Annual Report and Accounts 2018/19 North Bristol NHS Trust 2018/19 Annual Report and Accounts Annual Report 2018/19 Contents Overview Annual Governance Statement Chief Executive’s Statement 4 Scope of responsibility 47 Trust Purpose and Activities 7 The purpose of the system Overview – the last 12 months 8 of internal control 47 Governance Framework 47 Performance Risk Management 53 Capacity to handle risk 53 Performance Summary 11 The risk and control framework 54 Performance Analysis 14 Compliance with obligations under the Progress against 2018/19 objectives 15 Climate Change Act 65 2018/19 Financial Performance 20 Review of economy, efficiency and Listening to and working effectiveness of the use of resources 65 with our patients 22 Information governance 66 Fundraising, Fresh Arts and Volunteers 28 Annual Quality Account 66 Research and Innovation 30 Review of effectiveness 67 Our People 32 Conclusion 68 Sustainability 37 Remuneration Report Accountability Report Off Payroll Arrangements 71 Corporate Governance Report 43 Salary and Pensions entitlements of Directors’ Report 43 senior managers 2018/19 73 The Trust Board 43 Remuneration of Changes to the Trust Board 44 senior managers (audited) 73 Declarations of Interests 44 Pension Entitlements of Trust Board and Committees 44 senior managers (audited) 76 Audit Committee 45 Staff Report 78 External Auditors’ Remuneration 45 Public Sector Payment Policy – Annual Accounts 87 Better Payments Practice Code 45 Fraud, Bribery and Corruption 45 2 North Bristol NHS Trust 2018/19 Annual Report and Accounts 3 North Bristol NHS Trust 2018/19 Annual Report and Accounts Chief Executive’s Statement It was a year extended hours into the new financial year. of celebration in the NHS as Listening and improving we marked its 70th Our staff are our biggest asset and it is birthday. At important we listen to those on the frontline to North Bristol understand how we can support them and they NHS Trust in turn provide better care for our patients. (NBT) we heard from We held an extensive staff feedback exercise staff past and following the challenging 2017/18 winter. Staff present and told us that they expect it will be busy but they members of would welcome early notice of winter ward the public changes, good staffing ratios, support for taking about how the NHS has changed their lives. breaks and appreciate managers and leaders being visible at times of pressure. Across the board the Trust has made considerable progress on a number of fronts By listening to these suggestions our winter during 2018/19. We have stabilised our financial plan for 2018/19 was agreed early (June rather position and are gradually reducing our over- than November) and our ability to deliver high spend and I am pleased that so many staff quality care whilst ensuring staff felt supported have contributed to making sure we spend gave us our best winter experience so far. our resources wisely and get value from every We know staff have the answer to many of pound spent. Four years into the new hospital the challenges we face, we were delighted to and we have developed new services, including fully realise their aspirations through our award hospital at home, same day emergency surgical winning Perform programme. care, and ways of making our state of the art hospital really work for the increasing numbers Perform is a set of practical tools and of patients, with broad ranging conditions techniques that enable teams to set their own choosing to come to North Bristol. goals, monitor progress, provide focus on actions, celebrate successes and troubleshoot Our surgical teams are able to provide more problems. The approach has been tested operations on a day case basis, and for those elsewhere but at NBT we were keen that suitable for a short stay we are providing Perform should reach as many staff as possible. 23 hour post-operative care in our single medirooms enabling patients to be cared for We held OneNBT Perform bootcamps overnight and go home the next day. throughout the year with over 1,500 members of staff attending to understand tools and During the winter of 2018/19 we increased the techniques of working together. Every ward in hours of service for our medical ambulatory the hospital had a dedicated coach for a ten- emergency care service – patients can be week period to embed the tools and techniques assessed and treated within a few hours, which required to problem solve. saves an unnecessary inpatient admission. This has been so successful that we have continued 4 North Bristol NHS Trust 2018/19 Annual Report and Accounts As an improvement programme Perform has access physiotherapy, counselling and a wide helped staff realise their aims of reducing range of psychological support sessions and delays in patient stays, improving discharge classes, support for improving fitness, exercise, experience, making sure we have the right bed and healthy eating, and we put in place a nurse- available for patients when they are admitted led urgent care clinic for staff over winter. and starting the day with empty beds in our emergency area. Despite serving an increasing Improving access to our services and number of emergency patients this year (up by planning for future growth 10%) staff have been better placed to care for patients with fewer beds occupied every day In 2018/19 we saw more outpatient and more through better team working and management patients in our emergency department. The of inpatient care. Many wards and teams now increase in demand for our services is driven use the Perform huddle to review the days’ by a combination of factors; new housing and activities and priorities. increase in population, busy primary care, increased awareness of the importance of Staff survey health screening and new programmes, the range of specialties at North Bristol which Every year we get a snapshot view of how staff are not available elsewhere and an aging feel about working at the Trust, including their population who we are much better placed to experience at work, the culture and the care treat than ever before with minimally invasive they are able to provide. In 2017 we prioritised surgery, better treatments and personalised support to staff in managing their health and medicine. wellbeing, reducing work pressures and creating opportunities for staff to have their say. With this demand on our hospitals increasing every year it is a challenge to treat everyone as Our survey showed definite improvement in quickly as we would like. Our four hour accident staff feeling engaged and valued. We were and emergency waiting time standard improved told Perform, listening events and our award- from 2017/18 but at 79.78% was below our winning wellbeing programme means our Trust aim of 84%. However, set against the national is a better place to work. However, while the picture this placed NBT close to the national 2018 staff survey results show we’re making average of 81.58%, particularly when looking good progress, there is more we want to do at patients requiring more serious urgent care, including further support in management and described as type 1 care. leadership development, enabling staff to be engaged in Trust activities and development of their services, and feeling empowered to speak up. Our health and wellbeing programme includes a confidential employee advice service, fast 5 North Bristol NHS Trust 2018/19 Annual Report and Accounts At North Bristol we are also seeing an medicine. We continue to lead the way in increasing number of patients requiring cancer sustainability and Southmead Hospital Charity care and have planned ahead to increase and our volunteers have excelled in making our diagnostic capacity and recruit more NBT the heart-warming, welcoming place it is Consultants to ensure we can treat patients today. within 31 and 62 days during 2019/20. The Trust pioneered a new prostate cancer pathway I hope you enjoy reading this annual report. We which sees patients assessed via MRI reducing know we don’t always get things right, but we outpatient visits and more invasive diagnostic want to listen, and improve all the time. What tests. Our living with and beyond cancer these stories tell us is the story of the people service was praised by MacMillan as one of the who make up NBT and their commitment to best in any hospital in the country. excellence in all they do. As ever we know we must always live up to the trust that patients put As we move into our fifth year since we moved in us. It is a privilege to serve our patients and into the Brunel building, there is so much going we look forward to working with them and for on that makes NBT a great place for patients, them in 2019. volunteers and staff alike. We have improved our training facilities with the introduction of a state-of-the-art simulation room, we opened 112 new research studies meaning more patients have access to clinical trials, we were Andrea Young praised for our completion of trials to time Chief Executive and standard, winning an increasing share of June 2019 NHS research funding for 2019/20. We are also one of eight national genomic hubs in the country underpinned by exceptional diagnostic expertise, putting us at the forefront of modern 6 North Bristol NHS Trust 2018/19 Annual Report and Accounts Trust Purpose and Activities NBT is a centre of excellence for health care • Working well together in the South West in a number of fields as • Striving for excellence well as one of the largest hospital trusts in the • Recognising the person UK with an annual turnover of £605.8 million.