NHS Trust Development Authority: annual report and accounts 2018/19 HC 2346 NHS Trust Development Authority Annual report and accounts 1 April 2018 to 31 March 2019 Presented to Parliament pursuant to Schedule 15, paragraph 6(3) of the National Health Service Act 2006. Ordered by the House of Commons to be printed 11 July 2019. HC 2346 © NHS Trust Development Authority copyright 2019 The text of this document (this excludes, where present, the Royal Arms and all departmental or agency logos) may be reproduced free of charge in any format or medium provided that it is reproduced accurately and not in a misleading context. The material must be acknowledged as NHS Improvement copyright and the document title specified. Where third party material has been identified, permission from the respective copyright holder must be sought. Any enquiries related to this publication should be sent to us at: [email protected] This publication is available at www.gov.uk/official-documents ISBN: 978-1-5286-1456-6 CCS0419129332 07/19 Printed on paper containing 75% recycled fibre content minimum Printed in the UK by the APS Group on behalf of the Controller of Her Majesty’s Stationery Office NHS Improvement Wellington House, 133-155 Waterloo Road, London SE1 8UG Telephone: 020 3747 0000 Email: [email protected] Website: https://improvement.nhs.uk/ Publication code: Corp 02/19 About NHS Improvement NHS Improvement is responsible for overseeing NHS foundation trusts, NHS trusts and independent providers. We offer the support these providers need to give patients consistently safe, high quality, compassionate care within local health systems that are financially sustainable. By holding providers to account and, where necessary, intervening, we help the NHS to meet its short-term challenges and secure its future. NHS Improvement is the operational name for the organisation that brings together Monitor, NHS Trust Development Authority (NHS TDA), Patient Safety including the National Reporting and Learning System, the Advancing Change team and the Intensive Support Teams. About the NHS Trust Development Authority NHS TDA’s role is to provide support, oversight and governance for all NHS trusts in their aim of delivering what patients want; high quality services today, secure for tomorrow. The range of services provided by NHS trusts covers the entire spectrum of healthcare, from acute hospitals to ambulance services through to mental health and community providers; the size of organisation varies from very small providers through to some of the largest organisations in the NHS, and therefore each trust has a set of unique challenges. Due to this variation, we recognise that there is not going to be a ‘one size fits all’ solution to the challenges trusts face. Our goal is first and foremost to help each and every NHS trust to improve the services they provide for their patients. This report covers the period from 1 April 2018 to 31 March 2019. Monitor and NHS TDA continue to exist as legal entities, but this report refers mainly to NHS Improvement. 5 The NHS Long Term Plan says that when organisations work together they provide better care for the public. That is why on 1 April 2019 NHS Improvement and NHS England united as one – our aim, to provide leadership and support to the wider NHS. Nationally, regionally and locally, we champion frontline staff who provide a world-class service and constantly work to improve the care given to the people of England. 6 Contents Performance report……………………………………………………………………….8 Financial commentary…………………………………………………………………….76 Accountability report……………………………………………………………………79 Remuneration and staff report………………………………………………………….138 Financial statements………………………………………………………………….. 177 7 Performance report 8 Chair’s foreword I am pleased to introduce NHS Improvement’s annual report and accounts for 2018/19. It was a notable year for the NHS: we celebrated the NHS’s 70th anniversary and launched the blueprint for the next 10 years with the NHS Long Term Plan, and all through the year staff stepped up to the challenge of delivering outstanding care to patients as demand for their services continues to grow. I would like to thank everyone, from across the service and from within NHS Improvement, who worked so hard both on caring for patients today and tirelessly striving to improve their care, while developing and launching the NHS Long Term Plan and making it such a compelling vision of the future. The plan sets out how the NHS will improve prevention and reduce health inequalities, encourage and support the very best people to come and work for it, make best use of digital technology and innovation, and ensure best value from the taxpayers’ investment. It sets out how the 3.4% five-year funding settlement will help put the NHS back onto a sustainable financial path. Turning it into reality is our task now: with local NHS organisations and their partners, we must build care around patients rather than institutions, break down organisational barriers and nurture collaboration within local health and care systems. The last year has been one of significant change for NHS Improvement too. For if we are to play our part in implementing the transformation programme, we also need to change. We have laid the foundations for that, which will see a shift from a fragmented centre of the NHS to a more integrated one as we work more closely with NHS England, and a shift in our focus from regulation to improvement here to support frontline organisations to improve. The joint working programme has moved at pace through the year, and we end 2018/19 with a united NHS Executive team. Such was our progress on joint working that it became apparent to the boards of both our organisations that a structure with a single chief executive and a single chief operating officer was the best way to provide effective leadership and support to the NHS. As a result, Ian Dalton decided to step down from his role as Chief Executive of NHS Improvement. We are immensely grateful to Ian for his contribution, not just to NHS Improvement but to the NHS over a career of 35 years. His commitment to patients and the NHS has been exemplary, and we would not be able to take these next steps to align our organisations without his leadership and determination. As 9 this report shows, Ian has done an outstanding job both in delivering 2018/19 performance and in setting up the NHS for success in the future. I would also like to thank Stephen Hay and Dr Kathy McLean, who both stepped down from the NHS Improvement Board at the end of the year after extremely distinguished careers in the NHS. We wish them and Ian all the very best as they embark on the next phase of their lives. As we look forward to the new financial year, NHS Improvement has a critical role in implementing the Long Term Plan. What we do and the way we do it can make a significant difference to patients now and in the future. We need to play our part in shifting the NHS’s culture to focus more on people, so it embodies a just and fair learning culture, backed with robust and embedded improvement methodologies. Having recently launched the NHS’s first People Plan, I believe passionately that we need to focus more of our efforts on the people dimension of the NHS, to make the NHS the best place to work in the country, to honestly address the significant workforce shortages we have, and to work together to transform the way we work in the NHS to be fit for the opportunities and challenges of the 21st century. This will require significant work inside our organisation, as we continue to implement our joint working programme, but also NHS-wide, as we support local integrated care systems to implement the Long Term Plan. I’d like to thank everyone in NHS Improvement who has worked so hard over the last 12 months to deliver these excellent results, and I look forward to continuing to work with them to deliver the promise of the Long Term Plan for patients, staff and taxpayers alike. I hope this report offers an insight into the commitment and professionalism of our staff. They will, I know, play a vital role in the work we and NHS England carry out together during the year ahead. Baroness Dido Harding Chair of NHS Improvement 10 Chief Executive’s introduction The efforts of NHS staff in 2018/19 were extraordinary. Demand for services was at the highest levels ever seen: 7% more patients were admitted to hospital via accident and emergency departments in the last three months of the year than in the same period in 2017/18. Yet during winter the NHS achieved the first year-on-year improvements in key targets for five years. A&E staff saw almost 315,000 more patients within four hours than in the same quarter last year. Better patient flow raised the quality of patient experience. The NHS significantly reduced the longest waits for treatment: though patients waiting more than 52 weeks reached a peak of 3,500 in June 2018, by the end of the year their numbers had reduced by 63%. More patients started treatment within 18 weeks than in 2017/18, as trusts provided over 1,000 extra treatments every working day. Concerted efforts to reduce the number of long-stay patients in acute hospitals released the equivalent of more than 2,000 beds, while ambulance response times radically improved – by 1 minute and 35 seconds for life-threatening calls. Among patients experiencing a first episode of psychosis, 76.2% started treatment within two weeks, well above the 53% standard.