ANNUAL REPORT AND ACCOUNTS 2012-13 THIS PAGE IS INTENTIONALLY LEFT BLANK University Hospital of South Manchester NHS Foundation Trust Annual Report and Accounts 2012-13. Presented to Parliament pursuant to Schedule 7, Paragraph 25(4) of the National Health Service Act 2006. Contents 01 About University Hospitals of South Manchester NHS Foundation Trust Summary of 2012-13 1 02 Chairman’s statement 3 03 UHSM strategy 5 04 Quality Account 7 05 Directors’ report Business review and management commentary 67 5.1 Operational performance and service developments 75 5.2 Financial standing and outlook 80 5.3 UHSM Academy 85 5.4 Social responsibility 89 5.5 Sustainability 96 5.6 Directors; how we work together & remuneration report 100 5.7 Directors; biographical details & register of interests 112 06 Council of Governors 119 6.1 Composition of the Council of Governors 124 6.2 Membership and Membership Constituencies 128 07 Financial statements 133 7.1 Foreword to the accounts 133 7.2 Statement of the Chief Executive’s responsibilities as the Accounting Officer of University Hospital of South Manchester NHS FT 136 7.3 Annual governance statement 137 7.4 Independent External Auditor’s report 148 7.5 Financial statements 150 7.6 Notes to the accounts 155 08 Appendices Appendix 1 Explanation of Monitor risk ratings during 2012-13 Appendix 2 List of acronyms 01 About the Foundation Trust and Summary of 2012-13 The Board of Directors of the University Hospital of South Manchester NHS `Foundation Trust (UHSM) presents this, its seventh formal Annual Report, to its Members, Governors and other stakeholders. The Report describes the organisation – and the Board’s stewardship of it – from April 1, 2012 until March 31, 2013. UHSM is a major acute teaching hospital trust providing services for adults and children at Wythenshawe Hospital and Withington Community Hospital, and community services that were formerly operated by Manchester Primary Care Trust. We are recognised as a centre of clinical excellence and provide district general hospital services and specialist tertiary services to our local community. Our fields of specialist expertise - including cardiology and cardiothoracic surgery, heart and lung transplantation, respiratory conditions, burns and plastics, cancer and breast care services – not only service the people of South Manchester, but help patients from across the North West and beyond. We are also recognised in the region and nationally for the quality of our teaching, research and development. Our major research programmes focus on cancer, lung disease, wound management and medical education. UHSM has 6,400 members of staff, including those employed by our Private Finance Initiative partner South Manchester Healthcare Limited. We also have more than 500 valued volunteers, who give up their free time to help our patients and visitors. UHSM’s priority is to be a centre of health and wellbeing for patients and the local population, delivering safe, high quality care. We have a good reputation, and this is reflected in the way that more people are choosing its services than ever before. In 2012-13 the Trust treated almost 590,000 patients through the A&E department, or as inpatients or day-cases, or by needing our outpatient services. UHSM wants every patient to experience the best quality of care it can offer, and so continues to value and seek out feedback from patients on their experiences. As a self-governing Foundation Trust, the Board of Directors has ultimate responsibility for the management of UHSM but is accountable for its stewardship to the Council of Governors and Members. UHSM performance is also scrutinised by the Foundation Trust regulator, Monitor, and the Care Quality Commission (CQC). UHSM was able to report compliance with almost all of the key regulatory targets throughout 2012-13 and has maintained a strong performance. The ‘Green’ rating from regulator ‘Monitor’ slipped to Amber/Green during in quarters 3 and 4 due to failings against the Accident and Emergency 4 hour waiting target. We have maintained a clear registration with the Care Quality Commission. Meeting the NHS challenge to do more for less has been difficult to deliver. However, through a programme of transformation, UHSM has seen many improvements in many areas of the hospital and community services. For example, UHSM is pioneering 7 day a week consultant-led services and a culture of total transparency. Theatre improvement work continues and is seeing more patients treated on the same day, helping to avoid unsettling and costly overnight stays. Improvements to elective and emergency pathways are seeing the time patients have to spend Page | 1 with us reduced, helping them home earlier, which is where the vast majority tell us they would rather be. UHSM has continued to push forward its ‘Green Hospital’ agenda. We were acknowledged again as Britain’s Greenest Hospital. We continue to reduce our carbon footprint by radical carbon reduction management and staff sustainability programme. The relentless fight against infection continues. We have had only one case of hospital acquired MRSA during the year against a regulatory target of no more than three. We also reduced the incidence of C. difficile infection to 46, against a target of no more than 49. As a teaching hospital with strong affiliations to the University of Manchester we are proud to report that this year we recruited large numbers of patients into research studies and clinical trials again. UHSM is recognised as a centre of excellence for multidisciplinary research and development, and is proud to be a founding member of MAHSC (Manchester Academic Health Science Centre). More than 80 per cent of the staff who work at UHSM live in the immediate community we serve, and so building ever stronger links with the community continues to be a priority. The annual Open Day, held in September again attracted more than 2,000 visitors to the Wythenshawe Hospital site and was followed by the Annual Members’ Meeting, which attracted positive feedback and lively debate. Governors and volunteers continue to work with the Trust’s engagement team to strengthen communications with local schools and organisations to share best practice on infection prevention and sustainability. And last summer the hospital worked with others to deliver the Wythenshawe Games, which was recognised as the only community event of its kind outside the London 2012 Olympic and Paralympic Games with a priority on health and wellbeing. In the last 12 months we have made a very significant step towards our goal to promote local employment, investment and innovation by working with Manchester City Council and our neighbours at Manchester Airport to further develop our ‘MediPark’ concept. This ambitious and pioneering project for a major science and research park, will attract new investment and income to the local area. In the rest of this Report the Board of Directors explain how UHSM has performed during 2012-13 and its wider plans for the next 12 months. Page | 2 02 Chairman’s Statement 2012-13 At UHSM we believe that effective, safe, quality care requires an NHS which operates on every day of the week to the same consistently high standards. Over the past twelve months we have begun to put that belief into action. Many of our consultants and support teams have altered the way they work to provide services which are consultant-led on each day of the week. The hospital is investing in more consultants to spread this 7-day practice across the Trust. Support staff too have risen to the challenge to ensure that many diagnostic tests can be provided round the clock and that test results are delivered within hours or minutes. Supporting this change is a drive for total transparency on outcomes. Thanks to the work pioneered nationally by Dr Ben Bridgewater, a UHSM Cardiac Surgeon, we have the knowledge and technology to publish outcome data for all consultants. The process has already begun and is a priority. Web site details will include what the patients say about each individual. The past year has once again seen UHSM and many of our colleagues win major awards. Jacky Edwards, our lead nurse practitioner in Burns was selected as the National Nurse of the Year; UHSM was awarded one of the four national sites for the treatment of patients with severe respiratory symptoms using extra corporeal membrane oxygenation (ECMO); and the Trust became a Level One trauma centre. Research continues to go from strength to strength with a major breakthrough in the treatment of large, open wounds and more patients in clinical trials than in most other hospitals in the country. Education and the global health links continue to be a source of pride and inspiration with a new Uganda /UK health alliance brokered by UHSM colleagues and hosted at the Trust. Despite all the good things that have happened, there remain many challenges. There has been a significant rise in the numbers of very sick people presenting at UHSM’s A&E Department and requiring admission. We have failed our four-hour target for two consecutive quarters but changes put in place are improving performance. Infection prevention remains a core priority with a concerted effort to change antibiotic-prescribing habits. MRSA has been virtually eliminated but we still have some way to go to reduce C. difficile incidence to nil. The biggest challenge for UHSM is financial. Despite a steady increase in income, the Trust’s margins continue to erode. These are key areas for concentration over the next twelve months. Our Chief Executive of the past 4 years, Julian Hartley, has left us to set up and run the new national Health Improvement Agency for the NHS; a big accolade for him and for the Trust.