Sheffield Children‟S NHS Foundation Trust Annual Report and Accounts 2012/13

Sheffield Children‟s NHS Foundation Trust Annual Report and Accounts 2012/13

Sheffield Children‟s 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

Contents

Chairman and chief executive‟s welcome

1 An introduction to Sheffield Children‟s NHS Foundation Trust

2 Directors‟ report

3 Quality report

4 Governance arrangements

5 Remuneration report

6 Financial report

7 Annual accounts 2012/13

Sheffield Children‟s Hospital was first established in 1876. Since 1948 it has provided services under the NHS and, in 1992, it was established as an NHS trust. On 1 August 2006, it became Sheffield Children‟s NHS Foundation Trust under the Health and Social Care (Community Health and Standards) Act 2003.

For more information, please visit www.sheffieldchildrens.nhs.uk

Chairman and chief executive‟s welcome

Welcome to our annual report and accounts for ready for building work to commence in summer the year 2012/13. It gives us both great pride to 2013 with the new wing opening in 2015. It is our be able to present the achievements of Sheffield expectation that this will materially improve the Children’s NHS Foundation Trust, over what has current areas of negative patient feedback. been another very successful, yet extremely challenging, year. In parallel with this investment in our facilities is continued service improvement; a constant theme Never before has the health service been under as across the Trust, as individual members of staff much public scrutiny. The publication of Sir Robert and teams, both within and across disciplines and Francis’ report following the Mid Staffordshire NHS organisational boundaries, strive to develop Foundation Trust public inquiry, has placed trusts integrated services that respond to the often under, admittedly justified, pressure to complex needs of our patients and their families. demonstrate continued improvement in the quality of their services. The board of directors The number of patients coming to us for high accepts that the public inquiry has revealed quality specialised care continues to grow as we unacceptable shortcomings in patient care in Mid gain increased recognition as a centre of Staffordshire and is fully committed to reviewing excellence through striving to meet national the report’s recommendations over the coming standards of clinical care while also making real months. We will consult with our families, advances in delivering a better patient experience governors and staff to ensure that the culture of for all our patients. This has only been possible this Trust is centred on ‘Keeping children, young through the continued commitment of all our staff people and families at the heart of what we do’ - whose hard work, compassion and willingness to our newly agreed value statement, developed this embrace new ways of working continues to drive year alongside a framework of values and forward the performance of the Trust. supporting behaviours following input from a wide range of staff and groups across the Trust. At the same time as developing our specialised services, the transfer to the Trust of paediatric We are confident that we can look back over the community services in April 2011 has provided past year and clearly demonstrate that the Trust opportunities to demonstrate our commitment to has made significant progress towards realising the delivering improved health services to local objectives we set ourselves around delivering patients and, welcoming the opportunity to work improvements in clinical quality and the patient with GP commissioners and other local partners, experience. This progress is evidenced within our we are transforming healthcare services for quality report which, at the same time, sets some children in Sheffield, developing new models of challenging quality improvement priorities for the care to provide more care outside the hospital year ahead, recognising the need for the Trust to setting, while also making most effective use of make ongoing quality improvements. resources.

Indeed, our drive to improve the patient Throughout the year we have maintained our experience and the quality of our services is at the strong performance against key national targets forefront of our plans to invest in the quality of the with the exception of delivery of the 18-week accommodation within which we already deliver referral to treatment waiting time target. our high quality clinical care. Consistently our, Significant increased demand for some of the otherwise positive, patient survey feedback has Trust’s highly specialised services led the Trust to identified parking, privacy and dignity, parental under perform against this target between June accommodation, and way-finding as areas of and September 2012. Performance is now back on below average patient experience. During 2012/13 track and the Trust has put in place a range of we have made significant progress in moving measures to ensure that this is sustainable. Other forward with plans to develop a new hospital wing. targets and performance against clinical quality Positive review of our plans by Monitor, our indicators have been met and we retain our regulator, at the end of 2012 was an important reputation for infection prevention and control milestone in realising our ambition to improve our which continued to be a top priority for the facilities to a world-class standard. Enabling works organisation. During 2012/13, there were no cases for a £40 million patient wing are now underway of MRSA bacteraemia and, considering the

1. An introduction to Sheffield Children‟s NHS FT

1.1 Who we are

Sheffield Children‟s NHS Foundation Trust is one of only four dedicated children‟s hospital trusts in the UK providing integrated, highly specialist healthcare for children and young people in Sheffield, South Yorkshire and beyond.

We have some of the best medical and surgical services for children in the country and work with children and their families in the local community. We provide a full range of services for local residents as well as specialised services for patients from further afield. Our specialised services receive referrals from the UK and internationally and we have developed pioneering services in trauma and orthopaedics, paediatric transport, genetics and many more.

Demand for our services continues to grow year on year and we are increasingly delivering healthcare to patients over a wider geographical area as our reputation for providing outstanding specialist care grows. In 2012/13, we treated more patients than ever before with almost 30,000 patients admitted to hospital as inpatients or day cases and more than 164,000 attending outpatient clinics or being treated in our emergency department.

The Trust is committed to being a leader in the field of training and research in children‟s healthcare and we continue to deliver a strong portfolio of research and product innovation.

We employ more than 2,500 staff and strive to recruit and retain the best doctors, nurses, allied health workers and other staff; the commitment of our employees is key to the Trust‟s success and reputation.

Sheffield Children‟s NHS Foundation Trust is registered without conditions with the Care Quality Commission (CQC), the independent regulator of health and social care in England.

1.2 Our mission statement and strategic direction

The purpose of the Trust is set out in the agreed mission statement for the organisation, which is:

„Our aim is to provide care and treatment of the highest standard to the children and young people of Sheffield, South Yorkshire and beyond, working closely with children and their families, other partners, and our staff to improve the health, wellbeing and life chances of the younger population.‟

In response to the changing demands of patients, their families and commissioners, and in line with best practice in paediatric care (both nationally and internationally) the Trust is developing the ways in which we work with other providers and partners to ensure that we can deliver and sustain services for the future

Many of our departments and clinicians are UK leaders forging the way in paediatric care, in research and in delivering health outcomes and we can demonstrate that several of our specialised services are recognised as UK-wide and international centres. For this reason there has been a significant growth in referrals to the Trust, continuing the trend over recent years and reflecting the pattern that nationally a greater proportion of care for children is being undertaken at specialist centres with skilled staff who care for children on a regular basis. In response to this increase in activity and, as a means to support a strategy which plans for continued modest growth in our specialised services, the Trust has put in place a number of developments which will increase our capacity to provide high quality specialised services.

In order to maximise the Trust‟s opportunities to develop further as a specialist provider, it is critical that the focus on continually developing the quality of services remains strong as this is key to our reputation as an expert provider of services. It is also critical to ensure that the Trust‟s role as a provider of high quality research and training continues to be enhanced.

The development of a new wing of Sheffield Children‟s Hospital is part of our strategy to position the Trust as a highly specialised paediatric centre. This investment in our facilities and infrastructure will provide world-class facilities within which we can continue to deliver treatment of the highest quality, enhancing both the experience of patients and their carers and, for staff, clinical functionality.

In addition to its role as a specialist provider of care for children, the Trust will continue to provide high quality non-specialist general hospital and community services for children and families in Sheffield. With the exclusion of primary care, the Trust is now the sole provider of healthcare services for children in the city. Increasingly, emphasis is on providing as much care outside hospital as possible and the Trust is working closely in partnership with Sheffield Clinical Commissioning Group (CCG) and the local authority on the redesign of children‟s services in community settings, and assisting GPs in their care and management of children.

Economic pressures on NHS providers are becoming ever more severe, and the financial context within which we operate represents a major challenge for the Trust. While we continue to see increased levels of activity and ended the year in a strong financial position, cost pressures and capacity issues are greater than anticipated and key to our ability to respond effectively to increased demand for our services will be achieving substantial cost reductions. Our current surplus position has been generated strategically to fund necessary continued investment in both the Trust‟s infrastructure and the quality of our services and the board has either considered, or is due to consider, proposals for a number of important developments over the next three years, including the new ward block, the development of theatres, incorporating a 3T MRI scanner and the implementation of a replacement patient administration system as the first phase of an electronic patient record (EPR). All of which are directed towards increasing the range and quality of the services we are able to offer to our patients. Focus on the delivery of a substantial efficiency savings programme, and the delivery of significant cost savings over the next three years is therefore fundamental to our forward plan and our future success.

2.Directors‟ report

2.1 Our strategic objectives

Throughout 2012/13 we continued to make progress against the five-year objectives we set following a review of our strategic direction in 2010/11. These long term priorities for the organisation and its clinical services were developed following a series of strategy workshops involving clinical leaders and senior managers, the Trust board of directors and the Trust council of governors from which the Trust‟s five primary strategic objectives were set as:

1. To provide healthcare to children of the highest standards available in the UK;

2. To work in partnership with others to reshape healthcare for children in Sheffield;

3. To develop and expand our role as a provider of specialised services for children;

4. To expand the Trust‟s role as an expert provider of specialist pathology services; and

5. To be a national leader in research and education in children‟s healthcare.

In addition to the primary strategic goals, the Trust has four underpinning strategies which support the delivery of its long term priorities. These being:

Ensuring that the Trust has an appropriately trained and supported workforce;

Ensuring that the facilities and equipment used by the Trust are of high quality;

Ensuring that robust arrangements are in place to ensure financial stability; and

Ensuring that the Trust is well governed and works effectively in partnership.

With input from clinical leaders, senior management and the council of governors, these strategic objectives are reviewed annually against the changing context within which the Trust operates and against key drivers for change to ensure that they remain appropriate. Measurable staged actions and targets have been set against them and short-term objectives updated. This provides the framework for our annual plan for 2013/14 with progress against the delivery of strategic objectives monitored quarterly by the Trust board.

The directors‟ report, together with the quality report at section 3, contains many examples of the progress the Trust has made against these objectives in the last year.

2.2 Directors during 2012/13mments

Director Name

Chairman Nicholas Jeffrey

Medical Director Derek Burke

Chief Operating Officer Isabel Hemmings

Non-executive Director Meredydd Hughes

Non-executive Director Sarah Jones

Chief Finance Officer Jeremy Loeb

Non-executive Director Neil MacDonald

Chief Executive Simon Morritt

Director of Human Resources & Organisational Development Steven Ned

Director of Nursing & Clinical Operations John Reid

Non-executive Director, Senior Independent Director Gareth Watkins

Non-executive Director, Deputy Chairman David Williams

2.3 Principal activities of the Trust

The main focus of the Trust is to provide care and treatment of the highest standard for children and young people and to work with other organisations to help keep children healthy and safe. We have a strong commitment to delivering a wide breadth of co-ordinated healthcare services and following the successful transfer of community services for children from NHS Sheffield in April 2011, the Trust provides an extremely comprehensive range of integrated acute, community and mental health services for children.

We offer a broad range of healthcare to children and young people with complex needs, as well as providing specialist treatment to those with specific needs. Our services encompass a range of integrated acute, community and mental health services, all of which we aim to co-ordinate seamlessly and effectively so that families can access our services with ease and with support.

The Trust continues to develop its role in research into the causes and treatment of ill-health in children and, as a teaching hospital, undertakes a key role in the education of healthcare professionals. The Trust also provides highly specialised genetic and pathology services for all ages.

2.3.1 Location of premises / service bases

We treat children from our main hospital base on Western Bank and a number of other locations across Sheffield and South Yorkshire. The transfer to the Trust of community services for children and an increase in provision of outreach clinics and day case surgery at neighbouring hospitals around South Yorkshire, North Derbyshire and the Humber enables us to deliver co-ordinated and seamless services while allowing us to provide care closer to home.

The locations from which we delivered our services over the last year can be listed as:

Location Summary of services Area served South Yorkshire and the Acute hospital services, emergency Sheffield Children‟s Hospital, Humber, North Derbyshire, care, specialised paediatric medical and Western Bank Lincolnshire and, in some surgical services cases, national. Neurodisability services, child Sheffield and wider catchment Ryegate Children‟s Centre development services and specialist as above for specialist neurology neurology

Flockton House Speech and language therapy Sheffield

Base for community services (including child health), some child development Centenary House Sheffield services, Wellbeing and mental health services Wellbeing and mental health services 47 Wilkinson Street Sheffield community team Mental health community team, Sheffield Becton Centre for Children and Specialist mental health (tier 4) in-patient South Yorkshire, North Young People service and daycare Derbyshire

Northern General Hospital Children outpatient services Sheffield, South Yorkshire

Embrace Specialist critical care transport service Yorkshire and the Humber

Community paediatrics, school nurses, Community settings health visiting, speech & language Sheffield therapy, Sure Starts South Yorkshire, North Local district general hospitals Outreach outpatient services Derbyshire and the Humber

The Trust serves a population of children and young people living across South Yorkshire, North Trent, Lincolnshire and the Humber, and an increasing number of cases from across the country. Some specialised services provided by the Trust currently receive referrals on a national basis. There are also national contracts for some specialised services including Ehlers Danlos Syndrome and Osteogenesis Imperfecta services.

We are constantly striving to improve the services we provide to both our local population and those who travel from outside Sheffield to use our services. Some of the Trust‟s achievements in developing the quality and scope of our services during 2012/13, further described in section 2.4, include:

Making progress in meeting national standards for paediatric neurosurgery services;

Planning for the launch of a next generation sequencing facility early in 2013/14 following purchase of equipment through charitable funding;

Planning for two new operating theatres;

Expanding our neonatal surgical unit;

Opening new national beds at our assessment and treatment service for children with learning disabilities and challenging behaviour, Ruby Lodge at the Becton centre;

Implementing an ambitious research strategy;

Advancing new models of care in partnership with local GPs including the piloting of an unscheduled care project, launch of a GP advisory service and setting up urgent paediatric clinics; and

Working with commissioners to meet demand for speech & language therapy services, health visiting and school nursing services.

2.3.2 Patient activity

As described in section 2.3, Sheffield Children‟s NHS Foundation Trust delivers care in a variety of settings mainly via contracts with commissioners.

The total NHS care provided by Sheffield Children‟s NHS Foundation Trust across all settings in 2012/13 totalled almost 30,000 admissions for inpatient or day case treatment, 111,000 outpatient appointments and 53,000 emergency department attendances. With the exception of first outpatient attendances and therapy assessments and attendances, patient activity grew in all categories in 2012/13, as set out in the table below.

%Growth in Activity Type 2010/11 2011/12 2012/13 last year

15,055 16,845 17,743 5% Total elective

11,499 11,539 12,165 5% Non-elective spells

30,144 32,635 32,382 -0.8% First outpatient attendances

Follow-up outpatient attendances 74,939 76,504 78,984 3%

Total outpatient attendances 105,083 109,139 111,366 2%

Clinical genetics - First and follow-up 3,795 3,956 3,978 0.6% appointments

Emergency Department attendances 51,540 51,158 53,060 4%

34,102 39,272 38,148 -3% Therapy assessments and attendances

Mental health community contacts1 12,717 9,496 13,114 38%

Mental health inpatients (bed nights)2 3,282 6,267 7,194 15%

2 Mental health day cases 3,137 2,628 2,886 10%

1 Funding for CAMHs Tier 2 and 3 services was reduced by 17 per cent in 2011/12 from the previous year and resulted in a reduction in activity undertaken between 2010/11 and 2011/12 2 Tier 4 CAMHs services were fully opened during the year 2011/12 resulting in a change in both the profile and volume of inpatient and day case activity

The above table clearly shows that demand for the Trust‟s services continues to grow as it has consistently over the last five years. During 2012/13, the Trust treated more patients than ever before with an increase of nearly five per cent in planned admission to hospital for treatment.

The growth in activity was significant and reflects the trend over recent years with the Trust receiving a continued rise in referrals for specialist activity. This is in line with national trends, with a greater proportion of care for children now undertaken at specialist centres. This reflects the fact that children‟s healthcare requires specialist expertise provided by skilled staff who care for children on a regular basis.

2.3.3 Commissioning arrangements

Sheffield Children‟s NHS Foundation Trust delivered clinical activity in 2012/13 for commissioners both regionally and nationally.

The Trust secured income from patient care activities of £129 million in 2012/13. Of this 58 per cent related to our main contract with our local collaborative commissioners. In addition, we received income under national contracts for highly specialist work as well as specialist referrals from within the region.

Fig: Trust income from patient care 2012/13 by source of funding

% of income Income Type £000's from activities NHS - National Commissioning Group Contract Income 1,579 1% NHS - Collaborative Contract Income – PCT 75,418 58% NHS - Collaborative Contract Income – SCG 41,931 33% NHS - Other Contracts 1,193 1% NHS - NCA Income 2,411 2% NHS - Cost per case income, outside above contracts 6,180 5% Other income from patient care activities 421 0% 129,133 100%

Other Operating income 24,776

Total Income 153,909

2.4 Performance Review - Operational and financial performance

Sheffield Children‟s NHS Foundation Trust delivered strong operational performance across a wide range of measures during 2012/13. Targets for infection control and clinical quality were met and our emergency department performance remains robust – 97.5 per cent of our patients were admitted, transferred or discharged within four hours of their arrival in the department, against a national target of 95 per cent. For further details of our compliance with national priorities and core standards, please see section 3.3.4 in the quality report chapter.

Financially, we also performed well, generating a surplus £2.24 million above plan. This surplus enabled us to achieve an end of year financial risk rating of four with our regulator, Monitor. We outline in section 6 of the report the main factors for this favourable financial performance and explain that

while providing specific contingency to make much needed investment in our infrastructure, this end of year performance does not reduce the need for the Trust to generate efficiency savings in the future.

Monitor risk ratings

As a foundation trust, our performance is regulated by an external regulator, Monitor. We are assessed on a quarterly basis on the following key performance measures:

Financial risk rating, rated 1 to 5, where 1 represents the highest and 5 the lowest risk; and

Governance risk rating, rated red, amber/red, amber, amber/green or green

While we ended the year with a governance rating of green (the highest rating) demonstrating compliance with all performance indicators monitored by our regulator, for two quarters of the year we were rated amber/green. This was due to failure to achieve the 18-week referral to treatment waiting time target for admitted patients between June and September 2012. The Trust was assessed positively by Monitor in all four quarterly financial assessments.

Our quarterly risk ratings for the last two financial years are set out in the following tables against our expected performance within the respective year‟s annual plan:

Annual Plan Q1 2012/13 Q2 2012/13 Q3 2012/13 Q4 2012/13 2012/13 Financial risk rating 3 4 4 5 4

AMBER/ AMBER/ AMBER/ Governance risk rating GREEN GREEN GREEN GREEN GREEN

Annual Plan Q1 2011/12 Q2 2011/12 Q3 2011/12 Q4 2011/12 2011/12 Financial risk rating 3 3 3 4 4

Governance risk rating GREEN GREEN GREEN GREEN GREEN

We have performed better than our planned financial risk rating for 2012/13 due to higher than planned levels of clinical income and other factors described in the financial report set out in section 6 of the report.

2.4.1 Performance against strategic objectives

2012/13 was the second year of delivery of the Trust‟s five-year strategy as set out in section 2.1. During the year the Trust has driven forward with our primary aim of providing the highest quality services and made steady progress to achieving its main objectives. This progress is summarised here.

Strategic Objective I: To provide healthcare to children of the highest standards available in the UK

Progressing clinical quality and safe standards of care

The Trust maintained unconditional registration with the Care Quality Commission (CQC) throughout 2012/13. The Trust continues with an excellent record on infection control which remains a top priority for the organisation. During 2012/13, there were no cases of MRSA bacteraemia and low levels of

Clostridium difficile. Full details of our progress in improving the quality of our services are provided in the quality report provided in section 3.

An unannounced inspection by the CQC took place on 16 October 2012 as part of the CQC‟s routine schedule of planned reviews. Inspectors visited a number of wards and departments during the course of the day, speaking to staff, parents and patients and assessing how well the Trust was meeting the standards set by the CQC. A review was also made of the way in which the Trust manages complaints. The overall judgement was that the Trust was meeting all the essential standards of quality and safety and the formal report from the inspection included no recommendations for improvement or minor concerns. We take great pride in these results and extend much credit to all our staff who contribute to maintaining high levels of care.

The quality report in section 3 contains many examples of the Trust‟s response to external service reviews and reports from confidential enquiries in terms of the range of service and quality improvements implemented as a result.

Sustaining high performance across the range of healthcare indicators

Throughout the year we have maintained our strong performance against key national targets measured by our regulators, Monitor and the CQC, meeting all key targets with the exception of delivery of the 18-week referral to treatment waiting time target for admitted patients. Significant increased demand for some of the Trust‟s highly specialised services caused the Trust to under perform against the target for admitted patients between June and September 2012. The Trust is now meeting this target and has put in place a range of measures across all specialities to ensure that levels of performance are sustained. Other key targets and performance against national clinical quality indicators have been met.

All quality improvement and innovation goals agreed between the Trust and its commissioners under the Commissioning for Quality and Innovation (CQUIN) payment framework were met apart from the target for asthma management. While we have improved performance against the target for patients waiting for diagnostic tests we failed to achieve this contractual requirement in a number of months of the year and are working to improve consistency in this area. Performance has, however, been strong against other key targets, particularly cancer waiting times and, despite increasing pressures in our emergency department due to high volumes of patients, the four-hour Accident and Emergency (A&E) waiting target. With performance slightly dipping at the end of the year a high level of focus will be needed from both the organisation and the health community if we are to maintain performance against this target during the coming year.

More detail on how we have performed against our key performance indicators is contained within the quality report in section 3.

Improving patient experience

The Trust continues to use the results of patient surveys and other forms of feedback to form action plans to improve the patient experience. Consistently our otherwise positive patient survey feedback identifies parking, privacy and dignity, parental accommodation, and way-finding as areas of below average patient experience. During 2012/13 we made significant progress in moving forward with plans to develop a new hospital wing which has been driven by our recognition to improve the patient experience through investment in the quality of our accommodation.

Positive review of our plans by Monitor, our regulator, at the end of 2012 was an important milestone in realising our ambition to improve our facilities to a world-class standard. Enabling work for a £40 million patient wing which will deliver the high standards of clinical functionality and patient experience expected by our patients is now underway ready for building work to commence in summer 2013 with the new wing opening in 2015. The new wing will provide three new wards to replace three existing wards, each with a high percentage of single rooms with en-suite facilities and accommodation for parents staying with their child. The scheme will also provide priority car parking, a drop off point

outside and allow the expansion of the outpatient department. It is our expectation that this will materially improve the current areas of negative patient feedback.

The problem area of parking is being further addressed through plans we have to provide a „park and ride‟ service which we hope to start operating in the next year. This, together with the inclusion of some parking provision for priority patients within the new hospital development itself and progression by the University of Sheffield with its plans to build a public multi-storey car park close by, should ease the difficulties currently experienced by families and visitors.

Changes implemented as a result of other issues identified within the results of surveys include improvements in way-finding within the hospital using „breadcrumb‟ signage and provision of a separate adolescents‟ waiting room with age-appropriate facilities. Progress is also being made to increase the level of parent accommodation by working with The Sick Children‟s Charity who are providing new facilities for families with children needing treatment at the hospital. Further examples of the steps we are taking to enhance the experience of our patients and their families in response to their feedback are given in the quality report in section 3.

Strategic Objective II: To work in partnership with others to reshape healthcare for children in Sheffield

Becoming one of the most comprehensive providers of children‟s healthcare services nationally

Under the national agenda on transforming community services, the Trust took responsibility for a range of community health services for children in April 2011, including health visiting, school nursing and speech and language therapy. Providing a full range of community services for children, as well as providing for their acute and mental health care needs, saw the Trust become one of the most comprehensive providers of children‟s healthcare services nationally.

During 2012/13 work has continued on the integration of these services within the Trust, delivering improved performance against agreed key indicators and working with key partners on deriving the benefits of integration to improve the care of children in the city.

Specific discussion has been undertaken with our commissioners over the last 12 months to resolve issues relating to the specification of school nursing and health visiting services and plans have been agreed with NHS England for increasing numbers of health visitors from April 2013 onwards. Agreement has also been reached with the clinical commissioning group to expand the speech and language therapy service in order to meet growing demand for this service.

Over the last year the Trust has responded to changes made by the local authority to the funding available to support Sure Start services. The Trust will no longer provide these services with effect from July 2013 as a result of the new early years strategy.

Working in partnership to reshape healthcare for children locally

In the last year we have welcomed the opportunity to work with our new GP commissioners in transforming services to develop new models of care so that children are treated in the most appropriate settings and to make most effective use of resources. Together we are making good progress in reshaping the delivery of acute care for children in Sheffield by delivering more home and community based services to children and reducing the number of children admitted or readmitted to hospital.

Examples of progress being made include the successful pilot of a new model of unscheduled care for children involving the provision of consultant paediatrician advisory support to GPs managing children with acute illness. Based on the success of the project in diverting patients attending our hospital, Sheffield Clinical Commissioning Group (CCG) has commissioned an extension to the hours during which the service is provided in 2013/14. We have also agreed plans to site a GP collaborative out-of-

hours service in the hospital from early in 2012/13 as a first step towards more integrated unscheduled care provision.

We continue to work more broadly with partner agencies in Sheffield, including Sheffield City Council, NHS Sheffield (now Sheffield Clinical Commissioning Group), Sheffield Teaching Hospitals NHS Foundation Trust, and South Yorkshire Police and part of the Children‟s Health and Wellbeing Partnership Board. Jointly chaired by our chief executive and the director of children‟s services at Sheffield City Council we have been championing the need to prioritise, protect and improve children‟s health and wellbeing through this partnership approach.

Strategic Objective III: To develop and expand our role as a provider of specialised services for children

Treating more patients and developing our specialised services

The Trust is committed to developing further its specialised services. As our reputation as a provider of specialist paediatric healthcare within the North of England continues to grow, so too does the demand for our services as, again, we have seen further increases in patients coming from outside Sheffield this year. This reflects the fact that the Trust is uniquely placed within the region to develop specialised services for children; particularly as, nationally, higher standards of care have been defined for the safe treatment of children leading to more care being undertaken in specialist centres rather than in local hospitals.

Many of our departments and clinicians are UK leaders forging the way in paediatric care, in research and in delivering health outcomes and we can demonstrate that several of our specialised services are recognised as UK-wide and international centres. Indeed, three specialists were listed within The Times‟ list of the top 100 children‟s doctors. Consultant neurologists Dr Chris Rittey and Dr Peter Baxter and Professor Mark Everard, respiratory consultant, were included in the directory which compiles the top paediatric specialists in Britain, demonstrating that the Trust is at the forefront of paediatric care.

Focused work has taken place this year to consider strategic issues and assess future opportunities in relation to the development of specialised services and we have established a specialised service development group to lead on this. Current focus is to assess the Trust‟s services against new draft service specifications for specialised services published by NHS England and identify market opportunities to determine key clinical priority areas for future expansion.

A clear clinical priority for the Trust is the expansion of our highly specialised neurosciences services and we aspire to be one of the country‟s major neurosciences centres for children. To this end we have made further progress to develop these services in line with the nationally defined Safe and Sustainable standards for paediatric neurosurgery. We have strengthened our specialised neurology services with two new neurologists taking up posts from September 2012. We are also expanding our children‟s epilepsy surgical service. We have been involved in negotiations with commissioners around the future network arrangements for specialised paediatric neurosciences services for Yorkshire and the Humber which will involve three centres in Sheffield, Leeds and Newcastle working together and work will now be undertaken to formalise these network arrangements.

Building on the achievement of interim status as a major trauma centre for children from April 2012, we had a successful peer review visit in March 2013 and agreed with commissioners plans for work to achieve standards to meet fully current gaps in compliance.

As demonstrated in section 2.3.2 there has been a significant growth in referrals to the Trust, continuing the trend over recent years. To ensure that the Trust can respond to increased activity levels and maintain high standards of care, we have undertaken a range of measures to increase capacity and deliver productivity improvements in key areas of our service provision.

Under the scope of the Trust‟s three-year transformation programme set out last year, progress has been made during 2012/13 in increasing utilisation of our operating theatre capacity. Planned implementation within 2012/13 of a board approved capital scheme for additional theatres will further improve the efficient use of our theatres. Another element of our transformation project focusing on

increasing utilisation of our outpatient clinics by reducing cancellations, improving booking and reducing time lost, is supporting the delivery of additional outpatient activity to meet higher activity levels.

Completion in year of a capital scheme to expand our neonatal surgical unit will provide an effective response to increased demand and we plan to open two extra cots from April 2013 with neonatology medical expertise in place. Opening of national beds within our Ruby Lodge assessment and treatment service for children with learning disabilities and challenging behaviour is a further example of the Trust, with the support of commissioners, increasing capacity to provide care and support for more children and their families.

Strategic Objective IV: To expand the Trust‟s role as an expert provider of specialist pathology services

Advances within a number of key service developments has allowed the Trust to demonstrate that good progress has been made in delivering this strategic objective over the past twelve months. The Trust continues to develop its newborn screening service and in July 2012 launched a year-long study to screen thousands of newborn babies across the country for five rare diseases to see if undiagnosed illnesses can be prevented from developing in children. The Trust is the lead centre nationally for this trial and in partnership with the South Yorkshire Collaboration for Leadership in Applied Health Research and Care, will be co-ordinating the actions of the six centres across the country. At the end of the one year study, the national screening committee will determine whether these new conditions should form a regular part of the national screening programme in England.

Thanks to funding from the Children‟s Hospital Charity, the Trust was able to purchase equipment to launch a next generation sequencing facility early in 2012/13. Work has taken place this year to analyse and review patient pathways to assess how best to utilise this new genetics capability to transform and improve patient outcomes. Our new facility will ultimately provide multiple platforms for sequencing for the NHS and research communities within Sheffield with support from within the Trust‟s genetics service.

Strategic Objective V: To be a national leader in research and education in children‟s healthcare

Research is integral to the clinical services provided by the Trust. The Trust is committed to being a leader in the field of training and research in children‟s healthcare and continues to be home to a first class paediatric research facility, which works to develop innovative and pioneering treatments for children and supports high quality national projects.

The research portfolio of the Trust is growing following the approval by the Trust board in July 2012 of an ambitious research strategy. We have established targets for increasing our research activity, aiming to achieve between 20 and 40 per cent growth of our research portfolio year on year with a focus on growing commercial research activity. To support this we have put in place additional workforce support including two research nurses, a paediatric research assistant and the appointment of fellow in clinical research leadership with funding from the Yorkshire and Humber deanery.

In 2012/13 there were 119 active research studies taking place across the organisation involving more than 1,000 patients and 92 members of staff. This represents a growth in overall research activity of 38 per cent. In addition we saw our commercial research activity grow with a 50 per cent increase in the uptake of commercial studies in 2012/13 compared with activity in 2011/12. Notable successes during 2012/13 include the award of twelve Trust led grants, totalling in £0.75 million, with a further four successful grants with a combined value of £85k for studies where Trust researchers were co- applicants. Our quality report in section 3 provides examples of current research projects.

Underpinning objectives: Supporting the achievement of our five primary strategic objectives

As outlined above, the Trust has set itself ambitious strategic objectives, and it is striving to make these improvements to its services within a highly challenging financial context. Effective delivery of our five main strategic goals will require substantial transformation in the way in which clinical services are supported and to this end the Trust has identified a number of plans to underpin our clinical strategy.

These include plans to ensure that the Trust has appropriately skilled staff with the appropriate standard of accommodation and equipment to deliver our services effectively, and that there is a strong financial plan to underpin our ambitious plans for the future development of our services.

The Trust remains highly focused on the delivery of a substantial efficiency savings programme, acknowledging that delivering higher quality outcomes for patients within existing or reducing resources will require substantial change to the way we work. The first year of our three-year transformation programme aimed at delivering substantial productivity improvement has produced initial cost savings in some key areas, although further urgent focused work is needed to identify recurrent savings. Progress against the four key areas of transformation can be summarised as:

Theatre transformation - work has been undertaken this year to increase utilisation of our operating theatre capacity; reducing cancellations, improving booking and reducing time lost. We are now treating more patients within the same capacity, with a seven per cent rise in the average number of patients treated on our elective theatre lists. Planned implementation within 2012/13 of a board approved capital scheme for additional theatres will further improve the efficient use of our theatres.

Outpatient transformation – progress has been made identifying plans to increase utilisation of our outpatient clinics by reducing cancellations, improving booking and reducing time lost. New technology has been introduced to improve patient care and increase outpatient attendance rates. Netcall, a telephone messaging system, calls patients' parents to remind them about appointments, asking parents to confirm appointments and giving them an option to reschedule if necessary, will help to reduce missed appointments and waiting times and improve patient throughput.

Bed utilisation – we will ensure that we are using our bed capacity effectively, that patients are treated on a day case basis wherever possible and discharged from hospital as soon as they are ready to leave; and

IT enabled administration - a key component of our transformation programme is maximising the use of information technology to streamline the delivery of care and improve efficiency. The board recently approved a decision to finalise the procurement of a replacement for the Trust‟s patient administration system as the first phase of an electronic patient record (EPR). The timescale to go live with the new system is February 2014. The board is also due to consider a business case for an electronic data management system for clinical records which will improve the way our administration of clinical activity is undertaken.

In conjunction with our own transformation programme, the Trust is now a member of an acute services partnership „Working Together‟, which has outlined a programme for the seven acute providers in South Yorkshire, Mid Yorkshire and North Derbyshire to work together to help meet the current financial challenges and improve the quality of care they deliver. Working Together is driven by the need to continue to improve the quality of care, safety and the patient experience; deliver local access and improve activity (productivity); and do so in a way which is economically and financially sustainable.

Key to delivering our plans for the future is staff engagement and progress has been made against a number of workstreams to ensure that the organisation can continue to harness the skills, expertise and enthusiasm of our workforce. These include development of our new Values framework, increased focus on clinical leadership and setting up of the „Your Voice‟ staff engagement forum which will focus its work around ensuring that the findings of the staff survey are acted upon and that staff

engagement is prioritised across the Trust, more details of which are included in section 2.7 and the quality report in section 3.

2.4.2 Looking ahead – the main trends likely to impact the Trust

The Trust board has identified a number of key risks to the organisation which, if not managed, will impact on the Trust‟s ability to deliver its strategic goals. The recommendations of the Francis Report put into clear focus the need to continue to place patients at the heart of all we do, focus on improving further our clinical safety and outcomes, continue to enhance and develop our clinical services, make progress in improving our facilities, and continue to lead the way in providing more care in community and primary care settings. All this must be done while taking account of the increasingly tough financial climate we face, to ensure we are well placed to deal with the reduced levels of income we expect without compromising either the quantity or quality of our patient care, teaching and research.

Our strategic direction outlined in section 1.2, together with the update against our strategic objectives provided in the previous section reference, our key planned service and capital developments for the forthcoming year. Our annual plan sets out in detail our intentions for the coming year and can be downloaded from our website at www.sheffieldchildrens.nhs.uk

In delivering our plans for the next year the Trust faces a number of risks over the next five to six years which it must manage effectively. Key risks are:

Ensuring that we meet new nationally defined standards or care – changes being implemented to commissioning arrangements for specialised services place increased emphasis on the need for us to be able to clearly demonstrate compliance with defined national standards for specialised services. While the Trust is proud of the high standards of care it is able to provide for its patients it is likely that meeting new national standards set out by NHS England in recently published draft service specifications for specialised services will present financial pressures which we hope to resolve with the support of our commissioners in order to not only protect our position as a provider of specific specialised services but the viability of some of our integrated services.

Delivering our efficiency programme – While performance against our efficiency savings targets for 2012/13 has improved from previous years, there is a clear and urgent need to identify additional opportunities to reduce running costs on a recurrent basis while maintaining the quality of our services. Given the ambitious strategy we are aspiring to deliver, our transformation programme is fundamental to not only ensuring we can continue to be successful during the next few difficult years, but also to ensuring that we generate financial capacity to make necessary investment in our accommodation and infrastructure.

Co-ordinating key change programmes - the Trust is undertaking a significant number of change programmes simultaneously, placing pressure on both the management of capital and of resources The new ward block, the development of theatres, incorporating a 3T MRI scanner and the implementation of a replacement patient administration system as the first phase of an electronic patient record (EPR) are all important infrastructure developments taking place over the next three years that will require strong project management and appropriate resourcing.

Managing and responding efficiently to increased demand – while increased demand for our services provides significant opportunities for service development and income growth, capacity pressures present a risk to the Trust‟s operational efficiency and service quality. It will be necessary to work closely with local GP commissioners and the local authority to balance scheduled patient care with unscheduled patient care by continuing to develop and implement strategies to deliver care outside of the hospital setting.

Changes to paediatric tariff – while changes made to the specialist paediatric tariff are not projected to have a significant detrimental effect on the Trust‟s income for 2013/14, this still remains subject of national review as responsibility for tariff setting is transferred to Monitor. We shall, alongside colleagues from the UK Child Health Alliance, be working to ensure we continue to be funded appropriately for the provision of specialist paediatric care.

2.5 Quality governance reporting

Quality is at the heart of the Trust‟s corporate objectives which focus on the delivery of the highest standards of care and treatment to children and young people. Our key strategic and underpinning objectives detailed in earlier sections encompass a range of elements of safety, clinical outcomes and patient experience delivered through measurable staged actions and targets set against them.

Performance in relation to the delivery of objectives and the targets beneath them is regularly reported to the board of directors. Information about how the Trust assures the quality of the performance data is set out in the annual governance statement at page 103.

2.5.1 Assessment against Monitor‟s quality governance framework

The board has been able to make the in-year declaration that it is satisfied the Trust has, and will keep in place, effective arrangements for the purpose of monitoring and continually improving the quality of healthcare provided to its patients.

In making this declaration the board considered Monitor‟s quality governance framework and undertook a comprehensive self-assessment exercise of the ten component questions of the framework. Elements were considered by individual non-executive directors, allocated broadly in-line with board committee responsibilities, and local evidence and good practice were put forward in conjunction with executive leads. Responses were then collated into a single document for discussion at the November 2013 board of directors meeting.

The results of this exercise provided local evidence and examples of best practice arrangements in place to govern service quality across the Trust to provide the board with assurance around quality governance.

2.5.2 Patient care

Patient care is an integral part of the quality agenda at Sheffield Children‟s NHS Foundation Trust and, to this end, our quality report at section 3 contains further information about the work we have done in the past 12 months to improve our patients‟ clinical care and their overall experience of our services.

The Trust is using its foundation trust status to further develop its role and model of care through continued development of the quality of its services as set out in section 2.4.1. The Trust continues to develop innovative clinical care, both at our main hospital base and across our other facilities and community services. Progress towards enhancing the quality of care can be demonstrated in the following areas: 2.5.2.1 Patient safety

Patient safety is a key component of our desire to achieve the best standards for clinical effectiveness and this year has seen the introduction of a range of initiatives in this regard, many of which are described in our quality report (see section 3). 2.5.2.2 Service reviews and improvements

Throughout the year, we undertook a series of service reviews to ensure that individual specialties are properly resourced to meet the needs of patients and to identify trends that might require changes in the future.

Our service reviews have resulted in a range of improvements, these being detailed in our quality report in section 3.

2.5.2.3 Infection control

Sheffield Children‟s NHS Foundation Trust has a strong track record on infection prevention and control which has been maintained throughout 2012/13 despite the many challenges faced by the Trust in this area over the past year. The world-wide increase in resistant strains of bacteria has been evident in Sheffield and Trust staff have had to employ the highest standards to ensure that these organisms do not spread between patients. To that end focus on good hand hygiene continues, with audits showing 98 per cent overall Trust compliance with appropriate hand decontamination ‟before patient contact‟ – moment one of the World Health Organisation‟s evidence-based „your 5 moments for hand hygiene‟ which the Trust has adopted since January 2010.

The recent (and on-going) epidemics of measles and whooping cough have had an impact on cubicle usage and have resulted in numerous requests for advice from the infection prevention and control Team. A new member of staff will be welcomed to the department in May 2013 following the retirement in-year of one of the two specialist nurses, relieving some pressure on team members.

Our record on MRSA (Methicillin resistant Staphylococcus aureus) bacteraemia (blood infection) remains good with no cases recorded once again this year. This is in spite of a steady flow of colonised patients from the community and also some hospital acquired colonisations which have no obvious mode of spread and is a testament to the good practice employed with intravenous line care. As ever, there is no room for complacency and the department of health has issued new guidance on reporting of cases of bacteraemia, should any occur.

Cases of hospital associated Clostridium difficile associated diarrhoea have exceeded the threshold set for the Trust by the Department of Health of three cases per year (we detected eight cases) but it is agreed among experts that in many cases this infection is a chance finding in children and the epidemiology is not well understood. There are certainly differences in the criteria for testing between the specialist children‟s hospitals in England which mean comparisons cannot be made. Analysis of our eight cases shows that only two had significant disease and that guidelines for control were followed in all cases.

Planning for the new hospital wing and the theatre expansion throughout the year has involved the infection prevention and control team at every stage. This ensures costly mistakes are not made in the design or the finished buildings and although it is very time consuming the team recognises it is a very important part of their role.

The director of infection prevention and control‟s quarterly reports to the board detail the daily ward and departmental checklist compliance audit results and the unannounced inspections by a modern matron, infection prevention and control nurse and domestic services manager. These inspections take place across the Trust‟s premises including the Becton Centre for children and young people and Embrace critical care transport service.

2.5.3 Improving the patient experience

We have a dedicated patient and carers advisory group, which was set up in 2005 and includes patient and carer members who have had recent experience and knowledge of using the Trust‟s services. The group also has foundation trust governor representatives.

Meeting every three months, the group is a prime example of user involvement within the Trust and receives regular reports and data from a variety of sources designed to find out what our patients think of our services and where we should be making improvements. Chaired by the director of nursing and clinical operations and supported by the PALS (Patient Advice and Liaison Service) the group represents a strong consultation vehicle on operational matters.

Most recently the group has been involved in advising on many aspects of the hospital redevelopment project, the development of the Trust‟s quality accounts and the results and actions plans from the latest Picker patient experience surveys. The group also makes visits to, and receives presentations from, departments across the Trust to inform their consideration of patient experience matters.

At the same time, the board receives quarterly reports on patient experience activity, alongside data on complaints, compliments and queries dealt with by our patient advice and liaison service (PALS) being included in reports from the head of risk management. 2.5.3.1 A better patient environment

The Trust‟s most recent patient environment action team (PEAT) assessment took place the previous year, the results of which we reported in last year‟s annual report as presented in the table below. We have been working closely with NHS England as a pilot site for patient-led assessments of the care environment (PLACE) which will replace PEAT assessments from 2012/13 and our first formal assessments are due to take place in April 2013.

Environment Privacy & Site Name Food Score Score Dignity Score The Becton Centre for Children and Young 4 Good 4 Good 5 Excellent People

Main site Western Bank and adjoining 4 Good 4 Good 3 Acceptable properties

The Trust has long recognised the need for improvement in our estate to provide a higher standard of inpatient accommodation specifically in relation to meeting requirements around privacy and dignity. We are therefore pleased that progress has been made this year in realising our ambition to improve our facilities. The development of a new hospital wing is key to improving the patient environment through provision of more single en-suite bedrooms and will allow us to deliver the high quality clinical care we already carry out within world-class facilities. 2.5.3.2 Feedback from independent surveys

The Trust routinely participates in a programme of independent patient satisfaction surveys conducted by Picker and uses the results of these to improve its services in response to patient feedback. The results of surveys reported on during 2012/13 and the action plans implemented from them are described in the quality report in section 3. 2.5.3.3 Formal complaints process

The formal complaints process also remains vital in identifying trends and areas for improvement.

In line with apparent national trends, complaints to the Trust during 2012/13 have risen this year with 120 formal complaints received. While there has been an increasing trend taking place since 2006/07 in the number of formal complaints received, this needs to be set against a significant rise in total attendances. The most common reasons for complaints are where parents disagree with a diagnosis or treatment plan, or in relation to complications of treatment. We investigate every complaint with the family involved, but believe that improved communication is the key to correcting the above trend.

More detailed analysis is included in the quality report in section 3, together with examples of learning and change in practice as a result of complaints. Complaints are reported to the board as part of reports from the head of risk management.

2.6 Research and development

The Trust continues to be home to a first class research and innovation facility, which works to develop innovative and pioneering treatments for children and supports high quality national projects. Leading professionals from across the country with expertise in many rare diseases and conditions welcome families willing to take part in research and our cutting edge clinical research facility welcomes researchers looking to conduct clinical trials or systematic reviews.

The research portfolio of the Trust is growing following the approval by the Trust board in July 2012 of a research strategy. Implementation of this ambitious strategy is focused on the development of the Trust as a national leader in research and development, a Trust strategic objective which recognises the integral contribution research and development play in the commercial and clinical strategic development of the Trust.

The number of our patients receiving NHS services provided or sub-contracted by Sheffield Children‟s NHS Foundation Trust (as well as family members and healthy volunteers) and choosing to participate in our research in 2012/13 was 1066. Our quality report in section 3 provides examples of current research projects.

2.7 Working with our staff

The staff and volunteers of Sheffield Children‟s NHS Foundation Trust are the reason for our continued success. Without them we would not be able to deliver high quality patient care or offer the range of clinical services that we do. Following the transfer of community services in 2012 we are a truly integrated provider of children‟s services providing care to children and young people across a range of specialties, including child and adolescent mental health services, health visiting, school nursing, neurosciences and a range of specialised services. Our staff, who total 2,500, are our most important asset and we strive to recruit and retain the very best. Our staff are responsible for the Trust‟s ability to deliver high quality care, meet (and often exceed) national and local targets and improve efficiency.

Fig: Patient headcount by staff group

Students 0.7% Add Prof Scientific Additional Clinical and Technic Services Nursing and 5.1% Midw ifery Registered 12.3% 29.7%

Administrative and Clerical 21.1% Medical and Dental 13.7% Healthcare Scientists Allied Health 4.8% Professionals 6.3%

Estates and Ancillary 6.4%

Recorded sickness absence for the year was 3.85 per cent which is slightly above the position for last year and above the target set for the Yorkshire and Humber Region. We are working with staff and staff side representatives to ensure that we have robust policies to support our staff to remain healthy at work and we remain one of the best performing trusts in respect of managing sickness absence.

2.7.1 Statement of approach to staff engagement

Staff engagement remains a priority for the Trust and is vital to ensure that we continue to deliver high quality clinical services. Throughout this year we have worked specifically with staff from across the Trust to define and agree a set of Trust values. This work has involved over 200 staff who have jointly produced a set of organisational values which were approved by the council of governors and signed off by the board of directors in March 2012. Using the NHS constitution as a starting point we set out to agree organisational values which would define the acceptable standards which govern the behaviour of individuals within the organisation. The values of an organisation can provide a framework for the collective leadership of an organisation to support the achievement of the organisation's strategic plan and improve its performance and results. Following lengthy consultation and engagement with staff and other key stakeholders, the following set of values were agreed:

Keeping children, young people and families at the heart of what we do

Committed to Excellence

We will seek to improve the way we work and deliver a high quality standard of care.

We will be open to new ideas, through innovation, research and education nationally and internationally.

Accountability

We will create a supportive working environment where everyone takes responsibility for their own actions.

Compassion

We will show empathy and understanding, treating everyone with dignity and courtesy.

We will respect each other and those we care for.

Teamwork

We will work together with and for our patients and their families.

We will work to the best of our ability and take pride in our achievements.

Integrity

We will value differences and treat everyone with a fair and consistent approach.

We will take an open, honest and ethical approach.

Together we care

These values will help shape the Trust as we move forward and we are continuing our engagement with staff to ensure that these values are built into the way we manage the organisation on a day to day basis.

2.7.1 Staff consultation

The Trust has a well-established joint negotiating and consultative committee where policies and procedures are formally agreed in addition to seeking wider staff views on a broad range of subjects that may affect them through their representatives. Another forum for consultation and feedback is our council of governors who are central to the local accountability of a foundation trust and have an important role in ensuring that the Trust board takes into account the views of members and stakeholders when making major decisions. Over the past twelve months we have had active involvement from governors in the development of the new hospital ward block through membership of the project board. We have also consulted with governors on the redesign of our Trust website to ensure that when launched in early 2013/14 it meets the needs of patients and carers and stakeholder organisations.

Our health and wellbeing group, which includes staff governors, managers and clinicians, supports staff in achieving a good balance in their working lives by promoting and developing a wide range of benefits and hosting regular events. The group runs open days to inform colleagues about various staff benefits and visits our larger satellite locations, where they talk to staff, gather suggestions for change or improvements and look for areas of good practice.

The Trust has a range of mechanisms for communicating information on matters of concern to staff and we work hard to ensure that all staff feel informed about the latest issues facing the Trust. We are developing more innovative methods of communicating with staff, including video messages and team briefings as well as the usual traditional methods. In developing and revising our values we engaged and communicated with a wide range of staff from across the Trust in order to ensure that the values and behaviours reflected the wishes of staff at the forefront of delivering patient care. Based on positive feedback about this approach we will be using similar processes to engage with staff in developing responses to the staff attitude survey. This will include launching the new „Your Voice‟ staff engagement forum.

2.7.2 Staff awards

Each year the hard work, commitment and dedication of our staff is recognised through our annual staff awards ceremony. This year was no exception and staff from across the Trust made a record number of nominations for their colleagues who go „above and beyond‟ the call of duty. To commemorate Olympic year, this year‟s awards were presented by paralympians James Crisp and Steve Judge. This year‟s ceremony also recognised staff who have provided long service to the Trust and others who had been nominated by patients, parents or carers as NHS Heroes.

2.7.3 Supporting our staff

The Trust continues to provide learning and development opportunities for all staff. A key focus of our work this year has been to offer a range of leadership and management development courses to support staff in delivering the challenging agenda facing the Trust. A series of leadership masterclasses have been provided and well attended together with a specific course, developed in collaboration with Sheffield Teaching Hospitals and Sheffield Hallam University, offering postgraduate management and leadership training for clinical staff. We have the UK‟s first paediatric and neonatal clinical skills centre where doctors, nurses and other health care professionals working both in the Trust and those from other organisations in the region can practise complex, essential skills at this dedicated clinical skills unit.

Our performance management review process ensures all staff have an annual personal development review (PDR) and personal development plans (PDP). This framework provides the opportunity for staff to discuss their training needs and career development. We continue to focus efforts at ensuring all staff undertake an annual PDR together with the specified statutory and mandatory training to ensure we have a well trained, dedicated workforce

Maintaining an environment that is safe for staff, patients and visitors is of the utmost importance to us. We place a strong focus on providing a safe working environment for staff. The Trust has a range

of measures to support staff at work. Through our occupational health provider, we offer a confidential service for employees to discuss health related matters. We also offer a confidential counselling service for employees aimed at promoting the mental health and wellbeing of employees, and through this promote organisational effectiveness.

2.7.4 National staff survey

Each year the Trust takes part in the national staff attitude survey. This survey provides invaluable information to ensure that the views of staff at work are heard and appropriate responses to the feedback are made. While the results are encouraging, with an increase in the score for overall staff engagement, we will strive to ensure that continued improvements are made to enhance staff experience at work. Following the publication of this year‟s survey results we have set up a staff engagement forum „Your Voice‟ which will have representatives from across the Trust. A key remit of this group will be to ensure that the findings of the staff survey are acted upon and staff engagement is prioritised across the Trust.

The quality report in section 3 includes a summary of the Trust‟s 2012 national staff attitude survey results.

2.7.5 Service improvement

Responding to the needs of our patients and carers at the same time as addressing the reforms taking place within the broader NHS means that the Trust has had to look at new and different ways of delivering services by embracing change. In implementing changes to our services experience has shown us the importance of letting staff lead from the front line and of involving patients and families.

This year the Trust has joined forces with Sheffield Teaching Hospitals NHS Foundation Trust to pilot development of an Academy to provide training to frontline staff to become coaches in service improvement techniques. This partnership has developed in conjunction with Dartmouth Institute, New Hampshire, USA and supported by funding from the Health Foundation. The aim of the project is to provide training for coaches who will then work with clinical teams to achieve continuous healthcare improvement. This innovative project has already seen the first cohort of 30 coaches graduate from the Academy and the programme will run over the next three years to deliver sustainable service improvement capability across both organisations.

2.7.6 Back to the floor

Throughout this year we have continued with our programme which sees members of the Trust board experience the services we deliver from the „sharp end‟. The programme enables executive and non- executive directors to experience the services we provide rather than hearing about them in the board room. The programme also enables staff to communicate directly with board members about the challenges and opportunities of delivering front line services. The programme will continue and regular feedback from these visits is provided to the board of directors. The council of governors have also taken the opportunity to undertake visits to service areas, including visits to ward areas.

2.8. Equality and diversity

Sheffield Children‟s NHS Foundation Trust is committed to ensuring the advancement of equality of opportunity between different groups, whether they are employees or the patients and public we serve. As a public body we believe it is our duty to work towards eliminating discrimination and help foster positive relations between the different groups that make up society.

One of our objectives last year was to increase the number of staff responding positively to the question from the staff survey asking about access to equality and diversity training. We have made significant strides towards this in the year, increasing the uptake of equality and diversity training from 27 per cent to 43 per cent. We will continue to improve this as we still fall behind similar organisations on this indicator. We are also now working with partner organisations across the city to identify shared equality goals and looking to reduce health inequalities.

We are also, through our diversity and public involvement group, identifying areas of good practice in relation to equality and diversity as it relates to the service we provide. An example of this is the work done by one of our health visitors looking to identify the health needs of the increasing Roma population within the city.

2.9 Stakeholder relations

During 2012/13, Sheffield Children‟s NHS Foundation Trust worked with a variety of stakeholders, both internally and externally, on key projects

The Trust has close ties with other providers of services for children, working closely with partners in Sheffield and, as outlined in section 2.4.1, we are actively working in partnership with Sheffield City Council, NHS Sheffield, Sheffield Teaching Hospitals NHS FT, GPs and South Yorkshire Police as part of the Children‟s Health and Wellbeing Partnership Board to reshape healthcare for children in Sheffield.

The Trust works very closely with partners on safeguarding issues which are given the highest priority, including close working on serious case reviews.

The Trust provides outreach outpatient services in 13 sites across South Yorkshire, North Derbyshire and the Humber. Through our Embrace critical care transport service we continue partnership working with other trusts in the region as the service is delivered with the involvement of clinical staff from other local trusts, and the service reaches into all hospitals across Yorkshire and the Humber.

The Trust is now a member of an acute services partnership „Working Together‟, which has outlined a programme for the seven acute providers in South Yorkshire, Mid Yorkshire and North Derbyshire to work together to help meet the current financial challenges and improve the quality of care they deliver. Working Together is driven by the need to continue to improve the quality of care, safety and the patient experience; deliver local access and improve activity (productivity); and do so in a way which is economically and financially sustainable.

The Trust also works in close partnership with other specialist children‟s hospitals. Through the UK Child Health Alliance, the Trust works to promote children‟s healthcare and assist in the development of national policy.

We continue to work with the community through our public governors and with partners through our partner governors as described in section 4.1.2 and harness their support in canvassing the views of their members to inform our service developments and strategic direction.

2.9.1 Charitable support

The Trust continues to receive tremendous support from The Children‟s Hospital Charity and over the last 12 months the charity has raised more than £1.3 million to support and enhance the services of the Children‟s Hospital, Sheffield.

The charity‟s main focus in the last financial year has been its „Make it Better‟ appeal, launched in September 2012, which aims to raise £20 million over the next three years to support the £40 million transformation of the hospital.

In addition to this, there are a number of annual funds and projects the charity has continued to support this year including a special play fund used by the play specialists around the hospital, funding for giggle doctors, a special „Diabetes Camp‟, £250,000 for medical research and funding to support Treetop House parent accommodation at the hospital.

The charity-funded arts programme, Artfelt, has made contributions to projects within the hospital, managed and curated an evolving programme of art exhibitions in the hospital based „Long Gallery‟, and funded a part-time Artfelt workshop coordinator to enable more interaction with Artfelt in wards and departments.

The charity has continued to provide the hospital with facilities and services which are above and beyond standard NHS provision, for example:

state of the art equipment for the hospital‟s action lab - the only dedicated laboratory in our region for testing children's lung functions;

next generation gene sequencer equipment - a £400,000 suite of equipment to enable further research breakthroughs in the prevention of childhood illness;

a brand new £200,000 state-of-the-art hydrotherapy pool for the Ryegate Centre; and

sim junior manikin – a simulation based training aid for the intensive care unit.

The charity‟s campaigns and events have included „An evening with Jessica Ennis‟ event at Sheffield City Hall, the „Run with us‟ campaign, Three Dams walk and the Mistress Cutler‟s challenge - for corporate supporters.

The charity is due to launch its first ever mass fundraising day – Make it Better Day – to be held on 28 June 2013.

We also receive support from a range of other local charitable organisations. The Trustees of Sheffield Hospitals Charity are very supportive of our hospital development plans and have made a substantial award from the Trust‟s general funds, half of which we will be able to draw down in 2013/14 and the remainder the following year.

2.9.2 Volunteering

We continue to grow the strength of our volunteer community at the Trust with over a 100 volunteers active at the Trust at any one time. The range and diversity of the volunteering projects undertaken has also continued to grow including singing groups and local scouts providing weekly input on the children‟s wards. We are also seeing an increase in the number of apprenticeship schemes offered at the Trust. These include health and social care clinical support worker apprentices, business administration and pharmacy technician apprentices. We have recently been successful in becoming a pilot site for health science apprentices in the genetic service due to start in September 2013. Our work with apprentices has been recognised with our pharmacy educator, Caroline Ashworth winning an apprenticeship partnership award with Sheffield College. Apprentices add value to the Trust‟s teams by sharing new knowledge and skills and giving departments the opportunities to grow their own talent.

2.10 Sustainability and climate change

The Trust recognises that, as an NHS organisation, it has an important role to play in reducing carbon emissions – a key cause of climate change. During the year, the Trust has worked with partners at national, regional and local level to progress and deliver our sustainable development management action plan.

2.10.1 Sustainable development management plan

From the inception of the Trust‟s sustainable development management plan back in November 2010, work continues at pace to improve the organisation‟s overall environmental performance and to ensure that all departments are fully engaged and continue to play a vital part in minimising energy usage and consumption. We continue to monitor closely the work of the NHS Sustainable Development Unit and update our staff regularly with new ideas which come out of this important resource so that they remain fresh and focused on the task ahead to make further in-roads into improving our green credentials across all key areas of the sustainability agenda. The Trust also regularly reviews and updates its progress in respect of its commitment to the Good Corporate Citizenship Assessment Framework.

2.10.2 Reducing our energy usage

The Trust has an energy strategy which ensures that the consumption of all energy and utilities is minimised. Staff are responsible for ensuring that good practice guides are closely adhered to in respect of maximising the use of all energy resources and minimising energy consumption. Rigorous and in depth maintenance programmes in place to ensure that all engineering plant items continue to operate at maximum efficiency throughout their working life cycle.

Capital investment in year has allowed us to continue with a number of lighting upgrading schemes. We are installing LED high energy efficient light fittings which use much less energy and are fully programmable to react to natural lighting conditions and pedestrian traffic and automatically reduce lighting levels (and energy consumption) at times when local conditions allow. One significant investment during 2012/13 has been to totally replace our Ryegate Children‟s Centre Hydrotherapy Pool. We now have a brand new state of the art facility which is heated via a very energy efficient air source heat pump system complete with intelligent fully automatic controls which keep pool water in perfect harmony with the patient experience and use minimum energy.

As reported last year, our new development project manager and team have continued to progress the design of our new ward and outpatient facility. This this major new facility, which opens in 2015, has been designed to minimise its overall environmental impact, both during the construction phase, and ultimately when the building is fully operational. Its design and choice of materials and internal finishes will ensure longevity, reduced running costs and low embodied energy consumption parameters. These measures have been balanced with other requirements to achieve a building that is easy to use, meets all of its functional criteria, is a health supportive environment and meets the needs and expectations of patients and staff for many years to come.

The table below summarises the Trust‟s energy use in kilowatt hours (kwh):

2010/11 2011/12 2012/13 (kwh) (kwh) (kwh) Electricity 7,114,587 7,044,299 6,788,212 Gas 8,354,846 10,880,401 11,239,603 Oil 49,131 50,100 51,000 Total 15,518,564 17,974,800 18,078,815

2.10.3 Waste reduction and minimisation

The Trust‟s Waste Group meets regularly throughout the year and is responsible for ensuring that all waste streams are properly and effectively segregated, managed, minimised and disposed of effectively in line with all Department of Health guidance. Eighty six per cent of all general waste is recycled, and we currently recycle paper, cardboard, food cooking oil, batteries, scrap metal and electrical (WEEE) waste. When our new ward and outpatient facility opens in 2015 further recycling opportunities, which are currently being considered, will be available within the newly created dedicated service area.

3. Quality Report

3.1 Statement on quality from the chief executive of Sheffield Children‟s NHS Foundation Trust ……………………………………………………….. 32

3.2 Priorities for improvement and statement of assurance from the board ……………………………………………………………………………. 33 3.2.1 Quality improvement priorities identified for 2012/13 ………………………………. 33 3.2.1.1 Performance on quality priorities 2012/13 3.2.1.2 How performance will continued to be monitored 3.2.2 Quality improvement priorities identified for 2013/14 ………………………………. 35 3.2.2.1 Priorities 3.2.2.2 Rationale for selection 3.2.3 Statements of assurance from the board ……………………………………………. 36 3.2.3.1 General assurance 3.2.3.2 Audit and national confidential enquiry assurance

3.2.3.3 Clinical research

3.2.3.4 Use of the CQUIN framework 3.2.3.5 Registration with the care quality commission 3.2.3.6 Periodic review of medical staff

3.2.3.7 Information on the quality of data 3.2.3.8 Core indicator comparisons 3.2.4 Patient experience ……………………………………………………………………... 48 3.2.4.1 Out-patient survey 2012/13 3.2.4.2 Inpatient survey 2012/13

3.2.4.3 Accident and Emergency patient survey 2012/13 3.2.5 Complaints ……………………………………………………………………………… 50 3.2.5.1 Reason from the complaint 3.2.5.2 Learning from the complaint

3.2.5.3 Referral to the ombudsman 3.2.6 Serious untoward incidents …………………………………………………………… 53

3.3 Other information …………………………………………………………….. 54

3.3.1 Patient safety …………………………………………………………………………… 54

3.3.2 Clinical effectiveness ………………………………………………………………….. 55

3.3.3 Patient experience ……………………………………………………………………... 56

3.3.4 Other performance indicators ………………………………………………………… 57

3.3.5 National staff attitude survey ………………………………………………………….. 58 3.3.5.1 Summary of performance 3.4 Annex A: Statement of directors‟ responsibilities in respect of the quality report …………………………………………………………………... 61

3.5 Annex B: Consultation in the preparation of the quality report ……… 63

3.5.1 Consulted agencies or groups ………………………………………………………... 63 3.5.1.1 Sheffield Clinical Commissioning Group 3.5.1.2 Sheffield Healthwatch

3.5.1.3 Yorkshire Overview and Scrutiny Committee 3.5.1.4 Council of Governors, Sheffield Children‟s NHS Foundation Trust

3.2 Priorities for improvement and statements of assurance from the board 3.2.1 Quality improvement priorities identified for 2012-2013 3.2.1.1 Performance on quality priorities 2012-2013

Last year, the Trust set itself a number of quality improvement priorities measured by performance targets.

Improvement of the Sheffield Children‟s hospital facilities for resident families. Coordination of three year plan to build:

o New outpatient facilities – easy access to centralised clinic and support departments, e.g. pharmacy, therapies, X-ray and diagnostics.

o New inpatient facilities – wards based upon best design evidence with 70 per cent single en-suite family rooms, dedicated play and school facilities.

o New home from home - for resident parents of children in critical care and neonatal care, built in conjunction with the Sick Children‟s Trust.

Positive review by our regulator, Monitor, of our redevelopment plans have allowed enabling works to start ready for building work to commence in summer 2013 with completion of the new wing expected by late 2015. Demolition of existing buildings will commence this summer.

The Sick Children‟s Trust has commenced conversion of existing Northumberland Road villas into a home from home for resident parents. The facility will be linked by corridor to our critical care floor and is expected to be complete this summer.

Improvement of pathway for outpatients and inpatients – reducing delay and improving communication.

o Review of outpatient administration - installation of new patient administration software to improve written and electronic communication with families and redesign of booking arrangements for clinics to reduce cancellations and delay.

o Review of inpatient pathway – setting up of a separate day care unit for children not requiring surgery or anaesthetic. The surgical day care unit will then be used for day surgery and as an admissions unit for all children booked to come in for an operation.

o Changes to GP referral pathway – pilot scheme of a consultant paediatrician available to advise GPs on safe community management of acute childhood conditions that normally come to accident and emergency.

The Trust has contracted with McKesson to replace our patient administration software. Transfer of data and staff training will be taking place over this year to prepare for switch-on early next year. The new software includes new systems for Accident and Emergency (A&E) patient management, bed management, clinic booking and patient enquiries. We will combine this with a new electronic document management system to improve the patient notes available to clinicians and speed up communication with GPs.

The Trust has opened up a research and medical treatment lounge and plans to extend this during the summer. The new facility provides a day unit for children who need to have blood tests, allergy tests, occasional intravenous medication or other hospital visits that require a short stay but not on a ward. It is also where children and families can participate in research to improve treatment and outcomes.

Surgery has been transformed by increases in day surgery, routine pre admission clinics and the development of a theatre assessment unit (TAU). The TAU provides a single point of entry to elective surgery. It resembles a clinic and allows the child to play, doctors to examine

the child in the privacy of a consultation room and only requires the children to be in bed after the surgery has been carried out.

We have worked with our GP and midwifery colleagues to change their access to paediatric medical advice. A paediatrician is available each day to discuss cases with GPs and avoid unnecessary attendance at A&E. We have worked to transfer the Sheffield out of hours GP service to a clinic base within the hospital. This simplifies the pathway that families have to follow and gives GPs access to our diagnostic and clinical support. Four pathways for common conditions have been jointly updated to ensure that GPs, maternity and A&E staff are all working to the same guidelines and referral criteria.

Implement new ways of working with GP commissioners and partners to improve community care.

o Work with partners to set up Sheffield Health and Wellbeing Board – a new forum to coordinate public health, GPs, hospitals and community services to work in concert with social care and education to improve the welfare of Sheffield children.

o Expand health visitor numbers – work with university to train the additional health visitors and integrate them into workforce. Redesign health visiting to provide better universal services with additional focus on those areas of the city that need an enhanced service.

o Improve coordination of social care and health in Sheffield districts – work with the three service areas to allocate link health visitors in the teams that prioritise child protection resources.

We are key stakeholders in the Sheffield Health and Wellbeing Board and have used the membership to incorporate health visitors and school nurses into the “Integrated Front Door”, simplifying the public access to community health, social care and education resources. Initiatives to improve access to speech and language services for children and improved breast feeding friendly services for families in hospital have also been agreed.

Health visiting recruitment and training has been continuing according to the four year plan agreed with our commissioners and we are on track to have 22 additional health visitors in Sheffield by 2014/15. In addition, we are working closely with commissioners to redefine the service that is needed from school nurses, emphasising public health and preventative interventions.

Child protection arrangements have been reviewed with all our partners and we have reorganised named nurses for acute and community services. We have allocated safeguarding specialist nurses to each of the three main Sheffield service districts to work with the „Integrated Front Door Teams‟, participate in multi agency risk assessments and carry out combined safeguarding training.

Our other results are discussed in detail in section 3.3. 3.2.1.2 How performance will continue to be monitored

While the patient safety and clinical effectiveness indicators have changed to reflect new priorities, the areas of patient experience will continue to feature in our annual outpatient, Accident and Emergency (A&E) and inpatient surveys. Should our performance be below average in any area, we will again include it in our quality report as an area for improvement.

3.2.2 Quality improvement priorities identified for 2013-2014 3.2.2.1 Priorities

Implement the Department of Health‟s response to the Mid Staffordshire public inquiry, „Patients First and Foremost‟

o Review and define the culture of the organisation

o Publish nursing strategy

. Assess nursing establishments against workload annually

. Invest in ward sisters and charge nurses – free up from other duties to provide a role model and visible ward presence

. Review and prioritise nurse training

o Involve governors and families in inspection and oversight of our services

Publish regular information on our quality performance and the experience of our families

o Evaluate the experience of families in the community

o Regularly evaluate experience of families in Accident and Emergency (A&E) using a child friendly derivative of the family and friends test.

o Produce quality indicators for children and benchmark with similar health providers

Minimise disruption to the public from our construction of the new hospital wing

o Improve communication and signposting of access restrictions

o Provide a park and ride solution for parents and families

o Control noise, dust and disruption to normal services

o Manage services in the community, where possible 3.2.2.2 Rationale for selection

These priorities are based upon the priorities of our families or partners and have been consulted upon with our trust executive group and clinical governance committee. The priorities have also been circulated to wider stakeholders and reflect health commissioner and local authority priorities.

The Mid Staffordshire public inquiry produced evidence of serious failings in how the health service cares for patients and families. Although the report has concentrated on the care of adult patients, it is notable that one of the earliest indications of concern was the failure of the hospital to comply with standards in the Care of Critically Ill and Critically Injured Children's Peer Review in 2006. In accepting responsibility for the care of sick children, it is right that hospitals should be subject to the most exacting standards. The failures highlighted in the report have wider application to all hospitals, the health service and our regulators.

This Trust wishes to use the lessons learned to review how we provide care and the culture we have in our organisation. We wish to test our assumptions and to set out our priorities. It is our intention to show how we balance the need for compassionate care with the importance of speedy access to treatment and the financial discipline that taxpayers expect.

To retain the confidence of families and to embrace the spirit of openness advocated by the Mid Staffordshire report, we will survey areas of our services that have not been previously reviewed. We

employ health visitors and school nurses but do not systematically review the experience of the families they come into contact with. We will conduct the pilot for just such a review.

The friend and family test is now routinely used to evaluate adult care, although it is accepted that it is not well understood by children. We will develop a child friendly version and use it to evaluate our scores against those used in adult Accident and Emergency (A&E) units. We think we give good care generally but can we evidence it? We will constantly assess and publish how we perform on key indicators of quality care and benchmark ourselves with other children‟s units.

In planning to undertake a major building project over the next few years, we cannot forget that we will still be treating sick children on the site. Families need to be protected from the effects of building work and still be able to access a high quality setting that lends itself to healing. It will not be easy but we believe that we can protect our families and staff from the worst effects of the construction. This requires innovation, cooperation and communication.

3.2.3 Statements of assurance from the board 3.2.3.1 General assurance

During 2012/13 Sheffield Children‟s NHS Foundation Trust provided and/or sub-contracted 1021 relevant health services.

The Trust has reviewed all the data available to it on the quality of care in 100 per cent of these relevant health services.

The income generated by the relevant health services reviewed in 2012/13 represents 100 per cent of the total income generated from the provision of relevant health services by Sheffield Children‟s NHS Foundation Trust for 2012/13. 3.2.3.2 Audit and national confidential enquiry assurance

During 2012-13, 15 national clinical audits and zero national confidential enquiries covered NHS services that Sheffield Children‟s NHS Foundation Trust provides.

During 2012/13 Sheffield Children‟s NHS FT participated in 100 per cent of national clinical audits in which it was eligible to participate. The Trust was not eligible to participate in any national confidential enquiries in 2012/13.

The national clinical audits in which Sheffield Children‟s NHS Foundation Trust was eligible to participate during 2012/13 are as follows:

% of eligible cases National clinical audits for which the trust was eligible submitted Royal College of Paediatrics and Child Health (RCPCH): Childhood 100% epilepsy 12 Paediatric Intensive Care Audit Network (PICANET): Paediatric 100% intensive care Royal College of Paediatrics and Child Health (RCPCH): Paediatric 100% Diabetes Royal College of Physicians (RCP) [UK IBD Audit]: Inflammatory 100% bowel disease

British Thoracic Society (BTS): Paediatric pneumonia 100%

British Thoracic Society (BTS): Paediatric asthma 100%

1 Based upon the services specified in the NHS Provider contract for 2012-13.

% of eligible cases National clinical audits for which the trust was eligible submitted NHS Blood and Transplant (NHSBT): Potential donor audit (100%) Prescribing Observatory for Mental Health (POMH): Topic 10b – Re- 100% audit of prescribing antipsychotics for children and adolescents CE (CORP) Royal College of Paediatrics and Child Health (RCPCH) Child Health Audit Clinical Outcome Review Programme / Child 100% Health Reviews-UK (CHR-UK) CE (CORP) Royal College of Physicians (RCP): National audit of 100% asthma deaths (No reportable deaths) Department of Health: Accident and Emergency (A&E) data sharing 100%

College of Emergency Medicine (CEM): Fever in children 100%

Trauma Audit and Research Network (TARN): Trauma 77% NHS Blood and Transplant (NHSBT): Audit of the labelling of blood 100% samples for transfusion Intensive Care National Audit and Research Centre (ICNARC): 100% Cardiac arrest procedures

The reports of 14 national clinical audits were reviewed by the provider in 2012/13 and the Trust took the following actions to improve the quality of healthcare provided:

POMH: Prescribing antipsychotics for children and adolescents – audit and re-audit

Actions: The initial audit highlighted the need to raise awareness about the importance of undertaking physical examination, improved documentation in case notes and monitoring of medication using an agreed or individual pro forma.

The re-audit found an overall improvement in the above. National leaflets and monitoring sheets have been purchased to consolidate good practice.

NCEPOD: 2011 Surgery in children report, “Are we there yet”

Actions: Gap analysis and action plan produced. Evidence to support final compliance includes:

Ratification of transfer policies and procedures;

Multi-disciplinary pre-operative meeting minutes;

Consent and information for parents relating to risk of death; and

Additional clinical audits for special care review.

College of Emergency Medicine (CEM): Feverish children

Findings:

The local audit report found that the emergency department had a very low antibiotic prescribing rate and complied with NICE guidance relating to the guidance that “Oral antibiotics should not be prescribed to children with fever without apparent source of infection”; and Improved provision of adequate safety net advice following the use of the febrile child advice leaflet.

Actions in progress/completed:

Increased education for triage nurses and medical staff regarding the assessment of CRT (capillary refill time) and conscious level on febrile children on arrival;

Medical staff to improve the documentation of repeat observations prior to discharge;

A febrile child pro-forma has been designed and is currently being piloted in the department – if successful the pro-forma will be incorporated into the Accident and Emergency (A&E) electronic record;

All medical staff informed and all new cohorts to be informed during induction and teaching; and

It was proposed that an IT solution be sought to ensure full observations were completed but the IT lead has stated that this is not possible.

College of Emergency Medicine: Pain in children

Actions:

Increased education and training in pain assessment to nursing staff;

Recording of pain assessment is now included in the triage form; and

Pain assessment box has been added to the observation charts to enable ongoing monitoring.

PICANET 2011 (CA223)

The national report demonstrates that our standardised mortality is improving in line with national trends and compares favourably with other intensive care units in the region. Therefore there have been no actions arising from this report.

National Inflammatory Bowel Disease (IBD)

Actions taken:

Guidelines for management of acute severe colitis have been established;

Consideration for a named Clinical Lead for IBD;

Administration support for the designated lead; and

IBD nurse to initiate and maintain IBD database prospectively.

The reports of 265 local clinical audits service evaluations were reviewed by the provider in 2012/13. The reports were reviewed by clinical teams. Examples of the actions taken, or intending to be taken, by the Trust to improve the quality of healthcare provided include:

Pharmacy: CA363: Audit of prescribing errors and clinical interventions made for outpatients

Action identified and / or implemented:

• Slides added to level three medicines management training (& junior doctor induction);

• Promotion of addressographs label use ongoing;

• Presented findings at peer, medical and surgical audit forums;

• New pharmacy standard operating procedures (SOPs) to be developed to ensure all staff covering reception know to check all relevant information; and

• Future re-audit planned.

Child protection: SE21 User feedback in clinical assessment unit

Results showed:

. Overall feedback obtained was generally positive from patients, carers, and professionals alike;

. Individual comments about the doctor, where obtained, were entirely positive; and

. Regarding the service as a whole, the vast majority of comments from all the user groups were positive, with few negative comments around parking, and occasionally about waiting times.

Haematology and Oncology: CA380 Oral anticoagulant annual audit 2011

An audit was performed to show compliance to National Patient Safety Agency (NPSA) alert 18 concerning „actions that can make anticoagulant therapy safer‟.

Actions included:

. A copy of the anticoagulant results spreadsheet to be placed in the patient‟s medical notes at six monthly intervals;

. A formal pathway to deal with non-attendance for indicator testing was developed;

. Revised non-compliance letters sent to GP; and

. Provide written dosing instructions when parents forget to bring their yellow books.

Surgery: CA412 Audit of pre-operative World Health Organisation (WHO) theatre checklist

WHO launched a second global patient safety challenge, „Safe Surgery, Saves Lives‟, to reduce the number of surgical deaths across the world. The WHO checklist is part of this initiative.

Actions included:

Audit feedback to surgeons and theatre staff that they must write their full name in the staff identity section;

Emphasise importance of putting a patient details sticker and the date on the second page of the checklist; and

Checklist form revised to include: „staff name‟, „staff role, bleep number‟ and then „signature‟.

ENT: CA244 Re-audit of prescribing in paediatric tonsillectomy

This project was to re-audit the prescription of steroids and antibiotics during tonsillectomy following awareness and departmental teaching recommended from a previous audit project.

Actions included:

Steroids prescribed to all children undergoing tonsillectomy unless contra-indicated, and any contra-indications documented in notes. [Note: the following has been added to theatre lists for patients undergoing tonsillectomy - “Dexamethasone if not contra-indicated”];

Antibiotics not prescribed post-operatively to children undergoing tonsillectomy unless clinical reason documented in notes and no contra-indications; and

Dissemination of information regarding the use of antibiotics/steroids in the undertaking of this procedure.

CA224: Re-audit of completion of Sheffield paediatric end of life care pathway (EOLP)

The appointment of a palliative care consultant has resulted in increased awareness and education. The use of the end of life pathway is being more widely used in the Trust, community and local hospice.

Actions included:

Adapt current end of life pathway to make clearer the aspects that warrant completion;

Encourage prescribers to consider medications to combat side-effects of pain killers where indicated e.g. laxatives - continued education; and

Poster presented, European Congress of Paediatric Palliative Care, Rome, November 2012.

Further examples of actions resulting from completed audits are available on the Trust website or from the clinical governance department. 3.2.3.3 Clinical research

The research portfolio of the Trust is growing following the board approval of an ambitious research strategy in July 2012. The number of our patients receiving NHS services provided or sub-contracted by Sheffield Children‟s NHS Foundation Trust (as well as family members and healthy volunteers) choosing to participate in our research so far in 2012/13 is 1,066.

The South Yorkshire Comprehensive Local Research Network set a target of 708 participants to be recruited to studies in 2012/13. By year-end, researchers at our Trust recruited 915 subjects to portfolio studies.

Research studies taking place at the Trust cover five of the seven National Institute for Health Research (NIHR) topic specific networks (medicines for children, cancer, mental health, dementia and neurodegenerative diseases and diabetes) and include studies within eight Comprehensive Local Research Network (CLRN) specialty groups (metabolic and endocrine, musculoskeletal, haematology, cardiovascular, ENT, Genetics, infectious disease and injuries and emergencies).

Two examples of the research carried out during the year are given below:

Title: The Effect of Body Weight on Trabecular and Cortical Bone Structure and Strength from 8-30 Years. The Role of Hormones and Osteokines (The Body Weight and Bone Study - BWAB)

The BWAB study is being run in collaboration with researchers from the University of Sheffield and Sheffield Teaching Hospitals. This study is being conducted in both our Trust and at the Centre for Biomedical Research at the Northern General Hospital, Sheffield. The research involves both our patients and healthy volunteers and recruitment is well underway.

Overweight children appear to have lower bone mass relative to their body size and fracture more. Therefore, this study is designed to understand the differences in bone mass, geometry, microarchitecture and strength in a loaded (distal tibia) and a partially loaded (distal radius) skeletal site between obese and lean participants aged between 8 and 22 years. Furthermore, this study aims to determine relationships between fat-derived hormones and factors controlling bone turnover that may explain why overweight children are at greater risk of fracturing. By using the high resolution Xtreme CT scanner (only one of two in this country), this study will provide detailed information about the effect of excess fat mass on cortical and trabecular bone structure over a wide age range. The use of an engineering model (micro finite element analysis) will help to determine the effect of being overweight on bone quality and strength. Analysis of hormones that affect bone turnover in children and young adults will help to define pathways that may help to explain the relationship between fat and bone as children progress through puberty into adulthood.

Title: Hypertonic Saline in Acute Bronchiolitis (SABRE): Randomised controlled trial and economic evaluation

The SABRE trial is a Trust sponsored multi-centre randomised controlled trial which aims to determine whether the addition of three per cent hypertonic saline to usual care results in significant reduction in the duration of hospitalisation of infants with acute bronchiolitis. The trial has now run for two winter seasons with a possibility of an extension later this year to allow a third season of recruitment.

The primary hypothesis of the trial is that the addition of 3 per cent hypertonic saline to usual care results in significant reduction in the time to when infants admitted with acute bronchiolitis are „fit for discharge‟. Secondary hypotheses are that the addition of nebulised 3 per cent hypertonic saline to usual care is associated with:

improved quality of life outcomes for carers;

shorter length of stay;

improved quality of life for the infants;

reduced health care utilisation in the month after discharge;

cost effectiveness for the NHS; and

the effect is independent of the underlying virus. 3.2.3.4 Use of the CQUIN framework

A proportion of the Trust‟s income in 2012/13 was conditional upon achieving quality improvement and innovation goals agreed between the Trust and any person or body with whom they entered into a contract, agreement or arrangement for the provision of relevant health services, through the Commissioning for Quality and Innovation (CQUIN) payment framework. Further details of the agreed goals for 2012/13 and for the following 12 month period are available online at http://www.monitor- nhsft.gov.uk/sites/all/modules/fckeditor/plugins/ktbrowser/_openTKFile.php?id=3275

The amount of income in 2011/12 conditional upon achieving quality improvement and innovation goals was £1.28 million. The amount conditional upon achieving quality improvement in 2012/13 was £2.91 million.

A more detailed commentary on our achievement against the CQUIN quality indicators is given below:

CQUINs for specialist services

Title Description Outcome Implement safety Achieve safety thermometer requirements set Achieved thermometer out by local commissioners Reduce unplanned paediatric intensive care Out of network referrals PICU Achieved unit (PICU) Transfers First class Neonatal Tackling central line infections Achieved Intensive Care First class Neonatal Improving transition and discharge from Achieved Intensive Care neonatal intensive care CAMHS Tier 4 Access to Development and implementation of gate Achieved services keeping assessment process CAMHS Tier 4 CPA To ensure collaborative work is at the heart of Achieved Standards the care planning CAMHS Tier 4 Optimising Optimise length of stay (LOS) through Achieved length of stay understanding full pathway

CQUINs for core services

Title Description Outcome Patient experience – 95% of patients to be seen within 45 minutes Achieved Outpatient clinics after their booked outpatient clinic time in the specified clinics Patient experience – Commission an 800 patient survey and Achieved Accident and Emergency produce an action plan to address problems identified. Patient experience – Parent Commission and construct a Parents‟ Achieved hotel Accommodation block for parents with children on critical care floor. Improving the management Agree common pathways for: Achieved of common conditions Loss of birth weight Neonatal jaundice Bronchiolitis

Domestic violence indicator All cases of children from families with Achieved evidence of domestic violence from the data base will be flagged on Trust Accident and Emergency (A&E) systems

All identified children will be alerted to health visitors and school nurses of children who do not attend clinic for more than three months.

Looked after children All „looked after children‟ from the local Achieved Indicator authority data base will be flagged on Trust Accident and Emergency (A&E) systems.

All identified children will be alerted to health visitors and school nurses of children who do not attend appointments (DNA) for more than three months.

Referral to Sheffield Stop Number of referrals each quarter to the SSSS Achieved Smoking Service (SSSS) by health visitors to equal 25 Asthma management 90% of patients attending with a diagnosis of Partially acute exacerbation of asthma who are not Achieved admitted should be discharged home with a completed care bundle

The Trust set out to improve its patients‟ experience by reviewing the administration of its clinics. 95 per cent of clinics achieved this target but we are aware that complicated diagnostic tests can unexpectedly lengthen the duration of the visit. We aim to be clearer about the expected duration of clinic visits and to shorten these wherever possible.

The Trust has capitalised on its innovative patient safety net, whereby vulnerable patients are flagged up and followed up in the community, if they attend Accident and Emergency (A&E) or do not attend clinics. Looked after Children and children in households known to have domestic violence are now included.

Despite achieving compliance with the target in the first of two audits, the second audit showed less than 90 per cent of children were able to have the full bundle of care that was agreed for chronic asthma. The two areas where most improvement was required were: Checking inhaler technique and improved communication with GPs. Work is ongoing with A&E staff to ensure that this position improves.

3.2.3.5 Registration with the Care Quality Commission

Sheffield Children‟s NHS Foundation Trust is required to register with the Care Quality Commission (CQC) and its current registration status is unconditional. The Care Quality Commission has not taken enforcement action against the Trust during 2012/13.

The Trust has participated in special reviews or investigations by the CQC relating to the following areas during 2012/13:

Unannounced Inspection: Sheffield Children‟s Hospital, 16 October 2012

The Inspection report said:

Sheffield Children's Hospital was found to be meeting all the essential standards of quality and safety.

What people who use the service experienced and told us:

All children, young people and their parents spoken with said that they had been provided with relevant information which helped them understand the care and treatment choices available to them (or their child). They said that they had been involved in care and treatment decisions and that staff always involved them and listened to them. Children and young people said that staff were approachable and explained things in a way they could understand. Their comments included: "The nurses have always explained the choices for treatment and ask for consent to any treatment before they start."

"They (staff) are very good at explaining things. They always check that we (parent and child) have understood and are happy with what is happening."

People told us their privacy and dignity was respected by staff. They told us that staff were polite and respectful. Their comments included: "There are no issues about privacy. They (staff) always close the curtains, even if it is just for a chat, and they lower their voices."

"A doctor took us into a side office so that we could be private, and so that he could explain things properly to us. They were very good."

"If they (staff) need to speak to us they always pull the curtains around the bed. They are very respectful and always introduce themselves. They speak professionally to us and maintain confidentiality."

"They give (my child) lots of respect and let them make decisions."

During this inspection we observed interactions between nurses and parents and their child. Staff were seen to be polite and respectful. Nurses took time to talk with people to offer support and reassurance. Nurses were also overheard to ask people's opinions and check that they were satisfied.

Children and young people told us that they felt safe. Parents felt that there was enough staff on duty and that as a result their children were safe. Their comments included: "I really believe (my child) is very safe here. I have never had any concerns about their safety."

"I feel very safe here. There is no reason not to be."

"I have absolutely no worries about (my child's) safety. I feel able to leave them and know they are in good hands. I couldn't do that if I was worried at all."

We spoke with six nurses and a support worker from two wards at the hospital. Staff told us that they felt supported to provide care and treatment to children and young people staying at the hospital. A clinical nurse educator was employed to provide training and support to staff. Staff said that the support and training provided was excellent. They told us that they were provided with induction and mandatory training each year that covered topics such as moving and handling, infection control, child protection, medicines management, risk management and fire. Staff said

they also had access to specialist training such as dealing with specific medical conditions, communication, dealing with challenging behaviour and equality and diversity.

http://www.sheffieldchildrens.nhs.uk/Downloads/CQC%20Reports/CQC%20report%20November% 202012.pdf

3.2.3.6 Periodic revalidation of medical staff

Medical revalidation is the process by which all doctors who are licensed with the General Medical Council (GMC) regularly demonstrate that they are up to date and fit to practise. Doctors will normally revalidate every five years. Revalidation is based on a local evaluation of doctors‟ practice through appraisal. Its purpose is to affirm good practice.

In addition to the responsible officer, all eight of the first tranche of doctors recommended for revalidation have been approved by the GMC. 3.2.3.7 Information on the quality of data

Sheffield Children‟s NHS FT submitted records during 2012/13 to the Secondary Uses service for inclusion in the hospital episode statistics which are contained in the latest published data. The percentage of records in the published data:

which included the patient's valid NHS number - 99.5 per cent for admitted patient care; 99.9 per cent for outpatient care; and 99.2 per cent for accident and emergency care; and

which included the patient's valid general practitioner registration code - 100 per cent for admitted patient care; 100 per cent for outpatient care; and 100 per cent for accident and emergency care.

Sheffield Children‟s NHS Foundation Trust‟s information governance assessment report overall score for 2012/13 was 68 per cent, which was graded green (satisfactory).

The Trust was subject to the payment by results clinical coding audit during the reporting period by the Audit Commission. The error rates reported in the latest published2 audit for that period for diagnoses and treatment coding (clinical coding) are described below:

A total of 200 finished consultant episodes (FCEs) were scrutinised during the audit. The following were reviewed in the sample:

50 FCEs from paediatrics reporting an error rate of 8.0 per cent;

50 FCEs from trauma and orthopaedics reporting an error rate of 8.0 per cent; and

100 Accident and Emergency (A&E) attendances reporting an error rate of 9.0 per cent.

(The results should not be extrapolated further than the actual sample audited)

The Trust will be taking the following actions to improve data quality:

Feeding back the results of the audit to clinical coders to highlight the areas of inconsistent extraction;

Introducing an internal training and audit programme to address the issues identified in the audit;

Ensuring that accurate discharge summaries that contain all relevant diagnoses and procedures are always available to coders;

2 South Yorkshire and Bassetlaw PCT Cluster undertook to evaluate the completed audits and publish a summary report: at the time of submission, that report is still outstanding.

Feeding back the consistent areas of error found in this audit to the staff recording the information that data quality is improved; and

Reviewing the mapping of national investigation and treatment codes to their local equivalents. This includes the incorrect recording of codes for „none‟ and „other‟ when there are other investigations and treatments recorded. 3.2.3.8 Core indicator comparisons

The following section sets out the data made available to Sheffield Children‟s NHS Foundation Trust by the Health and Social Care Information Centre (HSCIC). The indicators below represent those relevant for the services provided by this trust. Most of the indicators specified are not relevant to a children‟s specialist trust and, following agreement with commissioners, are not submitted as a data return. N.B. Where data is historical, this is to comply with the latest national data released by the HSCIC.

19. Patients readmitted to a hospital within 28 days of being discharged. (i) 0 to 14 Unique Identifier: P009013 Link: http://nww.indicators.ic.nhs.uk/webview/ Source Data: Source Data P00913

National Average Maximum Minimum Financial Year % (%) (%) (%) 2010/11 11.9 10.85 12.42 7.95 2009/10 12.13 10.64 12.21 8.55 National data is based on the data for all acute specialist children's trusts (the category that the Trust comes under for this indicator).

19. Patients readmitted to a hospital within 28 days of being discharged. (ii) 15 or over Unique Identifier: P00904

Link: http://nww.indicators.ic.nhs.uk/webview/ Source Data: Source Data P00904

National Average Maximum Minimum Financial Year % (%) (%) (%)

2010/11 10.75 11.48 13.80 9.90

2009/10 14.66 12.27 15.13 8.84

National data is based on the data for all acute specialist children's trusts (the category that the Trust comes under for this indicator).

The Trust considers that this data is as described for the following reasons:

The Trust has a policy of giving safety net information to all parents telling them to contact the hospital if they have any concerns after discharge.

Sheffield Children‟s NHS Foundation Trust intends to take the following actions to improve this percentage, and so the quality of its services, by:

Continuing to encourage families to contact our specialist services if they have any concerns but to review patterns to see if we can produce generic information leaflets that encompass common concerns.

21. Staff who would recommend the trust to their family or friends. Unique Identifier: P01554 http://nhsstaffsurveys.com/cms/index.php?page=staff- Link: survey-2011 Source Data P01554.1 Source Data: Source Data P01554.2

National Average Maximum Minimum Year % (%) (%) (%) 2012 83 65 94 35 2011 84 65 96 33 National data is based on the data for all acute & acute specialist trusts (the category that the Trust comes under for this indicator).

The Trust considers that this data is as described for the following reasons:

This represents an indicator of the high standards our staff aspire to.

Sheffield Children‟s NHS Foundation Trust intends to take the following actions to improve this percentage, and so the quality of its services, by:

Continuing to work with our staff to maintain and improve the standards within our Trust.

24. Rate of C.difficile infection. Unique Identifier: P01557 http://www.hpa.org.uk/Topics/InfectiousDiseases/Infections Link: AZ/ClostridiumDifficile/EpidemiologicalData/MandatorySurv eillance/cdiffMandatoryReportingScheme/ Source Data: Source Data P01557

National Financial Year Rate Average Maximum Minimum 2011/12 12.2 20.6 51.6 0.0 2010/11 12.2 27.9 71.8 0.0

National data is based on the data for all trusts included in the indicator source data.

The Trust considers that this data is as described for the following reasons: The Trust has regularly reported low infection rates for C Difficile. This is due to the reduced susceptibility of children to this infection and to the high standards of infection control.

Sheffield Children‟s NHS Foundation Trust intends to take the following actions to improve this rate and so the quality of its services, by:

Continuing to work with our staff to maintain and improve the standards within our Trust.

25. Patient safety incidents and the percentage that resulted in severe harm or death. Unique Identifier: P01558 Link: http://www.nrls.npsa.nhs.uk/resources/ Source Data P01158.1 Source Data: Source Data P01158.2 Source Data P01158.3

National Rate per Period 100 patient Average Maximum Minimum admissions Apr 12 -Sep 12 8.34 7.5 24.88 1.37 Oct 11 - Mar 12 10.04 8.4 21.71 2.72 National data is based on the data for all acute specialist trusts (the category that the Trust comes under for this indicator). The data available for April 2011 - September 2011 is not split at this level so would not be comparable with the more recent data.

N.B. At a recent national meeting of auditors, Monitor has been alerted to the judgmental nature of this indicator. In the absence of a measurable national definition of severe harm, national figures cannot be relied upon for benchmarking purposes.

The Trust considers that this data is as described for the following reasons: The Trust is close to average for this group but feels that the grouping itself should be restricted to specialist children‟s trusts to give a more accurate benchmark.

Sheffield Children‟s NHS Foundation Trust intends to take the following actions to improve this number and/or rate and so the quality of its services, by:

Being open with families and carrying out root cause analysis on all such incidents, enabling learning from the outcomes reported.

3.2.4 Patient Experience 3.2.4.1 Outpatient survey 2012 -13

The 2012 Outpatient survey of 850 families (31.2 per cent response) showed that the majority of our clinic patients ranked their care well:

0.8%

1.3% 1.1% 7.5%

Excellent

Very good

Good 25.1% Fair

Poor 64.2% Not answered

3.2.4.2 Inpatient survey 2012 -13

The 2012 In-patient survey of 850 families (35 per cent response) showed that the majority of our ward children and parents ranked their care well:

1.4% 2.6%

3.3%

10.0% Excellent

Very good

Good 48.2% Fair Poor

Not answered 34.4%

3.2.4.3 Accident and Emergency (A&E) patient survey 2012 -13

The 2012 A&E patient survey of 850 families (30.8 per cent response) showed that the majority of our patients ranked their care well:

1.3% 0.3% 2.4%

Very good 23.7% Good

Fair

Poor

Not answered 72.2%

All surveys demonstrated that the chief problems were with access, car parking, way-finding and the facilities. We intend that our building plan will improve all of these issues over the next three years.

Comments included:

A&E: “The caring nature of all staff. The speed at which we were seen was fantastic. The parking worry is taken away with the spaces outside on the main road leaving you able to focus on your child.”

A&E: “Because I was suffering and really scared. So I was not feeling safe with them and also that a piece of glass was stuck in my foot and I told them to do a x-ray on my foot but they didn‟t listen to me and I am still a bit more scared.”

Inpatient: ”We lost all confidence in our local hospital. The children‟s hospital has always picked up the pieces and cured the problem. This is our 1st choice hospital and would recommend it to anyone. Wish we could find an adults hospital that we had as much faith in! Thanks.”

Inpatient: ”It was very noisy and no one told anyone when to be quiet. Why did they ask my bedtime which is about 8pm if there was not going to be any quiet until midnight?”

Outpatient: ”My child is acutely sensitive and I explained this to the staff on arrival that she does not respond well to negative words and to pass this on to the consultant. The nurse did so and the consultant handled her very well.”

Outpatient: ”Not having to be left in the foyer whilst my mum or dad parks the car. (We travel from 60 miles away & I can‟t walk far).”

3.2.5 Complaints

During the financial year 2012/2013, a total of 120 formal complaints were received as at 31 March 2013. The rate of complaints is set out in the following table:

No of complaints per Year Episodes of care Complaints 10,000 episodes 2004 - 2005 131,162 60 4.57

2012 - 2013 187,667 120 6.39

Further analysis shows the following are the main services receiving complaints:

Complaints by Service Area 2009-2013

45 43 42 40 36 36 35 33

25 23 19 20 20 18

15 13 10 10 7 8 5 5 2 0 In Patient Out Patient ED Mental Health Community Other

2009/2010 2010/2011 2011/2012 2012/2013

Complaints by Division 2012-13

30 Series1

0 Medicine / A&E Surgery/Critical Community/Camhs Diagnostics Administration Hotel services All divisions care

3.2.5.1 Reason for the complaint

Complaints are coded according to national coding descriptions:

Type of Complaint No.

All aspects of clinical treatment 61 Appointments, delay / cancellation (out patient) 17 Attitude of staff 9 Admission, discharge & transfer arrangements 9 Communication written and oral 6 Appointments, delay / cancellation (in patient) 4 Personal records 3

Transport 2 Breach of confidentiality 2 Condition of premises 2 Failure to follow agreed procedure 1 Car Parking 1 Consent 1 Equipment 1 Mortuary & post mortem arrangements 1

* 8 complaints were jointly made to more than one health care organisation and require a response from us because of our involvement in transporting infants from district maternity unit to neonatal critical care units at Jessop Hospital or Leeds.

The main types of complaint received in the „all aspects of clinical treatment‟ are as follows:

All Aspects of Medical Treatment

departmental wait 3% delayed appointment 3% pharmacy 2% nurse management 10%

diagnosis 38% delayed appointment departmental wait diagnosis medical care outcome nurse management pharmacy

medical care outcome 44%

Many of these complaints have several elements but there are recurrent themes the complainants are not satisfied with:

The diagnosis – this varies from the family not accepting the diagnosis to the diagnosis being shown to be inaccurate;

Medical care outcome – this varies from the treatment not correcting the symptoms to the child experiencing known complications of treatment;

Nursing care - this extends from poor communication to poor resident parent facilities on wards; and

Appointment frustrations feature again within this category – from extended waits within departments to appointments being delayed. 3.2.5.2 Learning from complaints

Although there are some complaints which we cannot do anything about, we take the view that the need to make a complaint demonstrates a failure in communication of our services. If a child experiences known complications of a treatment then it should not come as a surprise to the family. If a family is subject to delays then these should be reasonable and the family should have a right to be warned about them.

Some of the complaints which were made include:

Confusing guidelines for the management of an intravenous line (Portacath); Blood sugar monitoring failed to be carried out on a patient with diabetes who had been admitted for an unrelated condition; Miscommunication and misunderstanding led a family to believe that surgery would be carried out on a certain date; Dissatisfaction with post operative care and poor communication before and following surgery; Perception of Inappropriate referral for safeguarding assessment; Poor attitude of catering staff; Lack of pain relief; Conflicting advice from medical staff; Expectation of transport home following admission; and Cancellations and delays associated with appointments. The following describes some changes in practice as a result of lessons learnt following complaints: Review and redraft of care plans and guidance for portacaths which resulted in the production of a Trust policy for the management of portacaths in addition to the production of a portacath information leaflet; All patients with diabetes will have their blood sugar monitored even if the admission is not related to their diabetes; The booking form for patients coming in for surgery has been amended to enable additional information regarding admission to be recorded; Nurse educator to address specialised nursing care and effective communication with all staff. Safeguarding protocols and procedures reviewed and additional safeguarding training for junior medical and surgical staff identified; Appropriate internal process with the human resources department; Departmental staff receiving updated training on application of pain relief; Additional training delivered by the consultant to junior medical staff to prevent conflicting advice in relation to application of eye drops; and Redesign of our appointments booking processes and transformation of our hospital pathways to reduce the duration of processes such as pharmacy dispensing and discharge letter production.

There is an ongoing process to improve communication and we plan to launch a new website this year with increased patient access to leaflets, patient pathways and directed enquiries. We intend our new patient administration software to reduce some of the cancellations that result from overbooking with

appointments reminders now being received via SMS texts. Training remains a priority, with all nursing areas now having access to clinical skills training and dedicated training time being facilitated. 3.2.5.3 Referrals to the ombudsman

During the last financial year, a total of two complainants referred their complaint to the Parliamentary and Health Services Ombudsman (PHSO).

Complaint Ref Division File to PHSO Summary of Complaint PHSO Decision

Lack of information provided COM 50 Medicine February 2012 Awaiting decision to family Safeguarding procedures initiated due to persistent use COM 82 Medicine March 2013 Awaiting decision of alternative remedies against medical advice.

3.2.6 Serious untoward incidents During the last financial year 2012/13, the Trust reported seven serious untoward incidents.

Communication failure: Following death, a patient was transferred to an external hospital without consent of the coroner and in breach of local guidelines.

o Discussions and guidance agreed with the coroner, review and dissemination of local guidelines

Confidential data management – medical records were left unattended in a public area by a contracted third party courier during delivery. No breach of confidentiality resulted.

o Review of contracts held by Trust with postal service provider

Delay to escalation of care: Communication between clinical teams did not result in timely transfer of care between ward and coronary care unit.

o Revised observation chart with clear thresholds to seek assistance and timed instructions on required medical response.

Delay in return of samples to families: Delay in returning samples, retained with family consent, after agreed examination period.

o Merger of two internally used databases and change to oversight of service.

The following investigation reports have yet to be approved by the Trust‟s executive risk management committee:

1. Over dosage of opiate to a child who had not previously had opiates.

2. Potential delay in diagnosis in emergency department. Patient was later transferred out of Trust for specialised care.

3. Unnecessary X-ray scans on two patients.

Reports relating to the serious untoward incidents are shared with the relevant manager and clinical director or equivalent in addition to being presented at the executive risk management committee. Following the executive risk management committee, and in order to facilitate organisational learning, the reports are discussed at each directorate board meeting with any recommendations being monitored through the executive risk management committee.

All serious untoward incidents are subject to a root cause analysis and the result shared with the risk and audit board subcommittee.

3.3 Other information

The Trust set a number of quality indicators to be monitored during 2012/13. Our performance is set out below: 3.3.1 Patient safety

Patient Safety NATIONAL OR PERFORMANCE TARGET ACHIEVEMENT HISTORICAL 2011/12 PERFORMANCE 2012/13 AREA REVIEWED PERFORMANCE 2012/13 THRESHOLD Infection Control http://www.dh.gov. MRSA: To stay within MRSA: uk/prod_consum_ 0 Cases Monitor 0 Cases Maintain levels of MRSA dh/groups/dh_digit guidance for and C Difficile infection alassets/documen C Difficile: best practice C Difficile: within Monitor ts/digitalasset/dh_ 3 3 Cases levels. (<12) 8 Cases thresholds for best 132045.pdf practice. pp 64 and 68 Never events http://www.dh.gov. Nil events Nil events Nil events uk/prod_consum_ The Department of dh/groups/dh_digit Health has published 25 alassets/@dh/@e never events for 2012-13. n/documents/digit These are serious alasset/dh_13235 incidents that should 2.pdf never occur in a safe hospital. The Trust will do a gap analysis against these and report on progress quarterly. Management of http://www.nhsbsa Violence and 10% reduction 24 Incidents Aggression .nhs.uk/Document aggression i.e. no more s/SecurityManage incidents graded than 114 Management of children ment/NHS_SMS_ moderate: incidents for and young people in Workplace_Safety similar period. Child and Adolescent _Report_FINAL_ 149 Mental Health in a safe MERGED.pdf

and secure environment.

Staff should be trained p29 to a national standard appropriate to the psychiatric speciality and risk assessment. Individual risk assessments should be up to date.

3 http://www.monitor-nhsft.gov.uk/home/news-events-and-publications/our-publications/browse- category/guidance-foundation-trusts/mandat-7, p 46, note L.

These initiatives all addressed key areas of child safety. Infection control is a high priority for acute hospitals and is a difficult area to control in children and neonates, who are particularly susceptible to infection. In 2012, we increased the time available to our director of infection prevention and control, to ensure that there is a continuous onsite presence, 52 weeks per year. Despite this, our Clostridium difficile rate increased. Most cases of C difficile associated disease in children are derived from the child‟s own bowel and not as a result of cross infection. Small numbers of organisms may be present in the normal bowel and when conditions are favourable they may begin to overgrow and produce toxin, resulting in diarrhoea. Situations that make children prone to this include

Antibiotic treatment of serious infection

Chemotherapy

Malignant disease

Immune deficiency

The Trust is still within the safe level of 12 cases per year specified by Monitor for all trusts, since all were isolated cases. Monitor accepts that results below that level will fluctuate for reasons beyond the control of hospitals. Nevertheless, the Trust has now increased the hours available to infection control nurses to ensure that they are similarly available 52 weeks per year and has increased the cleaning frequency and monitoring of infection control within the oncology unit of the hospital.

The Department of Health‟s guidance on never events is designed to protect patients from the 25 events named by the guidance. Events that lead to death or severe harm include: wrong site surgery, wrongly prepared high-risk injectable medication, transfusion of ABO-incompatible blood components and misidentification of patients. I am pleased to record that there were no never events recorded by the Trust in that period.

The Trust‟s child and adolescent mental health services have seen an increase in the numbers of young people referred and an increase in the numbers of young people in crisis. This often manifests itself in violent behaviour, frequently directed at staff. The Trust committed itself to reduce the actual harm from these incidents both to the young people and staff concerned. As a result of specially adapted staff training in managing aggressive behaviour and environmental risk assessments, the number of such incidents at the Becton centre for children and young people has reduced from 149 to 24 incidents per year. The unit is working closely with our health and safety and security advisors to maintain this reduction.

3.3.2 Clinical effectiveness

Clinical Effectiveness NATIONAL OR PERFORMANCE TARGET ACHIEVEMENT HISTORICAL 2011/12 PERFORMANCE 2012/13 AREA REVIEWED PERFORMANCE 2012/13 THRESHOLD Achieve compliance http://www.dh.gov.u New Standard Compliance by Report indicates with agreed national k/prod_consum_dh/ under national independent compliance with standards for groups/dh_digitalas development assessment some areas for children‟s major sets/@dh/@en/doc medium term uments/digitalasset trauma. As set out improvement /dh_133585.pdf in the NHS related to: Operating 24 hr consultant Framework. p76. presence in A&E, Rehabilitation space, data returns and proximity of core interventional radiology specialities. Peer review 12 March 2013 Achieve compliance http://www.dh.gov.u New standard Compliance by Attainment of with agreed national k/prod_consum_dh/ under national independent compliance. standards for best groups/dh_digitalas development assessment Peer review 24 practice in sets/@dh/@en/doc uments/digitalasset Feb 2012 children‟s diabetes /dh_133585.pdf

p59.

These indicators are based upon nationally identified patient quality indicators. The three areas impact on core services for families in Sheffield and South Yorkshire. The Safe and Sustainable Standards for Neurosciences and consequent peer assessment are still being agreed.

3.3.3 Patient experience

Patient Experience NATIONAL OR PERFORMANCE TARGET ACHIEVEMENT HISTORICAL 2011/12 PERFORMANCE 2012/13 AREA REVIEWED PERFORMANCE 2012/13 THRESHOLD Initiate 850 patient No child specific Not available – To highlight Completed postal survey of national tool new survey areas of below http://www.sheffield experience in available average childrens.nhs.uk/Pa children‟s A&E performance Commission tool tient-views.htm and problem Tool should record in conjunction scores greater child and parent with other than 50% experience hospital Children‟s Services Complete an 11 Poor Facilities for Less than 25% The Home from bedded Home from performance parents staying dissatisfied Home was not Home for resident against resident overnight rated score resulting available during parents of children parent facilities as fair/poor from re-survey. the survey and in Critical Care. scores: p3 accordingly the

Patient Experience NATIONAL OR PERFORMANCE TARGET ACHIEVEMENT HISTORICAL 2011/12 PERFORMANCE 2012/13 AREA REVIEWED PERFORMANCE 2012/13 THRESHOLD result remains at 28%. The facility Work with the Sick http://www.sheffield 25% is currently under Children‟s Trust to childrens.nhs.uk/Do construction and ensure that parents‟ wnloads/Patient%2 should be needs are reflected 0views/Inpatient%2 0Survey%20Result complete by in design. s%202011%20pdf. Summer 2013. pdf Ensure that family No child specific Patient surveys Set up family University of needs are reflected national tool have reported focus groups to Sheffield has in design and available on existing assess the been contracted working practices practices and priorities of to carry out focus associated with new facilities rather families. group research hospital Outpatient than what this year with and Inpatient parents and Publish families and staff. facilities being built children want. responses and Research findings from 2012 - 2015 incorporate will be published findings in to advise new planning of new ways of working facilities. in 2014.

The Trust has largely based its capital building plan on family feedback. The needs expressed in the annual surveys have informed the access, way finding, clinic environment, ward facilities, resident parent facilities and working practices of the new hospital wing. Our Accident and Emergency (A&E) facilities and the satisfaction results obtained have informed the decision of local commissioners to relocate out of hours GP care to a clinic within the hospital, thus simplifying Sheffield wide provision.

3.3.4 Other Performance Indicators

18 Weeks referral to treatment

While the Trust met the 18 week referral for treatment for non-admitted patients throughout the year, and met the required performance for incomplete pathways, the Trust did not meet the 18 week referral to treatment standard for admitted patients between June and September 2012. The Trust has taken action to address the reasons for the under-performance in this area, and a programme board is in place to oversee the delivery of an action plan to improve processes which support the delivery of care.

Weekly patient tracking meetings are in place to monitor pathways and waiting times and improvements have been made to the processes used to manage pathways. The Trust has made good progress on reducing waiting times and all 18 week targets were met throughout the second half of 2012/13. Performance on incomplete pathways improved from 92.2 per cent to 95.9 per cent of patients waiting for treatment waiting less than 18 weeks by year end, demonstrating that there are now fewer longer wait patients, which reduces the risk to performance.

Patients waiting over 52 weeks

The Trust had one patient waiting longer than 52 weeks for treatment at the end of 2012/13. Further work is being undertaken to assess how to reduce the length of the pathway for patients waiting for surgery for which a complex assessment process is required.

Diagnostic waiting times

The Trust did not achieve the six-week diagnostic standard in most months of 2013/14. However, performance in the final months of the year showed much improvement with over 98 per cent of patients receiving their diagnostic test in February and March against the 99 per cent target. Access to sleep studies was the primary issue, with insufficient capacity in place to support increased demand in this area. Additional capacity has been made available, and it is expected that delivery against the six-week target will be achieved in this area during 2013/14.

Accident and Emergency (A&E) unplanned re-attendance rate

The re-attendance rate to A&E exceeded the A&E national quality standard of five per cent throughout the year. However, this target is set for general A&E departments and the Trust does not consider it sufficiently sensitive to paediatric only services.

3.3.5 National staff attitude survey

Each year the trust takes part in the national staff attitude survey. This survey provides invaluable information to ensure that the views of staff at work are heard and appropriate responses to the feedback are made. While the results are encouraging, with an increase in the score for overall staff engagement, we will strive to ensure that continued improvements are made to enhance staff experience at work. Following the publication of this year‟s survey results we have set up a staff engagement forum „Your Voice‟ which will have representatives from across the Trust. A key remit of this group will be to ensure that the findings of the staff survey are acted upon and staff engagement is prioritised across the Trust. 3.3.5.1 Summary of performance Response rate

2011 2012 Improvement/deterioration National National Our Trust Our Trust average average 47% 53% 40% 52% 7% deterioration

Top five ranking scores4

Percentage of staff experiencing discrimination at work in the last 12 months (the lower the score the better)

2011 2012 Improvement/deterioration National National Our Trust Our Trust average average 9% 10% 4% 8% 5% improvement

4 These scores are the five key findings from the staff attitude survey where Sheffield Children’s NHS Foundation Trust compares most favourably with other acute specialist trusts in England

Effective team working (the higher the score the better - on a scale of 1-5)

2011 2012 Improvement/deterioration National National Our Trust Our Trust average average 3.82 3.73 3.88 3.77 .06 improvement

Percentage of staff feeling pressure in the last 3 months to attend work when feeling unwell (the lower the score the better)

2011 2012 Improvement/deterioration National National Our Trust Our Trust average average 21% 22% 21% 23% No change

Percentage of staff reporting errors, near misses or incidents witnessed in the last 12 months (the higher the score the better)

2011 2012 Improvement/deterioration National National Our Trust Our Trust average average 97% 96% 95% 92% 2% deterioration

Percentage of staff believing the Trust provides equal opportunities for career progression or promotion (the higher the score the better)

2011 2012 Improvement/deterioration National National Our Trust Our Trust average average 95% 92% 91% 88% 4% deterioration

Bottom five ranking scores5

Percentage of staff having equality and diversity training in last 12 months (the higher the score the better)

2011 2012 Improvement/deterioration National National Our Trust Our Trust average average 27% 50% 43% 61% 16% improvement

5 These scores are the five key findings from the staff attitude survey where Sheffield Children’s NHS Foundation Trust compares least favourably with other acute specialist trusts in England

Percentage of staff feeling satisfied with the quality of work and patient care they are able to deliver (the higher the score the better)

2011 2012 Improvement/deterioration National National Our Trust Our Trust average average 73% 77% 76% 82% 3% improvement

Percentage of staff experiencing physical violence from patients, relatives or the public in the last 12 months (the lower the score the better)

2011 2012 Improvement/deterioration National National Our Trust Our Trust average average 5% 3% 12% 6% 7% deterioration

Percentage of staff experiencing harassment, bullying or abuse from patients, relatives or the public in the last 12 months (the lower the score the better)

2011 2012 Improvement/deterioration

National National Our Trust Our Trust average average 10% 8% 25% 21% 15% deterioration

Percentage of staff agreeing that their role makes a difference to patients (the higher the score the better)

2011 2012 Improvement/deterioration

National National Our Trust Our Trust average average 88% 90% 89% 91% 1% improvement

Key areas of improvement

Staff experience has improved in relation to staff receiving equality and diversity training in the last 12 months. However, we remain below the national average for acute specialist trusts. Fewer staff are reporting that they have experienced discrimination at work and we will continue to demonstrate improvements in this area. The „Your Voice‟ staff engagement forum will focus its work around the key areas for improvement identified in the survey and reports will be provided back to the board of directors.

3.4 ANNEX A: Statement of directors‟ responsibilities in respect of the quality report

The directors are 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 NHS foundation trust boards on the form and content of annual quality reports (which incorporate the above legal requirements) and on the arrangements that foundation trust boards should put in place to support the data quality for the preparation of the quality report.

In preparing the quality report, directors are required to take steps to satisfy themselves that:

the content of the quality report meets the requirements set out in the NHS Foundation Trust Annual Reporting Manual 2012-13;

the content of the quality report is not inconsistent with internal and external sources of information including:

o Board minutes and papers for the period April 2012 to June 2013

o Papers relating to quality reported to the board over the period April 2012 to June 2013

o Feedback from the commissioners dated 2 May 2013

o Feedback from governors dated 7 May 2013

o Feedback from local Health Watch organisations dated 7 May 2013

o The Trust‟s complaints report published under regulation 18 of the Local Authority Social Services and NHS Complaints Regulations 2009, entitled Risk Management Annual Report, April 2013

o The Trust‟s inpatient survey 2012

o The Trust‟s outpatient survey 2012

o The Trusts results from the national staff survey 2012

o The A&E survey 2012

o The head of internal audit‟s annual opinion over the Trust‟s control environment dated 21 May 2013

o CQC quality and risk profiles dated March 2013

the quality report presents a balanced picture of the NHS foundation trust‟s performance over the period covered;

the performance information reported in the quality report is reliable and accurate;

there are proper internal controls over the collection and reporting of the measures of performance included in the quality report, and these controls are subject to review to confirm that they are working effectively in practice;

the data underpinning the measures of performance reported in the quality report is 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 www.monitor-nhsft.gov.uk/annualreportingmanual ) as well as the standards to support data quality for the preparation of the quality report (available at www.monitor- nhsft.gov.uk/annualreportingmanual )

3.5 ANNEX B: Consultation in the preparation of the quality report

A number of staff, families and organisations were involved in the consultation process to produce this report and the Trust is grateful for the time and effort of all who have contributed. The final version has tried to accommodate the comments received or the minutes of the meetings at which it was discussed but it is accepted the production of the report is ultimately the responsibility of the board of directors. 3.5.1 Consulted agencies or groups 5.5.1.1 Sheffield Clinical Commissioning Group

The first draft report was provided to NHS Sheffield on 12 April 2013.

SCH QUALITY ACCOUNTS 2012/13

STATEMENT FROM SHEFFIELD CLINICAL COMMISSIONING GROUP

NHS Sheffield Clinical Commissioning Group (CCG) has had the opportunity to review and comment on the information in this quality account prior to publication. Sheffield Children‟s NHS Foundation Trust has considered our comments and made amendments where appropriate. We are confident that to the best of our knowledge the information supplied within this report is factually accurate and a true record, reflecting the trust‟s performance over the period April 2012 – March 2013.

Sheffield Children‟s NHS Foundation Trust provides a very wide range of general and specialised services, and it is right that all of these services should aspire to make year-on-year improvements in the standards of care they can achieve.

Our overarching view is that Sheffield Children‟s NHS Trust continues to provide high quality services, which are underpinned by strong operational performance. In year we have seen strong performance against key national indicators such as the 95% Accident and Emergency (A&E) target. Where we have had concerns in year around aspects of performance, for example the number of patients waiting over 52 weeks for treatment and the rate of 6 week diagnostic breaches, the trust has worked openly with NHS Sheffield CCG to provide assurance and to put measures in place to improve performance. The trust has unfortunately experienced one never event during 12/13, the CCG have worked closely with them to understand the reason for the never event and to ensure processes are in place to reduce the risk of recurrence.

Moving forward, NHS Sheffield will continue to work jointly with the trust to commission safe, high quality services. Sheffield Children‟s Trust has identified three priorities to take forward in 2013-14 (see below) which will further improve the quality and safety of patient care. The CCG is in agreement with the identified priority areas.

Implement the Department of Health Response to the Mid Staffordshire Public Enquiry, „Patients First and Foremost‟

Publish regular information on our quality performance and the experience of our families

Minimise disruption to the public from our construction of the new hospital wing

In 2013-14 the CCG will build on existing good clinical and managerial working relationships to progress initiatives around unscheduled care, we have agreed a CQUIN scheme that is challenging for the trust but will undoubtedly improve patient quality if achieved. We look forward to working closely with the trust to fully understand the improvements in patient quality as a result of the imminent large

scale capital development on the acute site, which is set to take place over the next 12 months.

Submitted by Jane Harriman on behalf of:

Kevin Clifford Chief Nurse and Ian Atkinson, Contract Lead SCH Sheffield Clinical Commissioning Group

2nd May 2013

5.5.1.2 Sheffield Healthwatch

The first draft report was provided to Healthwatch on 24 April 2013 and a meeting was held with key members of Healthwatch and the director of nursing and clinical operations on 30 April 2013. The following response was received:

Sheffield Children‟s NHS Foundation Trust Quality Report 2012-13 Commentary from Healthwatch Sheffield

Healthwatch Sheffield is grateful for sight of the Sheffield Children‟s NHS Foundation Trust‟s draft Quality Accounts for 2012-13 and welcomes the opportunity to provide comments. These comments are based on the Draft 1 version for consultation sent to Healthwatch Sheffield in April 2013 and paragraph references below relate to this version. We are pleased that Healthwatch Sheffield representatives were able to meet the Trust‟s Director of Nursing and Clinical Operations to discuss the Quality Account and comments made by Healthwatch at this meeting have been taken into account in the final document.

We hope that the Trust will be able to produce a summary easy to read version for wider public information.

Performance on Quality Priorities 2012-2013

We welcome the approval from Monitor to proceed with the construction of the new wing due to complete in 2015 which will provide new Outpatient facilities and Inpatient facilities. We are pleased that the new home from home for resident parents of children in Critical Care and Neonatal Care linked to the critical care floor by a corridor will be completed this summer. The reduction in delays and improvements in communication for both In- patients and Outpatients is welcome as this has been a concern for parents attending the Trust. The Rapid Access Clinics have reviewed 387 patients and of those only 13 have required admission after discussion with a paediatrician at the Trust. This is an excellent service which has been welcomed by GPs and Community midwives and health visitors.

2.2 Quality Improvement Priorities Identified for 2013-2014

We welcome the regular evaluation of performance in the community and the use of the family and friends test in A&E. The Mid Staffordshire Public Inquiry has raised public concern about health service failings in the treatment of patients and their families. We are pleased to see the steps the Trust will take to retain confidence in the provision of the services provided.

2.3.2 Patient Safety

We are pleased that the Trust has been able to reduce the number of incidents of violent behaviour at Becton. However we would like to see more details of CAMHs (Child and Adolescent Mental Health Service) included in the document especially in relation to waiting times for assessment which the LINk and Scrutiny have taken an interest in during 2012-13.

2.3.7 CQUIN Quality Indicators

The tables show that all of the seven Specialist Services CQUINS were achieved and this is welcome though it would be helpful to have more detailed figures if possible.

It is disappointing that all Core Service CQUINS were achieved with the exception of Asthma Management. We accept that the patient numbers involved are very low and that the target was achieved in the first audit but we remain concerned and will monitor this to check for improvement. We are aware that the system for discharge of those patients has changed and trust this will enable the Trust to achieve this next year.

2.4 Patient Experience

The results of the Inpatient, Outpatient and A&E surveys achieved a high response rate. The results showed that only just over 3% of Outpatients regarded their care as either fair or poor which is an excellent result. The In-patient survey showed similarly high levels of satisfaction with only 4% rating their care as fair or poor. A&E results also showed a 96% positive rating and the Trust should be commended on these results.

2.5 Complaints

We are grateful for the detailed breakdown of the complaints data although it is disappointing that the number of complaints has risen in all areas. We would hope to read a more positive result next year. However the overall number of complaints at just over 6% per 10,000 episodes of treatment is low compared to other comparable Trusts nationally. Nevertheless we urge the Trust to monitor complaints numbers closely with a view to reducing those relating to diagnosis and medical care outcomes. The section detailing learning from complaints is excellent and it is helpful to see the changes in practice as a result.

2.6 Serious Untoward Incidents

In the past Sheffield LINk has always asked Trusts to include information on Patient Safety Alerts (PSAs) in Quality Accounts. As the successor body Healthwatch Sheffield has been assured that only one PSA is outstanding and that this is waiting for a national resolution. We would also like to see reported in Quality Accounts information on any Coroners Rule 43 Requests that were received by the Trust in 2012-13 such as the number of Requests received during the year, their subjects, the actions taken and status of the Trust in respect of each.

The LINk expressed a view last year that results of staff surveys are important in an organisation‟s performance and we would have liked to see this in the Quality Account though we accept the information is available in the Trust Annual Report.

Mike Smith (Chair Sheffield LINk to March 2013} Pam Enderby (Chair Healthwatch Sheffield)

7 May 2013

3.5.1.3 Yorkshire Overview and Scrutiny Committee

The first draft report was provided to the South Yorkshire Oversight and Scrutiny Committee on 12 April 2013. The director of nursing and clinical operations attended the Committee on 17 April 2013. The following response was received:

. Sheffield City Council – Healthier Communities and Adult Social Care Scrutiny Committee

Response to Sheffield Children‟s Hospital NHS Foundation Trust Quality Report

PRESENT: Councillors Mick Rooney (Chair), Sue Alston, Janet Bragg, Katie Condliffe, Roger Davison, Tony Downing, Adam Hurst, Cate McDonald, Pat Midgley, Diana Stimely and Garry Weatherall

Non-Council Members (LINk):-

Mike Smith (Substitute for Helen Rowe)

7.1 John Reid, Director of Nursing and Clinical Operations, Sheffield Children‟s Hospital Foundation Trust, reported on the Quality Account for the Sheffield Children‟s Hospital for 2012/13.

7.2 The report summarised the performance of Trust in 2012/13 with regard to the quality of care, and also set out details of the quality priorities for 2013/14, in consultation with the Trust‟s families, governors and agency partners.

7.3 Mr Reid reported that Sheffield Children‟s NHS Foundation Trust was one of the best performing Foundation Trusts in the country, as recorded by Monitor (the Foundation Trust regulator) and the Care Quality Commission (CQC), and that the Trust had responsibility for most aspects of child health care in Sheffield, including hospital, community and mental health, as well as being a major provider of specialist hospital care for South Yorkshire and beyond. He reported that the reputation was built on the high satisfaction survey results and the quality of care provided. Reference was made to the construction of a new £40 million patient wing, which was due to commence in Summer 2013, and would result in material improvements to those areas of below average experience, such as parking, privacy and dignity, parental accommodation and way-finding.

7.4 He reported that the Trust‟s community services and its child and adolescent mental health service were key components of a holistic child health system in Sheffield and beyond, and the Trust had been working closely with local authority partners to ensure that its teams were integrated with social care and education to obtain the best outcomes for families. This was carried out through joint child protection arrangements, shared public health priorities and good communication. He referred specifically to complaints which had been received during 2012/13, which had showed an increase from the previous year, with the most common grounds for complaint relating to diagnosis or a treatment plan, or in relation to complications of treatment.

7.5 Members of the Committee and representatives of Sheffield LINk raised questions and the following responses were provided:-

It has been accepted, as highlighted by a recent case, that communication between clinicians has not always been effective. In response to this, a Paediatric Early Warning Tool had been developed, which comprised a system of coloured bands to enable consistency in terms of the assessments of different types of care, as well as setting down time limits in terms of doctors‟ responses and the levels of seniority of doctors dealing with different types of care.

It was agreed that complaints should be dealt with as a form of customer feedback. As mentioned earlier the number of complaints received has increased in the last few years, with the majority relating to a diagnosis or treatment plan. Whilst both issues were considered to be subjective, it had been agreed that all complaints should be viewed as valid, and a number of such complaints had been seen to be justified. An increasing number of issues were dealt with by the Patient Advisory and Liaison Service (PALS), which aimed to resolve as many issues as possible, prior to them becoming formal complaints.

Despite the recent news regarding the Leeds Cardiac Unit, the Trust did not have any concerns with regard to the ability and safety of surgeons at Leeds, and was currently the Trust‟s preferred partner in terms of cardiac surgery.

There had been considerable adverse publicity regarding the events at the actions of the Mid Staffordshire NHS Trust, where a high number of patients had died as a result of the alleged substandard care and staff failings. The mortality rate had been considerably higher than other hospitals of a similar size. Standardised mortality rates for children are heavily dependent on specialities at each hospital. The low numbers of children‟s deaths do not readily lend themselves to statistical interpretation – consequently independent investigation into each child death is conducted by the statutory Child Death Overview Panel. The Trust does report standardised mortality figures for its intensive care unit and this is published on the PICANET web site. The figures for the trust are about average for the mix of specialities.

The Trust has worked with GP and midwifery colleagues to improve their access to paediatric medical advice – a paediatrician is available each day to discuss cases and avoid unnecessary attendance at A&E.

The Trust had worked with health visitors in order to integrate them into the workforce. There had always been tension regarding whether health visitors should concentrate on a universal service or prioritise care for those families of greatest need. The trust is carrying out a 1200 family community satisfaction survey: it is hoped that this will help provide the Trust with evidence to support the best balance between these approaches.

It was accepted that there was no reference to meningitis in the report. Mr Reid undertook to supply the committee with data on meningitis diagnosis locally and nationally. The success rate for dealing with cases of meningitis depended predominantly on

what stage it was identified.

The car parking on Western Bank at the front of the Hospital was discussed. The trust has prioritised this for people attending A&E, as having an acutely ill child and therefore an urgent need to seek clinical attention.

In terms of equality and diversity issues, the Trust‟s Equality Scheme is published on its website on an annual basis. Any language needs were addressed by the operation of an interpretation service, which comprised both face to face interpretation and a telephone based language line in the emergency admissions department. Research has shown that families tended to attend the Hospital at similar times in the mornings and afternoons, and the Trust had attempted to address this by changing staff shift patterns and talking to NHS Sheffield regarding the out of hours GP based at the Hospital. Some BME communities use the A&E service differently from the general population and the trust is working with commissioners to see how this can be modified. The results of the A&E Patient Survey, which was targeted at families attending A&E, has been published on the Trust‟s website.

It was accepted that the Trust had failed a target on the issue of providing relevant information for asthma sufferers leaving the hospital. This was a relatively small audit but has resulted in changes to discharge arrangements to ensure that they had all the relevant advice.

In terms of the quality improvement priorities identified for 2013/14, specifically regarding the implementation of the Department of Health response to the Mid Staffordshire NHS Trust Public Enquiry – „Patients First and Foremost‟, the Trust would involve non-executive Board Members , Governors and families in any inspection and oversight of the Trust‟s services.

The number of 265 local clinical audits and service evaluations may appear high. The Trust carries out nationally commissioned audits and some trust commissioned audits – these are to quantify poorly understood risks. Most audits are carried out by trainee health staff as part of their educational programme and relate to areas of interest for them personally.

Although the committee recognised that Quality Accounts had to be drafted in a standard format, the Trust was asked to consider producing an easy-read version of the Quality Account that was more accessible to the public.

Parking was discussed. There had been a number of issues regarding the planning applications required for the hospital redevelopment on the basis that the Hospital was situated within a Conservation Area. Having underground parking below the Outpatient Department was one way to get round the strict limitations regarding Conservation Area planning consent. There were also plans to provide car parking on the triangular piece of land next to the Octagon, as well as providing off-site parking, with a shuttle bus service between the Hospital, the nearest Super tram stop and the proposed Tapton area car park.

7.6 RESOLVED: That this Committee:-

(a) notes the contents of the report now submitted on the draft Quality Account 2012/13, together with the responses to the questions raised;

(b) thanks John Reid for attending the meeting and responding to the questions raised; and

(c) requests (i) the Policy Officer (Scrutiny) to liaise with John Reid, with the aim of arranging a visit by Members to the new Home from Home villas and other areas of new build at the Hospital and (ii) John Reid to provide details of the results of the asthma audit which would be repeated in terms of the provision of advice to child asthma sufferers to this Committee.

3.5.1.4 Council of Governors Sheffield Children‟s NHS Foundation Trust

The first draft report was provided to the governors on 24 April 2013. The draft was the subject of a discussion on 7 May 2013 between the director of clinical operations and the council. The attached is an extract from the minutes of the meeting.

Extract from the draft minutes of the Council of Governors meeting. Draft Quality Report 7 May 2013

The Director of Nursing and Clinical Operations presented the quality report for 2013 taking governors through the content of the document. It was confirmed that the Trust was required by Monitor to publish the report, the format of which was specified for all trusts. Some of the data was not available at the present time and where data was missing this was highlighted within the draft report and would be added before publication. The purpose of sharing the document with the council was to give governors opportunity to ask questions and input into the development of the report as part of a formal consultation process. Comments and responses from all stakeholder groups involved in the consultation would be published within the report itself.

After highlighting key points within the report, the Director of Nursing and Clinical Operations asked for questions.

The first question raised by a Governor was around the increase in complaints reported in document and an explanation for this was requested. It was explained that most trusts were seeing an increase in the number of formal complaints received and comment was made about the increase in consumer-based behaviour within society in general, raised public expectations and awareness around quality and the public being better informed around complaint making .

It was stated that the trust had included additional detail within the report over and above the level specified by our regulator. This included an analysis of complaints by service area, division and reason for complaint to see if any trends or patterns could be identified. The report showed that using national coding descriptions many complaints fell into the category of 'all aspects of clinical treatment'. The main reasons are related to a diagnosis or treatment plan, or in relation to complications of treatment. The trust considers that improved communication is the key to correcting the above trend and while some other trusts state whether a complaint is upheld or not upheld it was explained that we consider that every complaint provides valuable feedback from which the trust can learn. The trust felt it important to set information about complaints within the context of other channels of patient feedback including patient survey results which included some very positive feedback.

A further request was made to explain the selection of the year 2004-2005 as the benchmark for complaints and levels of patient activity set out at the top of page 25. It was stated that this was the first year of data collection for complaints.

Discussion took place regarding quality improvement priorities identified for 2013- 14. The wider context of the new hospital wing improving the patient experience and quality of accommodation was used as rationale for the selection of the third priority. In terms of achievement of CQUIN quality indicators for specialist CAMHS services it was explained that the stated outcomes were subject to some updating / confirmation. It was acknowledged that the CQUIN could be more challenging and instead of setting compliance with survey returns as a target, improvement on outcomes could be specified. It was explained that the target was regionally set by specialised commissioners.

The draft quality report was noted by the Council of Governors.

4. Governance arrangements

Sheffield Children‟s NHS Foundation Trust is authorised to operate as a public benefit corporation under the National Health Service Act 2006. The overall responsibility for running the Trust lies with the board of directors and the council of governors is the collective body through which directors explain and justify their actions.

The responsibilities of both the Trust board and the council of governors are laid out in the Trust‟s constitution. The roles and responsibilities of each are described in the following sections of the report.

4.1 Council of governors

As a foundation trust, the council of governors has responsibility to represent the views and interests of the membership and partnership organisations, to hold the board of directors to account and to ensure that it is acting in a way that will not breach its terms of authorisation as a foundation trust. It consists of elected and nominated governors who provide an important link between the hospital, the population it draws its patients from and key stakeholder organisations by sharing information and views that can be used to develop and improve hospital services.

The council of governors works with the board of directors to shape the future strategy of the organisation and is responsible for providing feedback from the membership and stakeholders on strategic developments at the Trust. It also should keep members and stakeholders informed about any developments at the Trust.

The Trust keeps the council of governors fully informed on all aspects of the Trust‟s performance and seeks their advice on key service developments. This is done through formal council meetings where a summary of the board‟s business agenda remains a standing item on the agenda, and through working groups set up by the council of governors. These are explained in detail in section 4.1.2. Governors also sit on a number of Trust working groups.

4.1.1 Composition of the council of governors 2012/13

The council of governors comprises elected and nominated governors as shown below and has decision-making powers defined by statute. These powers are described in the Trust‟s constitution and principally refer to the appointment and removal of, and the remuneration for, the chairman and non-executive directors on the board of directors; the appointment and removal of the Trust‟s external auditors; the approval of the appointment of the chief executive and receiving the foundation trust‟s annual accounts, any report of the auditor on them, and the annual report.

The names of the governors during the year, including where governors were elected or appointed during the year and their lengths of appointment are set out in the following tables. During the year elections for 11 seats on the council were held across seven constituencies where governors‟ terms of office were due to expire or where vacancies had arisen mid-term (see section 4.2.2). Eight of these seats were contested resulting in elections being held in five constituencies. The number of candidates standing for these contested seats was greater than for recent elections and across these constituencies there was an average election turn-out of nine per cent. The two re-elected and nine newly elected governors were formally appointed to office at the annual members meeting held on 8 October 2012.

The full council of governors met formally five times during 2012/13 to discuss a wide range of subjects, including the patient experience, the Trust‟s business agenda and its service and strategic development plans. A record is kept of the number of meetings attended by individual governors.

The members of the council of governors who served during 2012/13 are outlined in the tables below:

Elected governors – patient / carer constituencies

Current Term Attendance from Name Constituency Elected from of Office 5 meetings *1 Kate Quail nd Interim Lead Governor from Oct 2012 Carer 2 Oct 2009 2 from 5

Holly-Rayne Bennett *2 Patient – Rest of England - Nov 2009 2 from 3

Holly Blair *3 Patient – Rest of England 1st Oct 2012 1 from 2

Paul Harrison Patient / Carer – Sheffield 1st Oct 2011 0 from 5

Lindsey Thompson Patient / Carer – Sheffield 1st Oct 2011 2 from 5

*1Kate Quail was initially elected in October 2009 for a three year term. She was re-elected for second term of three years from October 2012. *2Holly-Rayne Bennett was elected in November 2009 for a three year term. She nominated herself for a second term but was not elected in the summer 2012 elections and therefore stepped down from the council of governors at the annual members‟ meeting in October 2012. *3 Holly Blair was elected in the summer 2012 elections taking up her position at the annual members‟ meeting in October 2012

Elected Governors – public constituencies

Current Term Name Constituency Elected from Attendance of Office Pat Barker *4 Sheffield South East - Aug 2006 2 from 3

Momtaz Begum *5 Sheffield South East 1st Oct 2012 2 from 2

Thomas Hall Sheffield South East 1st Oct 2011 5 from 5

Luke Jenkinson *5 Sheffield South East 1st Oct 2012 2 from 2

Karoline Mellors *6 Sheffield South East - Oct 2009 0 from 3

Caroline Burgin-Razine Sheffield North East 1st Apr 2010 2 from 5 Linzey Scothern *7 Lead Governor until October 2012 Sheffield North East - Oct 2009 3 from 3

Jacqueline Griffin *8 Sheffield North East 1st Oct 2012 2 from 2

Joanne Morton *9 Sheffield North West - Oct 2009 0 from 3

Mary Gerrard *10 Sheffield North West 1st Oct 2012 2 from 2

Gillian Sykes Sheffield North West 1st Oct 2011 4 from 5

Tom Butler Sheffield South West 1st Oct 2009 2 from 5

Beth Dunne Sheffield South West 1st Apr 2010 4 from 5

Richard Knighton *11 Sheffield South West 1st Oct 2012 2 from 2

Sabine Vanacker *12 Sheffield South West - Aug 2006 1 from 3

Gerard Tayeh Barnsley 1st Oct 2011 5 from 5

Alison Cross Doncaster 1st May 2011 3 from 5

Hayley Ives *13 Rotherham - May 2011 0 from 1

Faye Wooding Rotherham 1st Oct 2012 2 from 2

1st (Remainder Hassan Hajat Rest of England & Wales March 2012 4 from 5 of 3 years)

*4 Pat Barker was initially elected from August 2006 for a three year term. She was re-elected for a second term of three years from October 2009 which ran until October 2012 when she stepped down from the council of governors at the annual members‟ meeting. *5 Momtaz Begum and Luke Jenkinson were both elected in the summer 2012 elections taking up their positions at the annual members‟ meeting in October 2012. *6 Karoline Mellors was elected from October 2009 for a three year term. She did not nominate herself for re- election for a second term and stepped down from the council of governors at the annual members‟ meeting in October 2012. *7Linzey Scothern was elected in November 2009 for a three year term. He nominated himself for a second term but was not elected in the summer 2012 elections and therefore stepped down from the council of governors at the annual members‟ meeting in October 2012. *8 Jacqueline Griffin was elected in the summer 2012 elections taking up her position at the annual members‟ meeting in October 2012. *9 Joanne Morton was elected from October 2009 for a three year term. She did not nominate herself for re- election for a second term and stepped down from the council of governors at the annual members‟ meeting in October 2012. *10 Mary Gerrard was elected in the summer 2012 elections taking up her position at the annual members‟ meeting in October 2012. *11 Richard Knighton was elected in the summer 2012 elections taking up his position at the annual members‟ meeting in October 2012. *12 Sabine Vanacker was initially elected from August 2006 for a three year term. She was re-elected for second term of three years from October 2009 which ran until October 2012 when she stepped down from the council of governors at the annual members‟ meeting. *13 Hayley Ives stepped down from the council of governors in June 2012 as she was no longer resident within the Rotherham constituency *14 Faye Wooding was elected in the summer 2012 elections taking up her position at the annual members‟ meeting in October 2012. A new election was held as it had not been possible to contact the next highest polling candidate at the 2011 election to take up this public governor vacancy.

Elected governors – staff governors

Current Term Name Constituency Elected from Attendance of Office Philip Ayrton *15 Non Clinical 1st Oct 2012 2 from 2

Clive Bradey Non Clinical 1st Oct 2011 3 from 5

Sue Taylor *16 Non Clinical - Aug 2006 0 from 0

Jane Buckham Other Clinical 1st May 2011 4 from 5

Valerie Kellett *17 Nursing & Midwifery - Oct 2011 0 from 3

Nicholas Roe *18 Nursing & Midwifery 1st Oct 2012 2 from 2

Deborah Salvin Nursing & Midwifery 1st May 2011 2 from 5

Joy Owens Medical/Dental 1st Oct 2011 4 from 5

*15 Philip Ayrton was elected in the summer 2012 elections taking up his position at the annual members‟ meeting in October 2012. *16 Sue Taylor was initially elected from August 2006 for a three year term. She was re-elected for a second term of three years from October 2009. She stepped down from the council of governors on retiring from the Trust at the end of April 2012. *17Valerie Kellet was elected in the summer 2011 elections taking up her position at the annual members‟ meeting in October 2011. She stepped down from the council of governors in January 2012 before completing her first term of office. *18Nicholas Roe was elected in the summer 2012 elections taking up his position at the annual members‟ meeting in October 2012.

Partner governors

Current Term Appointed Name Partner Organisation Attendance of Office from Alan Baranowski Yorkshire Ambulance Service 2nd Jun 2009 4 from 5

19 NHS Sheffield / Sheffield st Richard Oliver * 1 Apr 2012 3 from 5 Clinical Commissioning Group Julia Hirst Sheffield Hallam University 2nd Oct 2009 3 from 5

Amaka Offiah University of Sheffield 2nd Oct 2009 4 from 5

Dawn Walton Sheffield City Council 2nd Oct 2009 4 from 5

Vacancy Specialist Commissioners

Tom Newman*20 0-19+ Partnership 1st July 2012 4 from 4

Sue Greig*21 0-19+ Partnership 1st Apr 2012 1 from 5

*19 Richard Oliver took up his position of appointed Governor for NHS Sheffield in April 2012 in advance of the reorganisation of commissioning arrangements and the authorisation of Sheffield Clinical Commissioning Group. *20 Tom Newman filled a vacancy on the council of governors following the resignation of Emma Hinchcliffe in May 2011. *21 Sue Greig filled a vacancy on the council of governors following the resignation of Kerry Jones in October 2011. Sue took up this position after stepping down from the position of appointed governor for NHS Sheffield.

There is currently a vacancy for the governor position appointed to represent a non-Sheffield based commissioner (formerly a representative from North Trent PCT). We have been awaiting the outcome of the reconfiguration of commissioning arrangements before asking a relevant organisation to nominate a partner governor to fill this vacancy.

In the event of an elected governor‟s seat falling vacant for any reason before the end of a term of office, it shall be filled by the second placed candidate in the last election held for that seat provided that this candidate achieved at least five per cent of the vote.

Lead governor position

In October 2012, the council agreed that carer governor, Kate Quail should act as interim lead governor to replace the previous incumbent lead governor whose term of office had expired. A formal nomination and election process for the appointment of a lead governor on a one-year basis will now take place.

The lead governor is responsible for receiving from governors and communicating to the chair any comments, observations and concerns expressed by governors regarding the performance of the Trust or its business, other than those expressed directly by governors at meetings of the council of governors. The lead governor regularly meets with the chair, both formally and informally. In addition the lead governor communicates with other governors by way of regular e-mail correspondence and also meets on an ad-hoc basis with small groups of governors to discuss relevant matters.

4.1.2 Understanding the views of governors and members

Executive and non-executive directors attend council of governors meetings to offer their knowledge and particular expertise and to listen to the views of governors. The chairman of the Trust board also chairs the council of governors and provides a link between the two, supported by the foundation trust secretary; executive and non-executive directors are not members of the council of governors.

Strengthening links between the board of directors and council of governors and members

The board of directors has clearly reaffirmed its commitment to working in partnership with the council of governors, acknowledging the role of governors in encouraging openness and accountability between the Trust, patients / carers and the public.

Focused discussion has taken place between directors and governors throughout the year around steps that can be taken to build further on the links between these two groups. While much of this discussion preceded the publication of the report following the Mid Staffordshire NHS Foundation Trust public inquiry, the clear recommendations within it around enhancing the role of governors and providing necessary support and training have provided additional emphasis for this discussion. Significant joint working between the chairman and lead governor has taken place this year to further develop the effectiveness of council of governors‟ meetings and support governors to execute their extended responsibilities.

All board members have a standing invitation to attend council of governors meetings in order to ensure that they understand the views of governors and members and board members also attend the annual members‟ meeting to liaise with members. The board and governors meet jointly at least annually, most recently in January 2013 as part of enabling governors to input into the Trust‟s annual plan. Trust board meetings are now held in public and there is also the opportunity for public governor observers to attend the private session of Trust board meetings to widen opportunities for governors to observe Trust board business, supporting them in fulfilling their statutory duty of holding the board of directors to account and inform their assessment of non-executive directors.

There has also been continued focus on involving the council of governors in key developments and issues impacting the Trust. A summary of the involvement of governors in the activities of the Trust during 2012/13 includes:

collected feedback from parents and families by undertaking a programme of ward rounds; overseen the selection of the Trust‟s external auditors; provided input with regard to the Trust‟s quality priorities; considered the remuneration of non-executive directors; provided representation on staff awards panel; attended local public engagement events to recruit foundation trust members; taken part in „back to the floor‟ visits; provided staff governor representation on staff survey working group; agreed board appointments to senior independent director and deputy chairman roles; had opportunity to formally input into the appraisal of the performance of the chairman and non-executive directors, and provided input on focus groups for the rebuild of the Trust website

Attendance by directors at council of governors meetings

Attendance from 5 Name meetings Nicholas Jeffrey Chair 4 Derek Burke Medical director 3 Isabel Hemmings Chief operating officer 4 Meredydd Hughes Non-executive director 3 Sarah Jones Non-executive director 4 Jeremy Loeb Chief finance officer 3 Neil MacDonald Non-executive director 2 Simon Morritt Chief executive 4 Steven Ned Director of human resources 4 John Reid Director of nursing & clinical operations 3 David Williams Non-executive director & deputy chairman 3 Gareth Watkins Non-executive director & senior independent director 1

4.1.3 Meeting structure

During 2012/13 the council of governors had two formal sub-committees – a remuneration committee and a recruitment committee. The remuneration committee met once during 2012/13 to review the remuneration of the chair and non-executive directors and its recommendations were ratified by the council of governors at its meeting in May 2012. There was no reason to convene a meeting of the recruitment committee during 2012/13.

There are other working groups on the council of governors which also meet outside the formal council meetings and then present their recommendations to the larger group of governors at council meetings. The joint auditor appointment panel is an example of one such working group which met for a fixed term during 2012/13. Comprised of governors and non-executive members of the board of director‟s risk and audit committee, this panel oversaw the formal selection process for the appointment of the Trust‟s external auditors and put forward the preferred supplier for ratification at an extraordinary meeting of the council held on 09 October 2012.

Another working group of the council of governors is its membership and communications group who met during 2012/13 to discuss how to improve communication and increase members‟ involvement, as well as improving recruitment from under-represented groups. The work of the group over the last year has involved spearheading governor attendance at community events, co-ordinating ward rounds and promoting the elections held in the year.

Individual governors also represent the council of governors on Trust working groups and involvement over the past twelve months has included membership of the evaluation panel which assessed the architects‟ presentations for the design of the new hospital wing, judging staff awards and attending the patient and carers‟ advisory group.

In addition to quarterly formal council meetings there is an annual members‟ meeting at which the Trust‟s annual report and accounts are presented. At this meeting the governors and members are briefed on the overall performance of the Trust over the previous year and governors provide feedback to the board of directors. The annual members‟ meeting was held on 09 October 2012. There was also a need to hold an extraordinary meeting of the council of governors during 2012/13 and this took place on 09 October 2012.

4.1.3.1 Remuneration committee of the council of governors

It is the role of the remuneration committee of the council of governors to make recommendations to the rest of the council on the remuneration levels and terms and conditions of service of the chairman and non-executive directors to ensure they are fairly rewarded for their contributions to the organisation. There is an annual review of the level of remuneration paid to the chairman and the non- executive directors and consideration is given to the recommendation within Monitor‟s code of governance to market test these remuneration levels at least every three years.

The remuneration committee of the council of governors is comprised of the Trust chairman (who chairs the committee) and at least seven governors, the majority of whom should be patient / public governors with at least one staff governor and one partner governor.

The committee met once in 2012/13 on 16 April 2012. It considered the wider context in relation to pay settlements elsewhere in the NHS and agreed that on the basis of this and the fact that a recent recruitment process to appoint two non-executive directors had provided an effective test of the market, it was not appropriate to undertake a detailed market test of non-executive remuneration. The last review was undertaken in 2008.

No salary increases were awarded to non-executive directors in 2012/13. This recommendation was approved by the council of governors at their meeting in May 2012. Further information about the salaries of non-executive directors is included in section 5 of this report. 4.1.3.2 Recruitment committee of the council of governors

The role of the recruitment committee is to make recommendations to the council of governors on the suitability of either the chairman or any non-executive directors wishing to undertake a second term of

office. When a non-executive director reaches the end of their current term, and if they are still eligible and wish to be reappointed, the committee may nominate the individual for reappointment without competition. This will follow a recommendation from the nominations committee of the board of directors and be subject to the committee taking into account the result of any review of the individual‟s performance during their term of office and the balance of skills required for the board.

Should the committee choose not to nominate an individual for re-appointment, appointment to the office of non-executive director should be by way of an open competition. A formal, rigorous and transparent procedure to identify and select a suitable candidate for nomination must be in place. The recruitment committee will consider a recommendation from the nominations committee of the board of directors in respect of both the use of external search consultants and the skills required for the board.

The committee will co-ordinate the recruitment process and put forward to the full council of governors their recommended candidate for appointment to the chairmanship or to the office of non-executive director.

When considering the appointment of non-executive directors the recruitment committee comprises of four governors, two public governors, one partner governor and one staff governor, and is chaired by the chair of the council of governors (Trust chairman). When considering the appointment of the Trust chairman the composition of the committee includes one non-executive director who chairs the committee on these occasions – this is currently the senior independent director. The chief executive and director of human resources and organisational development are invited to attend to provide advice to the committee.

The council of governors has the power to remove a non-executive director before their term of office comes to an end and any such action requires the approval of three-quarters of the members of the council of governors. Should any circumstances arise, the committee is responsible for investigating the grounds for any resolution to remove the chairman or non-executive director, and preparing a report on this issue with recommendations for the consideration of the council of governors.

There was no need to convene a meeting of the recruitment committee of the council of governors in 2012/13.

4.1.4 Register of interests for the council of governors

The register of interests of individual governors on the council of governors is available to the public on request in writing to the Foundation Trust Office, Sheffield Children‟s NHS Foundation Trust, Western Bank, Sheffield S10 2TH, or by e-mail to [email protected].

4.2 Our membership

The Trust is accountable to the population it serves and members of the public can be members of the Trust. Members share their views and influence the way in which the Trust runs and develops its services.

The Trust considers its membership to be a valuable asset, which helps guide its work and the decisions it makes, while also holding us to account and ensuring we adhere to NHS values. It provides one of the ways in which the Trust communicates with patients, the public and staff.

The Trust has three membership categories:

Patient and Carer – anyone over 14 and under 19 who has attended any of the Trust‟s facilities as a patient or carer* in the period of five years immediately preceding the date of application for membership (*provided that such person is not providing care in pursuance of a contract (including a contract of employment) or as a volunteer for a voluntary organisation.)

Public – residents over 14 years of age and living in the areas of the Trust specified as an area for public constituency (North West Sheffield, North East Sheffield, South West Sheffield, South East Sheffield, Barnsley, Doncaster, Rotherham and the rest of England and Wales, notwithstanding those that are individual members of one of the classes of the patients‟ and carers‟ constituency or staff constituency

Staff – employees whose contract means that they can work for the Trust for longer than 12 months. Staff employed by other organisations exercising functions on behalf of the Trust are also eligible to become members, such as university staff employed on an honorary contract.

Members are able to vote and stand for election to the council of governors.

4.2.1 Membership strategy

During the year the Trust recruited over 1,600 new members and we currently have almost 11,000 members.

The Trust‟s membership strategy is focused on recruiting and nurturing a membership where as many members as possible are actively engaged in the activities of the Trust; developing and retaining our members; and providing accurate and timely information to assist members in making informed choices.

Consistent with this is the need to ensure that our membership is current and a data cleansing exercise of our membership database was conducted during 2012/13, resulting in a loss of just over 1,300 members. Our overall membership figures therefore remain very similar to those for the previous year, despite a successful year of recruiting new members.

Our membership strategy also centres on delivering a membership that is fully representative of the diverse communities the Trust provides services to regardless of gender, race, disability, ethnicity, religion or any other groups covered under the Equality Act 2012. While our current membership does broadly reflect the local and regional populations we serve, there is focus on increasing membership with the newly extended constituency for the rest of England and Wales in support of the Trust‟s strategy of growing demand for our specialised services from outside South Yorkshire, Derbyshire and the Humber.

For this reason our programme for membership engagement drives in 2012/13 incorporated events across an extended geographic area. In conjunction with events held within our original catchment areas, this allowed governors to engage with local people and hear their views first hand. Some of these events involved specific groups, including minority ethnic groups and students as well as more general community events such as fun days for the local community. A similar programme of events is planned for 2013/14 and we will also continue to capitalise on the opportunities afforded by social media to increase the coverage of our engagement activities in as cost effective manner as possible.

All members are invited to our annual members‟ meeting (AMM).

The break-down of our membership between constituencies is as follows:

Number of CONSTITUENCY SUB CONSTITUENCY members at 31 March 2013 Patient Patients living outside Sheffield 374 membership Patients living in Sheffield 267 Carers of Patients 1,442 Sub-total 2,083 Public In Sheffield membership North East Sheffield 1,030 North West Sheffield 1,053 South East Sheffield 1,079 South West Sheffield 1,288 Out of Sheffield Barnsley 285 Doncaster 306 Rotherham 478 Rest of England & Wales 569 Sub-total 6,088 Staff Medical and Dental 397 membership Other Clinical 544 Nursing 720 Administrative, Ancillary and Management 894 Sub-total 2,555 Grand 10,726 total

4.2.2 Elections

Elections were held in August 2012 for the following constituencies:

Public Constituency of Sheffield North East (contested)

Public Constituency of Sheffield North West (contested)

Public Constituency of Sheffield South West (contested)

Public Constituency of Sheffield South East (uncontested)

Public constituency of Rotherham (contested)

Patient Constituency - Rest of England and Wales (contested)

Staff constituency of Nursing & Midwifery (uncontested)

Staff constituency of Non Clinical (contested)

Public Constituency of Sheffield South West (contested)

Patient/Carer Constituency - Sheffield Patients/Carers (contested)

Full details of the composition of the council of governors and of the election results are posted on our website at www.sheffieldchildrens.nhs.uk. All elections are held in accordance with the election rules

set out in our constitution. This has been confirmed by the returning officer for the elections held during 2012/13.

Members who want to contact their representative governor or a member of the board may do so through the Foundation Trust Office, Sheffield Children‟s NHS Foundation Trust, Western Bank, Sheffield S10 2TH, or by e-mail to [email protected].

4.3 Board of directors

The board of directors is the decision-making body for strategic direction and the overall allocation of resources. It is responsible for providing strategic leadership to the Trust and ensuring that the Trust exercises its functions effectively. It delegates decision making for the operational running of the Trust to the Trust executive group in accordance with the standing orders, reservation and delegation of powers and standing financial instructions. This group has representatives from the clinical and management sides of directorates and departments.

Non-executive directors and the chairman are appointed by the nominations committee of the council of governors initially for a period of three years and for no more than two terms of office (a total of six years). They can also be removed by the council of governors in accordance with our constitution. Executive directors, including the chief executive are appointed by the nominations committee of the board of directors on permanent contracts. The chief executive‟s appointment must be approved by the council of governors. The board nominations and remuneration committee is responsible for agreeing the removal of the chief executive.

4.3.1 Composition of the board of directors 2012/13

The board of directors is led by the chair and comprises of five other non-executive directors and six executive directors, including the chief executive.

Nicholas Jeffrey, Chairman

Nicholas Jeffrey was appointed chairman of the foundation trust on 1 September 2010. He has 30 years of board level experience, having worked for a range of organisations in the public, private, educational and voluntary sectors. He is also the chairman of both Robinson Healthcare Ltd, and FMG Support Ltd, and a non-executive director of Templeton Insurance. Nicholas chairs the council of governors and also chairs its remuneration committee and recruitment committee. He chairs the board nominations and remuneration committee of the board of directors. His first term of office expires at the end of August 2013.

Meredydd Hughes, Non-executive director

Meredydd retired as Chief Constable for South Yorkshire Police in 2011 after 32 years in the force, having worked his way from a bobby on the beat to one of the highest ranks. He was the Assistant Chief Constable for Greater Manchester Police from the late 1990s until 2002. He became Chief Constable for South Yorkshire in 2004 and brought a strong performance culture to Sheffield‟s police force.

Meredydd is a member of the clinical governance committee, finance and resources committee and the board nominations and remuneration committee. Appointed to the board in April 2012, Meredydd‟s first term of office runs until 31 March 2015.

Sarah Jones, Non-executive director

Sarah is chief executive of learndirect which is a government funded organisation delivering skills training to over 250,000 adults across the UK each year. She is the principal accounting officer

responsible for the governance of the organisation and the distribution of public funds. Prior to learndirect, Sarah worked across BAE SYSTEMS for 15 years in various management roles.

Sarah joined the board in August 2008 and chairs the risk and audit committee. She is also a member of the finance and resources committee and the board nominations and remuneration. In May 2011 Sarah was reappointed for a second term of office which runs until 31 March 2014.

Neil MacDonald, Non-executive director

Neil has had an extremely successful career as a finance expert, starting out at engineering firm Firth Rixson, where, as Group Finance Director during the business‟ restructuring in the 1990s he was a key part of its transformation from a small company into one of the region's most successful businesses. Neil is a non-executive director at AES Engineering in Rotherham, and is involved with a number of other Sheffield based organisations, including being vice chair of the board of the Sheffield Theatres Trust and a non-executive director of St Luke‟s Hospice. Neil currently holds the position of Master Cutler.

Neil is a member of the clinical governance committee, risk and audit committee and the board nominations and remuneration committee. Appointed to the board in April 2012, Neil‟s first term of office runs until 31 March 2015.

Gareth Watkins, Non-executive director

Gareth is a part-time senior consultant for solicitors Nabarro. He was head of its Sheffield litigation practice for ten years and also served as an executive director on the Partnership Board. He has written extensively on health and safety and was formerly a deputy district judge. He also previously chaired a board of school governors and is currently president of his local community club.

Gareth chairs the clinical governance committee and is a member of the risk and audit committee and board nominations and remuneration committee. He is also our non-executive director with responsibility for mental health appeals. Gareth joined the board in November 2007 and was reappointed in 2010 for a second term to run until 31 October 2013.

In May 2012 the council of governors approved his appointment as the senior independent director of the Trust and part of his role is to lead the chairman‟s appraisal. He is also a funnel for staff, governors or members who want to raise concerns which have not been appropriately resolved through other channels such as the chairman or chief executive.

David Williams, Non-executive director

Until June 2008, David was chief executive of SIG Plc, a listed company with its headquarters in Sheffield. It has over 12,000 employees in ten countries and annual sales in excess of £2.5 billion. Before joining SIG in 1983, David gained a wide business experience both in the UK and overseas, chiefly in metal processing industries.

David chairs the finance and resources committee and is a member of board nominations and remuneration committee. David joined the board in November 2007 and was reappointed in 2010 for a second term to run until 31 October 2013. In May 2012 the council of governors approved his appointment as the deputy chair of the board of directors.

Derek Burke, Medical director

Derek is a consultant in the Emergency Department for much of his time. He took on the role of Medical Director within the Trust in 2007, and builds on his previous experience as medical director from 1998 to 2001. He is responsible for medical activity within the Trust and in particular the training and development of medical staff. Derek is central to the Trust‟s lead role for paediatric training in the area.

Isabel Hemmings, Chief operating officer

Isabel joined the Trust at the end of 2002 and is responsible for the strategic development of services and performance management and has a lead role in relation to the Trust‟s partnerships with other

organisations. She has worked in the NHS for 25 years, 15 of which have been in the management of children‟s health care. She has wide ranging experience in managing community and mental health services along with acute hospital services. Isabel has a masters degree in Health Services Management from Leeds Nuffield Centre and is a member of the Institute of Health Care Managers.

Jeremy Loeb, Chief finance officer

Jeremy was appointed as director of finance in 2007. He is a chartered accountant and has worked in both the public and private sector. He has worked in a variety of roles in the NHS including project managing the introduction of clinically relevant financial systems at the Radcliffe Infirmary, Oxford and Freeman Hospital, Newcastle. As director of finance at Barnsley Hospital, he led the financial aspects of its successful application for foundation trust status with the first wave of applicants. He is responsible for finance, IT, information, supplies and estates management.

Simon Morritt, Chief executive

Simon was appointed as chief executive in June 2011 bringing with him many years of experience. He has a degree in politics from Leicester University and an MBA from Liverpool John Moores University. He joined the NHS in September 1989 as a general management trainee in Greater Manchester. Simon has held posts in Manchester, Wakefield and Doncaster, where he joined the health authority in 1998. He became chief executive of Doncaster Central Primary Care Trust in October 2000 and in October 2004 became director of performance at West Yorkshire Strategic Health Authority. In October 2006 he was appointed chief executive of Bradford and Airedale Teaching Primary Care Trust (now NHS Bradford and Airedale).

Steven Ned, Director of human resources and organisational development.

Steven has worked in the NHS in South Yorkshire and Derbyshire for more than 20 years and joined us in August 2008 from Sheffield Teaching Hospitals NHS Foundation Trust. He has been working in the foundation trust system since taking Barnsley through its application as human resources director. He is responsible for all aspects of human resources, learning and development and library service functions within the Trust.

John Reid, Director of nursing and clinical operations

John was appointed to the Trust in May 2005, following a year on secondment in the same post. He has 25 years‟ experience of the NHS, first as a practising children's nurse and then in operational management. He has also worked in New Zealand and the Middle East. He is responsible for providing leadership for nursing staff in the Trust and also has executive responsibility for clinical governance, infection control, risk management and child protection. 4.3.1.1 Changes of board membership during the year

There have been no in-year changes to the membership of the board of directors during 2012/13. The most recent appointments to the board were of Meredydd Hughes and Neil MacDonald who both commenced their first terms of office on 1 April 2012.

In order to attract executive directors of sufficient calibre, their contracts are permanent with appropriate notice periods in line with employment law rather than fixed term. This is consistent with similar contracts in the marketplace. Planned and progressive refreshing of the board of directors is achieved through turnover of non-executive directors as terms expire, and natural turnover of executive directors in the progression of their careers. 4.3.1.2 Statement on the balance, completeness and appropriateness of the membership of the board

At the end of the year an assessment was made by the board nominations and remuneration committee of the composition of the board in the context of current and anticipated issues and challenges impacting the Trust. This was undertaken as part of the process of considering forthcoming non-executive director appointments. As outlined within the above biographies of board members, the board comprises individuals with senior level experience in the public and private sectors, across a

range of disciplines including finance, governance, risk management, human resources and change management. The board is satisfied that its current membership allows it to function effectively and that it is balanced, complete and appropriate. 4.3.1.3 Appointment and removal of board members

The arrangements for the appointment and removal of non-executive directors are set out in section 4.1.3.2 and those for appointing and removing directors in section 4.3.4.2.

4.3.2 Board members‟ other commitments and register of interests

Taking into account the NHS foundation trust code of governance published by Monitor, the board considers the chairman and all the non-executive directors to be „independent‟, with no interests that might conflict with their ability to carry out their management responsibilities. The register of interests of individual directors is available to the public on request in writing to the Foundation Trust Office, Sheffield Children‟s NHS Foundation Trust, Western Bank, Sheffield S10 2TH, or by e-mail to [email protected].

The Trust chairman, Nick Jeffrey is also chairman of both Robinson Healthcare Ltd and FMG Support Ltd and is a non-executive director of Templeton Insurance. There have been no significant changes to the chairman‟s commitments during the year.

4.3.3 Performance of the board of directors 2012/13

In light of a drive to become more efficient and effective as we mature as a foundation trust, the Trust chairman commissioned the foundation trust secretary and senior independent director to conduct an internal review of the current committee meeting structure. This put forward proposals for a reformed Board committee structure that came into effect at the start of 2012/13. This restructure was centred on the need to give an increased focus to financial risk and planning and provide for greater alignment between board committees to ensure the Trust could effectively respond to future challenges

At the end of 2012/13, following 12 months of operating under this revised committee structure, each individual board committee has reviewed its effectiveness against its own terms of reference and revised these as necessary. In line with reporting lines between committees, the risk and audit committee has reviewed the terms of reference of aligned board committees, ie the finance and resources committee and the clinical governance committee and made suggestions for further improving alignment between committees.

Other events that have prompted specific review during this year include the need to consider the composition and balance of the board in respect of the reappointment of the Trust chairman and two non-executive directors. Following changes made in advance of the implementation of the first commencement orders of the health and social care act 2012, the board has also evaluated the effectiveness of arrangements for the holding of Trust board meetings and the output of this review was presented to the March 2013 Board meeting. The chairman also makes provision for the non- executive directors to meet, where necessary, and discuss, among other matters, the way the board is working.

Performance evaluation of the directors is carried out through the annual appraisal system. The chief executive appraises each executive director while the chairman holds appraisals with each non- executive director and the chief executive. The senior independent director leads the chairman‟s appraisal. The views of executive board members are canvassed through the chief executive and those of other non-executive board members through the foundation trust secretary. Governors are invited to contribute their views through the lead governor.

4.3.4 Committees of the board

As referenced in the above section a comprehensive review of board governance arrangements was undertaken at the end of 2011/12. This put forward proposals to restructure the Trust‟s eight board committees into a smaller number of refocused committees which was implemented in April 2012. This new board committee structure has given an increased focus to financial risk and planning and provided for greater alignment between board committees to ensure the Trust could effectively respond to future challenges.

The four committees of the board of directors include the statutory committees of risk and audit and board nominations and remuneration and also include the clinical governance committee and the finance and resources committee.

Performance evaluation of the committees is carried out through the review of the terms of reference and the reporting arrangements of each committee to the board of directors. 4.3.4.1 Risk and audit committee

Membership of the risk and audit committee is comprised of three independent non-executive directors. One of these non-executive members of the committee has recent and relevant financial experience.

The risk and audit committee provides the board of directors with an independent and objective review of the system of internal control and overall assurance process associated with managing risk. It receives assurance from the executive risk management committee on all serious untoward incidents and routine and exception based reports from aligned board committees including the clinical governance committee and finance and resources committee to allow it to discharge its responsibility for providing assurance to the Trust board in relation to all aspects of governance, risk management and internal control. These assurances and this oversight form the basis for the chief executive‟s annual governance statement.

The committee is responsible for commissioning and reviewing work from independent external and internal audit services, counter fraud services and other bodies as required. The committee‟s work in undertaking these responsibilities is outlined in an annual report to the board.

Other key elements of the committee‟s work include reviewing the board assurance framework prior to presentation to the board of directors. The committee is also responsible for reviewing the annual financial statements, with particular focus given to major areas of judgement and changes in accounting policies, the basis of the board‟s determination that the Trust remains a going concern, and the annual governance statement. In addition to its own annual self-evaluation, the committee reviews the performance of internal audit, external audit and the local counter fraud specialist each year.

The committee‟s meetings are attended, in accordance with the agenda, by the internal and external auditors, the local counter fraud specialist, the chief finance officer, the director of nursing and clinical operations and the head of risk management. Other directors and senior managers attend when invited by the committee. The chief executive and the Trust chairman are invited to attend the meeting at which the annual accounts are presented. The foundation trust secretary is the committee secretary.

The risk and audit committee is responsible for making recommendations to the council of governors in relation to the appointment, re-appointment and removal of the external auditor. The NHS foundation trust code of governance published by Monitor states that governors should take the lead in agreeing with the committee the criteria for appointing, reappointing and removing auditors. In line with this code provision the Trust established a joint auditor appointment panel which comprised of governors and non-executive members of the risk and audit committee to oversee the formal selection process for the appointment of the Trust‟s external auditors. This working group met for a fixed term during 2012/13 and following a robust appointment process put forward KPMG as the preferred supplier for the Trust‟s external audit services for ratification at an extraordinary meeting of the council held on 09 October 2012.

KPMG provides its services within Monitor‟s audit code for NHS foundation trusts. The audit committee has delegated authority to commission additional investigative and advisory services outside this code. Where service would fall outside this code, the committee is advised of the objectives of the work to ensure integrity, independence and objectivity of the auditors. No such additional work was commissioned in 2012/13.

The Trust‟s internal audit service has been provided by Assure, a consortium principally serving a number of foundation and primary care trusts in the geographic area. The internal audit plan for 2012/13 was approved by the risk and audit committee on 22 May 2012.

Local counter fraud provision is commissioned from Assure and the annual counter fraud work plan is agreed between the local counter fraud specialist (LCFS) and the chief finance officer and overseen by the risk and audit committee on behalf of the board. Progress against identified areas for improvement is being monitored by the risk and audit committee.

The chief executive as the accounting officer is responsible for the preparation of the financial statements prior to them being audited by the external auditors. These responsibilities are detailed within the statement of accounting officer‟s responsibilities on page 102 and in the independent auditor‟s report. 4.3.4.2 Board nominations and remuneration committee

The board nominations and remuneration committee makes recommendations to the council of governors on the appointment and remuneration of the chairman and non-executive directors. It also oversees the process for the nomination of the chief executive for approval by the board, and ratification by the council of governors, and the process for the appointment of other executive directors.

It decides the pay and allowances, and other terms and conditions, of the executive directors. The committee is chaired by the Trust‟s chairman and comprises all non-executive directors. The committee‟s decisions in respect of executive director remuneration are informed by benchmarking information derived from published reward research, such as the IDS NHS Boardroom Pay Report, and surveys of other Trusts‟ remuneration for similar posts. This information is provided by the director of human resources and organisational development who is in attendance at the meeting. The chief executive is also in attendance to provide the committee with a report on the performance of the executive directors. Both the chief executive and the director of human resources and organisational development withdraw at the point where their remuneration is to be discussed.

The committee is chaired by the Trust‟s chairman. In respect of the re-appointment of the chairman or and individual non-executive director the individual would withdraw at the point where their reappointment is being considered. The committee secretary is the foundation trust secretary.

The committee met once during the year on 26 March 2013. It considered the balance, completeness and appropriateness of the skills of the directors against the requirements of the foundation trust. A decision was made to recommend to the recruitment committee of the council of governors that non- executive directors David Williams and Gareth Watkins whose terms of office both expire on 30 September 2013 be re-appointed to the board of directors for a further one-year period and that Nick Jeffrey be re-appointed as Trust chairman for a second three-year term of office from 1 September 2013).

Decisions were also made by the committee in respect of the remuneration of executive directors. The manner of making these decisions was in accordance with the committee‟s terms of reference and delegated powers.

The remuneration report is presented in section 9. 4.3.4.3 Other board committees

The board has also established the following further committees of the board, each of which is chaired by a non-executive director.

The clinical governance committee has been established to enable the board of directors to obtain assurance that high standards of care are provided by the Trust and, in particular, that adequate and appropriate clinical governance structures, processes and controls are in place throughout the Trust to promote safety and excellence in patient care and ensure the effective and efficient use of resources through evidence-based clinical practice

The finance and resources committee has been established to provide the board of directors with in-year assurance concerning the development and delivery of the Trust‟s annual business plan and to undertake a strategic advisory role in ensuring that the Trust develops long-term strategy and financial plans that address all identified business risks and opportunities and support the provision of care and services and getting best value for money and use of resources.

Attendance by directors at Trust board and board committee meetings

The following table outlines board members‟ attendance at board and committee meetings during 2012/13 against the total possible number of meetings for which an individual was a member. Committee attendance is shown in relation to those committees of which a director was formally a member (and in the case of the risk and audit committee, routinely attends).

Board of Clinical Finance & Nominations & Risk & Audit Name Directors Governance Resources Remuneration (7 meetings) (11 meetings) (6 meetings) (12 meetings) (1 meeting)

Nicholas Jeffrey, Chair 9 (1 of 1)# 1

Derek Burke, Medical 10 6 director Isabel Hemmings, Chief 10 11 operating officer Meredydd Hughes, Non- 9 5 8 1 executive director Sarah Jones, Non- 9 7 7 1 executive director Jeremy Loeb, Chief 10 7 12 finance officer Neil MacDonald, Non- 7* 6 2 0 executive director

Simon Morritt, Chief # 11 (1 of 1) 8 executive Steven Ned, Director of 10* 9 HR & OD

John Reid, Director of nursing & clinical 11 7 5 operations David Williams, Non- 11 4 9 1 executive director

Gareth Watkins, Non- 10 5 5 0 executive director

* Neil MacDonald attended the private session of the March 2013 Trust board but not the meeting held in public * Steven Ned attended the private session of the December 2012 Trust board but not the meeting held in public # The chairman and chief executive attend the meeting of risk and audit committee at which the annual accounts are discussed

4.4 Statement of compliance with the code of governance

The board of directors and the membership council are committed to the principles of good corporate governance as detailed in the code of governance. The code of governance was published in September 2006 and a revised version of the code came into effect from 1 April 2010.

The Trust complies with the provisions of Monitor‟s code of governance with the following exceptions

Provision A3.2 states that “At least half the board, excluding the Chairman, should comprise Non- executive Directors determined by the board to be independent.”

Explanation: The board of directors consists of six executive directors including the chief executive and six non-executive directors including the chairman. When the chairman is absent, the board of directors is chaired by another non-executive director. Paragraph 3.11 of the standing orders ensures that where a vote is taken at a board of directors meeting, the chairman of the meeting has a second, casting vote. This ensures that the non-executive members of the board can outnumber the executive members when a vote is required.

Provision E2.3 states that “the board of governors is responsible for setting the remuneration of non- executive directors and the chairman. The board of governors should consult external professional advisers to market-test the remuneration levels of the chairman and other non-executives at least once every three years and when they intend to make a material change to the remuneration of a non- executive.”

Explanation: At the meeting of the remuneration committee of the council of governors on 16 April 2012 members considered the need to undertake a detailed market test of non-executive remuneration which had last been undertaken in 2008. It was considered that success of the recent recruitment process to appoint two new non-executive directors had been an effective test of the market and that this, and reference to the wider economic economic climate, and in particular the current two-year pay freeze, did not warrant a detailed market test of non-executive remuneration. It was agreed that this explanation should be recorded as the rationale for not complying with Monitor‟s Code of Governance.

4.5 Other declarations/disclosures

Counter fraud

Throughout 2012/13, the board has remained committed to maintaining an honest and open atmosphere, ensuring that all concerns involving potential fraud have been identified and rigorously investigated. In all cases appropriate civil, disciplinary and or criminal sanctions have been applied, where guilt has been proven.

The Trust‟s local counter fraud specialist has continued to act as a conduit in creating an anti-fraud culture, which has enabled maximum deterrence and prevention measures to be embedded in the organisation.

Maintaining fraud levels at an absolute minimum ensures that more funds are available for patient care and services.

Fraud against the NHS is never acceptable and any concerns may be reported via the Fraud and Corruption Hotline on 0800 028 4060.

Serious Incidents involving data loss or confidentiality breach

The Trust takes its responsibility to keep personal data safe very seriously. New staff receive information governance training during induction in their first week at the Trust and it is mandated that all staff undertake information governance training annually. The Trust is required to annually certify against the Trust‟s compliance with NHS information governance standards.

There have been no serious incidents related to loss of data during 2012/13. To maintain this performance the Trust will continue to monitor and assess its information risks in order to identify and address any weaknesses and ensure continuous improvement of its systems.

The table below contains details of other reported personal data related incidents as categorised by the Department of Health.

Summary of personal data related incidents in 2012/13

Category Nature of incident Total Loss of inadequately protected electronic equipment, devices or paper I 0 documents from secured NHS premises Loss of inadequately protected electronic equipment, devices or paper II 1 documents from outside secured NHS premises. Insecure disposal of inadequately III protected electronic equipment, 1 devices or paper documents. IV Unauthorised disclosure 24

V Other 22

Going concern

In preparing this Annual Report and Accounts, the directors believe we have supplied all relevant audit information to the auditors and we have taken all necessary steps to make ourselves aware of such information and to ensure that this is so. After making enquiries, the directors have a reasonable expectation that the Trust has adequate resources to continue in operational existence for the foreseeable future. For this reason, they continue to adopt the going concern basis in preparing the accounts.

Current remuneration and pensions

Financial Year Cash Equivalent Transfer Value 1 April 12 - 31 March 13 Real increase in at at Other Real increase in lump sum at age Pension lump sum at age 60 Salary remuneration pension at age 60 60 at 31 March 2013 31-Mar-13 31-Mar-12 Real increase Current Remuneration and Pensions (bands of £5,000) (bands of £2,500) (bands of £5,000) Name Title £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 Simon Morritt Chief Executive 145 - 150 0 - 2.5 5 - 7.5 120-125 684 603 50 Isabel Hemmings Chief Operating Officer 100 - 105 - 0 - 2.5 0 - 2.5 95-100 616 565 21 Jeremy Loeb Chief Finance Officer 100 - 105 - 0 - 2.5 0 - 2.5 120-125 905 826 36 Derek Burke Medical Director 95 - 100 * 35 - 40 0 - 2.5 0 - 2.5 160-165 1099 992 55 Director of Clinical Operations John Reid and Nursing 90 - 95 - 0 - 2.5 0 - 2.5 110-115 789 720 32 Director of Human Resources and Organisational Steven Ned Development 90 - 95 - 0 - 2.5 2.5 - 5 90-95 498 457 18 Nicholas Jeffrey Chairman 45 - 50 ------Sarah Jones Non-executive Director 10 - 15 ------Neil MacDonald * Non-executive Director 10 - 15 ------Meredydd Hughes * Non-executive Director 10 - 15 ------Gareth Watkins Non-executive Director 10 - 15 ------David Williams Non-executive Director 10 - 15 ------

Band of Highest Paid Director's Total Remuneration (£'000) 145-150 Median Total 27,625 Remuneration Ratio 5.3

No directors received benefits in kind and the Foundation Trust has made no contributions to stakeholder pensions *Neil MacDonald and Meredydd Hughes - start date 1/4/2012 * Medical Directors salary split via different method to previous year. No change in overall cost.

Financial Year Cash Equivalent Transfer Value 1 April 11 - 31 March 12 Real increase in at at Other Real increase in lump sum at age Pension lump sum at age 60 Salary remuneration pension at age 60 60 at 31 March 2012 31-Mar-12 31-Mar-11 Real increase Current Remuneration and Pensions (bands of £5,000) (bands of £2,500) (bands of £5,000) Name Title £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 Christopher Sharratt* Chief Executive 10-15 - Simon Morritt** Chief Executive 115 - 120 2.5-5.0 7.5-10.0 110-115 603 470 84 Isabel Hemmings Chief Operating Officer 100 - 105 - 0 - 2.5 0 - 2.5 90-95 565 509 30 Jeremy Loeb Chief Finance Officer 100 - 105 - 0 - 2.5 2.5 - 5 115-120 826 757 35 Derek Burke Medical Director 85 - 90 50 - 55 0 - 2.5 0 - 2.5 150-155 992 898 50 Director of Clinical Operations John Reid and Nursing 90 - 95 - 0 - 2.5 2.5 - 5 100-105 720 650 37 Director of Human Resources and Organisational Steven Ned Development 90 - 95 - 0 - 2.5 0 - 2.5 85-90 457 374 51 Nicholas Jeffrey Chairman 45 - 50 ------Sarah Jones Non-executive Director 10 - 15 ------Peter Lamberton*** Non-executive Director 10 - 15 ------John Turner*** Non-executive Director 10 - 15 ------Gareth Watkins Non-executive Director 10 - 15 ------David Williams Non-executive Director 10 - 15 ------

Band of Highest Paid Director's Total Remuneration (£'000) 145-150 Median Total 27,625 Remuneration Ratio 5.3

No directors received benefits in kind and the Foundation Trust has made no contributions to stakeholder pensions

* C Sharratt retired 31st March 2011. Continued in his executive capacity until 13/06/2011. ** S Morritt- Start Date- 13/06/2011 *** J Turner & P Lamberton- End of term of office-31/03/2012

The banded remuneration of the highest-paid director in Sheffield Children‟s NHS FT in the financial year 2012-13 was £148k (2011-12, £148k). This was 5.3 times (2011-12, 5.3) the median remuneration of the workforce, which was £27,625 (2011-12, £27,625).

In 2012-13, 6 (2011-12, 4) employees received remuneration in excess of the highest-paid director. Remuneration ranged from £152k-£169k (2011-12, £150k-£167k).

Remuneration of staff in excess of the highest paid director, relates to medical consultants who are in receipt of national clinical excellence awards, which are in addition to their basic salaries but contractual.

Total remuneration includes salary, non-consolidated performance-related pay, benefits-in-kind as well as severance payments. It does not include employer pension contributions, employer national insurance contributions and the cash equivalent transfer value of pensions.

During 2012/13, the Trust has not entered into any 'off-payroll engagements' in relation to members of staff or directors, as set out by reporting requirements published by HM Treasury in PES(2012)17

The median salary of employees in the Trust has been calculated using a payroll download which shows all the staff on the Trust‟s payroll with the pay scale and point they were on at the end of the financial year. From this a basic salary on a full-time basis has been obtained. This does not include any additional hours, enhancements or other payments which a percentage of staff members receive.

In order to include staff recharged in from other Trusts and agency staff in the calculation, we have calculated an average cost per staff type minus any agency fees and on costs, and consequently the number of WTE‟s this amounts to.

The payroll download plus the staff recharges in and agency staff, not paid via payroll have then been sorted in ascending order of basic salary on a full time basis. The median salary is represented by the employee who falls exactly half way in whole time equivalent terms (WTE) in this list. In 2012-13 the total WTE from this exercise amounts to 2,326 WTE and so the employee who appears in the list at the position of 1,163 WTE was taken as the median salary.

6. Finance report

6.1 Overview of performance

Sheffield Children‟s NHS Foundation Trust‟s financial surplus for the year was £2.24 million above plan. This favourable performance was due to three main factors:

approximately £1 million of income in excess of plan;

an underspend against the reserve for the additional costs of the hospital development of £1 million;

the balance due to charitable donations exceeding plan.

Performance in 2012/13, while strong, produced a lower surplus than in 2011/12. This illustrates the impact of the reduced level of commissioner funding of inflationary cost pressures over the last few years. A significant proportion of the surplus is related to a short-term benefit associated with reserves for the new development. These will be fully committed by 2015/16.

The surplus enabled the Trust to maintain a positive financial risk rating throughout the year and end the year with a risk rating of four (where one is the worst and five is the best).

6.2 Financial performance indicators

Monitor‟s compliance framework uses five key financial performance indicators, each with a maximum score of five and a minimum score of one. The overall score for the year was four and confirms a good financial performance for 2012/13.

While the overall rating is unchanged from last year the individual indicators show deterioration from last year with the exception of liquidity. Fig: Financial performance indicators

Metric Weightin 2012/13 2011/12 g % Ratio Rating % Ratio Rating EBITDA Margin 25% 6.2 3 8.1 3 EBITDA % achieved against plan 10% 124.4 5 177.1 5 Return on Assets 20% 4.2 5 10 5 I&E surplus margin 20% 2.8 4 4.3 5 Liquidity ratio (days) 25% 62.7 5 53.6 4 days days Weighted average rating 4 4.3

6.2.1 EBITDA margin

Earnings before interest, taxation, depreciation and amortisation (EBITDA) shows the financial performance of the Trust before financing costs are considered.

6.2.2 EBITDA percentage achieved against plan

This compares the Trust‟s actual performance for the year against that planned at the start of the year and shows performance was higher than plan. This was due to higher than planned levels of clinical income, donated asset income and an underspend against the reserve for the additional costs of the hospital development. From 2015/16 the Trust will incur additional revenue costs of £3 million in respect of this development. This level of increased funding is being made available from internal efficiency savings over a number of years. A reserve has been created which is being used to meet non-recurrent expenditure requirements prior to the opening of the new ward / outpatient block.

6.2.3 Return on assets

This shows how efficiently the Trust‟s buildings, plant and machinery and medical equipment are used. As with many hospitals like Sheffield Children‟s which have old buildings, the Trust generates a high level of net income in proportion to the value of the estate.

6.2.4 Income and expenditure surplus margin

This shows the overall surplus after accounting for financing costs including depreciation, bank interest and public dividend interest which is a charge to the Department of Health for the use of public assets.

6.2.5 Liquidity ratio

This indicates how cash balances and our working capital facility relate to the day to day requirements for running the Trust. A high rating indicates that the Trust is in a strong position to meet expenditure commitments as they fall due.

The improved position over 2011/12 is largely due to short term phasing of capital expenditure with some planned in-year expenditure deferred until 2013/14.

6.3 Income and expenditure

6.3.1 Income

The following table shows our sources of funding. 82 per cent of the Trust‟s total income is provided by primary care trusts in payment for the health care services we provide.

Fig: Trust income 2012/13 by source of funding

Operating income by type 2012/13 % of total £000 income Income from activities Primary Care Trusts 126,541 82.2% Strategic Health Authorities 1,579 1.0% Local Authorities 592 0.4% NHS Foundation Trusts 296 0.2% NHS Trusts 14 0.0% Non-NHS: Private patients (186) -0.1% Non-NHS: Overseas patients (non-reciprocal) 59 0.0% NHS injury scheme 92 0.1% Non-NHS: Other 145 0.1% Total income from activities 129,132

Other operating income Research and development 1,735 1.1% Education and training 7,238 4.7% Charitable and other contributions to expenditure 776 0.5% Non-patient care services to other bodies 3,014 2.0% Income in respect of staff costs 6,915 4.5% Reversal of impairments on property, plant and equipment 9 0.0% Rental revenue from operating leases 91 0.1% Gain on disposal of assets held for sale 8 0.0% Other income 4,989 3.2% Total other operating income 24,775

Total operating income 153,907

6.3.2 Expenditure

Our staff are key to delivering high quality care and 72 per cent of our expenditure is on staff, with a further seven per cent being spent on clinical supplies and services, four per cent on drugs and three per cent on depreciation, amortisation and impairments.

Fig: Trust expenditure 2012/13 breakdown

Sum of % of total Expenditure £000 expenditure Employee expenses 106,953 72% Supplies and services - clinical (excluding drug costs) 11,051 7% Establishment & premises 8,550 6% Depreciation, Amortisation & Impairments 4,866 3% Drug costs 5,865 4% Supplies and services – general 1,629 1% Clinical Negligence 1,510 1% Other 8,017 5% Grand Total 148,441

6.4 Management commentary on financial performance

Although exceeding our planned financial surplus in 2012/13, in the presence of ever increasing economic pressures and our ambitious strategy to develop the range and quality of our services this strong result will not protect us from the need to identify savings for the future. While providing specific contingency to tackle a substantial need to invest in our infrastructure, our end of year performance does not lessen the need to deliver against our transformation programme to generate longer-term and sustainable savings in the future, as well as the need to look to create opportunities to bring in new income.

6.5 Financial outlook for 2013/14

Our financial strategy going forward is set against a context of an ever challenging financial environment for the economy as a whole and the NHS in particular. We are aspiring to deliver ambitious service developments and investment in our infrastructure and the need to deliver efficiency savings to support these planned developments will exert significant financial pressure on the Trust.

Key financial risks that the Trust will seek to manage over the next three years include:

the delivery of the Trust‟s efficiency savings programme and QIPP requirements;

the financial consequence of changes in commissioning arrangements associated with the government‟s changes to the health service;

additional costs of providing both staffing and infrastructure to support additional activity as well as maintaining clinical quality standards;

the loss of educational income associated with the introduction of national tariffs for teaching; and

the Trust is likely to continue to face real term reduction in its income for like for like services over the next three years and this has been taken into account in the Trust‟s long term financial model for the hospital redevelopment.

Independent auditors‟ report to the council of governors and board of directors of Sheffield Children‟s NHS Foundation Trust

We have audited the financial statements of Sheffield Children's NHS Foundation Trust for the year ended 31 March 2013 which comprise the Statement of Comprehensive Income, Statement of Financial Position, Statement of Changes in Taxpayers' Equity, Statement of Cash Flows and Notes to the Accounts. These financial statements have been prepared under applicable law and the NHS Foundation Trust Annual Reporting Manual 2012/13.

This report is made solely to the Council of Governors of Sheffield Children's NHS Foundation Trust in accordance with Schedule 10 of the National Health Service Act 2006. Our audit work has been undertaken so that we might state to the Council of Governors of the Trust, as a body, those matters we are required to state to them in an auditor's report and for no other purpose. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the Council of Governors of the Trust, as a body, for our audit work, for this report or for the opinions we have formed.

Respective responsibilities of the accounting officer and the auditor

As described more fully in the Statement of Accounting Officer's Responsibilities the accounting officer is responsible for the preparation of financial statements which give a true and fair view. Our responsibility is to audit, and express an opinion on, the financial statements in accordance with applicable law and International Standards on Auditing (UK and Ireland). Those standards require us to comply with the Auditing Practice's Board's Ethical Standards for Auditors.

Scope of the audit of the financial statements

An audit involves obtaining evidence about the amounts and disclosures in the financial statements sufficient to give reasonable assurance that the financial statements are free from-material misstatement, whether caused by fraud or error. This includes an assessment of whether the accounting policies are appropriate to the Trust's circumstances and have been consistently applied and adequately disclosed, the reasonableness of significant accounting estimates made by the accounting officer and the overall presentation of the financial statements. In addition we read all the financial and non-financial information in the annual report to identify material inconsistencies with the audited financial statements. If we become aware of any apparent material misstatements or inconsistencies we consider the implications for our report.

Opinion on financial statements

In our opinion the financial statements:

• give a true and fair view of the state of Sheffield Children's NHS Foundation Trust's affairs as at 31 March 2013 and of its income and expenditure for the year then ended; and

• have been prepared in accordance with the NHS Foundation Trust Annual Reporting Manual 2012/13.

Opinion on other matters prescribed by the Audit Code for NHS Foundation Trusts

In our opinion the information given in the Directors' Report for the financial year for which the financial statements are prepared is consistent with the financial statements.

Matters on which we are required to report by exception

We have nothing to report where under the Audit Code for NHS Foundation Trusts we are required to report to you if, in our opinion, the Annual Governance Statement does not reflect the disclosure requirements set out in the NHS Foundation Trust Annual Reporting Manual, is misleading or is not consistent with our knowledge of the Trust and other information of which we are aware from our audit of the financial statements.

We are not required to assess, nor have we assessed, whether all risks and controls have been addressed by the Annual Governance Statement or that risks are satisfactorily addressed by internal controls.

Certificate

We certify that we have completed the audit of the accounts of Sheffield Children's NHS Foundation Trust in accordance with the requirements of Chapter 5 of Part 2 of the National Health Service Act 2006 and the Audit Code for NHS Foundation Trusts issued by Monitor.

Timothy Cutler for and on behalf of KPMG LLP, Statutory Auditor Chartered Accountants St James' Square Manchester M26DS

28 May 2013

Independent auditor‟s report to the council of governors of Sheffield Children‟s NHS Children‟s Foundation Trust on the quality report

We have been engaged by the Board of Governors of Sheffield Children's NHS Foundation Trust to perform an independent assurance engagement in respect of Sheffield Children's NHS Foundation Trust‟s Quality Report for the year ended 31 March 2013 (the “Quality Report”) and certain performance indicators contained therein.

Scope and subject matter

The indicators for the year ended 31 March 2013 subject to limited assurance consist of the national priority indicators as mandated by Monitor:

Number of Clostridium difficile infections

Maximum waiting time of 62 days from urgent GP referral to first treatment for all cancers

We refer to these national priority indicators collectively as the “indicators”.

Respective responsibilities of the Directors and auditors

The Directors are responsible for the content and the preparation of the Quality Report in accordance with the criteria set out in the NHS Foundation Trust Annual Reporting Manual issued by Monitor.

Our responsibility is to form a conclusion, based on limited assurance procedures, on whether anything has come to our attention that causes us to believe that:

the Quality Report is not prepared in all material respects in line with the criteria set out in the NHSFoundation Trust Annual Reporting Manual;

the Quality Report is not consistent in all material respects with the sources specified; and

the indicators in the Quality Report identified as having been the subject of limited assurance in the Quality Report are not reasonably stated in all material respects in accordance with the NHS Foundation Trust Annual Reporting Manual and the six dimensions of data quality set out in the Detailed Guidance for External Assurance on Quality Reports.

We read the Quality Report and consider whether it addresses the content requirements of the NHS Foundation Trust Annual Reporting Manual, and consider the implications for our report if we become aware of any material omissions.

We read the other information contained in the Quality Report and consider whether it is materially inconsistent with [either refer back to the specified documents in the guidance, or list those documents below:

Board minutes for the period April 2012 to May 2013;

Papers relating to Quality reported to the Board over the period April 2012 to April 2013;

Feedback from the Commissioners dated 2 May 2013;

Feedback from local Healthwatch organisations dated 7 May 2013;

The Trust‟s complaints report published under regulation 18 of the Local Authority Social Services and NHS Complaints Regulations 2009, dated April 2013;

The latest national patient survey dated 2012;

The latest national staff survey dated 2012;

Care Quality Commission quality and risk profiles dated 31 March 2013;

The Head of Internal Audit‟s annual opinion over the Trust‟s control environment dated 25 April 2013;

Feedback from Overview and Scrutiny Committee dated 17 April 2013; and

Feedback from Governors dated 7 May 2013.

We consider the implications for our report if we become aware of any apparent misstatements or material inconsistencies with those documents (collectively, the “documents”). Our responsibilities do not extend to any other information.

We are in compliance with the applicable independence and competency requirements of the Institute of Chartered Accountants in England and Wales (ICAEW) Code of Ethics. Our team comprised assurance practitioners and relevant subject matter experts.

This report, including the conclusion, has been prepared solely for the Council of Governors of Sheffield Children's NHS Foundation Trust as a body to assist the Council of Governors in reporting Sheffield Children's NHS Foundation Trust‟s quality agenda, performance and activities. We permit the disclosure of this report within the Annual Report for the year ended 31 March 2013, to enable the Council of Governors to demonstrate they have discharged their governance responsibilities by commissioning an independent assurance report in connection with the indicators. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the Council of Governors as a body and Sheffield Children's NHS Foundation Trust for our work or this report save where terms are expressly agreed and with our prior consent in writing.

Assurance work performed

We conducted this limited assurance engagement in accordance with International Standard on Assurance Engagements 3000 (Revised) – „Assurance Engagements other than Audits or Reviews of Historical Financial Information‟ issued by the International Auditing and Assurance Standards Board („ISAE 3000‟). Our limited assurance procedures included:

Evaluating the design and implementation of the key processes and controls for managing and reporting the indicators.

Making enquiries of management.

Testing key management controls.

Limited testing, on a selective basis, of the data used to calculate the indicator back to supporting documentation.

Comparing the content requirements of the NHS Foundation Trust Annual Reporting Manual to the categories reported in the Quality Report.

Reading the documents.

A limited assurance engagement is smaller in scope than a reasonable assurance engagement. The nature, timing and extent of procedures for gathering sufficient appropriate evidence are deliberately limited relative to a reasonable assurance engagement.

Limitations

Non-financial performance information is subject to more inherent limitations than financial information, given the characteristics of the subject matter and the methods used for determining such information.

The absence of a significant body of established practice on which to draw allows for the selection of different but acceptable measurement techniques which can result in materially different measurements and can impact comparability. The precision of different measurement techniques may also vary. Furthermore, the nature and methods used to determine such information, as well as the measurement criteria and the precision thereof, may change over time. It is important to read the

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Quality Report in the context of the criteria set out in the NHS Foundation Trust Annual Reporting Manual.

The scope of our assurance work has not included governance over quality or non-mandated indicators which have been determined locally by Sheffield Children‟s NHS Foundation Trust.

Conclusion

Based on the results of our procedures, nothing has come to our attention that causes us to believe that, for the year ended 31 March 2013:

the Quality Report is not prepared in all material respects in line with the criteria set out in the NHS Foundation Trust Annual Reporting Manual;

the Quality Report is not consistent in all material respects with the sources specified above; and

the indicators in the Quality Report subject to limited assurance have not been reasonably stated in all material respects in accordance with the NHS Foundation Trust Annual Reporting Manual.

KPMG LLP, Statutory Auditor

Manchester

21 May 2013

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Annual governance statement – year ended 31 March 2013

1. Scope of responsibility implementation of risk management is delegated to executive directors with individual As Accounting Officer, I have responsibility for directors having specific accountabilities for maintaining a sound system of internal control different areas of risk. Risk management is a that supports the achievement of the NHS core component of the job descriptions of foundation trust‟s policies, aims and objectives, senior managers within the Trust. whilst safeguarding the public funds and departmental assets for which I am personally Staff training and guidance on responsible, in accordance with the management of risk responsibilities assigned to me. I am also responsible for ensuring that the NHS Risk management training and awareness is foundation trust is administered prudently and incorporated into the Trust‟s induction economically and that resources are applied programme for new starters and is a key efficiently and effectively. I also acknowledge element of annual mandatory training for all my responsibilities as set out in the NHS staff. The frequency and level of risk Foundation Trust Accounting Officer management training is identified through Memorandum. training need assessments which ensures that individual members of staff have the relevant training to equip them for their duties and level of responsibility.

2. The purpose of the system of Additionally, a range of policies are in place internal control and available to staff via the Trust intranet which describe the roles and responsibilities in The system of internal control is designed to relation to the identification, management and manage risk to a reasonable level rather than control of risk. Staff are made aware of these to eliminate all risk of failure to achieve policies and actively encouraged to access policies, aims and objectives; it can therefore them to ensure that they understand their own only provide reasonable and not absolute roles and responsibilities in this area.. assurance of effectiveness. The system of internal control is based on an ongoing The Trust is committed to using information process designed to identify and prioritise the from incident reporting, patient complaints risks to the achievement of the policies, aims analysis and internal audit reports, as well as and objectives of Sheffield Children‟s NHS learning from significant incidents and events Foundation Trust, to evaluate the likelihood of in other healthcare organisations, to those risks being realised and the impact continually enhance and improve its services should they be realised, and to manage them and standards of care. efficiently, effectively and economically. The system of internal control has been in place in 4. The risk and control framework Sheffield Children‟s NHS Foundation Trust for the year ended 31 March 2013 and up to the A robust and on-going risk-management date of approval of the annual report and process, embedded across the organisation is accounts. the basis for its system of internal control.

Set out within a comprehensive board- approved risk management strategy and 3. Capacity to handle risk policy is a clearly described, structured and systematic approach to the identification, Leadership evaluation and control of risk. The document describes the Trust‟s overall risk management The Trust has in place a robust risk process, within which the operation of an management strategy which clearly sets out assurance framework, corporate risk register the accountability and reporting arrangements and directorate risk registers, ensure that risk to the board of directors for the identification, management is an integral part of clinical, evaluation and management of risk within the managerial and financial processes across the Trust. On behalf of the chief executive, Trust. operational responsibility for the

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The use of a single standard assessment tool Ensuring that we meet new nationally to identify risks ensures a consistent approach defined standards of care is taken to the evaluation and monitoring risk. Using a grading matrix of likelihood and Delivering our efficiency programme consequence to produce a risk score enables risks to be prioritised against other risks on risk Co-ordinating key change registers. Low scoring risks are managed by programmes the area in which they are found while higher scoring risks are actively discussed at the Managing and responding efficiently to executive risk management committee with increased demand any risks identified as not being managed appropriately escalated to the risk and audit Changes to paediatric tariff committee via an exception report. . Risk control measures are identified, implemented These are outlined in more detail on page 20 and monitored to reduce the potential for of the report. adverse consequences. Children are generally Long term projects are in place to provide viewed as being vulnerable, dependent on efficiencies that improve outcomes within others and succumb quickly to illness. As a resources, for example: specialist children‟s trust, our appetite for patient safety risk is accordingly low. Outpatient transformation – reducing non attendance, improving booking In line with NHS policy the Trust has spent time developing and implementing an flexibility, reducing administrative assurance framework as a mechanism for complexity; proactively assessing risk and control at the Inpatient transformation – reducing very highest level. It contains the principal risks unnecessary admissions, length of to the achievement of the Trust‟s key strategic stay and utilisation of day care; aims and underpinning objectives as identified by the Trust board. Against these objectives Theatre transformation – more the Trust has considered the risks preventing consistent operating practices, all their achievement, together with the week working, reduction of associated controls in place and any sources unnecessary out of hours emergency of assurance through which the controls can working; be seen to be effectively working. This allows assessment by the board of directors of areas IT transformation – online where gaps in control exist and consideration documentation, faster and more of any measures the Trust would wish to convenient access to information, introduce to reduce identified risks. more accurate and consistent performance reports. Action plans within the assurance framework address how assurances will be provided; or, The Trust‟s risk management strategy clearly where assurances have identified inadequate sets out the role of the board of directors and controls, how controls will be improved. The its sub-committees, together with the individual assurance framework is reviewed regularly by responsibilities of the chief executive, the risk and audit Committee prior to executive directors and all staff in managing presentation to the full Trust board. Any risk. significant gaps in control are therefore identified for more intensive monitoring by All staff are responsible for managing risks other Trust and divisional groups and regular within the scope of their role and feedback requested by the board. responsibilities as Trust employees. Incident reporting is openly encouraged through staff This top-down process is supplemented by training and the Trust promotes open and routine review by the executive risk honest reporting of incidents, risks and management committee of the most significant hazards through its incident reporting policy risks facing the Trust, collated within a which is supported by a clear and structured corporate risk register derived from divisional process. The Trust board also receives and risk registers. reviews all reports and action plans following a serious incident investigation. The major risks facing the Trust are: Key structures in ensuring quality, safety and management of risk are the integrated

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committees of the board which provide the All committees of the board meet at least bi- mechanism for managing and monitoring risk monthly and are chaired by non-executive throughout the Trust and reporting through to directors. The board committee structure was the Trust board. reviewed and reorganised during the previous year and is now as set out in the figure below.

Each committee routinely reports into the Trust director of infection prevention and board with minutes presented to board control, head pharmacist, clinical meetings with relevant issues highlighted and governance lead, research lead, allied discussed by the full board where appropriate. health professionals lead. There are also clear reporting lines between individual committees with cross-committee Finance and resources committee: membership at both non-executive and Chief executive, finance director, chief executive level; acting as conduits of operating officer, director of human information and assurance across committees resources. in support of the Trust‟s integrated governance approach. These committees are supported by The risk and audit committee oversees the executive chaired committees / groups and system of internal control and overall divisional governance structures that channel assurance process associated with managing information up to and down from the Trust risk. It receives assurance from the executive board / board committees. risk management committee on all serious untoward incidents and routine and exception Leadership amongst the committees is derived based reports from aligned board committees from their membership of executive and non- to allow it to discharge its responsibility for executive directors. Key sources of providing assurance to the Trust board in information on risk include selected members / relation to all aspects of governance, risk attendees: management and internal control.

Risk and audit committee: NHS The clinical governance committee provides Protect representatives, internal and the board of directors with assurance that high external auditors and the Trust solicitor standards of care are provided by the Trust and head of Risk management. and, in particular, that adequate and appropriate clinical governance structures, Clinical governance committee: processes and controls are in place throughout Medical director, nursing director, the Trust to promote safety and excellence in

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patient care and ensure the effective and quality performance management and clear efficient use of resources through evidence- quality risk management process. Quality based clinical practice information is routinely presented to the board with rolling focus on risk management, patient The finance and resources committee has experience and clinical effectiveness. been established to provide the board of directors with in-year assurance concerning All risk management reporting is standardised the development and delivery of the Trust‟s and reports can be tailored to departmental annual business plan and to undertake a requirements. Root cause analysis is routinely strategic advisory role in ensuring that the used to learn from incidents and tailor standard Trust develops long-term strategy and financial operating procedures. New and revised plans that address all identified business risks policies are impact assessed by our patient and opportunities and support the provision of and public involvement group. Directorate care and services and getting best value for performance meetings are informed by money and use of resources. dashboards that give clinicians key historical trends in areas of achievement and where The board nominations and remuneration improvement is required. committee makes recommendations to the council of governors on the appointment and Information risks remuneration of the chairman and non- executive directors. It also oversees the Risks to information, including data process for the nomination of the chief confidentiality, integrity and availability, are executive for approval by the board, and managed and controlled through an ratification by the council of governors, and the information governance committee, which process for the appointment of other executive reports into the clinical governance committee directors. and the Trust board. The Trust has a senior information risk owner (SIRO) with In addition to these committees, the director of responsibility for leading and implementing the infection prevention and control directs reports NHS information governance risk assessment into the Trust board and provides a quarterly and management process within the Trust in report with regard to healthcare associated addition to advising the board of directors on infections. The chief pharmacist similarly has the effectiveness of information risk direct access to the board and provides a management throughout the Trust. regular update on issues related to controlled drug practice and medicines management. A range of measures is used to manage and mitigate information risks, including: mandatory Evidence for compliance against NHS staff training, physical security, data Litigation Authority (NHSLA) and Care Quality encryption, access controls, audit trail Commission (CQC) standards is held monitoring, departmental checklists and spot electronically and updated annually. Changes checks. In addition, a comprehensive to National Institute of Clinical Excellence assessment of information security is taken (NICE) guidance, national audit annually as part of the information governance recommendations, Information Governance toolkit and further assurance is provided from Toolkit performance and the output from internal audit and other reviews. serious incidents are analysed and incorporated into policies and training. The effectiveness of these measures is reported to the information governance Root cause analysis of information governance committee. This includes details of any incidents has resulted in, e.g. changes to the personal-data-related serious incidents, the information governance training programme, Trust‟s annual information governance toolkit purchase of encrypted portable computers for score and reports of other information community staff and serial removal of all governance incidents and audit reviews. information from computer hard drives with transfer to a password protected central Quality governance server. Monitor‟s quality governance framework is The Trust‟s commitment to quality governance used to annually review the non-executive is embedded in our values and our strategic board members views on the quality of the objectives clearly reference the provision of information supplied to the Board. It allows an healthcare to children of the highest standard honest reflection on the quality of the debate available in the UK. There is a clear system of and the challenge that is a feature of board

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meetings. It has been one of the key operational strategy is being developed in line instruments in informing review of the board with membership expectations. Included committee structures and facilitating routinely on council meeting agendas are involvement of governors in core Trust items on areas of risk. Examples during business. 2012/13 being: the Francis Report; hospital service expansion or contraction in line with As part of our quality governance service commissions; capacity to achieve arrangements, a framework exists for the government targets; financial performance or management and accountability of data problems identified through staff and patient quality, supported by a data quality policy. A survey. We talk to the governors about the data quality group develops and prioritises a types of serious incidents we experience and work programme each financial year that the complaints that we get. addresses data quality issues within the Trust and presents these for consideration by an The level of public and patient involvement in executive director-led information governance the development of our services provides committee which reports into the clinical assurance that the Trust is not operating in governance committee. Reports against isolation and is trying, wherever possible, to agreed data quality standards include: put the needs of children and their families at completeness and accuracy of data submitted the centre of our services. to the secondary uses service, including the use of that data under the payment by results Examples of where public stakeholders are system; comparision of data to externally being actively engaged by the Trust in an effort produced data quality reports and to external to bring continuous improvement to the Trust benchmarking information; and the accuracy of include: Trust‟s activity coding. Quarterly meetings of parent and Senior managers are identified as owners of carers‟ group information assets and as such are responsible for the data quality input and Quarterly meetings with LINks output from their own systems. Everyone representatives working with data of any kind has a responsibility for data quality. As such, Parent representation on inspection commitment to data quality is clearly set out in visits to look at hygiene and other job descriptions and person specifications. patient standards. Quarterly council of governors meetings to review Trust operations and plans 5. Public involvement in risk management Governor representation on clinical governance committee The views of our public stakeholders are very important to the Trust. Learning from many Governor attendance at board of varied sources external to the Trust enables director meetings the organisation to learn and develop practices in response to genuine need. Public representation on child death overview panel As a foundation trust the organisation aims to make best use of its membership and of its Joint bid with University of Sheffield to council of governors. We make every attempt conduct focus groups with parents, to involve the public in all aspects of our children and staff to investigate best business and have been routinely inviting a use of facilities and what resident governor to be present at clinical governance families need from staff. committee, and at our private and public Board meetings. All public board documents are available on the Trust website at http://www.sheffieldchildrens.nhs.uk/about- 6. Other statements us/board-of-directors.htm The foundation trust is fully compliant with the We engage the council of governors at every registration requirements of the Care Quality opportunity to ensure that the Trust‟s Commission (CQC). Compliance with the

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CQC‟s essential standards of quality and The long term financial model underpins the safety are one of the elements of the Trust‟s Trust‟s five year plan and provides assurance risk management process. An unannounced to the board and to Monitor that resources are inspection by the CQC took place on 16 well coordinated and that the plans are October 2012 as part of their routine schedule affordable. of planned reviews. The overall judgement was that the Trust was meeting all essential A key element of the five year plan is the standards of quality and safety. The formal efficiency programme which identifies projects report from the inspection included no to improve productivity, increase quality and recommendations for improvement. reduce cost.

As an employer with staff entitled to In 2012/13 a revised approach to monitoring membership of the NHS pension scheme, efficiency was introduced alongside four control measures are in place to ensure all corporate transformation projects covering employer obligations contained within the outpatients, theatres, inpatient bed utilisation scheme regulations are complied with. This and IT related innovation as referenced above. includes ensuring that deductions from salary, employer‟s contributions and payments into A number of developments took place in the the scheme are in accordance with the year to strengthen the efficient use of scheme rules, and that member pension resources. These included: scheme records are accurately updated in accordance with the timescales detailed in the The introduction of a performance regulations. scorecard covering service quality and delivery, finance and human Control measures are in place to ensure that resources; all the organisation‟s obligations under equality, diversity and human rights legislation Preparation for the introduction of are complied with. service line management and reporting from April 2013 which will The foundation trust has undertaken risk devolve more responsibility for the assessments and carbon reduction delivery management of patient care, income plans are in place in accordance with and expenditure to our clinical emergency preparedness and civil contingency divisions. requirements, as based on UKCIP 2009 weather projects, to ensure that this The benchmarking of payroll costs organisation‟s obligations under the Climate Change Act and the Adaptation Reporting An external review of procurement requirements are complied with. opportunities

With the exception of provision A3.2 which The Trust continues to participate in an relates to the composition of the Trust board external benchmarking club which analyses and provision E2.3 relating to the use of the comparative resource use in paediatric external professional advisors to market test centres. remuneration levels of the chairman and other non-executive directors, the Trust board Further opportunities for efficiency are being considers itself compliant with the NHS identified and then implemented as part of the foundation trust code of governance and has hospital redevelopment project. These include made disclosures required by the code in improved staff/patient communication systems section 4.4 of this annual report. and the rationalisation of plant and equipment particularly relating to energy management.

A major investment in the replacement and enhancement of our patient administration 7. Review of economy, efficiency systems in 2013/14 will provide increased and effectiveness of the use of efficiency in administrative processes. Self- registration for patients attending outpatients is resources one example of the opportunities linked to the system change. The Trust has a robust planning process which allocates resources strategically in its five-year The Trust has an annual programme of plan and then annually in its budget setting internal audit which is discussed with the process. management executive and members of the

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risk and audit committee. The risk and audit requirements in the NHS Foundation Trust committee monitors progress against this annual reporting manual. programme and the management executive addresses any improvement actions identified. Steps which have been put in place to The board reviews the Trust‟s financial position assure the board that the quality report every month and further detailed work is presents a balanced view and that there carried out by the risk and audit committee. In are appropriate controls in place to addition, both internal and external audit carry ensure accuracy of data include the out specific value-for-money reviews as following: requested and report their findings to the risk and audit committee and the Trust board as The board of directors has appointed the required. director of nursing and clinical operations as the executive lead for the During the year the board have received quality report. The annual quality report regular reports informing of the economy, provides a narrative of progress towards efficiency, and effectiveness of the use of achieving the quality improvement resources. Reports detailing the financial and indicators agreed in consultation with our clinical performance of the organisation during key stakeholders; the period are regularly produced with traffic light systems in place to flag areas for concern The quality report is compiled by the where they exist. These reports are produced director of nursing and clinical by the executive officers of the Trust. operations following both internal and external consultation to inform the Internal audit continues to review systems and improvement indicators; Details of the processes in place during the year and consultation process are to be found in publishes reports detailing specific actions to the annex to the quality report. ensure economy, efficiency and effectiveness of the use of resources is maintained. The Data is provided by nominated leads in outcome of these reports and the the Trust which include the head of risk recommendations therein are also graded management, the head of planning and according to their perceived level of risk to the performance and the clinical governance organisation, therefore assisting management department. These leads are action. responsible for ensuring the accuracy of the data they provide. The quality data This process has been supplemented by the reflects that which has generally been external audit reports which provide assurance available in summary to the Trust board on the Trust‟s arrangements for achieving or, in more detail, to the board economy, efficiency and effectiveness in its committees. Once compiled, the quality use of resources. report is scrutinised by the director of nursing and clinical operations who is The board of directors also received ultimately responsible to the Trust board assurances on the use of resources from and its committees for the accuracy of outside agencies including Monitor and the the quality report. Care Quality Commission. Monitor requires the board of directors to self-assess on a quarterly The quality report is subject to robust basis and scores the organisation using a challenge at a meeting of the clinical traffic light system. governance committee on both substantive issues and on data quality. Where a variance against a specific quality target is identified an explanation 8. Annual quality report is provided by the lead for the individual metric. Following scrutiny at this The directors are required under the Health committee the draft report is also Act 2009 and the National Health Service presented to the risk and audit (Quality Accounts) Regulations 2010 (as committee who are responsible for amended) to prepare Quality Accounts for determining the report‟s completeness, each financial year. Monitor has issued objectivity, integrity and accuracy before guidance to NHS foundation trust boards on it is submitted to the board of directors the form and content of annual quality reports for approval. which incorporate the above legal

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Statement of comprehensive income for the year ended 31 March 2013

2012/13 2011/12 NOTE £000 £000

Operating income from continuing operations 3.1 153,907 149,055

Operating expenses of continuing operations 4.1 (148,441) (141,816)

OPERATING SURPLUS 5,466 7,239

FINANCE COSTS

Finance income 8 125 62

Finance expense - financial liabilities 9 (199) (85)

Finance expense - unwinding of discount on provisions (10) (10)

PDC dividends payable (1,742) (1,789)

NET FINANCE COSTS (1,826) (1,822)

SURPLUS FOR THE YEAR 3,640 5,417

Other comprehensive income

Impairment losses on property, plant and equipment (625) (76)

Revaluation gains on property, plant and equipment 111 1,896

TOTAL COMPREHENSIVE INCOME FOR THE YEAR 3,126 7,237

The notes on pages 116 to 143 form part of these accounts.

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Statement of changes in taxpayers’ equity

Public dividend Income and capital Revaluation expenditure (PDC) reserve reserve Total £000 £000 £000 £000

Taxpayers' equity at 1 April 2012 36,751 14,216 25,270 76,237 Changes in taxpayers' equity for 2012/13 Surplus for the year 0 0 3,640 3,640 Impairment losses on property, plant and equipment 0 (625) 0 (625) Revaluation gains on property, plant and equipment 0 111 0 111 Transfer to retained earnings on disposal of assets 0 (175) 175 0 Transfer of the excess of current cost depreciation over historical cost 0 (154) 154 0 depreciation to the income and expenditure reserve

Taxpayers' equity at 31 March 2013 36,751 13,373 29,239 79,363

Taxpayers' equity at 1 April 2011 36,751 12,637 19,612 69,000

Changes in taxpayers' equity for 2011/12 Surplus for the year 0 0 5,417 5,417 Impairment losses on property, plant and equipment 0 (76) 0 (76) Revaluation gains on property, plant and equipment 0 1,896 0 1,896 Transfer to retained earnings on disposal of assets 0 0 0 0 Transfer of the excess of current cost depreciation over historical cost 0 (241) 241 0 depreciation to the income and expenditure reserve

Taxpayers' equity at 31 March 2012 36,751 14,216 25,270 76,237

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Statement of cash flows for the year ended 31 March 2013

2012/13 2011/12 £000 £000

Cash flows from operating activities Operating surplus from continuing operations 5,466 7,239

Non-cash income and expense: Depreciation and amortisation 4,216 4,333 Impairments 650 879 Reversal of impairments (9) (554) Donated property, plant and equipment (776) (461) (Increase) in trade and other receivables (1,554) (1,051) (Increase)/decrease in inventories 65 (304) Increase in trade and other payables 1,402 515 (Decrease) in other liabilities (26) (535) Increase/(Decrease) in provisions (305) 585 Other movements in operating cash flows (8) 59

Net cash generated from operations 9,121 10,705

Cash flows from investing activities Interest received 125 60 Purchase of intangible assets (235) (142) Sale of property, plant and equipment 554 0 Purchase of property, plant and equipment (3,043) (2,810)

Net cash outflow from investing activities (2,599) (2,892)

Net cash inflow before financing 6,522 7,813

Cash flows from financing activities Loans received 0 4,000 Loans repaid 0 (21) Interest paid (199) (52) PDC dividend paid (1,793) (1,625)

Net cash used in financing activities (1,992) 2,302

Increase / (decrease) in cash and cash equivalents 4,530 10,115

Cash and cash equivalents at 1 April 20,125 10,010

Cash and cash equivalents at 31 March 24,655 20,125

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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 ("FT ARM") which shall be agreed with HM Treasury. Consequently, the following financial statements have been prepared in accordance with the FT ARM 2012/13 issued by Monitor. The accounting policies contained in that manual follow International Financial Reporting Standards (IFRS) and HM Treasury's Financial Reporting Manual to the extent that they are meaningful and appropriate to NHS Foundation Trusts. The accounting policies have been applied consistently in dealing with items considered material in relation to the accounts.

1.1 Accounting period

The accounts of Sheffield Children's NHS Foundation Trust ("the Trust") have been drawn up for the year to 31 March 2013.

1.2 Accounting convention

These accounts have been prepared under the historical cost convention modified to account for the revaluation of property, plant and equipment, intangible assets and inventories and certain financial assets and liabilities.

1.3 Acquisitions and discontinued operations

Activities are considered to be 'acquired' only if they are taken on from outside the public sector. Activities are considered to be 'discontinued' only if they cease entirely. They are not considered to be 'discontinued' if they transfer from one public sector body to another.

1.4 Income

The main source of income for the Trust is from Primary Care Trusts, which are government funded commissioners of NHS health and patient care. Income is recognised in the period in which services are provided and is measured at the fair value of the consideration receivable. Income relating to patient care spells that are part-completed at the end of the reporting period are apportioned across the financial years on the basis of length of stay at the reporting date compared to expected total length of stay incurred to date compared to total expected average costs.

Where income is received for a specific activity which is to be delivered in the following financial year, that income is deferred.

Interest income is accrued on a time basis, by reference to the principal outstanding and interest rate applicable. 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.

1.5 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.

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Pension costs Past and present employees are covered by the provisions of the NHS Pension Scheme ('the Scheme'). The scheme is an unfunded, defined benefit scheme that covers NHS employers, general practices and other bodies, allowed under the direction of 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.

For early retirements other than those due to ill health the additional pension liabilities are not funded by the Scheme. The full amount of the liability for the additional costs is charged to the income statement at the time the Trust commits itself to the retirement, regardless of the method of payment.

1.6 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.

1.7 Property, plant and equipment

Recognition Property, plant and equipment is capitalised if it is capable of being used for a period which exceeds one financial year and: - 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 Trust; - the cost of the item can be measured reliably; - it individually has a cost of at least £5,000 or it forms a group of assets which individually have a cost of more than £250, 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; or - it forms 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.

Where a large asset, for example a building, includes a number of components with significantly different asset lives (eg plant and equipment), then these components are treated as separate assets and depreciated over their own useful economic lives. Measurement

Valuation

All property, plant and equipment is measured initially at cost, representing the costs directly attributable to acquiring or constructing the asset and bringing it to the location and condition for it to be capable of operating in the manner intended by management. All assets are subsequently measured at fair value, which is determined as follows:

Land and buildings used for the Trust's services or for administrative purposes are stated in the Statement of Financial Position at their revalued amounts, being the fair value at the date of revaluation less any subsequent accumulated depreciation and impairment losses. Revaluations are performed with sufficient regularity to ensure that carrying amounts are not materially different from those that would be determined at the date of the Statement of Financial Position. Fair values are determined as follows:

Land and non specialised buildings - market value for existing use Specialised buildings - depreciated replacement cost.

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Until 31 March 2008, the depreciated replacement cost of specialised buildings has been estimated for an exact replacement of the asset in its present location. HM Treasury has adopted a standard approach to depreciated replacement cost valuations based on modern equivalent assets and, where it would meet the location requirements of the service being provided, an alternative site can be valued.

Valuations are carried out by professionally qualified valuers in accordance with the Royal Institute of Chartered Surveyors (RICS) Appraisal and Valuation Manual. A revaluation was undertaken as at 31 March 2013 and is reflected in these financial statements.

Properties in the course of construction for service or administration purposes are carried at cost, less any impairment loss. Cost includes professional fees but not borrowing costs, which are recognised as expenditure immediately, as allowed by IAS 23 for assets held at fair value. Assets are revalued and depreciation commences when they are brought into use.

Until 31 March 2008 fixtures and equipment were carried at replacement cost, as assessed by indexation and depreciation of historic cost. From 1 April 2008 indexation has ceased. The carrying value of existing assets at that date will be written off over their remaining useful lives and new fixtures and equipment are carried at depreciated historic cost as this is not considered to be materially different from fair value.

Subsequent expenditure Subsequent expenditure relating to an item of property, plant and equipment is recognised as an increase in the carrying amount of the asset when it is probable that additional future economic benefits or service potential deriving from the cost incurred to replace a component of such item will flow to the Trust and the cost of the item can be determined reliably. Where a component of an asset is replaced, the cost of the replacement is capitalised if it meets the criteria for recognition above. The carrying amount of the part replaced is de-recognised. Other expenditure that does not generate additional future economic benefits or service potential, such as repairs and maintenance, is charged to the Statement of Comprehensive Income in the period in which it is incurred.

Depreciation Freehold land, as it is considered to have an infinite life, and properties under construction are not depreciated.

Otherwise, depreciation is charged on a straight-line basis to write off the costs or valuation of property, plant and equipment, less any residual value, over their estimated useful economic lives. The estimated useful economic lives and residual values are reviewed each year end, with the effect of any changes recognised on a prospective basis. Assets held under finance leases are depreciated over their estimated useful lives or, where shorter, the lease term.

The estimated useful economic lives of the Trust's property, plant and equipment are:

Assets held under finance leases Lower of lease term or useful economic life Buildings 12 years to 70 years Short leasehold buildings Lease term Engineering Equipment 5 years - 15 years Furniture 10 years Office & IT Equipment 5 years Medical Equipment 5 years - 15 years Mainframe IT Installation 8 years

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.

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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 At each Statement of Financial Position date, the Trust assesses whether there is any indication of impairment to its property, plant and equipment assets. In accordance with the FT ARM, impairments that are due to a loss of economic benefits 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 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 reversal is recognised.

Other impairments are treated as revaluation losses. Reversals of 'other impairments' are treated as revaluation gains.

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 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 the asset can be measured reliably. Expenditure on research is not capitalised. Expenditure on development is not capitalised unless the Trust can demonstrate the technical feasibility of the project and that there are adequate financial, technical and other resources available to complete the development of and sell or use the asset. The Trust must show that it intends to complete the asset and sell or use it and that it has the ability to do this. The Trust must also demonstrate how the intangible asset will generate probable future economic or service delivery benefits and that it can reliably measure the expenses attributable to the asset during development.

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, provided this exceeds £5,000. Subsequently, intangible assets are measured at fair value. Revaluation gains and losses and impairments are treated in the same manner as for property, plant and equipment. The Trust considers that amortised cost is a proxy for fair value.

Amortisation Intangible assets are amortised over their useful economic lives in a manner consistent with the consumption of economic or service delivery benefits. Software is amortised over the shorter of the term of the licence and their useful economic lives, usually between five and twenty years.

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1.9 Donated 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 imposes a condition that the future economic benefits embodied in the donation / 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 the grant funded assets are subsequently accounted for in the same manner as other items of property, plant and equipment.

1.10 Non-current assets held for sale

Non-current assets are classified as held for sale if their carrying amount will be recovered principally through a sale transaction rather than continuing use. This condition is regarded as met when the sale is highly probable, the asset is available for immediate sale in its present condition and management is committed to the sale, which is expected to qualify for recognition as a completed sale within one year from the date of classification. Non-current assets held for sale are measured at the lower of their existing carrying amount and fair value less costs to sell. Fair value is open market value including alternative uses. Depreciation ceases to be charged when assets are classified as 'held for sale'. Assets are de-recognised when all material sale contract conditions have been met.

The profit or loss arising on disposal of an asset is the difference between the sale proceeds and the carrying amount and is recognised in the income statement. On disposal, the balance for the asset on the revaluation reserve, donated asset reserve or government grant reserve is transferred to the income and expenditure reserve.

Property, plant and equipment which is to be scrapped or demolished does not qualify for recognition as 'Held for Sale'. Instead, it is retained as an operational asset and the economic life is adjusted. The asset is de-recognised when scrapping or demolition occurs.

1.11 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 asset and liability are recognised at the commencement of the lease. Thereafter the asset is accounted for as an item of property, plant and equipment.

The annual rental is split between the repayment of the liability and a finance cost so as to achieve a constant rate of finance over the life of the lease. The annual finance cost is charged to Finance Costs in the Statement of Comprehensive Income. The lease liability is derecognised when the liability is discharged, cancelled or expires.

Operating leases Other leases are regarded as operating leases and the rentals are charged to operating expenses on a straight-line basis over the term of the lease. Operating lease incentives received are added to lease rentals and charged to operating expenses over the life of the lease.

Leases of land and buildings When a lease is for land and buildings, the land component is separated from the building component and the classification for each is assessed separately.

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1.12 Inventories

Inventories are valued at the lower of cost and net realisable value using the first-in first-out cost formula. This is considered to be a reasonable approximation to fair value due to the high turnover of stocks.

1.13 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.

In the Statement of Cash Flows, cash and cash equivalents are shown net of bank overdrafts that are repayable on demand and that form an integral part of the Trust‟s cash management.

1.14 Provisions

The NHS foundation trust recognises a provision where it has a present legal or constructive obligation of uncertain timing or amount; for which 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. The amount recognised in the Statement of Financial Position is the best estimate of the resources required to settle the obligation. Where the effect of the time value of money is significant, the estimated risk-adjusted cash flows are discounted using the discount rates published and mandated by HM Treasury (2.2% in real terms).

When some or all of the economic benefits required to settle a provision are expected to be recovered from a third party, the receivable is recognised as an asset if it is virtually certain that reimbursements will be received and the amount of the receivable can be measured reliably.

1.15 Clinical negligence costs

The NHS Litigation Authority (NHSLA) operates a risk pooling scheme under which the Trust pays an annual contribution to the NHSLA, which, in return, settles all clinical negligence claims. The contribution is charged to operating expenses. Although the NHSLA is administratively responsible for all clinical negligence cases, the legal liability remains with the Trust. The total value of clinical negligence provisions carried by the NHSLA on behalf of the Trust is disclosed at Note 20 but is not recognised in the Trust‟s accounts.

1.16 Non-clinical risk pooling

The Trust participates in the Property Expenses Scheme and the Liabilities to Third Parties Scheme. Both are risk pooling schemes under which the 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.

1.17 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 23 where an inflow of economic benefits is probable.

Contingent liabilities are not recognised, but are disclosed in note 23, unless the probability of a transfer of economic benefits is remote. Contingent liabilities are defined as:

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- 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.

1.18 Value added tax

Most of the activities of the 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 property, plant and equipment. Where output tax is charged or input VAT is recoverable, the amounts are stated net of VAT.

1.19 Foreign currencies

The functional and presentational currencies of the Trust are sterling.

A transaction which is denominated in a foreign currency is translated into the functional currency at the spot exchange rate on the date of the transaction.

Where the Trust has assets or liabilities denominated in foreign currency at the Statement of Financial Position date: - monetary items (other than financial instruments measured at 'fair value through income and expenditure) are translated at the spot exchange rate on 31 March; - non-monetary assets and liabilities measured at historical cost are translated using the spot exchange rate at the date of the transaction; and - non-monetary assets and liabilities measured at fair value are translated using the spot exchange rate at the date the fair value was determined.

Exchange gains or losses on monetary items (arising from the settlement of the transaction or on re- translation at the Statement of Financial Position date) are recognised in income or expense in the period in which they arise.

Exchange gains or losses on non-monetary assets and liabilities are recognised in the same manner as other gains and losses on these items.

1.20 Third party assets

Assets belonging to third parties (such as money held on behalf of patients) are not recognised in the accounts since the 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. The Trust held no such assets during the year.

1.21 Corporation tax

The Finance Act 2004 amended Section 519A of the Income and Corporation Taxes Act 1998 to provide power to the Treasury to make certain non-core activities of the Trust, which are not related to, or ancillary to, the provision of healthcare and where profits exceed £50,000 per annum, potentially subject to corporation tax.

The Trust has no corporation tax liability as it considers all activities to be related to, or ancillary to, the provision of its core activity, healthcare.

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1.22 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. The Secretary of State can issue new PDC to, and require repayments of, PDC from the Trust. PDC is recorded at the value received. HM Treasury has determined that, as PDC is issued under legislation rather than under contract, it is not a financial instrument within the meaning of IAS 32.

A charge, reflecting the cost of capital utilised by the 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 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, (ii) net cash balances held with the Government Banking Services (GBS), excluding cash balances held in GBS accounts that relate to a short-term working capital facility, and (iii) 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 net relevant assets as set out in the 'pre-audit' version of the annual accounts. The dividend is not revised should any adjustment to net assets occur as a result of the audit of the annual accounts.

1.23 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 each individual case is handled.

Losses and special payments are charged centrally in expenditure on an accruals basis, including losses which would have been made good through insurance cover had NHS Foundation Trusts not been bearing their 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 accruals basis with the exception of provisions for future losses.

1.24 Financial instruments

Recognition Financial assets and financial liabilities which arise from contracts for the purchase or sale of non- financial items (such as goods or services), which are entered into in accordance with the 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 and liabilities in respect of assets acquired or disposed of through finance leases are recognised and measured in accordance with the accounting policy for lease described above.

All other financial assets and financial liabilities are recognised when the Trust becomes a party to the contractual provisions of the instrument.

De-recognition All financial assets are de-recognised when the rights to receive cashflows from the assets have expired or the 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.

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Classification and measurement Financial assets are categorised as 'loans and receivables' or „available for sale financial assets‟. Financial liabilities are classified as 'other financial liabilities'.

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 Trust's loans and receivables comprise cash at bank and in hand, NHS receivables, accrued income and 'other receivables'. Loans and receivables are recognised at fair value, net of transaction costs. Interest on loans and receivables is calculated using the effective interest method and credited to the Statement of Comprehensive Income.

Available-for-sale financial assets Available-for-sale financial assets are non-derivative financial assets which are either designated in this category or not classified within loans and receivables. They are included in non-current assets unless the Trust intends to dispose of them within 12 months of the Statement of Financial Position date.

Financial liabilities All financial liabilities are recognised at fair value, net of transaction costs incurred. 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 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 Trust assesses whether any financial asset is 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 cashflows of the asset. A provision for impaired receivables is used by the Trust to recognise any impairment of receivables and its value is assessed by reference to the Trust's aged receivables analysis between NHS and non-NHS receivables at the Statement of Financial Position date, plus any known further individual receivables whose recovery is judged to be doubtful.

1.25 Accounting standards that have been issued but have not yet been adopted

The following accounting standards, amendments and interpretations have been issued by the IASB and IFRIC but are not yet required to be adopted:

IFRS 7 - Financial Instruments: Disclosures (amendment) - Transfers of financial assets (effective from 2013/14) IFRS 9 - Financial Instruments: Financial Assets and Financial Liabilities (uncertain) IFRS 10 - Consolidated Financial Statements (effective from 2013/14) IFRS 11 - Joint Arrangements (effective from 2013/14) IFRS 12 - Disclosure of Interest in Other Entities (effective from 2013/14) IFRS 13 - Fair Value Measurement (effective from 2013/14) IAS 1 - Presentation of Financial Statements, on Other Comprehensive Income (effective 2013/14) IAS 19 (Revised 2011) - Employee Benefits (effective 2013/14) IAS 27 - Separate Financial Statements (effective 2013/14) IAS 28 - Associates and Joint Ventures (effective 2013/14) IAS 32 - Financial Instruments: Presentation (effective 2014/15)

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The Trust has considered the above new standards, interpretation and amendments to published standards that are not yet effective and concluded that they are either not relevant to the Trust or that they would not have a significant impact on the Trust's financial statements, apart from some additional disclosures. This conforms with the FT ARM 2012/13, which requires that any amendments to standards are applied in accordance with the applicable timetable, with early adoption not permitted.

1.26 Critical accounting judgements and key sources of estimation uncertainty

In the application of the Trust's accounting policies, management are required to make judgements, estimates and assumptions about the carrying amounts of assets and liabilities that are not readily apparent from other sources. The estimates and associated assumptions are based on historical experience and other factors that are considered to be relevant. Actual results may differ from those estimates and the estimates and underlying assumptions are continually reviewed. Revisions to accounting estimates are recognised in the period in which the estimate is revised if the revision affects only that period or in the period of the revision and future periods if the revision affects both current and future periods.

Key sources of estimation uncertainty There are no key assumptions concerning the future, or other key sources of estimation uncertainty at the end of the reporting period, that have a significant risk of causing a material adjustment to the carrying amounts of assets and liabilities within the next financial year. The main area of estimation uncertainty within the Trust is the carrying value of the property portfolio and the assumptions used in the determination of fair value at the Statement of Financial Position date. However, the Trust commissioned a property revaluation exercise as at 31 March 2013, which significantly reduces the risk of material misstatement in the next financial year.

2 Segmental analysis

The Trust Board, as the chief operating decision maker as defined by IFRS 8, consider that all of the Trust's activities fall under the single segment of 'Provision of Healthcare'. They consider that this is consistent with the core principle of IFRS 8 which is to enable users of the financial statements to evaluate the nature and financial effects of business activities and economic environments. No further segmental analysis is therefore required.

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3.1 Operating income by classification

2012/13 2011/12 £000 £000 Income from activities Elective income 31,505 29,069 Non elective income 23,178 20,424 Outpatient income 21,413 20,725 Accident and Emergency income 4,656 3,898 Other NHS clinical income 36,441 37,662 Community services income 11,382 11,313 Private and overseas patient income (127) 163 Other non-protected clinical income 684 730

Total income from activities 129,132 123,984

Other operating income Research and development 1,735 1,332 Education and training 7,238 6,888 Charitable and other contributions 776 478 Non-patient care services to other bodies 3,014 3,252 Income in respect of staff costs 6,915 7,710 Reversal of impairments on property, plant and equipment 9 554 Rental revenue from operating leases 91 89 Gain on disposal of assets held for sale 8 0 Other 4,989 4,768

Total other operating income 24,775 25,071

Total operating Income 153,907 149,055

Other NHS clinical income includes income for mental health services £12,985,000 (2011/12 - £13,345,000); non outpatient community services £2,381,000 (2011/12 - £2,434,000); genetics £1,712,000 (2011/12 - £1,535,000); screening £1,443,000 (2011/12 - £1,631,000); blood products income £1,892,000 (2011/12 - £1,788,000); and cost per case activity including drugs, bone marrow transplants and scoliosis £3,056,000 (2011/12 - £5,190,000).

Other income includes diagnostic test income of £3,686,000 (2011/12 - £3,400,000) and catering income £711,000 (2011/12 - £677,000).

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3.2 Private patient income

The statutory limitation on private patient income in section 44 of the 2006 Act was repealed with effect from 1 October 2012 by the Health and Social Care Act 2012. As a result, the financial statements disclosures that were provided previously are no longer required.

3.3 Operating income by type

2012/13 2011/12 £000 £000 Income from activities NHS Foundation Trusts 296 287 NHS Trusts 14 0 Strategic Health Authorities 1,579 1,354 Primary Care Trusts 126,541 121,318 Local Authorities 592 600 Non-NHS: Private patients (186) 142 Non-NHS: Overseas patients (non-reciprocal) 59 21 NHS injury scheme 92 129 Non-NHS: Other 145 133

Total income from activities 129,132 123,984

Other operating income Research and development 1,735 1,332 Education and training 7,238 6,888 Charitable and other contributions to expenditure 776 478 Non-patient care services to other bodies 3,014 3,252 Income in respect of staff costs 6,915 7,710 Reversal of impairments on property, plant and equipment 9 554 Rental revenue from operating leases 91 89 Gain on disposal of assets held for sale 8 0 Other income 4,989 4,768

Total other operating income 24,775 25,071

Total operating income 153,907 149,055

Income is almost totally from the supply of services. Income from the sale of goods is immaterial.

3.4 Mandatory and non mandatory income 2012/13 2011/12 £000 £000

Income from mandatory services 80,752 74,116 Income from non mandatory services 73,155 74,939

Total operating income 153,907 149,055

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4 Operating expenses 4.1 Analysis of operating expenses

2012/13 2011/12 £000 £000

Services from NHS Foundation Trusts 4,136 3,839 Services from NHS Trusts 806 697 Services from PCTs 811 753 Services from other NHS Bodies 559 530 Employee Expenses - Executive directors 867 825 Employee Expenses - Non-executive directors 129 130 Employee Expenses - Staff 105,705 101,847 Supplies and services - clinical (excluding drug costs) 11,005 10,480 Supplies and services - general 1,629 1,400 Establishment 2,130 1,999 Research and development 14 8 Transport 168 187 Premises 4,886 4,521 Provision for impairment of receivables (141) 188 Other provisions (294) 644 Rentals under operating leases 444 452 Drug costs 5,865 4,926 Depreciation on property, plant and equipment 4,011 4,037 Amortisation on intangible assets 205 296 Impairments on property, plant and equipment 650 879 Audit fees - statutory audit 55 58 Audit fees - regulatory reporting 15 12 Clinical negligence premiums 1,510 1,130 Loss on disposal of intangible fixed assets 0 59 Legal fees 76 70 Consultancy costs 768 740 Training, courses and conferences 717 543 Patient travel 46 46 Car parking and security 61 48 Termination benefits 252 231 Hospitality 62 69 Insurance 82 92 Other services 1,184 0 Losses, ex gratia and special payments 28 21 Other 0 59

148,441 141,816

'Other services' wholly relate to the costs incurred for the enabling works associated with the new Hospital Wing Development. These costs were incurred when the project was in its feasibility stage, in accordance with IAS 16, and mainly relate to fees to architects and other professional services.

4.2 Limitation on auditor's liability

The limitation on the Trust's auditor's liability is £1,000,000 (2011/12 - £1,000,000).

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5 Operating leases

5.1 Operating lease income 2012/13 2011/12 £000 £000

Rents recognised as income - building leases 91 89

Future minimum lease income due for building leases: Not later than one year 89 89 Later than one year and not later than five years 256 356 Later than five years 0 0

345 445

5.2 Arrangements containing an operating lease 2012/13 2011/12 £000 £000

Minimum operating lease payments 444 452

Future minimum lease payments due: Not later than one year 351 441 Later than one year and not later than five years 456 846 Later than five years 0 0

807 1,287

6 Employee expenses

6.1 Analysis of employee expenses

2012/13 2011/12 £000 £000

Salaries and wages 86,426 83,554 Social security costs 7,137 6,946 Employer contributions to NHS Pension Scheme 10,457 10,210 Termination benefits 252 231 Agency / contract staff 2,685 2,080

Total employee expenses 106,957 103,021

Less: Costs capitalised as part of property, plant and equipment (133) (118)

Total employee expenses excluding capitalised staff 106,824 102,903

6.2 Directors' Remuneration 2012/13 2011/12 £000 £000

Fees to non-executive directors 118 119 Executive Directors - Salaries * 671 656 Executive Directors - Benefits (NHS Pension scheme) 93 92

882 867

* Salaries stated are all emoluments paid to Executive Directors, including payments for clinical responsibility within the Trust.

Further information about the remuneration of individual directors and details of their pension arrangements are provided in the Remuneration Report.

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6.3 Average number of employees (whole time equivalent basis)

2012/13 2011/12 Number Number

Medical and dental 344 341 Administration and estates 505 494 Healthcare assistants and other support staff 288 277 Nursing, midwifery and health visiting staff 704 690 Nursing, midwifery and health visiting learners 16 8 Scientific, therapeutic and technical staff 416 404 Bank and agency staff 72 54 Other 1 1

Total 2,346 2,269

6.4 Employee benefits

There were no employee benefits during the year other than the benefits of the NHS Pension Scheme.

6.5 Early retirements due to ill health

During the year ended 31 March 2013, there were 3 (2011/12 - 3) early retirements from the Trust agreed on the grounds of ill-health. The estimated additional pension liabilities for ill-health retirements will be £207,000 (2011/12 - £189,000). The cost of these ill-health retirements will be borne by the NHS Business Services Authority - Pensions Division.

6.6 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 the 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 if it were a defined contribution scheme: the cost to the NHS Body 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 valuation, the Treasury FReM requires that "the period between formal valuations shall be four years, with approximate assessments in intervening years". An outline of these follows:

a) 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 formal actuarial valuation undertaken for the NHS Pension Scheme was completed for the year ended 31 March 2004. Consequently, a formal actuarial valuation would have been due for the year ended 31 March 2008. However, formal actuarial valuations for unfunded public service schemes have been 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 sector pension provision. Employer and employee contribution rates are currently being determined under the new scheme design.

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b) Accounting valuation

A valuation of the scheme liability is carried out annually by the scheme actuary as at the end of the reporting period. Actuarial assessments are undertaken in intervening years between formal valuations using updated membership data and are accepted as providing suitably robust figures for financial reporting purposes. However, as the interval since the last formal valuation now exceeds four years, the valuation of the scheme liability as at 31 March 2013, is based on detailed membership data as at 31 March 2010 updated to 31 March 2013 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 H M 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. c) Scheme provisions

The NHS Pension Scheme provided defined benefits, which are summarised below. This list is an illustrative guide only, and is not intended to detail all the benefits provided by the Scheme or the specific conditions that must be met before these benefits can be obtained:

The Scheme is a “final salary” scheme. Annual pensions are normally based on 1/80th for the 1995 section and of the best of the last three years pensionable pay for each year of service, and 1/60th for the 2008 section of reckonable pay per year of membership. Members who are practitioners as defined by the Scheme Regulations have their annual pensions based upon total pensionable earnings over the relevant pensionable service.

With effect from 1 April 2008 members can choose to give up some of their annual pension for an additional tax free lump sum, up to a maximum amount permitted under HMRC rules. This new provision is known as “pension commutation”.

Annual increases are applied to pension payments at rates defined by the Pensions (Increase Act 1971, and are based on changes in retail prices in the twelve months ending 30 September in the previous calendar year. From 2011/12, the Consumer Price Index (CPI) was used, replacing the Retail Prices Index (RPI).

Early payment of a pension, with enhancement, is available to members of the scheme who are permanently incapable of fulfilling their duties effectively through illness or infirmity. A death gratuity of twice final year‟s pensionable pay for death in service, and five times their annual pension for death after retirement is payable.

For early retirements other than those due to ill health the additional pension liabilities are not funded by the scheme. The full amount of the liability for the additional costs is charged to the statement of comprehensive income at the time the trust commits itself to the retirement, regardless of the method of payment.

Members can purchase additional service in the NHS Scheme and contribute to money purchase AVC‟s run by the Scheme‟s approved providers or by other Free Standing Additional Voluntary Contributions (FSAVC) providers.

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6.7 Staff exit packages 2012/13 2011/12 Other Other Exit package cost Compulsory departures Total exit Compulsory departures Total exit band redundancies agreed packages redundancies agreed packages Number Number Number Number Number Number

< £10,000 6 1 7 3 2 5 £10,001 - £25,000 3 1 4 4 1 5 £25,001 - £50,000 2 0 2 2 1 3 £50,001 - £100,000 1 0 1 0 0 0

12 2 14 9 4 13

Total cost (£000) 229 23 252 136 95 231

The Trust has agreed 2 staff exit packages during 2012/13 (2011/12 - 4) under the local 'Mutually Agreed Resignation Scheme' ('MARS'). Twelve (2011/12 - nine) further staff members were made compulsorily redundant.

7 Better Payment Practice Code and Late Payment of Commercial Debts

7.1 Better Payment Practice Code - measure of compliance 2012/13 2012/13 Number £000

Total Non-NHS trade invoices paid in the year 37,387 32,328 Total Non NHS trade invoices paid within target 36,049 30,814 Percentage of Non-NHS trade invoices paid within target 96% 95%

Total NHS trade invoices paid in the year 2,783 15,514 Total NHS trade invoices paid within target 2,660 15,045 Percentage of NHS trade invoices paid within target 96% 97%

The Trust operates 'The Better Payment Practice Code' which aims to pay all undisputed invoices by the due date or within 30 days of receipt of goods or a valid invoice, whichever is later.

7.2 The Late Payment of Commercial Debts (Interest) Act 1998

There were no claims arising under this legislation in the year ended 31 March 2013 (2011/12 - nil).

8 Finance income 2012/13 2011/12 £000 £000

Interest on bank accounts 125 62

9 Finance costs - interest expense 2012/13 2011/12 £000 £000

Loans from the Foundation Trust Financing Facility 199 85

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10 Impairment of assets Property, plant and equipment

2012/13 2011/12 £000 £000

Redevelopment impact 0 656 Changes in market prices 1,275 299

1,275 955

The impairment of property, plant and equipment is reflected in: Operating expenses 650 879 Revaluation reserve 625 76

1,275 955

11 Intangible assets Software Licences (purchased) 2012/13 2011/12 £000 £000

Gross cost at 1 April 1,803 1,759 Additions - purchased 235 142 Disposals 0 (98) Gross cost at 31 March 2,038 1,803

Amortisation at 1 April 1,281 1,024 Provided during the year 205 296 Disposals 0 (39) Amortisation at 31 March 1,486 1,281

Net book value - Purchased 552 516 - Donated 0 6 Total at 31 March 552 522

12 Property, plant and equipment

12.1 Revaluation of property, plant and equipment

All land and buildings are revalued using professional valuations in accordance with IAS 16 to ensure that property is stated at fair value. The default frequency of these valuations is currently every five years, in accordance with the FT ARM. However, interim valuations are also carried out as deemed appropriate by the Trust. Valuations are performed by professionally qualified valuers in accordance with the Royal Institute of Chartered Surveyors (RICS) Appraisals and Valuation Manual. The Trust commissioned an interim valuation of its land and buildings as at 31 March 2013, which was undertaken by the District Valuer Services within the Valuation Office Agency, an Executive Agency of HM Revenue and Customs.

Valuations are normally carried out on the basis of depreciated replacement cost, using the Modern Equivalent asset methodology, for specialised operational property, and existing use value for non-specialised operational property, in line with Department of Health guidance. The value of land for existing use purposes is assessed at existing use value. For non-operational properties including surplus land, the valuations are carried out at open market value. This is the basis on which the interim valuation was undertaken on 31 March 2013 and also the basis for the previous valuation performed as at 31 March 2012.

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12.2 Property, plant and equipment for the financial year 2012/13 comprises the following elements:

Buildings excluding Assets under Plant and Transport Information Furniture & Land dw ellings construction Machinery Equipment Technology fittings Total £000 £000 £000 £000 £000 £000 £000 £000 Cost or valuation At 1 April 2012 7,360 46,807 107 17,516 108 4,436 604 76,938 Additions - purchased 0 1,237 632 1,348 5 94 13 3,329 Additions - donated 0 92 0 684 0 0 0 776 Impairments charged to revaluation reserve 0 (625) 0 0 0 0 0 (625) Reclassifications 0 0 (517) 0 0 517 0 0 Revaluation surpluses 38 73 0 0 0 0 0 111 Revaluation - rebasing of current year valuation 0 0 0 (472) 7 (364) 0 (829) At 31 March 2013 7,398 47,584 222 19,076 120 4,683 617 79,700

Accumulated depreciation At 1 April 2012 0 539 0 9,847 59 3,416 212 14,073 Provided during the year 38 1,931 0 1,440 17 526 59 4,011 Impairments recognised in operating expenses 0 650 0 0 0 0 0 650 Reversal of impairments 0 (9) 0 0 0 0 0 (9) Revaluation - rebasing of current year valuation 0 0 0 (472) 7 (364) 0 (829) At 31 March 2013 38 3,111 0 10,815 83 3,578 271 17,896

Net book value - Owned 3,560 40,394 222 5,812 6 1,098 320 51,412 - Under finance lease 3,800 0 0 0 0 0 0 3,800 - Donated 0 4,079 0 2,449 31 7 26 6,592 Total at 31 March 2013 7,360 44,473 222 8,261 37 1,105 346 61,804

Net book value - Owned 3,560 42,069 107 5,540 2 909 360 52,547 - Under finance lease 3,800 0 0 0 0 0 0 3,800 - Donated 0 4,199 0 2,129 47 111 32 6,518 Total at 1 April 2012 7,360 46,268 107 7,669 49 1,020 392 62,865

The depreciation charged on assets held under finance leases for 2012/13 was £38,000 (2011/12- £41,000).

12.3 Analysis of property, plant and equipment at 31 March 2013 Buildings excluding Assets under Plant and Transport Information Furniture & Land dw ellings construction Machinery Equipment Technology fittings Total £000 £000 £000 £000 £000 £000 £000 £000 Net book value Protected assets 6,827 43,805 0 0 0 0 0 50,632 Unprotected assets 533 668 222 8,261 37 1,105 346 11,172 Total at 31 March 2013 7,360 44,473 222 8,261 37 1,105 346 61,804

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13 Inventories

13.1 Inventories analysis 31 March 2013 31 March 2012 £000 £000

Drugs 552 483 Consumables 1,288 1,422

1,840 1,905

13.2 Inventories recognised in expenses 31 March 2013 31 March 2012 £000 £000

Inventories recognised in expenses 18,268 16,222

14 Trade and other receivables

14.1 Analysis of trade and other receivables

31 March 2013 31 March 2012 £000 £000 Current NHS receivables 6,210 4,946 Other receivables with related parties 240 518 Provision for impaired receivables (633) (774) Prepayments 1,043 671 Accrued income 1,479 1,399 PDC dividend receivable 36 0 VAT receivable 372 264 Other receivables 1,066 1,199

Total current trade and other receivables 9,813 8,223

Non-current NHS receivables 0 0

The majority of trade is with Primary Care Trusts as commissioners for NHS patient care services. As Primary Care Trusts are funded by government to buy NHS patient care services, no credit scoring of them is considered necessary.

14.2 Provision for impairment of receivables 2012/13 2011/12 £000 £000

At 1 April 774 679 Increase in provision 410 548 Amounts utilised 0 (93) Unused amounts reversed (551) (360)

At 31 March 633 774

14.3 Analysis of impaired receivables 31 March 2013 31 March 2012 £000 £000 Ageing of impaired receivables 0 to 30 days 19 97 30 to 90 days 48 47 90 to 180 days 152 210 Over 180 days 414 420

633 774

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31 March 2013 31 March 2012 £000 £000 Ageing of non-impaired receivables past their due date 0 to 30 days 804 807 30 to 90 days 298 824 90 to 180 days 57 108 Over 180 days 85 129

1,244 1,868

15 Non-current assets held for sale Property, Plant and Equipment 2012/13 2011/12 £000 £000

Net book value at 1 April 546 546 Assets sold during the year (546) 0

Net book value at 31 March 0 546

Following the acquisition of the Becton property and the subsequent relocation of services, the freehold property at Shirle Hill was no longer required for operational purposes by the Trust. The property was therefore classified as held for sale during 2010/11 and continued to be classified as held for sale during 2011/12. The sale had been delayed but was completed in May 2012.

16 Cash and cash equivalents 2012/13 2011/12 £000 £000

At 1 April 20,125 10,010 Net change in year 4,530 10,115

At 31 March 24,655 20,125

Broken down into: Cash at commercial banks and in hand 120 242 Cash with the Government Banking Service 24,535 19,883

Cash and cash equivalents as in Statement of Financial Position 24,655 20,125

17 Trade and other payables

17.1 Analysis of trade and other payables

31 March 2013 31 March 2012 £000 £000 Current NHS payables 2,263 2,736 Amounts due to related parties 1,373 1,222 Trade payables - capital 608 322 Other trade payables 1,624 1,208 Social Security costs 1,058 967 Other taxes payable 1,077 1,096 Accruals 3,839 2,603 PDC dividend payable 0 15

Total trade and other payables 11,842 10,169

Outstanding pension contributions at 31 March (£'000) 1,373 1,222

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17.2 Early retirements

There are no early retirements included in NHS payables per Note 17.1.

18 Borrowings 31 March 2013 31 March 2012 £000 £000 Current Loan from Foundation Trust Financing Facility 118 0

Non-current Loan from Foundation Trust Financing Facility 4,860 4,979 Obligations under finance leases 3 2

4,863 4,981

A loan facility of £8 million was arranged with the Foundation Trust Financing Facility in 2009/10 to fund a new mental health services development. £1 million was drawn down in 2009/10 and a further £4 million has been drawn down in 2011/12. The loan repayment terms were renegotiated prior to the second drawdown and the remainder of the loan is now repayable over 20 years, commencing in January 2014, in six monthly instalments. Previously the loan was repayable over 25 years commencing in July 2011 in six monthly instalments.

19 Prudential borrowing limit

The Trust is required to comply and remain within a prudential borrowing limit (PBL). This is made up of two elements - the maximum cumulative amount of long-term borrowing. This is set by reference to the four ratio tests set out in Monitor's Prudential Borrowing Code for NHS Foundation Trusts . The financial risk rating set under Monitor's Compliance Framework determines one of the ratios and therefore can impact on the long term borrowing limit. - the amount of any working capital facility approved by Monitor.

Further information on the Prudential Borrowing Code for NHS Foundation Trusts and Compliance Framework can be found on the website of Monitor, the Independent Regulator for NHS Foundation Trusts.

Details of the Trust's prudential borrowing limit are as follows: 2012/13 2011/12 £000 £000

Long term borrowing limit set by Monitor 33,900 31,300 Working capital facility approved by Monitor 6,500 6,500

Total prudential borrowing limit 40,400 37,800

The Trust has utilised £4,981,000 (2011/12 - £4,981,000) against the long term borrowing limit. There has been no drawdown on the Trust's working capital facility in 2012/13 (2011/12 - £nil). The relevant Monitor ratios are shown below :- Approved Actual PBL Actual ratios PBL ratios ratios 2012/13 2012/13 2011/12 Minimum dividend cover 6.4 >1 6 Minimum interest cover 114 times >3 times 137 times Minimum debt service cover 52 times >2 times 110 times Maximum debt service to revenue 0.14% <2.5% 0.07%

This means that the Trust is able to meet its dividend payment on its Public Dividend Capital 6.4 times from the surplus that was generated in the year and that its interest and debt service covers from the surplus generated were 114 times and 52 times respectively at 31 March 2013. The maximum payments to service the debt and repay capital were 0.14% of revenue for the year ended 31 March 2013.

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20 Provisions for liabilities and charges

20.1 Provisions for liabilities and charges as at 31 March 2012 comprise the following elements:

Current Non-current 31 March 2013 31 March 2012 31 March 2013 31 March 2012 £000 £000 £000 £000

Pensions relating to former staff 1 1 6 6 Legal claims 61 33 0 0 Continuing care 0 0 0 0 Redundancy 55 407 0 0 Other 16 16 676 647

Total 133 457 682 653

20.2 Analysis of provisions for liabilities and charges

Pensions - former staff Legal claims Redundancy Other Total £000 £000 £000 £000 £000

At 1 April 2012 7 33 407 663 1,110 Change in discount rate 0 0 0 (27) (27) Arising during the period 1 38 55 62 156 Utilised during the period (1) (3) (284) (16) (304) Reversed unused 0 (7) (123) 0 (130) Unwinding of discount 0 0 0 10 10

At 31 March 2013 7 61 55 692 815

Expected timing of cashflows:

Not later than one year 1 61 55 16 133 Later than one year and not later than five years 3 0 0 362 365 Later than five years 3 0 0 314 317

Total 7 61 55 692 815

The provision for legal claims is in respect of employer's liability and public liability cases made against the Trust. This figure is based on information provided by the NHS Litigation Authority which at present represents the Trust's best assessment of the likely future costs associated with processing the claims. The eventual settlement costs and legal expenses may be higher or lower than that provided.

Other provisions include £391,000 (2011/12: £363,000) in respect of injury benefit cases. The provision has been calculated based on information provided by the NHS Business Services Authority - Pensions Division. There are uncertainties surrounding these provisions as the amounts incorporate assumptions made concerning the life expectancy of the individuals. The remaining £300,000 (2011/12: £300,000) within other provisions relates to anticipated dilapidations costs for short leasehold property currently leased by the Trust.

£3,046,000 is included in the provisions of the NHS Litigation Authority at 31 March 2013 (£4,013,000 as at 31 March 2012) in respect of clinical negligence liabilities of the Trust.

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21 Other liabilities 31 March 2013 31 March 2012 £000 £000 Current Deferred income 1,382 1,394

Non-current Deferred income 281 295

22 Revaluation reserve Property, plant and equipment

2012/13 2011/12 £000 £000

At 1 April 14,216 12,637 Impairment losses on property, plant and equipment (625) (76) Revaluation gains on property, plant and equipment 111 1,896 Disposal of property, plant and equipment (175) 0 Transfer of excess of depreciation over historic cost (154) (241) depreciation to income and expenditure reserve

At 31 March 13,373 14,216

23 Contingent liabilities 31 March 2013 31 March 2012 £000 £000

Gross and net value of contingent liabilities 33 19

The contingent liabilities relate to personal litigation claims of former staff above the amount included in provisions up to the maximum excess amount for which the Trust is liable.

24 Related party transaction details

Sheffield Children's NHS Foundation Trust is a corporate body established by order of the Secretary of State for Health.

During the year, none of the Board Members or members of the key management staff or parties related to them has undertaken any material individual transactions with Sheffield Children's NHS Foundation Trust. Disclosure relating to the salaries of board members are given in the Annual Report.

Certain members of the Trust's Governor's Council are appointed from key organisations with which the Trust works closely. These governors represent the views of the staff and the organisation with which the Trust works closely. This representation on the Governors' Council provides important perspective from these key organisations on the running of the Trust and is not considered to give rise to any potential conflicts of interest.

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24.1 Related party transactions

The total value of transactions with related parties during the year is: 2012/13 2012/13 Income Expenditure £000 £000

Department of Health 326 0 Other NHS bodies 147,604 13,468 Charitable funds 0 0 Other bodies (including WGA Bodies) 2,181 16,803

150,111 30,271

24.2 Related party balances

The total value of receivables and payables balances held with related parties as at 31 March is: 31 March 2013 31 March 2013 Receivables Payables £000 £000

Department of Health 36 0 Other NHS bodies 7,563 2,700 Charitable funds 0 0 Other bodies (including WGA Bodies) 725 3,508

8,324 6,208

The Department of Health ("the Department") is regarded as a related party. During the year the Trust has had a significant number of material transactions with the Department, and with other entities for which the Department is regarded as the parent Department. These entities include Strategic Health Authorities, Primary Care Trusts, NHS Foundation Trusts, NHS Trusts, the NHS Litigation Authority, the NHS Business Services Authority and the NHS Purchasing and Supply Agency. The main NHS entities are:

Sheffield Primary Care Trust (NHS Sheffield) Barnsley Primary Care Trust Yorkshire and the Humber Strategic Health Authority (NHS RotherhamYorkshire and PCT the Humber) Derbyshire County PCT Doncaster PCT NHS Leicester County Sheffield Teaching Hospitals NHS Foundation Trust

In addition, the Trust has had a number of material transactions with other Government Departments and other central and local Government bodies. Most of these transactions have been with HM Revenue and Customs (including National Insurance Fund), NHS Pension Scheme and Sheffield City Council.

At 31 March 2013 funds to the value of £1,282,000 (31 March 2012 - £1,021,000) were held on trust. There were outstanding expenditure commitments of £1,000,000 at 31 March 2013 (31 March 2012 - none). The responsibility for the management of these funds remains with the Sheffield Hospitals Charitable Trust, a registered charity within whose accounts the transactions are reported.

During the year ended 31 March 2013, the Trust also received revenue and capital funding from the Children's Hospital Charity, a registered charity that exists to support and enhance the work of the Sheffield Children's NHS Foundation Trust and its reputation as a regional centre of excellence for the research, prevention and cure of childhood illnesses. In the year ended 31 March 2013, the charity raised a total of £1,303,000 (year ended 31 March 2012 - £1,389,000). Two members of the Trust's Board are also Trustees of the charity.

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25 Contractual capital commitments 31 March 2013 31 March 2012 £000 £000

Property, plant and equipment 14 85

26 Finance lease obligations 31 March 2013 31 March 2012 £000 £000

Gross lease liabilities 10 10

of which liabilities are due not later than one year 0 0 later than one year and not later than five years 0 0 later than five years 10 10 Finance charges allocated to future periods (7) (8)

Net lease liabilities 3 2

of which liabilities are due not later than one year 0 0 later than one year and not later than five years 0 0 later than five years 3 2

The lease obligation relates to long leasehold land at Becton.

27 Events after the reporting period

On 1 April 2013, assets with a net book value of £291k have been transferred from NHS Sheffield to Sheffield Children's NHS Foundation Trust. This is part of the distribution of assets and functions due to the reorganisation of PCT's in the health economy. This will be recognised in the 2013/14 annual accounts.

28 Financial instruments

Financial risk management

International Financial Reporting Standard 7 ("IFRS 7") requires disclosure of the role that financial instruments have had during the period in creating and changing the risks a body faces in undertaking its activities. Because of the continuing service provider relationship that the Trust has with Primary Care Trusts and the way those Primary Care Trusts are financed, the Trust is not exposed to the degree of financial risk faced by business entities. Also financial instruments play a much more limited role in creating and changing risk than would be typical of listed companies, to which the financial reporting standards mainly apply. The Trust has limited powers to borrow or invest surplus funds and financial assets and liabilities are generated by day-to-day operational activities rather than being held to change risks facing the Trust in undertaking its activities.

The Trust's treasury management operations are carried out by the finance department, within parameters defined formally within the Standing Financial Instructions and policies agreed by the Board of Directors. Trust treasury activity is subject to review by the Trust's internal auditors.

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Currency risk

The Trust is principally a domestic organisation with the great majority of transactions, assets and liabilities being in the UK and sterling based. The Trust has no overseas operations. The Trust therefore has low exposure to currency rate fluctuations.

Credit Risk

Credit risk is the risk of financial loss to the Trust if a customer or counterparty to a financial instrument fails to meet its contractual obligations, and arises principally from the Trust's trade receivables. Because the majority of the Trust's income comes from contracts with other public sector bodies, the Trust has low exposure to

The carrying amount of financial assets represents the maximum credit exposure. Therefore the maximum exposure to credit risk at the reporting date was £8,362,000 (2011/12: £7,288,000), being the total of the carrying amount of financial assets.

With regard to the credit quality of financial assets and impairment losses, the movement in the allowance for impairment in respect of trade receivables during the year is disclosed in note 14.2 and the ageing of non- impaired trade receivables past their due date at 31 March 2013 is disclosed in note 14.3.

Interest Rate Risk

All of the Trust's financial liabilities carry nil or fixed rates of interest. In addition, the only element of the Trust's financial assets that is currently subject to a variable rate is cash held in the Foundation Trust's main bank accounts and in a short term deposit account. The Trust is therefore not exposed to significant risk of fluctuations in interest rates.

Liquidity risk

The Trust's operating costs are incurred under contracts with Primary Care Trusts and other NHS or Government bodies, which are financed from resources voted annually by Parliament. The Trust funds its capital expenditure from cash reserves or loans. All major capital expenditure is supported by detailed financial assessment including the assessment of cash flow requirements and impact on liquidity and any funding is within the Trust's prudential borrowing limit, as set by Monitor. The Trust is not, therefore, exposed to significant liquidity risks.

28.1 Financial assets by category

Loans and Available for receivables sale Total £000 £000 £000

Assets as per Statement of Financial Position NHS trade and other receivables excluding non financial 6,210 0 6,210 assets Non-NHS trade and other receivables excluding non 2,152 0 2,152 financial assets Non current assets held for sale 0 0 0 Cash and cash equivalents 24,655 0 24,655

Total at 31 March 2013 33,017 0 33,017

NHS trade and other receivables excluding non financial 4,724 0 4,724 assets Non-NHS trade and other receivables excluding non 2,564 0 2,564 financial assets Non current assets held for sale 0 546 546 Cash and cash equivalents 20,125 0 20,125

Total at 31 March 2012 27,413 546 27,959

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28.2 Financial liabilities by category

Liabilities at fair value Other through the financial Income liabilities Statement Total £000 £000 £000

Liabilities as per Statement of Financial Position Borrowings 4,978 0 4,978 Obligations under finance leases 3 0 3 NHS trade and other payables excluding non-financial assets 2,263 0 2,263 Non-NHS trade and other payables excluding non-financial 7,444 0 7,444 assets Provisions under contract 759 0 759

Total at 31 March 2013 15,447 0 15,447

Borrowings 4,979 0 4,979 Obligations under finance leases 2 0 2 NHS trade and other payables excluding non-financial assets 2,918 0 2,918 Non-NHS trade and other payables excluding non-financial 5,173 0 5,173 assets Provisions under contract 670 0 670

Total at 31 March 2012 13,742 0 13,742

28.3 Fair value of financial assets and liabilities at 31 March 2013

The fair value of all financial assets and liabilities held by the Trust at 31 March 2013 equates to book value.

29 Losses and Special Payments

There were 20 cases of losses and special payments totalling £36,000 during the year ended 31 March 2013 (37 cases totalling £74,000 during the year ended 31 March 2012). These amounts are reported on an accruals basis.

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Sheffield Children‟s NHS Foundation Trust Western Bank Sheffield S10 2TH

e-mail: [email protected]

telephone: 0114 271 7000