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