Annual Report and Accounts 2012/13 - Hillingdon Hospital NHS Trust
Annual Report and Accounts 2012/13 - Hillingdon Hospital NHS Trust
Annual Report and Accounts 2012/13 - Hillingdon Hospital NHS Trust
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The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation <strong>Trust</strong><br />
<strong>Annual</strong> <strong>Report</strong> <strong>and</strong> <strong>Accounts</strong> <strong>2012</strong>/<strong>13</strong>
The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation <strong>Trust</strong><br />
<strong>Annual</strong> <strong>Report</strong> <strong>and</strong> <strong>Accounts</strong> <strong>2012</strong>/<strong>13</strong><br />
Presented to Parliament pursuant to Schedule 7,<br />
paragraph 25(4)(a) of the National Health Service Act 2006
CONTENTS<br />
Page<br />
Introduction from the Chair <strong>and</strong> Chief Executive<br />
2<br />
Directors’ report 1<br />
4<br />
Governance report 2<br />
34<br />
Remuneration report<br />
52<br />
Quality report<br />
59<br />
Statement of Accounting Officer’s responsibilities<br />
97<br />
Statement of Directors’ responsibilities in respect<br />
of the accounts<br />
98<br />
<strong>Annual</strong> governance statement<br />
99<br />
Independent Auditor’s report<br />
110<br />
<strong>Annual</strong> accounts <strong>2012</strong>/<strong>13</strong><br />
112<br />
1 Including management commentary, staff survey, regulatory ratings, <strong>and</strong> public interest disclosures<br />
2 Including disclosures set out in the <strong>NHS</strong> Foundation <strong>Trust</strong> Code of Governance<br />
1
INTRODUCTION FROM THE CHAIR AND CHIEF EXECUTIVE<br />
The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation<br />
<strong>Trust</strong> has strong links with the local<br />
community, with around 80% of our patients<br />
being drawn from within the Borough of<br />
<strong>Hillingdon</strong>.<br />
During the last year the <strong>Trust</strong>’s clinical<br />
performance remained strong despite the<br />
prolonged <strong>and</strong> extremely busy winter. Our<br />
clinical <strong>and</strong> non-clinical staff performed<br />
admirably under the most severe pressures<br />
<strong>and</strong> we remained compliant against all<br />
Monitor targets for each quarter, including<br />
the challenging Accident & Emergency<br />
(A&E) access target <strong>and</strong> infection control<br />
targets. We managed to deliver these, whilst<br />
delivering our financial plan <strong>and</strong> retaining<br />
our financial risk rating at an acceptable<br />
level.<br />
The annual report <strong>and</strong> accounts outline some<br />
of the successes <strong>and</strong> achievements over the<br />
last year. These achievements would not<br />
have been possible without the hard work<br />
of our staff who are the lifeblood of this<br />
organisation. The <strong>Trust</strong> also benefits from<br />
the support of our Governors who have<br />
an increasingly important role at the <strong>Trust</strong>,<br />
<strong>and</strong> our volunteers <strong>and</strong> charity workers<br />
who play an important role in fundraising<br />
<strong>and</strong> supporting patients <strong>and</strong> staff on the<br />
<strong>Hillingdon</strong> <strong>and</strong> Mount Vernon <strong>Hospital</strong> sites.<br />
It is thanks to the dedication of all of these<br />
people that the lives of many thous<strong>and</strong>s of<br />
patients are saved <strong>and</strong> services maintained<br />
<strong>and</strong> improved each year.<br />
The commitment, skill, care, <strong>and</strong> hard work<br />
exhibited by all our staff is all the more<br />
impressive given the massive challenges<br />
currently facing the <strong>NHS</strong>.<br />
The <strong>NHS</strong> has just completed one of the<br />
biggest reorganisations in recent years.<br />
Under the strategic umbrella of a new<br />
national organisation, <strong>NHS</strong> Engl<strong>and</strong>, from<br />
1st April 20<strong>13</strong> the day-to-day responsibility<br />
for the bulk of healthcare commissioning<br />
has been delegated to local Clinical<br />
Commissioning Groups (CCGs) comprising of<br />
local GPs. <strong>Hillingdon</strong> CCG wishes to reduce<br />
the money that they spend at the hospital,<br />
in addition to the nationally set reductions<br />
in the ‘tariff’ that determines the income the<br />
<strong>Trust</strong> receives for each instance of patient<br />
treatment. This means that we must continue<br />
to balance tight control over finance with<br />
rising dem<strong>and</strong> <strong>and</strong> increasing political <strong>and</strong><br />
patient expectations on quality.<br />
To help balance these issues, the <strong>Trust</strong> is<br />
working in partnership with GPs to redesign<br />
clinical pathways, help to integrate care<br />
across community <strong>and</strong> hospital boundaries,<br />
<strong>and</strong> work more in the community to improve<br />
patient care <strong>and</strong> to make best use of scarce<br />
resources.<br />
Further significant changes affecting the<br />
<strong>Trust</strong>’s future development are outlined<br />
in the North West London clinical strategy<br />
‘Shaping a Healthier Future’. The proposals,<br />
approved in February 20<strong>13</strong>, set out the<br />
direction for the reshaping of health services<br />
in North West London to improve quality,<br />
cope with rising dem<strong>and</strong>, <strong>and</strong> ensure health<br />
services are affordable. They aim to reshape<br />
health services by increasing investment in<br />
community services <strong>and</strong> diverting activity<br />
out of the hospital environment. If successful<br />
the plan will reduce the number of major<br />
hospitals in this part of London. It is to the<br />
credit of our staff that <strong>Hillingdon</strong> <strong>Hospital</strong><br />
has been identified as a major acute hospital<br />
<strong>and</strong> a fixed point in the overall plans <strong>and</strong><br />
we anticipate the greater use of <strong>Hillingdon</strong><br />
<strong>Hospital</strong> by Ealing GPs <strong>and</strong> residents.<br />
Against this massive programme of change<br />
we will continue to focus on our prime<br />
purpose of delivering high quality patient<br />
care <strong>and</strong> improving the patient experience.<br />
We have recieved over £12m Public Dividend<br />
Captial from the Department of Health<br />
to invest in our emergency care services<br />
<strong>and</strong> over £0.7m to refurbish the birthing<br />
environment in our maternity unit. Much of<br />
this work will be undertaken during 20<strong>13</strong>/14<br />
2<br />
Introduction
<strong>and</strong> represents significant investment in our<br />
services.<br />
The national concerns over poor patient<br />
care, exemplified in the Public Inquiry on<br />
Mid Staffordshire <strong>NHS</strong> <strong>Trust</strong> are a salutary<br />
reminder to all hospitals that clinical quality,<br />
patient safety <strong>and</strong> patient experience are<br />
of paramount importance <strong>and</strong> must never<br />
be placed secondary to achieving financial<br />
balance. The <strong>Trust</strong>’s CARES values launched in<br />
May <strong>2012</strong>, were designed by staff <strong>and</strong> go to<br />
the heart of everything we do.<br />
By embedding CARES throughout the<br />
organisation we will ensure that the needs<br />
of our patients always come first <strong>and</strong> that<br />
staff can work in a culture that encourages<br />
openness <strong>and</strong> transparency. The Board<br />
<strong>and</strong> Governors are clear that we as an<br />
organisation will continue to put patient care<br />
at the very top of our agenda. We are clear<br />
that the <strong>Trust</strong> must not compromise clinical<br />
quality <strong>and</strong> safety despite the financial<br />
pressures facing the <strong>NHS</strong> nationally <strong>and</strong><br />
locally.<br />
Introduction<br />
3
DIRECTORS’ REPORT<br />
About us<br />
• 24,633 admissions were made for planned<br />
the <strong>Trust</strong> (25,267 in 2011/12) 3 operations <strong>and</strong> day surgery (23,385 in<br />
The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation<br />
2011/12).<br />
<strong>Trust</strong> was established on 1st April 2011 when<br />
Monitor authorised The <strong>Hillingdon</strong> <strong>Hospital</strong><br />
<strong>NHS</strong> <strong>Trust</strong> to be an <strong>NHS</strong> Foundation <strong>Trust</strong>.<br />
The <strong>Trust</strong> provides health services at two<br />
hospitals in North West London: <strong>Hillingdon</strong><br />
<strong>and</strong> Mount Vernon. <strong>Hillingdon</strong> <strong>Hospital</strong> is the<br />
only general hospital in the London Borough<br />
of <strong>Hillingdon</strong> <strong>and</strong> offers a wide range of<br />
services including accident <strong>and</strong> emergency,<br />
inpatient care, day surgery, outpatient clinics<br />
<strong>and</strong> maternity services. The <strong>Trust</strong>’s services<br />
at Mount Vernon <strong>Hospital</strong> include routine<br />
In recent years our vision has been ‘to be<br />
the best general hospital in the country’.<br />
Given the significant amount of changes<br />
underway in the environment in which we<br />
operate, the Board agreed that there was a<br />
need to update the <strong>Trust</strong>’s vision. Following<br />
consultation with staff, in May 20<strong>13</strong> the<br />
Board agreed a new vision for the <strong>Trust</strong> that<br />
will inform the 20<strong>13</strong>/14 business planning: ‘To<br />
put compassionate care, safety <strong>and</strong> quality at<br />
the heart of everything we do’.<br />
day surgery at a modern treatment centre,<br />
a minor injuries unit, <strong>and</strong> outpatient clinics.<br />
The <strong>Trust</strong> also acts as a l<strong>and</strong>lord to a number<br />
of other organisations that<br />
provide health services at Mount Vernon,<br />
including East & North Hertfordshire <strong>NHS</strong><br />
<strong>Trust</strong>’s Cancer Centre.<br />
The <strong>Trust</strong>’s turnover in <strong>2012</strong>/<strong>13</strong> was over<br />
£190m <strong>and</strong> we employ over 2,500 staff.<br />
The majority of our patients live in the<br />
London Borough of <strong>Hillingdon</strong> but we<br />
also provide healthcare to people living in<br />
the surrounding areas of Ealing, Harrow,<br />
Buckinghamshire <strong>and</strong> Hertfordshire, giving<br />
us a total catchment population of over<br />
350,000 people.<br />
In <strong>2012</strong>/<strong>13</strong>:<br />
• 110,354 attendances were made to our<br />
accident & emergency department <strong>and</strong><br />
minor injuries unit (108,719 in 2011/12)<br />
• 4,205 babies were born in our maternity<br />
unit (4,218 in 2011/12)<br />
• 289,041 attendances were made as<br />
outpatients (296,606 in 2011/12)<br />
• 24,271 admissions were made for<br />
emergency treatment across all parts of<br />
3 This figure reflects all emergency admissions to the <strong>Trust</strong>; emergency admissions to inpatient wards increased (see page 7<br />
for further information)<br />
4 Directors’ report
Our performance against key targets<br />
The following table summarises the <strong>Trust</strong>’s performance in <strong>2012</strong>/<strong>13</strong> against the targets used<br />
by Monitor to calculate the governance risk rating 4 :<br />
Indicator Target Performance Achieved<br />
Clostridium difficile 24 (maximum) 23 <br />
MRSA 3 (maximum) 1 <br />
All cancers: 31 days for second or subsequent<br />
94% 100% <br />
treatment (surgery)<br />
All cancers: 31 days for second or subsequent<br />
98% 100% <br />
treatment (anti-cancer drug treatments)<br />
All cancers: 62 days for first treatment from<br />
85% 93.3% <br />
urgent GP referral for suspected cancer<br />
All cancers: 62 days for first treatment from <strong>NHS</strong> 90% 93.9% <br />
Cancer Screening Service referral<br />
Maximum time of 18 weeks from point of referral 90% 97.5% <br />
to treatment – admitted<br />
Maximum time of 18 weeks from point of referral 95% 98.8% <br />
to treatment – non admitted<br />
Maximum time of 18 weeks from point of<br />
92% 97.3% <br />
referral to treatment – patients on an incomplete<br />
pathway<br />
All cancers: 31 days diagnosis to first treatment 96% 99.2% <br />
Cancer: two week wait from referral to date first 93% 97.9% <br />
seen for all urgent referrals (cancer suspected)<br />
Cancer: two week wait from referral to date first 93% 98.0% <br />
seen for symptomatic breast patients (cancer not<br />
initially suspected)<br />
A&E: Total time in A&E less than 4 hours (Accident 95% 96.7% <br />
& Emergency, Minor Injuries Unit, Urgent Care<br />
Centre)<br />
Self-certification against compliance with<br />
Fully Compliant Fully Compliant <br />
requirements regards access to healthcare for<br />
people with a learning disability<br />
Moderate Care Quality Commission (CQC)<br />
No declared risk No declared risk <br />
concerns regarding the safety of healthcare<br />
provision<br />
Major CQC concerns regarding the safety of No declared risk No declared risk <br />
healthcare provision<br />
Failure to rectify a compliance or restrictive No declared risk No declared risk <br />
condition(s) by the date set by CQC within the<br />
condition(s) (or as subsequently amended with<br />
the CQC’s agreement)<br />
Published <strong>NHS</strong>LA & CNST Maternity level Level 1 or higher 1 <br />
4<br />
Definitions for the indicators are included in Monitor’s ‘Compliance Framework’ (available on<br />
www.monitor-<strong>NHS</strong>ft.gov.uk)<br />
Directors’ report<br />
5
Infection control<br />
The <strong>Trust</strong> continued to drive forward the<br />
infection prevention <strong>and</strong> control agenda<br />
<strong>and</strong> met the performance targets for both<br />
MRSA <strong>and</strong> Clostridium difficile (C-diff) in<br />
<strong>2012</strong>/<strong>13</strong>. One MRSA bloodstream infection<br />
was reported against a threshold of three,<br />
which is a significant improvement from<br />
the previous year’s performance when we<br />
finished with four reported cases of MRSA.<br />
The <strong>Trust</strong> reported 23 cases against a<br />
threshold of 24 for C-diff infections. Whilst<br />
this meant we met the target, the <strong>Trust</strong> saw<br />
an increase in reported cases from quarter<br />
three resulting in the <strong>Trust</strong> remaining close<br />
to the target.<br />
All C-diff patients had detailed multidisciplinary<br />
root cause analysis (RCA)<br />
undertaken involving the Microbiologists,<br />
the patient’s clinical team (Consultant <strong>and</strong><br />
nursing staff), the infection control team <strong>and</strong><br />
other members of the multi-disciplinary team<br />
(MDT) as required. Key learning from RCAs<br />
undertaken for <strong>2012</strong>/<strong>13</strong> cases included:<br />
• Antimicrobial prescribing: clinical<br />
indication must be documented <strong>and</strong><br />
the antimicrobials reviewed at every<br />
ward round.<br />
• Documentation (both nursing &<br />
medical) needs to be thorough <strong>and</strong><br />
contemporaneous.<br />
• There is a need for improved<br />
communication between teams,<br />
especially when the patient is an<br />
outlier with regard to specialty.<br />
• Specimen results are checked as soon<br />
as possible by ward staff after sending<br />
to the laboratory.<br />
• There should be senior clinical<br />
decision-making in sending samples.<br />
• Patients with diarrhoea on admission<br />
require specimens <strong>and</strong> isolation at the<br />
earliest opportunity.<br />
These themes were shared widely across the<br />
organisation to ensure that the key learning<br />
was shared <strong>and</strong> used to shape future<br />
practice.<br />
The <strong>Trust</strong> faces an increased challenge for<br />
the new financial year with a target of zero<br />
for MRSA <strong>and</strong> 14 for C-diff. We do however<br />
believe that the learning from the root cause<br />
analysis <strong>and</strong> the continued work around<br />
education <strong>and</strong> close monitoring will enable<br />
the <strong>Trust</strong> to meet these more stringent<br />
targets.<br />
Cancer<br />
A comprehensive action plan was<br />
implemented in 2011/12 to strengthen<br />
management arrangements within the<br />
cancer services. As a result of which, the <strong>Trust</strong><br />
delivered strong performance on all cancer<br />
targets in <strong>2012</strong>/<strong>13</strong>.<br />
Referral to Treatment waiting times<br />
All 18 week targets for both admitted <strong>and</strong><br />
non-admitted patients were achieved <strong>and</strong><br />
exceeded. The strong performance across<br />
elective (planned treatment) waiting time<br />
st<strong>and</strong>ards continues to ensure that the <strong>Trust</strong><br />
remains one of the top performing hospitals<br />
in North West London on these targets which<br />
seek to minimise patients’ waiting time for<br />
treatment.<br />
Accident <strong>and</strong> Emergency (A&E)<br />
waiting times<br />
The <strong>Trust</strong> achieved the target for 95% (all<br />
types) of patients to have a total time in<br />
A&E of less than four hours, with a mean<br />
performance throughout the year of 96.6%.<br />
A majority of <strong>Trust</strong>s in London have been<br />
challenged in delivering the A&E st<strong>and</strong>ard<br />
throughout the last quarter of the year.<br />
Unprecedented numbers of ambulance<br />
arrivals <strong>and</strong> increased acuity of patients<br />
made delivery of the target particularly<br />
challenging. Ambulance arrivals increased<br />
6 Directors’ report
400<br />
TRUST TOTAL - ADMISSIONS<br />
Non-Elective Admissions<br />
Excluding: Observation, Specialist, Maternity, Paediatrics & Daniels Wards<br />
Avg 10/11: 256<br />
Avg 11/12: 273<br />
Avg 12/<strong>13</strong>: 287<br />
2010/2011<br />
2011/<strong>2012</strong><br />
<strong>2012</strong>/20<strong>13</strong><br />
350<br />
300<br />
250<br />
Count of Admissions<br />
200<br />
150<br />
100<br />
50<br />
0<br />
1 2 3 4 5 6 7 8 9 10 11 12 <strong>13</strong> 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52<br />
APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR<br />
Week Number<br />
by 3.9% between January <strong>and</strong> March 20<strong>13</strong>,<br />
which resulted in more acutely unwell<br />
patients attending the hospital <strong>and</strong> receiving<br />
care in the resuscitation unit. Patients<br />
admitted to the resuscitation unit are acutely<br />
unwell <strong>and</strong> require a medical team to meet<br />
their clinical needs. This can deplete staff<br />
in the ‘minors’ area, <strong>and</strong> as a consequence,<br />
performance was affected. The <strong>Trust</strong> did<br />
however still manage to deliver the 95%<br />
st<strong>and</strong>ard during January to March which was<br />
our busiest time.<br />
The chart above tracks the increased level of<br />
emergency admissions to our adult inpatient<br />
wards.<br />
Additional funds were made available<br />
by the Department of Health to support<br />
<strong>Trust</strong>s over the winter period. Furthermore,<br />
the <strong>Trust</strong> invested significant funds to<br />
ensure patients continued to be seen <strong>and</strong><br />
treated in a timely manner <strong>and</strong> to restore<br />
performance by increasing the number of<br />
medical, nursing <strong>and</strong> clinical support staff in<br />
the A&E department. An additional Senior<br />
Sister was allocated to every shift to organise<br />
<strong>and</strong> co-ordinate patient flows through the<br />
department.<br />
Extra medical staff were also allocated to<br />
the Emergency Admission Unit (EAU), which<br />
significantly improved flows through the<br />
A&E department by ensuring there were<br />
sufficient beds available in the <strong>Trust</strong> to meet<br />
surges in activity.<br />
The chart on the next page demonstrates<br />
a substantial increase in the number of<br />
patients that were discharged from the EAU<br />
rather than admitted to one of our inpatient<br />
wards.<br />
Access to healthcare for people with<br />
learning disabilities<br />
The <strong>Trust</strong> continues to fully comply with the<br />
requirements regarding access to healthcare<br />
for people with a learning disability.<br />
CQUIN delivery<br />
Commissioning for Quality <strong>and</strong> Innovation<br />
(CQUIN) is a national framework for locally<br />
agreed quality improvement schemes. It links<br />
a proportion of healthcare income to the<br />
achievement of local quality improvement<br />
goals. The financial value of the available<br />
CQUINs for <strong>2012</strong>/<strong>13</strong> was 2.5% of the <strong>Trust</strong>’s<br />
clinical activity income.<br />
CQUINs are divided between those that<br />
are set nationally for all hospitals, those<br />
which are set regionally, <strong>and</strong> those are<br />
agreed locally between the <strong>Trust</strong> <strong>and</strong><br />
Directors’ report<br />
7
120<br />
Emergency Assessment Unit (EAU)<br />
SHORT STAY ADMISSIONS<br />
The number of admissions to EAU, who are also discharged from EAU<br />
2010/2011<br />
2011/<strong>2012</strong><br />
<strong>2012</strong>/20<strong>13</strong><br />
100<br />
80<br />
No of Admissions<br />
60<br />
40<br />
20<br />
0<br />
1 2 3 4 5 6 7 8 9 10 11 12 <strong>13</strong> 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52<br />
APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR<br />
Week No<br />
commissioner. The table below outlines the<br />
overall achievement of the CQUINs across the<br />
year. The variation across the year reflects<br />
that the regional <strong>and</strong> local CQUINs become<br />
progressively more challenging as the year<br />
progresses.<br />
Q1: Achieved<br />
100%<br />
The anticipated final outcome is 76%<br />
achievement.<br />
Further detail on the individual CQUINs is<br />
outlined below:<br />
National<br />
Q2: Achieved<br />
100%<br />
Q3: Achieved<br />
93%<br />
Q4: 52%<br />
(anticipated)<br />
• VTE<br />
The <strong>Trust</strong> exceeded the 90% st<strong>and</strong>ard<br />
on assessment for risk of venous<br />
thromboembolism (VTE) every month in<br />
<strong>2012</strong>/<strong>13</strong>.<br />
• Patient experience<br />
The <strong>Trust</strong> achieved 20% of the patient<br />
experience CQUIN which focuses on<br />
improving response rates in the national<br />
patient experience survey. The <strong>Trust</strong><br />
improved on all of the survey questions<br />
measured for this CQUIN with the<br />
exception of ‘did a member of staff<br />
explain the potential side effects of<br />
your medication’. A review on how staff<br />
explain side effects to patients is being<br />
undertaken <strong>and</strong> further training will be<br />
provided if necessary.<br />
• <strong>NHS</strong> Safety Thermometer<br />
The <strong>Trust</strong> achieved 100% of the <strong>NHS</strong><br />
Safety Thermometer CQUIN which focused<br />
this year on collection <strong>and</strong> return of data.<br />
The intention of this CQUIN for <strong>2012</strong>/<strong>13</strong><br />
was to create systems to monitor staff<br />
training <strong>and</strong> to collect data to establish<br />
baselines to set trajectories for 20<strong>13</strong>/14. In<br />
20<strong>13</strong>/14 the CQUIN will focus on pressure<br />
ulcers <strong>and</strong> will measure performance of all<br />
health <strong>and</strong> social care providers.<br />
• Dementia screening<br />
The <strong>Trust</strong> made considerable progress<br />
in implementing systems to ensure that<br />
patients received the necessary dementia<br />
screening assessment. However, due to<br />
the difficulties with the IT system it was<br />
not possible to provide the necessary data.<br />
As a consequence, the <strong>Trust</strong> did not meet<br />
the required st<strong>and</strong>ards for this CQUIN.<br />
Regional<br />
• North West Formulary<br />
The <strong>Trust</strong> achieved 100% of the North<br />
West London Formulary CQUIN, which<br />
focuses on implementing a st<strong>and</strong>ard<br />
formulary for the prescribing of drugs.<br />
The purpose of the formulary is to<br />
8 Directors’ report
educe the risk of drug errors by ensuring<br />
clinicians <strong>and</strong> pharmacists are familiar<br />
with the medicines they prescribe <strong>and</strong><br />
dispense.<br />
• Real time<br />
The <strong>Trust</strong> anticipates that it will achieve<br />
81% of the ‘Real Time’ CQUIN. The<br />
purpose of this CQUIN was to promote<br />
the use of an electronic process to speed<br />
up communication between primary <strong>and</strong><br />
secondary care, including the sending<br />
of outpatient letters <strong>and</strong> discharge<br />
summaries following a hospital visit or<br />
admission.<br />
Local<br />
• Consultant assessment<br />
Considerable investments were made to<br />
achieve 50% of the 12 hour Consultant<br />
assessment CQUIN. There was a significant<br />
investment in paediatrics where two<br />
additional Consultants have been<br />
appointed. The <strong>Trust</strong> also appointed an<br />
additional Consultant to the Emergency<br />
Admissions Unit to ensure more patients<br />
received senior review within 12 hours<br />
of an emergency admission. The <strong>Trust</strong><br />
is committed to fully achieving the<br />
st<strong>and</strong>ards set out in this CQUIN which also<br />
supports the emerging Emergency Care<br />
Clinical Quality St<strong>and</strong>ards for London.<br />
• Diabetes care<br />
The <strong>Trust</strong> achieved 100% of the Diabetes<br />
Care CQUIN by significantly increasing<br />
specialist care given to patients with<br />
diabetes.<br />
• End of life care<br />
The <strong>Trust</strong> achieved 87% of the End of Life<br />
Care CQUIN. This was an important new<br />
CQUIN developed between the <strong>Trust</strong> <strong>and</strong><br />
local commissioners. The purpose of the<br />
CQUIN was to establish a database <strong>and</strong><br />
a better underst<strong>and</strong>ing of the needs of<br />
patients who require care at this time of<br />
their lives. The information gathered will<br />
help the commissioners <strong>and</strong> the <strong>Trust</strong> to<br />
better design <strong>and</strong> co-ordinate services<br />
more aligned to patients’ needs.<br />
Our finances<br />
Overview of financial performance<br />
The organisation’s second year as a st<strong>and</strong>alone<br />
Foundation <strong>Trust</strong> regulated by Monitor<br />
was, without doubt, even tougher than its<br />
first. The solid financial foundations laid<br />
down over the last ten years were therefore<br />
required more than ever as both the national<br />
economic context <strong>and</strong> more pertinently<br />
the local commissioning financial context<br />
impacted on the <strong>Trust</strong> to an even greater<br />
extent than in the past. Faced with this<br />
context, in May <strong>2012</strong> the Board reluctantly<br />
approved an annual forward financial plan<br />
of a £1.9m income <strong>and</strong> expenditure deficit<br />
for the financial year <strong>2012</strong>/<strong>13</strong>. However, the<br />
<strong>Trust</strong> had just enough financial headroom<br />
that it was able to maintain a financial risk<br />
rating of 3 in each quarter of the <strong>2012</strong>/<strong>13</strong><br />
financial year. The <strong>Trust</strong> achieved its financial<br />
plan for the year <strong>and</strong> although clearly<br />
disappointing, the deficit represented only<br />
1% of total turnover. This performance<br />
though must be viewed within the context<br />
of increased patient expectation, higher<br />
clinical st<strong>and</strong>ards <strong>and</strong> service dem<strong>and</strong>s,<br />
<strong>and</strong> the economic pressures facing the<br />
organisation. When added to the severe local<br />
commissioning financial restrictions, the fact<br />
more healthcare was delivered to a high<br />
st<strong>and</strong>ard was a notable achievement.<br />
Overall surplus for the year<br />
The £1.9m deficit included two significant<br />
non-recurrent transactions. These were<br />
charges for fixed asset impairments of<br />
£0.5m that are not included in Monitor’s<br />
financial risk rating metrics <strong>and</strong> a gain on the<br />
revaluation of its investment properties of<br />
£1.7m. 5<br />
5 Investment properties are those held by the <strong>Trust</strong> to earn rentals <strong>and</strong>/or capital appreciation rather than used to provide<br />
healthcare<br />
Directors’ report<br />
9
Clinical activity levels, which were higher<br />
than contracted by healthcare commissioners,<br />
increased overall <strong>Trust</strong> operating revenue by<br />
2.2% for the year. This drove operating costs<br />
higher for the year by 0.8%. In addition, the<br />
<strong>Trust</strong> underachieved on its efficiency savings<br />
target of £7m by £0.7m – a delivery rate of<br />
90%.<br />
The <strong>Trust</strong>’s Earnings Before Interest, Tax,<br />
Depreciation, <strong>and</strong> Amortisation (EBITDA)<br />
were boosted by bringing catering <strong>and</strong><br />
cleaning services back into direct <strong>Trust</strong><br />
management, <strong>and</strong> the award to the<br />
<strong>Trust</strong>, after a competitive exercise, of the<br />
contract to run pathology services for GPs in<br />
Hounslow.<br />
Cash flow<br />
The <strong>Trust</strong> generated £12.8m cash from<br />
operating as a healthcare provider for the<br />
year. From this £6.3m was used to purchase<br />
new assets <strong>and</strong> a further £3.3m was required<br />
to service the outst<strong>and</strong>ing debt <strong>and</strong> interest<br />
from loans <strong>and</strong> leases. A net £1.2m of<br />
Public Dividend Capital was repaid to the<br />
Department of Health. This resulted in the<br />
<strong>Trust</strong> increasing its cash levels at the yearend<br />
by £2m when the plan at the start of<br />
the year had been to reduce them by £1.5m.<br />
This meant that against the plan of £0.4m it<br />
ended the year with £3.9m cash.<br />
This increase in cash will serve two important<br />
objectives. First, it will allow £1.8m to be<br />
used to finance committed capital schemes<br />
that did not complete as planned by the end<br />
of the current financial year <strong>and</strong> second, it<br />
will provide some additional cash headroom<br />
for the <strong>Trust</strong> going forward.<br />
Capital investment<br />
The <strong>Trust</strong>’s own cash resources to invest<br />
were supplemented by £12.4m of new Public<br />
Dividend Capital received from DH in respect<br />
of a successful business case to upgrade <strong>and</strong><br />
better integrate emergency care facilities on<br />
the <strong>Hillingdon</strong> <strong>Hospital</strong> site. This project will<br />
continue throughout the 20<strong>13</strong>/14 financial<br />
year <strong>and</strong> will form a major element of the<br />
estate investment programme in 20<strong>13</strong>/14 (see<br />
the later section on capital developments).<br />
Apart from major development projects, the<br />
largest area of investment during the year<br />
was again the estate. This centred on the<br />
<strong>Trust</strong>’s plan to prioritise investment to keep<br />
operational buildings safe, fit for purpose,<br />
<strong>and</strong> compliant with statutory legislation.<br />
Given the nature of the <strong>Trust</strong>’s estate this<br />
will inevitably be a long-term process, <strong>and</strong><br />
there is a programme in place to continue<br />
with this investment for the foreseeable<br />
future focused on the highest risk areas.<br />
Other significant projects included the<br />
refurbishment of one of the <strong>Trust</strong>’s busiest<br />
emergency wards <strong>and</strong> the start of a public<br />
toilets upgrade programme.<br />
In addition to investing in the physical<br />
infrastructure of the organisation, the <strong>Trust</strong><br />
also continued to invest in updating its<br />
medical equipment across a range of clinical<br />
services.<br />
Investment in information technology<br />
infrastructure <strong>and</strong> capability also remained a<br />
priority with system upgrades in Maternity,<br />
Pharmacy <strong>and</strong> Pathology. Another important<br />
project saw the <strong>Trust</strong> implement new<br />
hardware <strong>and</strong> software with enhanced<br />
capabilities to better integrate patient<br />
information between hospital systems. Other<br />
investment focused on improving network<br />
infrastructure.<br />
Looking to the future<br />
The <strong>Trust</strong>’s 20<strong>13</strong>/14 Forward Plan will again<br />
be set in the context of a UK economy that<br />
looks like it will remain suppressed for the<br />
foreseeable future. This is having a direct <strong>and</strong><br />
ever increasingly tough financial impact on<br />
all UK public services.<br />
The <strong>NHS</strong> in Engl<strong>and</strong> is no different <strong>and</strong><br />
reductions in the prices providers can charge<br />
commissioners for services under the national<br />
10 Directors’ report
tariff look set to remain. After two years<br />
of general restraint, pay levels for all staff<br />
look set to increase by 1% in the coming<br />
financial year adding further pressure to<br />
<strong>Trust</strong> finances.<br />
The national tariff (which determines how<br />
much <strong>Trust</strong>s receive for providing specific<br />
treatments) seems likely to continue to set<br />
providers the challenge of achieving at least<br />
a 4% efficiency saving in effect to ‘st<strong>and</strong>still’.<br />
Other pressures on acute providers brought<br />
about by restrictions on payment of<br />
emergency admissions <strong>and</strong> readmissions<br />
together with tough penalties for failing to<br />
meet national st<strong>and</strong>ards is expected to add<br />
at least a further 1% to the total efficiency<br />
savings required to be achieved in 20<strong>13</strong>/14.<br />
With the formal abolition of Primary Care<br />
<strong>Trust</strong>s, Clinical Commissioning Groups (CCG)<br />
are taking on the roles <strong>and</strong> responsibilities<br />
<strong>and</strong> forming new organisations with GPs<br />
taking a front seat. Locally, <strong>Hillingdon</strong><br />
Clinical Commissioning Group (HCCG) was<br />
authorised <strong>and</strong> will operate within a cluster<br />
of four adjoining outer North West London<br />
CCGs in Brent, Harrow <strong>and</strong> Ealing.<br />
As <strong>Hillingdon</strong> Primary Care <strong>Trust</strong> ended the<br />
<strong>2012</strong>/<strong>13</strong> financial year requiring significant<br />
external financial support to break-even,<br />
<strong>Hillingdon</strong> CCG is implementing an ambitious<br />
three-year financial recovery plan. This is<br />
aligned to their out of hospital strategy <strong>and</strong><br />
will reduce the amount of work this <strong>Trust</strong><br />
will undertake for them as more healthcare<br />
provision is moved to alternative local<br />
settings.<br />
The impact of this could be as high as 10%<br />
in 20<strong>13</strong>/14, <strong>and</strong> over the three year recovery<br />
plan period could see the <strong>Trust</strong>’s clinical<br />
revenue reduced by up to £30m. This is in<br />
addition to the efficiency savings already<br />
required by the national tariff <strong>and</strong> will<br />
undoubtedly put margins under the severest<br />
strain. Conversely, should the commissioners’<br />
out of hospital strategy not be as successful<br />
at reducing activity as planned, then<br />
potentially the <strong>Trust</strong> will have to treat<br />
patients <strong>and</strong> not be fully paid. As highlighted<br />
elsewhere in the report, this is one of the<br />
key risks facing the <strong>Trust</strong>. To help mitigate<br />
this risk, the <strong>Trust</strong> <strong>and</strong> CCG are working<br />
with PricewaterhouseCoopers to review the<br />
sustainability of the local health economy.<br />
As outlined earlier in the report, the level<br />
of payment linked to delivering specific<br />
demonstrable quality improvement (CQUINs)<br />
will remain at 2.5% of the <strong>Trust</strong> healthcare<br />
contract revenue for the coming year. This<br />
amounts to around £4.3m of income that will<br />
be at risk especially as it is likely to require<br />
the <strong>Trust</strong> to make significant targeted<br />
investment to meet the improvement in<br />
st<strong>and</strong>ards required. To ensure the <strong>Trust</strong><br />
achieves the most it can from the payments,<br />
CQUINs will remain a key focus for clinicians<br />
<strong>and</strong> managers.<br />
These increased financial risks <strong>and</strong> efficiency<br />
saving requirements together with a very<br />
financially challenged local commissioner<br />
will continue to mean improvements in<br />
productivity <strong>and</strong> efficiency will remain<br />
a significant point of focus for the<br />
management team. Clearly, this will have<br />
to be achieved whilst national <strong>and</strong> local<br />
quality st<strong>and</strong>ards are at the very least<br />
maintained <strong>and</strong> increasingly will require the<br />
complete transformation of <strong>Trust</strong> services.<br />
The continued rigorous assessment of the<br />
clinical impact of all significant <strong>Trust</strong> plans<br />
will therefore remain a crucial focus for<br />
management.<br />
The <strong>Trust</strong> is embarking on a comprehensive<br />
transformation programme that will alter<br />
the way we provide almost all services within<br />
the hospital. The focus is on improving the<br />
quality of the services we provide, which will<br />
in turn improve both the patient experience<br />
<strong>and</strong> delivery of the required efficiencies.<br />
Some of the proposed changes will affect<br />
inpatient pathways. Quality initiatives, such<br />
as earlier Consultant review <strong>and</strong> better<br />
discharge planning, will improve the patient<br />
experience <strong>and</strong> reduce the length of time<br />
Directors’ report<br />
11
patients spend in hospital, which will in<br />
turn mean the <strong>Trust</strong> will need less beds.<br />
Critical to this will be the way we work with<br />
our local health, social <strong>and</strong> voluntary care<br />
partners to deliver an integrated system of<br />
care. Improvements to the way we schedule<br />
our theatres will reduce the number of<br />
operations cancelled <strong>and</strong> consequently make<br />
significant savings. The scale of savings <strong>and</strong><br />
transformation required means that the<br />
coming year will be extremely challenging,<br />
but one where we are fully committed to<br />
improving both the quality <strong>and</strong> experience of<br />
the services we provide.<br />
In this challenging external context the<br />
Board of Directors will remain focused<br />
on the considerable challenge of how<br />
the organisation can continue to meet its<br />
continuity of services licence condition, which<br />
requires the <strong>Trust</strong> to ensure it remains a<br />
going concern. In particular, work will focus<br />
on finding alignment between the <strong>Trust</strong>’s<br />
activity plans <strong>and</strong> <strong>Hillingdon</strong> CCG’s QIPP <strong>and</strong><br />
identifying opportunities for the <strong>Trust</strong> to<br />
re-provide services planned to be moved to<br />
an out of hospital setting. The Board will<br />
also further strengthen the <strong>Trust</strong>’s project<br />
management of efficiency savings <strong>and</strong> review<br />
options to reinforce its cash headroom.<br />
Work will also concentrate on how best<br />
to secure sufficient capital investment so<br />
<strong>Trust</strong> facilities remain fit-for-purpose <strong>and</strong><br />
the organisation can gain from the clinical<br />
<strong>and</strong> operational efficiencies technology can<br />
deliver within both medical equipment <strong>and</strong><br />
information technology.<br />
Non-<strong>NHS</strong> income<br />
Section 43(2A) of the <strong>NHS</strong> Act 2006 (as<br />
amended by the Health <strong>and</strong> Social Care Act<br />
<strong>2012</strong>) requires that the <strong>Trust</strong>’s income from<br />
the provision of goods <strong>and</strong> services for the<br />
purposes of the health service in Engl<strong>and</strong><br />
must be greater than its income from the<br />
provision of goods <strong>and</strong> services for any<br />
other purposes. In <strong>2012</strong>/<strong>13</strong>, the <strong>Trust</strong> met<br />
this requirement, with 97% (£188.7m) of the<br />
<strong>Trust</strong>’s income generated by activities for the<br />
purpose of the health service in Engl<strong>and</strong>.<br />
As the vast majority of <strong>Trust</strong> income is<br />
categorised as generated by activities for the<br />
purpose of the health service in Engl<strong>and</strong>, it is<br />
the Board’s view that other income does not<br />
detract from <strong>NHS</strong> provision to any material<br />
extent. Where other income is generated it<br />
supports the <strong>Trust</strong> to make optimum use of<br />
all its assets <strong>and</strong> is used to directly support<br />
principal patient care activities.<br />
Comparative financial performance<br />
The table below outlines how the <strong>Trust</strong><br />
compared to the Foundation <strong>Trust</strong> sector<br />
on a range of key financial performance<br />
indicators. 6<br />
The <strong>Hillingdon</strong><br />
<strong>Hospital</strong>s <strong>NHS</strong> FT<br />
All Foundation <strong>Trust</strong>s<br />
Average<br />
Financial risk rating 7 – Acute <strong>Trust</strong>s 2.8 3.0<br />
Financial risk rating – Small acute <strong>Trust</strong>s<br />
2.8 2.8<br />
(total turnover less than £200m)<br />
EBITDA 8 margin 5.7% 6.0%<br />
Cost improvement plans delivery 92.2% 83.8%<br />
Capital spend to turnover 3% 4%<br />
Cash balances £3.2m £27.0m<br />
6 The above comparative performance table is based on the Regulator, Monitor’s most recent available review of the<br />
Foundation <strong>Trust</strong> sector, of which 81 were acute, as at quarter 3 <strong>2012</strong>/<strong>13</strong>. To enable a direct comparison, the THH figures<br />
reflect performance as at end of quarter 3 <strong>2012</strong>/<strong>13</strong>.<br />
7 See ‘Regulatory ratings’ for further information on the financial risk rating<br />
8 Earnings Before Interest, Taxes, Depreciation, <strong>and</strong> Amortisation<br />
12 Directors’ report
Regulatory ratings<br />
Monitor, the independent Regulator of<br />
Foundation <strong>Trust</strong>s, assigns Foundation <strong>Trust</strong>s<br />
two risk ratings each quarter:<br />
• A financial risk rating (rated 1-5, where<br />
1 represents the highest risk <strong>and</strong> 5 the<br />
lowest); <strong>and</strong><br />
• A governance risk rating (rated red<br />
(highest risk), amber-red, ambergreen<br />
or green (lowest risk)).<br />
The financial risk rating is based on a range<br />
of metrics across four areas: achievement<br />
of plan, underlying performance, financial<br />
efficiency, <strong>and</strong> liquidity. The governance<br />
risk rating is based on a combination of:<br />
service performance (measured on the<br />
<strong>Trust</strong>’s performance against key performance<br />
indicators selected by Monitor from<br />
the Department of Health’s Operating<br />
Framework); the views of third parties such<br />
as the Care Quality Commission <strong>and</strong> <strong>NHS</strong><br />
Litigation Authority; the provision of the<br />
m<strong>and</strong>atory services that Foundation <strong>Trust</strong>s<br />
must provide; <strong>and</strong> other instances where the<br />
Board may fail to accurately certify on their<br />
performance or governance. In addition,<br />
Monitor retains the discretion to amend the<br />
governance risk rating should a Foundation<br />
<strong>Trust</strong> fail to meet the statutory requirements<br />
of other bodies.<br />
The <strong>Trust</strong>’s risk ratings for 2011/12 <strong>and</strong><br />
<strong>2012</strong>/<strong>13</strong> are presented below.<br />
The <strong>Trust</strong> had planned for a risk rating of<br />
four for the 2011/12 financial year. However,<br />
the rating of three for each quarter of the<br />
year was due to two of the four financial<br />
criteria being one rating below the planned<br />
level. These were in respect of achievement<br />
of plan <strong>and</strong> financial efficiency. The<br />
reason the actual rating in these cases was<br />
below plan was the <strong>Trust</strong> only made a surplus<br />
before impairments of £262k when the<br />
plan was for a surplus of £2.542m. This was<br />
primarily due to three factors: (a) a shortfall<br />
on the <strong>Trust</strong>’s planned efficiency savings; (b)<br />
the <strong>Trust</strong> undertook an amount of activity<br />
that under the terms of its contracts with<br />
commissioners it was not going to be paid<br />
for either in part or full 10 ; <strong>and</strong> (c) price<br />
inflation on goods <strong>and</strong> services required by<br />
the <strong>Trust</strong> had a greater impact on operating<br />
costs than originally planned. Monitor<br />
therefore requested that the <strong>Trust</strong> reforecast<br />
its financial position <strong>and</strong> capital programme.<br />
<strong>Annual</strong> Plan<br />
2011/12<br />
Q1 2011/12 Q2 2011/12 Q3 2011/12 Q4 2011/12<br />
Financial risk rating 4 3 3 3 3<br />
Governance risk rating Green Amber-red Amber-green Green Green<br />
<strong>Annual</strong> Plan<br />
<strong>2012</strong>/<strong>13</strong><br />
Q1 <strong>2012</strong>/<strong>13</strong> Q2 <strong>2012</strong>/<strong>13</strong> Q3 <strong>2012</strong>/<strong>13</strong> Q4 <strong>2012</strong>/<strong>13</strong> 9<br />
Financial risk rating 3 3 3 3 3<br />
Governance risk rating Green Green Green Green Green<br />
9 The Q4 risk ratings are based on the <strong>Trust</strong>’s submission to Monitor at the end of April 20<strong>13</strong>: the <strong>Trust</strong> does not have<br />
Monitor’s confirmed Q4 ratings at the time of finalisation of the report (May 20<strong>13</strong>).<br />
10 These included in areas such as emergency activity, readmitted patients, follow-up outpatient appointments, <strong>and</strong><br />
Consultant to Consultant referrals.<br />
Directors’ report<br />
<strong>13</strong>
At the start of the 2011/12 year, the <strong>Trust</strong><br />
had a governance risk rating of green based<br />
on its risk assessment when submitting the<br />
annual plan to Monitor. The amber-red<br />
rating in Q1 was due to the <strong>Trust</strong> failing<br />
to meet the 62 day cancer target 11 for the<br />
quarter <strong>and</strong> that the <strong>Trust</strong> declared a risk of<br />
failing the annual C-diff target. The <strong>Trust</strong>’s<br />
risk rating improved to amber-green in Q2:<br />
whilst the C-diff performance improved, the<br />
<strong>Trust</strong> again failed to meet the 62 day cancer<br />
target for the quarter. The <strong>Trust</strong>’s rating for<br />
Q3 improved to green as the <strong>Trust</strong> met all<br />
healthcare targets for the quarter, as it did in<br />
Q4.<br />
The <strong>Trust</strong> planned for a risk rating of 3 for<br />
the <strong>2012</strong>/<strong>13</strong> year, which included a planned<br />
financial deficit. The <strong>Trust</strong> maintained this<br />
risk rating throughout the year, but was<br />
requested by Monitor to reforecast the<br />
capital expenditure given the variance to<br />
plan. Based on the performance that was<br />
being sustained from the second half of<br />
2011/12, the <strong>Trust</strong> declared a risk rating of<br />
green for governance for the <strong>2012</strong>/<strong>13</strong> year.<br />
This was maintained for each quarter of the<br />
year, with the <strong>Trust</strong> meeting the required<br />
targets (as outlined in the table at the start<br />
of the report).<br />
Following the submission of the <strong>Trust</strong>’s<br />
<strong>2012</strong>/<strong>13</strong> annual plan, Monitor commissioned<br />
a ‘stage 2 review’ of the <strong>Trust</strong>’s annual<br />
plan. The review, undertaken by<br />
PricewaterhouseCoopers (PwC) sought<br />
to examine the risks around the <strong>Trust</strong>’s<br />
financial stability. The review confirmed the<br />
challenging <strong>and</strong> delicate nature of the <strong>Trust</strong>’s<br />
financial position, particularly in respect of<br />
its cash position, <strong>and</strong> recommended that<br />
the <strong>Trust</strong>’s programme management office<br />
arrangements be substantially strengthened<br />
in light of the level of savings required. The<br />
<strong>Trust</strong> developed an action plan in response<br />
to the report’s recommendations, which<br />
included a significant strengthening of<br />
the arrangements for the delivery of the<br />
efficiency savings programme, <strong>and</strong> increased<br />
Board reporting on cash flow <strong>and</strong> liquidity.<br />
In addition, the Board continues to explore<br />
longer-term options for further increasing<br />
the <strong>Trust</strong>’s liquidity <strong>and</strong> ensuring the <strong>Trust</strong>’s<br />
future sustainability.<br />
There have been no formal interventions by<br />
Monitor at the <strong>Trust</strong>.<br />
Environmental performance:<br />
Sustainability<br />
Sustainable development management<br />
plan<br />
The Sustainability Steering Group has been<br />
created for the purpose of ensuring a whole<br />
<strong>Trust</strong> approach to meeting the organisation’s<br />
sustainability obligations. Sustainability is<br />
now used in procurement specifications <strong>and</strong><br />
is accounted for as an evaluation scoring<br />
element in all new capital, estates, food,<br />
transport, energy <strong>and</strong> waste contracts.<br />
During 20<strong>13</strong> the <strong>Trust</strong> plans to trial a<br />
‘sustainable ward’ with a focus on waste<br />
reduction, energy management, recycling<br />
<strong>and</strong> procurement. The trial will seek to<br />
quantify the reduction in carbon footprint<br />
<strong>and</strong> identify the highest impact schemes<br />
which can be extended across other wards at<br />
the <strong>Trust</strong>.<br />
Reducing our energy use<br />
Another key element of the action plan is<br />
to reduce the <strong>Trust</strong>’s energy use. The Carbon<br />
Reduction Commitment Energy Efficiency<br />
Scheme (often referred to as simply ‘the CRC’)<br />
is a m<strong>and</strong>atory scheme aimed at improving<br />
energy efficiency <strong>and</strong> cutting emissions in<br />
large public <strong>and</strong> private sector organisations.<br />
The scheme features a range of reputational,<br />
behavioural <strong>and</strong> financial drivers, which<br />
aim to encourage organisations to develop<br />
energy management strategies that promote<br />
a better underst<strong>and</strong>ing of energy usage.<br />
11 Percentage of patients receiving first definitive treatment within 62 days of referral from an <strong>NHS</strong> Cancer Screening Service<br />
14 Directors’ report
The table below summarises the <strong>Trust</strong>’s energy use in Gigajoules (GJ):<br />
2008/09 2009/10 2010/11 2011/12 <strong>2012</strong>/<strong>13</strong><br />
Electricity 59,548 61,173 59,851 58,518 56,703<br />
Gas 121,241 89,369 89,327 66,806 87,551<br />
Steam (incinerator) 75,923 79,990 79,991 79,991 69,990<br />
Oil 0 0 0 0 0<br />
Total 256,712 230,532 229,169 205,315 214,244<br />
The <strong>Trust</strong> is on track for an absolute carbon<br />
reduction target of 10% by 2015 against a<br />
2007 baseline assessment.<br />
During 2011/12 the <strong>Trust</strong> reduced the total<br />
energy use by 23,854 Gigajoules (GJ) from<br />
the previous year. This was attributed<br />
to good incinerator reliability providing<br />
steam for the <strong>Hillingdon</strong> <strong>Hospital</strong> site <strong>and</strong><br />
a relatively mild winter. The level of gas<br />
consumption in <strong>2012</strong>/<strong>13</strong> increased from the<br />
previous year due to the extent <strong>and</strong> length of<br />
the winter weather conditions, <strong>and</strong> essential<br />
repair works to the incinerator which led<br />
to heavier use of the back up gas boiler in<br />
March 20<strong>13</strong>.<br />
From 1 st January 20<strong>13</strong> the <strong>Trust</strong> successfully<br />
secured a new five year contract with SRCL<br />
to operate the incinerator based on the<br />
<strong>Hillingdon</strong> <strong>Hospital</strong> site. This arrangement<br />
ensures our clinical waste travels a minimum<br />
distance before entering the incinerator<br />
process; it is also highly sustainable in that<br />
the steam created from burning clinical<br />
waste is used to provide 70% of the energy<br />
needed to heat the radiators <strong>and</strong> provide hot<br />
water at <strong>Hillingdon</strong> <strong>Hospital</strong>.<br />
Waste reduction <strong>and</strong> minimisation<br />
The <strong>Trust</strong>’s Waste Group has met on a<br />
regular basis during the year. Part of its role<br />
is to ensure waste is segregated, managed,<br />
recycled <strong>and</strong> disposed of effectively in line<br />
with the Department of Health publication<br />
‘Safe Management of Healthcare Waste’.<br />
There has been a significant focus on<br />
improving waste signage, ensuring<br />
appropriate waste storage areas are in place,<br />
<strong>and</strong> the correct segregation is followed.<br />
Of the 1,363 tonnes of waste generated at<br />
<strong>Hillingdon</strong> <strong>and</strong> Mount Vernon <strong>Hospital</strong>s in<br />
<strong>2012</strong>/<strong>13</strong>, 351 tonnes (26% of the total) was<br />
recycled. 545 tonnes (40%) of the total was<br />
clinical waste, which was incinerated <strong>and</strong><br />
generated steam to provide heating <strong>and</strong> hot<br />
water at the <strong>Hillingdon</strong> site. The remaining<br />
467 tonnes (34%) was sent for l<strong>and</strong>fill.<br />
Green travel<br />
The <strong>Trust</strong> has continued to promote green<br />
travel for staff <strong>and</strong> service users. Events took<br />
place at both hospital sites giving staff the<br />
opportunity to learn about changing to<br />
greener travel alternatives such as car sharing<br />
<strong>and</strong> cycling to work. The well attended<br />
events were sponsored by Transport for<br />
London <strong>and</strong> will be repeated again this year.<br />
The <strong>Trust</strong> is intending to update its Travel<br />
Survey looking at how people travel to<br />
hospital <strong>and</strong> will be supporting a wide range<br />
of initiatives in the year ahead including<br />
‘Bikewise’ events <strong>and</strong> ‘Walk to Work Week’<br />
<strong>and</strong> will work with Transport for London <strong>and</strong><br />
the local authority to promote better public<br />
transport services to the <strong>Trust</strong>’s hospitals.<br />
Developing our services<br />
Service developments<br />
The <strong>Trust</strong> has undertaken a number of service<br />
developments over the last year, some of<br />
which are outlined below.<br />
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15
Musculoskeletal (MSK) services<br />
The <strong>Trust</strong> has been working with<br />
commissioners to implement a redesigned<br />
Orthopaedic, Rheumatology <strong>and</strong> Pain Service<br />
model from April 20<strong>13</strong> with implementation<br />
of jointly agreed pathways. These pathways<br />
will involve the provision of more integrated<br />
care across primary <strong>and</strong> secondary care<br />
settings with the development of a Clinical<br />
Assessment <strong>and</strong> Treatment service (CATs) to<br />
triage referrals <strong>and</strong> streamline patients down<br />
the most appropriate care pathway. This<br />
large scale programme of work will continue<br />
to develop <strong>and</strong> evolve throughout 20<strong>13</strong>.<br />
Integrated care pilot<br />
The <strong>Trust</strong> has participated in the<br />
development of the outer North West<br />
London Integrated Care Pilot (ICP). The<br />
vision is to improve outcomes for patients<br />
by creating access to more integrated<br />
care outside of hospital. The overarching<br />
aim of this ambitious <strong>and</strong> transformative<br />
programme is to improve health <strong>and</strong><br />
social care support for some of our most<br />
vulnerable residents. Patient pathways will<br />
be redesigned by ICP partners, with an initial<br />
focus on care of the elderly (those over 75<br />
years of age) <strong>and</strong> adults with diabetes.<br />
This integrated approach is expected to<br />
deliver improved outcomes for patients<br />
by averting hospital attendances <strong>and</strong><br />
admissions, reducing length of stay for<br />
those patients who are admitted to hospital,<br />
improving patients’ experience of discharge<br />
from hospital, <strong>and</strong> preventing readmissions.<br />
As a result, a number of pilot schemes have<br />
begun locally in <strong>Hillingdon</strong> including a falls<br />
prevention management service.<br />
Pathology<br />
The <strong>Trust</strong> successfully won the tender for<br />
the provision of Hounslow GP pathology<br />
work. This was a significant result for the<br />
organisation given the very competitive<br />
environment that Pathology services operate<br />
in.<br />
A large scale strategic piece of work has<br />
also begun to explore the long term future<br />
strategy for Pathology services. Pathology is a<br />
rapidly evolving field; modalities of diagnosis<br />
are exp<strong>and</strong>ing <strong>and</strong> the necessity to perform<br />
multiple investigations on a sample is ever<br />
increasing.<br />
In response to these changes, in May <strong>2012</strong><br />
the <strong>Trust</strong> joined with five other <strong>Trust</strong>s in<br />
North West London to carry out a high<br />
level options analysis that would assist us in<br />
determining the most efficient operating<br />
model for the delivery of Pathology, whilst<br />
improving the quality of the service <strong>and</strong><br />
increasing opportunities for training <strong>and</strong><br />
research. Whilst the first phase of this project<br />
suggested a model with a single consolidated<br />
<strong>NHS</strong> hub along with local core laboratories<br />
at each <strong>Trust</strong> site, the next phase of the<br />
project will look to develop <strong>and</strong> review this<br />
option further, including a more detailed<br />
operational model covering all aspects of<br />
Pathology. It will also consider variations<br />
to this option as required by the <strong>Trust</strong>s,<br />
which may have particular needs or areas of<br />
specialist focus. The <strong>Trust</strong> Board is anticipated<br />
to consider the long term strategic options in<br />
late spring 20<strong>13</strong>.<br />
Capital developments<br />
As outlined earlier in the report, we<br />
have continued to invest in improving<br />
our hospitals. Three key developments<br />
in particular will improve the patient<br />
experience <strong>and</strong> the quality of the services<br />
provided by the <strong>Trust</strong>.<br />
Emergency <strong>and</strong> urgent care development<br />
A significant amount of work is currently<br />
taking place to redesign both the estate<br />
infrastructure <strong>and</strong> clinical model of care<br />
for emergency care services. Following<br />
the award of £12.4m of Public Dividend<br />
Capital from the Department of Health, <strong>and</strong><br />
approval of the full business case by the <strong>Trust</strong><br />
Board in March 20<strong>13</strong>, the <strong>Trust</strong> appointed a<br />
contractor to undertake the construction of a<br />
16 Directors’ report
new building. This will accommodate a new<br />
46-bed Acute Medical Unit (AMU) adjacent<br />
to the existing Emergency Department (ED),<br />
a new Rapid Assessment <strong>and</strong> Triage area to<br />
facilitate a quicker clinical assessment, <strong>and</strong> a<br />
new Urgent Care Centre (UCC) to integrate<br />
with community, social & mental health<br />
service providers.<br />
The aim is to provide improved high quality,<br />
safe, urgent <strong>and</strong> emergency care services<br />
for the local population. This will support<br />
achievement of the new A&E indicators,<br />
reduced length of stay, <strong>and</strong> provide an<br />
environment that will encourage integrated<br />
care with other healthcare providers,<br />
including the 111 telephone service. In<br />
addition to redesigning the A&E department<br />
<strong>and</strong> ambulatory emergency care pathways,<br />
the <strong>Trust</strong> plans to develop its workforce to<br />
meet the changing needs of patients that<br />
arrive in the emergency department.<br />
Improvements to the birthing room<br />
environment<br />
The <strong>Trust</strong> has been awarded over £700,000<br />
of Public Dividend Capital to improve the<br />
birthing room environment, within the<br />
Maternity Unit. This will entail refurbishing<br />
all ten rooms on the labour ward <strong>and</strong> include<br />
ensuring that all rooms are en-suite.<br />
Development of endoscopy services<br />
The <strong>Trust</strong> is undertaking an extensive<br />
programme of redevelopment of its<br />
endoscopy services at both Mount Vernon<br />
<strong>and</strong> <strong>Hillingdon</strong> sites. This will entail the<br />
reprovision of endoscopy services at Mount<br />
Vernon <strong>Hospital</strong> from the current location<br />
in the Main Building to the surgical floor in<br />
the Treatment Centre. Endoscopy services<br />
will also be redeveloped as part of the<br />
emergency care changes at the <strong>Hillingdon</strong><br />
site. This will require the current unit to be<br />
relocated to the new facility under the new<br />
AMU building. The endoscopy department<br />
will be equipped with two fully developed<br />
endoscopy suites.<br />
The redevelopment will support accreditation<br />
of both units by the Joint Advisory Group<br />
on Gastrointestinal Endoscopy Services.<br />
The relocation will also mean that patients<br />
will enjoy a significant improvement to the<br />
current environment.<br />
Service changes <strong>and</strong> challenges in<br />
the year ahead<br />
As highlighted in the introduction to the<br />
report, the environment in which the <strong>Trust</strong><br />
operates continues to significantly change.<br />
Several of the key strategic issues affecting<br />
the <strong>Trust</strong> in the coming year are outlined<br />
further below.<br />
Changes in the commissioning of services<br />
From 1st April 20<strong>13</strong>, <strong>NHS</strong> <strong>Hillingdon</strong> Clinical<br />
Commissioning Group is the statutory body<br />
for designing <strong>and</strong> commissioning local health<br />
services in <strong>Hillingdon</strong>, <strong>and</strong> therefore controls<br />
the majority of the <strong>Trust</strong>’s income. Their<br />
focus will be on securing better health care<br />
outcomes <strong>and</strong> responding to the needs <strong>and</strong><br />
wishes of our patients.<br />
They will do this by commissioning/buying<br />
the health <strong>and</strong> care services for the local<br />
population including:<br />
• Elective/planned hospital care<br />
• Rehabilitation care<br />
• Urgent <strong>and</strong> emergency care<br />
• Community health services<br />
• Mental health services.<br />
Other specialist services (for example<br />
neonatal care) will be commissioned by the<br />
National Commissioning Board.<br />
<strong>Hillingdon</strong> CCG covers the same geographical<br />
area as the London Borough of <strong>Hillingdon</strong><br />
<strong>and</strong> consists of all GP practices in the<br />
borough. The Governing Body consists of<br />
local GPs, a secondary care doctor, a senior<br />
nurse, lay members, a Chief Officer, <strong>and</strong> a<br />
Chief Financial Officer.<br />
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17
<strong>Hillingdon</strong> CCG is working with all the CCGs<br />
in North West London to implement the<br />
health care strategy for NW London ‘Shaping<br />
a Healthier Future’. The CCG fully supports<br />
the strategy <strong>and</strong> they are actively developing<br />
an out of hospital strategy, working<br />
closely with The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong><br />
Foundation <strong>Trust</strong>.<br />
The key priorities for the CCG in 20<strong>13</strong>/14 are<br />
to:<br />
• Enable people to die at their preferred<br />
place of death.<br />
• Reduce emergency admissions from<br />
care homes by 10 per cent.<br />
• Reduce by 10 per cent the number of<br />
days of the average length of stay for<br />
people aged 65 or over admitted as a<br />
result of a fall.<br />
North West London reconfiguration<br />
The <strong>Trust</strong> will continue to input into the<br />
reconfiguration proposals set out in the<br />
‘Shaping a Healthier Future’ programme.<br />
The purpose of this review is to improve the<br />
continued provision of high quality, safe<br />
elective, urgent <strong>and</strong> emergency care services<br />
to our local population.<br />
The <strong>Trust</strong> will work with its healthcare<br />
partners <strong>and</strong> other stakeholders to develop<br />
strategic plans to accommodate anticipated<br />
work flows as a result of proposed service<br />
changes.<br />
Urgent Care Centre (UCC)<br />
The <strong>Trust</strong> will be submitting a joint bid with<br />
an external partner for the UCC service which<br />
is being tendered by the CCG. As part of this<br />
bid, clinical pathways will be developed to<br />
identify numbers <strong>and</strong> types of patients to<br />
be treated in the UCC rather than A&E. It is<br />
anticipated that this will hopefully form part<br />
of a fully integrated emergency care model.<br />
Out of hospital care<br />
As healthcare moves out of hospitals<br />
into community settings, the <strong>Trust</strong> will<br />
continue to work with the commissioners<br />
to develop an integrated model of care for<br />
musculoskeletal (MSK) services. As outlined<br />
earlier in the report, this will include<br />
implementation of a Clinical Assessment <strong>and</strong><br />
Triage service (CATs) which ensures provision<br />
of clinically appropriate pathways to the<br />
local population.<br />
The <strong>Trust</strong> is also working in collaboration<br />
with other health <strong>and</strong> social care colleagues<br />
on sector wide Integrated Care Pathways.<br />
As part of this programme, £177k has been<br />
awarded for an assisted discharge pilot,<br />
which will be delivered in collaboration<br />
with Central & North West London <strong>NHS</strong><br />
Foundation <strong>Trust</strong> (CNWL). This is expected to<br />
reduce both length of stay <strong>and</strong> readmissions<br />
for patients in this programme by assisting<br />
them in their transition from acute to<br />
community care. A further £60k has also<br />
been awarded from the ICP innovation fund<br />
for the delivery of a diabetic educational<br />
programme for nursing home staff.<br />
The <strong>Trust</strong> fully anticipates working on a<br />
number of further out of hospital schemes,<br />
particularly as it relates to planned care, with<br />
new pathways developed in conjunction with<br />
our CCG colleagues.<br />
Development of dermatology services<br />
The <strong>Trust</strong> plans to provide an integrated skin<br />
centre at Mount Vernon <strong>Hospital</strong>, which will<br />
include the development of a tertiary service.<br />
The <strong>Trust</strong> will also be developing bids for<br />
dermatology community services as they are<br />
tendered in a number of localities.<br />
Partnership working<br />
The <strong>Trust</strong> has continued to develop<br />
<strong>and</strong> enhance its relationships with local<br />
health <strong>and</strong> social care partners. The <strong>Trust</strong><br />
has formally entered into a number of<br />
regional programmes of work, including<br />
the Integrated Care Pilot for outer North<br />
West London, a joint review of Pathology<br />
modernisation across the sector as well as<br />
formally being a member of the Imperial<br />
18 Directors’ report
College Health Partners Academic Health<br />
Science Partnership. The partnership brings<br />
together health providers in North West<br />
London with Imperial College with the aim<br />
of improving health outcomes by sharing<br />
research.<br />
Locally in <strong>Hillingdon</strong> we have looked to<br />
redesign pathways of care with the CCG<br />
through the redesign of MSK services which<br />
also includes CNWL as our local community<br />
service provider. The <strong>Trust</strong> is a member of<br />
the <strong>Hillingdon</strong> Health Economy Recovery<br />
Board which brings together health <strong>and</strong><br />
social care partners in <strong>Hillingdon</strong> to ensure<br />
there is a financially sustainable local health<br />
economy. The <strong>Trust</strong> is also a member of the<br />
<strong>Hillingdon</strong> Health & Wellbeing Board which<br />
comprises a wider range of health <strong>and</strong> social<br />
care organisations to underst<strong>and</strong> local needs<br />
<strong>and</strong> agree priorities for improving health <strong>and</strong><br />
reducing health inequalities.<br />
Risks <strong>and</strong> uncertainties<br />
The Board has identified a number of<br />
key risks to the organisation which, if not<br />
managed, will impact on the <strong>Trust</strong>’s ability<br />
to deliver its mission <strong>and</strong> objectives. In the<br />
current <strong>and</strong> forecast operating context the<br />
key risks relate to:<br />
• The unprecedented size of the efficiency<br />
savings required in the next five years <strong>and</strong><br />
the <strong>Trust</strong> not receiving payment for the<br />
activity it undertakes, both of which have<br />
the clear potential to impact on the <strong>Trust</strong>’s<br />
financial viability <strong>and</strong> financial capacity to<br />
invest in its services <strong>and</strong> infrastructure.<br />
• The risk that the strategies to deliver<br />
care out of the hospital setting do not<br />
achieve the necessary goals <strong>and</strong> thereby<br />
cause an impact on the <strong>Trust</strong>’s operational<br />
efficiency <strong>and</strong> quality.<br />
• The risk of uncertainty caused by the<br />
reconfiguration of services in North West<br />
London (‘Shaping a Healthier Future’) not<br />
occurring at the rate anticipated.<br />
The <strong>Annual</strong> Governance Statement contains<br />
further information on the risks facing the<br />
<strong>Trust</strong> <strong>and</strong> the approach to managing these.<br />
Quality reporting<br />
The Quality <strong>Report</strong> contains a comprehensive<br />
review of the quality of the <strong>Trust</strong>’s services,<br />
<strong>and</strong> the priorities for quality improvement.<br />
The following summary outlines some key<br />
points of note.<br />
At the heart of the <strong>Trust</strong>’s commitment to<br />
quality is a clearly defined clinical quality<br />
strategy, a system of quality performance<br />
management, <strong>and</strong> as outlined in the<br />
<strong>Annual</strong> Governance Statement, a clear risk<br />
management process. A key part of the<br />
Board’s assurance on quality <strong>and</strong> safety is<br />
the Quality & Risk Committee (QRC). The<br />
Committee was formed in October <strong>2012</strong><br />
following the annual review of the Board<br />
<strong>and</strong> Committees, <strong>and</strong> brought together the<br />
Integrated Risk Management Committee <strong>and</strong><br />
the Clinical Quality & St<strong>and</strong>ards Committee<br />
in order to ensure that quality <strong>and</strong> risk are<br />
considered in an integrated way. The Board<br />
monitors quality through the monthly quality<br />
<strong>and</strong> operational performance report <strong>and</strong> a<br />
more detailed quarterly quality report. The<br />
QRC reviews a further set of quality metrics<br />
<strong>and</strong> high <strong>and</strong> medium risks. High risks are<br />
reviewed by the Board, together with Serious<br />
Incidents <strong>and</strong> the actions taken in response<br />
to the investigation of such incidents.<br />
The <strong>Trust</strong> has a comprehensive clinical audit<br />
work plan covering both national <strong>and</strong> local<br />
audits. Information <strong>and</strong> progress on clinical<br />
audit is reported to the QRC <strong>and</strong> the Audit &<br />
Assurance Committee.<br />
The Board has reviewed itself against the<br />
Monitor Quality Governance Framework <strong>and</strong><br />
considers itself to meet the requirements<br />
in the Framework. In reviewing the<br />
<strong>Trust</strong>’s position against the Framework in<br />
December <strong>2012</strong>, the Board highlighted the<br />
importance of refreshing the <strong>Trust</strong>’s clinical<br />
strategy in light of the Mid Staffordshire<br />
Directors’ report<br />
19
<strong>NHS</strong> Foundation <strong>Trust</strong> Public Inquiry <strong>and</strong><br />
the information available to the Board on<br />
the quality of the <strong>Trust</strong>’s services. The Board<br />
noted the importance of ensuring quality<br />
governance is premised on behaviours,<br />
culture, <strong>and</strong> processes.<br />
Work is therefore currently underway to<br />
refresh the Board’s quality strategy. Priorities<br />
identified by the Board for this work include<br />
ensuring robust mechanisms are in place to<br />
ensure information flows from the ward to<br />
the Board; ensuring the Board receives both<br />
qualitative <strong>and</strong> quantitative information;<br />
<strong>and</strong> an ongoing focus on nursing st<strong>and</strong>ards,<br />
mortality levels, <strong>and</strong> patient safety. Following<br />
issues identified on an unannounced ward<br />
visit by members of the Board, a priority is<br />
to ensure that the Board is assured on the<br />
consistency of care across the <strong>Trust</strong>’s wards.<br />
The Care Quality Commission (CQC)<br />
undertook an unannounced visit in<br />
December <strong>2012</strong> as part of their planned<br />
review of the <strong>Trust</strong>. The report issued<br />
from this visit found the <strong>Trust</strong> to be fully<br />
compliant with the CQC’s Essential St<strong>and</strong>ards<br />
of Quality & Safety. The report made no<br />
recommendations, but highlighted comments<br />
made by patients <strong>and</strong> staff in relation to<br />
communication, the ward environment, <strong>and</strong><br />
staffing levels. An action plan was developed<br />
in response <strong>and</strong> reported through the Quality<br />
& Risk Committee.<br />
There have been no inconsistencies<br />
between the <strong>Annual</strong> Governance Statement<br />
(presented later in the report), the annual<br />
<strong>and</strong> quarterly Board statements submitted<br />
to Monitor as required by the Compliance<br />
Framework, the Quality <strong>Report</strong> (presented<br />
later in the report) <strong>and</strong> reports arising from<br />
the Care Quality Commission planned <strong>and</strong><br />
responsive reviews of the <strong>Trust</strong>.<br />
Further information on the quality of the<br />
<strong>Trust</strong>’s services <strong>and</strong> the Board’s priorities for<br />
improving clinical quality is presented in the<br />
Quality <strong>Report</strong>.<br />
Public, patient, <strong>and</strong> stakeholder<br />
engagement <strong>and</strong> experience<br />
Improvements following patient<br />
feedback<br />
The <strong>Trust</strong> continues to remain committed<br />
to using patient feedback to improve<br />
the services provided by the <strong>Trust</strong>. As<br />
part of this, the <strong>Trust</strong> has reviewed its<br />
approach to monitoring patient experience<br />
<strong>and</strong> established a new Experience <strong>and</strong><br />
Engagement Group which is chaired by<br />
a Non-Executive Director, <strong>and</strong> includes<br />
Executive Directors, divisional nursing leads,<br />
Public Governors, <strong>and</strong> a Staff Governor. The<br />
group meets bi-monthly <strong>and</strong> oversees the<br />
delivery of ‘Putting People First’ our patient<br />
<strong>and</strong> staff experience <strong>and</strong> engagement<br />
strategy. The strategy sets out a variety<br />
of methods that the <strong>Trust</strong> uses to gather<br />
feedback from patients. During <strong>2012</strong>/<strong>13</strong><br />
approximately 11,700 patients have given<br />
feedback using our real time survey system.<br />
The comments from these surveys along with<br />
feedback gained from patients who were<br />
asked what matters most to them were used<br />
to help the <strong>Trust</strong> to identify how we should<br />
prioritise improvements.<br />
In November <strong>2012</strong> the <strong>Trust</strong> implemented<br />
the Friends <strong>and</strong> Family Test (FFT); this is a<br />
st<strong>and</strong>ardised question that will be used<br />
across the <strong>NHS</strong> from April 20<strong>13</strong>. Under the<br />
FFT when patients receive care or treatment<br />
as an inpatient or in an Accident <strong>and</strong><br />
Emergency (A&E) department they are given<br />
the opportunity to state whether or not<br />
they would recommend the ward or A&E<br />
department to friends <strong>and</strong> family if they<br />
needed similar care or treatment. Patients<br />
can respond from one of six options ranging<br />
from ‘extremely likely’ to ‘don’t know’, <strong>and</strong><br />
they are also invited to provide comments<br />
relating to the score that they have given.<br />
The comments help staff to gain an insight<br />
on what patients value <strong>and</strong> the factors that<br />
influence a poor experience of care.<br />
20 Directors’ report
The results from the Friends <strong>and</strong> Family<br />
Test are analysed to determine if any action<br />
is required. An overall score is calculated<br />
by using the proportion of patients<br />
who ‘strongly recommend’ minus those<br />
who would not recommend, or who are<br />
indifferent; this score will be published<br />
on the <strong>NHS</strong> Choices website <strong>and</strong> be made<br />
available publicly by the <strong>Trust</strong> from July 20<strong>13</strong>.<br />
This year we have also refreshed the process<br />
for monitoring feedback that patients leave<br />
on the <strong>NHS</strong> Choices <strong>and</strong> Patient Opinion<br />
websites. All comments are responded to <strong>and</strong><br />
acknowledged by the <strong>Trust</strong>.<br />
Examples of action undertaken or underway<br />
in response to feedback are outlined below.<br />
• Building on work last year to implement<br />
a Visitors Charter, we are introducing<br />
a visitor’s card. The small card contains<br />
some key points from the Visitors Charter<br />
<strong>and</strong> ward telephone numbers. The<br />
cards can be modified at a ward level to<br />
include the Matrons’ contact details <strong>and</strong><br />
ward visiting times.<br />
• A nurse call bell st<strong>and</strong>ard was introduced<br />
in October <strong>2012</strong>. The st<strong>and</strong>ard sets our<br />
aim to respond to call bells within two<br />
minutes <strong>and</strong> never any longer than five<br />
minutes. We are able to monitor our<br />
progress in maintaining this st<strong>and</strong>ard<br />
through our inpatient survey. Our results<br />
from October <strong>2012</strong> to March 20<strong>13</strong> show<br />
that 95% of patients who have used the<br />
nurse call bell reported that their call bell<br />
was answered within the st<strong>and</strong>ard, with<br />
79% of patients reporting that it was<br />
answered within two minutes.<br />
• On 1st February 20<strong>13</strong> the Phlebotomy<br />
service at the Mount Vernon site brought<br />
forward its opening time to 7.30am in<br />
response to patient feedback.<br />
Complaints<br />
Complaints are an important source of<br />
patient feedback.<br />
In <strong>2012</strong>/<strong>13</strong> the <strong>Trust</strong> received 495 complaints,<br />
compared to 386 in 2011/12, a rise of 28%.<br />
The response rate for the year was 76.1%<br />
which means that 383 of the 495 complaints<br />
were answered within the timescale agreed<br />
with the complainant. The chart below<br />
shows the subjects involved. Each complaint<br />
often refers to more than one subject <strong>and</strong><br />
therefore the total on the chart adds up to<br />
more than the total number of complaints.<br />
Under the current complaints regulations,<br />
Complaints by subject categories<br />
Clinical Care<br />
Medical Staff<br />
Communication/<br />
Information to<br />
Patients<br />
Clinical Care<br />
Nursing Staff<br />
Appointments<br />
(OPD & A&E)<br />
Attitude<br />
(Medical Staff)<br />
Attitude<br />
(Nursing Staff)<br />
Hotel Services<br />
Number<br />
Subject<br />
Discharge<br />
Transport<br />
Attitude (Other<br />
Support Staff)<br />
Directors’ report<br />
21
the emphasis is on resolving complaints<br />
locally <strong>and</strong> this has been achieved in 456<br />
(92%) of complaints, with the majority<br />
of these resolved through the <strong>Trust</strong>’s first<br />
response. 27 (5.5%) of complaints were<br />
resolved through further local resolution,<br />
either by writing again to the complainants,<br />
or by meeting with them.<br />
12 of our complainants (2.4%) were not<br />
happy with our local responses <strong>and</strong> referred<br />
their complaint to the Parliamentary<br />
<strong>and</strong> Health Service Ombudsman for an<br />
independent review. The Ombudsman<br />
decided to investigate one complaint <strong>and</strong><br />
that is ongoing. Two complaints were<br />
rejected by the Ombudsman as properly<br />
resolved by the <strong>Trust</strong>. The <strong>Trust</strong> was asked to<br />
undertake further work locally to resolve the<br />
complaint in four cases, three of which have<br />
now been completed <strong>and</strong> closed, <strong>and</strong> one<br />
remains open. In five cases the papers have<br />
been supplied to the Ombudsman <strong>and</strong> we<br />
are awaiting their decision.<br />
The <strong>Trust</strong> has continued to work with<br />
complainants <strong>and</strong> use complaints as drivers<br />
for improvements to the services we<br />
provide. Once again this year changes <strong>and</strong><br />
improvements have been embedded in<br />
clinical areas as a result of complaints.<br />
A particular area of focus has been on<br />
ensuring that test results are followed up<br />
appropriately, <strong>and</strong> new systems have been<br />
put in place in the Clinical Support Services<br />
Division <strong>and</strong> in the Women’s <strong>and</strong> Children’s<br />
Division following a complaint in each<br />
Division that results had been overlooked.<br />
In the Division of Surgery, the Urology<br />
Department has been looking at catheter<br />
care, <strong>and</strong> staff have been working very<br />
closely with a patient who was keen to<br />
be involved in formulating new ideas for<br />
improving the experience <strong>and</strong> underst<strong>and</strong>ing<br />
of patients who have a catheter for a period<br />
of time.<br />
On a simpler level a patient informed us<br />
that after his eye clinic appointments his<br />
eyes were sore <strong>and</strong> it was uncomfortable<br />
to wait for transport in the Outpatient Hall<br />
because the seats were in a draughty area.<br />
The Matron responsible for the Outpatients<br />
Department met with Facilities staff <strong>and</strong> the<br />
seating area has been reconfigured; chairs<br />
have been moved away from the draught<br />
<strong>and</strong> a dedicated waiting area for those<br />
waiting for transport has been arranged,<br />
which is away from draughts. Signage is<br />
being made to identify the area.<br />
Improvements in patient <strong>and</strong> carer<br />
information<br />
Providing high quality <strong>and</strong> clear information<br />
is central to the patient experience.<br />
During <strong>2012</strong>/<strong>13</strong> the Patient Information<br />
Review Group continued to work with staff<br />
across the hospital to develop new patient<br />
<strong>and</strong> carer information <strong>and</strong> to refresh existing<br />
information.<br />
Our Readers Panel, service users, <strong>and</strong> patient<br />
involvement groups support <strong>Trust</strong> staff to<br />
ensure that the information we produce<br />
is clear, jargon free <strong>and</strong> user friendly. For<br />
example, our Fighting Infection Together<br />
(FIT) public involvement group worked with<br />
the <strong>Trust</strong> Infection Control Team to develop<br />
an ‘isolation leaflet’. The leaflet describes<br />
why a patient may be cared for in isolation<br />
<strong>and</strong> what relatives can expect. Input from<br />
patients <strong>and</strong> public has been particularly<br />
helpful in developing leaflets on sensitive<br />
issues. For example, our Readers Panel<br />
supported the production of a Post Mortem<br />
leaflet which is given to relatives soon after<br />
the death of a loved one. The panel ensured<br />
that the leaflet presents the relevant legal<br />
<strong>and</strong> technical information in a sensitive way.<br />
The <strong>Trust</strong> is developing a poster that will<br />
be used in A&E cubicles to illustrate the<br />
typical pathways through the emergency<br />
department explaining the points at which<br />
there may be waiting periods. The poster<br />
22 Directors’ report
is being developed in response to feedback<br />
from patients who are not always sure what<br />
is happening next, <strong>and</strong> why they may be kept<br />
waiting. The poster will support the verbal<br />
updates that are given by the staff in the<br />
department.<br />
Other condition/service specific information<br />
produced in <strong>2012</strong>/<strong>13</strong> included new leaflets in<br />
Radiology; a leaflet to support parents caring<br />
for children with a nasogastric tube; a leaflet<br />
on caring for a surgical wound at home; <strong>and</strong><br />
information on the Liverpool Care Pathway.<br />
During <strong>2012</strong>/<strong>13</strong> the <strong>Trust</strong> developed a Carers’<br />
Strategy <strong>2012</strong>-2015 that outlines the <strong>Trust</strong>’s<br />
commitment to working in partnership with<br />
all carers <strong>and</strong> families by listening, learning<br />
<strong>and</strong> responding to feedback. Our vision is to<br />
provide support <strong>and</strong> information to all carers<br />
ranging from breastfeeding mothers through<br />
to carers’ needs at the end of people’s lives.<br />
Our objectives are to improve a carer’s<br />
experience by:<br />
• Providing appropriate <strong>and</strong> timely<br />
information to support the carer <strong>and</strong> the<br />
person they support.<br />
• Actively involving carers where patient<br />
consent has been granted in decisions<br />
about the care <strong>and</strong> treatment of the<br />
person they care for.<br />
• Involving carers in the planning or<br />
developing of services <strong>and</strong> in monitoring<br />
patient <strong>and</strong> carer experience.<br />
• Providing support for carers who are<br />
caring for people with multiple <strong>and</strong><br />
complex needs e.g. learning disabilities,<br />
physical disabilities <strong>and</strong> dementia.<br />
• Improving staff awareness of the role of a<br />
carer in care delivery.<br />
• Ensuring carers are provided with<br />
sufficient information to enable<br />
safe planning of return to caring<br />
responsibilities.<br />
A Carer’s charter has been developed <strong>and</strong> is<br />
displayed throughout the <strong>Trust</strong>. Information<br />
for Carers is available from our Patient<br />
Advice <strong>and</strong> Liaison Service (PALS) <strong>and</strong> also on<br />
the <strong>Trust</strong> <strong>and</strong> <strong>Hillingdon</strong> Council websites.<br />
A carer survey is available to monitor carers’<br />
experiences.<br />
Consultation <strong>and</strong> engagement<br />
The <strong>Trust</strong> is committed to involving <strong>and</strong><br />
consulting with members, patients <strong>and</strong> the<br />
local community in the planning of service<br />
provision, the development of proposals for<br />
change, <strong>and</strong> decisions about how services<br />
operate. The <strong>Trust</strong> will continue to engage<br />
<strong>and</strong> consult with service users, public <strong>and</strong><br />
the wider local community in decisions<br />
about general service delivery to ensure that<br />
services are designed <strong>and</strong> adapted to better<br />
respond to individual needs.<br />
The Governors <strong>and</strong> members will clearly<br />
have an important role in any consultation<br />
<strong>and</strong> engagement on major service changes.<br />
However the <strong>Trust</strong> will seek to ensure that<br />
such engagement reaches beyond our<br />
membership, particularly where a group that<br />
is under-represented in our membership is<br />
affected.<br />
The <strong>Trust</strong>’s Head of Patient & Public<br />
Engagement proactively engages with the<br />
community <strong>and</strong> voluntary organisations<br />
to identify opportunities for the <strong>Trust</strong> to<br />
engage with their members. For example as<br />
part of this engagement, the <strong>Trust</strong> invited<br />
representatives from the Alzheimer’s Society,<br />
Age UK, <strong>Hillingdon</strong> Carers <strong>and</strong> Disablement<br />
Association <strong>Hillingdon</strong> (DASH) to attend<br />
a focus group to discuss how to improve<br />
services for patients with dementia.<br />
The <strong>Trust</strong> encourages <strong>and</strong> facilitates linkages<br />
between the Council of Governors <strong>and</strong><br />
groups <strong>and</strong> organisations which represent<br />
patients, public <strong>and</strong> the wider community.<br />
During <strong>2012</strong>/<strong>13</strong>, Public Governors attended<br />
Resident Association meetings across the<br />
Borough, ‘Street Champion’ meetings <strong>and</strong><br />
other community events to communicate<br />
with local residents <strong>and</strong> public members.<br />
Governors are encouraged to attend<br />
meetings in the community <strong>and</strong> report<br />
Directors’ report<br />
23
ack to the wider Council of Governors,<br />
to help ensure that the Council of<br />
Governors is aware of public comments <strong>and</strong><br />
concerns which have been raised in these<br />
meetings. The Membership Development &<br />
Engagement Strategy approved by the Board<br />
outlines the <strong>Trust</strong>’s policy on the involvement<br />
of members, patients <strong>and</strong> wider public,<br />
including a statement on the <strong>Trust</strong>’s approach<br />
to consultation, <strong>and</strong> addressing the overlap<br />
<strong>and</strong> interaction between the Governors <strong>and</strong><br />
other consultative <strong>and</strong> representative groups.<br />
The <strong>Trust</strong> did not undertake any formal<br />
consultations in the past year. <strong>NHS</strong> North<br />
West London led a public consultation on<br />
proposals for the reconfiguration of health<br />
services in North West London – entitled<br />
‘Shaping a Healthier Future’ which included<br />
consulting with residents living in the London<br />
Borough of <strong>Hillingdon</strong>.<br />
A selection of examples of public<br />
engagement activities undertaken during the<br />
year are outlined below:<br />
• Members of the Board attended<br />
<strong>Hillingdon</strong> Council’s External Services<br />
Scrutiny Committee on two occasions in<br />
<strong>2012</strong>/<strong>13</strong>. In April <strong>2012</strong> the Medical Director<br />
presented the <strong>Trust</strong>’s Quality Account <strong>and</strong><br />
in September <strong>2012</strong>, the Chief Executive<br />
<strong>and</strong> Medical Director provided an update<br />
on developments at the <strong>Trust</strong>.<br />
• The <strong>Trust</strong> continued to hold bi-monthly<br />
meetings of its ‘People in Partnership’<br />
forum. The forum enables the <strong>Trust</strong> to<br />
listen to the views <strong>and</strong> opinions of the<br />
communities we serve, share information<br />
about what the <strong>Trust</strong> is doing <strong>and</strong> planned<br />
future developments, <strong>and</strong> provides an<br />
opportunity for members to meet <strong>and</strong><br />
communicate with staff, Governors <strong>and</strong><br />
fellow members. The People in Partnership<br />
meetings have been refocused to be<br />
meetings between the members <strong>and</strong><br />
Governors, <strong>and</strong> several of the meetings<br />
are now held in the community during the<br />
day, attracting new members <strong>and</strong> raising a<br />
number of different issues.<br />
• The <strong>Trust</strong> continued an engagement<br />
project that sought to capture experiences,<br />
manage expectations, <strong>and</strong> improve the<br />
maternity experience for women from the<br />
Somali community. At a focus group at<br />
the Sahan Centre in Hayes the <strong>Trust</strong> was<br />
able to provide feedback on action taken<br />
following an earlier session, including<br />
the introduction of awareness sessions on<br />
the maternity department’s m<strong>and</strong>atory<br />
training programme. The maternity<br />
department has recently commenced<br />
a similar engagement process with an<br />
Afghani women’s group to mirror the<br />
success with the Somali women’s group<br />
engagement.<br />
• As outlined earlier in the report, the <strong>Trust</strong><br />
developed ‘Putting People First’ which<br />
sets out the <strong>Trust</strong>’s vision to be a leader<br />
in terms of the patient experience. The<br />
strategy followed a review of feedback<br />
from patients, staff, <strong>and</strong> public, <strong>and</strong> was<br />
widely consulted on with input from<br />
the Local Involvement Network (LINk),<br />
local patient interest groups, <strong>Hillingdon</strong><br />
Council, the Council of Governors, <strong>and</strong><br />
public <strong>and</strong> staff members.<br />
• The <strong>Trust</strong> has continued to work in<br />
close partnership with the <strong>Hillingdon</strong><br />
Local Involvement Network (LINk) <strong>and</strong><br />
appreciates the valuable contribution that<br />
the LINk provides to the organisation.<br />
Representatives from the LINk have<br />
regularly attended focus groups <strong>and</strong><br />
committees <strong>and</strong> are regular attendees<br />
at our People in Partnership meetings.<br />
This year the <strong>Trust</strong> has worked closely<br />
with the LINk on the consultation for the<br />
priorities for the Quality <strong>Report</strong> <strong>and</strong> the<br />
transfer of catering <strong>and</strong> cleaning services<br />
back to in-house management. The <strong>Trust</strong><br />
looks forward to working with the new<br />
Healthwatch which replaces the LINk from<br />
April 20<strong>13</strong>.<br />
24 Directors’ report
Developments in nursing care<br />
Nursing care is central to the patient<br />
experience <strong>and</strong> has been an issue that has<br />
received much attention nationally over the<br />
last year.<br />
The <strong>Trust</strong> has developed a series of essential<br />
nursing <strong>and</strong> midwifery st<strong>and</strong>ards aligned<br />
with our CARES values that underpin<br />
everyday nursing <strong>and</strong> midwifery practice.<br />
We are currently introducing an approach<br />
to ensure that care is consistent <strong>and</strong> reliable<br />
with a focus on responding to fundamental<br />
needs. Our aim is that our patients are<br />
always safe, comfortable, informed, <strong>and</strong><br />
involved whilst receiving care on our wards.<br />
This proactive care approach will help us<br />
to embed our essential st<strong>and</strong>ards into<br />
practice <strong>and</strong> steers nursing staff to use every<br />
scheduled contact with patients, for example<br />
when checking blood pressure <strong>and</strong> at regular<br />
intervals in between, to check on key aspects<br />
of care. These are known as the ‘Ps <strong>and</strong> Qs’.<br />
These include:<br />
• Pain: Does the patient have any pain?<br />
• Position: Is the patient comfortable <strong>and</strong><br />
warm enough, do they need assistance<br />
repositioning?<br />
• Possessions: Does the patient have a<br />
drink <strong>and</strong> all personal possessions such as<br />
tissues <strong>and</strong> spectacles within reach?<br />
• Personal: Does the patient need assistance<br />
to visit the toilet?<br />
• Questions: Does the patient have any<br />
questions about their care?<br />
Every contact with the patient should finish<br />
by asking the patient if there is anything else<br />
that is needed at that time.<br />
The <strong>Report</strong> of the Mid Staffordshire <strong>NHS</strong><br />
Foundation <strong>Trust</strong> Public Inquiry published in<br />
February 20<strong>13</strong> <strong>and</strong> the launch of ‘Compassion<br />
in Practice’, the national Nursing Midwifery<br />
<strong>and</strong> Care Staff Vision <strong>and</strong> Strategy reinforce<br />
the need for care to be based on empathy,<br />
respect <strong>and</strong> dignity. We are confident that<br />
this approach, agreed by our Senior Sisters<br />
<strong>and</strong> Matrons will encourage consistency in<br />
the fundamentals whilst leaving room to<br />
‘tailor’ care around each patient’s individual<br />
needs.<br />
Proactive care is discussed at nurse induction<br />
by the Deputy Director of Nursing <strong>and</strong> is<br />
being led at ward level by the Senior Sister<br />
<strong>and</strong> Matron; it will be supported by posters<br />
<strong>and</strong> a leaflet that will be given to all nurses<br />
in the <strong>Trust</strong>.<br />
Nursing Quality <strong>and</strong> Accreditation<br />
Framework<br />
Measuring the quality of care at a ward level<br />
is not simple or easily quantifiable <strong>and</strong> so<br />
the <strong>Trust</strong> utilises a variety of methods. The<br />
<strong>Trust</strong> has recently developed a new approach<br />
entitled ‘Observations of Care’. This is a<br />
qualitative approach that uses inside <strong>and</strong><br />
outside observers <strong>and</strong> a structured tool,<br />
together with observational prompts that are<br />
used by the Care Quality Commission (CQC)<br />
during their unannounced visits.<br />
Observations of Care are scheduled monthly<br />
<strong>and</strong> enable the <strong>Trust</strong>’s most senior nurses<br />
to spend time on wards increasing the level<br />
of scrutiny <strong>and</strong> vigilance on the quality<br />
of nursing care. The visits assess the ward<br />
environment, attitudes <strong>and</strong> behaviours of<br />
staff, team working <strong>and</strong> specific aspects<br />
of safety. There is also a review of nursing<br />
records to ensure that they reflect clear,<br />
accurate <strong>and</strong> up to date information about<br />
patients’ care <strong>and</strong> treatment. Patients are<br />
also given the opportunity to discuss any<br />
concerns, whilst the observers check that the<br />
patient has a good underst<strong>and</strong>ing of their<br />
care.<br />
Executive <strong>and</strong> Non-Executive Directors are<br />
also invited to join in the observational<br />
visits. The first observation took place in<br />
February 20<strong>13</strong>, when 18 wards were visited.<br />
Verbal feedback is given on the day of<br />
the visit; this is followed up by a written<br />
report highlighting areas of good practice<br />
Directors’ report<br />
25
<strong>and</strong> recommendations for improvement.<br />
Ward staff have stated that they value this<br />
approach <strong>and</strong> that it helps them prepare for<br />
unannounced CQC visits.<br />
Observations of Care provide important<br />
qualitative information that can be used<br />
as part of the <strong>Trust</strong>’s overall assessment of<br />
nursing quality; <strong>and</strong> they are an essential<br />
component of the Nursing Quality <strong>and</strong><br />
Accreditation Framework (NQAF) that the<br />
<strong>Trust</strong> began to develop in February 20<strong>13</strong>.<br />
The NQAF will be based on our aim of<br />
ensuring that patients on our wards are<br />
always safe, comfortable, informed, <strong>and</strong><br />
involved. The NQAF sets out a number of<br />
indicators <strong>and</strong> other quality factors that<br />
will be used to measure <strong>and</strong> demonstrate<br />
sustained improvements in quality. It also<br />
describes the assessment process <strong>and</strong> the<br />
potential rewards for achieving accreditation.<br />
The framework will be shared more widely<br />
<strong>and</strong> approved by senior nurses in the <strong>Trust</strong><br />
prior to its launch later in the first quarter<br />
of 20<strong>13</strong>/14. Our ambition will be for all our<br />
wards to achieve accreditation.<br />
Dementia<br />
In line with the National Dementia Strategy,<br />
improving care for patients with dementia is<br />
listed as a key priority in the <strong>Trust</strong>’s Business<br />
Plan for 20<strong>13</strong>/14. We want to ensure that<br />
older people have timely access to services<br />
that are easy to navigate <strong>and</strong> fit for purpose.<br />
We are driving improvements in both the<br />
organisation <strong>and</strong> delivery of services for<br />
patients <strong>and</strong> carers. These include providing<br />
dementia training to all staff to increase their<br />
knowledge of the condition, ensuring that<br />
care is skilled, compassionate <strong>and</strong> respectful.<br />
We are increasing access to dementia<br />
screening for patients over 75 years, with<br />
forward referral for further assessment as<br />
indicated. We are developing individualised<br />
care <strong>and</strong> treatment plans utilising recognised<br />
tools such as the Alzheimer’s Society’s ‘This Is<br />
Me’ to ensure patient <strong>and</strong> carer involvement.<br />
We are a signatory to the Dementia Action<br />
Alliance’s Declaration <strong>and</strong> are making<br />
changes to our environment to progress our<br />
aspiration of being dementia-friendly.<br />
We will measure achievement of this<br />
objective through a number of monitoring<br />
tools. The <strong>Trust</strong>’s Dementia Strategy work<br />
plan includes ‘SMART’ objectives to deliver<br />
improvements in dementia care. We have<br />
also published an action plan on the<br />
Dementia Action Alliance’s website, which<br />
we will review throughout the year. We will<br />
capture patient <strong>and</strong> carer feedback via direct<br />
questioning <strong>and</strong> review patient surveys,<br />
compliments, complaints <strong>and</strong> incidents<br />
to ensure service changes are resulting in<br />
positive patient <strong>and</strong> carer experience.<br />
Our staff<br />
Staff consultation <strong>and</strong> engagement<br />
The <strong>Trust</strong> has a range of mechanisms for<br />
communicating information on matters<br />
of concern to staff including regular<br />
communication from the Chief Executive,<br />
<strong>and</strong> the Core Brief – an electronic monthly<br />
update. The magazine for staff <strong>and</strong> public<br />
members of the Foundation <strong>Trust</strong>, ‘The<br />
Pulse’, is distributed throughout the <strong>Trust</strong>’s<br />
hospitals.<br />
In <strong>2012</strong>/<strong>13</strong> a weekly General Information<br />
bulletin was introduced to communicate<br />
other information such as upcoming events<br />
or policy changes as a response to requests<br />
for more managed mechanisms around this<br />
type of information.<br />
<strong>Hospital</strong> management <strong>and</strong> Staff in<br />
Partnership representatives meet regularly<br />
at the Joint Negotiating <strong>and</strong> Consultative<br />
Committee to share information <strong>and</strong><br />
discuss a broad range of subjects that may<br />
affect staff. Seven members of the Council<br />
of Governors are elected by staff; <strong>and</strong> a<br />
further Governor is appointed by the Joint<br />
Negotiating & Consultative Committee in<br />
recognition of the importance of partnership<br />
working between the unions <strong>and</strong> <strong>Trust</strong><br />
management.<br />
26 Directors’ report
Staff members are actively informed <strong>and</strong><br />
encouraged to contribute to the <strong>Trust</strong>’s<br />
performance via the above communication<br />
mechanisms <strong>and</strong> specific briefing items. In<br />
<strong>2012</strong>/<strong>13</strong> open briefing sessions with the Chief<br />
Executive were introduced <strong>and</strong> are now<br />
held regularly. At these sessions the Chief<br />
Executive discusses issues relevant to the<br />
<strong>Trust</strong>, including performance <strong>and</strong> financial<br />
matters, <strong>and</strong> responds to questions from<br />
staff. In March 20<strong>13</strong> ‘Listening Sessions’ were<br />
held on both the <strong>Hillingdon</strong> <strong>and</strong> Mount<br />
Vernon sites to discuss what can be learnt<br />
from the Mid Staffordshire <strong>NHS</strong> Foundation<br />
<strong>Trust</strong> Public Inquiry <strong>and</strong> to ask staff for their<br />
thoughts, views <strong>and</strong> concerns about how<br />
every patient can be provided with safe,<br />
quality care which encompasses our CARES<br />
values.<br />
Scores were less positive than other <strong>Trust</strong>s<br />
on team-working, staff working additional<br />
hours, staff receiving job-relevant training,<br />
availability of h<strong>and</strong> washing materials,<br />
incident reporting measures, staff<br />
experiencing violence <strong>and</strong> harassment at<br />
work, staff feeling pressure to attend work<br />
when feeling unwell, staff feeling unable to<br />
contribute towards improvements at work,<br />
equal opportunities for career progression,<br />
<strong>and</strong> staff experiencing discrimination at<br />
work. Tables 2 <strong>and</strong> 3 identify the <strong>Trust</strong>’s top<br />
<strong>and</strong> bottom ranking indicators.<br />
‘Bright ideas’, the <strong>Trust</strong>’s Staff Suggestion<br />
Scheme was launched in 20<strong>13</strong>. This scheme<br />
asks for suggestions from staff on a wide<br />
range of ideas they may have including<br />
ways of saving money, time, or making<br />
improvements in our hospitals.<br />
<strong>NHS</strong> staff survey<br />
Summary of performance<br />
The <strong>NHS</strong> staff survey provides the <strong>Trust</strong><br />
with valuable feedback on the views of our<br />
staff. In <strong>2012</strong>, 44% of staff responded to the<br />
national staff survey compared to 43% in<br />
2011, <strong>and</strong> a national response rate of 50%.<br />
Overall, staff engagement was above (better<br />
than) average when compared to other acute<br />
<strong>Trust</strong>s <strong>and</strong> an improvement on 2011.<br />
In the survey, <strong>Trust</strong> staff members gave<br />
more positive comments compared with<br />
other <strong>Trust</strong>s on a range of issues. These<br />
included staff feeling satisfied with the<br />
quality of work <strong>and</strong> patient care they are<br />
able to deliver, appraisals <strong>and</strong> PDRs (personal<br />
development reviews), good communication,<br />
recommending the <strong>Trust</strong> as a place to work<br />
or receive treatment, <strong>and</strong> staff motivation.<br />
Directors’ report<br />
27
Table 1: <strong>Trust</strong> response rate<br />
2011/<strong>2012</strong> <strong>2012</strong>/<strong>13</strong><br />
<strong>Trust</strong><br />
improvement/<br />
Deterioration<br />
<strong>Trust</strong> National average <strong>Trust</strong> National average<br />
Response rate 43% 54% 44% 50% Increase by 1%<br />
point<br />
Table 2: <strong>Trust</strong>’s top four ranking scores<br />
2011/<strong>2012</strong> <strong>2012</strong>/<strong>13</strong><br />
<strong>Trust</strong><br />
Improvement/<br />
Deterioration<br />
Top four ranking scores <strong>Trust</strong> National average <strong>Trust</strong> National average<br />
KF7 Staff appraised in 90% 81% 94% 84% Increase by 4%<br />
last 12 months<br />
KF8 Staff having well 44% 34% 46% 36% Increase by 2%<br />
structured appraisals in<br />
last 12 months<br />
KF14 Staff reporting 95% 96% 95% 90% No change<br />
errors, near misses or<br />
incidents witnessed in<br />
the last month<br />
KF9 Support from<br />
immediate line managers<br />
3.58 3.61 3.70 3.61 No change<br />
Table 3: <strong>Trust</strong>’s bottom four ranking scores<br />
2011/<strong>2012</strong><br />
<strong>2012</strong>/<strong>13</strong><br />
<strong>Trust</strong><br />
Improvement/<br />
Deterioration<br />
Bottom four ranking<br />
scores<br />
KF17 Staff experiencing<br />
physical violence from<br />
staff in last 12 months<br />
KF6 Staff receiving<br />
job-relevant training,<br />
learning or development<br />
in last 12 months<br />
KF5 Staff working extra<br />
hours<br />
KF10 Staff receiving<br />
health <strong>and</strong> safety<br />
training in last 12<br />
months<br />
<strong>Trust</strong> National average <strong>Trust</strong> National average<br />
1% 1% 4% 3% Increase by 3%<br />
76% 78% 77% 81% Increase by 1%<br />
58% 65% 75% 70% Increase by 17%<br />
81% 81% 65% 74% Decrease by 16%<br />
28 Directors’ report
Action plan<br />
In light of the Francis <strong>Report</strong>, as well as the<br />
outcomes from our own staff survey <strong>and</strong> the<br />
various listening events <strong>and</strong> communication<br />
exercises recently undertaken in the <strong>Trust</strong>, we<br />
are revisiting a range of current action plans<br />
to ensure that our work in response to what<br />
our staff tell us is co-ordinated <strong>and</strong> clear.<br />
We will be specifying what our priorities are<br />
<strong>and</strong> why this is the case, <strong>and</strong> we will also be<br />
linking our work plans closely to the CARES<br />
values that we have adopted. These actions<br />
may include:<br />
• Publicising the staff survey results for<br />
<strong>2012</strong> throughout the <strong>Trust</strong> utilising<br />
various media. As in previous years,<br />
this will be in the style of ‘You Said’,<br />
‘We Will’.<br />
• Promoting an environment that<br />
encourages the management of workrelated<br />
stress using a risk assessment<br />
approach.<br />
• Promoting the National<br />
Whistleblowing help-line.<br />
• Promoting the availability of statutory<br />
<strong>and</strong> m<strong>and</strong>atory training <strong>and</strong> exp<strong>and</strong><br />
options for its delivery.<br />
• Promoting the Dignity at Work policy,<br />
exploring options for providing a<br />
mediation service.<br />
We will communicate the outcome of this<br />
work to all staff as soon as possible.<br />
Future priorities<br />
CARES<br />
In 2011, following a number of focus groups<br />
<strong>and</strong> a period of voting, staff chose CARES<br />
(Communication; Attitude; Responsibility;<br />
Equity; <strong>and</strong> Safety) as the acronym to reflect<br />
the culture <strong>and</strong> values of the <strong>Trust</strong> along with<br />
some underpinning behaviours expected of<br />
all staff.<br />
In <strong>2012</strong>/<strong>13</strong> the CARES Champions group<br />
focused on raising awareness of our culture<br />
<strong>and</strong> values <strong>and</strong> role modelling behaviours<br />
<strong>and</strong> attitudes that CARES promotes. This<br />
has been done in a range of ways including<br />
the Champions talking about CARES to<br />
colleagues <strong>and</strong> patients across the <strong>Trust</strong>. In<br />
<strong>2012</strong> the <strong>Trust</strong> included specific questions on<br />
CARES in the staff survey. This indicated that<br />
84% of staff understood what CARES is.<br />
A CARES rating scale has been included in the<br />
PDR paperwork for this year, st<strong>and</strong>ardised<br />
questions have been developed for use<br />
during selection processes, <strong>and</strong> we have<br />
begun to integrate CARES into key policies<br />
<strong>and</strong> procedural documents. Future priorities<br />
will include further embedding of CARES <strong>and</strong><br />
developing the role of the CARES Champions<br />
into Ambassadors to elevate the status of the<br />
role <strong>and</strong> provide more structure.<br />
Putting People First (PPF) programme<br />
The Putting People First Programme<br />
was established in 2011 with the aim of<br />
improving both the patient experience <strong>and</strong><br />
staff experience <strong>and</strong> to increase patient <strong>and</strong><br />
staff engagement. The programme consists<br />
of work streams to embed <strong>and</strong> integrate<br />
Putting People First in our key processes.<br />
Progress to embed CARES <strong>and</strong> the impact<br />
on the <strong>Trust</strong> will be monitored via the<br />
Putting People First Steering Group using<br />
responses from patients <strong>and</strong> staff to specific<br />
questions in the patient <strong>and</strong> staff surveys.<br />
The group will also monitor the number<br />
of complaints received relating to staff<br />
attitude, communication <strong>and</strong> information<br />
to patients, <strong>and</strong> discrimination. Progress will<br />
be communicated to staff using a variety of<br />
methods, including ‘The Pulse’ <strong>and</strong> other<br />
appropriate newsletters.<br />
Policies in relation to disabled<br />
employees <strong>and</strong> equal opportunities<br />
The <strong>Trust</strong> has an Equality <strong>and</strong> Human Rights<br />
Policy <strong>and</strong> a single equality scheme which<br />
set out very clearly for our staff, patients<br />
<strong>and</strong> the community that we are committed<br />
to delivering an equality <strong>and</strong> human rightsbased<br />
approach to healthcare. The policy<br />
Directors’ report<br />
29
outlines how we will provide equality <strong>and</strong><br />
fairness for all those in our employment <strong>and</strong><br />
not discriminate on grounds of any of the<br />
legally designated protected characteristics<br />
(gender reassignment, marriage <strong>and</strong> civil<br />
partnership, pregnancy <strong>and</strong> maternity, race,<br />
religion <strong>and</strong> belief, sex, sexual orientation,<br />
disability, <strong>and</strong> age).<br />
The <strong>Trust</strong>’s policy is implemented in<br />
accordance with all current legislation<br />
relating to The Equality Act 2010. The <strong>Trust</strong> is<br />
accredited with the ‘two-ticks’ symbol which<br />
is awarded by Job Centre Plus to employers<br />
who have made commitments to employ,<br />
keep, <strong>and</strong> develop the abilities of disabled<br />
staff.<br />
In <strong>2012</strong> the <strong>Trust</strong> published its Equality<br />
Objectives <strong>Report</strong> with specific objectives<br />
around staff culture <strong>and</strong> values, including fair<br />
<strong>and</strong> inclusive recruitment processes. Progress<br />
against this objective is monitored by the<br />
Experience <strong>and</strong> Engagement Group.<br />
Occupational health <strong>and</strong> sickness<br />
absence data<br />
The <strong>Trust</strong> has an Occupational Health<br />
department who provide advice on how<br />
to protect individuals from harm, to help<br />
identify all those aspects of health which<br />
affect employees’ capacity to work efficiently,<br />
<strong>and</strong> improve their quality of life in a safe<br />
working environment. Staff have access to<br />
the Employee Assistance Programme (EAP)<br />
<strong>and</strong> a free confidential helpline that can<br />
provide advice <strong>and</strong> support on a range of<br />
issues such as financial difficulties, workplace<br />
difficulties, <strong>and</strong> health <strong>and</strong> wellbeing.<br />
Information on sickness absence is contained<br />
in note 6.2 to the accounts.<br />
Equality duty<br />
The <strong>Trust</strong> as a public health authority is<br />
‘listed’ under Schedule 19 of the Equality<br />
Act 2010 <strong>and</strong> is therefore required to comply<br />
with the equality duties under Section 149<br />
<strong>and</strong> Regulations 2011.<br />
This means that when staff are delivering<br />
services <strong>and</strong> carrying out the <strong>Trust</strong>’s<br />
functions, they must consciously think about<br />
<strong>and</strong> pay due regard to the three aims of the<br />
general equality duty as an integral part of<br />
the decision making process. Details of the<br />
equality duty aims <strong>and</strong> the <strong>Trust</strong>’s statement,<br />
documenting how the <strong>Trust</strong> is meeting the<br />
duty, have been published on the <strong>Trust</strong>’s<br />
website.<br />
The specific duties require public bodies to:<br />
• Publish relevant, proportionate<br />
information demonstrating their<br />
compliance with the general equality<br />
duty by 31st January 20<strong>13</strong><br />
• Set <strong>and</strong> publish specific, measurable<br />
equality objectives by 6th April 20<strong>13</strong>.<br />
On 31st January 20<strong>13</strong>, the <strong>Trust</strong> published<br />
its Service Equality Compliance <strong>Report</strong> <strong>and</strong><br />
Workforce Equality Compliance <strong>Report</strong><br />
on the <strong>Trust</strong>’s public website. Both reports<br />
include actions <strong>and</strong> initiatives taking place<br />
within the <strong>Trust</strong> to meet the Public Sector<br />
Equality Duty <strong>and</strong> that areas that continue<br />
to need addressing are being addressed via<br />
the four year objectives set in April <strong>2012</strong>. The<br />
<strong>Trust</strong> published an update of its objectives<br />
in April 20<strong>13</strong> <strong>and</strong> will do so thereafter on an<br />
annual basis.<br />
Financial disclosures<br />
The financial statements for the year ended<br />
31st March 20<strong>13</strong> have been prepared on a<br />
going concern basis. After making enquiries,<br />
the Directors have a reasonable expectation<br />
that the <strong>Trust</strong> has adequate resources to<br />
continue in operational existence for the<br />
foreseeable future. For this reason, they<br />
continue to adopt the going concern basis<br />
in preparing the accounts. In making this<br />
declaration the Board is mindful of the<br />
recent financial performance <strong>and</strong> the<br />
extremely challenging financial context<br />
facing the <strong>Trust</strong>, including the requirement<br />
for significant year on year efficiency savings<br />
<strong>and</strong> <strong>Hillingdon</strong> Clinical Commissioning<br />
30 Directors’ report
Group’s (CCG) intention to reduce the level<br />
of activity at the <strong>Trust</strong>. To mitigate these<br />
challenges the Board has invested in an<br />
enhanced programme management office<br />
to support the delivery of the savings, <strong>and</strong> is<br />
also able to draw upon <strong>Hillingdon</strong> <strong>Hospital</strong><br />
being identified as a ‘fixed point’ in the<br />
North West London ‘Shaping a Healthier<br />
Future Strategy’ which the CCG is committed<br />
to supporting.<br />
The <strong>NHS</strong> Foundation <strong>Trust</strong> <strong>Annual</strong> <strong>Report</strong>ing<br />
Manual states that it is best practice for<br />
<strong>NHS</strong> Foundation <strong>Trust</strong>s to disclose ‘other<br />
income’ when such amounts in the notes<br />
to the accounts are significant. There is<br />
no significant ‘other income’ to report.<br />
As outlined earlier in the report, the vast<br />
majority of the <strong>Trust</strong>’s income is from goods<br />
<strong>and</strong> services related to the Health Service in<br />
Engl<strong>and</strong>.<br />
The <strong>NHS</strong> Foundation <strong>Trust</strong> <strong>Annual</strong> <strong>Report</strong>ing<br />
Manual states that the annual report<br />
<strong>and</strong> accounts should highlight where any<br />
market values of fixed assets are known<br />
to be significantly different from values<br />
at which those assets are held in the<br />
<strong>Trust</strong>’s financial statements, where it is the<br />
Directors’ view that any such difference<br />
is of such significance that readers of the<br />
accounts should be alerted to this. There<br />
were no significant differences in market<br />
value compared to holding value to report<br />
for the financial year ending 31 March 20<strong>13</strong>.<br />
Investment properties were revalued to<br />
current market value as at 31st March 20<strong>13</strong><br />
from £<strong>13</strong>,124k to £14,816k, resulting in a<br />
gain of £1,692k.<br />
The <strong>NHS</strong> Foundation <strong>Trust</strong> <strong>Annual</strong> <strong>Report</strong>ing<br />
Manual states that it is best practice for <strong>NHS</strong><br />
Foundation <strong>Trust</strong>s to disclose the number of,<br />
<strong>and</strong> average additional pension liabilities for,<br />
individuals who retired early on ill-health<br />
grounds during the year. Four staff retired on<br />
grounds of ill health at a cost to the <strong>Trust</strong> of<br />
£165k (in 2011/12 there were nil retirements<br />
on grounds of ill health).<br />
The <strong>Trust</strong> policy on creditor payment is to<br />
endeavour to adhere to the Better Payment<br />
Practice Code of paying 95% of invoices in<br />
terms of numbers <strong>and</strong> value within 30 days<br />
of receipt, cash flows permitting. Information<br />
on the <strong>Trust</strong>’s payment of creditors <strong>and</strong><br />
compliance with the Better Payment Practice<br />
Code is included in note 7.1 of the accounts.<br />
In relation to the use of financial<br />
instruments, an indication of the financial<br />
risk management objectives <strong>and</strong> policies<br />
of the <strong>Trust</strong> <strong>and</strong> the exposure to price risk,<br />
credit risk, liquidity risk <strong>and</strong> cash flow risk<br />
can be found in note 1.38 of the accounts.<br />
Information on the pension arrangements<br />
<strong>and</strong> other retirement benefits are set out in<br />
note 1.12 of the accounts. Details of senior<br />
employees’ remuneration can be found in<br />
the remuneration report <strong>and</strong> note 6.9 of the<br />
accounts.<br />
Other disclosures<br />
Research <strong>and</strong> development<br />
Clinical teams are encouraged to invite their<br />
patients to participate in high quality multicentre<br />
research studies as part of the <strong>Trust</strong>’s<br />
commitment to improving the quality of<br />
care provided. Participation in research <strong>and</strong><br />
development enables patients to access new<br />
treatments that would not have otherwise<br />
been available <strong>and</strong> supports our clinicians to<br />
stay abreast of the latest treatments.<br />
The majority of the <strong>Trust</strong>’s research <strong>and</strong><br />
development activities are National Institute<br />
for Health Research (NIHR) portfolio adopted<br />
multi-centre studies where the <strong>Trust</strong> acts<br />
as a recruiting site on behalf of the lead<br />
centre. Our research portfolio is a balance of<br />
observational <strong>and</strong> treatment studies across<br />
many clinical areas in the <strong>Trust</strong> including<br />
Cancer, Stroke, Haematology, Paediatrics <strong>and</strong><br />
many of the general medicine <strong>and</strong> surgical<br />
specialities. The <strong>Trust</strong> also supports a small<br />
number of studies undertaken by our own<br />
staff <strong>and</strong> students from the local universities<br />
undertaking PhD <strong>and</strong> Masters courses.<br />
Directors’ report<br />
31
All of our research activity is scrutinised<br />
for quality <strong>and</strong> compliance to acceptable<br />
st<strong>and</strong>ards expected by the Research<br />
Governance Framework. Our research<br />
governance approval metrics comply with the<br />
30 day st<strong>and</strong>ards required by the Department<br />
of Health (NIHR).<br />
Charging for information<br />
The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation<br />
<strong>Trust</strong> complies with the cost allocation<br />
<strong>and</strong> charging requirements set out in<br />
HM Treasury <strong>and</strong> Office of Public Sector<br />
Information guidance. There is no additional<br />
charge for material made available to meet<br />
the needs of particular groups of people, e.g.<br />
in Braille or other languages.<br />
Serious incidents involving data loss or<br />
confidentiality breach<br />
The <strong>Trust</strong> takes its responsibility to keep<br />
personal data safe very seriously. New<br />
staff receive information governance<br />
training during induction in their first week<br />
at the <strong>Trust</strong> <strong>and</strong> it is m<strong>and</strong>ated that all<br />
staff undertake information governance<br />
training annually. The <strong>Trust</strong> Board is<br />
required to annually certify against the<br />
<strong>Trust</strong>’s compliance with <strong>NHS</strong> information<br />
governance st<strong>and</strong>ards.<br />
There has been one serious incident relating<br />
to loss of data during <strong>2012</strong>/<strong>13</strong>. In June <strong>2012</strong><br />
the <strong>Trust</strong> misplaced patient records which<br />
attracted media attention. This incident<br />
was investigated as a serious incident by<br />
the <strong>Trust</strong>, <strong>and</strong> reported to the Information<br />
Commissioner’s Office (ICO). The <strong>Trust</strong><br />
is currently assisting the ICO with their<br />
investigation.<br />
The table below contains details of other<br />
reported personal data related incidents as<br />
categorised by the Department of Health.<br />
Policies <strong>and</strong> procedures for countering<br />
fraud <strong>and</strong> corruption<br />
The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation<br />
<strong>Trust</strong> will not tolerate any form of fraud,<br />
bribery or corruption by, or of, its employees,<br />
associates, or any person or body acting on<br />
its behalf.<br />
The <strong>Trust</strong> is committed to ensure that the<br />
number of offences is kept to a minimum<br />
<strong>and</strong> that all allegations will be investigated<br />
thoroughly <strong>and</strong> the strongest sanctions<br />
including criminal sanctions will be taken<br />
against anybody found to be or having<br />
committed a fraud, bribery or corruption<br />
offence.<br />
SUMMARY OF PERSONAL DATA RELATED INCIDENTS IN <strong>2012</strong>/<strong>13</strong><br />
Category Nature of incident Total<br />
I Loss/theft of inadequately protected electronic equipment, devices or paper 2<br />
documents from secured <strong>NHS</strong> premises<br />
II Loss/theft of inadequately protected electronic equipment, devices or paper 1<br />
documents from outside secured <strong>NHS</strong> premises.<br />
III Insecure disposal of inadequately protected electronic equipment, devices 0<br />
or paper documents<br />
IV Unauthorised disclosure 3<br />
V Other 0<br />
32 Directors’ report
The <strong>Trust</strong> engages Parkhill as its Local<br />
Counter Fraud Specialist (LCFS) in accordance<br />
with Secretary of State Directions to support<br />
its work in this area.<br />
The <strong>Trust</strong>’s Audit & Assurance Committee<br />
agrees the annual work-plan for the<br />
LCFS <strong>and</strong> receives six-monthly reports on<br />
progress against its delivery. The Committee<br />
has agreed the <strong>Trust</strong>’s Counter Fraud Policy,<br />
which is the <strong>Trust</strong>’s policy for dealing with<br />
suspected fraud, bribery <strong>and</strong> corruption.<br />
Health & safety performance<br />
The <strong>Trust</strong> continues to set the highest<br />
st<strong>and</strong>ards of health <strong>and</strong> safety through our<br />
Health <strong>and</strong> Safety Strategy for all our staff<br />
in the workplace, for members of the public,<br />
patients, <strong>and</strong> others who come in to our<br />
premises.<br />
Health <strong>and</strong> safety governance: The <strong>Trust</strong> has<br />
a management group consisting of clinical<br />
<strong>and</strong> non clinical senior managers from across<br />
the <strong>Trust</strong> whose main purpose is health <strong>and</strong><br />
safety strategy implementation <strong>and</strong> planning<br />
that supports the function of the Health <strong>and</strong><br />
Safety Committee. The Health <strong>and</strong> Safety<br />
Committee has met quarterly throughout<br />
<strong>2012</strong>/<strong>13</strong> <strong>and</strong> the <strong>Trust</strong> Board has received<br />
quarterly reports on health <strong>and</strong> safety issues<br />
<strong>and</strong> performance during the year.<br />
Training: All new members of staff receive<br />
health <strong>and</strong> safety training during their<br />
corporate induction <strong>and</strong> are able to access<br />
refresher training via an e-learning package<br />
<strong>and</strong> face to face courses. The <strong>Trust</strong> has<br />
achieved over 80% compliance with its<br />
health <strong>and</strong> safety training.<br />
<strong>Trust</strong>’s auditors<br />
The Council of Governors has appointed<br />
Deloitte as the <strong>Trust</strong>’s external auditors.<br />
The audit fee is contained in note 4 of the<br />
accounts.<br />
The Board confirms that for each individual<br />
who was a Director at the time that this<br />
report was approved (28th May 20<strong>13</strong>):<br />
• so far as the Director is aware, there is<br />
no relevant audit information of which<br />
the <strong>NHS</strong> Foundation <strong>Trust</strong>’s auditor is<br />
unaware; <strong>and</strong><br />
• the Director has taken all the steps that<br />
they ought to have taken as a Director<br />
in order to make themselves aware of<br />
any relevant audit information <strong>and</strong> to<br />
establish that the <strong>NHS</strong> Foundation <strong>Trust</strong>’s<br />
auditor is aware of that information.<br />
Political <strong>and</strong> charitable donations<br />
During the year, the <strong>Trust</strong> has not made any<br />
political or charitable donations.<br />
Important events affecting the<br />
Foundation <strong>Trust</strong> occurring since the end<br />
of the financial year<br />
The Board confirmed at its meeting on 28th<br />
May 20<strong>13</strong> at which this annual report <strong>and</strong><br />
accounts were approved, that there were no<br />
events that required disclosure.<br />
Performance: During the reporting period<br />
there were a total of 1,936 incidents<br />
reported. 14 of these incidents were<br />
reportable to the Health & Safety Executive<br />
(HSE) under RIDDOR (<strong>Report</strong>ing of Injuries,<br />
Diseases <strong>and</strong> Dangerous Occurrence<br />
Regulations).<br />
Directors’ report<br />
33
GOVERNANCE REPORT<br />
Who does what<br />
The <strong>Trust</strong> is headed by the Board of Directors<br />
(often referred to as ‘the Board’). The Board’s<br />
key responsibilities are to:<br />
• Provide leadership to the Foundation<br />
<strong>Trust</strong> within a framework of processes,<br />
procedures <strong>and</strong> controls which enable risk<br />
to be assessed <strong>and</strong> managed.<br />
• Ensure the Foundation <strong>Trust</strong> complies<br />
with its Terms of Authorisation (<strong>and</strong><br />
from 1st April 20<strong>13</strong> its Licence which<br />
replaces the Terms of Authorisation);<br />
its Constitution; requirements set by<br />
Monitor; <strong>and</strong> relevant statutory <strong>and</strong><br />
contractual obligations.<br />
• Set the Foundation <strong>Trust</strong>’s vision, values<br />
<strong>and</strong> st<strong>and</strong>ards of conduct.<br />
• Set the Foundation <strong>Trust</strong>’s strategic aims<br />
<strong>and</strong> ensure that the necessary human <strong>and</strong><br />
financial resources are in place to deliver<br />
these.<br />
• Ensure the quality <strong>and</strong> safety of the<br />
healthcare services provided by the<br />
Foundation <strong>Trust</strong>.<br />
• Ensure that the Foundation <strong>Trust</strong> exercises<br />
its functions effectively, efficiently <strong>and</strong><br />
economically.<br />
The Board undertakes these responsibilities<br />
through a set business cycle that includes<br />
approving strategic documents such as the<br />
forward plan (also known as the annual<br />
plan) <strong>and</strong> other strategies, <strong>and</strong> receiving<br />
monitoring reports on areas such as key<br />
risks, financial, operational, <strong>and</strong> quality<br />
performance.<br />
The Board has approved a Scheme of<br />
Reservation <strong>and</strong> Delegation which outlines<br />
the decisions that must be taken by the<br />
Board <strong>and</strong> the decisions that are delegated<br />
to the management of the hospital.<br />
For example, contracts or investment<br />
proposals over a certain financial value<br />
must be approved by the Board, whereas<br />
the approval of lower value contracts is<br />
delegated to management.<br />
The Council of Governors is responsible for<br />
representing the interests of the Foundation<br />
<strong>Trust</strong> members <strong>and</strong> partner organisations<br />
in the governance of the Foundation <strong>Trust</strong>.<br />
The Council of Governors is responsible for<br />
providing feedback from the membership<br />
<strong>and</strong> stakeholders on strategic developments<br />
at the <strong>Trust</strong>, including for example on<br />
the annual plan, <strong>and</strong> in turn should keep<br />
members <strong>and</strong> stakeholders informed about<br />
developments at the <strong>Trust</strong>.<br />
At the start of the <strong>2012</strong>/<strong>13</strong> financial year, the<br />
Council of Governors’ statutory powers were<br />
to:<br />
• Appoint, <strong>and</strong> if appropriate, remove the<br />
<strong>Trust</strong> Chairman.<br />
• Appoint, <strong>and</strong> if appropriate, remove the<br />
Non-Executive Directors.<br />
• Decide the remuneration <strong>and</strong> terms <strong>and</strong><br />
conditions of office of the Chairman <strong>and</strong><br />
the Non-Executive Directors.<br />
• Approve the appointment of the Chief<br />
Executive.<br />
• Appoint, <strong>and</strong> if appropriate, remove the<br />
Foundation <strong>Trust</strong>’s external auditor.<br />
• Receive the Foundation <strong>Trust</strong>’s annual<br />
accounts, any report of the auditor on<br />
them, <strong>and</strong> the annual report.<br />
On 1st October <strong>2012</strong>, the ‘private patient cap’<br />
was abolished <strong>and</strong> Foundation <strong>Trust</strong> Councils<br />
of Governors gained new powers in relation<br />
to non-<strong>NHS</strong> income as a result of the Health<br />
& Social Care Act <strong>2012</strong>. If a Foundation <strong>Trust</strong><br />
Board is proposing to generate income from<br />
activities other than for the provision of<br />
goods <strong>and</strong> services for the Health Service in<br />
Engl<strong>and</strong>, then the Council of Governors must<br />
vote on whether it is satisfied that these<br />
activities will not significantly interfere with<br />
the <strong>Trust</strong>’s ability to undertake its principal<br />
purpose (the provision of goods <strong>and</strong> services<br />
34 Governance report
for the Health Service in Engl<strong>and</strong>) or its<br />
other functions. Any proposal by the Board<br />
to increase the proportion of total income<br />
earned from non-principal purpose activities<br />
by five percentage points or more (e.g. from<br />
2% to 7% of the <strong>Trust</strong>’s income) requires<br />
approval by the Council of Governors.<br />
From 1st April 20<strong>13</strong> the Board <strong>and</strong> Council<br />
of Governors gained further new statutory<br />
duties as a result of the Health & Social Care<br />
Act <strong>2012</strong>. These made explicit duties which<br />
were previously implicit in their role.<br />
• The Council of Governors gained<br />
duties to (a) to hold the Non-Executive<br />
Directors individually <strong>and</strong> collectively<br />
to account for the performance of the<br />
Board of Directors; <strong>and</strong> (b) to represent<br />
the interests of the members of the<br />
corporation as a whole <strong>and</strong> the interests<br />
of the public.<br />
• Similar to Directors’ duties under the<br />
Companies Act 2006, Board Directors<br />
collectively <strong>and</strong> individually gained a duty<br />
to promote the success of the <strong>Trust</strong> so as<br />
to maximise the benefits for members <strong>and</strong><br />
for the public; <strong>and</strong> gained duties to avoid<br />
conflict of interests, not to accept any<br />
benefits from third parties <strong>and</strong> declare<br />
interests in any transactions that involve<br />
the <strong>Trust</strong>.<br />
The Council of Governors also gained new<br />
powers to approve ‘significant’ transactions<br />
at the <strong>Trust</strong>.<br />
Whilst the Council of Governors is responsible<br />
for holding the Board, <strong>and</strong> in particular<br />
the Non-Executive Directors, to account<br />
<strong>and</strong> ensuring that it is acting in a way that<br />
means the <strong>Trust</strong> will meet its obligations, it<br />
continues to remain the Board’s responsibility<br />
to oversee the running of the hospital.<br />
Further information on the Board of<br />
Directors <strong>and</strong> Council of Governors is<br />
outlined below.<br />
Board of Directors<br />
As at 31st March 20<strong>13</strong> the Board comprised<br />
seven Non-Executive Directors, a Non-<br />
Executive Chairman <strong>and</strong> seven Executive<br />
Directors 12 . Details of Board members as at<br />
31st March 20<strong>13</strong> are outlined below.<br />
Mike Robinson: Chair<br />
Prior to joining the <strong>Trust</strong> in July 2009, Mike<br />
was Chairman of <strong>NHS</strong> <strong>Hillingdon</strong>, (formerly<br />
<strong>Hillingdon</strong> PCT). He has a BA from Queens<br />
University, Belfast <strong>and</strong> post graduate<br />
qualifications in teaching <strong>and</strong> planning. He<br />
worked for Bristol City Council as Director of<br />
Housing 1984-1991 then as Chief Executive<br />
1991-1994. In March 1994 he was appointed<br />
Deputy Under Secretary at the Ministry<br />
of Defence until June 1995, <strong>and</strong> from<br />
September 1995 until September 2003 he<br />
was Chief Executive of South Gloucestershire<br />
Unitary Council. Mike is also an advisor to a<br />
number of local authorities. Mike chairs the<br />
Board of Directors Nominations Committee<br />
<strong>and</strong> the Transformation Committee. Mike’s<br />
term of office expires on 31st March 2014.<br />
Katey Adderley: Non-Executive Director<br />
Appointed in December 2010, Katey is<br />
a Chartered Management Accountant<br />
with 11 years of investment experience at<br />
Charterhouse Capital Partners where she<br />
was a Director. She has an Economics degree<br />
from Cambridge University <strong>and</strong> a Masters<br />
degree in Economic Evaluation in Healthcare.<br />
As well as bringing up a young family Katey<br />
is active in local voluntary work. Katey is a<br />
member of the <strong>Trust</strong>’s Audit & Assurance<br />
Committee. Katey’s term of office expires on<br />
30th November 2014.<br />
12 Claire Gore, Director of People, was appointed to the Board from 1st March 20<strong>13</strong>, thereby increasing the number of<br />
Executive Directors on the Board to seven (from six). Whilst the Medical Director role has been undertaken as a job-share<br />
from 1st January 20<strong>13</strong>, only one of the job share partners sits on the Board at any time, thereby counting as one Executive<br />
member of the Board.<br />
Governance report<br />
35
Carol Bode: Non-Executive Director<br />
Appointed in April <strong>2012</strong>, Carol is an<br />
Organisational Development Specialist with<br />
30 years in retail, customer services, financial<br />
services, <strong>and</strong> health & education. Previous<br />
roles have included Non-Executive Chairman<br />
of Southern Health <strong>NHS</strong> Foundation <strong>Trust</strong>,<br />
<strong>Trust</strong>ee on the Foundation <strong>Trust</strong> Network<br />
Board, <strong>and</strong> a Corporate Board Director with<br />
a General Motors Company. Carol is an<br />
Associate Consultant with both Foresight<br />
Partnership <strong>and</strong> QGI, <strong>and</strong> a Senior Advisor<br />
to Newton Europe. Carol is also a Magistrate<br />
in North Hampshire, <strong>and</strong> a Director of<br />
The Costello School (an Academy <strong>Trust</strong>) in<br />
Basingstoke. Carol’s term of office expires on<br />
31st March 2015.<br />
Alan McLeod: Non-Executive Director<br />
First appointed in October 2008, Alan<br />
is currently Sales Director of BT UK’s<br />
International Business Unit, <strong>and</strong> has<br />
extensive experience within the international<br />
telecommunications industry from a sales,<br />
marketing <strong>and</strong> technical perspective. Previous<br />
roles have included Managing Director of a<br />
UK Telecoms Company <strong>and</strong> President of an<br />
international joint venture. Alan’s term of<br />
office expires on 30th November 20<strong>13</strong>.<br />
Anthony Palmer: Non-Executive Director<br />
Appointed in April <strong>2012</strong>, Anthony is an<br />
Independent Nursing Consultant <strong>and</strong><br />
Expert Witness providing advice to lawyers,<br />
Coroners, <strong>and</strong> the Crown Prosecution Service.<br />
Anthony was previously Deputy Chief<br />
Executive <strong>and</strong> Director of Nursing for Luton<br />
& Dunstable <strong>Hospital</strong> <strong>NHS</strong> Foundation <strong>Trust</strong>,<br />
<strong>and</strong> held Executive Director Board positions<br />
for over 14 years. Anthony has advised<br />
Public Inquiries, has been involved with Care<br />
Quality Commission reviews as a Clinical<br />
Advisor, <strong>and</strong> was a visiting Professor at the<br />
University of Bedfordshire between 2008 <strong>and</strong><br />
<strong>2012</strong>. Anthony’s term of office expires on<br />
31st March 2015.<br />
Pradip Patel: Non-Executive Director<br />
Appointed in August 2011, Pradip qualified<br />
with a First Class Honours degree in<br />
Pharmacy from the London School of<br />
Pharmacy <strong>and</strong> has an MBA from Nottingham<br />
University. He has worked for Boots for over<br />
34 years, of which the last 18 years have been<br />
at senior <strong>and</strong> Board levels. He was Managing<br />
Director for Boots Opticians <strong>and</strong> Executive<br />
Chairman following its merger with Doll<strong>and</strong><br />
<strong>and</strong> Atchison, <strong>and</strong> is currently Director of<br />
Healthcare Strategy for Alliance Boots. He<br />
is a Fellow of the Chartered Institute of<br />
Management <strong>and</strong> a Member of the Royal<br />
Pharmaceutical Society of Great Britain.<br />
Pradip’s term of office expires on 31st July<br />
2014.<br />
Dr James Reid: Non-Executive Director<br />
<strong>and</strong> Deputy Chair<br />
First appointed in February 2008, James<br />
is a former Chief Executive of a privately<br />
owned oil refining <strong>and</strong> trading company,<br />
with extensive risk management experience<br />
within the oil <strong>and</strong> gas industry. He has a PhD<br />
in Mathematics from Edinburgh University,<br />
<strong>and</strong> worked for Shell for many years holding<br />
senior management positions in Shell’s<br />
trading <strong>and</strong> shipping organisation. James<br />
chairs the Board’s Quality & Risk Committee<br />
<strong>and</strong> the Remuneration Committee <strong>and</strong><br />
is a member of the Audit & Assurance<br />
Committee. James is also a Non-Executive<br />
Director of West Indies Oil Company <strong>and</strong> has<br />
advised various oil companies. James’ term of<br />
office expires on 31st March 2015. In March<br />
<strong>2012</strong> the Council of Governors reappointed<br />
James as Deputy Chairman for a further one<br />
year period to April 20<strong>13</strong>.<br />
Craig Rowl<strong>and</strong>: Non-Executive Director<br />
<strong>and</strong> Senior Independent Director<br />
First appointed in October 2006, Craig<br />
is a qualified accountant <strong>and</strong> former<br />
Managing Director of BT Group’s UK<br />
Business Division. Prior to his career at BT,<br />
Craig worked for Coopers & Lybr<strong>and</strong> (now<br />
36 Governance report
PricewaterhouseCoopers - PwC) where he<br />
qualified as a Chartered Accountant. He<br />
then moved to BT where he performed a<br />
number of Finance Director roles before<br />
moving into general management. Before<br />
leaving BT Craig played a lead role in setting<br />
up BT’s Openreach Division. Craig is also<br />
a Board member of the Christian charity<br />
Tearfund. Craig chairs the <strong>Trust</strong>’s Audit &<br />
Assurance Committee. Craig’s term of office<br />
expires on 30th September 2014. In March<br />
<strong>2012</strong> Craig was reappointed as the <strong>Trust</strong>’s<br />
Senior Independent Director by the Board in<br />
consultation with Council of Governors for a<br />
further one year period to April 20<strong>13</strong>.<br />
Shane DeGaris: Chief Executive (acting<br />
Chief Executive until 22nd May <strong>2012</strong>)<br />
First appointed as the <strong>Trust</strong>’s Deputy Chief<br />
Executive & Chief Operating Officer, in May<br />
<strong>2012</strong> Shane was appointed as the <strong>Trust</strong>’s<br />
substantive Chief Executive following a<br />
period as Acting Chief Executive. Shane is<br />
an experienced <strong>NHS</strong> Director having worked<br />
in a number of London <strong>Trust</strong>s in senior<br />
management roles including as Director of<br />
Operations at Barnet & Chase Farm <strong>Hospital</strong>s<br />
<strong>NHS</strong> <strong>Trust</strong> <strong>and</strong> as Deputy Chief Executive<br />
at Epsom & St Helier University <strong>Hospital</strong>s<br />
<strong>NHS</strong> <strong>Trust</strong>. Australian by birth, he began his<br />
healthcare career in 1990 after training as a<br />
Physiotherapist in Adelaide, South Australia.<br />
Shane has been appointed by the Board<br />
as the <strong>Trust</strong>’s Director of Imperial College<br />
Health Partners, <strong>and</strong> is also a Board member<br />
of the North West London Local Education &<br />
Training Board (a sub committee of Health<br />
Education Engl<strong>and</strong>), which is a Non-Executive<br />
role.<br />
Claire Gore: Director of People<br />
Claire joined the <strong>Trust</strong> in 2010 as Director of<br />
People, <strong>and</strong> was appointed as an Executive<br />
member of the Board by the Board of<br />
Directors Nominations Committee in March<br />
20<strong>13</strong>. Claire is a Fellow of the Chartered<br />
Institute of Personnel <strong>and</strong> Development<br />
(FCIPD) <strong>and</strong> has worked at a senior level<br />
in human resources <strong>and</strong> training <strong>and</strong><br />
development in a number of public sector<br />
organisations including the London Borough<br />
of Brent <strong>and</strong> the Metropolitan Police Service.<br />
Claire has Board level responsibility for<br />
human resources (including recruitment,<br />
employee relations <strong>and</strong> temporary staffing),<br />
occupational health, nurse training,<br />
workforce <strong>and</strong> organisational development.<br />
Dr Richard Grocott-Mason: Medical<br />
Director (job-share)*<br />
Appointed as Medical Director on a jobshare<br />
basis in January 20<strong>13</strong>, Richard Grocott-<br />
Mason is a Consultant in Cardiology <strong>and</strong><br />
General Medicine at THH <strong>and</strong> Harefield<br />
<strong>Hospital</strong>. His clinical work at THH covers<br />
general adult Cardiology <strong>and</strong> acute<br />
medicine cover. At Harefield Richard is<br />
an interventional Cardiologist <strong>and</strong> is on the<br />
rota covering the heart attack centre. Prior<br />
to taking up the position of Medical Director<br />
he was the <strong>Trust</strong>’s Clinical Director for the<br />
Division of Medicine <strong>and</strong> Emergency Care.<br />
Richard has been involved in the Clinical<br />
Expert Panel setting Adult Emergency Care<br />
st<strong>and</strong>ards for <strong>NHS</strong> London <strong>and</strong> part of the<br />
audit team reviewing acute <strong>Trust</strong>s in London.<br />
Richard is the <strong>Trust</strong>’s Responsible Officer for<br />
Revalidation.<br />
* whilst Dr Khakoo <strong>and</strong> Dr Grocott-Mason undertake the role of Medical Director on a job-share basis, the Board member<br />
responsibilities are held by one of the job-share partners at any given time. Dr Khakoo sits on the Board January to June,<br />
with Dr Grocott-Mason holding these responsibilities July to December.<br />
Governance report<br />
37
Dr Abbas Khakoo: Medical Director (jobshare)*<br />
Appointed as Medical Director on a jobshare<br />
basis in January 20<strong>13</strong>, Abbas Khakoo<br />
is a Consultant in Paediatrics <strong>and</strong> the care<br />
of newborn babies. He also runs a children’s<br />
allergy service at <strong>Hillingdon</strong> <strong>Hospital</strong> <strong>and</strong><br />
at St Mary’s <strong>Hospital</strong>, part of Imperial<br />
College Healthcare <strong>NHS</strong> <strong>Trust</strong>. Since October<br />
2010 Abbas has been the Clinical Director<br />
of Paediatrics (Honorary) at <strong>NHS</strong> London,<br />
<strong>and</strong> chairs both the <strong>NHS</strong> London Paediatric<br />
Emergency Clinical Panel <strong>and</strong> the North West<br />
London Paediatric Clinical Implementation<br />
Group. Prior to taking up the position of<br />
Medical Director at THH he was the <strong>Trust</strong>’s<br />
Clinical Director for Quality <strong>and</strong> Safety.<br />
Karl Munslow Ong: Chief Operating<br />
Officer (Acting COO until 11th October<br />
<strong>2012</strong>)<br />
After joining the <strong>Trust</strong> as Director of<br />
Operational Performance, Karl was<br />
appointed as the <strong>Trust</strong>’s substantive Chief<br />
Operating Officer in October <strong>2012</strong> following<br />
a period as Acting Chief Operating Officer.<br />
Karl is an experienced senior manager<br />
who has worked in a number operational<br />
management roles in <strong>Trust</strong>s across London,<br />
having also worked at strategic health<br />
authority level <strong>and</strong> in the private sector<br />
for one of the big four accountancy firms.<br />
Karl holds Board level responsibility for<br />
the management of the clinical divisions,<br />
emergency planning, the QIPP programme<br />
(Quality, Innovation, Productivity <strong>and</strong><br />
Prevention) as well as for ensuring the <strong>Trust</strong><br />
meets <strong>and</strong> exceeds all national <strong>and</strong> local<br />
patient access st<strong>and</strong>ards.<br />
David Searle: Corporate Development<br />
Director<br />
Appointed in 2007, David is a Chartered<br />
Director with senior level experience in<br />
the aerospace <strong>and</strong> defence industries.<br />
David holds Board-level responsibility for<br />
estates <strong>and</strong> facilities, corporate governance<br />
(including risk management <strong>and</strong> information<br />
governance), business development,<br />
communications <strong>and</strong> marketing.<br />
Jacqueline Walker: Acting Executive<br />
Director of the Patient Experience &<br />
Nursing (from 22nd October <strong>2012</strong>)<br />
Appointed as the <strong>Trust</strong>’s Acting Executive<br />
Director of the Patient Experience & Nursing<br />
in October <strong>2012</strong>, Jacqueline joined the<br />
<strong>Trust</strong> in March 2008 as the <strong>Trust</strong>’s Deputy<br />
Director of Nursing. Jacqueline qualified<br />
as a Registered Nurse in 1990 <strong>and</strong> has held<br />
a variety of nursing posts, specialising in<br />
urology <strong>and</strong> renal nursing, <strong>and</strong> in recent<br />
years specialising in senior nurse manager<br />
roles. As Acting Director of the Patient<br />
Experience & Nursing, Jacqueline holds Board<br />
level responsibility for infection prevention<br />
<strong>and</strong> control, safeguarding people, the<br />
patient experience <strong>and</strong> engagement, <strong>and</strong><br />
nursing.<br />
Paul Wratten: Finance Director<br />
Appointed in 2000, Paul is a member of<br />
the Chartered Institute of Public Finance<br />
<strong>and</strong> Accountancy, <strong>and</strong> has spent almost all<br />
his working life within the <strong>NHS</strong>, including<br />
working in performance management for<br />
the <strong>NHS</strong> in London. Paul also holds Boardlevel<br />
responsibility for purchasing <strong>and</strong><br />
supplies; <strong>and</strong> the <strong>Trust</strong>’s information services<br />
<strong>and</strong> information technology functions, which<br />
includes the clinical coding team.<br />
38 Governance report
The Constitution states that the Council<br />
of Governors will appoint one of the Non-<br />
Executive Directors as the Deputy Chairman,<br />
whilst the Board, in consultation with the<br />
Council of Governors appoints the Senior<br />
Independent Director. In March <strong>2012</strong>, James<br />
Reid <strong>and</strong> Craig Rowl<strong>and</strong> were reappointed<br />
for a further one year term as the Deputy<br />
Chairman <strong>and</strong> Senior Independent Director<br />
respectively. In April 20<strong>13</strong> James Reid was<br />
appointed as the Senior Independent<br />
Director <strong>and</strong> Pradip Patel as the Deputy<br />
Chairman; these appointments are not<br />
explicitly time limited <strong>and</strong> therefore run<br />
until the remainder of their term of office,<br />
unless revised by the Board <strong>and</strong> Council of<br />
Governors respectively.<br />
Changes to Board membership<br />
during the year<br />
During <strong>2012</strong>/<strong>13</strong> there were a number of<br />
changes to the Board membership. Patricia<br />
Rushton’s term of office as a Non-Executive<br />
Director expired on 1st April <strong>2012</strong>, with Carol<br />
Bode <strong>and</strong> Anthony Palmer joining the Board<br />
as Non-Executive Directors in April <strong>2012</strong>.<br />
Shane DeGaris <strong>and</strong> Karl MunslowOng were<br />
substantively appointed to the positions of<br />
Chief Executive <strong>and</strong> Chief Operating Officer<br />
respectively, following a period of acting<br />
up to these positions. Dr Susan LaBrooy<br />
retired as the <strong>Trust</strong>’s Medical Director on<br />
31st December <strong>2012</strong>, with Dr Khakoo <strong>and</strong><br />
Dr Grocott-Mason taking up the position<br />
of Medical Director on a job-share basis.<br />
In October <strong>2012</strong> Jacqueline Walker was<br />
appointed as Acting Director of the Patient<br />
Experience & Nursing following Marie Batey’s<br />
secondment to <strong>NHS</strong> London.<br />
Statement on the balance,<br />
completeness <strong>and</strong> appropriateness<br />
of the membership of the Board<br />
The Board of Directors Nominations &<br />
Remuneration Committee is responsible for<br />
reviewing the structure, size <strong>and</strong> composition<br />
of the Board <strong>and</strong> makes recommendations<br />
to the Council of Governors on the skills<br />
required for any upcoming Non-Executive<br />
Director appointments. As outlined above,<br />
the Board comprises individuals with senior<br />
level experience in the public <strong>and</strong> private<br />
sectors, across a range of disciplines including<br />
finance, governance, risk management,<br />
human resources, <strong>and</strong> change management.<br />
Recent Non-Executive appointments with<br />
clinical expertise have further strengthened<br />
the balance of the Board. The Board<br />
therefore confirms that the current<br />
composition is considered to be appropriate.<br />
Taking account of the <strong>NHS</strong> Foundation<br />
<strong>Trust</strong> Code of Governance published by<br />
Monitor, the Board considers the Chairman<br />
<strong>and</strong> all of the Non-Executive Directors to<br />
be ‘independent’. Whilst Craig Rowl<strong>and</strong><br />
was first appointed to the Board of The<br />
<strong>Hillingdon</strong> <strong>Hospital</strong> <strong>NHS</strong> <strong>Trust</strong> more than six<br />
years ago (in October 2006), the Board’s view<br />
is that the Director retains an independent<br />
viewpoint <strong>and</strong> ability to challenge/scrutinise<br />
management.<br />
Board members’ other commitments<br />
<strong>and</strong> Register of Interests<br />
Company Directorships <strong>and</strong> other significant<br />
commitments held by Board members<br />
are outlined above. Board members are<br />
required to enter their relevant interests<br />
in the Register of Directors’ Interests which<br />
is formally reviewed by the Board at least<br />
annually. The full register is available from<br />
the <strong>Trust</strong> Secretary on 01895 279976.<br />
As outlined above, Mike Robinson, the <strong>Trust</strong><br />
Chair, is an advisor to a number of local<br />
authorities. During the course of the year,<br />
Mike ceased to be a Non-Executive Director<br />
of FR Morrison Plc.<br />
Appointment <strong>and</strong> removal of Board<br />
members<br />
In accordance with the requirements of<br />
the <strong>NHS</strong> Act 2006, the Foundation <strong>Trust</strong><br />
Constitution outlines the respective<br />
Governance report<br />
39
esponsibilities of the Directors <strong>and</strong><br />
Governors in appointing <strong>and</strong> removing Board<br />
members.<br />
The Council of Governors is responsible<br />
for appointing, <strong>and</strong> if necessary, removing<br />
the Chairman <strong>and</strong> Non-Executive Directors.<br />
The Council of Governors Nominations<br />
& Remuneration Committee has been<br />
established to make recommendations<br />
to the Council of Governors on the<br />
appointment <strong>and</strong> remuneration of these<br />
positions, including identifying suitably<br />
qualified c<strong>and</strong>idates for appointment. At<br />
the start of the recruitment process the<br />
Board of Directors Nominations Committee<br />
makes recommendations to the Council of<br />
Governors Nominations & Remuneration<br />
Committee on the capabilities required for<br />
these appointments in light of the current<br />
Board composition <strong>and</strong> the challenges facing<br />
the <strong>Trust</strong>.<br />
When considering the appointment <strong>and</strong><br />
remuneration of Non-Executive Directors,<br />
the Council of Governors Nominations<br />
& Remuneration Committee consists<br />
of the <strong>Trust</strong> Chairman (who chairs the<br />
Committee), three Public Governors,<br />
one Staff Governor <strong>and</strong> one Appointed<br />
Governor. When considering the<br />
appointment <strong>and</strong> remuneration of the<br />
Chairman, the Committee consists of three<br />
Public Governors, one Staff Governor, one<br />
Appointed Governor, <strong>and</strong> one Non-Executive<br />
Director (who chairs the Committee on<br />
these occasions - this is currently the Senior<br />
Independent Director). The Chief Executive<br />
<strong>and</strong> Director of People are invited to attend<br />
to provide advice to the Committee.<br />
Should any such circumstances arise, the<br />
Council of Governors Nominations &<br />
Remuneration Committee is responsible for<br />
investigating the grounds for any resolution<br />
to remove the Chairman or a Non-Executive<br />
Director, <strong>and</strong> preparing a report on this issue<br />
with recommendations for the consideration<br />
of the Council of Governors. Removal of<br />
the Chairman or a Non-Executive Director<br />
requires the approval of three-quarters of<br />
the members of the Council of Governors.<br />
The Chief Executive is appointed by the<br />
Board of Directors Nominations Committee<br />
which comprises the Chairman (Committee<br />
chair) <strong>and</strong> all of the Non-Executive Directors.<br />
The appointment must be approved by the<br />
Council of Governors. The Board of Directors<br />
Nominations Committee is responsible for<br />
agreeing the removal of the Chief Executive<br />
should this be required – any such decision<br />
does not require the Council of Governors’<br />
approval.<br />
The Board of Directors Nominations<br />
Committee is responsible for appointing <strong>and</strong><br />
removing the Executive Directors. The Chief<br />
Executive is also a member of the Committee<br />
when it is considering the appointment<br />
<strong>and</strong> removal of the Executive Directors. The<br />
Director of People is invited to attend the<br />
Committee to provide advice as required.<br />
Performance evaluation of the<br />
Board, its Committees, <strong>and</strong> Board<br />
members<br />
The Board reviews its performance annually.<br />
This annual review of the Board draws<br />
upon a self-assessment by each Board<br />
Committee, which includes a review of each<br />
Board Committee’s terms of reference. The<br />
review this year highlighted that there was<br />
a potential for overlap <strong>and</strong> duplication<br />
between the Integrated Risk Management<br />
Committee <strong>and</strong> the Clinical Quality &<br />
St<strong>and</strong>ards Committee, with both Committees<br />
considering issues of clinical risk. The Board<br />
therefore merged these Committees into a<br />
single Committee that focuses on all matters<br />
relating to risk <strong>and</strong> clinical quality, in order<br />
to ensure an alignment of the consideration<br />
of risk <strong>and</strong> issues relating to clinical quality<br />
<strong>and</strong> st<strong>and</strong>ards. The Board also concluded<br />
as part of this review that greater Board<br />
focus <strong>and</strong> scrutiny was required on the<br />
transformation that is essential for the <strong>Trust</strong><br />
to be able to respond to the challenging<br />
financial <strong>and</strong> operating context. The Board<br />
40 Governance report
therefore replaced the Finance & Investment<br />
Committee with a new Committee – the<br />
Transformation Committee – which seeks to<br />
replace a backward review of past financial<br />
statements with a more forward look at<br />
change projects. This new Committee is<br />
part of the Board’s recognition that the<br />
traditional approach of incremental savings<br />
will not be sufficient, which also led to the<br />
investment in an enhanced Programme<br />
Management Office.<br />
The Board agreed not to utilise external<br />
support for this Board evaluation in <strong>2012</strong>/<strong>13</strong><br />
given the significant level of external<br />
review of the <strong>Trust</strong>’s governance during<br />
the Foundation <strong>Trust</strong> application, <strong>and</strong> the<br />
external perspective that could be brought<br />
by recently appointed Board members.<br />
Board members are subject to an annual<br />
individual performance appraisal.<br />
• The Chair’s appraisal is led by the<br />
Senior Independent Director, whilst the<br />
Chairman leads the appraisal of the<br />
Non-Executive Directors. The Council<br />
of Governors, through the Council of<br />
Governors Nominations & Remuneration<br />
Committee, feed in their views to<br />
these appraisals <strong>and</strong> the full Council of<br />
Governors are formally briefed on the<br />
outcomes. The outcomes of the 2011/12<br />
appraisals were considered at the July<br />
<strong>2012</strong> Council of Governors meeting.<br />
• The Chief Executive undertakes the<br />
appraisal of the Executive Directors, <strong>and</strong><br />
the Chair undertakes the appraisal of the<br />
Chief Executive. The Board of Directors<br />
Remuneration Committee oversees the<br />
Chairman’s monitoring <strong>and</strong> evaluation<br />
of the Chief Executive’s performance,<br />
<strong>and</strong> the Chief Executive’s monitoring <strong>and</strong><br />
evaluation of the Executive Directors’<br />
performance. The Committee provides<br />
input into this process midway through<br />
the year <strong>and</strong> at the year-end.<br />
Nominations Committee meetings in<br />
<strong>2012</strong>/<strong>13</strong><br />
Board of Directors Nominations<br />
Committee<br />
The Committee met nine times in <strong>2012</strong>/<strong>13</strong>.<br />
The Committee appointed Shane DeGaris<br />
to the position of substantive Chief<br />
Executive, Karl Munslow Ong to the<br />
position of substantive Chief Operating<br />
Officer, <strong>and</strong> Theresa Murphy to the<br />
position of substantive Director of the<br />
Patient Experience & Nursing <strong>13</strong> following<br />
a thorough recruitment exercise involving<br />
the open advertisement of the positions,<br />
involvement of staff <strong>and</strong> stakeholders,<br />
<strong>and</strong> external assessors. The Committee<br />
appointed Richard Grocott-Mason <strong>and</strong><br />
Abbas Khakoo as Medical Directors on a jobshare<br />
following the advertisement of the<br />
positions internally <strong>and</strong> formal interviews.<br />
The Committee considered the action to<br />
be taken in respect of the Chair, given that<br />
Mike Robinson’s term of office was due to<br />
expire in July 20<strong>13</strong>. The Committee agreed<br />
to recommend to the Council of Governors<br />
that Mike be reappointed for a further short<br />
term (to the end of March 2014) in order<br />
to provide continuity <strong>and</strong> stability during<br />
the introduction of new commissioning<br />
arrangements <strong>and</strong> in light of the recent<br />
changes of Chief Executive <strong>and</strong> senior<br />
management.<br />
In line with its terms of reference,<br />
the Committee also reviewed talent<br />
management <strong>and</strong> succession planning at the<br />
<strong>Trust</strong>, including proposals for the structure of<br />
the Executive team portfolios.<br />
Council of Governors Nominations &<br />
Remuneration Committee<br />
The Committee met twice during <strong>2012</strong>/<strong>13</strong>.<br />
At its meeting in May <strong>2012</strong>, the Committee<br />
provided input on behalf of the Governors<br />
to the Chair’s <strong>and</strong> Non-Executive Directors’<br />
<strong>13</strong> Theresa Murphy is due to start at the <strong>Trust</strong> in May 20<strong>13</strong><br />
Governance report<br />
41
appraisals which were to be undertaken<br />
by the Senior Independent Director <strong>and</strong><br />
Chair respectively. At its meeting in October<br />
<strong>2012</strong>, the Committee considered the<br />
recommendation from the Board of Directors<br />
Nominations Committee on the appointment<br />
of the Chair. The Committee supported<br />
the recommendation that Mike Robinson<br />
be reappointed until the end of March<br />
2014. This recommendation was therefore<br />
presented to, <strong>and</strong> subsequently approved by,<br />
the Council of Governors. Given that this was<br />
a short term reappointment which sought<br />
to provide continuity, the position was not<br />
subject to competition.<br />
Audit & Assurance Committee<br />
The <strong>Trust</strong>’s Audit & Assurance Committee<br />
comprises three Non-Executive Directors, one<br />
of whom has recent <strong>and</strong> relevant financial<br />
experience. The Committee is responsible<br />
for providing an independent <strong>and</strong> objective<br />
review of the <strong>Trust</strong>’s systems of internal<br />
control (both financial <strong>and</strong> non-financial)<br />
<strong>and</strong> the underlying assurance processes in<br />
place at the <strong>Trust</strong>. The Committee is also<br />
responsible for ensuring that the <strong>Trust</strong> has in<br />
place independent <strong>and</strong> effective internal <strong>and</strong><br />
external audit functions. The Committee’s<br />
work in undertaking these responsibilities is<br />
outlined in an annual report to the Board.<br />
Key elements of the Committee’s work<br />
include reviewing the Board Assurance<br />
Framework, <strong>and</strong> reviewing the findings of<br />
the <strong>Trust</strong>’s internal <strong>and</strong> external auditors<br />
<strong>and</strong> Local Counter Fraud Specialist. The<br />
Committee is responsible for reviewing the<br />
annual financial statements, with particular<br />
focus given to major areas of judgement<br />
<strong>and</strong> changes in accounting policies, the basis<br />
of the Board’s determination that the <strong>Trust</strong><br />
remains a going concern, <strong>and</strong> the <strong>Annual</strong><br />
Governance Statement. The Committee<br />
also reviews the assurance available from<br />
the <strong>Trust</strong>’s clinical audit function, <strong>and</strong> has<br />
developed an increasing role in reviewing<br />
the robustness of data quality at the <strong>Trust</strong>. In<br />
addition to its own annual self-evaluation,<br />
the Committee reviews the performance of<br />
internal audit, external audit, <strong>and</strong> the Local<br />
Counter Fraud Specialist each year.<br />
The Committee is usually attended by the<br />
internal <strong>and</strong> external auditors, the Finance<br />
Director <strong>and</strong> the Executive Director of<br />
Corporate Development. The Local Counter<br />
Fraud Specialist attends at least two<br />
meetings a year, <strong>and</strong> other Directors <strong>and</strong><br />
senior managers attend when invited by<br />
the Committee. The <strong>Trust</strong> Secretary is the<br />
Committee Secretary.<br />
The Audit & Assurance Committee (AAC) is<br />
responsible for making recommendations to<br />
the Council of Governors on the appointment<br />
<strong>and</strong> removal of the external auditor. The<br />
Council of Governors has agreed that a full<br />
market testing will be undertaken in time to<br />
enable the Council of Governors to appoint<br />
the external auditor for the 20<strong>13</strong>/14 audit<br />
cycle, as Deloitte would then have provided<br />
external services to the <strong>NHS</strong> <strong>Trust</strong> <strong>and</strong><br />
Foundation <strong>Trust</strong> for five years. This market<br />
testing was in line with the recommendations<br />
of the AAC <strong>and</strong> is consistent with Monitor<br />
guidance.<br />
The Council of Governors has agreed a<br />
process for undertaking this market-testing,<br />
based on recommendations from the AAC.<br />
A working group comprising the AAC <strong>and</strong><br />
representatives of the Council of Governors<br />
will be established to agree the specification<br />
for the tender <strong>and</strong> make recommendations<br />
to the Council of Governors on the<br />
appointment. This process is expected to<br />
conclude with a recommendation to the<br />
Council of Governors in October 20<strong>13</strong> to give<br />
sufficient time for the appointed auditors to<br />
make preparations for the 20<strong>13</strong>/14 audit.<br />
At their meeting in April 2011 the Council<br />
of Governors approved a policy on the<br />
engagement of the external auditors<br />
to undertake additional services, which<br />
had been reviewed <strong>and</strong> recommended<br />
by the Audit & Assurance Committee.<br />
Under the policy, the Council of Governors<br />
42 Governance report
has delegated to the Audit & Assurance<br />
Committee the authority for commissioning<br />
additional services from the external auditor.<br />
Any such work will then be reported to the<br />
Council of Governors. No such additional<br />
work was commissioned in <strong>2012</strong>/<strong>13</strong>.<br />
Other Board committees<br />
As noted above, the Board agreed a revised<br />
Committee structure in <strong>2012</strong>/<strong>13</strong>, which<br />
took effect in January 20<strong>13</strong>. In addition to<br />
the Nominations Committee <strong>and</strong> Audit &<br />
Assurance Committee, the following Board<br />
Committees are in place. Each of these is<br />
chaired by a Non-Executive Director.<br />
• The Transformation Committee was<br />
established this year to assist the<br />
Board with the shaping, review <strong>and</strong><br />
challenge of service transformation,<br />
development <strong>and</strong> redesign, <strong>and</strong> to<br />
provide assurance that the strategy<br />
for the management of human,<br />
financial, estate, <strong>and</strong> IT resources<br />
support such business transformation.<br />
The Committee replaced the Finance<br />
& Investment Committee as the<br />
Board sought to ensure greater Board<br />
scrutiny <strong>and</strong> challenge on service<br />
transformation <strong>and</strong> redesign.<br />
• The Board of Directors Remuneration<br />
Committee, which solely comprises<br />
Non-Executive Directors, is responsible<br />
for agreeing the remuneration <strong>and</strong><br />
terms of service for the Chief Executive<br />
<strong>and</strong> Executive Directors. Further<br />
information on the Committee is<br />
outlined in the Remuneration <strong>Report</strong>.<br />
• The Charitable Funds Committee<br />
assists the <strong>Trust</strong> in its role as corporate<br />
trustee for The <strong>Hillingdon</strong> <strong>Hospital</strong>s<br />
<strong>NHS</strong> Foundation <strong>Trust</strong> charity <strong>and</strong> has<br />
been established to make <strong>and</strong> monitor<br />
arrangements for the control <strong>and</strong><br />
management of the <strong>Trust</strong>’s charitable<br />
funds.<br />
• The Quality & Risk Committee was<br />
established this year to provide<br />
assurance <strong>and</strong> make recommendations<br />
in matters relating to clinical quality<br />
<strong>and</strong> st<strong>and</strong>ards, <strong>and</strong> to ensure that risks<br />
to the delivery of the <strong>Trust</strong>’s services<br />
are identified <strong>and</strong> addressed. The<br />
Committee was created out of merger<br />
of the Integrated Risk Management<br />
Committee <strong>and</strong> Clinical Quality &<br />
St<strong>and</strong>ards Committee to ensure that<br />
risk <strong>and</strong> safety are considered in a fully<br />
integrated manner.<br />
Governance report<br />
43
Attendance at Board <strong>and</strong> Board Committee meetings<br />
The following table outlines Board members’ attendance at Board <strong>and</strong> Committee meetings<br />
during <strong>2012</strong>/<strong>13</strong> against the total possible number of meetings for which an individual was a<br />
member. Committee attendance is shown in relation to those Committees of which a Director<br />
was formally a member.<br />
Board of<br />
Directors<br />
(<strong>13</strong> meetings)<br />
Audit &<br />
Assurance<br />
Committee<br />
(5 meetings)<br />
Board<br />
Nominations<br />
Committee<br />
(9 meetings)<br />
Board<br />
Remuneration<br />
Committee<br />
(6 meetings)<br />
Charitable<br />
Funds<br />
Committee<br />
(3 meetings)<br />
Katey Adderley <strong>13</strong> of <strong>13</strong> 5 of 5 8 of 9 6 of 6 3 of 3<br />
Marie Batey 7 of 7 2 of 2<br />
Carol Bode 11 of <strong>13</strong> 4 of 4 5 of 9 4 of 6 3 of 3<br />
Shane DeGaris 12 of <strong>13</strong> 8 of 8<br />
Claire Gore 1 of 1<br />
Abbas Khakoo 3 of 3<br />
Susan LaBrooy 9 of 10<br />
Alan McLeod 12 of <strong>13</strong> 7 of 9 4 of 6<br />
Karl MunslowOng 12 of <strong>13</strong><br />
Anthony Palmer 11 of <strong>13</strong> 5 of 9 3 of 6<br />
Pradip Patel 11 of <strong>13</strong> 8 of 9 6 of 6<br />
James Reid 12 of <strong>13</strong> 5 of 5 8 of 8 6 of 6<br />
Mike Robinson <strong>13</strong> of <strong>13</strong> 9 of 9 6 of 6 3 of 3<br />
Craig Rowl<strong>and</strong> 12 of <strong>13</strong> 5 of 5 7 of 9 6 of 6<br />
David Searle <strong>13</strong> of <strong>13</strong><br />
Jacqueline Walker 6 of 6 1 of 1<br />
Paul Wratten <strong>13</strong> of <strong>13</strong> 3 of 3<br />
Clinical Quality<br />
& St<strong>and</strong>ards<br />
Committee<br />
(3 meetings)<br />
Finance &<br />
Investment<br />
Committee<br />
(4 meetings)<br />
Integrated Risk<br />
Management<br />
Committee<br />
(3 meetings)<br />
Quality & Risk<br />
Committee<br />
(1 meeting)<br />
Transformation<br />
Committee<br />
(3 meetings)<br />
Katey Adderley 4 of 4<br />
Marie Batey 0 of 3 2 of 3<br />
Carol Bode 1 of 1<br />
Shane DeGaris 2 of 3 3 of 3<br />
Claire Gore<br />
Abbas Khakoo 1 of 1 1 of 3<br />
Susan LaBrooy 2 of 3 3 of 3<br />
Alan McLeod 2 of 4 3 of 3 1 of 3<br />
Karl MunslowOng 2 of 3 2 of 3 1 of 1 2 of 3<br />
Anthony Palmer 3 of 3 2 of 3 1 of 1<br />
Pradip Patel 2 of 3 3 of 4 3 of 3<br />
James Reid 3 of 3 3 of 3 1 of 1<br />
Mike Robinson 3 of 3<br />
Craig Rowl<strong>and</strong> 4 of 4 2 of 3<br />
David Searle 4 of 4 3 of 3 1 of 1<br />
Jacqueline Walker 1 of 1 2 of 3<br />
Paul Wratten 4 of 4 3 of 3<br />
44 Governance report
Council of Governors<br />
The role <strong>and</strong> powers of the Council of Governors are outlined earlier in the report. The<br />
composition of the Council of Governors is outlined in the <strong>Trust</strong>’s Constitution.<br />
As at 31st March 20<strong>13</strong> there were 28 members of the Council of Governors: 17 elected to<br />
represent the public members, seven elected to represent the staff members, <strong>and</strong> four<br />
appointed by partner organisations (<strong>Hillingdon</strong> Council, <strong>Hillingdon</strong> Primary Care <strong>Trust</strong>, the<br />
London Ambulance Service, <strong>and</strong> the <strong>Trust</strong>’s Joint Negotiating & Consultative Committee).<br />
However, as at 1st April 20<strong>13</strong>, <strong>Hillingdon</strong> Primary Care <strong>Trust</strong> ceased to exist as a result of the<br />
changes to the commissioning structure in the <strong>NHS</strong> brought about by the Health & Social<br />
Care Act <strong>2012</strong>. Therefore the number of Appointed Governors reduced to three, with the<br />
overall size of the Council of Governors reducing to 27.<br />
The members of the Council of Governors who served during <strong>2012</strong>/<strong>13</strong> are outlined below:<br />
Public Governors<br />
North (5)<br />
Name<br />
Date took office<br />
<strong>and</strong> method (see<br />
key below)<br />
Term of office<br />
expires<br />
David Bishop 01/04/2011 (CE) 31/03/2014<br />
Tony Ellis 01/04/2011 (CE) 31/03/2014<br />
Ahmad Mallick 01/04/2011 (CE) 31/03/2014<br />
Alvan Seth-Smith 12/04/2011 (CE) 31/03/2014*<br />
Pamela Taverner 28/05/<strong>2012</strong> (CE) 31/03/2014*<br />
Rachel Owen<br />
(replaced by Pamela Taverner)<br />
01/04/2011 (CE) Resigned 2/05/<strong>2012</strong><br />
Donald Dakin 01/04/2011 (CE) 31/03/2014<br />
Martin Elliott 17/05/<strong>2012</strong> (CE) 31/03/2014<br />
Central (5)<br />
Neil Fyfe 17/05/<strong>2012</strong> (CE) 31/03/2014<br />
Kerstin Rolfe 01/04/2011 (CE) 31/03/2014<br />
Roger Shipton 01/04/2011 (CE) 31/03/2014<br />
John Coleman 01/04/2011 (CE) 31/03/2014<br />
John Davies 01/04/2011 (CE) 31/03/2014<br />
South (6)<br />
Graham Hawkes 17/05/<strong>2012</strong> (CE) 31/03/2014<br />
Asma Jalal 01/04/2011 (UE) 31/03/2014<br />
Abid Majeed 01/04/2011 (UE) 31/03/2014<br />
Sharda Mohan 01/04/2011 (UE) 31/03/2014<br />
Rest of Engl<strong>and</strong> (1) Stuart Marshall 06/08/<strong>2012</strong> (UE) 31/03/2014<br />
Staff Governors<br />
Doctors & dentists (1) Alvan Pope 17/05/<strong>2012</strong> (CE) 31/03/2014<br />
Bev Hall 01/04/2011 (CE) 31/03/2014<br />
Nurses, midwives,<br />
healthcare assistants (3)<br />
Allied health<br />
professionals (1)<br />
Support staff (2)<br />
Ann Morling<br />
(replaced by Am<strong>and</strong>a O’Brien)<br />
01/04/2011 (CE)<br />
Resigned<br />
11/05/<strong>2012</strong><br />
Am<strong>and</strong>a O’Brien 11/05/<strong>2012</strong> (UE) 31/03/2014<br />
Angela Wilson 01/04/2011 (CE) 31/03/2014<br />
Graham Coombs 01/04/2011 (CE) 31/03/2014<br />
Gay Bineham 01/04/2011 (CE) 31/03/2014<br />
Jennifer Roma 22/11/2011 (CE) 31/03/2014<br />
Governance report<br />
45
Appointed Governors<br />
Post ceased to exist<br />
31/03/20<strong>13</strong><br />
Council changed<br />
Cllr Philip Corthorne<br />
01/04/2011 (A)<br />
appointee<br />
6/11/<strong>2012</strong><br />
Cllr Mary O’Connor 6/11/<strong>2012</strong> (A) 11/05/2014<br />
<strong>Hillingdon</strong> PCT Sarah Cuthbert 20/07/2011 (A)<br />
London Borough of<br />
<strong>Hillingdon</strong> (1)<br />
London Ambulance<br />
Service (1)<br />
Joint Negotiating &<br />
Consultative Committee<br />
(1)<br />
Peter McKenna 01/04/2011 (A) 31/03/2014<br />
Lesley Dixon 01/04/2011 (A) 31/03/2014<br />
Key:<br />
CE – contested election<br />
UE – uncontested election<br />
A – appointed by partner organisation<br />
* The Constitution states that where a vacancy arises for an elected Governor other than by the end of a term of office, the<br />
Council of Governors may invite the next highest polling c<strong>and</strong>idate for that seat at the most recent election, who is willing to<br />
take office, to fill the vacant seat until the next election, at which time the seat will fall vacant <strong>and</strong> be subject to election for<br />
any unexpired period of the term of office. In accordance with these provisions, Alvan Seth-Smith & Pamela Taverner were<br />
invited to take up the positions vacated by Governor resignations. Therefore whilst the term of office is shown as 31st March<br />
2014, should there be an election in the North Public Constituency before this time then the two seats will fall vacant <strong>and</strong> be<br />
subject to election for the period until 31st March 2014.<br />
During <strong>2012</strong>/<strong>13</strong> elections for five constituencies were held. The following table outlines the<br />
turnout <strong>and</strong> number of c<strong>and</strong>idates.<br />
Constituency<br />
Number of<br />
positions<br />
Number of<br />
c<strong>and</strong>idates<br />
Number<br />
of eligible<br />
voters<br />
Turnout<br />
Public: Central 2 6 2,754 24%<br />
Public: South 1 4 2,873 17%<br />
Public: Rest of Engl<strong>and</strong> 1 1 176 N/A<br />
Staff: Doctors & dentists 1 2 433 20%<br />
Staff: Nurses, midwives & healthcare<br />
assistants<br />
1 1 1,321 N/A<br />
Where an election was contested, voting was undertaken by secret postal ballot, using<br />
the single transferable voting system by which members rank the c<strong>and</strong>idates in order of<br />
preference.<br />
46 Governance report
In <strong>2012</strong>/<strong>13</strong> the Council of Governors formally<br />
met four times. Governor attendance at<br />
these meetings is outlined below. Where<br />
a Governor was not in office for all four<br />
meetings, the maximum possible attendance<br />
is shown.<br />
Governor<br />
Meetings<br />
attended<br />
David Bishop (Public) 4 of 4<br />
Tony Ellis (Public) 3 of 4<br />
Ahmad Mallick (Public) 2 of 4<br />
Rachel Owen (Public) 0 of 0<br />
Alvan Seth-Smith (Public) 4 of 4<br />
Pamela Taverner (Public) 2 of 3<br />
Donald Dakin (Public) 2 of 4<br />
Martin Elliott (Public) 3 of 3<br />
Neil Fyfe (Public) 1 of 3<br />
Kerstin Rolfe (Public) 2 of 4<br />
Roger Shipton (Public) 4 of 4<br />
John Coleman (Public) 4 of 4<br />
John Davies (Public) 4 of 4<br />
Graham Hawkes (Public) 3 of 3<br />
Asma Jalal (Public) 2 of 4<br />
Abid Majeed (Public) 2 of 4<br />
Sharda Mohan (Public) 2 of 4<br />
Stuart Marshall (Public) 2 of 2<br />
Alvan Pope (Staff) 3 of 3<br />
Bev Hall (Staff) 3 of 4<br />
Ann Morling (Staff) 0 of 0<br />
Am<strong>and</strong>a O’Brien (Staff) 4 of 4<br />
Angela Wilson (Staff) 4 of 4<br />
Graham Coombs (Staff) 3 of 4<br />
Gay Bineham (Staff) 3 of 4<br />
Jennifer Roma (Staff) 3 of 4<br />
Sarah Cuthbert (Appointed) 0 of 4<br />
Cllr Philip Corthorne (Appointed) 0 of 3<br />
Cllr Mary O’Connor (Appointed) 1 of 1<br />
Peter McKenna (Appointed) 1 of 4<br />
Lesley Dixon (Appointed) 3 of 4<br />
Governors are required to declare any<br />
relevant interests which are then entered<br />
into the publicly available Register of<br />
Governors’ Interests. The Register is formally<br />
reviewed by the Council of Governors<br />
annually <strong>and</strong> is available from the <strong>Trust</strong><br />
Secretary on 01895 279976.<br />
Lead Governor<br />
In line with Monitor’s Code of Governance,<br />
the Council of Governors elects one of the<br />
Public Governors to be the ‘Lead Governor’.<br />
The main duties of the Lead Governor are to:<br />
• Act as a point of contact for Monitor<br />
should the Regulator wish to contact<br />
the Council of Governors on an issue<br />
for which the normal channels of<br />
communication are not appropriate.<br />
• Be the conduit for raising with Monitor<br />
any Governor concerns that the<br />
Foundation <strong>Trust</strong> is at risk of significantly<br />
breaching the Terms of its Authorisation<br />
(now Licence), having made every attempt<br />
to resolve any such concerns locally.<br />
• Chair such parts of meetings of the<br />
Council of Governors which cannot be<br />
chaired by the <strong>Trust</strong> Chair or Deputy Chair<br />
due to a conflict of interest in relation to<br />
the business being discussed.<br />
In April <strong>2012</strong> the Council of Governors<br />
appointed Roger Shipton as the Lead<br />
Governor for the <strong>2012</strong>/<strong>13</strong> financial year.<br />
In April 20<strong>13</strong>, Roger Shipton did not seek<br />
reappointment for the role <strong>and</strong> the Council<br />
of Governors elected John Coleman as Lead<br />
Governor to run until 31st March 2014.<br />
The Board’s liaison with Governors<br />
<strong>and</strong> members<br />
All Board members have a st<strong>and</strong>ing invitation<br />
to attend Council of Governors meetings in<br />
order to ensure they underst<strong>and</strong> the views<br />
of Governors <strong>and</strong> members. The Board <strong>and</strong><br />
Council of Governors meet jointly at least<br />
annually as part of enabling the Governors<br />
to input into the <strong>Trust</strong>’s annual plan <strong>and</strong><br />
also to discuss any other matters of joint<br />
concern. In <strong>2012</strong>/<strong>13</strong> two such meetings were<br />
held: in November <strong>2012</strong> <strong>and</strong> March 20<strong>13</strong>.<br />
Board meetings are held in public <strong>and</strong> there<br />
is an opportunity for members of public <strong>and</strong><br />
Governors to ask questions of the Board<br />
members present. Members of the Board<br />
also attend the <strong>Trust</strong>’s People in Partnership<br />
Governance report<br />
47
meetings <strong>and</strong> <strong>Annual</strong> Members’ Meeting to<br />
liaise with members <strong>and</strong> Governors.<br />
Attendance by Board members at the four<br />
meetings of the Council of Governors <strong>and</strong> the<br />
two joint meetings between the Board <strong>and</strong><br />
Council of Governors in <strong>2012</strong>/<strong>13</strong> is outlined in<br />
the table below.<br />
No of Council of Governor meetings<br />
Board Member<br />
attended in <strong>2012</strong>/<strong>13</strong> (including joint<br />
Board/Governor meetings)<br />
Mike Robinson (Chair) 6 of 6<br />
Katey Adderley (Non-Executive Director) 4 of 6<br />
Marie Batey (Executive Director of Patient<br />
Experience & Nursing)<br />
1 of 2<br />
Carol Bode (Non-Executive Director) 4 of 6<br />
Shane DeGaris (Chief Executive) 5 of 6<br />
Abbas Khakoo (Joint Medical Director) 2 of 2<br />
Susan LaBrooy (Medical Director) 0 of 4<br />
Alan McLeod (Non-Executive Director) 4 of 6<br />
Karl Munslow Ong (Chief Operating Officer) 2 of 6<br />
Anthony Palmer (Non-Executive Director) 3 of 6<br />
Pradip Patel (Non-Executive Director) 4 of 6<br />
James Reid (Deputy Chair & Non-Executive Director) 4 of 6<br />
Craig Rowl<strong>and</strong> (Senior Independent Director & Non-<br />
Executive Director)<br />
4 of 6<br />
David Searle (Executive Director of Corporate<br />
Development)<br />
3 of 6<br />
Jacqueline Walker (Acting Executive Director of the<br />
Patient Experience & Nursing)<br />
3 of 4<br />
Paul Wratten (Finance Director) 4 of 6<br />
48 Governance report
Membership<br />
The Foundation <strong>Trust</strong> membership is divided<br />
into two categories: public membership <strong>and</strong><br />
staff membership.<br />
Staff membership<br />
The staff constituency is a single constituency<br />
divided into the following classes:<br />
• Doctors <strong>and</strong> dentists<br />
• Nurses <strong>and</strong> midwives (including health<br />
care assistants)<br />
• Allied Health Professionals<br />
• Support staff<br />
Staff membership is open to all those<br />
employed by the <strong>Trust</strong> on a permanent basis,<br />
those who have a fixed term contract of at<br />
least 12 months, <strong>and</strong> those who have been<br />
working at the <strong>Trust</strong> for at least 12 months.<br />
These staff are automatically members of<br />
the Staff Constituency unless they ‘opt-out’<br />
from membership. So far no staff have opted<br />
out from being a member of the Foundation<br />
<strong>Trust</strong>. In addition, the following individuals<br />
may become staff members providing they<br />
have exercised these ‘functions’ for a period<br />
of 12 months <strong>and</strong> continue to do so:<br />
Public membership<br />
There are four public constituencies,<br />
which are collectively known as the Public<br />
Constituency. The majority of the public<br />
members are drawn from the three public<br />
constituencies which cover the electoral<br />
wards in <strong>Hillingdon</strong> Borough together<br />
with several neighbouring electoral wards.<br />
The fourth public constituency covers all<br />
other electoral areas in the rest of Engl<strong>and</strong>.<br />
Anyone can become a public member of the<br />
Foundation <strong>Trust</strong> providing they are 16 years<br />
or over, live within the Public Constituency,<br />
<strong>and</strong> are not eligible to be a staff member of<br />
the Foundation <strong>Trust</strong>.<br />
• Volunteers working at the <strong>Trust</strong> (other<br />
than those working for third party<br />
organisations).<br />
• Those working at the <strong>Trust</strong> through the<br />
temporary staffing ‘bank’.<br />
• Those working at the <strong>Trust</strong> through an<br />
independent contractor to provide a<br />
service out-sourced by the <strong>Trust</strong>.<br />
Staff membership will cease at the point that<br />
the member leaves the service of the <strong>Trust</strong>.<br />
Anyone eligible to be a staff member of the<br />
Foundation <strong>Trust</strong> cannot be a public member.<br />
Membership Development <strong>and</strong><br />
Engagement Strategy <strong>2012</strong>-2015<br />
The Board approved a three year<br />
Membership Development <strong>and</strong> Engagement<br />
Strategy in February <strong>2012</strong>. The strategy<br />
describes the <strong>Trust</strong>’s objectives for the<br />
membership <strong>and</strong> the approach we will use<br />
to ensure the <strong>Trust</strong> develops <strong>and</strong> engages<br />
with a representative membership. It<br />
outlines our plans for raising awareness<br />
about membership <strong>and</strong> for the recruitment,<br />
Governance report<br />
49
etention <strong>and</strong> involvement of members. The<br />
strategy was produced with the guidance<br />
<strong>and</strong> input of the Council of Governors <strong>and</strong><br />
builds upon <strong>and</strong> replaces the Membership<br />
Development <strong>and</strong> Public Engagement<br />
Strategy that was approved in 2008 <strong>and</strong><br />
subsequently updated in 2010. A high level<br />
action plan to deliver the Membership<br />
Development <strong>and</strong> Engagement Strategy has<br />
been developed with progress periodically<br />
reported to the Council of Governors <strong>and</strong> the<br />
Board.<br />
The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation<br />
<strong>Trust</strong> is committed to recruiting members<br />
from the diverse population served by<br />
the <strong>Trust</strong>. Membership is open to all those<br />
eligible to be a member regardless of gender,<br />
race, disability, ethnicity, religion or any<br />
other groups covered under the Equality Act<br />
<strong>2012</strong>.<br />
The membership base is regularly<br />
reviewed to ensure that the membership<br />
is representative of those eligible to be<br />
members. Specific groups that appear<br />
to be under-represented are targeted in<br />
recruitment campaigns in order to seek to<br />
increase membership representation in these<br />
areas, such as people between the ages of 16<br />
<strong>and</strong> 45.<br />
The Membership Development <strong>and</strong><br />
Engagement Strategy set the following<br />
targets for membership growth:<br />
Target Membership<br />
<strong>2012</strong>/<strong>13</strong> 20<strong>13</strong>/14 2014/15<br />
Public constituency 7,500 7,650 7,750<br />
Staff constituency 3,187* 3,187* 3,187*<br />
Total 10,687 10,837 10,937<br />
* These figures were set based on staffing levels as at<br />
February <strong>2012</strong>, with the recognition that this would depend<br />
on any future changes in staff numbers.<br />
In order to achieve the above targets there is<br />
a need to recruit approximately an additional<br />
500 public members each year to replace<br />
those who cease to be a member by virtue<br />
of moving or passing away. In agreeing the<br />
strategy it was felt that the above targets<br />
should represent a broad indication of our<br />
objective to increase the membership but<br />
the primary focus would be to maintain<br />
the current level of membership, address<br />
areas of under-representation <strong>and</strong> focus on<br />
engagement rather than growth.<br />
Key actions to grow membership are to:<br />
• Utilise existing publications (e.g.<br />
<strong>Hillingdon</strong> People), local groups (e.g.<br />
Street Champion meetings, Resident<br />
Associations <strong>and</strong> Community Voice) <strong>and</strong><br />
local events (May Day Fair <strong>and</strong> summer<br />
carnivals)<br />
• Attend local community <strong>and</strong> voluntary<br />
group meetings i.e. AGMs <strong>and</strong><br />
conferences<br />
• Attend joint public engagement<br />
meetings with <strong>Hillingdon</strong> Clinical<br />
Commissioning Group <strong>and</strong> Central <strong>and</strong><br />
North West London <strong>NHS</strong> Foundation<br />
<strong>Trust</strong><br />
• Attend regular ‘speak-easy’ carer events,<br />
hosted by <strong>Hillingdon</strong> Carers <strong>and</strong> the<br />
Council<br />
• Promote membership at <strong>Trust</strong><br />
engagement events, i.e. armed forces,<br />
BME focus groups <strong>and</strong> patient support<br />
groups<br />
• Organise membership recruitment<br />
events at <strong>Hillingdon</strong> <strong>and</strong> Mount Vernon<br />
<strong>Hospital</strong>s<br />
• Encourage Governors <strong>and</strong> members to<br />
sign up family, friends <strong>and</strong> members of<br />
the public<br />
• Invite ex-staff, their family <strong>and</strong> friends<br />
to become public members<br />
• Utilise existing networks in promoting<br />
membership with staff <strong>and</strong> students at<br />
local universities<br />
• Explore the possibility of holding a<br />
careers event for students attending<br />
local schools <strong>and</strong> colleges<br />
• Make membership forms available in<br />
local libraries <strong>and</strong> shopping centres.<br />
50 Governance report
Membership as at 31st March 20<strong>13</strong><br />
As at 31st March 20<strong>13</strong>, the <strong>Trust</strong> had<br />
7,172 public members. The table below<br />
illustrates the number of public members<br />
for each constituency compared to the total<br />
population.<br />
31 st<br />
March<br />
20<strong>13</strong><br />
% of<br />
membership<br />
Population<br />
base<br />
% of<br />
area<br />
Central 2,704 37.7 177,608 40<br />
North 1,462 20.4 102,842 23.1<br />
South 2,811 39.2 166,500 36.9<br />
Rest of 194 2.7 0 0<br />
Engl<strong>and</strong><br />
Total 7171 100 446,950 0<br />
During <strong>2012</strong>/<strong>13</strong>, the Foundation <strong>Trust</strong><br />
recruited 316 new public members <strong>and</strong> lost<br />
238 public members due to bereavement,<br />
members moving away without providing<br />
a new address or members cancelling their<br />
membership. This has resulted in the <strong>Trust</strong><br />
not meeting the target of 7,500 members.<br />
In April 20<strong>13</strong> the Board agreed a revised<br />
membership target of 7,400 public members<br />
at its Board meeting on 24th April 20<strong>13</strong> to<br />
cover the period April 20<strong>13</strong> to March 2014,<br />
in line with the view that the aim is to focus<br />
on engagement rather than recruitment.<br />
The <strong>Trust</strong> will strive to increase membership<br />
in the coming year to meet this revised<br />
target through a programme of focused<br />
recruitment <strong>and</strong> engagement using the<br />
actions outlined above.<br />
Contacting Directors <strong>and</strong> Governors<br />
Directors <strong>and</strong> Governors can be contacted<br />
through the Foundation <strong>Trust</strong> Office:<br />
• Email: foundation@thh.nhs.uk<br />
• Telephone: 0800 8766953<br />
• Post: Foundation <strong>Trust</strong> Office, <strong>Hillingdon</strong><br />
<strong>Hospital</strong>, Pield Heath Road, Uxbridge, UB8<br />
3NN.<br />
Compliance with the Code of<br />
Governance<br />
The Board considers itself compliant with all<br />
provisions of the <strong>NHS</strong> Foundation <strong>Trust</strong> Code<br />
of Governance <strong>and</strong> has made the required<br />
disclosures in this annual report. The Board<br />
has identified areas where the <strong>Trust</strong>’s<br />
compliance could be strengthened, most<br />
notably in relation to the evolving role of the<br />
Governors, <strong>and</strong> the assurance as to the extent<br />
the Governors consult with the membership.<br />
Work over the coming year will therefore<br />
seek to strengthen the <strong>Trust</strong>’s arrangements<br />
in relation to Governors’ engagement<br />
with the members, Governor engagement<br />
with the Board, <strong>and</strong> Governor training <strong>and</strong><br />
induction, in light of the Health & Social<br />
Care Act <strong>2012</strong> <strong>and</strong> the recommendations of<br />
the Mid Staffordshire <strong>NHS</strong> Foundation <strong>Trust</strong><br />
Public Inquiry.<br />
As at 31st March 20<strong>13</strong> the <strong>Trust</strong> currently had<br />
3,081 staff members. The following table<br />
provides a breakdown by staff group:<br />
Staff Class<br />
Number of members<br />
Doctors <strong>and</strong> Dentists 395<br />
Nurses, Midwives & Healthcare Assistants (including bank staff) 1,222<br />
Allied Health Professionals (including bank staff) 299<br />
Support staff (including bank staff <strong>and</strong> volunteers) 1,165<br />
Total 3,081<br />
Governance report<br />
51
REMUNERATION REPORT<br />
Board of Directors Remuneration<br />
Committee<br />
The Board of Directors Remuneration<br />
Committee comprises all of the Non-<br />
Executive Directors <strong>and</strong> is chaired by the<br />
Deputy Chair. The Chief Executive <strong>and</strong><br />
Director of People are invited to attend<br />
to provide professional advice, except<br />
for when the Committee is considering<br />
these individuals’ remuneration <strong>and</strong>/or<br />
performance. The <strong>Trust</strong> Secretary attends to<br />
take minutes of the Committee’s meetings.<br />
The Committee’s role <strong>and</strong> responsibilities<br />
are primarily two-fold: to agree the<br />
remuneration <strong>and</strong> terms of service for the<br />
Chief Executive <strong>and</strong> the Executive Directors;<br />
<strong>and</strong> to oversee the performance monitoring<br />
of the Chief Executive <strong>and</strong> Executive<br />
Directors. The Committee also reviews at a<br />
high level the remuneration of the <strong>Trust</strong>’s<br />
most senior employees beneath the Board<br />
(i.e. the first line reports to the Executive<br />
Directors <strong>and</strong> the <strong>Trust</strong>’s Consultants) to<br />
ensure this remains appropriate to the<br />
remuneration paid to the Executive Team.<br />
The Committee met six times in <strong>2012</strong>/<strong>13</strong>.<br />
At these meetings the Committee agreed<br />
the remuneration in relation to the<br />
acting <strong>and</strong> substantive Director of Patient<br />
Experience & Nursing positions, <strong>and</strong> for<br />
the Medical Director, Chief Executive, <strong>and</strong><br />
Chief Operating Officer appointments. The<br />
Committee also reviewed the <strong>Trust</strong>’s pay<br />
policy for the Executive Team <strong>and</strong> the case<br />
for any pay awards (see below for further<br />
information), <strong>and</strong> reviewed the remuneration<br />
for the <strong>Trust</strong>’s senior management <strong>and</strong><br />
Consultants. The Committee also reviewed<br />
the Chair <strong>and</strong> Chief Executive’s monitoring of<br />
the Chief Executive’s <strong>and</strong> Executive Directors’<br />
performance at the mid-point of the year<br />
(September <strong>2012</strong>) <strong>and</strong> at the end of the year<br />
(March 20<strong>13</strong>).<br />
At its meeting in May <strong>2012</strong> the Committee<br />
agreed not to award an increase in Executive<br />
Remuneration for <strong>2012</strong>/<strong>13</strong>. This decision was<br />
based on the fact that Agenda for Change<br />
staff <strong>and</strong> those on the medical <strong>and</strong> dentistry<br />
pay scales would not receive a cost of living<br />
increase in <strong>2012</strong>/<strong>13</strong>, <strong>and</strong> the current focus<br />
on efficiency savings <strong>and</strong> reductions in the<br />
<strong>Trust</strong>’s pay spend. The Committee noted<br />
that this meant that no increase had been<br />
awarded for two years, <strong>and</strong> agreed that<br />
external consultants should be commissioned<br />
to report to the March 20<strong>13</strong> meeting on<br />
Executive Remuneration. The Committee<br />
agreed that the report would also assist<br />
the Committee in considering whether its<br />
previous decision not to introduce a formal<br />
performance related element to Executive<br />
Remuneration remains appropriate.<br />
The Committee were mindful of the cost<br />
of commissioning this work <strong>and</strong> therefore<br />
the Chair of the Committee agreed with<br />
the Director of People to purchase an<br />
existing benchmarking report from Capita<br />
on FT remuneration. Hay Group were also<br />
commissioned by the Director of People to<br />
provide a bespoke report to the Committee<br />
on performance related pay.<br />
At the start of <strong>2012</strong>/<strong>13</strong> Capita provided<br />
services to the <strong>Trust</strong> in relation to the<br />
electronic distribution of the <strong>Trust</strong>’s<br />
membership magazine, but had ceased to<br />
provide these services at the time the report<br />
was provided to the Committee. Hay Group<br />
provided no other services to the <strong>Trust</strong> in<br />
<strong>2012</strong>/<strong>13</strong>.<br />
The Committee considered the reports from<br />
Capita <strong>and</strong> Hay at its meeting in March 20<strong>13</strong>.<br />
52 Remuneration report
The Committee confirmed the <strong>Trust</strong>’s<br />
Executive pay policy is to set remuneration at<br />
the median to upper quartile of comparator<br />
<strong>Trust</strong>s, with the following conditions to<br />
be taken into account when determining<br />
individual Executives’ pay:<br />
• Performance<br />
• Experience<br />
• Importance to the organisation<br />
• Marketability <strong>and</strong> likelihood of moving<br />
elsewhere.<br />
The Committee confirmed its previous<br />
decision that Executive Remuneration should<br />
not include provisions for bonus payments<br />
or proportions subject to performance<br />
conditions. The Committee confirmed that<br />
it would continue to consider individual <strong>and</strong><br />
overall <strong>Trust</strong> performance, when determining<br />
Executive remuneration as part of the pay<br />
policy outlined above.<br />
Having considered the pay policy <strong>and</strong> the<br />
benchmarking information provided by<br />
Capita, the Committee agreed that the Chief<br />
Executive <strong>and</strong> Executive Directors would not<br />
receive an increase in remuneration at the<br />
present time.<br />
Neither the Chief Executive nor the Executive<br />
Directors are currently appointed for fixed<br />
term contracts. The Board believes that<br />
such contracts would make it harder to<br />
attract <strong>and</strong> retain high-quality Executives<br />
in a competitive recruitment environment,<br />
<strong>and</strong> can lead to uncertainty affecting service<br />
delivery towards the end of the contract.<br />
The <strong>Trust</strong>’s policy on notice periods <strong>and</strong><br />
termination payments for Executive Directors<br />
is six months, in line with generally accepted<br />
practice at this level in the <strong>NHS</strong>. Any decision<br />
to allow an Executive Director to leave the<br />
<strong>Trust</strong>’s employment without this full notice<br />
period is subject to a risk assessment by the<br />
Board of Directors Nominations Committee,<br />
in line with the Code of Governance.<br />
As outlined earlier in the report, Jacqueline<br />
Walker is currently acting up from her<br />
substantive role as the <strong>Trust</strong>’s Deputy<br />
Director of Nursing to be the Acting<br />
Executive Director of Patient Experience &<br />
Nursing. This is to cover the period until the<br />
<strong>Trust</strong>’s new substantive Executive Director of<br />
Patient Experience & Nursing joins the <strong>Trust</strong><br />
(expected to be at the end of May 20<strong>13</strong>).<br />
Attendance at Remuneration Committee<br />
meetings in <strong>2012</strong>/<strong>13</strong> is outlined earlier in the<br />
‘Governance <strong>Report</strong>’.<br />
Pay policy for wider staff<br />
The Remuneration Committee annually<br />
reviews the pay of the first layer of<br />
management beneath the Board, to ensure<br />
that there is appropriate differential<br />
between the remuneration of the Executive<br />
team <strong>and</strong> their direct reports. As part of this,<br />
the Committee also reviews the structure of<br />
Consultant pay.<br />
Staff beneath the Board are paid according<br />
to nationally defined terms <strong>and</strong> conditions<br />
(i.e. the medical pay-scales or in the case<br />
of non-medical staff, Agenda for Change).<br />
When considering whether to increase<br />
executive remuneration the Remuneration<br />
Committee takes into account whether any<br />
cost of living increases have been awarded<br />
to staff on national terms <strong>and</strong> conditions.<br />
Non-executive remuneration<br />
The Council of Governors is responsible for<br />
agreeing the remuneration of the Chair <strong>and</strong><br />
Non-Executive Directors.<br />
At their meeting in October 2011 the Council<br />
of Governors agreed that the remuneration<br />
for the Chair <strong>and</strong> Non-Executive Directors<br />
should be increased to £45k pa <strong>and</strong> £<strong>13</strong>k<br />
pa respectively to reflect the additional<br />
responsibilities arising from Foundation <strong>Trust</strong><br />
status. In making this decision the Governors<br />
drew upon benchmarking information<br />
<strong>and</strong> independent analysis provided by<br />
Hay Group. In agreeing this increase, the<br />
Council of Governors was mindful of the<br />
wage restraint in the <strong>NHS</strong> <strong>and</strong> agreed that<br />
the increase would not take effect until<br />
1st April <strong>2012</strong> (<strong>and</strong> therefore a year after<br />
Remuneration report<br />
53
authorisation as a Foundation <strong>Trust</strong>) <strong>and</strong><br />
that Non-Executive remuneration would not<br />
be increased for a further two years.<br />
Non-Executive appointments are not within<br />
the jurisdiction of Employment Tribunals <strong>and</strong><br />
there is no entitlement for compensation for<br />
loss of office through employment law.<br />
In making decisions on Non-Executive<br />
Remuneration, the Council of Governors<br />
draws on the recommendations of the<br />
Council of Governors Nominations &<br />
Remuneration Committee. Attendance at<br />
the Committee’s two meetings in <strong>2012</strong>/<strong>13</strong> is<br />
outlined below.<br />
Number of<br />
Name<br />
meetings<br />
attended<br />
Mike Robinson (<strong>Trust</strong> Chair) 1 14 of 2<br />
John Coleman (Public Governor) 2 of 2<br />
Tony Ellis (Public Governor) 2 of 2<br />
Roger Shipton (Public Governor) 2 of 2<br />
Gay Bineham (Staff Governor) 1 of 2<br />
Peter McKenna (Appointed Governor) 2 of 2<br />
Directors’ remuneration in <strong>2012</strong>/<strong>13</strong><br />
For the purposes of the remuneration<br />
report, the Chief Executive has confirmed<br />
that the definition of senior manager covers<br />
the members of the Board, in line with the<br />
definition in Monitor’s <strong>Annual</strong> <strong>Report</strong>ing<br />
Manual that senior managers are ‘those<br />
persons in senior positions having authority<br />
or responsibility for directing or controlling<br />
the major activities of the Foundation <strong>Trust</strong>.’<br />
14 One of the meetings was to discuss Mike Robinson’s appointment <strong>and</strong> therefore this meeting was chaired by Craig<br />
Rowl<strong>and</strong>, the <strong>Trust</strong>’s Senior Independent Director at that time.<br />
54 Remuneration report
Directors’ remuneration (excluding pension contributions) fell within the following<br />
ranges:<br />
Directors' remuneration (excluding pension contributions) fell within the following ranges:<br />
NOTE<br />
NAME AND TITLE<br />
(B<strong>and</strong>s of £5000)<br />
Executive Directors £000s £000s £000s £000s £000s £000s £000s £000s £000s<br />
1 Shane DeGaris, Chief Executive 155-160 90-95 2.5-5 5-7.5 20-25 15-20 272 141 91<br />
Marie Batey, Executive<br />
2 Director of Patient Experience 50-55 90-95 - - 30-35 100-105 574 540 24<br />
<strong>and</strong> Nursing<br />
3 Claire Gore, Director of People 5-10 N/A N/A N/A N/A N/A N/A N/A N/A<br />
4<br />
Richard Grocott-Mason, Joint<br />
Medical Director<br />
40- 45 N/A N/A N/A 40-45 125-<strong>13</strong>0 768 N/A N/A<br />
5<br />
Abbas Khakoo, Joint Medical<br />
Director<br />
40-45 N/A N/A N/A 40-45 120-125 730 N/A N/A<br />
6<br />
Susan LaBrooy, Medical<br />
Director<br />
100-105 175-180 N/A N/A 70-75 215-220 N/A N/A N/A<br />
7<br />
Karl Munslow Ong, Chief<br />
Operating Officer<br />
100-105 5-10 0-2.5 0-2.5 10-15 35-40 <strong>13</strong>0 114 12<br />
David Searle, Executive<br />
Director of Corporate 95-100 95-100 0-2.5 0-2.5 15-20 55-60 380 345 24<br />
Development<br />
Jacqueline Walker, Acting<br />
8 Executive Director of Patient 35-40 N/A N/A N/A 20-25 60-65 N/A N/A N/A<br />
Experience <strong>and</strong> Nursing<br />
Paul Wratten, Finance Director 115-120 115-120 - - 40-45 120-125 709 664 31<br />
Non Executive Directors<br />
Salary<br />
<strong>2012</strong>/<strong>13</strong><br />
(excluding<br />
social<br />
security<br />
costs)<br />
(B<strong>and</strong>s of<br />
£5000)<br />
Salary<br />
2011/12<br />
(excluding<br />
social<br />
security<br />
costs)<br />
(B<strong>and</strong>s of<br />
£5000)<br />
Real<br />
increase in<br />
lump sum<br />
pension at<br />
age 60<br />
(B<strong>and</strong>s of<br />
£2500)<br />
Real<br />
increase in<br />
pension at<br />
age 60<br />
(B<strong>and</strong>s of<br />
£2500)<br />
Total accrued<br />
pension at<br />
age 60 at 31<br />
March 20<strong>13</strong><br />
(B<strong>and</strong>s of<br />
£5000)<br />
Lump sum at<br />
age 60 related<br />
to accrued<br />
pension at 31<br />
March 20<strong>13</strong><br />
Cash<br />
equivalent<br />
transfer value<br />
at 31 March<br />
20<strong>13</strong><br />
Cash<br />
equivalent<br />
transfer value<br />
at 31 March<br />
<strong>2012</strong><br />
Michael Robinson, Chair 35-40 30-35 N/A N/A N/A N/A N/A N/A N/A<br />
Katey Adderley, Non-Executive<br />
10-15<br />
Director<br />
5-10 N/A N/A N/A N/A N/A N/A N/A<br />
9<br />
Carol Bode, Non-Executive<br />
Director<br />
10-15 N/A N/A N/A N/A N/A N/A N/A N/A<br />
Alan McLeod, Non-Executive<br />
Director<br />
10-15 5-10 N/A N/A N/A N/A N/A N/A N/A<br />
9<br />
Anthony Palmer, Non-<br />
Executive Director<br />
10-15 N/A N/A N/A N/A N/A N/A N/A N/A<br />
Pradip Patel, Non-Executive<br />
Director<br />
10-15 0-5 N/A N/A N/A N/A N/A N/A N/A<br />
Craig Rowl<strong>and</strong>, Non-Executive<br />
10-15<br />
Director<br />
5-10 N/A N/A N/A N/A N/A N/A N/A<br />
James Reid, Non-Executive<br />
Director<br />
10-15 5-10 N/A N/A N/A N/A N/A N/A N/A<br />
10<br />
Patricia Rushton, Non-<br />
Executive Director<br />
0-5 5-10 N/A N/A N/A N/A N/A N/A N/A<br />
Real increase<br />
in cash<br />
equivalent<br />
transfer value<br />
<strong>2012</strong>/20<strong>13</strong> 2011/<strong>2012</strong><br />
<strong>2012</strong>/20<strong>13</strong> 2011/<strong>2012</strong><br />
B<strong>and</strong> of B<strong>and</strong> Highest of Highest Paid Paid Director’s Director's Total Total Remuneration Remuneration (£ 000) (£000) 155-160 175-180<br />
Median Total Remuneration<br />
Median Total Remuneration<br />
30,801<br />
30,801<br />
32,237<br />
32,237<br />
Ratio 5.11 5.51<br />
Ratio 5.11 5.51<br />
The HM Treasury Financial <strong>Report</strong>ing Manual (FReM), requires the <strong>Trust</strong> to disclose the median remuneration of the<br />
<strong>Trust</strong> staff <strong>and</strong> the ratio between this <strong>and</strong> the mid-point of the b<strong>and</strong>ed remuneration of the highest paid director. The<br />
calculation is based on full-time equivalent staff of the <strong>Trust</strong> at 31st March 20<strong>13</strong> on an annualised basis.<br />
The HM Treasury Financial <strong>Report</strong>ing Manual (FReM), requires the <strong>Trust</strong> to disclose the<br />
median remuneration of the <strong>Trust</strong> staff <strong>and</strong> the ratio between this <strong>and</strong> the mid-point of<br />
the b<strong>and</strong>ed remuneration of the highest paid director. The calculation is based on full-time<br />
equivalent staff of the <strong>Trust</strong> at 31st March 20<strong>13</strong> on an annualised basis.<br />
Remuneration report<br />
55
Notes<br />
1. (A) Acting Chief Executive until 21/5/<strong>2012</strong>; (B) Chief Executive from 22/5/<strong>2012</strong><br />
(A) Gross Pay 1/4/<strong>2012</strong> to 21/5/<strong>2012</strong> in b<strong>and</strong>s of £5000: £20k - £25k<br />
(B) Gross Pay 22/5/<strong>2012</strong> to 31/3/20<strong>13</strong> in b<strong>and</strong>s of £5000: £<strong>13</strong>5k - 140k<br />
2. To 29/10/<strong>2012</strong><br />
3. In post from 1/3/20<strong>13</strong><br />
4. In post from 1/2/20<strong>13</strong><br />
5. In post from 1/1/20<strong>13</strong>. Clinical work in b<strong>and</strong> of £15k - £20k, Director work in b<strong>and</strong> of £25k to £30k. Recharges out to<br />
Imperial College Healthcare <strong>NHS</strong> <strong>Trust</strong> <strong>and</strong> London Health Programme not included in above.<br />
6. To 31/12/<strong>2012</strong>. Salary was in b<strong>and</strong> of £90k - £95k in respect of executive activities <strong>and</strong> £10k - £15k in respect of clinical<br />
work. Salary is inclusive of a nationally funded excellence award. Time charged relating to a role at the North West<br />
London Cluster (to December <strong>2012</strong>) is excluded.<br />
7. (A) Acting Chief Operating Officer until 10/10/<strong>2012</strong>; (B) Chief Operating Officer from 11/10/<strong>2012</strong>.<br />
(A) Gross Pay 1/4/<strong>2012</strong> to 10/10/<strong>2012</strong> in b<strong>and</strong>s of £5000:£50k - £55k.<br />
During period (A) employed by Homerton <strong>NHS</strong> Foundation <strong>Trust</strong> <strong>and</strong> salary cost fully recharged to <strong>Hillingdon</strong> <strong>Hospital</strong>s<br />
<strong>NHS</strong> Foundation <strong>Trust</strong>.<br />
(B) Gross Pay 22/5/<strong>2012</strong> to 31/5/20<strong>13</strong> in b<strong>and</strong>s of £5000: £45k - £50k.<br />
8. In post from 22/10/<strong>2012</strong><br />
9. In post from 2/4/<strong>2012</strong><br />
10. In post from 1/4/12 to 2/4/<strong>2012</strong><br />
During <strong>2012</strong>/<strong>13</strong>, no compensation payments have been made to former senior managers,<br />
<strong>and</strong> no payments have been made to third parties for the services of a senior manager. No<br />
Executive Director currently serves as a Non-Executive Director of another organisation. The<br />
Directors received no benefits in kind.<br />
56 Remuneration report
Governor <strong>and</strong> Director expenses<br />
Governors <strong>and</strong> Directors are entitled to claim for certain expenses incurred whilst<br />
undertaking their role at the <strong>Trust</strong>. The rates payable to Governors are outlined in guidelines<br />
approved by the Board of Directors, whilst the rates payable to the Chair <strong>and</strong> Non-Executive<br />
Directors are outlined in guidelines approved by the Council of Governors. These are both<br />
based on the rates payable to the <strong>Trust</strong>’s staff on Agenda for Change Terms <strong>and</strong> Conditions.<br />
The Chief Executive <strong>and</strong> Executive Directors are eligible to claim expenses under the rates<br />
payable to staff employed on the Agenda for Change terms <strong>and</strong> conditions.<br />
The table below outlines the expenses paid to Board members in <strong>2012</strong>/<strong>13</strong> (rounded to<br />
nearest £).<br />
Name<br />
Role<br />
Travel (inc<br />
parking)<br />
Other<br />
Katey Adderley Non-Executive Director £<strong>13</strong>0 £0 £<strong>13</strong>0<br />
Total<br />
£94 £30 £124<br />
Marie Batey Executive Director of Patient Experience &<br />
Nursing 15<br />
Carol Bode Non-Executive Director £586 £0 £586<br />
Shane DeGaris Chief Executive £112 £75 £187<br />
Claire Gore Director of People 16 £0 £0 £0<br />
Richard Grocott- Joint Medical Director 17 £0 £0 £0<br />
Mason<br />
Abbas Khakoo Joint Medical Director 18 £0 £0 £0<br />
Susan LaBrooy Medical Director 19 £0 £0 £0<br />
Alan McLeod Non-Executive Director £0 £0 £0<br />
Karl Munslow Ong Chief Operating Officer £61 £0 £61<br />
Anthony Palmer Non-Executive Director £302 £0 £302<br />
Pradip Patel Non-Executive Director £0 £0 £0<br />
James Reid Non-Executive Director £0 £0 £0<br />
Mike Robinson Chair £0 £0 £0<br />
Craig Rowl<strong>and</strong> Non-Executive Director £0 £0 £0<br />
David Searle Executive Director of Corporate Development £140 £0 £140<br />
£106 £330 £436<br />
Jacqueline Walker Acting Executive Director of Patient<br />
Experience & Nursing 20<br />
Paul Wratten Finance Director £543 £0 £543<br />
No expenses claims were made by members of the Council of Governors in <strong>2012</strong>/<strong>13</strong>.<br />
15 To 29th October <strong>2012</strong><br />
16 From 1st March 20<strong>13</strong><br />
17 From 1st January 20<strong>13</strong><br />
18 From 1st January 20<strong>13</strong><br />
19 To 31st December <strong>2012</strong><br />
20 From 22nd October <strong>2012</strong><br />
Remuneration report<br />
57
<strong>Report</strong>ing related to the review of tax arrangements for public sector appointees<br />
There were three ‘off-payroll engagements’ costing over £58,200 per annum in place as<br />
of 31st January <strong>2012</strong> at the <strong>Trust</strong>. Of these, one has since come onto the <strong>Trust</strong>’s payroll.<br />
Following value for money <strong>and</strong> service considerations, two of the contracts were not<br />
re-engaged or renegotiated to pay via the <strong>Trust</strong>’s payroll or to seek assurance as to the<br />
individual’s tax obligations. However, these are now being reviewed <strong>and</strong>, where relevant,<br />
renegotiated in line with the imminent expiry dates of both of these contracts.<br />
There were no new ‘off-payroll’ engagements between 23rd August <strong>2012</strong> <strong>and</strong> 31st March<br />
20<strong>13</strong> that were for more than £220 per day <strong>and</strong> more than six months in duration.<br />
58 Remuneration report
quality report<br />
Quality <strong>Report</strong> <strong>2012</strong>/20<strong>13</strong><br />
Improving your local hospitals<br />
– our report to you<br />
Quality report<br />
59
Quality report: CONTENTS<br />
Page<br />
About this report<br />
61<br />
Introduction<br />
62<br />
Summary of <strong>2012</strong>/20<strong>13</strong> Quality <strong>Report</strong><br />
63<br />
Looking back<br />
65<br />
Looking forward<br />
77<br />
Statement of assurance from the Board<br />
82<br />
Annexe<br />
90<br />
60 Quality report
ABOUT THIS REPORT<br />
This Quality <strong>Report</strong> confirms the <strong>Trust</strong>’s<br />
commitment to put the patient <strong>and</strong> the<br />
quality of care at the heart of everything<br />
that we do. The report is the result<br />
of consultation with a wide group of<br />
stakeholders, including our Governors,<br />
commissioners, People in Partnership, <strong>and</strong><br />
our Local Involvement Network (LINk – now<br />
known as Health Watch).<br />
Within North West London the “Shaping<br />
a Healthier Future” programme has been<br />
approved by the Joint Committee of Primary<br />
Care <strong>Trust</strong>s. This programme places The<br />
<strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation <strong>Trust</strong> as<br />
one of the five major hospitals for providing<br />
a full range of 24/7 emergency care in the<br />
region. The programme also places an<br />
emphasis on the provision of a wider range<br />
of out-of-hours primary <strong>and</strong> urgent care,<br />
<strong>and</strong> we are working closely with our GP<br />
commissioners <strong>and</strong> other providers to ensure<br />
that across the healthcare community patient<br />
care is provided in the right place at the right<br />
time.<br />
The project plans for a new Emergency<br />
Care Department, incorporating a rebuilt<br />
Urgent Care Centre, have been approved,<br />
<strong>and</strong> building work on the first phase of the<br />
project (due to be completed in 18 months)<br />
has already commenced. This year we have<br />
also been successful with a Department<br />
of Health capital funding bid for a large<br />
maternity refurbishment, the second highest<br />
amount awarded by the <strong>NHS</strong> in London,<br />
which will improve the birthing environment<br />
for women <strong>and</strong> their partners. We have<br />
also secured <strong>NHS</strong> centrally funded money<br />
for dementia which will provide a better<br />
environment for patients with this condition<br />
during their hospital stay.<br />
steps to a seven day hospital. This forms one<br />
of our main priorities in the “Look Forward”<br />
section of the report.<br />
This year has also seen the publication of<br />
the Francis <strong>Report</strong> which highlights the<br />
failings of a hospital where quality was not<br />
the first priority <strong>and</strong> which did not listen<br />
to its patients or frontline staff. Our care<br />
priorities, which form one part of a range<br />
of measures of patient care, will continue to<br />
be refined <strong>and</strong> extended in the coming year.<br />
Along with using Communication, Attitude,<br />
Responsibility, Equity, Safety (CARES) as<br />
our values we will develop a framework<br />
for providing compassionate care, as well<br />
as monitoring the improvements made in<br />
delivering patient care.<br />
I hope you find this report well presented,<br />
<strong>and</strong> that it gives you useful information<br />
about the <strong>Trust</strong>. I would be very interested<br />
in your views on the style or content of the<br />
report. If you wish to comment please write<br />
to me via the e-mail address below.<br />
Yours sincerely<br />
Shane Degaris<br />
Chief Executive<br />
shane.degaris@thh.nhs.uk<br />
I confirm that to the best of my knowledge<br />
the information in this document is accurate.<br />
This year has seen the publication of<br />
a London-wide set of emergency care<br />
st<strong>and</strong>ards which include more senior decision<br />
making on a seven day a week basis to<br />
reduce weekend mortality <strong>and</strong> take the first<br />
Quality report<br />
61
INTRODUCTION<br />
This Quality <strong>Report</strong>, which looks back at our<br />
achievements in <strong>2012</strong>/<strong>13</strong> <strong>and</strong> summarises our<br />
key quality objectives for the coming year,<br />
will be available on the <strong>NHS</strong> Choices website<br />
<strong>and</strong> our own website – (www.thh.nhs.uk).<br />
Each of the priorities is aligned to the<br />
three domains of quality – safety, clinical<br />
effectiveness <strong>and</strong> patient experience.<br />
they were treated with dignity <strong>and</strong> respect,<br />
or whether they found it easy to access the<br />
service.<br />
What is CQUIN?<br />
CQUIN is a scheme to encourage <strong>NHS</strong> <strong>Trust</strong>s<br />
to improve quality <strong>and</strong> patient safety by<br />
setting targets <strong>and</strong> rewarding achievement<br />
of those targets financially. These targets are<br />
set with local, regional <strong>and</strong> national bodies.<br />
What do we mean when we talk<br />
about patient safety?<br />
“Treating <strong>and</strong> caring for people in a safe<br />
environment <strong>and</strong> protecting them from<br />
avoidable harm”, (National Patient Safety<br />
Agency), for example, ensuring that<br />
medicines are managed safely.<br />
What do we mean when we talk<br />
about clinical effectiveness?<br />
Clinical effectiveness is about whether or not<br />
a patient’s care or treatment was successful.<br />
In other words, did it have the impact that<br />
it was supposed to have? And did it achieve<br />
the best possible result for the patient?<br />
This may include improvement in specific<br />
medical or health conditions, but in the<br />
community we also have a strong focus<br />
on improving quality of life, for example,<br />
independence, mobility, activities of daily<br />
living <strong>and</strong> social participation.<br />
What do we mean when we talk<br />
about patient experience?<br />
Patient experience is about ensuring<br />
patients, relatives <strong>and</strong> carers have as<br />
positive experience as possible at every<br />
stage of the care or treatment that is being<br />
provided. Patient experience refers to the<br />
overall experience throughout the course of<br />
treatment, <strong>and</strong> not just the results that were<br />
achieved at the end.<br />
For example, a patient’s experience could<br />
be strongly influenced by whether they felt<br />
62 Quality report
SUMMARY OF <strong>2012</strong>/20<strong>13</strong><br />
QUALITY REPORT<br />
Looking back at quality<br />
improvement<br />
Our priorities during <strong>2012</strong>/20<strong>13</strong><br />
Priority 1 was the further embedding<br />
of the First Contact Project – Improving<br />
the Outpatient Experience where we<br />
fully achieved two of the four targets;<br />
implementing the Call Management<br />
System (CMS), <strong>and</strong> introducing a document<br />
scanning referral system for all cancer<br />
<strong>and</strong> symptomatic breast referrals. We<br />
partially achieved our plans to centralise<br />
all appointment bookings; the one target<br />
we did not achieve was introducing the<br />
electronic letters from the hospital clinics to<br />
the GP which is currently being piloted in<br />
four specialties.<br />
Priority 2 was about making Changes in<br />
Maternity where we achieved the majority<br />
of our targets (other than breastfeeding);<br />
improving the patient experience by<br />
2% from 86% to 88%; <strong>and</strong> reduced our<br />
caesarean section rates from 30.1% in<br />
2011/<strong>2012</strong> to 26.9% for <strong>2012</strong>/20<strong>13</strong>. Whilst<br />
breast feeding figures have increased to<br />
82.9%, we did not quite meet the target of<br />
85%. We have recruited women from ethnic<br />
minorities to work in clinical <strong>and</strong> non-clinical<br />
public facing roles. We have refurbished<br />
public areas which included a new layout in<br />
maternity triage <strong>and</strong> we were successful in<br />
securing significant funds to modernise the<br />
ten delivery rooms, where work is due to<br />
commence in June 20<strong>13</strong>.<br />
Priority 3 was Care Priorities where we<br />
achieved the target of 90% at year end for<br />
patients having the correct identification<br />
b<strong>and</strong>s <strong>and</strong> staff following the correct<br />
process for confirming identification <strong>and</strong><br />
for hydration/fluid balance. We did not<br />
achieve the 90% target for record keeping;<br />
achieving 79% at year end; although there<br />
was a significant increase of 7% between Q3<br />
<strong>and</strong> Q4 result. We are continuing to focus on<br />
improving nursing record keeping across the<br />
<strong>Trust</strong>.<br />
Priority 4 was The Leaving <strong>Hospital</strong><br />
Project where we have achieved some of<br />
the targets to date such as an increased<br />
positive patient experience for when patients<br />
leave hospital; ensuring patients have the<br />
appropriate discharge documentation <strong>and</strong><br />
keeping the Visual Management System<br />
(our colour coded system for where a<br />
patient is on their pathway) up to date.<br />
Several of the other st<strong>and</strong>ards are close to<br />
their target such as receiving a copy of your<br />
patient journey; 90% of patients are going<br />
home with their medication. We narrowly<br />
missed the 80% target for the proportion<br />
of patients being discharged home before<br />
8pm in the evening. We aim to discharge<br />
patients before 6pm wherever possible,<br />
but they may be discharged later where it<br />
is clinically appropriate <strong>and</strong> safe to do so,<br />
taking the patient’s home circumstances into<br />
consideration. Although we did not achieve<br />
the target of 85% of GPs receiving a copy of<br />
the patient’s discharge summary within 24<br />
hours, there has been an improvement from<br />
the 2011/<strong>2012</strong> baseline figure.<br />
Priority 5 was CQUINs (Commissioning<br />
for Quality <strong>and</strong> Innovation). Of the nine<br />
CQUIN schemes for <strong>2012</strong>/20<strong>13</strong> we have fully<br />
achieved four in Q3: preventing blood clots;<br />
collecting the data for the Patient Safety<br />
Thermometer (a local improvement tool<br />
for measuring, monitoring <strong>and</strong> analysing<br />
patient harm <strong>and</strong> ‘harm free’ care which<br />
includes assessment for blood clots, urinary<br />
catheter related infections, falls <strong>and</strong> pressure<br />
ulcers); using the North West London Drug<br />
Formulary <strong>and</strong> improving the care for<br />
patients with the complications of diabetes.<br />
We partially achieved four remaining CQUINs<br />
in Q3: an improvement of the patient<br />
experience; providing real time information<br />
about our patients for GPs; ensuring we have<br />
Consultant assessments within 12 hours of an<br />
Quality report<br />
63
emergency admission <strong>and</strong> achieving all the<br />
milestones for end of life care. We predict<br />
that we will not achieve our target for the<br />
dementia screening <strong>and</strong> risk assessment<br />
process for this year. Confirmed figures for<br />
the full year will be available in mid June.<br />
Looking forward at quality<br />
improvement<br />
Our priorities for 20<strong>13</strong>/2014<br />
The following five priorities have been<br />
identified for 20<strong>13</strong>/2014:<br />
1. Continuing with the First Contact<br />
Project which will further embed<br />
the way patients are contacted <strong>and</strong><br />
reminded about their appointments<br />
<strong>and</strong> to further centralise bookings. The<br />
Call Management System needs further<br />
development to ensure we are getting<br />
our messages right for patients. There<br />
will be significant resources allocated to<br />
establish an Electronic Document Record<br />
System which will allow easier clinician<br />
access to full healthcare records <strong>and</strong> to<br />
relevant referral forms, enhancing clinical<br />
decision making.<br />
2. Continuing with the Leaving <strong>Hospital</strong><br />
Project to include work with external<br />
experts regarding Improving Inpatient<br />
Care <strong>and</strong> Discharge, to enhance early<br />
assessments for elderly people <strong>and</strong><br />
reduce any unnecessary lengths of stay in<br />
hospital, as well as reducing readmissions.<br />
We will be improving the discharge<br />
process by better co-ordination of teams<br />
<strong>and</strong> working closer together with doctors,<br />
nurses, pharmacists <strong>and</strong> therapists when<br />
reviewing a patient’s needs before they<br />
leave hospital.<br />
on a seven day a week basis to enhance<br />
early senior clinical decision making<br />
<strong>and</strong> eliminate the difference between<br />
weekday <strong>and</strong> weekend mortality.<br />
4. Using CARES as our values. These were<br />
launched in May last year <strong>and</strong> are<br />
supported by a framework that sets out<br />
the st<strong>and</strong>ard in terms of attitude <strong>and</strong><br />
behaviours we expect from our staff.<br />
5. CQUINs (Commissioning for Quality <strong>and</strong><br />
Innovation): we will continue efforts<br />
to prevent blood clots however, we<br />
will be expected to achieve a higher<br />
percentage of patient assessment.<br />
The patient experience CQUIN will be<br />
based on the new “Friends <strong>and</strong> Family<br />
Test”. The dementia risk assessment will<br />
be continued <strong>and</strong> the Patient Safety<br />
Thermometer will be based on reductions<br />
in pressure sores <strong>and</strong> not just on data<br />
submission. Regional CQUINs are not<br />
confirmed but may include supporting<br />
care outside hospital, 12 hour consultant<br />
assessment <strong>and</strong> GP direct access to<br />
diagnostics <strong>and</strong> pathology. Local CQUINs<br />
may include the colorectal cancer<br />
pathway <strong>and</strong> improved communication<br />
between GPs <strong>and</strong> consultants for effective<br />
patient management.<br />
Our priorities will be monitored by the<br />
individual teams, through their Divisional<br />
Reviews <strong>and</strong> quarterly through reports to the<br />
Board or Board Committee <strong>and</strong> the results<br />
will be reported in the 20<strong>13</strong>/2014 <strong>Trust</strong><br />
<strong>Annual</strong> <strong>Report</strong>.<br />
3. Improving Emergency Care taking into<br />
account the Acute Emergency Care<br />
St<strong>and</strong>ards that have been set across<br />
London <strong>and</strong> an analysis of the <strong>Hospital</strong><br />
St<strong>and</strong>ardised Mortality Ratio (HSMR).<br />
There will be a focus on early consultant<br />
review of patients requiring admission<br />
64 Quality report
LOOKING BACK…<br />
This section starts by looking at key measurements in a dashboard format. These are derived<br />
from some m<strong>and</strong>atory requirements, our consultation with our stakeholders, <strong>and</strong> those of<br />
national importance that patients will want to know about.<br />
Dashboard of key quality measures<br />
Achieved target<br />
Narrowly Missing target<br />
Significantly missing target<br />
Latest data<br />
available to<br />
benchmark<br />
Domain:<br />
Patient Safety (PS)/<br />
Clinical<br />
Effectiveness (CE)/<br />
Patient<br />
Experience (PE)<br />
2011/12<br />
Performance<br />
<strong>2012</strong>/<strong>13</strong><br />
Target<br />
<strong>2012</strong>/<strong>13</strong><br />
Performance<br />
How<br />
London<br />
<strong>Trust</strong>s<br />
Perform<br />
National<br />
Performance<br />
1a: In <strong>Hospital</strong><br />
St<strong>and</strong>ardised<br />
Mortality Ratio<br />
(HSMR)<br />
1b: St<strong>and</strong>ardised<br />
<strong>Hospital</strong><br />
Mortality Index<br />
(SHMI)<br />
1c: the<br />
percentage of<br />
patient deaths<br />
with palliative<br />
care coded at<br />
diagnosis<br />
2a:<br />
Readmissions to<br />
hospital within<br />
28 days<br />
2b: Emergency<br />
readmissions<br />
to hospital<br />
within 28 days<br />
of discharge<br />
from hospital:<br />
0-15 years<br />
(St<strong>and</strong>ardised)<br />
Apr-<strong>2012</strong> to<br />
Dec-<strong>2012</strong><br />
[Dr Foster]<br />
Jul-2011 to<br />
Jun-<strong>2012</strong><br />
[Dr Foster]<br />
Jul-2011 to<br />
Jun-<strong>2012</strong><br />
[Dr Foster]<br />
Apr-<strong>2012</strong> to<br />
Sep-<strong>2012</strong><br />
[Dr Foster]<br />
Apr-2011 to<br />
Mar-<strong>2012</strong><br />
[HSCIC<br />
Indicator<br />
Portal]<br />
(Local)<br />
PS<br />
PS<br />
PS<br />
CE/PS<br />
107.2<br />
(99.2 - 115.6)<br />
0.8878<br />
(As Expected)<br />
n/a<br />
104.2<br />
(101 - 107.4)<br />
Latest data<br />
available to<br />
benchmark<br />
Domain:<br />
Patient Safety (PS)/<br />
Clinical<br />
Effectiveness (CE)/<br />
Patient<br />
Experience (PE)<br />
2011/12<br />
Performance<br />
<strong>2012</strong>/<strong>13</strong><br />
Target<br />
<strong>2012</strong>/<strong>13</strong><br />
Performance<br />
How<br />
London<br />
<strong>Trust</strong>s<br />
Perform<br />
National<br />
Performance<br />
2c: Emergency<br />
readmissions<br />
to hospital<br />
within 28 days<br />
of discharge<br />
from hospital:<br />
16+ years<br />
(St<strong>and</strong>ardised)<br />
Apr-2011 to<br />
Mar-<strong>2012</strong><br />
[HSCIC<br />
Indicator<br />
Portal]<br />
(Local)<br />
CE/PS 12.09% n/a<br />
[11.86%*]<br />
(7.5%)<br />
[11.95%]<br />
(n/a)<br />
[11.42%]<br />
(n/a)<br />
3: Non clinically<br />
justified<br />
single sex<br />
accommodation<br />
breach, rate per<br />
1,000 finished<br />
consultant<br />
episodes<br />
Apr-<strong>2012</strong> to<br />
Dec-<strong>2012</strong><br />
[Unify2/DH]<br />
PE 0.11 0 0.06* 0.73 0.21<br />
4: Cancer: Two<br />
week wait from<br />
GP referral<br />
to seeing<br />
a specialist<br />
(suspected<br />
cancer)/(breast<br />
symptoms)<br />
Apr-<strong>2012</strong> to<br />
Dec-<strong>2012</strong><br />
[OpenExeter/<br />
DH]<br />
CE/PS<br />
Suspected:<br />
98.3%<br />
Breast<br />
Symptom:<br />
96.4%<br />
93%<br />
93%<br />
97.9%”<br />
98.0%”<br />
95.3%<br />
95.1%<br />
95.5%<br />
95.4%<br />
5: Cancer: 31<br />
day maximum<br />
wait from<br />
diagnosis to first<br />
treatment<br />
6: Cancer: 31<br />
day maximum<br />
wait from<br />
diagnosis to<br />
subsequent<br />
treatment, drug<br />
or surgery<br />
7: Cancer: 62-<br />
day maximum<br />
wait from<br />
referral by<br />
GP/screening<br />
service/<br />
consultant<br />
upgrade to<br />
treatment<br />
8: Referral<br />
to treatment<br />
waiting times -<br />
admitted<br />
9: Referral<br />
to treatment<br />
waiting times -<br />
non admitted<br />
Apr-<strong>2012</strong> to<br />
Dec-<strong>2012</strong><br />
[OpenExeter/<br />
DH]<br />
Apr-<strong>2012</strong> to<br />
Dec-<strong>2012</strong><br />
[OpenExeter/<br />
DH]<br />
Apr-<strong>2012</strong> to<br />
Dec-<strong>2012</strong><br />
[OpenExeter/<br />
DH]<br />
Dec-<strong>2012</strong><br />
[Unify2/DH]<br />
Dec-<strong>2012</strong><br />
[Unify2/DH]<br />
CE/PS 97.9% 96% 99.2%” 98.1% 98.4%<br />
CE/PS<br />
CE/PS<br />
Drug: 100.0%<br />
Surgery:<br />
100.0%<br />
GP/GDP:<br />
92.6%<br />
Screening:<br />
68.6%<br />
Upgrade:<br />
98.3%<br />
98%<br />
94%<br />
85%<br />
90%<br />
85%<br />
100.0%”<br />
100.0%”<br />
93.3%”<br />
93.9%”<br />
98.6%”<br />
99.6%<br />
97.2%<br />
86.1%<br />
92.1%<br />
94.2%<br />
99.7%<br />
97.4%<br />
87.5%<br />
95.1%<br />
93.4%<br />
CE/PS 95.9% 90% 96.7%^ 92.4% 93.1%<br />
CE/PS 98.9% 95% 98.6%^ 97.9% 97.7%<br />
66 Quality report
Latest data<br />
available to<br />
benchmark<br />
Domain:<br />
Patient Safety (PS)/<br />
Clinical<br />
Effectiveness (CE)/<br />
Patient<br />
Experience (PE)<br />
2011/12<br />
Performance<br />
<strong>2012</strong>/<strong>13</strong><br />
Target<br />
<strong>2012</strong>/<strong>13</strong><br />
Performance<br />
How<br />
London<br />
<strong>Trust</strong>s<br />
Perform<br />
National<br />
Performance<br />
10: Referral<br />
to treatment<br />
waiting times -<br />
Incomplete1<br />
11: Fractured<br />
neck of femur<br />
emergency<br />
patients in<br />
theatre within<br />
36 hours<br />
Dec-<strong>2012</strong><br />
[Unify2/DH]<br />
Apr-2011 to<br />
Mar <strong>2012</strong><br />
NHF Database<br />
CE/PS 96.9% 92% 97.6%^ 93.4% 94.5%<br />
CE/PS 79.1% 90% 90.8% n/a n/a<br />
12: Total time<br />
in A&E: 4 hours<br />
or less<br />
Apr-<strong>2012</strong> to<br />
Jan-20<strong>13</strong><br />
[Unify2/DH]<br />
PE 97.9% 95% 96.7% 96.4% 96.2%<br />
<strong>13</strong>: Percentage<br />
of patients<br />
not treated<br />
within 28 days<br />
of having<br />
operation<br />
cancelled for<br />
non-clinical<br />
reasons<br />
14: Percentage<br />
of women in<br />
the relevant<br />
PCT population<br />
who have seen<br />
a midwife or<br />
a maternity<br />
healthcare<br />
professional,<br />
for health <strong>and</strong><br />
social care<br />
assessment of<br />
needs, risks<br />
<strong>and</strong> choices<br />
by 12 weeks<br />
<strong>and</strong> 6 days of<br />
pregnancy<br />
15: Stroke<br />
patients:<br />
Percentage of<br />
patients that<br />
have spent at<br />
least 90% of<br />
their time on<br />
the stroke unit<br />
16: Stroke<br />
patients:<br />
Percentage of<br />
high risk TIA/<br />
mini stroke<br />
patients who<br />
are treated<br />
within 24 hours<br />
Apr-Dec <strong>2012</strong><br />
[Unify2/DH]<br />
Apr-Dec <strong>2012</strong><br />
[Unify2/DH]<br />
Oct-<strong>2012</strong> to<br />
Dec-<strong>2012</strong><br />
[Unify2/DH]<br />
Oct-<strong>2012</strong> to<br />
Dec-<strong>2012</strong><br />
[Unify2/DH]<br />
CE/PS 3.4% 0% 6.0% 2.8% 4.6%<br />
PE/CE 90.2% 90%<br />
93.3%<br />
(Excluding<br />
Late Referrals)<br />
80.4% 86.9%<br />
CE 99% 80% 99.6% 93.8% 85.0%<br />
CE 100% 75% 100% 84.6% 75.9%<br />
Quality report<br />
67
17: MRSA<br />
18: Cdiff cases<br />
reported<br />
within the<br />
<strong>Trust</strong> amongst<br />
patients aged 2<br />
<strong>and</strong> over during<br />
the reporting<br />
period<br />
19: Percentage<br />
of patients who<br />
were admitted<br />
to hospital<br />
<strong>and</strong> who were<br />
risk assessed<br />
for Venous<br />
Thrombo<br />
Embolism (VTE)<br />
20a: Patient<br />
<strong>Report</strong>ed<br />
Outcome<br />
Measures<br />
(PROMs) scores<br />
(Health Gain),<br />
Groin Hernia,<br />
EQ-5D Index/<br />
VAS<br />
20b: PROMS<br />
(Health<br />
Gain), Hip<br />
Replacement,<br />
EQ-5D Index/<br />
VAS<br />
20c: PROMS<br />
(Health<br />
Gain), Knee<br />
Replacement,<br />
EQ-5D Index/<br />
VAS<br />
Latest data<br />
available to<br />
benchmark<br />
Apr-2011 to<br />
Mar-<strong>2012</strong><br />
[HPA]<br />
Apr-2011 to<br />
Mar-<strong>2012</strong><br />
[HPA]<br />
Oct-<strong>2012</strong> to<br />
Dec-<strong>2012</strong><br />
[Unify2/DH]<br />
Apr-<strong>2012</strong> to<br />
Sep-<strong>2012</strong><br />
[HES]<br />
Apr-<strong>2012</strong> to<br />
Sep-<strong>2012</strong><br />
[HES]<br />
Apr-<strong>2012</strong> to<br />
Sep-<strong>2012</strong><br />
[HES]<br />
Domain:<br />
Patient Safety (PS)/<br />
Clinical<br />
Effectiveness (CE)/<br />
Patient<br />
Experience (PE)<br />
PS<br />
PS<br />
2011/12<br />
Performance<br />
4 Cases<br />
2.9 Cases per<br />
100,000 bed<br />
days<br />
25 Cases<br />
19.3 Cases per<br />
100,000 bed<br />
days<br />
<strong>2012</strong>/<strong>13</strong><br />
Target<br />
3<br />
24<br />
<strong>2012</strong>/<strong>13</strong><br />
Performance<br />
1 Case<br />
0.77 Cases per<br />
100,000 bed<br />
days<br />
23<br />
16.2 Cases per<br />
100,000 bed<br />
days<br />
How<br />
London<br />
<strong>Trust</strong>s<br />
Perform<br />
114 Cases<br />
2.0 Cases<br />
per<br />
100,000<br />
bed days<br />
1,154<br />
21.1<br />
Cases per<br />
100,000<br />
bed days<br />
PS 87.5% 90% 91.9%+ 93.10%<br />
CE/PS n/a n/a 0.123 / 0.667* n/a<br />
CE/PS n/a n/a 0.4 / 12.105* n/a<br />
National<br />
Performance<br />
471 Cases<br />
1.3 Cases per<br />
100,000 bed<br />
days<br />
7,670<br />
21.8 Cases per<br />
100,000 bed<br />
days<br />
Lowest<br />
Performing<br />
82 Cases,<br />
51.6 Cases<br />
per 100,000<br />
bed days<br />
(Tameside FT)<br />
Highest<br />
Performing<br />
0 Cases<br />
(Birmingham<br />
Women’s)<br />
94.1%<br />
Lowest<br />
Performing<br />
84.6%<br />
(Croydon<br />
Health<br />
Services <strong>NHS</strong><br />
<strong>Trust</strong>)<br />
Highest<br />
Perfoming<br />
100%<br />
(South Essex<br />
Partnership<br />
University FT)<br />
0.091 / -0.603<br />
(i)<br />
0.437 / 10.863<br />
(ii)<br />
CE/PS n/a n/a 0.262 / 18.2* n/a 0.312 / 5 (iii)<br />
21: Inpatient<br />
Experience<br />
Programme<br />
(local survey<br />
results)<br />
88% YTD<br />
[Local Survey]<br />
68 Quality report<br />
PE 87% >87% 88% n/a n/a
Latest data<br />
available to<br />
benchmark<br />
Domain:<br />
Patient Safety (PS)/<br />
Clinical<br />
Effectiveness (CE)/<br />
Patient<br />
Experience (PE)<br />
2011/12<br />
Performance<br />
<strong>2012</strong>/<strong>13</strong><br />
Target<br />
<strong>2012</strong>/<strong>13</strong><br />
Performance<br />
How<br />
London<br />
<strong>Trust</strong>s<br />
Perform<br />
National<br />
Performance<br />
22: Outpatient<br />
Experience<br />
Programme<br />
(local survey<br />
results)<br />
87% YTD<br />
[Local Survey]<br />
PE 86% >86% 87% n/a n/a<br />
23: Maternity<br />
Experience<br />
Programme<br />
(local survey<br />
results)<br />
86%YTD<br />
[Local Survey]<br />
PE 85% >85% 86% n/a n/a<br />
24: Independent<br />
assessment of<br />
cleanliness of<br />
hospital<br />
88% YTD PE 92% >87% 87% n/a n/a<br />
25: Percentage<br />
of complaints<br />
responded to<br />
within agreed<br />
timescale<br />
n/a PE 84% 90% 74.5% n/a n/a<br />
26: <strong>Trust</strong>’s<br />
responsiveness<br />
to personal<br />
needs of our<br />
patients<br />
27: Percentage<br />
of staff<br />
who would<br />
recommend<br />
the <strong>Trust</strong> as a<br />
provider of care<br />
to their family<br />
<strong>and</strong> friends<br />
28: Patient<br />
safety incidents/<br />
percentage<br />
resulted in<br />
severe harm or<br />
death<br />
Apr <strong>2012</strong> to<br />
March 20<strong>13</strong><br />
[National<br />
Patient<br />
Survey]<br />
<strong>2012</strong> Survey<br />
[National<br />
Staff Survey]<br />
Apr <strong>2012</strong> to<br />
March 20<strong>13</strong><br />
[Datix]<br />
PE 62.9% 72% 65% n/a 67.4%<br />
PE 3.53 n/a 3.66 3.70<br />
PS 1% (45)NRLS n/a<br />
0.75% (41)<br />
(0.75 per 100<br />
admissions)<br />
3.57 average<br />
Lowest<br />
Performing<br />
2.90 (North<br />
Cumbria<br />
University<br />
<strong>Hospital</strong>)<br />
Highest<br />
Performing<br />
4.08 (Guy’s &<br />
St Thomas’)<br />
1.3 0.9<br />
Notes: <strong>2012</strong>/20<strong>13</strong> Performance is for Apr-<strong>2012</strong> to Mar-20<strong>13</strong> unless:<br />
* Same as Benchmark Period<br />
+ Apr -<strong>2012</strong> to Jan-20<strong>13</strong><br />
“ Apr-<strong>2012</strong> to Feb-20<strong>13</strong><br />
^ Mar-20<strong>13</strong><br />
Quality report<br />
69
(i) Groin<br />
Lowest<br />
performing<br />
Warrington And<br />
Halton <strong>Hospital</strong>s <strong>NHS</strong><br />
Foundation <strong>Trust</strong><br />
(-0.062)<br />
EQ-5D Index<br />
Highest<br />
performing<br />
University <strong>Hospital</strong>s<br />
Bristol <strong>NHS</strong><br />
Foundation <strong>Trust</strong><br />
(0.227)<br />
Lowest<br />
performing<br />
The Whittington<br />
<strong>Hospital</strong> <strong>NHS</strong> <strong>Trust</strong><br />
(-10.667)<br />
EQ-5D VAS<br />
Highest<br />
performing<br />
Guy’s And St<br />
Thomas’ <strong>NHS</strong><br />
Foundation <strong>Trust</strong><br />
(11.4)<br />
(ii) Hip<br />
Replacement<br />
Yeovil District <strong>Hospital</strong><br />
<strong>NHS</strong> Foundation <strong>Trust</strong><br />
(0.155)<br />
The Queen Elizabeth<br />
<strong>Hospital</strong>, King’s Lynn,<br />
<strong>NHS</strong> Foundation <strong>Trust</strong><br />
(0.69)<br />
Brighton And<br />
Sussex University<br />
<strong>Hospital</strong>s <strong>NHS</strong> <strong>Trust</strong><br />
(-10.571)<br />
Barts And The<br />
London <strong>NHS</strong> <strong>Trust</strong><br />
(30.6)<br />
(iii) Knee<br />
Replacement<br />
Royal National<br />
Orthopaedic <strong>Hospital</strong><br />
<strong>NHS</strong> <strong>Trust</strong> (0.031)<br />
Mid Cheshire <strong>Hospital</strong>s<br />
<strong>NHS</strong> Foundation <strong>Trust</strong><br />
(0.527)<br />
Imperial College<br />
Healthcare <strong>NHS</strong><br />
<strong>Trust</strong> (-10.667)<br />
Barnsley <strong>Hospital</strong><br />
<strong>NHS</strong> Foundation<br />
<strong>Trust</strong> (24.842)<br />
Supporting information about the<br />
indicators required in accordance with<br />
the Quality Account regulations<br />
Indicator 1b<br />
The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation<br />
<strong>Trust</strong> considers that this data is as described<br />
for the following reasons - national reporting<br />
shows a stable ratio over the past two years.<br />
The <strong>Trust</strong> is working on improving the<br />
variation between weekdays <strong>and</strong> weekends<br />
<strong>and</strong> will examine any outliers.<br />
Indicator 1c<br />
The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation<br />
<strong>Trust</strong> considers that this data is as described<br />
for the following reasons – not all patients<br />
who are receiving palliative care are<br />
on the Liverpool Care Pathway. Clearer<br />
identification of these patients will improve<br />
the palliative care coding.<br />
Indicator 2a, 2b <strong>and</strong> 2c<br />
The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation<br />
<strong>Trust</strong> considers that these percentages are<br />
as described for the following reasons – the<br />
<strong>Trust</strong> is aware from a variety of data sources<br />
that the figures are higher than expected.<br />
Several initiatives to improve these figures<br />
include strengthening our care pathways <strong>and</strong><br />
the Improving Inpatient Care initiative. Refer<br />
to priority 2 for 20<strong>13</strong>/2014 on page 78.<br />
Indicator 18<br />
The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation<br />
<strong>Trust</strong> considers that this rate is described for<br />
the following reasons – the <strong>Trust</strong> achieved a<br />
target of 23 out of 24 for <strong>2012</strong>/20<strong>13</strong> <strong>and</strong> has<br />
shown a year on year improvement. The <strong>Trust</strong><br />
will continue with all current initiatives. The<br />
<strong>Trust</strong> hosted a multidisciplinary workshop in<br />
May chaired by a national expert in infection<br />
control which will inform our measures to<br />
improve our targets for 20<strong>13</strong>/2014 of 14 for C<br />
Diff <strong>and</strong> 0 for MRSA.<br />
Indicator 19<br />
The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation<br />
<strong>Trust</strong> considers that this percentage is as<br />
described for the following reasons – the<br />
<strong>Trust</strong> has shown an improvement over the<br />
last two years. This is a CQUIN for 20<strong>13</strong>/14<br />
<strong>and</strong> work will be taken forward to bring<br />
about further improvement.<br />
Indicator 20a, 20b <strong>and</strong> 20c<br />
The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation<br />
<strong>Trust</strong> considers that the outcome scores are<br />
as described for the following reasons – Data<br />
shows that the five domains that this score<br />
refers to are hospital outcome measures (EQ<br />
– 5D index VAS). The <strong>Trust</strong> performs better<br />
70 Quality report
than average for hernias, but worse than<br />
average for hip <strong>and</strong> knee replacements, <strong>and</strong><br />
better than average for all three procedures<br />
from the patient’s perspective (EQ -5 index<br />
VAS).<br />
Indicator 26<br />
The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation<br />
<strong>Trust</strong> considers that this data is as described<br />
for the following reasons – there has been<br />
a slow improvement but still below target.<br />
Further work is being undertaken to improve<br />
the situation through our customer care<br />
programme, our CARES values initiative <strong>and</strong><br />
the Improving Inpatient Care initiative.<br />
Indicator 27<br />
The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation<br />
<strong>Trust</strong> considers that this data is as described<br />
for the following reasons – there has been<br />
a steady improvement but further work is<br />
being undertaken through our CARES values<br />
initiative.<br />
Indicator 28<br />
The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation<br />
<strong>Trust</strong> considers that this data is as described<br />
for the following reasons - whilst the <strong>Trust</strong><br />
has a lower than average rate of severe<br />
harm / death patient safety incidents, there<br />
is not a nationally established <strong>and</strong> regulated<br />
approach to reporting <strong>and</strong> categorising<br />
patient safety incidents. The approach<br />
taken to determine the classification of each<br />
incident, such as those ‘resulting in severe<br />
harm or death’, will often rely on clinical<br />
judgement. In addition, the classification of<br />
the impact of an incident may be subject to a<br />
potentially lengthy investigation which may<br />
result in the classification being changed.<br />
This change may not be reported externally<br />
<strong>and</strong> the data held by a <strong>Trust</strong> may not be the<br />
same as that held by the NRLS.<br />
Definitions of the two m<strong>and</strong>ated<br />
indicators<br />
Indicator 7<br />
Percentage of patients receiving first<br />
definitive treatment for cancer within 62<br />
days of an urgent GP referral for suspected<br />
cancer.<br />
Indicator 2a<br />
Percentage of emergency admissions to any<br />
hospital in Engl<strong>and</strong> within 28 days of the last<br />
previous discharge from hospital.<br />
Priority 1: The First Contact Project –<br />
improving the outpatient experience<br />
We said:<br />
We would centralise all outpatient<br />
appointment bookings to ensure that calls<br />
are answered more quickly; provide more<br />
telephone lines; patients won’t have to wait<br />
so long to be attended to; the system would<br />
also have an interactive element where<br />
patients will receive a phone call <strong>and</strong> text as<br />
a reminder of their appointment.<br />
We also said we would introduce a document<br />
scanning referral system <strong>and</strong> introduce the<br />
electronic transfer of outpatient clinic letters<br />
from the hospital clinicians to the GP.<br />
The changes would be measured for<br />
impact by reviewing the data from the Call<br />
Management System (CMS) detailing the<br />
average call waiting time <strong>and</strong> ab<strong>and</strong>onment<br />
rate, appointment non-attendance (DNA)<br />
rate <strong>and</strong> the number of complaints.<br />
Quality report<br />
71
We did:<br />
a PARTIALLY ACHIEVED<br />
Booking centralisation<br />
During <strong>2012</strong> staff that make new <strong>and</strong> follow<br />
up appointments have been centralised to<br />
one location. We recognise that this is the<br />
first step towards centralising all bookings<br />
<strong>and</strong> that further work to train staff <strong>and</strong><br />
equip them with the skills to deal with<br />
queries about any outpatient appointment<br />
related query is necessary.<br />
a ACHIEVED<br />
Call Management System (CMS)<br />
The CMS was implemented in June <strong>2012</strong> with<br />
an appointment reminder function going live<br />
in August <strong>2012</strong>.<br />
The CMS has changed the way The<br />
<strong>Hillingdon</strong> <strong>Hospital</strong> deals with telephone<br />
calls from patients about their outpatient<br />
appointments. Now patients are given one<br />
telephone number, they then choose from a<br />
list of options which ensures their call is dealt<br />
with by the correct member of staff (agent).<br />
If all agents are busy the patient is held in<br />
a queue <strong>and</strong> informed that their call will be<br />
answered.<br />
The system provides staff with comprehensive<br />
reports <strong>and</strong> real time information about call<br />
activity, response times, ab<strong>and</strong>onment rates<br />
<strong>and</strong> call resolution. Managers are able to<br />
adjust resources to meet the volume of calls.<br />
There has also been a reduction in Patient<br />
Advice <strong>and</strong> Liaison Services (PALs) concerns<br />
<strong>and</strong> complaints from 129 in 2011/<strong>2012</strong> to 77<br />
in <strong>2012</strong>/20<strong>13</strong>.<br />
The CMS has an optional appointment<br />
reminder functionality (called Remind+)<br />
which contacts patients by telephone seven<br />
days before their appointment to confirm<br />
their attendance. This is then further<br />
supplemented with a text messaging service<br />
which sends a reminder to a mobile number<br />
48 hrs before the appointment.<br />
a ACHIEVED<br />
Introduce a document scanning referral<br />
system<br />
Document scanning has been implemented<br />
for all cancer <strong>and</strong> symptomatic breast<br />
referrals. The new process allows outpatient<br />
appointment centre staff, Multi Disciplinary<br />
Team (MDT) coordinators <strong>and</strong> Health<br />
Care Assistants (HCAs) in outpatients to<br />
access the documents electronically which<br />
eliminates the risk of paper letters getting<br />
lost <strong>and</strong> subsequent delays. GPs are also<br />
increasingly making referrals <strong>and</strong> outpatient<br />
appointments via an electronic system called<br />
Choose <strong>and</strong> Book.<br />
r NOT ACHIEVED<br />
Electronic outpatient letters to GPs<br />
From January 20<strong>13</strong> the <strong>Trust</strong> is piloting the<br />
electronic delivery of outpatient letters to<br />
GPs in <strong>Hillingdon</strong> in the following specialities:<br />
Care of the Elderly, Stroke, Paediatrics <strong>and</strong><br />
breast surgery.<br />
There is much more to do particularly in<br />
relation to the centralisation of booking<br />
appointments <strong>and</strong> implementation of<br />
the electronic document <strong>and</strong> records<br />
management.<br />
Priority 2: Maternity<br />
We said:<br />
As part of our ongoing maternity strategy<br />
for improving quality of care we said that<br />
we would like to see an improvement in our<br />
patient experience survey by at least 1%<br />
<strong>and</strong> respond to shortfalls identified by both<br />
staff <strong>and</strong> comments made within the patient<br />
survey. We look forward to the rich source of<br />
information from the patient diary exercise,<br />
which commenced in November <strong>2012</strong>. As a<br />
response to a survey undertaken by the Local<br />
Involvement Network (LINk) survey we have<br />
engaged more with hard to reach groups<br />
including Somali <strong>and</strong> Afghan support groups.<br />
We also said we would improve the Labour<br />
72 Quality report
Ward environment; reduce caesarean section<br />
rates to 27.6% <strong>and</strong> increase breastfeeding<br />
rates.<br />
We also aimed to increase the number of<br />
non-obstetric deliveries – including an aim to<br />
increase the number of women having their<br />
babies at home.<br />
We also said that we would reconfigure<br />
our community services to improve the<br />
experience.<br />
We did:<br />
a ACHIEVED<br />
Patient experience in maternity is improving.<br />
The patient experience rate is 86% <strong>and</strong> by<br />
Q4 the figure is 88%; an increase so far this<br />
year of 2%. We continue to monitor this on a<br />
monthly basis.<br />
a ACHIEVED<br />
We have now managed to recruit women<br />
from a variety of cultural backgrounds<br />
(representative of the population we<br />
serve) to work in the reception area of the<br />
Maternity main foyer <strong>and</strong> Maternity helpers<br />
(now called maternity mates) on the wards,<br />
depending on language.<br />
Some of these women have a National<br />
Vocational Qualification (NVQ) in health <strong>and</strong><br />
social care <strong>and</strong> are looking to continue their<br />
education into nursing <strong>and</strong> midwifery.<br />
In June we will be meeting with women<br />
from the Afghan community to identify any<br />
specific needs to improve their experience<br />
of our service <strong>and</strong> staff. Key learning points<br />
identified from these informative meetings<br />
are shared with staff through relevant<br />
forums <strong>and</strong> training sessions.<br />
a ACHIEVED<br />
General refurbishment of the maternity unit,<br />
such as painting the stairwell <strong>and</strong> public<br />
areas, <strong>and</strong> the layout of the maternity triage<br />
area have been completed.<br />
The “Improving Birth Environments” bid,<br />
a Department of Health funding project<br />
to improve the physical environment of<br />
Maternity units in Engl<strong>and</strong>, has been<br />
successful <strong>and</strong> will allow us to modernise 10<br />
delivery rooms which will include en-suite<br />
facilities in each room <strong>and</strong> restructure the<br />
Labour Ward reception area. This work is due<br />
to commence in June 20<strong>13</strong>.<br />
a ACHIEVED<br />
The current year to date figure for caesarean<br />
sections is 26.9% for the year compared<br />
with the 2011/<strong>2012</strong> full year figure of 30.1%<br />
showing an improvement to date from last<br />
year.<br />
The multifaceted action plan for caesarean<br />
reduction continues to be monitored <strong>and</strong><br />
implemented to drive forward appropriate<br />
<strong>and</strong> safe changes in practice to allow for<br />
reduction in the overall rates of caesarean<br />
section, both elective <strong>and</strong> emergency.<br />
A three month trial of mixing ante <strong>and</strong><br />
postnatal women on both maternity wards<br />
is currently underway to increase Consultant<br />
presence to each area, to enable more<br />
confident decision making with junior staff.<br />
This will shortly end <strong>and</strong> be audited to<br />
review its impact on care provision.<br />
r NOT ACHIEVED<br />
Breastfeeding initiation rates are improving;<br />
the year to date figure is 82.9% for the<br />
year compared to 81.6% for last year,<br />
however, we did not reach our target of<br />
85%. Breastfeeding initiation stickers have<br />
helped to highlight information sharing <strong>and</strong><br />
training. There is still work to be done on<br />
improving these figures.<br />
With the appointment of a Breastfeeding<br />
Health Visitor, working with public health,<br />
we hope that the restructuring of our<br />
community services will strengthen the joint<br />
education <strong>and</strong> training of all staff with a<br />
view to improving rates further.<br />
Quality report<br />
73
Priority 3: Care priorities<br />
We said we would:<br />
• Ensure every patient is wearing a correctly<br />
labelled identib<strong>and</strong><br />
• Improve record keeping<br />
• Improve hydration <strong>and</strong> fluid balance of<br />
our patients during their stay in hospital.<br />
We did:<br />
a PARTIALLY ACHIEVED<br />
Care priority<br />
Patient<br />
identification<br />
Target<br />
<strong>2012</strong>/20<strong>13</strong><br />
90% 91%<br />
Record keeping 90% 79%<br />
Hydration/ fluid<br />
balance<br />
90% 90%<br />
Result<br />
<strong>2012</strong>/20<strong>13</strong><br />
part of this monthly assessment across all<br />
inpatient wards.<br />
• Matrons <strong>and</strong>/or senior sisters reviewed the<br />
nursing record of all patients on the ward<br />
as part of the monthly Patient Safety<br />
Thermometer survey. This provided an<br />
opportunity for immediate feedback to<br />
staff with clarification of the st<strong>and</strong>ard of<br />
record keeping required.<br />
Priority 4: Leaving hospital –<br />
improving the patient experience<br />
We said we would:<br />
Work to improve the information patients<br />
are given when they leave hospital to<br />
include the purpose <strong>and</strong> side effects of any<br />
medication that they will be taking when<br />
they get home <strong>and</strong> who to contact if they are<br />
worried after leaving hospital.<br />
We have achieved the target of 90% in two<br />
of our care priorities, patient identification<br />
<strong>and</strong> hydration/fluid balance. Record<br />
keeping is short of the target, achieving<br />
79% at year end. We did see a significant<br />
improvement of 8% between Q3 <strong>and</strong> Q4<br />
<strong>and</strong> we will continue to focus our attention<br />
on record keeping throughout 20<strong>13</strong>/2014<br />
to achieve our 90% target even though it is<br />
not included as a priority in the 20<strong>13</strong>/2014<br />
Quality Account. A number of initiatives to<br />
support improved record keeping were put<br />
into place in <strong>2012</strong>/20<strong>13</strong>, these include:<br />
• A Nursing Documentation Working<br />
Group has been set up. This group is<br />
made up of frontline staff <strong>and</strong> has been<br />
working to develop core care plans <strong>and</strong> to<br />
st<strong>and</strong>ardise some of the many charts that<br />
are used across the <strong>Trust</strong>.<br />
• The group will also be developing chart<br />
specific guidance to support accurate <strong>and</strong><br />
effective record keeping.<br />
• A new approach to the regular assessment<br />
<strong>and</strong> assurance of the quality of nursing<br />
care was developed. Peer review of the<br />
nursing documentation is an integral<br />
We did:<br />
St<strong>and</strong>ard<br />
Patient’s experience<br />
of leaving hospital is<br />
positive<br />
Patient receive<br />
a copy of ‘Your<br />
<strong>Hospital</strong> Journey’<br />
Discharge<br />
documentation is<br />
completed as per<br />
policy<br />
Patients underst<strong>and</strong><br />
where they are on<br />
their care pathway<br />
The Visual<br />
Management<br />
System (VMS) is kept<br />
updated<br />
Patient goes<br />
home with their<br />
medication<br />
GP receives copy of<br />
discharge summary<br />
within 24 hrs<br />
Patients discharged<br />
in a timely manner:<br />
Before 12pm<br />
Before 4pm<br />
Before 8pm<br />
Target for<br />
<strong>2012</strong>/20<strong>13</strong><br />
Result<br />
<strong>2012</strong>/20<strong>13</strong><br />
72% 82%<br />
100% 93%<br />
80% 93%<br />
90% 88%<br />
90% 95%<br />
90% 89%<br />
85% 73%<br />
25%<br />
60%<br />
80%<br />
15.8%<br />
42.3%<br />
79.5%<br />
74 Quality report
We saw an improvement in the patient<br />
experience of leaving hospital as measured<br />
by our follow up phone call. Additionally,<br />
many patients have commented that the<br />
follow up call is useful to check out any<br />
concerns that they may have. We continue<br />
to revise our processes so going forward<br />
into 20<strong>13</strong>/2014 our revised <strong>and</strong> simplified<br />
discharge checklist will be integrated into a<br />
new electronic tool that supports safe <strong>and</strong><br />
planned discharges.<br />
Key learning from this project such as the<br />
use of the coloured magnets to display key<br />
steps in the discharge process have now been<br />
incorporated into the electronic whiteboard.<br />
This is part of the Improving Inpatient Care<br />
Project that features in Looking Forward<br />
Priority 2 (see page 78).<br />
Our monthly Observations of Care visits<br />
to wards which began in February include<br />
asking patients key questions about their<br />
underst<strong>and</strong>ing of their care, current<br />
treatment <strong>and</strong> ongoing plans towards<br />
discharge.<br />
We are now looking at integrating<br />
information about who to contact if worried<br />
following discharge with an existing patient<br />
information leaflet.<br />
Quality report<br />
75
Priority 5: CQUINs – Commissioning for quality & innovation (subject to<br />
confirmation)<br />
Looking back:<br />
CQUIN targets for <strong>2012</strong>/20<strong>13</strong><br />
National<br />
Preventing blood clots<br />
Patient experience (patient survey)<br />
Dementia risk assessment (scoring tool to identify clinical risks)<br />
Collection of data for the Patient Safety Thermometer (see page 63<br />
for definition)<br />
Regional schemes<br />
Real time GP information (information for GPs about admission<br />
treatment <strong>and</strong> discharge of patients)<br />
Use of the North West London Formulary (a list of all medicines<br />
that are agreed for use across North West London between hospital<br />
<strong>and</strong> primary care services)<br />
Local schemes<br />
Consultant Assessments within 12 hours of emergency admission<br />
Patients with complications of diabetes<br />
End of life care (a structured pathway to ensure patients receive<br />
high quality patient focused care)<br />
What we did<br />
100% full year result<br />
20% predicted full year result<br />
Not achieved<br />
100% full year result<br />
84% predicted full year result<br />
100% full year result<br />
50% predicted full year result<br />
100% predicted full year result<br />
92% predicted full year result<br />
Exact percentages to be confirmed in mid<br />
June.<br />
Patient experience – The <strong>Trust</strong> achieved<br />
20% of the targets which was a steady<br />
improvement over 2 years.<br />
Dementia risk assessment – This depends<br />
on electronic recording of assessments, the<br />
system required to do this was not available<br />
at the time.<br />
Real time GP information – The IT<br />
system required to achieve this has been<br />
implemented for patients who attend<br />
A&E, <strong>and</strong> patients who are admitted as<br />
an emergency <strong>and</strong> inpatient discharge<br />
summaries. However, an electronic solution<br />
for sending outpatients letters was not<br />
available.<br />
Consultant assessments within 12 hours<br />
of emergency admission – The <strong>Trust</strong> has<br />
successfully achieved 55% of emergency<br />
admitted patients having a consultant<br />
assessment within 12 hours. It will continue<br />
to strive to achieve a higher percentage<br />
during 20<strong>13</strong>/14.<br />
End of life care – The drop in percentage<br />
points is due to a very high level of staff<br />
needing to be trained.<br />
76 Quality report
LOOKING FORWARD…<br />
Our priorities for 20<strong>13</strong>/2014<br />
No. Priority Safety Clinical Patient<br />
effectiveness experience<br />
1<br />
First contact – Continuing to improve the<br />
outpatient experience<br />
ü<br />
ü<br />
2<br />
Continuing with the leaving hospital Project to<br />
include work regarding Improving inpatient care ü ü ü<br />
<strong>and</strong> discharge<br />
3 Emergency care ü ü ü<br />
4 CARES ü<br />
5 CQUINs ü ü ü<br />
In arriving at these priorities, agreed by the<br />
<strong>Trust</strong> Board, we had a systematic process<br />
of stakeholder involvement, as in previous<br />
years. This included our public, in the form<br />
of our People in Partnership (PiP) which<br />
included a series of focus groups, our<br />
Governors, LINKs (which included difficult to<br />
reach groups) <strong>and</strong> our Commissioners. There<br />
was a strong opinion from our stakeholders<br />
that we should continue with projects started<br />
in previous years where further outcomes<br />
needed to be set <strong>and</strong> achieved to fulfil<br />
their potential. Hence the projects relating<br />
to an effective outpatient experience <strong>and</strong><br />
high quality inpatient care with efficient<br />
discharge planning have been retained.<br />
During <strong>2012</strong>/20<strong>13</strong> a review of inpatient care<br />
on one ward showed that the balance of<br />
nurses to healthcare assistants on the ward<br />
was not always at the planned level; multiprofessional<br />
communication was sometimes<br />
fragmented <strong>and</strong> nursing leadership on the<br />
ward needed to improve. We undertook a<br />
number of actions to address these issues<br />
<strong>and</strong> this work continues to inform our<br />
quality priorities, notably through the CARES<br />
<strong>and</strong> Improving Inpatient Care priorities<br />
outlined below. We will also be performing<br />
a detailed review of our ward staffing levels.<br />
During the later stages of the consultation,<br />
the Francis <strong>Report</strong> was released <strong>and</strong> we<br />
have incorporated a number of its key<br />
recommendations in this document. The<br />
“Emergency Care” priority will have targets<br />
related to improving mortality, <strong>and</strong> a full<br />
participation in the “Friends <strong>and</strong> Family” test<br />
which preliminary data from most <strong>Hospital</strong>s<br />
has found to be difficult to implement in<br />
A&E. The priority related to implementing<br />
our CARES framework of staff values goes to<br />
the heart of the Francis report by acting as<br />
the framework for providing patient-focused<br />
high quality, responsive <strong>and</strong> compassionate<br />
care.<br />
PRIORITY 1: First Contact –<br />
continuing to improve the<br />
outpatient experience<br />
Why is this one of our priorities?<br />
We recognise that we have made some<br />
changes to the way patients are contacted<br />
<strong>and</strong> are reminded about their outpatient<br />
appointments <strong>and</strong> these changes have now<br />
been made. Furthermore we have more work<br />
to do to centralise bookings <strong>and</strong> implement<br />
a new electronic document records<br />
management system; this work remains a<br />
priority because the changes have a clear<br />
impact on quality <strong>and</strong> patients’ experience.<br />
Quality report<br />
77
Our aims for 20<strong>13</strong>/2014:<br />
Call Management System (CMS)<br />
Implementation of the CMS has significantly<br />
changed the way we h<strong>and</strong>le calls <strong>and</strong> remind<br />
people about their outpatient appointments.<br />
This year we will set up a focus group to<br />
gain feedback from our patients <strong>and</strong> users<br />
about their experience in navigating the<br />
system so we can establish what further work<br />
is needed <strong>and</strong> take the appropriate action.<br />
Some of the things we will be discussing at<br />
the focus group are the opening times of<br />
the outpatient appointments centre <strong>and</strong><br />
communication with patients about times<br />
when we know the call volume will be high.<br />
We continue to provide staff training on<br />
customer care including telephone h<strong>and</strong>ling<br />
skills which reflects the CARES strategy<br />
(see Priority 4 on page 80). We use r<strong>and</strong>om<br />
call listening to support staff training <strong>and</strong><br />
development. Furthermore staff are being<br />
trained to deal with a variety of patients’<br />
queries with the aim to improve first call<br />
resolution.<br />
Electronic document records management<br />
This year the <strong>Trust</strong> is undertaking a<br />
major change to the way medical records<br />
are accessed <strong>and</strong> stored. The Electronic<br />
Document Records System is being proposed<br />
as a key infrastructure for the <strong>Trust</strong> in<br />
order to enhance the quality <strong>and</strong> efficiency<br />
of healthcare provided to our patients.<br />
The underlying vision for this case is to<br />
ensure that the best <strong>and</strong> most up to date<br />
information should be readily available to<br />
enable professional staff to offer appropriate<br />
care <strong>and</strong> treatment.<br />
It will also increase productivity <strong>and</strong><br />
improve quality of care provided through<br />
the facilitation of electronic forms <strong>and</strong><br />
workflows. Scanned documents e.g. referral<br />
letters will be used in workflow processes,<br />
allowing the conversion of paper formcentric<br />
processes into paperless ones with<br />
electronic forms being stored directly into<br />
patient records to support clinical decision<br />
making <strong>and</strong> administrative functions.<br />
Booking centralisation<br />
During 20<strong>13</strong>/2014 further work will take<br />
place to centralise the booking of new<br />
<strong>and</strong> follow up outpatient appointments<br />
across the <strong>Trust</strong>. We have already achieved<br />
the first stage of centralising where the<br />
Outpatient Appointments Centre now takes<br />
all telephone queries for Mount Vernon<br />
<strong>Hospital</strong> outpatient appointments.<br />
The performance targets we will use to<br />
measure the impact of the changes <strong>and</strong> new<br />
initiatives are:<br />
• Call ab<strong>and</strong>onment rate - we aim to<br />
keep this below 10% (currently 28% for<br />
January-March 20<strong>13</strong>)<br />
• 95% of calls to be answered within 60<br />
seconds<br />
• First contact resolution – aim to resolve<br />
more than 90% of the queries in the first<br />
contact (less than 10% of calls transferred<br />
to other departments)<br />
• Reduction in ‘did not attend’ rates (DNA)<br />
for outpatient appointments (to be<br />
agreed in quarter 1).<br />
PRIORITY 2: Continuing to improve<br />
the Leaving <strong>Hospital</strong> Project –<br />
improving inpatient care<br />
Why is this one of our priorities?<br />
Following the success of implementing our<br />
leaving hospital principles across all of our<br />
wards, we reviewed our goals <strong>and</strong> priorities<br />
<strong>and</strong> re-launched the project as “Improving<br />
Inpatient Care”. The overall objective of<br />
this programme of work is to ensure we<br />
provide high quality of care to all inpatients<br />
by improving the patient journey <strong>and</strong><br />
thereby decreasing length of stay.<br />
78 Quality report
How are we doing so far?<br />
Length of stay for inpatients at <strong>Hillingdon</strong><br />
<strong>Hospital</strong> has been a priority service<br />
improvement goal for a number of years. We<br />
know that the longer patients are in hospital,<br />
the more risks there are to the patient, <strong>and</strong><br />
fundamentally, we know people do not<br />
want to be in hospital. We want to support<br />
our patients to return to their homes <strong>and</strong><br />
be supported in the community as soon as<br />
clinically appropriate. We want to remove all<br />
unnecessary waits in hospital, <strong>and</strong> provide a<br />
better service, particularly for those patients<br />
with greater need, such as those who may<br />
need social care support or ongoing care in<br />
the community.<br />
Successful changes have been made gradually<br />
through individual teams <strong>and</strong> <strong>Trust</strong> wide<br />
initiatives which have enabled more effective<br />
working <strong>and</strong> as a result, more efficient, high<br />
quality care. Almost 50% of our emergency<br />
patients are discharged within 72 hours.<br />
The average length of stay for the <strong>Trust</strong> has<br />
reduced by 0.8 days over the past 12 months;<br />
we are heading in the right direction.<br />
Our aims for 20<strong>13</strong>/2014 are:<br />
The Improving Inpatient Care programme,<br />
initiated in December <strong>2012</strong>, is putting in<br />
place a series of changes across the <strong>Trust</strong> to<br />
continue to reduce the length of stay, by<br />
eliminating delays <strong>and</strong> improving the overall<br />
experience patients receive whilst in hospital.<br />
Examples of this work include:<br />
• Developing an enhanced service for frail<br />
<strong>and</strong> elderly patients who are admitted as<br />
an emergency. The full details are being<br />
developed <strong>and</strong> tested during the early<br />
part of 20<strong>13</strong>, but will aim to involve an<br />
enhanced comprehensive assessment<br />
completed by a specialist Care of the<br />
Elderly Consultant <strong>and</strong> a team of specialist<br />
occupational <strong>and</strong> physiotherapists on<br />
day one of admission. This will then<br />
mean the hospital can start putting in<br />
place everything the patient will need<br />
to get home, as soon as they are better.<br />
For example, for patients who might be<br />
unsteady on their feet, fitting rails in their<br />
home so they can manage stairs without<br />
coming to harm.<br />
• Improving how we set discharge dates,<br />
with better co-ordination of teams<br />
through doctors’ rounds, <strong>and</strong> supporting<br />
nurses, doctors, pharmacists <strong>and</strong><br />
therapists to work together better when<br />
reviewing a patient’s needs.<br />
• Implementing new electronic whiteboards<br />
to provide reminders of all patients’<br />
next steps for all teams who work on the<br />
wards.<br />
• Improving the clarity of information we<br />
provide to nursing <strong>and</strong> residential homes,<br />
in order to support them in looking<br />
after patients when they are discharged<br />
from hospital. This aims to reduce the<br />
likelihood of that person needing to come<br />
back into hospital, as their care teams<br />
will know how to manage their needs<br />
appropriately.<br />
Specific goals for this project are:<br />
• Reduce length of stay to become one of<br />
the top 25% of <strong>Trust</strong>s nationally<br />
• Achieve 40% of all discharges leaving<br />
before 12pm<br />
• Earlier therapy <strong>and</strong> specialist review for<br />
complex elderly patients, supporting up<br />
to an additional 400 patients per year<br />
• Reduce the rate of readmissions aiming to<br />
prevent up to 230 avoidable readmissions<br />
per year<br />
PRIORITY 3: Improving emergency<br />
care<br />
Why is this one of our priorities?<br />
There is national <strong>and</strong> London evidence to<br />
show that there are significant differences<br />
in the mortality rates for patients admitted<br />
as an emergency during the week compared<br />
with patients admitted as an emergency<br />
at the weekend. Reduced service provision<br />
Quality report<br />
79
at weekends has been associated with this<br />
higher mortality rate.<br />
In response to the data, <strong>NHS</strong> London have<br />
developed commissioning st<strong>and</strong>ards for<br />
emergency care with the aim of ensuring<br />
that consultants have early <strong>and</strong> continued<br />
involvement in the care of all patients<br />
admitted as an emergency.<br />
How are we doing so far?<br />
As a <strong>Trust</strong> we are committed to achieving the<br />
emergency care st<strong>and</strong>ards <strong>and</strong> have invested<br />
in additional senior doctor time, out of hours<br />
Monday to Friday <strong>and</strong> also at the weekends.<br />
Notably we have provided Consultant<br />
ward rounds twice a day on our medical<br />
Emergency Assessment Unit. This has ensured<br />
that our patients continue to receive care<br />
from our most senior doctors irrespective of<br />
the day of the week.<br />
We have also ensured that in Medicine,<br />
Surgery <strong>and</strong> Paediatrics, all Consultants<br />
covering A&E are freed from all other clinical<br />
commitments.<br />
Further investment has allowed for an<br />
increase in therapy provision at weekends<br />
which has facilitated patients with complex<br />
needs having access to a multi-disciplinary<br />
team assessment.<br />
In <strong>2012</strong> a detailed review of our hospital<br />
mortality data was carried out, specifically<br />
the measure of mortality known as the<br />
<strong>Hospital</strong> St<strong>and</strong>ardised Mortality Ratio<br />
(HSMR).<br />
This review concluded that the <strong>Trust</strong> had a<br />
lower than average palliative care <strong>and</strong> comorbidity<br />
coding which may falsely elevate<br />
the HSMR, but that some specialties had a<br />
higher than expected HSMR.<br />
In response to the findings of the report a<br />
great deal of work has been undertaken to<br />
improve coding for palliative care <strong>and</strong> comorbidity<br />
which are at a national average<br />
<strong>and</strong> now monitored monthly. Specialties<br />
that were identified to have a higher<br />
than expected HSMR have been or are in<br />
the process of being reviewed through<br />
clinical workshops. These workshops have<br />
provided the opportunity for clinical staff<br />
to come together to identify areas of care<br />
for improvement <strong>and</strong> also to ascertain the<br />
suitability of utilising a care bundle approach<br />
(a group of several clinical interventions).<br />
These approaches together have reduced the<br />
HSMR to 89.8 (up to <strong>and</strong> including January<br />
20<strong>13</strong>) but there is still some weekday versus<br />
weekend variability.<br />
Our aims for 20<strong>13</strong>/2014 are<br />
• To invest in evening <strong>and</strong> weekend<br />
Consultant emergency presence in<br />
Medicine, Surgery, A&E <strong>and</strong> Paediatrics.<br />
• Implement <strong>NHS</strong> London emergency care<br />
st<strong>and</strong>ards in relation to Consultant review<br />
within 12 hours of decision to admit:<br />
number of patients being seen within<br />
target time 20<strong>13</strong>/2014 is 90%, <strong>and</strong> to<br />
ensure that there is no weekday versus<br />
weekend variability.<br />
• To reduce HSMR to London average in<br />
20<strong>13</strong>/2014 <strong>and</strong> ensure no difference in<br />
weekday vs. weekend mortality.<br />
• Seven day access to pharmacy <strong>and</strong> all<br />
therapies (physiotherapy, respiratory, <strong>and</strong><br />
occupational therapy).<br />
• Full participation in the Friends<br />
<strong>and</strong> Family test (more than 15% of<br />
all attending patients) in the A&E<br />
Department where participation so<br />
far has been disappointing, running at<br />
around 5.7% for 2011/<strong>2012</strong>.<br />
PRIORITY 4: CARES<br />
Why is this one of our priorities?<br />
There continues to be an increased focus<br />
nationally on the patient/staff experience<br />
<strong>and</strong> engagement of these groups. It is<br />
essential that we see more significant<br />
changes in attitude <strong>and</strong> behaviour from<br />
our staff to improve the experience of our<br />
patients. Through analysing information<br />
captured from key sources such as the<br />
80 Quality report
National Patient Survey, Inpatient Survey,<br />
National Staff Survey <strong>and</strong> incidents <strong>and</strong><br />
complaints locally, we recognise that we can<br />
make improvements to the experience of our<br />
patients <strong>and</strong> staff.<br />
Our goal is to deliver the best possible<br />
experience to our patients <strong>and</strong> to our<br />
staff. In May <strong>2012</strong> we formally launched<br />
Communication Attitude Responsibility<br />
Equity Safety (CARES), which is our set of<br />
values supported by a framework that sets<br />
out the st<strong>and</strong>ard, in terms of attitude <strong>and</strong><br />
behaviours we expect from our staff. This<br />
will support our staff to deliver care with<br />
compassion as well as ensuring it is also safe<br />
<strong>and</strong> effective.<br />
Our aims for 20<strong>13</strong>/2014 are:<br />
• Complaints – We will ensure that all<br />
complaints are addressed using the CARES<br />
framework. We will make the framework<br />
an integral part of the investigation<br />
process to identify behavioural <strong>and</strong><br />
attitudinal issues as well as the technical<br />
aspects so that we can learn from them.<br />
• Performance <strong>and</strong> Personal Development<br />
Reviews (PDR) – All staff are expected to<br />
undertake a PDR annually with their line<br />
manager so they can ensure individual<br />
performance is linked to the achievement<br />
of <strong>Trust</strong> <strong>and</strong> departmental objectives.<br />
It is also essential to see how they are<br />
progressing in terms of their performance<br />
<strong>and</strong> provides an opportunity to discuss<br />
personal <strong>and</strong> professional development.<br />
We have introduced a CARES behavioural<br />
scale into the PDR paperwork to help<br />
initiate discussions around staff attitude<br />
<strong>and</strong> behaviours so that agreements can be<br />
reached on any developmental areas in an<br />
open manner.<br />
• Customer Care Training – We want all<br />
staff to recognise how their behaviours<br />
<strong>and</strong> attitudes can have a negative or<br />
positive impact on the experience of<br />
patients <strong>and</strong> colleagues. Through the<br />
delivery of a tailored Customer Care<br />
training programme we will support<br />
staff to underst<strong>and</strong> how by adopting the<br />
CARES behaviours they can enhance that<br />
experience.<br />
• CARES plays a large part in the work<br />
programme we are developing in relation<br />
to the Engagement <strong>and</strong> Experience<br />
Strategy.<br />
• Some Key Performance indicators for<br />
20<strong>13</strong>/2014 are presented in the table<br />
above; others are being developed in<br />
quarter 1.<br />
Performance indicator<br />
Communication, involvement <strong>and</strong><br />
information – using the cluster of<br />
questions in the patient survey<br />
Compassionate Care – using<br />
the cluster of questions in the<br />
questionnaire from the Improving<br />
Patient Care initiative.<br />
PRIORITY 5: CQUINs<br />
Target<br />
<strong>2012</strong>/<strong>13</strong><br />
Improve result<br />
by 2%<br />
Achieve 85%<br />
The National CQUINs for the next financial<br />
year will still include the prevention of blood<br />
clots, but we will be expected to achieve a<br />
higher percentage of patient assessment. The<br />
patient experience CQUIN will be based on<br />
the new “Friends <strong>and</strong> Family Test” <strong>and</strong> the<br />
dementia risk assessment will be continued.<br />
The Patient Safety Thermometer will be<br />
based on reductions in pressure sores <strong>and</strong> not<br />
just on data submission.<br />
Regional <strong>and</strong> local CQUINs are still to be<br />
agreed.<br />
Quality report<br />
81
Statements of assurance<br />
from the Board<br />
Information for our regulators<br />
Our regulators need to underst<strong>and</strong> how<br />
we are working to improve quality so the<br />
following pages are specific messages they<br />
have asked us to provide:<br />
Services<br />
During <strong>2012</strong>/20<strong>13</strong> The <strong>Hillingdon</strong> <strong>Hospital</strong>s<br />
<strong>NHS</strong> Foundation <strong>Trust</strong> provided medicine,<br />
surgery, clinical support services <strong>and</strong><br />
women’s <strong>and</strong> children’s <strong>NHS</strong> services. The<br />
<strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation <strong>Trust</strong><br />
has reviewed all the data available to them<br />
on the quality of care in all of these <strong>NHS</strong><br />
services. The income generated by the <strong>NHS</strong><br />
services reviewed in <strong>2012</strong>/20<strong>13</strong> represents<br />
100% of the total income generated<br />
from the provision of <strong>NHS</strong> services by the<br />
<strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation <strong>Trust</strong><br />
for <strong>2012</strong>/20<strong>13</strong>.<br />
Audit<br />
National audits<br />
During <strong>2012</strong>/20<strong>13</strong>, 38 national clinical audits<br />
<strong>and</strong> two national confidential enquiries<br />
covered <strong>NHS</strong> services that The <strong>Hillingdon</strong><br />
<strong>Hospital</strong>s <strong>NHS</strong> Foundation <strong>Trust</strong> provides.<br />
During that period The <strong>Hillingdon</strong> <strong>Hospital</strong>s<br />
<strong>NHS</strong> Foundation <strong>Trust</strong> participated in 82% of<br />
national clinical audits <strong>and</strong> 100% of national<br />
confidential enquiries for which it was<br />
eligible to participate in. The national clinical<br />
audits <strong>and</strong> national confidential enquiries<br />
that The <strong>Hillingdon</strong> <strong>Hospital</strong> <strong>NHS</strong> Foundation<br />
<strong>Trust</strong> was eligible to participate in during<br />
<strong>2012</strong>/20<strong>13</strong> are listed below alongside the<br />
number of cases submitted to each audit or<br />
enquiry as a percentage of the number of<br />
registered cases required by the terms of that<br />
audit or enquiry.<br />
82 Quality report
Audit Participated Cases submitted<br />
WOMENS AND CHILDRENS HEALTH<br />
Child Health Programme (CHR-UK) Yes 0% (only 1 patient applicable)<br />
Perinatal Mortality (MBRRACE-UK) Yes 100%<br />
Neonatal Intensive <strong>and</strong> Special Care (NNAP) Yes 100%<br />
Paediatric Pneumonia (British Thoracic Society) Yes 100%<br />
Paediatric Asthma (British Thoracic Society) Yes 100%<br />
Paediatric Fever (College of Emergency Medicine) No N/A<br />
Epilepsy 12 Audit (RCPH National Childhood Epilepsy Audit) Yes<br />
Data entry commenced 1 st March 20<strong>13</strong><br />
<strong>and</strong> continues throughout 20<strong>13</strong>/14 –<br />
<strong>Trust</strong> participating<br />
ACUTE CARE<br />
Emergency Use of Oxygen (British Thoracic Society BTS) Yes 100%<br />
Adult Community Acquired Pneumonia (BTS) Yes 100%<br />
Non-invasive Ventilation (BTS) Yes 85%<br />
Renal Colic (College Emergency Medicine) Yes 100%<br />
Hip, Knee <strong>and</strong> Ankle Replacements (National Joint Registry) Yes<br />
<strong>Hillingdon</strong> 71%<br />
Mount Vernon Treatment Centre 93%<br />
Adult Critical Care (ICNARC CMPD) No N/A<br />
Alcohol Related Liver Disease (National Confidential Enquiry<br />
NCEPOD)<br />
Yes 100%<br />
Subarachnoid Haemorrhage (NCEPOD) Yes Data submission ongoing<br />
Severe Trauma (Trauma Audit & Research Network, TARN) Yes 81%<br />
LONG TERM CONDITIONS<br />
Diabetes (National Audit Diabetes Audit) No N/A<br />
Diabetes (RCPH National Paediatric Diabetes Audit) Yes 100%<br />
National Review of Asthma Deaths Yes No applicable cases<br />
Chronic Pain (National Pain Audit) Yes 34.7%<br />
Inflammatory Bowel Disease (IBD)<br />
Yes<br />
Data submission commenced Jan<br />
20<strong>13</strong>, 100% patients included to date<br />
Adult Asthma (BTS) Yes 88%<br />
Adult Bronchiectasis (BTS) No N/A<br />
Paediatric Bronchiectasis (BTS) No N/A<br />
OTHER<br />
Elective Surgery (National PROMS programme)<br />
Yes<br />
Percentages unavailable, numbers are:<br />
Hip replacements: 249; knee<br />
replacements: 312; groin hernia: 167;<br />
varicose veins: 7.<br />
CARDIOVASCULAR DISEASE<br />
Acute Myocardial Infarction & other ACS (MINAP) Yes 100%<br />
Heart Failure (Heart Failure Audit)<br />
Yes<br />
59% due to staff changeover our<br />
participation is lower than previous<br />
years - this has now been resolved<br />
Cardiac Arrest (National Cardiac Arrest Audit)<br />
No<br />
N/A, <strong>Trust</strong> will be submitting data<br />
from July 20<strong>13</strong><br />
CANCER<br />
Head <strong>and</strong> Neck Oncology (DAHNO) Yes 100%<br />
Lung Cancer (National Lung Cancer Audit) Yes Expected 100%<br />
Bowel Cancer (National Bowel Cancer Audit Programme) Yes 100%<br />
Oesophago-gastric Cancer (National O-G Cancer Audit) Yes<br />
Deadline for submission October 20<strong>13</strong><br />
- expected 100%<br />
OLDER PEOPLE<br />
Fractured Neck of Femur (College of Emergency Medicine) Yes 70%<br />
National Audit of Dementia (NAD) Yes 100%<br />
Parkinson’s Disease (National Parkinson’s Audit) No N/A<br />
Sentinel Stroke National Audit Programme (SSNAP) Yes 100%<br />
Hip Fracture (National Hip Fracture Database) Yes 100%<br />
BLOOD <strong>and</strong> TRANSPLANT<br />
Blood Sample Labelling (National Comparative Audit of<br />
Blood Transfusion)<br />
Yes 100%<br />
Potential Donor Audit (<strong>NHS</strong> Blood <strong>and</strong> Transplant) Yes 100%<br />
Medical use of Blood (National Comparative Audit of Blood<br />
Transfusion)<br />
Yes 100% Quality report 83
Taking actions<br />
The reports of <strong>13</strong> national clinical audits were reviewed by the provider in <strong>2012</strong>/20<strong>13</strong> <strong>and</strong> The<br />
<strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation <strong>Trust</strong> intends to take the following actions to improve<br />
the quality of healthcare provided.<br />
Audit<br />
Neonatal intensive <strong>and</strong> special care (NNAP)<br />
Diabetes (RCPH) national paediatric<br />
diabetes audit<br />
Pain management in children (College of<br />
Emergency Medicine)<br />
Epilepsy 12 audit (rcph national childhood<br />
epilepsy audit)<br />
Paediatric asthma (British Thoracic Society)<br />
Emergency use of oxygen (British Thoracic<br />
Society)<br />
Non-invasive ventilation (British Thoracic<br />
Society)<br />
Severe sepsis & septic shock (College Of<br />
Emergency Medicine)<br />
Cardiac arrest procedures – time to<br />
intervene (NCEPOD)<br />
Inflammatory bowel disease (IBD)<br />
Lung cancer (National Lung Cancer Audit)<br />
Oesophago-gastric cancer (National O-G<br />
Cancer Audit)<br />
Hip fracture (National Hip Fracture<br />
Database)<br />
Actions<br />
The <strong>Trust</strong> performs well in the majority of the st<strong>and</strong>ards for this audit. We<br />
have not been submitting data for whether babies have an encephalopathy<br />
(neurological assessment) to allow us to review clinical practice, this has<br />
now been addressed <strong>and</strong> data will be available within future reports.<br />
The <strong>Trust</strong> now uses the Twinkle database which records all of the<br />
requirements for the national paediatric diabetes audit. Use of this<br />
database prompts awareness of diabetes clinical indicators to team<br />
members, improves the quality of data collection <strong>and</strong> will allow for a more<br />
automated submission to this national audit.<br />
To reduce admissions for diabetic ketoacidosis <strong>and</strong> to raise awareness for<br />
early diagnosis of diabetes, we are using the diabetes UK 4Ts campaign<br />
(toilet, thirsty, tired, thinner) in all our clinic letters sent to GPs <strong>and</strong> schools.<br />
A pain rating scale document is in development. This document can help us<br />
to assess pain severity quickly so we will be able to manage a child’s pain as<br />
soon as possible.<br />
A ‘transitional clinic’ to transfer from paediatric to adult epilepsy care has<br />
been set up. The first clinic ran in July <strong>2012</strong> <strong>and</strong> we plan to run 3 to 4 clinics<br />
per year.<br />
A <strong>Trust</strong> paediatric asthma guideline has been produced <strong>and</strong> was published<br />
for use in the hospital in December <strong>2012</strong>. Two new A&E Paediatric<br />
Consultants started in December <strong>2012</strong>, which will support implementation<br />
of this guideline <strong>and</strong> improve paediatric asthma st<strong>and</strong>ards.<br />
Improvements will be made, relating to documentation of prescribing of<br />
oxygen, as a result of an oxygen prescribing policy being published within<br />
the <strong>Trust</strong>. A new prescription chart is in development for the hospital,<br />
which includes a section on oxygen prescribing.<br />
The lead respiratory Consultants are using existing training sessions to reiterate<br />
the need to document a clear non invasive ventilation (NIV) plan.<br />
A clinical guideline specific to the emergency department is being agreed,<br />
this will be used in conjunction with the sepsis care bundle.<br />
The <strong>Trust</strong> has signed up to join the national cardiac arrest audit <strong>and</strong> will<br />
start submitting data from July 20<strong>13</strong>.<br />
Written information leaflets for surgical inflammatory bowel disease (IBD)<br />
patients now provided. Meetings with x-ray <strong>and</strong> gastroenterology have<br />
been restructured to discuss IBD patients, surgeons are present to discuss to<br />
relevant patients.<br />
The national lung cancer audit has been improved for the <strong>2012</strong> submissions.<br />
The development of closer links with the Royal Brompton <strong>and</strong> Harefield<br />
<strong>NHS</strong> Foundation <strong>Trust</strong> <strong>and</strong> locally between our clinical nurse specialist <strong>and</strong><br />
lung team co-ordinator has greatly facilitated a more streamlined reporting<br />
process.<br />
Patients within this audit are included as part of a review of emergency<br />
admission & re-admission rates of palliative care patients captured at<br />
local level. All patients are identified with a pall alert tag on the patient<br />
administration system. The Co-Ordinate My Care (CMC) system is a recent<br />
strategy to identify patients with their consent to reduce emergency<br />
admissions <strong>and</strong> re-admissions into hospital <strong>and</strong> guide community resources<br />
to them with appropriate care identified in the community.<br />
Following the introduction of the “assessment <strong>and</strong> protocol document<br />
for hip fragility fractures” compliance with hip fracture st<strong>and</strong>ards has<br />
improved, including falls assessment <strong>and</strong> both abbreviated mental tests.<br />
A separate audit of this document is now taking place <strong>and</strong> any identified<br />
improvements will be made.<br />
84 Quality report
Local audits<br />
The reports of 84 local clinical audits were reviewed by the provider in <strong>2012</strong>/<strong>13</strong> <strong>and</strong><br />
examples of The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation <strong>Trust</strong> actions to improve the quality of<br />
healthcare provided are detailed below.<br />
Audit of inpatient pathways <strong>and</strong> day of<br />
discharge processes<br />
Quality of inpatient care (treatment) plans<br />
Audit of Deep Vein Thrombosis pathway<br />
Re-audit - Staff survey of caring for<br />
vulnerable patients including those with a<br />
learning difficulty<br />
Survey of staff to evaluate the<br />
implementation of the mental capacity act<br />
2005 <strong>and</strong> DOLS - re-audit<br />
Staff taking blood cultures using best practice<br />
Measures of care nursing audits: Falls,<br />
hydration <strong>and</strong> fluid balance, medicines<br />
management, record keeping, privacy <strong>and</strong><br />
dignity, pressure ulcer prevention, food<br />
<strong>and</strong> nutrition, failure to rescue & patient<br />
identification<br />
Audit of children who Do Not Attend (DNA)<br />
Children’s Outpatients (Wendy Ward)<br />
Audit of records of women with safeguarding<br />
concerns in Maternity Department<br />
This audit was part of the improving inpatient care project <strong>and</strong> will<br />
roll out the new PAS+ system which will help streamline processes<br />
on the ward to the introduction of electronic white boards <strong>and</strong> real<br />
time bed management. This should support better discharge planning<br />
<strong>and</strong> recording of estimated dates of discharge.<br />
To improve quality of care plans we are working with each Division<br />
to devise ward round st<strong>and</strong>ards, which will include increased multidisciplinary<br />
input into care planning. We are also looking at ways to set<br />
<strong>and</strong> record estimated discharge dates consistently e.g. prompt stickers on<br />
ward rounds.<br />
Revised Deep Vein Thrombosis Pathway is under development in<br />
consultation with the Clinical Commissioning Group.<br />
This re-audit identified a general positive increase in awareness of caring<br />
for vulnerable patients. The use of the vulnerable adults action card<br />
<strong>and</strong> patient passport is continually re-inforced to staff, for example, at<br />
m<strong>and</strong>atory training <strong>and</strong> induction. The documents are available on the<br />
<strong>Trust</strong> Intranet.<br />
The re-audit identified the need for further training for staff on the<br />
Mental Capacity Act. Local training sessions have been provided within<br />
the <strong>Trust</strong>. In March 20<strong>13</strong> a training session was delivered by Central<br />
North West London <strong>NHS</strong> Foundation <strong>Trust</strong>.<br />
The blood culture audit has demonstrated a significant increase in<br />
blood culture training provided by the <strong>Trust</strong> from 16% in 2009 to 83%<br />
in <strong>2012</strong>. We have st<strong>and</strong>ardised blood culture equipment <strong>and</strong> all new<br />
medical staff receive blood culture theoretical training including a copy<br />
of the blood culture guidelines on induction. The Foundation Year 1 &<br />
2 doctors receive clinical skills & competency checks within 6 weeks of<br />
commencement in the <strong>Trust</strong>.<br />
During <strong>2012</strong>/<strong>13</strong> there has been an overall improvement with some<br />
areas sustaining well above target scores. To achieve this, the Nursing<br />
Performance Unit undertook bespoke teaching, one to one working,<br />
role modelling <strong>and</strong> observation feedback. This together with staff<br />
motivation, commitment, <strong>and</strong> engagement in undertaking audits <strong>and</strong><br />
hard work resulted in improvement.<br />
All clinic staff have been reminded of the need to document, in the<br />
patient notes, the process followed when a child does not attend their<br />
appointment. Each consulting room has a copy of the DNA process<br />
flowchart on the desk for staff to refer to.<br />
A postnatal communication sheet, to aid information sharing, has been<br />
developed <strong>and</strong> introduced. This document identifies the lead midwife,<br />
confirms the health visitor has been contacted <strong>and</strong> specifies the plan of<br />
action for individual safeguarding cases.<br />
Quality report<br />
85
Research<br />
Commitment to research as a driver for<br />
improving the quality of care <strong>and</strong> patient<br />
experience<br />
The number of patients receiving <strong>NHS</strong><br />
services provided by The <strong>Hillingdon</strong> <strong>Hospital</strong>s<br />
<strong>NHS</strong> Foundation <strong>Trust</strong>, that were recruited<br />
during the period to participate in research<br />
approved by a research ethics committee was<br />
547.<br />
The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation<br />
<strong>Trust</strong> has a good research track record for<br />
a hospital of its size. We are continuing<br />
with our strategy to broaden our research<br />
portfolio <strong>and</strong> this has enabled us to offer a<br />
greater number of patients, from different<br />
clinical areas the opportunity to participate<br />
in research. This year we invested in a<br />
research nurse to support our Cardiologists<br />
<strong>and</strong> Diabetes Consultants as a means of<br />
increasing commercially funded <strong>and</strong> portfolio<br />
adopted research activity in these areas.<br />
It is projected that within two years the<br />
commercial income generated should sustain<br />
this post thereafter.<br />
Participation in clinical research demonstrates<br />
The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation<br />
<strong>Trust</strong>‘s commitment to improving the<br />
quality of care we offer <strong>and</strong> to making our<br />
contribution to wider health improvement.<br />
This allows our clinical staff to stay abreast<br />
of the latest treatment possibilities <strong>and</strong><br />
active participation in research allows our<br />
patient’s access to new treatments that<br />
they otherwise would not have. With this<br />
in mind we aim to offer our patients the<br />
opportunity to participate in a wide range of<br />
clinical research projects. These studies are<br />
both funded by the pharmaceutical industry<br />
<strong>and</strong> by the Department of Health via the<br />
North West London Comprehensive Research<br />
Network (CLRN); for this work we received<br />
£524,911 from the CLRN.<br />
The money generated from this research<br />
activity funds research nurses <strong>and</strong> data<br />
managers to support the clinicians in this<br />
work. The majority of our studies are<br />
National Institute for Health Research (NIHR)<br />
portfolio adopted multi-centre studies where<br />
we are acting as a recruiting site on behalf<br />
of the lead centre. Our research portfolio is<br />
a balance of observational <strong>and</strong> treatment<br />
studies across many clinical areas in the <strong>Trust</strong><br />
including cancer, stroke, <strong>and</strong> haematology,<br />
many of the general medicine <strong>and</strong> surgical<br />
specialities <strong>and</strong> paediatrics. We also support<br />
PhD <strong>and</strong> Masters students from the local<br />
universities giving them access to our<br />
patients for their projects.<br />
During <strong>2012</strong>/20<strong>13</strong> we had 66 open or followup<br />
studies. We recruited 505 patients into<br />
30 NIHR Portfolio Studies, supported the<br />
repatriation of 20 patients recruited into<br />
treatment studies at other hospitals <strong>and</strong><br />
supported four Masters or PhD student<br />
studies.<br />
Our research management processes reflect<br />
the Research Support Services nationally<br />
<strong>and</strong> have a setup time that meets the NIHR<br />
national targets. On average our research<br />
governance review is undertaken in less than<br />
10 days which is well below the national<br />
target of 30 days.<br />
Summary of lessons learned from serious<br />
incidents<br />
During <strong>2012</strong>/20<strong>13</strong>, the <strong>Trust</strong> reported<br />
nine Serious Incidents where panel<br />
investigations were conducted. There were<br />
two Serious Incidents reported as ‘Never<br />
Events’; one of these was investigated by<br />
a panel. Never Events are serious grade<br />
2, largely preventable patient safety<br />
incidents that should never occur if the<br />
available preventable measures have been<br />
implemented by healthcare providers (NPSA<br />
2010). It is a legal requirement under CQC<br />
regulations to report them. Protecting<br />
patients from avoidable harm is something<br />
to which there is universal agreement <strong>and</strong><br />
the <strong>Trust</strong> has clearly defined processes <strong>and</strong><br />
procedures to follow to help avoid these<br />
events occurring.<br />
86 Quality report
Lessons learnt as a result of the serious incidents include:<br />
Area Division Summary<br />
CT scans<br />
Deteriorating patients<br />
Cancer <strong>and</strong> Clinical<br />
Support Services<br />
(CCSS)<br />
All divisions<br />
The investigation led to the requirement for more radiology<br />
staff.<br />
Training <strong>and</strong> use of an established structured communication<br />
tool (SBAR) for the deteriorating patient.<br />
Record keeping All divisions Training <strong>and</strong> audit programme in place.<br />
Administration of medicine for<br />
patients that are nil by mouth<br />
Review the Deep Vein<br />
Thrombosis (DVT) clinical<br />
pathway<br />
Refresher training for DVT <strong>and</strong><br />
Venous Thrombo Embolysis<br />
(VTE)<br />
Translation for non-English<br />
speaking patients<br />
Maternal sepsis<br />
Recognition <strong>and</strong> management<br />
of diabetes in the sick patient<br />
Sharing the learning from<br />
serious incidents<br />
Skills <strong>and</strong> drills training in the<br />
maternity triage area<br />
Neonatal resuscitation training<br />
Maternity escalation policy<br />
Supernumerary status for the<br />
maternity bleep holder<br />
CTG training <strong>and</strong> CTG ‘buddy’<br />
system<br />
Medicine<br />
Medicine<br />
All medical staff<br />
Maternity<br />
Maternity<br />
Medical staff<br />
Medical staff<br />
Maternity<br />
Paediatrics<br />
Maternity<br />
Maternity<br />
Maternity<br />
Reminder to staff regarding using alternative routes of<br />
medicine administration.<br />
Review undertaken <strong>and</strong> new pathway being implemented.<br />
Refresher training provided <strong>and</strong> access for doctors to the e<br />
learning module for DVT.<br />
Memo sent out to remind all staff to provide the <strong>Trust</strong><br />
translation service when required.<br />
Reminder sent to all staff regarding the use of the centre for<br />
maternal <strong>and</strong> child enquiries (cmace) guidelines <strong>and</strong> inclusion<br />
of giving antibiotics to cover listeria.<br />
Clinical training reviewed <strong>and</strong> updated.<br />
Conducted at the divisional clinical governance forums<br />
Now included in the regular skills <strong>and</strong> drills programme.<br />
(Skills <strong>and</strong> drills are practice clinical scenarios undertaken<br />
both formally, through m<strong>and</strong>atory training <strong>and</strong> informally<br />
through mock assessments (spontaneous <strong>and</strong> unexpected<br />
scenarios, practicing specific emergency situations, usually<br />
led by the practice development team <strong>and</strong> a Consultant).<br />
These are undertaken to ensure that staff are prepared for<br />
all emergency situations, <strong>and</strong> where shortfalls are identified,<br />
then further training implemented).<br />
Refresher training in place using the regular skills <strong>and</strong> drills<br />
programme (as above).<br />
Policy reinforced, ongoing monitoring of compliance being<br />
undertaken.<br />
Under review, all co-ordinators reminded about their<br />
supernumerary status.<br />
Reviewed <strong>and</strong> competencies being monitored, spot audits in<br />
place.<br />
Security of documents in transit Corporate Use of security envelopes across the <strong>Trust</strong>.<br />
Escalation of missing patient<br />
communication<br />
Corporate<br />
Monitored on the incident reporting system.<br />
Scanning cancer referral<br />
documents<br />
CCSS<br />
Scanning now in place.<br />
WHO surgical patient safety<br />
checklist<br />
Safe sedation<br />
Pain procedure lists <strong>and</strong> shifts<br />
Surgical<br />
Surgical<br />
Surgical<br />
Implemented <strong>and</strong> audit being undertaken. Reminder to use<br />
checklist sent out to staff.<br />
Reminder of safe sedation practice sent out to staff <strong>and</strong> audit<br />
being undertaken to ensure compliance.<br />
Review of workload undertaken, number, skill mix <strong>and</strong><br />
duration of lists.<br />
Quality report<br />
87
Goals agreed with commissioners<br />
(CQUINs)<br />
A proportion, 2.5%, of out turn value of<br />
The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation<br />
<strong>Trust</strong>’s income in <strong>2012</strong>/20<strong>13</strong> was conditional<br />
on achieving quality improvement <strong>and</strong><br />
innovation goals agreed between The<br />
<strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation <strong>Trust</strong><br />
<strong>and</strong> any body they entered into a contract,<br />
agreement or arrangement with for the<br />
provision of <strong>NHS</strong> services, through the<br />
Commissioning for Quality <strong>and</strong> Innovation<br />
payment framework. The monetary total for<br />
the associated payments was £3.3 million.<br />
Further details of the agreed goals for<br />
<strong>2012</strong>/20<strong>13</strong> <strong>and</strong> for the following 12 month<br />
period are available on request from the<br />
Financial Planning Department, The Furze,<br />
The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation<br />
<strong>Trust</strong>, Pield Heath Road, Uxbridge, Middlesex.<br />
UB8 3NN or from the <strong>Trust</strong> website www.thh.<br />
nhs.uk.<br />
Care Quality Commission<br />
The <strong>Trust</strong> is required to register with the Care<br />
Quality Commission <strong>and</strong> is registered without<br />
conditions. The CQC paid an unannounced<br />
visit in December <strong>2012</strong> as part of their<br />
planned review of the <strong>Trust</strong>. The report<br />
issued from this visit stated the <strong>Trust</strong> is fully<br />
compliant with the Essential St<strong>and</strong>ards of<br />
Quality <strong>and</strong> Safety.<br />
The <strong>Trust</strong> received notification on 15 th<br />
February 20<strong>13</strong> that it was an outlier for<br />
puerperal sepsis (maternal infection)<br />
following delivery <strong>and</strong> an update was<br />
also requested on maternal emergency<br />
readmission rates. Coding issues <strong>and</strong> clinical<br />
issues mostly relating to urinary catheters<br />
<strong>and</strong> infections were identified <strong>and</strong> a<br />
comprehensive action plan was put in place<br />
which enabled the readmission rate to<br />
reduce to less than 1% bringing us within the<br />
expected range <strong>and</strong> well below the national<br />
average.<br />
Data quality<br />
The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation<br />
<strong>Trust</strong> submitted records during April –<br />
January for <strong>2012</strong>/20<strong>13</strong> to the Secondary<br />
User’s Service (SUS) for inclusion in the<br />
<strong>Hospital</strong> Episode Statistics (HES) which<br />
included the patient’s valid <strong>NHS</strong> number (to<br />
month 10:)<br />
• 98.5% for admitted patient care<br />
• 99.8% for outpatients care<br />
• 96.4% for accident <strong>and</strong> emergency care.<br />
The percentage records in the published data<br />
which included the patient’s valid General<br />
Medical Practitioner Code was:<br />
• 100% for admitted patient care<br />
• 100% for outpatient care<br />
• 100% for accident <strong>and</strong> emergency care.<br />
The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation<br />
<strong>Trust</strong> will be taking forward the following<br />
actions to improve data quality:<br />
• continue to review <strong>and</strong> action data<br />
quality issues at the <strong>Trust</strong>’s data quality<br />
meetings<br />
• daily data quality reports are published<br />
on the <strong>Trust</strong>’s web based management<br />
information system for action <strong>and</strong><br />
rectification.<br />
Information Governance Toolkit<br />
The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation<br />
<strong>Trust</strong>’s Information Governance Assessment<br />
report overall score for <strong>2012</strong>/20<strong>13</strong> was 81%<br />
<strong>and</strong> termed as unsatisfactory as one of 44<br />
requirements remains at level 1; all the other<br />
scores are at level 2 or 3.<br />
Clinical coding error rate<br />
The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation<br />
<strong>Trust</strong> was subject to the Payment by Results<br />
Clinical Coding Audit during the reporting<br />
period by the Audit Commission. However,<br />
the final <strong>2012</strong>/20<strong>13</strong> report is yet to be<br />
published <strong>and</strong> so the latest published report<br />
is from 2011/<strong>2012</strong>.<br />
88 Quality report
The Audit Commission sampled Finished<br />
Consultant Episodes (FCEs) <strong>and</strong> the overall<br />
average Health Resource Group (HRG) error<br />
rate was 6.5% at episode level compared to<br />
a National average of 9.1% in 2009/2010.<br />
The error rates reported in that audit for<br />
diagnoses <strong>and</strong> treatment coding (clinical<br />
coding) was:<br />
• Primary diagnosis incorrect 4.0%<br />
• Secondary diagnosis incorrect 5.1%<br />
• Primary procedure incorrect 3.6%<br />
• Secondary procedure incorrect 16.2%.<br />
The results were not extrapolated further<br />
than the actual sample audited. The sample<br />
covered 100 case notes from Respiratory<br />
Medicine <strong>and</strong> 100 r<strong>and</strong>omly selected case<br />
notes across all specialties.<br />
Quality report<br />
89
ANNEXE<br />
Commissioner statement from<br />
<strong>Hillingdon</strong> Clinical Commissioning<br />
Group (CCG)<br />
<strong>Hillingdon</strong> CCG is pleased to receive The<br />
<strong>Hillingdon</strong> <strong>Hospital</strong>s Foundation <strong>Trust</strong><br />
<strong>2012</strong>/<strong>13</strong> Quality Account. We note that the<br />
involvement of your patients in identification<br />
of priorities for 20<strong>13</strong>/14 <strong>and</strong> that you have<br />
included reference to the Francis <strong>Report</strong>.<br />
<strong>2012</strong>/<strong>13</strong> priorities<br />
We share the <strong>Trust</strong>’s disappointment that<br />
not all the <strong>2012</strong>/<strong>13</strong> priorities were achieved;<br />
in particular those relating to information<br />
to GPs following discharge <strong>and</strong> discharging<br />
patients early in the day as these support<br />
effective <strong>and</strong> safe discharge from hospital<br />
for patients <strong>and</strong> reduces the likelihood<br />
of readmission. We would hope to see<br />
a strong patient voice in future work to<br />
improve discharge processes. We note<br />
the very positive steps taken as part of<br />
priority 4 Leaving <strong>Hospital</strong> – Improving the<br />
Patient Experience; especially the follow up<br />
telephone call <strong>and</strong> monthly observations of<br />
care visits. Priority 2 – Changes in Maternity<br />
also demonstrated well if not 100%<br />
achievement of targets set. It would be<br />
helpful to see more detail on the steps that<br />
will be taken to increase breast feeding rates.<br />
Quality measures<br />
Quality Measure 4: Independent measure of<br />
cleanliness was 88% <strong>and</strong> rated green. The<br />
National Inpatient Survey (CQC) indicated<br />
that the <strong>Trust</strong> scored below the national<br />
average for cleanliness of the toilets <strong>and</strong><br />
bathrooms as well as the hospital ward.<br />
There is some discrepancy between the<br />
scores.<br />
We notice that many of the performance<br />
achievements have been achieved by the<br />
<strong>Trust</strong>.<br />
20<strong>13</strong>/14 priorities<br />
Broadly speaking the CCG supports the<br />
priorities identified for 20<strong>13</strong>/14. It is<br />
reassuring to see a continued focus on<br />
patient experience through continuation<br />
of the CARES priority. We recognise it is<br />
important enough to be a st<strong>and</strong>-alone<br />
priority but would anticipate that these<br />
values underpin all other priorities.<br />
We were surprised that reference to the<br />
Emergency Care Intensive Support Team<br />
(ECIST) was not made in relation to the<br />
emergency care priority but pleased to see it<br />
identified as an area of focus in 20<strong>13</strong>/14.<br />
Information for regulators<br />
It would be useful in future reports to<br />
have a better underst<strong>and</strong>ing of the impact<br />
of actions where the action has been for<br />
example “reviews” or “memos”.<br />
The overall score for the Information<br />
Governance Toolkit was 81% <strong>and</strong> termed<br />
“unsatisfactory”. It would have been helpful<br />
if actions planned to improve the score had<br />
been included in the Quality Account.<br />
<strong>Hillingdon</strong> CCG can confirm that the review<br />
of the <strong>2012</strong>/<strong>13</strong> performance is consistent<br />
with the SLA monitoring information it has<br />
received in <strong>2012</strong>/<strong>13</strong>.<br />
Linking to our previous comment on<br />
discharge processes, there is a need to<br />
continue focus on reducing admissions.<br />
90 Quality report
<strong>Hillingdon</strong> Health Watch response<br />
to The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong><br />
Foundation <strong>Trust</strong> <strong>Annual</strong> Quality<br />
<strong>Report</strong><br />
Introduction<br />
Although Health Watch <strong>Hillingdon</strong> was only<br />
established under The Health <strong>and</strong> Social Care<br />
Act <strong>2012</strong> on 1st April 20<strong>13</strong>, it feels qualified<br />
to respond to The <strong>Hillingdon</strong> <strong>Hospital</strong>s<br />
<strong>NHS</strong> Foundation <strong>Trust</strong> (THH) Quality <strong>Report</strong><br />
<strong>2012</strong>-20<strong>13</strong>, due to the transfer of staff <strong>and</strong><br />
volunteers from <strong>Hillingdon</strong> Link who have<br />
been involved in working with THH in this<br />
<strong>and</strong> the previous year’s quality accounts<br />
programme.<br />
Health Watch <strong>Hillingdon</strong> wishes to thank<br />
THH for the opportunity to comment on the<br />
<strong>Trust</strong>’s Quality <strong>Report</strong> for the year <strong>2012</strong>-20<strong>13</strong>.<br />
We would also like to acknowledge the<br />
<strong>Trust</strong>’s continued commitment to engage<br />
with <strong>Hillingdon</strong> LINk during the last year. This<br />
has seen an open working relationship, in<br />
which the <strong>Trust</strong> has embraced the LINk as a<br />
critical friend, encouraging positive challenge<br />
for the improvement of service quality.<br />
The Chief Executive Officer, Chair <strong>and</strong><br />
Director of Nursing of the <strong>Trust</strong> met regularly<br />
with LINk representatives <strong>and</strong> LINk were<br />
invited to sit on a number of important<br />
groups to monitor patient experience<br />
<strong>and</strong> quality, such as the Experience <strong>and</strong><br />
Engagement Group, the Maternity Liaison<br />
Group, <strong>and</strong> The Leaving <strong>Hospital</strong> Project<br />
Group.<br />
Quality report<br />
Health Watch <strong>Hillingdon</strong> found this year’s<br />
Quality <strong>Report</strong> easy to read, with clear<br />
explanation throughout the document,<br />
making it accessible to the general public.<br />
Written in a similar style to the 2011/12<br />
report, this year’s report is more focused<br />
on quantitative outcomes, <strong>and</strong> although<br />
subjective, we have a preference for the<br />
qualitative touches from last year which<br />
quoted patients feedback.<br />
From the Quality <strong>Report</strong> <strong>and</strong> the work<br />
LINk has been doing with the <strong>Trust</strong> it is<br />
self-evident that the <strong>Trust</strong> is committed to<br />
improving the quality of the services they<br />
provide.<br />
Health Watch <strong>Hillingdon</strong> found the Quality<br />
<strong>Report</strong> to be an honest assessment of the<br />
<strong>Trust</strong>’s performance <strong>and</strong> provided a balanced<br />
report on the quality of their services.<br />
The <strong>Trust</strong> should be congratulated on<br />
achieving many of its targets <strong>and</strong> in making<br />
significant progress in many other areas. It<br />
was especially good to see the recruiting<br />
of women in Maternity reception <strong>and</strong> as<br />
Maternity Mates to meet the diverse cultural<br />
needs of the women in <strong>Hillingdon</strong>.<br />
We are pleased that the <strong>Trust</strong> has been<br />
c<strong>and</strong>id in acknowledging the areas which<br />
require improvement <strong>and</strong> in recognising<br />
shortfalls that the <strong>Trust</strong> has made<br />
commitments to improve in these areas. We<br />
particularly feel that for patients, further<br />
improvements around record keeping, <strong>and</strong><br />
discharge information given to GP’s <strong>and</strong><br />
community health services within 24 hours,<br />
will be specifically beneficial.<br />
We are in agreement with <strong>and</strong> support THH<br />
in their choice of 20<strong>13</strong>/14 quality priorities<br />
which has taken into account the views of<br />
LINk <strong>and</strong> the wider public.<br />
The First Contact Project has now been a<br />
<strong>Trust</strong> priority for four years <strong>and</strong> CARES is a<br />
long term programme. It would be helpful<br />
for the general public, where completion of<br />
a project is planned over a long period of<br />
time, for this to be indicated in the report,<br />
setting out the long term goals in addition<br />
to the short term. If this is not the case <strong>and</strong> a<br />
priority extends due to complexities, it would<br />
be useful if the reasons for this are reported.<br />
The <strong>Trust</strong> has also indicated in its future<br />
priorities for 20<strong>13</strong>/14 that it intends to<br />
Quality report<br />
91
increase those people discharged before<br />
12pm from 15.8% to 40% <strong>and</strong> that the<br />
number of patients being seen by a<br />
consultant within 12 hours of the decision<br />
to admit them will increase from 55% to<br />
90%. We very much welcome these areas as<br />
priorities, with improvements of this scale<br />
<strong>and</strong> the positive affect this will have on the<br />
patient experience. We are cautious of the<br />
effect these targets may have on patient<br />
expectation, especially around discharge.<br />
Health Watch <strong>Hillingdon</strong> look forward to<br />
continuing the relationship THH has had<br />
with LINk <strong>and</strong> working with THH in a joint<br />
commitment to monitor <strong>and</strong> improve quality.<br />
External Services Scrutiny<br />
Committee Statement<br />
Response on behalf of the External Services<br />
Scrutiny Committee at the London Borough<br />
of <strong>Hillingdon</strong><br />
The External Services Scrutiny Committee<br />
welcomes the opportunity to comment on<br />
the <strong>Trust</strong>’s <strong>2012</strong>/20<strong>13</strong> Quality <strong>Report</strong> <strong>and</strong><br />
acknowledges the <strong>Trust</strong>’s commitment to<br />
attend its meetings when requested.<br />
The Committee is pleased to note that the<br />
mortality rate is lower than the national<br />
average expected in hospitals. The <strong>Trust</strong> has<br />
met the year’s targets for infection control.<br />
The Committee has noted that the <strong>Trust</strong> has<br />
had only one incident of MRSA in the last<br />
year; <strong>and</strong> notes the target for next year is<br />
zero. The patient bed days are also below<br />
the national average <strong>and</strong> London average.<br />
The <strong>Trust</strong> has also met the 4 hour average<br />
waiting time at A&E.<br />
The Committee is mindful of the imminent<br />
closure of Ealing <strong>Hospital</strong>’s A & E department<br />
<strong>and</strong> whether this will have a big impact on<br />
<strong>Hillingdon</strong> <strong>Hospital</strong>. The Committee has<br />
noted that in theory rather than the numbers<br />
increasing at <strong>Hillingdon</strong>, people should<br />
be directed to the appropriate care. The<br />
Committee has noted the challenging times<br />
within the <strong>NHS</strong> <strong>and</strong> the planning involved in<br />
this. The <strong>Trust</strong> will be spending £12million<br />
in the next few years to start to gear up for<br />
this change. The Committee would like to be<br />
kept up to date on these changes <strong>and</strong> how<br />
they will affect the residents of <strong>Hillingdon</strong><br />
for better or worse.<br />
The Committee is aware that improving<br />
patient care <strong>and</strong> discharge continues to be<br />
a priority for the <strong>Trust</strong>. Complaints with<br />
regard to discharge have been identified<br />
as a problem that needs to be addressed;<br />
in particular with regard to when patients<br />
receive their medication. It has been<br />
recognised that this is a problem <strong>and</strong> the<br />
aim is to have patient’s papers ready on<br />
discharge. The Committee has noted that<br />
the targets for complaints response had<br />
not been met <strong>and</strong> suggested improvement<br />
in this area. There are some issues with<br />
the turnaround time for complaints which<br />
needed addressing. The Committee has<br />
noted that the <strong>Trust</strong> is still using a paper<br />
based system but there are plans for<br />
improvements to this.<br />
It is noted that the <strong>Trust</strong> has formulated 5<br />
priorities for the forthcoming year which are<br />
broadly similar to last years. These priorities<br />
are: First Contact Project; Improving Inpatient<br />
Care <strong>and</strong> Discharge; Improving Emergency<br />
Care; CARES <strong>and</strong> CQUINs.<br />
Overall, the Committee is pleased with<br />
the continued progress that the <strong>Trust</strong> has<br />
made over the last year but notes that<br />
there are a number of areas where further<br />
improvements still need to be made. We<br />
look forward to being informed of how the<br />
priorities outlined in the Quality <strong>Report</strong> are<br />
implemented over the course of 20<strong>13</strong>/14.<br />
92 Quality report
The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong><br />
Foundation <strong>Trust</strong> response to the<br />
consultation<br />
The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation<br />
<strong>Trust</strong> thanks all its stakeholders for their<br />
comments about the <strong>2012</strong>-<strong>13</strong> Quality <strong>Report</strong>.<br />
The <strong>Trust</strong> would like to reassure our<br />
Commissioners that there is a clear action<br />
plan to improve Information Governance<br />
training to achieve Level 2. This plan includes<br />
full training to all new staff on induction,<br />
more regular refresher sessions, bespoke<br />
training where needed, an up to date<br />
training record, <strong>and</strong> clear escalation for nonattendance.<br />
There is also a more detailed<br />
action plan to increase breastfeeding rates.<br />
to be articulated rather than just a one year<br />
strategy, <strong>and</strong> we will share these plans in the<br />
coming year.<br />
The External Services Scrutiny Committee<br />
comment on the potential impact of the<br />
implementation of Shaping a Healthier<br />
Future, <strong>and</strong> the <strong>Trust</strong> will involve all<br />
stakeholders, including the residents of<br />
<strong>Hillingdon</strong>, to ensure that a high quality<br />
service will be provided. A merging of the<br />
PALS <strong>and</strong> complaints teams, as well as our<br />
plan to deal with issues as they arise at<br />
the bedside, should lead to a reduction in<br />
complaints <strong>and</strong> a prompter turnaround.<br />
Our Commissioners are right in noting the<br />
importance of the <strong>2012</strong> Emergency Care<br />
Intensive Support Team (ECIST) report<br />
<strong>and</strong> the <strong>NHS</strong> Engl<strong>and</strong>: Improving A&E<br />
Performance report (Gateway reference<br />
00062, released April 20<strong>13</strong>), which both<br />
support our stated aims for improving<br />
emergency care. They also offer other best<br />
practice <strong>and</strong> operational recommendations<br />
many of which have been, or are being,<br />
implemented.<br />
Our Commissioners have rightly pointed out<br />
the difference between our independent<br />
measure of cleanliness (an audit of<br />
cleanliness st<strong>and</strong>ards) being higher than the<br />
National Inpatient Survey for the cleanliness<br />
of toilets <strong>and</strong> bathrooms as well as the<br />
hospital ward (a measure of the patients<br />
perception of cleanliness). The results of the<br />
National Inpatient Survey has historically<br />
been lower <strong>and</strong> is difficult to reconcile<br />
because they are asking different questions<br />
<strong>and</strong> measuring different things.<br />
Health Watch note the need for the <strong>Trust</strong> to<br />
continue to be c<strong>and</strong>id, balanced, <strong>and</strong> honest,<br />
qualities we agree are essential. We agree<br />
that a clear plan for long term project needs<br />
Quality report<br />
93
Independent Auditor’s <strong>Report</strong> to<br />
the Council of Governors of The<br />
<strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation<br />
<strong>Trust</strong> on the Quality <strong>Report</strong><br />
We have been engaged by the Council of<br />
Governors of The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong><br />
Foundation <strong>Trust</strong> to perform an independent<br />
assurance engagement in respect of The<br />
<strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation <strong>Trust</strong>’s<br />
Quality <strong>Report</strong> for the year ended 31 March<br />
20<strong>13</strong> (the “Quality <strong>Report</strong>”) <strong>and</strong> certain<br />
performance indicators contained therein.<br />
This report, including the conclusion, has<br />
been prepared solely for the Council of<br />
Governors of The <strong>Hillingdon</strong> <strong>Hospital</strong>s<br />
<strong>NHS</strong> Foundation <strong>Trust</strong> as a body, to assist<br />
the Council of Governors in reporting<br />
The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation<br />
<strong>Trust</strong>’s quality agenda, performance <strong>and</strong><br />
activities. We permit the disclosure of this<br />
report within the <strong>Annual</strong> <strong>Report</strong> for the year<br />
ended 31 March 20<strong>13</strong>, to enable the Council<br />
of Governors to demonstrate they have<br />
discharged their governance responsibilities<br />
by commissioning an independent assurance<br />
report in connection with the indicators.<br />
To the fullest extent permitted by law, we<br />
do not accept or assume responsibility to<br />
anyone other than the Council of Governors<br />
as a body <strong>and</strong> The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong><br />
Foundation <strong>Trust</strong> for our work or this report<br />
save where terms are expressly agreed <strong>and</strong><br />
with our prior consent in writing.<br />
Scope <strong>and</strong> subject matter<br />
The indicators for the year ended 31 March<br />
20<strong>13</strong> subject to limited assurance consist of<br />
the national priority indicators as m<strong>and</strong>ated<br />
by Monitor:<br />
• Maximum 62 day waiting time from<br />
urgent GP referral to treatment for all<br />
cancers;<br />
• Emergency readmissions within 28<br />
days of discharge from hospital.<br />
We refer to these national priority indicators<br />
collectively as the “indicators”.<br />
Respective responsibilities of the<br />
Directors <strong>and</strong> auditors<br />
The Directors are responsible for the content<br />
<strong>and</strong> the preparation of the Quality <strong>Report</strong><br />
in accordance with the criteria set out in<br />
the <strong>NHS</strong> Foundation <strong>Trust</strong> <strong>Annual</strong> <strong>Report</strong>ing<br />
Manual issued by Monitor. Our responsibility<br />
is to form a conclusion, based on limited<br />
assurance procedures, on whether anything<br />
has come to our attention that causes us to<br />
believe that:<br />
• the Quality <strong>Report</strong> is not prepared in<br />
all material respects in line with the<br />
criteria set out in the <strong>NHS</strong> Foundation<br />
<strong>Trust</strong> <strong>Annual</strong> <strong>Report</strong>ing Manual;<br />
• the Quality <strong>Report</strong> is not consistent in<br />
all material respects with the sources<br />
specified in the guidance; <strong>and</strong><br />
• the indicators in the Quality <strong>Report</strong><br />
identified as having been the subject<br />
of limited assurance in the Quality<br />
<strong>Report</strong> are not reasonably stated in<br />
all material respects in accordance<br />
with the <strong>NHS</strong> Foundation <strong>Trust</strong><br />
<strong>Annual</strong> <strong>Report</strong>ing Manual <strong>and</strong> the six<br />
dimensions of data quality set out in<br />
the Detailed Guidance for External<br />
Assurance on Quality <strong>Report</strong>s.<br />
We read the Quality <strong>Report</strong> <strong>and</strong> consider<br />
whether it addresses the content<br />
requirements of the <strong>NHS</strong> Foundation <strong>Trust</strong><br />
<strong>Annual</strong> <strong>Report</strong>ing Manual, <strong>and</strong> consider the<br />
implications for our report if we become<br />
aware of any material omissions.<br />
We read the other information contained in<br />
the Quality <strong>Report</strong> <strong>and</strong> consider whether it is<br />
materially inconsistent with the documents<br />
specified within the detailed guidance. We<br />
consider the implications for our report<br />
if we become aware of any apparent<br />
misstatements or material inconsistencies<br />
with those documents (collectively the<br />
94 Quality report
“documents”). Our responsibilities do not<br />
extend to any other information.<br />
We are in compliance with the applicable<br />
independence <strong>and</strong> competency requirements<br />
of the Institute of Chartered Accountants in<br />
Engl<strong>and</strong> <strong>and</strong> Wales (ICAEW) Code of Ethics.<br />
Our team comprised assurance practitioners<br />
<strong>and</strong> relevant subject matter experts.<br />
Assurance work performed<br />
We conducted this limited assurance<br />
engagement in accordance with<br />
International St<strong>and</strong>ard on Assurance<br />
Engagements 3000 (Revised) – “Assurance<br />
Engagements other than Audits or Reviews<br />
of Historical Financial Information” issued<br />
by the International Auditing <strong>and</strong> Assurance<br />
St<strong>and</strong>ards Board (“ISAE 3000”). Our limited<br />
assurance procedures included:<br />
• Evaluating the design <strong>and</strong><br />
implementation of the key processes<br />
<strong>and</strong> controls for managing <strong>and</strong><br />
reporting the indicators.<br />
• Making enquiries of management.<br />
• Testing key management controls.<br />
• Limited testing, on a selective basis, of<br />
the data used to calculate the indicator<br />
back to supporting documentation.<br />
• Comparing the content requirements<br />
of the <strong>NHS</strong> Foundation <strong>Trust</strong> <strong>Annual</strong><br />
<strong>Report</strong>ing Manual to the categories<br />
reported in the Quality <strong>Report</strong>.<br />
• Reading the documents.<br />
A limited assurance engagement is smaller<br />
in scope than a reasonable assurance<br />
engagement. The nature, timing <strong>and</strong> extent<br />
of procedures for gathering sufficient<br />
appropriate evidence are deliberately<br />
limited relative to a reasonable assurance<br />
engagement.<br />
Limitations<br />
Non-financial performance information<br />
is subject to more inherent limitations<br />
than financial information, given the<br />
characteristics of the subject matter <strong>and</strong><br />
the methods used for determining such<br />
information. The absence of a significant<br />
body of established practice on which to<br />
draw allows for the selection of different<br />
but acceptable measurement techniques<br />
which can result in materially different<br />
measurements <strong>and</strong> can impact comparability.<br />
The precision of different measurement<br />
techniques may also vary. Furthermore, the<br />
nature <strong>and</strong> methods used to determine such<br />
information, as well as the measurement<br />
criteria <strong>and</strong> the precision thereof, may<br />
change over time. It is important to read the<br />
Quality <strong>Report</strong> in the context of the criteria<br />
set out in the <strong>NHS</strong> Foundation <strong>Trust</strong> <strong>Annual</strong><br />
<strong>Report</strong>ing Manual.<br />
The scope of our assurance work has not<br />
included governance over quality or nonm<strong>and</strong>ated<br />
indicators which have been<br />
determined locally by The <strong>Hillingdon</strong><br />
<strong>Hospital</strong>s <strong>NHS</strong> Foundation <strong>Trust</strong>.<br />
Conclusion<br />
Based on the results of our procedures,<br />
nothing has come to our attention that<br />
causes us to believe that, for the year ended<br />
31 March 20<strong>13</strong>:<br />
• the Quality <strong>Report</strong> is not prepared in<br />
all material respects in line with the<br />
criteria set out in the <strong>NHS</strong> Foundation<br />
<strong>Trust</strong> <strong>Annual</strong> <strong>Report</strong>ing Manual;<br />
• the Quality <strong>Report</strong> is not consistent in<br />
all material respects with the sources<br />
specified in the guidance; <strong>and</strong><br />
• the indicators in the Quality <strong>Report</strong><br />
subject to limited assurance have not<br />
been reasonably stated in all material<br />
respects in accordance with the <strong>NHS</strong><br />
Foundation <strong>Trust</strong> <strong>Annual</strong> <strong>Report</strong>ing<br />
Manual.<br />
Deloitte LLP<br />
Chartered Accountants<br />
St Albans<br />
29 May 20<strong>13</strong><br />
Quality report<br />
95
Statement of Directors’<br />
responsibilities in respect of the<br />
Quality <strong>Report</strong><br />
The Directors are required under the Health<br />
Act 2009 <strong>and</strong> the National Health Service<br />
(Quality <strong>Accounts</strong>) Regulations 2010 as<br />
amended to prepare Quality <strong>Accounts</strong> for<br />
each financial year. Monitor has issued<br />
guidance to <strong>NHS</strong> Foundation <strong>Trust</strong> Boards<br />
on the form <strong>and</strong> content of <strong>Annual</strong> Quality<br />
<strong>Report</strong>s (which incorporate the above legal<br />
requirements) <strong>and</strong> on the arrangements<br />
that Foundation <strong>Trust</strong> Boards should put<br />
in place to support the data quality for the<br />
preparation of the Quality <strong>Report</strong>.<br />
In preparing the Quality <strong>Report</strong>, Directors are<br />
required to take steps to satisfy themselves<br />
that:<br />
• the content of the Quality <strong>Report</strong> meets<br />
the requirements set out in the <strong>NHS</strong><br />
Foundation <strong>Trust</strong> <strong>Annual</strong> <strong>Report</strong>ing<br />
Manual <strong>2012</strong>/20<strong>13</strong>;<br />
• the content of the Quality <strong>Report</strong> is not<br />
inconsistent with internal <strong>and</strong> external<br />
sources of information including:<br />
° Board minutes <strong>and</strong> papers for the<br />
period April <strong>2012</strong> to May 20<strong>13</strong><br />
° Papers relating to quality reported to<br />
the Board over the period April <strong>2012</strong> to<br />
May 20<strong>13</strong><br />
° Feedback from the Commissioners<br />
dated 22/5/20<strong>13</strong><br />
° Feedback from the Governors dated<br />
25/4/20<strong>13</strong><br />
° Feedback from LINks dated 7/5/20<strong>13</strong><br />
° The <strong>Trust</strong>’s Complaints <strong>Report</strong><br />
published under Regulation 18 of the<br />
Local Authority Social Services <strong>and</strong><br />
<strong>NHS</strong> Complaints Regulations 2009,<br />
17/5/20<strong>13</strong>;<br />
° The latest national patient survey<br />
published 16/4/20<strong>13</strong><br />
° The latest national staff survey<br />
28/2/20<strong>13</strong><br />
° The Head of Internal Audit’s annual<br />
opinion over the <strong>Trust</strong>’s control<br />
environment dated 8/5/20<strong>13</strong><br />
° CQC Quality <strong>and</strong> Risk Profiles dated<br />
from 1 April <strong>2012</strong> to 31 March 20<strong>13</strong><br />
• The Quality <strong>Report</strong> presents a balanced<br />
picture of the <strong>NHS</strong> Foundation <strong>Trust</strong>’s<br />
performance over the period covered;<br />
• The performance information reported in<br />
the Quality <strong>Report</strong> is reliable <strong>and</strong> accurate;<br />
• There are proper internal controls over the<br />
collection <strong>and</strong> reporting of the measures<br />
of performance included in the Quality<br />
<strong>Report</strong>, <strong>and</strong> these controls are subject to<br />
review to confirm that they are working<br />
effectively in practice;<br />
• The data underpinning the measures<br />
of performance reported in the Quality<br />
<strong>Report</strong> is robust <strong>and</strong> reliable, conforms<br />
to specified data quality st<strong>and</strong>ards <strong>and</strong><br />
prescribed definitions, is subject to<br />
appropriate scrutiny <strong>and</strong> review; <strong>and</strong><br />
the Quality <strong>Report</strong> has been prepared<br />
in accordance with Monitor’s annual<br />
reporting guidance (which incorporates<br />
the Quality <strong>Accounts</strong> Regulations)<br />
(published at www.monitor-<strong>NHS</strong>ft.gov.<br />
uk/annualreportingmanual) as well as<br />
the st<strong>and</strong>ards to support data quality for<br />
the preparation of the Quality <strong>Report</strong><br />
(available at www.monitor-<strong>NHS</strong>ft.gov.uk/<br />
annualreportingmanual).<br />
The Directors confirm to the best of their<br />
knowledge <strong>and</strong> belief they have complied<br />
with the above requirement in preparing the<br />
Quality <strong>Report</strong>.<br />
96 Quality report
STATEMENT OF THE CHIEF EXECUTIVE’S RESPONSIBILITIES AS<br />
THE ACCOUNTING OFFICER OF THE HILLINGDON HOSPITALS<br />
<strong>NHS</strong> FOUNDATION TRUST<br />
The <strong>NHS</strong> Act 2006 states that the Chief Executive is the Accounting Officer of the <strong>NHS</strong><br />
Foundation <strong>Trust</strong>. The relevant responsibilities of the Accounting Officer, including their<br />
responsibility for the propriety <strong>and</strong> regularity of public finances for which they are<br />
answerable, <strong>and</strong> for the keeping of proper accounts, are set out in the <strong>NHS</strong> Foundation <strong>Trust</strong><br />
Accounting Officer Memor<strong>and</strong>um issued by Monitor.<br />
Under the <strong>NHS</strong> Act 2006, Monitor has directed The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation<br />
<strong>Trust</strong> to prepare for each financial year a statement of accounts in the form <strong>and</strong> on the basis<br />
set out in the <strong>Accounts</strong> Direction. The accounts are prepared on an accruals basis <strong>and</strong> must<br />
give a true <strong>and</strong> fair view of the state of affairs of The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation<br />
<strong>Trust</strong> <strong>and</strong> of its income <strong>and</strong> expenditure, total recognised gains <strong>and</strong> losses <strong>and</strong> cash flows for<br />
the financial year.<br />
In preparing the accounts, the Accounting Officer is required to comply with the<br />
requirements of the <strong>NHS</strong> Foundation <strong>Trust</strong> <strong>Annual</strong> <strong>Report</strong>ing Manual <strong>and</strong> in particular to:<br />
• observe the <strong>Accounts</strong> Direction issued by Monitor, including the relevant accounting <strong>and</strong><br />
disclosure requirements, <strong>and</strong> apply suitable accounting policies on a consistent basis;<br />
• make judgements <strong>and</strong> estimates on a reasonable basis;<br />
• state whether applicable accounting st<strong>and</strong>ards as set out in the <strong>NHS</strong> Foundation <strong>Trust</strong><br />
<strong>Annual</strong> <strong>Report</strong>ing Manual have been followed, <strong>and</strong> disclose <strong>and</strong> explain any material<br />
departures in the financial statements; <strong>and</strong><br />
• prepare the financial statements on a going concern basis.<br />
The Accounting Officer is responsible for keeping proper accounting records which disclose<br />
with reasonable accuracy at any time the financial position of the <strong>NHS</strong> Foundation <strong>Trust</strong> <strong>and</strong><br />
to enable him/her to ensure that the accounts comply with requirements outlined in the<br />
above mentioned Act. The Accounting Officer is also responsible for safeguarding the assets<br />
of the <strong>NHS</strong> Foundation <strong>Trust</strong> <strong>and</strong> hence for taking reasonable steps for the prevention <strong>and</strong><br />
detection of fraud <strong>and</strong> other irregularities.<br />
To the best of my knowledge <strong>and</strong> belief, I have properly discharged the responsibilities set<br />
out in Monitor’s <strong>NHS</strong> Foundation <strong>Trust</strong> Accounting Officer Memor<strong>and</strong>um.<br />
Statement<br />
97
STATEMENT OF DIRECTORS’ RESPONSIBILITIES IN RESPECT OF<br />
THE ACCOUNTS<br />
The Directors are required under the National Health Service Act 2006 to prepare accounts<br />
for each financial year. Monitor, with the approval of the Secretary of State, directs that<br />
these accounts give a true <strong>and</strong> fair view of the state of affairs of the <strong>Trust</strong> <strong>and</strong> of the<br />
Statements of Comprehensive Income, Financial Position, Tax Payers Equity, Cash Flow <strong>and</strong> all<br />
disclosure notes in the <strong>Annual</strong> <strong>Accounts</strong>.<br />
In preparing those accounts, Directors are required to:<br />
• apply on a consistent basis accounting policies according to the <strong>NHS</strong> Foundation <strong>Trust</strong><br />
<strong>Annual</strong> <strong>Report</strong>ing Manual <strong>2012</strong>/<strong>13</strong> with the approval of the Secretary of State;<br />
• Make judgements <strong>and</strong> estimates which are reasonable <strong>and</strong> prudent;<br />
• State whether applicable accounting st<strong>and</strong>ards have been followed, subject to any<br />
material departures disclosed <strong>and</strong> explained in the accounts;<br />
• Comply with International Financial <strong>Report</strong>ing St<strong>and</strong>ards.<br />
The Directors are responsible for keeping proper accounting records which disclose with<br />
reasonable accuracy at any time the financial position of the <strong>Trust</strong> <strong>and</strong> to enable them<br />
to ensure that the accounts comply with requirements outlined in the above mentioned<br />
direction of the Secretary of State. They are also responsible for safeguarding the assets of<br />
the <strong>Trust</strong> <strong>and</strong> hence for taking reasonable steps for the prevention <strong>and</strong> detection of fraud<br />
<strong>and</strong> other irregularities.<br />
The Directors confirm to the best of their knowledge <strong>and</strong> belief they have complied with the<br />
above requirements in preparing the accounts.<br />
98
ANNUAL GOVERNANCE STATEMENT <strong>2012</strong>/<strong>13</strong><br />
1. Scope of responsibility<br />
As Accounting Officer, I have responsibility<br />
for maintaining a sound system of internal<br />
control that supports the achievement of the<br />
<strong>NHS</strong> Foundation <strong>Trust</strong>’s policies, aims <strong>and</strong><br />
objectives, whilst safeguarding the public<br />
funds <strong>and</strong> departmental assets for which<br />
I am personally responsible, in accordance<br />
with the responsibilities assigned to me. I am<br />
also responsible for ensuring that the <strong>NHS</strong><br />
Foundation <strong>Trust</strong> is administered prudently<br />
<strong>and</strong> economically <strong>and</strong> that resources are<br />
applied efficiently <strong>and</strong> effectively. I also<br />
acknowledge my responsibilities as set out in<br />
the <strong>NHS</strong> Foundation <strong>Trust</strong> Accounting Officer<br />
Memor<strong>and</strong>um.<br />
2. The purpose of the system of<br />
internal control<br />
The system of internal control is designed<br />
to manage risk to a reasonable level rather<br />
than to eliminate all risk of failure to achieve<br />
policies, aims <strong>and</strong> objectives; it can therefore<br />
only provide reasonable <strong>and</strong> not absolute<br />
assurance of effectiveness. The system of<br />
internal control is based on an on-going<br />
process designed to identify <strong>and</strong> prioritise<br />
the risks to the achievement of the policies,<br />
aims <strong>and</strong> objectives of The <strong>Hillingdon</strong><br />
<strong>Hospital</strong>s <strong>NHS</strong> Foundation <strong>Trust</strong>, to evaluate<br />
the likelihood of those risks being realised<br />
<strong>and</strong> the impact should they be realised, <strong>and</strong><br />
to manage them efficiently, effectively <strong>and</strong><br />
economically. The system of internal control<br />
has been in place in The <strong>Hillingdon</strong> <strong>Hospital</strong>s<br />
<strong>NHS</strong> Foundation <strong>Trust</strong> for the year ended 31<br />
March 20<strong>13</strong> <strong>and</strong> up to the date of approval<br />
of the annual report <strong>and</strong> accounts.<br />
3. Capacity to h<strong>and</strong>le risk<br />
The Board is responsible for reviewing<br />
the effectiveness of the system of internal<br />
control, including systems <strong>and</strong> resources<br />
for managing all types of risk. The <strong>Trust</strong><br />
Board approved Risk Management<br />
Strategy <strong>and</strong> Policy (including Board<br />
Assurance Framework) ensures that the<br />
<strong>Trust</strong> approaches the control of risk in a<br />
strategic <strong>and</strong> organised manner. It sets out<br />
the responsibilities of Executive Directors<br />
<strong>and</strong> Senior Managers in relation to their<br />
leadership in risk management <strong>and</strong> makes it<br />
clear that all employees have a role to play<br />
in risk management appropriate to their<br />
level within the organisation. The Board has<br />
established a Committee structure to provide<br />
assurance on <strong>and</strong> challenge to the <strong>Trust</strong>’s<br />
risk management process. Each of these<br />
Committees are chaired by a Non-Executive<br />
Director to enhance this challenge, <strong>and</strong> the<br />
Committee chairs report formally to the<br />
Board to escalate issues that require further<br />
Board discussion. An example of this is the<br />
attendance at the Quality & Risk Committee<br />
(QRC) of both the Clinical Director <strong>and</strong> the<br />
Matron for Children’s services to explain<br />
to the committee the complexities of<br />
staffing level risks in A&E <strong>and</strong> a lack of<br />
high dependency unit (HDU) facilities. This<br />
enabled the QRC to recommend to the Board<br />
that both of these risks are high on the risk<br />
register.<br />
The two main Board committees for risk<br />
management are the Audit & Assurance<br />
Committee (AAC) <strong>and</strong> the QRC. The QRC<br />
was formed in-year from an amalgamation<br />
of the former Integrated Risk Management<br />
Committee (IRMC) <strong>and</strong> the Clinical Quality<br />
& St<strong>and</strong>ards Committee (CQSC). The AAC<br />
provides assurance that there is a sound<br />
system of internal control <strong>and</strong> governance.<br />
The QRC ensures that risks to the delivery<br />
of the <strong>Trust</strong>’s services are identified <strong>and</strong><br />
<strong>Annual</strong> governance statement<br />
99
addressed. Corporate risks are reported<br />
from ward to Board/QRC via Divisional<br />
Governance Boards using the online risk<br />
register managed by the <strong>Trust</strong>’s Corporate<br />
Governance department. The QRC also<br />
provides assurance in matters relating to<br />
clinical quality <strong>and</strong> st<strong>and</strong>ards. The Medical<br />
Director <strong>and</strong> Director of Patient Experience<br />
& Nursing together provide leadership<br />
in Clinical Governance, supported by the<br />
Assistant Director of Clinical Governance &<br />
Quality.<br />
The Board Assurance Framework (BAF) is<br />
the key proactive risk identification tool<br />
for the <strong>Trust</strong>. The <strong>Trust</strong>’s Strategy on a<br />
Page which includes critical success factors,<br />
reviewed annually, is mapped into the<br />
BAF. The BAF aims to provide the Board<br />
with assurance that significant threats to<br />
achieving the principal <strong>Trust</strong> objectives have<br />
been identified <strong>and</strong> are being appropriately<br />
controlled, <strong>and</strong> that there is timely <strong>and</strong><br />
reliable assurance in place to evidence<br />
this. Action plans within the BAF address<br />
how assurances will be provided; or, where<br />
assurances have identified inadequate<br />
controls, how controls will be improved.<br />
The BAF provides a structure for the<br />
evidence to support the <strong>Annual</strong> Governance<br />
Statement. Any unacceptable residual levels<br />
of risk remaining are further risk assessed<br />
<strong>and</strong> added to the corporate risk register to<br />
ensure the gaps in control are reduced or<br />
closed as soon as reasonably practicable. The<br />
BAF has cross references from the delivery<br />
of strategic objectives to the corporate<br />
risk register; to regulatory st<strong>and</strong>ards e.g.<br />
<strong>NHS</strong>LA, CQC in order to demonstrate where<br />
a strategic objective links with a regulatory<br />
st<strong>and</strong>ard <strong>and</strong> the risks currently associated<br />
with the delivery of the objective; <strong>and</strong> to the<br />
monthly performance targets where trends<br />
in poor performance are picked up, noted<br />
in the BAF <strong>and</strong> the actions taken to mitigate<br />
the poor performance stated.<br />
The AAC <strong>and</strong> QRC have the opportunity to<br />
review <strong>and</strong> shape the BAF at their quarterly<br />
meetings. The <strong>Trust</strong> Board reviews the BAF<br />
twice a year <strong>and</strong> there is an annual Board<br />
Strategy Session which focuses on refreshing<br />
the BAF to ensure the principal risks have<br />
been identified. No significant gaps in<br />
control have been identified by the Board/<br />
Board Committees this year.<br />
There are structured processes in place<br />
for incident reporting, the investigation<br />
of Serious Incidents <strong>and</strong> following up<br />
outcomes from Board commissioned external<br />
reports. The <strong>Trust</strong> Board, through the Risk<br />
Management Strategy & Policy (including<br />
Board Assurance Framework) <strong>and</strong> the<br />
Incident Policy (including Serious Incident),<br />
promotes open <strong>and</strong> honest reporting of<br />
incidents, risks <strong>and</strong> hazards.<br />
The <strong>Trust</strong> has a positive culture of reporting<br />
incidents enhanced by accessible online<br />
reporting systems available across the <strong>Trust</strong>.<br />
The latest National <strong>Report</strong>ing Learning<br />
System (NRLS) report (March 20<strong>13</strong>) has shown<br />
the <strong>Trust</strong> to be in the 50th percentile for<br />
incident reporting. Clinical <strong>and</strong> non-clinical<br />
events that are assessed using the <strong>Trust</strong><br />
Incident (including Serious Incident) policy<br />
to be a Serious Incident (SI) are forwarded to<br />
the Chief Executive or designated Executive<br />
to confirm if the incident is an SI.<br />
Once declared, SIs are reported on the<br />
Department of Health Strategic Executive<br />
Information System (STEIS); to Monitor on<br />
a quarterly basis <strong>and</strong> a monthly update<br />
to the <strong>Trust</strong> Board on the progress of<br />
investigation/action progress <strong>and</strong> lessons<br />
learnt. Lessons learnt are shared within <strong>and</strong><br />
where appropriate across Divisions. Further<br />
information on the SIs at the <strong>Trust</strong>, <strong>and</strong><br />
the actions taken by the <strong>Trust</strong> as a result of<br />
the learning from these, is included in the<br />
Quality <strong>Report</strong>.<br />
100 <strong>Annual</strong> governance statement
The Board has proactively commissioned<br />
external assurance when the information<br />
reviewed by the Board, such as from Serious<br />
Incidents, mortality data, <strong>and</strong> ward visits<br />
has indicated that there is scope for further<br />
investigation <strong>and</strong> improvement.<br />
Risk management training <strong>and</strong> awareness is<br />
included in the m<strong>and</strong>atory New Employees<br />
Week (NEW) programme for all new<br />
employees. The <strong>Trust</strong>’s Health <strong>and</strong> Safety<br />
team deliver risk management training<br />
appropriate to all levels across the <strong>Trust</strong><br />
including the <strong>Trust</strong> Board. The Nursing<br />
Education Skills Programmes are reviewed<br />
three monthly, <strong>and</strong> updated to ensure the<br />
latest evidence-based/best practices are<br />
incorporated; this would include learning<br />
from for example NPSA alerts.<br />
The Board is committed to a culture of<br />
continual learning <strong>and</strong> quality improvement.<br />
Learning from risk management activities<br />
such as trends in incidents, complaints <strong>and</strong><br />
claims are monitored <strong>and</strong> acted upon at<br />
Divisional level. Where appropriate, Internal<br />
Audit <strong>and</strong> Clinical Audit is used to provide<br />
assurance that changes to practice have<br />
become embedded e.g. the programme of<br />
Infection Prevention <strong>and</strong> Control audit <strong>and</strong><br />
monitoring provides assurance to the Board<br />
<strong>and</strong> has played a pivotal role in the reduction<br />
in Healthcare Associated Infections. Major<br />
reports from Healthcare Regulators are<br />
used to assess what lessons the <strong>Trust</strong> can<br />
learn from significant incidents <strong>and</strong> events<br />
in other healthcare organisations in order<br />
to evaluate <strong>and</strong> improve our practice the<br />
most recent being the Independent Inquiry<br />
into care provided by Mid Staffordshire<br />
<strong>NHS</strong> Foundation <strong>Trust</strong> January 2005 – March<br />
2009 Volume II Robert Francis QC (Francis),<br />
published February 20<strong>13</strong>. Here a public<br />
Board paper was produced in February<br />
20<strong>13</strong> highlighting the key findings <strong>and</strong><br />
immediate actions to be taken by the <strong>Trust</strong>.<br />
Listening events have been held with staff<br />
in March 20<strong>13</strong> on both hospital sites as<br />
recommended by Health Secretary Jeremy<br />
Hunt. In addition, a presentation to the<br />
People in Partnership meeting was delivered;<br />
this provided an outline of the findings of<br />
the Francis Inquiry <strong>and</strong> its recommendations<br />
<strong>and</strong> allowed the <strong>Trust</strong> an opportunity to<br />
engage with its public <strong>and</strong> patients to hear<br />
their concerns <strong>and</strong> views in relation to<br />
the report. Recognising that the CQC will<br />
publish guidance for Governors to make<br />
their role more accountable, a presentation<br />
<strong>and</strong> discussion at a Council of Governors<br />
meeting was also undertaken. The Board<br />
will also consider the implications at a future<br />
Board Strategy session to ensure work that<br />
is to be taken forward is aligned with the<br />
conversations that have already taken place<br />
in relation to a new <strong>and</strong> refreshed clinical<br />
quality strategy.<br />
4. The risk <strong>and</strong> control framework<br />
The system of internal control is based on an<br />
on-going risk management process that is<br />
embedded in the organisation <strong>and</strong> combines<br />
many elements. The aforementioned<br />
comprehensive Risk Management Strategy<br />
& Policy (including BAF) is available to all<br />
staff on the <strong>Trust</strong>’s intranet site. All staff<br />
are responsible for managing risks within<br />
the scope of their role <strong>and</strong> responsibilities<br />
as employees of the <strong>Trust</strong>. The purpose of<br />
this risk management policy is to ensure<br />
that the <strong>Trust</strong> manages risks in all areas<br />
using a systematic <strong>and</strong> consistent approach.<br />
The document describes the <strong>Trust</strong>’s overall<br />
risk management process <strong>and</strong> the <strong>Trust</strong>’s<br />
risk identification, evaluation <strong>and</strong> control<br />
system, which includes the risk matrix used to<br />
evaluate risks. Risks are identified reactively<br />
<strong>and</strong> proactively.<br />
All risks are assessed against one st<strong>and</strong>ard<br />
tool this ensures that a consistent approach<br />
is taken to the evaluation <strong>and</strong> monitoring of<br />
risk in terms of the assessment of likelihood<br />
<strong>and</strong> impact. Risks are monitored through a<br />
formal reporting process where the assessed<br />
level of risk <strong>and</strong> its strategic significance<br />
determines where it will be reviewed <strong>and</strong><br />
<strong>Annual</strong> governance statement<br />
101
monitored. The monitoring of risks <strong>and</strong><br />
action plans have been undertaken by the<br />
<strong>Trust</strong> Board/<strong>Trust</strong> Board committees during<br />
<strong>2012</strong>/<strong>13</strong>.<br />
These committees are supported by<br />
Executive chaired committees/groups <strong>and</strong><br />
Divisional governance structures that channel<br />
information up to <strong>and</strong> down from the Board/<br />
Board committees via the online risk register.<br />
Risk appetite as well as risk tolerance is<br />
covered in the risk strategy. The Board has<br />
not set specific limits for this, but will view<br />
risks <strong>and</strong> the progress of actions designed<br />
to mitigate risk, on an individual risk basis.<br />
The accepted risks are reviewed at least<br />
annually by IRMC/QRC/Divisional Governance<br />
Boards to check that the controls for these<br />
accepted risks still st<strong>and</strong>. The Board’s IRMC/<br />
QRC recommends which corporate risks<br />
may be accepted based on the level of<br />
the required resource; assurance that all<br />
reasonable measures have been put in<br />
place to mitigate any risks; <strong>and</strong> that there is<br />
assurance that these are monitored regularly.<br />
Risk consequences are considered as part<br />
of cost improvement plans, business cases,<br />
capital expenditure projects <strong>and</strong> staffing<br />
<strong>and</strong> workforce priorities regarding vacancy<br />
authorisation. This ensures that the <strong>Trust</strong><br />
is taking account of the key inter-linking<br />
priorities <strong>and</strong> dependencies of finance,<br />
operation <strong>and</strong> service quality risk in order to<br />
deliver the best quality service to patients.<br />
The <strong>Trust</strong> Board reviews all of the high<br />
corporate risks quarterly; the IRMC/QRC<br />
reviews all the medium <strong>and</strong> high corporate<br />
risks quarterly <strong>and</strong> the Divisional Boards<br />
review all relevant risks at all levels quarterly.<br />
The main risks facing the <strong>Trust</strong> are<br />
summarised:<br />
• Significant clinical risks in-year:<br />
shortage of paediatric A&E nurses<br />
<strong>and</strong> lack of commissioned High<br />
Dependency Unit (HDU) facilities<br />
for children (the latter being a pan<br />
London issue). This is mitigated by<br />
adult trained nurses from other<br />
areas of A&E being deployed to the<br />
paediatric A&E as required; a senior<br />
staff nurse has been appointed as<br />
Head of Paediatric nursing to assist<br />
with staff cover including redeploying<br />
paediatric nurses from the ward to<br />
A&E as required. Paediatric HDU cover<br />
is provided by using bank/agency<br />
nursing staff; a dedicated paediatric<br />
clinical transfer bag is available <strong>and</strong><br />
in use <strong>and</strong> a paediatric ventilator<br />
has been procured <strong>and</strong> used prior to<br />
transferring children out of the <strong>Trust</strong><br />
as required this is monitored through<br />
internal incident reporting.<br />
• Financial – financial performance<br />
<strong>and</strong> liquidity. This risk is mitigated<br />
by a revised monthly <strong>and</strong> quarterly<br />
performance management framework,<br />
monthly QIPP Board <strong>and</strong> monthly<br />
<strong>Trust</strong> Board reporting. The <strong>Trust</strong> has a<br />
committed working capital facility <strong>and</strong><br />
written agreements from NW London<br />
Commissioners to support with cash in<br />
<strong>2012</strong>/<strong>13</strong> to maintain current financial<br />
risk rating <strong>and</strong> written agreement<br />
from NW London Commissioners to<br />
pay for valid over performance in<br />
<strong>2012</strong>/<strong>13</strong>.<br />
• Age <strong>and</strong> condition of the Estate poses<br />
both a clinical <strong>and</strong> financial risk with<br />
its extensive <strong>and</strong> old building stock<br />
on both sites; resulting in increasing<br />
frequency <strong>and</strong> severity of fabric failure<br />
<strong>and</strong> interruption of service delivery.<br />
This is managed by a prioritised<br />
five year forward view of high <strong>and</strong><br />
significant backlog maintenance<br />
requirements, risk assessed <strong>and</strong> rated<br />
against available capital.<br />
102 <strong>Annual</strong> governance statement
The main future risks facing the <strong>Trust</strong> are<br />
summarised:<br />
Future clinical risks:<br />
‣ NW London Shaping a Healthier<br />
Future does not develop at the<br />
anticipated rate affecting acute<br />
activity;<br />
‣ the large emergency care project<br />
(ECP) is not managed or delivered as<br />
planned to specific timescales/cost;<br />
<strong>and</strong> during the build the reduction in<br />
A&E treatment space is not efficiently<br />
managed; <strong>and</strong><br />
‣ potential staffing pressure <strong>and</strong> costs<br />
post Francis.<br />
These risks are mitigated by:<br />
‣ working closely with GPs <strong>and</strong> CCG<br />
leads to ensure that the right<br />
incentives <strong>and</strong> contract levers are in<br />
place to influence social care provision<br />
to facilitate timely discharge <strong>and</strong> an<br />
appreciation that shifting work from<br />
the acute hospital is only possible once<br />
the out of hospital strategy is worked<br />
up in the community;<br />
‣ for the ECP early clinical engagement<br />
to improve patient pathway<br />
efficiencies, reduce length of stay <strong>and</strong><br />
ensure adequate communication for<br />
staff, patients <strong>and</strong> visitors; <strong>and</strong><br />
‣ for staffing issues post Francis – the<br />
<strong>Trust</strong> has recently participated in a<br />
pan-London nursing <strong>and</strong> midwifery<br />
productivity benchmarking exercise<br />
which, along with other best practice<br />
guidance will inform our future<br />
staffing requirements; from April 20<strong>13</strong><br />
the <strong>Trust</strong> is implementing m<strong>and</strong>atory<br />
customer care training for all staff; a<br />
leadership strategy has been agreed<br />
by the Board <strong>and</strong> work has begun<br />
in a number of areas; over 30 of the<br />
<strong>Trust</strong>’s nursing leaders have undergone<br />
a three day leadership development<br />
course, in April the <strong>Trust</strong> will extend<br />
its Talent Management Programme to<br />
nearly 500 staff including consultants<br />
which will help identify any gaps in<br />
leadership skills amongst our leaders<br />
as well as identify those with potential<br />
whilst supporting our succession<br />
planning <strong>and</strong> training commissioning;<br />
a review of b<strong>and</strong> 1-4 roles <strong>and</strong><br />
development has also commenced.<br />
Future financial risk:<br />
‣ commissioning risk if activity is not<br />
paid for, potentially leading to clinical<br />
<strong>and</strong> financial viability concerns;<br />
‣ operational <strong>and</strong> investment cash gets<br />
extremely tight <strong>and</strong> starts to impede<br />
on service delivery; <strong>and</strong><br />
‣ unprecedented size of efficiency<br />
savings required in 20<strong>13</strong>/14 <strong>and</strong> for<br />
the next five years <strong>and</strong> its impact on<br />
quality of care provided.<br />
These risks are mitigated by:<br />
‣ regular meetings with the <strong>Hillingdon</strong><br />
Clinical Commissioning Group <strong>and</strong><br />
the North West (NW) London sector<br />
commissioners to identify issues early;<br />
‣ regular internal meetings in relation<br />
to contract management performance<br />
with responsible managers;<br />
‣ agreed robust mitigation plans are<br />
in place to manage the financial<br />
consequences of a reasonable<br />
reduction in revenue as a consequence<br />
of services being decommissioned.<br />
The <strong>Trust</strong> will remain focused on the tension<br />
between quality, safety, financial efficiency,<br />
<strong>and</strong> risk to ensure that patient care remains<br />
uncompromised. The <strong>Trust</strong> will do this by<br />
having regular Board <strong>and</strong> Executive reviews<br />
of progress <strong>and</strong> delivery of agreed plans <strong>and</strong><br />
checking that all schemes are quality impact<br />
assessed.<br />
For data security, the <strong>Trust</strong> has an established<br />
Information Security Management System<br />
(ISMS) similar to that defined within the<br />
<strong>Annual</strong> governance statement<br />
103
International St<strong>and</strong>ard (ISO) 27001. This<br />
entails the identification <strong>and</strong> classification of<br />
information assets, risk assessing those assets<br />
<strong>and</strong> then establishing control frameworks<br />
to keep those assets secure. The <strong>Trust</strong> has<br />
committed to establishing ISMS through its<br />
compliance with the Information Governance<br />
(IG) Toolkit. One key element of our<br />
compliance is having a current Information<br />
Risk Policy. The policy is supported by an<br />
Information Risk Strategy <strong>and</strong> accompanying<br />
procedures. These set out the arrangements<br />
for governing information risk processes,<br />
i.e. the framework of accountability <strong>and</strong><br />
the roles <strong>and</strong> responsibilities of staff,<br />
management <strong>and</strong> committees. Together<br />
these contribute to the organisation meeting<br />
its legislative <strong>and</strong> regulatory requirements,<br />
as well as meeting requirements from the<br />
Department of Health for organisations to<br />
manage the security of their information,<br />
defined within the Connecting for Health<br />
Information Governance Toolkit. Compliance<br />
evidence for version 10 of the Information<br />
Governance Toolkit has been uploaded<br />
to <strong>NHS</strong> Connecting for Health <strong>and</strong> all<br />
requirements are at a level 2 or 3 except for<br />
the requirement to have 95% of staff trained<br />
annually in Information Governance which<br />
is at level 1. IG training compliance will be<br />
driven by a change in <strong>Trust</strong> Statutory <strong>and</strong><br />
M<strong>and</strong>atory Training Policy which provides<br />
monthly reporting of staff compliance to<br />
managers, <strong>and</strong> by the delivery of bespoke<br />
training to specific staff groups.<br />
The key quality performance information is<br />
assessed monthly by the <strong>Trust</strong> Board which<br />
reviews the performance report – both the<br />
targets table <strong>and</strong> the prose which interprets<br />
the numbers, discrepancies <strong>and</strong> any required<br />
actions. The data is further assured by the use<br />
of Data Quality Badges which are described<br />
in each monthly performance report.<br />
Internal Audit reviewed IG arrangements in<br />
the <strong>Trust</strong> <strong>and</strong> gave substantial assurance. This<br />
took into account the one serious incident<br />
regarding data loss which was duly reported<br />
to the Information Commissioner, Monitor<br />
<strong>and</strong> fully investigated <strong>and</strong> managed by<br />
the <strong>Trust</strong>. Lessons learnt have now become<br />
established practice for example internal mail<br />
is now transported in sealed Envopaks rather<br />
than individual envelopes.<br />
Control measures are in place to ensure<br />
that all the organisation’s obligations<br />
under equality, diversity <strong>and</strong> human rights<br />
legislation are complied with.<br />
Equality impact assessments (EIA) are<br />
integrated into core <strong>Trust</strong> business e.g. they<br />
are carried out as st<strong>and</strong>ard procedure for<br />
all <strong>Trust</strong>’s policies. In addition the <strong>Trust</strong> has<br />
published its Service <strong>and</strong> Workforce Equality<br />
Compliance <strong>Report</strong>s on 31st January 20<strong>13</strong><br />
<strong>and</strong> reported on year one of its Equality<br />
Objectives on 6th April 20<strong>13</strong> providing<br />
assurance that the <strong>Trust</strong> is compliant with<br />
Equality legislation.<br />
As an employer with staff entitled to<br />
membership of the <strong>NHS</strong> Pension Scheme,<br />
control measures are in place to ensure<br />
all employer obligations contained within<br />
the Scheme regulations are complied with.<br />
This includes ensuring that deductions<br />
from salary, employer’s contributions <strong>and</strong><br />
payments to the Scheme are in accordance<br />
with the Scheme rules, <strong>and</strong> that member<br />
Pension Scheme records are accurately<br />
updated in accordance with the timescales<br />
detailed in the Regulations.<br />
Care Quality Commission (CQC)<br />
Compliance<br />
Compliance with the CQC essential st<strong>and</strong>ards<br />
of quality <strong>and</strong> safety are one of the elements<br />
of the organisation’s risk management<br />
process.<br />
The <strong>Trust</strong> is registered with the CQC without<br />
conditions. The <strong>Trust</strong> is fully compliant with<br />
the registration requirements of the Care<br />
Quality Commission.<br />
104 <strong>Annual</strong> governance statement
To ensure the <strong>Trust</strong> remains compliant with<br />
the CQC essential st<strong>and</strong>ards of quality <strong>and</strong><br />
safety the following assurance processes are<br />
in place:<br />
• Corporate Governance examines the<br />
Quality & Risk profile <strong>and</strong> produces a<br />
tracker risk profile for review by the<br />
Executive team <strong>and</strong> senior managers<br />
in the <strong>Trust</strong>. This enables any issues to<br />
be raised <strong>and</strong> challenged <strong>and</strong> opens<br />
dialogue with the CQC inspectors<br />
as required. The highest rated risk<br />
this year has been high amber for<br />
complaints; this has now dropped to<br />
low amber. Complaints have been<br />
picked up in the Board performance<br />
reports <strong>and</strong> systems are in place to<br />
increase efficiency with dealing with<br />
complaints.<br />
• CQSC/QRC receives a CQC compliance<br />
report twice yearly <strong>and</strong> AAC<br />
annually. This report is produced<br />
by Corporate Governance <strong>and</strong> is an<br />
outcome review of all the regulated<br />
outcomes. The provider compliance<br />
assessments (PCA) are used to ensure<br />
the <strong>Trust</strong> has due processes in place<br />
to enable compliance. However, the<br />
current <strong>Trust</strong> approach does not<br />
facilitate a granular approach to<br />
compliance monitoring <strong>and</strong> Corporate<br />
Governance are putting forward a<br />
case to install a software package that<br />
enables input of data from varied<br />
sources in order to gauge CQC (<strong>and</strong><br />
<strong>NHS</strong>LA) compliance across each area<br />
of the <strong>Trust</strong>. This will form part of the<br />
evolving Informatics Strategy.<br />
Internal audit reviewed a sample of our<br />
PCA <strong>and</strong> methodology of CQC compliance<br />
monitoring <strong>and</strong> gave substantial assurance in<br />
September <strong>2012</strong>.<br />
The CQC paid an unannounced visit to the<br />
<strong>Hillingdon</strong> <strong>Hospital</strong> site in December <strong>2012</strong>.<br />
The resulting report from the CQC stated full<br />
compliance with the essential st<strong>and</strong>ards of<br />
quality <strong>and</strong> safety. These two recent external<br />
reports, as well as the internal monitoring<br />
of CQC compliance, provide me with good<br />
assurance that the <strong>Trust</strong> continues to be fully<br />
compliant with the CQC essential st<strong>and</strong>ards<br />
of quality <strong>and</strong> safety.<br />
There has been one Internal Audit report<br />
giving Limited Assurance this year <strong>and</strong> this<br />
related to Oversees Visitors <strong>and</strong> the <strong>Trust</strong> not<br />
having robust systems in place to ensure that<br />
appropriate identification, billing, payment<br />
<strong>and</strong> debt collection procedures were in place<br />
<strong>and</strong> operating effectively. Since this report<br />
several improvements have been put in place<br />
at the frontline to ensure higher efficiency.<br />
The <strong>Trust</strong> involves its key public stakeholders<br />
with managing the risks that affect them<br />
through the following mechanisms:<br />
• Engagement with the local Health<br />
Overview <strong>and</strong> Scrutiny Committee<br />
• Engagement with the Local Involvement<br />
Network (Healthwatch from 1st April<br />
20<strong>13</strong>)The Council of Governors are<br />
consulted on key issues <strong>and</strong> risks as part<br />
of the annual plan<br />
• Board approved Membership<br />
Development <strong>and</strong> Engagement<br />
Strategy <strong>2012</strong>-15, which was consulted<br />
on extensively with the Council of<br />
Governors<br />
• Regular People in Partnership Forums<br />
which aim to involve patients <strong>and</strong> the<br />
local community in decision-making on<br />
the acute health services offered<br />
• <strong>Annual</strong> Members Meeting<br />
• Foundation <strong>Trust</strong> Office where members<br />
can raise specific issues with the <strong>Trust</strong><br />
<strong>and</strong>/or relevant Governor<br />
• Engagement with User Groups <strong>and</strong><br />
Support Groups e.g. People Improving<br />
Cancer Services, Fighting Infection<br />
Together, Somalian Maternity focus<br />
group, Disability Action Group, Readers<br />
Panel.<br />
<strong>Annual</strong> governance statement<br />
105
The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation<br />
<strong>Trust</strong> has undertaken risk assessments <strong>and</strong><br />
Carbon Reduction Delivery Plans are in place<br />
in accordance with emergency preparedness<br />
<strong>and</strong> civil contingency requirements, as based<br />
on UKCIP 2009 weather projects, to ensure<br />
that this organisation’s obligations under<br />
the Climate Change Act <strong>and</strong> the Adaptation<br />
<strong>Report</strong>ing requirements are complied with.<br />
Adaption reporting uses a risk assessment<br />
approach; coupled with regular detailed<br />
buildings condition survey, in conjunction<br />
with resilience planning, founded on<br />
weather-based risks e.g. heat wave, extreme<br />
cold, drought, <strong>and</strong> flood.<br />
Compliance with the Code of Governance -<br />
The Board considers itself compliant with all<br />
provisions of the <strong>NHS</strong> Foundation <strong>Trust</strong> Code<br />
of Governance. This is following discussion<br />
<strong>and</strong> review at the AAC <strong>and</strong> <strong>Trust</strong> Board. The<br />
Board has made the disclosures required by<br />
the Code in the Governance <strong>Report</strong> section<br />
of this annual report, including attendance<br />
records <strong>and</strong> coverage of work for each Board<br />
committee.<br />
5. Review of economy, efficiency<br />
<strong>and</strong> effectiveness of the use of<br />
resources<br />
The following key processes are in place to<br />
ensure that resources are used economically,<br />
efficiently <strong>and</strong> effectively:<br />
• Scheme of Delegation <strong>and</strong> Reservation<br />
of Powers approved by the Board sets<br />
out the decisions, authorities <strong>and</strong> duties<br />
delegated to officers of the <strong>Trust</strong>.<br />
• St<strong>and</strong>ing Financial Instructions detail<br />
the financial responsibilities, policies<br />
<strong>and</strong> procedures adopted by the <strong>Trust</strong>.<br />
They are designed to ensure that an<br />
organisation’s financial transactions<br />
are carried out in accordance with the<br />
law <strong>and</strong> Government policy in order<br />
to achieve probity, accuracy, economy,<br />
efficiency <strong>and</strong> effectiveness.<br />
• Robust competitive processes used for<br />
procuring non-staff expenditure items.<br />
Above £25k, procurement involves<br />
competitive tendering.<br />
• Cost improvement programmes (CIPs),<br />
which are assessed for their impact on<br />
quality with local clinical ownership <strong>and</strong><br />
accountability<br />
• Use of National <strong>and</strong> London<br />
benchmarking for non-clinical support<br />
functions.<br />
The <strong>Trust</strong> Board has gained assurance<br />
from the former Finance <strong>and</strong> Investment<br />
(F&I) Committee in respect of financial<br />
<strong>and</strong> budgetary management across the<br />
organisation <strong>and</strong> the AAC, which receives<br />
quarterly reports regarding Losses <strong>and</strong><br />
Compensations (with high value approved<br />
by the Board), Write-Off of Bad Debts, Going<br />
Concern <strong>and</strong> Contingent Liabilities. The AAC<br />
has agreed levels of charges for overseas<br />
visitors based on write offs to ensure that<br />
the charges take account of the risk of nonpayment.<br />
For information the F&I Committee has<br />
been disb<strong>and</strong>ed. The newly formed<br />
Transformation Committee (January 20<strong>13</strong>)<br />
was established to assist the Board with the<br />
shaping, review <strong>and</strong> challenge of service<br />
transformation, development <strong>and</strong> redesign,<br />
increasing governance of the CIPs (supported<br />
by a strengthened project management<br />
office established in the light of a Monitor<br />
<strong>Annual</strong> Plan Review recommendation);<br />
<strong>and</strong> to provide assurance that the strategy<br />
for the management of human, financial,<br />
estate, <strong>and</strong> IT resources support such business<br />
transformation. The Committee replaced<br />
the Finance & Investment Committee<br />
as the Board sought to ensure greater<br />
Board scrutiny <strong>and</strong> challenge on service<br />
transformation <strong>and</strong> redesign.<br />
Value for money discussions take place at<br />
Board strategy sessions based on service line<br />
reporting reviewing how much a service<br />
106 <strong>Annual</strong> governance statement
costs to run versus the income it generates<br />
<strong>and</strong> how it is performing both clinically<br />
<strong>and</strong> operationally. This is particularly the<br />
approach used around services where<br />
competition is greatest <strong>and</strong>/or where a<br />
service is out to tender.<br />
Further information with reference to the<br />
<strong>Trust</strong>’s financial future regarding the Going<br />
Concern assessment, is included in the<br />
‘Financial Disclosures’ section in the Directors<br />
<strong>Report</strong> of this <strong>Annual</strong> <strong>Report</strong>. This draws<br />
specific attention to the recent financial<br />
performance, the challenging financial<br />
context facing the <strong>Trust</strong> <strong>and</strong> the programme<br />
the Board is investing in to support the<br />
delivery of the savings identified going<br />
forward.<br />
There are a range of internal <strong>and</strong> external<br />
audits (e.g. Audit Commission external<br />
reviews on payment by results) that provide<br />
further assurance on quality of financial<br />
data, economy, efficiency <strong>and</strong> effectiveness,<br />
including internal audit reports on creditors,<br />
financial reporting <strong>and</strong> budgetary control,<br />
healthcare contracting & payment by results,<br />
cash management, cost improvement<br />
programmes <strong>and</strong> financial <strong>and</strong> activity data<br />
<strong>and</strong> how it is linked including clinical coding.<br />
These are all reported to AAC. All Internal<br />
Audit reports into finance functions have<br />
reported substantial assurance for the past<br />
three financial years.<br />
6. <strong>Annual</strong> Quality <strong>Report</strong><br />
The Directors are required under the Health<br />
Act 2009 <strong>and</strong> the National Health Service<br />
(Quality <strong>Accounts</strong>) Regulations 2010 (as<br />
amended) to prepare Quality <strong>Accounts</strong><br />
for each financial year. Monitor has issued<br />
guidance to <strong>NHS</strong> Foundation <strong>Trust</strong> Boards<br />
on the form <strong>and</strong> content of <strong>Annual</strong> Quality<br />
<strong>Report</strong>s which incorporate the above legal<br />
requirements in the <strong>NHS</strong> Foundation <strong>Trust</strong><br />
<strong>Annual</strong> <strong>Report</strong>ing Manual.<br />
The <strong>Trust</strong>’s commitment to quality <strong>and</strong><br />
quality governance is based on a clearly<br />
defined clinical quality strategy, a system<br />
of quality performance management, <strong>and</strong><br />
a clear risk management process. There is a<br />
performance <strong>and</strong> quality report presented<br />
to the Board which allows key threats <strong>and</strong><br />
risks to quality to be identified with more<br />
quality detail including review of incident,<br />
complaints data <strong>and</strong> the like being reviewed<br />
by the Board’s committee, the Clinical Quality<br />
<strong>and</strong> St<strong>and</strong>ards Committee (CQSC)/now the<br />
Quality & Risk Committee (QRC).<br />
The supply of information to the Board,<br />
<strong>and</strong> the management team, <strong>and</strong> oversight<br />
of this, is undertaken by a specialist team in<br />
clinical governance. This is led by a senior<br />
clinical manager <strong>and</strong> supported by specialist<br />
risk facilitators <strong>and</strong> a clinical audit <strong>and</strong><br />
effectiveness manager <strong>and</strong> audit team.<br />
The Board monitors quality through the<br />
following processes:<br />
1) the monthly quality operational report<br />
<strong>and</strong> a quarterly quality report;<br />
2) the reporting of serious incidents <strong>and</strong><br />
learning from them to the monthly<br />
Board meetings;<br />
3) a more in-depth review of quality <strong>and</strong><br />
parameters by the CQSC/QRC.<br />
4) Observations of care – undertaken on<br />
a monthly basis where Board members<br />
accompany senior nurses <strong>and</strong> visit<br />
wards on a rotational basis to review<br />
the quality of care. During the visit, the<br />
environment, attitudes <strong>and</strong> behaviours<br />
of staff, team working <strong>and</strong> specific<br />
aspects of patient experience <strong>and</strong><br />
safety are assessed.<br />
The <strong>Trust</strong> has a comprehensive clinical audit<br />
work plan covering both national <strong>and</strong><br />
local audits. Regular updates on clinical<br />
audit are reported to the CQSC/QRC. Issues<br />
raised via Clinical Audit result in changes in<br />
practice within the <strong>Trust</strong> e.g. as a result of<br />
the National Audit of Dementia the <strong>Trust</strong><br />
has implemented the following: A dementia<br />
<strong>Annual</strong> governance statement<br />
107
training programme that ensures the correct<br />
level of training for staff e.g. specialised<br />
training for staff working closely with<br />
dementia patients <strong>and</strong> ‘This is me’ document,<br />
which helps to find out better information<br />
about dementia patients to help care better<br />
for them <strong>and</strong> meet their individual needs.<br />
A Clinical Assurance Panel (CAP) has been<br />
set up to assess the quality impact of any<br />
changing service brought about for QIPP. This<br />
is a multi-professional clinical panel, chaired<br />
by the Medical Director, which formally<br />
reviews all cross-divisional service changes.<br />
A nursing quality dashboard has been<br />
developed to allow ward to Board reporting;<br />
this includes headline nursing metrics under<br />
the domains of clinical effectiveness, patient<br />
safety <strong>and</strong> patient quality experience.<br />
The dashboard is presented to the QRC<br />
on a quarterly basis <strong>and</strong> reviewed by the<br />
Director of Nursing at divisional performance<br />
meetings with senior nursing staff on a<br />
monthly basis.<br />
A framework exists for the management <strong>and</strong><br />
accountability of data quality, supported<br />
by a comprehensive audit programme <strong>and</strong><br />
the Data Quality Policy, which consist of a<br />
set of quality data groups that run across<br />
the organisation. These groups report to<br />
an Executive Director-led steering group<br />
which feeds quarterly into the AAC. These<br />
quarterly data quality reports to AAC cover<br />
the Monitor compliance data reported to<br />
the Board <strong>and</strong> other key data quality issues<br />
like <strong>NHS</strong> number <strong>and</strong> duplicate records. This,<br />
together with the data audit results, provides<br />
assurance to the Board on data quality<br />
issues <strong>and</strong> strength of internal control.<br />
Three key data areas have been identified<br />
this year where further actions are being<br />
implemented:<br />
1) Duplicate patient records – this involves<br />
the last few remaining <strong>Trust</strong> systems<br />
that have a relatively high number of<br />
duplicate records (above 3%).<br />
2) 18 week patient pathways - to<br />
strengthen controls to ensure these are<br />
always accurately recorded.<br />
3) VTE assessment sheets – to ensure<br />
these are always attached to patient<br />
notes.<br />
The priorities for the <strong>Annual</strong> Quality<br />
<strong>Report</strong> are drawn together <strong>and</strong> shaped<br />
via a structured timeline which engages<br />
our key stakeholders, such as Patients<br />
in Partnership, Governors, Healthwatch;<br />
the Clinical Divisions, Clinical Governance<br />
Committee <strong>and</strong> QRC. These processes <strong>and</strong><br />
the leadership involved ensure the Quality<br />
<strong>Report</strong> represents a balanced view.<br />
7 Review of effectiveness<br />
As Accounting Officer, I have responsibility<br />
for reviewing the effectiveness of the<br />
system of internal control. My review of<br />
the effectiveness of the system of internal<br />
control is informed by the work of the<br />
internal auditors, clinical audit <strong>and</strong> the<br />
executive managers <strong>and</strong> clinical leads<br />
within the <strong>NHS</strong> Foundation <strong>Trust</strong> who<br />
have responsibility for the development<br />
<strong>and</strong> maintenance of the internal control<br />
framework. I have drawn on the content<br />
of the quality report attached to this<br />
<strong>Annual</strong> <strong>Report</strong> <strong>and</strong> other performance<br />
information available to me. My review is<br />
also informed by comments made by the<br />
external auditors in their management<br />
letter <strong>and</strong> other reports. I have been advised<br />
on the implications of the result of my<br />
review of the effectiveness of the system<br />
of internal control by the Board, the Audit<br />
<strong>and</strong> Assurance Committee, Integrated<br />
Risk Management Committee/Quality<br />
& Risk Committee <strong>and</strong> Clinical Quality<br />
<strong>and</strong> St<strong>and</strong>ards committee, <strong>and</strong> a plan to<br />
address weaknesses <strong>and</strong> ensure continuous<br />
improvement of the system is in place.<br />
108 <strong>Annual</strong> governance statement
The process that has been used to maintain<br />
<strong>and</strong> review the effectiveness of the system of<br />
internal control centres on<br />
• the effectiveness of the Board has<br />
been reviewed during the year <strong>and</strong><br />
as a result the Board changed its<br />
committee arrangements to enable<br />
it to work in a more structured way<br />
with regards to service development<br />
<strong>and</strong> transformation, including the role<br />
of the <strong>Trust</strong>’s workforce, estate <strong>and</strong> IT<br />
services<br />
• the Board’s annual review of the<br />
Board Committee structure, their<br />
effectiveness <strong>and</strong> terms of reference<br />
which are reviewed by the Board <strong>and</strong><br />
by each Committee; of note this year<br />
the changes in amalgamating IRMC<br />
<strong>and</strong> CQSC to form the QRC, dissolving<br />
the F&I committee <strong>and</strong> forming the<br />
Transformation Committee;<br />
• development, review <strong>and</strong> challenge<br />
of the BAF which is compiled by<br />
Corporate Governance in conjunction<br />
with the relevant Executive Directors<br />
<strong>and</strong> their senior managers; the BAF<br />
is then scrutinised quarterly at both<br />
the former IRMC/QRC <strong>and</strong> AAC prior<br />
to being reviewed by the Board twice<br />
yearly.<br />
Internal audit have reviewed the BAF <strong>and</strong> the<br />
methodology involved in forming the tool<br />
<strong>and</strong> have given substantial assurance that the<br />
<strong>Trust</strong> has in place adequate <strong>and</strong> appropriate<br />
arrangements for gaining assurances about<br />
the effectiveness of the organisation’s system<br />
of internal control.<br />
Some of the more challenging areas this year<br />
have been the closeness to the Clostridium<br />
difficile target, A&E 4 hour target issues in<br />
the later part of quarters 3 <strong>and</strong> 4 <strong>and</strong> the<br />
cost improvement plan. However, despite<br />
these challenges the <strong>Trust</strong> has managed to<br />
maintain a financial risk rating of 3 <strong>and</strong> a<br />
green governance rating.<br />
On balance, I therefore conclude that that<br />
the Board has conducted a review of the<br />
effectiveness of the <strong>Trust</strong>’s system on internal<br />
controls <strong>and</strong> found them to be sufficient.<br />
Conclusion<br />
My review confirms that The <strong>Hillingdon</strong><br />
<strong>Hospital</strong>s <strong>NHS</strong> Foundation <strong>Trust</strong> has no<br />
significant internal control issues <strong>and</strong> a<br />
generally sound system of internal control<br />
that supports the achievement of its policies,<br />
aims <strong>and</strong> objectives.<br />
The BAF is reviewed <strong>and</strong> challenged as<br />
described in section 3 above. There is then<br />
an annual examination <strong>and</strong> refreshing of the<br />
principal objectives cited in the BAF, new risks<br />
added if required or risks amended to suit<br />
the current climate.<br />
<strong>Annual</strong> governance statement<br />
109
INDEPENDENT AUDITOR’S REPORT TO THE BOARD OF<br />
GOVERNORS AND BOARD OF DIRECTORS OF THE HILLINGDON<br />
HOSPITALS <strong>NHS</strong> FOUNDATION TRUST<br />
We have audited the financial statements of The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation<br />
for the year ended 31 March 20<strong>13</strong> which comprise the Income Statement, the Statement<br />
of Comprehensive Income, the Balance Sheet, the Cash Flow Statement, the Statement<br />
of Changes in Taxpayers Equity <strong>and</strong> the related notes 1 to 31. The financial reporting<br />
framework that has been applied in their preparation is applicable law <strong>and</strong> the accounting<br />
policies directed by Monitor – Independent Regulator of <strong>NHS</strong> Foundation <strong>Trust</strong>s.<br />
This report is made solely to the Board of Governors <strong>and</strong> Board of Directors (“the Boards”) of<br />
The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation <strong>Trust</strong>, as a body, in accordance with paragraph 4 of<br />
Schedule 10 of the National Health Service Act 2006. Our audit work has been undertaken<br />
so that we might state to the Boards those matters we are required to state to them in an<br />
auditor’s report <strong>and</strong> for no other purpose. To the fullest extent permitted by law, we do not<br />
accept or assume responsibility to anyone other than the trust <strong>and</strong> the Boards as a body, for<br />
our audit work, for this report, or for the opinions we have formed.<br />
Respective responsibilities of the accounting officer <strong>and</strong> auditor<br />
As explained more fully in the Accounting Officer’s Responsibilities Statement, the<br />
Accounting Officer is responsible for the preparation of the financial statements <strong>and</strong> for<br />
being satisfied that they give a true <strong>and</strong> fair view. Our responsibility is to audit <strong>and</strong> express<br />
an opinion on the financial statements in accordance with applicable law, the Audit Code<br />
of <strong>NHS</strong> Foundation <strong>Trust</strong>s <strong>and</strong> International St<strong>and</strong>ards on Auditing (UK <strong>and</strong> Irel<strong>and</strong>). Those<br />
st<strong>and</strong>ards require us to comply with the Auditing Practices Board’s Ethical St<strong>and</strong>ards for<br />
Auditors.<br />
Scope of the audit of the financial statements<br />
An audit involves obtaining evidence about the amounts <strong>and</strong> disclosures in the financial<br />
statements sufficient to give reasonable assurance that the financial statements are free from<br />
material misstatement, whether caused by fraud or error. This includes an assessment of:<br />
whether the accounting policies are appropriate to the trust’s circumstances <strong>and</strong> have been<br />
consistently applied <strong>and</strong> adequately disclosed; the reasonableness of significant accounting<br />
estimates made by the Accounting Officer; <strong>and</strong> the overall presentation of the financial<br />
statements. In addition, we read all the financial <strong>and</strong> non-financial information in the<br />
annual report to identify material inconsistencies with the audited financial statements <strong>and</strong><br />
to identify any information that is apparently materially incorrect based on, or materially<br />
inconsistent with, the knowledge acquired by us in the course of performing the audit. If we<br />
become aware of any apparent material misstatements or inconsistencies we consider the<br />
implications for our report.<br />
110 Auditor’s report
Opinion on financial statements<br />
In our opinion the financial statements:<br />
• give a true <strong>and</strong> fair view of the state of the trust’s affairs as at 31 March 20<strong>13</strong> <strong>and</strong> of its<br />
income <strong>and</strong> expenditure for the year then ended;<br />
• have been properly prepared in accordance with the accounting policies directed by<br />
Monitor – Independent Regulator of <strong>NHS</strong> Foundation <strong>Trust</strong>s; <strong>and</strong><br />
• have been prepared in accordance with the requirements of the National Health Service<br />
Act 2006.<br />
Opinion on other matter[s] prescribed by the National Health Service Act<br />
2006<br />
In our opinion:<br />
• the part of the Directors’ Remuneration <strong>Report</strong> to be audited has been properly prepared<br />
in accordance with the National Health Service Act 2006; <strong>and</strong><br />
• the information given in the Directors’ <strong>Report</strong> for the financial year for which the<br />
financial statements are prepared is consistent with the financial statements.<br />
Matters on which we are required to report by exception<br />
We have nothing to report in respect of the following matters where the Audit Code for <strong>NHS</strong><br />
Foundation <strong>Trust</strong>s requires us to report to you if, in our opinion:<br />
• the <strong>Annual</strong> Governance Statement does not meet the disclosure requirements set out in<br />
the <strong>NHS</strong> Foundation <strong>Trust</strong> <strong>Annual</strong> <strong>Report</strong>ing Manual, is misleading or inconsistent with<br />
information of which we are aware from our audit. We are not required to consider, nor<br />
have we considered, whether the <strong>Annual</strong> Governance Statement addresses all risks <strong>and</strong><br />
controls or that risks are satisfactorily addressed by internal controls;<br />
• proper practices have not been observed in the compilation of the financial statements;<br />
or<br />
• the <strong>NHS</strong> foundation trust has not made proper arrangements for securing economy,<br />
efficiency <strong>and</strong> effectiveness in its use of resources.<br />
Certificate<br />
We certify that we have completed the audit of the accounts in accordance with the<br />
requirements of Chapter 5 of Part 2 of the National Health Service Act 2006 <strong>and</strong> the Audit<br />
Code for <strong>NHS</strong> Foundation <strong>Trust</strong>s.<br />
Craig Wisdom (Senior Statutory Auditor)<br />
for <strong>and</strong> on behalf of Deloitte LLP<br />
Chartered Accountants <strong>and</strong> Statutory Auditor<br />
St Albans, United Kingdom<br />
29 May 20<strong>13</strong><br />
Auditor’s report<br />
111
ANNUAL ACCOUNTS <strong>2012</strong>/<strong>13</strong><br />
Foreword to the accounts<br />
The accounts for the year ended 31st March 20<strong>13</strong> have been prepared by the <strong>Hillingdon</strong><br />
<strong>Hospital</strong>s <strong>NHS</strong> Foundation <strong>Trust</strong> in accordance with paragraphs 24 <strong>and</strong> 25 of Schedule 7 of<br />
the National Health Services Act 2006 in the form which the Independent Regulator of <strong>NHS</strong><br />
Foundation <strong>Trust</strong>s (Monitor) has, with the approval of the Secretary of State, directed.<br />
112 <strong>Annual</strong> accounts
The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation <strong>Trust</strong> - <strong>Annual</strong> <strong>Accounts</strong> <strong>2012</strong>-<strong>13</strong><br />
STATEMENT OF COMPREHENSIVE INCOME NOTE 31 March 20<strong>13</strong> 31 March <strong>2012</strong><br />
£000 £000<br />
Operating Income 3 194,541 190,291<br />
Operating expenses 4 (192,732) (191,129)<br />
OPERATING SURPLUS / (DEFICIT) 1,810 (838)<br />
NON-OPERATING INCOME<br />
Finance income 8 14 14<br />
Other non-operating Income 9 1,692 2,347<br />
TOTAL NON-OPERATING INCOME 1,706 2,361<br />
NON-OPERATING COSTS<br />
Finance expense - financial liabilities 10 (1,778) (1,688)<br />
Finance expense - unwinding of discount on provisions 25 (63) (47)<br />
PDC Dividends payable (3,533) (3,723)<br />
TOTAL NON-OPERATING COSTS (5,374) (5,458)<br />
SURPLUS/(DEFICIT) FOR THE YEAR (1,858) (3,935)<br />
Other comprehensive income<br />
Impairments 12 (16) (5,062)<br />
Revaluations 12 420 6,212<br />
TOTAL COMPREHENSIVE INCOME / (EXPENSE) FOR THE YEAR (1,454) (2,785)<br />
All income <strong>and</strong> expenditure is derived from continuing operations.<br />
The notes on pages 117 <strong>13</strong>5 to 156 174 form part of these accounts.<br />
<strong>Annual</strong> accounts<br />
1<strong>13</strong>
The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation <strong>Trust</strong> - <strong>Annual</strong> <strong>Accounts</strong> <strong>2012</strong>-<strong>13</strong><br />
STATEMENT OF FINANCIAL POSITION NOTE 31 March 20<strong>13</strong> 31 March <strong>2012</strong><br />
£000 £000<br />
Non-current assets<br />
Intangible Assets 11 1,948 0<br />
Property, plant <strong>and</strong> equipment 12 114,917 115,771<br />
Investment property 14 14,816 <strong>13</strong>,124<br />
Trade <strong>and</strong> other receivables 18 1,473 1,344<br />
Total non-current assets <strong>13</strong>3,154 <strong>13</strong>0,239<br />
Current assets<br />
Inventories 17 3,042 2,916<br />
Trade <strong>and</strong> other receivables 18 <strong>13</strong>,319 14,509<br />
Cash <strong>and</strong> cash equivalents 19 3,906 1,897<br />
Total current assets 20,267 19,322<br />
Total assets 153,421 149,561<br />
Current liabilities<br />
Trade <strong>and</strong> other payables 20 (20,446) (18,348)<br />
Borrowings 21 (1,353) (1,351)<br />
Provisions 25 (165) (162)<br />
Total Current Liabilities (21,964) (19,861)<br />
Net current assets/(liabilities) (1,697) (539)<br />
Total assets less current liabilities <strong>13</strong>1,457 129,700<br />
Non-current liabilities<br />
Borrowings 21 (21,942) (21,186)<br />
Provisions 25 (1,948) (1,930)<br />
Total assets employed 107,567 106,584<br />
Financed by taxpayers' equity:<br />
Public dividend capital 60,251 57,814<br />
Revaluation reserve 23,090 23,436<br />
Retained earnings 24,226 25,334<br />
Total taxpayers' equity 107,567 106,584<br />
The financial statements on pages <strong>13</strong>1 to <strong>13</strong>4 were approved by the Board on 28th May 20<strong>13</strong> <strong>and</strong> signed on<br />
its behalf by:<br />
The financial statements on pages 1<strong>13</strong> to 116 were approved by the Board on 28th May 20<strong>13</strong> <strong>and</strong><br />
signed on its behalf by:<br />
Signed: …………………………(Chief Executive)<br />
Date: ……………………<br />
114 <strong>Annual</strong> accounts
The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation <strong>Trust</strong> - <strong>Annual</strong> <strong>Accounts</strong> <strong>2012</strong>-<strong>13</strong><br />
The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation <strong>Trust</strong> - <strong>Annual</strong> <strong>Accounts</strong> <strong>2012</strong>-<strong>13</strong><br />
STATEMENT OF CHANGES IN TAXPAYERS' EQUITY<br />
Income <strong>and</strong><br />
STATEMENT OF CHANGES IN TAXPAYERS' EQUITY<br />
Public Dividend Revaluation Income <strong>and</strong> Expenditure<br />
Public Total Dividend Capital Revaluation Reserve Expenditure Reserve<br />
Total<br />
£000<br />
£000 Capital<br />
£000<br />
£000 Reserve<br />
£000<br />
£000 Reserve<br />
£000<br />
£000<br />
Taxpayers' Equity at 1 April <strong>2012</strong> 106,584 57,814 23,436 25,334<br />
Taxpayers'<br />
Surplus/(deficit)<br />
Equity at 1 April<br />
for<br />
<strong>2012</strong><br />
the year<br />
106,584 57,814 23,436 25,334<br />
(1,858) 0 0 (1,858)<br />
Surplus/(deficit)<br />
Transfers<br />
for<br />
between<br />
the year<br />
reserves<br />
(1,858) 0 0 (1,858)<br />
0 0 (750) 750<br />
Transfers<br />
Impairments<br />
between reserves 0<br />
(16)<br />
0<br />
0<br />
(750)<br />
(16)<br />
750<br />
0<br />
Impairments<br />
Revaluations - property, plant <strong>and</strong> equipment<br />
(16)<br />
420<br />
0<br />
0<br />
(16)<br />
420<br />
0<br />
0<br />
Revaluations<br />
Public<br />
- property,<br />
Dividend<br />
plant<br />
Capital<br />
<strong>and</strong><br />
received<br />
equipment 420<br />
2,437<br />
0<br />
2,437<br />
420<br />
0<br />
0<br />
0<br />
Public Dividend<br />
Taxpayers'<br />
Capital<br />
Equity<br />
received<br />
at 31 March 20<strong>13</strong><br />
2,437<br />
107,567<br />
2,437<br />
60,251<br />
0<br />
23,090<br />
0<br />
24,226<br />
Taxpayers' Equity at 31 March 20<strong>13</strong> 107,567 60,251 23,090 24,226<br />
Taxpayers' Equity at 1 April 2011 108,569 57,014 23,262 28,293<br />
Taxpayers' Equity at 1 April 2011 108,569 57,014 23,262 28,293<br />
Surplus/(deficit) for the year (3,935) 0 0 (3,935)<br />
Surplus/(deficit) for the year<br />
Transfers between reserves (3,935) 0 0 (3,935)<br />
0 0 (976) 976<br />
Transfers between reserves<br />
Impairments 0 0 (976) 976<br />
(5,062) 0 (5,062) 0<br />
Impairments<br />
Revaluations - property, plant <strong>and</strong> equipment (5,062) 0 (5,062) 0<br />
6,212 0 6,212 0<br />
Revaluations - property, plant <strong>and</strong> equipment<br />
Public Dividend Capital received 6,212 0 6,212 0<br />
800 800 0 0<br />
Public Dividend Capital received<br />
Taxpayers' Equity at 31 March <strong>2012</strong> 800 106,584 800 57,814 0 23,436 0 25,334<br />
Taxpayers' Equity at 31 March <strong>2012</strong> 106,584 57,814 23,436 25,334<br />
<strong>Annual</strong> accounts<br />
115
The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation <strong>Trust</strong> - <strong>Annual</strong> <strong>Accounts</strong> <strong>2012</strong>-<strong>13</strong><br />
STATEMENT OF CASH FLOWS NOTE 31 March 20<strong>13</strong> 31 March <strong>2012</strong><br />
£000 £000<br />
Cash flows from operating activities<br />
Operating surplus/(deficit) 1,810 (838)<br />
Non-cash income <strong>and</strong> expense:<br />
Depreciation <strong>and</strong> amortisation 7,619 7,482<br />
Impairments 36 4,197<br />
(Gain)/Loss on disposal 441 0<br />
Receipt of Donated Assets (194) (1,281)<br />
(Increase)/Decrease in Trade <strong>and</strong> Other Receivables 1,126 (1,908)<br />
(Increase)/Decrease in Inventories (126) 78<br />
Increase/(Decrease) in Trade <strong>and</strong> Other Payables 2,159 5,116<br />
Increase/(Decrease) in Trade <strong>and</strong> Other Liabilities (63) 0<br />
Increase/(Decrease) in Provisions 21 (75)<br />
Other Movements in Cash Flow 1 0<br />
Net cash generated from/(used in) Operations 12,830 12,771<br />
Cash flows from investing activities<br />
Interest received 14 14<br />
Sales of property plant <strong>and</strong> equipment 5 0<br />
Purchase of intangible assets (20) 0<br />
Purchase of Property, Plant <strong>and</strong> Equipment (8,578) (5,425)<br />
Net cash generated from/(used in) investing activities (8,579) (5,411)<br />
Cash flows from financing activities<br />
Public dividend capital received 2,437 800<br />
Loans repaid to the Department of Health (390) (390)<br />
Capital element of finance lease rental payments (851) (721)<br />
Capital element of LIFT (257) (241)<br />
Capital Finance through Finance Leases 2,256 0<br />
Interest paid (284) (297)<br />
Late payment of Commercial Debts Interest (8) (3)<br />
Interest Element on Finance Lease (142) (128)<br />
Interest element of LIFT (1,344) (1,260)<br />
PDC Dividend paid (3,659) (3,723)<br />
Net cash generated from/(used in) financing activities (2,242) (5,963)<br />
Increase/(decrease) in cash <strong>and</strong> cash equivalents 2,009 1,397<br />
Cash <strong>and</strong> Cash equivalents at start of period 1,897 500<br />
Cash <strong>and</strong> Cash equivalents at end of period 19 3,906 1,897<br />
116 <strong>Annual</strong> accounts
Note 1 Accounting Policies<br />
1.1. Basis of Preparation<br />
Monitor, the Independent Regulator<br />
of <strong>NHS</strong> Foundation <strong>Trust</strong>s has directed<br />
that the financial statements of <strong>NHS</strong><br />
Foundation <strong>Trust</strong>s shall meet the<br />
accounting requirements of the <strong>NHS</strong><br />
Foundation <strong>Trust</strong>s <strong>Annual</strong> <strong>Report</strong>ing<br />
Manual (FT ARM), as agreed with HM<br />
Treasury. Consequently, the following<br />
financial statements have been<br />
prepared in accordance with the <strong>2012</strong>-<br />
<strong>13</strong> FT ARM. The accounting policies<br />
contained in that manual follow<br />
International Financial <strong>Report</strong>ing<br />
St<strong>and</strong>ards (IFRS) <strong>and</strong> the HM<br />
Treasury's Financial <strong>Report</strong>ing Manual<br />
(FReM) to the extent that they are<br />
meaningful <strong>and</strong> appropriate to <strong>NHS</strong><br />
Foundation <strong>Trust</strong>s. The particular<br />
policies adopted by the <strong>Trust</strong> are<br />
described below. They have been<br />
applied consistently in dealing with<br />
items considered material in relation<br />
to the accounts.<br />
1.2. Accounting judgments <strong>and</strong><br />
key sources of estimation <strong>and</strong><br />
uncertainty<br />
In the application of the <strong>Trust</strong>’s<br />
accounting policies management<br />
is required to make judgments,<br />
estimates, <strong>and</strong> assumptions about<br />
the carrying amount of assets<br />
<strong>and</strong> liabilities that are not readily<br />
apparent from other sources.<br />
The estimates <strong>and</strong> associated<br />
assumptions are based on historical<br />
experience <strong>and</strong> other factors<br />
considered of relevance. Actual results<br />
may differ from those estimates<br />
<strong>and</strong> underlying assumptions are<br />
continually reviewed. Revisions to<br />
estimates are recognised in the period<br />
in which the estimate is revised, if the<br />
revision affects only that period, or<br />
in the period of revision <strong>and</strong> future<br />
periods if the revision affects both<br />
current <strong>and</strong> future periods.<br />
The following are the areas that<br />
critical judgments have been made<br />
in the process of applying accounting<br />
policies at the end of the reporting<br />
period that have a risk of causing a<br />
material adjustment to the carrying<br />
amount of assets <strong>and</strong> liabilities within<br />
the next financial year<br />
• Going Concern<br />
• Asset valuation <strong>and</strong> lives<br />
• Impairments of receivables<br />
• Provisions<br />
• Accruals.<br />
The critical judgements are addressed<br />
in the accounting policies that follow.<br />
1.3. Going concern<br />
After making enquiries, the directors<br />
have a reasonable expectation that<br />
the Foundation <strong>Trust</strong> has adequate<br />
resources to continue in operational<br />
existence for the foreseeable future.<br />
For this reason, they continue to<br />
adopt the going concern basis in<br />
preparing these financial statements.<br />
1.4. Accounting convention<br />
These accounts have been prepared<br />
under the historical cost convention<br />
modified to account for the<br />
revaluation of property, plant<br />
<strong>and</strong> equipment, intangible assets,<br />
inventories <strong>and</strong> certain financial assets<br />
<strong>and</strong> financial liabilities.<br />
1.5. Current / non-current<br />
classification<br />
Assets <strong>and</strong> liabilities are classified as<br />
current if they are expected to be<br />
realised within twelve months from<br />
the Statement of Financial Position<br />
date, the primary purpose of the asset<br />
<strong>and</strong> liability is to be traded, or of<br />
<strong>Annual</strong> accounts<br />
117
loans <strong>and</strong> receivables where they have<br />
a maturity of less than twelve months<br />
from the Statement of Financial<br />
Position date. All other assets <strong>and</strong><br />
liabilities are classified as non-current.<br />
1.6. Consolidation<br />
The <strong>Trust</strong>’s charitable funds would<br />
be considered as a subsidiary entity<br />
in that the <strong>Hillingdon</strong> <strong>Hospital</strong>s<br />
<strong>NHS</strong> Foundation <strong>Trust</strong> are corporate<br />
trustees <strong>and</strong> as such exert control over<br />
the uses of these funds. The <strong>Trust</strong> also<br />
governs the financial <strong>and</strong> operational<br />
policies as homogeneous with those<br />
of the main body. However HM<br />
Treasury has granted a dispensation<br />
from applying IAS 27 for <strong>2012</strong>/<strong>13</strong>.<br />
1.7. Income recognition<br />
Income in respect of services provided<br />
is recognised when, <strong>and</strong> to the extent<br />
that, performance occurs, <strong>and</strong> is<br />
measured at the fair value of the<br />
consideration receivable. The main<br />
source of revenue for the <strong>Trust</strong> is from<br />
<strong>NHS</strong> commissioners for healthcare<br />
services.<br />
Where income is received for a<br />
specific activity that is to be delivered<br />
in the following year, that income is<br />
deferred.<br />
Income from the sales of non-current<br />
assets is recognised only when all<br />
material conditions of sale have been<br />
met, <strong>and</strong> is measured as the sums due<br />
under the sale contract.<br />
1.8. Partially Completed Spells<br />
The Partial Spells accrual relates to<br />
patients who remain undischarged at<br />
31/03/20<strong>13</strong> in relation to income. The<br />
<strong>Trust</strong> reflect income at the point of<br />
discharge in line with the matching<br />
concept. The <strong>Trust</strong> have accrued<br />
income on a per patient basis to<br />
31/03/20<strong>13</strong> based on average tariff<br />
rates for the speciality. Ordinarily<br />
this activity is coded once the patient<br />
has been discharged <strong>and</strong> generated<br />
a Health Resource Grouper code to<br />
which National Tariff rates are applied<br />
to calculate the income. Hence an<br />
average tariff is applied based on<br />
point of delivery <strong>and</strong> length of stay by<br />
speciality.<br />
1.9. Expenditure on employee<br />
benefits<br />
Short-term employee benefits<br />
Salaries, wages <strong>and</strong> employmentrelated<br />
payments are recognised in<br />
the period in which the service is<br />
received from employees.<br />
1.10. Pension costs<br />
Past <strong>and</strong> present employees are<br />
covered by the provisions of the <strong>NHS</strong><br />
Pensions Scheme. The scheme is an<br />
unfunded, defined benefit scheme<br />
that covers <strong>NHS</strong> employers, General<br />
Practices <strong>and</strong> other bodies, allowed<br />
under the direction of the Secretary<br />
of State, in Engl<strong>and</strong> <strong>and</strong> Wales. The<br />
scheme is not designed to be run in<br />
a way that would enable the <strong>NHS</strong><br />
Foundation <strong>Trust</strong> to identify its share<br />
of the underlying scheme assets <strong>and</strong><br />
liabilities. Therefore, the scheme is<br />
accounted for as if it were a defined<br />
contribution scheme: the cost to<br />
the <strong>NHS</strong> body of participating in<br />
the scheme is taken as equal to the<br />
contributions payable to the scheme<br />
for the accounting period.<br />
For early retirements other than<br />
those due to ill health the additional<br />
pension liabilities are not funded<br />
by the scheme. The full amount of<br />
the liability for the additional costs<br />
is charged to expenditure at the<br />
time the <strong>Trust</strong> commits itself to the<br />
retirement, regardless of the method<br />
of payment.<br />
118 <strong>Annual</strong> accounts
Further details of <strong>NHS</strong> Pensions<br />
payable under these provisions<br />
can be found on the <strong>NHS</strong> Pensions<br />
website at www.nhsba.nhs.uk/<br />
pensions.<br />
1.11. Other expenses<br />
Other operating expenses are<br />
recognised when, <strong>and</strong> to the extent<br />
that, the goods or services have<br />
been received. They are measured at<br />
the fair value of the consideration<br />
payable. Expenditure is recognised<br />
in operating expenses except where<br />
it results in the creation of a non<br />
current asset such as property, plant<br />
<strong>and</strong> equipment.<br />
1.12. <strong>NHS</strong> pension scheme<br />
The scheme is subject to a full<br />
actuarial valuation every four years<br />
(until 2004, every five years) <strong>and</strong> an<br />
accounting valuation every year. An<br />
outline of these follows:<br />
a. Full actuarial (funding) valuation<br />
The purpose of this valuation<br />
is to assess the level of liability<br />
in respect of the benefits due<br />
under the scheme (taking into<br />
account its recent demographic<br />
experience), <strong>and</strong> to recommend<br />
the contribution rates to be<br />
paid by employers <strong>and</strong> scheme<br />
members.<br />
The scheme is subject to full<br />
actuarial valuations. The last such<br />
valuation, which determined<br />
current contribution rates was<br />
undertaken as at 31 March 2004<br />
<strong>and</strong> covered the period from 1<br />
April 1999 to that date.<br />
The conclusion from the 2004<br />
valuation was that the scheme<br />
had accumulated a notional<br />
deficit of £3.3 billion against<br />
the notional assets as at 31<br />
March 2004. In order to defray<br />
the costs of benefits, employers<br />
pay contributions at 14% of<br />
pensionable pay <strong>and</strong> most<br />
employees had up to April 2008<br />
paid 6%, with manual staff<br />
paying 5%.<br />
Following the full actuarial review<br />
by the Government Actuary<br />
undertaken as at 31 March<br />
2004, <strong>and</strong> after consideration<br />
of changes to the <strong>NHS</strong> Pension<br />
Scheme taking effect from 1<br />
April 2008, his Valuation report<br />
recommended that employer<br />
contributions could continue<br />
at the existing rate of 14% of<br />
pensionable pay, from 1 April<br />
2008, following the introduction<br />
of employee contributions on<br />
a tiered scale from 5% up to<br />
8.5% of their pensionable pay<br />
depending on total earnings.<br />
On advice from the scheme<br />
actuary, scheme contributions<br />
may be varied from time to time<br />
to reflect changes in the scheme’s<br />
liabilities.<br />
b. Accounting valuation<br />
A valuation of the scheme liability<br />
is carried out annually by the<br />
scheme actuary as at the end of<br />
the reporting period by updating<br />
the results of the full actuarial<br />
valuation.<br />
Between the full actuarial<br />
valuations at a two-year<br />
midpoint, a full <strong>and</strong> detailed<br />
member data-set is provided<br />
to the scheme actuary. At this<br />
point the assumptions regarding<br />
the composition of the scheme<br />
membership are updated to allow<br />
the scheme liability to be valued.<br />
The valuation of the scheme<br />
liability as at 31 March 20<strong>13</strong>, is<br />
<strong>Annual</strong> accounts<br />
119
ased on detailed membership<br />
data as at 31 March 2008 (the<br />
latest midpoint) updated to 31<br />
March 20<strong>13</strong> with summary global<br />
member <strong>and</strong> accounting data.<br />
The latest assessment of the<br />
liabilities of the scheme is<br />
contained in the scheme actuary<br />
report, which forms part of the<br />
annual <strong>NHS</strong> Pension Scheme<br />
(Engl<strong>and</strong> <strong>and</strong> Wales) Resource<br />
Account, published annually.<br />
These accounts can be viewed on<br />
the <strong>NHS</strong> Pensions website. Copies<br />
can also be obtained from The<br />
Stationery Office.<br />
c. Scheme provisions<br />
The <strong>NHS</strong> Pension Scheme provided<br />
defined benefits, which are<br />
summarised below. This list is an<br />
illustrative guide only, <strong>and</strong> is not<br />
intended to detail all the benefits<br />
provided by the Scheme or the<br />
specific conditions that must be<br />
met before these benefits can be<br />
obtained:<br />
The Scheme is a “final salary”<br />
scheme. <strong>Annual</strong> pensions are<br />
normally based on 1/80th for the<br />
1995 section <strong>and</strong> of the best of<br />
the last three years pensionable<br />
pay for each year of service,<br />
<strong>and</strong> 1/60th for the 2008 section<br />
of reckonable pay per year of<br />
membership.<br />
Members who are practitioners<br />
as defined by the Scheme<br />
Regulations have their annual<br />
pensions based upon total<br />
pensionable earnings over the<br />
relevant pensionable service.<br />
With effect from 1 April 2008<br />
members can choose to give up<br />
some of their annual pension<br />
for an additional tax free lump<br />
sum, up to a maximum amount<br />
permitted under HMRC rules.<br />
This new provision is known as<br />
“pension commutation”.<br />
<strong>Annual</strong> increases are applied to<br />
pension payments at rates defined<br />
by the Pensions (Increase) Act<br />
1971, <strong>and</strong> are based on changes in<br />
retail prices in the twelve months<br />
ending 30 September in the<br />
previous calendar year.<br />
Early payment of a pension,<br />
with enhancement, is available<br />
to members of the scheme who<br />
are permanently incapable of<br />
fulfilling their duties effectively<br />
through illness or infirmity. A<br />
death gratuity of twice final<br />
year’s pensionable pay for death<br />
in service, <strong>and</strong> five times their<br />
annual pension for death after<br />
retirement is payable.<br />
For early retirements other<br />
than those due to ill health the<br />
additional pension liabilities are<br />
not funded by the scheme. The<br />
full amount of the liability for<br />
the additional costs is charged to<br />
the statement of comprehensive<br />
income at the time the <strong>Trust</strong><br />
commits itself to the retirement,<br />
regardless of the method of<br />
payment. These costs exclude<br />
voluntary early retirement, as<br />
these costs are borne by the<br />
employee.<br />
Members can purchase additional<br />
service in the <strong>NHS</strong> Scheme <strong>and</strong><br />
contribute to money purchase<br />
AVC’s run by the Scheme’s<br />
approved providers or by<br />
other Free St<strong>and</strong>ing Additional<br />
Voluntary Contributions (FSAVC)<br />
providers.<br />
120 <strong>Annual</strong> accounts
1.<strong>13</strong> Property, plant <strong>and</strong> equipment<br />
recognition<br />
Property, plant <strong>and</strong> equipment is<br />
capitalised if:<br />
• it is held for use in delivering services<br />
or for administrative purposes;<br />
• it is probable that future economic<br />
benefits will flow to, or service<br />
potential will be supplied to, the<br />
<strong>Trust</strong>;<br />
• the cost of the item can be<br />
measured reliably; <strong>and</strong><br />
• the item has cost of at least £5,000;<br />
or<br />
• collectively, a number of items<br />
have a cost of at least £5,000 <strong>and</strong><br />
individually have a cost of more<br />
than £250, where the assets are<br />
functionally interdependent, they<br />
had broadly simultaneous purchase<br />
dates, are anticipated to have<br />
simultaneous disposal dates <strong>and</strong> are<br />
under single managerial control; or<br />
• items form part of the initial<br />
equipping <strong>and</strong> setting-up cost<br />
of a new building, ward or unit,<br />
irrespective of their individual or<br />
collective cost.<br />
The <strong>Trust</strong> is permitted to borrow funds<br />
to the extent that it complies with the<br />
Prudential Borrowing Code for <strong>NHS</strong><br />
Foundation <strong>Trust</strong>s. The capital sum is<br />
recognised as a liability <strong>and</strong> interest<br />
incurred is charged to finance expenses<br />
in the Statement of Comprehensive<br />
Income. Total borrowings of the<br />
<strong>Trust</strong> <strong>and</strong> performance against the<br />
Prudential Borrowing Limit is disclosed<br />
in note 29.<br />
Componentisation<br />
Where a large asset, for example<br />
a building, includes a number of<br />
components with significantly different<br />
asset lives e.g. plant <strong>and</strong> equipment,<br />
then these components are treated as<br />
separate assets <strong>and</strong> depreciated over<br />
their own useful economic lives.<br />
Valuation<br />
All property, plant <strong>and</strong> equipment are<br />
measured initially at cost, representing<br />
the cost directly attributable to<br />
acquiring or constructing the asset<br />
<strong>and</strong> bringing it to the location <strong>and</strong><br />
condition necessary for it to be capable<br />
of operating in the manner intended<br />
by management. All assets are<br />
measured subsequently at fair value.<br />
L<strong>and</strong> <strong>and</strong> buildings used for the<br />
<strong>Trust</strong>’s services or for administrative<br />
purposes are stated in the Statement<br />
of Financial Position at their revalued<br />
amounts, being the fair value at the<br />
date of revaluation less any subsequent<br />
accumulated depreciation <strong>and</strong><br />
impairment losses. Revaluations are<br />
performed with sufficient regularity to<br />
ensure that carrying amounts are not<br />
materially different from those that<br />
would be determined at the end of<br />
the reporting period. Fair values are<br />
determined as follows:<br />
• L<strong>and</strong> <strong>and</strong> non-specialised buildings –<br />
market value for existing use<br />
• Investment Properties - market value<br />
<strong>and</strong> or net rental income stream<br />
• Specialised buildings – depreciated<br />
replacement cost.<br />
HM Treasury has adopted a st<strong>and</strong>ard<br />
approach to depreciated replacement<br />
cost valuations based on modern<br />
equivalent assets <strong>and</strong>, where it would<br />
meet the location requirements of the<br />
service being provided, an alternative<br />
site can be valued.<br />
Properties in the course of construction<br />
for service or administration purposes<br />
are carried at cost, less any impairment<br />
loss. Cost includes professional fees<br />
but not borrowing costs, which are<br />
recognised as expenses immediately, as<br />
allowed by IAS 23 for assets held at fair<br />
<strong>Annual</strong> accounts<br />
121
value. Assets depreciation commences<br />
when they are brought into use.<br />
A full revaluation exercise took place in<br />
the 20011/12 financial year. In line with<br />
Treasury guidance, where appropriate<br />
the revaluation was based on a<br />
Modern Equivalent Assets replacement<br />
basis. The valuation was carried out in<br />
accordance with the Royal Institute of<br />
Chartered Surveyors (RICS) Appraisal<br />
<strong>and</strong> Valuation Manual insofar as these<br />
terms are consistent with the agreed<br />
requirements of the Department of<br />
Health <strong>and</strong> HM Treasury. The Surveyors<br />
were Gerald Eve.<br />
The <strong>Trust</strong> carries out a full revaluation<br />
exercise at least every five years<br />
unless the <strong>Trust</strong> considers there has<br />
been significant market movement In<br />
the intervening years. The <strong>Trust</strong> has<br />
taken advice from Gerald Eve who<br />
have advised that there have been no<br />
significant market movements relating<br />
to the <strong>Trust</strong>'s l<strong>and</strong> <strong>and</strong> buildings for<br />
<strong>2012</strong>/<strong>13</strong> financial year.<br />
New fixtures <strong>and</strong> equipment are<br />
carried at depreciated historic cost as<br />
this is not considered to be materially<br />
different from fair value.<br />
Subsequent expenditure<br />
Subsequent expenditure relating to an<br />
item of property, plant <strong>and</strong> equipment<br />
is recognised as an increase in the<br />
carrying amount of the asset when<br />
it is probable that additional future<br />
economic benefits or service potential<br />
deriving from the cost incurred to<br />
replace a component of such item will<br />
flow to the enterprise <strong>and</strong> the cost of<br />
the item can be determined reliably.<br />
Where a component of an asset is<br />
replaced, the cost of the replacement<br />
is capitalised if it meets the criteria<br />
for recognition above. The carrying<br />
amount of the part replaced is<br />
de-recognised. Other expenditure that<br />
does not generate additional future<br />
economic benefits or service potential,<br />
such as repairs <strong>and</strong> maintenance,<br />
is charged to the Statement of<br />
Comprehensive Income in the period in<br />
which it is incurred.<br />
Depreciation, amortisation <strong>and</strong><br />
impairments<br />
Freehold l<strong>and</strong>, properties under<br />
construction, <strong>and</strong> assets held for<br />
sale are not depreciated. Otherwise,<br />
depreciation <strong>and</strong> amortisation are<br />
charged to write off the costs or<br />
valuation of property, plant <strong>and</strong><br />
equipment <strong>and</strong> intangible noncurrent<br />
assets, less any residual<br />
value, over their estimated useful<br />
lives, in a manner that reflects the<br />
consumption of economic benefits<br />
or service potential of the assets.<br />
The estimated useful life of an asset<br />
is the period over which the <strong>Trust</strong><br />
expects to obtain economic benefits<br />
or service potential from the asset.<br />
This is specific to the <strong>Trust</strong> <strong>and</strong> may be<br />
shorter than the physical life of the<br />
asset itself. Estimated useful lives <strong>and</strong><br />
residual values are reviewed each year<br />
end, with the effect of any changes<br />
recognised on a prospective basis.<br />
Assets held under finance leases are<br />
depreciated over the lease period.<br />
In accordance with the Foundation<br />
<strong>Trust</strong> <strong>Annual</strong> <strong>Report</strong>ing Manual (FT<br />
ARM), impairments that are due to a<br />
loss of economic benefits or service<br />
potential in the asset are charged to<br />
operating expenses. A compensating<br />
transfer is made from the revaluation<br />
reserve to the income <strong>and</strong> expenditure<br />
reserve of an amount equal to the<br />
lower of (i) the impairment charged<br />
to operating expenses; <strong>and</strong> (ii) the<br />
balance in the revaluation reserve<br />
attributable to that asset before the<br />
impairment.<br />
122 <strong>Annual</strong> accounts
Other impairments are treated as<br />
revaluation losses. Reversals of other<br />
impairments are treated as revaluation<br />
gains.<br />
An impairment arising from a loss of<br />
economic benefit or service potential<br />
is reversed when, <strong>and</strong> to the extent<br />
that, the circumstances that gave rise<br />
to the loss is reversed. Reversals are<br />
recognised in operating income to<br />
the extent that the asset is restored<br />
to the carrying amount it would have<br />
had if the impairment had never been<br />
recognised. Any remaining reversal is<br />
recognised in the revaluation reserve.<br />
Where, at the time of the original<br />
impairment, a transfer was made from<br />
the revaluation reserve to the income<br />
<strong>and</strong> expenditure reserve, an amount<br />
is transferred back to the revaluation<br />
reserve when the impairment reversal<br />
is recognised.<br />
Revaluation gains, losses <strong>and</strong><br />
de-recognition<br />
Revaluation gains are recognised<br />
in the revaluation reserve, except<br />
where, <strong>and</strong> to the extent that, they<br />
reverse a revaluation decrease that<br />
has previously been recognised in<br />
operating expenses, in which case they<br />
are recognised in operating income.<br />
Revaluation losses are charged to the<br />
revaluation reserve to the extent that<br />
there is an available balance for the<br />
asset concerned, <strong>and</strong> thereafter are<br />
charged to operating expenses.<br />
Gains <strong>and</strong> losses recognised in the<br />
revaluation reserve are reported in the<br />
Statement of Comprehensive Income<br />
as an item of ‘other comprehensive<br />
income’.<br />
De-recognition<br />
Assets intended for disposal are<br />
reclassified as ‘Held for Sale’ once all<br />
of the following criteria are met: 1) the<br />
asset is available for immediate sale<br />
in its present condition subject only to<br />
terms which are usual <strong>and</strong> customary<br />
for such sales; 2) the sale must be<br />
highly probable i.e. management are<br />
committed to a plan to sell the asset;<br />
or an active programme has begun to<br />
find a buyer <strong>and</strong> complete the sale; 3)<br />
the asset is being actively marketed<br />
at a reasonable price; 4) the sale is<br />
expected to be completed within 12<br />
months of the date of classification as<br />
‘Held for Sale’; <strong>and</strong> the actions needed<br />
to complete the plan indicate it is<br />
unlikely that the plan will be dropped<br />
or significant changes made to it.<br />
Following reclassification, the assets<br />
are measured at the lower of their<br />
existing carrying amount <strong>and</strong> their ‘fair<br />
value less costs to sell’. Depreciation<br />
ceases to be charged. Assets are derecognised<br />
when all material sale<br />
contract conditions have been met.<br />
Property, plant <strong>and</strong> equipment which<br />
is to be scrapped or demolished does<br />
not qualify for recognition as ‘Held<br />
for Sale’ <strong>and</strong> instead is retained as<br />
an operational asset <strong>and</strong> the asset’s<br />
economic life is adjusted. The asset<br />
is de-recognised when scrapping or<br />
demolition occurs.<br />
1.14. Investment property<br />
Investment property is property<br />
held to earn rentals or for capital<br />
appreciation or both. A key factor<br />
in determining classification would<br />
be whether property was saleable<br />
separately. In considering whether<br />
l<strong>and</strong> meets this criteria the <strong>Trust</strong> would<br />
consider whether property had direct<br />
public access.<br />
<strong>Annual</strong> accounts<br />
123
Investment property is accounted for<br />
under the fair value model. A gain<br />
or loss arising from a change in the<br />
fair value of investment property is<br />
recognised in profit or loss for the<br />
period in which it arises.<br />
1.15. Donated assets<br />
Donated property, plant <strong>and</strong><br />
equipment assets are capitalised<br />
at their fair value on receipt. The<br />
donation is credited to income at<br />
the same time, unless the donor has<br />
imposed a condition that the future<br />
economic benefits embodied in the<br />
donation are to be consumed in a<br />
manner specified by the donor, in<br />
which case, the donation is deferred<br />
within liabilities <strong>and</strong> is carried forward<br />
to future financial years to the extent<br />
that the condition has not yet been<br />
met.<br />
The donated assets are subsequently<br />
accounted for in the same manner<br />
as other items of property, plant <strong>and</strong><br />
equipment.<br />
1.16. Intangible assets<br />
Recognition<br />
Intangible assets are non-monetary<br />
assets without physical substance which<br />
are capable of being sold separately<br />
from the rest of the <strong>Trust</strong>s business<br />
or which arise from contractual or<br />
other legal rights. They are recognised<br />
only where it is probable that future<br />
economic benefits will flow to, or<br />
service potential be provided to, the<br />
Foundation <strong>Trust</strong> <strong>and</strong> where the cost of<br />
the asset can be measured reliably.<br />
• The project is technically feasible<br />
to the point of completion <strong>and</strong> will<br />
result in an intangible asset for sale<br />
or use;<br />
• The Foundation <strong>Trust</strong> (FT) intends to<br />
complete the asset <strong>and</strong> sell or use it;<br />
• The FT has the ability to sell or use<br />
the asset;<br />
• How the asset will generate<br />
probable future economic benefits<br />
e.g. the presence of a market for its<br />
output or where it is to be used for<br />
internal use, the usefulness of the<br />
asset;<br />
• Adequate financial, technical, <strong>and</strong><br />
other resources are available to the<br />
FT to complete the development<br />
<strong>and</strong> sell or use the asset during<br />
development.<br />
Internally generated intangible<br />
assets<br />
Internally generated goodwill,<br />
br<strong>and</strong>s, mastheads, publishing titles,<br />
customer lists, <strong>and</strong> similar items are not<br />
capitalised as intangible assets, neither<br />
is expenditure on research.<br />
Impairments<br />
Assets that are subject to amortisation<br />
are reviewed for impairment whenever<br />
events or changes in circumstances<br />
indicate that the carrying amount may<br />
not be recoverable. Any impairment<br />
loss is recognised in the Statement of<br />
Comprehensive Income to reduce the<br />
carrying amount to the recoverable<br />
amount.<br />
Expenditure on research is not<br />
capitalised.<br />
The <strong>Trust</strong> is permitted to borrow funds<br />
to the extent that it complies with the<br />
Prudential Borrowing Code for <strong>NHS</strong><br />
Foundation <strong>Trust</strong>s. The capital sum is<br />
recognised as a liability <strong>and</strong> interest<br />
incurred is charged to finance expenses<br />
in the Statement of Comprehensive<br />
Income. Total borrowings of the<br />
<strong>Trust</strong> <strong>and</strong> performance against the<br />
Prudential Borrowing Limit is disclosed<br />
in note.<br />
124 <strong>Annual</strong> accounts
Software<br />
Software which is integral to the<br />
operation of hardware e.g. an<br />
operating system, is capitalised as part<br />
of the relevant item of property, plant<br />
<strong>and</strong> equipment. Software which is not<br />
integral to the operation of hardware<br />
e.g. application software is capitalised<br />
as an intangible asset.<br />
Measurement<br />
Intangible assets are recognised<br />
initially at cost, comprising of all<br />
directly attributable costs needed<br />
to create, produce <strong>and</strong> prepare the<br />
asset to the point that it is capable of<br />
operating in the manner intended by<br />
management. Subsequently intangible<br />
assets are measured at fair value.<br />
Revaluation gains <strong>and</strong> losses <strong>and</strong><br />
impairments are treated in the same<br />
manner as for property, plant <strong>and</strong><br />
equipment. comprising of all directly<br />
attributable costs needed to create,<br />
produce <strong>and</strong> prepare the asset to the<br />
point that it is capable of operating in<br />
the manner intended by management.<br />
Subsequently intangible assets are<br />
measured at fair value. Revaluation<br />
gains <strong>and</strong> losses <strong>and</strong> impairments<br />
are treated in the same manner as<br />
for property, plant <strong>and</strong> equipment.<br />
Intangible assets held for sale are<br />
measured at the lower of their carrying<br />
amount or ‘fair value less costs to sell.<br />
Amortisation<br />
Intangible assets are amortised over<br />
their expected useful economic lives<br />
in a manner consistent with the<br />
consumption of economic or service<br />
delivery benefits.<br />
• Development expenditure up to 5<br />
years<br />
• Software up to 5 years.<br />
1.17. Leases<br />
The <strong>Trust</strong> as lessee<br />
Finance leases<br />
Where substantially all risks <strong>and</strong><br />
rewards of ownership of a leased asset<br />
are borne by the <strong>NHS</strong> Foundation <strong>Trust</strong>,<br />
the asset is recorded as property, plant<br />
<strong>and</strong> equipment <strong>and</strong> a corresponding<br />
liability is recorded. The value at which<br />
both are recognised is the lower of the<br />
fair value of the asset or the present<br />
value of the minimum lease payments,<br />
discounted using the interest rate<br />
implicit in the lease. The implicit<br />
interest rate is that which produces a<br />
constant periodic rate of interest on<br />
the outst<strong>and</strong>ing liability.<br />
The asset <strong>and</strong> liability are recognised<br />
at the commencement of the lease.<br />
Thereafter, the asset is accounted<br />
for as an item of property plant <strong>and</strong><br />
equipment.<br />
The annual rental is split between the<br />
repayment of the liability <strong>and</strong> a finance<br />
cost so as to achieve a constant rate<br />
of finance over the life of the lease.<br />
The annual finance cost is charged<br />
to finance costs in the Statement of<br />
Comprehensive Income. The lease<br />
liability, is de-recognised when the<br />
liability is discharged, cancelled or<br />
expires.<br />
Operating leases<br />
Other leases are regarded as operating<br />
leases <strong>and</strong> the rentals are charged<br />
to operating expenses on a straightline<br />
basis over the term of the lease.<br />
Operating lease incentives received are<br />
added to the lease rentals <strong>and</strong> charged<br />
to operating expenses over the life of<br />
the lease.<br />
Leases of l<strong>and</strong> <strong>and</strong> buildings<br />
Where a lease is for l<strong>and</strong> <strong>and</strong> buildings,<br />
the l<strong>and</strong> component is separated<br />
from the building component <strong>and</strong><br />
<strong>Annual</strong> accounts<br />
125
the classification for each is assessed<br />
separately.<br />
The <strong>Trust</strong> as Lessor<br />
Rental income from operating leases is<br />
recognised on a straight-line basis over<br />
the term of the lease. Initial direct costs<br />
incurred in negotiating <strong>and</strong> arranging<br />
an operating lease are added to the<br />
carrying amount of the leased asset<br />
<strong>and</strong> recognised on a straight-line basis<br />
over the lease term.<br />
1.18. Local Improvement Finance<br />
<strong>Trust</strong> (LIFT) transactions<br />
HM Treasury has determined that<br />
government bodies shall account for<br />
infrastructure LIFT schemes where the<br />
government body controls the use of<br />
the infrastructure <strong>and</strong> the residual<br />
interest in the infrastructure at the<br />
end of the arrangement as service<br />
concession arrangements, following<br />
the principles of the requirements of<br />
IFRIC 12. The <strong>Trust</strong> therefore recognises<br />
the LIFT asset as an item of property,<br />
plant <strong>and</strong> equipment together with<br />
a liability to pay for it. The services<br />
received under the contract are<br />
recorded as operating expenses.<br />
The annual lease plus payment<br />
is separated into the following<br />
component parts, using appropriate<br />
estimation techniques where necessary:<br />
a. Payment for the fair value of<br />
services received;<br />
b. Payment for the LIFT asset, including<br />
finance costs;<br />
The <strong>Trust</strong> is currently party to a 25-year<br />
LIFT lease plus contract.<br />
Services received<br />
The fair value of services received<br />
in the year is recorded under the<br />
relevant expenditure headings within<br />
‘operating expenses’.<br />
LIFT Asset<br />
The LIFT assets are recognised as<br />
property, plant <strong>and</strong> equipment,<br />
when they come into use. The assets<br />
are measured initially at fair value<br />
in accordance with the principles of<br />
IAS 17. Subsequently, the assets are<br />
measured at fair value, which is kept<br />
up to date in accordance with the<br />
<strong>Trust</strong>’s approach for each relevant<br />
class of asset in accordance with the<br />
principles of IAS 16.<br />
LIFT liability<br />
A LIFT liability is recognised at the<br />
same time as the LIFT assets are<br />
recognised. It is measured initially at<br />
the same amount as the fair value of<br />
the LIFT assets <strong>and</strong> is subsequently<br />
measured as a finance lease liability in<br />
accordance with IAS 17.<br />
An annual finance cost is calculated by<br />
applying the implicit interest rate in<br />
the lease to the opening lease liability<br />
for the period, <strong>and</strong> is charged to<br />
‘Finance Costs’ within the Statement of<br />
Comprehensive Income.<br />
The element of the lease plus payment<br />
that is allocated as a finance lease<br />
rental is applied to meet the annual<br />
finance cost <strong>and</strong> to repay the lease<br />
liability over the contract term.<br />
An element of the lease plus payment<br />
increase due to cumulative indexation<br />
is allocated to the finance lease. In<br />
accordance with IAS 17, this amount<br />
is not included in the minimum lease<br />
payments, but is instead treated as<br />
contingent rent <strong>and</strong> is expensed as<br />
incurred. In substance, this amount<br />
is a finance cost in respect of the<br />
liability <strong>and</strong> the expense is presented<br />
as a contingent finance cost in the<br />
Statement of Comprehensive Income.<br />
126 <strong>Annual</strong> accounts
1.19. Inventories<br />
Inventories are valued on a FIFO basis<br />
(First In First Out).<br />
1.20. Cash <strong>and</strong> cash equivalents<br />
Cash is cash in h<strong>and</strong> <strong>and</strong> deposits with<br />
any financial institution repayable<br />
without penalty on notice of not more<br />
than 24 hours. Cash equivalents are<br />
investments that mature in 3 months<br />
or less from the date of acquisition <strong>and</strong><br />
that are readily convertible to known<br />
amounts of cash with insignificant risk<br />
of change in value.<br />
In the Statement of Cash Flows, cash<br />
<strong>and</strong> cash equivalents are shown net of<br />
bank overdrafts that are repayable on<br />
dem<strong>and</strong> <strong>and</strong> that form an integral part<br />
of the <strong>Trust</strong>’s cash management.<br />
1.21. Provisions<br />
The amount recognised as a provision<br />
is the best estimate of the expenditure<br />
required to settle the obligation<br />
at the end of the reporting period,<br />
taking into account the risks <strong>and</strong><br />
uncertainties. Injury Benefits <strong>and</strong><br />
Early Retirement: Where a provision<br />
is measured using the cash flows<br />
estimated to settle the obligation, its<br />
carrying amount is the present value of<br />
those cash flows using HM Treasury’s<br />
discount rates.<br />
From <strong>2012</strong>/<strong>13</strong> The Treasury publishes<br />
three discount rates that are to be<br />
employed. These are short term less<br />
than 5 years. Medium term 5 to 10<br />
years <strong>and</strong> long term over 10 years.<br />
Where cash flows are expected to fall<br />
into into more than one on these time<br />
frames, then multiple discount rates<br />
will need to be used when calculating<br />
the carrying value of the provision.<br />
In discussion with the <strong>Trust</strong> Auditors,<br />
it has been agreed that the <strong>Trust</strong> will<br />
continue using its long term rate of<br />
3% as there is no material effect in<br />
changing the rate used.<br />
The period over which future cash<br />
flows will be paid is estimated using<br />
the Engl<strong>and</strong> life expense tables as<br />
published by the Office of National<br />
Statistics.<br />
1.22. Clinical negligence costs<br />
The <strong>NHS</strong> Litigation Authority (<strong>NHS</strong>LA)<br />
operates a risk pooling scheme under<br />
which the <strong>Trust</strong> pays an annual<br />
contribution to the <strong>NHS</strong>LA which in<br />
return settles all clinical negligence<br />
claims. The contribution is charged<br />
to expenditure. Although the <strong>NHS</strong>LA<br />
is administratively responsible for<br />
all clinical negligence cases the legal<br />
liability remains with the <strong>Trust</strong>.<br />
1.23. Non-clinical risk pooling<br />
The <strong>Trust</strong> participates in the Property<br />
Expenses Scheme <strong>and</strong> the Liabilities<br />
to Third Parties Scheme. Both are risk<br />
pooling schemes under which the <strong>Trust</strong><br />
pays an annual contribution to the <strong>NHS</strong><br />
Litigation Authority <strong>and</strong>, in return,<br />
receives assistance with the costs of<br />
claims arising. The annual membership<br />
contributions, <strong>and</strong> any excesses<br />
payable in respect of particular claims<br />
are charged to operating expenses as<br />
<strong>and</strong> when they become due.<br />
1.24. Contingencies<br />
A contingent liability is a possible<br />
obligation that arises from past<br />
events <strong>and</strong> whose existence will be<br />
confirmed only by the occurrence<br />
or non-occurrence of one or more<br />
uncertain future events not wholly<br />
within the control of the <strong>Trust</strong>, or<br />
a present obligation that is not<br />
recognised because it is not probable<br />
that a payment will be required to<br />
settle the obligation or the amount<br />
of the obligation cannot be measured<br />
sufficiently reliably. A contingent<br />
liability is not recognised but is<br />
<strong>Annual</strong> accounts<br />
127
disclosed unless the possibility of a<br />
payment is remote.<br />
A contingent asset is a possible asset<br />
that arises from past events <strong>and</strong> whose<br />
existence will be confirmed by the<br />
occurrence or non-occurrence of one<br />
or more uncertain future events not<br />
wholly within the control of the <strong>Trust</strong>.<br />
A contingent asset is not recognised<br />
but is disclosed where an inflow of<br />
economic benefits is probable.<br />
Where the time value of money is<br />
material, contingencies are disclosed at<br />
their present value.<br />
1.25. Public Dividend Capital (PDC)<br />
<strong>and</strong> PDC dividend<br />
Public dividend capital (PDC) is a type<br />
of public sector equity finance based<br />
on the excess of assets over liabilities<br />
at the time of establishment of the<br />
predecessor <strong>NHS</strong> <strong>Trust</strong>. HM Treasury has<br />
determined that PDC is not a financial<br />
instrument within the meaning of IAS<br />
32.<br />
A charge, reflecting the cost of capital<br />
utilised by the <strong>NHS</strong> Foundation <strong>Trust</strong>,<br />
is payable as public dividend capital<br />
dividend. The charge is calculated at<br />
the rate set by HM Treasury (currently<br />
3.5%) on the average relevant net<br />
assets of the <strong>NHS</strong> Foundation <strong>Trust</strong><br />
during the financial year. Relevant net<br />
assets are calculated as the value of all<br />
assets less the value of all liabilities,<br />
except for (i) donated assets (including<br />
lottery funded assets), (ii) net cash<br />
balances held with the Government<br />
Banking Services (GBS), excluding cash<br />
balances held in GBS accounts that<br />
relate to a short-term working capital<br />
facility, <strong>and</strong> (iii) any PDC dividend<br />
balance receivable or payable. In<br />
accordance with the requirements laid<br />
down by the Department of Health<br />
(as the issuer of PDC), the dividend for<br />
the year is calculated on the actual<br />
average relevant net assets as set out<br />
in the ‘pre-audit’ version of the annual<br />
accounts. The dividend thus calculated<br />
is not revised should any adjustment to<br />
net assets occur as a result of the audit<br />
of the annual accounts.<br />
1.26. Value Added Tax<br />
Most of the activities of the <strong>Trust</strong><br />
are outside the scope of VAT <strong>and</strong>, in<br />
general, output tax does not apply<br />
<strong>and</strong> input tax on purchases is not<br />
recoverable. Irrecoverable VAT is<br />
charged to the relevant expenditure<br />
category or included in the capitalised<br />
purchase cost of fixed assets. Where<br />
output tax is charged or input VAT is<br />
recoverable, the amounts are stated<br />
net of VAT.<br />
The <strong>Trust</strong> makes both taxable <strong>and</strong><br />
exempt supplies <strong>and</strong> incurs input tax<br />
that relates to both kinds of supply.<br />
The <strong>Trust</strong> is therefore classified<br />
as 'partly exempt'. Partly exempt<br />
businesses must undertake calculations<br />
which work out how much input tax<br />
they may recover. The percentage<br />
relating to partially exempt supplies<br />
is currently 1.25% which reduces the<br />
<strong>Trust</strong>'s VAT recovery. This percentage is<br />
reviewed annually.<br />
1.27. Corporation tax<br />
The <strong>Trust</strong> is a Health Service body<br />
within the meaning of s519A ICTA 1988<br />
<strong>and</strong> accordingly in relation to specified<br />
activities of a Foundation <strong>Trust</strong> (s519A<br />
(3) to (8) ICTA 1988).<br />
None of the <strong>Trust</strong>'s activities in the<br />
period are subject to a corporation tax<br />
liability.<br />
1.28. Third party assets<br />
Assets belonging to third parties (such<br />
as money held on behalf of patients)<br />
are not recognised in the accounts<br />
since the <strong>Trust</strong> has no beneficial<br />
interest in them.<br />
128 <strong>Annual</strong> accounts
1.29. Losses <strong>and</strong> special payments<br />
Losses <strong>and</strong> special payments are<br />
items that Parliament would not<br />
have contemplated when it agreed<br />
funds for the health service or passed<br />
legislation. By their nature they are<br />
items that ideally should not arise.<br />
They are therefore subject to special<br />
control procedures compared with<br />
the generality of payments. They are<br />
divided into different categories, which<br />
govern the way that individual cases<br />
are h<strong>and</strong>led.<br />
Losses <strong>and</strong> special payments are<br />
charged to the relevant functional<br />
headings in expenditure on an accruals<br />
basis.<br />
1.30. Financial instruments <strong>and</strong><br />
financial liabilities<br />
Recognition<br />
Financial assets <strong>and</strong> financial liabilities<br />
which arise from contracts to the<br />
purchase or sale of non-financial items<br />
(such as goods or services), which are<br />
entered into in accordance with the<br />
Foundation <strong>Trust</strong>'s normal purchase,<br />
sale or usage requirements, are<br />
recognised when, <strong>and</strong> to the extent<br />
which, performance occurs i.e. when<br />
receipt or delivery of the goods or<br />
services is made.<br />
Financial assets or financial liabilities<br />
in respect of assets required or<br />
disposed of through finance leases<br />
are recognised <strong>and</strong> measured in<br />
accordance with the accounting policy<br />
for leases described below.<br />
De-recognition<br />
All financial assets are de-recognised<br />
when the rights to receive cash flows<br />
from the assets have expired or the<br />
<strong>Trust</strong> has transferred substantially all<br />
of the risks <strong>and</strong> rewards of ownership.<br />
Financial liabilities are de-recognised<br />
when the obligation is discharged,<br />
cancelled or expires.<br />
Classification <strong>and</strong> Measurement<br />
Financial assets are categorised as loans<br />
<strong>and</strong> receivables or available for sale as<br />
financial assets. Financial liabilities are<br />
classified as other financial liabilities.<br />
1.31. Loans <strong>and</strong> receivables<br />
Loans <strong>and</strong> receivables are nonderivative<br />
financial assets with fixed or<br />
determinable payments which are not<br />
quoted in an active market. They are<br />
included in current assets if receivable<br />
in the current reporting period, or<br />
in non current assets if outside the<br />
current reporting period.<br />
The <strong>Trust</strong>'s loans <strong>and</strong> receivables<br />
comprise cash <strong>and</strong> cash equivalents,<br />
<strong>NHS</strong> debtors, accrued income <strong>and</strong><br />
other debtors.<br />
Loans <strong>and</strong> receivables are recognised<br />
initially at fair value, net of transaction<br />
costs, <strong>and</strong> are measured subsequently<br />
at amortised cost, using the effective<br />
interest method. The effective interest<br />
rate is the rate that discounts exactly<br />
estimated future cash receipts through<br />
the expected life of the financial asset<br />
or, when appropriate, a shorter period,<br />
to the net carrying amount of the<br />
financial asset.<br />
Interest on loans <strong>and</strong> receivables is<br />
calculated using the effective interest<br />
method <strong>and</strong> credited to the Statement<br />
of Comprehensive Income.<br />
1.32. Other financial liabilities<br />
All other financial liabilities are<br />
recognised initially at fair value, net<br />
of transaction costs incurred, <strong>and</strong><br />
measured subsequently at amortised<br />
cost using the effective interest<br />
method. The effective interest rate<br />
is the rate that discounts exactly<br />
estimated future cash payments<br />
through the expected life of the<br />
financial liability or, when appropriate,<br />
<strong>Annual</strong> accounts<br />
129
a shorter period, to the net carrying<br />
amount of the financial liability.<br />
They are included in current liabilities<br />
except for amounts payable more<br />
than 12 months after the reporting<br />
period, which reclassified as long-term<br />
liabilities.<br />
Interest on financial liabilities carried<br />
at amortised cost is calculated using<br />
the effective interest method <strong>and</strong><br />
charged to finance costs. Interest on<br />
financial liabilities taken out to finance<br />
property, plant <strong>and</strong> equipment or<br />
intangible assets is not capitalised as<br />
part of the cost of those assets.<br />
1.33. Impairment of financial assets<br />
At the end of the reporting period, the<br />
<strong>Trust</strong> assesses whether any financial<br />
assets, other than those held at ‘fair<br />
value through profit <strong>and</strong> loss’ are<br />
impaired. Financial assets are impaired<br />
<strong>and</strong> impairment losses recognised<br />
if there is objective evidence of<br />
impairment as a result of one or more<br />
events which occurred after the initial<br />
recognition of the asset <strong>and</strong> which has<br />
an impact on the estimated future cash<br />
flows of the asset.<br />
For financial assets carried at amortised<br />
cost, the amount of the impairment<br />
loss is measured as the difference<br />
between the asset’s carrying amount<br />
<strong>and</strong> the present value of the revised<br />
future cash flows discounted at the<br />
asset’s original effective interest rate.<br />
The loss is recognised in the Statement<br />
of Comprehensive Income <strong>and</strong> the<br />
carrying amount of the asset is reduced<br />
directly or through the use of a bad<br />
debt provision.<br />
1.34. Foreign currencies<br />
The <strong>Trust</strong>'s functional currency <strong>and</strong><br />
presentational currency is sterling.<br />
Transactions denominated in a foreign<br />
currency are translated into sterling at<br />
the exchange rate ruling on the dates<br />
of the transactions. Resulting exchange<br />
gains <strong>and</strong> losses are recognised in the<br />
<strong>Trust</strong>’s surplus/deficit in the period in<br />
which they arise.<br />
1.35. Prudential borrowing regime<br />
The <strong>Trust</strong> is permitted to borrow funds<br />
to the extent that it complies with the<br />
Prudential Borrowing Code for <strong>NHS</strong><br />
Foundation <strong>Trust</strong>s. The capital sum is<br />
recognised as a liability <strong>and</strong> interest<br />
incurred is charged to finance expenses<br />
in the Statement of Comprehensive<br />
Income.<br />
1.36. Government grants<br />
Government grants are grants from<br />
Government bodies other than income<br />
from primary care trusts or <strong>NHS</strong> trusts<br />
for the provision of services. Where<br />
a grant is used to fund revenue or<br />
capital expenditure it is taken to<br />
the Statement of Comprehensive<br />
Income to match that expenditure.<br />
The exception to this is where specific<br />
grant conditions apply regarding the<br />
recognition of income.<br />
1.37. Private patient income<br />
The statutory limitation on private<br />
patient income in section 44 of the<br />
2006 Act was repealed on 1 October<br />
<strong>2012</strong> by the Health <strong>and</strong> Social Care<br />
Act <strong>2012</strong>. The financial statements<br />
disclosures that were provided<br />
previously are no longer required.<br />
1.38. Financial risk management<br />
International Financial reporting<br />
st<strong>and</strong>ard IFRS 7 requires disclosure<br />
of the role that financial instruments<br />
have had during the period in creating<br />
or changing the risks a body faces<br />
in undertaking its activities. Because<br />
of the continuing service provider<br />
relationship that the <strong>NHS</strong> Foundation<br />
<strong>Trust</strong> has with primary care trusts <strong>and</strong><br />
the way those primary care trusts are<br />
financed, the <strong>NHS</strong> Foundation <strong>Trust</strong> is<br />
<strong>13</strong>0 <strong>Annual</strong> accounts
not exposed to the degree of financial<br />
risk faced by business entities. Also<br />
financial instruments play a much<br />
more limited role in creating or<br />
changing risk than would be typical<br />
of listed companies, to which the<br />
financial reporting st<strong>and</strong>ards mainly<br />
apply. The <strong>NHS</strong> Foundation <strong>Trust</strong> has<br />
limited powers to borrow or invest<br />
surplus funds <strong>and</strong> financial assets <strong>and</strong><br />
liabilities are generated by day-to-day<br />
operational activities rather than being<br />
held to change the risks facing the <strong>NHS</strong><br />
Foundation <strong>Trust</strong> in undertaking its<br />
activities.<br />
The <strong>Trust</strong>’s treasury management<br />
operations are carried out by the<br />
finance department, within parameters<br />
defined formally within the <strong>Trust</strong>’s<br />
st<strong>and</strong>ing financial instructions <strong>and</strong><br />
policies agreed by the board of<br />
directors. <strong>Trust</strong> treasury activity is<br />
subject to review by the <strong>Trust</strong>’s internal<br />
auditors.<br />
Currency risk<br />
The <strong>Trust</strong> is principally a domestic<br />
organisation with the great majority of<br />
transactions, assets <strong>and</strong> liabilities being<br />
in the UK <strong>and</strong> sterling based. The <strong>Trust</strong><br />
has no overseas operations. The <strong>Trust</strong><br />
therefore has low exposure to currency<br />
rate fluctuations.<br />
Interest rate risk<br />
To date, the <strong>Trust</strong> has only borrowed<br />
from UK Government for capital<br />
expenditure. The borrowings were for<br />
1 - 25 years, in line with the life of the<br />
associated assets, <strong>and</strong> interest charged<br />
at the National Loans Fund rate, fixed<br />
for the life of the loan. The <strong>Trust</strong><br />
therefore has low exposure to interest<br />
rate fluctuations.<br />
Credit risk<br />
Because the majority of the <strong>Trust</strong>’s<br />
income comes from contracts with<br />
other public sector bodies, the <strong>Trust</strong><br />
has low exposure to credit risk. The<br />
maximum exposures as at 31 March<br />
20<strong>13</strong> are in receivables from customers,<br />
as disclosed in the trade <strong>and</strong> other<br />
receivables note.<br />
Liquidity risk<br />
The majority of the <strong>Trust</strong>’s operating<br />
costs are incurred under contracts with<br />
Primary Care <strong>Trust</strong>s, which are financed<br />
from resources voted annually by<br />
Parliament. The <strong>Trust</strong> funds its capital<br />
expenditure from funds obtained<br />
within its prudential borrowing limit.<br />
The <strong>Trust</strong> is not, therefore, exposed to<br />
significant liquidity risks.<br />
1.39. Events after the reporting<br />
period<br />
There are no post balance sheet events<br />
to report.<br />
1.40. Research <strong>and</strong> development<br />
Research <strong>and</strong> development expenditure<br />
is charged against income in the year<br />
in which it is incurred, except insofar as<br />
development expenditure relates to a<br />
clearly defined project <strong>and</strong> the benefits<br />
of it can reasonably be regarded as<br />
assured. Expenditure so deferred is<br />
limited to the value of future benefits<br />
expected <strong>and</strong> is amortised through<br />
the Operating Cost Statement on<br />
a systematic basis over the period<br />
expected to benefit from the project.<br />
It should be revalued on the basis<br />
of current cost. The amortisation<br />
is calculated on the same basis as<br />
depreciation, on a quarterly basis.<br />
1.41. Significant accounting<br />
assumptions<br />
The <strong>Trust</strong> view is there is no material<br />
credit risk within its financial assets<br />
<strong>and</strong> liabilities. All significant potential<br />
suppliers are credit risk assessed before<br />
the <strong>Trust</strong> enters into a contract.<br />
The <strong>Trust</strong> is permitted to borrow funds<br />
<strong>Annual</strong> accounts<br />
<strong>13</strong>1
to the extent that it complies with the<br />
Prudential Borrowing Code for <strong>NHS</strong><br />
Foundation <strong>Trust</strong>s. The capital sum is<br />
recognised as a liability <strong>and</strong> interest<br />
incurred is charged to fiannce expenses<br />
in the Statement of Comprehensive<br />
Income. Total borrowings of the<br />
<strong>Trust</strong> <strong>and</strong> performance against the<br />
Prudential Borrowing Limit is disclosed<br />
in note 29.<br />
1.42. New st<strong>and</strong>ards <strong>and</strong><br />
interpretations<br />
IAS 1 Presentation of financial<br />
statements (Other Comprehensive<br />
Income) - subject to consultation<br />
IAS 12 Income Taxes amendment -<br />
subject to consultation<br />
IAS 19 Post - employment benefits<br />
(pensions) - subject to consultation<br />
IAS 27 Separate Financial<br />
Statements - subject to consultation<br />
IAS 28 Investments in Associates<br />
<strong>and</strong> Joint Ventures - subject to<br />
consultation<br />
IFRS 7 - Financial Instruments:<br />
Disclosures -amendments - subject to<br />
consultation<br />
IFRS 9 Financial Instruments - subject<br />
to consultation<br />
IFRS 10 Consolidated Financial<br />
Statements - subject to consultation<br />
IFRS 11 Joint Arrangements - subject<br />
to consultation<br />
IFRS 12 Disclosure of Interests<br />
in Other Entities - subject to<br />
consultation<br />
IFRS <strong>13</strong> Fair Value Measurement -<br />
subject to consultation<br />
IPSAS 32 - Service Concession<br />
Arrangement - subject to consultation<br />
<strong>13</strong>2 <strong>Annual</strong> accounts
The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation <strong>Trust</strong> - <strong>Annual</strong> <strong>Accounts</strong> <strong>2012</strong>-<strong>13</strong><br />
The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation <strong>Trust</strong> - <strong>Annual</strong> <strong>Accounts</strong> <strong>2012</strong>-<strong>13</strong><br />
Note 2<br />
Operating segments<br />
Note 2<br />
Surgical<br />
Medical Operating Women & segments Clinical Support Corporate<br />
Total<br />
Division<br />
Division Children's<br />
Services<br />
Division<br />
Surgical<br />
Medical Women & Clinical Support Corporate<br />
Total<br />
Division<br />
Division<br />
Division Children's<br />
Services<br />
Division<br />
31st March 20<strong>13</strong> ### 31st March 20<strong>13</strong> ### 31st March 20<strong>13</strong> ### 31st March 20<strong>13</strong> ### 31st March 20<strong>13</strong> ### 31st March 20<strong>13</strong><br />
Division<br />
###<br />
(£'000)<br />
###<br />
(£'000)<br />
###<br />
(£'000)<br />
###<br />
(£'000)<br />
###<br />
(£'000)<br />
###<br />
(£'000)<br />
###<br />
<strong>NHS</strong> Clinical Income<br />
(£'000)<br />
58,535<br />
(£'000)<br />
64,436<br />
(£'000)<br />
31,556<br />
(£'000)<br />
14,791<br />
(£'000)<br />
-<br />
(£'000)<br />
169,317<br />
Non<br />
<strong>NHS</strong><br />
<strong>NHS</strong><br />
Clinical<br />
Clinical<br />
Income<br />
Income<br />
58,535<br />
306<br />
64,436<br />
256<br />
31,556<br />
236<br />
14,791<br />
118 1,341<br />
- 169,317<br />
2,256<br />
Other<br />
Non <strong>NHS</strong><br />
Income<br />
Clinical Income<br />
2,306<br />
306<br />
1,911<br />
256<br />
1,217<br />
236<br />
2,389<br />
118<br />
10,421<br />
1,341<br />
18,244<br />
2,256<br />
Unallocated<br />
Other Income<br />
Income<br />
2,306<br />
-<br />
1,911<br />
-<br />
1,217<br />
-<br />
2,389<br />
-<br />
10,421<br />
-<br />
18,244<br />
4,724<br />
Total<br />
Unallocated<br />
Operating<br />
Income<br />
Revenue 61,147<br />
-<br />
66,603<br />
-<br />
33,009<br />
-<br />
17,298<br />
-<br />
11,762<br />
-<br />
194,541<br />
4,724<br />
Total Operating Revenue<br />
Pay<br />
61,147<br />
(29,730)<br />
66,603<br />
(31,144)<br />
33,009<br />
(17,893)<br />
17,298<br />
(23,773)<br />
11,762<br />
(19,572)<br />
194,541<br />
(122,1<strong>13</strong>)<br />
Non<br />
Pay<br />
Pay (14,036)<br />
(29,730)<br />
(10,942)<br />
(31,144) (17,893)<br />
(2,292) (10,089)<br />
(23,773)<br />
(24,570)<br />
(19,572) (122,1<strong>13</strong>)<br />
(61,929)<br />
Internal<br />
Non Pay<br />
Recharges<br />
(14,036)<br />
(2,351)<br />
(10,942)<br />
(2,045)<br />
(2,292)<br />
(844)<br />
(10,089)<br />
5,249<br />
(24,570)<br />
(10)<br />
(61,929)<br />
0<br />
Unallocated<br />
Internal Recharges<br />
Expenses<br />
(2,351)<br />
-<br />
(2,045)<br />
-<br />
(844)<br />
-<br />
5,249<br />
-<br />
(10)<br />
- (593)<br />
0<br />
Total Unallocated Operating Expenses Expenditure<br />
- - - - - (593)<br />
before Depreciation,Impairments<br />
Total Operating Expenditure<br />
<strong>and</strong> Interest<br />
before Depreciation,Impairments<br />
(46,117) (44,<strong>13</strong>1) (21,029) (28,6<strong>13</strong>) (44,152) (184,635)<br />
<strong>and</strong> Interest<br />
(46,117) (44,<strong>13</strong>1) (21,029) (28,6<strong>13</strong>) (44,152) (184,635)<br />
Earnings before Interest, Taxation,<br />
Depreciation, <strong>and</strong> Amortisation<br />
Earnings before Interest, Taxation,<br />
15,030 22,472 11,980 (11,315) (32,390) 9,906<br />
Depreciation, <strong>and</strong> Amortisation<br />
15,030 22,472 11,980 (11,315) (32,390) 9,906<br />
Unallocated Depreciation &<br />
Amortisation<br />
(7,619)<br />
Unallocated Depreciation &<br />
Unallocated<br />
Amortisation<br />
Impairments<br />
(7,619) (477)<br />
Operating<br />
Unallocated<br />
Surplus/(Deficit)<br />
Impairments<br />
15,030 22,472 11,980 (11,315) (32,390) 1,810<br />
(477)<br />
Operating Surplus/(Deficit) 15,030 22,472 11,980 (11,315) (32,390) 1,810<br />
Surgical Division<br />
Medical Women & Clinical Support Corporate<br />
Total<br />
Division Children's<br />
Services<br />
Division<br />
Surgical Division<br />
Medical Women & Clinical Support Corporate<br />
Total<br />
Division<br />
31st March <strong>2012</strong> ### 31st March Division <strong>2012</strong> ### 31st March Children's <strong>2012</strong> ### 31st March Services <strong>2012</strong> ### 31st March Division <strong>2012</strong> ### 31st March <strong>2012</strong> ###<br />
Division<br />
(£'000)<br />
###<br />
(£'000)<br />
###<br />
(£'000)<br />
###<br />
(£'000)<br />
###<br />
(£'000)<br />
###<br />
(£'000)<br />
###<br />
<strong>NHS</strong> Clinical Income<br />
(£'000)<br />
58,067<br />
(£'000)<br />
61,301<br />
(£'000)<br />
32,<strong>13</strong>8<br />
(£'000)<br />
<strong>13</strong>,494<br />
(£'000)<br />
-<br />
(£'000)<br />
165,000<br />
Non<br />
<strong>NHS</strong><br />
<strong>NHS</strong><br />
Clinical<br />
Clinical<br />
Income<br />
Income<br />
58,067<br />
263<br />
61,301<br />
310<br />
32,<strong>13</strong>8<br />
106<br />
<strong>13</strong>,494<br />
<strong>13</strong>9 1,151<br />
- 165,000<br />
1,969<br />
Other<br />
Non <strong>NHS</strong><br />
Income<br />
Clinical Income<br />
2,270<br />
263<br />
1,947<br />
310<br />
1,334<br />
106<br />
2,415<br />
<strong>13</strong>9<br />
7,720<br />
1,151<br />
15,686<br />
1,969<br />
Unallocated<br />
Other Income<br />
Income<br />
2,270 1,947<br />
-<br />
1,334<br />
-<br />
2,415<br />
-<br />
7,720<br />
-<br />
15,686<br />
7,636<br />
Total<br />
Unallocated<br />
Operating<br />
Income<br />
Revenue 60,600 63,558<br />
-<br />
33,578<br />
-<br />
16,048<br />
-<br />
8,871<br />
-<br />
190,291<br />
7,636<br />
Total Operating Revenue<br />
Pay<br />
60,600<br />
(29,663)<br />
63,558<br />
(30,298)<br />
33,578<br />
(17,879)<br />
16,048<br />
(23,406)<br />
8,871<br />
(17,511)<br />
190,291<br />
(118,757)<br />
Non<br />
Pay<br />
Pay (14,670)<br />
(29,663) (30,298)<br />
(9,321)<br />
(17,879)<br />
(2,256) (10,060)<br />
(23,406)<br />
(23,773)<br />
(17,511) (118,757)<br />
(60,080)<br />
Internal<br />
Non Pay<br />
Recharges<br />
(14,670)<br />
(2,302) (2,028)<br />
(9,321) (2,256)<br />
(865)<br />
(10,060)<br />
5,200<br />
(23,773)<br />
(5)<br />
(60,080)<br />
0<br />
Unallocated<br />
Internal Recharges<br />
Expenses<br />
(2,302)<br />
-<br />
(2,028)<br />
-<br />
(865)<br />
-<br />
5,200<br />
-<br />
(5)<br />
(6<strong>13</strong>)<br />
0<br />
Total Operating Expenditure before<br />
Unallocated Expenses - - - - (6<strong>13</strong>)<br />
Depreciation,Impairments <strong>and</strong><br />
Total Operating Expenditure before<br />
Interest<br />
(46,635) (41,647) (21,000) (28,266) (41,289) (179,450)<br />
Depreciation,Impairments <strong>and</strong><br />
Interest<br />
(46,635) (41,647) (21,000) (28,266) (41,289) (179,450)<br />
Earnings before Interest, Taxation,<br />
Depreciation, <strong>and</strong> Amortisation<br />
Earnings before Interest, Taxation,<br />
<strong>13</strong>,965 21,911 12,578 (12,218) (32,418) 10,841<br />
Depreciation, <strong>and</strong> Amortisation<br />
<strong>13</strong>,965 21,911 12,578 (12,218) (32,418) 10,841<br />
Unallocated Depreciation &<br />
Amortisation<br />
Unallocated Depreciation &<br />
(7,482)<br />
Unallocated AmortisationImpairments (4,197) (7,482)<br />
Operating<br />
Unallocated<br />
Surplus/(Deficit)<br />
Impairments<br />
<strong>13</strong>,965 21,911 12,578 (12,218) (32,418) (838)<br />
(4,197)<br />
Operating Surplus/(Deficit) <strong>13</strong>,965 21,911 12,578 (12,218) (32,418) (838)<br />
The only activity of the <strong>NHS</strong> Foundation <strong>Trust</strong> is Healthcare <strong>and</strong> its primary customers are<br />
Primary Care <strong>Trust</strong>s (PCTs). However, segmental information has been included on the basis<br />
The only The<br />
the<br />
activity only activity<br />
following<br />
of of<br />
information the <strong>NHS</strong> Foundation<br />
is reported <strong>Trust</strong> is Healthcare<br />
regularly to<br />
<strong>Trust</strong><br />
the Chief<br />
is <strong>and</strong> Healthcare, its primary customers<br />
Executive for the purpose<br />
<strong>and</strong> its are<br />
of<br />
primary customers are Primary Care <strong>Trust</strong><br />
Primary Care <strong>Trust</strong>s (PCTs). However, segmental information has been included on the basis<br />
(PCTs). However, allocating resources to that segment <strong>and</strong> assessing its performance. Transactions between<br />
the following segmental information is reported information regularly to has the Chief been Executive included for the purpose of basis the following information is reported<br />
divisions would reflect the re-allocation of shared costs. All services relating to transactions<br />
regularly<br />
allocating<br />
shown to the<br />
resources<br />
below Chief<br />
to<br />
were provided Executive<br />
that segment<br />
to external for<br />
<strong>and</strong> assessing<br />
customers the purpose<br />
its performance.<br />
of the <strong>Trust</strong>. of allocating<br />
Transactions<br />
resources<br />
between<br />
to that segment <strong>and</strong> assessing its<br />
divisions would reflect the re-allocation of shared costs. All services relating to transactions<br />
performance. Segmental shown below Transactions net were assets provided are not between recorded to external as customers part divisions of the of internal the would <strong>Trust</strong>. reporting reflect process the <strong>and</strong> re-allocation as such are not disclosed. of shared costs. All services relating<br />
to transactions The Segmental reportable net shown assets segments are below not are recorded different were as operational provided part of the divisions internal to external within reporting the <strong>Trust</strong>, process customers which <strong>and</strong> as provide such of are the not <strong>Trust</strong>. disclosed.<br />
different groups of service. They are managed separately as they involve different medical<br />
The reportable segments are different operational divisions within the <strong>Trust</strong>, which provide<br />
Segmental<br />
disciplines<br />
net<br />
<strong>and</strong><br />
assets<br />
patient<br />
are<br />
groups.<br />
not<br />
Segments<br />
recorded<br />
have<br />
as<br />
not<br />
part<br />
been aggregated<br />
different groups of service. They are managed separately of as they involve internal different reporting medical process <strong>and</strong> as such are not disclosed.<br />
disciplines <strong>and</strong> patient groups. Segments have not been aggregated<br />
The major external customer is <strong>NHS</strong> <strong>Hillingdon</strong> which accounted for revenue of £<strong>13</strong>1,997k <strong>and</strong> features in all segments.<br />
The reportable segments are different operational divisions within the <strong>Trust</strong>, which provide different groups of<br />
No other<br />
major<br />
customer<br />
external<br />
accounted<br />
customer is<br />
for<br />
<strong>NHS</strong><br />
more<br />
<strong>Hillingdon</strong><br />
than 10%<br />
which<br />
of revenue.<br />
accounted for revenue of £<strong>13</strong>1,997k <strong>and</strong> features in all segments.<br />
service.<br />
No<br />
They<br />
other<br />
are<br />
customer<br />
managed<br />
accounted<br />
separately<br />
for more than 10%<br />
as they<br />
of revenue.<br />
involve different medical disciplines <strong>and</strong> patient groups. Segments<br />
have not been aggregated.<br />
The major external customer is <strong>NHS</strong> <strong>Hillingdon</strong> which accounted for revenue of £<strong>13</strong>1,997k <strong>and</strong> features in all<br />
segments. No other customer accounted for more than 10% of revenue.<br />
<strong>Annual</strong> accounts<br />
<strong>13</strong>3
Page 22<br />
Note 3.1 Operating income (by classification) 31 March 20<strong>13</strong> 31 March 20<strong>13</strong> 31 March 20<strong>13</strong><br />
Total Total Total<br />
£000 £000 £000<br />
<strong>NHS</strong> Clinical Income<br />
Elective income 31,434 31,434<br />
M<strong>and</strong>atory Non M<strong>and</strong>atory<br />
Income<br />
Income<br />
Non elective income 53,837 53,837<br />
Outpatient income 41,216 41,216<br />
A & E income 11,397 11,397<br />
Other <strong>NHS</strong> clinical income 31,433 31,433<br />
Non-<strong>NHS</strong> Clinical Income<br />
Private patient income 253 253<br />
Other non-protected clinical income 2,031 2,031<br />
Total income from activities 171,601 169,317 2,284<br />
Other operating income<br />
Research <strong>and</strong> development 998 998<br />
Education <strong>and</strong> training 7,323 7,018 305<br />
Receipts from donated assets 194 194<br />
Non-patient care services to other bodies 8,176 8,176<br />
Other 4,204 4,204<br />
Rental revenue from operating leases 1,981 1,981<br />
Income in respect of staff costs where accounted on gross basis<br />
64 64<br />
Total other operating income 22,940 7,018 15,922<br />
Total Operating Income 194,541 176,335 18,206<br />
31 March <strong>2012</strong> 31 March <strong>2012</strong> 31 March <strong>2012</strong><br />
Total Total Total<br />
£000 £000 £000<br />
<strong>NHS</strong> Clinical Income<br />
Elective income 30,110 30,110<br />
M<strong>and</strong>atory Non M<strong>and</strong>atory<br />
Income<br />
Income<br />
Non elective income 52,444 52,444<br />
Outpatient income 39,755 39,755<br />
A & E income 10,831 10,831<br />
Other <strong>NHS</strong> clinical income 31,860 31,860<br />
Non-<strong>NHS</strong> Clinical Income<br />
Private patient income 243 243<br />
Other non-protected clinical income 1,902 1,902<br />
Total income from activities 167,145 165,000 2,145<br />
Other operating income<br />
Research <strong>and</strong> development 954 954<br />
Education <strong>and</strong> training 7,470 7,077 393<br />
Charitable <strong>and</strong> other contributions to expenditure 1,281 1,281<br />
Non-patient care services to other bodies 8,304 8,304<br />
Other 3,467 3,467<br />
Rental revenue from operating leases 1,626 1,626<br />
Income in respect of staff costs where accounted on gross basis<br />
44 44<br />
Total other operating income 23,146 7,077 16,069<br />
Total Operating Income 190,291 172,077 18,214<br />
M<strong>and</strong>atory income relates to the treatment of <strong>NHS</strong> patients <strong>and</strong> for the training <strong>and</strong> education for clinical<br />
healthcare M<strong>and</strong>atory Income staff. relates to the treatment of <strong>NHS</strong> patients <strong>and</strong> for the training <strong>and</strong> education for<br />
clinical healthcare staff.<br />
<strong>13</strong>4 <strong>Annual</strong> accounts
The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation <strong>Trust</strong> - <strong>Annual</strong> <strong>Accounts</strong> <strong>2012</strong>-<strong>13</strong><br />
Note 3.2 Operating income by entity 31 March 20<strong>13</strong> 31 March <strong>2012</strong><br />
£000 £000<br />
<strong>NHS</strong> Foundation <strong>Trust</strong>s 1,926 524<br />
<strong>NHS</strong> <strong>Trust</strong>s 7,228 7,726<br />
Department of Health 189 0<br />
Strategic Health Authorities 6,975 7,063<br />
Primary Care <strong>Trust</strong>s 172,586 167,028<br />
Local Authorities 41 54<br />
Non Government Bodies 5,596 7,896<br />
Total operating income 194,541 190,291<br />
Non Operating income 31 March 20<strong>13</strong> 31 March <strong>2012</strong><br />
£000 £000<br />
Finance Income (Interest on Bank <strong>Accounts</strong>) 14 14<br />
Valuation Gain on Investment Properties 1,692 2,347<br />
Total non operating income 1,706 2,361<br />
Note 3.3 Operating lease income 31 March 20<strong>13</strong> 31 March <strong>2012</strong><br />
£000 £000<br />
Operating Lease Income<br />
Rents recognised as income in the period 1,519 1,017<br />
Contingent rents recognised as income in the period 462 609<br />
TOTAL 1,981 1,626<br />
Future minimum lease payments due<br />
on leases of L<strong>and</strong> expiring<br />
- not later than one year; 1,150 659<br />
- later than one year <strong>and</strong> not later than five years; 4,600 2,637<br />
- later than five years. 82,800 48,075<br />
sub total 88,550 51,371<br />
on leases of Buildings expiring<br />
- not later than one year; 200 322<br />
- later than one year <strong>and</strong> not later than five years; 776 846<br />
- later than five years. 356 1,742<br />
sub total 1,332 2,910<br />
TOTAL 89,882 54,281<br />
Leasing arrangements relate significantly to l<strong>and</strong> rental on both the <strong>Hillingdon</strong> <strong>and</strong> Mount Vernon site.<br />
Most substantially, the <strong>Trust</strong> is party to a lease with BMI for l<strong>and</strong> rental on the Mount Vernon site. This is a<br />
99 year lease which commenced in March 1991. At the beginning of <strong>2012</strong>/<strong>13</strong> a revision of the lease<br />
agreement was signed by both parties, the end period for the lease remained the same, but one change<br />
was to update the contracted rental value written within the contract to 2011/12 price levels. As a result,<br />
rent previously reported as contingent rent, is now reflected within rents recognised as income. In<br />
addition, the future minimum lease payments, based upon the length of the lease <strong>and</strong> the rental value<br />
written within the lease, have increased substantially.<br />
<strong>Annual</strong> accounts<br />
<strong>13</strong>5
The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation <strong>Trust</strong> - <strong>Annual</strong> <strong>Accounts</strong> <strong>2012</strong>-<strong>13</strong><br />
Note 4. Operating expenses (by type) 31 March 20<strong>13</strong> 31 March <strong>2012</strong><br />
£000 £000<br />
Services from <strong>NHS</strong> Foundation <strong>Trust</strong>s 983 835<br />
Services from <strong>NHS</strong> <strong>Trust</strong>s 30 256<br />
Services from PCTs<br />
0 31<br />
Employee Expenses - Executive directors 889 918<br />
Employee Expenses - Non-executive directors <strong>13</strong>9 71<br />
Employee Expenses - Staff 121,231 117,774<br />
Supplies <strong>and</strong> services - clinical (excluding drug costs) 20,898 20,430<br />
Supplies <strong>and</strong> services - general 5,977 7,963<br />
Establishment 3,917 3,776<br />
Transport 1,335 1,270<br />
Premises 7,487 6,246<br />
Increase/(decrease) in provision for impairment of receivables 524 335<br />
Increase in other provisions 122 88<br />
Drugs 12,028 11,546<br />
Other impairment of financial assets 0 0<br />
Rentals under operating leases - minimum lease receipts 547 540<br />
Rentals under operating leases - contingent rent 63 38<br />
Depreciation on property, plant <strong>and</strong> equipment 7,108 7,482<br />
Amortisation on intangible assets 511 0<br />
Impairments of property, plant <strong>and</strong> equipment 36 4,197<br />
Audit services- statutory audit* 115 100<br />
Clinical negligence 5,155 4,574<br />
Loss on disposal of other property, plant <strong>and</strong> equipment 441 0<br />
Legal fees 98 <strong>13</strong>7<br />
Consultancy costs 40 8<br />
Training, courses <strong>and</strong> conferences 465 367<br />
Patient travel 5 6<br />
Car parking & Security 109 <strong>13</strong>6<br />
Redundancy - (Included in employee expenses) 51 112<br />
<strong>Hospital</strong>ity 16 25<br />
Insurance 231 267<br />
Other services, e.g. external payroll 2,030 1,168<br />
Losses, ex gratia & special payments- (Not included in employee expenses)<br />
53 49<br />
Other 98 384<br />
TOTAL OPERATING EXPENSES 192,732 191,129<br />
*The <strong>Trust</strong>s auditors Deloitte LLP have not limited their auditor's liability under their contract with the <strong>Trust</strong>.<br />
* The <strong>Trust</strong>’s auditors Deloitte LLP have not limited their auditor’s liability under their contract with the <strong>Trust</strong>.<br />
<strong>13</strong>6 <strong>Annual</strong> accounts
The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation <strong>Trust</strong> - <strong>Annual</strong> <strong>Accounts</strong> <strong>2012</strong>-<strong>13</strong><br />
5. Operating lease Expenditure<br />
Payments recognised as an expense 31 March 20<strong>13</strong> 31 March <strong>2012</strong><br />
£000 £000<br />
Minimum lease payments 547 540<br />
Contingent rents 63 38<br />
610 578<br />
Total future minimum lease payments 31 March 20<strong>13</strong> 31 March <strong>2012</strong><br />
£000 £000<br />
Payable:<br />
Not later than one year 362 603<br />
Between one <strong>and</strong> five years 0 352<br />
Total 362 955<br />
The <strong>Trust</strong> is is party to to a a five five year year lease lease agreement for for a Module a Module Healthcare Healthcare Complex Complex building building on the on the<br />
<strong>Hillingdon</strong> <strong>Hospital</strong> site.<br />
All future minimum lease payments relate to a single lease with a cessation date end October 20<strong>13</strong>.<br />
All future minimum lease payments relate to a single lease with a cassation date end October 20<strong>13</strong><br />
<strong>Annual</strong> accounts<br />
<strong>13</strong>7
The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation <strong>Trust</strong> - <strong>Annual</strong> <strong>Accounts</strong> <strong>2012</strong>-<strong>13</strong><br />
6. Employee costs <strong>and</strong> numbers<br />
6.1 Directors aggregate remuneration 31 March 20<strong>13</strong> 31 March 20<strong>13</strong> 31 March <strong>2012</strong> 31 March <strong>2012</strong><br />
Remuneration Number of Remuneration Number of<br />
£000 Directors ** £000 Directors<br />
Executive Directors (Details of Directors can be found in<br />
<strong>Annual</strong> <strong>Report</strong>)<br />
889 10 918 8<br />
Non Executive Directors* <strong>13</strong>9 9 71 7<br />
Total** 1,028 19 989 15<br />
**Analysis of Directors Remuneration (£000)<br />
Gross pay 849 799<br />
Employer Pension Contributions 96 97<br />
Employer National Insurance Contributions 83 93<br />
Total 1,028 989<br />
*Non Executive Directors are not members of the <strong>NHS</strong><br />
pension scheme.<br />
** The number of directors denotes the number of<br />
individuals employed in a director position at some point<br />
during the financial year, not the number of directors<br />
simultaneously employed.<br />
6.2 Staff sickness absence 31 March 20<strong>13</strong> 31 March <strong>2012</strong><br />
Number Number<br />
Days lost (long term) 18,020 17,176<br />
Days lost (short term) 12,327 11,815<br />
Total days lost 30,347 28,991<br />
Total staff years* 2,610 2,4<strong>13</strong><br />
Average working days lost 12 12<br />
Total staff employed in period (headcount) 2,904 2,701<br />
Total staff employed in period with no absence (headcount) 1,037 997<br />
Percentage staff with no sick leave 35.71% 36.91%<br />
*Staff years is a calculation based on the number of<br />
working days of full time <strong>and</strong> part time staff employed by<br />
the <strong>Trust</strong> converted into composite staff years.<br />
6.3 Early Retirements due to ill health 31 March 20<strong>13</strong> 31 March <strong>2012</strong><br />
Number Number<br />
No of early retirements on the grounds of ill-health 4 0<br />
31 March 20<strong>13</strong> 31 March <strong>2012</strong><br />
£000 £000<br />
Value of early retirements on the grounds of ill-health 165 0<br />
<strong>13</strong>8 <strong>Annual</strong> accounts<br />
Page 26
The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation <strong>Trust</strong> - <strong>Annual</strong> <strong>Accounts</strong> <strong>2012</strong>-<strong>13</strong><br />
The<br />
6. Employee<br />
<strong>Hillingdon</strong><br />
costs<br />
<strong>Hospital</strong>s<br />
<strong>and</strong> numbers<br />
<strong>NHS</strong> Foundation<br />
(continued)<br />
<strong>Trust</strong> - <strong>Annual</strong> <strong>Accounts</strong> <strong>2012</strong>-<strong>13</strong><br />
6.<br />
6.4<br />
Employee<br />
Employee costs<br />
costs <strong>and</strong> numbers (continued)<br />
31 March 20<strong>13</strong> 31 March <strong>2012</strong><br />
Total Permanently Other Total Permanently Other<br />
6.4 Employee costs 31 March employed 20<strong>13</strong> 31 March employed <strong>2012</strong><br />
Total Permanently Other Total Permanently Other<br />
£000 employed £000 £000 £000 employed £000 £000<br />
Salaries <strong>and</strong> wages 102,261 £000 97,661 £000 4,600 £000 99,612 £000 94,850 £000 4,762 £000<br />
Social security costs 9,079 8,777 302 8,919 8,583 336<br />
Salaries<br />
Employer<br />
<strong>and</strong><br />
contributions<br />
wages<br />
to <strong>NHS</strong> Pension scheme<br />
102,261 11,046 97,661 10,874 4,600 171 99,612 10,865 94,850 10,707 4,762 158<br />
Social Termination security benefits costs 9,079 51 8,777 51 3020 8,919 124 8,583 124 3360<br />
Employer Agency/contract contributions staff to <strong>NHS</strong> Pension scheme 11,046 2,140 10,8740 2,140 171 10,865 1,446 10,7070 1,446 158<br />
Termination Less Salary Costs benefits Recharged to Other Organisations (1,487) 51 (1,487) 51 0 (1,361) 124 (1,361) 124 0<br />
Agency/contract Less Termination staff Costs Recharged to Other Organisations 2,1400 0 2,1400 1,446 (12) (12) 0 1,4460<br />
Less Salary Costs Recharged to Other Organisations (1,487) (1,487) 0 (1,361) (1,361) 0<br />
Less Termination Costs Recharged to Other Organisations 0 0 0 (12) (12) 0<br />
Employee benefits expense 123,090 115,877 7,2<strong>13</strong> 119,593 112,891 6,702<br />
Of Employee the total benefits above: expense 123,090 115,877 7,2<strong>13</strong> 119,593 112,891 6,702<br />
Charged to capital 919 898 21 789 789 0<br />
Charged Of the total revenue above:<br />
Charged to capital<br />
122,171<br />
123,090 919<br />
114,979<br />
115,877 898<br />
7,192<br />
7,2<strong>13</strong> 118,804<br />
119,593 789<br />
112,102<br />
112,891 789<br />
6,702<br />
6,7020<br />
Charged to revenue 122,171 114,979 7,192 118,804 112,102 6,702<br />
6.5 Average number of people employed<br />
123,090 115,877<br />
31 March 20<strong>13</strong><br />
7,2<strong>13</strong> 119,593 112,891<br />
31 March <strong>2012</strong><br />
6,702<br />
6.5 Average number of people employed<br />
Total Permanently Other Total Permanently Other<br />
31 March employed 20<strong>13</strong> 31 March employed <strong>2012</strong><br />
Total Permanently Other Total Permanently Other<br />
Number employed Number Number Number employed Number Number<br />
Medical <strong>and</strong> dental Number 403 Number 398 Number 5 Number 399 Number 394 Number 5<br />
Administration <strong>and</strong> estates 702 665 37 709 660 49<br />
Medical Healthcare <strong>and</strong> assistants dental <strong>and</strong> other support staff 403 392 398 319 74 5 399 308 394 259 49 5<br />
Administration Nursing, midwifery <strong>and</strong> <strong>and</strong> estates health visiting staff 702 793 665 725 37 68 709 816 660 745 49 71<br />
Healthcare Scientific, therapeutic assistants <strong>and</strong> <strong>and</strong> other technical support staff staff 392 368 319 355 74 <strong>13</strong> 308 365 259 356 499<br />
Nursing, midwifery <strong>and</strong> health visiting staff 793 725 68 816 745 71<br />
Scientific,<br />
Total<br />
therapeutic <strong>and</strong> technical staff<br />
2,658 368 2,461 355 197 <strong>13</strong> 2,597 365 2,414 356 183 9<br />
Total Of the above:<br />
2,658 2,461 197 2,597 2,414 183<br />
Of Number the above: of whole time equivalent staff engaged on capital projects 15 15 0 12 12 0<br />
Number of whole time equivalent staff engaged on capital projects 15 15 0 12 12 0<br />
6.6 Exit Packages 31 March 20<strong>13</strong><br />
Exit package cost b<strong>and</strong> (including any special payment element)<br />
Total<br />
6.6 Exit Packages 31 March 20<strong>13</strong><br />
*Number of<br />
*Cost of<br />
number of Total cost of<br />
Exit package cost b<strong>and</strong> (including any special payment element) compulsory compulsory<br />
Total exit exit<br />
redundancies<br />
*Number of redundancies *Cost of<br />
number packages of Total packages cost of<br />
compulsory Number compulsory £000s Number exit £000s exit<br />
£200,001 0 0 0 0<br />
Total 2 51 2 51<br />
6.6 Exit Packages 31 March <strong>2012</strong><br />
Exit package cost b<strong>and</strong> (including any special payment element)<br />
Total<br />
6.6 Exit Packages *Number of<br />
*Cost 31 of March <strong>2012</strong> number of Total cost of<br />
Exit package cost b<strong>and</strong> (including any special payment element) compulsory compulsory<br />
Total exit exit<br />
redundancies<br />
*Number of redundancies *Cost of<br />
number packages of Total packages cost of<br />
compulsory Number compulsory £000s Number exit £000s exit<br />
£200,001 0 0 0 0<br />
Total 5 112 5 112<br />
<strong>Annual</strong> accounts<br />
<strong>13</strong>9<br />
Page 27
The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation <strong>Trust</strong> -- <strong>Annual</strong> <strong>Accounts</strong> <strong>2012</strong>-<strong>13</strong><br />
7 Better Payment Practice Code<br />
7.1 Better Payment Practice Code -- measure of<br />
compliance<br />
31 March 20<strong>13</strong> 31 March <strong>2012</strong><br />
Number £000 Number £000<br />
Total Non-<strong>NHS</strong> trade invoices paid in the year 56,422 68,300 48,339 59,804<br />
Total Non <strong>NHS</strong> trade invoices paid within target <strong>13</strong>,849 23,206 9,058 19,232<br />
Percentage of Non-<strong>NHS</strong> trade invoices paid within target 25% 34% 19% 32%<br />
Total <strong>NHS</strong> trade invoices paid in the year 2,418 14,085 2,579 <strong>13</strong>,934<br />
Total <strong>NHS</strong> trade invoices paid within target 453 5,516 442 4,719<br />
Percentage of <strong>NHS</strong> trade invoices paid within target 19% 39% 17% 34%<br />
The<br />
The Better<br />
Better Payment<br />
Payment Practice Practice<br />
Code Code<br />
requires requires<br />
the the<br />
<strong>Trust</strong> <strong>Trust</strong><br />
to to<br />
aim aim<br />
to to<br />
pay pay<br />
all all<br />
undisputed undisputed<br />
invoices invoices<br />
by the<br />
by the due date or within 30<br />
due days date of receipt or within of goods 30 days or of a receipt valid invoice, of goods whichever or a valid is invoice, later. whichever is is later.<br />
7.2 The Late Payment of Commercial Debts (Interest) Act 1998 31 March 20<strong>13</strong> 31 March <strong>2012</strong><br />
£000 £000<br />
Amounts included in finance costs from claims made under this legislation 8 3<br />
8 Finance income 31 March 20<strong>13</strong> 31 March <strong>2012</strong><br />
£000 £000<br />
Interest on bank accounts 14 14<br />
9 Other non -operating income 31 March 20<strong>13</strong> 31 March <strong>2012</strong><br />
£000 £000<br />
Change in fair value of investment property 1,692 2,347<br />
Total 1,692 2,347<br />
10 Finance expenses 31 March 20<strong>13</strong> 31 March <strong>2012</strong><br />
£000 £000<br />
Interest expense:<br />
Finance leases 142 128<br />
Interest on late payment of commercial debt 8 3<br />
Interest on Loans from the Department of Health 284 297<br />
Interest on LIFT contract 1,344 1,260<br />
Total 1,778 1,688<br />
140 <strong>Annual</strong> accounts
The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation <strong>Trust</strong> - <strong>Annual</strong> <strong>Accounts</strong> <strong>2012</strong>-<strong>13</strong><br />
Page 29<br />
11 Intangible Assets 31 March 20<strong>13</strong><br />
£000<br />
Cost brought forward at 1st April <strong>2012</strong> 0<br />
Reclassification from Property, Plant <strong>and</strong> Equipment 3,933<br />
Additions - purchased 20<br />
Cost at 31 March 20<strong>13</strong><br />
3,953<br />
Amortisation Brought Forward at 1st April <strong>2012</strong> 0<br />
Reclassification from Property, Plant <strong>and</strong> Equipment 1,494<br />
Amortisation provided in Year 511<br />
Amortisation at at 31 31 March March 20<strong>13</strong> 20<strong>13</strong><br />
2,005<br />
Net Book Value at 31 March 20<strong>13</strong><br />
1,948<br />
Intangible Assets consists of Software Licences<br />
Intangible assets consists of software licences.<br />
During the year Management identified that assets included in<br />
Property, Plant <strong>and</strong> Equipment within the heading Information<br />
Technology, would be more accurately disclosed as intangible<br />
During the year, management identified that assets included in Property, Plant <strong>and</strong><br />
assets.<br />
Equipment within the heading information Technology, would be more accurately disclosed<br />
as intangible assets.<br />
<strong>Annual</strong> accounts<br />
141
* The Prior Period Adjustment relates to the reversal of accumulated depreciation as at 31st March <strong>2012</strong> following a<br />
revaluation exercise of the <strong>Trust</strong>’s operational l<strong>and</strong> <strong>and</strong> buildings.<br />
** Protected assets are assets which are used in the <strong>Trust</strong>’s primary purpose for treating Page <strong>NHS</strong> 30 patients.<br />
* The Prior Period Adjustment relates to the reversal of accumulated depreciation as at 31 March <strong>2012</strong> following a revaluation exercise of the <strong>Trust</strong>'s operational l<strong>and</strong> <strong>and</strong> buildings.<br />
Protected Assets* 71,147 17,276 53,871 0 0 0 0 0 0<br />
Unprotected Assets 43,770 15,193 8,142 653 4,106 9,014 0 6,609 53<br />
Total 31 March 20<strong>13</strong> 114,917 32,469 62,0<strong>13</strong> 653 4,106 9,014 0 6,609 53<br />
Ownership Analysed as follows:-<br />
Net book value<br />
Owned 98,326 32,119 48,932 653 4,106 6,927 0 5,536 53<br />
Finance leased 2,256 0 0 0 0 1,183 0 1,073 0<br />
LIFT 10,783 350 10,433 0 0 0 0 0 0<br />
Donated 3,552 0 0 2,648 0 904 0 0 0<br />
Total 31 March 20<strong>13</strong> 114,917 32,469 59,365 3,301 4,106 9,014 0 6,609 53<br />
Net Book Value (A - B) 114,917 32,469 62,0<strong>13</strong> 653 4,106 9,014 0 6,609 53<br />
Depreciation at 1 April <strong>2012</strong> 38,017 762 11,544 874 0 14,359 18 8,193 2,267<br />
Prior Period Adjustments* (<strong>13</strong>,180) (762) (11,544) (874) 0 0 0 0 0<br />
Provided During the Year 7,108 0 3,326 163 0 2,340 0 1,269 10<br />
Impairments 36 0 36 0 0 0 0 0 0<br />
Reclassifications (1,494) 0 0 0 0 202 0 (1,696) 0<br />
Disposals (8,795) 0 0 0 0 (6,558) 0 0 (2,237)<br />
Depreciation at 31 March 20<strong>13</strong> (B) 21,692 0 3,362 163 0 10,343 18 7,766 40<br />
Additions - purchased 6,321 0 499 0 3,928 1,415 0 479 0<br />
Additions - Leased 2,256 0 0 0 0 1,183 0 1,073 0<br />
Additions - donated 194 0 0 0 0 194 0 0 0<br />
Impairments (16) 0 0 0 0 (16) 0 0 0<br />
Reclassifications (3,933) 0 719 0 (1,978) 269 0 (2,943) 0<br />
Revaluations 420 420 0 0 0 0 0 0 0<br />
Disposals (9,241) 0 0 0 0 (7,004) 0 0 (2,237)<br />
Cost or valuation at 31 March 20<strong>13</strong> (A) <strong>13</strong>6,609 32,469 65,375 816 4,106 19,357 18 14,375 93<br />
Cost or valuation at 1 April <strong>2012</strong> 153,788 32,811 75,701 1,690 2,156 23,316 18 15,766 2,330<br />
Prior Period Adjustment* (<strong>13</strong>,180) (762) (11,544) (874) 0 0 0 0 0<br />
.<br />
12.1 Property, plant <strong>and</strong> equipment Total L<strong>and</strong> Buildings Dwellings Assets under Plant <strong>and</strong> Transport Information Furniture &<br />
excluding<br />
construction machinery equipment technology fittings<br />
dwellings<br />
31 March 20<strong>13</strong> £000 £000 £000 £000 £000 £000 £000 £000 £000<br />
The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation <strong>Trust</strong> - <strong>Annual</strong> <strong>Accounts</strong> <strong>2012</strong>-<strong>13</strong><br />
142 <strong>Annual</strong> accounts
The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation <strong>Trust</strong> - <strong>Annual</strong> <strong>Accounts</strong> <strong>2012</strong>-<strong>13</strong><br />
12.1 Property, plant <strong>and</strong> equipment<br />
Total L<strong>and</strong> Buildings Dwellings Assets under Plant <strong>and</strong> Transport Information Furniture &<br />
Continuation<br />
excluding<br />
construction machinery equipment technology fittings<br />
dwellings<br />
<strong>and</strong> POA<br />
31 March <strong>2012</strong> £000 £000 £000 £000 £000 £000 £000 £000 £000<br />
Cost or valuation at 1 April 2011 145,932 34,595 69,573 1,238 602 22,243 18 15,333 2,330<br />
Additions purchased 5,425 0 1,763 0 2,156 1,073 0 433 0<br />
Additions donated 1,281 0 1,281 0 0 0 0 0 0<br />
Reclassifications 0 (1,558) 2,160 0 (602) 0 0 0 0<br />
Reclassified as held for sale 0 0 0 0 0 0 0 0 0<br />
Revaluation/indexation gains 6,212 1,519 4,241 452 0 0 0 0 0<br />
Impairments (5,062) (1,745) (3,317) 0 0 0 0 0 0<br />
Reversal of impairments 0 0 0 0 0 0 0 0 0<br />
At 31 March <strong>2012</strong> 153,788 32,811 75,701 1,690 2,156 23,316 18 15,766 2,330<br />
Depreciation at 1 April 2011 26,338 - 5,111 4<strong>13</strong> 0 12,103 18 6,445 2,248<br />
Impairments 4,197 762 3,343 92 0 0 0 0 0<br />
Charged during the year 7,482 - 3,090 369 0 2,256 0 1,748 19<br />
Depreciation at 31 March <strong>2012</strong> 38,017 762 11,544 874 0 14,359 18 8,193 2,267<br />
Net Book Value (A - B) 115,771 32,049 64,157 816 2,156 8,957 0 7,573 63<br />
Net book value<br />
Ownership Analysed as follows:-<br />
Owned 98,063 31,699 50,789 815 2,156 7,343 0 5,198 63<br />
Finance leased 1,301 - - 0 0 1,301 0 0 0<br />
LIFT 11,043 350 10,693 0 0 0 0 0 0<br />
Donated 2,989 - 2,675 1 0 3<strong>13</strong> 0 0 0<br />
Total 31 March <strong>2012</strong> 1<strong>13</strong>,396 32,049 64,157 816 2,156 8,957 0 5,198 63<br />
Protected Assets 70,169 17,276 52,893 0 0 0 0 0 0<br />
Unprotected Assets 45,602 14,773 11,264 816 2,156 8,957 0 7,573 63<br />
Total 31 March <strong>2012</strong> 115,771 32,049 64,157 816 2,156 8,957 0 7,573 63<br />
Page 31<br />
<strong>Annual</strong> accounts<br />
143
The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation <strong>Trust</strong> - <strong>Annual</strong> <strong>Accounts</strong> <strong>2012</strong>-<strong>13</strong><br />
12.2 Revaluation reserve balance for property, plant & equipment<br />
L<strong>and</strong> Buildings Dwellings Plant <strong>and</strong> machinery Furniture &<br />
Total<br />
excluding<br />
fittings<br />
dwellings<br />
£000 £000 £000 £000 £000 £000<br />
At 1 April <strong>2012</strong> 12,800 9,683 772 152 29 23,436<br />
Depreciation Adjustment 0 (543) (154) (44) (9) (750)<br />
Impairment 0 0 0 (16) 0 (16)<br />
Revaluation 420 0 0 0 0 420<br />
At 31 March 20<strong>13</strong> <strong>13</strong>,220 9,140 618 92 20 23,090<br />
L<strong>and</strong> Buildings Dwellings Plant <strong>and</strong> machinery Furniture &<br />
Total<br />
excluding<br />
fittings<br />
dwellings<br />
£000 £000 £000 £000 £000 £000<br />
At 1 April 2011 <strong>13</strong>,026 9,287 640 271 38 23,262<br />
Depreciation Adjustment 0 (529) (319) (119) (9) (976)<br />
Impairment (1,745) (3,316) (1) 0 0 (5,062)<br />
Revaluation 1,519 4,241 452 0 0 6,212<br />
At 31 March <strong>2012</strong> 12,800 9,683 772 152 29 23,436<br />
Page 32<br />
144 <strong>Annual</strong> accounts
The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation <strong>Trust</strong> - <strong>Annual</strong> <strong>Accounts</strong> <strong>2012</strong>-<strong>13</strong><br />
<strong>13</strong> Economic lives of fixed assets Min life Max life<br />
Years<br />
Years<br />
Buildings exc Dwellings<br />
5 50<br />
Dwellings 5 5<br />
Plant <strong>and</strong> Machinery 2 15<br />
Transport Equipment 0 0<br />
Information Technology 1 15<br />
Furniture <strong>and</strong> Fittings 5 15<br />
Intangible assets (Software licenses) 5 15<br />
14 Investment Property 31 March 20<strong>13</strong> 31 March <strong>2012</strong><br />
£000 £000<br />
At Fair Value<br />
Balance at Beginning of Period <strong>13</strong>,124 10,777<br />
Net gain/(loss) from Fair Value Adjustments 1,692 2,347<br />
Balance at End of Period 14,816 <strong>13</strong>,124<br />
Income from Investment Properties 1,399 1,172<br />
Expenses of Investment Properties (895) (818)<br />
Surplus 504 354<br />
15 Impairments 31 March 20<strong>13</strong> 31 March <strong>2012</strong><br />
£000 £000<br />
Loss on L<strong>and</strong> 0<br />
762<br />
Loss on Plant <strong>and</strong> Equipment 0<br />
3,343<br />
Loss on Building 36<br />
92<br />
Total 36 4,197<br />
16 Capital Commitments 31 March 20<strong>13</strong> 31 March <strong>2012</strong><br />
£000 £000<br />
Property, plant <strong>and</strong> equipment 366 0<br />
Intangible Assets 21 0<br />
Total 387 0<br />
Contracted capital commitments at 31 March not otherwise<br />
included in these financial statements:<br />
<strong>Annual</strong> accounts<br />
145<br />
Page 33
The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation <strong>Trust</strong> - <strong>Annual</strong> <strong>Accounts</strong> <strong>2012</strong>-<strong>13</strong><br />
17 Inventory Movement - <strong>2012</strong>/<strong>13</strong> Total Drugs Consumables Energy Other<br />
£000 £000 £000 £000 £000<br />
Carrying Value at 1st April 2,916 1,084 1,705 10 117<br />
Additions 24,148 11,498 12,440 7 203<br />
Inventories recognised as expenses (24,022) (11,387) (12,435) (7) (193)<br />
Carrying Value at 31st March 20<strong>13</strong> 3,042 1,195 1,710 10 127<br />
17 Inventory Movement - 2011/12 Total Drugs Consumables Energy Other<br />
£000 £000 £000 £000 £000<br />
Carrying Value at 1st April 2,994 1,159 1,714 9 112<br />
Additions 23,977 10,828 12,967 6 176<br />
Inventories recognised as expenses (24,055) (10,903) (12,976) (5) (171)<br />
Carrying Value at 31st March <strong>2012</strong> 2,916 1,084 1,705 10 117<br />
146 <strong>Annual</strong> accounts<br />
Page 34
The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation <strong>Trust</strong> - - <strong>Annual</strong> <strong>Accounts</strong> <strong>2012</strong>-<strong>13</strong><br />
18.1 Trade <strong>and</strong> other receivables 31 March 20<strong>13</strong> 31 March <strong>2012</strong><br />
£000 £000<br />
Current<br />
<strong>NHS</strong> receivables - - revenue 10,140 7,015<br />
<strong>NHS</strong> receivables - - accrued income 1,302 2,834<br />
<strong>NHS</strong> provision for credit notes (2,143) (1,328)<br />
<strong>NHS</strong> PDC Dividend Receivable 65 0<br />
Sub Total <strong>NHS</strong> 9,364 8,521<br />
Prepayments 1,526 1,706<br />
VAT receivable 392 326<br />
Other receivables 3,237 5,035<br />
Provision for impaired receivables (1,200) (1,079)<br />
Total current trade <strong>and</strong> other receivables <strong>13</strong>,319 14,509<br />
Non-Current<br />
Other receivables 1,473 1,344<br />
Total non-current trade <strong>and</strong> other receivables 1,473 1,344<br />
18.2 Provision for impairment of receivables 31 March 20<strong>13</strong> 31 March <strong>2012</strong><br />
£000 £000<br />
At 1 April 1,079 1,170<br />
Increase/Reduction in in provision) 523 333<br />
Amounts Utilised (403) (426)<br />
Amounts Reversed 1 2<br />
At end of Period 1,200 1,079<br />
18.3.1 Ageing of impaired receivables 31 March 20<strong>13</strong> 31 March <strong>2012</strong><br />
£000 £000<br />
0 - - 30 days 209 311<br />
30 - - 60 days 4 11<br />
60 - - 90 days 6 10<br />
90 - - 180 days 114 63<br />
over 180 days 867 684<br />
Total 1,200 1,079<br />
18.3.2 Ageing of non-Impaired receivables 31 March 20<strong>13</strong> 31 March <strong>2012</strong><br />
past their due date £000 £000<br />
0 - - 30 days 2,257 567<br />
30 - - 60 days 671 2,998<br />
60 - - 90 days 517 233<br />
90 - - 180 days 592 649<br />
over 180 days 3,147 3,075<br />
Total 7,184 7,522<br />
19 Cash <strong>and</strong> cash equivalents 31 March 20<strong>13</strong> 31 March <strong>2012</strong><br />
£000 £000<br />
Balance at at 1 April 1,897 500<br />
Net increase in in year 2,009 1,397<br />
Balance at at end of Period 3,906 1,897<br />
Made up of<br />
Cash with Government banking services 3,667 1,887<br />
Commercial banks <strong>and</strong> cash in in h<strong>and</strong> 239 10<br />
Cash <strong>and</strong> cash equivalents as in in statement of financial position 3,906 1,897<br />
Cash <strong>and</strong> cash equivalents as in in statement of cash flows 3,906 1,897<br />
Page 35<br />
<strong>Annual</strong> accounts<br />
147
The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation <strong>Trust</strong> <strong>Annual</strong> <strong>Accounts</strong> <strong>2012</strong>-<strong>13</strong><br />
The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation <strong>Trust</strong> - <strong>Annual</strong> <strong>Accounts</strong> <strong>2012</strong>-<strong>13</strong><br />
20 Trade <strong>and</strong> other payables 31 March 20<strong>13</strong> 31 March <strong>2012</strong><br />
20 Trade <strong>and</strong> other payables 31 March 20<strong>13</strong> 31 March <strong>2012</strong><br />
£000 £000<br />
£000 £000<br />
Current<br />
Current<br />
Receipts in advance 1,111 142<br />
Receipts in advance 1,111 142<br />
<strong>NHS</strong> payables revenue 2,506 1,525<br />
<strong>NHS</strong> payables - revenue 2,506 1,525<br />
Amounts due to other related parties revenue 1,633 1,442<br />
Amounts due to other related parties - revenue 1,633 1,442<br />
Other trade payables capital 584 563<br />
Other trade payables - capital 584 563<br />
Other trade payables revenue 7,768 8,527<br />
Other trade payables - revenue 7,768 8,527<br />
Social Security costs 2,802 2,802<br />
Social Security costs 2,802 2,802<br />
Other payables 380 42<br />
Other payables 380 42<br />
<strong>NHS</strong> PDC Dividend Receivable 61<br />
<strong>NHS</strong> PDC Dividend Receivable 0 61<br />
Accruals 3,662 3,244<br />
Accruals 3,662 3,244<br />
Total Trade <strong>and</strong> Other payables 20,446 18,348<br />
Total Trade <strong>and</strong> Other payables 20,446 18,348<br />
21.1 Borrowings 31 March 20<strong>13</strong> 31 March <strong>2012</strong><br />
21.1 Borrowings 31 March 20<strong>13</strong> 31 March <strong>2012</strong><br />
£000 £000<br />
£000 £000<br />
Current<br />
Current<br />
Loans from Department of Health 390 390<br />
Loans from Department of Health 390 390<br />
Obligations under finance leases 705 705<br />
Obligations under finance leases 705 705<br />
Obligations under LIFT contracts 258 256<br />
Obligations under LIFT contracts 258 256<br />
Total current borrowings 1,353 1,351<br />
Total current borrowings 1,353 1,351<br />
Non-current<br />
Non-current<br />
Loans from Department of Health 7,075 7,465<br />
Loans from Department of Health 7,075 7,465<br />
Obligations under finance leases 1,990 585<br />
Obligations under finance leases 1,990 585<br />
Obligations under LIFT contracts 12,877 <strong>13</strong>,<strong>13</strong>6<br />
Obligations under LIFT contracts 12,877 <strong>13</strong>,<strong>13</strong>6<br />
Total non current borrowings 21,942 21,186<br />
Total non current borrowings 21,942 21,186<br />
The <strong>Trust</strong> is party to two Department of Health loans relating to capital investment as follows:<br />
The <strong>Trust</strong> is party to two Department of Health loans relating to capital investment as follows:<br />
The <strong>Trust</strong> is party to two Department of Health loans relating to capital investment as follows:<br />
• Loan 1 received 15th December 2009 for £4.0m. Repayments commenced on 15th March 2010 <strong>and</strong> will continue<br />
Loan until received 15th September 15th December 2034. 2009 The loan for £4.0m. carries Repayments a fixed interest commenced rate at on 4.11%. 15th March 2010 <strong>and</strong> will<br />
- Loan 1 received 15th December 2009 for £4.0m. Repayments commenced on 15th March 2010 <strong>and</strong> will<br />
continue until 15th September 2034. The loan carries fixed interest rate at 4.11%.<br />
• continue Loan until 2 received 15th September 15th September 2034. The 2010 loan for carries £4.6m. a fixed Repayments interest rate commenced at 4.11%. on 15th March 2011 <strong>and</strong> will continue<br />
until 15th September 2030.The loan carries a fixed interest rate at 3.25%.<br />
Loan received 15th September 2010 for £4.6m. Repayments commenced on 15th March 2011 <strong>and</strong> will<br />
- Loan 2 received 15th September 2010 for £4.6m. Repayments commenced on 15th March 2011 <strong>and</strong> will<br />
continue until 15th September 2030. The loan carries fixed interest rate at 3.25%.<br />
continue until 15th September 2030. The loan carries a fixed interest rate at 3.25%.<br />
21.2 Loans Payments Scheduled 31 March 20<strong>13</strong> 31 March <strong>2012</strong><br />
21.2 Loans Payments Scheduled 31 March 20<strong>13</strong> 31 March <strong>2012</strong><br />
£000 £000<br />
£000 £000<br />
to Year 658 674<br />
0 to 1 Year 658 674<br />
to years 644 658<br />
1 to 2 years 644 658<br />
Years 1,849 1,891<br />
2 - 5 Years 1,849 1,891<br />
More Than Years 7,045 7,647<br />
More Than 5 Years 7,045 7,647<br />
Total Future Gross Loan Commitments 10,196 10,870<br />
Total Future Gross Loan Commitments 10,196 10,870<br />
Less Interest Element (2,731) (3,015)<br />
Less Interest Element (2,731) (3,015)<br />
Total Future Net Loan Commitments 7,465 7,855<br />
Total Future Net Loan Commitments 7,465 7,855<br />
148 <strong>Annual</strong> accounts<br />
Page 36<br />
Page 36
The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation <strong>Trust</strong> - <strong>Annual</strong> <strong>Accounts</strong> <strong>2012</strong>-<strong>13</strong><br />
22 Finance lease obligations<br />
lease arrangements relate to a number of equipment leases which vary in length from three<br />
The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation <strong>Trust</strong> - <strong>Annual</strong> <strong>Accounts</strong> <strong>2012</strong>-<strong>13</strong><br />
to seven years.<br />
22 Finance lease obligations<br />
Minimum lease Minimum lease<br />
payments payments<br />
The lease arrangements relate to a number of equipment leases<br />
31<br />
which<br />
March<br />
vary<br />
20<strong>13</strong><br />
in length<br />
31<br />
from<br />
March<br />
three<br />
<strong>2012</strong><br />
to seven years.<br />
Amounts payable under finance leases £000 £000<br />
Minimum lease Minimum lease<br />
Gross lease liabilities<br />
payments payments<br />
Within one year 814 782<br />
Between one <strong>and</strong> five years 31 March 2,226 20<strong>13</strong> 31 March <strong>2012</strong> 611<br />
Future Amounts Finance payable Charges under finance leases (345) £000 (103) £000<br />
Present value of minimum lease payments 2,695 1,290<br />
Gross lease liabilities<br />
Net Within lease one Liabilities year<br />
Within Between one one year <strong>and</strong> five years<br />
814<br />
2,226 705<br />
782<br />
705 611<br />
Between Future Finance one <strong>and</strong> Charges five years (345) 1,990 (103) 585<br />
Present The LIFT value agreement of minimum is for a lease 25 year payments period which commenced in December 2,695<br />
2008. The scheme 1,290<br />
is<br />
for the provision of clinical accommodation on the Mount Vernon <strong>Hospital</strong> site which comprises<br />
Net<br />
23 four lease<br />
<strong>NHS</strong> surgical Liabilities<br />
Local theatres Improvement <strong>and</strong> outpatient Finance suites. <strong>Trust</strong> The (LIFT) lease contract payment (inclusive of capital <strong>and</strong> services)<br />
Within is £1,557k one per year annum (before RPI indexing).Under IFRIC 12, the asset is treated 705 as an asset of the 705<br />
Between <strong>Trust</strong>; the one substance <strong>and</strong> five of years the contract is that the <strong>Trust</strong> has a finance lease <strong>and</strong> 1,990 payments comprise 585<br />
23.1 two LIFT scheme on-Statement of Financial Position<br />
The LIFT<br />
elements:<br />
agreement<br />
imputed<br />
is for<br />
finance<br />
a 25 year<br />
lease<br />
period<br />
charges<br />
which<br />
<strong>and</strong><br />
commenced<br />
service charges.<br />
in December<br />
There are 2,695 2008.<br />
no guarantees,<br />
The scheme 1,290 is<br />
obligations<br />
for The the LIFT provision agreement or other<br />
of is clinical<br />
rights for a associated 25 accommodation year period with which the<br />
on<br />
scheme.<br />
the commenced Mount Vernon in December <strong>Hospital</strong> 2008. site The which scheme comprises<br />
for the provision of clinical<br />
accommodation on the Mount Vernon <strong>Hospital</strong> site which comprises four surgical theatres <strong>and</strong> outpatient suites. The<br />
23 four <strong>NHS</strong> surgical Local theatres Improvement <strong>and</strong> outpatient Finance suites. <strong>Trust</strong> The (LIFT) lease contract payment (inclusive of capital <strong>and</strong> services)<br />
Total is lease £1,557k payment obligations per annum (inclusive for on-statement (before of capital RPI indexing).Under <strong>and</strong> of financial services) is position £1,557k IFRIC LIFT 12, per the contracts annum asset (before is due: treated RPI indexing). as an asset Under of the IFRIC 12, the asset is<br />
<strong>Trust</strong>; treated the as substance asset of of the the <strong>Trust</strong>; contract the substance is that the of <strong>Trust</strong> the contract has a finance is that lease the <strong>Trust</strong> <strong>and</strong> has payments a finance comprise lease <strong>and</strong> payments comprise<br />
23.1 two elements: LIFT scheme imputed on-Statement finance lease of charges Financial<br />
<strong>and</strong> <strong>and</strong> Position service charges. 31 There There March are are 20<strong>13</strong> no no guarantees, 31 March obligations <strong>2012</strong> or other rights<br />
LIFT obligations associated Payments with or other Scheduled scheme. rights associated with the scheme.<br />
£000 £000<br />
Not later than one year 1,160 1,198<br />
Later Total than obligations one year, for not on-statement later than of five financial years position LIFT contracts due: 4,481 4,559<br />
Later than five years 22,300 23,383<br />
Sub total Gross Payments 31 March 27,941 20<strong>13</strong> 31 March 29,140 <strong>2012</strong><br />
LIFT Payments Scheduled £000 £000<br />
Less: Not later interest than element one year (14,806) 1,160 (15,748) 1,198<br />
Later than one year, not later than five years 4,481 4,559<br />
Total Later Future than five Net years LIFT Liabilities <strong>13</strong>,<strong>13</strong>5 22,300 <strong>13</strong>,392 23,383<br />
Sub total Gross Payments 27,941 29,140<br />
23.2 The <strong>Trust</strong> Charges is committed to expenditure to the following service charge payments over the life<br />
Less: of the interest LIFT scheme:- element (14,806) (15,748)<br />
Total Future Net LIFT Liabilities 31 March <strong>13</strong>,<strong>13</strong>5 20<strong>13</strong> 31 March <strong>13</strong>,392 <strong>2012</strong><br />
LIFT Expenditure £000 £000<br />
Not The 23.2 later <strong>Trust</strong> Charges than is committed to one expenditure<br />
yearto the following service charge payments over the life 397 357<br />
Later of the than LIFT one scheme:-<br />
The <strong>Trust</strong> is committed year, not to later the following than five service years charge payments over the life 1,747 of the LIFT scheme:- 1,669<br />
Later than five years 7,031 7,506<br />
Total 31 March 9,175 20<strong>13</strong> 31 March 9,532 <strong>2012</strong><br />
LIFT Expenditure £000 £000<br />
Not later than one year 397 357<br />
Later than one year, not later than five years 1,747 1,669<br />
Later than five years 7,031 7,506<br />
Total 9,175 9,532<br />
<strong>Annual</strong> accounts<br />
149
The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation <strong>Trust</strong> - <strong>Annual</strong> <strong>Accounts</strong> <strong>2012</strong>-<strong>13</strong><br />
24 Related party transactions<br />
During the year none of the <strong>Trust</strong> board members or members of the key management staff, or parties related to any of<br />
them, has undertaken any material transactions with The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation <strong>Trust</strong>.<br />
The United Kingdom Government is regarded as a related party to the extent that it controls the Department of Health <strong>and</strong><br />
National Health Organisations through legislation <strong>and</strong> funding by the taxpayer. During the year The <strong>Hillingdon</strong> <strong>Hospital</strong>s<br />
<strong>NHS</strong> Foundation <strong>Trust</strong> has had a significant number of material transactions with the Department, <strong>and</strong> with other <strong>NHS</strong><br />
entities as well as directly with the UK Government. These transactions are itemised below subject to a minimum of £100k for<br />
transactions <strong>and</strong> £50k for balances for the year to 31st March 20<strong>13</strong>. These limits are in accordance with the Agreement of<br />
balances exercise for Whole Government <strong>Accounts</strong>.<br />
24.1 Balances<br />
Current<br />
Receivables as at<br />
31 March 20<strong>13</strong><br />
Current<br />
Receivables as at<br />
31 March <strong>2012</strong><br />
Current Payables<br />
as at 31 March<br />
20<strong>13</strong><br />
Current<br />
Payables as at<br />
31 March <strong>2012</strong><br />
Entities £000s £000s £000s £000s<br />
Central And North West London MH <strong>NHS</strong> Foundation <strong>Trust</strong> 749 572 343 67<br />
Chelsea And Westminster <strong>Hospital</strong> <strong>NHS</strong> Foundation <strong>Trust</strong> 70 91 52 7<br />
Royal Brompton And Harefield <strong>NHS</strong> Foundation <strong>Trust</strong><br />
<strong>13</strong>9 103 67 149<br />
East And North Hertfordshire <strong>NHS</strong> <strong>Trust</strong> 2,839 1,745 624 197<br />
Imperial College Healthcare <strong>NHS</strong> <strong>Trust</strong> 78 46 223 391<br />
North West London <strong>Hospital</strong>s <strong>NHS</strong> <strong>Trust</strong> 23 112 64 32<br />
Royal Free Hampstead <strong>NHS</strong> <strong>Trust</strong> 37 239 154 110<br />
London Strategic Health Authority 22 181<br />
Barnet PCT 79 27<br />
Buckinghamshire PCT 77 61<br />
Croydon PCT 28 66 502<br />
Ealing PCT 474 1,420 10<br />
Hammersmith And Fulham PCT 2 82<br />
Hampshire PCT 142<br />
Harrow PCT 317 166<br />
Hertfordshire PCT 382 253<br />
<strong>Hillingdon</strong> PCT<br />
3,264 3,311 3 7<br />
Hounslow PCT 670 148<br />
Surrey PCT<br />
<strong>NHS</strong> Blood <strong>and</strong> Transplant (excluding Bio Products Laboratory)<br />
<strong>NHS</strong> Business Services Authority (incl <strong>NHS</strong> Supply Chain)<br />
110 72<br />
160<br />
685<br />
Bexley <strong>NHS</strong> Care <strong>Trust</strong> PCT 4 1 63<br />
Greenwich Teaching PCT 9 91 24<br />
Islington PCT 55<br />
Other <strong>NHS</strong> 704 1,037 181 189<br />
Total <strong>NHS</strong> 10,140 9,849 2,506 1,907<br />
Charitable Funds 0 <strong>13</strong>1 0 0<br />
Central <strong>and</strong> Local Government 392 326 4,435 4,244<br />
Total 10,532 10,306 6,941 6,151<br />
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24.2Transactions<br />
Revenue Year to 31<br />
March 20<strong>13</strong><br />
Revenue Year to<br />
31 March <strong>2012</strong><br />
Expenditure Year to Expenditure Year to<br />
31 March 20<strong>13</strong> 31 March <strong>2012</strong><br />
Entities £000s £000s £000s £000s<br />
Central And North West London MH <strong>NHS</strong> Foundation <strong>Trust</strong> 1,352 222 654 659<br />
Chelsea And Westminster <strong>Hospital</strong> <strong>NHS</strong> Foundation <strong>Trust</strong> 1<strong>13</strong> 170 7 1<br />
Kings College <strong>Hospital</strong> <strong>NHS</strong> Foundation <strong>Trust</strong><br />
Moorfields Eye <strong>Hospital</strong> <strong>NHS</strong> Foundation <strong>Trust</strong><br />
205 210<br />
90<br />
Royal Brompton And Harefield <strong>NHS</strong> Foundation <strong>Trust</strong><br />
169 126 195 120<br />
Royal Free London <strong>NHS</strong> Foundation <strong>Trust</strong> 276 206<br />
University College London <strong>NHS</strong> Foundation <strong>Trust</strong> <strong>13</strong>8 84<br />
East And North Hertfordshire <strong>NHS</strong> <strong>Trust</strong> 6,462 6,577 1,075 451<br />
Imperial College Healthcare <strong>NHS</strong> <strong>Trust</strong> 5 784 636<br />
North West London <strong>Hospital</strong>s <strong>NHS</strong> <strong>Trust</strong> 549 576 402 20<br />
Royal Free Hampstead <strong>NHS</strong> <strong>Trust</strong> 309 121<br />
West Hertfordshire <strong>Hospital</strong>s <strong>NHS</strong> <strong>Trust</strong> 108 1<strong>13</strong> 79<br />
London Strategic Health Authority 6,975 7,058<br />
Barnet PCT 189 251<br />
Bedfordshire PCT 159 124<br />
Brent Teaching PCT 552 527<br />
Buckinghamshire PCT 102<br />
Croydon PCT 5,069 4,976<br />
Ealing PCT 12,914 12,365 10<br />
Hammersmith And Fulham PCT 370 495<br />
Hampshire PCT 4,465 3,900 1<br />
Harrow PCT 4,965 4,339<br />
Hertfordshire PCT 4,985 4,553<br />
<strong>Hillingdon</strong> PCT<br />
<strong>13</strong>1,997 128,391 0<br />
Hounslow PCT 2,647 1,773<br />
Kensington <strong>and</strong> Chelsea PCT 146<br />
Leicestershire <strong>and</strong> Rutl<strong>and</strong> PCT 125<br />
Luton Teaching PCT 123 104<br />
Redbridge PCT<br />
104<br />
South East Essex PCT 506 514<br />
Surrey PCT 446 434<br />
West Sussex 101<br />
Westminster PCT 111 1,388 1<br />
<strong>NHS</strong> Blood <strong>and</strong> Transplant (excluding Bio Products Laboratory)<br />
<strong>NHS</strong> Business Services Authority (incl <strong>NHS</strong> Supply Chain)<br />
1,207 1,485<br />
3,720<br />
<strong>NHS</strong> Litigation Authority 5,286 4,684<br />
Department of Health 189<br />
Other <strong>NHS</strong> 2,737 5,365 825 560<br />
Total <strong>NHS</strong> 188,904 184,757 10,984 12,932<br />
Central <strong>and</strong> Local Government 0 0 21,147 19,784<br />
Total 188,904 184,757 32,<strong>13</strong>1 32,716<br />
<strong>NHS</strong> Business Agency is no longer included in related<br />
<strong>NHS</strong> party Business transactions. Agency It is now longer classified included as a in related party transations. It is now classidied as a commercial company.<br />
commercial company.<br />
Page 39<br />
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151
The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation <strong>Trust</strong> - <strong>Annual</strong> <strong>Accounts</strong> <strong>2012</strong>-<strong>13</strong><br />
25 Provisions Current Non-current<br />
31 March 20<strong>13</strong> 31 March 20<strong>13</strong><br />
£000 £000<br />
Pensions relating to other staff 165 1,948<br />
Total 165 1,948<br />
Current<br />
Non-current<br />
31 March <strong>2012</strong> 31 March <strong>2012</strong><br />
£000 £000<br />
Pensions relating to other staff 162 1,930<br />
Total 162 1,930<br />
Analysis of Movements 31 March 20<strong>13</strong> 31 March <strong>2012</strong><br />
£000 £000<br />
At start of period 2,092 2,120<br />
Arising during the year 123 87<br />
Utilised during the year- accruals (42) (40)<br />
Utilised during the year- cash (123) (122)<br />
Unwinding of discount 63 47<br />
At end of period 2,1<strong>13</strong> 2,092<br />
Expected timing of cash flows:<br />
Within one year 165 162<br />
Between one <strong>and</strong> five years 660 648<br />
After five years 1,288 1,282<br />
Total 2,1<strong>13</strong> 2,092<br />
Provisions are liabilities that are of uncertain timing or amounts which the <strong>Trust</strong> expects to be<br />
settled by a transfer of economic benefits. The provision for staff pensions has been calculated using<br />
information supplied by <strong>NHS</strong> Business Service Authority Pensions Division.<br />
£29,487k is included in the provisions of the <strong>NHS</strong> Litigation Authority at 31st March 20<strong>13</strong> in respect<br />
of clinical negligence liabilities of the <strong>Trust</strong>. (£25,482k 31st March <strong>2012</strong>).<br />
152 <strong>Annual</strong> accounts
The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation <strong>Trust</strong> - <strong>Annual</strong> <strong>Accounts</strong> <strong>2012</strong>-<strong>13</strong><br />
26 Contingent liabilities 31 March 20<strong>13</strong>31 March <strong>2012</strong><br />
£000 £000<br />
Contingent liabilities 46 16<br />
Total 46 16<br />
The <strong>Trust</strong>'s contingent liabilities include £40k relating to employee work injuries <strong>and</strong> £6k relating to public<br />
slips or falls. Further liabilities relate to the excess payable on claims made against the Liabilities to Third<br />
parties Scheme which is a non-clinical risk pooling scheme operated by the <strong>NHS</strong> Litigation Authority.<br />
27 Financial instruments 31 March 20<strong>13</strong> 31 March <strong>2012</strong><br />
Book Value Fair Value Book Value Fair Value<br />
27.1 Financial Assets £000 £000 £000 £000<br />
<strong>NHS</strong> Receivables 10,140 10,140 9,849 9,849<br />
Non <strong>NHS</strong> Receivables 518 518 1,663 1,663<br />
Other Investments 14,816 14,816 <strong>13</strong>,124 <strong>13</strong>,124<br />
Cash <strong>and</strong> cash equivalents (at bank <strong>and</strong> in h<strong>and</strong>) 3,906 3,906 1,897 1,897<br />
Total at end of period<br />
29,380 0 29,380 26,533 26,533<br />
31 March 20<strong>13</strong> 31 March <strong>2012</strong><br />
Book Value Fair Value Book Value Fair Value<br />
27.2 Financial Liabilities £000 £000 £000 £000<br />
Borrowings excluding Finance lease <strong>and</strong> LIFT liabilities 7,465 7,465 7,855 7,855<br />
Obligations under finance leases 2,695 2,695 1,290 1,290<br />
Obligations under LIFT contract <strong>13</strong>,<strong>13</strong>5 <strong>13</strong>,<strong>13</strong>5 <strong>13</strong>,392 <strong>13</strong>,392<br />
<strong>NHS</strong> Trade <strong>and</strong> Other payables excluding non financial assets 2,506 2,506 1,874 1,874<br />
Non-<strong>NHS</strong> Trade <strong>and</strong> Other payables excluding non financial assets 12,394 12,394 12,088 12,088<br />
Provisions Under Contract 2,1<strong>13</strong> 2,1<strong>13</strong> 2,092 2,092<br />
Total at end of period 40,308 40,308 38,591 38,591<br />
31 March 20<strong>13</strong> 31 March <strong>2012</strong><br />
27.2 Maturity of Financial Liabilities £000 £000<br />
In one year or less 15,576 15,475<br />
In more than one year but not more than two years 1,307 1,081<br />
In more than two years but not more than five years 4,539 1,571<br />
In more than five years 18,886 20,464<br />
Total 40,308 38,591<br />
<strong>Annual</strong> accounts<br />
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28. 28 Financial Risk Risk Rating Rating<br />
31 March 20<strong>13</strong> 31 March <strong>2012</strong><br />
Metric Criteria Actual Rating Weighting Rating Weighting<br />
EBITDA Margin Underlying Performance 5.1% 3 25% 3 25%<br />
EBITDA, % achieved Achievement of Plan 88.4% 4 10% 3 10%<br />
Return on investment Financial Efficiency -1.4% 2 20% 2 20%<br />
I&E surplus margin Financial Efficiency -0.9% 2 20% 2 20%<br />
Liquid ratio Liquidity days 17.7 3 25% 3 25%<br />
Weighted Average Weighting 2.70 100% 2.60 100%<br />
Financial Risk Rating 3 3<br />
Financial Risk Rating boundaries:<br />
Weighting 5 4 3 2 1<br />
EBITDA Margin 25% 11.0% 9.0% 5.0% 1.0%
The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation <strong>Trust</strong> - <strong>Annual</strong> <strong>Accounts</strong> <strong>2012</strong>-<strong>13</strong><br />
29 Prudential borrowing limit<br />
31 March 20<strong>13</strong> 31 March <strong>2012</strong><br />
£000 £000<br />
Total long term borrowing limit set by Monitor per Terms of<br />
Authorisation<br />
23,700 37,100<br />
Working Capital Factilty Facility limit set by by Monitor<br />
<strong>13</strong>,800 <strong>13</strong>,800<br />
Total Prudential Borrowing Limit 37,500 50,900<br />
Borrowing (as defined in the Prudential Borrowing Code) at 1 April 22,537 23,889<br />
Net actual borrowing/(repayment) in year 758 (1,352)<br />
Long term borrowing at 31 March 23,295 22,537<br />
The <strong>NHS</strong> foundation trust is required to comply <strong>and</strong> remain within a prudential borrowing limit. This is<br />
The made <strong>NHS</strong> up Foundation of two elements:- <strong>Trust</strong> is required to comply <strong>and</strong> remain within a prudential borrowing limit. This is<br />
made up of two elements:<br />
1) The maximum cumulative amount of long-term borrowing. This<br />
1. is set The by maximum reference cumulative to the four amount ratio tests of long-term set out in the borrowing. Prudential This Borrowing is set by reference Code for to <strong>NHS</strong> the foundation four ratio<br />
trusts.<br />
tests<br />
The<br />
set<br />
financial<br />
out in the<br />
risk<br />
Prudential<br />
rating set<br />
Borrowing<br />
under Monitor's<br />
Code for<br />
Compliance<br />
<strong>NHS</strong> foundation<br />
Framework<br />
trusts.<br />
determines<br />
The financial<br />
one<br />
risk<br />
of<br />
rating<br />
the ratios<br />
set<br />
<strong>and</strong> therefore can impact on the long term borrowing limit; <strong>and</strong><br />
under Monitor’s Compliance Framework determines one of the ratios <strong>and</strong> therefore can impact on the<br />
2) The amount of any working capital facility<br />
long term borrowing limit; <strong>and</strong><br />
approved by Monitor.<br />
Further information on the<br />
2. Prudential The amount Borrowing of any Code working for <strong>NHS</strong> capital foundation facility approved trusts <strong>and</strong> by Compliance Monitor. Framework can be found on<br />
Further Monitor's information website. on the Prudential Borrowing Code for <strong>NHS</strong> foundation trusts <strong>and</strong> Compliance<br />
Framework can be found on Monitor’s website.<br />
<strong>Annual</strong> accounts<br />
155
The <strong>Hillingdon</strong> <strong>Hospital</strong>s <strong>NHS</strong> Foundation <strong>Trust</strong> - <strong>Annual</strong> <strong>Accounts</strong> <strong>2012</strong>-<strong>13</strong><br />
30 Third 30 Third party party assets assets<br />
The <strong>Trust</strong> held £3,432 cash <strong>and</strong> cash equivalents at 31 March 20<strong>13</strong> (£1,823 at 31 March <strong>2012</strong>) which relates to monies held by the<br />
<strong>NHS</strong> <strong>Trust</strong> on behalf of patients. This has been excluded from the cash <strong>and</strong> cash equivalents figure reported in the accounts.<br />
31 March 20<strong>13</strong> 31 March <strong>2012</strong><br />
31 Losses 31 Losses <strong>and</strong> <strong>and</strong> Special Special Payments Payments<br />
Cases Value Cases Value<br />
£000 £000<br />
Losses of cash:<br />
Theft/Fraud 1 1 0 0<br />
Overpayment of salaries, wages,fees <strong>and</strong> allowances 3 9 4 1<br />
Bad debts <strong>and</strong> claims ab<strong>and</strong>oned<br />
Private patients 18 61 3 1<br />
Overseas overseas visitors 168 338 157 353<br />
Other 0 0 2 2<br />
Totals 190 409 0 166 357<br />
Amounts Recovered 1 1 1 2<br />
The amounts reported in this note were incurred as actual costs for the year to date <strong>and</strong> do not contain any accrued costs. These<br />
sums have been reported to <strong>and</strong> approved by the Audit Committee of the <strong>Trust</strong>.<br />
156 <strong>Annual</strong> accounts
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