Annual Report and Accounts 2013-2014 University Hospitals Bristol NHS Foundation Trust Annual Report and Accounts 2013 - 2014 Presented to Parliament pursuant to Schedule 7, paragraph 25(4) of the National Health Service Act 2006 Annual Report and Accounts 2013 - 2014 1. Chairman’s Statement 7 1.1 Quality of care 7 1.2 Changes in the structure of the NHS 7 1.3 The financial challenge coupled with growing demand for services 7 1.4 The local perspective 8 1.5 Shared values 8 1.6 Strategy 8 1.7 Governance 9 1.8 Transforming Care 9 2. Chief Executive’s Foreword 11 2.1 Delivering best care 11 2.2 Improving patient flow 12 2.3 Delivering best value 13 2.4 Renewing our hospitals 13 2.5 Building capability 14 2.6 Leading in partnership 15 3. Strategic Report 17 3.1 Principal Activities of the Trust 17 3.2 Our Business Plan 18 3.3 Business Review 19 (a) Our Performance in 2013/14 (an overview of regulatory risk ratings) 19 (b) Review of quarterly performance 20 (c) Annual Performance against national access standards 23 (d) Contractual performance 24 (e) Financial performance 30 (f) Environmental impact and sustainability 35 (g) Human rights, social and community issues/matters 37 (h) Breakdown of the Number of Male and Female Directors 38 3.4 Statement of Going Concern 39 4. Directors’ Report 39 4.1 Directors of the Trust 39 4.2 Independence of the Non-executive Directors 40 4.3 Statement as to Disclosure to Auditors 40 4.4 An overview of quality 40 (a) Patient safety 40 Annual Report Page 3 of 98 Annual Report and Accounts 2013 - 2014 (b) Patient experience 41 (c) Clinical effectiveness 41 (d) Objectives for 2014/15 42 4.5 Management Costs 42 4.6 Research and innovation 43 4.7 Workforce Overview 45 (a) Workforce Profile 45 4.8 Teaching and Learning 46 4.9 Engaging with our staff 47 4.10 NHS staff survey 48 (a) Key areas of improvement 48 4.11 Communication with staff 49 (a) Key trust meetings 49 (b) Staff magazine 49 (c) Acknowledging excellence and recognising success 49 (d) Tackling harassment and bullying 50 4.12 Statement of approach to equality and diversity 51 (a) Equality objectives and statement of compliance with publication duties51 (b) The NHS Equality Delivery System 52 (c) Training and the Equality Act 52 (d) Equality and diversity in the workplace 52 (e) Analysis of staff diversity profile 52 4.13 Occupational health service 55 4.14 A safe working environment 55 (a) Sickness absence 55 4.15 Remuneration Report 56 (a) Remuneration of Executive Directors 56 (b) Remuneration of Non-executive Directors 57 (c) Assessment of performance 58 (d) Expenses 58 (e) Duration of contracts 58 (f) Early termination liability 58 (g) Review of tax arrangements of public sector appointees 58 (h) Sundry 60 5. NHS Foundation Trust Code of Governance 61 Annual Report Page 4 of 98 Annual Report and Accounts 2013 - 2014 5.1 Compliance with the Code 61 5.2 Trust Board of Directors 61 (a) Board of Directors – disqualification 63 (b) Members of the Trust Board of Directors 63 (c) Directors’ interests 65 (d) Meetings of the Board 65 5.3 Committees of the Trust Board of Directors 66 (a) Directors Nominations and Appointments Committee 66 (b) Remuneration Committee 66 (c) Audit Committee 66 (d) Quality and Outcomes Committee 70 (e) Finance Committee 71 (f) Membership and attendance at Board and Committee meetings 71 (g) Performance of the Board and Board Committees 73 5.4 Council of Governors 73 (a) Meetings of the Council of Governors 75 (b) Governors’ Nominations and Appointments Committee 75 (c) Membership and attendance at Council of Governors meetings 76 (d) Attendance at meetings of the Governor Project Focus Groups 79 (e) Qualification, appointment and removal of Non-executive Directors 81 (f) Business interests 82 (g) Performance & Development of the Council of Governors 82 (h) Trust’s Constitution 83 5.5 Foundation Trust membership 83 (a) Membership size and variations 83 (b) Analysis of current membership 84 (c) Developing a representative and engaged membership 85 (d) Engagement 85 (e) Elections 86 (f) Membership commentary and strategy 86 (g) Governors communication with members 88 (h) Governors by constituency – 1 April 2013 to 31 March 2014 88 6. Appendix A – Biographies of Members of the Trust Board of Directors 91 6.1 John Savage – Chairman 91 6.2 Robert Woolley – Chief Executive 91 Annual Report Page 5 of 98 Annual Report and Accounts 2013 - 2014 6.3 Non-executive Directors 91 (a) Emma Woollett – Vice-Chair 91 (b) Lisa Gardner – Non-executive Director 92 (c) Iain Fairbairn – Senior Independent Director 92 (d) David Armstrong – Non-executive Director 92 (e) Alison Ryan – Non-executive Director 93 (f) Guy Orpen – Non-executive Director 93 (g) Paul May – Non-executive Director 93 (h) Kelvin Blake – Non-executive Director 94 (i) John Moore – Non-executive Director 94 (j) Jill Youds – Non-executive Observer 94 (k) Julian Dennis – Non-executive Observer 95 6.4 Executive Directors 95 (a) Deborah Lee – Director of Strategic Development & Deputy Chief Executive 95 (b) Paul Mapson – Director of Finance and Information 95 (c) Claire Buchanan – Acting Director of Workforce and Organisational Development 96 (d) Helen Morgan – Acting Chief Nurse 96 (e) Sean O’Kelly – Medical Director 96 (f) Sue Donaldson – Director of Workforce and Organisational Development 97 (g) Carolyn Mills – Chief Nurse 97 (h) James Rimmer – Chief Operating Officer 97 7. Appendix B – Contact Details 98 8. Appendix C – Quality Report 2013/14 9. Appendix D – Annual Accounts 2013/14 – including the ‘Annual Governance Statement’ 10. Appendix E – Independent Auditor’s Report to the Board of Governors Annual Report Page 6 of 98 Annual Report and Accounts 2013 - 2014 1. Chairman’s Statement Welcome to the Annual Report and Accounts, including the Quality Report, for University Hospitals Bristol NHS Foundation Trust for the year from 1 April 2013 to 31 March 2014. It has once again been a momentous year for the whole of the NHS with challenges to work through in a variety of areas. 1.1 Quality of care The focus on the quality of care the NHS provides to patients rightly continued in the wake of the publication of three significant reports - the final report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, chaired by Robert Francis QC (the ‘Francis Report’); the Keogh Review by Professor Sir Bruce Keogh, NHS England Medical Director, and the Berwick Report by Professor Don Berwick. Here at University Hospitals Bristol NHS Foundation Trust (UH Bristol) we reviewed all of Robert Francis’ recommendations, and the other two reports, to consider what further improvements we can make to ensure that the interest of the patient is at the centre of all we do. We did this with a detailed self-examination of the Trust’s system of governance and shared Trust values, by considering the Francis Report’s recommendations for acute Trusts and assessing ourselves against those and with a qualitative analysis of information derived from discussions with Trust staff as well as from other forms of feedback from staff and patients. As a result, we identified a number of themes for us to address including perceived variation in attitudes to openness and sharing across the Trust, listening and learning more effectively throughout the Trust and making the process of change easier and more usual. 1.2 Changes in the structure of the NHS On 1 April 2013 Clinical Commissioning Groups (CCGs) replaced Primary Care Trusts as the lead commissioner for services such as ours. At a strategic level, the CCGs are focussed on a clinical Z\view of the decisions that underpin the commissioning process but, on a practical level, local relationships and ways of working have changed and we welcome the change in emphasis these changes have brought. The Health and Social Care Act 2012 also expanded the role of the Council of Governors, and this is something that we invested a significant effort in preparing for to ensure that we were ready not only to fulfil our duty of equipping our governors with the skills and knowledge they need, but also enabling them to fulfil their new statutory duties to hold the non-executive directors to account for the performance of the Board, and to represent the interests of the members, and the interests of the public. 1.3 The financial challenge coupled with growing demand for services Much has been written about the overall financial challenge faced by the NHS, coupled with the increased demand for NHS services. We know that austerity within public services will continue and, even although health spending is protected, this does not account for increases in health costs caused by things such as the advances in treatments and drug costs and the growing demand from a burgeoning elderly population. This Trust is not immune from these pressures – our savings target for 2013/14 was £21 million - and we are working hard to transform our services in response to these pressures. Annual Report Page 7 of 98 Annual Report and Accounts 2013 - 2014 1.4 The local perspective As a university hospitals trust in the centre of Bristol, with a key role in the delivery of education and training, research and development, and district and tertiary health services, University Hospitals Bristol plays an important role in Bristol and the surrounding areas. Central to how we perform, are the values we adhere and work to, our strategy as an organisation, our governance structure and the way in which we approach the challenges of the future.