OXFORD UNIVERSITY HOSPITALS NHS FOUNDATION TRUST Annual Report and Accounts 1 April 2017 – 31 March 2018 Oxford University Hospitals NHS Foundation Trust Annual Report and Accounts 1 April 2017 – 31 March 2018 Presented to Parliament pursuant to Schedule 7, paragraph 25 (4) (a) of the National Health Service Act 2006 © 2018 Oxford University Hospitals NHS Foundation Trust CONTENTS This report describes how Oxford University Hospitals NHS Foundation Trust has performed over the last financial year and how we account for the public money spent by the Trust over this period. This report includes our Quality Report, outlining our activities and priorities to improve quality of care and outcomes for patients who use our services. WELCOME1. Page Message from the Chief Executive 5 OVERVIEW AND PERFORMANCE ANALYSIS 7 About us – hospitals and clinical services 8 Our operational performance 14 Our healthcare market 29 Our ambition and future priorities 31 Service developments and innovation in care 35 Service improvement and redesign 40 The patient’s experience 48 Research and development 58 ACCOUNTABILITY 61 Directors’ report 62 Remuneration and staff report 84 Our workforce 99 Working in partnership 116 Expenses for governors and directors 119 NHS Foundation Trust Code of Governance 125 Regulatory ratings 134 Statement of Accountable Officer’s Responsibilities 135 Annual Governance Statement 136 QUALITY REPORT 149 (CONTAINING THE QUALITY ACCOUNT 2017-18) FINANCIAL STATEMENTS AND NOTES 213 Financial statements 214 Accounts 215 Useful websites 293 3 4 WELCOME Message from the Chief Executive Welcome to the Annual Report from 1 April 2017 to 31 March 2018 of Oxford University Hospitals NHS Foundation Trust. As we celebrate the seventieth anniversary of the NHS in 2018, I would like to reflect on a year of not only significant challenges but also notable successes in 2017-18. On behalf of the Trust Board I would like to thank personally all our staff who have gone above and beyond the call of duty over the last 12 months to maintain safe, high quality care for patients. During one of the busiest and most demanding winters which the NHS has experienced for many years, our staff braved adverse weather conditions to ensure that patients who rely on us continued to receive the best possible care. At our Staff Recognition Awards in December 2017, we heard patients, families and staff colleagues talk about the life-changing impact which remarkable teams and individual members of staff make every day of the year. In common with other NHS trusts, as demand on services continued to increase in 2017-18, we found it difficult to meet some of our key performance standards – especially in relation to the four hour ED access target and the 18 week referral to treatment standard. In response we are investing in strengthening the leadership of all our services and providing them with more support in order to deal with the increasing challenges. 2017-18 was a year of many significant achievements by staff across the Trust – the examples below give just a flavour of our successes. The hip fracture service at the Horton General Hospital was ranked as the best in the country when the latest National Hip Fracture Audit was published in October 2017. A new Energy Centre, which was officially opened at the John Radcliffe Hospital in November 2017, will cut the Trust’s CO₂ output by 10,000 tonnes per year. Stereotactic radiosurgery, a highly specialised treatment for small brain tumours, has 5 been introduced at the Churchill Hospital so that cancer patients can be treated locally. As we look forward to the future, we are committed to improving services in Oxfordshire by working with our staff, patients, Foundation Trust members and governors, partners in health and social care, GPs, MPs, local councillors, Healthwatch and others. The CQC’s report into Oxfordshire’s health and social care system, published in February 2018, highlighted the need for better co-ordination in order to improve our patients’ experience of their care. We also need to learn the lessons from Phase 1 of the Oxfordshire Transformation Programme in order to engage better and differently with the communities we serve when developing ideas to modernise and improve services. 2018-19 promises to be a busy and eventful year with so much to look forward to. We plan to expand both chemotherapy treatment and renal dialysis at the Horton General in Banbury, as part of our commitment to healthcare in north Oxfordshire, following Oxfordshire Clinical Commissioning Group’s confirmation in March 2018 that there are no plans to downgrade ED or Paediatrics at the Horton. On the John Radcliffe Hospital site we are looking forward to the development of a new Ronald McDonald House – a ‘home from home’ for parents of our youngest patients – and the expansion of the Resuscitation area in ED. On the Churchill Hospital site we are delighted that Sobell House – which provides palliative and end of life care – will be expanded so that more families can benefit from this essential service. I look forward to working with our staff and all those who have an interest in and passion for the NHS in this seventieth anniversary year. Dr Bruno Holthof Chief Executive 6 OVERVIEW AND PERFORMANCE ANALYSIS 7 Introduction The purpose of the overview section of the report is to give the reader a short summary that provides them with sufficient information to understand the Trust, its purpose, the key risks to the achievement of its objectives and how it has performed during the year. ABOUT US We have well over one million patient contacts each year Oxford University Hospitals (OUH) is one of the and, in addition to providing general hospital services, largest NHS teaching trusts in the UK with a we draw patients from across the country for specialist national and international reputation for the services not routinely available elsewhere. excellence of its services and its role in education and research. Clinical care is delivered by Most services are provided in our hospitals, but over 6% experienced specialists. Our Trust consists of four are delivered from 44 other locations. These include hospitals – the John Radcliffe Hospital (which also outpatient peripheral clinics in community settings and includes the Children’s Hospital and West Wing), satellite services in a number of surrounding hospitals Churchill Hospital and the Nuffield Orthopaedic such as: Centre, all located in Oxford, and the Horton a satellite surgical centre at Milton Keynes General General Hospital in Banbury. Hospital; renal dialysis units at Stoke Mandeville Hospital and Oxford University Hospitals NHS Trust was formally at the Great Western Hospital in Swindon. established on 1 November 2011 when the Nuffield Orthopaedic Centre NHS Trust merged with the Oxford The Trust delivers services from community hospitals in Radcliffe Hospitals NHS Trust. On the same date a formal Oxfordshire, including midwifery-led units. It is also Joint Working Agreement between the Trust and the responsible for a number of screening programmes, University of Oxford came into effect. This Agreement including those for bowel cancer, breast cancer, diabetic builds on existing working relationships between the two retinopathy, cervical cancer and chlamydia. organisations. 8 During 2017-18 we provided: 1.4 million patient contacts 107,371 planned admissions The Trust 96,223 unplanned and emergency admissions has a CQC rating of ‘good’ 1.3 million meals for inpatients 135,964 Emergency Department attendances and we delivered 7,500 babies! At the end of 2017-18, we provided: 1,298 beds including 157 for children 61 wards Our turnover in 48 operating theatres 2017-18 was 11,612 staff £1.03 billion 3,803 nurses and midwives 1,811 doctors 1,473 healthcare support workers 9 Our Integrated Business Plan The Trust Board set out its Integrated Business Plan (IBP) that explains the organisation’s plans over a five year period until 2019-20. It describes the services we provide, our plans for developing our services for the future, the money we spend and the people we employ. The Trust’s Integrated Business Plan can be found on the Trust website, alongside the Annual Business Plan www.ouh.nhs.uk/about/publications/business-plans.aspx There is an immediate focus on improving care for older, vulnerable patients, with plans to reduce delays in transfer from hospital care and to improve the psychological support and care given to this significant and growing group of patients. There is a continuing focus on integrating care pathways so that more seamless care is provided across many of our services and also across organisational boundaries. 10 Our hospitals The John Radcliffe Hospital in Oxford is the largest and outpatient clinics, with the outpatient of the Trust’s hospitals. It is the site of the county’s department running clinics with specialist consultants main accident and emergency service, the Major from Oxford in dermatology, neurology, Trauma Centre for the Thames Valley region, and ophthalmology, oral surgery, paediatric cardiology, provides acute medical and surgical services, radiotherapy, rheumatology, oncology, pain intensive care and women’s services. The Oxford rehabilitation, ear nose and throat (ENT) and plastic Children’s Hospital, the Oxford Eye Hospital and the surgery. Oxford Heart Centre are also part of the John Radcliffe Hospital. Acute general medicine also includes a medical assessment unit, a day hospital as part of specialised The site has a major role in teaching and research elderly care rehabilitation services, and a cardiology and hosts many of the University of Oxford’s service. Other clinical services include dietetics, departments, including those of the Medical occupational therapy, pathology, physiotherapy and Sciences Division. radiology. Review of services at the Horton The Churchill Hospital in Oxford is the centre for the In October 2016, due to a lack of medical staff, Trust’s cancer services and a range of other medical obstetric services at the Horton General Hospital and surgical specialties.