Annual Report, Quality Account and Annual Accounts 2018/19

1 2 Yeovil District Hospital NHS Foundation Trust Annual Report, Quality Account and Annual Accounts 2018/19 Presented to Parliament pursuant to Schedule 7, paragraph 25(4) (a) of the National Health Service Act 2006 3 ©2019 Yeovil District NHS Foundation Trust 4 CONTENTS 1. PERFORMANCE REPORT 6 (Including: History of YDH and its Statutory Background, Purpose and Activities of YDH, Statement on the Performance of YDH from the Chief Executive and Key Risks/Issues, Strategic Context, Vision and Strategy, 2018/19 Performance Summary, Performance Analysis and Assurance, Group Entities, Going Concern) Performance Analysis (Including: Summary Statement of Comprehensive Income, Income, Expenditure, Agency Staffing, Capital Investment, Summary Cashflow Statement, Summary Statement of Financial Position, Cost Improvement Plans, Environmental Sustainability, Energy Management, Waste Management) 2. ACCOUNTABILITY REPORT 27 (Including: NHS Foundation Trust Code of Governance Disclosures, How the Board of Directors and the Council of Governors Operate (Including the Handling of any Disputes), Audit Function and Audit Committee Role, Governors and Membership Information, Public Membership, Staff Membership, Elected Governors – Public Constituency, Elected Governors – Staff Constituency, Appointed Governors, Membership Strategy and Representation, Contact Information for Members) Directors Report (Including: Statement of Disclosure to the Auditors, Statement on Compliance with Cost Allocation and Charging Guidance Issued by HM Treasury, Income disclosures, Better Payment Practice Code, The Board, Performance Evaluation of the Board/Governance Arrangements (including details of External Facilitation)) Annual Remuneration Report (including Senior Managers’ Remuneration Policy and Annual Statement on Remuneration (Including: Fair Pay, Expenses of the Governors and Directors, Salary and Pension Entitlements of Senior Managers 2018/19, Salary and Pension Entitlements of Senior Managers 2017/19, Pension Benefits of Senior Managers 2018/19, Pension Benefits of Senior Managers 2017/18) Staff Report (Including: Staff Costs, Equality, Diversity and Human Rights (Including Policies Relating to Disabled Persons), Staff Policies and Actions applied during the Financial Year, Health and Safety, Occupational Health, Counter Fraud and Corruption, Engaging our People, Staff Survey, Future Priorities and Targets, Trade Union Disclosures, Expenditure on Consultancy, Off-payroll Arrangements, Exit Packages, Other Non-Compulsory Departure Payments, Non-Contractual Departure Payments) Regulatory Ratings (Including: Single Oversight Framework, Finance and Use of Resources, Statement of the Chief Executive's Responsibilities as the Accounting Officer of Yeovil District Hospital NHS Foundation Trust) Annual Governance Statement (Including: Scope of Responsibility, The Purpose of the System of Internal Control, Capacity to Handle Risk, Training, The Risk and Control Framework, Principles of Corporate Governance, Emergency Preparedness, Resilience and Response, Review of Economy, Efficiency and Effectiveness of the Use of Resources, Information Governance, Annual Quality Report, Review of Effectiveness, Conclusion) 3. Quality Report App 1 5 1. PERFORMANCE REPORT History of Yeovil District Hospital and its Statutory Background The hospital opened in 1973 and was established as an NHS Foundation Trust on 1 June 2006. It took over the responsibilities, staff and facilities of the previous organisation, East Somerset NHS Trust. As a public benefit corporation, Yeovil District Hospital NHS Foundation Trust (“YDH” or Yeovil District Hospital” or “the Trust”) is authorised under the National Health Service Act to provide goods and services for the purposes of the health service in England. Purpose and Activities of Yeovil District Hospital Yeovil District Hospital provides outpatient and inpatient consultant services to a catchment population of circa 200,000, primarily from the rural areas of South Somerset, North and West Dorset and parts of Mendip. Services are overseen by the Trust’s two strategic business units (urgent and elective care) covering the following areas: A&E, acute and general medical services (including inpatient cardiology, gastroenterology, respiratory medicine, elderly care medicine, diabetes & endocrinology), a full range of medical outpatient services, critical care, trauma and orthopaedics, emergency and general surgery (including urology, ENT, ophthalmology and oral surgery), oncology, diagnostic services, paediatrics, obstetrics/maternity and gynaecology. The Trust is an accredited Trauma Unit as part of the Severn Trauma Network. It is registered without conditions as a healthcare provider with the Care Quality Commission (CQC). The Trust has no branches outside the United Kingdom. Statement on the Performance of YDH from the Chief Executive and Key Risks/Issues Strategic Context Yeovil District Hospital is situated in Somerset, which is a largely rural county with a population of 550,000. The population of Somerset is relatively older than the national average, and over the next 25 years, the number of people over the age of 75 is expected to double. Whilst people in the region are living longer than they used to, there is an ever- increasing gap between life expectancy and healthy life expectancy with increasing numbers of people living longer with one or more complex long-term conditions. At the present time, approximately one third of the population has at least one long-term condition – this equates to 175,000 people in Somerset. This is a key driver of the significant rise in demand for health and care services across all providers within the county. In 2018/19, there have been continuing unprecedented levels of demand across the sector, and this has been reflected at Yeovil District Hospital. The pressure of this is felt across the local health and social care economy, with ever-increasing demand, coupled with difficulties in recruiting sufficient staff to deal with demand and complexity of patient conditions. Compared to 2017/18, Yeovil District Hospital has experienced a 10.4% year-on-year increase in emergency department attendances. During 2018/19, Yeovil District Hospital was one of a small number of trusts in the country that continued to maintain performance across the range of key performance standards including routinely being within the top five of acute trusts for its accident and emergency waiting times performance throughout the year. Further information on performance indicators and constitutional standards can be found on page 10 onwards. 6 In addition, the 2018 staff survey results reflected the positive culture that exists at Yeovil District Hospital. The Trust had the highest recorded response rate for any hospital in the country – 71 per cent compared to a national average of 44 per cent. The results put Yeovil District Hospital as the highest performing trust in the country for staff health and wellbeing. Furthermore, Yeovil District Hospital is also in the top 20 per cent of NHS trusts for a number of other areas within the staff survey, including diversity and inclusion; support from managers; staff morale; safety of the hospital environment; and staff engagement. More information on the staff survey results can be found on page 49. The Trust is actively engaged as a key partner in the Somerset Sustainability and Transformation Partnership (STP). Through this, the Fit for my Future (FFMF) programme has recognised the growing challenges across the healthcare system and the need to ensure that the various parts of the health and care system work more closely together. The ambition is to reduce the number of people becoming ill and mitigate the growth rate in accident and emergency attendances and emergency admissions across Somerset. Where people do become ill, the FFMF programme aims to ensure that people can get access to joined up health and care support in the community, away from hospitals where possible, to help them live independently for as a long as they can. A number of priority areas for change across the Somerset health and care system have been identified with the aim to address the main challenges faced. These priority areas include: preventing avoidable disease and promoting and enabling physical and mental wellbeing; tackling inequalities – services are not yet configured to address the greatest areas of need which are often driven by wider inequalities; providing holistic, integrated locality-based care; supporting independence and reducing dependency; ensuring promotion and support of people’s mental health and well as their physical health; ensuring viable specialist and inpatient services; and addressing the Somerset system health and care system financial challenges. The Trust does face significant challenges with regard to finances. Due to the scale of the deficit financial position for Yeovil District Hospital and the wider Somerset system, a review was undertaken during 2018 by NHS Improvement that aimed to identify and quantify the key deficit ‘drivers’. The resulting report outlined that the drivers of the deficit within the Somerset system could be split between the following categories: Operational drivers: essentially these relate those items solely within the control of a single organisation, for example internal productivity and efficiency; Strategic drivers: these relate to items relating to the scale and/or configuration of

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