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Annual Report and Accounts 2011/12

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Annual Report and Accounts 2011/12 Annual Report and Accounts 2011/12 Bolton NHS Foundation Trust Annual Report and Accounts 2011/12 Presented to Parliament pursuant to Schedule 7, paragraph 25 (4) of the National Health Service Act 2006 Contents 1 Foreword 7 2 Directors’ Report 11 3 Remuneration report 18 4 Disclosures for NHS Foundation Trust Code of Governance 21 5 Quality Report 33 6 Staff Survey 92 7 Regulatory Ratings 96 8 Other Public Interest Disclosures 97 9 Statement of Accounting Officer’s Responsibilities 105 10 Annual Governance Statement 106 ‐ 5 ‐ Page Bolton NHS Foundation Trust Annual Report and Accounts 2011/12 ‐ 6 ‐ Page Bolton NHS Foundation Trust Annual Report and Accounts 2011/12 1 Foreword 1.1 Chairman’s Welcome The year 2011/2012 saw a considerable change to us as an organisation as in July 2011 we welcomed staff and services based in the community to our Trust. This integration has been a major undertaking, occupying a great deal of time in planning and implementation. We are now beginning to see benefits for both staff and patients as we are able to reduce “barriers” and offer more streamlined care. The hard work and innovation of our staff was recognised locally, nationally and internationally throughout the year with a string of finalists and winners in a range of awards. In particular the use of our Bolton Improving Care System (BICS) to bring increased quality at the same as reducing inefficiencies has attracted a great deal of positive attention. Our staff have demonstrated that they truly care for our patients, constantly seeking to bring improvements for them in particular by reducing mortality rates and improve their experiences of health services. On the other hand there can be no denying that we failed to meet two key targets, notably the target for admitting, discharging or transferring 95% of patients at A and E within four hours, and also the 18 week inpatient target for referral to treatment. As a result of this, and not being able to assure Monitor that our remedial actions were timely or that our Board oversight was robust enough. In April 2012 we were found in significant breach of our authorisation as a Foundation Trust. This is something the Board took and continues to take extremely seriously. We are aiming that by the time this report is presented at our annual meeting in September we will be well back on track and sustaining an improved performance. This report therefore shows the highs and lows of the very busy year we had. Finally, I would like to take the opportunity to thank our staff, Governors, Board and indeed our patients and all our partners for the support they have shown the Trust. I would particularly like to thank Roger McMullen who retired as a Non‐Executive Director at the end of March 2012 and Yaseer Ahmed who retired at the end of October 2011 for the time and attention they gave to Trust matters. Cliff Morris Chairman Bolton NHS foundation Trust ‐ 7 ‐ Bolton NHS Foundation Trust Annual Report and Accounts 2011/12 Page 1 Foreword 1.2 Chief Executive’s Welcome 2011/12 was my first full year as Chief Executive of the Trust and it was certainly a year of challenge and change. As the Chairman has observed, the most serious part came right at the end of the year when, having failed to meet important patient waiting time targets, we were unable to assure Monitor, our regulator of the Board’s timely focus on performance and Board governance and we were found to be in significant breach of our authorisation as a Foundation Trust. When we identified the likelihood of missing the targets we put into place a series of measures to strengthen both the Trust’s performance and the Board’s governance arrangements but this should have happened much sooner. Further measures, such as the appointment of KPMG to review governance have been put in place since we were found in significant breach. As is their standard practice, Monitor has kept us at a red rating until we can demonstrate that both performance and governance meet the expectations and standards of our licence to be a Foundation Trust. The Board and I are determined to do this. In April further issues arose regarding our year end accounts which also put in question the robustness of the reporting to the Board on financial issues this has significant implications to the financial stability within the organisation and at the time of writing this report we have identified a year end deficit of £1.9 million rather than forecasted surplus. Again the Board will ensure an external review and a turnaround plan is immediately put in place. Missing targets for A and E waits and for the 18 week inpatient referral to treatment are failures of important patient guarantees and lead to a poor patient experience. There are, however, other areas where the Trust did well, particularly in improving safety and quality of care. In particular in reducing mortality rates, falls and pressure sores and in infection control and, as the Chairman has said in his introduction, the high number of awards Trust staff won in the year is testament to a commitment to improve and innovate and have high calibre staff working here. I’d like to pay tribute to all our staff. They worked hard caring for high numbers of sick patients against a background of national change in the NHS and the integration of community and hospital services last summer. On top of this there were changes in organisational structure and changes in location for many. As well as integrating with our community services in a major project we welcomed staff from Salford and Bury as part of the Making It Better programme which has seen us become a major centre for maternity and children’s services. It is a credit to the staff, their team leaders and managers, and to our corporate team that at a time of such change the Trust had its best ever results in the national staff survey. The results of this and other surveys, and information on our performance can be found in the pages of this annual report. Lesley Doherty Chief Executive 31st May 2012 ‐ 8 ‐ Bolton NHS Foundation Trust Annual Report and Accounts 2011/12 Page 1 Foreword 1.3 Trust Profile Bolton NHS Foundation Trust became an integrated care organisation on 1st July 2011. We provide patient care in the community at health centres and clinics as well as services such as school nursing, district nursing and health visiting. We also provide services at the Royal Bolton Hospital. Our vision is to develop the organisation and aim to match the best integrated care organisations internationally for the quality and efficiency of our services by 2016. Our renewed focus will give us three fundamental aims:‐ • Best care for better health (for our patients and our community). • Responsible use of resources (for the taxpayer). • Valued, respected and proud (for our staff, patients and public). Our strategic direction will be to address:‐ • Meeting the health needs of our population. • Improving the safety and quality of care. • Improving the patient’s experience. • Making our services more efficient. • Serving the population of Bolton (around 263,000) and many patients choose to come here from other locations. Facts and figures • RBH is one of the busiest hospitals in the North West for emergency admissions. • RBH has 622 inpatient beds, 36 day case beds and 15 endoscopy (gastrointestinal exploration) beds. • We employ around 5,700 staff. Mental health services are provided on the Royal Bolton Hospital site but are managed by Greater Manchester West Mental Health NHS Foundation Trust. Renal dialysis is provided and managed by Salford Royal NHS Foundation Trust at a dedicated unit at the Royal Bolton Hospital. Making it Better In 2011, the Royal Bolton Hospital became a regional 'supercentre' for the care of women, children and babies with a £20 million investment in services. We have expanded and improved our facilities to create a centre of excellence in maternity, paediatric and neonatal care. Work includes an improved maternity unit, a new children's ward and a new neonatal critical care unit. We have also invested in around 400 extra members of staff to provide the very best care for our patients. ‐ 9 ‐ Bolton NHS Foundation Trust Annual Report and Accounts 2011/12 Page 1 Foreword 1.4 Achievements Our departments and staff hold a wide range of awards and achievements. These include: • Excellence in HRM Award 2011 ‐ Healthcare People Management Association. • Clinical Leader of the Year 2011 ‐ British Medical Journal Group Awards. • Nurse of the Year 2011 ‐ Nursing Standard Awards. • North West Clinical Leader of the Year ‐ NHS North West Awards. • Best Process Improvement Project in Service & Transaction 2011 ‐ National Process Excellence Awards. • Hospital Catering Award 2010 ‐ Health Business Awards. • Diamond Care Award for Best Care ‐ NHS Bolton. • Patient Safety in Surgery ‐ National Patient Safety Awards 2011. • Apprentice of the Year 2011‐ NHS North West. • Working in Partnership to Narrow the Gap in Health Inequalities ‐ Community Empowerment Awards 2011. 1.5 Quality Governance The Directors used Monitor’s Quality Governance Framework to assess its processes and gain assurance that it has and will keep in place effective arrangements for the purpose of monitoring and continually improving the quality of healthcare provided to its patients. Further details on quality can be found within the quality section (page 34) and in the Annual Governance Report (page 107) Although the Trust was found to be in significant breach of its terms of authorisation in March 2012, the Board at all times were assured with regard to the quality and safety of care provided to patients.
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