Annual Report & Accounts 2011/12 Barnsley Hospital NHS FT Annual Report 2011/12 1 Barnsley Hospital NHS FT Annual Report 2011/12 2 Presented to Parliament pursuant to Schedule 7, paragraph 25(4) of the National Health Service Act 2006. Barnsley Hospital NHS Foundation Trust Annual Report and Accounts 2011/12 Barnsley Hospital NHS FT Annual Report 2011/12 3 Barnsley Hospital NHS FT Annual Report 2011/12 4 Contents About Barnsley Hospital Directors’ Report & Business Review Page 7 - Chairman and Chief Executive overview - Board of Directors - Management team - Performance overview - Key Performance Indicators (KPIs) - Providing high quality and safe services - Designing healthcare around the needs of our patients - Investing in our workforce - Making the best use of resources - Financial review Quality - Quality Report Page 58 Governance - Corporate governance Page 120 Governing Council Board of directors Committees Remuneration report Relations with members - Other disclosures Statement of accounting officer’s responsibilities Page 154 Annual Governance Statement Page 155 Financial Statements Page 167 Barnsley Hospital NHS FT Annual Report 2011/12 5 About Barnsley Hospital Barnsley Hospital NHS Foundation Trust was founded on 1 January 2005 under the Health and Social Care (Community Health and Standards) Act 2003, as re-enacted in the National Health Service Act 2006 (the 2006 Act). We were one of the first hospitals in the country to become a Foundation Trust. Since becoming a Foundation Trust in 2005 Barnsley Hospitals NHS Foundation trust has sought to utilise the foundation trust regime that this brings to benefit our patients. We provide a range of acute hospital services. These include emergency and intensive care, medical and surgical services, elderly care, paediatric and maternity services and diagnostic and clinical support services. We also provide a number of specialised services, including cancer and surgical services, in partnership with Sheffield Teaching Hospitals. The hospital was built in the 1970s, and covers a site of 8.2 hectares. It has c500 beds, and employs 3008 staff (at 31 March 2012 ). We serve a population of approximately 226,000 across an area which matches the same the geographical boundaries as Barnsley Metropolitan Borough Council and our main commissioner, NHS Barnsley. We work closely with a wide range of partners, including NHS Barnsley, South West Yorkshire Partnership NHS Foundation Trust, the local authority and other private and public sector partners. Barnsley Hospital NHS FT Annual Report 2011/12 6 Chairman & Chief Executive overview We knew that 2011/12 was going to be our toughest year ever. The sheer scale and pace of the NHS reforms, coupled with no inflationary uplift in our annual budget meant that we started the year facing unprecedented challenges. We had exacting performance and quality targets to meet as well as needing to make yet more efficiency savings, but we were also faced with unpredictable events. In particular, an unanticipated surge in unplanned admissions, due to factors outside our control, tested our flexibility and responsiveness. And so while our plans to meet our business objectives were largely on track, the unforeseen continued pressures on our unscheduled care services - such as the emergency department, medical admissions unit and diagnostics - placed incredible pressure on our teams and services. On top of this, we also had a disappointing report early in the year from the Care Quality Commission on our nutritional standards. So it is with a strong sense of pride and huge admiration for our staff that at the end of the year we are able to say we delivered on all our national and local targets and are in a stable financial position with a modest planned surplus. Given the challenges we faced, some anticipated, others unpredictable and outside our control - this is an incredible feat. Our performance Despite seeing the biggest rise in emergency department attendances in the whole of Yorkshire, we met our target to see and treat 95% of all patients within four hours. The stretch this placed on our staff - in both the emergency department and the teams across the hospital who help to diagnose conditions and admit and care for patients on wards - was very challenging at times. It is a tribute to their professionalism and dedication to patients that they succeeded in continuing to deliver high standards of care under such pressure. The Board, our Governors and the people of Barnsley and surrounding areas, are indebted to them. Already rigorous infection control standards were made even tougher when our C.Difficile target was more than halved – from 65 to 31. We had fewer cases than the target and also maintained our zero cases of MRSA bacteraemia for the second year in a row. This, too, is a phenomenal result, given the increased numbers of patients and the extra pressure that our staff were under. We managed the increase in unplanned patient numbers by opening escalation wards, as and when needed. While this helps us to cope with the peaks in demand, it means that our patients do not get an established ward Barnsley Hospital NHS FT Annual Report 2011/12 7 team looking after them. And this is not ideal. Our plans for greater continuity of care and improving urgent care services in the year ahead will help us to tackle this. The Chief Operating Officer, David Peverelle, talks about these plans in more detail in his performance report on pages 12 to 14, as well as illustrating just how tough the challenges have been and our response to them. Quality All the success of our staff’s hard work to meet the many high standards we are set and set ourselves was overshadowed by a Care Quality Commission report into our nutrition standards. The report followed an inspection into both nutrition and privacy and dignity. Although we met the privacy and dignity standards, we did not meet all those for nutrition. As a result, the CQC had moderate concerns around how we ensure people’s individual dietary needs around food and drink are met. We were extremely disappointed by the findings and immediately put in place a range of actions to tackle the shortcomings identified. In December we were reinspected and the final report praised the systems and processes we had introduced. You can read more about this and the many other quality standards we meet and work towards in both the quality account and the business review. Transformation Our biggest challenge last year lay not just in improving the efficiencies of our services but developing a wholesale approach to transforming how we work. We have reduced our costs two years in a row – and we can only cut back so much. As a district general hospital, our survival depends on coming together as a team to transform how we work. We took some significant steps. We appointed 13 of 14 clinical directors in March – from within our existing clinical teams - who will be at the centre of our transformation plans in the coming year, we developed advanced nurse practitioners who are helping to diagnose patient conditions and prescribe their medicines and we took an altogether fresh approach to managing patients through surgery by building their strength and resilience before some procedures. You can read about these developments in the business review. While these were significant steps, we are still at the beginning of our journey. We need to do much more if we are to not just survive, but thrive in the years ahead. Looking ahead If we are to meet our patients’ needs, if we are to put quality and safety first, if we are to flourish in the new NHS, then our wholesale transformation needs to start now. Barnsley Hospital NHS FT Annual Report 2011/12 8 The Health & Social Care Act reforms aim to improve patient outcomes, drive up quality and increase clinical leadership. Very soon, GPs will be our commissioners and later this year, competition for providing some NHS services will be opened up. In addition, the reforms will strengthen local accountability with increased powers for our governors. The findings from the Mid Staffordshire NHS Foundation Trust public enquiry are also anticipated later in 2012 and while we cannot predict what recommendations they will make for the whole of the NHS, we are making preparations to ensure that our response ensures that we are providing safe and effective care. To continue providing safe, high quality care and treatment for our patients while continuing to make savings, we need total dedication, personal excellence and partnership working. To have the best chance of success, we need greater clinical leadership. This is why we have introduced 14 clinical service units (CSUs), each with a clinical director at the helm. The units will be the way we do business and all our staff will support them in ensuring that patients are always at the centre of our decision making. To ensure the decisions being made are in the best interests of patients, we need to develop our clinical directors, governors and Board directors so that they are equipped to take on their enhanced roles. To transform, we need to think differently and act differently. In developing our plans, we involved our staff, governors, partners, patients and unions. These are their ideas, shaped through discussion, exploration and fine-tuning. Some of our plans are simple and straighforward, some are hugely ambitious. They have been developed to help us meet the enormous challenges ahead. We are confident we have prepared as well as we can and that the hospital is in the best possible position to succeed and prosper. The Board of Directors A strong Board is fundamental to the success of the hospital. It is made up of executive directors and non executive directors who develop and monitor the Trust’s strategic aims.