ANNUAL REPORT17 18 the Hillingdon Hospitals NHS Foundation Trust
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ANNUAL REPORT17 18 The Hillingdon Hospitals NHS Foundation Trust The Hillingdon Hospitals NHS Foundation Trust Annual Report and Accounts 2017/18 Presented to Parliament pursuant to Schedule 7, paragraph 25 (4) (a) of the National Health Service Act 2006. TABLE OF CONTENTS 6 SECTION 1 PERFORMANCE REPORT 7 1.1 OVERVIEW OF PERFORMANCE: 7 Statement from Chair & Chief Executive 11 Purpose Activities & History 12 Overview of Strategy and the Business Model 16 Key Issues 17 Key Risks 20 Going Concern Disclosure 21 Summary of Other Performance 23 1.2 PERFORMANCE ANALYSIS: 23 Approach to Measuring Performance 24 Analysis of Performance 29 Financial Performance 30 Environmental Performance 34 Community 35 Equality, Diversity and Inclusion – Patients and Service Users 36 Overseas Operations 36 Bribery 36 Modern Slavery 36 Developments since the end of the Financial Year 37 1.3 ACCOUNTING OFFICER APPROVAL OF THE PERFORMANCE REPORT 38 SECTION 2 ACCOUNTABILITY REPORT 39 2.1 DIRECTORS REPORT 66 2.2 REMUNERATION REPORT 73 2.3 STAFF REPORT 89 2.4 COMPLIANCE WITH NHS CODE OF GOVERNANCE 90 2.5 SINGLE OVERSIGHT FRAMEWORK 91 2.6 STATEMENT OF CHIEF EXECUTIVE RESPONSIBILITIES 92 2.7 ANNUAL GOVERNANCE STATEMENT 110 2.8 ACCOUNTING OFFICER APPROVAL OF THE ACCOUNTABILITY REPORT 111 SECTION 3 QUALITY REPORT 113 About the Trust’s Quality Report 114 Executive summary 118 PART 1 STATEMENT ON QUALITY FROM THE CHIEF EXECUTIVE OF THE TRUST 121 PART 2 PRIORITIES FOR IMPROVEMENT AND STATEMENTS OF ASSURANCE FROM THE BOARD 121 2.1 Looking Forward 135 2.2 Formal statements of assurance from the Board 161 2.3 Performance against Core Quality Indicators 2017/18 172 PART 3 KEY QUALITY IMPROVEMENTS WE HAVE MADE IN 2017/18 198 ANNEX 1 STATEMENTS FROM OUR STAKEHOLDERS AND INDEPENDENT AUDITOR’S REPORT TO THE COUNCIL OF GOVERNORS 212 ANNEX 2 STATEMENT OF DIRECTORS’ RESPONSIBILITIES IN RESPECT OF THE QUALITY REPORT 222 SECTION 4 STATEMENT OF DIRECTORS RESPONSIBILITIES IN RESPECT OF THE ACCOUNTS 224 SECTION 5 INDEPENDENT AUDITORS REPORT 234 SECTION 6 FOREWORD TO THE ACCOUNTS 236 SECTION 7 THE 2017-18 ACCOUNTS 6 ANNUAL REPORT AND ACCOUNTS 2017|18 1 Performance report ANNUAL REPORT AND ACCOUNTS 2017|18 7 1.1 OVERVIEW OF PERFORMANCE Statement on overview of performance from the Chair and Chief Executive Last year saw the Trust experience the busiest Trust a Control Total target that would have time in its entire history. This resulted in required savings in excess of £20 million. The 526,680 patient contacts - up by 2% on the Trust Board took the difficult decision to not sign previous 12 months. The winter months were up to the Control Total set by NHSI as we sought particularly demanding with more than 11,500 to be realistic about what was achievable. This patients visiting Hillingdon’s A&E department in meant we were penalised and unable to access November and December. other funding sources. Our staff With admission rates significantly higher than Staff continued to work hard to improve services coped usual it was difficult to find beds for patients and the overall hospital experience for patients. and the pressure on our staff both in A&E and This saw us successfully move to delivering admirably across the organisation was immense. Our staff 7-day services across the majority of our services. with the coped admirably with the increased pressures The Trust adopted a range of ‘Home first’ increased and we want to pay tribute to their considerable initiatives designed to support patients’ recovery pressures achievement in providing good quality, safe care and get them back home earlier, with additional throughout this most challenging period. community support where needed. We re- organised some of our wards at Hillingdon The increase in the demand for our services Hospital to better align services as well as speed- saw us unable to meet the A&E four-hour up the time it takes clinicians to travel between waiting time target more often than ever before wards to see patients. These changes and other although we performed well on this target initiatives are helping us to better manage the in the Minor Injuries Unit at Mount Vernon flow of patients through the hospital. To further Hospital . Despite this we largely continued to support service improvement, the Trust Board meet the target for our referral to treatment stepped-up scrutiny of cross-cutting Serious times and cancer treatment targets, although Incident themes including Sepsis and NEWS. these also dipped during our busiest months. We continue to make good progress towards On the financial front we successfully delivered the government’s target for the NHS to become £10 million of efficiency savings - more than paperless. We extended remote access to our double the year before - with no detrimental digital Hillingdon Care Record meaning clinical impact on quality. However, this fell short of staff can now view patient data anywhere. the £12.5 million target we had set ourselves. This enabled one Trust doctor to spot a life- Furthermore, NHS Improvement had set the threatening condition in a patient via his iPad 8 ANNUAL REPORT AND ACCOUNTS 2017|18 while at another hospital. All of our nursing Throughout the year the Trust invested more handovers are now done electronically, reducing than £4.5 million in improving and maintaining the potential for errors and enhancing patient the fabric of our buildings and services. This safety. The newly implemented electronic included improvements to our electrics, heating referral system means local GP referrals are and water supplies as well as carrying out now made online, streamlining the process and essential roof repairs. Almost £500,000 was making it easier to track. We implemented the spent on improving our car parks at both new Care Information Exchange system, further hospitals, installing Automatic Number Plate joining-up patient care by enabling all relevant Recognition (ANPR) systems, introducing pay- health and care providers to access and update on-exit so that visitors only pay for time used, a patient’s records. A pilot scheme introduced and segregating staff and public car-parking towards the end of the year now enables areas to make it easier for patients to park. patients to view their own medical records. In addition, we made improvements to our Alderbourne Rehabilitation Ward, installing a much-needed new nurses’ station, updating bathroom facilities and providing new secure storage. Thanks to a donation we were able to refurbish the specialist gym on our Stroke Unit and our Hospital Charity funded the upgrading of two Hillingdon wards. We invested in a new CT scanner at Hillingdon to complement our existing scanner and enable us to carry out more patient scans, more efficiently. Throughout the year the Trust invested more than £4.5 million in improving and maintaining the fabric of our buildings and services. ANNUAL REPORT AND ACCOUNTS 2017|18 9 We also spent more than £100,000 to kick-start Externally the Trust has been recognised for work on the £2.1 million A&E project we have its achievements winning a clutch of awards planned to expand our department – currently in the last year. These include our Catering one of the smallest in London for the number of Team winning a Health Business Award for patients we see. This much-needed expansion improvements to food for patients, staff and will be undertaken in the year ahead. visitors; our Procurement Team becoming the first London trust to attain level 2 of the We continue to work collaboratively with the NHS Standards for Procurement and our other key local health and care providers and Ophthalmology Service scooping a Macular Hillingdon Health and Care Partners (HHCP), our Society Award for Excellence. local Accountable Care Partner organisation, has made great strides in joining-up services in This year we’ve boosted our green credentials the last year. The Trust was an early adopter of by replacing four of our fleet of diesel vehicles the government’s ‘Home First’ approach, which with electric ones, which cost around 10% less aims to avoid unnecessary hospital admissions to run. We also worked in close partnership with and get people back home safely, with the Brunel University London and Hillingdon Council correct support, as soon as possible. This aligns to successfully secure a cycle-hire scheme for well with the overall HHCP ethos and is greatly the borough with a station being installed at supported by our own local initiatives - in Hillingdon Hospital. particular Discharge to Assess, which focuses on the over 65s with complex needs. Patients We continue to work hard to achieve the discharged under this scheme are assessed in highest standards in patient care and this year their own homes within two hours of arriving we received over 37,500 responses to the home. The assessment is undertaken in liaison Friends and Family test (FFT) with 96.2% of with social services, community services and patients saying they were happy to recommend the voluntary sector to ensure that all patient our services to their friends and family. needs are addressed. This approach has seen the length of stay in hospital being reduced by, on We once again, performed well in the national average, two days. In addition, our Frailty Unit at staff survey, with above average results in 13 Hillingdon Hospital (introduced last year) is now out of 32 areas. We scored well in the fields well established and providing a quick turn- of staff motivation at work and in the reduced around service to largely older residents. incidence of physically violent incidents involving patients, their relatives or the public, down from The big partnership news this year was the 15% to 13%.