nhs bradford district care trust: annual report & accounts 2012/13
DESCRIPTION
Our annual reports review a year in the life of our Trust, celebrate the achievements of our staff and give an overview of our plans for the coming year.TRANSCRIPT
You and Your Care
Annual Report & Accounts2012/13
2
Foreword by Chair and Chief Executive p3
About the Trust p4-9
Directors’ Report:
Quality p10-17
Patient Experience p18-25
Relationships p26-37
Value for Money p38-43
Progress with our Foundation Trust Application p44
Sustainability Report p45-47
Annual Governance Statement p48-55
2012/13 Financial Review p56-58
Summary of Financial Statements p59-64
Remuneration Report p65-69
Auditor’s Statement p70-71
Appendix 1: New Operational Structures Across BDCT Services p72
Appendix 2: Board Biographies p73-78
Appendix 3: Register of Board Members’ Interests p79-80
Appendix 4: Commentary on Key Performance Indicators and Glossary of terms p81
Appendix 5: Feedback on Annual Report p82
Contents
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We are proud to report on the work of our staff during this period given the groundwork we started in the previous year to embed a strategic direction around our vision wheel – quality, patient experience, value for money and relationships – and this has helped maintain a focus for our many different services.
Added to that, our programme to enhance our understanding of quality and safety issues – through our Taking Quality Forward programme – based upon the original enquiry undertaken by Robert Francis QC, has helped us to introduce some early actions leading to improvements for patients, service users and carers.
We have also introduced changes to the way our services are structured – now aligned to locality structures based around GP practices, refl ecting the new commissioning landscape with Clinical Commissioning Groups. And we have embarked upon a far reaching programme of transformational change that is affecting both frontline staff and back offi ce functions that aims to deliver services very differently in the future. Whether this is around our agile working programme, our stepped-care model for supporting people when being admitted to or leaving hospital or our acute care pathway in mental health where our doctors now ‘follow the patient’ during admittance to
a ward or support in the community, the changes being experienced by our staff are signifi cant.
On behalf of the whole Board, we would like to pay tribute to all our staff in the way they have kept focused on delivering high quality care set within such a changing environment. It is testament to them that we have seen positive feedback from our regulators, service users and carers on how we continue to create a positive patient experience.
In closing, we would like to thank those Board members that have helped provide leadership to the organisation during the year who have retired or moved on to do other things in their lives – Nick Morris (Director of Performance, Planning and Information), Councillors Jan Smithies and Dale Smith (Non Executive Directors representing Bradford Council), and Richard Pattinson (Board Special Adviser). Each of them made a signifi cant contribution to the organisation and continue to be our supporters.
Our aim is to continue to provide high quality services to our diverse, local communities and we look forward to the opportunity of using the Foundation Trust (FT) model to create an even stronger sense of purpose and accountability with our members and future Governors.
Simon LargeChief Executive
Michael SmithActing Chair
Foreword by Chair and Chief Executive
The Trust’s activity during 2012/13 has taken place against a backdrop of signifi cant change across the health service, particularly through two key developments: the Government’s reforms set out in the Health and Social Care 2012 Act; and the publication of the report into the public enquiry at Mid Staffordshire NHS Foundation Trust (‘the Francis Report’).
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Based across Bradford, Airedale and Craven, Bradford District Care Trust (BDCT) offers a wide range of health and social care services close to people’s homes.
We have been the main provider of mental health and learning disability services to local people since 2002 and, on 1 April 2011, the majority of NHS Bradford and Airedale’s community health services transferred to the Trust as part of the national Transforming Community Services (TCS) initiative. As a consequence, services such as district nursing, health visiting and dental services are now provided by BDCT. During the course of the year, we have integrated our mental health and community teams around new locality structures. This has helped to increase opportunities for strengthening care pathways and improving outcomes for local people.
Trust VisionOur vision is:
To provide the best possible care for the people of Bradford, Airedale and Craven and to be recognised as one of the country’s leading providers of integrated community healthcare services.
In support of this vision we recognise the need to focus on service user, patient and staff satisfaction and have put the statement You and Your Care at the centre of everything we aim to achieve.
Trust ValuesAlongside You and Your Care, we have made a commitment to how the Trust and its staff will behave. This is set out in a set of values developed through a process involving many staff, patients and other stakeholders. The Trust will work hard to promote:
Respect• We value people as individuals, working with them to
achieve their goals
• We treat people with dignity and kindness
• We embrace diversity and celebrate difference
Openness• We encourage and demonstrate honest
communication
• We ensure everyone has a voice
• We are open to change and new ways of working
Improvement• We maximize use of resources to deliver best value
• We adopt a ‘right fi rst time’ approach and learn from our mistakes, acting promptly to put them right
• We encourage accepting personal, individual responsibility at all levels, challenging each other to fi nd better ways of doing things
Excellence• We provide high quality, safe and effi cient services
• We are customer focused and deliver on our promises
• We use and develop the expertise of our staff to provide the best possible service user and carer experience
Together• We work best through teamwork celebrating our
successes together
• Users and carers are part of our team
• We work well with our partners for the benefi t of the communities we serve
We believe that our values, together with You and Your Care, captures the underpinning values of the NHS as enshrined in the NHS Constitution and we work to promote these with all our staff.
About the Trust
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PATI
ENT
EXPERIENCE
QUALITY
VALU
E FOR MONEY
RELATIO
NSHIP
S
Pers
onal
“You
giv
e m
e ch
oice
w
hen
resp
ondi
ng
to m
y ne
eds.
”
Safe
“I fe
el su
pported
and se
cure
in th
e
care
you g
ive m
e.”
Effective
“You use the latest
research so that I get
the best care.”
Involving
“You share your plans
with me and work
with my community.”
Integrated
“You bring the
experts together.”
Clear
“I’m given the latest
information to help
me m
ake a decision.”
Right Place
“My care is always
provided in the most
appropriate place to
meet my needs.”
Right Skil
ls
“I am
confiden
t that
the p
rofe
ssionals
I
see h
ave t
he skil
ls to
meet m
y nee
ds.”
Righ
t Fi
rst
Tim
e“M
y ne
eds
are
met
wit
hout
any
unn
eces
sary
dupl
icat
es, t
his
mus
t
cost
less
.”
Local
“ I can get the
care I need
close to home.”
Responsive
“ My records are shared
quickly and safely with the
people who need them
.”
Easy Access“ I understand how and
where I can get the support
I need and I don’t have
to explain myself to lots
of different people.”
RESPECT OPENNESS I MPROVEMENT EXCELLE
NCE
TO
GET
HER
You and Your Care
Vision WheelWe have four key aims to help deliver this vision illustrated through our Vision Wheel (see below) which are:
• To provide a top quality service
• To achieve excellence in patient experience
• To ensure great relationships between the Trust, its staff and stakeholders
• To deliver excellent value for money
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Community services:• District nursing care: a range of nursing procedures
working with family doctors, care homes and local hospitals. Teams also provide an out-of-hours service and a specialist service for tissue viability and continence care.
• End of life and palliative care: supporting those with a terminal condition, aimed at improving their quality of life.
• Long-term conditions: Community matrons and case managers supporting people who have had one or more long-term condition and who have had high attendance at accident and emergency departments, admission to hospital or who are at risk of admission to hospital.
• Health visiting: supporting families and children aged 0-5 years or until the child enters school and additional support for those experiencing post natal depression or requiring behavioural support.
• Family nurse partnership: working with vulnerable fi rst time teenage parents and their children.
• School nursing: working with schools and local communities to support children of school age, their families and teachers.
• Speech and language therapy: helping children and adults who experience speech, language, communication or swallowing diffi culties.
• Podiatry: providing a wide range of specialist footcare services operating out of 39 clinical locations across Bradford.
• Dental services: providing a scheduled dental service with a particular emphasis on people with special needs and hard-to-reach groups, such as asylum seekers, homeless and substance misuse groups. The service also provides an unscheduled out-of-hours dental service.
Mental health services• Adult Mental Health (AMH): providing a
comprehensive range of services for adults of a working age, based on individual need including:
o In-patient supporto intensive home treatment to facilitate the early
discharge from hospitalo community support provided by fi ve locality
based teamso an assertive outreach team aimed at service users
with long term conditions with complex conditions.
The AMH group also provides psychological therapy, and a number of specialist community-based services such as Health on the Streets, Health of Men and Working Women’s service.
• Older People’s Mental Health (OPMH): supporting people with mental health problems as a result of issues relating to later life such as dementia, through both in-patient and community services.
• Children and Adolescent Mental Health Services (CAMHS): working with young people up to the age of 18 who are experiencing emotional and psychological problems. The service focuses on a family centred approach working closely with families and carers.
• Substance Misuse Services: providing a comprehensive assessment and access to detoxifi cation programmes for those with a drug or alcohol dependence within an in-patient or home setting.
• Low Secure Services: providing a regionally commissioned specialist service for the assessment, care, treatment and rehabilitation of men who have committed a criminal offence.
Learning disability services• In-patient and assessment and treatment service:
providing a 6 bed assessment and treatment facility for learning disabled adults with existing mental health problems who could not reasonably gain access to AMH in-patient care.
• Community based clinical support and health facilitation: comprising of community matrons, health facilitation nurses and behavioural outreach workers who work with other services such as psychologists, speech and language therapists and physiotherapists with service users who struggle to have complex needs met by primary or secondary care services.
Our Services
In 2012/13 we delivered services across three key areas – community health services, mental health services and learning disability services – which are briefl y described below:
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BRADFORDBierley
Odsal
Wyke
Queensbury
Clayton
Denholme Thornton
Eccleshill
Idle
WilsdenOxenhope
CullingworthHardenHaworth
Oakworth
Menston
Burley-in-Wharfedale
RiddlesdenSteeton
Silsden
Cowling
Cononley
Addingham
BoltonAbbey
Barden
Broughton
Rylstone
Hetton
Long Preston
Thorpe
AppletreewickLangcliffe
Clapham Austwick
Thornton-in-Lonsdale
Ribblehead
Horton-in-Ribblesdale Halton Gill
Litton
SHIPLEYBINGLEY
KEIGHLEY
ILKLEY
SKIPTON
GARGRAVE
SETTLE
INGLETON
BENTHAMGRASSINGTON
BUCKDEN
A Strategic Look At Our Services Our services are not provided in isolation but are shaped by a number of factors throughout the year:
• National policy initiatives, best practice guidance and the prevailing economic climate.
• Local current and emerging healthcare challenges, many of which are unique to Bradford, Airedale and Craven’s urban and rural districts, and the consequences on the demand for our services.
• The expectations of the public, patients and partner organisations for high quality services that are available locally.
• A commitment to the Trust’s long term vision for integrated care as captured in the plans of commissioners. (Journey to Integration, October 2011)
In response to the changing commissioning landscape we have re-aligned our operational services to a locality structure based around GP practices so local teams are more aware of local populations and their healthcare needs. A summary of how we are now working differently across our teams is attached at Appendix 1.
Our PartnersWe work closely with a range of partner organisations across the Bradford, Airedale and Craven districts. Our main commissioners during 2012/13 were NHS Airedale, Leeds and Bradford (when the Primary Care Trusts (PCTs) for Bradford and Leeds were clustered), City of Bradford Metropolitan District Council (CBMDC) and NHS North Yorkshire and York.
Three Clinical Commissioning Groups (CCGs) have been established in our area to create a new commissioning landscape for 2013/14. Services will be commissioned through these CCGs for mental health and community services and by CBMDC (for school nursing and substance misuse) and the NHS Commissioning Board (for health visiting, dental and low secure services).
A map of the area covered by our services is shown right:
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We have worked hard at transforming the way care services are delivered. The Transforming Care Programme (TCP) works alongside the wider health and social care economy transformation work with CCGs and other providers. Some of our key operational achievements during the year include:
• In-patient re-design: we have continued to re-model in-patient care for people with mental health problems with the aim of better supporting people in their own home or as close to home as possible.
o Three adult acute in-patient wards at Lynfi eld Mount Hospital have been fully refurbished.
o Our in-patient rehabilitation unit has been relocated from Daisy Bank to Lynfi eld Mount Hospital.
o The public consultation on the transfer of the Psychiatric Intensive Care Unit to our Lynfi eld Mount site was completed and the newly refurbished unit opened in May 2013.
• Redesign of our Adult Mental Health Acute Care pathway (AMHAC): We have implemented the Productive Ward across all our in-patient wards which has had a signifi cant impact on releasing more time to care. Service user feedback is positive about these changes.
o 44 generic/healthcare support workers have undergone training in the new pathway and a wider range of therapies is now on offer.
• Review of adult community services: we are delivering the Calderdale Competency Training Framework to all Health Care Assistants in community nursing teams. The framework is a transformational tool used to improve the way people work in order to deliver safe and effective patient centred care.
o A number of community nursing practice standards have been developed and put in place.
o Patient experience and feedback continues to shape services: for example, our palliative care service has piloted electronic feedback to increase feedback about our service.
• ‘Primary care-centred’ integrated teams: we have changed our management structures to align our services with CCGs and GP practice centred populations.
o We have completed our Craven Centre Community and Westbourne Green Community Hubs, as pilots for estates rationalisation and agile working.
Delivering against our 2012/13 Operational Plan
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Risk managementOur risk management strategy sets out both the collective responsibilities of the Trust Board and its Committees and the individual responsibilities of the Chief Executive, Directors and all levels of staff across the Trust.
Effective risk management is the cornerstone of safety and the Trust embraces an open and learning culture which encourages all staff to report risks, incidents and potential incidents thereby facilitating individuals and the organisation as a whole to learn from such reports. We are one of the highest reporting Trusts in the country, illustrating our open and transparent reporting culture. The overall aim of the strategy is to ensure that high quality health and social care services are delivered to refl ect the safety and well being of those using our services and those working within the organisation.
During 2012/13 we refreshed our risk management strategy (September 2012) and held a Board workshop to defi ne the Board’s risk appetite statement and identify the level of maturity for risk and patient safety processes at Board level (March 2013). The workshop also received a presentation from Catherine Dixon, Chief Executive of the NHS Litigation Authority (NHSLA), about the changes within the NHSLA, its charges and ongoing work relating to risk profi ling.
We use a number of methods to assure ourselves of the risk management arrangements across the Trust including:
• Regular reviews and updates of risk registers by risk owners (therefore ensuring frontline staff are involved) and a regular review of the Trust’s Corporate Risk Register (CRR) by the Executive Management Team (EMT);
• Discussions about higher level risks at the bi-monthly Risk Assurance Group composed of Deputy Director-level staff and chaired by the Chief Executive;
• Consideration of key risks by Board Committees and a bi-annual review of the CRR by the Trust Board; and
• Further embedding of electronic risk registers since their introduction in 2011/12 which enables a greater degree of analysis across departments and teams.
Emergency planningWe understand our staff need to be prepared for major emergency situations, which may involve us and a range of other public and emergency services. As a result, we maintain a major incident plan which is compliant with NHS Emergency Planning Guidance and identifi es roles and responsibilities for key individuals and teams.
The progress achieved within the Trust in 2012/13 around emergency planning has been signifi cant, and is directly attributable to the additional resource secured for an emergency planning and resilience offi cer. However the re-structure of the wider NHS has resulted in slowed progress over the wider West Yorkshire and Humber region and has required major change to the emergency planning, response and resilience framework. 2013/14 should embed and test the changes in structures and the command and control framework.
The key achievements across the Trust during 2012/13 were:
• A full review, revision and approval of our resilience documentation;
• The implementation of the Business Continuity Management System delivering a standardised approach across all services;
• The delivery of a wider validation programme that exercised the newly developed service business continuity plans; and
• Improved partnership working through the Bradford Area Health Resilience Forum which BDCT co-chair.
Quality10
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Quality Statement
We recognise the importance of providing high quality services and that standards are met effi ciently, safely and in a way that maximizes a positive experience for our patients.
Our staff have adopted the following Quality statement:
‘ Everything we do is based upon safe, personal and effective interventions’
• Personal: evidenced through individual choice and effective care plans, demonstrated through the compassion, dignity and respect with which patients and carers are treated.
• Safe: as safe and effective as possible with robust risk management arrangements in place.
• Effective: informed by clinically proven interventions and best practice, measured through national and local metrics.
Quality
12
Quality AccountsEach year we publish our Quality Accounts which sets out our ongoing commitment to the quality of the services that we provide. This public report records how well we have performed against a challenging set of quality measures. The full Quality Accounts document is published in a separate report but a number of selected quality highlights during the year have been included in this report.
Delivering our CQUIN TargetsCommissioning for Innovation and Quality (CQUIN) schemes are a package of quality and improvement goals and targets locally agreed with Commissioners that aim to support Trusts to deliver stretching outcomes related to quality. In 2012/13 we agreed a CQUIN scheme for mental health, learning disabilities and community services with NHS Airedale, Bradford and Leeds, and a CQUIN scheme for low secure services with the Specialist Commissioning Group. The indicators within the CQUIN schemes were based on local and national priorities to refl ect innovation and quality.
The benefi ts from these schemes have included:
• Improved partnership working with our local acute trusts, identifying patients who were at greatest risk of admission to acute and long term care;
• A reduction in re-admissions to acute in-patient care for people with dementia, as a result of better discharge planning arrangements; and
• An increased number of young people requiring treatment for eating disorders and other mental health problems receiving intensive home treatment, so avoiding the need to be admitted to hospital.
Our Response to the Mid Staffordshire Public Enquiry by Robert FrancisProbably the most signifi cant event of the year across the NHS was the publication of the report by Robert Francis QC into the failings at Mid-Staffordshire NHS Foundation Trust.
The earlier independent inquiry, published in February 2010, had been a catalyst for our Board to implement a wide ranging programme aimed at understanding the quality and safety issues affecting patients, carers and staff. This programme – Taking Quality Forward – identifi ed a number of actions around fi ve themes of quality, risk, cultural change, service user engagement and clinical engagement. Two years on, it was shortlisted in the National Health Service Journal awards under the category of Board Leadership.
The fi nal report, published on 6 February 2013, required all NHS organisations to refl ect on its fi ndings and recommendations and to put in place a local response. Towards the end of this fi nancial year the Board reviewed the report with Professor Brian Edwards, a leading expert on the enquiry, and senior managers across the organisation.
Quality
13
Immediate Actions TakenAs well as developing some actions that we will take forward over the next 12-18 months, we implemented some immediate actions in response to the report. For example, we have:
• Adopted the 15 Steps Challenge as a method of assessing the quality of our services. This provides an opportunity for staff and service users to make an assessment of the quality of a specifi c service and is a natural progression to our ongoing improvement work. Feedback information from these challenges is shared on the day, collated and then reported back to managers with recommendations for action and improvement.
• Introduced the Family & Friends Test. We have opted to adopt this important measure at an early stage. The E-feedback system for Community Mental Health Services now includes the question ‘Would you recommend this service to friends and family?’ This question will also be included in the in-patient E-feedback system and used to measure the quality of services provided.
• Made an NHS Change Day Pledge. NHS Change Day on 13 March 2013 challenged NHS organisations to set out a ‘pledge’ which would result in a positive change. We developed the following pledge which supports our response to the Francis report and is published on the Trust website:
– Our Board pledges to ensure 15 Steps Quality Challenge is implemented across community services and the results are presented on our website.
– We pledge to invite all individuals who make a complaint about our services to be involved in one of our 15 Steps Quality Challenge panels.
In addition, we have engaged our workforce in other initiatives to highlight the importance of learning from the Mid Staffordshire experience including debates at our governance groups, service user/carer groups and our clinical and safety forum. We will continue to engage our staff and the wider public through our bespoke email address – [email protected] – to enable comments, questions and suggestions to be raised and followed up with senior managers.
Medium Term GoalsOver the course of the next 12 months we will be building on these actions with further work including:
• Board member-led events reinforcing our Trust values in the light of the Francis report
• A review of the quality indicators we use at Board meetings
• Further learning events for staff around incidents and complaints, aimed at improving services
• Preparatory work with our Governors to ensure quality is a real focus in their work
Professional Strategies to Support QualityDuring the year we have engaged our clinicians in developing a series of professional strategies that refl ect our vision and values and provide a framework for how we support patients. The Board has approved three strategies, which have all had signifi cant input from our staff:
• A Nursing Strategy, developed in consultation with our nursing workforce and service users that highlights the importance of nurses’ accountability for their practice and our collective commitment to delivering high quality, evidenced-based care;
• An Allied Health Professional (AHP) Strategy, a fi rst for our community and mental health AHPs that puts in place a positive patient experience based around delivering person-centred care in partnership with service users and carers; and
• A Psychological Therapies Strategy, which delivers excellent talking treatments through our psychological therapist workforce but recognises some therapies can also be delivered through other clinical staff.
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Dealing with ComplaintsWe seek to address complaints in a fair, open and transparent manner and identify and share any lessons that are learnt across the whole organisation. Our complaints process helps to clearly set out the complainant’s issues, our response and an identifi cation of where we might improve our services as a result. At the end of the complaints process, the complainant is invited to feedback on the handling of their complaint, and any actions are duly monitored by the relevant service managers.
During 2012/13, the Trust received 84 complaints, compared to 71 complaints received in 2011/12, as shown below:
National Indicator 2010/11 2011/12 2012/13
Total number of formal complaints 61 71 84
Responses within timescales agreed with complainant 95% 100% 100%
Total number of compliments 138 188 199
We take complaints very seriously and use them as a way of improving services, with service users and carers encouraged to contact either the PALS service or Complaints if they are dissatisfi ed with the service.
Some complaints covered a number of different components. A breakdown of the issues received during the year is shown in Figure 1 below:
18% Other
13% Lack of Support
11% Information
11% Attitude of Staff
5% Medication
4% Waiting for Appointment
4% Admission Arrangements
4% Medical Care (Dentist)
3% DiagnosisProblems
3% PhysicalHealth
3% CustomerServices
3% Access to Services
2% Nursing Care
2% Safety & Security
2% Verbal Abuse by Staff
2% Leave (Sect. 17)
2% Breach of Confi dentiality
2% Physical Abuse / Assault by Staff
2% Failure to Follow Procedures
2% Inappropriate Care Setting
2% Medical Care (Doctor)
Figure 1: Breakdown on complaints by component
Quality
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We have a quarterly Complaints Review Panel, chaired by a Non Executive Director, where an individual complaint and investigation process is reviewed in greater detail and feedback provided on the lessons learnt to the Board’s Service Governance Committee.
Complainants who are dissatisfi ed with our response have the right to ask the Parliamentary and Health Service Ombudsman (PHSO) to reconsider their complaint. The PHSO has published a guide that we follow called the ‘Principles of Remedy’ which sets out solutions where an injustice or hardship has been caused as a result of the way a complaint has been handled or because of poor service.
The PHSO published their annual review of complaint handling by the NHS. In 2011/12 BDCT had 22 Complaints referred to the PHSO. Out of these one complaint was accepted for full investigation. The complaint was investigated by the PHSO and not upheld. During this year, we were aware of 8 complainants who contacted the PHSO, compared to 7 the previous year. The PHSO closed two fi les against the Trust. They concluded they would not fully investigate the complaints and were satisfi ed with the outcome provided by the Trust.
The PHSO has indicated that they propose to investigate one complaint and asked us to respond to this proposition. The complaint relates principally to a parent wanting to obtain a diagnosis for their child. We have undertaken a comprehensive investigation and review of the complaint and could not offer any further resolution at local level.
PALS (Patient Advice & Liaison Service)Our PALS service provides assistance in resolving initial problems and concerns that service users, patients and carers may have. It offers confi dential advice, often acting as a sign posting service for information about the NHS and health related matters. Our PALS service received 1,094 enquires this year. The top three issues highlighted were issues around information, staff attitude and support.
During the year we have continued to review our services in the light of concerns received and made several improvements as a result. A selection of these are shown below:
• District Nursing teams to ensure there is a system in place where carers are made aware of referrals to other providers and that there are feedback mechanisms to the carers around any outcome;
• Ward staff to ensure they maintain weekly contact with family/carers where the carer is unable to visit the ward regularly; and
• To ensure all dentists inform patients of how and when they should make contact with services should their symptoms not settle.
Disclosure of Serious Untoward Incidents (SUIs)32 serious incidents were reported in 2012/13, a fall of nearly one third on the previous year (as pressure ulcers were no longer required to be reported in 2012/13). Just over half the incidents occurred in our in-patient wards and we had no ‘never events’ reporting during the year. In terms of completing investigations into serious incidents we have a 12 week deadline and since August 2012 we have met this timescale in all our cases. Learning from serious incidents has included discussions at the Serious Incident Forum and Clinical and Safety Learning Forum, the use of a toolkit aligned to the National Confi dential Inquiry for Suicides and Homicides and the production of a SUI newsletter shared with frontline staff.
Quality priorities for 2013/14Through a series of engagement workshops with stakeholders we have reviewed our performance against last year’s targets and identifi ed a number of new priorities for 2013/14. Based around our quality statement they include the following areas:
• Personal – capturing real-time feedback from patients and using it to improve services, using more stories not data and empower service users and carer voices to be heard about their treatment;
• Safe – minimizing harm, assessing and documenting risk and learning from incidents; and
• Effective – focusing on personalized care, the friends and family test and having one care plan that is accessible to the right people at the right time.
More of the detail within our Quality Accounts can be found at the Trust’s website at www.bdct.nhs.uk
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QUALIT
Y
Responding to our Vision WheelTo provide you with an excellent Patient Experience we have said that our services need to be:
Personal” You give me choice when responding to my needs.”
And so… We have continued to improve the in-patient environments we provide for people with dementia. Our specialist ward now has grab rails painted in bright red, one of the last colours people with dementia can identify. Toilet doors are also bright red and bedrooms doors are a bright blue, making it easier for patients to know the difference. Work has been done in some of the bathrooms with walls behind toilets changed from white to yellow. Previously, the white toilet, drop down rails and wall all blended together causing diffi culties for people with perceptual problems.
Clearer signage, together with easy to understand pictures are displayed to identify daily activities, menu options – even the weather! Family and friends are encouraged to write in memory books to help those with poor short term memory to remember they have had a visit from a loved one.
The practical changes we’ve introduced so far are helping people retain their independence for as long as possible. We hope in the future that we are able to continue to develop an environment specifi cally for people with dementia, supporting them to an optimum level of well-being. Jacquie Edwards, Ward Manager
We wanted to develop something that would support people with a learning disability and dysphagia to enjoy eating and drinking safely. Carers often told us they weren’t sure what the consistency food should be and what foods blended well together. It can be very stressful for carers to prepare meals and we wanted to support them too. Grainne Boyle, Dietitian
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We wanted to develop something
Safe“ I feel supported and secure in the care you give me.”
And so… We continue to go the extra mile for our patients. For example, the work our Speech and Language Therapists, Dietitians and Learning Disability experts have done as the ‘safer swallowing team’. This year they launched a specialty cookbook ‘Safe Swallowing Recipes’ fi lled with nutritious, great tasting recipes for people requiring modifi ed diets.
This all started as an idea in one of our speech and language therapist’s kitchen and was followed by speaking to carers and chefs to prepare and develop food particularly for people with swallowing diffi culties. Our team then cooked up a feast in the kitchens at Leeds University to create their tasty, safe delights for people with dysphagia. The recipe book is now being marketed externally.
Effective“ You use the latest research so that I get the best care.”
And so… We keep working on our commitment to Research and Development. We have in place a dedicated Research and Development team to support local people to get involved in studies and research that will develop the care we offer. Currently we have 50 research projects underway and we are working alongside the Universities of Bradford, Leeds, Huddersfi eld and York. We are now an Associated Teaching Trust to the University of Leeds School of Medicine, for the on-going research and teaching work we have done alongside the school.
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Patient Experience
19
Involving You 3 – From Involvement to EmpowermentIn June 2012, the Board reviewed our focus on patient experience and carer involvement through our third service user and carer involvement strategy – Involving You 3. This refl ected on the results of our Carer Experience Survey undertaken in 2011/12 and the national developments in patient experience policy as outlined within the Francis Report. Work has continued throughout the year to encourage a culture of engagement that is refl ected in the behaviour and attitude of our staff. Specifi c examples of initiatives have included:
• Our Values into Action programme
• The Carers Experience Survey
• Carer awareness raising training DVD for staff
• The service user led ‘Xplore Research’ travel study
• The development of a service user involvement network (i2i)
• Revision of care planning tools with service users in CAMHS
• Patient E-feedback system development and use in many services
Patient Experience
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Patient Feedback – The Feedback CycleWhilst there is always more that can be done, we are pleased that during the year service users/carers have been involved in governance, audit, research and service redesign steering groups. They have also been involved in evaluation of various transformation programmes, developing professional strategies and involvement in support groups for carers and service users across different services.
Our Involving You 3 strategy aims to adopt a continuous feedback system (see fi gure 2 below) that aims to:
• Involve service users in their own care and to ensure carers needs are assessed and appropriate support provided
• Involve service users and carers in all aspects of the work of the Trust in order to focus on the needs of service users and carers at all times
• Integrate service users and carer involvement into recruitment and selection, induction and training and development
• Support and develop service users, carers and staff to facilitate effective involvement
Understand the benefi ts of patient
experience feedback
Clarify the purpose and the business context for using patient feedback
Analyse feedback to provide meaninful
information on patient experience
Use feedback to design and implement service
improvements
Work with patients and staff on methods
and measurement
Collect data on patient experience
Evaluate the results and the impact of the improvement
Show how feedback has transformed services
Patient Experience
Figure 2
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Care Quality Commission (CQC) RegistrationAs a provider of NHS services, we are required to register with the CQC and our current status is ‘fully registered’ with no enforcement action taken against the Trust during the year. We have had two CQC visits relating to patient experience during the year – a routine inspection of our Lynfi eld Mount Hospital site in December 2012/January 2013 and a more specifi c review in February 2013 about the use of seclusion in our low secure services.
The fi rst visit demonstrated we were compliant against four categories of respecting and involving people who use our services; the care and welfare of people who use services, supporting workers; and our complaints procedures. The CQC rated us as non-compliant (moderate concern) on the category relating to medicines management and as a result we have put in place an action plan to address these issues.
On the second visit, compliance ratings were not applied and we are addressing a small number of areas for improvement identifi ed by the CQC. We have been proactive in responding to the CQC and actions are regularly monitored through the Board’s Service Governance Committee.
Patient StoriesPatient experience feedback and stories provide a rich source of information and help us measure our organisational reputation amongst local people, competitors and partners. Patient experience can also impact on commissioning, patients’ choice of services, referrals and the quality and commitment of staff attracted to work within the organisation. The Board identifi ed that including such information as a regular item at its meetings would help with business decisions and stay focused on patient experience, quality and safety issues. A patient story was introduced in the last quarter of the year as a feature at every Board meeting so Board members could begin the business from the perspective of service users and carers.
Research and Development (R&D)Over the past year, we have continued to invest in research, and together with West Yorkshire Comprehensive Local Research Network (WY CLRN) funding, this has resulted in signifi cant progress in achieving the goals of our research strategy – to develop our capacity and reputation to deliver excellent applied health research that has the potential to improve the health and well being of our local population.
We have continued to broaden our research portfolio, have been involved in recruiting to 50 research projects, and identifi ed 248 patients to participate in different research projects.
We recognise that a key part of growing success will be building on our existing strengths. From the feedback and review of current projects we have identifi ed some clear areas of excellence and will focus our efforts largely on the following areas:
• Dementia: Older peoples (mental health) research
• Addressing diversity: e.g. the development and modifi cation of assessment and referral tools
• Family and childhood: e.g. Eating disorders, obesity and Autism
• Service user and carer experience
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Patient Environment Action Team (PEAT) ScoresWe undertake an annual assessment of all in-patient healthcare sites which includes service users who make a signifi cant contribution to the scoring and rating process. Our current PEAT scores for non-clinical aspects of patient care including environment, food, privacy and dignity are all rated as “Excellent” as shown below for our in-patient sites at Lynfi eld Mount Hospital, Airedale Centre for Mental Health, Ward 24 based at Airedale General Hospital and Daisy Hill House.
A new patient-led inspection regime – Patient Led Assessments of the Care Environment (PLACE) – has been introduced by the Government to replace PEAT and our fi rst series of PLACE assessments have taken place with similarly high level results.
PEAT AREA TRUST RATING
ENVIRONMENT:All wards and mental health beds; All clinics, waiting areas and receptions; Stairwells, lifts, corridors and other public areas; All other patient areas including bereavement rooms and discharge lounges.
Excellent (96% – 100%)
FOOD:Menu; Choice & Availability; Quality & Quantity (portion size); Temperature;Presentation; Service & support; Beverages;Protected mealtimes; Nutritional screening.
Excellent
PRIVACY & DIGNITY:Sleeping accommodation; Toilets & bathrooms; Privacy; Confi dentiality;Modesty, dignity and respect; Social spacesWomen only day areas; Activity areas (indoor).
Excellent
Information GovernanceWe recognise the importance of managing information appropriately and securely and have nominated an Executive Director to be our Senior Information Risk Offi cer (SIRO). This role is responsible for ensuring the Board has assurance that appropriate controls are in place and that risks are properly managed in relation to all the information used for clinical, operational and fi nancial purposes.
Information governance and information risks are controlled and managed through our Information Governance (IG) Toolkit, which provides a framework to enable organisations to assess their compliance with current legislation, Government directives and other national guidance. The Toolkit encompasses 45 criteria, each of which has four score levels: 0, 1, 2 or 3. In order to be compliant with the toolkit in 2012/13, a minimum score of 2 in all 45 criteria must be achieved. The Trust has once again reached full compliance. The fi nal submission had 36 requirements at level 2, 8 at level 3 and one which is deemed not relevant to the Trust.
Charging for InformationWe are also required to report our compliance on setting any charges for information as detailed in the Treasury’s report Managing Public Money. We have a charging policy for accessing personal records which is in keeping with the Data Protection Act 1998. We are currently considering a fee schedule for hard copies of those documents included in its Publication Scheme, which would comply with the conditions set out in the Freedom of Information Act (FOI).
The number of requests for information under the FOI and the Data Protection Act (DPA) is shown below, refl ecting the increase in services provided by the Trust.
PEAT AREA 2010/11 2011/12 2012/13
Requests under FOI
104 145 158
Requests under DPA
216 317 403
Patient Experience
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Cleanliness AuditsDaily, weekly and monthly audit checks are carried out in all areas (where the Trust has responsibility for cleaning) using a handheld data collection device. Scores are an aggregate of all areas checked to produce an overall rating. The following chart shows this year’s cleanliness audit scores by individual area, showing we have performed at over 94% (against a target of 87%).
Area Performance
Organisation = BDCT In-PatientFor Audits made between: 01/04/2012 and 31/03/2013
BLOCKNo of Audits
No of Checks % 0% 100%
Ashbrook 13 2398 94.66
Assessment & Treatment Centre 12 2521 95.91
Baildon Ward 12 2602 94.93
Clover Ward 12 2250 94.89
Duchy Court 12 2584 95.63
Fern Ward 12 2486 94.53
Heather Ward 12 2870 95.54
Ilkley Ward 12 2646 95.39
LMH Out Patients Central 13 2592 92.28
Maplebeck 12 2350 90.81
Moors Suite 12 1972 95.74
Oakburn 12 2617 93.16
Step Forward Centre 12 2663 96.21
Thornton Ward 12 2558 95.23
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Local” I can get the care I need close to home.”
And so… In Children and Family services, we recruited a Consultant Psychiatrist, Community Psychiatric Nurses, a Psychologist, Family Therapist and Support workers into our Seven day Intensive Home Treatment and Specialist Eating Disorder Service within CAMHS. This was to make sure that our young people did not have to travel out of this area for high quality specialist care.
To tackle an eating disorder can be very scary for people. That is why we work closely with the young person and their family to support them throughout every step of the journey. Lisa Stead, CAMHS Team Manager
” I can get
PATIENT EXPE
RIENCE
Responding to our Vision WheelTo provide you with an excellent Patient Experience we have said that our services need to be:
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Effective“ I understand how and where I get the support I need and I don’t have to explain myself to lots of different people.”
And so… In Airedale, Wharfedale and Craven we are working with other partners in health, social and care sectors to offer integrated care for patients with complex needs. This sees a range of professionals including District Nurses, GPs and Social Workers working together from within one GP Practice to provide joined together care. To prevent confusion and the need to repeat their case history all community patients in Airedale, Wharfedale and Craven now have a named care co-ordinator to oversee their care.
Responsive“ My records are shared quickly and safely with the people who need them.”
And so… We have improved the level and consistency of recording our patient care by reviewing our electronic patient record (SystmOne) within Community Nursing Teams. 95% of patients on the District Nursing Caseload now have an electronic individual care plan, tailored to their needs and we want to improve on this fi gure in the coming year. Due to the changes we have made, at the end of this fi nancial year, clinical activity has increased by 1.6%. This means we have increased the time our nurses can spend in direct care.
Relationships26
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We recognise the importance of relationships with our stakeholders, staff and those using our services. To provide a high quality service we need to have well-developed relationships with our commissioners and a motivated workforce. This section summarises our work with partners and staff over the course of the year.
Relationships with Key StakeholdersAs part of its own learning and development, our Trust Board used a 360 degree feedback process with key stakeholders and senior staff. The results included positive comments around demonstrating strong transformation leadership, leading a values-based organisation and a good track record of achieving quality and fi nancial targets. There were also comments about the need for the Board to be more visible with Commissioners, work on building its reputation and play a greater role in liaising with partner agencies.
As a result, Board members have established a new approach to working with key partners including:
• A series of 1-2-1 meetings with those partners involved in the survey, to explore feedback and new ways of working.
• The approval of a more formal stakeholder engagement plan, which identifi ed individuals and organisations working closely with BDCT with Board members responsible for developing these relationships.
• More regular meetings with the CCGs to share our plans and help them understand the challenges facing Bradford’s health economy.
• The introduction of a ‘Board on the Road’ programme where the Board would hold one of its meetings at the offi ces of an organisation identifi ed to be one of our Appointed Governors and meet to discuss strategic issues affecting both organisations. In 2012/13, the Board met with the Bradford Assembly and the University of Bradford with meetings to be arranged with Barnardo’s and Sharing Voices in the coming year.
Relationships
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Relationships with our MembersAs we move further into the FT application process, our relationship with our members, and prospective Governors, becomes increasingly important. In preparation for this, we have focused our work on three main areas: a programme of recruitment events; a series of membership events; and providing appropriate governance arrangements in advance of Governor elections. By the end of March 2013, we had recruited over 8,500 members.
Over the summer months, we attended a number of local events providing opportunities to talk to people about the services we provide and discuss our plans for becoming a FT. We attended events at Ingleton, Northcliffe Wood, Queensbury, Skipton, Sutton and Wrose that helped to increase our membership numbers in areas that had previously been lower than average.
Between May 2012 and March 2013 we organised eight membership events aimed at educating people about the different services we provide. These events were open to staff and members of the public with a senior clinician presenting information on their service. The areas covered this year were:
• Children’s Mental Health: Drugs and Offending (May 2012)
• Eating Disorders (May 2012)
• Healthy Pregnancy, Healthy Baby (November 2012)
• Bladder Overactivity (November 2012)
• End of Life (January 2013)
• Teenage Pregnancy: the Family Nurse Partnership (February 2013)
• Sleep Routines for Babies (February 2013)
• Explaining Challenging Behaviour (March 2013)
Over the course of the year we have strengthened our governance arrangements in preparation for becoming a FT. The Board has approved a refreshed Membership Strategy aiming to ensure that membership is meaningful and representative and that members are given every opportunity to engage with the Trust. During 2013/14 there will be a greater use of social media to engage members and a programme of further recruitment to help identify potential Governor candidates. We have also explored the relationship we would like to see between the Board of Directors and the Council of Governors, developed an induction programme for our Governors and made preparations for Governor elections.
In April 2012, we refreshed the focus of our membership magazine, renaming it Your Health which now includes health promotion advice provided by our own in-house experts, real-life stories, self referral information that refl ects the wide range of health care services the Trust provides and key corporate information.
Relationships
29
Relationships with our StaffOur staff are the Trust’s most valuable asset, accounting for 76% of expenditure and we recognise that they should be equipped with the right skills, behaviours, competencies and leadership to excel in delivering high quality, value for money services that meet the needs of patients and to realise their full potential.
Staff PartnershipsThe Trust enjoys a positive relationship with staff side colleagues and has a partnership framework in place. The Trust has a joint staff partnership forum which meets regularly to discuss strategic issues and agree joint solutions and action plans as well as developing and reviewing policies, negotiating local terms and conditions of service and discussing the key workforce challenges and how these can be addressed. The forum agreed a work programme for the year and a comprehensive development programme is in place to help develop the members of the forum and strengthen relationships. This includes the development of a clear partnership competence framework, team building events training in confl ict resolution law and best practice in people management.
Workforce Development and LeadershipWe understand that a well-motivated and skilled workforce is essential in order to provide high quality services and that effective leadership is fundamental to achieving this. The Trust has developed a behavioural competence framework that refl ects the values of the organisation, which supports leadership development and ensures that all staff are clear about that which is expected of them and what they can expect from colleagues. Over the last 12 months we have invested signifi cantly in leadership development for staff on a number of levels. Our leadership and organisational development plan in 2012/13 aimed to:
• Develop competent and engaging managers and leaders who can manage and drive through change.
• Develop a talent map that enables the Trust to spot and nurture talented individuals.
• Develop a career framework for our support staff.
In delivery of the plan we have introduced:
• An ‘Inspiring Leaders’ programme aimed at equipping line managers with the necessary skills they require in their day to day management roles.
• A range of management modules including developing greater awareness of Trust policies and procedures and how to apply them and also the development of softer skills including having diffi cult conversations/managing confl ict.
• A series of interventions with community services staff new to the organisation which helped to underpin our core values and model of distributed leadership across the new organisation.
• A re-focus and development for those in ward manager roles, dealing with leadership in nursing teams, and facilitation of a nursing culture.
The Trust’s award winning Exciting Futures leadership development programme is in its fourth year and provides staff with formal learning and work place assignments that enables theory to be put into practice. The programme supports the emotional engagement of current and future leadership of the Trust with patients to increase commitment, understanding and connection to our values.
Medical leadership is also an integral element of the transformational agenda. With increasing demands on clinicians and a focus on developing clinical skills, leadership capability can often be overlooked. To support the leadership development of doctors we have developed a comprehensive leadership programme that will offer individuals a tailored development plan and include workshops, 360° feedback and coaching.
30
Our WorkforceOur age profi le indicates that the Trust has an ageing workforce with over 25% of the workforce aged 50 or over. Whilst this does present some challenges in terms of retaining staff in key roles such as health visiting and district nursing, where it is known that demand for these services will increase signifi cantly, it also provides us with opportunities to change the profi le of our workforce.
Staff EngagementWe recognise the importance of engaging staff particularly when there are signifi cant changes happening across the Trust and the wider NHS. We have developed a number of different communication tools to cascade information across the Trust including weekly E-updates, a monthly Board in Brief (describing what the Board has discussed), staff newsletters, and Connections (a bi-monthly magazine for staff and partners). In addition, we have regular Quality and Safety Walkabouts by Board members to services which report back issues raised by staff. In the coming year we will be looking at increasing the use of social media with staff and refresh our Trust website/intranet site to provide greater accessibility of information about our services.
In terms of recruitment of staff, we can demonstrate our commitment to the principles outlined in the Mindful Employer Charter, ensuring that we are positive about recruiting, retaining and supporting those who have experienced mental ill health. The Trust is committed to selecting candidates on merit and works hard to ensure it complies with anti-discrimination legislation. We hold the ‘Two Ticks’ symbol that demonstrates our commitment to employing people with disabilities and ensures that those applicants with a disability that meet the short listing requirements are guaranteed an interview.
Relationships
13 staff Under 20142 staff 61+
354 staff 21-30
793 staff 31-40
1,019 staff 41-50
764 staff 51-60
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NHS Staff Survey 2012Our staff survey results have shown a year on year improvement and 2012 is no exception. The results of the 2012 survey showed a number of improvements and highlight a number of areas where further improvements are to be developed. For survey purposes, we were placed within the mental health and learning disabilities sector and with a response rate of 56.99%, were above the national average for similar trusts (at 55.4%). Although a challenging year for staff, the 2012 survey results were our highest ever response rate.
The key fi ndings for our Trust meant that:
• We were in the top 20% of organisations for 10 out of 28 key fi ndings
• We were average or above in 26 out of 28 key fi ndings
• We were not in the bottom 20% of organisations for any key fi ndings
• Staff engagement rates have improved and we were in the top 20% nationally
• Staff satisfaction and motivation fi gures have improved
The most signifi cant improvements and areas of satisfaction were in relation to: percentage of staff contributing to improvements at work; percentage of staff that would recommend our Trust as a place to work or receive treatment; staff job satisfaction; and staff motivation in work.
The areas we have identifi ed as areas for improvement are: percentage of staff suffering work related stress in the last 12 months; percentage of staff reporting errors, near misses or incidents in the last month; percentage of staff working extra hours; percentage of staff saying hand washing materials are always available; and percentage of staff receiving health and safety related training in the last 12 months.
In 2013/14 we will be focusing on development interventions to address workplace stress and wellbeing (centred around understanding the perceived causes of stress and action planning based on that research) and staff involvement and feedback (improving and publicising the way in which staff are involved in decision making and developing clarity of feedback from staff suggestions / views).
We have reported some positive performance in terms of the following workforce indicators identifi ed by our staff:
Table 11 Workforce
Indicators
Agreed improvement
target / Benchmark 2012/13
The extent to which the Trust values my work (NHS Staff Survey)
42%National average
46%
Staff believing the Trust provides equal opportunities for career progression or promotion (NHS Staff Survey)
90%National average
90%
% of staff with up to date mandatory training – Fire Training
80%Target
85.48%
% of staff with up to date mandatory training – Other Mandatory Training
80%Target
79.76%
% of staff with an in date appraisal
80%Target
82.44%
Source: Local reporting system and NHS Staff Survey 2012
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Sickness AbsenceAs an organisation with historically high rates of sickness of over 6%, we have actively sought to deliver a signifi cant reduction in rates to reduce costs and improve the quality of patient care. Sickness absence this year equated to a cost of over £3 million to the organisation and the Board set a target of 5% by the end of March 2013 and then a further reduction to 4% by the end March 2014. Our current target has not been without some challenge, given the current agenda and pace of change facing the organisation. In recognition of these challenges signifi cant work has been put in place to support the reduction of sickness absence rates including a robust sickness absence process that supports early intervention so that staff can be supported to return to work as quickly as possible and new management reports for managers that detail staff who have triggered short-term sickness.
Our end of year performance recorded a fi gure of 5.5%. Although the sickness absence rates are challenging the Board concluded that the benefi ts to staff and patients of having low sickness absence rates are evident and we should continue to focus on achieving the agreed sickness absence targets in 2013/14. Ownership of the sickness absence data and achievement of next year’s target will be managed by individual Directors for their areas to help tackle hot spots across our organisation. Details of the number of staff days lost are found below.
Staff Sickness Absence
Total2011/12Number
Total2012/13Number
Total Days Lost 40,044 32,776
Total Staff Years 2,995 2,665
Average working Days Lost
13 12
The data above is based on the period January to December 2012, due to timing diffi culties with fi nancial year data. The Department of Health considers the resulting fi gures to be a reasonable proxy for fi nancial year equivalents. To preserve consistency, NHS bodies have been advised not to update the fi gures to a fi nancial year base, even if they have the ability to do so. These fi gures have been provided centrally by the Information Centre from the ESR national data warehouse from information provided by the trust.
Our Staff – Promoting Equality and Valuing DiversityWe have a diverse highly skilled workforce and recognise the importance of diversity across teams. Details of the ethnicity profi le of our workforce is shown below. We have seen a steady increase in BME staff employed within the workforce, rising from 17.8% in March 2010, 18.8% in March 2011, with a slight dip to 18.3% in March 2012 and back up to 19.0% in March 2013. The highest proportions of BME staff are located within Medical & Dental Staff, and unqualifi ed staff. The lowest proportions of BME staff remain within management. We are currently reviewing the number of BME applicants who are shortlisted and appointed to understand whether there are any signifi cant barriers to entry.
Ethnicity
Any Other Ethnic Group (13 staff)
Chinese (5 staff)
Any Other Black Background (9 staff)
African (45 staff)
Caribbean (39 staff)
Any Other Asian (23 staff)
Bangladeshi (21 staff)
Pakistani (200 staff)
Indian (90 staff)
Any Other Mixed (3 staff)
White & Asian (16 staff)
White & Black African (2 staff)
White & Black Caribbean (14 staff)
Any other White Background (55 staff)
White Irish (26 staff)
Relationships
33
Promoting a More Diverse LeadershipWe are one of fi ve organisations piloting the Innov8 Charter, which aims to promote a more diverse leadership across the NHS. We have made good progress during the year including:
• The appointment of a Board level champion to provide leadership to the Charter;
• Taking a more proactive approach when promoting development and leadership programmes to ensure a more diverse participation;
• Ensuring that internal management and leadership programmes explore with participants how they can promote inclusive leadership as well as how to effectively manage diverse teams;
• The roll-out of development centres to help us spot and nurture talent throughout the whole organisation.
In the coming year we will be developing an organisational wide talent map and action plan, within which the current position, aspirations and potential of BME staff will be refl ected. A booklet and video titled ‘Different Leaders’ is also planned for use with staff across West Yorkshire.
Transfer of Mental Health Services Under the Section 75 AgreementSince 2002, we have provided integrated and specialist services for adults with learning disabilities and adults with mental health needs on behalf of Bradford Council. Last year learning disabilities services were successfully transferred to other providers and in May 2012 we formally gave notice to terminate the Section 75 Agreement. As a result we worked closely with the local authority, our staff, staff-side, services users and carers to ensure that Assessment & Support, Safeguarding, Operational Commissioning, Budget Management, Housing Related Support and Wellbeing Services were successfully transferred to new providers. Service users and carers were consulted throughout the transition period, resulting in minimum disruption and all BDCT staff successfully transferred to the new providers under their existing terms and conditions.
Long Service AwardsIn January 2012, we celebrated our long service awards, achieved by 48 members of staff this year. Staff who have worked in the NHS for 20, 25 and 40 years were recognised for their long service and loyalty to the organisation at an awards ceremony lunch hosted by Non Executive Director members of the Trust Board.
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Celebrating with our Staff – You’re A Star Awards (YASA)Now in its fi fth year, and once again sponsored by Sovereign Healthcare, the YASA highlighted the hard work and commitment shown by our staff every day. This year’s event was organised around the fi ve Trust values of Respect, Openness, Improvement, Excellence and Together. Over 300 people were present at the National Media Museum to see the 15 shortlisted fi nalists’ work showcased. Congratulations go to all those who were nominated, with a special recognition to the fi ve winners:
Award Winner Impact on services
Respect Louise McChrystal, Consultant Speech and Language Therapist for Multilingual Communities
Design of new information leafl ets and communications tools aimed at families from Eastern European countries.
Openness Podiatry Service Knowing How We Are Doing Productive Community Service.
Introduction of a ‘virtual’ information and discussion board to help staff based at 39 different clinical sites.
Improvement HR Service DeskDevelopment of specialist IT software to create a single point of access for all HR queries.
Excellence Airedale Centre for Mental Health Housekeeping Team
Achieving consistently high standards of cleanliness on the wards and providing a supportive environment for services users during their stay.
Together Clinical Leads School Nursing with A&E Liaison Nurse
Helping to identify children who attend A&E not in education or registered with a GP and ensure their health/education needs are met.
Relationships
YOU’RE A STARAWARDS2013
35
Wider recognition of our staffOur pioneering work has also earned us a number of prestigious awards during the course of the year, including:
Winners Shortlisted
LD Transitions Team – Healthcare People Management Association Awards, Social Partnership Forum Award, for the transfer of LD services to other providers.
HSJ & Nursing Times National Patient Safety Awards, Board Leadership Category, for the Trust’s Taking Quality Forward programme.
Olwyn Lidster, Community Psychiatric Nurse won the Royal College of Nursing’s Mary Seacole Leadership and Development Award.
HSJ & Nursing Times National Care Integration Awards, for our work done on breast screening for people with learning disabilities.
Our School Nursing service’s Ur Choice project won the Clinical Team of the Year for Sexual Health at the GP Practice Awards.
HSJ Effi ciency Awards, Effi ciency in Information Technology, for our Physical Health Team’s ‘Living IT Project’.
Jane Norton, Speech and Language Therapist won the Outstanding Contribution to Speech and Language Therapy at the Royal College of Speech and Language Therapists Giving Voice Awards.
HSJ Effi ciency Awards, highly commended in the Effi ciency in Financial Services category for our Health Visiting Team’s ABC Costing Model.
Krishnakumar Nair was announced as National Lean Champion of the year at the Lean Healthcare Academy Awards.
The Hillside Bridge Health Visiting Team was shortlisted in the National Student Nursing Times Awards in the category, Student Placement of the Year: Community.
36
Involving” You share your plans with me and work with my community.”
And so… This year we’ve employed specialist Community Engagement Workers to improve the care of service users. In Older Peoples’ mental health Magda and Zahir work with service users from Eastern European and South Asian backgrounds and within Adult Mental Health Services, Violet works to improve the work we do with Gypsy and Traveller Communities.
36
RELATIONSH
IPS
We have a long history of research which shows Gypsy and traveller communities have stark health inequalities so it’s amazing that the Trust is doing some forward thinking and trying to fi nd cost effective ways to change these inequalities. Violet, Community Engagement Worker
It’s all about breaking cultural barriers. We understand and respect the diverse needs and beliefs of service users. This allows us to gradually establish a trusting relationship. Zahir Daji, Community Engagement Worker
Responding to our Vision WheelTo make sure we have great relationships with our staff and the people we serve we have said we need to be:
3737
We wanted to pull together information about all local services for people with dementia, whether they are provided by the NHS, the local council or voluntary sector. This resources gives the professionals the information they need to support people with dementia and their carers right at their fi ngertips. Chris North, Project Lead
Integrated“ You bring the experts together.”And so… This year we launched an exciting new online tool for professionals who work with people with dementia and their carers. Designed so that a range of professionals can guide the people they care for to information about everything from council tax, benefi ts, winter fuel payments, memory clinics and social activities we developed our new online directory which has details of more than 250 dementia services in Bradford.
Services are arranged by local areas under topics like ‘money and benefi ts’, ‘help with daily living’, ‘legal issues’ and ‘housing and travel’.
Clear“ I’m given the latest information to help me make a decision.”
And so… In November of this year we held a Trust-wide Involvement Group which gave our service users the opportunity to meet with heads of services to discuss our Involving You 3 Strategy. The strategy seeks to shift the way we work towards greater accountability to the people who use our services and their carers. Some of the successes of the Involving You 3 Strategy this year include:
• The creation of an Early Intervention Participation Group for young people aged 14 to 35 affected by psychosis and their families based at Culture Fusion in central Bradford.
• Comment cards, fax-back forms and ‘a question asked’ about every meal within our Food Services Team, as part of improving mealtimes for in-patients.
38
Value for Money
39
We recognise that in the challenging economic climate facing the NHS, providing value for money is critical and we must demonstrate to our Commissioners and other stakeholders how we are making effi ciencies whilst maintaining quality services. Further information about how we have managed our money is provided in the Financial Review of 2012/13. However, value for money is as much about raising productivity, introducing innovative practices and ‘doing more with less’.
Transforming Care ProgrammeThe Government’s new legislation around health and social care places a duty on organisations to promote working together through the integration of services and in turn deliver better value for money. Our Transforming Care Programme has identifi ed a number of projects which have been looking at how we can deliver our services and manage our business more effi ciently in the future. During the year we have developed a number of projects aimed at delivering greater productivity including:
• Our Children and Family Services review to make better use of electronic patient records and use the Activity Based Costing model to ensure the correct skill mix is in place.
• Our Community Mental Health Teams who are introducing a ‘stepped care’ model which will see service users seen by the most appropriate member of the team.
• Our Effective Estates project is reducing the number of offi ces we work from and making existing sites more accessible to our teams.
• Our Agile Working programme will help our workforce become more fl exible by using mobile working, wireless network and hot desking to be able to access information they need from any Trust site.
Value for Money
40
Operational PerformanceIn terms of monitoring our performance we have a framework in place which routinely measures our business against a range of key performance indicators (KPIs). These KPIs are a mixture of nationally recognised targets and those which our Trust Board has identifi ed to demonstrate the effi ciency and effectiveness of the organisation.
During the year our Board monitored performance monthly against CQC registration, compliance with national outcomes and our own quality and risk profi le. The Board has also agreed a wide range of other local KPIs which are reported to the Board’s Service Governance, Mental Health Legislation, and Finance, Business and Investment Committees.
We want to deliver clinical and operational excellence for all our service users/patients and where possible improve our performance. The table on page 43 highlights our performance during the year with previous data as a comparison. A brief description about what each KPI means is included at Appendix 4.
Any Qualified ProviderThe Government’s introduction of ‘Any Qualifi ed Provider (AQP)’ is an approach aimed at providing patients with greater choice from a list of qualifi ed providers who meet NHS service quality requirements which in turn drives up quality, empowers patients and enables innovation. In our local area, Commissioners have selected Podiatry as a service to be opened up to greater competition. As a result we have reviewed and benchmarked our service against other providers and sought views from existing patients. We have also costed our individual services to ensure we are providing value for money and introduced new, accessible information about the type and quality of the service offer, for both patients and GPs. Our website now provides a comprehensive A-Z list of foot care topics and information on the 39 sites across our district from which we provide podiatry services.
ProcurementTrust procurement is managed through Airedale Supplies, based at Airedale NHS Foundation Trust, who has been working with us to improve stock purchasing and streamline the range of similar products purchased within departments. Considerable effort has been applied to establish mechanisms to regulate stock and non stock purchasing, and to ensure that excess stock is not held for protracted periods of time. Sustainable principles including whole life costing and energy use in manufacture are new to the NHS but we are working closely with Airedale Supplies to include these principles in routine procurement.
Value for Money
41
Operational Performance
National Indicator2010/11
performance2011/12
performance Target2012/13
performance Trust Position
Number of in-patients being followed up (Patients receiving Contact within 7 days Discharge)
97% 97% 95% 95.5% Target met
CPA patients having a formal review within 12 months
81% 96.% 95% 95.1% Target met
Minimising Delayed Transfers of Care (Health)
1.0% 1.0% < 7.5% 3.1% Target met
Admissions to Hospital were accessed via Intensive Home Treatment Teams (IHTT)
98.8% 99.4% 90% 96.4% Target met
Access to healthcare for people with a learning disability
1 Amber5 Green
6 Green 6 Green 6 Green Target met
Completeness of MHMDS – Part 1
99.1% 99.4% 99% 99.3% Target met
Completeness of MHMDS – Part 2
63.6% 84.2% 50% 90.6% Target met
New psychosis cases by Early Intervention teams
Previous BACHS target
100% 95% 244.3% Target met
Dental referrals to treatment – waiting times (admitted)
Previous BACHS target
18.6% 18 weeks 100% Target met
Dental referrals to treatment – waiting times (non-admitted)
Previous BACHS target
13.2% 18 weeks 97% Target met
Dental referrals to treatment – waiting times (incomplete pathways)
New target - 18 weeks 99.7% Target met
Workforce Targets
National Indicator2010/11
performance2011/12
performance Target 2012/13 Trust Position
Mandatory training 78.1% 75.1% 80% 80.9% Target met
% staff receiving appraisal 82.8% 68.1% 80% 82.4% Target met
% medical staff appraisals 92.3% 89.4% 100% 96.2% Target not met
Labour turnover 9.2% 9.8% 10% 7.9% Target met
Sickness absence rate 6.8% 5.6% 5% 5.5% Target not met
4242
VALUE FOR M
ONEY
Responding to our Vision WheelTo provide you with Value for Money we have said that our services need to be:
Right Place” My care is always provided in the most appropriate place to meet my needs.”
And so… We’ve made improvements to our Adult Mental Health Acute Care Services. 80% of people who needed our Psychiatric Intensive Care unit based in Airedale came from in-patient wards in Bradford. To reduce the cost and risks of transferring very unwell people across sites, we relocated our Psychiatric Intensive Care Unit to a modern and purpose built facility on our Lynfi eld Mount Hospital site in Bradford.
4343
Right Skills“ I am confi dent that the professionals I see have the skills to meet my needs.”
And so… This year we approved our Medical Staff Appraisal Policy. This sets out how we expect all our doctors to have annual two way discussions about their practice and career development. It also looks at how our doctors demonstrate to the General Medical Council (GMC) that they remain up to date and fi t to practice. We have seen a year on year increase on the number of appraisals recorded.
Right First Time“ My needs are met without any duplication and this must cost less.”
And so… We continue our work alongside the Lean Health Care Academy to put in place the Lean Philosophy across all our ward, community and reception areas. The Lean philosophy was fi rst developed by car manufacturer Toyota in the 1950s to improve car production. It has since been adapted into a set of modules – the ‘Productive Series’ for use in healthcare settings. The series is about getting things right fi rst time, minimising waste and being open to change. Our staff are leading the way in this work, once again winning national awards this year for making small changes that are making a big difference to staff morale and patient care.
44
During the course of the year we have worked hard on our preparations for becoming a Foundation Trust and many of the projects and programmes mentioned in this report are focused on the work contained with our Integrated Business Plan (IBP).
We have made signifi cant progress with our application in meeting a number of governance, fi nancial and quality requirements including:
• An independent review of our corporate governance arrangements in July (know as the Board Governance Assurance Framework) which concluded that the Board has good governance arrangements in place
• A second stage of historical due diligence in August, looking at our fi nancial reporting, systems and processes
• A Board-2-Board assessment with the Strategic Health Authority (SHA) in September
• An independent review of our quality governance arrangements including site visits by the SHA in October
• Submission of our IBP to the Department of Health in November
• Further assessments by the NHS Trust Development Authority (NTDA) including additional quality visits in February and March
• Establishing a Trust-wide programme of developments in response to public enquiry report into quality concerns at Mid Staffordshire FT (the ‘Francis Report’) in March
We believe our staff have work hard to deliver this work whilst still ensuring that standards of patient care are maintained. We are committed to working with the NTDA and Monitor to progress our application during the remainder of 2013.
Progress with our Foundation Trust application
45
As a public body we are conscious of our obligations to ensure that our services are sustainable in the longer term which includes energy effi ciency, reducing our carbon footprint and encouraging changes in behaviour. We continue to work towards reducing our impact on the environment and introducing sustainable development in building projects.
In 2012/13 we implemented Year 1 of our new 5 Year Environmental Improvement Investment Plan developed from the Renewable Energy Opportunity Assessments carried out last year by local carbon reduction partners CO2 Sense.
Year one projects included:
• Upgrading roof and cavity insulation at Lynfi eld Mount Hospital.
• Replacing existing car park lighting with high effi ciency LED lighting at Lynfi eld Mount Hospital.
• Preparations for a new Energy Centre at Lynfi eld Mount Hospital which will include either a Combined Heat & Power plant [CHP] or a biomass boiler.
• External consultant support in running an Environmental Engagement event to encourage changes in staff behaviour and assist in developing our Environmental Engagement Strategy.
• Sustainability embedded in the Psychiatric Intensive Care Unit [PICU – Clover] developed at Lynfi eld Mount Hospital.
Trust Performance Against Carbon Reduction Targets
We are currently tracking performance against two carbon reduction targets, one voluntary and the other a formal NHS target. Firstly, the 10% reduction by 2015 of carbon emission set for the NHS by the NHS Carbon Reduction Strategy document – Saving Carbon Improving Health, which requires an overall reduction of 703 tonnes of CO2. The Trust achieved this target in 2010.
The second is our own voluntary target of a 30% reduction of emissions by 2015 as part of our Carbon Management Plan. The Plan involved calculating the baseline carbon footprint for the organisation, including data on areas such as energy usage, water, waste and business mileage. The Trust achieved this target in 2011.
EnergyEstate Rationalisation, where individual buildings have been sold or closed, with the associated teams and services moving to retained premises is more or less complete. This has had a large impact on our energy use, rationalising poorly performing buildings, and moving services into newer more energy effi cient premises.
Our new 5 Year Environmental Improvement Investment Plan will also continue to reduce our emissions through energy effi ciency and applying sustainable technologies in future developments. In the long term the Plan will reduce energy use signifi cantly, saving us up to £100,000 per year.
Changing behaviour is an important tool in reducing energy use and improving sustainability. We have developed an ongoing strategy of working with a wide range of staff and service user groups to explain the benefi ts of smarter energy use and create an opportunity for new ideas to be raised at a grass roots level which can then be included in our on-going investment plans.
Sustainability report
46
WasteFrom 1 November 2012, we commissioned a major change in our offi ce waste contract. With the new contract we will have achieved zero offi ce waste to landfi ll, which is a signifi cant step in our move to greater sustainability. All offi ce wastes will now be either recycled for reuse or used to create refuse derived fuel (RDF) for energy production. To achieve this, we are required to separate wastes into two main groups:
• Mixed Recycling Wastes – Plastics/Paper/Card/Metals (tin cans etc.) for reuse only.
• Low grade recycling (General Wastes) consisting of food contaminated wastes & Glass wastes which are segregated to produce fuels and further recyclable materials.
EU ETS – Greenhouse Gas Allowance Trading SchemeUnder the EU Emissions Trading Scheme (ETS), large emitters of carbon dioxide within the EU must monitor their CO2 emissions, and annually report them. Total Care Trust CO2 emissions from energy use are currently 3,922 tonnes, so do not meet the qualifying threshold. We therefore have no fi nancial obligations under the scheme.
Carbon Reduction Commitment Energy Efficiency Scheme (CRC)The CRC Energy Effi ciency Scheme is a mandatory energy saving and carbon emissions reduction scheme for the UK. Phase 1 of the scheme ran from April 2010 to March 2014, based on energy consumption in 2008.
Phase 2 of the Emissions Trading Scheme will begin in April 2014 and run until March 2019, based on energy consumption data in the new qualifying period which was the fi nancial year 2012/2013. Our electricity consumption through half hourly electricity meters between April 2012 and March 2013 was 3,325 MWh meaning that we will again not have a full participatory involvement in Phase 2 of the CRC Emissions Trading Scheme.
Ongoing Energy Usage
Electricity GasTotalCO2
TonneskWhConversion
FactorCO2 Tonnes kWh
Conversion Factor
CO2 Tonnes
2007/08 5,246,000 0.43 2,256 21,163,000 0.19 4,021 6,277
2008/09 4,915,000 0.43 2,113 19,861,000 0.19 3,774 5,887
2009/10 4,700,000 0.43 2,021 17,921,000 0.19 3,405 5,426
2010/11 4,425,000 0.43 1,903 16,130,000 0.19 3,065 4,967
2011/12 4,305,000 0.43 1,851 14,114,000 0.19 2,682 4,533
2012/13 4,140,884 0.43 1,781 11,270,934 0.19 2,141 3,922
The table above shows the steady reduction in energy use and carbon emissions we have achieved over the last six years. We are now using 21% less electricity and 47% less gas than when we fi rst started measuring energy use. We are also emitting 2,355 fewer tonnes of carbon dioxide per year, a 38% reduction in our original energy emissions.
Sustainability report
47
Display Energy Certificate PerformanceDisplay Energy Certifi cate (DEC) performance continues to be a priority for NHS Trusts. A performance rating of 100 (grade D) is considered to be typical performance compared with other buildings of its type and use. Due to estates rationalisation and the transfer of S75 properties we now have eight properties over 1000m3 requiring DECs. Of these fi ve are above the typical performance rating and we are focusing energy effi ciency programmes at the remaining sites.
In addition from January 2012, DECs are now required for buildings exceeding 500m3. DECs for these properties are only required once in every 10 years. We have seven properties in this category and DECs have been registered for all these properties. Six of the seven properties in this category have performance ratings better than 100.
48
1. Scope of ResponsibilityThe Board is accountable for the Trust’s system of internal control. As Accountable Offi cer and Chief Executive of this Board, I have responsibility for maintaining a sound system of internal control that supports the achievement of the organisation’s policies, aims and objectives. I also have responsibility for safeguarding the public funds and the organisation’s assets for which I am personally responsible, as set out in the Accountable Offi cer Memorandum.
Bradford District Care Trust (BDCT) forms part of the Bradford health economy. During the year, as Accountable Offi cer, I have worked closely with NHS Bradford and Airedale (NHSB&A), which was the main commissioner of the Trust’s health care services in 2012/13 and with the Yorkshire and Humber Strategic Health Authority who have had a performance management role to fulfi ll with regard to the Trust’s delivery of its objectives. I have also worked closely with NHS Airedale, Bradford and Leeds, when the NHSB&A and NHS Leeds were clustered together in preparation for the change in commissioning and the establishment of Clinical Commissioning Groups (CCGs).
The Trust has also been accountable in 2012/13 to Bradford Metropolitan District Council (BMDC) for the social care it provides through the Section 75 agreement., which terminated on 31 March 2013. In addition, there has been a joint contract management forum between the Trust, NHSB&A and the local authority. Regular meetings are held with BMDC and with the Overview and Scrutiny Committee.
2. Corporate Governance& Board Evaluation
The Trust Board is made up of a Chairperson, Non-Executive Directors, Chief Executive and Executive Directors. The role of the Trust Board is to:
• Set the overall strategic direction of the Trust;
• Regularly monitor our performance against goals;
• Provide effective fi nancial stewardship through value for money, fi nancial control and fi nancial planning;
• Ensure that the Trust provides high quality, effective services; and
• Promote good communication with the people we serve.
The Board of Directors meets monthly (with the exception of August) and discharges its day-to-day management of the Trust through the Chief Executive, individual Executive Directors and senior staff through a scheme of delegation which is approved by the Board.
The Board receives an integrated performance report at each Board meeting measuring performance against national and local targets relating to fi nance, quality and governance indicators. Where there is any deviation from plan, exception reports are presented for consideration of any necessary remedial action.
The Board reviews its own performance through an annual evaluation that covers Board composition, performance, team working, the role of the Chair and effectiveness of Board Committees. This was considered at the Board meeting in September 2012, and subsequently at a Board development Day in December 2012, focusing on the work of Board Committees, the Board Assurance Framework (BAF) and Board relationships. One signifi cant decision was to establish a Finance, Business and Investment Committee of the Board.
In 2011, the Department of Health introduced the Board Governance Assurance Framework (BGAF) aimed at assessing the effectiveness of corporate governance systems of Aspirant Foundation Trusts (AFTs). The Board approved a refreshed self assessment against the BGAF in June 2012 and submitted this to the SHA as part of the FT application process. An independent review of the Trust’s BGAF submission was undertaken by KPMG in July 2012 which concluded that the Board had good governance arrangements in place and there were ‘no signifi cant issues that needed immediate action or resulted in gaps in governance arrangements’. As an AFT, the Trust is not subject to the comply and explain principle set out in Monitor’s Code of Governance but as part of the work in response to Historical Due Diligence (Phase 1), the Board has considered each area of the Code and made a number of changes to its corporate governance arrangements as a result.
The Board has set out how it monitors its performance against the national priorities set out in the NHS Operating Framework, has a range of measures that are regularly reviewed at Board and Committee meetings and has seen a steady improvement during this reporting period.
Board Committee StructureThe Board has established a number of Committees to exercise its functions and provide assurance that the Trust is carrying out its duties effectively, effi ciently and economically, described below. The Board has co-opted a small number of senior managers to different Committees. The main duties of each Committee are set out below. Each Committee undertakes an annual evaluation and submits an Annual Report to the Board. These reports were considered by the Board at its May meeting as assurance against the wider Annual Report by the Trust. At each Board meeting there is also a written report highlighting any signifi cant issues from Committees and Committee
2012/13 Annual Governance Statement
49
minutes are circulated to all Board members. Over the course of 2012/13 work has continued, particularly on service governance areas, to review how assurances are provided under the new locality structures.
Audit CommitteeThe Audit Committee is responsible for the Trust’s systems of internal control. It provides the Board with an independent and objective review of fi nancial and corporate governance, risk management, external and internal audit programmes. It is responsible for making sure the Trust is well governed. Taking a risk-based approach, the Committee has worked to an annual plan covering the main elements of the Assurance Framework. The Committee met fi ve times in 2012/13.
Service Governance CommitteeThe Service Governance Committee has responsibility to monitor, review and report to the Board the adequacy of the Trust’s processes in the areas of clinical and social care governance and where appropriate facilitate and support existing systems operating across the Trust. This includes the monitoring of incidents and complaints, clinical policies, research and development, clinical audit and service improvements. The Committee met six times in 2012/13.
Resources Committee/Finance, Business and Investment Committee (FBIC)The Resources Committee examined a number of resource-related areas. This included the systems and processes that we have in place for human resources management, compliance against relevant (non-clinical) legislation (such as health and safety), facilities and estates management, informatics and various fi nancial aspects relating to the Trust’s business such as its capital programme, fi nancial effi ciency targets, Service Line Reporting and Payment by Results.
In July 2012, the Board considered a change in its Committee structure in response to the Historical Due Diligence (HDD1) Report from Grant Thornton which stated that, ‘The Trust should make provision for the development of the Investment Committee function in preparation for authorisation as a Foundation Trust’ and that this should be undertaken ‘Before Working Capital Stage’. The Board had also recently introduced an integrating performance report and the level of fi nancial reporting had changed as a result.
The Board concluded that a FBIC should be established to replace the existing Resources Committee, with a re-focus on fi nancial reporting and monitoring, fi nancial strategy and planning, and future investment priorities. Terms of reference were agreed and the fi nal Resources Committee meeting was held on 22 August 2012. The fi rst FBIC meeting was held on 29 October 2012.
Mental Health Legislation Committee (MHLC)The Mental Health Legislation Committee has a wide cross section of membership comprising Non-Executive and
Executive Directors, an Associate Hospital Manager, senior clinicians and service user and carer representatives. The Committee has responsibility to monitor, review and report to the Board on the adequacy of the Trust’s processes relating to all mental health legislation. It meets on a quarterly basis and met four times in 2012/13.
Remuneration CommitteeIn addition to these assurance committees, the Board has an established Remuneration Committee, comprised exclusively of Non Executive Directors, which considers the terms and conditions of appointment of the Executive Directors and Chief Executive. The Committee met fi ve times in 2012/13.
Nominations CommitteeDuring 2011/12 the Board established a Nominations Committee to review the structure, size and composition of the Board and, where necessary, be responsible for identifying and nominating for appointment candidates to fi ll posts within its remit. All Non Executive Directors are members of this Committee, which met three times in 2012/13. In preparation for becoming a Foundation Trust, the Board decided to dis-continue the role of Board Special Advisers. Its key responsibility in 2012/13 was therefore to oversee the appointment of two new Non Executive Directors and the appointment of a new Commercial Director.
Charitable Funds CommitteeThe Charitable Funds Committee oversees the Trust’s charitable activities and ensures we are compliant with the law and regulations set by the Charity Commissioners for England and Wales. The Board is responsible for this area but this Committee looks in detail at charitable matters and works with the Charity Commissioners where necessary.
Division of responsibilitiesThe Board is satisfi ed that there is a clear division of responsibilities between the Chair and Chief Executive and this was once again reviewed by the Board at its meeting in January 2013.
Confl icts of interestThe Board is satisfi ed that no direct confl icts of interest exist for any member of the Board, and an accurate register of interests is regularly maintained.
Discharge of statutory functionsThe Board is satisfi ed that, through its own Standing Orders and the work of its Committees, arrangements are in place for the discharge of its statutory duties, checked for any irregularities and are legally compliant.
Board attendanceAttendance at Board and Committee meetings is shown in the table overleaf.
50
Board Member Attendance at Committees and Board MeetingsApril 2012 – March 2013
Name Aud
it
Com
mit
tee
Serv
ice
Gov
erna
nce
Com
mit
tee
Reso
urce
Co
mm
itte
e
Fin
ance
, Bu
sine
ss a
nd
Inve
stm
ent
Com
mit
tee
Men
tal H
ealt
h Le
gisl
atio
n (M
HL)
Co
mm
itte
e
Rem
uner
atio
n Co
mm
itte
e
Nom
inat
ion
Com
mit
tee
Char
itab
le F
und
Com
mit
tee
Boar
d M
eeti
ng
Barry Seal (Chair) 1/1
Michael Smith (Chair) 1/1 1/1 2/3 5/5 3/3 12/12²
Simon Large 2/3 0/2 12/12
Nicola Lees 4/6 3/4 2/2 11/12
Nick Morris 2/3 3/3 5/6
Nadira Mirza 1/5 3/6 3/3 3/3 4/5 1/3 0/2 11/12
Derrick Palmer 5/5 3/3 2/3 4/4 3/3 2/2 11/12
Andy McEligott 6/6 3/4 12/12
Sandra Knight 3/3 12/12
Ralph Coyle 5/5 6/6 4/4 3/4 2/3 2/2 10/12*
Carol Stubley 3/3 3/3 2/2 12/12
Sue Butler 3/5 1/2 3/3 3/3 3/3 8/11
Susan Ince 3/3³ 6/6³
Rob Vincent 1/2
Ian Cherry 2/2
Richard Pattinson 1/1 1/1*
Dale Smith 0/1 1/1
Jan Smithies 1/1
Key
� Attended
� Did Not Attend
¹ One Board meeting was held solely in private (14 March 2013)
² One as a Non-Executive Director
³ As Acting Director of Performance, Planning and Information
* One as a Board Special Adviser
51
3. The Purpose of the System of Internal Control
The system of internal control is designed to manage risk to a reasonable level rather than to eliminate all risk of failure to achieve policies, aims and objectives; it can therefore only provide reasonable and not absolute assurance of effectiveness. The system of internal control is based on an ongoing process designed to:
• Identify and prioritise the risks to the achievement of the organisation’s strategic intents, policies, aims and objectives; and
• Evaluate the likelihood of those risks being realised and the impact should they be realised, and to manage them effi ciently, effectively and economically.
The system of internal control has been in place in BDCT for the year ended 31 March 2012 and up to the date of approval of the annual report and accounts.
4. Risk AssessmentProcess for assessing risk
The Board has endorsed the Trust’s revised Risk Management Strategy and Policy which drives the improvement process for the assessment and management of risk throughout the organisation. This strategy includes a comprehensive procedure on the assessment process that includes the Risk Assessment Matrix (RAM) which provides a baseline level of consistency to the process of risk rating.
Signifi cant progress has been achieved in 2012/13 in relation to the continued evolution, embedding and improvement of the electronic risk register (e-RR) process across the Trust. This included a realignment of the risk management system to meet the revised operational services structure. This approach supports continued effective assessment of risk including supporting decisions to escalate / de-escalate risks dependant on the current assessed risk rating. BDCT was one of the fi rst Trusts nationally to implement the electronic risk escalation function and the related automated notifi cations. This has proved useful in the iterative management of risk in terms of assessing, updating and monitoring risks.
Consideration of risk occurs at all levels of the organisation and electronic risk registers are in place at team, senior manager, locality/operational, directorate and corporate levels. This ensures that risks are identifi ed, assessed and managed at the most appropriate level.
The Quality and Risk Profi le produced by the Care Quality Commission provides a valuable overview of potential risk issues and is reported upon and reviewed by the Executive Management Team and the Trust Board, with actions in place to address risk issues identifi ed.
The Trust was externally assessed by the NHSLA in 2012/13 which resulted in 100% compliance with level 1 of the NHSLA Risk Management Standards.
52
Risk Profilea) New risks identifi ed during 2012/13
The Trust has in place a Corporate Risk Register (CRR) which is integrated into the electronic Risk Register, (e-RR), process. The CRR has been reviewed by the Board and Committees throughout the year.
During 2012/13 the Trust’s Executive and Board accepted the inclusion of the following risks onto the CRR and Board Assurance Framework (BAF). The statement against each confi rms whether that risk was mitigated in year and hence will not be included in 2013/14:
Changes to the CRR and BAF in 2012/13
Corporate Risk Register
May 2012
Failure to meet Health Visitor expansion targets as agreed with commissioners.
• Risk de-escalated to locality level in February 2013 as the expansion target was close to full achievement.
June 2012
Delivering the transforming care programme
• Removed from the CRR in August 2012; A risk register for the transforming care programme was developed and all risks associated with the project captured within that process.
June 2012
Implementation of performance & governance systems in relation to alignment with revised locality working.
June 2012
Local demand outstripping resource in relation to Community Mental Health Teams.
June 2012
Risk to delivery of plans due to poor relationships with Local Authority (adult services).
• Removed from the CRR in October 2012 as the Section 75 Agreement was finalised and as a result risk minimised.
June 2012
Risk to delivering community well-being processes
• Removed from the CRR in January 2013; felt to be sufficient and effective engagement in Well Being Boards, public health agendas etc.
August 2012
Risk to appropriate care co-ordination due to the size of Consultant case loads.
Nov 2012
Any Qualified Provider, Podiatry services; risk relating to potential loss of income.
Board Assurance Framework (Strategic Risks)
Sept 2012
Tariff reduction – Risk to the delivery of the Trusts Integrated Business Plan and maintaining a fi nancial risk rating of 3 if due to worsening economic climate that the actual tariff reduction in future fi nancial years is 0.5 % higher than planned.
Sept 2012
Organisational Development – Failure to maintain the level of organisational development and culture change required to deliver the agenda.
Removed from the BAF in January 2013 as Organisational development and cultural change included as aspects of the risk below added in Jan 2013.
Jan 2013
Inability to deliver service transformation and organisational change, resulting in non-delivery of service and fi nancial benefi ts in full and on schedule.
Jan 2013
Failure to reorganise services around commissioning organisations and meet their requirements.
March 2013
The Trust’s response to the Francis report does not meet the expectations of staff, service users and the public, losing the opportunity to understand and improve service quality and adversely affecting relationships and reputation.
53
The electronic risk register system enables a wider view of the Trust’s risk profi le as a whole with each risk allocated to a specifi c risk group. The source of the risk i.e. how the risk was identifi ed is also identifi ed and logged on the system. Examples of sources are: an incident; a complaint, from a benchmarking exercise.
The key risks identifi ed for 2013/14 are:
• The risk to quality of care arising from growth in demand for services;
• Maintaining sound systems of internal control during a period of signifi cant internal management reorganisation and transformation.
• Failure to respond successfully to competition for services and to exploit opportunities for acquisition or merger of services.
b) Lapses of data security (including any reported to the Information Commissioner.
Such lapses are reported internally through the web based incident reporting system (IR-e). The data is reported to and monitored by the Information Governance (IG) Group. Should there be a serious lapse in data security this would be reported as a serious incident and hence follow the serious incident management procedure as appropriate. Four incidents were reported and investigated during 2012/13. One of the improvement actions resulted in the development of a diary policy as an interim measure until agile working and electronic diaries are implemented. For all serious incidents the learning was fed back to teams and none required reporting to the Information Commissioner’s Offi ce.
5. The Risk and Control FrameworkKey elements of the Trust’s Risk Management Strategy include the principles, processes, accountabilities and the regulatory framework for managing risk.
The Trust Board has overall accountability for the risk management framework, systems, policy, procedures and activities of the organisation. The Medical Director is the nominated Executive Director lead for risk management.
The Service Governance Committee is a formally constituted Committee of the Board. This Committee has delegated responsibility and authority for monitoring the risk management process. However all formal Committees of the Trust Board also have responsibility for monitoring the risks relating to the work of that Committee. This is achieved by specifi c risks within the CRR being allocated to a named Committee; each Committee then undertakes regular, programmed reviews of allocated risks, seeking assurance as appropriate.
Each Committee is supported by the Risk Assurance Group which is chaired by the Chief Executive; membership includes Deputy Directors and Risk Specialists.
The Trust Board receives assurance from all formally constituted Committees of the Board, reporting back on meetings at the next Board meeting. The Audit Committee provides independent assurance on all aspects of governance and controls; this includes internal and external audit.
The Executive Management Team also routinely reviews the corporate risk register and assures itself that mitigating actions are in place to address and mitigate the risks.
The Risk Assurance Group is supported by the Clinical & Safety Learning Forum and the Health & Safety Learning Group, the former is being developed to encourage, embrace and share learning across the Trust from both good practice and lessons learned when things have gone wrong.
Risk management is fi rmly embedded within the governance processes and structures in both clinical services and support directorates. Service Governance groups have regular agenda items which include reviewing risks and incidents.
The National Patient Safety Agency (NPSA) defi ned high levels of incident reporting as a positive sign of an open reporting culture and a safer organisation. BDCT remains a consistently high reporting organisation which is evident in the six monthly ‘organisation patient safety incident report’ published by the NHS Commissioning Board.
Risk management contributes to the quality report which provides monthly reports on key performance indicators and provides an additional early warning system of risk which may affect delivery of a strategic objective.
The Trust shares all alerts and reports on serious incidents with Commissioners as soon as they occur or as soon as there is knowledge of the event. These individual reports are supported by quarterly reports which are presented internally to the Trust Board and Service Governance Committee. All other incidents are reported quarterly to the Service Governance Committee. Both of these quarterly reports are also presented at the Quality Performance Group for analysis and scrutiny by Commissioners.
6. Review of the Effectiveness of Risk Management and Internal Control
The implementation of the electronic risk register system (e-RR) has resulted in a complete review of the risk register structure and identifi ed all teams and departments that have a risk register. Each risk register has a nominated risk guardian who is responsible for that particular risk register and the regular review of the risks logged. The e-RR system
54
logs actions and assurances with a full audit trail of progress.
The activity on the risk registers is monitored as a key component of our risk management quality processes which are constantly being improved. Activity reports, trends and risk issues are reviewed by the Risk Assurance Group which provides assurance to the Board Committees on the process and escalates risks to the allocated Committee as appropriate and required.
An Internal Audit on risk management processes was undertaken in March 2013 and reported to Audit Committee in May 2013. The review provided signifi cant assurance that the Trust’s risk management arrangements, including risk registers, have been aligned to the organisation’s structure changes.
7. Review of EffectivenessAs Accountable Offi cer, I have responsibility for reviewing the effectiveness of the system of internal control. My review is informed in a number of ways. The Head of Internal Audit provides me with an opinion on the overall arrangements for gaining assurance through the BAF and on the controls reviewed as part of the internal audit work. A signifi cant opinion has been given. Robust procedures are in place for following up all internal audit recommendations.
Executive Directors and Senior Managers within the organisation, who have responsibility for the development and maintenance of the system of internal control, provide me with assurance.
The Trust’s BAF provides me with evidence that the effectiveness of controls that manage the risks to the organisation achieving its strategic intents have been reviewed.
My review is also informed by external assessments carried out by:
• Care Quality Commission
• Audit Commission/KPMG (our external auditors – at a cost of £67,000 for 2012/13)
• Registration Assessment
• NHSLA Risk Management Assessment
• Health and Safety Executive
• National patient and staff surveys
• Local Involvement Networks (Links)
• Bradford & Airedale and North Yorkshire Overview and Scrutiny Committees
Internal audits are undertaken to report on effectiveness throughout the year; all internal audit reports are presented at Audit Committee.
In January 2013, the Department of Health issued amendments to the National Health Service (Quality Accounts) Regulations 2010. These amendments came into effect from February 2013 and changed the reporting requirements for Quality Accounts for 2012/13. The regulations have been amended to take into account changes to the care system from April 2013, following the introduction of the Health and Social Care Act 2012; and change what information Trusts are required to report in future Quality Accounts. The proposed changes include mandatory reporting of a core set of quality indicators.
55
The Trust has worked with the external auditors who have reviewed the production of the Quality Accounts and its content. KPMG has presented a statement that they were confi dent that the Quality Accounts have been generated appropriately and robust systems featured in the controls ensuring that data was reported accurately. The Quality Accounts are submitted to the Service Governance Committee, and then the Board for approval, prior publication.
I have been advised on the implications of the result of my review of the effectiveness of the system of internal control by:
• Executive Management Team
• Executive Directors’ letters of representations
• Trust Board
• Audit Committee
• Service Governance Committee
• Resources Committee
• Finance, Business and Investment Committee
• Mental Health Legislation Committee
• Risk Assurance Group
With the exception of the internal control issues that I have outlined in this statement, my review confi rms that BDCT has a generally sound system of internal controls that supports the achievement of its policies, aims and objectives and that those control issues have been or are being addressed.
8. Significant IssuesDuring 2012/13, no signifi cant control issues have been identifi ed by the Trust’s systems of internal control. My review confi rms that Bradford District Care Trust has generally sound systems of internal control that supports the achievement of its policies, aims and objectives.
Simon LargeChief Executive
56
2012/13 has been a challenging but successful year from a fi nancial perspective. We have delivered a surplus of £1,462k (1%) in line with our fi nancial plan. The delivery of a 1% surplus is a requirement for all NHS Foundation Trusts in the 2012/13 NHS Operating Framework.
A key achievement has been the development of our integrated business plan and associated long term fi nancial model for the fi ve year period 2013/14 – 2017/18. The plan supports the delivery of our strategic vision and provides an increasing level of fi nancial head room in order to mitigate against the fi nancial risks posed by the challenging economic outlook. The plans that have been formulated as a consequence demonstrate an improvement in our net margin and earnings before interest, tax and amortisation (EBITDA) over the fi ve years ending 31 March 2018.
These plans support our Foundation Trust application and have been subject to external scrutiny.
There has been a substantial shift in the fi nancial risk that we have been exposed to in 2012/13 following the termination of the Section 75 Partnership Agreement and retrospective transfer of higher risk budgets back to the Council in April 2012. The negotiations secured a signifi cant milestone in our fi nancial strategy, addressing long standing cross-subsidisation from health funded budgets and removing longer term fi nancial risk.
Our 2012/13 fi nancial plan required us to deliver an overall cost reduction of £6.7m, equivalent to 5% on health budgets. The impact of the savings on quality has been risk assessed by the Medical Director and Deputy Chief Executive /Director of Nursing and monitored by the Board.
Our performance in year has been strong, and in addition to delivering the 2012/13 Cost Improvement Plan (CIP) target in full, we have delivered £1.3m of the 2013/14 CIP ahead of plan. This coupled with other service under spending has enabled a number of non recurrent programmes to be supported in year and to enable provisions to be made in the annual accounts for non recurrent restructuring costs associated with two of our transformational programmes.
A key strand of our cost improvement plans is the rationalisation of our estate. Substantial progress has been made in this area which has led to the disposal of the Leeds Road Hospital site, the Unity building and Bryan Sutherland House.
Financial Outlook 2013/14Our fi nancial plan has been based on the fi rst year of our integrated business plan and supports the delivery of our key fi nancial ratings, a risk rating of 4 under the current Monitor compliance framework and the achievement of a surplus of £3,481k.
We are targeting a higher level of planned surplus in 2013/14 to provide additional headroom to support the organisation in managing unplanned fi nancial risks and providing some mitigation against downside factors which include the impact of increased competition.
We are planning to achieve this increased surplus through the delivery of a CIP programme of £7.2m (5.4%) against budgets. The focus of the 2013/14 programme has been to continue to protect frontline services through the restructuring of management and back offi ce functions and progressing estate rationalisation. In addition, further savings will be delivered through the delivery of a number of transformational change programmes which deliver both service, quality and productivity gains. The impact of the savings on quality has been risk assessed by the Medical Director and Deputy Chief Executive / Director of Nursing.
Financial Review 2012/13
57
Financial Performance Report 2012/13NHS organisations are required to prepare their accounts using International Financial Reporting Standards (IFRS). A short glossary of some of the key IFRS terms used is set out below:
IFRS Defi nition
Revenue The total resources that the Trust receives for the year.
Statement of Financial Position
Snapshot at the end of the year of what the Trust owns and owes (assets and liabilities).
Non Current Not short term usually expected to relate to a period of more than one year.
Inventories Stock held by the Trust.
Receivables Money earned and owed to the Trust.
Payables Money the Trust owes, but has not yet paid.
Retained Earnings
The total net defi cit or surplus since the creation of the Trust.
Statement of Comprehensive Income
Records the Trust’s income and expenditure for the year and any recognised gains and losses.
As an NHS Trust, we have to meet four statutory fi nancial duties, as directed by the Government. The Trust has met all of its four statutory fi nancial targets in 2012/13 which are:
1. Break-even The reported defi cit of £1,861k includes impairments
charged to expenditure of £3,323k. This value has been treated as a technical adjustment in accordance with NHS accounting guidance and is excluded from the calculation of the Trust’s break even performance resulting in a surplus of £1,462k. We therefore met this target by making an in year retained surplus of £1,462k after impairments which is in line with our planned position.
2. Capital Absorption Rate We achieved a capital absorption rate of 3.5%.
3. External Financing Resource Limit We are required to manage our cash resources
within the external fi nancing resource limit set by the Department of Health. Our actual cash requirements were £2,039k lower than the external fi nancing resourcing limit.
This means that we had a higher cash balance at 31 March 2013 than originally planned. This position was in line with the forecast and refl ected the impact of earlier than normal settlement of NHS liabilities and uncertainty around April contract payments and the timing of settlement of old year liabilities by successor bodies as new arrangements come into effect across the NHS in 2013/14.
4. Capital resource limit. To manage capital expenditure within the capital
resource limit (CRL) set by the Department of Health. For 2012/13 we achieved an under spend of £374k against a limit of £1,081k. A summary of our fi nancial performance over the last fi ve years is summarised in the table below:
Financial Targets 2008/09£000
2009/10£000
2010/11£000
2011/12£000
2012/13£000
Retained surplus / (defi cit) for the year 546 103 104 108 1,462
% of Turnover 0.41 0.09 0.09 0.06 1.08
Capital Absorption Limit (Target 3.5%)
Rate achieved 4.6 3.5 3.5 3.5 3.5
External Financing Resource Limit
Undershoot / EFL achieved 5 399 48 5 2,039
Capital Resource Limit
Capital Resource Limit (CRL) 2,348 2,620 3,068 3,834 1,081
Undershoot / CRL Achieved 452 420 283 798 374
58
Under the Better Payment Practice Code, we are required to aim to pay 95% of all undisputed invoices by the due date or within 30 days of receipt of goods or a valid invoice, which ever is later. This is measured by both volume and value of transactions in year. In 2012/13, we have paid 91.5% (by volume) and 94.2% by value of Non NHS trade invoices, against a target of 95%. The same measures of compliance are also applied to NHS invoices and the percentages of these invoices paid within the target were 89.4% (by volume) and 95.2% (by value) against a 95% target.
During 2012/13, we committed our capital resources in the following areas:
• A review of how in-patient services are confi gured which has resulted in a phased approach to change and improve the ward based facilities. This has led to the development of PICU on Lynfi eld Mount Hospital site which will enable the longer term reconfi guration of in-patient beds for older people across the Bradford and Airedale sites.
• Relocation of community teams to Meridian House.
• Investment in information technology to upgrade systems, infrastructure and support the roll out of mobile technology to community based staff. This supports more effi cient ways of working.
• Backlog maintenance which keeps our buildings in good order as well as ensuring we comply with legal requirements including fi re safety.
• Improvements and adaptations to the physical condition of our buildings to ensure continued suitability for existing use in the short to medium term.
• Adaptations to enable the rationalisation of the number of kitchens on the Lynfi eld Mount site as part of our cost improvement plans.
The following 2 charts illustrate graphically from where we receive our income and what we spend it on.
Sources of Income in 2012/13
How Resources were Spent in 2012/13
Financial Review 2012/13
Key
� Primary Care Trusts
� Local Authorities
� Other Income
88%
9%
3%
� Supplies and Services
� Establishment
� Transport
� Premises
� Depreciation
� Other: including impairments / reversal of impairments of property, plant and equipment
� Services from NHS Trusts, NHS Bodies & PCT’s
� Purchase of Healthcare from Non NHS Bodies
� Staff Costs
76%
3%
4%
4%
5%
5%
2%
0%
1%
Key
59
Statement of Comprehensive Income for Year Ended 31 March 2013
Financial Targets 2012/13£000
2011/12£000
Gross employee benefi ts (102,317) (123,891)Other costs (33,940) (46,210)Revenue from patient care activities 125,205 158,624Other Operating revenue 10,653 8,467
Operating defi cit (399) (3,010)
Investment revenue 67 44Other losses 0 (10)Finance costs (230) (249)Defi cit for the fi nancial year (562) (3,225)Public dividend capital dividends payable (1,299) (1,575)
Retained defi cit for the year (1,861) (4,800)
Other Comprehensive Income
Impairments and reversals (793) (2,071)Net gain on revaluation of property, plant & equipment 323 732
Total comprehensive income for the year* (2,331) (6,139)
Financial performance for the year
Retained defi cit for the year (1,861) (4,800)Impairments 3,323 4,908
Adjusted retained surplus 1,462 108
* This sums the rows above and the defi cit for the year before adjustments for PDC dividend and
absorption accounting.
Financial PerformanceA Trust’s Reported NHS fi nancial performance position is derived from its Retained surplus/(defi cit), but adjusted for the following:
Impairments to Fixed Assets. Impairments of £3,323,000 have been charged to expenses during 2012/13 and are excluded from the calculation of the Trust’s break even position, resulting in a surplus of £1,462,000.
Summary of Financial Statements
60
Statement of Financial Position as at 31 March 2013
31 March 2013£000
31 March 2012 (restated)
£000
Current year local PPA
adjustment* £000
31 March 2012 (restated)
£000
31 March 2011 (restated)
£000
Non-Current Assets
Property, plant and equipment 47,829 52,305 0 52,305 60,859
Trade and other receivables 0 2,182 0 2,182 806
Total non-current assets 47,829 54,487 0 54,487 61,665
Current Assets
Inventories 9 12 0 12 13
Trade and other receivables 4,396 5,496 0 5,496 7,891
Cash and cash equivalents 16,326 14,542 0 14,542 9,088
Total current assets 20,731 20,050 0 20,050 16,992
Non-current assets held for sale 2,175 3,088 0 3,088 180
Total current assets 22,906 23,138 0 23,138 17,172
Total assets 70,735 77,625 0 77,625 78,837
Current Liabilities
Trade and other payables (11,625) (14,201) 0 (14,201) (11,772)
Provisions (2,947) (2,386) 0 (2,386) (1,028)
Borrowings (278) (482) 0 (482) (479)
Total current liabilities (14,850) (17,069) 0 (17,069) (13,279)
Net Current Assets 8,056 6,069 0 6,069 3,893
Total Assets less Current Liabilities 55,885 60,556 0 60,556 65,558
Non-current liabilities
Other Liabilities 0 (1,893) 0 (1,893) (520)
Provisions (511) (906) 0 (906) (906)
Borrowings (4,028) (4,080) 0 (4,080) (4,316)
Total non-current liabilities (4,539) (6,879) 0 (6,879) (5,742)
Total Assets Employed: 51,346 53,677 0 53,677 59,816
Financed by Taxpayers’ equity
Public Dividend Capital 34,109 34,109 0 34,109 34,109
Retained earnings (8,077) (7,072) 5,294 (12,366) (7,667)
Revaluation reserve 15,118 16,444 (5,294) 21,738 23,178
Other reserves 10,196 10,196 0 10,196 10,196
Total Taxpayers’ Equity: 51,346 53,677 0 53,677 59,816
* The local prior period adjustment relates to the impairment of the Unity Building in 2011/12. This was charged to the SOCI and the corresponding reserve transfer from the revaluation reserve to the retained earnings reserve was not completed. This has been refl ected as an adjustment to opening balances in the local accounts to provide consistency with Department of Health reporting requirements.
Financial Review 2012/13
61
Statement of Cash Flows for the Year Ended 31 March 2013
2012/13 £000s
2011/12 £000s
Cash Flows from Operating Activities
Operating Surplus/Defi cit (399) (3,010)
Depreciation and Amortisation 2,303 2,435
Impairments and Reversals 3,323 4,908
Interest Paid (230) (249)
Dividend (Paid) / Refunded (1,378) (1,627)
Decrease in Inventories 3 1
Decrease in Trade and Other Receivables 3,383 1,041
Increase/(Decrease) in Trade and Other Payables (3,530) 2,060
(Increase)/Decrease in Other Current Liabilities (1,893) 1,373
Provisions Utilised (1,458) (435)
Increase in Provisions 1,601 1,793
Net Cash Infl ow/(Outfl ow) from Operating Activities 1,725 8,290
Cash fl ows from investing activities
Interest Received 67 44
Payments for Property, Plant and Equipment (3,061) (2,817)
Proceeds of disposal of assets held for sale (PPE) 3,308 170
Net Cash Infl ow/(Outfl ow) from Investing Activities 314 (2,603)
NET CASH INFLOW BEFORE FINANCING 2,039 5,687
Cash flows from financing activities
Capital Element of Payments in Respect of Finance Leases and On-SoFP PFI (255) (233)
Net Cash Outfl ow from Financing Activities (255) (233)
NET INCREASE IN CASH AND CASH EQUIVALENTS 1,784 5,454
Cash and Cash Equivalents at beginning of the period 14,542 9,088
Cash and Cash Equivalents at year end 16,326 14,542
Summary of Financial Statements
62
Summary of Financial Statements
Statement of Changes in Taxpayers’ Equity for the Year Ended 31 March 2013
Public Dividend Capital £000
Retained Earnings
£000
Revaluation Reserve £000
Other Reserves
£000
TotalReserves
£000
Balance at 1 April 2012 34,109 (12,366) 21,738 10,196 53,677
Opening balance adjustments – local PPAs* 0 5,294 (5,294) 0 0
Local accounts – restated opening balance 34,109 (7,072) 16,444 10,196 53,677
Changes in taxpayers’ equity for 2012/13
Retained defi cit for the year (1,861) (1,861)
Net gain on revaluation of property, plant, equipment 323 323
Impairments and reversals (793) (793)
Transfers between reserves 856 (856) 0
Net recognised expense for the year 0 (1,005) (1,326) 0 (2,331)
Balance at 31 March 2013 34,109 (8,077) 15,118 10,196 51,346
Balance at 1 April 2011 34,109 (7,667) 23,178 10,196 59,816
Changes in taxpayers’ equity for the year ended 31 March 2012
Retained deficit for the year (4,800) (4,800)
Net gain on revaluation of property, plant, equipment 732 732
Impairments and reversals (2,071) (2,071)
Transfers between reserves 101 (101) 0
Net recognised expense for the year (4,699) (1,440) (6,139)
Balance at 31 March 2012 34,109 (12,366) 21,738 10,196 53,677
* The local prior period adjustment relates to the impairment of the Unity Building in 2011/12. This was charged to the SOCI and the corresponding reserve transfer from the revaluation reserve to the retained earnings reserve was not completed. This has been refl ected as an adjustment to opening balances in the local accounts to provide consistency with Department of Health reporting requirements.
63
Related Party TransactionsDetails of related party transactions with individuals are as follows:
During the year two Non Executive Board Members had transactions with the Department of Health totalling £65,000 (£0 2011/12), the NHS Institute of Innovation & Improvement totalling £2,853 (£0 2011/12) and with Hull Teaching PCT £666 (£0 2011/12).
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 material transactions with Bradford District Care Trust.
The Department of Health is regarded as a related party. During the year Bradford District Care Trust has had a signifi cant number of material transactions with the Department, and with other entities for which the Department is regarded as the parent Department. These entities are:
2012/13 Income£000
Expenditure£000
Bradford & Airedale Teaching Primary Care Trust 116,104 5,764
Barnsley PCT 4,540 3
North Yorkshire & York Primary Care Trust 3,747 0
Yorkshire and the Humber SHA 2,630 398
Bradford Teaching Hospitals Foundation Trust 1,009 1,742
Airedale NHS Foundation Trust 169 2,119
2011/12 – Prior Period Comparators Income£000
Expenditure£000
Bradford & Airedale Teaching Primary Care Trust 118,575 5,946
Barnsley PCT 4,549 3
North Yorkshire & York Primary Care Trust 4,016 12
Yorkshire and the Humber SHA 2,666 6
Bradford Teaching Hospitals Foundation Trust 1,030 1,812
Airedale NHS Foundation Trust 188 2,305
In addition, the Trust has had a number of material transactions with other government departments and other central and local government bodies. Most of these transactions have been with Bradford Metropolitan District Council and related to the Section 75 Agreement which has been terminated in 2012/13. These transactions are:
Income£000
Expenditure£000
2012/13 3,680 2,514
2011/12 – Prior Period Comparators 29,548 5,711
Receivables£000
Payables£000
2012/13 2,617 811
2011/12 – Prior Period Comparators 2,721 1,339
The Trust manages charitable funds on behalf of the Bradford District Care Trust Charitable Fund and Bradford and Airedale PCT Charitable Fund. These are both separately registered charities whose accounts are published in the Charity Commission website. An administration charge of £6,864 in 2012/13 was levied on the Care Trust charity for the services provided by the trust.
64
Better Payment Practice Code
Better Payment Practice Code – measure of compliance
2012/13 2011/12
Number £000 Number £000
Total Non-NHS trade invoices paid in the year 16,819 33,747 22,837 41,093
Total Non-NHS trade invoices paid within target 15,382 31,803 21,421 38,352
Percentage of Non-NHS trade invoices paid within target 91% 94% 94% 93%
Total NHS trade invoices paid in the year 890 15,474 752 32,130
Total NHS trade invoices paid within target 796 14,724 632 28,920
Percentage of NHS trade invoices paid within target 89% 95% 84% 90%
The Better Payment Practice Code requires the Trust to aim to pay all undisputed invoices by the due date or within 30 days of receipt of goods or a valid invoice, whichever is later.
The Trust has applied to sign up to the Prompt Payments Code.
Summary of Financial Statements
65
Audited Remuneration Report for 2012/13
Remuneration ReportThe Remuneration Committee assesses the performance objectives set by the Chief Executive for each Director and the Chair for the Chief Executive. The tables below contain details of senior managers’ remuneration and pensions relating to individuals who have held offi ce during the reporting year and details of exit packages agreed during 2012/13.
Salary & Allowances2012/13 2011/12
Name and Title
Salary(bands of £5000)
£000
Bonus Payments (bands of £5000)
£000
Benefi tsin Kind
Rounded to the nearest
£100
Salary(bands of £5000)
£000
Bonus Payments(bands of £5000)
£000
Benefi tsin Kind
Rounded to the nearest
£100
B Seal – Chairman (to 30.4.12) 0 – 5 20 – 25
M Smith – Chairman (Acting from 1.5.12, substantive from 6.9.12)
15 – 20
D Palmer – Non Executive Director 5 – 10 5 – 10
L Smith – Non Executive Director (to 10.10.11) 0 – 5
M Smith – Non Executive Director (to 30.4.12) 0 – 5 5 – 10
R Pattinson – Special Advisor (to 8.5.12) 0 – 5 5 – 10
R Coyle – Non Executive Director 5 – 10 5 – 10
D Clamp – Non Executive Director (from 5.8.10 to 31.5.11)
0 – 5
D Smith – Non Executive Director (from 21.7.11 to 30.4.12)
0 – 5 0 – 5
J Smithies – Non Executive Director (from 20.10.11 to 30.4.12)
0 – 5 0 – 5
N Mirza – Non Executive Director 5 – 10 5 – 10
S Butler – Non Executive Director (from 3.5.12) 5 – 10
R Vincent – Non Executive Director (from 1.3.13)
0 – 5
I Cherry – Non Executive Director (from 1.3.13) 0 – 5
continued over...
66
Benefi ts in kind relates to lease cars.
Bonus payments in 2011/12 for Dr S Hopker related to a National Clinical Excellence Award and was identifi ed separately for the fi rst time in 2011/12 as per the NHS Manual for Accounts.
The Remuneration Committee, which is made up entirely of Non Executive Directors, considers the terms and conditions of the Chief Executive and the Directors. The remuneration of the Chief Executive and Directors is in accordance with a locally developed framework which uses nationally benchmarked information for the market rates in similar types of Trusts. It takes account of both the job size and the complexity of the role. The pay scales, which have been developed within this framework, allow for progression and were developed in conjunction with the framework by an external organisation on the Trust’s behalf. Progression is subject to satisfactory performance against objectives as assessed by the Chief Executive but also taking feedback from the Chair and Non Executive Directors. The Trust would give 6 months’ notice of termination of a contract and the Chief Executive or Director would be required to give 3 months’ notice. All other terms and conditions relating to the Chief Executive and Directors are in accordance with Agenda for Change.
In accordance with Treasury PES (2012) 17 Annual Reporting Guidance 2012/13, the Trust has no off payroll engagements that would meet the criteria for disclosure with the annual accounts and annual report.
Reporting bodies are required to disclose the relationship between the remuneration of the highest paid director in their organisation and the median remuneration of the organisation’s workforce. The banded remuneration of the highest paid director in Bradford District Care Trust in the fi nancial year 2012/13 was £125,000 – £130,000 (2011/12 £155,000 to £160,000). This was 4.6 times (2011/12 – 5.7 times) the median remuneration of the workforce which was £27,625 (2011/12 – £27,625).
The median salary has been calculated by using the salary costs as set out below for all employees as at 31 March 2013. Where employees work part time, the salary cost has been grossed up to the full time equivalent salary. The calculation does not include bank or agency staff as these staff are engaged on a need to cover a shift basis rather than a full time equivalent basis. Information on the annual salary costs for individual bank and agency staff is not available. Any other form of proxy methodology to calculate a salary cost would not be deemed to provide a fair representation of the median salary of the organisation.
Audited Remuneration Report 2012/13
Salary & Allowances (continued)2012/13 2011/12
Name and Title
Salary(bands of £5000)
£000
Bonus Payments (bands of £5000)
£000
Benefi tsin Kind
Rounded to the nearest
£100
Salary(bands of £5000)
£000
Bonus Payments(bands of £5000)
£000
Benefi tsin Kind
Rounded to the nearest
£100
S Large – Chief Executive 125 – 130 125 – 130
C Stubley – Director of Finance, Contracting & Facilities
95 – 100 90 – 95
S Hopker – Medical Director (from 11.10.10 to 31.3.12)
125 – 130 25 – 30
S Knight – Director of Human Resources and Organisational Development
85 – 90 1,100 80 – 85 600
N Morris – Director of Performance, Planning and Information (to 31.10.12)
50 – 55 200 85 – 90 300
P Hogg – Trust Secretary 75 – 80 300 70 – 75 200
N Lees – Chief Operating Offi cer/Director of Nursing
100 – 105 95 – 100 200
A McElligott – Medical Director (from 1.4.12) 120 – 125 2,400
S Ince – Acting Director of Performance, Planning and Information (from 1.11.12)
35 – 40
N O'Neill – Director of Quality & Service Governance (to 29.2.12)
90 – 95 7,700
67
In 2012/13 two employees (2011/12 – no employees) received remuneration in excess of the highest paid director. Remuneration ranged from £5,000 to £139,000 ( 2011/12 £6,000 to £127,000). Total remuneration includes salary, non consolidated performance-related pay, benefi ts in kind as well as severance payments. It does not include employer pension contributions and the cash equivalent transfer value of pensions. In 2012/13, the highest paid director was the Chief Executive.
2012/13 2011/12
Band of Highest Paid Director’s Total Remuneration (£000)
125 – 130 155 – 160
Median Total Remuneration (£)
27,625 27,625
Ratio 4.6 5.7
68
Audited Remuneration Report 2012/13
Pension Benefits
Name & Title
Real Increase
in Pension at Age 60 (Bands Of £2,500)
£000
Real Increase
in Pension Lump Sum at Age 60 (Bands Of £2,500)
£000
Total Accrued
Pension at Age 60 at 31 March
2013(Bands Of £5,000)
£000
Lump Sum at Age 60 Related To
Accrued Pension at 31 March
2013(Bands Of £5,000)
£000
Cash Equivalent Transfer Value at 31 March
2013
£000
Cash Equivalent Transfer Value at 31 March
2012
£000
Real Increase in Cash
Equivalent Transfer
Value
£000
S Large – Chief Executive 0 – 2.5 0 – 2.5 40 – 45 135 – 140 871 803 26
C Stubley – Director of Finance, Contracting & Facilities
0 – 2.5 0 – 2.5 30 – 35 95 – 100 496 454 18
S Hopker – Medical Director (from 11.10.10 to 31.3.12)*
S Knight – Director of Human Resources and Organisational Development
0 – 2.5 0 – 2.5 30 – 35 90 – 95 607 559 20
N Morris – Director of Performance, Planning and Information (to 31.10.12)**
P Hogg – Trust Secretary 0 – 2.5 5 – 7.5 20 – 25 70 – 75 385 322 46
N Lees – Chief Operating Offi cer/Director of Nursing
0 – 2.5 0 – 2.5 50 – 55 150 – 155 875 804 28
A McElligott – Medical Director (from 1.4.12)
0 – 2.5 2.5 – 5 30 – 35 95 – 100 511 459 28
S Ince – Acting Director of Performance, Planning and Information (from 1.11.12)***
-2.5 – 0 -2.5 – 0 20 – 25 65 – 70 342 317 3
N O'Neill – Director of Quality & Service Governance (to 29.2.12)****
* Steve Hopker retired as Medical Director on 31.3.12 and received his pension benefi ts from 1 April 2012.
** Nick Morris retired as Director of Performance, Planning and Information on 31.10.12 and received his pension benefi ts from 1 November 2012.
*** Susan Ince was Acting Director of Performance, Planning and Information from 1 November 2012.
**** Nancy O Neill took up a secondment with NHS Bradford and Airedale which was effective from 1 March 2012.
As Non-Executive members do not receive pensionable remuneration, there will be no entries in respect of pensions for Non-Executive members.
A Cash Equivalent Transfer Value (CETV) is the actuarially assessed capital value of the pension scheme benefi ts accrued by a member at a particular point in time. The benefi ts valued are the member’s accrued benefi ts and any contingent spouse’s pension payable from the scheme. A CETV is a payment made by a pension scheme, or arrangement to secure pension
benefi ts in another pension scheme or arrangement when the member leaves a scheme and chooses to transfer the benefi ts accrued in their former scheme. The pension fi gures shown relate to the benefi ts that the individual has accrued as a consequence of their total membership of the pension scheme, not just their service in a senior capacity to which the disclosure applies. The CETV fi gures and the other pension details, include the value of any pension benefi ts in another scheme or arrangement which the individual has transferred to the NHS pension scheme. They also include any additional pension benefi t accrued to the member as a result of their purchasing additional years of pension service in the scheme at their own cost. CETVs are calculated within the guidelines and framework prescribed by the Institute and Faculty of Actuaries.
Real Increase in CETV – This refl ects the increase in CETV effectively funded by the employer. It takes account of the increase in accrued pension due to infl ation, contributions paid by the employee (including the value of any benefi ts transferred from another scheme or arrangement) and uses common market valuation factors for the start and end of the period. CPI infl ation of 5.2% has been used in accordance with DH guidance in 2012/13 (3.1% in 2011/12).
No directors have a stakeholder pension.
69
Exit Packages agreed in 2012/13 Exit Packages agreed in 2011/12
Exit package cost band (including any special payment element)
Number of compulsory
redundancies
Number of other
departures agreed
Total number of exit
packages by cost band
Number of compulsory
redundancies
Number of other
departures agreed
Total number of exit
packages by cost band
Less than £10,000 6 1 7 4 0 4
£10,001-£25,000 4 6 10 3 2 5
£25,001-£50,000 8 0 8 4 7 11
£50,001-£100,000 7 2 9 0 13 13
£100,001 – £150,000 2 0 2 0 5 5
Total exit packages by type 27 9 36 11 27 38
Total resource cost (£s) 1,205,503 246,504 1,452,007 197,000 1,882,000 2,079,000
Redundancy and other departure costs have been paid in accordance with the provisions of the NHS Scheme. Exit costs in this note are accounted for in full in the year of departure. Where the trust has agreed early retirements, the additional costs are met by the trust and not by the NHS pensions scheme. Ill-health retirement costs are met by the NHS pensions scheme and are not included in the table.
This disclosure reports the number and value of exit packages taken by staff leaving in the year.
Note: The expense associated with these departures may have been recognised in part or in full in a previous period.
Other departures includes voluntary early retirements and voluntary redundancy payments associated with the restructuring of corporate and administrative functions.
Staff Sickness Absence
TOTAL2012/13(number)
TOTAL 2011/12
(number)
Total Days Lost 32,776 40,044
Total Staff Years 2,665 2,995
Average working Days Lost 12 13
The data above is based on the period January to December 2012, due to timing diffi culties with fi nancial year data. DH considers the resulting fi gures to be a reasonable proxy for fi nancial year equivalents. To preserve consistency, NHS bodies have been advised not to update the fi gures to a fi nancial year base, even if they have the ability to do so. These fi gures have been provided centrally by the Information Centre from the ESR national data warehouse from information provided by the Trust.
70
INDEPENDENT AUDITORS REPORT TO THE DIRECTORS OF BRADFORD DISTRICT CARE TRUST.We have audited the fi nancial statements of Bradford District Care Trust for the year ended 31 March 2013 under the Audit Commission Act 1998. The fi nancial statements comprise the Standard of Comprehensive Income, the Statement of Financial Position, the Statement of Changes in Taxpayers’ Equity, the Statement of Cash Flows and the related notes. The fi nancial reporting framework that has been applied in their preparation is applicable law and accounting policies directed by the Secretary of State with the consent of the Treasury as relevant to the National Health Service in England.
We have also audited the information in the Remuneration Report that is subject to audit, being:
• The table of salaries and allowances of senior managers and related narrative notes;
• The table of pension benefi ts of senior managers and related narrative notes on page; and
• The table of pay multiples and related narrative notes.
This report is made solely to the Board of Directors of Bradford District Care Trust in accordance with Part II of the Audit Commission Act 1998 and for no other purpose, as set out in paragraph 45 of the Statement of Responsibilities of Auditors and Audited Bodies published by the Audit Commission in March 2010.
Respective responsibilities of Directors and auditorsAs explained more fully in the Statement of Directors’ Responsibilities in respect of the Accounts, the Directors are responsible for the preparation of the fi nancial statements and for being satisfi ed that they give a true and fair view. Our responsibility is to audit and express an opinion on the fi nancial statements in accordance with applicable law and International Standards on Auditing (UK and Ireland). Those standards also require us to comply with the Auditing Practices Board’s Ethical Standards for Auditors.
Scope of the audit of the financial statementsAn audit involves obtaining evidence about the amounts and disclosures in the fi nancial statements suffi cient to give reasonable assurance that the fi nancial statements are free from material misstatement, whether caused by fraud or error. This includes an assessment of: whether the accounting policies are appropriate to the Trusts’ circumstances and have been consistently applied and adequately disclosed; the reasonableness of signifi cant
accounting estimates made by the Trust; and the overall presentation of the fi nancial statements. In addition, we read all the fi nancial and non fi nancial information in the annual report to identify material inconsistencies with the audited fi nancial statements. If we become aware of any apparent material misstatements or inconsistencies we consider the implications for our report.
Opinion on financial statementsIn our opinion the fi nancial statements:
• give a true and fair view of the fi nancial position of Bradford District Care Trust as 31 March 2013 and of its expenditure and income for the year then ended; and
• have been prepared properly in accordance with the accounting policies directed by the Secretary of State with the consent of the Treasury as relevant to the National Health Service in England.
Opinion on other mattersIn our opinion:
• the part of the Remuneration report subject to audit has been prepared properly in accordance with the requirements directed by the Secretary of State with the consent of the Treasury as relevant to the National Health Service in England; and
• the information given in the annual report for the fi nancial year for which the fi nancial statements are prepared is consistent with the fi nancial statements.
Matters on which we report by exceptionWe report to you if:
• in our opinion the governance statement does not refl ect compliance with the Department of Health’s Guidance;
• we refer the matter to the Secretary of State under section 19 of the Audit Commission Act 1998 because we have reason to believe that the Trust, or an offi cer in the Trust, is about to make, or has made, a decision involving unlawful expenditure, or is about to take, or has taken, unlawful action likely to cause a loss or defi ciency; or
• we issue a report in the public interest under section 8 of the Audit Commission Act 1998.
We have nothing to report in these respects.
Conclusion on the Trust’s arrangements for se-curing economy, effi ciency and effectiveness in the use of resources.
Auditor’s Statement
71
Respective responsibilities of the Trust and auditorsThe Trust is responsible for putting in place proper arrangements to secure economy, effi ciency and effectiveness in its use of resources, to ensure proper stewardship and governance, and to review regularly the adequacy and effectiveness of these arrangements.
We are required under Section 5 of the Audit Commission act 1998 to satisfy ourselves that the Trust has made proper arrangements for securing economy, effi ciency and effectiveness in its use of resources. The Code of Audit Practice issued by the Audit Commission requires us to report to you our conclusion relating to proper arrangements, having regard to relevant criteria specifi ed by the Audit Commission.
We report if signifi cant matters have come to our attention which prevent us from concluding that the Trust has put in place proper arrangements for securing economy, effi ciency and effectiveness in its use of resources. We are not required to consider, nor have we considered, whether all aspects of the Trust’s arrangements for securing economy, effi ciency and effectiveness in its use of resources are operating effi ciently.
Scope of the review of arrangements for securing economy, efficiency and effectiveness in the use of resources.We have undertaken our audit in accordance with the Code of Audit Practice, having regard to the guidance on the specifi ed criteria, published by the Audit Commission in November 2012, as to whether the Trust has proper arrangements for:
• securing fi nancial resilience; and
• challenging how it secures economy, effi ciency and effectiveness.
The Audit Commission has determined these two criteria as those 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, effi ciency and effectiveness in its use of resources for the year ended 31 March 2013.
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 whether, in all signifi cant respects, the Trust had put in place proper arrangements to secure economy, effi ciency and effectiveness in its use of resources.
ConclusionOn the basis of our work, having regard to the guidance on the specifi ed criteria published by the Audit Commission in November 2012, we are satisfi ed that, in all signifi cant respects, Bradford District Care Trust put in place proper arrangements to secure economy, effi ciency and effectiveness in its use of resources for the year ending March 2013.
CertificateWe certify that we have completed the audit of accounts of Bradford District Care Trust in accordance with the requirements of the Audit Commission Act 1998 and the Code of Audit Practice issued by the Audit Commission.
John Graham Prentice, for and on behalf of KPMG LLP, Statutory Auditor
Chartered Accountants1 The Embankment, Neville Street Leeds LS1 4DW
6 June 2013
72
Appendix 1: New Operational Structures Across BDCT Services
Airedale, Wharfedale
& Craven Locality
Bradford East Locality
Bradford South
Locality
Specialist Services
Shipley Locality
Bradford West Locality
In-patient Services
Chief Executive
DeputyChief Executive
73
Barry SealChair (to 30 April 2012)
Dr Seal qualifi ed as a chemical engineer and worked in management. He then became a university lecturer with a PhD in Computer Control and a Harvard alumni. He was elected leader of Bradford Council Labour Group, and in 1979 was elected from Yorkshire West as their fi rst member of European Parliament. Having served 20 years attaining several of the most senior positions in the Parliament, he stood down in 1999. In 2002 Dr Seal was appointed Chair of North Kirklees PCT. Dr Seal was appointed as Chair in 2007.
Michael SmithActing Chair (from 1 May 2012)and Chair (from 17 September 2012)
As a graduate in systems engineering from the Open University and a MBA from Huddersfi eld University, Michael has held a number of senior management positions in the water industry, culminating in Director of Human Resources at Yorkshire Water until 2007. Michael is also involved with a voluntary organisation supporting people with learning disabilities.
Simon LargeChief Executive
Simon was appointed as Chief Executive of our Trust in 2006. Simon has a wealth of experience within mental health services. Starting out as a nurse, he successfully became a ward manager, followed by supporting the implementation of the Community Care Act. In the mid 1990s he led the planning arrangements for the re-provision of learning disability services from Meanwood Park Hospital and mental health services from High Royds Hospital.
Simon then became a health authority director for mental health services leading the integration of NHS services across Bolton, Salford and Trafford to form a new mental health trust. He held various positions in that Trust culminating in the interim chief executive post.
Appendix 2: Board biographies
74
Dr Andy McElligottMedical Director
Andy has worked in the NHS for over 20 years, including 14 years as a GP in Bradford. He has Board level experience as both a commissioner and provider, having joined our Trust in April 2012 from Bradford and Airedale Primary Care Trust where he was also Medical Director. Prior to becoming a Medical Director, Andy held a number of clinical-managerial posts including urgent care lead and clinical governance lead. More recently, he has been a member of NHS Employers’ national negotiating team involved in annual reviews of the GP contract.
Nicola LeesDeputy Chief Executive / Director of Nursing
Nicola has worked in mental health services since the early 1980s. She is a Registered Mental Health Nurse and holds a Masters degree in practitioner research. Nicola specialised in forensic mental health and has worked in low, medium and high secure services. Nicola joined us March 2009 on secondment from Greater Manchester West Mental Health Foundation Trust where she was Network Director for specialist mental health services including eating disorders, CAMHS, low and medium secure services, mental health and deafness and prison in-reach across the North West. Nicola was appointed substantively as Executive Director of Operations and Nursing in May 2011.
Carol StubleyDirector of Finance, Contracting & Estates
Carol has more than 20 years of NHS experience, mainly in the acute sector. Before joining the Care Trust she was seconded from Bradford Teaching Hospitals, where she had been Assistant Director of Finance. Following the merger of the ambulance services, Carol undertook a number of short term secondments including an external review of governance arrangements at Scarborough Healthcare NHS Trust and Interim Turnaround Director at Kirklees PCT.
75
Derrick PalmerNon-Executive Director, Chair of Audit Committee
Derrick brings a wide range of experience in fi nance, business planning and governance to our organisation. He is a qualifi ed accountant and was Finance Director of Bradford Community Housing Trust from its formation in 2003 until July 2008. Derrick has a portfolio of consultancy and non executive directorships.
Sandra KnightDirector of Human Resources & Organisational Development
Sandra has worked in the NHS for most of her career in a variety of corporate, human resources and organisational development roles at regional, district, hospital, community and primary care level. She joined our Trust in May 2007 having worked previously as Director of Corporate Development in Bradford City Teaching PCT and as interim director leading the HR, Communications and PALS/Patient and Public Involvement work streams, as the four PCTs merged to form Bradford and Airedale Teaching PCT. She is a qualifi ed executive Coach and ACAS trained mediator.
Nick MorrisDirector of Performance, Planning & Information (until 31 October 2012)
Nick started out his Psychiatric nursing carer in 1981 as a student and joined the Trust in 2006 as a Director. Nick has enjoyed a number of roles in mental health services as a Commissioner, Regional Mental Health Lead and Deputy Head of Mental Health Policy at the Department of Health. Some of Nick’s achievements include overseeing acute admission wards and re-confi guring day hospital services, leading the development of a new assessment and treatment service at Wirral Social Services and taking up operational lead for Mental Health services in Calderdale and South Kirklees. Nick retired from the NHS in October 2012.
Appendix 2: Board biographies
76
Nadira MirzaNon-Executive Director
Nadira is the Dean of the School of Lifelong Education and Development at the University of Bradford. Also a Director of Public and Community Engagement, Nadira has been involved in breaking down barriers to engagement with local communities with the University. She is an experienced Board member having held a number of public appointments previously, and is currently Co-Chair of the Born in Bradford Scrutiny and Advisory Committee.
Ralph CoyleNon-Executive Director, Chair of Service Governance Committee (from 3 May 2012)
Ralph has a wealth of law experience. He has held a variety of positions during his career including Legal Director and Company Secretary at Yorkshire Television in 1985, company secretary at CANAL+ International and deputy group company secretary for Commercial Union. Ralph was also director of Yorkshire Culture responsible for promoting culture in the Yorkshire and Humber Region. He was previously a Special Adviser to the Board prior to his appointment as a Non Executive Director.
Dr Susan ButlerNon-Executive Director, Chair of Mental health Legislation Committee (from 3 May 2012)
Prior to joining our Trust Board, Susan spent more than 20 years as a general practitioner, and a further nine years as a primary care trust medical director, most recently of NHS Hull. Since retiring from her medical director role Susan has continued her interest in the NHS as a Clinical Commissioning Champion for the Royal College of General Practitioners and as an independent consultant. Susan brings sound NHS knowledge and experience to our organisation. During her career Susan has worked with a range of NHS, local authority and community stakeholders to increase engagement of the local community.
77
Ian CherryNon-Executive Director (from 1 March 2013)
Ian brings a wealth of experience from the private sector to the Trust. Ian’s past experience includes overseeing the turnaround of West Yorkshire based Ventura, a division of Next PLC, as its Managing Director and Finance Director for almost 10 years. He has held a variety of management and fi nance roles during his career.
Councillor Jan SmithiesNon-Executive Director (until 30 April 2012)
Councillor Smithies represents the Keighley West Ward for the Labour Party. During her time on the BDCT Board she was a member of the Council’s Overview and Scrutiny Committee and she has had a long standing interest in health and health inequality issues.
Councillor Dale SmithNon Executive Director (until 30 April 2012)
Councillor Smith represents the Wharefdale ward for the Conservative Party and sits on a number of Council Committees and groups. He is Co-Chairman of the Strategic Disability Partnership and in May 2012 was elected Lord Mayor of Bradford for 2012/13.
Appendix 2: Board biographies
78
Rob Vincent CBENon-Executive Director (from 1 March 2013)
Rob is a former Chief Executive of two metropolitan councils. He has in-depth experience of managing the changing relationships between local government and the NHS. Rob has most recently been acting as a Local Government Adviser to the Department of Health’s Public Health Transitions Team.
Richard PattinsonSpecial Adviser to the Board (until 8 May 2012)
Richard started his banking career in Bradford in 1971. He was a member of the Senior Executive team at a leading UK bank and held a number of directorships in banking and fi nancial infrastructure companies both in the UK and overseas. Richard also sat on a number of international central bank committee’s and working groups. He was a Special Adviser to the Board from February 2008 until his resignation in May 2012.
79
Name Position Date of interest Interests Comments
Michael Smith
Non-Executive Director
2007Owner and Director, 11thousand Ltd
Human Resources Consultancy
2007Trustee and Chair, Dark Horse Theatre Company
A theatre company for professional actors and Learning Disabilities, Huddersfield
2011Trustee of Thornton Grammar School Trust, Bradford
Representing BDCT who are members of the Trust.
Nadira Mirza
Non-Executive Director
2007 – 2011
Ishico Lighting Distributors (Owner)
Trustee, Tong School
Chair of Governors and Trustee, University Academy, Keighley
Board Member, Enable 2 CIC Ltd
Provision of interpreting services to BDCT
Director of Student Success University of Bradford
Derrick Palmer
Non-Executive Director
Dec 2008on-going
Executive Director Derrick Palmer Associates Ltd
Business Consultancy
April 2009on-going
Governor Heptonstall Junior School
March 2013on-going
MemberAudit Committee Land Registry
Ralph CoyleNon-Executive Director
Jan 2004Trustee/ Director of Scarborough Museums Trust
2011Member of the Court, Leeds University
Dr Sue Butler
Non-Executive Director
January 2013
Sole Trader – Performance development coach – Clients include GPs
Contracted to:Agencia Consulting Ltd
Providing support to East Lancs CCG
Member of the Primary Care Faculty (NHS National Improvement Body)
Providing support to Commissioning Development Programme.
Associate to the Community Performance Partnership.
Organisation set up provide both volunteering for professionals and OD and coaching support to charitable and other not for profit organisations.
Appendix 3: Register of Board Members’ Interests
80
Robert Vincent
Non-Executive Director
Director of New Ing ConsultantsCurrently contracted to provide advice to Public Health England
Trustee of Lawrence Batley Theatre
Co-Owner of New Ing Consulting
Chair of Capital Appeal, Kirkwood Hospice.
Ian CherryNon-Executive Director
Director/Owner – Nexus Vehicle Rental
(Business to Business provider of general and specialist vehicles on rental through booking and ownership of vehicles.)
CPI – Commercial arm of Derwent Housing Association providing student and key worker accommodation.
Simon Large
Chief Executive
- Trustee, Bulls Foundation
A registered charity promoting community engagement, health and wellbeing across the Bradford district.
Dr Andy McElligott
Medical Director
- None
Nicola Lees
Deputy Chief Executive / Director of Nursing
- None
Sandra Knight
Director of Human Resources & Organisational Development
- None
Carol Stubley
Director of Finance, Contracting & Estates
- None
81
Here is a brief description about the national key performance indicators under which the Trust was assessed in 2011/12:
National indicator Commentary
Number of in-patients being followed up (Patients receiving Contact within 7 days Discharge)
The number of people under adult mental health specialties on CPA receiving follow up (by phone or face-to-face contact) after discharge.
CPA patients having a formal review within 12 months
Care Programme Approach (CPA) is a system set up to ensure that people with mental illness have the support and treatment they need from services. All clients on CPA should have a formal review with their care coordinator at least once a year.
Minimising Delayed Transfers of Care (Health)
The number of in-patients whose transfer of care was delayed.
Admissions to Hospital were accessed via Intensive Home Treatment Teams (IHTT)
The number of admissions to the Trust’s in-patient wards where a service user had been assessed before admission or if they were involved in the decision making process which resulted in admission.
Access to healthcare for people with a learning disability
Meeting the six criteria around the needs of people with a learning disability, based on recommendations set out in Healthcare for All (Department of Health, 2008).
Completeness of MHMDS – Part 1Measures information such as date of birth, gender, marital status, NHS number.
Completeness of MHMDS – Part 2Measures levels of diagnostic coding, and whether individuals’ employment status and settled accommodation has been appropriately recorded within the CPA areas of the clinical system
Staff satisfactionThe results of the annual survey of staff, usually completed by a random sample, which is used by the Trust, the Department of Health and the CQC.
Patient experienceThe results of an annual survey completed by service users within an in-patient setting.
New psychosis cases by Early Intervention teams
Number of cases of first episode psychosis supported and treated by the Trust during each year.
Dental referrals to treatment – waiting times (admitted)
Target of 23 weeks from date of referral to actual treatment.
Dental referrals to treatment – waiting times (non-admitted)
Target of 18 weeks from date of referral to actual treatment.
Appendix 4: Commentary on Key Performance Indicators and Glossary of terms
82
It is important our Annual Report is easy to read and understand and is available in a variety of versions including other languages and large print. In producing the Annual Report we have used guidance from the Department of Health and looked at how other Trusts have reported on their own performance.
We would value your feedback on this year’s report. Please complete the feedback form below and post the page to the address shown below. Alternatively you may email your comments to [email protected]
Strongly agree Agree Neither agree nor disagree
Disagree Strongly disagree
The information in this report was easy to understand
There was enough information about the Trust and its services
There was enough information about the Trust and its achievements
There was enough information about the Trust’s fi nances
The layout of the document was clear
Please post any feedback to:
Communications DepartmentBradford District Care TrustNew MillVictoria RoadShipleyBD18 3LD
Or telephone: 01274 228351
Appendix 5: Feedback on the Annual Report
83
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You and Your Care
Bradford District Care Trust Trust HeadquartersNew MillVictoria RoadSaltaireShipleyBD18 3LD
Tel: 01274 228300Web: www.bdct.nhs.ukEmail: [email protected]
Your opinions are valuable to us. If you have any views about this report please contact us at the above address.
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