Annual Report and Summary Accounts 2008/2009

Transcription

1 Annual Report and Summary Accounts 2008/2009

2 Contents 3 Chairman s Foreword 4 Health Strategy 5 Health Improvement 7 Efficiency/Access 8 Treatment 9 News 13 Staff 14 Finance 16 Auditors Statement 17 Activity 19 NHS Forth Valley Board Members 20 Board Organisational Chart 21 Annual Review Letter 2008/09 2

3 Chairman s Foreword The last year has seen NHS Forth Valley make considerable progress towards achieving our overarching vision of delivering 21 st century healthcare in a modern, well-equipped environment. The centrepiece of our Integrated Healthcare Strategy is the new Forth Valley Acute Hospital and it remains on track to accept its first patients in summer The programme to deliver the four community hospitals in Forth Valley is ongoing, and a significant milestone was achieved when the 20 million Clackmannanshire Community Healthcare Centre opened for patients in August this year. Plans for Falkirk, Stirling and Bo ness community hospitals remain on schedule and their establishment will result in services being provided closer to patients homes wherever possible. Further investment in services has continued with the completion of NHS Forth Valley s first purpose-built teach and treat dental centre. The 1m facility in Langlees, Falkirk created 7 new dental surgeries and new training facilities for 16 dental students each year. More than 70% of the population of Forth Valley now have access to NHS dental care, which compares well to the national average of 50%. Throughout every area of the organisation, our staff s commitment to a culture of continuous improvement in patient services has once again delivered significant enhancements in standards of care. This year, we have reduced the maximum waiting time for outpatient, inpatient and day case treatment from 18 weeks to 12 weeks; the national target is 15 weeks. Improvement in services for cancer patients continues, with 97.7% of people urgently referred with suspected cancer beginning their treatment within the 62 day target. It is a testament to the commitment of all of our staff that we continue to improve the quality of our services. In every ward and department, NHS staff deliver high quality patient-centred care, and their dedication to maintaining and improving standards is remarkable. For example, significant improvements have been made in minimising the risk of infection both in terms of hand hygiene and in a reduction in the incidence of common infections. Once again, NHS Forth Valley ended the year in financial balance. The current economic climate presents a challenging environment in which to deliver public services. The future is likely to remain at least as challenging, and I am grateful to staff for continuing to meet that challenge. Ian Mullen, OBE Chairman 3

4 Health Strategy Implementation of the integrated health strategy continued to be on target. The strategy ensures that patients will benefit from the care that is most appropriate to their needs in facilities that are fit for purpose New Forth Valley Acute Hospital Construction of the new acute hospital began in May The first patients are expected to arrive in summer 2010 as we start to gradually move services from Stirling and Falkirk infirmaries. By late 2011 the hospital will be fully operational and staffed by 1800 people round the clock from a total workforce of approximately 3,500. The new acute hospital will provide patients with the highest quality specialised treatment. Accident and Emergency services will be based there together with services including maternity and intensive care, children s services, cancer day care, psychiatric and mental health wards, outpatient therapies and a dedicated women s outpatient department. The new 293 million flagship hospital reached a key milestone in March 2009 with a topping out ceremony by First Minister Alex Salmond. Primary Care We are modernising GP and other primary care services to bring care closer to home, already we have built/upgraded facilities in Balfron, Callander and Langlees in Falkirk and are nearing completion of the new Alloa health centre. New health centres are currently being developed at Stenhousemuir and Meadowbank in Falkirk. The new medical centre in Stenhousemuir will house four GP practices - Ochilview, Parkview, Stenhouse and Viewpoint and will be much larger than the existing premises. Construction work on the project began in February The new building will provide a better environment for patients and provide improved access to a bigger range of services. Services planned include podiatry, physiotherapy, speech and language therapy with consulting space for outpatient psychiatry and dietetics. Community Hospitals The new Forth Valley acute hospital will be supported by four community hospitals; the existing Bo ness hospital and three new community hospitals in Clackmannanshire, Falkirk and Stirling. The first to be completed will be the Clackmannanshire Community Healthcare Centre. The 20 million centre will provide healthcare provision in the area, for a population of more than 49,000. The centre will contain a replacement for the current Alloa Health Centre and outpatient area, which will include three GP practices (l6 GPs) community nursing, podiatry, dental, physiotherapy and dermatology outreach. The centre will also be a base for social work teams. The centre will also offer 45 in-patient beds, used primarily for frail older people, including provision for intermediate care and rehabilitation, palliative care and continuing care of those with complex needs. A day therapy unit will offer assistance to a falls prevention scheme, while providing specialist services for those with both mental health and physical needs. It is anticipated that the centre will see around 800 patients a day and offer primary care to 25,000 patients a year and is expected to see it first patients in summer The Stirling Community Hospital will operate from the site of the existing Stirling Royal Infirmary and bring together services currently at Kildean, Bannockburn Hospital and Orchard House. The Community Hospital at Falkirk will operate from the site of Falkirk and District Royal Infirmary. Services currently provided at Bonnybridge Hospital will be relocated here. The final details in relation to both sites are being finalised. 4

5 Health Improvement Dental In 2008, 80.1% of 3-5 year olds were registered with a dentist. Work began on Forth Valley's first purpose-built 'teach and treat' dental centre. The centre opened in August The 875,000 facility, in the Langlees district of Falkirk, will provide seven dental surgeries. Of these four will be training chairs for final year students at Glasgow Dental School, who are supported by a senior dental officer/tutor. The training facility developed in collaboration with the University of Glasgow and NHS Education Scotland is part of the dental action plan by the Scottish Government and will help students hone their clinical skills before they graduate. Sixteen students a year will rotate through the Langlees Centre. Immunisation NHS Forth Valley has for many years achieved and maintained one of the highest rates of childhood immunisation in Scotland. For the calendar year 2008, Measles Mumps and Rubella (MMR) almost 97% for the first injection and nearly 91% for the booster. NHS Forth Valley continues to organise immunisation training days for GPs and public health nurses. HPV vaccines were given to girls across the area. By March 2009, 4,000 vaccines were given and those who had not received the jab were urged to come forward. The publicity surrounding Jade Goody led to a marked increase in the number of girls taking up the offer of an HPV injection and has raised awareness of the importance of cervical cancer screening. Smoking Cessation Work has continued in Forth Valley to meet the target reduction in the number of adults smoking. The joint approach in Forth Valley is led by the Tobacco Action Group. This brings together Community Health Partnerships, the voluntary sector, local employers and community groups. Services are provided by a number of professions. Community Pharmacies provide nicotine replacement therapy and advice. GP practices provide regular group sessions with members attending sessions for six to eight weeks. In addition, a project in Stirling and Clackmannanshire has developed resources to delivery smoking cessation to younger people. Currently 59% of community pharmacies offer smoking cessation services and 47% of pharmacies have support staff that have completed motivational training. Alcohol Work has been ongoing to meet the requirements to achieve 8,254 screenings and appropriate brief intervention. Three Health Promotion Officers and three Community Addiction Nurses have undertaken the training for trainers course on Brief Intervention in Alcohol with NHS Health Scot land. They will work in the community, train acute staff and staff in workplaces outwith the NHS It is anticipated that this will have a major impact over the next three years. There has been very good interest from Falkirk and Stirling GPs to undertake brief interventions in alcohol within their settings. 5

6 Health Improvement Heart Cancer People in Forth Valley who suffer a heart attack because of a blocked artery now benefit from a new service which helps save lives and reduces the chance of further heart attacks, stroke and angina. The service, known as optimal reperfusion, began on April 20 th 2009, means that patients are diagnosed and taken to a specialist treatment centre within 90 minutes. Anyone who cannot meet this deadline will be given a clot-busting drug before setting off. Optimal reperfusion is the term used to describe the restoration of blood flow to an organ or tissue. After the heart attack the immediate goal is to quickly open blocked arteries and restore blood flow to the heart muscles. Early reperfusion helps to reduce heart muscle damage and preserves the pumping function of the heart. The specialist centres for Forth Valley patients are at the Golden Jubilee National Hospital in Clydebank, and the Royal Infirmary in Edinburgh. People living in the west of the Board area go to Clydebank, those in the east are taken to Edinburgh. After treatment in Clydebank or Edinburgh, patients will either be discharged home or more likely be transferred within 24 hours to Stirling Royal Infirmary. Their treatment will be followed up by the Forth Valley Cardiac Service. By March 2009, nearly 50,000 bowel testing kits were sent out in the first year of the bowel screening programme in Forth Valley. Around 10 people a week are being referred to Falkirk and District Royal Infirmary for further assessment, so that any problems can be identified early. The screening programme targets men and women between the ages of 50 and 74, who will receive a testing kit at their home. In some cases in Forth Valley, speedy diagnosis of skin cancer is now being achieved using digital photography. The community-based fast-track method is the first of its kind in Scotland and means patients with skin cancers could have surgery within days. The pilot scheme involves GP s offering patients the opportunity of attending clinics where colour photographs are taken of suspect skin lesions. Figures reveal that 29% of those who underwent photo triage were booked directly for surgery and another 39% referred to a specialist lesion clinic for assessment. A third were reassured they did not have cancer or would need cryotherapy, a treatment using liquid nitrogen to destroy certain benign skin lesions. NHS Forth Valley is also the second best mainland Health Board in Scotland for the uptake in cervical screening, with 82.6% of year olds coming forward for screening. Long Term Conditions The increasing number of people living longer with long term conditions presents a major challenge for health and social care services and society. The work programme for long term conditions is coordinated through the three Community Health Partnerships and taken forward through the long term conditions group with a focus on the main work streams of self care/management, specialist care and complex care. Within this integrated approach there is a need for clear pathways that manage the interfaces across the entire healthcare economy achievable only through key partnership working with local authorities and the voluntary sector. Some key pieces of work underway includes; * Using case finding techniques (SPARRA) to identify patients with complex care needs who would benefit from an anticipatory care plan being shared across primary and secondary care services. * Developing a self management approach with a focus on supporting patients as partners to accept responsibility for their own health and management of their condition. * Developing integrated pathways providing better, local and faster access to services for people with long term conditions. 6

7 Efficiency and Access Inpatients and Outpatients No one waiting for either inpatient or day case treatment, or to be seen as an outpatient, waited longer than 15 weeks, the Scottish Government target. A&E By March 2009, 97% of patients were seen in A&E within the target time of four hours. Significant work is underway to ensure that procedures and staffing resource support this. Community Health Index The Community Health Index (CHI) number is a unique identifier for each patient, which is used to avoid any confusion. This year usage has been maintained at 98%. A range of actions will take place in the coming year to improve this yet further. Cancer NHS Forth Valley remains ahead of the national average for waiting times for cancer services. In December 2008, Forth Valley reached its highest ever performance with 97.7% of people urgently referred with a suspected cancer receiving their diagnosis and start their treatment within the target. This is against the Scottish average of 95.3% KSF At 31st March 2009, NHS Forth Valley successfully achieved the initial Knowledge and Skills Framework (KSF) target within the agreed national timeframes where all Agenda for Change staff have a KSF personal development plan in place. The Agenda for Change KSF leads group is currently reviewing the implementation plan to take into account the target where boards must ensure at least 80% of staff covered by Agenda for Change will have their annual KSF reviews and recorded by march Sickness Absence By 31st March 2009, there had been a significant improvement in sickness absence Work continues to reduce the sickness absence rate among staff from 4.74% to the national target of 4%. Delayed Discharges All three discharge targets were achieved in January 2009 and have been sustained since. Diagnostics NHS Forth Valley met the national target for certain key diagnostic tests to be performed within six weeks of referral. 7

8 Treatment Comments and Complaints In the year 2008/ complaints were received 96 fewer than the previous year. The overall performance in terms of response to complaints has been maintained and 76.32% of complaints were responded to within 20 days. The table below illustrates the performance in more detail. NHS FV 2008/09 Complaints Raised Complaints received Complaints received with appropriate consent Total complaints fully investigated and final response send to complainant Responded to within 20 days % response within 20 days Target response rate % of complaints acknowledged within 3 working days CHPs % 70% 100% Acute % 70% 100% Services NHS Board Total % 70% 100% Learning from feedback To minimise or eliminate a reoccurrence of the event which gave rise to a complaint, the patient relations team provide feedback to individual staff, wards and departments. This allows individual staff or teams to have the opportunity to reflect and learn from feedback. Where a complaint has arisen through lack of knowledge or understanding of systems and processes, training and education is undertaken. Where complaints arise from failures in facilities or systems, reviews are undertaken and changes made if necessary. Healthcare Associated Infections The prevention of Healthcare Associated Infections remains a key priority in NHS Forth Valley, and work proceeds in a number of areas. National Audit results for March 2009 show that NHS Forth Valley is the top board in Scotland for Hand Hygiene with a compliance rate of 98%. NHS Forth Valley has introduced a variety of sound and visual message units in the entrances to hospital wards, urging people to make sure their hands are clean and use the hand rub provided. 8

9 News Coverage April 2008 X Ray Vision Major changes were made to the way X Rays are handled and viewed in NHS Forth Valley. A move from the conventional film system to digital imaging is now in operation and will provide a more streamlined service for patients. It also means easier access for clinicians are now able to view X rays at the click of a mouse. April 2008 Water Babies Women in Forth Valley are now able to have the choice to labour and/or birth in water, thanks to a birthing pool which has been installed in the labour suite at Stirling Royal Infirmary. The pool cost around 18,000 and the efforts of student midwives and staff raised another 2,000 plus to buy accessories. May 2008 MMR Vaccine The proportion of children in Forth Valley vaccinated against MMR (Measles, Mumps and Rubella) is the second highest in Scotland. Just over 3,000 youngsters in the Forth Valley area were eligible to have the vaccine. May 2008 Healthy Start Mums in Forth Valley on certain benefits and all pregnant women under the age of 18 are now given free vitamins to give their baby the best start in life. They are now also able to claim during pregnancy and until the baby is one year old. 9

10 News Coverage June 2008 Naming People in Clackmannanshire were asked to choose the name for their 20 million pound health facility. The chosen name was Clackmannanshire Community Healthcare Centre. June 2008 Beating the Bulge A staggering 150 stone has been shed by men who attended a 12 week weight management programme run by NHS Forth Valley. Around 200 men have lost an average of 11 pounds each by joining men s health clinics July 2008 Investors in People NHS Forth Valley has become the first NHS Board in Scotland since 2004, when Trusts were abolished, to win a prestigious Investors in People award. July 2008 Parking Parking at the two Forth Valley infirmaries is to stay free of charge. Staff, visitors and patients were urged to park responsibly. A parking management scheme was introduced which saw car parks designated for particular users. 10

11 News Coverage July 2008 Picture Menus Picture menus were introduced by NHS Forth Valley, to help in-patients with communication difficulties to choose their meals. Dozens of photographs have been taken of items ranging from sandwiches to macaroni cheese and apple tart and will are now being used on special menus where people can point to what they would like. August 2008 Visit The new 300 million pound Forth Valley acute hospital being built at Larbert welcomed a special visitor when Cabinet Secretary for Health and Wellbeing, Nicola Sturgeon MSP donned safety gear for a tour of the site. She met some of the 450 construction workers and heard how the project is progressing. October 2008 Foot Care Homeless people in Stirling are walking on air thanks to a drop-in podiatry service provided by the Salvation Army in partnership with NHS Forth Valley. The scheme at the Salvation Army premises in Drip Road has been so successful, it is now hoped to extend it to Falkirk and Clackmannanshire. November 2008 Prescriptions A high-tech dispensing scheme in Forth Valley has more than halved the time that patients have to wait for prescriptions when being discharged from hospital. The innovative electronic system, designed and developed locally, is believed to be the first of its kind in Scotland. The new process means 80 to 90% of prescriptions are available in two hours. 11

12 News Coverage December 2008 Baby Café Scotland s first Baby Café opened in the West Stirlingshire village of Balfron. The project is being led by health visitors, who promote the physical and psychological benefits of breastfeeding, and bare on hand to help with weaning, child behaviour and safety. They are also available for one-to-one chats if needed. January 2009 Skin Cancer Speedy diagnosis of skin cancer within days rather than months is now being achieved in some cases in Forth Valley using digital photography. The community-based fast-track method is the first of its kind in Scotland and means patients with skin cancers can have surgery within days. March 2009 Heart Patients Heart patients in Forth Valley are now on track to benefit from a project costing around 600,000 which has seen cardiac rehabilitation switched from hospital to a community setting for the first time. The new NHS exercise studio is based at the Stirling Sports Village together with a counselling and treatment Room. March 2009 New Hospital The new 860-bed Forth Valley Acute hospital has reached a key milestone with a topping out ceremony by First Minister Alex Salmond. The laying of the top slab of the building represented the completion of the concrete works and structural stage of the project. Work has since been handed over to an army of electricians, plumbers and other trades to fit out the 300million hospital. 12

13 Staff Our Greatest Asset Whole Time Equivalent (WTE) at March 2009 Job Family Acute CHPs Corporate Facilities Admin Services & Managers Allied Health Professions Health Science Services Medical & Dental Medical & Dental Support Nursing & Midwifery Nursing & Midwifery (Unqualified) Other Therapeutic Personal & Social Care Support Services Overall Number of Staff at March 2009 Job Family Acute CHPs Corporate Facilities Admin Services & Managers Allied Health Professions Health Science Services Medical & Dental Medical & Dental Support Nursing & Midwifery Nursing & Midwifery (Unqualified) Other Therapeutic Personal & Social Care Support Services Overall

14 Finance Operating Cost Statement For the Year Ended 31 March Note Clinical Services Costs 339,797 Hospital and Community 4 354,726 26,868 Less: Hospital and Community Income 8 28, , , ,766 Family Health 5 127,270 6,237 Less: Family Health Income 8 5, , , ,458 Total Clinical Services Costs 447,467 2,823 Administration Costs 6 3, Less: Administration Income ,549 2,870 12,470 Other Non Clinical Services 7 13,727 3,249 Less: Other Operating Income 8 3,170 9,221 10, ,228 Net Operating Costs ,894 Summary of Revenue Resource Outturn ,228 Net Operating Costs (per above) 460, Capital Grants (to) / from Other Bodies 9-3, Profit / (Loss) on disposal of Fixed Assets 9-1,418-7,175 Annually Managed Expenditure (Write downs) -6,616-24,813 FHS Non Discretionary Allocation SFR 1-29,008 0 Other Allocations 0 406,081 Net Resource Outturn 420, ,081 Revenue Resource Limit SFR 1 423,973 2,000 Saving / (excess) against Revenue Resource Limit 3,525 14

15 Finance Balance Sheet As At 31 March Note FIXED ASSETS 0 Intangible Fixed Assets ,532 Tangible Fixed Assets , ,532 Total Fixed Assets 175,096 13,816 Debtors falling due after more than one year 13 14,778 CURRENT ASSETS 1,986 Stocks 12 1,166 9,513 Debtors 13 10,129 0 Investments Derivative Financial Instruments Cash at bank and in hand ,526 11,322 CURRENT LIABILITIES -48,253 Creditors due within one year 16-48,267-36,727 Net Current Assets / (Liabilities) -36, ,441 Total assets less current liabilities 152,929 0 CREDITORS DUE AFTER MORE THAN 1 YEAR ,095 PROVISIONS FOR LIABILITIES AND CHARGES 17-16,281-16,095-16, , ,648 FINANCED BY: 65,487 General Fund 19 58,475 79,148 Revaluation Reserve 20 77, Donated Asset Reserve , ,648 Summary of Capital Resource Outturn 2008 Note ,778 Net Capital Expenditure 10,101 7,778 Capital Resource Limit SFR 1 10,101 0 Saving / (excess) against Capital Resource Limit 0 15

16 Auditors Statement This section will be added following the laying of NHS Forth Valley s accounts before the Scottish Parliament. 16

17 Activity The following charts show the number of patients seen in 2008/09 within NHS Forth Valley. Inpatient/Day Case Activity 2008/09 Specialty Discharges Medical 14,867 Surgical 8,068 Geriatric Medicine 7,082 Orthopaedics 5,220 Urology 2,136 Medical Paediatrics 3,894 Gynaecology 2,661 Opthalmology 2,423 ENT 1,493 Oral Surgery/Oral Medicine 1,031 Obstetrics 4,033 Haematology 1,862 Other 671 TOTAL 55,441 Outpatient Activity 2008/09 Department Number of Outpatients Surgical 124,854 Medical 55,913 Women and Children 30,055 Theatres and ICU 4,938 A&E 85,303 Total 301,063 Source: SHARP. Total Outpatients i.e. New and Returns. Excludes DNAs 17

18 Activity Community Health Partnership Activity Community Health Partnership Activity 2008/09 Community Health Partnership Services 2008/09 Activity Pyschiatric and Frail Elderly Services 42,880 Child Health Services 14,961 1 Community Clinical Services 112,226 Community Addiction Services 23,669 *Community Nursing Services 459,519 Primary Care Clinical Services to In-Patients/Day Cases 41,347 1 Health Promotion/Education 12,193 *Provisional - data approx 98% complete 1 Changes to services and methods of data recording Outpatient Activity 2008/09 In addition to the figures above more than one million patient consultants take place in GP surgeries in Forth Valley every year. 18

19 NHS Forth Valley Board Members Mr Ian Mullen OBE Chairman Miss Fiona Mackenzie Chief Executive Ms Margaret Duffy Chief Operating Officer Professor Angela Wallace Nurse Director Dr Gareth Davies Medical Director Dr Anne Maree Wallace Director of Public Health Mrs Fiona Ramsay Director of Finance Mrs Helen Kelly Director of Human Resources Mr Tom Hart Employee Director Dr Allan Bridges Chairman, Area Clinical Forum Dr Stuart Cumming Chairman, CHP Professional Committee Dr Campbell Christie CBE Non-Executive Board Member Dr Karen Facey Non-Executive Board Member Mr Graeme Simmers CBE Non Executive Board Member Mrs Marlene Anderson Non Executive Board Member Mr Brendan Clark Non Executive Board Member Dr Vicki Nash Non Executive Board Member Cllr Sam Ovens Local Authority Member Cllr Linda Gow Local Authority Member Scott Farmer Councillor Local Authority Member Appointed 19/05/

20 Organisational Chart NHS BOARD ACUTE SERVICES Responsible for services in the two Acute Hospitals: Falkirk & District Royal Infirmary Stirling Royal Infirmary Public Involvement: Patient and Public Panel CLACKMANNAN- SHIRE CHP Works in partnership with Clackmannanshire Council and is responsible for Primary and Community Health services such as GP services, Pharmacy services, dentists and opticians. Also responsible for community based child health services and community mental health services which they run jointly with Clackmannanshire Council. Public Involvement: Clackmannanshire Public Partnership Forum FALKIRK CHP Works in partnership with Falkirk Council and is responsible for Primary and Community Health services such as GP services, Pharmacy services, dentists and opticians. Also responsible for community based services such as podiatry,, child health services and community mental health services. Public Involvement: Falkirk Public Partnership Forum STIRLING CHP Works in partnership with Stirling Council and is responsible for Primary and Community Health services such as GP services, Pharmacy services, dentists and opticians. Also responsible for community based services such as podiatry, child health services and community mental health services. Public Involvement: Stirling Public Partnership Forum 20

21 Annual Review Letter 2008/09 21

22 Annual Review Letter 2008/09 22

23 Annual Review Letter 2008/09 23

24 Annual Review Letter 2008/09 24

25 Annual Review Letter 2008/09 25

26 Annual Review Letter 2008/09 26

27 Annual Review Letter 2008/09 27

28 Annual Review Letter 2008/09 28