Salford Royal NHS Foundation Trust Annual Report and Accounts 1 April 2013 to 31 March 2014
Salford Royal NHS Foundation Trust Annual Report and Accounts 1 April 2013 to 31 March 2014
Presented to Parliament pursuant to Schedule 7, paragraph 25(4) of the National Health Service Act 2006
Contents
1 An Introduction to Salford Royal NHS Foundation Trust Page 6
2 An Overview from the Chairman and Chief Executive Page 10
3 Strategic Report Page 14 Delivery of the 2013/14 Annual Plan including Quality Accounts Page 15 Looking Forward to 2014/15 including Principal Risks and Uncertainties Page 174
4 Director’s Report Page 186 Composition of the Board Page 188 Quality and Performance against Mandatory Standards Page 189 Annual Governance Statement Page 196
5 Governance and Organisational Arrangements Page 202 Foundation Trust Membership Page 203 Council of Governors Page 206 Board of Directors Page 211 Remuneration Report Page 223 Statement of the Chief Executive’s Responsibilities as the Accounting O!cer of Page 225 Salford Royal NHS Foundation Trust Independent Auditor’s Report Page 226
6 Financial Review (part of the Directors Report) Page 228 Foreword to the Accounts Page 234 Accounts for the Period 1 April 2013 to 31 March 2014 Page 235
Salford Royal NHS Foundation Trust - Annual Report and Accounts 2013/14 5 1 An Introduction to Salford Royal NHS Foundation Trust
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The Salford Royal NHS Foundation Trust is a statutory body, which became a public bene#t corporation on 1 August 2006 following its approval as a NHS Foundation Trust by the Independent Regulator of the NHS Foundation Trusts (Independent Regulator) authorised under the Health and Social Care (Community Health and Standards) Act 2006 (the 2006 Act).
The principal location of business of the Trust is: The Trust is registered with the Care Quality Commission Salford Royal, Stott Lane, Salford, without conditions and provides the following Greater Manchester, M6 8HD Regulated Activities across the stated locations: Accommodation for persons who require nursing In addition to the above, the Trust has registered the or personal care following locations with the Care Quality Commission; Accommodation for persons who require Community Clinics and O!ces: treatment for substance misuse The Maples, Simpson Road, Worsley, Treatment of disease, disorder or injury. Salford, M28 1LT Assessment of medical treatment for persons Wigan Renal Satellite Unit, Boston House, detained under the Mental Health Act 1983 Frog Lane, Wigan, WN6 7LB Surgical procedures Bolton Renal Satellite Unit, Minerva Road, Farnworth, Bolton, BL4 0JR Diagnostic and screening procedures Rochdale Renal Satellite Unit, Transport services, triage and medical advice Whitehall Street, Rochdale, OL12 0NB provided remotely Community Clinics and O!ces: Termination of pregnancies Sandringham House Nursing Care (District Nurses and Health Visitors) Barton Moss Young O"enders Institute Family Planning Services Eccles Gateway Salford Royal NHS Foundation Trust provides community Heartly Green and hospital services and it’s core purpose is to provide Little Hulton Health Centre clinical, academic and service excellence ensuring the Ordsall Health Centre patient experience is at the forefront of care. Pendleton Gateway Salford Royal is a large teaching Trust providing The Foundation Trust’s head o!ce is at: community and hospital services, some 850 beds, over 6000 sta" and providing a comprehensive range of Chief Executive’s O!ce, services to the 240,000 population of Salford, as well Salford Royal NHS Foundation Trust, as a wider range of services across Greater Manchester, Stott Lane, the North West and beyond to meet the complex Salford, needs of patients nationally. Greater Manchester, M6 8HD The organisation provides over one million community and hospital contacts for patients across: 0161 789 7373 [email protected] Adult and Children’s Community Services Emergency and Elective Inpatient Services Daycase Services Outpatient Services Diagnostic and Therapeutic Services.
Salford Royal NHS Foundation Trust - Annual Report and Accounts 2013/14 7 1
It also includes: the full range of acute and specialist medical services include gastroenterology incorporating endoscopy & alcohol outreach, Cardiology, Diabetes & Endocrinology including Weight Management and Respiratory Medicine. The Metabolic Medicine service also sits within the Division providing specialist metabolic services to the national patient population. The Emergency Department provides services for Adults and Children with links to the Royal Manchester Children’s Hospital at Central Manchester Foundation Trust and partner Trusts in the Trauma Collaborative. The Trust was accredited as a key component of the Greater Manchester Trauma Centre Collaborative Community services are provided within our patients’ (GMTCC) on 30 March 2012. Within Greater homes and at the range of community locations Manchester, trauma patients will bypass their local detailed on page 7. hospital and be taken to a Trauma Unit or Centre to be stabilised and transferred as appropriate to the The majority of the Trust’s acute services are provided collaborative hospital most relevant to their clinical at the main Salford Royal site. Additionally the Trust needs. Components of the Trauma model are provided provides specialist services at The Maples Neuro- across the Divisions including access to Neurosurgery, rehabilitation Centre and Renal Dialysis provided at General Surgery, Trauma and Orthopaedics, Critical satellite units in Wigan, Bolton and Rochdale. Outpatient Care, Diagnostics and Rehabilitation. services for Neurology and Dermatology are provided across Greater Manchester and into Cheshire. Mental health support to our emergency department & inpatient wards is provided by Greater Manchester The Trust’s Divisional Structure acknowledges the West Mental Health Foundation Trust who provide a 24 di"erent populations (and associated commissioning hour Mental Health Liaison team. arrangements) served by Salford Royal. Details of services provided by the four Clinical Divisions are Division of Surgery described below: The Division of Surgery provides Surgical Services Division of Salford Healthcare including Breast Surgery, Colorectal Surgery, Upper Gastrointestinal Surgery, General Surgery, The Division of Salford Health Care provides the Gynaecology, Trauma and Orthopaedics, Urology, Oral majority of our community based services, including Surgery and Orthodontics to the population of Salford. Children’s services with PANDA, Health visiting and school nursing, Community & District Nursing, Specialist Cancer Services are provided to the patients Intermediate Care, GP out of hours and the Care of the North West Sector (Salford, Wigan and Bolton) Homes Medical Practice. The Division delivers and Specialist Surgery (Cancer and other services) services to the population of Salford and includes the across a wider Greater Manchester population. Emergency Department, Emergency Assessment unit, The Intestinal Failure and adult bowel lengthening Acute Medicine, Specialist Medicine & Ageing and surgical service is provided for a national population. Complex Medicine. The Division also provides Clinical Health Psychology services as well as community based sexual health and oral services.
Salford Royal NHS Foundation Trust - Annual Report and Accounts 2013/14 8 1
Division of Neurosciences & Renal Medicine The Division of Neurosciences and Renal Medicine provides a comprehensive surgical and medical Neuroscience service to the population of Greater Manchester incorporating regional Stroke services, Neurology, Neurophysiology and Neuro-rehabilitation provided at ‘The Maples’ and on site Neuro- rehabilitation wards. The Trauma Assessment Unit managed by Most of our Podiatry clinics run from Health Centres Neurosurgery and additional Neuro-rehabilitation and Gateways across Salford including; Irlam, Little capacity has been developed to support the Major Hulton, Ordsall, Pendlebury, Swinton, The Willows, Trauma Centre. The Trust operates a Stereotactic Eccles, Pendleton, Walkden and Higher Broughton. Radiosurgery Service as part of the Christie at Salford Acute services run from Salford Royal within the initiative. The Division provides Specialist Spinal hospital setting. services across Greater Manchester including specialist From April 2014, the Division will also manage all hotel spinal surgery and non-invasive treatments. services for the Trust. The Renal department provides an inpatient and The Radiology Service provides a wide range of outpatient service to the western sector of Greater general and neuroradiology diagnostic and screening Manchester and satellite dialysis services in Salford, services including CT, CTVC, MR and Gamma across Wigan, Bolton and Rochdale. New dialysis capacity is Greater Manchester. opening in Oldham early 2014. Pathology at Wigan & Salford (PAWS) is fully The Division also provide ENT and skull base surgery operational with the central laboratory on the Salford and comprehensive Pain Management Services. Royal Site and a “hot laboratory” on the Royal Albert hospital site in Wigan. Division of Clinical Support Services and The Division also manage Critical Care services Tertiary Medicine including the Intensive Care, Surgical High The Division of Clinical Support Services and Tertiary Dependency and Neuro High Dependency Units. Medicine provides a comprehensive range of clinical Tertiary Medical services include Dermatology, support services to our community and hospital- Rheumatology and Haematology. Dermatology based services including Radiology, Pharmacy, services are provided across Greater Manchester and Access Booking and Choice/Health Records, Allied Clinical Haematology including Oncology services are Health Professional Services, Cancer Services, South provided for patients of the North West sector Manchester Retinopathy Screening Service and Medical Equipment Services. The Division also takes a lead on Outpatient Improvement and Seven Day Working. An example of our Allied Health Professional services is the Podiatry Service o"ering assessment and treatment for a wide range of foot complaints as well as management of patients at high risk of foot problems such as those with diabetes, rheumatoid Sir David Dalton arthritis and peripheral vascular disease. Chief Executive Date: 29 May 2014
Salford Royal NHS Foundation Trust - Annual Report and Accounts 2013/14 9 2 An Overview from the Chairman and Chief Executive
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Salford Royal has demonstrated outstanding success and has stood tall as a well-recognised, highly performing NHS community and hospital service provider.
This success has been achieved because of the Well-developed measurement and monitoring hard work and determination of our sta" to deliver mechanisms, such as the Nursing Assessment and safe, clean and personal care to every patient. Our Accreditation System (NAAS) were further developed ambitions are set high to ensure reliability and for community and out-patient services. The highest continuous improvement in the quality and safety of accolade of this assessment process is SCAPE status care for our patients. - Safe, Clean and Personal Everytime, and many wards across the Trust proudly achieved this. Ahead of all The year began with Salford Royal celebrating being other NHS hospitals, we began to display nurse sta!ng rated as the best acute Trust in the 2012 National Sta" levels at the entrance to every ward. This is now well- Survey, and within the top 10% of all Trusts in England established across all wards within the hospital. in the 2012 National In-Patient Survey. Salford Royal’s fully integrated Community Services The Secretary of State for Health, Jeremy Hunt MP, were focussed on further improving discharge visited Salford Royal in April 2013 and publicly planning, developing a ground-breaking service for commended the Trust’s success in ensuring continuous frail-elderly patients, improving services for patients improvement in the quality of care for patients. The with long-term conditions and delivering high-quality Chief Executive and Executive Nurse were invited by adult community nursing services. the Prime Minister to participate on a national review The Out-patient Department Improvement Project of safety across the NHS, led by Professor Don Berwick. was about developing innovative ways of working The #nancial pressure on the NHS continued to be to improve patient experience. Much progress has felt at all levels during 2013/14. Salford Royal has been made to implement the Salford Standards, a a track record of strong #nancial management and programme of work to normalise key services provided delivered challenging cost reductions and productivity on Saturdays and Sundays, so that the same standard is improvements during 2012/13, while ensuring provided every day of the week. the quality of care we o"er our patients was not Salford Royal commenced replacement of the compromised. We appreciate the huge team e"ort electronic patient record (EPR) systems during 2012/13 of our sta" made, across our hospital and community and in June 2013 phase one was completed with services, which ensured that high quality care was the successful switch over to the new EPR. The rich maintained to patients. functionality of this new system is a key enabler to Salford Royal’s aim to be the safest NHS organisation. The Board continued to steer the Trust’s ambitious A number of next phase EPR projects are now quality improvement and patient safety plans. We underway. have reduced MRSA blood stream infections at the Trust by almost 100%, C. di!cile by 90% and cardiac The Trust and key partners across Salford embarked on arrests by 51%. We have achieved 12 months without designing a model for Integrated Care for Older People a single patient acquiring a single high-grade pressure across Salford during the !rst quarter of 2013/14. A ulcer on our wards. Our mortality rates are in the best memorandum of understanding is now in place setting 10% nationally and the best outside of London. The out the intent of this ground-breaking work. The Board ensured particular focus on key programmes model will be rolled out City-wide from April to July of work, including End of Life and Bereavement Care, 2014. Dementia and Delirium and Safety of Care in Theatres.
Salford Royal NHS Foundation Trust - Annual Report and Accounts 2013/14 11 2
During the Summer of 2013, an environmental The CQC con#rmed the Trust was providing exemplary health inspection resulted in a one star rating for services which were safe, e"ective, responsive, caring Salford Royal’s patient food kitchen. The Trust acted and well-led. The assurance this provides for the urgently, con#rming #rst and foremost that patients Trust should not be understated, the CQC as a main had not been exposed to risk of harm, this and other regulator inspected under a new, rigorous regime immediate actions resulted in environmental health and found the Trust to be compliant with essential con#rming that the kitchen was functioning safely. standards, highlighting many areas of best practice. A re-inspection took place in December and Salford Salford Royal was announced as Trust of the Year for Royal’s patient kitchen was awarded the highest rating North of England in December 2013 within the Dr of #ve stars. Foster Intelligence 2013 Good Hospital Guide. During September, the Secretary of State for Patients and sta" are now bene#tting from the three Health announced that Salford Royal would provide brand new operating theatres, which opened in improvement support to Buckinghamshire Healthcare December 2013. This £5m project provides additional NHS Trust. Key improvement themes were agreed and emergency operating theatres and increased operating commenced, including a #rst quality improvement theatre capacity allowing us to upgrade to our existing breakthrough collaborative at the Buckinghamshire 18 theatres. Trust and developing understanding about The 2014 New Year’s Honours List brought wonderful unscheduled care pathways from Salford Royal’s news for Salford Royal. Chief Executive, David Dalton, Emergency Village and Care of the Elderly Services. received a knighthood and Consultant Surgeon, Mr Iain Salford Royal’s Celebration Event took place in Anderson, an MBE. These honours are well-deserved November and senior sta" from the past celebrated and we are very proud that Salford Royal is associated with these achievements. Salford Royal’s development, across several decades. HAELO was also launched on this day, a In January, the Trust was invited to provide joint venture between the Trust and Salford Clinical improvement support to East Lancashire Hospitals NHS Commissioning Group creating a centre within Salford Trust. Work has commenced to ensure improvement for Improvement in Health and Healthcare. across key areas. The Trust continues to o"er support and share learning with many other NHS organisations. We are working in partnership with others to improve Several Open Days have been hosted throughout patient services and care, in line with the Healthier 2013/14, with visitors from across the country. Together Programme for Greater Manchester. Chief Executives and Medical Directors from the Salford, The Board embarked on a refresh of its #ve year Bolton and Wigan Foundation Trusts met during strategy during 2013, commissioning McKinsey to 2013/14, and surgical colleagues from the three trusts undertake a ‘stock-take’ of the Trust’s current position, are now driving developments forward to create a likely external in$uences and challenges for the single shared surgical service across the three localities. foreseeable future, and to showcase relevant business models and innovations that have led to success It had been announced In July 2013, that Salford Royal around the world. The Board and Senior Leadership was to be one of the low-risk organisations included Team developed this work at two events during in the #rst wave of inspections by the new NHS Chief February 2013 and will #nalise the strategy in June Inspector of Hospitals, Care Quality Commission 2014. (CQC). This CQC Inspection took place in October and the report from the inspection, the CQC Inspection Quality Report, was presented at an event with all key stakeholders in December 2013.
Salford Royal NHS Foundation Trust - Annual Report and Accounts 2013/14 12 2
Work had been underway throughout 2013/14 to apply the main themes from the Robert Francis Enquiry into the failings of the Mid Sta"ordshire NHS Foundation Trust. This work has led to wholesale redesign of Salford Royal’s Quality Improvement Strategy, which is soon to be launched for 2014/17. The Trust developed its People Strategy during James J Potter 2013/14. Our improved contribution (performance) Chairman management processes will be launched from April Date: 29 May 2014 2014, as a key enabler to our aims for the future. Activity continued to be very high within the Accident and Emergency during the !nal quarter of 2013/14, critical care areas were at full capacity and maintaining e"ective patient $ow across the hospital was challenging. We appreciate the huge e"ort our sta" made during the extended winter period to ensuring high quality care has been maintained for patients. Sir David Dalton Chief Executive The Trust maintained the best possible quarterly Date: 29 May 2014 governance risk rating, from the sector regulator Monitor, during 2013/14, re$ecting achievement of key targets and indicators. Financial risk ratings were also achieved, on a quarterly basis, either on or above plan. Salford Royal’s well-established #nancial management controls ensured our excellent track record of delivery against plans continued and by the end of 2013/14 we were posting a normalised surplus of £6m, against a plan of £2.7m. Salford Royal has developed as one of the safest and best run NHS Foundation Trusts in the country, delivering some of the best health outcomes for populations with the highest health needs. As we approached 2014/15, the Trust learnt of the #ndings from the 2013 National NHS Sta" Survey and National NHS Patient Survey. The former had placed Salford Royal as the best place to work in the NHS, and the latter rated Salford Royal as the best acute trust in England. What better way for Salford Royal to stride into this new #nancial year, recognising all the challenges it brings, with aims set high and determination to succeed once again.
Salford Royal NHS Foundation Trust - Annual Report and Accounts 2013/14 13 3 Strategic Report
14 3 Delivery of the 2013/14 Annual Plan
The Strategic Report is prepared in accordance with sections 414A, 414C and 414D of the Companies Act 2006, as interpreted with the Financial Reporting Manual (FReM)
This report is presented to provide a fair review of Theme 1: the business of Salford Royal. We have aimed to provide a balanced and comprehensive analysis of the Pursuing Quality development and performance of the Trust during the Improvement to become the #nancial year and the position of the business at the safest organisation in the NHS end of the #nancial year, to the extent necessary for people to understand. Quality is our primary focus at Salford Royal, across all The Board of Directors at Salford Royal considers the community and hospital services. We have had a clear annual report and accounts, taken as a whole, are Quality Improvement Strategy in place since 2008. The fair, balanced and understandable and provide the current Quality Improvement Strategy describes how information necessary for patients, regulators and we intend to achieve reductions in Harm and Mortality, other stakeholders to assess the NHS Foundation improve Patient Experience and deliver Reliable Care. Trust’s performance, business model and strategy. Salford Royal’s achievements during 2013/14 in It is Salford Royal’s vision to be the safest organisation delivering the Quality Improvement Strategy are in the NHS by continuing to reduce our standardised detailed within the Quality Accounts section of this hospital mortality rate (HSMR), to be in the top decile Report - please see pages 16 to 146. of NHS performance, and continuing to reduce avoidable harm through the delivery of the Trust’s planned programme of Quality Improvement Projects, aimed at ensuring we provide Safe, Clean and Personal care to every patient, every time. The Trust sets its aims and objectives through its 5 year Service Development Strategy and Annual Business Plan. The main aims for 2014/15 are: Pursuing Quality Improvement to become the safest organisation in the NHS. Safely reducing costs by £19m. Supporting high performance and improvement. Improving care and services through integration and collaboration. Whilst ensuring compliance with all Mandatory Standards and delivering: Research & Development. Education. The Estates Strategy. Information Management & Technology. Corporate & Social Responsibility and Public Health Strategies.
Salford Royal NHS Foundation Trust - Annual Report and Accounts 2013/14 15 uality Accounts 2013-2014 Contents
1 Achievements in quality Page 18 4 Review of quality performance Page 112 2013/14 Achievements Page 19 Performance against national targets Page 113 Statement on quality from the Chief Executive Page 20 and regulatory requirements 2013/14 The NHS Outcomes Framework indicators Page 114 2 Our quality achievements Page 23 Performance against Trust selected metrics Page 119 Our aims Page 24 NHS England Safety Alert Compliance 2013/14 Page 120 Clinical microsystems Page 26 How we keep everyone informed Page 121 A focus on the community Page 35 Statements from Clinical Commissioning Page 122 The Salford Integrated Care Programme Page 38 Group, Healthwatch and Overview Improving our outpatient department Page 40 and Scrutiny Committees Using volunteers to enhance Page 42 Statement of Directors’ responsibilities Page 124 Patient choice in end of life Page 44 in respect of the quality report Safer sta!ng levels Page 49 Independent auditor’s report to the Council Page 125 of Governors of Salford Royal NHS Foundation Performance against national targets Page 50 Trust on the annual quality report 2013/14 A review of Quality Improvement Projects Page 51 Appendices Page 127 2013/14 5 Appendix A: Page 128 3 Our plans for the future Page 98 National clinical audits: actions to improve quality The Quality Improvement Strategy 2011/14 Page 99 Appendix B: Page 133 The Berwick Review Page 102 Local clinical audit: Our quality priorities 2014/15 Page 104 actions to improve quality Statements of assurance from the board Page 105 Appendix C: Page 135 Review of services Page 105 National con"dential enquiries: actions to improve quality Participation in clinical audits Page 105 Participation in clinical research Page 108 Appendix D: Page 136 Commissioning for quality and Goals agreed with commissioners: Page 108 innovation payment framework use of the CQUIN payment framework Appendix E: Page 143 Data quality: relevance of data quality Page 109 Glossary of de"nitions and action to improve data quality NHS number of general medical Page 110 practice code validity If you require any further information about the Information governance toolkit Page 110 2013/14 Quality Accounts please contact: attainment level The Quality Improvement Team on 0161 206 8167 Clinical coding error rate Page 110 What others and the Care Quality Page 111 or email Liam Doyle at [email protected] Commission say about Salford Royal NHS Foundation Trust 17 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 1 Achievements in Quality
Over 7 years we have achieved: 2013/14 achievements: 24% increase in patients having an accurate list 8.7% reduction in risk adjusted of medications in the we have continued to maintain our weekend mortality Emergency Assessment Unit 10% position for risk adjusted mortality over 420 days without a MRSA over a Year blood stream infection without a serious incident in Theatres reduction in MRSA blood stream within the Division of Surgery 100% 62% reduction in Clostridium maintained 95% infections di!cile infections compliance with evidence based Surgical Site Infections Bundle over 365 days without a Grade reduction in Clostridium di!cile 3 or 4 pressure ulcer 95% compliance with Salford 90% Royal’s Dementia and infections of wards have achieved 12 Delirium Care Bundle 50% months without a pressure ulcer of any grade 97.9% of Salford Royal patients receive harm free care reduction in cardiac arrests 96% of patients have VTE risk 51% assessment completed of Salford Royal patients 90% rate their care as excellent reduction in readmission or very good elimination of Grade 3 and 4 pressure 38% rate for elective hip and knee surgery patients Best Trust nationally in the NHS 100% ulcers and 45% reduction in Grade 2 Sta! Survey 2013
18 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 1 2013/14 Achievements
Dr Foster Good Hospital Guide 2013 Salford Royal Sta! Survey Kieran O’Flynn Salford Royal Named Trust of the Year for the Con!rmed as the Best Place to Work in the NHS North West Regional Award for Training, British North of England - Salford Royal’s people rate the Trust as the Association of Urological Surgeons (BAUS) best place to work in the NHS, according to the national annual NHS Sta" Survey (2013) NHS Employers Health Visitors Recognise Salford Royal for achieving Equality Awarded Stage 2 accreditation for UNICEF Baby & Diversity Partners 2012/13 Catheter Related Urinary Tract Friendly Initiative Infections Project Wins best presentation at British Association of Stroke Research Network Urological Nurses Conference Salford Renal Team Wins Patient Carer and Public Involvement Winners of ‘Creating and Improving E#ciencies’ Team of the Year Award category, HQIP Conference Dr Robert Taylor Head of Clinical Engineering receives Salford Royal Innovating for Life Award Professor Gordon Carlson Reports highest patient satisfaction scores for Fellowship of Royal College of Surgeons for the North West - 94 per cent of Salford Royal outstanding contribution to surgery cancer patients experienced ‘excellent’ or ‘very New Year’s Honours 2014 good’ care, as reported by the Cancer Patient Salford Royal Chief Executive David Dalton Experience Survey 2013 receives a Knighthood Sir David Dalton Iain Anderson (Consultant Surgeon) receives is named in top 10 list of Top Chief Executives 2014 - Health Service Journal Specialist Multiple Sclerosis MBE Salford Royal MS Specialist Nurse Lindsay Harrison named as a joint winner in the Cath Fitzsimmons Car Parking Customer Care Team Multiple Sclerosis Trust’s ‘My Super Nurse’ British Parking Association’s Park Mark award Receives the Henry Garnett Award from Award 2013 for sta" car park (MSCP) and the Central and Macmillan Cancer Support North car parks for patients and visitors
19 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 1 Statement on Quality from the Chief Executive
20 1
Salford Royal NHS Foundation Trust has a clear ambition Our mortality rates are in the best 10% nationally and the to be the safest organisation in the NHS. This means that best outside of London and in addition fewer Salford Royal assuring patient safety and service quality are at the heart patients now die, if they are admitted over a weekend, due of everything we do; with our sta# being proud to provide to the changes we have made to our services to ensure safe, clean and personal care to every patient, every time. patients receive the same high quality care at the weekend As a consequence of our hard work and results, we are as throughout the week. increasing our national reputation as a leader in quality These Quality Accounts o#er a detailed look at our improvement and patient safety. As Chief Executive I am improvement work at Salford Royal where our Quality proud of our achievements to date and, with the Board, Improvement Strategy focuses on four key areas: have committed myself to deliver further improvements. Reducing mortality This Quality Account describes those achievements for last year and plans for next year. Reducing harm Improving the reliability of the care we provide In 2008 we launched our ambition to become the safest organisation in the NHS through delivering safe, clean Improving the patient experience and personal care to every patient, every time. We were Within the last year Salford Royal was one of the "rst Trusts determined that we would lower our mortality rates and nationally to undergo one of the Care Quality Commission’s ensure that fewer patients experienced harm whilst in our new style of inspections, having been chosen to take care. part in the "rst wave as it is classed as a low risk Trust. A As part of our Quality Improvement Strategy, we team of inspectors, including doctors, nurses and trained introduced and rolled out a wide range of patient safety members of the public visited the organisation on both initiatives to tackle issues such as cardiac arrests, falls, an announced and unannounced basis in October and pressure ulcers and surgical site infections. examined a range of Salford Royal’s wards and services. Additionally, inspectors spoke to sta#, patients and visitors Nearly six years later, we know our patients are bene"tting during focus groups, interviews and a patient listening greatly from this work. Since 2008 we have reduced MRSA event. blood stream infections at the Trust by almost 100%, C-Di!cile by 90% and cardiac arrests by 51%. Recently, we In the "nal inspection report on Salford Royal, inspectors achieved 12 months without a single patient acquiring a declared that the organisation is providing exemplary high grade pressure ulcer on any of our wards. services which are safe, e#ective, responsive, caring and well led, in addition to highlighting a strong culture of learning and a real drive to continuously improve.
21 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 Myself and Executive Nurse Director Elaine Inglesby-Burke In site and infrastructure developments, we opened three were honoured to be invited to sit on the panel of experts new ‘state of the art’ theatres at the end of 2013. Salford for Professor Don Berwick’s National Advisory Group on Royal has seen a steady rise in surgical activity over the the Safety of Patients in England, which was established at last few years and the new facilities will provide the extra the request of Prime Minister David Cameron following the capacity that is now needed to ensure that patients get Francis Report into the crisis at Mid-Sta#ordshire Hospital. timely access to surgery. In addition to this, Elaine was one of a number of senior We also celebrated the successful launch of our new nurses across the country to form ‘Safe and Sound’ - the Electronic Patient Record (EPR). Around 7,000 health care Safe Sta!ng Alliance to demand minimum registered professionals will bene"t from using the new system, nurse sta!ng levels. As part of our commitment to safety including on-site sta#, sta# working in the community and transparency, we have introduced a system where and 160 GPs from all practices across the city. For patients, each ward at Salford Royal has a sta!ng level board which the new system provides the Trust with the platform to displays the required and actual numbers of sta# on shift transform care and allow a patient’s record to be accessed throughout the day. by the clinicians involved in their care regardless of location, for example, the hospital or GP surgery. In 2013, we received the accolade of Trust of the Year for the North of England in the 2013 Dr Foster Hospital Guide The new EPR "rmly places Salford Royal at the forefront awards. of health informatics and will allow the organisation to introduce further innovation, for example allowing patients We were delighted to receive the news that Salford Royal’s to log on and view their own health records via a portal. people rate the Trust as the best place to work in the NHS, according to the national annual NHS Sta# Survey (2013). I am pleased to con"rm that the Board of Directors has For the past two years, we’ve had the best survey results of reviewed the 2013/14 Quality Account and con"rm that it all acute Trusts so to improve on this position by receiving is a true and fair re$ection of our performance. We hope the best results across all Trusts, of every type, is absolutely that this Quality Account provides you with a clear picture wonderful. It is now our ambition to be considered one of of how important quality improvement, patient safety and the best places to work in the country, not just in the NHS, patient and carer experience are to us at Salford Royal. but in any sector or industry. We know that there’s a strong link between highly engaged workforces and high quality patient care so these results are not only excellent results Sir David Dalton May 2014 for our people but for our patients too. Chief Executive Salford Royal NHS Foundation Trust
22 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2 Our Quality achievements
Quality is our primary focus at Salford Royal, and we have had a clear Quality Improvement Strategy in place since 2008. The diagram below summarises the Quality Improvement Strategy for 2011/2014.
Using data to drive 7-day working improvement Emergency / urgent Quality improvement care redesign TS courses Clinical Assessment & Lean methodology Accreditation System Capability Reliable ward round Microsystems ord Standards and clerking & Measurementmethodology PROJEC Salf Safest organisation Assurance & Sustainability in the NHS Leadership for quality Leadership improvement Values Patient / customer focus Teamwork and Respect communication Continuous improvement Creating a culture of safety Accountability Divisional Quality Strategies
* Maintain position in 10% of NHS organisations with the lowest risk adjusted mortality ** 95% of patients receive harm free care as measured by the following 4 harms: Pressure ulcers, Catheter associated urinary tract infection, Venous thromboembolism, Harm from falls *** Achive 95% reliability in the following: Advancing Quality Care bundles, Intentional rounding, Structured ward rounds, Infection bundles **** Achieve top 20% for patient and sta! experience surveys
23 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2 Our aims
The current Quality Improvement Strategy describes how we intend to achieve reductions in Harm and Mortality and improve Patient Experience and the delivery of Reliable Care. This section of our Quality Accounts looks brie$y at some of the achievements that we have made so far.
Reducing harm We have undertaken targeted work to reduce harm 97.9% of our patients receiving harm to our patients: free care (measured by the Safety Over seven years we have achieved: Thermometer) 100% reduction in MRSA blood stream infection Harm is suboptimal care which reaches the 90% reduction in Clostridium di!cile infections patient either because of something we 51% reduction in cardiac arrests shouldn’t have done or something we didn’t do 45% reduction in Grade 2 pressure ulcers that we should have done. Hospital acquired infections, medication errors, surgical infections, In 2013/14 we have achieved: pressure sores and other complications are 8.7% reduction in risk adjusted weekend mortality when examples of harm which can occur within a compared to last "nancial year healthcare setting. Over one year without a Grade 3 or 4 pressure ulcer At Salford Royal we aim to reduce harm. We 50% of wards have achieved 12 months without a measure the outcomes of many individual pressure ulcer of any grade harms to identify the impact of any 62% reduction in Clostridium di!cile infections improvement work we undertake. We are proud Over a year without a serious incident in Theatres of the achievements which we have highlighted within the Division of Surgery here, however, whilst harm is taking place in the compliance with evidence based organisation we still have work to do. Maintained 95% Surgical Site Infections Bundle 95% compliance with Salford Royal’s Dementia and Delirium Care Bundle 96% of patients have VTE risk assessment completed 24% increase in patients having an accurate list of medications in the Emergency Assessment Unit The Department of Health Safety Thermometer has shown that 97.9% of our patients receive harm free care
24 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2
Reducing mortality Achieved position of top 10% of NHS Trusts for risk adjusted experience trackers, all of which provide us with vital mortality and an 8.7% reduction for risk adjusted weekend information on how to improve. We had some fantastic mortality results from this year’s National Patient Experience Survey We use two measures of mortality both of which adjust our and we will continue to put a major focus on what matters outcomes for the risk in our patient group. They compare most to our patients in the coming year. the number of patients that would be expected to die, Salford Royal performs better than average on 45 questions given the severity of their conditions, when compared in the patient survey to national models against the number of patients who Salford Royal performs better than last year on 18 questions actually die. These measures are HSMR (Hospitalised Standardised Mortality Ratio) and SHMI (Summary Salford Royal performs average or better for ALL questions Hospital-level Mortality Indicator), they are both measures asked to our patients of mortality but have slightly di#erent calculation methods. Salford Royal’s HSMR performance is in the top 10% of NHS Improving reliability Trusts, as it is statistically better than expected with a rate 90% of Salford Royal patients rate their care as of 79.6 as reported in the Dr Foster Hospital Guide for 2013. excellent or very good Since the start of SHMI our quarterly value has not been above the national average, indeed out of the 12 quarters It is widely acknowledged that aspects of healthcare do for which data is available seven quarters have been not perform as well as they should. Studies have shown statistically better than expected. that there is inconsistency in the delivery of high quality care and that patients often only receive a fraction of the In addition, we continue to work on seven-day working to care that is recommended. Reliability science can help make sure our Trust is safe throughout the entire week. Our healthcare providers redesign systems to make sure more weekend HSMR is also below the national average at 89.6. patients receive all the elements of care they need. Improving patient experience We are using the principles of reliability science to maintain high performance, improve care where needed and 90% of Salford Royal patients rate their care as improve processes in the following areas: excellent or very good Community-acquired pneumonia The views of our patients and sta# are very important Heart failure to us. We spend a lot of time collecting and responding Hip and knee replacement to information we receive about our services from our Myocardial infarction (heart attack) patients and sta#. We receive feedback through a number Stroke of methods, including surveys, patient stories and patient Intentional Rounding
25 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2 Clinical Microsystems Coaching
Clinical Microsystems Coaching works on the principle that all sta# have two jobs, one to deliver care and two to improve how that care is delivered. New for 2013/14, the Clinical Microsystems approach supports teams to lead and manage their own improvement work with focussed coaching in quality improvement methodology to ultimately build Trust wide improvement capability. What makes this programme di#erent to established Quality Improvement projects and collaboratives is the pace and structure of the coaching programme, and the fact that teams involved are more likely to have ownership of the improvement work, achieved predominantly through the multi-disciplinary team highlighting areas for improvement themselves using quality improvement methods. What: A structured six month coaching programme working with teams on a weekly basis on areas highlighted by them, whilst spreading Trust wide improvement capabilities By when: New for 2013/14 - now annual programme Progress: On plan Multiple teams have seen signi"cant improvements in their Improvements achieved area of work, some examples of this can be seen in the 12 teams completed the programme in 2013/14, exposing following pages a large number of sta# to a wide range of improvement Teams engaged and empowered to develop their own tools and techniques: ideas for improvement and continue to meet once formal Wave 1 teams and project focus: coaching has ended Improving spinal surgery outcomes Annual programme now established, teams for 2014/15 are: Paediatric Continence Service Wave 2 teams and project focus: Tertiary Medicine - clinical correspondence and administrative processes Renal Services - dialysis unit stock processes Improvements in stoma care Post-transplant patient review Pharmacist Prescriber on Surgical Admissions Lounge Intestinal Failure Unit - improvements in handover process General Surgery theatre listings process Improvements in early in$ammatory arthritis pathway Ward L2 - co-ordinated collaborative working with Quality Improvement Wards B1 and B2 - improvement in ward round processes Pre-operative optimisation of complex spinal patients Stroke services - improvement in timeliness of thrombolysis Haematology Day Case - scheduling and patient experience Timeliness of medications ready for patient discharge Improvement in Physiotherapy services Pre-operative anaemia Pharmacy - Improving medication accuracy PANDA Unit
26 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2
Re$ections on Clinical Microsystems Coaching
Physiotherapy Microsystems Team As a team we were relatively new to Quality Improvement For instance, measurement and displaying of data was concepts and so started with a basic introduction to QI interesting and helped us to understand if our changes had methodology, which enabled us to outline the areas we needed made a clinically significant difference. to focus on and how we might tackle the issues highlighted. In essence, as senior physiotherapists in our department we We had good structure and ground rules to our meetings from have been effectively introduced to a process that will help us the start and a detailed plan of actions from week to week to improve the way our department runs and will help us to that kept us focussed. QI related teaching and theories were objectively measure this. Ultimately this enhances the quality tailored to suit the progress of the team so it was meaningful of care that we give to patients. We have a number of other and pertinent to the stage of the project. projects that we are planning to apply the QI process to.
27 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2
Using clinical microsystems coaching to reduce Further improvements identi!ed Vitamin D de!ciency in spinal surgery patients Working with General Practitioners regarding action We have shown that many of our patients who need following identi"cation of Vitamin D insu!ciency complex spinal surgery do not have enough Vitamin D. Retesting in Surgical Admissions Lounge to check Vitamin D is crucial for the body, particularly the bones. supplementation has worked If patients’ Vitamin D levels are not improved it may lead Discussions with pharmacy colleagues about delivering to complications after surgery, increase length of time in regime for supplementation hospital and prolong the recovery period. Telemedicine for informing patients regarding Vitamin D What we set out to achieve: result 95% patients will have a Vitamin D speci"c test on pre- Re$ections on Clinical Microsystems Coaching operative assessment 95% patients will have that test reviewed within 14 days
As a team who assess and prepare patients for complex Dr Leigh Willoughby spinal surgery, we are ideally placed to assess our Consultant Anaesthetist patients’ Vitamin D status prior to surgery. We wanted In the NHS we’re pretty poor at getting all team members in the to develop a system to make sure that patients are same room and listening to each other’s ideas and perspectives. in the best possible condition prior to their surgery. We fail to understand the roles which are unseen to us, only communicate on a superficial level and get frustrated when we fail Focussing on using the time leading up to surgery to to change the system. Clinical Microsystems changes all that - it improve the Vitamin D status of our patients is the "rst is exactly the collaborative environment your project needs to get step. In the future we plan to develop a bundle of your ideas off the ground in small manageable steps. It combines targeted nutritional interventions to make sure our the gentle guidance of your coach, a structured approach to planning and tackling a project and a highly effective weekly patients are in the best possible condition prior to meeting format which drives your project forward quicker than surgery and therefore at lower risk of complications you would imagine. Its value is in providing a listening environment, during their admission and quick to regain active lives building trust between stakeholders and enhancing the group’s in the community. ability to work together which speeds up progress. The Microsystems approach has been instrumental in helping us Improvements achieved start our pre-operative optimisation of complex spinal surgery patients. We have achieved all our preliminary goals and have Over 95% patients have a Vitamin D speci"c test on pre- had fantastic appreciative feedback from our patients. By operative assessment optimising aspects of health prior to surgery using current guidelines we anticipate reduction in complications and better Over 95% patients have test reviewed within 14 days functional outcomes. It is still early in the project but we now Patient information lea$et developed have the momentum and the results to spur us on to enhance this approach further. Medicines Management approval for supplementation obtained 28 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2
Spinal outcomes team - using data to improve Improvements achieved our services Increased number of patients consenting to take part in Salford is one of the largest centres for spinal surgery Spine Tango in Europe, with more than 2,200 patients having spinal Co-ordinated working with Pre-operative service and surgery every year. In 2011, Salford joined ‘Spine Tango’ Theatres department (an international register of spinal surgeries) to assess Improved patient information patient reported outcomes for spinal operations. We Improved timeliness and quality of consultant surgery forms joined to ensure that we are providing safe and high quality care to our patients, to evaluate our performance Increased response rate from patients following surgery at an international level and to enable research to improve Provision of a variety of methods to complete treatment and outcomes. questionnaire e.g. telephone, email, postal return The Spinal Outcomes Team are responsible for collecting, Increased awareness of the Spine Tango project and the analysing and publishing information regarding patients’ Spinal Outcomes Team symptoms prior to surgery, information on the surgery Streamlined administrative processes within the Spinal itself and patients’ symptoms following spinal surgery. Outcomes Team
What we set out to achieve Further improvements identi!ed To explore ways of improving the performance of the Continue with weekly meetings to drive further Spinal Outcomes Team improvement To achieve 80% compliance with Spine Tango patient Centralisation of performance measures reported outcome measures (PROMS) Linkage of spinal outcome measures to surgeons’ goals and objectives Spine Tango % FormsCompleted at Time of Surgery (Including Weekend and Emergency Patients)
100
CTL = 92.49 90 UCL = 84.99
LCL = 80.29 80
70
CTL = 62.48 60
50
Start of Coaching Start test
% forms completed on day of surgery 40 LCL = 39.96 improvement work started of change
02/04/201308/04/201315/04/201322/04/201329/04/201306/05/201313/05/201320/05/201327/05/201303/06/201310/06/201317/06/201324/06/201301/07/201308/07/201315/07/201322/07/201329/07/201305/08/201312/08/201319/08/201326/08/201302/09/201309/09/201316/09/201323/09/201330/09/201307/10/201314/10/201321/10/201328/10/201304/11/201311/11/201318/11/201325/11/201302/12/201309/12/201316/12/201323/12/201330/12/201306/01/201413/01/201420/01/201427/01/201403/02/201410/02/201417/02/201424/02/2014 29 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2
Re$ections on Clinical Microsystems Coaching
The Spinal Outcomes Team The structure of the weekly meetings has helped us to focus our improvement, using Plan-Do-Study-Act cycles to test and facilitate changes. We have been surprised at just how quickly compliance has improved and feel the coaching programme has helped us to raise the profile of the Spine Tango project amongst the Trust.
30 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2
Establishing a paediatric continence service Further improvements identi!ed We believed that there were a number of inappropriate To continue to meet as a microsystem and focus on attendances to specialist enuresis (bed-wetting) and other elements of the project to continually develop the constipation clinics because of lack of appropriate advice Paediatric Continence Service within di#erent community based teams. Although we Repeat the training day for other sta# and update the had lots of dedicated and passionate sta#, there was training annually no established Paediatric Continence Service and no Referral pathways to be "nalised and distributed standardised continence training for Health Visitors, Nursery Nurses, School Nurses or Specialist Nurses. Register the training assessment on Snowdrop to allow monitoring on compliance Review of paperwork to support the key visits and to What we set out to achieve include health and school visits To reduce the number of inappropriate attendances at To support the 2014/15 constipation CQUIN the constipation and enuresis clinics by 30%
Improvements achieved Paediatric Continence Training Day with over 50 attendees including: Consultant Paediatricians School Nurses Specialist Nurses Health Visitors Student Nurses Attendees received training on appropriate patient consultations, toilet training and toileting plans, advice on medications and guidance on continence assessment and product ordering
31 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2
Re$ections on Clinical Microsystems Coaching
Paediatric Continence Service We worked well as a Microsystems Team, everyone had a voice and the varied expertise within the group was valuable. The regular meetings helped to give the project focus and we were amazed at how much we achieved.
32 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2
Improvements in stoma care Further improvements identi!ed A stoma is a surgically created opening on the abdomen Share practice across the Trust which allows stools (faeces) to exit the body. Leakage of Continue data collection bowel content from newly formed stomas after surgery Maintain momentum of current project has been a concern at Salford Royal. Leakages can be emotionally devastating for patients trying to come to Carry on microsystems approach with next topic terms with their altered body image, as well as potentially leading to wound infections with associated longer stays in hospital.
What we set out to achieve Reduce stoma leakages, enhancing patient experience
Improvements achieved Data collection tool Involvement of a Foundation Year One Doctor as a research project Standardised sta# training Introduction of standardised stoma bags to be used in theatre Changes in clinical practice Development of a stoma care protocol to standardise practice Reduction in stoma leakage post operatively Improved patient experience
33 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2
Re$ections on Clinical Microsystems Coaching
Mr Jonathan Epstein Consultant Colorectal Surgeon Our microsystems group defined the problem and brought together a multi-disciplinary team of involved professionals as well as a patient expert to look at each step in the process between forming the stoma and the first scheduled bag change. We visited Theatre together, looked at and simplified equipment and made a sequence of step changes in technique following the Plan-Do-Study-Act cycle. Data was collected to audit practice. Our weekly meeting with the QI facilitator provided a clear focus and the meeting structure contributed to changes being carried through in a timely manner as we all felt a responsibility not only to the project but to the microsystem itself. The project has raised awareness of the importance of best practice in stoma bag application and all but eliminated early bag leakage.
34 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2 A focus on community
The work to improve patient care continues across the organisation. The Quality Improvement initiatives focus on the whole patient experience in hospital and in the community and the District Nursing Team and Intermediate Care play a key role in all of the improvement initiatives and continue to work on ensuring the systems and processes across the community are e#ective. These pages detail a number of areas that our teams are working on to improve. Harm free care in the community The Department of Health’s Safety Thermometer is a tool which measures four key harms in healthcare. We have collected data in the community using it since July 2013. The data from this is key to helping us understand whether we are achieving our aims around harm for the organisation as a whole. We are pleased to say that our District Nursing Teams collect this data every month on all of the patients that they visit for one day. Currently, 97.1% of our patients are free from harmful falls, new pressure ulcers, new catheter associated urinary tract infections and new blood clots. Safety thermometer - community % of patients unharmed - new harms only 100 UCL = 99.17 UCL = 99.15
98 CTL = 97.81
CTL = 96.58 96 LCL = 96.48
94 LCL = 93.99 %
92
90
88
86
01/05/201101/06/201101/07/201101/08/201101/09/201101/10/201101/11/201101/12/201101/01/201201/02/201201/03/201201/04/201201/05/201201/06/201201/07/201201/08/201201/09/201201/10/201201/11/201201/12/201201/01/201301/02/201301/03/201301/04/201301/05/201301/06/201301/07/201301/08/201301/09/201301/10/201301/11/201301/12/201301/01/201401/02/2014
35 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2
Pressure ulcer reduction in the community What: To reduce healthcare acquired pressure ulcers in the community How much: 50% reduction in community acquired pressure ulcers By when: March 2015 Outcome: We now have almost 12 months of data as a baseline to identify targets and improvement Progress: Baseline data established Grade 2 pressure ulcers UCL = 21.21
20 Improvements achieved Data collection is now set up and we have almost 12 months of 15 data from the District Nursing Teams Mean = 11.18 COMFE tool has now been implemented across the community 10 teams and is a structured process where nursing sta# carry out regular checks with individual patients at set intervals 5 Number of Community Grade 2 Pressure Ulcers Carer’s communication sheet is left with patient’s carers to ensure LCL = 1.15 we explain to both carers, and nursing home sta# what the needs 0
of the patient are between visits 01/03/2013 01/04/2013 01/05/2013 01/06/2013 01/07/2013 01/08/2013 01/09/2013 01/10/2013 01/11/2013 01/12/2013 01/01/2014 Month Grade 3 and 4 pressure ulcers
Further improvements identi!ed 5.0 UCL = 4.87 We are updating our package of changes aimed at helping reduce 4.5 pressure ulcers in the community to re$ect the standard steps to 4.0 follow for tissue viability in the patient journey with the nursing 3.5 teams 3.0 2.5 Harm Free Care meetings chaired by senior leaders and the Tissue 2.0 Viability Team are underway and provide valuable learning as we 1.5 Mean = 1.36 continue to work to prevent pressure ulcers occurring 1.0
The Tissue Viability Team in the community has merged with 0.5
the hospital team and will look to share learning and improve Number of Community Grade 3 & 4 Pressure Ulcers 0.0 communication as patients move into and out of the hospital by
having joint safety huddles 01/03/2013 01/04/2013 01/05/2013 01/06/2013 01/07/2013 01/08/2013 01/09/2013 01/10/2013 01/11/2013 01/12/2013 01/01/2014
36 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2
Community Assessment and Accreditation System (CAAS) Measuring the quality of nursing care delivered by Other areas of development in the community individuals and teams is not easy. We have had a include: performance assessment framework based on the Trust’s The Clinical Support Team continues to work with all Safe, Clean and Personal approach to service delivery new starters and all bands of sta# to sign-o# clinical which incorporates Essence of Care standards and has been competencies and ensure harm free care is embedded widely used at the Trust in the acute hospital for a number within each team of years; this system is known as the Nursing Assessment and Accreditation System (NAAS). Over the last few years The District Nursing Teams now have a Matron role to we have started to develop a Community Assessment help embed quality and safety and Accreditation System (CAAS). Each question in the All team leaders are undertaking or have completed a CAAS is linked to the 6Cs of compassionate care: care, leadership course compassion, competence, communication, courage and The Senior Nursing Team remaining highly visible across commitment, whilst providing evidence for the Care the community and walkabout happens every second Quality Commission’s core standards. Friday where the Senior Nursing Team visit a team not Community teams are very keen to demonstrate the under their care to develop peer review at a senior level services they provide and have engaged very positively Weekly senior safety huddles with ADNS and Lead Nurses with the CAAS process. The assessments are generally All collaborative QI work now has an integrated approach a two day review including assessments of home visits, The Community Nursing Teams all have mobile devices. observations of clinics in the various locations throughout These devices allow community nurses to be able to the city and spending time with team leaders and their upload activity. Future ‘apps’ are looking to be developed sta#. There are currently zero red or amber services and 22 to help them to electronically record the care provided to green services assessed so far. The aim is to have assessed patients rather than using paper all identi"ed community services by the end of 2014. Successfully leading complex discharges to home The recent introduction of iPads throughout many adult from hospital, including ‘in reaching’ into the hospital community services has enabled teams to have improved to support patients at the end of life to be discharged access to systems already available to acute hospital sta#. quickly and safely if they wish to die at home
37 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2 The Salford Integrated Care Programme
Achieving greater independence and improved wellbeing for older people in Salford by integrating care within communities
The Salford Integrated Care Programme (SICP) aspires to improve the health care system for older people (aged 65 and above) in Salford and is being delivered in partnership with Salford City Council, Salford Clinical Commissioning Group, Salford Royal NHS Foundation Trust and Greater Manchester West Mental Health Trust. During 2012/13 the programme of work was piloted in two of Salford’s neighbourhoods and is focussed around a "ctional older person, ‘Sally Ford’ and her family. The next phase moves into implementation, delivered via three work-streams: Promotion and increased use of Local Community Assets to support increased independence and resilience for older people Establishment of an Integrated Centre of Contact to support navigation, monitoring and support Establishment of Multi-Disciplinary Groups supporting older people who are most at risk, as well as providing a broader focus on prevention and signposting to community support
Programme aims: Neighbourhood Embed in Swinton and Eccles MDGs Testing model Phased roll-out to other 8 Reducing emergency admissions and re-admissions processes neighbourhoods up to May 2015
City-wide work on priorities emergency admissions / Reducing permanent admissions to residential and nursing homes readmissions and admissions to residential and care homes
Improving quality of life for users and carers Care Homes and Housebound Roll out MDG admissions Phased implementation Develop approach e.g. targeted reviews of Standards approach Increasing the proportion of older people that feel supported to admissions reviews
manage their own conditions Centre of Contact Preparation / feasibility Phased roll out for service levels and elements Increasing satisfaction with the care and support provided to older Community Assets Extend to other neighbourhoods and link capacity to other people Capturing resources model components FEB APRIL JUNE AUG OCT Increasing $u vaccine uptake 2014 Increasing the proportion of older people that die in preferred place MARCH MAY JULY SEPT Underpinned by development of Service Standards, Process Targets and Shared Care Record Estimated diagnosis rate for people with Dementia
38 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2
The Salford Integrated Care Programme Standards for Care provided at Home, Nursing, and Residential Care Homes By when: by 2020 In order that consistent care is delivered across Salford Outcome: In progress we are currently in development across the stakeholders involved in the programme and will be signed o# by the Progress: On plan Salford Health and Wellbeing Board Malnutrition Task Force Improvements achieved Linked with the Integrated Care Programme, the Tests of Change with improved outcomes for service Malnutrition Task Force is a pilot programme being tested users in relation to the following: in "ve areas across the UK, the aims and timescales for Drinks Diaries (UTIs, Constipation, Falls, Dehydration) which are currently in development Postural Hypotension (Falls, Medication Reviews) Alliance Agreement Postural Stability (Direct access to stability classes from The Alliance provides a "nancial, governance and GP. Falls and fear of falls) contractual framework ensuring that the new Integrated Non Elective Emergency Admission Noti"cations (email Care Model is delivered coherently and services are not alerts straight to GP practice on weekly basis) fragmented by organisational, professional or service boundaries. The Alliance is operational in shadow form All Care Homes Practice End of Life Care Plans reviewed. for 2014/15, and is intended to be operational for a Better Care Fund further "ve years in the "rst instance The £3.8bn Better Care Fund (formerly the Integration Transformation Fund) was announced by the Further improvements identi!ed Government in June 2013, to ensure a transformation in Phased implementation of an Integrated Care Record for integrated health and social care. The Better Care Fund Older People (BCF) is a single pooled budget to support health and Development of Key Workers and new roles to support social care services to work closer together in local areas. Integrated Care Applications to the Better Care Fund were submitted in Development of Alliance Governance processes 2014 and Salford’s application was successful, enabling Development of a Shared Care approach to 7 day working the delivery of the Integrated Care Programme through Monitoring of improvement measures the Better Care Fund Awareness raising and engagement with older people, sta# and other stakeholders Continued re"nement of the service and "nancial plans Branding and Marketing of Sally Ford and the Integrated Care Programme 39 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2 Improving our Outpatients Department
The Outpatients Department at Salford Royal has clinics across a range of specialties, providing services to over 300,000 patients every year. Our Outpatient Improvement Strategy 2012/15 will deliver the best outpatient experience in the NHS and become the "rst choice care provider for our patients.
We will deliver an outpatient experience that is: Patient Centred E!cient Innovative We are focussing our attention on projects that will see signi"cant improvements in patient $ow, creating value in every appointment.
Tool for delivery Expected standards Teamwork & Pathway redesign communication Customer services Lean methodology training Technology solutions Communication The BEST Department redesign Reducing unnecessary outpatient attendance department 7-day working in the NHS Patient Values Sustainability centred Patient & customer focus Leadership E"cient Respect Continuous focus on Innovative Continuous patient experience improvement Exploring & developing Accountability new ways of working
40 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2
Patient centred Acute and community outpatient DNA rate We understand that outpatient appointments are brief, and critical
UCL = 14.48 14 decisions are made during this time. That is why we are continuing to Mean = 13.57
UCL = 12.84 LCL = 12.67 move to a model of patient centred care, particularly in the context of 12 long term conditions. We continue to review and improve our services Mean = 11.14 UCL = 10.32 10 Mean = 9.61 LCL = 9.43 through the following: LCL = 8.90 Patient engagement events to understand what is important 8 % DNA to our patients in their outpatient consultation and they have helped 6
us to design innovative patient pathways 4
Customer service skills training for outpatient sta# 2
Involvement in the Patient and Family Experience Collaborative 0
01/04/201101/05/201101/06/201101/07/201101/08/201101/09/201101/10/201101/11/201101/12/201101/01/201201/02/201201/03/201201/04/201201/05/201201/06/201201/07/201201/08/201201/09/201201/10/201201/11/201201/12/201201/01/201301/02/201301/03/201301/04/201301/05/201301/06/201301/07/201301/08/201301/09/201301/10/201301/11/201301/12/201301/01/2014 E!cient Patients a!ected by cancellations We aim to improve patient experience by delivering an e!cient 900 The spike in June (Rheum) & Nov (Urology) is part of 800 outpatient service, with minimal waiting times underpinned by clinically the transfer of services onto Managed Booking. agreed pathways and robust processes. 700
600 We have reduced the number of patients a#ected by appointment Rheumatology Urology cancellations to less than 1% (*Rheumatology and Urology patients) 500 and the number of patients who fail to attend their appointment (DNAs) 400 across the Trust has reduced to 8%. 300
200
Improvements achieved 100
Appointment reminders introduced across all specialities 0
including paediatrics 04/2012 05/201206/201207/2012 08/201209/201210/2012 11/201212/201201/2013 02/201303/201304/2013 05/201306/201307/2013 08/201309/201310/201311/2013 12/201301/2013 Managed Booking - follow up appointments booked Innovative no more than six weeks in advance introduced in In the outpatient setting there is an evolution towards Rheumatology and Urology information-intensive consultations. Clinical decision Rapid improvement events to improve patient pathways making and patient education are supported by electronic and increase value of follow-up appointments for patients patient records and health information on the Trust’s Further improvements identi!ed internet pages. We have supported projects which include using patient Service speci"c appointment reminders portals, telemedicine and self-testing. These projects Roll out Managed Booking across all specialties will be further developed, so that they are more widely available to larger groups of patients. 41 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2 Using volunteers to enhance patient experience
Salford Royal continues to expand its volunteering Intermediate care centre volunteers activities with the aim to enhance the experience of Volunteers joined our Intermediate Care our patients, carers and visitors. We now have over Centre (The Limes and Heartly 340 volunteers working throughout our hospital and Green) which has meant community services. Volunteers enable us to work in more activities for patients new ways and help us to provide a more personal touch admitted to the units. when interacting with people. This can be as simple Alongside supporting as sharing a cup of tea with someone or a game of patients at meal dominoes; making our patients feel more at ease and times and generally reassuring those that care about them. Over the past spending time talking and playing year we have started a number of successful projects: games, our volunteers have been supporting Volunteers’ Driver Scheme reminiscence sessions The Volunteers’ Driver Scheme supports cancer patients and card making. These from Irlam and Cadishead to travel to clinic appointments. types of activities are Travel and parking have often been regarded as one of something that nursing sta# the ‘hidden costs’ of cancer and the service has had a are often not in a position to dramatic impact on the lives of the patients involved. The support, whereas our volunteers can volunteers set up and manage this service themselves. The dedicate time and attention to the setup and coordination scheme has now covered over 3,000 miles and is hoping to expand to the Walkden and Little Hulton areas. Volunteer guides Navigating their way across the hospital site has always been an issue for our visitors. The Trust is expanding the number of volunteer guides we have around the site to assist our visitors. We are trialling a volunteer led mobility scooter service where visitors with mobility issues will be shuttled to their appointment.
Volunteer recruitment We are always looking for new volunteers to join our community here at Salford Royal. If you are interested in becoming a volunteer, please contact [email protected] or 0161 206 8942 for more information.
42 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2
Sandra’s story Sandra has been a Patient Activity Volunteer for just over a year on the Acute Neurology Unit. Here she describes her role as a volunteer.
As a Patient Activity Volunteer I support patients on the Acute Neurology Unit and The Maples Unit. This is a varied role as it can include helping patients with letters or forms that require completing, or listening to concerns they may have. This could be whilst they are in the process of having care packages finalised to go home or waiting for treatment or test results. Part of the role is as an ‘appropriate adult’. This can include accompanying vulnerable patients to the shop or to clinic for any treatment that is required away from the ward. Often just spending time with a patient who may not have visitors or whose family live too far away to visit can be a rewarding part of the role for both patient and worker. Cleanliness and good housekeeping is an essential part of any role within the NHS, therefore clearing and picking up items in order to keep the unit safe and infection free is included in the role. Taking the ‘tea trolley’ round the ward is a good way of ensuring that patients are hydrated and introducing oneself to them. It is a good ‘ice breaker’ particularly for patients who may be embarrassed to ask for help initially. Volunteering can help to enable choices regarding future career. The Volunteer Co-ordinator helped to match my personal attributes and qualifications with a volunteering role and clinical area. I knew that I wanted to work within a health psychology setting but after working as a Patient Activity Volunteer on the ANU I found an innate interest and passion for Neurology and neurological conditions. My time as a volunteer has helped me tremendously in gaining confidence when dealing with patients or discussing health issues; something that is vital for any potential healthcare employee. It has helped me to find a specific niche which I feel fits my interests and personal skills and has reignited an interest in following a clinical based career path.
43 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2 Patient choice in End of Life Care
Dealing with death and dying is very stressful for patients and families. At Salford Royal, we aim to ease some of this stress by providing excellent care to patients at the end of life and their families. Since last year, our portfolio of improvement work for these patients has increased and several of these programmes are pro"led below.
What: To develop a skilled and con!dent workforce The TRANSFORM Programme (Route to Success) to deliver high quality end of life care for - transforming End of Life Care in acute hospitals residents whose preferred place of care/death is The Trust continues with its commitment to the National the care home in which they live (1,526 total beds TRANSFORM Programme and as an integrated organisation for Salford), whilst also reducing the number of (acute and community services together) actively promotes inappropriate hospital admissions. implementation of the "ve key enablers across care settings and service providers. The enablers are comprised of: How much: Our aim is for 92% of care homes in Salford to have Advance Care Planning completed the Six Steps training programme Electronic Palliative Care Co-ordination System (EPaCCS) By when: July 2015 Rapid Discharge Pathway Outcome: Eleven care homes (35%) have already AMBER Care Bundle successfully completed the programme, with a National Independent Review of the Liverpool Care further 11 due to complete in 2014 Pathway (LCP) - ‘More Care : Less Pathway’ Progress: On target
44 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2
A key example of how this work has been extended to Advance care planning and EPaCCS Salford care homes is described below: The best way that the Trust has for engaging patients and Six steps to success in care homes carers in advance care planning is Salford’s version of the (Route to Success) Electronic Palliative Care Co-ordination System or EPaCCS. EPaCCS has been established across Salford Royal, GP The Six Steps programme is directly related to the Route systems (including Out of Hours), St Ann’s Hospice, North to Success initiative that evolved under the support of the West Ambulance Service and the Local Authority Social National End of Life Care Programme (now End of Life Care Care system (CareFirst). NHS Improving Quality), the initiative encompasses: From April 2013 to February 2014 of the 359 people who Step 1 - Discussions as the end of life approaches died with an advance care plan recorded in EPaCCS, 82% Step 2 - Assessment, care planning and review died at their place of choice. Step 3 - Co-ordination of care We continually strive to improve engagement with patients Step 4 - Delivery of high quality care and carers to maximise achievement of preferences. Step 5 - Care in the last days of life Further end of life care improvement initiatives for 2014/15 Step 6 - Care after death include: Since the programme commenced there has been an To increase the numbers of medical and nursing sta# increase in the number of care home residents completing in the hospital setting with the skills and con"dence an Advance Care Plan (ACP). There has also been improved to engage in advance care planning with patients and collaborative working between care home sta#, District carers using EPaCCS to capture and record this Nurses, GPs and hospital sta#. Increased knowledge and To develop a system of best practice in advance care skills of care home sta# has improved the standard of care planning communication in Primary Care and the given to all residents, regardless of whether or not they are community - using the ‘Palliative Care Meeting Checklist’ reaching the end of their life. by District Nurses (ensuring ACP information from Improvements achieved: EPaCCS directly informs the care o#ered to patients and carers - both in and out of hours) Improved sta# engagement in advance care planning across hospital and community settings Widespread delivery of advanced communication skills training to enable sta# to undertake advance care planning discussions with patients and carers, which are then recorded on our Electronic Palliative Care Co-ordination System (EPaCCS)
45 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2
The Rapid Discharge Pathway (RDP) National Independent Review of the Liverpool The Palliative Care Team (in partnership with clinical teams Care Pathway (LCP) – ‘More care: less pathway’ across the Trust) has been driving the increased use of In response to the publication of the independent review the Rapid Discharge Pathway (RDP); enabling patients of the LCP in July 2013, Salford has taken the proactive in hospital who are dying and want to be at home to approach of developing new care of the dying guidance be discharged with all equipment and services in place. to ensure sta# continue to deliver the highest quality care In 2013/14 (April - February) we have co-ordinated 31 for dying patients. The LCP is currently in use until July successful rapid discharges; demonstrating the signi"cant 2014 but where carers do not wish the LCP to be used their commitment to helping achieve patients’ preferred place of wishes will be respected and care will not be compromised. care and death. The Trust remains committed to continued provision of an exceptional level of support to patients and their families and carers in the last days of life. This is achieved by: The AMBER Care Bundle - for End of Life Care Employing dedicated Clinical Facilitators to support patients whose recovery is uncertain sta# in the delivery of high quality care across hospital, The AMBER Care Bundle is for the management of acutely community and care homes unwell end of life care patients in hospital - whose recovery Ensuring that comprehensive information is available is uncertain and stands for: for carers to accompany sensitive discussions about the A ssessment diagnosis of dying and what to expect in the last days of life M anagement Ensuring access to appropriate bereavement care est practice Developing new quality markers to ensure the highest B standard of care is achieved ngagement E Developing the existing End of Life Care education R ecovery uncertain programme for undergraduate and postgraduate medical, nursing and social care sta# The process involves direct discussions with patients and/ In implementing the recommendations from the 2013 or carers about their wishes, preferences and future care national independent inquiry into use of the LCP the Trust within the context of their illness and its treatment (taking is reviewing and developing: full account of the Mental Capacity Act). We currently have an Amber Care Bundle Facilitator in post (from May 2013) Comprehensive information for patients, carers and families that has extended implementation of the AMBER Care End of life care education and training Bundle from two to six wards. Engagement with user and carer groups New guidance and documentation (electronic and paper versions) for sta# across care settings
46 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2
Palliative and End of Life Care Practice Over 1,700 health and social care sta# from across Salford Development Team have attended these sessions in the past year. In addition, Almost all health and social care sta# will at some time care we contribute to the continual development of end of life for someone who is approaching the end of life. One of the care services through participation in local, regional and key roles of health and social care sta# is to help patients national audits, data collection and quality improvement and carers, as far as is possible and appropriate, to come initiatives, such as the National Care of the Dying Audit to terms with the transition from life to death. If sta# have (Hospitals) and Dying Matters. the necessary knowledge, skills and attitudes to provide good end of life care it can be immensely rewarding. Emergency Assessment Unit and Ambulatory Although end of life care may not be a key part of their Assessment Area (EAU/AAA) - Assertive in-reach day to day role, it is important that sta# feel prepared and project able to make a positive contribution when it is needed. Initially established as a six month project, this initiative is Therefore training and support to provide sta# with a basic now being embedded into clinical practice and has led to knowledge and awareness of end of life care as well as an increase in the number of palliative care patients being appropriate communication skills is essential. appropriately discharged directly from EAU/AAA through The main aim of the Practice Development Team is to timely and co-ordinated partnership working. The project develop a workforce that is con"dent and able to work has resulted in more appropriate care, symptom control, with people at the end of their lives. The team consists advanced care planning and less inappropriate admissions of a Practice Development Lead and specialist End of Life to hospital: Care Educator/Facilitators working across the community, 91% of palliative care patients are reviewed within 24 hospital and care homes. We work in collaboration with hours (i.e. the same day - previously 76%) a range of education providers across health and social 95% of palliative care patients are reviewed directly on care to deliver core competency training as set out in the EAU/AAA (previously 68%) National End of Life Care Strategy (2008). 25% of palliative care patients are discharged directly These include: from EAU/AAA (previously 16%) Communication skills (e.g. starting the conversation) Potential reduction in 30 day readmissions to hospital Assessment and care planning Improved working relationships between Palliative Care Symptom control (including safe use of equipment) and EAU sta# Provision of psychological, social and spiritual care Improved links between Palliative Care and Community Care in the last days of life and into bereavement Services Improved care co-ordination with specialist teams and support services (e.g. Acute Oncology, Community Respiratory Team, Discharge Co-ordinators) 47 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2
Palliative care patients - admissions to hospital (within 30 days of previous admission)
UCL = 18.33
15
10 Mean = 9.22
Number of Patients 5
Start of Assertive In-reach Project 0 LCL = 0.11 Speci"cally for this group of patients the following interventions were trialled in two District Nursing clusters: Provision of blood glucose monitors 01/03/2013 01/04/2013 01/05/2013 01/07/2013 01/08/2013 01/09/2013 01/10/2013 01/11/2013 01/12/2013 Month Guidelines for monitoring blood glucose levels and appropriate management of hyperglycaemia Monitoring blood glucose in the community District Nurse training in use of guidelines and blood glucose monitors The Palliative Care North West Audit Group (NWAG) Formal evaluation of the intervention through clinical highlighted the lack of appropriate instructions for blood audit registration glucose monitoring for corticosteroid prescribing in advanced malignancy across a number of organisations in Initial results have shown the number of patients requiring the North West. In Salford the Palliative Care Teams formed blood glucose monitoring in the community is relatively a working group to improve blood glucose monitoring small. However, given the negative outcomes of lack of in the community, in order to maximise patient safety, monitoring/management, this intervention for palliative prevent the development of debilitating symptoms and care patients who are prescribed corticosteroids is being reduce inappropriate hospital admissions. embedded across all care settings, with a key focus on the The group identi"ed a lack of policies and guidelines for the areas below: management of these patients in the community and that Established sta# training in core guideline competencies there were no robust systems in place to monitor blood Reliable identi"cation and follow up of patients glucose levels. Improved communication across all settings
48 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2 Safer sta"ng levels All wards are sta#ed to a ratio of at least one quali!ed nurse to eight patients while many exceed this number Inadequate sta!ng levels on hospital wards were highlighted as a major issue by the Francis Report into care failures at Mid Sta#ordshire NHS Foundation Trust. At Salford Royal, we have embraced the idea of essential safe sta!ng levels based on research from Southampton University, King’s College London and the National Nursing Research Unit. This research shows that patient care is unsafe on wards where each quali"ed nurse is looking after more than eight patients.
We have a commitment at Salford that the “one quali"ed nurse to eight patients ratio” is a minimum*, and regularly review our sta!ng levels to ensure we get sta!ng right for the patients we look after. On day shifts wards have an additional Shift Co-ordinator allowing a Ward Manager to adopt a supervisory role. In addition, sta!ng levels are displayed at the entrance of We believe it is important to provide assurance to the every ward at Salford Royal. The sta!ng level boards are Trust as well as reassurance for patients and their relatives one of the "rst things visitors see when they come on to that we are paying adequate attention to safe sta!ng the ward and provides them with details of the Shift Co- levels. Our senior nursing team has introduced a daily ordinator, the numbers of quali"ed and unquali"ed nurses conference call with senior nurses from across the hospital the ward should have for each shift, and the numbers they and community services to provide an overview of sta!ng actually do have. The aim is to share sta!ng levels with our levels on each ward and department, providing the patients, families and sta# in an open and transparent way, opportunity to highlight areas of immediate concern and and to provide reassurance that the organisation is taking take action to address sta!ng issues. Capacity planning sta!ng seriously, giving patients and families a greater meetings are also held four times daily, in which sta!ng sense of safety. issues are discussed. *This ratio does not include trainee nurses or healthcare assistants, but only fully-quali"ed nurses. 49 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2 Performance against national targets 2013/14
Below are a list of national quality targets and Salford Royal’s performance against these.
National Targets and Target Target 2013/14 2012/13 2011/12* 2010/11* Minimum Standards (2013/14) Number of clostridium di!cile cases 35 18 47 58 101 Infection Control Number of MRSA blood stream infection cases 0 0 3 5 8 % of cancer patients waiting a maximum of 31 days from diagnosis to !rst de!nitive treatment 96% 98.2% 98.9%* 98.4% 98% % of cancer patients waiting a maximum of 31 days for subsequent treatment (anti-cancer drugs) 98% 100% 100%* 100% 100% % of cancer patients waiting a maximum of 31 days for subsequent 97.8% 99.2% treatment (surgery) 94% 98.3% 99.4%* Access to % of cancer patients waiting a maximum of 31 days for subsequent 94% 100% 100%* 100% N/A Cancer Services treatment (radiotherapy) % of cancer patients waiting a maximum of 2 months from urgent GP referral to treatment 85% 86.8% 88.7%* 89.6% 89.6% % of cancer patients waiting a maximum of 2 months from the 90% 96.4% 85.2%* 92.6% 85% consultant screening service referral to treatment (NB low numbers (NB low numbers mean this is below means this is below the deminimis) the deminimus) % of cancer patients waiting a maximum of 2 weeks from urgent GP referral to date !rst seen 93% 97.9% 98.4%* 98.6% 99.3% % of symptomatic breast patients (cancer not initially suspected) waiting a maximum of 2 weeks from urgent GP referral to date !rst seen 93% 95.6% 97.5%* 95.5% 96.2% 18 weeks Referral to Treatment - admitted patients 90% 93.0% 94.5% 90.34% 91.53% Access to Treatment 18 weeks Referral to Treatment - non-admitted patients 95% 96.2% 96.79% 95.48% 95.95% 18 weeks Referral to Treatment - patients on an incomplete pathway 92% 95.1% 96.4% N/A N/A
Access to A&E % of patients waiting a maximum of 4 hours in A&E from arrival to 95% 95.9% 95.46% 98.86% 97.39% admission, transfer or discharge
Access to patients with The Trust provides self-certi!cation that it meets the requirements to N/A Yes Yes Yes Yes a learning disability provide access to healthcare for patients with a learning disability
Cancelled operations % of in-patients whose operations were cancelled by the hospital for 0% 0.56% 0.52% 0.53% 0.63% non-clinical reasons on day of or after admission to hospital Cancelled operations not % of those patients whose operations were cancelled by the hospital for non-clinical reasons on day of or after admission to hospital, and 0% 0.78% 0.89% 3.54% 3.90% treated within 28 days were not treated within 28 days
* Some of these !gures have been updated from our performance published in previous Quality Accounts. This is because we had provided data up to the end of February in the respective years and this has now been replaced with data up to the end of the !nancial year.
50 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2 A review of Quality Improvement projects 2013/14
Below is a list of quality initiatives in progress and their current status. Each project is explained in the individual project pages Target Achieved Close to Behind / On Plan Target Plan SAFE Harm Free Care Pressure Ulcers - Acute and Community Falls Catheter Associate of Urinary Tract Infections Venous Thromboembolism The Salford Standards Clinical Quality Academy Teaching of QI to Junior Doctors - TICkLe Clinical Microsystems Readmissions Collaborative in Kidney Replacement Therapies Medication Safety Reliable Care / Advancing Quality Sepsis Theatre Safety Culture Executive Safety WalkRounds Intestinal Failure Unit Improvement CLEAN Meticillin Resistant Staphylococcus Aureus (MRSA) Clostridium di!cile (C-di") Surgical Site Infections PERSONAL Fundamentals of Nursing Patient Experience Collaborative Patient and Sta" Feedback Dementia and Delirium End of Life Care Bereavement Improvement
51 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2 Harm free care 97.9% of our patients receiving harm free care*
What: Patients will be free from falls, pressure ulcers, CA-UTI, VTE How much: 95% By when: Ongoing Outcome: 97.9% Progress: Target achieved
Keeping our patients safe whilst they are under our care is very important to us. We use a tool called the Safety Thermometer every month to audit our patients’ care (both in the hospital and in the community) to help us understand how well we are doing and to highlight areas % of patients that were NOT harmed while under our care for further improvement. The Safety Thermometer records 100 UCL = 99.17 UCL = 99.15 how many of our patients su#er from four types of harm:
98 CTL = 97.81 Pressure Ulcers CTL = 96.58 Falls 96 LCL = 96.48
Urinary tract infections in patients who are catheterised 94 (CA-UTI) LCL = 93.99 % Blood clots (VTE) 92
90 Each of the four harms measured by the Safety
Thermometer are then looked at in a more in depth way by 88 dedicated project teams; their work on improvement can be seen in the coming pages. 86 *Data source: Safety Thermometer
01/05/201101/06/201101/07/201101/08/201101/09/201101/10/201101/11/201101/12/201101/01/201201/02/201201/03/201201/04/201201/05/201201/06/201201/07/201201/08/201201/09/201201/10/201201/11/201201/12/201201/01/201301/02/201301/03/201301/04/201301/05/201301/06/201301/07/201301/08/201301/09/201301/10/201301/11/201301/12/201301/01/201401/02/2014 *As measured by the Safety Thermometer
52 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2 Pressure ulcer reduction in the hospital
30 months without a Grade 4 pressure ulcer developing in the hospital 12 months without a Grade 3 pressure ulcer developing in the hospital 50% of the wards have now achieved 12 months without a pressure ulcer of any grade Pressure ulcers occur when an area of skin is placed under pressure and the skin and tissue breaks down. Su#ering a pressure ulcer can cause great pain, discomfort and upset for patients. There are a number of things that we can do to prevent them, including regular changing of a patient’s position, using pressure relieving equipment and devices to protect any parts of the body that are particularly vulnerable to pressure damage.
Pressure relieving equipment can include specially designed mattresses and cushions, boots to relieve pressure and devices such as oxygen masks with softer edges.
What: To reduce healthcare acquired pressure ulcers across the hospital (non-device related) How much: 50% reduction in hospital acquired Grade 2 pressure ulcers Elimination of Grade 3 and 4 pressure ulcers By when: March 2014 Outcome: Grade 2 pressure ulcers have not seen a signi!cant
reduction (3% fewer than last year) Intentional Rounding Food Record Chart N/A Patient Name: ...... Ward: ...... Dietary Code Offered Hosp No.: Date: ALL ...... 1/4 1/2 3/4 But Refused NHS No.: BREAKFAST RN responsible for care: RN AM: Cereal / Porridge ) RN Night: RN Night: Sugar ( ) RN PM: RN Toast (number of slices ) RN 00:00 365 days without a Grade 3 or 4 pressure ulcer RN RN 18:00 19:00 20:00 22:00 RN 14:00 15:00 16:00 17:00 Drink (type 09:00 10:00 11:00 12:00 13:00 TIME: 02:00 04:00 06:00 08:00
MID MORNING ) Please indicate Y or N below Supplement drink (type ) PROMPT: Pain Snack (state ) PROMPT: Personal Cares Drink (type
PROMPT: Position 4 ‘P’s 4 Progress: Grade 2: Behind schedule LUNCH PROMPT: Possessions Soup Glasses / Hearing Aid / Dentures / Water Jug / Meat / Fish / Other Glass / Nurse Call etc Potato / Rice / Pasta Falls Risk: G = Green, Vegetables ) A = Amber, R = Red Alert / Confused / Sandwich (type ) Asleep / Agitated / Salad (type Delirium / Dementia Pudding A / C / As / Ag /
Grade 3 and 4: Target achieved Risk Falls Del / Dem Custard Is footwear appropriate Mousse Hourly - Yes / No Yoghurt Surface - Cheese and biscuits Appropriate mattress? / Fruit seat cushion appropriate OTHER - SPECIFY / sheets smooth Skin Condition - MID AFTERNOON ) Document skin check Supplement drink (type ) key (Document frequency Snack (state ) in variance box)
Drink (type Bundle SKIN
EVENING MEAL Change position Soup Meat / Fish / Other Designation Potato / Rice / Pasta Vegetables ) Signature Sandwich (type ) Salad (type Is there anything else I can do for you? POSITION Codes: LR : Log rolled Pudding SKIN Codes (use as many as required): AA : Absent from ward P : Position changed F : Dressing removed and Custard A : No marking to ST/C : Standing from chair M : Mobile replacement not required pressure areas E : Electronic mechanism LT : Left side Mousse G : Spontaneously moving - B : Blanching erythema used for position change RT : Right side Yoghurt skin NOT inspected C : Non-blanching R : Restless B : Back H : Skin not inspected Cheese and biscuits erythema T : Therapy C : Chair I : Patient refused inspection Fruit D : Intact dressing H : Patient refused J : Patient too unstable to E : Dressing renewed I : Patient to unstable to move OTHER - SPECIFY move X : Skin excoriated SUPPER
© G14040902
© G14040902, Design Services, Salford RoyalUnique NHS Foundation Identifier: TE05(14).Trust. All ReviewRights Reserved date: April 2014. 2016 This document MUST NOT be photocopied. G14040902 WZA461 This is a STOCK ITEM: STOCK CODE - 53 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2
Improvements achieved While the aim focussed on non-device related pressure Count of hospital acquired grade 2 pressure ulcers ulcers, we have achieved a reduction in this type. In 30 2012/13 we saw 45 device related pressure ulcers across 28 the Trust in 2013/14 we have seen 24 26 24 UCL = 23.88
A package of changes aimed at preventing pressure 22
ulcers has been rolled out across the hospital 20 45% reduction in the mean in January 2012 50% of the wards have now achieved 12 months without 18 16 a pressure ulcer of any grade UCL = 15.19 14 Mean = 13.04 ‘Teach back’ techniques have been used to help inform 12
patients why we need to move them to reduce their risk 10
8 of acquiring a pressure ulcer Number of Grade 2 Pressure Ulcers Mean = 7.16 Pressure Ulcer Focus months on wards, where the 6 4
LCL = 2.21 following areas of good practice are highlighted: 2 LS 1 LS 2 LS 3 LS 4 Summit Review of Pressure Ulcers Change Package in the 0
Handover Meeting 01/01/201001/02/201001/03/201001/04/201001/05/201001/06/201001/07/201001/08/201001/09/201001/10/201001/11/201001/12/201001/01/201101/02/201101/03/201101/04/201101/05/201101/06/201101/07/201101/08/201101/09/201101/10/201101/11/201101/12/201101/01/201201/02/201201/03/201201/04/201201/05/201201/06/201201/07/201201/08/201201/09/201201/10/201201/11/201201/12/201201/01/201301/02/201301/03/201301/04/201301/05/201301/06/201301/07/201301/08/201301/09/201301/10/201301/11/201301/12/201301/01/201401/02/2014 Month Two person skin checks with patients to ensure any Date Source: Datix incident reports concerns are picked up as soon as possible Pressure Ulcer Champions who talk to the ward sta# Days between a grade 3 or 4 pressure ulcer about concerns, ensure cream is applied to all patients 350
who need it and who keep up to date on the waterlow 300
scores for the patients on the ward UCL = 259.91 250 Education packages and all of the ward sta# complete the Trust’s E-Learning package 200
150
Further improvements identi!ed 100 Review panels for all hospital acquired pressure ulcers 50
hosted by the senior nursing leaders to enable us to learn CTL = 17.83 from any acquired pressure ulcers 0 Implement more pressure ulcer education sessions by our Tissue Viability Team 11/01/201115/01/201129/01/201119/02/201122/02/201103/03/201107/03/201108/03/201118/03/201119/04/201129/04/201130/04/201102/05/201109/05/201123/05/201125/06/201111/08/201109/09/201116/09/201113/12/201110/09/201213/09/201222/11/201201/11/201324/03/2014 Continue to test new equipment that may help us to Date Source: Datix incident reports prevent pressure ulcers caused by equipment
54 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2 Reduction in falls
Patient falls in hospitals are common and can cause injuries, prolonged hospital stays and have a long term impact on a person’s con"dence, ultimately leading to a reduction in mobility long after injuries have healed. The risk of falls in hospital needs to be understood and minimised to reduce harm from falls. What: Reduce the number of patient falls How much: 10% reduction in overall falls rate; 5% reduction in falls with harm rate Count of hospital chart showing inpatient falls per 1,000 bed days By when: April 2015 8 Outcome: Baseline data established: The data collection 7 methods were reviewed and changed in May 2013 6 UCL = 5.34 we now have adequate data to identify sustained 5 improvement for the next 12 months 4 CTL = 4.05
3 Progress: On plan Inpatient Falls Rate LCL = 2.76 2 Improvements achieved 1 Nursing sta# on wards are testing visual communication tools with Therapy sta# to ensure the relevant patient information is 0
01/05/2013 01/06/2013 01/07/2013 01/08/2013 01/09/2013 01/10/2013 01/11/2013 01/12/2013 01/01/2014 always known by all sta# ensuring patients move around the ward Month in a safe manner Inpatient falls resulting in moderate, major and The Falls Assessment and Management Tool has been redesigned catastrophic falls per 1,000 bed days with input from experts where required for di#erent parts of the UCL = 0.35 tool e.g. medication that may increase a patient’s risk of falling 0.35 Increased adherence to use of non-slip socks 0.30 Further improvements identi!ed 0.25 Improve the reliability of the bay tagging system so we can ensure 0.20
a member of sta# is in the patient bay at all times 0.15
CTL = 0.13 Test tagging for sta# members providing one to one care to 0.10
ensure if a patient requires one to one supervision then that is Harm in Resulting Falls Inpatient of Rate maintained at all times 0.05
Patient education around the risks of falling in the bathroom 0.00
01/05/2013 01/06/2013 01/07/2013 01/08/2013 01/09/2013 01/10/2013 01/11/2013 01/12/2013 01/01/2014 Month 55 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2 Catheter associated Urinary Tract Infections (CaUTI) Award winning CaUTI project The most common hospital acquired infection is an urinary tract infection and many of these (around 80%) are linked to the patient having a catheter. We aim to reduce the number of catheters in use in the hospital by making sure they are removed when they have served their purpose or are only put in for the right clinical reasons. If we can reduce the number of inappropriately used catheters we can have a real impact in the number of infections in the hospital as a result.
What: To reduce catheter associated urinary tract infections How much: 20% By when: December 2013 Outcome: No sustained reduction Progress: Behind plan
Improvements achieved Increase in the number of wards involved in the project Continence Link Nurse Meetings have been set up which provide an opportunity to work together to improve catheter care Awarded an oral presentation at the Federation of Infection Societies Conference in 2013 Indications for Won best oral presentation at the British Association of Catheterisation Urological Nurses (BAUN) conference T issue Viability Training for catheter insertion has been successful with R etention of Urine 181 nurses having completed the training in 2013 A cutely Unwell P atient Preference P ost Urological Surgery
56 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2
Further improvements identi!ed Trust catheter associated infections Since last year’s 44% reduction in catheter associated
infections on pilot wards, we have not seen any 60 additional reduction when expanding this work across
UCL the hospital. This next year will concentrate further on 50 spreading the good work of the pilot areas
A ‘Catheter Walk Round’ has been developed which is 40
designed to evaluate appropriate catheter use, catheter Mean
care and knowledge on the wards around catheters 30 A Catheter Associated Urinary Tract Infection Review Tool is being tested to help us understand if we could have 20 LCL prevented the infection and to learn from it if possible We aim to standardise all of the medical supplies we use to catheterise patients 01/05/201201/06/201201/07/201201/08/201201/09/201201/10/201201/11/201201/12/201201/01/201301/02/201301/03/201301/04/201301/05/201301/06/201301/07/201301/08/201301/09/201301/10/201301/11/201301/12/201301/01/201401/02/2014 A package of changes developed by the project will be launched for all areas that use catheters The TRAPP acronym is now in use in most of the hospital, if a catheter does not fall under one of the TRAPP indications it should not remain in the patient TRAPP stands for Tissue viability (catheter inserted to prevent skin damage) Retention of urine Acutely unwell (patient is too unwell to go to the bathroom) Patient preference (as part of the palliative care pathway) Post urological surgery We are looking into developing a CaUTI e-Learning package
57 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2 Prevention of venous thromboembolism (VTE)
96% of patients have VTE risk assessment completed Venous thromboembolism (VTE) is a term that covers both deep vein thrombosis and its possible consequence: pulmonary embolism (PE). A deep vein thrombosis (DVT) is a blood clot that develops in the deep veins of the leg. If the blood clot becomes mobile in the blood stream it can travel to the lungs and cause a blockage (PE) that could lead to death. In 2005, the House of Commons Health Committee reported that an estimated 25,000 people die from preventable hospital acquired VTE in the UK every year. The risk of hospital-acquired VTE can be greatly reduced by risk assessing patients and prescribing them appropriate measures that prevent a VTE from occurring.
What: To assess all patients admitted to hospital for their risk of developing VTE To improve root cause analysis (RCA) completion after episodes of VTE are identi!ed How much: 95% of patients risk assessed 95% RCA completed after identi!cation of VTE (Jan-Mar 2014) By when: Ongoing Outcome: 96% risk assessment 95% RCA completed (Q4 to date) Progress: On plan
Improvements achieved Implemented a structured process for root cause Further improvements identi!ed analysis of all cases of identi"ed Hospital Associated Sustain high compliance to risk assessment and Thromboembolism (HAT) preventative measures 88% of reviewed cases identi"ed care where all aspects of Sustain compliance with root cause analysis to ensure assessment and prevention had been carried out perfectly we learn from cases where Hospital Associated The root cause analysis process has led to changes in the Thromboembolism occurs way certain groups of patients are risk assessed to further Use the newly upgraded electronic patient record improve care where possible to produce a new risk assessment which Ongoing induction and training on VTE for Junior Doctors automatically ‘notices’ changes in the patient condition to new to the Trust improve prevention and prescribing
58 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2 The Salford Standards
decrease in risk adjusted weekend mortality when compared 8.7% to last "nancial year The di#erence in care across the days of the week is something that is often highlighted in the national press and can result in higher than expected death rates at the weekend. This has developed further over the last 12 months with national plans to tackle the issue being led by Sir Bruce Keogh (National Medical Director for NHS England). We are proud to say that we started working on this issue a number of years ago (2010/11) when we developed The Salford Standards. We focussed on increasing senior consultant presence as well as access to diagnostic tests at the weekend. What: Increase the level of senior consultant input in the hospital at the weekend Increase access to diagnostics Increase access to emergency theatres Increase the number of emergency admission patients receiving consultant involvement within 12 hours of admission (to 75%) By when: Ongoing - this work re$ects a whole scale change of our systems and will continue to be progressed year on year Outcome: 17% reduction in weekend risk adjusted mortality (when compared to data from before The Salford Standards were introduced) 8.7% reduction in weekend risk adjusted mortality when compared to last year Progress: On plan
59 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2
Improvements achieved Each area within the hospital has developed individual plans addressing the key principles of seven day working In reach of specialist medicine consultants to Emergency Assessment Unit at weekends Changes to doctor rotas so that weekends are covered appropriately Doctors worked with the IT team introducing the new electronic patient record to develop a single, continuous medical record which helps to make sure our doctors and nurses have access to all of the information required to treat our patients wherever they are in the hospital Standardisation of the daily review of inpatients
Further improvements identi!ed Non-elective weekend mortality (for Saturday and Sunday Continuous measurement of process admissions, excluding obstetrics, midwifery and neonatology) Understanding and measurement of culture across the UCL = 104.44
hospital 100
Continuous work to ensure >95% compliance with UCL = 90.89 90 structured ward rounds across the hospital Development of post-acute structured ward rounds 80 Mean = 71.51 70
60 Mean = 59.23 Relative Risk 50
40 LCL = 38.58
30 LCL = 27.57
01/04/200901/07/200901/10/200901/01/201001/04/201001/07/201001/10/201001/01/201101/04/201101/07/201101/10/201101/01/201201/04/201201/07/201201/10/201201/01/201301/04/201301/07/201301/10/201301/01/2014
60 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2 Clinical Quality Academy
Salford Royal aims to be the safest organisation in the NHS. One of our primary drivers is to educate sta# with quality improvement skills. Whilst we o#er a variety of Quality Improvement courses our Clinical Quality Academy is the most detailed programme to date. We run the programme annually, usually accepting 10 teams who spend 12 months learning improvement science whilst working on a project in their clinical area.
What: To educate and train a group of senior leaders and clinical sta" in quality improvement methods to build system wide improvement capability By when: Annual programme (now in its 5th year) Progress: On plan
Improvements achieved A large number of senior sta#, from across the Teams have been recruited from the community as well organisation have been trained in QI methodology as from a hospital setting through the programme CQA Projects have been recently accepted at International Improvement forums Consultants 60 Sta# have taken their skills and continued to use these to General Practitioner 1 lead improvement across the organisation Medical trainees 6 CQA recruits have recommended the programme to colleagues who have entered the programme, thus Specialist nurses / advanced practitioners 27 spreading capability Lead nurses / ADNS / Matron 13 Examples of successful teams below: Ward / Community / Theatre nurses 27 Reduction in pressure ulcers in a community setting Allied healthcare professionals 11 Improved experience for patients on Day Surgery Unit Non-clinical 25 by reducing waiting times prior to operation Reduced length of stay for new patients on Intestinal Failure Unit
61 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2
Clinical Quality Academy focus Community Harm Free Care Tool (COMFE) The harm free care tool (COMFE) was introduced as part of the pressure ulcer collaborative/change package project within the District Nursing Service. COMFE stands for:
C Are you Comfortable? Do you have any pain? Are you positioned correctly? Do you go to bed at night? O Observe the environment Is your skin feeling numb? O!er skin inspection, mainly pressure points M Are you able to Move and Mobilise? Are your walking aids within easy reach? Check appropriate footwear/clothing in use F Food and Fluids, are they available? Who provides meals Are food, "uids and possessions within easy reach? E Elimination: bowel and bladder functions okay? Are you able to get to the bathroom, commode? Products used correctly including catheter care?
As part of the project we introduced this tool to the Eccles District Nursing Team initially as a test of change. The tool has become part of the nursing documentation and is used daily to assess/check patients’ risk and safety at each planned visit. We used Quality Improvement methodology in particular PDSA cycles (Plan-Do-Study-Act) to facilitate change as we embedded the tool across the city following the initial roll out in the Eccles team.
62 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2
Intestinal Failure Unit Enhanced recovery after surgery The project developed using the ‘Model for Improvement’. With our ageing population, joint replacement surgery The team generated a driver diagram to articulate both the has become a major part of the NHS commitment to the aim of the project and develop a measurement strategy. community. With a signi"cant impact on quality of life, Team members identi"ed key areas within the drivers in more of these operations are being performed across the which to conduct sequential Plan-Do-Study-Act (PDSA) country every year. cycles to test ideas for change. The Intestinal Failure Unit Focus on the quality and patient centred interventions has improvement team met on a weekly basis to review the been one of the leading drives on our organisation. data and the tests of change, to ensure a rapid progression Through the CQA and using scienti"c and pragmatic through testing to implementable solutions. Meetings also approach, we managed to create an enhanced enabled all sta# to feel engaged with the project work and recovery after surgery programme in orthopaedics. A understand the data presented. multidisciplinary approach has been in the forefront of We have achieved a 21% reduction in the average length our 18 month project. A very successful implantation of stay on the Intestinal Failure Unit (55.7 to 44.0 days); has brought about improved outcome to patients and combined with a signi"cant reduction of 72.9% in the signi"cant drop in length of stay after joint replacement average length of time spent waiting for Intestinal Failure surgery. We have also achieved a dramatic drop in Unit admission (65.7 days to 17.8 days). These changes were complication rates and more importantly the programme also associated with an accompanying reduction in 30-day has improved patient experience overall. readmission rates down from 12.1% to 4.5% and early Finally, an integral part of the experience has been the suggestions of reduced inpatient and waiting list mortality. interaction with other teams across the organisation, which The programme has demonstrated it is possible to improve have provided us with a great chance to learn from each the e!ciency of a large national service for complex patients other. using Quality Improvement methodology, resulting in improved access and reduced waiting list mortality.
63 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2 Trainees Improving Care Through Leadership and Education (TICkLE)
On the publication of the Francis Report in February 2013, the Prime Minister David Cameron asked Professor Don Berwick, a leading expert in patient safety to look at what needs to be done “to make zero harm a reality in our NHS”. In that report two key recommendations were made: Improvements achieved TICkLE Committee established with terms of reference Give the people of the NHS career-long help to learn, reporting to the Trust’s Executive Quality and Safety master and apply modern methods for quality control, Committee quality improvement and quality planning. Delivery of Patient Safety-focussed ‘Grand Rounds’ where Mastery of quality and patient safety sciences incidents are discussed, with the presentation of quality and practices should be part of initial preparation improvement work around it and lifelong learning of all healthcare professionals, Invitations for TICkLE doctors to sit on Trust management including managers and executives. committees Non-consultant representation on major Trust projects What: To provide training to non-consultant doctors such as End of Life Care, Sepsis and the Electronic Patient Record Redevelopment Board in quality improvement, safety and leadership, Timetable of clinical governance and management and to engage them in Quality Improvement meetings around the organisation to allow non- projects. consultant doctors to attend
By when: Annual programme Further improvements identi!ed Progress: On plan Develop and deliver a quality improvement methodology curriculum into the 2014/15 Foundation Teaching TICkLE was formed by a group of junior doctors committed Programme to learning about Quality Improvement, safety and Build a list of consultant mentors to facilitate quality leadership. The TICkLE group harnesses the skills and improvement projects enthusiasm of doctors in training to help the Trust meet the Increase numbers of Foundation Year one and two doctors recommendations of the Berwick report. We aim to build to complete and present a quality improvement project a lasting foundation for all doctors who train at Salford Royal to equip them with the skills they need to lead Create and maintain a TICkLE group website containing improvement and safety initiatives, by working with Quality information about the opportunities and resources Improvement projects as part of the regular training. available at the Trust 64 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2 Readmissions
38% Reduction in readmission rate for elective hip and knee surgery patients A proportion of patients discharged from hospital are readmitted as an emergency within 30 days. This can be because complications have arisen as a consequence of an initial admission to hospital, problems with rehabilitation and poor communication between patients and care providers. Although not always avoidable, there are things we can do to help prevent readmissions. For example, identifying patients who are more likely to re-attend, explaining medication instructions in a manner the patient understands, following up patients once they have left hospital or providing a telephone helpline for patients to discuss any worries they may have. What: Reduce the number of patients who are readmitted as an emergency within 30 days of discharge from hospital How much: 5% By when: July 2014 Outcome: In progress (readmission rate remains stable at 11%) Progress: Behind plan
Reducing readmissions is an incredibly complex long-term project and remains a key improvement priority for the Trust. A Trust-wide improvement collaborative established in 2013/14 involves sta# from wards, departments and the community working together to solve this problem.
65 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2
Improvements achieved Telephone helpline for patients with wound related Readmission rate for elective hip and knee patients queries after discharge UCL = 16.23 16 Introducing ‘Teach-back’ - clearly explaining information 14 and making sure patients feel con"dent in how we have 12 explained this and have understood the information 10 UCL = 10.00 Telephone follow-ups for patients after discharge 8 Mean = 7.83
Identi"cation of re-attending patients for early review 6
Improved patient information to help patients to 4 Mean = 4.00
understand their illness and medications % Readmission Rate for Hips and Knees 2 Ensuring patients get the right nutrition and sleep on 01/01/2013 01/02/2013 01/03/2013 01/04/2013 01/05/2013 01/06/2013 01/07/2013 01/08/2013 01/09/2013 01/10/2013 01/11/2013 01/12/2013 wards - to ensure they are "t for discharge Month Community nurse visits for patients who are more likely Hip and knee wound / limb related accident and to be readmitted emergency attendances Regular discharge planning meetings on wards to ensure UCL = 20.95
that patients and their families are ready to leave hospital 20 Occupational Therapy home visits to ensure patients are discharged to an environment suitable for their needs
15 Further improvements identi!ed Test the improvements achieved across a wider section of UCL = 12.04 Mean = 11.00 the hospital and community 10 Improved district nurse referral process and education packages for secondary care providers
Ward review of readmissions to identify trends Mean = 5.20 5 Improved handovers between care providers in the hospital and community giving details about their
LCL = 1.05
patients to prevent patients from being readmitted % Hip and knee wound/limb related A&E attendances 0
01/01/201301/02/201301/03/201301/04/201301/05/201301/06/201301/07/201301/08/201301/09/201301/10/201301/11/201301/12/2013 Month
66 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2
Readmissions collaborative - orthopaedic and general surgery case study
Andra Jones & Kathleen Jones Orthopaedic Infection Surveillance Specialist Nurse & General Surgery Infection Surveillance Nurse Following elective hip and knee replacement surgery and As some operations are done as emergencies and are not certain general surgery procedures we send out a wound planned, we also try to visit every patient whilst in hospital healing questionnaire to assess how well our patients are to introduce ourselves and make sure everyone gets the healing after their operation and if they had a surgical site same information. infection post discharge. A number of our patients reported Since we started the helpline we have received over 200 calls signs of a wound infection, which led to them to attending (25% at weekend and out of hours), the majority of which either their General Practitioner or Accident and Emergency relate to wound care, for example dressings. More often and in some cases resulted in being readmitted to hospital. than not our patients are seeking reassurance that what We investigated this further and found a large number of they are experiencing is normal and we have managed to solve patients consulting their General Practitioner for wound most queries over the phone. Any problems that cannot be related problems were prescribed antibiotics. Furthermore, resolved over the phone are handed over to the appropriate we discovered that more patients were attending Accident professionals, such as doctors, physiotherapists and other and Emergency with wound related problems during the nurses, both in the hospital and in the community, ensuring evenings and at weekends, when there was no-one to contact that all queries are dealt with regardless of their nature. at the hospital or no access to their General Practitioner. Early evaluation suggests that this service has not only In order to address this we trialled a telephone helpline for reduced readmissions for hip and knee surgery patients from patients having undergone an elective (planned) hip or knee 7.8% to 4.0%, but Accident and Emergency attendances replacement, hernia repair or gallbladder removal, specifically from 11.1% to 5.3% and cases of surgical site infections. for wound related problems following discharge from hospital. Feedback from patients has been excellent, they feel reassured We started the helpline in July 2013, and operate seven days by knowing they can speak to a nurse if they have a query or are a week 11am-7pm to cover weekends and evenings. worried about something once they have left hospital. All patients undergoing planned procedures are sent a letter Because of the positive results and feedback from patients prior to surgery giving information about the symptoms the helpline will continue and we are looking to recruit to look out for after leaving hospital, contact details and additional staff to ensure the service is sustainable long- opening hours. term to the benefit of all our patients.
67 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2 Collaboration in kidney replacement therapies
The collaborative in kidney replacement therapies is an improvement programme which began in April 2010 to improve delivery of care to renal patients in the Salford Renal Network. This network is responsible for providing kidney care to a catchment population of 1.3 million and provides dialysis services for patients with end stage kidney disease in Bolton, Wigan, Rochdale, Oldham and Salford. Phases one and two used a modi"ed Institute for Healthcare Improvement Breakthrough Series collaborative model to achieve the attainment of clinical audit standards that a#ect mortality and morbidity in dialysis patients in our network, benchmarked to the best in the UK. For phase three we brought together stakeholders, experts and patients to discuss comprehensive sta# and patient satisfaction as well as clinical data. Two clear themes emerged as targets for improvement for 2013/14 - sta# culture and patient experience. Both of these have been demonstrated in NHS research to correlate with patient outcomes such as survival, hospitalisations and quality of life.
Sta# culture and satisfaction What: For dialysis sta" to feel highly valued, supported and that they’re working in a positive team environment by improvement in the sta" engagement score on the NHS Sta" Survey to the best in the UK by October 2014 How: Strong supportive leadership with a culture that nourishes and improves sta" Learning and development - e"ective appraisals and personal learning plans Improved teamwork, work processes and communication Improved sta#ng and sickness absence Outcome: Leadership coaching for managers Microsystem improvements in $ow and work processes Training needs analysis and sta" development to lead to a ‘culture of learning’ Team structures, roles and communications approaches reviewed and ‘tested’ Progress: On target
68 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2
Patient experience What: Our patients to have an excellent experience of kidney care as measured by 90% of patients rating their care as good or excellent by November 2014 How: Improve communication between sta" and patients Use technology and multimedia to give patients information they need, the way they want Peer support, mentoring and coaching Shared decision-making and self-care training to empower patients Create a positive, comfortable and welcoming environment for patients Outcome: Newsletters, videos and articles about kidney disease by and for patients Kidney patients recruited as mentors Activities and celebrations on dialysis units such as ‘India’, ‘Pakistan’ and ‘St Patrick’s’ days Improvements achieved Experience-based design methodology used to Our achievements have been recognised at a improve the experience of patients attending national and international level via academic peer clinic review. We have also won several awards for our improvement work including a Health Quality Improvements to travel arrangements and meals Improvement Partnership award in 2013. We for dialysis patients remain resolute in our ambition to make kidney care delivered by Salford Royal some of the best in Progress: On target the country.
69 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2 Medication safety
increase in patients having an accurate list of medications on the 24% Emergency Assessment Unit
Salford Royal has been selected by the Health Foundation, an independent charity working to improve the quality of healthcare, to participate in a pilot project to lead the way on reliable prescribing systems.
Medication errors at Salford Royal rarely cause harm to patients because our systems are designed to stop this from happening. However, medication errors that have the potential to cause harm do occur. We aim to design a system which removes the potential for harm and delivers a reliable medication process to patients. This is from the point of prescribing, through dispensing and "nally in the administration of the medicine to the patient. What: Reduce medication errors during prescription, dispensing and administration of medicines How much: 50% decrease in errors relating to the prescribing, dispensing and administration of medicines By when: April 2014 Outcome: In progress Progress: On plan
70 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2
Improvements achieved Further improvements identi!ed An e-learning package for high risk medicines extended After the pilot project in 2013 the patient Information to Nurses, Pharmacists and non-medical prescribers. Helpline will be rolled out to all ward areas in 2014. Further high risk medicines will be added to the package The aim of the helpline is to help improve a patient’s over 2014 understanding of their medicines A pilot project on the Surgical Admissions Lounge was The "rst stage of the Safer Clinical Systems "nished in completed to assess the impact of a Pharmacist using the January 2014 but Salford Royal will continue the project. ‘on-hold’ function to increase the number of patients who The areas to be addressed in the next stage are: have their medicines prescribed correctly Providing structured feedback to junior doctors on On the Renal and Intestinal Failure Units patients are able prescribing errors within EAU to be referred to the Pharmacy team to ask any questions When a patient is discharged we need to increase the they may have about their medicines accuracy of information provided to primary care on Updated system introduced to audit non-medical any changes to the patient’s medication during their prescribers hospital stay The percentage of patients with an accurate list of To increase the accuracy of prescribed medicines medicines at 24 hours was increased from 66% to 82% during weekends on EAU on the Emergency Assessment Unit (EAU). The following interventions have been implemented on EAU: % of patients in Emergency Assessment Unit with Pharmacist use of the ‘on-hold’ function to provide prescription correct at 24 hours 100 UCL = 99.00 accurate information to prescribing doctors to streamline the prescribing process 90 CTL = 82.10 An additional Pharmacist to provide support to the 80 70 Ambulatory Assessment Area to complete medicines CTL = 66.27
reconciliations (a process to ensure medicines 60 LCL = 54.99 prescribed on admission correspond to those taking 50
before admission) % 40 Increased Pharmacy Technician presence on LCL = 33.54 Emergency Assessment Unit to provide support 30 Improved communication between Pharmacists and 20 the ward team at the daily safety huddle 10
0
05/10/201208/10/201216/10/201224/10/201201/11/201209/11/201212/11/201220/11/201228/11/201206/12/201214/12/201217/12/201203/01/201311/01/201314/01/201322/01/201330/01/201307/02/201315/02/201318/02/201326/02/201306/03/201314/03/201322/03/201325/03/201302/04/201310/04/201318/04/201326/04/201329/04/201307/05/201315/05/201323/05/201331/05/201303/06/201311/06/201319/06/201327/06/201305/07/201308/07/201316/07/201324/07/201301/08/201309/08/201312/08/201320/08/201328/08/201305/09/201313/09/201316/09/201324/09/201303/10/201310/10/201318/10/201321/10/201329/10/201306/11/201313/11/201321/11/201324/11/201302/12/201310/12/201318/12/201326/12/201329/12/2013
71 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2 Reliable care
Salford Royal is participating in a region-wide programme known as Advancing Quality. The aim is to measure and report the level of compliance to a set of evidenced-based quality standards which de"ne good clinical practice which all patients should receive for a range of clinical conditions.
What: To participate in the North West Advancing Quality Programme aiming to improve the quality of care received by patients with: Acute Myocardial Infarction (AMI) or heart attack Hip and Knee (H&K) Heart Failure (HF) Stroke Community Acquired Pneumonia (PN) How much: Appropriate Care Score (ACS) for the following conditions: AMI (Heart attack) 88.19% Hip and Knee (H&K) 84.86% Heart Failure (HF) 62.15% Stroke 91.90% Community Acquired Pneumonia (PN) 68.77% By when: March 2014 Progress: Target achieved: AMI (Heart attack) Community Acquired Pneumonia (PN) Hip and Knee (H&K) Stroke Close to target: Heart Failure (HF)
Appropriate Care Score Appropriate Care Score (ACS) Composite Process In addition to a#ecting large Target (ACS) 2013/14 April 13 - November 13 Score (CPS) numbers of people every year these AMI (Heart attack) 88.19% 89.10% 96.54% conditions have clear, evidence Heart Failure (HF) 62.15% 61.22% 83.11% based interventions that can improve outcomes. Advancing Quality aims Community Acquired Pneumonia (PN) 68.77% 74.88% 89.42% to ensure that every time a patient presents with one of these conditions Hip and Knee H&K 84.86% 90.67% 84.86% they receive all of the care measures Stroke 91.90% 92.56% 91.90% necessary to gain maximum bene"t.
72 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2
Improvements achieved Stroke High compliance of Physiotherapy and Occupational Therapy All conditions – Smoking cessation information added to assessments within 72 hours of admission to hospital Discharge Co-ordinators checklist. The service also measures against a revised Sentinel Stroke AMI (Heart attack) National Audit Programme (SSNAP) target of assessments within Clinical leadership attention on achievement of quality 24 hours moving towards seven day assessment provision standards through Advanced Nurse Practitioners assisting with clinical and Electronic Patient Record (EPR) record Improved the number of patients weighed on admission keeping issues raised by Cardiac Rehabilitation Team Performance data is reviewed each month. With opportunities Continued engagement with cardiology medical sta# to to improve performance highlighted and acted upon appropriately record AMI on EPR system as this will ensure Increase in Composite Process Score and Appropriate Care the Cardiac Rehabilitation Team receive an automated alert Score Heart Failure (HF) Referrer education to highlight heart failure patients as a ‘Two Further improvements identi!ed Week Wait’ to enable the Cardiac Rehabilitation Team to book AMI (Heart attack) an appointment within required timescale Continued clinical engagement to increase referral to Cardiac Consultants on ward rounds (L3) identify patients who ful"l Rehabilitation Team Advancing Quality Heart Failure criteria and nurses trained to Heart Failure (HF) give discharge instructions and ensure the patient is referred Discharge instructions for patients with a hospital stay of less to the Heart Failure team than 24 hours Consultants on EAU/AAA refer patients with a diagnosis of Community Acquired Pneumonia (PN) heart failure to the Heart Failure service Continued clinical leadership attention for CURB 65 and initial Cardiologists when undertaking in-reach to EAU to ensure antibiotic received within six hours of hospital admission discharge instructions are given and a referral has also been Electronic prescribing and record keeping within the Emergency generated to the Heart Failure Nurses Department to assist with correct antibiotic selection Raised awareness with clinical teams of services the Heart Hip and Knee (H&K) Failure Specialist Nurses can o#er Development of an electronic order set to improve the administration of VTE prophylaxis (a preventative measure to Community Acquired Pneumonia (PN) help stop the formation of a blood clot) thus improving the Structured ward round on H2 (respiratory ward) and EAU to rate of correct administration to 100% highlight CURB-65 score (a clinical prediction used to predict mortality in community acquired pneumonia) Stroke Focus on brain scan within one hour of admission and Discharge checklist introduced when leaving the Emergency improvement of patient arrival to administering of Department Thrombolysis (a drug given to dissolve a blood clot to prevent Consultant led board rounds within the Emergency Department damage to the brain) to promote decision making and education Weekend therapist input to ensure the assessment service is fully covered 73 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2 Sepsis
Sepsis arises when the body’s response to an infection damages its own tissues and organs and can lead to shock, multiple organ failure and death, especially if it is not recognised early and treated promptly. Between a third and a half of all patients who have sepsis do not survive. The Sepsis 6 is a group of actions that can be taken when a patient is diagnosed with sepsis. They are designed to treat the condition and if the patient receives these steps quickly, they have a much better chance of survival. What: Reduce death from sepsis by increasing recognition and implementing the Sepsis 6 How much: 95% compliance with ‘Sepsis 6’ By when: April 2014 Quality Improvement Outcome: In progress Sepsis Collaborative Progress: Behind plan The Sepsis 6…
1. Give oxygen as per 02 guidelines Improvements achieved 2. Give a fluid challenge All in 1 Hour! Wards are testing the creation of the EMBRACE acronym 3. Take blood cultures for delivering the Sepsis 6 4. Give antibiotics as per guidelines E nsure oxygen is given appropriately 5. Measure lactate and blood gas M easure serum lactate and full blood count 6. Measure accurate urine output B lood cultures Daniel Rowbotham on 0161 206 8230. eview urine output Resources and information available from R Continuous Improvement Respect A dminister IV $uids Patient and Customer Focus Accountability C ommence IV antibiotics E ngage senior team Further improvements identi!ed An education programme is in development with the use Surgical wards and emergency departments have of a simulation exercise to evaluate response to sepsis reviewed patients with sepsis and our response to and advise where we can improve administering the bundle and developed tests of change in the areas where we need to improve The new electronic patient record system is being explored and we may be able to identify how the system We carried out awareness raising activities as part of can identify the signs of sepsis and then lead us through World Sepsis Day including a Trust wide screen saver the Sepsis 6 in a timely fashion
74 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2 Theatre improvement Over a year without a serious incident in Theatres within the Division of Surgery What: To achieve a culture of safety within Theatres and reduce the number of serious untoward events in Theatres How much: Zero serious untoward incidents in Theatres By when: March 2015 Outcome: 6 months without a serious untoward incident (SUI) in Theatres Trust-wide including both the Division of Surgery and the Division of Neurosciences and Renal Services (12 months without an SUI in Division of Surgery alone) Progress: On target
We are currently working towards embedding a culture of safety within our theatres. This means we want our sta# to feel able to speak out about, and are enabled to solve, any problems they encounter which might have a negative impact on patient safety. As a direct impact of changing culture, we are aiming to reduce the number of serious untoward incidents which occur within Theatres. We would like our Theatres to become the safest within the NHS. The key measurable aims are to: (1) Have zero serious untoward incidents (2) Achieve 100% compliance with the "ve steps to safer surgery (3) Improve Theatre culture, as measured by the Safety Attitudes Questionnaire
75 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2
Never Event Description Key !ndings following Root Cause Analysis Actions to prevent recurrence Wrong site surgery Wrong level spinal Anatomical abnormalities of the patient’s spine. Anaesthetists will be engaged in the proposed process for surgery con!rmation of correct level intra - operatively. Wrong site surgery Removal of wrong No formal agreement or written procedure in Further strengthening of the procedure for identifying the correct mole place for referral of patients from the clinic to operating level when di#culties occur, including Radiology input. Theatre, or for pre and intraoperative checks. Develop a documented procedure for referral to theatre and There are no monitoring mechanisms in place to procedural actions in theatre. identify multiple failed appointments. Development of computer systems to allow monitoring of patients with multiple cancellations.
Improvements achieved Further improvements identi!ed Quality Improvement Collaborative started in 2013 Work with suppliers on improving availability of kit Leadership Safety WalkRounds started in Theatres required to perform surgery Sta# in Theatres completed a Safety Culture Questionnaire Electronic measurement of compliance with the "ve steps to safer surgery is to be trialled and tested by Spring 2014. The survey allows us to look more deeply into Theatre Full roll out of electronic measurement of compliance culture and has helped us to focus our improvement with Theatre / Directorate / Consultant / Divisional e#orts in the right areas breakdown planned to be in place by June 2014 Piloting of audit of the "ve steps to safer surgery by Re-survey of sta# using Safety Attitudes Questionnaire is Senior Anaesthetic Trainees started in February 2014 planned for early 2015 On each $oor of Theatres, boards are in place where sta# signal areas for improvement that they have encountered Days between serious untoward incidents and ‘Never Events’ across all Theatres at Salford Royal in the course of their daily duties 600 UCL = 589.36 These areas comprise three boards for: (i) areas to work on, 500
(ii) ‘in progress’ and 400
(iii) completed improvements. These are currently full 300 of sta# suggestions and are reviewed daily and weekly Number of Days 200 Current date - not an SUI
Teams brief at the beginning of each Theatre list using 100 the OP SAFE acronym CTL = 43.19 0
06/04/201123/05/201126/05/201105/09/201129/09/201126/10/201112/01/201218/03/201230/10/201205/11/201205/12/201201/02/201306/06/201318/09/201321/02/2014 Date of SUI/Never Event
76 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2 Executive Safety WalkRounds 79 visits conducted this year Executive Safety WalkRounds started in February 2009. WalkRounds bring together front-line sta# with executive leadership to highlight the priority of patient safety.
WalkRounds consist of visits to clinical and non-clinical Feedback from ward sta# regarding the WalkRounds: areas where Executives work alongside sta# and talk to patients, to gain a deeper understanding about individual areas and the challenges faced by the frontline sta#. Stroke Rehabilitation Unit The goals: 1. Increase awareness of safety issues among all sta" The WalkRound highlights to the executive team the different safety issues wards have and how ward teams manage those issues 2. Make safety a priority for senior leaders by effectively to reduce their occurrence and that staff celebrate their spending dedicated time with front-line sta" achievements with each other. discussing patient safety Eccles Health Visitors 3. Highlight patient experience and satisfaction The WalkRound provided the opportunity to build links with the 4. Promoting a safety culture hospital staff and promote our service. Also we had the opportunity to share our personal experience in line with Salford Royal. Eccles Progress: On target Health Visiting team really enjoyed the opportunity to promote the Health Visiting service to encourage future networks between hospital staff and community. Improvements achieved 79 areas have been visited since April 2013 Trauma Assessment Unit Community areas, including children’s services are now The Executive was very interested in the team and listening to their individual roles and responsibilities. They were also willing to speak with fully incorporated into the WalkRounds schedule patients about their experience. Overall it was a positive experience. Feedback from visited areas is collected and continues to be positive Switchboard It was great to let the Executives see what happens within the Further improvements identi!ed communications department on a daily basis. Continuous review of the format of the WalkRounds to Day Surgery Unit ensure that patient safety is maintained as a priority The Executive Safety WalkRounds give the staff on the shop floor Incorporate medical sta# into the WalkRounds by the opportunity to meet and put a face to the names of members of the Executive team. It gives staff the opportunity to share their Executives attending ward rounds concerns, experiences etc. It also gives the Executive members the opportunity to speak to patients and hear first-hand what kind of care they are receiving on the ward. 77 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2 Improving quality on the Intestinal Failure Unit
73% reduction in days patients spend on the waiting list for the IFU service In 2010, there was a signi"cant waiting list for admission to the Salford Intestinal Failure Unit (IFU), one of two nationally accredited centres in the UK. There had been a steady increase in the number of new patients referred to the service (89 patients in 2005; 152 patients in 2012) and the number of established patients requiring home parenteral nutrition (HPN) (135 patients in 2005; 206 patients in 2012) over the last decade. What: Continued reduction of time on the waiting list for treatment in the Intestinal Failure Unit How much: Below 20 days By when: March 2014 Outcome: Mean of 18 days Further improvements identi!ed Progress: Target achieved Reduce Parenteral Nutrition waste by 10% by September 2014 Enhanced Nurse handovers Improvements achieved Patient Reported Outcome measures Waiting list template restructured Website development Proactive weekly waiting list reviews Average days waiting on Intestinal Failure waiting list Outreach Nurse practitioner appointed for improved 200 patient care
Enhanced structuring of referral documentation 150 Electronic bloods ordering for outpatients
Outpatient investigation log 100 Outpatient clinic review Process mapping of referral pathway 50 Average days waiting on IFU waiting list on IFU waiting waiting days Average Successful peer review Focus group 0
01/201003/201005/201007/201009/201011/201001/201103/201105/201107/201109/201111/201101/201203/201305/201207/201209/201211/201201/201303/201305/201307/201309/201311/201301/2014 Parenteral Nutrition waste monitoring Month of completed episode
78 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2 Meticillin Resistant Staphylococcus Aureus (MRSA) 0 MRSA blood stream infections in 2013/2014 What: To have zero avoidable MRSA blood stream infections (bacteraemia) How much: Target for 2013/14 was zero avoidable MRSA bacteraemias By when: March 2013 Outcome: 0 MRSA bacteraemias Progress: Objective achieved
Improvements achieved We have achieved a period of over 420 days without an MRSA bacteraemia To minimise risk of blood stream infection we continue to treat patients with MRSA in the community after their discharge from hospital
Further improvements identi!ed MRSA bacteraemias 2004/05 to 2013/14 90 Review and enhance the Intra Venous service to ensure best practice for placement and management of Intra 80 Venous devices 70
Sustain compliance with Aseptic non-touch technique to 60 minimise risk of infection 50 Sustain compliance with hand hygiene practices 40
Working across the community to have a whole system Number of Cases approach to the reduction of MRSA bacteraemias 30
20
10
0 2004/2005 2005/2006 2006/2007 2007/2008 2008/2009 2009/2010 2010/2011 2011/2012 2012/2013 2013/2014
79 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2 Clostridium di!cile (C-di") 62% reduction in Clostridium di!cile infections compared to last year 95% compliance with correct antibiotic prescribing procedures Clostridium di!cile is a common cause of hospital acquired diarrhoea. It is a common bacterium that is harmlessly in the bowel of 3% of healthy adults and up to 30% of elderly patients. Antibiotics disturb the balance of bacteria in the bowel and Clostridium di!cile can then multiply rapidly and produce toxins which cause diarrhoea and illness. What: To sustain a reduction in preventable Clostridium di!cile infections How much: Target for 2013/14 was 35 cases of Clostridium di!cile By when: March 2014 Outcome: 18 cases of Clostridium di!cile 2013/14 Progress: Objective achieved
Improvements achieved 95% reduction in Clostridium di!cile infections since 2004/05 62% reduction in Clostridium di!cile infections compared to last year Over 95% compliance with correct antibiotic prescribing procedures as part of our ‘Green for Go’ campaign Implemented guidelines on the appropriate use of a group of drugs called proton-pump-inhibitors, used to reduce the amount of acid production in Clostridium di!cile infections 2004/05 to 2013/14 the stomach, but have been associated with an increased risk of 500 developing a Clostridium di!cile infection. 450
Administering of probiotics for patients aged 65 and over and on 400
antibiotic therapy 350 Further improvements identi!ed 300 Focus on reducing all healthcare acquired infections (HCAIs) to 250
200
minimise use of antibiotics and therefore further reduce the risk Number of Cases
of Clostridium di!cile infections 150
Sustain 95% compliance with antimicrobial stewardship audits 100
Sustain compliance with hand hygiene practices 50
Working across the health economy to have a whole system 0 2004/2005 2005/2006 2006/2007 2007/2008 2008/2009 2009/2010 2010/2011 2011/2012 2012/2013 2013/2014 approach to the reduction of Clostridium di!cile infections 80 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2 Surgical site infections Maintained 95% compliance with evidence based care bundle Sometimes after a patient undergoes surgery, the healing wound becomes infected. Studies have shown that surgical site infections (SSI) account for up to 20% of all hospital acquired infections and that in the region of 5% of all patients who undergo a surgical procedure develop a surgical site infection (NICE, 2008). Many surgical site infections are preventable and measures can be taken before, during and after surgery to reduce the risk of infection (NICE, 2008). In particular, we have focussed on reliably delivering a series of interventions known collectively as the surgical site infection ‘bundle’. The Salford SSI bundle includes the following: Antibiotics started within one hour prior to surgery Maintaining normal body temperature Control of blood sugar level for diabetic patients
What: To reduce SSI through increased compliance with evidence based practice How much: Sustain 95% compliance with the SSI Bundle By when: April 2014 Outcome: 95% compliance trust wide Progress: Target achieved
81 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2
Improvements achieved Enhanced recovery after surgery (ERAS) pathway in place % of Orthopaedic* surgery patients with a for all elective joint arthroplasty with dedicated ERAS surgical site infection specialist nurse in post 20
Root Cause Analysis meetings involving SSI Surveillance 18
Nurse and Consultant leads taking place in each 16 UCL = 15.84 Directorate Clean elective ward breached with trauma 14 Anaesthetists receive their own monthly bundle First Learning Session 12 compliance data 10
Patients are walked to Theatre wherever possible to % SSI maintain body temperature 8 CTL = 6.96 Intravenous $uid warming cabinets are in place in all 6 anaesthetic rooms 4
Optimised system in place for ensuring relevant 2 Separation of Elective and Trauma cases on Ortho wards Summit information is given to patients in the pre-operative 0 department 01/04/200901/05/200901/06/200901/07/200901/08/200901/09/200901/10/200901/11/200901/12/200901/01/201001/02/201001/03/201001/04/201001/05/201001/06/201001/07/201001/08/201001/09/201001/10/201001/11/201001/12/201001/01/201101/02/201101/03/201101/04/201101/05/201101/06/201101/07/201101/08/201101/09/201101/10/201101/11/201101/12/201101/01/201201/02/201201/03/201201/04/201201/05/201201/06/201201/07/201201/08/201201/09/201201/10/201201/11/201201/12/201201/01/201301/02/201301/03/201301/04/201301/05/201301/06/201301/07/201301/08/201301/09/201301/10/201301/11/201301/12/201301/01/2013 Signi"cant adoption of chlorhexidine based skin preparation % compliance with the SSI bundle Trust wide 100 Wound care UCL = 97.24 Adoption of dressings with clear window to reduce CTL = 95.43 need to remove dressing earlier than necessary LCL = 93.62 UCL = 91.52 Expectation established that dressings will not be 90 CTL = 88.70 disturbed within "rst 48 hours after surgery LCL = 85.89 %
Further improvements identi!ed 80 The bundle is only a part of best practice when preventing SSI - the Trust Surgical Site Infection Steering Group will continue to monitor themes arising from root cause analyses and use these to direct further 70 improvement work
01/02/201201/03/201201/04/201201/05/201201/06/201201/07/201201/08/201201/09/201201/10/201201/11/201201/12/201201/01/201301/02/201301/03/201301/04/201301/05/201301/06/201301/07/201301/08/201301/09/201301/10/201301/11/201301/12/201301/01/201401/02/2014 Month
82 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2 Fundamentals of nursing
Nurses at Salford Royal strive to provide safe clean and personal care to every patient. Nursing sta# must account for the quality of care is delivered to patients and that care should be evidence based and appropriate to the needs of the patient.
The Nursing Assessment and Accreditation System (NAAS) Measuring the quality of nursing care delivered by individuals and teams is not easy. This performance assessment framework based on the Trust’s Safe, Clean and Personal approach to service delivery incorporates Essence of Care standards, key clinical indicators and each question is linked to Compassionate Care, the 6Cs of: care, compassion, competence, communication, courage and commitment, whilst providing evidence for the Care Quality Commission’s Core standards. The framework is designed around 13 standards with each standard broken down into environment, care and leadership. The 13 standards are: NAAS Scores Organisation and management of the clinical area, Safeguarding patients, 2009/10 2011/12 2012/13 2013/14 Pain management, SCAPE WARDS 0 13 23 25 Patient safety, Environmentalsafety, GREEN WARDS 22 23 20 20 Nutrition and hydration, AMBER WARDS 10 7 2 1 End of life care, Medicines management, RED WARDS 8 0 0 0 Person centred care, Pressure ulcers, Elimination, Communication and infection control Each standard will correlate to one or more aspects of Safe, Clean and Personal and this will be denoted on the heading of each standard.
83 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2 Congratulations to the 25 wards that have achieved SCAPE status so far:
Heart Care Unit How NAAS has changed ward culture Medical Investigations Unit Sta# delivering safe, clean and personal care L6 Promotes a positive and friendly culture B1 Good team working in evidence Medical High Dependency Unit Well managed care and e!cient delivery H8 Solid framework for sta# to follow H4 Involves the whole team not just nurses Acute Stroke Unit Puts patients at the centre of everything we do Day Surgery Unit Highlights best practice which is then shared throughout the organisation B2 SCAPE wards are beacon wards for the organisation n ● p Haematology Unit lea er Identi"es when processes and systems are not in place c so Surgical High Dependency Unit ● n e a f l M3 a NAAS next developments s B7 All wards to get SCAPE and maintain it C1 Create new Assessment and Accreditation L3 programmes B5 TAAS - Theatre Assessment (TAAS) M2 Outpatients assessment (OPAAS) Intensive Care Unit Care Homes review / setting standards L2 - (CHNAAS) Stroke Rehabilitation Unit Multidisciplinary Team Assessments L8 Service assessments i.e. neurosurgery, H2 bereavement team Theatre Recovery 1 & 3 Development of a "ve year plan for B8 SCAPE Continued rollout to community services - CAAS
84 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2
Ward notice boards Sta!ng boards They have been well received across all wards by patients and visitors as well as helping all sta# identify the nurse In 2013 Salford Royal made the decision to display nursing in charge, and ful"ls the aim of the government’s current sta!ng levels for each shift at the entrance to each ward sta!ng agenda to drive up standards throughout the NHS. and unit. The Government response to the Francis report Patient boards recommends that all Acute Trusts publish sta!ng levels twice a year. It states this should be at ward level and not What Matters To Me boards have been introduced to every just across organisations. One of the 10 recommendations ward after a pilot scheme in 2013. made by ‘The National Quality Board’ was to display Patients admitted to any ward are given a magnetic board sta!ng information to ensure openness and transparency. on which the things that are most important to them are Organisations will be required to show very clearly in each written. Some patients have used the boards to say they ward or unit their current sta!ng levels and key points of want family and friends close by, while others have given contact for patients and visitors. These have now been their preferences regarding pain relief, their treatment or obtained and are displayed at the entrance to every ward sleeping patterns. and unit in the organisation. Displaying the board above the patient’s bed means The information displayed is clear and consistent everyone can see the answers and it is often a talking point, throughout the Trust, including the name of the nurse in helping sta# to get to know patients better. charge, the number of patients present, the number of quali"ed and unquali"ed Patients have welcomed the idea as a simple way to nursing sta# on duty provide a bit more personal and the minimum information that may not and maximum always be transferred number of nursing from one member sta# allocated of sta# to another. per unit or ward.
85 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2
Patient feedback Inpatient survey The Friends and Family Test We ask all of our inpatients to complete a survey when From 1 April 2013, all organisations providing acute NHS they are in the process of being discharged. We have services are required to implement the Friends and Family undertaken a lot of work in this area and have reduced the question across adult acute inpatients (who have stayed number of questions that we ask our patients following at least one night in hospital) and adult patients who have feedback from them that the survey was too long. We then attended A&E and left without being admitted. use the responses to these questions to help us to improve the experience that patients have. Salford Royal implemented the Friends and Family Test across these patient groups, initially via SMS text messaging We aim to be in the top 20% for patient satisfaction in the and landline voice messaging with the addition of post NHS and that 90% of our patients will rate their care as cards at the point of discharge in August 2013 across a ‘good’ or ‘excellent’. The inpatient survey shows us that we limited number of wards to improve response rates. are achieving this. Patients must be surveyed at discharge or within 48 hours of discharge and the standardised question format must be used, as follows: “How likely are you to recommend our ward (or A&E department) to friends and family if they needed similar care or treatment? “ From April 2013 to January 2014 the Trust’s monthly net promoter scores have ranged between 62 and 74. Response rates have been steadily improving and are currently 40.6% for inpatients in January 2014. Whilst the Trust is currently exceeding the minimum response rate requirement set, further work is required to ensure on going improvement to meet future increases required.
86 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2 Patient, Family and Carer Experience Collaborative 90% of Salford Royal patients rate their care as excellent or very good In January 2013 Salford Royal launched an ambitious project aimed at improving patient, family and carer experience and making it the best organisation in the NHS. This project has been designed to deliver what matters most to our patients and is part of our wider Patient Experience Strategy. The Patient Experience Strategy has been designed to encompass all parts of the patient journey from before admission to after discharge from hospital and including community healthcare. What: To be in the top 20% for patient satisfaction in the NHS By when: April 2014 Outcome: Top 20% for patient satisfaction Progress: Target achieved
Improvements achieved Development of ‘Always Events’. These are things that our patients should always receive when they interact with healthcare professionals and the organisation Delivery of a Patient, Family and Carer Experience Collaborative aimed at helping the whole Trust to embed our ‘Always Events’ Testing of ‘teach-back’ on many wards. This is a technique that helps us to understand how well we have delivered important information to our patients about their condition or medications We have developed uniform colour posters to help patients and carers understand and identify who is involved in their care Installing of ‘What matters to me’ whiteboards behind each patient bed. So that when we are looking after our patients we know what is important to them about their hospital stay Pen and note pads at our patients’ bedsides so that they (and their families) can note down anything that they might have questions about during their stay in hospital A number of teams have developed videos aimed at helping patients understand aspects of their care, for example a walk through guide of an operating theatre or a video showing what a lumbar puncture is Many wards have implemented $exible or open visiting hours
87 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2
Further improvements identi!ed Further development of our Patient Experience Strategy % of patients rating their care as excellent or very good to ensure that we continue to push ourselves to deliver 100 the best possible experience for our patients, their UCL = 94.52 CTL = 91.42 90 families and carers AIm: 90% LCL = 88.33 Development of improved information on procedures, 80 diagnoses and medications
Customer service training % 70 Interventions to help patients sleep better such as ear 60 plugs and eye masks
Development of work on care partners (this is where 50 family or friends of patients who know them well can help us deliver the best care to our patients) 40
01/11/201201/12/201201/01/201301/02/201301/03/201301/04/201301/05/201301/06/201301/07/201301/08/201301/09/201301/10/201301/11/201301/12/201301/01/201401/02/2014 Development of programmes on shared decision making Month (this helps us involve patients in their care decisions rather than assuming we understand what treatment is Patient was involved as much as they want to be in decisions best for them) about care and treatment (locally selected measure) (currently 66% of patients responded Yes always 100
90 AIm: 90%
80
UCL = 71.40
70
CTL = 66.16
60 LCL = 60.92
% of Patients Responding Yes Always 50
40
01/11/201201/12/201201/01/201301/02/201301/03/201301/04/201301/05/201301/06/201301/07/201301/08/201301/09/201301/10/201301/11/201301/12/201301/01/201401/02/2014 Month
88 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2
Neil Black My life changed forever when I suffered my first heart attack and was rushed to hospital with my father’s heart attack running through my head. Little did I know that this was going to be a life changing moment. My experience as a Salford patient has left me wanting to give something back. I now volunteer at Heartly Green Intermediate Care and visit cardiac rehab fitness classes to talk to patients setting out on their first steps to recovery. I was invited to join The Patient and Family Experience group and am passionate about culture and customer service and use my experience to help Salford improve for future patients. I am very impressed with the improvement work taking place at the Trust to provide the patients with the care and attention that they require. In summary, my heart attack has prompted me to completely revaluate my life thanks to the staff at Salford Royal giving me a second chance and educating me on how to look after my health and continue with recovery. I will continue to offer back as much as I can in way of thanks, with my free time but am also writing a book called Heart Attack Business making the analogy between business and us humans and how both suffer symptoms of poor life resulting in heart attacks and some will die but others can survive and live on for many years. Hopefully the book will help people and business put in place now what they have to do to prevent having a heart attack and to live a healthy life.
89 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2 Patient and sta! feedback
The views of our patients and sta# are very important to us. We spend a lot of time collecting and responding to information we receive about our services from our patients and sta#. We receive feedback through a number of methods, including surveys, patient stories and patient experience trackers, all of which provide us with vital information on how to improve. This page details a selection of results from our Patient Experience Trackers and the national surveys that were conducted in 2013. Areas of signi!cant year on year improvement What: To continually improve patient and sta" for Salford Royal satisfaction By when: On-going Patients being asked for their views on quality of care Progress: On plan Patients using bath or shower As well as our Patient, Salford area who shared with the Family and Carer Royal performed opposite sex Experience Collaborative better than we spend a lot of time average on understanding what our 45 questions Patients being bothered by noise patients tell us about their from sta! and other patients time in our Trust.
In order to "nd out what Salford Areas of signi!cantly better than average our patients think, we are Royal performed performance for Salford Royal one of 76 organisations average or better that take part in the for all questions At discharge feeling involved in annual Picker Survey. asked to our decisions about care patients Here are some of the Risks and bene"ts of surgery results and "ndings from being explained the Picker Survey Salford Royal performed Having con"dence and trust in better than last doctors and nurses treating year on 18 questions Cleanliness of wards and bathrooms
90 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2
What our sta# said: Salford Royal’s 2013 Sta# Survey report highlights that we have high levels of sta# engagement, our sta# would recommend the Trust as a place to work or receive treatment and that they work in highly e#ective teams. The 2013 sta# survey was undertaken between October and December 2013, the results reported were formally published by the Care Quality Commission in February 2014. It asks NHS employees a broad range of questions seeking their views on and experiences of sta# satisfaction, training, line management, appraisals, work related stress, violence and abusive behaviour and making a di#erence to patients.
This year’s results once again see the Trust scored as top Acute Trust in the country with 96% of our results being in above average or best categories. Out of 28 key "ndings the Trust was found to be: Best 20% in 20 Above average in 7 Average in 1 Below average in 0 Worst 20% in 0
The areas where Salford Royal is in the ‘best 20%’ include reporting good communication between managers and sta#, sta# job satisfaction, support from immediate managers and being able to contribute towards improvements at work. On the overall cluster of scores which produces a ‘sta# engagement’ result, the Trust is the best in the country.
91 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2
Patient stories:
My journey started in March 2013, while out for a meal with my wife and son. I felt excruciating pain in the centre of my back. The pain was so intense that we had to leave the restaurant early and my wife, had to drive back from Sheffield to Glossop. As I went to bed that night, I touched the duvet and it felt icy cold. This was a strange sensation as the room was warm. I was awake for most of the night despite some pain relief. In the shower the following morning I was washing my hair and whilst rubbing the shampoo in, it felt like I was rubbing pebbles into my hair. My symptoms continued for a couple of days and that weekend was my son’s wedding. My wife suggested that I miss this given what I was going through but I was adamant that it was his wedding and that I wasn’t going to miss it. I attended the wedding but my wife and I left early and I asked her to take me straight to A&E. After some tests a consultant informed that I had Gullian- Barre Syndrome (GBS). He was blunt but made no apologies for this, he said that he had to be honest with me because if he wasn’t then I wouldn’t trust him in the ensuing months. He told me that I would be in hospital for 12 months and that I would need to be intubated. The news was shocking but I respected the consultant for telling me the way he did. I found it difficult to accept what he had told me and felt that I would not be in hospital for that long. However, the information about being intubated made me feel it was very serious.
92 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2
I was moved to HDU and it was here I suffered the worst night whilst using it, like the time that I was trying to tell my wife of my life. I felt that the ward was short staffed and there about the garage and she spelt cabbage instead meaning we was a high number of transfers to the department that night, had to start all over again … I could have throttled her. this made sleep on the unit impossible. During the night, I The nursing care on ICU was excellent and the staff always asked a nurse for a bottle as I needed to urinate. I was told ‘in seemed to be prepared to go the extra mile. I recall one a minute’ and accepted this as the nurses were busy. However, occasion where I asked a nurse called Paul whether I could have I was not seen to and despite asking regularly, I waited two my hair washed. He was most accommodating and tilted my hours. Eventually, I could not wait any longer and had to go in bed and used a special basin to do this. It meant a lot to me the bed. I informed the nurse that this had happened and they and I really remember the experience. On another occasion, I came and changed my bed. I was angry and surprised that was feeling down as a friend of mine who I had trained with was they only changed the bed and did not wash me down. When killed whilst working for the Red Cross in Afghanistan. Sarah, I asked the nurse whether this was going to happen, I said ‘is one of the nurses, recognised that I was down and she sat that it?’ she sharply responded ‘yeah!’. with me for over an hour listening to me as I offloaded. Again, The following day I spoke to the sister on the ward and the experience stays with me and it demonstrated to me that informed her that I was angry and upset. The sister was the nurses were prepared to go above and beyond. angry that this had happened and assured me that she One other occasion was when one of the junior doctors would deal with the nurse involved. arranged for me to go outside. It was a lovely day in June I was taken to ICU and was put in cubicle 9. A small point but and although I was keen, I felt like it was going to be too my room looked out on a brick wall, this was a problem as it was logistically difficult. However, the junior doctor did everything boring and I got to thinking whether a mural could be put on required which involved a portable ventilator, clearing the the wall. Another minor thing whilst on ICU was a faulty waste route from ICU to A&E, ensuring that nursing support could bin which slammed down and would regularly keep me awake. It accompany me and making sure that A&E were aware I was is something that the ward probably would not have thought outside should there be an emergency. It must have taken about but it was a real worry for me whilst on the unit. hours of planning but the half an hour I was able to spend outside meant the world to me. I was intubated whilst on the unit and this meant I was not able to talk. This was incredibly stressful for me, my wife and I was transferred from Salford Royal to the Devonshire Unit my family. The speech therapist got me using the alphabet in Stockport where my rehabilitation continued and I was board which was useful but also frustrated as they were never discharged at Easter this year. I think that my dogged used in a standardised way. My friends began visiting every determination was key in getting me through the last 12 months second Wednesday and they became pretty expert on the but I could not have done it without the nurses, doctors, my board but there was the odd frustrating and funny moment family and my wife. I will be forever grateful to them.
93 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2 Improving care for patients with dementia & delirium
compliance with Salford Royal’s Dementia & 95% Delirium Care Bundle The term dementia describes a set of symptoms which include loss of memory, mood changes, and problems with communication and reasoning. These symptoms occur when the brain is damaged by certain diseases, including Alzheimer’s disease and damage caused by a series of small strokes. It is progressive, which means the symptoms will gradually get worse. Delirium is a common clinical syndrome characterised by What: To deliver a world class service for patients disturbed consciousness, cognitive function or perception, which can develop suddenly, and can come and go. with dementia and/or delirium that is safe, clean, and personal every time While delirium and dementia are di#erent conditions, patients with dementia are at increased risk of delirium and How much: 95% compliance with Salford Royal care many have both conditions. It can sometimes be di!cult bundle to distinguish between delirium and dementia and there By when: October 2014 is some overlap in terms of idealised care for patients who have dementia and/or delirium. Outcome: 95% compliance As part of the Quality Improvement Collaborative which Progress: Target achieved took place over the past year, a bundle of care has been developed by Clinicians at Salford Royal. Compliance with this bundle was identi"ed as one of our key quality priorities in the Quality Accounts for 2012/13. The elements of the bundle are detailed below: Discharge planning started within 24 hours Weight assessment completed and appropriate management in place Intentional Rounding completed to protocol If antipsychotics prescribed at Salford Royal then there is a clear rationale documented Sensory impairment assessment and correction completed
94 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2
% compliance with the dementia & delirium care bundle
100 The Trust is taking part in the Royal College of Nursing CTL = 94.80 Dementia Development Programme. Funded by the 90 Royal College of Nursing (RCN) Foundation, this year-long CTL = 82.73 programme supports key nursing sta# working in general 80 hospitals through a number of events, development days LCL = 73.74 and site visits. Feedback from our recent RCN site visit 70 provided the following initial feedback: “We were struck by the enthusiasm, dedication and % Bundle Compliance 60 commitment you all have for supporting improvements in care for people with dementia in your Trust.” 50 LCL = 46.87 Environmental changes to lighting, $oor coverings and
40 improved way-"nding have been made 04/02/201311/02/201318/02/201325/02/201304/03/201311/03/201318/03/201325/03/201301/04/201308/04/201315/04/201322/04/201329/04/201306/05/201313/05/201320/05/201327/05/201303/06/201310/06/201317/06/201324/06/201301/07/201308/07/201315/07/201322/07/201329/07/201305/08/201312/08/201319/08/201326/08/201302/09/201309/09/201316/09/201323/09/201330/09/201307/10/201314/10/201321/10/2013 New garden area speci"cally designed for patients with Month dementia has been constructed Improvements achieved Trained a cohort of volunteers to engage dementia Quality Improvement Collaborative has been completed, patients in therapeutic activities at the hospital resulting in development of a Change Package for Development of core competencies for dementia care for patients with dementia and/or delirium adoption by Nursing sta# Increased use of the Hospital Passport (as reported by sta#) Further improvements identi!ed This document is completed by the patient with their family / carers and provides sta# with information Embed Change Package about the person with dementia to enhance the care Implementation of delirium and support given while they are in an unfamiliar guidelines for Trust sta# environment. We aim for the Passport to remain with the Redesign of ward spaces patient wherever they go within the healthcare system, in Elderly Care with so it makes sense for the document to be commenced at needs of dementia Residential Care Homes where this is a patient’s home patients in mind Many areas are now photocopying the Passport on Achieve 95% discharge and ensuring it is scanned into the patient’s compliance with electronic record, so that if a physical copy is lost then National Dementia they can easily access a backup copy Audit Standards
95 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 2 Bereavement care
Salford Royal is part of a Royal Alliance providing bereavement and organ and tissue donation services across three hospitals (Salford Royal, Royal Bolton Hospital and Wigan, Wrightington and Leigh) with the purpose of providing excellent end of life care for all.
Death and dying is very di!cult to deal with, even for sta# Improvements achieved who work in hospitals, but helping patients and their We continually strive to make our end of life care service families at their time of greatest need is hugely important the best that it can possibly be and have set up a group to to us. To do this we believe that we must ensure that continually review and improve the way we help patients, patients and their families are able to easily access all of the families and carers through the end of life period. services on o#er to support them in times of bereavement. Colleagues involved include: Around the time of death there are many choices available Community and ward nurses (including Hospital at both to patients and their families and whilst this is often Night Team) a di!cult subject, we know that patients and their families Hospital Doctors appreciate being given help to understand these choices. Palliative care sta# This can include information around: Bereavement specialist sta# Spiritual care Organ and tissue donation specialist sta# Understanding organ and tissue donation Chaplaincy sta# Accessing the mortuary services Mortuary sta# Convenience of accessing the registrar on site
This pioneering work has developed and driven an inclusive package of care for patients and their relatives, irrespective of place of death.
The Alliance has also resulted in close partnership working and innovation across all three organisations, developing a Bereavement Care and Donation Service model widely recognised as ‘best practice’.
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Further improvements identi!ed Dignity in death symbol used throughout the Improving visiting and viewing facilities in the Mortuary organisations easily recognisable and a reminder of On-going dialogue with family (and patient where excellence in practice possible) to ensure they understand what is happening, Care after death policy and also to explore any individual wishes to facilitate Nurse veri"cation of death policy across the Alliance personalised care including nursing homes Close working with community based sta# to allow rapid Reduction in times from patient death to arrival in the discharge for patients wishing to die at home - including Mortuary ventilated patients Organ and tissue donation referral/rate has dramatically Police and coroners engaged in cases of sudden and improved unexpected deaths can directly refer to Specialist Bereavement Nurses. Sharing of ideas and best practice across Bolton, Wigan and Salford resulting in high quality end of life care Specialist Bereavement Nursing Team available to regardless of location and whether death is expected support ward sta# Bereavement study days allowing sta# to develop their All families are o#ered the opportunity to be involved knowledge in bereavement care in care after death and to accompany their loved one to Mortuary if required Understand satisfaction with end of life care through questionnaires and monitoring of complaints Transition to Bereavement Team to support families with practicalities and act as a single point of contact, Engagement of all sta# groups in improvement work and including follow-up from Specialist Bereavement Nurses training opportunities identifying any support, such as emotional support, Integration of agencies outside of the NHS including referrals to counselling services and the opportunity to Greater Manchester Police, HM Coroner for Manchester address any concerns with services such as PALS West and the Registrar O!ces Availability of a dedicated Book of ‘Comfort packs’ for families and ‘memory bags’ for Remembrance deceased patient’s property Relatives’ rooms for the families and carers of dying patients and beds available on every ward to allow relatives to stay with their loved ones Promotion and inclusion of the Chaplaincy services. Helping relatives and carers remember dying loved ones by giving handprints, locks of hair and taking photos
97 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 3 Our plans for the future
98 3 The Quality Improvement Strategy 2011/14
Our Quality Strategy for 2011/14 sets ambitious aims to be the safest organisation in the NHS. An explanation of the aims and the work programmes required to achieve these aims are set out below.
Our aims Harm We aim to be the safest organisation in the NHS as well as AIM: the "rst choice care provider for our patients. 95% of patients receive harm free Key goals care as measured by the following Reduce mortality four harms Reduce harm Pressure ulcers Reliable care Catheter associated urinary tract infection Improve patient experience Venous thromboembolism We will focus our attention on projects that will reduce Harm from falls harm and mortality, improve patient experience and make the care that we give to our patients reliable and grounded We use a tool developed by the Department of Health in the foundations of evidence based care. in order to detect and track harm over time. The tool is known as the Safety Thermometer and it requires members Reduce mortality (risk adjusted mortality) of nursing sta# to conduct an audit where all patients on a given day are reviewed. Audits are also conducted in AIM: community settings such as care homes or on patients Maintain position in 10% of NHS allocated to a district nursing team. During this audit organisations with the lowest risk speci"c harms are monitored, these are pressure ulcers, adjusted mortality falls, catheter associated urinary tract infections and venous thromboembolism. In order to maintain a focus on the reduction of mortality In 2014/15, we will continue our relentless focus on we undertake a multi-disciplinary review of all patients who reducing harm by continuing to work on many of the die whilst under our care. This allows us to learn from the projects pro"led in this account, including: pressure death of patients where appropriate and make adjustments ulcers, catheter associated urinary tract infection, venous to the care that we give. Over the next year we will continue thromboembolism, falls, readmissions, medication errors, to review all deaths to glean ideas for improvement. We are and hospital associated infections. continually looking for defects in care processes that could cause harm in the future. Themes we have observed over the past year include faster escalation of early deterioration and better recognition of patients needing palliative care.
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Reliable care AIM: Improving experience for our patients, their families and their carers Achieve 95% reliability in the is one of the key areas of the 2011/14 Quality Improvement Strategy. following: In the past year we have launched a detailed Patient, Family and Carer Experience Strategy and alongside it a Quality Improvement Community acquired pneumonia care bundle Collaborative aimed at improving all aspects of patient, family and carer experience. Heart failure care bundle Hip and knee care bundle We have detailed a series of ‘Always Events’ that all of our patients should expect we deliver. We will continue to work on delivering Myocardial infarction (heart attack) care bundle these ‘Always Events’ to every patient at every interaction. Stroke care bundle Intentional rounding To be in the top 20% Structured ward rounds for patient satisfaction in the NHS Infection bundles SAFE CLEAN PERSONAL During the course of the strategy we are using Patient & Customer Focus Accountability Continuous Improvement Respect principles of reliability science to maintain high Always Event 1 performance, improve care where needed and Sta# will always communicate with, inform and respect the patient and/or carers improve processes in the areas highlighted above. Always Event 2 Patients, families and/or carers will always know who is in charge of their care Patient experience Always Event 3 AIM: Patients, families and/or carers are always listened to Achieve top 20% for patient and sta# experience surveys Always Event 4 Patients’ physical, social and emotional needs will always be reviewed
It is our ambition that we will deliver a series of Always Event 5 projects that will make Salford Royal’s patients Patients, families and/or carers will always receive information and education to facilitate self-care describe us as their "rst choice of care provider Always Event 6 based on the quality of their experience. Patients, families and/or carers will always be included in the discharge process
Outpatients Pre admission Inpatient Discharge Community
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Measurement Workforce capability and organisational culture Measurement is a vital part of improvement; if we do not Organisational culture is very di!cult to de"ne but is vital measure then we have no way of knowing whether the to address if the ambition is to be the best in the NHS. changes or intended improvements that we are making Organisational culture can be de"ned as the assumed have had any impact. understandings between the sta# of an organisation. It As an organisation we expect that data is presented on means that they share views on the way sta# should work run and control charts so that we can understand change together and treat each other and their patients. We have over time. We have also continued to develop our Quality an ambition to be an organisation that has a culture of Improvement Dashboard throughout 2013/14. The safety. measures on this dashboard help us to understand the One of the key features of an organisation that has a quality of care that we are providing to patients, this is safety culture is that it has a workforce that is capable of reviewed frequently by the Board of Directors. delivering improvement. This is something that we have Measures within the dashboard include: prioritised at the highest level. This means that our sta# must respond well to change and embrace initiatives, be Mortality indicators such as HSMR and crude mortality open to new ideas and encourage forward thinking, taking "gures ownership for continuous learning and self-development. Length of stay and readmission rate data Over the course of the coming year, we will continue to: Patient satisfaction indicators Provide our sta# with training opportunities to develop Harm measures - such as falls, pressure ulcers, ventilator quality improvement capability, this includes: associated pneumonia, days between MRSA blood A suite of modules which cover the basics of many stream infections, Clostridium di!cile infections, and aspects of Quality Improvement results from the Safety Thermometer A comprehensive deep-dive into improvement In 2014/15 we will look to add measures that can highlight methods and techniques through the Clinical Quality the variation of care across the Trust, in addition to the Academy (now in its "fth year) aggregate measures already used. Bespoke Quality Improvement training as requested by divisions, wards and departments to support local quality agendas Implementation of Clinical Microsystems Coaching on a rolling programme Training on human factors
101 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 3 The Berwick Review
Salford Royal NHS Foundation Trust is a high performing organisation with statistically better than expected risk adjusted mortality, a proven track record of reducing harm to patients, and an ambitious plan to put our patients at the heart of everything we do.
e The Mid Staffordshir
However, it is every Trust’s responsibility to learn from NHS Foundation Trust the Francis report. The recommendations set out in both Public Inquiry Chaired by Robert Francis QC Francis reports, the Government response to Francis, and the Berwick Review, have been assessed by Salford Royal. The Trust is compliant with the "rst set of Francis recommendations. Since the second set of Report of recommendations were published, the Berwick Review and the Government’s response, we have used these reports to the Mid Staffordshire Foundation Trust inform several improvements in the past year. NHS Public Inquiry The next steps will be to use these national recommendations to further inform the development Executive summary of the next Quality Improvement Strategy, using the experience and ideas from front-line sta# to help shape the A promise to learn direction of the strategy. – a commitment to act Salford Royal’s chosen improvement methodologies, the Model for Improvement, and the Breakthrough Series HC 947 Collaborative are based around empowering front-line sta# Improving the Safety of Patients to use their expertise of the system to solve problems. The in England Trust has numerous examples of successful change ideas National Advisory Group on the that were solely developed by the front-line sta# including Safety of Patients in England using manual observations for detecting deteriorating patients. The Trust has captured the ideas from front-line sta# whilst running a series of Berwick Review sessions where the Berwick report was discussed at over 50 sessions and areas for improvement were identi"ed by front-line sta# across the Trust which will now be used to inform the future Quality Improvement Strategy for the Trust. August 2013
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Salford Royal was honoured to have two of our leaders The most frequently used words by sta# in these sessions: participate on the Berwick Review, Sir David Dalton, Chief Executive, and Elaine Inglesby Burke, Executive Nurse Director and Deputy Chief Executive. The Berwick Review was a small group of quality and safety leaders convened to study the various accounts of Mid Sta#ordshire, as well as the recommendations of Robert Francis and others, to distil for Government and the NHS the lessons learned, and to specify the changes that are needed. The Berwick Report begins by stating that: “The most important single change in the NHS in response to this report would be for it to become, more than ever before, a system devoted to continual learning and improvement of patient care, top to bottom and end to end.” The report made 10 A PROMISE TO LEARN - A COMMITMENT TO ACT: IMPROVING THE SAFETY OF PATIENTS IN ENGLAND recommendations and these are The Patient Quality First Leadership = Voice should Commitment, Early themes emerging for the next Quality Improvement summarised as: be heard at Safety Visibility, every level of Above All Encouragement, Strategy are: the service Compasssion E#ective learning systems Build Capability, Measure, Transparency, Improvement Addressing variation Science, Sta"ng Levels Understand Variation Networked Culture and teamwork interventions Learning
Don Berwick, MD Step change in doctor involvement At Salford Royal, we have taken the Berwick Report to Greater focus on patient and carer experience our frontline, running over 50 workshops for more than Sensitivity to operations: capacity and demand 500 sta# to date. These workshops, led by senior leaders management discussed the Berwick Report themes, discussed how Real time and predictive data current Salford Royal initiatives "t into this framework, and asked our sta# to tell us what we should work on next We look forward to presenting our new strategy to the in order to implement these recommendations. With the public in the coming months after further feedback is feedback from these workshops we will draft a new Quality gleaned from our sta# and our patients. Improvement Strategy to be published in 2014.
103 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 3 Our quality priorities 2014/15
The Quality Account has provided an overview of the Quality Improvement work which has taken place across the organisation. There are a number of projects which we will be taking forward into the coming year and focussing our attentions upon. We would however, like to highlight the following projects as key priorities for 2014/15:
Catheter associated urinary tract infections Patient experience The most common hospital acquired infection is urinary Patient, family and carer experience will always be one tract infection and many of these (around 80%) are linked of our top priorities and each year we would like to push to the patient having a catheter. We aim to reduce the ourselves further to improve. This year we want to focus on: number of catheters in use in the hospital by making sure Development of improved information on procedures, they are removed when they have served their purpose diagnoses and medications or are only put in for the right clinical reasons. If we can Customer service training reduce the number of inappropriately used catheters we can have a real impact on the number of infections in the Interventions to help patients sleep better such as ear hospital as a result. plugs and eye masks Test working with care partners (this is where family Sepsis or friends of patients who know them well can help us deliver the best care to our patients) Sepsis arises when the body’s response to an infection Development of programmes on shared decision making damages its own tissues and organs and can lead to shock, (this helps us involve patients in their care decisions multiple organ failure, and death, especially if it is not rather than assuming we understand what treatment is recognised early and treated promptly. Between a third best for them) and a half of all patients who have sepsis do not survive. The ‘Sepsis Six’ is a group of actions that can be taken when a patient is diagnosed with sepsis. They are designed to Safe sta"ng levels treat the condition and if the patient receives these steps We believe it is important to provide assurance to the Trust quickly, they have a much better chance of survival. We as well as reassurance for patients and their relatives that aim to develop an educational programme to improve the we are paying adequate attention to safe sta!ng levels. timely recognition and treatment of sepsis and to use our While we already display sta!ng boards at the entrance new electronic patient record system to support this. of every ward at Salford Royal, we also want to work on measuring this daily and increasing the reliability of established sta!ng levels.
104 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 3 Statements of assurance from the Board
Review of services During 2013/14 the Salford Royal NHS Foundation Trust Table 1: National clinical audits provided and/or sub-contracted 43 relevant health services. Acute coronary syndrome or Acute myocardial infarction The Salford Royal NHS Foundation Trust has reviewed all (MINAP) the data available to them on the quality of care in 100% of Bowel cancer (NBOCAP) these relevant health services. Cardiac Rhythm Management (CRM) The income generated by the relevant health services Diabetes (Adult) ND(A), includes National Diabetes Inpatient reviewed in 2013/14 represents 100 per cent of the total Audit (NADIA) income generated from the provision of relevant health Diabetes (Paediatric) (NPDA) services by Salford Royal NHS Foundation Trust for 2013/14. Emergency use of oxygen Epilepsy 12 audit (Childhood Epilepsy) Falls and Fragility Fractures Audit Programme (FFFAP) Participation in clinical audits Head and neck oncology (DAHNO) During 2013/14, 26 national clinical audits and four national ICNARC Adult Critical Care Case Mix Programme (CMP) con"dential enquiries covered NHS services that Salford In"ammatory bowel disease (IBD) Lung cancer (NLCA) Royal NHS Foundation Trust provides. Moderate or severe asthma in children (care provided in During that period Salford Royal NHS Foundation Trust emergency departments)* participated in 96% national clinical audits and 100% National Audit of Seizures in Hospitals (NASH) national con"dential enquiries of the national clinical audits National Chronic Obstructive Pulmonary Disease (COPD) Audit and national con"dential enquiries which it was eligible to Programme participate in. National Comparative Audit of Blood Transfusion programme National emergency laparotomy audit (NELA) The national clinical audits and national con"dential National Heart Failure Audit enquiries that Salford Royal NHS Foundation Trust was National Joint Registry (NJR) eligible to participate in during 2013/14 are as follows: Oesophago-gastric cancer (NAOGC) Paracetamol overdose (care provided in emergency departments) Rheumatoid and early in"ammatory arthritis Sentinel Stroke National Audit Programme (SSNAP)* Severe sepsis & septic shock Severe trauma (Trauma Audit & Research Network, TARN)
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Table 2: National con#dential enquiries The national clinical audits and national con"dential enquiries that Salford Royal NHS Foundation Trust Lower Limb Amputation participated in, and for which data collection was Tracheostomy Care completed during 2013/14, are listed below alongside the Subarachnoid Haemorrhage Alcohol Related Liver Disease number of cases submitted to each audit or enquiry as a percentage of the number of registered cases required by the terms of that audit or enquiry. Table 3: National clinical audit projects participants Title Eligible Participated % Submitted Peri and Neonatal Maternal, Newborn and Infant Clinical Outcome Review Programme (MBRRACE-UK) NO Not Applicable to Salford Royal Services Neonatal intensive and special care (NNAP) NO Not Applicable to Salford Royal Services Children Child Health Clinical Outcome Review Programme (CHR-UK) NO Not Applicable to Salford Royal Services Congenital Heart Disease (Paediatric Cardiac Surgery) (CHD) NO Not Applicable to Salford Royal Services Diabetes (Paediatric) (NPDA) 100% Epilepsy 12 Audit (Childhood Epilepsy) 100% Moderate Or Severe Asthma in Children (Care Provided In Emergency Departments) 100% Paediatric Asthma NO Not Applicable to Salford Royal Services Paediatric Bronchiectasis NO Not Applicable to Salford Royal Services Paediatric Intensive Care (PICA Net) NO Not Applicable to Salford Royal Services Acute Care Emergency use of oxygen 100% ICNARC Adult Critical Care Case Mix Programme (CMP) Ongoing National Cardiac Arrest Audit (NCAA) NO Did not participate in the current year National Emergency Laparotomy Audit (NELA) Ongoing Paracetamol Overdose (Care Provided In Emergency Departments) 100% Severe Sepsis and Septic Shock 100% Long Term Conditions Diabetes (Adult) ND(A), Includes National Diabetes Inpatient Audit (NADIA) 100% In$ammatory Bowel Disease (IBD) Ongoing National Audit Of Seizures in Hospitals (NASH) 100% National Chronic Obstructive Pulmonary Disease (COPD) Audit Programme Ongoing Rheumatoid and Early In$ammatory Arthritis Ongoing
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Title Eligible Participated % Submitted Elective Procedures Coronary Angioplasty NO Not Applicable to Salford Royal Services National Adult Cardiac Surgery Audit NO Not Applicable to Salford Royal Services National Joint Registry (NJR) Ongoing National Vascular Registry NO Not Applicable to Salford Royal Services Cardiovascular Disease Acute Coronary Syndrome or Acute Myocardial Infarction (MINAP) Ongoing Cardiac Rhythm Management (CRM) Ongoing National Heart Failure Audit Ongoing Pulmonary Hypertension (Pulmonary Hypertension Audit) NO Not Applicable to Salford Royal Services Sentinel Stroke National Audit Programme (SSNAP) 100% Renal Disease Renal Replacement Therapy (Renal Registry) Cancer Bowel Cancer (NBOCAP) Ongoing Head and Neck Oncology (DAHNO) Ongoing Lung Cancer (NLCA) Ongoing Oesophago-Gastric Cancer (NAOGC) Ongoing Trauma Falls And Fragility Fractures Audit Programme (FFFAP) Ongoing Severe Trauma (Trauma Audit & Research Network, TARN) Ongoing Psychological Conditions National Audit of Schizophrenia (NAS) NO Not Applicable to Salford Royal Services Blood Transfusion National Comparative Audit of Blood Ongoing Transfusion Programme
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Table 4: NCEPOD projects participation Title Eligible Participated % Submitted Lower Limb Amputation 100% Tracheostomy Care 100% Subarachnoid Haemorrhage 100% Alcohol Related Liver Disease 100%
The reports of 21national clinical audits were reviewed by the provider in 2013/14 and Salford Royal NHS Foundation Trust intends to take the following actions to improve the quality of healthcare provided (See Appendix A). The reports of 16 local clinical audits were reviewed by the provider in 2013/14 and Salford Royal NHS Foundation Trust intends to take the following actions to improve the quality of healthcare provided (See Appendix B).
Participation in clinical research The number of patients receiving NHS services provided or For 2013/14, Salford Royal has received sign-o# to date sub-contracted by that the milestones relating to quarters 1-2 of 2013/14 Salford Royal NHS Foundation Trust in 2013/14 that were have been delivered. The Trust is awaiting con"rmation recruited during that period to participate in research in respect of quarter 3. The quarter 4 performance will approved by a research ethics committee was 4,900. be shared with commissioners at the end of April but con"rmation is not expected from commissioners until the Goals agreed with commissioners: use of the end of May. CQUIN payment framework Further details of the agreed goals for 2014/15 and for the following 12 month period are available on request. For A proportion of Salford Royal NHS Foundation Trust 2012/13 the baseline value of the CQUIN was £6.7m. income in 2013/14 was conditional on achieving quality improvement and innovation goals agreed between The Trust achieved 99.6% of its CQUIN goals but as there Salford Royal NHS Foundation Trust and any person or body was an over performance against the activity / income they entered into a contract, agreement or arrangement targets and re$ects 2.5% of the outturn value the actual with for the provision of relevant health services, through CQUIN income received for 2012/13 was £6.76m. the Commissioning for Quality and Innovation payment framework (CQUIN). For 2013/14 the baseline value of the CQUIN was again 2.5% of the contract value (£7.8m). If the agreed milestones were not achieved during the year or the outturn contract value was lower than the baseline contract, then a proportion of CQUIN monies would be withheld. 108 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 3
Relevance of data quality and action to improve data quality It is well known that good quality information underpins Daily review of outpatient activity to ensure attendance the e#ective delivery of improvements to the quality of outcome is recorded timely and to ensure patients who patient care. have DNA’d have correct postal addresses in comparison Improving data quality will therefore improve patient care to National Spine portal and improve value for money. High quality information Weekly enhanced death reports from National Spine means better patient care and patient safety. portal to ensure out of hospital deaths are recorded on the Trust’s Patient Administration System (PAS) with a High quality information is: plan to extend this to include non Salford Royal North Accurate West Hospital deaths. Up to date By validating the above metrics we ensure that personal Free from duplication (for example, where two or more data held on the Trust’s system is accurate in keeping with di#erent records exist for the same patient) the Data Protection Act. Salford Royal NHS Foundation Trust will be taking the Furthermore it prevents the formation of duplicate records following actions to improve data quality: ensuring the safety of patients and enabling high quality Daily validation to improve ethnicity recording for acute care. and community activity Daily validation of new registrations to reduce the number of duplicate registrations Weekly submissions to demographic batch service to trace records against the National Spine portal to ensure accurate data Daily monitoring of day case activity and regular attenders to improve live ADT Ward audits and monitoring of 11pm to 6am discharges to improve ADT Auditing of all returned patient related correspondence to the Trust to ensure correct demographic data is held
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NHS number of General Medical Practice code Clinical coding error rate validity Salford Royal NHS Foundation Trust was not subject to the Salford Royal NHS Foundation Trust submitted records Payment by Results clinical coding audit during 2013/14 during 2013/14 to the Secondary Uses service for inclusion by the Audit Commission as part of this year’s assurance in the Hospital Episode Statistics which are included in the framework. However, the Trust commissioned its own latest published data. external audit of 1000FCEs for 2013/14. The percentage of records in the published data: 500 FCE of random activity 2013/14 Which included the patient’s valid NHS number was: 100 deceased FCES 99.19% for admitted patient care; 100 Division of Salford Health Care 100 Division of Clinical Support Services and Tertiary 99.46% for outpatient care; and Medicine 98.89% for Accident and Emergency care 100 Division of Surgery 100 Division of Neurosciences and Renal Services Which included the patient’s valid General Medical Practice Code was: The draft error rates reported for that period for diagnoses 99.96% for admitted patient care; and treatments coding (clinical coding) were: 99.52% for outpatient care; and Secondary Diagnoses Incorrect 2.2% Primary Procedures Incorrect 99.97% for Accident and Emergency care 4.1% Secondary Procedures Incorrect 9.1% The clinical coding results should not be extrapolated Information governance toolkit attainment level further than the actual sample size audited. The IG Toolkit is an online system which allows NHS organisations and partners to assess themselves against Salford Royal achieved level 2 for the Information Department of Health Information Governance policies Governance audit for 2013/14 which supports Information and standards. It is fundamental to access to the NHS N3 Governance toolkit requirements 505, 508, 510. network and to promote safe data sharing. It also allows The error rates identi"ed were: members of the public to view participating organisations’ Secondary Diagnoses Incorrect 3.12% IG Toolkit assessments. Primary Procedures Incorrect 9.24% Salford Royal NHS Foundation Trust Information Secondary Procedures Incorrect 2.19% Governance Assessment Report score score overall for 2013/14 was 90% and was graded Green.
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What others and the Care Quality Commission say about Salford Royal NHS Foundation Trust: Salford Royal NHS Foundation Trust is required to CQC inspection of Health Services for Looked After Children register with the Care Quality Commission and its current and Safeguarding. The Inspectors followed the child’s registration status is “Registered without conditions”. journey, re$ecting the experiences of the children and Salford Royal NHS Foundation Trust has the following young people or parents/carers to whom they spoke to, conditions on registration “none”. or whose experiences we tracked or checked through The Care Quality Commission has not taken enforcement documentation. In total they took into account the action against Salford Royal NHS Foundation Trust during experiences of 64 children and young people. The review 2013/14. highlighted areas of good practice across all interfaces within the Trust whereby, children were kept safe. Salford Royal NHS Foundation Trust has participated in special reviews or investigations by the Care Quality There is no rating following the inspection, however, initial Commission relating to the following areas during 2013/14: feedback from the CQC Inspectors was “there are some very inspiring and committed health professionals CQC inspection of The Maples (care home with nursing) where the following outcome standards were assessed: working in Salford, who are passionate about ensuring that vulnerable children and young people within the Consent to examination or treatment 2 local communities are kept safe”. The CQC highlighted 4 Care and welfare of people who use services issues with the paper based records system in Accident and 5 Meeting nutritional needs Emergency and that a small number of policies in Accident 13 Sta!ng and Emergency and Children’s Care were past their review 16 Assessing and monitoring the quality of services date. Salford Royal NHS Foundation Trust intends to take the The Trust was judged to be meeting all "ve of the standards following action to address the conclusions of requirements assessed, with no actions to be taken. reported by the CQC: Salford Royal NHS Foundation Trust underwent an A comprehensive action plan has been developed and inspection as a pilot of the CQC’s new inspection process. implemented to address concerns raised As this was a pilot the Trust did not receive a rating as a result of this inspection, but on publication of the report Salford Royal NHS Foundation Trust has made the following the CQC stated that the “Trust’s services were safe, progress by 31 March 2014 in taking such action effective, responsive, caring and well led. The values There is a plan in now in place to ensure all records and behaviour of staff showed that the Trust has in Accident and Emergency will be recorded on the an excellent culture of learning and openness with a Electronic Patient Record by the end of April 2014. commitment of continuous improvement.” Identi"ed policies are now review and all policies are available on the Trust intranet site with on-going monitoring processes in place 111 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 4 Review of quality performance
112 4 Performance against national targets and regulatory requirements 2013/14
Salford Royal aims to meet all national targets and priorities. We have provided an overview of the national targets and minimum standards including those set out within Monitor’s Compliance Framework below. Further indicators of performance can be found in section 4 of the Quality Accounts.
National Targets and Target Target 2013/14 2012/13 2011/12* 2010/11* Minimum Standards (2013/14) Number of clostridium di!cile cases 35 18 47 58 101 Infection Control Number of MRSA blood stream infection cases 0 0 3 5 8 % of cancer patients waiting a maximum of 31 days from diagnosis to !rst de!nitive treatment 96% 98.2% 98.9%* 98.4% 98% % of cancer patients waiting a maximum of 31 days for subsequent treatment (anti-cancer drugs) 98% 100% 100%* 100% 100% % of cancer patients waiting a maximum of 31 days for subsequent 97.8% 99.2% treatment (surgery) 94% 98.3% 99.4%* Access to % of cancer patients waiting a maximum of 31 days for subsequent 94% 100% 100%* 100% N/A Cancer Services treatment (radiotherapy) % of cancer patients waiting a maximum of 2 months from urgent GP referral to treatment 85% 86.8% 88.7%* 89.6% 89.6% % of cancer patients waiting a maximum of 2 months from the 90% 96.4% 85.2%* 92.6% 85% consultant screening service referral to treatment (NB low numbers (NB low numbers mean this is below means this is below the deminimis) the deminimus) % of cancer patients waiting a maximum of 2 weeks from urgent GP referral to date !rst seen 93% 97.9% 98.4%* 98.6% 99.3% % of symptomatic breast patients (cancer not initially suspected) waiting a maximum of 2 weeks from urgent GP referral to date !rst seen 93% 95.6% 97.5%* 95.5% 96.2% 18 weeks Referral to Treatment - admitted patients 90% 93.0% 94.5% 90.34%** 91.53%* Access to Treatment 18 weeks Referral to Treatment - non-admitted patients 95% 96.2% 96.79% 95.48%** 95.95%** 18 weeks Referral to Treatment - patients on an incomplete pathway 92% 95.1% 96.4% N/A N/A
Access to A&E % of patients waiting a maximum of 4 hours in A&E from arrival to 95% 95.9% 95.46% 98.86% 97.39% admission, transfer or discharge
Access to patients with The Trust provides self-certi!cation that it meets the requirements to N/A Yes Yes Yes Yes a learning disability provide access to healthcare for patients with a learning disability
Cancelled operations % of in-patients whose operations were cancelled by the hospital for 0% 0.56% 0.52% 0.53% 0.63% non-clinical reasons on day of or after admission to hospital Cancelled operations not % of those patients whose operations were cancelled by the hospital for non-clinical reasons on day of or after admission to hospital, and 0% 0.78% 0.89% 3.54% 3.90% treated within 28 days were not treated within 28 days
* Some of these !gures have been updated from our performance published in previous Quality Accounts. This is because we had provided data up to the end of February in the respective years and this has now been replaced with data up to the end of the !nancial year. ** These !gures have been amended as the access to treatment target changed in 2012/13 from admitted and non-admitted 95th percentile (displayed in weeks) to a percentage achieved.
113 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 4 The NHS outcomes framework 2013/14 indicators
The NHS Outcomes Framework 2013/14 sets out high level national outcomes which the NHS should be aiming to improve. The Framework provides indicators which have been chosen to measure these outcomes. An overview of the indicators is provided in the table. It is important to note that whilst these indicators must be included in the Quality Accounts the most recent national data available for the reporting period is not always for the most recent "nancial year. Where this is the case the time period used is noted underneath the indicator description.
Domain Indicator 2013/14 National Where Applicable Where Applicable Trust Statement 2012/13 2011/12 2010/11 Average - Best Performer - Worst Performer SHMI value and 0.91 1 The Whittington Blackpool Teaching The Salford Royal NHS Foundation Trust considers that this data is as 0.86 93.59 N/A banding Band 2 Band 2 Hospital Hospitals described for the following reasons. Mortality reduction has been a constant Band 3 Band 2 (July 2012 - June (Band 2 =as (as (SHMI value 0.63) (SHMI value 1.16) focus for the Trust over the course of successive Quality Improvement (better (as 2013)* expected) expected) Strategies than expected) Band 3 (better than Band 1 (worse than expected) expected) expected) The Salford Royal NHS Foundation Trust has taken the following actions to improve this rate, and so the quality of its services, by the implementation of Preventing wide ranging Quality Improvement Strategies which have aimed to improve people mortality and harm by focussing on a series of interventions including: from dying A programme of work known as the Salford Standards which is designed prematurely to improve mortality by ensuring care is equitable across the seven days Enhancing of the week quality Trust wide harm reduction Quality Improvement Collaboratives (as can be of life for seen through the content of this Quality Account) people with Where available data for last three reporting periods is displayed to the right. long-term 0.86 Band 3 (better than expected) conditions % of admitted 2.49% 1.14% N/A N/A TThe Salford Royal NHS Foundation Trust considers that this data is as 2% 1.8% N/A patients whose described for the following reasons. The Trust has a very well established treatment Palliative Care Team, who provide in reach to all areas of the hospital. included palliative The Salford Royal NHS Foundation Trust continues to take the actions care highlighted in this Quality Account to improve this percentage and so the (July 2012 - June quality of its services, by continuing to place the upmost importance on high 2013) (taken from quality palliative care for our patients Dr Foster Mortality Comparator) Where available data for last three reporting periods is displayed to the right. Patient reported 0.026 0.086 N/A N/A The Salford Royal NHS Foundation Trust considers that this data is as 0.083 0.083 0.138 outcome scores (29 sample size) described for the following reasons. (45 sample (small for groin hernia The Salford Royal NHS Foundation Trust continues to take the following size)(Note: sample surgery (April - actions to improve this outcome and so the quality of its services, by this !gure size of 22) September 2013)* developing a signi!cant amount of work in the area of theatre improvement, updated this in the form of an Improving Culture in Theatres Collaborative project this since last work has been underway for over a year. Quality Helping Accounts) people Where available data for last three reporting periods is displayed to the right. recover from Patient reported N/A N/A N/A N/A This procedure is not carried out at the Trust. N/A N/A N/A episodes of outcome scores ill health or for varicose vein following surgery (April - injury September 2013)* Patient reported 0.513 0.45 N/A N/A The Salford Royal NHS Foundation Trust considers that this data is as 0.388 0.487 0.479 outcome scores for (16 sample size) described for the following reasons. (83 sample (small hip replacement The Salford Royal NHS Foundation Trust continues to take the following size)(Note: sample surgery (April - actions to improve this outcome and so the quality of its services, by this !gure size of 10) September 2013)* developing a signi!cant amount of work in the area of theatre improvement, updated this in the form of an Improving Culture in Theatres Collaborative project this since last work has been underway for over a year. Quality Where available data for last three reporting periods is displayed to the right. Accounts)
114 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 4
Domain Indicator 2013/14 National Where Applicable Where Applicable Trust Statement 2012/13 2011/12 2010/11 Average - Best Performer - Worst Performer Patient reported 0.214 0.34 N/A N/A The Salford Royal NHS Foundation Trust considers that this data is as 0.316 0.385 0.301 outcome scores for (15 sample size) described for the following reasons. (92 sample (small knee replacement The Salford Royal NHS Foundation Trust continues to take the size) (Note: sample surgery following actions to improve this outcome and so the quality of its this !gure size of 8) (April - September services, by developing a signi!cant amount of work in the area of updated since 2013)* theatre improvement, this in the form of an Improving Culture in last Quality Theatres Collaborative project this work has been underway for over Accounts) Helping a year. people Where available data for last three reporting periods is displayed to recover from the right. episodes of ill health or 28 day readmission 8.8% 10.01% N/A N/A The Salford Royal NHS Foundation Trust considers that this data is as 9.1% 10.18% 12% following rate for patients described for the following reasons. (Note: (Note: (Note: injury aged 0-15 (Most The Salford Royal NHS Foundation Trust continues to take the following this !gure this !gure this !gure continued recent data actions to improve this outcome and so the quality of its services, by updated since updated updated available for this developing a signi!cant amount of work in the area of readmission last Quality since last since last reporting period is reduction this in the form of a Trust wide Readmissions Reduction Accounts) Quality Quality 2011/2012) Collaborative. In addition, readmissions reduction has been a focus of Accounts) Accounts) much work across the divisions in the form of reducing readmissions due to alcohol, a discharge planning project and an integrated care project which aims to reduce readmissions by improving integration of care across the health economy. Where available data for last three reporting periods is displayed to the right. 28 day readmission 12.27% 11.45% N/A N/A The Salford Royal NHS Foundation Trust considers that this data is as described. 11.87% 11.84% 11.99% rate for patients The Salford Royal NHS Foundation Trust continues to take the following (Note: this !gure (Note: (Note: aged 16 or over actions to improve this outcome and so the quality of its services, by updated since this !gure this !gure (Most recent data developing a signi!cant amount of work in the area of readmission last Quality updated updated available for this reduction this in the form of a Trust wide readmissions reduction Accounts) since last since last reporting period is collaborative. In addition readmissions reduction has been a focus of Quality Quality 2011/2012) much work across the divisions in the form of reducing readmissions Accounts) Accounts) due to alcohol, a discharge planning project and an integrated care project which aims to reduce readmissions by improving integration of care across the health economy. Where available data for last two reporting periods is displayed to the right. Responsiveness to 70.6% 68.1% N/A N/A The Salford Royal NHS Foundation Trust considers that this data is as described. 68.6% 66.6% 70.6% inpatients’ personal The Salford Royal NHS Foundation Trust continues to take the following needs: CQC actions to improve this outcome and so the quality of its services, by national inpatient developing a signi!cant amount of work in the area of patient, family survey score* and carer experience, this in the form of an Trust wide Patient, Family Ensuring (2012/2013 data) and Carer Experience Improvement collaborative project. that people Where available data for last two reporting periods is displayed to have a the right. positive experience Percentage of 88.5% 67% Queen Victoria Mid Yorkshire The Salford Royal NHS Foundation Trust considers that this data is as described. 85% 84% 83% of care sta" who would Hospital NHS Hospitals NHS Trust The Salford Royal NHS Foundation Trust continues to take the following recommend the Foundation Trust (40%) actions to improve this outcome and so the quality of its services, by provider to friends (94%) developing a signi!cant amount of work in the area of patient, family or family needing and carer experience, this in the form of an Trust wide Patient, Family care***** and Carer Experience Improvement collaborative project. Where available data for last two reporting periods is displayed to the right.
115 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 4
Domain Indicator 2013/14 National Where Applicable Where Applicable Trust Statement 2012/13 2011/12 2010/11 Average - Best Performer - Worst Performer % of admitted 96% 95.7% N/A N/A The Salford Royal NHS Foundation Trust considers that this data is as 96.5% 94.6% N/A patients risk- described. (Note: assessed for Venous The Salford Royal NHS Foundation Trust continues to take the following this !gure Thromboembolism actions to improve this outcome and so the quality of its services, by updated (April - December developing systems to ensure that patients receive risk assessments for since last 2013)** venous thromboembolism. Monthly Safety Thermometer walk rounds Quality highlight the importance of timely risk assessments in the prevention of Accounts) blood clots. Where available data for last two reporting periods is displayed to the right. Rate of C.Di!cile 21.6 17.3 South Tyneside (5.5) North Tees and The Salford Royal NHS Foundation Trust considers that this data is as 27.1 44.3 45.6 Treating per 100,000 bed Count of Trust Hartlepool (30.8) described. Count Count Count and caring days(2012/2013) apportioned Count of Trust The Salford Royal NHS Foundation Trust continues to take the following of Trust of Trust of Trust for people ***For up to date cases = 47 apportioned cases = 7 Count of Trust actions to improve this outcome and so the quality of its services, by placing apportioned apportioned apportioned in a safe data on the most apportioned cases infection control as the highest priorities and ensuring that all sta" are fully cases = 58 cases = 101 cases = 125 environment recent !nancial = 61 compliant with mandatory training for antiseptic non-touch technique. (Note: (Note: (Note: and year performance Where available data for last two reporting periods is displayed to the right. this !gure this !gure this !gure protecting please see the updated updated updated them from speci!c C.Di!cile since last since last since last avoidable page within the Quality Quality Quality harm Quality Accounts Accounts) Accounts) Accounts) Rate of patient 9.4 Data Not North Devon (17.5) Basildon Hospital (1.7) The Salford Royal NHS Foundation Trust considers that this data is as 8.4 8.4 8.43 safety incidents Count of Provided ****** ****** described. Count of Count of Count of per 100 admissions incidents Please note count of Please note count of The Salford Royal NHS Foundation Trust continues to take the following incidents incidents incidents (Oct 12 - Mar = 3,474 incidents is not given incidents is not given actions to improve this outcome and so the quality of its services, by = 3,474 = 3,627 = 3,4 13)**** as di"erent trusts have as di"erent trusts have encouraging a culture of voluntary reporting and endorsing a fair blame reported data for a reported data for a culture. April-Sept April-Sept April-Sept di"erent number of di"erent number of 2012) 2011) 2010) months months Where available data for last two reporting periods is displayed to the right. % of patient safety 0.38% Data not Data not provided Data not provided The Salford Royal NHS Foundation Trust considers that this data is as 0.4% 0.4% 0.4% incidents reported Count of provided described. Count of Count of Count of that resulted in incidents The Salford Royal NHS Foundation Trust continues to take the following incidents incidents incidents severe harm or = 15 actions to improve this outcome and so the quality of its services, by = 13 = 15 = 14 death (Oct 12 - encouraging a culture of voluntary reporting and endorsing a fair blame April-Sept April-Sept April-Sept Mar 13)**** culture. 2012) 2011) 2010) High Reporters Where available data for last two reporting periods is displayed to the right. should be shown as better Inpatient Friends 72 72 Fair!eld Hospital (95) Medway Hospital (18) The Salford Royal NHS Foundation Trust considers that this data is as N/A N/A N/A and Family Test (Highest placed NHS described. (February 2014 hospital) The Salford Royal NHS Foundation Trust continues to take the following Ensuring Data) actions to improve this outcome and so the quality of its services, by that people encouraging a culture of voluntary reporting and endorsing a fair blame have a culture. positive Where available data for last two reporting periods is displayed to the right. experience of care Accident and 58 55 Dartford and Medway Hospital (-5) The Salford Royal NHS Foundation Trust considers that this data is as N/A N/A N/A Emergency Friends Gravesham (90) described. and Family Test The Salford Royal NHS Foundation Trust continues to take the following (February 2014 actions to improve this outcome and so the quality of its services, by Data) encouraging a culture of voluntary reporting and endorsing a fair blame culture. Where available data for last two reporting periods is displayed to the right.
* Information obtained from the Health & Social Care Information Centre ** Information obtained from the Department of Health *** Information obtained from Health Protection Agency **** Information obtained from NHS England ***** Information obtained from the NHS Sta" Survey 2013 Results ****** Data used for comparison obtained from the National Patient Safety Agency & compares only trusts that are in the Small Acute, Medium Acute, Large Acute and Acute Teaching categories of hospital 116 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 4
Domain: preventing people from dying Domain: ensuring that people have a positive prematurely experience of care The Standardised Hospital Level Mortality Indicator (SHMI) Responsiveness to inpatients’ personal needs is a measure of mortality developed by the Department of This indicator provides a measure of quality, based on Health, which compares our actual number of deaths with the Care Quality Commission’s National Inpatient Survey. our predicted number of deaths. Each hospital is placed The score is calculated by averaging the answers to "ve into a band based upon their SHMI; Salford Royal is in band questions in the inpatient survey. The highest score 2 which is ‘as expected’. achievable is 100%. Salford Royal launched a Patient Experience Strategy Domain: helping people to recover from in January 2013, which provides a structure for all work episodes of ill health or following injury. streams "tting under this heading. Salford Royal is proud that the number of sta# members Patient reported outcome scores who would recommend us to friends and family needing A patient reported outcome measure is a series of treatments is higher than the national average. questions that patients are asked in order to gauge their views on their own health. In the examples of groin hernia, knee replacement, hip replacement and varicose vein surgery, patients are asked to score their health before and after surgery. We are then able to understand whether patients see a ‘health gain’ following surgery. The data provided gives the average di#erence between the "rst score (pre-surgery) and second score (post-surgery) that patients give themselves. In all procedures where data is available there are improvements in the average score. However, it is important to note that the sample size for all patient reported outcome scores is very small which may impact upon the meaningfulness of the data, this is recti"ed when the full year data is provided.
117 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 4
Domain: Treating and caring for people in a safe environment and protecting them from avoidable harm Risk assessing inpatients for venous thromboembolism (VTE) is important in reducing hospital acquired VTE. Salford Royal has worked hard to ensure that not only are our patients risk assessed promptly but that any prophylaxis is given reliably.
Domain: Treating and caring for people in a safe environment and protecting them from avoidable harm Patient safety incidents are reported to NHS England. The rate of patient safety incidents per 100 admissions reported by Salford Royal is 9.5. Organisations that report more incidents usually have a better and more e#ective safety culture. We believe you cannot learn and improve if you do not know what the problems are. Salford Royal will continue to encourage a culture of open reporting in order to learn and improve.
118 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 4 Performance against Trust selected metrics
2013/14 2012/13 2011/12 2010/11 2009/10 2008/09 Hospital Standardised Mortality Rate* 73.72 75.4 76.7 80.4 82 80.6 Patient Safety Stroke Mortality Rates (Acute Cerebral 90.0 100.7 112.2 108.2 103.4 94.8 Outcomes Vascular Disease)* Cardiac arrests outside critical care units per 0.49 0.52 0.40 0.49 0.66 0.91 1,000 admissions Advancing Quality Composite Quality Score 96.54% 97.95% 95% 97.42% 96.80% 95.56% for Acute Myocardial Infarction** Advancing Quality Composite Quality Score 84.86% 99.04% 98.59% 97.65% 97.98% 79.54% Clinical for Hip and Knee Surgery** E"ectiveness Advancing Quality Composite Quality Score 83.11% 82.22% 82.38% 85.62% 73.91% 59.29% for Congestive Heart Failure** Advancing Quality Composite Quality Score 89.42% 90.37% 83.38% 74.42% N/A N/A for Pneumonia** % of adult in-patients who felt they were 88% 82% 85% 81% 86% 85% treated with respect and dignity*** % of adult in-patients who had con!dence in 88% 84% 84% 81% 85% 87% the Trust doctors treating them*** % of in-patients whose operations were cancelled by the hospital for non-clinical 0.56% 0.52% 0.53% 0.63% 0.64% 0.54% reasons on day of or after admission to hospital Patient % of those patients whose operations were Experience cancelled by the hospital for non-clinical reasons on day of or after admission to 0.78% 0.89% 3.54% 3.9% 2.7% 2.4% hospital, and were not treated within 28 days Count of patients who waited greater than 52 11**** N/A N/A N/A N/A N/A weeks for treatment GP Out of Hours - Time from case active to de!nitive telephone clinical assessment. 98.23% 96.38% 97.28% N/A N/A N/A Urgent calls within 20 minutes***** GP Out of Hours - Time from case active to de!nitive telephone clinical assessment. Non- 98.06% 96.26% 97.14% N/A N/A N/A urgent calls within 60 minutes***** * Following recalculation of Dr Foster data, Dr Foster will not be the same as that reported in the 2012/13 Quality Accounts due to the re-basing of data. ** Data covers the period April 2013 - December 2013 as there is a time delay in the data reporting system. *** Indicates data taken from the Inpatient Survey 2013. **** Action plans are being provided by the service teams for these patients ***** Data from Adastra system
119 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 4 NHS England safety alert compliance 2013/14
Through the analysis of reports of safety incidents, and safety information from other sources, NHS England develops advice for the NHS that can help to ensure the safety of patients, visitors and sta#. As advice becomes available, NHS England issues alerts on potential and identi"ed risks to safety. At Salford Royal, these alerts are coordinated and monitored by the governance team who work with clinicians and managers in the appropriate areas to con"rm compliance or to form an action plan to monitor compliance against it. Salford Royal is fully compliant with all alerts for which compliance deadlines have passed. The following table shows those alerts issued by NHS England during 2013/14, and progress against them.
Reference Alert Title Issue Date Response Deadline Non-luer spinal (intrathecal) devices for Assessing level of risk and action requirement. NHS/PSA/D/2014/002 chemotherapy 20/04/2014 Alert progressing within required timeframe 20/08/2014 Risk of hypothermia in patients receiving Action on-going, on target for completion NHS/PSA/W/2014/001 continuous renal replacement therapy 6/04/2014 within deadline 6/03/2014 Placement devices for nasogastric tube insertion NHS/PSA/W/2013/001R DO NOT replace initial position checks 6/12/2013 Action completed 8/01/2014 Placement devices for nasogastric tube insertion NHS/PSA/W/2013/001 DO NOT replace initial position checks 5/12/2013 Replaced by alert NHS/PSA/W/2013/001R 8/01/2014
120 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 4 How we keep everyone informed
With more than 6,000 members of sta#, over 20,000 Foundation Trust Members and patients and visitors accessing our services from across the city of Salford and far beyond, the Trust uses a variety of communications channels SiREN to ensure everyone is kept informed about the organisation. This year, members of the Trust’s senior team led a series of Berwick Review Learning Sessions, which prompted sta# to re$ect on and discuss topics like the Francis Report and the Berwick Report and consider their own suggestions for reducing patient harm and improving patient experience. Ideas from these sessions are helping the Trust to develop the next Quality Improvement Strategy. The SiREN e-bulletin and the intranet are two of the more regular mechanisms that the Trust uses to keep sta# up to speed with news about the organisation. The Trust’s quarterly magazine The Loop is distributed to all Foundation Trust Members and includes news and updates along with details of up and coming events and activities, which Members can become involved in. During 2013/14, more than 200 Foundation Trust Members attended the popular Medicine for Members seminars with interactive presentations on subjects including preventing falls, asthma and joint replacement surgery. The schedule for 2014/15 includes seminars on trauma, dementia and research. The Trust’s Open Day and Annual Members’ Meeting is another opportunity for Foundation Trust Members, along with members of the public, to visit Salford Royal to "nd out more about our services, give their feedback and meet members of sta#. Salford Royal’s successes and achievements are celebrated on its weekly page in the local newspaper the Salford Advertiser and our 5,800 followers on Twitter get regular updates on Trust news and information.
121 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 4 Statements from Clinical Commissioning Group, Healthwatch and Overview and Scrutiny Committees
Quality Accounts Commentary from NHS Salford - May 2014 NHS Salford Clinical Commissioning Group (CCG) welcomes We fully support the Trust in continuing to focus on the opportunity to comment on the 2013/14 Quality improving safety as outlined in the priorities for 2014/15. Accounts for Salford Royal NHS Foundation Trust. In maintaining this emphasis on reducing harm we would We have been working closely with the Trust during the year, ask that the Trust considers an ambition to reduce weekend gaining assurance of the delivery of safe and e#ective services. mortality rates further so that they are consistent with Their quality and performance is monitored through regular weekday rates. meetings where data is shared, reviewed and discussed. The focus on improving patient experience and listening We are pleased to see that the information presented to the voice of patients is evident in the initiatives outlined. within the Quality Accounts is consistent with information Openness and transparency is clearly demonstrated by the supplied to the commissioners throughout the year. inclusion of a patient story that highlights some negative Review of regulatory inspections form part of our quality observations on his experiences as well as the positive assurance processes and we commend the Trust on the aspects of care delivered. As commissioners we are keen excellent feedback from the CQC inspection undertaken to work with the Trust to gain more direct feedback from during the year. The importance of this independent and patients on their experience so that further improvements external view on the quality of service provision is helpful can be made. in providing additional assurance to our direct discussions The information included with the Quality Accounts and observations. The positive comments in terms of provides an excellent overview of the improvements made e#ective leadership, the values and behaviour of sta# and across the organisation over the past 12 months. We are the commitment to continuous improvement reinforce our pleased that the Trust is fully committed to a programme own re$ections on working with the Trust. of improving the quality and safety of services as well We recognise the commitment of the Trust in as ensuring that patients receive a positive experience. implementing recommendations from recent national We would welcome an increased emphasis on quality inquiries and particularly welcome the work on safe sta!ng improvement initiatives within community services levels within in-patient wards. We would be keen to see and would hope to see more examples of these in the this work expanded to include community sta!ng levels Quality Accounts for 2015/16. We will continue to work over the next 12 months. in collaboration with the Trust in driving forwards further changes and improvement over the coming year. The organisations commitment to improving safety and reducing harm is recognised as excellent practice as Alan Campbell evidenced through the successful harm free care projects, Chief Accountable O#cer reduction in hospital acquired infections and reduction in NHS Salford Clinical Commissioning Group mortality rates. 122 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 4
Healthwatch Salford Overview and Scrutiny Committee During the "rst 12 months of operation Healthwatch Once again I am delighted to comment on the Quality Salford has developed a constructive working relationship Accounts for Salford Royal NHS Foundation Trust. To read with Salford Royal NHS Foundation Trust. On behalf of the such an inspiring report where most of the objectives have people of Salford and the Trust’s service users we seek to been achieved is an inspiration and my congratulations be a critical friend o#ering constructive feedback based on must go to all the sta# and trustees on achieving such evidence generated from patients, sta# and visitors. good results and seeing, where areas of improvement are needed, a comprehensive plan is put in place to reach the Healthwatch Salford contributed to the Care Quality level of satisfaction up to 100%. Commission’s more rigorous inspection process in October 2013. Our contributions included participating in and To be recognised as both the best Acute Hospital Trust contributing to the Quality Summit that reviewed the in the North West for patients and best place to work in "nal inspection report. From the Summit it was clear the NHS for sta# after a survey commissioned by the Care that Salford Royal is judged to be safe, e#ective, caring, Quality Commission in 2013 is a great achievement. To responsive and well led. continue to be in the top quartile of Hospital Trusts in the country is also a great achievement and to be recognised The Trust’s ambition to ensure that each patient’s as such is outstanding, this is down to the hard work and experience is safe, clean and personal appears to be determination of all sta# and trustees. achieving its goal. Our own independent patient feedback exercise included the following “I am very happy with the I and the population of Salford are proud of our Trust and way I have been dealt with and I can’t fault the service” and look forward to even greater improvements next year. support the Trust’s view that 90% of patients rate their care as excellent or very good. We acknowledge and applaud the Trust’s many successes and achievements during 2013/14. However, we recognise that challenges remain in ensuring the on-going delivery of safe and compassionate care and we look forward to playing our part in highlighting and resolving them.
Tim Smith Councillor Valerie Burgoyne Development Manager Chairman of the City of Salford’s Health and Wellbeing Strategic Unlimited Potential Scrutiny Committee Healthwatch Steward
123 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 4 Statement of Directors’ responsibilities in respect of the Quality Report
The directors are required under the Health Act 2009 and The quality report presents a balanced picture of the NHS the National Health Service Quality Accounts Regulations foundation trust’s performance over the period covered. to prepare quality accounts for each "nancial year. The performance information reported in the quality Monitor has issued guidance to NHS Foundation Trust report is reliable and accurate. boards on the form and content of annual quality reports There are proper internal controls over the collection (which incorporate the above legal requirements) and on and reporting of the measures of performance included the arrangements that NHS Foundation Trust boards should in the Quality Report, and these controls are subject to put in place to support the data quality for the preparation review to con"rm that they are working e#ectively in of the quality report. practice. In preparing the quality report, directors are required to The data underpinning the measures of performance take steps to satisfy themselves that: reported in the Quality Report is robust and reliable, The content of the quality report meets the requirements conforms to speci"ed data quality standards and set out in the NHS Foundation Trust Annual Reporting prescribed de"nitions, is subject to appropriate scrutiny Manual 2013/14 and review. The content of the quality report is not inconsistent with The Quality Report has been prepared in accordance with internal and external sources of information including: Monitor’s annual reporting guidance (which incorporates Board minutes and papers for the period April 2013 to the Quality Accounts Regulations) published at www. May 2014 monitor-nhsft.gov.uk/annualreportingmanual as well as the standards to support data quality for the Papers relating to Quality reported to the Board over preparation of the Quality Report (available at www. the period April 2013 to May 2014 monitor-nhsft.gov.uk/annualreportingmanual) Feedback from commissioners dated May 2014 The directors con"rm to the best of their knowledge and Feedback from governors dated May 2014 belief they have compiled with the above requirements in Feedback from local Healthwatch organisations dated preparing the Quality Report. May 2014 The Trust’s complaints report published under regulation 18 of the Local Authority Social Services 29 May 2014 Date and NHS Complaints Regulations 2009 Chairman The latest patient survey 2013 The latest national sta# survey 2013 The Head of Internal Audit’s annual opinion over the 29 May 2014 Date Trust’s control environment dated May 2014 Chief Executive CQC quality and risk pro"les dated March 2014 124 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 4 Independent Auditor’s Report to the Council of Governors of Salford Royal NHS Foundation Trust on the Annual Quality Report
We have been engaged by the Council of Governors of Salford We read the Quality Report and consider whether it addresses Royal NHS Foundation Trust to perform an independent assurance the content requirements of the NHS Foundation Trust Annual engagement in respect of Salford Royal NHS Foundation Trust’s Reporting Manual, and consider the implications for our report if Quality Report for the year ended 31 March 2014 (‘the Quality we become aware of any material omissions. Report’) and certain performance indicators contained therein. We read the other information contained in the Quality Report Scope and subject matter and consider whether it is materially inconsistent with: The indicators for the year ended 31 March 2014 subject to limited Board minutes for the period April 2013 to 29 May 2014; assurance consist of the national priority indicators mandated by Papers relating to quality reported to the Board over the Monitor: period April 2013 to 29 May 2014; Maximum waiting time of 62 days from urgent GP referral to "rst Feedback from the Commissioners received in May 2014; treatment for all cancers; and Feedback from local Healthwatch organisations received in Emergency re-admissions within 28 days of discharge from hospital May 2014; We refer to these national priority indicators collectively as the The Trust’s complaints report published under regulation 18 ‘indicators’. of the Local Authority Social Services and NHS Complaints Regulations 2009, in May 2014; Respective responsibilities of the Directors and Auditors The national 2013 patient survey dated published in February The Directors are responsible for the content and the preparation 2014; of the Quality Report in accordance with the criteria set out in the The national 2013 sta# survey published in February 2014; NHS Foundation Trust Annual Reporting Manual issued by Monitor. Care Quality Commission quality and risk pro"les dated 31 Our responsibility is to form a conclusion, based on limited March 2014; and assurance procedures, on whether anything has come to our The Head of Internal Audit’s annual opinion over the Trust’s attention that causes us to believe that: control environment dated 2 May 2014. The Quality Report is not prepared in all material respects in line with the criteria set out in the NHS Foundation Trust Annual We consider the implications for our report if we become aware Reporting Manual; of any apparent misstatements or material inconsistencies The Quality Report is not consistent in all material respects with with those documents (collectively, the ‘documents’). Our the sources speci"ed in Monitor’s 2013/14 Detailed Guidance for responsibilities do not extend to any other information. External Assurance on Quality Report; and We are in compliance with the applicable independence The indicators in the Quality Report identi"ed as having been and competency requirements of the Institute of Chartered the subject of limited assurance in the Quality Report are not Accountants in England and Wales (ICAEW) Code of Ethics. Our reasonably stated in all material respects in accordance with team comprised assurance practitioners and relevant subject the NHS Foundation Trust Annual Reporting Manual and the six matter experts. dimensions of data quality set out in the Detailed Guidance for External Assurance on Quality Reports.
125 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 4
This report, including the conclusion, has been prepared solely for Limitations the Council of Governors of Salford Royal NHS Foundation Trust Non-"nancial performance information is subject to more as a body, to assist the Council of Governors in reporting Salford inherent limitations than "nancial information, given the Royal NHS Foundation Trust’s quality agenda, performance and characteristics of the subject matter and the methods used for activities. We permit the disclosure of this report within the Trust’s determining such information. Annual Report for the year ended 31 March 2014, to enable the Council of Governors to demonstrate they have discharged their The absence of a signi"cant body of established practice on governance responsibilities by commissioning an independent which to draw allows for the selection of di#erent but acceptable assurance report in connection with the indicators. To the measurement techniques which can result in materially di#erent fullest extent permitted by law, we do not accept or assume measurements and can impact comparability. The precision of responsibility to anyone other than the Council of Governors as a di#erent measurement techniques may also vary. Furthermore, body and Salford Royal NHS Foundation Trust for our work or this the nature and methods used to determine such information, as report save where terms are expressly agreed and with our prior well as the measurement criteria and the precision thereof, may consent in writing. change over time. It is important to read the Quality Report in the context of the criteria set out in the NHS Foundation Trust Annual Assurance work performed Reporting Manual. We conducted this limited assurance engagement in accordance The scope of our assurance work has not included governance with International Standard on Assurance Engagements 3000 over quality or non-mandated indicators which have been (Revised) - ‘Assurance Engagements other than Audits or Reviews determined locally by Salford Royal NHS Foundation Trust. of Historical Financial Information’ issued by the International Auditing and Assurance Standards Board (‘ISAE 3000’). Our limited Conclusion assurance procedures included: Based on the results of our procedures, nothing has come to our Evaluating the design and implementation of the key processes attention that causes us to believe that, for the year ended 31 and controls for managing and reporting the indicators; March 2014: Making enquiries of management; The Quality Report is not prepared in all material respects in Testing key management controls; line with the criteria set out in the NHS Foundation Trust Annual Reporting Manual; Limited testing, on a selective basis, of the data used to calculate the indicators back to supporting documentation; The Quality Report is not consistent in all material respects with the sources speci"ed above; and Comparing the content requirements of the NHS Foundation Trust Annual Reporting Manual to the categories reported in The indicators in the Quality Report subject to limited the Quality Report; and assurance have not been reasonably stated in all material respects in accordance with the NHS Foundation Trust Annual Reading the documents. Reporting Manual. A limited assurance engagement is smaller in scope than a reasonable assurance engagement. The nature, timing and extent of procedures for gathering su!cient appropriate evidence Grant !ornton are deliberately limited relative to a reasonable assurance 4 Hardman Square, Spinning!elds, Manchester, M3 3EB engagement. Date: 29 May 2014
126 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 5 Appendices
127 5 Appendix A
National Clinical Audit: actions to improve quality
Audit Title Actions to be Taken Children Diabetes (Paediatric) (NPDA) Salford Paediatric Diabetes Team has continued to deliver high quality care to children and young people with diabetes. Figures from the latest National Paediatric Diabetes Audit (NPDA) 2011-2012 published in December 2013 highlight that Salford Royal NHS Foundation Trust do better than the national average with an average HbA1c of 8.5% compared nationally with 8.9%. The team continue with an on-going audit and are developing an action plan, following the latest report, to maintain the current level of excellence. Epilepsy 12 Audit (Childhood Epilepsy) This project was newly commenced in 2013 and Salford Royal submitted the organisational audit. The clinical data collection was delayed until 2014 following issues with the national data collection portal. Data collection is currently in progress following identi!cation of the patient group and will be completed in May 2014. Concurrent with the data collection will be collection of a set of Patient Experience Measures which will be included in the !nal report which is scheduled to be published in September 2014. Moderate Or Severe Asthma In Children (Care PANDA sta" continue to work on improvements to patient and parent information for information/advice given to parents, checking inhaler technique and Provided In Emergency Departments) follow-up arrangements. This is aimed to enhance safety for discharge/ transfer planning. Acute Care Emergency Use Of Oxygen 98% of Salford Royal patients using oxygen had a valid prescription or written order compared with 55% nationally Salford Royal sta" had set oxygen saturation target ranges for 93% of patients using oxygen compared with 52% nationally 96% of Salford Royal patients who were receiving supplementary oxygen had this documented properly on drug rounds compared with 21% nationally 72% of Salford Royal patients using oxygen had saturation level within the target range at the most recent observations round compared with 64% nationally These outstanding results at Salford Royal are based on 10 years of oxygen education and support and sta" training at Salford Royal with regular feedback of audit results to ward teams. The outcome for patients at Salford Royal is enhanced patient safety with reduced risk of any Salford Royal patient receiving too little oxygen or too much oxygen. Excessively low or excessively high oxygen levels can be harmful to patients. In many common conditions, the risk of death if reduced if the patient is successfully maintained within the pre-speci!ed target range for that patient. The audit has shown that oxygen therapy at Salford Royal is safer than in most UK hospitals and this may contribute to the lower than average overall mortality !gures at Salford Royal. ICNARC Adult Critical Care Case Mix The data collected is used to benchmark the service against national and regional performance. This has demonstrated that mortality at Salford Royal is Programme (CMP) better than regional and national indicators. Participation in the project has assisted the departmental morbidity and mortality reviews in identifying outliers from their predicted outcome and helping to identify most timely and e"ective interventions. Information from the audit has helped to improve service development by informing bed capacity and $ow analysis as well as supporting the forecasting future requirements as Salford Royal develops its major trauma role. Improvements in data collection for the project has tightened the documentation of admission timing and helped to identify admission delays which may impact patient outcome. National Emergency Laparotomy Audit Salford Royal successfully submitted the organisational audit for this newly started project. Data collection for procedures was delayed due to technical (NELA) problems at The Royal College of Anaesthetists but commenced in January 2014. Data collection is now on-going. Paracetamol Overdose (Care Provided In Data collected during the current year awaiting publication of the audit report Emergency Departments) Severe Sepsis & Septic Shock Data collected during the current year awaiting publication of the audit report
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Audit Title Actions to be Taken Long Term Conditions Diabetes (Adult) ND(A), Includes National The diabetes team carries out an annual service self-assessment in which all quality measures are reviewed. Diabetes Inpatient Audit (NADIA) With respect to inpatients NaDIA 2013 continues to demonstrate the bene!cial impact of the reorganised, and by comparison with other trusts rather small, inpatient team an on glucose control and medication safety. Changes introduces include altered DSN roles and responsibilities, investing time in ward sta" training using the Guildford programme, training sessions for junior doctors, improved elective surgical (especially day case surgical) pathway, EPR prescribing guidance and new VRII system. Prevention of inpatient heel ulcers and prompt management of new diabetic foot admissions has improved following implementation of new systems as well. And additional length of stay is down. Despite these encouraging changes there are on-going concerns about dangerous hyperglycaemia in patients given high dose steroids, insulin errors, severe hypoglycaemia rates and secondary prevention of DKA ‘frequent $iers’. Improvement programmes are under way for each including new policy and EPR alerts, networked POCT glucose testing, EPR VRII prescribing and collaboration with liaison psychiatry.
Further data collection is currently in progress with report expected in August 2014. The project consists of 4 parts; 1. Assessing the processes and outcomes of up to 50 consecutive prospectively identi!ed admissions for ulcerative colitis (UC) in 2013. In$ammatory Bowel Disease (IBD) 2. Questionnaires to be sent by participating hospitals to the 50 patients admitted for ulcerative colitis to re-audit IBD inpatient experience. 3. The continued entry of data into the audit of the use of biological therapies for IBD as recommended by NICE. The annual report published in August 2013 highlighted that Salford Royal had a higher percentage of patient treated with biological therapies (Salford Royal 73%, National 61%) and that those therapies were appropriately prescribed (SRFT 61% National 57%). 4. Entering data on the organisation and structure of IBD services. For the !rst time sites will be able to re-audit their service provision against the IBD standards.
National Audit Of Seizures In Hospitals Salford Royal completed the data collection for the project during 2013. Provisional data published in January 2014 demonstrates that Salford Royal (NASH) maintains a high level of performance in the care bundle for patients with !rst seizures being almost 10% above the national benchmark. Neurology team continue to review the provisional !ndings in anticipation of publication of the full report in 2014. Further work will then be directed to local action planning to improve any areas of concern. National Chronic Obstructive Pulmonary Respiratory nurse in-reach service for all the patients discharged that do not require hospital follow up and set time aside to contact the patients. If unable Disease (COPD) Audit Programme to contact them by telephone to contact the surgery and advise that the patient needs early review. A Trust wide project is planned to train all appropriate sta" to assess inhaler technique and record on the EPR. A project is on-going to improve the knowledge and skill of nursing sta" in the Emergency Department to manage patients presenting with asthma exacerbation e#ciently and e"ectively. The CRI team to undertake the spirometric tests prior to discharge where possible. This will be discussed on the ward rounds and the ward nursing sta" will use the developed criteria to direct the electronic requests for further follow-up. Rheumatoid And Early In$ammatory Data collection was delayed for this project but commenced in December 2013 and is currently on-going. Publication of the national report is scheduled for Arthritis June 2015.
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Audit Title Actions to be Taken Elective Procedures National Joint Registry (NJR) Improvements have been made in NJR Pre op consent at Pre-operative booking clinic. NJR sta" provided additional training for Theatre sta", Consultants and Doctors in the use of the online web tool during 2013. Consultant engagement has improved with appointment of lead consultant for this project. Cardiovascular Disease Acute Coronary Syndrome Or Acute High quality of interventional and non-interventional care of all patients with MI - STEMI or NSTEMI: Myocardial Infarction (MINAP) 92 % of all MI patients were seen by or discussed with cardiology team Increase from 26% to 64% in appropriate patients with MI transferred to and managed on cardiology wards Increase in % patients treated with post-MI bundle of drugs (aspirin 100%/clopidogrel 98% /beta blocker 99% /ACE inhibitor 96% /statin 98% 94 % of patients were referred for coronary intervention (as in-patients or out-patients) % patients with assessment of LV function post MI - this is also a focus of the AMI Advancing Quality Programme as a shadow measure with the initiation of daily morning echocardiogram lists on HCU during weekdays. Data for the current year is under collection Improved management of diabetes post MI and liaison with diabetes teams Increase in uptake of smoking cessation. A focus of the AMI AQ programme Increase in use of cardiac rehab for all MIs. A focus of the AMI AQ programme Better communication between cardiology and non-cardiology specialties, especially with regard to EAU - Daily Specialty input during weekdays Cardiac Rhythm Management (CRM) Data collection is currently on-going. Audit and Cardiology teams reviewed the current audit process to examine feasibility of automated data transfer. Currently reviewing national report published in 2014. National Heart Failure Audit Data collection delays have been reduced with the appointment of new sta". Data con!rms that continued good provision of echo & Heart Failure liaison service as well as high prescription of beta-blockers for patients with LVSD. The ACE inhibitor measure, when triangulated with data from other audits undertaken in Cardiology, demonstrates that Salford Royal provides a more accurate assessment and good compliance with NICE guidelines regarding these agents. The audit has recurrently demonstrated that patient survival is improved if patients with Heart Failure are managed on cardiology ward. The Trust continues to develop an in-reach policy to patients admitted to other wards. Sentinel Stroke National Audit Programme Dedicated stroke audit sta" continue to submit data to the project. (SSNAP) Salford Royal continues to perform as one of the top hospitals nationally and are consistently the best performing Trust in the North-west. Thrombolysis continues to improve and compliance with stroke patients’ door to needle time of 60 minutes remains high. Our challenge is in maintaining this level of performance. A widening of focus across the whole stroke pathway - from onset to 6 months post event - is a continued part of improvement within the service.
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Audit Title Actions to be Taken Renal Disease Renal replacement therapy Data collection is on-going currently awaiting appointment of new Audit Lead for Renal Medicine. (Renal Registry) Cancer Bowel Cancer (NBOCAP) Salford Royal has a well-established and successful Colorectal Cancer Service and continues to collect data to show the mortality and outcomes for patients undergoing surgery for cancer of the large bowel. This data was published in 2013 by Salford Royal and, at consultant-level, through the national audit under the Department of Health’s “Everyone Counts” Initiative. As part of its drive for the highest quality, safest possible care, comparison of actual versus expected death rates given the underlying health of the patients treated and the nature of the surgery they are undergoing is facilitated by the collection of this comprehensive data set. Mortality data for 163 patients who underwent emergency or elective (planned) major surgery with the intention of cure for bowel cancer at Salford Royal during the period April 2010 to March 2012 are summarised below. Rectal Cancer - 30 patients Actual 90 day mortality = 0% (expected 4.8%) Colon Cancer - 133 patients Actual 90 day mortality = 1.5% (expected 5.75%) These data mean that six more patients survived this surgery at Salford Royal than would usually have been expected at an “average” hospital. Salford Royal remains committed to o"ering the very highest standards of safe, reliable care for all our patients. We believe that the public are entitled to see, and have con!dence in these results, of which the Trust is justi!ably proud.
Head And Neck Oncology (DAHNO) Salford Royal Hospital has instigated a number of measures to improve quality performance within the Head and Neck Team. All patients will have a pre-treatment assessment of their dietary status and requirements to be undertaken by Head and Neck Nurse Specialists and a Dietician attached to the Clinic. All patients diagnosed with head and neck cancer will have pre-treatment and post treatment assessment of swallowing needs by a dedicated Head and Neck Speech and Language Therapist. An initial audit of staging and documentation of performance status of patients exhibited that there were some de!ciencies. Processes have now been changed and there is a signi!cant improvement in the number of patients who have performance status assessed and complete staging data on referral to MDT. All patients from the Head and Neck Clinic with a diagnosis of cancer are discussed at the MDT which is hosted at the Christie Hospital. Lung Cancer (NLCA) Following their participation in the NLCA, the Salford Lung team have worked hard to improve their service across a number of key areas including time to treatment, access to specialist testing, cancer breaches, patient information and uploading information to the national lung cancer database. Each of the key measures relating to active treatment, surgical resection, chemotherapy for small cell lung cancer and median survival continue to demonstrate high performance. Expanding our diagnostic service to include medical thoracoscopy continues to develop. We are also working towards supporting our incurable patients at home in order to prevent hospital admissions. Oesophago-Gastric Cancer (NAOGC) Improvements in the audit process has improved data completeness. A robust data collection process which involved our local partner trusts has resulted in our data completeness and accuracy improving and was demonstrated in the published report in 2013. We will continue to re!ne this process and clinical practice has bene!ted from a greater awareness of our data and the importance of accuracy within this.
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Audit Title Actions to be Taken Trauma Falls And Fragility Fractures Audit Salford Royal performance has continued to improve in all areas measured by the audit against national benchmarks. Compliance with the Best Practice Programme (FFFAP) Tari" has increased to above 70% on average. Current plan is to analyse the impact of increased compliance on length of stay, mortality, and complication rates for the forthcoming year. Performance in falls monitoring and bone health medication on discharge has also improved over the last year.
Severe Trauma (Trauma Audit & Research Data quality and completeness continues to remain above target. Following improvement activities the audit has successfully addressed outlying excess Network, TARN) mortality present in 2012, meeting NICE standard for time to CT in eligible head injury patients. Blood Transfusion National Comparative Audit Of Blood National Comparative Audit Of Blood Transfusion Programme Audit report was published in April 2013 following participation during the year. Results have Transfusion Programme been subject to initial review and action planning is currently underway. Results show that Salford Royal remain at regional benchmark and slightly below national benchmarks for pre and post transfusion Haemoglobin assays with Salford Royal being third lowest for missing post transfusion haemoglobin and missing no patients pre-transfusion.
132 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 5 Appendix B
Local Clinical Audit: actions to improve quality
Local Audit Project Actions to be Taken An audit assessing the documentation The project looked at completeness and quality of documentation recorded on the Electronic Patient Records (EPR) against Salford Royals local standards. of discussions with patients/ relatives on Findings detailed that there was a high level of compliance with the standards, but in order to achieve full compliance, further improvements are planned to Intensive Care Unit the Local induction handbook and the Intensive Care website. These will include advice for documenting family trees to clearly identify next of kin. Physiotherapy TELER Audit TELER is a system for making and presenting patient clinical notes to establish the e"ectiveness of the treatment or care. TELER also reveals information on the overall service that provides the care. Put simply, TELER is a methodology for recording and reporting patient-measured outcomes. The Physiotherapy team applied this method to Women’s Health Clinics for pelvic $oor assessment following hysterectomy, continence surgery and prolapse repair. Almost 90% of patients showed that symptoms were resolved or greatly improved. Additionally, patient reported satisfaction with the service was more than 85%. The team plan to repeat the audit in 2014 and to include measures for improving chronic pain. Referral and Palliative Care Assessment of This audit aimed to look at current palliative and end of life care/provision currently available in Salford against the standards set out by ‘Together for Short Lives’ babies, children and young people and identify gaps and areas for development. It is clear from the audit information that the Diana CCN team, o"er a well co-ordinated palliative care service. However there are gaps identi!ed within practice. These include communication between hospital and community sta"; standard documentation for end of life care planning, personal resuscitation plans and 24 hour community access. The team are planning to review their documentation and training to address these shortcomings and feedback to Senior Nursing Board to address wider transfer issues. Audit of management of acute Paracetamol This audit has been performed to determine whether the Emergency Department adhere to the acute paracetamol overdose standards as set out by Clinical overdose Standards of Emergency Departments (College of Emergency Medicine – February 2013). The Emergency Department team demonstrated high compliance with 4 of the 6 standards and plan to update and review practice by amending their documentation to include time of ingestion and whether that was staggered or a result of therapeutic excess. Immediate changes in continuous positive This was a ground breaking audit project. Obstructive sleep apnoea occurs in many morbidly obese patients referred for bariatric surgery. The audit airway pressure after bariatric surgery in highlighted that bariatric surgery induces an immediate reduction in positive airway pressure requirement in morbidly obese people with obstructive sleep obese people with obstructive sleep apnoea apnoea long before any appreciable weight loss has been measured. This has never been previous reported and the project was published in The European Journal Of Internal Medicine in October 2013. An audit following implementation of the It is clear from results that patients are commenced on a VRII for appropriate reasons; however whilst in use the striking !nding is that problems arise Variable Rate Insulin Infusion (VRII) chart because of non-adherence to the guidance embedded in the VRII chart. Diabetes Specialist Nurses have arranged educational sessions for the junior doctors to assess process compliance and target and ward nurses to help reduce hypoglycaemic incidents. achievement To what degree are people with multiple Neurology sta" conducted a project looking at services for Multiple Sclerosis. The aim of the project was to audit the standard of healthcare services provided sclerosis satis!ed with the services available to people with MS in multiple settings and for contacts with all the healthcare professionals recommended in NICE guidance. The audit demonstrated that the to them most actively used services were physiotherapy and MS specialist nurses in hospital and these services would be recommended in Friends and Family questions as being knowledgeable, approachable, informative and understanding. Overall 95% of patients reported that they were satis!ed with services provided. Audit of the guidelines for the collaborative, Community Rehabilitation and the Supported Discharge team receive a signi!cant amount of referrals for patients who have fallen or who are at risk of falls. rehabilitative management of elderly people Following the results of the audit, sta" recommended adoption of new documentation of patient risk assessment and that greater physiotherapy input to who have fallen lower risk patients to prevent future readmissions. Symptomatic management of nausea & Salford Royal collaborated in a North Western Regional Audit group project to re-evaluate the symptoms and medical management of nausea and vomiting vomiting in the medical management of in malignant bowel obstruction following a previous audit in 2011. Malignant bowel obstruction is a well-recognised complication in patients with malignant bowel obstruction abdominal or pelvic malignancy. While it may develop at any stage during the disease process, it occurs most frequently with advanced malignancy. The project highlighted a reduction in standards compliance but overall early management of symptoms could be improved by use of corticosteroids. Clinical teams are reviewing the !ndings and completing local action plans to improve symptomatic relief. Initial management of acute otitis media The PANDA team examined this common cause of attendance at the department to assess compliance with NICE and SIGN guidance. The project aimed to look at and tonsillitis on PANDA whether patients were receiving appropriate antibiotics and pain medication on attendance and whether microbiological swabs were appropriately taken. Overall, compliance was not as good as predicted and a reassessment of protocols for antibiotic prescribing and pain management is to be undertaken as part of an improvement project to revise the current protocol. Reinforcing the criteria for taking microbiological swabs will also form part of the protocol revision.
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Local Audit Project Actions to be Taken Management of suspected cardiac chest This project was carried out to assess whether patients received appropriately timed investigations in line with current guidance and best practice. The pain in the Emergency Department project was submitted as part of a wider regional audit to ensure that timely investigation, diagnosis and treatment is equitably and consistently applied across the health economy. The audit found that, whilst ECG was not performed consistently within 10 minutes of arrival, this may be attributed to insu#cient equipment at peak demand rather than delays in assessing patients. It was found that 100% of patients had an appropriate ECG review and that no abnormal readings were missed. Further !ndings revealed that aspirin was appropriately given and investigation of serum enzymes, indicating cardiac dysfunction, were consistently compliant with current guidance and best practice. Overall the project recommended further action to integrate risk management protocol to improve consistency in treatment for all patients and re-audit in the future to assess the impact of improvement actions. An audit of acute urinary retention in the To assess if patients presenting to Salford Royal with Acute Urinary Retention are managed according to best practice guidelines as directed by the Emergency Department College of Emergency Medicine and with Salford Royal policy. Data was collected over a 3 month period on the time taken to catheterise patients and the appropriateness of investigations as to the cause of the patient’s retention. Overall all 6 standards were consistently met however more than 10% of patients were not catheterised in a timely manner. The audit team plan to increase awareness amongst all sta" on the need to complete the appropriate forms as soon as possible at initial assessment and will review their local induction packs to include forms and instruction for use. This will be complimented by an additional educational sessions at team meetings. Spontaneous pneumothorax; adherence This project reviewed patients presenting with pneumothorax over an 18 month period and sought to measure compliance with the guidance from to British Thoracic Society Management the British Thoracic Society and the College of Emergency Medicine. All patients, whether their condition required admission or not, had follow-up by Guidelines Respiratory Physicians and compliance was assessed as greater than 80% within the small sample taken. The 20% remaining patients had more complex problems which explained their deviation from the standards. The team plan to develop a new pathway document for structured guidance to the management of the condition and plan to raise awareness amongst all sta" on the importance of patient advice lea$ets for patients who are not admitted. An audit of the management of ankle This project was conducted by Junior Medical Sta" as part of their post-graduate educational programme. The project examined whether patients pain injuries was appropriately assessed and documented and whether Ottawa rules (part of best practice guidance) were appropriately applied. The project found that both criteria were routinely recorded for more than 90% of patients. It was also highlighted that some 10% of patients had x-ray investigations that were not indicated under the Ottawa rules and that this could highlight an area where strict adherence to the Ottawa rules would ensure greater e#ciency in the service. The team plan to produce laminated copies of the Ottawa rules to be displayed in the Emergency department and to include them in the induction programme for junior Medical Sta". An audit on azathioprine prescribing in Azathioprine is used in a number of dermatological conditions such as eczema and dermatitis and there is guidance available from the British Association Dermatology of Dermatologists as to its use in these conditions. Azathioprine suppresses the immune system and careful checks of usage and monitoring of blood levels of the drug are essential to ensure patients bene!t from this therapy. The audit highlighted many areas of good practice at Salford Royal including toxicity monitoring, discussing follow-up and blood tests with patients and long -term follow-up. Areas for improvement were highlighted as more detailed discussion of speci!c side e"ects and contra-indications with patients at treatment initiation and follow-up. The team also plan to implement checklists at initiation of treatment to aid prescribers and at follow-up to ensure that optimal guidance compliance is achieved. Review health issue diagnosis coding in The Metabolic medicine team reviewed recorded diagnoses for patients moving from Central Manchester to Salford Royal. This is an important area to Electronic Patients Records(EPR) for patients ensure continuity of patient treatment where the team may not be aware of patient’s admission with an acute condition and sta" have no access to previous in transition condition-speci!c information. The audit highlighted condition-speci!c health issues codes were missing from the EPR system and have now compiled a detailed list of codes to be added to the EPR. The team are also in close contact with Central Manchester to ensure that a smoother facilitation of the transition between Trusts. Emergency care record audit in general Many patients with general metabolic disorders need specialised emergency management and as patients live over a wide area we know they may not metabolic patients be admitted to our hospital therefore we provide them with Emergency Cards and if needed a Dietetic Emergency Regimen. The audit examined whether patients with these emergency alerts had diagnoses recorded on their Electronic Patient Record to trigger an alert when patients arrived at the Emergency Department. The audit found that almost 80% of eligible patients had a copy of their Emergency Cards attached to the Electronic Patient Record. In line with previous audits the project plan to improve the diagnosis and ensure that all eligible patients have the appropriate Emergency Card attached to their electronic record. This action will assist appropriate advice to enable continuity of care for emergency admissions outside of Salford ensuring that the safest and most e"ective treatment is given in line with the overall management of their conditions. The use of disease modifying drugs for This audit was carried out by a Consultant Neurologist looking at prescribing patterns and requirement for outpatient follow-up over an 18 year period. The multiple sclerosis project highlighted a reduction in Beta-interferon prescribing and an increase in the prescription of Copaxone. The !ndings also suggest a requirement for increased clinic capacity to address the increasing numbers of patients requiring follow-up and annual review and the team plan to audit annually to ensure that the current system aligns with any increased service demand.
134 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 5 Appendix C
National con!dential enquiries: actions to improve quality
Title Actions to be taken Lower limb amputation Organisational audit was completed and submitted within timescale. Data extract submitted within timescale. Limited patients numbers were submitted due to Salford Royal not carrying out vascular surgery and it is expected that only a few patient questionnaires will be sent for submission. The survey report is expected to be published in November 2014. Tracheostomy care Organisational audit was completed and submitted within timescale. Prospective patient data collection was completed in June 13 within timescale (for 100% applicable patients). The study report is expected to be published in June 2014. Subarachnoid haemorrhage The study’s report was published in November 2013 and self-assessment toolkit (SAT) to be complete by each participating hospital released at the same time. SAT currently being completed by the clinical teams but Salford Royal is currently compliant with recommendations made in the report. Alcohol related liver disease The report of the study was published in June 2013 and self-assessment toolkit (SAT) released at the same time. The SAT is partially completed but work stalled due to sta" changeover. The SAT is now being taken up by a newly appointed Consultant and is currently in progress.
135 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 5 Appendix D
Goals agreed with commissioners: commissioning for Quality and Innovation Payment Framework (CQUIN)
Goal Name Description of Goal - Acute contracts Proportion Expected Financial of CQUIN Value of Goal Friends and Family - Phased Delivery of the nationally agreed roll-out plan to the national timescales (maternity by the end of October 2013 and additional 1.50% £117,099 Expansion services - yet to be de!ned - by the end of March. As Salford Royal do not provide maternity services, a local roll-out has been agreed). Friends and Family - Increased Provider achieving an increase in response rate in quarter 4 that improves on Q1 and is 20% or over 2.00% £156,131 Response Rate Friends and Family - Improved Improved performance or remaining in the top quartile on the sta" Friends and Family Test 1.50% £117,099 Performance NHS Safety Thermometer - A complete survey for each month in the quarter is submitted to the Information Centre in each quarter 2.50% £195,164 Data Collection NHS Safety Thermometer - Reduction in the prevalence of pressure ulcers. 2.50% £195,164 Improvement 100 days between a hospital acquired grade 3 or 4 pressure ulcer during 13/14 and no more than 3 non ITU in a year Numerator: The number of days between a Hospital acquired grade 3-4 pressure ulcer. Denominator: N/A Q4 milestone: to have achieved 100 days between hospital acquired grade 3-4 ulcers and less than 7 grade 3 or 4 non-device pressure ulcers. Dementia - Find, Assess, The proportion of patients aged 75 and over to whom case !nding is applied following emergency admission. 1.00% £78,065 Investigate and Refer (FAIR) Threshold is 90% or greater in each of the elements of the indicator each month for any three consecutive months in the !rst year. Dementia - Find, Assess, The proportion of those identi!ed as potentially having dementia who are appropriately assessed. 1.00% £78,065 Investigate and Refer (FAIR) Threshold is 90% or greater in each of the elements of the indicator each month for any three consecutive months in the !rst National CQUIN Goals CQUIN National year. Dementia - Find, Assess, Number referred on to specialist services. 1.00% £78,065 Investigate and Refer (FAIR) 90% or greater in each of the elements of the indicator each month for any three consecutive months in the !rst year.
Dementia - Clinical Leadership Provider must con!rm named lead clinician and the planned training programme (to be determined locally) for dementia for 0.50% £39,033 the coming year, Dementia - Supporting Carers Provider must demonstrate that they have undertaken a monthly audit of carers of people with dementia to test whether they 1.50% £117,099 feel supported and reported the results to the Board. VTE Risk Assessment 95% of all adult inpatients who have had a VTE risk assessment on admission to hospital suing the clinical criteria of the 2.50% £195,164 national tool. VTE RCA The number of root cause analyses carried out on cases of hospital associated thrombosis 2.50% £195,164 Q1: Achievement of 80% for both risk assessment and the root cause analysis for each month during that quarter Q2: Achievement of 85% for both risk assessment and the root cause analysis for each month during that quarter Q3: Achievement of 90% for both risk assessment and the root cause analysis for each month during that quarter Q4: Achievement of 95% for both risk assessment and the root cause analysis for each month during that quarter
136 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 5
Expected Financial Goal Name Description of Goal - Acute contracts Proportion of CQUIN Value of Goal Reducing Short Stay <24hr Reduction in admissions of <24hrs 1.48% £115,449 Admissions Numerator: All admissions to inpatient units with a length of stay of 72 hours or less Denominator: All admissions to inpatient units Clinical Peer Review - All 2-3 Clinical Peer Reviews (points prevalence surveys) are carried out on areas of concern in relation to transfers of care 2.01% £156,680 Providers identi!ed and agreed with commissioners using agreed evidence based clinical models. Recommended model to use is the 3R approach
End of Life - Percentage of Numerator: Number of patients identi!ed as being in the last twelve months of life, who have had an Advance Care Plan (ACP) 0.77% £60,473 patients, with an life expectancy recorded. This information must be documented in the medical notes with the inclusion of patients who have refused an ACP of <12months, who had an ACP Denominator: Number of patients that have been identi!ed as being in the last twelve months of life. Increase from 65% to 75% in quarter 4 2013/14. End of Life - Percentage of Numerator: Number of patients, identi!ed as being in the last twelve months of life, who died in their preferred place of death 0.78% £60,508 patients, with an life expectancy Denominator: Number of patients, identi!ed as being in the last twelve months of life, with a recorded preferred place of of <12months who died in their death in their notes. preferred place of death Maintain or improve on baseline of 83% by up to 4% i.e. 83% - 86% in quarter 4 2013/14. End of Life - Percentage of Numerator: Number of patients, identi!ed as being in the last twelve months of life, who are transferred to their preferred 0.78% £60,508 patients, with an life expectancy place of death within 24hrs of the patient/ carers requesting this. of <12months who transferred Denominator: Number of patients, identi!ed as being in the last twelve months of life, with a recorded preferred place of to their preferred place of death death in their notes. within 24 hours of request Maintain or improve on baseline of 83% by up to 4% i.e. 83% - 86% in quarter 4 2013/14. Homelessness Development of a local protocol 2.01% £156,680 Numerator: Progress with developing and agreeing protocol Denominator: Full protocol developed and agreed Reducing Alcohol Abuse Numerator: Progress with action plan milestones to achieve the following targets: Greater Manchester CQUIN Goals CQUIN Manchester Greater 2.32% £181,419 All patients scoring 1 AAF (Alcohol Attributable Fraction) to be contacted post discharge and o"ered support. This will include: (1) AUDIT score; (2) O"ered home visit; (3) Signposting / limited advocacy. Patients will be followed up after 3 months for a repeat AUDIT score. Exclusions: All patients known to Alcohol Specialist Nurse team / Assertive Outreach Team. This support package will be given to a maximum number of 20 patients per month. There will be no minimum as this complex group of patients are notoriously di#cult to engage, and presentation numbers can $uctuate Denominator: All Action Plan Milestones
Academic Health Science Improve collection of data in relation to medication errors: 2.01% £156,680 Network - Improve collection of Monthly surveying all appropriate patients (as de!ned in the NHS Safety Thermometer guidance) to collect data on four data in relation to medication medications safety issues which can result in harm errors Q1: Participate in the development and testing Q2: Participate in the development and testing and commencement of data collection Q3 & Q4: Monthly Submission of Medication ST Academic Health Science Engage in AHSN Network 2.01% £156,680
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Expected Financial Goal Name Description of Goal - Acute contracts Proportion of CQUIN Value of Goal AQ Acute Myocardial Infarction The Appropriate Care Score (ACS) aggregates delivery of several underlying clinical interventions into a single measure of quality. An example of how ACS is calculated can be found in section 6. The underlying clinical process measures for AMI in 13/14 are: 0.57% £44,200 (1) Aspirin at arrival; (2) Aspirin prescribed at discharge; (3) ACEI or ARB for LVSD; (4) Smoking cessation advice/counselling; (5) Beta blocker at arrival; (6) Fibrinolytic therapy received within 30 minutes of hospital arrival; (7) PCI received within 90 minutes of hospital arrival; Numerator: Total number of patients receiving ‘perfect care’. The rules for achievement of a measure are as quali!ed by the AQ Data Dictionary. Denominator: The total number of clinically eligible patients presenting. As quali!ed by the AQ Data Dictionary. 88.19% AQ Heart Failure The Appropriate Care Score (ACS) aggregates delivery of several underlying clinical interventions into a single measure of 0.57% £44,200 quality. An example of how ACS is calculated can be found in section 6. The underlying clinical process measures for Heart Failure in 13/14 are: (1) Left Ventricular Systolic (LVS) assessment; (2) Detailed discharge instructions; (3) ACEI or ARB for LVSD; (4) Smoking cessation advice/counselling; (5) Beta blocker at discharge; (6) Specialist review. Numerator: Total number of patients receiving ‘perfect care’. The rules for achievement of a measure are as quali!ed by the AQ Data Dictionary. Denominator: The total number of clinically eligible patients presenting. As quali!ed by the AQ Data Dictionary. 62.15% AQ Hip and Knee Replacement The Appropriate Care Score (ACS) aggregates delivery of several underlying clinical interventions into a single measure of 0.57% £44,200 quality. An example of how ACS is calculated can be found in section 6. The underlying clinical process measures for Hip & Knee Replacement in 13/14 are: (1) Prophylactic antibiotic received within one hour prior to surgical incision; (2) Prophylactic antibiotic selection for surgical patients; (3) Prophylactic antibiotics discontinued within 24 hours after surgery end time; (4) Recommended Venous Thromboembolism prophylaxis ordered; (5) Appropriate Venous Thromboembolism prophylaxis within 24 hours prior to surgery to 24 hours after surgery; (6) VTE appropriate duration. Numerators: Total number of patients receiving ‘perfect care’. The rules for achievement of a measure are as quali!ed by the AQ Data Dictionary. Regional AQ CCQUIN Goals CCQUIN AQ Regional Denominator: The total number of clinically eligible patients presenting. As quali!ed by the AQ Data Dictionary. 84.86% AQ Pneumonia The Appropriate Care Score (ACS) aggregates delivery of several underlying clinical interventions into a single measure 0.57% £44,200 of quality. An example of how ACS is calculated can be found in section 6. The underlying clinical process measures for Pneumonia in 13/14 are: (1) Oxygenation assessment within 24 hours prior to or after hospital arrival; (2) Initial antibiotic selection; (3) First dose of antibiotics within six hours after hospital arrival; (4) Smoking cessation advice/counselling; (5) CURB-65 assessment. Numerator: Total number of patients receiving ‘perfect care’. The rules for achievement of a measure are as quali!ed by the AQ Data Dictionary. Denominator: The total number of clinically eligible patients presenting. As quali!ed by the AQ Data Dictionary. 68.77% AQ Stroke The Appropriate Care Score (ACS) aggregates delivery of several underlying clinical interventions into a single measure of quality. 0.57% £44,200 An example of how ACS is calculated can be found in section 6. The underlying clinical process measures for Stroke in 13/14 are: (1) Direct admission to a stroke unit within 4 hours of hospital arrival; (2) Screened for swallowing disorders within 24 hours of admission; (3) Brain scan within 24 hours of admission; (4) Aspirin within 24 hours of admission; (5) Physiotherapy assessment within !rst 72 hours of admission; (6) Assessment by an Occupational Therapist within !rst 72 hours of admission; (7) Weighed at least once during admission. Numerator: Total number of patients receiving ‘perfect care’. The rules for achievement of a measure are as quali!ed by the AQ Data Dictionary Denominator: The total number of clinically eligible patients presenting. As quali!ed by the AQ Data Dictionary. 91.9% (however locally agreed that if 89% + target will be deemed to have been achieved).
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Expected Financial Goal Name Description of Goal - Acute contracts Proportion of CQUIN Value of Goal Care Planning Protocols Enhance current care by developing clear pathways on discharge to provide GP’s, Patients and Specialists with a clear 1.98% £154,787 understanding of pre and post-operative care. This will involve pre-referral criteria (e.g. workup required in General Practice), Patient responsibilities and requirements and follow up care including discharge planning (e.g. medication / number of follow up appointments etc.) Development of 3 Care Planning Protocols for a) Complex Cancer Pathway in Lower GI b) Laparoscopic Nissan Fundoplication (mid-range procedure) and c) hernia (routine procedure). Improved Clinical Communication Numerator: As part of the pilot a sample size (over a speci!ed period) will be evaluated by both secondary and primary 2.42% £189,185 between secondary care care clinicians for quality and meeting the objectives (I.e. full completion of the templates). The sample size is yet to be clinicians and primary care determined. clinicians (Year 3) Denominator: All the templates (sample size) in the evaluation. Shared Care Protocols - Numerator: Number of amber drugs where a SCP has been refreshed . 0.70% £54,462 Refreshed Denominator: Number of amber drugs where an SCP needs to be refreshed. Shared Care Protocols - Numerator: Number of amber drugs where a SCP has been consolidated. 0.70% £54,462 Consolidated Denominator: Number of amber drugs where an SCP needs to be consolidated. Shared Care Protocols - Numerator: Number of amber drugs where a SCP has been newly written. 0.70% £54,462 Newly Written Denominator: Number of amber drugs where an SCP needs to be newly written. Patient Decision Making Aids Numerator: Number of patients o"ered PDA’s. 2.09% £163,387 Denominator: Number of patients on the elective pathway for the condition where the PDA is being implemented. Management of repeat This indicator is in two parts. 2.09% £163,387 attenders to A&E with The !rst part is to review the audit undertaken in 2012/13 including a review of numbers coded in wards and A&E. self-harm The second part is to develop a multi-professional approach to managing patients who present at A&E on 3 or more occasions with self-harm in a rolling 12 month period.
Local CQUIN Goals Local CQUIN Breastfeeding To develop specialist knowledge of lactation within the health visiting team to support a robust referral pathway which will in 2.09% £163,387 turn support continuation of breast feeding. The outcome of this indicator will be evidenced activity such as enhanced drop in sessions and team dissemination of knowledge for 3 sta". (i.e. Health Visitor already holding specialist (IBCLC) quali!cation, HV due to take specialist quali!cation in July 13, new HV nomination for 2014 exam). Paediatric Asthma Develop a comprehensive pathway for the management of asthma in children. 1.21% £94,593 Management Pathway - To monitor compliance with the pathway. Pathway Compliance To achieve a target proportion of eligible children following the pathway. Numerator: Eligible children completing in scope elements of the pathway (tbd during q1). Denominator: Children eligible to complete the in scope elements of the pathway (tbd during q1). Paediatric Asthma Develop a comprehensive pathway for the management of asthma in children. 1.21% £94,593 Management Pathway - To achieve a target reduction in unplanned admissions coded as asthma. Admission Reduction Numerator: Number of presentations at PANDA with Asthma in baseline period (tbd during q1). Denominator: Total number of presentations at PANDA with Asthma (tbd during q1). Multi-Disciplinary Assessments Set up and administer 1 multi-disciplinary meeting / month in each of the 4 Salford localities to assess and plan care for 0.88% £68,795 for Children - Quorate Meetings children with complex needs. To establish on-going quorate (tbd) meetings in each of the remaining three localities as soon as possible (the approach has been successfully piloted in one). Numerator: Number of quorate meetings held. Denominator: Number of meetings targeted / locality.
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Expected Financial Goal Name Description of Goal - Acute contracts Proportion of CQUIN Value of Goal Multi-Disciplinary Assessments Set up and administer 1 multi-disciplinary meeting / month in each of the 4 Salford localities to assess and plan care for 0.88% £68,795 for Children - Parents Surveyed children with complex needs. To assess and review a target proportion of eligible (e.g. those referred) children in each locality. Numerator: Percentage of parents reporting that the process has a positive impact on the care of their child. Denominator: Percentage of parents surveyed. Healthy Start Vitamins Produce a training and awareness package suitable for services delivering to pregnant women and children aged 0-5. 1.76% £137,589 Train as many eligible sta" as possible (to be more accurately de!ned). Monitor the e"ect on increase in uptake of Healthy start vitamins through redeemed vouchers. Numerator: Number completing the training. Denominator: Number of eligible (tbd) sta". Advance Care Planning in End To increase in the number of healthcare sta" within 2 speci!ed hospital wards or departments and 2 district nursing teams 2.42% £189,185 of Life Care - hospital and by Q3 2013/14 who have received appropriate communication skills training and have given the patient the opportunity to community discuss advance care planning (ACP) including their family/carer. Numerator: Number of eligible established healthcare sta" within the two speci!ed hospital wards or departments (must have frequent contact with patients in the last year of life) and two district nursing teams, who have received communication skills training (locally agreed training on facilitating advance care planning customised for each setting). Denominator: Number of eligible established healthcare sta" within two speci!ed hospital wards or departments (must have frequent contact with patients in the last year of life) and two district nursing teams. LD Community Services - Community Services (Diabetes, Weight Management, Rapid Response, D/N (Irlam) and Community SALT ) to manually $ag 1.76% £137,589 Physical access and patients with LD to record their physical access and communication needs and o"er a HAP on discharge. communication needs and HAP Numerator: Number of LD patients within the !ve community services identi!ed as having their physical access and communication needs recorded and being o"ered a HAP on discharge. Denominator: Number of LD patients within the !ve community services identi!ed. Q1: 75% Local CQUIN Goals continued Local CQUIN Q2: 85% Q3: 95% Q4: 100% LD Awareness Training to 75% of Sta" who have frontline contact with patients to receive basic ‘LD Awareness Training’. (NB: this builds on the CQUIN 1.76% £137,589 frontline sta" (including for 2012/13 where 25% of frontline sta" completed the LD e-learning package. This will mean that 75% of frontline sta" will volunteer sta") have been trained in total by end March 2014). Numerator: Number of frontline sta" (i/c volunteers as appropriate) who have received LD Awareness Training. Denominator: Number of frontline sta" (including volunteers as appropriate). Reduce DNA rates for Out-Patient Explore DNA rates for patients with LD, identify themes and trends, and work with LD Service to develop & implement an 1.54% £120,390 Appointments for patients ‘action plan’ to reduce the rates. with LD Numerator: Number of DNA New and FU Out-Patient appointments for patients with LD. Denominator: Number of New and FU Out-Patient appointments for patients with LD. Long Term Conditions 2013/14 Numerator: Number of patients aged 16+ with a diagnosed LTC from the list above who are admitted for an elective surgical 2.09% £163,387 (Year 2) procedure at SRFT and receive the LTC-speci!c pre-op. Denominator: Total number of patients aged 16+ with a diagnosed LTC from the list above who are admitted for an elective surgical procedure at Salford Royal and have a pre-op assessment.
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Expected Financial Goal Name Description of Goal - Acute contracts Proportion of CQUIN Value of Goal Adult Neurosurgery - To ensure To reduce to 10% or less the number of new shunts* requiring revisions within 30 days of insertion due to infection. 4.34% £338,650 patients receive optimal *New shunts includes de novo shunts and replacements of previous shunts if the replacement shunt is not been placed into a outcomes from neurosurgical previously infected site. shunt surgery Numerator: The number of new shunts* requiring revision within 30 days of insertion due to infection. Denominator: Total number of new shunt insertions.
Renal dialysis 2 - Patients This CQUIN measures the number of patients under the care of a renal unit who are registered with Renal Patient View. 2.17% £169,325 registered with Renal Patient It also measures the rate of use of Renal Patient View as a proportion of the number of patients under the care of a renal unit. View (RPV) Numerator: Number of patients in each renal unit who are registered with Renal Patient View. Denominator: Number of renal replacement therapy patients under the care of the renal unit. Renal dialysis 2 - Patients This CQUIN measures the number of patients under the care of a renal unit who are accessing Renal Patient View. 2.17% £169,325 accessing Renal Patient View It also measures the rate of use of Renal Patient View as a proportion of the number of patients under the care of a renal unit. (RPV) Numerator: Number of patients accessing Renal Patient View per renal unit. Denominator: Number of renal replacement therapy patients under the care of the renal unit. Renal -Reducing the incidence Proportion of emergency admissions developing severe AKI: 2.17% £169,325 of preventable severe Acute Numerator: The number of people admitted to hospital as an emergency who develop severe AKI per quarter. Kidney Injury (AKI). Proportion Denominator: The number of people admitted to hospital as an emergency per quarter. of emergency admissions developing severe AKI:
Renal -Reducing the incidence Proportion of patients who receive intermittent haemodialysis to treat severe AKI: 2.17% £169,325 of preventable severe Acute Numerator: Number of patients who receive intermittent haemodialysis to treat severe AKI . Kidney Injury (AKI). Proportion of Denominator: Number of patients who receive intermittent haemodialysis to treat severe AKI per quarter. patients who receive intermittent haemodialysis to treat severe Specialist CQUIN Goals Specialist CQUIN AKI:
Major Trauma - Improving In 2012, regions in England commenced implementation of regional major trauma networks. This indicator builds on year one 2.17% £169,325 outcomes of major trauma development of a prescription for rehabilitation. The CQUIN aims to incentivise improvement in outcomes for patients who have orthopaedic injuries (severe su"ered severe orthopaedic injuries. The CQUIN incentivises decreased time to de!nitive treatment known to improve outcomes open lower limb fractures) for trauma care patients. Numerator: 1. Number of patients who have de!nitive cover of severe open lower limb fractures within BOAST 4 guidelines within 72 hours of injury to !rst receiving hospitals (this includes TU (secondary transfers) or MTC (primary transfers). Denominator: 1. Total number of patients within the networks and admitted to the MTC who have an ISS >8 and have severe and open lower limb fractures requiring skin coverage (OPCS codes to be used to de!ne group). Major Trauma - Improving In 2012, regions in England commenced implementation of regional major trauma networks. This indicator builds on year one 2.17% £169,325 outcomes of major trauma development of a prescription for rehabilitation. The CQUIN aims to incentivise improvement in outcomes for patients who have orthopaedic injuries (long bone su"ered severe orthopaedic injuries. The CQUIN incentivises decreased time to de!nitive treatment known to improve outcomes fractures) for trauma care patients. Numerator: Number of patients who have one or more long bones stabilised within 24 hours of injury1 to !rst receiving hospitals (this includes TU (secondary transfers) or MTC (primary transfers). Denominator: Total Number of patients within the networks and admitted to the MTC who have an ISS >8 and have one or more long bone fracture (OPCS codes to be used to de!ne group).
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Goal Name Description of Goal - Acute contracts Proportion Expected Financial of CQUIN Value of Goal Specialised Cancer - Access to To assess the impact of CNS support on the patients’ experience of their cancer journey and agree action plan to improve and impact of clinical nurse experience. 4.34% £338,650 specialist (CNS) support on Action is to undertake the survey for up to 3 speci!ed rarer cancers e.g. brain / sarcoma / penile. patient experience Human Immunode!ciency Proportion of patients diagnosed with HIV registered with and disclosed to their GP. Sample is all patients diagnosed with HIV. 2.17% £169,325 Virus (HIV) - Registration and Target is 70%. communication with GPs about Numerator: Number of patients diagnosed with HIV registered with and disclosed to GP. the care of HIV patients Denominator: Number of patients diagnosed with HIV.
Human Immunode!ciency Annual (at least) communication with GPs about the care of HIV patients who are registered with and disclosed to a GP. 2.17% £169,325 Virus (HIV) - Annual Sample is patients registered with a GP and disclosed. Target is 100% of those patients disclosed. communication with GPs Numerator: Number of patients who have consented to GP letters about whom a letter has been sent to the GP in the last 12 about the care of HIV patients months. Denominator: Number of patients who have consented to GP letters.
Embed and demonstrate routine This indicator is aimed at ensuring that Providers continue to embed and routinely use the required clinical dashboards for 2.17% £169,325 use of the use of specialised specialised services services clinical dashboards - renal
Embed and demonstrate routine This indicator is aimed at ensuring that Providers continue to embed and routinely use the required clinical dashboards for 2.17% £169,325 Specialist CQUIN Goals continued Specialist CQUIN use of the use of specialised specialised services. services clinical dashboards - major trauma Highly specialised services Highly specialised services clinical outcome collaborative audit workshop and Provider report. clinical outcome collaborative 2.17% £169,325 audit workshop and Provider report - AUGIR / IF Highly specialised services Highly specialised services clinical outcome collaborative audit workshop and Provider report. clinical outcome collaborative 2.17% £169,325 audit workshop and Provider report - LSD TOTAL 100% £7,806,613
142 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 5 Appendix E
Glossary of de!nitions
Term Explanation AAA Ambulatory Assessment Area. Administering The act of giving the medicine to the patient, usually by a nurse. Advance Care Plan A written statement of wishes or preferences relating to their patient care at the end of life. ADNS Assistant Director of Nursing Services. A job role in the hospital relating to nursing management. Always Events What patients should always receive when they use our services. Arthroplasty Arthroplasty is a surgical procedure to restore the integrity and function of a joint. A joint can be restored by resurfacing the bones. Aseptic If something is aseptic it is sterile, sanitised, or otherwise clean of infectious organisms. Bay tagging Practice where there is a member of sta" in patient bay areas at all times. Bacteraemia The presence of bacteria in the blood. Berwick Report Review of the Francis Report to give recommendations on how the NHS should improve patient safety continually and forever reduce patient harm by embracing wholeheartedly an ethic of learning. Cardiovascular care Relates to the heart and blood vessels. Care bundle A group of interventions which are proven to treat a particular condition. Care partner A patient’s relative, carer of friend who knows them well, who works with healthcare professionals to help us deliver the best care to our patients. Care provider An organisation that cares for patients. There are many examples some of which are a hospital, doctors surgery or care home. Catheter Catheters are medical devices that can be inserted in the body to treat diseases or perform a surgical procedure. Catheters are used for many reasons, for example, draining urine and in the process of haemodialysis. Catheter associated An infection which it is believed has been caused by a urinary catheter. urinary tract infection CCG Clinical Commissioning Group responsible for most healthcare services available within a speci!c geographical area. CfH NHS Connecting for Health (NHS CFH) is part of the Department of Health Informatics Directorate. Change Package A group of changes or interventions developed to help tackle a particular problem. Clinical Relating to the care environment. Clostridium di!cile A type of infection. Collaborative Working together towards a shared purpose. COMFE Comfortable, Observe, Move & Mobilise, Food and Fluids, Elimination. This is a form of intentional rounding in the community. Condition An illness or disease which a patient is su"ering from. Control Charts Control charts, also known as Shewhart charts or process control charts (SPC Charts), are graphs used to determine whether or not a process is stable. This is helpful in monitoring performance and monitoring improvement work. If there is an active improvement e"ort going on, these tools can also be used to determine if an improvement has indeed been made. COPD Chronic obstructive pulmonary disease. The name for a collection of lung diseases including chronic bronchitis, emphysema and chronic obstructive airways disease. Core Values A group of ideals which the Trust believes all sta" should exhibit. CQC Care Quality Commission - The independent regulator of all health and social care services in England. CQUIN Commissioning for Quality and Innovation. This is a system introduced in 2009 to make a proportion of healthcare providers’ income conditional on demonstrating improvements in quality and innovation in speci!ed areas of care. CURB-65 CURB-65 is a clinical prediction rule that has been validated for predicting mortality in community-acquired pneumonia and infection of any site. The CURB-65 is based on the earlier CURB score and is recommended by the British Thoracic Society for the assessment of severity of pneumonia. Deep Vein Thrombosis A blood clot occurring in the deep veins of the leg. Dispensing The provision of medications by the pharmacy.
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Term Explanation EAU Emergency Assessment Unit. Electronic patient record A software program which is used to enter information about a patient which is accessible by members of sta" at the Trust. Emergency village A ward of the hospital which receives di"erent types of patients into the hospital for example from the emergency department. Episodes An interval of healthcare provided. Executive Safety A visit to wards and departments by members of the Executive Team where members of sta" can discuss concerns relating to patient safety. WalkRounds Executive Team The most senior managers in the Trust consisting of the Chief Executive, the Deputy Chief Executive, the Executive Medical Director, the Executive Nurse, Executive Director of Organisational Development & Corporate A"airs and the Executive Director of Strategy and Development. FCE = !nished The total time a patient spends under the care of an individual consultant. consultant episode Francis Report Report led by Robert Francis QC, of the Mid Sta"ordshire NHS Foundation Trust Public Inquiry. The report highlighted areas of concerns relating to patient safety to aid organisational learning. Geriatricians Doctors who specialise in working with older people. Grand Round A teaching session which forms part of the medical education of junior doctors. Haemodialysis A process where blood taken from the body to be cleaned in a !lter known as a dialyser. Haemodialysis catheter- A blood stream infection caused by catheters inserted into the body which are required for patients requiring haemodialysis. related bacteraemia Haemoglobin A part of red blood cells. Its function is to carry the oxygen from your lungs to your tissues. Harm An unwanted outcome of care intended to treat a patient. HELP Hospital Empowering Loved-ones and Patients. Hippocratic Oath The Hippocratic oath is a long-standing tradition in medicine. Named after the Greek physician Hippocrates, the written oath was intended to act as a guideline for those entering the medical profession. HSMR Hospital Standardised Mortality Ratio. A system which compares expected mortality of patients to actual mortality. Huddle A brief meeting often at the start and !nish of shifts in care areas. IHI The Institute for Healthcare Improvement. The mission of IHI is to improve healthcare. Information intensive Appointments that include a large amount of information for patients often from di"erent sources such as the internet and electronic patient records consultations Intervention A treatment which is intended to improve a patient’s condition. Intentional rounding A structured process where nursing sta" carry out regular checks with individual patients at set intervals, typically hourly. Intermediate care units Units which patients go to when they no longer require the acute care of the hospital but are not yet ready to go home. IV Intravenous. Means within a vein but often seen in the context of giving medications which means administered directly into the vein. IV diuretic treatment Diuretics, also called water-pills, are a class of medications used to treat high blood pressure, heart failure and other diseases that cause $uid build-up in the body. Just culture A culture which understands that poorly designed systems are most commonly the cause of adverse events rather than individuals. Lean Methodology Lean methodology is an approach to improve $ow and eliminate waste that was developed by Toyota. Lean is about getting the right things to the right place, at the right time, in the right quantities, while minimising waste and being $exible and open to change. Liverpool Care Pathway The Liverpool Care Pathway for the Dying Patient (LCP) is a UK care pathway covering palliative care options for patients in the !nal days or hours of life. Locum A temporary member of sta" who !lls in when Trust sta" aren’t available, usually a doctor (locum doctor) or nurse (locum nurse). Lumbar puncture A procedure that takes $uid from the spine in the lower back through a hollow needle, usually done for diagnostic purposes. Managed Booking Outpatient appointment booking system where follow-up appointments are booked no more than six weeks in advance. Medicines reconciliations A process to ensure medicines prescribed on admission correspond to those taken before admission.
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Term Explanation Model for Improvement The Model for Improvement is a quality improvement tool which asks three questions: 1) What are we trying to accomplish? 2) How will we know that a change is an improvement? 3) What changes can we make that will result in improvement? These three questions, coupled with the Plan, Do, Study, Act method of testing change form the Model for Improvement. Source: Associates for Process Improvement. Monitor Monitor was established in 2004 and authorises and regulates NHS Foundation Trusts. Monitor works to ensure that Foundation Trusts comply with the conditions they signed up to and that they are well led and !nancially robust. Morbidity Morbidity comes from the word morbid, which means “of or relating to disease” . Mortality Mortality relates to death. In health care mortality rates means death rate. MRSA blood stream Methicillin-resistant Staphylococcus Aureus (MRSA) is a type of blood stream infection. infection Multidisciplinary Consisting of members of sta" from di"erent professional groups. Never Event Never Events are patient safety incidents that are preventable and should not occur because: there is guidance that explains what the care or treatment should be; there is guidance to explain how risks and harm can be prevented; there has been adequate notice and support to put systems in place to prevent them from happening NHS Quest NHS QUEST is a network for Foundation Trusts who wish to focus relentlessly on improving quality and safety. NICE National Institute of Clinical Excellence. An independent organisation that provides national guidance and standards on the promotion of good health and the prevention and treatment of ill health. Non-statutory Not required by law. Nursing Assessment and The Nursing Assessment and Accreditation System is quality and performance assessment framework used to monitor nursing standards throughout the organisation. Accreditation System (NAAS) Open ($exible) visiting Visiting hours extended beyond traditional set times to allow carer and relatives to visit patients at more convenient times. hours Patient Experience Hand held device that is used to record patient feedback. Trackers Patient portals Patient Portals are healthcare-related online applications that allow patients to interact and communicate with their healthcare providers. P-D-S-A Plan, Do, Study, Act. A test of change methodology within Quality Improvement which is used to try something out for a short period of time. Tests of change help us to understand whether the things that we think will make something better will work in practice. Peritoneal dialysis Peritoneal dialysis is one of the two types of dialysis (removal of waste and excess water from the blood) that is used to treat people with kidney failure. In PD, the process of dialysis takes place inside the body. The abdomen has a lining called the peritoneal membrane, which can be used as a !lter to remove excess waste and water. Peritonitis Peritonitis is an in$ammation of the peritoneum, the thin tissue that lines the inner wall of the abdomen and covers most of the abdominal organs. Phosphate Phosphate is a mineral in the body, and together with calcium makes up most of our bones. Pilot ward / area A ward / area involved in the initial testing period of a project. Piloting / Piloted Testing / tested. Prescriber Someone who writes prescriptions for medicines for patients. Prescribing The act of deciding which medicines a patient needs, usually by a doctor. Prophylaxis Preventative medicine or care. Psychological safety The perception of being able to speak up without fear of reprisal from others. Pulmonary embolism (PE) A blood clot which has become lodged in the lungs.
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Term Explanation Quality Improvement A document which outlines the aims and objectives of the Trust relating to patient safety and improving quality. Strategy Readmission Where a patient is admitted to the hospital after an initial period of treatment. Relationship based care A patient centred model of communication that encourages patient involvement and two-way communication. Reliability science The science relating to ensuring that all processes and procedures perform their intended function. Root Cause Analysis A method of problem solving that tries to identify the root causes of issues and why they are happening. (RCA) Run Charts Run charts are graphs used to display data for quality improvement purposes. Run charts are easier for teams to work with than control charts, although they may be less statistically sensitive. Run charts are helpful in monitoring performance and monitoring improvement work. If there is an active improvement e"ort going on, these tools can also be used to determine if an improvement has indeed been made. Safety Thermometer A point of care survey which is used to record the occurrence of four types of harm (pressure ulcers, falls, catheter associated urinary tract infection and venous thromboembolism). SCAPE Safe, Clean and Personal Everytime. Scoping Phase The scoping phase of a project relates to introductory work which is required in order to make the project a success in the future. This may include collection and review of data, research of best practice and world class performance, building a team to direct the project, early work with pilot teams. Self-testing Tests which patients are able to perform for themselves, for example taking blood sugar readings. Shared decision making A method of actively involving patients in decisions about their treatment. Shear Shear is a cause of pressure ulcers and is caused by bones moving against soft tissue. SHMI Standardised Hospital Mortality Index. A system which compares expected mortality of patients to actual mortality (similar to HSMR). Specialing Certain patients may require one on one nursing care within the ward setting. This may be due to the patient being at high risk of falls, due to confusion or for some other reason. When this one on one care is required it is known as specialing. Steering Group A group of people who are involved in the management of a piece of work or a project. Teach-back This is a technique that helps us to understand how well we have delivered important information to our patients about their condition or medications. Telehealth The delivery of health-related services and information via telecommunications technologies. Telehealth kit The equipment needed to deliver health-related services and information via telecommunications technologies. Telemedicine The application of clinical medicine where medical information is transferred through the phone or the Internet and sometimes other networks for the purpose of consulting, and sometimes remote medical procedures or examinations. Test of Change A small test used in Quality Improvement which is used to try something out for a short period of time. Tests of change help us to understand whether the things that we think will make something better will work in practice. The Picker Institute The Picker Institute is a not-for-pro!t organisation that works to improve patient care. The Picker Institute organise surveys throughout healthcare including the Department of Health, NHS Trusts and Boards, hospitals and voluntary organisations. The Trust Salford Royal NHS Foundation Trust. A Foundation Trust is part of the National Health Service in England and has to meet national targets and standards. NHS Foundation Trust status also gives us greater freedom from central Government control and new !nancial $exibility. Thrombolysis This is the breakdown of blood clots by the injection of speci!c medicine. TICkLE Trainees Improving Care through Leadership and Education (TICkLE) . Two Week Wait Two week maximum wait from urgent GP referral to !rst outpatient appointment for all urgent suspected cancers. Urea reduction ratio Reduction in urea (waste product in urine) as a result of dialysis. Urinary Catheter A device which is placed into a patient’s bladder for the purpose of draining urine. Venous A blood clot forming within a vein. Thromboembolism (VTE) Vertically integrated The integration of areas of work that have one common user. In the case of Salford the acute hospital and community services have been integrated in order to improve the care given to patients.
146 Salford Royal NHS Foundation Trust - Quality Accounts 2013/14 Theme 1: Improving patient !ow and reducing Pursuing Quality readmissions Improvement to become the Reducing emergency readmissions is a key safest organisation in the NHS improvement priority for Salford Royal NHS Foundation Trust; hence the establishment of a Trust-wide improvement collaborative to prevent sub-optimal Consistently high standards of care across 7 care which can lead to patients returning to hospital. days and the ‘Salford Standard’ The Readmissions Collaborative started in June 2013 We continue to work towards early and on-going and involves patients, sta" and health economy assessment of our emergency admission patients by partners to provide a mechanism for innovation and senior medical sta". We have started to roll this out sharing local improvements. beyond the emergency village and incorporate the standards being agreed across Greater Manchester for Team improvement ideas were developed from the treatment of emergency surgical cases. analysing local readmissions data and ideas developed The Trust already has the best access to Radiology to address speci#c issues. outside weekday working hours in Greater Manchester. Key interventions: A pilot has commenced in angiography on a Sunday morning, historically patients would have had to wait Teach-back - crucial information conveyed in a until Monday morning and research has shown that manner so that the patient fully understands. excessive delays can impact patient’s recovery and Identi#cation of patients re-attending A&E for early outcomes. We now have a specialist CT radiographer senior review and admission avoidance. on site 24 hours a day, seven days a week to improve MDT discharge planning and readmissions review CT access for major trauma and stroke patients. for learning. A di"erent model for the medical management of surgical patients has been implemented in Orthopaedics Strategy to identify patients at a “high risk” of with the appointment of 2 Acute Physicians who work readmitting. full time on the 2 orthopaedic wards. Community nurse visits for alcohol related liver The model is in the process of being reviewed to assess disease (ALD) patients at risk of readmission. the bene#t of rolling it out to other surgical specialities. Post-hospital Syndrome - focusing on enhancing A steering group has been established for 7-day sleep whilst in hospital. working and one of the key work streams is looking Telephone follow-up for patients post-discharge. at how we develop processes to incorporate and OT home assessments for patients at high risk or review clinical outcome and audit data in Divisional readmitting. Governance Committees to ensure learning and improvement can be implemented and monitored. Telephone helpline for wound care related queries post discharge. Flexible visiting hours. Improved patient information and patient/carer education e.g. medication changes.
Teams are continuing to test changes and measure impact over the coming months to support the improvement of our services.
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Theme 1: Patient, family and carer experience collaborative Pursuing Quality The aim of the collaborative: Improvement to become the safest organisation in the NHS To be in the top20% for Work towards delivering the Greater patient satisfaction in the NHS Manchester Surgical Standards & the Acute Abdomen Pathway The Patient and Family Experience Strategy and Collaborative are inextricably linked to our Acute abdominal pathway has now been developed in organisation’s core values, Patient and Customer focus, collaboration with the Central Manchester University Continuous Improvement, Respect, Accountability and Hospitals NHS Foundation Trust and the Innovation is designed to encompass all elements of the patient Centre. Organisational audit, prior to implementing journey within the hospital and community, taking the care pathway, took place in August 2013 and a account of the diversity of our patient population, and data collection system was set up in December 2013. delivering equity across the Total Health Journey. Lead Clinicians were identi#ed and the pathway was implemented in January 2014. Patients are now This collaborative has involved over twenty wards and bene#tting from the high standards of care embedded departments who have looked at di"erent ways of within this clinical pathway. This work has enabled improving the patient experience and initiating such participation in the National Emergency Laparotomy changes as ‘what matters most to me ‘ which is now on Audit (NELA) that aims to improve the quality of every patients’ behind the bed board. care for patients undergoing emergency laparotomy Patient experience survey through the provision of high quality comparative data from all providers of emergency laparotomy. Patient experience results for inpatients are collected via the bedside Hospedia Entertainment System. Patients are asked to complete the free survey as near Improve patient experience to maintain to their discharge as possible. indicators in the top 20% nationally Results are available direct to the ward and service Patient experience managers on a weekly basis allowing more frequent The Trust continues to receive and act on patient review and opportunity for improvements. Overall, experience data from various sources: 91% of patients positively rated the care received on the wards. Patient, Family and Carer Collaborative. Patient Experience Survey. Nursing Assessment & Accreditation System - NAAS Nursing Assessment and Accreditation System (NAAS). The Trust must account for the quality of care it delivers to the patients and that care should be evidence- based and appropriate to the needs of the patient. The NAAS framework continues to see wards awarded with accreditation status (SCAPE - safe, clean and personal every time status). Throughout 2013/14 the Trust saw 5 wards gain SCAPE status bringing the total of SCAPE accredited wards to 25.
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Theme 1: Friends and Family Test Pursuing Quality The Friends and Family Test was introduced across Improvement to become the hospitals in April 2013. Every patient across adult safest organisation in the NHS acute inpatients and patients who have attended A&E should be given the opportunity to answer a single question: whether they’d want a friend or relative to CAAS - Community Assessment and be treated there in their hour of need. Whilst the Trust Accreditation System is currently exceeding the minimum response rate, Community assessments are a 2 day review including further work is required to improve the number of assessments of home visits, observations of clinics patients who respond. Ward teams and services are in the various locations throughout the City and vital in checking patients’ phone numbers are correct spending time with team leaders and their sta". and encouraging patients to respond to improve both Assessments to date have con#rmed 0 red or amber response rates and in acting on comments received services and 23 green services. The aim is to have assessed from patients. E"orts focused on publicising the all identi#ed community services by the end of 2014. Friends and Family Test and ensuring explanation to patients will promote and sustain improvement. The recent introduction of ipads throughout many adult community services has enabled teams to have improved access to systems already available to acute hospital sta". Safe sta"ng / Nursing establishments The Trust has a dual approach to setting safe sta!ng National Picker Inpatient Survey 2013 levels. Based on available evidence, the Trust has taken The results of the National Inpatient Survey were the decision to adopt a standard whereby the available released in February 2014. Overall results placed patient to nurse ratio never exceeds 8 patients Salford Royal as the best performing hospital, with 6 (inpatient beds) per registered nurse, and that both out of 10 sections improved and ranked better when the shift coordinator and ward manager function in a compared to other Trusts. supervisory capacity. Action plans are being formulated to further improve All wards and departments publicly display expected areas including: versus actual sta!ng levels for the forthcoming 24 hours to provide a transparent and open approach for patients, Waiting Lists. visitors and sta" and to highlight that the issues around Waiting to get a bed on a ward. safe nurse sta!ng is a key priority for the organisation. Doctors. Senior oversight of sta!ng levels is achieved through Discharge. four touch points throughout the day, beginning with a Further information about this is provided within the daily safe-sta!ng teleconference of senior nursing sta" Directors Report. from the four clinical Divisions and chaired by a Deputy Director of Nursing and continued at the three formal bed capacity meetings throughout the day. The Trust is currently developing a daily electronic data capture system which will more easily provide aggregated Trust-wide data, with an ability to drill-down to individual ward/department level and provide assurance around our ability to reliably deliver safe sta!ng levels. This information will also provide the evidence around sta!ng for external reporting requirements.
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Theme 2: Theme 3: Achieving cost improvements, Supporting high performance income & cost targets to and improvement improve margins
Cost Improvement programmes were agreed with all Improve sta# contribution to corporate clinical divisions and corporate departments supported objectives and values by focus on improving pro#tability and margins. The core values agreed in 2011/2012 support the Teams have been focused on improving the e!ciency Trust’s Quality Improvement aims and set out of contracted activity including planned service expectations as to how sta" should behave towards developments, making optimum use of beds, theatre and outpatient capacity. each other and to patients. All members of sta" at Salford Royal are expected to be: Contracts, service level agreements and leases have been kept under constant review to ensure they re$ect Patient and customer focussed: services provided and received within and outside the Communicates to all relevant parties in an holistic, organisation. timely manner. Workforce plans have been continually reviewed Anticipates and delivers on patient needs. to ensure they meet service demands, compare Cares for the patient and their families as well as for favourably when benchmarked and minimise the use Salford Royal’s reputation. of temporary sta" at premium cost. Procurement has been scrutinised to ensure costs are Supportive of continuous improvement: minimised. Responds well to change and embraces initiatives. Collaborative working has been undertaken between Open to new ideas and encourages forward thinking. Divisions, within the Health Economy and between Trusts Takes ownership for continuous learning and self- to ensure all opportunities to identify savings are explored. development. Salford Royal’s well-established #nancial management controls ensured our excellent track record of delivery Respectful: against plans continued and by end of 2013/14 we Strong focus and personal accountability on actions were posting a normalised surplus of £6m, against a and results. plan of £2.7m. Takes responsibility for own actions. Financial performance for 2013/14 can be found in the Accounts for wider pieces of work rather than Financial Review section on page 228. limited job description duties.
Accountable: Acts as a team player; Recognises and rewards others. Fosters a participative work environment.
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Theme 3: Supporting high performance and improvement
The strategy highlights the commitment to the development of a safety culture. The main elements of a safety culture being: Open and frequent communication. High functioning multidisciplinary teams. Leadership Award: ‘Just’ culture (understanding of system versus Naomi Davenport, Lead Nurse, Neurosciences. individual errors). Lin Hurst Award: Ruth Garside, District Nurse, Adult Robust error reporting systems that ‘close the loop’. Community Nursing. HR practices that support a culture of safety. Living Our Values Award: Brian Lowe, Joiner. Leadership. Nurse of the Year Award: Focus on never events. Melanie McDougall, Bereavement Specialist Liaison Willingness to address bad behaviours. Nurse, Pam Woods Suite. Accountability for improvement and safety at all levels. Research Practitioner of the Year Award: Measurement for improvement. Tracey Evans, Critical Care Research Manager. Support Worker of the Year Award: Janet Walsh, In November 2013 a number of dedicated doctors, Healthcare Assistant, Adult Community Nursing, inspiring nurses, caring support workers and Walkden. compassionate volunteers were all centre stage at Salford Royal’s annual Sta" Awards. The following Team Contribution to Patient Care Award: Pain Team. winners, as voted by all members of sta", were then The Big Idea/Safely Reducing Costs Award: revealed on the night: Joanne Kelly-Robbins, Housekeeper A&E. Administrative/Secretarial Worker of the Year: Improving Safety Award: Kathryn Kanu, Ward Clerk, Critical Care. Colleagues from across the organisation involved Allied Health Professional/Scienti#c Worker of the in the safe activation of the new Electronic Patient Year: Tony Goldstraw, Theatres. Record (EPR) system on June 8th and 9th. Collaboration Award: Comprehensive Older People Improving Cleanliness Award: Evaluation (COPE) Team on EAU. Home and Hospital IV Teams. Doctor of the Year Award: Dr Niamh Collins, Improving Personal Care Award: Dr Michelle Needham, Specialty Doctor in Emergency Medicine. Consultant Respiratory Physician. Individual Volunteer of the Year Award: Chief Executive’s Outstanding Achievement Award: Colin Wainwright, Welcome Volunteer PALS. Pathology at Wigan and Salford (PAWS). Jill Simpson Award for Clinical Excellence: Chairman’s Unsung Hero: Intestinal Failure Team. Janet Briscall, Karen Quelcutti, Marie McGuire, Clare White and Jeanie O’Neal (H5 and H4 nurses).
Salford Royal NHS Foundation Trust - Annual Report and Accounts 2013/14 151 Theme 3: Team building strategies Supporting high performance Team building strategies have been developed with and improvement particular attention in areas of organisational change including Pathology, Theatre and Pharmacy.
Develop a high performance culture Implementation of the new Electronic The focus for 2013/2014 has been to deliver the clinical Patient Record (EPR) and management development, team performance & After nine months of planning, the Trust migrated one talent management programmes, a framework for earned million patient records and 180 million results, orders autonomy and collaboration. The approach has included: and documents from its old systems into the new Divisional ownership of the coaching approach to Electronic Patient Record (Sunrise Clinical Manager) high performance. during the rollout weekend in early June 2013. During Talent identi#cation and development. the #rst four days, more than 56,000 orders, results and Team building strategies. documents were viewed and entered electronically into the new EPR system by more than 3350 caregivers. Safely embed earned autonomy within the assurance framework. Live areas of the system include electronic prescribing and medication administration, order communications Developing a common purpose. for radiology and pathology requesting, results Mentoring, coaching and performance assessment reporting, nursing assessments, doctors’ notes, clinical for clinical leaders. summaries and clinical decision support. Following a Collaborative working across divisions. successful activation in June 2013 the system is now Developing skills in response to changing service live across all the Trust’s wards and clinics. models. This paved the way to start the exciting journey that Developing skills around building valued has taken place over the past months, exploring the relationships, collaborative decision making, rich functionality available to us via the new EPR facilitation and con$ict resolution. system. Salford Royal has an ambition to be the safest organisation in the NHS and our new EPR supports us in working towards this. A number of EPR projects have commenced since the switchover to the new system, looking at implementing new functionality to support accident & emergency, critical care. Bed management and further enhancements to electronic prescribing and medication administration which are scheduled to be implemented in 2014/15. These developments will further improve clinical pathways and enhance clinical outcomes.
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Theme 3: Supporting high performance and improvement
Implement the Membership and Public Engagement Strategy During 2013/14 Salford Royal looked to sustain its sizeable membership and concentrate on increasing the number of members within groups that were under-represented. Over 240 new members aged 16-30 joined us. We wrote to patients living in Ordsall and Langworthy, Irlam and Cadishead and East Salford Patients also joined us for a focus group to share their inviting them to become members, as these public experiences of Day Surgery. In response to suggestions constituencies had lower numbers of members. from patients we have introduced volunteers to the Involving members, patients and public to help design Day Surgery Unit to talk to patients and keep them and improve services has been a huge part of our informed about what is happening. Sta" on the Day work over the last year. Here are some examples. Surgery Unit provide business cards for family and Members were asked to join our Dementia Patient loved ones so they have a number they can call at any and Carer Group to help improve the general hospital time to #nd out what is happening. environment for people living with dementia. The We carried out our Annual Membership Survey, to group gave us their thoughts on the design of new canvass the opinion of the Trust’s members, public and signs to be used in the hospital. partners regarding the Trust’s priorities, objectives and A focus group was held with strategy for the forthcoming year. members to redesign the Members and the public were able to submit their Outpatient Information views online, by freepost or directly to Governors Booklet to make it easier to who attended Community Committees and various understand. The new Information for voluntary and community forms to gather views booklet has been published Outpatients on topics including the use of new technologies in and is now in use. Outpatients, integrating services for older people in Salford and discount car parking schemes. The results of the Annual Membership Survey were reported to the Board of Directors via the Council of Governors subgroups and informed the development of the Annual Plan for 2014/15.
Outpatients 0161 789 7373 www.srft.nhs.uk
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Theme 4: An Alliance Agreement has been formed by the statutory Improving care & services partners, taking e"ect in shadow form in 2014/15 which de#nes the key services in Salford providing care and through Integration & support to the over 65+ population. The Agreement is to Collaboration enable the pooling of resources to allow risk and bene#t sharing across services and partners whilst facilitating Deliver the Integrated Care programme for true integration through redesign and new ways of Older People working to bene#t older people. During 2013/14 Salford Royal continued to work with The programme is the delivery framework for the Salford CCG, the City Council, Greater Manchester Better Care Fund and has been approved by the Health West and non-statutory partners to #nd better and Wellbeing Board who will monitor performance ways of supporting older people, to improve their during 2014/15. independence and quality of life. Integration and collaboration within the From February to December 2013 a new model of north west sector care was trialled and tested in two neighbourhoods (Swinton & Pendlebury and Eccles, Barton & Winton). Following the successful collaboration with Wrightington, The model has three inter-related parts which are: Wigan & Leigh Foundation Trust in creating the Pathology at Wigan & Salford model, blood sciences transferred Promotion and increased use of Local Community to Salford Royal, completing the redesign of Pathology Assets (e.g. carer support, self-management, services between the two organisations. community groups) to support increased independence and resilience for older people. Joint Consultant appointments have been made delivering Clinical Haematology services in both Establishment of Multi-Disciplinary Groups (i.e. Wrightington, Wigan & Leigh and Salford Royal. structured, multi-disciplinary population based Strategically Wrightington, Wigan and Leigh wish to care) to support older people who are most at risk maintain Inpatient and Outpatient services ensuring as well as a providing a broader focus on screening, services for the local population. primary prevention and signposting to community support. The Trust continued to work throughout the year with Wrightington, Wigan & Leigh Foundation Trust Development of an Integrated Contact Centre (i.e. a to improve the reliability and $exibility of the Sterile hub to support navigation, monitoring and support) Services service to respond to the needs of services that brings together aspects of telephony and tele- within both organisations. care support for older people. The Trust has been working with surgeons and managers The model has been further developed following the in both Wrightington, Wigan & Leigh and Bolton to develop testing phase. The new integrated model will be rolled sector solutions to the ‘Healthier Together’ strategy. out citywide using a phased approach from April 2014 to July 2015, and will initially embed in the two pilot neighbourhoods of Swinton and Eccles. Key additional components will be the development of standards for di"erent areas of care provision and the use of a shared care record to summarise and make accessible all important aspects of care in one place.
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Theme 4: Improving care & services through Integration & Collaboration
Collaborate within Greater Manchester and beyond / service developments The Trust continued to strengthen services throughout 2013/14. Key developments included: Meeting Major Trauma standards. Developing Salford Royal’s position within the Greater Manchester Healthier Together programme. Responding to increased patient $ow from Tra"ord following implementation of the New Health Deal. Expanding capacity for stroke care. Start collaboratively delivering Neuroscience services for Greater Manchester. Developing Neuro-rehabilitation services and ensuring capacity to meet demand. Securing additional radiology capacity and equipment replacement. Improving access to onsite DEXA imaging facility. DEXA images the bone density of patients and is used to assess the likelihood of fractures in patients who may be su"ering from osteoporosis, thus allowing preventative measures to be established. It is also used as a monitoring examination for patients on long term drug therapy when the type of therapy may have an impact on bone density. Upgrading the magnetic resonance (MR) scanning facility. Increasing capacity for Mohs surgery and providing this service for patients in Stockport. Transferring Gynaecology-oncology services to Central Manchester University Hospitals NHS Foundation Trust to consolidate specialist cancer services.
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Theme 4: Improving care & services through Integration & Collaboration
Service developments and redesign outpatient improvements Throughout the year the Outpatient Improvement Plan has continued to deliver a number of improvements for patients. These include: An innovation conference was held in spring 2013 and the DISCC Award (Design Innovative Solutions in Clinical Care) was launched. The winner of the award was Dr David Rog, Consultant Neurologist with the winning proposal of creating short video clips which introduce patients to the hospital, Redesigned anticoagulation services sta" and what they can expect at their outpatient 50 patients within the anticoagulation service currently appointment. self-test and provide positive feedback regarding this The theme of innovation has been key this year method of care. Our aim is to increase the number of to enable us to deliver our services in ways which patients who enjoy the freedom of self-testing to more better meet our patients’ needs. than 100 by summer 2014 as part of a pilot. The service redesign team continue to be supported In the Annual Members’ Survey 2013, 50% of by commissioners to achieve this goal, with the view respondents said they would like to use self-testing that self-testing should be the standard for all patients models where appropriate. We have agreed with who require anticoagulation monitoring. commissioners to pilot anti-coagulant self-testing and we have implemented remote cardiac monitoring for Links have been formed with a variety of providers of patients #tted with pacemakers. These innovations technological communication solutions to support the will see a reduction in the number of times patients are patients in the management and monitoring of their required to attend the Trust. therapy. We have worked with Governors and members, as described earlier in this report, to develop an Spinal services Outpatient Information Lea$et. We have worked Spinal services continue to be developed jointly by across the Trust to standardise patient letters and Neurosurgical and Spinal teams to address demand ensure that we give patients consistent way-#nding from within and outside Greater Manchester, and in information. Patients now get a full colour copy of particular to meet the needs of an adolescent population. the hospital map on the reverse of appointment Clinics have been established in Leighton, Bolton letters, an idea suggested by our members. and plans are being developed to open clinics in We have improved the way we book follow-up other locations. The integration of neurosurgical and appointments in rheumatology and urology. We orthopaedic spinal surgery is proceeding well. have issued text reminders to more patients this year to help remind patients about their appointments.
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Theme 5: Inclusion and Equality Sta! Sta! Demonstrate compliance with Age 2012/13 % 2013/14 % Mandatory Standards 16-19 33 0.52% 19 0.28% 20-29 1,048 16.63%1,189 17.75% 30-59 4,877 77.39%5,094 76.03% Performance against mandatory standards including 60-74 344 5.46% 398 5.94% Monitor and CQC targets and registration requirements TOTAL 6,302 100.0%6,700 100.0% can be found in the Directors Report. Ethnic Group Asian 477 7.57% 533 7.96% Not Speci!ed 62 0.98% 48 0.72% Workforce standards Chinese 30 0.48% 29 0.43% At the end of 2013/14 the Trust employed 6,700 people White - Other 164 2.60% 191 2.85% and details of the workforce are given below: White - British & Irish 5,265 83.54%5,573 83.18% Mixed 61 0.97% 76 1.13% Workforce by Sta" Group Black 174 2.76% 174 2.60% Sta! Group Headcount Percentage Any other Ethnic Group 69 1.09% 76 1.13% Professional, Scienti!c and Technical 242 2.61% TOTAL 6,302 100.0%6,700 100.0% Administrative and Clerical 1,453 21.69% Gender Nursing and Midwifery Registered 2,033 30.64% Male 1,361 21.60%1,452 21.67% Allied Health Professionals 355 5.30% Female 4,941 78.40%5,248 78.33% Additional Clinical Services 1,307 19.51% TOTAL 6,302 100.0%6,700 100.0% Students 1 0.01% Disabled Medical and Dental 568 8.48% No 3,361 40.7% 4,176 62.33% Estates and Ancillary 435 6.49% Not Declared 1,271 9.85% 2,281 34.04% Healthcare Scientists 286 4.27% Unde!ned 1,494 47.48% 2 0.03% TOTAL 6,700 100.0% Yes 176 1.97% 241 3.60% TOTAL 6,302 100.0%6,700 100.0% Workforce by Division Male Female Sta! Group Headcount Percentage Executive and Non-Executive Directors 8 5 Division of Neurosciences & Renal Services 1,260 18.81% Trust Senior Leaders (exc hosted services) 24 19 Division of Surgery 903 13.48% Other sta" 1,423 5,221 Hosted Services 195 2.91% Facilities Division 425 6.34% Division of Salford Health Care 1,590 23.73% Corporate Services Division 565 8.43% Division of Clinical Support Services & Tertiary 1,762 26.30% Medicine TOTAL 6,700 100.0%
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Theme 5: The Trust’s Annual Equality Reports, monitoring data/ Demonstrate compliance with statistics and other relevant information can also be Mandatory Standards viewed on the Trust website at: http://www.srft.nhs.uk/about-us/diversity- equality/ Equality and Diversity Standards This information enables the Trust to review and monitor outcomes for both its workforce and service The Trust’s Executive lead for Equality and Diversity user’s data by protected groups. Through this analysis is the Director of Organisational Development and the Trust is able to identify areas of good practice and Corporate A"airs. The Trust’s approach to inclusion areas for improvement. This information is reviewed and equality is that all sta" and managers are expected and monitored by the Trust’s Equality & Diversity to take responsibility and deliver on this agenda sub-group and used to develop the Trust’s Equality throughout their working lives. Performance Report. The Trust recognises delivering on inclusion and The Trust’s Single Equality Scheme, is also published equality can be a key driver to achieving the Trust’s on the website and outlines and promotes the ambition to be the safest organisation in the NHS. Trust’s commitment to this agenda, ensuring that the It gives us a real opportunity to place people at the organisation clearly de#nes it assurance, governance centre of the work we undertake, recognising how and engagement strategy. actively involving individuals from diverse groups enables us to prioritise and address health inequalities. Equality & diversity partners 2013 We will also continue to engage and involve our sta" The Trust re-applied and was awarded Equality & to ensure that they are; fully informed on this agenda, Diversity Partners status with NHS Employers in 2013. have the necessary skills and con#dence to support This recognises that the Trust has demonstrated its the needs of patients and colleagues, understand commitment and leadership to the Inclusion and the inequalities that impact on protected groups Equality agenda. and support us in identifying where we can deliver improved outcomes for the workforce. To support its Service user champion forum commitment to this agenda, inclusion & equality is We launched and developed this forum in partnership part of the mandatory training programme for all sta" with local community groups and key stakeholders. across the Trust. The Trust’s compliance rate in 2013 The forum has representatives from diverse groups has been consistently over 99%. and has enabled the Trust to listen directly to their The Trust is fully committed to meeting its experiences and agree joint plans of action to improve requirements of the Equality Act 2010 and is compliant outcomes for our most vulnerable groups. with the Public Sector Equality Duty. Working with the Piloting meet, greet and support service Department of Health’s toolkit, the Equality Delivery System (EDS), the Trust held consultation events over After listening to concerns raised by the User 2013/14 with key stakeholders, which included both Champion Forum, on how vulnerable groups access sta" and local community groups. This has enabled services at the hospital site, the Trust is currently in the the Trust to publish locally agreed scores against the process of piloting a Meet, Greet & Support service. EDS standards and refresh its Equality Objectives. This will enable individuals to pre-book a volunteer to assist them to attend their outpatient appointment.
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Theme 5: Further development of the Service User Champion Demonstrate compliance with Forum to ensure that the views and opinions of individuals from protected groups are used Mandatory Standards to develop the Trust’s Annual Plan and Equality Objectives and to improve health outcomes. In particular support the work of the Trust’s Equality Supporting the Trust’s Governor Led Campaign for 2014/15; improving outcomes for Engagement Plan people with sensory impairments. By working in partnership and sharing the experiences Support the Sta" Inclusion Network work-streams, of the Champion Forum with them, the Trust’s with a focus on the Trust’s policy ‘Employing Governor led engagement plan now has a key focus on Individuals with Disabilities’; by working with involving seldom heard groups. expert organisations to review and improve the implementation of reasonable adjustments in both Targeted training and development recruitment (e.g. two tick compliance, targeted The Trust has engaged with patients and sta" in training for recruitment managers) and employment relation to improving outcomes for diverse groups. practice, including developing pathways to retain The Trust subsequently developed and delivered a the skills of individuals who become disabled while series of training and awareness sessions throughout working at the Trust. the year. These have enabled sta" to meet directly Continue to work with the Trust’s Governors to with representatives from local groups and discuss develop an e"ective engagement programme developing service improvements plans in partnership. which ensures we can listen and respond e"ectively to ‘seldom heard groups’. Future priorities and targets Continue to improve and develop the role of Through the active engagement and data analysis Support Advisors who support sta" experiencing the Trust undertook over 2013 we have developed Bullying and Harassment at work, including working a comprehensive Equality Performance Report and with the Sta" Equality Network to identify areas of Action Plan (including Equality Objective). This plan good practice. will be continually reviewed and updated through Work in partnership with Victim Support to develop regular engagement with key stakeholder groups, targeted and timely support systems for both sta" current priorities are: and patients/families in high impact areas. In line with the development of the Equality In line with the development of the Equality Delivery Delivery System, continue to develop innovative System, continue to develop innovative ways to ways to involve and consult with patient, public involve and consult with patient, public and sta" and sta" groups. Though this inclusive approach groups. and working with key partners, we will support and in$uence the strategic direction of service Establish process to improve the sta" reporting improvement across the health economy, improving #gures across key protected groups e.g. religion/ health and employment outcomes. belief and disability. Performance and monitoring of these targets will be undertaken by the Equality and Diversity sub-group and key stakeholders through the Equality Delivery System.
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Theme 5: The production of SiREN, the employee newsletter, and also brie#ngs through Leaders Forum and the Demonstrate compliance with Trust’s Intranet site, support these afore mentioned Mandatory Standards mechanisms for consultation to take place. There are #ve sta" governors that represent the views of sta" at the Council of Governors and in working Sta# engagement groups. They are also involved in gaining sta" views The Trust recognises that its aim to become the safest on a range of issues from Bullying & Harassment to care provider in the NHS will only be achieved with the Inclusion to Sta" Engagement. support of an engaged workforce. Highly engaged Priorities for 2014/15 are to continue to improve sta" are reported to provide a better and safer patient communications with senior managers, to reduce experience and the Trust will be undertaking work to bullying and harassment, to improve the ability of consider both Inpatient and Sta" Experience measures sta" to speak up and raise concerns, to improve the relate to each other. appraisal/contribution review process and to improve The Trust was pleased to be able to report that the sta" health and wellbeing. The Trust contracted National Sta" Survey results showed the sta" to with Safecall in 2013 for the provision of an external have the highest level of engagement across all NHS con#dential reporting service for sta". Work has providers in 2013 and once again had 20 of the Key commenced in the #rst 4 of these areas with a Health Findings rated in the best 20% of Acute Trusts category. and Wellbeing Strategy to be developed and launched in 2014/15. The Trust scores highly on the Sta" Friends and Family question with the highest score for an Acute Trust. A local sta" survey is sent to a sample of sta" each month and reports on sta" satisfaction across the The Trust has a formal recognition agreement in Trust (scale summary score between 1 and 5). This has place with the sta" organisations representing sta" demonstrated an average score across the year that employed by the Trust. There are also consultation would be ranked as top 20% of Acute Trusts in the mechanisms through the Joint Local Negotiating National NHS Sta" Survey. This has been developed Committee for Medical sta" and the Joint Partnership for the coming year with a bi-annual survey for each Forum for all sta". division to allow for more in depth reporting at They will consult speci#cally with sta" regarding Divisional level which will support on-going Divisional proposed service changes, changes to working action plans. practices or management changes.
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Theme 5: Demonstrate compliance with Mandatory Standards
Sickness absence The management of sickness absence serves to reduce costs and maintain the quality of our services. The Trust recognises that at times sta" will become ill and expects managers to provide support to sta" and deal with them sympathetically at all times. The Trust expects managers to make reasonable adjustments for sta" who are disabled to help maintain their employment and to consider such adjustments for other sta" who are ill. The Trust however has a duty to provide care to patients in an e"ective and economic 2013/14 2012/13 2011/12 2010/11 manner and may on occasions, having considered 01 April 3.83% 3.87% 3.57% 3.71% adjustment, have to retire or dismiss employees who 02 May 3.73% 3.89% 3.62% 3.76% are absent from work, long term, due to sickness. 03 June 3.85% 3.73% 4.16% 3.83% 04 July 4.01% 3.98% 4.10% 3.86% It is our aim to reduce sickness to a target level of 05 August 3.68% 3.91% 3.73% 3.69% 3.6%. During 2013/2014 absence levels were 4.07% 06 September 4.02% 3.92% 3.71% 3.92% compared to the previous year’s level of 4.05%. Within this #gure, short term absence accounts for 40% 07 October 4.16% 3.98% 3.72% 4.03% whilst long term absence accounts for 60%. In total, 08 November 4.28% 4.24% 3.89% 4.17% 43.8% of our sta" recorded no sickness absence (an 09 December 4.31% 4.46% 3.94% 4.91% improvement on the previous year’s total of 40.6%). 10 January 4.64% 4.50% 3.87% 4.53% 11 February 4.26% 4.13% 4.38% 3.56% Sta! Sickness Absence 2013/14 2012/13 12 March 4.09% 3.96% 4.25% 3.63% Days lost - long term 69,901 64,471 Overall Percentage 4.07% 4.05% 3.90% 3.97% Days lost - short term 27,859 27,651 Total days lost 97,760 92,122 An examination of reasons for sickness absence Total sta! years 6,474 6,117 reveals that the most common cause of long term Average working days lost 15.1 15.1 sickness absence is stress/anxiety disorder at 25.85% Total sta" employed In period (headcount) 6,704 6,302 followed by musculo-skeletal conditions (incl. back Total sta" employed In period with no absence 2,938 2,561 (headcount) problems) at 20.8% of total days lost. For frequent Percentage sta" with no sick leave 43.8% 40.6% short term absences, the most common causes are gastro problems (25%) and colds/$u (14.7%) in terms of number of episodes occurring.
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Theme 5: The Adverse Incident Reporting (AIR) System is Demonstrate compliance with managed by the team. The Trust continues to perform well in its management of incident reports, seen in the Mandatory Standards national #gures released from the National Reporting and Learning system (NRLS).
Health and safety of our sta# Occupational Health (Health and Wellbeing) The Trust is committed to safeguarding the health and The Trust recognises the important role played by the safety of its employees, patients, visitors and anyone Health and Wellbeing Department, which operates as who may be a"ected by its activities. The Trust has a joint venture with Salford City Council, in reducing a Health and Safety Committee which is made up sickness absence and thereby reducing unnecessary of representatives from all clinical and non-clinical costs, contributing to safe recruitment and, in the groups, trade unions and sta". The Committee also longer term, the retention of employees. Emphasis is includes advisors with expertise in core health and placed on assisting employees to improve their health safety topics. and wellbeing, giving advice on smoking, alcohol, During 2013/14 the Risk and Health and Safety focus healthy eating, physical exercise, stress and mental has been: health. The department also manages the annual $u vaccination programme. On-going maintenance of the Trust’s Incident Management systems. To assist management of the three most common causes of sickness absence - stress, back conditions and Improving the quality and timeliness of Incident musculoskeletal disorders - the department provides: Investigations. A con#dential counselling service to which sta" can On-going management and monitoring of the self-refer. Trust’s Central Alert Systems. Access to a mental health worker. On-going review of Risk Assessment and Risk Access to physiotherapy treatment of joint or Register processes. muscle pain. This is particularly useful for sta" who Reviewing and strengthening the Assurance may be struggling to manage with a condition at processes, structures and performance for Health work or who have been forced to take sickness and Safety absence as a result. Undertaking systems and performance reviews on key safety related topics. Community engagement The Trust continues to expand its volunteering The Trust’s Risk Management team provides an activities with an aim to enhance the experience of advisory service on safety related matters. Providing our patients, carers and visitors. We now have over training on a variety of topics. The team co-ordinates 340 volunteers working throughout our hospital and all alerts relating to the Trust from the Central Alert community services. Volunteers enable us to work in System (CAS) and disseminates and coordinates the new ways and often provide a more personal touch responses and actions required following the initiation when interacting with people. This can be as simple of an alert. as sharing a cup of tea with someone or a game of Compliance with timeframes set by CAS has again dominos; making our patients feel more at home while been consistently achieved throughout 2013/14. reassuring those that care about them.
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Theme 5: Demonstrate compliance with Mandatory Standards
Over the past year we’ve started a number of interesting projects. A new volunteer’s driver’s scheme supporting cancer patients from Irlam and Cadishead has proven a great success. The volunteers involved raised the funds to support the service themselves from a number of local benefactors and all play hand in the management of the scheme and its #nances. Travel and parking have often been regarded as one of the ‘hidden costs’ of cancer and the service has had a dramatic impact The Trust continues to host GATEway events on the lives of the patients involved. The scheme has and provides access for unemployed people now covered over 3000 miles and the Trust is hoping to into employment, education or volunteering. In expand to the Walkden and Little Hulton area. partnership with Jobcentre Plus, Salford City Council, Volunteers joined our Intermediate Care Centre (The Salford College, our PFI Limes and Hartley Green) which has meant more partner Cofely, 130 people activities for the patients who are admitted to the moved into employment from units. Alongside supporting patients at meal times and socially disadvantaged or key generally spending time talking and playing games employment priority groups. our volunteers have been supporting reminiscence During 2013/14, 340 of our new sessions and card making. These types of activities starters were residents of Salford are something that sta" are often not in a position to and the percentage of people support, whereas our volunteers can dedicate time and employed by the Trust living in attention to the setup and coordination. Salford is 52%. The Trust is currently increasing the number of In terms of training to gain employment, we deliver volunteer guides we have around the site to support employment pathways in partnership with and for the way-#nding across the hospital. We will trial a Princes Trust, Pure Innovations, Skills for Health and volunteer led mobility scooter service which visitors Salford Foundation. We have supported 9 teams for will be able to call into from the car park and be the Princes Trust which include looked after children shuttled to their appointment. If successful this will and lone parents. We have a supportive relationship form a part of the overall strategy for way-#nding at with Liberty House and The Foyer and our employees the Trust to help alleviate the problems of a large and regularly provide food, clothing and toiletries parcels growing hospital site. to these young people. During 2013/14, we have In addition to supporting volunteers, we continue to taken 2 cohorts of 10 unemployed young people with play our role as a socially responsible organisation and learning di!culties and we employed 8 trainees from support the local community into employment. We the #rst cohort and to date 2 trainees from the 2nd engage with disadvantaged groups and all age groups cohort have obtained employment. We continue to in Salford to help people build con#dence, self-esteem, provide 4-8 weeks work experience in partnership with motivation and employability skills with the aim of Jobcentre Plus and Princes Trust and work experience enabling them to progress into paid employment. to local school children.
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Theme 5: The second incident was a loss of paper pathology Demonstrate compliance with results sent from Public Health England (a part of CMFT). As Salford Royal is one of the partners Mandatory Standards in this joint service the process features two data controllers and Salford Royal will support the on-going investigations. Finance & IM&T standards Counter fraud service Information Governance Salford Royal has an established Counter Fraud Service Going concern provided by Mersey Internal Audit Agency (MIAA), Salford Royal has prepared its 2013/14 Annual with a dedicated Local Counter Fraud Specialist (LCFS) Accounts on the basis of being a going concern. After In line with the standards for providers for Fraud, making enquiries, the directors have a reasonable Bribery and Corruption issued by NHS Protect, the expectation that the NHS Foundation Trust has Trust is committed to embedding an anti-crime culture adequate resources to continue in operational throughout the Organisation. This is supported in full existence for the foreseeable future. For this reason, by the Board of Directors and monitored on a regular they continue to adopt the going concern basis in basis by the Trust’s Audit Committee. The Trust’s preparing the accounts. commitment to protecting valuable public funds from fraud, bribery and corruption is unwavering. Information Governance Toolkit Attainment Level A number of key tasks were undertaken this year to The Information Governance Toolkit is an online prevent fraud, bribery and corruption: assessment system which provides NHS organisations, patients and partners the ability to assess themselves Inform and involve against Department of Health Information Governance Anti-Fraud, Bribery and Corruption presentations were standards. The core standards provide assurance in delivered to sta" via e-learning packages as well as the Trust’s ability to the securely store, transfer, share presented personally by the LCFS at team meetings and destroy data both within the organisations and and organised training events to help us to create and between organisations. Salford Royal Information embed an anti-fraud, bribery and corruption culture. Governance Assessment Report score overall score for We also arranged anti-crime awareness campaigns 2013/14 was 90% and was graded green. which are done in partnership with the Trusts Salford Royal has been involved in two data losses, Human Resources Department, the Local Security both involving data controlled / collected for other Management Specialist and Greater Manchester Police organisations. and Victim Support to raise awareness around criminal The #rst incident was the theft of a consultant’s activities, to promote the role of the LCFS and to advise personal laptop which contained the personal people on the routes available to report all types of data of sudden child death review. This is currently concerns. with the Information Commissioner’s O!ce however Manchester Clinical Commissioning Group commissions the service, Central Manchester University Hospitals NHS Foundation Trust (CMFT) runs the service and none of the patients are Salford patients therefore Salford Royal is not the data controller in this case.
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Theme 5: Building and facilities Demonstrate compliance with Mandatory Standards standards Domestic services Domestic Services continue to review schedules Prevent and deter and revise cleaning programmes to meet the ever The Trust has agreed with the LCFS a Communications growing demands of service users. High standards Strategy and has a dedicated the Trust has its own Anti- of cleanliness are maintained across Salford Royal Fraud page on the Intranet for all sta" which is used to and audits throughout 2013/14 con#rmed national publicise fraud related articles including outcomes of standards were consistently exceeded. recent fraud to deter people. A new innovation was introduced during 2013/14, a The LCFS reviews a variety of policies and processes scheme which deploys a team of bed makers to the to ensure these are robust and help to minimise the Emergency Assessment Unit and Aging and Complex opportunities for crime to occur. Medicine wards to free up nursing time and ensure beds are available in a timely manner for the next patient. Hold to account The Trust has participated in the National Fraud Initiative exercise which is a government initiative Noleen Fulop aimed at cross-referencing all government data to Domestic Services Manager identify any risks of fraud. The LCFS also conducts The feedback we have had so far regarding the Bed proactive exercises aimed at detecting potential or Making Team has been extremely positive. The thorough apparent fraud in relation to the use of fuel cards and cleaning of a bed area can take anything up to 25-30 bank/agency sta" timesheets. minutes, which is very time consuming for a nurse on a The Trust ensures that every allegation is investigated busy ward or department. Patients are always our main to prove or disprove if an o"ence has been committed priority and we hope the speedy turnaround of beds will and seeks redress whenever possible so that money help to improve their experiences during their stay with recovered can be put back into patient care. us, while also easing the pressures on nursing staff. A key part of Salford Royal’s vision and values is accountability and that is why we assure you that we will do everything in our power to protect the public funds with which we have been entrusted.
The pilot will be evaluated and if successful rolled out across the Trust.
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Theme 5: Demonstrate compliance with Mandatory Standards
Patient kitchen The Environmental Health Unit inspected Salford Royal’s In-patient kitchen in August 2013 and assigned The Executive Director of Strategy and Development a one star rating for food hygiene standards (5 being undertook a review of the governance system and the highest rating). management arrangements across Estates and Facilities. This was subsequently reviewed by the The EHO’s #ndings fell in to 3 main categories: lack of Board of Directors and the Trust’s Audit Committee to policy documentation; failure to address the lack of ensure relevant assurance processes were improved policy documentation over a 2 year period; failure in and con#rmed as robust. All recommendations have record keeping and operational food hygiene practices been fully implemented. observed by the Inspector on the visit. The Trust immediately recognised that the failures identi#ed in The Environmental Health Unit carried out a further the report represented potential risk to patient safety. inspection of Salford Royal’s In-patient kitchen in Within 24 hours of the inspection, the Trust Infection December 2013 and assigned a #ve star rating for food Control Team and the Public Health England were able hygiene standards (the highest rating). to con#rm that there was no evidence of any patients Salford Royal’s chefs work closely with dieticians, ward su"ering food-related illness during or following in- sta" and patients to ensure that patients receiving patient care at Salford Royal over the previous two years. care on our wards have access to a wide range of A review was undertaken of the issues requiring menu choices, with high nutritional value. The immediate action and they were all addressed. catering team buy the best local products available A thorough investigation in to the causes of this and in the coming year are aiming to achieve the Soil failure was also launched immediately, adopting the Association’s Food for Life Catering Mark. methodology the Trust uses for all serious incidents. In March 2014, the catering team played a central The EHU visited the Trust again in early September part in the annual Nutrition and Hydration Week. and con#rmed satisfaction with action taken and that This campaign aims to raise awareness and improve the management action plan that was in place. In understanding about the vital importance of good parallel with the investigation two external audits nutrition and hydration, not just for patients and older, were undertaken, the #rst by an experienced catering vulnerable people, but for all. As part of this initiative, manager (and former Environmental Health O!cer), the team brought traditional tray bakes and cream from Guys and St Thomas’s NHS Foundation Trust, and cakes to patients on our wards, creating a Trust-wide a second by a team of technical experts from Sodexo. `Afternoon Tea` event. Immediate recommendations were fully implemented The catering team also supported Ward L2 in a `Come and plans set for further improvement. Dine With Me` event, which gave patients on the ward The Trust commissioned Sodexo to provide interim the opportunity to invite a loved one or a relative to management support for the patient catering service dine with them on the ward. The aim was to highlight and the co-ordination of hotel services within the Trust, the huge social aspect of eating and drinking in our and to review the functioning of other hotel services to daily lives and how being in hospital can impact on provide external assurance on standards. this. Feedback from these events has been excellent.
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Theme 5: Demonstrate compliance with Mandatory Standards
Patient-led Assessment of the Care Environment (PLACE) Patient-led Assessments of the Care Environment (PLACE) is a new system for assessing the quality of the hospital environment. PLACE Assessments put patient views at the centre of the process, with patients and their representatives making up more than 50% of the assessment team, and use information gleaned directly from patient assessors to report how well a hospital is performing in the areas assessed - privacy and dignity, cleanliness, Access standards food and general building maintenance. It focuses Working with the Trust’s Service User forum and, entirely on the care environment and does not cover following a public consultation with the local care provision or sta" behaviours. community on car parking access, safety and costs; The assessments are undertaken annually and results the Trust is currently piloting two schemes to improve are reported publicly to help drive improvements in access across the hospital site: the care environment. Mobility Scooter Scheme & Meet, Greet & The PLACE inspection took place at Salford Royal on Support Service the 20 June 2013. The table below shows how the Facilities Hotel Services and our HR Equality & Inclusion hospital performed in the four areas assessed. Manager have been working closely together to Areas Assessed National Average Salford Royal Score introduce the new mobility scheme supported by a meet and greet service. We aim to have a number of Cleanliness 95.74% 99.17% volunteers on hand each day to assist patients who Food 84.98% 90.67% Privacy and Dignity 88.87% 98.05% have any form of disability that requires assistance. We Appearance Maintenance 88.75% 97.38% aim to provide a personal touch where patients not only have access the mobility scooters but can if they wish have an escort to their place of appointment. The Trust has recently purchased 4 standard scooters and 1 bariatric scooter, which are available upon request from the main reception desk in the Hope Building. In 2014/15 we will fully advertise this service and develop an online booking system where patients can access and pre-book in advance of any appointments.
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Theme 6: Implement Enabling Strategies
Deliver the Research & Development strategy The aim of Research and Development within Salford Royal is to deliver research that improves care and contributes to improving the health for the people of Salford. Performance targets were achieved in 2013/14, which ensure that Salford Royal is e"ectively contributing to health improvement. In the past year, over 5,000 people took part in research studies within There has been an increase in the number of clinical Salford Royal. More than 140 new studies became studies taking place within the Trust and more clinical available to the patients of the Trust. sta" are leading on studies locally. To support our sta" we have expanded the role of the Salford Royal Salford Royal has worked with a number of national Training Academy to ensure they have the skills and leaders in research to build capability to support knowledge needed. research in a number of key areas including Public Health, service delivery and new health technologies. We continue to work closely with our partner Working with specialists within the University of education and NHS organisations. As a partner in the Manchester and elsewhere, we have secured a number Manchester Academic Health Science Centre (MAHSC) of major national funding awards to support research we contributed to the successful Department of Health evaluating the impact of changing consultants designation process to secure the partnership for the working hours in A&E, the creation of an integrated future. We have actively pursued opportunities to care system within Salford, Public Health and research develop new models to share support services and implementation programmes. We have focussed continue to do so. on developing new ways to use anonymised clinical information to answer research questions. We have worked with people in Salford to raise awareness of clinical research and to promote opportunities for involvement. Salford Royal’s #rst highly successful public research open day was held in May. A partnership has been created with Salford City College to work with the students to promote understanding of both clinical care and research. The innovative Salford Citizen Scientist Project received national recognition in the form of a nomination for a prestigious Health Service Journal award. Over 1,000 people in Salford are now involved in the project which aims inform the public about Health research.
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Theme 6: Deliver undergraduate teaching Implement Enabling Medical student exposure to critical care medicine Strategies has by tradition been minimal. At Salford Royal we recognised critical care as an under-utilised but invaluable undergraduate educational resource. Following a pilot led by Dr Jay Nesbitt, from October Deliver under & post graduate teaching 2013 all Year 3 medical students have been o"ered a Both departments report to the Trust’s Executive “hot week” working within the critical care team. Education and Research Committee which provides Dr Anu Trehan initiated dedicated Clinical Reasoning the board level responsibility and supervision required seminars for Year 3 students and has further developed by the General Medical Council, the University of these in 2013/14. The key learning objective is that Manchester and the Northwest Postgraduate Deanery. students appreciate the cognitive skills required for the diagnostic process and practice by working through Deliver postgraduateteaching clinical scenarios. Postgraduate Medicine has engaged fully with In 2013/14, the Salford UGME team implemented a enhancing safety and e!cacy for non-training new quality management system to evidence quality grade junior doctors this year with improvements in standards set by Manchester Medical School (MMS) supervision, training as well as pastoral support. In the and the GMC. As part of a pilot MMS QA process, the Foundation Programme the introduction of the ARCP Hospital Dean and UGME Manager have undertaken process has strengthened the already well-established QA visits to all our linked hospitals. and successful year-end sign-o" processes that existed. This sign-o" process will help to improve patient safety Signi#cant progress has been made in developing and quality of care in the long-term. service level agreements and service line reporting with directorates so that the education funding stream Postgraduate medicine has worked closely with is explicit and matched against protected time for Skills for Heath to improve the Induction process for teaching. This work is critical to maintaining and doctors in training so that a Core Skills Register allows enhancing our position as a centre of excellence for agreed Mandatory Training packages to be recognised medical student teaching. between Trusts and reduces repetition for the trainee. Postgraduate medicine has liaised with the Medical Director, HR and the Divisions to promote Trainee Engagement within the Trust, in light of the Keogh Report and continues to work closely with the Quality Improvement department on pertinent projects. We continue to collaborate with Undergraduate medicine, the Trust’s Revalidation team and the Deanery in order to develop a robust evidence data set for consultant educational appraisal according to the GMC requirements.
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Theme 6: Implement Enabling Strategies
Learning and Development The Learning and Development team and its associated divisional practice development teams together provide support and learning and development to all sta", to ensure they meet their professional development and mandatory training requirements. The purpose of this development is to ensure sta" are equipped to deliver safe, clean and personal care. The vocational team The Vocational Development Team have expanded and Student and mentor support recruited 2 members of sta", one delivering Healthcare The Practice Education Facilitator (PEF) team is and one delivering Maths, English & Information responsible for ensuring that students on placement Technology (IT) Functional Skills. We now have 111 within the Trust have the appropriate clinical skills and apprentices currently across the Trust. a valuable and productive learning experience through The #rst cohorts of apprentices from the ‘Pre- the development and support of their mentors. This employment programme’ started with the Trust in placement experience is monitored regularly for areas October and are progressing well. These learners are of good practice and where areas for concern are all based within the Neurosciences directorate. highlighted, the PEF team work with the individual We have our #rst administrative & clerical pre- placement educational leads create an action plan to employment programme due to end their placements maintain the quality and capacity of placements. The in May 2014, this will then be evaluated for future team also continues to deliver its successful in-house cohorts. multi-professional mentorship programme with Stirling University. This programme gives the trust the $exibility to train sta" to become mentors in areas of Trust library the Trust where they are needed and continues to be The Trust library’s aim is to enable the delivery of very successful. safe, clean and personal healthcare. It does this by providing access at the point of need, 24/7, to the high The PEF team continues to develop and promote quality evidence base required for decision making, Inter Professional Learning (IPL) across the Trust. IPL integrating best practice and also supports education contributes to maintaining our high quality care, by and Continuing Professional Development for the learning from, with and about all members of the whole workforce. The standards used to measure this healthcare team, which supports more timely and aim are known as the NHS Library Quality Assurance appropriate referrals to the appropriate healthcare Framework (LQAF) England. In August 2013 the library teams, improving our patients’ experience. The team service was assessed as 93% compliant with these works collaboratively with Greater Manchester Mental standards, a 2% increase on 2012 and 1.9% above the Health Trust and Tra"ord General Trust enabling a North West Acute Trust average of 91.3%. broader range of professions access to the IPL sessions.
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Theme 6: Senior leaders programme Implement Enabling 37 Consultant Medical sta" and 1 non-medical Strategies Consultant are currently participating in 2 cohorts of leadership development at the Trust. The cohorts conclude in March and May 2014 respectively. This development was commissioned as a result of very Mandatory training (Snowdrop) positive feedback from 2 previous cohorts in 2010 and We continue to support the Trust achieve required 2011. It is hoped to re commission this very popular levels of compliance with Mandatory Training. Targets programme for 2014/15 and to include senior non- have been consistently exceeded this year - currently clinical leaders as well. This programme also includes 99.1% compliance (approx. 80,000 courses completed). understanding personal impact, coaching and quality improvement. We brought in a system to enable sta" to access online learning on any device (smartphones, Tablets). This Bespoke development is in place for our online induction programme, we’re moving other content to the system shortly. The Divisions of Salford Health Care, Surgery, Neurosciences and Renal Medicine continue to run The system allows us to introduce ‘social learning’ to bespoke development for bands 5, 6 and 7 nurses enable sta" to share learning with each other - helping which includes quality improvement and coaching us learn from our mistakes and share best practice. feedback. We have evolved induction for new starters to o"er a red-carpet welcome. On day one sta" take part in Resuscitation and simulation interactive workshops to facilitate understanding of The team continue to support improved patient our values and the requirement to deliver world class safety within the Trust and wider community. They care and customer service. On subsequent days we have achieved this through the delivery of e"ective deliver core mandatory training to help us achieve our educational programmes and the introduction of high aim of being the safest place in the NHS. #delity simulation to the clinical environment. The team have gathered information and audited the Trusts response to the acutely unwell patient to ensure that Leadership development each patient receives the highest possible standard of The clinical leadership programme care. We deliver several national resuscitation courses Cohort 9 of this ‘experiential’ development programme including the Advanced Life Support, Advanced are nearing the end of their time together and Paediatric Life Support and European Trauma Courses. presents to the Board of Directors in March 2014. This These programmes have attracted candidates and is the #rst cohort of community and hospital sta" faculty from across the country and Europe. coming together as part of this learning community, In addition to the development of speci#c clinical skills numbering 20 in total. This patient centred the team highlight the importance and signi#cance programme includes understanding personal impact, of Human Factors and their contribution leading to coaching skills and Quality Improvement. adverse incidents within the Trust. Through the use Recruitment for cohort 10 of this very popular of simulation in the clinical environment skills such programme has begun, it is expected that the as leadership, team work, situational awareness, programme will commence in May 2014. communication and error recognition can be developed.
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Theme 6: Implement Enabling Strategies
Deliver the hospital redevelopment strategy Patients and sta" are now bene#tting from the three brand new theatres which came into operation on 9th December 2013. This £5m project provides an additional emergency theatre together with increased The ward upgrade programme will continue together theatre capacity on site allowing us to commence a with improvements in the environment to support the signi#cant programme of backlog maintenance in our care of Dementia patients. existing 18 theatres. Work has also commenced on the re-provision of 2 Deliver the IM&T strategy Angiography rooms to replace older rooms on site. The focus of the 2014/15 IM&T Strategy was the new These will be complete towards the end of 2014 and Electronic Patient Record to replace and extend the will be located in the old ICU department in Turnberg scope of the existing electronic record and future proof Building. The proximity to Critical Care beds and Level with additional functionality. This huge undertaking 3 theatres will improve $ows for patients. over a period of nine months, has successfully The programme to improve all hospital corridors delivered this new capability on time and on budget. has continued, this year the Level 1 corridor in Irving The Strategy has also driven commencement of new Building has been upgraded and now bene#ts from developments within the EPR system which include a complete redecoration, new lighting and artwork implementing new functionality to support: featuring local scenes. The Ladywell corridor will be Accident & Emergency. upgraded in 2014. Critical Care. Salford Royal’s Orthopaedic Outpatients department Bed Management. is undergoing a major refurbishment. Patients Further enhancements to Electronic Prescribing and will bene#t from a much more modern, spacious Medication Administration. environment once the programme of works is completed in July. Chemotherapy Prescribing. My Patient Record to support Outpatient Improvement. Consultation rooms in the Orthopaedic and Fracture Clinic department will be bigger and self-contained, meaning X-rays and 1:1 discussions will be carried out in the same room enabling patients to view the X-ray images with the doctor. Phase 3 and 4 will focus on the consultation rooms while the #nal stages will include work on a new reception area. The strategy to demolish the Clinical Sciences Building has been approved there will be a detailed programme of moves during 2014 both on and o" site.
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Theme 6: Implement Enabling Strategies
Deliver the corporate and social responsibility and public health strategy The Trust continues to implement the ‘Live Well, Work Well’ strategy agreed in 2011/12, with the following priority themes Patient and Sta" Health & Wellbeing objectives include: Provision of exercise classes on site for sta". Launch of discounted gym membership scheme for sta" with Salford Community Leisure. Participation in the North West NHS Games and development of a sta" Sports and Social Club. Supported programme of activities on the Health Bus, in local communities. Review of healthy eating options available for sta" and visitors.
The Social Responsibility element of the strategy The Sustainability and Environmental Impact part of includes: the strategy builds on the progress made in previous Supporting the development of the Sustainable years, including: Alliance - a volunteer programme across the Salford area. New cycle ‘hub’ opened in spring 2013, o"ering excellent changing and storage facilities for cyclists. Continued expansion and development of the Trust volunteer programme. Bid for additional storage facility with Transport for Greater Manchester. Provision of work placements and career opportunities, including Princes Trust placements. Project in procurement to encourage the use of Fair Trade, local and sustainable products within the Development of a partnership with St. Patrick’s Trust. RC High School, to deliver health and wellbeing messages, and raise aspirations. Implementation of the Green Travel Plan. The Trust has set values, behaviours and ways of working which are core to Salford Royal and for which each and every employee is responsible for upholding. These values are supported by a range of policies and processes that ensure compliance with relevant laws, regulations and Salford Royal standards.
Salford Royal NHS Foundation Trust - Annual Report and Accounts 2013/14 173 3 Looking Forward to 2014/15
During 2013/14 the Trust has been developing both its operational plan for 2014/15 and the Service Development Strategy (SDS) for 2014/15 to 2018/19. In producing these plans the Trust has engaged with stakeholders within and outside the Trust and commissioned McKinsey to support this work.
In developing these plans the Trust has considered: Theme 1: Changing demographics and health trends. Pursuing Quality The economic climate and Commissioner Plans. Improvement to become the Recon#guration of services to achieve clinically safest organisation in the NHS sustainable models. Delivery of reliable 24/7 services meeting the 2014/15 will be the seventh year of a sustained focus required clinical standards and outcomes. on Quality Improvement, with the Trust currently Workforce plans. #nalising its third three-year Quality Strategy. The aim Productivity and e!ciency. continues to be ‘the safest organisation in the NHS’. Service redesign and innovation. The principal priorities within the strategy are to reduce mortality and harmful events and to improve The Board of Directors has recognised that the NHS reliability of care and patient experience. is entering a period of signi#cant uncertainty and challenges over the next #ve years, including changes The new strategy addresses the recommendations within the commissioning landscape, impact of de#cit of the Francis and Berwick reports, with wide reduction on the wider public sector and a general sta" engagement through training sessions. Key election in 2015. It is more important than ever that developments include: the Trust has robust plans for the future. Development of an accreditation system for doctors Having delivered an unprecedented level of cash- with the ambition to combine with the current releasing savings over the last three years, the Trust NAAS (Nursing Assessment & Accreditation System) faces the prospect of needing to deliver 5% year- once fully functioning. on-year savings for at least the next #ve years (over A system to rigorously review compliance against £100m based on current turnover). This will need to be NICE guidance. delivered in an environment where expectations and demands on the NHS are likely to increase and, given An internal mock CQC assessment process. the Trust’s ambition to be the safest organisation in the Joint nursing and doctor learning and problem NHS, not at the expense of service quality or patient solving processes across the Trust. experience. Engagement with Safe and Reliable Health Care Given this challenging context, the Trust is addressing (previously known as Pascal Metrics) to roll out the in its plans every opportunity to develop new culture and teamwork survey and training across the transformational models of care, in partnership with Trust. other organisations, that both manage population Speci#c emphasis on Theatres including the culture demand and safely reduce the cost of service provision. collaborative and human factors training to facilitate improving the quality of the use of the WHO checklist. Medical engagement in quality improvement being piloted in the sepsis project.
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Theme 1: Pursuing Quality Improvement to become the The aim continues to be the safest organisation in the NHS safest Themes also emerging for inclusion in the new strategy organisation include: in the NHS Leadership and culture (Doctor involvement, duty of candour, communication and sta!ng). Focus on community services (Community nursing, Improve the reliability of care to be the collaboration with GPs, integrated care). safest organisation in the NHS Patient and carer experience (shared decision In 2014/15 there will be on-going measurement of making, individualised care, coaching & customer harms, and a focus on reducing avoidable harm. These care and communication). include: Healthcare acquired infections including surgical Capability and measurement (Analytics, real time site infection rates. data, Human Factors, Trainees Improving Care through Leadership and Education (TICKLE), Cardiac arrests. Consultant level data, demand and capacity Safety Thermometer measures: Pressure Ulcers, Falls, planning). CAUTI & Venous Thromboembolism. Development of learning systems (Listening to & Medication errors. supporting sta", integrated governance, coaching, Sepsis. prospective thinking). Reliable care will also be measured by achieving Collaborative projects supporting key themes. 95% reliability in the following care processes and packages, using the principals of reliability science to maintain high performance. Maintain the relative risk of mortality to be within the top 10% of acute Trusts in the NHS Community acquired pneumonia care bundle. Heart failure care bundle. Mortality is measured by both HSMR (Hospital Hip and knee care bundle. Standardised Mortality Rate) and SHIMI (Standardised Hospital Level Mortality Indicator). SHIMI has added a Myocardial infarction care bundle. focus on deaths within 30 days of leaving the hospital. Stroke care bundle. The mortality review process put in place in 2011/12 Intentional rounding. continues to identify themes and learning, which are Structured ward rounds. reviewed within Divisional Governance arrangements Infection bundles. and learning shared between Divisions where appropriate A tool has been developed within the new Electronic Patient Record to support mortality reviews, identifying deaths to the core team and prompting data collection to support the review process.
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Theme 1: Improving patient !ow and reducing Pursuing Quality readmissions Improvement to become the There will be a focus on improving patient $ow into, safest organisation in the NHS through and from the Trust, with discharging planning commencing earlier, improved patient information and follow up post discharge. Implementation of Consistently high standards of care across 7 the patient $ow system and a focus within quality days improvement collaboratives will support this work. Plans to implement 7 day working have progressed Quality improvement work is also focused on reducing over the last 12 months with every service identifying 30 days emergency readmissions. their requirements to meet these standards. Initial plans to implement 7 day standards have Improve patient experience to maintain been focused on delivery of the ‘Salford’ and Trauma Standards, initially focused on the emergency village indicators in the top 20% nationally for the assessment, diagnosis and treatment of The experience of patients continues to be of utmost patients admitted non-electively. This includes early importance and it is the Trust’s ambition that we make and on-going assessment by senior medical sta". that experience the best that it can possibly be. The Further roll out of this project will extend beyond the priorities are to: emergency village and is being scoped internally, Respect patients’ values, preferences and expressed with particular focus on working towards the Greater needs. Manchester standards for the treatment of emergency Coordinate and integrate care across boundaries of surgical cases and improving patient $ow. Beyond the system. this, discussions have commenced to consider models of care between Trusts as part of the development of Provide the information, communication, and service models within Healthier Together workstreams. education that people need and want. Sta!ng to provide 24/7 cover in hospitals receiving Guarantee physical comfort, emotional support, and acute cases is within this review. the involvement of family and friends.
The Trust already has the best access to Radiology Key themes with the Trust’s Patient, Family and Carer outside weekday working hours in Greater Manchester, Experience project include: but will be making a wider range of services available Explanation of medication side e"ects to patients. out of hours in 2014/15, including improved access to Angiography, Doppler and CT. Ensuring patients know who to talk to about their worries and fears. Ensuring patients are involved as much as they want to be in decisions about their care. Ensuring that when patients have important questions. Services will be reviewed and redesigned to enable more patients to be more involved and take responsibility for their care.
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Theme 2: Theme 3: Safely Reducing Costs by Supporting high performance £19m and improvement
Cost improvement programmes have been agreed Improve sta# contribution to corporate with all clinical divisions and corporate departments objectives and values supported by a focus on improving pro#tability and margins. The contribution framework in place for the last three years has been reviewed and simpli#ed for 2014/15. It Teams are focused on improving the e!cient delivery will align individual and team objectives to the Trust’s of contracted activity including planned service plan and monitor progress through the appraisal developments, making optimum use of beds, theatre process. Adherence to Trust values is also aligned to and outpatient capacity. this and recruitment processes. Contracts, service level agreements and leases are Leadership development is focussed on driving high kept under constant review to ensure they re$ect performance and collaboration. services provided and received within and outside the organisation. The hosting model is being developed at the Trust. Improve employee well being Workforce plans are being continually reviewed A strategy to improve the health and well-being of sta" to ensure they meet service demands, compare will be agreed and implemented in 2014/15. favourably when benchmarked and minimise the use Patient and sta" health and wellbeing has been a focus of temporary sta" at premium cost. over the last few years with the implementation of the Procurement is being scrutinised to ensure costs are ‘Live Well, Work Well’ strategy. The Trust will continue minimised. to run exercise classes (SRFiT) and provide access to Salford Community Leisure facilities. More collaborative working will be undertaken between Divisions, within the Health Economy and There will also be an increased focus on reducing between Trusts to identify savings. sickness absence rates and reducing the instances of bullying and harassment. Details of the #nancial plans for 2014/15 are provided in the Trust’s Annual Plan.
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Theme 3: Supporting high performance and improvement
Develop workforce plans A #ve year workforce strategy will be developed to ensure the Trust has su!cient numbers and the right skill mix of sta" within the a"ordability envelope. This will incorporate a strategy for learning and development. Workforce plans are being developed within each service team, to address issues of sta" shortage. Plans also identify the required skills necessary to ensure sta" are developed to meet the needs of the service and include talent identi#cation. The plan will seek to reduce the turnover rate of sta". An ideal set of terms of conditions will be developed and a small scale trial considered.
Improve culture and engagement The Trust has developed a communication strategy Implement the Membership and Public to ensure sta" are engaged and informed. There is Engagement Strategy particular emphasis on ensuring communication is e"ective and supporting learning within the Trust and In 2014/15, the Trust and Council of Governors will with partner organisations. continue to implement the Membership and Public Engagement Strategy and the related Membership and There will be a speci#c focus on targeted engagement Public Engagement Plan. with junior doctors and trainees to: Key priorities will be to: Help identify areas of both good and poor practice within the Trust and reduce risk. Ensure the Trust’s membership is representative of Engage doctors to become integral and valued the population served. members of Trust, including QI projects. Support Governors to ful#l their responsibility to Use their knowledge to aid further developments to represent members’ and public interest particularly EPR and Trust polices. in relation to the strategic direction of the Trust. Increase involvement in learning from adverse Ensure the Membership and Public Engagement incidents. Strategy is aligned to the Patient, Family and Carer Experience Strategy to ensure complementary There will be on-going engagement in quality and strategic patient and public engagement improvement including the Theatre Culture throughout the Trust. Collaborative. The Trust will apply for the Times Top 100 places to work.
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Theme 4: The Trust and partners have developed a joint Service Improving care & services and Financial Plan, which covers the next four years and includes the requirements of the Better Care Fund. through Integration & Collaboration Integration and collaboration within the north west sector Salford: Deliver the Integrated Care Programme (ICP) for Older People The Salford Royal and Wrightington Wigan and Leigh Trusts have worked closely to develop joint Sterile and A new integrated care model for older people has Pathology services and these are now running well been developed for Salford, following the testing under a joint services board. phase in 2013/14. The new model will be rolled out citywide using a phased approach from April 2014 to The Trust is working closely with Wrightington, Wigan July 2015, and will initially be embedded in the two & Leigh and Bolton Foundation Trusts to develop pilot neighbourhoods of Swinton and Eccles. Key sector solutions to the ‘Healthier Together’ strategy, components include the development of standards focusing on the model for emergency surgery. This for di"erent areas of care provision and the use of a will provide #nancial and operational bene#ts but it is shared care record to summarise and make accessible likely to be within years 3-5 of the plan period before all important aspects of care in one place. any impact is materially felt. The model has three inter-related parts: Collaborate within Greater Manchester and Promotion and increased use of Local Community Assets (e.g. carer support, self-management, beyond community groups) to support increased The Trust will continue to strengthen its position in independence and resilience for older people. respect of specialist services including Neurosciences, Establishment of Multi-Disciplinary Groups (i.e. Intestinal Failure, Renal Medicine, Cancer surgery, structured, multi-disciplinary population based Metabolic medicine and Dermatology. care) to support older people who are most at risk As a Major Trauma Centre, the Trust will continue to as well as a providing a broader focus on screening, raise standards in Regional Trauma care by meeting the primary prevention and signposting to community requirements of the service speci#cation. support, and Further developments planned include, the Development of an Integrated Contact Centre (i.e. a establishment of an Orthopaedic Spoke for Pelvic hub to support navigation, monitoring and support) reconstruction with Wrightington, Wigan and Leigh, that brings together aspects of telephony and tele- a link for Plastics support with South Manchester care support for older people. and capacity for Trauma follow up in the Central Manchester maxillofacial clinic. An Alliance Agreement has been formed by the statutory partners, taking e"ect in shadow form in 2014/15 which de#nes the key services in Salford providing care and support to the over 65+ population. The Agreement is to enable the pooling of resources to allow risk and bene#t sharing across services and partners whilst facilitating true integration through redesign and new ways of working to bene#t older people.
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Theme 4: As part of the re-con#guration of services across Tra"ord, Improving care & services the business case jointly developed by Tra"ord CCG and Central Manchester Foundation Trust has changed to the through Integration & provision of emergency care on the Tra"ord hospital site. Collaboration This has resulted in an increase in both attendances through A&E and admissions into the hospital. The Trust Within Neurosciences, the collaborative model will be has expanded A&E provision to ensure the delivery of further explored including Neurology in Stockport and safe care for Tra"ord residents as well as ensuring that Neurosurgery in Pennine. the inpatient admissions are managed appropriately through Salford Royal’s medical beds. This plan Plans for further development of the Comprehensive includes both income and expenditure relating to this Stroke Centre have been agreed, with the Hyper increase in service requirement with Tra"ord CCG. Acute stroke model being implemented in year. This will require the Trust to develop additional capacity The Trust will also pilot a community based Pain to receive more stroke admissions from Greater Management service in Manchester in 2014. Manchester and East Cheshire CCGs. 2014/15 #nancial Spinal services will continue to develop to address plans contain both the income and expenditure plans demand from within and outside Greater Manchester that have been agreed with Greater Manchester CCGs. and, in particular, to meet the needs of an adolescent Progress has been made over the last two years to population. collaboratively commission Neurosciences across The Oldham Dialysis Unit will open in Spring 2014 and Greater Manchester, with Salford Royal now managing outpatient clinics will be developed in satellite units. the provision of most outpatient Neurology services. The Greater Manchester Healthier Together team Completion of the model will be progressed for the has developed a programme structure which is remaining outpatient service in Stockport and discussions overseeing the activity, #nancial and estate modelling will be pursued in respect of neurosurgery. Community associated with the planned recon#guration ahead and GP clinics will be developed in neurology. of the consultation period. Salford Royal Consultant Salford Royal will lead, develop and improve access to sta" have been engaged in this process and taking neuro-rehabilitation for Greater Manchester, working leadership roles in developing the model and local closely with commissioners and other providers. The implementation of it. Salford Royal is expecting to Trust is providing additional services on site in the be identi#ed as a specialist centre for surgery and short term and planning with Central Manchester planning to increase capacity to accommodate this, NHS Foundation Trust to transfer beds to the Tra"ord working with partners to agree sustainable sta!ng General site in year, where they will be co-located models to deliver the associated clinical standards. This with other Neuro-rehabilitation, and will be managed is expected to result in additional activity, contribution by Salford Royal. Provision of Neuro-rehabilitation to margin and overall unit cost reductions. Services across Greater Manchester requires additional The Trust will respond to tenders to secure the position investment from Commissioners to ensure that the of Salford Royal as a centre for cancer surgery, including correct capacity exists across the conurbation. It has Urology and Upper Gastrointestinal surgery in-year. been agreed that 10 beds will be commissioned from It will work in partnership with screening centres to Salford Royal that will allow the already over stretched agree a delivery model for Breast surgery and support capacity to deal with demand. The #nancial plan the North West sector bowel screening programme, includes the income and expenditure relating to the by providing additional scope sessions in 2015. Mohs commissioning of this additional bed capacity. (dermatology) surgery and Stereotactic Radio Surgery (neurosurgery) capacity will also be expanded.
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Theme 4: Service developments, redesign & innovation Improving care & services The Outpatient Improvement Plan has implemented a through Integration & number of improvements over the last 2 years and will Collaboration build on this in 2014/15 with a focus on: Reducing DNAs with appointment reminders. Implementation of the Radiology Strategy will continue, Identifying meaningful measures which better including securing additional MR capacity, equipment demonstrate appropriate clinical follow-up in line replacement, exploring home reporting options with national pathways. and a joint venture model for plain #lm reporting. Collaboration with other Trusts will continue to improve Roll out managed bookings. access to Vascular and Interventional radiology. Improve customer service using the patient Further progress will be pursued in delivery of the engagement collaborative. Dermatology Strategy, including expansion of the The third and #nal year of the strategy will see: Moh’s service, development of Paediatric services and My Patient Record go live in rheumatology and services in collaboration with Stockport Foundation anticoagulant areas. My Patient Record is similar to Trust from April 2014. internet banking, where patients are provided with The Trust will work in partnership with Christie Trust a username and password and they can access their to agree a new model for the provision of Gynae- clinic letters, results and information online. Patients oncology services, with inpatient surgery moving from will also be able to complete questionnaires before Salford Royal. Discussions will continue to develop their appointment and contact their clinical team. a model for in-reach provision of Pain Management Further work on reducing waiting times in clinics. services from Salford Royal into Christie. Stereotactic surgery developments continue, using the Christie@ Refurbishment of the main outpatient area. Salford Royal linear accelerators, with particular focus Undertake rapid improvement events to pursue on extra cranial SRS. The Trust is now hosting the service redesign. Christie Trust mobile PET scanner 3 days a week and will continue to work with Christie to develop plans to The Trust will develop capacity planning meet the increasing demand for the service. methodologies in year for hospital, community and support services. The Trust will work in partnership with Central Manchester Foundation Trust to develop Neuro- The Trust continues to host QUEST and will work rehabilitation and Elective Orthopaedic services at with other members to improve quality and Tra"ord General hospital. A new model of service for innovation, including provision of a leadership Gynae-oncology is being developed in conjunction network, development of measurement, running an with the Christie Trust. The Trusts will also work improvement programme and building capacity. together to plan the provision of clinical and The Trust will pursue opportunities to innovate models laboratory immunology, paediatric dermatology and of service delivery and standardise services at scale. interventional/vascular radiology. The two Trusts will The Trust will also provide management support to work together to ensure ENT services address the need other Trusts including Buckinghamshire and East for 7-day working. Lancashire.
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A series of other service developments, redesign and Theme 6: innovations will be further explored in year. These Implement Enabling include: Strategies Metabolic medicine satellite services. Expansion to chronic fatigue, sleep, weight management and psychology services. The enabling strategies in this section are reviewed Development of functional neuropsychology & and updated as part of the annual planning process neurophysiology. and where necessary to re$ect longer term strategic intentions. Cell salvage. Homecare services. Deliver the research & development strategy Self care models. The focus of the Research & Development (R&D) The Trust will also incorporate the development of an Strategy is for Salford Royal to lead on Population innovation pipeline as part of a longer term business Health Improvement, through participation in the planning process. Greater Manchester Academic Health Science Network (GM AHSN) and Manchester Academic Health Science Centre (MAHSC).
Deliver under & post graduate teaching Theme 5: Demonstrate compliance with The focus of the Trust’s education strategy is to: Mandatory Standards Improve teaching capacity. Respond to the National Education tari" and associated Education Standards. There are an increasing number of: Respond to the University of Manchester curriculum Monitor standards. “evolution” in line with GMC requirements. Care Quality Commission standards. Consolidate Salford as a “test bed” for new National, Specialist Commissioner and Local developments in Undergraduate Medical Education. Commissioner CQUIN standards. Develop new Quality Assurance processes to These are assigned within the organisation in line support the new Manchester Medical School system with the assurance framework to be managed by of Sector Review. service lines, directorates and divisions. Assurance on Support the organisation of additional workplace compliance will be received through the divisional and assessments, specialty blocks and adoption of new corporate assurance committees. systems. Address issues arising from the shortage of junior doctors.
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Theme 6: Deliver the IM&T strategy Implement Enabling The IM&T priorities for 2014/15 include: Strategies Continued enhancement and development of integrated records within Salford, including shared health and social care records, and developing Deliver the hospital redevelopment strategy links with partner organisations across Greater Manchester to support coordinated care. The Trust has developed its capital programme to Realising the bene#ts of the new Electronic Patient support our two year plan for 2014/15 and 2015/16. Record (EPR) system. It is part-way through the creation of it next #ve- year SDS, covering the period 2014/15 to 2018/19. Improved support to clinical pathways within the As part of emerging priorities, the Trust is exploring Trust by harnessing the increase capabilities of opportunities to bring forward key projects to support the New Electronic Patient Record System (EPR) to this, some of which may require capital investment. enhance clinical outcomes for patients and support In particular, in the context of Greater Manchester’s evidence based practise. Healthier Together Programme, the Trust is considering Implementation of new EPR functionality in A&E how it best creates surgical capacity to support the and Critical care to support e!cient and e"ective consolidation of inpatients services across the wider practise to enhance clinical outcomes for patients. conurbation. Deployment of new mobile technologies to The focus of the programme for 2014/15 and 2015/16 community sta" including District nurses to support will be to demolish the Clinical Sciences Building, in delivery of care in patients’ homes. preparation for a new building, with delivery of the Implementation of a replacement PACS and RIS enabling programme. systems to support the reporting of radiology A Community Estate Strategy will be developed to images (X-Rays, CT and MRI scans) in partnership rationalise the locations of services and make provision with other Trusts across Greater Manchester. for more community based services. Continued support for the Outpatient Improvement The theatre backlog and ward refurbishment plan, through identifying and harnessing new programmes is on-going. technologies and capability within the new EPR.
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Theme 6: The sustainability and environmental impact part of Implement Enabling the strategy builds on the work done so far and has set further targets to: Strategies Reduce and recycle waste. Reduce energy use. Deliver the corporate & social responsibility Reduce carbon emissions through increased and public health strategy awareness and a sustainability event. The Trust continues to implement the ‘Live Well, Work Implement the Green travel plan including Well’ strategy agreed in 2011/12, with the following improving facilities for cycles. priority themes. Increase the use of local and fair-trade goods. The Patient & Sta" Health & Well Being objectives The Trust has recently reviewed its carbon reduction include: delivery plan and in conjunction with the Carbon Alcohol screening and referral in pre-operative & Energy Fund will implement a series of further assessment. improvements to the energy infrastructure at the Brief intervention and referral to smoking cessation Salford Royal Hospital to improve e!ciency and reduce services. carbon emissions from the site. Reduced Accidental injuries in children. The plans include the replacement of the main hospital Supporting Infection Control measures in hospital boiler house with more e!cient modern plant. A new and community. carbon reduction delivery plan will be produced when the full scheme has been rati#ed. The social responsibility element of the strategy The climate change risks outlined in the UK Climate includes: Impacts Programme (UKCIP) 2009 weather projects Further Implementation of the Volunteering have been considered and further adaptation planning strategy and sustainable alliance a city wide will be incorporated when new facilities are procured volunteer programme. Projects include hospital under the long term capital programme for the Trust. guides, support to older patients in intermediate The Hospital site is fortunate in that it is not located care centres and Renal Youth mentors promoting in an area subject to $ooding from local rivers or digital technology to older people. watercourses. Engagement with REACHE. The problems relating to the increase in global Increased community engagement. temperatures and heat waves have been addressed in the most recent buildings by the inclusion of cooling Work placements and career opportunities. for patient areas to deal with excessive external Roles are being developed with the Princes Trust temperatures. programme to develop roles to support patients for the 2014 intake. The issue of extreme cold will be partially addressed through the improvements to the site energy Engagement with the membership in respect of infrastructure mentioned above and future service developments and redesign. redevelopment work on older buildings.
Salford Royal NHS Foundation Trust - Annual Report and Accounts 2013/14 184 3 Principal Risks and Uncertainties
As part of good governance the Trust continues to identify potential risks to achieving its strategic developments. A robust Assurance Framework is maintained which enables the identi#cation, analysis and management of risk. The issues below describe the risks that the Board of Directors considers to be of particular signi#cance. There may be other risks or uncertainties not yet identi#ed by the Trust that could impact on future performance.
Orthopaedic treatment pathways The Trust is undertaking a full review of all current open treatment pathways for orthopaedic patients to ensure timely, high quality care for patients.
Trust-wide clinical sta"ng The Trust is implementing current sta!ng plans to minimise the impact of the national shortage of training grade medical sta" and quali#ed nursing sta". A working group has been established with speci#c project management responsibilities for ensuring e"ectiveness of clinical sta!ng plans and overseeing trust-wide implementation.
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186 4
The Directors’ report is prepared in accordance with relevant sections of the Companies Act 2006, the Large and Medium-sized Companies and Groups Regulations, and additional disclosures required by the FReM and Monitor.
The report includes the following: Information about the composition of the Board of Directors during 2013/14. Information about quality governance and quality of care. The Trust’s work to ensure compliance with its registration with the Care Quality Commission, incorporating the outcome of inspections during 2013/14 and the Trust’s response to any recommendations made. Reference to the improvements being made to patient /carer information as part of the Out-patient Improvement Project. National In-patient Survey. National Sta" Survey. Information on Complaints Handling. Performance against key health care targets. The Annual Governance Statement. Financial Performance (please see pages 228 to 233).
Salford Royal NHS Foundation Trust - Annual Report and Accounts 2013/14 187 4 Composition of the Board of Directors
Salford Royal is headed by a Board of Directors with responsibility for the exercise of the powers and the performance of the NHS Foundation Trust.
Chairman Mr James J Potter
Chief Executive Sir David N Dalton
Executive Directors Mr Tony Whit#eld (until 7.1.2014) Executive Director of Finance / Deputy Chief Executive Mr Stephen Kennedy (from 8.1.2014 to 30.4.2014) Acting Executive Director of Finance Mr Ian Moston (to commence on 1.5.2014) Executive Director of Finance Mr Chris Brookes (commenced secondment 1.9.2013) Executive Medical Director Dr Peter Turkington (from 1.9.2013) Interim Executive Medical Director Mrs Elaine Inglesby-Burke Executive Nurse Director and Deputy Chief Executive (from 8.1.2014) Mr Simon Neville (until 28.4.2014) Executive Director of Strategy & Development Mr Jack Sharp (to commence on 1.5.2014) Executive Director of Service Strategy & Development Mr Paul Renshaw (commenced 8.4.2013) Executive Director of Organisational Development & Corporate A!airs
Non- Executive Directors Mr John Willis CBE Vice-Chairman / Non-Executive Director / Chairman of the Audit Committee Mr Howard Forster Non-Executive Director Mrs Diane Brown Non-Executive Director / Senior Independent Director Mrs Anne Williams CBE Non-Executive Director Mrs Rowena Burns (commenced 1.7.2013) Non-Executive Director Dr Joanna Bibby (commenced 1.7.2013) Non-Executive Director
Salford Royal NHS Foundation Trust - Annual Report and Accounts 2013/14 188 4 Quality and Performance against Mandatory Standards
Care Quality Commission: Essential standards of quality and safety The Trust has a rigorous assessment process against all In June 2013, the CQC inspected Heartley Green applicable outcomes of the Care Quality Commission Intermediate Care Facility. The Unit was assessed (CQC)’s Essential Standards. This process tests against the following #ve standards: compliance across all Trust services. Care and welfare of people who use services This is complemented by a corporate process whereby Cleanliness and infection control. a Corporate Team performs assessments of outcomes Requirements relating to workers. in randomly selected service areas and 4 that has been Assessing and monitoring the quality of service selected by the Divisions. provision. Comparison against the service’s own self-assessment Records. is undertaken, recommendations made where The Unit was assessed as compliant with all #ve necessary and action plans produced and monitored outcomes. The full report can be accessed at: where required. The Trust’s Audit Committee reviews http://www.cqc.org.uk/directory/rm301 the assessment process and reports. The Trust is registered with the Care Quality Commission The Maples residential care facility was also inspected without conditions. by the CQC using their existing methodology. In October 2013, the Trust underwent an inspection On 4 December 2013 the CQC visited The Maples as a pilot of CQC’s new inspection process. As a pilot carrying out an inspection under the existing site the Trust did not receive a rating as a result of methodology. this inspection but on publication of the report the 5 standards were assessed which were: CQC stated that Inspectors concluded that the Trust’s Consent to Examination or Treatment. services were safe, e"ective, responsive, caring and well led. The values and behaviour of sta" showed Care and Welfare of People who Use Services Meeting that the Trust has an excellent culture of learning Nutritional Needs. and openness with a commitment to continuous Sta!ng. improvement. Assessing and Monitoring the Quality of Services.
For further information see: The CQC found full compliance with all #ve outcomes. http://www.cqc.org.uk/media/chief-inspector- The full report can be accessed at: hospitals-publishes-his-!ndings-salford-royal- http://www.cqc.org.uk/directory/rm3x1 nhs-foundation-trust
Salford Royal NHS Foundation Trust Salford Royal Hospital Quality report
Stott Lane, Salford Manchester M6 8HD Date of inspection visit: Telephone: 0161 206 4100 23-24 and 29 October 2013 www.srft.nhs.uk Date of publication: December 2013
Salford Royal NHS Foundation Trust - Annual Report and Accounts 2013/14 189 4
From the 3 March - 7 March 2014, the Salford Royal Quality governance NHS Foundation Trust underwent a Review of Health During 2013/14, the Trust’s Executive Quality and Services for Children Looked After and Safeguarding. Safety Governance Committee reviewed the Trust’s quality governance arrangements using the Quality Governance Framework developed by the Foundation The Review Team on initial verbal feedback: Trust Regulator, Monitor. This has been reported via Please could you thank all your staff involved in this the assurance reporting arrangements to the Trust inspection process on our behalf, as commented Audit Committee and Board of Directors. Also, as by the Inspectors at the feedback meeting on part of the Trust’s Safely Reducing Costs Programme, Friday 7 March, there are some very inspiring a quality and safety assessment process is a key and committed health professionals working in component. Salford, who are passionate about ensuring that The assessment evaluates the impact of a Safely vulnerable children and young people within the local Reducing Costs initiative at Divisional or Departmental communities are kept safe level, against a number of key quality and safety indicators. The Trust’s Waste Board holds responsibility The review follows the child’s journey re$ecting the for ensuring schemes do not impact adversely on the experiences of children and young people or parents/ quality and safety of services. Further detail about the carers to whom they spoke to, or whose experiences we Trust quality governance arrangements are included tracked or checked through documentation. In total within the Annual Governance Statement on page 196. they into account the experiences of 64 children and young people. The review highlighted areas of good practice across all interfaces within Salford Royal NHS Improving patient and carer information Foundation Trust whereby, children were kept safe. Within the Strategic Report we described how we Salford Royal NHS Foundation Trust was one of the four have worked with Governors and members to develop providers of children’s services including the Salford an Outpatient Information Lea$et. We have worked Clinical Commissioning Group (CCG). across the Trust to standardise patient letters and ensure that we give patients consistent way-#nding There is no rating following the review, however, information. Patients now get a full colour copy of the a number of recommendations for improvement hospital map on the reverse of appointment letters, an are made for each organisation. Salford Royal NHS idea suggested by our members. Foundation Trust have seven recommendations of which an action plan will be provided to the CQC to demonstrate improvement.
Salford Royal NHS Foundation Trust - Annual Report and Accounts 2013/14 190 4 PALS and Complaints 2013/14
Salford Royal NHS Foundation Trust - Annual Report and Accounts 2013/14 191 4
Salford Royal NHS Foundation Trust - Annual Report and Accounts 2013/14 192 4
National NHS Inpatient Survey 2013 National NHS Sta# Survey 2013 The results of the National Inpatient Survey were A summary of performance is as follows: released in February 2014. This survey saw Salford 2012/13 2013/14 Royal benchmarked against 76 Organisations that National National Trust participated in the Picker Inpatient Survey. 329 Response Rate TrustAverage Trust Average Improvement / (Medical) (Medical) Deterioration patients returned the completed questionnaire that 60%50% 58% 49% -2% asked 61 questions about all aspects of care ranging from admission, operations to discharge. 2012/13 2013/14 Trust Top Ranking Scores TrustNational Trust National Improvement / Compared to the survey completed in 2012, Salford Average Average Deterioration Royal was signi#cantly better on 18 questions and KF9 signi#cantly worse on 0 questions. Compared with Support from 3.71 3.61 3.89 3.64 +0.18% other Trusts Salford Royal NHS Foundation Trust were immediate managers signi#cantly better than average on 45 questions and KF24 signi#cantly worse on 0 questions. Sta" recommendation of the Trust as a place 4.03 3.57 4.25 3.68 +0.22% Overall results placed Salford Royal as the best to work or receive performing acute organisation, with 6 out of 10 treatment sections improved and ranked better when compared KF4 E"ective team working 3.92 3.72 3.94 3.74 +0.02% to other Trusts. KF32 Action plans are being formulated to further improve Sta" job satisfaction 3.76 3.58 3.81 3.60 +0.05% areas including: 2012/13 2013/14 Waiting Lists. Trust Bottom Ranking TrustNational Trust National Improvement / Waiting to get a bed on a ward. Scores Average Average Deterioration Doctors. KF11 Percentage of sta" Discharge. su"ering work-related 0.34 0.37 0.37 0.37 -3% stress in last 12 months KF17 Percentage of sta" experiencing physical 0.02 0.03 0.02 0.02 0% violence from sta" in last 12 months KF5 Percentage of sta" 68 70 70 70 -2% working extra hours KF19 Percentage of sta" experiencing 20 24 22 24 -2% harassment, bullying or abuse from sta" in last 12 months
Of the scores above only those changes to KF 9 and KF 24 are thought to be statistically signi#cant by the CQC and the Trust is ranked in the top 20% of Trusts in both these factors.
Salford Royal NHS Foundation Trust - Annual Report and Accounts 2013/14 193 4
Performance against national targets
National Targets and Target Minimum Standards Target (2013/14) 2013/14 2012/13 2011/12* 2010/11* Number of clostridium di!cile cases Infection Control 35 18 47 58 101 Number of MRSA blood stream infection cases 0 0 3 5 8
% of cancer patients waiting a maximum of 31 days 96% 98.2% 98.9%* 98.4% 98% from diagnosis to !rst de!nitive treatment % of cancer patients waiting a maximum of 31 days for 98% 100% 100%* 100% 100% subsequent treatment (anti-cancer drugs) % of cancer patients waiting a maximum of 31 days for 94% 98.3% 99.4%* 97.8% 99.2% subsequent treatment (surgery) % of cancer patients waiting a maximum of 31 days for 94% 100% 100%* 100% N/A Access to subsequent treatment (radiotherapy) Cancer Services % of cancer patients waiting a maximum of 2 months 85% 86.8% 88.7%* 89.6% 89.6% from urgent GP referral to treatment % of cancer patients waiting a maximum of 2 months 90% 96.4% 85.2%* 92.6% 85% from the consultant screening service referral to (NB low numbers (NB low numbers mean this is means this treatment below the is below the deminimis) deminimus) % of cancer patients waiting a maximum of 2 weeks 93% 97.9% 98.4%* 98.6% 99.3% from urgent GP referral to date !rst seen % of symptomatic breast patients (cancer not initially suspected) waiting a maximum of 2 weeks from urgent 93% 95.6% 97.5%* 95.5% 96.2% GP referral to date !rst seen 18 weeks Referral to Treatment - admitted patients 90% 93.0% 94.5% 90.34%** 91.53%* 18 weeks Referral to Treatment - non-admitted patients 95% 96.2% 96.79% 95.48%** 95.95%** Access to Treatment 18 weeks Referral to Treatment - patients on an 92% 95.1% 96.4% N/A N/A incomplete pathway
Access to A&E % of patients waiting a maximum of 4 hours in A&E 95% 95.9% 95.46% 98.86% 97.39% from arrival to admission, transfer or discharge Access to patients The Trust provides self-certi!cation that it meets with a learning the requirements to provide access to healthcare for N/A Yes Yes Yes Yes disability patients with a learning disability % of in-patients whose operations were cancelled by Cancelled the hospital for non-clinical reasons on day of or after 0% 0.56% 0.52% 0.53% 0.63% operations admission to hospital
Cancelled operations % of those patients whose operations were cancelled by the hospital for non-clinical reasons on day of or not treated within 0% 0.78% 0.89% 3.54% 3.90% 28 days after admission to hospital, and were not treated within 28 days
* Some of these !gures have been updated from our performance published in previous Quality Accounts. This is because we had provided data up to the end of February in the respective years and this has now been replaced with data up to the end of the !nancial year. ** These !gures have been amended as the access to treatment target changed in 2012/13 from admitted and non-admitted 95th percentile (displayed in weeks) to a percentage achieved.
Salford Royal NHS Foundation Trust - Annual Report and Accounts 2013/14 194 4
Monitor standards Monitor is the sector regulator for health services in From the third quarter of 2013/14, Monitor published England with the job of protecting and promoting the two ratings, as set out in Monitor’s Risk Assessment interests of patients by ensuring that the whole sector Framework (that replaced the Compliance Framework): works for their bene#t. the ratings are Continuity of Services and Governance: As part of its responsibilities, Monitor makes sure Continuity of Services rating (rated 1-4, where 1 foundation hospitals, ambulance trusts and mental represents the highest risk and 4 the lowest). health and community care organisations are well led Governance rating (trusts are rated green if no and are run e!ciently, so they can continue delivering issues are identi#ed and red where enforcement good quality services for patients in the future. action is being taken). Monitor measures and assesses the actual performance of each NHS Foundation Trust, against 2013/14 each foundation trust’s annual plan (as approved by Q1 Q2 Q3 Q4 Monitor). Most Foundation Trusts are assessed by Financial risk Rating: Monitor on a quarterly basis. Planned 3 3 3 3 Actual 3 3 4 3 Up until the third quarter of 2013/14, Monitor Governance risk rating GREEN GREEN N/A N/A published three ratings for each Foundation Trust, as set out in Monitor’s Compliance Framework: the ratings Mandatory services GREEN GREEN N/A N/A were Financial; Governance and Mandatory Services. Continuity of Service N/A N/A GREEN GREEN Salford Royal’s compliance for 2012/13 was published Risk Rating as follows:
2012/13 Q1 Q2 Q3 Q4 Financial risk rating 3 4 4 4
Governance risk rating AMBER AMBER GREEN GREEN / GREEN / GREEN Mandatory services GREEN GREEN GREEN GREEN
Salford Royal NHS Foundation Trust - Annual Report and Accounts 2013/14 195 4 Annual Governance Statement
Scope of responsibility Capacity to handle risk As Accounting O!cer, I have responsibility for I am responsible for risk management across all maintaining a sound system of internal control that organisational, #nancial and clinical activities. I am supports the achievement of the NHS foundation the Chairman of the Executive Assurance and Risk Trust’s policies, aims and objectives, whilst Committee that reviews and sets the Risk Management safeguarding the public funds and departmental assets Strategy for the Trust. The Risk Management Strategy for which I am personally responsible, in accordance provides a framework for managing risks across the with the responsibilities assigned to me. I am also organisation which is consistent with best practice and responsible for ensuring that the NHS Foundation Trust Department of Health guidance. is administered prudently and economically and that The Strategy provides a clear, systematic approach to resources are applied e!ciently and e"ectively. I also the management of risks to ensure that risk assessment acknowledge my responsibilities as set out in the NHS is an integral part of clinical, managerial and #nancial Foundation Trust Accounting O!cer Memorandum. processes across the organisation. The Strategy sets out the role of the Board and its Standing Committees The purpose of the system of internal control together with the individual responsibilities of the Chief Executive, Executive Directors and all sta" in The system of internal control is designed to manage managing risk. risk to a reasonable level rather than to eliminate all risk of failure to achieve policies, aims and objectives; In particular, the Executive Assurance and Risk it can therefore only provide reasonable and not Committee, through its Executive Governance absolute assurance of e"ectiveness. The system Committees of Patient and Sta" Experience, Clinical of internal control is based on an ongoing process E"ectiveness, Finance and Information, Quality designed to identify and prioritise the risks to the and Safety, and Education and Research, provides achievement of the policies, aims and objectives the mechanism for managing and monitoring of Salford Royal NHS Foundation Trust, to evaluate risk throughout the Trust and reporting through the likelihood of those risks being realised and the to the Board. Established Divisional governance impact should they be realised, and to manage them arrangements maintain e"ective risk management e!ciently, e"ectively and economically. The system of arrangements across all Directorates and maintain internal control has been in place in Salford Royal NHS Divisional Risk Registers. The Audit Committee, Foundation Trust for the year ended 31 March 2014 comprising all Non-Executive Directors other than the and up to the date of approval of the annual report Chairman, oversees the systems of internal control and and accounts overall assurance process associated with managing risk. The Board of Directors routinely receives the summary minutes of all Standing Committees. The Board receives assurances from the Executive Assurance and Risk Committee relating to the management of all serious untoward incidents, including never events, as well as receiving an integrated report on complaints, claims and incidents, which it receives twice a year. The Trust has mechanisms to act upon alerts and recommendations made by all relevant central bodies.
Salford Royal NHS Foundation Trust - Annual Report and Accounts 2013/14 196 4
Risk management training is provided through the Incident Reporting is openly encouraged through sta" induction programme for new sta". In addition, training and further embedded by the Trust’s adoption tailored training for individual roles is identi#ed by and promotion of a fair blame culture. Risks identi#ed managers and agreed with sta" through personal from serious untoward incidents that impact upon development plans. public stakeholders are managed by involving the relevant patient and/or their family and ensuring their The corporate induction programme ensures that all satisfaction that all lessons have been learned. new sta" are provided with details of the Trust’s risk management systems and processes and is augmented The Trust has a Board Assurance Framework, which is by local induction organised by line managers. This based on six key elements: includes the comprehensive induction of all junior Clearly de#ned principal objectives agreed doctors with regard to key policies, standards and with stakeholders together with clear lines of practice prior to commencement in clinical areas. responsibility and accountability. Mandatory training, re$ects essential training needs, and includes risk management processes such as Clearly de#ned principal risks to the achievement of health and safety, manual handling, resuscitation, these objectives together with assessment of their infection control, safeguarding patients, blood potential impact and likelihood. transfusion and information governance. Each of these Key controls by which these risks can be managed, processes is included within an e-learning programme this includes involvement of stakeholders in available to sta". agreeing controls where risks impact on them. Root Cause Analysis training is provided to sta" Management and independent assurances that risks members who have direct responsibility for risk are being managed e"ectively. management within their area of work. Lessons learned when things go wrong are shared via Board reports identifying that risks are being Corporate and Divisional governance systems. reasonably managed and objectives being met together with gaps in assurances and gaps in risk control. The risk and control framework Board action plans which ensure the delivery of Risk management requires participation, commitment objectives, control of risk and improvements in and collaboration from all sta". The process starts assurances. with the systematic identi#cation of risks throughout Quality drives the Trust’s strategy and annual plan the organisation via structured risk assessments. and, via the processes described above, the Board Identi#ed risks are documented on risk registers. These of Directors are aware of potential risks to quality. risks are then analysed in order to determine their The Trust conducts an annual self-assessment relative importance using a risk scoring matrix. Low against Monitor’s Quality Governance Framework, scoring risks are managed by the area in which they that is reviewed via the Executive Quality and are found whilst higher scoring risks are managed at Safety Governance Committee and the Trust’s Audit progressively higher levels within the organisation. Committee, and ensures continuous improvement. Achieving control of the higher scoring risks is given priority over lower scoring risks. Risk control measures Information governance risks are managed as part of are identi#ed and implemented to reduce the potential the processes described above and assessed using the for harm. Information Governance Tool kit. The risk register is updated with the currently identi#ed information risks.
Salford Royal NHS Foundation Trust - Annual Report and Accounts 2013/14 197 4
Data quality and data security risks are managed and Information is uploaded onto Prodacapo (software controlled via the risk management system. Risks solution for reporting and compiling performance for to data quality and data security are continuously each managed service) by the individual responsible assessed and added to the IM&T risk register, which for delivering or monitoring the target which ensures is reviewed by the Executive Assurance and Risk accountability and promotes reliability. Through Committee. In addition, independent assurance is Prodacapo all performance information is linked to the provided by the Audit Commission’s PbR (Payment by Annual Plan, Risk Registers and Executive Governance Results) Data Assurance Framework review and the Committees. Information Governance Toolkit self-assessment review The Trust is registered with the Care Quality by internal audit. Commission and systems exist to ensure compliance The Board approved Quality Improvement with the registration requirements. A process of self- Strategy which includes a dynamic series of quality assessment is in place and undertaken annually by improvement projects, under the headings Safe, Clean each service following the prompts within the CQC and Personal, include processes to improve clinical Essential Standards of Quality and Safety judgement standards, patient experience, sta" knowledge and framework. sustainability across the organisation and are assured The outcomes of each assessment are discussed on a bi-monthly basis through the Executive Quality through the Service Review process twice yearly and and Safety Governance Committee. via the Executive Assurance and Risk Committee, This committee is chaired by the Executive chaired by the Chief Executive. In addition, further Nurse Director, who has organisational Executive assurance is provided by the Audit Committee who responsibility for quality improvement, and is attended commission speci#c reviews by the Trust’s internal by all Executive Directors. In addition to the dedicated auditors. Any areas of concern are risk assessed and quality and safety committee there are four other applied where necessary to the local and corporate risk Executive Governance Committees which ensure registers. quality is at the heart of all Trust business. The Board All of the CQC Essential Standards of Quality and of Directors is committed to the delivery of the Trust’s Safety have an identi#ed lead within the organisation Quality Improvement Strategy and the #rst section of and it is their responsibility to provide compliance all Board meetings provides an opportunity to discuss evidence and evaluation to relevant Executive the Trust’s Quality Improvement Strategy and progress Governance Committee on an annual basis. A CQC against the de#ned projects and outcomes, thus mock assessment programme is in operation whereby providing leadership and direction throughout the unannounced visits take place across each of the organisation. divisional areas. The Quality Accounts, within this Annual Report and A summary report that collates assurance from each Accounts, describe quality improvements and quality of these controls is presented to the organisations governance in more detail. Executive Assurance and Risk Committee and Board at Performance targets and indicators (including the end of each #nancial year. An additional assurance contractual obligations and CQUIN schemes) are all for the period 2013/14 was obtained following the assigned to an Executive Lead, an Information Lead, successful outcome of the CQC inspection in October and an Operational Lead. Each lead is accountable for 2013. the delivery of the target or indicator and for ensuring that a robust monitoring system is in place.
Salford Royal NHS Foundation Trust - Annual Report and Accounts 2013/14 198 4
During 2013/14, the Trust’s major risks in-year related The Trust has assessed compliance with the NHS to: Foundation Trust condition 4 (FT governance). Audit Committee reviewed the assessment in detail with Implementation of the new Electronic Patient the Chief Executive at its meeting on 2 May 2014. The Record and ensuring the e"ectiveness of data Trust believes that e"ective systems and processes controls set in contract with the Trust’s external are in place to maintain and monitor the following partner (Allscripts) to safeguard personal data from conditions: risk of inappropriate access. The e"ectiveness of governance structures. E"ectiveness of the Intermediate Rehabilitation Service across Greater Manchester. The responsibilities of Directors and subcommittees. Delivery of the high operational standards expected Reporting lines and accountabilities between the of the Trust’s joint venture with the Wrightington, board, its subcommittees and the executive team. Wigan and Leigh NHS Foundation Trust to provide The submission of timely and accurate information Decontamination and Sterile Services. to assess risks to compliance with the Trust’s licence. Patient readmissions to hospital within 30days. and Prevention of Clostridium di!cile infections. The degree and rigour of oversight the board has over the Trust’s performance. E"ectively communicating learning from serious untoward incidents, across the organisation. These conditions are detailed within the Corporate Ensuring the highest food hygiene standards for Governance Statement, the validity of which is assured preparation of patient food. via the Board of Directors’ Audit Committee. Ensuring all Trust premises complied with current Risk management is embedded in the activity of the #re safety legislation. organisation. The risk management systems are fully incorporated within the Trust’s Assurance Framework. Capacity to manage high increases in referrals in a The Trust’s corporate risk register is integrated with number of specialties. the Board Assurance Framework thereby ensuring Robust leadership from the Board of Directors has that risks are not only managed and communicated ensured successful mitigation of these risks during e!ciently, but that the management of them is 2013/14. embedded in the Trust’s practice. When things do go wrong the Trust encourages Major risks for 2014/15 include: its sta" to report incidents whether there was any Orthopaedic treatment pathways - the Trust is consequence resulting from the incident or not. undertaking a full review of all current open treatment Anonymous reporting is accepted to mitigate against pathways for orthopaedic patients to safe-guard any concerns the reporter of an incident may have. patient care. However, if the reporter of an incident does Trust-wide clinical sta!ng - the Trust is implementing include who they are, then they receive automated current sta!ng plans to minimise the impact of the feedback for every incident they report. This is to national shortage of training grade medical sta" and help demonstrate the value of reporting and that quali#ed nursing sta". Working group established things have changed as a result, with the intent on with speci#c project management responsibilities for encouraging sta" to report more incidents. ensuring e"ectiveness of clinical sta!ng plans and overseeing trust-wide implementation.
Salford Royal NHS Foundation Trust - Annual Report and Accounts 2013/14 199 4
Public stakeholders are involved in managing risks Review of economy, e"ciency and which impact on them. When serious incidents e#ectiveness of the use of resources are investigated, members of the Trust speak and if possible meet with those who were a"ected. Relevant The #nancial plan is approved by the Board and feedback from these discussions would be considered submitted to Monitor. The plan, including forward during the investigation and a copy of the #nal report projections, is monitored in detail by the Executive is shared. This gives the opportunity for comment Governance Finance and Information Committee on on the report to be considered and if appropriate a monthly basis with key performance indicators and included. monitor metrics reviewed by the Board. A full copy of the monthly integrated Finance and Performance Salford Royal NHS Foundation Trust is fully compliant Report is issued to all Board Directors. The Trust’s with the registration requirements of the Care Quality resources are managed within the framework set by Commission. the Corporate Governance Framework Manual, which As an employer with sta" entitled to membership includes Standing Financial Instructions. Financial of the NHS Pension Scheme, control measures are in governance arrangements are supported by internal place to ensure all employer obligations contained and external audit to ensure economic, e!cient and within the Scheme regulations are complied with. e"ective use of resources. This includes ensuring that deductions from salary, Divisional, directorate and corporate departments employer’s contributions and payments into the are responsible for the delivery of #nancial and other Scheme are in accordance with the Scheme rules, and performance targets via a performance management that member Pension Scheme records are accurately framework incorporating service reviews with the updated in accordance with the timescales detailed in Executive Team. the Regulations. Control measures are in place to ensure that all the organisation’s obligations under equality, diversity and Annual Quality Report human rights legislation are complied with. The directors are required under the Health Act 2009 and the National Health Service (Quality Accounts) TheFoundation Trust has undertaken risk assessments Regulations 2010 (as amended) to prepare Quality and Carbon Reduction Delivery Plans are in place in Accounts for each #nancial year. Monitor has issued accordance with emergency preparedness and civil guidance to NHS Foundation Trust boards on the contingency requirements, as based on UKCIP 2009 form and content of annual Quality Reports which weather projects, to ensure that this organisation’s incorporate the above legal requirements in the NHS obligations under the Climate Change Act and the Foundation Trust Annual Reporting Manual. Adaptation Reporting requirements are complied with. The Annual Quality Report 2013/14 has been developed in line with relevant national guidance and is supported internally through the Board Assurance Framework. The Trust has a dedicated Executive Quality and Safety Governance Committee which is attended by all Executive Directors. All data and information within the Quality Report is reviewed through this committee and is supported through a comprehensive documented three year Quality Improvement Strategy.
Salford Royal NHS Foundation Trust - Annual Report and Accounts 2013/14 200 4
The Board of Directors review the content of the The Trust’s Assurance Framework itself provides me Quality Improvement Strategy on a monthly basis with evidence that the e"ectiveness of controls that within the quality improvement section of the Board manage the risks to the organisation achieving its agenda, which includes regular review of the Quality principal objectives have been reviewed. Internal Improvement Dashboard and progress against Audit provides me with an opinion about the identi#ed projects. e"ectiveness of the assurance framework and the internal controls reviewed as part of the internal audit The Trust has an identi#ed Quality Improvement plan. Work undertaken by internal audit is reviewed by Department with relevantly skilled individuals to the Assurance Framework’s Committees and the Audit support the execution of the Quality Improvement Committee. The assurance framework/risk register is Strategy across the organisation. Capability building in reviewed by the Board of Directors four times a year Quality Improvement techniques and skills has been and it provides me and the Board with evidence of the and remains a key objective of the organisation. Sta" e"ectiveness of controls in place to manage risks to at all levels exposed to either collaborative working, achieve the organisations principal objectives. clinical micro systems or speci#c quality improvement educational programmes both internally and externally My review is also informed by External Audit to ensure skills are developed and maintained. In opinion, inspections carried out by the Care Quality addition, some members of the Board have completed Commission, the NHS Litigation Authority risk the ‘Board on Boards’ training programme in Quality management accreditation, and other external Improvement awareness and skills. inspections, accreditations and reviews. The quality report has been reviewed through both The processes outlined below are well established internal and external audit processes and comments and ensure the e"ectiveness of the systems of internal have been provided by local stakeholders including control through: commissioners, patients and the local authority. Board review of Board Assurance Framework, including risk registers and action plans. Review of e#ectiveness Audit Committee scrutiny of controls in place. As Accounting O!cer, I have responsibility for Review of serious untoward incidents and learning reviewing the e"ectiveness of the system of internal by the Assurance Framework committees, control. My review of the e"ectiveness of the system including those for risk management and clinical of internal control is informed by the work of the e"ectiveness. internal auditors, clinical audit and the executive Review of progress in meeting the Care Quality managers and clinical leads within the NHS foundation Commission’s Essential Standards by the Executive trust who have responsibility for the development Governance Committees. and maintenance of the internal control framework. Internal audits of e"ectiveness of systems of internal I have drawn on the content of the Quality Report control. attached to this Annual Report and other performance information available to me. My review is also Conclusion informed by comments made by the external auditors No signi#cant internal control issues have been identi#ed. in their management letter and other reports. I have been advised on the implications of the result of my review of the e"ectiveness of the system of internal Sir David Dalton control by the board and the audit committee and a Chief Executive plan to address weaknesses and ensure continuous Date: 29 May 2014 improvement of the system is in place.
Salford Royal NHS Foundation Trust - Annual Report and Accounts 2013/14 201 5 Governance and Organisational Arrangements
202 5 Foundation Trust Membership
Each NHS Foundation Trust has its own Governance Structure. The basic governance structure of all NHS Foundation Trusts includes the: 1. Membership 2. Council of governors and 3. Board of directors
This structure is established and well developed at Salford Royal, as set out in the Trust’s Constitution that Public members is published at: We have nine public member constituencies. Eight of www.srft.nhs.uk these re$ect Salford City Council neighbourhood wards, and in the in the NHS Foundation Trust directory on the ninth is for people who live outside of Salford. All Monitor’s website: members of the public who are over 16 years of age, www.monitor-nhsft.gov.uk. living in one of the following constituencies can become a member: In addition to this basic structure, Salford Royal NHS Claremont, Weaste & Seedley Foundation Trusts also make use of board committees East Salford and sub-groups, comprising directors and/or governors, as a practical way of dealing with speci#c Eccles issues. Irlam and Cadishead Little Hulton & Walkden Ordsall & Langworthy Trust membership Become a Swinton Engaging members is an essential part of planning, Worsley & Boothstown member! designing and improving services that meet the needs Outside of Salford Maybe you would like to know of the communities we serve. The Membership and what’s happening here. Maybe you would like to comment Public Engagement Strategy 2013-2016 sets out the on our future plans. Trusts objective to: Sta# members Or maybe you would like to show your support to Salford Royal. Maintain and continue to develop the signi#cant Sta" who are permanently Become a member of Salford and representative membership that has been employed by the Royal NHS Foundation Trust and have your say on what we do established since authorisation. Foundation Trust or hold Enhance the scope and range of patient and public a #xed term contract engagement activity to improve services and the of at least 12 months, patient experience. or who have been Provide a variety of routes and mechanisms for continuously employed engagement that actively engages members from by the Foundation Trust seldom heard groups. for at least 12 months are automatically registered Salford Royal NHS Foundation Trust membership is as members unless they made up of public and sta" members. choose to opt out.
Salford Royal NHS Foundation Trust - Annual Report and Accounts 2013/14 203 5
How many members do we have? 2014/15 Public Constituency 2013/14 (Estimated) The table below highlights the Trust’s actual and target At year start (April 1) 14,549 15,133 membership #gures for 31 March 2014: New members 1,289 467 Actual Target Members leaving 705 1,000 Constituency 31 March 2014 31 March 2014 At year end (March 31) 15,133 14,600 Public - Salford residents 9,561 9,350 Sta! Constituency Public - Out of Salford 5,572 5,050 At year start (April 1) 6,569 6,689 Sta" 6,689 6,000 New members 964 600 TOTALS 21,822 20,400 Members leaving 844 600 At year end (March 31) 6,689 6,689 The following tables analyse the current and estimated membership #gures for a number of indicators to Number of Members Eligible highlight areas of representation. Public Constituency 31 March 2014 Membership Public Constituency Breakdown Actual 31 March 2014 Age (Years) 0-16 6 49,402 Claremont, Weaste and Seedley 1,323 881 17,132 East Salford 1,155 17-21 Eccles 1,859 22+ 13,083 173,860 Unknown 1,163 - Irlam and Cadishead 775 Little Hulton and Walkden 1,193 Ethnicity White 13,085 210,862 Ordsall and Langworthy 1,078 Mixed 178 4,616 Swinton 1,345 Worsley and Boothstown 833 Asian or Asian British 772 9,249 Out of Salford 5,572 Black or Black British 543 6,541 TOTAL 15,133 Other 68 2,485 Unknown 487 - Sta! Constituency Breakdown Actual 31 March 2014 Socio-economic Grouping Salford Healthcare 1,569 ABC1 3,351 13,468 Neurosciences and Renal 1,240 C2 4,211 26,201 Clinical Support Services and Tertiary Medicine 1,767 D 3,296 15,230 Corporate Services 1,172 E 4,091 25,298 Surgery 941 Unknown 184 - TOTAL 6,689 Gender Male 5,462 120,468 Female 8,457 119,926 Unknown 1,214 -
Salford Royal NHS Foundation Trust - Annual Report and Accounts 2013/14 204 5
The Trust has implemented a number of feedback mechanisms to ensure regular engagement and communication with members these include: Members Newsletter - The Loop E-communications Medicine for Members Patient Focus Groups Online Surveys Open Day and Annual Members Meeting
Additionally, members were again asked for their thoughts on developing our Annual Plan for 2014/15, ensuring the Trust’s priorities re$ected the thoughts of our members, patients, sta" and visitors. Over 200 members responded to the web-based survey, and the Trust has included all emerging themes within the 2014/15 Annual Plan. Members and the public also responded by freepost or directly to Governors who attended Community Committees and various voluntary and community forms. Further information on becoming a member, opportunities to engage with the Trust and the positive outcomes from engagement can be found on the Trust’s website: www.srft.nhs.uk/for-members Additionally, members can contact their respective Governor directly via the form in the Members section. Medicine for Members Seminars 2014 Dementia Members who wish to communicate with Directors can Did you know... do so via the Trust Secretary: There are 800,000 people with dementia in the UK and this number Mrs Jane Burns is set to rise to 1 million by 2021? This seminar is for Foundation Trust Associate Director of Corporate A#airs/ members who want to learn more about the disease. There is also the Foundation Trust Secretary opportunity for the audience to ask questions about the seminar topic. Trust Executive O!ces, Tuesday 27 May 2014, 10.30am - 11.30am Date (refreshments served from 10am) 3rd Floor, Mayo Building, If you have any special requirements (including dietary or access needs), please let the Membership Team know when booking. Salford Royal NHS Foundation Trust, Location Humphrey Booth Lecture Theatre (Level 1), Mayo Building, Salford Royal, Stott Lane, Salford, M6 8HD. Booking Online Booking Form: www.srft.nhs.uk/memberevents Email: [email protected] Stott Lane, Telephone: 0161 206 3133 Places are limited, we would advise you book in advance Salford, Want to attend and currently not a member? Why not complete our online Membership Form?
© G14043001, Design Services M6 8HD.
Salford Royal NHS Foundation Trust - Annual Report and Accounts 2013/14 205 5 Council of Governors
When Parliament created NHS Foundation Trusts it gave them independence from central government and a governance structure designed to ensure that people from the communities served by NHS foundation trusts can take part in governing their local Trust.
Salford Royal’s governors are the direct representatives The table below provides details of all elections and of local communities. They do not manage the our Council of Governors throughout 2013/14: operations of NHS Foundation Trusts; rather they The composition of the Council of Governors from challenge Salford Royal’s Board of Directors and hold 1 April 2013 to 10 October 2013 was as follows: them to account for the Trust’s performance. Two acts of Parliament, the National Health Service Act Term of O"ce (End of 2006 (the 2006 Act) and the Health the Annual and Social Care Act 2012 (the 2012 Act), provide Consituency / Members Name Organisation Meeting) governors with statutory responsibilities Public Governors and the rights to help them deliver these. Mrs Valerie Ivison* Claremont, Weaste & Seedley 3 years (2013) Governors at Salford Royal are the link between Mr Michael Bamberger East Salford 3 years (2013) the Foundation Trust’s members and the Trust. Mrs Diana Tyldesley Eccles 3 years (2013) Together they form the Council of Governors and Mr David Pike Irlam & Cadishead 3 years (2014) have a collective responsibility to support the Trust Ms Jean Whittaker Little Hulton & Walkden 3 years (2014) in developing plans and services and representing Mr Peter Halliwell Ordsall & Langworthy 3 years (2013) members’ views to the Trust’s Board of Directors. Mr Roy Harding Swinton 3 years (2014) The statutory powers and duties of the Council of Mr Paul Burgess Worsley & Boothstown 3 years (2014) Governors include: Mr Peter Rose Out of Salford 3 years (2013) Appoint and, if appropriate, remove the Chairman. Mrs Susan Edwards** Out of Salford 3 years (2014) Appoint and, if appropriate, remove the other Non- Dr Michelle Byrne Out of Salford 3 years (2014) executive Directors. Mr David Carney Out of Salford 3 years (2013) Decide the remuneration and allowances and other Sta! Governors terms and conditions of o!ce of the Chairman and Dr Ronan O’Driscoll Salford Healthcare 3 years (2013) the other Non-executive Directors. Mrs Carol Darke Clinical Support & Tertiary Services 3 years (2014) Approve the appointment of the Chief Executive; Mr Lee Hay Surgery 3 years (2014) Appoint and, if appropriate, remove the NHS Mr Craig Wood Corporate & General Services 3 years (2013) Foundation Trust’s Auditor, and Dr Sheila Basu Neurosciences & Renal 3 years (2014) Appointed Governors Receive the NHS Foundation Trust’s annual Councillor Tracy Kelly Salford City Council 3 years (2014) accounts, any report of the auditor on them, and Dr Jennifer Walton General Medical Practitioner 3 years (2014) the annual report. Professor Nick Grey University of Manchester 3 years (2014) In preparing the NHS Foundation Trust’s forward Professor Celia Hynes University of Salford 3 years (2014) plan, the Board of Directors must have regard to the views of the Council of Governors. * Mrs Valerie Ivison resigned 06/2013, the position remained vacant until 10/2013 Salford Royal’s Council of Governors has seen a lot of ** Mrs Susan Edwards resigned 10/2013 changes in 2013/14, including saying goodbye to some of our longest serving Governors.
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The composition of the Council of Governors from 10 October 2013 to 31 March 2014 was as follows: Term of O"ce (End of the Annual Consituency / Members Name Organisation Meeting) Public Governors Mrs Jackie Flynn Claremont, Weaste & Seedley 3 years (2016) Mrs Ann-Marie Pickup East Salford 3 years (2016) Mrs Michelle Watson Eccles 3 years (2016) Mr David Pike Irlam & Cadishead 3 years (2014) Ms Jean Whittaker Little Hulton & Walkden 3 years (2014) Mr Peter Halliwell Ordsall & Langworthy 3 years (2016) Having been appointed at the June 2013 Council of Mr Roy Harding Swinton 3 years (2014) Governors, Mr Peter Halliwell and Mr Paul Burgess Mr Paul Burgess Worsley & Boothstown 3 years (2014) took up o!ce as the Lead Governor and Deputy Lead Mr David Trenbath Out of Salford 3 years (2016) Governor respectively. Mrs Janet Booth Out of Salford 3 years (2014) A number of elections were held during the year, Dr Michelle Byrne Out of Salford 3 years (2014) which resulted in changes to our Council of Governors. Mr Keith Ellis Out of Salford 3 years (2016) Sta! Governors Date of Total Election on Number of Eligible Turnout Mr Jarrod Walton-Pollard Salford Healthcare 3 years (2016) Constituency 2013/14 Nominations to Vote (%) Mrs Carol Darke Clinical Support & Tertiary Services 3 years (2014) Public - East 19.09.2013 3 1,015 18.1% Mr Lee Hay Surgery 3 years (2014) Salford Mrs Nicola Kent Corporate & General Services 3 years (2016) Public - Eccles 19.09.2013 2 1,844 18.5% Dr Sheila Basu Neurosciences & Renal 3 years (2014) Appointed Governors Public - Ordsall 19.09.2013 2 978 16.9% and Langworthy Councillor Tracy Kelly Salford City Council 3 years (2014) Public - Out of 19.09.2013 10 5,095 14.7% Dr Jennifer Walton General Medical Practitioner 3 years (2014) Salford Professor Nick Grey University of Manchester 3 years (2014) Public - Claremont, Uncontested Professor Celia Hynes University of Salford 3 years (2014) Weaste & Seedley Public - Corporate Uncontested A comprehensive induction programme was & General Services provided for all new governors in 2013, through a Public - Salford Uncontested joint programme hosted by Salford Royal and in Healthcare collaboration with neighbouring Foundation Trusts. This enabled new governors to meet new governors from several other Foundation Trusts. The Council of Governors took part in a comprehensive Training and Development Programme during 2013/14 to ensure the statutory duties of Governors were fully understood, including the additional statutory duties within the Health and Social Care Act 2012, and ensure the processes in place to ful#l those duties were e"ective.
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Register of interests All Governors are required to comply with the Trusts Code of Conduct and declare any interests that may result in a potential con$ict of interest in their role as Governor of the Trust. The register of interests is maintained and available to the public via the Trust’s Secretary at the following address: Trust Headquarters Salford Royal NHS Foundation Trust Name Title Attendance Stott Lane Mr Paul Burgess Public Governor - 4/4 Worsley & Boothstown Salford Mr Peter Rose Public Governor - 2/2 M6 8HD Out of Salford Telephone: 0161 2065249 Mrs Susan Edwards Public Governor - 1/2 Email: [email protected] Out of Salford Dr Michelle Byrne Public Governor - 3/4 Council of Governors meetings Out of Salford Mr David Carney Public Governor - 0/2 Since the start of the year the Council of Governors Out of Salford have met on 4 occasions: Mr David Trenbath Public Governor - 2/2 - Wednesday, 12 June 2013 Out of Salford - Wednesday, 4 September 2013 Mr Keith Ellis Public Governor - 2/2 Out of Salford - Wednesday, 4 December 2013 Mrs Janet Booth Public Governor - 2/2 - Wednesday, 26 March 2014 Out of Salford Dr Ronan O’Driscoll Sta" Governor - 2/2 The following table summarises Governor Salford Healthcare attendance at Council of Governor meetings Mr Jarrod Walton-Pollard Sta" Governor - 2/2 1 April 2013 - 31 March 2014: Salford Healthcare Mrs Carol Darke Sta" Governor - Clinical 4/4 Name Title Attendance Support & Tertiary Medicine Mrs Valerie Ivison Public Governor - Claremont, 1/1 Mr Lee Haye Sta" Governor - Surgery 4/4 Weaste and Seedley Mr Craig Wood Sta" Governor - Corporate 2/2 Mrs Jackie Flynn Public Governor - Claremont, 2/2 & General Services Weaste and Seedley Mrs Nicola Kent Sta" Governor - Corporate 2/2 Mr Michael Bamberger Public Governor - East Salford 1/2 & General Services Mrs Anne-Marie Pickup Public Governor - East Salford 1/2 Dr Sheila Basu Sta" Governor - Neurosciences 3/4 Mrs Diana Tyldesley Public Governor - Eccles 1/2 & Renal Services Mrs Michelle Watson Public Governor - Eccles 1/2 Councillor Tracy Kelly Appointed Governor - 0/4 Mr David Pike Public Governor - 3/4 Salford City Council Irlam & Cadishead Dr Jennifer Walton Appointed Governor - 3/4 Ms Jean Whittaker Public Governor - 2/4 General Medical Practitioner Little Hulton & Walkden Professor Nick Grey Appointed Governor - 2/4 Mr Peter Halliwell Public Governor - 4/4 University of Manchester Ordsall & Langworthy Professor Celia Hynes Appointed Governor - 3/4 Mr Roy Harding Public Governor - Swinton 4/4 University of Salford
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During the #nancial year, a number of Governors were paid expenses to reimburse their travel costs incurred whilst attending meetings and events at the Trust.
2013/14 2012/13 Expenses rounded Expenses rounded to nearest £100 to nearest £100 £000 £000 Total expenses paid during 2013/14 to 8 Governors 1.7 1.4 (2012/13 : 6) who served during the !nancial year
Governors continue to ful#l both their statutory and non-statutory duties through established Subgroups. Last year Governors embarked on a great piece of Subgroups are supported by both Executive and Non- work to #nd out how to engage with seldom heard Executive Directors. groups in our community. The Council of Governors recognised that there were some sectors of the Subgroups of the Council of Governors include: community which were often not heard or listened Engagement Subgroup. too and whose views were often under represented. Quality Subgroup. Barriers such as age, culture, language and disability Strategic Direction Subgroup. can prevent people from being able to be involved and these are often our most vulnerable patients. Nominations, Remuneration and Terms of O!ce Governors attended training, delivered by key partner Committee. organisations, to develop their own knowledge and understanding of both the local population of During 2013/14, the Council of Governors, utilising the Salford and the pro#le of patients at Salford Royal established Nominations, Remuneration and Terms of and reviewed evidence at national and local level on O!ce Committee, ensured appropriate oversight and health inequalities experienced by vulnerable groups. decision relating to: Governors used this information to select 3 groups The Chairman’s 2012/13 performance appraisal. with which to work more closely over the next year - The 2012/13 performance appraisals for Non- Men, Sensory Disabilities and BME groups. We look Executive Directors. forward to telling you more about this work next year. The remuneration levels for all Non-Executive There are a number of easy ways for members and the Directors, including the Chairman. public to communicate with the Council of Governors. The reappointment of Mr John Willis and Mr Email: [email protected] Howard Forster for a period of 1 year based upon the area of expertise provided by both Non- Telephone: 0161 206 3133 Executive Directors being ‘business critical’ for Website: www.srft.nhs.uk/for-members/council-of- the continuing success of Salford Royal. governors/contact-your-governor The appointments of Dr Joanna Bibby and Mrs Write to your Governor at: Rowena Burns as Non-Executive Directors with Membership Department expertise relating to population health and Trust Executive, strategic business partnerships. Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD
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The Board of Directors’ relationship with the The Board of Directors support the outward facing Council of Governors and members engagement work of each Subgroup and are involved in analysis of this work, such as outcomes from the The Board works closely with the Trust’s Council of Annual Membership Survey, Focus Groups and Governors. The Foundation Trust’s Chairman is also the Governor-led engagement. Chairman of the Council of Governors and is supported at every meeting of the Council of Governors by The following table summarises Director attendance at the Chief Executive or Deputy Chief Executive. The Council of Governors’ meetings: Chairman works closely with the nominated Lead and Deputy Lead Governors to review all relevant matters. Name Title Attendance The Chairman, Chief Executive, Vice-Chairman, Senior Mr James Potter Chairman 4/4 Independent Director, Trust Secretary, Lead Governor Mr John Willis Deputy Chairman 3/4 and Deputy Lead Governor meet prior to each meeting Mr Howard Forster Non-Executive Director 1/4 of the Council of Governors to set the Agenda and Mrs Diane Brown Non-Executive Director 4/4 review key issues. Mrs Anne Williams Non-Executive Director 3/4 Mrs Diane Brown continued in her role as Senior Mrs Rowena Burns Non-Executive Director 0/3 Independent Director during 2013/14. She actively Dr Jo Bibby Non-Executive Director 2/3 pursues an e"ective relationship with the Council of Sir David Dalton Chief Executive 4/4 Governors and participates fully in the development Mr Tony Whit!eld Deputy Chief Executive and 2/3 and facilitation of key learning events for Governors. Executive Director of Finance Mr Stephen Kennedy Acting Director of Finance 1/1 The Senior Independent Director and the other Non-Executive Directors attend each meeting of Mrs Elaine Inglesby-Burke Executive Nurse Director 1/4 the Council of Governors, along with all Executive Mr Chris Brookes Executive Medical Director 1/1 Directors, as observers and take part in open Mr Peter Turkington Interim Executive Medical Director 2/3 discussions that form part of each meeting. The Mr Paul Renshaw Executive Director of Organisational 4/4 Development & Corporate A"airs Council of Governors and Board of Directors met Mr Simon Neville Executive Director of Stategy and 3/4 on two occasions during 2013/14; 29 July 2013 to Development discuss the Greater Manchester Healthier Together Programme and ‘Shaping the Future’ for Salford Royal, Although meetings of the Board of Directors are and on 25 November 2013 to discuss known risks held in public and Governors can and do attend, the and opportunities relating to the development of the Chairman provides a Board of Directors feedback 2014/15 Business Plan, and the review of the Trust’s session for Governors within a week of each Board longer-term Strategic Plan. meeting. The Chairman comprehensively describes Executive Directors or their Deputies, and Non- the matters discussed and decisions made within the Executive Directors, are assigned to and are integral public and private sessions of the Board meetings, and members of each of the three Council of Governors’ responds to any questions or concerns that Governors Sub-groups - Engagement Sub-group, Quality Sub- may have. group and Strategic Direction Sub-group. Participation in each quarterly Subgroup meeting ensures an understanding of the views of Governors and subsequently members of the public.
Salford Royal NHS Foundation Trust - Annual Report and Accounts 2013/14 210 5 Board of Directors
The Board of Directors operates according to the highest corporate governance standards. It is a unitary Board with collective responsibility for all aspects of the performance of the Trust, including #nancial performance, clinical and service quality, management and governance. The Board is legally accountable for the services provided by the Trust and key responsibilities include:
Setting the strategic direction (having taken into The Board met in formal session on ten occasions account the Council of Governors’ views). during 2013/14. These sessions were held in public Ensures that adequate systems and processes are apart from where the Board resolved to meet in maintained to deliver the Trust’s Annual Plan. private session, by reason of the con#dential nature of Ensuring that its services provide safe, clean, business. personal care for patients. The Board is of su!cient size and the balance of skills Ensuring robust governance arrangements are in and experience is appropriate for the requirements place supported by an e"ective assurance framework of the business and the future direction of the Trust. that support sound systems of internal control. Arrangements are in place to enable appropriate Ensuring rigorous performance management which review of the Board’s balance, completeness and ensures that the Trust continues to achieve all local appropriateness to the requirements of the Trust. and national targets. All Executive and Non-Executive Directors undergo Seeking continuous improvement and innovation. annual performance evaluation and appraisal. The Measure and monitor the Trust’s e"ectiveness and outcomes of the Executive Director appraisals are e!ciency. provided to Non-Executive Directors at a meeting of the Nominations, Remuneration and Terms of Service Ensuring that the Trust, at all times, is compliant with Committee. The outcomes of Non-Executive Director its Licence, as issued by the sector regulator Monitor. appraisals are provided to the Council of Governors’ Exercising the powers of the Trust established under Nominations, Remuneration and Terms of O!ce statute, as described within the Trust’s Constitution Committee (detail) and then a general meeting of the available at www.srft.nhs.uk. Council of Governors (summary). The Board of Directors is also responsible for establishing Board performance is evaluated further through the values and standards of conduct for the Trust and focussed discussions at Board Away Days, Strategic its sta" in accordance with NHS values and accepted Meetings and on-going, in-year review of the Board standards of behaviour in public life including Assurance Framework. sel$essness, integrity, objectivity, accountability, The performance of Board committees is evaluated openness, honesty and leadership (The Nolan Principles). and reported annually to the Board. This is clearly set out at Salford Royal within the Corporate The Board’s Assurance Framework and associated Governance Framework Manual that is published at Service Review Programme enable continuous and www.srft.nhs.uk. Our values and behaviours form the comprehensive review of the performance of the Trust, basis of the Trust’s Contribution Framework. against the agreed plans and objectives. The Board has resolved that certain powers and The Board of Directors participated in a national decisions may only be exercised or made by the Board research project about board governance and in formal session. patient safety in NHS Hospital Trusts during 2013/14, These powers and decisions, and those of the Trust’s conducted by the University of Birmingham and the Council of Governors, are set out in the Reservation of National Institute of Innovation and Improvement. The Powers to the Board and Scheme of Delegation within #ndings will be published during 2014. the Trust’s Corporate Governance Framework Manual available at www.srft.nhs.uk.
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Non-executive Directors
Mr James J. Potter - Chairman Jim Potter was born and raised in the Greater Manchester area, educated at Ambrose Barlow School and subsequently Salford Technical College and Moston College of Further Education. He has spent most of his working life in electrical engineering, initially as an engineer then later moving into management, relocating to the West Midlands in 1969 and then to the Middle East in 1980 where he lived and worked until 1988. Jim moved back to the UK in 1988 to join a packaging company based on Salford Quays working as Export Salford Director and in 1990 he was made Managing Director, the position he still holds today. In addition to the UK operation Jim also has responsibility for the company’s French, US and China- based operations. Jim lives in Salford and was appointed as a Non-Executive Director at Salford Royal in November 1999. He was appointed as Chairman on 1 July 2008 and at a general meeting in March 2012, the Council of Governors reappointed Jim for a further term of three years, commencing on 1 July 2012.
Mr Howard Forster - Non-Executive Director Howard was appointed as Non-Executive Director in April 2007 and has recently been reappointed for a period of twelve months commencing 1 April 2014. Howard is Director of Programme Investment at Northern Gas Networks, a UK Utility Company, which is responsible for the distribution of gas to homes and businesses across the north of England; an area covering East, North and West Yorkshire, the North East and northern Cumbria. For 10 years prior to this, Howard was a Partner in a Global Built Asset Consultancy firm. He has over 17 years’ experience in the health sector, including Executive Director roles in the NHS. Howard maintains an extensive network within the health sector and with the business community in the North West. Howard is the Chairman of the Trust’s Charitable Funds Committee.
Mr John Willis CBE - Vice-Chairman/Chairman of Audit Committee John is a qualified accountant and was Chief Executive of Salford City Council from 1993 until his retirement in 2006. John led the team that secured funding for the Lowry, and oversaw much of the regeneration of Salford. In 2006, he was appointed a Commander of the British Empire for services to local government in Salford. John has considerable experience of managing large, complex public sector organisations with substantial revenue and capital budgets. John was appointed as Non-Executive Director in January 2008. The Board of Directors elected John to be the Trust’s Vice-Chairman in July 2008 and Chairman of the Audit Committee. The Council of Governors has recently reappointed John for a period of twelve months commencing 1 January 2014.
Mrs Diane Brown - Non- Executive Director / Senior Independent Director Diane has over 30 years’ experience as HR Director, Talent Director and Global Business Partner. She has worked with Senior Global Leaders in FTSE 100 companies such as AstraZeneca Pharmaceuticals, M&S Money & Marks & Spencer PLC. Diane has developed a commercial understanding of both business & people related issues as a key member of executive teams working across the UK, Europe and North America. She has played a significant role in introducing Talent & Performance Management frameworks across continents as well as driving transformational change and continuous improvement. Diane is Fellow of the Chartered Institute of Personnel & Development. She mentors leaders in the Arts, NHS and small businesses. Diane was appointed as Non Executive Director in January 2009 and her current term of office will come to an end in December 2014. Diane is the Board of Directors’ Senior Independent Director.
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Non-executive Directors
Mrs Anne Williams CBE - Non-Executive Director Anne has over 30 years of experience in social care working in the NHS, voluntary sector and Local Authorities. From 1999 to 2005 she was Director of Community and Social Services at Salford City Council managing Neighbourhood Services and Children’s and Adult Social Care. Between September 2005 and September 2008, as Strategic Director, she managed Neighbourhood Services, Adult Social Care and Culture and Leisure Services. She has an Honorary Doctorate from the University of Salford. Anne was an active member firstly of the Association of Directors of Social Services and then of the Association of Directors of Adult Social Services (ADASS), both locally and nationally. She became Vice President of ADSS from October 2006 and was the first President of ADASS from its launch on 26 March 2007. During her presidential year she was closely involved in work with the Department of Health on a number of fundamental initiatives across adult social care and health, such as Putting People First, the Darzi Review and World Class Commissioning. Anne was awarded a CBE in June 2009 for services to Local Government. Between 2008 and June 2011 Anne was the National Director for Learning Disabilities at the Department of Health. She was extensively involved with the development of the national policy ‘Valuing People Now’ and its implementation. Since November 2011 she is a Non-Executive Director of HC-ONE, a new company which provides care homes for older people and those with disabilities. Anne was appointed as Non-Executive Director in October 2009 and her current term of office comes to an end in September 2015. During 2011/12, Anne became Chairman of the Trust’s Research and Development Joint Steering Board.
Mrs Rowena Burns - Non-Executive Director Rowena took up the role of Chief Executive at Manchester Science Parks in summer 2012, and remains a Non-Executive Director at Bruntwood, and Chairman of Cityco. Educated at the University of Wales and at University College London, and having trained in nursing, Rowena’s early career was spent with the Greater Manchester Passenger Transport Authority and Manchester City Council, working in a variety of transport and economic development roles, including the first phase of Manchester’s Metrolink light rail system. Over ten years she moved through a number of roles with the Manchester Airport Group, including latterly that of Group Commercial Director, where her brief included airport acquisitions, economic regulation and overall business strategy, as well as responsibility for revenue generation. Rowena returned to the city in March 2008, as COO in commercial property company Bruntwood, a role which takes her into every part of the business, with a strong focus on service improvement and organisation development. She took up the reins at MSP after Bruntwood acquired a 51% stake in the company earlier this year. She describes the role as perfect, a public/private sector partnership focused on driving growth and opportunity in the most vibrant and innovative sectors of the economy. Rowena’s professional feet are very firmly planted in city life, where she is active on several boards and initiatives, including the role of Chairman of CityCo, Manchester’s city centre management organisation. Away from work, she has a passion for all things rural, and is rarely found indoors other than round a dining table with family or friends. Rowena was appointed as Non-Executive Director in July 2013 for three years.
Dr Joanna Bibby - Non-Executive Director Jo Bibby joined the Health Foundation in November 2007. She has worked in healthcare at national and local level for the last 17 years, with a focus on quality improvement and performance. Jo has a PhD in Medical Biophysics. At the Health Foundation, Jo is responsible for providing direction and leadership to ensure the organisation maximises its impact on improving quality across the UK. Before joining the Health Foundation, Jo was most recently the Director for the Calderdale and Kirklees Integrated Service Strategy where she led a major service reconfiguration programme to deliver improvements in quality, safety and patient experience. Jo’s career has included 10 years at the Department of Health working in public spending, work force planning and health technology assessment. As Head of NHS Performance, she oversaw the implementation of the policy agenda set out in the NHS Plan. At the NHS Modernisation Agency, Jo led an international quality improvement initiative - Pursuing Perfection - and at the NHS Institute for Innovation and Improvement she worked in an associate role to develop models to support mass participation in quality improvement. Jo was appointed as Non-Executive Director in July 2013 for three years.
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Executive Directors
Sir David N Dalton - Chief Executive Sir David Dalton has been a Chief Executive for 19 years - 12 of these at Salford Royal. He has a strong profile, both locally within Greater Manchester, and also nationally in the areas of quality improvement and patient safety. Under Sir David’s leadership, the Trust set out its clear ambition to be the safest organisation in the NHS and has adopted a disciplined approach of applied ‘improvement science’ coupled with deep staff involvement. Sir David’s other interest is in sustaining an organisational culture which delivers high reliability of clinical standards, this has included supporting clinical leaders and creating a new framework for aligning an individual’s contribution to the goals and values of the organisation. Sir David chairs a network organisation of Foundation Trusts - NHS QUEST - which aims to achieve unprecedented levels of quality improvement and he leads the Greater Manchester Academic Health Science Network, which aims to improve health through better adoption of evidence of best practice. Sir David received his knighthood in the New Year’s Honours List 2014 for his services to the NHS.
Mr Tony Whitfield - Executive Director of Finance and Deputy Chief Executive (until 7.1.2014) Tony began his career in the NHS in 1983, joining Salford Royal in 2003. He is a fellow of the Chartered Institute of Management Accountants and holds an MA in Financial Management. He was President of HFMA during 2013. He has responsibilities for Finance, IT Information, Procurement along with being Executive Lead for the Division of Neurosciences and Renal Services. He is married with two children. He has a keen interest in service line management as a tool for organisational engagement to deliver effective patient services, efficiently and to the highest standards.
Mr Stephen Kennedy - Acting Director of Finance (from 8.1.2014) Stephen joined the Trust in April 2003 and spent the majority of that time as the Deputy Director of Finance, however he has spent the last four months as Acting Finance Director. He has been a qualified accountant for 20 years and spent his whole working career within the Acute Sector of the NHS. Stephen has a keen interest in Finance staff development and has led Salford Royal’s accreditation for Finance staff development to the highest levels for the last six years, through the national Finance staff Development Advisory Group. He also has a strong record in shaping and delivering the Trusts financial strategy including the successful bid for Foundation Trust status in 2006. Stephen is married with one son and lives in Cheadle Heath.
Mr Ian Moston - Executive Director of Finance Ian joined Salford Royal Board of Directors in May 2014 from the NHS Trust Development Authority where he was the Business Finance Director for London. Ian started his NHS career in 1991 as a Regional Financial Management Trainee and has held Finance Director positions in Primary Care, Acute and Intermediate Tier Organisations since 2005. During this time he has worked on a number of large scale transactions including the development of a new national service for cancer treatment, organisational merger and acquisition and the development of a joint venture company to deliver commercial benefits to the NHS. Ian brings a range of other experiences from both the private and charitable sectors and is a Non-Executive Board Member of Weaver Vale Housing Trust. He is also a keen advocate of Finance staff development and is chair of the Towards Excellence Programme which accredits NHS North West Finance functions. Ian is the Executive Lead for Finance, Information, Procurement, Contracting and Commissioning and the Division of Neurosciences and Renal Services.
Mr Chris Brookes - Executive Medical Director (commenced secondment to the Greater Manchester Healthier Together Programme on 1.9.13) Chris commenced as Executive Medical Director on 1 May 2010. Chris has continued to focus his efforts on infection control and through the contribution of all staff members in Salford Royal there has been significant progress made in ensuring that our patients receive care which is safe and does not expose them to Hospital Acquired Infections (HAI). Chris continues to practice as a Senior Consultant in A&E and is Executive Lead for the Division of Surgery. Away from the hospital, Chris is married with three children and provides medical care to the Wigan Warriors and England Rugby League Teams.
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Executive Directors
Dr Peter Turkington - Interim Executive Medical Director (from 1.9.13) Originally from Northern Ireland, Pete completed his medical training in Yorkshire before moving to Salford Royal in 2003 to take up his Consultant Post in Respiratory Medicine. His main subspecialty interests are Obstructive Sleep Apnoea, Ventilatory Failure and Non-Invasive Ventilation (NIV). He has set up a Sleep Clinic in Salford for patients with all forms of sleep disorder and has published several papers in peer reviewed journals on Sleep Apnoea. Pete was Clinical Director of Respiratory Medicine between 2007 and 2010 and Chair of the Division of Salford Healthcare between 2010 and 2013 during which time he led the development of the Emergency Village and seven day working for acute medicine. He has led a number of initiatives within Salford Royal including a collaborative project to improve the management of acutely unwell patients, which won a BUPA foundation Award in 2009 and a HSJ Award for Quality and Productivity in 2010.
Mrs Elaine Inglesby-Burke - Executive Nurse Director and Deputy Chief Executive Elaine joined the Salford Royal in April 2004. Elaine has held Executive Nurse Director positions since 1996 in both specialist and large acute Trust’s. She qualified as a Registered nurse in 1980 at Warrington District General Hospital and specialised in critical care and general medicine. She has held various clinical positions at ward level and as a nurse specialist. Educated to postgraduate degree level Elaine maintains her professional /clinical development by regular clinical shifts and Executive safety shifts with frontline staff. She is a Florence Nightingale leadership Scholar and took the opportunity to undertake a women’s leadership programme for global executives at Harvard University as well as the Executive Quality Academy at the Institute of Healthcare Improvement, Boston. She has a strong track record in professional nursing and operational management. Elaine is the Executive Lead for Nursing, Governance, Patient Safety and Quality Improvement, and the Division of Salford Healthcare. Elaine was appointed Deputy Chief Executive in January 2014.
Mr Simon Neville - Executive Director of Strategy and Development (until 28.4.14) Simon is a career NHS Manager with extensive experience in general management, service development and capital planning, where notably he has led two £100m plus PFI schemes from conception to close. Simon is educated to degree level and is an accredited OGC Gateway reviewer having reviewed a number of major programmes on behalf of the Department of Health. Simon is responsible for the Trust’s planning processes and for the development of strategy. He is also the Lead Executive for Clinical Support Services and Tertiary Medicine and for Facilities and Estates services. Simon has led the Trust’s Hospital Redevelopment Programme in a £200m investment in improved facilities of the Salford Royal Site.
Mr Jack Sharp - Executive Director of Service Strategy and Development (to commence 1.5.14) Jack joined Salford Royal in May 2008 and was appointed to the Board of Directors in May 2014. Originally from Newcastle upon Tyne, Jack moved to the North West to complete a Masters degree. He started his career in the NHS as a graduate management trainee and has held a wide range of general management posts. Jack has worked in Salford since 2003, having previously been employed by NHS Salford Primary Care Trust. He has led the development of a number of large scale change programmes, including the transfer and integration of community services within the Trust and the development of Salford’s strategy to integrate health and social care services for older people. Jack is the Executive Lead for Strategic and Operational Planning, Integrated Care, Cancer Services, Estates and Facilities, and the Division of Clinical Support Services and Tertiary Medicine.
Mr Paul Renshaw - Executive Director of Organisational Development and Corporate Affairs (commenced 8.4.13) Paul is a senior HR leader with more than 20 years’ experience of HR strategy development and service delivery, including leading significant change management initiatives. He joined Salford Royal in April 2013 from the leadership team at the National Nuclear Laboratory, the leading nuclear technology services provider in the UK. Paul started his career with Marks and Spencer in 1988 and has also worked for Matalan, BUPA, David McLean Ltd and Serco. Paul is married with two children.
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Independence of Non-executive Directors Declaration of interests of the Board of The Board of Directors undertakes an annual review Directors of the independence of its Non-Executive Directors. The Board of Directors undertakes an annual review The Board determines whether each director is of its Register of Declared Interests. At each meeting independent in character and judgement and whether of the Board of Directors a standing agenda item also there are relationships or circumstances which are requires all Executive and Non-Executive Directors to likely to a"ect, or could appear to a"ect, the director’s make known any interest in relation to the agenda, and judgement. At its meeting in April 2014 the Board of any changes to their declared interests. Directors con#rmed that it considers all Non-Executive The Register of Declared Interests for the Board of Directors to be independent, namely: Directors is held by the Foundation Trust Secretary Mr James J Potter and is available for public inspection. Members of the Mr John Willis public can gain access by contacting: Mr Howard Forster Mrs Jane Burns Mrs Diane Brown Associate Director of Corporate A#airs / Trust Secretary Mrs Anne Williams Trust Executive O!ces, Mrs Rowena Burns 3rd Floor, Mayo Building, Dr Joanna Bibby Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD
Executive Directors
Appointment Date Board Name Responsibilities From To Attendance David N. Dalton Chief Executive 2001 Present 9/10 Tony Whit!eld Director of Finance / Deputy Chief Executive 2003 7.1.14 7/8 Stephen Kennedy Acting Director of Finance 8.1.14 28.4.14 2/2 Ian Moston Executive Director of Finance 1.5.14 Present 0/0 Chris Brookes Executive Medical Director 2010 secondment 4/4 from 1.9.13 Peter Turkington Interim Executive Medical Director 1.9.13 Present 6/6 Elaine Inglesby-Burke Executive Nurse Director 2004 Present 10/10 Simon Neville Executive Director of Strategy and Development 2002 28.4.14 10/10 Jack Sharp Executive Director of Service Strategy and Development 1.5.14 Present 0/0 Paul Rehshaw Executive Director of Organisational Development and Corporate A"airs 8.4.13 Present 8/10
Salford Royal NHS Foundation Trust - Annual Report and Accounts 2013/14 216 5
Non-executive Directors
Board Name Responsibilities Appointment Attendance James J. Potter Chairman In post as Vice-Chairman when Salford Royal became a Foundation Trust in August 2006. Appointed as Chairman on 1.7.08 9/10 Re-appointed on 1.7.12 until 30.6.15 Jim is now in his 8th year with Salford Royal John Willis Vice Chair / Non-Executive Appointed 1.1.08 Director Re-appointed 1.1.12 Reappointed 1.1.14 until 31.12.14 10/10 John is now in his 7th year with Salford Royal Howard Forster Non-Executive Director Appointed 1.4.07 Re-appointed 1.4.11 Re-appointed 1.4.13 7/10 Re-appointed 1.4.14 until 31.3.15 Howard is now in his 8th year with Salford Royal Diane Brown Non-Executive Director / Appointed 1.1.09 Senior Independent Director Re-appointed 1.1.12 until 31.12.14 9/10 Diane is now in her 6th year with Salford Royal Anne Williams Non-Executive Director Appointed 1.10.09 Re-appointed 1.10.12 until 30.9.15 10/10 Anne is now in her 5th year with Salford Royal Rowena Burns Non-Executive Director Appointed 1.7.13 until 30.6.16 7/8 Rowena is in her 1st year with Salford Royal Joanna Bibby Non-Executive Director Appointed 1.7.13 until 30.6.16 Jo is in her 1st year with Salford Royal 5/8
Salford Royal NHS Foundation Trust - Annual Report and Accounts 2013/14 217 5 Committees of the Board of Directors
Committees of the Board of Directors The Chief Executive attends the Committee in relation The Board of Directors has established the following to discussions about Board composition, succession committees: planning, remuneration and performance of Executive Directors. The Chief Executive was not present Nominations, Remuneration and Terms of Service during discussions relating to his own performance, (NRTS) Committee. remuneration and terms of service. The Executive Audit Committee. Director of Organisational Development & Corporate Charitable Funds Committee. A"airs attended meetings as Committee Secretary, Executive Assurance and Risk Committee. and to o"er advice and guidance, but he withdraws Strategy Advisory Group. from the meeting when discussions about his/her own performance, remuneration and terms of service And other key committees, including: are held. The Trust Secretary took over as Committee Shared Services Board. (Salford Royal NHS Secretary in February 2014. Foundation Trust and Wrightington, Wigan and The committee met its responsibilities set out in its Leigh NHS Foundation Trust’s joint ventures to terms of reference by: provide sterile services and pathology services). Monitoring and evaluating the performance of Joint Research and Development Steering Group. the Chief Executive and Executive Directors. Integrated Care Board. Determining appropriate remuneration, relative to individual and Trust performance. Evaluating the balance of skills, knowledge Nominations, remuneration and terms of and experience on the Board and approving service (NRTS) committee descriptions of roles, and appointment processes, The Board of Directors has established a Nominations, for the appointment of Executive Directors. Remuneration and Terms of Service Committee. Its Implementing and keeping under review responsibilities include consideration of matters local remuneration and performance-related pertinent to the nomination, remuneration and pay/bonus arrangements for the most senior associated terms of service for Executive Directors managers (sub-Executive Director level) within (including the Chief Executive), matters associated the Trust. with the nomination of Non-Executive Directors and remuneration of senior managers/clinical leaders. The Council of Governors appointed two Non-Executive Directors during 2013/14 to the job descriptions and The Committee comprises the Trust’s Chairman and person speci#cations developed by the Board of all Non-Executive Directors of the Trust. Attendance Directors following review of the skills and expertise during 2013/14 was as follows: required by the Board. Non-Executive Directors were Mr James Potter 3/3 appointed who have the key core qualities and skills Mr John Willis 3/3 required, and the following speci#c skills: Mr Howard Forster 2/3 Strategic business skills, in particular experience Mrs Diane Brown 3/3 of developing strategic partnerships. Mrs Anne Williams 2/3 Translation of research into practice, speci#cally in terms of population health. Further information relating to the NRTS Committee can be found in the Remuneration Report.
Salford Royal NHS Foundation Trust - Annual Report and Accounts 2013/14 218 5
Audit committee Audit Committee provides an independent and objective review of the Trust’s system of integrated governance, risk management and internal control, across the whole of the organisation’s activities (both clinical and non-clinical), that supports the achievement of the Trust’s objectives. The Trust’s Non-Executive Directors (with the exception of the Chairman) are members of the Audit Committee. Attendance during 2013/14 was as follows: Mr John Willis 5/5 Mr Howard Forster 3/5 Mrs Diane Brown 4/5 Mrs Anne Williams 5/5 Mrs Rowena Burns 1/3 Dr Jo Bibby 2/3
A review of the e"ectiveness of the Audit Committee during 2013/14 has been conducted and will be reported to the Board of Directors on 2 June 2014. The Board will receive con#rmation that all aspects of Audit Utilising the work of Internal Audit, External Audit Committee’s terms of reference have been ful#lled, and Executive Governance Committees, and sought that the review has informed Audit Committee’s work reports and assurances from directors and managers programme for 2014/15 and the refreshed terms of as appropriate. (e.g. Review of Medical Investigation reference will be presented for Board approval. Unit and Salford Renal Unit, Patients Kitchen, Energy The committee met its responsibilities during 2013/14, Procurement and Theatres). signi#cant areas of work included: Reviewing the work and #ndings of the External Reviewing all risk and control related disclosure Auditor, assessing the e"ectiveness of the external statements (in particular the Annual Governance audit process. Statement), together with the accompanying Head Reviewing the Accounting Policies for 2012/13 of Internal Audit statement and External Audit Annual Accounts and the Annual Accounts (April 13). Opinion, prior to endorsement by the Board. Reviewing Salford Royal NHS Foundation Trusts CQC Reviewing the Corporate Governance Framework Compliance Framework and the 2013/14 Corporate Manual. CQC Assurance Reviews. Reviewing the 2013/14 Board Assurance Reviewing the assessment that had been undertaken Framework/Corporate Risk Register. of the Trust as a ‘going concern’ to support the Reviewing the adequacy of the policies and production of the Annual Accounts for 2012/13. procedures for all work related to fraud and Reviewing Losses and Special Payments Reports. corruption as set out in Secretary of State Directions Reviewing the 2012/13 Annual Report and Financial and as required by the Counter Fraud and Security Statements before submission to the Board. Management Service.
Salford Royal NHS Foundation Trust - Annual Report and Accounts 2013/14 219 5
Reviewing the Register of Interests for Senior The Chairman of Audit Committee regularly provides Sta" and Gifts and Hospitality Registers to ensure overview of key issues reviewed by Audit Committee compliance with the Trust’s Standards of Business to the Strategic Direction Subgroup of the Council of Conduct. Governors. During 2013 this took place in April, July, Reviewing the Clinical Audit 2012/13 Annual Report, September and December. 2013/14 Progress Report and Proposed Programme In accordance with The Code of Governance for NHS for 2014/15; received presentation of the Clinical Foundation Trusts the Council of Governors will be Audit from Division of Neurosciences and Renal consulted on the Audit Committee Terms of Reference regarding the Care of Stroke Patients. at the meeting of the Council of Governors meeting on Additionally, Audit Committee members visited 25 June 2014. the Accident and Emergency Department (A&E) The Trust has an Internal Audit function. Internal to understand causal factors related to the then Audit is an independent and objective appraisal current pressures in A&E and agreed action service which has no executive responsibilities within plans. Visited theatres to better understand the the line management structure. It pays particular improvement project and Renal Services to assess attention to any aspects of risk management, control culture and patient experience. or governance a"ected by material changes to the Trust’s risk environment, subject to Audit Committee approval. The Trust’s External Audit service is provided by Grant Thornton. Grant Thornton does not provide non-audit services to Salford Royal NHS Foundation Trust.
Salford Royal NHS Foundation Trust - Annual Report and Accounts 2013/14 220 5 NHS Foundation Trust Code of Governance
The Trust applies the main and supporting principles of the NHS Foundation Trust Code of Governance, as published by Monitor Independent Regulator of NHS Foundation Trusts.
The Board of Directors has established governance Council of Governors’ Agenda-setting process. policies that re$ect the principles of the NHS Collective Performance Evaluation mechanism for Foundation Trust Code of Governance, these include: the Council of Governors. Corporate Governance Framework Manual - Membership Development Strategy, Implementation incorporating the Standing Orders of the Board Plan and Key Performance Indicators. of Directors, Standing Orders of the Council of Governors, Scheme of Reservation and Delegation Nominations, Remuneration and Terms of Service of Powers, and Standing Financial Instructions. Committee of the Board of Directors. Established role of Senior Independent Director. Nominations, Remuneration and Terms of O!ce Committee of the Council of Governors. Regular private meeting between the Chair and the Non-Executive Directors Performance Appraisal Agreed recruitment process for Non-Executive Process for all Non-Executive Directors, including Directors. the Chairman, developed and approved by the High quality reports to the Board of Directors and Council of Governors. Council of Governors. Formal induction programme for Non-Executive Board evaluation and development plan. and Executive Directors. Council of Governors’ presentation of performance Attendance records for Directors and Governors at and achievement at Annual Members Meeting. key meetings. Code of Conduct for Governors. Comprehensive Induction Programme for Governors. Going Concern Report. Register of Interests – Directors, Governors and Robust Audit Committee arrangements. Senior Sta". Governor-led appointment process for External Council of Governors’ Policy for Raising Serious Auditor. Concerns. Whistle-blowing Policy and Counter Fraud Policy Established roles of Lead and Deputy-Lead Governor. and Plan. Monthly private meeting between the Chair and The Board of Directors conducts an annual review Governors to review matters reviewed at the Board of the Code of Governance to monitor compliance of Directors’ meetings. and identify areas for further development. Audit Comprehensive Assurance Brie#ng Report Committee reviewed the Trust’s assessment of developed by the Council of Governors and compliance for 2013/14. provided to all meetings of the Council of The Board has con#rmed that, with the exception Governors. of the following provisions the Trust complies with E"ective Council of Governors’ sub-committee the provisions of the NHS Foundation Trust Code of structure. Governance issued by Monitor that took e"ect from January 2013.
Salford Royal NHS Foundation Trust - Annual Report and Accounts 2013/14 221 5
The Trust departed from the following provisions of the of the new non-executive, and to make Code during 2013/14: recommendation for appointment to the Council of This has determined that the Trust complied with the Governors’ meeting on 6 March 2013. Code’s provisions, with the exception of: Extensive search was undertaken as speci#ed by the B.1.2: at least half the board, excluding the chair should Search Committee and shortlisting took place on comprise independent NEDs. It was necessary for 18 February 2013. Interviews were conducted on 1 the Trust to depart from this provision up until the March 2013 however, after much deliberation, the Council of Governors meeting in June 2013. From Nominations Committee were unable to select an that point forward, the Trust has fully complied with appropriate candidate to recommend to the Council this provision. of Governors for appointment. This position was reported to the Council of Governors later in March, B.7.1: In exceptional circumstances, NEDs may serve and approval was obtained for the process to be longer than six years (two three-year terms following repeated. authorisation of the FT) but subject to annual reappointment. During Q4, 2012/13, the Board had also approved a second role description and person speci#cation for a non-executive director with expertise in translating/ Balance of board members implementing research into population health. This role description/person speci#cation was presented During 2012/13, the Trust departed from provision to the Council of Governors in March 2013 and the A.3.2: at least half the board, excluding the chair should Nominations Committee was tasked to also oversee comprise independent NEDs. the recruitment of this Non-Executive Director. A dual As reported within the 2011/12 Annual Report, search was therefore conducted and shortlisting and Professor David Thompson had retired during 2011 interviews were concluded on 10th May 2013. The and the Board and Council of Governors had agreed Council of Governors approved the appointment that the vacant Non-executive Director role would of Mrs Rowena Burns and Dr Joanne Bibby as Non- not be #lled at this time, due to the $uidity associated Executive Directors at its meeting on 12 June 2013. with some developing strategic plans. In order to determine the necessary background/expertise required of a new Non-executive Director, it was also Chairman’s term of o"ce agreed that a review should take place within such a As reported within Salford Royal’s 2011/12 and timescale as to allow any appointee, as appropriate, to 2012/13 Annual Reports, the Council of Governors’ take up the position during the summer of 2012. Nominations Committee approved a further term of Robust plans were in place during Q4, 2012/13 to three years for the Chairman in March 2012, taking appoint a non-executive director. The Board had his collective term to beyond the six years (cited by reviewed its composition in October 2012 and agreed Monitor’s guidance as a point at which the need for the areas of expertise it required from in-coming progressive refreshing of the Board should be taken non-executive directors. In December 2012, the Board into account). The Nominations Committee and the approved role description and person speci#cation Council of Governors were clear that the signi#cant for a new non-executive director, with expertise in ambition of the Trust, in a current strategic climate of strategic partnership development. The Council of considerable future challenge and expected change, Governors received the role description and person warranted a vital need for stability in the leadership of speci#cation in December 2012 and tasked its the Board of Directors. Nominations Committee with the search and selection
Salford Royal NHS Foundation Trust - Annual Report and Accounts 2013/14 222 5 Remuneration Report
The Nominations, Remuneration and Terms of Service (NRTS) Committee is established by the Board of Directors to consider matters pertinent to the nomination, remuneration and associated terms of service for Executive Directors (including the Chief Executive), matters associated with the nomination of Non-Executive Directors and remuneration of senior managers/clinical leaders. The Committee met on three occasions during 2013/14. Further details about the NRTS Committee can be found within this Annual Report, within the section about Committees of the Board.
During 2013, the NRTS Committee re-stated its earlier Performance-related payments were awarded to position to freeze the basic salaries of Executive Executive Directors and to Senior Managers, in Directors for 2013/14. The Committee approved a accordance with schemes previously approved by the 1% increase for the second half of the remuneration Committee. year for senior leader salaries (excluding the executive In making its decision about rewarding performance, team). This increase was only applied to those with a twice-yearly organisational and team performance contribution rating of ‘successful’ or above. assessment currently considers the following within The Trust remuneration policy is to ensure that pay it: patient safety against national standards; #nancial should be in the upper quartile of equivalent NHS performance; and contractual obligations, along organisations and that improvements to individual with Monitor’s Compliance Framework performance remuneration should consider Trust performance measures. as a leading provider, achievement of annual plan, Currently there is no relative weighting given to these a"ordability and consideration of national issues as individual measures, however this forms part of a wide- well as personal performance, including behaviour scale review of senior manager remuneration strategy linked to the four Trust values. and practices which is currently underway. Any improvement in recurrent senior manager pay The contracts of employment for all senior managers is subject to individuals achieving at least ‘successful’ are substantive (permanent), continuation of which is contribution as de#ned by the Trust’s performance subject to regular and rigorous review of performance. management system. All such contracts contain a maximum notice period of The band maximum for the Executive team and our six months. most senior managers can only be accessed and The Council of Governors’ Nominations, Remuneration retained on the basis of high personal performance. and Terms of O!ce (NTRO) Committee recommended Directors’ remuneration is primarily determined by the a £1000 increase to the remuneration of the Senior Trust policy of upper quartile pay and a"ordability. Independent Director during 2013. An increase to Principles for wider Executive and senior manager the Chairman and general Non-Executive Director reward incentives are that they should be designed remuneration was not recommended for 2013/14 or to reward sustained high performance at a team and 2014/15 following a market review, undertaken by individual level. the NRTO Committee. These recommendations were approved by the Council of Governors at its meeting in The Trust operates a non-recurrent bonus scheme for December 2013. senior managers. Senior managers are only eligible for a payment under this scheme if they achieve at least a There were no termination payments, compensation ‘successful’ rating. payments or signi#cant awards made to senior managers in 2013/14.
Salford Royal NHS Foundation Trust - Annual Report and Accounts 2013/14 223 5
Table 1 - O"-payroll engagements as of 31 March 2014 costing more than £220 per day that have lasted for more than 6 months. The Trust has not had any new appointments in 2013/14 that reached 6 months in duration or latest longer than 6 months. The Trust does not have any board members or senior o!cials with signi#cant #nancial responsibility engaged ‘o"-payroll’.
Table 1 Number of existing arrangements as of 31 March 14 1 Number that have existed for between one and two years 1 at the time of reporting
An assessment was made that assurance was required to con#rm that the individual in the table above is paying the right amount of tax and that assurance has been sought. Where the Trust has released an Executive Director, for example to serve as a Non-executive Director elsewhere, and remuneration is provided, the Director does not retain such earnings.
Sir David Dalton Chief Executive Date: 29 May 2014
Salford Royal NHS Foundation Trust - Annual Report and Accounts 2013/14 224 5 Statement of the Chief Executive’s Responsibilities as the Accounting O!cer of Salford Royal NHS Foundation Trust
The NHS Act 2006 states that the chief executive The accounting o!cer is responsible for keeping is the accounting o!cer of the NHS Foundation proper accounting records which disclose with Trust. The relevant responsibilities of the accounting reasonable accuracy at any time the #nancial position o!cer, including their responsibility for the propriety of the NHS Foundation Trust and to enable him/her to and regularity of public #nances for which they are ensure that the accounts comply with requirements answerable, and for the keeping of proper accounts, outlined in the above mentioned Act. are set out in the NHS Foundation Trust Accounting The Accounting O!cer is also responsible for O!cer Memorandum issued by Monitor. safeguarding the assets of the NHS Foundation Under the NHS Act 2006, Monitor has directed Salford Trust and hence for taking reasonable steps for Royal NHS Foundation Trust to prepare for each the prevention and detection of fraud and other #nancial year a statement of accounts in the form irregularities. and on the basis set out in the Accounts Direction. To the best of my knowledge and belief, I have The accounts are prepared on an accruals basis and properly discharged the responsibilities set out in must give a true and fair view of the state of a"airs of Monitor’s NHS Foundation Trust Accounting O!cer Salford Royal NHS Foundation Trust and of its income Memorandum. and expenditure, total recognised gains and losses and cash $ows for the #nancial year. In preparing the accounts, the Accounting O!cer is required to comply with the requirements of the NHS Foundation Trust Annual Reporting Manual and in particular to: Sir David Dalton Chief Executive Observe the Accounts Direction issued by Monitor, including the relevant accounting and Date: 29 May 2014 disclosure requirements, and apply suitable accounting policies on a consistent basis. Make judgements and estimates on a reasonable basis. State whether applicable accounting standards as set out in the NHS Foundation Trust Annual Reporting Manual have been followed, and disclose and explain any material departures in the #nancial statements. Ensure that the use of public funds complies with the relevant legislation, delegated authorities and guidance. Prepare the #nancial statements on a going concern basis.
Salford Royal NHS Foundation Trust - Annual Report and Accounts 2013/14 225 5 Independent auditor’s report to the Council of Governors and Board of Directors of Salford Royal NHS Foundation Trust
We have audited the #nancial statements of Salford Respective responsibilities of accounting Royal NHS Foundation Trust (‘the Trust’) for the year o"cer and auditor ended 31 March 2014 which comprise the group and Trust statement of comprehensive income, the group As explained more fully in the Chief Executive’s and Trust statement of #nancial position, the group Statement, the Chief Executive as Accounting O!cer and Trust statement of cash $ows, the statement of is responsible for the preparation of the #nancial changes in taxpayers’ equity and the related notes. The statements and for being satis#ed that they give a true #nancial reporting framework that has been applied in and fair view. their preparation is the NHS Foundation Trust Annual The Accounting O!cer is responsible for the Reporting Manual issued by Monitor, the Independent maintenance and integrity of the corporate and Regulator of NHS Foundation Trusts. #nancial information on the Trust’s website. Legislation We have also audited the information in the in the United Kingdom governing the preparation and Remuneration Report that is subject to audit, being: dissemination of the #nancial statements and other information included in annual reports may di"er from The table of salaries and allowances of directors and legislation in other jurisdictions. related narrative notes. Our responsibility is to audit and express an opinion on The table of pension bene#ts of directors and the #nancial statements in accordance with applicable related narrative notes. law, the Audit Code for NHS Foundation Trusts issued The ratio of median remuneration disclosures and by Monitor, and International Standards on Auditing related narrative notes. (UK and Ireland). Those standards require us to comply with the Auditing Practices Board’s (APB’s) Ethical This report is made solely to the Council of Standards for Auditors. Governors and Board of Directors of Salford Royal NHS Foundation Trust, as a body, in accordance with Scope of the audit of the $nancial statements paragraph 24(5) of Schedule 7 of the National Health Service Act 2006. Our audit work has been undertaken An audit involves obtaining evidence about the so that we might state to the Trust’s Governors and amounts and disclosures in the #nancial statements Directors those matters we are required to state to su!cient to give reasonable assurance that them in an auditor’s report and for no other purpose. the #nancial statements are free from material To the fullest extent permitted by law, we do not misstatement, whether caused by fraud or error. This accept or assume responsibility to anyone other than includes an assessment of: whether the accounting the Trust, the Trust’s Governors as a body and the policies are appropriate to the Trust’s circumstances Trust’s Board of Directors as a body, for our audit work, and have been consistently applied and adequately for this report, or for the opinions we have formed. disclosed; the reasonableness of signi#cant accounting estimates made by the Trust; and the overall presentation of the #nancial statements. In addition, we read all the #nancial and non-#nancial information in the annual report to identify material inconsistencies with the audited #nancial statements and to identify any information that is apparently materially inconsistent with the knowledge acquired by us in the course of performing the audit. If we become aware of any apparent material misstatements or inconsistencies we consider the implications for our report.
Salford Royal NHS Foundation Trust - Annual Report and Accounts 2013/14 226 5
Opinion on the $nancial statements Matters on which we are required to report In our opinion the #nancial statements: by exception Give a true and fair view of the state of the #nancial We have nothing to report in respect of the following position of the group and Salford Royal NHS matters where the Audit Code for NHS Foundation Foundation Trust as at 31 March 2014 and of the Trusts requires us to report to you if, in our opinion: Trust’s and the group’s income and expenditure for The Annual Governance Statement does not meet the year then ended; and the disclosure requirements set out in the NHS Have been properly prepared in accordance with the Foundation Trust Annual Reporting Manual or is NHS Foundation Trust Annual Reporting Manual and misleading or inconsistent with information of the directions under paragraph 25(2) of Schedule 7 which we are aware from our audit. of the National Health Service Act 2006. We have not been able to satisfy ourselves that the Trust has made proper arrangements for securing economy, e!ciency and e"ectiveness in its use of Opinion on other matters prescribed by the resources. Audit Code for NHS Foundation Trusts The Trust’s Quality Report has not been prepared In our opinion: in line with the requirements set out in the NHS The part of the Remuneration Report subject to Foundation Trust Annual Reporting Manual or is audit has been properly prepared in accordance inconsistent with other sources of evidence. with paragraph 25 of Schedule 7 of the National Health Service Act 2006 and the NHS Foundation Certi$cate Trust Annual Reporting Manual 2013/14 issued by Monitor. We certify that we have completed the audit of the #nancial statements of Salford Royal NHS Foundation The information given in the annual report for the Trust in accordance with the requirements of Chapter #nancial year for which the #nancial statements are 5 of Part 2 of the National Health Service Act 2006 and prepared is consistent with the #nancial statements. the Audit Code for NHS Foundation Trusts issued by Monitor.
Sarah Howard for and on behalf of Grant Thornton UK LLP 4 Hardman Square Spinning!elds, Manchester, M3 3EB
Date: 29 May 2014
Salford Royal NHS Foundation Trust - Annual Report and Accounts 2013/14 227 6 Financial Review
228 6
Introduction Performance compared to annual plan The Trust has again continued with its excellent targets - Continuity of Service Risk Rating #nancial management track record of delivery against (CoSRR) plans by posting a normalized surplus of £6.0 million Rating for Weighting Planned Actual Actual Risk compared to the planned level of £2.7 million. This March 2014 Result Result Score is against the back drop of continued public sector Debt service cover 50% 1.74 1.95 3 expenditure restraint at a time when the NHS is required to deliver increases in the quality and safety Liquidity 50% 4.40 13.90 4 of patient care. Overall actual CoSRR score 4 Planned CoSRR 3 Summary of performance The following are the main headlines of #nancial Statement of comprehensive income position performance for the Salford Royal in 2013/14. This statement within the Annual Accounts shows the The underlying “trading” surplus (after adjusting total value of Income and Expenditure for the year for impairment charges and non-operating ended 31 March 2014. The following table summarises transactions) is a surplus of £6.0 million which is the actual income and expenditure performance as at £3.3 million better than planned. the 31 March 2014. The overall income and expenditure position Actual Results shows a surplus of £14.0 million, but this is after £000’s accounting for a number of non-operational Income 449,480 items into the Trust surplus, which are set out in Expenditure (421,319) the section below. EBITDA 28,161 The #nancial risk rating (Continuity of Pro!t / (loss) on asset disposals - Service Risk Rating - CoSRR) using Monitor’s Exceptional Income / costs and impairment charges 4,871 methodology (as set out in the Compliance Depreciation and amortisation (9,881) Framework 2013/14) to assess the level of Total interest receivable / (payable) (7,100) #nancial risk based on the position as at the end Unwinding of discount on provisions (44) of March 2014 is a 4. PDC dividends (2,003) Salford Royal as a Foundation Trust submits its Annual Net Surplus (as per Annual Accounts) 14,004 Plan to Monitor at the start of the #nancial year which Normalising Adjustments sets out detailed #nancial plans for the year in line Net impairments and accelerated depreciation of (4,871) with Monitor’s compliance regime. The following table non-current assets summarises the performance against the plan for the Hosted services non-operating income and (3,123) Continuity of Service Risk Rating (COSRR) in 2013/14. expenditure adjustment Underlying Surplus 6,010
Salford Royal NHS Foundation Trust - Annual Report and Accounts 2013/14 229 6
Normalising adjustments The Foundation Trust has an underlying trading The #nancial performance of the Advancing Quality surplus of £6.0 million, which has come from the Alliance is entirely separate from the operational delivery of operational healthcare services. Whilst #nancial performance of Salford Royal and, as such, its the “bottom line” of the Annual Accounts show a net #nancial results excluded from the reported underlying surplus of £14.0 million this is due to the charging at performance of the operational element of Salford non-operating income and expenditure items during Royal. the year which need to be removed from the #nancial results (“normalised”) when assessing the Foundation Trust’s performance against the Monitor #nancial regime to identify the underlying “trading” surplus achieved by Salford Royal from operating activities i.e. the provision of healthcare. Trust income The #rst non-operating income and expenditure Salford Royal receives the majority of its income for adjustment (normalising adjustment) made to the the delivery of patient care (£383 million - 83%) from results reported in the Statement of Comprehensive commissioners of NHS services (predominantly Clinical Income is to exclude the impact of impairment charges Commissioning Groups), of this total, Salford Royal recognised in the Annual Accounts in respect of land received £133 million during the year from its lead and building assets. Salford Royal accounting policies commissioner, NHS Salford. require that land and building assets are revalued In addition Salford Royal received £67 million for the with su!cient regularity to ensure that the carrying delivery of non-patient care services, with £22.8 million amounts are not materially di"erent to those that (29%) coming from the Health Education England to would be determined at the end of the reporting period support the costs of providing education and training following a valuation. Owing to indications that market to NHS sta". In the year Salford Royal also received conditions have changed since the end of the last income of £13.3 million in respect of Research and #nancial year, the Valuation O!ce was commissioned Development activities. to undertake a ‘desktop’ revaluation of the Salford Royal Salford Royal’s income from the provision of goods land and building assets. The outcome of the valuation and services for the purposes of the health service was an overall increase in the value of our asset base in 2013/14 (commissioner requested services) was and an exceptional net bene#t of £4.8 million was £380 million. This compares to £3.4 million received recorded in the Statement of Comprehensive Income. for other patient care activities i.e. private patients, There was also an associated £4.4 million net increase overseas visitor charges and compensation paid by the in the balances recorded in the revaluation reserve as a NHS Injury Costs Recovery Scheme to Salford Royal result of an upward revaluation. for treatment costs for patients who have sustained The second non-operating income and expenditure injuries and claim and receive personal injury adjustment (normalising adjustment) made is to compensation. remove from the #nancial results the £3.1 million Income from the provision of goods and services for surplus generated by services hosted by Salford Royal the health service represents over 99% of Salford - predominantly the Advancing Quality Alliance which Royal’s total income. Income from non-mandatory is a health care quality improvement body hosted by patient care activities at under 1% of the total is Salford Royal but funded by its members who include: reinvested in health services for Salford. Foundation Trusts, Mental Health Trusts and Clinical Commissioning Groups.
Salford Royal NHS Foundation Trust - Annual Report and Accounts 2013/14 230 6
The following graph sets out the income received by The #nancial performance reported in 2013/14 the Trust during the #nancial year. includes the successful delivery of the Foundation Trust’s Safely Reducing Costs programme delivering savings of £19.1 million during the year. The over- 3% 5% 3% riding aim of the programme is to reduce costs without 3% 4% reducing the high quality of care provided to our patients. The following graph sets out the major headings of operating expenses for the Trust. 1% 3% 6% 4% 8%
82% 16%
Clinical Commissioning Groups Other income for patient care and NHS England services Research & Development Education and training 62% Income received on behalf of Other operating income hosted services
Employee costs including Supplies and services - drugs costs Operating expenses Research & Development sta" The Trust employs in excess of 6,224 whole-time Supplies and services - Other supplies and services clinical supplies equivalent sta" and expenditure on pay costs Research & Development Services from other NHS bodies (including directors costs) is the single largest item of including the NHSLA Other expenses expenditure for the Trust, with £259.1 million spent during the year representing 61% of total operating expenses. Of the non-pay related expenditure, drugs costs accounts for £65.6 million of the total £421.3 million spent (15% of operating expenses), with expenditure on clinical supplies the next biggest item of spend at £34.3 million (8% of operating expenses).
Salford Royal NHS Foundation Trust - Annual Report and Accounts 2013/14 231 6
Jointly controlled operations Salford Royal is a party to two jointly controlled operations (i.e. an arrangement is established without the Heading £m’s Description creation of a separate corporate entity) with the purpose New Theatres 5.3 The provision of three additional theatres to enable the Trust to deliver additional Surgical to deliver NHS services. Salford Royal has a 50% activity and allow for decanting to enable interest in each jointly controlled asset and these are: maintenance of existing Theatres. Sterile Services Decontamination Unit jointly IM&T Investments 3.0 The Trust continues to invest in its IM&T infrastructure to enable high quality clinical controlled with Wrightington, Wigan and Leigh services, including £1.3 m further investment NHSFT that cleans and sterilises reusable medical in Electronic Patient Record, £0.7 m to equipment on behalf of the two Foundation facilitate Bed Side recording of data, plus further investment in Infrastructure £1.0 m. Trusts. Medical Equipment 2.6 Additional investment in the Medical Pathology At Wigan and Salford (PAWS) jointly Equipment infrastructure across the Trust, including the replacement programme controlled with Wrightington, Wigan and Leigh managed by the Medical Equipment Committee NHS Foundation Trust to provide pathology £1.2 m, additional radiology equipment £0.9 m, services to the two Foundation Trusts. plus other smaller items £0.5 m. Backlog 1.5 Investments in ensuring the site infrastructure Salford Royal’s share of the costs of each of these Maintenance remains in safe working order including lift jointly controlled operations is included in the upgrades and corridor refurbishments. operating #nancial results reported in the Annual Other Schemes 3.1 Other schemes with a value not exceeding Accounts. £0.5 m. Total Expenditure 15.5 Capital expenditure investments Salford Royal has continued to invest in its estate and equipment assets with another comprehensive capital Liquidity and short term investments investment programme for 2013/14. Salford Royal’s cash balance remains strong at Capital expenditure totalled £15.5 million in 2013/14, £56 million at the #nancial year end, with interest the table below summarises the main themes of receivable of £0.1 million earned (compared to £0.2 capital expenditure across the Trust in 2013/14. million in 2012/13). The interest received total remains low entirely due to the current economic conditions The capital programme was funded by a combination and the low rates of interest being o"ered by low risk of Salford Royal own internally generated funds, and investment organisations, including the High Street a loan from the Foundation Trust Financing Facility Banks and the National Loans Fund. The Trust currently of £10 m, the balance of this loan will be invested in holds the majority of its cash within the Government capital assets in 2014/15. Banking Service (GBS). The following table sets out the key themes of investments made in capital assets during 2013/14 with a brief description of the development activities.
Salford Royal NHS Foundation Trust - Annual Report and Accounts 2013/14 232 6
Accounting policies Audit information Salford Royal reviews its accounting policies on As far as the Directors are aware, there is no relevant a regular basis following the requirements of audit information of which the auditors are unaware. International Financial Reporting Standards and The Directors have taken all of the steps that they Monitor’s Annual Reporting Manual. These policies ought to have taken as Directors in order to make are discussed and agreed by the Audit Committee themselves aware of any relevant audit information and re$ect the changing nature of the guidance and and to establish that the auditors are aware of that the external environment within which Salford Royal information. functions.
Salford Royal’s key accounting policies are set out Cost allocation and charging from page 242 of the annual accounts included in this report. There were only minor changes made Salford Royal has complied with the cost allocation to the accounting policies during 2013/14 and all and charging requirements set out in HM Treasury and of the changes implemented were in line with the O!ce of Public Sector Information guidance. Foundation Trust Annual Reporting Manual (FT ARM). Accounting policies for pensions and other retirement A look forward bene#ts are set out in a note to the accounts (note 1.7) and details of senior employees’ remuneration can be The #nancial outlook for the NHS as whole continues found on pages 263 to 266 of the annual accounts. to be a di!cult one given the continued requirement by the Government to reduce public expenditure. Even though Health Spending is protected, costs within the Going concern sector will continue to rise above the funded levels. Couple this with the increase in demand for NHS Salford Royal has prepared its 2013/14 Annual services and this provides a backdrop of cost savings at Accounts on the basis of being a going concern. After a time when standards of care are required to rise. making enquiries, the directors have a reasonable expectation that Salford Royal has adequate resources The Trust has submitted its Annual Plan to Monitor to continue in operational existence for the foreseeable that covers the #nancial years 2014/15 and 2015/16, future. For this reason, they continue to adopt the and the Trust is planning a surplus of circa £2.5 million going concern basis in preparing the accounts. in both years. To help achieve these results the Trust is planning a Safely Reducing Costs programme of £20 million per annum to ensure that #nancial plans are Post balance sheet events achieved and that investment in front line services are enhanced where required. There are no signi#cant post balance sheet events. Investment will continue in the Trust’s asset base with the investment of circa £24 million in 2014/15 and £18 million in 2015/16. This will predominantly be investments in upgrading the clinical facilities, the maintenance and upkeep of the buildings along with purchase of new medical equipment.
Salford Royal NHS Foundation Trust - Annual Report and Accounts 2013/14 233 6 Foreword to the Accounts
Salford Royal NHS Foundation Trust The Annual Accounts of Salford Royal NHS Foundation Trust for the year ended 31 March 2014. Prepared in accordance with paragraphs 24 and 25 of Schedule 7 to the National Health Service Act 2006.
Sir David Dalton Chief Executive Date: 29 May 2014
Salford Royal NHS Foundation Trust - Annual Report and Accounts 2013/14 234 6 Accounts for the Period 1 April 2013 to 31 March 2014
Statement of comprehensive income for the year ended 31 March 2014 for Salford Royal NHS Fundation Trust and Salford Royal NHS Foundation Trust General Charitable Fund 2013/14 2013/14 Trust - pre- Trust - pre- Note consolidation Consolidated consolidation Consolidated £000 £000 £000 £000 Operating income from patient care activities 3 382,972 382,972 363,469 363,469 Other operating income 4 66,507 66,715 65,796 65,968 Operating expenses - excluding impairments and accelerated depreciation 7 (431,200) (431,614) (410,309) (410,753) Upward revaluation of building assets 11,007 11,007 0 0 Impairments and accelerated depreciation charged to the Statement of (6,136) (6,136) (14,729) (14,729) Comprehensive Income Operating surplus/(de$cit) 23,150 22,944 4,226 3,954 Finance costs: Finance income 13 124 239 165 268 Finance expense - #nancial liabilities 14 (7,224) (7,224) (5,619) (5,619) Finance expense - unwinding discount on provisions 28 (44) (44) (65) (65) Public dividend capital dividends payable 33 (2,003) (2,003) (1,796) (1,796) Net $nance costs (9,147) (9,032) (7,315) (7,212) Surplus/(De$cit) for the year 14,003 13,912 (3,089) (3,258) Other comprehensive income Gain/(loss) from transfer by modi#ed absorption from demising bodies 380 380 0 0 Impairments charged to the Revaluation Reserve (58) (58) (2,439) (2,439) Revaluations charged to the Revaluation Reserve 4,153 4,153 744 744 Other reserve movements (55) (55) 0 0 Sub-total other comprehensive income 4,420 4,420 (1,695) (1,695) Fair value gain / (loss) on available for sale #nancial investments held by 0 226 0 383 the Charitable Funds Total other comprehensive income / (expense) for the period 4,420 4,646 (1,695) (1,312) Total comprehensive expense for the year 18,423 18,558 (4,784) (4,570)
The Trust (excluding the #nancial results of the charitable fund) has an underlying trading surplus of £6,010k in 2013/14 (£7,496k in 2012/13) as follows:
£000 Trust surplus for the year 14,003 Less: revaluation, accelerated depreciation and impairment charges reported as operating income / expenditure (4,871) Deduct surpluses reported by hosted organisations (3,123) Underlying surplus for 2013/14 6,010
The group results including the Foundation Trust and Charitable Fund are from continuing operations and the results are wholly attributable to the parent organisation, Salford Royal NHS Foundation Trust. The Trust is corporate trustee of the Salford Royal NHS Charitable Fund and has control over and bene!ts from the charity which makes the charitable fund a subsidiary of the Trust. As such, the !nancial results for the charity for the year ended 31 March 2014 have been consolidated into the Foundation Trust’s !nancial statements for the same period. In previous years, HM Treasury has granted dispensation to NHS Foundation Trusts that meant charitable funds did not require consolidation; this dispensation is no longer available with e"ect from 1 April 2013. This represents a change in the Foundation Trust’s accounting policies and the 2012/13 accounts have been restated to show the impact of consolidating the charitable fund in last year’s !nancial statements. A summary statement of the charity’s statement of !nancial activities and statement of !nancial position are provided on page 240. The notes on pages 242 to 295 form part of these accounts. The totals in the notes show the detail of the consolidated group position including both the Foundation Trust and the charity !nancial results.
Salford Royal NHS Foundation Trust - Annual Report and Accounts 2013/14 235 6
Statement of $nancial position as at 31 March 2014
2013/14 2012/13 1 April 2012 Trust - pre- Trust - pre- Trust - pre- Note consolidation Consolidated consolidation Consolidated consolidation Consolidated £000 £000 £000 £000 £000 £000 Non-current assets Intangible assets 15 5,284 5,284 1,638 1,638 2,191 2,191 Property, plant and equipment 16 222,778 222,778 210,132 210,132 211,260 211,260 Other investments 18.1 0 4,163 0 3,957 0 3,592 Trade and other receivables 21 1,657 1,657 1,236 1,236 1,439 1,439 Total non-current assets 229,719 233,882 213,005 216,962 214,890 218,482 Current assets Inventories 19 3,528 3,528 3,819 3,819 3,390 3,390 Trade and other receivables 21 31,320 30,896 23,488 23,467 20,745 20,696 Cash and cash equivalents 22 55,981 56,374 45,055 45,144 53,836 54,164 Total current assets 90,829 90,798 72,362 72,430 77,971 78,250 Current liabilities Trade and other payables 23 (49,366) (49,388) (36,226) (36,270) (42,929) (43,026) Borrowings 24 (3,627) (3,627) (3,061) (3,061) (3,504) (3,504) Provisions 28 (2,782) (2,782) (3,091) (3,097) (3,097) (3,110) Tax and Social Security 23 (5,070) (5,070) (4,722) (4,722) (4,230) (4,230) Other liabilities 25 (9,158) (9,158) (11,792) (11,792) (16,232) (16,232) Total current liabilities (70,003) (70,025) (58,892) (58,942) (69,992) (70,102) Total assets less current liabilities 250,545 254,655 226,475 230,450 222,869 226,630 Non-current liabilities Trade and other payables 23 (699) (699) (699) (699) (699) (699) Borrowings 24 (120,871) (120,871) (114,531) (114,531) (108,360) (108,360) Provisions 28 (5,497) (5,497) (4,819) (4,819) (3,631) (3,631) Other liabilities 25 0 0 (2,090) (2,090) (1,059) (1,059) Total non-current liabilities (127,067) (127,067) (122,139) (122,139) (113,749) (113,749) Total assets employed 123,478 127,588 104,336 108,311 109,120 112,881 Financed by taxpayers’ equity: Public dividend capital 115,045 115,045 114,326 114,326 114,326 114,326 Revaluation reserve 29 26,200 26,200 22,081 22,081 23,825 23,825 Income and expenditure reserve (17,767) (17,767) (32,071) (32,071) (29,031) (29,031) Sub-total Taxpayers’ Equity 123,478 123,478 104,336 104,336 109,120 109,120 Charitable Funds 0 4,110 0 3,975 0 3,761 Total Taxpayers’ Equity and Charitable Funds 123,478 127,588 104,336 108,311 109,120 112,881
The #nancial statements on pages 242 to 295 were approved by the Audit Committee with delegated authority from the Board of Directors on 23 May 2014 and signed on its behalf by: Sir David Dalton Chief Executive Date: 29 May 2014
Salford Royal NHS Foundation Trust - Annual Report and Accounts 2013/14 236 6
Statement of changes in taxpayers’ equity
Public Income & NHS Dividend Expenditure Revaluation Charitable Capital (PDC) Reserve Reserve Fund Reserve Total £000 £000 £000 £000 £000 Taxpayers’ equity at 1 April 2013 114,326 (32,071) 22,081 3,975 108,311 Surplus / (de#cit) for the year 0 14,003 0 15 14,018 Transfers by modi#ed absorption - gains on 1 April 2013 transfers 0 380 0 0 380 from demising bodies (Salford PCT) Transfers by modi#ed absorption - between reserves 0 (57) 57 0 0 Public Dividend Capital received 768 0 0 0 768 Public Dividend Capital adjustment - PCT asset transfers (49) 0 0 0 (49) Impairments 0 0 (58) 0 (58) Revaluations 0 0 4,153 0 4,153 Asset disposals 0 0 0 0 0 Receipt of assets from Salford PCT on 1 April 2013 0 0 0 0 0 Recognition of revaluation reserve associated with assets received 0 0 0 0 0 from Salford PCT Fair values gain / (loss) on available for sale #nancial investment 0 0 0 226 226 Other reserve movements 0 (22) (33) 0 (55) Charitable funds consolidation adjustment 0 0 0 (106) (106) Balance at 31 March 2014 115,045 (17,767) 26,200 4,110 127,588
The Public Dividend Capital (PDC) Reserve represents the value of the Government’s shareholding in the Foundation Trust for which it receives an annual dividend payment. New PDC was received during 2013/14 of £768k following a successful bid to the NHS England Nursing Technology Fund for capital funding to support the costs of providing enhanced in-patient observation. The Income and Expenditure Reserve records the annual surplus or de#cit of the Foundation Trust on a cumulative basis. The Revaluation Reserve records increases in fair value of non-current assets owned by the Foundation Trust. Gains from increases in values of non-current assets are recorded in reserves and not recognised as a source of income through the Statement of Comprehensive Income. If an asset that has previously experienced a revaluation gain is subsequently subject to a downward valuation, then that downward valuation is charged to the Revaluation Reserve to the extent that there is a balance in the Reserve for that particular asset. Any further reductions in value are then charged to the Statement of Comprehensive Income as an impairment charge. On 1 April 2013, non-current equipment assets used to support provision of community-based health care services valued at £324k were transferred from Salford PCT to the Trust to complete the transfer of community services from Salford PCT. The community services functions transferred to the Trust on 1 April 2011. The e"ect on the Trust’s #nancial statements is to increase the value of property, plant and equipment reported on the Statement of Financial Position by £324k, to increase depreciation reported on the Statement of Comprehensive Income by £216k and to increase reserves as shown above by £324k.
Salford Royal NHS Foundation Trust - Annual Report and Accounts 2013/14 237 6
Statement of changes in taxpayers’ equity
Public Income & NHS Dividend Expenditure Revaluation Charitable Capital (PDC) Reserve Reserve Fund Reserve Total £000 £000 £000 £000 £000 Taxpayers’ equity at 1 April 2012 114,326 (29,031) 23,825 0 109,120 Prior period adjustment - consolidate Charitable fund 0 0 0 3,761 3,761 Changes in taxpayers’ equity for 2012/13 114,326 (29,031) 23,825 3,761 112,881 Surplus / (de#cit) for the year 0 (3,090) 0 (48) (3,138) Impairments 0 0 (2,439) 0 (2,439) Revaluations 0 0 744 0 744 Asset disposals 0 4 (4) 0 0 Fair values gain / (loss) on available for sale #nancial investment 0 0 0 383 383 Other reserve movements 0 45 (45) 0 0 Charitable funds consolidation adjustment 0 0 0 (121) (121) Balance at 31 March 2013 114,326 (32,071) 22,081 3,975 108,311
Salford Royal NHS Foundation Trust - Annual Report and Accounts 2013/14 238 6
Statement of cash !ows for the year ended 31 March 2014
2013/14 2012/13 Trust - pre- Trust - pre- Note consolidation Consolidated consolidation Consolidated £000 £000 £000 £000 Cash !ows from operating activities Operating surplus / (de#cit) from continuing operations 23,150 22,944 4,226 3,954 Non cash and income expense Depreciation and amortisation 7 13,088 13,088 9,985 9,985 Impairments 7 2,929 2,929 14,729 14,729 Reversals of impairments (11,007) (11,007) 0 0 Gain / (loss) on disposal of assets 0 0 11 11 (Increase)/decrease in trade and other receivables (8,620) (8,207) (2,539) (2,585) (Increase)/decrease in inventories 291 291 (429) (429) Increase/(decrease) in trade and other payables 13,617 13,617 (5,468) (5,468) Increase/(decrease) in other liabilities (4,725) (4,725) (3,409) (3,409) Increase/(decrease) in provisions 325 325 1,117 1,117 NHS charitable funds net adjustments for working capital 0 (38) 0 (42) movements, non-cash transactions and non-operating cash$ows Other movements in operating cash$ow 0 0 12 12 Net cash generated from operating activities 29,049 29,217 18,235 17,875 Cash !ows from investing activities Interest received 124 124 150 150 Purchase of intangible assets (2,020) (2,020) 0 0 Purchase of property, plant and equipment (14,992) (14,992) (16,265) (16,265) Charitable funds net cash $ows from investments 0 135 0 121 Net cash generated (used in) investing activities (16,888) (16,753) (16,115) (15,994)
Cash !ows from $nancing activities Public dividend capital received 768 768 0 0 Public dividend capital adjustment - PCT asset transfers (49) (49) 0 0 Loans received from the Foundation Trust Financing Facility 10,000 10,000 0 0 Capital element of PFI obligations (3,094) (3,094) (3,489) (3,489) Interest paid on loans received from the Foundation Trust (56) (56) 0 0 Financing Facility Interest element of PFI obligations (7,168) (7,168) (5,620) (5,620) PDC dividend paid (1,636) (1,636) (1,792) (1,792) Net cash (used in) $nancing activities (1,235) (1,235) (10,901) (10,901) Net increase/(decrease) in cash and cash equivalents 10,926 11,229 (8,781) (9,020) Cash and cash equivalents at the 1 April 2013 45,055 45,144 53,836 54,164 Cash and cash equivalents at the 31 March 2014 22 55,981 56,374 45,055 45,144
Salford Royal NHS Foundation Trust - Annual Report and Accounts 2013/14 239 Consolidation of NHS charitable funds
Following removal of HM Treasury’s dispensation in 2013/14 allowing the Trust to not consolidate its charitable funds, the #nancial results of the Charity have been consolidated. As this is a change to accounting policy, in accordance with IAS8, the Trust’s opening statement of #nancial position has been restated and prior-year comparatives provided in these accounts. Provided below is the Charitable Fund’s statement of #nancial activities and statement of #nancial position before consolidation. A reconciliation of the amounts included in the Charity’s #nancial statements to those disclosed in these consolidated accounts is also provided below.
Salford Royal NHS Foundation Trust charitable fund statement of #nancial activities for the year ended 31 March 2014 Unrestructed Restricted Endowment Total Funds Total Funds Notes Funds Funds Funds 2013/14 2012/13 £000 £000 £000 £000 £000 Incoming resources Incoming resources from generated funds: Voluntary income: Donations 210 0 0 210 187 Legacies 84 0 0 84 60 Total voluntary income 294 0 0 294 247 Investment income 115 0 0 115 103 Other incoming resources 20 0 0 20 46 Total incoming resources 429 0 0 429 396 Resources expended Costs of generated funds: Investment management costs (24) 0 0 (24) (23) Charitable activities: Research (234) 0 0 (234) (225) Purchase of equipment (40) 0 0 (40) (94) Sta" education and welfare (187) 0 0 (187) (195) Patient education and welfare (17) 0 0 (17) (10) Direct charitable expenditure (478) 0 0 (478) (524) Governance costs: (18) 0 0 (18) (18) Total resources expended (520) 0 0 (520) (565) Net expenditure for the year before transfers (91) 0 0 (91) (169) Net (outgoing) resources before recognised gains and (91) 0 0 (91) (169) losses Realised and unrealised gains (losses) on investment assets 226 0 0 226 383 Net movement in funds 135 0 0 135 214 Reconciliation of funds Funds brought forward 3,942 22 11 3,975 3,761 Total funds carried forward 4,077 22 11 4,110 3,975
Salford Royal NHS Foundation Trust - Annual Report and Accounts 2013/14 240 Consolidation of NHS charitable funds
Salford Royal NHS Foundation Trust charitable fund statement of #nancial position for the year ended 31 March 2014 Unrestructed Restricted Endowment Funds Funds Funds Total Funds Total Funds Total Funds Notes 2013/14 2013/14 2013/14 2013/14 2013/14 1 April 2012 £000 £000 £000 £000 £000 £000 Fixed assets Investments 4,152 0 11 4,163 3,957 3,592 Total $xed assets 4,152 0 11 4,163 3,957 3,592 Current assets Debtors 34 0 0 34 24 42 Cash at bank and in hand 371 22 0 393 89 328 Total current assets 405 22 0 427 113 370 Current liabilities Creditors: Amounts falling due within one year (480) 0 0 (480) (89) (188) Provisions 0 0 0 0 (6) (13) Net current assets (75) 22 0 (53) 18 169 Total assets less current liabilities 4,077 22 11 4,110 3,975 3,761 Net assets 4,077 22 11 4,110 3,975 3,761 The funds of the charity Endowment funds 0 0 11 11 11 11 Restricted 0 22 0 22 22 28 Unrestricted 4,077 0 0 4,077 3,942 3,722 Total funds 4,077 22 11 4,110 3,975 3,761
Reconciliation of the charitable fund #nancial statements to the amounts consolidated
31 March 31 March Statement of Financial Activities 2014 2013 Total resources expended (520) (565) Expended with Salford Royal NHS Foundation Trust 106 121
Disclosed in Consolidated Accounts (414) (444)
31 March 31 March 1 April Statement of Financial Position 2014 2013 2012 Creditors: amounts falling due within one year (480) (89) (201) Due to Salford Royal NHS Foundation Trust 458 45 91
Disclosed in Consolidated Accounts (22) (44) (110)
Salford Royal NHS Foundation Trust - Annual Report and Accounts 2013/14 241 6 Notes to the Accounts
1 Accounting policies Where the transferring body recognised revaluation reserve balances attributable to the assets, the Trust 1.1 Accounting policies makes a transfer from its income and expenditure These accounts are prepared on a going concern basis. reserve to its revaluation reserve to maintain transparency within public sector accounts. Monitor has directed that the #nancial statements of NHS Foundation Trusts shall meet the accounting requirements of the Foundation Trust Annual 1.4 Critical accounting judgements and key Reporting Manual (FT ARM) which shall be agreed with sources of estimation uncertainty HM Treasury. Consequently, the following #nancial In the application of the Foundation Trust’s accounting statements have been prepared in accordance with the policies, management is required to make judgements, Foundation Trust ARM 2013/14 issued by Monitor. The estimates and assumptions about the carrying amounts accounting policies contained in that manual follow of assets and liabilities that are not readily apparent International Financial Reporting Standards (IFRS) and from other sources. The estimates and associated HM Treasury’s Financial Reporting Manual (FReM) to assumptions are based on historical experience and the extent that they are meaningful and appropriate other factors that are considered to be relevant. to NHS Foundation Trusts. The accounting policies Actual results may di"er from those estimates and the have been applied consistently in dealing with items estimates and underlying assumptions are continually considered material in relation to the accounts. reviewed. Revisions to accounting estimates are recognised in the period in which the estimate is revised 1.2 Accounting convention if the revision a"ects only that period or in the period These accounts have been prepared under the of the revision and future periods if the revision a"ects historical cost convention modi#ed to account for both current and future periods. the revaluation of property, plant and equipment, Critical judgements in applying accounting policies intangible assets, inventories and certain #nancial assets and #nancial liabilities. Estimates and judgements have to be made in preparing the Foundation Trust’s annual accounts. These are 1.3 Transfers of functions from other NHS bodies continually evaluated and updated as required, For functions that have been transferred to the although actual results may di"er from these estimates. Foundation Trust from another NHS organisation , Key judgements the assets and liabilities transferred are recognised Going concern in the accounts as at the date of transfer. The assets and liabilities are not adjusted to fair value prior to IAS1 requires management to assess as part of the recognition. The net gain or loss corresponding to the accounts preparation process the Foundation Trust’s net assets or liabilities transferred is recognised within ability to continue as a going concern. This is a the Statement of Comprehensive Income but not within judgement made by Foundation Trust management operating activities. The net gain or loss corresponding that these accounts are prepared on a going concern to the net assets transferred from Salford PCT is basis. recognised within the income and expenditure reserve. Other For property plant and equipment assets and Key judgements made in preparing these accounts intangible assets, the cost and accumulated include the application of the accounting policies depreciation or amortisation balances from the set out on pages 242 to 255 of these accounts in the transferring entity’s accounts are preserved on recognition of transactions, assets and liabilities for the recognition in the Foundation Trust’s accounts. purposes of preparing these accounts.
Salford Royal NHS Foundation Trust - Annual Report and Accounts 2013/14 242 6
Key sources of estimation uncertainty Partially completed spells at the reporting date The following are the key assumptions concerning the Income relating to in-patient care spells that are part- future, and other key sources of estimation uncertainty completed at the year end are apportioned across the at the end of the reporting period, that have a #nancial years on the basis of length of stay at the end signi#cant risk of causing a material adjustment to the of the reporting period compared to expected total carrying amounts of assets and liabilities within the length of stay. This is based on estimated length of next #nancial year. stay data that applies to the types of clinical activity being undertaken on an in-patient basis as at the Valuation of property, plant and equipment reporting date and totals £1,211k as at 31 March 2014 As at 31 March 2014, the Valuation O!ce Agency (£1,206k as at 31 March 2013). The estimated length of provided a valuation of the Foundation Trust’s land stay and the type of in-patient clinical activity may vary and building assets (estimated #nancial value and materially from one balance sheet date to another. estimated remaining useful life) applying a modern equivalent asset method of valuation. This valuation, Actuarial assumptions for costs relating to the NHS based on estimates provided by a suitably quali#ed pension scheme professional, led to a material reduction in the reported The Foundation Trust reports, as operating value of the Foundation Trust’s land and building expenditure, employer contributions to sta" pensions. asset values. As a result, the carrying value of the This employer contribution is based on an annual Foundation Trust’s building assets has been amended actuarial estimate of the required contribution to meet with a net overall increase of £8,966k. Future the scheme’s liabilities. It is an expense that is subject revaluations of the Foundation Trust’s asset base may to change. The current employer contribution is 14% result in further material changes to the carrying value of pensionable pay as set out in note 10 on page 264. of non-current assets. Accruals for income and expenditure not invoiced at Equipment assets are carried at fair value, with the reporting date depreciated historic cost used as a proxy for fair value. At the end of the #nancial year, the Foundation Trust Financial value of provisions for liabilities and charges may have received goods and services which have The Foundation Trust makes #nancial provision not been invoiced at the balance sheet date. In these for obligations of uncertain timing or amount at circumstances, an estimated value of the cost is the reporting date. These are based on estimates included in the Foundation Trust’s reported #nancial using as much relevant information as is available results. In some cases the estimated value is based on at the time the accounts are prepared. They are the quoted value provided by the supplier when the reviewed to con#rm that the values included in the goods were ordered; in other cases, the charge may be #nancial statements best re$ect the current relevant estimated based on methods such as the number of information. Where this is not the case, the value of hours of service provided or the last price paid for the the provision is amended. The current provisions are same goods or service. set out in note 278 on page 286 of these accounts. Accrual for annual leave not taken by sta" at the reporting date The Trust has a #nancial liability for any annual leave earned by sta" but not taken by 31 March to the extent that sta" are able to carry forward untaken leave into the next #nancial year. The estimated cost of untaken annual leave at 31 March 2014 including annual leave entitlement for sta" on maternity leave is £953k (£933k at 31 March 2013).
Salford Royal NHS Foundation Trust - Annual Report and Accounts 2013/14 243 6
1.5 Income Pension costs - NHS Pension Scheme Income in respect of services provided is recognised Past and present employees are covered by the when, and to the extent that, performance occurs, provisions of the NHS Pension Scheme. The scheme and is measured at the fair value of the consideration is an unfunded, de#ned-bene#t scheme that covers receivable. The main source of income for the NHS employers, General Practices and other bodies, Foundation Trust is from commissioners for healthcare allowed under the direction of the Secretary of State, services. Income relating to patient care spells that are in England and Wales. The scheme is not designed part-completed at the year end are apportioned across to be run in a way that would enable an NHS body to the #nancial years on the basis of length-of-stay at the identify its share of the underlying scheme liabilities. end of the reporting period compared to expected Therefore, the scheme is accounted for as if it were total length of stay. a de#ned-contribution scheme: the cost to the NHS body of participating in the scheme is taken as equal Where income is received for a speci#c activity that is to the contributions payable to the scheme for the to be delivered in the following year, that income is accounting period. deferred. Employers pension cost contributions are charged to Income from the sale of non-current assets is operating expenses as and when they become due. recognised only when all material conditions of sale have been met and is measured as the sums due under Additional pension liabilities arising from early the sale contract. retirements are not funded by the scheme except where the retirement is due to ill health. The full Income earned by new commercially-funded clinical amount of the liability for the additional costs is trials for the Foundation Trust will be recognised as charged to operating expenses at the time the operating income during the year. Foundation Trust commits itself to the retirement, The Foundation Trust receives income under the NHS regardless of the method of payment. Injury Cost Recovery Scheme, designed to reclaim the cost of treating injured individuals to whom personal Pension costs - National Employment Savings Trust injury compensation has subsequently been paid, (NEST) e.g. by an insurer. The Foundation Trust recognises The Pension Act 2008 requiring that from 2012 all the income when it receives noti#cation from the eligible workers who are not already in a workplace Department of Work and Pension’s Compensation scheme must be automatically enrolled into a Recovery Unit that the individual has lodged a qualifying workplace pension scheme. compensation claim. The income is measured at The NHS Pensions Scheme is a qualifying pension the agreed tari" for the treatments provided to the scheme and is the default Scheme for all NHS injured individual, less a provision for unsuccessful employees and they are automatically enrolled into compensation claims and doubtful debts. it. However, not all sta" are eligible to join the NHS Pension Scheme. Those sta" are automatically enrolled to the NEST Scheme where employers pension cost 1.6 Employee Bene#ts contributions are charged to operating expenses as Short-term employee bene#ts and when they become due. Salaries, wages and employment-related payments are recognised in the period in which the service is received from employees. The cost of leave earned but not taken at the end of the period is recognised in the #nancial statements to the extent that employees are permitted to carry forward leave.
Salford Royal NHS Foundation Trust - Annual Report and Accounts 2013/14 244 1.7 Expenditure on other goods and services Valuation Expenditure on goods and services is recognised All property, plant and equipment assets are measured when, and to the extent that they have been received, initially at cost, representing the costs directly and is measured at the fair value of those goods and attributable to acquiring or constructing the asset and services. Expenditure is recognised in operating bringing it to the location and condition necessary expenses except where it results in the creation of a for it to be capable of operating in the manner non-current asset, e.g. property or equipment. intended by management. All assets are measured subsequently at fair value. 1.8 Property, Plant and Equipment Land and buildings used for the Foundation Trust’s services or for administrative purposes are stated in Recognition the statement of #nancial position at their revalued Property, plant and equipment is capitalised if: amounts, being the fair value at the date of revaluation It is held for use in delivering services or for less any subsequent accumulated depreciation and administrative purposes. impairment losses. Revaluations are undertaken It is probable that future economic bene#ts will with su!cient regularity to ensure that the carrying $ow to, or service potential will be supplied to, the amounts are not materially di"erent to those that Foundation Trust. would be determined at the end of the reporting It is expected to be used for more than one #nancial period. Fair values are determined as follows: year. Land and non-specialised buildings - market value The cost of the item can be measured reliably; and for existing use. The item has cost of at least £5,000; or Specialised buildings - depreciated replacement cost. Collectively, a number of items have a cost of at The Foundation Trust’s land and building assets have least £5,000 and individually have a cost of more been revalued using a modern equivalent asset than £250, where the assets are functionally valuation as at 31 March 2014. This valuation was interdependent, they had broadly simultaneous provided by Mrs S. Hall, MRICS, of the Valuation O!ce purchase dates, are anticipated to have Agency using current indices (and not alternative sites simultaneous disposal dates and are under single valuations) in March 2014 to provide a valuation as at managerial control; or 31 March 2014. The value of buildings has changed to Items form part of the initial equipping and setting- such an extent that revised values have been included up cost of a new building, ward or unit, irrespective in these accounts. of their individual or collective cost. This valuation was prepared in accordance with the Where a large asset, for example a building, includes terms of the Royal Institution of Chartered Surveyors’ a number of components with signi#cantly di"erent Valuation Standards insofar as these terms are asset lives, the components are grouped into consistent with the agreed requirements of the NHS, categories and the groups are treated as separate the Department of Health and HM Treasury. assets and depreciated over their own useful economic Equipment assets are carried at fair value, with lives. depreciated historical cost used as a proxy for fair value. Equipment asset lives are estimated by sta" with experience of operating the particular type of equipment. The ranges of useful lives used in the Foundation Trust’s accounts are set out in note 16.3 on page 276.
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Subsequent expenditure Revaluation gains and losses Subsequent expenditure relating to an item of Revaluation gains are recognised in the revaluation property, plant and equipment is recognised as an reserve, except where, and to the extent that, they increase in the carrying amount of the asset when it reverse a revaluation decrease that has previously is probable that additional future economic bene#ts been recognised in operating expenses, in which case or service potential deriving from the cost incurred they are recognised in operating income. to replace a component of such item will $ow to the Revaluation losses are charged to the revaluation Foundation Trust and the cost of the item can be reserve to the extent that there is an available balance determined reliably. Where a component of an asset is for the asset concerned, and thereafter are charged to replaced, the cost of the replacement is capitalised if it operating expenses. meets the criteria for recognition above. The carrying amount of the part replaced is de-recognised where Gains and losses recognised in the revaluation reserve it can be reliably determined. Other expenditure that are reported in the Statement of Comprehensive does not generate additional future economic bene#ts Income as an item of ‘Other comprehensive income’. or service potential, such as repairs and maintenance, is charged to the Statement of Comprehensive Income Impairments in the period in which it is incurred. In accordance with the Foundation Trust ARM, impairments that are due to a loss of economic bene#ts Depreciation or service potential in the asset are charged to operating Items of property, plant and equipment are expenses. A compensating transfer is made from the depreciated over their remaining useful economic revaluation reserve to the income and expenditure lives in a manner consistent with the consumption reserve of an amount equal to the lower of: of economic or service delivery bene#ts. Freehold (i) the impairment charged to operating expenses; land is considered to have an in#nite life and is not and depreciated. (ii) the balance in the revaluation reserve attributable Property, plant and equipment that has been to that asset before the impairment. reclassi#ed as ‘Held for Sale’ ceases to be depreciated An impairment arising from a loss of economic bene#t upon the reclassi#cation. Assets in the course of or service potential is reversed when, and to the construction are not depreciated until the asset is extent that, the circumstances that gave rise to the brought into use. loss is reversed. Reversals are recognised in operating income to the extent that the asset is restored to the carrying amount it would have had if the impairment had never been recognised. Any remaining reversal is recognised in the revaluation reserve. Where, at the time of the original impairment, a transfer was made from the revaluation reserve to the income and expenditure reserve, an amount is transferred back to the revaluation reserve when the impairment reversal is recognised. Other impairments are treated as revaluation losses. Reversals of ‘other impairments’ are treated as revaluation gains.
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De-recognition 1.9 Intangible Assets Assets intended for disposal are reclassi#ed as ‘Held for Recognition Sale’ once all of the following criteria are met: Intangible assets are non-monetary assets without The asset is available for immediate sale in its physical substance which are capable of being sold present condition subject only to terms which are separately from the rest of the Foundation Trust’s usual and customary for such sales. business or which arise from contractual or other legal The sale must be highly probable, i.e.: rights. They are recognised only where it is probable Management are committed to a plan to sell the that future economic bene#ts will $ow to, or service asset. potential be provided to, the trust and where the cost of the asset can be measured reliably. An active programme has begun to #nd a buyer and complete the sale. Internally generated intangible assets The asset is being actively marketed at a Internally generated goodwill, brands, mastheads, reasonable price. publishing titles, customer lists and similar items are The sale is expected to be completed within 12 not capitalised as intangible assets. months of the date of classi#cation as ‘Held for Expenditure on research is not capitalised. Sale’; and Expenditure on development is capitalised only where The actions needed to complete the plan indicate all of the following can be demonstrated: it is unlikely that the plan will be cancelled or The project is technically feasible to the point of signi#cant changes made to it. completion and will result in an intangible asset for Following reclassi#cation, the assets are measured at sale or use. the lower of their existing carrying amount and their The Trust intends to complete the asset and sell or ‘fair value less costs to sell’. Depreciation ceases to be use it. charged. Assets are de-recognised when all material The Trust has the ability to sell or use the asset. sale contract conditions have been met. How the intangible asset will generate probable Property, plant and equipment which is to be scrapped future economic or service delivery bene#ts e.g. the or demolished does not qualify for recognition as ‘Held presence of a market for it or its output, or where it for Sale’ and instead is retained as an operational asset is to be used for internal use, the usefulness of the and the asset’s economic life is adjusted. The asset is asset. de-recognised when scrapping or demolition occurs. Adequate #nancial, technical and other resources are available to the Trust to complete the development and sell or use the asset; and The Trust can measure reliably the expenses attributable to the asset during development.
Software Software which is integral to the operation of hardware, e.g. an operating system, is capitalised as part of the relevant item of property, plant and equipment. Software which is not integral to the operation of hardware, e.g. application software, is capitalised as an intangible asset.
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Measurement 1.11 Leases Intangible assets are recognised initially at cost, Finance leases comprising all directly attributable costs needed to Where substantially all risks and rewards of ownership create, produce and prepare the asset to the point that of a leased asset are borne by the Foundation Trust, it is capable of operating in the manner intended by the asset is recorded as property, plant and equipment management. and a corresponding liability is recorded. The value at Subsequently intangible assets are measured at fair which both are recognised is the lower of the fair value value. Revaluations gains and losses and impairments of the asset or the present value of the minimum lease are treated in the same manner as for property, plant payments, discounted using the interest rate implicit in and equipment. the lease. Intangible assets held for sale are measured at the The asset and liability are recognised at the lower of their carrying amount or ‘fair value less costs commencement of the lease. Thereafter, the asset is to sell’. accounted for an item of property plant and equipment. The annual rental is split between the repayment Amortisation of the liability and a #nance cost so as to achieve Intangible assets are amortised over their expected a constant rate of #nance over the life of the lease. useful economic lives in a manner consistent with the The annual #nance cost is charged to Finance Costs consumption of economic or service delivery bene#ts. in the Statement of Comprehensive Income. The lease liability is de-recognised when the liability is discharged, cancelled or expires. 1.10 Donated and government grant funded assets Operating leases Donated and grant funded property, plant and Other leases are regarded as operating leases and equipment assets are capitalised at their fair value the rentals are charged to operating expenses on receipt. The donation/grant is credited to income on a straight-line basis over the term of the lease. at the same time, unless the donor has imposed a Operating lease incentives received are added to the condition that the future economic bene#ts embodied lease rentals and charged to operating expenses over in the grant are to be consumed in a manner speci#ed the life of the lease. by the donor, in which case the donation/grant is deferred within liabilities and is carried forward to Leases of land and buildings future #nancial years to the extent that the condition Where a lease is for land and buildings, the land has not yet been met. component is separated from the building component and the classi#cation for each is assessed separately. The donated and grant funded assets are subsequently accounted for in the same manner as other items of property, plant and equipment.
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1.12 Private Finance Initiative (PFI) Transactions PFI liability HM Treasury has determined that government A PFI liability is recognised at the same time as the PFI bodies shall account for infrastructure PFI schemes assets are recognised. It is measured initially at the where the government body controls the use of same amount as the fair value of the PFI assets and is the infrastructure and the residual interest in the subsequently measured as a #nance lease liability in infrastructure at the end of the arrangement as service accordance with IAS 17. concession arrangements, following the principles An annual #nance cost is calculated by applying the of the requirements of IFRIC 12. The Foundation implicit interest rate in the lease to the opening lease Trust therefore recognises the PFI asset as an item liability for the period, and is charged to ‘#nance costs’ of property, plant and equipment together with an within the Statement of Comprehensive Income. equivalent #nance lease liability to pay for it. The The element of the annual unitary payment that is services received under the contract are recorded as allocated as a #nance lease rental is applied to meet operating expenses. the annual #nance cost and to repay the lease liability The annual unitary payment is separated into the over the contract term. following component parts, using appropriate An element of the annual unitary payment increase estimation techniques where necessary: due to cumulative indexation is allocated to the a) Payment for the fair value of services received. #nance lease in accordance with IAS 17. This amount b) Payment for the PFI asset, including #nance costs is not included in the minimum lease payments, but is and, if applicable, prepayments for assets not yet in instead treated as contingent rent and is expensed as operational use; and incurred. In substance, this amount is a #nance cost in respect of the liability and the expense is presented c) Payment for the replacement of components of the as a contingent #nance cost in the Statement of asset during the contract ‘lifecycle replacement’. Comprehensive Income.
Services received Lifecycle replacement The fair value of services received in the year is Components of the asset replaced by the operator recorded under the relevant expenditure headings during the contract (‘lifecycle replacement’) are within ‘operating expenses’ in the Statement of capitalised where they meet the Foundation Trust’s Comprehensive Income. criteria for capital expenditure. They are capitalised at the time they are provided by the operator and are PFI Asset measured initially at their fair value. However, at this The PFI assets are recognised as property, plant and time, as the hospital redevelopment scheme is newly equipment, when they come into use. The assets are constructed, life-cycle replacement costs are low. measured initially at fair value in accordance with the principles of IAS 17. Subsequently, the assets are The element of the annual unitary payment allocated measured at fair value, which is kept up to date in to life-cycle replacement is pre-determined for each accordance with the Foundation Trust’s approach for year of the contract from the operator’s planned each relevant class of asset in accordance with the programme of life-cycle replacement. Where the principles of IAS 16 as described in notes 1.8 and 1.9 of life-cycle component is provided earlier or later these accounts. than expected, a short-term #nance lease liability or prepayment is recognised respectively.
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Where the fair value of the life-cycle component is 1.15 Contingencies less than the amount determined in the contract, A contingent asset is a possible asset that arises from the di"erence is recognised as an expense when the past events and whose existence will be con#rmed replacement is provided. If the fair value is greater by the occurrence or non-occurrence of one or more than the amount determined in the contract, the uncertain future events not wholly within the control di"erence is treated as a ‘free’ asset and a deferred of the Foundation Trust. A contingent asset is disclosed income balance is recognised. The deferred income is where an in$ow of economic bene#ts is probable. released to the operating income over the shorter of the remaining contract period or the useful economic Where the time value of money is material, life of the replacement component. contingencies are disclosed at their present value. Contingent liabilities are not recognised in the Assets contributed by the Trust to the operator Statement of Financial Position, but are disclosed Assets contributed (e.g. cash payments, surplus in note 30, unless the probability of a transfer of property) by the Foundation Trust to the operator economic bene#ts is remote. Contingent liabilities are before the asset is brought into use, which are de#ned as: intended to defray the operator’s capital costs, are a) Possible obligations arising from past events whose recognised initially as prepayments during the existence will be con#rmed only by the occurrence construction phase of the contract. Subsequently, of one or more uncertain future events not wholly when the asset is made available to the Foundation within the Foundation Trust’s control; or Trust, the prepayment is treated as an initial payment b) Present obligations arising from past events but for towards the #nance lease liability and is set against the which it is not probable that a transfer of economic carrying value of the liability. bene#ts will arise or for which the amount of the obligation cannot be measured with su!cient 1.13 Inventories reliability. Inventories are valued at the lower of cost and net realisable value other than pharmacy stocks which are valued at average cost. This is considered to be a 1.16 Provisions reasonable approximation to fair value due to the high The NHS Foundation Trust recognises a provision turnover of stocks. where it has a present legal or constructive obligation of uncertain timing or amount, for which it is probable that there will be a future out$ow of cash or other 1.14 Cash and Cash Equivalents resources, and a reliable estimate can be made of the Cash is cash in hand and deposits with any #nancial amount. The amount recognised in the Statement of institution repayable without penalty on notice of not Financial Position is the best estimate of the resources more than 24 hours. Cash equivalents are investments required to settle the obligation. Where the e"ect of that mature in three months or less from the date of the time value of money is signi#cant, the estimated acquisition and that are readily convertible to known risk-adjusted cash $ows are discounted using the amounts of cash with insigni#cant risk of change in discount rates published and mandated by HM value. Treasury.
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The NHS Litigation Authority (NHSLA) operates a risk- 1.17 Financial Instruments pooling scheme under which the Foundation Trust Financial assets pays an annual contribution to the NHSLA which, in Financial assets are recognised when the Foundation return, settles all clinical negligence claims. From Trust becomes party to the #nancial instrument time to time, it may be necessary for the NHSLA to contract or, in the case of trade receivables, when the increase the Foundation Trust’s annual contribution goods or services have been delivered. Financial assets to recognise the cost to the NHSLA of the Foundation are de-recognised when the contractual rights have Trust’s historic clinical negligence claims. In these expired or been cancelled or the or the Foundation cases, the Foundation Trust makes an accrual for Trust has transferred substantially all of the risks and these backdated charges at the point at which it is rewards of ownership. noti#ed of the increased cost. Although the NHSLA is administratively responsible for all clinical negligence Financial assets or #nancial liabilities in respect of cases, the legal liability remains with the Foundation assets acquired or disposed of through #nance leases Trust. The total value of clinical negligence provisions are recognised and measured in accordance with the carried by the NHSLA on behalf of the Foundation accounting policy for leases described in section 1.11 above. Trust is disclosed at note 28 on page 286 but is not Financial assets are classi#ed into the following recognised in the Foundation Trust’s accounts. categories: #nancial assets at fair value through Non-clinical risk pooling income and expenditure; held to maturity investments; available for sale #nancial assets, and loans and The Foundation Trust participates in the Property receivables. The classi#cation depends on the nature Expenses Scheme and the Liabilities to Third Parties and purpose of the #nancial assets and is determined Scheme. Both are risk-pooling schemes under which at the time of initial recognition. the Foundation Trust pays an annual contribution to the NHSLA and in return receives assistance with Impairment of #nancial assets the costs of claims arising. The annual membership At the Statement of Financial Position date, the contributions, and any ‘excesses’ payable in respect of Foundation Trus assesses whether any #nancial assets, particular claims are charged to operating expenses other than those held at ‘fair value through income when the liability arises. and expenditure’ are impaired. Financial assets are For buildings and contents, the Foundation Trust also impaired and impairment losses are recognised if, and has “top-up” insurance provided through a commercial only if, there is objective evidence of impairment as a insurer that insures from the NHSLA limit of cover of result of one or more events which occurred after the £1m to total reinstatement value (as assessed by the initial recognition of the asset and which has an impact Valuation O!ce). The annual premium is charged to on the estimated future cash $ows of the asset. operating expenses when the liability arises. For #nancial assets carried at amortised cost, the amount Other commercial insurance held by the Foundation of the impairment loss is measured as the di"erence Trust includes building contract works, motor vehicle, between the asset’s carrying amount and the present personal accident, group travel (for clinical sta" value of the revised future cash $ows discounted at required to work o"-site and overseas travel) and the asset’s original e"ective interest rate. The loss is professional indemnity and public liability for services recognised in the Statement of Comprehensive Income provided not covered by the NHSLA. The annual and the carrying amount of the asset is reduced premiums and any excesses payable are charged to directly or, where such a provision for impairment has operating expenses when the liability arises. been made in previous accounting periods and already charged to the Statement of Comprehensive Income, through the use of a “bad debt” provision.
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Held to maturity investments Held to maturity investments are non-derivative These #nancial assets and #nancial liabilities are #nancial assets with #xed or determinable payments recognised initially at fair value, with transaction and #xed maturity and where there is a positive costs expensed in the Statement of Comprehensive intention and ability to hold to maturity. After initial Income. Subsequent movements in the fair value recognition, they are held at amortised cost using the are recognised as gains or losses in the Statement of e"ective interest method, less any impairment. Interest Comprehensive Income. is recognised using the e"ective interest method. Financial assets held as available for sale Loans and receivables The Charitable Funds has an investment portfolio Loans and receivables are non-derivative #nancial managed by Investec Wealth & Investment Limited. assets with #xed or determinable payments which are The investment manager is able to buy and sell assets not quoted in an active market. They are included in on behalf of the Charity although there are certain current assets. restrictions set by the Trustees of the Charitable Funds such as limits being placed on the maximum The Foundation Trust’s loans and receivables comprise: percentage value of assets in a particular category current investments, cash and cash equivalents, NHS to be held to minimise risk of losses to the Charity receivables, accrued income and other receivables. It and not permitting investment in certain markets excludes prepayments and any PDC dividend receivable. e.g. tobacco products, alcohol or armaments. As the Loans and receivables are recognised initially at fair investment manager can buy and sell charitable assets, value, net of transactions costs, and are measured they are considered to be ‘assets available for sale’ and, subsequently at amortised cost, using the e"ective as such, their market value is reported in the Statement interest method. The e"ective interest rate is the rate of Financial Position with in-year gains and losses that discounts exactly estimated future cash receipts reported as ‘other comprehensive income’ on the through the expected life of the #nancial asset, or Statement of Comprehensive Income. when appropriate, a shorter period, to the net carrying amount of the #nancial asset. Financial liabilities Financial liabilities are recognised on the Statement of Interest on loans and receivables is calculated using Financial Position when the Foundation Trust becomes the e"ective interest method and credited to the party to the contractual provisions of the #nancial Statement of Comprehensive Income. instrument or, in the case of trade payables, when Financial assets and #nancial liabilities at fair value the goods or services have been received. Financial through income and expenditure liabilities are de-recognised when the liability has been discharged. The liability has been paid or has expired. Financial assets and #nancial liabilities at ‘fair value through income and expenditure’ are #nancial assets Other #nancial liabilities or #nancial liabilities held for trading. A #nancial asset or #nancial liability is classi#ed in this category After initial recognition at fair value net of transaction if acquired principally for the purpose of selling in costs, all other #nancial liabilities are measured at the short-term. Derivatives are also categorised as amortised cost using the e"ective interest method. held for trading unless they are designated as hedges. The e"ective interest rate is the rate that exactly Derivatives which are embedded in other contracts but discounts estimated future cash payments through which are not ‘closely-related’ to those contracts are the life of the asset to the net carrying amount of separated out from those contracts and measured in the #nancial liability. Interest is recognised using the this category. Assets and liabilities in this category are e"ective interest method. classi#ed as current assets and current liabilities.
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They are included in current liabilities except for 1.21 Public Dividend Capital (PDC) and PDC amounts payable more than 12 months after the Dividend Statement of Financial Position date, which are Public Dividend Capital represents taxpayers’ equity classi#ed as non-current liabilities. in the Foundation Trust. PDC is recorded at the value Interest on #nancial liabilities carried at amortised received. As PDC is issued under legislation rather than cost is calculated using the e"ective interest method under contract, it is not treated as an equity #nancial and charged to Finance Costs. Interest on #nancial instrument within the meaning of IAS32. liabilities taken out to #nance property, plant and An annual charge, re$ecting the cost of capital utilised equipment or intangible assets is not capitalised as by the Foundation Trust, is payable to the Department part of the cost of those assets. of Health as public dividend capital dividend. The charge is calculated at the real rate set by HM Treasury 1.18 Value Added Tax (currently 3.5%) on the average carrying amount of Most of the activities of the Foundation Trust are all assets less liabilities, except for donated assets, outside the scope of VAT and, in general, output tax average daily cash balances with the Government does not apply and input tax on purchases is not Banking Services (GBS) and the National Loans Fund recoverable. Irrecoverable VAT is charged to the (NLF) excluding cash balances held in GBS that relate relevant expenditure category or included in the to a short term working capital facility, net assets capitalised purchase cost of #xed assets. Where output transferred from bodies that ceased to exist on 1 April tax is charged or input VAT is recoverable, the amounts 2013 and any PDC dividend balance receivable or are stated net of VAT. payable. The average carrying amount of assets is calculated 1.19 Foreign Currencies as a simple average of opening and closing relevant The Foundation Trust’s functional currency and net assets. In accordance with the requirements laid presentational currency is sterling. Transactions down by the Department of Health (as the issuer of denominated in a foreign currency are translated into PDC), the dividend for the year is calculated on the sterling at the exchange rate ruling on the dates of actual average net relevant assets as set out in the ‘pre- the transactions. At the end of the reporting period, audited’ version of the Foundation Trust’s accounts. monetary items denominated in foreign currencies are The dividend calculated this way is not revised even if retranslated at the spot exchange rate on 31 March. adjustments are made to the net assets as a result of Resulting exchange gains and losses for either of these the audit of the Foundation Trust’s accounts. are recognised in the Foundation Trust’s Statement of Comprehensive Income in the period in which they arise.
1.20 Third Party Assets Assets belonging to third parties (such as money held on behalf of patients) are not recognised in the accounts since the Foundation Trust has no bene#cial interest in them. However, details of third party assets are given in Note 36 to the accounts in accordance with the requirements of HM Treasury’s Financial Reporting Manual.
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1.22 Losses and Special Payments 1.24 Consolidation - Other Subsidiaries Losses and special payments are items that Parliament Material entities over which the Foundation Trust has would not have contemplated when it agreed funds the power to exercise control so as to obtain economic for the National Health Service or passed legislation. or other bene#ts are classi#ed as subsidiaries and are By their nature they are items that ideally should not consolidated. Their income and expenses; gains and arise. They are therefore subject to special control losses; assets, liabilities and reserves; and cash $ows procedures compared with the generality of payments. are consolidated in full into the appropriate #nancial They are divided into di"erent categories, which statement lines. The capital and reserves attributable govern the way that individual cases are handled. to minority interests are included as a separate item on the Statement of Financial Position. Appropriate Losses and special payments are charged to the relevant adjustments are made on consolidation where the functional headings in expenditure on an accruals basis, subsidiary’s accounting policies are not aligned with including losses which would have been made good the Foundation Trust’s or where the subsidiary’s through insurance cover had the Foundation Trust not accounting date is before 1 January or after 30 June. been bearing its own risk (with insurance premiums Inter-entity balances, transactions, gains and losses are then being included as normal revenue expenditure). eliminated in full on consolidation. However, the note on losses and special payments is compiled directly from the losses and compensations register which reports amounts on a cash basis with 1.25 Consolidation - Joint Operations the exception of provisions for future losses. Joint operations are activities undertaken by the Foundation Trust in conjunction with one or more 1.23 Consolidation - Charitable Fund other parties but which are not performed through The Foundation Trust is a corporate trustee to the Salford a separate entity. The Foundation Trust records in Royal NHS Charitable Fund. The Foundation Trust has its #nancial statements its share of the income and assessed its relationship to the charitable fund and expenditure, assets and liabilities and cash $ows. determined it to be a subsidiary because the Foundation Trust has the power to govern the #nancial and operating 1.26 Corporation Tax policies of the charitable fund so as to obtain bene#ts Under s519A Income and Corporation Taxes Act 1988 from its activities for itself, its patients or its sta". the Foundation Trust is regarded as a Health Service Prior to 2013/14 the Foundation Trust Annual body and is therefore exempt from taxation on its Reporting Manual permitted the Foundation Trust not income and capital gains. Section 148 of the 2004 to consolidate the charitable fund. From 2013/14, the Finance Act provided the Treasury with powers to Foundation Trust has consolidated the charitable fund disapply this exemption. Accordingly the Foundation and has applied this as a change in accounting policy. Trust is potentially within the scope of corporation The charitable funds statutory accounts are prepared tax in respect of activities which are not related to, or to 31 March 2014 in accordance with the UK’s Charities ancillary to, the provision of healthcare and where the Statement of Recommended Practice (SORP) which pro#ts exceed £50,000 pa. Activities such as sta" and is based on UK Generally Accepted Accounting patient car parking are considered to be ancillary to Principles (UK GAAP). On consolidation, necessary the core healthcare objectives of the Foundation Trust adjustments are made to the charity’s assets, liabilities (and not entrepreneurial) and therefore not subject to and transactions to recognise and measure them in corporation tax. Any tax liability will be accounted for accordance with the Foundation Trust’s accounting within the relevant tax year. policies and eliminate intra-group transactions, balances, gains and losses.
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1.27 Accounting standards that have been 2 Operating Segments issued but have not yet been adopted The Treasury FReM does not require the following The Foundation Trust reports its #nancial results under Standards and Interpretations to be applied in the heading of a single segment - ‘Healthcare’. 2013/14. The application of the Standards as revised Whilst the Foundation Trust has a divisional structure in would not have a material impact on the accounts for place the services that are provided are essentially the 2013/14, were they applied in that year: same (patient care) and the majority of risks faced by IFRS9 Financial Instruments - e"ective date not yet each division are fundamentally the same. The clinical known divisions are substantially similar working under a IFRS 10 Consolidated Financial Statements - common governance structure reporting to Executive expected to be adopted in the EU in 2014/15 Assurance Committees of the Board of Directors and to the Board of Directors. IFRS 11 Joint Arrangements - expected to be adopted in the EU in 2014/15 Notes 3 to 6 show the breakdown of income received IFRS 12 Disclosure of Interests in Other Entities - by the Foundation Trust during the #nancial year by expected to be adopted in the EU in 2014/15 customer type and by activity. IFRS 13 Fair Value Measurement - not yet adpored by All income received in the Foundation Trust was in HM Treasury relation to healthcare. Income received into the IAS27 Separate Financial Statements - expected to Charitable Funds was predominantly from donations be adopted in the EU in 2014/15 and legacies. IAS28 Associates and Joint Ventures - expected to 2013/14 be adopted in the EU in 2014/15 Charitable Healthcare Funds Consolidated IAS32 Financial Instruments Presentation - e"ective £000 £000 £000 from 2014/15 Income 1 449,479 314 449,687 Surplus / (De#cit) 14,003 (91) 13,912 Net assets: 123,478 4,110 127,588 1.28 Accounting standards issued that have segment net assets been adopted early No accounting standards in issue have been adopted 2012/13 early. Charitable Healthcare Funds Consolidated £000 £000 £000 Income 429,265 293 429,437 Surplus / (De#cit) (3,089) (169) (3,258) Net assets: 104,336 3,975 108,311 segment net assets
1 - £106k of income reported by the Foundation Trust in 2013/14 (£121k in 2012/13) came from the charitable funds. Therefore £106k (2012/13 - £121k) is eliminated from the consolidated total for income.
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3 Income From Patient Care Activities 3.2 Income from Patient Care Activities - by Point of Delivery 3.1 Income from Patient Care Activities 2013/14 2012/13 - by Source £000 £000 2013/14 2012/13 Elective income 64,111 56,237 £000 £000 Non-elective income 67,229 60,807 Strategic health authorities 0 40,115 Outpatient income 58,829 53,631 Primary Care Trusts 0 315,181 A&E income 10,936 10,357 CCGs and NHS England 371,018 0 Other clinical activity income Local authorities 3,343 73 Charges for enzyme replacement 34,646 34,167 NHS other* 5,185 5,784 therapy drugs and infrastructure Non NHS: Drugs and medical devices charged 23,045 19,963 to commissioners on a cost-per-case Private patients 1,221 976 basis Overseas patients (non-reciprocal) 79 145 Intensive care and high dependency 15,901 14,984 NHS injury costs recovery scheme 2,115 1,154 services Non-NHS Other 12 40 Renal dialysis services 11,609 11,792 Total Income from Activities 382,972 363,469 Intestinal failure services 8,545 8,645 Commissioning for Quality and 6,892 7,400 On 1 April 2013, Strategic Health Authorities Innovation (CQUIN) Rehabilitation and continuing care 7,018 5,418 and Primary Care Trusts were abolished. Their services commissioning functions were taken over by Clinical Direct access to diagnostic services 4,481 4,494 Commissioning Groups (CCGs), NHS England and Local to GPs Authorities. Other clinical activity* 22,641 31,049 The NHS Injury cost recovery income is subject to a Community services activity 43,663 42,210 Private patient income and non- 1,300 1,121 provision for impairment of receivables of 26.4% to reciprocal overseas visitors re$ect expected rates of collection. This rate is based Other non-protected clinical income 2,127 1,194 on the collection rates achieved during the period TOTAL 382,972 363,469 covered by these accounts.
* ‘NHS other’ includes income received from non- *‘Other clinical activity’ income is income earned under English health bodies in the UK. contracts with NHS commissioners. The most signi#cant There is no income in the Charitable Funds relating to individual transactions are listed above. The balance income from patient care activities. described as ‘other clinical activity’ contains a number of smaller sums of income for services such as pain management, diagnostic imaging, multi-disciplinary team activity, palliative care and sleep apnoea. Other non-protected non-NHS clinical income includes income from the NHS injury costs recovery scheme (£2,115k) and income from prescription charges. There is no income in the Charitable Funds relating to income from patient care activities.
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3.3 Income from patient care activities - 3.4 Private Patient Income Commissioner Requested Services and The Foundation Trust earns a small proportion of its other income from activities clinical income from private patient activity; 0.3% of total clinical income. All income earned is reinvested in 2013/14 2012/13 NHS services for Salford Royal NHS Foundation Trust. £000 £000 The Health and Social Care Act 2012 repealed the Income from Commissioner 379,545 361,154 Requested Services activities Private Patient Income Cap. Achieving the Cap was a requirement of the Foundation Trust in 2011/12 but Income from other patient care 3,427 2,315 activities this limit has now been removed. TOTAL 382,972 363,469 2013/14 2012/13 £000 £000 Commissioners may designate patient care activities Private patient income 1,221 1,121 as ‘Commissioner Requested Services’. This means that the provider of these services must hold an NHS Total patient related income 389,972 363,469 provider licence issued by Monitor which imposes Percentage of patient related income 0.32% 0.31% conditions on providers of NHS services to ensure that the health sector works for the bene#ts of patients. The Trust has an NHS Provider Licence issued by Monitor and as at 31 March 2014, all patient care services provided by the Trust are designated as Commissioner Requested Services.
Salford Royal NHS Foundation Trust - Annual Report and Accounts 2013/14 257 4 Other Operating Income
2013/14 2012/13 Charitable Charitable Healthcare Funds Consolidated Healthcare Funds Consolidated £000 £000 £000 £000 £000 £000 Research and development 13,272 0 13,272 12,516 0 12,516 Education and training 22,265 0 22,265 22,199 0 22,199 Receipt of grant for capital acquisitions to improve 439 0 439 0 0 0 the environment for patients with dementia Donations, legacies and other charitable income 0 314 314 0 293 293 Non-patient care services to other bodies 6,874 0 6,874 7,768 0 7,768 Other income (see note 5 for detail) 23,230 0 23,230 22,840 0 22,840 Income from Salford Royal NHS Charitable Funds - (106) 0 (106) (121) 0 (121) eliminated on consolidation Revaluation of building assets 11,007 0 11,007 0 0 0 Rental revenue from operating leases - minimum 414 0 414 459 0 459 lease receipts Rental revenue from operating leases - contingent 14 0 14 14 0 14 rent Total Other Operating Income 77,408 314 77,722 65,675 293 65,968
During the year, the Foundation Trust commissioned the Valuation O!ce to provide up-to-date assessments of the value of the Foundation Trust’s land and building assets with an e"ective date of 31 March 2014. The total value of the revaluation was an increase in the value of building assets of £8,966k which is summarised in note 16.5 on page 276. Other income includes income earned by the Advancing Quality Alliance (AQuA) of £9,106k. AQuA is an NHS organisation that aims to drive quality improvements in NHS services in the North West. AQuA is hosted by Salford Royal NHS Foundation Trust. Whilst AQuA manages its own income and expenditure, it is not a legal entity; as the host organisation, the Foundation Trust acts as a legal entity able to issue or accept contracts such as contracts of employment or contracts for service on AQuA’s behalf. This is a typical arrangement in the NHS and the Trust hosts a number of other services in a similar way. Non patient care services to other bodies largely comprises income from other NHS bodies for clinical diagnostic and other services with £4,812k of the total received from other NHS organisations.
Salford Royal NHS Foundation Trust - Annual Report and Accounts 2013/14 258 6
5 Other Operating Income: 6 Operating Lease Income Analysis of Other Income 2013/14 2012/13 2013/14 2012/13 £000 £000 £000 £000 Operating lease income Car parking 1,731 1,326 Rental revenue from operating 414 459 leases - minimum lease receipts Estates services provided to 1,051 704 external customers Contingent rents recognised as 14 14 income during the period IT recharges 34 0 Pharmacy sales 390 498 Total 428 473 Clinical tests 10 98 Future minimum lease payments Clinical excellence awards 1,487 1,573 due: buildings expiring - not later than one year 196 415 Catering 353 1,149 - later than one year and not later 786 1,659 Property rental 714 621 than #ve years Income received on behalf of hosted 9,106 10,508 - later than #ve years 589 1,244 services - AQuA Income received on behalf of hosted 4,534 1,729 Sub-Total Buildings 1,571 3,318 services Future minimum lease payments PFI transitional support funding 3,690 3,190 due: other leases expiring From Salford Royal NHS Charitable 106 121 - not later than one year 0 0 Funds - later than one year and not later 0 0 Other 24 1,323 than #ve years TOTAL 23,230 22,840 Sub-Total Other Leases 0 0 GRAND TOTAL 1,571 3,318 In August 2013 the non-patient catering service transferred to Host; an external provider of catering Future minimum lease receipts are expected to reduce services. As a result, from this date the Trust no longer within the next #nancial year as accommodation in the reports income associated with sales of catering Foundation Trust’s Clinical Sciences Building currently services to sta" and visitors. leased to the University of Manchester is planned for demolition. It is expected that the Foundation During 2013/14 the Foundation Trust received £2,531k Trust will provide replacement accommodation for funding from NHS England (2012/13 £1,690k from NHS the University and this is most likely to be in rented North West) and released £1,159k of deferred income premises, meaning that the income received from (£1,500k in 2012/13) to support the transitional costs the University in future will be reported as sub-lease associated with the PFI development. income in note 8 to the accounts.
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7 Operating Expenses
2013/14 2012/13 Charitable Charitable Trust Funds Consolidated Trust Funds Consolidated £000 £000 £000 £000 £000 £000 Services from NHS Foundation Trusts 4,452 0 4,452 4,993 0 4,993 Services from NHS Trusts 1,974 0 1,974 1,982 0 1,982 Services from PCTs 0 0 0 439 0 439 Services from CCGs and NHS England 207 0 207 0 0 0 Services from other NHS bodies 342 0 342 396 0 396 Purchase of healthcare from non NHS bodies 2,007 0 2,007 1,717 0 1,717 Employee expenses - Executive Directors’ costs 1,109 0 1,109 1,087 0 1,087 Employee expenses - Non-Executive Directors’ costs 134 0 134 126 0 126 Employee expenses - Sta" costs 246,410 0 246,410 231,822 0 231,822 Employee expenses - Sta" costs for hosted services 4,775 0 4,775 3,316 0 3,316 Employee expenses - Research and Development 6,668 0 6,668 6,169 0 6,169 Supplies and services - clinical (excluding drugs costs) 34,306 0 34,306 35,067 0 35,067 Supplies and services - general 4,379 0 4,379 4,531 0 4,531 Establishment 4,984 0 4,984 4,713 0 4,713 Research and development (non-salary costs incurred by the R&D department) 6,307 0 6,307 6,077 0 6,077 Transport 688 0 688 669 0 669 Premises 17,328 0 17,328 17,233 0 17,233 Increase in provision for impairment of receivables 797 0 797 1,446 0 1,446 Change in provisions discount rate from 2.35% to 1.80% 233 0 233 0 Inventories written down 52 0 52 40 0 40 Supplies and services - drugs and medical gases 65,797 0 65,797 60,321 0 60,321 Rentals under operating leases - minimum lease receipts 4,517 0 4,517 4,755 0 4,755 Rentals under operating leases - contingent rent 0 0 0 19 0 19 Rentals under operating leases - sublease income (277) 0 (277) (300) 0 (300) Depreciation on property, plant and equipment 8,975 0 8,975 9,432 0 9,432 Amortisation on intangible assets 906 0 906 553 0 553 Accelerated depreciation - Clinical Sciences Building 3,207 0 3,207 0 0 0 Impairments of property, plant and equipment 2,929 0 2,929 14,729 0 14,729 Audit fees 0 0 - audit services - statutory audit including quality accounts 58 8 66 60 8 68 Other auditors’ remuneration - other assurance services provided to SRFT 0 0 0 0 0 0 - other data assurance services provided to AQuA 68 0 68 97 0 97 Audit fees payable to external audit of Charitable funds 0 0 0 0 0 0 Clinical negligence 4,417 0 4,417 3,947 0 3,947 Loss on disposal of tangible assets 0 0 0 11 0 11 Legal fees 201 0 201 236 0 236 Consultancy costs 856 0 856 792 0 792 Consultancy costs incurred by hosted services 4,286 0 4,286 4,293 0 4,293 Training, courses and conferences 1,397 0 1,397 1,255 0 1,255 Patient travel 126 0 126 99 0 99 Car parking and security ( non-salary costs not charged as part of the PFI 174 0 174 275 0 275 unitary charge) Redundancy (not included in employees expenses) 122 0 122 475 0 475 Early retirements - (not included in employee expenses) 0 0 0 216 0 216 Insurance 199 0 199 199 0 199 Other services including external payroll with e"ect from 1 October 2010 591 0 591 607 0 607 Losses, ex gratia and special payments (not included in employee expenses) 188 0 188 175 0 175 Other 1,447 0 1,447 969 0 969 Sub-total before Charitable Funds consolidation 437,336 8 437,344 425,039 8 425,047 NHS Charitable funds: Other resources expended with Salford Royal NHS 0 (106) (106) 0 (121) (121) Foundation Trust - eliminated on consolidation NHS Charitable funds: Other resources expended 0 512 512 0 557 557 Total including Charitable Funds expenditure 437,336 414 437,750 425,039 444 425,483
Sta" costs - Please refer to note 9.2 on page 263 for an explanation of the key reasons for increases to ‘employee expenses - sta" costs’ during the year.
Salford Royal NHS Foundation Trust - Annual Report and Accounts 2013/14 260 6
Depreciation and Impairments of property, plant Audit fees - data assurance services provided to AQuA and equipment Salford Royal hosts the Advancing Quality Alliance During the year, the Foundation Trust commissioned (AQuA), which is run as a separate entity from Salford the Valuation O!ce to provide an up-to-date Royal NHS Foundation Trust with its own directors. assessment of the value of the Foundation Trust’s AQuA is not a statutory body, cannot contract services land and building assets with an e"ective date of in its own right and does not produce statutory 31 March 2014. The total impact of the revaluation accounts. Expenditure incurred by AQuA is controlled was an increase in the value of non-current building by these directors but included in Salford Royal NHS assets of £8,966k of which £11,007k was recognised in Foundation Trust’s accounts as expenditure under operating income (in note 4) and £2,929k charged as the hosting agreement. The ‘other data assurance an impairment expense (note 7) with a further £3,207k services provided to AQuA’ shown above is a payment charged as accelerated depreciation in relation to the to Grant Thornton UK LLP for provision of clinical data Clinical Sciences Building in note 7. The balance of the assurance services to the Alliance. The procurement revaluation is reported as a change to the revaluation of these audit services was carried out by AQuA and reserve (note 29). relates to services provided exclusively to the AQuA The Valuation O!ce uses the existing use valuation not to Salford Royal NHS Foundation Trust. methodology where possible to asses the value of Grant Thornton UK LLP are also the external auditors the Foundation Trust’s land and buildings which of Salford Royal NHS Foundation Trust, and are paid to is based on market value. Where a building asset carry out the statutory #nancial statement audit and is specialised to the extent that no reliable market the audit of the quality accounts, per the table above. value can be estimated, a depreciated replacement The directors of Salford Royal NHS Foundation Trust cost based on a modern equivalent asset value has do not in$uence AQuA’s procurement of their external been used. As at 31 March 2014, the market value of advisors. buildings and the cost of construction of new assets in the area has risen which is why the Foundation Trust is reporting an £11,007k reversal of past impairments (downward valuations). Material downward valuations of building assets included in these accounts relate to the accelerated depreciation of the Clinical Sciences Building (£3,207k) which is due to be demolished and accommodation re-provided in 2014/15 and a valuation of the Foundation Trust’s three new operating theatres which is £2,555k lower than actual build costs (including fees).
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8 Operating Leases
8.1 As Lessee
2013/14 2012/13 £000 £000 Payments recognised as an expense Minimum lease payments 4,517 4,755 Contingent rents 0 19 Less sub-lease payments received (277) (300) TOTAL 4,240 4,474
2013/14 2013/14 2013/14 2013/14 2013/14 2012/13 Total Land Buildings Plant & Machinery Other Total £000 £000 £000 £000 £000 £000 Total future minimum lease payments Payable: Not later than one year 4,355 231 3,187 506 431 4,399 Between one and #ve years 2,251 99 558 1,000 594 1,878 Later than 5 years 5 0 0 5 0 44 TOTAL 6,611 330 3,745 1,511 1,025 6,321 Total of future minimum sub-lease payments (2,159) 0 (1,911) 0 (248) (443) to be received at the balance sheet date
The Foundation Trust has operating leases for a number of buildings used to provide community-based patient care services. The plant and machinery leases are for clinical and non-clinical equipment and a number of leased vehicles including those used by the Foundation Trust’s Transport Department and sta" providing community clinical activity services which individually have annual lease values of less than £100k. See page 259 for an explanation of the projected increase to sub-lease income.
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9 Employee Expenses and Numbers
9.1 Employee Expenses 2013/14 2012/13 2013/14 Permanently 2013/14 2012/13 Permanently 2012/13 Total Employed Other Total Employed Other £000 £000 £000 £000 £000 £000 Salaries and wages 205,610 205,610 0 191,973 191,973 0 Social security costs 15,178 15,178 0 14,367 14,367 0 Employer contributions to NHS Pension scheme 21,699 21,699 0 21,579 21,579 0 Termination bene#ts 122 122 0 475 475 0 Agency / contract sta" 16,589 0 16,589 14,475 0 14,475 Total sta# costs (excluding Non-Executive Directors 259,198 242,609 16,589 242,870 228,395 14,475 but including sta# charged to capital projects)
9.2 Average Number of People Employed 2013/14 2012/13 2013/14 Permanently 2013/14 2012/13 Permanently 2012/13 Total Employed Other Total Employed Other £000 £000 £000 £000 £000 £000 Medical and dental 640 639 1 608 608 0 Administration and estates 1,308 1,290 18 1,210 1,195 15 Healthcare assistants and other support sta" 1,148 1,086 62 1,063 1,002 61 Nursing, midwifery and health visiting sta" 1,787 1,774 13 1,667 1,659 8 Nursing, midwifery and health visiting learners 0 0 0 2 2 0 Scienti#c, therapeutic and technical sta" 959 942 17 904 890 15 Bank and agency sta" 383 0 383 291 0 291 TOTAL 6,224 5,730 494 5,745 5,356 389
The numbers shown above are average full time equivalent values. The Charitable Fund does not employ any sta". Sta" numbers have increased during the year with the key movements being: + 126 whole time equivalent nursing sta" to ensure safe sta!ng levels on wards; + 109 whole time equivalent sta" to deliver service developments at the foundation trust during the year including the opening of new theatre capacity; + 75 whole time equivalent sta" employed on behalf of hosted services during the year; + 59 whole time equivalent sta" providing SSDU services on behalf of the Trust (employed by Wrightington, Wigan and Leigh NHS Foundation Trust); and + 32 whole time equivalents employed on a temporary basis to deliver projects including Electronic Patient Record implementation, record scanning and to manage increased patient activity during the winter months.
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10 Pension Costs
10.1 Pension Costs Past and present employees are covered by the The latest assessment of the liabilities of the scheme is provisions of the NHS Pensions Scheme. Details of the contained in the scheme actuary report, which forms bene#ts payable under these provisions can be found part of the annual NHS Pension Scheme (England and on the NHS Pensions website at www.nhsbsa.nhs.uk/ Wales) Pension Accounts, published annually. These pensions. The scheme is an unfunded, de#ned-bene#t accounts can be viewed on the NHS Pensions website. scheme that covers NHS employers, GP practices Copies can also be obtained from The Stationery O!ce. and other bodies, allowed under the direction of the Secretary of State, in England and Wales. The scheme is not designed to be run in a way that would enable b) Full Actuarial (Funding) Valuation NHS bodies to identify their share of the underlying The purpose of this valuation is to assess the level scheme assets and liabilities. Therefore, the scheme of liability in respect of the bene#ts due under the is accounted for as if it were a de#ned contribution scheme (taking into account its recent demographic scheme. The cost to the NHS Body of participating experience), and to recommend the contribution rates. in the scheme is taken as equal to the contributions The last published actuarial valuation undertaken payable to the scheme for the accounting period. for the NHS Pension Scheme was completed for the In order that the de#ned-bene#t obligations recognised year ending 31 March 2004. Consequently, a formal in the #nancial statements do not di"er materially from actuarial valuation would have been due for the year those that would be determined at the reporting date ending 31 March 2008. However, formal actuarial by a formal actuarial valuation, the FReM requires that valuations for unfunded public service schemes “the period between formal valuations shall be four were suspended by HM Treasury on value for money years, with approximate assessments in intervening grounds while consideration is given to recent changes years”. An outline of these follows: to public service pensions, and while future scheme terms are developed as part of the reforms to public a) Accounting Valuation service pension provision due in 2015. A valuation of the scheme liability is carried out The Scheme Regulations were changed to allow annually by the scheme actuary as at the end of contribution rates to be set by the Secretary of State the reporting period. Actuarial assessments are for Health, with the consent of HM Treasury, and undertaken in intervening years between formal consideration of the advice of the Scheme Actuary and valuations using updated membership data and are appropriate employee and employer representatives accepted as providing suitably robust #gures for as deemed appropriate. #nancial reporting purposes. The valuation of the The next formal valuation to be used for funding scheme liability as at 31 March 2014, is based on the purposes will be carried out at as at March 2012 and valuation data as 31 March 2013, updated to 31 March will be used to inform the contribution rates to be used 2014 with summary global member and accounting from 1 April 2015. data. In undertaking this actuarial assessment, the methodology prescribed in IAS 19, relevant FReM interpretations, and the discount rate prescribed by HM Treasury have also been used.
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c) Scheme Provisions d) Estimated contributions in 2014/15 The NHS Pension Scheme provided de#ned bene#ts, In 2014/15, employer contributions to pensions will which are summarised below. This list is an illustrative remain at 14%; however, employee contributions are guide only and is not intended to detail all the bene#ts expected to rise following a three-year tiered contribution provided by the Scheme or the speci#c conditions that increase announcement e"ective from 2012/13. The must be met before these bene#ts can be obtained: estimated employers pension contributions in 2014/15 is £23m with total contributions including employee The Scheme is a “#nal salary” scheme. Annual pensions contributions estimated at £40m. are normally based on 1/80th for the 1995 section and of the best of the last three years pensionable pay for each year of service, and 1/60th for the 2008 section of 10.2 Retirements Due to Ill-health reckonable pay per year of membership. Members who During 2013/14 there were 13 (2012/13 : 7) early are practitioners as de#ned by the Scheme Regulations retirements from the Foundation Trust agreed on have their annual pensions based upon total the grounds of ill-health. The estimated additional pensionable earnings over the relevant pensionable pension liabilities of these ill-health retirements will service. be £537k (2012/13: £216k). The cost of these ill-health retirements will be borne by the NHS Business Services With e"ect from 1 April 2008 members can choose to Authority - Pensions Division. give up some of their annual pension for an additional tax-free lump sum, up to a maximum amount permitted under HMRC rules. This new provision is 11 Directors’ Remuneration known as “pension commutation”. 11.1 Directors’ Remuneration Annual increases are applied to pension payments at rates de#ned by the Pensions (Increase) Act 1971, Key Management Compensation and are based on changes in retail prices in the twelve During the year, key management received the months ending 30 September in the previous calendar following payments from the Foundation Trust. year. From 2011/12 the Consumer Price Index (CPI) will 2013/14 2012/13 be used to replace the Retail Prices Index (RPI). £000 £000 Early payment of a pension, with enhancement, Remuneration and short term 1,132 1,103 bene#ts including employers national is available to members of the Scheme who are insurance contribution for Executive permanently incapable of ful#lling their duties and Non-Executive Directors e"ectively through illness or in#rmity. A death gratuity Employers contribution to pension in 110 117 of twice their #nal year’s pensionable pay for death in relation to executive directors service, and #ve times their annual pension for death TOTAL 1,243 1,213 after retirement is payable. In total, during the year, eight individuals had bene#ts For early retirements other than those due to ill health accruing under a de#ned-bene#ts scheme, the costs the additional pension liabilities are not funded by of which are included in the ‘employers contribution to the Scheme. The full amount of the liability for the pension’ above. These are the Executive Directors listed additional costs is charged to the employer. in note 11.2 for the year to 31 March 2014. Members can purchase additional service in the NHS Key management is de#ned as the Executive and Non-Executive Directors of the Foundation Trust. Scheme and contribute to money purchase AVC’s run Further details of their remuneration can be found in by the Scheme’s approved providers or by other Free notes 11.2 and 11.3 of these accounts and also in the Standing Additional Voluntary Contributions (FSAVC) 2013/14 remuneration report published as part of the providers. Foundation Trust’s annual report.
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11.2 Director’s Remuneration
Remuneration for the year to 31 March 2014 The following table, which is subject to external audit, shows directors’ remuneration for the year. Taxable bene#ts in column B were for lease car or personal car allowances.
Taxable Bene#ts Annual Pension related Other salary paid (lease car or Performance- Long-term bene#ts - annual as a clinician and car allowance) related performance- increase in NHS not as Executive Total Salary Name and Title Salary Bands rounded to bonuses bands related pension entitlement Medical Director bands of of £5000 nearest £100 of £5000 bonuses bands of £2500 in bands of £5,000 £5000 £000 £000 £000 £000 £000 £000 £000 D.N. Dalton Chief Executive 200-205 8.1 25-30 0 12.5-15.0 0 250-255 T.A. Whit#eld Deputy Chief Executive 115-120 6.4 5-10 0 12.5-15.0 0 140-145 and Executive Director of Finance S. Kennedy Acting Director of Finance 20-25 0.9 N/A 0 0.0-2.5 0 20-25 E. Inglesby-Burke Deputy Chief 120-125 5.6 15-20 0 37.5-40.0 0 185-190 Executive and Executive Nurse S.H.G. Neville Executive Director of 120-125 6.1 0 0 10.0-12.5 0 135-140 Strategy & Development P. Renshaw Executive Director 110-115 5.5 0 0 37.5-40.0 0 155-160 of Organisational Development and Corporate A"airs C. Brookes Executive Medical Director 50-55 0.0 0 0 15.0-17.5 20-25 90-95 P. Turkington Interim Executive 75-80 0.0 N/A 0 22.5-25.0 40-45 145-150 Medical Director J.J. Potter Chair 45-50 0.0 0 0 N/A 0 45-50 J. Willis Non-Executive Member 15-20 0.0 0 0 N/A 0 15-20 H. Forster Non-Executive Member 10-15 0.0 0 0 N/A 0 10-15 D. Brown Non-Executive Member 10-15 0.0 0 0 N/A 0 10-15 A. Williams Non-Executive Member 10-15 0.0 0 0 N/A 0 10-15 R. Burns Non-Executive Member 5-10 0.0 0 0 N/A 0 5-10 J. Bibby Non-Executive Member 5-10 0.0 0 0 N/A 0 5-10
Non-Executive Directors do not receive pensionable remuneration which is why the column is marked n/a for this group. Tony Whit#eld left on 19 January 2014 and Stephen Kennedy became Acting Director of Finance on 20 January 2014. Elaine Inglesby-Burke became Deputy Chief Executive on 20 January 2014 in addition to her role as Executive Nurse. Paul Renshaw joined the Trust as Executive Director of Organisational Development and Corporate A"airs on 8 April 2013 Chris Brookes accepted a non-permanent role as Medical Director of the Greater Manchester Healthier Together programme on 31 August 2013. Pete Turkington became Interim Medical Director on 1 September 2013. Rowena Burns and Jo Bibby joined the Trust as Non-Executive Directors on 1 July 2013 During the year, Executive and Non-Executive Directors were reimbursed expenses for costs incurred on travel and other costs associated with their work for the Foundation Trust. The total amounts paid during the year are summarised below. 2013/14 2012/13 Expenses rounded Expenses rounded to to nearest £100 nearest £100 £000 £000 Total expenses paid in 2013/14 to 8 Executive Directors who served during the #nancial year 2.3 1.9 Total expenses paid in 2013/14 to 7 Non-Executive Directors who served during the #nancial year 1.9 2.2 TOTAL 4.2 4.1
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Remuneration for the year to 31 March 2013
Taxable Bene#ts Annual Pension related Other salary paid (lease car or Performance- Long-term bene#ts - annual as a clinician and car allowance) related performance- increase in NHS not as Executive Total Salary Name and Title Salary Bands rounded to bonuses bands related pension entitlement Medical Director bands of of £5000 nearest £100 of £5000 bonuses bands of £2500 in bands of £5,000 £5000 £000 £000 £000 £000 £000 £000 £000 D.N. Dalton Chief Executive 200-205 7.7 20-25 0 (42.5)-(40.0) 0 220-225 T.A. Whit#eld Deputy Chief Executive 140-145 7.7 5-10 0 (27.5)-(27.0) 0 145-150 and Executive Director of Finance E. Inglesby-Burke Executive Nurse 120-125 5.6 10-15 0 (30.0)-(27.5) 0 130-135 S.H.G. Neville Executive Director of 120-125 5.8 0-5 0 (17.5)-(15.0) 0 120-125 Strategy & Development D.P. Wood Executive Director of 90-95 4.2 5-10 0 (30.0)-(27.5) 0 95-100 Organisational Development and Corporate A"airs C. Brookes Executive Medical Director 130-135 0.0 0-5 0 27.5-30.0 50-55 160-165 J.J. Potter Chair 45-50 0.0 0 0 0 0 45-50 J. Willis Non-Executive Member 15-20 0.0 0 0 0 0 15-20 H. Forster Non-Executive Member 10-15 0.0 0 0 0 0 10-15 M. Halsall Non-Executive Member 10-15 0.0 0 0 0 0 10-15 D. Brown Non-Executive Member 10-15 0.0 0 0 0 0 10-15 A. Williams Non-Executive Member 10-15 0.0 0 0 0 0 10-15
David Wood retired as Executive Director of Development and Corporate A"airs on 31 December 2012. Mike Halsall’s term of o!ce as a Non-Executive Director ended on 31 March 2013.
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11.3 Director’s Remuneration: Pension Bene#ts
Pension Bene$ts for the year to 31 March 2014 Real Real Increase/ Increase/ (Decrease) Total Accrued Lump Sum at Cash Cash Real Increase (Decrease) in Pension Pension at Age 60 Related Equivalent Equivalent in Cash in Pension Lump Sum Age 60 at 31 to Accrued Transfer Transfer Equivalent at Age 60 at Age 60 March 2014 Pension as at Value at Value at Transfer Value 31 March 2014 31 March 31 March (Bands of (Bands of (Bands of 2014 2013 £2500) £2500) £5000) (Bands of £5000) Name and Title £000 £000 £000 £000 £000 £000 £000 D.N. Dalton Chief Executive 0.0-2.5 0.0-2.5 85-90 260-265 1,706 1,609 61 T.A. Whit#eld Deputy Chief Executive 0.0-2.5 0.0-2.5 60-65 190-195 1,358 1,281 49 and Executive Director of Finance S. Kennedy Acting Director of Finance 0.0-2.5 0.0-2.5 35-40 110-120 684 679 5 E. Inglesby-Burke Deputy Chief 0.0-2.5 2.5-5.0 55-60 165-170 1,121 1,035 64 Executive and Executive Nurse S.H.G. Neville Executive Director of 0.0-2.5 0.0-2.5 45-50 135-140 872 821 33 Strategy and Development P. Renshaw 0.0-2.5 0 0-5 0 19 0 19 Executive Director of Organisational Development and Corporate A"airs C.N. Brookes Executive Medical Director 0.0-2.5 0.0-2.5 45-50 145-150 978 898 26 P. Turkington 0.0-2.5 2.5-5.0 45-50 145-150 481 459 22 Interim Executive Medical Director
Paul Renshaw joined the Trust as Executive Director of Organisation. The Total Accrued Pension, Lump Sum at Aged 60 and the CETV (Cash Equivalent Transfer Value) at 31 March 2014 are reported as the values at 31 March 2014 for all Executive Directors, including those who were Executive Board members for part of the year. In the case of P Turkington, S Kennedy and C Brookes the pension bene#ts reported are shown for the period of time they were Executive Board members. As Non-Executive members do not receive pensionable remuneration, there are no entries in respect of pensions for Non- Executive members. A CETV is the actuarially assessed capital value of the pension scheme bene#ts accrued by a member at a particular point in time. The bene#ts valued are the member’s accrued bene#ts and any contingent spouse’s pension payable from the scheme. A CETV is a payment made by a pension scheme, or arrangement to secure pension bene#ts in another pension scheme or arrangement when the member leaves a scheme and chooses to transfer the bene#ts accrued in their former scheme. The pension #gures shown relate to the bene#ts that the individual has accrued as a consequence of their total membership of the pension scheme and not just their service in a senior capacity to which the disclosure applies. The CETV #gures and other pension details include the value of any pension bene#ts in another scheme or arrangement which the individual has transferred to the NHS pension scheme. They also include any additional pension bene#t accrued to the member as a result of their purchasing additional years of pension service in the scheme at their own cost. CETVs are calculated within the guidelines and framework prescribed by the Institute and Faculty of Actuaries. Real Increase in CETV re$ects the increase in CETV e"ectively funded by the employer. It takes account of the increase in accrued pension due to in$ation, contributions paid by the employee (including the value of any bene#ts transferred from another pension scheme or arrangement) and uses common market valuation factors for the start and end of the period.
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Pension Bene$ts for the year to 31 March 2013 Real Real Increase/ Increase/ (Decrease) Total Accrued Lump Sum at Cash Cash Real Increase (Decrease) in Pension Pension at Age 60 Related Equivalent Equivalent in Cash in Pension Lump Sum Age 60 at 31 to Accrued Transfer Transfer Equivalent at Age 60 at Age 60 March 2013 Pension as at Value at Value at Transfer Value 31 March 2013 31 March 31 March Applying (Bands of (Bands of (Bands of 2013 2012 In$ation at £2500) £2500) £5000) (Bands of £5000) 5.2% Name and Title £000 £000 £000 £000 £000 £000 £000 D.N. Dalton (2.5)-0 (7.5)-(5.0) 80-85 250-255 1,609 1,519 11 Chief Executive T.A. Whit#eld (2.5)-0 (5.0)-(2.5) 60-65 185-190 1,281 1,205 13 Deputy Chief Executive and Executive Director of Finance E. Inglesby-Burke Deputy Chief (2.5)-0 (5.0)-(2.5) 50-55 160-165 1,035 976 8 Executive and Executive Nurse S.H.G. Neville Executive Director of (2.5)-0 (2.5)-0 40-45 130-135 821 771 9 Strategy and Development D.P. Wood Executive Director of (2.5)-0 (5.0)-(2.5) 45-50 145-150 0 876 0 Development and Corporate A"airs C.N. Brookes 0-2.5 2.5-5.0 45-50 135-140 898 806 50 Executive Medical Director
Sir David Dalton Chief Executive Date: 29 May 2014
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11.4 Ratio of Median Remuneration of all Sta" Compared to Chief Executive’s Remuneration There is a requirement to disclose the median remuneration of the Trust’s sta" and the ratio between this and the mid-point of the banded remuneration of the highest paid director (who is the Chief Executive) including salary and bene#ts in kind. The calculation is based on full-time equivalent sta" employed as at 31 March paid via the Foundation Trust’s own payroll and also includes costs of sta" recharged from other NHS or University organisations and the costs of bank and agency nursing sta" and locum medical sta" as at 31 March 2014 multiplied by 12 to estimate an annualised total pay cost per full-time equivalent. 2013/14 2012/13 £000 £000 Median remuneration of sta" 28 28 Chief Executive’s mid-point banded remuneration plus 238 230 bene#ts in kind
Ratio 8.6 : 1 8.2 : 1
11.5 Sta" Exit Packages During 2013/14, the Foundation Trust agreed exit packages with six members of sta" through mutually agreed resignation schemes, redundancy or Treasury approved schemes at a cost of £122k (in 2012/13 exit packages were agreed with 17 members of sta" at a cost of £476k).
2013/14 2013/14 2013/14 2013/14 2012/13 2011/12 Number of Cost of Number Exit Package Cost compulsory compulsory of other Cost of other Number of other Cost of redundancies redundancies departures departures Departures Departures £000 £000 £000 £000 £000 £000 <£10,000 0 0 2 15 5 37 £10,000 - £25,000 1 19 2 48 7 125 £25,001 - £50,000 1 40 0 0 4 128
TOTAL 2 59 4 63 17 476
Redundancy and other departure costs have been paid in accordance with the provisions of the NHS Scheme. Exit costs in this note are accounted for in full in the year of departure.
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12 Better Payment Practice Code
12.1 Better Payment Practice Code - Measure of Compliance
2013/14 2012/13 Number £000 Number £000 Total non-NHS trade invoices paid in the year 80,533 180,806 67,316 166,577 Total non-NHS trade invoices paid within target 76,578 174,538 64,631 161,954 Percentage of non-NHS trade invoices paid within target 95% 97% 96% 97% Total NHS trade invoices paid in the year 3,736 53,652 3,906 62,985 Total NHS trade invoices paid within target 3,052 49,554 3,707 62,073 Percentage of NHS trade invoices paid within target 82% 92% 95% 99%
The Better Payment Practice Code requires the Foundation Trust 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.
12.2 The Late Payment of Commercial Debts (Interest) Act 1998 No costs were incurred made in respect of late payment of commercial debts.
13 Finance Income
2013/14 2012/13 Charitable Charitable Trust Funds Total Trust Funds Total £000 £000 £000 £000 £000 £000 Interest income: On loans and receivables 124 115 239 165 103 268 TOTAL 124 115 239 165 103 268
Interest income was earned on surplus operating cash held in the Foundation Trust’s Government Banking Service account and by the Charitable Funds from interest on investments.
14 Finance Costs - Interest Expense
2013/14 2012/13 £000 £000 Loan interest from the Foundation Trust Financing Facility 56 0 Interest on obligations under PFI contracts: Main #nance cost 5,508 4,269 Contingent #nance cost 1,660 1,350 TOTAL 7,224 5,619
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15 Intangible Assets
15.1 Intangible Assets
Development Computer Expenditure Software Licenses and (Internally Assets Under Purchased Trademarks Generated) Construction Total 2013/14: £000 £000 £000 £000 £000 Gross cost at 1 April 2013 4,069 4 1,458 0 5,531 Additions - Electronic Patient Record System 1,331 0 0 688 2,020 Transfer from Tangible Assets Under 2,533 0 0 0 2,533 Construction 2012/13 - EPR Gross cost at 31 March 2014 7,933 4 1,458 688 10,083 Amortisation at 1 April 2013 3,299 0 594 0 3,893 Charged during the year 906 0 0 0 906 Amortisation at 31 March 2014 4,205 0 594 0 4,799 Net book value Purchased as at 31 March 2013 770 4 864 0 1,638 Donated as at 31 March 2013 0 0 0 0 0 Total at 1 April 2013 770 4 864 0 1,638 Net book value Purchased at 31 March 2014 3,728 4 864 688 5,284 Donated as at 31 March 2014 0 0 0 0 0 Total at 31 March 2014 3,728 4 864 688 5,284
15.2 Intangible Assets - Prior Year
Development Computer Expenditure Software Licenses and (Internally Purchased Trademarks Generated) Total 2012/13: £000 £000 £000 £000 Gross cost at 1 April 2012 4,069 4 1,458 5,531 Gross cost at 31 March 2013 4,069 4 1,458 5,531 Amortisation at 1 April 2012 3,027 0 313 3,340 Charged during the year 272 0 281 553 Amortisation at 31 March 2013 3,299 0 594 3,893 Net book value Purchased as at 31 March 2012 1,042 4 1,145 2,191 Donated as at 31 March 2012 0 0 0 0 Total at 1 April 2012 1,042 4 1,145 2,191 Net book value Purchased at 31 March 2013 770 4 864 1,638 Donated as at 31 March 2013 0 0 0 0 Total at 31 March 2013 770 4 864 1,638
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15.3 Intangible assets : Asset Lives and Government Grant Funded Carrying Value None of the Foundation Trust’s intangible assets have been revalued or impaired during the year. Minimum Maximum Life Life Years Years Intangible assets internally generated Development expenditure 1 5 Intangible assets purchased Software 1 10
2013/14 2012/13 £000 £000 Intangible assets acquired by government grant Initial fair value 887 1,144 Carrying amount at 1 April 2013 887 1,144 Carrying amount at 1 April 2014 583 887 Measured using cost or revaluation model Cost Cost
Intangible assets acquired by government grant relates to the North West E-Health Project which was funded by a grant from the North West Development Agency, which amounted to £4.4m over a four-year period (which ended 31 December 2011). The North West e-Health Project is a collaboration between the Foundation Trust, Salford CCG and the University of Manchester which aims to deploy Project-developed analytical tools to enable clinical research and to support optimal delivery of patient care. As this project is a collaboration, the Foundation Trust reports its ‘fair share’ of the North West E-Health asset in the annual accounts, which in 2013/14 remains a one-third share. The North West E-Health asset is currently valued at amortised historic cost. The asset is subject to amortisation on a straight-line basis over its estimated useful life of #ve years (starting from 2010/11).
15.4 Revaluation reserve balance for intangible assets The Foundation Trust does not have a balance in the revaluation reserve that is attributable to intangible assets.
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16 Property, Plant and Equipmwnt
16.1 Property, Plant and Equipment Assets Under Buildings Construction Inform- Furniture Excluding & Payments Plant and Transport ation and Land Dwellings Dwellings on Account Machinery Equipment Technology Fittings Total 2013/14: £000 £000 £000 £000 £000 £000 £000 £000 £000 Cost or valuation at 1 April 2013 12,850 172,655 1,294 5,133 36,942 59 9,739 2,205 240,878 Prior period adjustments 0 0 0 0 0 0 0 0 0 Cost or valuation at 1 April 2013 12,850 172,655 1,294 5,133 36,942 59 9,739 2,205 240,878 - restated Transfers by absorption - modi#ed 0 0 0 0 1,132 0 4 36 1,173 Additions purchased 0 7,616 3 3,170 2,848 0 1,186 40 14,863 Additions donated 0 0 0 0 0 0 0 0 0 Impairments charged to 0 (58) 0 0 0 0 0 0 (58) revaluation reserve Reclassi#cations 0 426 0 (4,161) 0 0 1,201 0 (2,533) Revaluations 0 4,017 136 0 0 0 0 0 4,153 Transferred to disposal group as 0 0 0 0 0 0 0 0 0 asset held for sale Disposals 0 0 0 0 0 0 0 0 0 Cumulative depreciation 0 (123) (31) 0 0 0 0 0 (154) adjustment following revaluation Cost or valuation at 31 March 2014 12,850 184,534 1,402 4,142 40,923 59 12,130 2,281 258,321 Accumulated depreciation as at 0 0 0 0 25,400 52 4,656 638 30,746 1 April 2013 Transfers by absorption - modi#ed 0 0 0 0 814 0 2 31 847 Provided during the year 0 8,201 31 0 2,587 5 1,063 295 12,182 Impairments recognised in 0 2,929 0 0 0 0 0 0 2,929 operating expenses Revaluations 0 (11,007) 0 0 0 0 0 0 (11,007) Disposals 0 0 0 0 0 0 0 0 0 Cumulative depreciation 0 (123) (31) 0 0 0 0 0 (154) adjustment following revaluation Depreciation at 31 March 2014 0 0 0 0 28,801 57 5,721 964 35,543 Net book value Owned at 1 April 2013 12,850 85,555 0 5,133 11,298 7 5,083 1,555 121,481 PFI at 1April 2013 0 82,047 1,294 0 0 0 0 0 83,341 Donated at 1April 2013 0 5,054 0 0 244 0 0 12 5,309 Total at 1 April 2013 12,850 172,655 1,294 5,133 11,542 7 5,083 1,567 210,132 Net book value Owned at 1 April 2014 12,850 89,817 (0) 4,142 11,923 3 6,409 1,308 126,452 PFI at 1April 2014 0 88,906 1,402 0 0 0 0 0 90,308 Donated at 1April 2014 0 5,811 0 0 199 0 0 8 6,017 Total at 31 March 2014 12,850 184,534 1,402 4,142 12,121 3 6,409 1,316 222,778
As at 31 March 2014 the Foundation Trust had no land, buildings or dwellings valued at open market values. Key additions during the year include the setting up of three new operating theatres at £5.3m, additions relating to the continuing investment in a new Electronic Patient Record system at £2.0m, the take on of assets from Salford PCT pertaining to community activity with a carrying value of £1.2m, continuation of the programme to refurbish patient areas not inside the PFI-footprint at £1.3m, ongoing work to recon!gure the outpatient facilities and develop our Angiography facilities at £1.0m, investment in Radiology equipment including the upgrade of the MR scanner at £0.8m, investments in IT equipment of £2.1m (partially funded by an increase in Public Dividend Capital of £0.8m) and £1.5m invested in replacing medical and other essential equipment. Assets under construction include the Electronic Patient Record System (£0.7m), angiography works (£1.1m), nurse technology funded electronic ward observation project (£0.8m) and various ongoing schemes to improve patient care services and the Trust environment (£1.3m).
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16.2 Property, Plant and Equipment - Prior Year Assets Under Buildings Construction Inform- Furniture Excluding & Payments Plant and Transport ation and Land Dwellings Dwellings on Account Machinery Equipment Technology Fittings Total 2012/13: £000 £000 £000 £000 £000 £000 £000 £000 £000 Cost or valuation at 1 April 2012 13,750 178,088 1,141 342 35,563 59 7,898 1,922 238,763 Prior period adjustments 0 (197) 197 0 0 0 0 0 0 Cost or valuation at 1 April 2012 13,750 177,891 1,338 342 35,563 59 7,898 1,922 238,763 - restated Additions purchased 0 15,972 0 5,082 1,586 0 1,841 251 24,732 Additions donated 0 0 0 0 7 0 0 0 7 Impairments charged to (900) (1,523) (16) 0 0 0 0 0 (2,439) revaluation reserve Reclassi#cations 0 43 0 (291) 216 0 0 32 0 Revaluations 0 744 0 0 0 0 0 0 744 Transferred to disposal group as 0 0 0 0 0 0 0 0 0 asset held for sale Disposals 0 0 0 0 (430) 0 0 0 (430) Cumulative depreciation 0 (20,471) (28) 0 0 0 0 0 (20,499) adjustment following revaluation Cost or valuation at 31 March 2013 12,850 172,656 1,294 5,133 36,942 59 9,739 2,205 240,878 Accumulated depreciation as at 0 0 0 0 23,108 43 3,972 380 27,503 1 April 2012 Provided during the year 0 5,742 28 0 2,711 9 684 258 9,432 Impairments recognised in 0 14,729 0 0 0 0 0 0 14,729 operating expenses Disposals 0 0 0 0 (419) 0 0 0 (419) Cumulative depreciation 0 (20,471) (28) 0 0 0 0 0 (20,499) adjustment following revaluation Depreciation at 31 March 2013 0 0 0 0 25,400 52 4,656 638 30,746 Net book value Owned at 1 April 2012 13,750 89,135 0 342 12,170 17 3,926 1,528 120,868 PFI at 1April 2012 0 83,716 1,141 0 0 0 0 0 84,857 Donated at 1April 2012 0 5,236 0 0 285 0 0 14 5,535 Total at 1 April 2012 13,750 178,087 1,141 342 12,455 17 3,926 1,542 211,260 Net book value Owned at 1 April 2013 12,850 85,555 0 5,133 11,298 7 5,083 1,555 121,481 PFI at 1April 2013 0 82,047 1,294 0 0 0 0 0 83,341 Donated at 1April 2013 0 5,054 0 0 244 0 0 12 5,309 Total at 31 March 2013 12,850 172,656 1,294 5,133 11,542 7 5,083 1,567 210,132
As at 31 March 2013 the Foundation Trust had no land, buildings or dwellings valued at open market values.
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16.3 Property, Plant and Equipment: Asset Lives The range of asset lives for all classes of property, plant and equipment assets held are shown below. Minimum Maximum Life Life Years Years Land No minimum Inde#nite Buildings (excluding dwellings) 1 60 Dwellings 42 42 Plant and machinery 1 15 Transport equipment 1 10 Information technology 1 10 Furniture and #ttings 1 7
The Valuation O!ce provides the Foundation Trust with information on asset lives.
16.4 Asset utilsation - tangible non-current assets
Buildings Assets Equipment and Under including IT & Land Dwellings Construction Furniture & Fittings Total £000 £000 £000 £000 £000 Non-current assets used to provide Commissioner Requested 12,850 160,540 0 0 173,390 Services as at 31 March 2014 Non-current assets not used to provide Commissioner Requested 0 25,396 4,142 19,850 49,388 Services as at 31 March 2014 12,850 185,936 4,142 19,850 222,778 Non-current assets used to provide Commissioner Requested 12,850 150,116 0 0 162,966 Services as at 31 March 2013 Non-current assets not used to provide Commissioner Requested 0 23,833 5,133 18,200 47,166 Services as at 31 March 2013 12,850 173,949 5,133 18,200 210,132
16.5 Impairment, revaluation and accelerated depreciation of non-current assets
2013/14 2012/13 £000 £000 Changes in market price - downward valuation of non-current assets charged to SoCI 2,929 17,168 Changes in market price - downward valuation of non-current assets charged to Revaluation Reserve 58 0 Changes in market price - upward valuation of non-current assets (reversals of past impairments) (11,007) 0 Changes in market price - upward valuation of non-current assets (4,153) (744) Accelerated depreciation of assets (Clinical Sciences Building) 3,207 0 Total impairments, revaluations and accelerated depreciation (8,966) 16,424
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17 Assets Held Under PFI Contracts
17.1 Assets Held Under PFI Contracts Buildings - Hospital Redevlopment Dwellings (Mayo & Hope Buildings) - The Maples Total 2013/14: £000 £000 £000 Cost or valuation at 1 April 2013 82,047 1,294 83,341 Additions purchased 429 3 432 Operating expenses 8,322 0 8,322 Revaluation surpluses 0 136 136 Cumulative depreciation adjustment (1,892) (31) (1,923) At 31 March 2014 88,906 1,402 90,308 Accumulated depreciation as at 1 April 2013 0 0 0 Provided during the year 1,892 31 1,923 Cumulative depreciation adjustment (1,892) (31) (1,923) Depreciation at 31 March 2014 0 0 0 Net book value PFI at 1 April 2013 82,047 1,294 83,341
Net book value PFI at 31 March 2014 88,906 1,402 90,308
17.2 Assets Held Under PFI Contracts - Prior Year Buildings - Hospital Redevlopment Dwellings (Mayo & Hope Buildings) - The Maples Total 2012/13: £000 £000 £000 Cost or valuation at 1 April 2012 83,716 1,705 85,421 Prior period adjustment (197) 197 0 Additions purchased 10,318 0 10,318 Cumulative depreciation adjustment (11,790) (608) (12,398) At 31 March 2013 82,047 1,294 83,341 Accumulated depreciation as at 1 April 2012 0 0 0 Provided during the year 2,264 28 2,292 Impairments recognised in operating expenses 9,526 16 9,542 Cumulative depreciation adjustment (11,790) (44) (11,834) Depreciation at 31 March 2013 0 0 0 Net book value PFI at 1 April 2012 83,716 1,141 84,857
Net book value PFI at 31 March 2013 82,047 1,294 83,341
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18 Capital Commitments
Contracted capital commitments at 31 March not otherwise included in these #nancial statements:
31 March 31 March Capital Commitments include £3.1m for replacing 2014 2013 imaging equipment in an angiography scheme, £000 £000 £0.8m for the new Electronic Patient Record system Property, plant and equipment 7,704 8,659 and £0.5m for the new Heart Care Unit scheme. There are commitments (£1.0m) for schemes for TOTAL 7,704 8,659 the improvement of clinical areas. For purchases of medical and non-medical equipment there are commitments of £0.3m. 18.1 Investments The charitable fund holds investments managed by investment managers on a discretionary basis with an objective to provide a balance between capital growth and income whilst maintaining a medium level of risk. The Charitable Funds Committee receives regular updates from the investment advisors including formal quarterly reports and uses this information to review and con#rm the policy on managing the portfolio. Trust Consolidated Trust Consolidated Trust Consolidated 31 March 2014 31 March 2014 31 March 2013 31 March 2013 1 April12 1 April 2012 £000 £000 £000 £000 £000 £000 Total Investment 0 4,163 0 3,957 0 3,592
19 Inventories
19.1 Inventory movements 2013/14 Total Drugs Consumables Energy £000 £000 £000 £000 Carrying Value at 1 April 3,819 1,430 2,151 238 Additions 51,690 19,421 32,269 0 Inventories recognised in expenses (51,929) (19,585) (32,314) (30) Write-down of inventories recognised as an expense (52) (52) 0 0 Carrying Value at 31 March 2014 3,528 1,214 2,106 208
19.2 Inventories movements 2012/13 Total Drugs Consumables Energy £000 £000 £000 £000 Carrying Value at 1 April 3,390 1,218 1,926 246 Additions 56,684 21,392 35,292 0 Inventories recognised in expenses (56,215) (21,140) (35,067) (8) Write-down of inventories recognised as an expense (40) (40) 0 0 Carrying Value at 31 March 2014 3,819 1,430 2,151 238
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20 Disclosures of Aggregate Amounts for Assets and Liabilities of Jointly Controlled Operations
The following table sets out the gross amounts associated with jointly controlled operations. These transactions are not included in the #nancial results of the Foundation Trust. The values included in the #nancial statements are shown in note 20.1. 31 March 31 March 2014 2013 £000 £000 Current assets 0 0 Non-current assets 5,800 7,460 Total assets 5,800 7,460 Income and expenditure reserve 0 0 Operating income 100 330 Operating expenses (99) (330) Total of assets, liabilities, reserves and charges to SoCI 1 0
The Foundation Trust has three projects that it classes as jointly-controlled operations. These are the North West E-Health development project, the Sterile Services Decontamination Unit (SSDU) and Pathology At Wigan and Salford (PAWS). The North West E-Health development project is an intangible non-current asset originally funded by a government grant. The Foundation Trust includes a one-third share of the transaction in its accounts re$ecting the Foundation Trust’s proportionate share of the asset which is equally shared with NHS Salford and the University of Manchester. The SSDU and PAWS projects are jointly controlled with Wrightington, Wigan and Leigh NHS Foundation Trust providing essential clinical and support services to both Foundation Trusts. The following note - 20.1 - provides further details of the fair values of the Foundation Trust’s investment in each operation. These transactions are included in the #nancial statements of the Foundation Trust.
20.1 Fair value of investments in jointly controlled operations
Assets Liabilities Revenue Pro!t / (Loss) Interest Held £000 £000 £000 £000 £000 North West e-Health 583 (200) 100 1 33 Decontamination Unit 1,927 0 0 0 50 Pathology At Wigan & Salford 666 0 0 0 50 As at 31 March 2014 3,176 200 100 1 North West e-Health 887 (200) 330 0 33 Decontamination Unit 2,209 0 0 0 50 Pathology At Wigan & Salford 841 0 0 0 50 As at 31 March 2013 3,937 (200) 330 0
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21 Trade and Other Receivables
21.1 Trade and Other Receivables
Current Non-current 31 March 31 March 1 April 31 March 31 March 1 April 2014 2013 2012 2014 2013 2012 £000 £000 £000 £000 £000 £000 NHS receivables - revenue - commissioners 16,904 5,877 7,392 0 0 0 NHS receivables - revenue - Foundation Trusts and 3,306 5,739 3,869 0 0 0 NHS Trusts NHS receivables - revenue - other 0 353 177 0 0 0 Other receivables with related parties - revenue 1,014 3,592 875 0 0 0 Provision for the impairment of receivables (1,504) (1,647) (1,011) (594) (443) (262) Receivable from Salford Royal NHS Charity 458 45 91 0 0 0 Prepayments 2,671 3,014 2,904 0 0 0 PFI prepayments - Life-cycle replacements 126 98 0 0 0 0 Operating lease receivables 0 114 118 0 0 0 PDC receivables 337 704 708 0 0 0 VAT receivable 889 658 627 0 0 0 Other receivables 7,119 4,942 4,995 2,251 1,679 1,701
TOTAL 31,320 23,488 20,745 1,657 1,236 1,439
Charitable Funds receivables 34 24 42 0 0 0 Receivable from Salford Royal NHS Charity - value (458) (45) (91) 0 0 0 eliminated on consolidation
TOTAL 30,896 23,512 20,787 1,657 1,236 1,439
Other receivables with related parties includes money owed by NHS National Services of Scotland for specialist services provided to patients (£634k) and money owed by health organisations in Northern Ireland for clinical services provided (£380k). A review of all receivables has been undertaken and a provision for impairment made where the debtor’s ability to pay is such that the Foundation Trust may not receive payment.
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21.2 Provision for Impairment of Receivables (Current and Non Current)
31 March 31 March 2014 2013 £000 £000 At 1 April 2,090 1,273 Increase in provision 1,540 1,818 Amounts utilised / reversed unused (1,532) (1,001) At 31 March 2,098 2,090
The provision for impairment of receivables is only applied to receivables owed to the Foundation Trust (and not to the Charitable Funds) estimated based on three key factors: a) For NHS receivables, a provision is made where another NHS body registers a dispute against the value invoiced by the Foundation Trust where, in the opinion of Trust management, it is possible that following investigation, all or part of the charge will be reversed. b) For receivables expected from claims made via the NHS Injury Recovery scheme, a provision for impairment is made based on the Foundation Trust’s last 12-months experience of the proportion of claims that are rejected. c) For receivables due from non-NHS customers, a provision for impairment is made based on an estimate of the value of outstanding debt that may not be recoverable even in those cases where legal judgement is given in favour of the Foundation Trust.
21.3 Analysis of Impaired Receivables 31 March 31 March 2014 2013 £000 £000 Ageing of impaired receivables 0 - 30 days 151 497 30 - 60 days 116 183 60 - 90 days 242 135 90 - 180 days 251 241 Over 180 days 1,338 1,034 TOTAL 2,098 2,090 Ageing of non-impaired receivables past their due date 0 - 30 days 17,799 15,937 30 - 60 days 592 1,385 60 - 90 days 2,262 532 90 - 180 days 659 912 Over 180 days 2,730 2,843 TOTAL 24,042 21,609
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22 Cash and Cash Equivalents
31 March 2014 31 March 2013 1 April 2012 Charitable Charitable Charitable Healthcare Funds Consolidated Healthcare Funds Consolidated Healthcare Funds Consolidated £000 £000 £000 £000 £000 £000 £000 £000 £000 Balance at 1 April 45,055 89 45,144 53,836 328 54,164 34,127 368 34,495 Net change in year 10,926 304 11,230 (8,781) (239) (9,020) 19,709 (40) 19,669 Balance at 31 March 55,981 393 56,374 45,055 89 45,144 53,836 328 54,164 Made up of Commercial banks and 169 370 539 145 66 211 215 256 471 cash in hand Cash with the Government 55,812 23 55,835 44,910 23 44,933 53,621 72 53,693 Banking Service Cash and cash equivalents 55,981 393 56,374 45,055 89 45,144 53,836 328 54,164 as in statement of $nancial position
Cash and cash 55,981 393 56,374 45,055 89 45,144 53,836 328 54,164 equivalents as in statement of cash !ows
23 Trade and Other Payables
Current Non-current 31 March 31 March 1 April 31 March 31 March 1 April 2014 2013 2012 2014 2013 2012 £000 £000 £000 £000 £000 £000 Receipts in advance 0 65 418 0 0 0 NHS payables 9,215 3,317 15,676 0 0 0 Amounts due to other related parties 3,306 3,839 5,122 445 455 455 Other trade payables - capital 574 624 1,446 0 0 0 Social Security costs 2,369 2,229 1,932 0 0 0 Other taxes payable 2,701 2,493 2,298 254 244 244 Other payables 17,474 6,839 7,231 0 0 0 Accruals 18,797 21,542 13,036 0 0 0 Sub-total Trust trade and other payables 54,436 40,948 47,159 699 699 699 Charitable Funds Payables 22 44 97 0 0 0 Total trade and other payables 54,458 40,992 47,256 699 699 699
Amounts due to other related parties - include: £3,560k (2012/13 £3.191k) outstanding pensions contributions at 31 March 2014. This is reported as £3,306k current liability (2012/13-£2,953k) and £254k non-current liability (2012/13-£244k). Accruals are amounts owed to suppliers of goods and services where the goods / services have been received but the associated invoice(s) not received by the Foundation Trust by 31 March 2014.
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24 Borrowings
Current Non-current 31 March 31 March 1 April 31 March 31 March 1 April 2014 2013 2012 2014 2013 2012 £000 £000 £000 £000 £000 £000
Loans from Independent Trust Financing Facility 512 0 0 9,488 0 0 PFI liabilities: Main liability 3,115 3,061 3,054 111,383 114,531 108,360 Total Trust borrowings 3,627 3,061 3,054 120,871 114,531 108,360
The Foundation Trust’s PFI borrowings relate to its two On-Statement of Financial Position privately #nanced assets - The Maples and the main hospital redevelopment scheme (see note 27). The Maples concession period ends in 2025. The hospital redevelopment concession ends in 2042. During 2013/14, the Foundation Trust borrowed £10 million to be repaid over a 20-year period at a rate of interest of 2.8% from the Foundation Trust Financing Facility to #nance part of its capital expenditure plans during the year. All borrowings relate to the Foundation Trust. The Charitable Funds did not have any borrowings in the period between 1 April 2012 and 31 March 2014.
25 Other Liabilities
Current Non-current 31 March 31 March 1 April 31 March 31 March 1 April 2014 2013 2012 2014 2013 2012 £000 £000 £000 £000 £000 £000
Deferred income 9,158 11,792 16,232 0 2,090 1,059
Total Trust other liabilities 9,158 11,792 16,232 0 2,090 1,059
26 Finance Lease Obligations
Other than the two private #nance initiative funded building schemes (hospital redevelopment and the Maples), the Foundation Trust does not have any #nance lease obligations.
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27 Private Finance Initiative Contracts During 2013/14, the operator recalculated the #nancial model that sets the value of the unitary payment. Owing 27.1 PFI Schemes On-Statement of Financial Position to a number of variations to the PFI contract since scheme commencement, the impact of the #nancial model re- The Maples PFI Scheme run was to increase the value of the pre-in$ated unitary payment by £86k per year. This increased payment is The Maples scheme is for the provision of long-term clinical e"ective from 1 April 2013 and the impact included in the accommodation and hotel services for patients with acute results reported in these accounts. neuro-rehabilitation requirements. There are no guarantees, obligations or other rights associated with the scheme. A limited number of the services provided within the agreement may be subject to market-testing every #ve There are no deferred assets or residual interests associated years beginning in 2011 as required by the Foundation Trust. with the Maples PFI transaction. These eligible services include security services and pest- The Maples scheme commenced in March 2000 with a 25- control services. year concession period. At the end of the agreement, the Under the terms of the Project Agreement, the Foundation Foundation Trust has a right to purchase the asset at open Trust has the right to use the assets built by Consort that are market value. included as part of the scheme to deliver services to the public. The unitary payment for the Maples is subject to annual The agreement includes sections relating to termination increase which is based on a formula that uses movements of the contract. Termination may be implemented in the in the value of the retail price index calculated annually from event of signi#cant failures on the part of the PFI project February to February. company to deliver the speci#ed level of quality and The Hospital Redevelopment PFI Scheme services, including completing construction of the assets by the agreed ‘long-stop’ dates. Other actions leading to a The Hospital Redevelopment Scheme is for the provision right to terminate include the project company becoming of clinical and non-clinical accommodation through an insolvent, undertaking a change in control outside of the agreement with Consort, the PFI partner. This has been scope allowed in the agreement, having a serious breach of achieved by the construction of two new buildings and the health and safety law or a failure to pay the Foundation Trust development of link corridors to join existing Foundation material sums due on time. Trust owned buildings to the PFI buildings. The project agreement does not include renewal clauses. The agreement also includes the provision of a number At the end of the concession period, all assets revert to the of services to the Foundation Trust by Consort including Foundation Trust. building maintenance and lifecycle services, grounds and During the concession period, the building assets are gardens maintenance, security services, pest control, utilities required to be maintained at a speci#ed level of condition and a helpdesk facility. and service. The PFI project company manages and The hospital redevelopment scheme commenced in 2007 maintains a life-cycle plan to ensure that the assets remain with a 35-year concession period which ends in 2042. At the in the speci#ed condition. During the concession period end of the agreement, the assets will pass to the Foundation it is likely that major works such as lift replacements and Trust for nil consideration. window replacements will be necessary. These will be the The annual payment for the Hospital Redevelopment responsibility of the PFI project company. Scheme increased in 2012/13 as the construction period Having considered the content included in International ended in June 2012 and the full complement of building Financial Reporting Standards in respect of service concession and other assets were handed over to the Foundation Trust arrangements, in particular International Financial Reporting for operational use. The proportion of the annual payment Interpretations Committee (IFRIC) publication 12, the due to Consort to re$ect the phasing of handover of the PFI hospital redevelopment project has been classed as a service building assets increased from 80% to 100% in June 2012. concession arrangement for the provision of infrastructure. The proportion of the unitary charge payable will remain at Under International Financial Reporting Interpretation 100% for the remainder of the concession period. Committee guidance 12 (IFRIC 12), both the Maples and the The full annual unitary payment is subject to annual increase in hospital redevelopment assets are treated as assets of the line with changes in the retail price index, calculated annually Foundation Trust. The substance of the contracts are that from February to February. Each 1% rise in the RPI index the Foundation Trust has a #nance lease and the payment increases the unitary payment made by the Trust by c. £150k. streams comprise two elements; imputed #nance lease RPI for 2014/15 applied to the PFI scheme will be 2.67%. charges and service charges.
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27.2 Total Obligations for On-Statement of Financial Position PFI Contracts:
31 March 31 March 2014 2013 Total Total £000 £000 Gross PFI liabilities 200,827 209,430 Of which liabilities are due: Not later than one year 8,476 8,560 Later than one year, not later than #ve years 32,788 33,111 Later than #ve years 159,563 167,759 Less #nance charges allocated to future periods (86,329) (91,838) Net PFI liabilities 114,498 117,592
Of which liabilities are due: Not later than one year 3,115 3,064 Later than one year, not later than #ve years 12,830 12,575 Later than #ve years 98,553 101,954 Net PFI liabilities 114,498 117,592
27.3 Total Commitments for On-Statement of Financial Position PFI Contracts The Foundation Trust is committed to making the following payments in respect of the service element of its on-SoFP PFI service payments:
31 March 31 March 2014 2013 Total Total Commitments in Respect of the Service Element £000 £000
Not later than one year 5,197 4,578 Later than one year, not later than #ve years 21,538 19,848 Later than #ve years 187,311 183,807 TOTAL 214,046 208,233
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28 Provisions
Current Non-current 31 March 31 March 1 April 31 March 31 March 1 April 2014 2013 2012 2014 2013 2012 £000 £000 £000 £000 £000 £000 Pensions relating to former directors 0 0 0 0 0 0 Other legal claims 239 244 121 0 0 89 Injury bene#t and non-clinical claims 2,543 2,847 2,976 5,497 4,819 3,542 TOTAL 2,782 3,091 3,097 5,497 4,819 3,631 Charitable Funds provisions 0 6 13 0 0 0 Total Provisions 2,782 3,096 3,110 5,497 4,819 3,631
Legal Injury Bene#t and Other Claims Restructuring Costs Provisions Total £000 £000 £000 £000 As at 1 April 2013 244 6,534 1,131 7,909 Charitable Funds provisions 0 0 6 6 As at 1 April 2013 restated 244 6,534 1,137 7,915 Change in the discount rate to 1.80% 0 233 0 233 Arising during the year 146 1,403 709 2,258 Used during the year - accruals (2) (33) 0 (35) Used during the year - cash (14) (649) (170) (833) Reversed unused (135) (1,168) 0 (1,303) Unwinding of discount 0 44 0 44 At 31 March 2014 239 6,364 1,676 8,279 Expected timing of cash !ows: Not later than 1 year 239 1,152 1,391 2,782 Later than 1 year and not later than 5 years 0 2,600 285 2,885 Later than 5 years 0 2,612 0 2,612 TOTAL 239 6,364 1,676 8,279
Provisions are liabilities that are of uncertain timing or amount which the Foundation Trust expects to be settled by a transfer of economic bene#ts. Provisions for legal claims are based on information supplied by the NHS Litigation Authority. The amount shown is based on the maximum sum the Foundation Trust would be required to fund on the event of a successful claim adjusted by a ‘probability of settlement’ factor. The Foundation Trust has made a provision for other liabilities and claims based on information provided by professional advisers. These include provisions for future pension payments for former sta" claiming permanent injury bene#t based on information supplied by NHS Pensions Agency and provisions for NHS employment costs based on information supplied by the Foundation Trust’s legal advisers. £63,851k (2012/13 - £53,748k) is included in the provisions of the NHS Litigation Authority at 31 March 2014 in respect of clinical negligence liabilities on behalf of the Foundation Trust. The Charitable Funds did not have any provisions arising in the year. Charitable Fund provisions brought forward from 2012/13 were utilised through cash payments during the year.
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29 Revaluation Reserve
Revaluation Reserve - Property, Plant and Equipment £000 Reserves at 1 April 2013 22,081 Impairment losses on property, plant and equipment (58) Revaluation gains / (losses) on property, plant and equipment 4,153 Transfers by absorption -modi#ed (Salford PCT assets) 57 Transfers to income and expenditure account in respect of assets disposed of 0 Transfers of the excess of current cost depreciation over historical cost depreciation (to income (33) and expenditure reserve) Reserves at 31 March 2014 26,200 Reserves at 1 April 2012 23,825 Impairment losses on property, plant and equipment (2,439) Revaluation gains / (losses) on property, plant and equipment 744 Transfers by absorption - modi#ed 0 Transfers to income and expenditure account in respect of assets disposed of (4) Transfers of the excess of current cost depreciation over historical cost depreciation (to income (45) and expenditure reserve) Reserves at 31 March 2013 22,081
The Foundation Trust does not hold any revaluation reserve balances for intangible assets.
30 Contingencies
30.1 Contingent Liabilities 31 March 2014 31 March 2013 £000 £000 Gross value of contingent liabilities (942) (1,392)
TOTAL (942) (1,392)
For each provision included in note 28 where a ‘probability of settlement’ factor is applied to estimate the value of the provision, the di"erence between the estimated total liability and the amount included in provisions is reported as a contingent liability to re$ect the non-probable liability for the Foundation Trust. The contingent liabilities shown in this note relate to legal claims, potential permanent injury bene#t and non-clinical claims. There are £117k of contingent liabilities relating to amounts noti#ed by the NHSLA for potential employer and public liability claims above the amounts provided for in note 28 to these accounts. In addition, contingent liabilities for potential permanent injury bene#ts not provided for in note 28 to these accounts of £826k are included in this note, 30.1.
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31 Financial Instruments
31.1 Financial Assets by Category
Loans and Available for Receivables Sale Assets Total £000 £000 £000 Trade and other receivables not including non-#nancial assets 27,728 0 27,728 Cash and cash equivalents 55,981 0 55,981 NHS charitable funds #nancial assets 427 4,163 4,590 Total at 31 March 2014 84,136 4,163 88,299 NHS trade and other receivables not including non-#nancial assets 11,969 0 11,969 Non-NHS trade and other receivables not including non-#nancial assets 7,659 0 7,659 Cash and cash equivalents 45,055 0 45,055 NHS charitable funds #nancial assets 113 3,957 4,070 Total at 31 March 2013 64,796 3,957 68,753
Items included in note 31.1 not included above are: 2013/14 2012/13 £000 £000 Prepayments 2,671 3,014 PFI prepayments - lifecycle 126 98 PDC receivables 337 704 Non-current receivables 1,657 1,236 4,791 5,051
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31.2 Financial Liabilities by Category
Other Financial Liabilities £000 Loans from the Foundation Trust Financing Facility 10,000 Obligations under PFI contracts 114,498 NHS trade and other payables not including non-#nancial liabilities 9,215 Non-NHS trade and other payables not including non-#nancial liabilities 18,048 Other #nancial liabilities 22,357 Provisions under contract 7,655 NHS charitable fund #nancial liabilities 22 Total at 31 March 2014 181,795 Obligations under PFI contracts 117,592 NHS trade and other payables not including non-#nancial liabilities 3,317 Non-NHS trade and other payables not including non-#nancial liabilities 7,463 Other #nancial liabilities 25,635 Provisions under contract 7,278 NHS charitable fund #nancial liabilities 50 Total at 31 March 2013 161,335
Items included on the Statement of Financial Position not included in note 31.2 above are:
2013/14 2012/13 £000 £000 Receipts in advance 0 65 Social Security and other taxes payable 5,515 5,167 Deferred income 9,158 13,882 Provisions not under contract 624 632 15,297 19,746
31.3 Maturity of Financial Liabilities
31 March 31 March 2014 2013 £000 £000 In one year or less 55,371 41,933 In more than one year but not more than two years 5,074 4,214 In more than two years but not more than #ve years 12,682 11,061 In more than #ve years 108,668 104,127
TOTAL 181,795 161,335
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31.4 Financial Risk Management Financial reporting standard IFRS 7 requires disclosure Credit risk of the role that #nancial instruments have had during Because the majority of the Foundation Trust’s income the period in creating or changing the risks a body comes from contracts with other public sector bodies, faces in undertaking its activities. Because of the the Foundation Trust has low exposure to credit risk. service provider relationship that the Foundation Trust The maximum exposures as at 31 March 2014 are in has with Clinical Commissioning Groups, NHS England receivables from customers, as disclosed in the trade and local authorities and the way those commissioners and other receivables note. of healthcare are #nanced, the Foundation Trust is not exposed to the degree of #nancial risk faced by Liquidity risk business entities. Also #nancial instruments play a The Foundation Trust’s operating costs are incurred much more limited role in creating or changing risk under contracts with CCGs, NHS England and local than would be typical of listed companies, to which authorities, which are #nanced from resources voted the #nancial reporting standards mainly apply. The annually by Parliament . The Foundation Trust funds Foundation Trust has limited powers to borrow or its capital expenditure from internally generated invest surplus funds and #nancial assets and liabilities resources plus a #xed interest loan from the FTFF. The are generated by day-to-day operational activities Foundation Trust is not, therefore, considered to be rather than being held to order to change the risks exposed to signi#cant liquidity risks. facing the Foundation Trust in undertaking its activities. Charitable Fund investment The Foundation Trust’s treasury management The Charity’s investments are managed by the operations are carried out by the #nance department, investment managers, Investec, on a discretionary within parameters de#ned formally within the policy basis with an objective to provide a balance between agreed by the board of directors. Foundation Trust capital growth and income whilst maintaining a treasury activity is subject to review by the Foundation medium level of risk. The Charitable Funds Committee Trust’s internal auditors. receives regular updates from the investment advisers including full quarterly reports and uses Currency risk this information to review and con#rm the policy on The Foundation Trust is principally a domestic managing the portfolio. The value of the investment organisation with the great majority of transactions, portfolio at 31 March 2014 is £4,163k and generated assets and liabilities being in the UK and sterling based. income of £115k. The Charitable Funds Committee The Foundation Trust has no overseas operations. Chairman and the Executive Director of Finance are The Foundation Trust therefore has low exposure to noti#ed if the portfolio value falls by a material sum currency rate $uctuations. (5%+ or c.£200k) and advice on required actions to minimise risk is taken from the investment managers. Interest rate risk The Foundation Trust is permitted to borrow to fund capital expenditure, subject to a"ordability as con#rmed by Monitor, the Independent Regulator of Foundation Trusts. As at 31 March 2014, the Foundation Trust has borrowed £10 million from the Foundation Trust Financing Facility at a #xed rate of interest of 2.80% and therefore has a low exposure to interest rate risk.
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Fair values of #nancial assets as at 31 March 2014 31 March 2014 31 March 2014 31 March 2013 31 March 2013 1 April 2012 1 April 2012 Book Value Fair Value Book Value Fair Value Book Value Fair Value £000 £000 £000 £000 £000 £000 Non current trade and other 1,657 1,657 1,236 1,236 1,439 1,439 receivables excluding non #nancial assets Sub-total Trust 1,657 1,657 1,236 1,236 1,439 1,439 Charitable Funds investment 4,163 4,163 3,957 3,957 3,592 3,592 assets TOTAL 5,820 5,820 5,193 5,193 5,031 5,031
Fair values of #nancial liabilities as at 31 March 2014 31 March 2014 31 March 2014 31 March 2013 31 March 2013 1 April 2012 1 April 2012 Book Value Fair Value Book Value Fair Value Book Value Fair Value £000 £000 £000 £000 £000 £000 Non current trade and other 699 699 699 699 699 699 payables excluding non #nancial liabilities Provisions under contract 8,279 8,279 7,910 7,910 6,728 6,728 Loans from the FTFF 10,000 10,000 0 0 0 0 PFI liabilities 114,498 114,498 117,592 117,592 111,864 111,864 Total Trust liabilities 133,476 133,476 126,201 126,201 119,291 119,291
The Charitable Funds do not have any non-current #nancial liabilities. The fair value of all assets and liabilities is reported as being equal to their book value as no alternative method of valuation that gives a materially more accurate result has been identi#ed.
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32 Events After the Reporting Period 34 Prudential Borrowing Limit
There are no material events after the reporting date. The prudential borrowing code requirements set out in section 41 of the NHS Act 2006 were repealed with e"ect from 1 April 2013 by the Health and Social Care Act 2012. As a consequence, the prudential 33 Public Dividend Capital Dividends Paid borrowing limit note is no longer provided as part of the Foundation Trust’s accounts. Since 2010/11 the dividend payable on Public Dividend Capital is based on the actual (rather than forecast) average relevant net assets and therefore the actual capital cost absorption rate is automatically 3.5%. Any di"erence between the amount actually paid in the year and the 3.5% required is recorded as a receivable or payable as appropriate in the Statement of Financial Position. The calculation of the value of the PDC dividend reported in the Statement of Comprehensive Income is shown below.
2013/14 2012/13 Average Average net relevant assets £000 £000 £000 Total Public Dividend Capital 123,478 104,336 113,907 and Reserves of the Trust prior to consolidation of the Charitable Funds Less : net book value of (6,017) (5,309) (5,663) donated assets Less : net average daily (55,794) (44,909) (50,352) cleared balances in GBS bank accounts (2013/14 requirement. In 2012/13 the GBS balance as at 31 March 2013 was used) Less : net assets and liabilities (324) 0 (162) transferring from Salford PCT (2013/14 adjustment only) Less : PDC receivable (337) (704) (521) Total 61,006 53,414 57,210 3.5% dividend on average 2,003 net relevant assets
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35 Related Party Transactions
Salford Royal NHS Foundation Trust is a public interest body authorised by Monitor - the Independent Regulator for NHS Foundation Trusts. Certain members of the Board of Directors, key members of sta" (or parties related to them) and members of the Council of Governors have connections with organisations which also have transactions with the Foundation Trust. These organisations are listed below.
Income From Expenditure to Amounts Due Amounts Owed Related Related From Related to Related Party Party Party Party To 31 March 2014 £000 £000 £000 £000 Value of transactions / balances with board members 0 1,119 0 0 2013/14 (expenditure is salary cost) Value of transactions / balances with other related parties Department of Health including PDC dividend repayment 4,683 0 424 0 Other NHS bodies 420,109 18,073 20,123 9,214 Provision for impairment of receivables - NHS 0 0 (456) 0 Charitable Funds 314 414 0 0 Loan from Foundation Trust Financing Facility 0 0 0 10,000 NHS Shared Business Services 0 271 0 19 Other 9,041 47,853 1,903 9,076
TOTAL 434,147 67,730 21,994 28,309
Other related parties include local authorities, HM Revenue and Customs and the NHS Pensions Agency. The Department of Health is regarded as a related party and the parent organisation of the Foundation Trust. During the year Salford Royal NHS Foundation Trust has had a signi#cant number of material transactions with the Department, and with other entities for which the Department is also regarded as the parent Department. These entities include: NHS England Clinical Commissioning Groups NHS Trusts NHS Litigation Authority NHS Business Services Authority The Foundation Trust has also received revenue and capital income from Salford Royal NHS Foundation Trust charitable funds, certain of the Foundation Trustees for which are also members of the Foundation Trust Board of Directors.
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Income From Expenditure to Amounts Due Amounts Owed Related Related From Related to Related Party Party Party Party To 31 March 2013 £000 £000 £000 £000 Value of transactions / balances with board members 0 1,213 0 0 2012/13 (expenditure is salary cost) Value of transactions / balances with other related parties Department of Health including PDC dividend repayment 2,449 12 1,035 0 Other NHS bodies 403,726 18,393 11,638 3,336 Provision for impairment of receivables - NHS 0 0 (758) 0 Charitable Funds (eliminated on consolidation) 293 444 0 0 NHS Shared Business Services 0 518 0 69 University of Manchester 1,013 7,803 184 20 Medtronic 0 1,518 0 46 GlakxoSmithKline Unlimited 2,972 0 412 0 Baxter Healthcare 0 3,363 0 18 Johnson and Johnson Medical 0 2,099 0 34 Genzyme 106 1,276 7 0
TOTAL 410,559 36,639 12,518 3,523
36 Third Party Assets
The Foundation Trust held £49k of cash and cash equivalents at 31 March 2014 (£42k - at 31 March 2013) which relates to monies held by the Foundation Trust on behalf of patients. The Foundation Trust also held £284k on behalf of the North West e-Health project (£327k - 2012/13). Both of these amounts have been excluded from the cash and cash equivalents #gure reported in the accounts. In addition, the consolidated #nancial position includes £393k of cash held by the Charitable Funds which is not available to the Foundation Trust to spend.
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37 Losses and Special Payments
There were 124 cases of losses and special payments (2012/13: 72 cases) totalling £406k (2012/13: £232k) incurred during 2013/14. Losses and special payments are reported on an accruals basis but exclude any provision for future losses. Details of losses reported in 2013/14 are provided below.
Number Value Losses £000 Bad debts and claims abandoned 63 98 (excluding cases with other NHS bodies) Stores losses including damage to 1 52 buildings and other property as a result of theft, criminal damage and neglect Total Losses 64 150 Number Value Special Payments £000 Extra contractual payments 0 0 Loss of personal e"ects 19 11 Extra-statutory and extra-regulatory 0 0 payments Compensation payments 35 124 Other employment payments 6 122 Ex-gratia payments 0 0 Total Special Payments 60 257 Total losses and special payments 124 406
38 Auditor’s Liability
There is no speci#ed limitation in the Foundation Trust’s contract with its external auditors, Grant Thornton, that provides for limitation of the auditor’s liability; however, in the event of a claim, the contract limits the sum to an amount that is fair and reasonable, as so determined.
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