Annual Report and Accounts 2016/17 Royal Devon and Exeter NHS Foundation Trust Royal Devon & Exeter NHS Foundation Trust Annual Report and Accounts 2016/17 Presented to Parliament pursuant to Schedule 7, paragraph 25 (4) (a) of the National Health Service Act 2006 © 2017 Royal Devon and Exeter NHS Foundation Trust Annual Report 2016/17 Contents Page CHAIRMAN’S INTRODUCTION .......................................................................................................................7 PERFORMANCE REPORT: OVERVIEW .............................................................................................................9 Introduction by the Chief Executive ............................................................................................................9 About the Royal Devon & Exeter NHS Foundation Trust ............................................................................12 Our Strategy .............................................................................................................................................19 PERFORMANCE ANALYSIS ...........................................................................................................................31 ACCOUNTABILITY REPORT ...........................................................................................................................39 Enhanced Quality Governance Reporting ..................................................................................................46 Stakeholder Relations ...............................................................................................................................52 Disclosures ...............................................................................................................................................54 Remuneration Report ...............................................................................................................................55 Staff Report ..............................................................................................................................................64 Board Assurance Framework ....................................................................................................................74 Audit Committee .....................................................................................................................................75 NHS Improvement Single Oversight Framework ........................................................................................78 Care Quality Commission .........................................................................................................................79 Statement of Accounting Officer’s Responsibilities ....................................................................................80 Annual Governance Statement .................................................................................................................81 Our Governors and Members ...................................................................................................................88 Sustainability Report ...............................................................................................................................100 Equality and Diversity .............................................................................................................................104 ANNUAL ACCOUNTS ..................................................................................................SEE SEPARATE REPORT QUALITY REPORT .......................................................................................................SEE SEPARATE REPORT Page 5 Annual Report 2016/17 CHAIRMAN’S INTRODUCTION It is my pleasure to introduce our Annual Report, Quality Report and Accounts for 2016/17. Shortly after I joined your Board of Directors five years ago, we agreed to establish a hierarchy of priorities: ‘what matters; who matters’. It was clear at that time that the gap between demand and expectations on the one hand and financial resources on the other would continue to grow and that we needed to be very focused and consistent in the way we take decisions to ensure the optimal use of the resources available to us. Our top three priorities for ‘what matters’ were: outcomes, safety and quality and, for ‘who matters’: our communities, patients and staff. We recognised that finances and regulators were important (both fourth in our hierarchy) but believed that good finances and regulatory compliance must be the product of what we do and not the drivers of what we do. So how did we do? Our new Chief Executive will go into more detail in her report but I wanted to set out my own “score card”. We have continued to improve safety within the RD&E from an already strong level and outcomes and quality remain very good. Timely access to our services-judged by several metrics-remains challenging, however. We have struggled to meet our A&E four hour wait for most of the year and have also struggled with a number of our cancer waiting time targets and more recently our 18-week Referral to Treatment (elective care) target. It would be very easy to take solace from the fact that our performance is better than most others and that we are assured that patients are not coming to harm. These targets are important, however, and we will continue to strive to improve upon the current performance, particularly for A&E and cancer waiting times. In this respect, I would congratulate our colleagues on recovering by the end of the year compliance with our diagnostic targets which we were failing to meet as a consequence of significant growth in demand. I am particularly pleased with the results of our staff and patient surveys. There is strong evidence that happy and supported staff provide safer and more compassionate care. Our staff surveys have improved in each of the last five years and our various patient surveys show strong support for the RD&E and its services. I was particularly proud of our cancer patient survey. Despite missing some of the waiting time targets, our patient survey ranked us third highest in the whole country and we were the only complex cancer centre to feature in the top 10 - a truly extraordinary performance. And how did we do with our finances and regulators? As predicted last year, we budgeted for a lower deficit and we did much better than we had planned for, coming in at £2.3m (including STF, but excluding impairment and gains on transfer by absorption), less than half the budgeted deficit we had agreed with our regulators. Our quality rating was as planned (the best rating of Green) and our (financial) sustainability rating was a 2, better than the 3 agreed with our regulators. Importantly, our cash reserves which we had budgeted to fall have actually risen from £6.7m planned at year end to £17.5m . There were three major developments in 2016/17. In October, 2016 we took over the community hospitals and community nursing in Mid and East Devon. While unconnected, our assumption of these services (which had been long delayed) coincided with a review of beds required in community hospitals in our area. We welcome our new staff and thank them for the way in which they have engaged with us, particularly in challenging circumstances. While the integration plan is still at an early stage, the benefits (both patient and financial) we have already seen are promising. The integration of acute and community health services is important in its own right but is also just one stage in integrating care so that we can focus on the total health and well-being of our communities and not just individual episodes of care. Your Board is firmly of the view that we need to focus on what matters to our communities, rather than imposing on them our views of what we believe is the matter with them. We are also absolutely convinced that it is in the interests of our patients that they should only be admitted to acute hospitals when requiring acute intervention and should be discharged from hospital (with appropriate care packages) as soon as they are medically fit for discharge. Page 7 Annual Report 2016/17 The second major development was the formation of the Sustainability and Transformation Plans/Partnerships (STPs). Forty-four STPs were established across England to bring together leaders across health, social care and local government to develop and implement new models of care which are both clinically and financially sustainable. Our STP covers the whole of Devon (including Plymouth and Torquay) and built on the work already commenced by the Success Regime. Your Board fully supports the general ambitions of the STP and has committed significant management resource to it. We are very keen that the debates with our communities are candid and transparent, that the allocation of the resource that we have is fair and that the changes we make are implemented in a way that ensures that new services are available before old ones are reduced or removed. We will endeavour to ensure that the new models of care are aligned with the hierarchy of priorities we have set out. The third was the appointment of our new Chief Executive Officer, Suzanne Tracey, who had previously been the Trust’s Deputy Chief Executive and Chief Financial Officer. Suzanne’s appointment followed an international search after the departure of Angela Pedder to become Lead Chief Executive of the Devon Success Regime. Suzanne has hit the ground running and she and her executive colleagues