Transcript The Rotherham NHS Foundation Trust Annual General Meeting 2014

Tuesday 23rd September
2014
Welcome
Martin Havenhand
Trust Chairman
This evening’s agenda:
Setting the scene – Martin Havenhand, Trust Chairman
Review of 2013/14 – Louise Barnett, Chief Executive
Quality Report 2013/14 – Tracey McErlain-Burns, Chief Nurse
Financial overview of 2013/14 – Anna Anderson, Interim Finance
Director
Auditor’s Report 2013/14 –Amy Warner, KPMG LLP
Governors’ response – Jean Dearden, Lead Governor
Looking forward - Louise Barnett , Chief Executive
Questions from the floor
Close
Setting the scene for 2013/14:
You will hear about a year of:
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Providing quality services at a price the Trust could not afford
-
Financial challenge
- Fractured Board Governance
- Significant changes in the Board, both executive and non-executive
- Operating in breach of our Licence
- Damage to our reputation
- Planning for recovery
Setting the scene for 2013/14:
A year of significant challenges
• Bolt Partners leading a recovery plan – financial difficulties
• Four Chief Executives in 2012/14
• Three Chairmen in 2013/14
Monitor found the Trust to be in breach of its licence in February 2013:
• In April 2013 – The Trust was asked to sign undertakings with regard to breaches in
Board governance financial planning and Electronic Patient Records
• In July 2013 – The Trust was required by monitor to provide a 5 year financial plan
and a set of strategic options
Setting the scene for 2013/14:
A year of significant challenges:
Governance Issues
• Chairman resigns in June 2013
• Interim Chairman appointed in June 2013
• July 2013 - Deloitte independent review of Board Governance
• 2 NEDs resign
• 3 new NEDs appointed in September 2013
• I was appointed Chairman in February 2014
Executive Restructuring
• Clinical Services management restructured in October 2013
• Bolt Partners contract ended in December 2013
• Interim CEO and Deputy CEO/Director of Transformation appointed in November
• Louise Barnett was appointed CEO in March and started on 1st April 2014
Quality of service was maintained throughout the year.
Review of 2013/14
Louise Barnett
Chief Executive
About the Trust in 2013/14
•
Hospital and community settings
•
Located on 8 sites in total
•
Employed circa 4,240 members of staff
•
160 volunteers supporting services
•
430 beds available at Rotherham Hospital site
•
20 inpatient beds at Oakwood Community Unit
•
20 inpatient beds at BreathingSpace
•
Delivered 2,794 babies during the financial year
•
Saw 74,083 patients in the A&E Department
•
Treated 90,697 outpatients during the financial year
•
Served a growing population of circa 257,000 people
Strategic Objectives 2013/14
Annual Plan 2013/14:
Monitor had given dispensation for the strategic element of the Annual Plan,
normally submitted at this time, to be submitted in December 2013 as part of
the recovery process.
During this period the Trust aimed to address five key risks:
• Board Governance
• Liquidity
• Cost Improvement Programmes
• Electronic Patient Records
• Secure permanent board appointment to NED/Executive Director roles
The Trust submitted three strategic options to Monitor in December 2013:
• Option 1 – The Trust as a stand alone entity
• Option 2 – Vertical integration with a social care provider
• Option 3 – Merger with another acute provider
December 2013, Option 1 was agreed as the preferred option
Overview 2013/14: Performance
•
18 week waits – delivered overall and at
specialty level
•
4-hour A&E targets – delivered – (1 in only
18 Trusts to do so)
•
C.Diff – failed to achieve our target of less
than 22 (actual = 29)
•
Serious Incidents reported = 23 (compared
with 9 in 2012/13)
•
Commissioner agreed quality targets –
95% compliance rate achieved
Overview 2013/14: Performance
• Cost Improvement Programme savings target – achieved £8.33M against
a target of £10.95M
• Significant progress in terms of Electronic Patient Record system,
resulting in enforcement being lifted in July 2014
• Restructuring clinical service units from 11 to 4 to strengthen leadership
and focus on priorities
• Appointed 3 NEDS in September 2013 and Chairman in February 2014.
Overview 2013/14: Our Staff
National Staff Survey results were, on the whole, poor.
Bottom five ranking scores included:
•
Staff motivation at work
•
Staff recommendation as a place to work or receive treatment
•
89% of staff agreeing that their role makes a difference to patients
•
64% of staff able to contribute towards improvements at work
•
74% of staff feeling satisfied with the quality of their work and patient care
they are able to deliver
Overview 2013/4: Our Staff
However, the survey showed some improved areas too:
Top five ranking scores included:
•
26% of staff witnessing potentially harmful errors / near misses in the last month
•
96% of staff reporting potentially harmful errors / near misses in the last month
•
8% of staff experiencing discrimination at work in the last 12 months
•
25% of staff feeling pressure in the last 3 months to attend work when feeling
unwell
•
21% of staff experiencing harassment, bullying or abuse from staff in the last 12
months
Thank you to our staff
Quality Report
2013/14
Tracey McErlain-Burns,
Chief Nurse
Quality Report: Our regulators
A CQC inspection took place in June 2013, the purpose of which was
to assess compliance against:
•
•
•
•
•
•
Outcome 2: Consent to care and treatment
Outcome 4: Care and welfare of people who use services
Outcome 8: Cleanliness and Infection Control
Outcome 12: Requirements relating to workers
Outcome 14: Supporting workers
Outcome 16: Assessing and monitoring the quality of service provision
The Trust met the standards for each Outcome
Since this inspection:
• CQC intelligent monitoring reports – October 2013 to July 2014
• New style CQC inspections and how we self assess compliance
Quality Report 2013/14
Our priorities and achievements for 2013/14
Priority
1
Description
Achieved ?
Patient Safety: Intraoperative fluid management
2
Improving data quality
3
Review of Death Certificates
4
Patient Experience - Dementia
Improved
Quality Report 2013/14: What we achieved
Q1 – Q4 ED performance
Q1
Q2
Q3
Q4
2013/14
94.20%
94.33%
96.13%
95.81%
95.10%
Total No. of
attendances
18772
Total No. of
attendances
18909
Total No. of
attendances
17923
Total No. of
attendances
18479
Total No. of
attendances
74083
Further Achievements:
• New Clinical Decision Unit
• New Wharncliffe Ward
• Strengthened Safeguarding Team
• One stop service developed in ear care services
• Nurse Technology funding awarded to enhance digital working within
District Nursing
Quality Report 2013/14
Other Issues:
• Complaint handling: full review of the process was undertaken,
resulting in an overall reduction in the number of complaints received
in 2013/14
• In-patient survey results similar to previous year, but a number of
areas where improvements could be made, were identified
• Employee sickness absence rates averaged 4.55%
(similar to previous year).
• Pressure Ulcer incidence
Quality Report 2013/14
Our priorities for 2014/15
• To further reduce hospital Mortality
• To achieve a minimum of 96% Harm free care and zero avoidable pressure
ulcers grade 2 – 4, and avoidable falls with harm.
• To achieve all national waiting times targets (cancer, A&E, 18 weeks)
• To achieve improvement in all Friends and
Family Test scores
Overview 2013/14: Our nationally
recognised staff
Just some of the National Awards received:
• Excellence Award for Haematology Clinical Nurse Specialist for Innovation and
Nursing
• Health and Safety Gold Award from the Royal Society for the prevention of
Accidents
• Soil Association Award for Catering services at Rotherham Hospital
• Solar Europa Environmental Business Awards for our environmental best
practice
The Jay Report - Child Sexual Exploitation
•
August 2014 Professor A Jay OBE published her report
•
TRFT is a member of the Rotherham Local Safeguarding Children (and Adult) Board
•
Full review of capacity to provide ongoing support to victims of exploitation and assault
•
Enhanced staff training – See Something – Say Something
•
Intelligence sharing
•
If you have concerns about the welfare of a child or young person, dial 999 and tell the police; 101;
Crimestoppers; or MASH - 01709 823987 (336080 out of hours)
Financial
Overview 2013/14
Anna Anderson
Interim Director of Finance
Insert official
AA photo
Financial Overview 2013/14
•
The Trust has a deficit of £3.2m better than plan of £4.8m and a deficit in
two previous years of over £6m
•
Operating income of £235.1m (£234m in 2012/13)
•
Operating expenditure of £235.9m (£238m in 2012/13)
Financial Overview 2013/14
Operating income of £235.1m included:
Revenue from patient care activities
£217m (£212m)
- emergency patients, planned patients, outpatients
Education and training activities
£5.4m (£4,981m)
Non patient care services (to other bodies)
£2.7m (£3,905m)
Other (includes pharmacy sales, parking, etc.)
£10m
- Switch from PCTs to CCGs, Local Authority and NHS England
Financial Overview 2013/14
Operating expenses of £235.9m included:
Staffing costs
£150.3m (£151m)
Drugs
£14.6m (£13.5m)
Other clinical supplies and services
£24.9m (25.5m)
Premises
£11.9m (£10.7m)
Clinical negligence
£4.6m (£4.1m)
Other (includes depreciation, impairments, etc.)
£28.5m
Financial outlook for 2014/15
• Aim for a year end surplus of £0.7m
• Need £10.9m of savings to achieve this
• Patient numbers above plan, especially emergency patients, admitted to
hospital
• Financial Pressures: Spend above plan – extra inpatient capacity, use of
temporary staff
• Overall we are working hard to achieve our financial plan as well as providing
high quality care for our patients
Auditor’s Report:
Amy Warner
KPMG LLP
The Rotherham NHS
Foundation Trust
Annual Audit 2013-14
Presentation to the Annual General
Meeting
23 September 2014
The Role of External Audit
Financial
Statements
Audit
Use of
Resources
Audit
Review of Annual
Report and Annual
Governance
Statement
Review Quality
Report
Testing of selected
indicators
Audit Opinion and
Report on Quality
Report
ISA 260 and Audit
Opinion
Present to Audit
Committee and
Governors
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Swiss entity. All rights reserved.
30
Key issues arising
■ Clean, unqualified audit opinion issued
■ One unadjusted audit difference in relation to recognising
movement in provision for impairment of receivables as
income rather than an operating expense. This had no
impact on the bottom line.
Financial
statements
Audit
■ No adjusted audit differences.
■ Four recommendations raised in relation to processes:
■ Adhering to the internally agreed reporting timetable
■ Improving processes for when key financial staff are
off for long periods
■ Signing employment contracts on a timely basis
■ Evidencing review of starter and leaver forms
© 2014 KPMG LLP, a UK limited liability partnership, is a subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative, a
Swiss entity. All rights reserved.
31
Key issues arising
■ Qualified Use of Resources conclusion as a result of:
■ The Trust still being in significant breach with Monitor
at year end
Financial
Statements
Audit
■ Board Assurance Framework under development
during 13/14.
■ Annual Report and Annual Governance Statement
consistent with financial statements and complies with
Monitor’s Annual Reporting Manual
© 2014 KPMG LLP, a UK limited liability partnership, is a subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative, a
Swiss entity. All rights reserved.
32
Key issues arising
■ The content of the Quality Report complies with the
requirements of Monitor’s Annual Reporting Manual
■ The content of the Quality Report is not inconsistent with
other information sources as specified by Monitor
■ Three indicators tested:
 Clostridium difficile (mandated by Monitor)
Quality
Report
 Emergency readmissions within 28 days of discharge
from hospital (mandated by Monitor)
 Dementia Screening CQUIN (selected by governors)
■ No issues identified with Clostridium difficile.
■ One recommendation raised in relation to emergency
readmissions within 28 days of discharge from hospital
around accurately recording admissions.
■ One recommendation raised in relation to Dementia
Screening CQUIN around accurately recording and
reporting dementia assessment.
© 2014 KPMG LLP, a UK limited liability partnership, is a subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative, a
Swiss entity. All rights reserved.
33
Thank you
Presentation by Amy Warner
Governors’
Response:
Jean Dearden
Lead Governor
Looking Forward
Louise Barnett
CEO
Looking forward 2014/15
5 strategic objectives:
• Patients
• Staff
• Governance
• Finances
• Partners
Your Questions