Birmingham Community Healthcare NHS Trust
Birmingham Community Healthcare NHS Trust Annual Report 2010/11
1 Contents
Section 1 Statement From the Chair 3 Message From the Chief Executive 5 Section 2 Welcome to Birmingham Community Healthcare NHS Trust 6 Section 3 Our services 7 Section 4 Where we provide services: 10 Activity figures 11 Our values 11 Section 5 Our year at a glance 12 Section 6 Management commentary 14 How we measure performance 15 How we are performing 16 Section 7 Meet our Trust Board 27 Section 8 2010/11 Financial position 30 Section 9 Annual accounts 32 Section 10 Income and expenditure accounts 37 Section 11 Independent auditor’s report to the Board of Directors of 47 Birmingham Community Healthcare NHS Trust
Front cover picture: Ann Arscott (centre), who is receiving speech therapy following a stroke, pictured with (left) clinical psychologist Sue Wright and speech and language therapist Leona Bramble.
2 BCHC Annual Report 2010/11 Statement From the Chair
Welcome to our 2010/11 annual report; brought to you at a momentous time in the development of community health services across the city of Birmingham and beyond.
I am particularly pleased to present the first annual report of Birmingham Community Healthcare NHS Trust as it marks the formal transition of what was South Birmingham Community Health into a fully fledged NHS Trust on 1st November 2010. This represents a major step in our journey towards becoming authorised as a Community Foundation Trust.
The year 2010/11 also saw the Trust transfer in community services from neighbouring Primary Care Trusts, reflecting the Department of Health’s Transforming Community Services policy. As a result of these services joining us, we are now in a position to link the best in community healthcare across our city of one million people and into the wider West Midlands region.
We are now one of the largest providers of community-based healthcare services in the country, operating from over 400 sites and providing over 100 different services. Our services are now delivered by over 5,000 employees. I would like to take this opportunity to welcome staff that are new to the Trust as a result of the service transfers and to thank all of our staff - from whichever former Primary Care Trust they came - for their hard work in making this transition possible and for their continuing commitment to the successful integration of services.
This annual report spans a period in which a number of significant achievements have been made - not just for the Trust as an independent organisation, but more importantly for the provision of healthcare to the individuals and communities we serve. The structure of the NHS is changing again but ultimately the forms of the organisations delivering services are relatively unimportant; it is only the results for patients and service users that matter. As a Trust we know that change occurs when services are moved and that it does bring with it some challenges. We have risen to these by redoubling our efforts to ensure that our patients and service users are at the heart of everything that we do.
In addition to the successful transfer in of services and staff, we have worked hard to ensure that we continue to achieve the highest standards. We were successfully registered with the Care Quality Commission (CQC) following our establishment as an NHS Trust and we have continued to meet their essential standards of quality and safety. Our excellent record in meeting infection control targets has been maintained during 2010/11 and at the same time we have met our other performance and financial targets.
None of this could have been achieved without the hard work and dedication of our staff. I would like to publicly thank them for their magnificent efforts in maintaining service performance at a time of large scale organisational change.
Looking forward we aim to continue to set the pace for the effective transformation of community services. We will build upon the work that already undertaken to redesign services and provide better care for the individual and better value for the NHS. Although much has been achieved in the last year
3 we are mindful of the challenge that lies ahead as we continue on our journey towards Foundation Trust status. We will continue to work hard to ensure that this is achieved.
Finally, I want to thank my colleagues on the Trust Board for their hard work over the last year. Working together, the Trust Board and our staff have achieved the successes that I have outlined above. We believe this good start paves the way for the future success of Birmingham Community Healthcare as a leader in community services.
Philip Davis Chair
4 BCHC Annual Report 2010/11 Message From the Chief Executive
It is a privilege to introduce the first annual report for Birmingham Community Healthcare NHS Trust and indeed to have been appointed as its Chief Executive.
2010/11 was a significant year in many respects for the organisation and our establishment as a statutory NHS Trust on the 1st November 2010 was a key milestone in the organisation’s development; this was followed by the integration of the core community services across Birmingham on the 1st December 2010. We ended the year in a financially stable position which will prepare us well for the financial challenges ahead and also support crucially our ability to sustain financial viability and maintain safe and effective service delivery.
We place great importance on the experiences of service users when they receive care and over the past year we have demonstrated an increasing commitment to put quality of care at the top of the Board agenda ensuring a joined up approach from ward and team to Board level. Collectively, all of these achievements provide a firm foundation for us to move forward on our journey to Foundation Trust status and demonstrate continuous improvement along the way.
I am particularly grateful to all of our staff for the hard work, effort and dedication that they have shown throughout 2010/11 and I look forward to the next stages of our journey together.
Tracy Taylor, Chief Executive
5 Welcome to Birmingham Community Healthcare NHS Trust
Who we are Our aims
Birmingham Community Healthcare was Our vision is to work with, for and in the established as an NHS Trust on 1st November community to deliver excellent, accessible 2010. The Trust was formerly known as South person-centred community health services for Birmingham Community Health, or the provider people throughout their lifetime. We aspire to be arm of the Primary Care Trust NHS South the service of choice, the partner of choice and Birmingham, and although we had been operating the employer of choice and this report sets out the independently from the PCT since April 2008, progress that we have made in 2010/11 towards we remained a part of it in legal terms. achieving this.
The granting of NHS Trust status was a major landmark in that it saw the establishment of the former South Birmingham Community Health as a separate legal entity from the Primary Care Trust and an organisation in its own right.
What we do
At the time of our establishment as an NHS Trust we provided what are known as ‘core community services’ to the population of South Birmingham and some of our more ‘specialist community services’ to the city of Birmingham and to the wider West Midlands region.
In line with Department of Health policy, on 1st December 2010 a number of community services from our neighbouring Primary Care Trusts, Heart of England Teaching PCT and Birmingham East and North PCT transferred to us, and we now provide core community services to the population of Birmingham, in addition to the specialist community services that we provide to the wider West Midlands. On 1st February 2011, community I was so grateful to get the dental services from Sandwell and Dudley also care I needed at home. It’s been transferred to us and we are now responsible for these services. absolutely fantastic – like having the hospital come to you. A table setting out the full range of services that we provide and where we provide them can be Patrick Holohan, found on pages 8 and 9 of this document. Rapid response service user
6 BCHC Annual Report 2010/11 Our services
We provide an extensive and diverse range of services across the city of Birmingham and these are delivered through three clinical divisions. A summary of our services and where they are provided is set out below and the tables on the following two pages describe our services in further detail.
Division Name Example of Services Provided Area Covered
Adults and Community District nursing, community podiatry City of Birmingham and physiotherapy, community inpatient facilities and offender healthcare.
Children and Families Universal children’s services including health City of Birmingham visiting and mainstream school nursing
Specialist Services comprising:
Birmingham Dental A range of dental services and training for West Midlands region Hospital dental students
Community Dental Orthodontics, special care, surgical dentistry Birmingham, Sandwell and Services and paediatric dental surgery Dudley
Rehabilitation Services In-patient neuro-rehabilitation, brain and West Midlands region spinal injury clinics, wheelchair service, amputee rehabilitation and prosthetics
Learning Disability Services Birmingham Community Assessment and City of Birmingham Treatment Centre, respite and short care breaks, supported living and community forensic services.
7 Adults and Community Division
Citywide Services: South Locality: »» Dietetics and nutrition »» Moseley Hall Hospital »» Speech and language therapy »» Sheldon Unit »» Smoking cessation »» West Heath Hospital »» Stroke »» Rapid Response Team »» Continence »» Multidisciplinary teams »» CVD/diabetes »» End of Life Care »» COPD/respiratory »» Referral Management Centre »» Parkinson’s disease »» Assessment and Treatment Service »» Thalassaemia »» Outpatients »» Rheumatology »» Tissue viability and lymphoedema »» Podiatry
Central and West Locality: East and North Locality: »» Norman Power »» Ward 29 Heartlands Hospital »» Riverside Lodge »» Ward 3 Good Hope Hospital »» Community intermediate care/falls »» Perry Tree Centre »» Community occupational therapy »» Ann Marie Howes Centre »» Long-term conditions case management »» Intermediate Care »» Adult nursing »» Long-term conditions case management »» Community physiotherapy »» Adult nursing »» End of Life Care »» Rehabilitation pathway »» HM Prison Birmingham »» Musculo-skeletal »» Orthopaedic triage
Children and Families Division
Citywide Services: Central and West; East and North; and South »» Community paediatrics Localities: »» Speech and language therapy »» Health visiting, under-5s »» Physiotherapy »» Children’s centres »» Occupational therapy »» Family nurse partnership (South and East & »» Child development centres North) »» Designated nurse and team »» School nursing and immunisation »» Community children’s nursing »» Paediatric health visiting liaison »» Palliative care and complex care »» Paediatric eye service (South only) »» Special school nursing and ADHD »» Looked after children nursing service »» Nurse advisors medical needs in school and early years »» Additional healthcare needs – Edgewood Road
8 BCHC Annual Report 2010/11 Specialist Services Division
Community Dental Service: Birmingham Dental Hospital: Regional Service Citywide Services: Geographic areas covering Birmingham, Dudley, Sandwell, Walsall* »» Restorative dentistry (*April 2011) »» Oral surgery »» Orthodontics »» Orthodontics »» Conservative dentistry »» Special care »» Paediatric dentistry »» Surgical dentistry »» Special needs clinic »» Paediatric dental surgery »» Periodontal department »» Prosthodontics/prosthetic dentistry »» School of Dental Hygiene and Therapy »» Dental nursing »» Oral medicine »» Walk-in primary dental care »» Radiography
Rehabilitation Services: Regional Service Learning Disability Services: Citywide Service
»» Inpatient neuro-rehabilitation »» Community Multi Disciplinary Learning »» Outpatient brain injury Disability Teams (incorporating psychiatry, »» Posture and mobility psychology, specialist nursing, physiotherapy, »» Spinal injuries clinic occupational therapy, dietetics, and speech »» Young adults clinic and language therapy) »» Brain injury clinic »» Birmingham community assessment and »» ACT/ECS treatment service »» Amputee rehabilitation (West Midlands »» Assertive Community Outreach Service Rehabilitation Centre/Stoke/Wolverhampton) »» Supported living outreach team »» Wheelchair service »» Community forensic team »» Clinical measurements »» Low secure forensic rehabilitation »» Spasticity clinic »» Older adults service (including specialist »» General rehabilitation dementia and palliative care services) »» Neuromuscular clinic »» Respite care and short breaks »» Multiple sclerosis clinic »» Health facilitation »» Intrathecal baclofen »» Domiciliary care »» Prosthetics »» Social care homes »» Birmingham neuro-rehabilitation team »» Day services »» Information service on disability »» Pharmacy »» Functional electrical stimulation
9 Where we provide services:
Our core community and universal children’s services provided for the population of Birmingham, which has in excess of one million residents, are organised into the following localities:
»» Central and West Birmingham »» East and North Birmingham »» South Birmingham
In addition to providing a learning disability service to the city of Birmingham, the specialist services that we provide on a regional basis also serve the counties of Staffordshire, Herefordshire, Shropshire, Worcestershire and Warwickshire. We also provide a range of healthcare services for patients in HM Prison Birmingham through a partnership arrangement with Birmingham and Solihull Mental Health Foundation Trust.
We support our divisions to deliver care to patients through a range of corporate services including human resources, finance, performance and risk management, and we have a team dedicated to ensuring that the experiences that our patients have of our services are monitored and enhanced.
East and North
Central and West
Staffordshire
South Shropshire Wolverhampton
Birmingham Coventry
Worcestershire Warwickshire
Herefordshire
10 BCHC Annual Report 2010/11 Activity Figures
The following table is a summary of the treatment that we provided to patients in 2010/11:
Setting Number
Community 1,833,035
Outpatients 185,815
Day cases and planned case patients 44,192
Unscheduled treatment 104,793
Care Home 13,147
Our values
We have worked extensively with our staff and stakeholders to determine the values that are important to us in the delivery of our services and these are as follows:
1 Accessible We will provide services that reach out into the community and are within reach when needed 2 Responsive We will listen and work with our service users and partners to meet needs and improve health and well being 3 Quality We will provide safe, effective personalised care to the highest standard 4 Caring We will deliver out services with respect, understanding and thoughtfulness 5 Ethical We will make morally sound, fair and honest decisions and be openly accountable 6 Commitment Through our actions and commitment we will make a positive difference to people’s lives.
11 Management commentary
In this section, we will set out how we have performed in the financial year 2010/11 in terms of meeting all of our targets. We have met all national standards and targets despite the challenges of a major integration programme that has brought three organisations into one. Although we did not become an NHS Trust until 1st November 2010, we have reported on our performance for the organisation as it was configured prior to the service transfers for the whole of 2010/11.
We have obtained performance data for the year for the services that transferred to us on 1st December 2011 from Heart of Birmingham teaching Primary Care Trust and from NHS Birmingham East and North and have set this out separately. We have been actively monitoring performance in the newly transferred services since the date of transfer and will be reporting our performance as an integrated organisation from April 2011/12 onwards.
We have not reported on performance for the community dental services that transferred to us on 1st February 2011 because of the short period that these services have been with us but we will be monitoring and reporting on their performance in 2011/12 as part of our Performance Management Framework.
Performance at a glance:
Key Achievements 2010/11
Care Quality Commission (CQC) – we were compliant with the Care Quality Commission’s essential care and quality standards and achieved full and unconditional registration with the CQC.
Healthcare Acquired Infections - we have continued to deliver high performance in relation to healthcare acquired infections (HCAIs) which include Methicillin Resistant Staphylococcus Aureous (MRSA) infections and Clostridium difficile (C-diff) and met all of our targets for reducing infection rates.
NHS Litigation Authority Risk Management Standards – we have achieved level 1 and we are working hard to achieve level 2.
National Performance Targets – we have met all applicable national performance targets.
Financial Targets – we have met all of our statutory financial duties.
12 BCHC Annual Report 2010/11 How we measure performance
Internal and external targets Our hospitals were highly rated for patient We have developed internal reporting processes privacy and dignity and cleanliness by the that measure how well we are performing against Patient Environment Action Team (PEAT), key standards and objectives and performance. This which assesses all inpatient units nationally is reported to the Board on a monthly basis. with 10 or more beds. We were also As part of the Performance Management declared to be compliant with the essential Framework, the Board receives a monthly report care and that details overall organisational performance quality using a performance scorecard that contains details standards set of our activity, finance, and quality measures such out by the as basic standards of care and measures of the Care Quality experience that our patients have of our services. Commission The scorecard incorporates all national and local (CQC). targets and these are linked to our objectives.
Performance against business objectives
In addition to monitoring performance against national, statutory and quality targets, the Trust “Being a mum is a wonderful, rewarding Board also measures performance against the experience but also harder than anything strategic objectives that it has set to ensure that else I could imagine. I am so grateful for all the organisation moves forward. A set of strategic the countless objectives were developed for 2010/11 as a step hours the towards delivering our longer term vision. team spent Progress was made against all of the strategic helping me objectives with the exception of those relating through to information technology. A dedicated team of tough times staff has however been established during the year and for all and progress against the IT-related objectives is the practical expected in 2011/12. help.
Quality “As much as anything, the health visiting service provides opportunities for mums We are committed to providing high quality to support one another – navigating that services and have worked hard to develop locally unfamiliar world is one of the hardest parts agreed targets that enable us to monitor and at first. I’m sure that the friendships I’ve met measure the quality of the services that we provide. through the post-natal group will Performance against key national and local targets be lifelong.” is set out below but we have published a separate set of Quality Accounts that provide more detail for Catherine Ardagh-Walter, 2010/11 and these can be obtained by contacting New mum and health visiting service user the Trust Board Secretary at Trust Headquarters.
13 How we are performing
The following tables set out our performance against key targets, some of which are national targets and some of which are local targets.
Former South Birmingham indicators:
Local (L) or Indicator Target Position National (N) target N MRSA new bacteraemias There should be no more than 5 1 case new MRSA bateraemias.
N Clostidium difficile infections There should be no more than 22 cases 88 cases of clostridium difficile infections.
N Community Matrons There should be 15 Community 15 Matrons.
N Case Manager There should be 21 Case 21 Managers.
N Breastfeeding prevalence This is a public health target 43% that states that 42% of babies should be exclusively breastfed or ‘supplemented’ (i.e. some breast and some formula).
N Breastfeeding coverage We are required to record 98% whether or not babies are being breastfed at their 6-8 week check. The target is for this information to be recorded in 95% of cases.
N Obesity prevalence at We are required to record the 97.4% reception height and weight of children at reception age in 94% of cases.
14 BCHC Annual Report 2010/11 Local (L) or Indicator Target Position National (N) target
N Obesity prevalence at year 6 We are required to record the 93.2% height and weight of children at year six in 87% of cases.
N Compliance with Care Quality The organisation should be able 100% Commission standards to declare full compliance with the CQC standards.
N Percentage of Serious 100% of Serious Incidents 100% Incidents reported within 2 should be reported within 2 working days working days. N Quality of stroke care Patients should spend 90% of 100% the admission on a stroke unit.
N 18 week non-admitted At least 95% of non-admitted 98% pathway patients should be treated within 18 weeks of referral from a consultant.
N 18 week admitted pathway At least 90% of admitted 93% patients should be treated within 18 weeks of referral from a consultant.
N Monitor Risk Score The organisation should have a 3 speculative Monitor risk rating of no less than 3.
L Percentage sickness absence The percentage of sickness 5.62% absence on a rolling 12 month average should be 5.27% or less.
L Spend on temporary staff The spend on temporary staff 9.20% should be 5% or less of total pay.
15 Local (L) or Indicator Target Position National (N) target L Delayed transfers of care There should be fewer delayed 783 (numbers) transfers of care than in 2009/10 (601 cases).
L Delayed transfers of care There should be less delayed 16.90% (percentage) transfers of care than in 2009/10 (11.6%).
Former Birmingham East and North Provider Indicators:
N Breastfeeding coverage We are required to record 96% whether or not babies are being breastfed at their 6-8 week check. The target is for this information to be recorded in 95% of cases.
N Breastfeeding Prevalence This is a public health target that states that 42% of babies 40% should be exclusively breastfed or ‘supplemented’ (i.e. some breast and some formula).
N Compliance with Care Quality The organisation should be able 100% Commission Standards to declare full compliance with the CQC standards.
N 18 week non-admitted At least 95% of non-admitted 95.87% pathway patients should be treated within 18 weeks of referral from a consultant.
N Percentage of Serious 100% of Serious Incidents 80% Incidents reported should be reported within 2 working days.
L Delayed transfers of care Target not set. 12 (numbers)
16 BCHC Annual Report 2010/11 Local (L) or Indicator Target Position National (N) target L Percentage sickness absence The percentage of sickness 5.11% absence on a rolling 12 month average should be 4.1% or less 5.11%.
Former Heart of Birmingham Provider Indicators:
N MRSA new bacteraemias There should be no more than 3 0 new MRSA bacteraemias.
N Clostridium difficile Target not set. 0
N 18 week non-admitted At least 95% of non-admitted 99.80% pathway patients should be treated within 18 weeks of referral from a consultant.
N Compliance with Care Quality The organisation should be able 100% Commission Standards to declare full compliance with the CQC standards.
N Percentage of Serious 100% of Serious Incidents 100% Incidents reported should be reported within 2 working days.
L Delayed transfers of care Target not set. (numbers)
L Percentage sickness absence The percentage of sickness 5.22% absence on a rolling 12 month average should be 4.50% or less. L Spend on temporary staff Spend on temporary staff should 8% be less than 5% of total pay.
A busy year ended with a high level seal of approval when Secretary of State for Health Andrew Lansley declared himself impressed with our patient-focussed approach following a visit to our urgent care bureau at West Heath Hospital and the home of an elderly rapid response service patient.
17 Areas where we have performed well Areas where we are seeking improvement There are a number of indicators that showed Whilst we achieved all of the national targets that excellent performance during 2011/11, including: apply to us we did not meet two of our locally Healthcare Associated Infections (HCAIs). set targets and we know that we need to make We maintained our strong record in infection improvements in these areas in the coming year. control through effective management of Delayed transfers of care Methicillin-Resistant Staphylococcus Aureus (MRSA) bacteraemia and Clostridium difficile (C.diff) Although we do provide inpatient services we infections. All targets for reducing these infection are not subject to the national target for delayed rates were met. transfers of care which relates to acute care only. This is however a keen area of focus for the Board The services that have transferred to us have also as it not only has an impact on our patients but on performed well in respect of MRSA infections and the health economy as a whole. We will continue we will continue to build on this performance to work with the local acute Trusts and the local as we understand that this is an area that is of authority to find solutions and to minimise the fundamental importance to our patients. impact on the health economy as a whole and upon patient care. The community diabetes Sickness absence team started trialling information We did not meet the target that was set for sessions at a Sikh reducing sickness absence but we did nevertheless temple to target make great strides throughout the year by reducing the communities sickness absence levels to the lowest that they have most at-risk of been for 18 months. The services that transferred developing the to us from Heart of Birmingham teaching Primary illness. Care Trust and NHS Birmingham East and North did not meet their locally agreed targets for sickness Waiting times absence and we will work on implementing the new attendance management policy that has been The national target is that a minimum of 90% developed to ensure that performance improves of admitted patients and 95% of non-admitted across the entire Trust in 2011/12. patients start treatment within 18 weeks of referral. These targets were met in 2010/11. Sickness Absence Data
Stroke care The following table provides further details of sickness absence for the Trust as it was configured We are committed to providing the best care and before the services transferred to us in December treatment for patients that have suffered a stroke 2010 and February 2011. We have not reported and 100% of our patients have been cared for in this data for the new services as they joined us with a dedicated stroke bed which exceeds the national only a quarter of the financial year remaining; we target of 90%. have however been monitoring sickness absence across our new organisation and will report this for The inpatient neurological rehabilitation the Trust as a whole in 2011/12. unit (INRU) at Moseley Hall Hospital was on the ‘team of the year’ shortlist at the annual Nursing Times awards in recognition of their success in creating closer integration of staff from a range of clinical disciplines, to the benefit of patients and their families.
18 BCHC Annual Report 2010/11 Staff Sickness Complaints – using them to help us to Explanation 2010/11 Absence improve Total number This is the total 57,833 Unfortunately we do not always get it right but of days lost number of days lost we are committed to learning from our mistakes through long through long and wherever possible. and short term short term sickness sickness) The latest national guidance for managing Total staff years A full time member of 2,830 complaints in the NHS states that Trusts are under staff working all year an obligation to respond to complaints within a is equivalent to one maximum of six months. We have set a local target staff year of responding to complaints within three months Average work- The total number of 20.4 and try to do so wherever possible. ing days lost days lost to sickness divided by the total Sometimes, we cannot meet this because, for staff years example, we need to obtain further information and, when this occurs, we contact the complainant to explain the situation and agree a new deadline. Aiming to be a Foundation Trust We have recently made changes to the way in which we deal with complaints to ensure that the In March 2011 we agreed a new timeline with the outcome is optimal for the complainant and that Strategic Health Authority (NHS West Midlands) for we maximise the opportunity to learn lessons and achievement of authorisation as a Foundation Trust make changes. in 2012/13. We recognise that the Foundation Trust application Complaints are investigated by senior staff and process is necessarily challenging and we will responses are then approved and signed by continue with our efforts to ensure that we do all the Chief Executive. We always endeavour to that is required of us throughout the journey. satisfy the complainant by providing a thorough response but in the event that they are dissatisfied, We will shortly be commencing our campaign and we cannot resolve the matter locally, to ask our patients, their relatives and carers and then complainants can ask the Health Service members of the public that we serve to join us on Ombudsman to review the way in which the our journey towards authorisation and ultimately complaint was managed. operation as a Foundation Trust so that we can be accountable to those that use our services, and Our complaints policy was approved by the Trust work with our communities to shape the future of Board and includes the Ombudsman’s Principles for our organisation. Remedy.
We saw a further “Getting help to give up smoking has given extension of our me a whole new sense of freedom about community-based my life and that’s thanks to the right support support services being available at the moment when I with the opening was really of a shopping motivated to centre-based quit.” drop-in centre offering accessible Mum-of- help and advice two Alison for smokers who Murphy want to quit.
19 Giving patients a better experience as part of our membership we are assessed against the steps that we take to improve patient safety Our patient experience team is led by the Associate and prevent incidents where harm is caused. We Director of Patient Experience and is dedicated to were awarded level 1 which is commendable given improving the experience that our patients have. that we were previously assessed against Primary Care Trust standards and we are now working hard The Patient Advice and Liaison Service (PALS) is to ensure that we reach level 2. part of the team and provides support to patients, carers, relatives and visitors and plays an important In 2011/12 we will ensure that our quality role in helping to resolve concerns as they arise. measures are rolled out across all of the services Comments and suggestions about service that transferred to us to ensure that we continue to improvements can also be made via the service and provide a consistently safe service and to strive to we also welcome compliments from our patients make improvements wherever possible. following a good patient experience as it is helpful to us to know what it is that we do well so that we We have produced a separate Quality Account for can share good practice. 2010/11 and a copy can be obtained from the Trust Board Secretary at Trust Headquarters. We also undertake regular patient surveys that provide us with ‘real time’ feedback from our patients and we use this to make improvements wherever we can. “The podiatry team have been very patient in treating me over a number of years. Now I We understand that coming into hospital is a have far fewer problems but whenever there daunting experience for patients and we are is a sore spot, committed to providing the highest standards of they treat it privacy, dignity and respect. We employ a number very promptly of ‘Dignity Champions’ to ensure that these and very standards are met and we are fully compliant with effectively. I the requirements to treat people in wards with can’t speak patients of the same sex. highly enough All of this work is supported by an active Patient about them.” Involvement and Action Group (PIAG) that works alongside us to improve the services that we offer Donald Parker, and we are grateful to the chair of the group, Podiatry service user Brian Hanson and the other members for their continuing support. Valuing staff Patient safety During the past 12 months the organisation We take the safety of our patients very seriously. has undergone considerable change. Following The Trust Board monitors our patient safety and establishment as an NHS Trust on 1st November quality measures on an on-going basis through our 2011 our name changed to Birmingham Community Healthcare NHS Trust from South monthly Quality Report. All of our board members Birmingham Community Health, and a number participate in our Patient Safety Walkabout of services and staff transferred to us on 1st Programme which ensures that there is a strong December 2011 and on 1st February 2011. link from the ward to the board and that we constantly put our patients first. As a result of these changes it has been essential to maintain channels of communications with our We are a member of the NHS Litigation Authority’s existing employees and develop these with those Clinical Negligence Scheme for Trusts (CNST) and that are new to our organisation.
20 BCHC Annual Report 2010/11 How we have engaged with our staff Dr Sabiha Azmi and Noreen Naz (pictured at last year’s AGM with Sabiha’s children) were Corporate Restructuring and Consultation joint winners of the ‘quality and innovation’ staff award. As a result of the transfer in of services, a restructuring exercise was carried out in December Sabiha and 2010 in relation to corporate services and the Noreen were management structure. This included a period recognised of consultation that was launched by the Chief for their work Executive at a large-scale event for those staff to ensure affected. A number of questions were raised and people from responded to in this forum and staff responded South Asian positively. communities have access to high quality support when caring for adults with learning Details of the proposed structure and of the disabilities. consultation were also sent out using email and the intranet and feedback was received via both media. Staff are recognised as the organisation’s greatest asset. Their efforts are Joint Negotiating Committee (JNC) acknowledged in many ways, including a staff awards scheme. The annual awards are The Trust has an active Joint Negotiating presented for Committee that meets on a monthly basis and achievements is chaired by the Chief Executive with the Staff that bring the Side convenor as deputy chair. Meetings are well organisation’s attended by nominated representatives from values to life, management and staff. We also recognise several with categories trade unions and representation at this forum is reflecting the welcomed from all bodies. A collaborative approach six values – is taken to this forum and this is borne out by the accessible, responsive, quality, caring, ethical positive working relationship and proven track and commitment – plus one for partnership record in joint achievement. working.
Policy development Staff from a wide cross-section of clinical and non-clinical activities have been The transfer of services into the Trust has brought recognised for their quality of service, together three different sets of policies and, as part achievement and innovation. of the programme of work that is underway to integrate services, an exercise to harmonise these Birmingham Community Healthcare’s policies into one document is underway. commitment to engaging with staff was recognised as its in-house A best practice model to develop policies newsletter ‘Archway’ won collaboratively has been developed that involves a silver award from the staff from across the organisation, management Chartered Institute of Public representatives and key stakeholders. This Relations. The bi-monthly approach is also being held up as a model of best newsletter, published to practicewithin the local health economy and will be keep staff update with news, replicated by other Trusts who are integrating developments and ideas, was services from other providers. praised for its use of striking imagery and plain English.
21 Management behaviour workshops The annual staff survey revealed positive The Trust has run a number of management opinions overall about the organisation as behaviour workshops in which staff were consulted a place to work with four out of five staff and had the opportunity to input to the Trust’s saying they were treated with respect by values and management behaviours. These took colleagues while two thirds of respondents place at a variety of locations throughout the city – well above national average - expressed and were well attended. confidence that a family member being General staff engagement cared for by one of our clinical teams would receive a good standard of care. Our staff are our most important asset and in recognition of this we endeavour to maintain good During the year, we have worked hard communication with them. This is no easy task on areas staff identified for improvement, given that we have staff at over 400 sites across the including improving our one-to-one appraisal city of Birmingham and we are therefore constantly systems and reaffirming our commitment looking at ways to improve the information to providing colleagues with the skills and that we give to staff and how we communicate knowledge this. We have a dedicated communications needed to deal team with responsibility for internal and external with aggression communications and we communicate with our and other staff in the following ways: challenging »» Trust induction - All new employees are behaviour. required to attend the Trust induction programme and at which the Chief Executive or other member of the Executive Team is in attendance to welcome staff and introduce our vision, values and strategy. How we contribute to the local health »» Intranet site - We have an intranet site that economy we update regularly to ensure that it contains current and “live” information. It was used We recognise that the way in which we deliver successfully as a means of communicating services has a wider impact on the local health with staff through the restructuring process economy. We take our responsibility as a corporate but it is also a medium for sharing good news citizen very seriously and have taken the following stories and requesting feedback from staff, for actions to make a positive contribution to the example, using the Survey Monkey tool. health economy in which we operate and to the »» Email - A Trust-wide “all staff email” has population that we serve. recently been developed which is sent weekly to all staff by the communications team. This • Equality and diversity provides staff with a wide range of information including training opportunities, facilities and We are committed to providing support to events. employees with a disability and we have met »» Written communication - Where significant our responsibilities under the Equality Act 2010 proposals for change are being made we by ensuring that our Recruitment and Selection write to staff at their home address or attach Guidelines, Management of Attendance Policy and correspondence to payslips to ensure that we Capability Policy reflect the legislation, and specific do reach all of our staff. training has been provided for managers.
We enjoy a positive working relationship with the Occupational Health Service and with our Staff Side colleagues, and have a well established Disability
22 BCHC Annual Report 2010/11 Advisory Group that comprises staff, service users and carers with a wide range of disabilities. We are also committed to ensuring equality in all aspects of employment and service delivery. We expect our staff and service users to be treated with dignity and respect and we have an equality policy that has been developed within our overall framework for valuing diversity.
In the wider context we have an established equality impact assessment framework which ensures that equality and equal opportunity considerations are built into policy development and design and delivery our services.
• Improving data security We need to keep personal information relating to our patients and the care we provide to them. We also need to keep personal information relating to our staff so that we can pay them and contact them when we need to.
We take our responsibility to protect this data very seriously and have strict policies in place that set out how we store and use personal data.
The table on page 24 sets out the serious incidents involving data loss that have occurred at the Trust in 2010/11 that have been reported to the Information Commissioner.
We began the year as one of the first health sector organisations with an investors in people bronze award, recognising our extra investment in the skills of our workforce. The advanced accreditation means we are in the top three per cent of the 36,000 organisations that hold the IiP standard.
23 Summary of Serious Untoward Incidents involving personal data as reported to the Information Commissioner 2010-2011
Date of Nature of incident Nature of data potentially Number Notification Incident affected of steps people December Loss of paper documents Names and addresses 20-50 None as this may 2010 from outside secured cause undue NHS premises. Theft from stress employee car
Further All staff reminded diary must be kept secure at all times and not to be left in cars action on information risk
Date of Nature of incident Nature of data potentially Number Notification Incident affected of steps people November Unauthorised disclosure of Personnel ID, first name, + 100 Individuals 2010 information. Negligent or surname and title, date of notified by email inappropriate use of any birth, marital status, national information system insurance number and salary details
Further All recipients were contacted to establish whether they had accessed the data and action on requested to delete it from within their email system and data drives. A new process information of checking emails before sending them out has been established as part of normal risk procedure.
Date of Nature of incident Nature of data potentially Number Notification Incident affected of steps people December Unauthorised disclosure Names Less than 50 50 None 2010 of information. Negligent or inappropriate use of an information system
Further The review of the investigation has resulted in the conclusion that the incident was action on caused by a combination of system based factors with an element of human error. The information documents were recovered and secured. Staff within the service have been reminded to risk be vigilant and check documents before disposal and printing only where necessary.
24 BCHC Annual Report 2010/11 Summary of other personal data related incidents
Category Nature of incident Total
I Loss of inadequately protected electronic equipment, devices or paper documents from secured NHS premises
II Loss of inadequately protected electronic equipment, devices or paper documents from outside secured NHS premises III Insecure disposal of inadequately protected electronic equipment, devices or paper documents IV Unauthorised disclosure 6
V Other
The environment Raising and maintaining staff awareness of sustainability agenda We are committed to acting in a sustainable and environmentally responsible way in the planning The importance of the sustainability agenda is a key and delivery of services, and to supporting all message that is given to all new staff as part of the staff in embedding such practices into their daily Trust induction programme and basic messages in routines and this section sets out how we do this. relation to recycling and turning off lights and PCs is given in staff communications. Bins for recyling paper are available in office areas and for glass and NHS Carbon Reduction Strategy and Climate plastics in kitchens. Change Act A local sustainability group has been established in We have a sustainable development strategy and order to: policy that were revised in May 2010, in light of the update to the NHS Carbon Reduction Strategy »» Raise and maintain staff awareness of ‘Saving Carbon, Improving Health’ of January the role that they have to play in 2010.Under this strategy we must reduce our total the sustainability agenda carbon emissions from emission levels in 2007/08 »» Advise on the our transport policy as follows: »» Roll out the use of video conferencing »» Reduce the amount of paper that we use. »» 10% by 2015 »» 18% by 2020 Internal Communications representatives sit on »» 86% by 2050 the Local Sustainability Group and promote the agenda of this group via the staff newsletter and We monitor carbon emissions and energy usage the Intranet pages and maintain the environmental across our estate through the Performance sustainability pages. Following on from the transfer Management Framework. Targets are set at in of services, the group will be expanded to ensure divisional level and the Trust as it was established that there are representatives from all areas of our on 1st November 2010 is on target to achieve the organisation. national standards.
25 Transport policy and promoting transport Our estate alternatives The increase in size of our organisation following We held a sustainable transport day at Moseley Hall the transfer of services will increase the amount Hospital in September where advice was available of travel that is necessary. We are currently in relation to a number of alternatives to using a establishing an estates team who will be tasked car, including the Cycle to Work Scheme and the with looking at our estate and working out how ‘Dr Bike’ cycle check-up and tuning service. we can minimise the number of buildings that The local sustainability group will now: we operate from and reduce the environmental and financial cost of travel. We will also look to evaluate the benefits of repeating this event at increase the use of video conferencing and consider other locations developing hot-desk facilities for those staff that source funding to replicate the successful Cycle need to travel to a location to attend a meeting so to Work Scheme that they can work there when the meeting has Promote the establishment of cycling and finished. walking groups.
Emergency preparedness Video conferencing It is essential that we meet our statutory duties Video conferencing equipment was installed across under the Civil Contingencies Act by being well the estate so that meetings can take place without prepared in case of a major incident. This is when staff having to travel to attend. This not only something happens, with little or no warning that reduces the cost of travelling time but helps us to could cause a number of deaths and injuries and a reduce the environmental impact of travel. general big impact on our communities. In the coming year we will focus on installing video conferencing facilities across the wider We have a variety of measures in place to ensure organisation. that we can fulfil our obligations including a major incident plan which is available on our intranet and comprehensive training for staff and is fully Reducing paper usage compliant with the NHS emergency planning guidance. We also work closely with other NHS Our procurement group is currently piloting a organisations and external partners to ensure that project in the Learning Disability Service to reduce we can collaborate effectively in the event of a paper usage across our organisation. The project major incident and have taken part in a number involves outsourcing our printers to a private of exercises that have taken place across the West company who levy a charge per sheet printed and Midlands conurbation. changing the setting of our printers to ensure that they use less paper. Following the transfer of services into the Trust, our business continuity arrangements have been The information that is obtained from the pilot comprehensively reviewed and enhanced to ensure will be used by the local sustainability group to that we can continue to operate effectively in the determine how paper usage can be reduced event of an actual or potential major incident. and monitored via the performance reporting framework.
26 BCHC Annual Report 2010/11 Meet our Trust Board
The Trust Board is responsible for setting the strategic direction of the organisation.
It is made up of Executive and Non-Executive Directors; all of whom have equal voting rights with the exception of the Director of Performance and Organisational Development who is a non-voting board member.
Our Non-Executive Directors are led by our Chair and are laypeople that are drawn from the local community. They are accountable to the Secretary of State and are recruited through an open competitive process.
The Chief Executive was appointed via a competitive process that involved the Chief Executive of the Strategic Health Authority (NHS West Midlands) and the Chair of the Trust. The Executive Directors were appointed following an open competition application procedure and selected via a panel that included the current Chief Executive, the Chief Executive of the former host PCT and non-executive directors. All of the Directors have a contract of employment with a notice period of six months by either party.
The Trust’s Remuneration Committee which is made up of, the Chair and Non-Executive Directors, determines the level of remuneration for each of the Executive Directors, including any element of performance related pay or bonuses. None of the Executive Directors received any performance related pay or bonuses in 2010/11.
The Trust’s audit committee comprises the Non-Executive Directors with the exception of the Chair and is chaired by Paul Tilsley.
Although our Board as been in place since 2008, we were not formally established as an NHS Trust until November 2010 and so the Chief Executive and Director of Finance, whilst in post since their appointment, did not take up the statutory accountable officer responsibilities commensurate with their positions until NHS Trust establishment. The Chief Operating Officer was appointed as Deputy Chief Executive Officer in January 2011 following the formal appointment of the Chief Executive.
Directors Role Commencement Date
Philip Davis »» Non-Executive Chair January 2009
Ian Buckley »» Non-Executive Director/Deputy Chair August 2008 »» Chair of Foundation Trust and Integration Programme Board »» Audit Committee member
27 Directors Role Commencement Date
Celia Furnival »» Non-Executive Director August 2008 »» Chair of the Governance and Risk Committee »» Chair of the Charitable Funds Committee »» Audit Committee member
Karen Bloor »» Non-Executive Director August 2008 »» Audit Committee member
Coun Paul Tilsley »» Non-Executive Director August 2008 »» Chair of Audit Committee
Dr John Craggs »» Non-Executive Director May 2009 »» Chair of Investment Committee »» Vice Chair Audit Committee
Tracy Taylor »» Chief Executive July 2007 Formally appointed as Chief Executive Officer February 2011
Peter Axon »» Director of Finance June 2009
28 BCHC Annual Report 2010/11 Directors Role Commencement Date
Rick Roberts »» Medical Director October 2006 Formally appointed on NHS Trust establishment
Beverly Ingram »» Director of Nursing and Therapies March 2008
Andy Harrison »» Chief Operating Officer July 2008
Joanne Thurston »» Director of Performance and Organisational March 2008 Development (non-voting)
29 2010/11 Financial Position
How is our financial performance assessed?
As an NHS Trust we are accountable to the Department of Health for meeting the targets that are set out below:
Definition of Target Achieved Total
Income and Expenditure Break Even Yes Our overall end of year surplus was (Managing Services with the income £0.686 million. received by the Trust) External Financing Limit Yes The EFL of the Trust was set equivalent Managing Services with the “cash to the Capital Resource limit issued limit” agreed with the Department of and was therefore achieved. Health) Capital Resource Limit Yes Our Capital Programme was £10k Managing Capital Expenditure within under spent against target. the Capital Resource Limits agreed with the Department of Health Remain within cash limit Yes
Although we were only required to meet these Service transfers achieved during 2010/11 were targets as of 1st November 2010 when we were not allowed to materially impact on PCT planned established as an NHS Trust, for the past three surpluses. As such these services were transferred years we have managed our finances in accordance on a break even basis for the portion of the with NHS Trust requirements and for the third financial year. This included services from HoB PCT, consecutive year we are able to report that we have BEN PCT and South Birmingham PCT (the latter met all of our financial targets. relating to balances prior to the creation of BCHC NHS Trust on 1st November 2010). The annual plan for 2010/11 was set prior to the creation of the NHS Trust and transfer into BCHC Therefore, the original plan as presented to NHS Trust of services totalling approximately £90m. South Birmingham PCT Autonomous Provider Therefore, as an autonomous provider organisation Organisation, to deliver a 1% surplus on a baseline within South Birmingham PCT the target for of £160m turnover, has been achieved. 2010/11 was to achieve a 1% surplus on a revenue budget of £160 million (requiring a planned surplus of £1.6 million). The creation of the Trust on 1st Efficiency savings November 2010 and resultant Department of Health merger guidance resulted in £993k of the In addition to meeting these duties in 2010/11 we planned surplus remaining with South Birmingham had to identify and achieve savings in excess of PCT. The resulting target surplus for the final 5 £4 million in order to meet the required national months of the year as an NHS Trust from November efficiency savings and we are pleased to report that 2010 to March 2011 totalled £667k. This was we substantially met this target. achieved. 30 BCHC Annual Report 2010/11 Average number of staff:
The average number of staff that we employed in 2010/11 by category is set out below:
Category Total Number Permanently Other Employed Medical and dental staff 183 181 2
Ambulance staff 0 0 0
Administration and estates 1,097 1,093 4
Healthcare assistants and other support 109 99 10 staff Nursing, midwifery and health visiting 2,448 2,200 248 staff Nursing, midwifery and health visiting 0 0 0 learners Scientific, therapeutic and technical 1,082 1,072 10 staff Social care staff 0 0 0
Where our money comes from Capital investment
The majority of our income comes from the We spent £5.402 million of capital in 2010/11. provision of patient care which totals £226,061k. £3.13 million was spent on the purchase of The remainder of £25,931k comes from other equipment assets from South Birmingham PCT activities such as education, training and research. when we were established as an NHS Trust and we spent a further £2.272 million on new equipment across the new Trust. Significant areas of How we spend our money investment included a new telephone system which is being installed across the Trust at a cost of £0.9 In the financial year 2010/11 we spent £251,307k. million and a state-of-the-art Cone Beam Scanner The largest proportion of this expenditure was for Birmingham Dental Hospital at a cost of £0.28 on the salaries and wages that we pay our staff million. which totalled £181,510k. Further details on our expenditure can be found in the Income and Expenditure section of the Financial Statements section of this report.
31 Annual Accounts
Foreword to the accounts To the best of my knowledge and belief, I have properly discharged the responsibilities as set out in These accounts for the year ending 31st March the Accountable Officers’ Memorandum. 2011 have been prepared by Birmingham Community Healthcare NHS Trust under merger accounting guidelines as instructed by the Department of Health. This guidance states that the services and functions that have transferred to us have to be accounted for from the start of Tracy Taylor, Chief Executive the financial year. The accounts have therefore been prepared as if the Trust was in existence from the 1st April 2010 and the functions and services transferred on that date. The accounts for the year include functions transferred from South Statement on internal control Birmingham PCT, Heart of Birmingham Teaching PCT, Birmingham East and North PCT, Dudley PCT 1. Scope of responsibility and Sandwell PCT. The Board is accountable for internal control. As Accountable Officer, and Chief Executive of Statement of the Accountable Officer’s this Board, I have responsibility for maintaining responsibilities a sound system of internal control that supports the achievement of the organisation’s policies, The Chief Executive of the NHS has designated aims and objectives. I also have responsibility that the Chief Executive should be the Accountable for safeguarding the public funds and the Officer to the Trust. The relevant responsibilities of organisation’s assets for which I am personally Accountable Officers are set out in the Accountable responsible as set out in the Accountable Officer Officers Memorandum issued by the Department of Memorandum. Health. These include ensuring that: • There are effective management systems in place I work closely with Birmingham commissioners, to safeguard public funds and assets and assist in partner organisations within the NHS, other public the implementation of corporate governance sector bodies and the private sector to ensure that • value for money is achieved from the resources value for money is achieved from the resources available to the Trust available to the Trust. • the expenditure and income of the Trust has been applied to the purposes intended by The Trust also participates fully in the performance Parliament and conform to the authorities which management framework set by the Strategic Health govern them; Authority thereby ensuring review of the Trust’s • effective and sound financial management objectives, management arrangements and internal systems are in place; and control. • annual statutory accounts are prepared in a format directed by the secretary of State with The Trust has continued to work closely with NHS the approval of the Treasury to give a true and West Midlands and the Department of Health fair view of the state of affairs as at the end of throughout the year to strengthen its internal the financial and the income and expenditure, control and governance arrangements. recognised gains and losses and cash flows for the year
32 BCHC Annual Report 2010/11 2. The purpose of the system of internal are effective and that appropriate challenge can be control made at each reporting level.
The system of internal control is designed to BCHC has Governance and Risk Committee which manage risk to a reasonable level rather than is a sub-committee of the Board. This Committee to eliminate all risk of failure to achieve policies, governs the Risk Management Committee, aims and objectives; it can therefore only provide Clinical Governance Committee and Finance and reasonable and not absolute assurance of Performance Management Group; pulling together effectiveness. The system of internal control is all aspects of the based on an ongoing process designed to: non-financial governance agenda in one place. The Governance and Risk Committee undertakes »» identify and prioritise the risks to the achievement a review of the Care Quality Commission Essential of the organisation’s policies, aims and objectives, Standards for Safety and Quality and declaration. It »» evaluate the likelihood of those risks being reports monthly to the Board. realised and the impact should they be realised, and to manage them efficiently, effectively and The Audit Committee has responsibility for financial economically. and corporate governance arrangements and The system of internal control has been in place reports to the Board regularly. in Birmingham Community Healthcare NHS Trust The Trust takes a pro-active non-punitive approach for the year ended 31 March 2011 and up to to risk management in order to encourage open the date of approval of the annual report and debate and sharing of best practice within all levels accounts. The impact of the transfer in of services of the organisation. The outcomes of incidents are and functions from Heart of Birmingham Teaching incorporated within training to share lessons learnt Primary Care Trust and NHS Birmingham East and and develop best practice. The Risk Management North on 1st December 2010 and from Sandwell Operational Development Group compiles incident and Dudley on 1st February 2011 upon the system and best practice reports for the Risk Management of internal control has been assessed and managed Committee and Governance and Risk Committee accordingly. and general management.
3. Capacity to handle risk The corporate induction process has a programme that meets all mandatory training requirements for Executive level leadership of the Risk Management staff commenced in year. and Governance processes within the Trust is through the Director of Performance and Serious incidents are reviewed at Risk Management Organisational Development. and Governance and Risk Committees in order to identify trends and lessons learned. Operational leadership of the risk management process has been strengthened through the The Board reviews the Assurance Framework on a Associate Director of Risk and Performance that quarterly basis and the Corporate Risk Register is supports a dedicated central risk management reviewed by the Governance and Risk Committee team and delivery of the risk management and on a monthly basis. governance strategy and organisational objectives at a service level.
There is a Risk Management Committee and a Clinical Governance Committee in place. Operating committees with clear terms of reference and agendas continue to operate and to support delivery of the strategy. Membership at both committees and operating groups ensures that they
33
4. The risk and control framework The Assurance Framework
Risk Management Strategy The Board has undertaken a review of its Strategic Annual Objectives which have been updated in The Organisation Risk Management and line with its medium term plan. Principal risks to Governance Strategy 2008 – 2010 has remained the achievement of these objectives have been current during this year. A new Risk Management identified and recorded within the Assurance and Governance Strategy is being developed Framework. A process of quarterly review of the for the new organisation. The strategy outlines Assurance Framework, monitoring and updating arrangements for the management of risks at all of action plans by the Board has also been levels within the organisation and clearly identifies undertaken. how risks should be identified, analysed, evaluated and the arrangements that are in place for their The annual business plan and organisational management and control. objectives are cascaded to staff through the appraisal and personal development processes. The organisation continues to implement a The risk management process has been embedded consistent approach to risk management and within the culture of the organisation through clinical governance through their respective an active risk management department coupled committees and operating group structures, with Executive and Associate Director support. A agendas and reporting cycles to the Governance clear strategy, comprehensive policies and training and Risk Committee. In addition, there is also have also contributed to risk management being regular reporting to the Board. embedded at all levels of the organisation.
The organisation continues to utilise an integrated risk management software package allowing The Corporate Risk Register the reporting and investigations of incidents via the Intranet. The package also supports PALS, The organisation consists of three service divisions Complaints and the Risk Register and has been and a number of corporate departments. All extensively developed throughout the year in order divisions and departments have risk registers. to capture greater and more meaningful data to Risks within the risk register graded at risk score promote effective lesson learning. of 15 or higher are considered to be of significant importance to the organisation and in need of Embedding risk management attention at executive level and are entered onto the Corporate Risk Register. The Board reviews the organisation’s strategic objectives on an annual basis in order to set the A report of new entrants to the Corporate Risk starting point for its business cycle for the year. Register, risks graded 15 or above, those due for Risks to the strategic objectives are reviewed review within one month and requests for removal by the Board in order to develop the Assurance from the Corporate Risk Register are reviewed by Framework and are then communicated across the the Risk Management Committee and Governance organisation in order to commence the business and Risk Committee on a bi-monthly basis. planning cycle. In addition, a summary of the full Corporate Risk A risk review is embedded within this business Register is presented on a quarterly basis. During planning and development process and recorded 2010/11, the Board has reviewed the Corporate against each plan and development. Risk process to further improve governance of the strategic risk at Board level going forward. Action plans to reduce the identified risks are monitored at the Risk Management and Governance and Risk Committees.
34 BCHC Annual Report 2010/11 Stakeholder involvement Compliance with Climate Change Adaptation reporting There is patient and user representation on the Clinical Governance Committee where risks are To meet the requirements under the Climate discussed and the Patient Information and Action Change Act 2008, the Trust has undertaken a Group receives regular reports on aspects of patient climate change risk assessment and developed safety. The Board receives on a monthly basis, an Adaptation Plan, to support its emergency patient stories and experiences to consider risk and preparedness and civil contingency requirements, governance from a user experience. as based on the UK Climate Projections 2009 (UKCP09), to ensure that this organisation’s obligations under the Climate Change Act are met. Essential standards of quality and safety
The Trust is declaring full compliance with the Care Disclosure on CQC Essential Standards of Quality Commission Essential Standards of Quality Quality and Safety (where applicable to and Safety. The Trust is fully compliant with these the organisation) standards. The Trust is fully compliant with CQC Essential Standards Of Quality And Safety. Compliance with NHS Pension Scheme regulations Data security As an employer with staff entitled to membership of the NHS Pension Scheme, control measures The organisation has established an Information are in place to ensure all employer obligations Governance Steering Group which has contained within the Scheme regulations are responsibility for the effective and efficient complied with. This includes ensuring that governance of information and data security under deductions from salary, employer’s contributions the executive leadership of the Medical Director / and payments in to the Scheme are in accordance Senior Information Risk Officer (SIRO) with the Scheme rules, and that member Pension Scheme records are accurately updated in The Information Governance Steering Group accordance with the timescales detailed in the meets monthly and reports to the Governance regulations. and Risk Committee. Both an Information Privacy Officer and an Information Security Manager have Compliance with equality, diversity and been appointed in order to further strengthen human rights legislation existing arrangements for information governance throughout the organisation. Control measures are in place to ensure that all the organisation’s obligations under equality, diversity Following the introduction of the latest NHS and human rights legislation are complied with. Information Governance toolkit, and a review by internal audit to confirm the level of compliance, the Trust is working to deliver an agreed plan to ensure mandatory compliance going forward. All incidents where information security may have been breeched during the year are reviewed and, where appropriate, these are reported as Serious Incidents (SIs) and subjected to root cause analyses, lessons learnt have been identified and measures implemented to reduce the likelihood of recurrence. These are reviewed at the Risk Management
35 Committee and actions reported to the Governance The Board has given an undertaking to review the and Risk committee. Where appropriate these Assurance Framework and the principal strategic incidents are also reported to the Information risks to the trust in achieving its objectives on a Commissioner’s Office and the Strategic Health quarterly basis. Authority. Other Board sub-committees and operating groups 5. Review of effectiveness will continue to manage the operational risks and to further review, develop and strengthen systems As Accountable Officer, I have responsibility for of internal control. Attainment levels from external reviewing the effectiveness of the system of internal sources of assessment and assurance will continue control. My review is informed in a number of to be fed into these groups in order that action ways: plans can be updated to address any areas for improvement. The Head of Internal Audit provides me with an opinion on the overall arrangements for gaining assurance through the Assurance Framework and My review confirms that Birmingham Community on the controls reviewed as part of Internal Audit’s Healthcare NHS Trust has a generally sound system work. The Head of Internal Audit Opinion has of internal control that supports the achievement of provided me with a significant level of assurance on its policies, aims and objectives. the Trust’s internal control systems and processes. Executive managers within the organisation who On behalf of the Board, have responsibility for the development and maintenance of the system of internal control provide me with assurance.
The Trust Assurance Framework itself provides me with evidence that the effectiveness of controls that manage the risks to the organisation achieving its principal objectives have been reviewed. Tracy Taylor, Chief Executive My review is also informed by the results of 8th June 2011 external assessments and feedback from national initiatives such as the staff survey results and the National Reporting and Learning System (NRLS) Incident Trend reports from the National Patient Safety Agency (NPSA). Feedback from both internal and external audit reviews and the self-assessment declaration process also inform my review.
I have been advised on the implications of the result of my review of the effectiveness of the system of internal control by the Board, Governance and Risk Committee, Risk Management Committee, Clinical Governance Committee, Audit Committee, Finance and Performance Management Group, Information Governance Steering Group and input from our Internal Auditors. A plan to address weaknesses and ensure continuous improvement of the system is in place.
36 BCHC Annual Report 2010/11 Income and expenditure accounts
The financial statements are set out in this section of the report. A full set of accounts, including notes, can be obtained from Peter Axon, Director of Finance at Trust Headquarters.
Income and expenditure
Statement of comprehensive income for the year ended 31 March 2011 2010/2011 £000 Revenue Revenue from patient care activities 226,061 Other operating revenue 25,931 Operating expenses (251,306) Operating surplus / (deficit) 686 Finance costs: Investment revenue 0 Other gains and losses 0 Finance costs 0 Surplus/(deficit) for the financial year 686 Public dividend capital dividends payable 0 Retained surplus/(deficit) for the year 686 Other comprehensive income Impairments and reversals 0 Gains on revaluations 0 Receipt of donated/government granted assets 10 Net gain/(loss) on other reserves (eg. defined benefit pension scheme) 0 Net gains/(losses) on available for sale financial assets 0 Reclassification adjustments: Transfers from donated and government grant reserves (2) On disposal of available for sale financial assets 0 Total comprehensive income for the year 694
Reported NHS financial performance position [adjusted retained surplus/(deficit)] Retained surplus/(deficit) for the year 686 IFRIC 12 adjustment 0 Impairments 0 Reported NHS financial performance position [Adjusted retained surplus/(deficit)] 686
37 Statement of Financial Position as at 31 March 2011 31st March 2011 £000 Non-current assets Property, plant and equipment 4,858 Intangible assets 220 Other financial assets 0 Trade and other receivables 0 Total non-current assets 5,078 Current assets Inventories 427 Trade and other receivables 8,418 Other financial assets 0 Other current assets 0 Cash and cash equivalents 23,892 32,737 Non current assets held for sale 0 Total current assets 32,737 Total assets 37,815 Current liabilities Trade and other payables (34,198) Borrowings 0 Other liabilities 0 Other financial liabilities 0 Provisions (1,773) Net current assets/ (liabilities) (3,234) Total assests less current liabilities 1,844 Non current liabilities Borrowings 0 Trade and other payables 0 Other financial liabilities 0 Provisions 0 Other liabilities 0 Total assets employed 1,844 Financed by taxpayers’ equity: Public dividend capital 5,411 Retained earnings 686 Revaluation reserve 0 Donated asset reserve 8 Government grant reserve 0 Other Reserves (4,261) Total taxpayers equity 1,844 The financial statements were approved by the Board on 8th June 2011 and signed on its behalf by: (Chief Executive) 38 BCHC Annual Report 2010/11 Statement of cash flow for the year ended 31 March 2011 Cash flows from operating activities Operating surplus/(deficit) 686 Depreciation and amortisation 334 Impairments and reversals 0 Net foreign exchange gains/(losses) 0 Transfer from donated asset reserve (2) Transfer from government grant reserve 0 Interest paid 0 Dividends paid 0 (Increase)/decrease in inventories (34) (Increase)/decrease in trade and other receivables (12,479) (Increase)/decrease in other current assets 0 Increase/(decrease) in trade and other payables 30,544 Increase/(decrease) in other current liabilities 0 Increase/(decrease) in provisions 1,085 Net cash inflow/(outflow) from operating activities 20,134 Cash flows from investing activities Interest received 0 (Payments) for property, plant and equipment (1,647) Proceeds from disposal of plant, property and equipment 0 (Payments) for intangible assets (143) Proceeds from disposal of intangible assets 0 (Payments) for investments with DH 0 (Payments) for other investments 0 Proceeds from disposal of investments with DH 0 Proceeds from disposal of other financial assets 0 Revenue rental income 0 Net cash inflow/(outflow) before financing (1,790) Net cash inflow/(outflow) before financing 18,344
39 Cash flows from financing activities Public dividend capital received 5,411 Public dividend capital repaid 0 Loans received from the DH 0 Other loans received 0 Loans repaid to the DH 0 Other loans repaid 0 Other capital receipts 102 Capital element of finance leases and PFI 0 Net cash inflow/(outflow) from financing 5,513 Net increase/(decrease) in cash and cash equivalents 23,857 Cash (and) cash equivalents (and bank overdrafts) at the beginning of the financial 35 year Effect of exchange rate changes on the balance of cash held in foreign currencies 0 Cash (and) cash equivalents (and bank overdrafts) at the end of the financial year 23,892
40 BCHC Annual Report 2010/11 Total £000 0 686 0 0 0 1,844 0 0 0 0 10 0 0 (4,261) 5,411 (2) 0 0 0 Other reserve £000 0 0 0 (4,261) 0 0 (4,261) 0 0 Government grant reserve £000 0 0 0 0 0 0 0 0 0 0 0 Donated asset reserve £000 0 0 0 8 0 0 0 10 0 (2) 0 Revaluation reserve £000 0 0 0 0 0 0 0 0 0 0 0 0 Retained earnings £000 0 686 0 686 0 0 0 0 0 Public dividend capital (PDC) £000 0 0 0 5,411 0 0 0 0 0 5,411 0 - transfers from donated assets/government grant reserve - on disposal of available for sale financial assets - on disposal of available Statement of changes in taxpayers’ equity Change in tax payers equity for 2010-11 April 2010 Balance at 1 Total comprehensive income for the year Total Retained surplus/ (deficit) for the year Transfers between reserves Transfers 2011 Balance at 31 March Impairments and reversals Other movements in PDC year Net gain on revaluation of property, plant and of property, Net gain on revaluation equipment of intangible assets Net gain on revaluation of financial assets Net gain on revaluation assets Receipt of donated/government granted defined benefit Net gain/loss on other reserves (e.g pension scheme Movements in other reserves PDC written off Reclassification adjustments: PDC repaid in year Reserves eliminated on dissolution New PDC received Originating capital for trust establishment in year
41 Management costs for the year ended 31st March 2011 2010/2011 Management costs £000
Management costs 21,473 Income 251,992 Cost as a percentage of Income 8.5%
Better Payments Practice Code
The Trust is committed to following the ‘Better Payment Practice Code’ in dealing with suppliers of goods and services and the table below sets out our performance in 2010/11.
Better Payment Practice Code – Measure of Compliance 2010/11 Number £000 Total Non-NHS trade invoices paid in the year 45,466 37,459 Total Non NHS trade invoices paid within target 38,836 31,324 Percentage of Non-NHS trade invoices paid within target 85% 83%
Total NHS trade invoices paid in the year 740 26,334 Total NHS trade invoices paid within target 510 22,516 Percentage of NHS trade invoices paid within target 69% 86% The Better Payment Practice Code requires Trusts to aim to pay all undisputed invoices by the due date or within 30 days of receipt of goods or a valid invoice, whichever is later.
Prompt Payment Code
The Trust did not sign up to the code in the period since it was established as an NHS Trust but will do so in 2011/12.
Late payment of Commercial Debts (interest) Act 1998
The Trust did not incur any charges for late payment of commercial debts in 2010/11.
42 BCHC Annual Report 2010/11 Fees and charges
The Trust has complied with all applicable Treasury Guidance on setting charges for information.
Related parties
During the year, none of the Board members or members of the key management staff or parties related to them has undertaken any material transactions with Birmingham Community Healthcare NHS Trust other than those shown in the table below.
The figures disclosed in the table below are transactions between the organisation and the related party listed in the table, rather than transactions with the individual board members.
Related parties transactions 2010/11 Payments to Receipts from Amounts Amounts due related party related party owed to to related related party party £ £ £ £ Mr Phillip Davis - Chairman West Midlands Constitutional Convention (2002) Ltd Nil Nil Nil Nil Islington Gates Management Company Nil Nil Nil Nil Sandwell and West Birmingham Hospitals NHS Trust 0.00 0.00 86,725.85 Mr Rick Roberts - Medical Director Primary Care Research Centre Trust for Birmingham Nil Nil Nil Nil Midlands Research Practices Consortium Nil Nil Nil Nil Mrs Joanne Thurston - Director of Performance and Organisational Development West Midlands Ambulance Service Nil Nil 45,351.00 Nil Coun Paul Tilsley - Non-Executive Director NEC Group Nil Nil Nil Nil Birmingham International Airport Nil Nil Nil Nil Birmingham City Council Nil Nil Nil 2,033,104.63 Liberal Democrats Nil Nil Nil Nil Dr John Craggs - Non-Executive Director Acta Estates Services Ltd Nil Nil Nil Nil University of Birmingham Nil Nil Nil 25,778.20 Alta Cyclotron Services Ltd Nil Nil Nil Nil The University of Birmingham Pension and Assurances Scheme Nil Nil Nil Nil Bishop Vesey Grammar School Nil Nil Nil Nil Mr Ian Buckley - Non-Executive Director Whitehall Manor Maintenance Ltd Nil Nil Nil Nil Irridian Ltd Nil Nil Nil Nil Adflyer Nil Nil Nil Nil
43 The Department of Health is regarded as a related party. During the year Birmingham Community Healthcare NHS Trust has had a significant number of material transactions with the Department, and with other entities for which the Department is regarded as the parent Department. These entities are listed below:
Birmingham and Solihull Mental Health NHS Foundation Trust Birmingham Children’s Hospital NHS Foundation Trust Birmingham East and North Primary Care Trust Heart Of England NHS Foundation Trust Birmingham Women’s NHS Foundation Trust Dudley Primary Care Trust Heart Of Birmingham Teaching Primary Care Trust Royal Orthopaedic Hospital NHS Foundation Trust Sandwell and West Birmingham Hospitals NHS Trust Sandwell Primary Care Trust University Hospitals Birmingham NHS Foundation Trust Warwickshire Primary Care Trust West Midlands Ambulance Service NHS Trust West Midlands Strategic Health Authority
In addition, Birmingham Community Healthcare NHS Trust has had a significant number of material transactions with other Government Departments and other central and local Government bodies. Most of these transactions have been with Birmingham City Council.
44 BCHC Annual Report 2010/11 Remuneration entitlement of senior managers Name and Position Salary (bands Other Benefits in of £5,000) Remuneration Kind (bands of (rounded to the £5,000) nearest £000) Tracy Taylor – Chief Executive 110-115 Nil Nil Philip Davis – Chair 20-25 Nil Nil Andy Harrison – Chief Operating Officer 80-85 Nil Nil Rick Roberts – Medical Director 25-30 160-165* Nil Beverly Ingram – Director of Nursing and Therapies 80-85 Nil Nil Peter Axon – Director of Finance 85-90 Nil Nil Joanne Thurston – Director of Performance and Organisational 80-85 Nil Nil Development (non-voting Board member) Ian Buckley – Non-Executive Director 5-10 Nil Nil Celia Furnival – Non-Executive Director 5-10 Nil Nil Karen Bloor – Non-Executive Director 5-10 Nil Nil Paul Tilsley – Non-Executive Director 5-10 Nil Nil John Craggs – Non-Executive Director 5-10 Nil Nil *other remuneration Mr Roberts - this is a salary payment as a Dental Consultant Remuneration entitlement of senior managers
Name and Real increase Real increase Total accrued Lump sum at Cash Cash Real increase Title in pension at in pension pension at 60 at related equivalent equivalent in cash age 60 (bands lump sum at age 60 at to accrued transfer value transfer value equivalent of £2,500) age 60 (bands 31 March pension at 31 at at transfer of £2,500) 2011 (bands March 2011 31 March 31 March value of £5,00) (bands of 2011 2010 £5,00) £000 £000 £000 £000 £000 £000 £000 T Taylor 5-7.5 17.5-20 30-35 95-100 426 410 16 A Harrison 2.5-5 10-12.5 25-30 85-90 443 447 (4) R Roberts 0-2.5 5-7.5 85-90 255-260 2021 2067 (45) B Ingram 0-2.5 5-7.5 25-30 75-80 383 398 (15) P Axon 0-2.5 7.5-70 15-20 45-50 153 152 1 J Thurston 0-2.5 5-7.5 15-20 45-50 181 191 (10)
The summary financial statements were approved by the Board and signed on its behalf by:
Tracy Taylor, Chief Executive Peter Axon, Director of Finance
45 Capital cost absorption duty Our internal audit service is provided by CW Audit Services and the cost of the service for the year The dividend payable on public dividend capital is was £108k. based on the actual (rather than forecast) average relevant net assets and therefore the actual capital cost absorption rate would automatically be Independent auditor’s report to the 3.5%. However, due to the establishment of the Board of Directors of Birmingham Trust on the 1st November 2010, and the delay Community Healthcare NHS Trust in transfer of the land and buildings assets from commissioners the average relevant net assets for I have examined the summary financial statement the Trust would be a negative number. On this for the year ended 31 March 2011 set out on pages basis no dividend is payable and a return of 3.5% 37 to 46. cannot be generated as the Department of Health This report is made solely to the Board of Directors states dividends should be zero where the average of Birmingham Community Healthcare NHS Trust relevant net assets are negative. in accordance with Part II of the Audit Commission Act 1998 and for no other purpose, as set out in Difference between the carrying paragraph 45 of the Statement of Responsibilities amount and market value interest of Auditors and Audited Bodies published by the inland. Audit Commission in March 2010. The Trust does not own any land or buildings and Respective responsibilities of directors and auditor this is not applicable. The directors are responsible for preparing the Pension liability Annual Report. An indication of how pension liabilities are treated My responsibility is to report to you my opinion on in the accounts and a reference to the statements the consistency of the summary financial statement of the relevant pension scheme can be found in within the Annual Report with the statutory Note 11 of the annual accounts of the Trust. financial statements. International Financial Reporting I also read the other information contained in the Annual Report and consider the implications for my Standards (IFRS) report if I become aware of any misstatements or These accounts have been prepared in accordance material inconsistencies with the summary financial with International Financial Reporting Standards. statement. Countering fraud and corruption I conducted my work in accordance with Bulletin 2008/03 “The auditor’s statement on the summary Our Local Counter Fraud Service is provided by our financial statement in the United Kingdom” issued Internal Audit service and we have an annual plan by the Auditing Practices Board. My report on the of work that is compliant with the Secretary of statutory financial statements describes the basis of State’s directions. This is aimed at preventing and my opinion on those financial statements. detecting fraud and ensure that we take action where necessary. Opinion In my opinion the summary financial statement is External and internal audit consistent with the statutory financial statements Our external auditors are the Audit Commission of Birmingham Community Healthcare NHS Trust who were the auditors for our former host PCT for the year ended 31 March 2011. I have not NHS South Birmingham. They were formally considered the effects of any events between the appointed as auditors to Birmingham Community date on which I signed my report on the statutory Healthcare NHS Trust upon our establishment as financial statements (9 June 2011) and the date of an NHS Trust in November 2010. Our audit cost in this statement. respect of statutory services for the year was was £130k with a further £28k for assurance around John Gregory Payment By Results. £12k of the audit charge will Officer of the Audit Commission be reflected in 2011/12 accounts due to additional 2nd Floor, no 1 Friarsgate ,1011 Stratford Road works performed in the audit of the financial Solihull, West Midlands, B90 4EB statements relating to the accounting for the 1 July 2011 mergers in year.
46 BCHC Annual Report 2010/11 C5206 BENGALI
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jy qusIN ies prcy nMU iksy hor bxqr, v`fI CpweI, bryl, suxn vwlI typ/sIfI jW iksy hor bolI iv`c lYxw cwhuMdy ho qW ikrpw krky hyTW id`qy nMbr au~qy Pon kro[
0121 442 3600
47 Birmingham Community Healthcare Moseley Hall Hospital Alcester Road Moseley Birmingham B13 8JL
Tel: 0121 442 5600 Minicom: 0121 449 8352 Email: [email protected] Website: www.bhamcommunity.nhs.uk
Accessible, Responsive Community Healthcare
48 BCHC Annual Report 2010/11