Royal Berkshire NHS Foundation Trust Annual Report and Financial Statements for the year ended 31 March 2016 Presented to Parliament pursuant to Schedule 7, paragraph 25(4) of the National Health Service Act 2006 Royal Berkshire NHS Foundation Trust Annual Report and Financial Statements for the year ended 31 March 2016 ©2016 Royal Berkshire NHS Foundation Trust Annual Report 2015/16 Contents Page No Chairman’s and Chief Executive’s Introduction 5 Performance Report Overview of performance 8 Performance analysis 8 Accountability Report Directors’ Report 13 Statement as to disclosure to auditors Income disclosures Enhanced quality governance reporting Governance arrangements Remuneration Report 35 Annual statement on remuneration Senior managers’ remuneration policy Annual report on remuneration Staff Report 46 Introductory paragraph Staff survey Expenditure of consultancy/off payroll NHS Code of Governance 52 Regulatory Ratings 56 Statements of Accounting Officer’s Responsibilities 57 Annual Governance Statement 59 Quality Account 67 Annual Accounts 140 Chairman’s Report I am delighted to be part of the Royal Berkshire NHS Foundation Trust. I began with the organisation in August 2015 and wish to thank Janet Rutherford who acted as Chair for five months prior to my arrival. I would also like to acknowledge the Non-Executive Directors, Executives and Governors all of whom have through their various roles in driving the Trust forward and, for supporting me as I gain an understanding of the complexity surrounding the NHS. It has been a year of continual change and challenge. Like many trusts we continue to see unprecedented levels of demand on our Emergency Department as well as significant pressure on other services in all our locations. The Trust has continued to make steady progress in so many areas throughout the year. Achieving our forecast financial position, achieving the 18 week Referral To Treatment standard and improving our data quality are just a few of the significant achievements made; an unannounced inspection of our maternity services noted it ‘a very different place’. We have continued to develop our Trust strategy and are working closely with partners to plan for the development of an Accountable Care System in West Berkshire. This is all very exciting and enables an agreement that allows us and our partners to set priorities, agree how we will work together and create a more joined up view of the service we need to provide to the Berkshire public, long term. This will be so much better for all our patients. All our team members across the Trust, all our volunteers and the charities that support us have all made a tremendous contribution to the Trust this year and I thank them all deeply. We could not do what we do without you. Likewise I am proud to lead a Board that only has our patients and staff in mind as we drive our future. The year ahead sees further challenges but I am confident we have the right skills to take us into the future. I look forward to 2016/17 and working with you all to ensure the Trust achieves its vision in providing high quality healthcare to our entire community. 5 Chief Executive’s Report The past year has seen the Royal Berkshire NHS Foundation Trust improve its performance in a number of areas. Despite increasing numbers attending the Emergency Department (ED), we achieved the ED access standard for three of the four quarters but due to the pressure in Quarter 4 with high attendances and admissions, despite best efforts we could not meet the standard. We achieved the planned trajectory to improve the 18 week Referral To Treatment (RTT) standard and have met this standard since October 2015. Achieving the Cancer standards remains challenging particularly due to increased demand and the national recruitment difficulties in securing Dermatology and Gastroenterology consultants. Significant progress has been made on our quality priorities. It has been pleasing to see increased incident reporting but lower levels of harm. The national Friends and Family survey results place us as one of the best performing acute trusts in the country. The Trust was also named as the best performing Cardiology and Hyper Acute Stroke Unit (HASU) in the country. We were delighted that the Care Quality Commission (CQC) found significant improvements in our Maternity services following an unannounced inspection in November 2015. Three areas were rated as “good” and two as “requires improvement” in their report of April 2016. The total number of Clostridium Difficile (C.Diff.) cases reported for 2015/16 was 31 against a full year target of 27. 13 cases demonstrated no lapses in care. Pleasingly we have achieved our forecast financial deficit and we will be working to create a surplus in 2016/17. In September 2015 we held the first Staff Excellence Awards in the Trust for three years. It was a chance to celebrate and recognise our staff. Our Head Porter, Jose Cabrera-Abreu, went on to be shortlisted for a Regional Leadership Award for his work. Long Service Awards were also reintroduced by the Trust and it has been humbling to see the long standing commitment of many of our staff. Information Management and Technology has been a key issue for the Trust, but we can now see evidence of our strategy being implemented and progress being made. Specifically, over the past year, data quality has been improved. The Data Assurance Team has been restructured with more senior leadership and our old, undocumented data warehouse replaced. A contract with Cerner was signed in September 2015 which provides new Electronic Patient Record (EPR) hardware and introduction of several products to help improve operational running. The main implementation is “Order Communications” which is the electronic ordering of Radiology and Pathology tests. Work has also started to go “paperless at the point of patient” contact by 2018. The Trust also offered all patients free WiFi during the year. The “#hellomynameis” work started last year has further developed, and is something that was noted by Healthwatch locally. This powerful message has also been recognised by patients who write in or comment on NHS Choices. The Trust improved its NHS Choices rating. This medium is to be one way that NHS England measures patient satisfaction. The 4.5 star is one we are proud of, and includes a number of 5 star ratings from patients. Where we receive less favourable feedback, we act on it and, where necessary, seek to improve our patients’ experience. 6 The Trust continued to improve services throughout the year. We refurbished the relatives room for bereaved relatives in the ED. We added new information screens and staff in the department sought meaningful feedback via ‘Quality Time’ to shape behaviour and improve patient experience. We also increased the amount of time geriatricians spend on ED to ensure our older patients get early expert assessment. Establishment of a virtual fracture clinic has been successful; our endoscopy unit received accreditation and a new Lucentis room at Prince Charles Eye Unit opened in March 2016. The Trust successfully tackled a reduction in its maintenance backlog, reducing outstanding jobs from over 500 to less than 50. This has improved the standard of the facilities we operate and helped to improve patient care. Our award winning Portering team has increased productivity and generated savings of £147K from the introduction of the Task Management System (TMS). An additional 23,774 portering tasks were carried out compared to the year before with 79% of the 197,273 jobs completed on target. Work continues on creating the Berkshire Surrey Pathology Partnership and all of our pathology laboratories have been accredited by Clinical Pathology Accreditation (CPA) UK. Over 1,000 staff were trained on mental health including caring for patients with dementia and we improved our “home early settled and safe” programme to ensure vulnerable people return home early in the day. In July a major incident was caused by an unplanned power loss in Battle and part of North Block caused by a mains water leak and a subsequent small but contained fire in the Cardiac Care Unit (CCU). Whilst service was disrupted, actions were taken immediately and throughout the ensuing few days to mitigate the immediate impact of these events and maintain patient and staff safety, and to minimise the impact of the incident. Temporary generators and lighting were quickly installed and full operations were reinstated within four days. Plans were carefully developed over the following days to restore the mains power supply and generator backup whilst successfully ensuring minimal disruption to services. Our staff did a fantastic job in keeping services going. Our relationships with our partner organisations have continued to progress and we are creating a more integrated way of working which will help us manage the demands as a system. The Trust, Berkshire Healthcare NHS Foundation Trust and Berkshire West Clinical Commissioning Groups (CCGs) signed a Memorandum of Understanding for the Accountable Care System (ACS) in order to explore new and integrated ways of working across the local area. Individual staff have made contributions too numerous to mention and a number of services have received accolades for their high performance. These include Stroke, Cardiology, and End of Life Care. The progress we have made is down to our staff, our partner organisations, our large team of volunteers and the charities that support us. Thank you to our governors for their on-going commitment to the Trust and to the Board and senior management team for working so hard over the past year. 2016/17 will be no less challenging but we are in a good position to make even more achievements in the coming year.