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Torbay and South Devon NHS Foundation Trust Annual Report and Accounts 2018/19

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Torbay and South Devon NHS Foundation Trust Annual Report and Accounts 2018/19 Torbay and South Devon NHS Foundation Trust Annual Report and Accounts 2018/19 Torbay and South Devon NHS Foundation Trust Annual Report and Accounts 2018/19 Presented to Parliament pursuant to Schedule 7, paragraph 25 (4) (a) of the National Health Service Act 2006 ©2019 Torbay and South Devon NHS Foundation Trust Contents Foreword by the Chairman and Chief Executive 6 Part I – Performance Report 8 Part II – Accountability Report 25 Part III – Remuneration Report 44 Part IV – Staff Report 54 Part V – Governance Statements 67 Appendix A – Biographies of Members of the Foundation Trust Board of Directors 93 Appendix B – Further Information and Contact Details 99 Appendix C – Annual Accounts 2018/19 101 Appendix D – Quality Report 2018/19 165 Appendix E – Independent Auditor’s Report to the Council of Governors 249 Page 5 Foreword by the Chairman and Chief Executive Welcome to the Annual Report 2018/19 for Torbay and South Devon NHS Foundation Trust. This report summarises our achievements and challenges over the past 12 months, our ambitions for 2019/20 and describes the context in which we have operated. It also includes the Quality Account, which details our approach to quality and improvement priorities. The past 12 months have been extremely challenging for the NHS with continued financial squeeze in all sectors, coupled with growing levels of demand, culminating in increasing occupancy rates in hospitals and a steady decline in financial and operational performance. A shortage of qualified staff to fill important roles, and the impact of Brexit, has compounded this position. Despite this we have continued to focus our work to further integrate health and care services in this part of Devon, whilst also investing in our acute care pathways and collaborating with other NHS Foundation Trusts in our county through our Sustainability and Transformation Partnership. As we move in to 2019/20, the Foundation Trust has already seen the further development of integrated services with the formation of a new county-wide service for children’s and young person. This service called ‘Family Health Devon’ will see us work in partnership with Devon Partnership Trust, Royal Devon and Exeter NHS Foundation Trust and Northern Devon Healthcare NHS Trust. There still remains much to do and our financial position presents us with ongoing challenges as we move in 2019/20. We are also aware that our Devon system will need to consider how to meet the continuing pressure on performance targets and the availability of financial resources. In responding to this we recognise that our staff are our greatest resource and therefore enabling them to make the best use of their skills competence and experiences to do what is important for the people they support and care for is paramount. A commitment to the wellbeing of our staff whilst keeping our values of ‘working with you, for you’ is the golden thread underpinning our new focus, that will enable decision making and control of resources to be delegated to teams within a defined self-organising structure. At the same time, we have been working towards establishing a new operational delivery structure that will mean our model of care being delivered through five new Integrated Service Units. This is the next step in our becoming a fully integrated organisation, thanks to enhanced clinical leadership and a focus on clinical pathways aligned to each of our five localities. Maintaining quality and safety of all our services is paramount at this time of change, and will be a key focus over the coming year as this model develops and embeds. We therefore believe that we have now reached a position where a person’s care pathway from home to hospital to community hospital to home is as seamless as it has ever been. We are privileged to have a very supportive community and our local charities, including The League of Friends, have continued to raise an incredible amount of money to support patient care and made many generous donations throughout the year to the hospital and community services. 6 Finally, we would like to thank all our colleagues for the outstanding care they have provided to our local community, both in our hospitals and through community services, and to pay tribute to the people who make our ambition of providing integrated care a reality for people in our care. Thanks are also due to our Non-Executive Directors and Governors who have helped, supported and challenged constructively throughout the year. There remains much to do to achieve our goals and aspirations but we are grateful for the opportunity we have to positively affect our patients and our local community that we serve. This is an important time for us as we develop further as an integrated care organisation and we will continue to do all we can to provide the best possible health care to our local community as we continue on ‘Our Journey’. Richard Ibbotson, KBE, CB, DSC, DL Liz Davenport Chairman Chief Executive 28 May 2019 28 May 2019 7 Part I – Performance Overview of performance The purpose of this overview of performance is to provide the reader with sufficient information to understand the organisation, its purpose, main objectives, the key risks to the achievement of its objectives, and how it has performed during the year. Chief Executive’s statement on performance The performance of the Foundation Trust is monitored and overseen by the Foundation Trust Board of Directors through reviewing monthly performance reports which are provided to the Finance, Performance, and Investment Committee and the Board. These reports cover all the key national and local performance standards to provide evidence on key performance indicators for the Board to consider. Monitoring of performance during the year was delivered via four Service Delivery Units covering medicine, surgery, community and women, children, and diagnostics and therapies. Performance monitoring required Service Delivery Units to review quality and performance dashboards relevant to each of their units and to present plans where there were risks or concerns. This process provided the Foundation Trust Executive and Foundation Trust Board assurance that performance rules are understood, and remedial action plans are taken forward when necessary. Looking ahead to 2019/20, the process of performance monitoring will be delivered through the creation of a new operational management structure seeing the change from the previous service delivery units to service alignment around a locality based integrated service unit model. The process of executive review meetings for the monitoring of performance will cover each of the five Integrated Service Units (‘ISUs’). These meetings will require ISU teams to review their quality and performance dashboards and to present plans where there are risks or concerns. This process will give the Executive Team and Board, assurance against performance delivery that risks are identified early with remedial action plans taken forward where necessary. The Clinical Commissioning Groups (‘CCG’) in Devon merged with effect from 1 April 2019, and the Foundation Trust is now commissioned by Devon CCG for the significant majority of the services it delivers. The Devon STP is now coterminous with the CCG, along with 43 other STPs in England. The STP was established to enable the pooling of resources, and expertise where appropriate, so that a sustainable health and care system exists across Devon. Our Foundation Trust is one of the partners in the Devon STP. The STP has been a positive catalyst for Devon. It has helped leaders build a collaborative and system-wide approach across the NHS and local government. As a result, Devon is in a stronger position in which to further integrate services health and care services for the benefit of its population. The collective work by leaders will be vital to help tackle the financial and service performance challenges to be faced. The focus of working as part of an integrated health and care system in Devon, and as an STP, has been the driver for developing innovative new approaches, as well as some major successes shown below: o Ground-breaking collaboration: all four organisations providing acute hospital services have agreed a ‘mutual support’ approach to benefit patients. NHS 8 England have highlighted it as an “exemplar of joint working”. The first phase of Acute Services Review has developed ‘Best Care for Devon’ standards for urgent and emergency care, stroke, and maternity services, with clinical recommendations to provide services at all four of Devon’s major hospitals if these standards are met. The next phase will look at wider service collaboration and new clinical networks will support this approach. o ‘The best bed is your own bed’: We are enhancing community services to support thousands more people to live independently at home. This has led to a reduction in acute and community hospitals beds by 213 over the past two years whilst at the same time improving outcomes for people and service performance o No health without mental health: Devon has many leading and innovative mental health services. These include liaison psychiatry in each A&E to ensure people get the right help when they need it, psychological therapies for people with long-term conditions, specialist support for women with postnatal depression and a new specialist unit opening next year so women can stay near their families so they do not need to travel outside the county. o All GP Practices in Devon rated ‘Outstanding’ or ‘Good’ in the latest CQC assessment. o Innovative collaboration between the NHS and social care: an award-winning campaign, led by Devon County Council with support from the NHS, is having a positive impact on recruiting people to work in the health and care sector in Devon.
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