Annual General Meeting

Transcription

1 Annual General Meeting 26 September

2 Annual General Meeting Nick Marsden Chairman

3 Agenda 1. Introduction and Welcome Nick Marsden, Chairman 2. Annual Report 2015/16 Peter Hill, Chief Executive 3. Annual Accounts and Audit Opinion 2015/16 4. Care Quality Commission Inspection Actions and Improvements Malcolm Cassells, Director of Finance & Procurement Lorna Wilkinson, Director of Nursing Dr Christine Blanshard, Medical Director 5. Outpatients and Diagnostic Imaging Alison Montgomery Diagnostic Services Manager Lucy Bushby Consultant Radiologist / Clinical Lead 6. Council of Governors report to members Alastair Lack, Lead Governor 7. Questions and Answers Nick Marsden, Chairman

4 Annual Report 2015/16 Peter Hill Chief Executive 4

5 District General Hospital Services Maternity Diagnostics Emergency Department Children s Services Facilities Medicine Orthopaedics Surgery

6 Regional Specialist Services Laser Centre Cleft Lip & Palate Wessex Rehabilitation Genetics Burns Plastic Surgery

7 Supra-Regional Spinal Services

8 Facts & Figures for 2015/16 Elective Admissions 6,000 Day Cases 24,000 Regular Day Attendees 8,000 Emergency Admissions 29,000 A&E Attendances 45,000 Outpatients 180,000 Number of Births 2,500 Number of Diagnostic scans (CT, MRI) and X-Ray 175,500 Number of Staff employed 4,000 +

9 Review of Performance for 2015/16 SFT National Targets 94.8% A&E attendees admitted, treated or discharged within 4 hours 95% 92% Cancer patients waited less than 18 weeks of GP referral 92% 94.3% Cancer patients seen within two weeks 93% 99.2% Cancer patients started treatment within 31 days 96% 88.4% Cancer patients treated within 62 days of referral from GP 85%

10 0 MRSA bacteraemia 0 15 Trust apportioned Clostridium Difficile cases Target: 19 or less 98.3% Patients who had a CT scan within 12 hours of admission with a stroke Target: 100% 90% Stroke patients who spend 90% of care on Stroke Unit National Average is 84%

11 What our patients say: Feedback Recommend Hospital FRIENDS AND FAMILY April March 2016 Percentage of patients that would recommend this Hospital to Friends and Family (Inpatients and A&E Attendances) 1.4% Would Recommend 1.6% Quality of Care REAL-TIME FEEDBACK April March 2016 Overall, how would you rate the quality of care you received? 98.4% Good - Excellent Poor - Fair n = 1741 Would Not Recommend 98.6% n = % Dignity & Respect REAL-TIME FEEDBACK April March 2016 Are you being treated with care and compassion? Yes No 295 Complaints 99.4% n =

12 What our patients say: National Surveys Inpatient Survey Highest score in region and above national average Cancer Survey 9 out of 10 care rating by patients Positive findings from parents, children and young adults survey Maternity Survey One of best for women in labour and during birth 12

13 What our staff say: 4.20 Staff recommendation of the Trust as a place to work or receive treatment Best in the South of England and 2 nd best ratings in the country Salisbury NHS Foundation Trust Southampton University Hospital Poole Hospital Portsmouth Hospitals The Royal Bournemouth Hospital Hampshire Hospitals (Basingstoke Winchester) Royal United Hospital Bath Great Western Gloucestershire Hospital Swindon Royal Hospital

14 Achievements Wiltshire Health and Care First for laser prostate surgery National pilot site for scan4safety Refurbishment of bungalows

15 Achievements cont Salisbury District Hospital Top 100 places to work Leadership award Patient Safety Awards Top Hospitals Award 15

16 Contribution of Patients, Public, Volunteers and Governors Patients and Public Involvement: Patients Involved in over 30 projects using patient stories, focus groups and Real Time Feedback Volunteers: Over 700 volunteers give over 1,900 hours a week of extra support, helping on wards and departments, acting as guides and supporting one off projects Other volunteers: cover all types of work and includes, Stars Appeal, ArtCare, League of Friends, Horatio s Garden, Engage and Pets as Therapy Governors: 27 Governors (Public, Staff and Nominated) representing over 17,200 members Link with membership, statutory duties, support services and sample patient experience

17 Our Focus for 2016/17 Challenges: Increasing demand Staff Recruitment National and local initiatives to keep people out of hospital Financial situation Implementation of CQC action plan Partnership working - Sustainability and Transformation Plans Areas for improvement: Rapid treatment of sepsis Continue reduction in pressure ulcers Reduction in falls resulting in fracture or serious harm

18 CQC Inspection There is nothing broken in Salisbury There is a great deal to celebrate at Salisbury and also issues that need to be addressed. Mary Cridge Head of Hospital Inspections (South West)

19 CQC Inspection Salisbury NHS Foundation Trust Safe Effective Caring Well Led Overall A&E Med/COP Surgery C.Care Mat / F.Planning Children End of Life Ot.pts & Diagnostics Spinal Unit RI G G RI RI G G G RI G G RI G RI G G G RI RI G G G G RI G G G RI G G G G RI G NR G G G RI RI G I RI RI G G RI RI RI G RI G RI RI G RI G G RI RI

20 Results to April 2016 (Acute Hospitals) Outstanding 2 Good 32 Requires Improvement Over 100 Inadequate Outstanding Good Requires Improvement Inadequate

21 Where we stand Inadequate Requires Improvement Good * 25 Over Salisbury NHS Foundation Trust *Outstanding

22 Financial Performance 1 April 2015 to 31 March 2016 Malcolm Cassells Director of Finance and Procurement

23 Summary Facts for The SFT Group accounts for include the consolidation of Salisbury District Hospital Charitable Fund together with the subsidiary accounts of Odstock Medical Ltd, and Salisbury Trading Ltd. We recorded a consolidated deficit of 6,517k which was in accordance with plan. Year on year the Dept of Health has been cutting the tariff under which we get paid by 4% in real terms. This has resulted in the need for large savings which is becoming unrealistic. We failed to achieve our savings target of 8.0m but achieved 6.5m ( 2.2m non-recurring). The national quality emphasis continued to add to our costs without supporting income. In addition the ability to recruit to key clinical posts has become more difficult. In we spent 8.0m on agency staff in order to maintain services. Each day on average the Hospital spends over 570k Net Current Assets fell to 8.8m from 11.9m at the end of the previous year We had an operating deficit of 1.1m compared with a 3.8m surplus in the previous year Increased in-patients treated due to non-elective work and big increase in day case work Positive External Audit Report

24 000 Our performance since being a FT (excludes subsidiaries and charitable funds) 30,000 25,000 20,000 15,000 surplus (+)/deficit (-) year end cash working capital long term borrowings inc PFI 10,000 5, ,000-10,000

25 Group Statement of Comprehensive Income Income: From clinical activities 181, ,554 Other operating income 21,980 23,366 Total Operating Income 203, ,920 Operating Expenses -199, ,002 OPERATING SURPLUS (+VE) / DEFICIT (-VE) 3,824-1,082 Finance income Public Dividend Capital payable -3,675-3,650 Other finance costs -1,922-2,014 RETAINED SURPLUS FOR THE YEAR -1,533-6,517 Revaluation gains/losses (-) ,111 Fair value gains on investments TOTAL SUPLUS (+)/DEFICIT (-) -1,727-7,833 RETAINED SURPLUS (+)/Deficit (-) for SFT ONLY ,313

26 Group Revenue Total Group Revenue was 205.1m ( 204.0m in ) Revenue in respect of SFT only was 198.7m Revenue from Patient Care was 181.6m ( 181.7m in ) Revenue from other activities was 23.4m ( 22.0m in ) National Tariff declined by 4% Subsidiaries, OML and STL, traded profitably during Income from My Trusty skin care products 120k

27 Analysis of Group Revenue Other Income 8,926 Private P 2,068 OML 1,852 Charitable 2,299 STL - laundry 3,841 Non-NHS care 2,124 Research 754 FTs and NHSTs 3,885 Educ & Training 5,904 Local Auths 1,797 NHS England 39,996 Other CCGs 4,801 W. Hants CCG 14,518 Dorset CCG 19,605 Wilts CCG 92, ,000 40,000 60,000 80, ,000

28 Analysis of Group Revenue 000 Private, 2,068 Elective, 34,545 Nonclinical, 23,366 Nonelective, 56,750 ED, 5,514 Outpatients, 25,808 Other clinical, 56,869

29 Group Expenditure Total Expenditure was 209.7m (of which SFT is 204.9m) Total Operating Expenditure 206.0m 129.7m (61.9%) spent on paying staff 38.5m spent on clinical supplies & healthcare 37.8m spent on buildings, departments and non-clinical supplies etc Good Efficiency - SFT costs are 8% less than National Average for England [source national reference costs] Management and administrative costs less than 4% of turnover

30 Operating Expenditure - Pay (total 126.2m SFT only) Other Board & Sen Managers 6,059 6, Admin & Clerical Healthcare Assts 13,118 13,442 13,597 14,500 Scientific & Therapy 19,549 19,974 Medical & Dental 33,797 34,731 Nursing & Midwifery 35,012 36,

31 Operating Expenditure - Non-Pay (total 73.1m SFT only) Other 2,140 2,541 External Consultancy Other NHS Orgs CNST & Insurance ,976 3,096 4,322 6, / /16 Use of Non-NHS 1, Depreciation 9,088 8,081 Premises incl IT 7,836 7,838 General Supplies 6,298 6,022 Clinical Supplies 19,912 20,182 Drugs 16,840 18,

32 Group Statement of Financial Position at at Non-current Assets - Property, plant & equip 146, ,508 Current Assets 27,920 30,963 Current Liabilities -19,117-19,019 Total Assets less current liabilities 155, ,452 Less Non-current Liabilities -24,342-19,610 TOTAL ASSETS EMPLOYED 131, ,842 FINANCED BY: Public Dividend Capital 54,016 53,631 Revaluation Reserve 55,039 56,740 Income & Expenditure Reserve 10,422 16,220 Charitable Funds reserve 11,829 12,188 Minority Interest TOTAL CAPITAL & RESERVES 131, ,842

33 Capital Expenditure m Key schemes include: m Medical equipment IT systems and technology Ward upgrades and improvements 775 Building works Air handling units programme 420 Efficiency and innovation 212

34 Financial Ratings Monitor Financial Sustainability Risk Rating: Capital Service Capacity Revenue available for debt service divided by capital service costs RATING 1 Liquidity I&E Margin I&E Margin Variance Cash divided by expenditure per day The degree to which the organisation is operating at a surplus/deficit Variance between planned and actual I&E margin Overall rating 2

35 Key Messages from A very tough financial year: A significant 3% in-year loss which was expected due to the cuts in the tariff and the increased cost of agency and CNST payments Continued cuts to the national tariff have undermined the financial position of many acute provider organisations Further reductions in the national tariff likely in future years We have done more activity but not sufficient to break even, and not enough of the profitable elective in-patient work Focus on patient safety and service quality has driven up costs especially on agency staff Concern about how to improve and renew assets if we do not generate surpluses We are 8% more efficient that the national average so achieving recurring cost savings is even more difficult

36 Charitable Receipts a record year! Donations, Legacies & Grants of 1,459k together with other net Charitable Income of 782k and fund raising during the previous year Enabled Work to start on the New Breast Care Unit!! Medical Equipment & Facilities 1,349k Patients Welfare & Amenities 651k Staff Education & Welfare 466k Medical Research and Clinical Support 272k Thank you!!!

37 An outstanding experience for every patient Care Quality Commission Inspection Actions and Improvements Lorna Wilkinson Director of Nursing Dr Christine Blanshard Medical Director

38 The Inspection December inspectors 9 core services 38

39 Our Results 39

40 What we are proud of EFFECTIVE TREATMENT: delivered in line with national standards and evidence based Performance in national audits same as or better than national average CARE: kindness and compassion Emotional and psychological support services CULTURE: Open and honest culture Eagerness to learn and improve PATIENT & STAFF FEEDBACK 40

41 Key Challenges Workforce Nursing and Midwifery recruitment Mandatory training and appraisals Process time to first assessment in Emergency Dept. provision for children in ED Ward moves and delays for patients How we organise our theatre lists Waiting list management (spinal unit) Documentation 41

42 A hospital under pressure 42

43 43

44 Non Elective Admissions 2000 NE Admissions NE Admissions 44

45 Patients with a Delayed Transfer of Care 45

46 So we struggle with Pressure on beds Single sex accommodation on the acute medical unit Pathways through theatre Recruiting enough staff Keeping appraisals up-to-date and getting everything signed off Documenting everything, every time, at the time 46

47 Our action plan Each core service has an action plan Monitored through CQC steering group Executive leads CB and LW Good progress so far: Permanently opened an additional ward Recruited additional nurses Halved the follow-up backlog in the spinal unit Testing more efficient processes in ED Improved appraisal rates trust target 85% We will request re-inspection 47

48 Our staff passionate about providing the best care 48

49 Outpatients and Diagnostic Imaging Overview of CQC Outcome and Action Plan Alison Montgomery Diagnostic Services Manager Lucy Bushby Consultant Radiologist/Clinical Lead 49

50 What did CQC say? SAFE Evidence of systems in place that supported staff in protecting patients from avoidable harm, prevent the spread of infection, the safe administration and storage of medicines and maintenance of equipment Good availability of medical records, safety checklists and personal protective equipment CARING Good communication with all patients of all ages, treating them with dignity and respect Staff were kind and compassionate, patients had no complaints with the care they received Patients were involved with their own care and treatment. Carers and relatives, where necessary, were also involved with the consent of the patient 50

51 What did CQC say? RESPONSIVE Diagnostic imaging close to meeting waiting times. Outpatients meeting its referral to treatment time targets In Out-patients between Apr Aug 15, 86% of patients waited 30 minutes or less to be seen Provision of outreach clinics and one stop clinics supported by diagnostic imaging Good complaints management and learning from the patients experience Networking to resolve issues WELL-LED Staff reported feeling very well supported by their immediate line manger, the directorate management team and the trust executive team Evidence that everyone in both departments encouraged to be involved with governance with good structures and feedback mechanisms Evidence of risk registers in place and good management of these Overall the culture in both departments was focused on the needs of patients and was open and honest Staff felt actively engaged in changes that affected their departments 51

52 Daily & weekly check of equipment Staff consistently adhere to the Trust Infection Control Policy CQC Action Plan Outside prescription forms auditing and monitoring Annual appraisal Compliance with mandatory training Hand Hygiene Audit

53 What are we proud of? Overall outcome of Good rating for our services The achievement despite the constant pressures and challenges on both services Evidence shone through that staff are aware of the role they play in helping the Trust to achieve its vision and demonstrated that they worked the trust values into their daily work The feedback from our service users given to the CQC 53

54 Diagnostic Services Sustain and develop services Benchmarking data to ensure high quality, and efficient Trust networking Governance structure and service improvement Commitment to capital equipment programme 54

55 Diagnostic Services Walk-In XR service Salisbury, Shaftsbury and Westbury Eliminated waiting times Same day reporting of XRs Good feedback from GPs and patients 55

56 Diagnostic Services Stroke Imaging Bowel cancer Using CT scanner 56

57 Diagnostic Services Network Interventional radiology service Cardiac CT Formal network commenced with Southampton 57

58 Council of Governors report to members Dr Alastair Lack Lead Governor 58

59 Questions and answers 59