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Royal Devon and Exeter NHS Foundation Trust Annual Report and Accounts 2012/13

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Royal Devon and Exeter NHS Foundation Trust Annual Report and Accounts 2012/13 1. Our Year Royal Devon and Exeter NHS Foundation Trust 1 RoyalAnnual Devon Report andand Accounts Exeter 2012/13 NHS Foundation Trust Royal Devon and Exeter NHS Foundation Trust Annual Report and Accounts 2012/13 Royal Devon & Exeter NHS Foundation Trust Annual Report and Accounts 2012/13 Presented to Parliament pursuant to Schedule 7, paragraph 25(4) of the National Health Service Act 2006 2 Royal Devon and Exeter NHS Foundation Trust Annual Report and Accounts 2012/13 Annual Report and Accounts 2012/13 Presented to Parliament pursuant to Schedule 7, paragraph 25(4) of the National Health Service Act 2006 Contents1. Our Year Royal Devon and Exeter NHS Foundation Trust 3 Annual Report and Accounts 2012/13 Contents Section 1: Our Year 5 Chairman's Introduction 6 Chief Executive's Introduction 8 About the RD&E 12 Highlights of the Year 14 Section 2: Our Trust 25 Directors' Report 26 Our Business 40 Patient Care and Quality Improvements 42 Our Staff 44 Sustainability Report 51 Section 3: Quality Report 62 Quality Report 2012/13 63 Independent Auditor's Report on the Annual Quality Report 64 Section 4: Our Governance 67 Board Effectiveness and Evaluation 72 The Board of Directors 75 Remuneration Report 80 Audit Committee 89 Compliance with the NHS Foundation Trust Code of Governance 91 Annual Governance Statement 92 Quality Governance Reporting 98 Regulatory Ratings/CQC Reports and Response 98 Disclosure to Auditors and Further Disclosures 100 Section 5: Our Governors and Members 101 Council of Governors 102 Governor profiles 112 Our Governors 2012/13 116 Our Members 121 Section 6: Our Finances 134 4 1. Our Year Royal Devon and Exeter NHS Foundation Trust Annual Report and Accounts 2012/13 Royal Devon and Exeter NHS Foundation Trust 5 Annual Report and Accounts 2012-13 1Our Year 6 1. Our Year Royal Devon and Exeter NHS Foundation Trust Annual Report and Accounts 2012/13 Chairman's Introduction Welcome to our new Annual Report, Quality Report and Accounts 2012/13. I joined the Trust as Chairman at what in the hands of GP Clinical Whole-system is a particularly interesting time for Commissioning Groups, from 1 April the NHS – never before in its 65 year 2013. Innovations in technology and approach history has it faced such significant treatment, an ageing population and Our population demographic in the changes and challenges. increasing expectations mean that the area we serve is older than the UK NHS is being asked to deliver more than This year has been a period of average, so a higher percentage of our ever before. At the same time the health transition as we prepared for new patients are frail, older people, with service has to save £20 billion by 2014 organisational structures, which, often complex health needs, who need and much of this saving will be focused among a raft of changes, included a longer than average hospital stay. This placing the majority of commissioning on acute hospitals like the RD&E. places huge pressure on our capacity, particularly over the winter months. This year, as well as investing in two new wards for frail older patients, we worked with our partners across the health community to take a whole-system approach to meeting the challenge of ensuring sufficient capacity. We know that sometimes people come to the Emergency Department of their local hospital when a pharmacist or GP could help them. At the other end of the patient journey, when people are well enough to leave hospital, and where they may need further rehabilitation in a care home or additional support at home, ensuring they are able to leave acute care in a way that is appropriate and safe is also challenging. Yet we know that supporting patients in this way, when they no longer need to be in an acute hospital setting, is better for them as well as more financially efficient. By planning and responding jointly with our colleagues in primary care, social services and public health, we were able to deliver much more integrated healthcare and make better use of our limited resources. This approach 1. Our Year Royal Devon and Exeter NHS Foundation Trust 7 Annual Report and Accounts 2012/13 served us well for our winter planning, Third, we must start to have honest consequences of evolving policy, for though more remains to be done. debates as to how we will spend example in relation to competition. As stated elsewhere in this Report, increasingly scarce resources. In a We are very fortunate at the RD&E that services were stretched at times over time of austerity, how do we balance we have great clinicians, leaders and the winter period, but not to breaking the attachment some people have to support staff, the vast majority of whom point, as in some hospitals. existing facilities even where these are completely focused on doing their may offer less good clinical outcomes We now need to extend that best for our patients each day. or be delivered more expensively? partnership approach more generally. Choices will need to be made: if there During my tenure as Chairman, I The RD&E has to deliver £17 million of is willingness to maintain such facilities, intend to work with our staff, partners savings year-on-year. That’s a significant what other services will we then need and stakeholders to find innovative sum of money. What’s more, we want to reduce or stop? There are no easy solutions and new pathways that to deliver the savings whilst continuing answers to these questions, but over will deliver the sustainable future to maintain, or ideally improve, the the coming years it is precisely these our patients deserve. There will be level and quality of services we offer. trade-offs that will shape public debate. many bumps along the road but I am It’s just not possible to keep taking In my view, it is best to engage in these confident that we will be able to look money out of services whilst costs and debates openly now to jointly develop back with pride on how we achieved demand are increasing. an approach that is right for the much more for less to the benefit communities we serve and avoid the of our communities, staff and other Meeting the inevitable polarisation that can occur stakeholders. challenges once proposals are put on the table. It is my opinion that the best way to First, we need to dispel the myth that ensure a sustainable future for the NHS financial sustainability and high quality is to take a whole-service and whole- clinical care are somehow divorced or system approach. If we allow clinical James Brent even in competition. To provide high leadership to configure truly integrated Chairman quality and safe clinical services we health and social care services, then need to employ sufficient high quality the by-product will be improved staff to operate in a high quality service, greater efficiency and financial We are very fortunate environment; we can only provide savings. Working more closely with our high quality clinical care sustainably if colleagues in Clinical Commissioning at the RD&E that we we as an organisation are financially Groups will be a step towards this, but have great clinicians, sustainable. we will need to go much further and be bold in embracing radical service leaders and support Second, we need to work hard to redesign. make the system more efficient, not staff. only within the hospital walls but in I am keen that the RD&E plays its part the wider system too - and not only in engaging with our communities, in healthcare but in social care also. through our Governors and If we focus solely on making cuts, Members, to debate how we can for example by reducing the ratio of become more efficient and allocate nurses to patients, then the quality of scarce resources to their benefit and care will decline. And we have already do so in an honest and transparent seen from the Francis Report the manner. We must not allow denial of unacceptable and tragic consequences the challenge to deflect us from dealing that can bring. with it and we must be clear on the 8 1. Our Year Royal Devon and Exeter NHS Foundation Trust Annual Report and Accounts 2012/13 Chief Executive's Introduction I have been Chief Executive of the Trust for 17 years now, and I can honestly say that the past year has been the most challenging I have experienced in all that time. I know from my visits around the Trust and discussions with many of our staff that they too are feeling the pressure more than ever before. We are operating in a context of significant change - we serve an ageing population with increasingly complex health needs, our budget is decreasing in real terms year on year, and the NHS is also currently undergoing a major restructure. The publication of the second Francis Report was a stark reminder to all involved in the delivery of patient care of how important it is, particularly in challenging financial times, to keep our focus on delivering safe compassionate care to all our patients. My own experience at the RD&E is that our staff care passionately about our patients and they take great pride in delivering excellent services – whether that’s in frontline healthcare or support services. Every day, great things happen at the RD&E because of our staff and this view is endorsed by feedback from our patients, their families and carers, as well as our regulators.
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