from the provision of goods value also equates to fair value. and services for the purposes of All Financial Assets and Financial The Trust’s main accounting the health service in England is Liabilities are held in sterling. policies, including policies for

Page 64 Blackpool Teaching Hospitals NHS Foundation Trust Credit Risk Market Risk External Contracts

The bulk of the Trusts All of the Trust's financial liabilities The Trust has a number of commissioners are NHS carry nil or fixed rate of interest. external contracts as detailed organisations, which minimises In addition, the only element of below:- the credit risk from these the Trust's financial assets that is customers. Non-NHS customers currently subject to variable rate is Blackpool Clinical Commissioning do not represent a large cash held in the Trust's main bank Group (CCG) proportion of income and the account and therefore the Trust is Fylde and Wyre Clinical majority of these relate to bodies not exposed to significant interest Commissioning Group (CCG) which are considered low risk - rate risk. Lancashire North Clinical e.g. universities, local councils, Commissioning Group (CCG) insurance companies, etc. Cheshire, Warrington and Wirral Area Team (for specialist areas) Cost Allocation and Blackpool Council – Public Health Charging Lancashire County Council – Liquidity Risk Public Health The Trust has complied with the National Commissioning Board – The Trust’s net operating costs cost allocation and charging Local Area Team are incurred under service requirements set out in HM agreements with NHS England Treasury and Office of Public The Trust also has contractual and local Commissioning Care Sector Information Governance. arrangements with the following Groups, which are financed essential organisations:- from resources voted annually by Parliament. The Trust largely • Pricewaterhouse Coopers finances capital expenditure (PwC) - who are the Trust’s through internally generated External Auditors funds and from loans. • KMPG LLP – who are the Trust’s Page Annual Report and Accounts 2013/14 65 Internal Auditors (1st October by the Council of Governors at fraud and create an anti-fraud 2012 – present) their meeting on 17th March culture supported by appropriate • Hempsons Solicitors – who are 2014. deterrence and prevention the Trust’s solicitor measures. Progress against the • Spiral The Trust limits work undertaken plan is regularly reported to the • NHS Supply Chain provider by the external auditors Audit Committee. of medical consumables and outside the audit code to capital items for general wards ensure independence is not and theatres compromised. In 2013/14 PwC • Medtronic UK provider of did not provide any other services Principal Risks and general medical technologies to the Trust. Uncertainties and services • ISS Facilities Healthcare The NHS is changing rapidly provider of facilities services and for the Trust this gives • Siemens Healthcare Counter Fraud many opportunities as well as Diagnostics provider of general risk and uncertainty. The Board NHS Protect (formerly The NHS medical goods and services of Directors has identified Counter Fraud and Security • Boston Scientific provider of the strategic risks facing the Management Service) has set out general medical technologies Trust. These risks are formally the framework within the NHS and services reviewed on a quarterly basis by plans to minimise losses through the Board of Directors’. Current fraud. The Trust’s local policy strategic risks are identified in the complements the national and Annual Governance Statement regional initiatives and sets out External Auditors in the table at section 4.4 and the arguments for the reporting appropriate risk management The Council of Governors and the elimination of fraud. and mitigation plans are in place previously approved the for each. appointment of PwC as the Trust’s The Finance Director is nominated external auditors until 31st March to make sure that the Trust’s 2014. PwC were paid £50,500 in requirements are discharged respect of statutory audit fees. and is aided by a local Counter A supplementary fee included Fraud specialist (LCFS). The Trust £12,500 for the independent has invested in a full time in reporting work in relation to the house LCFS who has developed Independent Auditor’s report in a Counter Fraud Plan that is the annual quality report. aimed to proactively reduce A formal competitive tendering process was initiated early in 2014 to select and appoint a provider for External Audit Services for 2014/15 and beyond, under the NHS Shared Business “...The Board of Directors has identified Services Framework Agreement NHS/11/SG/ZY/6982. Based on the strategic risks facing the Trust. These the findings of the evaluation panel, the Trust recommended risks are formally reviewed on a quarterly the appointment of PwC basis by the Board of Directors’...” as their provider of External Audit Services until May 2017 with the option to extend the appointment for an additional year until May 2018, and this recommendation was approved

Page 66 Blackpool Teaching Hospitals NHS Foundation Trust Our Future Business Plans

The Board of Directors recognise improve joint working across its that allow professionals to share that the changing environment acute and community services records more readily. The use and external factors, such as The to provide integrated care that of early supported discharge Operating Framework 2014/15, is safe, effective and caring. Our schemes and ‘prehabilitation’ the current financial climate, models of delivering care will models across therapy services patient choice and the quality change so that we can better will mean shorter lengths of stay improvement agenda impact on support improvements in the for those patients who do require our future business plans. health and well-being of the a hospital admission. population through partnership We believe that our Vision and working with health and social In-hospital care continued implementation of the care, focusing on ill-health Admission to hospital will Quality Innovation Productivity prevention, management of long only occur when acute care is and Prevention agenda will term conditions, and timely access necessary, and standardised care ensure that our future business to treatment. We will ensure pathways will be used across the plans accommodate the impact that as much care as possible diagnostic, treatment, recovery of these factors and are aligned is provided in community and rehabilitation stages of with the direction of travel for the settings, preventing unnecessary patient care. The management wider NHS. admissions to hospital by of emergency admissions will providing better support to the be streamlined to deliver care The Trust’s Strategic Direction, most needy and frail patients. Our in an appropriate setting, with as set out in the Annual Plan people-centred workforce will improved integration between 2014/15, and our Vision and provide safe, high quality care, in-hospital and community- Values, as reviewed and agreed with patients and their carers centred services to ensure that by the Board of Directors in 2013, involved in decisions about their patients do not stay in hospital underpin the work programme care. any longer than is necessary. for 2014/15. Over the last 12 Operating theatres and diagnostic months we have undertaken a Our vision is based on three key services will be used efficiently great deal of work to develop our themes: and effectively, with support from approach to delivering our future community health and social care Vision. Community-centred services pre- and post-surgery to models of care ensure that length of stay in an The elderly and those living with acute setting is optimised, with no Whole Health long term conditions will be unnecessary delays at discharge. Community Vision better supported by an holistic health and social care system Lancashire partnerships that provides coordinated The vision for the local health The Trust will be a key partner care in a domiciliary setting economy is to introduce new in the planning and delivery of or community health centre. models of care that will see our safe, high quality, sustainable Patients will have well-defined approach change to be more care across Lancashire and South care plans that allow health holistic, focused on continuous Cumbria through its willingness and social care professionals to and proactive care provision to participate in the federation of maintain continuity of care and instead of the reactive, episodic services and to share resources follow appropriate treatment approach that has traditionally across local public sector plans that prevent unnecessary been used by the NHS. providers. acute admissions. The use of telehealth to support monitoring The Trust’s strategic plan, which of patients in their own homes is supported by our local Clinical will be introduced, along with the Commissioning Groups, is to use of electronic patient records

Page Annual Report and Accounts 2013/14 67 Plans for the use associated with paper referrals together to ensure that the and results reporting. range of services and activity of Information During 2014/15 the Trust is levels within the contract are Technology bringing all aspects of Information adequate to meet the needs of Management and Technology the population. As previously, During 2013/14 the Trust has back under one directorate to part of the contracting process rolled out a clinical portal to ensure efficiency and consistency included the agreement of a overlay existing clinical and in the road map to delivering a range of schemes against which administrative systems to enable fully integrated Electronic Patient the Trust will receive CQUIN clinical staff to access patient Record (EPR). The aim over the (quality incentive) monies. These level information through one next three years is to deliver schemes have been targeted to interface, this includes radiology a fully integrated community areas which will benefit patients results, pathology results, clinical administrative and clinical through a focus on improving correspondence, patient related system, electronic prescribing, outcomes. activity, theatres information, electronic documentation existing co-morbidities and access storage, electronic referrals and During the year the Trust GP information through the a fully integrated acute patient worked with commissioners Medical Interoperability Gateway administration and clinical system. to understand the emerging (MIG). national health care agenda and Contracting impact of the reorganisations The Trust also rolled out order The Trust’s contract to provide of local commissioning teams. communications functionality to services during 2013/14 was Relationships with Clinical all inpatient wards covering all co-ordinated by Blackpool Commissioning Groups pathology and radiology plain CCG on behalf of the associate have been developed and film x-rays, allowing clinicians commissioners with each strengthened to support contract to order tests and view reports agreeing their respective activity discussions for 2014/15. electronically negating delays baselines. All parties have worked

Page 68 Blackpool Teaching Hospitals NHS Foundation Trust Environmental us to continue to reduce our direct Development CO2 emissions, however with The financial year 2014/15, will wholesale energy see further improvements in our prices forecast to rise environmental management by between 5% and and performance. We will 10%; it is unlikely continue to explore third party that we will be able funding opportunities, such as, to achieve an overall Salix finance, to support energy reduction in energy efficiency projects and seek cost. innovative technologies to deliver cost savings to the Trust. In 2014/15, we will continue to work Continued improvements to our with contractors and building management system suppliers to identify will be a key focus for 2014/15 alternative products to ensure all plant is operating and systems to as efficiently and economically improve compliance as possible, while maintaining and reduce costs. a safe and comfortable patient Our key focus will environment. Developments in be on the reduction lighting technology will allow for of Clinical Waste for the installation of automatically Incineration. As these at production level through to controlled lighting, via PIR changes are implemented within on site waste movement and sensors, in non-patient areas more areas, we should see an collection systems. alongside further utilisation improvement in compliance rates of LED technology. The later and cost reductions in clinical Further work over the next year stage of 2014/15 will see the waste disposal. will look to achieve 100% landfill implementation of an Energy diversion and on reducing Campaign to engage with We will look to further disposal and processing costs by staff and visitors focusing on extending our partnership with segregating food and organic energy awareness and reducing ISS Mediclean within Waste waste. Work with all our disposal consumption throughout the Management through 2013/14 and recovery contractors’ means estate. with improvements in waste we will exceed our target of 41% compound operations and for recycling in 2014/15. These measures should allow investigations into waste storage

This Strategic report was approved by the Board of Directors on 21st May 2014.

Signed: Date: 21st May 2014

Gary Doherty Chief Executive

Page Annual Report and Accounts 2013/14 69 “Express our thanks to the staff in the Orthopaedic Department for the excellent care and treatment we received yesterday. We were delighted with the super-efficient way in which all aspects of the process were carried out.” Mr D & Mrs J Barber, Blackpool

Page 70 Blackpool Teaching Hospitals NHS Foundation Trust Directors’ Report

Profile of the Board

voting member of the Board of Directors:- Ian Johnson Chairman Term of Office from 16.4.12 to 15.4.15 (First Term)

• 30 years experience as a • Master of Laws (LL.M). qualified solicitor • Non Executive Director of the University of Cumbria • Former Trustee of the Crossfield Housing (Arnside) Society Limited, Lancashire • Member of the Law Society and Institute of Directors • Director of WennLaw Limited Experience: Legal Consultancy • Former Chief Counsel and Member of the Management Qualifications: Board of Alstom Power-Gas • Master of Arts (M.A)

voting member of the Board of Directors:- Paul Olive Non-Executive Director and Deputy Chairman Term of Office from 20.5.10 to 31.5.13 (Extended Third Term) (Resigned 31.5.13)

Experience: Qualifications: • Former Finance Director of • Chartered Accountant – Stanley Leisure plc Fellow of the Institute of • Former Non-Executive Chartered Accountants Director of Crown Leisure plc • Former Governor of Blackpool Sixth Form College • Former Trustee of Age Concern

Page Annual Report and Accounts 2013/14 71 voting member of the Board of Directors:- Karen Crowshaw Non-Executive Director and Deputy Chairman Term of Office from 1.6.11 to 31.5.14 (First Term)

• Former Managing Director • Post Graduate Diploma in (Regulated Sales), Lloyds Personnel (CIPD) Banking Group • Chartered Institute of Bankers • Former Regional Director, HBOS (CIB) PLC • Former Project Manager, National Sales Conference • Former HR Director, Halifax Retail

Experience: Qualifications: • Director, Crowshaw • Masters in Business Consulting Limited Administration (MBA)

Voting member of the Board of Directors:- Tony Shaw Non-Executive Director & Senior Independent Director Term of Office from 1.7.10 to 30.6.13 (First Term) and from 30.6.13 to 29.6.16 (Second Term)

• Former General Manager at • Chair of Trustees of the Blackpool Gazette and Herald Blackpool Ladies Sick Poor • Former Managing Director at Association Blackpool Gazette and Herald • Trustee/Director/Treasurer of • Former Director of United Age UK, Blackpool and District Provincial Newspapers • Former Non-Executive Qualifications: Director of Blackpool, Wyre • Certified Accountant (Retired) and Fylde Community Health Experience: Services NHS Trust • Former Managing Director • Former Chairman of Business Link Fylde Coast Blackpool PCT

Page 72 Blackpool Teaching Hospitals NHS Foundation Trust voting member of the Board of Directors:- Doug Garrett Non-Executive Director Term of Office from 1.6.11 to 31.5.14 (First Term)

• Regeneration in Blackpool • Chairman of Blackpool and Belfast - £1.5 billion of Enterprise Board investment and 25,000 jobs • Operations management, Qualifications: marketing and advertising • Post Graduate Diploma in • Company Director – R & Z Marketing Houses of Fashion • International Business • Company Director - Closelink Degree, BA (Honours) • Company Director – House of • Fellow of the Royal Society for Roma the Arts Experience: • Company Director – Rackhall • Fellow of the Chartered • Current CEO/Director - private Ltd Institute of Marketing businesses • Chairman/Trustee of • Fellow of the Institute of • Current national and Groundwork Trust North West Direct Marketing international trade in • Trustee/Trustee of the St • Member of Real Estate body antiques, sport and leisure, Annes Community Trust CORENET Global property investment via • Trustee Curious Minds (Arts companies Charity)

voting member of the Board of Directors:- Alan Roff Non-Executive Director Term of Office from 1.12.11 to 30.11.14 (First Term)

• Former Chair of North West • Higher Education and IT Regional Action Plan (ERDF) Consultant • Former Chair of Lancashire • Honorary Doctorate Economic Partnership Board from University of Central • Former Chair of Preston Lancashire Strategic Partnership Executive Qualifications: • Former Council Member of • BA (Hons) Mathematics North West Region Learning • MA Quantitative Social and Skills Council Science Experience: • Former Board Member of • Fellow of Royal Statistical • Former Deputy Vice North West Business Link Society Chancellor, University of • Former Head of Computing Central Lancashire Services, UCLAN

Page Annual Report and Accounts 2013/14 73 voting member of the Board of Directors:- Jim Edney Non-Executive Director Term of Office from 01.06.2013 to 31.05.16 (First Term)

• Board Member of University Qualifications: of Central Lancashire (UCLAN) • CPFA (Chartered Institute of • Former Deputy Chief Public Finance & Accountancy Executive and Executive • BA (Hons) History Director of Resources at Lancashire County Council • Former Chief Financial Officer at Essex County Council • Former Deputy County Treasurer at Lincolnshire Experience: County Council • Director of Coleridge Interim Limited voting member of the Board of Directors:- Michele Ibbs Non-Executive Director Term of Office from 01.09.2013 to 31.08.16 (First Term)

• Former Board Director/Pro- • PGDip Marketing & Market Vice Chancellor (Marketing, Research Commercial & International) • Diploma of the Market - Liverpool John Moores Research Society University • Former Marketing Director - Princes Limited, Mitsubishi Corporation • Former Marketing Director UK – Waterford Wedgwood plc Experience: • Non-Executive Director – Qualifications: Marsden Building Society • B.A (Hons) English Language & Literature

Page 74 Blackpool Teaching Hospitals NHS Foundation Trust voting member of the Board of Directors:- Gary Doherty Chief Executive Appointed in April 2013

• Over 20 years general management experience in the NHS including senior posts at Central Manchester & Manchester Children’s University Hospital and North Cheshire Hospitals NHS Trust • Joined NHS as Management Trainee

Experience: Qualifications: • Former Chief Operating • B.A. (Hons) – Politics & Officer/Deputy Chief Economics Executive of Wirral University Teaching Hospital NHS Foundation Trust

voting member of the Board of Directors:- Pat Oliver Director of Operations Appointed in April 2011

• Former Associate Director Nursing and Patient Services of Operations (Surgery) at at Wrightington, Wigan & Blackpool Teaching Hospitals Leigh NHS Trust NHS Foundation Trust • Former General Manager of Qualifications: the Musculo-Skeletal Division • Registered General Nurse at Wrightington, Wigan & • Diploma in Nursing Studies Leigh NHS Trust • BSc (Hons) (incorporating • Former General Manager of management module) Rehabilitation and Elderly • LLB (Hons) Experience: Care at Wrightington, Wigan • PRINCE 2 • Former Interim General & Leigh NHS Trust • Chartered Institute of Manager for the Surgical • Former Acting Deputy Marketing Certificate Division at the University Director of Nursing Hospitals of South and Patient Services at Manchester NHS Foundation Wrightington, Wigan & Leigh Trust (seconded from the NHS Trust Trust) • Former Acting Director of

Page Annual Report and Accounts 2013/14 75 voting member of the Board of Directors:- Dr Mark O’Donnell Medical Director Appointed in April 2012

• Consultant Geriatrician at Blackpool, Fylde and Wyre Hospitals NHS Trust from 1994 • Private Medical Practice • Medical Director of Lancaster Diocese Lourdes Pilgrimage

Qualifications: • MB ChB 1980 University of Experience: Liverpool • Consultant Physician in Stroke • MD 1993 University of Medicine at Blackpool, Fylde Birmingham and Wyre Hospitals NHS Trust • Diploma in Rehabilitation since 2007 Medicine 1993 RCP London • FRCP London 1998

voting member of the Board of Directors:- Marie Thompson Director of Nursing and Quality Appointed in February 2009

Nursing and Midwifery Qualifications: Workforce and delivery of the • Registered General Nurse Trust’s Quality Improvement • MSc Human Resource Objectives Leadership • Responsibility for Nursing • BSc Hons Nursing Studies standards, Patient Experience, • Post Graduate Certificate in Infection Prevention, Education Safeguarding Children, Young • Post Graduate Diploma People and Adults, and Management Studies Emergency Planning Experience: • Former Deputy Director of • Registered General Nurse Nursing and Governance for • Over 20 years experience in Wrightington, Wigan and a variety of clinical, practice Leigh Hospitals NHS Trust development and managerial • Former Deputy Director of roles Nursing North East Lancashire • Responsibility for the Trust’s Hospitals

Page 76 Blackpool Teaching Hospitals NHS Foundation Trust voting member of the Board of Directors:- Feroz Patel Acting Director of Finance Appointed in November 2012 (until November 2013)

Experience: • Former National Finance • Former Associate Director of Management Trainee Finance at Blackpool Teaching Hospitals NHS Foundation Qualifications: Trust • BA (Hons) – Economics • Former Contract Manager • Chartered Public Finance at Wrightington, Wigan and Accountant Leigh PCT. • Former Clinical Financial Advisor at Countess of Chester voting member of the Board of Directors:- Janet Benson Acting Director of Human Resources and Organisation Development Appointed in January 2013 (until June 2013)

• Former Head of Employee • Associate of Chartered Relations, Policy of HR Insurance Institute Strategy at AEGON UK • Former Senior HR Business Partner at AEGON UK • Former HR Manager at Guardian Royal Exchange

Qualifications: Experience: • BA (Hons) English Language • Former interim Head of & Literature Employee Relations at Greater • Chartered Institute of Manchester Police Personnel & Development

Page Annual Report and Accounts 2013/14 77 voting member of the Board of Directors:- Tim Bennett Director of Finance Appointed in November 2013

and Deputy Chief Executive • Former Chairman of the at University Hospitals student conference of the of Morecambe Bay NHS Finance Skills Development Foundation Trust Association • Former Director in a Primary • Non-Executive Board Care Trust Member of a local cancer • Former Director in a large charity. Health Authority. • Former chair of the Qualifications: Healthcare Financial • Qualified Accountant with an Experience: Management Association MBA • Former Director of Finance (North West)

voting member of the Board of Directors:- Nicky Ingham Director of Workforce & Organisational Development Appointed in November 2013

Chief Executive at Bolton NHS Qualifications: Foundation Trust. • Fellow of the Chartered • Former Director of HR & OD at Institute of Personnel and Alder Hey Children’s Hospital Development • Chair of Cumbria and • MSc HR Leadership Lancashire HRD Forum • BA (Hons) Business Studies • Member of the North West • NLP Practitioner Social Partnership Forum • Member of the Cumbria and Lancashire LWEG Experience: • Member of the HENW LETB • Former Director of Workforce • HPMA HR Director of the Year & OD and Acting Deputy in 2010

Page 78 Blackpool Teaching Hospitals NHS Foundation Trust Non-voting member of the Board of Directors:- Robert Bell Director of Facilities and Clinical Support Appointed in March 2009 (formerly Director of Facilities and Estates from March 2009) (Resigned 22.11.13)

Foundation Trust Qualifications: • Former Head of Technical • Bachelor of Science Degree in Services for Ocado (Waitrose) Mechanical Engineering Ltd • Chartered Engineer • Former Technical Services • Member of the Chartered Director for Tibbett & Britten Institute of Building Services Ltd Engineers • Former Principal Technical • Associate Member of the Officer for Merseyside Police Institute of Mechanical Experience: Authority Engineers • Former Director of Facilities • Non-Executive Director of and Estates at Blackpool Spiral Health CIC Teaching Hospitals NHS

Non-voting member of the Board of Directors:- Wendy Swift Director of Strategy/Deputy chief executive Appointed in December 2013 (formerly Managing Director of Community Services and Transformation from November 2011)

• Former Deputy Chief • Trustee of Palatine High Executive of Blackpool Wyre School National Challenge and Fylde Community Health Trust Services Trust • Chairman of Spiral Health CIC • Former Director of Planning • Trustee of Rock Centre and Operations in East (Learning Disabilities) Lancashire Hospitals • Trustee of Blackpool Football • 32 years extensive experience Club Community Trust of working in Acute, • Trustee of Lancashire Experience: Community and Primary Care Community Foundation • Former Chief Executive of services Blackpool Primary Care Trust • Trustee of Collegiate High Qualifications: • Chair of the NHS North West School National Challenge • Diploma in Health Service 111 Programme Board Trust Management (Dip HSM) • Lead commissioner role for • Governor of Collegiate High • B.A. (Hons) – Business Studies the North West Ambulance School Service

Page Annual Report and Accounts 2013/14 79 In addition Jacqui Bate was appointed as the Interim Director of HR & OD from June 2013 until December 2013. All Board members have declared their relevant and material interests and the Register of Directors’ Interests is available for inspection by members of the public via the Foundation Trust Secretary at the following address:-

Address: Trust Headquarters Victoria Hospital Whinney Heys Road Blackpool FY3 8NR

Telephone: 01253 306856

Email: [email protected]

Disclosures included in Strategic Report

A number of the disclosures, detailed in the table below, required to be made in the Directors’ Report have instead been included in the Strategic Report. This is because they relate to our staff, our performance and our future business plans and the Strategic Report includes a comprehensive section in respect of all these sections and the disclosures can therefore be considered in the context of each section.

Table 1: Disclosure Requirements for inclusion in the Director’s Report Disclosure requirement Any important events since the end of the financial year affecting the NHS foundation trust. An indication of likely future developments at the NHS foundation trust. An indication of any significant activities in the field of research and development. An indication of the existence of branches outside the UK. Policies applied during the financial year for giving full and fair consideration to applications for employment made by disabled persons, having regard to their particular aptitudes and abilities. Policies applied during the financial year for continuing the employment of, and for arranging appropriate training for, employees who have become disabled persons during the period. Policies applied during the financial year for the training, career development and promotion of disabled employees. Actions taken in the financial year to provide employees systematically with information on matters of concern to them as employees. Actions taken in the financial year to consult employees or their representatives on a regular basis so that the views of employees can be taken into account in making decisions which are likely to affect their interests. Actions taken in the financial year to encourage the involvement of employees in the NHS foundation trust’s performance. Actions taken in the financial year to achieve a common awareness on the part of all employees of the financial and economic factors affecting the performance of the NHS foundation trust. In relation to the use of financial instruments, an indication of the financial risk management objectives and policies of the NHS foundation trust and the exposure of the entity to price risk, credit risk, liquidity risk and cash flow risk, unless such information is not material for the assessment of the assets, liabilities, financial position and results of the

Page 80 Blackpool Teaching Hospitals NHS Foundation Trust Page Annual Report and Accounts 2013/14 81 “The procedure Mr Bittar carried out on me was grand, it’s done a lot of good, I’m getting a lot better and it has really improved the quality of my life. I still get out of breath at times, but I can do so much more than I could.” Mr L Haygarth, Cumbria

Page 82 Blackpool Teaching Hospitals NHS Foundation Trust Board of Directors’ Report

The business of the Foundation Trust is managed by the Board of Directors which is collectively responsible for the exercise of the powers and the performance of the NHS Foundation Trust subject to any contrary provisions of the NHS Act 2006 as given effect by the Trust’s Constitution. These have changed slightly following the introduction of the Health and Social Care Act in March 2012.

the Trust’s Constitution which detailed under ‘Board Roles and Management sets out the types of decisions Structures’. Commentary and that are required to be taken by the Board of Directors. As a self-governing Foundation Principal Activities The assurance framework Trust, the Board of Directors has identifies those decisions that ultimate responsibility for the The Board of Directors is are reserved by the Board of management of the Trust, but is responsible for providing Directors and those that can be accountable for its stewardship to strong leadership to the Trust. delegated to its Trust Managers. the Trust’s Council of Governors Responsibilities include: The Constitution also describes and Foundation Trust Members. In which decisions are to be addition, the Trust’s performance • Setting strategic aims and reserved for the Council of is scrutinised by Monitor and the objectives, taking into account Governors. Care Quality Commission. the views of the Council of Governors. The Board of Directors comprises In order to understand the roles • Ensuring that robust assurance, seven Non-Executive Directors and views of the Council of governance and performance (including the Chairman) and six Governors and the Foundation management arrangements Executive Directors (including Trust Members, members of the are in place to deliver identified the Chief Executive). In addition, Board of Directors undertake the objectives. there is one non-voting Executive following: • Ensuring the quality and Director. The names of the Board safety of healthcare services, members during the financial year • Attend Council of Governors education, training and are outlined in the “Profile of the meetings – the Chairman, Chief research and applying the Board” section. Each director has Executive, Director of Strategy, principles and standards of a shared and equal responsibility Director of Finance and robust clinical governance. for the corporate affairs of the Director of Operations attend • Ensuring that the Trust Trust in strategic terms and for all meetings and two Non- complies with its Terms of promoting the success of the Executive Directors attend on Authorisation, its Constitution, Trust. a rotational basis. Attendance mandatory guidance as was extended in 2013 to laid down by Monitor and There were a number of changes include at least one of the other relevant contractual or to the membership of the Board remaining Executive Directors statutory obligations. of Directors during 2013/14 as from amongst the Director of • Ensuring compliance with

Page Annual Report and Accounts 2013/14 83 Nursing, Medical Director and produced to ensure that sufficient the strategy. The Chairman Director of Workforce & OD. time is devoted to matters relating facilitates the contribution of • Attend meetings of the to patient safety and quality, the Non-Executive Directors Membership Committee - one finance and workforce. The and facilitates the constructive nominated Non-Executive Board takes strategic decisions relationships between Executive Director attends meetings of and monitors the operational and Non Executive Directors. the Membership Committee. performance of the Trust, holding The Chairman also leads the the Executive Directors to account Council of Governors and In addition, in order for the for the Trust’s achievements. In facilitates its effective working. Council of Governors to addition, Board Development The effectiveness of both the understand the views of the Board Events are held on a monthly Board and the Council, and the of Directors, Governors undertake basis to ensure that sufficient relationships between the Board the following:- time is devoted to strategic issues and Council, are reviewed by the and to consider specific issues in Chairman. The Chief Executive • Attend, as observers, Board of depth. is responsible for executing the Directors meetings which have Board’s strategy for the Trust been held in public since July There is a clear division of and the delivery of key targets, 2013. responsibilities between for allocating resources and for • Attend, as observers, Board the Chairman and the Chief management decision-making. sub-committees, for example, Executive. The Chairman Finance Committee, Quality ensures that the Board has a On a day to day basis the Chief Committee. strategy which delivers a service Executive is responsible for • Attend monthly service visits which meets and exceeds the effective running of the and monthly formal patient the expectations of its served hospital. Specific responsibilities, safety walkabouts. communities and an Executive for example operational Team with the ability to execute performance, are delegated The Non-Executive Directors are appointed by the Trust’s Council of Governors and, under the terms of the Trust’s Constitution, they must form the majority of the Directors.

The Chairman is committed to spend a minimum of three days per week on Trust business. The Chairman’s other significant commitments are outlined in the “Profile of the Board” section. The Non-Executive Directors are committed to spend a minimum of four days per month on Trust business. Both the Chairman and the Non-Executive Directors routinely spend in excess of their commitment of three days per week and four days per month respectively on Trust business. “...The Board takes strategic decisions and monitors the operational The Board of Directors meets in public a minimum of eight times performance of the Trust...” per year and the Board Agenda is

Page 84 Blackpool Teaching Hospitals NHS Foundation Trust by the Chief Executive to the Executive Directors, comprising the Director of Finance, the Director of Operations; the Medical Director, the Director of Nursing & Quality and the Director of Workforce and Organisation Development. The Director of Strategy also reports directly to the Chief Executive.

The composition of the Board of Directors is regularly reviewed and, following the recent changes, it is considered to be balanced and appropriate to the has responded positively and the NHS Foundation Trust Code of requirements of the Trust. promptly to the points raised and Governance”. significant improvements in the The Board recognises that effectiveness of the Board have Board of Directors’ meetings a regular evaluation of its been made and that decision have taken place as follows in collective and individual making is effective with no 2013/14:- director performance is critical material concerns noted”. to continuous development • Formal Board Meetings – 7 and high performance. The In October 2012 the Board • Extraordinary Board Meeting – performance of the Board of commissioned KPMG to 1 Directors in its entirety has been undertake a Quality Governance • Confidential Board Meetings – regularly reviewed during the Review which commenced 7 past few years. Following the in January 2013 and the • Corporate Trustee Meetings – 4 Board Effectiveness Review in outcome was reported to the • Board Seminars – 7 2010/11, the purpose of which Board in February 2013. An • Away Days - 1 was to review the Board’s action plan was developed performance and governance and all recommendations Following a review of the arrangements to ensure that were implemented by 31st committee structure early in the Board was appropriate and July 2013. More recently, a 2013, there are three statutory effective in undertaking its role, Risk Management Review and committees of the Board and both KPMG and Deloitte issued a Governance Arrangements three sub-committees of the a detailed report and action Review have been undertaken Board. plan. During 2011/12, the Board with positive outcomes. Action of Directors implemented the plans have been developed to The statutory committees are as recommendations from the ensure that all recommendations follows: KPMG and Deloitte reports which are implemented within agreed were monitored on a monthly, timescales. • Nominations Committee and subsequently quarterly, • Remuneration Committee basis to ensure compliance. A More information about • Audit Committee follow-up review was undertaken the evaluation of the Board by Deloitte in December 2011/ in 2013/14 can be found in The sub-committees are as January 2012 to ascertain whether “Our Finances” section under follows: the recommendations contained the heading “Performance in Deloitte’s detailed action Against Monitor’s Compliance • Quality Committee plan had been implemented. Framework” and in the “Board of • Finance Committee The outcome of the follow-up Directors’ Report” section under • Strategy & Assurance review was that “the Board the heading “Compliance with Committee

Page Annual Report and Accounts 2013/14 85 Attendance at the Board of Directors’ meetings, Board statutory committee meetings and Board sub- committee meetings (former structure) is summarised in the following table:-

Finance & HR, OD & Extraordinary Charitable Healthcare Board of Business Audit Teaching Remuneration Board Members Board of Funds Governance Directors Monitoring Committee Governance Committee Directors Committee Committee Committee Committee * Number of 7 1 2 6 4 2 1 7 Meetings Ian Johnson 7 1 2 N/A 1 1 N/A 7 Paul Olive 2 1 2 2 N/A N/A N/A 1 (until 31.5.13) Tony Shaw 7 1 2 N/A N/A N/A N/A 7 Doug Garrett 7 1 2 6 4 N/A N/A 6 Karen Crowshaw 6 1 2 N/A N/A N/A 1 7 Alan Roff 6 1 2 6 3 N/A N/A 7 Jim Edney 5 N/A N/A 4 N/A N/A N/A 5 (from 1.6.13) Michele Ibbs 4 N/A N/A N/A N/A N/A N/A 3 (from 1.9.13) Marie Thompson 7 1 1 N/A 0 2 1 N/A Dr Mark O’Donnell 7 1 2 N/A 1 2 N/A N/A Robert Bell ** 0 0 0 N/A N/A N/A N/A N/A (until 22.11.13) Pat Oliver 7 1 2 N/A N/A 2 1 N/A Wendy Swift ** 7 1 2 N/A 1 0 N/A N/A Feroz Patel 5 1 2 5 1 0 1 N/A (5.11.12 – 25.11.13) Janet Benson 2 1 2 N/A N/A 0 1 1 (1.1.13 to 2.6.13) Jacqui Bate 1 N/A 1 N/A N/A N/A N/A N/A (3.6.13 - 19.12.13) 1 (by Gary Doherty 7 1 2 invitation) N/A N/A 1 N/A Nicky Ingham 3 N/A N/A 1 N/A N/A N/A 1 (from 1.11.13) Tim Bennett 3 N/A N/A 1 1 N/A N/A N/A (from 25.11.13)

* Human Resources and Organisational Development ** Non-voting members of the Board of Directors

Page 86 Blackpool Teaching Hospitals NHS Foundation Trust Attendance at the Board of Directors’ meetings, Board statutory committee meetings and Board sub- committee meetings (existing structure) is summarised in the following table:-

Extraordinary Strategy & Board of Finance Audit Quality Remuneration Board Members Board of Assurance Directors Committee Committee Committee Committee Directors Committee Number of 7 1 4 11 6 3 7 Meetings Ian Johnson 7 1 4 11 N/A 3 7 Paul Olive 2 1 N/A N/A 2 N/A 1 (until 31.5.13) Tony Shaw 7 1 4 10 N/A N/A 7 Doug Garrett 7 1 3 3* 6 N/A 6 Karen Crowshaw 6 1 4 9 N/A N/A 7 Alan Roff 6 1 4 3* 6 N/A 7 Jim Edney 5 N/A 4 9* 4 N/A 5 (from 1.6.13) Michele Ibbs 4 N/A 2 7 N/A 3 3 (from 1.9.13) Marie Thompson 7 1 3 1 N/A 3 N/A Dr Mark O’Donnell 7 1 3 0 N/A 3 N/A Robert Bell ** 0 0 0 0 N/A N/A N/A (until 22.11.13) Pat Oliver 7 1 3 9 N/A N/A N/A Wendy Swift ** 7 1 4 10 N/A N/A N/A Feroz Patel 5 1 3 8 5 N/A N/A (5.11.12 – 25.11.13) Janet Benson 2 1 0 N/A N/A N/A 1 (1.1.13 to 2.6.13) Jacqui Bate 1 N/A 2 N/A N/A N/A N/A (3.6.13 - 19.12.13) Gary Doherty 7 1 4 10 1 3 N/A Nicky Ingham 3 N/A 1 5 1 1 1 (from 1.11.13) Tim Bennett 3 N/A 1 6 1 N/A N/A (from 25.11.13)

*These Non-Executive Directors are not members of the Finance Committee. ** Non-voting members of the Board of Directors

The work of the Board statutory committees and sub-committees is evaluated on an annual basis against agreed work programmes with assurance reports and minutes provided to the Board of Directors.

Page Annual Report and Accounts 2013/14 87 Compliance with Foundation Trusts are required to Statement as report against this Code each year the NHS Foundation in their Annual Report on the basis to Disclosure to Trust Code of of either compliance with the Auditors Code provisions or an explanation Governance where there is non-compliance. The Board of Directors is not The compliance statement below aware of any relevant audit The creation of Foundation reflects the Trust’s declaration information that has been Trusts has led to the requirement regarding compliance with the withheld from the Trust’s auditors. for a framework for corporate Code as stated in the latest Annual Each individual member of the governance, applicable across Report 2013/14. Board has taken all necessary the Foundation Trust Network. steps they ought to have taken, This is to ensure that standards of The Board of Directors and as a director, in order to make probity prevail and that Boards Council of Governors of the Trust themselves aware of any relevant operate to the highest levels of are committed to the principles of audit information and to establish corporate governance. good corporate governance. The that the Trust’s auditor is aware Trust is fully supportive of the new of said information, by making Monitor has produced the Code and the ‘comply or explain’ such enquiries of their fellow NHS Foundation Trust Code approach it requires. The Audit directors and the Trust’s auditors of Governance (updated in Committee, at its meeting on 29th for said purpose and exercising December 2013). This code April 2014, requested a review reasonable care, skills and consists of a set of Principles and will obtain external (audited) diligence. and Provisions and may be assurance in benchmarking the viewed on Monitor’s website at: Trust’s performance against a www.monitor.nhsft.gov.uk/ standard of full compliance with publications.php?id=930. the Code.

The Board of Directors has previously established governance policies in the light of the main and supporting principles of the Code of Governance.

Page 88 Blackpool Teaching Hospitals NHS Foundation Trust Page Annual Report and Accounts 2013/14 89 “The work done at the Cardiac Centre is really unbelievable. I wouldn’t be here today if it wasn’t for everyone involved. From the intensive care staff to the people on the Cardiac Ward and the Doctor who put right the condition that caused this in the first place. I can’t thank everyone involved enough from the ambulance crew to the nurses and doctors who treated me. They were all fantastic.” Mr L Shields, Blackpool

Page 90 Blackpool Teaching Hospitals NHS Foundation Trust Council of Governors

The Council of Governors was formed on 1st December 2007 in accordance with the NHS Act 2006 and the Trust’s Constitution. The Council of Governors is responsible for representing the interests of NHS Foundation Trust members and partner organisations in the local health economy.

The Council has the following • To appoint or remove the the Trust’s External Auditor in 2013/14 three main roles:- Chairman and other Non- has been agreed by the Council. Executive Directors. i) Advisory – to communicate This duty was exercised during 2013/14. • To be presented with the with the Board of Directors Annual Accounts, any report the wishes of members • To approve the appointment of the External Auditor on of the Trust and the wider (by the Non-Executive the Annual Accounts and the community; Directors) of the Chief Annual Report. This duty was exercised during 2013/14. ii) Guardianship – to ensure Executive. that the Trust is operating This duty was not exercised during 2013/14, however, it was exercised in • To provide their views to the in accordance with its 2012/13 resulting in a newly appointed Board of Directors when the Constitution and is compliant chief Executive with effect from 1st April Board of Directors is preparing with its authorisation; and 2013. the document containing iii) Strategic – to advise on a information about the longer-term direction to • To decide the remuneration Foundation Trust’s forward help the Board effectively and allowances, and the other planning. determine its policies. terms and conditions of office, This duty was exercised during 2013/14. of the Non-Executive Directors. This duty was exercised during 2013/14. The essence of these roles is • To respond as appropriate elaborated on within Monitor’s when consulted by the Board • To appoint or remove the document entitled “Your Statutory of Directors in accordance with Foundation Trust’s External Duties – A reference guide for NHS the Constitution. Foundation Trusts Governors”. Auditor. This duty was exercised during 2013/14. This document is provided to all This duty was exercised during 2013/14 resulting in the appointment of PwC Governors. following a robust evaluation process • To undertake such functions and involvement/approval by the as the Board of Directors shall The specific statutory powers Council of Governors. from time to time request. and duties of the Council of This duty was exercised during 2013/14. Governors, which are to be carried • To appoint or remove any other out in accordance with the Trust’s External Auditor appointed to • To prepare and, from time to Constitution and the Foundation review and publish a report time review the Foundation Trust’s Terms of Authorisation, are on any other aspect of the Trust’s Membership Strategy as follows:- Foundation Trust’s affairs. and its policy for the This duty was not exercised during composition of the Council 2013/14, however, the appointment of

Page Annual Report and Accounts 2013/14 91 of Governors and of the The Council of Governors The initial elected Governors were Non-Executive Directors comprises a total of 34 Governors, appointed for either two years or and, when appropriate, to including 18 Public Governors three years (in December 2007). make recommendations (elected from the constituencies All elected Governors are eligible for the revision of the Trust’s of Blackpool, Fylde, Wyre, for re-election at the end of their Constitution. Lancashire and South Cumbria initial term of office for a further This duty was not exercised during and the North of England), six six years, i.e. two terms of office. 2013/14. Staff Governors (elected from the However, elected Governors are staff groups of Medical & Dental, not eligible for subsequent re- The Council of Governors and the Nursing & Midwifery, Clinical election, i.e. in excess of nine years. Board of Directors continue to work Support, Non-Clinical Support together to develop an effective and Community Health Services) The Appointed Governors are working relationship. Board and 10 Appointed Governors appointed for three years and are members regularly attend Council (from a range of key stakeholder eligible for re-appointment at the of Governors Meetings to ensure organisations). end of their three year term for that members of the Board develop a further six years, i.e. two terms and gain an understanding of the of office. However, Appointed Governors’ and Members’ views Governors are not eligible for about the Trust. further re-appointment, i.e. in excess of nine years.

Page 92 Blackpool Teaching Hospitals NHS Foundation Trust The Trust’s Constitution sets out the composition for the Council of Governors as follows:- Appointed Governors Role Principal Local Councils – 2: To represent key local non-NHS Local Health Blackpool Council (1) Economy partners. Lancashire County Council (1) Principal University – 1: To ensure strong teaching and research partnership University of Central Lancashire and to represent other University interests. Voluntary Sector – 1: To engage and assist the Trust in identifying the Council for Voluntary Services needs of the local community. To engage and assist the Trust in identifying needs Lancashire Care Foundation Trust - 1 of local community. To engage and assist the Trust in dialogue with the Blackpool Youth Council – 1 younger catchment population. To ensure strong teaching and research partnership University of Liverpool – 1 and to represent other University interests. To engage and assist the Trust in dialogue with the Institute of Directors (Lancashire Branch) – 1 wider catchment population of Lancashire. To engage and assist the Trust in identifying the Citizens Advice Bureau (Blackpool Branch) – 1 needs of the local community. VACANCY – 1 TO BE CONFIRMED Total Appointed Governors – 10 Elected Staff Governors Role To assist the Trust in developing its services and Class 1 – Medical Practitioners – 1 ensure active representation from those who deliver the services. Class 2 - Nursing and Midwifery – 2 As above. Class 3 - Clinical Support Staff – 1 As above. Class 4 - Non-Clinical Staff – 1 As above. Class 5 – Community Health Services – 1 As above. Total Elected Staff Governors – 6 Elected Public And Patient Governors Role To Represent:- Area 1 - Blackpool – 8 To represent patients who are resident in Blackpool. Area 2 - Wyre – 4 To represent patients who are resident in Wyre. Area 3 - Fylde – 3 To represent patients who are resident in Fylde. To represent of patients who are resident in the Area 4 - Lancashire & South Cumbria – 2 wider environs of South Cumbria and Lancashire. To represent patients who are resident in the wider Area 6 – North of England – 1 environs of the North of England. Total Elected Public and Patient Governors – 18 Total Membership Of Council Of Governors Appointed Governors (nominated) – 10 (currently one vacancy) Staff Governors (elected) – 6 Public Governors (elected) - 18 (currently three vacancies) Total membership of Council of Governors – 34

Page Annual Report and Accounts 2013/14 93 There were elections to the Council of Governors during 2013/14 as follows:-

Public Governors:- Blackpool Constituency Fylde Constituency North of England Constituency Carol Measures Clive Barley Sam Wallace * Neal Brookes Gillian Wood Zacky Hameed Sheila Jefferson Robert Hudson

Staff Governors:- Nursing and Midwifery Clinical Support Community Health Services Sharon Vickers Ashok Khandelwal Mike Phillips Janet Briers

Appointed Governors:- Blackpool Council Lancashire County Council University of Liverpool Councillor Martin Mitchell County Councillor Ron Shewan Ceri Coulby

* Resigned from the Council of Governors (6th November 2013).

The next elections to the Council of Governors will take place in July 2014 for the following vacancies:-

Blackpool - 4 Fylde - 2 Wyre - 2 Lancashire & South Cumbria - 2 North of England - 1 “...The Council of Governors comprises

Nursing & Midwifery - 1 a total of 34 Governors, including 18 Non Clinical Support - 1 Public Governors (elected from the Medical & Dental - 1 constituencies of Blackpool, Fylde, All elections to the Council of Wyre, Lancashire and South Cumbria Governors have been conducted by the Electoral Reform Services and the North of England), six Staff Limited on behalf of the Trust and in accordance with the Model Governors (elected from the staff Election Rules. groups of Medical & Dental, Nursing & Midwifery, Clinical Support, Non- Clinical Support and Community Health Services) and 10 Appointed Governors (from a range of key stakeholder organisations)...”

Page 94 Blackpool Teaching Hospitals NHS Foundation Trust Membership of the Trust’s Council of Governors is set out below:

Term of Name Constituency/Organisation Office Public Governors John Butler (from September 2011) ** Blackpool 3 years Clifford Chivers (from September 2011) ** Blackpool 3 years Hannah Harte (from December 2010) * Blackpool 3 years Chris Thornton (from December 2010) * Blackpool 3 years Eric Allcock (from September 2010) * Blackpool 3 years Mark Chapman (from December 2010) * Blackpool 3 years Chris Smith (from September 2011) ** Blackpool 3 years George Holden (from September 2011) ** Blackpool 3 years Anne Smith, OBE (from September 2011) * Fylde 3 years John Longstaff (from September 2011) * Fylde 3 years Tony Winter (from September 2010) * Fylde 3 years Peter Askew (from September 2011) ** Wyre 3 years Ramesh Gandhi,JP. DL. OBE. FRCS. Wyre 3 years (from December 2010) John Bamford (from December 2010) Wyre 3 years Lynden Walthew (from September 2011) ** Wyre 3 years Vacant Lancashire and South Cumbria 3 years Vacant North Lancashire (until August 2013) 3 years Vacant Lancashire & South Cumbria (from August 2013) 3 years Staff Governors Dr Tom Kane (from September 2011) ** Medical and Dental 3 years Sam Woodhouse (from September 2011) * Nursing and Midwifery 3 years Andrew Goacher (from September 2010) * Nursing and Midwifery 3 years Tina Daniels (from September 2011) ** Non-Clinical Support 3 years Cherith Haythornthwaite (from September 2010) * Clinical Support 3 years Claire Lewis (from April 2012) * Community Health Services 3 years Appointed Governors Councillor John Boughton (from September 2011) * Blackpool Council 3 years Councillor Martin Mitchell (from May 2013) Blackpool Council 3 years County Councillor Paul Rigby (from September 2011) * Lancashire County Council 3 years County Councillor Ron Shewan (from July 2013) Lancashire County Council 3 years Mike Bullock Council for Voluntary Service 3 years Susan Rigg ** Lancashire Care Trust 3 years Jean Taylor ** University of Central Lancashire 3 years Ceri Coulby (from September 2013) University of Liverpool 3 years James Morrison-Eaves * Blackpool Youth Council 3 years Phillip Hargreaves (from April 2014) Institute of Directors (Lancashire Branch) 3 years Tony Winter (from April 2014) Citizens Advice Bureau (Blackpool) 3 years Vacant To Be Confirmed 3 years

* Resigned / Not Re-Elected or Re-Appointed in 2013 ** Due for re-election / re-appointment in 2014

Page Annual Report and Accounts 2013/14 95 Meetings of the Council of Governors took place on the following dates in 2013/14:-

• 21st May 2013 • 16th August 2013 • 15th November 2013 • 17th March 2014 (rescheduled from 14th February 2014)

Attendance at Council of Governors Meetings:

Governor Attendance Number of Number of Governors Governors Meetings (4) Meetings (4) John Butler 4 John Bamford 2 Clifford Chivers 3 Lynden Walthew 4 Hannah Harte * 1 Sam Wallace ** 0 Chris Thornton * 1 Dr Tom Kane 3 Eric Allcock * 1 Andrew Goacher * 2 Mark Chapman * 0 Tina Daniels 3 Chris Smith 3 Sharon Vickers ** 2 George Holden 4 Janet Briers ** 1 Carol Measures ** 1 Ashok Khandelwal ** 1 Neal Brookes ** 1 Mike Phillips ** 2 Zacky Hameed ** 1 Councillor John Boughton * 0 Robert Hudson ** 1 Councillor Martin Mitchell ** 2 Anne Smith * 2 County Councillor Paul Rigby * 0 Tony Winter * 0 County Councillor Ron Shewan ** 2 Clive Barley ** 2 Jean Taylor 2 Gillian Wood ** 1 Susan Rigg 3 Sheila Jefferson ** 1 Ceri Coulby ** 0 Peter Askew 3 Mike Bullock 2 Ramesh Gandhi 4

* Resigned / Not Re-Elected or Re-Appointed in 2013 ** Elected / Appointed during 2013/14

Governor sub-groups were a Governors’ sub-group meeting Governors by the deadline of the established in respect of the took place in March 2014 which 4th April 2014. following:- included a detailed presentation by the Director of Strategy and The Chief Executive, Director of • The Annual Report and the Director of Finance followed Strategy, Director of Finance and Accounts and the Quality by useful feedback from the Director of Operations routinely Report 2013/14. Governors and an overview at the attend meetings of the Council of • The Annual Plan 2014/15. subsequent Council of Governors Governors. Two Non-Executive • Membership Sub-Groups meeting. The Annual Plan was Directors attend the Council • Membership Task & Finish approved in principle at the of Governors Meetings on a Groups Council of Governors meeting in rotational basis. Attendance of March 2014 and signed-off by the Executive Directors was extended With regard to the Annual Plan, Lead Governor on behalf of the in 2012 to include one additional

Page 96 Blackpool Teaching Hospitals NHS Foundation Trust Executive Director from amongst Governor Elections, Membership Governors have also been the Director of Nursing and of the Foundation Trust involved in the following Quality, Medical Director, and Governors’ Association, Patient meetings/events:- Director of Workforce and OD. Experience, Clinical Audit, Board • Board Sub-Committees. Assurance Framework, Corporate • Governors’ Patient Experience During 2013/14, the Council Risk Register and Lead Governor Committee (including visits) of Governors received regular Role. • Formal Patient Safety assurance reports/updates from Walkabouts. the Chief Executive plus regular Following the resignation of Anne • Attendance at Board Meetings, strategic, finance, performance Smith, Public Governor (Fylde initially as observers at private and membership reports. Constituency) / Lead Governor, meetings and, subsequently, as in September 2013, Peter observers at meetings held in Presentations/reports were also Askew, Public Governor (Wyre public. given to the Council in respect of Constituency), was appointed • Governors’ Sub-Group the following:- Lead Governor. The duties of the Meetings. Lead Governor include acting - Voluntary Services as the point of contact between In addition, Governors have - Board Processes the Council of Governors and participated in external events as - Fylde Coast Public the Trust, playing a pivotal role follows:- Consultation in the relationship with the - Review into the Care and Chairman, the Board of Directors • Foundation Trust Governors Quality of Treatment and External Agencies as well Association National Provided by 14 Hospital as the community served by Development Day. Trusts in England the Trust, acting as the point of • North West Governors’ Forum. - Mortality Reduction Action contact between the Council of • GovernWell Events. Plan Governors and Monitor (should - Nurse Staffing Levels this be necessary) and meeting There are currently two Governor - Annual Report & Accounts routinely with the Chairman of Sub-committees, namely the and Quality Accounts the Board of Directors and the Nominations Committee and - Finance Statements Audit Council of Governors and with the Membership Committee, - Quality Accounts Review the Foundation Trust Secretary to comprising three and nine - Multi Storey Car Park and plan and prepare the agenda for Governors respectively, details of Main Entrance Project Council of Governor meetings. which are identified in the tables - Provision of External Audit on the next page: Services Following the Governor - Keogh Review/Berwick elections in September Report 2013, a Governors’ - Fleetwood Hospital/Rossall Introductory Meeting Hospital Developments took place in October - Annual Plan 2013 which included the - Governors Development following:- Programme Welcome and Introductions Other items discussed at the / Role of the Governor / Council of Governors Meetings Presentation on Current included the Compliance & Future Challenges for Monitoring Assurance Report, the Trust / Feedback from Serious Untoward Incidents, Election Process / Question Chairman’s and Non-Executive and Answer Session / Directors’ Appraisals/Objectives/ Networking Opportunities Remuneration, Declarations / Tour of the BVH site. of Interests, Trust Constitution,

Page Annual Report and Accounts 2013/14 97 Governor Attendance at Nominations Committee Meetings:

Number of Number of Committee Members (4) Committee Members (4) Meetings (2) Meetings (2) Eric Allcock (until September Ian Johnson (Chairman) 2 2 2013) Peter Askew 1 Jean Taylor 1

Governor Attendance at Membership Committee Meetings:

Number of Number of Committee Members (9) Committee Members (9) Meetings (4) Meetings (4) Anne Smith** (Chairman) (until Hannah Harte** (until September 2 2 September 2013) 2013) Chris Smith (Chairman) (from 4 George Holden 4 October 2013) Sheila Jefferson* (from January Peter Askew (from October 2013) 1 1 2014) Sharon Vickers* (from October Clive Barley* (from January 2014) 1 1 2013) John Boughton** (until May 2013) 0 Lynden Walthew 3 John Butler 4 Gillian Wood* (from January 2014) 1 Clifford Chivers (until January 4 2014)

* Elected in 2013/14 ** Resigned in 2013/14

Governors are also involved in Committee and will continue a number of Trust Committees, to have the opportunity to visit namely the Health Informatics wards/departments/clinics on a Committee, Charitable monthly rather than a quarterly Funds Committee, Patient basis. Led Assessments of the Care Environment (PLACE), Healthy Governors are required to comply Transport Committee, Waste with the Trust’s Code of Conduct Management Committee, and to declare interests that Equality, Diversity and Human are relevant and material to the Rights Committee, Staff Car Council of Governors. Parking Working Group and Fire Committee.

The Governors’ Patient Experience Committee, which was established during 2011/12, continued to meet on a quarterly basis until it was disbanded in February 2014. Governors will be involved in the Patient & Carer Experience & Involvement

Page 98 Blackpool Teaching Hospitals NHS Foundation Trust Governor Expenses* 2013/14

Apr May June July Aug Sept Oct Nov Dec Jan Feb Mar Name and title 2013 2013 2013 2013 2013 2013 2013 2013 2013 2014 2014 2014 Andrew Goacher 375.87 Anne Smith Brian Rowe Clive Barley Cherith Haythornthwaite Chris Lamb Chris Smith Chris Thornton Claire Lewis 15.00 62.07 Clifford Chivers Councillor John

Boughton County Councillor Paul

Rigby Denys Smith-Hart Dr Tom Kane 170.01 31.86 15.52 21.11 Dr Tom Kennedy Eric Allcock George Holden 95.94 Gillian Wood 37.80 Hannah Harte 45.00 James Morrison-Eaves Janet Briers 59.70 Jean Taylor Joanne MacDonald John Bamford John Butler John Longstaff 30.00 Lynden Walthew 100.85 67.00 Mark Chapman Mike Bullock Nicole Burke Peter Askew Ramesh Gandhi Roy Fisher Sam Woodhouse 57.95 57.95 57.95 64.58 290.11 Sheila Jefferson 102.60 Susan Rigg 41.80 Tina Daniels 124.84 168.84 292.26 153.41 Tony Winter

*Governor expense claims relate to travel expenses.

Page Annual Report and Accounts 2013/14 99 All Governors have read and signed the Trust’s Code of Conduct which includes a commitment to actively support the NHS Foundation Trust’s Vision and Values and to uphold the Seven Principles of Public Life, determined by the Nolan Committee.

All Governors have declared their relevant and material interests and the Register of Interests is available for inspection by members of the public via the Trust’s website www.bfwhospitals.nhs.uk or the Foundation Trust Secretary at the following address:-

Address: Trust Headquarters Victoria Hospital Whinney Heys Road Blackpool FY3 8NR

Telephone: 01253 306856

Email: [email protected]

Any member of the public wishing to make contact with a member of the Council of Governors should, in the first instance, contact the Foundation Trust Secretary.

Page 100 Blackpool Teaching Hospitals NHS Foundation Trust Page Annual Report and Accounts 2013/14 101 “My foot is now pretty much all sorted. I’ve been discharged from the scheme after four months of treatment. I can’t thank the doctor and nurses more.” Mr S Aspden, Staining

Page 102 Blackpool Teaching Hospitals NHS Foundation Trust Membership Report

Over the past 12 months, the Trust’s membership has slightly decreased.

Public Members Staff Members Trust volunteers are eligible to All members of the public who Staff who work for the Trust become members under the are aged 16 or over and who automatically become members public constituency. live within the boundaries of unless they choose to opt out. Blackpool, Fylde and Wyre These include: Growth of Public Members Borough Councils, or the wider The number of public members catchment area of Lancashire • Staff who are employed by has slightly decreased over the and South Cumbria for which the Foundation Trust under a last 12 months. The Trust’s public we provide tertiary cardiac and contract of employment which membership currently stands at haematology services, are eligible has no fixed term or has a fixed 5,642. to become members. Other term of at least 12 months, and members of the public who do • Staff who have been not fall into these categories, continuously employed by either due to age or place of the Foundation Trust under a residence, are eligible to become contract of employment. affiliate members of the Trust.

Membership Report for Blackpool Teaching Hospitals from 01/04/2013 to 31/03/14

Public constituency Last year (2013/2014) As at start (1 April 2014) 5,715 New Members 316 Members leaving 389 At year end (31 March 2014) 5,642

Staff constituency Last year (2013/2014) As at start (1 April 2014) 6,585 New Members 1,208 Members leaving 1,763 At year end (31 March 2014) 6,030

Page Annual Report and Accounts 2013/14 103 Public constituency Number of members Age(years): 0 - 16 37 17 - 21 146 22+ 4,637

Ethnicity: White 4,499 Mixed 13 Asian 64 Black 15 Other 12

Socio-economic groupings: AB 701 C1 3,815 C2 691 DE 389

Gender analysis: Male 2,825 Female 2,762

Recruitment of Members road shows held within local • The Trust has dedicated In order to maintain our companies. membership telephone membership level and in order • Continue to use the Trust’s line on 01253 306673 and to recruit new public members, Face book social network email address:- members@ we have implemented various site to engage and inform bfwhospitals.nhs.uk initiatives over the past year. These members and the wider public include: of developments and events at Over the next 12 months we the Trust. will continue to look at new and • Membership information • Continue to use the Trust’s fresh ways of promoting the displayed at entrances to Twitter social network page benefits of membership in order hospitals and in outpatient to attract new members, to maintain and increase our total departments. in particular target young membership. • Recruitment stands at events members. Currently the Trust for the public and community has over 1,116 followers. Retention of Members meetings, such as Area Forums • The Membership Volunteer The Trust recognises the in conjunction with Blackpool continues to come in two importance and value of a Council. afternoons a week and help out representative membership and • Distribution of recruitment in recruitment, engagement of has continued to focus on and posters and leaflets to GP members and administration. progress opportunities for the surgeries throughout the Fylde • The Trust has a dedicated engagement and retention of Coast. Membership and Governors existing members. • Continue to liaise with public Officer who acts as link health organisers from Primary between the members, Council It is particularly important to Care in order to attend health of Governors and the Trust. the Trust to not only build its

Page 104 Blackpool Teaching Hospitals NHS Foundation Trust membership, but to ensure that WiFi Experience’ for inpatients • Continue to keep members the membership is being fully and visitors. up-to-date with events at the utilised. • Membership seminars continue hospital, such as the health to be held monthly and are seminars, official openings of Numerous and varied initiatives well attended, with a range of new facilities and fundraising have taken place over the last year topics from ‘Diabetes’, ‘Chief activities via email. to retain our existing members. Executive’s Public Question Time’ and ‘The Role of a In October 2012, a revised • Continue to make members’ Governor’. Membership Strategy was seminars more interactive by • Members are able to contact ratified by the Board of Directors. involving patients/members to the Membership Office with The Board requested that a relay their experiences of the any queries or ideas via a two-page summary document treatment/services provided by dedicated membership hotline be produced identifying the the Trust. and email address. delivery of the Membership • Introduced Chief Executive’s • All members were invited to the Strategy. A document entitled Public Question Time so that Annual Members’ and Public ‘Implementation of the Key members can engage with the Meeting in September 2012, a Elements of the Membership Executive Team. formal meeting to discuss the Development Strategy 2012- • Continue to produce the Trust, its developments, future 2015’ was produced. This has newsletter ‘Your Hospitals’, services and membership. This continued to be implemented which keeps members was attended by around 300 during 2013/14. informed on current staff and public members. developments within the Trust, • Following the monthly health The document sets out a keeps members up-to-date seminars, Governors have summary of the Trust’s strategic with Fundraising activities made themselves available objectives for membership and and asks members their to members to deal with any identifies the key aims of delivery opinions on a wide range of queries or issues members may of these objectives. topics through consultations. have. The newsletter also gives details of a wide variety of local services and businesses that provide discounts for members, on production of their membership card. Copies of ‘Your Hospitals’ are also available on the Trust’s website from Issue 1 to Issue 16. In January 2013 the Trust changed the name of the member’s newsletter to reflect the integration of community services to ‘Your Health’. • Continue to use the ‘Consultation Corner’ section of the newsletter to gain valuable opinions from members on a variety of topics. The information is collated and used to influence decisions that are made about the Trust services. The most recent consultation has been on ‘Improving the

Page Annual Report and Accounts 2013/14 105 “...The Trust recognises the importance and value of a representative membership and has continued to focus on and progress opportunities for the engagement and retention of existing members...”

Membership Committee membership of which would Both groups are progressing Sub Groups be extended to all Governors this work and will be providing The Trust recognises the enabling those with relevant feedback to the Membership importance of having a experience to become involved. Committee on a regular basis. membership that is informed and The Trust recognises the need representative of the community Two Task and Finish Groups have to understand the level of it serves. been established to review the involvement members wish to following: - have and link this to member The Membership Committee activities. This ensures that we agreed in January 2014 that • Key membership messages and fully harness the experience, any future projects would be promotional material knowledge and skills of our progressed by establishing • Proposal for engagement with members, recognising and using Task and Finish Groups, the members them to add value to the decision

Page 106 Blackpool Teaching Hospitals NHS Foundation Trust making process and supporting effective governance and delivery of the Trusts objectives. We wish to encourage a partnership approach between the Trust, its membership and other like- minded organisations, working together for the benefit of our organisations, our members and the community served.

Membership Representation One of the key elements that we want to bring to our membership is that it is representative of the community that we serve. We have been focussing on ways of growing our young membership, as this remains under- represented. We shall also be concentrating on recruiting from ethnic minority groups, which also remains under-represented, by attending community groups. Another key element we want to bring to our membership is that we are actively engaging our members, and using their skills and expertise to add value to the services the Trust offers for the benefit of the whole community which it serves.

Page Annual Report and Accounts 2013/14 107 “The physios came to see me nearly every day, but they never pushed me to do anything. They listened to me, they took things at my pace, if I started to get in pain they stopped, they let my body decide how far we went. “They were amazing people, they explained everything to me and gave me belief in myself and that I could achieve my dream to walk again.’’ Mr M Foster, Blackpool

Page 108 Blackpool Teaching Hospitals NHS Foundation Trust Audit Committee Report

The prime function of the Audit Committee is to provide the Board of Directors with an independent assurance over the establishment and maintenance of an effective system of integrated governance, risk management and internal control across the whole of the organisation’s activities (both clinical and non-clinical) with the aim of supporting the achievement of the Trust’s objectives.

Role of Audit Committee The Trust limits work undertaken of the evaluation panel, the Trust It provides assurance on the by the external auditors recommended the appointment independence and effectiveness outside the audit code to of PwC as their provider of External of both external and internal audit. ensure independence is not Audit Services until May 2017 It ensures that standards are set compromised. In 2013/14 PwC did with the option to extend the and that compliance is monitored not provide any other services to appointment for an additional in all areas of the Trust that fall the Trust. year until May 2018, and this within the remit of the Committee. recommendation was approved The Audit Committee takes the The Board maintains a policy on by the Council of Governors at lead in reviewing the integrity of the engagement of the external their meeting on 17th March 2014. the Annual Financial and Quality auditor for the provision of Accounts and the related External non-audit services, which was Composition of the Audit Auditor’s Reports. In addition it approved by the Audit Committee Committee and Board of Directors in July 2011 reviews the Annual Governance The Committee operates in and August 2011 respectively. The Statement prepared by the accordance with the revised effect of the policy is that if the Chief Executive in his role as the Terms of Reference (as per Executive Team retains the external Accountable Officer. the new Audit Committee auditor for the supply of non-audit Handbook) agreed by the Board services with a value of more than External Auditors of Directors on 31st July 2013 the annual external audit fee, the and has met on six occasions The Council of Governors, on express approval of the Council during the year ended 31st 16th August 2013, approved the of Governors would need to be March 2014. Since June 2013 the continued appointment of PwC sought and obtained for any Committee’s membership has as the Trust’s external auditors for further work. a further year (2013/14). Payment consisted of three Non-Executive Directors (NEDs). Each member’s of £50,500 (excluding VAT) was A formal competitive tendering attendance at these meetings paid to PwC in respect of statutory process was initiated early in 2014 complied with the criterion for audit fees. A supplementary to select and appoint a provider frequency of attendance as set fee included £12,500 for the for External Audit Services for out in the Audit Committee’s independent reporting work 2014/15 and beyond, under the Terms of Reference. All meetings in relation to the Independent NHS Shared Business Services since June 2013 were attended by Auditor’s Report in the Annual Framework Agreement NHS/11/ all three NEDs. Quality Report. SG/ZY/6982. Based on the findings

Page Annual Report and Accounts 2013/14 109 The Committee is chaired by Mr Board meeting also held on 23rd External Audit Jim Edney (CPFA), who joined the May 2013. The initial draft of The Committee has reviewed the Trust in June 2013. The Board the Annual Report and Quality work and findings of the External considers Mr Edney to have Accounts for the year ending 31st Auditors by:- relevant financial experience March 2014 was discussed at the following his role as a qualified Committee meeting held on 28th • Discussing and agreeing the accountant and former Finance January 2014. The continuing scope and cost of the audit Director of two large local development and improvement detailed in the Annual Plan for authorities. In addition to the of the Quality Accounts was 2013/14. Committee members, standing also considered at a number of • Considering the extent of co- invitations are extended to the meetings and presentations made ordination with, and reliance on, Finance Director, External and thereon by the External Auditors. Internal Audit. Internal Audit representatives, • Consideration of mechanisms the Local Counter Fraud Officer, As stated in last year’s Audit regarding self-assessment of the the Interim Associate Director of Committee report the Trust Audit Committee’s effectiveness. Corporate Affairs and Governance is continuing to monitor its • Consideration of a number of and the Assistant Finance Director performance against the Key accounting treatments under (and Acting Finance Director). Lines of Enquiry for Auditors International Financial Reporting In addition other officers have Local Evaluation (KLOE) standards Standards (IFRS) and the impact been invited to attend the and the progress of this review thereon in relation to the Annual Audit Committee where it was was considered throughout the Accounts. felt that to do so would assist current year. • Presentations on Quality Update the Committee to effectively and Commercial Assurance. fulfil its responsibilities; these Internal Control and Risk • Consideration of matters in included the Chief Executive, the Management Systems relation to Fraud Responsibilities Managing Director for Community Throughout the year the and Raising Awareness. Development and Transformation, Committee has received regular • Receiving and considering the Director of Workforce and reports from both Internal and the Annual Audit Letter at its Organisational Development, the External Auditors in relation to the meeting on 23rd May 2013 Financial Accountant, the Head adequacy of the systems of internal which was presented to the of Procurement and the Assistant control and also received regular Board of Directors at its meeting Director, Clinical Support & reports from the Interim Associate also on 23rd May 2013. Facilities Management. Director of Corporate Affairs and • The accounting treatment of Governance on the robustness of Charitable Funds and their Administrative support has been risk management and governance relationship with the Trust’s provided by Miss Kayleigh Briggs arrangements throughout the accounts and Mrs Paula Clark, former and Trust. Specifically, the Committee current PA to the Finance Director. gained assurance by reviewing Internal Audit the Governance Briefing Report, Audit Committee Financial With effect from 1st October 2012 Standing Orders and Delegated the Trust appointed new internal Activities Powers of Authority, the reporting auditors having been serviced for a The Committee reviewed the Framework for the Trust’s new considerable time by Audit North Draft Annual Report and Accounts committees, the Procurement West. Formal tendering procedures and Quality Report for the year Assurance Report, Divisional took place and the contract was ended 31st March 2013 at its Risk Registers, the Corporate awarded to KPMG LLP. meeting on 30th April 2013 and Risk Register and the Board the final Audited Accounts and Assurance Framework. The Trust The Committee has reviewed and Quality Report at its subsequent Annual Governance Statement considered the work and findings meeting on 23rd May 2013 was considered at the meeting of Internal Audit by: and formally recommended to held on 30th April 2013 and was • Discussing and agreeing the the Board of Directors that the recommended to the Board for nature and scope of the Annual Accounts be approved at the approval. Internal Audit Plan.

Page 110 Blackpool Teaching Hospitals NHS Foundation Trust • Receiving and considering responsibilities, ways of working the first time. There has been progress against the plan and delegations. significant turnover at Executive presented by the Chief Internal • Progress of the implementation level, which has meant a certain Auditor and Internal Audit of the Trust electronic rostering amount of discontinuity. June Manager. system. 2013 saw the Keogh review team • Receiving reports on the • Progress on the review of “inspect” the Trust’s performance Assurance Framework, Risk Managed Equipment Services. in caring for patients as well as its Management System and CQC • Quality Governance and latest wider performance in serving its Quality and Safety Standards. trends in Quality Reporting. communities on the Fylde Coast At its meetings on 30th April • The working of the PMO and other parts of Lancashire. The 2013 and 23rd May 2013, the regarding QuIPP or CIP. Trust was one of fourteen reviewed Committee received the Head • The Trust’s approach to waivers and one of the three Trusts not put of Internal Audit Opinion which to standing orders and the into special measures as a result. A gave “significant assurance” that finalisation of a revised approval detailed improvement action plan there was a generally sound system. was adopted as a consequence system of internal control for the • The actions taken to reduce the of the review and was largely year ended 31st March 2014. level of overpayments made to implemented over the remainder staff. of the year. The Committee also met in private • The implications for the Trust of with Internal Audit representatives the Bribery Act. Looking Ahead so as to allow discussion of matters • Updates on current legal issues. The Committee will be looking in the absence of Executive Offices. • The continuous review of at how the new governance training and development arrangements settle down and will Other Matters needs for Audit Committee offer constructive advice where In addition to the matters outlined members and attendance at necessary. Pressure will continue in this report, the following areas/ relevant courses. to improve the experience of issues were discussed and reviewed • The identification and and outcomes for patients and by the Committee during the year: agreement of matters for growing demand for services is consideration by the Board. likely in the year ahead. The Trust’s • The Trust’s approach to • Further information regarding finances remain in a healthy but procurement and its Annual financial risks, including QuIPP delicate state and good resource Procurement Plan. or CIP and liquidity is detailed management will be essential. • Storage and Disposal of Personal in Section 4.4 of the Annual The Committee will play its part data Governance Statement in promoting service review and • The 2012/13 Audit Committee improvement, together with Annual Report and matters Conclusion greater integration of services and arising. 2013/14 has been another year of value for money. At all times these • Local Counter Fraud Specialist progress and change. The Trust’s will need to be done to the highest Reports and Annual Report, governance arrangements were standards and within the agreed together with a formal review of substantially re-designed with a policies of the Trust. The year ahead the Local Counter Fraud Service. view to making accountability therefore looks challenging and I • The Role of the Audit Committee or actions sharper and to reduce take this opportunity to thank my itself, particularly in the light of duplication of committee and fellow Audit Committee Members the Trust’s revised Committee Board effort. The Board has for their help and assistance during structure and membership, begun to meet in public for the year covered by this report.

Signed: Date: 21st May 2014

Jim Edney Audit Committee Chairman

Page Annual Report and Accounts 2013/14 111 “I wish to thank you and your staff at the hospital and commend all departments. My mother is a regular user of the hospital. We have always been treated with the utmost courtesy, we have always had all options explained clearly and been given choices.” Ms G Bancroft, Cheshire Remuneration Committee Report

The membership of the Trust’s Remuneration Committee comprises all six Non- Executive Directors, plus the Chairman.

Membership of the Mr Tony Shaw Seven meetings of the Committee Remuneration Committee Mrs Karen Crowshaw took place during 2013/14 as is as follows:- Mr Alan Roff follows: - 24th April 2013, 29th Mr Jim Edney (from 1st June 2013) May 2013, 26th June 2013, 31st Mrs Michele Ibbs (from 1st July 2013, 25th September 2013, Mr Doug Garrett – Chairman of September 2013) 30th October 2013 and 16th the Committee Miss Judith Oates/Mrs Nicky December 2013 with attendance Mr Ian Johnson Ingham – Secretary as follows:- Mr Paul Olive (until 31st May 2013)

Committee Members (7) Number of Meetings (7) Mr Doug Garrett (Chairman) 6 Mr Ian Johnson 7 Mr Tony Shaw 7 Mrs Karen Crowshaw 7 Mr Alan Roff 7 Mr Paul Olive (until 31st May 2013) 1 Mr Jim Edney (from 1st June 2013) 5 Mrs Michele Ibbs (from 1st September 2013) 3 Mrs Janet Benson – Secretary (April 2013) 1 Miss Judith Oates – Secretary (May/June/July 2013) 3 Mr Richie Siziba – Secretary (September/October 2013) 2 Mrs Nicky Ingham – Secretary (December 2013) 1

The Committee establishes pay guidance, pay awards made evidenced by performance ranges, progression and pay to other staff groups through appraisal and monitoring and uplifts for the Chief Executive, national awards and by obtaining evaluation through the Chairman Executive Directors and other intelligence from independent or Chief Executive. Senior Manager posts. specialists in pay and labour market research. Any increments At the meeting in April 2013, the The Committee undertakes its to pay would be subject to Committee agreed that, in line duties by reference to national satisfactory performance, with national pay uplifts for the

Page Annual Report and Accounts 2013/14 113 nationally agreed staff groups, of Workforce & OD and Mr Tim to all staff. There were no early a 1% increase would be applied Bennett as the Director of Finance. termination payments made in to Directors and other senior the year. posts that are reviewed by the All Executive Directors are on Committee. permanent contracts. Notice The following tables provide and termination payments are details of the remuneration During the course of the year, made in accordance with the and pension benefits for senior the Committee has also formally provisions set out in the standard managers for the period 1st April ratified the appointment of Mrs NHS conditions of service and 2013 to 31st March 2014. These Nicky Ingham as the Director NHS pension scheme as applied tables are subject to audit review

Signed: Date: 21st May 2014

Gary Doherty Chief Executive

Page 114 Blackpool Teaching Hospitals NHS Foundation Trust A) Remuneration 2013/14 Annual Long-term Performance performance- Loss of Salary & Fees Taxable Pension-related Related related Office Total (bands (bands of benefits benefits (bands of Name and title bonuses bonuses (bands of of £5,000) £5,000) £’00 £2,500) (bands of (bands of £5,000) £5,000) £5,000) I Johnson - Chairman 45 - 50 45 - 50 G Doherty - Chief Executive 160 - 165 255 -257.5 415 - 420 (from 01/04/13) T Bennett - Director of Finance 45 - 50 35 - 37.5* 80 - 85 (from 25/11/13) F Patel - Acting Director of 70 - 75 135 -137.5* 205 - 210 Finance (to 24/11/13) P Oliver - Director of 110 - 115 (15) -(12.5)** 95 - 100 Operations M O’Donnell - Medical 215 - 220 2.5 - 5 220 - 225 Director M Thompson - Director of 110 - 115 5 - 7.5 115 - 120 Nursing and Quality W Swift - Managing Director of Community Development 130 - 135 2.5 - 5 135 - 140 and Transformation R Bell - Director of Facilities (to 35 - 40 12.5 - 15 90 - 95 140 - 145 22/11/13) J Benson - Acting Director of Human Resources (to 15 - 20 15 - 20 30/06/13) N Ingham - Director of Human Resources (from 40 - 45 40 - 42.5* 85 - 90 01/11/2013) PA Olive - Non Executive (to 0 - 5 0 - 5 31/05/13) J Edney - Non Executive (from 15 - 20 15 - 20 01/06/13) RA Shaw - Non Executive 10 - 15 10 - 15 K Crowshaw - Non Executive 10 - 15 10 - 15 D Garrett - Non Executive 10 - 15 10 - 15 A Roff - Non Executive 10 - 15 10 - 15 M Ibbs - Non Executive (from 5 - 10 5 - 10 01/09/13)

Band of Highest Paid Directors Total 215 - 220 Remuneration (£'000) Median Total Remuneration (£) 24,799 Ratio (times) 8.8

Page Annual Report and Accounts 2013/14 115 2012/13 Annual Long-term Performance performance- Loss of Salary & Fees Taxable Pension-related Related related Office Total (bands (bands of benefits benefits (bands of Name and title bonuses bonuses (bands of of £5,000) £5,000) £’00 £2,500) (bands of (bands of £5,000) £5,000) £5,000) I Johnson - Chairman 45 - 50 45 - 50 A Kehoe - Chief Executive (to 95 - 100 15 - 17.5 115 - 120 04/11/12) T Welch - Deputy Chief Executive (to 04/11/12) 135 - 140 25 - 27.5 160 - 165 Acting Chief Executive (05/11/12 to 31/03/2013 F Patel - Acting Director of 35 - 40 25 - 27.5 60 - 65 Finance (from 05/11/12) P Oliver - Director of 110 - 115 (10)-(7.5)** 100 – 105 Operations M O'Donnell - Medical 215 - 220 620 -622.5* 835 - 840 Director M Thompson - Director of 105 - 110 (22.5)-(20)** 85 - 90 Nursing and Quality W Swift - Managing Director of Community Development 130 - 135 5 - 7.5 135 - 140 and Transformation R Bell - Director of Facilities 105 - 110 17.5 - 20 125 - 130 N Grimshaw - Director of Human Resources (to 80 - 85 (25) -(22.5)** 55 - 60 31/03/12) J Benson - Acting Director of Human Resources (from 20 - 25 20 - 25 01/01/2013) PA Olive - Non Executive 15 - 20 15 - 20 MG Faulkner - Non Executive 5 - 10 5 - 10 (to 17/12/12) RA Shaw - Non Executive 10 - 15 10 - 15 K Crowshaw - Non Executive 10 - 15 10 - 15 D Garrett - Non Executive 10 - 15 10 - 15 A Roff - Non Executive 10 - 15 10 - 15

Band of Highest Paid Directors Total 215 - 220 Remuneration (£'000) Median Total Remuneration (£) 24,799 Ratio (times) 8.8

Page 116 Blackpool Teaching Hospitals NHS Foundation Trust The remuneration report table as PB is the annual rate of pension, ** Where the actual increase in an above has been prepared in line adjusted for inflation, that would individual’s pension entitlement during with 2013/14 ARM for FT’s. The be payable to the director if the year is less than the CPI percentage assumed in the calculation (2013/14: 2.2%) 2013/14 guidance requires new they became entitled to it at the a negative real pension increase can arise. basis for calculation of pension beginning of the financial year; In practice this would be limited to cases related benefits. As a result where the individual has a minimal (or nil) prior year comparatives have LSE is the amount of lump sum salary increase and/or only a few months’ been restated in line with new that would be payable to the contributions (e.g. where they left early in the year). Such a negative real increase guidance. director if they became entitled to could in turn lead to a negative amount in it at the end of the financial year; the “pension related benefits” column in the As explained in more detail above table. below, the basis of calculation LSB is the amount of lump sum, shows the pension accrued in adjusted for inflation, that would No directors or senior managers year multiplied by a factor of 20. be payable to the director if of the Trust have received non This has resulted in large pension they became entitled to it at the cash benefits as part of their related benefits being shown in beginning of the financial year; remuneration package in the remuneration report table and, 2013/14. above. EC is the employee’s contribution During 2013/14 compensation The basis of calculation for paid during the year. payments of £92,155 were pension related benefits is in line paid to R Bell for loss of office, with section 7.62 of the ARM, and In summary the new basis of comprising payment of £55,293 follows the ‘HMRC method’ which calculation as above, shows in lieu of notice for termination is derived from the Finance Act the pension accrued in year of employment, and £36,982 2004 and modified by Statutory multiplied by a factor of 20. This in respect of the employee’s Instrument 2013/1981. The has resulted in large pension statutory and contractual calculation required is: related benefits as shown in the redundancy payment. Both remuneration report table as elements of the compensation Pension Benefit Increase = above. payment have been calculated in ((20 x PE) + LSE) - ((20 x PB) + LSB) - EC accordance with the employee’s *The pension related benefits are especially terms and conditions of Where: large for new directors in post in year, employment. these being the Chief Executive, Director of Finance and the Director of HR, who have PE is the annual rate of pension received pay increases in year in line with No executive directors of the that would be payable to the their new office. Trust hold external non-executive director if they became entitled to director appointments. it at the end of the financial year;

Page Annual Report and Accounts 2013/14 117 Pension Benefits - Values subject to audit review

Salary and Pension Entitlements of Senior Managers

B) Pension Benefits Lump sum Total Real at age 60 Real accrued Cash Cash Real increase related to increase in pension at Equivalent Equivalent Increase in pension accrued pension at age 60 at Transfer Transfer in Cash Name and title lump sum pension at age 60 31st March Value at Value at Equivalent at age 60 31st March (bands of 2014 1st April 31st March Transfer (bands of 2014 £2500) (bands of 2013 2014 Value £2500) (bands of £5000) £5000) £000 £000 £000 £000 £000 £000 £000 G Doherty Chief Executive (from 10 - 12.5 40 - 45 35 - 37.5 125 - 130 425 625 191 01/04/2013) T Bennett Director of Finance 0 - 2.5 45 - 50 0 - 2.5 135 - 140 708 775 18 (from 25/11/2013) F Patel Acting Finance Director 2.5 - 5 15 - 20 12.5 - 15 55 - 60 160 251 57 (from 05/11/2012 to 30/01/2014) M O'Donnell 0 - 2.5 80 - 85 2.5 - 5 240 - 245 1,668 1,782 78 Medical Director W Swift Managing Director of Community 0 - 2.5 55 - 60 2.5 - 5.0 170 - 175 1,177 1,261 58 Development and Transformation P Oliver 0 - 2.5 35 - 40 0 - 2.5 110 - 115 626 820 179 Director of Operations M Thompson Director of Nursing and 0 - 2.5 35 - 40 2.5 - 5 115 - 120 591 635 32 Quality N Ingham Director of Human 0 - 2.5 20 - 25 2.5 - 5 60 - 65 253 296 16 Resources (from 01/11/2013) R Bell Director of Facilities (to 0 - 2.5 5 - 10 0 - 2.5 0 - 5 117 140 13 22/11/2013)

Page 118 Blackpool Teaching Hospitals NHS Foundation Trust As Non-Executive members benefits that the individual has in accrued pension due to do not receive pensionable accrued as a consequence of their inflation, contributions paid by remuneration, there will be no total membership of the pension the employee (including the entries in respect of pensions for scheme, not just their service in value of any benefits transferred Non-Executive members. a senior capacity to which the from another pension scheme or discloseure applies. The CETV arrangement) and uses common A Cash Equivalent Transfer Value figures, and from 2004/05 the market valuation factors for the (CETV) is the actuarially assessed other pension details, include the start and end of the period. capital value of the pension value of any pension benefits in scheme benefits accrued by a another scheme or arrangement In his budget of 22 June 2010 member at a particular point in which the individual has the Chancellor announced that time. The benefits valued are transferred to the NHS pension the uprating (annual increase) the member's and any other scheme. They also include any of public sector pensions would contingent spouse's pension additional years of pension service change from the Retail Prices payable from the scheme. A in the scheme at their own cost. Index (RPI) to the Consumer Prices CETV is a payment made by a CETV's are calculated within Index (CPI) with effect from April pension scheme, or arrangement the guidelines and framework 2011. As a result the Government to secure pension benefits in prescribed by the Institute and Actuaries Department undertook another pension scheme or Faculty of Actuaries. a review of all transfers factors. arrangement when the member leaves a scheme and chooses to Real increase in CETV - this reflects transfer the benefits accrued in the increase in CETV effectively their former scheme. the pension funded by the employer. It figures shown relate to the takes account of the increase

Page Annual Report and Accounts 2013/14 119 Executive Director Expenses

Reporting related to the Review of Tax Arrangements of Public Sector Appointees

C) Executive Director Expenses Apr May June July Aug Sept Oct Nov Dec Jan Feb Mar Name and title 2013 2013 2013 2013 2013 2013 2013 2013 2013 2014 2014 2014 (£) (£) (£) (£) (£) (£) (£) (£) (£) (£) (£) (£) G Doherty Chief Executive 7.00 41.52 45.67 66.39 8.40 8.81 from 01/14/2013 F Patel Acting Finance 4.80 49.84 12.00 9.70 Director to 24/11/2013 T Bennett Finance Director 21.83 46.32 from 25/11/2013 M O’Donnell 10.69 10.70 10.69 10.69 10.69 10.69 10.69 10.69 10.69 10.69 10.69 10.69 Medical Director* P Oliver Director of 74.98 129.25 Operations M Thompson Director of 155.61 185.98 125.65 80.97 Nursing and Quality J Benson Acting Director of 196.97 53.73 HR to 30/06/2013 N Ingham Director of HR 22.10 136.75 from 01/11/2013 W Swift Managing Director of Community Development and Transformation R Bell Director of Clinical Support and Facilities Management to 22/11/2013

*Expense claims for M O’Donnell are for telephone allowances. All other claims relate to travel expense claims.

Page 120 Blackpool Teaching Hospitals NHS Foundation Trust Off-Payroll Engagements As part of the Review of Tax Arrangements of Public Sector Appointees published by the Chief Secretary to the Treasury on 23rd May 2012, Foundation Trusts are required to publish information in relation to the number of off- payroll engagements.

Table 1: For all off-payroll engagements as of 31 March 2014, for more than £220 per day and that last longer than 6 months No. of existing engagements as of 31 March 2014 0

Table 2: For all new off-payroll engagements, or those that reached six months in duration, between 1 April 2013 and 31 March 2014, for more than £220 per day and that last for longer than 6 months No. of new engagements 3 Of which: No. of new engagements which include contractual clauses giving the department the 2 right to request assurance in relation to income tax and National Insurance obligations Of which: No. for whom assurance has been accepted and received 2 No. for whom assurance has been accepted and not received 0 No. that have been terminated as a result of assurance not being received 0 Total 3

Table 3: For any off-payroll engagements or board members, and/or, senior officials with significant financial responsibility, between 1 April 2013 and 31M arch 2014, for more than £220 per day and that last for longer than 6 months No. of off-payroll engagements of board members, and/or, senior officials with 1 significant financial responsibility, during the financial year. No. of individuals that have been deemed “board members and/or senior officials with 1 significant financial responsibility” during the financial year.

Page Annual Report and Accounts 2013/14 121 “I would like to say a huge and heartfelt thank you to my midwife’s for my second pregnancy. Thank you for your patience and caring nature. Thank you for your support and making me feel special. I will never be able to thank you enough for what you have done.” Mrs C Davis, Blackpool Nominations Committee

The Nominations Committee is a formally constituted sub-committee of the Council of Governors and comprises the Trust Chairman (Chair of the Committee) and three Governors.

specifications for each of and feedback to the Council of Membership of these posts to take account Governors. the Nominations of general and specific requirements in terms of roles • To agree a mechanism for Committee:- and responsibilities. the evaluation of the Trust Chairman, led by the Senior Mr Ian Johnson – Trust Chairman • To determine a schedule Independent Director. (Chairman) for advertising, shortlisting, Mr Peter Askew – Elected interview and appointment • To address issues related to Governor (Wyre Constituency) of candidates with requisite Board development and to Mr Eric Allcock – Elected Governor skills and experience. This ensure that plans are in place (Blackpool Constituency) (until will include identification of for succession to posts as September 2013) appropriate independent they become vacant so that a Mrs Jean Taylor – Appointed assessors for appointment balance of skills and experience Governor (UCLAN) panels. is maintained. There have been two meetings • To recommend suitable people Board Recruitment:- of the Nominations Committee for appointments to be ratified • The recruitment process to during 2013/14. by the Council of Governors. appoint one replacement Non-Executive Director and Terms and Conditions – Chair one additional Non-Executive The Nominations and Non-Executive Directors:- Director was undertaken Committee has the • To recommend salary by an external company following responsibilities:- arrangements and related in conjunction with the terms and conditions for the Nominations Committee. Jim Recruitment and Appointment Chairman and Non-Executive Edney and Michele Ibbs were of Non-Executive Directors:- Directors for agreement by the appointed and took up post • To agree the skill mix and Council of Governors. on the 1st June 2013 and 1st process for the appointment September 2013 respectively. of Non-Executive Directors, Performance Management and in accordance with the Trust’s Appraisal:- • The recruitment process for Terms of Authorisation and • To agree a process for the an additional Non-Executive Monitor’s requirements. setting of objectives for Non- Director with a clinical Executive Directors, subsequent background will take place in • To draw up person appraisal by the Trust Chairman 2014/15

Page Annual Report and Accounts 2013/14 123 “A huge thank you to all the staff on the Surgical Day Unit. The care and consideration by all was first class. I know folk are quick to grumble, but I feel I must say a genuine thank you when it is deserved. My wife had an operation a couple of years ago and the care shown from surgeons to cleaners could not have been better.” Mr & Mrs J Howarth, Preston Annex A: Quality Account

Part 1: Statement on Quality from the Chief Executive

Blackpool Teaching Hospitals NHS Foundation Trust aims to be the safest organisation within the NHS. This means that patient safety and quality are at the heart of everything that we do. As Chief Executive, I am incredibly proud of what we, at the Trust have achieved so far. We hope that you find that this Quality Account describes our achievements to date and our plans for the future.

Our staff are committed to work we have been doing over in our local results of the national providing safe, high quality care the past 12 months to ensure patient survey in areas such as; to every patient every time. We our patients receive the highest privacy and dignity, cleanliness, believe that staff who enjoy their quality and safest care possible. waiting times and communication work and have pride in it, will It includes a detailed overview of between staff and patients. provide patients with better care. the improvements we have made during 2013/14 and sets out our Once again we received national I am delighted to introduce our key priorities for the next year recognition for our work to improve fourth Quality Account which 2014/15. patient safety and quality and the highlights the excellent progress Trust’s Maternity Substance Misuse we have made over the past 12 In last year’s Quality Account we team was recognised nationally, months in ensuring our patients set ourselves a number of specific winning the Women’s Health receive the highest quality care quality objectives and I am pleased category at the National Care possible. to report that we have made Integration Awards for its Integrated significant progress against these Care Pathway for Pregnant Women Each year NHS Foundation Trusts objectives. who misuse substances. The team are required to include a report has developed and improved the within their annual report on Infection rates have continued care and support given to pregnant quality standards within their to fall and are now at their lowest women who misuse substances organisation. levels with a 91% reduction and this good practice has been in incidents of clostridium recognised both inside and outside Ensuring patients receive high difficile over the last six years the Trust. quality and safe care is our and 89% in Methicillin-Resistant Trust’s key priority. Our services Staphylococcus Aureus (MRSA) In June 2013 the Trust was selected are constantly changing and Bacteraemia when compared for a review of Quality of Care and improving to meet the needs to 2007/08. We have also seen Treatment led by Sir Bruce Keogh, of the community and we have significant reductions in pressure Medical Director, NHS England. introduced new initiatives to ulcers and patient falls. We welcomed this review and improve the quality of care and the opportunity to demonstrate patient experience. Ensuring our patients receive a the quality of care and treatment positive experience of care was provided by the organisation The Quality Account for the another priority and we are pleased and to highlight many areas of 2013/14 period highlights the that we have made improvements improvement being undertaken.

Page Annual Report and Accounts 2013/14 125 This visit linked well with our For example we are now able to the organisation. Although we are ongoing work to improve service offer intravenous therapy treatments pleased with our achievements we quality and reduce mortality, which in the home or community setting strive continuously to improve both has seen average standardised which allow long-term recipients the quality and safety of our care mortality ratios for the Trust of intravenous drugs to be allowed and want to share with you our story decreasing since July 2012. home from a hospital ward to of continuous improvement in our continue their treatment. annual Quality Account. I hope that We have continued to make you will see that we care about, and progress on reducing mortality Our Rapid Response Plus multi- are improving, the things that you rates and this is something the Trust disciplinary team, which is able to would wish to see improved at our is totally committed to achieving. respond within two hours to an Trust During the past 12 months our urgent health or social care need Summary Hospital – Level Mortality which does not require immediate We aim to be responsive to patients Indicator (SHMI) and Risk Adjusted hospitalisation, is also a great example needs and will continue to listen to Mortality Index (RAMI) have of providing fast and efficient care in a patients, staff, stakeholders, partners reduced significantly (SHMI 118- safe and controlled way. and Foundation Trust members and 109 and RAMI from 102-87) and your views are extremely important we confidently expect the data to The Trust is also piloting a dedicated to us. We are pleased that Governors be within the expected range by team working with 15 care homes and other local stakeholders April 2014. On all (HSMR) mortality across Blackpool. The team has have played a part in shaping our worked with care home staff and priorities for the future. They have metrics the Trust’s relative risk has other professionals to develop shared their ideas and comments reduced year-on-year following individual care plans for each so that we can continue to improve a number of operational and resident which ensure they always the quality of care and patient clinical quality initiatives which receive appropriate treatment when experience in areas when needed. have now resulted in substantial needing medical intervention. improvements in mortality figures. To the best of my knowledge the Our Better Care Now scheme has This is just a flavour of some of the information in the Quality Account developed a number of clinical excellent progress that has been 1st April 2013 – 31st March 2014 is pathways that impact most on made over the past 12 months. The a balanced and accurate account of mortality and morbidity figures full report contains many more facts the quality of services we provide. and are focusing particularly on and figures and I would encourage the first 24-36 hours of patient care you to read about the numerous to standardise and improve the initiatives and measures that are in treatments they receive and this is place to improve quality and reduce providing excellent results. avoidable harm.

Please note: SHMI and RAMI data taken Our plans for 2014/15 aim to build from CHKS information website and is the 12 month rolling average figure taken as at on the progress we have made as 18.05.2014). well as new improvement targets in relation to patient care. In 2013 The Trust has also invested more we launched our five strategic than £1.5M in clinical staff with aims for 2020: 100% patients and more than 180 qualified nurses and carers included in decisions about more than 40 doctors joining the their care, 100% compliance with organisation. agreed patient pathways, Zero inappropriate admissions, Zero We have also been undertaking patient harms and Zero delays. intensive work to deliver High Quality Whilst these targets are ambitious care within the community and they will underpin everything we do. developed a number of initiatives to provide care outside the hospital Looking forward to the year ahead, setting in particular for the frail elderly we intend to increase our efforts Gary Doherty and those with long term conditions. even further towards driving quality Chief Executive and safety improvements across 21st May 2014

Page 126 Blackpool Teaching Hospitals NHS Foundation Trust Part 2: Our Quality Achievements

In this section the Trust’s performance in 2013/14 is reviewed and compared to the priorities that were published in the Trust’s Quality Account in 2012/13. Priorities for improving the quality of services in 2014/15 that were agreed by the Board in consultation with stakeholders are also set out in this section. Legislated statements of assurance from the Board of Directors complete Section 2.

2.1 How we performed on Quality in 2013/14 against Priorities in 2012/13 Quality Account

This section tells you about some of the quality initiatives we progressed during 2013/14 and how we performed against the quality improvement priorities and aims we set ourselves last year.

A programme of work has been established that corresponds to each of the quality improvement areas we are targeting. Each a particular number represents detailed in the 2012/13 Quality individual scheme within the good or poor performance. Account is provided in Table programme has contributed Wherever possible, references of 1. A more detailed description to one, or more, of the overall the data sources for the quality of performance against these performance targets we have improvement indicators will be priorities for clinical effectiveness set. Considerable progress stated, within the body of the of care, quality of the patient and improvements have report or within the Glossary of experience and patient safety will been delivered through Terms, including whether the be reported on in detail in Part 3, staff engagement and the data is governed by national section 3.4. commitment of staff to make definitions. improvements. The following symbols will tell Wherever applicable, the report you how we are performing and will refer to performance in whether we met our aims. When previous years and comparative we set our aims these were either performance benchmarked data set in year or to cover a three- with other similar organisations. year period. This was part of our This will enable the reader to quality journey. We are therefore understand progress over time pleased to report the significant and as a means of demonstrating progress made against our aims. performance compared to other An overview of performance Trusts. This will also enable the in relation to the priorities for reader to understand whether quality improvement that were

Page Annual Report and Accounts 2013/14 127 Table 1: Performance Against Trust Priorities

Key: Target Achieved/ On Plan Close to Target Behind Plan Actual Expected Priority 1: Clinical Effectiveness of Care 2011/12 2012/13 2013/14 Target Score 2013/14 2013/14 Provisional Reduce premature mortality from the major causes of death 1.16 Results - Reduce ‘preventable’ mortality by reducing the Trust’s Hospital < 1.18 due October Mortality Rates / Summary Hospital Mortality Indicators 2014 - The value and banding of the Summary Hospital-Level Mortality Not Indicator (SHMI) for the Trust (See section 2.3.7 Core Clinical reported in 1 1 Indicators for results) 2011/12 - The percentage of patient deaths with palliative care coded at Not either diagnosis or specialty level for the trust for the reporting reported in 18.90% 10.57% period. (See section 2.3.7 Core Clinical Indicators for results) 2011/12 Result North West Advancing Quality initiative that seeks compliance with CQS Target 2011/12 2012/13 2013/14 Achieved best practice to improve patient experience in six clinical areas: 2012/13 2012/13 - Acute Myocardial Infarction 95% 98.54%

- Hip and Knee Surgery 95% 95.54%

- Coronary Artery Bypass Graft Surgery Data not 95% 98.19% available - Heart Failure until Sept 82.84% 91.14% 2014 - Community Acquired Pneumonia 87.39% 90.77% 89.34% - Stroke 90% / 50% /57.74% Enhancing quality of life for people with dementia: Not Improve the outcome for older people with dementia by ensuring reported in 68% 90% 90% of patients aged 75 and over are screened on admission 2011/12 Medical Care Indicators used to assess and measure standards of 82% 95% clinical care and patient experience Acute 95% 95% Nursing Care Indicators used to assess and measure standards of N/A N/A ALTC 58% 95% clinical care and patient experience Trust 87% 95% Improving outcomes from planned procedures by Improving Patient Provisional Reported Outcomes Measure (PROMs) scores for the following data elective procedures: i Groin hernia surgery 0.085 0.089 Data not ii Varicose veins surgery 0.091 0.097 available until Sept iii Hip replacement surgery 0.405 0.366 2014 iv Knee replacement surgery 0.298 0,297

16+ Not available Reduce emergency readmissions to hospital (for the same condition) Not 12.04 Data not -16.77% at this time within 28 days of discharge (See section 2.3.7 Core Clinical Indicators reported in available < 16 Not available for results) 2011/12 10.73 -16.77% at this time

Page 128 Blackpool Teaching Hospitals NHS Foundation Trust Priority 2: Quality of the Patient Experience 2011/12 2012/13 2013/14 2013/14 2013/14 Improve hospitals’ responsiveness to inpatients’ personal needs by National improving the CQC National Inpatient Survey results in the following Picker BTHFT actual five areas: average 85% said • Were you involved as much as you wanted to be in decisions 88% definitely or to about your care and treatment? some extent 47.9% said • Did you find someone on the hospital staff to talk to about your 44% definitely or to worries and fears? some extent 90% said • Were you given enough privacy when discussing your condition or 91% always/ treatment? sometimes 44% said yes • Did a member of staff tell you about medication side effects to completely or 45% watch for when you went home? yes to some extent • Did hospital staff tell you who to contact if you were worried about 70% 73.7% said ye your condition or treatment after you left hospital? National Improve staff survey results in the following area: BTHFT actual average Not yet Not Not Not To be the • Percentage of staff who would recommend their friends or family reporting reported in reported in reported in Best 20% needing care starts April 2011/12 2012/13 2013/14 of Trusts 2014 To be Not yet Not Not Not • Report on Friend and Family Test and achieve above national above reporting reported in reported in reported in target national starts April 2011/12 2012/13 2013/14 average 2014 Improving the experience of care for people at the end of their lives: 2011/12 2012/13 2013/14 2013/14 2013/14 Patient Patient • Seeking patients and carers views to improve End of Life Care views to be questionnaire sought in place • Ensure that patients who are known to be at the end of their lives Facilitate Identification are able to spend their last days in their preferred place across all preferred of preferences services. place for future care Actual Expected Patient Led Assessment of the Care Environment (PLACE) Survey 2013/14 Score 2013/14 • To improve PLACE survey results/standards Excellent Excellent Actual Expected Priority 3: Patient Safety 2011/12 2012/13 2013/14 2013/14 Score 2013/14 Achieve 95% Harm Free care to our patients by 2016 through the following strands of work: Risk-assessment for Thrombo-Embolism (VTE) - Improve the percentage of admitted patients who were risk- assessed for VTE; 97. 50% 99.40% 96% 99.5% and - Compare the national average for the above percentage - (See section 2.3.7 Core Clinical Indicators for results) - Achieve a 10% reduction on the previous year in all VTE 10% 49.5%

Actual Expected Table 1: Performance Against Trust Priorities 2011/12 2012/13 2013/14 Performance 2013/14 Score 2013/14 Rates of Clostridium Difficile and MRSA - Reduce the incidence of Clostridium Difficile infection rates in the 29 26 Trust as reflected by national targets - Reduce the incidence of MRSA infection rates in the Trust as 0 1 reflected by national targets

Page Annual Report and Accounts 2013/14 129 Actual Expected Priority 3: Patient Safety 2011/12 2012/13 2013/14 2013/14 Score 2013/14 Reported Patient Safety Incidents - To monitor the rate of patient safety incidents and reduce the 38 18 percentage resulting in severe harm or death • Reduce the incidence of inpatient Falls by 30% resulting in 25 39 moderate or major harm • Reduce the incidence of Medication Errors by 50% resulting in 17 15 moderate or major harm Stage 2 – 25% 30% - Reduce the incidence of new hospital acquired pressure ulcers Stage 60% stage 2 by 30%, stage 3 by 40% and stage 4 by 100%; and 3-40% Stage 4 100% -100% Stage 2 12% -10% - Reduce stage 2, 3 and 4 community acquired pressure ulcers by Stage 59% 10% (see page 60 for definitions) 3-10% Stage 4 0% -10% - Overall reduction in Hospital Acquired pressure Ulcers- 33% 33% Not Not Pilot in Pilot in - Introduce the Think Glucose Programme reported in reported in progress progress 2011/12 2012/13

Page 130 Blackpool Teaching Hospitals NHS Foundation Trust 2.2 Selected Priorities for Quality Improvement in 2014/15

This section tells you about how we prioritised our quality improvements for 2014/15. This section also includes a rationale for the selection of those priorities and how the views of patients, the wider public and staff were taken into account. Information on how progress to achieve the priorities will be monitored, measured and reported is also outlined in this section.

2.2.1 How we Prioritised our Quality Improvements in 2014/15 The Board of Directors has developed an organisational Strategic Framework which governors, managers and clinical Outcomes Framework 2014/15 underpins the quality programme staff. The Trust has shared its which set out the high-level set out in this Quality Account proposed priorities for 2014/15 national outcomes that the NHS for 2013/14. We believe the with our Clinical Commissioning should be aiming to improve. The quality programme will enable Groups, Blackpool Healthwatch, priorities focus on 3 key elements us to maintain a focus on the Lancashire Healthwatch, in the quality of care. These are: quality and safety agenda, Blackpool Overview and Scrutiny whilst delivering our Strategic Committee, Lancashire Overview • Clinical Effectiveness of Care Framework to improve the and Scrutiny Committee and • Quality of the Patient health and outcomes of our local a sub group of the Council of Experience population based on the values Governors. • Patient Safety and principles set by the Board of Directors. The Trust has taken the feedback Four additional quality received into account when improvement priorities have also 2.2.2 Rationale for the developing its priorities for quality been selected by the Board of Selection of Priorities in improvement for 2014/15 and Directors as a priority in 2014/15 2014/15 after consultation at Board level, and are detailed in Table 2 in bold The Trusts priorities for 2014/15 the following quality improvement italics. in relation to the key elements priorities outlined in Table 2 were of the quality of care for clinical proposed and agreed by the Board effectiveness, quality of the of Directors which it believes will patient experience and patient have maximum benefits for our safety, and the initiatives chosen patients. to deliver these priorities These quality improvement were established as a result priorities are also reinforced by of consultation with patients, the standards outlined in the NHS

Page Annual Report and Accounts 2013/14 131 Table 2: Priorities for Quality Improvement National Level Trust Level Key Description of Priority Indicators for Quality NHS Outcomes Elements in Improvement 2014/15 Framework the Quality (DH 2014/15) of Care Quality Domain(s) Domain 1: To provide and Clinical Reduce premature mortality from the major Preventing maintain high Effectiveness causes of death people quality and safe of Care - Reduce ‘preventable’ mortality by reducing from dying services. To deliver the Trust’s hospital mortality rates prematurely. consistent best- - The value and banding of the Summary practice NHS care Hospital-Level Mortality Indicator (SHMI) for Domain 2: which is evidence the Trust Enhancing based. - The percentage of patient deaths with quality of life palliative care coded at either diagnosis or for people To actively work in specialty level for the trust for the reporting with long-term the prevention of ill period. conditions. health as well as its treatment. Domain 1: To provide patient Clinical Our strategic aim is 100% compliance with agreed Preventing centred care across Effectiveness pathways by 2016 through the following strands people integrated pathways of Care of work: from dying with primary/ - Sepsis prematurely. community/ - Pneumonia secondary and social - Stroke care. - Cardiac Chest Pain - Acute Kidney Injury

North West Advancing Quality initiative that seeks compliance with best practice to improve patient outcomes in eight clinical pathway programmes: - Acute Myocardial Infarction - Hip and Knee Surgery - Coronary Artery bypass graft surgery - Heart Failure - Pneumonia - Stroke - Patient Experience Measures - Acute Kidney Injury Domain 2: To provide and Clinical Enhancing quality of life for people with dementia Enhancing maintain high Effectiveness - Improve the outcome for older people with quality of life quality and safe of Care dementia by ensuring 90% of patients aged for people services 75 and over are screened on admission with long-term conditions. To deliver consistent best-practice NHS care which is evidence based

Page 132 Blackpool Teaching Hospitals NHS Foundation Trust Table 2: Priorities for Quality Improvement National Level Trust Level Key Description of Priority Indicators for Quality NHS Outcomes Elements in Improvement 2014/15 Framework the Quality 2013/14 of Care Domains of Quality Domain 3: To provide and Clinical Medical Care Indicators and Nursing Care Helping people maintain high Effectiveness Indicators used to assess and measure standards of to recover quality and safe of Care clinical care. from episodes services - Improving outcomes from planned of ill health or procedures following injury. To deliver consistent best-practice - Improve Patient Reported Outcomes Measure NHS care which is (PROMs) scores for the following elective evidence based. procedures: i Groin hernia surgery To actively work in ii Varicose veins surgery the prevention of ill iii Hip replacement surgery health as well as its iv Knee replacement surgery treatment. Emergency readmissions to hospitals within 28 days of discharge (Quality Accounts January 2014 DH) - The percentage of patients’ of all ages and genders (aged 0 to14) and (15 or over) readmitted to a hospital which forms part of the Trust within 28 days of being discharged from hospital; and - Compare the National Average for the above percentage Domain 4 To provide and Quality of Improve hospitals’ responsiveness to inpatients’ Ensuring that maintain high The Patient personal needs by improving the CQC National people have quality and safe Experience Inpatient Survey results in the following five questions: a positive services - Were you involved as much as you wanted experience of to be in decisions about your care and care. To deliver consistent treatment? best-practice - Did you find someone on the hospital staff to NHS care which is talk to about your worries and fears? evidence based. - Were you given enough privacy when discussing your condition or treatment? - Did a member of staff tell you about medication side effects to watch for when you went home? - Did hospital staff tell you who to contact if you were worried about your condition or treatment after you left hospital? Improve staff survey results in the following area: - Percentage of staff who would recommend the Trust to friends or family needing care. - Report on Friends and Family Test

Page Annual Report and Accounts 2013/14 133 Table 2: Priorities for Quality Improvement National Level Trust Level Key Description of Priority Indicators for Quality NHS Outcomes Elements in Improvement 2014/15 Framework the Quality 2013/14 of Care Domains of Quality Domain 4 To provide and Quality of Improving the experience of care for people at the end Ensuring that maintain high quality The Patient of their lives people have and safe services Experience - Seeking patients and carers views to improve End a positive of Life Care experience of To deliver consistent - Ensure that patients who are known to be at the care. best-practice NHS end of their lives are able to spend their last days care which is evidence in their preferred place across all services. based. Domain 5 To provide and Patient Safety Achieve 95% Harm Free Care to our patients by 2016 Treating and maintain high quality through the following strands of work: caring for and safe services people in a safe Risk-assessment for Thrombo-Embolism (VTE) environment and To deliver consistent - Improve the percentage of admitted patients who protecting them best-practice NHS were risk- assessed for VTE; and from avoidable care which is evidence - Compare the national average for the above harm. based. percentage - Achieve a 10% reduction on the previous year in To actively work in the all VTE prevention of ill health Rates of Clostridium Difficile and MRSA as well as its treatment. - The rate of Clostridium Difficile infections per 100,000 bed days amongst patients aged two years and over apportioned to the Trust; and - Compare the national average for the above rate. - Reduce the incidence of MRSA infection rates in the Trust as reflected by national targets Reported patient safety incidents - To monitor the rate of patient safety incidents the Trust have reported per 100 admissions; and - The proportion of patient safety incidents the Trust has reported that resulted in severe harm or death - Reduce the incidence of Falls resulting in patient harm by 30% at low, minor moderate and serious impact levels - Reduce the incidence of medication errors resulting in moderate or severe harm by 30% - Reduce the incidence of new hospital acquired pressure ulcers stage 2 by 50%, stage 3 by 100% and stage 4 by 100%; and - reduce stage 2, 3 and 4 community acquired pressure ulcers by 30% Continue to introduce the plan Think Glucose Programme The Priority Indicators for Quality Improvement will be measured through the objectives and Strategic Aims that are identified within the Organisational Strategic Framework. The Priority Indicators for Quality Improvement will be monitored by the Board at each of its meetings through the Chief Executive Assurance Report, and a number of committees within the Board Committee Structure. Further information can be found in section 2.2.5 and in the Glossary of Terms

Page 134 Blackpool Teaching Hospitals NHS Foundation Trust 2.2.3 Rationale for the views of patients, public, staff will track performance against Selection of Priorities to be and governors has been through improvement targets at all levels removed in 2014/15 feedback from local and national from ward level to Board level on patient surveys, information a monthly basis using the ward This section includes a list of gathered from formal complaints, quality boards and the integrated priorities that have been chosen comments received through divisional quality monitoring to be removed by the Board the Patient Relations Team reports. The priorities for quality of Directors from the quality and various local stakeholder improvement will also be improvements priorities for meetings and forums. monitored through the high level 2014/15. The rationale for the Risk Register and Divisional Risk de-selection of the following Listening to what our staff, Register process and by the Sub- priorities is that considerable governors, patients, their families Committees of the Board. progress and improvements have and carers tell us, and using this been delivered or put in place information to improve their The Trust will also report and other improvements have experiences, is a key part of the ongoing progress regarding become a priority. Trust’s work to increase the quality implementation of the quality of our services. improvements for 2014/15 to our Information regarding the staff, patients and the public via improvements made to The Trust wants to make sure that the performance section of our demonstrate evidence for their staff, governors, patients, their website. You can visit our website removal is outlined in Part 3. It families and carers have the best and find up-to-date information has been agreed to remove the possible experience when using about how your local hospitals following quality improvement our services. are performing in key areas: priority used in 2013/14. Although infections, death rates, patient falls this will continue to be monitored 2.2.5 how we will and medication errors. Improving by the relevant committee’s patient safety and delivering detailed below, this will not be Monitor, Measure and Report ongoing Progress the highest quality care to our reported in the 2014/15 Quality patients is our top priority. We Accounts: to Achieve our Priorities believe that the public have a for Quality Improvement right to know about how their • The one priority removed is in 2014/15 local hospitals are performing in relation to improving Patient We use a number of tools these areas that are important to Led assessments of the Care to measure our progress on them. As well as information on Environment (PLACE) as the improving quality and these key patient outcomes, the website Trust constantly achieves high tools inform the reports we also includes data on our waiting standards, and this will be present to the Board and its Sub- times, length of stay, complaints, continued to be monitored at Committees. The priorities for patient harms, cleanliness, the PLACE Committee. quality improvement in 2014/15 hospital food, and patients and will continue to be monitored staff opinion of our hospitals. 2.2.4 Engagement with and measured and progress Patients, Public, Staff and reported to the Board of Directors We are keen to build on the Governors at each of its meetings as part of amount of data we publish but The Trust has taken the views the Board Business Monitoring we want to make sure that the of patients, relatives, carers and Report and the Quality and Safety information is what you want the wider public into account Assurance Report. For priorities to see and that it is easy to for the selection of priorities for that are calculated less frequently, understand. Please have a look at quality improvement through the these will be monitored by these web pages and let us know completion of feedback forms the Board of Directors by the if there are any areas that could which are available from the submission of an individual report. be improved by completing this Trust’s website. The Trust has well-embedded feedback form or alternatively visit delivery strategies already in place the website: http://www.bfwh. Other methods of obtaining the for all the quality priorities, and nhs.uk/about/performance/

Page Annual Report and Accounts 2013/14 135 2.3 Statements of Assurance from the Board of Directors

The information in this section is mandatory text that all NHS Foundation Trusts must include in their Quality Account. We have added an explanation of the key terms and explanations where applicable.

2.3.1 Review of Services During 2013/14 the Blackpool Teaching Hospitals NHS Foundation Trust provided and/or subcontracted 49 relevant Health Services. • Divisional monthly relevant Health services that performance reports Blackpool Teaching Hospitals NHS The Blackpool Teaching Hospitals • Quality Boards based in our Foundation Trust provides. NHS Foundation Trust has wards and departments reviewed all the data available to • Clinical audit activities and During 2013/14 Blackpool them on the quality of care in 49 reports Teaching Hospitals NHS of these relevant Health services. Foundation Trust participated The informal patient safety in 86% national clinical audits The income generated by walkabout visits undertaken and 100% national confidential the relevant Health services by the Executive Directors on enquiries of the national clinical reviewed in 2013/14 represents a weekly basis and the formal audits and national confidential 88 per cent of the total income patient safety walkabouts enquiries for which it was eligible. generated from the provision of visit, undertaken by Executive These are detailed in Column A of relevant Health services by the Directors and Non-Executive Tables 3 and 4. Blackpool Teaching Hospitals NHS Directors on a monthly basis have Foundation Trust for 2013/14. been a powerful tool in making The national clinical audits and the Trust’s quality and safety national confidential enquiries The quality aspirations and agenda tangible to ward staff, that Blackpool Teaching objectives outlined for 2013/14 prompting us to take ownership Hospitals NHS Foundation Trust reached into all care services of our services in a new way. participated in during 2013/14, provided by the Trust and This initiative has been of great and for which data collection therefore will have had impact on value in assisting clinical staff in was completed during 2013/14, the quality of all services. achieving the highest quality are listed in Column B of Tables environment in a very visible way. 3 and 4 alongside the number The data reviewed on various of cases submitted to each audit activities enables assurance or enquiry as a percentage of that the three dimensions of 2.3.2 Participation in the number of registered cases quality improvement for clinical Clinical Audits and National required by the terms of that audit effectiveness, patient experience Confidential Enquiries or enquiry identified in Column C and patient safety is being During 2013/14, 46 national and D of Tables 3 and 4. achieved including: clinical audits and 3 national confidential enquiries covered

Page 136 Blackpool Teaching Hospitals NHS Foundation Trust Table 3: National Clinical Audits List of National Clinical Audits in which Blackpool Teaching Hospitals NHS Foundation Trust was eligible to participate during 2013/14 Column D Number of cases Column A Column C submitted as a Column B Number National Clinical Audit Title Eligible to Number of cases percentage of Participated In participate in submitted the number of registered cases required 1 NNAP: neonatal intensive care P P 322 100% 2 ICNARC CMPD: adult critical care units P P 1048 100% 4 NJR: hip and knee replacements P P 440 100% 5 DAHNO: head and neck cancer P P 81 100% MINAP (inc ambulance care): AMI & 6 P P 1448/1598 91% other Acute Coronary Syndrome 7 Heart Failure Audit P P 334 115% X 8 NHFD: hip fracture Not required for 13/14 QA 9 TARN: severe trauma P P 158 100% Sentinel Stroke National Audit 10 P P 358 100% Programme (SSNAP) X National Audit of Dementia: dementia 11 NA Not required care for 13/14 QA BTS Not British Thoracic Society: National running 12 NA Bronchiectasis Audit this period 2013/14 X 13 RCP: National Care of the Dying Audit NA Not required for 13/14 QA National comparative audit of blood 14 P P 309 100% transfusion in adult cardiac surgery Awaiting 15 Coronary angioplasty P P confirmation Oesophago-gastric cancer (National O-G 16 P P 130 100% Cancer Audit) 17 CCAD: Adult Carotid interventions P P 1223 100% CCAD :Heart rhythm management 18 (pacing and implantable cardiac P P 861 100% defibrillators (ICDS) CCAD: Congenital Heart Disease 19 P P 5 100% Paediatric Cardiac surgery Adult cardiac surgery: CABG and valvular 20 P P 1223 100% surgery 22 NBOCAP: bowel cancer P P 219 100% 23 NLCA: lung cancer P P 293 100% RCP: Audit to assess and improve service 24 for people with inflammatory bowel P P 9/100 9% disease

Page Annual Report and Accounts 2013/14 137 Table 3: National Clinical Audits List of National Clinical Audits in which Blackpool Teaching Hospitals NHS Foundation Trust was eligible to participate during 2013/14 Column D Number of cases Column A Column C submitted as a Column B Number National Clinical Audit Title Eligible to Number of cases percentage of Participated In participate in submitted the number of registered cases required BTS Not Adult community acquired pneumonia running 25 NA (British Thoracic Society) this period 2013/14 Emergency use of oxygen (British 26 P P 29 100% Thoracic Society) X Renal colic (College of Emergency 27 NA Not required Medicine) for 13/14 QA BTS Not Non-invasive ventilation - adults (British running 28 NA Thoracic Society) this period 2013/14 X Potential donor audit (NHS Blood & 29 NA Not required 326 100% Transplant) for 13/14 QA 30 National Cardiac Arrest Audit (NCAA) P P 388 100% National Vascular Registry (elements include CIA, peripheral vascular surgery, 31 P P VSGBI Vascular Surgery Database, AAA, NVD) X Pulmonary hypertension (Pulmonary 32 NA Not required Hypertension Audit) for 13/14 QA BTS Not running 33 Adult asthma (British Thoracic Society) NA this period 2013/14 Diabetes (Adult) ND(A), includes National 34 P P 108 100% Diabetes Inpatient Audit (NADIA) 35 Diabetes (Paediatric) (NPDA) P P 69 100% National Review of Asthma Deaths 36 P P 1 100% (NRAD) Awaiting 37 Pain database P Confirmation X 38 Fractured neck of femur NA Not required for 13/14 QA Elective surgery (National PROMs 39 P P NA 67.7 Programme) 41 Epilepsy 12 audit (Childhood Epilepsy) P NA 39 100%

Page 138 Blackpool Teaching Hospitals NHS Foundation Trust Table 3: National Clinical Audits List of National Clinical Audits in which Blackpool Teaching Hospitals NHS Foundation Trust was eligible to participate during 2013/14 Column D Number of cases Column A Column C submitted as a Column B Number National Clinical Audit Title Eligible to Number of cases percentage of Participated In participate in submitted the number of registered cases required “Maternal, infant and newborn programme (MBRRACE-UK)*

(Also known as Maternal, Newborn and Infant Clinical Outcome Review 42 P P 43 100% Programme)

*This programme was previously also listed as Perinatal Mortality (in 2010/11, 2011/12 quality accounts)” Paediatric asthma (British Thoracic 43 P P 22 100% Society) X Paediatric fever (College of Emergency 44 NA Not required Medicine) for 13/14 QA Not eligible at 45 Paediatric intensive care (PICANet) X this Trust Paediatric pneumonia (British Thoracic 46 P P 10 100% Society) National audit of seizure management in 47 P P 30 100% Hospitals National emergency laparotomy audit 48 P P 54 100% (NELA) Paracetamol overdose (care provided Awaiting 49 in Emergency Departments - College of P P confirmation Emergency Medicine) Not eligible at 50 Pleural procedures X this Trust Suspended Severe sepsis & septic shock (College of due to Sepsis 51 P Emergency Medicine) Pathway March 14 X 52 Vital signs NA Not required for 13/14 QA Intra thoracic transplantation (NHSVT UK Not eligible at 53 x transplant registry) this Trust Liver transplantation (NHSVT UK Not eligible at 54 x transplant Registry) this Trust X 55 Prostate Cancer NA Not required for 13/14 QA

Page Annual Report and Accounts 2013/14 139 Table 3: National Clinical Audits List of National Clinical Audits in which Blackpool Teaching Hospitals NHS Foundation Trust was eligible to participate during 2013/14 Column D Number of cases Column A Column C submitted as a Column B Number National Clinical Audit Title Eligible to Number of cases percentage of Participated In participate in submitted the number of registered cases required X 56 COPD Discharge Audit NA Not required for 13/14 QA Awaiting 57 National COPD Audit Programme (RCP) P confirmation Awaiting 58 Paediatric Bronchiectasis P P confirmation Not eligible at 59 Renal Registry x this Trust Renal transplantation (NHSVT Transplant Not eligible at 60 x Registry) this Trust Rheumatoid and early inflammatory Awaiting 61 P arthritis confirmation Not eligible at 62 Learning disabilities/feasibility study X this Trust Mental health clinical outcome review programme NCEPOD into suicide and Not eligible at 63 x homicide with people with mental this Trust illness Not eligible at 64 National audit of psychological therapies x this Trust Not eligible at 65 National audit of schizophrenia x this Trust Prescribing observatory for mental Not eligible at 66 x health this Trust Falls and fragility fractures audit Awaiting 67 P programme confirmation Not eligible at 68 National audit of memory clinics X this Trust X Parkinson’s Disease (Nationals 69 NA Not required Parkinson’s audit) for 13/14 QA X Familial Hypercholesterolaemia (National 70 NA Not required clinical audit management of FH) for 13/14 QA X 71 National audit of intermediate care NA Not required for 13/14 QA X National health promotion in hospitals 72 NA Not required audit for 13/14 QA Patient transport (National kidney care Not eligible at 73 X audit) this Trust

Page 140 Blackpool Teaching Hospitals NHS Foundation Trust Table 3: National Clinical Audits List of National Clinical Audits in which Blackpool Teaching Hospitals NHS Foundation Trust was eligible to participate during 2013/14 Column D Number of cases Column A Column C submitted as a Column B Number National Clinical Audit Title Eligible to Number of cases percentage of Participated In participate in submitted the number of registered cases required X Fitting childcare in emergency 74 NA Not required departments for 13/14 QA X Mental health care in emergency 75 NA Not required departments for 13/14 QA X Older people care in emergency 76 NA Not required departments for 13/14 QA X Speciality rehabilitation for patients with 77 NA Not required complex needs for 13/14 QA X Child health clinical outcome review 78 NA Not required programme (CHR/UK) for 13/14 QA X 79 Heavy menstrual bleeding NA Not required for 13/14 QA Awaiting 80 Paediatric Asthma audit P P confirmation X Pain management (College of 81 NA Not required emergency medicine) for 13/14 QA

P – Eligible to participate or actively participating NA – Eligible to participate however not required for QA (Data collection dependent upon individual audit) or stage of audit with managing body for this time period Not eligible at this Trust – The service to which this service relates to is not undertaken within the Trust

Page Annual Report and Accounts 2013/14 141 Table 4: National Confidential Enquiries List of National Confidential Enquiries that Blackpool Teaching Hospitals NHS Foundation Trust was eligible to participate in during 2013/14. Column D Number of cases National Confidential Column A Eligible Column B Column C Number of submitted as a percentage of Number Enquiries to Participate In Participated In cases submitted the number of registered cases required Tracheostomy Care 1 Yes Yes 17 100% Study 7 Lower Limb Data collection not 2 Yes Yes 100% Amputation Study due to complete at time of report Data collection not Gastro Intestinal 3 Yes Yes due to complete at 100% Haemorrhage Study time of report Alcohol Related 4 Yes Yes 7 100% Liver Disease

Data source: Clinical Audit Programme and final reports. This data is governed by standard national definitions

Page 142 Blackpool Teaching Hospitals NHS Foundation Trust The reports of 2 National Clinical Audits (Confidential Enquiries) were reviewed by the provider in 2013/14 and Blackpool Teaching Hospitals NHS Foundation Trust intends to take or has taken the following actions to improve the quality of healthcare provided as shown in Table 5.

Table 5: National Clinical Audits (Confidential Enquiries) National Clinical Details of actions taken or being taken to improve the quality of local services and Audits (Confidential the outcomes of care. Enquiries) presented for assurance to the Board of Directors Sub Arachnoid All patients presenting with acute severe headache in a secondary care hospital should Haemorrage Study have a thorough neurological examination performed and documented. – • All patients presenting to the emergency department with acute severe headache have a GCS recorded in the observations section of the electronic patient record by Report issued Nov the initial assessment nurse. Documentation of full neurological assessment by a 2013 doctor is recorded in the hospital notes Managing the • A full audit of all patients admitted with a suspected sun arachnoid haemorrage Flow? will be part of a clinical audit undertaken by the Lead Consultant to determine A review of the neurological assessment in A&E care received by A CT- scan should be performed immediately in this group of patients as defined by the patients who ‘National Clinical Guideline for Stroke’. were diagnosed • The Trust provides 24 hr CT scanning In hours, with an aneurysmal • The PACS system at Blackpool Teaching Hospitals NHS Trust is linked directly to subarachnoid the PACS system at Central Lancashire Teaching Hospitals NHS Trust. The images haemorrhage. are therefore immediately available for review by the neurosurgical on call at Royal Preston Hospital prior to transfer.

The nationally-agreed standard (‘National Clinical Guideline for Stroke’) of securing ruptured aneurysms within 48 hours should be met consistently and comprehensively by healthcare professionals who treat this group of patients. This will require providers to assess the service they deliver and move towards a seven-day-service. • Neurosurgical services at Royal Preston Hospital conveniently located within15 minutes of a “blue light” ambulance transfer. • Critical care support is provided for transfer of patients intubated or with airway concerns.

Organ donor policy in place within the Trust with appointed Specialist Nurse – Organ Donation (BVH) Alcohol Related • The Trust has appointed a multi disciplinary Alcohol Care Team that is led by a Liver Disease Study Consultant. Report issued June • The Alcohol Specialist Nurse Service offers a 7 day service. 2013 • Policies are in place re the identification and management of alcohol misuse. Measuring the • All patients are assessed on admission using an approved tool – ( Audit – C) Units • Antibiotics and terlipressin are offered to all patients with a history of alcohol abuse A review of patients and gastro intestinal haemorrhage until the results of endoscopy are reviewed. who died with • Escalation of care is actively pursued based on renal function of individuals and alcohol-related liver need. disease

Data source: Clinical Audit Programme and final reports. This data is governed by standard national definitions

Page Annual Report and Accounts 2013/14 143 Local clinical audit is important completion. The number of audits to take the following actions to in measuring and benchmarking being monitored by the Clinical improve the quality of healthcare clinical practice against agreed Audit Department is 53 % (127). provided (see Table 6 below). markers of good professional This includes all audits that have Additional information can be practice, stimulating changes not been fully completed at end found in the Annual Clinical to improve practice and re- of Q4. Audit Report 2013/14 which is measuring to determine any published on the Trusts website service improvements. The reports of 113 local clinical and is available via the following audits were reviewed by link: http://www.bfwh.nhs.uk/ During 2013/14, 90 % (215) of the provider in 2013/14 and about/performance/. A copy of audits were completed or are Blackpool Teaching Hospitals the Annual Clinical Audit report of running according to schedule for NHS Foundation Trust intends is available on request.

Table 6: Local Clinical Audits Local Clinical Audits presented for Details of actions taken to improve the quality of local services and the outcomes of assurance to the Board of Directors care. Ventilatory Associated Pneumonia (VAP) CC1202 - Daily Ward Round Chart to check VAP / CPIS scores have been completed care bundles in ICU Bedside Nurses to complete VAP bundle on ICU day chart Management of basal cell carcinoma DER1101 The use of immiquimod in treatment of BCC will be constantly monitored. with topical immiquimod Secondary prevention of Osteoporosis GM092 - Size A4 flow chart developed. Discharge check list developed. Regular in patients with low trauma fracture education to junior doctors ongoing. neck of femur GM1032 - No change to MDT referral & assessment as better than regional ones but Audit of diagnosis and management continuing to monitor. Recruitment of 2 specialist nurses underway for specific Early of inflammatory arthritis against NICE Arthritis Clinic incorporating urgent new patient slots & monthly follow up for newly guidance diagnosed patients according to agreed protocols. GM1118 - Plan to take up the ‘Think Glucose’ campaign is underway. Plans to Drug errors in adult patients with make a separate insulin prescription with electronic prescribing tool can only be diabetes implemented when Vision is active. 30 day mortality and 8 day GM1217 Patient leaflet has been updated. Coding problems have been addressed. complications Feedback process has been introduced for contact clinicians. GM1210 - Action plan implemented. Ongoing education and information Colonic Biopsies for chronic diarrhoea disseminated to all colonoscopists. GM1218 - Ongoing education of junior doctors, ward staff, and other Allied Health BTS National Emergency Oxygen Audit Professionals in drug chart inspection and importance of oxygen prescription. 2011 Continued from 12/13 Oxygen therapy to be part of ward level indicators. GM1219 - Continued rolling programme of training on all EOLC tools. Increased ward National Care of the Dying Acute based training on LCP, communication, symptom management and best EOLC. Hospitals Audit (NCDAH) Interim audit Unable to implement recommendation of changing questions on NCI as request for Continued from 12/13 this has been rejected at this time. GM1226 - New pathway and checklist developed with real time feedback / Adult Community Acquired Pneumonia accountability for performance. Education and communication on pathway ongoing. Continued from 12/13 Information available on intranet. Mortality review in the acute medical GM1303 Continual education to improve documentation on AMU noting times, unit at BVH dates and clinician performing review. GM1306 - Early referral/discussion with Gastroenterologist/SpR of all acute upper Management of acute upper gastrointestinal haemorrhage patients. AMU and A&E staff notified. Rockall/ gastrointestinal haemorrhage (AUGH) Blatchford score to be a mandatory field in endoscopy e-request agreed with Vision & Alert. Re-Audit of patient casenotes who have GM1307 - Introduction of orange casenote stickers to ensure all notes are returned to undergone peripheral blood stem cell transplant coordinator for completion of casenotes. transplantation

Page 144 Blackpool Teaching Hospitals NHS Foundation Trust Table 6: Local Clinical Audits Local Clinical Audits presented for Details of actions taken to improve the quality of local services and the outcomes of assurance to the Board of Directors care. CC1204 - Ongoing education of nursing and medical staff regarding the need to use Re-audit Assessment of compliance new POTTS charts and remove old versions. with NICE CG50 in Acutely ill patients in Monitor compliance with observation recording via NCI and spot checks by Matrons hospital Full audit of 2222 calls to be undertaken in 2013 Audit of management of paediatric AN1207 - Discussed with ENT Surgeons who do not support the use of topical local postoperative pain management anaesthetics for paediatric tonsillectomies. Adequacy of medical records in CAR1203 - ITU round sheet introduced and in use. Medical staff more diligent to Cardiothoracic surgical inpatients patient identifier details date and time. GS1206 Training to all staff at all levels in relation to completed daily reviews of patients being undertaken according to CVC care bundle and clear documentation The management of central venous on indication and on-going needs. Training to all health care professionals, junior catheter in surgical and medical wards doctors and nurses involved in the insertion and maintenance of cvc regarding central line associated infection. GS1204 Regular TRUS biopsy sessions introduced with extra sessions to accommodate peaks in demand. New standard letter introduced showing procedural steps. Fast track system developed for prostatic biopsies. Appointment of NW Regional Bladder Cancer Audit a further Consultant. All Consultants now have clinic slots reserved for giving positive results to cancer patients. Procedural operation note agreed that specifically requires the number of cores to be documented. Patients suitable for trials to be discussed at MDT and outcome of discussion to be documented. CAR1302 - Ongoing education/presentation to raise awareness of current ESC DSE guided revascularisation guidelines. VTE prophylaxis in patients undergoing GS1302 Changes have been made to trust policy to reflect prescribing Dalteparin. elective urological procedures Junior doctors advised in the increase in frequency of prescribing Dalteparin. CAR1306 - Ongoing education to doctors to refer all clinical suspicions of heart Diagnostic investigations in heart failure failure without requirement of an echo and echoes should include assessment of left ventricular diastolic function where possible. GS1005 All surgical patients to have VTE assessment on admission Monitoring VTE prophylaxis in urology Anaesthetists to consider regional anaesthesia to reduce risk of VTE patients Patients to be offered thromboprophylaxis to reduce VTE risk Minimise hospitalisation by considering minimal invasive procedures Timeframe between listing for the laser OP1103 - New specific diabetic retinopathy clinic to be set up. Awaiting appointment treatment in Diabetic Retinopathy of new consultant to oversee all ophthalmic diabetic patients. Compliance with inpatient chart clinical PH1215 Ensure all pharmacists obtain and have access to up to date standards verification audit PH1214 - Trust policies to be amended to include critical care area procedures. Continue to educate newly qualified doctors to ensure awareness of importance of NPSA Alert - Loading Dose Audit stopping the loading dose and continuing with maintenance dose. Warfarin posters on display throughout hospital to clarify policy. Disseminate policy to all nursing and medical staff. Reducing harm from omitted and PH1211 Supply a critical drugs list to each ward, step by step easy to follow flow chart delayed medicines in hospital/ The on how to obtain medication and the list of omission codes and what appropriate correct use of omission codes action needs to be taken to be placed in the drugs trolley on each ward. PH1212 - SOP116 has been reviews, policies covering how to deal with suppliers, reps and waste management have been written. Procedure for dealing with Re-audit of Pharmaceutical Procurement breaches of minimum and maximum specified temperatures and records reviewed. Services A documented training programme has been incorporated into training and competency records. A training record is now available for all staff working in procurement. CH1306 - Raise awareness of Baby transfer notification within Women’s unit. Updated Clinical handover of care of neonates Baby Transfer Notification form to provide signature. Raise awareness of Baby transfer notification within Women’s Unit.

Page Annual Report and Accounts 2013/14 145 Table 6: Local Clinical Audits Local Clinical Audits presented for Details of actions taken to improve the quality of local services and the outcomes of assurance to the Board of Directors care. OB1217 - Review of discharge plan: Health Visitor Liaison only to be phoned if Discharge of babies from the Neonatal Neonatal Nursing Unit discharge occurs at weekend. Otherwise Health Visitor Liaison unit will visit for discharge information during the week. OB1220 - Risk assessments for every woman to be completed. Women identified as intermediate or high risk of VTE following risk assessment by the obstetrician must be Venous thromboembolism (VTE) informed to carry out assessment and develop a management plan. Documentation reflects the advice and care provided. OB1221 - Comprehensive discharge documentation developed that includes Discharge antenatal record, discharge advice, prescription as required and post discharge care of mother and baby. OB1222 - SBAR communication tool promoted for use of transfer of handover and care inter department. SBAR sticker proforma now includes information from the Handover of care obstetrician St3 and the anaesthetist which details plan of care recorded in birth record. Management of postpartum OB1212 - Update current guideline to include pathway. Consider consultant baton haemorrhage bleep and inclusion 2222. OB1210 - Improve communication with GP & Community Midwives regarding Folic Obesity in Pregnancy Acid and Vitamin D. Improve documentation. Ongoing training. North West Diabetes Pregnancy Audit OB1207 - replaced by OB1302 ongoing audit Actions noted in Health Action Plans; C013 Provide Mandatory Training to Clinicians; Feedback to team managers and audit of record of action completion Clinicians; Evidence of meeting KPI’s CG1213 - Results cascaded to relevant trust members, committees and external Health Promotion in Hospitals organisations. Ongoing training of staff in brief interventions for alcohol and tobacco use. Ongoing half day training in obesity.

2.3.3 Participation in research approved by a research closing during 2013/14. Clinical Research in ethics committee was 1,658*, 2013/14 identified in Graph 1, of which * It should be noted that 2013/14 the number of patients recruited NIHR Portfolio Study data is not The number of patients receiving to National Institute of Health signed off nationally until 30th June relevant health services provided Research (NIHR) Portfolio Studies is 2014. We therefore estimate the or sub-contracted by Blackpool 1,592*. This figure was less than the total patient recruitment total to be Teaching Hospitals NHS Foundation number recruited in 2012/13 due to higher than currently reported (as at Trust in 2013/14 that were recruited a number of high recruiting studies 31st March 2014). during that period to participate in

Graph 1: Participation in Clinical Research

Data source: NIHR Portfolio Database of studies. This data is governed by standard national definitions.

Page 146 Blackpool Teaching Hospitals NHS Foundation Trust The National Institute of Health recruitment and follow up by Blackpool Teaching Hospitals NHS Research (NIHR) Portfolio studies network staff. Foundation Trust was involved are high quality research that in conducting 140 clinical has had rigorous peer review Participation in clinical research research studies during 2013/14. conducted in the NHS. These demonstrates Blackpool Teaching There were over 80 clinical studies form part of the NIHR Hospitals NHS Foundation Trust’s staff participating in research Portfolio Database which is commitment to improving the approved by a research ethics a national data resource of quality of care offered and to committee at Blackpool Teaching studies that meet specific making our contribution to wider Hospitals NHS Foundation Trust eligibility criteria. In England, health improvement. Our clinical during 2013/14. These staff studies included in the NIHR staff remain abreast of the latest participated in research covering Portfolio have access to possible treatment possibilities, 19 medical specialties as outlined infrastructure support via the and active participation in in Table 7 below. Please note the NIHR Comprehensive Clinical research leads to successful data on the Table 7 is provided by Research Network. This support patient outcomes. the NIHR whose figures are not covers study promotion, set up, finalised until 30th June 2014.

Table 7: Number of patients recruited to National Institute of Health Research Portfolio studies No. of Patients No. of Patients No. of Patients No. of patients No. of patients Specialty Recruited Recruited Recruited recruited recruited 2009/10 2010/11 2011/12 2012/13 2013/14 Age and Ageing 0 0 0 10 17 Cancer 111 140 419 303 197 Cardiovascular 223 275 449 549 353 Critical Care 25 963 359 8 6 Dementias and Neurodegenerative 5 11 6 0 9 Diseases Dermatology 0 21 10 9 23 Diabetes 0 6 150 702 307 Genetics and Congenital 0 0 171 177 29 Dis Health Services Research 2 7 133 4 2 Infection 3 24 6 26 42 Injuries and Emergencies 0 14 4 101 47 Meds for Children 30 43 24 15 6 Musculoskeletal 31 18 1 9 11 Neurological 0 0 0 0 6 Ophthalmology 0 1 0 0 22 Oral and Gastrointestinal 67 106 67 52 85 Paediatric 0 20 223 160 128 Paediatrics (non 10 10 32 66 11 medicines) Renal and Urogenital 114 90 0 0 0 Reproductive Health 88 54 41 35 26 Respiratory 13 19 22 20 20 Stroke 83 94 116 44 33

Page Annual Report and Accounts 2013/14 147 In addition, over the last three years, 145 publications have resulted from our involvement in NIHR research, which shows our commitment to transparency and desire to improve patient outcomes and experience across the NHS. The improvement in patient health outcomes in Blackpool Teaching Hospitals NHS Foundation Trust demonstrates that a commitment to clinical research leads to better treatment for patients.

2.3.4 Information on the Use of the Commissioning is intended to embed quality to register with the Care Quality for Quality and Innovation at the heart of commissioner- Commission (CQC) and its current Framework provider discussions by making registration status is compliant a small proportion of provider with no conditions. A proportion of Blackpool payment conditional on locally Teaching Hospitals NHS agreed goals around quality The CQC has not taken Foundation Trust’s income in improvement and innovation. enforcement action against 2013/14 was conditional on Blackpool Teaching Hospitals NHS achieving quality improvement The total planned monetary value Foundation Trust during 2013/14. and innovation goals agreed of income of CQUIN in 2013/14 between Blackpool Teaching conditional upon achieving Hospitals NHS Foundation quality improvement and Special Reviews/Investigations Trust and any person or body innovation goals is £ 7,678,469; In June 2013 the Trust had a visit they entered into a contract, however, it is estimated that the from a team under the direction agreement or arrangement Trust will achieve a monetary of Sir Bruce Keogh. The Trust was with for the provision of relevant total value of £ 7,301,025 for the one of 14 Trusts identified as a health services, through the associated payment in 2013/14. persisting outlier on the national Commissioning for Quality and Summary Hospital Level Mortality Innovation payment framework. The main areas of risk are the Indicator (SHMI) measure based Further details of the agreed goals Dementia (Screening, Assessment on data from pre 2012. We for 2013/14 and for the following & Referral), Patient Experience welcomed this opportunity to 12 month period are available and AQ (CABG, Stroke and Heart demonstrate the quality of care online at: http://www.bfwh.nhs. Failure), CQUIN themes; however provided by the organisation uk/about/performance/ performance against these and to highlight many areas of measures will not be confirmed improvement being undertaken. The Commissioning for Quality until August 2014. This visit linked well with our and Innovation (CQUIN) payment ongoing work to improve framework aims to support 2.3.5 Registration with the service quality and reduce the cultural shift towards mortality, which has seen average making quality the organising Care Quality Commission and Periodic/Special standardised mortality ratios for principle of NHS services. In the Trust decreasing since July particular, it aims to ensure Reviews 2012. The Trust was one of only that local quality improvement Statements from the Care three organisations not placed in priorities are discussed and Quality Commission special measures following the agreed at board level within Blackpool Teaching Hospitals review. and between organisations. The NHS Foundation Trust is required CQUIN payment framework Page 148 Blackpool Teaching Hospitals NHS Foundation Trust The Trust has committed itself to impact on patients using this improving the nurse and doctor service being identified. A Red Alert was developed by the to patient ratios over coming Director of Nursing and Quality years and is spending over £1m Based on the final report the Trust and the Medical Director. The new monies this year to reduce developed an action plan and Alert was sent out to all Ward the number and severity of commenced implementation of Managers to present to staff at incidents that could result in the recommendations to address handover for a period of one patient harms and ensure high the areas for improvement week. An e-mail was also sent standards of clinical care are detailed above. all Consultants regarding the maintained. contents of the red alert. Following a subsequent visit from Blackpool Teaching Hospitals NHS the CQC in November 2013, the The completed action plan and Foundation Trust has participated CQC confirmed that the Trust progress report detailed above in special reviews or investigations has demonstrated compliance has been submitted to the Care by the Care Quality Commission with Outcome 17. This has been Quality Commission in October relating to the following areas achieved by the following: 2013 following approval by the during 2013/14. The Care Quality Board. Commission has undertaken two The Trust’s Operation Procedure visits during 2013/14 in relation – Patient Relations Department Unannounced Follow up Visit – to an unannounced visit in June (Corp/Proc/403) has been Complaints Service 2013 and unannounced follow up updated with regards to the The Care Quality Commission visit in November 2013 to review investigation timescales to carried out a second the Trust’s Complaints Service. ensure they are manageable and unannounced follow up visit on fit for purpose. This has been 26th November 2013 to review Unannounced Visit – Cardiac undertaken in conjunction with a of the Trust’s compliance against Directorate and Trust Non Executive Director. The Trust Outcome 17. The Trust was able Complaints Service has also reviewed the Safeguard to evidence that they were taking On 11th June 2013 the Care electronic system to ensure the improvement of complaints Quality Commission carried flexibility in date recording. management very seriously and out an unannounced visit to was found to be meeting the Blackpool Teaching Hospitals NHS If a complaint is delayed a holding standard fully. Foundation Trust and reviewed letter is sent to the complainant the following standards: and a date identified of when Chief Inspector of Hospitals the Division will have the final inspection Visit Outcome 1: Respecting and response mailed out to the Announced visit to Blackpool Involving People Who Use complainant. Teaching Hospitals NHS Services Outcome 2: Consent to Care and Treatment Outcome 4: Care and Welfare of People Who Use Services Outcome 16: Assessing and Monitoring the Quality of Service Provision Outcome 17: Complaints

Following this visit the final report provided overall positive feedback, however the Trust was deemed to have not met the standard in respect of Outcome 17: Complaints, with moderate

Page Annual Report and Accounts 2013/14 149 Foundation Trust by the Care months after the Keogh visit and caring, responsive to peoples Quality Commission (CQC) subsequent report and action needs and are they well-led. plan. The CQC inspected acute In January 2014, Blackpool services covering; Accident and The CQC’s final report, published Teaching Hospitals acute Emergency, Medical Care, Surgery, on 2 April, 2014 gave an overall services at Victoria Hospital, Intensive/critical care, Maternity rating to the Trust of “requires Clifton Hospital and Fleetwood and family planning, Children’s improvement” with the following Hospital were inspected as part care, End of Life Care and ratings for each of the 5 key of the Care Quality Commission’s Outpatients. The CQC focused inspection questions: new national programme of on five areas of inspection. These inspections. This inspection was 6 were: Are services safe, effective,

Are acute services at this Trust safe? Requires Improvement Are acute services at this Trust effective? Requires Improvement Are acute services at this Trust caring? Good Are acute services at this Trust responsive? Requires Improvement Are acute services at this Trust well-led? Requires Improvement

Of the 68 individual ratings plan has been developed and • The delivery of safe, effective, given 42 were good, 2 were this has also been shared with relevant and timely patient outstanding, 22 were requires Commissioners. The final action care, thereby minimising clinical improvement and 2 areas plan was returned to the CQC by risk were deemed inadequate. 30th April 2014. • Providing patients with the Maternity Services were rated as highest level of clinical and ‘inadequate’ due to the ongoing An action plan is currently being administrative information review of PPH cases that had produced to ensure all matters • Providing efficient resulted in a hysterectomy, 5 cases requiring improvement will be administrative and in a 6 month period. The expected attained. This plan will be agreed clinical processes such as range for our Trust is 2 cases per by the Trust Board and with our communication with patients, year. The RCOG undertook their commissioners and with Monitor families and other carers case review on 30th April and the and will be implemented in involved in patient treatment CQC wish to receive a copy of this 2014/15. • Adhering to clinical governance report and to agree with the Trust standards which rely on a date for re-inspection of the 2.3.6 Information on the accurate patient data to identify Maternity Service. Quality of Data areas for improving clinical care • Providing a measure of our own Good quality information and Following the Quality Summit activity and performance to data are essential for: on the 28th March it was allow for appropriate allocation agreed to formulate one quality of resources and manpower improvement action plan following the CQC visit. The new CQC action plan and monitoring dashboard incorporates the main areas of continued focus from the Keogh Action plan e.g. monitoring mortality reduction, patient experience, incident reporting and staffing. The high level CQC action plan has been agreed with Commissioners and shared with Monitor. A detailed draft action

Page 150 Blackpool Teaching Hospitals NHS Foundation Trust • External recipients to have • 99.9% for Outpatient Care; and for Health website (www.igt. confidence in our quality data, • 99.9% for Accident and connectingforhealth.nhs.uk). for example, service agreements Emergency Care. for healthcare provisions ** based on provisional April Blackpool Teaching Hospitals NHS • Improving data quality, such 2013- February 2014 SUS data at Foundation Trust will continue to as ethnicity data, which will the month 11 inclusion date work towards maintaining and thus improve patient care and improving compliance standards improve value for money Information Governance during 2014/15 monitored by the Assessment Report 2013/14 Health Informatics Committee. NHS Number and General Blackpool Teaching Hospitals NHS Medical Practice Code Validity Foundation Trust’s Information The Data Quality and Records Blackpool Teaching Hospitals NHS Governance Assessment Report Management attainment levels Foundation Trust submitted records overall score for 2013/14 was 82% assessed within the Information during 2013/14 to the Secondary and was graded Satisfactory (Green). Governance Toolkit provide an Uses Service for inclusion in the overall measure of the quality Hospital Episode Statistics which For 2013/14 the grading system is of data systems, standards and are included in the latest published based on: processes within an organisation. data. The percentage of records in the published data: • Satisfactory - Level 2 or above Payment by Results (PBR) achieved in all requirements Clinical Coding Audit - which included the patient’s • Not Satisfactory - minimum Blackpool Teaching Hospitals NHS valid NHS Number was: Level 2 not achieved in all Foundation Trust was subject to • 99.5% for Admitted Patient requirements the Payment by Results clinical Care; coding audit during the reporting • 99.7% for Outpatient Care; and This rating links directly to the NHS period by the Audit Commission • 98.6% for Accident and Operating Framework (Informatics and the error rates reported in Emergency Care. Planning 2010/11) which requires the latest published audit for that organisations to achieve Level 2 period for diagnosis and treatment - which included the Patient’s or above in all requirements. A coding (clinical coding) were 6.7%. valid General Practitioners list of the types of organisations The results are detailed in Table Registration Code was: included along with compliance 8 and demonstrate better than • 100% for Admitted Care data is available on the Connecting national average performance:

Table 8: Data Published by the Audit Commission Clinical Coding Percentages Primary Diagnoses Incorrect 6.0% Secondary Diagnoses Incorrect 9.4% Primary Procedures Incorrect 4.5% Secondary Procedures Incorrect 46.2%

Data source: External audit carried out by an approved auditor through the Audit Commission. This data is governed by standard national definitions

The following actions were o Establish a method of Please see explanatory note for identified to improve the quality capturing pressure ulcers clinical coding: of coding in the latest audit and information • The results should not be are detailed below: o Remove the facility from the extrapolated further than the system to add and remove actual sample audited. • Provide feedback and training codes from any staff other • The following services were to the coders on the issues than coding staff and other reviewed within the sample as highlighted in this report essential users shown in Table 9 including:

Page Annual Report and Accounts 2013/14 151 Table 9: Data Sampled Specialty/ Sub-chapter/ Area Audited Healthcare Resource Group Sample size Theme Trauma and Orthopaedic 100 Speciality Random Sampling 100

Statements or Relevance of been identified and actioned to Accounts. Additionally, where the Data Quality and Actions to maintain the Trust’s high quality necessary data is made available Improve Data Quality standards. to the Trust by the Health and Blackpool Teaching Hospitals NHS Social Care Information Centre, Foundation Trust will be taking 2.3.7 Core Quality a comparison of the numbers, the following actions to improve Indicators percentages, values, scores or data quality: rates of the Trust (as applicable) From 2013/14 all Trusts are are included for each of those required to report against a • Data quality indicators on listed in Table 10 with: core set of Quality indicators, NHS number coverage, GP for at least the last 2 reporting of patient, Ethnicity, Gender, a) the national average for the periods, using the standardised national secondary users same; and statement set out in the NHS service (SUS) quality markers (Quality Accounts) Amendment will continue to be monitored b) with those NHS Trusts and Regulations 2013. on a daily, weekly and monthly NHS Foundation Trusts with basis from the Trust’s dedicated the highest and lowest of Set out in Table 10 are the core data quality team all the way the same, for the reporting quality indicators that Trusts are through to the Board. period. required to report in their Quality • Areas of improvement have

Page 152 Blackpool Teaching Hospitals NHS Foundation Trust Table 10: Core Quality Indicators The data made available to the Trust by the Information Centre is with regard to –

(a) the value and banding of the summary hospital-level mortality indicator (“SHMI”) for the Trust for the reporting period; and (b) the percentage of patient deaths with palliative care coded at either diagnosis or specialty level for the Trust for the reporting period.

SHMI Palliative Care Coding England England England England England England Period Trust Trust Average Highest Lowest Average Highest Lowest October 2012 to 117 100 118 63 0.86% 1.19% 14.09% 0.00% September 2013 July 2012 to June 116 100 116 63 0.88% 1.23% 13.93% 0.00% 2013 July 2011 to June 126 100 126 71 0.92% 1.09% 15.51% 0.00% 2012

**Internally calculated data suggests the Trust’s SHMI score on next release will be 110.9 *The palliative care indicator is a contextual indicator

The Blackpool Teaching Hospitals NHS Foundation Trust considers that this data is as described for the following reasons: • The Trust has embarked on an intensive plan for reducing mortality both in hospital and within 30 days of discharge.

The Blackpool Teaching Hospitals NHS Foundation Trust has taken the following actions to improve this rate/number, and so the quality of its services, by undertaking the following actions: • The Trust has shown a significant and sustained improvement in not only Risk Adjusted Mortality Index (RAMI) over the last three years but has also since July 2012 shown marked improvements in HSMR and SHMI mortality measures that have historically portrayed the Trust in a poor light.

See section 3.4.1- For further information to Reduce the Trust’s Hospital Mortality Rate / Summary Hospital Mortality Indicators (SHMI) and any actions taken to improve performance.

Page Annual Report and Accounts 2013/14 153 The data made available to the Trust by the Information Centre with regard to the Trust’s patient reported outcome measures scores for: (i) groin hernia surgery, (ii) varicose vein surgery, (iii) hip replacement surgery, and (iv) knee replacement surgery, during the reporting period.

National Eligible Average National National Year average episodes health gain Highest Lowest health gain 2011/12 405 0.089 0.087 0.143 -0.002 2010/11 369 0.052 0.085 0.156 -0.02 Groin Hernia 2009/10 360 0.06 0.082 0.136 0.011 **Provisional scores for 2012/13 show Trust position as 0.089 to be verified in September 2014

National Eligible Average National National Year average episodes health gain Highest Lowest health gain 2011/12 269 0.366 0.413 0.499 0.306 Hip 2010/11 238 0.267 0.405 0.503 0.264 Replacement 2009/10 236 0.353 0.411 0.514 0.287 **Provisional scores for 2012/13 show Trust position as 0.366 to be verified in September 2014

National Eligible Average National National Year average episodes health gain Highest Lowest health gain 2011/12 322 0.297 0.303 0.385 0.181 Knee 2010/11 323 0.231 0.298 0.407 0.176 Replacement 2009/10 251 0.279 0.294 0.386 0.172 **Provisional scores for 2012/13 show Trust position as 0.297 to be verified in September 2014

National Eligible Average National National Year average episodes health gain Highest Lowest health gain 2011/12 443 0.097 0.095 0.167 0.049 2010/11 377 0.005 0.091 0.155 -0.007 Varicose Vein 2009/10 341 0.058 0.094 0.15 -0.002 **Provisional scores for 2012/13 show Trust position as 0.097 to be verified in September 2014 The Blackpool Teaching Hospitals NHS Foundation Trust considers that this data is as described for the following reasons: • The comparison data for internal PROMS between Blackpool Teaching Hospitals Provisional PROMs Data 2011-12 (April 2011 - March 2012) and Provisional PROMs Data 2012-2013 (April 2012 - March 2013) shows an improvement against the national scores, but reviewing the negative scores, the Trust has improved on previous data. The Blackpool Teaching Hospitals NHS Foundation Trust intends to take the following actions to improve this percentage, and so the quality of its services, by the following actions: Enhance our relationships with the provider, Capita, and work with clinicians essentially across the orthopaedic speciality to enhance the patients reported outcomes and provide greater information to clinicians on their feedback. See section 3.4.1 – For further information regarding improving outcomes from planned procedures - Patient Reported Outcome Measures (PROMS) and any actions taken to improve performance.

Page 154 Blackpool Teaching Hospitals NHS Foundation Trust The data made available to the Trust by the Information Centre with regard to the percentage of patients aged - (i) 0 to 15; and (ii) 16 or over, Re-admitted to a hospital which forms part of the Trust within 28 days of being discharged from a hospital which forms part of the Trust during the reporting period.

Age Group 2013/14 2012/13 2011/12 England Average 0 to 15; and 10.70 10.40 8.80 N/A 16 or over, 6.70 6.30 6.51 N/A **Latest readmission percentages for 2013/14 show the Trust rate as – 7.00. However the English Average is not available until December 2014. The Blackpool Teaching Hospitals NHS Foundation Trust considers that this data is as described for the following reason • The data shows that the work being undertaken across the health economy has started to impact on the percentage of readmissions seen at the Trust.

The Blackpool Teaching Hospitals NHS Foundation Trust has taken the following actions to improve this percentage and so the quality of its services: • A clinically led review of readmissions to identify implement actions required to reduce the number of avoidable admissions • Joint work with Clinical Commissioning Groups to identify and implement health economy wide readmission avoidance schemes, including single point of access services to ensure patients access the most appropriate care, improvements to discharge and on-going care planning

See section 3.4.1 - For further information regarding Reduce Emergency Readmissions to Hospital within 28 days of Discharge and any actions taken to improve performance.

Page Annual Report and Accounts 2013/14 155 The data made available to the Trust by the Information Centre with regard to the Trust’s responsiveness to the personal needs of its patients during the reporting period.

England England England Year Trust Average Highest Lowest 2012/13 65.6 68.1 84.4 57.4 2011/12 67 67.4 85 56.5 2010/11 68.3 67.3 82.6 56.7 2009/10 66.1 66.7 81.9 58.3

The Blackpool Teaching Hospitals NHS Foundation Trust considers that this data is as described for the following reasons: in that the Trust considers patients feedback to be pivotal in ensuring our services continue to develop in order for the Trust to meet individual patient needs.

The Blackpool Teaching Hospitals NHS Foundation Trust intends to take the following actions to improve this score, and so the quality of its services, by • Developing training to assist team leaders to maximise and sustain the capacity and capability of individual team members. • Developing a more robust Patient Relations Service and continuing to analyse concerns and complaint data to inform service improvement. • Developing processes to gain more qualitative and quantitative feedback from patients. • Planning services around the patient by working with the Trust’s Patient Panel and local patient participation groups. • Enhancing communication and providing treatment specific information to patients if appropriate, calling upon specialist nurses to assess patient’s individual concerns around specific disease pathways. • Encouraging patients to discuss any concerns they may have with staff at the time so they feel assured about their care plan. See section 3.4.2 - For further information regarding Priority 3: Quality of the Patient Experience and any actions taken to improve performance.

Page 156 Blackpool Teaching Hospitals NHS Foundation Trust The data made available to the Trust by the Information Centre with regard to the percentage of staff employed by, or under contract to, the Trust during the reporting period who would recommend the Trust as a provider of care to their family or friends.

England England England Year Trust Average Highest Lowest 2012 63 63 98 35 2013 65 65 94 40 2014 72 67 100 12

The Blackpool Teaching Hospitals NHS Foundation Trust considers that this data is as described for the following reasons: • Increased activity and demand on some services seeing an increase in hospitals admissions and pressures on discharges • Staffing levels and agency and locum use, with some staff being moved from their own work area to cover staffing shortfalls • Levels of sickness in some areas, increased levels of work related stress which also adds to the pressure on other staff to come to work despite not feeling well • High levels of negative press reporting linked to patient mortality statistical reporting and regulatory reviews • Levels of staff morale, pressure and conflicting demands placed on staff

The Blackpool Teaching Hospitals NHS Foundation Trust has taken the following actions to improve the standard of care provided by this organisation by undertaking the following actions: • Significant investment has been made in nurse and doctor staffing including increased levels of international recruitments and widening access secondments to increase supply of staff • Better Care Now project to develop best evidence based care and pathways in key priority areas such as stroke, sepsis, pneumonia and cardiac chest pain • Roll out of Targeted Support initiative that includes Patient Experience Revolution training aimed at helping staff to be at their best more of the time and improve their resilience and wellbeing as well as compassionate care – metrics link the numbers of staff trained and increased patient satisfaction levels • TalkSafe project continues to be implemented with training for clinical staff to have conversations about safe and unsafe acts to help embed a safety culture through increased awareness and personal responsibility • Development and launch of the Trust values to help support a culture of compassionate care • Continued investment in our quality assured health and wellbeing services including therapies, mindfulness, fitness programmes, and in-house physiotherapist, etc. • Increased visibility of the senior managers and leaders of the organisation including out of hours • Review of the Whistleblowing Policy to make it easier for staff to raise a concern • Recognition events taking place in each division to share good practice taking place across the Trust • Investors In People (IIP) Gold interim review in preparation for a full reaccreditation • Pilot of Aston University Team Based Working Pilot, with a research base that predicts that effective and high performing team will improve patient outcomes and reduce mortality

Page Annual Report and Accounts 2013/14 157 The data made available to the Trust by the Information Centre with regard to the percentage of patients who were admitted to hospital and who were risk assessed for venous thrombo-embolism during the reporting period.

England England England Quarter Trust Average Highest Lowest Q3 2013/14 99.81% 96% 100.00% 77.7% Q3 2012/13 99.40% 94.10% 100.00% 84.60% Q3 2011/12 97.50% 90.70% 100.00% 32.40%

The Blackpool Teaching Hospitals NHS Foundation Trust considers that this data is as described for the following reasons: • The Trust has aimed to implement current best practice guidelines in order to ensure that all adult inpatients receive a Venous Thrombo-Embolism Risk Assessment on their admission to the hospital, and that the most suitable prophylaxis is instituted. The Trust has embedded and improved the implementation of VTE guidelines within the Trust and has demonstrated this by achieving above the 90% compliance indicator. From 1st April 2011 to 31st August 2011 the Trust did not achieve the VTE target, however from 1st September 2011 - 31st March 2012 the Trust achieved above 90% compliance due to the hard work, commitment and the actions taken by staff. Since then we have been able to sustain this improvement as shown by latest figures from March 2012 to 31st March 2014.

The Blackpool Teaching Hospitals NHS Foundation Trust has taken the following actions to improve this 90 percentage compliance indicator and so the quality of its services, by undertaking the following actions: • A senior clinician and a senior nurse have been identified to provide leadership to facilitate ongoing improvements in compliance with trust processes and consequently improvements in patient care with regards VTE. The National Institute for Health and Clinical Excellence Venous Thrombo-Embolism guideline (CG 92) has been incorporated into easy to follow risk assessment forms across various specialties and is an integral part of clerking documents. This will not only ensure that VTE risk assessments are undertaken and embedded permanently in the admission pathway but also facilitates its documentation for subsequent analysis. The Thrombosis Committee monitors performance of individual clinical areas. • Since December 2013, the clinical audit department have collected real time VTE data to give feedback to individual areas and address poor performance pro- actively.

See section 3.4.3 - For further information to Improve the percentage of admitted patients risk assessed for Venous Thrombo-Embolism (VTE).

Page 158 Blackpool Teaching Hospitals NHS Foundation Trust The data made available to the Trust by the Information Centre with regard to the rate per 100,000 bed days of cases of Clostridium Difficile infection reported within the Trust amongst patients aged 2 or over during the reporting period.

England England England Year Trust Average Highest Lowest 2012/13 10.4 16.1 30.8 0 2011/12 20.4 21.8 51.6 0 2010/11 38.9 29.6 71.8 0

The Blackpool Teaching Hospitals NHS Foundation Trust considers that this data is as described for the following reasons: • Following the significant reductions in Clostridium Difficile Infection (91% for the last six years for the Acute Trust from 2007/2008) the Trust has continued to embed measures to reduce levels further within the organisation. • There have been 26 cases of Clostridium Difficile Infection (CDI) attributed to the Acute Trust between April 2013 and March 2014, in comparison to 28 for the period April 2012 to March 2013, demonstrating a reduction of 7%. The Trust was required to achieve a trajectory of 29, a reduction of 24%, based on the 38 incidences of Clostridium Difficile between October 2011 and September 2012 by March 2014. Information on how the criterion for this indicator has been calculated is detailed in the Glossary of Terms.

The Blackpool Teaching Hospitals NHS Foundation Trust has taken the following actions to improve this trajectory of 51 cases, and so the quality of its services, by undertaking the following actions: • To mitigate the risk of breaching the Trust’s infection prevention target, we continued to deliver a wide ranging programme of work which emphasises to all staff that remaining compliant with the requirements of the Code of Practice for Healthcare Associated Infections is everyone’s responsibility.

See section 3.4.3 - For further information to Reduce Clostridium Difficile Infection Rates as Reflected by National Targets and any actions taken to improve performance.

Page Annual Report and Accounts 2013/14 159 The data made available to the Trust by the Information Centre with regard to the number and, where available, rate of patient safety incidents reported within the Trust during the reporting period, and the number and percentage of such patient safety incidents that resulted in severe harm or death.

Please note that the data supplied by HSCIC is provisional. Incidents Resulting in Severe Harm or Death England England England Percentage Percentage Percentage Percentage Trust Rate Rate Rate Rate Period of Total of Total of Total of Total per 100 per 100 per 100 per 100 (Trust) (England) (Highest) (Lowest) (Average) (Highest) (Lowest) 01/04/2013 to 3.99 N/A N/A N/A 0.347 N/A N/A N/A 30/09/2013 01/04/2012 to 8.3 6.7 13.61 1.99 0.1 0.7 2.5 0 30/09/2012 01/04/2011 to 5.92 5.99 10.08 2.75 0.2 0.8 2.9 0.1 30/09/2011

The Blackpool Teaching Hospitals NHS Foundation Trust considers that this data is as described for the following reasons: • There has been a steady increase in the number of untoward incidents reported over the past four financial years. Patient Safety Incidents account for approximately 76% of all reported untoward incidents.

The Blackpool Teaching Hospitals NHS Foundation Trust has taken the following actions to improve this 25 percent of patient safety incidents resulting in harm, and so the quality of its services, by undertaking the following actions: • It is essential that lessons are learned from Serious Untoward Incident’s in order to mitigate the risk of reoccurrence, these lessons are fedback to staff within the Divisions through training, ward meetings, SUI reports being uploaded onto the Risk Management site of the Intranet, the bi-monthly LIRC Committee meetings and the Trust wide monthly “lessons learned” newsletter. • Engagement with the patient and their relatives is very important to the Trust to embed an open and honest culture, and to the patient and their family as a healing tool. Patients and relatives are informed when an incident has occurred and that an investigation is to be undertaken. They are also offered feedback in relation to the investigation findings.

See section 3.4.3 For further information to monitor the rate of patient safety incidents and reduce the percentage resulting in severe harm or death and any actions taken to improve performance.

Page 160 Blackpool Teaching Hospitals NHS Foundation Trust Part 3: Other Information - Review of Quality Performance

The Quality Account has provided an overview of the Quality Improvement work which has taken place across the organisation. There are a number of projects which we will be taking forward into the coming year and focusing our attention upon them. We would however, like to highlight the following projects as key priorities for 2013/14:

3.1 An Overview of the Quality of Care Based on Performance in 2013/14 with an Explanation of the Underlying Reason(s) for Selection of Additional Priorities

Table 1 in Part 2 sets out the priorities for improvement which • Stroke conditions that impact most were identified in the 2012/13 • Cardiac Chest pain on our mortality and morbidity. report and none of these priorities • Acute Kidney Injury Five pathways have been changed in 2013/14 because implemented to date and a they were all considered to be The Better Care Now project - work plan for 2014/15 agreed of importance by the Board of pathways stream, was launched in to address other high mortality Directors. Additional information August 2013 and links our quality areas. regarding the rationale for the and safety initiatives under one priority selection is detailed in umbrella. It has 3 workstreams: Data is collected real time and fed 2.2.2 and 2.2.3. We also identified • Pathways back to clinicians and teams to four additional priorities for quality • Waits allow immediate improvements improvement for monitoring in • Workforce to be made. All pathways 2013/14 in relation to improving have seen an improvement in patient pathways with our service It has been proven that the use compliance with the mission users. The additional priority has of clinical pathways supports critical points of the pathways, been identified and included and standardised management and there has been a downward monitored during the reporting and delivery of patient care, trend in mortality for pneumonia, period 2013/14 for the following improves patient outcomes, and sepsis and stroke. ` reasons detailed below: can contribute to a reduction in mortality, hospital complications Many complaints and negative Improving Patient Pathways and length of stay. feedback comments are related in: – to poor communication or lack • Pneumonia The pathways identified and of information. The Foundation • Sepsis developed to date are for Trust is constantly seeking to

Page Annual Report and Accounts 2013/14 161 establish the most effective way of stay these pathways improve enforcement action. Except communicating with patients and communication between clinical where otherwise stated, any trust exploring new ways to address staff and patients by providing commissioned to provide services communication barriers faced them with a recovery diary to will be subject to the relevant by patients using our services. update daily on their recovery. governance indicators associated The following developments with those services. highlight our commitment to improving the pathway of care Part 3, Section 3.2 and detailed with all our service users and are 3.2 Performance in table 11 sets out the relevant very focussed on providing clearer Against Key National indicators and performance information and improving the thresholds outlined in Appendix pathway of care with all our Priority Indicators A of Monitors Risk Assessment service users. And Thresholds Framework. Unless stated in the supporting notes, these are 100 Day Pathway Campaign The NHS Outcomes Framework monitored on a quarterly basis. The Fylde Coast Scheduled Care for 2013/14 sets out high level Please note: where any of these vision is committed to introducing national outcomes which the NHS indicators have already been end-to-end pathways for should be aiming to improve. reported on in Part 2 of the quality specific conditions to maximise The Board of Directors monitors report, in accordance with the convenience and safety for performance compliance against Quality Accounts Regulations, patients and overall efficiency. the relevant key national priority they will not be repeated here. Over 20 local pathways relating indicators and performance Only the additional indicators to the high demand procedures thresholds as set out in the NHS which have not already been undertaken by the hospital in Outcomes Framework 2013/14. reported in part 2 will be reported 2012 in areas such as general This includes performance against here to avoid duplication of surgery, gynaecology and the relevant indicators and reporting. orthopaedics were launched in performance thresholds set out in December 2013. These not only the Risk Assessment Framework Please note: there will be some overlap provide clear guidance to GP’s, 2013/14 which can be accessed with indicators set out in part 2 which are now mandated by the Quality Accounts Practice Nurses, Consultants and via the following link: http://www. Regulations. Only the additional indicators other clinical staff but have been monitor-nhsft.gov.uk/sites/ which have not already been reported made available for patients on the default/files/publications/RAF_ in part 2 will be reported here to avoid Fylde Coast to access through the Update_AppC_1April14.pdf duplication of reporting. Trust’s web site so they can see the care they can expect to receive. Monitor uses a limited set of Performance against the key national measures of access and national priorities is detailed on Enhanced Recovery Pathways outcome objectives as part of the Business Monitoring Report Enhanced Recovery is an their assessment of governance at to the Board of Directors each approach to elective surgery NHS Foundation Trusts. Monitor month and is based on national based on the principles that uses performance against these definitions and reflects data patients are in the optimal indicators as a trigger to detect submitted to the Department condition for treatment, have potential governance issues. of Health via Unify and other different care during their national databases. operation and experience optimal NHS Foundation Trusts failing post-operative rehabilitation. to meet at least four of these Table 11 shows the results from A number of patient pathways requirements at any given time, or the Trust’s self assessment of have been developed and are in failing the same requirement for performance against the relevant use in Gynaecology, Cardiology, at least three quarters, will trigger key national priority indicators Orthopaedics and Urology. As a governance concern, potentially and thresholds over the past 4 well as a reduction in length of leading to investigation and years.

Page 162 Blackpool Teaching Hospitals NHS Foundation Trust Table 11: Performance against Relevant Key National Priority Indicators and Thresholds Trust Self Trust Self Trust Self Trust Self Quality Standard Assessment Assessment Assessment Assessment 2010/11 2011/12 2012/13 2013/14 All Cancers: one month diagnosis to treatment: Achieved Achieved Q1 Achieved: Q1 Q1 99.5% 99.3%, Q2 98.9% Q2 First Treatment (target >= 96%) Achieved Q2 99.6% 99.4%, Q3 98.9% Q3 Q3 99% Q4 98.5%, Q4 99.8% Q4 99.8% 98.9% 99.3% Achieved Achieved Q1 Achieved: Q1 Q1 100% 100%, Q2 99.2% Q2 Subsequent Treatment – Drugs (Target Achieved Q2 100% Q3 100%, Q3 100% Q3 >=98%) 99.3% Q4 99.2%, Q4 100% Q4 99.3% 98.6% 100% Achieved Achieved Q1 Achieved: Achieved Q1 100% 100%, Q2 Q1 100% Q2 Subsequent Treatment – Surgery (Target 100% for all 4 Q2 100% Q3 95.8%, Q3 98.7% Q3 >=94%) quarters 100% Q4 96.7%, Q4 96.3% Q4 100% 100% 97.3% Subsequent treatment – Radiotherapy Not Not Not Not (Target >=94%) applicable applicable applicable applicable All Cancers: two month GP urgent referral to treatment: Achieved Achieved Q1 Achieved: Q1 Q190.8% Q2 85.1%, Q2 86.6% Q2 62 day general (target >=85%) Achieved 87.2% Q3 89.5%, Q3 89.4% Q3 92.3% Q4 85.5%, Q4 85.2% Q4 87% 83% 86.6% Annual percentage Excluding rare cancer 86.5% Achieved: Q1 86.8% Q2 62 day general (target >=85%) Including Not Not Not 89.4% Q3 Rare Cancers applicable applicable applicable 85.4% Q4 86.7% Annual percentage 87.1% Achieved Q1 Achieved Achieved: Q1 90.5% Q2 Q1 94%, 89.1% Q2 62 day screening (target >=90%) Achieved 93.7% Q3 Q2 91.3%, 91.7% Q3 86.8% Q4 Q3 98%, Q4 90.1% Q4 96.7% 96.6% 94.7% Achieved Q1 Achieved: Q1 Achieved Achieved 91.4%, Q2 85.4% Q2 greater than greater than 62 day upgrade (Target TBC) 90.9%, Q3 95.9% Q3 95% in all 4 94% in all 4 92.2%, Q4 93.6% Q4 quarters quarters 95.6% 92.6%

Page Annual Report and Accounts 2013/14 163 Table 11: Performance against Relevant Key National Priority Indicators and Thresholds Trust Self Trust Self Trust Self Trust Self Quality Standard Assessment Assessment Assessment Assessment 2010/11 2011/12 2012/13 2013/14 Achieved Q1, Achieved Q1 Achieved Q1 Achieved: Q1 93.7%; Q2, 94.1% Q2 93.8%, Q2 94% Q2 94.8% Breast Symptoms – 2wk wait (Target 93%) 95.7%; Q3, 94.7% Q3 96.5%, Q3 Q3 96.7% Q4 94.9%; Q4, 93.2% Q4 97.2%, Q4 93% 96.2% 96.4% 93.4%

Reperfusion – Primary PCI Achieved Achieved Achieved Achieved Delayed Transfers of Care (target <3.5%) Achieved Achieved Achieved Achieved Under Percentage of Operations Cancelled (target Achieved Achieved Achieved 0.6% Achieved 0.8%) 0.56% 0.45% 0.92% Percentage of Operations not treated within Achieved 0% Achieved 0% Achieved 0% Achieved 0% 28 days (target 0%) Under- Under- National In-Patient Experience Survey Achieved Achieved achieved achieved No longer No longer No longer Quality of Stroke Care Achieved measured measured measured Ethnic Coding Data quality Achieved Achieved Achieved Achieved Maternity Data Quality Achieved Achieved Achieved Achieved 3.70 (Highest Staff Satisfaction Achieved Achieved Achieved best 20% nationally)

18 week Referral to Treatment (Admitted Achieved Achieved Achieved Achieved Pathway) (target >=90%) 94.08% 91.89% 94.66% 92.02% 18 week referral to treatment Open Pathways Achieved Achieved Not Applicable Not Applicable (Target >+92%) 94.37% 94.78% 18 week Referral to Treatment (Non- Achieved Achieved Achieved Achieved Admitted Pathways [including Audiology]) 96.46% 95.76% 97.51% 96.78% (Target >=95%) 18 week Referral to Treatment (non admitted No longer No longer Not Applicable Achieved pathways) 95th percentile (target 18.3 weeks) measured measured 18 week Referral to Treatment (admitted No longer No longer Not Applicable Achieved pathways) 95th percentile (target 23 weeks) measured measured

Incidence of MRSA 4 (target <=3) 2 (target <=3) 3 (target <=3) 1 (target 0) 101 (target 53 (target 28 (target 26 (target Incidence of Clostridium Difficile <=152) <=86) <=51) <=29) Mixed Sex Accommodation (Target 0) 2 breaches 5 breaches 12 breaches 15 breaches

Total time in A&E (target 95% of patients to Not updated Achieved Achieved Achieved be admitted, transferred or discharged within on National 97.69% 95.93% 96.61% 4hrs) website as yet Total time in A&E (95th percentile) (Target Under- Under- Under- Not applicable 240 minutes) achieved achieved achieved

Page 164 Blackpool Teaching Hospitals NHS Foundation Trust Table 11: Performance against Relevant Key National Priority Indicators and Thresholds Trust Self Trust Self Trust Self Trust Self Quality Standard Assessment Assessment Assessment Assessment 2010/11 2011/12 2012/13 2013/14

Total time to initial assessment (95th Under- Under- Under- Not applicable percentile) (Target 15 minutes) achieved achieved achieved Time to treatment decision (median) (Target Under- Under- Not applicable Achieved 60 minutes) achieved achieved Not updated Unplanned re-attendance (Target 5%) Not applicable Achieved Achieved on National website as yet Not updated Left without being seen (Target 5%) Not applicable Achieved Achieved on National website as yet Ambulance Quality (Category A response Not applicable Not applicable Not applicable Not applicable times)

Waiting times for Rapid Access Chest Pain 100% 100% 100% 100% Clinic Access to healthcare for people with a Achieved Achieved Achieved Achieved learning disability Participation in heart disease audits Achieved Achieved Achieved Achieved Under- Smoking during pregnancy achieved 24.59% 24.56% 23.2% 26.99% Under- Breast-feeding initiation rates target (average achieved 60.47% 56.35% 65.7% rate within 48 hrs) 63.14% Emergency Preparedness ** ** ** ** Where needed the criteria for the above indicators has been included in the Glossary of Terms

** The Pandemic Influenza Plan (Version 8) was reviewed in April 2014 and ratified by the Board of Directors.

This document defines the key pandemic influenza management systems and responsibilities of staff**. The suite of emergency plans are all to be reviewed in early 2014 due to the release of new national guidance in November 2013 and the Emergency Preparedness, Resilience and Response Core Standards being issued which have been reviewed and are to be approved by the Trust Board in January 2014. (Version 5) were reviewed in March the key roles and responsibilities The Major Incident Plan (Version 2014 and ratified by the Board of of staff during those incidents 6) and Decontamination Plan Directors. These documents define and the management systems.

Page Annual Report and Accounts 2013/14 165 Decontamination training is information on alternative options and silver command activation undertaken every 6 weeks with to deliver their services. exercises for on call staff to the responding departments. A The Emergency Planning rehearse their roles. regional major incident exercise Manager and Local Security was hosted by NHS England Management Specialist continue Readmissions within 30 days in October 2013 with all NHS to undertake group training The Trust has been working with organisations in Lancashire taking sessions for the seventy eight on its health economy partners part. call or duty staff, this includes Duty to implement strategies to Directors, Duty Managers (Acute reduce readmissions. Overall the To support these arrangements and Community Health Services), percentage of all readmissions the Trust has a Trust wide Business members of the Acute Response 2013/14 was above peer average; Continuity Plan (Version 3) which Team, Associate Directors of however for readmissions was reviewed and ratified by Nursing, Senior Nurses covering following non-elective admissions the Board of Directors in March bleep 002, On Call Consultant the Trust was above peer 2013. Beneath the Trust Business Haematologists and Loggists. average as shown in Table 12. Continuity Plan are 9 Corporate, Work continues to improve 19 CSFM, 3 Scheduled Care, 4 The Emergency Planning the performance of patients Unscheduled Care, 26 Adults and Manager and Local Security readmitted following an elective 8 Families Business Continuity Management Specialist also procedure. Plans (total 69) with operational deliver quarterly lockdown

Table 12: 28 Day Readmissions Indicator Trust 2011/12 Peer 2011/12 Trust 2012/13 Peer 2012/13 Trust 2013/14 Peer 2013/14 All 6.9% 6.9% 6.4% 6.8% 6.8% 6.6% Admissions Non-elective 11.5% 10.8% 10.8% 10.7% 11.2% 10.4% Elective 2.9% 3.2% 3.3% 3.1% 3.2% 3.1%

Data source: CHKS Quality and Patient Safety Tool. This data is not governed by standard national definitions

figure increases to 87.1% when and tokens of appreciation from 3.3 Additional Rare Cancers are included (as patients and their families. Other Information required by Monitor). A significant The number of formal complaints amount of work was undertaken received by the Trust during in Relation to the to understand and address the the same period was 506 this Quality of NHS issues within pathways and across includes 395 written complaints organisations for the benefit registered via the Trust and 32 Services of patients. Information on the Community formal complaints. criteria for this indicator is detailed There were also 79 verbal 62 day Cancer Waiting Time in the Glossary of Terms. complaints made. The numbers of Standard formal complaints received shows Delivery of the 62 day Waiting Learning from Patients an overall increase of 49 cases Time standards for both GP We encourage patients to give compared to the previous year as urgent and screening programme us feedback, both positive and shown in the Table 13 below. referrals continued to require negative, on their experiences of significant work and pathway our hospital services so that we development across the Trust, the can learn from them and develop local health economy and wider our services in response to Cancer Network during 2013/14 patients’ needs. and the year end figure was During the financial year 1st April 86.50% (excluding Rare Cancers) 2013 to 31st March 2014 we The overall annual performance received 3794 thank you letters

Page 166 Blackpool Teaching Hospitals NHS Foundation Trust Table 13: Complaints Date - Financial Year Complaints 506 Total 2013/2014 (439 Trust + 67 Community) 457 Total 2012/2013 (376 Trust + 81 Community) 483 Total 2011/2012 (399 Trust + 84 Community) 2010/2011 347 (Trust only)

The main categories of complaints organisation. are related to: Following recommendations • Treatment Issues 263 in the Keogh Report, • Communication 42 the Trust holds a • Staff Attitude 56 monthly Complaint • Waiting Times 48 Review Panel to • Administration 51 discuss ‘upheld’ formal complaints. Once the complaint has been The panel address acknowledged by the Trust, it is if the divisions sent to the appropriate Division complaints have for local investigation. Once been managed in this investigation has been line with agreed completed, their response is timeframe, compiled and, following quality investigated assurance checks, the response is thoroughly and signed by an Executive Director proportionally and posted to the complainant. and the response Divisions are actively encouraged is appropriate. to arrange face to face meetings Evidence is with complainants and during reviewed and 2013/14, 63 meetings were held lessons learned in order to resolve a complaint discussed to in a more timely manner (9 after discover emerging a final response and 54 before a themes and final response), a decrease of four trends arising from complaint 2 have been reported as ‘not from the previous year. investigations. The panel will also upheld’, one ‘partially upheld’ and review complainants that are 10 are still under consideration To help reduce the number of deemed vexatious and agree a and classed as being ‘referred to complaints within the Trust, suitable response. the second stage’. lessons learned are discussed within the Divisional Governance Once local resolution has been Informal Complaints meetings, whilst lessons that can exhausted the complainant has The aim of the Patient Relations be learned across the organisation the right to contact the Health Team, previously known as and trends in the number of Service Ombudsman for a review Patient and Liaison Service (PALS) category of complaints are of the complaint. During 2013/14, is to be available for on-the-spot discussed at the Learning from 16 complaints were considered enquiries or concerns from NHS Incidents and Risks Committee and by the Ombudsman. Of these, service users and to respond to the weekly complaints meeting the Ombudsman has decided ‘no those enquiries in an efficient and to ensure learning is across the further investigation’ is required, timely manner.

Page Annual Report and Accounts 2013/14 167 Table 14 below shows the number of issues dealt with by the by PALS team over the last four years.

Table 14: Informal Complaints Date - Financial Year Number of Cases Number of Issues 2013/2014 2,284 4,307 2012/2013 2,496 2,702 2011/2012 3,124 3,508 2010/2011 2,609 2,887

The number of cases handled by trends arising from complaint these schemes and initiatives we the Patient Experience Team this investigations. The panel will also must achieve a particular level year has decreased by 212 cases review complainants that are of excellence, this then directly in comparison to the previous deemed vexatious and agree a impacts on the quality of care and year. Out of the 2,284 cases 2,182 suitable response. provides evidence for the Trust have been resolved and 102 that we are doing all we can to cases are ongoing or require final provide clinical effectiveness of closure. The main themes that care. have emerged from the cases 3.4 Detailed recorded are: Description of Reduce the Trust’s Hospital Mortality Rate / Summary • Administration (476 issues) Performance on Hospital Mortality Indicators • Staff Attitude (158 issues) Quality in 2013/14 (SHMI) • Treatment Issues (466 issues) The Blackpool Teaching Hospitals • Waiting Times (449 issues) against Priorities NHS Foundation Trust considers • Communication (198 issues in 2012/13 Quality that this data is as described for the following reasons: To help reduce the number of Accounts The Trust has embarked on complaints within the Trust, an intensive plan for reducing This section provides a detailed lessons learned are discussed mortality both in hospital and description regarding the within the Divisional Governance within 30 days of discharge. Since quality initiatives that have been meetings, whilst lessons that can July 2012, a series of distinct work progressed by the Trust including be learned across the organisation streams have been developed both hospital and community and trends in the number of to ensure that national mortality services information based on category of complaints are ratio measures accurately reflect performance in 2013/14 against discussed at the Learning from the Trust’s position as well as the 2012/13 indicators for the Incidents and Risks Committee ensuring safe, appropriate, harm following priorities: and the weekly complaints free care is being delivered, these meeting to ensure learning is include but are not limited to: • Priority 1: Clinical Effectiveness across the organisation. Following of Care; recommendations in the Keogh • Improving the process of • Priority 2: Quality of the Patient Report, the Trust holds a monthly consultant sign-off for coding Experience and; Complaint Review Panel to discuss of deaths. The purpose of this • Priority 3: Patient Safety. ‘upheld’ formal complaints. The is to ensure that all diagnoses panel address if the divisions attributed to a patient complaints have been managed 3.4.1 Priority 1: Clinical accurately reflects the prevalent in line with agreed timeframe, Effectiveness of Care condition. This allows us to investigated thoroughly and There are many schemes and identify areas of high mortality proportionally and the response is initiatives that we can participate and plan appropriate action. appropriate. Evidence is reviewed in that help us deliver high • Improved documentation and lessons learned discussed to quality care. By meeting the processes to ensure safer discover emerging themes and exact and detailed standards of handover of clinical care and

Page 168 Blackpool Teaching Hospitals NHS Foundation Trust ensure information is available the improvements are local, management of deteriorating to attribute accurate clinical measurable and immediate and patients and increased nurse to codes are owned by the team providing patient staffing levels. • Engagement with Northwest the care. area AQUA team to develop Blackpool Teaching Hospitals was a definitive action plan for The Trust has shown a significant one of the 14 Trusts identified for mortality improvement and sustained improvement in not review by Sir Bruce Keogh as a • Development of enhanced only Risk Adjusted Mortality Index persisting outlier on the national informatics tools for early (RAMI) over the last three years SHMI measure based on data identification of mortality issues but has also since July 2012 shown from pre March 2012. The Trust • Initiated a review of the marked improvements in SHMI. welcomed this review and was compliance with agreed care one of only three organisations pathways and care bundles The Trust continues to be part not placed in special measures within clinical areas of a North West Collaborative following the review. • Detailed review of all mortality Programme for mortality indicators with Chief Executive reduction and has implemented The Trust has also recently been involvement programmes specifically inspected by the CQC where its around the care of patients with work on reducing mortality and At the same time we have pneumonia and patients with improving care pathways was maintained our focus on harm severe sepsis. In addition to this commended. reduction strategies such as work hospital mortality has been reducing medical outliers improved by the implementation These reviews have helped the (medical patients receiving of harm reduction strategies organisation in creating a focused treatment on non-medical wards), including reduction in hospital action plan for improving patient hospital acquired infections and acquired infections, progress care around the key themes of medication errors. Progress on on reducing Venous Thrombo- Governance and Leadership, all these objectives has been Embolism (VTE), strict adherence Mortality, Patient Experience and reported to the Board on a regular to quality measures as part of the Workforce and Safety. basis. The emphasis has been North West Advancing Quality on improving processes so that initiative and improving the

Graph 2: SHMI Ranking by month

Data source: HED data evaluation tool and Trust SHMI Calculation Tool. This data is governed by standard national definitions

Page Annual Report and Accounts 2013/14 169 Since commencement of work in internal calculations has fallen and more significantly a reduction July 2012 the Average Summary by over 12 points compared to in the crude mortality rate (the Hospital Mortality Indicator (SHMI) the period from June 2010 to percentage of patients that died as produced by the Healthcare commencement of work. in hospital compared to the Evaluation Data Tool (HED) and total number of discharges from hospital). Graph 3: Deaths in Hospitals by Calender Year North West Advancing Quality Initiative The Trust participates in the NHS North West (Strategic Health Authority) Advancing Quality Programme, which focuses on the delivery of a range of interventions for each of the following conditions listed in Table 15. Examples of the interventions can be found in the following information and Tables overleaf:

• Acute Myocardial Infarction (Heart Attack) • Hip and Knee Replacement Surgery • Coronary Artery By-pass Graft Surgery • Heart Failure • Community Acquired Pneumonia • Stroke

Research has shown that consistent application of these interventions has substantially improved patient outcomes resulting in fewer deaths, fewer hospital readmissions and shorter hospital lengths of stay.

Applying all the interventions will support our goals of reducing hospital mortality, reducing Data source: Trust Patient Administration System (PAS). This data is governed by standard preventable harms and improving national definitions patient outcomes, thereby improving the quality of patient The graph above demonstrates Mortality Indicators but also the experience. Approximately 3,000 that not only have improvements Trust has managed a reduction patients a year will benefit from been made in Risk Adjusted in the overall number of deaths this programme.

Page 170 Blackpool Teaching Hospitals NHS Foundation Trust Table 15 : Commissioning for Quality and Innovation Commissioning for Quality and Innovation (CQUIN) and the respective Targets For The Trust Scheme Threshold Collection Period Acute Myocardial Infarction (Heart 88.08% Attack) Hip and Knee Replacement Surgery 83.17% Coronary Artery By-pass Graft (CABG) 95% Discharges which occur between 1st Heart Failure 77.85% April 2013 and 31st March 2014 Community Acquired Pneumonia 64.58% Stroke 54% Patient Experience Measures (PEMs) N/A

Data source: NHS North West Advancing Quality Programme. This data is governed by standard national definitions.

Comparison of Data The Trust’s performance against working to a world class service. For each of the key areas a series each of the seven key areas The Cardiac Specialist Nurses of appropriate patient care is detailed in the following have ensured that all relevant measures has been determined, information. A Clinical Lead and data is collected and uploaded known as the Composite Quality Operational Manager have been into the database and they check Score (CQS). Data is collected to identified for each key area and compliance with all measures. demonstrate if these measures regular meetings are held to are being met and a Composite identify the actions required to The Cardiac Specialist Nurses Quality Score for each key area improve scores achieved to date. ensure that all information is is derived for every Trust in captured in the Myocardial the programme. Performance Please note: The 2013/14 data cannot Ischemia National Audit Project thresholds have been agreed be published until Grant Thornton have (MINAP). The Advancing Quality completed their audit to validate the data, using this data which, whilst which is anticipated to be September/ Adult Smoking Cessation advice/ challenging, are aimed at each October 2014. counselling is further checked by Trust having the opportunity to be the Cardiac Rehabilitation Team to awarded the full amount retained ensure this is included within the through the Commissioning for A cute Myocardial Infarction patients individualised treatment Quality and Innovation (CQUIN) (Heart Attack) plan. framework. The percentage levels The Trust has always performed which would generate a CQUIN well against the advancing quality All data is shared with the payment for each organisation measure for Acute Myocardial Consultant Team and Health and the data collection periods for Infarction (Heart Attack). A Professionals at the monthly each scheme are slightly different, number of measures have been Directorate meeting and at and therefore each CQUIN and introduced to ensure compliance the Divisional Governance the respective targets for the Trust with all performance measures. meeting. are detailed in Table 15 above. The Trust achieved the Composite Quality Score (CQS) of 98.54% as In addition, to qualify for the shown in Table 16. Commissioning for Quality and Innovation awards, Trusts must A number of measures have been achieve a minimum cumulative introduced to ensure that we clinical coding and Quality meet all performance measures Measures Reporter (QMR) data which highlights that the Trust is completeness score of 95%.

Page Annual Report and Accounts 2013/14 171 Table 16: Acute Myocardial Infarction Acute Myocardial Infarction (Heart Attack) Trust Performance Oct 09 – Mar Apr 10 – Mar Apr 11 – Mar Apr 12 – Mar Measure 10 11 12 13 Aspirin at arrival 100.00% 100.00% 99.78% 99.65% Aspirin prescribed at discharge 100.00% 100.00% 100.00% 99.74% ACEI or ARB for LVSD 100.00% 100.00% 100.00% 98.91% Adult smoking cessation advice/counselling 96.00% 96.61% 95.12% 96.73% Beta Blocker prescribed at discharge 100.00% 98.79% 99.54% 99.01% Beta Blocker at arrival Fibrinolytic therapy received within 30 66.67% minutes of hospital arrival Primary Coronary Intervention (PCI) received within 90 minutes of hospital 100.00% 95.12% 91.50% 92.88% arrival Survival Index 99.00% 90.80% 96.52% 98.52% Acute Myocardial Infarction (AMI) 99.62% 97.98% 98.17% 98.54% Composite Quality Score (CQS) Top 25% CQS Threshold 99.04% Top 50% CQS Threshold 98.00% CQUIN Threshold 87.35% 95.00% 95.00% 95% The Trust had to achieve the CQUIN Threshold of 95%. The Trust met the CQUIN Threshold – we scored 98.54% (green)

Hip and Knee Replacement Compliance with the Venous Gentamicin antibiotics as a first Surgery Thrombo-Embolism prophylaxis line for patients without Penicillin/ Both antibiotic and Venous protocol is 98% or better. With Cephalosporin antibiotic allergy, Thrombo-Embolism regard to antibiotic prophylaxis and are compliant in this area. The prophylaxis is the subject of a we have developed a system, Trusts performance is shown in set of departmental protocols. involving both Flucloxacillin and Table 17.

Page 172 Blackpool Teaching Hospitals NHS Foundation Trust Table 17: Hip and Knee Replacement Surgery Hip and Knee Replacement Surgery Trust Performance Oct 09 – Mar Apr 10 – Mar Apr 11 – Mar Apr 12 – Mar Measure 10 11 12 13 Prophylactic antibiotic received within 1 88.14% 97.96% 94.97% 93.13% hour prior to surgical incision Prophylactic antibiotic selection for surgical 97.36% 99.59% 97.18% 91.06% patients Prophylactic antibiotic discontinued within 98.31% 96.64% 95.63% 97.13% 24 hours after surgery end time Recommended Venous Thrombo- 99.66% 100.00% 99.11% 98.73% Embolism prophylaxis ordered Received appropriate Venous Thrombo- Embolism (VTE) prophylaxis w/I 24 hrs prior 99.66% 100.00% 98.96% 98.73% to surgery to 24 hrs after surgery Readmission (28 Day) avoidance index 94.02% 92.50% 91.98% 94.78% Hip and Knee Composite Quality Score 96.19% 97.78% 96.25% 95.54% (CQS) Top 25% CQS Threshold 96.89% Top 50% CQS Threshold 94.27% CQUIN Threshold 75.67% 95.00% 95.00% 95.00% The Trust had to achieve the CQUIN Threshold of 95%. The Trust met the CQUIN Threshold – we scored 95.54% (green).

Coronary Artery Bypass Graft (CABG) Surgery There are four Trusts undertaking Coronary Artery Bypass Graft Surgery within the North West, all of which have scored highly. It is very competitive due to the low number of Trusts involved in this initiative.

A number of actions have been introduced to further improve performance against the measures. Compliance with all measures has continued to improve. All data is collected and uploaded by a member of the administrative team working closely with the clinical lead. antibiotic stop times. This ensures Professionals at the monthly that clinicians review each patient Directorate meeting and in the The introduction of a new and only continue with antibiotics Divisional Governance meeting. prescription sheet within the based on individual clinical need if The Trust achieved the Composite Cardiac Intensive Care Unit with they are re-prescribed. Quality Score (CQS) of 98.19% as the facility to prescribe antibiotics shown in Table 18. for a 48 hour period only has All data is shared with the assisted with the compliance on Consultant Team and Health

Page Annual Report and Accounts 2013/14 173 Table 18: Coronary Artery Bypass Graft Surgery Coronary Artery Bypass Graft Surgery Trust Performance Oct 09 – Mar Apr 10 – Mar Apr 11 – Mar Apr 12 – Mar Measure 10 11 12 13 Aspirin prescribed at discharge 98.54% 98.68% 99.30% 100% Prophylactic antibiotic received within 1 hr 87.89% 95.59% 99.68% 98.52% prior to surgical incision Prophylactic antibiotic selection for surgical 94.88% 98.30% 99.68% 99.59% patients Prophylactic antibiotic discontinued within 89.82% 93.62% 90.42% 94.52% 24 hrs after surgery end time Coronary Artery Bypass Graft Composite 92.73% 96.54% 97.23% 98.19% Quality Score (CQS) Top 25% CQS Threshold 97.75% Top 50% CQS Threshold 97.73% CQUIN Threshold 95.00% 95.00% 95.00% 95.00% Year 3 - The Trust had to achieve the CQUIN Threshold of 95%. The Trust met the CQUIN Threshold – we scored 98.19% (green)

Heart Failure possible and prevents extended seen by the Cardiac Rehabilitation The Trust has shown an length of stay. The Consultant Team who ensures appropriate improvement in performance in Cardiologist who is responsible discharge advice has been given. relation to the management of for the treatment of patients with patients with Heart Failure. Heart Heart Failure is actively involved All data is shared with the Failure Specialist Nurses attend the with patient management across Consultant Team and Health Adult Medical Unit on a daily basis the Trust. Regular ward rounds are Professionals at the monthly to identify any patients who have undertaken within the Medical Directorate meeting and in the been admitted with Heart Failure. Directorate to review patients to Divisional Governance meeting. This ensures that these patients are assist with effective diagnosis and The Trust achieved the Composite treated by the most appropriate treatment. Near the end of the Quality Score (CQS) of 91.14% as health professional as swiftly as patients hospital stay, patients are shown in Table 19.

Table 19: Heart Failure Heart Failure Trust Performance Oct 09 – Mar Apr 10 – Mar Apr 11 – Mar Apr 12 – Mar Measure 10 11 12 13 Discharge instructions 18.42% 34.43% 76.79% 81.01% Evaluation of LVS function 84.62% 87.70% 96.40% 96.18% ACEI or ARB for LVSD 81.37% 84.84% 92.88% 97.65% Adult smoking cessation advice / 53.85% 28.13% 76.79% 97.50% counselling Heart Failure Composite Quality Score (CQS) 59.10% 65.94% 88.37% 91.14% Top 25% CQS Threshold 77.60% Top 50% CQS Threshold 72.19% CQUIN Threshold 65.34% 65.34% 75.08% 82.24% The Trust had to achieve the CQUIN Threshold of 82.24%. The Trust met the CQUIN Threshold – we scored 91.14% (green)

Page 174 Blackpool Teaching Hospitals NHS Foundation Trust Community Acquired Community Acquired Pneumonia. meetings and recent clinical Pneumonia An e-learning tool is being cases are reviewed in order that The figures in Year 3/4 clearly launched for all medical staff to areas for improvement can be show that the Trust has continued complete ensuring that they are identified. The Trust is confident to make significant progress fully aware of the need to deliver that the introduction of a compared to year one. A Advancing Quality measures for pneumonia care pathway which number of measures have been pneumonia. will be recorded on the electronic implemented during the year patient record will further improve including the introduction of Multidisciplinary meetings our performance parameters. Advancing Quality Pneumonia continue with nurses and Quality Cards, which is a credit managers from the Accident Performance of Blackpool card sized reminder for all medical and Emergency Department, Teaching Hospitals NHS staff of what is required in terms of the Acute Medical wards and the Foundation Trust shows the ensuring high quality patient care Medical specialties. Performance Composite Quality Score (CQS) to for patients suspected of having is openly discussed at these be 90.77% as shown in Table 20.

Table 20: Community Acquired Pneumonia Community Acquired Pneumonia Trust Performance Oct 09 – Mar Apr 10 – Mar Apr 11 – Mar Apr 12 – Mar Measure 10 11 12 13 Oxygenation assessment 100.00% 99.81% 100.00% 100% Blood Cultures performed in A&E prior to 41.60% 80.35% 77.82% 81.97% initial antibiotics received in hospital Adult smoking cessation advice / 39.62% 39.26% 50.00% 58.67% counselling Initial antibiotic received within 6 hrs of 64.94% 79.24% 83.60% 87.53% hospital arrival Initial antibiotic selection for Community Acquired Pneumonia in immune- 97.32% 99.68% 100.00% 99.48% competent patients CURB-65 score 75.63% 87.25% Community Acquired Pneumonia 76.28% 86.29% 85.74% 90.77 Composite Quality Score (CQS) Top 25% CQS Threshold 84.03% Top 50% CQS Threshold 82.24% CQUIN Threshold 78.41% 78.41% 84.81% 87.39% The Trust had to achieve the CQUIN Threshold of 87.39%. The Trust met the CQUIN Threshold – we scored 90.77% (green)

Page Annual Report and Accounts 2013/14 175 Stroke Foundation Trust shows the Score (ACS) as 57.74% as shown in Performance of Blackpool Composite Quality Score (CQS) to Table 21. Teaching Hospitals NHS be 89.34% and Appropriate Care

Table 21: Stroke Stroke (New Target Introduced October 2010) Trust Performance (1.10.2010 – (Apr 11 – Apr 12 – Mar Measure 31.3.2011) Mar 12) 13 Stroke Unit Admission 41.92% 74.19% 66.67% Swallowing Screening 97.77% 97.96% 95.73% Brain Scan 68.15% 84.41% 95.21% Received Aspirin 90.71% 99.09% 96.32% Physiotherapy Assessment 98.48% 96.69% 95.81% Occupational Assessment 97.01% 95.47% 92.88% Weighed 98.15% 98.49% 95.99% Stroke Composite Quality Score (CQS) 83.65% 92.07% 89.34% Stroke Appropriate Care Score (ACS) 34.27% 68.11% 57.74% CQS - CQUIN Threshold 90% 90% 90% ACS - CQUIN Threshold 50% 50% 50% Year 1 – The Trust had to achieve two CQUIN Thresholds – CQS target of 90% and ACS target of 50% The Trust did not achieve the CQUIN Threshold – we scored 83.65% (CQS) and 34.27% (ACS) (red = no payment received). This was due to patient’s not being admitted to the Stroke Unit within 24 hours of suffering a TIA and not having a brain scan within the appropriate timescale. Year 2 – The Trust met the CQUIN Threshold – target 90% / 50% and we scored 92.07% / 68.11%. Year 3 – The Trust achieved the ACS CQUIN target but failed the CQS CQUIN target.

Enhancing quality of life for The work-streams are: 1. CQUIN artefacts. The memory walk people with dementia –Improve and pathways; 2. Safety and will be fully operational by June the outcome for older people environment; 3. Pharmacology; 2014. with dementia by ensuring 90% 4. Education and training and • Distraction/comfort boxes of patients aged 75 and over are specialist nurses; 5. Volunteers have been introduced to try screened on admission and Partnership. The Dementia to engage our patients more Dementia is a significant Advisory Board continues to effectively. These boxes contain challenge for the NHS with it meet regularly and significant familiar everyday items such estimated that 25% of general improvement to all aspects of as buttons, clothes pegs, and hospital beds in the NHS are dementia care is demonstrated a wide range of ‘sensory’ occupied by people with within each of the ongoing work materials such as crinkly, furry dementia, rising to 40% or even -streams. fabrics or items with lights that higher in certain groups such as flash and twinkle. The aim is elderly care wards or in people • A successful bid to the Blue to stimulate a range of senses with hip fractures. The Dementia Skies Charity fund has meant and help staff to engage with Project – Large Scale Change is that plans have now been the patients, whilst also helping led by two Associate Directors drawn up for the development to relieve the anxiety felt by of Nursing and was introduced of a memory walk. The location patients in an unfamiliar setting. within the Trust to implement and members of a project • Development of a Dementia the Dementia Quality Standard team have been identified and Pathway is now completed and and further raise awareness of discussions have taken place the launch of this will coincide dementia. The project is divided with local businesses and artists with “Dementia Awareness” into five main work-streams each who have kindly donated week. with a lead person responsible. picture boards and local • The butterfly scheme has been

Page 176 Blackpool Teaching Hospitals NHS Foundation Trust re-launched this last month and work continues to ensure the principles of this approach are embedded within the organisation. • Dementia Training and education continues to be improved. Opportunities for staff now include dementia awareness full day for all staff, Best Practice module in Dementia care, Level 3 course at UCLAN, Caring for people with Dementia, Delirium Awareness and risk assessment for junior doctors. Tool, which consisted of a medical introduction of dedicated audit • Guidelines have been notes component, a flag to mark staff to collect data and feedback implemented for the the patients involved, and a tracer compliance real time. This has prescription of antipsychotic backing form, was introduced into shown some improvement medications. every inpatient hospital ward on (17% in quarter), and it is the 29th October 2012. envisaged that the Trust will build A national target of 90% of on this over the coming year, but patients admitted to hospital as The goal of the Dementia the Trust did not meet the 90% an emergency aged over 75 years, Care Bundle is to improve the national target overall as shown will receive screening, assessment identification of patients with Table 22. The Blackpool Teaching and onward referral for further dementia and other causes of Hospitals NHS Foundation memory assessment if indicated. cognitive impairment alongside Trust considers that this data is After engagement with clinical their other medical conditions as described for the following staff and working with the NHS and to prompt appropriate reasons: Institute, a Care Bundle Approach, referral and follow up after they which is a process where printed leave hospital. The bundle is • Despite the bundle leading checklist paper forms of accepted part of the national CQUIN for to an increased awareness clinical guidelines are introduced improving dementia screening in of dementia and cognitive to relevant wards and made an acute hospital. conditions amongst medical conveniently available to all staff, with a huge increase clinicians, was agreed as the Despite the introduction of the in usage of the Dementia best way for doctors to screen Dementia Care Bundle and a Assessment tool, it has patients for dementia and ensure mechanism to audit, the Trust been identified that further that a proper assessment and was unable to meet the 90% education is required to raise appropriate referral took place. national target in 2012/13. Further awareness of the importance in improvements were made during completing the assessments. The Initial Dementia Assessment quarter 4 of 2013/14 through the

Table 22: Monthly Trust-wide performance – Dementia Screening Nov March June September December April Target 90% 2012 2013 2013 2013 2013 2014 Screening Question 29% 73% 52% 57% 70% 59% Assessment 39% 75% 61% 52% 71% 59% Referral 0% 0% 0% 20% 0% 54%

Data source: Internal data system and data submitted to the Department of Health. This data is governed by standard national definitions. Please note: data has not been signed off for the April 2014 data or submitted to the Department of Heath

Page Annual Report and Accounts 2013/14 177 The Blackpool Teaching Hospitals Medical Care Indicators Used to Reports are circulated to identify NHS Foundation Trust has taken the Assess and Measure Standards the following: following actions to improve this of Clinical Care and Patient percentage and so the quality of its Experience • Overall Trust Results services, by the following actions: The framework for the medical • Divisional Results care indicators was designed • Ward Level results • A daily alert email is sent to to support medical staff to • Consultant level results Ward Managers and Ward understand how they deliver Clerks that alerts them to specific aspects of their care. Between March 2012 and March patients that need to have their As with the nursing care 2014 the three month average assessment completed within indicators, our overall aim when number of consultants who 24 hours in order to meet the introducing these performance achieved 85% compliance or 72 hour criteria. measures is to reduce harm better increased from 24 (Mar • A weekly performance report is and improve patient outcomes 12 to May 12) to 55 (Jan 14 to now available that breaks down and experience. The metrics are Mar 14) and the three month ward compliance and identifies visible and therefore by using average number of consultants which consultants were in this system we can ensure that who achieved 95% compliance or charge at the time. accountability is firmly placed on better increased from 6 (Mar 12 to • Practice Development Sisters the medical teams providing the May 12) to 16 (Jan 14 to Mar 14) offer additional training on bedside care. dementia for clinical staff In April 2013 new criteria were that will include content on The results are obtained from a added to the audit which led how to complete the bundle monthly spot prevalence audit, to the average consultant score particularly the Dementia and the Indicators are based on falling from 87% to 68% and no Assessment. questions relating to medical consultants achieving a score • Since December 2013, clinical documentation, antibiotic for that month above 85%. By audit assistants have collected prescribing, DNARCPR, Consultant September 2013 the scores had data and provided real time review and care planning, VTE risk recovered to the levels seen just feedback to clinicians to identify assessment and mortality prior to the introduction of the areas where improvements new criteria. can be made to patient care relating to dementia screening and care planning

Page 178 Blackpool Teaching Hospitals NHS Foundation Trust These indicators are shown in Graph 4 and Graph 5. The overall Medical Assessment Trend is shown in Graph 6.

Graph 4: Medical Care Indicators

Graph 5: Medical Care Indicators

Graph 6: Acute Nursing Care Indicator Score

Page Annual Report and Accounts 2013/14 179 Nursing Care Indicators Used To are made visible in the ward We have been observing nursing Assess and Measure Standards environment and therefore by care using the Nursing Care of Clinical Care and Patient using this system we can ensure Indicators for the past five years. Experience that accountability is firmly placed The process involves a monthly The Nursing Care Indicators are on the nurses providing bedside review of documentation, ward used as a measure of the quality care. We have learned from this environments and the nursing of nursing care that is provided process and as a result have care delivered in each ward. The to patients during their stay made significant reductions in Associate Directors of Nursing in hospital. The framework for patient harms. Compliance with closely analyse each area for the nursing care indicators is nursing care indicators such as trends and non-compliance designed to support nurses in recording of observations and and, where required, instigate understanding how they can completion of risk assessments improvement plans that reflect deliver the most effective patient associated with the development any changes in practice that may care, in identifying what elements of pressure ulcers have ensured be required. The Trust recognises of nursing practice work well, that our frontline nurses can see that it has set high standards to be and in assessing where further the efforts of their work and make achieved, with a target of 95% for improvements are needed. Our the link between the effective all indicators. overall aim when introducing assessment and treatment of these measures is to reduce harm patients and improved outcomes. In the development of the and to improve patient outcomes By improving the monitoring of Nursing Care Indicators, key and experiences. vital signs we have reduced harms themes for measurement were from deterioration and failure identified from complaints, By benchmarking our nursing to rescue rates. By including the the Patients’ Survey, the Trust care across the Trust, we can care of the dying indicators we documentation audit, the increase the standard of nursing have improved our referral times benchmarks held within the care that we provide, so that best to palliative care services and the essence of care benchmarking practice is shared across all wards way that our staff interacts with tool, and assessments against and departments. The measures relatives at this difficult time. Trust nursing practice standards.

Page 180 Blackpool Teaching Hospitals NHS Foundation Trust Measurement of the Nursing Care o Pain Management 2013/14. The variation in scores Indicators is an evolving process o Falls Assessment seen is the type expected in a and is subject to annual internal o Tissue Viability normal process. The trend clearly review to ensure the indicators o Nutritional Assessment shows an overall improvement reflect current best practice and o Medication Assessment over the year. they are expanded into non ward o Infection Control based areas. In 2013 the criteria o Privacy & Dignity In April 2013, Nursing Care for all the indicators was reviewed o Care of the Dying Indicators were introduced into and amended to reflect changing o Continence Care the community setting. Five best practice. An additional o Management of patient indicators are being measured: indicator, ‘Management of Patient property o Nutritional Assessment property’ was also added. o Pain Management Graph 7 shows the overall Trust o Falls Assessment The following themes are performance, expressed as o Tissue Viability measured monthly: an average percentage of all o Care of the Dying Patient o Patient Observations 11 nursing care indicators, for

Graph 7: Adult and Long Term Conditions Nursing Care Indicator

Data source: Ward-based prevalence audit of clinical records. This data is governed by standard national definitions

Improving outcomes from ii) Varicose veins surgery programme organised by the planned procedures iii) Hip replacement surgery Department of Health. Initially • Patient Reported Outcome iv) Knee replacement surgery covering four clinical procedures, Measures (PROMS) PROMs calculate the health gain Patient Reported Outcome after surgical treatment using pre Improve the scores for the Measures (PROMs) measure and post operative surveys. The following elective procedure quality from the patient Trust Participation rates are as i) Groin hernia surgery perspective, it is a national shown in Table 23.

Table 23: Participation Rates Date Participation rate (full year) 2011/2012 75.7% 2012/2013 73.7% 2013/2014 76.5%

The Blackpool Teaching Hospitals between Blackpool Teaching 2013) is shown in Table 24. The NHS Foundation Trust considers Hospitals Provisional PROMs Data data shows an improvement that this data is as described 2011 -12 (April 2011 - March 2012) against the national scores, the for the following reasons: The and Provisional PROMs Data positive scores are highlighted in comparison data for PROMS 2012-2013 (April 2012 - March green but reviewing the negative

Page Annual Report and Accounts 2013/14 181 scores, the Trust has improved appear to have slightly decreased, 2012 data all scores have seen an on previous data. In regard to but in reviewing the scores increase in value. varicose vein PROMS the Trust comparing full year 2011/12 data scores against national scores to part year April to December

Table 24: Provisional PROMs Data Comparison between Blackpool Teaching Hospitals NHS Foundation Trust Provisional PROMs Data 2011 -12 (April 2011 - March 2012) and Provisional PROMs Data 2012 - 2013 ( April 2012 - March 2013) Comparison between Blackpool Teaching Hospitals NHS Foundation Trust Provisional PROMs Data 2011 -12 (April 2011 - March 2012) and Provisional PROMs Data 2012 - 2013 ( April 2012 - March 2013) Measure EQ-5D EQ-5D Condition Condition Percentage Improving EQ-VAS EQ-VAS Index Index Variance Variance Specific Specific Variance 2011-12 2012-13 2011-12 2012-13 2011-12 2012-13 Groin Hernia 48.8% 44.8% -4.0% 41.5% 39.0% -2.5% N/A N/A N/A Hip Replacement 88.8% 86.0% -2.8% 61.3% 65.4% 4.1% 96.8% 95.50% -1.3% Knee Replacement 80.1% 79.6% -0.5% 60.3% 58.2% -2.1% 95.3% 89.40% -5.9% Varicose Vein 54.9% 50.0% -4.9% 49.0% 38.9% -10.1% 80.4% 88.20% 7.8%

Comparison between Blackpool Teaching Hospitals NHS Foundation Trust Provisional PROMs Data 2011 -12 (April 2011 - March 2012) and Provisional PROMs Data 2012 - 2013 ( April 2012 - March 2013) Measure Percentage Getting EQ-5D EQ-5D Condition Condition EQ-VAS EQ-VAS Worse Index Index Variance Variance Specific Specific Variance 2011-12 2012-13 2011-12 2012-13 2011-12 2012-13 Groin Hernia 14.0% 19.8% 5.8% 35.8% 42.6% 6.8% N/A N/A N/A Hip Replacement 7.0% 2.8% -4.2% 28.5% 22.6% -5.9% 2.6% 4.50% 1.9% Knee Replacement 6.6% 10.8% 4.2% 30.5% 27.8% -2.7% 3.7% 9.00% 5.3% Varicose Vein 14.4% 11.6% -2.8% 40.0% 47.8% 7.8% 19.6% 11.80% -7.8%

Data source: Health and Social Care Information Centre (HSCIC). This data is governed by standard national definitions

The Blackpool Teaching Hospitals days of Discharge the following actions to improve NHS Foundation Trust intends The Trust has been working with this percentage and so the quality to take the following actions to its health economy partners of its services: improve this percentage, and so to implement strategies to the quality of its services, by the reduce readmissions. Overall the • A clinically led review of following actions: percentage 28 day readmissions readmissions to identify/ in 2013/14 was below peer implement actions required We continue to work with average as shown in Table 25. to reduce the number of CAPITA our new survey provider avoidable admissions to get accurate detail relating The Blackpool Teaching Hospitals • Joint work with Clinical to participation rates and also NHS Foundation Trust considers Commissioning Groups to patient level detail at consultant that this data is as described identify and implement health level, once this work is complete for the following reason in that economy wide readmission the Scheduled Care Division will it shows that the work being avoidance schemes, including be asked to be greater involved undertaken across the health single point of access services in developing improvement economy has started to impact on to ensure patients access actions relating to direct surgeon the percentage of readmissions the most appropriate care, feedback. seen at the Trust as shown in improvements to discharge Graph 8. and on-going care planning. Reduce Emergency Readmissions to Hospital (for The Blackpool Teaching Hospitals the same condition) within 28 NHS Foundation Trust has taken

Page 182 Blackpool Teaching Hospitals NHS Foundation Trust Table 25: 28 Day Readmissions Trust Peer Trust Peer Trust Peer Indicator 2011/12 2011/12 2012/13 2012/13 2013/14 2013/14 All Admissions 6.9% 6.9% 6.4% 6.8% 6.8% 6.6% Non-elective 11.5% 10.8% 10.8% 10.7% 11.2% 10.4% Elective 2.9% 3.2% 3.3% 3.1% 3.2% 3.1%

Data source: CHKS Quality and Patient Safety Tool. This data is not governed by standard national definitions

NB: No exclusions are made from the CHKS data and therefore includes (day cases, obstetrics, cancer patients, etc). The Trust is unable to replicate the national methodology in full. The Trust has reviewed its raw data (not standardised as in national data) and non elective readmissions for the Trust equates to 16.77% for 2013/14.

Graph 8: 28 Day Readmissions

3.4.2 Priority 2: Quality of Institute, an independent Trust considers patients feedback the Patient Experience organisation. Between the period to be pivotal in ensuring our October 2013 and January 2014 services continue to develop The Trust will only be able to a questionnaire was sent to 850 in order for the Trust to meet improve and maintain high recent inpatients. 369 patients individual patient needs. quality services if we listen to the responded. Table 26 shows people who use our services and a comparison of data for five their carers. They are the experts indicators from 2011 to 2014 and in the care we provide and the progress remains consistent. Trust continually tries to learn from the experience of individuals These indicators were chosen to to ensure we get it right first time, be monitored since they relate every time. to key issues that are of great importance to the Board and/ Improve Hospitals’ or have been identified by our Responsiveness to Inpatients’ patients’ as being the most Personal Needs by Improving important to them. the CQC National Inpatient Survey Results in the Following The Blackpool Teaching Hospitals Areas: - NHS Foundation Trust considers The CQC National Inpatient that this data is as described for Survey is undertaken on an the following reasons: in that the annual basis by the Picker

Page Annual Report and Accounts 2013/14 183 Table 26: Care Quality Commission National Inpatient Survey Comparison to Indicator 2011/12 Results 2012/13 Results 2013/14 Results last year’s results Were you involved as much as 87.3% said yes 82.6% said yes 84.8% said yes you wanted to be in decisions often or yes often or yes # often or yes about your care and treatment? sometimes sometimes sometimes Did you find someone on the 52.2% said yes 75.4% said yes 76.9% said yes hospital staff to talk to about definitely or yes definitely or yes # often or yes your worries and fears? to some extent to some extent sometimes Were you given enough privacy 89.2% were 91.3% were 89.9% were when discussing your condition always or always or $ always or or treatment? sometimes sometimes sometimes Did a member of staff tell you 55.7% said yes 51.5% said yes 57.4% said yes about medication side effects completely or completely or completely or # to watch for when you went yes to some yes to some yes to some home? extent extent extent Did hospital staff tell you who to contact if you were worried about your condition 67.3% said yes 66.7% said yes # 73.7% said yes or treatment after you left hospital? Data source: Patient Perception Survey carried out by Picker Institute Europe an independent organisation. This data is governed by standard national definitions. The Blackpool Teaching Hospitals NHS Foundation Trust intends to take the following actions to improve this score, and so the quality of its services, by enhancing the standard of communication and information given to our patients.

The Trust is in the process of improving the score in relation to the question “Were you given enough privacy when discussing your condition or treatment?”. The Patient Experience Team are conducting regular spot audits to identify areas where patients discharge. The pharmacy team will be presented to the Board of feel they are not given enough are developing information to Directors on a monthly basis to privacy, informing divisional leads enable patients’ to be aware of the monitor improvements made. of their findings so action can be use of community pharmacists in taken in real time. medication reviews or any issues Improve Staff Survey Results in relating to medications. the Following Area The clinical divisions are also looking at what actions are Improvements to the indicators • Percentage of Staff Who needed to ensure information will be monitored on a monthly Would Recommend Their relating to medication side effects basis through the Nursing Care Friends or Family Needing is discussed with the patients on Indicators and this information Care

Page 184 Blackpool Teaching Hospitals NHS Foundation Trust The National Staff Survey is or have been identified by our a training programme to help undertaken on an annual patients as of most importance to staff to be at their best more of basis by the Picker Institute, them. the time when delivering care an independent organisation. to patients Between the period October 2012 The Blackpool Teaching Hospitals • The Trust is highlighting the and January 2013 a questionnaire NHS Foundation Trust considers friends and family test data and was sent to 1996 staff. 938 staff that this data is as described for is investing in a team to work responded. Table 27 shows the the following reasons: with this in real time result for the indicator. • Additional monies have been • We continue to focus energy identified to support increased This indicator was chosen to and efforts on improvements to nurse recruitment to enhance be monitored since this relates patient outcomes, quality care patient care but this is still to a key issue that is of great and patient experience ongoing importance to the Board and/ • The Trust is part way through

Table 27: National Staff Survey Results Comparison to last years results Indicator 2012 Result 2013 Result Percentage of staff who would 89% of staff would be happy to 86% of staff would be happy to recommend their friends or recommend their friends or family recommend their friends or family family needing care needing care needing care Data source: Staff Perception Survey carried out by Picker Institute Europe, an independent organisation. This data is governed by standard national definitions. The Blackpool Teaching Hospitals training to clinical staff and provide a consistent level of care NHS Foundation Trust has taken complete the actions as described to all our patients and service the following actions to improve above. In addition the Trust has users and their families. We this percentage, and so the quality updated its Strategic Aims and continue to invest in development of its services, by continuing to is consulting on new values and of staff at the front line and to roll out the patient experience behaviours to ensure we each review performance. The Trust has

Page Annual Report and Accounts 2013/14 185 updated its Whistle blowing Policy methods of capturing, responding and reporting on the number which is currently being consulted and understanding the patients of responses along with local on in order that it can be launched experience data. reports. by the Chief Executive. The Trust will also implement a range of Why the test is important for our The Friends and Family Test is recommendations from the patients? simple and centred around one Francis, Keogh and CQC reports as Patients will be able to use this question: it deems necessary. information to make decisions about their care and also to • How likely are you to Improvements to the indicator challenge us in improving services recommend our (ward name/ will be monitored on an ongoing as well as celebrating areas of A&E Department) to friends monthly basis through the good care. and family if they needed Patient Experience Revolution similar care or treatment? engagement questionnaire and Why the test is important for this information will be presented our staff? Respondents can respond by to the Board of Directors on Sharing this data with staff will ticking: a quarterly basis to monitor increase the transparency of our improvements made. Trust and empower all levels • Extremely likely of staff to target and carry out • Likely Further findings from the Staff improvements. Along with • Neither likely or unlikely Survey are reported separately tracking the test results staff • Unlikely in the Annual Report. And can will also be able to see where • Extremely unlikely be accessed via the following targeted improvements have • Don’t know link http://www.bfwh.nhs. been effective and sustained. Staff uk/departments/comms/ being engaged in this process We also asked a small number publications.asp#ann will be key to its success and data of additional questions find out collection. what influenced their decision Report on Friends and Family and gain deeper understanding Test Expected requirements for the of thier patient experience. The Friends and Family Test (FFT) Test has been implemented within We use the test to survey patients The Trust is marked according the inpatient areas and accident after they have experienced to the net promoter score based and emergency dept from 1st an episode of care, therefore on the Department of Health April 2013 and across Maternity participants are those adult scoring methodology. Scores are Services from October 2013. patients at the point of discharge calculated based on the following from acute inpatient care (with calculation: The test will provide us with a an overnight stay) and all patients simple, easily understandable who have attended A&E and from • Proportion of respondents who headline matric which combined October 2013 this also included would be extremely likely to with other information, maternity services including ante recommend minus proportion patient feedback and follow natal, delivery, home birth and of respondents who would up questions can support the post natal care. not recommend (response trust in pinpointing areas for categories neither likely nor improvement, and will inform The aim of the test is to promote unlikely, unlikely and extremely and empower the ward, and the a responsive, patient led NHS. unlikely) board, to tackle areas of weak Ideally all patients in the target performance and enhance areas group should be given the The net promoter score is marked of excellent practice. opportunity to take part, so the from plus 100 to minus 100. The Trust has been collecting data Trust scores and response rates The test will be designed to be a every day, not just on selected are detailed in Table 28 overleaf: single matric and we will still need dates. We survey as many patients to supplement this with other as possible as well as monitoring

Page 186 Blackpool Teaching Hospitals NHS Foundation Trust Table 28: Friends and Family Test Emergency Trust Overall Inpatient Maternity Month Responses Department score Response Rate Response rates Response Rate April 2013 72 453 19.7% 0.1% Not surveyed May 2013 74 724 25.7% 1.5% Not surveyed June 2013 76 877 32% 2.5% Not surveyed July 2013 72 1021 37.7% 7.4% Not surveyed August 2013 73 938 29.4% 4.1% Not surveyed September 2013 76 814 25.60% 3.10% Not surveyed October 2013 74 1128 30.70% 6.50% 9.7% November 2013 70 1521 41.2% 13.4% 8.6% December 2013 73 1816 44% 17.7% 9.8% January 2014 66 2005 43.4% 21.7% 7.9% February 2014 71 1611 41.8% 15.4% 12% March 2014 72 1636 37% 14.1% 19.45% Data obtained from Health and Social Care Information Centre

Improving the Experience of • Ensure that Patients Who Based on the national Route Care for People at the End of Are Known to be at the End to Success ‘How to’ guide on Their Lives of Their Lives are able to Transforming end of life care in • Seeking Patients and Carers Spend Their Last Days in their acute hospitals, a ward based Views to Improve End of Life Preferred Place Across All training programme has been Care Services developed and 3 senior nurses The Trust Cancer and End of The Trust End of Life Care Team appointed to the Transform Life Teams are working closely continues to promote the tools Training Team. The aim of the with Trinity Hospice and available to enable patients to Transform Project is to increase representatives from community have choices in where they are the quality of end of life care in the groups to promote quality in end cared for at end of life. A local Trust for patients and their carers of life care. A conference was held family have worked with the and promote earlier identification on Wednesday 15th May 2013 team to share their experience of end of life with the opportunity to promote ‘Dying Matters’ week of choice and preferences for for advance care planning and to raise awareness of the care care at end of life. Their daughter discussions, realistic treatment that is available across the health participated in a poster campaign, choices and reduced emergency economy. The targeted audience which received television and admissions at end of life. It included community leaders from radio coverage. The aim of will enhance communication, all agencies to build a network the campaign is to encourage documentation, training and that can support, inform and patients, carers and staff to have patient choice to improve the inspire others. discussions about their wishes overall journey and experience. and choices. These posters were The Cancer Network and launched throughout the Trust Patient Led Assessment of the Macmillan Cancer Support have in May 2013 and were again Care Environment (PLACE) supported a project to provide supported with media coverage. • To Improve PLACE Survey comprehensive bereavement The Trust continues to support Results/Standards information packs for all bereaved same day or next day rapid Our aim is to deliver the best families across Lancashire and discharges for those patients environment for our patients South Cumbria. These packs who wish to be cared for outside to ensure that the patient will be offered at the time of hospital in their last few weeks of experience exceeds the standards registration of death. life. set by the National Patient Safety Agency. Providing a clean and

Page Annual Report and Accounts 2013/14 187 safe environment for our patients areas which are audited are: publicised nationally on an annual is extremely important to the basis. In 2013/14, PLACE audits Trust. We monitor this through the • Cleanliness were extremely encouraging Patient Led Assessments of the • Specific bathrooms/toilet across all hospital sites resulting Care Environment (PLACE) annual cleanliness in excellent standards achieved. audits across all hospital sites. • Catering Services The results in Graph 9 and Graph • Environment 10 demonstrate the commitment The teams comprise of a • Infection Prevention and dedication of all staff within multidisciplinary team, including • Privacy and Dignity the Trust who strive to ensure that a patient’s representative and • Access all external areas the patient experience is met or an external PLACE assessor who exceeded during their stay in our conduct annual audits regarding The audit follows guidelines set hospitals. the quality of standards we by the National Patient Safety provide to our patients. The key Agency and the results are

Graph 9: Patient Led Assessment of the Care Environment (PLACE)

Graph 10: Patient Led Assessment of the Care Environment (PLACE)

Key: Blue data indicates Trust scores, green data indicates National Average.

Data source: Local data from the Patient – Led Assessment Care Environment survey. This data is governed by standard national definitions set by the Health and Social Care Information Centre

Page 188 Blackpool Teaching Hospitals NHS Foundation Trust 3.4.3 Priority 3: Patient receive a Venous Thrombo- ongoing improvements Safety Embolism Risk Assessment on in compliance with trust their admission to the hospital, processes and consequently We know that our service must and that the most suitable improvements in patient care not only be of high quality and prophylaxis is instituted. The with regards VTE. The National effective, but that they must Trust has embedded and Institute for Health and Clinical always be safe. We have a range improved the implementation Excellence Venous Thrombo- of processes and procedures to of VTE guidelines within the Embolism guideline (CG 92) ensure that safety always remains Trust and has demonstrated has been incorporated into a top priority. this by achieving above the easy to follow risk assessment new 95% compliance indicator. forms across various specialties Achieve 95% Harm Free Care to We have been able to sustain and is an integral part of Our Patients by 2016 through previous improvement as clerking documents. This will the following strands of work shown by latest figures from not only ensure that VTE risk March 2013 to 31st March 2014 assessments are undertaken Improve the Percentage of as shown in graph 11. and embedded permanently in Admitted Patients Risk Assessed the admission pathway but also for Venous Thrombo-Embolism The Blackpool Teaching Hospitals facilitates its documentation (VTE) - NHS Foundation Trust has taken for subsequent analysis. the following actions to improve The Thrombosis Committee The Blackpool Teaching Hospitals this 95% percentage compliance monitors performance of NHS Foundation Trust considers indicator and so the quality of individual clinical areas. that this data is as described for its services, by undertaking the • Since December 2013, the the following reasons: following actions: clinical audit department have collected real time VTE data • The Trust has aimed to • A senior clinician and a senior to give feedback to individual implement current best nurse have been identified to areas and address poor practice guidelines in order to provide leadership to facilitate performance pro- actively. ensure that all adult inpatients

Graph 11: Trustwide Venous Thrombo-Embolism Risk Assessment

Data source: UNIFY national reporting. This data is governed by standard national definitions.

Page Annual Report and Accounts 2013/14 189 • Compare the VTE national average for the above percentages The average proportion of acute patients reported as having any type of VTE form the national Safety Thermometer (February 2013 to February 2014 inclusive) is 2.89%

• Achieve a 10% reduction on the previous year in all VTE In 2012/13, based on Safety Thermometer data, 563 out of 9030 hospital in-patients were reported as having a VTE. This represents a proportion institution. Symptomatic patients There have been 26 cases of of 6.23%. In 2013/14, 285 out are those whose stools contain Clostridium Difficile Infection of 9054 hospital in-patients both the organism and the (CDI) attributed to the Acute Trust were reported as having a VTE. toxins which it produces, and between April 2013 and March This represents a proportion have diarrhoea. Those patients 2014, in comparison to 28 for the of 3.15%. The reduction in the who are most at risk of acquiring period April 2012 to March 2013, proportion of patients reported Clostridium Difficile diarrhoea are demonstrating a reduction of 7%. as having a VTE from last year the elderly, those on antibiotic The Trust was required to achieve to this year is therefore 49.51%. therapy and surgical patients. a trajectory of less than 29 cases. The average proportion of Antibiotic administration is the Clostridium Difficile rates for April acute patients reported as most important risk factor for 2013-March 2014 as shown in having any type of VTE form the Clostridium Difficile diarrhoea, Graph 12. Information on how national Safety Thermometer which is also known as Antibiotic the criterion for this indicator has (February 2013 to February Associated Diarrhoea. The been calculated is detailed in the 2014 inclusive) is 2.89% clinical features of Clostridium Glossary of Terms. Difficile infection can range from Reduce the Infection Rate of diarrhoea alone, to diarrhoea The Blackpool Teaching Hospitals Clostridium Difficile andM RSA accompanied by abdominal NHS Foundation Trust has taken Bacteraemia pain and pyrexia to Pseudo the following actions to decrease Membranous Colitis (PMC) with the levels of Clostridium Difficle Reduce the rate of Clostridium toxic megacolon, electrolyte and improve the quality of its DifficileI nfections per 100,000 imbalance and perforation. services: bed days amongst patients aged two years and over The Blackpool Teaching Hospitals • To mitigate the risk of breaching apportioned to the Trust, and NHS Foundation Trust considers the Trust’s infection prevention compare the national average that this data is as described for target, we continued to deliver for the above site the following reasons: a wide ranging programme of work which emphasises to all Clostridium Difficile is an • Following the significant staff that remaining compliant organism which may be present reductions in Clostridium with the requirements of the in approximately 2% of normal Difficile Infection (91.95% for Code of Practice for Healthcare adults. This percentage rises the last six years for the Acute Associated Infections is with age and the elderly have Trust from 2007/2008) the everyone’s responsibility. colonisation rates of 10-20%, Trust has continued to embed Ongoing actions included: depending on recent antibiotic measures to reduce levels i. Effective Antibiotic exposure and time spent in an further within the organisation. Stewardship has had a

Page 190 Blackpool Teaching Hospitals NHS Foundation Trust significant impact on the iv. Ensuring cleaniliness of policies and procedures rates of C.difficile and on patient environment by continue to be trust antibiotic compliance ATP bioluminescence implemented, including rates. This is provided by testing. in particular hand regular ward rounds by the v. Proactive management of hygiene, environmental consultant microbiologist. GDH positive, who are likely and decontamination ii. Introduction of probiotics colonised with C.difficile by standards; and drinks for patients the infection prevention viii. Training on all aspects considered to be at team. of infection prevention high risk for C.difficile by vi. Continuing to raise continues to be delivered; consultant microbiologists awareness and leading by ix. Outcomes were assessed iii. Decontamination of example; by reviewing progress patient environment and vii. Ongoing audits of with the C.difficile target, equipment as and when compliance to ensure and auditing compliance possible by using hydrogen all infection prevention with national standards/ peroxide fogging system. measures and control regulations

Graph 12: Clostridium difficile Infection Rates

Data source: Department of Health M.E.S.S. This data is governed by standard national definitions

• Reduce the Incidence of last few years and embed Infection 0 cases for the reporting period. MRSA Bacteraemia Infection Prevention principles across the The Trust has reported 1 case for Rates in the Trust as Reflected organisation, ensuring that the this year, which is above trajectory by National Targets risk of acquiring an infection for and against Monitor’s Compliance patients is further reduced as Framework target, as detailed in Following the significant shown in Graph 9 and 10. Graph 13 Information on how reductions in Methicillin Resistant the criterion for this indicator has Staphylococcus Aureus (MRSA) The delivery of the MRSA been calculated is detailed in the Bacteraemia by 96.42% for the Bacteraemia target remains a Glossary of Terms. Acute Trust when compared to clinical risk, in relation to Monitor’s 2007/08, the Trust has continued to Compliance Framework which make tremendous progress in the identifies an MRSA trajectory of

Page Annual Report and Accounts 2013/14 191 Graph 13: MRSA Bacteraemias Rate and as such were reported to the National Patient Safety Agency. Of these 10957 patient safety incidents, 2,821 or 25.7% resulted in harm to the patient and in comparison to the number of attendances at the Trust (556,994) there is a patient safety incident reported for every 1 in 51 patients.

However only one patient safety incident resulting in harm was reported for every 205 patients during 2013/14.

Since 2011/2012 there has been Data source: Health and Social Care Information Centre – NHS Outcomes Framework. This an increase in the number of data is governed by standard national definitions patient safety incidents that have resulted in severe patient To Monitor the Rate of Patient • There has been a steady harm (Graph 15 and Table 29). Safety Incidents the Trust have increase in the number of This continues to be monitored reported per 1000 admissions untoward incidents reported through analysis of trends and and the proportion of Patient over the past 4 financial themes, lessons being learned Safety Incidents the Trust has years (Graph 14). Patient and actions being taken at lower reported that resulted in Severe Safety Incidents account for level incidents. The Trust has Harm or Death approximately 76% of all a policy of reporting incidents An analysis of patient safety reported untoward incidents. In within 24 hours of occurrence, incidents is undertaken by the year 2013/2014 there have 71% of severe harm or death the Trust on a monthly basis. been 14414 untoward incidents incidents were reported within Incidents are coded based on reported and of these 10957 24 hours of occurrence. In the potential harm to the patient were patient safety incidents order to address this shortfall all and on the actual harm to the patient. Incidents coded as severe Graph 14: Rolling Comparison of Reported Incidents involve any patient safety incident that appears to have resulted in permanent harm to one or more persons receiving care in the Trust. Incidents resulting in death relate to those incidents where the incident directly resulted in the death of one or more persons receiving care in the Trust. Further information can be found in the Glossary of Terms

The Blackpool Teaching Hospitals NHS Foundation Trust considers that this data is as described for the following reasons:

Data source: Hospital Incident Reporting System (HIRS) provided by the Safeguard Risk Management System. This data is not governed by standard national definitions.

Page 192 Blackpool Teaching Hospitals NHS Foundation Trust induction, clinical mandatory and incident has occurred action and procedures in relation to specific incident reporting and needs to be taken promptly to holding staff accountable for investigation training includes the prevent a reoccurrence especially actions or omissions in care which importance of contemporaneous if the incident has resulted in may impact on patient safety. reporting. The message being severe harm or death. The Trust communicated is that if an is currently reviewing its policies

Graph 15: Patient Safety Reported Incidents

Data source: Hospital Incident Reporting System (HIRS) provided by the Safeguard Risk Management System. This data is not governed by standard national definitions.

Table 29: Patient Safety Incidents That Resulted In Severe Patient Harm/Death Financial Year Severe/Major Harm Disaster/Death Total 2004-05 22 5 27 2005-06 6 3 9 2006-07 10 2 12 2007-08 8 1 9 2008-09 7 2 9 2009-10 8 4 12 2010-11 24 0 24 2011-12 12 0 12 2012-13 13 4 17 2013-14 28 10 38

Data source: Hospital Incident Reporting System (HIRS) provided by the Safeguard Information System. This data is not governed by standard national definitions

Page Annual Report and Accounts 2013/14 193 In 2013/14 there have been 0 incidents where following a serious untoward investigation it has become evident that the cause of death was as a direct consequence of the incident.

There was one ‘Never Event’ incident reported at the end of the 2013/14 year which is being investigated under the Serious Untoward Incident investigation process.

All level 4 and 5 patient safety incidents are investigated within the Serious Untoward Incident (SUI) process. Following completion of the investigation report the recommendations and action plan are monitored. Assurance that actions have been completed and practice changed is gained from evidence collection, audit findings and further monitoring of reported incidents. A requirement for a risk assessment is considered within the SUI process, in relation to the contributory factors which led to the SUI, which will be monitored and reviewed by the Divisions and the Board.

The Blackpool Teaching Hospitals NHS Foundation Trust has taken the following actions to help learned are also discussed where staff who were involved reduce the rate of 25 percent at the bi-monthly Learning in an incident have the of patient safety incidents from Incidents and Risks opportunity to re-enact the resulting in harm and to improve Committee. All completed scenario, reflect on the events the quality of its services, by SUI reports are published on and evaluate what went wrong undertaking the following actions: the Trust’s Risk Management and why. Feedback from staff site on the intranet so that any has been extremely positive • It is essential that lessons member of staff can access especially with those staff are learned from SUI’s in and use it as a learning tool. who have been involved in an order to mitigate the risk of Links with the Learning and incident where the patient was reoccurrence, these lessons Development Team have been severely harmed or died. are fedback to staff within the adopted so that training and • Engagement of the patient Divisions through training, development can be tailored and their relatives/carers is ward meetings and the around real life incidents very important to the Trust Trust wide monthly “lessons and patient experiences. The not only in developing an learned” newsletter. Lessons Trust’s simulation centre has open and honest culture, but undertaken several sessions as a healing tool. Patients and

Page 194 Blackpool Teaching Hospitals NHS Foundation Trust relatives are informed when a • Introduction of movement is taking place in unscheduled serious incident has occurred sensors in all the clinical care. and that an investigation is divisions, both on the acute • Falls exercise programmes to be undertaken. In some wards and in the community have been introduced within cases they are asked for their hospitals, for patients who are all localities of the community version of events and this identified to be at high risk of setting has been reflected within the falling. The sensors are discreet • The current falls prevention report. Following completion and can be placed either under policy is under review to of the investigation report the mattress of the bed, or incorporate community they are given the opportunity on the chair if the patient is requirements and make it more to discuss the findings and sitting out of their bed. The robust any actions taken to prevent sensors alert the ward nurses • A falls RCA template was further occurrence. A section via a pager system if a patient being introduced in the entitled Duty of Candour attempts to get out of bed or New Year 2014, to support has been added to the SUI move from the chair unaided. effective analysis of incidents report template to ensure The sensors have already and dissemination of lessons that communication with the helped prevent potential injury learned. patient/family/carer is captured to patients as the nursing staff • Monthly falls data is now made and monitored. have been alerted swiftly and available at trust, divisional and assistance given. ward level, for interrogation and Reduce the Incidence of • Low beds have been identification of trends/issues Inpatient Falls by 30% at low, introduced across the Trust to in order to implement quality minor and Serious Impact levels prevent falls for those patients improvements where required. – Resulting in Patient Harm at higher risk. Patient falls are one of the most • A footwear trial has been In 2012/13 there were 2,226 falls common patient safety incidents completed and we have with harm compared with 1,934 reported. The majority of slips, changed the products used in 2013/14 as demonstrated trips and falls result in low or across the Trust in Graph 16. This represents a no harm to patients physically. • We have developed a slipper reduction of 13.12%. However, However, any slip, trip or fall can exchange scheme in the care of the Trust recognises that there has result in the patient losing their the older adult wards been improved reporting of falls. confidence. There have been • Greater cross boundary significant improvements within working with colleagues Please note that the data for the all areas of the Trust in reducing working in the community. last two months of the year is the numbers of falls as shown in • The Trust Falls Steering Group unvalidated and all falls totals are Graph 18 and 19 below. There has been re-invigorated and liable to change. have been a number of initiatives is now multi-disciplinary and introduced during 2013/14 to includes voluntary agencies. 1,934 falls resulted in low or minor promote the reduction in falls • A falls prevention workbook harm being experienced by the resulting in harm. has been developed and rolled patient and there were 44 (2.3%) out across the organisation to patients who experienced a fall • There has been targeted improve education of staff. This that resulted in a moderate/serious support and training given is currently being reviewed harm. This is a 0.74% increase to wards within both the following feedback to simplify it on the number of patients who Scheduled and Unscheduled for staff. experienced serious harm or above Divisions to improve the staffs • Falls prevention leaflets have in 2012/13 (34), but only a 0.1% understanding in relation to been developed to improve increase on the 2011/12 figure of bone health and falls risks. This patient education. 36. Measures have been put into included education around the • Ward level standards have been place as outlined above to ensure falls risk assessment and the introduced in Scheduled Care. that the Trust will see a downward formulation of a care plan for • A trial of green wrist bands to trend for patient falls in 2014/15. As patients at risk of falling. identify patients at risk of fall seen in Graph 17.

Page Annual Report and Accounts 2013/14 195 Graph 16: Patient Slips, Trips and Falls The Trust maintains current and coherent medicines policies, protocols and guidance that aim to increase patient access to medicines and safety. The Trusts policies on medicines and medicine safety cover every step of the journey from the development of medicines to their use by the patient.

The provision of Medicines Management Mandatory training continues to re-inforce the safe management of medicines within the Trust for all professionals to reduce the risk of medication errors. Medication incidents / Data source: Hospital Incident Reporting System (HIRS) provided by the Safeguard Risk errors are reported through the Management System. This data is not governed by standard national definitions. Trust Ulysses system which is fed into the National Reporting and Learning System. Currently Graph 17: Patient Slips, Trips and Falls (Serious/Major medication errors reported by the Harm) Trust are identified in Graph 18.

Medication errors can occur anywhere within the care pathway including dispensing, preparing, administering, monitoring, storing or communication. The number of medication process errors are identified in Graph 18. The Medicines Management Team continue to ensure that the principles, safety and recommendations from all the National Patient Safety Agency Alerts are firmly embedded and maintained within all clinical areas. A robust and comprehensive audit process assures the Trust Data source: Hospital Incident Reporting System (HIRS) provided by the Safeguard Risk Management System. This data is not governed by standard national definitions. that standards are sustained on an annual basis.

Reduce the Incidence of Trust continues to engage both The Medicines Management Medication Errors by 30% staff and patients in the safe usage Committee meets bi-monthly. Resulting in Moderate or Severe of prescribed medicines within A report is supplied by the risk Harm all Specialities. Medicines are the department which details all Medicines and medicine safety most frequently and widely used medication errors, drug type, are an integral part of care NHS treatment and account for level of harm to the patient, provision within the Trust. The over 12% of NHS expenditure. cause group and area. A trend

Page 196 Blackpool Teaching Hospitals NHS Foundation Trust and theme analysis is completed result of staff being interrupted than 2012/13. The number of with the aim that target areas whilst completing drug rounds, all drug administration errors with can be highlighted and action nurses are now required to wear serious and above harms was plans devised to mitigate the ‘do not disturb’ tabards when 17 in 2012/13 and this fell to 10 risk. Several areas now have completing drug rounds. in 2013/14, a reduction of 41%, dedicated pharmacist cover, though the number of drug this has been found to reduce The September 2013 report administration errors with minor medication errors in these areas, published by the National or less serious harms increased by it is hoped that this service will Patient Safety Agency (NPSA) 81.6% over the same period. (It be extended over the coming is based on incidents which should be noted that the data for year. The Trust has introduced occurred between 1st October February and March are yet to be Specialist Nurse Practitioners who 2012 and 31st March 2013 and validated at the time of writing are able to prescribe a set group were reported to the National and may change). of medications; this has been Reporting and Learning System shown to reduce prescription (NRLS) by the 31st May 2013. The Trust is able to report an errors and waiting times for improvement in the number of discharge medication. Drug Medication incidents incidents reported by staff and a administration has been shown A total number of 10957 incidents reduction in the level of serious to be consistently the highest were reported by the Trust. 1304 patient harm. This emphasises cause group as demonstrated in were medication errors and this the improvement in safety and Graph 19, further analysis of the equates to 11.9% of all incidents. medication awareness within incidences indicated that many The total number of medication clinical areas. of these incidences were as a errors was 52% higher in 2013/14

Page Annual Report and Accounts 2013/14 197 Graph 18: Medication Errors priority indicator to enable the Trust to meet national healthcare directives and current local quality improvement priorities for 2013/14. To improve the quality of care provided, the Trust made a commitment to ensure that all patients who suffered a hospital acquired pressure ulcer stage 2, 3 or 4 would have a root cause analysis undertaken.

Through the implementation of a quality improvement initiative programme the Trust has demonstrated how pressure ulcers have been reduced and targets met due to the initiative being implemented over the last Data source: Hospital Incident Reporting System (HIRS) provided by the Safeguard Risk twelve months as shown in Graph Management System. This data is not governed by standard national definitions. 20.

Graph 19: Medication Errors The above strand of work is being monitored to enable the Trust to measure progress in reducing avoidable patient harms and to improve patient outcomes and experiences.

Work will continue to ensure that changes are embedded into practice and the improvements in performance are sustained. During 2013, the Acute site integrated with Community Health Services. Collaborative working between the staff has seen an improvement in the reporting of pressure ulcer incidents in the community setting and the implementation Data source: Hospital Incident Reporting System (HIRS) provided by the Safeguard Risk of improvement processes has Management System. This data is not governed by standard national definitions. commenced.

Reduce the Incidence of New pressure. They are sometimes The Trust is delighted that it Hospital Pressure Ulcers stage known as bedsores. They can be continues to see a significant and 2 by 30%, stage 3 by 40% and classified into four grades, with sustained year on year reduction stage 4 by 100%. one being the least severe and in the number of hospital A definition of pressure ulcers: four being the most severe. acquired pressure ulcers. Since Pressure ulcers are localised March 2009, hospital acquired injuries to the skin and/or The reduction of pressure ulcers pressure ulcers have reduced by underlying tissue as a result of has also been identified as a 84.34%. The last 12 months since

Page 198 Blackpool Teaching Hospitals NHS Foundation Trust April 2013 have seen a 32.89% slightly exceeded trajectory (45 9) and there were zero Stage 4 reduction in the number of reported against a trajectory hospital acquired pressure ulcers; hospital acquired pressure ulcers. of 42), the number of Stage 3 hence overall the Trust met the hospital acquired pressure ulcers overall target for its reduction in Although the number of Stage 2 was lower than trajectory (6 hospital acquired pressure ulcers. hospital acquired pressure ulcers reported against a trajectory of

Graph 20: Hospital Acquired Pressure Ulcers (HAPU) - Acute

Data source: Ward-based prevalence audit. This data is governed by standard national definitions.

Page Annual Report and Accounts 2013/14 199 Reduce stage 2, 3 and 4 ulcers by 10% across all Stages reduction of 26.67% in pressure Community Pressure Ulcers by of pressure ulcers. Although the ulcers acquired whilst the 10% number of Stage 4 pressure ulcers patient was under the care of the slightly exceeded trajectory (10 community services, hence overall Target - Reduce stage 2, 3 and 4 reported against a trajectory of the Trust met the overall target pressure ulcers acquired whilst 9), the number of Stage 3 ulcers for its reduction in new pressure the patient is under the care of the was much lower than trajectory ulcers in the community setting. community services by 10%. (14 reported against a trajectory of 31) and the number of Stage In addition, 93% of community In the Adult and Long Term 2 ulcers was below trajectory based staff completed Pressure Condition (ALTC) community (72 reported against a trajectory Ulcer Prevention training setting the aim was to reduce of 74); This means that since workbooks. the number of new pressure April 2013, the trust has seen a

Graph 21: Hospital Acquired Pressure Ulcers (HAPU) - Adult and Long Term Conditions

To Introduce the Think Glucose education programme and there pre-audits on how diabetes is Programme will be a link nurse in place on being managed on the wards Plans to take up the ‘Think each ward. This will improve staff and is ongoing with this. Both pre Glucose’ campaign is underway. knowledge on diabetes, reducing and post audits are undertaken It is a new project that due to be insulin errors and providing a to monitor the impact the project launched in April 2014, which better patient experience. has. Staff will then be educated will highlight the needs and on diabetes management over care for patients with diabetes. The project is due to be piloted a series of weeks and another The aim of the “Think Glucose” on Wards 11 and 18 over the next audit will be performed post project is to improve patient care month, and further information training to measure the level by promoting proactive care will be available on the intranet in of improvement that has been for patients who have diabetes due course; details of which are made. as a secondary diagnosis. The still being finalised. Last week, project will also introduce a new the “Think Glucose” Clinical Nurse referral system, as well as a rolling Specialist lead commenced the Page 200 Blackpool Teaching Hospitals NHS Foundation Trust The Quality Account was discussed with the Council of Governors which acts as a link between the Trust, its staff and the local community who have contributed to the development of the Quality Account.

3.6 How to Provide Feedback on the Quality Account

The Trust welcomes any comments you may have and asks you to help shape next year’s Quality Account by sharing your views and contacting the Chief Executive’s Department via:

Telephone: 01253 655520 Contact us on: www.bfwh.nhs.uk

3.4 Statements Account, while Local Healthwatch 3.7 Quality Account organisations and OSC’s have Availability from Local Clinical been offered the opportunity to Commissioning comment on a voluntary basis. If you require this Quality Account Following feedback, wherever in Braille, large print, audiotape, Groups (CCG’s), possible, the Trust has attempted CD or translation into a foreign Local Healthwatch to address comments to improve language, please request one of the Quality Account whilst at these versions by telephoning Organisations and the same time adhering to 01253 655632. Overview and Monitor’s Foundation Trusts Annual Reporting Manual for Additional copies of the Quality Scrutiny Committees the production of the Quality Account can also be downloaded (OSCs) Account and additional reporting from the Trust website: requirements set by Monitor. www.bfwhospitals.nhs.uk The statements supplied by the above stakeholders in relation to their comments on the 3.5 Quality Account information contained within the 3.8 Our Website Quality Account can be found in Production The Trust’s website gives more Annex A. Additional stakeholder information about the Trust and feedback from Governors has We are very grateful to all the quality of our services. You can also been incorporated into contributors who have had also sign up as a Trust member, the Quality Account. The lead a major involvement in the read our magazine or view our Clinical Commissioning Group production of this Quality latest news and performance has a legal obligation to review Account. information. and comment on the Quality

Page Annual Report and Accounts 2013/14 201 Part 4: Appendices

Statements from Local Clinical Commissioning Groups (CCGs), Local Healthwatch Organisations and Overview and Scrutiny Committees (OSCs)

1.1 Statement from Blackpool Clinical Commissioning Group and Fylde & Wyre Clinical Commissioning Group – 16.05.14

Re: Blackpool Teaching Hospitals NHS Foundation Trust Quality Account for 2013/14 Blackpool CCG as Lead Commissioner together with Fylde and Wyre CCG as Associate Commissioners welcome the with the focus on patients and the Clinical Audits and 100% of opportunity to appraise the public as the key audience. National Confidential Enquiries content of the Quality Account Quality Priorities and this is a clear indication of an for 2013-2014 and are pleased to 2013/14 organisation with a commitment acknowledge that there is a clear Blackpool Teaching Hospital to delivery of evidence based focus on the key quality elements NHS Foundation Trust continues and safe care. However, the CCG and Blackpool Teaching Hospital to be an outlier for hospital would like to see participation in NHS Foundation Trust has clearly mortality. The CCG are pleased 100% of eligible National Clinical referenced its organisational to note the reductions in hospital Audits for 2014/15. objectives, focusing on the five mortality rates reported under key domains of quality as outlined Standardised Hospital Mortality Blackpool CCG notes that in Planning for Patients 2013/14. Index (SHMI) and Risk Adjusted Blackpool Teaching Hospital Mortality Indicator (RAMI) during NHS Foundation Trust has rated The Quality Account is concise the year however, a continued themselves green against the given the breadth of information focus on mortality should be requirements of the Information it is required to reference, well- maintained in order to see the Governance Toolkit with and presented and reflects the new Hospital Standardised Mortality overall rating of satisfactory requirements to benchmark Rate achieve a reduction. As lead with no serious breaches in data against peers. commissioner, Blackpool CCG security and as such patients monitors actions to achieve this and the public can be assured The Quality and Engagement reduction. that data held is stored, used Committee of the CCG noted and transferred securely and that due to the complexity Blackpool Teaching Hospital NHS confidentially. Blackpool CCG of the information reported, Foundation Trust continues to however, note the high % of consideration could be given to participate in 86% of National secondary procedures coded producing a précis of the report Page 202 Blackpool Teaching Hospitals NHS Foundation Trust incorrectly at 46.2%, as clinical is also to be commended for the Foundation Trust commitment coding supports clinical care, sustained reduction in HCAI with to participation in the Patient treatment and outcomes and is a continued commitment to zero Safety and Quality visits and in directly linked to payment and tolerance for MRSA bacteraemia particular the recent Maternity costs we would welcome sight in 2014/15. Clostridium Difficile review visit. The Trust welcomed of the associated action plan for Infections (CDI) attributed to the representation from the CCG, improvement. Acute Trust shows a 7% reduction LCSU, Health Watch, Non from the previous year and both Executives and Ley Members and Research is well supported at commissioners and provider details of the full report have been Blackpool Teaching Hospital agree that there needs to be shared with the Trust who are NHS Foundation Trust Blackpool continued focus on reduction. responding to the outputs. CCG confirm that a research active provider demonstrates a Blackpool Teaching Hospital NHS We can confirm that Blackpool strong commitment to clinical Foundation Trust continues to Teaching Hospital NHS effectiveness in support of see an increase in the number of Foundation Trust has achieved improving the quality of care patient safety incidents reported targets for the majority of delivered. together with an associated the national performance decrease in reported level of measures but diagnostic waiting Core Quality Indicators harm and view this as a positive times for cystoscopy rates are identified to be progressed indicator that demonstrates an showing above the threshold 2014/15 organisation with an open and as a result of national screening Blackpool CCG is pleased to transparent reporting mechanism campaigns with an action plan in note improvement in Patient and a robust patient safety development. Reported Outcome Measures process and culture. particularly in relation to groin Patient and Public Initiatives to hernia procedure which has Of significant note and be progressed 2014/15 identified that patients level of commendation is Blackpool In accordance with the NHS comfort has increased. The Trust Teaching Hospital NHS Outcomes framework privacy

Page Annual Report and Accounts 2013/14 203 and dignity continues to be a aspects in “real time” during the of trained competent staff priority area for both provider year. In respect, it should be noted who are responsible about and commissioners and we that the Council of Governors has providing outstanding patient note that 91% of those surveyed had a positive impact on a number treatment and care”. said they were treated with of reported areas. • “Full staff buy in and dignity and respect. However implementation of pathways”. Blackpool Teaching Hospital Here is some feedback on the • “Faster implementation of NHS Foundation Trust has Quality Accounts, provided by technology to assist staff with notified 6 breaches in mixed sex Governors:- accurate record keeping and accommodation and we would reduce uneccessary paper anticipate a reduction in 2014-15. “As and elected Governor for the crunching”. Fylde, we feel assured that there • “We also wish to see actions Dementia care was noted to be is significant progress against from the CQC report achieved rated red with the expected score these objectives in the Acute and and the CQC CQUINN threshold for assessing and treat patients Community services:- targets improved”. at 75% against a target of 90%. The Nursing Care Indicators have • Infection rates have continued Do not be put off by the length achieved green for the Trust but to fall. and complex nature of this red for delivery in the Community • Significant reductions in report; there is a lot of valuable Services at only 58% against a pressure ulcers and patient falls. information and extremely 95% target. As such the CCG • Improvements in our local useful insight contained within would like to see a significant results of the national patient its pages. That information and improvement in scores for both survey in areas such as; privacy insight highlight the striving for Dementia Care and Nursing and dignity, cleanliness, waiting Excellence and the Trust’s aim to Care Indicators specifically in times and communication be the “safest organization within Community Services for 2014/15. between staff and patients. the NHS”. • National recognition for our Blackpool CCG look forward to work to improve patient safety seeing the improvements to and quality and the Trust’s the quality of services provided Maternity Substance Misues 1.3 Statement from as outlined in this Trust Quality Team. Local Healthwatch Account. • Continued to make progress on reducing mortality rates. Blackpool - 12-05- • Invested more than £1.5M in 2014 clinical staff with more than 1.2 Statement from 180 qualified nurses joining the A comprehensive document Governors – 16-05- organization and more than 40 detailing the many quality issues doctors” being addressed by the Trust both 2014 mandatory and in-house. “Some form of measurement Creation of the Quality Accounts is on volunteer/member/patient However, the sheer volume of the a vital process in the yearly activity involvement/engagement & issues being addressed makes of an NHS Trust. The document, by contribution. Involvement and the Quality Account a not very its nature, contains a huge amount engagement in my opinion are user- friendly publication and in of data and information and is a good quality indicators”. its present form it is not ideal for reflection of the complex nature distribution to the general public of providing quality care to a large In response to a question about as a whole. Its use of technical and diverse population. Whilst this what are some of the priorities and medical terms would make is a report as to what happened for quality improvement for the it difficult to interpret by many. in the previous year, it should be coming year:- Couple this with the fact that noted that Governors were able the visually impaired would to provide input and support, as • “Provision of adequate levels require the QA to be available in well as to question various quality

Page 204 Blackpool Teaching Hospitals NHS Foundation Trust an alternative format as would certain ethnic minorities who do not have English as a first language. A separate publication, perhaps a 6 fold document, highlighting the salient points for public consumption could be produced and made available in patient/public areas, such as GP surgeries and libraries.

The Trust’s comprehensive Clinical Audit and Research programmes ensure that BTHFT participates in identifying improvements in treatments and care in the national picture, and it is good to accuracy. The comments we have time limit for public organizations see that the Trust complies with received from the public during was done for positive reasons - the CQC and CQUINN standards. 2013/14 do not indicate particular to make the public sector more trends in care provision – positive responsive and accountable. However, it is concerning that the or negative. The Quality Accounts Over time many organizations Trust has fallen behind plan (Red- appear to provide evidence of an have come to see 20 days noat as lighted) in two important points organisation that is focused on the maximum standard but just in its Priority 1, namely medical service improvement. as the standard. We are sure the and Nursing care indicators used Trust is aware of this issue and will to assess and measure standards We are pleased to see the take steps to monitor the use of of clinical care and patient commitment to engaging holding letters. experience, which should be at the with patients, public, staff and fore-front of any Quality Account. governors. We would encourage We would welcome sight of the a systematic approach to this improvement action plan referred We would like to see more with some clarity on shared to in 2.3.5 and also information evidence of the use of the Family expectations of what the Trust is on the outcome of the RCOG case and Friends Test in future Quality trying to find out, what will change review. Accounts. as a result of the engagement and how people will find that out. The progress on reducing mortality rates is welcome, It would have been useful to know although more still needs to be 1.4 Statement from what the reasons were for the Trust done. It is to be welcomed that Local Healthwatch failing to meet the complaints in the four areas - Groin Hernia, outcome 17 when the CQC visited Hip & Knee Replacement and Lancashire – in June 2013. It is encouraging Varicose Vein - all of the average 20.05.2014 that the Trust was subsequently health gain numbers show deemed to be fully meeting the improvement. We do not yet We welcome the efforts of the standard, but we have some know how these compare to Trust to deliver fit for purpose concerns about the decision to the national averages, but it is services for local people. Based introduce a holding letter when the encouraging. on the information we have response to a complaint is delayed. gathered during the year, the This seems quite reasonable, but We would welcome an Quality Accounts broadly reflect the risk is that it becomes the explanation in the “steady what we know and what we have norm, not the exception and that increase in the number of been told about the Trust. We complaints take longer as a result. untoward incidents reported have no reason to doubt their For example, the introduction of in the past four financial years”. the 20 day maximum response Is this because there are more

Page Annual Report and Accounts 2013/14 205 such incidents or because the Trust to friends and family The Trust states that it ‘will reporting culture has improved? needing care. Hopefully this continue to listen to patients, is also an indicator of the state staff, stakeholders, partners and In “Learning from patients” in of staff morale, which is a key Foundation Trust members’ and section 3.3, we fully support the part of delivering good quality the Committee will maintain an Trust capturing and reporting services. oversight of how the Trust will on the positive things said by • We are concerned about evidence this and takes on board patients. However the tendancy the numbers of Medication the views provided in the shaping of Trusts generally to present Incidents where errors were of their priorities for the future. this information as it it is a made. There appears to have counterbalance to complaints is been a very large increase in not particularly helpful. We know these during 2013/14 and it that people do not complain for would be helpful to get more 1.6 Statement from well documented reasons and information about why this is Blackpool Health that as result, the number of and what is being done about recorded complaints is always it. Overview and lower than the number of people Scrutiny Committee who later feel that they should We would like to make a general have complained. For this reason point about the presentation - 13-05-2014 we are also not persuaded that of the Quality Accounts, which “The Health Scrutiny Committee seeking to reduce complaints as applies to most of the ones that would like to thank Blackpool a target is necessarily a positive we have read. It is not totally clear Teaching Hospitals NHS thing. The issue should be about who the target audience for the Foundation Trust for the the Trust’s culture being open to document is. We would have opportunity to view and complaints, seeing them as an thought that a basic test would comment on the Trust’s important quality improvement be that a member of the public, 2013/14 Quality Account. The tool and applying the learning. sitting in a waiting area at the Committee is satisfied with Trust, should be able to read this the level of engagement and Some brief points about some of document and understand how information it has received the reported outcomes: well the Trust is doing. Realistically from the Trust throughout the this document does not pass that year and is pleased with the • We strongly support the work test. This is not just an issue for way that the Trust has dealt being undertaken to achieve theis Trust and from Healthwatch with queries, requests for the Dementia Screening Lancashire’s perspective there is a information and attendance at Targets. The current scores are question about what purpose of Committee meetings. In relation unacceptably low. the Quality Account is. to the Account document, the • The CQC’s National Inpatient Committee expressed the view Survey information presented that from the perspective of the in Table 28 shows that a general public, it was a lengthy very low number of patients 1.5 Statement from document and could be difficult reported that staff told Lancashire Health to interpret. It would therefore be them about medication in favour of the production of a side effects to look out for at Overview and document that summarised the home. Although this is an Scrutiny Committee main content and findings of the improvement on the previous Account. year, we welcome the fact that - 14-05-2014 clinical divisions and pharmacy The Committee notes the The Committee looks forward to are looking at how this number progress that the Trust has working with the Trust during the can be increased. made over the past 12 months coming year, particularly in the • The Trust is to be congratulated and looks forward to effective areas of scrutinising quality, safety on the high number of staff engagement around their plans and patient care”. who would recommend the for 2014/15.

Page 206 Blackpool Teaching Hospitals NHS Foundation Trust Annex B: Statement of Directors’ Responsibilities in Respect Of the Quality Account

The Board of Directors is 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 - Feedback from the - The Head of Internal Audits NHS Foundation Trust Boards commissioners - Blackpool annual opinion over the on the form and content of Clinical Commissioning Trust’s control environment annual Quality Reports (which Group and Fylde & Wyre approved 16/04/2014; incorporate the above legal Clinical Commissioning - CQC quality and risk profiles requirements) and on the Group – dated 16/05/2014; dated 31.05.2013, 30.06.2013 arrangements that Foundation - Feedback from Governors and 31.07.2013; Trust Boards should put in place dated 17/03/2014 and - The CQC Intelligent to support data quality for the 16/05/2014; Monitoring Report dated preparation of the Quality Report. - Feedback from Local 21.10.2013, 13.03.2014. Healthwatch organisations In preparing the Quality Report, – Local Healthwatch • The Quality Report presents a Directors are required to take Lancashire – Not received balanced picture of the NHS steps to satisfy themselves that: - Feedback from Local Foundation Trust’s performance Healthwatch organisations – over the period covered; • The content of the Quality Local Healthwatch Blackpool Report meets the requirements dated 12.05.2014 • The performance information set out in the NHS Foundation - Feedback from the Blackpool reported in the Quality Report Trust Annual Reporting Manual Council’s Health Scrutiny is reliable and accurate; 2013/14: Committee dated 13.05.2014 - The Trusts Complaints Report • There are proper internal • The content of the Quality published under regulation controls over the collection Report is not inconsistent with 18 of the Local Authority and reporting of the measures internal and external sources of Social Services and NHS of performance included in information including: Complaints Regulations the Quality Report, and these - Board minutes and papers 2009, dated 16/05/2014; controls are subject to review to for the period April 2013 – - The latest 2013 national confirm that they are working March 2014 patient survey published effectively in practice; - Papers relating to Quality February 2013; reported to the Board over - The latest 2013 national staff • The data underpinning the the period April 2013 to survey published February measures of performance March 2014; 2014; reported in the Quality Report is

Page Annual Report and Accounts 2013/14 207 robust and reliable, conforms to specified data quality standards and prescribed definitions, is subject to appropriate scrutiny and review; and the Quality Report has been prepared in accordance with Monitor’s annual reporting guidance (which incorporates the Quality Accounts regulations) (published at http://www. monitor-nhsft.gov.uk/ annualreportingmanual) as well as the standards to support data quality for the preparation of the Quality Report (available at http:// www.monitor-nhsft.gov.uk/ annualreportingmanual).

The Directors confirm to the best of their knowledge and belief they have complied with the above requirements in preparing the Quality Report.

By order of the Board:

Signed: Date: 21st May 2014

Ian Johnson Chairman

Signed: Date: 21st May 2014

Gary Doherty Chief Executive

Page 208 Blackpool Teaching Hospitals NHS Foundation Trust Annex C: External Auditor’s Limited Assurance Report on the Contents of the Quality Report

Independent Auditors’ Limited Assurance Report to the Council of Governors of Blackpool Teaching Hospitals NHS Foundation Trust on the Annual Quality Report

We have been engaged by the Council of Governors of Blackpool Teaching Hospitals NHS Foundation Trust to perform an independent assurance engagement in respect of Blackpool Teaching Hospitals NHS Foundation Trust’s Quality Report for the year ended 31 March 2014 (the ‘Quality Report’) and specified performance indicators contained therein.

our attention that causes us to Scope and subject Respective believe that: matter responsibilities of • The Quality Report does The indicators for the year the Directors and not incorporate the matters ended 31 March 2014 in the auditors required to be reported on Quality Report that have been as specified in Annex 2 to subject to limited assurance (the The Directors are responsible for Chapter 7 of the FT ARM and “specified indicators”) consist of the content and the preparation the “Detailed requirements for the following national priority of the Quality Report in quality reports 2013/14”; indicators as mandated by accordance with the specified • The Quality Report is not Monitor: indicators criteria referred to on consistent in all material pages of the Quality Report as respects with the sources Specified listed above (the “Criteria”). The specified below; and Specified indicators Directors are also responsible for • The specified indicators have Indicators criteria the conformity of their Criteria not been prepared in all Section 3.4.3 with the assessment criteria material respects in accordance Clostridium of the Quality set out in the NHS Foundation with the Criteria and the six Difficile Report (Page Trust Annual Reporting Manual dimensions of data quality set 53) (“FT ARM”) and the “Detailed out in the “2013/14 Detailed requirements for quality guidance for external assurance Maximum reports 2013/14” issued by the on quality reports”. waiting time of Section 3.3 of Independent Regulator of NHS 62 days from the Quality Foundation Trusts (“Monitor”). We read the Quality Report and urgent GP Report (Page consider whether it addresses the referral to first 34) Our responsibility is to form a content requirements of the FT treatment for conclusion, based on limited ARM, and consider the implications all cancers assurance procedures, on for our report if we become aware whether anything has come to of any material omissions.

Page Annual Report and Accounts 2013/14 209 We read the other information We consider the implications for Assurance work contained in the Quality Report our report if we become aware and consider whether it is of any apparent misstatements performed materially inconsistent with the or material inconsistencies with following documents: those documents (collectively, the We conducted this limited “documents”). Our responsibilities assurance engagement in • Board minutes for the period do not extend to any other accordance with International April 2013 to the end of April information. Standard on Assurance 2014; Engagements 3000 ‘Assurance • Papers relating to the Quality We are in compliance with the Engagements other than Report reported to the Board applicable independence and Audits or Reviews of Historical over the period April 2013 to competency requirements Financial Information’ issued by the end of April 2014; of the Institute of Chartered the International Auditing and • Feedback from the Accountants in England and Assurance Standards Board (‘ISAE Commissioners Blackpool Wales (“ICAEW”) Code of Ethics. 3000’). Our limited assurance Clinical Commissioning Group Our team comprised assurance procedures included: and Fylde and Wyre Clinical practitioners and relevant subject Commissioning Group dated matter experts. • reviewing the content of the 16/05/2014; Quality Report against the • Feedback from Governors This report, including the requirements of the FT ARM dated 17/03/2014 and conclusion, has been prepared and “Detailed requirements for 16/05/2014; solely for the Council of Governors quality reports 2013/14”; • Feedback from local of Blackpool Teaching Hospitals • reviewing the Quality Report Healthwatch organisations NHS Foundation Trust as a body, for consistency against the Local Healthwatch Blackpool to assist the Council of Governors documents specified above; dated 12/05/2014 and Local in reporting Blackpool Teaching • obtaining an understanding Healthwatch Lancashire dated Hospitals NHS Foundation Trust’s of the design and operation of 20/05/2014; quality agenda, performance and the controls in place in relation • Feedback from the Blackpool activities. We permit the disclosure to the collation and reporting Council’s Health Scrutiny of this report within the Annual of the specified indicators, Committee dated 13/05/2014; Report for the year ended 31 including controls over third • The Trust’s complaints report March 2014, to enable the Council party information (if applicable) published under regulation 18 of Governors to demonstrate they and performing walkthroughs of the Local Authority Social have discharged their governance to confirm our understanding; Services and NHS Complaints responsibilities by commissioning • based on our understanding, Regulations 2009, dated an independent assurance report assessing the risks that the 16/05/2014; in connection with the indicators. performance against the • The 2013 national patient To the fullest extent permitted by specified indicators may be survey dated February 2014; law, we do not accept or assume materially misstated and • The 2013 national staff survey responsibility to anyone other determining the nature, dated February 2014; than the Council of Governors as timing and extent of further • Care Quality Commission a body and Blackpool Teaching procedures; quality and risk profiles dated Hospitals NHS Foundation Trust • making enquiries of relevant 31/05/2014, 30/06/2013 for our work or this report save management, personnel and, and31/07/2013 ; where terms are expressly agreed where relevant, third parties; • Intelligent Monitoring Reports and with our prior consent in • considering significant dated 21/10/2013 and writing. judgements made by the NHS 13/03/2013; and Foundation Trust in preparation • The Head of Internal Audit’s of the specified indicators; annual opinion over the Trust’s • performing limited testing, on control environment dated a selective basis of evidence 16/04/2014. supporting the reported

Page 210 Blackpool Teaching Hospitals NHS Foundation Trust performance indicators, measurements and can impact Conclusion and assessing the related comparability. The precision disclosures; and of different measurement Based on the results of our • reading documents. techniques may also vary. procedures, nothing has come Furthermore, the nature and to our attention that causes us to A limited assurance engagement methods used to determine believe that for the year ended 31 is less in scope than a reasonable such information, as well as the March 2014, assurance engagement. The measurement criteria and the • The Quality Report does nature, timing and extent precision thereof, may change not incorporate the matters of procedures for gathering over time. It is important to read required to be reported on sufficient appropriate evidence the Quality Report in the context as specified in Annex 2 to are deliberately limited relative of the assessment criteria set out Chapter 7 of the FT ARM and to a reasonable assurance in the FT ARM and the Criteria the “Detailed requirements for engagement. referred to above. quality reports 2013/14”; • The Quality Report is not The nature, form and content consistent in all material Limitations required of Quality Reports are respects with the documents determined by Monitor. This specified above; and may result in the omission of Non-financial performance • the specified indicators have information relevant to other information is subject to more not been prepared in all users, for example for the purpose inherent limitations than material respects in accordance of comparing the results of financial information, given the with the Criteria and the six different NHS Foundation Trusts. characteristics of the subject dimensions of data quality set matter and the methods used for out in the “2013/14 Detailed In addition, the scope of our determining such information. guidance for external assurance assurance work has not included on quality reports”. governance over quality or The absence of a significant body non-mandated indicators in of established practice on which the Quality Report, which have to draw allows for the selection been determined locally by of different but acceptable Blackpool Teaching Hospitals NHS measurement techniques which Foundation Trust. can result in materially different

PricewaterhouseCoopers LLP Chartered Accountants Manchester 28th May 2014

The maintenance and integrity of the Blackpool Teaching Hospitals NHS Foundation Trust’s website is the responsibility of the directors; the work carried out by the assurance providers does not involve consideration of these matters and, accordingly, the assurance providers accept no responsibility for any changes that may have occurred to the reported performance indicators or criteria since they were initially presented on the website.

Page Annual Report and Accounts 2013/14 211 Annex D: A Statement of the Chief Executive’s responsibilities as the Accounting Officer

Statement of the Chief Executive’s responsibilities as the Accounting Officer of Blackpool Teaching Hospitals NHS Foundation Trust

The National Health Service NHS Foundation Trust and of its statements on a going concern Act 2006 states that the Chief income and expenditure, total basis. Executive is the Accounting recognised gains and losses and Officer of the NHS Foundation cash flows for the financial year. The Accounting Officer is Trust. The relevant responsibilities responsible for keeping proper of Accounting Officer, including In preparing the accounts, the accounting records which disclose their responsibility for the Accounting Officer is required to with reasonable accuracy at any propriety and regularity of the comply with the requirements time the financial position of public finances for which they are of the NHS Foundation Trust the NHS Foundation Trust and answerable, and for the keeping Annual Reporting Manual and in to enable him/her to ensure of proper accounts, are set out particular to: that the accounts comply in the NHS Foundation Trust with requirements outlined Accounting Officer Memorandum • observe the Accounts Direction in the above mentioned Act. issued by the Independent issued by Monitor, including The Accounting Officer is also Regulator of NHS Foundation the relevant accounting and responsible for safeguarding the Trusts ("Monitor"). disclosure requirements, and assets of the NHS Foundation apply suitable accounting Trust and hence for taking Under the NHS Act 2006, Monitor policies on a consistent basis; reasonable steps for the has directed Blackpool Teaching • make judgements and prevention and detection of fraud Hospitals NHS Foundation Trust estimates on a reasonable basis; and other irregularities. to prepare for each financial year a • state whether applicable statement of accounts in the form accounting standards as set out To the best of my knowledge and and on the basis set out in the in the NHS Foundation Trust belief, I have properly discharged Accounts Direction. The accounts Annual Reporting Manual have the responsibilities are set out are prepared on an accruals been followed, and disclose and in Monitor's NHS Foundation basis and must give a true and explain any material departures Trust Accounting Officer fair view of the state of affairs of in the financial statements, and Memorandum. Blackpool Teaching Hospitals • prepare the financial

Signed: Date: 21st May 2014

Gary Doherty Chief Executive

Page 212 Blackpool Teaching Hospitals NHS Foundation Trust Annex E: Annual Governance Statement 2013/14

Annual Governance Statement 2013/14

BLACKPOOL TEACHING HOSPITALS NHS FOUNDATION TRUST

to eliminate all risk of failure management and integrated 1. Scope of to achieve policies, aims and governance systems in place Responsibility objectives; it can therefore within the Trust and for meeting only provide reasonable and all statutory requirements and As Accounting Officer, I have not absolute assurance of adhering to guidance issued by responsibility for maintaining a effectiveness. The system of Monitor in respect of governance sound system of internal control internal control is based on and risk management. I lead the that supports the achievement an ongoing process designed Risk Management process as Chair of the NHS Foundation Trust’s to identify and prioritise the of the Trust’s Risk Committee, policies, aims and objectives, risks to the achievement of the which meets on a bi-monthly whilst safeguarding the public policies, aims and objectives of basis. The Risk Committee has funds and departmental assets Blackpool Teaching Hospital NHS its membership drawn from the for which I am personally Foundation Trust (the Trust), to Directors within the Trust. The responsible, in accordance with evaluate the likelihood of those Chairman of the Trust is also in the responsibilities assigned to risks being realised and the attendance. The Risk Committee me. I am responsible for ensuring impact should they be realised, oversees all risk management that the NHS Foundation Trust and to manage them efficiently, activity and ensures the correct is administered prudently and effectively and economically. The strategy is adopted for managing economically and that resources system of internal control has risk; controls are present and are applied efficiently and been in place for the Trust for the effective; and action plans are effectively. I also acknowledge my year ended 31 March 2014 and robust for those risks which remain responsibilities as set out in the up to the date of approval of the intolerant. The Risk Committee also NHS Foundation Trust Accounting annual report and accounts. comprised the Interim Associate Officer Memorandum. Director of Corporate Affairs and Governance, Senior Managers and 3. Capacity to specialist advisors who routinely 2. The Purpose attend each meeting. In the Handle Risk last year, the Board Committee of the System of Structure was reviewed and the Internal Control 3.1 Leadership internal auditors KPMG, found As Accounting Officer, I have significant assurance. This review saw the establishment of separate The system of internal control overall accountability and committees for the management is designed to manage risk to responsibility for ensuring of Risk and Quality in the Trust. a reasonable level rather than that there are effective risk

Page Annual Report and Accounts 2013/14 213 The Committee structure will be The Board of Directors has overall is also responsible for “soft” reviewed again this year internally responsibility for setting the facilities management. The to ensure that it is efficient and strategic direction of the Trust and Director of Nursing and Quality effective and is continuing to meet managing the risks in delivering is supported by the Interim the needs of the organisation. that strategy. All committees with Associate Director of Corporate These reviews ensure the risk management responsibilities Affairs and Governance who committees structure is working at have reporting lines to the is responsible for reporting to its optimum, prevent duplication Board. Some aspects of risk the Board of Directors on the of work and ensure there are are delegated to the Executive development and progress of clear lines of responsibility and Directors: the Risk Management Strategy accountability to the Trust Board, and for ensuring that the Council of Governors and our • The Director of Strategy/ strategy is implemented and regulatory bodies as required. Deputy Chief Executive is evaluated effectively; responsible for Strategy, • The Director of Operations is The Trust has reviewed and including the Estate responsible for developing updated the Risk Management Management and Fire Safety. risk based operational Key Strategy which clearly describes The Deputy Chief Executive Performance Indicators and for the roles and responsibilities of is the Senior Information Risk monitoring performance and individual Executive Directors Owner (SIRO) and as has overall reporting to the Board on a specifically and generally and responsibility for Information monthly basis; is reviewed and endorsed by Governance risk. • The Director of Workforce and the Board of Directors annually. • The Finance Director provides Organisational Development The Risk Management Strategy the strategic lead for financial is responsible for workforce applies to all employees and risk, Capital Programme planning, staffing issues, requires an active lead from Management and the effective education and training; managers at all levels to coordination of financial • The Interim Associate ensure risk management is a controls throughout the Trust; Director of Corporate Affairs fundamental part of the total • The Medical Director (jointly and Governance is the approach to quality, safety, with the Director of Nursing management lead responsible corporate and clinical governance, and Quality) is responsible for ensuring a fully integrated performance management to the Board for Clinical Risk and joined up system of risk and assurance. There is a Management and is the and control management is in clearly defined structure for the professional risk lead for all place and embedded on behalf management and ownership of Doctors within the Trust. The of the Board; and risk through the development of Medical Director is also the • All Divisional Directors, Heads the Board Assurance Framework Executive Lead responsible of Departments, Associate and Corporate Risk Register. for health and safety, is the Directors of Nursing, and Caldicott Guardian and ward/departmental managers A lead Executive Director has therefore responsible for have delegated responsibility been identified for each principal information governance risk in for the management of risk defined within the Board relation to patient information. risk in their areas. Risk is Assurance Framework and • The Director of Nursing integral to their day-to-day Corporate Risk Register and and Quality has shared management responsibilities. It each risk is linked to the CQC responsibility for Clinical Risk is also a requirement that each Quality and Safety Standards. Management with the Medical individual division produces These ‘high level’ risks within the Director and is the professional a divisional/directorate risk Board Assurance Framework risk lead for Nurses, Midwives register, which is consistent and and Corporate Risk register are and Allied Health Professionals mirrors the Trust’s Corporate subject to ongoing review by the within the Trust. The Director Risk Register requirements Risk Committee and the Board of of Nursing and Quality is the and is in line with the Risk Directors on a quarterly basis. Executive Lead responsible Management Strategy; for infection prevention and

Page 214 Blackpool Teaching Hospitals NHS Foundation Trust Governors have an important handling, resuscitation, infection are undertaking risk assessments role to play and are responsible prevention, safeguarding patients, and managing risk as part of their for providing leadership in order blood transfusion and information role. to operate effectively, represent governance. A comprehensive the interests of members and training needs analysis has been The overarching performance influence the strategic direction kept under review which sets out management system within the of the Trust. The Council of the training requirements for all Trust ensures that controls are Governors is responsible for members of staff and includes in place to identify and manage holding the non-executive the frequency of training in each any risks to the delivery of key directors, individually and case. Trust Board members have performance targets. This collectively, to account for the participated in bespoke risk process is utilised as a further performance of the board of management training. assurance mechanism to maintain directors This is attained for an effective system of internal example by Governors attending To ensure the successful control. and observing committees of the implementation and Board, attending Board meetings maintenance of the Trust’s Employees, contractors and in public and meeting with the approach to risk management, agency staff are required to Chairman, Chief Executive and staff at all levels are appropriately report all adverse incidents and Committee Chairs as well as trained in risk assessment, concerns. The Trust supports a at meetings of the Council of incident reporting and root cause learning culture, ensuring that an Governors. analysis training. The Trust uses objective investigation or review an integrated electronic risk is carried out to continually learn 3.2 Training management system, known as from incidents, only assigning Staff are trained or equipped to Ulysses which is used to record ‘blame’ to individuals where it is manage risk in a way appropriate and manage incidents and risk clear that policies and procedures to their authority and duties. The registers both at Corporate and have not been appropriately Trust has in place an induction Divisional level. The system followed. programme for new employees, allows for the recording and which includes awareness of assessment of risks using a The Learning from Incidents the Trust’s Risk Management generic scoring matrix. The and Risks Committee meets on Strategy. Risk management risk management leads within a bi-monthly basis to ensure is a dedicated session on the each Division and Corporate concerns identified from Corporate Mandatory Training Directorate are responsible incidents, complaints and claims, Programme and each Division for coordinating the ongoing are investigated to ensure that and Corporate Directorate has a review and management of risks lessons are learned and as a responsibility to develop specific identified, collated, reported and method of improvement and departmental local induction reviewed locally through the sharing good practice. The Trust programmes, which includes Trust Governance structures. fosters an environment where awareness of the Division/ individuals are treated in a fair and Directorate Risk Management All members of staff have just way, and where lessons are Strategy. In addition, training responsibility for participation learned rather than blame being is also provided to relevant in the risk management system attributed. staff on risk assessment, through awareness of risk incident reporting and incident assessments which have been The Trust seeks to learn from investigation. The Trust has in carried out in their place of work good practice and will investigate place a mandatory training and to compliance with any any serious incidents, complaints programme and the Board has set control measures introduced and serious untoward incidents out the minimum requirements by these risk assessments. The requiring investigation via the for staff training required to Trust recognises the importance Serious Incident Review and control key risks and includes risk of supporting staff and the risk Action Team. The findings are management processes such management team act as a reviewed by the Action Team as health and safety, manual support and mentor to staff who to ensure learning points are

Page Annual Report and Accounts 2013/14 215 implemented. Assurance is gained patient harms and ensure high example, Patient Safety Strategy, by presenting an overview of standards of clinical care are Untoward Incident and Serious the investigation reports to the maintained. Incident Reporting Procedure. Trust’s Quality Committee, the The Risk Management Strategy Learning from Incidents and Risks The Trust actively seeks to share is available to all staff via the Committee and the Board of learning points with other Document Library on the Trust Directors. Any learning points for health organisations, and pays Intranet. staff when things go wrong are regard to external guidance shared via Divisional governance issued. Accordingly, the Trust will The Trust’s vision and values, systems and published via the undertake a gap analyses and (which have recently been Staff Lessons Learned Newsletter adjust systems and processes reviewed and will now be and via the Risk Management as appropriate in line with best ratified by the Board) identify Website and the Knowledge practice. the accepted culture within the Management Website for all staff organisation; these are linked to access. to the corporate objectives and therefore support the In addition to the Trust reviewing 4. The Risk and risk management framework. all internally driven investigation Control Framework The Trust has developed a risk reports, the Trust also adopts appetite maturity matrix. This is an open approach to the 4.1 Key Elements of the a very useful tool in aiding our learning derived from third party Risk Management Strategy thinking on risk, our risk tolerance investigations and audits, and/or and our corporate decision The Risk Management Strategy is external reports. During 2013/14, making. This is a simple approach validated by the Risk Committee the Trust has taken on board to quantifying risk in order to and approved by the Board recommendations from a number define qualitative measures of of Directors. It covers all risks of external reports including consequences and likelihood. and is subject to an annual ongoing work in relation to the This allows construction of a Risk review to ensure it remains Francis report on Mid Staffordshire Matrix, which can be used as the appropriate and current. The Risk NHS Foundation Trust. basis of identifying acceptable Management Strategy assigns and unacceptable risk. responsibility for the ownership, In June 2013 the Trust had a visit identification and management from a team under the direction of risks to all individuals at all 4.2 Key Elements of the of Bruce Keogh. We welcomed levels in order to ensure that Quality Governance this opportunity to demonstrate risks which cannot be managed Arrangements the quality of care provided by locally are escalated through the organisation and to highlight Strategy the organisation. The process many areas of improvement Patient safety, clinical effectiveness populates the Board Assurance being undertaken. This visit linked and patient experience, alongside Framework and Corporate Risk well with our ongoing work to improving efficiency, drive the Register, to form a systematic improve service quality and Board’s strategic framework, record of all identified risks. The reduce mortality, which has seen which identifies key elements control measures, designed to average standardised mortality in the quality of care it delivers mitigate and minimise identified ratios for the Trust decreasing to its patients and provides the risks, are recorded within the since July 2012. . basis for annual objective setting. Board Assurance Framework and The potential risks to patient Corporate Risk Register. The Trust has committed itself to safety, clinical effectiveness or improving the nurse and doctor patient experience are identified Risks are identified from risk to patient ratios over coming and escalated to the Board in assessments and from the years and is spending over £1m accordance with the process analysis of untoward incidents. new monies this year to reduce outlined in section 4.1 above. The Risk Management Strategy the number and severity of is referenced to a series of related incidents that could result in Capabilities and Culture risk management documents, for The Board of Directors has

Page 216 Blackpool Teaching Hospitals NHS Foundation Trust ensured it has the necessary of Directors monitor quality risks. The HIC is chaired by the leadership, skills and knowledge by reviewing the Compliance Deputy Chief Executive who is to deliver on all aspects of the Assurance Monitoring Report also the nominated Board Lead quality agenda. In addition, and the Assurance Report on for Information Governance and the Board has put in place a monthly basis. Safety, quality the Senior Information Risk Owner a clinical leadership model and patient experience are (SIRO) for the Trust. which puts senior medical paramount in the proceedings of and nursing colleagues at the the senior corporate committees; The reporting and investigation heart of decision-making and namely the: Risk Committee, of incidents is an integral part of management. Our culture Quality Committee, and the Audit all employees’ duties. It applies to continues to develop the Committee. ALL staff and all untoward events ‘Blackpool Way’ now re-launched and near misses. Information and renamed “the Trust Way”, in Information reported to the Board, Security Incidents are known relation to the way we do things regarding performance against as an ‘Information Governance around here’, with our new core nationally mandated targets, related Serious Incident Requiring values which places people at the is collated from the dataset Investigation’ (IG SIRI). As a guide centre of all that we do in addition submitted to the DoH. Likewise this includes any incident which to compassion, excellence and data to support compliance with involves actual or potential failure positivity. locally commissioned services and to meet the requirements of targets is reported to the Board the Data Protection Act 1998 Processes and Structure from the dataset provided to and/or the Common Law of Accountability for patient safety, commissioners. Confidentiality. clinical effectiveness and patient experience and improved Measurement Using information about the efficiency are set out within the Information relating to patient context, scale and sensitivity job descriptions and objectives safety, clinical effectiveness and of what has occurred IG SIRI’s of the Executive Team, senior patient experience is analysed are categorised into one of the leaders and staff. All policies and scrutinised by the Board on following levels: and procedures clearly set out a monthly basis, and steps are roles and responsibilities for taken to assure the robustness 0 Near miss/non-event. all colleagues involved in the of data as part of the internal 1 Confirmed IG SIRI but no delivery of patient care. The Board and external audit programmes. need to report to ICO, DH actively seeks feedback from The information within the and other central bodies. patients, members, governors monthly Compliance Assurance 2 Confirmed IG SIRI that must and other stakeholders in the Monitoring Report and Assurance be reported to ICO, DH and pursuit of excellence and as part Reports are used to evaluate other central bodies. of the continuous improvement and drive accountability for cycle. Executive Directors performance and delivery. During 2013/14 the Trust has routinely participate in patient incurred no incidents classified as safety walkabouts in clinical 4.3 How Risks to Data an IG SIRI severity level 2. Should areas to engage with frontline Security are Being an incident of this level take teams, patients and visitors, and Managed place a detailed report would be to evaluate the safety, clinical included in the Trust’s Annual effectiveness and experience of The Health Informatics Committee Report. care for patients. (HIC) is responsible for all aspects of Information Management, The Board commences a Information Governance and significant number of formal Information Communications meetings with a patient story, Technology throughout the Trust reflecting on positive and known collectively as Information negative experiences of patients Management; this includes the using our services. The Board identification and management of information and data security

Page Annual Report and Accounts 2013/14 217 Incidents classified at severity level 1 are aggregated and reported in the table below.

Summary Of Level 1 Personal Data Related Incidents In 2013-14 Category Breach Type Total A Corruption or inability to recover electronic data 2 B Disclosed in Error 20 C Lost in Transit 6 D Lost or stolen hardware 4 E Lost or stolen paperwork 15 F Non-secure Disposal – hardware 0 G Non-secure Disposal – paperwork 0 H Uploaded to website in error 0 I Technical security failing (including hacking) 1 J Unauthorised access/disclosure 13 K Other 4

4.4 Organisations Key Risks The key organisational risks for the year were identified from the corporate strategic objectives for 2013/14, forming part of the Board Assurance Framework and included the following:

In-Year Risks Future Major and Significant Clinical Risks 2012/13 2013/14 To provide patient centred care across integrated To provide patient centred care across integrated pathways with primary / community / secondary pathways with primary / community / secondary and social care and social care • To reduce Mortality Rates within the Trust • To deliver safe and high quality care to medical • To reduce Patient Falls patients through Winter • To Reduce the Risk of Acquiring MRSA • To reduce mortality rates within the Trust Bacteraemia • To manage changes within the surgical vascular • To Reduce the Risk of Acquiring Clostridium services at BTH Difficile • To manage targets within the Trust • To achieve CQUIN Local Contractual Measures • To reduce patient falls • To implement actions from Keogh review • To reduce the risk of acquiring MRSA Bacteraemia • To continue to implement the action plan • To reduce the risk of acquiring Clostridium following the AQUA review Difficile • To achieve CQUIN Local Contractual Measures • To implement actions from Keogh review • To continue to implement the action plan following the AQUA review

Page 218 Blackpool Teaching Hospitals NHS Foundation Trust To be financially sound and able to re-invest in To be financially sound and able to re-invest in future services future services • To Implement the Trust’s electronic patient record • To achieve QuIPP improvements and deliver • Cash Balances/The Organisation needs to against cost improvement plan targets. deliver and increase Liquidity to meet Monitor’s • To implement Electronic Health Records (EDMS) Compliance Framework • To deliver the cash balances the organisation • Loss of income due to actual activity levels below needs to deliver and increase Liquidity to meet plan as a result of demand management schemes Monitor’s Compliance Framework • To maintain financial balance • To prevent significant breach of Provider Licence • To achieve QuIPP improvements Conditions • To reduce Fraud Within the Trust • To manage the loss of income due to actual • To prevent Significant Breach of Authorisation activity levels below plan as a result of demand management schemes • To reduce fraud within the Trust To deliver consistent best practice NHS care which is To deliver consistent best practice NHS care which is evidence based evidence based • To achieve Monitor’s Compliance Framework • To achieve Monitor’s Compliance Framework performance measures performance measures • To prevent the Deterioration of Quality & Safety • To fully roll out ward based Pharmacists Standards of Patient Care in line with the Francis • To ensure appropriate levels of anaesthetic cover Report when patient’s condition deteriorates out of • To maintain CNST Level 1 and 2 hours • To embed Clinical Audit Activity process within • To maintain and improve quality and safety divisions to support clinical improvement. standards of patient care in line with the Francis • To Maintain NHSLA Risk Management Standards Report General Assessment – Level 3 • To embed clinical audit activity process within • Cardiothoracic Surgical Services divisions to support clinical improvement. • To comply with Health and Safety regulations • To maintain NHSLA Risk Management Standards General Assessment – Level 3 • Cardiothoracic Surgical Services • To comply with Health and Safety regulations • To maintain CNST Level 1 and 2 To support and develop a workforce that is To support and develop a workforce that is appropriately skilled and flexible in order to achieve appropriately skilled and flexible in order to achieve the new models of working the new models of working • To Attract, Develop & Retain a Highly Skilled • To achieve Mandatory Training Compliance Workforce • To retain a safe and sufficient workforce • To reduce the Shortage of Junior and Middle • To reduce the level of vacancies of junior and Grade Doctors middle grade doctors • Ineffective Roll out and use of E-Rostering system • To effectively roll out and use of E-Rostering • To Ensure Effective Attendance Sickness and system Absence • To attract, develop and retain a highly skilled • To Achieve Mandatory Training Compliance workforce • To ensure effective attendance sickness and absence

The above risks have been Trust has taken effective action • Improvement of maternity risk assessed and managed and reduced the overall risk of patient’s experience within impact scores validated significant harm in the following • Improvement in patient by the Board of Directors. In areas: feedback in some areas of the preceding 12 months, the National Cancer Patient Survey

Page Annual Report and Accounts 2013/14 219 • Management of old onto a database for analysis. Root Wherever possible the Trust seeks Anaesthetic Machines cause analysis is undertaken and to minimise risk by deterrence, all • Delays in imaging for Inpatients, all identified changes in practice security related incident reports Out Patients and GP Fast Track are implemented. are reviewed by the LSMSs on a Patients weekly basis and investigations • Maintenance of Medical Risk Management is embedded instigated as appropriate and if Devices within the Trust within the Trust through key required a review undertaken of • Closure of Rossall Hospital committees identified in the any security measures in place for Corporate Governance Structure effectiveness. Mitigating actions against a and consists of clinical and non- number of potential significant clinical committees, which report The Trust employs a security team in-year risks 2013/14 are to the Risk Committee on a bi- for the Blackpool Victoria Hospital detailed in Section 7 of the monthly basis. site. The team are trained to a high Annual Governance Statement. standard and form an integral part Outcomes of each risk remain The security of staff, service users, of the Trusts deterrence strategy. under constant review and are carers, relatives, visitors and assessed by reviewing progress property is a key Trust priority. The Trust has a focus on positive with measurable targets, and The delivery of high levels of reporting giving details of any auditing compliance with national safety and security is critical to the security event; these consist of and local standards/regulations. delivery of the highest possible physical and non physical assaults Mitigating actions and outcomes standards of clinical care and against staff; theft or damage are monitored as a minimum on Blackpool Teaching Hospitals NHS (including burglary, arson, and a quarterly basis by the reporting Foundation Trust is committed to vandalism) to NHS property or committees identified in the risk improving the environment and equipment issued to staff; theft management strategy. Escalation sense of overall personal security or damage to staff or patients’ and de-escalation of risks is for those who access our services personal property. dependent upon progress to and for those who provide those achieve outcomes. services. We are committed to ensuring that Trust staff are properly 4.5 How Risk Management One of the key areas of work for protected and appropriate is Embedded in the Activity the Local Security Management training is recognised, as a key of the NHS Foundation Specialists (LSMS) is working to factor Conflict Resolution and reduce violence against NHS Breakaway Training and Security Trust staff, and a key part of this is to Awareness Training is offered to all Risk Management is embedded constantly measure the scale front line staff and is included as in the activity of the organisation of the problem. All staff are part of the Corporate Induction through Induction Training, encouraged to report any incident regular Risk Management Training to enable changes to be driven The lone worker system and ad-hoc training when need forward within the Trust, helping introduced within the Trust has is identified. Staff are openly to deliver an environment that is been continually financially encouraged to report incidents safe and secure for both patients supported by the Board of and near misses through the and staff. Constant development Directors. The lone worker monthly drop-in training sessions in incident reporting, action device enables staff to be better and through the corporate and planning, risk assessment and protected by discreetly calling mandatory training. The Trust ongoing monitoring ensures that for assistance in a potentially encourages reporting within all safety risks within the Trust, aggressive situation. Additionally, an open and fair culture, where including property assets, staff this ensures that staff are quickly reporting is congratulated and and patient safety, are protected, and accurately located and the individuals are not blamed or thereby allowing care to be whereabouts and movements of penalised if they speak out. An delivered without fear of violence lone workers obtained when an Untoward Incident and Serious and aggression. alert is activated. We are delighted Incident reporting system is in that the NHS lone worker service place and incidents are entered Page 220 Blackpool Teaching Hospitals NHS Foundation Trust introduced into the Trust was a policies and procedures; completing the full assessment winner at the National Personal • conducting fraud detection which details the actions to be Safety Awards 2010. This award exercises into areas of risk; taken, along with a time frame, recognises those who have • investigating any allegations of to eliminate or reduce as far as helped people to stay safe from suspected fraud; and possible any adverse impact. A violence and aggression, and • obtaining, where possible, copy of the action plan is sent to demonstrated best practice in the appropriate sanctions and the Trust’s Equality Diversity and field. redress. Human Rights Steering Group for monitoring on its progress. The Trust CCTV working group Each Division has undertaken a continues to oversee and develop self assessment and completed Equality and Diversity training the Closed Circuit Television a fraud risk assessment which is is part of the Trust’s Induction (CCTV) monitoring system, for monitored on a local level and Programme and the Trust’s overall the Blackpool Victoria, Clifton and existing controls continue to mandatory training programme. Fleetwood sites. There have been mitigate the risk. some new camera instillations 4.6 Elements of the during the 2013/14 period which The Audit Committee is a Assurance Framework were highlighted as gaps by the committee of the Board The Board Assurance Framework CCTV Working group and they of Directors and provides has been fully reviewed during cover what would be considered independent assurance on 2013/14. The Assurance critical assets to the Trust. The aspects of governance, risk Framework: CCTV improvement enhanced management and internal throughout a number of premises controls. The Risk Committee • Covers all of the Trust’s main is anticipated this will enhance the links with the Audit Committee, activities; chance of criminals being caught Quality Committee and reports • Identifies the Trust’s corporate and act as a visual deterrence to directly to the Board of Directors. objectives and targets the Trust people mindful of committing is striving to achieve; criminal offences. The security The Trust has been carrying out • Identifies the risks to the room both monitor and control Equality Impact Assessments achievement of the objectives some 150 cameras (EIA) since 2007. Since their and targets; inception within the Trust all • Identifies the system of internal Security audits have been policies, procedures, guidelines, control in place to manage the introduced within the Trust by the schemes, strategies etc have to risks; LSMS where visits to individual have a completed EIA attached • Identifies and examines departments are conducted before being sent to the relevant the review and assurance so security/safety issues can be committee for discussion and mechanisms, which relate to addressed and the LSMS can work signing off. Likewise completion the effectiveness of the system with the department to produce of an EIA is expected when there is of internal control; its own individual Lockdown a new service to be implemented, • Records the actions taken by action card. a change to a service or cessation the Board of Directors and of a service along with the Officers of the Trust to address The Trust has a zero-tolerance relevant consultation and control and assurance gaps; approach to fraud and the engagement with service users. and Counter Fraud service is provided Where an adverse impact is • Covers the CQC essential by Audit North West. This helps identified during the completion Quality and Safety Standards to embed and tackle fraud and of the initial assessment, a full on which the Trust has potential fraud in several ways: EIA is carried out. This involves registered with the CQC with consulting and engaging with no conditions during 2013/14. • developing an anti-fraud people who represent protected culture across the Trust’s characteristic groups and other The Risk Committee considers workforce; groups if required to do so. high/significant risks and if • fraud proofing of all of our An action plan is drawn up after appropriate, recommends their

Page Annual Report and Accounts 2013/14 221 inclusion on the Corporate Risk The Finance Director and the local in-patient survey and Register and/or Board Assurance Interim Associate Director patient feedback is reviewed on Framework. This is presented to of Corporate Affairs and an ongoing basis with summary the Board of Directors for formal Governance are members reports reviewed regularly by ratification. of the Risk Committee and the Board. The Chief Executive provide Governance and Risk regularly holds public “Question Risk prioritisation and action Management assurance to the Time” sessions where any planning is informed by the Trust’s Audit Committee at each of member of the public can attend corporate objectives which have its meetings, thus ensuring an and raise any issue they would like been derived from internal and integrated risk management to have addressed. external sources of risk identified approach. from national requirements and The Trust has engaged with Staff guidance, complaints, claims, The Trust manages gaps in and Public Governors to provide incident reports and Internal Audit assurance by way of the Audit them with assurance that the risks findings. This also includes any Committee who will review these across the organisation are being other sources of risk derived from gaps and assess the required managed and mitigated. The Ward, Departmental, Directorate assurances to review systems and Trust has worked with Deloitte LLP, and Divisional risk assessments, processes. an independent Management which feed up to Divisional and Company, to undertake a review of Corporate level management. 4.7 How Public the effectiveness of the Governors Action plans are developed for Stakeholders are Involved in preparation for the new Health unresolved risks. in Managing Risks Which and Social Care Act Legislation and the Trust is working with the Lead Executive Directors and Impact on Them Governors to help them fulfil in Lead Managers are identified to The Governance Framework their role. address the gaps in control and requires the Trust to involve both assurance and are responsible patients and public stakeholders Issues raised through the Trust’s for developing action plans to in the Governance agenda. This Risk Management processes that address the gaps. The Board has been achieved through impact on partner organisations, Assurance Framework serves to engagement with the Trust for example, Lancashire Care assure the Board of Directors that membership and Governors, NHS NHS Foundation Trust would the Trust is addressing its risks Blackpool, NHS North Lancashire, be discussed at the appropriate systematically. The action plan Blackpool Overview and Scrutiny forum in order that appropriate arising from each risk serves as a Committee, Lancashire Overview action can be agreed. work plan for the Trust through and Scrutiny Committee, Blackpool the Lead Managers to ensure Local Safeguarding Children’s Board, An established communications mitigation against risks and Blackpool Vulnerable Adults Board, framework is in place in the form closure of any gaps in control or Learning Disability Partnership of a Major Incident Plan, and cross- assurance. Board and Local Involvement community emergency planning Networks (LINk), now Healthwatch. arrangements are in place. The ‘elements’ of the Board The Trust has a Patient and Public Assurance Framework are Involvement Strategy in place 4.8 Disclosure of monitored and reviewed on and this has been continuously Registration Requirements a bi-monthly basis by the Risk implemented throughout 2013/14. The NHS Foundation Trust is fully Committee and the Audit This is now a core component of compliant with the registration Committee followed by the Board the Trust Membership Strategy. requirements of the CQC. of Directors. This demonstrates Public Stakeholders are consulted that the document is live and with regard to any future service Announced visit to Blackpool continuous and provides developments and changes in Teaching Hospitals NHS evidence to support the Annual service development. Foundation Trust by the CQC Governance Statement. Patient feedback is actively In January 2014, Blackpool solicited through the monthly Teaching Hospitals acute services Page 222 Blackpool Teaching Hospitals NHS Foundation Trust at Victoria Hospital, Clifton Emergency, Medical Care, Surgery, The CQC’s final report, published Hospital and Fleetwood Hospital Intensive/critical care, Maternity on 2 April, 2014 gave an overall were inspected as part of the and family planning, Children’s rating to the Trust of “requires CQC’s new national programme care, End of Life Care and improvement” with the following of inspections. This inspection was Outpatients. The CQC focussed ratings for each of the 5 key 6 months after the Keogh visit on five areas of inspection. These inspection questions: and subsequent report and action were: Are services safe, effective, plan. The CQC inspected acute caring, responsive to people’s services covering; Accident and needs and are they well-led.

Are acute services at this Trust safe? Requires Improvement Are acute services at this Trust effective? Requires Improvement Are acute services at this Trust caring? Good Are acute services at this Trust responsive? Requires Improvement Are acute services at this Trust well-led? Requires Improvement

Of the 68 individual ratings given plan has been developed and Following this visit the final 42 were good, 2 were outstanding, this has also been shared with report provided overall positive 22 were requires improvement and Commissioners. The final action feedback, however the Trust was 2 areas were deemed inadequate. plan is due to be returned to the deemed to have not met the Maternity Services were rated as CQC by 30th April 2014. standard in respect of Outcome ‘inadequate’ due to the ongoing 17: Complaints, with moderate review of PPH cases that had An action plan is currently being impact on patients using this resulted in a hysterectomy, 5 produced to ensure all matters service being identified. cases in a 6 month period. The requiring improvement will be expected range for our Trust is 2 attained. This plan will be agreed Based on the final report the Trust cases per year. The RCOG are due by the Trust Board and with our developed an action plan and to undertake their case review on commissioners and with Monitor commenced implementation of 30th April and the CQC wish to and will be implemented in the recommendations to address receive a copy of this report and to 2014/15. the areas for improvement agree with the Trust a date for re- detailed above. The Trust has inspection of the Maternity Service. Unannounced Visit – Cardiac demonstrated compliance with Directorate and the Trust’s Outcome 17. This has been Copies of the CQC reports and Complaints Service achieved by the following: the high level action plan have On 11th June 2013 the CQC been provided in the Board carried out an unannounced visit The Trust’s Operation Procedure papers. Following the Quality to Blackpool Teaching Hospitals – Patient Relations Department Summit on the 28th March it NHS Foundation Trust and (Corp/Proc/403) has been was agreed to formulate one reviewed the following standards: updated with regards to the quality improvement action plan investigation timescales to following the CQC visit. The new Outcome 1: Respecting and ensure they are manageable and CQC action plan and monitoring Involving People Who Use fit for purpose. This has been dashboard incorporates the main Services undertaken in conjunction with a areas of continued focus from the Outcome 2: Consent to Care and Non Executive Director. The Trust Keogh Action plan e.g. monitoring Treatment has also reviewed the Safeguard mortality reduction, patient Outcome 4: Care and Welfare of electronic system to ensure experience, incident reporting People Who Use Services flexibility in date recording. and staffing. The high level CQC Outcome 16: Assessing and action plan has been agreed with Monitoring the Quality of Service If a complaint is delayed a holding Commissioners and shared with Provision letter is sent to the complainant Monitor. A detailed draft action Outcome 17: Complaints and a date identified of when

Page Annual Report and Accounts 2013/14 223 the Division will have the final 4.10 Compliance with 5. Review of response mailed out to the Equality, Diversity and Economy, Efficiency complainant. Human Rights Legislation and Effectiveness of A Red Alert was developed by the Control measures are in place to Director of Nursing and Quality ensure that all Trust’s obligations the Use of Resources and the Medical Director. The under equality, diversity and Alert was sent out to all Ward human rights legislation are As at 31 March 2014 the Trust’s Managers to present to staff at complied with. This is evidenced governance risk rating status, handover for a period of one by the annual review during the published on Monitor’s website is week. An e-mail was also sent year of the Single Equality Scheme “Green”. all Consultants regarding the at the Equality and Diversity and contents of the red alert. Human Right Steering Committee The Trust achieved its planned which reports to the Clinical delivery of a Continuity of Service The completed action plan and Governance Committee. This is Rating (CoS) of 3 at the 31st March progress report detailed above also evidenced by demonstrating 2014. has been submitted to the CQC in that all procedural documents October 2013 following approval incorporate an equality impact The Trust is meeting Monitor’s by the Board. assessment prior to ratification by quarterly monitoring the relevant committee. requirements on an ongoing Unannounced Follow up Visit – basis. Complaints Service The Trust has adopted the The CQC carried out a second national NHS Employers toolkit The Trust has arrangements unannounced follow up visit on known as the Equality Delivery in place for setting objectives 26th November 2013 to review System to assist the Trust in and targets on a strategic and of the Trust’s compliance against meeting the legal requirements annual basis and during 2013/14 Outcome 17. The Trust was able of the Equality Act 2010 and the Trust has consolidated and to evidence that they were taking the Human Rights Act 1998. developed a number of systems the improvement of complaints This involves carrying out and processes to help deliver management very seriously and self assessments and public an improvement in the financial was found to be meeting the consultation grading events performance which includes the standard fully. on any work around equality following, namely: - and diversity to ensure a more inclusive approach to the access 4.9 Compliance with the • Heads of Department Budget of services and service provision. NHS Pension Scheme presentations to a group of Executive Directors and Regulations 4.11 Compliance with Non Executive Directors; As an employer with staff entitled Climate Adaptation incorporating: - to membership of the NHS Requirements under the o Department Strengths, Pension Scheme control measures Climate Change Act 2008 Weaknesses, Opportunities are in place to ensure all employer and Threats (SWOT) analysis; obligations contained within the The Trust has undertaken o Providing more care in the Scheme regulations are complied risk assessments and Carbon community; with. This includes ensuring Reduction Delivery Plans are o QuIPP ideas; that deductions from salary, in place in accordance with o Department activity plan; employer’s contributions and emergency preparedness and o Key deliverables; payments into the Scheme are in civil contingency requirements, o Clinical and quality priorities; accordance with the Scheme rules as based on UKCIP 2009 weather o Key risks and mitigations. and regulations, and that member projects, to ensure that this • Approval of the annual budgets Pension Scheme records are organisation’s obligations by the Board of Directors. accurately updated in accordance under the Climate Change Act • Monthly Finance and Business with the timescales detailed in the and the Adaptation Reporting Monitoring Committee to regulations. requirements are complied with. ensure Directors meet their

Page 224 Blackpool Teaching Hospitals NHS Foundation Trust respective financial targets successfully implemented the identifies where improvements reporting to the Board. vast majority of the action plan can be made. • Monthly Divisional matters. Those actions which • The Trust has a standard Performance Meetings require ongoing improvement, assessment process for future attended by the Executive including the Trust’s objective business plans to ensure value Team to ensure that Divisions to continue to reduce mortality for money and to ensure that meet the required level of rates will be combined with the full appraisal processes are performance for key areas. new action plan which will be employed when considering • Monthly Cash Committee formulated following the CQC the effect on the organisation is actively continuing with visit in January, 2014. Procedures are in place to measures to further improve • The Divisions play an active part ensure all strategic decisions cash balances which reports in ongoing review of financial are considered by the Board of to the Finance and Business performance including Cost Directors. Monitoring Committee. The Improvement Requirements / Cash Committee has minimised QuIPP delivery. the risk of the Trust using • Monthly reporting to the the Working Capital Facility. Board of Directors on key 6. Annual Quality The measures taken include performance indicators Report creditor stretch, improvements covering Finance activity; in receivables processes Quality and Safety activity and The Trust’s Directors are required and improvements to cash Human Resource targets. under the Health Act 2009 and the forecasting. • Weekly reporting to the National Health Service (Quality • The Trust has in place a Executive Team on key Accounts) Regulations 2010 (as Programme Management influences on the Trust’s amended) to prepare Quality Office to scrutinise CIP planning financial position including Accounts for each financial year. and delivery. In addition, activity on quality and safety Monitor has issued guidance to the Trust is utilising external performance and workforce NHS Foundation Trust Boards on support to identify areas of indicators. the form and content of Annual improvement and develop Quality Reports which incorporate / implement action plans to The Trust also participates in the above legal requirements in deliver the required efficiency. initiatives to ensure value for the NHS Foundation Trust Annual • In light of the Francis Report on money, for example: - Reporting Manual. Mid Staffordshire Hospitals and the Trust being identified as • Value for money is an important The Trust has built on the having high mortality rates, the component of the Internal extensive work undertaken to Trust was selected as part of the and External Audit plans that develop the Quality Account review by a national advisory provide assurance to the Trust and has drawn on the various group set up by NHS Medical regarding processes that are guidance published in-year Director, Sir Bruce Keogh into in place to ensure the effective in relation to the Quality 14 hospitals which had higher use of resources. Account. We developed our than expected mortality rates. • In-year cost pressures are vision, values and priorities Further details are outlined rigorously reviewed and through wide involvement and in section 7. The review took challenged, and mitigating in consultation with patients, place from the 17th June 2013. strategies are considered. staff, external stakeholders and Sir Bruce Keogh published • The Trust subscribes to a Governors. The consultation his report summarising the national benchmarking of the Quality Account was findings and actions the organisation (CHKS). This launched and included a number Trust needed to take. From provides comparative of presentations made to the this, the Trust produced an information analysis on Council of Governors on Quality action plan based on the patient activity and clinical Accounts, a workshop session findings of the Keogh review, indicators. This informs the with representatives from the and monitored and has now risk management process and Council of Governors and Local

Page Annual Report and Accounts 2013/14 225 Healthwatch (previously known to ensure the accuracy of data. these areas against regulatory as LINk) as well as members of the These steps cover the following requirements and approved public. In addition a website was areas as detailed below: plans and objectives. developed to obtain the views of the public regarding the quality • Governance and Leadership • People and Skills accounts priorities for 2012/13. The quality improvement The ‘Blackpool Way’, now Through this engagement, the system is led directly by the renamed the “Trust Way”, Trust was able to ensure the areas Board of Directors which outlines and reinforces the chosen provided a balanced view also exercises its governance expected behaviour across the of the organisation’s priorities for responsibilities through Trust and actively encourages 2013/2014. In the preparation monitoring and review of the and supports employees to of the Quality Account, the Trust Trust’s quality performance. gain the skills and qualifications appointed a Quality Account The Risk Committee reporting that will support their future Project Lead to develop the directly to the Board leads employability and meet the Quality Account, reporting direct the quality improvement needs of the organisation. to the Director of Nursing and strategy and reviews quality Locally the focus in 2013/14 Quality, and a Quality Account improvement projects on a was to continue developing Steering Group was established. regular basis. managers in coaching and A formal review process was leadership skills particularly for established, involving the • Policies those colleagues who lead our submission of our initial draft Key policies for quality clinical teams to ensure that all Quality Report to our external improvement are in place staff are safe to practice and to stakeholders (Commissioners, and these are linked to risk care for our patients. Overview and Scrutiny management and clinical Committees and Healthwatch). governance policies. Trust data The Learning and Development The Quality Account drafts were quality policies and procedures Team continues to provide skills formally reviewed through the score highly on the national support through widening Trust’s governance arrangements, Information Governance access to education for staff in formal Executive Directors’ Toolkit and all evidence is the workforce. The purpose is meeting and the Board of delivered and audited. Data to ensure that all staff are skilled, Directors. The Trust set 2013/14 quality reports are developed competent and able to make a priorities for improvement for and submitted through the full contribution to the success clinical effectiveness, quality of the Health Informatics Committee, of the organisation. patient experience and patient Performance Board and safety. Priorities were developed through to the Trust Board. • Data Use and Reporting to embed and monitor quality Data quality staff are in post The Trust is provided with improvement processes, set with relevant job descriptions external assurance on a against the needs of our patients whose remit is to provide selection of the quality data in the delivery of our services. training, advice and review identified within the Quality and (where applicable) correct Report which was taken from The Board of Directors can anomalies. national data submissions, confirm that they have met the CHKS and national patient necessary requirements under the • Systems and Processes survey results, Local Inpatient Health Act 2009 and the National The Board of Directors ensures Survey results and Information Health Service (Quality Accounts) that adequate systems and Governance Toolkit results. Regulations 2010 to prepare its processes are maintained to Local internal assurance is also Quality Accounts for the financial measure and monitor the provided via the analysis of year 2013/14. Steps have been Trust’s effectiveness, efficiency data following local internally put in place to assure the Board and economy as well as the led audits in relation to nursing that the Quality Report presents quality of its healthcare delivery. care indicators, analysis of data a balanced view and that there The Board regularly reviews following incidents in relation are appropriate controls in place the performance of the Trust in to medication errors and

Page 226 Blackpool Teaching Hospitals NHS Foundation Trust slips, trips and falls incidents all Divisions have implemented continuous improvement of the for patients. The quality and the actions required to meet the system is in place. safety metrics are also reported quality standards. Monitoring was monthly to the Board through overseen through a number of In describing the process that has the business monitoring report committees and forums. been applied in maintaining and and the quality and safety reviewing the effectiveness of the report. The Board of Directors at the system of internal control, I have Trust can confirm it has the detailed below some examples The Trust has a fully controlled appropriate mechanisms in of the work undertaken and the process for the provision of place to prepare, approve and role of the Board of Directors, external information with publish its Quality Report for the Audit Committee, Quality control checks throughout 2013/14. The Board of Directors is Committee, Clinical Audit, Internal the process. Formal sign satisfied that the Quality Report Audit and External Audit in this off procedures and key provides a balanced view and the process. My review has been performance indicators on appropriate controls are in place informed by: data are submitted through to ensure accuracy of data and a the Information Management true reflection of overall quality • The self-assessment of the Department. within the organisation. maintenance of compliance against NHSLA Level 3 Risk Data reporting is validated by Management Standards status internal and external control that provided assurance on systems involving Clinical Audit, 7. Review of controls. the Audit Commission and Effectiveness • The self-assessment of the Senior Manager and Executive maintenance of compliance Director reviews. As Accounting Officer, I have against CNST Maternity Level 2. responsibility for reviewing the • Self-assessment of the Trust’s The Trust has reviewed its effectiveness of the system of performance against the Key objectives and re-emphasised its internal control. My review of Lines of Enquiry for Auditors commitment to quality, with the the effectiveness of the system Local Evaluation standards aim of achieving excellence in of internal control is informed by and the progress of this review everything it does. Its aspirations the work of the internal auditors, was considered by the Audit for quality improvement in clinical audit and the executive Committee throughout the 2013/14 were to: managers and clinical leads within current year. the Trust who have responsibility • The Clinical Quality Department • Improve our hospital for the development and facilitates the participation in standardised mortality rate; maintenance of the internal projects and monitoring of • Conform to best practice by control framework. I have drawn reports that result from national fully implementing Advancing on the content of the quality clinical audits. In response to Quality, 100,000 Lives and report attached to this Annual the audit findings, the Clinical Saving Lives interventions; Report and other performance Audit Group monitors the • Reduce avoidable harms; and information available to me. actions taken to improve the • Improve the patient experience. My review is also informed by patient safety and quality The Trust has maintained progress comments made by the external outcomes and an assurance to deliver top 10% performance auditors in their Management report is provided to the Audit for clinical quality and has Letter and other reports. I have Committee and the Board of strengthened its performance been advised on the implications Directors. management structure in of the result of my review of the • Internal Audit reviewed the relation to delivering the CQC effectiveness of the system of Board Assurance Framework quality and safety standards. The internal control by the Board, and the effectiveness of the Trust believes quality should be the Audit Committee and overall system of internal supported at every level of the Quality Committee and a plan to control as part of the Internal organisation and has ensured that address weaknesses and ensure Audit Annual Plan which is

Page Annual Report and Accounts 2013/14 227 agreed by the Chief Executive by the Board and on a regular • Procurement (Part 2) and the Audit Committee. basis by the Audit Committee, • Business Planning Processes and the Risk Committee. The Head of Internal Audit We do not consider the ratings, Opinion It should be noted that despite and specifically the detailed Our overall opinion is that our positive conclusion around findings within the reviews, to significant assurance can be given the overall framework for impact upon our overall audit that there is a generally sound seeking and receiving assurance opinion on internal control system of internal control on around strategic risks, we do within the Trust, for the following key financial and management not feel that the BAF document reasons: processes. These are designed as currently used reflects the to meet the Trust’s objectives, totality of the strategic risks • the areas of individual review and controls are generally being facing the Trust. This is principally and risk, and/or gaps in control applied consistently. due to the risks not being found, do not have a significant added to in year. The way the impact on the system of The basis for forming our opinion Board manages its approach internal control; and is as follows: to identifying, managing and • those areas of risk identified monitoring strategic risks would not necessarily be • An assessment of the could be considerably more classified as significant risks design and operation of the systematic and efficient. The according to the definitions underpinning Assurance Trust has recognised this and used in the assurance Framework and supporting are currently implementing new framework processes; and risk management processes • An assessment of the individual throughout the organisation. No significant issues remained opinions arising from risk-based outstanding as at the year end audit assignments completed We have raised a series of which would impact upon our in line with our annual audit recommendations over the past opinion. plan to 31 March 2014. Our 18 months around the format of assessment takes into account the document and operation of Internal Audit provided an overall the relative materiality of these governance around the BAF, to significant assurance opinion for areas. bring it in line with best practice. 2013/14. This conclusion was We do not consider these issues to formed following the completion Commentary affect our overall annual opinion on of 5 core reviews, of which two The commentary below provides assurance and risk management received moderate assurance the context for our opinion and but would recommend the Trust and three received significant together with the opinion should take action to address issues assurance. be read in its entirety. identified in relation to the BAF to improve the strength of the A further 11 strategic reviews The design and operation of assurance the BAF provides, and the were also completed. Two the Assurance Framework and efficiency of its operation. reviews, in relation to associated processes procurement and business A range of individual opinions planning processes, received Our review found that the arising from risk-based audit limited assurance opinions. The Assurance Framework in place assignments, contained within Trust identified these two areas is founded on a systematic risk-based plans that have been for review based on known risks. risk management process and reported throughout the year. Our findings are not indicative of provides appropriate assurance to significant issues with the system the Board. During the year we have of internal control within the Trust undertaken two reviews which and have therefore no impacted The Board Assurance Framework were given Limited Assurance upon our significant assurance reflects the key risks to the Trust ratings. These were based on risk opinion. and is reviewed at least quarterly areas identified by the Trust:

Page 228 Blackpool Teaching Hospitals NHS Foundation Trust Actions have been agreed to • The Board of Directors, Risk As at 31st March 2014, the Trust address recommendations Committee, Audit Committee, had the following potential raised in the year with the aim to Executive Directors Meeting significant risks identified which improve the systems of control. and the Quality Committee are currently being mitigated, Management have already have advised me on the although in 2013/14 they implemented or are in the process implications of the result of my could have a direct bearing on of implementing these actions in review of the effectiveness of compliance with the terms of order to improve systems of internal the system of internal control. Authorisation, CQC registration control in the areas identified. The These committees also advise or the achievement of corporate Audit Committee monitors the outside agencies and myself on objectives should the mitigation implementation of the action serious untoward events. plans be ineffective: plans and progress against the recommendations made in order • All of the relevant committees • In relation to clinical to be provided with assurance that within the Corporate sustainability and quality risk improvements are made Governance Structure have a and ensuring the reduction clear timetable of meetings and in Hospital Standardised • The Trust maintained a clear reporting structure to Mortality Index (Dr Foster) registration with the CQC allow issues to be raised. and the Summary Hospital without compliance conditions Mortality Indicators, the Trust for 2013/14. • The Quality Committee has embarked on an intensive manages and reviews the plan for reducing mortality • The Trust’s assessment of 82% Board Assurance Framework both in hospital and within compliance (Satisfactory) with in conjunction with Executive 30 days of discharge. A series the Information Governance Directors. The minutes of of distinct work streams have Toolkit standards for 2013/14 the Quality Committee are been developed to ensure (version 11) demonstrates a presented to the Board that national mortality ratio high level of compliance with of Directors. The Quality measures accurately reflect the requirements set. Committee produce an annual the Trust’s position as well as Risk Management report, ensuring safe, appropriate • The Annual Risk Management which is presented to the Audit and harm free care is being Report and the Quality and Committee followed by the delivered. Safety Report, which evidence Board of Directors and this action on all aspects of provides assurance on controls. At the same time we have governance including, risk maintained our focus on harm management. • The Audit Committee reduction strategies such as review the establishment improving staffing, reducing • The Board Assurance and maintenance of an medical outliers (medical Framework itself provides the effective system of Integrated patients receiving treatment on Trust with evidence of the Governance, Risk Management non-medical wards), hospital effectiveness of the system of and internal control across the acquired infections and internal controls that manage whole of the Trust’s activities medication errors. Progress on the risks to the organisation. The (both clinical and non-clinical) all these objectives has been Board of Directors also monitor that supports the achievement reported to the Board on a and review the effectiveness of of the overall Trust objectives. regular basis. The emphasis has the Board Assurance Framework The Audit Committee been on improving processes on a quarterly basis. Internal review the Board Assurance so that the improvements Audit provided a Significant Framework on a quarterly basis. are local, measurable and Assurance opinion on the Board immediate and are owned by Assurance process. As the Vision, • The Trust has a robust process the team providing the care. Aims and objectives of the Trust for ensuring recommendations are updated, so too is the BAF. made in assurance reports are The Trust has shown a implemented on a timely basis. significant and sustained

Page Annual Report and Accounts 2013/14 229 improvement in not only Risk • As reported elsewhere in this report will be produced in the Adjusted Mortality Index (RAMI) statement, the CQC inspected near future. over the last three years but the Trust in January, 2014 has also since July 2012 shown and gave the Trust a rating of • In relation to the financial marked improvements in HSMR “requires improvement”. performance and the and SHMI mortality measures economic downturn risk, the that have historically portrayed • The Trust achieved the Trust achieved a Continuity of the Trust in a poor light. The Clostridium Difficile targets Service Rating of 3 in 2013/14. Trust has a mortality action plan during 2013/14. To mitigate In response to the potential and progress is monitored by the risk of breaching the Trust’s stabilisation or fall in NHS the Mortality Board and the infection prevention targets, income, and potential failure Board of Directors on a monthly we continued to deliver a wide of CCG demand management basis to ensure improvements ranging programme of work schemes we identified a risk are made. As at March 2014 the which emphasises to all staff in respect of CCG affordability Trust has delivered the planned that remaining compliant and this risk was adequately reduction in its SHMI rate, and with the requirements of the mitigated in 2013/14. A is now within the expected Code of Practice for Healthcare satisfactory outcome was range for a Trust of our size and Associated Infections is achieved with a level-3 CoS complexity. everyone’s responsibility. rating which, under Monitor’s Ongoing mitigation included: Compliance Framework, • In light of the Francis Report on indicates sound financial Mid Staffordshire Hospitals and (i) Continuing to raise performance. the Trust being identified as awareness and leading by having high mortality rates, the example; • In relation to the Transforming Trust was selected as part of the Community Services risk, the review by a national advisory (ii) Ongoing audits of Trust took on the provider arm group set up by NHS Medical compliance to ensure of NHS Blackpool and part of Director, Sir Bruce Keogh into all infection prevention NHS North Lancashire as at 14 hospitals which had higher and control policies and 1st April 2012. Performance than expected mortality rates. procedures continue of integration was monitored Further details are outlined to be implemented, through achievement in section 7. The review took including in particular hand of actions in the Post place from the 17th June 2013. hygiene, environmental Transaction Action Plan by the Sir Bruce Keogh published and decontamination Transformation Programme his report summarising the standards; and Board. Strategic issues are findings and actions the Trust addressed through formal and needed to take. From this, the (iii) Training on all aspects informal reports to the Board. Trust produced an action plan of infection prevention The Pre Transaction Action Plan based on the findings of the continues to be delivered; and Benefits Realisation Plan Keogh review, and monitored was monitored and signed off and has now successfully (iv) Outcomes were assessed by the Board in April 2012. The implemented the vast majority by reviewing progress New ‘Families’ and Community of the action plan matters. with the Clostridium Adults/Long Term Conditions Those actions which required Difficile target and auditing Divisions has been formally ongoing improvement, compliance with national integrated into the organisation including the Trust’s objective standards/regulations. in April 2013. Work is ongoing to continue to reduce mortality on pathway redesign and rates will be combined with • Towards the end of the 2013/14 improved service modelling. the new CQC inspection action financial year, the Trust had one Close working relationships plan which will be formulated “never event”. At the time of have been established following the CQC visit in writing this report, this incident with the local Clinical January, 2014. is being investigated and a full Commissioning Groups, Local

Page 230 Blackpool Teaching Hospitals NHS Foundation Trust Authorities and the National tertiary services, and can be with third party suppliers, for Commissioning Board to updated by relevant healthcare both clinical systems that are identify and implement service professionals across these currently in use and proposed development, improvements services. Given this, the Trust’s new clinical systems, in order and new models of care, as forward strategy will be one to ensure that the Trust identified through the Strategic that is based on the integration achieves its aim of electronic Framework. Friends and Family of existing systems, along with health records. The Trust has Test is being undertaken, the use of multiple specialist reconfigured its Executive team Patient Experience Revolution systems, with all systems being to create a Board level post of project instigated, Ward Audits used across the Trust’s range of Director of Information, which it and Patient Led Assessment of geographic settings and linked hopes to recruit to in 2014/15. Care Environment (PLACE) are via interoperability. undertaken. The Trust has engaged with • In relation to failing to ALERT Life Sciences Computing, 8. Conclusion implement ALERT as the and the parties have mutually My review of the effectiveness of Trust’s full electronic patient agreed to a change in scope the systems of internal control record, the Trust has reviewed of the ALERT® deployment in has taken account of the work its strategic approach to order to support the Trust’s of the Executive Management the development and revised way of working. It has Team within the organisation, implementation of electronic been agreed that the Trust will which has responsibility for the health records across the continue to use the ALERT® development and maintenance local health community. The solution in the A&E Department of the internal control framework Trust recognises that it must at the Trust and in a selected within their discreet portfolios. ensure that electronic health number of outpatient services In line with the guidance on records are readily accessible including Senior Review Clinic, the definition of the significant across all healthcare services the Colposcopy Outpatients internal control issues, I have not and geographic settings, Service and the Paediatric identified any significant control including GPs, community Diabetes Outpatients Service. issues. services, acute services and The Trust will be engaging

Signed: Date: 21st May 2014

Gary Doherty Chief Executive

Page Annual Report and Accounts 2013/14 231 Annex F: Independent Auditor’s Report To The Council of Governors

Independent auditors’ report to the Council of Governors of Blackpool Teaching Hospitals NHS Foundation Trust

13. the Statement of Cash Flows An audit involves obtaining Report on the for the year ; evidence about the amounts Financial Statements 14. the Statement of Changes in and disclosures in the financial Taxpayers’ Equity for the year; statements sufficient to give Our opinion and reasonable assurance that the In our opinion the financial 15. the notes to the financial financial statements are free from statements, defined below: statements, which include material misstatement, whether a summary of significant caused by fraud or error. This 9. give a true and fair view of the accounting policies includes an assessment of: state of the NHS Foundation and other explanatory Trust’s affairs as at 31 March information. • whether the accounting 2014 and of its income and policies are appropriate to expenditure and cash flows The financial reporting framework the NHS Foundation Trust’s for the year then ended ; and that has been applied in their circumstances and have been preparation is the NHS Foundation consistently applied and 10. have been prepared in Trust Annual Reporting adequately disclosed; accordance with the NHS Manual 2013/14 issued by the Foundation Trust Annual Independent Regulator of NHS • the reasonableness of Reporting Manual 2013/14. Foundation Trusts (“Monitor”). significant accounting estimates made by the This opinion is to be read in the In applying the financial reporting directors; and context of what we say in the framework, the directors have remainder of this report. made a number of subjective • the overall presentation of the judgements, for example in respect financial statements. of significant accounting estimates. What we have audited? In making such estimates, they In addition, we read all the The financial statements, which have made assumptions and financial and non-financial are prepared by Blackpool considered future events. information in the Annual Report Teaching Hospitals NHS to identify material inconsistencies Foundation Trust, comprise: What an audit of financial with the audited financial statements involves? statements and to identify any 11. the Statement of Financial information that is apparently We conducted our audit in Position as at 31 March 2014; materially incorrect based on, accordance with International 12. the Statement of or materially inconsistent with, Standards on Auditing (UK and Comprehensive Income for the knowledge acquired by us the year ; Ireland) (“ISAs (UK & Ireland)”).

Page 232 Blackpool Teaching Hospitals NHS Foundation Trust in the course of performing the • in our opinion the Annual Reporting Manual 2013/14. audit. If we become aware of any Governance Statement does Our responsibility is to audit apparent material misstatements not meet the disclosure and express an opinion on or inconsistencies we consider the requirements set out in the the financial statements in implications for our report. NHS Foundation Trust Annual accordance with the National Reporting Manual 2013/14 or is Health Service Act 2006, the Audit misleading or inconsistent with Code for NHS Foundation Trusts information of which we are issued by Monitor and ISAs (UK & Opinion on other aware from our audit. We are not Ireland). Those standards require matters prescribed required to consider, nor have us to comply with the Auditing we considered, whether the Practices Board’s Ethical Standards by the Audit Code Annual Governance Statement for Auditors. for NHS Foundation addresses all risks and controls or that risks are satisfactorily This report, including the Trusts addressed by internal controls; opinions, has been prepared • we have not been able to for and only for the Council of In our opinion: satisfy ourselves that the NHS Governors of Blackpool Teaching

Foundation Trust has made Hospitals NHS Foundation Trust in • the information given in proper arrangements for accordance with paragraph 24 of the Strategic Report and securing economy, efficiency Schedule 7 of the National Health the Directors’ Report for and effectiveness in its use of Service Act 2006 and for no other the financial year for which resources; or purpose. We do not, in giving the financial statements are • we have qualified, on any these opinions, accept or assume prepared is consistent with the aspect, our opinion on the responsibility for any other financial statements; and Quality Report. purpose or to any other person to • the part of the Directors’ whom this report is shown or into Remuneration Report to be whose hands it may come save audited has been properly Responsibilities for the where expressly agreed by our prepared in accordance with the Financial Statements and prior consent in writing. NHS Foundation Trust Annual the audit. Reporting Manual 2013/14. Our responsibilities and those Certificate. of the directors Other matters on which we As explained more fully in We certify that we have completed are required to report by the Directors’ Responsibilities the audit of the financial statements in accordance with the exception. Statement the directors are responsible for the preparation of requirements of Chapter 5 of Part We have nothing to report in the financial statements and for 2 to the National Health Service respect of the following matters being satisfied that they give a true Act 2006 and the Audit Code for where the Audit Code for NHS and fair view in accordance with NHS Foundation Trusts issued by Foundation Trusts requires us to the NHS Foundation Trust Annual Monitor. report to you if:

Rachel McIlwraith (Senior Statutory Auditor) for and on behalf of PricewaterhouseCoopers LLP Chartered Accountants and Statutory Auditors Manchester 28th May 2014

(a) The maintenance and integrity of the Blackpool Teaching Hospitals NHS Foundation Trust website is the responsibility of the directors; the work carried out by the auditors does not involve consideration of these matters and, accordingly, the auditors accept no responsibility for any changes that may have occurred to the financial statements since they were initially presented on the website. (b) Legislation in the United Kingdom governing the preparation and dissemination of financial statements may differ from legislation in other jurisdictions.

Page Annual Report and Accounts 2013/14 233 Annex G: Accounts for the Period 1st April 2013 to 31st March 2014

Foreword To The Account

BLACKPOOL TEACHING HOSPITALS NHS FOUNDATION TRUST

These accounts for the period ended 31st March 2014 have previously been prepared by Blackpool Teaching Hospitals NHS Foundation Trust in accordance with Schedule 7, Sections 24 and 25 of the National Health Services Act 2006 in the form which Monitor (the Independent Regulator of foundation trusts) has directed.

Signed: Date: 21st May 2014

Gary Doherty Chief Executive

Page 234 Blackpool Teaching Hospitals NHS Foundation Trust Annual Accounts 2013/14

STATEMENT OF COMPREHENSIVE INCOME FOR THE YEAR ENDED 31 March 2014

2013/14 2012/13

NOTE £000 £000

Income from activities 3 347,254 333,315 Other operating income 4 25,951 34,409

Operating income 373,205 367,724

Operating expenses 5 (380,419) (358,149)

OPERATING (DEFICIT) / SURPLUS (7,214) 9,575

Finance Costs Finance income 8 68 184 Finance costs 9 (1,261) (2,343) Public Dividend Capital dividends payable (4,003) (4,204)

Net Finance Costs (5,196) (6,363)

(DEFICIT) / SURPLUS FOR THE YEAR (12,410) 3,212

Surplus for the financial year before exceptional items 3,355 3,375 Exceptional items Net (loss)/gain from non current asset impairments 11 (14,686) 3,977 Net (loss) on disposal of non current assets 7 (197) (3,095) Redundancy 6 (882) (1,045) (Deficit) / Surplus for the financial year after exceptional items as stated above (12,410) 3,212

Other comprehensive income: Gain from transfer by absorption from demising bodies 173 0 Revaluation losses on property, plant and equipment 11 (5,889) (997) Revaluation gains on property, plant and equipment 11 4,727 4,407

TOTAL COMPREHENSIVE INCOME FOR THE YEAR (13,399) 6,622

The notes on pages v to xxxvi form part of these accounts. All revenue and expenditure is derived from continuing operations.

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STATEMENT OF FINANCIAL POSITION AS AT 31ST MARCH 2014

31st March 31st March 1st April 2014 2013 2012 NOTE £000 £000 £000 NON-CURRENT ASSETS: Intangible assets 10 2,094 2,178 4,487 Property, plant and equipment 11 189,677 192,591 185,392 Trade and other receivables 15 620 549 913 Total non-current assets 192,391 195,318 190,792

CURRENT ASSETS: Inventories 14 2,314 2,394 2,279 Trade and other receivables 15 12,492 11,440 9,942 Cash and cash equivalents 16 25,292 27,358 19,641 Total current assets 40,098 41,192 31,862

CURRENT LIABILITIES: Trade and other payables 17 (35,808) (32,080) (29,138) Borrowings 19 (3,172) (2,762) (2,637) Provisions 20 (5,103) (5,412) (4,376) Other liabilities 18 (5,060) (5,673) (5,581) Total current liabilities (49,143) (45,927) (41,732)

NON-CURRENT LIABILITIES: Borrowings 19 (40,430) (37,568) (34,600) Provisions 20 (1,924) (1,233) (1,162) Total non-current liabilities (42,354) (38,801) (35,762)

TOTAL ASSETS EMPLOYED 140,992 151,782 145,160

TAXPAYERS' EQUITY Public dividend capital Page iii 143,640 141,031 141,031 Revaluation reserve Page iii 26,201 27,467 26,094 Income and expenditure reserve Page iii (28,849) (16,716) (21,965)

TOTAL TAXPAYERS' EQUITY 140,992 151,782 145,160

The financial statements on pages v to xxxvi were approved by the NHS Foundation Trust Board on 21 May 2014 and are signed on its behalf by:

Signed: Gary Doherty, Chief Executive Date: 21 May 2014

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STATEMENT OF CHANGES IN TAXPAYERS' EQUITY AT 31st March 2014

Total Public Revaluation Income and taxpayers' Dividend reserve Expenditure equity Capital reserve NOTE £000 £000 £000 £000

Taxpayers' equity at 1 April 2013 151,782 141,031 27,467 (16,716) Total Comprehensive Expense for the year: Deficit for the financial year (12,410) 0 0 (12,410) Transfers by modified absorption: Gain on 1 April 2013 transfers from demising bodies 173 0 0 173 Transfers by modified absorption: transfers between reserves 0 0 3 (3) Impairment of property, plant & equipment 11 (5,889) 0 (5,889) 0 Revaluation gains on property, plant & equipment 11 4,727 0 4,727 0 Public Dividend Capital Received 13 2,583 2,583 0 0 PDC adjustment for cash impact of payables/receivables transferred from legacy teams 13 26 26 0 0 Transfer between reserves 0 0 (107) 107 Taxpayers' equity at 31st March 2014 140,992 143,640 26,201 (28,849)

Taxpayers' equity at 1 April 2012 145,160 141,031 26,094 (21,965) Total Comprehensive Income for the year: Surplus for the financial year 3,212 0 0 3,212 Impairment of property, plant & equipment 11 (997) 0 (997) 0 Revaluation gains on property, plant & equipment 11 4,407 0 4,407 0 Transfer between reserves 0 0 (2,037) 2,037 Taxpayers' equity at 31st March 2013 151,782 141,031 27,467 (16,716)

The notes on pages v to xxxvi form part of these accounts.

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CASH FLOW STATEMENT FOR THE YEAR ENDED 31st March 2014

Year ended Year ended 31st March 31st March NOTE 2014 2013 £000 £000

Cash flows from operations Total operating (deficit) / surplus (7,214) 9,575 Adjusted for: Depreciation 11 5,408 5,566 Amortisation 10 682 1,101 Impairments 11 17,212 1,409 Reversal of Impairments 11 (2,526) (5,387) Increase in trade and other receivables (898) (1,409) Decrease/(increase) in inventories 80 (115) Increase in trade and other payables 2,579 2,544 (Decrease)/increase in other liabilities (613) 91 Increase in provisions 277 1,020 Other movements in operating cash flows 155 2,452 Net cash generated from operations 15,142 16,847

Cash flows from investing activities Interest received 101 185 Purchase of property, plant and equipment (17,157) (6,491) Purchase of intangible assets (553) (222) Sales of property, plant and equipment 0 470 Net cash used in investing activities (17,609) (6,058)

Cash flows from financing activities Public Dividend Capital received 2,583 0 Loans received 6,100 13,300 Loans repaid to the Department of Health (2,828) (2,485) Capital element of on-statement of financial position PFI repaid 0 (7,722) Interest paid (1,198) (970) Interest paid in respect of on-statement of financial position PFI 0 (472) Finance charge in respect of on-statement of financial position PFI termination 0 (794) Public Dividend Capital dividends paid (4,256) (3,929) Net cash generated from / used in financing activities 401 (3,072)

(Decrease) / Increase in cash and cash equivalents (2,066) 7,717

Cash and cash equivalents at the beginning of the financial year 27,358 19,641

Cash and cash equivalents at the end of the financial year 16 25,292 27,358

The notes on pages v to xxxvi form part of these accounts. All revenue and expenditure is derived from continuing operations.

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NOTES TO THE ACCOUNTS 1. Accounting policies and other information

Monitor has directed that the financial statements of NHS Foundation Trusts shall meet the accounting requirements of the NHS Foundation Trust Annual Reporting Manual which has been agreed with HM Treasury. Consequently, the following financial statements have been prepared in accordance with the 2013/14 NHS Foundation Trust Annual Reporting Manual issued by Monitor. The accounting policies contained in that manual follow International Financial Reporting Standards (IFRS) and HM Treasury’s Financial Reporting Manual (the "FReM") to the extent that they are meaningful and appropriate to NHS Foundation Trusts. The accounting policies have been applied consistently unless otherwise stated in dealing with items considered material in relation to the accounts. Accounting convention These accounts have been prepared under the historical cost convention modified to account for the revaluation of certain non-current assets.

1.1 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 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. The NHS Foundation Trust estimates the month 12 patient related income based on an average cost for the activity delivered in the month for each speciality, as fully coded Healthcare Resource Group (HRG) data is not available in time for the closure of the annual accounts. The NHS Foundation Trust receives income under the NHS Injury Cost Recovery Scheme, designed to reclaim the cost of treating injured individuals to whom personal injury compensation has subsequently been paid e.g. by an insurer. The NHS Foundation Trust recognises the income when it receives notification from the Department of Work and Pension's Compensation Recovery Unit (CRU) that the individual has lodged a compensation claim. The income is measured at the agreed tariff for the treatments provided to the injured individual, less a provision for unsuccessful compensation claims and doubtful debts.

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 less the carrying amount of the asset sold.

1.2 Expenditure on 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. Pension Costs NHS 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 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. Employers 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 NHS Foundation Trust commits itself to the retirement, regardless of the method of payment.

1.3 Expenditure on other goods and services Expenditure on goods and services is recognised when, and to the extent that they have been received, and is measured at the fair value of those goods and services. Expenditure is recognised in operating expenses except where it results in the creation of a non-current asset such as property, plant and equipment.

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1.4 Exceptional items Exceptional Items are those items that, in the NHS Foundation Trust's view, are required to be disclosed separately by virtue of their size or incidence to enable a full understanding of the Trust's financial performance.

1.5 Property, Plant and Equipment Recognition 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 NHS Foun dation Trust; • it is expected to be used for more than one financial year; and • the cost of the item can be measured reliably. Additionally, for items of property, plant and equipment to be capitalised they: • individually have a cost of at least £5,000; or • form a group of assets which collectively have a cost of at least £5,000, where the assets are functionally interdependent, they had broadly simultaneous purchase dates, are anticipated to have simultaneous disposal dates and are under single managerial control; or • form part of the initial setting-up cost of a new building or refurbishment of a ward or unit, irrespective of their individual or collective cost. Measurement Valuation All property, plant and equipment assets are measured initially at cost, representing the costs directly attributable to acquiring or constructing the asset and bringing it to the location and condition necessary for it to be capable of operating in the manner intended by management. Land and buildings are subsequently measured at fair value based on periodic valuations less subsequent depreciation and impairment losses. The valuations are carried out by professionally qualified valuers in accordance with the Royal Institute of Chartered Surveyors (RICS) Appraisal and Valuation Manual, and performed with sufficient regularity to ensure that the carrying value is not materially different from fair value at the reporting date. Fair values are determined as follows:

- Specialised operational property - Depreciated Replacement Cost using a Modern Equivalent Asset (MEA) approach - Non specialised property - Existing Use Value - Land - Market value for existing use Assets in the course of construction are valued 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 (Borrowing Costs) for assets held at fair value. Assets are revalued when they are brought into use. Operational plant and equipment are carried at depreciated historic cost as this is not considered to be materially different to fair value. Plant and equipment surplus to requirements is valued at net recoverable amount. Subsequent expenditure Where subsequent expenditure enhances an asset beyond its original specification, the directly attributable cost is added to the asset's carrying value. Where subsequent expenditure is simply restoring the asset to the specification assumed by its economic useful life then the expenditure is charged to operating expenses.

Depreciation Items of property, plant and equipment are depreciated using the straight line method over their estimated useful economic lives as follows: Buildings & Dwellings 90 years Plant & Machinery 5 to 15 years Transport equipment 5 to 10 years Information Technology 5 to 15 years Furniture & Fittings 5 to 15 years Freehold land is considered to have an infinite life and is not depreciated. Management have determined that each building within the NHS Foundation Trust's estate is one component, the whole of which is maintained to a standard such that the useful economic life of the whole building and the elements within the building is the same. The assets' residual values and useful lives are reviewed annually, where significant. Property, plant and equipment which has been reclassified as 'held for sale' ceases to be depreciated upon the reclassification. Assets in the course of construction are not depreciated until the asset is brought into use.

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1.5 Property, Plant and Equipment continued Depreciation is charged to operating expenses from the first day of the quarter commencing 1st April, 1st July, 1st October, or 1st January, following the date that the asset becomes available for use. Depreciation is charged in full in the quarter in which an asset becomes unavailable for use or is sold and then ceases to be charged. Where assets are revalued any accumulated depreciation is eliminated against the gross carrying amount of the asset with the net amount restated to equal the revalued amount. 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'. Impairments In accordance with the FT ARM, impairments that are due to a loss of economic benefit 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 revaluation reserve. Where, at the time of the original impairment, a transfer was made from the revaluation reserve to the income and expenditure reserve, an amount is transferred back to the revaluation reserve when the impairment is recognised. Other impairments are treated as revaluation losses. Reversals of 'other impairments' are treated as revaluation gains.

De-recognition Assets intended for disposal are reclassified as 'held for sale' once all of the following criteria are met: • the asset is available for immediate sale in its present condition subject only to terms which are usual and customary for such sales; • the sale must be highly probable i.e.: - management are committed to a plan to sell the asset; - an active programme has begun to find a buyer and complete the sale; - the asset is being actively marketed at a reasonable price; - the sale is expected to be completed within 12 months of the date of classification as 'held for sale'; and - the actions needed to complete the plan indicate it is unlikely that the plan will be dropped or significant changes made to it. Following reclassification, the assets are measured at the lower of their existing carrying amount and their 'fair value less costs to sell'. Depreciation ceases to be charged and the assets are not revalued, except where the 'fair value less costs to sell' falls below the carrying amount. Assets are de-recognised when all material sale contract conditions have been met. Property, plant and equipment which is to be scrapped or demolished does not qualify for recognition as 'held for sale' and instead is retained as an operational asset and the asset's economic life is adjusted. The asset is de-recognised when scrapping or demolition occurs.

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1.6 Leases Finance Leases Where substantially all risks and rewards of ownership of a leased asset are borne by the Trust, the asset is recorded as Property, Plant and Equipment and a corresponding liability is recorded. The value at which both are recognised is the lower of the fair value of the asset or the present value of the minimum lease payments, discounted using the interest rate implicit in the lease. The implicit interest rate is that which produces a constant periodic rate of interest on the outstanding liability. Assets are depreciated over the lower of their useful economic life and the period of the lease.

The asset and liability are recognised at the inception of the lease, and are de-recognised when the liability is discharged, cancelled or expires. The annual rental is split between the repayment of the liability and a finance cost. The annual finance cost is calculated by applying the implicit interest rate to the outstanding liability and is charged to Finance Costs in the Statement of Comprehensive Income.

Operating Leases Payments made under operating leases (net of any incentives received from the lessor) are charged to operating expenses on a straight-line basis over the period of the lease.

Leases of land and buildings Where a lease is for land and buildings, the land component is separated from the building component and the classification for each is assessed separately. 1.7 Private Finance Initiative (PFI) transactions HM Treasury has determined that government bodies shall account for infrastructure PFI schemes where the government body controls the use of the infrastructure and the residual interest in the infrastructure at the end of the arrangement as service concession arrangements, following the principles of the requirements of IFRIC 12. The Trust therefore recognises the PFI asset as an item of property, plant and equipment together with a liability to pay for it. The services received under the contract are recorded as operating expenses. The annual unitary payment is separated into the following component parts, using appropriate estimation techniques where necessary:

a) Payment for the fair value of services received and; b) Payment for the PFI asset, including finance costs Services received The fair value of services received in the year is recorded under the relevant expenditure headings within ‘operating expenses’. PFI Asset The PFI assets are recognised as property, plant and equipment, when they come into use. The assets are measured initially at fair value in accordance with the principles of IAS 17. Subsequently, the assets are measured at fair value, which is kept up to date in accordance with the NHS Foundation Trust’s approach for each relevant class of asset in accordance with the principles of IAS 16. PFI liability A PFI liability is recognised at the same time as the PFI assets are recognised. It is measured initially at the same amount as the fair value of the PFI assets and is subsequently measured as a finance lease liability in accordance with IAS 17. An annual finance cost is calculated by applying the implicit interest rate in the lease to the opening lease liability for the year, and is charged to ‘Finance Costs’ within the Statement of Comprehensive Income. The element of the annual unitary payment that is allocated as a finance lease rental is applied to meet the annual finance cost and to repay the lease liability over the contract term. An element of the annual unitary payment increase due to cumulative indexation is allocated to the finance lease. In accordance with IAS 17, this amount is not included in the minimum lease payments, but is instead treated as contingent rent and is expensed as incurred. In substance, this amount is a finance cost in respect of the liability and the expense is presented as a contingent finance cost in the Statement of Comprehensive Income. Assets contributed by the NHS Foundation Trust to the operator for use in the scheme Assets contributed for use in the scheme continue to be recognised as items of property, plant and equipment in the NHS Foundation Trust’s Statement of Financial Position.

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1.8 Intangible assets Recognition Intangible assets are non-monetary assets without physical substance which are capable of being sold separately from the rest of the NHS Foundation Trust's business or which arise from contractual or other legal rights. They are recognised only where it is probable that future economic benefits will flow to, or service potential be provided to, the Trust and where the cost of an asset can be measured reliably, and where the cost is at least £5,000, or form a group of assets which collectively have a cost of at least £5,000, where the assets are functionally interdependent, had broadly simultaneous purchase dates, are anticipated to have simultaneous disposal dates and are under single managerial control. Internally generated intangible assets Internally generated goodwill, brands, mastheads, publishing titles, customer lists and similar items are not capitalised as intangible assets. Expenditure on research is not capitalised. Expenditure on development is capitalised only where all of the following can be demonstrated: • the project is technically feasible to the point of completion and will result in an intangible asset for sale or for use; • the NHS Foundation Trust intends to complete the asset and sell or use it; • the NHS Foundation Trust has the ability to sell or use the asset; • how the intangible asset will generate probable future economic service delivery benefits e.g. The presence of a market for it or its output, or, where it is to be used for internal use, the usefulness of the asset; • adequate financial, technical and other resources are available to the NHS Foundation Trust to complete the development and sell or use the asset; and • the NHS Foundation Trust can measure reliably the expenses attributable to the asset during development. Software Software which is integral to the operation of hardware e.g. An operating system, is capitalised as part of the relevant item of property, plant and equipment. Software which is not integral to the operation of hardware e.g. Application software, is capitalised as an intangible asset.

Measurement Intangible assets are recognised initially at cost, comprising all directly attributable costs needed to create, produce and prepare the asset to the point that it is capable of operating in the manner intended by management. Intangible assets relate to development expenditure, software and licences and are carried at amortised cost which management consider to materially equate to fair value and a review for impairment is performed annually. Increases in asset values arising from impairment reviews are recognised in the revaluation reserve, except where, and to the extent that, they reverse an impairment previously recognised in operating expenses, in which case they are recognised in operating income. Decreases in asset values and impairments 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'. Intangible assets held for sale are measured at the lower of their carrying amount or 'fair value less costs to sell'. Amortisation Intangible assets are amortised on a straight line basis over their expected useful economic lives, as follows: Software licences 5 to 15 years Licences and Trademarks 5 to 15 years

Amortisation is charged to operating expenses from the first day of the quarter commencing 1st April, 1st July, 1st October, or 1st January, following the date that the asset becomes available for use. Amortisation is charged in full in the quarter in which an asset becomes unavailable for use or is sold and then ceases to be charged.

1.9 Donated, government grant and other grant funded assets Donated and grant funded property, plant and equipment assets are capitalised at their fair value on receipt. The donation / grant is credited to income at the same time, unless the donor has imposed a condition that the future economic benefits embodied in the grant are to be consumed in a manner specified by the donor, in which case, the donation / grant is deferred within liabilities and is carried forward to future financial years to the extent that the condition has not yet been met.

The donated and grant funded assets are subsequently accounted for in the same manner as other items of property, plant and equipment.

1.10 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.

1.11 Inventories Inventories are valued at the lower of cost and net realisable value using the weighted average cost method for drugs and the first-in first-out method for other inventories, less any provisions deemed necessary.

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1.12 Financial instruments and financial liabilities Recognition Financial assets and financial liabilities which arise from contracts for the purchase of non-financial items (such as goods or services), which are entered into in accordance with the NHS Foundation Trust's normal purchase, sale or usage requirements, are recognised when, and to the extent which, performance occurs i.e. when receipt or delivery of the goods or services is made. Financial assets or liabilities in respect of assets acquired or disposed of through finance leases are recognised and measured in accordance with the accounting policy for leases described at note 1.6. All other financial assets and financial liabilities are recognised when the NHS Foundation Trust becomes a party to the contractual provisions of the instrument. De-recognition All financial assets are de-recognised when the rights to receive cash flows from the assets have expired or the NHS Foundation Trust has transferred substantially all of the risks and rewards of ownership. Financial liabilities are de-recognised when the obligation is discharged, cancelled or expires. Classification and measurement Financial assets are categorised as 'Loans and receivables'. Financial liabilities are classified as 'Other Financial Liabilities'. Financial assets and financial liabilities at 'Fair Value through Income or Expenditure' Financial assets and financial liabilities at 'Fair Value through Income or Expenditure' are financial assets or financial liabilities held for trading. The NHS Foundation Trust does not have financial assets or liabilities classified in this category. Loans and Receivables Loans and receivables are non-derivative financial assets with fixed or determinable payments which are not quoted in an active market. They are included in current assets. The NHS Foundation Trust’s loans and receivables comprise: cash and cash equivalents, NHS receivables, accrued income and ‘other receivables’. Loans and receivables are recognised initially at fair value, net of transactions costs, and are measured subsequently at amortised cost, using the effective interest method. The effective interest rate is the rate that discounts exactly estimated future cash receipts through the expected life of the financial asset or, when appropriate, a shorter period, to the net carrying amount of the financial asset.

At each year end, the NHS Foundation Trust reviews trade receivables for recoverability and makes provisions to the extent that recovery of specific debts is considered to be doubtful. Interest on loans and receivables is calculated using the effective interest method and credited to the Statement of Comprehensive Income. Other financial liabilities Other financial liabilities are recognised initially at fair value, net of transaction costs incurred, and measured subsequently at amortised cost using the effective interest method. The effective interest rate is the rate that discounts exactly estimated future cash payments through the expected life of the financial liability or, when appropriate, a shorter period, to the net carrying amount of the financial liability. They are included in current liabilities except for amounts payable more than 12 months after the statement of financial position date, which are classified as non-current liabilities. Interest on financial liabilities carried at amortised cost is calculated using the effective interest method and charged to Finance Costs. Interest on financial liabilities taken out to finance property, plant and equipment or intangible assets is not capitalised as part of the cost of those assets.

Impairment of financial assets At the statement of financial position date, the NHS Foundation Trust assesses whether any financial assets are impaired. Financial assets are impaired and impairment losses are recognised if, and only if, there is objective evidence of impairment as a result of one or more events which occurred after the initial recognition of the asset and which has an impact on the estimated future cash flows of the asset. 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 through the use of a bad debt provision. 1.13 Provisions The NHS Foundation Trust provides for legal or constructive obligations that are of uncertain timing or amount at the reporting date on the basis of the best estimate of the expenditure required to settle the obligation. Provisions are recognised where it is probable that there will be a future outflow of cash or other resources and a reliable estimate can be made of the amount. Where the effect of the time value of money is significant, the estimated risk-adjusted cash flows are discounted using HM Treasury’s discount rate of 2.2% in real terms (2012/13: 2.2%), except for early retirement provisions and injury benefit provisions which both use the HM Treasury's pension discount rate of 1.8% in real terms (2012/13: 2.35%).

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1.13 Provisions Clinical negligence costs The NHS Litigation Authority (NHSLA) operates a risk pooling scheme under which the NHS Foundation Trust pays an annual contribution to the NHSLA, which, in return, settles all clinical negligence claims. Although the NHSLA is administratively responsible for all clinical negligence cases, the legal liability remains with the NHS Foundation Trust. The total value of clinical negligence provisions carried by the NHSLA on behalf of the NHS Foundation Trust is disclosed at note 19. A provision is held in the NHS Foundation Trust's accounts for the excess payable by the NHS Foundation Trust to the NHSLA and is disclosed under 'other legal claims' in note 20. Non-clinical risk pooling The NHS Foundation Trust participates in the Liabilities to Third Parties Scheme. This is a risk pooling scheme under which the NHS Foundation Trust pays an annual contribution to the NHS Litigation Authority and in return receives assistance with the costs of claims arising. The annual membership contributions, and any ‘excesses’ payable in respect of particular claims are charged to operating expenses when the liability arises. 1.14 Borrowings The NHS Foundation Trust is permitted to borrow funds. The capital sum is recognised as a liability and Interest incurred is charged to finance expenses in the statement of comprehensive income. Total borrowings of the NHS Foundation Trust are disclosed in note 19.

1.15 Contingencies Contingent assets (that is, assets arising from past events whose existence will only be confirmed by one or more future events not wholly within the entity’s control) are not recognised as assets, but are disclosed in note 22 where an inflow of economic benefits is probable. Contingent liabilities are not recognised, but are disclosed in note 22, unless the probability of a transfer of economic benefits is remote. Contingent liabilities are defined as: • Possible obligations arising from past events whose existence will be confirmed only by the occurrence of one or more uncertain future events not wholly within the entity’s control; or • Present obligations arising from past events but for which it is not probable that a transfer of economic benefits will arise or for which the amount of the obligation cannot be measured with sufficient reliability. 1.16 Public dividend capital Public dividend capital (PDC) is a type of public sector equity finance based on the excess of assets over liabilities at the time of establishment of the predecessor NHS Trust. HM Treasury has determined that PDC is not a financial instrument within the meaning of IAS 32. A charge, reflecting the cost of capital utilised by the NHS Foundation Trust, is payable as public dividend capital dividend. The charge is calculated at the rate set by HM Treasury (currently 3.5%) on the average relevant net assets of the NHS Foundation Trust during the financial year. Relevant net assets are calculated as the value of all assets less the value of all liabilities, except for (i) donated assets (including lottery funded assets), (ii) average daily cash balances held with the Government Banking Services (GBS) and National Loans Fund (NLF) deposits, excluding cash balances held in GBS accounts that relate to a short-term working capital facility, (iii) for 2013/14 only, net assets and liabilities transferred from bodies which ceased to exist on 1 April 2013, and (iv) any PDC dividend balance receivable or payable. In accordance with the requirements laid down by the Department of Health (as the issuer of PDC), the dividend for the year is calculated on the actual average relevant net assets as set out in the “pre-audit” version of the annual accounts. The dividend thus calculated is not revised should any adjustment to net assets occur as a result the audit of the annual accounts. 1.17 Value Added Tax (VAT) 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.

1.18 Corporation Tax The NHS Foundation Trust is a Health Service Body within the meaning of s519A ICTA 1988 and accordingly is exempt from taxation in respect of income and capital gains within categories covered by this. There is power for the Treasury to disapply the exemption in relation to specified activities of a Foundation Trust (s519A (3) to (8) ICTA 1988). Accordingly, the NHS Foundation Trust is potentially within the scope of corporation tax in respect of activities which are not related to, or ancillary to, the provision of healthcare, and where the profits therefrom exceed £50,000 per annum. 1.19 Third Party Assets Assets belonging to third parties (such as money held on behalf of patients) are not recognised in the accounts since the NHS Foundation Trust has no beneficial interest in them. However, they are disclosed in a separate note to the accounts in accordance with the requirements of HM Treasury's FReM.

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1.20 Foreign currencies The NHS Foundation Trust's functional currency and presentational currency is sterling. Transactions denominated in a foreign currency are translated into sterling at the exchange rate ruling on the dates of the transactions. At the end of the reporting period, monetary items denominated in foreign currencies are retranslated at the spot exchange rate on 31 March. Resulting exchange gains and losses for either of these are recognised in the NHS Foundation Trust’s surplus/deficit in the period in which they arise. 1.21 Losses and Special Payments Losses and special payments are items that Parliament would not have contemplated when it agreed funds for the health service or passed legislation. By their nature they are items that ideally should not arise. They are therefore subject to special control procedures compared with the generality of payments. They are divided into different categories, which govern the way that individual cases are handled. Losses and special payments are charged to the relevant functional headings in expenditure on an accruals basis, excluding provisions for future losses, but including losses which would have been made good through insurance cover had the NHS Foundation Trust not been bearing its own risks (with insurance premiums then being included as normal revenue expenditure).

However the losses and special payments note is compiled directly from the losses and compensations register which reports on an accrual basis with the exception of provisions for future losses. 1.22 Accounting standards not adopted Monitor have directed that NHS Foundation Trusts adopt International Financial Reporting Standards set out by the International Accounting Standards Board. The NHS Foundation Trust have adopted all relevant standards as they apply to NHS Foundation Trusts.

1.23 Accounting standards adopted early The NHS Foundation Trust has not adopted any accounting standards early in 2013/14. 1.24 Accounting standards not yet effective and not adopted early The Treasury FReM does not require the following Standards and Interpretations that have been published and are mandatory for accounting periods beginning on or after 1st April 2013 to be applied in 2013-14. The application of the Standards as revised would not have a material impact on the accounts for 2013-14, were they applied:

IAS 27 Separate Financial Statements IAS 28 Investments in Associates and Joint Ventures IFRS 9 Financial Instruments IFRS 10 Consolidated Financial Statements IFRS 11 Joint Arrangements IFRS 12 Disclosure of Interests in Other Entities IFRS 13 Fair Value Measurement IPSAS 32 - Service Concession Arrangement

1.25 Accounting estimates, judgements and critical accounting policies Component depreciation

IAS 16 (Property, Plant and Equipment) requires that "each part of an item of property, plant and equipment with a cost which is significant in relation to the total cost of the item, shall be depreciated separately”. The standard also states, "A significant part of an item of PPE may have a useful life and a depreciation method that are the same as the useful life and depreciation method of another significant part of the same item. Such parts may be grouped in determining the depreciation charge". The NHS Foundation Trust has elected to depreciate each building and its constituent elements as a single component on the basis that this more fairly reflects the way that the NHS Foundation Trust is managed and maintained. The appropriateness of this treatment will be reviewed annually. Revaluation of land, buildings and dwellings At 31st March 2014 the NHS Foundation Trust's valuer carried out a full revaluation of the land, buildings and dwellings. This has resulted in an downward valuation of these non-current assets by £15.8m, split between a revaluation reserve decrease of £1.2m, impairment charge to operating expenditure of £17.2m and recognition of (£2.5m) in operating income relating to the reversal of impairments previously charged to operating expenses. See Note 11 for further details on these revaluations. Selection of asset lives Property, plant & equipment assets are allocated an asset life as stated in note 1.5 when acquired. The useful economic lives of assets are reviewed annually by management where significant. Individual asset lives are adjusted where these are materially different to their remaining life.

Restructuring costs The NHS Foundation Trust has recognised termination benefits to staff of £0.882 million during the financial year arising from the efficiency programme. See Note 6 for further details. Going concern These financial statements have been prepared on a going concern basis. Management have conducted an appraisal of the NHS Foundation Trust's financial forecasts for a two year period to 31st March 2015 in support of this assessment.

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1.25 Accounting estimates, judgements and critical accounting policies continued

Charitable Fund The NHS Foundation Trust is the corporate trustee to Blackpool Teaching Hospitals Charitable Fund (Registered number 1051570). The NHS Foundation Trust has assessed its relationship to the charitable fund and determined it to be a subsidiary because the NHS Foundation Trust has the power to govern the financial and operating policies of the charitable fund so as to obtain benefits from its activities for itself, its patients or its staff. Prior to 2013/14, the FT ARM permitted the NHS Foundation Trust not to consolidate the charitable fund. From 2013/14, is required to consolidate, however because the income and expenditure of the fund represent 0.2% of the NHS Foundation Trust income and expenditure, the fund is not considered to be material and has not been consolidated. 1.26 Transfers of functions from other NHS bodies For functions that have been transferred to the NHS Foundation Trust from another NHS body, the assets and liabilities transferred are recognised in the accounts as at the date of transfer. The assets and liabilities are not adjusted to fair value prior to recognition. The net loss of £20,123 corresponding to the net current liabilities transferred from Blackpool PCT and the net gain of £190,369 corresponding to the non current assets transferred from North Lancashire Teaching PCT are recognised within the income and expenditure reserve.

For the property plant and equipment assets and intangible assets transferred from North Lancashire Teaching PCT, the Cost and Accumulated Depreciation / Amortisation balances from the transferring entity’s accounts are preserved on recognition in the trust’s accounts. A revaluation reserve balance of £2,685 attributable to the transferring assets has been recognised within the NHS Foundation Trust's revaluation reserve.

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2. Operating segments

2013/14 Unscheduled Scheduled Families Adult Clinical Corporate Total Care Care Community Support & Services Services and Facilities Long Term Management Conditions £000 £000 £000 £000 £000 £000 £000 Income 106,108 112,828 38,594 55,107 18,666 39,376 370,679 Expenditure (80,600) (95,305) (30,410) (55,668) (58,143) (35,912) (356,038) EBITDA 25,508 17,523 8,184 (561) (39,477) 3,464 14,641 Restructuring costs (882) Net loss on revaluation of non current assets (14,686) Depreciation and amortisation (6,090) Net loss on disposal of non current assets (197) Interest receivable 68 Interest payable (1,261) PDC dividend (4,003) Deficit for the Financial Year (12,410)

In 2013/14 the NHS Foundation Trust has reported Surgery and Cardiac divisions as Scheduled Care Division, and created two new divisions: a Families Division incorporating Women's and Children's Health and an Adults and Long Term Conditions comprising of the Community and Therapy Services.

2012/13 Unscheduled Scheduled Community Clinical Corporate Total Care Care Health Support & Services Services Facilities Management £000 £000 £000 £000 £000 £000 Income 105,170 139,951 70,889 14,016 32,177 362,203 Expenditure (75,482) (109,446) (65,536) (60,779) (34,556) (345,799) EBITDA 29,688 30,505 5,353 (46,763) (2,379) 16,404 Restructuring costs (1,045) Net gain on revaluation of non current assets 3,978 Depreciation and amortisation (6,667) Net loss on disposal of non current assets (3,095) Interest receivable 184 Interest payable (2,343) PDC dividend (4,204) Surplus for the Financial Year 3,212

Segmental information Financial and operational performance data is reviewed by the Trust Board of Directors on a monthly basis. The Board are responsible for setting financial performance targets for each of the divisions within the Trust. The Trust Board of Directors are therefore considered to be the Chief Operating Decision Maker (CODM). Each of the NHS Foundation Trust's healthcare divisions have been deemed to be a reportable segment under IFRS 8 (Segmental Reporting). The financial performance of each segment is managed against an EBITDA target. The NHS Foundation Trust does not report on assets or liabilities by segment.

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2. Operating segments continued

The majority of the NHS Foundation Trust's revenue is generated from external customers in England, with the exception of the bodies listed below, and transactions between segments are immaterial.

2013/14 2012/13 £000 £000 Scottish NHS bodies 207 322 Local Health Boards in Wales 219 237 Northern Ireland Health and Social Care Trusts 67 59

The Trust has three external customers which generate income amounting to more than 10% of the Trust's total income. The values of income from the largest customers are set out in note 26. The income from these customers is included in all of the segments reported above.

3. Income from activities Restated

3.1 Income from Activities by category Year ended Year ended 31st March 31st March 2014 2013 £000 £000 Elective income 59,003 60,510 Non elective income 77,280 80,164 Outpatient income 33,490 33,511 A & E income 8,210 8,146 Community Trust income from Primary Care Trusts * 0 68,587 Community Trust income from CCG's & NHS England 59,929 0 Community Trust income not from CCG's & NHS England 7,964 0 Other NHS Clinical income * 99,511 80,996 Private patient income 1,867 1,401

347,254 333,315 Of which operating income from activities relates to: Year ended 31st March 2014 £000 Commissioner requested services 336,931 Non-commissioner requested services 10,323

347,254

* Community Trust income from Primary Care Trusts was not seperately disclosed in 2012/13 and was previously reported within Other NHS Clinical income. The income note has been restated.

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3. Income from activities continued 3.2 Income from activities by source Year ended Year ended 31st March 31st March 2014 2013 £000 £000 NHS Foundation Trusts 1,387 888 NHS Trusts 0 13 Strategic Health Authorities 0 558 Clinical Commissioning Groups and NHS England 331,413 0 Primary Care Trusts 0 327,902 Department of Health 0 37 Local Authorities * 9,219 1,041 NHS Other 791 0 Non NHS: - Private patients 1,866 1,401 - NHS Injury scheme income 1,256 590 - Other 1,322 885 347,254 333,315

* Income from Local Authorities has increased due to the transfer of commissioning of some services from Primary Care Trusts.

4. Other Operating Income Year ended Year ended 31st March 31st March 2014 2013 £000 £000 Research and Development 1,760 3,189 Education, training and research * 11,642 12,435 Charitable and other contributions to expenditure 115 692 Non-patient care services to other bodies ** 4,988 7,252 Profit on disposal of property, plant & equipment 0 198 Reversal of impairments of property, plant & equipment 2,526 5,387 Sales of goods and services *** 2,554 2,333 Income in respect of staff costs where accounted on gross basis 679 932 Other 1,687 1,991 25,951 34,409

* Education, training and research income comprises income relating the North West Leadership Academy for which the NHS Foundation Trust is the host organisation, and funding received from NHS Northwest for junior doctors training. ** Non-patient care services to other bodies includes service level agreement income from other NHS bodies for estates, IT and payroll services provided by the NHS Foundation Trust. *** Sales of goods and services includes income from catering sales, commercial laundry services, staff accommodation rentals, and car parking.

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5. Operating expenses

5.1 Operating expenses comprise: Year ended Year ended 31st March 31st March NOTE 2014 2013 £000 £000 Services from Foundation Trusts 1,361 1,435 Services from NHS Trusts 276 126 Services from other NHS bodies 2,968 2,488 Purchase of healthcare from non NHS bodies 6,571 7,187 Non Executive Directors' costs 138 139 Executive Directors' costs 6 1,076 1,055 Employee costs (excluding Executive Directors' costs) 6 235,231 224,045 Redundancy * 6 882 1,045 Drug costs 24,242 23,637 Supplies and services - clinical 40,680 38,427 Supplies and services - general 8,071 8,168 Establishment 5,116 5,602 Transport 1,034 908 Premises 15,028 16,214 Rentals payable under operating leases 1,932 2,141 Increase / (decrease) in provision for impairment of receivables 393 (426) Increase in other provisions 20 490 1,355 Depreciation 11 5,408 5,566 Amortisation 10 682 1,101 Non-current asset impairments 11 17,212 1,409 Loss on disposal of property, plant and equipment ** 11 197 3,293 Audit services - statutory audit 76 76 Clinical negligence 5,307 4,010 Training, courses and conferences 2,271 4,259 Legal, professional and consultancy fees 2,913 2,057 Insurance costs 195 288 Other *** 669 2,544 380,419 358,149

* Redundancy costs consist of amounts paid to staff and an accrual for other agreed redundancies as part of the NHS Foundation Trust's efficiency programme. ** The loss on disposal of property, plant and equipment in 2012/13 relates to demolition of properties prior to the construction of the multi-storey car park and main entrance. See note 7 for further details. *** Other expenditure includes costs for internal audit services, and losses and special payments.

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5. Operating expenses continued

5.2 Other auditor's remuneration PricewaterhouseCoopers LLP provide statutory audit services to the NHS Foundation Trust and to the Blackpool Teaching Hospitals Charitable Fund. The cost of audit services for the charitable fund are not included in operating expenses but are paid for by the charity. The cost for statutory audit of the charity was £9,600 in 2013/14 (2012/13: £9,600) Pricewaterhouse Coopers LLP did not provide any other services to the NHS Foundation Trust in 2013/14 (2012/13: Nil) other than for statutory audit.

5.3 Auditor liability limitation agreements The audit engagement contract with PricewaterhouseCoopers LLP approved by the Board of Governors on 17th March 2014 contains a £1million limit on their liability for losses or damages in connection with the audit contract for their audit work. This limitation does not apply in the event of losses or damages arising from fraud or dishonesty of PricewaterhouseCoopers LLP.

5.4 Operating leases

As lessee

5.4.1 Payments recognised as an expense Year ended Year ended 31st March 31st March 2014 2013 £000 £000 Minimum lease payments 1,932 2,141 1,932 2,141

5.4.2 Total future minimum lease payments Year ended Year ended 31st March 31st March 2014 2013 Payable: £000 £000 Not later than one year 733 1,648 Between one and five years 905 1,245 Later than five years 31 0 1,669 2,893 5.4.3 Significant leasing arrangements The significant operating lease arrangements held by the NHS Foundation Trust relate to medical equipment and buildings and are subject to the following terms: - No transfer of ownership at the end of the lease term. - No option to purchase at a price significantly below fair value at the end of the lease term. - Leases are non-cancellable or must be paid in full. - No secondary period rental or at best market rate. - Lease payments are fixed for the contracted lease term.

Annual Lease Significant operating lease arrangements held by the NHS Foundation Trust relate to: commitment term £000 Years - MRI Scanner 167 5 - Electric Beds 129 7 - Theatre patient monitoring 82 5 - Endoscopy equipment 52 5 - Patient Monitors 47 5 - Theatre Ultrasound 36 5

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6. Employee costs and numbers

6.1 Staff costs Year ended Year ended 31st March 31st March 2014 2013 Permanently Other Total Total employed £000 £000 £000 £000 Salaries and wages 186,327 0 186,327 179,739 Social security costs 12,922 0 12,922 12,798 Employers contribution to NHS Pension Scheme 21,726 0 21,726 20,507 Agency / Contract staff 0 15,332 15,332 12,056 Termination benefits 882 0 882 1,045 Total 221,857 15,332 237,189 226,145

Employee costs above reconciles to the total of Executive Directors' costs and Employee costs on Note 5.1 Operating expenses. Termination benefits relate to amounts paid to staff for agreed departures under the schemes set out in note 6.2.

6.2 Exit Packages

As part of its efficiency programme the NHS Foundation Trust has commenced a review of its functions to reduce costs. During the year exit packages have been agreed with staff to enable a reduction in pay costs. Termination benefits consist of three types of exit package used by the NHS Foundation Trust: - Compulsory redundancy - Voluntary redundancy - Mutually agreed resignation scheme (MARS)

The following table discloses the number and cost to the NHS Foundation Trust of all exit packages that were agreed as at 31 March 2014. (2012/13 comparatives shown in brackets).

Exit package cost band Other Compulsory departures Total redundancies agreed Number Number Number <£10,000 3 (0) 0 (10) 3 (10) £10,000 - £25,000 2 (0) 4 (12) 6 (12) £25,001 - £50,000 5 (0) 3 (10) 8 (10) £50,001 - £100,000 2 (0) 3 (4) 5 (4) £100,001 - £150,000 1 (0) 0 (0) 1 (0) £150,001 - £200,000 0 (0) 0 (1) 0 (1) £200,001 - £250,000 0 (0) 0 (0) 0 (0) Total number of packages by type 13 (0) 10 (37) 23 (37)

£000 £000 £000 Total resource cost - 2013/14 505 377 882 Total resource cost - 2012/13 0 1,045 1,045

Details of exit packages agreed for non executive and executive directors of the NHS Foundation Trust can be found in the Remuneration Report

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6. Employee costs and numbers continued 6.3 Average number of persons employed Year ended Year ended 31st March 31st March 2014 2013 Permanently Other Total Total employed WTE WTE WTE WTE Medical and Dental 360 70 430 412 Administration and estates 1,102 142 1,244 1,220 Healthcare assistants and other support staff 1,272 0 1,272 1,220 Nursing, midwifery and health visiting staff 2,031 59 2,090 1,993 Scientific, therapeutic and technical staff 748 32 780 710 5,513 303 5,816 5,555

6.4 Retirements due to ill health In the year ended 31st March 2014 there were 5 early retirements from the NHS Foundation Trust on the grounds of ill- health. The estimated additional pension liabilities of these ill-health retirements will be £471,479. (2012/13: 6 cases with estimated liability of £337,087) The cost of these ill-health retirements will be borne by the NHS Pension Scheme. Accordingly, no provision is recognised in the NHS Foundation Trust's accounts.

6.5 Pension costs Past and present employees are covered by the provisions of the NHS Pensions 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 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 a defined contribution scheme: the cost to the Trust 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. This utilises an actuarial assessment for the previous accounting period in conjunction with updated membership and financial data for the current reporting period, and are accepted as providing suitably robust figures for financial reporting purposes. The valuation of the scheme liability as at 31 March 2014, is based on valuation data as 31 March 2013, updated to 31 March 2014 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 ending 31 March 2004. Consequently, a formal actuarial valuation would have been due for the year ending 31 March 2008. However, formal actuarial valuations for unfunded public service schemes were suspended by HM Treasury on value for money grounds while consideration is given to recent changes to public service pensions, and while future scheme terms are developed as part of the reforms to public service pension provision due in 2015. The Scheme Regulations were changed to 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. The next formal valuation to be used for funding purposes will be carried out at as at March 2012 and will be used to inform the contribution rates to be used from 1 April 2015.

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7. Net (loss) on disposal of non current assets

Year ended Year ended 31st March 31st March 2014 2013 £000 £000 Gain on disposal of property, plant and equipment 0 198 (Loss) on disposal of property, plant and equipment (197) (3,293) (197) (3,095)

The loss on disposal of property, plant and equipment in 2012/13 has arisen due to the demolition of properties on the Victoria Hospital site in advance of construction of the new multi-storey car park and hospital main entrance. The gain on disposal arises from the sale of residential properties no longer required.

8. Finance income Year ended Year ended 31st March 31st March 2014 2013 £000 £000 Interest from bank accounts 68 184

9. Finance costs Year ended Year ended 31st March 31st March NOTE 2014 2013 £000 £000

Interest on obligations under on-statement of financial position PFI schemes 0 303 Finance charge on early termination of PFI schemes 21 0 794 Contingent rentals under on-statement of financial position PFI schemes 0 169 Loans from Foundation Trust financing facility 1,228 1,037 Unwinding of discount on provisions 20 33 40 1,261 2,343

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10. Intangible assets Intangible assets comprise the following elements: Software Licences & Total

Licences Trademarks £000 £000 £000

Cost at 1st April 2013 5,347 1,081 6,428 Additions purchased 598 0 598 Cost at 31st March 2014 5,945 1,081 7,026

Accumulated amortisation at 1st April 2013 3,751 499 4,250 Charged during the year 205 477 682 Accumulated amortisation at 31st March 2014 3,956 976 4,932

Net book value at 31st March 2014 1,989 105 2,094 Net book value Purchased at 31st March 2014 1,989 105 2,094 Total at 31st March 2014 1,989 105 2,094

Prior year: Cost at 1st April 2012 5,187 1,072 6,259 Additions purchased 160 9 169 Cost at 31st March 2013 5,347 1,081 6,428

Accumulated amortisation at 1st April 2012 1,416 356 1,772 Charged during the year 958 143 1,101 Impairments recognised in operating expenses 1,377 0 1,377 Accumulated amortisation at 31st March 2013 3,751 499 4,250

Net book value at 31st March 2013 1,596 582 2,178 Net book value Purchased at 31st March 2013 1,596 582 2,178 Total at 31st March 2013 1,596 582 2,178

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11. Property, plant and equipment

11.1 Property, plant and equipment

Property, plant and equipment comprises the following elements: Land Buildings Dwellings Assets under Plant and Transport Information Furniture & Total excluding construction Machinery Equipment Technology fittings dwellings £000 £000 £000 £000 £000 £000 £000 £000 £000 Cost or valuation at 1st April 2013 9,209 166,380 3,873 4,448 26,610 76 7,182 43 217,821 Additions purchased 0 3,085 0 11,613 2,998 0 536 0 18,232 Additions donated 0 0 0 0 115 0 0 0 115 Transfers by absorption - Modified 0 0 0 0 99 51 0 42 192 Impairment charges to revaluation reserve (535) (5,218) (136) 0 0 0 0 0 (5,889) Impairments recognised in operating expenses / income (157) (14,529) 0 0 0 0 0 0 (14,686) Reclassifications 0 16,061 0 (16,061) 0 0 0 0 0 Revaluations 0 4,696 31 0 0 0 0 0 4,727 Disposals 0 0 0 0 (1,547) (8) 0 (42) (1,597) Transfer of depreciation to gross book value following revaluation 0 (2,648) (76) 0 0 0 0 0 (2,724)

Cost or valuation at 31st March 2014 8,517 167,827 3,692 0 28,275 119 7,718 43 216,191

Accumulated depreciation at 1st April 2013 0 0 0 0 21,069 71 4,076 14 25,230 Charged during the year 0 2,648 76 0 1,647 52 978 7 5,408 Disposals 0 0 0 0 (1,390) (8) 0 (2) (1,400) Transfer of depreciation to gross book value following revaluation 0 (2,648) (76) 0 0 0 0 0 (2,724)

Accumulated depreciation at 31st March 2014 0 0 0 0 21,326 115 5,054 19 26,514

Net book value at 31st March 2014 8,517 167,827 3,692 0 6,949 4 2,664 24 189,677

Net book value Owned Purchased at 31st March 2014 8,517 164,148 3,692 0 5,923 4 2,661 24 184,969 Donated at 31st March 2014 0 3,679 0 0 1,026 0 3 0 4,708 Total at 31st March 2014 8,517 167,827 3,692 0 6,949 4 2,664 24 189,677

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11. Property, plant and equipment (continued)

Revaluation of property, plant and equipment Land and buildings (including dwellings) valuations are carried out by professionally qualified valuers in accordance with the Royal Institute of Chartered Surveyors (RICS) Appraisal and Valuation Manual. The last full asset revaluation took place on 31st March 2014 based on modern replacement cost and was undertaken by Andrew M Wilson MRICS of DTZ.

The revaluation of some assets has resulted in market value revaluation gains that reverse market value impairments charged to operating expenses in previous years. Gains up to the value of any previous impairment on the same asset have been recognised in operating income with any excess being recognised in the revaluation reserve.

The impact of the revaluation on charges to operating expenses and reserves is as follows:

2013/14 2012/13 £000 £000

Revaluation gains recognised in the revaluation reserve (4,727) (4,407) Impairments charged to the revaluation reserve 5,889 997 Impairments recognised in operating expenses 17,212 32 Reversal of impairments recognised in other operating income (2,526) (5,387)

15,848 (8,765)

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11. Property, plant and equipment (continued)

Prior year: Land Buildings Dwellings Assets Plant and Transport Information Furniture & Total excluding under Machinery Equipment Technology fittings dwellings construction £000 £000 £000 £000 £000 £000 £000 £000 £000 Cost or valuation at 1st April 2012 9,209 158,564 6,530 182 27,700 76 7,509 328 210,098 Additions purchased 0 2,143 0 4,266 285 0 173 6 6,873 Additions donated 0 296 0 0 396 0 0 0 692 Impairment charges to revaluation reserve 0 (996) (1) 0 0 0 0 0 (997) Impairments recognised in operating expenses / 0 5,355 0 0 0 0 0 0 5,355 income Reclassifications 0 0 0 0 339 0 (48) (291) 0 Revaluations 0 4,334 73 0 0 0 0 0 4,407 Disposals 0 (888) (2,657) 0 (2,110) 0 (452) 0 (6,107) Transfer of depreciation to gross book value 0 (2,428) (72) 0 0 0 0 0 (2,500) following revaluation

Cost or valuation at 31st March 2013 9,209 166,380 3,873 4,448 26,610 76 7,182 43 217,821

Accumulated depreciation at 1st April 2012 0 0 0 0 20,976 70 3,514 146 24,706 Charged during the year 0 2,447 109 0 1,971 1 1,034 4 5,566 Reclassifications 0 0 0 0 156 0 (20) (136) 0 Disposals 0 (19) (37) 0 (2,034) 0 (452) 0 (2,542) Transfer of depreciation to gross book value 0 (2,428) (72) 0 0 0 0 0 (2,500) following revaluation

Accumulated depreciation at 31st March 2013 0 0 0 0 21,069 71 4,076 14 25,230

Net book value at 31st March 2013 9,209 166,380 3,873 4,448 5,541 5 3,106 29 192,591

Net book value Owned Purchased at 31st March 2013 9,209 162,480 3,873 4,448 4,278 5 3,102 29 187,424 Donated at 31st March 2013 0 3,900 0 0 1,263 0 4 0 5,167 Total at 31st March 2013 9,209 166,380 3,873 4,448 5,541 5 3,106 29 192,591

Purchased at 1st April 2012 8,871 147,992 6,530 182 5,509 6 3,990 182 173,262 Donated at 1st April 2012 0 3,349 0 0 1,215 0 5 0 4,569 Assets under PFI arrangement Finance lease at 1st April 2012 338 7,223 0 0 0 0 0 0 7,561 Total at 1st April 2012 9,209 158,564 6,530 182 6,724 6 3,995 182 185,392

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12. Capital Commitments Commitments under capital expenditure contracts at the statement of financial position date were £3.499m (2012/13: £13.19m). All commitments relate to the acquisition of property, plant and equipment assets. 2013/14 2012/13 £000 £000 Multi-storey Car Park / Main Entrance 706 12,126 Stroke Ward 0 433 Midwife Led Therapy Unit 0 631 Energy Efficiency Scheme 296 0 Complex Needs Suite 497 0 Other - Equipment replacement programme 2,000 0 3,499 13,190

13. Public Dividend Capital During 2013/14 the NHS Foundation Trust has received Public Dividend Capital to for the following schemes: 2013/14 £000 Energy Efficiency Improvements 1,375 Improving Birthing Environments 682 Electronic Prescribing 150 Electronic Document Management System 300 Improving Maternity Care 22 Nursing Technology Fund 54 2,583

The Trust has received assets and liabilities as at 1st April 2013 from the transfer of functions from Blackpool PCT and North Lancashire PCT. For the period 1st April 2013 to 31st August 2013 payments in respect of receivables and payables were met by the Department of Health on behalf of the NHS Foundation Trust. At 31st August 2013 the NHS Foundation Trust accounted for the net payments made by the Department of Health as an increase in Public Dividend Capital as follows: 2013/14 £000 Blackpool PCT 26 North Lancashire PCT 0 26

14. Inventories 31st March 31st March 2014 2013 £000 £000 Drugs and consumables 2,314 2,394

There have been no write-downs or reversal of write-downs of inventories during 2013/14 (2012/13: Nil). Management have performed a review for obsolete or slow moving stock in order to identify the need for an inventory provision and do not consider that a provision is required as at 31st March 2014. Inventories charged to operating expenses include drugs totalling £19.143m (2012/13 £18.731m) issued through the in- house pharmacy and cardiac consumables totalling £3.236m (2012/13: £3.596m). The figure reported for drugs in operating expenses includes costs of non-inventory items.

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15. Trade and other receivables

15.1 Trade and other receivables 31st March 31st March 2014 2013 £000 £000 NHS receivables 4,144 3,460 Other receivables with related parties 1,506 1,037 Provision for impairment of receivables (639) (338) Prepayments 1,077 1,013 Accrued income 1,402 2,298 Interest receivable 6 39 PDC dividend receivable 467 214 VAT receivable 971 705 Other receivables 3,558 3,012 Trade and other receivables - current 12,492 11,440 Other receivables 971 808 Provision for impairment of receivables (351) (259) Trade and receivables - non-current 620 549 Total 13,112 11,989

The NHS Foundation Trust has declared an amount receivable of £2.2m (2012/13 £2.1m) from the Compensation Recovery Unit (CRU) in respect of charges due under the NHS Injury Scheme. The NHS Foundation Trust recovers approximately £1.25m each year and this amount has been classified as current.

15.2 Ageing of receivables past their due date but not impaired 31st March 31st March 2014 2013 £000 £000 0 - 30 days 273 385 30- 60 days 153 193 60- 90 days 157 79 90- 180 days 306 274 Over 180 days 154 136 1,043 1,067

15.3 Analysis of provision for impairment of receivables Non NHS NHS Debts Total Debts £000 £000 £000 As at 1st April 2013 167 430 597 Amounts written off during the year as uncollectible 0 0 0 Amounts reversed unused during the year (167) (39) (206) Increase in allowance recognised in operating expenses 246 353 599 As at 31st March 2014 246 744 990

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15. Trade and other receivables (continued) 15.4 Ageing of impaired receivables 31st March 31st March 2014 2013 £000 £000 0 - 30 days 25 167 30- 60 days 0 0 60- 90 days 45 9 90- 180 days 83 9 Over 180 days 837 412 990 597 16. Cash and cash equivalents 31st March 31st March 2014 2013 £000 £000

Balance at beginning of the year 27,358 19,641 Transfers by absorption 0 (453) Net change in the year (2,066) 8,170 Balance at 31st March 25,292 27,358

Made up of: Cash with Government Banking Service 25,184 27,238 Cash in transit and in hand 108 120 25,292 27,358

17. Trade and other payables 31st March 31st March 2014 2013 £000 £000 NHS payables 2,750 4,074 Amounts due to other related parties 4,549 2,963 Non-NHS trade payables - revenue 16,507 10,712 Non-NHS trade payables - capital 3,020 1,900 Accruals 4,690 7,992 Subtotal 31,516 27,641 Tax & social security costs 4,292 4,439 Trade and other payables - current 35,808 32,080

18. Other liabilities 31st March 31st March 2014 2013 £000 £000 Deferred income 5,060 5,673 Other liabilities - current 5,060 5,673

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19. Borrowings 31st March 31st March 19.1 Borrowings 2014 2013 £000 £000 Loans from Foundation Trust Financing Facility 3,172 2,762 Borrowings - current 3,172 2,762 Loans from Foundation Trust Financing Facility 40,430 37,568 Borrowings - non-current 40,430 37,568 Total borrowings 43,602 40,330

Loan 1: £25m expiring on 30th March 2034 and attracts interest at a fixed rate of 3.7%. The NHS Foundation Trust is committed to repaying 2.17% of the balance in each September and March with effect from 30th September 2011. Loan 2: £5.6m expiring on 30th March 2016 and attracts interest at a fixed rate of 1.45%. The NHS Foundation Trust is committed to repaying 12.5% of the balance in each September and March with effect from 30th September 2012. Loan 3: £16.5m expiring on 18th June 2037 and attracts interest at a fixed rate of 2.06%. The NHS Foundation Trust is committed to repaying 2.08% of the balance in each September and March with effect from 18th December 2013. Loan 4: £9.25m expiring on 18th September 2021 and attracts interest at a fixed rate of 1.42%. The NHS Foundation Trust is committed to repaying 7.69% of the balance in each September and March with effect from 18th September 2015. At 31st March 2014 the NHS Foundation Trust had drawn down £2.9m against this loan.

19.2 Prudential borrowing limit The prudential borrowing code requirements in section 41 of the NHS Act 2006 have been repealed with effect from 1 April 2013 by the Health and Social Care Act 2012. NHS Foundation Trust compliance with the code is no longer required.

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20. Provisions 20.1 Provisions analysis 31st March 31st March 2014 2013 £000 £000 Pensions relating to other staff 17 17 Permanent Injury Benefit 76 71 Other legal claims 158 162 Other 4,852 5,162 Provisions - current 5,103 5,412

Pensions relating to other staff 142 140 Permanent Injury Benefit 1,232 1,093 Other 550 0 Provisions - non-current 1,924 1,233

TOTAL 7,027 6,645

20.2 Provisions in year movement and timing of cash flows

Pensions Permanent Other Legal Other Total relating to Injury Benefit Claims other staff £000 £000 £000 £000 £000 At 1st April 2013 157 1,164 162 5,162 6,645 Change in discount rate 4 68 0 0 72 Arising during the year 11 122 117 4,132 4,382 Utilised during the year (17) (75) (121) 0 (213) Reversed unused 0 0 0 (3,892) (3,892) Unwinding of discount 4 29 0 0 33 At 31st March 2014 159 1,308 158 5,402 7,027

Expected timing of cash flows: Within one year 17 76 158 4,852 5,103 Between one year and five years 66 290 0 550 906 After five years 76 942 0 0 1,018 Total 159 1,308 158 5,402 7,027

The provisions for pensions relating to other staff and permanent injury benefit are stated at the present value of future amounts estimated as payable using life expectancy tables provided by the Office of National Statistics. Payments are made on a quarterly basis to the NHS Pension Scheme and NHS Injury Benefit Scheme respectively. Other legal claims represent an estimate of the amounts payable by the NHS Foundation Trust in relation to the excess on claims for clinical negligence and injury to third parties. In return for an annual contribution from the NHS Foundation Trust to the NHS Litigation Authority, the claims are settled by the NHSLA on the NHS FoundationTrust's behalf and excess amounts charged to the NHS Foundation Trust at that point. £58,337,293 is included in the provisions of the NHSLA at 31 March 2014 in respect of clinical negligence liabilities of the NHS Foundation Trust (2012/13: £52,994,659). The other category consists of provisions for the following: 1) Potential return of £4.7m non-recurrent funding conditional on completion of development initiatives in 2014/15. 2) Lease property dilapidation costs £0.15m 3) Additional contract costs relating to the Victoria Hospital Commercial Centre, £0.55m

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21. Private Finance Initiative Transactions

PFI scheme deemed on-Statement of Financial Position

During 2012/13 the NHS Foundation Trust terminated the PFI Partnership Agreement for the provision of healthcare services to the public at Wesham, Rossall and Bispham. The contract was due to run for 27 years from April 2001. The termination of the contract has resulted in the NHS Foundation Trust acquiring the rights, title and interest in the assets which are recorded as held under freehold ownership at 31st March 2013. The NHS Foundation Trust has also brought in- house the facility management services previously provided by the contractor. The financial impact of the termination agreement, which took effect on 24 August 2012 was that the liability of £7.722 million with the contractor was extinguished and a finance charge arising from the early termination of £0.794 million was recognised.

During the year the following PFI financing payments have been made to the contractor:

31st March 31st March 2014 2013 £000 £000

Repayment of borrowings 0 7,722 Finance expense - Interest 0 303 Finance expense - Contingent rent 0 168 Finance expense - Termination charge 0 794 0 8,987

The NHS FoundationTrust has made no service payments (2012/13: £0.5 million) for facility management during the year.

22. Contingencies 31st March 31st March Contingent liabilities 2014 2013 £000 £000 Employer and Occupier Liability 82 77

This is the maximum potential liability for Staff and Occupiers Liability, which represents the difference between the balance provided and the excess due to the NHS Litigation Authority (NHSLA) scheme of which the NHS Foundation Trust is a member. This estimate is based on an assessment of the outcome of each case and as such may vary up to the point of settlement or withdrawal. Costs are charged to the NHS Foundation Trust up to the value of the excess by the NHSLA as they are incurred. The NHS Foundation Trust has no contingent assets.

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23. Financial Instruments The NHS Foundation Trust does not have any listed capital instruments and is not a financial institution. Due to the nature of the NHS Foundation Trust's current financial assets/liabilities and non current financial liabilities, book value equates to fair value. All financial assets and liabilities are held in sterling. The NHS Foundation Trust’s treasury management operations are carried out by the finance department, within parameters defined formally within the NHS Foundation Trust’s standing financial instructions and policies agreed by the board of directors. NHS Foundation Trust treasury activity is subject to review by the NHS Foundation Trust’s internal auditors.

Credit Risk The bulk of the NHS Foundation Trust's commissioners are part of the NHS, which minimises the credit risk from these customers. Non-NHS customers do not represent a large proportion of income and the majority of these relate to bodies which are considered low risk - e.g. universities, local councils, insurance companies, etc. Liquidity Risk The NHS Foundation Trust's net operating costs are incurred under service agreements with Clinical Commissioning Groups, which are financed from resources voted annually by Parliament. The NHS Foundation Trust largely finances capital expenditure through internally generated funds and from loans.

Market Risk All of the NHS Foundation Trust's financial liabilities carry nil or fixed rate of interest. In addition the only element of the NHS Foundation Trust's financial assets that is currently subject to variable rate is cash held in the NHS Foundation Trust's main bank account and therefore the NHS Foundation Trust is not exposed to significant interest rate risk.

31st March 31st March 23.1 Financial Assets by category 2014 2013 Loans and Loans and Receivables Receivables £000 £000 NHS Trade and other receivables 5,153 4,917 Non-NHS Trade and other receivables 3,568 3,303 Cash and cash equivalents 25,292 27,358 Total Financial Assets 34,013 35,578

23.2 Other Financial Liabilities by category 31st March 31st March 2014 2013 £000 £000 NHS Trade and other payables (2,965) (4,074) Non-NHS Trade and other payables (28,551) (23,567) Subtotal - Trade and other payables (31,516) (27,641) Other borrowings (43,602) (40,330) Subtotal - Borrowings (43,602) (40,330) Total Financial Liabilities at amortised cost (75,118) (67,971)

The NHS Foundation Trust has four loans with the Foundation Trust Financing Facility categorised within financial liabilities. The carrying value of the liability is considered to approximate to fair value as the arrangement is of a fixed interest rate and equal instalment repayment feature and the interest rate is not materially different to the discount rate.

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23. Financial Instruments 24. Third party assets

The NHS Foundation Trust does not have any listed capital instruments and is not a financial institution. Due to the nature The NHS Foundation Trust held the following cash and cash equivalents on behalf of third parties which have been of the NHS Foundation Trust's current financial assets/liabilities and non current financial liabilities, book value equates to excluded from cash and cash equivalents in the NHS Foundation Trust's statement of financial position: fair value. 31st March 31st March All financial assets and liabilities are held in sterling. 2014 2013 The NHS Foundation Trust’s treasury management operations are carried out by the finance department, within £000 £000 parameters defined formally within the NHS Foundation Trust’s standing financial instructions and policies agreed by the Patients' monies 18 5 board of directors. NHS Foundation Trust treasury activity is subject to review by the NHS Foundation Trust’s internal Blackpool Teaching Hospitals Charitable Fund 2,116 1,580 auditors. 2,134 1,585 Credit Risk The bulk of the NHS Foundation Trust's commissioners are part of the NHS, which minimises the credit risk from these 25. Losses and special payments customers. Non-NHS customers do not represent a large proportion of income and the majority of these relate to bodies 2013/14 2012/13 which are considered low risk - e.g. universities, local councils, insurance companies, etc. Number £'000 Number £'000 Liquidity Risk Losses: Cash losses 14 31 The NHS Foundation Trust's net operating costs are incurred under service agreements with Clinical Commissioning 0 0 Groups, which are financed from resources voted annually by Parliament. The NHS Foundation Trust largely finances Bad debts and claims abandoned 0 0 4 46 capital expenditure through internally generated funds and from loans. Total losses 0 0 18 77

Market Risk Special payments: All of the NHS Foundation Trust's financial liabilities carry nil or fixed rate of interest. In addition the only element of the Extra-contractual payments 0 0 1 30 NHS Foundation Trust's financial assets that is currently subject to variable rate is cash held in the NHS Foundation Trust's Ex-gratia payments 59 29 58 73 main bank account and therefore the NHS Foundation Trust is not exposed to significant interest rate risk. Special severance payments 1 20 00 Total special payments 60 49 59 103 31st March 31st March Total Losses and Special Payments 60 49 77 180 23.1 Financial Assets by category 2014 2013 Loans and Loans and Losses and special payments are reported on an accruals basis but do not include provisions for future losses. Receivables Receivables £000 £000 26. Related party transactions

NHS Trade and other receivables 5,153 4,917 Ultimate parent Non-NHS Trade and other receivables 3,568 3,303 Cash and cash equivalents 25,292 27,358 The NHS Foundation Trust is a public benefit corporation established under the NHS Act 2006. Monitor, the Regulator of NHS Foundation Trusts has the power to control the NHS Foundation Trust within the meaning of IAS 27 'Consolidated and Total Financial Assets 34,013 35,578 Separate Financial Statements' and therefore can be considered as the NHS Foundation Trust's parent. Monitor does not prepare group accounts but does prepare separate NHS Foundation Trust Consolidated Accounts. The NHS Foundation 23.2 Other Financial Liabilities by category Trust Consolidated Accounts are then included within the Whole of Government Accounts. Monitor is accountable to the 31st March 31st March Secretary of State for Health. The NHS Foundation Trust's ultimate parent is therefore HM Government. 2014 2013 £000 £000 NHS Trade and other payables (2,965) (4,074) Non-NHS Trade and other payables (28,551) (23,567) Subtotal - Trade and other payables (31,516) (27,641) Other borrowings (43,602) (40,330) Subtotal - Borrowings (43,602) (40,330) Total Financial Liabilities at amortised cost (75,118) (67,971)

The NHS Foundation Trust has four loans with the Foundation Trust Financing Facility categorised within financial liabilities. The carrying value of the liability is considered to approximate to fair value as the arrangement is of a fixed interest rate and equal instalment repayment feature and the interest rate is not materially different to the discount rate.

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26. Related party transactions continued

Whole of Government Accounts Bodies All government bodies which fall within the whole of government accounts boundary are regarded as related parties because they are all under the common control of HM Government and Parliament. This includes, for example, all NHS bodies, all local authorities and central government bodies.

During the year the FT has had a significant number of transactions with the other NHS bodies. The entities with which the highest value of transactions occurred are listed below: Income Receivables 31st March 31st March 2013/14 2012/13 2014 2013 £'000 £'000 £'000 £'000 Blackpool CCG 123,550 0 969 0 Blackpool PCT 0 130,846 0 1,349 Central Lancashire PCT 0 4,147 0 68 Cumbria CCG 2,188 0 0 0 Cumbria PCT 0 1,781 0 250 East Lancashire Teaching PCT 0 1,294 0 224 Fylde & Wyre CCG 99,475 0 161 0 Greater Preston CCG 5,235 0 56 0 Health Education England 8,062 0 86 0 Lancashire Care NHSFT 943 1,384 122 110 Lancashire North CCG 15,393 0 0 0 Lancashire Teaching Hospitals NHSFT 2,195 1,823 446 821 NHS England 81,871 0 2,624 0 North Lancashire PCT 0 145,229 0 1,258 North West SHA 0 10,119 0 0 University Hospitals of South Manchester NHSFT 2,256 1,821 10 25 Western Cheshire PCT 0 43,798 0 10 341,168 342,242 4,474 4,115 Most income from CCG's (2012/13: PCTs) is in respect of services provided under healthcare contracts and priced using national prices (Payment by Results).

Expenditure Payables 31st March 31st March 2013/14 2012/13 2014 2013 £'000 £'000 £'000 £'000 Blackpool PCT 0 3,508 0 544 Lancashire Teaching Hospitals NHS Foundation Trust 800 1,373 474 434 National Blood Authority 2,729 2,832 42 71 NHS Litigation Authority 5,307 4,014 0 0 NHS Property Services 5,725 0 1,395 0 North Lancashire PCT 0 2,948 0 1,645 Pennine Acute Hospitals NHS Trust 0 43 615 503 University Hospitals of South Manchester NHS Foundation Trust 1,537 41 12 8 16,098 14,759 2,538 3,205

None of the receivable or payable balances are secured. Amounts are generally due within 30 days and will be settled in cash. In addition to the amounts above, provisions in respect of the excess on legal claims have been recognised and, if due, are payable to the NHS Litigation Authority. These are disclosed and explained in note 20.

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26. Related party transactions (continued)

Non Whole of Government Accounts Bodies Some of the Governors of the NHS Foundation Trust hold positions at Universities or with Spiral Health CIC. The NHS Foundation Trust has had transactions with these bodies as set out below: Income Receivables 31st March 31st March 2013/14 2012/13 2014 2013 £'000 £'000 £'000 £'000 University of Central Lancashire 173 234 13 7 University of Cumbria 147 105 0 28 Spiral CIC 1,270 1,334 306 634 1,590 1,673 319 669

Expenditure Payables 31st March 31st March 2013/14 2012/13 2014 2013 £'000 £'000 £'000 £'000 Age UK 29 0 5 0 University of Central Lancashire 297 397 0 191 University of Cumbria 3 14 1 2 Spiral CIC 3,629 2,964 0 0 3,958 3,375 6 193

Key management personnel Key management includes directors, both executive and non-executive. The compensation paid or payable in aggregate to key management for employment services is shown below: Aggregate Highest paid director

Year ended Year ended Year ended Year ended 31st March 31st March 31st March 31st March 2014 2013 2014 2013

£000 £000 £000 £000 Salaries and other short term benefits 1,083 1,183 219 268 Exit package 92 0 0 0 Pension contributions: Employer contributions to the NHS Pension Scheme 132 141 25 24 Accrued pension under NHS Pension Scheme 350 349 81 78 Accrued lump sum under NHS Pension Scheme 1027 1020 243 234 Number Number Number of directors to whom benefits are accruing 10 10 under the NHS Pension Scheme During the year reported in these accounts, none of the Board Members, Governors or key management staff have undertaken any material transactions with Blackpool Teaching Hospitals NHS Foundation Trust. None of the key management personnel received an advance from the NHS Foundation Trust. The NHS Foundation Trust has not entered into guarantees of any kind on behalf of key management personnel. There were no amounts owing to Key Management Personnel at the beginning or end of the financial year.

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26. Related party transactions (continued)

Blackpool Teaching Hospitals Charitable Fund The NHS Foundation Trust has also received revenue and capital payments from Blackpool Teaching Hospitals Charitable Fund and related charities (formerly Blackpool, Fylde and Wyre Hospitals Charitable Fund). The Charity is registered with the Charity Commissioners (Registered Charity 1051570) and has its own Trustees drawn from the NHS Foundation Trust Board. Transactions with the fund are as follows: 2013/14 2012/13 £'000 £'000 Donations received from the charitable fund, recognised as income 115 691 Amounts receivable from the fund as at 31st March 348 105

The amount receivable at 31st March is not secured and is not subject to particular terms and conditions.

NHS Pension Scheme

The NHS Pension Scheme is a related party to the Foundation Trust. Transactions with the NHS Pension Scheme comprise the employer contributions disclosed in note 6.1. At 31st March 2014 the Trust owed £2.972 million (31 March 2013: £2.752 million) relating to employees and employer contributions to the scheme. Additionally, the Trust has recognised provisions in respect of reimbursements to the NHS Pension Scheme for early retirement costs. These are explained in note 20.

27. Events after the reporting period

The are no events after the reporting period.

(xxxvi) Page (xxxvi) Blackpool Teaching Hospitals NHS Foundation Trust Notice of the Trust’s Members and Annual Public Meeting

The Annual Members and Public Meeting of the Blackpool Teaching Hospitals NHS Foundation Trust will be held on Monday, 22nd September 2014 at 6.00 pm.

Further copies of the Annual Report and Accounts for the period 1st April 2013 to 31st March 2014 can be obtained by writing to:

Miss J A Oates Foundation Trust Secretary Blackpool Teaching Hospitals NHS Foundation Trust Trust Headquarters Blackpool Victoria Hospital Whinney Heys Road Blackpool FY3 8NR

Alternatively the document can be downloaded from our website www.bfwhospitals.nhs.uk

If you would like to make comments on our Annual Report or would like any further information, please write to:

Mr Gary Doherty Chief Executive Blackpool Teaching Hospitals NHS Foundation Trust Trust Headquarters Blackpool Victoria Hospital Whinney Heys Road Blackpool FY3 8NR

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Annual Report and Accounts 2013/14