Annual report and accounts 2009/10

Presented to Parliament pursuant to Schedule 7, paragraph 25(4) of the National Health Service Act 2006

Birmingham and Mental Health NHS Foundation Trust Annual Report and Accounts 2009/10

Contents WELCOME 2 OUR STAFF, OUR GREATEST ASSET 36 Welcome to our trust 2 Our workforce profile 36 About our trust 4 Equality and diversity 37 Our mission 4 Staff wellbeing 39 Our services 4 National staff survey 2009 41 An award-winning trust 5 Internal communications 42 In the spotlight 6 Working in a healthy, safe and PATIENT CARE 7 secure environment 42 Developing services and improving Managing violence and aggression 42 patient care 7 MEET THE BOARD 44 Care Quality Commission annual health check 7 Audit committee 47 Patient Environment Action Team Remuneration committee 47 (PEAT) inspections 8 MEET OUR GOVERNORS 48 Improvements following staff or patient input 8 What do governors do? 48 Progress on targets from commissioners 8 Governor constituency map 49 New services for patients 9 Our governors 49 Improvements in patient care information 10 A busy year for our governors 49 Comments and complaints:- FINANCIAL ACCOUNTS 50 How we handle them 10 Going concern 50 Infection prevention and control 11 International Financial Reporting Standards 50 Learning lessons 11 Financial performance 50 Looking to the future 13 Income and expenditure 51 STAKEHOLDER RELATIONS 14 Cash flow 51 Communicating with our stakeholders 14 Overview of capital investment Our membership 14 and asset values 51 Engaging with our community 16 Management costs 51 Consulting with our community about External audit 52 the services we provide 18 Public sector pay policy 52 NON-FINANCIAL REPORTING 20 Looking forward 52 Sustainability and climate change 20 Reducing the cost of fraud in the NHS 52 Regulatory ratings 22 Statement of the chief executive's QUALITY REPORT 25 responsibilities 53 Part 1: Statement of quality from Statement on internal control 54 the chief executive 25 Auditor’s report 58 Part 2: Priorities for improvement 26 Statement of comprehensive income 59 Statements relating to quality 28 Statement of financial position 60 Part 3: Other information 30 Statement of changes in taxpayers’ equity 61 Annex: Statements from Primary Care Statement of cash flows 62 Trusts (PCTs), Local Involvement Networks Remuneration report 63 (LINks) and Overview and Scrutiny Pension benefits 65 Committees (OSCs) 34 Ill health retirements 65

1 Museum and Art Gallery in Chamberlain Square Welcome Welcome to our trust We are pleased to introduce you to our annual report for Birmingham and Solihull Mental Health NHS Foundation Trust for the 12 month period from April 1, 2009 to March 31, 2010. This report represents the work carried out during our first full year as an NHS foundation trust. We were granted foundation trust status on July 1, 2008 by the independent regulator, Monitor.

Throughout the period, we have continued to Furthermore, a number of our staff and services demonstrate our commitment to making sure were recognised this year as our trust won a clutch people with mental health problems receive swift of national and regional awards for its achievements and appropriate treatment in the best possible and excellence. setting to suit their needs. Our estates and facilities team won a prestigious During 2009 our commitment to investing in Health Service Journal award for good corporate services continued as construction work began on citizenship for their energy-saving and recycling the Juniper Centre – a new £17.7m development schemes, while staff at The Bridge project in for our Mental Health for Older People Services Solihull continued their run of success by being division – in , in July. The site, in the named psychiatric team of the year at the Royal grounds of Moseley Hall Hospital, was blessed by College of Psychiatrists Awards. Dr Gráinne eight faith leaders in August, and a topping out Fadden received the Marsh Award for Mental ceremony took place in March. This brand new Health Work from charity Rethink for her facility will be handed over to the trust later this involvement with the Meriden Family Project. year, with staff and service users due to move in by Shortly after BSMHFT celebrated its first birthday the end of 2010. as a foundation trust on July 1, 2009, the Care BSMHFT also secured a new seven-year, multi- Quality Commission (CQC) – which replaced the million pound contract to provide all healthcare Healthcare Commission as a health watchdog – services to inmates and staff at HMP Birmingham, awarded our trust top marks in its annual health in Winson Green. Previously our trust provided check. The CQC, issuing its ratings for the first time, mental health and addiction services under an ranked both the trust’s quality of financial agreement with its commissioners Heart of management and its quality of care as excellent. Birmingham Primary Care Trust. This success is reflection of the continued

2 Solihull High Street (Photo courtesy of Stephen Hogan)

dedication and professionalism of our staff, and communities a voice. Over the next year, we will their determination to provide top quality care. work closely with our 13,500 members, involving The future for our trust will be to build on our them in our work. financially stable base and facilitate the Furthermore, we will do our best to improve our engagement of our governors within the service users' lives through our work with other communities we serve, ensuring our long-term organisations. This means working with people's strategies can be truly responsive to local needs. carers, their families and the wider community to We are determined to continue making help them lead purposeful lives among people who improvements and to demonstrate that we offer accept them - breaking down the barriers of stigma, some of the best mental health care available in which often accompany mental health problems and this country. lead to social isolation. Foundation trust status has given us greater On behalf of the trust board, we would like to flexibility over our finances, service provision and acknowledge and thank our staff for the hard planning, enabling us to build on our solid work, professionalism and dedication they show foundations and develop new and innovative each and every day in delivering modern, high services for the communities we serve. Over the quality and safe services to our service users, carers coming years our plans include investments in and their families. medium secure facilities, developments in older We would also like to thank our service users, people’s services, and the redesign of processes carers, volunteers, community and faith groups, which eliminate waste and errors ultimately partner organisations and stakeholders who have, improving cost effectiveness, quality and safety. and continue to support us with our overall mission However, we must not become complacent and to help people get better by getting better together. acknowledge that the coming years are not without their challenges. Financially there are tough times ahead which will require difficult choices as to how we spend our money and changes to how our services our shaped. We will continue making the bold investments to improve our facilities, making us more efficient and further improving the care we give to our patients, but this will also bring an ever greater need to quickly realise greater efficiencies. We acknowledge that we must work harder to increase our membership base. During 2010/11 we aim to grasp the many opportunities there are to Sue Turner Peter Marquis work with the public, giving those in seldom heard Chief executive Chairman

3 Park Lane Garden Centre volunteer Emma James with gardener Mark Eveleigh and the garden’s silver medal.

About our trust To achieve foundation trust status we had to demonstrate that we are legally constituted, well Our trust was established as Birmingham and governed and financially viable. Solihull Mental Health NHS Foundation Trust on July 1, 2008. This annual report covers 12 month Our mission period from April 1, 2009 to March 31, 2010 for the financial year 2009/2010. Getting better together. That’s our mission We provide a comprehensive mental healthcare statement, pure and simple. service for residents of Birmingham and Solihull, We want to help people get better and create a and to communities in the and service we are all happy to recommend to others. beyond. We serve a culturally and socially-diverse •To support this, our vision is that: population of 1.2 million spread over 172 square People with common mental health problems are miles, have an annual budget of £221 million and a managed effectively within the primary care dedicated workforce of more than 4,000 staff - • system; making this one of the largest and most complex People with complex mental health problems are mental health foundation trusts in the country. swiftly referred to and managed as appropriate by Our catchment population is ethnically diverse and • specialist services in our trust; characterised in places by high levels of deprivation, Focused and co-ordinated activities are low earnings and unemployment. developed to help improve tolerance and These factors create a higher requirement for understanding within neighbourhoods and access to health services and a greater need for communities, and enhance access to excluded innovative ways of engaging people from the most • groups; affected areas. Strategic partnerships (sub-contracting out, if As a foundation trust we have more financial appropriate) are established with non-statutory control over the services we provide, allowing us to sector organisations, community and user-led provide even better services and to involve our local groups to create a continuum of: communities in the bigger healthcare decisions that a) appropriate employment, educational, social we make. and leisure opportunities; It will help us to actively engage our staff in b) appropriate housing (independent and shaping how BSMHFT is run, make sure the views supported). of service users and their carers and families are Our services central to everything we do, and better understand the different needs of our diverse communities to BSMHFT provides a wide range of inpatient, create services more in tune with local needs. community and specialist mental health services for service users from the age of 16 upwards.

4 These services are located within our three therapeutic space to show at the Gardeners’ World divisions; Youth, Addictions, Secure and Complex Live event at Birmingham’s NEC. Care (YASSC); Mental Health Services for Older Their Hazy Days garden was selected from more People (MHSOP), and Adults of Working Age than 1,000 designs to become one of the 22 show (AWA). Together, these services include elements of gardens, and it also won a silver medal from the rehabilitation, crisis and home treatment, assertive Royal Horticultural Society. BSMHFT was also the outreach, early intervention, addictions, day services first mental health trust to exhibit at the prestigious, and mental health wellbeing. We provide our national event. services on a local, regional and national basis, Our innovative substance misuse service The dependent upon client group. Bridge, in Solihull, continued its winning streak – In addition, our trust manages the delivery of the project previously won four prizes including all healthcare services at HMP Birmingham, in Health Service Journal and Guardian Public Service Winson Green, and works closely with the criminal awards in 2008/9 – at the inaugural Royal College justice system. of Psychiatrists Awards in October. Our dedicated, specialist teams work closely with The Bridge Substance Misuse Service, lead by patients, their carers and families to put together a Dr Sanju George, was named Psychiatric Team of plan of care which suits each individual person and the Year for its work in preventing overdoses and offers different types of support including deaths among heroin addicts. community, inpatient, outpatient and day services. Our Solihull inpatient alcohol detox service We have worked, and will continue to work, hard received a special award for its services from to support and improve the mental health of people Solihull Primary Care Trust in October. Judges across our patch through a range of locally based handed the team the Bridging the GAP award for inpatient and community services. We have, and its partnership working between the local continue to develop, close links with partners from community mental health team, inpatients wards, a education, local authorities and voluntary specialist service and the voluntary sector. organisations and work in partnership to provide November was another successful month with integrated health and social care - a real benefit for trust staff scooping two major awards for their work. our service users. Consultant psychiatrist Dr Gráinne Fadden, who leads the Meriden Family Programme, received the An award-winning trust prestigious Marsh Award for Mental Health Work There is no doubt that 2009/10 was a very from charity Rethink. successful year for BSMHFT, with staff across our Dr Fadden and her team have trained more than trust winning awards for innovative and successful 2,700 therapists to work with families in the West approaches to care, sustainability and even Midlands, and a further 1,200 nationally and gardening. internationally. This is the fourth award the Meriden Park Lane Garden Centre in Aston is run as a team have won since 2008. commercial business but it also offers accredited BSMHFT won a prestigious Health Service horticultural training for people who have Journal Award for good corporate citizenship, for its experienced mental health difficulties. In June, a innovative approach to saving energy and its ‘green’ team of green-fingered volunteers worked with agenda, led by Neil Cross, our trust’s energy and garden designer Mark Eveleigh to create a calming, environment manager. Among the innovations that impressed the judges were regular night audits of our sites, part of our aim to reduce the trust’s carbon footprint by 18 per cent by 2015, and our Earthman energy saving campaign to encourage staff to switch off lights and computers before they go home.

Our trust’s team celebrate winning the HSJ award for good corporate citizenship.

5 In the spotlight also by one national newspaper. Key reports Birmingham Mail, Birmingham Post This past financial year has been one of featured in the Daily Telegraph. achievement and change for our trust, much of and which has made local and national headlines. We continued to make the news in October, when As a summary, Birmingham and Solihull Mental BSMHFT’s choir made their debut at Birmingham Health NHS Foundation Trust featured in 24 press Rep theatre on World Mental Health Day to launch and magazine articles. Of these 19 were in local our trust’s new arts and mental health strategy. newspapers, four in specialist press, and one The launch of our RAID service at City Hospital in national news story. December also drew a positive response in the Birmingham Mail. Our stunning Hazy Days display at Gardeners’ This was followed by a two-page Nursing Standard World Live in June generated a two-page spread in spread in the in March. Health Service Journal the Birmingham Post’s Friday magazine, focussing Our success at the on our success and an interview with one volunteer awards, where our trust received the good on how gardening can help boost mental wellbeing. corporate citizenship award, was reported in the Birmingham Mail, The Nursing Standard ran two features, in August followed by a four-page article in Health and Social Care Today and March, about how our trust is leading the way. on how BSMHFT The first was on how the NHS is coping with a rise has become one of the greenest mental health – linked to the recession – in mental health trusts in the country. diagnoses, and singled out our partnership with However the trust’s consultation over the future of JobCentre Plus and its work with MG Rover when the personality disorder service at Main House, in its factory closed. Northfield, was widely reported from December to The second was a double-page spread on our March. These were largely informed by new venture within A&E at City Hospital, in Winson campaigners keen to keep the consultation in the Birmingham Green, where our Rapid Assessment Intervention public eye. Stories appeared in the Mail, Birmingham Mail Extra Birmingham Post. and Discharge service (RAID) was launched in and December. Our involvement in devising new guidance for The board’s approval of the outline business case GPs and health workers to help them recognise for a new medium secure unit in Yardley Green was potential signs of domestic abuse and violence in reported in the Birmingham Mail Extra and female patients was also well reported in the Solihull News. Birmingham Post in August. In September, NHS West Midlands published the findings of an independent inquiry into the care and treatment of Glaister Earle Butler – five years on from the death of Detective Constable Michael Swindells. The publication of Robert Francis QC’s report was reported widely by the local media and

Our trust continued to make the news with its awards, new developments and reports this year. (Photo by Sarah Smith)

6 The Barberry, part of the National Centre for Mental Health: Birmingham Patient care Developing services and improving patient care The performance of our trust is assessed, like other NHS organisations, through a number of national and local methods. Nationally our performance is monitored by the Care Quality Commission, through annual and periodic reviews, service reviews and surveys. In addition, the local performance of our services is Healthcare Commission’s annual health check. monitored and reviewed by our commissioners, This was the first year of the CQC’s annual health which includes primary care trusts, local authorities check, previously conducted by the Healthcare and drug action teams. Commission, which scores NHS organisations on Now we are a foundation trust, our performance is many aspects of their performance including quality also reviewed by Monitor who do this through a of services, cleanliness, safety and patient feedback, compliance framework and the publication of and how well they manage their finances. quarterly governance and mandatory services risk The outcome of the CQC’s rating of our trust ratings. relates to the financial year 2008/9 and further We continue to work in partnership with third party demonstrated our commitment to improving organisations in our geographical boundary, services which make a real difference to the care including the overview and scrutiny committees, and experience of our service users, their carers local involvement networks, and community groups and relatives receive. to ensure they are kept well informed of our This double excellent in both categories is a performance. reflection of the continued dedication and This section relates to the 12-month period of professionalism of our staff, and their determination 2009/10. to provide high quality care. Our staff certainly have much to be proud of. Care Quality Commission annual Our 2008/9 quality of services rating of excellent health check confirmed we were compliant with the CQC’s In October 2009, our trust was rated as excellent assessment framework. for both its quality of care and financial management, under the Care Quality Commission’s (CQC) first annual health check. In 2008/9 we also received an overall rating of excellent in the

7 Our Ardenleigh unit for women and children in .

Patient Environment Action Team view us. We can then improve our services (PEAT) inspections accurately. In July 2009 the trust was rated excellent for Examples of improvements made as a result of the quality of their inpatient environments in an •the mystery shopper exercises include: annual report published by the National Patient Trust sites now all display the patient core Safety Agency. information leaflets in their reception area Of our 23 inpatient sites, 13 scored excellent • (Mystery Shoppers programme 2009); across the three categories – environment, food, Over 50 sites now have welcome display banners and privacy and dignity - with nine earning one or featuring PALS customer care information. more excellent ratings. • (Mystery Shoppers programme 2009); The annual Patient Environment Action Team Improved welcome signage at Deaf Service (PEAT) inspections check NHS hospitals and units (Jasmine) for deaf and hearing visitors (Mystery in with more than 10 inpatient beds. Every • Shoppers - March 2009); unit is assessed against each category, and given a Patient information leaflets displayed in rating of excellent, good, acceptable, poor or community languages at various sites across the unacceptable. trust (Mystery Shoppers – March, May, October This is a significant improvement on last year’s • 2009); PEAT scores, when only one of our sites – Little Closer monitoring of misuse of disabled parking Bromwich - received maximum scores. The 2008 spaces at various sites including Oleaster, results did not include our new Barberry, Oleaster Barberry, Harry Watton, (Mystery and Zinnia centres, which only opened last year. Shoppers – March, May, July, September, Overall 16 of the 23 inpatient units scored • December 2009); excellent in the environment category, with the Improvements to the patient information displayed remaining seven rated as good, compared to on the trust internet site (Mystery Shoppers - acceptable/good scores last year. • December 2009); and New PALSPosters displayed at various sites Improvements following staff or (Mystery Shoppers – March, May, July, October patient input 2009). Mystery Shoppers Progress on targets from Mystery shopping in our trust involves a dedicated commissioners and trained team of users and carers who make In addition to the national targets, we are also unannounced visits to centres, wards and units to required to report to commissioners progress on assess how well we are meeting certain core locally agreed measures to support the standards. The results allow us to see how others implementation of agreed service plans.

8 Specifically as part of the mental health contract New services for patients requirements, commissioners receive a monthly Rapid Assessment Interface and performance report which provides an overview of Discharge (RAID) Service progress on national targets for mental health trusts as well progress against locally agreed indicators. Our trust joined forces with an acute NHS trust to launch a new mental health team, the first of its •Key local indicators include: kind in the country, to assess and treat patients in The provision of community mental health team one of Birmingham’s busiest A&E centres in support covering key services including the early December. intervention service, assertive outreach teams and The Rapid Assessment Interface and Discharge the crisis resolution home treatment teams to (RAID) service will provide a single point of access support the management of new referrals as well to mental health and substance misuse services to as supporting existing caseloads, ensuring all patients over 16, including older adults, at appropriate support and treatment is provided for City Hospital. • service users in line with identified needs. This new service, a joint venture between Preventing/reducing emergency readmissions BSMHFT and Sandwell and West Birmingham within 28 days of discharge - ensuring that on Hospitals NHS Trust, will assess and treat patients discharge from inpatient care, service users are within the hospital – both inpatients and those who provided with the appropriate care attend A&E – to provide a smooth transition from package/community support to minimise the risk acute to specialist care, where needed. of readmission. The trust’s readmission rate for The RAID mental health team will aim to see all 2009/10 of 4.5 per cent remains well below the A&E referrals within an hour, with others – including 10 per cent threshold agreed with inpatients – to be seen within 24 hours. This will • commissioners. become a round the clock service, seven days a Reducing outpatient waiting times for GP week shortly. referrals. The trust has continued to ensure that This project has enabled easy access of mental the majority of services users are seen for their health and substance misuse services, including first appointment following a referral from their older adult, to the busy acute general hospital. It GP within six weeks, significantly below the provides mental health services at the front door of 2009/10 13-week national maximum outpatient the health service and meaningfully addresses the waiting time target. needs of the difficult to reach patients from minority ethnic and gender groups. In addition, as part of the Commissioning for This new team includes nurses, psychiatrists, Quality and Innovation (CQUIN) scheme introduced psychologists and social workers who will also work by the Department of Health, the trust agreed the closely with community service Aquarius. •following local priorities: During the 18-month pilot scheme, they will see Progress and delivery of HONOS Payment by any patient who attends A&E or any inpatient who Results implementation (allocation of GP referrals medical staff believe might have mental health to a care cluster) – 90 per cent target for March issues. 2010 achieved. The Health of the Nation Outcome Scale (HONOS) is a standard measurement tool used by mental health services. This is completed as part of reviewing the needs of individual patients enabling clinicians to allocate referrals to appropriate care pathways and treatment plans. The HONOS process is one that is being taken forward on a • national basis. Reducing length of stay where appropriate for acute inpatients. This is a specific programme of work agreed with Birmingham commissioners to work with our partners to ensure that service users who do not need to be in hospital are appropriately discharged with the relevant support and care package being in place. Good progress has been made in the past year with further plans this year to maintain this approach.

Dr George Georgiou, consultant psychiatrist, at the RAID launch

9 HMP Birmingham contract project introduced new electronic ways to measure In 2009, commissioners, Heart of Birmingham and record how our patients feel we are meeting PCT awarded our trust, in partnership with South their needs, while using our services. Birmingham Community Health, a seven-year multi- Our trust believes in full user and carer million pound contract to provide all primary involvement in the planning of our services. A team healthcare services to prisoners at HMP of staff, led by a service user governor and carer, Birmingham. recently won a mental health leadership challenge The Category B remand prison in Winson Green is organised by the Health Service Journal. They put home to about 1,450 prisoners, all requiring medical their success down to their ability to work in attention – from dealing with addictions or long- partnership as equals. term conditions to common illnesses like ‘flu. Patient Advice and Liaison Service (PALS) Previously BSMHFT had provided mental health Our PALS Customer Care service has operated 24 and addiction services to the prison’s population hours a day throughout the year, and has received under an agreement with its healthcare over 10,000 requests for support, advice and commissioners Heart of Birmingham Primary information. This year was its first year as a 24-hour Care Trust. operation, since the service was transformed, to Improvements in patient care fully meet the needs of patients, staff, users, carers information and the public. PALS was launched in 2002 and is now the Patient experience and involvement country’s leading mental health PALS service. The experience of our patients and carers is It received a transforming services award at the a major priority for the trust. We use multiple Health and Social Care Awards 2009, which was a methods to measure and improve upon the defining moment for the team. Since then they have patient experience. been accepted to join the Mental Health Helplines We have dedicated user involvement staff – and Partnership. we work closely with a wide range of advocacy The team of dedicated PALS officers deal with partners and carers agencies. Our monthly enquiries by freephone, fax, email and text. They networking meetings allow us to share information also take time to visit wards and inpatient facilities and views, keeping user and carer concerns to meet and talk to staff and patients. They paramount. replenish information leaflets and posters while out Our team of dedicated mystery shoppers are all on visits around the trust. service users or carers, by background. They visit To contact PALS call: 0800 953 0045 our sites anonymously to keep a check of our Comments and complaints: standards, and they tell us when services are good, How we handle them not just when things go wrong. We are investing in real time patient feedback and Our trust uses experience gained from dealing with have been successfully involved in a South complaints to improve mental health services within Birmingham pilot scheme. The Share to Care Birmingham and Solihull. We encourage complaints or concerns to be addressed by relevant front line staff, for example, a ward manager or head of department. However, when this is not possible, the complaints department can be contacted. Our complaints department provides information and assistance to service users, their relatives and visitors who wish to complain about the service our trust provides. It also gives help and advice to staff who are involved in the investigation of a complaint. Complaints received by the department are formally acknowledged within three working days. Our aim is to provide a full response as speedily as possible, however if we are unable to provide a response within the agreed timescale, the person is contacted to discuss the delay and to agree a new timescale in which a full response is to be provided. The vast majority (97 per cent) of complaints received by the trust between April 1, 2009 and March 31, 2010 were answered within the agreed timescale. The Learning Lessons and Trend Analysis Group works to ensure that improvements resulting from Sharon Duffy, senior nurse for infection control, demonstrating how to wash your hands properly.

10 Joe Taylor (right), Deaf Link co-ordinator, signing with an interpreter. complaints are implemented and will monitor any The IPC team undertook regular inspections of actions identified. clinical areas and worked closely with matrons and For more information about the complaints estates and facilities staff to ensure standards department or the trust’s complaints procedure relating to cleanliness were regularly monitored and please contact the complaints team@ on Tel: 0121 reported. 301 2000 or e-mail: comms.team bsmhft.nhs.uk Learning lessons Infection prevention and control Ensuring improvements result as a result of Following investment for the Infection Prevention incidents, staff experience and feedback from and Control (IPC) service, identified in the previous service users is a significant element of our clinical year, posts were recruited to and the IPC team has governance processes (how we ensure quality three infection control nurses, a hygiene advisor improvement). and a decontamination officer. In addition, the As a result of reviews undertaken of all serious facilities department now have an in-house rapid incidents recommendations are made for individual response cleaning team. This increased resource services. The trust also reviews these issues across has facilitated continued compliance with the all services to identify areas where learning can hygiene code and the registration requirements of take place across the organisation. the Care Quality Commission. A number of policies have been introduced to The emphasis of hand hygiene at point of •reinforce best practice these include: care has been actively promoted in accordance Dual diagnosis ensuring appropriate training and with National Patient Safety Agency and World pathways are in place for service users with Health Organisation’s five moments of care. • mental health and alcohol issues; There has been active promotion of hand washing • Trust wide bed management; and for staff and visitors and investment in hand Patient falls policy and assessment process. washing facilities. Good practice involving hand hygiene and Changes have been made to existing policies environmental cleanliness played a significant role •and documentation: during the swine flu pandemic in minimising the risk Section 17 – improvements to the S17 of transmission of the virus. The team also provided • leave form; education, information and support to staff in taking • Being open policy; and appropriate precautions to reduce the risk of Serious untoward incident (SUI) policy. infection from swine flu and other infectious conditions. Service user involvement has also been encouraged and members of the team are included in Service User Experience Group meetings.

11 Circles – service user artwork, Phoenix Centre art group.

In other issues policies have been reinforced where were significant shortcomings in Mr Butler’s care, •non compliance has been identified: and that our trust had to improve its assurance Referral management arrangements - to ensure systems to reduce the risk of any recurrence. The referrals to the organisation are appropriately independent inquiry also concluded the sequence of • managed in a timely way; events which resulted in DC Swindells’ death could Warning markers - ensuring flags are used to not have been predicted. • identify significant risks in service user records; The overall conclusion of the external panel Ensuring effective support to service users and mirrored that from our own earlier investigation. Mr • staff when incidents occur; Butler’s situation and condition could, and should, Ensuring effective transfer arrangements are in have been more assertively managed and treated. • place; and NHS West Midlands, who commissioned the Missing patient procedures. independent inquiry’s report in November 2005, was reassured that many action points raised in •Other improvements made have included: recommendations had already been implemented Raising awareness to relevant staff over issues when it was published on September 10, 2009. identified from reviews these include issues such Since 2004, and prior to the publication of • as ensuring concerns are escalated; Mr Francis’s findings, our trust has focused on Improving safeguards to strengthen the security improving services. We produced and progressed • of patient identifiable information; our own internal action plan, which was refreshed in Improving training (particularly in relation to September to take on board further • infection control); recommendations made by the independent inquiry. Improvements identified as a result of a power Our trust agreed a joint action plan with its loss incident to prevent reoccurrence. commissioners Birmingham East and North Independent inquiry into treatment of PCT and Heart of Birmingham tPCT, which are Glaister Earl Butler being followed up and overseen by the PCTs and Monitor. On May 21, 2004, a service user Glaister Earle Changes and improvements have included the Butler – who was under the care of Aston Assertive implementation of standardised methods of Community Outreach Team – stabbed and killed assessing and recording risk across community DC Mick Swindells, a officer. assertive outreach services, a reorganisation of Both an internal investigation and an independent services to ensure the right staff, with the right inquiry, led by Robert Francis QC, were conducted skills, are in the right place at the right time. in order to understand the events that lead up to Better systems for sharing key information this tragic incident and how we could learn from it. with partners have also been devised, while our Both reports drew similar conclusions: That there clinical support and managerial systems which

12 underpin the safe delivery of these services have The Juniper Centre also been overhauled. In 2008/9 our trust opened the Barberry, Oleaster A press conference was held at NHS West and Zinnia centres as part of the National Centre Midlands, following an extraordinary board meeting, for Mental Health: Birmingham. By the end of and subsequently stories appeared in the 2010, the £17.7m Juniper Centre for older people’s Birmingham Mail, Birmingham Post, Daily and the services - currently being built on the Moseley Hall Telegraph, Central with reports also featuring on Hospital site in south Birmingham - will become the News, Midlands Today and various local radio fourth centre to open under this scheme. stations. Coverage of the report’s findings was Work has progressed at a pace since a faith overall balanced and fair. blessing was held at the site in August, and Improvements in how we manage risk staff got their first look at their new workplace The trust has made improvements to further on an exclusive tour prior to a topping off improve feedback to staff on incidents. Over ceremony in March. 12,000 incidents are reported a year across the This purpose-built, specialist centre will bring trust, ensuring that staff can flag up any concerns together acute services and diagnostic facilities or identify issues which could impact on patient for managing physical and mental health issues on safety. the same site, enabling staff to offer patients the Information is now published monthly on the best possible care and support to their carers intranet for any member of staff to be able to and families. review any trends or details of incidents which have Spread over two floors, the new hospital houses arisen in a particular location or time period. three suites – Bergamot, Rosemary and Sage – By openly sharing this information staff are further each with 18 single en-suite rooms. It also has a supported to address concerns and reassured of café, therapy suite, outpatients department, the positive benefits of incident reporting. education suite and a therapeutic garden. Interserve, our contractors and partners in this Looking to the future project, are due to hand over the new building to This year has seen our trust improve and evolve to the trust in November. It is hoped patients and staff provide care, facilities and services fit for purpose in will move in by the end of 2010. the 21st century. Yardley Green Medium Secure Unit BSMHFT will continue to develop and grow its business which will be based on both the strategic Plans to open a 90-bed medium secure unit for objectives and the needs of the communities we men in east Birmingham have progressed since last serve. Wherever possible, our developments will be year, with the trust securing the borrowing flexibility made in partnership and after engagement with our to raise the finance for the building work. service users, carers and members. In March, the board approved the full business We will continue to provide services which are at case for this project, which will be built on the the very forefront of modern mental health care Yardley Green NHS site. Based on current plans, over the coming years, which will include some of the new facility should open during autumn 2012. the following schemes. A series of four community engagement events are planned for summer 2010 to inform local residents and businesses about the development and the career opportunities it will bring to the area.

Simon Parkes, capital development manager for BSMHFT, placing a tile on the roof of the new Juniper Centre.

13 Recent covers of our popular Trust Talk magazine.

Stakeholder relations Communicating with our stakeholders Our trust is a transparent and forward thinking organisation which believes open and trustworthy communication can support the creation of a positive working environment, cement working relationships with external parties, and set the tone for the entire organisation. We recognise that improving communication with Electronic copies are available to download from our stakeholders is key to ensuring effective mental our website. health services which meet the needs of the people BSMHFT website accessing them. Our website was re-launched in April, following a To us good communication is more than a simple radical redesign to make it easier to navigate and exchange of information or messages, we believe it more interactive for visitors. involves attitude and behaviour too. We are The website www.bsmhft.nhs.uk also includes committed to fostering an environment of trust and useful information for patients and carers with openness, and have a number of initiatives which dedicated pages covering everything from latest assist the establishment of effective, robust trust vacancies, how to become a member of the communications. trust, and details on the services we provide. During the past year, we have engaged with a Electronic copies of board papers, minutes and number of stakeholders to understand their board summaries are also available on the website, communication needs and as a result of their for people to read and download. feedback, we have developed a comprehensive Visitors are encouraged to communicate with us three-year communications strategy which was via a two-way email system, while members have approved by our board in March 2008. access to a special members-only area which Trust Talk includes details of our free member seminars. Our magazine Trust Talk is the main way we communicate with our members and service users. Our membership Copies of this popular bi-monthly publication, which In 2009, the trust agreed a strategy to increase celebrates our achievements, are available at all of the number of members to 12,000 by March 31, our sites. A personal copy is also sent to every 2010. However, by that date our trust had recruited member of the trust through the postal service. 13,595 members, meaning we exceeded our

14 projected figure by over 1,500 new members. Members can join the following constituencies depending on where they live: •Recruitment activities to date have included: - Heart of Birmingham • Attending meetings with partner organisations; - Birmingham East and North • Participating in voluntary sector events; - South Birmingham Face to face recruitment in local shopping - Solihull • centres; - Rest of England and Wales. • Publicity on the trust website and intranet; Targeted work with communities perceived As well as joining the trust depending on where • as hard to reach; they live, members are also categorised by their Dedicated members area of the trust interests, members are categorised into the • website; and following groups: Public members, service user Free member seminars on a number of mental members and carer members. Each group of health and trust related topics. members is represented by a governor. Members can join the trust online via the website The free seminars, which have proved very or through filling out a membership form which are popular with our members, covered a wide range of distributed across trust sites and are also given out subjects including tackling stigma associated with widely at events the trust attends. mental health, exploring spirituality in mental health Members can keep in touch with their governor by and recovery and wellbeing. sending messages@ to a dedicated e-mail address However, the focus of the membership strategy contact.governors bsmhft.nhs.uk, calling the has moved away from being merely about the governor liaison office (0121 301 1229), or by growth in number of new members and more on writing to the governor c/o: continuing to engage and involve our current Governor Liaison Office, members, depending on their interests and level BSMHFT, 50 Summer Hill Road, they wish to become involved in the trust. Birmingham, B1 3RB. Being a member of BSMHFT is a great way of challenging the stigma and discrimination that people with mental health difficulties can sometimes face.

Map of membership areas Sutton Four Oaks Handsworth Dorridge Sutton Trinity Wood Longbridge Hockley Heath Sutton New Hall East Northfield Blythe Sutton Vesey Castle Bromwich Aston Brandwood Smith’s Wood Oscott Billesley Kingshurst Soho Fordbridge Erdington Springfield Bickenhill Tyburn Moseley Meriden Elmdon Sheldon Lyndon Washford Heath Quinton Solihull Hodge Hill Shirley East Shirley South Shirley West St Alphege Knowle

IIIII Birmingham East and North PCT IIIII Heart of Birmingham PCT IIIII South Birmingham PCT IIIII Solihull Care Trust PCT

Fig 1: Map of membership areas

15 Table 1: Breakdown of members by constituency 2009/10 Public constituency At year start (April 1) 6,404 New members 1,413 Members leaving (172) At year end (March 31) 7,645 Staff constituency At year start (April 1) 3,845 New members 535 Members leaving (162) At year end (March 31) 4,218 Patient/Carer constituency At year start (April 1) 1,153 New members 391 Members leaving (10) At year end (March 31) 1,534 Total at year end 13,397

Table 2: Breakdown of public members by constituency Birmingham Heart of South Solihull Rest of Total East & North Birmingham Birmingham England & Wales Total At year start April 1, 2009 1297 1360 1490 569 1688 6404 Added 264 278 369 97 405 1413 Deleted 32 18 43 23 56 172 End date total March 31, 2010 1529 1620 1816 643 2037 7645

Engaging with our community health – and becoming a member of our trust. Over two days, they signed up 219 new foundation As our trust serves a culturally diverse population in trust members. various communities across Birmingham and Throughout the year the trust have also appeared Solihull, it is vital that we engage with the people on various television and radio shows to reach we serve. Our community engagement team BME populations, to discuss issues around mental attend numerous events, ranging from recruitment health, tackling its stigma and challenging fairs and workplace seminars, to religious events stereotypes. Appearances were made on Noor TV and carnivals. and BritAsia in October, March and April, and Unity One in three employees at Birmingham-based law FM in October. firm Browne Jacobson signed up to become As a Stonewall Diversity Champion, our trust members of our trust as workplace ambassadors, believes people perform best when they can be following a recent presentation by Lakhvir Rellon, themselves, so the role played by gay, lesbian and director of community engagement. bisexual staff in our organisation was celebrated at Other projects this year included a six-month a special Peak Performance event in November. schools initiative, visiting more than 15 schools. This event, hosted by comedienne Barbara Nice, Lakhvir and her team spoke to Year 10, 11 and was supported by Advantage West Midlands and sixth form students, about mental health issues and the West Midlands Employer Coalition. challenging the stigma around them. These Finally, drama continues to be a successful sessions also promoted active discussions about medium for BSMHFT to get its anti-stigma and working within mental health and the NHS as a awareness messages out to the public. Specialist positive career option. productions such as Unworkable, which focused on Dragons’ Den star, entrepreneur and chef Levi wellbeing in the workplace, have proved popular. Roots visited Reaside in October, as part of the In May 2010, our community engagement team team’s engagement around World Mental Health will officially launch a short film called Revolving Day and Black History Month. He spent a lot of Door, produced in partnership with the Vine time talking to service users and staff, which was magazine and A&E Productions. It explores the appreciated all round. story of Marcus, a young man who develops mental As the recession continued to bite throughout this health difficulties and highlights some the complex year, thousands of people found themselves issues he faces. struggling to find or keep a job in the West Midlands. More than 3,200 jobseekers attended a Events – getting out and about in our Futures recruitment fair at Villa Park, in Aston, in community February. Community engagement staff were there This year has been an exceptionally busy one for to highlight the benefits of working within mental events with celebrations, showcases and launches

16 Comedienne Barbara Nice makes a big noise for mental health during Arts All Over The Place. (Photo by Emma Brady)

17 taking place across our trust. Our first birthday as a foundation trust was on In May, the Zinnia Centre celebrated its first July 1, 2009 but the celebrations took place at a birthday with a special open day, while The Bridge special family fun day staged in the grounds of Substance Misuse Service cemented its partnership Uffculme, in Moseley, in September. Staff divided with charity Welcome, Str8 Up, and a government- into teams to enter a series of sports day style funded initiative - the Drug Intervention Programme races, with various stalls and activities also taking - to form Solihull Integrated Addictions Service place. The event was hailed a success with about (SIAS). 300 people attending. Our events blossomed in June when volunteers This was followed by the trust’s annual general and staff from Park Lane Garden Centre exhibited meeting, held at the Council House, in Birmingham their Hazy Days space at Gardeners’ World Live at city centre, which included workshops, stalls and a the NEC – where they received a silver medal from special members’ seminar by local historian the Royal Horticultural Society. Professor Carl Chinn. Arts All Over The Place, a three week arts festival BSMHFT’s community gospel choir made their organised by the Creatives Network for Arts and debut on stage at the Birmingham Rep Theatre as Health and supported by our trust, celebrated its the trust launched its Arts in Mental Health strategy biggest year to date. More than 1,000 people on World Mental Health Day in October. This flocked to over 40 events staged across strategy was devised to follow in the footsteps of Birmingham and Solihull during the festival. A new the Arts All Over The Place festival to incorporate strand to this was the introduction of events at arts into our recovery and wellbeing service. inpatient units, which were visited by Stagebus and Finally our new RAID service was launched at City Community Vibe drama group. Hospital, in Winson Green, in December attended A special five-a-side football tournament was held by executives from both BSMHFT, Sandwell and at Goals in Star City, Nechells, to highlight the West Birmingham Hospitals NHS Trust, PCTs and important link between sport and mental wellbeing third-sector organisations to see how bringing as part of Men’s Health Week in June. Edgbaston mental health services into an A&E setting would Utd - a team of trust staff, service users and speed up the patient’s journey from an acute volunteers who took part – may not have won the hospital to specialist services. tournament but they received a special judges’ award at the West Midlands Health and Social Care Consulting with our community Awards in May. about the services we provide Further progress on the new £17.7m Juniper Consulting on the future of Main House Centre, our development on the Moseley Hall Main House in Northfield provided residential Hospital site, was celebrated by a host of faith treatment for up to 14 people diagnosed with leaders who came together to bless the site in personality disorder for up to one year. Residential August, before construction began. treatment was provided in a highly structured Celebrity gardener Monty Don visited Park Lane therapeutic community setting and was completely Garden Centre in September to present volunteers voluntary. Individuals may have been prescribed and trainees with certificates for their City and psychotropic medication (for example major Guilds in horticulture, and even got his hands dirty tranquillisers or anti-depressants) and were planting a wellbeing rose at the centre in Aston. expected to come off these, if appropriate, in the first three months of treatment. Each month, residents elected people from the group to work jointly with staff in making decisions about the running of the community, which included the selection of new residents. The service also ran groups which prepared people before they entered the community and supported them when they left. The funding of these services was secured through a national commissioning process which was part of a replication study involving the Henderson Hospital in London and Webb House in Crewe. Trusts participating in the replication study were commissioned to provide these services on a national basis through the National Specialised Commissioning Advisory Group (NSCAG) up until March 31, 2006, after which time funding was devolved on a pro rata basis to each PCT across England. While the trust board recognised the valuable Monty Don planting a wellbeing rose at Park Lane Garden Centre

18 RAID team manager Mike Preece outside City Hospital’s A&E department, where the new service is based. (Photo courtesy of Nursing Standard)

• work done by staff at Main House and the benefits There is a need for a tier 4 service for the West to individual patients, due to the reduction in funded Midlands and that commissioners need to referrals from PCTs the service was incurring a establish a clear strategy and funding model at a significant financial loss. The preliminary view of the regional level. trust board was that it was not justifiable to subsidise Main House from other income streams, In general terms, it was also clear from the and so further options for the future of Main House consultation that there is unanimous support within had to be considered. the trust and beyond for people with personality In conjunction with Birmingham East and North disorders to receive appropriate, targeted care and Primary Care Trust, our trust launched a specialist treatment when required. consultation to gather views and suggestions for The board also noted the commitment from the future of Main House. Both trusts were fully BEN PCT to make the necessary investment in committed to the outcome of the consultation. developing intensive day therapy services (tier 3). The consultation opened on December 18, 2009 The board also welcomed the commitment from the and closed on March 17, 2010. A total of 98 PCT to seek to co-ordinate and develop a tier 4 responses were received. commissioning strategy for the West Midlands, Following the end of the consultation on the whilst also recognising that the preferred model trust’s tier 4 residential service at Main House, the was unlikely to replicate the Main House service. trust board met on March 23 to consider the Having carefully considered the outcome of the responses and to make a decision on its future. consultation and the commissioning context, it was A report was submitted to the trust board which concluded that the Main House residential service highlighted the following themes that emerged from was no longer financially viable and therefore, with •the responses: regret, should be closed. However, the board An understanding of the position the trust has reaffirmed its commitment to work with its found itself in and about the questions set out in commissioners to develop an alternative tier 4 • the consultation; service model, once a clear strategy and funding Main House offers a unique treatment but it model has been agreed by the PCT. • doesn’t work for everyone; • That staff skills and expertise should not be lost Service provision for people with a personality disorder should be moved to a more community based service (tiers 1-3); and

19 The grounds of one trust site, the Uffculme centre, in Moseley.

Non-financial reporting Sustainability and climate change Our trust is committed to sustainable development, reducing its carbon emissions to minimise its impact on the environment and climate change. Sustainability forms an integral part of the trust’s environmental strategy.

Policies, systems and where appropriate plans, • waste, emissions and expenditure. have been developed and implemented to comply Investing in new buildings, plant, equipment and with legislation and enable delivery of national, (and technology to improve efficiency, and provide the trust’s own) targets with regard to sustainability, • more with less. reducing emissions and the use of resources. Adopting procurement practices which promote A trust-wide Sustainable Development and sustainable development. Consciously specifying, Carbon Management Working Group manages, procuring and recycling materials from monitors and reports progress made by the trust. • sustainable sources. Principles are practiced to promote awareness of Promoting the need to embed sustainability as the trust’s responsibilities and to engage staff, part of the trust’s day-to-day business. service users and carers. Specifically with regard to Awareness training having been provided to more the following, which form part of the NHS Carbon than 2000 staff to date. •Reduction Strategy for England. Raising awareness of the need to manage resources more effectively, reducing consumption,

Waste minimisation Table 3: Waste minimisation Area Non- Non- Financial Financial Area financial data financial data data (£K) data (£K) Year 2008/09 2009/10 2008/09 2009/10 Waste minimisation Total waste 1,230 1,258 Total £172,261 £184,943 and management produced by tonnes tonnes expenditure BSMHFT on waste disposal Waste 61% 70% recycling

20 Figure 2: Waste tonnage disposed of and recycled Waste tonnage disposed of and recycled

s 1500 1,258 e 1,230

n 885 n 1000

o 753 T 500 61% 70% 0 2008/09 2009/10 Financial Years IIII Total waste tonnes IIII Total tonnage recycled

Finite resources AlthoughEne wastergy cons tonnagesumption 200within8/09 BSMHFT and 2009/10 have 35,000 remained similar31,763 between 2008/09 and 2009/10, 30,624 The table and supporting graphs below the30,000 graph demonstrates how the level of waste •demonstrate how: recycling25,000 has increased from 61 per cent to 70 per Gas and electric actual expenditure in 2009/10 cent20,000 thus avoiding unnecessary landfill costs and • decreased from 2008/09 by a total of £147K. helping15,000 to reduce carbon emissions. Gas and electric actual consumption in 2009/10 10,864 10,278 10,000The increase in costs is attributable to the has decreased from 2008/09. Electric usage compliance-led5,000 move to community site based has decreased by 5.5 per cent and despite the clinical0 waste collections and the statutory landfill Gas KWhr Electricity KWhr coldest winter for 30 years gas has seen a 3.6 tax escalator. IIII 2008/09 IIII 2009/10 per cent reduction in usage.

TableEne 4:rg Finitey finan cialresources comparison 2008/09 and 2009/10 £1,200,000 Area Non-financial£1,16 Non-financial8,371 Financial Financial £1,150,000 data data £1,124,621 data (£K) data (£K) £1,096,724 £Year1,100,000 2008/09 2009/10 2008/09 2009/10 £1,050,000 water 138,547£993,457 130,380 water £403,052 £346,376 £1,000,000 Cubic metres Cubic metres electricity£950,000 10,864 10,278 electricity £1,168,371 £1,124,621 £900,000 Mega watts Mega watts Gas £ Electricity £ gas 31,763 IIII 2008/09 IIII 2009/30,62410 gas £1,096,724 £993,457 Mega watts Mega watts

Water financial comparison 2008/09 and 2009/10

410000 £403,052 400000 390000 380000 370000 360000 £346,376 350000 340000 330000 320000 310000 IIII Water cost £

Water consumption comparison 2008/09 and 2009/10

140,000 138,547 138,000

136,000

134,000

132,000 130,380 130,000

128,000

126,000 IIII Water cubic metres

Delayed discharges percentage of occupied bed-days delayed (Monitor)

7%

6%

Our5% Earthman character has been used to help inform staff of the importance of switching off lights and computers, and saving energy. 4%

3% 21 2%

1%

0 1 e n n

o 1500 753 s

T 1,230 1,258 e

n 500 885

n 1000 Waste tonnage disposed of and recycled 61% 70% o 753

T 15000 Waste tonnage disposed of and recycled

s 1,258 500 1,2302008/09 2009/10 e 1500 Financial Years n 885 s 1000 1,230 61%1,258 70% n e IIII Total waste tonnes IIII Total tonnage recycled

o 753

n 0

T 885

n 1000 2008/09 2009/10 Figure 3: Energy consumptionFinancial Ye 2008/9ars The positive performance on energy, waste and

o 500 753 T and 2009/10IIII Total waste tonnes61% IIII Total tonnage recycled 70% water in 2009/10 is primarily due to: 500 • 0 Energy consumption 2008/09 and 2009/10 2008/0961% 2009/10 70% Investment in plant, technology and improvements 35,000 Financial Years 0 31,763 30,624 • to facilities; IIII Tota2008/09l waste tonnes IIII Total tonnage 2009/10 recycled 30,000 Energy consumptionFin a200ncial8/09 Years and 2009/10 The continued drive to minimise energy wastage 235,000 IIII Total waste tonnes IIII Total tonnage recycled 31,763 30,624 • and promote environmental efficiencies; and 2030,000,000 Energy consumption 2008/09 and 2009/10 Energy and water tariffs / procurement reductions. 215,0005,000 35,000 10,864 Priorities and achievements Energy31c,763onsumption 2008/09 and 200910,2/1078 2100,000,000 30,624 35,00030,000 31,763 15,0005,000 30,624 Building on achievements made in previous years, 235,0000,000 10,864 10,278 10,0000 •during 2009/10 the trust has: 25,00020,000 Gas KWhr Electricity KWhr Completed the National Carbon Management 5,000 IIII 2008/09 IIII 2009/10 215,0000,000 Programme for the NHS, being one of the first 0 10,864 10,278 15,00010,000 Gas KWhr Electricity KWhr 10,864 • mental health trusts to do so; IIII 2008/09 IIII 2009/10 10,278 Figure15,0000,000Ene 4:rgy Energyfinancial financialcomparis oncomparison 2008/09 an d 2009/10 Developed a range of tools and material to £1,200,000 on5,000 2008/90 and 2009/10 £1,168,371 Gas KWhr Electricity KWhr promote its commitment to sustainability and £1,150,000Energy financial comparison 2008/09 and 2009/10 0 IIII 2008/09 IIII 2009/10 £1,124,621 engage staff and service users; and £1,0Ga96,7s KWhr24 Electricity KWhr • £1,200,0001,100,000 IIII 2008/09 IIII 2009/£1,16108,371 Played an active part promoting sustainability in £1,150,000£1,050,000 Energy financial comparison 2008/09 and£1,2009124,621/10 the wider community in collaboration with other £1,096,724£993,457 £1,11,000,00000,000 £1,200,000 organisations from the public, private and Energy financial comparison 2008£/091,168,371 and 2009/10 £1,0£950,000 £1,200,000£1,150,000 voluntary sectors. £993,457 £1,168,371£1,124,621 £1,000,000£900,000 £1,096,724 £1,150,000£1,100,000 Gas £ Electric£it1,y12£ 4,621 The trust’s commitment to sustainability and £950,000 £1,096,724 IIII 2008/09 IIII 2009/10 £1,0£1,150,00000,000 achievements made were recognised nationally £900,000 £993,457 £1,01,000,00050,000 Gas £ Electricity £ when the trust won the Health Service Journal £993IIII 2008/,457 09 IIII 2009/10 £1,000,000£950,000Water financial comparison 2008/09 and 2009/10 award for good corporate citizenship in 410000££900,000950,000 £403,052Gas £ Electricity £ November 2009. Water400000£900,000Wat eConsumptionr financial compariIIII 2008/son09 2008/ IIII 2009/09 a10nd 2009/10 Gas £ Electricity £ The trust recognises that sustainability is not a 390000 Figure410000 5: Water financialIIII 2008/ comparison09 IIII 2009/10 2008/9 and project, and has no end, rather that it is integral to 380000 £403,052 2009/10400000 370000 and impacts on all of its activities, day-to-day 390000Water financial comparison 2008/09 and 2009/10 360000 business and the quality and cost of services. 410000380000Water financial comparison 2008/09£3 46,3and762009/10 350000 £403,052 340000070000 Recognising this, the principal focus for 2010 will 410000 340000 £403,052 390000360000 be reinforcing the need to embed sustainability in 433000000000 £346,376 338000050000 320000390000 the day-to-day planning, management and 334000070000 310000380000 utilisation of resources and promoting its impact on 333000060000 IIII Water cost £ 370000 £346,376 320000350000 the environment. 360000 340000310000 £346,376 350000 This will include: 330000 IIII Water cost £ • 340000Water consumption comparison 2008/09 and 2009/10 320000 The new hospital developments being progressed 330000 140310000,000 on the Moseley Hall and Y 320000 138,547 ardley Green Hospital IIII Water cost £ 138,000310000Water consumption comparison 2008/09 and 2009/10 sites, both of which will achieve a BREEAM 136140,000 IIII Water cost £ rating - a measure used to assess a building’s 138,547 134,000Figure138,000 6: Water consumption comparison Water consumption comparison 2008/09 and 2009/10 environmental impact - of excellent rating and 132,0001362008/9,000 and 2009/10 provide the most energy efficient facilities in 140W,000ater consumption comparison 2008/130,09380 and 2009/10 134,000130,000 138,547 the trust. 140138,000,000 • 132,000128,000 138,547 The positive steps being taken to promote and 136138,000,000 130,380 126,000130,000 encourage staff to consider sustainability in the 134,000136,000 IIII Water cubic metres 128,000 day-to-day planning, management and utilisation 134,000132,000 126,000 130,380 of resources. 132,000130,000 DelayIIIIe Waterd dis cubiccharg meestres130,380 128,000130,000percentage of occupied bed-days delayed (Monitor) Regulatory ratings 126,000128,000 7% DelayIIIIe Waterd dis cubiccharg meestres Since attaining foundation trust status and for the 126,000 6% percentage of occupied bed-days delayed (Monitor) IIII Water cubic metres financial year 2009/10 to date, the trust board has 7%5% confirmed a continuing declaration of compliance Delayed discharges 4%6% percentage of occupied bed-days delayed (Monitor) with the Trusts Terms of Authorisation in line with 5%3% Delayed discharges 7% percentage of occupied bed-days delayed (Monitor) Monitor’s Compliance Framework requirements. For 4%2% 2009/10, as at Quarter 3, Monitor has confirmed a 7%6% 9 9 0 9 9 9 9 9 9 9 0 3%1% 0 green rating for our trust’s governance risk rating 0 0 0 1 0 0 0 0 0 0 1 6%5% 1 ------2%0% - r l

n and for the mandatory services risk rating. t b r v y c p n a 4%5% g u a c e p 9 9 0 9 9 9 9 9 9 9 0 0 o a e e u u J J M 1% F A O 0 0 0 1 0 0 0 0 0 0 1 J

1 For 2009/10, our trust has met all four mental N S D A 3% M - -

4% ------

0% r l n t b r health national indicators and related thresholds as v y c p n a 2% g

3% u a c e p o a e e u u J J M F A O

J specified within the compliance framework. N S D A 1% M 9 9 0 9 9 9 9 9 9 9 0 2% 0 0 0 0 1 0 0 0 0 0 0 1 1 ------9 9 0 9 9 9 9 9 9 9 0 1%0% 0 r

Workfl orce sickness absence rate n t b r 0 0 0 1 0 0 0 0 0 0 1 v y 1 c p n a g u a c - - e - p o a e e u u ------J

2007/08, 2008/09 aJ nd 2009/10 M F

0% r A O J l N S n D t b A r M v y c p n a g u a c e p o a e e u 8% u J J M F A Workforce O sickness absence rate 22 J N S D A M 7% 2007/08, 2008/09 and 2009/10

6%8%

75 A A Table 5: Monitor 2009/10 Compliance Framework: Delivery of national indicators for mental health foundation trusts 2009/10 Indicator Indicator Monitor Quarter 1 Quarter 2 Quarter 3 Quarter 4 2009/10 Number title target YTD 1 Healthcare Full Full Full Full Full Full Standards compliance compliance compliance compliance compliance compliance 2009/10 > 2 CPA 7 day or = 95% 97.7% 97.4% 96.4% 96.4% 97.5% follow up > 3 Delayed or equal 4.4% 4.7% 5.0% 5.5% 4.9% transfers of to 7.5% care (as % of bed-days) <> 4 Admissions or = 90% 98.8% 94.7% 93.8% 98.3% 96.6% via crisis resolution home treatment teams > 5 Maintain level 9.5 10 9* 9* 9* 9* (from of crisis Aug 2009) resolution teams set in 03/06 planning round (maintenance target)

* In agreement with commissioners, the number of crisis resolution home treatment teams has been reduced from 10 to 9 with related activity being maintained.

Our trust is currently rated as excellent by the Care to ensure they are kept well informed of our Quality Commission (CQC) for quality of services performance. based on its 2008/09 assessment framework This section provides an overview of our covering core healthcare standards assessment and performance against key targets. For the purpose compliance against 11 national targets for mental of this report, this section relates to the 12-month health trusts. Based on our continued focus, we period of 2009/10. hope to maintain this rating for 2009/10 although Quality of services this will not be confirmed until autumn 2010. Our 2008/09 quality of services rating of excellent, Established performance management processes confirmed that we were compliant with the CQC’s are in place to ensure continued progress as well assessment framework which covers core as ensuring that areas for improvement are healthcare standards assessment in the following identified, taking targeted action where necessary. seven areas: Developing services and improving • Safety patient care • • Clinical and cost effectiveness The performance of our trust is assessed, like other • Governance NHS organisations, through a number of national • Patient focus and local methods. Nationally our performance is • Accessible and responsive care monitored by the CQC, through annual and periodic • Care environment and amenities reviews, service reviews and surveys. Public health. In addition, the local performance of our services is monitored and reviewed by our commissioners, In addition, mental health trusts were also which includes primary care trusts, local authorities •assessed against 11 key national targets including: and drug action teams. • Experience of patients; Now we are a foundation trust, our performance is Support in the community – provision of a care also reviewed by Monitor who do this through a • co-ordinator; compliance framework and the publication of • Drug misusers sustained in treatment; quarterly governance and mandatory services • Data quality on ethnic group; risk ratings. • Crisis resolution team implementation/access; We continue to work in partnership with third party • Data quality of mental health minimum data set; organisations in our geographical boundary, Core programme approach – seven day follow-up including the overview and scrutiny committees, • post discharge; local involvement networks, and community groups Staff satisfaction;

23 E

£ G £1,150,000 £1,124,621 IIII 2008/09 IIII 2009/10 £1,096,724 £1,100,000

£1,050,000 Water financial comparison 2008/09 and 2009/10 £993,457 £1,000,000 410000 £403,052 •£950,000 400000 Fig 8: Seven day follow-up - percentage of discharges £900,000Minimising delayed transfers of care; 390000 • Gas £ Electricity £ 380000 Seven day follow-up – percentage of discharges Best practice in mentalIIII 2008/ health09 IIII 2009/services10 for people with a learning disability; and 370000100% • 36000098% £346,376 Child and adolescent mental health services – 350000 Water financial comparison 2008/09 and 2009/10 96% access and provision of appropriate services. 34000094% 410000 £403,052 33000092% 400000 32000090% 390000This national assessment process confirmed that 31000088% our380000 trust achieved the required standard of IIII Water cost £ 9 9 9 0 9 9 9 9 9 9 0 86% 0 0 0 0 0 1 0 0 0 0 0 1 performance370000 in 2008/9. We will continue to 1 ------84% - r l n t b 360000 r v y c p n a g u a c e

ensure that these high standards are maintained p a £346,376 o e e u u J J M 350000 F A O J N S D A and improved where appropriate. Water consumpM tion comparison 2008/09 and 2009/10 340000 140,000 Waiting330000 times 138,547 320000 138,000 Our trust has consistently met the national 310000 136Sickness,000 absence outpatient waiting time standardsIIII Water cost £ of no more than 134,000Working on the frontline in mental health services 11 weeks. On average, our service users wait three 132,000can be demanding and requires resilience. The trust weeks for an outpatient appointment, with the vast 130,380 Water consumption comparison 2008/09 and 2009/10 130,000employs a range of measures to support staff in majority (93 per cent) seen within six weeks. 140,000 128,000accessing the right support and guidance when Delayed transfers138,547 of care 138,000 126,000they are unwell to aid their recovery and assist IIII Water cubic metres 136We,000 continue to work hard to reduce the numbers of them in returning to work as quickly as possible. 134,000patients ready for discharge who are delayed by the The management of attendance (sickness absence)

1lack32,000 of suitable accommodation or support. Our policy encouragesDel aymanagersed discharg toes recognise when 130,380 percentage of occupied bed-days delayed (Monitor) 130,000trust works with its partners including social staff may require specific support. Staff are able to 7% 1services28,000 and the independent sector to support and access professional advice and support via our 6% 126,000ensure appropriate, safe and timely discharge. occupational health provider, confidential staff IIII Water cubic metres 5%support and physiotherapy service. We have also Fig 7: Delayed discharges - percentage of occupied bed 4%developed annual health and wellbeing roadshows days delayed 3% Delayed discharges to raise awareness regarding health issues percentage of occupied bed-days delayed (Monitor) 2%among staff. 7% 1% 9 9 0 9 9 9 9 9 9 9 0

It is encouraging that average sickness0 levels 0 0 0 1 0 0 0 0 0 0 1 1 - - 0% ------6% - r

have fallen sincel 2007/8 but that there remains n t b r v y c p n a g u a c e p o a e e u u J J M F A O 5% J N S D A room to M reduce these even further. 4%

3% Figure 9: Workforce sickness absence rate 2007/8, 2008/9 and 2009/10 2% Workforce sickness absence rate 1% 2007/08, 2008/09 and 2009/10 9 9 0 9 9 9 9 9 9 9 0 0 0 0 0 1 0 0 0 0 0 0 1 1 ------0% - 8% r l n t b r v y c p n a g u a c e p o a e e u u J J M F A O 7% J N S D A M 6%

5%

The average number of delayed transfers of care 4% Workforce sickness absence rate each week has2007 fallen/08, 2 0from08/09 39 an din2009 2007/8/10 to 32.6 in 3% 2009/10. This ensures that available inpatient 8% 2% capacity is being used effectively reducing the 7% 1% l t r r v y c p n n g b u c a length of stay for patients who no longer need to p a 0% o e a e u u e

6% J A O J J F M S N D A be in hospital. M 5% However, we have seen a rise recently which will 2007/08 2008/09 2009/10 4% need to be closely monitored. 3% Seven day follow-up 2% Our1% trust strives to meet the national target of l t r r v y c p n n g b u c a p a o e

0% a e u u e

ensuring that all patientsJ are appropriately followed A O J J F M S N D A up within sevenM days of being discharged from hospital. Evidence has2007 /08shown 2008/ that09 this 2009/10 is the time that some patients feel most vulnerable and are more at risk of committing suicide. We have continued to exceed the target set by Monitor of 95 per cent. In 2009/10, 97.6 per cent of patients were followed up with within seven days of discharge, exceeding the Monitor-based national target of 95 per cent.

24 (Photo courtesy of NHS Photo Library) Quality report Part 1: Statement of quality from the chief executive I am proud to present the first full quality account for the trust and the opportunity this gives me to highlight the quality of service provided by the trust. • This report has been produced following Ensuring compliance with our Integrated Care engagement and feedback from service user Record. We have introduced a standard care and carer representatives, local teams and staff record across all services. This ensures core across the organisation. This has included the information is available to relevant teams when •engagement of: service users are transferred and also reinforces • Trust board and senior directors; • a standard common approach for all staff. • Assembly of governors; Piloting new ways to obtain patient feedback • Patient Experience Committee; • through real time feedback. • Carers voice group; and Improving arrangements for joint working and Trust and local Programme Clinical Governance transferring service users across teams. Committees. Over the past year the trust has developed its reporting systems for quality in relation to safety, The results from the national patient survey clinical effectiveness and user experience which highlight a number of areas where the trust have reinforced the focus of our clinical governance achieves scores in the top 20 per cent of arrangements. comparative trusts. These include: • Overall the quality of care experienced by our Provision of talking therapies; • service users particularly reflects the Informing and supporting service users in how to professionalism and commitment from all of our make a complaint; and • staff and this report is a testimony to the work of Being contacted by a community team after everyone within our trust. discharge from hospital. To the best of my knowledge the information Some of the initiatives that have had the most contained in this report, which has been reviewed significant impact on improving quality over the past by the trust board through the year, is accurate. •year have included: Development of the mystery shopper surveys. Feedback from surveys has been issued to relevant areas, which are required to demonstrate Sue Turner that improvements have been made as a result. Chief executive May 2010

25 Part 2: Priorities for improvement Priority areas for improvement identified A description of the areas for improvement in 2009/10 report in 2010/11 A summary of progress against the priorities We have identified the following priorities for identified last year and how these were measured improvement over the coming year: are set out in Part 3.

SAFETY OBJECTIVE: To ensure all staff working in inpatient units have received training in relation to the management and prevention of violence.

Rationale The trust aims to ensure that inpatient environments are safe for service users and staff, where service users are particularly unwell this can present challenges in relation to minimising potentially violent behaviour. Evidence shows that where staff have the appropriate skills such behaviours can be far more effectively managed. Over the past five years many staff in the trust have received effective training, however increasingly this has become more difficult to sustain due to the nature of the training and the demands this has on staff time on the wards. Aims The aim is to refocus training relating to management and prevention of violence to enable this to be provided to more staff across the trust ensuring 95 per cent of all inpatient staff have are up to date with trust training requirements by end of 2010 /11. Current status The trust provides an extensive training programme for staff on the management and prevention of violence. This has led to pressures in staff being able to attend. Plans Training programme reviewed to enable basic requirements to be delivered within shorter and more accessible sessions. Monitoring and Monitoring of compliance will take place as part of the statutory and mandatory reporting training monitoring system through the new staff training database. Leads Director of quality improvement and patient experience.

CLINICAL EFFECTIVENESS OBJECTIVE: To reduce the levels of antipsychotics prescribed to service users with dementia against national benchmark. Rationale Long standing concerns have been expressed over antipsychotics being given for the wrong indication, for prolonged periods, at high doses, and of polyprescribing. Long term treatment with antipsychotics carries a cumulative risk of cognitive decline, falls and other side effects. NICE guidance for dementia (CG 42) was issued in November 2006 and makes explicit recommendations for using antipsychotics only in specific situations for severe non cognitive symptoms. Aims To achieve 10 per cent below average benchmark levels of usage of antipsychotic drugs for service users who are suffering dementia. Current status Trust has been developing new guidelines for prescribing of antipsychotic drugs for service users who are suffering dementia. It is considered that current levels of prescribing could be reduced. Plans Implement revised prescribing guidelines. Ensure guidelines are communicated and followed by medical staff. To introduce regular monitoring of antipsychotics prescribed to service users with dementia. Monitoring and Quarterly monitoring of use to be reviewed and presented to Clinical Governance reporting Committee through the Pharmacological Therapies Committee. Leads Professor Chitra Mohan, associate medical director, Dr Lisa Brownell, chair of the Pharmacological Therapies Committee, Nigel Barnes, director of pharmacy.

26 CLINICAL EFFECTIVENESS OBJECTIVE: To develop the use of outcome measures in all clinical services.

Rationale Unlike acute services the identification of clearly understood outcome measures has always been more difficult in mental health services. Aims To develop a suite of outcome measures to ensure that service outcomes can be clearly demonstrated. Current status The trust has introduced the use of HONOS (outcome measure) scores during the year 2009/10. Use of other outcome measures is limited at present. Plans Complete involvement with Royal College of Psychiatrists for the development of outcome measures in relation to community mental health teams. Identify other outcome measures for all services Monitoring and Use of HONOS scores. Introduce quarterly reporting of identified outcome measures. reporting Leads Medical director.

USER EXPERIENCE OBJECTIVE: To increase patient and carer involvement in the planning of their care and treatment.

Rationale The effective involvement of service users and carers in the development of plans for care and treatment is recognised to be crucial to ensuring benefits. Effective engagement means that service users are more likely to have had the treatment plans explained to them and been offered choices and flexibility to support their needs. As a result compliance and outcomes of these plans are more likely to result in successful outcomes. Aims To demonstrate an improvement in experience of patient and carer involvement in the planning of their care and treatment. Achieving a five per cent improvement in national patient survey score in relation to ‘Your Care Plan’. Current status Patients do not always feel that they have been fully involved in the planning of their care and treatment. This is reflected in the National Patient Survey results which •show: Percentage of service users who say they have been given or offered a written/printed • copy of their care plan in the last year (37 per cent). Percentage of service users who think their views were taken into account when deciding what was in their care plan (46 per cent) (2010 Listening to Patients Survey) The trust has also monitored the level of involvement in the care planning process through a proxy measure of completeness of its Integrated Care Record (ICR). Service user views recorded in ICR inpatients 60 per cent, NAIPS 68 per cent, community 68 per cent (Quarter 3, 2009/10 results) Plans The trust will develop a quality focused audit of its Integrated Care records which will be undertaken quarterly across all teams. The trust will increase the level of formal carer assessments undertaken. The trust will introduce service users and carers into the training programmes for CPA. Monitoring and CPA (Care Programme Approach) care record audit – the trust will monitor and audit reporting the quality of care plans and evidence of user engagement in the process of the development of care plans. •Outcomes will also be monitored through: • Annual patient survey • Real time feedback systems Number of carer assessments completed Leads Medical director, CPA manager.

27 Statements relating to quality Information on the review of services The national clinical audits and national confidential enquiries that Birmingham and Solihull Mental During 2009/10 Birmingham and Solihull Mental Health NHS Foundation Trust participated in during Health NHS Foundation Trust provided and/or 2009/10 are as follows: sub-contracted 17 NHS services. • National Confidential Inquiry into Suicide and Birmingham and Solihull Mental Health NHS Homicide by People with Mental Illness. Foundation Trust has reviewed all the data • POMH (Prescribing Observatory Mental Health): available to them on the quality of care in 17 of prescribing topics in mental health services: these NHS services. - POMH 5c: Benchmarking the prescribing of The income generated by the NHS services high does and combination anti-psychotics on reviewed in 2009/10 represents 100 per cent of adult acute and intensive care wards. the total income generated from the provision of - POMH 2d: Screening for metabolic side effects NHS services by the Birmingham and Solihull of antipsychotic drugs in patients treated by Mental Health NHS Foundation Trust for 2009/10. assertive outreach teams. Information on participation in clinical - POMH 6b: Assessment of side effects of audits and national confidential enquiries depot antipsychotic medication - POMH 1 re-audit: Prescribing high dose and During 2009/10, one national clinical audit and combination anti-psychotics on acute wards one national confidential enquiry covered NHS (No. 43). services that Birmingham and Solihull Mental The national clinical audits and national confidential Health NHS Foundation Trust provides. enquiries that Birmingham and Solihull Mental During 2009/10, Birmingham and Solihull Health NHS Foundation Trust participated in, and Mental Health NHS Foundation Trust participated for which data collection was completed during in 25 per cent of national clinical audits and 100 2009/10, are listed below alongside the number of per cent of national confidential enquiries which it cases submitted to each audit or enquiry as a was eligible to participate in. percentage of the number of registered cases The national clinical audits and national required by the terms of that audit or enquiry. confidential enquiries that Birmingham and Solihull Mental Health NHS Foundation Trust was eligible •to participate in during 2009/10 are as follows: National Confidential Inquiry into Suicide and • Homicide by People with Mental Illness; NAPTAD: Psychological Therapies for Anxiety and Depression; (details of this audit have been • obtained to participate in 2010/11) National Falls and Bone Health Audit; (Details of this audit has been obtained to • participate in 2010/11) POMH: prescribing topics in mental health • services; and RCP Continence Care Audit. Audit Percentage of the number of registered cases required by terms of the audit

POMH 5c: Benchmarking the prescribing of high does and combination anti-psychotics on adult acute and PICU wards 100%

POMH 2d: Screening for metabolic side effects of antipsychotic drugs in patients treated by assertive outreach teams 30% POMH 6b: Assessment of side effects of depot antipsychotic medication 100%

Confidential Inquiry

National Confidential Inquiry into Suicide and Homicide by It has not been possible to People with Mental Illness. obtain this information

28 The reports of five national clinical audits were Information on the use of the reviewed by the provider in 2009/10 and CQUIN framework Birmingham and Solihull Mental Health NHS A proportion of BSMHFT income in 2009/10 was Foundation Trust intends to take the following conditional upon achieving quality improvement and actions to improve the quality of healthcare innovation goals agreed between BSMHFT and •provided: any person or body they entered into a contract, Ready reckoners were given out to Foundation agreement or arrangement with for the provision of Year 1 doctors to put in their BNFs so they can NHS services, through the Commissioning for • easily work out appropriate prescribing levels; Quality and Innovation (CQUIN) payment Posters explaining about combining framework. Further details of the agreed goals for antipsychotics (produced by POMH) are given 2009/10 and for the following 12 month period • to wards; are available on request from Georgina Dean, Pharmacists’ feedback to multi disciplinary team’s director of finance. had an effect as shown by wards where the The total amount of our contract which related to percentage fell, all were visited on a regular basis CQUIN frameworks was £904,023. The actual • by pharmacist; payment received was £866,007 Nationally produced workbook is to be used to educate clinicians about combination and high Information relating to registration with the Care Quality Commission (CQC) and • dose antipsychotics; and Pharmacological Therapies Committee is periodic/special reviews developing a policy on the prescribing of Birmingham and Solihull Mental Health NHS high-dose antipsychotic treatments. Foundation Trust is required to register with the CQC and its current registration status is that it has The reports of over 121 local clinical audits were no conditions on registration reviewed by the provider in 2009/10 and The CQC has not taken enforcement action Birmingham and Solihull Mental Health NHS against BSMHFT during 2009/10. Foundation Trust intends to take the following Birmingham and Solihull Mental Health NHS actions to improve the quality of healthcare Foundation Trust is not subject to periodic review •provided: by the CQC. Actions taken to rationalise elements of the Birmingham and Solihull Mental Health NHS • integrated care record to further improve use; Foundation Trust has not participated in any special Additional training on the use of the ICR to reviews or investigations by the CQC during the • include one-to-one tuition and on-site training; reporting period. To review the current clinical risk Information on the quality of data • assessment tool; Revisions to methods for the use of identity Birmingham and Solihull Mental Health NHS labels to record the service user’s name, Epex Foundation Trust submitted records during and NHS number on the continuation sheets or 2009/10 to the Secondary Uses service for • printing the continuation sheets from Epex; inclusion in the Hospital Episode Statistics which Deliver a programme of training by pharmacy are included in the latest published data. The staff to support good practice in rapid •percentage of records: • tranquillisation; Which included the patient’s valid NHS Number Range of mattresses have been purchased to was: 99.2 per cent for admitted patient care and replace older stock; • • 99.3 per cent for outpatient care. Accountabilities and understanding of Which included the patient’s valid General • accountabilities for bed cleaning reinforced; Practitioner Registration Code was: 99.1 per Compliance with the trust observation guidelines cent for admitted patient care and 98.1 per cent has improved to 100 per cent for FCAMHS and • for outpatient care. • the women’s forensic service; and Birmingham and Solihull Mental Health NHS The frequency, quality and recording of Foundation Trust information quality scores for one-to-one sessions between staff and service 2009/10, assessed using the information users at one non-acute inpatient unit has governance toolkit, were 76 per cent for clinical improved significantly. information assurance, 66 per cent for secondary Information on participation in use assurance, and 66 per cent for corporate clinical research information assurance.

The number of patients receiving NHS services Birmingham and Solihull Mental Health NHS provided or sub-contracted by BSMHFT that were Foundation Trust was not subject to the Payment recruited during that period to participate in by Results clinical coding audit during the reporting research approved by a Research Ethics period by the Audit Commission. Committee was 1,309.

29 Part 3: Other information Overview of quality of care based on produced in ‘pivot table’ format) are made available performance in 2009/10 on the trust intranet and therefore any member of As part of its Quality Report in 2009/10 the trust staff has access to them. identified a number of targets for improvement. The trust has placed significant emphasis over These targets have been reviewed on a quarterly the year on improving the responsiveness to basis by the trust’s Clinical Governance Committee incident reporting systems. This has led to a and reported to the trust board for review. They significant improvement in ensuring that incidents have also been shared with Commissioners. are reported to the risk management office in a timely way and also improving our reporting to the Improving safety National Patient Safety Agency. Over the past year BSMHFT has introduced The trust was assessed against level 2 standards significant improvements across the trust to for Clinical Negligence Scheme for Trusts (CNST) support staff to learn from incidents and encourage and achieved compliance level in four out of the reporting of incidents. five standards. Work has since been undertaken to Data from all incidents is now routinely produced overhaul our monitoring systems for statutory and in a format which allows individual staff and staff mandatory training in order to demonstrate teams to interrogate data for their area of service compliance with all five standards. and look for trends. The reports (which are

Topic Objective Target Outcome Comments

MRSA Maintain zero levels of 0 0 Target achieved bacteriemia MRSA bacteriemia infections. infections.

Dual diagnosis Ensure all community Not achieved - Over the year the trust has reviewed its training teams have core dual arrangements and clinical pathways for supporting dual diagnosis skills. diagnosis. As a result it has developed a clear policy for dual diagnosis and reviewed the training requirements for staff as a result of this. Additional training has been provided and continues into 2010/11 to support the new policy.

Violent assaults Reduce number 450 382 Target achieved sustained by incidents incidents staff per year per year

Absent without Reduce the total 400 441 Not achieved - Incident review has also highlighted that leave / number of occurrences incidents incidents the number of incidents increased in quarter 3. As a absconsion of AWOL. per year per year result actions were taken which have achieved a incidents significant improvement for quarter 4.

Annual level of Maintain levels below The trust has experienced an increase in the number of suicides national average. identified cases of suicides of service users. This has occurred against the current economic climate and it is understood nationally that an increase in suicide rates is recognised. Unfortunately it is not possible to compare trust rates for the year with national benchmark data as there is a two year delay before national data is fully analysed and published.

Never ever In patients suicide 0 0 Target achieved events using non collapsible (as per national rails. Escape from within guidance): the secure perimeter of 0 0 medium or high secure mental health services by patients who are transferred prisoners.

30 • Improving clinical effectiveness Ensuring that the exchange of information Over the past year the trust has achieved a between teams when service users are significant improvement in the use of its Integrated transferred is provided in a format which is Care Record (ICR). This was developed and common to everyone and therefore more easily introduced into the trust to ensure effective record • communicated. keeping and risk histories were maintained. Minimising repetition/duplication of The trust has used the implementation of the information and requests for information made ICR as the key driver for improving quality over • to service users. the past two years. The benefits are multifaceted Focus on ensuring that service users are involved in care planning and are provided with •but include: Incorporation of requirements of national • opportunities to reflect this in the clinical record strategies and best practice including: • Ensuring equitable care across the organisation. - Care Programme Approach (CPA) The ability to audit record keeping in a - NICE guidance consistent way. - Physical health - Suicide prevention.

Topic Objective Target Outcome Comments

Compliance with Achieve target of 75% Achieved Inpatients records consistently over target during the care record compliance in all teams year. documentation with care record CMHT records met the required standard from August documentation. up to year end. See chart.

Completion of Achieve 90% recording 90% 90% Target achieved HoNoS scores of HoNoS scores for all new cases

Level of CBT Demonstrate increase 990 1295 per Increase of 10% activity has been achieved. activity of 10% in activity of contacts month 1295 Average monthly contacts/ month CBT. per month

Topic Objective Target Outcome Comments

Record of Improve reporting of 75% Achieved Compliance for inpatient assessments now above 75%. physical health physical health assessments assessments within (by trust or GP) user record.

31 d e t e l p m o c s d d l e ICR Audit Results for Inpatients and CMHTs t e i

e August 2008 to April 2010 f l p

100 % m o

90 c s

80 d l e i

70 f

60 % ICR Audit Results for Inpatients and CMHTs August 2008 to April 2010 50 100 40 90 30 80 20 70 10 l t t r r r r v v 60 y c c p p n n n g g b b u c c a a p p a o o e e a a e e u u u e e

0 J A A O O J J J M M F F N S S N D D A A 50 M

40 ––––– Acute inpatients ––––– CMHTs 30

This graph shows the improvement in compliance with completion of all components3 of our patient record for acute inpatient and adult

community20 teams (CMHTs) 6 1

Recorded0 levels of CBT activity per month

10 7 l 8 t t r r r r 1 v v y c c p p n n (FBT recn orded in darker blue) g g b b u c c 9 a a p p a o o e e a a e e u u u e e

0 J 6 A A O O J J J M M F 1800 F S N S N 1 D D A A M 2 7 1 8 8 6 1 1 1600 1 TARGET = 990

9 ––––– Acute inpatients ––––– CMHTs 4

1400 9 3 0 1 6 3 3 1200 1 2 0 1 4 7 Re7 corded levels of CBT activity per month

1000 9 8 1

9 (FBT recorded in darker blue) 1 9 0 3 6 3 3 0 5 3 0 800 2 6 8 5 9 0 1 9 2 4 6 7 2 7

1800 1 2 7 1 3 0 1 4 5 9 5 2 2 0 2 6 8 8 600 6 1 1 1 1 1 1 1 1 1 1 1 1 1 1600 1 TARGET = 990 400 9 1400 4 9 200 0 9 9 9 9 9 9 9 9 9 9 9 9 1 1200 3 0 0 0 0 0 0 0 0 0 0 0 512992700276120 3 ------l t r 0 r v y c p n n 2 g b 1 u c a p o a 4 e a e 1000 u u e 7 J A O J J M F 9 N S D A M 1 9 0 3 6 3 5 0 3 3 0 800 2 8 5 9 0 1 9 6 4 2 7 2 7 3 0 1 4 5 9 2 2 5 0 2 6 600 1 1 1 1 1 1 1 1 1 1 1

400 9 9 9 9 9 9 9 9 9 9 9 200 9 0 0 0 0 0 0 0 0 0 0 0 512992700276120 ------l t r r v y

0 c p n n g b u c a p o a e a e u u e J A O J J M F N S D A M

This graph shows the levels of Cognitive Behavioural Therapy (CBT) activity recorded for the year. The target last year (based on performance was 990 sessions per month).

32

Improving service user experience demonstrate that actions have been taken to The mystery shopper initiative has continued address these. throughout the year engaging service users in the The trust has piloted the use of real time feedback systematic review of all services across the trust. systems in a number of units. As a result a decision Where mystery shopper visits have highlighted poor has been taken to expand coverage to all main standards, individual services have been required to service user areas.

Topic Objective Target Outcome Comments

User feedback Increase Level of ‘real Pilots have been completed, time’ feedback from approval given for roll out. service users

Out of hours Use of PALS service 469 calls Achieved Increase has been demonstrated, calls now support outside working hours per month average 569 per month.

Complaints All complaints 94% 97% Target achieved responsiveness responded to within 97% complaints responded to agreed timescales agreed timescales. for whole year.

Performance against key national priorities The trust has met Monitor’s performance and national core standards thresholds for the following four national mental During 2009 /10 there were 11 national priority health indicators that are a part of Monitor’s indicators for mental health set by the Care Quality 2009/10 Compliance Framework requirements for Commission (CQC) which are relevant to the trust. mental health foundation trusts specifically At the time of this report the assessment •including: thresholds of a number of indicators are not known CPA – seven-day follow up post discharge from as they are dependant on final assessment by the • hospital; CQC as a result of the accumulation and • Minimising delayed transfers of care assessment of data from other trusts. Subject to Admissions to inpatient services having access to confirmation the trust believes it has met the • crisis resolution home treatment teams Maintain level of crisis resolution teams set in •requirements of the initial seven indicators below: Access to crisis resolution/home treatment 03/06 planning round (or subsequently contracted with PCT) • services; Care programme approach (CPA) seven-day These targets were met on a quarterly basis for • follow-up; each quarter. • Delayed transfers of care; • Drug users in effective treatment; The trust declared compliant with all 24 national • Ethnic coding data quality; Mental health minimum data set (MHMDS) data core standards. • completeness; and Mental health minimum data set (MHMDS) patterns of care.

The following indicators remain subject to •assessment threshold: Access to healthcare for people with a learning • disability; Child and adolescent mental health services • (CAMHS); • Patient experience; and Staff satisfaction.

33 Annex: Statements from Primary Care Trusts (PCTs), Local Involvement Networks (LINks) and Overview and Scrutiny Committees (OSCs)

Statements were requested from our Lead PCT We have not received any formal response from our commissioner, Local Involvement Network and Local Improvement Network. Overview and Scrutiny committees following circulation Our lead commissioner has provided a response as of draft versions of the Quality Account, prior to its follows below. submission to Monitor. Due to the period of local elections our OSC was not able to provide a formal response.

Corroborating statement from NHS Birmingham East and North (Commissioning PCT)

NHS Birmingham East and North (NHS BEN), in its role as Host Commissioner for the Birmingham PCTs and the Local Authority in respect of services delivered by Birmingham and Solihull Mental Health NHS Foundation Trust (BSMHFT) is pleased to review and to comment about this Quality Account. A key priority of NHS BEN is to ensure high quality safe services for the population it serves and this Quality Account contributes to that. This Quality Account has been presented to and considered by the NHS BEN and BSMHFT Clinical Quality Review Group. This group fulfils a remit of quality assurance and improvement and holds BSMHFT to account for the quality of services delivered. Members of the group review and discuss, without limitation, any issues or concerns relating to the quality and safety of care. They also identify and seek to replicate areas of good practice. The NHS BEN and BSMHFT Clinical Quality Review Group has checked the accuracy of data provided in this Quality Account and confirms that it is consistent with that supplied to and reviewed by the group during the year. On this basis, NHS BEN can confirm that this Quality Account represents a fair reflection of the quality of services provided by BSMHFT. NHS BEN regards the engagement with service users and the public in both service development and in the production of the Quality Accounts as a high priority. In this respect we are pleased to note the engagement and feedback from service user and carer representatives, local teams and staff across BSMHFT. NHS BEN recommends that the Quality Account process for 2010/11 be further developed to become more accessible and informative to users of services and their carers and will work with BSMHFT, through the Clinical Quality Review Group, in order to produce more user-friendly Quality Accounts in the future.

Dr Doug Wulff Medical Director

34 35 A group of staff get a preview of the new Juniper Centre

Our staff, our greatest asset Our workforce profile While the people our trust cares for are at the centre of what we do, delivering top quality care and services for them would be impossible without the dedication and commitment of our highly skilled staff.

We recognise that the delivery of high quality workforce. Our trust continually looks at ways of services is only possible with our dedication and improving staff working lives through leadership, commitment of our highly skilled and motivated support and staff benefits.

Table 6: Workforce profile by staff group and gender (April 1, 2009 - March 31, 2010) Female Male Staff group No. of staff % of staff No. of staff % of staff Total Admin and clerical 524 85% 94 15% 618 Allied health professional 2 50% 2 50% 4 Ancillary 169 73% 62 27% 231 Art therapist 7 87% 1 13% 8 Consultant 40 35% 75 65% 115 Dietician 6 100% 0 0% 6 Drug worker 43 68% 20 32% 63 Estates 0 0% 25 100% 25 Graduate worker 5 100% 0 0% 5 Manager 78 58% 56 42% 134 Medic 85 50% 86 50% 171 Medical technical officer 16 89% 2 11% 18 Nursing assistant 484 71% 200 29% 684 Nurse 975 68% 450 32% 1425 Occupational therapist 80 86% 13 14% 93 Pharmacist 9 64% 5 36% 14 Physiotherapist 14 93% 1 7% 15 Psychologist 207 82% 46 18% 253 Scientist 9 50% 9 50% 18 Senior manager 78 53% 68 47% 146 Support time recovery worker 28 76% 9 24% 37 Technician 17 85% 3 15% 20 Technical instructor 26 49% 27 51% 53 Grand Total 2902 70% 1254 30% 4156

36 Table 7: Workforce profile by ethnicity (April 1, 2009 - March 31, 2010) Trust staff Birmingham Ethnicity profile and Solihull Feb 2010 Population0% 1% 0% White British 54.62% 69.68% Irish 3.95% 3.03%6% Mixed Other White 2.43% 1.45% White and Black Caribbean 1.15% 1.45% 17% White and Black African 0.43% 0.14% White and Asian 0.43% 0.59% 72% Other Mixed 0.34%4% 0.42% Asian or Indian 5.73% 5.05% British Asian Pakistani 2.62% 8.92% Bangladeshi 0.53% 1.78% Other Asian 1.37% 0.89%■ Black or Black Caribbean 9.17% 4.19%■ White Black British Black African 6.52% 0.55%■ Mixed Other Black 0.91% 0.50%■ Asian or British Asian Chinese Chinese 0.29% 0.49%■ Black or Black British Other Ethnic Other Ethnic ■ Chinese Group Group 1.11% 0.57%■ Other Ethnic Group Undefined Not Stated 8.40% - Undefined

Fig 10: Ethnicity of Birmingham and Solihull Fig 11: Ethnicity of trust workforce 0% 1% 0% 1% 0% 8% 6%

17% 17% 59% 72% 4% 10% 5%

■ ■ ■ White ■ White ■ Mixed ■ Mixed ■ Asian or British Asian ■ Asian or British Asian ■ Black or Black British ■ Black or Black British ■ Chinese ■ Chinese ■ Other Ethnic Group ■ Other ethnic group Undefined Undefined

Equality and diversity We are committed to promoting equality of directly or indirectly through applying conditions or 1% opportunity0% for everyone, both in the provision of requirements that cannot be shown to be justified. It services and employment8% of staff. Our trust seeks is our policy to treat all job applicants and to provide services and employment in an employees fairly, regardless of race, gender, environment free from discrimination, which benefits nationality or national origin, marital status, disability, from diversity,17% participation and involvement of staff, sexual orientation, age, trade union membership and 59% service users and their carers. religious belief. We recognise10% that inequalities exist within our Furthermore, we monitor and publish the society and we are fully committed to looking at composition of our workforce and introduce positive 5% ways to remedy this. Our trust will not discriminate action if it appears necessary.

■ ■ White ■ Mixed ■ Asian or British Asian ■ Black or Black British Chinese ■ 37 ■ Other ethnic group Undefined Table 8: Staff in post: Equality and diversity data 2008/09 and 2009/10 Staff in post: Equality and diversity data 2008/09 and 2009/10

Gender 08/09 % 09/10 % Female 2706 69.2% 2785 69.9% Male 1202 30.8% 1198 30.1% Total 3908 100% 3983 100% Age profile < 08/09 % 09/10 % 22 26 0.7% 17 0.4% 22-29 461 11.8% 467 11.8% 30-39 1081 27.7% 1086 27.3% 40-49 1319 33.7% 1327 33.3% 50-59 809 20.7% 864 21.7% 60-65 186 4.8% 172 4.3% 65+ 26 0.6% 50 1.2% Total 3908 100% 3983 100% Disability 08/09 % 09/10 % No 2136 54.7% 2134 53.6% Not Declared 2 0% 1 0% Undefined 1689 43.2% 1750 43.9% Yes 81 2.1% 98 2.5% Grand Total 3908 100% 3983 100%

We have maintained the Employment Service’s Equality steering group disability ‘two ticks’ symbol, which recognises our Our equality steering group is responsible for ongoing commitment to recruit and retain staff with monitoring the progress of the single equality disabilities. As an equal opportunities employer we scheme and ensuring that overall standards, targets celebrate diversity and operate workforce policies and objectives are met. that help us recognise and respond to the individual Equality impact assessment needs of our staff. These policies include making sure we Equality impact assessments are key to ensuring accommodate the needs of disabled staff by the embedding of equality and diversity across all making reasonable adjustments to their jobs and trust activities. Our approach of applying one impact the working environment so they can continue to assessment to all six diversity strands ensure that work effectively and support the delivery of our when ensuring equality for one group we do not services. We also operate recruitment practices that disadvantage another. These are published in ensure we avoid discrimination and promote best summary half yearly. practice. Consultation Leadership The trust has well established arrangements in The chief executive is accountable for the equality place to ensure effective consultation and and diversity agenda, with lead responsibility for engagement with communities, staff, service users monitoring the delivery of the action plan and other stakeholders. We involve key undertaken by the medical director (operational stakeholders and those who are likely to be service delivery issues) and director of affected by proposed policies or service change. organisational development and performance A core part of our communications strategy is to improvement (workforce issues). The directors of engage with service users and staff in all areas of strategic delivery are responsible for ensuring that the work we do. the equality and diversity agenda is delivered in Staff support networks their divisions. There are three staff-led diversity networks. These Single equality scheme are the lesbian, gay, bisexual and transgender We have developed and published our Single (LGBT), disability, and black ethnic minority (BME) Equality Scheme 2008-2011. This is supported by staff networks. The networks meet regularly and a detailed action plan setting out targets, outcomes, are active in supporting individual staff issues and leads and timescales for focussed action across all reviewing trust policies. of the strands of diversity. The plan is an integral Mandatory training component of our annual plan. Our services are provided through our staff, usually

38 through direct contact with the service user or other staff deployment and recruitment is already a member of staff. Given the multicultural feature of our workforce strategy and will help environment within which staff work it is vital each support progress towards achieving that objective member of staff ensures the service they provide is within the actions for 2010/11. sensitive, and responsive to the needs of all individuals. We therefore provide mandatory training Staff wellbeing in equality and diversity for all staff. The wellbeing of our staff is of paramount Equality impact assessment training is available importance to us and, as such, we have various for all managers of services. All training is policies and support services in place to assist them monitored and the data is published on an annual in maintaining a healthy work-life balance. These basis. •include: Monitoring • an occupational health service; flexible working options; The trust is engaged in ongoing work to harness • physiotherapy services; patient and staff demographic data and to ensure • staff support services; this is provided in a meaningful format. See • tax free cycle scheme; workforce statistics on tables 6, 7 and 8. • childcare voucher scheme; and Publication • access to physical therapies service. We annually publish employment monitoring data, consultations, equality impact assessments, single To underline the importance of establishing a good equality scheme and annual reports. work-life balance, our trust also staged a series of Going forward staff wellbeing events during 2009/10 which proved popular and were well attended. These included: Under the NHS Employers – Equality and Diversity • Stress Down Day Partners Programme we have been selected for • Launch of a staff smoking cessation scheme partner status for the period April 1, 2010 to • Family fun day. March 31, 2011. A key focus of work going forward which cuts Organisation-wide cultural change across operational activity and workforce is the need to look at strategies to ensure where possible We are continuing to shape our culture to become the composition of clinical teams reflects the one where continuous service and organisational diversity of service users receiving care. improvement is integral to everything we do. The flexing of our workforce through effective Our Capacity and Capability Unit has been

Verona Reid relaxes as physiotherapy technical instructor Natalie Belle demonstrates massage at our AGM.

39 Staff teams pull together in a three-legged race at our family fun day.

successful in delivering service improvement establishments and work to expand the initiatives, providing internal consultancy and qualifications on offer to include workplace organisational development programmes coaching and team building. consistently across our trust – enabling our staff to We are committed to working in partnership with deliver real changes from ground level upwards. other NHS organisations across Birmingham and Although we are in the early stages of Solihull and, as such, we have a coaching implementing a lean approach, our commitment to collaborative to deliver qualifications in coaching improving our business and clinical practices, and across a number of organisations. adopting processes to eliminate waste, is This will also see the development of a coaching undeterred. We continue to encourage every tracking system and a move towards cross- member of staff to adopt lean principles in their organisational coaching. This project was supported work and we have already seen improvements in in 2009/10 by the Birmingham and Sandwell some areas of our trust – addictions, care records Locality Stakeholder Board. management processes, inpatient and pharmacy Team development services. Our investment in staff development has so far A commitment to learning and development enabled us to deliver a number of programmes During the year, our learning and development resulting in a positive shift in the way our staff work. department has continued to expand its portfolio of These programmes which include team building, programmes available to staff. The joint investments measurement and analysis of improvement and we have with NHS West Midlands and the Learning project management have benefited more than Skills Council have enabled us to deliver more 400 staff of all grades and disciplines. National Vocational Qualifications (NVQs), During the next financial year we will be working particularly in customer service, care, and to support the transformational change programme administration. in our Mental Health Services for Older People Funding has also enabled us to offer basic skills division. programmes in partnership with Bournville College, Team performance developing skills in literacy and numeracy. Measuring team performance is crucial as it allows Management and leadership development us to continue to identify areas of good practice Our continued partnership with De Montfort and the delivery of trust business. Our trust uses University and links with the Institute of Leadership the Aston team performance inventory and team and Management enables us to continue to offer workbook series as a measurement tool in a some of their qualifications to our staff. number of different settings. During the coming months, we will build on the Our future plans for learning and development will success of the programmes offered by these see us move towards fully integrated learning and

40 development function, incorporating both clinical National staff survey 2009 and non-clinical training. Through the annual NHS staff survey our trust Staff engagement strives to understand staff views and work towards We continue to be committed to actively working achieving improvements for our staff. However we with staff, recognising the valuable contribution that remain committed to gaining staff views in a variety they make on a day-to-day basis, and also the of ways including staff networks, forums, team brief innovation they can bring to service design and and our new staff impressions on line survey. improvement. Our trust will build on information gathered from We are also developing a long term People the annual staff survey by asking employees to give Change Plan. This will identify how we continue to specific details regarding some of the issues raised build on our commitment to having a meaningful through the new staff impression survey dialogue with staff, to ensure that they are fully (harassment and bullying, physical violence, health engaged as part of the workforce and have a full and safety training and pressure to attend work opportunity to contribute to our success, in when unwell). providing quality services to service users and This will inform how we address staff issues, both our own staff. on a short and long term basis, while also providing clear targets for measured improvements. Managers will also deliver concise presentations to staff regarding the survey’s results and encouraging staff feedback. While some of the measures we are taking in response to the staff survey will ensure that we engage with staff, we recognise that we need to continue to develop innovative mechanisms to allow all staff to have a voice.

Table 9: Staff survey response rate 2008/09 2009/10 Response rate Trust National average Trust National average Trust deterioration 58% 54% 46% 55% Decrease by 9%

Table 10: Staff survey – Top four ranking scores 2009/10 The table left indicates Top four ranking scores Trust National Trust where we have achieved average change positive results within the F24. Percentage of staff experiencing physical violence Increase trust and how we improved from patients / relatives in last 12 months 14%* 18% of 2% on our position since the KF32. Percentage of staff agreeing that they understand Increase previous survey was their role and where it fits in 51% 45% of 5% conducted. While these KF12. Percentage of staff receiving job-relevant training, results are encouraging, we learning or development in last 12 months 82% 81% No change will continue to strive to KF7. Percentage of staff working in a well structured Increase improve. team environment 44% 41% of 3%

*The lower the score the better

Table 11: Staff survey – Bottom four ranking scores 2009/10 Bottom four ranking scores Trust National Trust average change KF27. Percentage of staff experiencing harassment, Increased bullying or abuse from staff in last 12 months 21%* 16% by 1% KF30. Percentage of staff feeling pressure in last 3 months to attend work when feeling unwell 24%* 19% KF25. Percentage of staff experiencing physical violence No from staff in last 12 months 3%* 2% change KF17. Percentage of staff receiving health and safety Increased training in last 12 months 62% 75% by 1%

*The lower the score the better

41 The results above indicate that we have significant This will ensure we strengthen our position in work to do in addressing our lowest ranking scores those areas within our staff survey results where we within this survey. The issues specifically relating to need to make sustained improvements: harassment, bullying, abuse and physical violence in Communication; promoting an anti-bullying and the workplace are a key focus for us. Through harassment culture; and specifically ensuring staff working with all staff it is hoped we can have more flexibility and freedom to achieve a successfully address these issues. We continue to greater work-life balance and to be able to manage actively promote the role of the harassment and the pressures of continuing to deliver. bullying advisors within the trust to provide confidential advice and support to staff. Internal communications We continue to be committed to actively working Internally our intranet for staff is currently being with staff, recognising the valuable contribution that redesigned and a series of communications they make on a day-to-day basis and also their workshops is also being planned. By enhancing capacity to innovate in the delivery of our services. existing channels and establishing new modes of Through the annual staff survey we strive to contact, such as a central email ‘hotline’, we can actively listen to our staff and work towards ensure our staff are fully engaged and well achieving improvements in the staff experience in informed about key activities and know how to the workplace. Responses from the staff survey influence and provide feedback on strategic continue to inform how we are endeavouring to developments and policies. address staff concerns both on a short and long We regularly update our staff with the latest term basis while also, providing clear targets for information about our trust through regular measured improvements. face-to-face meetings, team briefings, global While some of the measures that we are taking in emails as well as our comprehensive intranet site, response to the staff survey will ensure that we which includes a daily newsfeed. engage with staff, we recognise that we need to continue to develop innovative mechanisms to allow Working in a healthy, safe and all staff to have a voice and to ensure that we act secure environment on their concerns. Our commitment to providing a safe, secure and However we also remain committed to healthy environment for our staff is unwavering. encouraging staff to submit their views about our As part of this commitment, every member of staff organisation and their experience of it in a number receives mandatory training in a number of areas of other ways, such as using staff networks, including health and safety and fire safety. Our forums, team briefings and our new staff specialised health and safety staff make regular impressions survey. assessments proving assurance that all standards As a result we are reviewing our long term of health and safety legislation are adhered to approach to improving staff engagement and plan at all times. to introduce new initiatives to allow all staff to have Occupational health services are provided to all a voice and to help target efforts to improve their staff by an external provider, Team Prevent. overall employment experience. Managing violence and aggression We believe that any incident involving violence and/or abuse is unacceptable and as such, we take prevention and management of these issues extremely seriously. Our trust continues to deliver a programme of measures which are implemented by our local security management specialist who supports any individual who has been affected by such incidents, with a specific emphasis on liaising with the appropriate criminal justice agencies to ensure sanctions are imposed on the aggressor when appropriate. Our local security management specialist is part of the risk management department and is available to provide advice and support to clinical teams, individuals, and in some areas, service users across our trust in relation to tackling violence against staff and reducing the impact of crime on staff and service users.

Julie Cresswell, one of the joint overall winners of our annual Board Challenge event, receives her prize from chief executive Sue Turner.

42 Dragons’ Den star and entrepreneur Levi Roots continued to support our trust during the year.

43 The Uffculme centre in Moseley, a trust site which occasionally hosts trust board meetings.

Meet the board All of the trust’s directors, as listed over the following pages, declare that as far as they are aware, there is no relevant audit information of which the NHS body’s auditors are unaware. Professor Peter Marquis – Chairman Peter was appointed as chairman of the trust in 2007. He has been a non–executive director in the NHS for over 10 years and a member of the trust board since its creation in 2004. Up until his retirement in 2008, Peter was an academic at the University of Birmingham involved in the research and development of materials for joint and tooth replacement. He was appointed as Professor of Biomaterials in 1991 and subsequently became Head of the School of Dentistry and then Dean of Life and Health Sciences, serving as a member of the university senior management team for over four years. Peter holds a BSc (Hons) in Physics and a Doctorate in Materials Science and is a Fellow of the Institute of Materials, Minerals and Mining. Interests: Emeritus Professor, University of Birmingham.

Sue Turner – Chief executive Sue has worked in the NHS for 27 years in a variety of senior management roles, with the past 14 years as chief executive. She has led major service reconfigurations and organisational ‘turnarounds’ initially in London acute hospital services and, more recently, in mental health services across Birmingham and Solihull. A strong advocate of third sector partnerships and service provision, Sue has been a trustee of charitable organisations and facilitated a range of commercial and public sector partnerships. Most recently Sue has been the NHS representative on the steering committee which developed the Government’s New Horizon’s national mental health strategy. With a keen interest in personal and organisational development, Sue continues to coach/mentor staff working within public and independent sectors. Sue holds an honours degree (BSc). Interests: None declared.

44 Frances Allcock – Director of organisational development and performance improvement Frances, who was appointed to her role within the trust in February 2010, was previously director for organisational development and change at the BBC. Frances also has a strong record in the private sector, having worked in various blue chip companies including Cable & Wireless, BT Global Services and PriceWaterhouseCooper. She has a BA (Hons) in history, an MA in management learning, and is a graduate of the Institute of Personnel and Development. Interests: None declared.

Stan Baldwin – Non-executive director Stan, who was appointed as a non-executive director in 2003, has extensive public sector experience including eight years developing community services in Birmingham and senior posts in Cheshire and Worcestershire. Formerly a chief executive of Wyre Forest District Council, Stan also has wide ranging consultancy experience including work with the Audit Commission, the Office of the Deputy Prime Minister, the Regional Office and with Sport England. Previous posts held include chairman of governors Kidderminster College, chair of Birmingham Community Resource and Information Service, and chairman of BSMHFT’s finance committee. He has an MSc in Management, MEd in Adult Education, is a Fellow of the Chartered Institute of Management, and a member of the Institute of Sport, Parks and Leisure. Interests: None declared.

David Boden – Non-executive director David was appointed to the board as a non-executive director in October 2006, after serving as chairman of the PPI Forum for Birmingham and Solihull Mental Health NHS Trust. For the past year he has served as vice chair of the trust, senior independent director and chair of the Mental Health Act committee. At the same time he is CEO of a small family business and an investor and manager of commercial properties. Prior to this he was a management consultant under the DTI Enterprise Initiative, a senior lecturer at Aston University and marketing manager at 3M UK dealing in healthcare products. He is also a serving magistrate and chair, and was once a deputy director of the Samaritans of Solihull. He has a BSc in Chemistry and an MSc in Industrial Administration Interests: Company director (bookmaking and property), magistrate on Bench.

Sukhbinder Singh Heer – Non-executive director Sukhbinder was appointed as a non-executive director in 2007. He is the founder and executive chair of ic2 Capital, a crossborder private equity firm. Prior to this, Sukhbinder was the managing partner of RSM Robson Rhodes, the UK member of RSM – one of the world’s largest accounting and consulting firms. Sukhbinder is a chartered accountant and member of the Institute of Chartered Accountants of England and Wales. He holds a BA Hons in economics and a post-graduate diploma in management, from Harvard University. Interests: ic2 Capital, ic2 Capital (PVT) India, Hadley Industries plc, Whiting Landscape Limited, member of the Chairman’s Circle of the Birmingham Symphony and Town Hall, Governor of the King Edward’s School Foundation in Birmingham.

Stella Layton – Non-executive director Stella was appointed as a non-executive director in September 2007. She is European President of Cookson Precious Metals European Division with a turnover of around ¤200 million, a position she has held since 2001. Cookson Precious Metals is part of the Cookson Group plc, a FTSE registered company. Stella was the first woman to hold the position of chairperson of the British Jewellers’ Association. She is also member of the CBI West Midlands Council, CBI UK Manufacturing Council, CBI Manufacturing Advisory Group. She has an MBA, and in 2005 was awarded the CBI First Women Award for Manufacturing in its inaugural year. She received an honorary degree of Doctor of Science from Cranfield University in June 2006, and was also finalist in the West Midlands’ Business Woman of the Year. She is a guardian of the Birmingham Assay Office and a liveryman of the Worshipful Company of Goldsmiths. Interests: Cookson Metaux Precious Ltd, Cookson Drijfhourt BV, Cookson Precious Metals Ltd Ireland, CPM UK Ltd, CPM Thailand Ltd, Sempsa Joyeria Plateria, SA, CPM Drijhout Holland, Hallmark Healy UK Ltd, Cookson Clal Ltd.

45 Dr Peter Lewis –Medical director Dr Peter Lewis was appointed medical director for Birmingham and Solihull Mental Health NHS Foundation Trust in June 2009. Peter completed his medical training at the University of the West Indies in 1972, then specialised in psychiatry, gaining his FRCP from University of Toronto, in Canada. Peter joined the trust as a consultant psychiatrist in 2001. Prior to that he was a consultant psychiatrist for a mental health trust in north west England, and also had a number of consultant assignments for global organisations including the United Nations and World Health Organisation. Interests: Harriet Tubman House – provision of consultant psychiatric services.

Alison Lord – Non-executive director Alison is the chief executive of Options Group, a provider of residential care and education to young people and adults with autistic spectrum disorders and young people with behavioural, emotional and social difficulties. A qualified accountant, she has 20 years’ experience of financial and operational restructuring and also runs her own consulting company, Allegra Ltd. She is a Fellow of the Chartered Association of Certified Accountants and a member of the Society of Business Recovery Professionals. Interests: Chief executive – Allegra Limited; Chief executive - Options Group.

Chris Tidman – Deputy chief executive/executive director of resources Chris joined BSMHFT as executive director of finance and resources in 2006. Throughout his NHS career, Chris has held a number of directorships and senior management positions within the NHS. Chris has a wealth of experience in leading on PFI finance, capital investment, business planning and contract development. He holds a first class degree in accountancy and is a member of the Chartered Institute of Management Accountants. Interests: None declared.

Denise Wilson – Executive director of quality, improvement and patient experience Denise was appointed to her role with our trust in February 2010, having more than 25 years’ experience in mental health settings. Denise’s previous senior roles include associate director of operations for a large health economy in the north-west, leading a service redesign, reconfiguration and developing a range of new services. Latterly, as deputy director of nursing and director of clinical design, she led work to develop the service and workforce models for a major capital scheme to replace mental health inpatient services across Lancashire. She holds a BSc in nursing studies, a diploma in psychological interventions and is a registered mental nurse. Interests: None declared.

46 The BSMHFT Community Gospel Choir performing at Warwick Arts Centre.

Audit committee The committee meets every six weeks, when at The audit committee’s function is to review least three members of the committee are required integrated governance, risk management and to meet. The director of finance, medical director, internal control across the whole of our executive director of quality, improvement and organisation’s activities (both clinical and non- patient experience will also attend these meetings, clinical) which supports the achievement of our as should appropriate internal and external audit objectives. representatives. Its members are our five non-executive directors: Finally the committee also meets at least once a Stan Baldwin, David Boden, Sukhbinder Singh Heer year in private with the external and internal (chairman), Stella Layton and Alison Lord. auditors.

Remuneration committee performance of the chief executive and the executive directors. •The committee members are: All members of the trust board subscribe to the • The chairman of the committee; Code of Conduct for NHS Managers. Our directors, • The trust chairman; and Four non-executive directors. managers and staff are required to adopt high standards of corporate and personal conduct in The remuneration committee of the NHS trust is a respect of offers of hospitality, declaration of sub-committee of the trust board, which determines interests and prevention of fraud and corruption. the remunerations, allowances and terms of service Policies relating to these matters are available from of the chief executive and those executive directors the director of finance. reporting directly to the chief executive. Our chief executive (appointed April 1, 2003) and In considering the remuneration of senior executive directors were appointed via rigorous executives, the committee considers any guidance nationwide recruitment processes in line with or best practice issued by the Secretary of State for national and local guidance. Health as well as the affordability of any increases. The committee will monitor and evaluate the

47 Governors are a key link with the communities our trust serves. (Photo courtesy of NHS Photo Library)

Meet our governors What do governors do? All NHS foundation trusts must have an assembly of governors to represent members’ interests in the development of their organisation.

Our trust is served by 33 governors across running of the organisation, nor can they inspect its Birmingham and Solihull, comprising of nine from services or overrule decisions made by the board as public constituencies, nine representing service they are not employed by the trust. It is also not an users, five for trust staff and 10 for partner appropriate platform for those who wish to pursue organisations. Each of the four primary care trusts political agendas or represent pressure groups, which make up our trust’s area – Heart of as they must represent their constituency’s range Birmingham, Birmingham East and North, South of views. Birmingham and Solihull – are each have two Governors are expected to maintain regular public and one service user governor seats. See the contact with members within their constituencies, map below for how this is configured. which at a minimum involves briefing them on the Governors are a key link with the communities the outcome of assembly meetings. trust serves, who feedback to the board of directors Members can contact governors through the on issues their constituents feel need addressing Foundation Trust Office@ on 0121 301 1229 or by and ideas for service improvement or development. email to ft.membership bsmhft.nhs.uk. Part of their role is to ensure the views of service Who can become a governor? users, stakeholders and local communities are • taken into account when plans for services are • Anyone who is a member of our trust; being drawn up. They are also ambassadors for the • Candidates must be aged 18 or over; trust who champion initiatives to tackle the stigma They must live within the constituency area they associated with mental illnesses. • wish to represent; and The governors’ relationship with the board of Candidates must fit the profile of the vacancy, so directors is also critical as they also have a strategic only service users can qualify to stand as a role, helping to set priorities for change and service user governor, likewise for carers and improvement. A major responsibility is the • public seats. appointment of the trust’s chairman and non- All vacancies and notice of elections are executive directors, and to approve the appointment published on our website www.bsmhft.nhs.uk. of the chief executive. Governors are not involved in the day-to-day

48 Our governors A busy year for our governors Bishop Dr Joe Aldred - Public: Birmingham East and North It has been a busy and productive year for our trust, Councillor Sue Anderson - Stakeholder and our governors have been involved in some key Darren Cooper - Staff: Nursing developments and events during 2009/10. Carl Foulkes - Stakeholder: West Midlands Police They were consulted during a special assembly of Lawrence Innis - Carer governors meeting on May 27, 2009, for their input MP Lynne Jones - Stakeholder into our annual plan, which sets out what the trust Dr Asaf Khan - Staff: Clinical wants to achieve in the coming year. Vinodrai Mehta - Staff: Other clinical The assembly of governors met four times during Gerry Moynihan - Public: Heart of Birmingham 2009/10 in June, September, December and Sue Nixon - Stakeholder: PCT commissioners March. Renganathan Ramamoorthy - Public: Birmingham East and North Governors were also involved with the Main House Sally Selvey - Staff: Nursing consultation from December 18, 2009 to March 17, Lynda-Jane Smith: Service User - South Birmingham 2010. Faheem Uddin - Service User: Heart of Birmingham The trust is currently looking at how the governors’ Dr Charles Zuckerman - Stakeholder: Local medical committee role within our organisation can be further Peter Lea - Stakeholder: Solihull Metropolitan Borough Council developed, to include new tools such as a scrutiny Khalid Ali - Public: Rest of England and Wales plan. Peter Brown - Service User: Solihull Ann Davis - Stakeholder: University of Birmingham Elsie Genieve Gayle - Service User: Rest of England and Wales Naomi Hawkins - Staff: Non-clinical Kenneth Jeffers - Public: Heart of Birmingham Maureen Johnson - Public: Solihull Ann McKenzie - Carer Jane Morel - Stakeholder: Terrence Higgins Trust Bernadette Murray - Public: South Birmingham Bridie Nugent - Public: South Birmingham John Robinson - Service User: Birmingham East and North Brian Sheppard - Public: Solihull Loris Tapper - Carer Paul Illingworth - Stakeholder: Birmingham City University

Figure 10: Map of governor constituencies

Map of governor constituencies Sutton Four Oaks Handsworth Bartley Green Dorridge Sutton Trinity Wood Longbridge Hockley Heath Sutton New Hall Lozells East Northfield Blythe Sutton Vesey Nechells Kings Norton Castle Bromwich Kingstanding Aston Brandwood Smith’s Wood Oscott Ladywood Billesley Kingshurst Perry Barr Soho Hall Green Fordbridge Erdington Springfield Acocks Green Bickenhill Tyburn Sparkbrook Moseley Meriden Shard End Bordesley Green Kings Heath Elmdon Sheldon Edgbaston Lyndon South Yardley Harborne Olton Washford Heath Quinton Solihull Hodge Hill Weoley Castle Shirley East Stockland Green Selly Oak Shirley South Stechford Bournville Shirley West St Alphege Knowle

IIIII Birmingham East and North PCT IIIII Heart of Birmingham PCT IIIII South Birmingham PCT IIIII Solihull Care Trust PCT

49 Financial accounts Financial performance This section provides a commentary of our trust’s financial performance for financial year 2009/10. It provides an overview of our income, expenditure, cashflows and capital expenditure in the year. We ended the year with an operating surplus of £2.9 million, leading to a financial risk rating of 3 from Monitor. This equates to a score of good for our use of resources. Going concern Financial performance The board of directors considers that the trust has This has been a challenging year for the trust adequate resources to continue in operational particularly in light of the current financial climate existence for the foreseeable future and the and growing pressure on public finances. An accounts have been prepared on a going concern operating surplus of £2.9m was achieved after basis. In reaching this decision the board taking into account impairments of £13m. These considered the short, medium and long term charges relate to the reduction in value of our financial plans of the organisation including both buildings due to the current economic conditions. the cashflows and income and expenditure position. The achieved operating surplus was below the planned surplus of £3.7m. One of the key reasons International Financial Reporting being the impact of the Main House closure and Standards the lost income associated with this. In addition we From April 1, 2009 the trust was required to adopt saw a general increase in our costs across both pay International Financial Reporting Standards (‘IFRS’). and non pay costs in the past few months of the The key difference for the trust is the impact on PFI year. The underlying reasons for this are being reporting. Under IFRS we show the PFI assets on addressed and actions being taken to manage the our balance sheet as our assets with a liability to position going forward. reflect the amounts due to our PFI provider. The The delivery of a surplus over recent years has accounts have therefore been prepared on this been key in delivering our plans and ensuring the basis and the comparatives for 2008/09 have been financial stability of the trust. In 2009/10 this has restated under IFRS to show a direct comparison. included the Juniper Centre development and continued investment in our estate. The surplus has also allowed us to invest in improving the quality of

50 our services and patient experience. In 2009/10 Figure 11: How our total expenditure is split we have invested in a range of developments 4%4% •including: • Strengthening of our clinical audit function; • Pharmacy strategy; • Implementation of an E-rostering solution; and Continued development of the IT infrastructure including remote access for staff. 92% Income and expenditure Table 12: Income and expenditure 2008/9 and 2009/10

2009/10 2008/09 ■ Healthcare activites Restated ■ ■ Education, training and research £000 £000 Other Income from activities 203,959 190,707 Other operating income 18,680 30,418 It can be seen that staffing is our most valuable Total income 222,639 221,125 and expensive resource. However, we also operate Operating expenses (209,269) (205,206) from over 100 sites across Birmingham and Solihull EBITDA 13,370 15,919 meaning premises costs are a major cost driver. Depreciation (4,270) (4,606) Impairments (13,206) (31,176) Cash flow Profit/loss on asset Our trust has reviewed its cash and working capital disposal 57 (1) management with the aim of bringing cash Interest received 112 697 management into2% line5% with the commercial cash Interest payable (3,541) (2,764) management9% arrangements required of foundation Public dividends payable (2,783) (5,123) trusts.3% At the end of the financial year 2009/10 our Surplus /(deficit) (10,261) (27,054) trust has a cash balance of £32.1million and an Operating surplus 2,945 4,122 agreed8% working capital facility of £16 million, Income and expenditure showing that the trust’s liquidity position remains surplus margin 1.3% 1.9% strong. In line with the trust’s 7Treasury3% management EBITDA Margin 6.0% 7.2% policy we invested cash reserves in selected banks * EBITDA – earnings before interest, tax, depreciation in the year to maximise the interest received. and amortisation Overview of capital investment and ■ In the financial year 2009/10, the trust generated asset values ■ Pay income totalling £223 million. A breakdown of this We invested■ D£10.3mepreciati inon improving and imp airmeour assetsnt this income is detailed in the chart below: year. The■ largestClinical scheme supplie wass and the se Moseleyrvices Hall ■ Premises Figure 10: Where our income comes from development where construction started in year, we have spent■ £5.5mServices against from aot hertotal NH plannedS bodies value of Other 4% 4% £17m. Other schemes included improvements to the Reaside site; preparatory work for the Yardley Green site and a range of smaller schemes to improve the environment, ensure compliance with statutory standards and IT infrastructure. Due to the changing economic climate, we have reviewed the value of our entire estate. This has 92% resulted in an adjustment to reduce the value of our buildings by £20 million – a reduction of circa 15 per cent. This exercise ensures that the true value ■ of the trust’s assets are recorded in the balance ■ Healthcare activites sheet and assists in future financial planning. ■ Education, training and research Other Management costs Management costs are defined on the In total 92 per cent of our income comes from management cost website at PCTs for the delivery of healthcare services. We www.dh.gov.uk/PolicyAndGuidance/Organisatio continue to be a major provider of education and nalPolicy/FinanceAndPlanning/NHSManageme training in the West Midlands and so this represents ntCosts/fs/en approximately four per cent of our total income.

51 2% 5% 9%

7

■ The management costs for the year were £12.4 Public sector pay policy million, which represents 5.6 per cent of income. Our trust adopts a Better Payment Practice Code in External audit respect of invoices received from NHS and non- NHS suppliers. The code requires our trust to aim The external auditor is the Audit Commission. In the to pay all undisputed invoices within 30 calendar year fees of £75,000 were paid for statutory audit days of receipt of goods or a valid invoice services. (whichever is the later), unless other payment terms have been agreed. To meet compliance with this target at least 95 per cent of invoices must be paid within 30 days, or within the agreed contract term. Our trust’s performance against the target is summarised in the table below:

Table 13: Performance against payment targets 2008/9 and 2009/10 2009/10 2008/09 Number £000 Number £000 Total NHS invoices paid in the period 794 9,820 910 11,862 Total NHS invoices paid within target 760 9,413 876 11,784 Percentage of NHS invoices paid within target 96% 96% 96% 99% Total non-NHS invoices paid in the period 33,535 52,073 38,400 49,202 Total non-NHS invoices paid within target 30,971 50,368 34,947 47,189 Percentage of non-NHS invoices paid within target 92% 97% 91% 96%

We paid no interest during the year under the Reducing the cost of fraud Late Payment of Commercial Debts (Interest) in the NHS Act 1998. Fraud in the NHS is a drain on the valuable assets Looking forward meant for patient care and costs the health service hundreds of millions of pounds. In 2010/11 we plan to take forward a number of The situation is improving year on year as •developments including: recovery of money, prosecution of offenders and Development of a male medium secure unit on awareness of the issue continue to build. However • the Yardley Green site; a considerable amount of money is still lost through • Implementation of an electronic care record; and patient, practitioner and staff fraud. The NHS Further investment in our IT infrastructure. Counter Fraud Service aims to reduce this to an absolute minimum, and maintain it at that level. We believe that these investments will improve the BSMHFT has in place a team of Local Counter quality of our services and also help to deliver Fraud Specialists (LCFS) who are the first line of efficiencies in the future. However this scale of defence against fraud. investment and of borrowing does mean that we Their role includes raising awareness of the risk of have reduced our flexibility in the short term. The fraud amongst trust staff, reducing the risk of fraud board has made this decision as it believes it is through a programme of proactive work and, in the right for our services and recognises the risks event of a suspicion being raised, conducting formal associated with this. We have developed mitigation investigations. strategies to minimise the impact of these risks. To find out more contact one of the@ trust’s LCFS. Contact: Lorna Barry email LBarry deloitte.co.uk or call 0121 695@ 5157, or David Fletcher email DCFletcher deloitte.co.uk or call 0121 695 5162.

Summary financial statements The annual report includes summary financial statements. A full set of accounts is available on request by contacting:

Georgina Dean, director of finance Finance department B1, 50 Summerhill Road Birmingham B1 3RB

52 Reeds – service user artwork, Phoenix Centre art group.

Statement of the chief executive's responsibilities as the accounting officer of Birmingham and Solihull Mental Health NHS Foundation Trust

• The National Health Service Act 2006 states that state whether applicable accounting standards as the chief executive is the accounting officer of the set out in the NHS foundation trust Financial NHS foundation trust. The relevant responsibilities Reporting Manual have been followed, and of accounting officer, including their responsibility disclose and explain any material departures in for the propriety and regularity of public finances for • the financial statements; and which they are answerable, and for the keeping of prepare the financial statements on a going proper accounts, are set out in the accounting concern basis. officer’s memorandum issued by the Independent Regulator of NHS Foundation Trusts (“Monitor”). The accounting officer is responsible for keeping Under the National Health Service Act 2006, proper accounting records which disclose with Monitor has directed the Birmingham and Solihull reasonable accuracy at any time the financial Mental Health NHS Foundation Trust to prepare for position of the NHS foundation trust and to enable each financial year a statement of accounts in the him/her to ensure that the accounts comply with form and on the basis set out in the Accounts requirements outlined in the above mentioned Act. Direction. The accounts are prepared on an The accounting officer is also responsible for accruals basis and must give a true and fair view of safeguarding the assets of the NHS foundation the state of affairs of Birmingham and Solihull trust and hence for taking reasonable steps for the Mental Health NHS Foundation Trust and of its prevention and detection of fraud and other income and expenditure, total recognised gains and irregularities. losses and cash flows for the financial year. In To the best of my knowledge and belief, I have preparing the accounts, the accounting officer is properly discharged the responsibilities set out in required to comply with the requirements of the Monitor's NHS Foundation Trust Accounting Office NHS foundation trust Financial Reporting Manual Memorandum. •and in particular to: observe the Accounts Direction issued by Monitor, including the relevant accounting and disclosure requirements, and apply suitable Sue Turner • accounting policies on a consistent basis; Chief executive make judgements and estimates on a reasonable basis; Date: May 14, 2010

53 STATEMENT ON INTERNAL CONTROL 2009/10

Birmingham and Solihull Mental Health NHS Foundation Trust

1. Scope of responsibility The medical director has particular responsibility for The board is accountable for internal control. As overseeing the care programme approach, clinical accounting officer, and chief executive of this board, effectiveness, information governance and acts as I have responsibility for maintaining a sound system the Caldicott Guardian. The medical director chairs of internal control that supports the achievement of the Information Governance Steering Group, using the organisation’s policies, aims and objectives, the information governance toolkit to identify and whilst safeguarding the public funds and manage risks around data security and data loss. departmental assets for which I am personally The director quality, improvement and patient responsible, in accordance with the responsibilities experience (director of nursing) has board level assigned to me. I am also responsible for ensuring responsibility for risk management and chairs the that the NHS Foundation Trust is administered Risk Management Committee. She is supported by prudently and economically and that resources are the associate director of governance who has applied efficiently and effectively. I am personally operational responsibility for ensuring that risk responsible as set out in the NHS Foundation Trust management processes are in place across Accounting Officer Memorandum. the trust. The director quality, improvement and patient 2. The purpose of the system of internal experience (director of nursing) also has particular control responsibility for risk management processes around health and safety, infection control, local The system of internal control is designed to security management (NHS SMS), CNST, manage risk to a reasonable level rather than to safeguarding children, safeguarding vulnerable eliminate all risk of failure to achieve policies, aims adults and complaints. and objectives; it can therefore only provide The executive director of resources / deputy chief reasonable and not absolute assurance of executive has responsibility for managing the effectiveness. The system of internal control is development, implementation and management of •based on an ongoing process designed to: financial control and IM&T systems. The trust’s Identify and prioritise the risks to the achievement Finance Committee plays a key role in managing • of the organisation’s policies, aims and objectives, financial risk and in ensuring that resources are Evaluate the likelihood of those risks being deployed economically and effectively. Following the realised and the impact should they be realised, departure of the director of workforce and and to manage them efficiently, effectively and organisational development in October 2009, he economically. also chairs the Performance Management and Improvement Board, ensuring that performance The system of internal control has been in place in across a range of quality and productivity metrics is Birmingham and Solihull Mental Health NHS monitored and delivered, and that action plans are Foundation Trust for the year ended March 31, in place to address any identified weaknesses. 2010 and up to the date of approval of the annual The director of organisational development and report and accounts. performance Improvement has delegated responsibility for managing risks associated with the 3. Capacity to handle risk recruitment, retention, training and development and Leadership arrangements for risk management are remuneration of our workforce. clearly documented in the Risk Management The director of commercial services and asset Strategy approved by trust board, and are further management has overall responsibility for the trust supported by the trust’s business plan objectives estate, plant, waste management, fire safety, and individual job descriptions. environmental management and major incident As accountable officer, I sign the Statement on planning. Internal Control (SIC) on behalf of the board. To Three directors of strategic delivery have discharge this accountability, I delegate risk delegated responsibility for managing operational management responsibilities across my senior risk across their divisions. director team as follows. It should be noted that Clinical directors and the other professional heads executive portfolios changed during the year. have responsibility for the systems of risk The medical director and the director of quality, management at divisional level and lead their improvement and patient experience (director of implementation. nursing) have joint delegated responsibility for The trust’s risk management training policy clinical risk management and clinical governance defines the range of statutory and mandatory risk and jointly chair the Clinical Governance Committee. management training identified for staff based upon

54 a trust wide training needs analysis. Training also tool (likelihood x impact, where 1 is low and 5 high), includes a course for managers to ensure they are supported by agreed assurance level definitions equipped to manage risks appropriate to their level ensures a standard approach is taken to prioritising of responsibility and duties, and are competent to risks. All notified risks are then validated by the fulfil their roles. In addition, there is a range of trust’s risk management team to ensure policies in place to describe staff roles in relation to consistency. All divisional risks rated at 12 or over the identification and management of risk. All are captured on the trust risk register. relevant policies are available on the intranet. The trust has developed a clinical quality Furthermore, all new members of staff are required dashboard approach to systematically focus on to attend a mandatory induction that covers key areas of key clinical risk. The trust’s Clinical elements of risk management. Governance Committee has continued to focus on The trust learns from good practice through a exceptions, trends and lessons learned. This has range of mechanisms including benchmarking, been supported by the appointment of account clinical supervision and reflective practice, individual directors who have the key responsibility to and peer reviews, performance management, investigate serious untoward incidents and to continuing professional development programmes, safeguard the patient experience within the Adults clinical audit and application of evidence-based of Working Age Division. practice and meeting risk management standards. There are robust formal mechanisms for engaging Furthermore, the trust ethos is to systematically with partner organisations, governors, service users review and learn from untoward incidents and and the wider public, ensuring that risks are fully complaints. There is a Learning Lessons Group understood and are embedded into business which reports to the Clinical Governance Committee planning and performance management processes. on actions taken in response to trends and themes. The trust works closely with key stakeholders and Good practice and changes to policies are there are a number of joint structures that already communicated through email, intranet, divisional exist between agencies (e.g. strategic partnership reports, newsletters and team briefs. boards). The trust will endeavour to involve partner There are formal mechanisms in place to ensure organisations in all aspects of risk management. that external changes to best practice, such as Key partners include providers of shared services to those issued by the National Institute for Health the trust, PCTs, other NHS organisations, social and Clinical Excellence, are incorporated into trust care, HMP Birmingham, the police, statutory and policies procedures and clinical guidelines. voluntary bodies and service user and carer groups. The Assurance Framework 2009/10 is developed 4. The risk and control framework via the Strategic Risk Management Committee throughout the year and reported to the board on a The risk management strategy clearly defines the quarterly basis. The key risks are used to inform the leadership and processes required to manage risk trust’s annual planning processes. The assurance and states the important link to the performance Framework provides the board with the required management and business planning systems. assurance that risks to achieving key strategic The trust’s approach to risk is made clear to all objectives are being effectively controlled. staff: that is that risk cannot be eliminated and that The foundation trust is fully compliant with the sometimes risks of a particular intervention need to core Standards for Better Health. be balanced against the risk of doing nothing. It is In response to a number of national issues around also emphasised that a completely risk averse breaches in patient confidentiality, the Information culture can sometimes stifle innovation and service Governance Committee has endorsed a policy to improvement. Therefore, the trust emphasises the mitigate the risks around data security, and data importance of measuring and mitigating risk, rather loss. We had one serious data security incident than seeking to eradicate all risk. The principle of during the year relating to a stolen laptop, which learning lessons is also stressed - it is every staff contained both confidential patient and staff data member’s duty to seek to minimise risk and to on its hard drive. Despite being password controlled, report untoward incidents where they occur in order the laptop had not been encrypted. We have liaised to prevent recurrence. All members of staff are with the Information Commissioner’s Office (ICO) to responsible for managing risks within the scope of ensure we have followed best practice when their role and as part of their responsibilities as contacting those affected. We have also given a employees of the trust, working to professional written undertaking to the ICO with regards to codes of conduct. preventing a re-occurrence and have initiated an The trust board, through the risk management urgent project to encrypt all remaining laptops. policy, promotes open and honest reporting of As an employer with staff entitled to membership incidents, risks and hazards. This is supported by a of the NHS pension scheme, control measures are range of policies that staff are required to in place to ensure all employer obligations comply with. contained within the scheme regulations are Use of a nationally recognised 5 x 5 risk rating

55 complied with. This includes ensuring that controls over ordering, and to support staff in deductions from salary, employer’s contributions and tendering for better value services. During the year, payments in to the scheme are in accordance with we have tendered for a single pathology provider as the scheme rules, and that member pension well as commencing the processes to appoint new scheme records are accurately updated in external audit and payroll providers for 2010/11. accordance with the timescales detailed in the We have also implemented a number of electronic regulations. The trust has also undertaken its own procurement systems to speed up our processes. data cleanse exercise with all staff to ensure Due to the significant spend on bank and agency records are maintained at an optimum level. staffing; we are also rolling out an electronic Control measures are in place to ensure that all rostering system in order to assist our ward the organisation’s obligations under equality, managers in optimising our use of nursing diversity and human rights legislation are complied resources. with. Finally, we have been employing lean thinking The foundation trust has undertaken risk methodology in a number of service improvement assessments and Carbon Reduction Delivery Plans events, with the aim of redesigning processes to are in place in accordance with emergency eliminate waste and errors, improving both cost preparedness and civil contingency requirements, as effectiveness and quality. based on UKCIP 2009 weather projects, to ensure For these reasons, I am satisfied that our systems that this organisation’s obligations under the and processes for ensuring value for money remain Climate Change Act and the adaptation reporting strong. requirements are complied with. 6. Annual Quality Report 5. Review of economy, efficiency and The directors are required under the Health Act effectiveness of the use of resources. 2009 and the National Health Service (Quality As the economic environment within the NHS gets Accounts) Regulations 2010 to prepare Quality more challenging, it will be imperative that we Accounts for each financial year. Monitor has issued continue to focus on value for money. Due to the guidance to NHS foundation trust boards on the continued efforts of all BSMHFT staff during form and content of annual quality reports which 2009/10, he trust delivered a financial risk rating of incorporate the above legal requirements in the 3, which equates to a use of resources rating of NHS Foundation Trust Annual Reporting Manual. good. This would have been a score of 4 Reports relating to quality account metrics have (excellent), would it have not been for the been reported through the trust clinical governance transitional costs of redesign. Despite a challenging processes to the trust board over the past year. 3 per cent year on year savings target, we have The main indicators reflect data which is cascaded again managed to deliver the vast majority of this down from corporate level to individual clinical on a recurring basis. programmes and are therefore subjected to review The Head of Internal Audit opinion given for at team/programme and corporate level. 2009/10 has also given BSMHFT significant Proposals for the Quality Account have been assurance on its core internal control systems, discussed through a range of different groups and including the way in which the trust manages its •committees which include: budgetary control and financial management Trust board and senior directors and informal systems. While we did receive limited audit • discussions assurance on some aspects of our creditor payment • Assembly of governors processes, we have speedily rectified these • Patient experience committee weaknesses and are satisfied that our systems are • Carers voice group robust. Trust and local programme clinical governance The trust’s finance team also began to utilise the committees cost and volume contracting information to produce service line reporting analysis, indicating the relative Proposals for the Quality Account have been productivity of each ward and team against internal developed from a long list of prioritised which have and external benchmarks. This has helped to inform been tested in discussions prioritised as a result. the trust’s strategic planning as well as focus on Quality report metrics have been incorporated into areas for efficiency improvement. dashboard reports which are produced monthly We also commissioned a benchmarking analysis around a quarterly cycle reflecting the key from the Audit Commission, indicating our relative dimensions of safety, clinical effectiveness and user spending and productivity metrics against our peer experience. These are presented for review at the group. This has been used to inform our strategic Clinical Governance Committee and as a result planning. presented to trust board and also commissioners. During the year we have also strengthened our own procurement team to ensure improved internal

56 7. Review of effectiveness – Clinical audit – Annual health check performance and Standards for Better Health, where we have declared full compliance for the whole of 2009/10. – PCT Performance and clinical quality reviews

During 2009/10, the trust did receive a letter from the CQC expressing some concerns regarding documentation and communication issues arising from the findings of a coroner’s Inquest. The trust was able to satisfy the CQC that this was not a systemic problem, and in response, service improvement sessions were held with a number of clinical staff to ensure that lessons had been learned.

Conclusion As accounting officer, I can confirm that BSMHFT has a sound system of internal control that supports the achievement of the organisation’s plans, aims and objectives and that the Statement of Internal Control is a balanced reflection of the systems in place during 2009/10.

Signed: Sue Turner

Chief executive Birmingham and Solihull Mental Health NHS Foundation Trust

Date: May 26, 2010

57 Auditor’s report Independent Auditor’s report to the board of governors of Birmingham and Solihull Mental Health NHS Foundation Trust.

Opinion on the summary financial Opinion statements In my opinion the summary financial statement is I have examined the summary financial statement consistent with the statutory financial statements of for the year ended March 31, 2010 which the Birmingham and Solihull Mental Health NHS comprises the statement of comprehensive income, foundation trust for the year ended March 31, statement of financial performance, statement of 2010. I have not considered the effects of any changes to taxpayers equity, cashflow statement set events between the date on which I signed my out on pages 49 to 52 . report on the statutory financial statements This report is made solely to the board of (June 3, 2010) and the date of this statement. governors of Birmingham and Solihull Mental Health NHS Foundation Trust as a body in accordance with paragraph 24(5) of Schedule 7 of the National Health Service Act 2006. My work Mark Stocks was undertaken so that I might state to the board Officer of the Audit Commission of governors those matters I am required to state to No 1 Friarsgate, 1011 Stratford Road, it in an auditor’s report and for no other purpose. In Solihull, B90 4EB those circumstances, to the fullest extent permitted [Date] by law, I do not accept or assume responsibility to anyone other than the foundation trust as a body, for my audit work, for the audit report or for the opinions I form.

Respective responsibilities of directors and auditor The directors are responsible for preparing the annual report. My responsibility is to report to you my opinion on the consistency of the summary financial statement within the annual report with the statutory financial statements. I also read the other information contained in the annual report and consider the implications for my report if I become aware of any misstatements or material inconsistencies with the summary financial statement. The other information comprises only welcome, patient care, stakeholder relations, non finance reporting, our staff our greatest asset, meet the board, meet our governors and financial accounts and the unaudited part of the remuneration report. I conducted my work in accordance with Bulletin 2008/03 “The auditor's statement on the summary financial statement in the ” issued by the Auditing Practices Board. My report on the statutory financial statements describes the basis of my opinion on those financial statements.

58 Statement of comprehensive income

Table 14: Statement of comprehensive income

STATEMENT OF COMPREHENSIVE INCOME Year ending 9 month period ending 2009/10 2008/09 £000 £000 Operating income from continuing operations 222,696 168,987 ᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈ ᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈ Operating expenses of continuing operations (226,745) (191,548) OPERATING DEFICIT (4,049) (22,561)

FINANCE COSTS Finance incom 112 507 Finance expense - financial liabilities (3,541) (2,368) ᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈ ᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈ PDC Dividends payable (2,783) (3,842) NET FINANCE COSTS (6,212) (5,703) ᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈ ᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈ Corporation tax expense 0 0 Deficit from continuing operations (10,261) (28,264) Surplus/(deficit) of discontinued operations and the gain/(loss) ᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈ ᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈ on disposal of discontinued operations 0 0 DEFICIT FOR THE YEAR (10,261) (28,264) Other comprehensive income Revaluation gains/(losses) and impairment losses property, plant and equipment (6,666) (16,661) Reduction in the donated asset reserve in respect of depreciation, ᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈ ᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈ impairment, and/or disposal of on donated assets (62) (56) TOTAL COMPREHENSIVE EXPENSE FOR THE PERIOD (16,989) (44,981)

59 Statement of financial position

Table 15: Statement of financial position

STATEMENT OF FINANCIAL POSITION Mar 31, 2010 Mar 31, 2009 July 01, 2008 £000 £000 £000 Non-current assets Intangible assets 0 0 0 Property, plant and equipment 165,169 178,972 229,008 ᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈ ᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈ ᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈ Trade and other receivables 1,172 1,059 852 Total non-current assets 166,341 180,031 229,860 Current assets Inventories 460 524 342 Trade and other receivables 4,695 7,936 7,993 ᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈ ᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈ ᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈ Cash and cash equivalents 32,097 19,862 14,566 Total current assets 37,252 28,322 22,901 Current liabilities Trade and other payables (15,319) (12,018) (11,768) Borrowings (2,060) (2,035) (1,521) Provisions (919) (588) (662) Tax payable (3,336) (3,183) (3,005) ᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈ ᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈ ᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈ Other liabilities (10,625) (5,674) (3,093) Total current liabilities (32,259) (23,498) (20,049) Total assets less current liabilities 171,334 184,855 232,712 Non-current liabilities Borrowings (71,512) (68,258) (70,214) ᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈ ᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈ ᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈ Provisions (894) (720) 0 ᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈ ᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈ ᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈ Total non-current liabilities (72,406) (68,978) (70,214) ᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈ ᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈ ᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈ Total assets employed 98,928 115,877 162,498

Financed by (taxpayers' equity)

Public dividend capital 100,067 100,027 101,667 Revaluation reserve 20,441 27,048 43,321 Donated asset reserve 1,884 2,092 2,901 ᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈ ᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈ ᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈ Income and expenditure reserve (23,464) (13,290) 14,609 ᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈ ᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈ ᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈ Total taxpayers' equity 98,928 115,877 162,498

The summary financial statements on pages 59 to 62 were approved by the board on May 26, 2010 and signed on its behalf by:

Signed: (Chief executive)

Date: May 26, 2010.

60 Statement of changes in taxpayers’ equity

Table 16: Statement of changes in taxpayers’ equity

STATEMENT OF CHANGES Total Public Revaluation Donated Income and IN TAXPAYERS' EQUITY dividend reserve assets expenditure capital reserve reserve £000 £000 £000 £000 £000 Taxpayers' equity at April 1, 2009 - as previously stated 115,877 100,027 27,048 2,092 (13,290) Prior period adjustment 0 0 Taxpayers' equity at April 1, 2009 - restated 115,877 100,027 27,048 2,092 (13,290) At start of period for new FTs 0 0 Surplus/(deficit) for the year (10,261) (10,261) Revaluation gains/(losses) and impairment losses property, plant and equipment (6,666) (6,520) (146) Reduction in the donated asset reserve in respect of depreciation, impairment, and/or disposal of on donated assets (62) (62) Transfers to the income and expenditure 0 (87) 87 account in respect of assets disposed of ᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈ ᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈ ᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈ ᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈ ᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈ Public Dividend Capital received 40 40 Taxpayers' equity at March 31, 2010 98,928 100,067 20,441 1,884 (23,464)

Taxpayers' equity at April 1, 2008 as previously stated 0 0000 Prior period adjustment 0 0 Taxpayers' equity at April 1, 2008 - restated 0 0000 At start of period for new FTs 162,498 101,667 43,321 2,901 14,609 Surplus/(deficit) for the year (28,264) (28,264) Revaluation gains/(losses) and impairment losses property, plant and equipment (16,661) (15,833) (828) Reduction in the donated asset reserve in respect of depreciation, impairment, and/or disposal of on donated assets (56) (56) Transfer of the excess of current cost depreciation over historical cost depreciation to the Income and expenditure reserve 0 (365) 365 Public Dividend Capital repaid (1,640) (1,640) ᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈ ᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈ ᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈ ᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈ ᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈ Other transfers between reserves 0 0 (75) 75 ᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈ ᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈ ᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈ ᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈ ᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈ Taxpayers' equity at March 31, 2009 115,877 100,027 27,048 2,092 (13,290)

61 Statement of cash flows

Table 17: Statement of cash flows

STATEMENT OF CASH FLOWS 2009/10 2008/09 £000 £000 Cash flows from operating activities Operating deficit from continuing operations (4,049) (22,561) ᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈ ᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈ Operating deficit of discontinued operations 0 0 Operating deficit (4,049) (22,561) Non-cash income and expense: Depreciation and amortisation 4,270 3,678 Impairments 13,206 31,005 Transfer from the donated asset reserve (62) (56) (Increase)/Decrease in trade and other receivables 3,128 (150) (Increase)/Decrease in inventories 64 (182) Increase in trade and other payables 3,332 4,289 Increase in other liabilities 4,951 0 Increase in provisions 505 646 ᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈ ᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈ Tax received 153 0 NET CASH GENERATED FROM/(USED IN) OPERATIONS 25,498 16,669 Cash flows from investing activities Interest received 112 507 Purchase of property, plant and equipment (10,834) (2,946) Sales of property, plant and equipment 312 1,638 ᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈ ᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈ Cash flows attributable to investing activities of discontinued operations 0 Net cash generated from/(used in) investing activities (10,410) (801) Cash flows from financing activities Public dividend capital received 40 0 Public dividend capital repaid 0 (1,640) Loans received 5,300 0 Capital element of Private Finance Initiative obligations (2,035) (1,442) Interest paid (54) 0 Interest element of Private Finance Initiative obligations (3,473) (2,368) ᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈ ᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈ PDC Dividend paid (2,631) (5,122) ᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈ ᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈ Net cash generated from/(used in) financing activities (2,853) (10,572) Increase/(decrease) in cash and cash equivalents 12,235 5,296 ᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈ ᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈᎈ Cash and cash equivalents at April 1, 2009 19,862 14,566 Cash and cash equivalents at March 31, 2010 32,097 19,862

62 Remuneration report The information in this section of this report has been audited by the Audit Commission

Table 18: Salary and pension entitlements of senior managers: Salaries and allowances

Year ending March 31, 2010 Year ending March 31, 2009* Salary Other Benefits in Salary Other Benefits in (bands of remuneration kind (bands of remuneration kind £5000) (bands of (rounded to £5000 (bands of (bands of £5000) the nearest £5000) the nearest £100) £100)

Name and title £000 £000 £ £000 £000 £ Prof P Marquis 40-45 0 0 30-35 0 0 (Non-executive director, Chairman) Mrs S Layton 10-15 0 0 10 - 15 0 0 (Non-executive director) Ms A Lord 10-15 0 0 10 – 15 0 0 (Non-executive director) Mr WS Baldwin 10-15 0 0 10 – 15 0 0 (Non-executive director) Mr S Heer 10-15 0 0 10 – 15 0 0 (Non-executive± director) Mr D Boden 10-15 0 0 10 - 15 0 0 (Non-executive director) Ms S Turner 190-195† 0 0 150-155 0 0 (Chief executive) Mr C Tidman 125-130 0 0 115-120 0 0 (Executive director of resources/ Deputy chief executive) Dr P Lewis 100-105 55-60 0 n/a n/a n/a (Medical director) Ms Frances Allcock 20-25 0 0 n/a n/a n/a (Executive director of organisational and workforce development) Ms D Wilson 15-20 0 0 n/a n/a n/a (Executive director of quality, innovation and patient experience and executive nurse) Mrs K Martin 70-75 0 0 115-120 0 0 (Director of organisational and workforce development) Ms R Alstead 60-65 0 0 100-105 0 0 (Director of nursing) Dr N Deuchar 15-20 5-10 0 115-120 20-25 0 (Medical director)

Dr Neil Deuchar left the Trust on May 31, 2009 Dr Peter Lewis came into post on June 1, 2009 Mrs Karen Martin and Mrs Ros Alstead left the Trust on October 31, 2009 Ms Frances Allcock and Ms Dee Wilson joined the Trust on February 1, 2010

† This includes an amount relating to 2008/9. * Under accounting rules, the annual report must state a comparator of directors’ remuneration and pension benefits for the previous period. Given that Foundation Trust status was granted on July 1, 2008, the comparator period is shown for the whole of 2008/9 financial year to aid the readers of these accounts, as well as the statutory requirement for the nine month period from incorporation.

63 Remuneration report continued

Table 19: Salary and pension entitlements of senior managers: Salaries and allowances. For the 9 months, ending March 31, 2009

9 months ending March 31, 2009 Salary Other Benefits in (bands of remuneration kind £5000) (bands of (rounded to £5000) the nearest £100)

Name and title £000 £000 £ Prof P Marquis 25-30 0 0 (Non-executive director, Chairman) Mrs S Layton 10-15 0 0 (Non-executive director) Ms A Lord 10-15 0 0 (Non-executive director) Mr WS Baldwin 10-15 0 0 (Non-executive director) Mr S Heer 10-15 0 0 (Non-executive± director) Mr D Boden 10-15 0 0 (Non-executive director) Ms S Turner 115-120 0 0 (Chief executive) Mr C Tidman 90-95 0 0 (Executive director of resources/ deputy chief executive) Dr P Lewis n/a n/a n/a (Medical director) Ms Frances Allcock n/a n/a n/a (Executive director of organisational and workforce development) Ms D Wilson n/a n/a n/a (Executive director of quality, innovation and patient experience and executive nurse) Mrs K Martin 90-9 0 0 (Director of organisational and workforce development) Ms R Alstead 75-80 0 0 (Director of nursing) Dr N Deuchar 105-110 12-20 0 (Medical director)

64 Pension benefits

Table 20: Pension benefits (12 month period)

12 month period Real increase Lump sum Total Lump sum Cash Cash Real increase in pension at age 60 accrued at age 60 equivalent equivalent in cash at age 60 related to pension at related to transfer transfer equivalent real increase age 60 accrued value ending value ending transfer value in pension ending pension March 31, March 31, during period March 31, ending 2010 2009 2010 March 31, 2010 (bands of (bands of (bands of (bands of £2500) £2500) £5000) £5000) Name and title £000 £000 £000 £000 £000 £000 £000 Ms S Turner 2.5-5 12.5-15 55-60 170-175 1,115 932 136 (Chief executive) Mr C Tidman 2.5-5 7.5-10 25-30 85-90 393 326 59 (Executive director of resources/deputy chief executive) Dr Peter Lewis 0-2.5 5-7.5 10-15 40-45 0 0 0 (Medical director) Ms Frances Allcock 0-2.5 0 0-5 0 4 0 1 (Executive director of organisational and workforce development) Ms D Wilson 0-2.5 0-2.5 15-20 55-60 292 235 7 (Executive director of quality, innovation and patient experience and executive nurse) Mrs K Martin 0-2.5 5-7.5 40-45 130-135 762 642 51 (Director of organisational and workforce development) Ms R Alstead 0-2.5 0-2.5 40-45 125-130 865 760 39 (Director of nursing) Dr N Deuchar 0-2.5 0-2.5 25-30 80-85 562 500 6 (Medical director)

Table 21: Pension benefit (9 month period)

9 month period Real increase Lump sum Total Lump sum Cash Cash Real increase in pension at age 60 accrued at age 60 equivalent equivalent in cash at age 60 related to pension at related to transfer transfer equivalent real increase age 60 accrued value ending value ending transfer value in pension ending pension March 31, June 30, during period March 31, ending 2009 2008 2009 March 31, 2009 (bands of (bands of (bands of (bands of £2500) £2500) £5000) £5000) Name and title £000 £000 £000 £000 £000 £000 £000 Ms S Turner 5 – 7.5 15 – 17.5 50 – 55 150 – 155 932 644 275 (Chief executive) Dr N Deuchar 0 – 2.5 0 – 2.5 25 – 30 80 – 85 500 374 118 (Medical director) Mr C Tidman 5 – 7.5 15 – 17.5 20 – 25 70 – 75 326 212 109 (Finance ddirector) Mrs K Martin 5 – 7.5 15 – 17.5 35 – 40 115 – 120 642 429 205 (Director of organisational and workforce development) Ms R Alstead 0 – 2.5 2.5 - 5 35 - 40 115 - 120 760 575 174 (Director of nursing)

Remuneration received by non- executive members is not pensionable and so this information is not applicable. Ill health retirements During the year there were six early retirements due to ill health. The costs of these are borne by the NHS Business Services Authority – Pensions Division. The value of these early retirements was £467,000.

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Annual report and accounts 2009/10

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