Annual Report 2016/17

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1 Annual Report 2016/17

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3 Contents Performance Report Chairman and Chief Executive Introduction About Us How we are Organised Key Objectives for 2016/17 KPI s (Key Performance Indicators) Finance Report Sustainability Annual Report Review of the Year Accountability Report Corporate Governance Report Directors Report Governance Statement Remuneration and Staff Report Audit Opinion and Report Financial Statements and Notes 95 3

4 Performance Report Chairman and the Chief Executive Introduction Chairman Introduction Professor Sheila Salmon Chairman We are delighted to introduce the Mid Essex Hospital Services NHS Trust (MEHT or the Trust ) Annual Report for 2016/17 and to give challenging and exciting. 4 This past year has again seen unprecedented demands on our emergency services, with higher A&E attendances compared to the previous year. This hospital has put considerable pressure on the whole system. We cannot, and will not discharge any patient from our care until the right care package is in place, and they are going home to a safe environment, whether that is a care home or their own home. The CQC visited us again last June, with the were all delighted that the very hard work of everyone across the Trust was rewarded with an assessment of Good. The Burns and Plastics Service within the St Andrew s Centre was judged to be Outstanding, a Because of the pressures on the whole health system, new ways of treating and caring for patients have to be found, as the current expenditure is unsustainable. Discussions within NHS England, looking at the pressures across the whole health system countrywide, brought forward the idea for pilot projects to be put in place, ensuring all local services, Councils, health providers (primary, acute and mental) alongside the local commissioners, work together to provide joined up, cost effective care for patients. Professor Sheila Salmon Trust Chairman In our area, this project is called the South and Mid Essex Success Regime (ESR) and was launched in 2015 as one of a small number of similar pilot projects across the country. Since the beginning of the project, closer working has been established between MEHT and both Southend and Basildon hospitals, the two other Trusts which are part of the regime. This has resulted in clinical services across each of the hospital sites liaising on how services can best serve patients closer to their home, and how we can make best use of our support services. As a Trust we always try to listen closely to the feedback we receive from all of our patients and continue to be committed to being open in the way we work, putting Our Patient Engagement Group goes from strength to strength and as a Trust we work closely with our Patient Council,

5 Healthwatch Essex and other local voluntary organisations. We would both like to offer our sincere thanks to every volunteer who continues to support us in all aspects of our work at all of our hospital sites, on a daily basis. Our volunteers are the lifeblood of the hospital and support us in so many ways, helping site, and supporting on the wards, providing help with feeding and companionship during meals to ensure good nutrition and hydration. We are also indebted to the Friends of Friends) who continue to support the Trust, always making a positive difference and helping with raising funds for our Charity. The year ahead will again no doubt bring us many challenges, as we look to engage closely with our fellow community health providers and partner organisations in ensuring the new option proposals we jointly decide on across Essex would provide more our patients, and services closer to home for them and their families. Professor Sheila Salmon Trust Chairman Performance Report The following sections give an overview of the Trust s purpose, the key risks to achievement of its objectives and how it has performed during 2016/17. Statement from the Chief Executive - Clare Panniker I was delighted to be appointed as the Chief Executive of MEHT in April 2016, as I have Clare Panniker Chief Executive always been aware of the excellent clinical work that has gone on at the Trust. Since joining MEHT, and following the launch of The South and Mid Essex Success Regime project, myself and the executive team have been working closely with the clinical leads in looking at ways in which we can put in place the options for joint working across the three Southend, whilst looking at the best ways to utilise all our joint assets and planning needs. Over recent years it has become clear that for most, if not all, NHS commissioners fundamental and systemic changes to the NHS will be needed to deliver and maintain has seen the need for this at a number of levels evidenced by the steadily increasing demand for care, the increasing seriousness of conditions with which patients are 5

6 presenting and the growing age of patients, It has been estimated that without transformational change, the current NHS years. If this were to happen, then the local NHS would be unable to meet the year-onyear growth in demand for services. The Mid and South Essex Success Regime has the overarching aim of restoring the total health and social care system years by delivering the best joined-up and personalised care for patients. Healthwatch Essex and local patient user groups will all be involved in this decision making as we go forward, along with senior clinicians across the Trusts, to work out what we need, and how we need to deliver it. Centres of excellence are the way forward, with specialist services being located in a single place, so resources can be centred at that location, and with patients getting a higher level of expertise delivered to them, this will give better clinical outcomes. Having the three Trusts working together under one Joint Working Board (JWB), will also give us a greater pooled resource, more locations and greater budgetary power to make these By the time you read this report, we will have travelled a long way towards gaining the necessary clinical and public opinion on the service options outlined and we will be approaching the time when a decision can be made about the way forward, and about the new structures that need to be put in place to make this happen. However, one thing that will not change, across MEHT or any of the other two Trusts, is our commitment to the quality of care we provide, the standards we set ourselves and the pride we all have in ensuring we continue to do the very best we can for our patients and their families. This year I was pleased to attend the fourth year of our annual OSCAs (Outstanding Service and Care Award s) for staff. These awards are an evening of recognition of staff and departments, who have gone the extra mile in providing care to our patients. The nominations came from both fellow staff and from patients themselves, highlighting to us all, year on year, the care and compassion shown by the people who work for us here at MEHT. Clare Panniker Chief Executive Professor Sheila Salmon Trust Chairman Clare Panniker Chief Executive 6

7 About Us MEHT was established as an NHS Trust in 1992 and continues to provide local elective and emergency services to over 380,000 people living in and around the districts of Chelmsford, Maldon and Braintree (including Witham). The Trust also provides a county-wide plastics, head and neck and upper gastrointestinal (GI) surgical service to a population of 3.4 million and a supra regional burns service that serves a population of 9.8 million patients. In 2016/17 the Trust had a total turnover of over 315m and employs over 4,000 staff. The PFI (Public Finance Initiative) funded Hospital site was opened in November 2010, a move which enabled the Trust to centralise the majority of its services onto one site. From 1st April 2014 the Trust also took over the management and delivery of services at Braintree Community Hospital. To provide better care, support and service delivery, we have been working throughout the year to change our management and Board meeting structures (working together with our colleagues in the hospital Trusts at Basildon and Southend) to support the Mid and South Essex Success Regime (ESR). This has included creating a shared Executive Director team who carry out the same role across the three Trusts. With those changes in place, we can align the quality agendas of the three Trusts based on experience gained from all three Trust areas, and create specialist hubs to serve the patients of the three Trust areas with the best available expertise. Key Statistics - Activity Data 2016/17 A&E Attendances 97,077 Daycase admissions 38,952 Elective inpatient admissions 11,294 Non-elective inpatient admissions 45,907 Maternity deliveries 4,695 First outpatient attendances 218,705 Follow-up outpatient attendances 429,218 Our stakeholders The Trust continues to work closely with all local stakeholders in the provision of healthcare for the Mid Essex population. This obviously includes the Basildon and Southend Trusts. The Trust is a member of having strong links with Chelmsford, Maldon, Braintree and Uttlesford local authorities. The Trust also has very close ties to Anglia Ruskin University, working jointly on clinical training and research projects. These close working relationships will assume greater importance as the planning of joined up services, through ESR, gathers momentum. The Trust maintains good relationships with the Clinical Commissioning Groups (CCGs), and particularly with Mid Essex CCG, and continues to support various initiatives with voluntary organisations and the department of work and pensions in offering apprenticeships, work placements and supported employment opportunities. Quality Account Our Quality Account for 2016/17 sets out the Trust s progress on the quality initiatives and standards that were set last year, and the new quality challenges that have been set by the executive team for the year ahead, including our Quality Improvement Plan. The Quality Account is available to download from the Trust website at 7

8 How We Are Organised 8 The Trust s Board of Directors is led by a Non-Executive Chairman and consists of following Executive Director posts: Chief Executive Chief Nurse Additional non-voting Trust Executive Resources, Information and Estates and Facilities. All the Executive Directors hold the same posts in the Basildon and Southend acute Trusts. The Board is supported by the Trust Secretary. Clinical Directorates Up until 1st July 2016 the Trust operated on a directorate basis. The original Clinical years ago, with each one being led by a Clinical Director. From July 2016, a new structure was put in place, separating the directorates into four newly formed divisions, headed by Divisional Directors. Each Divisional Director within these Finance, HR and IT support to manage its day to day service arrangements. The new divisional structures are as follows:- Division 1 Medicine & Emergency Care Medicine Acute General Allergy Service Cardiology Dermatology Diabetes & Endocrinology Elderly Gastroenterology HIV Neurology Renal Respiratory Stroke Emergency Care Accident & Emergency / Emergency Department Acute Medical Unit (AMU) Emergency Short Stay (ESS) Division 2 Surgical General Surgery Breast Unit Endoscopy General Surgery Patient Services Urology Vascular Specialist Surgery Audiology Ear, Nose & Throat (ENT) / Otolaryngology Eye Clinic Ophthalmology Oral Surgery Orthodontics Orthoptics St. Andrews (Burns and Plastics) Burns

9 Cleft Service Plastic Surgery Psychotherapy St. Andrews Therapy Musculoskeletal Appliances Dexa Service Fracture Clinic Rheumatology Trauma & Orthopaedics Division 3 Cancer and Clinical Support Services Anaesthetics and Theatres Anaesthetics Day Stay Centre General High Dependency Unit (GHDU) General Intensive Care Unit (GICU) Pain Medicine Peripherally Inserted Central Catheter (PICC) Service Pre-Operative Assessment Resuscitation Training Sterile Services Technology Services Theatres Therapeutic Services Dietetics Occupational Therapy Pharmacy Physiotherapy Diagnostic and Clinical support Cancer Services Multi-Disciplinary Team (MDT) Day Therapy Haematology Medical Photography Mortuary Oncologists Palliative Care Pathology Pharmacy Phlebotomy Radiology / Imaging Research & Development Division 4 Women & Children s Services Women & Children s Services ED Paediatrics Gynaecology Maternity Neonatal Unit New born Hearing Screening Obstetrics Paediatrics Wizard Ward 9

10 Key Objectives for 2016/17 10 where the organisation needed to focus on improving services, and these have been highlighted below. These priorities tied in with the Creating Our Culture project, focusing on the values and behaviours both staff and patients wanted to see from the Trust. There were three main priorities, Reducing avoidable harm and engaging and enabling staff to continuously improve services, Clinical Effectiveness, increasing the reliability of care and Improving Patient Experience. The systems and processes put into place to address these three main topics are listed below. Priority 1: Reducing avoidable harm and engaging and enabling staff to continuously improve services To improve emergency care and hospital In recent years the NHS has seen a dramatic rise in attendances at acute trusts, right across the country, which in turn leads to a rise in our bed occupancy and presents in achieving the 4 hour emergency access standard whereby people who come to an Emergency Department (ED) should be seen and treated within 4 hours of arrival. These same challenges impact on appropriate placement of patients on admission and timely discharge to the appropriate place of care. Our aim was to put in place a system resilience improvement plan, working closely with our healthcare partners to provide a joined up approach. The improvement plan required the Trust to: Pilot and then roll out the NHS bundle across the Trust. The SAFER bundle is a practical tool to reduce delays for patients in adult inpatient wards (excluding maternity); Implement Home to Assess ; Establish the frailty unit; Establish Multi-disciplinary, Accelerated Discharge Events (MADE); Embed internal professional standards; and Review the workforce in the Emergency Department and the Clinical Operations Team. This was an ambitious and challenging improvement priority for the Trust, but with the implementation of both the SAFER care bundle and the Red/Green day initiatives have allowed staff to optimise capacity while giving excellent patient care and experience and ensures that patients coming in through All wards within medicine are now using the SAFER bundle. Red and Green days show the status of any patient, whether or not they would be considered for discharge on a particular day. To reduce harm from falls through use of falls multifactorial risk assessment There is a recognised risk of patients falling whilst in hospital. In-patient falls that result in moderate or severe harm increase pain, reduce independence and patient The aim was to ensure that the multifactorial risk assessment was carried out and supports the delivery of appropriate individualised patient care.

11 There has been an overall decrease in all falls with serious harm by 38% from this time last year to now. The work to reduce avoidable harm from falls will remain a key priority for 2017/18. Reducing surgical site infection and avoidable readmission in caesarean section and major gynaecological surgery Surgical site infections have acknowledged morbidity in terms of delayed recovery, resulting in a poor patient experience and prolonged bed stays. The aim for the Trust was to improve safety and enhance the patient experience by reducing surgical site infections. In gynaecology there was a 50% reduction in reported surgical site infection during the year compared to the previous year. This was achieved by: Continuing to implement the use of patient wipes prior to surgery and constantly reviewing the use of skin; Preparation prior to surgery; Improving the training on surgical site surveillance and nominating a surgical surveillance lead on the gynaecological ward; and Undertaking a quarterly audit of the surgical site infections reported from gynaecological surgery and caesarean section and readmissions with suspected surgical site infections. Increase Board visibility (15 steps) The aim was to increase Director visibility across the Trust and to support improved patient experience and staff engagement. The Trust Board and Directors have embraced the 15 steps challenge walking onto a ward or clinical area. Whilst impromptu visits to wards and departments by Directors were in place, the opportunity to develop this element of Board to Ward visibility was taken when Non-Executive Directors were on site between closed and public Board sessions. Findings from the visits were shared immediately in the wards and departments at the conclusion of each visit followed by the Directors meeting together to give collective and minuted feedback. This minuted feedback was shared with senior staff for later action. This feedback process has continued in latter part of the year when the emphasis of the visits was altered to make the visits themed around issues known to be affecting the Trust or clinical area. The programme will continue in 2017/18. Values based appraisal and recruitment to be in place Staff that are recruited and regularly appraised against an agreed set of values identify more effectively with the organisation s shared vision and take greater personal responsibility for their contribution. When Board members are visible in the workplace there are opportunities to improve the quality of patient care by viewing the ward and care environment from the patient s perspective and reinforcing our commitment to high standards of care. The aim was to implement values based recruitment and appraisal processes, following the launch of the Trust s new initiative Values and Behaviours in March The process of embedding the key elements commenced with a series 11

12 12 of targeted workshops based in part on feedback from a survey of new recruits. Two workshops took place in May 2016 to review Nursing, Allied Health, and Administrative job descriptions establishing key behavioural requirements for each role. Feedback from the workshops and the recruitment survey enabled us to build a composite picture of successful values based recruitment (VBR). This programme of implementation will continue and during the last quarter of 2016/17 an audit was carried out to assess how successfully the values based approach has embedded. Develop a communication strategy with a consistent approach There is an increasing body of evidence to demonstrate a correlation between an engaged workforce and improved patient experience and outcomes. For this reason the communications strategy includes a aimed at ensuring staff are informed and involved. The national staff survey and quarterly staff Friends and Family Test surveys highlighted opportunities for us to improve staff engagement across the Trust. Our aim has been to support the embedding of the Trust s new values and behaviours and develop a focussed approach to improve meaningful engagement with staff across the Trust. During the year we introduced a number of new initiatives to support and embed the new values and behaviours and to deliver more effective communication, this included: Introducing a monthly Recognition and Reward scheme with Employee and Department awards for those nominated by colleagues based on the values Kind, Professional Positive Holding a dedicated week of engagement events such as lunch and learn in September 2016 and Marquee week ; Introduced various forums for staff to meet with the Executive Team such as Exec catch up, the Chief Executive and Managing Director monthly staff forum, and ad hoc Managing Director Improvements in staff engagement were with the overall percentage of staff who would recommend the organisation as a place to work up from 64% to 71% and to receive treatment and care up from 70% to 76%. Improved clinical communication Safe and effective care is dependent on the quality of communication between the patient and members of the healthcare team. With this information must include documentation of timely discussion, handover and decision making on treatment escalation plans. The Trust s aim was to develop strategies for improved clinical communication on admission, at handover and at discharge of key clinical decision making. Treatment escalation planning During 2016/17, a clinical lead was appointed to develop a policy on treatment escalation plans. This work will support the availability of information about, and appropriate limitations to, interventions which are likely to be futile or contrary to the patient s wishes.

13 This work has progressed and it is anticipated the policy will launch in May Clinical Handover Implementation of an electronic system now supports nurses in recording patient observations and improves track and trigger scoring. Implementation of modules to support automated escalation when patients deteriorate and clinical handover is also being explored. Discharge information The provision of a timely discharge summary for a patient s GP supports continuous care delivery. During 2016/17 achieving the target of over 95% of inpatients having a discharge summary sent has not been achieved with the rate consistently close to or just above 90%. It is anticipated that the implementation of the new Electronic Patient Record will increase this performance during 2017/18. Improve Quality Improvement capability As part of the Trust s ambition to improve services and the quality of care provided to patients the Trust has implemented a quality improvement and change management development programme. The aim was to increase the capability of staff to design services that meet the patient s needs. 42 staff attended workshops in summer 2016 and 16 staff are participating in the improvement programme - wave 1 launched in autumn 2016, and 38 staff are participating in wave 2. As part of the continued ambition to redesign services that place patients at the centre of all that the Trust does, the quality will be expanded in 2017/18 to ensure that the Trust has the right skills in place for continuous improvement. Sign Up to Safety Campaign The Trust committed to the Sign Up to Safety Campaign in Each year, the improvement priorities associated with the campaign are reviewed and reported within the Trust s Quality Account. In 2016/17, the Trust participated in the 2 year anniversary activity with displays in the atrium and ward visits celebrating progress and sharing lessons learnt. Improving the quality of care for our patients through delivery of the ward/department accreditation system A ward-based performance assessment framework supports a culture of safety by helping nurses monitor the quality of care in their own areas. It supports communication, accountability, team working and leadership, empowering staff to focus their attention on improvement and ensures patients are placed at the centre of the provision of services. The aim was to develop and implement a ward based accreditation scheme. During 2016/17 a system was developed that goes further than existing accreditation systems. It not only ensures baseline standards are met but is also a vehicle for real ground level staff engagement and a means of rewarding departments for excellent practice which is shared across the Trust. 13

14 The approach taken is an accreditation for excellence which fosters positivity, generating healthy competition which motivates a desire for excellence. Therefore the MEHT accreditation standards are Bronze, Silver, Gold and Platinum accreditation. Accreditation is based on achieving indicators aligned with the corporate vision and objectives, with each level having a unique set of metrics encompassing existing standards with the addition of new aspirational standards for the silver and above. Assessments commenced in January 2017 the Chief Nurse on 9 February 2017 with 6 wards achieving bronze accreditation. There were 2 wards who were able to meet the requirements of silver accreditation at their The assessment process will continue into 2017/18. Priority 2: Clinical Effectiveness, increasing the reliability of care Improve the early recognition and management of patients with sepsis Sepsis accounts for 44,000 deaths across the UK each year. Early recognition and management of sepsis can reduce mortality and avoid unnecessary intensive care admissions. The aim was to monitor the use of the Sepsis 6 care bundle and to continuing education and training for staff to drive improvement. The Sepsis Team have implemented a comprehensive programme to support care delivered to, patients with sepsis. This programme has developed throughout from an on-going audit of compliance with the Sepsis 6 care bundle and included a comprehensive communication strategy, targeted education packages, sepsis trolleys in A&E, increasing the Early Senior Assessment Triage from one bed to four, introduction of a maternity screening tool and pack, public awareness stands, and raise awareness amongst the public. The on-going data collection indicates that April 2016, particularly with key indicators such as giving antibiotics within 1 hour of arrival at A&E. Sustainable improvement is reliant on screening and education to ensure patients are treated appropriately in the early stages. In the Emergency Department screening has been carried out consistently for over 80% of patients and we aim to sustain and improve this performance. It is pleasing to note that the number of patients admitted to the Intensive Care Unit with sepsis has reduced despite the number of patients with an indicator for sepsis increasing. We remain committed to further improvement and will continue to focus on this area of care in 2017/18. The aim for 2017/18 is to improve care and recognition of patients with or at risk of sepsis throughout the Trust. This will involve targeted support for all wards and departments. 14

15 Develop Trust response to National Safety Standards for Invasive Procedures incorporating a Human Factors approach The National Safety Standards for Invasive procedures (NatSSIPs) were published by NHS England in September 2015 to support learning from harm, near misses and never events. By having effective standards in place to govern the processes associated with invasive procedures and by training staff in team skills or human factors, an improved safety culture can be established and maintained. The aim in 2016/17 was to establish a working group to support the implementation of this national guidance and to continue with the delivery of human factors training for staff. This resulted in: A working group being established to identify the specialist areas where bespoke guidance would be helpful; An overarching guidance document was been developed in draft and has been circulated to the group for comments; Bespoke safety checklists and guidance has been developed in Interventional Radiology and for the insertion of Central Venous Catheters; Internal audit and Commissioner led audit have taken place across the Trust to monitor performance and identify areas of practice for improvement; and The Human Factors programme has continued to be delivered throughout the year and to be well evaluated by those that attend. To date 347 staff have attended the training. Dealing with death and dying is upsetting and stressful for patients and those close to them. We strive to always provide the best end of life care possible, ensuring people are treated with dignity and respect, kept informed by their healthcare team and involved in decision making. We aimed to enhance end of life care for patients and their relatives and carers, by continued during 2016/17. for aligned to the Ambitions for developed. The Trust participated in the National Care of the Dying audit. We revised the documentation we use to assess and plan care for patients who are in the last days of their life. Educational sessions were taught, aimed at all staff groups as well as holding system wide events that involved stakeholders from across the Mid Essex locality. A bereavement survey was introduced to allow us to learn from the relatives of patients who have died in our hospital. The Trust signed up to the Gold Standards Framework, a national quality improvement The swan symbol, synonymous with care in the last days of life and bereavement, was introduced. 15

16 Improve Mortality review Reviewing case records of patients who have died is an opportunity to learn from what went well with a patient s care and where there are aspects of their care that could have been improved. All notes of patients who die in hospital are viewed by the Medical incident reporting. Many of the clinical teams have established mortality reviews in place but these are based within departments and learning is not reliably shared across the Trust. The structured judgemental review an initial review and the second tier is an in depth analysis undertaken if the care of a patient is assessed as falling below acceptable standards or if the death was judged to have been avoidable. The aim was to introduce a whole Trust approach to the two-tier mortality review using a structured judgement approach with the aim to target appropriate case note review at tier one each month using the structured process. In stage one we have introduced a retrospective case record review of the notes of patients who have died at the Trust. We are using the template produced by the Royal College of Physicians. We are currently reviewing 20-30% of deaths per month and sharing any learning through the Mortality Review Group back to the clinical teams. This review looks at the patient s journey from initial care, care during stay, care at the end of life and scores care overall, looking for any evidence of avoidability. We have made plans to establish mortality leads who will undertake the reviews in accordance with the new national 16 will be supported by a quality assurance process using criteria-based case selection, discussion, learning and quality improvement. Priority 3: Improving Patient Experience Embed listening events for patients and staff A key work stream from the Culture Project was to regularly carry out listening events to enable our patients to tell us about their experiences of our hospital. This also helped us to assess whether the implementation of the new Values and Behaviours were having a positive impact on the patient experience. A series of listening events were held during the year. The areas included Emergency Care, Day Surgery, Surgical Wards, Medical Wards, Maternity and Children s services. An In Your Shoes listening event took place in November which was attended by 16 patients who told their story to staff. When they were asked what would have made the biggest difference to their stay, the key theme was for staff to take more time to talk to them about their care. The feedback was analysed and presented back to the clinical teams to help them determine where they could improve their services for their patients. The outcome of this was also shared with the patients who attended the listening event. Next year, a new schedule of listening events is planned. These will all be In Your Shoes sessions as it has been recognised that this methodology provides a rich amount

17 of patient feedback that provides the detail which helps our staff make the changes that will make a positive difference. Improve the environment and make our wards quieter and more restful, especially at night Patients reported through listening events and national surveys that our wards can be noisy at night affecting their ability to rest and recover. A work stream to establish and address the main causes of noise at night was led by the patient experience team working closely with clinical staff. What we achieved: an audit was carried noise at night were hospital staff activities. Subsequently the Trust developed a 10 point success plan for all staff groups to adopt including: ward; Reducing the volume of telephones at night; Reminding staff of the importance of talking in hushed tones; Reminding staff of the importance of wearing soft soled shoes; Porters and estates staff to keep bleeps/radios on mute; and Reduce the use of alarms where possible. The Trust has purchased 5 noise monitors which alert staff when noise levels reach unacceptable levels. These will be used in a pilot programme where the implementation of the 10 point plan on 5 of our busiest wards will be tested. Staff engagement is key to the success of this initiative and each ward will have an the programme. A communication campaign is also planned to support this initiative. Improve the management of pain for inpatients During the culture patient listening events in 2015/16, patients reported that we were not always managing their pain in a timely and effective manner. An improvement plan was developed as part of the Culture Project to address any short falls in pain management across the needed support in complying with the agreed guidance. These wards developed plans to improve. On-going audits of pain management take place across the organisation and the further improvements. The achievements made to date include the successful recruitment of 3 pain Clinical Nurse Specialists who will support the delivery of the new training programme. All front line nursing staff of all grades will complete the pain training programme. The programme will cover pain physiology, pharmacological and non-pharmacological methods of pain relief. The key aim is to ensure a consistent approach to the delivery of appropriate pain assessment and management. Newly appointed junior doctors will also receive dedicated training from a Pain Consultant and a Clinical Nurse Specialist. This work stream is led by a multiprofessional working party. 17

18 In the coming year there are plans for a Pain Consultant to join the ward rounds on the that are supported by the senior Clinical Nurse Specialist. This model has been wellevaluated by staff across the disciplines. arrangements for them to be stored locally in clinical areas. The Trust Safety Alerts have been very well received, with staff feeding back that they Improve the mechanisms for learning from clinical incidents We know that despite our aspiration to always provide excellent care for our patients, things will occasionally go wrong. It is important that we react to any serious incident by being open and honest with those involved, by investigating what happened, learning for the future. In 2016/17 we wanted to embed a process for sharing what has been learnt from serious incident investigations across the Trust. We developed a template that can be completed after an investigation to share what the incident was, the situation, the background leading up to the incident, an assessment of what went well and what went wrong and what the Trust and individuals can do to stop the same thing happening again. These incident summaries or Trust Safety Alerts are circulated be to all staff. As with the investigation process, the aim is to avoid blaming individuals, but to identify issues in the systems and processes that allowed an error to occur. This encourages a pro-active safety culture where staff incidents and near misses. The Trust has developed an intranet page so that these incident summaries can be saved on the Trust Intranet allowing staff to easily access previous versions and make 18

19 Key Performance Indicators (KPI s) What are Key performance indicators (KPIs)? Key performance indicators (KPIs) are used by many organisations, including our Trust, to see if we are meeting our and measure progress towards our organisational goals. As the primary means of communicating performance across the organisation, KPIs focus on a range of areas. Once an organisation has analysed measuring progress toward these goals. Other performance measures, such as length of stay, mortality rates, readmission rates and day case rates can all be analysed. For example the length of stay for a particular procedure, may be different from the national benchmark. Therefore this may highlight where a process can be investigated and changed. Four hour maximum wait in A&E Our reported performance for the four hour maximum wait in A&E for the year is 80.9% against a 95% standard. The Trust has undertaken a comprehensive review of its emergency care pathways both internally and across the health economy to understand our performance against the national quality standards improves. Following this diagnostic review of poorly performing areas, the Trust redesigned emergency care pathways in the year. This led to developing streaming at the front door into an Emergency Village that directed minor illnesses, where appropriate, to inhouse GPs, low acuity A&E attendance to an ambulatory care service and a provision for adult and frail GP direct admissions into appropriate assessment areas. This was implemented in September During 2016 progress was hindered by delays in recruitment to consultant and middle grade posts in the Emergency Department. Following a recent successful recruitment campaign, a high proportion of these longstanding medical vacancies were recruited to and staff are due to take up position in May We have fully engaged with ECIST (Emergency Care Intensive Support Team) during the year and will continue to develop on their recommendations on internal patient (MFFD) or are delayed transfers of care (DTOC). 18 Weeks Performance The Trust met the 18 week Referral to Treatment (RTT) waiting times standard in 2016/17. This means that 92% of patients that were waiting for elective treatment were seen and treated within 18 weeks from their initial referral date. This measure is an important indicator of overall waiting times for patients who are waiting for elective treatments. We are continuing to review opportunities to improve the patient experience and our performance. The introduction of a new Electronic Patient to track patient pathways more easily and support the reduction in waiting times. We anticipate this will continue to be delivered at or above target during 2017/18. Cancer Waiting Time Standards The Trust has had consistent high performance against the 14 day standard for those patients on the two week wait 19

20 pathway. Achievement of the 31 day standard between diagnosis and treatment has not been consistent over 2016/17, with particular delays for subsequent surgery due to theatre capacity issues. Due to a particular focus on addressing the delays, the Trust achieved the 31 day standard in all treatment groups in March days) was also challenging over 2016/17, although there was a gradual improvement, with the Trust ending the year in March 2017 at 79.1%. This improvement has been due to focussed work from the cancer tracking team and the specialties to ensure delays are eliminated wherever possible. The Trust has committed to continued improvement in all cancer pathways, with a trajectory to achieve 85% for the 62 day standard by the end of July Key performance indicator MRSA bacteraemia There have been 3 cases of MRSA attributed to the Trust in 2016/17 against an annual ceiling of no avoidable cases. Each case is investigated thoroughly and actions taken to address learning. Whilst the source of one outbreak remains unclear in spite of extensive investigation, intense cleaning of the unit, including an enhanced cleaning regime and refurbishment of the staff changing rooms was successful in bringing the outbreak to a close. Following this case the infection Prevention Team monitor incidence of hospital acquired MRSA even more closely and instigate terminal cleaning and /or enhanced cleaning when there is an increase in incidence on a ward. 20 The Trust has worked collaboratively with Southend University Hospital Trust and Basildon and Thurrock University Hospital to create a regional cancer recovery plan, which brings together actions for each hospital with shared pathway actions. This has facilitated joint work to address delays in patient pathways and to ensure that transfers between the Trusts are made in a timely and seamless manner. Diagnostics standard The Trust has consistently achieved above the 6 week diagnostic standard, achieved through rigorous management of diagnostic pathways and a zero tolerance approach to breaches. However, MRI capacity remains a risk and the Trust continues to outsource to manage demand. Capital plans for MRI are progressing with a view to increase capacity in December 2017.

21 18 week RTT is for the month of Mar-17 all other data is for the year to 31 March 2017 were successfully appealed against. Summary Hospital-level Mortality Indicator The Summary Hospital-level Mortality Indicator (SHMI) reports on mortality at Trust level across the NHS in England. The SHMI covers all deaths of patients admitted to hospital and those that occur up to 30 days after discharge from hospital and is the ratio between the actual number of patients who die and the number that would be expected the characteristics of the patients treated. It is well recognised that Mortality rates in themselves cannot be interpreted as a measure of clinically unexpected deaths issues with documentation, clinical coding or clinical care. The Trust has consistently maintained the SHMI relative risk rate within the expected range over the last 12 months. MEHT SHMI for the period October 2015 to September 2016 assesses groups of patients with conditions that commonly result in death, such as heart attacks or strokes, to see how many, on average in England, survive their stay in hospital. Rates of death take account of patient age, the nature of their illness and issues such as whether they live in a deprived area. Within the Trust, mortality is monitored by the Mortality Review Group. The Group have developed an improvement plan for 2017/18 that builds on progress with the 2016/17 improvement work to ensure there is full understanding of the factors resulting in the raised HSMR and takes account of the requirements of the National Quality Board s Helping people recover from illness and injury Patients undergoing elective inpatient surgery for four common elective procedures (hip and knee replacement, varicose vein surgery and groin hernia surgery) are asked to complete questionnaires before and after their operations. These Patient Reported Outcome Measures (PROMs) calculate health improvement from a patient perspective by asking them about their health and quality of life before and after their The Trust recognises that the Hospital Standardised Mortality Rate (HSMR) which in an alternative mortality indicator, remains higher than expected. For the 12 month period March 2016 to February 2017, the HSMR for the 12 month period is higher than expected. This indicator rates are provided in the table below and it was pleasing to note the very high participation rates for the joint replacement procedures. 21

22 Patient Safety Thermometer Unfortunately the majority of the sample sizes within the most recently available dataset were too small to analyse however replacement was above the national average. The NHS Safety Thermometer is a national data collection which records the presence or absence of four harms on a given day every month. The harms included are pressure ulcers, falls, urinary tract infections (UTIs) in patients with a catheter and new venous thromboembolisms (VTEs). This comprehensive dataset helps us to identify where we need to focus our attention to improve the quality of services. In order to aid staff on the wards collecting the data, additional guidance was developed in 2016/17 and where possible specialist teams supported validation of the data before submission. Monthly data for harm free care for the 12 months to March

23 Monthly data for types of harm for the 12 months to March 2017 Pressure ulcers are caused by sustained pressure being placed on a particular part of the body. This interrupts the blood supply to the affected area of skin causing damage. People with normal mobility do not develop pressure ulcers, as their body automatically makes hundreds of regular movements that prevent pressure building up. Patients may be admitted to hospital with inherited pressure damage or can be at risk of developing pressure damage for a number of reasons. In 2016/17, the Trust had a number of changes in the corporate nursing team who provide clinical support to ward staff to prevent and treat pressure damage. We believe this team change contributed to the monthly variation in the numbers of inherited and new pressure ulcers reported via the Safety Thermometer each month. Despite these challenges, the Trust was pleased that no patients acquired grade 4 pressure ulcers during their stay.in 2017/18, preventing pressure damage in our patients will be one of the Trust s key Quality Improvement Priorities. Venous thromboembolism (VTE) It has been estimated that every year in England 25,000 deaths occur as a result of hospital-acquired VTE. In many cases, deaths resulting from blood clots that develop during an inpatient stay are preventable. It is therefore important that adult patients are assessed for their risk of developing a clot when they are admitted to hospital so that preventative measures can be put in place to reduce the risk. The percentage of our patients who are assessed for their risk of developing a VTE is an important measure of the quality of care we provide. This information is collated and reported on both within the Trust and externally to our commissioners and regulators. 23

24 In December 2016 our reported performance on risk assessment for VTE was 96.1% above the average for England (95.3%). patients aged 2 or over to be collated and monitored - please see the table below. We recognise that work is required to ensure we are appropriately reporting those patients being assessed, against those patients eligible for assessment in line with NICE guidance. 24 The Trust intends to take the following actions to improve VTE risk assessment: A review of this clinical pathway has been undertaken; and the Trust has invested in an IT solution to support a move away from the paper based system of capturing and reporting when a patient has had a VTE risk assessment; Implementation of this electronic system has been delayed in 2016/17 however we hope to transition to the new reporting system early in 2017/18; A new chair has recently been appointed to the Thrombosis Group and this will provide a forum to drive continuous improvement in the way we assess and treat patients at risk of hospital-acquired VTE. The number of cases of acquired Clostridium marker of effective infection prevention and control practice. Each healthcare provider is required to report monthly on the number of This allows national data on the rate per infection reported within the Trust amongst The local data for 2016/17 is based on 35 cases. Of these 35, the Trust has successfully appealed against 19 cases through demonstrating to an external scrutiny panel that the management of the patients infection was compliant with national and local policy. We are pleased to note that the most recent national data demonstrates that MEHT remained well below the national average in spite of challenging targets and complex patients. The increase in the number of cases in 2016/17 is a concern. It is not clear why there has been an increase in numbers, but testing. is kept under very close surveillance. The Infection Prevention Team maintain a database which tracks the ward history of positive within the Trust. This allows potential addressed. The Trust will continue to take the following actions to minimise the risks of all hospital acquired infections. to hospital, all bays and side rooms associated with the patient s admission episode are terminally cleaned.

25 on a ward, selected areas will be terminally cleaned and enhanced cleaning commenced throughout the ward. (both pre and post 72 hours) are sent for Different ribotypes indicate that cases are unlikely to be due to person to person transmission. Patients associated with the same ward in the Trust do not tend to be colonised with the same strain and this indicates that transmission between patients is rare. It is likely that a number of the general population are pre-colonised with Clostridium patient is admitted and prescribed antibiotics for sound clinical reasons. The panel looks at all aspects of care before and after the result is reported including antibiotic prescribing, time of sampling and isolation, documentation, treatment of the and cleanliness of the environment. is communicated Trust-wide. However, as stated earlier many cases are found to be completely compliant with guidance and are successfully appealed at the scrutiny panel hosted by Mid Essex Clinical Commissioning Group. Patient Safety Incidents Incident reporting It is recognised that in organisations providing complex healthcare, things will sometimes go wrong bringing with it the potential for patient harm. By reporting such incidents and near misses, an organisation can learn and improve the way healthcare is delivered. The rate of patient safety incidents reported relative to activity, and the number and percentage of patient safety incidents that result in severe harm or death, are important indicators of an NHS provider s safety culture. A high incident reporting rate usually indicates a more mature safety culture. The Trust s most recent published reporting rate per 1,000 bed days was 0.38% compared to 0.40% for all acute Trusts please see below. Source: 25

26 Whilst reporting rates have increased locally month on month, there remains an inconsistent level of reporting across different staff groups and departments. The Trust implemented the following actions in 2016/17 to support staff in reporting incidents which we anticipate will sustain and further improve the current improved reporting rate seen in Trust staff continue to receive training on reporting incidents and near misses at induction and investigation training; In addition we established a Datix User Group and completed a staff survey to understand how we could improve the incident reporting system. As a result we have changed the web-based report form and revised the incident categories so they are more intuitive. In 2017/18 we will continue to work with staff to encourage reporting and local learning through ward and department safety huddles, department governance meetings and across the Trust through our safety alerts. Serious Incidents Some incidents that occur in the NHS incidents in healthcare are uncommon but when they occur in the Trust, we ensure these are thoroughly investigated so that action can be taken to mitigate the risk of similar incidents occurring in the future. Never Events Never events are serious incidents that have been designated by NHS Improvement as preventable as barriers and guidance exist to stop them from ever occurring. Each never event has the potential to cause serious patient harm or death. However, serious harm or death is not a criteria for an incident to be categorised as such. From April 2016 to February 2017, 380 never events were reported across the NHS in England. In the Trust, 4 never events were reported in the period April 2016 to March Each incident has been, or is being, rigorously investigated so that lessons can be learned. These cases were: One wrong tooth extraction One wrong lesion removed One case of wrong implant/prosthesis. One case of retained foreign object post procedure. Readmissions within 28 days Readmission to hospital within 28 days of discharge can be an important measure of the quality of care provided to patients. The reasons for readmission are often complex with no single causal factor. However there are opportunities to help prevent potentially avoidable readmissions by reviewing where organisations have low readmission rates. The most recent nationally published data is from 2011/12 indicating that the Trust had a favourable readmission rate at that time. Please see below the National comparison to England and other Medium Acute Trusts data for the percentage of patients readmitted within 28 days of being discharged from 2016/17 is also provided. 26

27 a) All emergency readmissions (16+ years) b) All emergency readmissions (0-15 years) The more recent local data indicates there has been a rise in the rate of readmissions and the Trust s operational and quality improvement teams are working together to understand whether the increase is due to natural variation or whether there are underlying issues that can be addressed. If required, collaborative work with the clinical teams will follow to ensure care provision is reviewed in detail and any issues addressed. Patient Friends and Family Test The Friends and Family Test (FFT) was introduced in 2013 to help service providers and commissioners understand how and the services we provide, and where improvements can be made. The FFTasks people if they would recommend the services they have used and offers a range of responses. The survey is a quick and anonymous way for patients to give real time feedback on the Trust s inpatient areas, accident and emergency, maternity and outpatient services. The results of the NHS Friends and Family Test for those admitted to the Trust and attending the Emergency Department in March 2017 are included on the next page. 27

28 Source: Feedback from the FFT is shared widely across the Trust. The information is shared locally via departmental meetings encouraging staff ownership for delivering improvements and also at Divisional and Director level to allow performance to be monitored. Historically in some cases the level of local ownership for performance in the patient FFT was limited. During the last year the Trust recognised that the response rates and scores for a number of areas needed to improve. As a result the Trust intends to take the following action to improve: A new strategy will support improved local ownership to ensure the FFT feedback is used by ward and department teams to understand the patient experience and where improvements were needed. Guidance on responding to the feedback received is being provided on an on-going basis and wall mounted feedback stations within the departments entitled You Said, We Did are planned for 2017/18. National Staff Survey experience and well-being. The annual survey asks NHS staff to give their views anonymously about their experiences at work, including reporting incidents, training and stress. The results are also used by NHS England to support national assessments of quality and safety Staff Friends and Family Test In April 2014, NHS England introduced the Staff Friends and Family Test (FFT) in all NHS Trusts in England. The vision for Staff FFT is that all staff should have the opportunity to feedback their views on their organisation at least once per year. It is hoped that Staff FFT will help to promote a big cultural shift in the NHS, where staff have further up, and where the views of staff are increasingly heard and are acted upon; Staff are asked how likely they would be to recommend the NHS services they work in to friends and family who need similar treatment or care. The percentage of staff who responded agree or strongly agree with this statement was 76% compared to 69% nationally. Staff experiencing harrassement, bullying or abuse Nationally, the NHS Staff Survey results provide an important measure of staff 28

29 Results for the percentage of staff experiencing harassment, bullying or abuse from staff and equal opportunities for career progression in the last 12 months Source: Home/NHS-Staff-Survey-2016/ The Trust has the following plans in place to improve staff feedback about their experience of working at the Trust. Extensive work continues, to improve the Trust s culture and embed of the Trust s Values and Behaviours; The Trust has a Bullying and Harassment policy; There is increased communication with regard to cascading learning; The Trust has a Speak Up Policy and there is an awareness of the Policy and that matters can be raised in how to escalate when the matter is not progressing appropriately/timely. Care Quality Commission The Care Quality Commission (CQC) is the organisation which regulates and inspects health and social care services in England. All NHS hospitals are required to be registered with the CQC in order to provide services and are required to meet fundamental standards in order to retain their registration.the Trust is required to register with the (CQC) and at 31 March 2017 was registered with no conditions attached to that registration. During the year the Trust was subject to a CQC focused review of those services that were rated as Requires Improvement at hospitals inspection. published in December 2016 and the Trust was rated as Good overall with Burns and Plastics rated as Outstanding and Urgent and Emergency Care rated as Requires Improvement. The Care Quality Commission has not taken enforcement action against Mid Essex Hospital Services Trust during April 2016 to improvements that had been made following their hospital inspection, including in urgent and emergency care. The Trust intends to take the following actions to improve performance: improve the timescales for progressing cases appropriately and the communication with all participants; and The Trust is in the process of agreeing a Standard Operating Procedure to improve how the Trust responds and 29

30 Finance Report 2016/ /17. The Trust performance against its other targets is set out in the table below. Figure 1.1 National Targets * Breakeven duty excludes the effect of accounting policy changes for impairments and the removal of donated asset eserves and additional costs incurred following the adoption of International Financial Reporting Standards (IFRS), see note 33.1 to the accounts for full details. been driven by emergency care pressures, high agency staff usage and cancelled elective activity. Whilst agency staff spend fell to 17.9 million from 24.4 million in 2015/16, there continues requirements, and high medical staff vacancies in hard to recruit areas such as Emergency Care and Radiology. Caps on agency staff usage and agency staff rates introduced during 2015/16 have helped to bring agency staff spending down during 2016/17. Capital spend was 12.5 million for the year which was slightly under plan following a request from the Department of Health to curtail the original plan by 2.0 million. The Trust delivered savings of 11.8 million in year against a plan of 14.0 million. These savings were closely monitored and assessed prior to implementation through the Trust s Quality Assessment Group (QAG) to ensure that savings were delivered with no adverse impact on patient safety, nor the quality of service provided to patients, nor adverse impact against the 30

31 excellent experience that the Trust seeks to maintain for all its service users. receiving loans of million from the Department to Health to fund the target carefully monitored but payment of suppliers was affected and the percentage of invoices paid with the target of 30 days, from receipt of valid invoice, dropped during the year as follows:- If the plan is met the Trust will receive Sustainability & Transformation funding of million. The focus in 2017/18 will be to reduce actual spend within the hospital by working with the other two Trusts under the new Joint Working arrangement, as outlined earlier. The Trust has entered into a cost and volume contract with Mid Essex CCG and its associates, that means we will be paid for activity on a case by case basis (rather than block contract, activity, that was in place for 2016/17). Financial Outlook climate and also within the Essex sub economy, which has been designated one England. been submitted and agreed with NHS to 33.6 million. This plan assumes that the Trust will achieve a minimum of 16.4 million There is a risk therefore, that if activity reduces, then the Trust will not recover the income to cover its costs. However, as a the Sustainability & Transformation funding, Mid Essex CCG will not be able to apply which have averaged over 5.0 million in recent years. Specialised services contracts such as burns, renal and dental are negotiated outside of this arrangement and will continue to be paid for on a cost per case basis. There is an opportunity for the Trust to increase its private patient income and this will be pursued, along with continuing to ensure that the Trust utilises its estate in the 31

32 patient movement into, through, and out of, the hospital. The theatre productivity project will work to ensure maximum use is made of the facilities Hospital. A continued focus on recruitment and the deployment of nurses recruited from costs are driven down, in conjunction with the implementation of the national agency caps. Procurement initiatives will continue to make best use of collaborative opportunities with other Trusts to reduce the costs of clinical and non-clinical supplies. The Trust will continue its involvement in the programme, extending its scope into estates, ahead, it has achieved its control total in 2016/17 and has robust plans in place to achieve the agreed control total in 2017/18. A revenue support loan facility has been made available from the Department of operating cash for the foreseeable future. This means that the Trust believes it has adequate resources to continue to operate and continues to adopt the going concern basis in preparing its accounts. As far as the directors are aware, there is no relevant audit information of which the auditors are unaware and the directors have taken all reasonable steps to make themselves aware of any relevant audit information and to establish that the auditors are aware of that information. Financial Statements report. As directed by the Secretary of State the Trust s statements have been compiled in accordance with the accounting requirements for NHS Trusts manual for accounts issued by the Department of Health. The Trust s accounting policies applied generally follow International Financial Reporting Standards and HM Treasury s Resource Accounting Manual to the extent that the Department of Health has decreed these as being applicable to the NHS. The accounts were considered and approved by the Board on 31 May 2017 and are signed on their behalf. The accounts have been prepared on the basis that the Trust is a going concern. 32

33 Sustainability Annual Report 1.1 Introduction Sustainable development aims to ensure the basic needs and quality of life for everyone is met, now and for future generations. Climate change is the biggest global health threat of the 21st century and without action now it will continue to affect the health and wellbeing of people everywhere. The Board at Mid Essex Hospital Services NHS Trust (MEHT) takes its corporate responsibilities seriously, and is fully committed to ensuring sustainable development in all activities. The Trust sets a clear example for others to follow by working towards sustainable service delivery, improving health and wellbeing and delivering high quality care now and for future generations within the resources. Supporting sustainable actions is a global responsibility, and in 2015 the Paris Agreement was adopted at the United Nations Climate Change Conference. This agreement was signed by 175 countries as well as the European Union and sets out a global ambition to limit climate temperature increase to no higher than 2oC. Additionally, the agreement aims to increase the ability of countries to deal with the impacts of climate with a low greenhouse gas emissions and climate-resilient pathway. It supports legally binding commitments which is aimed at every organisation to achieve a reduction of 80% of greenhouse gas emissions by 2050, as set out in the Climate Change Act (2008). The national Sustainable Development Unit (SDU) launched the Sustainable Development Strategy for the Health, Public Health and Social Care System This strategy aims to support the health system to meet and comply with the targets set out in the Climate Change Act and the strategy sets out a vision for a sustainable health and care system: A sustainable health & care system works within the available environmental and social resources protecting and improving health now and for future generations. It recognises the challenge to continually improve health and wellbeing and deliver high quality care now and for future and environmental resources. The latest carbon footprint report from the SDU was published in January 2016 and is based on 2015 data. It shows that the NHS carbon footprint in England is 22.8 million tonnes of carbon dioxide equivalents (MtCO2e). However, between 2007 and 2015 the NHS carbon footprint has reduced by 11%. 33

34 Even though this is an encouraging achievement from the largest single organisation in the UK, all NHS organisations have a duty to continue to reduce their impact on the environment and local communities as well as mitigating against the effects of climate change (including extreme weather events and humanitarian crisis). Being directly responsible for the health of the nation further compels all NHS organisations to take this agenda seriously and to act to make 1.2 Sustainable Estate Development The Trust s successful bid to the Department of Health Carbon and Energy Fund will cost savings, estimating to reduce the energy carbon footprint by over 30%. This exciting project is currently in the process of NHSI approval. It had an anticipated commencement of September 2016, which due to formal approvals and governance processes has now been delayed to September Once operational it will reduce the Trust s future reliance on fossil fuels and will enable a reduction of Scope 1 carbon emissions. Due to the centralised district heating nature of the project it will allow any future Trust This sustainability report has been developed in line with the HM Treasury Sustainability Reporting in the Public Sector 2016/2017 guidance to ensure sustainability performance is reported on in line with the Greening Government Commitments. 34

35 Analysis of key performance data: Greenhouse Gas Emissions Even though the total gross emissions have continued a decreasing trend, the related energy consumption of oil has been at its highest since before 2013/14. This has been affected by a During cold winter periods, the oil and overall energy required is similarly higher. In England, 35

36 2016/17 facing temperatures on average 0.50C below that experienced during 2015/16. These weather conditions also contribute to a higher energy demand which can in part also provide clarity on these Waste continued upward trend of overall waste weight. However, positive signs have been observed in the increasing recycled waste stream which has been a key focus throughout 2016/17. Further analysis can be found within section 1.6. Waste Management. Finite Resource Consumption Water and sewage costs have witnessed sharp declines when compared to the previous data values. During 2015/16 a Peters hospital site which was resolved. 1.4 Sustainability Strategy The Trust s Sustainable Development Management Plan (SDMP), adopted in 2014 recognises the challenging global and national sustainable development ideals, and it is guiding the Trust s actions up to It realises the Trust s current position regarding sustainable development challenges and achievements and it sets out our vision and goals for Making a Difference to Secure Our Future. the Bruntland report (2009) which described sustainable development as: Development that meets the needs of the present without compromising the ability of future generations to meet their own needs Within the annual work plan, carbon reduction remains a priority and our commitments are aimed at achieving the national targets as set out in the NHS Carbon Reduction Strategy (2010 update) which requires all NHS organisations to reduce their carbon emissions by 34% by 2020 based on the 2007 baseline, as well as working towards a reduction of 80% by It sets out our vision for a sustainable health and care system by reducing carbon emissions, protecting natural resources, preparing our community for extreme weather events and promoting healthy lifestyles and environments Sustainability Champions The Sustainability Champion Network was re-launched in early 2017, with NHS Sustainability Day acting as an aid in promoting this staff initiative. On the day many staff signed up to act as champions within their working area which brings the total number of Sustainability Champions to 160. In line with the (SDMP), sustainable actions are promoted, and focus on the following areas: Models of Care, Community Engagement, Workforce, Facilities Management, Procurement, Travel and Transport and Buildings and Adaption. E-bulletin newsletters are sent to all champions, offering project updates and ways in which they can positively support the sustainable development ideals. Initiative is highly appreciated, with encouragement 36

37 given to champions offering their own views on how sustainability objectives can be achieved. The Trust s Outstanding Service and Care Awards (OSCA s) recognises individual and team achievements, with one dedicated category celebrating the annual Sustainability Award (awards for individual and team of the year). Jenny Tebby from the HSDU Department was selected as Sustainability champion of the year for 2017 for developing and implementing surgical instrument containerization, drastically reducing the amount of unnecessary packaging used by the Trust. This initiative is an excellent example of sustainable development in of care), the Trust (reducing the amount of waste that must be disposed) and also the environment (by reducing unrecyclable waste The Procurement Department, led by sustainability champion Pauline Baker, were chosen as the Sustainability Team of the Year. This was for their extraordinary engagement in delivering a number of sustainable projects including the implementation of 100% recycled toilet paper dispensers, installing sustainable eco settings on our new range of Xerox printers and supporting the rollout of recycled paper throughout all areas of the Trust Events and Campaigns The Trust continues to have an annual work plan of sustainability events, focussed on delivering events and campaigns that supported the aims of national and local sustainability initiatives. Vibrant and engaging events were held to support NHS Sustainability Day 2017, European Mobility Week 2016, the Trust s Nurture campaign (a celebration of caring associated with community volunteering activities) and also various events that supported the delivery of the Trust s Get Healthy...Stay Healthy health & wellbeing strategy. Events and activities included regular Woodland & Garden Walks, Twilight Bat Walks, participation in events offered by Active Essex, Nutrition and Hydration Week 2017 and many more. 1.5 Greenhouse Gas Emissions Targets set out in the Climate Change Act (2008) require a 34% reduction in carbon emissions by 2020 to enable a shift towards achieving the overall ambition of an 80% carbon reduction by The most up to be published in Since 2007/08 the Trust s carbon footprint has been increasing at an annual average the opening of the new PFI and it also takes account of the reductions achieved through the centralisation of clinical services and the sale of both St Michael s and St John s hospitals. The 2020 target is based on a 1990 baseline year, but as detailed back-casting data proved unreliable it has also been modelled on a baseline year of 2007/08 to ensure continuity of approach. Predictions based on this trend indicate that the Trust would not meet the required 34% reduction by It is likely that by 2020, the Trust would be emitting a further 7,042 tonnes of CO2e per annum than 2015/16 s measurements and 37

38 that would amount to a 62% shortfall for reaching our targets. It is worth noting however that the carbon intensity of goods and services (Scope 3) are decreasing and as a result the predicted shortfall should be reduced (although the extent of this cannot reliably be predicted). The potential development of an Energy Innovation Centre will also have a positive effect on future Scope 1 & 2 emission predictions. 2007/ /16: MEHT non-adjusted carbon emissions 1.6 Waste Management throughout 2016/17 with improvements to the availability of Dry Mixed Recycling (DRM) facilities. Overall, the Trust has recycled an additional 14 tonnes, continuing the positive trend domestic waste (691t) have likewise increased over the past year around the Trust, this can be explained by ever increasing site activity. rates and lower domestic waste is predicted. In 2017/18 the Trust will also be splitting its clinical waste stream into Offensive clinical waste and Infectious clinical waste. The introduction of the offensive waste stream will see potentially processed unnecessarily. Both these waste management initiatives are likely to reduce the Trust s future environmental impact. 38

39 1.7 Healthy Food Choices In line with the Trust s Food and Drink Strategy, much emphasis is being placed on providing healthier and more sustainable food to patients, staff and visitors. The strategy set out the Trust s commitment to implement the recommendations made in the Hospital Food Standards Panel s report on standards for food and drink in NHS hospitals and focuses on the following areas: The nutrition and hydration of patients Healthier eating for the whole hospital community, especially staff Procurement of sustainable food and catering services In October 2016, MEHT participated in the Quorn Mince Challenge. Throughout the month the Trust replaced all of its meals containing minced beef with alternative protein mince dishes. Feedback from this initiative was extremely positive with 96% of responses stating that they enjoyed the meal on offer and 89% would consider choosing an alternative protein option in the future. As a result of this successful campaign, the Trust s on site restaurant (Puddingwood Café) will now supply at least one alternative protein dish per week as a healthy alternative. In March 2017 the Trust supported Nutrition and Hydration Week. The focus of the activities included an emphasis on the importance of maintaining hydration levels throughout the day. A Thirsty Thursday and an afternoon tea event were raised to raise public awareness through provision of a nutrition and hydration awareness stand in the Atrium. The week was successful and highlighted the excellent collaborative working of Dietetic, Nursing, Health & Wellbeing and Catering teams in the Trust - all working towards improved hydration for all. The Trust has continued with its frozen 2015/16 year. This system maintains a close partnership with our food supplier towards reducing food waste. Working closely with the supplier, the Trust is able to be compliant with various government buying standards including; moving to the complete use of sustainable Palm Oil, meeting various animal welfare standards, sustainable farming and dairy produce, fair trade bananas and the use of Marine Stewardship Council approved 1.8 Climate Change Adaptation and Mitigation The Trust continues to utilise the Community Risk Register which was set up by the representation from local authorities, local water and energy companies, schools, hospitals, GPs) to identify risk related to climate change in the Trust s geographical area. Members of the Trust s staff attend the forums to prepare for the coastal and emergency plans in supplying health care service in those situations. The Trust s Heat wave and Cold Weather Plan developed in 2013 sets out the emergency manual and planned response to years the plans has been updated to include risks regarding UV exposure and pollution, as recommended by NHS England. 39

40 1.9 Biodiversity and Natural Environment The Trust is proud to have a variety of natural locations including therapeutically designed gardens and courtyards in addition to ancient woodlands on site. Management and retention of these areas are taken seriously with sensitive environmental actions taken. The Natural Health Service Programme is an environmental and social initiative to protect our natural heritage and enhance the Hospital s green space for our patients, staff, visitors and local community through Hospital. Through this programme we offer volunteering opportunities for people with various abilities, children, youth and adults to through hands-on learning in the hospital grounds. During 2016/17 eleven garden volunteering sessions were held in the Trust s Vegetable Garden and Orchard equating to a total of voluntary hours contributed by City of Chelmsford MENCAP students and students from local schools. In addition to the vegetable and orchard volunteering, woodland and bat educational walks took place providing an opportunity to experience the hospital s natural environment in greater depth. 19 walks took place throughout the year and the leaders contributing 24 voluntary hours. 2016/17 also saw corporate activities taking place, with 60 staff representing Tesco in the Community providing 390 hours to assist in grounds maintenance. 40

41 in April Over 25 volunteer sessions were organised through the Chelmsford 41 Club, from the First Dig Day in November in spring Due to the success of this project, a second dementia-friendly garden has already been approved and fully funded through charitable means. Construction of the second garden will commence in the summer of Further plans for 2017/18 include the Historic Sunken Garden (to be used primarily by the patients of the Hellen Rollason cancer treatment centre) and also other ambitious development of the hospital s entrances and garden spaces. Following on from the success of the St. will also be introducing a garden volunteering group in 2017 to offer additional opportunities for individuals and groups to get involved in the on-going garden development projects and garden maintenance activities Sustainable Procurement It continues to be recognised that the Trust s purchasing decisions have a large impact on our local communities and within our region, and we aim for our procurement activity to have a positive impact on local social, economic and environmental wellbeing. For their work on these exceptional projects, Procurement has been awarded Sustainable Department of the Year The Trust is committed to complying with, and where possible exceeding, relevant legislation whilst focussing on reducing the demand for goods and services by minimising waste and focusing on the re-use and recycling of existing goods and medical equipment. We are engaging with our suppliers to promote awareness, encourage suppliers to adopt similar ethical and sustainable approaches in their supply chains, address barriers to entry for SMEs and local suppliers, encourage development and promotion of new sustainable medical equipment /devices, services and initiatives. 41

42 During 2016 the Sustainable Procurement Working Group was established. The main objectives for the group are: To identify opportunities to increase sustainability, prioritise and take action Produce a sustainable procurement action plan & communicate to staff Assess impacts of key suppliers on sustainable procurement objectives. The group has aided in the introduction of eco-settings preinstalled on the range of new printers and multifunctional devices towel and toilet roll dispenses, which used 100% recycled paper, have also been introduced in all areas. The procurement team have played a pivotal role in switching MEHT from virgin starched paper to 100% recycled paper, saving the Trust money and associated emissions. Recycled paper will now be used for all internal and external correspondence for the Trust Sustainable Construction were undertaken during 2016/17. Future developments will be planned and delivered in a sustainable manner consistent with the manner in which the Trust s rationalisation works were conducted in previous years. The Trust s rationalisation strategy was completed during 2013/14 and the project was recognised on a national level in 2014 with a Public Sector Sustainability Award for Most Innovative Project Travel The Trust maintained an ECC Travel Planning Accreditation Award from Essex County Council for travel planning initiatives delivered throughout 2016/17. This year the Trust achieved silver level accreditation, an improvement from the year before. This accreditation recognises the ambitions of activities which set out to reduce single car journeys to the site and to encourage staff to consider healthy travel as part their commute to work. Working in partnership with local authorities and corporate partners the Trust focusses on developing and promoting more sustainable and alternative methods of transport. 42

43 Additional secure motorcycle parking units have also been installed at the front These units, supplied by MotoParking UK organisation and provide free, secure parking and equipment storage for all motorcycle users wishing to access the site. The units have been very well received by staff and visitors alike and were well used throughout the year. During 2016/17 various initiatives and schemes were promoted through the dedicated staff Travel Centre. Membership scheme continues to grow and the sales of subsidised bus tickets are increasing on a monthly basis People (Public Health Improvement) In 2015, the Trust adopted a new health and wellbeing strategy Get Healthy Stay hugely successful physical activity campaign for staff (Challenge 2014). 43

44 The aims of this strategy are to promote health and wellbeing for both hospital staff to develop more sustainable workforce as well as for the wider hospital community. Activities in 2016/17 focussed on delivering the ambitions of the strategy to deliver a public health campaign that will enable individuals to make positive lifestyle changes in four areas; Smoking Cessation; Nutrition and Hydration; Physical Activity and Mental Wellbeing. The Trust s Health & Wellbeing Group ensures the successful delivery of the strategy and a programme of events and activities are delivered on an annual basis. Working closely with the local Clinical Commissioning Group, the Trust supports national health promotion campaigns (e.g. Stoptober, Alcohol Awareness Week etc.) and the Making Every Contact Count initiative is promoted in partnership with Essex Connect and Essex County Council. To promote physical activity for staff, an open tarmac area was transformed into the Wellbeing Terrace. This location now provides greenery and seating areas for lunch, in addition to physical activities including table tennis, swing-ball and Frisbee golf through the warmer months. Hopscotch, walking labyrinths and sounds sculptures complete the area s welcoming appeal. Constructed in 2015, the terrace has been used daily and is continuing to offer both a physical and calming location to enjoy. In 2016, the Trust delivered a cycle challenge month initiative, promoting physical activity. Fortnightly woodland garden walks were also available, and an inaugural bat walk was held in August in partnership with a local bat expert Governance The non-executive Trust Board level champion is the Trust s Chairman, Professor Sheila Salmon, with executive leadership provided by the Chief Director of Estates & Facilities. The Board recognises strategic leadership as a key determinant for realising the Trust s ambitious sustainable development ideals Sustainability Strategy Group The Trust s Sustainable Development Management Plan remains reinforced by a governance structure reporting to the Board to ensure that sustainability action plans are implemented and monitored. A sustainability strategy group has been in place since January This group is informed by individual sustainability working groups and reports to the Finance and Performance Committee, in turn providing assurance to the Trust Board East of England Regional Sustainability Group The Trust s Head of Sustainable Development and Strategic Projects remains chair of the regional East of England Sustainability Network. The network holds regional cross system representation and focusses on shared learning, disseminating best practice and providing support with the delivery of the sustainable development agenda throughout the NHS and other system partners. 44

45 Good Corporate Citizenship Assessment The Trust has participated in the NHS Sustainable Development Unit s (SDU) Good Corporate Citizenship self-assessment (GCCA). This assessment measures the extent to which Trusts are responsible for meeting social, legal, ethical and economic responsibilities placed on them. The national target score for 2015 is 50% with a target of 75% by The Trust s 2015/16 development performance which highlights that the 2015 target has been met. The GCCA assessment undertaken during 2016/17 highlighted that MEHT reached the national performance against measured policy areas. It recognises an improvement in all areas, and highlights future priority areas as travel, procurement and adaptation planning Awards & Recognition 45

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47 Review of the Year April 2016 Hospital The Trust launched a new free to patients Wi-Fi service. The service being funded by Our Charity and offering 24-7 full streaming access for people visiting the hospital and patients on the wards. have free access to Wi-Fi to use on their mobile phones or tablets, thanks to funding provided by the hospital s charitable funds. Our Charity Trustees were delighted to support this important project to implement Wi-Fi access across the hospital site, based on the existing contractual relationship with Hospedia. The new Wi-Fi solution is now fully funded the fundraising drive to raise even more money to ensure patients have access in years to come. For many patients who frequently visit the hospital, such as those with repeated outpatient visits, a series of chemotherapy treatments or dialysis, improved with this access to Wi-Fi. number of hospitals providing free Wi-Fi to patients, visitors and staff, which helps to further improve the patient experience. provided by Hospedia in conjunction with The Cloud and the Trust is the latest in a growing number of NHS Trusts selecting Hospedia as their Wi-Fi partner. Acting Chief Executive, Cathy Geddes said: We are delighted to be able to provide free Wi-Fi access at our hospital to both our patients and their visitors. Patients with us for to keep in touch with friends and family via and social media, and I would like to thank Our Charity here at Mid Essex for providing the funding to make this happen. There is also the opportunity for patients to let us know about the care they received during their stay by completing the online Friends and Family test. May 2016 Gala Night for Hospital Charity Chelmsford City Race Course was the venue for this Mid Essex Hospitals Charity black tie gala charity event. Mayor of Chelmsford, Councillor Patricia Hughes and her consort Mr Paul Hughes to by the charity for many years. With the superb back drop of the outstanding Chelmsford race course venue, over 240 guests enjoyed a sumptuous three course dinner with plenty of music and entertainment. raising hundreds of pounds, saw many lucky guests going home with a variety of top notch vintage aeroplane to a holiday in the south of France. All the items had been generously donated for this event and things that you could not normally buy on the high street. said: We have been overwhelmed with the 47

48 years, and we are delighted to have raised over 12,000 for our Charity that supports the important work at Mid Essex Hospitals Trust. users and staff, has made an impact on how we listen and respond to patient concerns. more queries this year, compared to 2015, and this is a real positive as it means we are helping resolve these patient concerns, rather than them becoming a complaint. I would like to thank all staff here at Mid Essex Hospitals for their commitment to patient care and quality of service, and this announcement supports the good work and improvements I have seen over the last year. June 2016 Mid Essex Hospitals hits the Top Ten! Mid Essex Hospitals was named as one of the top ten most improved trusts in the country in regards to patient experience. the Trust had an improvement of +15 from and commitment towards improving the culture and values within the organisation. In autumn 2015, the Trust held a number of patient engagement events to help create a culture and set of values and behaviours to take forward. The feedback, given by patients and staff at a series of listening events, helped identify the values we all wanted to aspire to, the way we all wanted to be treated. Cathy Geddes, Chief Nurse at Mid Essex Hospitals said: I am delighted with this news, as it shows all the patient listening events, and the feedback from our service July 2016 Hospitals launch Olympic themed knitted teddy competition Knitters were getting ready to assemble at the starting blocks ahead of a race to the knitted teddy making competition. Entries were accepted, for the Rio 2016 Teddy Sports Star Competition until the end of the Olympics on Sunday, August 21. These teddies will provide a cuddly distraction for children who are staying at Hospital or St Peter s Hospital in Maldon. There were gold, silver and bronze winners for each hospital, who had their teddies displayed, as well as winning a prize and having their photo taken with children and staff. Cathy Geddes, Chief Nurse at Mid Essex Hospitals said: We are delighted to launch this competition and are excitedly 48

49 is an opportunity for the community to work together to help brighten children s stays at our hospitals. Sophie Wahlich, Principal Pharmacist for Haematology and Oncology, and her Haematology Pharmacist, are based in an of chemotherapy and associated supportive medications. As part of this, their duties also include responding to medication queries from clinical staff, liaising with consultants about the possibility of obtaining drugs which are new to the market, and working with the manufacturing team to ensure that all medications are of the highest standard. September 2016 New Haematology and Oncology Pharmacists describe their working lives supporting cancer care Two new members of the Haematology and Oncology Pharmacy Team have spoken of their enthusiasm for their roles, offering an insight into the pharmaceutical processes that support the provision of care for patients with cancer. Behind the counter in the main atrium is a labyrinthine series of high-tech hives of activity where drugs are manufactured or ordered in, stored and then distributed key part of this is the pharmacy robot a machine which can be programmed to select drugs from the storage area and move them at high speed to a collection point, ready for transportation. There is hustle and bustle as teams pack the medication, juxtaposed with the quiet of the sterile rooms where technicians manufacture They support the Chemotherapy Day Unit, assisting 35 patients per day with their treatment regimens and between 10 and 20 further patients with oral medication. September 2016 class honours degree following her training Zoe Kemp completed her three-year BSc Healthcare Science course in June and has now been awarded this accolade from Anglia Ruskin University in Cambridge. Her duties as a full-time member of staff at the Cardiac Centre are to test and monitor heart function, including rhythm and electrical activity. Zoe said: The course looked really interesting because it is about helping people. I love the patient interaction we see so many patients with a variety of problems 49

50 and illnesses. It is nice to see patients develop and improve with our help. She now plans to continue working towards her professional development by pursuing further study, starting with a pacing exam next year. I really enjoyed working towards my degree, both the practical side and the studying. I felt like I had the best of both worlds. September 2016 Helideck team invite for behind-the-scenes tour a huge asset to hospital trained crew like coiled springs ready to leap into action. helicopter by the HEMS (Helicopter Emergency Medical Service) desk at the East of England Ambulance Service or down, with calls to the Resuscitation Unit - and also the Burns ITU if required. Next, they page one of four Bouygue support volunteers to report to the helideck immediately. Preparation continues with the team kitting member of the team is asked to secure a lift, while another positions a special trolley at the helideck ready to transport the patient. transferred to the helideck phone and the entire team stand by on the helideck after which are rigorously maintained and stringently checked before the helideck is declared open each day. Once the helicopter has landed safely and shut down the team also assist the HEMS medics as directed and escort the patient to the receiving emergency care teams. Jim said: The primary role of the team is to should the unthinkable happen a helicopter crash onto the helideck or roof area meeting a response time of less than 15 seconds. 50 With just 10 minutes notice, they must be able to prepare the helideck for an incoming helicopter to land with a seriously ill patient on board. Every second counts from the moment the call comes in and it s the seamlessly.

51 October 2016 Delegates travel to the St Andrew s Centre from around the globe to hear from our experts about burn care Delegates from across the world attended a course to learn about the burn care delivered at the world renowned St Andrew s Centre. 22 medical staff and students attended techniques employed at the centre. The series of presentations were followed the burn care journey from the time of injury to discharge from hospital. Topics included initial treatment, wound management, surgery, physiotherapy and scar management. In addition, the expert speakers discussed aspects of care such as the use of prosthetics, mental health, and pain management. Accepting her doctorate from Professor Iain Martin, Anglia Ruskin Vice Chancellor, she said: When I started out on my nursing career, more years ago than I care to remember, I never dreamt that I would one day be receiving recognition like this. NHS I believe passionately in improving the lives of others. I set high standards for myself as a nurse to achieve that goal. As a chief executive, I want to ensure that every single colleague who walks through the door best possible opportunity to do that too every day, in every interaction, with every patient. October 2016 Hospital chief executive receives honorary doctorate Chief Executive Clare Panniker has been awarded an honorary doctorate by Anglia Ruskin University in recognition of her services to the NHS. Clare, who is also chief executive of Basildon and Thurrock University Hospitals NHS Foundation Trust (BTUH), received the award of Honorary Doctor of Health Science at a ceremony on Thursday, October 13. She has been leading change and improving the quality of healthcare in the NHS for more than 20 years and was appointed as chief executive of MEHT in May. November 2016 Trust receives a good rating from the Care Quality Commission (CQC) The Trust received a good rating following the Care Quality Commission (CQC) inspection in June. The Trust was previously inspected in November and December 2014, with a requires improvement overall rating being delivered. 51

52 The CQC rated our Trust as good for being effective, caring, responsive and well-led, and requires improvement for being safe in June CQC s Chief Inspector of Hospitals, Professor Sir Mike Richards, said: Our inspectors found a number of improvements had been made at Mid Essex Hospital Services NHS Trust since our last inspection. The leadership of the interim chief executive the Trust and this was evident during our inspection. She was well known, approachable and visible to all staff. The Trust has moved from a culture of blame, with staff not feeling supported or listened to, to one of openness and transparency. The previous culture of fear had been dispelled and staff now felt empowered to perform well across all services. Our inspectors observed that staff consistently acted in a friendly and caring manner with people who used the service and those close to them. We were particularly impressed with the Trust s burns service where we witnessed extremely good care. The service had innovative developments and plans and outcomes for patients with serious burns were comparably amongst the best in the world and were consistently exceptional. The Trust should be proud of the progress made and it knows what it needs to ensure the necessary improvements are made which we will check on when we next inspect. Clare Panniker, Chief Executive said: Moving the Trust from requires 52 improvement to good required enormous commitment, focus and excellent leadership and I would like to thank Cathy Geddes and her team for providing the right environment in which all staff could make this happen. Cathy Geddes, Chief Nurse, said: I am delighted to announce that the hard work of all staff across the Trust over the last two years has resulted in this excellent achievement. November 2016 career role would change. From carrying out blood tests using a pipette controlled by mouth and manually counting the cells under a microscope to requiring a 10-minute wait to read sample results that are now generated by an analyser in approximately 40 seconds, her work has been revolutionised by technological advances. She was just 16 years old in 1966, when she started her career at the former Hackney Hospital. She applied for the role while at found out that she had been successful on the last day of term. Her position as a student laboratory technician would pave the way for her future career, progressing professionally by for three years to become a junior laboratory technician.

53 She said: There were more manual processes in the old days, whereas now we use analysers. We used pipettes and test tubes and each part of the full blood count was an individual operation. We had simple analysers in the late 60s, but come the 70s they had introduced some basic ones which were fairly comprehensive. We have really changed our methodology and have new technology, but the interpretation of the results produced by the analyser still requires practice. Tommie Randall, 11, of Poole, Dorset, was with his family at Arena Essex Raceway near happened. He was watching his stepdad practicing motor racing at about 2pm when he became interested in the motocross taking place on the other side of a steel fence, which was about 10 feet tall, when he fell, causing the injuries. He then underwent a nine-hour operation to repair the damage to his hand. Mr Sood explained that he worked closely with a specialist team including expert anaesthetists and nursing staff, which were completely amputated, and to repair a severe injury to the muscles, tendons and nerves in his thumb, which was attached by skin alone. St Andrew s Centre has one of the largest replantation services in the country. November 2016 Mr Sood added that such procedures have less chance of success in adults with other health or lifestyle complications such as diabetics and those who smoke due to the impact on nerve regrowth. Young patient who suffered serious extremely unusual injuries has hand repaired A young patient who suffered serious, extremely unusual injuries, severing two scaling a metal fence, has had his hand repaired by consultant plastic surgeon Mr Manu Sood and the expert team at the St Andrew s Centre. 53

54 November 2016 Company makes 15,000 donation to the Neonatal Unit for new incubator A Braintree company made a generous donation of 15,000 to buy an incubator for infrastructure, groundwork and reinforced concrete frame services, raised the sum through its inaugural fundraising event in July Held at the Fennes in Braintree, the occasion featured dinner and dancing with In total, they raised 80,000 for four local charities which were nominated by their staff members. The Neonatal Unit was suggested by Trudie Mann, whose son Jason was born at 32 weeks and stayed in the unit for seven weeks. proud of the care we deliver to babies admitted to the Neonatal Unit. This donation will allow us to continue to develop our service in caring for newborn infants born either prematurely or at term, requiring intensive care. December 2016 Daughter raises more than 1,000 for St Andrews Centre team in thanks for saving her mum s life The daughter of a woman who was severely burnt in a patio heater explosion has raised more than 1,000 for the St Andrews St Centre in thanks for saving her mum s life. suffered 40 per cent burns all over her body when a mistake while refuelling the heater resulted in it exploding, covering her skin in extremely hot fuel. induced into a two-week coma and stayed in intensive care for two months, undergoing multiple surgeries. She is still under the care of the department for scar management. She said: I had fantastic treatment and support from the team. It was a very hard time for all of the family one of the worst things was not being able to see the children for so long. old daughter April, supported by her sisters Angel, 14, and Bailie-Rae, 8, decided to organise a 5k run with about 20 friends and family members to raise funds for the team. They completed the run and raised 1,100 in total. April said: I wanted to help other people and say a massive thank you to all of the people who helped my mum. 54

55 January 2017 Guests celebrate commissioning of new Chaplaincy members An audience of colleagues, friends and special guests gathered to celebrate the commissioning of the new members of the Chaplaincy Team. December ,000 probe to the Ophthalmology Department kindly donated a 6,000 probe to the Ophthalmology Department. The probe allows clinicians to establish a clear, full view of the eye. It can be used for patients with conditions such as diabetes, cataracts and bleeding of the retina. Mr Ajay Sinha, joint clinical lead and retinal consultant, thanked the Friends at been bleeding in the eye we need to be able to look in and see what is happening. During the service, Tim Blake was commissioned as a Trust Chaplain; Ralf Cook, Margaret Rees-Evans and Trudy Stevens were commissioned as Ward Chaplains; and Babs Owers was commissioned as Eucharistic Minister. It was also an opportunity to welcome Father Paul Cracknell as Roman Catholic Chaplain. Attendees heard from a number of speakers, International, the network of Charismatic Community Churches that Tim Blake is drawn from, and MEHT staff. Cathy Geddes, Chief Nurse, said: As a nurse I was trained very much about the importance of giving holistic care to our patients. It isn t just about physical care, the spiritual needs of all of our patients are really important. 55

56 January 2017 Chelmsford and District Cardiac Support Group donate more than 2,000 of equipment to Cardiac Rehabilitation The Chelmsford and District Cardiac Support Group has kindly donated more than 2,000 of equipment to the Cardiac Rehabilitation memory of their late chairman, Peter Spring. Peter passed away in September 2015 and the amount comprised donations in his memory and from several other members, as well as a generous donation from the Terling from a variety of new additions including an exercise bike with a memorial inscription, weights and a CD player. The group has given more than 66,000 to the Cardiac Unit and the Cardiac Rehabilitation Department since it began in Hall once a month, where they share their experiences. The group has achieved a great deal over the years, such as a successful campaign for funding from the British Heart Foundation to appoint a cardiac nurse to the team, helping to stock the gym with exercise equipment, and giving support to those who have suffered cardiac problems. January 2017 Family fundraises for eye gaze machine in memory of loved one A family is fundraising for an eye gaze machine to help locked in patients to communicate. The endeavour, which is in memory of Gerard Donachie, will see his family walk up Mount Snowdon on April 8 to help circumstances. Mr Donachie suffered a massive brain stem stroke on November 17 last year and was locked in for the two weeks prior to his death on December 1. Patients in a locked in condition are unable to move any part of their body, apart from their eyelids. His communication at this time was limited to blinking responses to questions. The eye gaze machine gives patients who are locked in the ability to have their pupil movements tracked to a screen where they can select letters, words or phrases to improve their ability to communicate. The family chose to undertake a Snowdon challenge as Mr Donachie completed the walk for charity in They have currently reached more than 2,700 of their 5,000 target for this challenge, with a further 5,000 towards the approximate 10,000 cost of the machine already raised. 56

57 January 2017 of her 33 year career work and the most memorable moments of her 33 year career in the NHS. Amanda Seager, who worked as Training has recently moved to Braintree Community Hospital to lead as the Acting Band 7 for Theatres. She began her training at Sunderland School of Nursing in 1983, working in theatres upon completion. In 1990 she took on her many years before accepting a post as a Hospital in While at the hospital, she has held positions as a sister prior to her most recent role. She recalled highlights of her career including recruiting over 100 new staff to theatres over the last year. She said she has enjoyed working with such dedicated and friendly individuals. Many changes have taken place in theatres since Amanda began working as a nurse. I saw keyhole surgery come in in 1987 and that has gone from strength to strength now with the introduction of things like the robot. We do procedures now that we wouldn t have thought possible, there have been amazing innovations that ensure patients are given the best opportunity to recover from illness. I am delighted to have witnessed this over the years, she said. February 2017 plugs to reduce risk of falls and enhance dignity bathroom sinks as part of a scheme to reduce the risk of falls and enhance patient dignity. This is the most recent development of launched at the end of 2015, and has been implemented by Carrie Tyler, Falls Practitioner, and Angela Wade, Deputy Associate Chief Nurse for the Emergency Throne Audit that there were no sink plugs in some patient wash areas. Due to the use of other items, such as aprons and bowls in their place, it led to the for patient safety which was not conducive to maintaining patient dignity. Other changes made as part of the project have included ordering new equipment such 57

58 as perching stools, fall alarms, posters, and Project as part of the annual audit, writing a fact sheet for staff, and sharing the results on study days. part of the journey to improve the culture across the Trust. February 2017 February 2017 Friends and colleagues bid farewell to Chief Nurse Cathy Geddes Friends and colleagues gathered to bid farewell to Cathy Geddes at her leaving party (February 8). Cathy left her role as Chief Nurse to take up the post of Improvement Director with NHS Improvement. Cathy joined the Trust in the role of Chief Nurse from Barnet & Chase Farm in 2014 and stepped into the role of acting Chief Executive in 2015, a role she maintained until April Bouygues Team donate 1,200 towards The Bouygues Team raised 600 each for Danbury Ward and The Chemotherapy Unit in memory of two of their colleagues. reaching a fundraising sum of 600, which Contract Director Barry Coleman agreed that the company would generously match. We chose to donate to the hospital because sadly last year we lost two members of the 58 Her many and varied achievements in the role include successfully leading the Trust through a CQC re-inspection in which we were upgraded from requires improvement to good. She was also hugely instrumental in driving the programme to develop and embed the new values and behaviours as

59 February 2017 Nurses learn more about orthopaedics at special educational event Nurses had the opportunity to learn more about orthopaedics at a special event at The study day featured a programme of educational sessions to expand knowledge and enhance training. This included working with models of bones and surgical tools. The event was attended by 35 members of ward staff, plus therapy staff. It was organised by three Senior Sisters: Gemma Hughes, Caroline Forder and Prabha Guske. Prabha Guske, Senior Sister at Notley Ward, said: The staff enjoyed the day and gave lovely feedback. They said they felt involved, and that it was educational, fun, and helped improve morale. February 2017 Midwife looks back on career spanning more than three decades spoken of the great fondness she feels for her career on her retirement. Hospital, had a childhood ambition to become a nurse, and she commenced a three-year training course upon leaving school, qualifying in During her training she was seconded to a 12-week midwifery programme which sparked her interest for her future career. After completing her nursing training and working as a staff nurse for nine months, she began an 18-month midwifery training course at Colchester Maternity Hospital. This led to many years working in Colchester as a staff midwife, progressing to a junior sister post before taking several years out to look after her two children. She undertook a Return to Midwifery Course at the Trust in 2000, ahead of taking on the role of staff midwife. She later became the Antenatal and Newborn Screening Coordinator, supporting expectant parents who for 35 years and have seen many changes during this time. I have worked with lots of wonderful people who have supported me over the years and in return I have always tried to guide others, especially within the role of Antenatal and Newborn Screening Co-ordinator. I remember how anxious we were as midwives moving from St Johns to 59

60 being a distant but fond memory. analyser, which it uses to analyse clotted blood samples. It is being used to detect a wide range of diseases including HIV, Hepatitis and Syphilis. February 2017 Our Charity supports 1.3 million fundraising appeal for new surgical robot February 2017 Microbiology Team new equipment will revolutionise diagnosing of illness The Microbiology Team presented some new equipment which will revolutionise its work to diagnose illness both within our hospital and as part of its national activities. Two of the cutting-edge analysers are already in use, having arrived in the department last year. The team is using a Hologic Panther (NAAT), a molecular technique which can detect a particular pathogen in a specimen for a faster diagnosis as it can identify the pathogen as soon as it is present in the body. Hilary Beach, Senior Advanced Specialist Biomedical Scientist, said: It is an extremely sensitive test and is very rapid. We can now have the results within three hours of a sample coming through the door. Using traditional methods with previous days. 60 Our Charity is calling on our generous supporters to help us reach our goal of funding a new 1.3 million surgical robot for This state-of-the-art piece of equipment will help to transform the care we provide to our patients with a wide range of clinical applications. Our Charity would also like to thank those who have already donated to the appeal. The Essex Oesophago-Gastric Cancer Support Group gave 1,000 towards the project to For more information about how you can get involved with the appeal, please contact Charities Manager Yvonne Carter on (extension 4559) or yvonne.carter@meht.nhs.uk Chief Executive 31 May 2017

61 Accountability Report Corporate Governance Report Accountability Report The directors are responsible for the preparation of the annual reports and accounts and they consider the annual report and accounts taken as a whole are fair, balanced and understandable and provide the information necessary for patients and other stakeholders to assess the Trust s performance, business model and strategy. They are also responsible for meeting Parliaments key accountability requirements. The corporate governance report, as below, outlines the composition and organisation of the governance arrangements within the Trust Corporate Governance Report Director s Report The Trust Board manages the Trust. It is made up of executive directors, who are full time employees and non-executive directors, who are members of the local community term basis by the NHS Trust Development Authority. non-executive directors, including the Chair and Chief Executive. The Chief Executive was appointed in April Clare Panniker, the Chief Executive at Basildon & Thurrock University Hospitals NHS Foundation Trust has been appointed to a joint post, also shared with Southend University Hospital NHS Foundation Trust. The individuals who served as executive and non-executive directors of the Trust during were:- Chairman Sheila Salmon Chief Executive Cathy Geddes / Clare Panniker Watson / David Meikle / James O Sullivan Robert Gosh / Celia Skinner Cathy Geddes / Diane Sarkar Abell Director of Strategy & Corporate Services Carin Charlton Director of Operations Margaret Farley / Nick Alston / Colin Grannell / Karen Hunter / Parm Phipps As part of the joint working arrangements agreed between the three Trusts, a single leadership team (forming a joint executive group JEG) was established following consultation and a formal appointments process, including the use of external expert assessors. With effect from 1 February 2017, the appointees became the executive members of each of the Trust Boards. These arrangements are in the form of secondments from the postholders substantive roles and will be reviewed by the three Trust Boards before 31 March

62 As at 31 March 2017 the Trust Board consisted of: Chairman - Sheila Salmon Chief Executive - Clare Panniker O Sullivan Non Executive Directors: In addition to these voting members the Trust Board also has non-voting members. These are:- Callingham Chief Estates & Facilities Director Carin Charlton Chief Human Resources Director Mary Foulkes OBE Nicholas Alston Colin Grannell Karen Hunter Parm Phipps Membership of Board sub committees as at 31st March

63 Trust Board as follows:- Remuneration & Nominations Committee Audit Committee Patient Safety and Quality Committee Finance and Performance Committee Charitable Funds Committee Whilst the membership of the Audit Committee consists only of non-executive directors, the members are supported by the Finance Directorate and internal and external auditors. Parm Phipps is also the Non Executive member of the Transformation Steering Group. In 2016 the board created a Success Regime Committee, comprising the Trust Chair, two Non Executives, Colin Grannell and Nick Alston, and the Chief Executive, to be the Trust representative committee at the Success Regime Joint Working Board. This comprises a committee in common, made up from the Success Regime Committee of each of the acute Trusts of Mid Essex, Basildon and Southend. The Joint Working Board meets monthly together with the intent of coordinating a joint approach to the common issues facing each Trust, and reports to the individual Strategic Trust Boards. Further details of the joint governance agreements are included in the Annual Governance Statement, later in this report. Public Trust Board Meetings A public Trust board meeting is held every other month. Members of the public are welcome to attend these meeting and to ask the Board members questions. The Trust s Annual Public Meeting for 2015/16 took place on 15 September 2016 Public Meeting for 2016/17 will take place on Audit Services The Trust s external auditors, who were appointed by the Public Sector Audit and Barry Pryke is the Trust s External Audit Manager. Audit work is determined by the National as follows: 2015/16 Audit Completion Report June /16 Quality Account Report July /17 Annual Audit Plan April 2017 The total fee for external audit services can be found in note 14 to the accounts. Counter Fraud During the year the Trust has continued to work with counter fraud specialists to promote the awareness of fraud and how to report it. A number of investigations have been carried out during the year and reported to the Audit Committee. A selfassessment was made against a reporting framework developed by NHS Protect and work has been carried out during the year to improve Trust practices 63

64 Register of Interests The Trust maintains a formal Register of Directors Interest. The Register is available for inspection, on request, at the Information Data Incidents The Trust reported one security incident to the Information Commissioner in the period of this annual report which was successfully resolved. There were no issues brought to the attention of the Caldicott Guardian requiring advice. For further detail please refer to the Governance Report section of this report. Statement of Disclosure to Auditors Each individual who is a member of the Trust at the time the Directors Report is approved so far as the member is aware, there is no relevant audit information of which the Trust s auditor is unaware that would be relevant for the purposes of their audit report; the member has taken all the steps that they ought to have taken in order to make him or herself aware of any relevant audit information and to establish that the Trust s auditor is aware of it. 64

65 Statement of Directors Responsibilities in Respect of the Accounts The directors are required under the National Health Service Act 2006 to prepare accounts these accounts give a true and fair view of the state of affairs of the Trust and of the income accounts, directors are required to: apply on a consistent basis accounting policies laid down by the Secretary of State with the approval of the 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 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. above requirements in preparing the accounts. By order of the Board 31 May 2017 Chief Executive 65

66 Statement of the Chief Executive s of the Trust The Chief Executive of the NHS Trust Development Authority has designated that the Chief Executive of the NHS Trust Development Authority (operating as NHS Improvement). 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 which govern them; annual statutory accounts are prepared in a format directed by the Secretary of State with the approval of the Treasury to give a true and fair view of the state of affairs as at the end To the best of my knowledge and belief, I have properly discharged the responsibilities set out in auditors are unaware, and I have taken all the steps that I ought to have taken to make myself aware of any relevant audit information and to establish that the Trust s auditors are aware of that information. and that I take personal responsibility for the annual report and accounts and the judgments required for determining that it is fair, balanced and understandable. Chief Executive 31 May

67 Governance Statement 2016/2017 Mid Essex Hospital Services NHS Trust - RQ8 1. Scope of responsibility Executive of the Trust, I have a responsibility for maintaining a sound system of internal control that supports the achievement of the Trust s policies, aims and objectives and meets the accountability requirements of the Trust Board for internal control. I also have responsibility for safeguarding quality standards and public funds and the Trust s assets for which I am personally responsible as assigned to me and set out in the responsibilities include ensuring that there are effective management systems in place, that value for money is achieved, that income and expenditure has been applied for proper purposes, and that effective and sound I am accountable to the Chairman of the Trust and have regularly provided performance reports to the NHS Improvement and NHS England, which have monitored progress and performance against the NHS Accountability Framework for the year to 31 March In order to help maintain internal control, the Trust has also worked with the Mid Essex Clinical Commissioning Group, national and local strategic health bodies and advisers and other health economy partners including the acute Trusts at Basildon and Southend, Essex County Council and community services providers. 2. The Governance Framework of the Trust The Trust has a system of internal control which has been in place throughout the year ending 31 March 2017 and up to the date of the approval of this annual report and accounts. This Governance Framework provides a system of internal control designed to manage risk to a reasonable level, rather than to eliminate all risk to the achievement of its policies, aims and objectives altogether. As such it can provide reasonable but not absolute assurance of effectiveness. Through an established structure of Board Committees reporting directly through their Chairs at every public Board meeting, the challenges to the Trust s achievement of its and can be analysed and prioritised. This allows for the likelihood of harm to be assessed and for managerial measures to be put in place to address the impact effectively. The Trust s internal auditors reported in March 2017 that the organisation has an adequate and effective framework for risk management, governance and internal enhancements to the framework of risk management, governance and internal control to ensure that it remains adequate and effective. In particular I am alert to the issues relating to Financial Planning and Delivery, including Cost Improvement Plans (CIPs) and the use of e-rostering, where only partial assurance internal audit opinions were given in the year. Together with the Trust s own assurance processes, this forms part of a regular in these areas and also know where there can be additional improvement. I consider that the arrangements in place for the discharge by the Trust of its statutory functions have been checked for irregularities and that these arrangements are legally compliant. Charities, Remuneration, Audit, Patient Safety and Quality and Finance and 67

68 Performance. The latter three are the principal committees within the system of internal control, meeting regularly and delivering Board assurance and risk assessment. The Transformation Steering Group, reporting to the Board was set up in mid-2016 to meet the need for a Board level review and monitoring forum for the Quality Improvement and Recovery Governance initiatives triggered by the Care Quality pressures within the Trust. This has since moved forward to encompass Trust based elements of the systemic changes required to deliver the expectations of the Essex Success Regime. The public Board meeting receives summary reports from the Chairs of all the committees and the Transformation Steering Group. In the year ending 31 March 2017 the Trust restructured its internal governance arrangements, with the establishment of four new clinical Divisions in the summer of 2016 accountability pathways. These are supported by dedicated governance staff within the Divisions. In particular, the Trust uniform electronic recording of risks across all Divisions. The Clinical Governance Group, into which the Divisions report on clinical issues was established in the 2014/15 year, and has matured into the Patient Safety Group. This is contributing to stronger Trust-wide reporting and analysis of clinical issues and risk whilst still reporting to the Patient Safety and Quality Committee. The Divisions also report on performance, quality, safety and managerial issues to the site management team at regular monthly accountability meetings. These follow an established format and agenda to ensure coverage of all critical areas. 68 During the year, the governance groups reporting to the Patient Safety and Quality Committee were reviewed, and currently include Health and Safety, Patient Safety, Patient Experience, Integrated Effectiveness, Informatics, Operational Performance, Research and Development, Infection Prevention and Control and Workforce. These reporting pathways will continue to be developed in the year ahead to strengthen the internal control systems covering the risks to patient safety and experience. Changes will most likely involve the Informatics Group reporting to the Finance and Performance Committee and the development of an Integrated Governance Group. An internal audit report in March governance and accountability structure already provided reasonable assurance. During the year, the Trust moved substantially towards working more closely with its neighbouring acute Trusts in South Essex as part of the Essex Success Regime in order to better harness the clinical and the streamlining of supporting services. To give effect to this, in December 2016, the Boards of Directors of the three acute trusts in Mid and South Essex agreed to enter into a collaborative governance framework with a supporting contractual joint venture in order to enable them to work more closely together to redesign essential clinical, clinical support and corporate support services as part of the Mid and South Essex Success Regime. All three Trusts remain separate and sovereign statutory organisations. This framework came into effect on 1 January As a result of the governance provisions of that agreement, the Trusts now have a shared Executive management team

69 and Chief Executive and, since February 2017, have met monthly together as a Joint Working Board, made up of individual Trust Success Regime Committees mandated from each of the separate Trusts, but acting as a Committee in Common, reporting to the Trust Boards. The Joint Working Board meets in public for the majority of its business. The individual Success Regime Committees from each Trust have delegated to them all of law and good governance, be delegated. The Board of Directors of each Trust remains ultimately accountable for the performance of that particular Trust. However the Trust Boards now meet less frequently than previously, focussing upon the exercise of those functions and governance responsibilities which cannot be delegated and receiving assurance about the performance of the Trust and the effectiveness of the Success Regime Committee and other committees that report to the Trust Board. The consequences of these governance changes and further anticipated changes will be the subject of planned review. A Joint Oversight Committee has been established for this purpose. Notwithstanding these changes, the Trust Board and all the committees and groups reporting to it remain in place to provide the necessary assurance to the Trust. All the committees have considered their terms of reference in the context of the joint working changes during the year and most new joint arrangements, Executive and Site Director attendance and quoracy. This work was anticipated by the Trust Board in its acceptance of the Joint Working Agreement and resultant changes, and is on-going. The Trust Board, committees and the Transformation Steering Group are and have been adequately attended to discharge essential business. There was a transitional period when the Transformation Steering Group did not need to meet, and one occasion when the Charitable Funds Committee was not quorate as a result of unexpected illness on the day of the meeting. There have been no quoracy issues impacting upon the work of the Trust and quorate meetings. All the committees and the Trust Board have a standard agenda structure and reporting format to help The Audit Committee, comprising only of Non-Executive Directors, oversees the systems of internal control and the overall assurance processes associated with managing risk and has particularly focussed on the Risk Assurance Framework, Board Assurance Framework and Clinical Audit processes in the year ending 31 March This will continue in 2017/18 under a new Board that the Audit Committee will continue its overarching independent and objective scrutiny of the systems of control. The Audit Chair and another Non Executive contribute to the Joint Oversight Committee of the three Trusts. The Finance and Performance Committee is the principal forum for reporting and and performance issues. It is supported by a sub-structure of reporting Groups and departments including those covering investment. It meets on a two monthly basis in close proximity to the date of the Trust Board meeting to enable greater scrutiny 69

70 be available in the time available in the Trust Board meeting itself. The focus of business in the year has remained upon increased emergency demand and the cost shortages. During the year the schedule of meetings whereby the Finance and Performance Committee and the Patient Safety and Quality Committee have met on the same morning every two months, has proved successful and has contributed to the continuity of Non-Executive Director attendance and the establishment of an integrated governance overview of the Trust. The Chair of the Finance and Performance Committee and of the Patient Safety and Quality Committee will each attend their new associated Joint Committees in Common as part of the joint Trust arrangements. The Patient Safety and Quality Committee is the principal forum for the assessment of safety, quality, and patient experience across the Trust. It seeks and receives assurance on governance and risk management, reviews the risk assurance framework documents from the Directorates and Divisions and receives reports from the relevant site or Joint Working Board Directors of Nursing, Medicine and Operations in relation to all the areas within their remit. These are contained within the new Integrated Quality and Performance report introduced in the year. Additionally the Committee receives reports on clinical audit, investigations, and learning from experience. This combination allows for the review and understanding of Never Events, Serious Incidents, and follow-up actions at a local level. The Directors are required under the Health Act 2009 and related Quality Account 70 Regulations to prepare Quality Accounts Report 2016/17 has been developed in line with this guidance and the Trust s quality strategy, and has been supported throughout the year by the Board Assurance Process. The data and information it contains has been the subject of regular report to the Patient Safety and Quality Committee and thereafter to the Trust Board. The process has also been subject to Audit resting with the Trust Board. During the year there have been two Patient Safety and Quality Committee and Finance and Performance Committee. The arrangements with the two other South Essex acute Trusts mentioned earlier as part of the Essex Success Regime. The second has been the pressure upon the Trust to deliver national performance standards, particularly in relation to access, against a backdrop of recruitment pressures, agency usage and increasing workforce demand and expense. continued to impact, as has the drive to Trust has remained a reason for vigilance throughout the year with medical and nursing staff agency costs and capacity pressures combining to place pressure on the already were contained in the very last part of the year as a result of internal and external initiatives. As part of the system of internal control, the risks associated with this key Assurance Framework and the regular reports from the Committees.

71 The Trust has needed to address quality and safety issues raised in earlier external reviews, and therefore welcomed receiving a CQC rating of Good following a CQC visit and detailed review during the year. The Non-Executive Director membership of the Trust Board has remained stable and committed, and has adapted to the governance changes and new ways of working associated with joint working with the two other Essex Trusts. Executive Director changes in the year have been substantial, with the appointment of myself as Joint Chief Executive for the acute Trusts at Basildon and Southend as well as Mid Essex. A new Managing Director for the Mid Essex Trust was appointed in the summer. More recently, and as part of the agreed joint working arrangements, a new Chief Finance have been appointed, with these roles also being jointly held in the other two Trusts by the post holders. This links the three Trusts with a shared Executive Director team in common. A Joint Executive Group provides a strategic managerial overview across all three Trusts whilst each Trust retains a separate site Director team responsible for the day to day running of each Trust. Prior to these new appointments and changed roles, a combination of successful internal acting up and external recruitment resulted in effective cover being maintained across all these roles within the Trust during the transitional period. Whole-Board development in the year has continued with a focus on the joint working arrangements between the three success regime Trusts. This has included detailed and a joint session with the full Trust Boards of each Trust in January As in previous years, the focus of the Board has always been on the patient, with a continuation of the drive to improve safety, quality and patient experience. The culture and vision initiative, The Culture Project, commenced in late 2015, has continued with further staff and patient input sessions and with tracking of the resulting actions. patient and staff survey results. The opportunity for Executive and Non- Executive Directors to visit the operational sections of the hospital has also continued with the introduction of themed visits as part of the pre-existing 15 steps Board to Ward initiative. Work is nearing completion in May 2017 to implement a new Electronic Patient Record system which will provide a unique patient compatibility of systems across the Trust and the success regime Trusts. 3. RISK ASSESSMENT The Trust Board, through the Chief Executive, is responsible for risk and organisational activities of the Trust. In support of this the Trust has a two year risk management strategy which was approved in May 2016 and is subject to current review to of and interaction with the joint arrangements with the two other success regime Trusts. The strategy provides the framework for the management of risks across the Trust and is designed to identify, minimise, control and wherever possible eliminate any risks that may have an adverse effect on the health, safety and welfare of patients, staff, visitors or the Trust as a whole. 71

72 72 The risk management strategy sets out the Trust s risk appetite and approach to the management of risks. It also includes the role of individuals and the Trust Board and its committees in managing risks. This includes the responsibility of the relevant Executive Directors for the areas under their control. The Trust trains all staff in risk issues according to their particular work situation and provides relevant courses and additional training to those with specialist needs according to need. This level of staff readiness is maintained by a process of mandatory training which addresses the risk management processes including health and safety, manual handling, infection control, resuscitation, safeguarding, and information governance. All staff are encouraged to report incidents and near misses so that learning can take place and future concerns can be addressed, and the governance structure is designed to encourage this shared learning. The Trust is currently developing a reporting module to ensure senior approval of the risks and associated scoring. The Trust has measures in place to disseminate and act upon alerts and recommendations made by all relevant bodies. In the year ending 31 March 2017 the Trust adopted a Divisional structure with an escalation process for risk encompassing structured assurance meetings with senior managers and upward transmission to the Senior Management meeting of the Trust and to the Trust Board. Additionally Directorates within the Divisions have continued to produce and update their Risk Assurance Frameworks which are considered in the Patient Safety and Quality Committee and in turn feed the Board s Assurance Framework. The Divisions themselves are adopting a governance agenda template approved by the site Directors which requires review of high scoring and emerging risks at the Divisional Governance Board Meetings, and which will support the quarterly divisional exception reports to the Patient Safety Group. The Board Assurance Framework has been revised in the year and has been well received. This draws from the Directorate and Divisional Risk Assurance Frameworks and also Trust Board and committee feedback to identify the key risks to the Trust. Visibility of risk movement, risk related performance indicators and risk score movement has been improved. The process is subject to review and Trust Board scrutiny and the outcomes are reviewed by the Executive and site teams, Patient Safety and Quality Committee and the Joint Working Board as part of the system of internal control within the governance framework. At the close of the year the Trust s major Framework were: Performance and National Targets Compliance with CQC Fundamental Standards Delivery of the Financial Plan for 2016/17 Workforce Shortages Building, Engineering and Infrastructure Medical Equipment Informatics Success Regime Of these, performance and national targets, workforce pressures and delivery of the

73 Going forward in 2017/18, it is likely that these risks will remain prominent with an emphasis on seeking to reduce risks particularly from emergency demand and bed pressures. In relation to emergency demand and the impact on the A&E four hour wait the Trust has been and continues to work with external agencies to address the Additionally, the effect on operational delivery from the demands upon staff developing joint working arrangements will be monitored. controls to record and authorise agency staff use will feature in the forthcoming year as they have in 2016/17. The Trust has developed plans in response requiring action and has implemented a number of processes to address these. Integrating services as part of the success continue to feature. continuously assessed and reviewed by the Informatics Steering Group. In May 2017, the Trust was one of a number of NHS organisations across the country to be affected by the Malware Cyber Attack on IT systems. This attack targeted organisations worldwide, but caused additional operational pressures on already stretched services within the NHS during this attack. As with all major incidents, the Trust had business continuity plans in place right across the organisation which were implemented as soon as the scale of the problem was realised with only 27 operations and 28 appointments being cancelled and all All urgent tests and surgical work continued as normal throughout this period. The Trust will undertake a review of the incident and impact to ensure any lessons are learned. Addressing rising demand caused by population growth and demographic changes ongoing attention to resource management and the understanding of achievable priorities within the Trust. This will feature across all three Trusts now working more closely together under the success regime. Information Governance Risks are managed as part of the risk assessment process and are assessed using the Information Governance Toolkit. There is an Informatics Risk Assurance framework which is reviewed as an integral part of the system of internal control and risks to data quality and security are 73

74 There were no issues brought to the attention of the Caldicott Guardian requiring advice, other than those already addressed by information governance processes. The risk and control framework is designed to manage risk and has been continually in place for the Trust in the year to 31 March 2017 and up to the date of the approval of the Annual Report and Accounts. At its core is the governance framework of committees and reporting described above which underpin the internal control mechanisms. Risk management requires the engagement of all staff and starts with the recognition and assessment of risk in a systematic way using the structured process contained in the risk management strategy and policy. The relative importance of the risk is established using the nationally recognised risk scoring matrix, with lower scoring risks being addressed locally and higher scoring risks being escalated to progressively higher levels and achieving higher priority. Risk reporting is encouraged and staff training is provided. Risks from clinical or other incidents, including serious incidents are managed in a way that involves patients and their families where possible to encourage learning and patients regularly share their experiences directly in Trust Board meetings. Quality and safety remain the driving factors with understanding, operational and management action being the main elements in the future prevention of risk. 74

75 The key elements of the risk management process, which includes the risks relating to the security and quality of Trust information are: A risk management strategy and policy reviewed by the Audit Committee and approved by the Trust Board Established procedures at all levels of the Trust in relation to risk management, including a serious incident policy which encourages the reporting of all incidents and issues Trust Board committees with Non- Executive leadership and reporting sub Groups with Executive Director leadership tasked with reviewing risk and seeking assurance Public/Patient involvement in committees and attendance at bimonthly Trust Board meetings Clear and short management lines for risk management Appropriate risk management training for all staff. Proactively as part of the Trust s annual business planning process Reactively in response to an incidents or assurance review Through the Risk Assurance Framework process at Directorate and Divisional level and by Executive and Trust Board reviews. Progress towards risk mitigation or elimination is monitored by the regular review of management actions and re-scoring against the risk scoring matrix and against established timeframes. In turn, the revised Risk Assurance Frameworks that emerge from this process are considered by the Patient Safety and Quality Committee and Executive Directors. This process is supported by the Board Assurance Framework, which for each of the the The risk description and details The Trust objectives and CQC domains affected The risk rating, scoring history and movement Risk appetite Direction of travel Controls and assurance on controls Gaps in controls and assurance, and future mitigation measures Related high risks Relevant key performance indicators Internal audits have continued to ensure that gaps in the application of the risk assurance and that the prescribed system of control, including keeping policies, plans and procedures up to date and available is in place. Any actions to improve assurance that these controls are systematically applied are agreed with named responsible managers and dates for delivery are agreed and reviewed. The Trust monitors Information Governance progress from its annual return of the Information Governance Toolkit data to Connecting for Health on behalf of the Department of Health. The Trust achieved Governance Toolkit submission for 2016/17. The overall score was 69% and was graded green, indicating acceptable performance. The Trust retains counter fraud advisors to assist in delivering its counter-fraud deterrent reviewed by the Audit Committee. Work is currently underway to strengthen the Trust s 75

76 interests and to provide additional assurance in relation to staff in a position to place contracts. The Trust obligations under equality, diversity and human rights legislation are complied with via the Equality and Diversity group which reports via the Workforce Group to the Patient Safety and Quality Committee. Elective waiting list data quality is assured via a weekly process of data validation. Reports are compiled by the information department, following clear audited processes, and then validated by an experienced operational team before the pathways are reviewed to ensure accuracy. Risks associated with initial human error with entries are minimised through the detailed validation process. Automation of waiting list compiling is not possible due to a lack of a system generated unique system malfunction in calculation of waiting times reporting. A new electronic patient record system, which will provide a unique management will be introduced in May 2017 and will address these issues. 5. Review of effectiveness of risk management and internal control During the year the Trust successfully addressed the areas where it had been found not to be fully compliant following CQC inspections in late 2014 and early In mid-2016 the CQC revisited and later reported that he Trust was in the Good category. However, the need to remain vigilant to the maintenance of standards has resulted in the Trust retaining the need to meet essential CQC standards as a key risk in the 2017/18 Board Assurance 76 Framework. Performance against expected standards and improvement expectations remains subject to regular review and action. Mitigation action in relation to all the principal Framework is on-going and is reported at each Trust Board meeting. Accordingly, there are effective systems and processes in place to monitor and maintain the effectiveness of governance structures, the responsibilities of committees and Directors, reporting lines and accountabilities and the submission of accurate information to assess the Trust s risk position and compliance status. for reviewing the effectiveness of the system of internal control. My review is informed in a number of ways: The Trust s internal auditors reported in March 2017 that the organisation has an adequate and effective framework for risk management, governance and further enhancements to the framework of risk management, governance and internal control to ensure that it remains adequate and effective. Issues relating to Financial Planning and Delivery, including CIPs and the use of e-rostering, where only partial assurance internal audit opinions were given in the year, are being addressed. This provides me with the assurance to in place for the discharge of statutory functions have been checked for any irregularities and that they are legally compliant.

77 Executive Directors / managers 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 recent improved patient and staff surveys, public involvement reviews through the Culture project, declarations and reviews in relation to the CQC essential standards, and other reviews by the NHS Improvement and NHS England. I have been advised on the implications of the result of my review of the effectiveness of the system of internal control by the Trust Board, the Audit Committee, the Patient Safety & Quality Committee and the Finance & Performance Committee. Continuous improvement of the system is in place and includes: Continued review of the Risk Management Strategy, Assurance Frameworks and Board Assurance Framework. Continued improvement to the process for identifying, recording and reviewing risks. Implementing new assurance pathways from the Divisions to the principal committees and the Trust Board The Board Assurance Framework and and assurances is linked to the Trust s strategic objectives and the Trust s internal audit programmes. The Trust Board has monitored the achievement of corporate objectives as part of the performance monitoring process and the Standing Financial Instructions and other corporate documents have been updated accordingly. A process is in place to regularly review them and it is likely that further amendment will be required to align these with those of the other Trusts within the success regime. performance. The Trust s historical structural remains a restrictive factor. The Trust faced a on-going need for central cash support and an on-going risk to meeting its breakeven obligations and this position is likely to Services NHS Trust has a generally sound system of internal control that supports the achievement of its policies, aims and objectives. Date: 31 May 2017 Clare Panniker Chief Executive 77

78 Remuneration & Staff Report The Secretary of State has determined that NHS Trusts should disclose certain information in relation to those individuals who are considered to be senior managers the major business activities of NHS Trusts. The Chief Executive has determined that the senior managers of the Trust in 2016/17 were the Executive and Non-Executive Directors of the Board and other directors who attend Board meetings. supplied by the NHS Pensions Agency. The salaries and allowances of senior managers senior managers, staff numbers and the pay multiples information, have been audited by Remuneration Committee The remuneration policy for Executive Directors is set by the Remuneration Committee, a sub-committee of the Trust Board. This committee is responsible for the appointment and/or dismissal of all Executive Directors, as well as the approval of their remuneration, terms of service and the monitoring of their performance. It is chaired by the Trust Chairman and all Non Executive Members of the Board sit on the Committee. The Chief Executive and Director of Human Resources attend the committee as requested to advise on matters relating to the other Executive Directors and the performance of the Trust. a six month notice period. No contracts have provisions for compensation for early termination. The policy on remuneration of Executive Directors is in line with the Department of Health Guidelines Senior managers pay progression is subject to achievement against corporate objectives. They are assessed against performance measures set during the appraisal process. A regular report to the Board, which updates the progress on the corporate objectives, is used by the Remuneration Committee to assess whether the senior managers performance conditions have been met. Non-Executive Directors remuneration policy The Chairman and Non-Executive Directors are appointed to the Trust by the NHS Trust Development Authority. They are appointed for terms of up to four years, with a maximum total of two terms being permissible before the post is subject to external advertisement. A maximum of ten years is permissible with one organisation. 78 Executive Directors remuneration policy Executive Directors are appointed through open competition by Members of the Remuneration Committee. All Executive Directors contracts are permanent and have

79 Salaries and Allowances 79

80 Salaries and Allowances (cont) *The Chief Executive post was a shared post during the year **In line with joint working arrangements with Basildon & Thurrock University Hospital NHS Foundation Trust and Southend University Hospital NHS Foundation Trust a Joint Working Board was established from 1 February The members of the Joint Working Board are paid via one of the three Trusts but are executive directors of all three Trusts. The table below details the total pay of the Joint Working Board members for the year to 31 March 2017 where they are in joint post across all three Trusts. to their paid employment with the Trust or the period of employment in post. 80

81 81

82 Performance pay and bonus relates to Clinical Excellence Awards which recognise and regard NHS consultants who perform over and above the standard expected of their role. Awards are given for quality and excellence, acknowledging exceptional personal contributions. To be considered for an award, consultants will have to demonstrate achievements in developing and delivering high-quality patient care, and a commitment to the continuous improvement of the NHS. 82

83 The NHS Pensions Scheme covers past and present employees. The scheme is accounted payable to the scheme for the accounting period. For more details, see accounting policy note 9 in the annual accounts within this report. Reporting of relationship between highest paid and median remuneration 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. 83

84 17 was 150k - 155k ( , 170k-175k). This was 6 times ( , 7) the median remuneration of the workforce, which was 26k ( k). In and , total remuneration was calculated on an annualised basis, using the actual pay scale of all staff. It includes salary and non-consolidated performance-related pay, but not severance payments. It does not include employer pension contributions, and the cash In , 22 employees received remuneration in excess of the highest-paid director ( , 13). Remuneration ranged from 15k to 213k ( , 15k - 201k). This is based on actual salary and allowances paid to employees (rather than on the annualised basis described previously) but not severance payments, employer pension contributions, and the cash Reporting of other compensation schemes exit packages There were no compensation schemes or exit packages agreed or paid in 2016/17. Reporting of off-payroll engagements 84

85 All off payroll engagements have been reviewed to assess as to whether assurance is required that the individual is paying the right amount of tax and where necessary assurance has been sought. There have been no new off-payroll engagements since 31 March Expenditure on Consultancy During the year expenditure on consultants was 852k. Consultancy spend covered a range of reviews including consultancy in relation to the Electronic Health Record project. Sickness absence data During the calendar year 2016 the Trust lost 34,978 full time equivalent days through sickness, an average of 9 days per full time equivalent (2015, 33,078 full time equivalent days an average of 9 days). Effective and consistent management of sickness absence is key to ensuring the availability of staff to maintain the continuity of high quality patient services without the reliance on temporary sickness absence rate that is below the average for all medium Acute Trusts. The Trust will remain committed on proactive ways of supporting managers and staff for 2017/18. Staff numbers 85

86 Staff Composition *Staff not on Agenda for Change staff band (this includes all senior managers reported in the tables above). Valuing and caring for our staff In 2016/17 the Trust built on the work of the Culture Change and Values Week project where over 1,500 patients and colleagues shared their views and experiences through a number of listening and feedback sessions. to help develop new Trust values and behaviours which set out how we expect everyone who works at the Trust, whatever their role or level, to behave with both patients and colleagues. These were successfully launched in March 2016, with the new Trust values and behaviours statement of At our best, we are a kind, professional, positive team. The Executive Team are making a series of informal visits around clinical and non-clinical areas in addition to regular morning catchup sessions. This is part of an on-going plan to increase their visibility and accessibility around the Trust. The Trust has continued to work on the introduction of values based interventions such as values based recruitment, leadership development, appraisal and talent management in line with the objectives of the Trust s Workforce Strategy. Recruitment & Retention As with many NHS provider organisations, workforce supply of some professional groups, particularly in respect of the recruitment of medical and nursing staff has continued to be a major issue throughout 2016/17. The Trust has remained committed to increasing the registered nurse establishment with comprehensive recruitment initiatives across Europe and 86

87 elsewhere overseas. The Trust has also continued its commitment to support work based learning for existing health care support worker s as well as supporting return to practice for registered nurses. This recruitment activity is being monitored at an operational level by the Nurse Recruitment and Retention group which is chaired by the Deputy Chief Nurse with regular progress reports being made to the Workforce Programme Board. The number of registered nurse in post increased by WTE during 2016/17. The focus on recruiting our workforce will WTE European / overseas staff have been recruited but were delayed by legislation these should be in post by September The retention of experienced staff is also key and the Trust continues to maintain a healthy turnover rate of less than 10% (an average 8.51% for 2016/17) which compares extremely favourably with other Acute Trust within the region. Our Exit Questionnaire focuses on breaking down themes such as career progression. This enables us to inform our actions as part of the Trust s Retention Recognition and Reward strategic plan. This will be a key aspect of our workforce priorities for 2017/18. the Trust The learning and development priorities for 2016/2017 were aligned to the Trust operating plan, and staff were supported to undertake modules, attend conferences, workshops, and further develop in the following areas: Critical, urgent and emergency care; especially the emergency practitioner role; Diagnostic and assessment skills; Vulnerable adults care (including dementia); Expanding the role of specialist nursing; Non-medical prescribing; expanding the practitioner role; Maternity, neonatal and paediatric care; and Medical professional development. Education (medical and non-medical) was commissioned, approved and fully utilised to the total value of just under 600,000. Commissions were based on statutory and professional requirements, outputs from appraisal and talent management discussions, and local agreed priorities. MEHT is a local partner of the NHS a further 80 multidisciplinary staff have been sponsored to undertake leadership and development programmes consistent with their role, professional and service requirements. In collaboration with our Mid and South Essex Partners, we have pioneered a local delivery of the leadership academy s Mary Seacole Programme. Our own trained facilitators deliver this innovative programme. This focus will be maintained during 2017/18. Mandatory and risk management training agenda which underpins the Trust s patient safety agenda. The Trust has achieved an overall average of 87% in 2016/17, a 3% sustained increase on the previous year. All divisional governance meetings feature a standing agenda item regarding training performance. All mandatory elements are national and regional events. 87

88 We continue to produce bespoke reports as well as a suite of validated and accurate data which support the divisional governance meetings. The Trust s induction processes continue to be well evaluated, and the supplementary ten day clinically focussed nursing programme continues to be embraced. The Trust has continued to support the development of the pre-professional workforce; staff have been supported through the following: - apprenticeships in healthcare, business administration and customer care; foundation degrees in nursing and healthcare which will enable staff to undertake a shortened work programme; 12 staff have successfully completed the now been employed into substantive registered posts. The Trust has participated in local initiatives to increase the workforce pipeline through employing a talent for care co-ordinator. This role supports the allocation of work experience, taster employment and recruitment events. A collective apprenticeship strategy is in formation in order to maximise usage of the government imposed apprentice levy and further support routes into healthcare. Post graduate medical training continues to be led by our Clinical Tutor who in and Development oversees the qualitative aspects of education provision. The quality performance annual review of all educational placements was successfully undertaken 88 in March 2017 with a good compliance outcome. We will continue to prioritise educational placements as key to increasing the workforce pool. Undergraduate Medical Training has continued to be well evaluated and the Trust has maintained University Status awarded by Medical School. Trainers are praised for their commitment to the undergraduate experience. We are now working with Anglia Ruskin in the development of a local medical school. continues to perform extremely well. Our last quality assessment review in September 2015 resulted in 97% compliance across all measured domains. This was validated by users. Our focus for 2017/18 will be to build on our successes and continue our positive relationships with our education partners. Measuring staff satisfaction and prioritising areas for improvement The Trust continued with its programme of staff engagement during 2016/17, including conducting both the local staff survey Staff Impressions and the NHS National Staff Survey. In terms of the National Survey results, staff engagement has continued to increase to 76% which has increased from 76% recorded in 2015/16. launched 9 January 2017 and remained open until midnight 31 March The survey included quarter 4 Friends and Family Test (FFT) questions. The results

89 from this have been received and shared with staff union representatives and all other staff through various communications. The 2016/17 quarter 4 survey had a response rate of 9.7% with 481 staff responding, this was higher than 2015/16 when 322 staff responded giving a response rate of 7%. A working group is to be set up involving all staff groups to help incorporate the emerging themes of the survey into the wider on going Improving our Culture work. The 2016 National Staff Survey was sent out via Quality Health to a sample of 1,250 staff during quarter 3 of 2016/17. The response rate of 37% was 12% higher than were released in February 2017 and shared with the Trust Board and with staff. Staff regarding the survey results, held by the Chief Executive. The Workforce Programme Board which will oversee the development and implementation of action plans that will focus on areas for improvement and transformational change. The Trust invited nominations for its fourth Outstanding Service and Care Awards (OSCAs) event to recognise and reward members of staff who provide outstanding service and patient care. This is an extremely important event that will positively impact upon the motivation of staff in the coming year. Staff health and wellbeing The Trust continues to build on the efforts of an open culture to speak up and to never walk by to improve our services for patients and the staff who work here. We continue to have various ways and mechanisms open to staff who have a concern, including a Speaking Up phone line, a dedicated address and Board representatives staff can talk to. The Trust has invested in a new software system to support staff with raising An annual work plan and programme of activities has continued throughout 2016/17 governed through the Health & Wellbeing Group with a variety of activities and events successfully delivered. The annual staff Festive Thank you event was hosted for the fourth year in December. A selection of mince pies, cakes, nonalcoholic mulled wine and hot drinks were given to staff in the atrium as a thank you from the Executive Team for all the hard work and effort throughout the year. The MEHT choir sang at the event, City of Chelmsford MENCAP were invited to sell some of their festive games were provided throughout the day; hampers were also delivered to Braintree Community Hospital. Nominations were received for the Environmental, Sustainability and Health & Wellbeing champion of the year, and Environmental, Sustainability and Health & Wellbeing Department of the Year, as part of the OSCA s event that praises staff who have gone above and beyond while working at MEHT. As part of the Essex Success Regime, MEHT is working with partner Trusts to consider business cases outlining new operating models to provide an improved Occupational Health Service across the three Trusts (MEHT, Basildon & Thurrock University Hospital NHS Foundation Trust and Southend University Hospital NHS Foundation Trust). 89

90 The Trust s commitment to promoting Equality, Diversity and Inclusion The Trust strives to provide a positive and inclusive environment for patients, carers, the general public and its workforce. The aim is to have an environment where all care is accessible to all people and there are no barriers preventing any individual or group being treated the same as any other. The Trust actively manages inclusion through an Equality and Diversity Steering Group chaired by the Chief Nurse. This group includes workforce managers, Patient Council representatives, nursing specialists, external stakeholders and involvement from other executive and nonexecutive directors as required. Throughout 2016/17, the Trust has continued to implement the Department of Health s Equality Delivery System (EDS 2) which has been used to record progress in different parts of the Trust and to identify where there are gaps in knowledge, consultation or involvement. A project plan has been developed to address these gaps and identify/remove potential barriers to inclusion. barrier to effective treatment. In addition, the national WRES Data Report for 2016 positively highlights our Trust for having an above average proportion of Board Members from Black or Minority Ethnic backgrounds. Equality analysis Equality Impact Assessments are carried out for relevant policies to review their impact on different groups of people. The Trust s public website has a comprehensive range of additional information about how the Trust is meeting the Public Sector Equality Duty and the needs of the diversity of all people using the hospital services or working within it. Date: 31 May 2017 Clare Panniker Chief Executive 90 We are also fully committed to the NHS England Workforce Race Equality Standard (WRES). The Trust Board, via its subcommittee, has asked for regular progress reports on actions that will make a difference to outcomes. The Trust uses the EDS 2 and WRES data as a means to obtain information and evidence that helps us identify where different groups of people might encounter a barrier. For instance, for employees this could be a possible barrier to career progression, and for patients, it could be a

91 Independent Auditor s Report to the Directors of Mid Essex Hospital Services NHS Trust of Mid Essex Hospital Services NHS Trust (the Trust) for the year ended 31 March 2017 the Statement of Comprehensive Income, the Statement of Financial Position, the Statement of Changes in Taxpayers Equity, the Statement of Cash Flows and the related notes. has been applied in their preparation is applicable law and International Financial Reporting Standards (IFRSs) as adopted by the European Union, and as interpreted and adapted by the Government Financial Reporting Manual (the FReM) as contained in the Department of Health Group Accounting Manual (the GAM) and the Accounts Direction issued by the Secretary of State with the approval of HM Treasury as relevant to the National Health Service in England (the Accounts Direction). We have also audited the information in the Remuneration and Staff Report that is described in that report as having been audited. This report is made solely to the Board of Directors of Mid Essex Hospital Services NHS Trust, as a body, in accordance with Act 2014 and as set out in paragraph 43 of the Statement of Responsibilities of Auditors and Audited Bodies published by Public Our audit work has been undertaken so that we might state to the Directors of the Trust those matters we are required to state to them in an auditor s report and for no other purpose. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the Trust and the Board of Directors of the Trust, as a body, for our audit work, this report, or for the opinions we have formed. Respective responsibilities of Directors, the As explained more fully in the Statement of Directors Responsibilities in respect of the Accounts, the Directors are responsible for and fair view. Our responsibility is to audit statements in accordance with applicable law and International Standards on Auditing (UK and Ireland). Those standards require us to comply with the Auditing Practices Board s Ethical Standards for Auditors. As explained in the Statement of the Chief Executive s responsibilities, as and effectiveness in the use of the Trust s resources. We are required under section 21(3)(c), as amended by schedule 13 the Trust has made proper arrangements effectiveness in its use of resources. Section Act 2014 requires that our report must not proper arrangements are in place. We are not required to consider, nor have we considered, whether all aspects of the Trust s arrangements for securing economy, resources are operating effectively. 91

92 An audit involves obtaining evidence about free from material misstatement, whether caused by fraud or error. This includes an assessment of: whether the accounting policies are appropriate to the Trust s circumstances and have been consistently applied and adequately disclosed; accounting estimates made by the Directors; and statements. accounts to identify material inconsistencies 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. Scope of the review of arrangements effectiveness in the use of resources We have undertaken our review in accordance with the Code of Audit Practice, having regard to the guidance on the and Auditor General in November 2016, as to whether the Trust had proper arrangements to ensure it took properly informed decisions and deployed resources to achieve planned 92 and sustainable outcomes for taxpayers and local people. The Comptroller and Auditor General determined this criterion as that necessary for us to consider under the Code of Audit Practice in satisfying ourselves whether the Trust put in place proper arrangements for securing economy, resources for the year ended 31 March We planned our work in accordance with the Code of Audit Practice. Based on our risk assessment, we undertook such work as we considered necessary to form a view on had put in place proper arrangements to in its use of resources. position of Mid Essex Hospital Services NHS Trust as at 31 March 2017 and of its expenditure and income for the year then ended; and have been prepared properly in accordance with the National Health Service Act 2006 and the Accounts Direction issued thereunder. Emphasis of matter going concern statements which sets out the the Directors Trust in the context of the National Health Service framework in which it operates and their conclusion that there are material about the ability of the Trust to continue as a

93 respect of this matter. Opinion on other matters In our opinion: the parts of the Remuneration and Staff Report to be audited have been properly prepared in accordance with the Accounts Direction made under the National Health Service Act 2006; and the other information published together in the annual report and accounts is Matters on which we are required to report by exception Exception report section 30 referral Accountability Act 2014 to refer the matter to the Secretary of State if we have a reason Trust, is about to make, or has made, a decision involving unlawful expenditure, or is about to take, or has taken, unlawful action On 22 May 2017 we referred a matter to the Secretary of State under section 30 of as the Trust has breached its statutory breakeven duty. Exception report use of resources Auditor s responsibilities that the trust has put in place proper and effectiveness in its use of resources. The Trust s outturn position for 2016/17 in line with the its control total, achieved in part through non-recurent means which places additional strain on the Trust in the Sustainability and Transformation Funding) with a cost improvement programme target challenge to the Trust. The Trust s medium to a breakeven position without additional funds being made available. These issues are evidence of weaknesses in effectively to support the sustainable delivery of strategic priorities and maintain statutory functions. On the basis of our work, having regard to the guidance issued by the Comptroller & Auditor General in November 2016, with the exception of the matter reported in the basis Mid Essex Hospital Services NHS Trust put in place proper arrangements to secure its use of resources for the year ended 31 March Other matters we report by exception We are required to report to you if: in our opinion the Annual Governance Statement does not comply with the NHS Trust Improvement s guidance; or 93

94 we issue a report in the public interest Accountability Act 2014; or we make a written recommendation to Audit and Accountability Act We have nothing to report in these respects. We certify that we have completed the audit of the accounts of Mid Essex Hospital Services NHS Trust in accordance with Accountability Act 2014 and the Code of Audit Practice. Zoe Thompson Appointed Auditor Ipswich, UK 01 June 2017 registered in England and Wales (with registered number OC305127). 94

95 Mid Essex Hospital Services NHS Trust Annual Accounts for the period 1 April 2016 to 31 March 2017 Statement of Comprehensive Income for year ended 31 March 2017 adjusted for the following:- The revenue cost of bringing PFI assets onto the balance sheet (due to the introduction of International Financial Reporting Standards (IFRS) accounting in 2009/10) - NHS Trusts Treasury measuring Departmental expenditure. Therefore, the incremental revenue expenditure resulting from the application of IFRS to PFI, which has no cash impact and is not chargeable for overall budgeting purposes, should be reported as a technical adjustment. This additional cost is not considered part of the organisation s operating position. An impairment charge and the reversal of impairment charge is not considered part of the Trust s operating position. The impact of donations is eliminated for reporting purposes. The notes on pages 99 to 132 form part of this account. 95

96 Statement of Financial Position as at 31 March 2017 The notes on pages 99 to 132 form part of this account. signed on its behalf by Chief Executive: Date: 31 May

97 Statement of Changes in Taxpayers Equity For the year ending 31 March 2017 Information on reserves 1 Public dividend capital assets over liabilities. Additional PDC may also be issued to Trusts by the Department of Health. Health as the public dividend capital dividend. 2 Retained earnings reserve 3 Revaluation Reserve Increases in asset values arising from revaluations are recognised in the revaluation reserve, except where, and to the extent that, they reverse impairments previously recognised in operating expenses, in which case they are recognised in operating income. Subsequent downward movements in asset valuations are charged to the revaluation reserve to the extent that a previous gain was recognised unless the downward movement represents a clear 97

98 98 Statement of Cash Flows for the Year ended 31 March 2017

99 NOTES TO THE ACCOUNTS 1. Accounting Policies meet the accounting requirements of the Department of Health Group Accounting Manual, been prepared in accordance with the DH Group Accounting Manual issued by the Department of Health. The accounting policies contained in that manual follow International Financial Reporting Standards to the extent that they are meaningful and appropriate to the NHS, as determined by HM Treasury, which is advised by the Financial Reporting Advisory Board. Where the Group Accounting Manual permits a choice of accounting policy, the accounting policy which is judged to be most appropriate to the particular circumstances of the Trust for the purpose of giving a true and fair view has been selected. The particular policies adopted by the Trust are described below. They have been applied consistently in dealing with items considered material in relation to the accounts. 1.1 Accounting convention for the revaluation of property, plant and equipment, intangible assets, inventories and certain has considered the principle of Going Concern and has concluded that there are material about it s ability to continue as a going concern. Nevertheless, the going concern basis remains support from the Department of Health is available so that the Trust can continue to deliver the full range of mandatory services for the foreseeable future. The Trust is working with its Sustainability and Transformation Plan partners across Mid and 1.2 Critical accounting judgements and key sources of estimation uncertainty In the application of the NHS Trust s accounting policies, management is required to make judgements, estimates and assumptions about the carrying amounts of assets and liabilities that are not readily apparent from other sources. The estimates and associated assumptions are based on historical experience and other factors that are considered to be relevant and are outlined in the notes as follows:- 99

100 Provisions - note 1.14 Other expenditure - note 1.5 Partially Completed Spells - note 1.3 Actual results may differ from those estimates and the estimates and underlying assumptions are continually reviewed. Revisions to accounting estimates are recognised in the period in which the estimate is revised if the revision affects only that period or in the period of the revision and future periods if the revision affects both current and future periods. 1.3 Revenue Revenue in respect of services provided is recognised when, and to the extent that, performance occurs, and is measured at the fair value of the consideration receivable. The main source of revenue for the Trust is from commissioners for healthcare services. Revenue relating to patient care spells that are part-completed at the year end are apportioned across expected total length of stay/costs incurred to date compared to total expected costs. income is deferred. The NHS Trust receives income under the NHS Injury Cost Recovery Scheme, designed to reclaim the cost of treating injured individuals to whom personal injury compensation has subsequently been paid e.g. by an insurer. The Trust recognises the income when it receives individual has lodged a compensation claim. The income is measured at the agreed tariff for the treatments provided to the injured individual, less a provision for unsuccessful compensation claims and doubtful debts. Salaries, wages and employment-related payments are recognised in the period in which the service is received from employees. The cost of leave earned but not taken by employees at permitted to carry forward leave into the following period. Past and present employees are covered by the provisions of the NHS Pension Schemes. Practices and other bodies, allowed under the direction of the Secretary of State in England and Wales. The schemes are not designed to be run in a way that would enable NHS bodies to 100

101 identify their share of the underlying scheme assets and liabilities. Therefore, the schemes are participating in a scheme is taken as equal to the contributions payable to the scheme for the accounting period. For early retirements other than those due to ill health the additional pension liabilities are not funded by the scheme. The full amount of the liability for the additional costs is charged to expenditure at the time the Trust commits itself to the retirement, regardless of the method of payment. The schemes are subject to a full actuarial valuation every four years and an accounting valuation every year. 1.5 Other expenses Other operating expenses are recognised when, and to the extent that, the goods or services have been received. They are measured at the fair value of the consideration payable. 1.6 Property, plant and equipment Recognition Property, plant and equipment is capitalised if: it is held for use in delivering services or for administrative purposes; to the Trust; the cost of the item can be measured reliably; and either the item cost at least 5,000; or Collectively, a number of items have a total cost of at least 5,000 and individually have a cost of more than 250, where the assets are functionally interdependent, they had broadly simultaneous purchase dates, are anticipated to have simultaneous disposal dates and are under single managerial control. different asset lives, the components are treated as separate assets and depreciated over their own useful economic lives. Valuation All property, plant and equipment are measured initially at cost, representing the cost directly attributable to acquiring or constructing the asset and bringing it to the location and condition necessary for it to be capable of operating in the manner intended by management. Assets that are held for their service potential and are in use are measured subsequently at their current value in existing use. Assets that were most recently held for their service potential but are 101

102 surplus are measured at fair value where there are no restrictions preventing access to the market at the reporting date. that carrying amounts are not materially different from those that would be determined at the end of the reporting period. Current values in existing use are determined as follows: Specialised buildings depreciated replacement cost, modern equivalent asset basis. HM Treasury has adopted a standard approach to depreciated replacement cost valuations based on modern equivalent assets and, where it would meet the location requirements of the service being provided, an alternative site can be valued. Properties in the course of construction for service or administration purposes are carried at cost, less any impairment loss. Cost includes professional fees and, where capitalised in accordance with IAS 23, borrowing costs. Assets are revalued and depreciation commences when they are brought into use. cost, as assessed by indexation and depreciation of historic cost. From 1 April 2008 indexation ceased and the carrying value of existing assets at that date were written off over depreciated historic cost. From 1 April 2012, plant & machinery and information technology equipment will be independently valued every three years (or otherwise if conditions exist that denote material changes of current value). The last valuation was carried out on 31st March An increase arising on revaluation is taken to the revaluation reserve except when it reverses an impairment for the same asset previously recognised in expenditure, in which case it is credited to expenditure to the extent of the decrease previously charged there. A revaluation decrease that does not result from a loss of economic value or service potential is recognised as an impairment charged to the revaluation reserve to the extent that there is a balance on the reserve for the asset and, thereafter, to expenditure. Impairment losses that arise from a clear in the revaluation reserve are reported as other comprehensive income in the Statement of Comprehensive Income. Subsequent expenditure attributable cost is capitalised. Where subsequent expenditure restores the asset to its original is written-out and charged to operating expenses. 102

103 1.7 Intangible assets Recognition Intangible assets are non-monetary assets without physical substance, which are capable of sale separately from the rest of the Trust s business or which arise from contractual or other to, or service potential be provided to, the Trust; where the cost of the asset can be measured reliably, and where the cost is at least Intangible assets acquired separately are initially recognised at cost. Software that is integral to the operation of hardware, for example an operating system, is capitalised as part of the relevant item of property, plant and equipment. Software that is not integral to the operation of hardware, for example application software, is capitalised as an intangible asset. Expenditure on research is not capitalised: it is recognised as an operating expense in the period in which it is incurred. Internally-generated assets are recognised if, and only if, all of the following have been demonstrated: the technical feasibility of completing the intangible asset so that it will be available for use; the intention to complete the intangible asset and use it; the ability to sell or use the intangible asset; potential; intangible asset and sell or use it; and the ability to measure reliably the expenditure attributable to the intangible asset during its development. Measurement The amount initially recognised for internally-generated intangible assets is the sum of the expenditure incurred from the date when the criteria above are initially met. Where no internally-generated intangible asset can be recognised, the expenditure is recognised in the period in which it is incurred. Following initial recognition, intangible assets are carried at current value in existing use by reference to an active market, or, where no active market exists, at the lower of amortised replacement cost (modern equivalent assets basis) and value in use where the asset is income of increases in development costs and technological advances. 1.8 Depreciation, amortisation and impairments Freehold land, assets under construction or development, and assets held for sale are not depreciated/amortised. 103

104 Otherwise, depreciation or amortisation is charged to write off the costs or valuation of property, plant and equipment and intangible non-current assets, less any residual value, on a straight line basis over their estimated useful lives. The estimated useful life of an asset is the period itself. Estimated useful lives and residual values are reviewed each year end, with the effect depreciated over the shorter of the lease term and the estimated useful lives. property, plant and equipment or intangible non-current assets have suffered an impairment loss. If there is indication of such an impairment, the recoverable amount of the asset is estimated to determine whether there has been a loss and, if so, its amount. Intangible assets A revaluation decrease that does not result from a loss of economic value or service potential is recognised as an impairment charged to the revaluation reserve to the extent that there is a balance on the reserve for the asset and, thereafter, to expenditure. Impairment losses impairment loss subsequently reverses, the carrying amount of the asset is increased to the revised estimate of the recoverable amount but capped at the amount that would have been determined had there been no initial impairment loss. The reversal of the impairment loss is credited to expenditure to the extent of the decrease previously charged there and thereafter to the revaluation reserve. 1.9 Donated assets Donated non-current assets are capitalised at current value in existing use, if they will be held for their service potential, or otherwise at value on receipt, with a matching credit to income. They are valued, depreciated and impaired as described above for purchased assets. Gains and losses on revaluations, impairments and sales are treated in the same way as for purchased assets. Deferred income is recognised only where conditions attached to the donation preclude immediate recognition of the gain. The Trust as lessee 104 of the lease, at fair value or, if lower, at the present value of the minimum lease payments, rate of interest on the remaining balance of the liability. Finance charges are recognised in

105 Operating lease payments are recognised as an expense on a straight-line basis over the lease rentals on a straight-line basis over the lease term. Contingent rentals are recognised as an expense in the period in which they are incurred. Where a lease is for land and buildings, the land and building components are separated and 1.11 Private Finance Initiative (PFI) transactions HM Treasury has determined that government bodies shall account for infrastructure PFI schemes where the government body controls the use of the infrastructure and the residual interest in the infrastructure at the end of the arrangement as service concession arrangements, following the principles of the requirements of IFRIC 12. The NHS Trust therefore recognises the PFI asset as an item of property, plant and equipment together with a liability to pay for it. The services received under the contract are recorded as operating expenses. The annual unitary payment is separated into the following component parts, using appropriate estimation techniques where necessary: a. Payment for the fair value of services received; b. c. Payment for the replacement of components of the asset during the contract lifecycle replacement. Services received The fair value of services received in the year is recorded under the relevant expenditure headings within operating expenses PFI Asset The PFI assets are recognised as property, plant and equipment, when they come into use. The assets are measured initially at fair value or, if lower, at the present value of the minimum lease payments, in accordance with the principles of IAS 17. Subsequently, the assets are measured at current value in existing use. PFI liability A PFI liability is recognised at the same time as the PFI assets are recognised. It is measured initially at the same amount as the initial value of the PFI assets and is subsequently measured opening lease liability for the period, and is charged to Finance Costs within the Statement of Comprehensive Income. 105

106 An element of the annual unitary payment increase due to cumulative indexation is allocated to payments, but is instead treated as contingent rent and is expensed as incurred. In substance, Lifecycle replacement Components of the asset replaced by the operator during the contract ( lifecycle replacement ) are capitalised where they meet the Trust s criteria for capital expenditure. They are capitalised at the time they are provided by the operator and are measured initially at their fair value. The element of the annual unitary payment allocated to lifecycle replacement is pre-determined for each year of the contract from the operator s planned programme of lifecycle replacement. Where the lifecycle component is provided earlier or later than expected, a short-term accrual or prepayment is recognised respectively. Where the fair value of the lifecycle component is less than the amount determined in the contract, the difference is recognised as an expense when the replacement is provided. If the fair value is greater than the amount determined in the contract, the difference is treated as a free asset and a deferred income balance is recognised. The deferred income is released to operating income over the shorter of the remaining contract period or the useful economic life of the replacement component. Assets contributed by the NHS Trust to the operator for use in the scheme Assets contributed for use in the scheme continue to be recognised as items of property, plant and equipment in the NHS Trust s Statement of Financial Position. Other assets contributed by the NHS Trust to the operator Assets contributed (e.g. cash payments, surplus property) by the NHS Trust to the operator before the asset is brought into use, which are intended to defray the operator s capital costs, are recognised initially as prepayments during the construction phase of the contract. Subsequently, when the asset is made available to the NHS Trust, the prepayment is treated as liability. On initial recognition of the asset, an equivalent deferred income balance is recognised, representing the future service potential to be received by the NHS Trust through the asset being made available to third party users. 106

107 The balance is subsequently released to operating income over the life of the concession on a straight-line basis Inventories cost formula. This is considered to be a reasonable approximation to fair value due to the high turnover of stocks Cash and cash equivalents notice of not more than 24 hours. Cash equivalents are investments that mature in 3 months or less from the date of acquisition and that are readily convertible to known amounts of cash with In the Statement of Cash Flows, cash and cash equivalents are shown net of bank overdrafts that are repayable on demand and that form an integral part of the NHS Trust s cash management Provisions Provisions are recognised when the Trust has a present legal or constructive obligation as a result of a past event, it is probable that the Trust will be required to settle the obligation, and a reliable estimate can be made of the amount of the obligation. The amount recognised as a provision is the best estimate of the expenditure required to settle the obligation at the end of the reporting period, taking into account the risks and uncertainties. Where a provision is Early retirement provisions are discounted using HM Treasury s pension discount rate of positive 0.24% ( : positive 1.37%) in real terms. All other provisions are subject to three Financial Position date: to and including 5 years over 5 years up to and including 10 years over 10 years. All percentages are in real terms. recovered from a third party, the receivable is recognised as an asset if it is virtually certain that 107

108 reimbursements will be received and the amount of the receivable can be measured reliably Clinical negligence costs for all clinical negligence cases the legal liability remains with the NHS Trust. The total value of Non-clinical risk pooling Parties Scheme. Both are risk pooling schemes under which the NHS Trust pays an annual claims arising. The annual membership contributions, and any excesses payable in respect of particular claims are charged to operating expenses as and when they become due Carbon Reduction Commitment Scheme (CRC) CRC and similar allowances are accounted for as government grant funded intangible assets if they are not expected to be realised within twelve months, and otherwise as other current assets. They are valued at open market value. As the NHS Trust makes emissions, a provision is recognised with an offsetting transfer from deferred income. The provision is settled on surrender of the allowances. The asset, provision and deferred income amounts are valued at fair value at the end of the reporting period Contingencies A contingent liability is a possible obligation that arises from past events and whose existence events not wholly within the control of the NHS Trust, or a present obligation that is not recognised because it is not probable that a payment will be required to settle the obligation or disclosed unless the possibility of a payment is remote. A contingent asset is a possible asset that arises from past events and whose existence will Where the time value of money is material, contingencies are disclosed at their present value. 108

109 1.19 Financial assets contract or, in the case of trade receivables, when the goods or services have been delivered. Financial assets are derecognised when the contractual rights have expired or the asset has been transferred. initial recognition. Loans and receivables which are not quoted in an active market. After initial recognition, they are measured at amortised cost using the effective interest method, less any impairment. Interest is recognised using the effective interest method. The effective interest rate is the rate that exactly discounts estimated future cash receipts and impairment losses recognised if there is objective evidence of impairment as a result of one or more events that occurred after the initial recognition of the asset and that have an impact on 1.20 Financial liabilities trade payables, when the goods or services have been received. Financial liabilities are derecognised when the liability has been discharged, that is, the liability has been paid or has expired. liabilities are initially recognised at fair value Value Added Tax Most of the activities of the Trust are outside the scope of VAT and, in general, output tax does not apply and input tax on purchases is not recoverable. Irrecoverable VAT is charged to the Where output tax is charged or input VAT is recoverable, the amounts are stated net of VAT. 109

110 1.22 Third party assets Assets belonging to third parties (such as money held on behalf of patients) are not recognised are given in Note 35 to the accounts Public Dividend Capital (PDC) and PDC dividend Public dividend capital represents taxpayers equity in the NHS Trust. At any time the Secretary of State can issue new PDC to, and require repayments of PDC from, the Trust. PDC is recorded at the value received. As PDC is issued under legislation rather than under contract, it Department of Health as public dividend capital dividend. The charge is calculated at the real rate set by HM Treasury (currently 3.5%) on the average carrying amount of all assets less liabilities (except for donated assets and cash balances with the Government Banking Service). The average carrying amount of assets is calculated as a simple average of opening and closing relevant net assets. In accordance with the requirements laid down by the Department of Health (as the issuer of PDC), the dividend for the year is calculated on the actual average relevant net assets as set out in the pre-audit version of the annual accounts. The dividend thus calculated is not revised should any adjustment to net assets occur as a result the audit of the annual accounts. agreed funds for the health service or passed legislation. By their nature they are items that ideally should not arise. They are therefore subject to special control procedures compared with the generality of payments. They are divided into different categories, which govern the way that individual cases are handled. an accruals basis, including losses which would have been made good through insurance cover had the NHS Trust not been bearing its own risks (with insurance premiums then being included as normal revenue expenditure) Research and Development 110 Research and development expenditure is charged against income in the year in which it is be revalued on the basis of current cost. The amortisation is calculated on the same basis as depreciation, on a quarterly basis.

111 1.26 Accounting Standards that have been issued but have not yet been adopted The HM Treasury FReM does not require the following Standards and Interpretations to be applied in These standards are still subject to HM Treasury FReM interpretation, with IFRS 9 and IFRS 15 being for implementation in , and the government implementation date for IFRS 16 still subject to HM Treasury consideration. IFRS 9 Financial Instruments Application required for accounting periods beginning on or after 1 January 2018, but not yet adopted by the FReM: early adoption is not therefore permitted; IFRS 15 Revenue from Contracts with Customers - Application required for accounting periods beginning on or after 1 January 2018, but not yet adopted by the FReM: early adoption is not therefore permitted; January 2019, but not yet adopted by the FReM: early adoption is not therefore permitted. 2. Operating segments These accounts have been prepared on the basis that there is one segment. This decision has been taken because, whilst information is provided to the Trust Board as supplementary information, major strategic decisions are taken following review of the overall position of the Trust. 3. Income generation activities The Trust does not underatke any income generation activities where the full cost exceeds 1m. 4. Revenue from patient care activities Injury cost recovery income is subject to a provision for impairment of receivables of 18.1% to 111

112 5. Other operating revenue 6. Overseas visitors disclosure 7. Operating expenses 112

113 *Services from NHS bodies does not include expenditure which falls into a category below Mid Essex Hospital Services NHS Trust as lessee 9.2. Retirements due to ill-health 113

114 Pension costs Past and present employees are covered by the provisions of the two NHS Pension Schemes. NHS employers, GP practises and other bodies, allowed under the direction of the secretary of State in England and wales. They are 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, participating in each scheme is taken as equal to the contributions payable to that scheme for the accounting period. materially from those that would be determined at the reporting date by a formal actuarial valuation, the FReM requires that the period between formal valuations shall be four years, with approximate assessments in intervening years. An outline of these follows: a) Accounting valuation A valuation of scheme liability is carried out annually by the scheme actuary (currently the Government Actuary s Department) as at the end of the reporting period. This utilises an actuarial assessment for the previous accounting period in conjunction with updated at 31 March 2017, is based on valuation data as 31 March 2016, updated to 31 March 2017 with summary global member and accounting data. In undertaking this actuarial assessment, the methodology prescribed in IAS 19, relevant FReM interpretations, and the discount rate prescribed by HM Treasury have also been used. The latest assessment of the liabilities of the scheme is contained in the scheme actuary report, which forms part of the annual NHS Pension Scheme (England and Wales) Pension Accounts. These accounts can be viewed on the NHS Pensions website and are published annually. b) Full actuarial (funding) valuation due under the schemes (taking into account their recent demographic experience), and to recommend contribution rates payable by employees and employers. The last published actuarial valuation undertaken for the NHS Pension Scheme was completed for the year ending 31 March The Scheme Regulations allow for the level of contribution rates to be changed by the Secretary of State for Health, with the consent of HM Treasury, and consideration of the advice of the Scheme Actuary and appropriate employee and employer representatives as deemed appropriate.

115 The next actuarial valuation is to be carried out as at 31 March This will set the employer contribution rate payable from April 2019 and will consider the cost of the Scheme relative to the employer cost cap. There are provisions in the Public Service Pension Act 2013 to adjust or contribution rates will be determined by the Secretary of State for Health after consultation with the relevant stakeholders. 10. Better payment practice code Measure of compliance The Better Payment Practice Code requires the NHS body to aim to pay all valid invoices by the due date or within 30 days of receipt of a valid invoice, whichever is later. 11. Investment Revenue 115

116 13. Finance costs 14. Auditor disclosures Other auditor remuneration years or Property, plant and equipment 116

117 Revaluation Reserve Balance for Property, Plant & Equipment Additions to Assets Under Construction in Property, plant and equipment prior-year (cont). Property, plant and equipment During the year donations made by Mid Essex Hospital Services Charitable Fund were utilised to purchase a number of items of medical equipment and make improvements to clinical areas. Of the totals as at 31 March 2017 there were no land and buildings valued at open market value. 117

118 during , therefore land and buildings will be valued in line with our 3 year valuation policy in Intangible non-current assets Intangible non-current assets Intangible non-current assets prior year The Trust had no intangible assets during

119 17. Analysis of impairments and reversals 17.1 Analysis of impairments and reversals recognised in The impairment relates to the termination of a leased property following changes to service provision Analysis of impairments and reversals recognised in Commitments Capital commitments statements: 119

120 19. Inventories 20. Trade and other receivables Trade and other receivables The great majority of trade is with Clinical Commissioning Groups and NHS England. As NHS England and Clinical Commissioning Groups are funded by Government to buy NHS patient care services, no credit scoring of them is considered necessary Receivables past their due date but not impaired 120

121 20.3. Provision for impairment of receivables of recovery ( k). 717k relates to the collection of debt following the emergency admission of an overseas patient. Other impairments relate to individuals where there has been 21. Cash and Cash Equivalents 22. Trade and other payables 121

122 Other payables include 2,412k outstanding pension contributions at 31 March 2017 ( 2,294k at 31 March 2016). 23. Borrowings Borrowings / Loans - repayment of principal falling due in: 24. Deferred income 25. Finance lease obligations as lessee The Trust leases a number of items of equipment. The lease terms of renewal and purchase options vary with the individual leases. 122

123 26. Provisions Early Departure costs are calculated in accordance with NHS Pensions Scheme rules based on age, salaries and length of service of employees effected. and public liability insurance. provisions in relation to the allowance payable to the government for CO2 emissions during

124 27. Contingencies Authority,(22 cases in ) and (19 cases in ). The liabilities are based on the excess value of the claim against the likelihood of success. The Trust has a S106 agreement with Essex County Council relating to infrastructure works to be carried out in order to conclude planning obligations. Staff Accommodation Scheme During , the Trust concluded contracts under the Private Finance Initiative (PFI) accommodation including the management of the accommodation and other related services, i.e. cleaning, estates, etc. The PFI scheme was approved by the NHS Executive and HM Treasury. Following an assessment of the scheme, in the light of HM Treasury s Technical Note 1 (revised) How to account for PFI transactions, in the Trust s opinion the scheme was accounted for off of the Statement of Financial Position. Given the change to IFRS this has now been reconsidered under IFRIC 12 and in the Trust s opinion the scheme should now be accounted for on the Statement of Financial Position. do not require the property there is a priority list of alternative public sector workers to whom the accommodation may be offered. The accommodation was valued on 31 March 2015 at 10.4 million. The only payment that the Trust makes under the scheme is for those on-call rooms and medical student rooms that the Trust wishes to rent. All rental income is paid directly to the operator, Swan Housing Association. 124 end of the 35 year initial concession period, which commenced in when the property construction was completed.

125 In the event of Operator default, the Trust has the option to re-tender the contract or pay a termination sum determined by an expert valuer. Hospital facilities scheme During , the Trust concluded contracts under the Private Finance Initiative (PFI) with provision of related services, i.e. estates maintenance, etc. The PFI scheme was approved by East of England Strategic Health Authority, the Department of Health and HM Treasury. Following an assessment of the scheme, in the light of HM Treasury s Technical Note 1 (revised) How to account for PFI transactions, in the Trust s opinion the scheme was to be accounted for off balance sheet. However, HM Treasury determined that government bodies shall account for infrastructure PFI schemes where the government body controls the use of the infrastructure and the residual interest in the infrastructure at the end of the arrangement as service concession arrangements, following the principles of the requirements of IFRIC 12. The Trust therefore recognised the PFI asset as an item of property, plant and equipment together with a liability to pay for it when it was handed over in August The services received under the contract are recorded as operating expenses. The Trust makes monthly repayments to reduce the liability and for services received. Braintree Community Hospital Following the re-organisation of NHS organisations, the PFI scheme operated by Mid Essex was considered to be shown on balance sheet. The Trust therefore recognised an asset as an item of property, plant and equipment together with a liability. The services received under the contract are recorded as an operating expense. The Trust makes monthly repayments to reduce the liability and for services received. The information below is required by the Department of Heath for inclusion in national statutory accounts. 125

126 The estimated annual payments in future years are expected to be materially different from this is: 29. Impact of IFRS treatment 126

127 30. Financial Instruments Financial risk management have had during the period in creating or changing the risks a body faces in undertaking its activities. Because of the continuing service provider relationship that the Trust has with Clinical generated by day-to-day operational activities rather than being held to change the risks facing the NHS Trust in undertaking its activities. by the board of directors. Trust treasury activity is subject to review by the Trust s internal auditors. Currency risk The Trust is principally a domestic organisation with the great majority of transactions, assets and liabilities being in the UK and sterling based. The Trust has no overseas operations. The Interest rate risk by NHS Improvement. The borrowings are for 1 25 years, in line with the life of the associated amortised cost, the repayments to the PFI operators are indexed by RPI and so the Trust is when it falls due. Credit risk Because the majority of the Trust s revenue comes from contracts with other public sector bodies, the Trust has low exposure to credit risk. The maximum exposures as at 31 March 2017 are in receivables from customers, as disclosed in note 20.1, trade and other receivables. 127

128 Liquidity risk The Trust s operating costs are incurred under contracts with other public sector bodies, expenditure from funds obtained within its prudential borrowing limit. The Trust is not, therefore, Financial Assets 31. Events after the end of the reporting period events take place before this date provided information about conditions existed at 31 March There have been no subsequent events. 128

129 32. Related party transactions During the year none of the Department of Health Ministers, Trust board members or members of the key management staff, or parties related to any of them, has undertaken any transactions with Mid Essex Hospital Services NHS Trust. The Department of Health is regarded as a related party. During the year, and during the prior with entities for which the Department is regarded as the parent Department. For example transactions have been with: During : Barking And Dagenham CCG Basildon And Brentwood CCG Castle Point And Rochford CCG East And North Hertfordshire CCG Havering CCG Ipswich And East Suffolk CCG Mid Essex CCG North East Essex CCG Redbridge CCG Southend CCG Thurrock CCG West Essex CCG East Midlands Specialised Commissioning Hub East of England Specialised Commissioning Hub Barts Health NHS Trust Department of Health Health Education England Southend University Hospitals NHS Foundation Trust NHS Blood and Transplant During : Barking And Dagenham CCG Basildon And Brentwood CCG Castle Point And Rochford CCG East And North Hertfordshire CCG Havering CCG Mid Essex CCG North East Essex CCG Redbridge CCG Southend CCG Thurrock CCG West Essex CCG 129

130 Central Midlands Commissioning Hub East Commissioning Hub Barts Health NHS Trust Essex County Council Department of Health Health Education England Southend University Hospitals NHS Foundation Trust NHS Blood and Transplant In addition, the Trust has had a number of transactions with other government departments and other central and local government bodies during and For example transactions have been with: HM Revenue & Customs NHS Pension Scheme (Own staff employers and employees contributions) National Insurance Fund Chelmsford City Council The Trust has also received revenue and capital payments from Mid Essex Hospital Charitable Fund, see note 5, for which the Trust is the corporate Trustee. The audited accounts of the Charitable Fund are included in a separate annual report. An administration fee is charged to the Charitable Fund 76k ( 78k ). The total number of losses cases in and their total value was as follows: 130

131 34. Financial performance targets which the targets were set for those years Breakeven performance * Due to the introduction of International Financial Reporting Standards (IFRS) accounting guidance issued by HM Treasury measuring Departmental expenditure. Therefore, the incremental revenue expenditure resulting from the application of IFRS to IFRIC 12 schemes (which would include PFI schemes), which has no cash impact and is not chargeable for overall budgeting purposes, is excluded when measuring Breakeven performance. Other adjustments are made in respect of accounting policy changes (impairments and the removal of the donated asset and government grant reserves) to maintain comparability year to year. not been restated to IFRS and remain on a UK GAAP basis Capital cost absorption rate The dividend payable on public dividend capital is based on the actual (rather than forecast) average relevant net assets based on the pre audited accounts and therefore the actual capital cost absorption rate is automatically 3.5%. 131

132 34.4. Capital resource limit The Trust is given a capital resource limit which it is not permitted to exceed. 35. Third party assets The Trust held cash and cash equivalents which relate to monies held by the Trust on behalf reported in the accounts. 132

133 133

134 134 Notes

135 Notes 135

136 At our best, we are a...