Annual Report and Accounts Year ended 31st March 2019 NHS LOTHIAN ANNUAL REPORT AND ACCOUNTS FOR THE YEAR ENDED 31ST MARCH 2019 INDEX PAGE Annual Report 3 Section A: The Performance Report 3 1. Overview 3 2. Performance Analysis 14 Section B: The Accountability Report 31 Corporate Governance Report 31 - Directors report 31 - Statement of Health Board Members’ Responsibilities in respect of Accounts 32 - Statement of Chief Executive’s Responsibilities as the Accountable Officer of the Health Board 36 - The Governance Statement 37 Remuneration and Staff Report 46 Parliamentary Accountability Report 61 Independent Auditor’s Report 62 Accounts’ Primary Financial Statements 65 Notes to the Accounts 70 Accounts Direction 110 2 NHS LOTHIAN ANNUAL REPORT AND ACCOUNTS FOR THE YEAR ENDED 31ST MARCH 2019 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 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 about 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 2018/19 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 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. The aims of the changes to the leadership structure were 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. “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. During 2018/19 we have further developed our approach to leadership. We published the NHS Lothian Staff Engagement and Experience Development Plan for 2018-20. The plan is for staff at all levels and is all about improving staff experience. We want to make sure that staff feel safe, supported, that they belong, have a purpose, and know that they make a difference to the services we provide across health and social care. Listening and responding to what staff have said through iMatter surveys, the Plan pulls together what we are doing, and what we will be doing to enhance staff experience. The Plan is supported by a detailed Delivery Framework which sets out how and when the various commitments in the Plan will be implemented. 3 NHS LOTHIAN ANNUAL REPORT AND ACCOUNTS FOR THE YEAR ENDED 31ST MARCH 2019 The above Plan sets out what we mean by leadership. Leadership is an activity, which is about influencing other people to engage in change. It is something that every member of staff does every day, and all staff are leaders, no matter what role or level they work in. Our key commitment in the Development Plan is to enhance our leadership culture by enabling all staff at all levels to realise everyone has a leadership role to play, and to work well together across the organisation. Within NHS Lothian we wish to promote an open, honest and supportive culture where all staff are encouraged to speak up if they have any concerns about patient safety, wrongdoing or malpractice, and to support those who do. We want to give staff the confidence that they will be listened to and their concerns will be addressed fairly and objectively. Seeking, hearing and acting upon feedback are really important for us to learn together. In March 2019 we appointed our first Speak up Ambassadors. The Ambassadors will report directly to me, and will have overall responsibility for ensuring that staff are supported in speaking up and any organisational barriers are dealt with. The Ambassadors will work with our Non-Executive Whistleblowing Champion and our Director of Human Resources & Organisational Development, to develop appropriate infrastructure, communication and governance arrangements which will support the wider launch of our Speak Up initiative in 2019/20. Health & Social Care Innovation Test Bed and Data Driven Innovation Programme for the East Region Developing efficient and effective delivery of innovation in priority areas is a key part of the East Region’s strategic planning, including the goals to: Enable people to live longer healthier lives at home, or in a homely setting Provide a healthcare system with integrated health and social care Focus on prevention, anticipation and supported self-management Manage multi-morbidity more effectively Reduce health inequalities Decrease the demand-capacity gap through new ways of working The Chief Scientist’s Office (CSO) has provided funding to the East Region and two other regional areas has to develop an innovation test bed model. This will support collaborative working between the NHS, integration joint boards, academia and industry. The aim is to increase economic growth through the delivery of NHS and social care strategic priorities, in partnership with local enterprise and South East Scotland City Deal stakeholders. For the South East Scotland City Deal there is a particular focus around delivering data-driven innovation. The strategic objective is to develop a coordinated approach to curate and encourage the use of all our healthcare data assets across all specialties to drive innovation, and to improve patient care and reduce health inequalities across the region. To achieve this we propose to develop, test and implement a data storage repository (DataLoch) that permits linkage in near real-time of multiple data assets from primary, secondary and social care including all acute and chronic conditions. This will facilitate a data-driven approach to prevention, treatment and care, and will enable us to develop a world-leading learning healthcare system. The East Region Programme Board has approved that NHS Lothian will be the host Board, and with that role it has also been asked to take a lead in developing and implementing the strategic plans as to how these funds will be utilised to support the development of an East Region Innovation Test Bed and Data Driven Innovation Programme. In March 2019 we secured £4.1m from the City Deal for the Innovation Test Bed. There are strategic plans in place for the East Region Health & Social Care Innovation Test Bed and Data Driven Innovation (DDI) Programme. They both align with the NHS Lothian Quality Strategy (2018-2023). Those plans set out how we will establish the infrastructure and approach to implement them successfully. Emergency Access Standard 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. My 2017/18 statement set out some of the initial actions which were taken, and a programme of work continued throughout 2018/19. The Board has received progress reports throughout the year, and the following key points were reported on 6 February 2019. 4 NHS LOTHIAN ANNUAL REPORT AND ACCOUNTS FOR THE YEAR ENDED 31ST MARCH 2019 We established a Programme Delivery Group to provide leadership, strategic advice, and guidance on the delivery of our 4 Hour Emergency Access Standard Improvement Programme. The Deputy Chief Executive chaired the Programme Delivery Group. The Programme included measures to improve quality and performance against unscheduled care standards, and developing sustainable leadership capacity and capability. The Programme also included implementing the recommendations from the review which the Academy of Medical Royal Colleges and Faculties in Scotland carried out, and published in April 2018.