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Annual Report 2008-2009 Oct 08

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Annual Report 2008-2009 Oct 08 Annual Report and Accounts October 1 2008 to March 31 2009 Annual Report & Accounts 2008/2009 - - 1 - - Annual Report & Accounts 2008/2009 - - 2 - - Presented to Parliament pursuant to Schedule 7, paragraph 25 (4) of the National Health Service Act 2006 Royal Bolton Hospital NHS Foundation Trust Annual Report & Accounts October 1 2008 to March 31 2009 Annual Report & Accounts 2008/2009 - - 3 - - Contents 1 Welcome: Chairman & Chief Executive’s statement 6 2 Hospital services at the heart of Bolton About us 7 Our partners 7 3 Quality report Quality narrative 8 Our aims and strategy 11 Improving what we do 12 Review of 2008/09 14 Our priorities and plans for quality and safety in 2008/09 18 4 Improving patient care Building better services 38 Care of the highest level 39 Learning through lean 39 Awards 40 5. Patient and public involvement Informing and involving patients 41 Listening to patients 41 Complaints 42 6. Being a good citizen Looking after the environment 43 A smoke free site 43 Equality & diversity 44 Health & safety 44 Emergency preparedness 44 Research 44 7. Our staff Staff involvement 45 Education 45 Staff health and well being 46 Attendance management 46 Staff values 47 8. Business review Introduction 48 Main sources of income 48 Financial performance in 2008/09 48 Looking forward 50 Risks and uncertainties 51 Summary 52 9. Planning for the future 53 Annual Report & Accounts 2008/2009 - - 4 - - 10 Governance Code of governance 54 Membership 55 Our Council of Governors 58 Our Board of Directors 61 Audit committee 65 Nomination and remuneration committee 65 Remuneration report 66 Statement of accounting officer’s responsibilities 69 Independent auditor’s report 70 Statement on internal control 73 Freedom of information and data protection 84 11. Accounts 2008/09 Our financial performance 85 Foreword to the accounts Financial statements 2008/09 Notes to the accounts NOTE: On October 1 2008 Bolton Hospitals NHS Trust achieved foundation trust status. For the first six months of 2008/9 it operated as an NHS trust. All the assets and services of the former Bolton Hospitals NHS Trust were then transferred to the Royal Bolton Hospital NHS Foundation Trust. The operating and financial requirements of foundation trusts differ from those of non- foundation trusts and separate accounts and financial statements are required for each. This document provides a report and accounts for the period October 1 2008 to March 31 2009, following authorisation as an NHS foundation trust. A separate document covers the earlier part of the financial year. Annual Report & Accounts 2008/2009 - - 5 - - 1. Welcome We’re delighted to welcome you to this, our first “annual” report since we became an NHS Foundation Trust. In fact as we achieved FT status in October 2008, this report concentrates on the six months since then. It has been both an exciting and a challenging time. We now have a membership of over 3,750 staff and around 3,700 members of the public and a very enthusiastic Council of Governors. The Governors have been helping us to formulate the way forward for the Trust on behalf of local people. There have been many investments and developments in services and a number of individuals and teams have received national recognition for their work. These range from investment of almost £1 million in a new department for orthopaedic X-rays, to our bereavement staff being highly commended in the Nursing Times team of the year award. The Trust’s Bolton Improving Care System continues to be highly regarded both at home and abroad for its innovative approaches to bringing benefits to patients and staff using “lean” management techniques. Just one example is that BICS has helped us improve our stroke services which audits show now offer some of the fastest and most effective care for patients in the country. This year we have made significant improvements in our work around infection control, vital to the wellbeing of our patients. MRSA infections reduced by 48% and C difficile was reduced by 61%. We have also performed well in our target to ensure nobody waits more than 18 weeks from GP referral to hospital treatment. There have, however, been some areas where we have not performed as well and where we recognise that we need to make improvements. For example our “turnaround” times for A and E patients to be admitted, discharged or transferred were much lower in the last six months of 08/09 than we would have liked. While much of this can be explained by a combination of an early and severe winter, respiratory illness and norovirus, we have been working hard to look at how we can consistently meet our targets. This report gives further information on both our achievements and our challenges and also details our plans for the future. It can also be accessed online at www.royalboltonhospital.nhs.uk Cliff Morris & David Fillingham Chairman & Chief Executive Annual Report & Accounts 2008/2009 - - 6 - - 2. Hospital services at the heart of Bolton About us: The Royal Bolton Hospital NHS Foundation Trust became a foundation trust on October 1st 2008 and was founded under the National Health Service Act 2006. Royal Bolton Hospital NHS Foundation Trust offers patients a wide range of services based at the Royal Bolton Hospital in Farnworth. The hospital: Serves the population of Bolton (around 265,000) and many patients choose to come here from other locations. Had 33,204 emergency admissions (excluding obstetrics) in 2008/09. Delivered 4,445 babies during 2008/09 at the hospital’s Princess Anne Maternity Unit. Has 671 inpatient beds, 32 day case beds and 15 endoscopy (gastrointestinal exploration) beds. Employs around 3,660 staff. Had a turnover of approximately £93 million for the six months ended 31 March 2009 (£183 million for 2008/09.) Was given 'good' ratings by the Healthcare Commission for 2007/08 (latest ratings). There are four operational divisions: Medicines and Emergency Care Anaesthetics and Surgery Women's, Child Health and Outpatients Therapies, Diagnostics and Facilities In addition, the organisation is also supported by these directorates: Corporate Services Medical Nursing and Performance Improvement Service Development Finance, Procurement and Information Workforce and Organisational Development Our partners We have a wide range of partners with whom we work closely in order to provide health and other services for local people. These include NHS Bolton (Bolton Primary Care Trust), the North West Strategic Health Authority and neighbouring trusts. There are clinical networks across organisations, for instance in bringing together multi-disciplinary experts on cancer, independent contractors such as GPs and opticians, Bolton Metropolitan Borough Council, commercial organisations such as ISS Mediclean which provides our domestic and portering services, and voluntary sector organisations. We consider our staff and our patients to be partners also. Annual Report & Accounts 2008/2009 - - 7 - - 3 Quality report 2008/2009 Narrative and view of 2008/09 – David Fillingham, Chief Executive We have set out an ambitious vision for Royal Bolton Hospital. We aim to provide the best possible care for our patients at all times and across every service. We recognise that this aim cannot be achieved overnight. Indeed it may take us many years. But we have made a determined start and there is great enthusiasm and commitment from our staff to realise this vision. This first Quality Report is an opportunity for us to explain the work we have been doing over the last three years to improve safety and quality, to describe some of the successes we have had and to set out the challenges that remain. Since 2005 we have been working to create what we have called BICS, the Bolton Improving Care System. We know that the challenge of delivering safe, high quality healthcare day in day out is no easy task. It requires thousands of processes, involving a myriad of contacts between patients and individual members of staff, to be well designed and consistently implemented. BICS uses the best evidence from management and improvement science in a wide range of fields including Industry and commerce as well as best practice in healthcare. It gives frontline staff the tools to improve their work on a daily basis. Most importantly of all it engages every single member of staff and empowers them to be problem solvers. We will only have succeeded when all 3,500 staff see improvement as their daily business. So what are the results? We have had some really encouraging early successes. Our first priority was to tackle high mortality rates within our trauma services. We had a long standing concern that patients who were admitted with fractured hips did not get the best possible care. Using our BICS approach we redesigned the patient journey, making many small improvements such as reducing the time to get patients to theatre, establishing a Trauma Stabilisation Unit and improving our discharge processes. The results were impressive: a 30% reduction in mortality with patients staying in hospital 33% less time. Applying BICS to elective orthopaedic operations for older patients demonstrated similar success with an impressive 85% reduction in complication rates. Our stroke service was another area where our mortality rates were worryingly high. In 2006 our stroke services were rated in the bottom quarter of all trusts in the country on a range of clinical process measures known as the “Sentinel Audit”. The same audit repeated in 2008, after our BICS redesign, ranks them as the fifth best, and the mortality rates have fallen by 25%. One of the biggest concerns of patients coming into hospital is whether of not it will be clean and hygienic and that they will remain infection free.
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