Luton & Dunstable University Hospital NHS Foundation Trust NHS Foundation Hospital University & Dunstable Luton Annual Report & Accounts 2018-2019 2018-2019 & Accounts Annual Report Annual Report and Accounts for the period April 2018 to March 2019 Incorporating Quality Account Quality Incorporating Annual Reportincorporating Quality Account & Accounts 2010-2011 Luton & Dunstable University Hospital NHS Foundation Trust Lewsey Road Luton LU4 0DZ Incorporating Quality Report Telephone 01582 49 11 66 www.ldh.nhs.uk Luton and Dunstable University Hospital NHS Foundation Trust Luton and Dunstable University Hospital NHS Foundation Trust Annual Report & Accounts for the period April 2018 to March 2019 incorporating Quality Account Presented to Parliament pursuant to Schedule 7, paragraph 25 (4) (a) of the National Health Service Act 2006 © 2019 Luton and Dunstable University Hospital NHS Foundation Trust Contents INTRODUCTION 3 GOVERNANCE REPORT 81 About this Report 5 Board of Directors 82 Chief Executive Introduction 6 Committees of the Board of Directors 89 Chairman’s Statement 7 Audit and Risk Committee 90 Council of Governors 93 STRATEGY 9 Foundation Trust Membership 97 Annual Report Executive Summary 10 2019/20 Strategic Approach 16 FINANCIAL PERFORMANCE REPORT 101 Maintaining our Performance 19 Review of Financial Performance 102 Corporate Objectives 2019/20 20 Remuneration report 104 Service Developments planned for 2019/20 21 Fundraising and Charitable Donations 105 Performance against Corporate Objectives 2018/19 25 Service Developments delivered during 2018/19 29 ANNUAL GOVERNANCE STATEMENT AND ACCOUNTS 109 Improving Quality 33 Statement of the Chief Executive’s Responsibilities 110 OPERATIONAL PERFORMANCE REPORT 35 Annual Governance Statement 2018/19 111 Principal activities of the Trust 36 Independent Audit Opinion 119 Review of Operational Performance 38 Foreword to the Accounts 126 Regulatory Quality CQC Performance 39 Statement of comprehensive income 127 Research Performance 42 Statement of financial position 128 Education and Performance 43 Statement of changes in equity 129 Sustainability/Climate Change Performance 48 Statement of cash flows 130 Emergency Preparedness, Resilience and Response Performance 50 APPENDIX 1 QUALITY ACCOUNT 169 Awards and Congratulations 52 What is a Quality Account? 170 About Our Trust 171 OUR PATIENTS, OUR STAFF AND OUR PARTNERS 55 A Statement on Quality from the Chief Executive 173 Our Patients 56 Corporate Objectives 2018/19 174 Our Staff 60 Achievements in Quality Improvement Equality and Diversity 69 Priorities 2018/19 175 Working with our Partners 76 Quality Improvement Priorities 2019/20 197 Awards and Congratulations 77 Statements of Assurance from the Board 201 Review of Quality Performance 218 Glossary 239 Statement of Directors responsibilities for Quality Account 242 Stakeholder Feedback 243 Independent Auditor Assurance Report 246 L&D: INTRODUCTION Introduction Contents 1 About this Report 5 Chief Executive Introduction 6 Chairman’s Statement 7 3 ANNUAL REPORT & ACCOUNTS 2018/19 & ACCOUNTS REPORT ANNUAL L&D: About this Report INTRODUCTION The report follows best corporate practice reporting on the Trust’s strategy and performance against the objectives. The report presents information on national targets and financial performance and also gives a review of the quality of services. The report is structured as follows: Introduction Statements from the Chairman and the Chief Executive Executive Summary An overview of the Annual Report Strategy The Trust strategic vision, performance against 2018/19 objectives and the corporate objectives for 2019/20 Operational Performance Report Includes performance against national targets, Research and Development and sustainability. Our Patients, Our Staff and Our Partners Includes other information about patient care, staff, Equality and Diversity and working with partners Governance Report Includes details of the Board of Directors, Council of Governors and Foundation Trust membership Financial Performance Report Includes performance against financial targets and any risks for the future 5 Annual Governance Statement and Annual Accounts Includes the Annual Governance Statement and the annual accounts Quality Account Includes details of the progress against quality objectives for 2018/19, the plans for 2019/20 and the annual quality statements. Chief Executive Introduction Dear Colleagues organisations work together with a shared vision. We will continue to look to gain approval for the redevelopment The Trust has continued its excellent performance in of the hospital and proposed merger with Bedford. ensuring patients can access our services quickly either through our emergency pathway, as elective outpatients We have engaged actively with the Integrated Care or as a cancer referral. We also met our required surplus System as we see this as a major part of the solution amounting to 3% of our turnover and as a result, received to achieve a more sustainable local health economy performance bonus funding taking our final surplus to and stem the rising demand for our services. Central £22.6m. This financial performance has been achieved by to this will be the digital strategy which aims to link up good operating efficiency (we have the NHS record lowest all parties in the system in delivering care to our local ‘weighted average unit’ – this is the measure used by the patients. We will play a leading role in the delivery of the Model Hospital to measure productivity). infrastructure which will support this aim. During the year we have concentrated much of our In all this is great thanks to a dedicated workforce efforts on laying solid foundations to enable us to who were recognised by CQC as ‘Good’ and who we continue our future success. Whilst some of these acknowledge in our vision statement as central to our changes have been related to our estate (such as future success in serving our local population. our electrical works, our preparedness to create a new energy centre, our new operating theatres and our new endoscopy decontamination unit) the most important ones relate to our people and our services. The publication of the CQC’s report and its confirmation of our ‘Good’ rating (and all core services as at least ‘Good’) provides us with a platform to achieve our goal of providing ‘Outstanding’ services. Our quality improvement approach, led by our new Director of Quality, Catherine Thorne, will be our way of achieving that aim. In the summer staff engagement event we presented the final piece of our work on vision and values with David Carter the translation of those values into behaviours. Our Chief Executive foundation for the future is our staff and we recognise that our success has been built on delivering a culture which supports staff to ‘live’ those values every day. We are also continuing to build the foundations for our partnership with Bedford Hospital. The development of a plan to bring our pathology services together from April 2020 demonstrates what can be achieved when the two 6 ANNUAL REPORT & ACCOUNTS 2018/19 & ACCOUNTS REPORT ANNUAL L&D: Chairman’s Statement INTRODUCTION Last year I started my statement We are second highest (i.e. cheapest) in the Weighted by addressing the Hospital’s Average Unit cost score across the hospital sector performance over that winter and, very unusually, achieve a surplus of around 3% of ravaged by snow, cold and flu. revenue – all of which, of course, gets reinvested in the This winter may have been, on services. Our ability to achieve this last year rested in the face of it, less severe in terms part with our Finance Director, Andrew Harwood, who of the snow but, as anyone who sadly left at the end of the calendar year after serving lived through it will remember, the Hospital (always achieving financial targets) for 19 the lack of precipitation was made up for by keen biting years. His Deputy, Matthew Gibbons, is currently acting in winds. Since the year just closed, we experienced our the post and demonstrates the same discipline. highest number of daily attendances, 550, at A&E; only 10 years ago this figure would have been averaging below We also welcomed Liz Lees who joined us as our Chief 200. The fact that this Hospital managed to survive that Nurse from June 2019 and Catherine Thorne in a new post pressure and cancelled operations because of equipment, as Director of Quality & Safety Governance, between them rather than staffing failure - is a tribute to the quality and combining responsibility, with our Medical Directors, for determination of all those at the Hospital. This was further coordinating our core objective of patient service. confirmed by the results of our patient survey, conducted nationally, which makes it very clear that our services are At the Non-Executive level, we have to say a very warm particularly (better than the average) appreciated by those thank you to those who have left us: John Garner, who who use them. In part this is because we continue to lead consistently demonstrated a determination to put patients the country on all the core statistics, taken in aggregate, from all walks of life and backgrounds absolutely at the for access to our services – A&E, general medicine, cancer forefront of the Hospital’s agenda, and David Hendry, who and diagnostic tests. David Carter has addressed this in was called back to do his duty and serve as Chief Finance greater detail in his introduction. Officer to Crossrail having chaired with great attention, sympathy and effort, our Audit Committee for nearly We, as a Board, supported by our excellent group four years. We wish them both well. We welcome onto the of Governors, are very clear that our “day job” is to Board Non-Executives Mark Prior who joins us to chair our maintain that level of service to our local community. Redevelopment Committee, and Simon Barton to replace But we also have to be aware how the nature of that David Hendry as Chair of Audit. We are very fortunate responsibility is changing: to have been able to choose from such a strong list of candidates – perhaps a final confirmation of the regard in • We now are expected to participate much more actively which the Hospital is massively held.