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Contents
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Strategic Report
2
Directors’ Report and Annual Governance Statement
3
Sustainability Report
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4
Remuneration Report
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Membership of the Remuneration Committee
Statement on the policy on the remuneration of senior managers for current
and future years
Contracts
Termination liabilities for executive directors
Details of service contracts
Emoluments disclosure
Pensions disclosure
Pay multiples
Reporting of staff exit packages
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Introduction
Key achievements in 2014
Trust overview
Operational performance
Challenges we have faced
Annual accounts
Quality Performance
Workforce Summary
Introduction
Scope of Responsibility
Governance Framework of the Organisation
Key Governance Systems
Shadow Council of Governors
Board of Directors’ Review of Effectiveness
Board of Directors Member appraisals
The purpose of the system of internal control
The risk and control framework
Capacity to handle risk
Other risks to note
Internal audit reports
Quality governance
Quality Accounts 2014/15
Information governance
Review of effectiveness
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Summary Accounts
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Administrative details
Audit
Going Concern
Counterfraud
Openness and Accountability
Pensions
Staff Sickness and Absence
NHS Trust Manual for Accounts 2014-15
Statement of Comprehensive Income
Statement of Financial Position
Statement of Cash Flows
Trust Statement of Changes in Taxpayers’ Equity
Group Statement of Changes in Taxpayers’ Equity
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Directors’ interests
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7
Statement of the Chief Executive’s responsibilities
as the accountable officer of the Trust
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Statement of Directors’ responsibilities in respect of the accounts
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9
Independent Auditors’ Report to the Directors
of Royal United Hospital Bath NHS Trust
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Glossary
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Strategic Report
Introduction by the Chairman and Chief Executive
We are delighted to introduce the last annual report of the Royal United Hospital Bath as an NHS Trust, recording a
momentous seven months of development in our organisation’s history as we passed through the rigorous tests of
good governance, legal constitution, local representation and financial sustainability to achieve the very significant
milestone of Foundation Trust status.
The year opened on the heels of our selection as one of 12 trusts to lead the way on embedding an open, transparent
and compassionate culture as part of the national “Sign up to Safety” Campaign. It also hailed the start of operation
for some fantastic new facilities in the form of both our new Pathology building and an urgent care centre on site –
where GPs now work side by side with Emergency Care physicians. This paved the way to starting work on improved
accommodation for our information management, technology and medical records teams and a £1.6m investment in a
lighter yet more energy efficient environment across the whole hospital.
In May we formally submitted our application to Monitor, commencing the five-month journey of in-depth assessment
towards authorisation as a Foundation Trust. Meanwhile, taking on substantial new business in the form of both an
extension of our catchment area to the North West, following the closure of Frenchay hospital at the end of May and
ensuring the safe transfer of maternity services and staff on the 1 June. As a result of maternity moving to the RUH, a
new Division of Women and Children’s has been created covering services for maternity, gynaecology, paediatrics and
neonatology.
Brian Stables,
Amazing staff have been the bedrock of all our
Chairman
achievements. 2014 saw national recognition of this
at some of the most prestigious award ceremonies
in British healthcare – winning in the Safety in Surgical Recovery category and with no less than four
nominations across other categories at the Patient
Safety and Care Awards (HSJ and Nursing Times)
awards for patient Safety and Care. Our emphasis
on looking after our future workforce was also recognised by The Student Nursing Times who named the
Royal United Hospital Bath as the best for student
nurse placements.
Following significant investment in nursing in 2013
we have further enhanced our nursing strategy
in year, particularly investing in improvements to
midwife to birth ratios and creating a new role of Supervisory Senior Sister/
Charge Nurse on our wards to ensure we continue to offer the best support
to staff and can attract and retain the right people in the right roles. Our
nursing team have also run successful campaigns this year to achieve significant reductions in pressure ulcers and to raise awareness of sepsis. On
World Sepsis Day in September the RUH were able to celebrate the training
of over 600 staff across 60 days to ensure prompt diagnosis and treatment
of the condition.
Of course there have also been challenges to overcome including management of demand pressures and the forces of nature as storms in July 2014
caused some significant water damage and disruption to patient experience
across a number of areas of the main hospital. Despite these we have been
able to demonstrate overall good operational, quality and financial performance with work continuing to embed a range of new ways of working both internally and with partners to improve resilient delivery of the four hour target.
Finally, we would like to take this opportunity to once again thank all our
dedicated staff and many supporters – particularly the Friends of the Royal
United Hospital Bath and their 330 fantastic volunteers who regularly give up
their time to support us.
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James Scott, Chief Executive
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Trust overview
The Royal United Hospital Bath NHS Trust (RUH) provides general acute and emergency treatment and care for
a catchment area of Bath and North East Somerset, Wiltshire (West and North), Somerset (Mendip) and South
Gloucestershire. The catchment population of the RUH is around 400,000.
The Trust occupies a 52-acre site about one and a half miles from Bath city centre and became a National Health
Service Trust in 1992. All acute services are provided on the RUH site and the Trust also provides a range of
outpatient and diagnostic services from ten community sites.
In June 2014 The RUH took over maternity services for the area. In addition to the maternity wing at the hospital, the
RUH runs maternity units in Trowbridge, Chippenham, Frome, Paulton and Shepton Mallet.
The Trust’s lead commissioners are Wiltshire Clinical Commissioning Group, Bath and North East Somerset
Clinical Commissioning Group (B&NES CCG) and B&NES, Gloucestershire, Swindon and Wiltshire Specialised
Commissioning Group. B&NES CCG commissions on behalf of seven other CCGs, including Somerset and South
Gloucestershire.
Operational Performance
The Trust has had a very good year to date, performing well against a range of key access and outcome measures,
Table 1
Performance Indicator
Performing Weighting Q1
Q2
Four hour maximum wait in A&E
(All types from April 2014)
95%
1.0
94.4%
C Diff>= 72 hours post admission (
target for year = 37) Cum
37
1.0
RTT - admitted - 90% in 18 weeks
all specialties
90%
RTT - non-admitted - 95% in 18
weeks all specialties
Score
Q3
Score
94.3% 93.6%
1
93.6%
1
3
9
0
11
0
1.0
90.5%
90.5% 90.1%
0
90.1%
0
95%
1.0
95.7%
95.5% 91.6%
1
91.6%
1
RTT - open pathways in 18 weeks
92%
1.0
93.1%
92.4% 92.3%
0
92.3%
1
31 day diagnosis to first treatment
for all cancers
96%
0.5
98.0%
98.3% 96.9%
0
96.9%
0
31 day second or subsequent
treatment - surgery
94%
95.4%
97.6% 97.1%
31 day second or subsequent
treatment - drug treatments
98%
100%
100%
31 day second or subsequent
cancer treatment - radiotherapy
treatments
94%
98.8%
99.0% 97.0%
2 week GP referral to 1st
outpatient
93%
94.6%
94.0% 93.7%
2 week GP referral to 1st
outpatient - breast symptoms
93%
95.4%
95.6% 96.6%
62 day referral to treatment from
screening
90%
98.3%
95.6% 100.0%
62 day urgent referral to treatment
of all cancers
85%
88.7%
91.6% 86.9%
0.5
Yes
Yes
8.5
1
1
Access to healthcare for people
with learning disabilities - Trust
compliance
Governance Risk Rating
n/a
1.0
0.5
1.0
Oct 14
11
97.1%
100%
0
0
97.0%
0
93.7%
0
96.6%
100.0%
0
Yes
0
0
86.8%
Yes
2
Green
8
100%
0
2
Green
including cancer waiting times, 18 weeks RTT and Clostridium Difficille. The year to date position is shown in Table 1.
The Trust scored highly against the Trust Development Agency Accountability Framework five key quality domains
Table 2
Quality
TDA Accountability June
Framework 2014/15 2014
Caring
5
Effective
5
Responsive
5
Safe
4
Well Led
5
Overall Quality
5
July
2014
4
5
5
5
4
5
August
2014
5
5
5
5
5
5
September
2014
4
5
4
5
4
5
October
2014
4
5
4
5
4
5
shown in Table 2, reported from June 2014:
Internal Trust reports against an Integrated Balanced Score Card, providing monthly performance under the five
domains: Caring, Effective, Responsive, Safe and Well led. As Maternity services joined the Trust in June 2014, key
reporting metrics were reported to the Board.
Challenges we have faced
Four hour performance
We delivered green rated performance in May and July. The remaining months saw an increase of 150 Emergency
Department attendances per month – (2.0%). We saw unprecedented levels of emergency admissions peaking at
14%, an extra 500 patients in one month compared with last year. This was mirrored right across the region.
We are proud of our supportive relationship with the ambulance service and cooperate fully to ensure that they reach
their patients in good time by making sure no crews are delayed at the ED.
We have developed an Urgent Care Improvement Board which has identified key issues which we have worked with
Figure 1
RUH ED 4 Hour Monthly Performance Monitor - Type 1
100%
95%
90%
Actual Performance
85%
Standard
Target Trajectory - Low
80%
Target Trajectory - Stretch
75%
70%
Apr-14
May-14
Jun-14
Jul-14
Aug-14
Sep-14
Oct-14
Nov-14
Dec-14
Jan-15
Feb-15
Mar-15
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our Community partners to resolve. We agreed a trajectory to get back on track, as illustrated in Figure 1.
We have focused on three work streams:
•
Front door – ensuring patients flow freely from the ED to the medical and surgical assessments. We have
formalised the pathway for patients referred directly by their GP. We have seen a much improved patient
experience for patients through Emergency Surgery Ambulatory Care (ESAC), shorter waits, reduced length of
stay and high patient satisfaction.
•
Flow – we have changed the way our site and bed management teams are working, focusing much more on
getting patients to the right bed first time. Ward teams have been instrumental in making this happen, ensuring
that patients are given the best care in the most appropriate setting by the right teams.
•
Back door – We have worked closely with our community partners to improve the pace at which patients can
leave the hospital. We are working to further improve the delays for patients awaiting onward placement. We
have made some progress but there is still a lot to do.
We invited the Emergency Care Intensive Support Team (ECIST) back to the hospital to see what more could be
done. We took note of changes required, which included mobilising of the ambulatory care units and completed all
actions in preparation for winter.
We made changes to our four-hour all types reporting to include the on-site Urgent Care Centre following guidance
from NHS England in October 2014 in agreement with our Commissioners.
18 weeks RTT
We have maintained delivery of elective care for our patients, managing competing demands of emergency and
planned care.
Figure 2
18 weeks RTT - Admitted pathway 90%
95.0%
94.0%
93.0%
92.0%
91.0%
90.0%
89.0%
88.0%
Apr-14
May-14
Jun-14
Performance
Jul-14
Aug-14
Sep-14
Oct-14
Admitted pathway target
As emergency pressures continued through the summer months, the number of patients waiting more than 18
weeks increased. This was in part due to increased levels of in referrals across the specialties of Dermatology,
Gastroenterology, General Surgery, ENT and Oral Surgery.
In response a number of actions were taken:
•
•
•
The Trust employed additional consultants across the range of specialties
The Commissioners have put in place robust referral management services to help to manage demand
The Trust has further developed relationships with alternative providers within the local area, providing greater
choice and improved waiting times for our patients.
Looking forward the Trust has plans in place to treat the longest waiting patients during November in line with the
National 18 weeks RTT guidance.
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We have performed well against the 6 week diagnostic maximum wait providing early diagnosis and treatment for our
patients. Performance for the period to October 2014 is provided in Table 3.
Figure 3
Patients waiting > 18 weeks
Patient numbers
800
600
400
330
200
0
Apr-14
May-14
Jun-14
Jul-14
Patients waiting > 18 weeks
Aug-14
Sep-14
Oct-14
Target > 18 weeks target
Table 3
Diagnostic
Tests within April
6 weeks
Performance
(%)
0.2
2014
May
June
July
Aug
Sept
Oct
1.1
0.2
0.2
0.3
0.2
0.2
Annual accounts
Context
The RUH was granted licence to operate as a Foundation Trust on 1st November 2014. As a result, two sets of
accounts have to be submitted, one for each legal entity: one as an NHS Trust for seven months 1st April 2014 to 31st
October 2014) and one as an NHS Foundation Trust for five months (1st November to 31st March 2015).
This report relates to the period 1st April 2014 to 31st October 2014, when the RUH was an NHS Trust. The Trust
reported a surplus for the seven month period of £2.1m before accounting for technical adjustments (accounting for
donated assets and impairments).
In addition, as reported as part of the Group accounts, the Trust consolidated the RUH Hospital charitable fund
accounts into the Trust accounts this year as required. The impact on Income and Expenditure for the year was a net
of £10k. This consisted of donation income offset by employee expenses and non-pay expenses. The impact on the
Statement of Financial Position was £6.9m, mainly in charitable investments.
As an NHS Trust, the Trust’s performance is measured against its statutory financial duties, the Trust achieved all
targets and performance is summarised as follows:
Plan
Income and expenditure surplus (excluding the impact of
impairments and accounting for donated assets)
Income and expenditure retained surplus
Actual
Variance
£3m
£2.1m
£0.9m
£3.6m
£1.1m
£2.6m
Cost improvement plan (QIPP)
£5.8m
£5.5m
£0.4m
External Financing Limit (EFL)
£0.3m
£0.3m
-
Capital Resource Limit (CRL)
£11.3m
£6.3m
£5m
3.5%
3.5%
-
Capital Absorption rate %
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The Trust achieved a planned surplus of £1.1m, which was £2.6m lower than plan. The actual retained surplus as
at 31st October included an impairment £1.3m for the Pathology building that was fully commissioned in June 2014;
however the plan did not expect this impairment to happen until March 2015. The other key variance is the under
recovery of donated income £0.5m due to the delay in the friends coffee shop refurbishment and the purchase of
medical equipment.
The Trust’s final reported surplus is adjusted to remove the effects of accounting for donated assets leaving a net
surplus of £2.1m, by achieving this target the Trust has achieved its statutory breakeven duty and ensured that its inyear expenditure has not exceeded its income.
The Trust has also achieved its other key financial duties, both the External Financing Limit (EFL), this sets out how
the Trust must manage its cash flow and borrowing requirements and Capital Resource Limit (CRL), the maximum
a Trust can invest in fixed assets during the year. The Trust also has achieved its capital absorption rate, the Trust is
required to make a return on assets it employs of 3.5% based on actual assets help through the year, the Trust then
pays 3.5% of this value as its dividend payment.
Capital spend
The capital programme for the seven months totalled £7m, the key developments included the near completion of the
IM&T building (£1.9m), which was fully commissioned in January 2015 and the replacement electronic patient record
system (EPR) (£0.6m).
Capital plan
April- Nov Plan
(£’000)
April- Nov Actuals
(£’000)
April- Nov Variance
(£’000)
Estates
2,704
1,271
(1,433)
IM&T
2,345
1,310
(1,036)
Medical Equipment
1,483
793
(690)
Strategic capital schemes
4,344
3,644
(700)
Total capital
10,876
7,018
(3,859)
Better payment practice code
The Trust has responsibility to pay its suppliers in line with the payment terms agreed at the time of purchase. Failure
to do this harms the reputation of the Trust and the wider NHS, as well as damaging supply sources and straining
relationships with suppliers.
The Trust has adopted the national NHS Better payment practice code. The target set is that at least 95% of all trade
creditors should be paid within 30 days of a valid invoice being received or the goods being delivered, whichever is the
later – unless other terms have been agreed previously.
The Trust’s detailed performance against this target for non-NHS creditors is set out in note 10 in the annual accounts.
Measure of compliance
2014-15 M1-7
Number
2014-15 M1-7
£000s
Total Non-NHS Trade Invoices Paid in the Year
40,923
71,963
Total Non-NHS Trade Invoices Paid Within Target
39,595
68,816
Percentage of NHS Trade Invoices Paid Within Target
96.8%
95.6%
Total NHS Trade Invoices Paid in the Year
1,116
21,733
Total NHS Trade Invoices Paid Within Target
1,054
20,613
Percentage of NHS Trade Invoices Paid Within Target
94.4%
94.8%
Non-NHS Payables
NHS Payables
Future Prospects
The financial outlook for the NHS as a whole continues to be a challenging one given the continued requirement by
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the Government to reduce public expenditure. The Trust had submitted its annual plan to the Trust Development
Authority (TDA) which included delivering a savings plan of £11m in 2014/15. As at the end of October the Trust had
achieved 94% of the savings planned to date, putting it in a strong position to meet the on-going challenges.
Now the Trust has been authorised as a Foundation Trust the most significant development is the acquisition of
the Royal National Hospital for Rheumatic Diseases planned for February 2015. The acquisition will ensure the
continuation of services currently provided on the RNHRD site, including long term rheumatic, pain and fatigue
conditions. Investment will continue in the Trust’s asset base with the investment of circa £31m in 2015/16 to construct
a new pharmacy building and the continuation of the electronic patient record system.
The Trust’s future financial plans do require the Trust to ensure that key financial risks are addressed. The main
financial risks facing the Trust include:
•
•
•
The delivery of the required surpluses each year to be able to implement the Trust Estates strategy
•
•
The Trust has identified a number of factors which will strengthen its ability to respond to these potential risks
•
The level of QIPP delivery in 2014/15 year to date shows confidence, the embedded processes and clear
governance structure reduces the risk of underperformance in year.
The ability to deliver the full savings plans year on year
To be able to respond flexibly to changes in demand, both from potential increases in activity and changes more
locally as commissioners continue to implement changes to community pathways
The Trust is working closely with its commissioning partners and contracts are signed for 2014/15, giving more
certainty to the financial position
Accounting Policies
The Trust reviews its accounting policies regularly, following the requirements of International Financial Reporting
Standards and Monitor’s Annual Reporting Manual. These policies are discussed and agreed at the Audit Committee
and reflect the changing nature of the guidance and the external environment within which the Trust functions.
Going concern
The RUH has prepared its 2014/15 accounts on the basis of being a going concern. The Directors have a reasonable
expectation that the RUH has adequate resources to continue operational existence for the foreseeable future. For
this reason, they continue to adopt the going concern basis in preparing the accounts.
Countering Fraud
The Trust works closely with the NHS Counter Fraud Service to tackle fraud and corruption in all areas of income
and expenditure. The aim of the service is to reduce fraud to an absolute minimum thereby releasing much needed
resources for providing better patient care and services. The Local Counter Fraud Specialist (LFCS) works throughout
the year to prevent and investigate fraud issues and the causes of fraud within the Trust. This is done through a
combination of planned risk assessments, and investigations in response to Trust matters raised by staff or other
sources. The importance of countering fraud and the existence of the service is promoted through staff training,
newsletters and on the staff intranet.
External Audit
During 2014-15 The Trust engaged Grant Thornton LLP as its external auditors. The fees paid to the auditor in respect
of the statutory audit for the period is £40,549, excluding VAT.
The directors who held office at the date of the director’s report confirm that so far as they are aware there is no
relevant audit information of which the Trust’s external auditors are unaware. They also confirm they have taken all
steps that they ought to have taken as directors in order to make themselves aware of any relevant audit information
and to establish that the auditors are aware of that information.
Auditor’s Report
The independent Auditor’s report to the Directors of the Trust can be found in the introduction to the Accounts.
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Quality Performance
This year has been very challenging as we continue to see a high number of patients requiring admission to hospital.
In 2013 we introduced our Urgent Care Programme and other initiatives to support patient flow in the hospital.
During the early part of October 2014 there was a week-long focus supporting the principle, which we called ‘Green
space – space for tomorrow’, seeing how we could better support the discharge process. We piloted several pieces of
work which all support the principle of creating space.
The successful discharge of patients following an emergency admission to hospital, in particular older people,
relies on effective joint working between NHS, social care partners and the independent sector. A joint approach is
important to anticipate and promptly respond to potential bottlenecks or obstacles to an early supported discharge. We
spent time this year reviewing our processes and have created a single form which all agencies can feed in to and this
is helping to streamline the discharge and referral process.
The Emergency Care Intensive Support Team (ECIST) were invited back to the RUH to review our schemes as part of
the Urgent Care Programme, and their feedback has been very positive, recognising the work we have undertaken.
The Trust has not actually run maternity services here since 1992, so it was exciting news at the beginning of 2014 to
learn that we had won the bid to provide maternity services, not only at the hospital, but at community birthing centres
in Wiltshire and Somerset. The handover of services from Great Western Hospital to the RUH took place on 1 June
2014 and we are pleased that the integration of maternity staff, putting new policies into place and the implementation
of a new computer system went extremely well.
To rationalise our services we set up a third division to encompass Gynaecology, Maternity and Paediatrics. The new
Women and Children’s Division is focussed on family, and patient-centred care, and we believe that we will now be
able to look after mothers and babies together much more effectively. This has given us the opportunity to streamline
a lot of the processes involved in looking after patients.
Our innovative work to improve patient safety meant that the RUH was chosen to help lead a national campaign. In
a major speech on patient safety, Mr Hunt said that the RUH would be one of 12 Trusts in England who will form the
vanguard of ‘Sign up to Safety’ – a campaign which aims to embed an open, compassionate and transparent culture
within the NHS and to reduce incidents of avoidable harm to patients. This is tremendous news for the Trust and
reflects the hard work of all our staff in ensuring we are recognised as one of the leading lights in pioneering patient
safety in England. We have identified five priority areas for improvement – these are Sepsis, Acute Kidney Injury,
Deteriorating patient, Venous Thromboembolism and falls.
A new Urgent Care Centre opened at the RUH in April, for patients who have an urgent need to see a GP or nurse but
whose illness or injury is not life-threatening and does not require a visit to the Emergency Department. This service is
available 24 hours a day, seven days a week. Patients are triaged on arrival to the Emergency Department to ensure
that they receive prompt, effective and appropriate care.
Fast access to high quality safe treatment was highlighted by the Care Quality Commission (CQC) which found that
the Trust met all essential quality and safety standards following an inspection of the hospital by the CQC in December
2013. The Trust received a positive report from the inspection; however there were a number of recommendations
made which the Trust has focused on throughout 2014/15. The CQC has also introduced an intelligent monitoring
system. This involves more than 150 different indicators to monitor the quality of the services we provide. These
indicators relate to the five key questions the regulator asks – are services safe, effective, caring, responsive, wellled? Our risk score is very low, just two out of a possible 164 which gives us a risk rating of six, making us one of the
lowest risk hospitals in the country.
We continue to monitor our Hospital Standardised Mortality Ratio (HSMR) which remains below average at 92.69
for the period September 2013 to August 2014. HSMR is a complex indicator and compares the actual number of
deaths in hospital with the predicted number which takes into account a patient’s age, medical problems and other risk
factors. It is an indicator of healthcare quality that measures whether the mortality rate at a hospital is higher or lower
than you would expect. Our HSMR is lower than expected meaning that the likelihood of patients dying at the RUH is
better than the average. (A score of 100 indicates that the actual number of deaths matched the expected number).
In April we implemented a new way of improving care we provide to patients, called rapid spread, with the aim of
eliminating all avoidable hospital-acquired pressure ulcers. This approach used a systematic 12-week programme
combining proven improvement techniques and evidence-based practice to deliver the outcome of eliminating
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pressure ulcers quickly. Staff showed real commitment and willingness to take on a new idea and work with it to
ensure patients have an improved experience whilst in our care.
We immersed nearly 100 staff in the new way of working using a patient story as a catalyst for change. Staff from
a number of disciplines were trained in the new pressure ulcer prevention pathway, the SSKIN care bundle and
completing new documentation. We recognised the importance of involving the wider team, such as staff from the
medical equipment library who are responsible for delivering pressure ulcer relieving mattresses.
Just three months later, we achieved 96% of staff trained and competent to use the new care bundle.
We believe that our results are testament to the dedication and commitment of our staff:
•
Nine Category 2 pressure ulcers were recorded from April to July 2014, in the same period last year, when we
had 88 – that’s a 90% reduction on last year’s figure;
•
No Category 3 and Category 4 pressure ulcers were recorded from April to July 2014, compared to last year,
when we recorded five.
We have made real progress in promoting the early recognition and treatment of Severe Sepsis, one of the Trust’s
safety priorities for 2014/2015, particularly for patients admitted to our Emergency department. The instigation of
prompt treatment within an hour and the use of the ‘Sepsis 6’ bundle has shown improvement in compliance and
CQUIN targets have been achieved.
The Trust has appointed Sepsis nurses who are having a positive impact on performance and training staff across the
wards. In the coming year, we plan to spread Sepsis work to the community and increase public awareness.
We continue to run our very successful ‘See it My Way’ programme which provides a unique opportunity for staff to
see things from a patient or family perspective. This year, the highly sensitive topic of organ donation was discussed –
and it proved to be an emotional couple of hours with some inspirational and frank words from guest speakers.
The RUH believes that an empathetic understanding of the patient’s experience is vital for delivering great quality care
– and, for delivering great care to patients with dementia, we have developed our five-year vision.
A special ‘ageing suit’, created by health solutions specialists Hill-Rom Liko, was developed to give staff the
opportunity to experience the physical impact of dementia and this has proved a useful training tool.
A series of events and training initiatives took place at the hospital throughout National Dementia Awareness Week in
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May 2014, and a number of projects to improve dementia care at the RUH have been established including:
•
•
•
Specially designed dementia garden for Combe, Pulteney and Midford wards;
•
‘The Parlour’ – a specially created retreat on Forrester Brown ward for elderly patients and those with Dementia.
Re-evaluation of and renewed focus of our successful Dementia Charter Mark scheme;
Dementia Champions training as part of the Alzheimer’s Society’s drive to see one million Dementia Friends
trained by 2015;
It was a proud night for the RUH in July 2014 when a number of our staff were recognised for the great work they are
doing to improve patient safety at a glittering awards ceremony in London. Held jointly by the Health Service Journal
(HSJ) and the Nursing Times, the Patient Safety and Care Awards celebrate excellent, safe and innovative care
throughout the health service. The awards recognise those organisations successfully implementing initiatives whilst
improving quality, clinical efficiency, effectiveness and safety at the same time.
We were well-represented on the shortlist – with three teams nominated across four separate categories. We were
delighted that our team led by Dr Lesley Jordan were named winners in the Safety in Surgical Recovery category for
their work in reducing the incidence of Perioperative Hypothermia.
Senior Sister Natasha Howard and her team were nominated in the Patient Safety in Hospital Care category of the
awards for their work on improving hydration in an acute setting, and the Acute Diabetes Team, led by Dr Marc Atkin,
were nominated in both the Diabetes Care and Patient Safety in Hospital Care categories.
For the past three years, RUH teams have been finalists at these prestigious awards. This year we were represented
by four separate entries in the finals and we are extremely proud to have won the award for Safety in Surgical
Recovery. It is great to see our staff recognised for the work they do, and for the innovations they have developed.
With input from staff and patient representatives, the Trust Board of Directors agreed a two-year Quality Strategy
in 2014 which aims to ensure every patient receives the safest, highest quality care personalised to their needs.
The focus is on ensuring that our patients have the best clinical outcomes, delivered with compassion in a safe
environment, resulting in the best possible experience. The Quality Strategy outlines the approach everyone will take
to improve quality. It builds on our strengths and complements our governance, risk and safety infrastructure, but also
addresses those areas where we know we could improve. It outlines our priorities, and sets out what success will look
like in 2016, together with the framework for delivery and the methodology for measuring our progress.
Workforce Summary
Service Line Management (SLM) Development
Service Line Management is about becoming a clinically led organisation. The SLM Development programme
comprises four half-day sessions focusing on clinical strategy development, quality and service development,
business management, finance and performance.
This bespoke programme is designed and delivered by RUH staff to meet the development needs of clinical leaders
responsible for service lines. It enables doctors, managers and senior nurses to learn together about leading services
in a complex environment. In addition, clinical teams have benefited from team strategy sessions which enable whole
teams to develop a shared vision and work plan for their service. Individual and team coaching has been provided to
assist clinicians to develop their leadership skills.
Staff Engagement
The Trust views staff engagement as a high priority. There is a convincing and growing evidence base which makes
the link between engaged staff and high quality patient care.
Two years’ ago the Trust adopted a different approach to the way in which it identifies what helps and hinders staff
engagement. Rather than relying entirely on the information in the annual NHS Staff Survey the Trust analysed an
array of information gathering mechanisms to identify what is important to staff. This information was and continues to
be tested with staff, staff governors, staff side representatives and RUH Leaders.
Over the past two years the Trust engagement score, as evidenced in the NHS Staff Survey, has improved from 3.63
in 2012 to 3.78 in 2013. The national average score for acute trusts in 2013 was 3.74 which means that the RUH’s
score was above (better than) average when compared with similar trusts.
16
Our staff engagement activity is themed into five areas and over the past year has included:
Embed continuous quality improvement
•
•
•
Success stories and staff innovations publicised in @RUH Bath and In the Week
•
RUH is one of 12 Trusts chosen to help lead a national campaign ‘Sign up to Safety’ because of its innovative
work to improve patient safety
•
Spring to Green, Green Line, Perfect Day approach introduced.
Innovation Panel introduced
A link from ‘In the Week’ to the nomination process for RUH awards makes it easier for staff to nominate and
acts as a reminder to do so
Embed Service Line Management
•
•
•
•
•
•
•
•
Service Line Management (SLM) Development Programme
SLM Next Steps discussion taken place
Oversight of SLM now sits within the Divisions as part of business as usual
Leadership development programme for ward sisters launched
Matron Development programme
Individual and Team coaching sessions offered to SLM triumvirate
Good take up of NHS Leadership Academy programmes from RUH staff
RUH Leaders Forum introduced.
17
Continuing and Personal & Professional Development
•
•
•
Customer Service training programme piloted in Women & Children’s Division
•
Preceptorship programme for newly registered professionals – additional sessions on discharge planning and
human factors as a result of requests from staff
•
In-situ simulation in mobile MRI van – response to radiographer’s concerns regarding their own health and
safety, and changes implemented to improve patient and staff safety
•
•
•
Resuscitation Link practitioners immersion event
Acute Care Programme introduced
IV workbook update and IV assessor training revamp – response to staff concerns raised during training
programmes, and in partnership with UWE to support transfer from student nurse to staff nurse
Conflict Resolution training revamped and shortened in response to staff feedback
In-situ simulation training established within Women & Children’s Division.
Communication
•
•
Listening events within divisions e.g. cleaning staff;
•
•
•
•
•
•
In the Week, @RUH, Open Staff Meeting, Director Patient Safety visits;
Fresh Eyes (formerly known as Happy Anniversary) listening event, an opportunity to hear about new starters’
experience of working at the RUH;
RUH annual objectives circulated with payslips;
Editorial Board open to staff to attend with their ideas;
Friends & Family test for staff implemented;
Trauma Risk Management (TRIM) process introduced;
Visits to all birthing centres as part of welcome to RUH and to hear and respond to concerns raised.
Friends & Family Test (FFT) for Staff
The Trust was required to implement the FFT during 2014/15 ensuring that all staff are asked two questions over the
course of 12 months. The questions ask about the extent to which they would or would not recommend the Trust as a
place to receive treatment and as a place to work.
In the first two quarters specific staff groups were asked to respond to the survey using a link from an email. In
quarter 1 the response rate was 34%. A total of 581 responses were received from the 1729 staff surveyed which
included AHP’s, healthcare scientists, medical, admin & clerical, general management.
In quarter 2 the response rate was lower at 18%. A total of 319 responses were received from the 1780 staff surveyed
which included support to AHPs, support to healthcare scientists, registered nurses & midwives, support to nursing
e.g. HCAs, maintenance & ancillary.
In summary, 76% (headcount: 3509) of staff have been sent a survey and 26% (headcount: 900) of those asked
completed the survey.
In quarter 3 all staff will be asked for their views via the NHS National Staff Survey. In quarter 4 all staff will be asked
to respond to the FFT for staff. Information about how to do so will be communicated to staff via their payslips.
This information will be analysed at the end of March 2015 to identify priority areas for staff engagement activity in the
coming year.
Leadership Development
This year we have introduced a bespoke development programme for Matrons which has helped them develop the
Nursing Strategy for the Trust.
We have launched a leadership programme specifically aimed at Ward Sisters and Charge Nurses, to provide an
18
Substantive
Apr
Headcount Bank
4253
407
Total
WTE
4249
May
432
Jun
4565
466
Jul
4603
Aug
476
4612
Sep
498
4661
Oct
512
4674
518
4656
4685
5031
5079
5110
5173
5192
3591.53
3594.85
3840.31
3880.87
3891.65
3940.18
3946.31
opportunity for them to come together to explore, challenge and improve their leadership practice.
The programme objectives are to develop awareness of personal leadership qualities and to identify personal
strengths and limitations:
•
•
•
•
•
Self-knowledge
Self-awareness
Resilience and determination
Self-confidence
Reflection.
It provides leaders with a ‘toolkit’ and strategies to help them develop leadership behaviours which:
•
•
•
•
Reduces risk and makes healthcare safer
Promotes patient and family centred care
Creates an environment in which improving quality is part of everyday work
Fosters team working and engagement.
Evaluations of the first cohort are very positive and we plan to offer the opportunity to every ward sister over the
coming two years.
Pay Progression
Following the changes that came into effect on 1 April 2013 to the national Agenda for Change Terms & Conditions
(Pay Circular (AforC) 2/2013), pay progression through all incremental pay points is now conditional upon individuals
demonstrating that they have the requisite competencies for their role and that they have demonstrated the required
level of performance and delivery during the review period. They must also have demonstrated satisfactory conduct,
attendance and positive behaviours linked to values.
In effect, this is a way of fostering individual motivation by rewarding effort, achievement and good performance with
financial reward. Consequently expectations around standards and performance, and how these will be measured,
have also been made clear.
Consultant Job Planning
The purpose of this new policy is to support the process of consultant job planning, recognising the links to appraisal.
It consolidates, in one document, local agreements and approaches developed at RUH since the introduction of
the new consultant contract, clarifying responsibilities and timescales for action. This policy helps ensure that
clinical services are aligned to utilise consultant resources most effectively and to deliver most efficiently the activity
commissioned by CCGs and the nationally determined patient care standards such as waiting list targets. Other
objectives such as service changes or leadership of key initiatives can also be agreed as part of this process.
Maternity
320 maternity staff transferred to the RUH from the Great Western Hospital NHS Foundation Trust in June following
the successful award of the maternity services tender to the RUH. Support from the HR Directorate has been ongoing to welcome these staff to the RUH and establish a successful Women and Children’s division to take these
services forward.
19
Directors’ Report and Annual
Governance Statement
Introduction
This Annual Governance Statement covers the period from 1 April 2014 to 31 October 2014. There is a separate
Annual Governance Statement which covers the period from 1 November 2014 (the date when the Trust became an
NHS Foundation Trust) until 31 March 2015.
The Chief Executive, in his capacity as Accounting Officer for the NHS in the Department of Health, requires the Accountable Officer (AO) for the Royal United Hospital Bath NHS Trust to give him assurance about the stewardship of
his organisation. For the Royal United Hospital Bath NHS Trust the Accountable Officer is James Scott, Chief Executive.
Scope of responsibility
The Board of Directors is accountable for internal control. As Accountable Officer, and Chief Executive of the Board of
Directors, I have responsibility for maintaining a sound system of internal control that supports the achievement of the
organisation’s policies, aims and objectives. I also have responsibility for safeguarding the public funds and the organisation’s assets for which I am personally responsible as set out in the Accountable Officer Memorandum.
The governance framework of the organisation
The Trust has developed its governance structures over a period of time to deliver an integrated governance agenda.
Integrated governance is the combination of systems, processes and behaviours which the Trust uses to lead, direct
and control its functions in order to achieve its organisational objectives.
The Board of Directors leads on integrated governance and delegates key duties and functions to its seven standing
sub-committees. In addition, the Board reserves certain decision-making powers including, decisions on strategy and
budget setting. The following diagram gives an overview of the integrated governance structure.
The roles and responsibilities of all committees are described more fully below. There are three key committees within
the structure that provide assurance to the Board of Directors. These are:
•
•
•
The Non-Clinical Governance Committee
The Clinical Governance Committee
The Audit Committee
There are a range of mechanisms available to these assurance committees to gain assurance that our systems are robust and effective. These include utilising internal and external audit, peer reviews, management reporting and clinical
audit. Where systems and processes cover both clinical and non-clinical areas, for example, the storage of medicines
and materials management, more than one assurance committee will need to assure itself and in turn the Board of
Directors that the approach is effective and robust. To do this the Trust has developed a mechanism for cross-referring
items to seek the other assurance committee’s view of relevant systems and processes. In addition, the Non-Clinical
and Clinical Governance Committees hold two joint meetings a year.
The Board of Directors is accountable for the operations of the Trust. Due to the size and complexity of the operations
involved, it delegates responsibility for operational delivery to the Trust’s Management Board, which in turn delegates
authority to a number of sub-groups as appropriate. The expected outcomes, as prescribed by the Board of Directors
through the Management Board’s Terms of Reference, are delivered by the organisation through a series of defined
systems and processes.
Committee structure and reporting
Details of the key committees in the Trust’s governance structure are given below. Each Committee Chair has information that ensures a consistent approach across all groups, including Terms of Reference, upward reporting and review
of effectiveness. Guidelines for the development of agendas and for papers to be presented at the groups are also
20
Board of Directors
Management Board
Non-Clinical
Governance
Committee
Clinical Governance
Committee
Audit Committee
Nominations and
Remuneration
Committee
Charities Committee
Commercial
Transactions Steering
Group
available. This information has been developed in line with the Productive Leader Toolkit created by the NHS Institute
for Innovation and Improvement.
The Board of Directors
The Board of Directors meets monthly (with the exception of August). The dates of the meetings are published on the
Trust’s public website. The agenda, reports and minutes of the public Board of Directors meetings are also published
on the Trust’s website in advance of the meetings. The agenda for the meetings is based on four key areas of:
•
•
•
Quality – Patient Safety, Effectiveness and Experience;
•
Strategy/Business Planning and Improvement – This covers strategy decision making, approval of business
plans and business cases.
Operational Performance and Use of Resources;
Corporate Governance/Risk/Regulatory – This gives the Board an opportunity to consider key risks, the Board
Assurance Framework, legislative changes which may impact on the function of the Trust, other governance
issues and regular reports from its sub committees;
The Board of Directors annually reviews the Terms of Reference for each of the sub-committees. The Board of Directors receives regular reports from its sub-committees on the business covered, risks identified and actions taken.
These reports are delivered by the Non-Executive Director Chairs of each of these groups, supported by the Executive
Director lead.
The Board approves an Annual Cycle of Business in advance of the financial year which identifies the key reports
which will be presented in year. Reporting to the Board is based on the principles of exception reporting to ensure that
the Board considers the key issues and utilises its time effectively.
The Board conducts the majority of business in public, but where this is not possible, due to reasons of confidentiality,
it excludes members of the public pursuant to the Public Bodies (Admission to Meeting) Act 1960.
To ensure adequate flows of information from the Board of Directors to the Management Board, the Chief Executive
provides a verbal update to the Management Board on business transacted at the Board of Directors and other issues
of importance.
Membership of the Board of Directors is currently made up of the Trust Chairman, five independent Non-Executive
Directors and five Executive Directors, including the Chief Executive, and three non-voting Executive Directors. The
key roles and responsibilities of the Board are as follows:
21
•
•
•
•
•
To set and oversee the strategic direction of the Trust;
•
To receive reports from the Audit Committee, the annual internal auditor’s report and external auditor’s report
and take action as appropriate;
•
To approve the Annual Report and Annual Accounts.
Continued appraisal of the financial and operational performance through Director Reports;
Direct operational decisions as required;
To discharge their duties of regulation and control;
To ensure the Trust continues to maintain patient quality and safety as its primary focus, receiving and reviewing data analysis and comment in the form of the Quality Report;
The document which describes how the Trust operates is called the Standing Orders. The Standing Orders are supported by the Standing Financial Instructions and a Scheme of Delegation which shows which decisions the Board
has reserved for itself and which it has delegated and to whom it has delegated these.
The Board receives monthly reports on operational performance which includes an integrated balanced scorecard
which shows performance against the identified key performance indictors which contain national, local and internally
driven targets. The integrated balanced scorecard is structured around the Care Quality Commission’s five domains
(safety, effectiveness, caring, responsive and well-led).
In addition, the Board of Directors receives a monthly Quality Report which outlines progress towards delivering the
quality agenda and also provides a mechanism for updating the Board of Directors on key quality issues which may
require their attention. The monthly Quality Report also reports on the Trust’s Family and Friends Test results, feedback from Meridian Patient Surveys and patient safety. The Board of Directors receives a more detailed quarterly
report on Complaints, Patient Advice and Liaison Service contacts, serious incidents and inquests. This enables the
Board of Directors to triangulate data from a number of different sources.
A breakdown of attendance for the Board of Directors is presented below:
Title
Name
Chairman
Brian Stables
6
Non-Executive Director
Moira Brennan
5
Non-Executive Director
Joanna Hole
6
Non-Executive Director
Michael Earp
6
Non-Executive Director
Nicholas Hood
5
Non-Executive Director
Nigel Sullivan
6
Chief Executive
James Scott
6
Medical Director
Tim Craft
6
Director of Nursing and Midwifery
Helen Blanchard
6
Chief Operating Officer
Francesca Thompson
6
Deputy Chief Executive and Director of Finance
Sarah Truelove
6
Director of Estates and Facilities*
Howard Jones
6
Director of Human Resources*
Claire Buchanan
6
Commercial Director*
Jocelyn Foster
6
*Indicates non-voting members of the Board of Directors
The key Board sub-committees are as follows:
•
•
•
•
22
Management Board
Non-Clinical Governance Committee
Clinical Governance Committee
Audit Committee
Attendance
(from 6)
Management Board
The Management Board is chaired by the Chief Executive and is held monthly. The membership of the Board is as
follows:
Title
Name
Attendance
(from 7)
Chief Executive (Chair)
James Scott
5
Chief Operating Officer
Francesca Thompson
7
Commercial Director
Jocelyn Foster
5
Medical Director
Tim Craft
4
Director of Nursing and Midwifery
Helen Blanchard
4
Director of Human Resources
Claire Buchanan
6
Deputy Chief Executive
Sarah Truelove
7
Director of Estates and Facilities
Howard Jones
6
Head of Division – Surgery
Monica Baird
6
Head of Division – Women and Children
(from 1 June 2014)
Bernie Marden
5 of 5
Head of Division – Medicine
William Hubbard
4
Divisional Manager – Medicine
Fiona Bird
7
Divisional Manager – Surgery
Suzanne Wills
6
Divisional Manager – Women and Children
(from July 2014)
Rhiannon Hills
4 of 4
Head of Nursing – Medicine
Jo Miller
4
Head of Nursing – Surgery
Sharon Bonson
7
Head of Nursing and midwifery
(from 1 June 2014)
Vicky Tinsley
5 of 5
The Management Board has delegated powers from the Board of Directors to oversee the day-to-day management of
an effective system of integrated governance, risk management and internal control across the whole organisation’s
activities (both clinical and non-clinical), which also supports the achievement of the organisation’s objectives.
Non-Clinical Governance Committee
The Non-Clinical Governance Committee (NCGC) focuses primarily on providing assurance to the Board that the Trust
has a robust framework for the management of risks arising from or associated with estates and facilities, environment
and equipment, health and safety, workforce, reputation management, information governance, business continuity
and other non-clinical areas.
The NCGC is chaired by a Non-Executive Director. The Committee meets bi-monthly.
Membership of this Committee includes:
Title
Name
Non-Executive Director
Joanna Hole (Chair)
Attendance
(from 3)
2
Non-Executive Director
Nigel Sullivan
1
Director of Human Resources (Lead Executive)
Claire Buchanan
2
Director of Facilities and Estates
Howard Jones
3
Chief Operating Officer
Francesca Thompson
3
Commercial Director
Jocelyn Foster
2
Trust Secretary
Julie Hill
2
23
The primary objective of the Committee is to provide assurance to the Board that the key critical non-clinical systems
and processes are effective and robust.
Clinical Governance Committee
The Clinical Governance Committee focusses primarily on providing assurance to the Board that the Trust has a
robust framework for the management of risks arising from or associated with incident management and reporting,
quality improvement, compliance with the Care Quality Commission’s standards, medical records, patient experience,
research and development and maintaining clinical competence.
The Committee meets bi-monthly and is chaired by a Non-Executive Director.
The membership of the Committee is as follows:
Title
Name
Attendance
(from 3)
Non-Executive Director (Chair)
Michael Earp
3
Non-Executive Director
Nicholas Hood
2
Director of Nursing and Midwifery
Helen Blanchard
3
Medical Director
Tim Craft
2
Associate Medical Director for Quality Improvement
Carol Peden
1
Trust Secretary
Julie Hill
3
The primary objective of the Committee is to provide assurance to the Board that the key critical clinical systems and
processes are effective and robust.
Joint Committee Meetings
The Non-Clinical Governance Committee and Clinical Governance Committee hold six monthly joint meetings to seek
assurance of key systems and processes which impact on both non-clinical and clinical areas. The Joint Meeting of
the Non-Clinical and Clinical Assurance Committees met in September 2014 and considered Medical Records, the
2015 Patients Record Programme, the Quality, Innovation, Productivity and Prevention (QIPP) programme, the Trust’s
re-launched Raising Concerns Policy and reviewed the progress in addressing the recommendations in the CQC
Quality Report concerning the supervision of children attending the Emergency Department and developing pathways
for children to avoid them waiting unnecessarily in a mixed Emergency Department.
Audit Committee
The Committee is chaired by a Non-Executive Director and meets no less than four times a year. Membership of this
Committee is made up of three Non-Executive Directors (including the Chair).
Title
Name
Attendance
(from 3)
Non-Executive Director (Chair)
Moira Brennan
Non-Executive Director
Michael Earp
2
Non-Executive Director
Joanna Hole
2
3
At least one of the members of the Audit Committee is required to have recent and relevant financial experience.
Moira Brennan provides this experience and also chairs this committee.
Further details on the experience and qualifications of the Board of Directors can be found on the Trust website at
www.ruh.nhs.uk
24
Additional staff will be invited as required; these could include:
•
•
•
•
•
•
•
Chief Executive
Deputy Chief Executive and Director of Finance
Trust Board Secretary
External Auditor
Internal Auditor
Local Counter Fraud Specialist
Head of Financial Services
The Committee’s key roles and responsibilities are as follows:
Governance
The Committee reviews the establishment and maintenance of an effective system of internal control and probity
across the whole of the organisation’s activities.
Internal Audit
The Committee shall ensure that there is an effective internal audit function established by the Trust that meets mandatory NHS Internal Audit Standards and provides appropriate independent assurance to the Audit Committee, Chief
Executive and Board of Directors. The Committee will review the audit function at least annually and agree its plan of
work for the forthcoming year.
External Audit
The Committee shall review the work and findings of the External Auditor and consider the implications and management response to their work.
Local Counter Fraud Specialist
The Committee shall ensure that there is an effective counter fraud function established by management that meets
NHS Counter Fraud standards and provides independent assurance to the Audit Committee, Chief Executive and
Board of Directors. Other assurance functions such as reviews by the Department of Health and/or other regulators/
inspectors.
Management
The Committee shall request and review reports and positive assurances from directors and managers on the overall
arrangements for governance, probity and internal control. They may also request specific reports from individual functions within the organisation as they may be appropriate to the overall arrangements.
Risk Management
The Audit Committee is responsible for assuring the Board of Directors that the Trust’s risk management system is
robust and effective. To do this the Committee will test the system through Internal Audit Review, as well as corporate
and operational review.
Remuneration Committee
Membership of the Remuneration Committee includes the Chairman of the Board of Directors and all Non-Executive
Directors. The Committee meets at least twice annually and its key roles and responsibilities are to determine the appropriate employment and remuneration and terms of employment for the Chief Executive and Executive Directors.
25
Title
Name
Attendance
(from 2)
Chairman
Brian Stables
Non-Executive Director
Moira Brennan
2
Non-Executive Director
Joanna Hole
2
Non-Executive Director
Michael Earp
1
Non-Executive Director
Nigel Sullivan
2
Non-Executive Director
Nick Hood
1
2
Charities Committee
The Royal United Hospital Charitable Fund was formed under a Deed dated 10 September 1996 as amended by a
Supplemental Deed dated 9 December 2009. It is registered with the Charity Commission in England and Wales (Registered number 1058323) (“the Charity”).
The Trust is the Corporate Trustee of the Charity, acting through its voting Board of Director members who are collectively referred to as the Trustee’s Representatives (“Trustees”) and their duties are those of trustees.
The main beneficiaries of the Charity are the Trust’s patients and staff through the provision of grants to the Trust for
purchasing and developing facilities; training and development of staff; and research and development.
The Charity’s structure is diverse and reflects the breadth of variety of activities within the Trust. There are in excess of
70 separate funds.
The Charitable Fund has a significant and proactive fundraising operation in the form of The Forever Friends Appeal
that is primarily, but not totally, focussed on principal Campaigns agreed with the Charities Committee and the Corporate Trustee.
Whilst the Charities Committee is a formal subcommittee of the Board of Directors, arrangements have been implemented to operate this group and the Full Corporate Trustee of the charity at arm’s length from the Trust. These
arrangements include: a formal service level agreement between the Trust and the charity outlining the support and
associated costs to the charity, reporting to the Full Corporate Trustee of the Charity Annual Report and Accounts and
a separate charity strategy.
The Charities Committee is chaired by an Independent Trustee. Membership of the committee includes a further two
Non-Executive Directors, the Director of Nursing and Midwifery and Deputy Chief Executive and Director of Finance.
The Committee meets quarterly.
Title
Name
Attendance
(from 2)
Independent Trustee
Roger Newton
Non-Executive Director
Moira Brennan
2
Non-Executive Director
Brian Stables
2
Director of Nursing and Midwifery
Helen Blanchard
1
Deputy Chief Executive and Director of Finance
Sarah Truelove
2
2
Commercial Transactions Steering Group
The Board of Directors established a new standing committee in September 2014 to provide scrutiny and assurance
of aspects of tenders and other significant transactions as delegated by the Board of Directors. The Commercial
Transactions Steering Group did not meet during the period of this report.
26
Annual Committee Effectiveness Reviews
Each Committee is required to consider how well it has performed during the year against the objectives as set out in
their Terms of Reference and against the delivery of their work plans for the year. This information is collated and then
presented to the Board of Directors alongside any revisions to the Terms of Reference and the following year’s work
plan. Any deviation from plan is highlighted to allow the Board of Directors to consider whether any further changes to
membership or committee constitution are required. The Board of Directors also considers the whole of its committee
structure to ensure that it is delivering its requirements.
Key Governance Systems
The Trust has identified the following as key systems which support the delivery of the Trust’s objectives:
•
•
•
Risk Management
Performance Management
Business Planning and Budget Setting
Supporting these systems are sub-systems which include, but are not limited to:
•
•
•
•
Workforce planning
Maintaining clinical and non-clinical competencies
Health & Safety
Equality & Diversity
The Board of Directors’ assurance committees test these systems to ensure they are robust and effective. Where additional assurance is required, the Trust’s internal auditors are tasked with undertaking a more comprehensive review
and actions are taken to address any shortfall against the expected standards.
Governance changes during the year
The most important governance change in 2014/15 was becoming an NHS Foundation Trust on 1 November 2014.
There is a separate Annual Report covering the period from 1 November 2014.
During the period of this report, the key governance change was the establishment of the new Women and Children’s
Division following the transfer of responsibility for Maternity Services from Great Western Hospitals NHS Foundation
Trust to the RUH Bath NHSTrust on 1 June 2014. The new division brought together Paediatrics, Neonatal and Gynaecology services as well as Maternity Services.
The Board of Directors agreed with effect from April 2014 that the membership of the Management Board would be
reduced to enable more time to be focussed on strategic debate. The revised membership is:
•
•
•
•
Executive Team
Clinical Heads of Division
Heads of Nursing/Midwifery
Divisional Managers
As previously mentioned, the Board of Directors has also established a Commercial Transactions Steering Group.
There have been no other significant governance changes implemented during the period. The governance systems
will be continually monitored to ensure that the Trust continues to learn from best practice and update systems so they
meet revised guidance throughout the year.
The Shadow Council of Governors
The Shadow Council of Governors meets on a quarterly basis and has established three working groups on: Quality,
Strategy and Business Planning and Membership and Outreach.
27
The Board of Directors’ Review of Effectiveness
The Board of Directors is required to consider whether it has been effective in leading the organisation on an annual
basis. The Board has undertaken an evaluation and has determined that the Board of Directors is operating at a satisfactorily level. This is supported by the following evidence:
•
The Trust’s performance has been rated as Performing as measured against the NHS Trust Development
Authority’s (TDA) Accountability Framework. This confirms that the Trust has met all of the National Priorities as
set out in the NHS TDA Accountability Framework.
•
The Trust’s performance would also be classified as Green against the Monitor Risk Assessment Framework
Performance rating process.
•
External review of the Trust’s Quality Governance Framework by KPMG (April 2014) identified a high level of
clinical engagement and strong quality focused culture and strong executive leadership.
•
A Quality Impact Assessment (QIA) was undertaken, both at the start of and regularly during the currency of
every QIPP project to identify whether there were any unintended negative consequences to quality which
would mean that the project would be amended or stopped.
•
The Trust has continued to build its membership base which is both representative and inclusive of the local
population. As at 31 October 2014, the Trust has recruited over 7,763 public members and the majority of eligible staff are members.
•
The Board of Directors has a full complement of Executive and Non-Executive Directors.
The Board of Directors’ assessment has been supported by the following external assessments:
•
The Trust was one of the first wave of 18 acute trusts selected to pilot the CQC’s new inspection regime. The
inspection took place in December 2013. Following the visit, the CQC lifted the warning notice. The CQC concluded that: “patients received safe and effective care”.
•
The CQC identified one area where the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 were not met and the Trust should improve. The CQC stated: “the trust must protect
people from the risks of inappropriate and unsafe care and treatment by means of effective operations systems
designed to – regularly assess, and monitor of the quality of services; identify, assess and manage risks; and
make changes in the treatment or care relating to the analysis of incidents that resulted in, or had the potential
to result in harm.”
•
The CQC made another 17 recommendations where the Trust could improve and the Trust, in consultation with
its key stakeholders has developed an ambitious Improvement Plan to address the CQC’s recommendations.
The Trust has developed a comprehensive improvement plan to address the issues identified by the CQC.
•
The Trust is subject to regular inspection by a number of external agencies. Whilst a number of improvement
actions have been identified through the process of inspection, no regulatory actions have been imposed on the
Trust.
•
The Trust has undertaken another self-assessment against Monitor’s Quality Governance Assurance Framework. The Trust commissioned KPMG to conduct an independent review and the outcome of their review was
reported to the Board of Directors meeting in April 2014.
•
KPMG concluded that: “Overall, there appears to be a strong quality governance focus at the Trust, with an
awareness from staff of the value that effective systems and processes can have on services provided to patients”.
•
KPMG made a number of recommendations for further improvement and an action plan was developed to take
forward the actions, monitored by the Quality Board.
•
In May 2014, the Trust’s application to become an NHS Foundation Trust was reactivated. During this period,
Monitor’s assessment team conducted its review which included observing a number of the Trust’s Boards and
Committees, interviewing members of the Board of Directors, senior staff and holding focus group meetings with
patients, nurses, consultants and junior doctors. Monitor also received feedback from the Trust’s key stakeholders, including commissioners, the CQC and the Trust Development Authority.
28
Board of Directors Member Appraisals
Each member of the Board of Directors is appraised against their performance during the year, which culminates with
an annual appraisal against their objectives for the year. The appraisers for each group of Board of Directors’ members are as follows:
Appraisee
Appraiser
Non-Executive Directors
Chairman
Chief Executive
Chairman
Executive Directors (as line reports)
Chief Executive
Executive Directors (as Board of Directors members)
Chairman
Chairman
NHS Trust Development Authority
The purpose of the appraisal is to monitor progress against the set objectives and identify any development needs or
support required to ensure that by year end the objective is delivered. For the Chief Executive and Executive Directors, delivery against the objectives is taken into consideration when determining if any bonus is to be awarded and
the level of the stated bonus. The amount of any bonus awarded to the Chief Executive and Executive Directors is
reported in the Annual Report for the following year.
During the period, the Senior Independent Director, Michael Earp, also undertook an appraisal of the Chairman. In
future years, and once licensed as an NHS Foundation Trust, the governors of the Trust will be involved in the Chairman’s appraisal.
The Purpose of the System of Internal Control
The system of internal control is designed to manage risk to a reasonable level rather than to eliminate all risk of
failure to achieve policies, aims and objectives; it can therefore only provide reasonable and not absolute assurance of
effectiveness. The system of internal control is based on an on-going process designed to:
•
•
Identify and prioritise the risks to the achievement of the organisation’s policies, aims and objectives; and
Evaluate the likelihood of those risks being realised and the impact should they be realised; and to manage
them efficiently, effectively and economically.
The system of internal control has been in place at the Trust for the year ended 31 October 2014 and up to the date
of approval of the annual report and accounts. There is a separate annual report and accounts for the period since
becoming an NHS Foundation Trust on 1 November 2014 until 31 March 2015.
Capacity to handle risk
I have overall responsibility for all risks. A nominated lead Director, the Director of Nursing and Midwifery, has been
designated as the Director responsible for clinical governance and risk management. I am responsible for corporate
governance issues.
The Board of Directors is ultimately responsible for managing and directing the Trust's business. However, there are
three Assurance sub-committees which provide the Board with assurance. These are the Clinical Governance Committee, Non-Clinical Governance Committee, and the Audit Committee.
The Board of Directors has approved the risk management processes and defined the objectives for managing risk.
The Trust has a Trust-wide Risk Register. All new significant risks are reviewed by the Management Board and by the
Board of Directors. The Management Board then takes on oversight of the significant risks until they have been managed to a reduced level of risk.
Assurance Committees have been established as sub-committees of the Board of Directors, with membership from
Executive and Non-Executive Directors, clinical representatives from the Divisions and other senior clinical and managerial representatives. The Strategic Framework for Risk Management includes a reporting structure to the Board of
Directors.
29
Each clinical specialty has a forum for discussing risk management and clinical governance issues. Each clinical
specialty has a nominated lead for risk management, clinical effectiveness, research & development, education and
training, and patient and public involvement.
Guidance on risk management is included in the Strategic Framework for Risk Management.
The Clinical Governance Performance Framework includes standards on risk management and the pillars of clinical
governance. Key Performance Indicators (KPIs) have been developed for clinical governance and these are monitored
through the Trust’s performance measures and included in a corporate scorecard on a monthly basis. The evidence
used to monitor against the KPIs has been used in a number of areas to provide evidence for the on-going compliance
with the Care Quality Commission.
The Trust seeks to ensure that lessons learned from incident, complaint and other investigations are used to update
and improve practice. These issues are regularly communicated to the Operational Governance Committee where
Trust wide representatives have the opportunity to discuss themes which may emerge from these investigations and
make recommendations for, and implement, policy or procedural change. The Operational Governance Committee
reports to the Management Board and escalates issues which require higher level scrutiny.
The Risk and Control Framework
Context
The Strategic Framework for Risk Management identifies the key risk areas for the Trust as clinical risk, non-clinical
risk, financial risk, human resource risk and information risk.
The Strategic Framework for Risk Management includes a clear risk management process. If a risk cannot be resolved at a local level, the risk can be referred through the operational management structure to the Management
Board or ultimately to the Board of Directors. The risk is also added to the risk register with a plan detailing ways to
minimise the risk. Each risk is assessed for its severity and likelihood of occurrence, and is allocated a risk 'traffic
light'. Risks are reviewed to ensure that any inter-dependencies are understood, along with the cumulative effect of
risks. The level of exposure to risks is also assessed, and an acceptable level of exposure is assigned to each risk. In
assessing the Trust's response, due regard is paid to the financial, service delivery and reputational consequences of
risks. The Head of Risk and Assurance acts as a gate keeper to the Risk Register to ensure consistency of scoring, as
well as the accuracy and currency of the register.
The Management Board reviews each new significant risk and either explores the solutions or accepts the risk. The
highest rated risks are reviewed quarterly by the Board of Directors. Training in risk management is included as part of
the induction programme for new members of staff and is included in the development planner for the Board of Directors.
Assurance Framework
The Assurance Framework is a process by which the Trust gains assurance that it has a well-balanced set of objectives for the year and that there are controls and assurances in place to manage the key risks associated with achieving the objectives.
The Assurance Framework was developed using the Trust's Integrated Business Plan and the corporate objectives for
the year. The strategic objectives were assessed, and risks in achieving the objectives identified, including any gaps in
assurance or control. The Assurance Framework was reviewed by the Board of Directors, its Assurance Committees
and the Executive Director leads for each risk regularly throughout the year.
Internal Audit reviewed the Trust’s risk management arrangements twice during the year. The Internal Auditor’s report
on Risk Management published in August 2014 concluded that: “the RUH have a clear and well documented process
in place for recognising, reporting and reviewing risk. This is clearly laid out in the Strategic Framework for Risk Management. During our review it was demonstrated that the policy was being actively followed by the Trust, with risks
reviewed at relevant Committees/Board.”
The Trust has in place a Major Incident Plan that is fully compliant with the requirements of the NHS Emergency Planning Guidance 2005 and all associated guidance. The Trust has also developed a Business Continuity Plan which was
refreshed in light of guidance issued in relation to the new arrangements for local health Emergency Planning Resilience and Response (EPRR). The Trust has a full time dedicated Resilience Manager in post.
30
Other Risks to Note
The Trust has identified the following as its top three clinical risks:
Bed capacity and patient flow to ensure right patient, in the right bed, first time
The Trust recognises that when patient flow impacts on capacity and the acute hospital is under pressure, there are
significant potential challenges for the delivery of safe, effective and high quality care and an increase in the risks that
need to be managed.
In response to an unprecedented increase in demand for Emergency Department services in August 2014, which was
reflected nationally, the Trust invited Emergency Care Intensive Support Team (ECIST) to conduct another review of
the emergency care programme. In a letter to the Trust dated 8 October 2014, ECIST concluded that: “Overall, the
Trust’s approach to urgent and emergency care appears to be sound and coherent. Governance and leadership are
strong, clinical engagement is good and the balance between improvement support and performance management
appears comprehensive. The patient flow model, particularly within the Emergency Department is generally good.”
Capability, capacity and staffing numbers
The risk relating to capability, capacity and staffing numbers particularly relates to the bed capacity risk above and to
corresponding availability of nursing staff to manage the opening of additional ward capacity in addition to unplanned
escalation and a high volume of clinical outliers.
To manage this risk, a number of actions have been taken and delivered through the Strategic Workforce Committee,
Nursing Workforce Group and Divisional Boards. Actions have included:
•
•
Recruitment campaign for key groups of staff, including recruitment overseas
•
Using winter monies to provide a dedicated consultant led team to care for medical outliers.
Investment in nursing staffing during 2013/14 and 2014/15 focussing on safeguarding (adults and children),
older person’s wards, acute gastroenterology ward and supporting the development of a model of supervisory
ward sister.
Medical records and health record keeping
A risk was identified to medical records in relation to the accessibility and availability of records, timeliness and coding
and the overall use of the health record.
In order to improve the availability and storage of case notes, a secondary Health Record active library has been
developed at Peasedown St John, near Bath. The Trust conducts weekly audits of nursing documentation and the
standard of record keeping has improved significantly.
The Trust’s top financial and business risks during this period were identified as:
Delivering the Quality Innovation Productivity and Prevention Programme (QIPP) and the
Impact of Clinic
A risk was identified in relation to the non-delivery of the Trust’s QIPP Programme and the impact of Commissioners
QIPP Plans. The Board of Directors approved a five year QIPP Strategy in April 2014 which sets out the approach the
Trust is taking to deliver QIPP to ensure that the Trust continues to provide high quality, sustainable and cost effective
healthcare that leads to the best outcomes for patients. The Board of Directors also approved revised governance
arrangements for the QIPP Programme, taking into account the consolidation of Service Line Managements ways of
working and the alignment of the transformation and efficiency programmes into one QIPP programme, overseen by
the Transformation Board.
The Trust’s Internal Auditors conducted a review of the QIPP Programme and their report published in April 2014 concluded that: “QIPP is more established in the Trust’s culture with greater emphasis on quality and patient care with a
secondary and supporting focus on financial achievements. This, in turn has led to greater take up from clinicians and
front line staff in delivering QIPP targets”.
31
The Clinical Commissioning Reference Group maintains an overview of joint QIPP plans. The Urgent Care Working
Group provides oversight of all urgent care demand. The Trust has developed its bed model designed to provide up to
date likely scenario analysis to allow greater mitigation planning.
Failing to deliver the agreed standards of care leading to a failure to achieve the CQUIN
gateway and best practice tariffs and additional income
The Trust has identified a risk in relation to the non-delivery of the CQUIN targets and the associated loss of income.
To mitigate the risk, the Trust has set up the CQUIN Steering Group to serve as the central point of programme
management. The Group is chaired by the Director of Nursing and Midwifery and includes representation from Business Intelligence (contract monitoring and data) and Finance (allocation of resources). CQUIN scheme leads submit
monthly updates on progress to the meeting (achievements against action plan, risks, mitigations, required support).
There is clinical engagement in agreeing the CQUIN schemes.
The key principle that has been agreed with the Commissioners is that all elements of each scheme are completely
within the scope of the Trust to deliver, without reliance on external agencies.
Internal Audit Reports
During the period 1 April to 31 October 2014, the Trust’s Internal Auditors conducted the following reviews:
Area
Overall Report Rating
Charitable Donations
Significant Assurance
Risk Management
Significant Assurance with Minor Improvement Opportunities
Procurement
Significant Assurance with Minor Improvement Opportunities
Learning from Serious Incidents
Significant Assurance with Minor Improvement Opportunities
Data Quality
Significant Assurance with Minor Improvement Opportunities
Cash Management
Adequate
Quality Governance
Quality Governance is a key element of the overall governance arrangements of the Trust. Quality is woven into all
groups but the key groups involved in delivering the quality agenda are:
Each group as presented above plays a key role in the quality governance of the Trust. Their roles are as follows:
•
The Board of Directors approved the Quality Strategy 2014-16 in April 2014 and has oversight of the delivery of
quality through the performance management system and risk management systems.
•
The Management Board as the key operational delivery group in the Trust oversees operational performance
against quality indicators and receives regular information on quality and patient safety work.
•
The Quality Board, which is accountable to the Management Board, has responsibility for formulating the quality
improvement strategic direction. This has been achieved through the development of the quality improvement
strategy approved by the Board of Directors. The Quality Board oversees the implementation of the strategy.
The Quality Board ensures that the Board of Directors, via the Management Board, is aware of risks to the
quality of care being delivered and plans to mitigate these risks, and poorly performing services and the actions
being taken to improve them.
•
The Operational Governance Committee is the group which delivers quality improvement at an operational
level. The Operational Governance Committee works closely with the Quality Board and the Quality Board’s sub
groups – the Patient Safety Steering Group, the Patient Experience Group and the Clinical Outcomes Group –
as well as the Divisional Clinical Governance Groups.
From April 2010 health and adult social care providers had to be registered with the Care Quality Commission (CQC)
and this required Trusts to comply with the “Essential standards of quality and safety”, as set out in the Health and
Social Care Act 2008 (Regulated Activities) Regulations 2009 and the Care Quality Commission (Registration) Regulations 2009. These standards allow Trusts to measure the quality of services they provide and ensure that Trusts are
accountable for meeting the regulations.
The Trust has been registered with the Care Quality Commission without conditions since March 2010.
32
Patient Safety
Steering Group
Board of Directors
Quality
Board
Patient Experience
Group
Clinical Outcomes
Group
Management
Board
Clinical Governance
Committee
Divisional
Boards
Divisional Governance
Groups
Operational
Governance
Committee
The Trust recognises that the Health Act 2006 introduced a statutory duty on NHS organisations to observe the provisions of the Code of Practice on Healthcare Associated Infections. The Board of Directors is aware of its responsibilities in assuring that it has suitable systems and arrangements in place to ensure that the Code is being observed.
Quality Accounts 2014/15
All providers of NHS Health Care are required to produce an annual Quality Accounts Report about the quality of
services delivered. A range of both internal and external groups have helped to develop the Quality Accounts report
2014/15 and to identify the Quality Priorities for 2015/16, including staff, governors, Healthwatch and Clinical Commissioning Groups. The Trust’s external auditors are responsible for reviewing the Quality Accounts against national
requirements and for testing a sample of the quality indicators disclosed in the Quality Accounts to ensure that the
performance information contained in the Quality Accounts is accurate and robust. Further information about the Quality Accounts 2014/15 is provided in the Trust’s NHS Foundation Trust’s Annual Report.
Board to Ward
The Trust has further developed its key lines of communication between both the Board of Directors and Ward level.
The main features of this communication are outlined below:
Matron Presentations
The Matrons from the three clinical divisions are each invited to present to the Board twice each year. The topics
raised are selected by the Matrons and are focused around new initiatives, developments and also quality improvements. This is also an opportunity for the Matrons to interactive with the Board of Directors to share ideas, concerns
and other issues.
Patient Stories
The Board of Directors has introduced a patient story at the beginning of each Board of Directors meeting aligned to
the Quality & Patient Safety Report. The story takes the form of either a recorded interview with a patient, or is a statement read out by a member of staff on behalf of the patient. These stories ensure that the Board of Directors receives
both positive and negative messages about the care being delivered within the Trust in the words of patients, carers
and family members.
33
Integrated Balanced Scorecards
The Board of Directors has adopted the use of an Integrated Balanced Scorecard for monitoring performance. The
revised scorecard presents together quality, operational and financial performance, so that an informed view can be
taken across the whole without impacting on one area. This approach is being rolled out throughout the Trust to Divisional, Specialty and Ward levels. This consistency in approach will ensure that the Board has oversight of information
from Ward to Board.
Information Governance
Information Governance within the Trust is managed and controlled through the implementation of the Trust’s Information Governance Strategy which is owned by the Board of Directors. The strategy is delivered through an action plan
for Information Risk Management and through a commitment to initiate work as early as possible on completing the
NHS Information Governance Toolkit and national legislation, policies and directives, thus gaining maximum benefit
from introduced improvements.
Further information about the Trust’s compliance against the Information Governance Toolkit is set out in the NHS
Foundation Trust Annual Report. A rolling programme of Information Risk Management audits has been continued in
the current year with action plans being produced to further ensure risks are reduced and legal compliance with the
Data Protection Act maintained.
During the period of this report, there has been effective reporting of Information Governance incidents and near
misses and follow up on all incidents has ensured corrective actions where necessary. There were 14 level 1 information governance incidents from 1 April 2014 to 31 October 2014 relating to data:
•
•
•
Disclosed in error (12)
Lost or stolen paperwork (1)
Other (1)
Review of Effectiveness
As Accountable Officer, I have responsibility for reviewing the effectiveness of the system of internal control. My review
is informed in a number of ways. The Head of Internal Audit provides me with an opinion on the overall arrangements
for gaining assurance through the Assurance Framework and on the controls reviewed as part of the Internal Audit
work. Executive Directors within the organisation who have responsibility for the development and maintenance of
the system of internal control provide me with assurance. The Assurance Framework itself provides me with evidence
that the effectiveness of controls that manage the risks to the organisation achieving its principal objectives have been
reviewed.
My review is also informed by:
•
•
•
•
•
•
•
•
•
•
•
Care Quality Commission registration
Care Quality Intelligent Monitoring reports
Care Quality Commission planned and responsive inspections
Internal Audit reports
External Audit reports
Auditors' Value for Money Assessment
Clinical audits
Patient and staff surveys
Friends and Family Test
Benchmarking information
External Review of the Quality Governance Assurance Framework
I have been advised on the implications of the results of my review of the effectiveness of the system of internal con-
34
trol by the Board of Directors, Audit Committee, Clinical Governance Committee, Non-Clinical Governance Committee
and the Management Board. When issues are identified, plans are put in place to ensure that any learning is embedded in the organisation. This ensures that the system is subject to continuous improvement.
The Trust has an on-going process to assess compliance with the CQC's Essential standards of quality and safety,
and on-going monitoring of the evidence to demonstrate compliance with the standards. No issues have been identified from this process which would affect the Trust's registration. Improvements identified through this process have
been incorporated into action plans which are subject to rigorous review. There are no significant control issues to
report.
During the period, the Trust's major risks were the delivery of sustained performance, the achievement of financial
savings and associated workforce changes required to deliver the savings. These risks will continue to be closely
monitored.
The Board of Directors has a vital role in ensuring that the Trust has an effective system of internal control. The Board
of Directors and its sub-committees have functioned effectively throughout the year.
My review confirms that the Royal United Hospital Bath NHS Trust has a generally sound system of internal control
that supports the achievement of its policies, aims and objectives.
Accountable Officer: James Scott, Chief Executive
Organisation: Royal United Hospital Bath NHS Trust (RD1)
Signature:
Date:
27 May 2015
35
Sustainability Report
In the last year the Estates & Capital Projects teams have successfully completed a number of major projects which
have brought real benefits for staff and patients at the hospital. The year started off with the opening of the new
Urgent Care Centre adjacent to the Emergency Department which has enabled the provision of a new walk-in service.
This new unit which includes 5 consulting rooms and reception was constructed into an unused courtyard providing
excellent clinical accommodation. It was officially opened by Sir Bruce Keogh in July 2014.
The next major project to be completed was the opening of the new £13m Pathology laboratory and mortuary which
was incrementally commissioned throughout May and June. All the departments were moved over successfully and
this important service for the hospital transferred to the new state of the art building without interruption of service.
The building has proved to be very popular and hugely successful in providing modern Pathology analytical services
on two floors and a new Mortuary and bereavement suite on the ground floor which was designed with our chaplaincy
staff and end of life nurses. It is a handsome building and is connected to the hospital on two levels, with discrete
vehicular access. The completion of this building allows us to demolish the old Pathology Laboratory located adjacent
to Combe Park enabling the construction of a new patient and visitor car park as described in our Estates Strategy.
The major refurbishment of Parry Ward was completed in August 2014 to time and budget, correcting a number of
safety issues inherent in the existing building but at the same time providing a much better environment for nursing
this group of patients. It is bright and colourful and has set the pattern for future ward upgrading’s.
In October Mary Berry, renowned food writer and television presenter on BBC Television who was born in Bath,
opened the new Friends Coffee shop to great acclaim. It was funded entirely by the Friends from charitable donations
and sits alongside a new landscaped garden for Combe Ward which was funded earlier in the year by the Department
of Health. This has now transformed what was a rather dowdy courtyard into a beautiful new area for all to enjoy.
Apart from these major capital buildings, we have invested heavily during the year in the electrical infrastructure,
installing a new standby generator to protect the central area of the hospital and the new Pathology Laboratory and as
it is remotely operated, it allows the Trust to generate electricity for sale to the grid. We have also upgraded wards and
public spaces and provided ten additional bed spaces on site, including four en-suite rooms in the Older Persons Unit.
The cardiac ward has been fitted with new windows, flooring and has been re-decorated throughout. In the Princess
Anne Wing the maternity ward has benefited from the creation of a Bereavement Suite which was funded from DH
monies. The intention is to spend our limited resources wisely in order to improve the environment based on a priority
list and risk assessments.
The major capital resource activity this year has been spent in planning the new Pharmacy Department which represents Phase 1 of our major development programme named ‘Fit for the Future’. It is hoped work will commence
in May 2015. The new Pharmacy will be located in the former P3 car park and will include five Aseptic Suites, thus
future proofing it for the manufacture of radiotherapy, chemotherapy and gene therapy drugs. The new unit is located
adjacent to the main clinical areas of the hospital and will improve the effectiveness of this service.
Furthermore, the space released by the old Pharmacy will allow us to construct a new integrated Therapies Department which could be named the Royal National Hospital for Rheumatic Diseases at the RUH. Some of the new
accommodation will be created for the Rheumatology service which transfers from the RNHRD to the RUH in due
course. We are now planning the footprint of this building so that the construction will follow on from the demolition of
the old Pharmacy. Plans are also in place to design the new Cancer building which will be constructed immediately
after the new Therapies Centre is opened and the old demolished.
Apart from the new developments it is good to see that through targeted investment and demolition we are able to
report a reduction in our backlog maintenance liability of £10m. We are therefore on track to virtually eliminate this
figure by the end of the development programme.
36
Alongside the Capital Development Plan the Estates and Facilities Division has been targeting investment to improve
our sustainability performance. Over the past five years we have demonstrated leadership through a number of
important initiatives which have saved the Trust considerable sums of money, transformed many areas of the hospital
and greatly reduced our environmental impact. Examples are given below:
•
A new Combined Heat and Power (CHP) engine within the new boiler house saved the Trust an estimated
£415,000 in 2014.
•
We have been awarded funding to install an absorption chiller to convert summer heat from the CHP unit into
cooling for the planned new Pharmacy building.
•
Retrofitting the majority of the hospital’s lighting with LED units has greatly improved the ambience of our buildings and saved at least £150,000 per annum in energy and maintenance costs. LED lamps use approximately
half the energy of the compact fluorescent lamps which they replaced. The maintenance savings arise from a
reduction in lamp replacements and corresponding maintenance labour, due to the lamps’ 5 year warranty. This
project was funded through a grant obtained from the Department of Health.
•
A new Environment Champions Toolkit has been developed which will support future engagements with staff,
helping them reduce their environmental impact on a day to day basis and providing user feedback.
•
The re-use and recycling system ‘Any Takers’ has been moved from an email distribution list to a website which
will foster greater uptake.
•
We have worked with the BANEs Council team to promote sustainable transport and have invited them to engage with our staff through their transport road shows.
•
We have also agreed a deal with the City Car Club to place 2 new hybrid cars on site for business and personal
use which will assist greatly with journeys to and from our expanding community services, i.e. Maternity birthing
centres and the RNHRD.
•
The salary sacrifice Cycle Scheme processed 94 bicycles in 2014, saving staff an average of £240 each and
the RUH £9,731 in National Insurance costs.
•
We have adopted the ‘Next Bikes’ scheme which works in the same way as London’s ‘Boris Bikes’, siting a station outside our main entrance that allows for better cycling connectivity with town and the train station.
37
•
•
There has been increased usage of our Park & Ride scheme from Odd Down, which is subsidised by the RUH.
•
Improved heating controls have been installed in the on-site accommodation blocks, the West ward area, Bath
and Wessex House, the Oasis Centre, and Theatres 9A and 9B.
•
A five-year partnership with Avon Wildlife Trust has been initiated to proactively manage biodiversity during new
building projects at the site and to maximise crossover with the charity’s health and well-being projects that
promote the health benefits of enjoying the outdoors and nature.
•
There have also been significant investments in staff capacity with the appointment of Dr Gareth Veal, Compliance and Sustainability Manager and a Compliance and Sustainability Analyst.
Investments were made to enable waste segregation during transport on site and a new waste manual is under
development which will better support staff in reducing the amount of waste they produce and in safely managing that which is unavoidable.
Historic data on the consumption of finite resources is given below. Please note that the data is reported year to
date until October 31st 2014, when the RUH achieved Foundation Trust status. Full year data will be provided in the
2014/15 Foundation Trust Annual report.
The projects listed above demonstrate the commitment of the RUH to improving our sustainability performance. We
have high-level support from Howard Jones (Director of Estates and Facilities) and Moira Brennan (Non-Executive
Director) acting as sustainability champions. In 2015/16 our new Compliance and Sustainability Manager will lead a
review of our historic sustainability objective which has been to ‘Improve the efficiency of our estate through improved
utilisation, functionality and sustainability of our buildings.’ The aim is to update this objective with performance
targets that align with national sustainability targets. We also plan to formalise our sustainability management and
reporting system, selecting and implementing an internationally recognised management system. These two initiatives will enable us to develop a ten year sustainability strategy for the organisation which will involve setting specific
performance targets that align with UK policy.
Energy and CO2 emissions
2010/11
Non-financial
indicators
(tonnes CO2)
Total gross CO2
emissions
(excluding travel)
Apr-14 Oct-14
14,727
14,140
6,319
Electricity
7,518
5,432
6,141
6,309
1,258
Natural gas
6,242
7,742
8,270
7,503
5,010
88
310
62
74
36
Data unavailable
84
254
254
14
Total
48.6
53.5
56.1
57.5
29.8
Electricity
14.3
10.2
11.3
11.0
2.6
Natural gas
34.0
42.2
44.5
45.5
27.1
Fuel oil
0.3
1.1
0.3
1.0
0.1
Total
1,991
2,301
2,526
2,554
1,138
Electricity
1,158
1,017
993
1,012
328
811
1,207
1,516
1,485
801
22
77
17
57
10
Natural gas
Fuel oil
38
2013/14
13,568
Fugitive refrigerant
(CO2 equivalent)
Financial indicator
(£k)
2012/13
13,848
Fuel oil
Related energy
consumptions
(millions kWh)
2011/12
Waste production
2010/11
Non-financial indicators (tonnes)
Financial indicators
(£k)
Total Waste
2011/12
2012/13
2013/14
Apr-14Oct-14
1,566
1,720
1,364
1,213
694
Incinerated
165
138
145
161
97
Alternative treatment
228
222
202
265
145
Landfill
690
613
640
638
361
Recycled
482
723
353
149
90
Total Waste
Disposal Cost
430
319
330
265
116
Incinerated
182
104
104
72
45
89
78
91
74
42
110
84
91
91
13
67
64
56
27
16
Alternative treatment
Landfill
Recycled
Water usage
2010/11
2011/12
2012/13
2013/14
Apr-14Oct-14
Non-Financial
Indicator ('000m3)
Water Consumption
189
177
173
206
131
Financial Indicator
(£k)
Water Supply Costs
274
286
303
367
271
39
Remuneration Report
Membership of the Remuneration committee
All, and only, Non-Executive Directors are members of the committee. The committee is quorate with four members.
From 1 March 2014 to 31 October 2014 the following individuals were Non-Executive Directors:
Brian Stables
Michael Earp
Moira Brennan
Joanna Hole
Nigel Sullivan
Nick Hood
Statement on the policy on the remuneration of senior managers
for current and future years
Starting salaries for Executive Directors are determined by the Remuneration Committee by reference to independently obtained NHS salary survey information, internal relativities and equal pay provisions and other labour market
factors where relevant, e.g. for cross sector, functional disciplines such as human resources.
Progression is determined by the Committee for:
•
Annual inflation considerations in line with nationally published indices (RPI/CPI), DH guidance and other nationally determined NHS pay settlements;
•
Specific review of individual salaries in line with independently obtained NHS salary survey information, other
labour market factors where relevant , e.g. for cross sector, functional disciplines, internal relativities and equal
pay provisions. Such review is only likely where an individual Director’s portfolio of work or market factors
change substantially.
A discretionary performance related payment system for Executive Directors exists. The arrangement provides for
directors to receive an annual inflation uplift provided that performance is judged to be satisfactory. Additionally, a
non-consolidated bonus of up to five per cent may be paid to individuals whose performance exceeds expectation. For
individuals judged to have outstanding performance a non-consolidated bonus of up to 10 per cent may be paid.
Other senior managers are paid in accordance with the national NHS Agenda for Change pay system.
Contracts
Contracts are normally substantive (permanent) contracts subject to termination by written notice of six months, by
either party.
On occasion as required by the needs of the organisation appointments may be of a temporary or ‘acting‘ nature in
which case a lesser notice period may be agreed.
Termination liabilities for Executive Directors
There are no provisions for compensation for early termination for any Executive Directors, as detailed in the table on
page 41.
Other termination liabilities for all executive directors are the entitlements under the NHS Whitley Council and/or
Agenda for Change and the NHS Pension scheme. Statutory entitlements also apply in the event of unfair dismissal.
The balance of annual leave earned but untaken would be due to be paid on termination.
40
Details of service contracts
Name
Post Title
Date of
Contract
Unexpired
Term
Notice
period
Provision for
Other
Compensation Termination
for Early
Liability
Termination
James
Scott
Chief Executive
01/06/2007
Substantive
6 months
None
See section
6.4 above
Tim
Craft
Medical Director*
01/04/2004
Substantive
6 months
None
As above with
respect to
Medical Director responsibilities
Howard
Jones
Director of Facilities
03/11/2008
Substantive
6 months
None
As above
Sarah
Truelove
Director of Finance and
Deputy Chief Executive
24/06/2013
Substantive
6 months
None
As above
Francesca Chief Operating Officer
Thompson
25/09/2006
Substantive
6 months
None
As above
Claire
Buchanan
Director of Human Resources
07/10/2013
Substantive
6 months
None
As above
Jocelyn
Foster
Commercial Director
30/07/2012
Substantive
6 months
None
As above
Helen
Blanchard
Director of Nursing
28/08/2013
Substantive
6 months
None
As above
* Tim Craft’s substantive appointment is as a Medical Consultant, to which Consultant Contract termination liabilities
apply.
41
42
This section is subject to audit.
Non-Executive Director
Nicholas Hood
Chairman
Brian Stables
0-5
0-5
0-5
0-5
0-5
10-15
25-30
55-60
60-65
80-85
60-65
65-70
55-60
0-5
5-10
5-10
5-10
10-15
5-10
10-15
£000
£000
95-100
Performance
pay and
bonuses
(bands of
£5,000)
Salary
(bands
of
£5,000)
35-40
£000
Other
Pay2
(bands
of
£5,000)
12.5-15
7.5-10
7.5-10
20-22.5
7.5-10
n/a
12.5-15
£000
All
pension
related
benefits
(bands
of
£2,500)
0-5
0-5
0-5
0-5
0-5
10-15
75-80
65-70
80-85
85-90
90-95
85-90
60-65
120-125
£000
Total
(bands
of
£5,000)
5-10
5-10
5-10
5-10
5-10
20-25
30-35
45-50
105-110
105-110
60-65
115-120
95-100
165170
£000
Salary
(bands
of
£5,000)
140-145
£000
Other
Pay2
(bands
of
£5,000)
5-10
5-10
5-10
10-15
£000
Performance
pay and
bonuses
(bands of
£5,000)
2013-14
152.5-155
112.5-115
22.5-25
35-37.5
137.5-140
n/a
50-52.5
£000
All
pension
related
benefits
(bands of
£2,500)
5-10
5-10
5-10
5-10
5-10
20-25
260-265
160-165
130-135
105-110
95-100
260-265
100-105
230-235
£000
Total
(bands
of
£5,000)
* There were no taxable expenses allowances of long term performance pay and bonuses paid during this period. A performance related payment was paid in 2014/15 which related to
2013/14.
2
Tim Craft’s substantive appointment is as a Medical Consultant. His remuneration is therefore split between his responsibilities as Medical Director (salary) and that earned in his
substantive appointments (other pay).
1
Medical Director
Tim Craft
Non-Executive Director
Director of Human
Resources
Claire Buchanan
Nigel Sullivan
Commercial Director
Jocelyn Foster
Non-Executive Director
Director of Finance and
Deputy Chief Executive
Sarah
Trulove
Joanna Hole
Director of Nursing and
Midwifery
Helen
Blanchard
Non-Executive Director
Chief Operating Officer
Francesca Thompson
Non-Executive Director
Director of Estates and
Facilities
Howard Jones
Moira Brennan
Chief Executive
James Scott
Michael Earp
Title
Name
1 April 2014-31 October 2014
The remuneration of the Chairman and the Non-Executive Directors is set by the Appointment’s Commission.
Emoluments Disclosure1
Pensions Disclosure3
Name
Title
Real
increase
in pension at
age 60
(bands of
£2,500)
£000
Real
increase
in pension
lump
sum at
age 60
(bands of
£2,500)
£000
Total
accrued
pension at
age 60 at
31 October 2014
(bands of
£5,000)
£000
Lump
sum at
age 60
related to
accrued
pension
at 31
October
2014
(bands of
£5,000)
£000
James
Scott
Chief
Executive
0 - 2.5
2.5 - 5
60 – 65
Jocelyn
Foster
Commercial
0 - 2.5
Director
0 - 2.5
0 - 2.5
Francesca Director of
Thompson Nursing
3
Cash
Equivalent
Transfer
Value at 1
April 2014
£000
Cash
Equivalent
Transfer
Value at
31 October 2014
£000
Real
increase
in Cash
Equivalent transfer Value
£000
190 – 195 1,226
1,284
59
5 - 10
10 – 15
96
16
0 - 2.5
30 – 35
100 – 105 701
719
18
81
Tim Craft
Medical
Director
0 - 2.5
0 - 2.5
65 – 70
205 - 210
1,380
1,401
21
Helen
Blanchard
Director of
Nursing
0 - 2.5
0 - 2.5
30 - 35
90 - 95
558
597
40
Claire
Buchanan
Director
of Human
Resources
0 - 2.5
0 - 2.5
25 - 30
80 - 85
467
470
4
This section is subject to audit.
Non-executive directors do not receive pensionable remuneration (2013/14: nil). Howard Jones has reached retirement age so calculation is no longer applicable. The Trust did not contribute to any Director’s stakeholder pension
scheme (2013/14: nil).
Pension details have only been disclosed for those Directors in post during 2014/15 up to 31 October 2014. Balances
for those in post during 2013/14 can be obtained from the 2013/14 Annual Report.
Cash Equivalent Transfer Values
A Cash Equivalent Transfer Value (CETV) is the actuarially assessed capital value of the pension scheme benefits
accrued by a member at a particular point in time. The benefits valued are the member’s accrued benefits and any
contingent spouse’s pension payable from the scheme. A CETV is a payment made by a pension scheme or arrangement to secure pension benefits in another pension scheme or arrangement when the member leaves a scheme and
chooses to transfer the benefits accrued in their former scheme. The pension figures shown relate to the benefits that
the individual has accrued as a consequence of their total membership of the pension scheme, not just their service in
a senior capacity to which disclosure applies. The CETV figures and the other pension details include the value of any
pension benefits in another scheme or arrangement which the individual has transferred to the NHS pension scheme.
They also include any additional pension benefit accrued to the member as a result of their purchasing additional
years of pension service in the scheme at their own cost. CETVs are calculated within the guidelines and framework
prescribed by the Institute and Faculty of Actuaries.
Real Increase or decrease in CETV
This reflects the increase in CETV effectively funded by the employer. It takes account of the increase in accrued pension due to inflation, contributions paid by the employee (including the value of any benefits transferred from another
scheme or arrangement) and uses common market valuation factors for the start and end of the period.
43
Pay multiples
Reporting bodies are required to disclose the relationship between the remuneration of the highest-paid director in
their organisation and the median remuneration of the organisation’s workforce.
The banded remuneration of the highest paid director in the Royal United Hospital Bath NHS Trust in the financial
year 2014-15 was £180,000-£185,000 (2013-14:£175,000-£180,000). This was 6.5 times (2013-14: 6.6) the median
remuneration of the workforce, which was £28,173 (2013-14: £26,993). In 2013-14, two (2013-14: three) employees
received remuneration in excess of the highest-paid director.
Total remuneration includes salary, non-consolidated performance-related pay, benefits-in-kind but not severance
payments. It does not include employer pension contributions and the cash equivalent transfer value of pensions. The
median and the ratio include bank and locum staff but do not include agency staff.
As at 31 October 2014
As at 31 March 2014
Band of Highest Paid Director’s
Total Remuneration (£’000)
180-185
Band of Highest Paid Director’s
Total Remuneration (£’000)
175-180
Median Total Remuneration (£)
28,173
Median Total Remuneration (£)
26,993
Ratio
6.5
Ratio
6.6
Reporting of staff exit packages
The Trust is required, in line with Department of Health guidelines, to report exit packages which have been agreed
with former staff as part of this report.
1 April 2014-31 October 2014
Exit
package
cost band
(including
any special
payment
element)
Number of
compulsory
redundancies
Number of
other
departures
agreed
Less than
£10,000
0
£10,001 £25,000
2013/14
Total
number of
exit
packages
by cost
band
(total
cost)
Of which,
number
where
special
payments
have been
made
(totalled)
Total
number of
exit
packages
by cost
band
(total
cost)
Number of
departures
where
special
payments
have been
made
(totalled)
9
10
(£29,000)
0
0
5
5
(£15,000)
0
1
0
1
(£17,000)
0
0
0
0
0
£25,001£50,000
0
0
0
0
0
0
0
0
£50,001£100,000
0
0
0
0
0
0
0
0
£100,001£150,000
0
0
0
0
0
0
0
0
£150,001£200,000
0
0
0
0
0
0
0
0
>£200,000
0
0
0
0
0
0
0
0
Total
number of
exit
packages
by type
(total cost)
1
9
11
(£46,000)
0
0
0
5
(£15,000)
0
James Scott, Chief Executive
27 May 2015
44
Number of
Number
compulsory
of other
redundancies departures
agreed
45
Summary Accounts
The summary financial statements which follow do not contain sufficient information to allow as full an understanding
of the results and state of affairs of the Trust and its policies and arrangements as provided by the full set of annual
accounts.
The auditor’s report on the full annual report and accounts was unqualified and the auditor’s statement confirmed the
strategic report and directors’ reports were consistent with the accounts and were unqualified.
A full set of the accounts is available on request from the Director of Finance.
The following statements are attached:
•
•
•
•
Summary Financial Statements
Annual Governance Statement
Directors’ Statements
Independent Auditor’s report
The summary financial statements do not include the results for Royal United Hospital Bath Charitable Fund. The
Charitable Fund is registered with the Charity Commission for England and Wales under registration number,
1058323. Its principle office is at the Royal United Hospital NHS Trust, Combe Park, Bath BA1 3NG. Details of the
charitable fund can be found on the website: www.ruh.nhs.uk. The main fundraising appeal of the fund, the Forever
Friends Appeal, can be found at www.foreverfriendsappeal.co.uk.
Administrative details
Trust contact:
Director of Finance
Royal United Hospital Bath NHS Trust
Malvern House
Combe Park
Bath BA1 3NG
Solicitors: Bevan Brittan Solicitors
35 Colston Avenue
Bristol BS1 4TT
Bankers:
Government Banking Service
Sutherland House
Russell Way
Crawley
West Sussex RH10 1UH
Auditors:
Grant Thornton LLP
Hartwell House
55-61 Victoria Street
Bristol BS1 6FT
Telephone: 01225 428331
E-mail: [email protected]
Audit
The independent auditor’s statement is included within the Summary Financial Statements. The Trust, and its auditors, have processes in place to ensure that conflicts of interest are minimised and that the auditor’s independence is
not compromised. This includes providing the auditor with direct access to the Chair of the Audit Committee, and it’s
other Non-Executive Members. The Audit Committee seeks confirmation on an annual basis that the audit function
is independent from management. During the seven-month period, the external auditor was paid £51,438 including
VAT for their statutory work, of which £3,900 relates to the audit of the full financial year for the RUH Charitable Funds
(2013/14: £107,076).
46
All of this work related to their statutory activities under the Audit Commission’s ‘Code of Audit Practice’.
In respect of the preparation of the accounts for the period from 1 April 2014 to 31 October 2014, as far as the Directors are aware there is no relevant audit information of which the Trust’s auditors are unaware. The Trust’s Directors
have taken all steps that they ought to have taken as Directors to make themselves aware of any relevant audit information and to establish that the auditors are aware of that information.
Going concern
The Directors have a reasonable expectation that the Trust has adequate resources to continue in operational existence for the foreseeable future, and for a period exceeding twelve months from the date of signing the accounts. For
this reason, the accounts have been prepared on the going concern basis.
Counter fraud
The Trust has taken all reasonable steps to comply with the requirements set out in the Code of Conduct for NHS
managers, and has a named individual nominated to provide the lead local counter fraud specialist function: an accredited counter fraud specialist. If you suspect that fraud may have occurred, affecting either the Trust or any other
NHS organisation, please contact the counter fraud helpline on 0800 028 4060.
Openness and accountability
The Trust is committed to ensuring that it operates within an open and transparent environment, where this does not
conflict with its legal responsibilities. The Trust is compliant with the requirements of the Freedom of Information Act.
The Annual Report and Accounts provides the public with a comprehensive review of the Trust’s annual performance
and has been subject to audit scrutiny.
Pensions
Past and present employees are covered by the provisions of the NHS Pensions Scheme. The scheme is an unfunded, defined benefit scheme that covers NHS employers, General Practices and other bodies, allowed under the
direction of the Secretary of State, in England and Wales. The scheme is not designed to be run in a way that would
enable NHS bodies to identify their share of the underlying scheme assets and liabilities. Therefore, the scheme is
accounted for as if it were a defined contribution scheme: the cost to the NHS body of participating in the scheme is
taken as equal to the contributions payable to the scheme for the accounting period.
Staff sickness absence
The Manual for Accounts requires that the Trust disclose details of staff sickness absences. This disclosure is included
below:
Total days lost
Total staff years1
1 Apr-13 Oct 2014
2013/14
2012/13
18,871
29,411
26,775
2,217
3,441
3,300
Average working days lost 8.5
8.5
8.10
1
The number of equivalent years of staff service worked during the current year based on the number of working days
in a year.
2
The number of working days lost on average for each employee. This is calculated by dividing the total number of
days lost by the total of staff years.
2
Data used in this calculation is on a calendar year basis, for the years ended 31 December 2013 and 31 October 2014
and are used as approximations of the information related to the financial years.
47
NHS Trust Manual for Accounts
The operating and financial review has been prepared in accordance with the NHS Trust Manual for Accounts for
2014/15, as directed by the Secretary of State.
Statement of Comprehensive Income 1 April 2014 to 31 October 2014
Trust
Group
Note 7 months to 2013-14 7 months to 2013-14
31 October
£000s
31 October
£000s
2014
2014
Gross employee benefits
9.1
(94,565)
(149,734)
(94,565)
(149,734)
Other operating costs
7
(51,152)
(80,932)
(51,592)
(81,595)
Revenue from patient care activities
4
139,276
222,950
139,276
222,950
Other Operating revenue
5
10,935
17,995
11,357
22,646
4,494
10,279
4,476
14,267
Operating surplus/(deficit)
Investment revenue
11
24
40
26
135
Other gains and (losses)
12
0
(35)
6
48
Finance costs
13
(70)
(151)
(70)
(151)
4,448
10,133
4,438
14,299
(3,066)
(4,999)
(3,066)
(4,999)
1,382
5,134
1,372
9,300
0
0
0
0
Net gain/(loss) on revaluation of property,
plant & equipment
5,183
5,787
5,183
5,787
Total Comprehensive Income for the year*
6,565
10,921
6,555
15,087
1,382
5,134
1,372
9,300
972
0
972
0
Adjustments in respect of donated gov't grant
asset reserve elimination
(251)
72
(251)
(453)
Adjusted retained surplus/(deficit)
2,103
5,206
2,093
8,847
Surplus/(deficit) for the financial year
Public dividend capital dividends payable
Retained surplus/(deficit) for the year
Other Comprehensive Income
Impairments and reversals taken to the Revaluation Reserve
Financial performance for the year
Retained surplus/(deficit) for the year
Impairments (excluding IFRIC 12 impairments)
* The adjustments made to accounting outturn to arrive at reported performance include £670,000 donated income
with respect to capital purchases and £419,000 depreciation for donated assets.
48
Statement of Financial position as at 31 October 2014
Note
Trust
31 Oct
31 Mar
2014
2014
£000s
£000s
Group
31 Oct
31 Mar
2014
2014
£000s
£000s
Non-current assets:
Property, plant and equipment
14
178,223
171,929
178,223
171,929
Intangible assets
15
795
844
795
844
0
0
6,038
6,032
1,272
1,371
1,272
1,371
180,290
174,144
186,328
180,176
18
4,400
4,295
4,400
4,295
19.1
15,540
15,154
15,358
14,825
0
0
0
0
8,527
9,198
9,564
10,493
Other Investments - Charitable
Trade and other receivables
19.1
Total non-current assets
Current assets:
Inventories
Trade and other receivables
Other current assets
Cash and cash equivalents
20
Total current assets
Total assets
28,467
28,647
29,322
29,613
208,757
202,791
215,650
209,789
Current liabilities:
Trade and other payables
22
(19,462)
(18,664)
(19,456)
(18,753)
Provisions
26
(943)
(1,331)
(943)
(1,331)
Borrowings
23
(119)
(90)
(119)
(90)
0
0
0
0
(990)
(990)
(990)
(990)
(21,514)
(21,075)
(21,508)
(21,164)
6,953
7,572
7,814
8,449
187,243
181,716
194,142
188,625
Other financial liabilities
Capital loan from Department
23
Total current liabilities
Net current assets/(liabilities)
Non-current assets plus/less net current assets/liabilities
Non-current liabilities:
Provisions
26
(1,470)
(2,076)
(1,470)
(2,076)
Borrowings
23
(70)
(126)
(70)
(126)
Capital loan from Department
23
(6,440)
(6,935)
(6,440)
(6,935)
(7,980)
(9,137)
(7,980)
(9,137)
179,263
172,579
186,162
179,488
139,806
139,685
139,806
139,685
Retained earnings
(6,368)
(8,671)
(6,368)
(8,671)
Revaluation reserve
45,826
41,565
45,826
41,565
Charitable Funds Reserve - Restricted
0
0
5,799
5,668
Charitable Funds Reserve - Unrestricted
0
0
1,100
1,241
Other reserves
0
0
0
0
179,263
172,579
186,162
179,488
Total non-current liabilities
Total Assets Employed:
FINANCED BY:
TAXPAYERS' EQUITY
Public Dividend Capital
Total Taxpayers' Equity:
James Scott, Chief Executive
27 May 2015
49
Statement of Cash Flows 1 April 2014 to 31 October 2014
Trust
Group
7 months 2013-14 7 months 2013-14
to 31
to 31
October
October
2014
2014
£000s
£000s
£000s
£000s
CASH FLOWS FROM OPERATING ACTIVITIES
Operating Surplus/(Deficit)
4,494
10,279
4,476
14,267
Depreciation and Amortisation
4,981
9,031
4,981
9,031
972
0
972
0
(357)
(560)
(357)
(560)
Impairments and Reversals
Donated Assets received credited to revenue but non-cash
Interest Paid
(62)
(134)
(62)
(134)
(2,572)
(5,011)
(2,572)
(5,011)
(Increase)/Decrease in Inventories
(179)
(594)
(179)
(594)
(Increase)/Decrease in Trade and Other Receivables
(398)
(4,315)
(545)
(3,956)
0
0
0
0
(515)
4,781
(610)
4,787
Dividend (Paid)/Refunded
(Increase)/Decrease in Other Current Assets
Increase/(Decrease) in Trade and Other Payables
Provisions Utilised
(322)
(647)
(322)
(647)
Increase/(Decrease) in Provisions
(672)
(210)
(672)
(210)
0
0
0
73
Net Cash Inflow/(Outflow) from Operating Activities
5,370
12,620
5,110
17,046
NHS Charitable Funds – net adjustments for working capital
movements, non-cash transactions and non-operating cash flows
CASH FLOWS FROM INVESTING ACTIVITIES
Interest Received
(Payments) for Property, Plant and Equipment
(Payments) for Intangible Assets
24
40
26
40
(5,594) (15,203)
(5,594)
(15,203)
(70)
(183)
(70)
(183)
(Payments) for Other Financial Assets
0
0
0
(4,000)
Proceeds of disposal of assets held for sale (PPE)
0
35
0
35
NHS Charitable Funds – net cash flows relating to investing
activities
0
0
0
0
(5,640) (15,311)
(5,638)
(19,311)
(528)
(2,265)
Net Cash Inflow/(Outflow) from Investing Activities
NET CASH INFLOW/(OUTFLOW) BEFORE FINANCING
50
(270)
(2,691)
Trust
7 months
to 31
October
2014
£000s
Group
2013-14
£000s
7 months 2013-14
to 31
October
2014
£000s
£000s
CASH FLOWS FROM FINANCING ACTIVITIES
Public dividend capital received
121
2,329
121
2,329
0
0
0
0
Loans repaid to DH – capital investment loans
repayment of principal
(495)
(990)
(495)
(990)
Loans repaid to DH – Revenue Support Loans
0
0
0
0
(27)
(147)
(27)
(147)
0
0
0
0
Net Cash Inflow/(Outflow) from financing activities
(401)
1,192
(401)
1,192
NET INCREASE/(DECREASE) IN CASH AND CASH
EQUIVALENTS
(671)
(1,499)
(929)
(1,073)
Cash and Cash Equivalents (and bank overdraft) at
beginning of the period
9,198
10,697
10,493
11,566
Cash and Cash Equivalents (and bank overdraft) at year end
8,527
9,198
9,564
10,493
Loans received from DH – new capital investment loans
Capital element of payments in respect of finance leases and
on-SoFP PFI and LIFT
NHS Charitable Funds – net cash flows relating to financing
activities
51
Trust Statement of Changes in Taxpayers’ Equity
1 April 2014 to 31 October 2014
TRUST
Balance at 1 April 2014
Public
Dividend
capital
£000s
139,685
Retained
earnings
Revaluation Other
Total
reserve
reserves reserves
£000s
£000s
(8,671)
£000s
41,565
£000s
0
172,579
Changes in taxpayers’ equity for 7 months to 31 October 2014
Retained surplus/(deficit) for the year
1,382
Net gain / (loss) on revaluation of property, plant,
equipment
Transfers between reserves
922
1,382
5,183
5,183
(922)
0
Reclassification Adjustments
New PDC Received – Cash
121
121
Charitable Funds Adjustment
Net recognised revenue/(expense) for the year
121
2,304
4,261
0
6,685
Balance at 31 October 2014
139,806
(6,368)
45,826
0
179,264
Balance at 1 April 2013
137,356
(15,651)
37,625
0
159,330
Changes in taxpayers’ equity for the year ended 31 March 2014
Retained surplus/(deficit) for the year
5,134
Impairments and reversals
5,134
5,787
Transfers between reserves
1,847
Transfers under Modified Absorption Accounting –
PCTs & SHAs
(1,847)
5,787
0
(1)
0
(1)
Reclassification Adjustments
New PDC Received – Cash
2,329
2,329
Charitable Funds Adjustment
Net recognised revenue/(expense) for the year
Balance at 31 March 2014
52
2,329
6,980
3,940
0
13,249
139,685
(8,671)
41,565
0
172,579
Group Statement of Changes in Taxpayers’ Equity
1 April 2014 to 31 October 2014
GROUP
Balance at 1 April 2014
Public
Retained Revaluation
Dividend earnings reserve
capital
£000s
£000s
£000s
139,685
(8,671)
41,565
Charitable
Funds
Reserve
£000s
6,910
Other
reserves
Total
reserves
£000s
£000s
0
179,489
Changes in taxpayers’ equity for 7 months to 31 October 2014
Retained surplus/(deficit) for the year
1,382
Net gain / (loss) on revaluation of property, plant, equipment
Transfers between reserves
922
1,382
5,183
5,183
(922)
0
Reclassification Adjustments
New PDC Received – Cash
121
121
Charitable Funds Adjustment
Net recognised revenue/(expense)
for the year
(11)
(11)
121
2,304
4,261
(11)
0
6,675
Balance at 31 October 2014
139,806
(6,367)
45,826
6,899
0
186,164
Balance at 1 April 2013
137,356
(15,651)
37,625
2,743
0
162,073
Changes in taxpayers’ equity for the year ended 31 March 2014
Retained surplus/(deficit) for the year
Impairments and reversals
5,134
Transfers between reserves
5,787
Transfers under Modified Absorption
Accounting – PCTs & SHAs
1,847
Reclassification Adjustments
New PDC Received – Cash
5,134
(1,847)
Balance at 31 March 2014
0
(1)
0
(1)
2,329
2,329
Charitable Funds Adjustment
Net recognised revenue/(expense)
for the year
5,787
4,167
4,167
2,329
6,980
3,940
4,167
0
17,416
139,685
(8,671)
41,565
6,910
0
179,489
53
Directors’ Interests
Surname
First Name
Role
Declared Interest
Blanchard
Helen
Director of Nursing
No interests currently declared
Brennan
Moira
Non-Executive Director
Bathampton Parish Councillor
Treasurer of Bathampton Village Hall
Trustee of St John’s
Buchanan
Claire
Director Human Resources
(Non-Voting)
Craft
Tim
Medical Director
Earp
Michael
Non-Executive Director
No interest currently declared
Foster
Jocelyn
Commercial Director
Chair of Trustees, Apex Works
(Charitable organisation in Leicester providing
services to support disadvantaged and
marginalised individuals in Leicester into work)
No interest currently declared
Medical Director and shareholder of
Anaesthetic Medical Systems (AMS) Ltd
Director and shareholder of 10Bar Ltd
Complaints Panellist - Dental Complaints
Service - Private Complaints Resolution Service
Trustee of the Disabilities Trust (a national
organisation providing brain injury rehabilitation,
autism and physical disability services)
Hole
Joanna
Non-Executive Director
No interest currently declared
Hood
Nick
Non-Executive Director
No interest currently declared
Jones
Howard
Director of Estates and Facilities
(Non-Voting)
No interest currently declared
Scott
James
Chief Executive
Vice Chairman of West of England
Academic Health Science Network
Stables
Brian
Chairman
Director of Profex Associates Ltd Management Consultancy
Associate Lecturer, Open University Mary
Seacole Programme
Trustee, Wiltshire Air Ambulance
Charitable Trust
Wife works part-time at Apetito,
Trowbridge (food supplier for the RUH)
Daughter is registered with the Trust’s
Temporary Staff Bank
Sullivan
Nigel
Non-Executive Director
Director of West Four Apartments
Management Company Ltd
Thompson
Francesca
Director of Nursing
Daughter is registered with the Trust’s
Temporary Staff Bank
Truelove
Sarah
Director of Finance &
Deputy Chief Executive
Married to the Chief Finance Officer for
Wiltshire Clinical Commissioning Group
School Governor - The Corsham School
54
Statement of the Chief Executive’s
responsibilities as the accountable officer
of the Trust
The Chief Executive of the NHS Trust Development Authority has designated that the Chief Executive should be the
Accountable Officer to the Trust. The relevant responsibilities of Accountable Officers are set out in the Accountable
Officers’ Memorandum issued by the The Chief Executive of the NHS Trust Development Authority. These include
ensuring that:
•
There are effective management systems in place to safeguard public funds and assets and assist in the implementation of corporate governance;
•
Value for money is achieved from the resources available to the Trust;
•
The expenditure and income of the trust has been applied to the purposes intended by Parliament and conform
to the authorities who govern them;
•
Effective and sound financial management systems are in place; and
•
Annual statutory accounts are prepared in a format directed by the Secretary of State, with approval of the
Treasury, to give a true and fair view of the state of affairs as at the end of the financial year and the income and
expenditure, recognised gains and losses and cash flows for the year.
To the best of my knowledge and belief, I have properly discharged the responsibilities set out in my letter of appointment as an Accountable Officer.
James Scott, Chief Executive
27 May 2015
55
Statement of Directors’ responsibilities in
respect of the accounts
The directors are required under the National Health Service Act 2006 to prepare accounts for each financial year.
The Secretary of State, with the approval of HM Treasury, directs that these accounts give a true and fair view of the
state of affairs of the Trust and of the income and expenditure, recognised gains and losses and cash flows for the
year. In preparing those accounts, the directors are required to:
•
Apply on a consistent basis accounting policies laid down by the Secretary of State with the approval of HM
Treasury;
•
Make judgements and estimates which are reasonable and prudent;
•
State whether applicable accounting standards have been followed, subject to any material departures disclosed and explained in the accounts.
The Directors are responsible for keeping proper accounting records which disclose with reasonable accuracy at
any time the financial position of the Trust and to enable them to ensure that the accounts comply with requirements
outlined in the above mentioned direction of the Secretary of State. They are also responsible for safeguarding the
assets of the Trust and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities.
The Directors confirm to the best of their knowledge and belief they have complied with the above requirements in
preparing the accounts.
By order of the Board
James Scott, Chief Executive
27 May 2015
Sarah Truelove, Deputy Chief Executive & Director of Finance
27 May 2015
56
Independent Auditor’s Report to the Directors
of Royal United Hospital Bath NHS Trust
We have audited the financial statements of Royal United Hospital Bath NHS Trust for the seven month period ended
31 October 2015 under the Audit Commission Act 1998. The financial statements comprise the Trust and Group Statement of Comprehensive Income, the Trust and Group Statement of Financial Position, the Statement of Changes in
Taxpayers' Equity, the Trust and Group Statement of Cash Flows and the related notes. The financial reporting framework that has been applied in their preparation is applicable law and the accounting policies directed by the Secretary
of State with the consent of the Treasury as relevant to the National Health Service in England.
We have also audited the information in the Remuneration Report that is subject to audit, being:
•
•
•
the table of salaries and allowances of senior managers and related narrative notes on page 42
the table of pension benefits of senior managers and related narrative notes on page 43
the table of pay multiples and related narrative notes on page 44.
This report is made solely to the Board of Directors of Royal United Hospital Bath NHS Trust in accordance with Part II
of the Audit Commission Act 1998 and for no other purpose, as set out in paragraph 44 of the Statement of Responsibilities of Auditors and Audited Bodies published by the Audit Commission in March 2014. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the Trust's directors and the Trust as a
body, for our audit work, for this report, or for the opinions we have formed.
Respective responsibilities of Directors and auditor
As explained more fully in the Statement of Directors’ Responsibilities in respect of the accounts, the Directors are
responsible for the preparation of the financial statements and for being satisfied that they give a true and fair view.
Our responsibility is to audit and express an opinion on the financial statements in accordance with applicable law
and International Standards on Auditing (UK and Ireland). Those standards also require us to comply with the Auditing
Practices Board’s Ethical Standards for Auditors.
Scope of the audit of the financial statements
An audit involves obtaining evidence about the amounts and disclosures in the financial statements sufficient to give
reasonable assurance that the financial statements are free from material misstatement, whether caused by fraud
or error. This includes an assessment of: whether the accounting policies are appropriate to the Trust and Group’s
circumstances and have been consistently applied and adequately disclosed; the reasonableness of significant accounting estimates made by the directors; and the overall presentation of the financial statements. In addition, we read
all the financial and non-financial information in the annual report which comprises the Strategic report, Sustainability
Report, information on Social and Community Issues and Director's Interests to identify material inconsistencies with
the audited financial statements and to identify any information that is apparently materially incorrect based on, or
materially inconsistent with, the knowledge acquired by us in the course of performing the audit. If we become aware
of any apparent material misstatements or inconsistencies we consider the implications for our report.
Opinion on financial statements
In our opinion the financial statements:
•
give a true and fair view of the financial position of Royal United Hospital NHS Trust for the seven month period
ended 31 October 2014 and of its expenditure and income for the year then ended;
•
give a true and fair view of the financial position of the Group for the seven month period ended 31 October
2014 and of its expenditure and income for the year then ended; and
•
have been prepared properly in accordance with the accounting policies directed by the Secretary of State with
the consent of the Treasury as relevant to the National Health Service in England.
57
Opinion on other matters
In our opinion:
•
the part of the Remuneration Report subject to audit has been prepared properly in accordance with the requirements directed by the Secretary of State with the consent of the Treasury as relevant to the National
Health Service in England; and
•
the information given in the annual report for the financial year for which the financial statements are prepared
is consistent with the financial statements.
Matters on which we report by exception
We report to you if:
•
in our opinion the governance statement does not reflect compliance with the NHS Trust Development Authority's Guidance
•
we refer the matter to the Secretary of State under section 19 of the Audit Commission Act 1998 because we
have reason to believe that the Trust, or an officer of the Trust, is about to make, or has made, a decision involving unlawful expenditure, or is about to take, or has taken, unlawful action likely to cause a loss or deficiency; or
•
we issue a report in the public interest under section 8 of the Audit Commission Act 1998.
We have nothing to report in these respects.
Certificate
We certify that we have completed the audit of the accounts of Royal United Hospital Bath NHS Trust in accordance
with the requirements of the Audit Commission Act 1998 and the Code of Audit Practice issued by the Audit Commission.
John Golding
for and on behalf of Grant Thornton UK LLP, Appointed Auditor
Grant Thornton UK LLP
Hartwell House
55-61 Victoria Street
Bristol BS1 6FT
58
Glossary
Term
Definition
Agenda for Change
Current NHS pay system (excluding doctors, dentists and some senior managers) implemented to
standardise pay across various staff groups and across NHS organisations.
Amortisation
An amount which is charged to expenditure on a periodic basis to reflect the use of an intangible asset
over more than one reporting period.
Asset
A balance which represents the value of finance benefit the Trust will gain in future periods as a result
of a past transaction or event.
Borrowings
Amounts which the Trust has borrowed, either as a loan or as a finance lease.
Breakeven Duty
A statutory requirement for the Trust to ensure that it balances income and expenditure over a period of
three years (or in certain exceptions, five years).
Cash Equivalents
Assets that can be easily and quickly converted into cash.
Current Asset
An asset used or sold in the Trust’s normal activities, such as stocks.
Depreciation
An amount which is charged to expenditure and which recognises the reduction in value of a non-current asset over its life due to wear and tear, technological changes or the general passing of time.
Donated Asset Reserve
An account which is credited with a balance to reflect assets donated to the Trust.
Exit packages
A financial arrangement with an employee which will result in a termination of their contract of employment with the Trust. This can be the result of a MARS scheme, redundancy, severance agreement, or
pay in lieu of notice.
Finance Costs
A balance which represents interest costs, arising from borrowings and unwinding the discounts applied to future liabilities reflecting the time-value of money.
Finance Lease
A contractual agreement arising where an underlying asset is transferred to the lessee, but where legal
ownership remains with the lessor.
IFRS
International Financial Reporting Standards, a set of rules that were set up to standardise accounting
procedures and reporting processes across international boundaries. These have been applied for the
first time in 2009/10.
Impairment
The reduction in value of an asset due to damage or obsolescence.
Independent Sector
Treatment Centres
Privately owned treatment centres which perform procedures on behalf of the NHS.
Intangible Asset
An asset which cannot be seen or touched but which have value, such as software licences.
Inventories
Stock.
Liabilities
A balance which represents an expected future financial outflow to the Trust arising as a result of a
past transaction or event.
MARS
Mutually Agreed Resignation Scheme. The Scheme enables individual employees – in agreement with
their employer – to choose to leave their employment voluntarily, in return for a severance payment. It
is not a redundancy.
Non-Current Asset
An asset which is held for more than one year and not sold during the normal course of Trust activities,
such as medical equipment.
Operating Expenses
Costs incurred through carrying out the day to day activities of the Trust i.e. patient care activities.
Operating Revenue
Income received from the day to day activities of the Trust i.e. patient care activities.
Payables
Balances owed to others.
PDC Dividend
An amount which represents a return on the net assets of the Trust which is paid annually to HM
Treasury. The net assets used for this calculation excludes the value of donated assets and cash held
in Government Banking Services bank accounts.
Provision
A liability arising as a result of a past event which will be payable in future periods.
Public Dividend Capital
(PDC)
Represents Central Government’s investment in the Trust. This is similar to the ‘Share Capital’ in a
company.
Receivables
Balances owed by others.
Redundancy
Termination of employment of an employee or a group of employees for business reasons.
Revaluation Reserve
A reserve which is credited with historic increases in the value of assets as a result of changes in
prices. Any reductions in values are also when assets are assessed and found to have increased in
value the additional amount is recorded here.
Taxpayers’ Equity
A balance representing the net assets of the Trust.
UK GAAP
UK Generally Accepted Accounting Practice represents the collective term for the standards, rules and
practices which developed in the UK. From 2009/10 onward, these have been replaced by International Financial Reporting Standards in the NHS.
59
Are we talking your language?
If you need this document in another format,
including large print,
please contact the
Patient Adivce and Liaison Service
Tel: 01225 825656
E-mail: [email protected]
Se você gostaria desta informação em seu idioma,
por favor nos contate em 01225 825656.
如果你希望这一信息在你的语言,请联系我们关于
01225 825656.
Are we talking your
language?Jeśli chcesz tę informację w twoim języku,
o kontakt
If you needprosimy
this document
in z 01225 825656.
another format, including
large print, please
contact the Patient Adivce
and Liaison Service Tel:
01225 825656
E-mail: [email protected]
We value your opinion
We want to make sure future reports give you all the information you need on
our services, so please tell us if you think we could improve.
If you would like to know more, or to comment on our plans,
please write to the
Chairman Brian Stables or
Chief Executive James Scott at:
Royal United Hospital Bath NHS Trust
Combe Park
BATH
BA1 3NG
Telephone: 01225 824032
E-mail: [email protected]
Website: www.ruh.nhs.uk
Date of publication: May 2015
Ref: RUHAR 0004/7
© Royal United Hospital Bath NHS Trust
60
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