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NHS Lothian Annual Accounts 2017-2018

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NHS Lothian Annual Accounts 2017-2018 Annual Report and Accounts Year ended 31 st March 2018 ` NHS LOTHIAN ANNUAL REPORT AND ACCOUNTS FOR THE YEAR ENDED 31 ST MARCH 2018 INDEX PAGE Annual Report 3 Section A: The Performance Report 3 • Overview 3 • Performance Analysis 16 Section B: The Accountability Report 40 • Corporate Governance Report 40 - Directors report 40 - Statement of Health Board Members’ Responsibilities in respect of Accounts 42 - Statement of Chief Executive’s Responsibilities as the Accountable Officer of the Health Board 44 - The Governance Statement 45 • Remuneration and Staff Report 54 • Parliamentary Accountability Report 68 Independent Auditor’s Report 69 Accounts’ Primary Financial Statements 72 Notes to the Accounts 77 Accounts Direction 118 2 NHS LOTHIAN ANNUAL REPORT AND ACCOUNTS FOR THE YEAR ENDED 31 ST MARCH 2018 ANNUAL REPORT SECTION A: THE PERFORMANCE REPORT 1. Overview This Overview aims to succinctly provide any reader with sufficient information to understand the NHS Board, its purpose, the key risks to the achievement of its objectives and how it has performed during the year. Should you wish to find out more detailed information we have provided this in the rest of the Performance Report, the Accountability Report and the financial statements. NHS Lothian routinely publishes a wide range of information on its services and activities on its website which you can find at: http://www.nhslothian.scot.nhs.uk/Pages/default.aspx a) Statement from the Chief Executive on the Performance of the NHS Board I would like to acknowledge the hard work of all of the Board’s staff, and thank them for all their efforts which allow us to continue to provide safe, effective, person-centred care. For a number of years NHS Lothian has had an annual awards event, Celebrating Success, to recognise those employees who embrace NHS Lothian’s core values of Care and Compassion, Dignity and Respect, Quality, Teamwork, and Openness, Honesty and Responsibility. It is an opportunity to recognise examples of inspirational and selfless work by our employees. Members of the public can nominate their Health Hero. You can find out more ab`out this process, including details of previous winners at the following link: http://www.nhslothian.scot.nhs.uk/MediaCentre/CelebratingSuccess/Pages/csa.aspx As is the case for every year, in 2017/18 NHS Lothian and its employees have produced a wide range of achievements and improvements. You can find a summary of these in Section 2 of this Performance Report, the Performance Analysis. Developing Organisational Culture and Leadership The fundamental challenge facing the leadership team is how to address the fact that the growth in demand is outstripping the growth in resources (human, financial and estate). There is also a more complex organisational landscape with the emergence of integration joint boards (“IJB”) and the continued development of regional planning across health board areas. We need to deliver genuinely transformed models of service delivery – encouraging supported self care, prevention, alternatives to secondary care in the community, primary and social care and new ways of delivering secondary and tertiary care. We need to embrace technology, innovation and experimentation and we need to have the capacity and capability to take giant leaps as well as small steps of change. In my previous statements I have set out how we have made changes to the leadership structure which should help to free up my role as the Chief Executive to focus principally on strategic transformational change and also to have a stronger leadership role in the East of Scotland region (see below). The aim of the changes to the leadership structure is to develop a culture that promotes enabled, clinically-led, distributed leadership. I use the term “distributed leadership” to express where front line clinicians feel enabled and supported to experiment and innovate in pursuit of improving the quality of their services. This is often quite at odds with the micro- management often associated with top-down targets which is so evident in our current system. “Distributed leadership” requires local clinical leaders and their teams to have the motivation and confidence to take responsibility for improving things, and being willing to try new things which may or may not work. Our Quality Management System (QMS) is the means to turn this aspiration into reality. The QMS approach begins by understanding and describing the systems underpinning core, day-to-day processes and pathways. We then deploy our analytical service to extract the data underpinning these pathways to understand the causes and consequences of unwarranted variation. By training, enabling and empowering front line teams to manage quality, tests of change to continuously improve performance are then undertaken. These will be supported by 3 NHS LOTHIAN ANNUAL REPORT AND ACCOUNTS FOR THE YEAR ENDED 31 ST MARCH 2018 patient-level costing systems, which will enable us to understand the cost savings associated with reduction in unwarranted variation and waste. Nowhere in Lothian have I seen a better example of this distributed leadership model than in the Quality Improvement Programme for Mental Health. The Quality Improvement Team, supported by senior leadership in our mental health services, have generated a real enthusiasm and created a momentum around engagement and participation that is frankly astonishing. We hoped that people would engage but now our problem is keeping up with demand. The planning for the next three years has some extremely strong foundations to build upon. I look forward with great interest to seeing this programme go from strength to strength, working with our staff, our partners, our patients, and our patients to improve the quality of our mental health services in Lothian. Emergency Access Standard In my 2016/17 statement I highlighted that in the previous 5 years we had undertaken a lot of work to develop the organisation’s culture, and summarised some of the measures that we had put in place. During 2017/18 specific concerns were raised under the Board’s whistleblowing arrangements about the alleged mismanagement of the emergency access standard waiting times reporting and an alleged culture of bullying and intimidation in the emergency department at St John’s Hospital. How we address the waiting times issues is critically important. The organisation has worked very hard to promote a culture based around Our Values , and the value of Openness, Honesty and Responsibility , is particularly important in this context. When the concerns were raised steps were immediately taken to ensure that the issues were promptly escalated to the Board and the Scottish Government, and that the issue would be discussed in a public meeting of the Board. Management commissioned a report from the internal auditors. Additionally the Scottish Government commissioned the Scottish Academy of Medical Royal Colleges to review the issue and make recommendations for improvement. Management were clear that immediate steps needed to be taken to support staff and improve the systems of internal control, rather than wait for the external review to conclude and report. Consequently in December 2017 the Board received the internal auditors’ report together with management’s analysis of the issues raised and an action plan. Promoting a culture based upon openness and honesty had been at the very top of the leadership agenda for the previous five years, and it could not have received greater prominence. The review of the issues prompted some serious soul-searching and reflection on how far and deep the programme of changing culture had reached, and what the organisation had actually learned over the previous five years. It highlights that the endeavours to improve the organisational culture in every aspect of operational practice should not be underestimated, and requires relentless effort. The reported issues highlight the challenges of creating a quality-driven organisation through distributed leadership, when the starting point is a top-down target-driven organisation that is subject to micro-management. The Board has in one of its development sessions considered the topic of performance management, and the inherent risk of “hitting the target but missing the point”. Part of the duty of Best Value is “ to make arrangements to secure continuous improvement in performance whilst maintaining an appropriate balance between quality and cost .” We must bear in mind that changing organisational culture is a long-term programme of work, particularly in an organisation of the scale and complexity of NHS Lothian. The goal of continuous improvement does require continuous effort and systematic rigour, which our quality management approach will increasingly provide in the future. The steps that have been taken have been based on finding out what happened, why it happened, and what can be done to better support our employees going forward. Management have developed an Emergency Department Improvement Plan which includes: • A new Standard Operating Procedure (SOP) aligned to national guidance to support the accurate recording and reporting of Emergency Department performance • An emergency department SOP Dashboard to support management in reviewing the process. • A Staff Organisational Development Programme to support individual and team development within and across sites • Refreshed terms of reference and membership for the Access and Governance Committee, so as to rebalance organisational focus on unscheduled care along with scheduled care. • Increasing the visibility of senior management across the adult sites. 4 NHS LOTHIAN ANNUAL REPORT AND ACCOUNTS FOR THE YEAR ENDED 31 ST MARCH 2018 Waiting Times Throughout 2017/18 unfortunately there has been an increase in waiting times for our inpatients, day cases, and outpatients. There has been a significant focus on action to deliver improvements to mitigate the impact on patients. Some of measures taken are summarised below: Outpatients • We have reduced the number of people who do not attend scheduled appointments, thereby improving the use of our operational capacity.
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