Lancashire Teaching Hospitals 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 Lancashire Teaching Hospitals NHS Foundation Trust CONTENTS . Overview 1 • Chairman’s and Chief Executive’s Welcome . Performance report 2 • Overview of performance 3 • Performance analysis 7 . Accountability report 17 • Directors’ report 18 • Remuneration report 43 • Staff report 55 • Disclosures set out in the NHS Foundation Trust Code of Governance 70 • NHS Improvement’s Single Oversight Framework 75 • Statement of accounting officer’s responsibilities 76 • Annual governance statement 77 • Council of Governors’ report 93 • Membership report 98 • Audit Committee report 103 . Quality report 110 • Independent auditors’ report to the Council of Governors on the Quality report 186 . Financial review 189 • Independent auditors’ report to the Council of Governors on the financial statements 190 • Foreword to the accounts 197 • Statement of comprehensive income 198 • Statement of financial position 199 • Statement of changes in equity for the year 200 • Statement of cash flows 201 • Notes to the accounts 202 This symbol indicates that more information is available on our website: www.lancsteachinghospitals.nhs.uk CHAIRMAN’S AND CHIEF EXECUTIVE’S WELCOME Welcome to our annual report for the financial year 2017/18, which sets out our achievements, activity and performance. The annual report is also an opportunity to share our vision and priorities at a time of significant pressure and change within the NHS. Our fantastic, state-of-the-art, cancer robot has been making a huge difference to Lancashire and South Cumbria cancer patients this year. The robot, purchased for us by the Rosemere Cancer Foundation, means we can operate with greater precision, and provide life saving treatment for many patients for whom conventional surgery isn’t an option. Our commitment to developing the best cancer care for our communities was further reinforced with the opening of the chemotherapy unit at Chorley in 2017, so that local patients can receive treatment closer to home. We have also continued to drive innovation through world-class research, education and training in the past year. We are delighted to have opened the Clinical Research Facility to support us to develop new drugs and treatment for this and future generations. We are very proud of Alison Birtle, Consultant Oncologist, who this year presented results of a groundbreaking trial that will improve survival rates for patients with upper urinary tract cancer. We also recruited our first ovarian cancer patient to the 100,000 genomes project – an ambitious programme that is sequencing the DNA of patients with rare conditions. As in previous years we recruited patients to national and international trials and studies, and are proud to have led a practice-changing trial for bladder cancer. Every year demand for care increases and last year was no different. When wards are as busy as they have been there are delays admitting patients from emergency departments, and our ability to treat those waiting for planned operations is affected. As a result we have not achieved all the national performance standards this year. In November we began implementation of a continuous improvement plan, and have established 11 workstreams to improve patient flow in a systematic way so that change is embedded. We are confident this new approach will improve patient experience, quality and safety of care, and working lives. Despite making £20m savings this year, the continued growth in demand along with rising costs and workforce shortages means our deficit has increased. We will not compromise the quality and safety of care we provide but instead are very much focusing on improving efficiency so that we deliver better value for money and reduce waste. As ever our governors, volunteers and staff together with patients, carers, families and partner organisations continue to work with tremendous commitment and on behalf of the Board we thank them all for their passion and effort. Another tough year looms but we have made really exciting progress this year and have truly laid the foundations for our continous improvement journey. Sue Musson Karen Partington Chairman Chief Executive 25 May 2018 25 May 2018 1 Lancashire Teaching Hospitals NHS Foundation Trust PERFORMANCE REPORT 2017/18 2 OVERVIEW OF PERFORMANCE The purpose of this report is to inform the users of the Trust’s performance and to help them assess how the directors have performed in promoting the success of the Trust. This report is prepared in accordance with sections 414A, 414C and 414D Companies Act 2006, as interpreted by paragraphs 5.2.6 to 5.2.11 of the Treasury’s Financial Reporting Manual. For the purposes of this report, we have treated ourselves as a quoted company. Additional information on our forward plans is available in our operational plan on our website. Information on any mandatory disclosures included within this report is provided on pages 70 to 73. The accounts contained within this report have been prepared under a direction issued by NHS Improvement under the National Health Service Act 2006. Who we are Lancashire Teaching Hospitals NHS Foundation Trust was established on 1 April 2005 as a public benefit corporation authorised under the Health and Social Care (Community Health and Standards) Act 2003. We are registered with the Care Quality Commission without conditions to provide the following regulated activities: • diagnostic and screening services • maternity and midwifery services • surgical procedures • termination of pregnancies • treatment of disease, disorder or injury • management of supply of blood and blood-derived products • assessment or medical treatment for persons detained under the Mental Health Act 1983 We provide acute services to our local population of around 400,000 and provide a number of tertiary services to around 1.6 million people across Lancashire and South Cumbria. Most of our clinical services are provided on our two hospital sites – Chorley and South Ribble Hospital and Royal Preston Hospital. We also have a specialist mobility and rehabilitation service in Preston, the Broadoaks child development centre in Leyland and we provide dialysis units in various locations in Lancashire. We provide the following general hospital services to our local population: • 24-hour emergency department facilities • intensive, high dependency and coronary care units • general medicine, including elderly care • general surgery and urology • child health • ear, nose and throat surgery • orthopaedics • maternity services • gynaecology • anaesthetics • oral and maxilla-facial surgery • ophthalmology • support services for diagnosis and treatment, such as pathology, x-ray, physiotherapy, occupational therapy and specialist nurse • rehabilitation services 3 People in Lancashire and South Cumbria also access the following specialist services: • neurosurgery and neurology • oncology (radiotherapy and chemotherapy) and complex cancer surgery • elective and emergency vascular surgery • renal and plastic surgery • specialist mobility and rehabilitation services • major trauma services Our business model The governance structure of a foundation trust is prescribed through legislation, and is reflected within our constitution. All foundation trusts are required to have a board of directors and a council of governors as well as a membership scheme, which is open to members of the public and staff who work at the foundation trust. Members vote to elect governors and can also stand for election themselves. The council of governors is responsible for representing the interests of NHS foundation trust members and the public and staff in the governance of the Trust. It remains the responsibility of the board to design and then implement agreed priorities, objectives and the overall strategy of the organisation. Governors are responsible for regularly feeding back information about the Trust, its vision and its performance to members and the public and the stakeholder organisations that either elected or appointed them. The board of directors retains the overall responsibility for decision-making within the organisation, except where the council has statutory responsibilities. The board does, however, work closely with the council in formulating its forward plans. A schedule of matters reserved to the board is in place and this document details the matters reserved to the board, as well as providing more detailed information on the respective roles of the council of governors and the board of directors. Our strategic aims and ambitions We have three equally important strategic aims: 1. To offer excellent hospital care and treatment to our local communities 2. To provide a range of the highest standard of specialised services to patients in Lancashire and South Cumbria 3. To drive innovation through world-class education, training and research. These strategic aims are underpinned by our four ambitions, which provide the framework for our business planning process, as well as our recruitment and appraisal processes: 4 Our strategic aims, together with our four ambitions, provide the focus and drive on clinical quality and long-term sustainability, whilst informing local service planning and development priorities. During 2017/18 the Trust committed to the adoption of a continuous improvement approach and has appointed a new Director of