median Page 1 Medway NHS Foundation Trust Annual Report and Accounts 2017/18 Presented to Parliament Pursuant to Schedule 7, Paragraph 25 (4) (a) of the National Health Service Act 2006 © 2018 Medway NHS Foundation Trust Contents PERFORMANCE REPORT Foreword from the Chairman ............................................................................................ 7 Overview ............................................................................................................................. 9 About Medway NHS Foundation Trust ........................................................................... 11 Key developments / achievements ................................................................................. 13 Performance analysis ...................................................................................................... 16 Overview of financial performance ................................................................................ 19 Environmental performance ........................................................................................... 22 Community Engagement ................................................................................................. 29 Future developments ....................................................................................................... 30 Overseas operations ....................................................................................................... 31 Directors’ Report .............................................................................................................. 33 Governors’ report ............................................................................................................ 44 Remuneration report ....................................................................................................... 49 Staff report ........................................................................................................................ 52 Staff engagement ............................................................................................................. 56 Governance Disclosures ................................................................................................. 61 Annual Governance Statement ....................................................................................... 74 Governance Structure ..................................................................................................... 77 Corporate Governance Statement .................................................................................. 84 Statements of compliance ............................................................................................... 85 QUALITY REPORT Quality Report Contents .................................................................................................. 88 About the Quality Report ................................................................................................. 89 Part 1: Statement on quality from the chief executive .................................................. 90 Part 2: Priorities for improvement and statements of assurance from the board ...... 94 Part 3: Other information ............................................................................................... 130 Annex 1: Statements from commissioners, local Healthwatch organisations and Overview and Scrutiny Committees...................................................................... 137 Annex 2: Statement of directors’ responsibilities for the quality report ................... 141 Glossary.......................................................................................................................... 146 ANNUAL ACCOUNT Statement of the Chief Executive's responsibilities as the Accounting Officer of Medway NHS Foundation Trust .................................................................................... 154 Independent Auditor’s Report to the Board of Governors and Board of Directors of Medway NHS Foundation Trust ............................................................... 155 Statement of Comprehensive Income 2017/18 ............................................................ 163 Statement of Financial Position 2017/18 ...................................................................... 164 Statement of Cash Flows for the year ended 2017/18 ................................................ 165 Taxpayers’ Equity for the year ended 31 March 2018 ................................................. 166 Notes to the Accounts ................................................................................................... 167 Foreword from the Chairman When I first took over as chairman about 12 months ago the Trust was celebrating exiting special measures, but Medway was still facing huge challenges that were affecting the experience of patients. We immediately launched our improvement plan, Better, Best, Brilliant, improving patient flow through the hospital as our first priority. Soon more people were being seen, treated and admitted or discharged within four hours from our Emergency Department, and we began to discharge people in a more timely way, for example to community settings. However, over the year our improvement trajectory has not been Stephen Clark constant: there have been many setbacks such as the bad winter Chairman we have experienced. But I am proud that we have never returned to the conditions or the performance of the past. Despite the euphoria experienced when the Trust left special measures, staff have still felt very pressurised, such is the nature of working in an acute trust, especially in the depths of the most severe weather. But they have risen to the challenge to meet demand, even struggling through the snow – the best of people delivering the best of care. It is important that our staff feel supported to do the best for patients, even when the going is tough. We therefore have many initiatives in place to ensure our workforce can continue to improve services, from training programmes and culture change projects, to investing in technology. Our patients benefit greatly from these investments, for example from our new hip fracture pathway and frailty programme, through to new robotic surgery delivering better outcomes for urology patients. We are fortunate to have the support of many highly committed volunteers who work alongside staff on the wards and throughout the hospital, enhancing patient experience during their stay. This is also helped by the funding received from our wonderful League of Friends who raised impressive amounts for the hospital in the last year. This is further boosted by the money raised by the hospital’s own charity, and by Abigail’s Footsteps which funded our gold standard bereavement suite, and the Oliver Fisher Trust which raises funds for our special care baby unit. The Trust is greatly blessed to have such dedicated supporters. I would also like to thank my fellow non-executive directors who bring so much expertise to the Board, including Adrian Ward who joined us last summer and Jan Stephens whose term of office came to end in July. Finally, a big thank you to our Governors who freely give their time, attending meetings, engaging with staff, and acting as a bridge between the Trust and the community we serve. I look forward to another successful 12 months in which we will aim to transform our services improving the experience for our patients and making the hospital sustainable for the future. Stephen Clark Chairman Page 7 PERFORMANCE REPORT Overview Introduction from the Chief Executive This year has been really important at Medway and I would like to take this opportunity to reflect on the challenges and achievements of the last 12 months. Exiting special measures last year was significant for the Trust and our main focus in 2017/18 has been to maintain this momentum. In May we launched our Better, Best, Brilliant improvement programme. Built around our four strategic objectives – integrated health care, innovation, people and financial stability – Better, Best, Brilliant sets out our bold and ambitious plans to build on the progress already made and provide brilliant care for our community. Lesley Dwyer Chief Executive During the past year patient safety has continued to be a focus. We implemented a range of changes to make sure patients receive safe and compassionate treatment, and to ensure a better safety culture throughout the hospital. Integral to this is a heightened concentration on recognising and responding quickly to patients whose condition deteriorates. These improvements have led to a significantly reduced mortality rate. We have developed an open and transparent culture throughout the organisation, where we encourage everyone to talk about patient safety, reporting incidents when they occur and ensuring that we can all learn from them. I’m delighted to say that our approach to patient safety improvement was commended by Jeremy Hunt, the Secretary of State for Health and Social Care, when he visited the Trust in September. We continue to make strides in enhancing the experience of patients at Medway and we have focussed on trying to improve the flow of patients throughout the hospital. This is aided by the timely discharge of patients, which also benefits patients presenting at the ‘front door’ of the organisation – our Emergency Department – by reducing the waiting time for beds. Getting patients home when they are ready to leave our care isn’t always straightforward,