Annual Report 2017/18 Bedfordshire Cambridgeshire Luton Norfolk Peterborough Suffolk Annual Report Adult services District nursing

Specialist nurses/long 2017/18 term conditions Community matrons

Neuro-rehabilitation (from 1/4/18)

Outpatient clinics (until Sept 17) Our vision Our portfolio of services in 2017/18 were provided from GP surgeries and health Improve the health and wellbeing of people Dietetics centres, community settings such as schools, (until Sept 17) across the diverse communities we serve. children’s centres and people’s own homes, Specialist services as well as from the following main sites: Community dental Our mission • Bedfordshire: Kings Brook in Bedford and services and/or oral a range of community based facilities. surgery Provide high quality care through our excellent people. • Cambridgeshire: Brookfields in Musculoskeletal Cambridge, Doddington Hospital, services Princess of Wales Hospital in Ely, North Sexual health services Our 2017/18 objectives Cambridgeshire Hospital in Wisbech, Oaktree Centre and Hinchingbrooke Children’s services 1. Provide outstanding care Hospital in Huntingdon. Acute services 2. Collaborate with other organisations • Luton: Luton Treatment Centre, Redgrave Children and Young People’s Centre and a 3. Be an excellent employer Health visiting range of community based facilities. (from 1/4/18) 4. Be a sustainable organisation • Norfolk: Breydon Clinic in Great School nursing Yarmouth, Oak Street Clinic in Norwich (from 1/4/18) and Vancouver House in Kings Lynn and a Therapies range of community based facilities. (from 1/4/18) • Peterborough: Rivergate and Kings Community nursing Our values Chambers. (from 1/4/18) • Suffolk: Orwell Clinic in Ipswich, Regent Audiology Honesty Road in Lowestoft, Abbey View in Bury St Edmunds, and a range of community Community Empathy based facilities. paediatricians (from 1/4/18) Family Nursing Ambition Partnership (from 1/4/18) (from 31/3/18) Respect National Child Measurement Programme

School immunisation programme

Emotional Health and Wellbeing service

2 Introduction 3 Contents

1. Introduction 2

Performance Report 7 2. Chair and Chief Executive’s Welcome 8 3. Overview 10 4. Performance Analysis 12 STRATEGIC OBJECTIVE 1 – Provide outstanding care 12 STRATEGIC OBJECTIVE 2 – Collaborate with other organisations 28 STRATEGIC OBJECTIVE 3 – Be an excellent employer 29 STRATEGIC OBJECTIVE 4 – Be a sustainable organisation 35 5. Looking to the future 66

Accountability Report 69 Through adversity comes legacy 6. Corporate Governance Report 70 7. Governance Statement 73 The #hellomynameis campaign was founded by The Trust is proud to support the #hellomynameis Dr Kate Granger and her husband Chris Pointon campaign. Matthew Winn, Chief Executive Remuneration and Staff Report 2016/17 87 following Kate’s diagnosis at the age of just 29 said: “Few people have had such a profound with terminal cancer. impact on me as Kate had when I met her 8. Remuneration and Staff Report 88 two years ago. Whilst facing her own illness Since Kate’s untimely death at the age of 34, 9. Staff Report (subject to audit) 94 with such courage, she and Chris launched Chris kept the campaign alive by visiting the Trust the #hellomynameis campaign which has now during a global tour including Australia, New reached every continent across the globe. 10. Independent Auditor’s Report to the Directors Zealand and Great Britain. Kate truly was inspirational and her legacy of Cambridgeshire Community Services NHS Trust 100 Chris said: “As a doctor Kate was shocked continues with the slogan #hellomynameis now during treatment to find that many staff looking synonymous across the NHS and beyond for after her did not introduce themselves before compassionate care.” Annual Accounts 2016/17 105 delivering care. For Kate, this simple introduction 11. Notes to the Accounts 110 wasn’t just about common courtesy but about making a human connection. Julia Sirett, Chief Nurse added: “#hellomynameis was born from Kate’s passion 12. Glossary for Key Performance Indicators 136 to help health workers connect with their The #hellomynameis campaign patients, instantly helping to build trust in is embedded within our quality difficult circumstances. The NHS is amazing improvement programme and, if each and I am so proud that my late wife’s legacy of us makes just a small difference, continues to change the shape of global together we can achieve something healthcare.” phenomenal. Performance Report

Chair and Chief 8 Executive’s Welcome

Overview 10

Performance Analysis 12

Looking to the future 66 Chair and Chief Executive’s Welcome

Welcome to the 2017/18 annual report for Cambridgeshire in 19 out of the 32 areas rated (including staff The invaluable support from our dedicated recommendation of the Trust as a place to work volunteers including those at our community Community Services NHS Trust. or receive treatment), and better than average hospitals, as well as the Dreamdrops children’s in 29 of the 32 areas is simply phenomenal. We charity, continued to provide a vital role in Quality is at the heart of all we do and we are which will bring together closely related MSK know that an engaged and happy workforce is helping us improve the quality of services we proud to provide high quality services that enable specialities - orthopaedic, pain management, directly linked to the provision of good patient provide. Without their dedication and support, people to live healthier lives and receive care rheumatology and spinal. outcomes, so we were particularly pleased that our task would be even harder. closer to home. During the year we launched our staff engagement score was the 9th highest • Introducing Chathealth in Cambridgeshire, a Our focus for the coming twelve months will ‘Our Quality Way’ and ‘Our Improvement Way,’ nationally for all NHS provider organisations. text based service that allows young people to be to achieve our ambitious plans as outlined in which set out our approach to quality and service seek advice and guidance on a range of issues During the year, 33,501 service users provided our Five Year Plan and Operational Plan 2017- improvement, empowering our committed staff from local health professionals. feedback on our services. We consistently 19. Central to this is working collaboratively to realise a range of innovative achievements in exceeded our target of 90% of service users with commissioners and partner organisations 2017/18. A few highlights include: • Supporting staff at our Oliver Zangwill Centre saying they were likely to recommend our to develop seamless care, irrespective of for Neuropsychological Rehabilitation and • Launching iCaSH Express Test in Bedfordshire, services, to friends and family if they needed organisational boundaries. within our iCaSH service, to complete the similar care or treatment (exceeding the national Norfolk and Suffolk where anyone aged over We continued Into receiveline with invaluable our strategicsupport from plans, hundreds we of will dedicat continueed volunteers, as well Health Education East Quality Improvement as charities such as the Dreamdrops children’s charity, the Arthur Rank Hospice charity, and 16 with no symptoms, can test quickly and average). Fellows Programme. This will result in the the Friends of toHospital submit at Home bids in to Pe winterborough, and retain all of whom business provided and a vital role in helping easily for sexually transmitted infections, using The Trust has achieved the vast majority of usits improve thedevelop quality of servicesnew models we provide. of careWithout within their dedication the specialist, and support, our task design of a client evaluation system for would be even harder. an online and postal service, without the need quality, financial and performance ambitions high quality services that make up our portfolio. neuro-rehabilitation patients and improve the We continued to receive invaluable support from hundreds of dedicated volunteers, as well to visit a clinic. and targets in the last 12 months. 2017/18 Ourhas focus for 2015/16Thisas will charities is onenable ach suchieving as otherthe our Dreamdrops ambitious commissioners children’s plans charity,for the and the future, Arthur aligned Rank Hospice to the charity, and wellbeing of people living with HIV through system-wide prioritiesthe Friendsidentified of Hospital by our at commissioners Home in Peterborough, and which all of whom are responsiveprovided a vital to rolethe in helping been another challenging year financially for the populationsus improve the to quality benefit of services from we provide. our expertise.Without their dedication and support, our task • Introducing electronic patient records and the clinical psychologist-led support groups. specific needs of thewould local be populationseven harder. we serve. Central to this is working collaboratively Trust but we successfully achieved an operatingwith our staff, GPs, social care practitioners and hospital clinicians, to develop seamless ‘Order Comms’ programme in our regional Please enjoy reading our annual review and As a result of our commitment to ongoing quality surplus of £937,000. As the Trust has managedcare irrespective ofOur organisational focus for 2015/16 boundaries. is on achieving our ambitious plans for the future, aligned to the iCaSH service, enables patients to be notified we systemlook- wideforward priorities toidentified another by our commissionerssuccessful and year which in are responsive to the improvements, we are proud to confirm that its budget to the plan agreed at the beginningIn line with our fivespecific year plan, needs w ofe thewil llocal continue populations to submit we serve. bids Central to expand to this isthe working geographic collaboratively area of their results in a timely manner and test 2018/19.with our s taff, GPs, social care practitioners and hospital clinicians, to develop seamless the Care Quality Commission rated our services of the year, we have been awarded a one offacross which we providecare irrespective the specialist, of organisational high quality boundaries. services that now makes up our portfolio. results to be imported directly into individual This will enable other commissioners and populations to benefit from our expertise in ‘Good’ in all five key lines of enquiry areas, patient records from our pathology provider, financial sum (Sustainability and Transformationproviding these specialistIn line with services our five ,year which plan, focus we wil onl continue health to promotion submit bids andto expand prevention the geographic of ill area following its inspection visit in March and April Fund) from NHS Improvement of £2.25 million.health. across which we provide the specialist, high quality services that now makes up our portfolio. reducing the potential for transcription errors. This will enable other commissioners and populations to benefit from our expertise in 2018. This is testament to our fantastic staff, Therefore adding together our real surplus and providing these specialist services, which focus on health promotion and prevention of ill The Government policyhealth. prior to the May 2015 General Election was that NHS Trusts, as an • Successfully completing two ‘Primary Care with particular congratulations to our community the national System Transformation Fund createsorganisational form, could not continue long term. As a smaller organisation providing Home’ projects in Luton in partnership with Dental Healthcare service who were rated specialist services,T wehe Governmentwill determine policy during prior to 2015the May our 2015 future General organisational Election was thatform NHS in theTrusts, as an an annual surplus figure for our accounts ofcontext of what is inorganisational the best interests form, could of notpatients continue and long our term staff.. As aWhilst smaller we organisation await policy providing GPs to improve clinical outcomes. The first ‘Outstanding’ for their ‘Caring’ approach. guidance from the specialistnew Government services, we on will options determine available during 2015 in relationour future to organisational organisational form formin the, £3,189,000. context of what is in the best interests of patients and our staff. Whilst we await policy involved comprehensive medication reviews we will take forwardguidance development from the worknew Government to evidence on optionsour viability available as ina relationstand- toalone organisational form, On 1 April 2018 we welcomed to the Trust for patients over the age of 75 taking more As ever, these achievements are entirely theorganisa result tion, whateverwe will form take thatforward takes. development We anticipate work to evidence that this our process viability willas a takestand -alone colleagues from Bedfordshire children’s, oral of the outstanding commitment of staff andapproximately we two organisayears totion, come whatever to fruition, form that during takes. whichWe anticipate time we that will this contin processue will to take operate as than 10 medications. The second engaged an NHS Trust. We approximatelywill of course two involve years to staff, come commissioners to fruition, during which and thtimee Trust we will Development continue to operate as health improvement, acquired brain injury and acknowledge and thank them for their amazingAuthority in these deliberations.an NHS Trust. We will of course involve staff, commissioners and the Trust Development diabetic patients, particularly of South Authority in these deliberations. neuro-rehabilitation services. This is part of a new dedication. East Asian origin, in structured education Please enjoy readingPlease our enjoy annual reading review our annualand we review look and forw weard look to forw a successard to a successful yearful inyear in partnership with East London NHS Foundation programmes. 2015/16. 2015/16. Trust, which now means that between both Our thanks go to colleagues within the • Introducing the Norfolk Just One Number organisations we provide all community health Cambridgeshire outpatient services based at single point of access and care co-ordination and mental health services across Bedfordshire Doddington and Princess of Wales hospitals, who hub. This new approach enables parents and and Luton. transferred to North West Anglia Foundation Trust on 1 September 2017. Despite the professionals to speedily access consistent Nicola Scrivings Matthew Winn We would like to take this opportunity to say challenges presented during periods of change, Nicola Scrivings Matthew Winn and evidence based services, from the right Chairman Chair ChiefChief Executive Executive a huge thank you to every member of staff for these groups of staff continued to put patientsNicola Scrivings Matthew Winn healthcare professional within our Healthy June 2015 making the Trust such a fantastic place to work, first and provided high quality care throughout.Chairman 25 May 2018 Chief Executive25 May 2018 Child Programme services. as evidenced through our amazing staff survey June 2015 • Redesigning, with partners, a new integrated results published in March 2018. Being rated community musculoskeletal (MSK) model, best in the country when compared to our peers

8 Performance Report 9

4

4

Overview

This overview provides a brief summary of the Trust’s background, service portfolio, income, aims and aspirations, as well as our 2018/19 Revenue by Commissioner (£000’s) approach to risk management. £0 £5,000 £10,000 £15,000 £20,000 £25,000 Norfolk County Council £22,437

We became a community NHS Trust in England on This report sets out our many achievements Luton CCG £19,222 1 April 2010 and was established under sections over the last 12 months, focusing on how we 25(1) and 272(7) of, and paragraph 5 of Schedule have successfully improved existing services and C&P CCG £17,281 4 of the National Health Service Act 2006 introduced innovative new ones, in line with our (Establishment Order 2010 no. 727). We report aim to deliver services that: East London FT* £15,133 under the Accounts Direction determined by the • are locally accessible - provided close to or in Other £13,867 Department of Health (Secretary of State) and people’s own homes Cambridgeshire approved by the Treasury. The Accounts Direction £12,740 County Council is made under the following legislation: National • are provided to the highest standard by skilled Specialist £7,074 Health Service Act 2006 c. 41 Schedule 15: and compassionate staff Commissioning Preparation of annual accounts. The Trust Board is • promote good health and the prevention of ill NHSE £6,375 accountable to NHS Improvement. health Suffolk County £4,676 The Trust’s portfolio predominantly consists of • reduce inequalities and ensure equity of Council a range of high quality specialist services. Our access, including through working with partner Luton Borough £3,990 annual budget for 2017/18 was £113 million. As organisations Council a result of winning procurements and services Cambridgeshire & £3,508 transferring out of the Trust (as outlined earlier) • are integrated across health and social care Peterborough FT ‘boundaries’ our annual budget will be £129 million for Bedford Councils £2,297 2018/19. • are focussed on maximising an individual’s

Many of our services are provided at a regional potential and independence. 0% 5% 10% 15% 20% 25% level and are predominantly focused on Note: * above refers to a new partnership with East London NHS Foundation Trust where between both Like all public sector organisations in the current organisations we provide all community health and mental health services across Bedfordshire and Luton. preventative care, funded by public health economic climate we continued to face significant commissioners. The future will be characterised challenges during 2017/18, which we expect by tenders to retain and win business within the to continue in 2018/19 and beyond, including To meet these financial challenges we will The Board retains ultimate responsibility for the clearly defined parameters set out in our five year known reductions in local authority public continue to work with our commissioners to Trust’s risk management framework and a formal plan, including developing new models of care, health budgets. These challenges are replicated redesign services, and our partners and staff risk management system is in place, to identify working proactively with commissioners to secure nationally and for the Trust, this equates to us to develop cost improvement schemes and and evaluate both internal and external risks. available contract extensions where we remain needing to make a 2.3% efficiency saving in collaborative initiatives, to support achievement The Board and Audit Committee regularly review best placed to deliver the service. 2018/19, the equivalent of £3.0 million. of commissioners’ plans. From a Trust perspective, strategic risks. Component risks of the corporate The work we undertake will become more The following chart shows the Trust’s £129 million these plans will ensure that, where it is clinically risk register are reviewed by appropriate Board important as the NHS seeks to prevent ill health income by percentage and type of commissioner appropriate, services will move from the acute sub-committees. hospital setting to the community, making in the context of an ever growing population, for 2018/19. Further information on risk management them more accessible for patients and more increasing level of obesity and the complexity procedures is provided within the annual cost effective for the system as a whole, whilst of need being managed within the community governance statement (page 79). setting. maintaining the quality of care provided. The narrative in the following Strategic Report The Trust can be affected by a variety of meets all the requirements and disclosures of financial, clinical, operational and regulatory Strategic Reports as required by the Companies risks and uncertainties. The organisation’s risk Act 2006. management strategy clarifies responsibility for the identification, assessment and management of risk throughout the Trust.

10 Performance Report 11 Performance Analysis

STRATEGIC OBJECTIVE 1 2017/18 Performance (Mean) for harm free % The prevalence of all incidents is reflected in the Incident reports are shared with relevant external care delivered by services provided solely breakdown below. organisations where possible and any feedback Provide outstanding care by CCS NHS Trust received is communicated to the reporter and The Trust was pleased to host a team of Care Target 98.5 local team. All incidents, regardless of where they Quality Commission (CQC) inspectors to the Trust Actual 98.6 originate, are discussed at team meetings. This in March and April 2018, as part of their planned 10% demonstrates an open reporting culture where programme of inspection visits. We are incredibly We have been coordinating a ‘Thinking Differently 3% staff are keen to learn from all incidents. proud to report that the inspection team rated the about Pressure Ulcers’ project relating to the patients All patient safety incidents that occur as a direct Trust ‘Good’ in all areas inspected, as summarised that our Luton community adult services staff care Who was result of care delivered by CCS are submitted to below. for. A number of actions to improve prevention, caring for the the National Reporting Learning System (NRLS). early identification and management of pressure patient/service The graph below provides a summary of patient user when 52% Overall rating for this trust Good ulcers are underway including the following: safety incidents by level of harm reported by 35% the incident Are services safe? Good • a focus on education for staff, partner agencies occured the Trust, compared to other NHS community Are services effective? Good and the public organisations. The latest information covers the period 1 April 2017 – 31 September 2017 and Are services caring? Good • consistent use of assessment tools demonstrates that over 90% of all patient safety Are services responsive? Good • ensuring that appropriate pressure relieving incidents result in no or low harm to patients. Are services well-led? Good equipment is in place • audit and research In addition, the inspection team rated our Dental Under CCS Care Domicilliary care agency Healthcare services ‘Outstanding’ for its ‘Caring’ • collaboration with other organisations Another No professional health / approach. Organisation social care input

These ratings reflect the innovation, hard work Patient safety incidents and commitment demonstrated by our staff on a daily basis. During the previous 12 months, approximately 2,500 patient safety incidents and near miss We aspire to a rating of ‘Outstanding’ across all incidents were reported via our web-based NRLS 90% our services and are confident that we will achieve incident reporting system Datix. This is an Data this rating next time round! increase over the previous 12 month period 80% of approximately 25%. This level of reporting 70% equates to approximately 0.25% of the almost 60% Patient safety one million contacts our staff have with service Harm free care users each year. 96% of these incidents resulted 50% in no or low harm, with the remaining 4% 40% This national programme aims to help resulting in ‘moderate’ harm. organisations to understand the prevalence of 30% Staff are encouraged to record incidents: four harm areas that affect patients: pressure 20% ulcers, falls, catheter infections and venous • that occur as a direct result of CCS care thromboembolus. 10% • which originated whilst the patient was cared 0% In line with national guidance, patients visited by for by another organisation (i.e. an acute trust None Low Moderate Severe Death community nurses on a nationally specified day or domiciliary care agency), referred to as NHS Cohort 53.90% 37.80% 7.60% 0.50% 0.20% each month were included in data collection. ‘happened upon incidents’ CCS 74.90% 20.60% 4.50% 0.00% 0.00% • where there has been no professional health/ social care input

12 Performance Report 13 Serious Incidents (SIs) Safeguarding achievements 2017/18 Safeguarding training (children and adults) The Trust undertakes full Root Cause Analysis • We achieved 91% compliance for safeguarding of all serious incidents. These investigations are children supervision against a target of 95%. % achieved % achieved % achieved undertaken to identify learning, which can be Supervision is a priority for the Trust and we will 2015/16 2016/17 2017/18 shared across relevant services to reduce the risk continue to focus on achieving compliance in Children’s safeguarding training of similar incidents occurring. 2018/19. Level 1 mandatory for all staff 92% 96% 98% There were a total of eight serious incidents • We have standardised adult safeguarding reported during 2017/18, which comprised of: information for our Luton based adult services. Level 2 mandatory for all clinical and non- 90% 96% 98% clinical staff in regular contact with parents, • 1 x pressure ulcer grade 3 • We have improved our oversight of all children and young people safeguarding cases where information was • 2 x information governance incidents relating previously held at team level. to breach of confidentiality Level 3 mandatory for all staff predominantly 84% 90% 88% • Improvements have been made to our staff working with children, young people and • 3 x failure to escalate concerns safeguarding intranet pages to enable staff to parents • 1 x surgical issue (Dental Healthcare service) find relevant information quickly. • 1 x patient accident • Our safeguarding teams in each locality have Adult safeguarding training 94% 90% 96% The serious incident in the Dental Healthcare contributed to multi agency audits as directed service mentioned above met the criteria of by Local Safeguarding Children and Adults a never event. Never events are preventable Boards. Information Governance The second incident involved the use of a non ‘safe-haven’ fax to send patient records. Again the patient safety incidents that should never occur • We continue to work within Multi Agency The Trust’s Information Governance Toolkit Self- records were recovered. This incident was referred if appropriate systems and checks are in place. Safeguarding Hubs alongside police and social Assessment score for 2017/18 was 80% and to the ICO and no further action was taken by This incident involved the extraction of a wrong care colleagues. hence was graded satisfactory. tooth and was considered alongside two other the ICO. The ICO recommended a number of • Over 90 staff attended our successful never events reported earlier in 2016/17. An For the 39 standards involved, there were four improvement actions; some of which were already safeguarding children and adults development independent expert review was commissioned ratings possible (0, 1, 2, or 3, with 3 being the in place and the remainder were in the process of day. to ensure that appropriate actions were being most positive outcome). The Trust achieved level being implemented at the point this report was undertaken. This review concluded that the 2 for 22 standards and level 3 for 16 standards. finalised. service demonstrated an open and honest One standard was considered not relevant to the Key activities planned for 2018/19 reporting culture for patient safety and that Trust’s portfolio. Emergency Planning, Resilience and appropriate actions had been instigated. • We will review and implement the new This assessment provides assurance that the Trust National Adult Safeguarding Competency Response Learning from these incidents is shared across is meeting its obligations in relation to information requirements. our services and with other stakeholders where governance. Action plans for improvement were The Trust works closely with Bedfordshire and appropriate. • With our multi agency partners we will update monitored by the Trust’s Information Governance Luton and Cambridgeshire and Peterborough our staff training and awareness of the Prevent Steering Group, with progress reports presented Local Health Resilience Partnerships (LHRPs) and agenda and introduce named champions in our quarterly to the Quality Improvement and Safety with Norfolk and Suffolk LHRPs. It continues Implementation of the Duty of Candour services. Committee. to meet its statutory duties and obligations for delivering an effective response to disruptions and The Trust achieved 92% compliance for The Trust has fully implemented the requirements • We will introduce improvements to our emergencies. of the Duty of Candour. safeguarding adult reporting systems. information governance training, against our annual target of 95% compliance. Our colleagues assessed the Trust as substantially The Trust has a well recognised open and honest • A new model of supervision and training will be compliant on the national NHS England Core During 2017/18, there were four information incident reporting culture as detailed earlier. The introduced in our integrated Contraception and Standards for Emergency Preparedness, Resilience governance incidents that required full root cause Trust’s policy supports staff to apologise when Sexual Health (iCaSH) service. and Response (EPRR). The Trust is also compliant analysis. All four were reported to the appropriate things go wrong. The policy is monitored through with the NHS Commissioning Board Emergency • The Trust will focus on achieving all training commissioning organisation and closed. None of our web-based incident reporting system. Preparedness Framework 2013 and associated targets in 2018/19 and in particular level 3 these incidents resulted in harm to any patient. children’s safeguarding training. guidance. Two of these information governance incidents Infection Prevention and Control were reported to the Information Commissioner’s The Trust continued to roll out an extensive Office (ICO). In one instance, paper records were infection prevention and control work inappropriately sent in the post. The records were programme. We are proud to report that there recovered and the actions taken by the Trust to were zero cases of MRSA and Clostridium difficile prevent reoccurrence were acknowledged by the across the Trust in 2017/18. ICO. No further action was required by the Trust.

14 Performance Report 15 ChatHealth is a confidential text messaging service ChatHealth launched for young people aged 13-19.

This platform provides an alternative way for 500 in Cambridgeshire young people to engage with school nurses, on topics including relationship advice, healthy eating, 450 smoking cessation, bullying and exam stress. 400 Fleur Seekins, Clinical Lead for the 0-19 Pathway 350

said: “We’re very excited to be using ChatHealth 300 as it has been a huge success for our colleagues in Norfolk. Using text messaging opens a new 250 line of communication to our young people in 200 Cambridgeshire, and it makes our school nurses Recruitment figure 150 more accessible than ever before. 100 Figure 1: Shows 50 projected annual It’s important to stress that recruitment (red 0 ChatHealth does not replace Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar dash line) and interventions with our school nurses, actual recruitment (solid black line). it compliments them so we can target our resources to really make a difference for young people. The breakdown of recruitment to each study is shown in figure 2. Our iCaSH service was particularly successful 91 in its research activities, being responsible for 89% of the Trust participant recruitment. The Clinical Effectiveness improved training for staff relating to use of a Figure 2: recruitment into the Safetxt study (figure 3) ‘catheter record booklet.’ Recruitment resulted in the teams being within the top five Clinical Audit and Effectiveness 198 • Ensuring the right pressure relieving equipment numbers to each recruiting Trusts nationally. The service also had Clinical audit is a quality improvement process is left at the patient’s home. NIHR portfolio success in the ‘Positive Voices’ survey (a survey that seeks to demonstrate improvements in 69 study (2017/18) of the lives, experiences, and healthcare needs patient care. The Trust’s programme of clinical • Various patient record-keeping audits focused of people living with HIV in the UK) and the audits was informed by national audits, those on ensuring patient information is kept secure. rapid set up and recruitment of clients into the identified by the National Institute for Health and national Pre-exposure Prophylaxis in HIV (PReP) 5 Care Excellence (NICE), CQC outcomes, service 9 30 study. 1 improvement activity, incidents and complaints. Trust Clinical Research, Innovation and Fellowships The Trust participated in four national audits: safetext read, play, talk the Unicef Breastfeeding Baby Friendly Initiative, We actively participate in clinical research and BOOST Positive voices Parkinson’s UK and two sexual health national encourage all clinical areas to adopt appropriate Pres PrEP national studies and develop their own research audits. Cost of Autism projects. The past year has been the most A sample of outcomes from these audits successful in our history and our staff should demonstrated improvements in the following be congratulated on the amount and quality of areas: research undertaken. • Children attending appropriate clinic settings. We participated in seven National Institute for • Development of a patient information leaflet Health Research (NIHR) portfolio studies and one regarding the link between depression and non-portfolio study. heart failure. Over 400 participants were recruited into portfolio • Helping vulnerable adults by ensuring they research studies in this period (excluding those Figure 3: NIHR receive the best care when attending dental studies still in the set up phase), exceeding Portfolio Study: Safetxt services. the projected targets set for us by the Clinical Randomised Controlled Research Network (CRN) (Figure 1). The studies Trial. Study is looking • Development of information for patients with range from observational to interventional. at the impact of text urinary catheters to prevent infections, and messages on behaviour change in 16-24 year olds.

16 Performance Report 17 The DynamicHealth (musculoskeletal Fellowships, Internships and Awards Patient Experience physiotherapy service) was the first centre to We actively encourage staff to apply for funded successfully reach its recruitment targets to the Engaging the public and service users in programmes that combine personal development BOOST study, led by the University of Oxford developing and providing feedback on our opportunities with a clinically based project. We (Figure 4). This study is looking at two different services helps us to monitor quality and make received funding for the development of staff approaches to the management of spinal improvements. The following summarises some of research skills from the Health Education East stenosis in older adults - the usual care treatment the initiatives and actions during the past year. of England NIHR Clinical Academic Internship approach compared to a gym based educational, Programme. Three allied health professionals, a Cognitive Behavioural Therapy (CBT) and exercise health visitor and a nursery nurse were awarded Complaints, Concerns and Patient Advice and programme. The principal investigator is a fellowships, securing five out of a total of six Liaison Service (PALS) contacts physiotherapist in the service. fellowships available in the region. The table below summarises the total number of A consultant paediatrician in Luton was awarded complaints, concerns and PALS enquiries received a prestigious CLAHRC Fellowship, looking at in 2017/18. co-production of information for parents with children diagnosed with generalised global delay. The same consultant also obtained Greenshoots 2015/16 2016/17 2016/17 BOOST funding from CRN Eastern to encourage clinical Formal Complaints 136 112 82 staff to engage in portfolio research. study Concerns (for investigation) 135 131 190 Two of our clinical psychologists have successfully completed their year long part-time Quality PALS (inc comments & enquiries & signposting) 459 573 660 Improvement Fellowship. One was looking at how to empower clients with HIV within a supportive Difficult study Complaints to recruit into group setting. The other was looking at how to involve clients and their carers in the assessment The Trust received fewer complaints than the results, how these could be communicated to average received by comparable NHS community others and how changes in their scores could be trusts (see graph below). reflected in their rehabilitation programmes. First study centre In the last year, seven peer-reviewed publications 40 to complete their have resulted from research carried out in the recruitment Trust, helping to improve patient outcomes and 35 experience across the NHS. These publications 30 related principally to neuro-rehabilitation 25 including: music therapy following a stoke, Cambridgeshire Community Impressed U of Oxford computerised CBT after stroke, outcome 20 Services NHS Trust who has requested measures, assistive telehealth, use of psychological Average Number of 15 formulations, hearing improvements in children Complaints in Comparable additional numbers to Community Trusts be recruited and inclusive design in access to back pain 10 care. Clinical staff also attended national and 5 international conferences to present their work, either via oral presentations or academic posters. 0 Q1 Q2 Q3 Q4 Six members of staff had trainging on the CBT and excercise programme Parliamentary and Health Services Ombudsman (PHSO) A complainant referred their concerns to the PHSO in 2017/18 about referral times and Figure 4: Highlights treatment in our DynamicHealth musculoskeletal from the BOOST Study. physiotherapy service. The PHSO investigated the complaint and concluded that the referral time and treatment offered were in line with established good practice. The complaint was therefore not upheld by the PHSO.

18 Performance Report 19 Surveys 33,501 service users responded to local and national surveys seeking feedback on our services. 32,411 of these included the Friends and Family Test question: “How likely are you to recommend our service to friends and family if they needed similar care or treatment?” Over 90% of respondents recommended our services every month and we achieved higher percentage scores than the national average for community trusts.

100%

90%

80% National FFT CCS NHS Trust FFT 70% Trust target

60%

50% Luton trainers recognised for helping Jul 17 Jan 18 Jun 17 Oct 17 Feb 18 Apr 17 Sep 17 Dec 17 Nov 17 Mar 18 Aug 17 May 17 to protect neglected children

Percentage of each response given to the A specialist training team was recognised Service), Salma Fazil (Luton Flying Start) and FFT question for CCS NHS Trust by the NSPCC for pioneering a programme Alison Braniff (Luton Children’s Community Extremely Likely to help protect children from neglect across Health Services). Likely Luton. CCS Since the implementation of the GCP 2 tool over NHS Neither Likely or Unlikely Trust Unlikely The professionals were among the first 200 cases of neglect have been identified (from Extremely Unlikely to receive the charity’s Elephant Award in April to December 2017). recognition of their work to train staff to use 0% 20% 40% 60% 80% 100% Don’t Know a unique assessment tool. The Graded Care Profile 2 (GCP2) helps professionals to measure the quality of care being given to a child by Alison Braniff Trainer and Health Visitor with helping them identify anything that puts a child Luton Children’s Community Health Services said: Patient Advice and Liaison Service (PALS) Compliments at risk of harm. This tool helps practitioners to The Patient Advice and Liaison Service (PALS) Over 29,000 positive comments and compliments identify parents’ strengths, weaknesses and Neglect can mean something to received and satisfactorily resolved 660 contacts were received by services during the year, which is what needs to be changed so that they can get one person and a different thing to during the year as summarised below: an increase of over 14,000 compared to last year. them the right support to improve the life of another. The Graded Care Profile is a their children. common language across the UK to Enquiry/signposting 654 The NSPCC Elephant Award, which aims define what is neglect. We can work to acknowledge practitioners who have with the family to identify what they Comments and suggestions 6 demonstrated focus and commitment to are doing well and where they need ensuring successful implementation of GCP2 help. It’s about empowering families was presented to: Debbie Brown (Early Help to be involved.

20 Performance Report 21 Service Name You said… We did…

We have re-sent our information sheet, Luton Deep We weren’t sure how to including information on how to find us, to GPs Vein Thrombosis find you – so found a map with a request that they share this information (DVT) Service via google. sheet with all patients they refer to us.

We have introduced a new patient passport for people with venous leg ulcers which includes: An appointment card would • A page for appointment information. be useful, and we would • In-depth, easy to read literature to support Luton Tissue like more information on the whole patient journey from assessment, Viability Service whether the ulcer is healing discharge to long term self management. and how long it will take to • Information on the causes and treatment get better. options and a section for the patient to write notes/questions in, to ask at their next appointment. Improving services using patient feedback: You Said, We Did I would have really New link nurse for breastfeeding in the SCBU appreciated it if anyone team has attended the BFI Breastfeeding Train We used patient feedback to improve the services would have helped with the Trainer course. This will enable her to deliver we provide. Just a few examples are set out below: breastfeeding – correct breastfeeding training to SCBU and Holly staff, positioning, etc. and in turn help more mums. Service Name You said… We did… Special Care We would like more Improved access to The department now runs open gym sessions Baby Unit We developed a leaflet providing information information about antibiotic supervised gym sessions. for current patients twice a week. (SCBU), Cambs about tests required and antibiotic treatment. treatment. DynamicHealth More flexibility of Saturday appointments are now available. We would like more Huntingdon appointments. We developed a leaflet, which outlines information regarding information and advice regarding the use of Access to drinking water in Drinking water dispensers are now available for the use of dummies and dummies. the waiting area. patients. premature babies.

Funding was secured to provide additional No groups to go to with Dental emergency appointments from 1 October Additional emergency older preschool children and Service reviewed the situation with the local HealthCare 2017 to the end of March 2018, with a view appointments. a new baby now that the children’s centre and families with older Peterborough to requesting further funding for the following one stop drop ins are for preschool children are now able to attend. financial year. Norfolk people with babies only. Healthy Child Patients raised several Dental Programme • Service has introduced a letter that is sent to all concerns that they were The service has extended the opening hours of Parents requested more HealthCare (HCP) parents when child reaches 3/4 months with finding it difficult to make the minor oral surgery phone lines. information and support on Cambridge relevant information about introducing solids. an appointment. when to start weaning and early introduction to solid • Introduction of weaning workshops across More bookable We changed our Monday walk-in clinic to the county supported by Norfolk HCP staff iCaSH Suffolk food for babies. appointments. appointments only. who have been given updated training.

iCaSH Drop in clinics for all age Norfolk HCP We served fruit at our Christmas party and the As of January 2018 there has been sit and wait We want our children to Bedfordshire groups and not just for - FNP Great community dental service attended and gave sessions for all ages. have healthy habits. Bedford under 25’s. Yarmouth advice, and free toothbrushes and toothpaste.

More places to meet rather Offered alternatives to meet such as children’s Norfolk HCP, Luton Parents fed back that they Health visitors arranged for another room at the than at home. centre, TOKKO, community café. Thorpe Hamlet Family Nurse did not like having to wait centre to be a waiting area, where parents can CC Child Health Partnership Discussed learning styles and alternative in a queue. sit and wait to be called through to the clinic. Less paper please. Clinic resources to use to support learning.

22 Performance Report 23 Patient Stories Luton: Norfolk Children and Young People’s Health indicators, measured at referral and post care. Services A new validated outcome tool; the MSK-HQ Each public Board meeting starts with a patient • The TB and respiratory services team worked has been introduced. Follow up assessment story. Every story provides insight into how with health and social care organisations • Staff attended several events to promote data from 270 patients (May - August 2017) patients experience our services, identifying across Luton to stage the borough’s first TB Chathealth (a confidential texting service for detected a meaningful increase in self-reported excellence and areas where we can make Conference in November. young people) including the Royal Norfolk improvements to QOL (scores rising from 28 improvements. This feedback is essential and is Show, South Norfolk Show and Norwich Pride • The children’s epilepsy team have worked to 35). We will further improve data capture, used to improve the overall patient experience. Day. The latter was also attended by Terrence with children and young people to introduce routine analysis and reporting for MSK services, Higgins Trust enabling promotional messages Stories have included: a Skype-style software, to enable teenagers and dissemination of findings. around contraception, sexual health and to attend their appointment via a virtual clinic • The excellent care our Luton Macmillan Chathealth to attendees throughout the day. • A goal based outcomes approach utilising from home if they wish. specialist palliative care and district nurses strengths and difficulties questionnaires is • A Chathealth focus group, involving students provide and the impact their integrated care Bedfordshire: used in our Norfolk Healthy Child Programme from City College Norwich, has considered how has on patients, family and friends. services for all interventions with 5-19 year olds. • A letter was received from a patient stating to capture and measure service user feedback. Routine data collection and analysis ensure we • How social media is used within the Norfolk how impressed they were with the iCaSH A text message seeking feedback using face are able to identify and address variations in health visiting service as a way for patients, service. However, during their consultation emojis will be sent to the young person at the outcomes and share good practice. Twice yearly parents and carers to get in contact and make they were asked a question about domestic end of each conversation, with data then input reports are provided to commissioners. changes. abuse, which took them completely by surprise. on to Friends and Family Test. They suggested that a note be included on the • How the little things can have a big impact on • A stakeholder event was held to support patient information sheet that this question patient care, specifically the compassion shown teenage mothers and young fathers and seek may be asked during their consultation, so Diversity and Inclusion by a dentist to a child with visual impairment. their input into the redesign of Healthy Child that they can prepare themselves and respond We are committed to providing personal, fair and • How the DynamicHealth team tailored a Programme services. appropriately. This suggestion has been accessible services to our diverse communities, programme to a patient’s individual need discussed and implemented within the service. and promoting equality and diversity in the work to support physical benefits but also mental Cambridgeshire: Patient Outcomes place and eliminating discrimination, in line with wellbeing, following assessment by a senior our responsibilities under the Equality Act 2010. clinician to determine diagnosis. • The Evelyn Community Head Injury Service Our priority is to deliver high quality care and This includes our duty to: (ECHIS) hold a user group called Patient Café, ensure the best outcomes for those who use our • How our community nursing services in Luton where people are asked to review and influence services. Here are just a few examples of patient • Eliminate unlawful discrimination, harassment can work more cohesively with social care the service’s development outcomes: and victimisation and other conduct prohibited services, to improve the care provided to service by the Act. users, including through understanding the • DynamicHealth has introduced separate • Acute paediatric diabetic services nationally psychology of communication and emotional changing facilities for the patients attending were assessed using the Royal College of • Advance equality of opportunity between intelligence and the signals that carers may the gym sessions. This change came directly Paediatrics Clinical Services Quality Measures. people who share a protected characteristic demonstrate when struggling to cope. from recommendations made by a patient Results identified our service as one of only two and those who do not. during their story presented to the Trust Board. providers from 17 in the East of England, which • The collaborative work carried out between the • Foster good relations between people who were rated ‘Good’ in all three areas assessed. Trust, Norfolk and Norwich University Hospitals • The Peterborough school immunisation share a protected characteristic and those who NHS Foundation Trust and the local authority, service is working with the Muslim Council of • iCaSH Peterborough undertakes regular Patient do not. to form the Nurture Group, which has directly Peterborough and Peterborough City Council Reported Outcome Measure (PROM) surveys, We are using the Equality Delivery System (EDS2), benefited a family. to encourage parents to accept the nasal flu including seven questions about whether as a tool to help us to deliver against our statutory vaccination for primary school children. Owing advice delivered would alter future behaviour. requirements in relation to our staff and service to porcine gelatine in the vaccine, Muslim 148 responses were received in December users. Patient and Public Engagement communities in Peterborough have been 2017 with planned improvements reported by Our teams regularly seek service user feedback reluctant to consent to the vaccine. patients in all seven areas. in different ways and make adjustments to their • Following feedback from parents, a new link • An audit of 1000 randomly selected call logs Trust Demographic Profile practice and ways of working. The changes nurse for breastfeeding in the Special Care from our Physio Direct telephone assessment Our Communities teams make are reported to the Trust’s Clinical Baby Unit has attended the Breastfeeding Train service, identified 55% of patients were able We provide a range of healthcare services in Operational Boards. the Trainer course. to self-manage their condition following Bedfordshire, Cambridgeshire, Luton, Norfolk, telephone assessment, demonstrating effective Activities included: • Engagement with a local school resulted in Peterborough and Suffolk. Each locality has its use of resources and patient empowerment. students designing and producing peacock own vibrant and diverse community and our feathers to be displayed around the new • Our DynamicHealth service has successfully service improvement and redesign aspirations Peacock Centre in Cambridge. used the EQ5D patient reported outcome tool reflect the specific needs of each. historically, demonstrating positive outcomes against health related quality of life (QOL)

24 Performance Report 25 Our Workforce Service users Over the last year, the Patient and Service Users’ four EDS objectives. We will use this information Sub Group have: as well as feedback received from patient and Charts showing the demographic profile of our The Trust is deeply committed to improving the staff surveys and other sources, to develop an workforce as at 31 March 2018 are included in access, experiences, health outcomes and quality • Provided oversight of the Trust’s translation improvement plan for the next 12 months and the Staff Report on page 98. of care for all our service users, in the diverse services. agree our objectives for 2018/19. communities we serve. The Trust Board has agreed four diversity and • Reviewed the ‘Safeguarding and Community inclusion annual objectives as detailed below. A few examples of how we have successfully Inclusion Report,’ jointly produced by the Measuring Outcomes engaged with service users in harder to reach Cambridgeshire, Peterborough and Norfolk groups include: Local Safeguarding Children Boards. Every year, we work with our staff, patients, families, carers and the public to assess our • Our community matrons, in partnership with a • Raised awareness and provided guidance for performance in equality and diversity and agree local GP practice and the Noah Welfare Centre, staff to effectively support service users on faith Objective 1 an improvement plan for the following year. All delivered the flu vaccination and ‘mini health at end of life. our progress reports and action plans can be Achieve an improvement in check’ to the homeless population in Luton. the percentage of service • Used DisabledGo surveys to produce site accessed through our website. Additionally, our users who report that they • Our Luton based children’s epilepsy service accessibility guides. Board receives an annual report on equality and are able to access the Trust has introduced skype based appointments diversity, including the proposed improvement for young people, enabling the delivery of services they require. Workforce plan for the following year. The Trust introduced a accessible services at times and settings that People Participation Committee in April 2018. The meet the needs of these young people. To support the two workforce Equality Delivery Diversity and Inclusion Steering Group will now System (EDS) objectives and to take action in line • A programme of diabetic self-care programmes report to the Board through this committee. Objective 2 with the Workforce Race Equality Standards, the in our Luton based adult services, particularly Trust has introduced unconscious bias training Enhance our those of South East Asian origin, supported and awareness raising. Face-to-face training is Providing outstanding care: approach to self-care through high quality advice and Objective 3 now being delivered as part of our Trust induction Looking forward to 2018/19 involving and resources. for all new staff and at our training for new capturing the Using the Our Quality and Clinical Strategy has been • A Bengali interpreter in our Luton service is line managers. It is also part of our recruitment experience of national ‘A Call refreshed to focus on improving the quality of offering excellent support for families within and selection training for anyone taking part in hard to reach / to Action on the services we deliver through a series of four this community managing a diagnosis of recruitment. The Trust has also rolled out our seldom heard / Bullying and priorities: varied community Aggression’ epilepsy, encouraging parents to access a South e-learning package to deliver unconscious bias groups. internally, to Asian parent group and education sessions to training to all staff. Priority 1: Safety broaden understanding of this condition. Goal - A mature patient safety culture is promote our The Trust supported the formation of a staff evidenced throughout our services. zero tolerance • Our dental service’s oral health promotors led diversity and inclusion network, to help us policy and delivered training to health visitors in create a fairer and more diverse workforce. The Priority 2: Evidence Based & Innovative address bullying Peterborough to ensure consistent oral health network provides a forum for our staff to come Practice and aggression messages. This is linked to a programme that together, drawing from their own experiences to Goal - Clinicians deliver practice based on best when it occurs. funded a toothbrush and toothpaste for every celebrate diversity, share ideas, raise awareness available evidence and the effectiveness of child having their yearly check. of challenges, provide support to each other and treatments and interventions is measured. identify improvement actions. Objective 4 • Our dental service also reached out to ensure Priority 3: People Participation that diverse groups are able to access the In partnership with the Royal College of Nursing, Goal - We will move from a ‘patient engagement’ Ensure that the Workforce Race service. In particular, they have worked with: we introduced the role of Cultural Ambassadors to a ‘people participation’ approach where service Equality Standard is embedded special needs schools, traveller communities, and continue to embed this role across the users, patients and local communities help to and undertake proactive work Milton Hospice, Asian women’s support groups, Trust. Our Cultural Ambassadors are a cohort of shape and improve future service provision. around any areas of under- nursing and care homes, learning disabilities volunteers from our senior black and minority Priority 4: Learning and Continuous representation identified. groups, Ida Darwin Nursery and the brain injury ethnic (BME) workforce, trained to act as Improvement In particular, we will seek unit in Ely. critical friends at internal people management Goal – High quality care is delivered by clinicians innovative methods to have procedures, such as disciplinary and grievances This year, our internal auditors conducted an audit who have learned from the experiences of co-opted representation on the involving BME staff, to challenge any bias in the of the Trust’s Accessible Information Standard and patients, service users and staff and continually Trust Board from more diverse process, decision making and advise the panels. backgrounds. achieved a ‘reasonable reassurance’ assessment. seek to improve. Recommendations will be implemented in line The Trust also supported a number of BME staff to These priorities build on our overarching with the agreed timelines. This will be overseen by undertake the national programmes of leadership programme ‘Our Quality Way,’ launched in the Patients and Service Users’ Sub-Group, with development for BME staff, delivered by the NHS 2017, which helps staff to understand their assurance provided to the Board via the People Leadership Academy and promoted our support role in delivering high quality care. The annual Participation Committee to be launched in April for International Women’s Day in March 2018. implementation plans for the strategy will be 2018. We held engagement sessions with our staff and based on Trust-wide programmes of work. service users to assess our progress against the

26 Performance Report 27 STRATEGIC OBJECTIVE 2 • Pathway to Parenting Courses are taking place STRATEGIC OBJECTIVE 3 The full list of areas where we scored better than across Norfolk involving CCS staff, children’s average is: Collaborate with other centres staff and acute hospital midwives. Be an excellent employer • KF13 - Quality of non-mandatory training, organisations • Joint musculo-skeletal virtual clinics are being We continued to recognise our staff’s strengths learning or development held with three hospitals across Cambridgeshire Working in partnership with other agencies is and build on best practice to develop a workforce, • KF20 - Percentage of staff experiencing and Peterborough for patients with complex fundamental to our shared success and ambition with a shared vision and values aligned to our discrimination at work in the last 12 months neurosurgical (spinal) and orthopaedic strategic objectives. The following sections set out to ensure the best outcomes for local residents. • KF21 - Percentage of staff believing that the conditions, ensuring appropriate patients are how we have achieved this. Examples of partnership initiatives include: referred to the right service. organisation provides equal opportunities for career progression or promotion • Our regional iCaSH services are working with • Leading the leadership and development acute trusts to deliver universal care for HIV Staff survey • KF30 - Fairness and effectiveness of procedures programmes in Bedfordshire, Luton and patients who present with complex needs in for reporting errors, near misses and incidents Milton Keynes, and the Cambridgeshire and For the fifth year running staff rated working the hospital setting. Peterborough Sustainability and Transformation for the Trust incredibly positively, reflecting the • KF31 - Staff confidence and security in Partnerships. • Community and hospital dental service fantastic culture and behaviours our staff helped reporting unsafe clinical practice colleagues in Cambridgeshire are delivering to create. The results from the 2017 staff survey, • We have worked closely with commissioners • KF18 - Percentage of staff attending work in joint appointments for patients who would which was sent electronically to all staff, were in Norfolk and Suffolk to align with local plans the last three months despite feeling unwell, otherwise undergo multiple anaesthesia. published nationally in March 2018. and contribute to local health priorities, in line because they felt pressure from this manager, with our public health commissioned services. • Our South Bedfordshire/Luton end of life Being rated best in the country when compared colleagues or themselves services are further improving multi-disciplinary to our peers in 19 out of the 32 areas rated • Continuing to work with Health Service • KF19 - Organisation and management interest team (MDT) working across the acute, hospice (including staff recommendation of the Trust as Laboratories (a venture between two NHS in and action on health and wellbeing and community settings. a place to work or receive treatment), and better organisations and a private sector partner) to than average in 29 of the 32 areas is simply • KF15 - Percentage of staff satisfied with the introduce and deliver at home testing iCaSH • Community paediatricians and psychiatrists phenomenal. In 2016, these figures were 9 out of opportunities for flexible working services in Bedfordshire, Suffolk and Norfolk. in Cambridgeshire are holding joint clinics to 32 and 27 out of 32 respectively. support the delivery of accessible services, • KF1 - Staff recommendation of the • Continuing to work with the Terence Higgins for children with ADHD diagnoses and co- In 29 out of the 32 key findings (KFs) the Trust organisation as a place to work or receive Trust to provide contraception and sexual morbidity. scored ‘better than average’ when compared to treatment health services in Bedfordshire, Cambridgeshire, other community trusts nationally. The Trust’s top • KF4 - Staff motivation at work Norfolk and Suffolk. We also continue to work • We are proactively developing, with partners in ranking scores were: with Brook in Bedfordshire. Cambridgeshire and Peterborough, proposals • KF7 - Percentage of staff able to contribute for a single point of clinical triage within MSK • Effective use of patient/service user feedback • A ‘joint venture’ is underway between ourselves towards improvements at work services to avoid the need for initial referrals to and Cambridgeshire and Peterborough NHS • Effective team working • KF8 - Staff satisfaction with level of acute hospital consultants. Foundation Trust (CPFT) to ensure services for • Recognition and value of staff by managers and responsibility and involvement children and young people in Cambridgeshire • As the co-ordinating partner, we continued to the organisation • KF9 - Effective team working and Peterborough, are delivered to the same work with East London NHS Foundation Trust, high standard through patient centred, Luton Borough Council, Virgin, and Luton & • Support from immediate managers • KF5 - Recognition and value of staff by integrated care delivery. Dunstable Hospital to introduce the Adult At • Percentage of staff attending work in the managers and the organisation Home First model, where health and social • Together with CPFT we have launched an last three months, despite feeling unwell • KF6 - Percentage of staff reporting good care partners are collaboratively maintaining Emotional Health and Wellbeing service across because their felt pressure from their manager, communication between senior management patients’ independence and avoiding hospital Cambridgeshire and Peterborough, which will colleagues or themselves and staff admissions. support professional to access services and We know that an engaged and happy workforce • KF10 - Support from immediate managers help schools improve the emotional health and • We have developed a new partnership is directly linked to the provision of good patient wellbeing of pupils. with East London NHS Foundation Trust to outcomes, so we were particularly pleased that • KF32 - Effective use of patient/service user successfully bid and win the contract to deliver feedback • We have introduced orthopaedic clinics in our staff engagement score was 9th highest children and adults community health services Cambridgeshire for children and young people nationally for all NHS provider organisations, and • KF23 - Percentage of staff experiencing physical across Bedfordshire from April 2018. with complex physical disabilities, bringing the highest score compared to all community violence from staff in last 12 months trusts. together a paediatric physiotherapist, acute • KF25 - Percentage of staff experiencing hospital orthopaedic consultant and community harassment, bullying or abuse from patients, paediatrician, to make holistic decisions relatives or the public in the last 12 months about service users’ surgical, medical and physiotherapy care needs.

28 Performance Report 29 There were no key findings where the Trust scored • KF10 - Support from immediate managers ‘worse than average’ (in 2016 there were three • KF32 - Effective use of patient/service user areas). feedback Eight key findings have improved from 2016 The two key findings that have deteriorated are: results and two have deteriorated. The key findings that have improved are: • KF28 - Percentage witnessing potentially harmful errors, near misses or incidents in last • KF11 - Percentage appraised in last 12 months months • KF30 - Fairness and effectiveness of procedures • KF22 - Percentage experiencing physical for reporting errors, near misses and incidents violence from patients, relatives or the public in • KF19 - Organisation and management interest last 12 months in and action on health and wellbeing In response to the 2016 results the Trust • KF1 - Staff recommendation of the developed an improvement plan, which focused organisation as a place to work or receive on five key findings. An improvement in ranking treatment has been achieved in four out of those five, with the fifth remaining the same. A summary of • KF14 - Staff satisfaction with resourcing and progress on these findings is detailed below: support • KF5 - Recognition and value of staff by managers and the organisation Gender Pay Gap Report Supporting staff and staff engagement The Trust published a Gender Pay Gap Report The Trust: in March 2018. The gender pay gap shows the Change – • Continued to introduce innovative recruitment difference in the average pay between all men Key Finding from 2016 Ranking in 2017 initiatives in hard to recruit areas. to 2017 and women in a workforce. The gender pay gap is different to equal pay. Equal pay deals with the • Successfully transferred staff into the Trust as KF27 - Percentage of staff/colleagues reporting Average pay differences between men and women who a result of procurements won and introduced most recent experience of harassment, bullying (ranking in 2016 below carry out the same jobs, similar jobs or work of inductions specifically designed to meet the or abuse Increase (worse than) average equal value. needs of new staff. Above (better than) average This report shows that for pay bands up to and • Supported services and staff transferring out KF24 - Percentage of staff/colleagues reporting including Agenda for Change (AfC) band 8d, of the Trust, with a transition programme that most recent experience of violence (ranking in 2016 below No change (worse than) average) there is no gender pay gap, with the exception of ensured they left the Trust in the best state of 287 staff in band 7 where the gender pay gap is readiness to positively move forward. Average in favour of female staff. • Supported strategic service redesign KF11 - Percentage appraised in last 12 months (ranking in 2016 below The Trust’s overall mean gender pay gap is programmes enabling staff and services to Increase (worse than) average 30.04% which includes a relatively small gender review and implement plans to meet patient needs. Average pay gap within a higher paid staff group. It is KF16 - Percentage of staff working extra hours important to remember that this is about the No change (ranking in 2016 average) • Provided bespoke team development, support gender pay gap not the equal pay gap. On and skills training for teams leading service face value, the staff group/banding analysis is Below (better than) average redesign programmes. KF23 - Percentage of staff experiencing physical reassuring in respect of pay. However, analysis violence from staff in last 12 months No change (ranking in 2016 average) shows that the gender pay gap is mainly • Provided coaching and mentoring support attributed to executive level (Band 9 roles) and to team leaders, supporting services and medical consultant roles, typically the highest staff implementing change and transition. earning roles within the Trust. In these roles, there Implemented a Mentoring Programme for BME are disproportionately more men than women. staff. Such is the disproportionality, relative to the pay • Continued to implement action plans based on rates for all staff groups, the gender pay gap is staff feedback. enhanced. We are taking forward an action plan • Reviewed Trust-wide training and education to increase the number of male employees overall needs to plan, procure and implement within the Trust and in particular in lower paid programmes of development, to support staff bands, and to ensure career progression for our to deliver high quality services. female employees and increase the number of females externally recruited into higher banded • Promoted the benefits of effective appraisals roles. and achieved 91% compliance.

30 Performance Report 31 • Launched a new appraisal career and personal • Implemented a confidential line for informal Our award winning staff and national • We have submitted two case studies, development planning process. support to staff experiencing bullying or recognition together with our Norfolk County Council harassment. commissioners, to highlight innovation/service • Revised and embedded our leadership • Debbie Brown (Early Help Service), Salma redesign in our Norfolk Just One Number behaviours. Fazil (Luton Flying Start) and Alison Braniff service and our 5-19 service pathway, to the (Luton Children’s Community Health Services) • Offered flexible working and family friendly Mandatory training Public Health England Annual Conference received the Elephant Award from the NSPCC, arrangements, a carer’s and special leave policy being held on 11-12 September 2018. The Trust: for pioneering a programme to help protect and a zero tolerance approach to violence in children from neglect across Luton. • A case study from our regional iCaSH services the workplace. • Continued to improve access to e-learning for was showcased in the NHS Providers State mandatory training subjects and supported • The Trust was presented with the international • Continued to offer mindfulness and personal of the Provider Sector publication entitled staff to access via a telephone helpdesk. Green Apple Award for collaborative work resilience training programme to enhance the ‘Community Services: Taking Centre Stage.’ with Cambridgeshire and Peterborough NHS already successful training for personal welfare, • Continuously reviewed and amended our Trust Foundation Trust and Serco, for an innovative • Our Norfolk Just One Number service was which supports our Live Life Well programme. induction based on staff feedback and Trust requirements. waste management/recycling project. cited as an example of good practice in the • Continued to chair the bi-monthly Joint Royal College of Paediatrics and Child Health • Our Luton GP Liaison Service was shortlisted Consultative Negotiating Partnership to engage • Rolled out unconscious bias training as part of document ‘Facing the Future: Standards for for two Health Service Journal Value Awards with trade union representatives to exchange e-learning for all those involved in recruitment. Children with Ongoing Health Needs.’ The for an urgent care project it runs with Luton information, harmonise human resources publication provides a vision of how paediatric In response to the 2016 NHS Staff Survey, we Clinical Commissioning Group, Luton and policies and processes, following the transfer care can be delivered to provide a high quality engaged with our staff to complete actions Dunstable Hospital and Consultant Connect, in of staff and to consult and negotiate on service that meets the needs of infants, children addressing areas requiring improvement. which provides the mobile communications for employment matters. and young people with ongoing health needs. the service, which seeks to support patients to remain in their own home and avoid hospital • Our HR Team was one of three teams, which admission. were shortlisted in the HPMA awards for the Issue raised Action taken ‘Best use of the Electronic Staff Record system • The following Trust services were nominated to support their business objectives and deliver Staff/colleagues Introduced unconscious bias training at induction and embedding it by local MPs for the NHS 70th Parliamentary service improvements.’ reporting most into all training and leadership programmes. Awards. Following a regional assessment recent experience of Developed new role of Cultural Ambassadors, mentoring and process, both were identified as the Regional • The Food First Team for Luton, Bedfordshire and harassment, bullying support to staff and ensuring good uptake on national development Winners for the NHS Midlands and East area. Hertfordshire Valleys attended the Advancing or abuse. programmes for our BME workforce. Healthcare Awards, and were finalists in the Scottish Government’s Award for Improving Our Chair of Staffside made herself available to staff on a confidential Supported Quality: Measuring and Demonstrating Impact, Nomination Category basis, to discuss their experiences and advise on possible actions. by which MP for their shared leadership approach to tackling malnutrition in care homes. In addition, two Staff/colleagues We reviewed and revised our approach to bullying and harassment. Norfolk Just Person Chloe Smith of the team’s dietitians, Francesca Brown and reporting most recent This has included updating our policy, introduction of staff leaflet to One Number Centred Care (Norwich Catie Blanchard, were both awarded the AHA experience of violence raise awareness, training and further efforts to enforce a zero policy North) Rising Star Award for showing an exceptional on any bullying instances. Sir Henry level of initiative, skill and commitment. This Bellingham initiative was also one of three finalists in the Staff appraised in the Appraisal training has been provided since the 2016 survey and (North West NICE Shared Learning Awards held in June last 12 months uptake of appraisal reached 91% compliance in 2017/18 against a Norfolk) 2018. target of 90% • Our annual excellence awards celebrated the Professor Lifetime Jo Churchill Staff working extra The implementation of “Let’s Collaborate”, the Trust’s new online outstanding achievements of our staff, day Barbara Achievement (Bury St hours forum, aims to prevent staff from having to travel and use up in day out, which make a real difference to Wilson (for Edmunds) “working time,” as discussions can take place online. The Trust has people’s lives. On 19 September 2017 the dedicating also encouraged increased use of the BT Meet Me facility. ceremony saw eight awards presented: over 40 years of her life to »» Chairman’s Innovation Award: awarded to Staff experiencing A review of our conflict resolution training and many facilitated team the Norfolk Healthy Child Programme service physical violence in last sessions for staff who had experienced abuse from patients/the public. brain injury 12 months “On your side” leaflets have been produced to support staff in their rehabilitation) »» Shine a Light Annual Award: Winner - Jan response to abuse and violence. Wilkins, Family Support Practitioner »» Kate Granger Person Centred Care Award: Winner - Alice Hill, Speech and Language Therapist, Huntingdon Children and Young People’s Service

32 Performance Report 33 • Develop the skills of our clinical staff in quality, STRATEGIC OBJECTIVE 4 including diversity and inclusion..” service improvement and redesign tools and As a part of the NHS, public health and social techniques, providing bespoke programmes Be a sustainable organisation care system, it is our duty to contribute towards of leadership development, for services the level of ambition set in 2014 of reducing the undergoing significant service redesign. Sustainable Development carbon footprint of the NHS, public health and • Continue to work with partners across local We have continued to deliver our Sustainable social care system by 34% (from a 1990 baseline) Sustainability and Transformation Partnerships Development Strategy, using the Good Corporate equivalent to a 28% reduction from a 2013 (STPs) to implement the nursing associate role. Citizen assessment tool to demonstrate baseline by 2020. It is the Trust’s aim to exceed compliance. This programme of work includes a this target by reducing our carbon emissions 28% • Continue to expand the opportunities for focus on carbon reduction and: by 2020/21 using 2012/13 as the baseline year. apprenticeships across our workforce, following implementation of the Apprenticeship Levy • transport and travel policies and further higher apprenticeships becoming • procurement processes Policies available for our clinical and non-clinical workforce. • energy efficient properties, waste management In order to embed sustainability within our and recycling business, it is important to explain where in our • Roll out the preceptorship training programme, process and procedures sustainability features. currently being developed and finalised by HEE, • community engagement to all our preceptors. • workforce issues including diversity and Is sustainability inclusion Area • Continue to offer our successful Chrysalis and considered? Stepping Up leadership and management Our achievements to date and aspirations for the development programmes and bespoke future are set out in our Annual Sustainability Travel Yes »» Rising Star Award: Winner - Fiona programmes, which support team development Report 2017/18 (not subject to audit) set out Hammond, Deputy Sister Special Care Baby in services. below. Business Cases Yes Unit (SCBU) • Introduce, in our Cambridgeshire and »» Supporting our Services to Excel: Winner Procurement Yes Peterborough locality, the Mary Seacole (environmental) - Pina Hoque, Linkworker, Luton children’s leadership development programme to Sustainability Report services develop knowledge and skills in leadership and As an NHS organisation, and a recipient of public Procurement Yes There were three team-based awards for management. funds, we have an obligation to work in a way (social impact) an initiative, service or development which • Continue to embed a coaching and mentoring that has a positive effect on the communities we demonstrated improvements to clinical or patient culture across the Trust, investing in further serve. Sustainability means spending public money Suppliers' impact Yes report outcomes: health coaching training for our clinical well, the efficient using of natural resources »» Ambulatory services: Winner - Outreach workforce and mentor development aimed at and building healthy, resilient communities. By One of the ways in which an organisation can team iCaSH Peterborough encouraging staff and leadership development, making the most of social, environmental and embed sustainability is through the use of an talent development, and opportunities for staff »» Children & Young People’s services: Winner economic assets we can improve health both SDMP. The Board approved our SDMP in the last to achieve career ambitions, including for BME - Cambridgeshire Paediatric Speech and in the immediate and long term, even in the 12 months so our plans for a sustainable future staff. Language Therapy team context of the rising cost of natural resources. are well known within the organisation and • Continue to implement manager/supervisor Demonstrating that we consider the social and clearly laid out. »» Luton Children and Adults’ community environmental impacts ensures that the Trust self-service in the Electronic Staff Record (ESR) Our organisation evaluates the environmental health services: Winner - Special Needs meets the legal requirements set out in the Public and developments that support services to and socio-economic opportunities during our School Nursing service Services (Social Value) Act (2012). record and report staff compliance. procurement process in the following ways: • We continued to recognise teams and In order to fulfil our responsibilities for the role • Continue to implement our 2016-21 • During the tendering process we try to individuals through our monthly Shine a Light we play, the Trust has the following sustainability workforce, organisational development and evaluate environmental and socio-economic awards. mission statement located in our sustainable service redesign strategy, focussing on the opportunities by including sustainability and development management plan (SDMP): following five programmes of work: added value social outcomes, as part of the Attracting and retaining a quality workforce: »» a highly engaged workforce “The Trust’s “Objective 4: Be a sustainable agreed evaluation criteria and by asking Looking forward to 2018/19 organisation”, includes a commitment to be a contract specific questions. For example, two of » an appropriately trained workforce » good corporate citizen, and focus on carbon our questions for the draft waste invitation to We will: »» a healthy and well workforce reduction and transport and travel policies, tender are: • Expand opportunities for apprenticeships and procurement processes, energy efficient »» diversity and inclusion for all »» “Please detail your methodologies for focus on the development of our Bands 1-4 properties, waste management and recycling, reducing the carbon footprint, maximising workforce, linking with the Health Education »» an organisational culture of continuous community engagement and workforce issues East of England (HEE) Grow Your Own initiative. improvement.

34 Performance Report 35 innovation and delivering a sustainable Adaptation Partnerships solution across the contract.” Climate change brings new challenges to our The NHS policy framework already sets the scene »» “Please detail how you will bring additional business both in direct effects to the healthcare for commissioners and providers to operate in a social, environmental and economic value to estates, but also to patient health. Examples from sustainable manner. Crucially for us as a provider, the geographies in which the Contracting recent years include: the effects of heat waves, evidence of this commitment will need to be Authority delivers services and how this will extreme temperatures and prolonged periods provided in part through contracting mechanisms. be measured and evaluated.” of cold, floods, droughts etc. The organisation We have not currently established any strategic has identified the need for the development of a • Supply Chain: endeavouring to use local sustainability partnerships. For commissioned Board approved plan for future climate change suppliers for practical and FM work and services here is the sustainability comparator for risks affecting our area. commit to paying them under the NHS prompt our CCGs: payment scheme. Events such as heatwaves, cold snaps and flooding are expected to increase as a result • Local Recruitment: through focussing on local CCG Name SDMP GCC SD Reporting score of climate change. To ensure that our services recruitment and fully linking into apprenticeship continue to meet the needs of our local schemes and non-qualified staff. NHS Cambridgeshire and Peterborough Yes No Good population during such events, we have NHS Luton No No Minimum One of the ways in which we measure our developed and implemented a number of policies impact as an organisation on corporate social and protocols in partnership with other local NHS Bedfordshire Yes No Good responsibility is through the use of the Sustainable agencies. Development Assessment Tool (SDAT). The last We understand the potential impacts of climate More information on these measures is available here: time we used the SDAT was in April 2017, scoring change and are including these impacts, such www.sduhealth.org.uk/policy-strategy/reporting/organisational-summaries.aspx 8%. As an organisation that acknowledges as heat waves and flooding, in our emergency its responsibility towards creating a sustainable planning strategy. future, we help achieve that goal by running Performance awareness campaigns that promote the benefits of sustainability to our staff. Organisation Green space and biodiversity We have not fully assessed the social and Since the 2007 baseline year, the NHS has The Trust has not developed an overarching policy, environmental impacts of the Trust; however the undergone a significant restructuring process however, as part of the sustainability and Live Life Trust has adopted the following: and one which is still ongoing. Therefore in order Well agendas the following initiatives have been to provide some organisational context, the • Work Experience: by offering a wide range implemented: following table may help explain how both the of work experience opportunities and fully • The creation of an outdoor garden area (from organisation and its performance on sustainability recognising the need to attract and train the an abandoned overgrown piece of land) for has changed over time. ‘workforce of tomorrow.’ staff to meet, eat and support the upkeep. • Volunteering: the Trust’s ‘Live Life Well’ action • The installation of electric vehicle charging Context info 2014/15 2015/16 2016/17 2017/18 plan will create support mechanisms for those points. staff wishing to volunteer to support local Floor Space (m2) 56,451 40,404 27,375 34,944 groups. • Installing ‘smart’ meters across the Trust’s Number of Staff 2,719 1,667 1,757 1,717 estate. Our statement on Modern Slavery is available at: http://www.cambscommunityservices. • Initiating the use of solar/LED street lighting In 2014 the Sustainable Development Strategy nhs.uk/about-us/priorities-and-how-we- with intelligent power management (light outlined an ambition to reduce the carbon are-doing/slavery-and-human-trafficking- output reduction to 30% when no activity footprint of the NHS as a system by 28% (from a statement-for-2017/18 detected). 2013 baseline) by 2020. We have supported this • The refurbishment of a former palliative care ambition in the following ways. unit to a children’s unit with sensory garden for the children (service users) and their families.

36 Performance Report 37 Energy Re-use The Trust has spent £392,775 on energy in The re-use of goods and community equipment 2017/18, which is a 1.8% increase on energy in the NHS has several key co-benefits, reducing spend from last year. cost to the NHS. It also reduces emissions from procuring and delivery of new goods and can provide social value when items are re-used in the community. Carbon Emissions - Energy Use Category 2014/15 2015/16 2016/17 2017/18 8,000 Gas Internal reuse of durable goods £ 0 0 0 0 Oil External reuse of durable goods £ 0 0 0 0 e) 2 6,000 Coal

Electricity The Trust has not been monitoring the re-use of • Further re-use of surplus meeting tables and 4,000 Green Electricity durable goods over the past five years however, chairs from one site to create a staff break out during 2017/18 there have been a number of area in another site, in a different county. Carbon (tCO active re-use incentives, including: • Recovery and re-use of circa 30 locker units. 2,000 • Motorcycle parking rack lifted and reused to • The salvage furniture (purchased circa 18 create safety barrier for new built storage room months previously) to the value of £27,000 and remainder used to create barrier against 0 from a site closure to re-fit an entire newly cars impacting new security gate. 2014/15 2015/16 2016/17 2017/18 acquired office/hub at almost zero cost. • 10 out of specification operator chairs and • Three surplus medical plinths taken from one 10 large meeting tables reused in a different service to another, including the ethical disposal service saving c. £3,000. The Trust has continued to achieve a reduction in This will include: replacing the district heating of the aged stock that was replaced. carbon emissions associated with energy usage system, installing modern CHP plant and • Re-use of a surplus temperature control cabinet • Over purchased chairs from one service and is well on target to achieve a 28% reduction replacing the sites generator. We will also be by clinical team and similarly with a staff room reallocated to another with unsuitable chairs, by 2020 on a 2012/13 baseline. However, the looking into the potential installation of Solar PV fridge. Trust was fully reliant on Grid electricity and did and will include LED lighting as standard for all via staff cars. not generate any electricity from renewable refurbishment work. It is unlikely that this work • Initiation of a post share scheme between the sources in 2017/18. will be completed in time to affect the 2020 resident services producing a saving of £300- carbon reduction target however, it will help the 400 in a shared building. The Trust is looking to make a substantial Trust to proceed toward meeting the next target investment in the energy infrastructure at North in 2030. Cambridgeshire Hospital. Paper The move to a paperless NHS can be supported by staff reducing the use of paper at all levels. This reduces the environmental impact of paper, reducing cost of paper to the NHS and can help improve data security:

Paper 2014/15 2015/16 2016/17 2017/18 Volume used Tonnes 0 0 0 0

Carbon emissions tCO2e 0 0 0 0

The Trust has not been monitoring paper usage separately over the past five years however, we will be looking at initiatives associated with promoting a paperless environment and these will be included in the next review of our Sustainable Development Management Plan.

38 Performance Report 39 Travel accidents and noise all cause health problems for Waste our local population, patients, staff and visitors We can improve local air quality and improve the and are caused by cars, as well as other forms of health of our communities by promoting active transport. travel – to our staff and the patients and public Waste Breakdown that use our services. Around 5% of travel and transport in England is due to NHS services, so we have quantified Every action counts and we are a lean 200.0 the impacts on health. In 2017/18 travel and Recycling (tonnes) organisation trying to realise efficiencies across transport related to our services reduced the Other recovery (tonnes) the board for cost and carbon (CO2e) reductions. local population health by 0.0 Quality Adjusted We support a culture for active travel to improve 150.0 High Temp disposal (tonnes) Life Years (QALYs), as an organisation we aim to staff wellbeing and reduce sickness. Air pollution, Landfill (tonnes) minimise our impact. 100.0 Category Mode 2014/15 2015/16 2016/17 2017/18 50.0 Patient and visitor km 0 0 0 0 own travel tCO e 0.00 0.00 0.00 0.00 2 0.0 km 4,203,476 2,577,122 1,688,477 2,654,420 2014/15 2015/16 2016/17 2017/18 Staff commute tCO2e 959.70 579.11 379.18 587.72 Business travel km 1,584,173 3,034,538 3,709,214 3,004,914 The Trust is continuing to reduce the amount The Trust was presented with the international and fleet tCO e 361.68 681.89 832.98 665.32 of waste the Trust sends to landfill, while Green Apple (bronze) award for collaborative 2 substantially increasing the volume of recycled work with Cambridgeshire and Peterborough Active & public km 2,851 5,754 7,168 5,108 waste. The Trust is on target to achieve the NHS Foundation Trust and Serco for an innovative transport tCO e 0.00 0.00 0.00 0.00 Sustainable Operation in the Government Estates’ waste management/recycling project. The project 2 target of a 75% recycling rate by 2020. was also presented at the Infection Prevention km 0 0 0 0 Society’s Annual Conference. Owned Electric In 2017/18 we have been decreasing the number and PHEV mileage tCO2e 0.00 0.00 0.00 0.00 of office bins to help increase recycling rates The second phase of this project has recently been Total cost of £ 0.00 0.00 0.00 1,474,928.00 further, as well as working to improve clinical initiated with the introduction of “tiger waste business travel waste segregation. bags” to facilitate the minimisation of “orange waste bags” in Trust clinical settings.

While there has been a noticeable increase in staff commute, there has been a substantial reduction Finite resource use – Water in business travel from the previous year. We understand that this is due, in part, to the increase Water 2014/15 2015/16 2016/17 2017/18 in the geographical area that the Trust provides 3 services for. We are looking to increase electric car Mains Water m 34,005 23,338 35,730 15,062 charging infrastructure at Trust locations. tCO2e 31 21 33 14 Water & Sewage Spend £ 127,579 59,971 82,270 41,109

Water consumption has decreased from the previous year. We have recently changed our water supplier and will be working closely with our new supplier to identify potential water saving initiatives.

40 Performance Report 41 Modelled Carbon Footprint Climate Change Act target The Trust has an estimated carbon footprint of 15,573 tonnes of carbon dioxide equivalent 4% emissions (tCO e) and a carbon intensity of 132 25,000 2 20% Community grams of carbon dioxide equivalent emissions per Supply Chain pound of operating expenditure (gCO2e/£). This Commissioning compares favourably to the national benchmark 20,000 for community services which is 160 gCO e/£ Proportions 5% 2 Core of Carbon e) Footprint 2 Climate Change Act Target 15,000 CCS NHS Trust target

71% 10,000

Carbon Emission (tCO 5,000 Core Supply chain

Commissioning Community 0

2012/...2013/...2014/...2015/...2016/...2017/...2018/...2019/...2020/...2021/...2022/...2023/...2024/...

Breakdown of 2017/18 emissions (tCO e) 2 The Trust can clearly demonstrate that it is contributing to the NHS and Government’s commitment to meet the 2020 Climate Change Act target. Other Aol Core Gas Core Benchmarking Oil Coal Commissioning Electricity Supply chain Renewable Heat Organisation Carbon Footprint by Operating Expenditure (gCO2 e/£) Imported Heat/ Steam Community Business and Fleet travel 200 Waste products and recycling Water and sanitation 150 Community e/£)

Anaesthetic Gases 2 100 Supply Chain Commissioning Other AoI procurement Commissioning (gCO 50 Construction & Capital spend

Carbon Emissions Core Business services 0 Food and catering 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 Benchmark (Community) Freight transport Information and communication technologies Manufactured fuels chemicals and gases Medical Instruments / equipment Other manufactured products There has been a marginal increase in the Sustainable Development Assessment Tool Other procurement carbon footprint when measured by operating (SDAT) Paper products expenditure after a steep decline over the past Pharmaceuticals One of the ways in which we measure our three years. Other Aol Community impact as an organisation on corporate social Staff commuting Patient & Visitor travel responsibility is through the use of the Sustainable Development Assessment Tool (SDAT). The 0 1,000 2,000 3,000 4,000 tool replaces the Good Corporate Citizenship

Carbon Emissions (tCO e) Sustainability Assessment Tool and will be used 2 by the Trust on an annual basis, to measure performance across a comprehensive range of sustainability metrics.

42 Performance Report 43 year plan. This approach will include developing Business Development 2017/18 new models of care, working proactively with Better Payment Practice Code The Trust established a new partnership with commissioners to secure available contract (30 day target) Number £’000 East London NHS Foundation Trust (ELFT) to extensions where we remain best placed to deliver Non-NHS Payables tender and win the community health services the service. contract in Bedfordshire. Since 1 April 2018 the Total Non-NHS Trade Invoices Paid in the Year 15,747 48,044 Trust has provided children’s services, together with some specialist adults’ services including the Total Non-NHS Trade Invoices Paid Within Target 14,120 45,246 Acquired Brain Injury service, as a sub-contractor Financial assessment to ELFT, which holds the main contract with 2017/18 has been another challenging year Percentage of Non-NHS Trade Invoices Paid Within Target 89.67% 94.18% commissioners. In addition, the Trust has been financially for the Trust but we successfully awarded a contract for therapy services in Luton, achieved an operating surplus of £937,000. NHS Payables which it will provide through the teams who Because the Trust has managed its budget to transferred to the Trust following the Bedfordshire the plan agreed at the beginning of the year, Total NHS Trade Invoices Paid in the Year 1,283 10,652 tender. These awards represent a significant we have been awarded a one off financial sum Total NHS Trade Invoices Paid Within Target 1,073 8,975 addition to the Trust’s portfolio. (Sustainability and Transformation Fund) from NHS Improvement of £2.25 million. Therefore In addition, we successfully bid to retain the Percentage of NHS Trade Invoices Paid Within Target 83.63% 84.26% adding together our real surplus and the national contracts to deliver minor oral surgery in Sustainability and Transformation Fund creates Cambridgeshire and West Suffolk and to expand an annual surplus figure for our accounts of delivery of these services in Peterborough and £3,189,000. • The Trust’s 2017/18 accounts have been • The Freedom of Information Act (FOIA) gives West Norfolk. externally audited by Grant Thornton UK LLP. individuals the right to ask any public sector Key messages for the year are set out below: The Board agreed to serve notice to External audit fees for 2017/18 were agreed as organisation for the recorded information they commissioners for the provision of children’s acute • The Trust has maintained its high level of £42,300 excluding VAT (2016/17 fees with BDO have on any subject. Most requests are free but services delivered from Hinchingbrooke Hospital in financial governance, recognised by the Internal LLP £66,462 excluding VAT), where the fee was in some cases individuals may be asked to pay Huntingdon. Since Hinchingbrooke Hospital and Auditors giving an opinion of “reasonable agreed in a tender process. a small amount for photocopies or postage.The assurance” over the Trust’s financial systems, Trust has complied with Treasury’s guidance on Peterborough and Stamford Hospitals merged • The Trust is a member of the NHS Pension budget control and financial improvement. setting charges for information. into one organisation, the Board concluded Scheme. The scheme is unfunded with defined that the new hospital Trust (North West Anglia • The Trust has a responsibility to pay its suppliers benefits. Full details of the treatment of the • So far as the directors are aware, there is no NHS Foundation Trust) was better placed to run in line with the payment terms agreed at the Trust’s Pension Policy can be found in note 8 relevant audit information of which the auditors the services going forward. The decision was time of purchase. Failure to do this harms the of the annual accounts. The Remuneration are unaware. Directors have taken all of the also consistent with the Cambridgeshire and reputation of the Trust and the wider NHS, as and Staff Report on page 88 shows the salary steps that they ought to have taken in order to Peterborough Sustainability and Transformation well as damaging supply sources and straining and pension entitlements of the directors of make themselves aware of any relevant audit Plan. It is anticipated the services will transfer out relationships with suppliers. the Trust. information, and to establish that the auditors of our Trust on 31 October 2018. are aware of that information. • The Trust has adopted the national NHS Better • There have been no accounting policy changes At the invitation of the Joint Commissioning Unit Payment Practice Code. The target set is that at during 2017/18. Critical accounting judgements • The directors have a reasonable expectation (representing Cambridgeshire and Peterborough least 95% of all trade payables should be paid and key sources of estimation of uncertainty are that the Trust has adequate resources to Clinical Commissioning Group, Peterborough City within 30 days of a valid invoice being received shown in note 1.2 and 1.2.1 of the accounts. continue in operational existence for the Council and Cambridgeshire County Council), the or the goods being delivered, whichever is foreseeable future. Although 2018/19 will be • The Trust has spent £5.94 million in 2017/18 Trust is collaborating with Cambridgeshire and later – unless other terms have been agreed financially challenging with a savings target (2016/17 £5.74 million) on items that come Peterborough NHS Foundation Trust in the design previously. The Trust’s detailed performance in excess of £3 million, cash flow forecasts within the NHS management costs definition. of children’s mental and physical health services, against this target for NHS and non-NHS support the conclusion that the Trust is a ‘going This represents 5.2% (2016/17 4.9%) of total and intends to enter into a Contractual Joint trade payables is set out in note 9.1 in the concern’. For this reason, directors continue to turnover for the financial year. Venture for the provision of these services from annual accounts and is also shown in the table adopt the ‘going concern’ basis in preparing April 2019. This will secure the Trust’s current below. Its performance in relation to non-NHS • All Trusts were set caps relating to agency the accounts. To obtain further detail of our contract revenue. payables improved during the year, but there expenditure during 2017/18. The Trust had financial performance, please write to: was a decline in relation to NHS payables. a cap of £3.332 million and remained within As a result of new services won and services Director of Finance and Resources The Trust will continue to work to improve its this, with year end spend on agency of £2.301 transferring out of the Trust, we will commence Cambridgeshire Community Services NHS Trust performance against target. million. The Trust will continue our robust 2018/19 with an annual budget of £129 million. Unit 3, Meadow Lane, St Ives, PE27 4LG programme of work to reduce expenditure in The future will be characterised by participating this area in 2018/19. Our full audited accounts will be available on our in tenders to retain and win business within the website at www.cambscommunityservices.nhs.uk clearly defined parameters set out in our five

44 Performance Report 45 Young people from Norfolk featured Commissioner – Cambridgeshire and Peterborough Clinical Commissioning Group (CCG) in radio DJ’s health podcasts for teens

Key: Red = target not achieved, Green = target achieved Presenter Cel Spellman, who hosts the Sunday afternoon slot on BBC Radio One and stars in ITV 2017/18 2015/16 2016/17 2017/18 Indicator drama Cold Feet said: “I feel pretty privileged to target actual actual actual have heard such honest and touching personal stories, Young people today have to deal with all the Children’s Specialist Services classic teenage worries and troubles, but it doesn’t Percentage of service users on incomplete RTT end there. With social media, current affairs and pathways (yet to start treatment) waiting no more 92% 98% 93% 99% online, this digital generation have much more to than 18 weeks from referral deal with. Sometimes these sort of problems can be misunderstood by our peers who say we’ve never Percentage of service users waiting 6 weeks or < 1% 0 0 0 had it so easy, so get on with it.” more from referral for a diagnostic test The podcasts are designed for people who like to listen through headphones whilst on the move, Zero tolerance MRSA 0 0 0 0 users can also stream the podcasts directly from our Minimise rates of Clostridium Difficile 0 0 0 0 website using: http://bit.ly/norfolk-healthuncovered Zero tolerance RTT waits over 52 weeks for Young people our Children and Young Sian Larrington, Head of Service, Norfolk Children 0 0 0 0 People’s Health Services in Norfolk featured and Young People’s Services has expressed her incomplete pathways in a series of podcasts hosted by BBC Radio delight with the outcome. She said: One presenter and actor Cel Spellman. SEND – number of requests completed and returned within timeframe (6 weeks from receipt Baseline N/A N/A 99% The series aimed to get more young people To communicate effectively with of request) in tune with their health and wellbeing our young people in the Norfolk Children Looked After - Initial health assessments by sharing a variety of candid discussion community, we have to speak 100% 100% 100% 100% programmes. The two episodes our teams completed within 20 working days their language and communicate were involved in were episode 3 “mental using formats they find easy and Children Looked After - Initial Health assessments health - me and my emotions” and episode 100% 100% 100% 100% 4 “sexual health - are you ready?” accessible, this selection of podcasts undertaken by medical practitioner does just that. Children Looked After - Review assessments 100% 100% 100% 100% completed in 15 working days

Performance against contractual targets targets. A number of these targets are nationally Ambulatory Services in 2017/18 measured; other targets are locally contracted by each commissioner. A series of tables on the Percentage of service users on incomplete RTT Throughout the year, the Trust’s Board has following pages summarise our performance pathways (yet to start treatment) waiting no more 92% 93% 92% 100% scrutinised performance against targets and against these key performance targets by than 18 weeks from referral remedial action plans through: commissioner. Zero tolerance RTT waits over 52 weeks for • Bi-monthly reporting at Board meetings against 0 0 0 0 Some key performance indicators are new and incomplete pathways all quality, risk, financial, performance and accordingly there is no corresponding result from contracted targets and indicators. No urgent operation should be cancelled for a previous years. 0 0 0 0 • Comprehensive governance arrangements second time Some targets are marked as ‘on-track’. This is including weekly executive team meetings and for performance indicators being measured over monthly wider executive team meetings. All consultant-led services delivered by the provider a reporting period that does not align with the shall have the names of the consultants or 100% 100% 100% 100% • Bi-monthly clinical operational boards across April-March financial year. In these cases at March healthcare provider within that service published the Trust’s three divisions: Luton children and 2018 performance is currently on-track to achieve against them adults services; Cambridgeshire and Norfolk the end-of-year target. children and young people’s health services; Out-patient appointments delivered by the provider Remedial action plans are maintained for all KPIs and ambulatory services across all localities. shall be available via NHS e-referral as a directly 100% 100% 100% 100% below target to deliver improved performance in bookable service (subject to any exclusions) During 2017/18 the Trust was monitored against future month. a range of key performance indicators (KPIs) and

46 Performance Report 47 Commissioner – NHS England Commissioner - Luton Clinical Commissioning Group (CCG)

Key: Red = target not achieved, Green = target achieved Key: Red = target not achieved, Green = target achieved

2017/18 2015/16 2016/17 2017/18 2017/18 2015/16 2016/17 2017/18 Indicator Indicator target actual actual actual target actual actual actual

School Aged Immunisations Service Percentage of patients on incomplete, non- emergency pathways (yet to start treatment) 92% 100% 100% 99% HPV vaccination by end of school year nine dose 1 90% (5% 84% 88% On-track waiting no more than 18 weeks from referral tolerance) Diagnostic Tests - Percentage waiting no longer HPV vaccination by end of school year nine dose 2 90% (5% 99% 100% 100% 79% 86% 84% On-track than six weeks from referral tolerance) Number of failures to notify the relevant person of School leaver booster (Td/IPV) by end of school 80% (5% 100% 85% 87% an incident that resulted in severe harm or death - 0 0 0 0 year 9 dose 1 tolerance) Duty of Candour

Men ACWY by end of school year 9 80% (5% 81% 86% 88% Zero tolerance of RTT waits over 52 weeks 0 0 0 0 tolerance) Percentage of new children from high prevalence Childhood Flu vaccination school years R, 1, 2, 3 60% (5% areas who have not been vaccinated for TB who 59% 60% 66% 100% 100% 100% 100% and 4 tolerance) have been seen by the TB service within 28 working days Schools participating in the programme 100% (5% 99% 99% 100% tolerance) Percentage of children who were being breastfed at point of transferring to CCS at 10 to 12 days 60% 72% 79% 78% Vaccine administration training 100% 100% 100% 100% who continue to be breastfed at 6-8 weeks

Patient/ service user satisfaction 85% 88% 92% 100% Percentage of children with a breastfeeding status 95% 99% 99% 99% recorded at six – eight weeks Dental Services Percentage of new birth visits within 14 days of 100% 100% 100% 100% Percentage non admitted patients starting birth treatment within a maximum 18 weeks from 95% 99% 99% 99% referral At new baby review information is provided to parents regarding UNICEF safe sleeping guidance 98% N/A 98% 99% Percentage of patients on incomplete, non- (inc smoke free homes as appropriate). emergency pathways (yet to start treatment) 92% 99% 99% 99% waiting no more than 18 weeks from referral All children between the ages of 0-4 seen by CCS staff have their eligibility for Healthy Start Vitamins 50% N/A 90% 87% Zero tolerance RTT waits over 52 weeks 0 0 0 0 determined and a voucher form provided if they are not on the programme RTT (Median Wait in weeks) - non admitted Decreasing Compliant Compliant Compliant Percentage eligible patients who complete TB completed pathways trend 95% 100% 100% 100% treatment subject to exclusion criteria RTT (Median Wait in weeks) - non admitted Decreasing Compliant Compliant Compliant Referral to the Live Well Luton Weight incomplete pathways trend 75 in year 66 5 75 Management Programme that result in uptake

Note: references to ‘on-track’ refers to performance indicators, which are being measured over a reporting Number of adults with a BMI ≥30 referred to the 120 in year 38 53 84 period that does not align with the April-March financial year. In these cases at March 2018 performance is Live Well Luton service currently on-track to achieve the end-of-year target. Deliver the National Child Measurement Programme to eligible school children in Reception 90% 99% 99% 95% and Year Six

48 Performance Report 49 2017/18 2015/16 2016/17 2017/18 2017/18 2015/16 2016/17 2017/18 Indicator Indicator target actual actual actual target actual actual actual

Percentage of non-admitted patients starting CCS answer rate for Urgent Connect 80% N/A 94% 97% treatment within 18 weeks from referral - non 95% 99% 100% 99% consultant led Immunisation rate for all children who have received a TB vaccination within 90 days of birth – 90% 87% 26% 75% Percentage of patients on incomplete non- rolling year emergency pathway waiting no longer than 18 92% 100% 100% 99% weeks - non consultant led Percentage of GP letters following 1st outpatient Q1 – 60% (community paediatric) attendance sent within 5 Q2 – 70% N/A 55% 70% All complaints to be reviewed and acted upon in working days. Q3 – 80% 100% 100% 100% 100% line with Department of Health requirements Q4 – 90%

Increase in hospital admission avoidance activity Percentage of follow-up reports sent (6 weeks in 3600 3880 4008 5164 90% N/A 79% 90% (Adult Services) arrears)

Number of patient surveys collected 600 1209 3271 5496

All Looked After Children coming into care and placed in Luton or the agreed health area, will have an Initial Health Assessment completed by a 100% 92% 100% 64% paediatrician within 15 working days of the LAC Health Team receiving a fully completed referral and signed consent

All Looked After Children coming into care and First tuberculosis (TB) conference a success placed outside of Luton or the agreed healthcare area, will have an Initial Health Assessment 100% 80% 100% 42% completed by a paediatrician or medical practitioner Our TB and Respiratory Services team worked with health and social care organisations across Luton to All Looked After Children placed in Luton or the stage the borough’s first TB Conference. agreed health area, will receive their Review Health 100% 34% 100% 70% Assessment by the due date (6 monthly for 0-4 The event, in partnership with Luton Clinical years and annually for 5-17 years) Commissioning Group, the Luton and Dunstable Hospital, Luton Borough Council and Public Health All Looked After Children placed out of Luton or England drew a maximum capacity crowd of 100 the agreed health area, will receive their Review 100% with 10% 100% 45% people. It brought together experts in the field Health Assessment by the due date (6 monthly for exceptions including our TB Clinical Nurse Specialist, Mike 0-4 years and annually for 5-17 years) McMahon, to give GPs and those working in primary care information about the national NHS TB All care leavers are given a copy of their health 100% N/A 100% 94% strategy and the extent of TB prevalence in Luton. history

All care leavers are offered a healthcare leaving 100% N/A 100% 96% service Mike said: In Luton we have begun Latent TB Number of avoidable pressure ulcers grade 3 0 avoidable 6 0 0 intervention to reduce the prevalence Number of avoidable pressure ulcers grade 4 0 avoidable 0 0 0 locally. In the last three or four years we have successfully reduced the Number of MRSA bacteraemia 0 0 0 0 incidence of TB by 10 per cent a year.

Number of community acquired Clostridium 100% 100% 100% 100% Difficile infections followed up

All missed appointments in children’s services are 100% 100% 100% 100% followed up and action taken followed up

50 Performance Report 51 Commissioner – Suffolk Integrated Healthcare 2017/18 2015/16 2016/17 2017/18 Indicator target actual actual actual

Key: Red = target not achieved, Green = target achieved Percentage of people with needs relating to STI contacting a service who are offered to be seen 2017/18 2015/16 2016/17 2017/18 or assessed with an appointment or as a 'walk-in' 98% 99% 100% 100% Indicator within two working days of first contacting the target actual actual actual service iCaSH Service Percentage of people with needs relating to STI's Number of all contacts of index cases of contacting a service who are seen or assessed by a 0.6 80% 89% 93% 93% gonorrhoea attending STI service within 4 weeks of 0.7 0.7 0.9 healthcare professional within two working days of contacts the date of first PN discussion first contacting the service

Number of all contacts of index cases of chlamydia Percentage of users experiencing waiting times in 0.6 Baseline 0% 0% 1% attending STI service within 4 weeks of the date of 0.8 0.8 0.6 clinics of over 2 hours contacts first PN discussion Percentage of people having STI tests (chlamydia, Percentage of first time service users (of clinical HIV, syphilis, gonorrhoea) who can access their based service users offered a HIV test (excluding 100% 100% 100% 100% results via text (both positive and negative) within 95% 84% 100% 100% those already diagnosed HIV positive) ten working days of the date of the sample (excluding those requiring supplementary tests) Percentage of first time service users (of clinical based service users accepting a HIV test (excluding 80% 87% 85% 84% Percentage LARCs (injections, IUDs, IUSs, implants baseline of those already diagnosed HIV positive) separately) prescribed by iCaSH Suffolk as a 51% 53% 53% 47%-55% percentage of all prescribed contraceptives Percentage of positive chlamydia screens by iCaSH 5-12% 8% 8% 10% Suffolk Percentage of people receiving EHC on same day 100% 100% 100% 100% as request (where clinically appropriate) Percentage of all chlamydia screens for all Trajectory 75% 75% 75% attendances at iCaSH Suffolk under 25 years 51-75% Percentage of women who have access and 100% N/A 100% 100% availability of full range of contraceptive methods Percentage of those with positive chlamydia result 95% 96% 97% 100% treated within six weeks of test date Percentage LARCs offered as percentage of all first contacts attended services for contraception 90% N/A 95% 100% purpose

% of patients accessing psychosexual counselling 100% 100% 100% 100% within 18 weeks

52 Performance Report 53 Commissioner – Cambridgeshire County Council 2017/18 2015/16 2016/17 2017/18 Indicator target actual actual actual

Percentage of users experiencing waiting times in 30 minute Key: Red = target not achieved, Green = target achieved 100% 100% 100% clinics of under 2 hours threshold 2017/18 2015/16 2016/17 2017/18 Indicator Increase in the number of men accessing services increase N/A compliant +8% target actual actual actual Percentage of specialist reproductive health iCaSH Service 100% 100% 100% 100% referrals from GP seen within 18 weeks of referral Percentage of people offered an appointment or 98% 98% 98% 100% walk-in, within 48 hours of contacting a provider Condom distribution schemes (C-Card) provision to 100% 100% 100% 100% all sexual health clinics Percentage of clients accessing service to be seen 80% 89% 93% 93% within 48 hours of contacting the service Percentage of women who have access to urgent contraceptive advice and services (including 90% 100% 100% 100% Care pathways with other organisations to include emergency contraception) within 24 hours of Established partner notification and/or linked services (e.g. 100% 100% 100% contacting the service pathways alcohol, mental health etc.) are clearly defined Percentage of women who have access to LARC Percentage of women having access to and method of choice within five working days of 90% 90% 54% 56% availability of the full range of contraceptive 100% 100% 100% 100% contacting service methods Percentage of individuals accessing services who Percentage of first time service use (of clinical have sexual history and STI/HIV risk assessment 100% 100% 100% 100% 100% 100% 100% 100% based services) offered a HIV test undertaken

Percentage of first time service use (of clinical People who have a new diagnosis of HIV and have 85% 86% 86% 87% based services) offered and accepting a HIV test symptoms and/or signs potentially attributable to HIV infection (including those of primary infection) 100% 100% 100% 100% The proportion of people newly diagnosed in must be referred for urgent (within 24 hours) primary care who are seen in a HIV specialist 100% 100% 100% 100% specialist assessment department within two weeks of diagnosis Percentage of routine STI laboratory reports of results (or preliminary reports), which are received Documented evidence within clinical records that 100% 100% 100% 100% partner notification has been discussed with people by clinicians within seven working days of a living with HIV within four weeks of receiving a 90% 100% 100% 100% specimen being taken positive HIV diagnosis and within one week of Ratio of all reported contacts of index gonorrhoea identifying subsequent partners at risk 0.6 0.6 0.6 0.9 who attend the service Ratio of contacts per gonorrhoea and chlamydia At least 0.6 index case, such that the attendances of these Ratio of all reported contacts of index chlamydia contacts 0.6 0.6 0.7 0.6 contacts at Level 1, 2 or 3 service was documented 0.6 0.6 0.6 who attend the service per index as reported by index case, or by a HCW, within case four weeks of the date of the first PN discussion Percentage of nurses dual trained to deliver contraceptive (including LARC methods) and GUM 75% N/A N/A 93% Services Percentage of patients receiving positive/negative 95% 100% 100% 100% results within 10 working days of sample date Monitor percentage of LARCs prescribed as a Benchmark 44% 51% 59% proportion of all contraceptives by age Percentage of all under 25 year olds screened for 75% 91% 86% 100% chlamydia Maintain/achieve You’re Welcome accreditation/ 100% N/A N/A 100% standards Percentage of positive patients who received 95% 100% 100% 100% treatment within six weeks of test dates Percentage of service user feedback on surveys that 70% N/A N/A 98% rates satisfaction as good or excellent Number of outreach sessions and attendance conducted in areas of high deprivation or aimed at 70% 70% 81% 63% The proportion of people newly diagnosed with vulnerable groups, including prison HIV who have a CD4 count result in their clinical 95% 100% 100% 100% record within one month of their HIV diagnosis

54 Performance Report 55 2017/18 2015/16 2016/17 2017/18 Commissioner – Peterborough City Council Indicator target actual actual actual

The proportion of people with known HIV infection Key: Red = target not achieved, Green = target achieved who have accessed HIV clinical services within the 95% 100% 99% 100% past 12 months 2017/18 2015/16 2016/17 2017/18 Indicator target actual actual actual For 95% of MSM living with a diagnosed HIV 95% 80% 95% 100% infection to have a suppressed viral load iCaSH Service

Percentage of people with STI needs offered Healthy Child Programme appointment or walk in within two working days 98% 86% 94% 80% Percentage Antenatal contact 50% N/A N/A 24% of first contact

Percentage New Birth Visits within 14 days 90% N/A N/A 96% Percentage people with STI needs seen or assessed by healthcare professional within two working days 80% 84% 93% 79% Percentage New Birth Visits 90% N/A N/A 98% of first contact

Percentage New Birth Visits advice given about Percentage of people who have a relevant sexual 90% N/A N/A 100% 97% 100% 100% 100% registering with Children’s Centres history taken (as per BASHH guidance)

Percentage 6-8 week review 90% N/A N/A 85% Percentage of people with STI needs offered HIV test at first attendance (excl. those already 97% 99% 100% 100% Percentage 12 month review by 12 months 90% N/A N/A 95% diagnosed with HIV)

Percentage of people with STI needs with record of Percentage 12 month review by 15 months 95% N/A N/A 96% 80% 87% 90% 87% HIV test at first attendance (excl. as above) Percentage 2-2.5 yr. review with ASQ 90% N/A N/A 94% Percentage of reports issued by lab within 5 97% N/A N/A 97% Percentage Breastfeeding status recorded at 6-8 working days of specimen being received by lab 90% N/A N/A 85% week Percentage of final reports on supplementary Percentage Breastfeeding prevalence 6-8 week testing or following referral to reference lab issued 56% N/A N/A 53% 97% N/A N/A 100% (fully/partial) by lab within 10 working days of specimen being received by lab Percentage Mothers who smoke referred to stop 95% N/A N/A 100% smoking service Percentage of people accessing STI test results within 10 working days of sample taken (excl. 95% 95% 99% 100% Percentage schools having a named school nurse 100% N/A N/A 100% supplementary tests)

Percentage of all contacts of index cases of 0.6 Note: The Trust provided the Cambridgeshire Healthy Child Programme in 2016/17. References to N/A gonorrhoea attending STI service within four weeks contacts 78% 100% 0% in the relevant column above reflect that performance monitoring for this service was suspended mid of first PN discussion per index 2016/17, pending development of a new performance specification for 2017/18. Percentage of all contacts of index cases of 0.6 chlamydia attending STI service within four weeks contacts 83% 90% 14% of first PN discussion per index

Percentage of women with emergency/urgent contraceptive needs offered access on the same 95% 100% 100% 100% working day

Percentage of people with contraceptive needs offered appointment to be seen within two 95% 96% 87% 56% working days of first contact

Percentage of people experiencing waiting times of >75% 100% 100% 100% less than two hours in walk in services

56 Performance Report 57 Ellen Ballantyne, service manager for iCaSH Commissioner – Norfolk County Council Norfolk said:

We are always looking for innovative Key: Red = target not achieved, Green = target achieved ways to meet the needs of patients. Several targets have been increased in 2017/18 – they may show as compliant in previous iCaSH Express Test is free, quick and easy years when the target was lower. to use. Once registered, service users receive a free kit through the post, which 2017/18 2015/16 2016/17 2017/18 Indicator contains individually packaged tests and target actual actual actual instructions. The kit is discreetly wrapped Introducing iCaSH in plain packaging. Once the tests have Norfolk Healthy Child Programme been completed, they simply attach the Percentage women that received their first face freepost label to the front of the kit and to face antenatal health promotion visit from 28 90% 80% 58% 91% Express Test pop it into the nearest post box. weeks pregnancy with a HV SCPHN

Percentage of women receiving a face to face New 90% 93% 90% 95% Population needs are changing and our Express Test launched in Norfolk in July 2017, Baby Review by a HV SCPHN within 14 days focus is on modernising our services to meet Bedfordshire in October 2017, Suffolk in February them; so we introduced iCaSH Express Test. 2018 and most recently Cambridgeshire in April/ Percentage of infants aged six - eight weeks that May 2018. received a six - eight week assessment from the HV 90% 94% 90% 99% Developed by iCaSH Norfolk, Express Test SCPHN is an alternative to a clinic appointment for Service users can test for Chlamydia, Gonorrhoea, service users who have no symptoms, are Syphilis and HIV. We are also offering Hepatitis B Percentage of all infants at six - eight week check 47.5% 46% 49% 46% aged 16 and over and want to test for STI’s and C testing for those who are assessed as at risk that are totally or partially breastfed without coming into clinic. from assessment questions, during the registration process. Any service users with positive results are Percentage of infants receiving the Bookstart Baby 90% 98% 100% 100% invited into clinic for their treatment. Pack at the six - eight week check

Percentage of mothers who received a Maternal 95% N/A 88% 99% Mood review when the child is aged 9-12 months 2017/18 2015/16 2016/17 2017/18 Indicator Percentage of children who received a one year target actual actual actual assessment/12 month review by the time they 85% N/A 68% 96% turned 12 months Percentage of women offered access to LARC method of choice within 10 working days/ two calendar weeks 90% 100% 96% 91% of first contact (where medically appropriate) Percentage of children who received a one year assessment/12 month review by the time they 95% 88% 81% 98% turned 15 months Percentage of women having access to and availability of full range of contraceptive methods 100% 100% 100% 100% (and choice within products) Percentage of children that received a developmental review by the age of 2.5 years 90% 85% 76% 91% (which must include the ASQ™3 assessment) Percentage chlamydia positive patients receiving 95% 100% 98% 98% treatment within six weeks of test date Population vaccination coverage - MMR for two 90% N/A 92% 93% doses (5 years old) Percentage of staff who have completed nationally accredited training relevant to their scope of 100% 100% 100% 100% Percentage coverage of hearing screening in practice and fulfil update requirements 95% N/A 95% On-track children in the Reception class cohort Percentage of people screened for safeguarding 100% 100% 100% 100% Percentage coverage of vision screening in children issues 95% N/A 95% On-track in the Reception class cohort Percentage of people screened for alcohol / drug 100% 100% 100% 100% interventions Percentage of eligible children in Reception class that were weighed and measured as part of the 95% N/A 95% On-track NCMP Percentage of people screened for domestic abuse 100% 100% 100% 100%

Percentage of children and young people screened Note: references to ‘on-track’ refers to performance indicators, which are being measured 100% 100% 100% 100% for child sexual exploitation over a reporting period that does not align with the April-March financial year. In these cases at March 2018 performance is currently on-track to achieve the end-of-year target.

58 Performance Report 59 2017/18 2015/16 2016/17 2017/18 2017/18 2015/16 2016/17 2017/18 Indicator Indicator target actual actual actual target actual actual actual

Percentage of eligible children in Year 6 that were Percentage of new FNP service users enrolled 95% N/A 95% On-track 60% N/A 21% 100% weighed and measured as part of the NCMP before 16 weeks pregnant

Percentage of Looked After Children (LAC) Review Percentage of FNP breastfeeding prevalence at 6-8 22% N/A 22% 20% Health Assessments (RHA) requested that have 100% 100% 100% 100% weeks been completed within timescales Percentage of FNP service users who smoke less Percentage of Looked After Children (LAC) aged at 36 weeks pregnant, than when they joined the 60% N/A 60% 67% 100% N/A 100% 100% 0-4yrs with an up to date RHA programme

Percentage Looked After Children (LAC) aged Percentage of FNP Infants with up-to-date 100% 100% 100% 100% 100% N/A 95% 95% 0-5yrs with up-to-date immunisations immunisations at 24 months infancy

Percentage of urgent referrals, including all Percentage of SEN Co-ordinators (or other relevant safeguarding referrals, who a) received a same day member of staff) who requested training from the or next working day response to the referrer and b) 100% 100% 100% 100% HCP Service that have received it (to support the 100% N/A 100% 100% received a HV contact with the family within two development of care plans for children and young working days people who have a significant health needs).

Percentage of referrals from whatever source Percentage of service users who would recommend 75% 97% 100% 88% (including families transferring in) where a) a the service (friends and family test or equivalent) response was made to the referrer within 5 100% N/A 100% 100% working days and b) contact was made with the family within 10 working days iCaSH Service Percentage of individuals accessing STI services Percentage of staff who have completed who have a sexual history and STI/HIV risk/ 100% 100% 100% 100% mandatory training at levels commensurate with 90% 76% 95% 94% contraception assessment undertaken roles and responsibilities (levels 1, 2, 3) in child protection within the last three years Max. Female rate of repeat infections within one year. 7.2% N/A N/A 5.9% Percentage of transfers to another Healthy Child Max. Male rate of repeat infections within one year. 8.5% N/A N/A 4.4% Programme (i.e. another county) for children on a 100% 100% 100% 100% Child Protection Plan where there has been a direct Percentage of first time service users (of clinical contact with the relevant team 100% 100% 100% 100% based services) offered a HIV Test via Hub Percentage of transfers from another Healthy Child Percentage of first time service users (of clinical Programme (i.e. another county) for children on a 80% 81% 85% 85% 100% 100% 100% 100% based services) accepted a HIV Test via Hub Child Protection Plan where there has been a direct contact with the relevant team Percentage of first time MSM service user (of 100% 100% 100% 100% clinical based services) offered a HIV test via Hub Percentage of transfers from another Healthy Child Programme (i.e. another county) where records are 100% N/A 100% 100% Percentage of first time MSM service user (of requested within two weeks of being notified of 90% 80% 90% 95% clinical based services) accepting a HIV test via Hub the new child Percentage of contacts for all gonorrhoea index cases Percentage of transfers to another Healthy Child documented within 4 weeks of the date of the first 60% N/A N/A 71% Programme (i.e. another county) for children on a 100% N/A 100% 100% PN discussion (>0.6 contacts per index case ) Child Protection Plan where there has been a direct contact with the relevant team.] Max. percentage of HIV late diagnoses (i.e. count 50% 0% 0% 0% below 350 Percentage of data completeness of all minimum 90% N/A 98% 98% data Set fields Percentage of service users who receive results 95% 100% 100% 99% within two weeks from consultation date Percentage FNP nurse caseload maintained per 80% 91% 96% 92% quarter

60 Performance Report 61 2017/18 2015/16 2016/17 2017/18 2017/18 2015/16 2016/17 2017/18 Indicator Indicator target actual actual actual target actual actual actual

Percentage of results given to the client within 10 Percentage of specialist SRH referrals from general Baseline to working days of test taken -screening programme 95% 99% 100% 99% practice seen within 18 weeks of referral be assessed 100% 100% 100% only after 1 year

Percentage of patients receiving a positive test Percentage of staff delivering contraceptive and STI offered treatment within six weeks of test date 95% 97% 99% 98% services who have successfully completed nationally 100% 100% 100% 100% (date on the test form) accredited training, according to their scope of practice, and fulfilled relevant update requirements Percentage of chlamydia index cases documented as offered ≥ 1 PN discussion (including telephone Percentage of clinical staff (doctors and nurses) 97% 99% 99% 99% discussion) with a HCW with the appropriate dually trained to deliver contraceptive and STI/HIV 60% 42% 81% 77% documented competence services

Percentage of chlamydia index cases for whom Percentage of clinical staff trained to deliver drug all their contacts have a documented action(s) or 97% 96% 99% 99% and alcohol brief interventions to the patients in 60% 63% 96% 93% decision (not to contact). line with the national guidelines

Percentage of all contacts that were notified Percentage of staff received training on domestic through the PN scheme and attended the service, violence within 6 months of commencement of 60% 77% 99% 93% 100% 97% 100% 100% at either Level 1, 2 or 3, as reported by index case contract award. All new staff to receive training or HCW within four weeks of first PN Discussion within 6 months

Percentage of women having access to the and % of service user feedback on surveys that rates availability of the full range of contraceptive 100% 100% 100% 100% satisfaction with the service as good or excellent 70% 97% 95% 96% method (including choice within products) via a natural medium

Percentage LARCs offered as a percentage of all eligible contacts attending services for 90% 100% 100% 100% contraception purposes

Percentage LARCs (Injections, IUDs, IUSs, implants separately) prescribed by contraceptive services as a Total > 47% 54% 59% percentage of all contraceptives by age (5 year age 40% bands)

Percentage of people receiving EHC who received it within 24 hours of requesting it (exceptional 100% 100% 100% 100% reporting required)

Percentage of people accessing EHC and leaving 100% 100% 100% 100% with a plan of ongoing contraception

Percentage of STI screens directly conducted through outreach services (outreach services target 15% 12% 35% 25% high risk and vulnerable groups) as a percentage of all screens

Percentage of people offered an appointment, or 100% 100% 100% 100% walk-in, within 48 hours of contacting service

Percentage of clients accessing service to be seen 70% 96% 96% 96% within 48 hours of contacting service

Percentage of people experiencing waiting times of 90% 99% 99% 99% less than two hours in walk in services

62 Performance Report 63 Commissioner – Bedfordshire Borough and Central Bedfordshire 2017/18 2017/18 Indicator target actual

Key: Red = target not achieved, Green = target achieved Percentage of women offered access to LARC method of choice within 10 working days/ 2 calendar weeks of first contact (where medically 80% 66% 2017/18 2017/18 appropriate) Indicator target actual Year on year increase in the number of young men accessing services 10% 34% iCaSH Service Percentage of users experiencing waiting times for walk-in clinics of < 2 Percentage of people who have a relevant sexual history taken (as per BASHH 95% 99% 97% 100% hours guidance) Percentage of nurses dual trained to deliver contraceptive (including where Percentage of people with STI needs offered HIV test at first attendance (exc. those 40% 71% 97% 100% appropriate LARC methods) and Sexual Health services already diagnosed with HIV) Percentage of staff delivering STI services who have successfully completed STI testing: percentage uptake of HIV testing for people having a first STI check 80% 88% accredited competency based training, according to their scope of practice and 85% 100% (screen) fulfilled relevant update requirements in accordance with FSRH and BASHH Percentage of people who can access STI test results within 10 working days of 95% 100% Percentage of patients notified of chlamydia screen result (positive and 100% (Borough sample taken (exc. supplementary tests) 90% negative) within ten working days from date of test and Central Beds) Percentage of LARC prescribed as a proportion of all contraception (excluding 40% 41% Number of contacts per index case who have attended a healthcare site condoms) 0.5 Borough and for testing and epidemiological treatment within four weeks of the first PN 0.6 0.3 Central Beds Percentage of women who have access to urgent contraceptive advice and services discussion 100% 100% (inc. emergency contraception) within 72 hours of contacting service Percentage of index cases documented as offered PN discussion with a 67% Borough Percentage of women having access to and availability of full range of contraceptive healthcare worker with the appropriate documented competency.’ 97% and 51% Central 100% 100% method (and choice within products) Beds Percentage of index patients receiving treatment within 6 weeks of test date 100% (Borough Ratio of contacts per gonorrhoea index case treated in the integrated sexual health 95% service or confirmed treated elsewhere within four weeks of the date of the first PN 0.6 0.3 and Central Beds) discussion Percentage of positive people treated within 14 days from the date of 75% 96% Percentage of routine STI laboratory reports of results (Routine = GC, Chlamydia, specimen collection syphilis & HIV) (or preliminary reports) which are received by clinicians within seven 100% 100% Percentage of positive people treated within 30 days from the date of working days of a specimen being taken 90% 100% specimen collection Percentage of first time sexually active (clinical based) service users in high risk 80% 100% Percentage of 15-24-year olds tested within the ISH service 90% 80% groups - MSM offered an HIV Test Number of C-Card Registrations (average monthly) 50 82 Point of Care HIV testing 120 325 Proportion of young people (under 18) assessed using CSE checklist (first Chlamydia screening 100% offered MSM 100% 100% 100% 100% attendance) Chlamydia screening 75% accepting MSM 75% 66% All new or first in year attendance clients to be asked smoking status and Clients receive a letter with an appointment date within 28 days of opting into the recorded. All smokers to be given brief advice and signposted to Stop 100% 100% 100% 100% service. Smoking Services.

Clients presenting with a sexual dysfunction report improvement in their condition Percentage of people screened for domestic violence 100% 100% 60% 83% on exiting All new and first in year attendances assessed for FGM. Any identified, 100% 100% Percentage of psychosexual clients seen for initial assessment within 18 weeks recorded and referred to specialist care. 100% 100% of referral All new and first in year attendances assessed for drugs and alcohol use. Percentage of people with STI needs offered appointment or walk in within 2 98% 68% Recording and referral for specialist advice and care. 100% 100% working days of first contact All appropriate new and first in year attendances BMI rates assessed and Percentage of people with STI needs seen or assessed by healthcare professional 100% 100% 80% 66% recorded (patients attending for contraception) within 2 working days of first contact

Percentage of people with contraceptive needs offered appointment to be seen Representation at the quarterly SARC Operational Group 100% 100% 80% 78% within 2 working days of first contact

64 Performance Report 65 specialties and their importance to our service Financial outlook portfolio. Since establishment in 2010, the Trust has each Looking to the future The Trust will work with stakeholders to develop year achieved a financial surplus for re-investment new care models consistent with the aspirations in our services. set out in our Five Year Plan, and in line with The financial plan for 2018/19 assumes the system-wide Sustainability and Transformation following: Partnerships. Our objectives for • The Trust has a planned turnover of £129 2018/19 are to: million for 2018/19 and plans to deliver a 1.6% Underpinning strategies surplus equating to £2.1 million. • provide outstanding care The following strategiesWe continued and to receivework invaluableprogrammes support from hundreds• A £17.5 of dedicat millioned volunteers, increase as in well revenue as a result • collaborate with will underpin theas successfulcharities such delivery as the Dreamdrops of our children’s charity,of the the Arthur successful Rank Hospice new charity, partnership and with East objectives: the Friends of Hospital at Home in Peterborough, all ofLondon whom provided NHS Foundationa vital role in helping Trust to provide other organisations us improve the quality of services we provide. Without their dedication and support, our task would be even harder. children’s services in Bedfordshire. • quality and clinical strategy • be an excellent employer Our focus for 2015/16 is on achieving our ambitious• plansThe for Trust the future, has applied aligned to cost the and income uplifts • workforce, organisational development and system-wide priorities identified by our commissionersin and line which with are nationalresponsive planningto the assumptions to • be a sustainable service redesignspecific needs of the local populations we serve. Central to this is working collaboratively organisation with our staff, GPs, social care practitioners and hospitalproduce clinicians a, torobust develop 2018/19 seamless financial plan. • information communicationcare irrespective of organisationaland technology boundaries. • To deliver the planned surplus, the Trust has • communicationsIn line with our five year plan, we will continue to submita costbids to improvement expand the geographic target area of £3 million, across which we provide the specialist, high quality services that now makes up our portfolio. • estates This will enable other commissioners and populations equatingto benefit from to our2.3% expertise of turnover, in and has providing these specialist services, which focus on healthidentified promotion schemesand prevention to ofachieve ill this target. These Each of these strategieshealth. has an annual are a combination of pay and non-pay related implementationT planhe Government that forms policy part prior of to the May 2015 Generalschemes Election was and that have NHS Trusts,associated as an quality impact Trust’s annual Operationalorganisational form,Plan. could not continue long term. As a smaller organisation providing specialist services, we will determine during 2015 our assessmentsfuture organisational where form appropriate. in the Our objectives have formed the basis of our Work stream 2: Improving Organisational context of what is in the best interests of patients and• ourThe staff. Trust Whilst has we a awaitcapital policy plan for 2018/19, Five Year Plan and our Operational Plan 2017- Capability guidance from the new Government on options available in relation to organisational form, Contracts for serviceswe will take forward development work to evidence ourwhich viability includes as a stand major-alone investment in its estate 19 and are aligned to the system-wide priorities organisation, whatever form that takes. We anticipate that this process will take • Infrastructure programme, focussing on and the provision for information technology identified by our commissioners. Central to this Our contracts forapproximately services with two years commissioners to come to fruition, during which time we will continue to operate as estates and information communication and an NHS Trust. We will of course involve staff, commissionersinfrastructure. and the Trust Development is working collaboratively with commissioners covering Bedfordshire,Authority inCambridgeshire, these deliberations. Luton, technology support, provided and managed and partner organisations to develop seamless Norfolk, Peterborough and Suffolk set out services to improve responsiveness to changes Please enjoy reading our annual review and we look forward to a successful year in care irrespective of organisational boundaries, ambitious objectives and targets for the coming in clinical services. 2015/16. Signed: including through the Cambridgeshire and year. We have every expectation of achieving Peterborough, and the Bedfordshire, Luton and • Corporate contract procurement and re- these, ensuring that local people are able to Milton Keynes Integrated Care System. provision for ICT, financial services, estates, access services that promote healthier lives closer procurements and contracts. to home. Progress against our objectives will be governed Matthew Winn,

through four broad work streams: Chief Executive Work stream 3: Business Development Nicola Scrivings Matthew Winn Chairman Chief Executive25 May 2018

Work stream 1: Service Development Plans We will submit vibrant bids for commissioner-led June 2015 procurements where: • Cambridgeshire Children and Young People’s Services service redesign (including joint venture • These are for services similar to those we with Cambridgeshire & Peterborough NHS already provide, and Foundation Trust) • they are aligned to our existing service localities. • Norfolk Children and Young People’s service This will enable us to implement our innovative redesign approach to service redesign for the benefit • Luton 0-19 Healthy Child Programme service of a wider range of local communities, whilst redesign also bringing more long term funding and sustainability to the Trust. 4 • Luton adult community Health services Where contract periods come to an end for • Cambridgeshire and Peterborough services that we currently deliver (having DynamicHealth service development historically won tender bids), we will bid to retain programme these contracts given our expertise in these

66 Performance Report 67 Accountability Report

Corporate 70 Governance Report

Governance Statement 73 Corporate

We continued to receive invaluable support from hundreds of dedicated volunteers, as well as charities such as the Dreamdrops children’s charity, the Arthur Rank Hospice charity, and the Friends of Hospital at Home in Peterborough, all of whom provided a vital role in helping Governance Report us improve the quality of services we provide. Without their dedication and support, our task would be even harder.

Our focus for 2015/16 is on achieving our ambitious plans for the future, aligned to the system-wide priorities identified by our commissioners and which are responsive to the Directors’ Report 2017/18 Statement of Accountablespecific needs of the local populations we serve. CentralAs far to thisas Iis am working aware, collaboratively there is no relevant audit • Apply on a consistent basis, accounting policies with our staff, GPs, social care practitioners and hospitalinformation clinicians, ofto develop which seamless the Trust’s auditors are laid down by the Secretary of State with the Officer’s Responsibilitiescare irrespective of organisational boundaries. The Trust’s Board of Executive and Non- unaware. I have taken all the steps that I ought approval of the Treasury. In line with our five year plan, we will continue to submitto have bids totaken expand to the make geographic myself area aware of any Executive Directors is responsible for overseeing The Chief Executive is the designated • Make judgements and estimates that are across which we provide the specialist, high quality relevantservices that audit now makeinformation,s up our po rtfolio.and to establish the development of strategic direction and Accountable Officer for the Trust. TheThis relevant will enable other commissioners and populations to benefit from our expertise in reasonable and prudent. compliance with all governance, probity and responsibilities of Accountable Officersproviding are set these out specialist services, which focus on healththat thepromotion Trust’s and auditors prevention are of ill aware of that health. • State whether applicable accounting standards assurance requirements. in the Accountable Officers Memorandum issued information. We continued to receive invaluable support from hundreds of dedicated volunteers, as well The Government policy prior to the May 2015 General Election was thatas charitiesNHS Trusts, such as as an the Dreamdrops children’s charity,have the Arthur been Rank followed, Hospice charity, subject and to any material Details of the Trust’s Chair, Chief Executive, by the Department of Health. These include I confirm that thethe Friends annual of Hospital report at and Home accounts in Peterborough, all of whom provided a vital role in helping organisational form, could not continue long term. As a smaller organisation providing departures disclosed and explained in the Executive Directors and Non-Executive Directors ensuring that: specialist services, we will determine during 2015 ouras futurea whole organisational is fair,us improve balancedform in the the quality and of understandable services we provide. Without their dedication and support, our task would be even harder. accounts. are set out later in the Governance Statement context of what is in the best interests of patients andand our I staff.take Whilst personal we await responsibility policy for the annual • There are effective management systemsguidance in from the new Government on options available in relation to organisational form, Our focus for 2015/16 is on achieving our ambitiousThe plans directors for the future, are aligned responsible to the for keeping proper (page 73), together with information on place to safeguard public funds andwe assets, will take forward development work to evidence reportour viability and as accountsa stand-alone and the judgments required organisation, whatever form that takes. We anticipate that this processsystem will take-wide priorities identified by our commissionersaccounting and which are records, responsive which to the disclose with reasonable membership of the Trust’s Board and its sub- and assist in the implementation of corporate for determiningspecific that needs it is fair,of the balancedlocal populations and we serve. Central to this is working collaboratively approximately two years to come to fruition, during which time we will continue to operate as accuracy at any time, the financial position of committees. governance as exemplified in the Codesan NHS of Trust. We will of course involve staff, commissionersunderstandable. and the withTrust our Development staff, GPs, social care practitioners and hospital clinicians, to develop seamless Authority in these deliberations. care irrespective of organisational boundaries. the Trust and to enable them to ensure that the Conduct and Accountability. Information on personal data related incidents accounts comply with requirements outlined in where these have been formally reported to Please enjoy reading our annual review and we look forward to a successIn lineful with year our in five year plan, we will continue to submit bids to expand the geographic area • Ensure that all items of expenditure,2015/16 including. Signed: across which we provide the specialist, high quality theservices above that mentionednow makes up directionour portfolio. of the Secretary of the information commissioner’s office are payments to staff, fall within the legal powers This will enable other commissioners and populationsState. to benefit They from are our also expertise responsible in for safeguarding incorporated in the Performance Report providing these specialist services, which focus on health promotion and prevention of ill of the Trust, exercised responsibly and with due health. the assets of the Trust and hence for taking (page 15). regard to probity and value for money. The Government policy prior to the May 2015 Generalreasonable Election was steps, that NHS for Trusts, the prevention as an and detection • The expenditure and income of the Trust has Matthew Winn,organisational form, could not continue long term. Asof a fraudsmaller and organisation other irregularities.providing specialist services, we will determine during 2015 our future organisational form in the been applied to the purposes intended by Chief Executive Compliance statement context of what is in the best interests of patients andThe our directors staff. Whilst confirm we await policyto the best of their Parliament and conform to the authoritiesNicola Scrivings Matthew Winn guidance from the new Government on options availableknowledge in relation and to organisational belief that form they, have complied with A register of directors’ interests for the Trust is 25 May 2018 we will take forward development work to evidence our viability as a stand-alone which govern them. Chairman Chief Executive the above requirements in preparing the accounts. maintained and is available on our website or on organisation, whatever form that takes. We anticipate that this process will take June 2015 approximately two years to come to fruition, during which time we will continue to operate as request by contacting our Corporate Secretary on • Effective and sound financial management an NHS Trust. We will of course involve staff, commissioners and the Trust Development 01480 308219. No Trust Board members hold a systems are in place. Authority in these deliberations. By order of the Board company directorship with companies who are • Annual statutory accounts are prepared in a Please enjoy reading our annual review and we look forward to a successful year in 2015/16. Signed: likely to do business or are seeking (or may seek) format directed by the Secretary of State with Statement of Directors’ Signed: to do business with the NHS. the approval of the Treasury, to give a true Responsibilities in Respect The Trust has undertaken the necessary action and fair view of the state of affairs as at the of the Accounts to evidence that each director has stated, that as end of the financial year and the income and expenditure, recognised gains and losses and Matthew Winn, Mark Robbins far as he/she is aware, there is no relevant audit The directors are required under the National information of which the NHS body’s auditors are cash flows for the year. Health Service Act 2006 to prepare accounts Chief Executive Director of Finance Nicola Scrivings Matthew Winn unaware and he/she has taken all the steps that for each financial year. The Secretary4 of State, 25 May 2018 25 May 2018 • Appropriate advice is tendered to the Board on Chairman Chief Executive he/she ought to have taken as a director, in order all matters of financial probity and regularity. with the approval of the Treasury, directs that to make themselves aware of any relevant audit these accountsJune give 2015 a true and fair view of the information, and to establish that the NHS body’s To the best of my knowledge and belief, I have state of affairs of the Trust and of the income auditors are aware of that information. The Trust properly discharged the responsibilities set out and expenditure, recognised gains and losses also conducts annual Fit and Proper Persons Test in my letter of appointment as an Accountable and cash flows for the year. In preparing those checks for all directors. Officer. accounts, directors are required to:

4

70 Accountability Report 71 Governance Statement Team effort to Scope of responsibility review to be conducted by Deloitte, with a final report expected to be issued in May 2018. A help young hear The Board of Directors (the Board) is accountable timeline for implementation of improvement for risk management and internal control. As actions identified will be presented to the Accountable Officer, and Chief Executive of this Board for approval once the review has been A new device being Board, I have responsibility for maintaining a completed. sound system of risk management and internal In 2017/18, the Trust undertook an annual developed could control, which supports the achievement of the review of the Board and sub-committee terms organisation’s policies, aims and objectives. This of reference to improve governance processes bring relief to children includes risk management, counter-fraud and within the Trust. The updated terms of reference bribery, external audit, internal audit and internal were implemented in 2017/18. suffering from the financial control. The Board approved a refreshed quality and frustration of glue ear. I also have responsibility for safeguarding the clinical strategy. The strategy centres on four public funds and the organisation’s assets for priorities: which I am personally responsible, as set out in the Accountable Officer’s Memorandum. • Safety As the Accountable Officer, I ensure the • Evidence based and innovative practice organisation works effectively, in collaboration • People involvement Dr Brown said: with NHS Improvement, local authorities, local primary care, NHS and foundation trusts. I • Learning and continuous improvement Watchful waiting is a very and the Trust, actively participate in relevant As part of the Trust’s commitment to continuous sensible approach, but it can be Chief Executive and partner fora, to deliver the improvement, the Trust has now launched a long and frustrating time for expectations as stated in the NHS Constitution. ‘Our Quality Way’; a framework for the Trust’s children and impact on language I acknowledge the Accountable Officer’s approach to quality governance. Our Quality Way development. We wanted to find a responsibilities as set out in the Accountable is based on the Care Quality Commission’s five solution to that. Collaborating with domains and their key lines of enquiry. All our Experts from the Trust and Officer’s Memorandum and my responsibilities the clinical engineering department services have completed a self-assessment based Cambridge University Hospitals contained therein for the propriety and regularity was a great success and, with the of public finances in the Trust, for the keeping on these five domains. This is supported by an (CUH) NHS Trusts pooled their help of other organisations, we have of proper accounts, for prudent and economical internal programme of peer reviews, to support expertise to adapt an existing the services to celebrate their successes and innovated with what we believe is administration, for the avoidance of waste and brand of sports headphone so it identify actions for improvement. a really practical and cost-effective extravagance, and for the efficient and effective helps young sufferers to hear. solution. use of all the resources in my charge. Implementation of the quality and clinical Instead of fitting over blocked ears, the strategy and other Trust-wide clinical governance headphones sit on the cheek bones and arrangements, are overseen by the quality contain a tiny mechanism that vibrates The development work was funded through The governance framework improvement and safety committee. The when it picks up a signal from a remote Cambridge University Health Partners and a pilot of the organisation following key areas underpin the Trust’s clinical microphone. The vibrations travel along the study is being carried out with support from governance framework: cheekbone before arriving in the inner ear Cambridge Hearing Trust, Health Enterprise The Trust conducted a self-assessment against the • Clinical audit and effectiveness where they are interpreted as sound. It’s East, the British Society of Audiology, BAPA Well Led Framework in 2017/18 and developed known as “bone conduction”. and Health Education East of England. The pilot an improvement plan, which is now being • Incidents and complaints The development follows collaboration study, involving about 20 youngsters will report implemented. The self-assessment was based • Professional practice in Spring 2018 and support submission for on input from the wider executive team and between CCS’s community paediatrician, • Patient experience Dr Tamsin Brown, medical engineer, Cara classification as a Medical Device. The headset discussions by the Board. • Quality performance Cooper, from the CUH’s Clinical Engineering will hopefully be launched late in 2018. The last external review of the Trust’s governance Department, and other academic and health The team has set up a website about their work arrangements against the Well Led Framework • Safeguarding colleagues locally. was completed in 2014. The Trust has at https://hearglueear.wordpress.com/ • Resilience commissioned another independent governance

72 Accountability Report 73 The effectiveness of our clinical governance is Trust Board Board Development Programme assessed using internal systems, including peer The Board comprises of the Chair and five other The Board Development Programme for 2017/18 reviews, clinical audit, early warning trigger tool independent members (non-executive directors), covered the following areas: and oversight by non-executive directors through the Chief Executive and four executive directors. the Board and its sub-committees. The Trust also One non-executive director came to the end of Theme Areas of focus utilises independent reviews to provide assurance her term on 31 December 2017. Two new non- including internal audit. Patient experience and engagement • Unconscious bias training executive directors joined the Board on 1 May During the past twelve months, the Trust has 2017 and 1 October 2017 respectively. The Trust Staff experience and engagement • Unconscious bias training reviewed and implemented fundamental changes also appointed a new Chief Nurse following the Development of the board • General Data Protection Regulation (GDPR) to its Board Assurance Framework. This has been retirement of the previous post holder. The Chief collectively and individually agreed by the Board and is now implemented. Nurse was formally appointed to post on 1 April • Self-Assessment against the Well Led Framework The new approach includes assurance maps 2018, although the successful individual had • Session to get to know each other better and to providing information flow, which allows the been acting up in to this role since 1 May 2017. understand our preferred ways of working Board to be assured of the activities across the The Trust Board met six times in public this • Refresh of the Trust’s five year Business Plan whole organisation and is available in the Chief financial year. All Board meetings in 2017/18 Executive’s report in public board papers. • Engagement with Sustainability and Transformation Plans were appropriately constituted and were quorate. • A review of the Trust’s approach to research Agendas and minutes of the meetings are available to the public via the Trust’s website. • Collaborating with other organisations Compliance with the UK Corporate Strategic issues The table shown in Annex 1 (page 84) of this • The Board’s role in developing a healthy culture across Governance Code Governance Statement sets out attendance the Trust We are not required to comply with the UK levels by each director, for all Trust Board sub- • Review of strategic risks Corporate Governance Code. However, we committee meetings. • Use of resources self-assessment have reported on our corporate governance The Board is supported by the Assistant Director arrangements by drawing on best practice of Corporate Governance (the Corporate available, including those aspects of the UK Secretary), who acts as principal adviser on all The Board has established nine standing sub- Board after every sub-committee meeting, covering Corporate Governance Code we consider to be aspects of corporate governance within the Trust. committees, all chaired by non-executive directors, key issues and escalation points. Additionally, relevant to the Trust. which have key roles in relation to the system of all Board members have access to papers of all The Board continued to be focussed on delivering The Board is compliant with the main principles governance and an integrated review and analysis Board committees. From April 2018, the Board is the Trust’s four strategic objectives throughout of The Healthy NHS Board including: of quality, workforce, finance, performance and introducing a new people participation committee. the year. risks. All Board committees present a report to the • Operating as a unitary board. • Continuously working on improving Board and sub-committee effectiveness through Trust Board periodically reviewing and refreshing the skills on our Board, annual effectiveness reviews and implementation of the Well Led improvement plan. Luton Children Audit Committee Remuneration & Adults Clinical • Openly assessing Trust performance and risk in Committee Operational Board Estates Committee public meetings.

• Having a formal and transparent process Ambulatory Care Charitable Funds for developing Trust policy on executive Clinical Operational Committee remuneration, in line with national guidance, Board which is overseen by an independent remuneration committee. Strategic Children’s & Young Change Board • And effectively managing relationships with key People Clinical Operational stakeholders. Board Arrangements are in place for the discharge of

statutory functions and these have been checked Quality Improvement for any irregularities, and are legally compliant. & Safety Committee

Bi-monthly Quarterly Annually

74 Accountability Report 75 Audit Committee During 2017/18, the committee met five times The Trust’s management team has agreed actions Clinical Operational Boards and in addition to the above, the committee to address the findings reported by internal The audit committee has responsibility for The three clinical operational boards met six times reviewed all reports from completed internal audit during 2017/18. These actions will be providing assurance to the Board that risk is this year to support the Board by undertaking audit assignments for the 2017/18 work plan, implemented in 2018/19 in line with the timeline being managed appropriately, maintaining detailed, integrated analysis of the following and which had been agreed by the committee at the agreed with the internal auditors. direct oversight of all high level risks, including highlight areas of concern requiring the Board’s start of the year. clinical, generic and specific risks arising from the The Information Commissioner’s Office attention and/or action: integrated business plan and risks to financial conducted an independent review of the Trust’s • Quality standards (patient safety, patient processes and control. It is also responsible for data sharing agreements. The review evaluated Head of internal audit opinion 2017/18 experience and clinical effectiveness). reviewing the effectiveness of risk management the design and operation of controls to ensure arrangements through the internal audit The organisation has an adequate and effective the sharing of personal data complies with the • Financial strategy and budget setting including programme and the review of resulting reports. framework for risk management, governance and principles of the Data Protection Act 1998, and Cost Improvement Plans. internal control. In January 2018, the committee completed an the good practice recommendations set out in • Workforce issues. annual review of all risks rated moderate and However, our work has identified further the Information Commissioner’s Data Sharing • Investment proposals and activity information above across the Trust. enhancements to the framework of risk Code of Practice. The Trust has now implemented the recommendations from the audit. A follow- to support the income of the Trust and The committee is constituted in accordance with management, governance and internal control to up report was submitted to the Information achievement of Trust performance objectives. the provisions of the NHS Audit Committee ensure that it remains adequate and effective. Commissioner’s Office in March 2018 providing Handbook and has overseen the audit of 2017/18 • Key performance indicators (KPIs). The following table summarises the outcomes evidence of implementation of the action plan. accounts, the development of internal and from those assignments against the four possible • Efficiency and economy, effectiveness external audit plans and the risk management opinions: and efficacy. Progress on the tendering, and internal control processes, including control Estates Committee negotiation and finalisation of contracts with processes around counter fraud. commissioners and suppliers. The role of the estates committee is to ensure that there are effective structures and systems in The committees highlight, as required, emerging Review Title Internal Audit place, to support the continuous improvement areas of concern on quality and workforce as Assurance Opinion of the Trust’s estate, that our estate is statutorily well as financial and operational risk, gaps in control, gaps in assurance and actions being Risk Management and Assurance Reasonable assurance compliant and that it supports quality services and safeguards high standards of patient care. undertaken to address these issues. Service level Accessible Information Standards Reasonable assurance The committee is also responsible for advising risks are identified by the leads in each area and are reviewed and discussed by the clinical Key Financial Controls Reasonable assurance the Board on Trust compliance with health and safety and sustainability requirements and for operational boards, and escalated to the Board in Financial Planning and Delivery Reasonable assurance providing an effective reporting, escalation and line with the Trust’s procedures. In 2017/18 the Trust had the following clinical operational boards Pre-Employment Checks Reasonable assurance engagement route for key groups with estates services to the Trust and commissioners and overseeing each area of service or geography: Contract Management – Services to Support Clinical Delivery Reasonable assurance the corresponding return of information. The • Ambulatory Care Services committee is also responsible for reviewing the Management of Agency Cap Partial Assurance • Children and Young People’s Health Services estates risk register including risks identified on Safeguarding Supervision Partial Assurance the strategic risk register. During 2017/18, the • Luton Children and Adults Community Health Estates Tendering and Project Management – Brookfields MSK Partial Assurance committee met four times. Services and iCaSH Projects The issues considered by the committee during the year included: Information Governance Advisory Quality Improvement and Safety Committee • Assurance on estates management services GDPR Governance Advisory The quality improvement and safety committee compliance supports the Board to foster a culture of • Implementation of the estates strategy continuous improvement with regard to: • Estates developments • Ensure patient safety is at the heart of the delivery of services in the Trust and to provide • Trust’s annual capital plan assurance, that the Trust meets all its duties and • Estates related cost improvement plans responsibilities to its patients, users and staff. • Sustainability • Ensure that there are effective structures and • Estates risks systems in place to support the continuous improvement of quality services, and safeguard • Key issues and escalations from the sub groups. high standards of patient care and to advise the Board on quality standards, research governance and associated clinical risk

76 Accountability Report 77 management. The committee met six times during the year Risk assessment impact should they be realised, and to manage to review the delivery of strategic programmes them efficiently, effectively and economically. • Advise the Board on Trust compliance with and transitions. The key issues considered by the quality standards, regulatory requirements and The system of internal control is designed to The system of internal control has been in place committee included: accreditation. manage risk to a reasonable level rather than in the Trust for the year ended 31 March 2018 to eliminate all risk of failure to achieve policies, and up to the date of approval of the annual • Review and approve an annual clinical audit aims and objectives. It can therefore only provide report and accounts. programme and advise the Board on learning reasonable and not absolute assurance of from the outcomes. effectiveness. The system of internal control is The Trust has risk registers that track and monitor clinical risks that are escalated to the Board, via The committee met six times during 2017/18 based on an ongoing process designed to identify sub-committees, in line with the Trust’s escalation and considered a range of themes as illustrated and prioritise the risks to the achievement of the framework. Key strategic risks as at 31 March below: policies, aims and objectives of Cambridgeshire Community Services NHS Trust, to evaluate the 2018 include: likelihood of those risks being realised and the

Risk Risk ID Description Score 2610 There is a risk that the Trust doesn’t fully identify plans to recurrently deliver 12 Charitable Funds Committee the £3m savings target for 2018/19, and the result could be that this could Cambridgeshire Community Services NHS Trust contribute to the Trust being financially unsustainable in the future. is the corporate trustee for charitable funds. The Board, on behalf of the Trust, is responsible for 2257** There is a risk that the Trust becomes financially unsustainable through a 6 the effective overall management of charitable combination of events such as: funds. The role of the committee is to oversee • Failure to secure contract extensions the management, investment and disbursement • Failure to secure new business opportunities of charitable funds, as delegated, within the • Loss of business through procurement Remuneration Committee regulations provided by the Charities Commission and to ensure compliance with the laws • Decommissioning of services The remuneration committee supports the Board governing NHS charitable funds and the wishes • Unable to mitigate amber and red rated risk schemes to ensure fairness, equity and consistency in of the donors. The committee met three times • The impact of the Public Health grant cuts without a corresponding change remuneration practices and undertake succession during 2017/18. in contracted activity levels planning for the executive tier. The committee met once during the year to determine Executive directors and their managers are • Need to identify efficiencies and CIP’s for 2017/18 clinical excellence awards and executive level responsible for maintaining effective systems of control on a day-to-day basis. A full governance 2636 There is a risk that the delivery of high quality care will be adversely affected if 6 remuneration. The committee also received levels of staff morale reduce. assurance that fit and proper persons test checks framework has been developed providing had been completed for all directors. terms of reference and escalation policies for all 2730 There is a risk that due to the potential ambiguity of partnership arrangements 12 sub-committees and the Board, together with with other organisations, responsibility and accountability for the delivery of standing items, which are in turn encapsulated services may be unclear. Strategic Change Board into cycles of business for each committee and the Board. 1320** There is a risk that services fail to remain compliant with the CQC 8 The strategic change board oversees the Trust’s Fundamental Standards Framework, leading to patient safety incidents, key strategic change programmes on behalf regulatory enforcement action and reduction in confidence from the public of the Board. It provides oversight of the and commissioners in specific services. effectiveness of changes that are implemented to ensure that the outcomes and benefits of these ** Highlights risks carried over from prior periods. are realised, sustained and embedded within the organisation. Risks 2610, 2636 and 2730 were newly identified in financial year 2017/18. All other risks were carried over from prior periods. Outcomes will be assessed against appropriate action plans and projects, managed through the designated leads and overseen by the Board and relevant sub-committees.

78 Accountability Report 79 As of 31 March 2018, the Trust has 161 open The following two risks were scoring 15 or above Two of these information governance incidents risks. The chart below presents an overview of all as at 31 March 2018: were reported to the Information Commissioner’s open risks Office (ICO). In one instance, paper records were • Risk 2731 - There is a risk that removal of inappropriately sent in the post. The records were consent override in Systm1 at the end of recovered and the actions taken by the Trust to March will negatively impact on the sharing of prevent reoccurrence were acknowledged by the safeguarding information to protect children. ICO. No further action was required by the Trust. • Risk 2456 - There is a risk that the safeguarding The second incident involved the use of a non teams, which currently operate to capacity, are ‘safe-haven’ fax to send patient records. Again unable to meet any additional demands placed the records were recovered. This incident was 29% Clinical on their service and with reduced capacity referred to the ICO’s office and no further action within HCP the ability to back fill or support was taken by the ICO. The ICO recommended a Fire the service, as a short term, is not possible. 43% Overview number of improvement actions; some of which of all current This places pressure on the safeguarding team, were already in place and the remainder were in Health and Safety risks across which could lead to staff sickness or an inability the process of being implemented at the point the Trust Information to meet expected safeguarding targets. this report was finalised. 1% Note: action plans related to the two risks Organisational The strategic risk register is shared with key recorded as ‘extreme’ are currently being stakeholders and risks relating to the contracts implemented. 21% with the commissioners are identified and 6% The Trust has identified and risk-assessed cost discussed during the contract negotiation stage. improvement plans across the organisation and Control measures are in place to ensure that all will be monitoring their achievement on an the organisation’s obligations under equality, ongoing basis, as follows: diversity and human rights legislation are • Service related schemes via clinical operational complied with. boards. As an employer with staff entitled to All current risks by directorate • Corporate support functions schemes via the membership of the NHS pension scheme, the Trust Board. Trust is compliant with NHS Pension Scheme Regulations. Control measures are in place to 30 Low • Transformation and service redesign schemes ensure all employer obligations contained within Moderate via the strategic change board. the scheme regulations are complied with. This 25 High • Estates schemes via the estates committee. includes ensuring that deductions from salary, employer’s contributions and payments in to Extreme The Trust’s information governance toolkit self- 20 the scheme are in accordance with the scheme assessment score for 2017/18 was 80% and rules, and that member pension scheme records hence was graded satisfactory. 15 are accurately updated in accordance with For the 39 standards involved, there were four the timescales detailed in the regulations. A

Number of Risks 10 ratings possible (0, 1, 2, or 3, with 3 being the Contributions Assurance Statement has been most positive outcome). The Trust achieved level submitted to the NHS Business Services Authority, 5 2 for 22 standards and level 3 for 16 standards. confirming that that the contributions remitted One standard was considered not relevant to the properly represent amounts due to the scheme. Trust’s portfolio. 0 The Trust’s preparation for climate change, Ambulatory Care Children and Luton Community Trustwide This assessment provides assurance that the and the necessary adaptations, form part of its Young Peoples Services Trust is meeting its obligations in relation to emergency preparedness and civil contingency information governance. Action plans for requirements, as based on the UK Climate improvement were monitored by the Trust’s Projections 2009 (UKCP09), to ensure that this information governance steering group, with organisation’s obligations under the Climate progress reports presented quarterly to the Change Act are met. The Trust has a major quality improvement and safety committee. incident plan that is fully compliant with the requirements of the Civil Contingencies Act During 2017/18, there were four information (2004) and NHS Emergency Planning Guidance governance incidents that required full root cause 2010 and all associated guidance. analysis. All four were reported to the appropriate commissioning organisation and closed. None of these incidents resulted in harm to any patient.

80 Accountability Report 81 The risk and control framework line with the Trust’s risk management policy, all and internal control” and identified further Significant Issues other risks rated 15 or above are escalated to the enhancements to the framework of risk The Trust has a risk management policy, which The following audits were undertaken for which Board. All risks rated 12 or above are reviewed management, governance and internal control makes it clear that managing risk is a key a partial assurance opinion was provided: regularly by identified Board sub-committees and to ensure that the Trust remains adequate and responsibility for the Trust and all staff employed an escalation process is in place, as outlined in effective. The Trust will implement the identified • Management of Agency Cap by it. The Board receives regular reports that the risk management policy. actions in 2018/19. detail risk, financial, quality and performance • Safeguarding Supervision issues and, where required, the action being Risk is assessed at all levels in the organisation Executive managers within the organisation, • Estates Tendering and Project Management – taken to reduce identified high-level risks. from individual members of staff within business who have responsibility for the development and We continued to receive invaluable support from hundredsBrookfields of dedicated volunteers,MSK and iCaSH as well Projects units to the Board. This ensures that both maintenance of the system of internal control, The principles of risk management are included as charities such as the Dreamdrops children’s charity, the Arthur Rank Hospice charity, and strategic and operational risks are identified and provide me withthe assurance. Friends of Hospital The assurance at Home in Pe terborough, allAction of whom plans provided have a vital been role inestablished helping and are being as part of the mandatory corporate induction us improve the quality of services we provide. Without their dedication and support, our task addressed. Risk assessment information is held in framework itself provides me with evidence that implemented to address these. programme and cover both clinical and non- would be even harder. an organisation-wide web-based risk register. the effectiveness of controls that manage the clinical risk, an explanation of the Trust’s risks to the organisationOur focus for achieving 2015/16 is onits ach principalieving our ambitious plans for the future, aligned to the approach to managing risk and how individual The Trust has in place a strategic risk register, system-wide priorities identified by our commissionersConclusion and which are responsive to the objectives have specificbeen reviewed.needs of the localMy populationsreview is alsowe serve. Central to this is working collaboratively staff can assist in minimising risk. Additional which sets out the principal risks to delivery of informed by clinicalwith our audits, staff, GPs, the social Trust’s care external practitioners and hospitalThere clinicians has been, to develop no evidence seamless presented to myself support is provided to individuals and teams via the Trust’s strategic objectives. Executive directors care irrespective of organisational boundaries. auditors and any assessments conducted by the or the Board to suggest that at any time during the clinical and corporate governance functions. review the risk register and enter strategic risks CQC, Ofsted, theIn line Information with our five yearCommissioner’s plan, we will continue to submit2017/18, bids to expandthe Trust the geographic has operated area outside of its onto the corporate risk register. In addition, other across which we provide the specialist, high quality services that now makes up our portfolio. Guidance and training are also provided to staff Office and NHS Protect. statutory authorities and duties. In relation to our corporate risks scoring 15 or above that have This will enable other commissioners and populations to benefit from our expertise in through specific risk management training, wider providing these specialist services, which focus on healthreporting promotion of the and Trust’sprevention corporate of ill governance been reviewed by the relevant sub-committee, I have been advisedhealth. on the implications of management training, policies and procedures, arrangements, we have drawn from the best are escalated in line with the Trusts’ escalations the result of my review of the effectiveness of information on the Trust’s intranet and feedback The Government policy prior to the May 2015 Generalpractice Election including was that NHS those Trusts, elements as an of The Healthy processes. The executive director with delegated the system of internal control by the clinical from audits, inspections and incidents. Included organisational form, could not continue long term. AsNHS a smaller Board, organisation which areproviding applicable to the Trust. responsibility for managing and monitoring each operational boardsspecialist and services, the audit, we will estates, determine and during 2015 our future organisational form in the within all of this is sharing of good practice risk is clearly identified. The strategic risk register quality improvementcontext andof what safety is in the committees. best interests of patients andMy our review staff. Whilst confirms we await that policy Cambridgeshire and learning from incidents. Information from guidance from the new Government on options available in relation to organisational form, identifies the key controls in place to manage A plan to addresswe willweaknesses take forward anddevelopment ensure work to evidence Communityour viability as aServices stand-alone NHS Trust has a generally a variety of sources is considered in a holistic each of the principal risks and explains, how continuous improvementorganisation, whateverof the system form that is takes. in We anticipatesound that this system process of will internal take control that supports the manner to provide learning and inform changes approximately two years to come to fruition, during which time we will continue to operate as the Board is assured that those controls are in place. an NHS Trust. We will of course involve staff, commissionersachievement and th eof Trust its Developmentpolicies, aims and objectives. to practice that would improve patient safety, place and operating effectively. These include the Authority in these deliberations. and overall experience of using the Trust’s The Board’s role is to determine the overall monthly integrated performance report, minutes services. In 2017, the Board revised the risk strategic directionPlease and enjoy to readingprovide our active annual review and we look forward to a successful year in of the clinical operational boards, audit, estates 2015/16. Signed: management policy including drafting a Risk leadership of the Trust within a framework of and quality improvement and safety assurances Appetite Statement for the Trust. prudent and effective controls, which enables risk provided through the work of internal and to be assessed and managed. The Trust refreshed The risk management policy sets out the key external audit, the CQC and the NHS Litigation its Five Year Business Plan in November 2017. responsibilities for managing risk within the Authority. Trust objectives for 2017/18 were agreed as part Matthew Winn, organisation, including the ways in which risk is Specific areas of risk such as fraud, corruption of that plan (2016-2021) as follows: Chief Executive identified, evaluated and controlled. It identifies and bribery are addressed through specific Nicola Scrivings Matthew Winn strategic and operational risk and how both 1. Provide outstandingChairman care Chief Executive25 May 2018 policies and procedures and regular reports made should be identified, recorded and escalated and to the Board via the sub-committees. 2. CollaborateJune with 2015 other organisations highlights the open and honest approach the Board expects with regard to risk management. 3. Be an excellent employer The Trust’s risk assessment policy describes Review of the effectiveness of risk 4. Be a sustainable organisation the process for standardised assessment of management and internal control risk, including assessment of likelihood and All objectives have identified outcomes, measures consequence. As Accountable Officer, I have responsibility and timescales. The objectives integrate external for reviewing the effectiveness of the risk (e.g. national targets), local (e.g. commissioners’ The Board has identified the risks to the management processes. My review is informed contract targets) and internal (e.g. effective achievement of the Trust’s objectives. The in a number of ways. The head of internal audit patient care) drivers of the organisation. nominated lead for each risk has identified provides me with an opinion on the overall Indicators relating to the Quality Account and existing controls and sources of assurance that 4 arrangements for gaining assurance through and the Commissioning for Quality and Innovation these controls operate effectively. Any gaps in on the controls reviewed as part of the internal (CQUIN) framework have been incorporated controls have been identified and action plans audit work. where appropriate, along with other measures put in place to strengthen controls, where agreed with executive directors. appropriate. The outcome of this process is The head of internal audit’s opinion is that “the articulated in the strategic risk register and which organisation has an adequate and effective is presented to the Board monthly for review. In framework for risk management, governance

82 Accountability Report 83 Annex 1 - Attendance at Where membership of Board sub-committees Sub Committee Members Names Title Board meetings and Board changed in year, these are reflected in the (* Indicates Chairs of that committee) attendance levels shown below indicating that sub-committees individuals may not have been members of sub- Nicola Chair Charitable Funds Committee; Estates Committee; Ambulatory committees for the full year, or where directors Scrivings Care Clinical Operational Board; Children & Young People’s The table below sets out the number of meetings attended meetings on an ad hoc basis as ‘ex (Chair) Clinical Operational Board; Luton Children & Adults Clinical attended by each Board member during 2017/18. officio’ members. Operational Board; Remuneration Committee; Strategic Change Board*.

Richard Non-Executive Audit; Ambulatory Care Clinical Operational Board*; Strategic Cooper Director Change Board.

Name and Position Dr Anne Non-Executive Audit; Ambulatory Care Clinical Operational Board; Quality

Board McConville Director Improvement & Safety Committee*; Committee Committee Luton Clinical Remuneration Board Meetings Board Charitable Funds Strategic Change Audit Committee

Children’s Clinical Children’s Gill Thomas Non-Executive Estates Committee; Children & Young People’s Clinical Operational Board Operational Board Operational Board Estates Committee Ambulatory Clinical & Safety Committee Quality Improvement Quality Improvement Director Operational Board*; Remuneration Committee*; Strategic Change Board. Nicola Scrivings (Chair) 5(6) 1(1) 3(3) 3(4) 5(5) 2(2) 6(6)

Trish Davies (NED) 5(5) 2(4) 4(4) 5(6) Geoff Non-Executive Audit*; Charitable Funds Committee*; Luton Children retired (31December 2017) Lambert Director & Adults Clinical Operational Board *; Remuneration Dr Anne McConville Committee; 5(6) 1(1) 6(6) 2(3) 5(6) (NED) Oliver Non-Executive Estates Committee*; Children & Young People’s Clinical Gill Thomas (NED) 5(6) 1(1) 1(1) 4(4) 4(5) 6(6) Judges Director Operational Board; Quality Improvement & Safety Committee; Geoff Lambert (NED) 5(6) 5(5) 1(1) 3(3) 4(4) 6(6) Matthew Chief Executive Ambulatory Care Clinical Operational Board; Strategic Change Richard Cooper (NED) 5(6) 1(1) 3(4) 5(6) effective (1 May 2017) Winn Board.

Oliver Judges (NED) 3(4) 1(1) 2(2) 1(1) Anita Pisani Deputy Chief Charitable Funds Committee; Luton Children & Adults Clinical effective (1 October 2017) Executive and Operational Board; Quality Improvement & Safety Committee; Matthew Winn Director of Strategic Change Board. 6(6) 1(1) 1(1) 4(5) 5(6) (Chief Executive) Workforce and Anita Pisani (Deputy Service Re-Design Chief Executive and 6(6) 5(6) 1(1) 2(3) 4(5) 6(6) Director of Workforce Dr David Medical Director Ambulatory Care Clinical Operational Board; Luton Children and Service Re-Design) Vickers & Adults Clinical Operational Board; Quality Improvement & Safety Committee; Dr David Vickers 6(6) 6(6) 4(6) 4(6) (Medical Director) Mark Director of Charitable Funds Committee; Estates Committee; Children & Mark Robbins Robbins Finance and Young People’s Clinical Operational Board; (Director of Finance 6(6) 5(5) 3(3) 4(4) 5(5) 4(6) Resources and Resources) Mandy Renton Julia Sirett Chief Nurse Estates Committee; Children & Young People’s Clinical (Chief Nurse) 1(1) 1(1) Operational Board; Quality Improvement & Safety Committee; retired (30 April 2017) Julia Sirett NB. This shows the sub-committee membership as at the end of the 2017/18 financial year. (Chief Nurse) 6(6) 1(1) 5(5) 2(2) 2(2) 4(6) effective (1 May 2017)

Figures in brackets show total number of meetings members could have attended in year.

84 Accountability Report 85 Remuneration and Staff Report 17/18

Remuneration 88 and Staff Report

Staff Report 94 (subject to audit) Service Contracts (not subject to audit) Details of remuneration payable to the senior Remuneration and managers of Cambridgeshire Community Services NHS Trust in respect of their services for the year ended 31 March 2018 are given in the Staff Report 2017/18 tables on the following four pages.

Unexpired Early Date of Notice Membership of the Remuneration, Terms Where national review bodies govern salaries, Name Position term (if termination contract Period of Service and Nominations Committee then the national rates of increase have been applicable) terms (not subject to audit) applied. Where national review bodies do not cover staff, then increases have been in line Matthew Winn Chief Executive 01/04/2010 N/A N/A 3 months Name Position with the percentage notified by the NHS chief David Vickers Medical Director 01/04/2010 N/A N/A 3 months Gill Thomas Non Executive Director executive and approved by the remuneration (Chair of the Committee) committee. Mark Robbins Director of 01/05/2015 N/A N/A 3 months Finance & Geoffrey Lambert Non Executive Director The remuneration committee takes the Resources Nicola Scrivings Chairman of the Board financial circumstances of the organisation into consideration in making pay awards, as well as Anita Pisani Director of 01/06/2012 N/A N/A 3 months Matthew Winn Chief Executive (in advance letters of advice from the Department Workforce and attendance for relevant of Health. All uplifts were discussed with and Transformation discussions only). decided by the remuneration committee, which & Deputy CEO is supported by a human resources professional. Anita Pisani Deputy Chief Executive Mandy Renton Chief Nurse 23/01/2012 N/A N/A 3 months (in attendance for (to 30th April relevant discussions only) Policy on performance conditions 2017) The Trust’s annual objectives are set through the Julia Sirett Chief Nurse 01/04/2018 N/A N/A 3 months Policy on the remuneration of senior annual business planning cycle. The Trust’s Chair (interim 1st May managers then agrees these objectives with the Chief 2017) For the purposes of the remuneration report the Executive whose performance is monitored Chief Executive considers the executive directors via monthly one-to-one meetings. The Chief of the Trust to be ‘senior managers’. Executive agrees his objectives with the Trust’s executive directors and holds similar monthly Remuneration payments made to the non- one-to-ones to manage their performance. executive directors are set nationally by the The Chair also holds bi-monthly performance Secretary of State. The remuneration of meetings with each of the executive directors. executive directors is set by the remuneration committee. The committee considers comparative salary data, benchmarking Policy on duration of contracts, notice information for similar organisations and periods and termination payments labour market conditions in arriving at its final decision. All executive directors are employed on Executive directors’ contracts are subject to permanent contracts with the Trust. three months’ contractual notice. Termination payments are made in accordance with NHS No remuneration was waived by members and policy. no compensation was paid for loss of office during the financial year ended 31 March 2018. No payments were made to co-opted members and no payments were made for golden hellos. The Trust does not have any staff members on performance related pay systems.

88 Remuneration and Staff Report 2017/18 89 Remuneration 2017/18 (subject to audit) The Trust does not make any payments to Review of Tax Arrangements of Public directors based on the financial performance of Sector Appointees (not subject to audit) 2017/18 the Trust. For all off-payroll engagements as of 31 March Expense All pension Salary and other remuneration exclude the 2018, for more than £245 per day and that last Name Position Salary Payments Bonus related Total (bands (taxable) Payments benefits (bands employer’s pension contributions and is gross of longer than six months: of total to (bands of (bands of of pay charges to other NHS Trusts. £5,000) nearest £100 £5,000) £2,500) £5,000) Number Reporting bodies are required to disclose Nicola Scrivings Chair 20-25 0 0 0 20-25 Number of existing engagements 1 the relationship between the remuneration as of 31 March 2018 Non Executive Director Trish Davies 0-5 0 0 0 0-5 of the highest paid director and the median (to 31st January 2018) Of which, the number that have existed: remuneration of the organisation’s workforce. Gillian Thomas Non Executive Director 5-10 0 0 0 5-10 for less than one year at the time of reporting 0 The mid-point of the banded remuneration for between one and two years at the time of Anne 0 Non Executive Director 5-10 0 0 0 5-10 reporting McConville of the highest paid director in 2017/18 was £140,622 (2016/17 comparator £144,914). for between 2 and 3 years at the time of reporting 1 Geoffrey Non Executive Director 5-10 0 0 0 5-10 This was 4.89 times the median remuneration Lambert for between 3 and 4 years at the time of reporting 0 of the workforce (subject to audit), which was for 4 or more years at the time of reporting 0 Non Executive Director Richard Cooper 5-10 0 0 0 5-10 £28,746 (2016/17 comparator was 5.09 times (from 1st May 2017) the median remuneration of the workforce The Trust has undertaken a risk based Non Executive Director Oliver Judges 0-5 0 0 0 0-5 which was £28,462). Remuneration ranged (from 1st October 2017) assessment as to whether assurance is required, from £7,300 to £140,622. See the salaries that the individual is paying the correct amount Matthew Winn Chief Executive 140-145 0 0 0 140-145 and allowances table on the previous page for of tax and National Insurance (NI). The Trust has David Vickers Medical Director * 125-130 0 5-10 15-20 150-155 details of the highest paid director. concluded that the risk of significant exposure in

Mark Robbins Director of Finance and Resources 90-95 0 0 0 90-95 The calculation was based on staff employed in relation to these individuals is minimal. substantive and bank contracts as at 31 March Deputy Chief Executive & Director For all new off-payroll engagements or those Anita Pisani 110-115 0 0 55-60 170-175 of Workforce and Transformation 2018, sorted by full time equivalent salary value that reached six months in duration, between and then taking the middle employee from this Mandy Renton Chief Nurse (to 30th April 2017) 5-10 0 0 0 5-10 1 April 2017 and 31 March 2018, for more list. than £245 per day and that last longer than six Julia Sirett Chief Nurse (from 1st May 2017) 70-75 0 0 0 70-75 In 2017/18, 0 employees (2016/17 comparator months: 2016/17 0 employees) received remuneration in excess of Nicola Scrivings Chair 20-25 24 0 0 20-25 the highest paid director. Number Trish Davies Non Executive Director 5-10 0 0 0 5-10 Number of new engagements, or those that Total remuneration includes salary, non reached six months in duration, between 1 April 0 Gillian Thomas Non Executive Director 5-10 0 0 0 5-10 consolidated performance-related pay, benefits 2017 and 31 March 2018 in kind, as well as severance payments. It does Of which: Anne Non Executive Director 5-10 0 0 0 5-10 McConville not include employer pension contributions and Number assessed as caught by IR35 0 the cash equivalent transfer value of pensions. Geoffrey Number assessed as not caught by IR35 0 Non Executive Director 5-10 0 0 0 5-10 Lambert No payments were made in respect of ‘golden Matthew Winn Chief Executive 135-140 0 0 7.5-10 145-150 hellos’ or compensation for loss of office. Number engaged directly (via PSC contracted to 0 department) and are on the departmental payroll David Vickers Medical Director * 125-130 0 15-20 95-97.5 240-245 No compensation payments were made to Number of engagements reassessed for consistency/ 1 Director of Finance and Resources a third party for the services of an executive assurance purposes during the year Mark Robbins 90-95 0 0 17.5-20.0 110-115 (From 1st May 2015) director or non-executive director. Number of engagements that saw a change to IR35 0 Deputy Chief Executive & Director status following the consistency review Anita Pisani 100-105 0 0 0 100-105 of Workforce and Transformation

Mandy Renton Chief Nurse 95-100 0 0 22.5-25 115-120 One engagement was entered into without contractual clauses through their own private limited company and was assessed for * David Vickers is employed as both a paediatric consultant and medical director at the Trust. His “salary” includes his role as a paediatric consultant (£125,000 - £130,000). consistency with IR35 during the year.

90 Remuneration and Staff Report 2017/18 91 The Trust has had three exit packages in 2017/18 Pension Benefits - 2017/18 (subject to audit) (subject to audit) all of which were compulsory We continued to receive invaluable support from hundredsredundancies. of dedicated volunteers, as well 2017/18 as charities such as the Dreamdrops children’s charity, the Arthur Rank Hospice charity, and Real Real Total Lump sum at Cash the Friends of Hospital at Home in Peterborough, all of whom provided a vital role in helping us improve the quality of services we provide. WithoutExit their package dedication cost and support, our task Number Cost of Total Number of Cost of special Increase Increase accrued age 60 related Equivalent Cash Real band (including *Number of *Cost of of other other number Total cost departures where payment element in in lump pension to accrued Transfer Equivalent Increase Employer’s would be even harder. Name Position any special compulsory compulsory departures departures of exit of exit special payments included in exit pension sum at age 60 pension Value Transfer in Cash contribution Our focus for 2015/16 is on achieving our ambitious paymentplans for element) the future,redundancies aligned to the redundancies agreed agreed packages packages have been made packages at age 60 at age 60 at 31 March at 31 March at 31 Value Equivalent to system-wide priorities identified by our commissioners and which are responsive to the (bands of (bands of 2018 (bands 2018 (bands March at 1 April Transfer stakeholder WHOLE WHOLE WHOLE specific needs of the local populations we serve. Central to this is working collaboratively WHOLE NUMBERS £2,500) £2,500) of £5,000) of £5,000) 2018 2017 Value pension NUMBERS £s NUMBERS £s NUMBERS £s £s with our staff, GPs, social care practitioners and hospital clinicians, to develop seamless ONLY £’000 £’000 £’000 £’000 £’000 £’000 £’000 £’000 ONLY ONLY ONLY care irrespective of organisational boundaries. Matthew Chief Less than 0-2.5 0-2.5 25-30 75-80 438 401 37 N/A 1 3,430 1 3,430 Winn Executive In line with our five year plan, we will continue to submit£10,000 bids to expand the geographic area across which we provide the specialist, high quality services£10,000 that now makes up our portfolio. David Medical 1 12,254 1 12,254 0-2.5 2.5-5 45-50 145-150 1,140 1,066 74 N/A This will enable other commissioners and populations- £25,000to benefit from our expertise in Vickers Director providing these specialist services, which focus on health promotion and prevention of ill £25,001 health. 1 33,258 1 33,258 Anita Director of - £50,000 Pisani Workforce and 2.5-5 7.5-10 30-35 90-95 542 451 91 N/A £50,001 Transformation The Government policy prior to the May 2015 General Election was that NHS Trusts, as an 0 0 organisational form, could not continue long term. As- a£100,000 smaller organisation providing Mandy Chief Nurse specialist services, we will determine during 2015 our£100,001 future organisational form in the 0 0 Renton* (to 30th April 0 0 0 0 0 711 -711 N/A context of what is in the best interests of patients and- our£150,000 staff. Whilst we await policy 2017) guidance from the new Government on options available in relation to organisational form, £150,001 we will take forward development work to evidence our viability as a stand-alone 0 0 Julia Chirf Nurse organisation, whatever form that takes. We anticipate- that£200,000 this process will take Sirett** (from 1st May 17.5-20 52.5-55 15-20 50-55 360 0 360 N/A approximately two years to come to fruition, during which> £200,000 time we will continue to operate as 0 0 2017) an NHS Trust. We will of course involve staff, commissioners and the Trust Development Total 3 48,942 0 0 3 48,942 0 0 Mark Director of Authority in these deliberations. 0-2.5 0-2.5 20-25 70-75 440 408 32 N/A Robbins Finance Please enjoy reading our annual review and we look forward to a successful year in Signed: 2015/16. *Decrease in real increase in cash equivalent transfer value is due to retirement **High real increase in cash equivalent transfer value is due to existing NHS employee being appointed to a Director role

Matthew Winn Chief Executive Prior Year - Pension Benefits - 2016/17 Nicola Scrivings Matthew25 Winn May 2018 Chairman Chief Executive 2016/17

June 2015 Real Real Total Lump sum at Cash Increase Increase accrued age 60 related Equivalent Cash Real in in lump pension to accrued Transfer Equivalent Increase Employer’s Name Position pension sum at age 60 pension Value Transfer in Cash contribution at age 60 at age 60 at 31 March at 31 March at 31 Value Equivalent to (bands of (bands of 2017 (bands 2017 (bands March at 1 April Transfer stakeholder £2,500) £2,500) of £5,000) of £5,000) 2017 2016 Value pension £’000 £’000 £’000 £’000 £’000 £’000 £’000 £’000 Matthew Chief 0-2.5 2.5-5 25-30 75-80 401 372 29 N/A Winn Executive David Medical 2.5-5 12.5-15 45-50 140-145 1,066 912 154 N/A Vickers * Director 4 Anita Director of Pisani Workforce and 0-2.5 0-2.5 25-30 80-85 451 434 17 N/A Transformation Mandy Chief Nurse 0-2.5 2.5-5 35-40 105-110 711 660 51 N/A Renton Mark Director of 0-2.5 2.5-5 20-25 70-75 408 374 34 N/A Robbins Finance

*Increase in real increase in cash equivalent transfer value is due to Clinical Excellence award

92 Remuneration and Staff Report 2017/18 93 The following table shows an analysis of the average whole time equivalent staff, Staff Report split between staff groups and permanently employed and other for 2017/18 and 2016/17 for the prior year. (subject to audit) Total Total Permanently Permanently Average Staff Numbers Current Other Prior Other Employed Employed Year Year Medical and dental 82 64 18 87 66 21 As at 31 March 2018, the Trust employed 2104 staff. The following chart shows an analysis of Ambulance staff 0 0 0 0 0 0 the total number of staff by occupational code. Administration and estates 410 377 33 422 389 33

Healthcare assistants and other support staff 305 298 8 305 298 7

Nursing, midwifery and health visiting staff 712 699 12 732 709 23

Nursing, midwifery and health visiting 29 2 27 38 3 35 23 Add Prof Scientific and Technical learners

410 Additional Clinical Services Scientific, therapeutic and technical staff 160 157 3 173 166 7

482 Administrative and Clerical Healthcare Science Staff 4 4 0 0 0 0 184 Allied Health Professional Bank Staff 0 0 0 0 0 0 Total number of staff 4 Healthcare Scientists Other 0 0 0 0 0 0 108 Medical and Dental Total average numbers 1703 1601 102 1757 1631 126 Staff engaged on capital projects 859 Nursing and Midwifer Registered 0 0 0 0 0 0 (included above) 34 Student

The following table shows an analysis of pay costs for 2017/18 split between permanently employed and other.

2017/18 Employee Benefits Current Year - Permanently Gross Expenditure Total Employed Other £000s £000s £000s Salaries and wages 58,235 54,838 3,397

Social security costs 5,342 5,342 0

Apprenticeship levy 265 265 0

Employer Contributions to NHS BSA - Pensions 7,249 7,249 0 Division

Other pension costs 0 0 0

Termination benefits 49 49 0

Total employee benefits 71,140 67,743 3,397

94 Remuneration and Staff Report 2017/18 95 Find us online Analysis of gender distribution within our workforce The DynamicHealth musculoskeletal We are a frontrunner in supporting the The following charts set out the gender physiotherapy and specialist team launched national shift towards empowering patients distribution across the Trust as of 31 March 2017 a website, which leads the way in sharing to self-care and stay well. Our patients will information on innovative and evidenced based find resources on our website or through our Gender distribution – Directors models of care. Facebook page to enable them to manage (including Executive & Non-executive Directors) their musculoskeletal conditions themselves Anyone interested in our service will benefit (where it’s clinically appropriate). from this fantastic resource created by our staff, trained to provide expert professional To find out more please visit: advice and care to meet the needs of patients. Website: www.eoemskservice.nhs.uk The team has a proven track record of Director – Director – Facebook: www.facebook.com/ providing modern, high quality and responsive Male (6) Male (60%) DynamicHealthMSK care, as evidenced by the Trust’s good rating Director – Director – Twitter: twitter.com/CCSMSK awarded by the Care Quality Commission. Female (4) Female (40%) Information on what services we offer, who is eligible and how to refer them to our services, is easily accessible. You may even find information on services you didn’t realise we provided such as occupational health and pelvic health physiotherapy. Gender distribution – Senior Managers (excluding Directors)

Senior Manager Senior Manager – Male (7) – Male (44%) The following chart provides an analysis of the The following chart provides an analysis of the Senior Manager Senior Manager number of Board members within the Trust, number of senior managers within the Trust, – Female (9) – Female (56%) by band. by band.

3 3 Gender distribution – Employees Band Board Headcount Percentage of Total Headcount distribution Members 5 - Senior by Band 3 10 Managers 1 Employee – Employee – 1 Male (148) Male (7%) Employee – Employee – Female (1959) Female (93%)

Executive directors - Band 9 Band 8b Executive directors - Non AFC Banding Band 8c Non-executive directors - Chair Band 8d Non-executive directors excluding Directors

96 Remuneration and Staff Report 2017/18 97 As part of the Trust’s commitment to promoting belief, maternity and adoption, and race reflect Health and wellbeing and admin teams through our internal celebration and ensuring inclusion and diversity across our this analysis and support our programme of sickness absence reduction - love your admin week. We continue to workforce, we analyse workforce data against work to promote inclusion and diversity across promote and offer resilience training and have eight of the nine protected characteristics the Trust. Live Life Well added mindfulness techniques to this portfolio. set out in the Equality Act 2010. The gender We now offer workshops for managers on Currently we do not collect data relating to distribution charts/tables set out above and We continued to support staff to be as well managing mental health too. gender reassignment and will be reviewing this below relating to age, marriage and civil as they can be, as part of our Live Life Well issue during 2018/19. We have supported Live Life Well through a partnership, disability, sexuality, religion and initiatives. This included promoting the use of charitable funds for team events. series of articles in our weekly staff briefing (Comms Cascade) and Live Life Well newsletter. Age of staff Marriage & Civil Partnership We trialled the use of activity trackers to The latter having increased its frequency based promote physical activity for desk based staff. on positive staff feedback and great stories. 1400 700 625 1289 We also researched and published advice to 585 We also continued to offer our rapid access to 600 1200 staff on the effects of the menopause, with the musculoskeletal (MSK) service for staff who are 500 488 1000 aim to support staff and reduce stigma. off sick (or at risk of going off sick) as a result of 400 800 We also shone a spotlight on mental wellbeing an MSK condition for which they are awaiting 300 600 552 240 to coincide with the national awareness investigation, treatment or surgery. 200 400 156 campaign in May 2017 and Time to Talk Day in 100 200 The following table provides information on the 141 64 February 2018, reminding staff what support 1 9 14 30 14 0 0 Trust’s sickness absence rates. Civil Legally is available. This focus was then built upon in Under 20 20-29 30-39 40-49 50-59 60-69 Over 70 Divorced Married Single Unknown Widowed Partnership Separated May 2018. Appreciation was also shown to our

Sexual Orientation/ LGBT Religion and Belief Data category 2014/15 2015/16 2016/17 2017/18 Does not include staff who did not wish to disclose Does not include staff who did not wish to disclose

700 Average WTE* 2854 1952.79 1762.79 1713.34 632 450 423 600 400 Average monthly sickness rate 4.73% 4.38% 4.67% 4.45% 500 350 300 WTE days lost 49,993 31,427 30,111 20,795 400 250 300 200 WTE days available 1,042,141 700,107.26 645,165.81 466,911.36

200 150 100 76 Cumulative sickness rate - 100 66 4.80% 4.49% 4.67% 4.59% 66 50 24 48 based on yearly totals 2 3 2 2 9 2 3 0 0 Bisexual Gay Heterosexual Lesbian Undefined Atheism Buddhism Christianity Hinduism Islam Judaism Other Sikhism Undefined *WTE refers to Whole Time Equivalent (e.g. a full time post equivalent to 37.5 hours per week) Note: the above table reflects data from our internal monitoring process for based on a full calendar year e.g. 365 days. As such, the sickness rates included within the Trust’s annual accounts, which are based on Department of Health 1 estimated figures over 225 days per year (i.e. excluding weekends and bank holidays) will not correlate with the above. 7 3 White (British, Irish, Any other White background) 29 Staff policies commitments towards disabled people and as a 79 Mixed (White & Black Caribbean, White & Asian, 92 Mindful Employer, which increases awareness of Any other mixed) The Trust aims to ensure that no employee mental health in the workplace. in employment or job applicant receives less Asian or Asian British (Indian, Pakistani, favourable treatment because of their race, Bangladeshi, Any other Asian) colour, nationality, ethnic or national origin Ethnicity Consultancy expenditure Black or Black British (Caribbean, African, or on the grounds of gender, marital status, of staff Any other Black) disability, age, sexual orientation or religion; or Consultancy Service expenditure for 2017/18 was £183,531. Any Other Ethnic Group is disadvantaged by conditions or requirements which are not justified by the job. Chinese 1716 The Trust’s Equality and Diversity work stream, Off payroll arrangements Filipino alongside our Equal Opportunities Policy, Recruitment and Selection Policy, Dignity at Work The Trust had one off payroll engagement during Policy, and Training, Education and Development 2017/18. Policy are central in achieving this aim. Total staff headcount - as at 31st March 2018 2104 During 2017/18, the Trust continued to receive Exit packages Disability - number of staff recorded in ESR (Electronic Staff Record) system as disabled 28 accreditation to use the Disability Confident The Trust made three exit packages in 2017/18 number of staff identified as on Maternity or Adoption leave 64 Scheme for employers who meet a range of Maternity & Adoption leave - (subject to audit).

98 Remuneration and Staff Report 2017/18 99 Other information Opinion on other matters required by the Code of Audit Practice Independent auditor’s report to The Directors are responsible for the other information. The other information comprises In our opinion: the information included in the Annual Report • the parts of the Remuneration Report and set out on pages 1 to 91 other than the financial the Directors of Cambridgeshire Staff Report to be audited have been properly statements and our auditor’s report thereon. prepared in accordance with IFRSs as adopted Our opinion on the financial statements does by the European Union, as interpreted and not cover the other information and, except Community Services NHS Trust adapted by the Department of Health and to the extent otherwise explicitly stated in our Social Care Group Accounting Manual 2017/18 report, we do not express any form of assurance and the requirements of the National Health conclusion thereon. Report on the Audit of the financial statements section of our report. We are Service Act 2006; and independent of the Trust in accordance with the In connection with our audit of the financial Financial Statements • based on the work undertaken in the course ethical requirements that are relevant to our audit statements, our responsibility is to read the of the audit of the financial statements of the financial statements in the UK, including other information and, in doing so, consider Opinion and our knowledge of the Trust gained the FRC’s Ethical Standard, and we have fulfilled whether the other information is materially through our work in relation to the Trust’s We have audited the financial statements of our other ethical responsibilities in accordance inconsistent with the financial statements or arrangements for securing economy, efficiency Cambridgeshire Community Services NHS Trust with these requirements. We believe that the our knowledge obtained in the course of our and effectiveness in its use of resources, the (the ‘Trust’) for the year ended 31 March 2018, audit evidence we have obtained is sufficient and work, including that gained through work in other information published together with the which comprise the Statement of Comprehensive appropriate to provide a basis for our opinion. relation to the Trust’s arrangements for securing financial statements in the annual report for the Income, the Statement of Financial Position, the value for money through economy, efficiency financial year for which the financial statements Statement of Changes in Equity for the year and effectiveness in the use of its resource or are prepared is consistent with the financial ended 31 March 2018, the Statement of Cash Who we are reporting to otherwise appears to be materially misstated. Flows and notes to the financial statements, statements. This report is made solely to the Directors of the If we identify such material inconsistencies including a summary of significant accounting Trust, as a body, in accordance with Part 5 of or apparent material misstatements, we are policies. The financial reporting framework that the Local Audit and Accountability Act 2014. required to determine whether there is a material Matters on which we are required to report has been applied in their preparation is applicable Our audit work has been undertaken so that we misstatement in the financial statements or a by exception law and the Department of Health and Social might state to the Trust’s Directors those matters material misstatement of the other information. Care Group Accounting Manual 2017/18 and the Under the Code of Audit Practice we are required we are required to state to them in an auditor’s If, based on the work we have performed, we requirements of the National Health Service Act to report to you if: report and for no other purpose. To the fullest conclude that there is a material misstatement of 2006. extent permitted by law, we do not accept or this other information we are required to report • we have reported a matter in the public interest In our opinion the financial statements: assume responsibility to anyone other than the that fact. under Section 24 of the Local Audit and Accountability Act 2014 in the course of, or at • give a true and fair view of the financial Trust and the Trust’s Directors, as a body, for our We have nothing to report in this regard. the conclusion of the audit; or position of the Trust as at 31 March 2018 and audit work, for this report, or for the opinions we of its expenditure and income for the year then have formed. • we have referred a matter to the Secretary ended; and Other information we are required to report of State under Section 30 of the Local Audit on by exception under the Code of Audit and Accountability Act 2014 because we had • have been properly prepared in accordance Conclusions relating to going concern Practice reason to believe that the Trust, or an officer with International Financial Reporting Standards We have nothing to report in respect of the of the Trust, was about to make, or had made, (IFRSs) as adopted by the European Union, as Under the Code of Audit Practice published following matters in relation to which the ISAs a decision which involved or would involve the interpreted and adapted by the Department by the National Audit Office on behalf of the (UK) require us to report to you where: body incurring unlawful expenditure, or was of Health and Social Care Group Accounting Comptroller and Auditor General (the Code about to take, or had begun to take a course Manual 2017/18; and • the Directors’ use of the going concern basis of of Audit Practice) we are required to consider of action which, if followed to its conclusion, accounting in the preparation of the financial whether the Annual Governance Statement does • have been prepared in accordance with the would be unlawful and likely to cause a loss or statements is not appropriate; or not comply with the guidance issued by NHS requirements of the National Health Service Act Improvement, or is misleading or inconsistent deficiency; or 2006. • the Directors have not disclosed in the financial with the information of which we are aware • we have made a written recommendation to statements any identified material uncertainties from our audit. We are not required to consider the Trust under Section 24 of the Local Audit that may cast significant doubt about the whether the Annual Governance Statement and Accountability Act 2014 in the course of, Basis for opinion Trust’s ability, to continue to adopt the going addresses all risks and controls or that risks are or at the conclusion of the audit. We conducted our audit in accordance with concern basis of accounting for a period of at satisfactorily addressed by internal controls. least twelve months from the date when the We have nothing to report in respect of the International Standards on Auditing (UK) (ISAs We have nothing to report in this regard. (UK)) and applicable law. Our responsibilities financial statements are authorised for issue. above matters. under those standards are further described in the Auditor’s responsibilities for the audit of the

100 Independent Auditor’s Report 101 Responsibilities of the Directors and Those Report on other legal and regulatory by the Comptroller and Auditor General in Report on other legal and regulatory Charged with Governance for the financial requirements – Conclusion on the Trust’s November 2017, as to whether in all significant requirements – Certificate statements arrangements for securing economy, respects, the Trust had proper arrangements We certify that we have completed the audit efficiency and effectiveness in its use of to ensure it took properly informed decisions As explained more fully in the Statement of of the financial statements of Cambridgeshire resources and deployed resources to achieve planned and Director’s Responsibilities set out on page 71, Community Services NHS Trust in accordance sustainable outcomes for taxpayers and local the Directors are responsible for the preparation Matter on which we are required to with the requirements of the Local Audit and people. The Comptroller and Auditor General of the financial statements in the form and on report by exception - Trust’s arrangements Accountability Act 2014 and the Code of Audit determined this criterion as that necessary for the basis set out in the Accounts Directions, for for securing economy, efficiency and Practice. us to consider under the Code of Audit Practice, being satisfied that they give a true and fair view, effectiveness in its use of resources in satisfying ourselves whether the Trust put in and for such internal control as the Directors Under the Code of Audit Practice we are required place proper arrangements for securing economy, determine is necessary to enable the preparation to report to you if, in our opinion we have not efficiency and effectiveness in its use of resources of financial statements that are free from material been able to satisfy ourselves that the Trust for the year ended 31 March 2018, and to report misstatement, whether due to fraud or error. has made proper arrangements for securing by exception where we are not satisfied. Ciaran McLaughlin In preparing the financial statements, the economy, efficiency and effectiveness in its use of Director We planned our work in accordance with Directors are responsible for assessing the Trust’s resources for the year ended 31 March 2018. the Code of Audit Practice. Based on our risk for and on behalf of Grant Thornton UK LLP ability to continue as a going concern, disclosing, We have nothing to report in respect of the assessment, we undertook such work as we Grant Thornton UK LLP as applicable, matters related to going concern above matter. considered necessary to be satisfied that the 30 Finsbury Square and using the going concern basis of accounting Trust has put in place proper arrangements for London unless the Trust lacks funding for its continued securing economy, efficiency and effectiveness in EC2P 2YU existence, or when policy decisions have been Responsibilities of the Accountable Officer its use of resources. made that affect the services provided by the 29 May 2018 Trust. As explained in the Statement of the Chief Executive’s Responsibilities, as the Accountable The Audit Committee is Those Charged with Officer of the Trust, the Accountable Officer Governance. is responsible for putting in place proper arrangements for securing economy, efficiency and effectiveness in the use of the Trust’s Auditor’s responsibilities for the audit of the resources. financial statements Our objectives are to obtain reasonable assurance about whether the financial statements as a Auditor’s responsibilities for the review whole are free from material misstatement, of the Trust’s arrangements for securing whether due to fraud or error, and to issue economy, efficiency and effectiveness in its an auditor’s report that includes our opinion. use of resources Reasonable assurance is a high level of assurance, We are required under Section 21(3)(c) and but is not a guarantee that an audit conducted Schedule 13 paragraph 10(a) of the Local Audit in accordance with ISAs (UK) will always and Accountability Act 2014 to be satisfied that, detect a material misstatement when it exists. the Trust has made proper arrangements for Misstatements can arise from fraud or error and securing economy, efficiency and effectiveness are considered material if, individually or in the in its use of resources and to report where we aggregate, they could reasonably be expected to have not been able to satisfy ourselves that it influence the economic decisions of users taken has done so. We are not required to consider, on the basis of these financial statements. nor have we considered, whether all aspects of A further description of our responsibilities for the the Trust’s arrangements for securing economy, audit of the financial statements is located on the efficiency and effectiveness in its use of resources Financial Reporting Council’s website at: www. are operating effectively. frc.org.uk/auditorsresponsibilities. This description We have undertaken our review in accordance forms part of our auditor’s report. with the Code of Audit Practice, having regard to the guidance on the specified criterion issued

102 Independent Auditor’s Report 103 Annual Accounts 2017/18

Annual Accounts 106

Notes to the Accounts 110 Statement of Comprehensive Income Statement of Financial Position

2017/18 2016/17 31 March 2018 31 March 2017 NOTE £000s £000s NOTE £000s £000s

Operating income from patient care activities 3 110,348 110,650 Non-current assets Other operating income 4 6,192 5,920 Intangible assets 10 185 280 Operating expenses 5 (111,742) (112,908) Property, plant and equipment 11 51,506 50,532 Operating surplus/(deficit) from continuing operations 4,798 3,662 Total non-current assets 51,691 50,812 Current assets

PDC dividends payable (1,609) (1,564) Inventories 13 41 41 Surplus / (deficit) for the year 3,189 2,098 Trade and other receivables 14 12,767 12,158 Cash and cash equivalents 15 8,698 7,775 Total current assets 21,506 19,974 Other Comprehensive Income

Current liabilities Will not be reclassified to income and expenditure: Trade and other payables 16 (12,080) (14,352) Impairments 6 (53) - Provisions 18 (449) (443) Revaluations 12 1,542 - Other liabilities 17 (428) (674) Total comprehensive income / (expense) for the period 4,678 2,098 Total current liabilities (12,957) (15,469) We continued to receive invaluable support from hundreds of dedicated volunteers, as well as charities such as the Dreamdrops children’s charity,Total the assets Arthur Rankless current Hospice liabilitiescharity, and 60,240 55,317 the Friends of Hospital at Home in Peterborough, all of whom provided a vital role in helping The notes on pages 110 to 135 form part of this account. us improve the quality of services we provide. Without their dedication and support, our task would be even harder. Non-current liabilities

Our focus for 2015/16 is on achieving our ambitiousTrade plans andfor the other future, payables aligned to the 16 (1,045) (1,045) system-wide priorities identified by our commissionersProvisions and which are responsive to the 17 (1,803) (1,558) specific needs of the local populations we serve. Central to this is working collaboratively with our staff, GPs, social care practitioners and hospitalTotal clinicians non-current, to develop liabilities seamless (2,848) (2,603) care irrespective of organisational boundaries. Total assets employed 57,392 52,714

In line with our five year plan, we will continue to submit bids to expand the geographic area across which we provide the specialist, high quality services that now makes up our portfolio. This will enable other commissioners and populationsFINANCED to benefit fromBY: our expertise in providing these specialist services, which focus on healthPublic promotion dividend andcapital prevention of ill 2,107 2,107 health. Revaluation reserve 18,772 17,283 The Government policy prior to the May 2015 GeneralOther Election reserves was that NHS Trusts, as an 46 46 organisational form, could not continue long term. As a smaller organisation providing specialist services, we will determine during 2015 ourIncome future andorganisational expenditure form reserve in the 36,467 33,278 context of what is in the best interests of patients and our staff. Whilst we await policy guidance from the new Government on options availableTotal in taxpayers' relation to organisational equity form, 57,392 52,714 we will take forward development work to evidence our viability as a stand-alone organisation, whatever form that takes. We anticipate that this process will take approximately two years to come to fruition, during which time we will continue to operate as an NHS Trust. We will of course involve staff, commissionersThe notes and on th epages Trust Development 110 to 135 form part of this account. Authority in these deliberations.

Please enjoy reading our annual review and we look forward to a successful year in 2015/16. Chief Executive:

Matthew Winn

Date: 31 May 2018 Nicola Scrivings Matthew Winn Chairman Chief Executive

June 2015

106 Annual Accounts 2017/18 107

4

Statement of Changes in Equity for the year ended 31 March 2018 Statement of Cash Flows

Public Income and 2017/18 2016/17 dividend Revaluation Other expenditure NOTE £000s £000s capital reserve reserves reserve Total £000s £000s £000s £000s £000s Cash flows from operating activities Operating surplus / (deficit) 4,798 3,662 Taxpayers' equity at 1 April 2017 2,107 17,283 46 33,278 52,714 - brought forward Non-cash income and expense: Surplus/(deficit) for the year - - - 3,189 3,189 Depreciation and amortisation 11 2,616 2,194 Impairments - (53) - - (53) (Increase) / decrease in receivables and other assets 14 (609) 2,163 Revaluations - 1,542 - - 1,542 Increase / (decrease) in payables and other liabilties 16 (2,285) (1,339) Taxpayers' equity at 2,107 18,772 46 36,467 57,392 Increase / (decrease) in provisions 18 251 490 31 March 2018 Net cash generated from / (used in) operating activities 4,771 7,170

Statement of Changes in Equity for the year ended 31 March 2017 Cash flows from investing activities Purchase of intangible assets - (182) Public Income and Purchase of property, plant, equipment and investment (2,066) (3,528) dividend Revaluation Other expenditure property capital reserve reserves reserve Total £000s £000s £000s £000s £000s Net cash generated from / (used in) investing activities (2,066) (3,710)

Taxpayers' equity at 1 April 2016 2,107 17,283 46 31,180 50,616 Cash flows from financing activities - brought forward PDC dividend (paid) / refunded (1,782) (1,368) Surplus/(deficit) for the year - - - 2,098 2,098 Net cash generated from / (used in) financing activities (1,782) (1,368) Taxpayers' equity at 31 March 2,107 17,283 46 33,278 52,714 Increase / (decrease) in cash and cash equivalents 923 2,092 2017 Cash and cash equivalents at 1 April - brought forward 7,775 5,683 Cash and cash equivalents at 31 March 15 8,698 7,775 Information on reserves Available-for-sale investment reserve Public dividend capital This reserve comprises changes in the fair value of available-for-sale financial instruments. When Public dividend capital (PDC) is a type of public these instruments are derecognised, cumulative sector equity finance based on the excess of gains or losses previously recognised as other assets over liabilities at the time of establishment comprehensive income or expenditure are of the predecessor NHS organisation. Additional recycled to income or expenditure. PDC may also be issued to trusts by the Department of Health and Social Care. A charge, reflecting the cost of capital utilised by the trust, Other reserves - Merger reserve is payable to the Department of Health as the public dividend capital dividend. In line with Department of Health accounting instructions in the 2010-11 Manual for Accounts the net assets (£1,653,000) of the Trust’s Revaluation reserve predecessor Autonomous Provider Organisation (APO) were acquired by the Trust upon Increases in asset values arising from revaluations establishment. The transaction resulted in the are recognised in the revaluation reserve, Trust making a payment to NHS Cambridgeshire, except where, and to the extent that, they returning the reserves associated with these reverse impairments previously recognised in assets to them. This created a merger reserve in operating expenses, in which case they are the CCS NHS Trust’s 2010/11 accounts. recognised in operating income. Subsequent downward movements in asset valuations are charged to the revaluation reserve to the extent Income and expenditure reserve that a previous gain was recognised unless the downward movement represents a clear The balance of this reserve is the accumulated consumption of economic benefit or a reduction surpluses and deficits of the trust. in service potential.

108 Annual Accounts 2017/18 109 have exercised judgement in calculating an The value of the benefit received when accessing estimate for the costs and do not expect that funds from the the Government’s apprenticeship Notes to the to differ significantly to those finally incurred on service is recognised as income at the point payment. The liabilities will be settled during the of receipt of the training service. Where these normal course of the Trust’s business. funds are paid directly to an accredited training provider, the corresponding notional expense is Accounts also recognised at the point of recognition for the Asset lives, impairment and depreciation benefit. methodology 1.2 Critical judgements in applying In line with IAS 16, Property, Plant and 1. Accounting policies and 1.4 Expenditure on employee benefits other information accounting policies Equipment (PPE), the Trust depreciates its Non The need for the application of management Current PPE in line with the assets’ useful Short-term employee benefits 1.1 Basis of preparation economic lives. The Trust’s management team judgement within the Trust’s accounts is limited Salaries, wages and employment-related believe that the economic benefits associated The Department of Health and Social Care has by the nature of its transactions. 63% of the payments such as social security costs and the with such assets are broadly consumed on a directed that the financial statements of the trust Trust’s expenditure is in relation to staff costs that apprenticeship levy are recognised in the period straight line basis in line with the useful economic shall meet the accounting requirements of the are paid in the month the costs are incurred. in which the service is received from employees. lives contained within note 11.3. Department of Health and Social Care Group The cost of annual leave entitlement earned but Accounting Manual (GAM), which shall be agreed not taken by employees at the end of the period with HM Treasury. Consequently, the following 1.2.1 Sources of estimation uncertainty is recognised in the financial statements to the 1.3 Income financial statements have been prepared in There are a number of areas in which extent that employees are permitted to carry- accordance with the GAM 2017/18 issued by management have exercised judgement in Income in respect of services provided is forward leave into the following period. the Department of Health and Social Care. The order to estimate Trust liabilities. Management recognised when, and to the extent that, accounting policies contained in the GAM follow do not consider that any of these constitute a performance occurs and is measured at the fair International Financial Reporting Standards to the material risk to the financial statements of the value of the consideration receivable. The main Pension costs extent that they are meaningful and appropriate source of income for the trust is contracts with Trust, however more information on these risks is NHS Pension Scheme to the NHS, as determined by HM Treasury, detailed below. commissioners in respect of health care services. which is advised by the Financial Reporting Past and present employees are covered by the Where income is received for a specific activity Advisory Board. Where the GAM permits a choice provisions of the NHS Pension Scheme. The which is to be delivered in a subsequent financial of accounting policy, the accounting policy that scheme is an unfunded, defined benefit scheme The Trust’s provision for the impairment of year, that income is deferred. is judged to be most appropriate to the particular receivables that covers NHS employers, general practices circumstances of the trust for the purpose of The NHS trust receives income under the NHS and other bodies, allowed under the direction giving a true and fair view has been selected. The There are a number of long standing debts owed Injury Cost Recovery Scheme, designed to of Secretary of State, in England and Wales. The particular policies adopted are described below. to the Trust from non NHS bodies. Management reclaim the cost of treating injured individuals scheme is not designed in a way that would These have been applied consistently in dealing have reviewed all debts past their due date and to whom personal injury compensation has enable employers to identify their share of the with items considered material in relation to formed a judgement on each one’s recoverability. subsequently been paid e.g. by an insurer. The underlying scheme assets and liabilities. There, accounts. This provision represents the sum of all those NHS trust recognises the income when it receives the schemes are accounted for as though they debts that management consider to be at notification from the Department of Work and are defined contribution schemes. significant risk. Resolution on these outstanding Pension’s Compensation Recovery Unit that the Employer’s pension cost contributions are 1.1.1 Accounting convention debts is expected within the next financial year. individual has lodged a compensation claim. The charged to operating expenses as and when they income is measured at the agreed tariff for the These accounts have been prepared under the become due. historical cost convention modified to account for treatments provided to the injured individual, less Accruals and provisions Additional pension liabilities arising from early the revaluation of property, plant and equipment, a provision for unsuccessful compensation claims retirements are not funded by the scheme except intangible assets, inventories and certain financial In line with the framework set out by and doubtful debts. where the retirement is due to ill-health. The full assets and financial liabilities. International Financial Reporting Standards, the Trust has made expenditure accruals and amount of the liability for the additional costs provisions for transactions (and other events) that Revenue grants and other contributions to is charged to the operating expenses at the 1.1.2 Going concern relate to 2016/17 irrespective of whether cash or expenditure time the trust commits itself to the retirement, its equivalent has been paid. regardless of the method of payment. These accounts have been prepared on a going Government grants are grants from government concern basis and the Trust has no material In some cases, this has resulted in estimates being bodies other than income from commissioners or uncertainties that would affectr this assessment. made by management for transactions or events trusts for the provision of services. Where a grant that have already occurred but whose costs are is used to fund revenue expenditure it is taken not known exactly. In such cases management to the Statement of Comprehensive Income to match that expenditure.

110 Annual Accounts 2017/18 111 1.5 Expenditure on other goods and services Land and buildings used for the Trust’s services Depreciation that, the circumstances that gave rise to the or for administrative purposes are stated in the loss is reversed. Reversals are recognised in Expenditure on goods and services is recognised Freehold land, assets under construction or statement of financial position at their revalued operating expenditure to the extent that the when, and to the extent that they have been development, and assets held for sale are not amounts, being the current value in existing use asset is restored to the carrying amount it would received, and is measured at the fair value depreciated/amortised. at the date of revaluation less any impairment. have had if the impairment had never been of those goods and services. Expenditure is Otherwise, depreciation or amortisation is recognised. Any remaining reversal is recognised recognised in operating expenses except where it Revaluations of property, plant and equipment charged to write off the costs or valuation of in the revaluation reserve. Where, at the time results in the creation of a non-current asset such are performed with sufficient regularity to ensure property, plant and equipment and intangible of the original impairment, a transfer was made as property, plant and equipment. that carrying amounts are not materially different non-current assets, less any residual value, on a from the revaluation reserve to the income and from those that would be determined at the straight line basis over their estimated useful lives. expenditure reserve, an amount is transferred end of the reporting period. Current values in The estimated useful life of an asset is the period back to the revaluation reserve when the 1.6 Property, plant and equipment existing use are determined as follows: over which the NHS trust expects to obtain impairment reversal is recognised. 1.6.1 Recognition • Land and non-specialised buildings – market economic benefits or service potential from the Other impairments are treated as revaluation value for existing use. asset. This is specific to the NHS trust and may Property, plant and equipment is capitalised losses. Reversals of ‘other impairments’ are be shorter than the physical life of the asset where: • Specialised buildings – depreciated replacement treated as revaluation gains. itself. Estimated useful lives and residual values cost, modern equivalent asset basis. • it is held for use in delivering services or for are reviewed each year end, with the effect of administrative purposes HM Treasury has adopted a standard approach any changes recognised on a prospective basis. 1.6.3 Useful economic lives of property, to depreciated replacement cost valuations based Assets held under finance leases are depreciated • it is probable that future economic benefits will plant and equipment flow to, or service potential be provided to, the on modern equivalent assets and, where it would over the shorter of the lease term and the trust meet the location requirements of the service estimated useful lives. Useful economic lives reflect the total life of an being provided, an alternative site can be valued. asset and not the remaining life of an asset. The

• it is expected to be used for more than one range of useful economic lives are shown in the IT equipment, transport equipment, furniture and financial year Revaluation gains and losses table below: fittings, and plant and machinery that are held • the cost of the item can be measured reliably for operational use are valued at depreciated Revaluation gains are recognised in the • the item has cost of at least £5,000, or historic cost as this is not considered to be revaluation reserve, except where, and to the Min life Max life materially different from current value in existing extent that, they reverse a revaluation decrease Years Years • collectively, a number of items have a cost of at use. that has previously been recognised in operating least £5,000 and individually have cost of more expenses, in which case they are recognised in Land - - than £250, where the assets are functionally An increase arising on revaluation is taken to operating income. Buildings, excluding dwellings 25 25 interdependent, had broadly simultaneous the revaluation reserve except when it reverses Dwellings - - purchase dates, are anticipated to have similar an impairment for the same asset previously Revaluation losses are charged to the revaluation disposal dates and are under single managerial recognised in expenditure, in which case it is reserve to the extent that there is an available Plant & machinery 5 10 control. credited to expenditure to the extent of the balance for the asset concerned, and thereafter Transport equipment - - decrease previously charged there. A revaluation are charged to operating expenses. Information technology 5 5 Where a large asset, for example a building, decrease that does not result from a loss of Furniture & fittings 5 10 Gains and losses recognised in the revaluation includes a number of components with economic value or service potential is recognised reserve are reported in the Statement of significantly different asset lives, eg, plant and as an impairment charged to the revaluation Comprehensive Income as an item of ‘other Finance-leased assets (including land) are equipment, then these components are treated reserve to the extent that there is a balance comprehensive income’. depreciated over the shorter of the useful as separate assets and depreciated over their own on the reserve for the asset and, thereafter, economic life or the lease term, unless the useful economic lives. to expenditure. Impairment losses that arise trust expects to acquire the asset at the end from a clear consumption of economic benefit Impairments of the lease term in which case the assets are should be taken to expenditure. Gains and losses 1.6.2 Measurement depreciated in the same manner as owned recognised in the revaluation reserve are reported In accordance with the GAM, impairments that assets above. Valuation as other comprehensive income in the Statement arise from a clear consumption of economic of Comprehensive Income. benefits or of service potential in the asset are All property, plant and equipment are measured charged to operating expenses. A compensating 1.7 Inventories initially at cost, representing the cost directly transfer is made from the revaluation reserve attributable to acquiring or constructing the asset Subsequent expenditure to the income and expenditure reserve of an Inventories are valued at the lower of cost and and bringing it to the location and condition amount equal to the lower of (i) the impairment net realisable value. Where subsequent expenditure enhances an necessary for it to be capable of operating in the charged to operating expenses; and (ii) the asset beyond its original specification, the manner intended by management. Assets that balance in the revaluation reserve attributable to directly attributable cost is capitalised. Where are held for their service potential and are in that asset before the impairment. use are measured subsequently at their current subsequent expenditure restores the asset to value in existing use. All assets are measured its original specification, the expenditure is An impairment that arises from a clear subsequently at valuation. capitalised and any existing carrying value of consumption of economic benefit or of service the item replaced is written-out and charged to potential is reversed when, and to the extent operating expenses. 112 Annual Accounts 2017/18 113 1.8 Cash and cash equivalents amount of the asset is reduced directly/through a Contingent rentals are recognised as an expense membership contributions, and any “excesses” provision for impairment of receivables. in the period in which they are incurred. payable in respect of particular claims are charged Cash is cash in hand and deposits with any to operating expenses when the liability arises. financial institution repayable without penalty If, in a subsequent period, the amount of the on notice of not more than 24 hours. Cash impairment loss decreases and the decrease can Leases of land and buildings equivalents are investments that mature in 3 be related objectively to an event occurring after 1.12 Public dividend capital months or less from the date of acquisition and the impairment was recognised, the previously Where a lease is for land and buildings, the that are readily convertible to known amounts of recognised impairment loss is reversed through land component is separated from the building Public dividend capital (PDC) is a type of public cash with insignificant risk of change in value. expenditure to the extent that the carrying component and the classification for each is sector equity finance based on the excess of amount of the receivable at the date of the assessed separately. assets over liabilities at the time of establishment impairment is reversed does not exceed what of the predecessor NHS organisation. HM 1.9 Financial instruments and financial the amortised cost would have been had the Treasury has determined that PDC is not a liabilities impairment not been recognised. 1.10.2 The trust as lessor financial instrument within the meaning of IAS 32. Financial assets are recognised when the NHS Operating leases trust becomes party to the financial instrument At any time, the Secretary of State can issue new Financial liabilities Rental income from operating leases is recognised contract or, in the case of trade receivables, on a straight-line basis over the term of the PDC to, and require repayments of PDC from, the when the goods or services have been delivered. Financial liabilities are recognised on the lease. Initial direct costs incurred in negotiating trust. PDC is recorded at the value received. Financial assets are derecognised when the statement of financial position when the NHS and arranging an operating lease are added to A charge, reflecting the cost of capital utilised contractual rights have expired or the asset has trust becomes party to the contractual provisions the carrying amount of the leased asset and by the trust, is payable as public dividend capital been transferred. of the financial instrument or, in the case of trade recognised as an expense on a straight-line basis dividend. The charge is calculated at the rate payables, when the goods or services have been Financial assets are initially recognised at fair over the lease term. set by HM Treasury (currently 3.5%) on the received. Financial liabilities are de-recognised value. average relevant net assets of the trust during the when the liability has been discharged, that is, financial year. Relevant net assets are calculated All of the Trust’s financial assets fall into the loans the liability has been paid or has expired. All of 1.11 Provisions as the value of all assets less the value of all and recievables category, as defined by IAS 39. the Trust’s financial liabilities fall into the category The trust recognises a provision where it has liabilities, except for The classification depends on the nature and of other financial liabilities as defined by IAS 39. purpose of the financial assets and is determined a present legal or constructive obligation of (i) donated assets (including lottery funded at the time of initial recognition. uncertain timing or amount; for which it is assets), Other financial liabilities probable that there will be a future outflow of cash or other resources; and a reliable estimate (ii) average daily cash balances held with the After initial recognition, all other financial Government Banking Services (GBS) and National Loans and receivables can be made of the amount. The amount liabilities are measured at amortised cost using recognised in the Statement of Financial Position Loans Fund (NLF) deposits, excluding cash Loans and receivables are non-derivative financial the effective interest method, except for loans is the best estimate of the resources required to balances held in GBS accounts that relate to a assets with fixed or determinable payments which from Department of Health, which are carried settle the obligation. short-term working capital facility, and are not quoted in an active market. After initial at historic cost. The effective interest rate is the (iii) any PDC dividend balance receivable or recognition, they are measured at amortised rate that exactly discounts estimated future cash payable. cost using the effective interest method, less payments through the life of the asset, to the net Clinical negligence costs any impairment. Interest is recognised using the carrying amount of the financial liability. Interest In accordance with the requirements laid down NHS Resolution operates a risk pooling effective interest method. is recognised using the effective interest method. by the Department of Health and Social Care scheme under which the trust pays an annual (as the issuer of PDC), the dividend for the year At the end of the reporting period, the NHS contribution to NHS Resolution, which, in return, is calculated on the actual average relevant net trust assesses whether any financial assets, other 1.10 Leases settles all clinical negligence claims. Although assets as set out in the “pre-audit” version of the than those held at ‘fair value through profit and NHS Resolution is administratively responsible annual accounts. The dividend thus calculated loss’ are impaired. Financial assets are impaired Leases are classified as finance leases when for all clinical negligence cases, the legal liability is not revised should any adjustment to net and impairment losses recognised if there is substantially all the risks and rewards of remains with the trust. The total value of clinical assets occur as a result the audit of the annual objective evidence of impairment as a result of ownership are transferred to the lessee. All other negligence provisions carried by NHS resolution accounts. one or more events that occurred after the initial leases are classified as operating leases. on behalf of the trust is disclosed at note 18.2 recognition of the asset and that have an impact but is not recognised in the trust’s accounts. on the estimated future cash flows of the asset. 1.13 Value added tax 1.10.1 The trust as lessee For financial assets carried at amortised cost, Most of the activities of the trust are outside the amount of the impairment loss is measured Operating leases Non-clinical risk pooling the scope of VAT and, in general, output tax as the difference between the asset’s carrying Operating lease payments are recognised as an The trust participates in the Property Expenses does not apply and input tax on purchases is not amount and the present value of the revised expense on a straight-line basis over the lease Scheme and the Liabilities to Third Parties recoverable. Irrecoverable VAT is charged to the future cash flows discounted at the asset’s term. Lease incentives are recognised initially as a Scheme. Both are risk pooling schemes under relevant expenditure category or included in the original effective interest rate. The loss is liability and subsequently as a reduction of rentals which the trust pays an annual contribution to capitalised purchase cost of fixed assets. Where recognised in expenditure and the carrying on a straight-line basis over the lease term. NHS Resolution and in return receives assistance output tax is charged or input VAT is recoverable, with the costs of claims arising. The annual the amounts are stated net of VAT.

114 Annual Accounts 2017/18 115 1.14 Losses and special payments 1.16 Standards, amendments and 2. Operating Segments community nursing, therapy and hospital based interpretations in issue but not yet effective services for both Adults and Children throughout Losses and special payments are items that or adopted Luton, Children’s and Young Peoples Services Parliament would not have contemplated when IFRS 8 requires income and expenditure to be (including Health Visiting, School Nursing and it agreed funds for the health service or passed The HM Treasury FReM does not require the broken down into the operating segments Speech Therapies services within Cambridgeshire) legislation. By their nature they are items that following Standards and Interpretations to be reported to the Chief Operating Decision and Other Services which includes Corporate ideally should not arise. They are therefore applied in 2017-18. These standards are still Maker. The Trust considers the Board to be the Costs, Contracted income and other indirect subject to special control procedures compared subject to HM Treasury FReM interpretation, with Chief Operating Decision Maker because it is costs. The Trust’s operating segments reflect with the generality of payments. They are divided IFRS 9 and IFRS 15 being for implementation in responsible for approving its budget and hence the services that it provides across Bedfordshire, into different categories, which govern the way 2018-19, and the government implementation responsible for allocating resources to operating Cambridgeshire, Luton, Suffolk and Norfolk. that individual cases are handled. Losses and date for IFRS 16 still subject to HM Treasury segments and assessing their performance. Expenditure is reported to the Board on a regular special payments are charged to the relevant consideration. The Trust has four Divisions, Ambulatory basis by Division. functional headings in expenditure on an accruals Care Services, providing a diverse range of • IFRS 9 Financial Instruments – Application basis, including losses which would have been primary care services including sexual health, required for accounting periods beginning on The Statement of Financial Position is reported to made good through insurance cover had the trust musculoskeletal services, Dental and outpatients, or after 1 January 2018, but not yet adopted the Board on a Trust wide basis only. not been bearing their own risks (with insurance Luton Community Unit, providing a range of by the FReM: early adoption is not therefore premiums then being included as normal revenue permitted expenditure). Income Pay Non-Pay Net Total • IFRS 15 Revenue from Contracts with 2017/18 £’000 £’000 £’000 £’000 However the losses and special payments Customers - Application required for note is compiled directly from the losses and accounting periods beginning on or after 1 Division Level compensations register which reports on an January 2018, but not yet adopted by the accrual basis with the exception of provisions for Ambulatory Care Services 1,760 (17,149) (10,741) (26,130) FReM: early adoption is not therefore permitted future losses. Childrens & Younger Peoples Services 2,406 (30,054) (4,717) (32,365) • IFRS 16 Leases – Application required for Luton Community Unit 509 (17,083) (2,817) (19,391) accounting periods beginning on or after Other Services 111,866 (6,855) (23,937) 81,074 1.15 Early adoption of standards, 1 January 2019, but not yet adopted by amendments and interpretations the FReM: early adoption is not therefore CCS Total 2017/18 116,541 (71,141) (42,211) 3,189 permitted. No new accounting standards or revisions to existing standards have been early adopted in Income Pay Non-Pay Net Total 2017/18. 2016/17 £’000 £’000 £’000 £’000

Division Level Ambulatory Care Services 1,799 (19,162) (11,566) (28,928) Childrens & Younger Peoples Services 2,802 (30,774) (5,034) (33,007) Luton Community Unit 519 (17,499) (2,558) (19,539) Other Services 111,450 (5,920) (21,958) 83,572 CCS Total 2016/17 116,570 (73,355) (41,116) 2,098

2017-18 2016-17 £000 £000

Revenue from patient care activities 110,348 110,650 Other operating revenue 6,192 5,920 Operating expenses (111,742) (112,908) Operating surplus 4,798 3,662

Public dividend capital dividends payable (1,609) (1,564) Retained Surplus for the financial year 3,189 2,098

116 Annual Accounts 2017/18 117 3. Operating income from patient care activities 5. 5.1 Operating Expenditure 2017/18 2016/17 3.1 Income from patient care activities (by nature) £000s £000s 2017/18 2016/17 £000s £000s Community services Purchase of healthcare from NHS and DHSC bodies 6,585 7,808 Community services income from CCGs and NHS England 48,716 47,619 Purchase of healthcare from non-NHS and non-DHSC bodies 2,853 2,466 Income from other sources (e.g. local authorities) 55,636 57,550 Staff and executive directors costs 71,091 73,306 All services Remuneration of non-executive directors 57 50 Private patient income 139 177 Supplies and services - clinical (excluding drugs costs) 2,233 2,440 Other clinical income 5,857 5,304 Supplies and services - general 4,154 3,990 Total income from activities 110,348 110,650 Drug costs (drugs inventory consumed and purchase 6,247 4,154 of non-inventory drugs) Consultancy costs 184 143 2017/18 2016/17 3.2 Income from patient care activities (by source) £000s £000s Establishment 1,824 2,019 Premises 6,089 6,697 Income from patient care activities received from: Transport (including patient travel) 1,973 1,813 Depreciation on property, plant and equipment 2,521 2,134 NHS England 10,001 7,797 Amortisation on intangible assets 95 60 Clinical commissioning groups 38,715 39,822 Increase/(decrease) in provision for impairment of receivables 169 101 Department of Health and Social Care 81 8 Increase/(decrease) in other provisions 97 - Other NHS providers 3,369 3,173 Change in provisions discount rate(s) 154 - NHS other 2,805 1,770 Audit fees payable to the external auditor Local authorities 49,381 52,599 audit services- statutory audit 48 78 Non-NHS: private patients 139 177 Internal audit costs 66 62 NHS injury scheme 2 13 Clinical negligence 373 321 Non NHS: other 5,855 5,291 Research and development - 4 Total income from activities 110,348 110,650 Education and training 815 804 Of which: Rentals under operating leases 3,320 2,904 Related to continuing operations 110,348 110,650 Redundancy 49 - Other 745 1,554 Total 111,742 112,908 4. Other operating income Of which: Related to continuing operations 111,742 112,908 2017/18 2016/17 £000s £000s 5.2 Limitation on auditor’s liability Education and training 159 137 There is no limitation on auditor’s liability for Charitable and other contributions to expenditure 44 51 external audit work carried out for the financial Sustainability and transformation fund income 2,252 1,586 years 2017/18 or 2016/17. Rental revenue from operating leases 2,998 3,547 Income in respect of staff costs where accounted on gross basis 80 121 6. Impairment of assets Other income 659 478 Total other operating income 6,192 5,920 2017/18 2016/17 £000s £000s Of which: Related to continuing operations 6,192 5,920 Total net impairments charged to operating surplus / deficit - - Impairments charged to the revaluation reserve 53 - Total net impairments 53 -

118 Annual Accounts 2017/18 119 7. Employee benefits 9. Operating leases

2017/18 Total 2016/17 Total 9.1 Cambridgeshire Community Services NHS Trust as a lessor £000s £000s This note discloses income generated in operating lease agreements where Cambridgeshire Community Services NHS Trust is the lessor. Salaries and wages 54,887 56,766

Social security costs 5,342 5,394 2017/18 2016/17 Apprenticeship levy 265 - £000s £000s Employer's contributions to NHS pensions 7,249 7,373 Termination benefits - 88 Operating lease revenue Temporary staff (including agency) 3,397 3,685 Minimum lease receipts 2,998 3,547 Total staff costs 71,140 73,306 Total 2,998 3,547

31 March 2018 31 March 2017 Note 7.1 Retirements due to ill-health a) Accounting valuation £000s £000s During 2017/18 there were 4 early retirements A valuation of scheme liability is carried out from the trust agreed on the grounds of ill- annually by the scheme actuary (currently the Future minimum lease receipts due: health (1 in the year ended 31 March 2017). The Government Actuary’s Department) as at the - not later than one year; 2,973 3,140 estimated additional pension liabilities of these ill- end of the reporting period. This utilises an - later than one year and not later than five years; 1,906 4,017 health retirements is ££249k (£225k in 2016/17). actuarial assessment for the previous accounting - later than five years. 107 147 period in conjunction with updated membership The cost of these ill-health retirements will be Total 4,986 7,304 and financial data for the current reporting borne by the NHS Business Services Authority - period, and is accepted as providing suitably Pensions Division. robust figures for financial reporting purposes. The valuation of the scheme liability as at 31 9.2 Cambridgeshire Community Services NHS Trust as a lessee 8. Pension costs March 2018, is based on valuation data as 31 March 2017, updated to 31 March 2018 with This note discloses costs and commitments incurred in operating lease Past and present employees are covered by the summary global member and accounting data. arrangements where Cambridgeshire Community Services NHS Trust is the lessee. provisions of the two NHS Pension Schemes. In undertaking this actuarial assessment, the methodology prescribed in IAS 19, relevant FReM Details of the benefits payable and rules of the 2017/18 2016/17 Schemes can be found on the NHS Pensions interpretations, and the discount rate prescribed £000s £000s website at www.nhsbsa.nhs.uk/pensions. Both by HM Treasury have also been used. are unfunded defined benefit schemes that The latest assessment of the liabilities of the Operating lease expense cover NHS employers, GP practices and other scheme is contained in the report of the scheme Minimum lease payments 3,320 2,904 bodies, allowed under the direction of the actuary, which forms part of the annual NHS Total 3,320 2,904 Secretary of State in England and Wales. They Pension Scheme Accounts. These accounts can are not designed to be run in a way that would be viewed on the NHS Pensions website and are enable NHS bodies to identify their share of published annually. Copies can also be obtained 31 March 2018 31 March 2017 £000s £000s the underlying scheme assets and liabilities. from The Stationery Office. Therefore, each scheme is accounted for as if it b) Full actuarial (funding) valuation were a defined contribution scheme: the cost to Future minimum lease payments due: the NHS body of participating in each scheme is The purpose of this valuation is to assess the level - not later than one year; 3,082 2,904 taken as equal to the contributions payable to of liability in respect of the benefits due under the - later than one year and not later than five years; 8,501 9,175 that scheme for the accounting period. schemes (taking into account recent demographic - later than five years. 5,962 6,820 experience), and to recommend contribution rates In order that the defined benefit obligations Total 17,545 18,899 payable by employees and employers. recognised in the financial statements do not differ materially from those that would be The last published actuarial valuation undertaken determined at the reporting date by a formal for the NHS Pension Scheme was completed for actuarial valuation, the FReM requires that the year ending 31 March 2012. The Scheme “the period between formal valuations shall be Regulations allow for the level of contribution four years, with approximate assessments in rates to be changed by the Secretary of State intervening years”. An outline of these follows: for Health, with the consent of HM Treasury, and consideration of the advice of the

Scheme Actuary and employee and employer

representatives as deemed appropriate. 120 Annual Accounts 2017/18 121 10. 11. 10.1 Intangible assets - 2017/18 11.1 Property, plant and equipment - 2017/18

Software Development Buildings licences expenditure Total excluding Plant & Transport Information Furniture £000s £000s £000s Land dwellings machinery equipment technology & fittings Total £000’s £000’s £000’s £000’s £000’s £000’s £000’s Valuation / gross cost at 1 April 2017 - brought forward 211 245 456 Gross cost at 31 March 2018 211 245 456 Valuation/gross cost at 1 April 2017 - Amortisation at 1 April 2017 - brought forward 40 136 176 brought forward 11,709 42,884 1,239 1 1,581 531 57,945 Provided during the year 46 49 95 Additions - 1,490 154 - 97 265 2,006 Impairments Amortisation at 31 March 2018 86 185 271 - (53) - - - - (53) Revaluations - 1,542 - - - - 1,542 Valuation/gross cost Net book value at 31 March 2018 125 60 185 at 31 March 2018 11,709 45,863 1,393 1 1,678 796 61,440 Net book value at 1 April 2017 171 109 280

Accumulated depreciation at 1 April 2017 - brought forward - 5,946 783 - 552 132 7,413 10.2 Intangible assets - 2016/17 Provided during the year - 2,012 101 - 336 72 2,521 Accumulated depreciation at Software Development 31 March 2018 - 7,958 884 - 888 204 9,934 licences expenditure Total £000s £000s £000s Net book value at 31 March 2018 11,709 37,905 509 1 790 592 51,506 Valuation / gross cost at 1 April 2016 - as previously stated 29 245 274 Net book value at Valuation / gross cost at 1 April 2016 - restated 29 245 274 1 April 2017 11,709 36,938 456 1 1,029 399 50,532 Additions 182 - 182 Valuation / gross cost at 31 March 2017 211 245 456 11.2 Property, plant and equipment - 2016/17

Buildings Amortisation at 1 April 2016 - as previously stated 29 87 116 excluding Plant & Transport Information Furniture Amortisation at 1 April 2016 - restated 29 87 116 Land dwellings machinery equipment technology & fittings Total Provided during the year 11 49 60 £000’s £000’s £000’s £000’s £000’s £000’s £000’s Amortisation at 31 March 2017 40 136 176 Valuation / gross cost Net book value at 31 March 2017 171 109 280 at 1 April 2016 - as previously stated 11,709 40,176 1,239 1 798 332 54,255 Net book value at 1 April 2016 - 158 158 Additions - 2,708 - - 783 199 3,690 Valuation/gross cost at 31 March 2017 11,709 42,884 1,239 1 1,581 531 57,945

Accumulated depreciation at 1 April 2016 - as previously stated - 4,131 718 - 334 96 5,279 Provided during the year - 1,815 65 - 218 36 2,134 Accumulated depreciation at 31 March 2017 - 5,946 783 - 552 132 7,413

Net book value at 31 March 2017 11,709 36,938 456 1 1,029 399 50,532 Net book value at 1 April 2016 11,709 36,045 521 1 464 236 48,976

122 Annual Accounts 2017/18 123 11.3 Property, plant and equipment financing - 2017/18 13. Inventories

Buildings excluding Plant & Transport Information Furniture 31 March 2018 31 March 2017 Land dwellings machinery equipment technology & fittings Total £000s £000s £000’s £000’s £000’s £000’s £000’s £000’s £000’s Consumables 41 41 Total inventories 41 41 Net book value at 31 March 2018 of which: Owned - purchased 11,709 37,905 509 1 790 592 51,506 Held at fair value less costs to sell - - NBV total at 31 March 2018 11,709 37,905 509 1 790 592 51,506 Inventories recognised in expenses for the year were £0k (2016/17: £0k). Write-down of inventories recognised as expenses for the year were £0k (2016/17: £0k).

11.4 Property, plant and equipment financing - 2016/17

Buildings excluding Plant & Transport Information Furniture 14. Land dwellings machinery equipment technology & fittings Total 14.1 Trade receivables and other receivables £000’s £000’s £000’s £000’s £000’s £000’s £000’s 31 March 2018 31 March 2017 Net book value at £000s £000s 31 March 2017 Owned - purchased 11,709 36,938 456 1 1,029 399 50,532 Current NBV total at Trade receivables 11,284 8,610 31 March 2017 11,709 36,938 456 1 1,029 399 50,532 Accrued income 724 2,556 Provision for impaired receivables (606) (437) Prepayments (non-PFI) 1,200 1,288 12. Revaluations of property, a full quinquennial valuation and an interim VAT receivable 165 141 plant and equipment calculation in the third year of each quinquennial Total current trade and other receivables 12,767 12,158 cycle. In any intervening year the Trust will carry out a review of movements in appropriate In accordance with the requirements of the Of which receivables from NHS and DHSC group bodies: land and building indices and where material Group Accounting Manual 2017/18, the Trust’s Current 5,510 5,006 freehold land and buildings were valued in fluctuations occur, will engage the services of 2014/15 by external valuers Boshiers and a professional valuer to determine appropriate Company, Chartered Surveyors, in accordance adjustments to the valuations of assets to ensure 14.2 Provision for impairment of receivables with the requirements of the RICS Valuation that the book values reflect fair values. Fair values Standards and International Accounting are determined as follows: 31 March 2018 31 March 2017 Standards. In March 2018 Boshiers reviewed the The valuation of each property was on the basis £000s £000s Trust freehold operational assets valuation and of fair value, subject to the assumption that all concluded that there had been an increase in property would be sold as part of the continuing At 1 April as previously stated 437 336 value of £1.489m which has been reflected in the enterprise in occupation. Prior period adjustments - - PPE valuation. At 1 April - restated 437 336 The Valuers opinion of the market value was In March 2018 Boshiers also reviewed the asset Increase in provision 265 67 primarily derived using comparable recent market lives of the Trusts freehold operational assets and transactions on arms length terms Unused amounts reversed (96) 34 determined revised asset lives up to a maximum At 31 March 606 437 of 37 years, which will be applied from 2018/19. The depreciated replacement cost method of valuation as the specialised nature of the asset Revaluations are performed with sufficient means that there is no market transaction of The great majority of trade with NHS bodies and Local Authorities. As thes are regularity to ensure that carrying amounts are this type except as part of the enterprise in funded by Governement to buy NHS patient care services, no credit scoring of them not materially different from those that would be occupation and is subject to the prospect and is considered necesssary. determined at the Statement to Financial Position viability of the continued occupation and use. date. In practice the Trust will ensure there is

124 Annual Accounts 2017/18 125 14.3 Credit quality of financial assets 16.

31 March 2018 31 March 2017 16.1 Trade and other payables Trade and other Trade and other receivables receivables 31 March 2018 31 March 2017 £000s £000s £000s £000s

Ageing of impaired financial assets Current 0 - 30 days 21 75 Trade payables 6,113 6,184 30-60 Days 24 9 Capital payables 102 162 60-90 days 47 15 Accruals 4,776 6,453 90- 180 days 138 33 Other taxes payable 1,066 1,357 Over 180 days 376 305 PDC dividend payable 23 196 Total 606 437 Total current trade and other payables 12,080 14,352

Ageing of non-impaired financial assets past their due date Non-current 0 - 30 days 4,243 297 Other payables 1,045 1,045 30-60 Days 494 665 Total non-current trade and other payables 1,045 1,045 60-90 days 334 317

90- 180 days 781 751 Of which payables from NHS and DHSC group bodies: Over 180 days 1,922 1,767 Current 3,078 4,127 Total 7,774 3,797 Non-current - -

15. Cash and cash equivalents 16.2 Early retirements in NHS payables above movements The payables note above includes amounts in relation to early retirements as set out below: Cash and cash equivalents comprise cash at bank, in hand and cash equivalents. Cash 31 March 2018 31 March 2017 equivalents are readily convertible investments of £000s £000s known value which are subject to an insignificant risk of change in value. - to buy out the liability for early retirements over 5 years - - - number of cases involved 2017/18 2016/17 £000s £000s - outstanding pension contributions 607 618

At 1 April 7,775 5,683 Prior period adjustments - - At 1 April (restated) 7,775 5,683 17. Other liabilities Net change in year 923 2,092 31 March 2018 31 March 2017 At 31 March 8,698 7,775 £000s £000s

Broken down into: Current Cash at commercial banks and in hand 4 5 Deferred income 428 674 Cash with the Government Banking Service 8,694 7,770 Total other current liabilities 428 674 Total cash and cash equivalents as in SoCF 8,698 7,775

126 Annual Accounts 2017/18 127 18. The Trust’s treasury management operations are Improvement. Interest rates are confirmed by the carried out by the finance department, within Department of Health and Social Care (the lender) 18.1 Provisions for liabilities and charges analysis parameters defined formally within the Trust’s at the point borrowing is undertaken. standing financial instructions and policies agreed The Trust therefore has low exposure to interest Other Total by the board of directors. rate fluctuations. £000s £000s Currency risk At 1 April 2017 2,001 2,001 Credit risk Change in the discount rate 154 154 The Trust is principally a domestic organisation Because the majority of the Trust’s revenue comes Arising during the year 201 201 with the great majority of transactions, assets and liabilities being in the UK and sterling based. from contracts with other public sector bodies, Reversed unused (104) (104) The Trust has no overseas operations. The Trust the Trust has low exposure to credit risk. The At 31 March 2018 2,252 2,252 therefore has low exposure to currency rate maximum exposures as at 31 March 2018 are in Expected timing of cash flows: fluctuations. receivables from customers, as disclosed in the - not later than one year; 449 449 trade and other receivables note. - later than one year and not later than five years; 1,571 1,571 Interest rate risk - later than five years. 232 232 Total 2,252 2,252 The Trust borrows from government for capital Liquidity risk expenditure, subject to affordability as confirmed The Trust’s operating costs are incurred under by NHS Improvement. The borrowings are for Other: Dilapidations in a good condition and state of repair, which contracts with CCG’s and Local Authorities, 1 – 25 years, in line with the life of the associated which are financed from resources voted usually requires a level of reinstatement, repair or assets, and interest is charged at the National The Trust occupies a number of properties on annually by Parliament . The Trust funds its decoration. As such, it is deemed aprropriate to Loans Fund rate, fixed for the life of the loan. The short term leasehold agreements (see note capital expenditure from funds obtained within create a provision to ensure that leased properties Trust therefore has low exposure to interest rate 9.2). There are a number of lease covenants its prudential borrowing limit. The Trust is not, can be maintained and vacated in correct fluctuations. requiring that during and on expiry of the condition. Sweett UK Limited were appointed by therefore, exposed to significant liquidity risks. leases, the properties need to be maintained the Trust to advise on this. The Trust may also borrow from government for revenue financing subject to approval by NHS 18.2 Clinical negligence liabilities At 31 March 2018, £786k was included in provisions of NHS Resolution in respect of 19.2 Carrying values of financial assets clinical negligence liabilities of Cambridgeshire Community Services NHS Trust (31 March 2017: Loans and Total book £675k). receivables value £000s £000s

19. Contractual capital commitments Assets as per SoFP as at 31 March 2018 Trade and other receivables excluding non financial assets 11,275 11,275 31 March 2018 31 March 2017 £000s £000s Cash and cash equivalents at bank and in hand 8,698 8,698 Total at 31 March 2018 19,973 19,973 Property, plant and equipment 102 162 Total 102 162 Loans and Total book receivables value £000s £000s 19. Financial instruments are financed, the Trust is not exposed to the degree of financial risk faced by business entities. Note 19.1 Financial risk management Also financial instruments play a much more Assets as per SoFP as at 31 March 2017 limited role in creating or changing risk than Trade and other receivables excluding non financial assets 10,130 10,130 Financial reporting standard IFRS 7 requires would be typical of listed companies, to which disclosure of the role that financial instruments the financial reporting standards mainly apply. have had during the period in creating or Cash and cash equivalents at bank and in hand 7,775 7,775 The Trust has limited powers to borrow or invest changing the risks a body faces in undertaking Total at 31 March 2017 17,905 17,905 surplus funds and financial assets and liabilities its activities. Because of the continuing service are generated by day-to-day operational activities provider relationship that the Trust has with rather than being held to change the risks facing commissioners and the way those commissioners the Trust in undertaking its activities.

128 Annual Accounts 2017/18 129 19.3 Carrying value of financial liabilities 21. Related parties the Department, and with other entities for which the Department is regarded as the parent Other financial Total book The Department of Health is regarded as a Department. The Trust also had transactions with liabilities value related party. During the year Cambridgeshire other government bodies which are regarded as £000s £000s Community Services NHS Trust has had a related parties. These entities are: significant number of material transactions with Liabilities as per SoFP as at 31 March 2018 Trade and other payables excluding non financial liabilities 10,887 10,887 Payments Receipts Amounts Amounts Total at 31 March 2018 10,887 10,887 to from owed to due from Related Related Related Related Party Party Party Party Other financial Total book £’000 £’000 £’000 £’000 liabilities value £000s £000s Bedfordshire CCG 0 1,372 0 180 Cambridgeshire and Peterborough CCG 18 20,112 6 533 Liabilities as per SoFP as at 31 March 2017 Luton CCG 0 16,596 0 401 Trade and other payables excluding non financial liabilities 13,473 13,473 West Norfolk CCG 0 96 0 162 Total at 31 March 2017 13,473 13,473 NHS England Core 87 2,252 32 1,555 Local Area Teams - East Local Office 0 2,093 0 338 19.4 Maturity of financial liabilities Specialist Commissioning - East Commissioning Hub 0 7,908 0 810 Bedford Hospital NHS Trust 1,540 131 273 65 31 March 2018 31 March 2017 Ipswich Hospital NHS Trust 117 0 38 0 £000s £000s Norfolk Community Health and Care NHS Trust 137 0 22 0 St Helens and Knowsley Hospital Services NHS Trust 174 0 16 0 In one year or less 10,887 13,473 Cambridge University Hospitals NHS Foundation Trust 585 556 291 464 Total 10,887 13,473 Cambridgeshire and Peterborough NHS Foundation Trust 684 3,525 568 249 Essex Partnership University NHS Foundation Trust 407 1 196 2 James Paget University Hospitals NHS Foundation Trust 37 0 1 0 Luton and Dunstable University Hospital NHS Foundation Trust 100 255 54 172 20. Losses and special payments Norfolk and Norwich University Hospital NHS Foundation Trust 373 79 64 23 North West Anglia NHS Foundation Trust 5,492 1,161 1,220 137 2017/18 2016/17 Queen Elizabeth Hospital, Kings Lynn NHS Foundation Trust 281 544 84 144 Total number Total value Total number Total value West Suffolk NHS Foundation Trust 129 0 29 0 of cases of cases of cases of cases Number £000s Number £000s Bedford Unitary Authority 4 2,348 0 0 Cambridgeshire County Council 24 13,224 0 0 Losses Huntingdonshire District Council 1,348 0 0 0 Cash losses 1 1 - - Lincolnshire County Council 0 187 0 0 Total losses 1 1 - - Luton Borough Council 181 4,159 0 0 Special payments Norfolk County Council 7 22,585 0 0 Ex-gratia payments 3 1 - - Peterborough City Council 7 1,450 0 0 Total special payments 3 1 - - Suffolk County Council 136 5,047 0 0 Total losses and special payments 4 2 - - Health Education England 0 2,937 3 0 Compensation payments received - - NHS Resolution 372 4 0 0 Care Quality Commission 202 0 0 0 NHS Property Services 340 0 145 7 HM Revenue and Customs 5,607 0 1,066 0 NHS Pension Scheme 7,249 0 0 0

130 Annual Accounts 2017/18 131 The NHS Pension Scheme is a related party to the Details of directors’ and senior managers Prior Year 2016/17 Trust. remuneration are given in the Remuneration Report included in the Trust’s Annual Report. Transactions with the NHS Pension Scheme Payments Receipts Amounts Amounts comprise the employer contribution disclosed The Trust is corporate Trustee for the children’s to from owed to due from in note 8. No contributions were owed at the charity Dreamdrops and the Community Services. Related Related Related Related start or end of the financial year. The Scheme This has not been consolidated within the Trust’s Party Party Party Party is administered by the NHS Business Services accounts on the grounds of materiality, with the £’000 £’000 £’000 £’000 Authority. unaudited results for 2017/18 being £108k of income generation, revaluation gains of £35k, a Bedfordshire CCG 0 1,354 0 90 There have been transactions in the ordinary consolidated opening balance adjustment of £-6k, Cambridgeshire and Peterborough CCG 39 21,370 27 626 course of the Trust’s business with an resources expended of £116k and a closing fund organisation with which Directors of the Trust Luton CCG 137 16,522 68 96 balance of £1,039k. are connected. The Chief Executive is Chair of West Norfolk CCG 0 138 0 99

both the Cambridgeshire and Peterborough and NHS England Core 0 1,586 0 776 Bedfordshire/Luton and Milton Keynes Local Local Area Teams - East Local Office 0 2,187 0 260 Workforce Action Boards, both hosted by Health Local Area Teams - Central Midlands Local Team 0 38 0 3 Education England. The Chairman is the Chair of Specialist Commissioning - East Commissioning Hub 33 5,572 33 54 Cambridge Housing Society. The Medical Director is Trustee for East Anglia’s Childrens Hospices. Bedford Hospital NHS Trust 134 152 93 37 Hinchingbrooke Health Care NHS Trust 3,129 763 742 63 Ipswich Hospital NHS Trust 136 0 128 0 Norfolk Community Health and Care NHS Trust 329 0 24 0 Cambridge University Hospitals NHS Foundation Trust 933 459 890 382 Cambridgeshire and Peterborough NHS Foundation Trust 337 4,105 277 1,247 James Paget University Hospitals NHS Foundation Trust 169 0 18 0 Luton and Dunstable University Hospital NHS Foundation Trust 139 222 257 403 Norfolk and Norwich University Hospital NHS Foundation Trust 323 45 124 0 Peterborough and Stamford NHS Foundation Trust 2,930 78 398 0 Queen Elizabeth Hospital, Kings Lynn NHS Foundation Trust 305 554 244 554 South Essex Partnership University NHS Foundation Trust 417 (46) 28 2 West Suffolk NHS Foundation Trust 232 6 147 6 Bedford Unitary Authority 20 1,021 0 213 Cambridgeshire County Council 23 13,614 0 923 Huntingdonshire District Council 1,098 0 0 0 Peterborough City Council 153 1,535 29 138 Suffolk County Council 96 5,259 0 0 Health Education England 11 1,814 0 63 NHS Property Services 801 2 397 1 HM Revenue and Customs 5,394 0 1,357 0 NHS Pension Scheme 7,373 0 0 0

22. Events after the reporting date

On the 1st April 2018 the Trust became the provider of Childrens Community Health Services in Bedfordshire which equated to £17.65m. This included providing services to Beds CCG, Central Beds and Beds Borough Councils and Luton CCG.

132 Annual Accounts 2017/18 133 23. Better Payment Practice code 26. Breakeven duty financial performance

2017/18 2017/18 2016/17 2016/17 2017/18 Number £000s Number £000s £000s

Non-NHS Payables Adjusted financial performance surplus / (deficit) (control total basis) 3,189 Total non-NHS trade invoices paid in the year 15,747 48,044 19,667 52,564 Breakeven duty financial performance surplus / (deficit) 3,189 Total non-NHS trade invoices paid within target 14,120 45,246 17,153 48,014 Percentage of non-NHS trade invoices paid within target 89.67% 94.18% 87.22% 91.34%

NHS Payables 27. Breakeven duty rolling assessment Total NHS trade invoices paid in the year 1,283 10,652 1,446 8,559 Total NHS trade invoices paid within target 1,073 8,975 1,098 6,829 Percentage of NHS trade invoices paid within target 83.63% 84.26% 75.93% 79.79% 2010/11 £000s 2011/12 £000s 2012/13 £000s 2013/14 £000s 2014/15 £000s 2015/16 £000s 2016/17 £000s 2017/18 £000s

The Better Payment Practice code requires the NHS body to aim to pay all valid invoices by the due Breakeven duty in-year financial performance 513 681 1,632 777 766 576 2,098 3,189 date or within 30 days of receipt of valid invoice, whichever is later. Breakeven duty cumulative position 513 1,194 2,826 3,603 4,369 4,945 7,043 10,232 Operating income 102,793 158,331 161,921 157,589 160,501 110,365 116,570 116,540 Cumulative breakeven position as a percentage of operating 24. External financing income 0.50% 0.75% 1.75% 2.29% 2.72% 4.48% 6.04% 8.78%

The trust is given an external financing limit against which it is permitted to underspend: The Trust was established as an independent NHS resulting from the application of IFRS to IFRIC Trust on 1st April 2010 and can therefore only 12 schemes (which would include PFI schemes), 2017/18 2016/17 provide 7 years of historic performance. which has no cash impact and is not chargeable for overall budgeting purposes, is excluded £000s £000s Due to the introduction of International Financial when measuring Breakeven performance. Other Reporting Standards (IFRS) accounting in 2009-10, adjustments are made in respect of accounting Cash flow financing (923) (2,092) Trust’s financial performance measurement needs policy changes (impairments and the removal of External financing requirement (923) (2,092) to be aligned with the guidance issued by HM the donated asset and government grant reserves) Treasury measuring Departmental expenditure. External financing limit (EFL) - (1,292) to maintain comparability year to year. Under / (over) spend against EFL 923 800 Therefore, the incremental revenue expenditure

25. Capital Resource Limit

2017/18 2016/17 £000s £000s

Gross capital expenditure 2,006 3,872 Charge against Capital Resource Limit 2,006 3,872

Capital Resource Limit 3,000 4,144 Under / (over) spend against CRL 994 272

134 Annual Accounts 2017/18 135 Glossary

Term Definition Term Definition

ASQ™3 Assessment The ASQ-3 is an assessment tool that helps parents provide GUM Genitourinary medicine information about the developmental status of their young child across five developmental areas: communication, gross motor, fine HCW Healthcare worker motor, problem solving, and personal-social HPV Human Papilloma Virus, a vaccine for cervical cancer BASHH The British Association for Sexual Health and HIV HV SCPHN Health visitor (specialist community public health nursing) BCG Bacillus Calmette-Guérin/ TB Vaccine iCaSH integrated Contraception and Sexual Health Service C Card C-Card is a confidential, free condom distribution scheme for young people IUD Intrauterine device or coil (contraceptive)

CCG Clinical Commissioning Group IUS The IUS (intrauterine system), a hormonal contraceptive

CCS Cambridgeshire Community Services NHS Trust LAC Looked After Children and Young People

CD4 White blood cell count LARC Long Acting Reversible Contraception

CFS/ME Chronic Fatigue Syndrome Men ACWY The Men ACWY vaccine protects against four types of meningitis

CHIS Child Health Information System MMR Measles, Mumps and Rubella (German measles) vaccine

Chlamydia Sexually transmitted infection, particularly common in sexually MRSA Methicillin-Resistant Staphylococcus Aureus active teenagers and young adults MSM Men who have sex with men Clostridium Difficile Also known as C. difficile or C. diff, is a bacterium that can infect the bowel and cause diarrhoea NBBS New-born blood screening

Cover Cover of Vaccination Evaluated Rapidly, the UK childhood NBV New Birth Visit immunisation programme. NCMP National Child Measurement Programme CPD Continuing Professional Development NHSE NHS England Deduction Lists When a patient cancels their registration at a practice or medical service OT Occupational Therapy

DNA Did not attend appointment PN Discussion Post-natal

Duty of Candour The intention of this regulation is to ensure that providers are open RTT Waits Referral to Treatment Waiting Times and transparent with people who use services and other 'relevant persons' (people acting lawfully on their behalf) in general in SCPHN Specialist community public health nursing relation to care and treatment SEND Special Education Needs and Disabilities EHC Emergency Hormone Contraception SRH Sexual and Reproductive Health FNP Family Nursing Partnership STI Sexually Transmitted Infection

136 Glossary 137 If you require this information in a different format such as in large print or on audio tape, or in a different language, please contact the Trust’s communications team on 01480 308216 or email [email protected] Produced by Cambridgeshire Community Services NHS Trust www.cambscommunityservices.nhs.uk

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