Annual Report 2012/13
Financial and Quality Accounts
www.hacw.nhs.uk
Contents
Introduction - (pages 4-14)
4 Message from The Chairman and Chief Executive
6 About our Trust
7 Our services
10 Our Trust
13 Key Development and Achievements 2012/13
Achieving our strategic goals - (pages 15-37)
15 We will always provide an excellent patient experience
23 Our services will always be safe and effective
29 Our organisation will be efficient, inclusive and sustainable
33 Working in partnership to improve the integration of health and care
Information and performance - (pages 38-44)
38 Looking after our staff
40 Keeping our staff in the loop
41 Our Trust in the natural environment
Quality Account - (pages 45-86)
45 Introduction to the Quality Account
48 Review of 2012/13
56 Review of 2012/13 - Patient Safety
66 Looking Forward
69 Technical Section
79 Responses to QA
85Statements
Financial Accounts - (pages 87-119)
88 Summary Financial Statements
100Statements
102 Operating and Financial Review (OFR)
109 Remuneration Report
2 | Annual Report 2012/13
113
115
118
Audit Committee Annual Report 2012/13
Details of Directors
Glossary of terms used in the Annual Report
3 | Annual Report 2012/13
Introduction
Introduction
Like all health organisations we are
visited regularly by inspectors and
health regulators. The Strategic Health
Authority, The Care Quality Commission
and the West Midlands Quality Review
Team have all scrutinised our services
over the last year and in general the
feedback we have received has been
extremely positive.
As part of our transformation plans
we are looking at all aspects of our
business to see if we can do things
differently and more efficiently. This
includes our front-line services and
we have developed transformational
projects which we believe will
improve services and peoples’ overall
experiences while at the same
time saving money and improving
efficiency.
We are pleased to report a healthy
financial position and are able to
evidence clear plans for sustaining
this over the coming year and beyond.
However we won’t allow financial
requirements to get in the way of
delivering high quality, safe care which
patients have the right to expect.
Worcester Cathedral and the River Severn, Worcester
Message from the Chairman
and the Chief Executive
Worcestershire Health and Care NHS Trust is the
main provider of Community and Mental Health NHS
services for Worcestershire. We deliver a wide range
of services in a variety of settings including in peoples’
own homes, care homes, schools, community centres
,prisons and in our in-patient facilities including our
five community hospitals. We provide services to
people across all age groups, from Health Visitors
services for new born babies and their families,
through to services which support older people with
complex health and social care needs.
4 | Annual Report 2012/13
It has been a year of real progress
and achievement for the Trust and
we are very proud of all of the service
developments and improvements that
have been progressed for the benefit of
our patients.
Quality has remained our utmost
priority this year and the publication
of the Francis Inquiry into poor care at
Mid Staffordshire NHS Foundation Trust
has brought this sharply into focus.
We have reflected on the findings with
our staff and have considered what
more we need to do. We cannot be
complacent and continue to be totally
committed to driving up standards of
care further.
One of the key indicators of quality is
the friends and family test, which we
now utilise in many of our services.
Another key indicator is the results of
the national NHS Staff Survey 2012
which were a reassuring indication
that the care and treatment that we
offer is of high quality and is safe.
We came in the top 20% of trusts
nationwide in the category which
asked our own staff whether they
would be happy to recommend their
service to their friends and family. In
addition the survey revealed that our
staff were among the most motivated
in the country.
Finally, but most importantly, we would
like to place on record our thanks to all
our staff who work so hard to maintain
and exceed the really high standards
we have set. In an ever changing
environment they continue to put our
patients first.
We confirm that to the best of our
knowledge the information in this
report is accurate
Chris Burdon
Chairman
We are also very keen to work with
our local partners in Worcestershire
to improve the way we work together
and to create a more joined up, well
connected health and social care
system which is easier for patients,
families and carers to use. The Well
Connected project is now fully up
and running across Worcestershire,
bringing together senior leaders to
work together to deliver improvements
locally.
Our Foundation Trust application is
progressing well and we are delighted
to have so many public members who
have joined us. We really appreciate
their engagement over the last year
and look forward to working with
everyone to develop and enhance our
services.
Sarah Dugan
Chief Executive
5 | Annual Report 2012/13
Introduction
Introduction
Our Services
Bringing together the range
of community and mental
health services previously
provided by Worcestershire
Primary Care NHS Trust
and Worcestershire Mental
Health Partnership NHS Trust
has offered opportunities
to improve integration and
partnership working which
are central to the new Trust’s
objectives.
Community and mental health
services are provided to a population
of approximately 560,000 across
Worcestershire’s 500 square miles,
covering the city of Worcester
together with the towns of Bewdley,
Bromsgrove, Droitwich, Evesham,
Kidderminster, Malvern, Pershore,
Redditch, Stourport, Tenbury Wells
and Upton Upon Severn.
Load Street, Bewdley
The Trust works closely with the three
local Clinical Commissioning Groups
(Redditch & Bromsgrove, Wyre
Forest and South Worcestershire),
Worcestershire Acute Hospitals NHS
Trust, Worcestershire County Council
and a number of other statutory and
non-statutory organisations.
Almonry Museum, Evesham
6 | Annual Report 2012/13
The services provided by each Service Delivery Unit are detailed on the following
pages.
Community Care provides in-patient, out-patient and community services on a locality basis to adults and older
adults across Worcestershire. With five community hospitals, four older adult mental health in-patient wards,
district nursing and podiatry, as well as numerous specialist services, this is the Trust’s largest service delivery unit.
Worcestershire Health and Care NHS Trust was
established on 1 July 2011 in response to the
Department of Health’s ‘Transforming Community
Services’ initiative.
The Trust manages the vast majority
of the services which were previously
managed by Worcestershire Primary
Care NHS Trust’s Provider Arm, as well
as the mental health services that
were managed by Worcestershire
Mental Health Partnership NHS Trust
which sought dissolution as part of
the process.
• Community Care
• Adult Mental Health
• Children, Young People and Families
• Specialist Primary Care
• Learning Disabilities
Community Care
Arrow Valley, Redditch
About our Trust
The services provided by the Trust are divided into five service delivery units
(SDUs):
SOUTH WORCESTERSHIRE
CLINICAL SERVICES
REDDITCH AND BROMSGROVE
CLINICAL SERVICES
WYRE FOREST
CLINICAL SERVICES
• District Nursing
• Enhanced Care Teams x3
• Community Stroke
• Health Trainers
• Evesham Community Hospital
• Pershore Community Hospital
• Malvern Community Hospital
• Tenbury Community Hospital
• Older Adult Mental Health Inpatients
(Athelon Ward)
• Neuropsychology
• Nurse Advisors to the Elderly
• Occupational Therapy
• Complex Neuro Team
• Chronic Fatigue Service
• Physiotherapy
• Podiatry
• Speech and Language Therapy
• Care Homes Nurses Pilot
• District Nursing
• Care Managers
• Intermediate Care
• Community Matrons
• Nurse Advisors to the Elderly
• Older Adult Mental Health Inpatients
Clent Ward
• Older Adult Mental Health
Community Mental Health Team
• Podiatry
• Loan Equipment
• End of Life Team
• Complex Neuro Team
• Princess of Wales Community
Hospital
• Expert Patient
• Occupational Therapy
• District Nursing
• Care Managers
• Intermediate Care
• Community Matrons
• Virtual Ward
• Older Adult Mental Health
Community Mental Health Team
• Older Adult Mental Health Inpatients
Witley Ward
• Early Intervention (county wide)
• IV Therapy Team (county wide)
• Nurse Advisors to the Elderly
• Tissue Viability
• Occupational Therapy
• Continence Service
7 | Annual Report 2012/13
Introduction
Introduction
Adult Mental Health
Specialist Primary Care
The Adult Mental Health Service Delivery Unit provides mainly community and in-patient services to adults with
mental health needs across Worcestershire, with community mental health services being delivered through
integrated health and social care teams. The Specialist Primary Care Service Delivery Unit provides sexual, dental,
and offender health services.
COMMUNITY SERVICES
ACUTE SERVICES
Clinical Services
OTHER SERVICES
SEXUAL HEALTH SERVICE
DENTAL SERVICE
OFFENDER HEALTH SERVICE
• Perinatal Services
• Eating Disorders Service
• CMHT
• Assertive Outreach
• Early Intervention
• Employment and
Reablement Services –
Shrub Hill Workshop, Link
Nurseries, Orchard Place
and IPS
• Asperger’s Team
• A&C Manager
• Primary Care, MH IAPT
• Substance Misuse
• Inpatient Services – ECT,
Holt, Harvington, Hill
Crest and Hadley (PICU)
Wards
• Recovery – Shrubbery
Avenue, Cromwell House,
Keith Winter Close, Tudor
Lodge and Community
Recovery
• Home Treatment –
Countywide
• Assessment Teams and
Psychiatric Liaison
• Occupational Therapists
• Governance
• High Risk Specialist Nurse
• AMHPs
• Out of County Placements
• Substance Misuse
• Genito-Urinary Medicine (GUM)
(Clinics in Redditch and Worcester
and in Prisons)
• Pregnancy Assessment and Support
Service
• Early medical termination service
• Chlamydia Screening and Treatment
• Vasectomy
• Time4U
• Contraceptive & Reproductive
Health Care (C&RHC)
• Psychosexual Counselling and
Sexual Health
• Training and Education
• Access Element – Therapists, Dental
Health Educators, Dental Nurses,
Receptionists
• Specialist Element – Therapists,
Dental Health Educators, Dental
Nurses, Receptionists
• Pharmacy
• HMP Oakwood
• HMP Hewell
• Substance Misuse within prisons
• HMP Long Lartin
Children, Young People and Families
Learning Disability Services
The Children, Young People and Families Service Delivery Unit provides general child health and specialist mental health
services to children, young people and their families across Worcestershire.
The Integrated Learning Disabilities Service Delivery Unit provides adult and children’s respite, out-patient and community
contact activity for people with Learning Disabilities and their families, mainly for the population of Worcestershire.
PAEDIATRIC CHILD
HEALTH
CHILDREN’S SERVICES,
COMMUNITY NURSING
AND THERAPIES
CHILD AND ADOLESCENT
MENTAL HEALTH
SERVICES (CAMHS)
SPECIAL NEEDS /
DISABILITY
• County wide Consultant
Led Community Specialist
Paediatrician Teams
• Safeguarding & Looked
After Children named and
designated doctors
• Looked After Children’s
Nurse
• Child Death Review and
Rapid Response
• Children’s Community
Nursing (Orchard Service)
• Home support
• Ludlow Road Short breaks
• Paediatric Speech and
Language Therapies –
county wide
• School Health Nursing –
county wide
• Immunisation Team
• Health Visiting,
• Breast feeding support
• Healthy weight advisors
• Paediatric Physiotherapy
– county wide
• Paediatric Occupational
Therapy – county wide
• Audiology and Hearing
Screening Service
• Tier 3 Locality teams
• Young Gateway Workers
• Youth Offending CPN
• Integrated Service for
Looked After Children
• Out of Hours / Liaison
• SPACE (substance misuse)
• Locality Teams
• Child Development Team
(county wide)
• Special Schools Nursing
8 | Annual Report 2012/13
NORTH WORCESTERSHIRE
SOUTH WORCESTERSHIRE
Practice Lead
• Churchview
• Epilepsy/ Electroencephalography
(EEG) Service
• Wyre Forest Community Learning
Disabilities Team
• Bromsgrove/Redditch Community
Learning Disabilities Team
• Osborne Court
• Wychavon/Malvern Community
Learning Disabilities Team
• Worcester/Droitwich Community
Learning Disabilities Team
• Specialist Health Liaison Nurses
• Health Liaison Team
9 | Annual Report 2012/13
Introduction
Introduction
Our Trust
Strategic Goals
Before the establishment of the Trust, staff from both Worcestershire Primary
Care NHS Trust and Worcestershire Mental Health Partnership NHS Trust
worked with patients and stakeholders to help define what kind of organisation
Worcestershire Health and Care NHS Trust would like to be. This work has
continued in the new organisation and is defined through the Trust’s vision,
values and strategic goals which are set out below.
Our Vision
What we aspire to be
A leading organisation that works effectively in partnership with our stakeholders to deliver
high quality, integrated, health and care services.
What we want our organisation to achieve
• We will always provide an excellent patient experience (page 13)
• Our services will always be safe and effective (page 19)
• We will work in partnership to improve the integration of health and care (page 25)
• Our organisation will be efficient, inclusive and sustainable (page 29).
Corporate objectives
Specific corporate objectives that relate to the strategic goals
• To stimulate a revolution in the way we engage with patients
• To redesign clinical pathways
Our Values
What we believe in and how we will behave
• To ensure patient safety
• To ensure seamless care through integrating services
• Courageous
• Ambitious
Displaying integrity, loyalty and the courage to always do what is right
Striving to innovate and to improve through effective teamwork
• To strengthen leadership within our services
• To develop our workforce
• To improve our use of technology
• Responsive
Focusing on the needs and expectations of people using our services
• Empowering
Empowering people to take control of their own health and wellbeing
• To develop business opportunities
• To deliver our efficiency programme
• To make effective use of our estate.
• Supportive
10 | Annual Report 2012/13
Enabling our staff to achieve their full potential and take pride in the
services that they deliver.
11 | Annual Report 2012/13
Introduction
Introduction
The area we serve
The Trust provides a wide range of community and mental health services across
the county. Services are focused on supporting patients to live independently
at home, reducing the need for patients to be admitted into hospital. Where
admission is appropriate the Trust makes use of Community Hospitals and
mental health in-patient units across the county to provide care as close to
home as possible.
The diagram below shows the location of services across Worcestershire that are based within relatively large facilities.
However, a significant proportion of the Trust’s care is delivered through community based services delivered in the
patient’s home, or local facilities.
Wyre Forest
Redditch and Bromsgrove
South Worcestershire
Key development and achievements - 2012/13
To stimulate a revolution in the way we engage with patients
• Significant improvement in CAMHS (Child and Adolescent Mental Health Service) waiting times
• Health Checkers used to seek Learning Disability service users’ views across the health economy
(including acute and community hospitals and GP surgeries)
• New dental anxiety management clinic established
• Net Promoter and ‘real time’ patient feedback introduced via electronic tablet devices
• New complaints process introduced
• Intentional rounding (care rounds) introduced to engage with the patient/carer and improve
communication (eg. discharge planning, understanding medication)
• Members events introduced
To redesign clinical pathways
• Primary Care Mental Health services pilot and redesign completed
• Inpatient re-design completed with a reduction of beds
• Single point of access launched for CAMHS
• New paediatric audiology pathway implemented
• New model of inpatient care developed for Older Adult Mental Health patients
• In-reach service into acute hospitals developed so patients can be discharged earlier
• New transitions and challenging behaviour pathways introduced for people with a Learning
Disability
• New dental pathways established
To ensure patient safety
• Use of the safety thermometer tool embedded within the organisation
• Benchmarking data demonstrates the Trust is above average in delivering harm free care
• Development of an integrated quality dashboard with quality metrics reported to the Quality and
Safety Committee
• Quality, Equality Impact Assessments routinely undertaken for new schemes and developments
• Patient safety walk-a-rounds established and undertaken by Board members
• Clinical newsletter introduced for staff containing key learning from incidents and serious incidents
• Positive CQC visits and inspections during the year
To ensure seamless care through integrating services
• Expansion of partnership working with a number of key stakeholders, including the Acute Trust
and Worcestershire County Council
• Integrated community teams launched in several localities
• Integration of social workers into CAMHS team
• Improvements in transition for children and young people to adult services
12 | Annual Report 2012/13
13 | Annual Report 2012/13
Introduction
To strengthen leadership within our services
• Managers and team leaders provided with monthly Key Performance Indicator information
• Band 6 and 7 team leaders attended a team leader development programme
• Mentoring and coaching scheme developed for current and emerging team leaders
• Consultant in Special Care Dentistry appointed
To develop our workforce
• Development of a detailed workforce plan for the next 30 months to manage the anticipated
workforce change
• Development of a comprehensive monthly workforce performance dashboard which drills down
to individual teams and employees
• Transformation champions developed within services
• Apprenticeship scheme expanded with a wider variety of opportunities available
• Recruitment of 5 new health visitors, as part of the national programme
• Staff communication strengthened; updated intranet and team brief
To improve our use of technology
• Investment in the development of a new IT system
To develop business opportunities
• 24/7 Mental Health Liaison service established, based within the Acute Trust
• Blood transfusion service established at Malvern Community Hospital
• 100% success rate responding to ‘Any Qualified Provider’ tenders including Podiatry, Vasectomy
(Wyre Forest), NHS Health Checks and Children’s Short breaks
• Integrated Substance Misuse Service contracts secured for HMPs Hewell and Long Lartin
• £3.69 million of recurrent income and £2.86 million of non recurrent income secured
To deliver our efficiency programme
• 12/13 cost improvement programme delivered in full and recurrently
• CIP (Cost Improvement Programme) schemes identified for 30 months, as specified by Monitor
To make effective use of our estate
• Major re-development of New Haven (previously Brook Haven) completed, totalling £7 million
• Lucy Baldwin unit sold for £1 million
• Estate strategy re-organisation plan agreed with service delivery units
• Key Primary Care Trust assets transferred to the Trust
Achieving our strategic goals:
We will always provide
an excellent patient experience
14 | Annual Report 2012/13
Strategic Goal: We will always provide an excellent patient experience
Strategic Goal: We will always provide an excellent patient experience
Transforming services
Our Clinical Strategy
Our Clinical Strategy, which was formally adopted by the Trust at the
start of 2013, sets out our priorities for transforming the organisation
between 2012 and 2017 and what we need to do differently to develop
our services; this includes the development of new roles, skills and ways of
working for all our staff and adopting new technologies.
The primary focus of the strategy is:
To ensure high quality safe care
To deliver the right care for every individual
To provide care closer to home
Some of our services will be
transformed to continue to meet
the needs and expectations of the
communities it serves and as part of
the requirement to make savings of
around £8 million per year for the next
five years. Despite this challenge we
are committed to maintaining our high
standards and reconfiguring services so
they meet expectations, increase access
and provide more choice for people in
as efficient a way as possible. Principally
our Transformation programme is
about providing safe, high quality care
closer to, or at, home and supporting
people to live well, be independent and
recover quickly.
For example we are developing our
community-based services to support
more people in their own homes, and
proposing to develop the range of
treatments and services available from
Community Hospitals so they deliver
a wider range of services which are
less bed based, offer more community
support options including more variety
around treatment and day case activity.
This will in turn help to relieve some of
the pressure on acute hospitals.
Earlier this year we closed the Berkeley
Ward at Newtown Hospital in Worcester
which traditionally cared for people
with dementia. This was as part of the
approach to supporting more people
at home.
There is a significant financial challenge
facing the NHS over the next few years,
but the main motivation for change for
the Trust is finding new and innovative
ways of caring and treating people in
or as close to home as possible. This is
what people tell us they want; whether
they are a young person with a mental
illness, or older and more vulnerable
who can no longer care for themselves
without our help.
The need for beds reduced because
of the increase in community-based
services for patients and carers to
support them to live well in their own
homes, despite their illness.
To promote recovery and independence
To deliver through integrating services.
Our Clinical Strategy, developed
with extensive clinical involvement,
makes a commitment to deliver high
quality expertise and choices for
people with a range of health needs
and/or disabilities that enable them
to live independently at home or as
close to home as possible.
16 | Annual Report 2012/13
The Trust has identified a series of
transformational programmes that
focus on achieving this aim. The
programmes are
• Adult mental health
• L earning disability enhanced
community service
• Children and family services
• Heath and social care integration
• Sub-acute care
• Care closer to home
• Older adult mental health
17 | Annual Report 2012/13
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18 | Annual Report 2012/13
19 | Annual Report 2012/13
Strategic Goal: We will always provide an excellent patient experience
Enhancing the role of our
Community Hospitals
Our Community Hospitals make a real
contribution to the health and wellbeing of local people and are important
to the delivery of our strategy. We have
five across Worcestershire; in Malvern,
Evesham, Tenbury, Princess of Wales
in Bromsgrove and Pershore and our
aim is to enhance the range of services
provided from these settings.
The aim of our Community Hospitals
will be to:
• Support a greater number of patients
in their local community rather than
in an acute setting
• In consultation with our partners to
improve access to outpatient and day
treatment services by widening the
range of activity delivered from the
hospitals
• Provide a base for the majority of
Community Enhanced Teams, so there
is a concentration of expertise within
each locality.
Our plan will ultimately allow us to
develop the services we can offer out of
the hospitals so that they are less bed
based, offer more community support
options and offer more variety around
treatments, day cases and intervention
options.
20 | Annual Report 2012/13
Strategic Goal: We will always provide an excellent patient experience
Staff sign up to pledge to care campaign
Our staff highly motivated
As part of the Trust’s ambition to
sustain high quality care, a campaign
has been launched to encourage all
staff to sign a ‘Pledge to Care’.
The key principles of the ‘Pledge to
Care’ are designed to ensure:
• Our patients will have a good
experience
• We provide a clean, safe and
stimulating environment
• We are recognised as a Trust that
cares.
By working together to put patients at
the heart of everything we do we will
be able to deliver true excellence in
care.
Vicky Preece, Deputy Director of
Nursing who is leading the campaign
said; “We are passionate about
ensuring staff provide patients with the
fundamentals of care they deserve.”
The campaign outlines ‘the bare
essentials of care that every one of our
patients should be able to assume they
will receive’. She adds: “It is no more
than I would expect for my family and
that is what everyone should receive.
As a Trust, we are fully committed to
the campaign.”
Figures show that our staff are one
of the most motivated groups of
NHS workers in the country. The
figures also show how staff would
be happy to recommend the Trust’s
services to family and friends.
The results of a nationwide NHS
staff survey, conducted by the
Department of Health in 2012,
reveal that staff at the Trust marked
their motivation at work with an
average score of just under four out
of five(with five being enthusiastic
and absorbed). This puts the Trust’s
performance for this category in
the top 20 per cent in the country
compared with other similar trusts.
The Trust is also in the top 20 per
cent nationally in the category
which asks whether staff would
recommend the Trust as a place of
work or to receive treatment, with
an average score of 3.74 (with five
being most likely to recommend)
against the national average of 3.54.
A random sample of 850 staff
were asked to complete the
questionnaire between September
and December 2012 with most
questions remaining the same from
previous years to allow trusts to
track progress over time. However,
new questions were added to glean
more information about things
staff say matter most to them,
such as whether they feel they are
supported to do a good job and
whether they have the opportunity
to improve the way they work.
Trust Chief Executive, Sarah
Dugan, said:
“We know from the
evidence that highly
motivated staff deliver
the best care so we
will continue to drive
improvements to support
our staff at work to
provide the best possible
care to patients. I would
like to reinforce that
everything we do as
an organisation will
be motivated by the
continuous drive to
improve outcomes for
our patients and service
users.”
One area of improvement the
Trust will be looking into is the
percentage of staff suffering from
stress over the last twelve months,
as this year’s score of 37 per cent
has increased from last year’s 27
per cent. Although it is still below
the national average of 41 per
cent the Trust nonetheless provide
support through various training
opportunities.
These include the monitoring of
appraisals to ensure all staff have
the opportunity to discuss their
performance on a regular basis with
their manager and receive feedback.
The organisation also has a health
and well-being strategy which
ensures wherever possible illness is
prevented and staff are supported
to remain healthy.
21 | Annual Report 2012/13
Strategic Goal: We will always provide an excellent patient experience
Strategic Goal: We will always provide an excellent patient experience
New Haven
The New Haven mental health unit
in Worcestershire will change the
way older people with mental health
illnesses receive care and treatment in
an inpatient environment. We believe
it will be unique to the UK in its design
and delivery of care – a beacon facility
for the whole country!
The unit is in Bromsgrove on the site
of the town’s Community Hospital.
It will be a true centre of excellence
serving the whole of the county and
its unique and innovative outdoor
‘home from home’ design will make
it a beacon site for the whole of
the UK. It will provide a modern,
private and stimulating environment
for the patient, encouraging and
facilitating interaction with the local
community, including local schools,
and significantly supporting them to
recover quickly and regain a sense of
normality and control of their lives.
It will inspire recovery and provide a
stimulating environment to improve
patient care and outcomes. It also
signifies a change in the way people
with mental illnesses are treated.
Much emphasis at New Haven will
be on stimulating positive memories,
providing calming and therapeutic
activities and giving people
meaningful things to see and do. It’s
about providing the right kind of
environment and recognising growing
medical evidence which suggests that
this approach is more conducive to
aiding recovery and delivering a more
positive patient experience.
New Haven, Bromsgrove
Achieving our strategic goals:
Our services will always
be safe and effective
22 | Annual Report 2012/13
23 | Annual Report 2012/13
Strategic Goal: Our services will always be safe and effective
Strategic Goal: Our services will always be safe and effective
The Francis Report
The Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry was published on 6th February 2013. The
public inquiry chaired by Robert Francis QC, built on the first inquiry that was published in 2010. The first report
outlined standards of care for patients within the Trust that were shocking and distressing. The treatment patients
received is acknowledged to be well below acceptable but was also linked to a higher mortality ratio than would
be expected. The 2010 report identified that these failings were primarily caused by a serious failure on the part of
the provider Trust Board. It focused on trying to understand why, given the amount of external scrutiny within the
NHS, the failings weren’t identified earlier and acted upon. In looking at this issue Robert Francis QC has made 290
recommendations.
Of the 290 recommendations 94 have been identified as being most relevant for Worcestershire Health and Care
NHS Trust. Our March Quality and Safety Committee took the unusual step of standing down the regular agenda and
devoting the time to considering the Francis Report in detail. The committee took part in a workshop to look at the
recommendations that required actions on the Trust’s behalf, to consider the Trust’s response and to begin to consider
how the actions identified will be implemented.
As soon as the report was published information and briefing material was made available to staff and the organisation
posted a statement on our web site expressing our distress at the suffering caused to patients. Since then we have
developed a process for sharing the report with staff and allowing for reflection and discussion on the findings.
We have more events and conferences currently being planned for us to share and discuss this with all staff in more
detail.
The message remains for us to not be complacent and to continually work hard to drive up standards even further.
Health Trainers - Making a difference
Health trainers work in the community across Worcestershire and provide one-toone support and advice to help people (often those at greatest risk of developing
chronic ill health) to identify and set achievable goals based on healthy eating,
physical activity, smoking cessation and sensible use of alcohol. They also signpost
people to a wider range of other local services that people can use to improve their
individual health and wellbeing. The service is open to anyone aged sixteen years
and over. The Health Trainer Service has been inspirational in the transformation
of many people’s lives. They have improved the health and wellbeing of over 5,000
people since the service was first offered in Worcestershire in August 2010. The
service has 20 members of staff who support clients from all over the county and
there are bases in Worcester, Evesham, Malvern, Redditch, Bromsgrove, Droitwich
and Kidderminster.
“One lady was so delighted with the support and
motivation she received she encouraged her partner to
join as well, they have both made small changes to their
diet, cooking and shopping habits and over time have
managed between them to lose 4.5 stone. They think
the service is fabulous and can’t thank their health trainer
enough for the encouragement they received. The change
it has made to both of their lives has made them fitter and
happier than they have been in years.”
Jayne McCullough
Health Trainer Coordinator
24 | Annual Report 2012/13
25 | Annual Report 2012/13
Strategic Goal: Our services will always be safe and effective
Strategic Goal: Our services will always be safe and effective
Boost for Children’s Service
Work has been taking place to further
improve child and adolescent mental
health services across the county.
The Trust’s Child and Adolescent
Mental Health Service (CAMHS) has
introduced a new system that will
help service users receive the right
treatment sooner by allowing GPs and
professionals to refer their patients via
one point of contact.
The CAMHS Single Point of Access (SPA)
will improve access for children and
Putting Recovery at the heart of what we do
young people. It will ensure service
users are efficiently directed to the
most appropriate service at the start
of their journey. Previously, GPs and
professionals would have to find the
nearest CAMHS contact for a service
user but now SPA will handle the
referral directly.
For more information on the
CAMHS service go to
www.hacw.nhs.uk/childrenshealth
The Worcestershire Recovery College
in Worcester has been hailed a great
success by organisers and participants.
The pilot course, which offers an
introduction to recovery, involves 6
sessions aimed at supporting people
in their recovery journey. People are
offered the opportunity to explore
what recovery means for them and
are introduced to a number of tools
that will aid their recovery as well
as learning about mindfulness and
the impact that diet has on mental
wellbeing.
Worcestershire Health and Care
NHS Trust has been able to pilot this
innovative educational approach
through funding from the National
Institute of Adult Continuing Education
(NIACE) and in partnership with a
number of voluntary organisations. The
sessions are co-delivered by people
with lived experience and staff and it is
fast becoming a vital element in mental
health services across the county.
course - Managing Your Emotions.
This is an upbeat, friendly course
offering practical tips and techniques
to help you manage your emotions
in a positive way. The pilot has been
successfully run in Bromsgrove and
Worcester and will be rolled out to
Malvern, Evesham, Kidderminster and
Redditch.
People then have an opportunity
to attend a 12 week ‘Moodmaster’
Sarah Taylor-Robinson, Practice Educator for the Trust had this to say about the college’s success:
“We’ve now completed the course in Bromsgrove and Worcester and both have been
successful in helping patients in their recovery from various mental illnesses. Some of the
comments from the participants have been really encouraging. There are now plans to
develop and expand our programme of courses.”
One of the participants said;
“Getting involved in the Recovery College has been such a positive experience for me in my
recovery journey. As well as giving me the opportunity to learn new skills and knowledge,
I am meeting some wonderful people, gaining confidence and it has given me some real
purpose and motivation.”
SHA Quality Assurance visit
A team from the SHA (Strategic Health Authority) visited us in 2012 to assess our approach to quality and safety. They
met senior leads, held a number of staff focus groups and visited many of our sites. This was part of our process towards
becoming a Foundation Trust. The informal feedback from the SHA was very positive.
Some of the headlines were:
• They found the Trust to be a welcome and well organised organisation;
• They felt that the clinical services visited were of a high quality and that clinical staff were very enthusiastic and able to
articulate how they were improving services for patients;
• They thought our governance processes for quality and safety were effective; and
• They were very impressed with all of the transformation and innovative work that is happening in the Trust and felt that
some of the work around physical and mental health integration was really ahead of the game and worthy of sharing
as best practice.
26 | Annual Report 2012/13
Any clients who are in contact with
either Primary or Secondary Care
mental health teams will be eligible
to be referred onto the courses which
are free.
27 | Annual Report 2012/13
Strategic Goal: Our services will always be safe and effective
After care for stroke patients praised
The majority of stroke patients in the
county said they were very satisfied
with the advice and support provided
to them after leaving hospital.
Ruth Freeman, Deputy Manager
of the Community Stroke Service
explained how the service monitors
patient feedback:
However, even with such positive
results the team said they still have
room to improve and plan to develop
the service.
Our Community Stroke Service (CSS)
had the results back from a countywide questionnaire, completed by all
patients who were seen on one or more
occasion.
“As a specialist stroke service
we are very aware of the
prevalence of anxiety and
depression post-stroke.
This is regularly monitored
and reviewed using both
standardised assessments,
observation of the patient
and discussions with the
patient and family.”
Sue Baker, Matron of the Community
Stroke Service, said;
The survey showed how 93% of
Worcestershire patients and their
families were “very satisfied” with the
advice and support provided by the
team. The results come off the back of
a report from the Stroke Association
which highlighted the need for more
emotional support for people who had
a stroke after leaving hospital.
The Community Stroke Service was
set up in May 2008 with an aim to
provide patients being discharged from
hospital support, advice and relevant
treatment when recovering from a
stroke, as well helping to cope with
emotional difficulties.
Following discharge from the service,
which is usually at about 6 weeks,
patients are invited to a clinic review at
3, 6 and 12 months post-stroke.
“The recent results show
we’re doing a good job but
we can still make the service
better. We’re in the process
of implementing an outcome
measure which specifically
looks at the well-being and
distress of the patient and
the carer, as well as looking
at specific impairments and
their impact on daily life.”
This appointment routinely includes
a review of the patient’s mood, their
perception of their recovery and the
impact their stroke is still having on
the quality of their life and that of their
families.
Recognition for a job well done
Our Older Adults Mental Health
Team at the Princess of Wales
Community Hospital in Bromsgrove
were nominated for a prestigious
international award. They were in
the hat for the Multi-disciplinary
Teamwork honour in the
International Journal of Palliative
Nursing award. The Clent Ward team
were nominated by Mary Fisher, CNS
Palliative Care at Pershore Hospital,
for their work improving the delivery
of Palliative Care. Here is a short
extract from the submission which
sums up what a great job they are
doing.
28 | Annual Report 2012/13
“The older adult mental health team (at the Princess of
Wales) are always striving to provide the best care for
their patients. They work effectively as a team across
boundaries and are always willing to engage with
change, embracing the vision for equity of service
provision and delivering excellent palliative care to all of
their patients.”
Achieving our strategic goals:
Our organisation will be
efficient, inclusive and sustainable
29 | Annual Report 2012/13
Strategic Goal: Our organisation will be efficient, inclusive and sustainable
Strategic Goal: Our organisation will be efficient, inclusive and sustainable
Foundation Trust bid
AQP (Any Qualified Provider)
The Trust remains one of only a few nationally to have remained on target against all FT application milestones. We are
planning for authorisation early in 2014 and throughout all assessment phases the focus has remained on quality and safety of
services, governance, financial viability and legal constitution.
As part of its attempts to driving
up quality and improving care for
patients, the Government introduced
the principal of any qualified provider
(AQP)giving patients choice over
where they receive certain community
services. Some will be from within the
NHS, while others may be from the
independent and voluntary sectors.
Choice of any qualified provider means
that when patients are referred (usually
by their GP) for a particular service,
they should be able to choose from
a list of qualified providers who meet
NHS service quality requirements,
prices and normal contractual
obligations. This approach is already in
place for routine elective procedures.
Another outcome from the Francis Report was the need for aspirant FT’s to remain focussed on what’s important, which is
providing safe and effective services to patients.
Membership and Council of Governors
We now have over 12,000 members,
8,000 of which are the general
public. This is significantly more
than the minimum requirement and
we are using our members to help
shape decisions and priorities. The
Foundation Trust will also have a
Council of Governors comprising 13
Governors elected by public members,
7 Governors elected by staff members
and 4 Governors appointed by partner
organisations. Members aged 16 and
above are entitled to stand for election
to the Council of Governors.
All public and staff members are
entitled to vote for individuals standing
for election in their respective public
sub-constituency or staff class. The first
election will take place in late autumn
2013. It will be a postal ballot.
To help members decide if they wish
to stand for election to the Council of
Governors, presentations on the role
of the Council of Governors will be
delivered during 2013 well before the
first election is held. The presentations
will also cover the election process
and the grounds for disqualification
from membership of the Council of
Governors.
Getting involved
Key Principles of the AQP
approach:
• Providers qualify and register to
provide services via an assurance
process that test providers fitness
to offer NHS funded services
• Commissioners set local pathways
and referral protocols which
providers must accept
• Referring clinicians offer patients
a choice of qualified providers for
the service being referred to
• Competition is based on quality,
not price. Providers are paid
a fixed price determined by a
national or local tariff.
This potentially has a significant impact
on providers of healthcare like us. We
held a workshop for relevant staff in
April 2012 to discuss what AQP and the
wider competition legislation means
and how best we can ensure that as
a business we are well positioned to
respond to threats and capitalise on
new opportunities.
After completing a rigorous
qualification exercise we are pleased
to report the Trust’s Podiatry Team
was successful in their application to
continue to deliver this service.
Emergency preparedness
Redditch and Bromsgrove, Worcester
City and Worcester Rural - and they
meet every two months. Forums
consist of a presentation by Trust staff
about service developments, and
the members give opinions about
changes, suggest ways to improve
the experience of those people who
use our services, and also advise on
developments or changes occurring in
each locality.
The Trust continues to work with local responders to ensure that it is able to provide the best possible response to a major
incident situation.
There is a Major Incident Plan in place which has been tested and reviewed this year and a range of other contingency plans
to ensure the Trust can continue to deliver services in exceptional circumstances. The Trust’s plans are compliant with the
requirements placed on the organisation by NHS England, legislation and guidance. Whilst there were no major incidents for
the organisation in 2012/13, the Trust took part in the co-ordination of the wider response to a number of local incidents and
events including severe weather, flooding, industrial action and the Olympic Torch relay.
Anyone who would like to come along
to a forum, you would be warmly
welcomed. You may be a patient, carer,
member of the public or involved in
a group or organisation. You may be
interested in all our services or only
one of them. Your voice and opinions
matter.
We are committed to engaging
patients, service users, their families
and carers, members of the community
and local organisations in the planning,
development and monitoring of Trust
services. The Trust wants to hear the
views and concerns of the communities
it serves. Involving the community
30 | Annual Report 2012/13
is important because it assists us in
making decisions and shaping services
to meet the needs and preferences of
those who use them.
One way the Trust seeks to do this is
by holding forums across the county.
There are four forums - Wyre Forest,
If you would like to attend or, in the
first instance would like to know more,
please contact Jane Thomas at Jane.
Thomas1@hacw.nhs.uk or on 01905
733827, or Kate Richards at
Kathryn.Richards@hacw.nhs.uk
31 | Annual Report 2012/13
Strategic Goal: Working in partnership to improve integration
Lost Minds group help shape CAMHS service
We have improved our Child and Adolescent Mental Health Service, CAMHS, by engaging with our own service users.
The service currently meets with a young peoples’ board known as Lost Minds which is made up of members who are either
service users, ex-service users or who have been affected by mental health in one way or another. The group provides feedback
on services in order to assess the treatment of young people.
One member of Lost Minds, Rory Barnes from Worcester said:
“The Trust listened to our ideas and introduced the
Single Point of Access (SPA) service which is a great
idea. There are fewer hoops for service users to jump
through.”
Engagement events
The vast majority of those who attended
our first members’ road-shows in the
spring are in support of our strategy
to care for more people in or closer to
home.
We ran hour long events across the
county which together attracted around
100 people. The sessions were a chance
for attendees to hear more about the
Trust’s plans for the future. In particular
the Trust is aiming to reconfigure some
of its services so they can care and treat
more people in or closer to the place
where they live. This will in turn reduce
avoidable admissions to acute hospitals
and ease some of the strain on those
services.
Trust managers also outlined their
vision for the future of the county’s five
community hospitals. They want them
to be used more effectively, which will
mean the sites in Pershore, the Princess
of Wales in Bromsgrove, Malvern,
Tenbury and Evesham are equipped and
designed to provide a greater variety
of day treatments and other activities
e.g. IV therapies and blood transfusions
as well as the inpatient services they
currently offer. The new treatments
wouldn’t require people to stay in the
32 | Annual Report 2012/13
hospitals overnight or be admitted to
in-patient wards, and so this, combined
with the vision to care for more people
in or closer to home, could lead to
community hospitals running as hubs
with more variety of treatments than
currently provided in the longer term.
Results of a questionnaire handed
out at the events shows support for
the Trust’s direction of travel. It asked
whether people supported the vision
for more care in or closer to home. Just
over 90% of those who completed the
questionnaire said they were in favour
of care in or closer to home.
Jim Bulman, who attended one of
the events and who also chairs one of
the Trust’s patient forums, said: “I find
the attitude of the Trust towards the
treatment of people in their own homes
very reassuring. It has been well thought
through. People will be much happier
about this when they realise that they
will be treated at the very nearest
location to their homes so it is simpler
for family and friends to visit them.”
Shan Moule, Chair of Princess of
Wales League of Friends group,
added:
“These are indeed exciting
times for health care in
Bromsgrove. Patients will be
able to return home and or
be treated in their homes
which we understand has
so many benefits. We are
extremely proud of our
flagship hospital and think
this can only have a positive
effect on healthcare across
the county.”
Achieving our strategic goals:
We will work in partnership to improve
the integration of health and care
33 | Annual Report 2012/13
Strategic Goal: We will work in partnership to improve the integration of health and care
Strategic Goal: We will work in partnership to improve the integration of health and care
West Midlands Quality Review
Ensuring services are Well Connected
The Well Connected programme is a
coming together of chief executives
and leads from all the local NHS
organisations (Acute Trust, Health and
Care Trust and Clinical Commissioning
Groups), Worcestershire County Council
and key representatives from the
voluntary sector. Together we aim to
better join up and co-ordinate health
and care for people and support
them to stay healthy, recover quickly
following an illness and ensure that
care and treatment is received in the
most appropriate place. It is hoped this
will lead to a reduction in avoidable
hospital admissions and the length
of time people who are admitted to
hospital need to stay there. Part of
this approach is to develop alternative
services in the community, allowing
people to remain at home, or close to
home, perhaps with the aid of new
technology and receive an equivalent
or better experience to what they
would have had in a hospital. This
will reduce demand on acute and
A&E services, leaving them with the
capacity to care for and treat those
people who need the specialist level of
support they are equipped to provide.
The review, which took place in early
2013, was assessing the provision
of care for people with long-term
conditions (LTCs) across the local health
economy. This meant that as well as
looking at the services we provide,
the review team also visited the Acute
Trust and our Commissioners to ensure
what is being delivered is of sufficient
standard.
The feedback specific to our Trust was
really positive. For example the initial
draft report said that our governance
and training arrangements for caring
for people with LTCs was robust.
Overall NHS organisations in
Worcestershire were shown to be
clearly working together to improve
the care of people with long-term
conditions. This group of patients had
been identified as a priority for our
three CCGs. The report added that
county-wide groups were in place
to drive improvements in services
for people with diabetes, chronic
neurological conditions, heart failure
and respiratory diseases and lead GPs
had been identified for each long-term
condition.
Joint Services Review
There have been lots of reports in the
media following the announcement
by the JSR in March. The headlines are
around potential changes to the A&E
department at the Alexandra Hospital
in Redditch to become an Emergency
Care Unit and an MIU and the more
complex activity being centralised and
provided at the Worcestershire Royal.
There are also developments on the
future provision of Children’s Inpatient
Services and Maternity Services which
again could see the more serious and
urgent cases treated at Worcester.
The potential for some services at the
Alex to be delivered by Worcestershire
Acute NHS Trust or by an alternative
local NHS provider requires more work
around competition rules.
The process will now be taken forward
to work up the details of options in
readiness for public engagement and
full consultation.
For us, we have and will continue to
support the process and whatever the
outcome our focus is on continuing
to provide the very best community
services we can for the people of
Redditch and across Worcestershire.
Reconfiguring Mental Health Services
We are redesigning our Adult
Community Mental Health Teams,
which aims to:
• Support a focus on recovery rather
than maintenance
• Provide greater support to service
users in the greatest need through
planned evidence based interventions
• Support service users ‘closer to home’
in a more robust Enhanced Primary
Care Mental Health Service.
We are now seeing those changes
happen. In Wyre Forest a new mental
health pathway was launched in
October of last year. Community
Psychiatric Nurses and Social Workers
34 | Annual Report 2012/13
are providing a Link worker role and
are offering dedicated sessions to
GP surgeries to look at all potential
referrals into mental health services,
and where appropriate, offer a brief
intervention, signpost to a more
appropriate service or refer on to
secondary mental health services. In
addition the Consultant Psychiatrists
offer a time each day when they are
available to speak to GPs direct.
In Evesham we have piloted a slightly
different approach with a more
discrete Enhanced Primary Care
Service, developing a single point
of access for all Community Mental
Health Teams and Primary Care Mental
Health referrals. Again the aim has
been to offer people more timely, brief
interventions following referral from a
GP. Work is continuing in Redditch and
Bromsgrove and this is likely to follow
the Wyre Forest model. There are plans
to provide a single point of access
and establish Link workers within GP
practices.
“It’s great to have a mental
health nurse practitioner inhouse for advice and to see
referrals. I feel I now have a
link in to secondary care.”
A local GP
35 | Annual Report 2012/13
Strategic Goal: We will work in partnership to improve the integration of health and care
Acute Hospital Mental Health Service
Co-Sleeping project being rolled out
known risk factors for cot death and
how these can be reduced.
Following the pilot in Redditch, the
Trusts will be rolling out a similar
programme in Worcester and
Malvern, with the aim of it
being in place county-wide by the
start of 2014.
Helen Edwards, Clinical Services
Manager for the Health and Care
Trust’s Children, Young People and
Families Department, said:
A new project set up to inform new
parents of the risks of co-sleeping
with their new-born babies is set to
be rolled out across Worcestershire.
Worcestershire Health and Care
NHS Trust and Worcestershire Acute
NHS Trust have recently launched a
new safer sleeping risk assessment.
It has been successfully piloted in
Redditch and involves midwives and
health visitors working with parents
to better review where baby sleeps
and discuss specific questions about
“We know that there are
known risk factors which
can cause serious harm to
new born babies; these
include smoking, drug
and alcohol consumption
and bed sharing. There
are still over 300 cases of
SIDS (Sudden Infant Death
Syndrome) each year in
the UK and we recognise
Strategic Goal: We will work in partnership to improve the integration of health and care
that more advice and
information is needed to
alert new parents of the
risks associated with
co-sleeping.”
The risk assessment tool is a
questionnaire undertaken at home
by Midwives and Health Visitors
in partnership with parents both
before and after a baby’s birth. It
is designed to highlight parents’
awareness of possible risk factors
e.g. observing where a baby sleeps
both at night and in the day, bed
sharing, smoking and medication.
As well as informing of the dangers
of co-sleeping, it is another
opportunity to share information
with parents about sleeping
positions of babies i.e. on their backs
and feet to foot, room temperature,
use of suitable bedding, avoidance
of sleeping on sofa’s and in car seats,
discussion around use of dummies
and what to do if your baby is
unwell.
Our mental health team working within
both the Alexandra and Worcestershire
Royal Acute hospitals actively supports
the delivery of care to patients 16 and
over with physical and concurrent
mental health needs as well as
undertaking assessments of people
presenting in A&E with mental health
needs, including drug and alcohol
problems and cognitive impairment.
routine referrals during working hours,
Monday to Friday. The service will
operate 24 hours, seeing all patients
with mental health co-morbidity in
A&E, in and out of hours. Out of hours
the service will also respond to hospital
wide requests for urgent advice and
support for in-patients who may be
presenting with challenges related to
mental health presentations.
The Acute Hospital Mental Health
Service has developed following recent
new investment from commissioners
and builds on the existing Adult Liaison
services which has been operating
successfully in the Acute Trust for the
last five years. This new service will
have a low threshold for accepting
Umbrella Pathway launched
assessment, management and care
for all children and young people
presenting with neuro-developmental
disorders which may be attributable to
Attention Deficit Hyperactivity Disorder,
Autism Spectrum and associated
conditions, such as developmental
co-ordination difficulties, sensory
processing and tic disorders.
Launched in March 2013, The Umbrella
Pathway (Neuro-Developmental
Assessment and Care) has been
developed to provide a comprehensive
36 | Annual Report 2012/13
The pathway will provide a
multidisciplinary and multi-professional
service with a clear entry point, an
assessment process, diagnostic pathway
and management plans and support for
children and young people both those
receiving a specific diagnosis at the end
of the assessment process and those
where no specific diagnosis is reached
but a care plan and on-going support
is recommended. The pathway works
with collaboration and support between
families, education, health, social
care and voluntary care services. The
Community Paediatricians will manage
this pathway and children and young
people will only go into the single point
of access for CAMHS if they also have a
mental health need.
37 | Annual Report 2012/13
Information and performance
Information and performance
Equality and Diversity
Looking after
our staff
As services change, the roles for some
of our staff may change too. Some may
be required to learn new skills to meet
the demands of a new or different role
and in those instances the Trust will
support the individual to help make
sure they are equipped to do the job.
Our commitment is, where possible, to
re-deploy affected staff into alternative
posts, and re-train people as required
so our high standards are maintained.
In short we want to support the staff
we currently have. For those staff
whose roles change we fully recognise
the importance of supporting them
and their managers throughout. Over
the next five years our workforce
numbers overall will reduce but we aim
to manage this through redeployment
and planned turnover, such as
retirements.
Our Equality and Inclusion Policy
embraces the Equality Act 2010
which harmonised previous
legislation such as the Race
Relations Act 1976 and Disability
Discrimination Act 1995 with a
single Act. With the Act came
the Public Sector Equality Duty,
placing a requirement on all
public sector organisations to
make society fairer by tackling
discrimination, advancing
equality of opportunity and
If it’s not right, speak up!
As a Trust we are committed to
ensuring staff are encouraged to
flag up anything which concerns
them. In fact one of the key
messages to staff following the
Francis Report has been to take
a step back and look critically at
services to see if they are up to
standard.
We recognise that everyone is
diverse; we value all individuals
for their contribution to the
Trust through their experience,
knowledge and skills. In this
respect the Trust fully endorses
the principles of Equality and
Diversity in respect of Trust
employees, service users
(patients, carers, visitors and
communities) and partners
(healthcare economy, voluntary/
third sector etc.).
encourage staff to come forward
but we know we need to keep on
top of this. Our message to staff
is clear: if it’s not right, speak up!
This is in keeping with one of
our key values which is about
displaying integrity, loyalty and
the courage to always do what is
right.
fostering good relations
regardless of age, disability,
gender reassignment, marriage
and civil partnership, pregnancy
and maternity, race, relation or
belief, sex and sexual orientation
- known as the nine protected
characteristics. Inclusion and
human rights is integral to our
values and delivery of services,
with a view to addressing health
inequalities and improving
health outcomes. At the core of
Human Rights are the principles
of FREDA – Fairness, Respect,
Equality, Dignity and Autonomy.
We take every opportunity to
strengthen our approach to
equality and diversity in the
design, delivery and review of
all of our functions, policies and
practices.
We are pleased to say we have
been awarded the Two Tick
Symbol by Jobcentre Plus
in recognition of meeting
commitments regarding the
recruitment, employment
retention and career
development of a person with a
disability. We are positive about
the abilities individuals bring
to our organisation to create a
more diverse workforce and one
that reflects the communities we
serve.
The Trust is committed to
ensuring employees work in
an environment characterised
by dignity and respect. Every
person working for the Trust
has a personal responsibility for
implementing and promoting
Equality, Diversity & Human
Rights. It is expected that
employees will treat each other,
service users and partners in
the same way with a view to
creating a service that is fair and
accessible to all.
Fast Track Physiotherapy
All our staff can access fast-track physiotherapy services. The service is available for staff off sick due to musculo-skeletal
problems, and also for staff at work but who have musculo-skeletal problems that are affecting their ability to undertake
their duties. The aim of fast track physiotherapy is to enable staff to return to work quickly following musculo-skeletal related
sickness. Also to tackle musculo-skeletal problems before they necessitate absence from work.
We have also made a point of
re-iterating our whistleblowing
policy to staff so they are
comfortable with the process
and the options available should
they feel something needs
bringing to attention. We pride
ourselves on being an open and
transparent organisation. We are
confident that we have a culture
and an environment that does
38 | Annual Report 2012/13
39 | Annual Report 2012/13
Information and performance
Information and performance
Our Trust and the Natural Environment
The incentive to reduce the effect we have on our environment is stronger than ever; doing so not only
helps to reduce the impact of climate change but also saves money and improves our efficiency. Our
staff and patients benefit too: sustainable lifestyles, with more active travel and less energy intensive
diets, are healthier lifestyles.
The Trust emits 8,957 tonnes of CO2 equivalents a year (based on 2010/11 consumption figures), costing us
£3,751,913. Our target for reduction figure is 7,466 tonnes CO2e by 2015. To date, the Trust has implemented
the following projects to move towards this ambitious target:
Keeping our staff in the loop
It is vital that we have a workforce which is well informed and engaged with Trust news and developments. It is also important
that staff have a voice and can comment on and shape the decision-making process.
The Staff Survey carried out in 2012 revealed that staff wanted more information communicated face-to-face and in team
meetings delivered by their line or unit manager. We have responded to this and reconfigured our internal communications
approach to provide more suitable and relevant information in more effective ways. This has included developing news channels
to share and disseminate information, and providing new ways for staff to feedback views and ideas.
Our internal communications channels are listed below:
Team Brief
Staff Intranet
This is our main staff newsletter which is
provided monthly. It is designed so that
team leaders and managers can take
the content and update their staff on
local implications and effects. Included
in each edition is an online comment
box where staff or teams can feedback,
comment and seek further information/
clarity from the executive team. They
can also use the comment box to give
suggestions for future content.
We have developed a new online
news section on the staff intranet to
provide staff with day-to-day news and
updates, including changes to team
contact details, staff achievements and
highlighting changes to IT systems. The
site is the default homepage for all staff
when accessing the internet.
40 | Annual Report 2012/13
Members of the Executive team,
including the Chief Executive and
Chairman, regularly visit sites across the
county to talk to and meet staff. It is an
opportunity to discuss the implications
of developments at a really ‘local’ level,
and a chance for staff to ask questions
and suggest ideas to senior managers.
The Trust currently procures its energy supply requirements through the Government Procurement Service (GPS). Its
priority is to provide procurement savings for central government, health and the wider public sector. By procuring
energy through the GPS we get the best value energy on the market (due to the large buying power of the GPS).
The GPS ensure tariff charges are competitive, not least because of the overall buying power but also savings from
wholesale procurement and procuring in advance.
The Trust now has energy contracts in place with the following government preferred energy suppliers:
• Corona (contract to 31/03/2016)
• British Gas (contracting to 2017, exact date TBC)
• EDF (contract to 31/03/2016)
‘Mythbuster’/comments and
suggestions
Chief Executive’s weekly
brief
This is emailed to all staff every
Friday and is an opportunity for the
chief executive to update on key
developments or news from that
week. This includes outcomes from
inspections, updates on performance
levels or information on developments
from within the wider health and care
economy.
Staff briefings, management
visits
• Implemented a single waste contractor for all sites at reasonable prices with greater recycling in August 2010, rather
than having lots of different waste contractors. We now recycle around 20 times the amount of rubbish we used to
and estimate we’ve cut costs by around £30-40,000 per year
• Installed new lights, controls and insulation in Evesham Community Hospital and the Princess of Wales Community
Hospital.
• Estates Rationalisation (Phase 1)
• Installed Electricity Automatic Meter Readers (AMRs) at all applicable smaller sites
• Installed new boilers in the Theatre Boiler House at Evesham Community Hospital
• Installed new plate exchangers and burners making the existing Building Management System at Princess of Wales
Community Hospital more efficient. By reducing our energy costs by 3% in 2012/13, we have saved £35,435, the
equivalent of 6 hip operations.
Staff can seek clarity of any rumours
which are emerging via an anonymous
online comment facility. They can also
make comments or suggestions through
this tool too.
Desktop displays
A new channel which enables us to
share updates in a more visual way,
including details of staff briefing events
and thank-you messages from the Chief
Executive.
41 | Annual Report 2012/13
Information and performance
Information and performance
The PID will focus on a number of areas to insure we are planning our journeys efficiently and reducing our environmental
impact from travel.
The Trust is looking into several areas such as:
• Reviewing the travel policy to ensure it is in line with peer organisations and that it supports the needs of the organisation
and its staff
• Supporting projects being delivered across the organisation which seek to implement new ways of working, particularly the IT
and estates strategy
• Scoping any potential tax reliefs or benefits that may be open to the Trust
• Changing behaviours re travel for instance increase usage of teleconferencing. Use of portable IT in specific teams
• Looking at having specific fuel stations at a better rate
• Looking at developing an e-system for travel claims
• Reviewing similar trusts to identify similar projects to incorporate learning from their work.
Carbon Emissions
12000
Road
10000
Tonnes Co2e
During 2012/13 our total expenditure on business travel was £2,264,917. A Travel and Transport Project Initiation Document
(PID) has been drawn up (June 2012) to introduce a planned approach to reduce travel expenditure across the organisation and
the carbon footprint of the Trust.
Gas
8000
Electricity
6000
4000
2000
0
2008/09
2009/10
2010/11
2011/12
2012/13
Year
Figure 2. Carbon emissions for the Trust over the last 5 years
The table above illustrates that our measured greenhouse gas emissions have increased by 0,634 tonnes this year. However,
this is primarily due to the reduced proportion of renewable electricity we are receiving from our one of our electricity
suppliers.
Carbon Dioxide Emissions (Tonnes) 2010 - 2015
10000
9500
Water Consumption in Cubic Meters
9000
90,000
8500
80,000
70,000
8000
60,000
7500
50,000
40,000
7000
2010
2011
2012
2013
2014
2015
20,000
Year
Predicted Business as Usual Emissions (tCO2)
Target Emissions (tCO2)
30,000
10,000
Actual Emissions (tCO2)
0
2008/09
2009/10
2010/11
2011/12
2012/13
Year
Figure 1. Carbon dioxide emmissions resulting from Trust operations
This illustrates that the Trust is reducing its emissions (Actual) demonstrated partially by the projects implemented. The Trust
has reduced its carbon emissions by 286 tonnes from the baseline year (2010-12) to Year 1 (2011-2012); 110 tonnes was from
Estate Rationalisation (Phase 1).
42 | Annual Report 2012/13
Figure 3. Water consumption for the Trust over the last 5 years
Our water consumption has reduced by 6,231 cubic meters in the recent financial year.
43 | Annual Report 2012/13
Information and performance
Quality Account
Expenditure on Waste
£600,000
Waste incinerated /
energy from waste
£500,000
Waste recycled / reused
£400,000
Waste sent to landfill
Total waste arising
£300,000
£200,000
£100,000
0
2011/12
Year
2012/13
Figure 4. Trust expenditure on waste in the last two years
We recover or recycle 175.585 tonnes of waste, which is 24% of the total waste we produce.
Waste and water consumption reduction are primarily as a result of estates rationalisation and better work behaviour.
Some of the Trust’s 2012-13 figures are estimated based on ERIC data.
Quality Accounts
The following section is the
Trust’s Quality Accounts for 2012/13
44 | Annual Report 2012/13
45 | Annual Report 2012/13
Quality Account
Introduction to the Quality Account
A Quality Account is an annual report that providers of NHS healthcare services must publish.
This Quality Account is Worcestershire Health and Care NHS Trust’s second annual report to the public and other stakeholders
about the quality of the services we provide. It presents our achievements during 2012/13 in terms of clinical effectiveness,
safety and patient experience and demonstrates that our staff are committed to providing evidence based, quality care to all
of the people we care for. It will also show that we regularly review the services we provide with a view to improving them and
ensuring that our patient’s treatment outcomes are the best they can be.
It will give a balanced view of what we are good at and what we need to improve on. We recognise that whilst we have seen
some progress in our priorities from last year, there is still more work for us to do. In the production of this report we have
also taken into account the comments and opinions from external parties on the 2011/2012 Quality Account by, for example,
setting smarter objectives within the our priorities for next year. Looking ahead we have defined five main priorities for
improvement over 2012/13 which were agreed by the Board on 14 March 2013. These are set out later in the Quality Account.
As the Trust was formed on 1 July 2011, we do not yet have two full year’s data to provide direct comparisons to measure
progress year on year. We will however be able to demonstrate how we have progressed over the last 12 months.
Whilst patient feedback and involvement is extremely important to us, we also rely on other measures of safety and clinical
effectiveness to satisfy ourselves that treatment is evidence-based and delivered by appropriately trained staff. Examples
of these measures are detailed in this Quality Account. Some evidence includes technical and statistical data and some are
presented in short ‘stories’.
Quality Account
This Quality Account links directly to our Trust’s three year Quality Strategy. The monthly quality report to the Quality and
Safety Committee includes progress reports on the Quality Account priorities to enable a regular check and balance on
progress.
At the end of this document you will find details of how to let us know what you think of our Quality Account, what we can
improve on and how you would like to be involved in developing the report for next year.
How do we get people involved?
Worcestershire Health and Care NHS Trust is committed to engaging patients, service users, their families and carers, members
of the community and local organisations in the planning, development and monitoring of Trust services. The Trust wants to
hear the views, opinions and concerns of the community it serves. Involving the community is important because it assists the
Trust in making decisions and shaping services to meet the needs and preferences of those who use the services.
The work of the Community Engagement Team ensures local people and organisations have the opportunity to become
involved. The team works in accordance with the Department of Health guidelines and seeks to make community involvement
clear, accessible and open. Our work is about building relationships, promoting a listening environment and responding to
what is said.
There are many ways we seek to involve members of the community which gives people lots of choice about how they want
to become involved. For example, we regularly hold forums at venues across the county, which provides the opportunity for
patients, service users, carers, members of the public and representatives of key stakeholder groups in a given locality to come
together. At the forums we give and receive information and discuss ideas, developments and issues. The forum members act
as a critical friend to the Trust. The Trust listens to the points and issues raised and it then responds to the forum members. We
also provide information about a range of health matters and the work of the Trust, at our Foundation Trust events and through
our Membership Matters newsletter. Information is also shared through the media, through our website and at display areas in
Trust premises and at events being hosted by partner organisations that we attend.
Patient and public involvement also extends to lay representation on various Trust committees and on interview panels for staff
recruitment. In addition, some patients, service users and carers carry out inspections of Trust premises, checking standards
and making suggestions and recommendations for improvement. There are also opportunities to volunteer at the Trust or
to take part and give opinions through surveys or questionnaires. Finally, some patients, service users and carers share their
experience and so support the work in the Big Recovery and the Recovery College.
Whilst much of this work is ongoing, some patient and public involvement work is in response to a particular idea or proposed
development in Trust services. Such proposals may impact particular groups or areas and, in this case, the team can be active in
supporting involvement events that have a particular focus, work with particular groups, and that are time limited. Such events
may take the form of a forum, meeting or focus group.
Community Engagement assumes an already established link with the community, and its aim is to seek out and listen to
opinions, ideas and suggestions. However, there are some groups whose voices and opinions we seldom hear. This includes
children and young people, gypsies and travelers, people from black and minority ethnic communities, people who are lesbian,
gay, bisexual or transgender, people who are homeless and people who live in rural isolation. (This list is not exhaustive and
there are other groups and communities too). The Trust is keen to hear from these groups and therefore looks to develop
links with these communities and work with them so that it might learn from their perspectives and experiences, and develop
services that respond to their needs.
In conclusion, the Trust recognises that different people and different groups want to be involved in different ways. The Trust
seeks to be both flexible and responsive by offering a range of different involvement opportunities that allow people to get
their voice heard in the way that is right for them.
46 | Annual Report 2012/13
47 | Annual Report 2012/13
Quality Account
Quality Account
Review of 2012/13
Our Quality Account Priorities
Last year we set five priorities for improvement. Our focus on these priorities has delivered some improvements; these
are summarised ‘at a glance’ in the table below and are explained further in this section. Where we have not yet met the
priorities and objectives that we set ourselves, we explain why, and outline the plans we have put in place to ensure we
meet our target in the future.
Objective
We will listen and learn from complaints
Achieved
Almost Achieved

Our workforce will be fit for
purpose
Patients will receive clinically effective care
Behind Schedule


We will have no incidents of avoidable
pressure ulcers

We will improve our care of patients who
have dementia and their carers

We will listen and learn from complaints
What did we measure?
The percentage of complaints responded to
within Policy timeframe (25 working days)
During 2012/13 the Trust has
focused on improving the responses
to complainants, both in terms of
timeliness and quality. The Trust
received 302 written complaints in
during the year compared to 686
recorded compliments. To give this
number some context, our services
see thousands of patients every day,
and the number of patient interactions
over the year would run into many
thousands.
We do place a high value on complaints
and compliments as a resource
to support service improvement.
48 | Annual Report 2012/13
Results at end of March 2013
100%
Agreeing and undertaking actions as
a result of complaints investigations
where mistakes have been made or
services have not been delivered as
we might have hoped, is the most
important factor in ensuring that we
improve services as a result of learning
from complaints.
We measure the percentage of
complaints responded to within our
trust’s policy timeframe (25 working
days). The process for investigating
and responding to complaints was
changed during the year which has
steadily improved our response times
and in March we are proud to say that
we have achieved a 100% performance
in this target.
Our Complaints Policy abides by the
good practice ‘Principles for Remedy’
and aim to produce reasonable, fair and
proportionate responses to complaints.
The Principles are:
1 Getting it right
2 Being customer focused
3 Being open and accountable
4 Acting fairly and proportionately
5 Putting things right
6 Seeking continuous improvement.
Over the last 12 months there has
been a steady increase in the number
of patients, carers and members of the
public contacting the Patient Relations
Team for advice and support about the
Trust’s services. There has also been
a slight increase in the number of
complaints received, partly due to HMP
Oakwood opening part way through
the year. The highest number of
complaints is received from HMP Long
Lartin, the category A prison.
Clinical services have learning plans
from complaints so that tangible
changes are made if this is possible.
We review all trends for specific
trends or hotspots. Issues around
communication are the most frequent
cause for complaints. Further
complaints trends can be seen in the
trust Board reports which are available
on our internet pages.
Some of things that we have been told which could have been preventable, and which learning has been put in
place to prevent happening again are:
• Not responding to a message left for the clinician/service - the Team have now reviewed the process for taking
telephone calls so that messages are responded to when a particular therapist is not available to return the call.
• Appointment letters not sent in a timely fashion - all referrals to another service are now diarised and follow up systems
are in place to prevent any future delays or this happening again. Appointment letters used within the administration
and clinical team are being reviewed to ensure that there is clear communication to the patient.
• The way a person was greeted and acknowledged - this has been picked up with the individual member of staff.
• No apology or explanation offered when there was a delay for treatment/appointment - this has been picked up with
the individual member of staff and the team.
Some of the good things that people have told us are:
• “I just wanted to say how superb the service was. I would also like to congratulate the whole team on an excellent and
invaluable service. I am unable to drive when on some IVs as they make me very ill. Being able to call up and request
help is just such a relief.”
• “a big thank you to all the kind heroes who came to attend my husband’s needs after returning from hospital. It was a
delight to have them in the house, we miss them a lot but now we are able to cope”
• “the Home Treatment Team made my recovery quicker. The whole team worked together during my recovery. They all
worked with me and each other to give me excellent treatment and make my recovery quicker than my family thought
possible”
• “For taking time out to listen to us and never making us feel that we were in the way”
• “I have always felt that there is someone to help, guide and reassure me if required. She listens carefully before making
any judgement or giving any advice. I feel this has been crucial in helping my family”
• I feel when something is done with such professionalism it should be recognised and I cannot begin to thank them
all. My needs were met and I didn’t seem to be a burden. I really felt I could talk to them and get an answer to every
question. Thank you again”
Offering advice and guidance
For those patients, service users, carers and families who don’t wish to pursue a formal complaint, but would like some help
in navigating the services provided by the Health and Care Trust, the Patient Relations Team can help. The team provide an
informal and confidential service to assist with any questions, queries or concerns that anyone may have about the services
provided by us.
Plans for the Future
We will be carrying listening and learning from complaints forward as a priority for next year. Both our Board and the people
who we consulted on our 2013/14 priorities thought that this should remain at the forefront of our quality measures.
49 | Annual Report 2012/13
Quality Account
Quality Account
Worcestershire Health and Care Trust Apprentice of the Year 2012 - Luke Sugg
Our workforce will be fit for purpose
The Trust is promoting the health and
wellbeing of its employees as part of
the High Impact Action “Fit and Well to
Care”. The rolling 12 month sickness
rate in the Trust has fallen from 4.61%
in March 2012 to 4.38% in March 2013.
The West Midlands SHA had set a
challenging target to reduce sickness
absence to 3.39% by the end of March
2013.
months is monitored closely, the metric
forming part of the monthly Workforce
Metrics Dashboard and a monthly staff
list is sent out to managers identifying
staff who have become overdue for
their appraisal or who will require one
within the next few months. At the end
of March 2012 86.74% of staff were
recorded as having an appraisal. A year
later at the end of March 2013 this was
84.39%. Our target is 100%.
finalist and not believing that I stood a
chance. When the awards evening came,
I was actually out the country on holiday
in Tenerife and remember getting a text
just as I landed from Kate Leese, who
was my line manager at the time, telling
me I had won the Apprentice of the Year
award - I thought she was joking, but it
was a proud moment in my career - for
others to nominate me and vote for me and to also see the effort I put in, outside
of sport, where I’ve won all my previous
awards. This was the first award I’d ever
won that wasn’t Sport Related - a very
proud moment!
The results of the 2012 NHS National
staff survey were formally released
on Thursday 28 February 2012. The
survey results have demonstrated
improvement in our staff engagement.
We scored 3.82 for overall staff
engagement in the 2012 survey. This
was in the highest (best) 20% when
compared with trusts of a similar type.
Many of the Staff Survey results for 2012
have improved on the 2011 results.
The proportion of eligible staff who
have had an appraisal within the last 12
The top five ranking scores for the Trust were:
• Percentage of staff receiving health and safety training in last 12 months
• Percentage of staff experiencing harassment, bullying or abuse from patients, relatives or the public in last 12 months
• Effective team working
• Percentage of staff believing the trust provides equal opportunities for career progression or promotion
• Percentage of staff reporting errors, near misses or incidents witnessed in the last month.
The trust’s score in the highest (best) 20% for overall staff engagement when compared with trusts of a similar type.
Plans for the Future
Although a number of significant
workforce developments have been
made in the last 12 months we are
not complacent about the challenges
ahead. We understand that successful
service transformation will depend on
our ability to manage and positively
respond to the scale of workforce
change necessary whilst continuing
to maintain positive engagement
with staff. Our workforce strategy
was developed over the summer of
2012 and approved by the Board
in the autumn. It outlines the
workforce development priorities for
Worcestershire Health and Care NHS
Trust over the next 5 years to 2017. The
strategy will be reviewed and refreshed
annually (in harmony with the annual
business planning cycle) to ensure it
remains aligned with the Trust’s vision
and emerging priorities. This refresh
will commence in July 2013 and staff
and stakeholder engagement plans are
currently being developed.
2012 was definitely a year to remember
for me in many ways.”
In Luke’s words:
“I gained a lot of things by doing my
apprenticeship. Before I undertook the
scheme, I was quite low on confidence
and the belief in my own abilities to get
a job. It gave me a sense of confidence
and assurance that I was still going
along the right career path. I found
it essential to me for me to fully learn
the ins and outs of a business working
environment, and also gave me added
confidence that I was performing well. I
undertook the course to find a stepping
stone within an organisation - to show I
was willing to learn, and develop my own
career further. It also allowed for a mini
financial income to help me grow in the
working world.
The announcement that I had won the
Apprenticeship of the Year Staff Award
came as quite a shock to me. I remember
talking about it when knew I was a
Exemplar Employers Scheme
In Sylv’s words:
“My Paid Training Placement at the Trust
enabled me to work within the Patient
Relations Team for 6 months as an
Administration Assistant in Worcester.
I was really nervous about starting my
new role but the Patient Relations Team
made me feel at ease. This really helped
me settle into the role as I was so nervous
on that first day. My duties included
general admin work such as post,
scanning, filing, data entry, answering
the phone and taking messages. This
role has allowed me to reuse a lot of the
skills that I have gained over the years as
well as the new skills I learnt at Shrub Hill
Workshop.
I have really enjoyed my experience of
working within the Patient Relations
Team. I’m not as nervous as I was before
and I now feel I have a purpose in life. It
has certainly opened the door to many
more opportunities as I have now gained
a permanent admin position within the
NHS at Bewdley Clinic.
I am so glad that I never gave up. I now
know what I want to do and that is to
continue doing what I am doing. I feel so
confident in lots of ways and would like
to continue putting something back into
the NHS for the help that I have received
over the last few years.”
We are proud of Sylv and Luke and all of our other committed, hardworking staff.
50 | Annual Report 2012/13
51 | Annual Report 2012/13
Quality Account
Quality Account
Patients will receive clinically effective care
An effective service can be defined as one that provides the right service, to the right person, at the right time. We have
two indicators to help demonstrate this:
What did we measure?
Results at end of March 2013
Percentage of NICE compliance
assessments completed within
timeframe
100%
Percentage of clinical audits running
to plan
100%
Clinical audit involves systematically
improving the quality, effectiveness,
and outcome of patient care by looking
at and measuring the gaps between
best and current practice and making
improvements where necessary. There
is a Department of Health requirement
for NHS organisations to participate
in national clinical audits, but we
also undertake local clinical audits to
continually improve standards across
the services we deliver. Our clinical
services have a three year plan for
52 | Annual Report 2012/13
audits, focusing on those areas that
have the highest demand. Details
of our audit activity can be seen in
the Technical Section of this Quality
Account.
We issue a quarterly Clinical Audit
Bulletin which is a compendium of
clinical audit activity from across all
five Service Delivery Units within the
Trust, including junior doctor audits
and multi-agency projects. The
editorial is presented in easy to read
Harm free care is defined as the
number of patients in whom
all of the following harms are
absent:
• A Pressure ulcer of any category
2, 3, or 4, acquired anywhere;
• A fall which resulted in any
degree of harm within the
previous 72 hours in a care
setting;
précis format, and publicises the audit
findings of individuals and teams to as
wide an audience as possible in order
to share learning. It is also a vehicle to
raise awareness of other services, and
to celebrate and thank staff for their
continued commitment to clinical
audit.
Clinical effectiveness can also be
measured from the number of ‘harms’
reported on the monthly Safety
Thermometer audit.
• A Venous thromboembolism
(VTE) of any type acquired whilst
under our care; and
• Treatment for Urinary Tract
Infection (UTI) in patients with
an indwelling urethral urinary
catheter.
We have calculated the level of harm
free care to only take account of
new harms within the Trust. New
harms incorporate any harm that has
developed within our care.
We can see from the Safety
Thermometer audits that since April
2012, the Trust has consistently
delivered a higher level of harm free
care, compared to the regional and
national benchmarking figures.
100%
98%
96%
94%
92%
90%
88%
86%
84%
2
r-1
Ap
2
y-1
Ma
2
n-1
Ju
2
l-1
Ju
Trust (including all harms)
-12
g
Au
-12
pt
Se
Oc
Trust (new harms only)
2
t-1
2
v-1
No
2
c-1
De
Regional benchmark
-13
Jan
b
Fe
-13
3
r-1
Ma
National benchmark
Plans for the Future
We aim to build on our performance in this area by:
• Sharing the learning from clinical audit projects more widely
• Presenting specific audits to groups of staff and our committees to demonstrate learning
• Recognising staff commitment to continuous quality improvement achieved through clinical audit activity by
sending a certificate of achievement to the service when an audit has been successfully completed.
53 | Annual Report 2012/13
Quality Account
Quality Account
Dementia
Pressure Ulcers
What did we measure?
Harm free care through the Safety
Thermometer - pressure ulcers
We want to reduce the incidence of
avoidable pressure ulcers; we know
pressure ulceration causes significant
pain and distress for patients. A target
of 100% ‘harm free’ care is challenging
as patients may come into our services
with existing pressure ulcers.
Pressure ulcers are graded at grades 2,
3 and 4, which relates to the severity
and level of damage to the skin, with a
grade 4 pressure ulcer being the most
severe grade.
Although we haven’t yet met the
What did we measure?
Results at end of March 2013
Number of patients admitted in
community hospital who were on the
dementia care pathway
98%
ambitious target of having no
avoidable pressure ulcers, we have
made significant progress in this area
which will help us take this priority
forward. We have increased staff
awareness across the Trust of the need
to report pressure ulcers as an incident.
Our hospitals, district nursing services
and learning disability services take
part in a monthly point prevalence
audit called ‘the Safety Thermometer’.
This is one of the ways we measure
whether the number of incidents of
pressure ulcers is decreasing. We have
developed a pressure ulcer working
group with membership from clinicians
representing teams across the
organisation, led by the specialist tissue
viability nurses. The working group
has begun the process of clinically
reviewing all pressure ulcer incidents,
identifying trends, undertaking a
thematic analysis and developing
a robust action plan to reduce the
incidence of pressure ulcers and
improve practice in the community.
Plans for the Future
We are committed to eradicating avoidable pressure ulcers and we are taking this priority forward into next year.
Results at end of March 2013
70%
Dementia is one of the biggest challenges we face. The number of people diagnosed with dementia is expected
to increase significantly over the coming years.
Our aim in this priority was to achieve a better awareness of dementia so that people who have dementia and
use our services experience high quality treatment.
From May to December 2012 a further
112 members of staff have accessed
in house dementia training. More staff
have accessed Worcestershire wide
training programmes. The Community
Hospital care of people with dementia
project has developed further with
support from the nurse consultant
and practice educator. There is now
an Advanced Nurse Practitioner in
post covering Evesham and Pershore
Community Hospitals.
The intended outcomes of the
project, which is continuing through
2013/14, are:
• P erson centred care will be delivered
to all patients with dementia and a
physical illness
• The patient’s physical health and care
needs are not compromised by their
cognitive impairment
• P rimary carer(s) knowledge and skills
will be recognised and used as a rich
source of information for staff to
deliver appropriate and person centred
care
• Staff knowledge and skills will be
enhanced to improve the patient
experience
• Reduced length of stay in hospital
• The environment is conducive to the
care of people with dementia.
We produced an integrated multiprofessional care pathway for patients
who have both dementia and delirium
into the community hospitals. The
pathway incorporates best practice
as published by the National Institute
for Health and Clinical Excellence.
Following extensive consultation and
careful planning, the Implementation
of the pathway commenced in
December 2012 and will continue to be
implemented across the Trust.
We have also undertaken environmental
audits across all appropriate directorates
and put in place improvements to make
the wards more patient-friendly.
We have a specialist Early Intervention
Dementia service that works across
the county and offers assessment
and diagnosis, followed by support,
information and advice to those who
need it. People are often reluctant to
ask for help or do not know what help
is available, and as a result do not have
any form of support until there is a crisis.
The Early Intervention Service offers
support to families and carers affected
by dementia and gives them the chance
to think and talk about the future.
Our Admiral Nursing service has an
open referral and provides tailored
information, advice and emotional
support for families of people who
have dementia. The Admiral Nurses also
provide supportive educational and
consultancy role to other professionals,
the voluntary sector and communities
supporting people with dementia.
Plans for the Future
More staff will undertake dementia training during 2013/2014. The project evaluations will inform further interventions
and support in the community hospitals.
A major new facility, New Haven is currently being built at the Princess of Wales Community Hospital in Bromsgrove. The
£7m development will see the creation of a thirty bed in-patient unit for people with both organic (such as dementia)
and functional (such as depression) disorders. We will be able to use the beds flexibly to accommodate changes in
demand for mental health services. Preparation of the site is complete and building work is already underway with the
project due to be completed with patients moving in by July 2013.
54 | Annual Report 2012/13
55 | Annual Report 2012/13
Quality Account
Quality Account
Review of 2012/13 - Patient Safety
Infection Prevention and Control
Actively minimising healthcare
associated infections is a priority for the
Trust. We are committed to ensuring
that the risk of infections is kept to an
absolute minimum. During 2013/14 we
maintained an excellent performance
on the prevention and control of
infection across our services.
For 2012/13, by year end the number
of cases of Clostridium Difficile (C-diff)
was below the target threshold set by
the commissioners and we had zero
cases of MRSA bacteraemia presenting
in the year.
Within the Trust it is widely
acknowledged that infection
prevention and control is everyone’s
responsibility; this is in addition to
the Infection Prevention and Control
team who provide specific advice and
guidance to staff.
Across the Trust there have been
a number of initiatives to reduce
infection:
The Patient Environment Action
Team (PEAT) carried out the formal
inspections during 2012/13 and we
are very pleased to have maintained
continued improvement in PEAT
standards across our sites. All our sites
scored either excellent or good.
• Ensuring staff attend appropriate
training - the uptake of infection
control training by year end is at
nearly 90%
• Promoting hand hygiene and
undertaking audits
• An infection control charter for both
patient, service users, visitors and staff.
Never Events
Never Events are defined by the Department of Health as ‘serious, largely preventable safety incidents that should not
occur if the available preventative measures have been implemented by healthcare providers’. Fifteen of the list of
twenty five never events are relevant to the Trust. There have been no occurrences of Never Events in the Trust during
2012/13.
Central Alerting System
The Central Alerting System is a means of alerting health and social care providers to the important safety information from a
number of different sources. The actions required as a result of the alerts can be minor or involve significant change. All alerts
are cascaded to managers in the Trust within 48 hours of being received. During 2012/13 140 alerts were received, all of which
were responded to within the required timeframe.
Type of Alerts Received
Month
Medical
Device Alerts
April
7
May
8
Gateway Alert
1
1
Totals
Pharmacy
Only Alerts
8
2
9
6
1
9
1
1
14
0
Safeguarding
October
7
There has been much activity related
to safeguarding in the Trust since the
last Quality Account. The Integrated
Safeguarding Team along with
the Safeguarding Working Groups
have been involved in embedding
safeguarding in all aspects of the Trust’s
work as the organisation grows and
develops.
November
6
56 | Annual Report 2012/13
Oxygen Alert
8
9
• Learning from multi agency Adult and
Children’s Serious Case Reviews
• Update of Adult and Child
Safeguarding Policies
• Implementing a new model of
safeguarding practice supervision for
staff who work with children.
• Strengthening the work of the
partnership working with both Adults
and Children’s Safeguarding Boards
• Working with Safeguarding Children’s
Board identifying processes for
Chief Medical
Office
13
8
Key Activities have been the
following:
Drug
Distribution
(DDL)
July
August
abusive relationships and awareness
of signs of sexual abuse.
• Mandatory Safeguarding Training
levels that must be completed by
all staff have now reached 88% for
safeguarding children and 90% for
safeguarding adults.
Estates
Facilities
Alerts
June
September
monitoring safeguarding performance
that evidences improved outcomes
for children.
• Work to improve communication
with patients and the public related
to safeguarding matters has resulted
in an update of the Safeguarding
Declaration on the Trust website
and an information page on what
patients and public can do if they are
concerned that a child or an adult is at
risk of significant harm.
Field Safety
Notice
December
2
January
3
1
1
1
4
1
1
1
1
February
6
1
March
11
1
1
1
10
4
14
5
7
2
7
1
3
1
6
3
7
5
13
3
107
33
The Trust maintains its approach of
zero tolerance of the abuse of children
and adults who are at risk of harm.
http://www.hacw.nhs.uk/our-services/
safeguarding-children-and-adults/
worcestershire-health-and-care-trustsafeguarding-declaration/
http://www.hacw.nhs.uk/our-services/
safeguarding-children-and-adults/
• Recognising that many staff
are also parents has prompted
communications and training for staff
related to young people who are in
57 | Annual Report 2012/13
Quality Account
Quality Account
Patient Safety Incidents and Serious Incidents
The Trust meets all contractual
requirements to assure healthcare
commissioners and regulators of the
quality of our services. We maintain a
Risk Register and systematically review
specific actions to work towards risk
reduction.
We promote a culture of learning and
reporting and see the rise in reporting
of incidents as an indication that
staff feel confident to report such
occurrences. This helps us learn more
about changes that we need to make
to reduce the risk of harm to patients.
Quality Goals dashboard every month
and have actions in place to improve
performance.
Incidents are not always being
reported within 48 hours of the
incident occurring (80% in March 2013)
as required by Trust policy and seen as
best practice by the CQC. We therefore
include the number of incidents
reported within 48 hours as one of
our quality indicators in our Trust
Staff have told us that our current
incident reporting system is difficult
to use so we have procured a new
incident reporting system which
is more user-friendly. This will be
introduced during the summer of
2013/14.
DNA policy highlights that our staff
may be uncertain of recent policy
change and/or awareness of policies.
All trust policies can be located on the
Policies page of the trust intranet site.
in reducing the incidents of Absent
without Leave (AWOLs) from our
mental health inpatient units. This
demonstrates that individual learning
can facilitate sustainable change.
Systems of disseminating learning
exist within Service Delivery Units via
our Quality and Governance Leads,
Clinical Leads and Team Managers. This
includes the Implementing Learning
Group in Adult Mental Health SDU
which has had significant impact
In implementing our learning from
Serious Incidents we will continue to
improve our high level quality of care
we offer to patients.
All serious pressure ulcers (grade 3 and
4) are reported as serious incidents
nationally. All pressure ulcers in the
hospital and community are reported
on our current online incident
reporting system and all serious
pressure ulcers are investigated using
root cause analysis.
of pressure ulcers in the community.
This is challenging to manage because
many people are looked after in the
community by people that the Trust
has no responsibility for. The Trust is
committed to reducing pressure ulcers
in the community setting and is taking
this forward as a priority into 2013/14.
avoidable throughout the year.
Although some progress is being made
we recognise we have lot more to do.
The Trust has very few community
hospital acquired pressure ulcers.
However there are a larger number
The chart below presents the
percentage of grade 3 and 4 pressure
ulcers that have been found to be
organisational level by sustainable
changes, improvements in process,
policy, systems and procedures
relating to patient safety within our
organisation. One of many policy
improvements is demonstrated in
the revision of the old Did Not Attend
Policy (DNA), renamed to Management
of Defaulted Appointments where
there are Potential Safeguarding
Issues (DNA Policy and Procedures).
Evidence from a recent Serious Incident
investigation related to the revised
Pressure Damage
Monthly trend for Patient Safety Incidents - 1 July 2011 to 31 March 2013
300
225
A Tissue Viability conference held
in March 2013 allowed healthcare
providers from the county to come
together to share lessons learned. Our
Tissue Viability Team are implementing
and monitoring an action plan and
continuously promote best practice
across the Trust.
Monthly trend for Pressure Damage incidents - 1 July 2011 to 31 March 2013
150
Jul
Aug Sept Oct
Nov Dec Jan
Feb Mar Apr May June July Aug Sept Oct
Nov Dec Jan
Feb Mar
100
The Francis Report has given
prominence to alarmingly poor
care and its delivery. The report has
implications for the whole NHS. One of
the main objectives of serious incident
reporting, the root cause analysis
and learning process from incidents
is reducing the risk of recurrence of
patient safety incidents. The learning
process should be embedded in
practice, and dissemination of learning
should happen at a timely and at an
appropriate opportunity following the
investigation.
The trust has a number of key
58 | Annual Report 2012/13
processes to enhance the learning
process following a Serious Incident
(SI) including Root Cause Analysis
(RCA), round table, multi disciplinary
discussion, support mechanisms for our
patient/relatives/carers and our staff.
All SI investigations are reviewed at
the Serious Incident Forum, which
includes Specialist Practitioners such as
Tissue Viability Nurse, Falls Prevention
Nurse and Quality Leads from Service
Delivery Units. Recommendations and
action plans are reviewed and critiqued
for the best possible learning to be
disseminated to the practice areas,
wider organisation and/or including
our stakeholders.
In light of this the Serious Incident
Forum has adopted an action log to
ensure the learning from incidents
are followed up. The Root Cause
Analysis template has been revised
and disseminated to Investigating
Officers. This will encourage a more
comprehensive and analytical
approach to the RCA. This in turn will
encourage the learning process, action
planning and review of the actions.
Learning can be demonstrated at
80
60
40
20
0
Jul
Aug Sept Oct
Nov Dec Jan
2011/12
Feb Mar Apr May June July Aug Sept Oct
Nov Dec Jan
Feb Mar
2012/13
59 | Annual Report 2012/13
Quality Account
Quality Account
Slips, Trips and Falls
Absent Without Leave
We have been using the data to try and
inform us where to target the resources
to reduce the number of incidents of
falls. The graph below sets out the
time of day when falls have occurred
which helps us to know which times of
the day are highest risk - and therefore
when to target the resources.
10%
5%
0%
AM
The Mental Health Act 1983 (amended
2007) is the law in England that allows
people with a mental disorder to be
admitted to hospital, detained for
a period and treated without their
consent; either for their own health and
safety, or for the protection of other
people.
The Trust provides care and treatment
to people suffering from mental
disorder and subject to the Mental
Health Act 1983.
circumstances. Essentially it means
that patients who either leave the ward
without the knowledge of the staff, or
fail to return from leave, are considered
to be absent without leave.
Under section 18 of this Act patients
can be considered to be absent
without leave (AWOL) in a variety of
PM
The Serious Incident definition of Absent Without Leave is:
0
1
2
3
4
5
6
7
8
9
10 11 12 13 14 15 16 17 18 19 20 21 22 23
The table below sets out the quarterly trend for the number of slips trips and falls reported in the Trust since July 2011.
250
‘Any patient that meets the Mental Health Act 1983 definition of absent without leave and whose assessment of risk leads
the care team to conclude that the patients risk to themselves or others is such that the police are informed and an incident
is registered which requires the police to act.’
Monthly trend for AWOL’s - 1 July 2011 to 31 March 2013
225
20
200
175
2011/12
15
2012/13
150
Q2 Q3 Q4 Q1 Q2 Q3 Q4
10
5
During 2012/13 our Falls Prevention
team set up a multi-disciplinary Falls
Steering Group to direct organisational
initiatives for reducing falls, for
example by rolling out a ‘falls ruck
sack’ to each ward which contains
equipment to be used when a patient
has fallen. This means patients can be
assessed promptly and the right kind of
equipment is readily available to staff.
Jul
Aug Sept Oct
Nov Dec Jan
2011/12
The chart below shows falls per bed days.
1.40%
0
Over the last year we have had a total
of 26 AWOL incidents compared to
66 during 2011/12. This reduction is
the result of staff taking the learning
from incidents of AWOLs and putting
measures in place as a result. Individual
care plans are in place for patients who
Monthly Trend for Community Hospital Wards
1.20%
Feb Mar Apr May June July Aug Sept Oct
Nov Dec Jan
Feb Mar
2012/13
are at risk or who have previously gone
AWOL.
The Care Quality Commission (CQC)
monitors the Trust use of the Mental
Health Act 1983 and in 2012/2013, nine
Trust services providing mental health
care were visited by a Commissioner.
During these visits - which may be
announced or unannounced - the
Commissioners talk to patients and
staff and then provide the Trust with
an action plan which the Trust must
answer.
1.00%
0.80%
0.60%
0.40%
0.20%
0.00%
Jul
Aug Sept Oct
Nov Dec Jan
2011/12
60 | Annual Report 2012/13
Feb Mar Apr May June July Aug Sept Oct
Nov Dec Jan
Feb Mar
2012/13
61 | Annual Report 2012/13
Quality Account
Quality Account
Patient Experience
Patient Safety Walkrounds
Patient safety walkrounds are one of
the ways we ensure that executives
are informed first hand, regarding
the safety concerns of frontline staff.
They are also a way of demonstrating
visible commitment by listening to and
supporting staff when issues of safety
are raised. Walkrounds are instrumental
in developing our open culture where
the safety of patients is the priority of
the organisation. Our non-executive
directors and executive directors have
undertaken a number of walkrounds
over the past year and have enjoyed
listening to staff’s pride in their
services, and also to their concerns.
It was as a result of the walkarounds
that the decision was taken to change
our incident reporting system. Many
staff explained how frustrating the
current system is and demonstrated
how long it currently takes to log an
incident. Many of the other issues
raised were connected to estates
issues. The Trust has an Estates
Strategy to ensure our buildings are
suitable for our staff and patients in the
years ahead.
Our High Impact Action campaign
and the introduction of 2 hourly care
Care Rounds were introduced in all
our community hospitals and mental
health in-patients units on the 28th
May 2012 with the aim being to
improve the quality of patient care by
tailoring care to patients needs and by
supporting staff to do this. Care Rounds
are a structured approach whereby
ward staff undertake regular checks
on patients at set intervals, typically 2
hourly and consider patients comfort,
safety, emotional state, nutrition and
hydration.
Within the in-patient settings the Care
Rounds will ensure patients know they
can expect to see a member of staff at
least every 2 hours.
The concept of leadership rounding
was also introduced. Leadership rounds
are completed 3 times per week by the
Matron, Ward Manager or their deputy.
Each leadership round consists of
talking to five patients (or their relatives
if the patient does not have capacity)
and assessing if there is any cause
for concern regarding the care being
delivered on the ward.
not suit some of our services. People
who have been admitted to a mental
health ward for example may find the
concept of recommending the service
difficult.
The following graph sets out the
results for the net promoter surveys we
undertook three times during the year.
Period 3
Our ambition is to sustain high quality
care so that our patients will have a
good experience, provided in a clean,
safe and stimulating environment
and they will recognise us as a Trust
that cares. In this way we aim to keep
the focus firmly on the fundamental
qualities of care. In the short time that
the pledge has been available to staff,
we are seeing increasing numbers of
staff signing up and putting their name
to our ambition.
rounds are two of the work streams
that come under ‘Pledge to Care’. High
Impact Actions continues to be a
focal point for staff when considering
the care being delivered to patients.
The 7 Champions have introduced
several new initiatives during the past
year, some cover individual actions
and others incorporate all. A pocket
sized ‘Aid to Good Practice’ has been
developed which provides staff with
the ‘bundle’ of care that should be
implemented for every patient that it is
applicable for.
Period 2
‘Pledge to Care’ is a campaign being led
by the Quality Directorate and clinical
colleagues in the service delivery units,
to ensure our staff embrace, practice
and promote high standards of quality
care provision.
80%
moving towards a much more joined
up approach in order that we can
maximise the learning from what
patients tell us, and ultimately improve
outcomes.
We took part in the ‘net promoter’ - the
family and friends test - although the
question ‘would you recommend this
service to your family and friends’ does
Period 1
Pledge to Care and Care Rounds
In line with the Government’s principle
of “no decision about me without me”,
we worked hard last year to develop
and implement ways of measuring the
effectiveness of the care we provide
from the patient’s point of view.
Although there is plenty of evidence
of teams gathering patient experience
data in the Trust, for 2013/14 we are
60%
+50% Excellent in Industry standard
40%
20%
0%
Along with the Family and Friends test question we asked other questions depending on the service.
The graph below shows the results from a dental service survey.
Was this service easy to access?
Responses
Yes54
No0
Yes
Total54
The graph below shows the results from surveys carried out in our sexual health clinics during the year.
Have staff communicated well with you?
Responses
Extremely Well
129
Very Well9
150
100
Not Well0
Not at all Well0
Total138
50
0
Extremely Well
62 | Annual Report 2012/13
Very Well
63 | Annual Report 2012/13
Quality Account
Quality Account
Same-sex Accommodation
The graph below shows the results from the sexual health clinics.
Have staff communicated well with you?
Responses
Extremely Well
During 2012/13 we have met all the standards set by the Government to provide accommodation for patients that is not shared
with the opposite sex.
150
132
Very Well6
100
Not Well0
Our 2012/13 Commissioning for Quality and Innovation (CQUIN) Performance
50
Not at all Well0
Total138
CQUIN scheme requires Trusts to improve quality and innovation by discussing, agreeing and monitoring quality indicators
with its commissioners. It is a locally agreed package of quality improvement goals and indicators which, if achieved, enables
the Trust to earn a payment.
0
Extremely Well
Very Well
The graph below shows the results from a survey in the community hospitals.
Do you feel safe in our care?
A CQUIN scheme should address the three pillars of quality: safety, effectiveness and patient experience, whilst also reflecting
innovation.
Responses
Extremely Safe
47
The indicators set out in the table below were set for 2012/13 and present our performance. We were pleased to achieve all of
the quality improvement measures in our CQUINs and in some cases exceed them.
Safe
Safe34
Not Safe0
Not at all Safe0
Total81
Extremely Safe
CQUIN Goal description
0 10 20 30 40 50
Further information and data from all of our patient surveys will be available to see on our new patient experience webpage
which is being launched in the early summer of 2013.
Offender Healthcare Survey
Our Offender Healthcare team
undertook a survey in HMP Long Lartin
to understand whether prisoners knew
about the healthcare services available
to them and how to access them.
As a result of feedback from the
questionnaire, it became apparent
that some patients were unsure of
the services that healthcare offer.
The healthcare team linked in with
the prison’s education team and the
64 | Annual Report 2012/13
lower literacy group and agreed that
students/patients from this group
would devise a health application form
that would help people understand
more about the services that are
available. The entire A4 poster/
form has been designed by prisoner
patients.
now been rolled out across the three
prisons. This good practice is being
shared with colleagues from other
secure estates across the country to
help ensure prisoners know how to
access healthcare.
Achieved
Net Promoter ‘Friends and Family’ introduction and roll out

Roll out of three further patient experience questions

Triangulation of patient experience data

Venous Thromboembolism Assessments

Safety Thermometer data submissions

Organisational Commitment for Making Every Contact Count

Establishment and implementation of dementia pathway in the Community
Hosptials

CAMHS (Child and Adolescent Mental Health Service) discharge planning

Mental Health -Primary Care and Community Mental Health Teams
development

Mental Health - Improved Service User Engagement Plans

The healthcare team trialled it on
the prison wings in the prison and
following positive feedback, it has
65 | Annual Report 2012/13
Quality Account
Quality Account
Looking Forward
4. Improve Evidence that We Learn from Patient Safety Incidents and Near Misses
Quality Account Priorities for 2013/14
This section describes the Quality
Improvement Priorities that have been
adopted for 2013/2014.
Suggestions for the priorities were
drawn from a number of sources:
• the Trust’s own review of its quality
performance, based on information
for example from our incident data
and complaints
• recommendations, where they could
be applied to our services, from the
Winterbourne View Hospital and The
Francis Report into Mid Staffordshire
NHS Foundation Trust
• the NHS Constitution
• the NHS Mandate
• the NHS Outcomes Framework
• Monitor’s Quality Governance
Assurance Framework.
Our local engagement forums were
asked to vote on which priorities they
thought we should select and a survey
was placed on our public website. We
recognise that we need to improve
the level of engagement we have in
deciding the priorities; for the 2013/14
accounts we are setting up workshops
in November and December for
stakeholders and members of our
executive team to review this year’s
priorities and determine those for next
year. We will also be balloting our
staff for their views on what we should
prioritise.
How will improvement be measured?
• Revised incidence reporting policy to further underpin the learning from incidents
• Revised Root Cause Analysis training
• New patient safety reporting system which will give better reporting to teams so that trends can be identified
5. Continue the work to Reduce Avoidable Pressure Ulcers
How will improvement be measured
• Safety Thermometer audits
• Data from the Incident Reporting System
• Data from nursing metrics via the new whiteboards on the wards
After considering feedback from the Forums and the public survey Board decided on five priorities. The first three
reflect the commitment that Board have to improving our listening and learning from patients. The priorities for
2013/14 are:
1. Improved Use of Patient, Carer and Staff Feedback, including the ‘Friends and
Family’ Test
How will improvement be measured and monitored?
• Increase the number of people surveyed each quarter during the year.
• Report to the Engagement Forums, Quality and Safety Committee and Board on examples of changes that have been
made as a result of the surveys
2. Improvement in the Capture of Real Time Feedback from Patients
How will improvement be measured and monitored?
• Patient Experience Strategy to written and ratified. This will include new initiatives for gaining feedback from patients.
• Register of current patient surveys and themes
• Results of real time feedback and actions taken to be reviewed by the Patient Experience Group, which will be fed
through to Board.
3. Continue to Improve our Response Times and Learning from Complaints
How will improvement be measured?
• Monitoring of response times to complaints
• Survey of complainants, after the complaint has been closed, to establish views on whether our responses were of
good quality
• Analysis of communication issues with the outcome of determining training needs for staff
66 | Annual Report 2012/13
67 | Annual Report 2012/13
Quality Account
Quality Account
CQUINS for 2013/14
The following CQUINS have been agreed with our commissioners for 2013/14. We are committed to delivering these quality
improvements and will be reporting on our progress with each of them to Trust Board and our commissioners during the year.
CQUIN Theme/Title
Brief Description of Indicator
NHS Safety Thermometer
• Continue to submit monthly surveys
• 50% reduction in pressure ulcers reported in Safety Thermometer
Family & Friends (net promoter)
• Phased roll out to include MIUs and Outpatient Physiotherapy
• Increase in numbers surveyed
• Action plans to address findings
Improving patient flow - linked to the
work of the Patient Flow Programme
Board
1. Point prevalence audit of in-patients
2. Analyse results and agree actions
3. Training to staff re. discharge care planning
4. Evaluate
Integrated teams
Continue with the current level of integrated working and participation in MDT/ Clinical management
planning in Wyre Forest. Jointly establish the methodology for undertaking the pilots with the Senior
Programme lead and head of service development within CCGs and jointly establish an evaluation tool.
• Report number of meetings and production of Care Management plans.
• Evaluation
2012/2013 Quality Account
Technical Section
Mandatory Statements
The following section contains the mandatory statements common to all Quality Accounts as required by the regulations set
out by the Department of Health.
The Trust identifies any guidance issued by the Secretary of State which relates to chapter 2 of the Health Act 2009, and acts
upon it appropriately.
Review of services
During 2012/13 the Worcestershire Health and Care Trust provided and/or subcontracted 5 NHS services.
• Community Care
• Adult Mental Health
• Children, Young People and Families
• Specialist Primary Care
• Learning Disabilities.
IV Therapy
Training and competency assessment to be completed for % of identified staff
End of Life – Amber Care bundle
1. Trial on 2 wards
2. Agree training
3. Roll out to % of identified staff
Advanced Care Planning
1. Identify number of staff who need training and training package
2. Train % of identified staff
Engagement of family/friends and
carers and advocates in the care
planning process
For the identified clusters and an agreed % sample of patients
To collect , collate and analysis feedback and provide a report to commissioners on the suite of metrics agreed.
The income generated by the NHS services reviewed in 2012/13 represents 100 per cent of the total income generated from the
provision of NHS services by the Worcestershire Health and Care NHS Trust for 2012/13.
Crisis Support Plans
To ensure patients on CPA to have on discharge from acute or secondary care services an agreed Crisis
Support Plan which is communicated with GPs.
Participation in clinical audits
Improving the physical healthcare
for people with severe and enduring
mental health problems.
To improve the uptake of physical health checks within clusters 1 – 17 patients and to ensure the recording of
5 key physical health characteristics within mental health documentation.
PbR (Payment by Result) Improving
the rate of care cluster reviews
Patients on all clusters to have a review in line with at the expected review intervals as set down by the PbR
Guidance December 19th 2012 using the Honos Assessment and Care Programme Approach.
We are increasingly working with our partners across the county, such as the Acute Trust and Social Care providers, to ensure that
patient care pathways are as seamless as possible. For example, during 2013/14 we will be looking at how we can clearly establish
whether patients are in the right care setting for their needs, and how transfer and discharge plans can be improved. We will be
reporting on this initiative in next year’s Quality Account.
The Worcestershire Health and Care NHS Trust has reviewed all the data available to them on the quality of care in five of these
NHS services.
During 2012/13 four national clinical audits and one national confidential enquiry covered NHS services that Worcestershire
Health and Care NHS Trust provides.
During that period Worcestershire Health and Care NHS Trust participated in 100% national clinical audits and 100% national
confidential enquiries of the national clinical audits and national confidential enquiries which it was eligible to participate in. The national clinical audits and national confidential enquiries that Worcestershire Health and Care NHS Trust was
eligible to participate in during 2012/13 are as follows:
• POMH-UK Screening of metabolic side effects of antipsychotic drugs
• POMH-UK Prescribing for people with a personality disorder
• POMH-UK Prescribing antipsychotics for people with dementia
• National Audit of Psychological Therapies for Anxiety and Depression (NAPT)
• National Confidential Inquiry into Suicide and Homicide by people with Mental Illness (NCISH)
The national clinical audits and national confidential enquiries that Worcestershire Health and Care NHS Trust participated in,
and for which data collection was completed during Worcestershire Health and Care NHS Trust are listed below alongside the
number of cases submitted to each audit or enquiry as a percentage of the number of registered cases required by the terms of
that audit or enquiry. 68 | Annual Report 2012/13
69 | Annual Report 2012/13
Quality Account
National clinical audits 2012/13
Quality Account
Participation
% cases submitted
Prescribing for people with a personality disorder
Yes
100%
Screening of metabolic side effects of antipsychotic drugs
Yes
100%
Prescribing antipsychotics for people with dementia
Yes
100%
Other national audits
Yes
100%
National Audit of Psychological Therapies for Anxiety and Depression
(NAPT)
Yes
100%
The reports of three national clinical audits were reviewed by the provider in 2012/13 and Worcestershire Health and
Care NHS Trust intends to take the following actions to improve the quality of healthcare provided.
Prescribing Observatory for Mental Health (POMH-UK)
Subject of audit
Standard where audit
identified need for
improvement
Actions that have been put
in place since audit
Outcome
National Audit of Schizophrenia
Essential physical health indicators
were monitored.
A physical health CQUIN has been
proposed around the number of
patients with severe and enduring
mental illness who have had an
annual physical check under the
QOF.
To be confirmed.
Where indicated, advice about diet
and exercise was offered.
Following the review of the CPA
policy, a working group is being
set up to look at documentation.
There are strong arguments for the
inclusion of lifestyle factors and
cardiovascular risks for all people
on CPA.
There are rigorous guidelines for
this physical health check which
include monitoring of weight
(BMI) and general advice on the
prevention of heart disease which
would include exercise.
Under MECC (Make Every Contact
Count) programmes, staff are being
trained in ‘health chats’ and brief
interventions around lifestyle. There
is also general awareness-raising
about physical health among staff
and patient groups.
70 | Annual Report 2012/13
Patients are prescribed a single
antipsychotic. (Polypharmacy,
i.e. the prescription of more
than antipsychotic at a time, is
sometimes appropriate.)
The Trust participates in a review
of poly-pharmacy with POMHUK. Medication is reviewed by
pharmacists on a ward level.
There are rigorous guidelines for
this physical health check which
include a check of medication and
collaboration in reviewing risk/
benefits with secondary care.
Patients whose illness was not
responsive to antipsychotics were
offered appropriate psychological
therapy.
1. Psychological intervention
pathways and psychology are being
reviewed.
2. Education/information to be
circulated to staff about the range
of psychological therapies that are
available and that people may be
receiving.
The Map of Medicine care pathways
have been completed locally for
psychosis clusters. Further work
around Patient numbers and core
interventions for the various clusters
will allow for planning of service
provision to meet current need.
POMH-UK Use of antipsychotic
medicine in CAMHS
1. The indication for treatment with
antipsychotic medication should be
documented in the clinical records.
2. Side effects of antipsychotic
medication should be reviewed
at least once every 6 months. This
review should include assessment
for the presence of extrapyramidal
side effects (EPS), weight, BP,
glucose, lipids and raised prolactin.
Introduction of an antipsychotic
monitoring sheet.
All results are routinely recorded at
commencement of medication and
then at 6 monthly intervals.
Where the clinical decision was
taken not to request a test then this
is clearly documented within the
clinical notes with an explanation
and dated.
Prescribing for people with a
personality disorder
No specific areas requiring
improvement per se.
Plans to develop a training session
for medical staff based around case
studies with a mix of teaching and
small group work.
Too early to report.
71 | Annual Report 2012/13
Quality Account
Quality Account
The reports of 27 local clinical audits were reviewed by the provider in 2012/13 and Worcestershire Health and Care
NHS Trust intends to take the following actions to improve the quality of healthcare provided.
Statements for the CQC
Worcestershire Health and Care NHS
Trust is required to register with the
Care Quality Commission and its
current registration status is registered.
Worcestershire Health and Care NHS
Trust has no conditions imposed on its
registration.
The Care Quality Commission has not
taken enforcement action against
Worcestershire Health and Care NHS
Trust during 2012/13.
reviews or investigations by the CQC
during the reporting period.
Subject of audit
Standard where audit identified need
for improvement
Actions that have been put in place
since audit
Condition of walking aids used by residents with
a residential care home.
Walking frame assessments.
Patients requiring frames were reassessed and
new frames ordered, and replacement ferrules
fitted where necessary.
Delays in Electroconvulsive Therapy (ECT)
treatment and pre-ECT assessment of capacity
to consent.
Completion of capacity to consent to ECT
assessment within 24 hours of each ECT session.
Patients scheduled for Monday ECT clinics to
have their capacity to consent assessed within
the previous 24 hours by the on call SHO on the
Sunday or planned for early in the morning.
Day time enuresis in children.
Record keeping.
Paperwork amended to prompt for specific
details.
Data Quality
Minimum standards for physical health
assessments on mental health inpatient wards.
All areas of physical health assessment.
Admissions proforma developed to prompt for
physical health assessment.
Worcestershire Health and Care NHS Trust will be taking the following actions to improve data quality.
Chronic Obstructive Pulmonary Disease (COPD)
in Offender Health.
Patient assessments.
Medication errors at a community hospital.
Errors in medication administration.
Patients reassessed using the MUST tool
(Malnutrition Universal Screening Tool). Anxiety
and depression assessments undertaken and a
system update requested for the COPD template
to enable capture of required data.
Laminated aide memoirs installed on the drugs
trolley, and the wearing of distinctive tabards
which act as a visual indictor to people on the
ward that the nurses should not be interrupted
whilst dispensing medication.
Please note this is a sample only to give an idea of the spread of audit work across the services.
Worcestershire Health and Care NHS
Trust has not participated in any special
Community Care Ethnic origin
Action
By whom
By when
Monthly lists of attended community contacts
where patient’s ethnic origin code is unknown
to be produced.
Information Dept
April 2013 data onwards
Share list with Locality Managers. Trust’s Patient
Admin System to be updated to ensure the
correct ethnic origin is recorded.
Information Dept / Service Delivery Units
April 2013 data onwards
% Completeness of Ethnic origin to be reported
within monthly performance dashboards to
Finance & Performance Committee
Performance Dept.
May 2013 onwards
Action
By whom
By when
Monthly lists of episodes with a missing
‘decided to admit date’ to be produced.
Information Dept
April 2013 data onwards
Share list with Service Delivery Units. Patient
systems to be updated to ensure the correct
date is recorded/or the correct admission
method is used.
Information Dept/ Service Delivery Units
April 2013 data onwards
Inpatient Decided to Admit Date
Participation in clinical research
The number of patients receiving NHS
services provided or sub-contracted by
Worcestershire Health and Care NHS
Trust in 2012/13 that were recruited
during that period to participate in
research approved by a research ethics
committee was 75.
Participation in clinical research
demonstrates Worcestershire Health
and Care NHS Trust’s commitment
to improving the quality of care we
offer and to making our contribution
to wider health improvement. Our
clinical staff stay abreast of the latest
possible treatment possibilities and
active participation in research leads to
successful patient outcomes.
Goals agreed with Commissioners
A proportion of Worcestershire Health
and Care NHS Trust income in 2012/13
was conditional on achieving quality
improvement and innovation goals
agreed between Worcestershire Health
and Care NHS Trust and any person
72 | Annual Report 2012/13
or body they entered into a contract,
agreement or arrangement with for
the provision of NHS services, through
the Commissioning for Quality and
Innovation payment framework.
Further details of the agreed goals
for 2011/12 and for the following
12 month period are available
electronically at www.hacw.nhs.uk
73 | Annual Report 2012/13
Quality Account
Quality Account
Mandated Indicators
Outpatient: Postcode of usual address
Action
By whom
By when
Cross reference records with unknown postcode
with the regular batch trace results in the data
warehouse.
Information Dept
31 May 2013
Amend monthly processing outpatient MDS
procedure to use batch trace results as a data
source for unknown postcodes
Information Dept
31 May 2013
Any postcodes identified are to be shared with
Service Delivery Units for them to update the
source system.
Information Dept
Ongoing
Worcestershire Health and Care NHS Trust submitted records during 2012/13 to the Secondary Uses Service for inclusion in the
Hospital Episode Statistics which are included in the latest published data.
Care Programme Approach (CPA) follow up contact within seven days of discharge from hospital.
The Department of Health monitors the Trust’s performance in this area on a quarterly basis as part of the NHS Performance
Framework indicators. In order to achieve the highest level of compliance in this area (“Performing”) the Trust must achieve 95%
of inpatients on CPA followed up within seven days of discharge from hospital.
The Trust is pleased to report that a level of ‘Performing’ was consistently achieved, with scores over 98%, for each quarter in
2012/13. The quarterly scores are shown in Table 1 below.
Table 1: Percentage of people on CPA followed up within 7 days of discharge from hospital.
Performance Thresholds
Actual Quarterly Performance 2012/13
Performing
Underperform
Quarter 1
Quarter 2
Quarter 3
Quarter 4
95% or over
90% or less
99.1%
98.6%
100.0%
99.4%
The percentage of records in the published data which included the patient’s valid NHS Number was:
• 100% for admitted patient care;
• 99.8% for outpatient care; and
• Not applicable for accident and emergency care.
Which included the patient’s valid general medical practice was:
• 99.9% for admitted patient care;
• 99.6% for outpatient care; and
• Not applicable for accident and emergency care.
Information Governance Toolkit Attainment Levels
Worcestershire Health and Care NHS Trust Information Governance Assessment Report score overall score for 2012/13 was 69%
and was graded satisfactory (highest grade obtainable).
Minimising Delayed Transfers of Care
Measuring delayed transfers of care is a mandatory requirement of the CQC, and helps us to assess the impact of communitybased care in facilitating timely discharge from hospitals.
People should receive the right care in the right place at the right time and we must ensure that people move on from the
hospital environment once they are safe to transfer.
The indicator seeks to encourage organisations to work in partnership to minimise the number of patients remaining in
hospital settings who are ready for discharge.
The definition is as follows: “the number of patients (acute and non-acute, aged 18 and over) whose transfer of care was
delayed, expressed as a percentage of the number of consultant and non-consultant led occupied beds.”
Clinical coding error rate
In order to achieve the highest level of compliance in this area (“Performing”) the Trust must keep delayed transfers of care to
7.5% or less during each quarter.
Worcestershire Health and Care NHS Trust was not subject to the payment by results clinical coding audit during 2012/13 by
the Audit Commission.
Table 2 shows the Trust’s position for 2012/13. The Trust is pleased to report that a level of ‘Performing’ was consistently
achieved, with scores of 6.7% and under, for each quarter in 2012/13.
We routinely monitor our performance in this area across all services and where performance consistently falls below target we
implement recovery plans that are monitored by the Trust Board. We actively work with our partner organisations to minimise
any delays.
Table 2: Percentage delayed transfers of care.
74 | Annual Report 2012/13
Performance Thresholds
Actual Quarterly Performance 2012/13
Performing
Underperform
Quarter 1
Quarter 2
Quarter 3
Quarter 4
7.5% or less
10% or over
6.7%
6.5%
3.9%
4.6%
75 | Annual Report 2012/13
Quality Account
Quality Account
The number of admissions to the Trust’s mental health acute wards that were gate kept by the Assessment and Home
Treatment Teams
When service user admissions are assessed (“gate kept”) by their local Assessment and Home Treatment Team, service users
have the opportunity to be treated in their own home. Wherever possible we offer service users the choice to be supported in
their own home as an alternative to hospital admission. This is recognised as best practice and monitored by the Department of
Health in the NHS Performance Framework.
The method for calculating performance is as follows: “the number of admissions to the Trust’s acute wards (excluding internal
transfers between wards, patients recalled from community treatment orders, and patients on leave under Section 17 of the
Mental Health Act) that were gate kept by the Assessment and Home Treatment team prior to admission. An admission has
been ‘gate kept’ if the team assessed the service user before admission and involved them in the decision making process
that resulted in the hospital admission. This is expressed as a percentage of total admissions to the Trust’s acute mental health
wards.”
In order to achieve the highest level of compliance (“Performing”) the Trust must ensure that 95% of admissions to acute
mental health wards were gate kept by the Assessment and Home Treatment Teams.
The 2012/13 performance is shown in Table 3. The Trust is pleased to report that a level of ‘Performing’ was consistently
achieved, with scores over 97%, for each quarter in 2012/13.
Table 6: Patient experience of contact with a health or social care worker:
Trust’s 2012 score.
(score out of 10)
Compared with the
national response,
we scored:
Listening:
for the health or social care worker seen most recently was listening carefully to them.
8.7
About the same
Involvement:
for the health or social care worker seen most recently taking their views into account
8.5
About the same
Trust and confidence:
for having trust and confidence in the health or social care worker seen most recently
8.5
About the same
Respect and dignity:
for being treated with respect and dignity by the health or social care worker seen most
recently
9.4
About the same
Time:
for being given enough time to discuss their condition and treatment with the health or
social care worker seen most recently
8.2
About the same
Overall experience of contact with the health or social care worker seen most recently.
8.7
About the same
Figures taken from the CQC website: http://www.cqc.org.uk/survey/mentalhealth/R1A
Table 3: Percentage of admissions to mental health acute wards that were gate kept.
Rate of Patient Safety Incidents Reported and the Number and Percentage of such Patient Safety Incidents that resulted in
Severe Harm or Death
Performance Thresholds
Actual Quarterly Performance 2012/13
Performing
Underperform
Quarter 1
Quarter 2
Quarter 3
Quarter 4
95% or over
90% or less
99.5%
97.0%
98.4%
98.6%
Percentage of staff employed by the Trust during 2012/13 who would recommend the Trust as a provider of care to
family or friends:
We were in the top 20% for our group of trusts and scored 74.4%.
Patient experience of community mental health services.
To improve the quality of services that the Trust delivers, it is important to understand what people think about their care and
treatment. One way of doing this is by asking people who have recently used our services to tell us about their experiences.
To assist with this, each year a survey of people aged 18 and over accessing community mental health services is conducted
and collated by the Care Quality Commission.
Between 1st April 2012 until 31st March 2013 the percentage of patient safety incidents resulting in severe harm or death =
2.23%
No. of Incidents
Percentage
Low
1235
38.75%
Moderate
562
17.63%
None
1186
37.21%
Severe
41
1.29%
Death
30
0.94%
Not Recorded
133
4.17%
TOTAL
3187
100%
A questionnaire was sent to 850 people who accessed community mental health services between 1st July 2012 and 30th
September 2012. A total of 303 people responded, giving a 36% response rate for the Trust. This compares to the national
response rate of 32%.
An excerpt of the survey results, specifically covering the patient’s experience of contact with a health or social care worker, are
shown in Table 6 below. The full report has been published by the CQC and is available on their website.
76 | Annual Report 2012/13
77 | Annual Report 2012/13
Quality Account
Quality Account
And finally for our Quality Account, one of our volunteers tells her story.
Worcestershire Health Overview and Scrutiny Committee
response to the Quality Account
Volunteer Hospital Visitor Mary
The meeting with Mary was greeted with a waft of wonderful smells coming
from her kitchen, they were a batch of cakes she had just made to take around
to the hospital for a group of staff as a treat for that afternoon.
It did not take many minutes to see that
giving out to others was something that
defined Mary as a person. She was quick
to say she didn’t do much just a bit of
this and a bit of that which in the end
amounted to a lot.
On 10 July 2012 Mary received
the distinction of becoming the
Worcestershire Health and Care NHS
Trust Volunteer of the Year. She went
along to a ceremony to celebrate
staff achievements held at the Artrix
Theatre in Bromsgrove and was
awarded a plaque by Sarah Dugan. Her
granddaughter Samantha who was
with her told her nan how she felt really
proud of her.
Like so many of our volunteers, Mary
experiences the pleasure in giving
rather than receiving. She said, “I am
selfish really” going on to tell me that
she gets just as much pleasure from her
volunteering as the people she helps.
She said she would only be watching
the TV otherwise. “It’s a two-way thing”,
she said.
The Worcestershire Health Overview and Scrutiny Committee (HOSC) does not take the view that its role is to be a ‘critical
friend’. It aims to be constructive at all times but it reserves the right to make robust objections when appropriate, which it
considers will help maintain public confidence in the service under scrutiny.
The HOSC also continues to hold the view (which was recently endorsed in the Robert Francis Report*) that each health
provider should make full use of the statutory requirement to publish Quality Accounts to ensure that progress towards highquality care is led by the Board and that the public is provided with meaningful information on outcomes of care.
It is considered that implicit in the term meaningful information is that the Quality Account is available for the public and easily
understood.
Due to this year’s local elections, the HOSC’s consideration of draft Quality Accounts was scheduled earlier than usual. Health
service providers kindly provided early drafts of their Quality Accounts to accommodate the HOSC. Councillors are aware that
therefore some of the comments made by the HOSC are likely to be addressed in subsequent versions of the Quality Accounts.
In making its response the HOSC considers information made available throughout the year which is supported by the Quality
Account. The information received on a regular basis regarding Worcestershire Health and Care NHS Trust includes:
• Regular public published newsletters which have recently been supplemented by a bi-monthly Board Bulletin;
• Regular programmed meetings between the HOSC Chairman, Chief Executive and Director of Business Development; and
• Board Meetings, to which Councillors Roger Berry and Maddy Bunker, the lead HOSC members for the Trust, were invited.
Board meetings are open to the public.
Communications
• The report is written in a style accessible to the public;
• The HOSC was impressed by the simplicity achieved in the Trust’s publications using the SpeakEasy service; and
• There was something of a break-down in communications during the year however on a perceived proposal to close
community hospital beds.
Mary grew up in the Isle of Wight and
upon leaving school became a Nanny.
Afterwards she was drafted into the
land army on the Isle of Wight and later
transferred to St Michaels near Tenbury
Wells where she met and married
her husband. She and her husband
had three children and Mary now has
eight grandchildren plus six great
grandchildren. Prior to retiring Mary
worked at Spar in Tenbury and now
sees volunteering as taking that place.
Comments
• More information is needed on the outcomes of last year’s priorities (see 4. Review of 2012/13):
a. Almost Achieved: Listen and learn from complaints (see work outlined re friends and family etc in Priorities for
2013/14); workforce fit for purpose; improve care of dementia patients / carers; and
b. Behind Schedule: avoidable pressure ulcers.
• The HOSC is encouraged that the Trust is making an early and active response to the Francis Report*; and
• Data needed to be included with the final Quality Account about the number of complaints and compliments about the Trust.
Twice a week Mary volunteers at her
local Sue Ryder shop serving at the
counter, and on the days she does not
go there, she goes to Tenbury Wells
hospital spending time chatting to
patients.
Volunteering at the hospital all began
over twenty years ago when Mary was
visiting a friend and noticed that the
woman in the next bed never had a
visitor so Mary began chatting to her
also and then to other women on the
ward.
78 | Annual Report 2012/13
Pictured: Mary with her achievement award and certificate
79 | Annual Report 2012/13
Quality Account
Priorities for 2013/14
• The result measures seem a bit vague:
o Improvement monitoring - how?
o Increasing the number of people surveyed could be an increase of 1; and
o Will the Board see the data or just ‘examples of changes’?
• Learning from complaints:
o Will this be challenged?
• Reduce avoidable pressure ulcers:
o It is noted that the Trust is not in position to help people in the community who are at risk of developing pressure
sores until they are referred to the Trust’s services. However, there is a project to educate particularly staff in nursing
homes about tissue viability.
• It is noted that Worcestershire Acute Hospitals NHS Trust is well-experienced in a number of Worcestershire Health and Care
NHS Trust’s priorities and information should be provided in the final Quality Account about any sharing of experience and
best practice between the organisations; and
• The HOSC accepts that the priorities and targets set by the Trust are made as a matter of professional judgement but it is
reiterated that these would instil even more confidence were they produced as a result of cross-trust collaboration.
*The Mid Staffordshire NHS Foundation Trust Public Inquiry - Chaired by Robert Francis QC
Quality Account
Healthwatch Worcestershire
response to the Quality Account
Healthwatch Worcestershire, which came into being on 1 April 2013 welcomes the opportunity to consider the 2012/13 Quality
Account that has been prepared by the Worcestershire Health & Care NHS Trust. We have considered the Quality Account in the
light of the Department of Health’s Guidance and have prepared the following comments:
Do the priorities of the provider reflect the priorities of the local population?
In that the national targets are prescriptive, the priorities of the Trust reflect those areas which are underperforming or not
delivering consistent results e.g. infection control, accident and emergency treatment, mortality rates, falls and stroke treatment,
and which obviously must continue to be very important to the local population in terms of access and confidence.
The local Clinical Commissioning Groups (previously NHS Worcestershire) have the flexibility to reflect their population’s priorities,
and those of the Worcestershire Health & Well Being Board, in the Trust’s contract and the Commissioning for Quality and
Innovation Payment framework (CQUIN).
Are there any important issues missed in the Quality Account?
It would have been useful to explain more about the ‘Big Recovery’ and ‘Recovery College’.
Worcestershire Health Overview and Scrutiny Committee
Although the Information Governance Toolkit score is 69% and satisfactory, it would be useful to know the areas which need
improvement, and the plan to do so.
Response and changes made as a result of HOSC commentary
Has the provider demonstrated they have involved patients and the public in the production of the Quality Account?
The Trust Patient Relations and Community Engagement Teams organise patient and carers inspection visits, local engagement
forums and website interaction; Worcestershire LINks (Healthwatch Worcestershire from 1.4.13) also provided regular feedback
which should all contribute to the Trust’s planning.
Worcestershire Health and Care NHS Trust thanks the members of HOSC for their comments. The following changes have been
made to the text of the account. The quality account will be part of the Trust’s Annual Report which will more fully reflect the
sharing of information between organisations.
The following amendments have:
• More information added on last year’s priorities
• Data regarding complaints and compliments added
• Clarity added around measures for next year’s priorites
Involvement in clinical audits and research, and the subsequent learning is welcomed. It is hoped that results from the staff Net
Promoter test will improve as appraisals, sickness levels, mandatory training and the Pledge to Care achieve full participation and
greater contribution to process and practice improvements.
Is the Quality Account clearly presented for patients and the public?
The document is very readable and informative. Action taken from complaints is demonstrated and several regional and national
benchmarks are compared and illustrated. There were very few abbreviations used and the commentary was relevant and
understandable.
We look forward to working with the Trust in the preparation of its Quality Account for the coming year, and for which we will be
able to comment from a more informed position.
Healthwatch Worcestershire
80 | Annual Report 2012/13
81 | Annual Report 2012/13
Quality Account
Quality Account
NHS Redditch & Bromsgrove, South Worcestershire and Wyre Forest Clinical
Commissioning Groups (CCGs).
Whilst it is accepted that the majority of these are not acquired within the ward environment and that a small percentage increase
may be due to raised awareness of the need to report, it is not clear in this document how the Trust commitment to reducing
community acquired pressure damage will be achieved. For example is the Trust planning any wider ‘systems’ review of services
where there is evidence of increasing numbers of pressure damage incidents, in order to gain assurance that all the fundamental
contributory factors are understood so that they can be addressed?
A significant component of the work undertaken by the three new Clinical Commissioning Groups (CCGs) for Worcestershire - NHS
South Worcestershire CCG, NHS Redditch and Bromsgrove CCG and NHS Wyre Forest CCG - involves the quality assurance of health
services provided for the population of Worcestershire. This includes steps to assure the public of the data included within this
Quality Account.
Commissioners would wish to see objectives demonstrated through SMART objectives that clearly detail how the trust will
address this increase and demonstrate learning from incidents to improve clinical effectiveness, patient safety and the patient
experience and so provide assurance to both commissioners and the wider public.
response to the Quality Account
The three CCGs welcome the opportunity to comment on the 2012/13 Quality Account for Worcestershire Health and Care NHS
Trust. Based on the on-going assurance processes adopted with the Trust and the information available to us, we believe this
provides a representative and balanced perspective of the quality of healthcare provided
As the second Quality Account published by the organisation it is encouraging to continue to see the breadth of work and
achievement against existing quality standards and initiatives across the three domains of patient safety, patient experience and
clinical effectiveness.
The sustained performance against the majority of the quality indicators as monitored both internally and by commissioners
through the Clinical Quality Review process, is recognised and commended. The quality of reports submitted to commissioners
have improved considerably, however could be further developed in order to demonstrate learning, actions and trajectories in
place to support improved performance.
Commissioners will continue to hold the Trust to account for performance against the priorities and improvement targets detailed
in this Quality Account during 2013/14 through the quality assurance processes established with the Trust. The information in the
account provides evidence of achievements, challenges and future aspirations.
NB Offender Healthcare Services. Currently the Trust delivers Offender Healthcare Services for a number of West Midland’s
Prisons. These services are currently commissioned through Staffordshire and Shropshire Area Team as lead commissioner for the
West Midlands, who monitor performance of the Trust in this area. As such this response by the three Worcestershire CCGs has not
commented on any areas relating to Offender Healthcare specifically.
On behalf of NHS Redditch & Bromsgrove, South Worcestershire and Wyre Forest Clinical
Commissioning Groups (CCGs).
The achievement against the quality improvement measures within the CQUIN scheme for 2012/13 is also indicative of a
commitment to delivering high quality and safe care for patients.
The Trust is to be commended for consistently high performance across Mental Health mandated Indicators. Particularly of note
is the decrease in ‘Absent Without Leave’ incidents reported across MH services over the last 12 months, indicating that staff are
taking learning from previous incidents and putting measures in place to improve safety.
The Trust is also to be commended on its focus on Falls Prevention which has resulted in a downward trend in in-patient patient
falls over the last 12 months, and its excellent performance on the prevention and control of infection.
The Trust shows a clear commitment to learn from incidents and complaints, however is it unclear how many national or local
clinical audits the Trust has completed or contributed to, or if there was any participation in clinical research. As such it is not
apparent what learning and improvements in practice have occurred as a result of these activities. Commissioners would wish
to see the numbers of actual audits and research trials the Trust has participated in, what learning has taken place, and where
improvement or changes in practice have occurred.
As a result of comments and feedback from staff regarding their frustrations with the existing incident reporting system, the trust
responded by introducing a new, more ‘user friendly’ system. This demonstrates the organisations commitment to improving the
quality and timeliness of incident reporting and ‘listening’ to its staff.
The Trust should be commended on the work of the Community Engagement Team and its commitment to seeking the views,
opinions and concerns of the community it serves and engaging patients, their families and carers and the wider community
in the development and monitoring of its services. This is crucial in ensuring that all voices are heard and contribute to shaping
services that meets the needs and expectations of its users and demonstrates the Trust’s commitment to being ‘inclusive’.
The Trust continues to report and monitor grade 3 and 4 pressure damage and is able to describe the steps it has taken to establish
a pressure ulcer working group to learn from incidents and improve practice. However the data presented disappointedly shows
an increase over the last 12 month period in ‘avoidable’ pressure damage.
82 | Annual Report 2012/13
83 | Annual Report 2012/13
Quality Account
Quality Account
Statement of directors’ responsibilities in respect of the Quality Account
The directors are required under the Health Act 2009 to prepare a Quality Account for each financial year. The Department
of Health has issued guidance on the form and content of annual Quality Accounts (which incorporates the legal
requirements in the Health Act 2009 and the National Health Service (Quality Accounts) Regulations 2010 (as amended by
the National Health Service (Quality Accounts) Amendment Regulations 2011).
In preparing the Quality Account, directors are required to take steps to satisfy themselves that:
• The Quality Accounts presents a balanced picture of the Trust’s performance over the period covered;
• The performance information reported in the Quality Account is reliable and accurate;
• There are proper internal controls over the collection and reporting of the measures of performance included in the
Quality Account, and these controls are subject to review to confirm that they are working effectively in practice;
• The data underpinning the measures of performance reported in the Quality Account is robust and reliable, conforms to
specified data quality standards and prescribed definitions, and is subject to appropriate scrutiny and review; and
• The Quality Account has been prepared in accordance with Department of Health guidance.
The directors confirm to the best of their knowledge and belief they have complied with the above requirements in
preparing the Quality Account.
By order of the Board
12 June 2013 Date
Chair
12 June 2013 Date
Chief Executive
Statements
INDEPENDENT AUDITORS’ LIMITED ASSURANCE REPORT TO THE DIRECTORS OF WORCESTERSHIRE HEALTH AND CARE
NHS TRUST ON THE ANNUAL QUALITY ACCOUNT
We are required by the Audit Commission to perform an independent limited assurance engagement in respect of Worcestershire
Health and Care NHS Trust’s Quality Account for the year ended 31 March 2013 (“the Quality Account”) and certain performance
indicators contained therein as part of our work under section 5(1)(e) of the Audit Commission Act 1998 (the Act). NHS trusts are
required by section 8 of the Health Act 2009 to publish a Quality Account which must include prescribed information set out
in The National Health Service (Quality Account) Regulations 2010, the National Health Service (Quality Account) Amendment
Regulations 2011 and the National Health Service (Quality Account) Amendment Regulations 2012 (“the Regulations”).
Scope and subject matter
The indicators for the year ended 31 March 2013 subject to limited assurance consist of the following indicators:
• Percentage of patient safety incidents that resulted in severe harm or death; and
• The number of admissions to the Trust’s mental health acute wards that were gate kept by the Assessment and Home Treatment
Teams.
We refer to these two indicators collectively as “the indicators”.
Respective responsibilities of Directors and auditors
The Directors are required under the Health Act 2009 to prepare a Quality Account for each financial year. The Department of
Health has issued guidance on the form and content of annual Quality Accounts (which incorporates the legal requirements in the
Health Act 2009 and the Regulations).
In preparing the Quality Account, the Directors are required to take steps to satisfy themselves that:
• the Quality Account presents a balanced picture of the trust’s performance over the period covered;
• the performance information reported in the Quality Account is reliable and accurate;
• t here are proper internal controls over the collection and reporting of the measures of performance included in the Quality
Account, and these controls are subject to review to confirm that they are working effectively in practice;
• t he data underpinning the measures of performance reported in the Quality Account is robust and reliable, conforms to specified
data quality standards and prescribed definitions, and is subject to appropriate scrutiny and review; and
• t he Quality Account has been prepared in accordance with Department of Health guidance.
The Directors are required to confirm compliance with these requirements in a statement of directors’ responsibilities within the
Quality Account.
Our responsibility is to form a conclusion, based on limited assurance procedures, on whether anything has come to our attention
that causes us to believe that:
• the Quality Account is not prepared in all material respects in line with the criteria set out in the Regulations;
• t he Quality Account is not consistent in all material respects with the sources specified in the NHS Quality Accounts Auditor
Guidance 2012/13 issued by the Audit Commission on 25 March 2013 (“the Guidance”); and
• t he indicators in the Quality Account identified as having been the subject of limited assurance in the Quality Account are not
reasonably stated in all material respects in accordance with the Regulations and the six dimensions of data quality set out in the
Guidance.
We read the Quality Account and conclude whether it is consistent with the requirements of the Regulations and to consider the
implications for our report if we become aware of any material omissions.
We read the other information contained in the Quality Account and consider whether it is materially inconsistent with:
• Board minutes for the period April 2012 to June 2013;
• papers relating to the Quality Account reported to the Board over the period April 2012 to June 2013;
• feedback from the Commissioners dated 17/6/2013;
• feedback from Local Healthwatch dated 17/6/2013;
• t he Trust’s complaints report published under regulation 18 of the Local Authority, Social Services and NHS Complaints (England)
Regulations 2009, dated 20/5/2013;
84 | Annual Report 2012/13
85 | Annual Report 2012/13
Quality Account
Financial Accounts
• feedback from other named stakeholder(s) involved in the sign off of the Quality Account;
• the latest national patient survey dated 27/3/2013;
• the latest national staff survey dated 28/05/2013;
• the Head of Internal Audit’s annual opinion over the trust’s control environment dated 18/4/2013;
• the annual governance statement dated 18/4/2013; and
• Care Quality Commission quality and risk profiles dated 10/4/2013.
We consider the implications for our report if we become aware of any apparent misstatements or material inconsistencies with
these documents (collectively “the documents”). Our responsibilities do not extend to any other information.
This report, including the conclusion, is made solely to the Board of Directors of Worcestershire Health and Care NHS 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. We permit the disclosure
of this report to enable the Board of Directors to demonstrate that they have discharged their governance responsibilities by
commissioning an independent assurance report in connection with the indicators. To the fullest extent permissible by law, we
do not accept or assume responsibility to anyone other than the Board of Directors as a body and Worcestershire Health and Care
NHS Trust for our work or this report save where terms are expressly agreed and with our prior consent in writing.
Assurance work performed
We conducted this limited assurance engagement under the terms of the Audit Commission Act 1998 and in accordance with the
Guidance. Our limited assurance procedures included:
• evaluating the design and implementation of the key processes and controls for managing and reporting the indicators;
• making enquiries of management;
• testing key management controls;
• analytical procedures;
• limited testing, on a selective basis, of the data used to calculate the indicators back to supporting documentation;
• comparing the content of the Quality Account to the requirements of the Regulations; and
• reading the documents.
A limited assurance engagement is narrower in scope than a reasonable assurance engagement. The nature, timing and extent of
procedures for gathering sufficient appropriate evidence are deliberately limited relative to a reasonable assurance engagement.
Limitations
Non-financial performance information is subject to more inherent limitations than financial information, given the characteristics
of the subject matter and the methods used for determining such information.
The absence of a significant body of established practice on which to draw allows for the selection of different but acceptable
measurement techniques which can result in materially different measurements and can impact comparability. The precision of
different measurement techniques may also vary. Furthermore, the nature and methods used to determine such information, as
well as the measurement criteria and the precision thereof, may change over time. It is important to read the Quality Account in
the context of the criteria set out in the Regulations.
The nature, form and content required of Quality Accounts are determined by the Department of Health. This may result in
the omission of information relevant to other users, for example for the purpose of comparing the results of different NHS
organisations.
In addition, the scope of our assurance work has not included governance over quality or non-mandated indicators which have
been determined locally by Worcestershire Health and Care NHS Trust.
Financial Accounts
The financial statements shown on the following
pages are a summary of the information set out in
the Trust’s statutory accounts for the year ended
31 March 2013.
Conclusion
Based on the results of our procedures, nothing has come to our attention that causes us to believe that, for the year ended 31
March 2013:
• the Quality Account is not prepared in all material respects in line with the criteria set out in the Regulations;
• the Quality Account is not consistent in all material respects with the sources specified in the Guidance; and
• the indicators in the Quality Account subject to limited assurance have not been reasonably stated in all material respects in
accordance with the Regulations and the six dimensions of data quality set out in the Guidance.
Grant Thornton UK LLP, Colmore Plaza, 20 Colmore Circus, Birmingham, B4 6AT
26 June 2013
86 | Annual Report 2012/13
87 | Annual Report 2012/13
Financial Accounts
Financial Accounts
Summary financial statements
The Financial Statements shown on the following
pages are a summary of the information set out in the
Trust’s statutory accounts for the year ended 31 March
2013. The Annual Report and complete Annual
Accounts document is available on request from the
Director of Finance at Isaac Maddox House, Shrub Hill
Road, Worcester, WR4 9RW (Tel: 01905 733491).
It is pleasing to report that for the
second consecutive year the Trust has
achieved each of its statutory financial
duties by delivering overall financial
balance, operating within its external
financing limit and managing capital
expenditure within its capital resource
limit.
The operating revenue surplus of
£2.5m was delivered on a turnover
Summary financial statements
adequately funded for inflation and
that the Trust has a contingency
reserve of 1%.
I am pleased to report that the Trust
is well placed to deliver its healthcare
responsibilities over the longer term
with the Trust Board having approved
a robust 5 year long term financial plan
and integrated business plan.
of £171m; and the cash and capital
out-turns were both satisfactorily
managed, the latter to within a
thousand pounds of the agreed limit.
These plans have been critically
appraised and tested to ensure that
there will be no diminution in the
quality of our services.
The 2013/14 budgets have been
approved by the Trust Board and
Service Delivery Unit managers
can look forward to operating and
managing services in the knowledge
that their budgets have been
The Trust is proud of the achievements
delivered over the last year and looks
forward with confidence to 2013/14
and beyond.
Statement of Comprehensive Income for year ended 31 March 2013
2012/13
2011/12
£000 £000
Employee benefits
(124,255)
(120,659)
Other costs
(43,224)
(50,059)
Revenue from patient care activities
155,906
154,102
14,929
16,981
3,356
365
35
16
Other gains / (losses)
(363)
0
Finance costs
(204)
(201)
Surplus/(deficit) for the financial year
2,824
180
Public dividend capital dividends payable
(986)
(1,051)
Retained surplus/(deficit) for the year
1,838
(871)
(272)
0
Net gain/(loss) on revaluation of property, plant & equipment
0
1,632
Net gain/(loss) on revaluation of intangibles
0
0
Net gain/(loss) on revaluation of financial assets
0
0
Net gain/(loss) on other reserves
0
0
Net gain/(loss) on available for sale financial assets
0
0
Net actuarial gain/(loss) on pension schemes
0
0
Reclassification adjustment on disposal of available for sale financial assets
0
0
1,566
761
1,838
(871)
Prior period adjustment to correct errors
0
0
IFRIC 12 adjustment
0
0
667
2,353
17
18
0
0
2,522
1,500
Other Operating revenue
Operating surplus/(deficit)
Investment revenue
Other comprehensive income
Impairments and reversals
Total comprehensive income for the year
Financial performance for the year
Retained surplus/(deficit) for the year
Impairments
Adjustments iro donated asset/gov't grant reserve elimination
Adjustment re Absorption accounting
Adjusted retained surplus/(deficit)
Broadway Tower, Worcestershire
88 | Annual Report 2012/13
The Trust’s reported NHS financial performance position is derived from its retained surplus/(deficit), but adjusted for the following:-
a) Impairments to non-current assets which were based upon the District Valuer’s report on the Trust’s land and buildings. b)
Depreciation on donated assets, which has been confirmed as an adjustment item following a national change in accounting policy.
89 | Annual Report 2012/13
Financial Accounts
Financial Accounts
Statement of Financial Position as at 31 March 2013
31 March
2013
31 March
2012
£000
£000
43,241
38,114
36
58
Investment property
0
0
Other financial assets
0
Statement of Financial Position as at 31 March 2013 continued
31 March
2013
31 March
2012
£000
£000
Trade and other payables
0
0
0
Other Liabilities
0
0
0
0
Provisions
(1,889)
(1,690)
43,277
38,172
(38)
(114)
Non-current assets
Property, plant and equipment
Intangible assets
Trade and other receivables
Total non-current assets
Non-current liabilities
Borrowings
Current assets
Other financial liabilities
0
0
Inventories
Working capital loan from Department
0
0
Capital loan from Department
(5,517)
(3,581)
Trade and other receivables
Other financial assets
Other current assets
444
422
7,707
11,732
0
0
Total non-current liabilities
(7,444)
(5,385)
Total Assets Employed:
35,387
32,052
34,181
32,412
0
0
9,105
1,168
17,256
13,322
1,150
1,150
Total current assets
18,406
14,472
Retained earnings
(90)
(2,038)
Total assets
61,683
52,644
Revaluation reserve
1,270
1,652
Cash and cash equivalents
Total current assets
Non-current assets held for sale
Current liabilities
Trade and other payables
(14,377)
0
0
Provisions
(910)
(590)
Borrowings
(76)
(76)
Other financial liabilities
0
0
Working capital loan from Department
0
0
(764)
(164)
(18,852)
(15,207)
42,831
37,437
Capital loan from Department
Total current liabilities
Non-current assets plus/less net current assets/liabilities
90 | Annual Report 2012/13
Public Dividend Capital
Other reserves
(17,102)
Other liabilities
Financed by: Taxpayers’ equity
Total Taxpayers' Equity:
26
26
35,387
32,052
91 | Annual Report 2012/13
Financial Accounts
Financial Accounts
Statement of Changes in Taxpayers’ Equity for the year ended 31 March 2013
Balance at 1 April 2012
Public
Dividend
capital
Retained
earnings
Revaluation
reserve
Other reserves
Total reserves
£000
£000
£000
£000
£000
32,412
(2,038)
1,652
26
32,052
Changes in taxpayers’ equity for
2012-13
Statement of Changes in Taxpayers’ Equity for the year ended 31 March 2013
cont...
Public
Dividend
Retained
Revaluation
Balance at 1 April 2011
capital
earnings
reserve
Other reserves
Total reserves
£000
£000
£000
£000
£000
32,869
(10,031)
8,427
26
31,291
Changes in taxpayers’ equity for 2011-12
Retained surplus/(deficit) for the year
0
(871)
0
0
(871)
Net gain / (loss) on revaluation of property, plant, equipment
0
0
1,632
0
1,632
Retained surplus for the year
0
1,838
0
0
1,838
Net gain / (loss) on revaluation of property, plant, equipment
0
0
0
0
0
Net gain / (loss) on revaluation of intangible assets
0
0
0
0
0
Net gain / (loss) on revaluation of intangible assets
0
0
0
0
0
Net gain / (loss) on revaluation of financial assets
0
0
0
0
0
Net gain / (loss) on revaluation of financial assets
0
0
0
0
0
Net gain / (loss) on revaluation of assets held for sale
0
0
0
0
0
Net gain / (loss) on revaluation of assets held for sale
0
0
0
0
0
Impairments and reversals
0
0
0
0
0
Impairments and reversals
0
0
(272)
0
(272)
Movements in other reserves
0
0
0
0
0
Movements in other reserves
0
0
0
0
0
Transfers between reserves*
0
12
(12)
0
0
Transfers between reserves*
0
110
(110)
0
0
Release of reserves to Statement of Comprehensive Income
0
0
0
0
0
Release of reserves to Statement of Comprehensive Income
0
0
0
0
0
Reclassification adjustments
Transfers to/(from) Other Bodies within the Resource Account
Boundary
0
0
0
0
0
0
0
0
0
0
(32,869)
8,852
(8,395)
0
(32,412)
32,412
0
0
0
32,412
Reclassification Adjustments
Transfers between Revaluation Reserve & Retained Earnings in
respect of assets transferred under absorption
0
0
0
0
0
On Disposal of Available for Sale financial Assets
On Disposal of Available for Sale financial Assets
0
0
0
0
0
Reserves eliminated on dissolution
Reserves eliminated on dissolution
0
0
0
0
0
Originating capital for Trust established in year
Originating capital for Trust established in year
0
0
0
0
0
New PDC Received
0
0
0
0
0
New PDC Received**
2,718
0
0
0
2,718
PDC Repaid In Year
0
0
0
0
0
PDC Repaid In Year**
(949)
0
0
0
(949)
PDC Written Off
0
0
0
0
0
PDC Written Off
0
0
0
0
0
Transferred to NHS Foundation Trust
0
0
0
0
0
Transferred to NHS Foundation Trust
0
0
0
0
0
Other Movements in PDC In Year
0
0
0
0
0
Other Movements in PDC In Year
0
0
0
0
0
Net Actuarial Gain/(Loss) on Pension
0
0
0
0
0
Net Actuarial Gain/(Loss) on Pension
0
0
0
0
0
Net recognised revenue/(expense) for the year
(457)
7,993
(6,775)
0
761
1,769
1,948
(382)
0
3,335
32,412
(2,038)
1,652
26
32,052
34,181
(90)
1,270
26
35,387
Net recognised revenue/(expense) for the year
Balance at 31 March 2013
Balance at 31 March 2012
Notes:
* Transfers between reserves relates to backlog depreciation.
** The values for new PDC received in year and PDC repaid in year relate to the transfer of assets between this Trust and Worcestershire
Acute Hospitals NHS Trust.
92 | Annual Report 2012/13
93 | Annual Report 2012/13
Financial Accounts
Financial Accounts
Statement of Cash Flows for the year ended 31 March 2013
2012/13
£000
2011/12
£000
Cash Flows from operating activities
Statement of cash flows for the year ended 31 March 2013 cont...
2012/13
£000
2011/12
£000
Public Dividend Capital Received
2,718
0
Cash Flows from financing activities
Operating Surplus/’Deficit’
3,356
365
Depreciation and Amortisation
2,288
2,270
Public Dividend Capital Repaid
(949)
0
667
2,353
Loans received from DH - New Capital Investment Loans
3,000
0
Other Gains / (Losses) on foreign exchange
0
0
Loans received from DH - New Working Capital Loans
0
0
Donated Assets received credited to revenue but non-cash
0
0
Other Loans Received
0
0
Government Granted Assets received credited to revenue but non-cash
0
0
Loans repaid to DH - Capital Investment Loans Repayment of Principal
(464)
(164)
(153)
(160)
0
0
(1,053)
(1,024)
(76)
(76)
0
0
Cash transferred to NHS Foundation Trusts
0
0
(22)
22
Capital Element of Payments in Respect of Finance Leases and On-SoFP PFI and LIFT
0
0
4,092
(3,825)
Capital grants and other capital receipts
0
0
0
0
Net cash inflow/(outflow) from financing activities
4,229
(240)
1,829
2,711
7,937
15
0
0
Net increase/(decrease) in cash and
cash equivalents
(198)
(875)
Cash and cash equivalents at beginning of the period
1,168
1,153
666
550
0
0
11,472
2,387
9,105
1,168
35
16
(8,748)
(2,148)
(Payments) for Intangible Assets
0
0
(Payments) for Investments with DH
0
0
(Payments) for Other Financial Assets
0
0
(Payments) for Financial Assets (LIFT)
0
0
949
0
Proceeds of disposal of assets held for sale (Intangible)
0
0
Proceeds from Disposal of Investment with DH
0
0
Proceeds from Disposal of Other Financial Assets
0
0
Proceeds from the disposal of Financial Assets (LIFT)
0
0
Loans Made in Respect of LIFT
0
0
Loans Repaid in Respect of LIFT
0
0
Rental Revenue
0
0
(7,764)
(2,132)
3,708
255
Impairments and Reversals
Interest Paid
Dividend paid
Release of PFI/deferred credit
(Increase)/Decrease in Inventories
(Increase)/Decrease in Trade and Other Receivables
(Increase)/Decrease in Other Current Assets
Increase/(Decrease) in Trade and Other Payables
(Increase)/Decrease in Other Current Liabilities
Provisions Utilised
Increase/(Decrease) in Provisions
Net cash inflow/(outflow) from operating activities
Loans repaid to DH - Working Capital Loans Repayment of Principal
Other Loans Repaid
Effect of exchange rate changes in the balance of cash held in foreign currencies
Cash and cash equivalents at year end
Cash Flows from investing activities
Interest Received
(Payments) for Property, Plant and Equipment
Proceeds of disposal of assets held for sale (PPE)
Net cash inflow/(outflow) from investing activities
Net cash inflow/(outflow) before financing
94 | Annual Report 2012/13
95 | Annual Report 2012/13
Financial Accounts
Pension liabilities Past and present employees are covered by the provisions of the
NHS Pensions Scheme. Details of the benefits payable under these
provisions can be found on the NHS Pensions website at www.
nhsbsa.nhs.uk/pensions. The scheme is an unfunded, defined
benefit scheme that covers NHS employers, GP practices and other
bodies, allowed under the direction of the Secretary of State, in
England and Wales. The scheme is not designed to be run in a
way that would enable NHS bodies to identify their share of the
underlying scheme assets and liabilities.
Financial Accounts
Related party transactions
Other Creditors include £1,616,000 pension costs at 31 March 2013
(£1,628,000 at 31 March 2012). The accounting policy for Pensions
and outline of the scheme is set out on page 22 of the Trust’s Annual
Accounts. The remuneration report on page 109 of the Annual Report provides
the details of the pension entitlements of Senior Managers.
Therefore, the scheme is accounted for as if it were a defined
contribution scheme: the cost to the NHS Body of participating in the
scheme is taken as equal to the contributions payable to the scheme
for the accounting period. During the financial year ending 31 March 2013 there have been no related party transactions between the Trust and Trust Board
members.
Worcestershire Health and Care NHS Trust is a corporate trustee of Worcestershire Health and Care NHS Trust Charitable Funds (Charity
No. 1060335) The Trust has received revenue payments from this Charity, which are summarised below. The unaudited summary
financial statements of this Charity are included in the Trust’s Annual Report.
Payments to
Related
Party
£
Receipts from
Related
Party
£
Amounts owed
to Related Party
£
Amounts due
from Related
Party
£
0
16,330
0
0
The transactions between the Trust and the Charity are:
Administration fee
The Trust has not made any provisions for doubtful debts.
The Department of Health is regarded as a related party. During the year Worcestershire Health and Care NHS Trust has had a significant
number of material transactions with the Department and with other entities for which the Department is regarded as the parent
Department. The entities where these transactions were at least £500,000 in value for the year are:
Better Payment Practice Code - measure of compliance
2012-13
number
2012-13
£000
2011/12
number
2011/12
£000
Non-NHS payables
Total Non-NHS trade invoices paid in the year
31,900
27,527
29,855
23,869
Total Non-NHS trade invoices paid within target
31,093
27,087
27,289
23,148
Percentage of Non-NHS trade invoices paid within target
97.5%
98.4%
91.4%
97.0%
NHS payables
Total NHS Trade Invoices Paid in the Year
987
19,193
974
23,870
Total NHS Trade Invoices Paid Within Target
977
19,135
808
20,020
99.0%
99.7%
83.0%
83.9%
Percentage of NHS Trade Invoices Paid Within Target
The Better Payment Practice Code requires the Trust to aim to pay all valid invoices by the due date or within 30 days of receipt of a valid
invoice, whichever is later.
Prompt Payments Code
The Trust has applied (pending references) to join the Prompt Payment Code in accordance with David Nicholson’s letter of 18 May 2009
that referred to the ten day payment commitment which has been set for Government Departments.
Related party
Purpose of Transaction
Birmingham East and North Primary Care Trust
Supply of Healthcare
Herefordshire Primary Care Trust
Supply of Healthcare
South Birmingham Primary Care Trust
Supply of Healthcare
South Staffordshire Primary Care Trust
Supply of Healthcare
Stoke on Trent Primary Care Trust
Supply of Healthcare
West Midlands Strategic Health Authority
Funding for Training - MADEL
Worcestershire Acute Hospitals NHS Trust
Purchase/Supply of Healthcare
Worcestershire Primary Care Trust
Supply of Healthcare
In addition, the Trust has had a number of material transactions, a total of at least £100,000 in value in year, with other government
departments and other central and local government bodies. These transactions have been with:
Related party
Purpose of Transaction
Bromsgrove District Council
Payment of Rates
HM Revenue & Customs
Payment of Income Tax
Malvern Hills District Council
Payment of Rates
NHS Pensions Agency
Payment of Superannuation
Redditch Borough Council
Payment of Rates/Supply of Healthcare
Staffordshire County Council
Supply of Healthcare
Worcestershire City Council
Payment of Rates
Worcestershire County Council
Supply of Healthcare/Staff Costs
Wychavon District Council
Payment of Rates/Rent
Wyre Forest Council
Payment of Rates
96 | Annual Report 2012/13
97 | Annual Report 2012/13
Financial Accounts
Financial Accounts
NHS Trust Charitable Funds
The unaudited summary financial statements for Worcestershire Health and Care NHS Trust Charitable Funds (Charity No. 1060335) are shown
below:
NHS Trust Charitable Funds
Unaudited Balance Sheet as at 31 March 2013
Recommended categories by activity
Unrestricted
funds
£000
Restricted
funds
£000
Endowment
funds
£000
Total
2012/13
£000
Total
2011/12
£000
Investments
246
538
0
784
733
Total fixed assets
246
538
0
784
733
Stock and work in progress
0
0
0
0
0
Debtors
1
3
0
4
0
Cash at bank and in hand
6
101
0
107
39
Total current assets
7
104
0
111
39
Creditors: amounts falling due within one year
2
9
0
11
12
Net current assets
5
95
0
100
27
251
633
0
884
760
251
0
0
251
240
Restricted income funds
0
633
0
633
520
Endowment funds
0
0
0
0
0
251
633
0
884
760
Unaudited Statement of Financial Activities for year ended 31 March 2013
Recommended categories by activity
Unrestricted
funds
£000
Restricted
funds
£000
Endowment
funds
£000
Total
2012/13
£000
Total
2011/12
£000
Incoming resources
Voluntary income
Current assets
42
142
0
184
197
Activities for generating funds
0
0
0
0
0
Investment income
5
18
0
23
25
47
160
0
207
222
Total incoming resources
Resources expended
Costs of Generating Funds
Fixed assets
1
3
0
4
5
45
47
0
92
380
Governance costs
6
13
0
19
20
Funds of the Charity
Other resources expended
0
22
0
22
23
Unrestricted funds
Total resources expended
52
85
0
137
428
Net incoming/(outgoing) resources before other recognised
gains/(losses)
(5)
75
0
70
(206)
Gains and losses on investment assets
16
38
0
54
(10)
Net movement in funds
11
113
0
124
(216)
Total funds brought forward at 1 April 2012
240
520
0
760
976
Total funds carried forward at 31 March 2013
251
633
0
884
760
Charitable activities
98 | Annual Report 2012/13
Total net assets
Total funds
99 | Annual Report 2012/13
Financial Accounts
Statements
Independent auditor’s report to the directors of Worcestershire Health and Care NHS Trust
We have examined the summary financial statement for the year ended 31 March 2013 which comprises the Statement of
comprehensive income for year ended 31 March 2013, Statement of financial position as at 31 March 2013, Statement of Changes
in Taxpayers’ Equity for the year ended 31 March 2013, Statement of cash flows for the year ended 31 March 2013, Pension
liabilities, Better payment practice code - measure of compliance, Related party transactions and Reporting of other compensation
schemes - exit packages.
This report is made solely to the Board of Directors of Worcestershire Health and Care NHS 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. To the fullest extent permitted by law, we do not accept
or assume responsibility to anyone other than the Trust’s directors and the Trust as a body, for our audit work, for this report, or for
opinions we have formed.
Respective responsibilities of directors and auditor
The directors are responsible for preparing the Annual Report.
Our responsibility is to report to you our opinion on the consistency of the summary financial statement within the Annual Report
with the statutory financial statements.
Financial Accounts
Statement of the Chief Executive’s responsibilities as the Accountable Officer of the Trust
The Chief Executive of the NHS has designated that the Chief Executive should be the Accountable Officer to the trust. The
relevant responsibilities of Accountable Officers are set out in the Accountable Officers Memorandum issued by the
Department of Health. These include ensuring that:
- there are effective management systems in place to safeguard public funds and assets and assist in the implementation of
corporate governance;
- value for money is achieved from the resources available to the trust;
- the expenditure and income of the trust has been applied to the purposes intended by Parliament and conform to the
authorities which govern them;
- effective and sound financial management systems are in place; and
- annual statutory accounts are prepared in a format directed by the Secretary of State with the approval of the Treasury
to give a true and fair view of the state of affairs as at the end of the financial year and the income and expenditure,
recognised gains and losses and cash flows for the year.
To the best of my knowledge and belief, I have properly discharged the responsibilities set out in my letter of appointment
as an Accountable Officer.
3 June 2013Chief Executive
We also read the other information contained in the Annual Report and consider the implications for our report if we become
aware of any misstatements or material inconsistencies with the summary financial statement.
We conducted our work in accordance with Bulletin 2008/03 “The auditor’s statement on the summary financial statement in the
United Kingdom” issued by the Auditing Practices Board. Our report on the statutory financial statements describes the basis of
our opinion on those financial statements.
Opinion
In our opinion the summary financial statement is consistent with the statutory financial statements of the Worcestershire Health
and Care NHS Trust for the year ended 31 March 2013. We have not considered the effects of any events between the date on
which we signed our report on the statutory financial statements [6 June 2013] and the date of this statement.
Grant Thornton UK LLP
Colmore Plaza
20 Colmore Circus
Birmingham
B4 6AT
21 June 2013
Statement of Director’s responsibilities in respect of the accounts
The directors are required under the National Health Service Act 2006 to prepare accounts for each financial year. The
Secretary of State, with the approval of the Treasury, directs that these accounts give a true and fair view of the state of
affairs of the trust and of the income and expenditure, recognised gains and losses and cash
flows for the year. In preparing those accounts, directors are required to:
- apply on a consistent basis accounting policies laid down by the Secretary of State with the approval of the Treasury;
- make judgements and estimates which are reasonable and prudent;
- state whether applicable accounting standards have been followed, subject to any material departures disclosed and
explained in the accounts.
The directors are responsible for keeping proper accounting records which disclose with reasonable accuracy at any time
the financial position of the trust and to enable them to ensure that the accounts comply with requirements outlined in the
above mentioned direction of the Secretary of State. They are also responsible for safeguarding the assets of the trust and
hence for taking reasonable steps for the prevention and detection of fraud and other irregularities.
The directors confirm to the best of their knowledge and belief they have complied with the above requirements in
preparing the accounts.
By order of the Board
3 June 2013Chief Executive
30 May 2013Finance Director
100 | Annual Report 2012/13
101 | Annual Report 2012/13
Financial Accounts
Financial Accounts
Operating and Financial Review (OFR)
A brief history of the NHS body and
its statutory background.
1. N
ature, objectives and strategies of the business. This provides an understanding of the NHS body, including a
description of:
The location and type of facilities
provided and the structure of the
business including its main services
and users.
The Trust is governed by a Board, which is supported by the following formal committees who meet on a
regular basis throughout the year to review and assess and regulate the activities and responsibilities of the
Trust:
• Finance and Performance
• Quality and Safety
• Audit
• Remuneration
• Foundation Trust Programme
• Charitable Funds
The Worcestershire Health and Care NHS Trust successfully registered with the CQC (Care Quality Commission)
on 1st July 2011, achieving this with no conditions being imposed on the services provided.
The Trust currently measures performance against three performance regimes, which are the Trust
Development Authority Provider Management Regime, the Mental Health Performance Framework and
Monitor’s Compliance Framework.
The external environment in which
it operates
102 | Annual Report 2012/13
This is the second year of the Trust’s operation and the Trust’s focus going forwards is to build upon the
success of the first two years and to:
The Trust is one of two local National Health Service organisations that provide healthcare services
commissioned by the three Clinical Commissioning Groups (CCGs) in Worcestershire and other neighbouring
commissioners, including Worcestershire County Council. The Trust’s main responsibilities cover:
1. Working to deliver the best possible healthcare to the Trust’s patients in hospital, in the community and
at home. For example the Trust provides these services from sites across Worcestershire, including the
community hospitals in Bromsgrove, Evesham, Pershore, Malvern and Tenbury along with various health
centres and clinics.
2. Safeguarding the organisation’s assets and public funds.
3. M
aintaining a sound system of internal control that supports the achievement of the organisation’s
objectives.
4. R eporting upon its performance across the targets and performance indicators required by the Trust
Development Authority, which has taken over responsibility for the performance and regulation of NHS
providers from the former NHS Midlands and East Strategic Health Authority (SHA); and to the Department
of Health.
5. Delivering healthcare that is good value for money.
The Worcestershire Mental Health Partnership NHS Trust demised on 30 June 2011 and the Worcestershire
Health and Care NHS Trust was established on 1 July 2011 to manage the vast majority of the services which
were previously managed by Worcestershire Primary Care Trust’s provider arm, as well as the mental health
services that were managed by Worcestershire Mental Health Partnership NHS Trust. Bringing together the
range of services provided by the two organisations has offered opportunities to improve integration and
partnership working which are central to the Trust’s objectives.
• Work with the new NHS commissioners on the Joint Service Review and Integrated Care Project.
• Implement the transformational change of services.
• Deliver the Trust’s Clinical Strategy over the period up to 2017.
The goals of the Clinical Strategy are as follows:
• The people of Worcestershire recognise that Worcestershire Health and Care NHS Trust provides excellent care.
• That staff will be empowered to deliver excellent care with time to be patient focused.
• Patient centred quality care with desirable/measurable outcomes.
• We will be an organisation that values innovation and supports staff to embrace change.
• Enables individuals to optimise their health and well-being.
• We will provide integrated health and care services to benefit all.
The objectives of the Trust over
the long term, the time scale used
being dependent on the type
of objective. Objectives will be
defined in terms of non-financial
and financial performance.
More detail on this subject is included on page 10 of the Annual Report underneath the heading ‘Our Trust’.
Ten corporate objectives have been defined by the Trust and these are as follows:
• Stimulate a revolution in the way we engage with patients
• Redesign clinical pathways
• Ensure patient safety
• Ensure seamless care through integrating services
• Strengthen leadership within our services
• Develop our workforce
• Improve our use of technology
• Develop business opportunities
• Deliver our efficiency programme
• Make effective use of our estate
The Trust provides health services for approximately 560,000 people who live in Worcestershire. The county
has a diverse population with complex needs ranging from pockets of urban deprivation to relatively affluent
neighbourhoods. In its rural areas the Trust provides for an increasingly ageing population, whereas in
Worcester City there is a significant student population.
103 | Annual Report 2012/13
Financial Accounts
The directors’ strategies for
achieving the objectives of the
NHS body and the effect of past
and current actions undertaken.
This includes the Key Performance
Indicators, both financial and nonfinancial, used by the directors to
assess progress against their stated
objectives.
Financial Accounts
At the start of 2012/13 the Board recognised that it had a series of development needs and has throughout
the year worked to ensure that the directors continue to enhance and develop their skills and competencies
to deliver the Trust’s vision. The Chairman has for example attended the Appointment Commission’s induction
programme for newly appointed chairs, along with the City University London (Cass) Business School’s NHS
Foundation Trust’s Chairs Academy Programme. The afternoon of each of the six public Board meetings and
an additional five days have been used to address specific Board development needs; or to dedicate time to
consider a particular strategic issue e.g. the clinical strategy.
The Trust’s aims and objectives are to establish mechanisms for monitoring and reviewing management
performance and to ensure the Trust’s objectives are met, to oversee the delivery of planned services,
to develop and maintain an annual business plan and to ensure that national policies and strategies are
effectively addressed and implemented within the Trust. Key issues remain the quality and safety of services
provided, identifying risks to strategic goals, identifying and delivering cost improvement programmes and
achieving Foundation Trust status.
The executive directors have all agreed personal objectives with the Chief Executive which deliver their
contribution to the Trust’s strategies and key objectives. The directors cascade their objectives to the
associate directors, who in turn discuss and agree the objectives that they lead on. The associate directors
then follow the same annual process with the Service Delivery Unit leads and other Heads of Service.
Analysis of the main trends and
factors that directors consider likely
to impact on the future, including
the development of new services
or the benefits expected from
capital investment.
The formal committees to the Board e.g. Finance and Performance Committee meet on a regular basis
throughout the year to review and assess progress with the delivery of the Trust’s strategies and objectives.
The committees are supported in their work by other key stakeholders meetings, such as the Contract
Management Board, which is chaired by the one of the local Clinical Commissioning Groups.
The current level of investment
expenditure; and planned future
expenditure and how this will
assist the NHS body to achieve its
objectives.
The chairman of each committee presents a report to the Board on the important matters considered by their
respective committees.
The main trends and factors that directors consider likely to impact on the future include the requirement for
delivering the Trust’s £7.7m cost improvement programme, in a recurrent manner; the development of service
line reporting and the planned achievement of Foundation Trust status in the Autumn of 2013.
Currently, the Trust does face a degree of delivery risk, for planned schemes, arising from commissioner
approval. In particular further discussions are required to enable delivery of schemes relating to community
bed capacity and integrated community teams. Should a shortfall arise from this further schemes will need to
be identified and brought forward. This work is underway.
The main capital developments planned within the 2013/14 £6.0m programme concern the completion of
the Brook Haven older adult mental health in-patient unit (£1.5m), implementation of the estates strategy
(£1.5m), backlog maintenance (£0.9m), information technology (£0.7m), ward refurbishment (£0.4m) and
PLACE (Patient Led Assessments of the Care Environment) £0.4m.The balance of £0.6m will be invested in
areas such as equipment replacement, anti-ligature works and invest to save schemes.
The Trust Board also receives performance reports at every meeting.
In 2012/13 the Trust used internally generated funds from depreciation and brought forward revenue
surpluses together with a £3m capital loan to cover a capital programme of £6,926,000. The Trust’s main
strategic scheme during the year was the modernisation of Brook Haven, which cost £4,967,000. The Trust
also spent £600,000 on a new Patient Administration System and made other investments in information
technology amounting to £344,000. Backlog maintenance expenditure was £336,000 and £359,000 was spent
on PLACE. The other areas of substantial expenditure included single sex accommodation works £101,000,
anti-ligature works of £80,000 and the replacement of equipment £80,000. The balance of £59,000 was spent
on other minor schemes.
Overall there was an £1,000 under spend against the Trust’s Capital Resource limit.
The Trust’s performance against the 2012/13 key national targets are reported upon elsewhere within this
report (see pages 38 and 39).
2. Development and performance of the business for the period under review and in the future.
3. The resources, principal risks and uncertainties and relationships that may affect the entity’s long term value.
The significant features of the
development and performance of
the NHS body in the year.
A description of the resources
available to the NHS body and how
they are managed.
The Trust received additional demography funding of £1.4m (1.15%) and Commissioning for Quality and
Innovation (CQUIN) funding of £1.3m.
There are a number of major redesign programmes that the Trust plans over the next 5 years that are
designed to have a significant impact on how services are delivered. Progressing these developments will
also offer opportunities to work with commissioners and other local stakeholders to improve patient care
and extend the scope of services that the Trust delivers. The developments will build on the organisation’s
strategic goal to work in partnership to deliver integrated care. The significant developments are:
• The establishment of Community Treatment Hubs
• The development of Integrated Community Teams
• The redesign of Mental Health Inpatient Care
• The redesign of clinical pathways across the range of services provided
Currently there are 193 community hospital beds on five sites across the county and 69 older adult mental
health beds on three sites across the county. The aim is to develop ‘Community Treatment Hubs’, which will
deliver a range of services and increasingly support clinical pathways that enable patients to be seen and
treated closer to home, reduce admissions to Worcestershire Acute Hospitals NHS Trust and support early
discharge. The efficient use of these important resources will require close integration with other community
services. A key requirement is to reduce current length of stay, which will release capacity to develop a
sub-acute care model. The integrated structure that the Trust has adopted also introduces opportunities
to improve the care for older adults and introduce mental health assessment and treatment within the
community treatment hubs. The Trust is working with commissioners to define how this approach could be
implemented.
104 | Annual Report 2012/13
For 2012/13, the total operating revenue resources for the Trust (mainly received via healthcare contracts
with the Worcestershire Primary Care Trust and other NHS commissioners) was £171m (unchanged from last
year). Budgets are set throughout the Trust up to this limit and it is the responsibility of the budget holders
to ensure that the Service Delivery Units are managed within the allocated budget. Progress during the year
on this important area of responsibility is reported at Trust Board meetings and in detail at the Finance and
Performance Committee. The business of the Trust is governed by the Trust’s Standing Orders and Standing
Financial Instructions; and spending decisions regulated through an approved Scheme of Delegation.
The reported NHS financial performance for the year is an end of year surplus of £1.8m. This is adjusted for
two technical items:
• impairments of the Trust’s assets (due to professionally assessed building valuations) £667k and
• depreciation on the Trust’s donated assets £17k.
The adjusted retained surplus is therefore £2.5m, which is in accordance with the plan and target surplus
agreed with the NHS Midlands and East Strategic Health Authority.
105 | Annual Report 2012/13
Financial Accounts
Disclosure of strategic, commercial,
operational and financial risks
where these may significantly
affect the NHS body’s strategies
and development.
Financial Accounts
The Board Assurance Framework is a document in which the Trust Board sets out what it considers to be
the most significant risks it sees in meeting its 2012/13 objectives. Annual workshops are arranged for the
Board to review the framework by the Trust’s internal auditors and these are facilitated by Price Waterhouse
Coopers.
The principal risks identified in February 2013 are set out below under the relevant strategic headings:
Our services will always be safe and effective:
• The Board considered that there is a risk that there is a lack of confidence in statistical information provided
on patient safety. An action plan has been drawn up to promote the need to report incidents and near misses
and to “close” those that are recorded as “open” on the current system. An implementation plan for the new
system is to be rolled out fully by 31 July 2013.
4. Position of the business, including a description of the capital structure, treasury policies and objectives and
liquidity of the entity both in the period under review and in the future.
The events that have impacted on
the financial position of the NHS
body during the year, and factors
that are likely to affect the financial
position going forward.
• Paediatric Intensive Care Unit, Non Contracted Activity and reduction of out of
county contract income - £477k
• Continence service - £357k
• Bank, agency and locums - £562k
• Service Level Agreements with other NHS organisations - £267k
• Crime Reduction Initiative - £100k
Our organisation will be efficient, inclusive and sustainable:
• Limited resources are available to bring about the change that is required in the use of technology. Work
is underway in order to determine whether the future delivery of services should be at Trust level, or at a
county level shared with the local acute Trust. Market testing is now underway for the technical aspects of the
information technology support service.
This is the Trust’s second Annual Report and this year’s surplus of £2.5m has been recorded on a turnover of
£171m, which represents 1.48%, up from 0.8% in 2011/12.
• Identifying and delivering cost improvement plans over a 5 year period is a high level risk. Actions have since
been taken to close the gap in 2012/13 and to secure a 30 month rolling programme of plans, which takes the
Trust up to 31 March 2015.
• Two risks were identified on the estate. Firstly, external factors impact on the Trust’s ability to deliver changes
to the estate; and secondly resources are not available to deliver an estate that is fit for purpose. The national
guidance confirming that the assets, valued at £44.1m, previously owned by the Worcestershire Primary Care
Trust are to transfer to the Trust was received in December 2012.
The Trust has identified similar future risks for 2013/14, but is confident that these can be managed by
establishing and maintaining positive relationships with the newly established commissioning bodies and
our partner organisations.
The directors’ policy for managing
principal risks is to be disclosed.
The Risk Management Strategy of the Trust sets out a policy approved by the Board in July 2012 for managing
risk, which identifies accountability arrangements, the processes to be used, and contains guidance on what
may be regarded as an acceptable level of risk (organisational, clinical, financial and strategic) within the
organisation.
The Trust commenced the financial year with a robust set of budgets and a £1.6m contingency reserve, which
was created in order to help the Trust manage risks and cost pressures and unexpected service demands
arising during the course of the year.
The main cost pressures reported to the Finance and Performance Committee during 2012/13 were as
follows:
Looking forward the medium term financial position has a robust base with the Trust being able to
confidently forecast a £2.3m (1.4%) surplus position for 2013/14, having created and maintained a
contingency reserve (1%) for non-recurrent purposes.
Accounting policies focusing on
those which have required the
particular exercise of judgement
and which have changed during
the year.
Standard NHS accounting policies have been adopted. The Trust has prepared its 2012/13 draft Final
Accounts in a form that complies with the International Financial Reporting Standards (IFRS) and submitted
them to the Department of Health and auditors by the required date of 22 April 2013.
Cash flow issues which supplement
information provided in the annual
accounts.
During the year the Trust took measures to secure the Foundation Trust liquidity requirements of the
economic regulator Monitor. This maintenance of 10 days operating cash resulted in an under-shoot of the
Trust’s EFL target for 2012/13 by £7.7m.This undershoot is allowable by the NHS Midlands and East SHA and
there is no adverse impact on the Trust’s performance.
Carrying value versus market value
of land.
The carrying value of the Trust’s land is £7.1m, which is based upon the District Valuation Office’s valuation as
at 31 March 2013.
The Trust recognises that risk management is an integral part of good governance and management practice
and seeks to ensure that all principal risks, which may prevent the organisation from achieving its corporate
objectives, are identified and managed. The following will be actively addressed:
• reducing the risk of harm to patients, staff and others by means of avoidance,
effective control or transfer of risk;
• making best use of available resources, in order to provide quality patient services and care;
• minimising the costs diverted to the consequences of risk by maintaining high risk management standards.
A robust infrastructure is in place to manage risks from front line services to Trust Board level. Every member
of staff will be supported and enabled to identify and correct/escalate shortcomings and/or deficiencies in
practice, equipment or systems. Where risks crystallise, demonstrable improvements will be put in place.
Information about significant
relationships with stakeholders,
which are likely, directly or
indirectly, to influence the
performance of the Trust.
106 | Annual Report 2012/13
The Trust has good working relationships with a wide range of partners ranging from local NHS
commissioners, suppliers, trade unions and employees to the Worcestershire County Council for the delivery
of healthcare through the Section 75 pooled budgets.
These strong and positive partnerships are a major strength helping the Trust to achieve its objectives.
107 | Annual Report 2012/13
Financial Accounts
Financial Accounts
5. P
olicies adopted and the extent to which they have been successfully implemented regarding environmental, social
and community issues:Sustainability report
This is included on Page 18 of the Annual Report and Accounts underneath ‘The NHS in the Natural
Environment’.
Emergency preparedness
This is included on Page 12 of the document Annual Report and Accounts underneath ‘Emergency
preparedness’.
Complaints handling procedure
and principles for remedy
This is included on Page 7 of the document Annual Report and Accounts underneath ‘Listening to our
patients’.
Better Payments Practice Code
The Trust’s measure of compliance on the Better Payments Practice Code is shown on the spread sheet on
page 96.
Remuneration Report
Details of the membership of the
Remuneration Committee.
b) To monitor and evaluate the performance of individual executive directors.
c) To advise on, and oversee, appropriate contractual arrangements for executive directors, including the
proper calculation and scrutiny of termination payments taking account of such national guidance as is
appropriate.
The Trust has achieved full compliance on all 4 measures.
Prompt Payments Code
The Trust has applied to become a signatory to the Prompt Payments Code, and authorisation is awaited,
pending receipt of references.
The action taken to maintain
or develop the provision of
information to and consultation
with the Trust’s employees.
The Trust Board have agreed 29 corporate policies, 21 that relate to health and safety and security and 8
human resource policies, which are all shown on the Trust’s website. The significant contributions made by
the Trust’s staff at all levels across clinical and non-clinical activities continues to be a key factor in the Trust’s
success and the Trust acknowledges that much of the work done is over and above that contracted for.
Policy in relation to disabled
employees and on equal
opportunities.
This is included on Page 14 of the document Annual Report and Accounts underneath ‘Equality and diversity’.
Sickness absence data
The total days lost in 2012/13 was 31,251, over the equivalent of 3,334 staff years with the average working
days lost being 9.
External audit disclosure
The Trust’s auditor is Grant Thornton and the agreed statutory audit fees for 2012/13 were £69k (excluding
VAT). In addition to these fees the Trust paid £10k (excluding VAT) for a review of the Trust’s Quality Account.
The Remuneration Committee of the Trust is a sub-committee of the Trust Board, which determines the
remunerations, allowances and terms of service of the Chief Executive and those executive directors
reporting directly to the Chief Executive. The membership of the committee will comprise of the Chairman of
the Trust and two non-executive directors. The committee shall undertake the following duties:
a) To agree appropriate remuneration and terms of service for the Chief Executive and other executive
directors including:
• all aspects of salary (including any performance-related elements/bonuses)
• provisions for other benefits, including pensions
• arrangements for terminations of employment and other contractual terms for all Trust employees.
For 2012/13 the pay of the directors and senior managers was not increased in April 2012, and no
performance bonuses were paid to the Chief Executive or the other directors.
The remuneration and pension entitlements of senior managers are included in the table on page 112 of this
report.
Pay multiples.
Reporting bodies, including the Trust are required to disclose the relationship between the remuneration of
the highest paid director in the Trust and the median remuneration of the organisation’s workforce.
The banded remuneration of the highest paid director in the Trust in 2012/13 was £145k (£141k in 2011/12).
This was 5.5 (6.5 in 2011/12) times the median remuneration of the workforce which was £26k (£22k in
2011/12). In 2012/13 two doctors received remuneration in excess of the highest paid director at £165k and
£153k respectively (none in 2011/12). The movements from 2011/12 are due to better information being
available, which has enabled a more detailed analysis of the Trust’s median salary figure.
Total remuneration includes salary, non-consolidated performance related pay, benefits in kind as well as
severance payments. It does not include employer pension contributions and the cash equivalent transfer
value of pensions.
Serious untoward incidents
This is included on Page 9 of the document Annual Report and Accounts underneath ‘Patient Safety Incidents
and Serious Incidents’.
Progress against agreed
non-financial target
This is included on Page 16 of the document Annual Report and Accounts underneath ‘Performance’.
The policy on the remuneration of
senior managers for current and
future financial years.
This is decided by the Remuneration Committee and for 2012/13 the agreement was in line with the national
guidance.
Social and community issues
The Trust has a Community Engagement Committee, which is a sub-committee of the Trust Board. The
Community Engagement Team has developed a Community Engagement Strategy. A key part of community
engagement is effective relationships and an active dialogue with a range of groups such as:
Reporting related to the Review of
Tax arrangements of Public Sector
Appointees.
The Trust have reviewed in detail the extent to which it complies with the new Annual Report disclosure
requirement in this area and considers that whilst the Trust doesn’t have any arrangements to declare for
2012/13 there are some clinician commitments associated with service level agreements that are under
review and may transfer to the payroll of neighbouring NHS Trusts/Foundation Trusts. Negotiations are now
underway, although the process may take some time to regularise in the manner required by Her Majesty’s
Treasury.
The methods used to assess
whether performance conditions
were met and why those methods
were chosen. If relevant, why the
methods involved comparison with
outside organisations.
The objectives of the directors are set in line with the Trust’s statement of overall objectives.
• The Locality Forums
• The Lost Minds Group (for children and young people who have accessed Child and Adolescent Mental
Health Service or have been affected by mental health issues)
• A range of community and voluntary sector organisations
• Healthwatch
• Foundation Trust members
Members of the Locality forums were asked to vote for their priorities for the 2012/2013 Quality Account.
Their opinions and views are regularly sought on a range of matters involving Trust services.
Persons with whom the entity has
contractual or other arrangements
which are essential to the business
of the entity
108 | Annual Report 2012/13
The overall corporate objectives are monitored and disclosed to the Board on a regular basis as well as there
being an individual assessment by the Chief Executive with each director. This is in line with NHS practice.
The Trust works with a wide range of partners, from contracted and trade suppliers, to those who jointly
deliver services with us e.g. Worcestershire County Council (for pooled budget arrangements).
109 | Annual Report 2012/13
Financial Accounts
Financial Accounts
The relative importance of
the relevant proportions of
remuneration which are, and which
are not, subject to performance
conditions.
The Remuneration Committee uses baseline director salaries, which are then bench-marked against similar
NHS Trusts across the West Midlands.
A summary and explanation of
policy on duration of contracts,
and notice periods and termination
payments.
The policy on contracts is that they are all substantive and the contract follows the national template.
All contracts include three months’ notice period from the individual and six months from the Trust. Any
termination payments are contractual, in line with national guidance and the NHS Midlands and East SHA
process. No deviations are agreed.
Details of the service contract for
each senior manager who has
served during the year:
• date of the contract, the
unexpired term, and details of the
notice period;
• provision for compensation for
early termination; and
• other details sufficient to
determine the entity’s liability in
the event of early termination.
In 2012/13 7 staff left the Trust under the NHS Redundancy Scheme. The payments involved the sum of
£177k. The staff leaving during the year included 1 senior manager at level 8A and above.
Pension Scheme and liabilities of
the Trust.
Explanation of any significant
awards made to past senior
managers.
Board of Directors salaries and allowances for the annual report and accounts 2012/13
2012/13
NHS creditors include £1.6m pension costs at 31 March 2013 (£1.6m at 31 March 2012). The accounting policy
for pensions and outline of the scheme is set out on page 22 of the Trust’s Annual Accounts.
Refer to the Remuneration Report.
2011/12
Salary
(bands of
£5000)
Other
remuneration
(bands of
£5000)
Bonus
Payments
(bands of
£5000)
Benefits
in kind
(rounded to
nearest
£’00)
Salary
(bands of
£5000)
Other
remuneration
(bands
of £5000)
Bonus
Payments
(bands of
£5000)
Benefits
in kind
(rounded to
nearest
£’00)
Name and title
Date
started
£000
£000
£000
£00
£000
£000
£000
£00
Chris Burdon,
Chairman
Jul 11
20 - 25
Nil
Nil
Nil
15 - 20
Nil
Nil
Nil
Jill Gramann,
Non-executive Director
Jul 11
5 - 10
Nil
Nil
Nil
0-5
Nil
Nil
Nil
Martin Connor,
Non-executive Director
Jul 11
5 - 10
Nil
Nil
Nil
0-5
Nil
Nil
Nil
Peter Lachecki,
Non-executive Director
Jul 11
5 - 10
Nil
Nil
Nil
0-5
Nil
Nil
Nil
David Priestnall,
Non-executive Director
Sep 11
5 - 10
Nil
Nil
Nil
0-5
Nil
Nil
Nil
5 - 10
Nil
Nil
Nil
5 - 10
Nil
Nil
Nil
135 - 140
Nil
Nil
20
120 - 125
Nil
Nil
15
115 - 120
25 - 30
Nil
Nil
100 - 105
40 - 45
Nil
Nil
100 - 105
Nil
Nil
Nil
75 - 80
Nil
Nil
Nil
95 - 100
Nil
Nil
Nil
90 - 95
Nil
Nil
Nil
Colin Phillips,
Non-executive Director
Sarah Dugan,
Chief Executive
May 11
Dr William Creaney,
Medical Director
Robert Mackie,
Director of Finance
Jul 11
Janet Ditheridge,
Director of Service Delivery
Date left
Sandra Brennan,
Director of Quality
Jul 11
90 - 95
Nil
Nil
Nil
65 - 70
Nil
Nil
Nil
Susan Harris,
Director of Strategy and Business Development
May 12
75 - 80
Nil
Nil
Nil
Nil
Nil
Nil
Nil
80 - 85
Nil
Nil
Nil
80 - 85
Nil
Nil
Nil
Robert Hipwell,
Company Secretary
The salaries and allowances shown in 2011/12 are part year costs for all but 4 of the Trust’s Directors.
Therefore salaries stated for 2012/13 are significantly higher for certain individuals.
110 | Annual Report 2012/13
111 | Annual Report 2012/13
Financial Accounts
Financial Accounts
Audit Committee Annual Report 2012/13
Pension benefits
Name and title
Date started
Sarah Dugan,
Chief Executive
May 11
Date left
Dr William Creaney,
Medical Director
Robert Mackie,
Director of Finance
Jul 11
Janet Ditheridge,
Director of Service Delivery
Real
increase in
pension at
age 60
(bands of
£2,500)
Real
increase in
pension
lump sum
at age 60
(bands of
£2,500)
Total
accrued
pension at
age 60 at 31
March 2012
(bands of
£5000)
Lump sum at
age 60
related to
accrued
pension at
31 March
2012
(bands
of £5,000)
£000
£000
£000
£000
£000
£000
£000
£000
(0 - 2.5)
(0 - 2.5)
40 - 45
125 - 130
727
674
18
0
0 - 2.5
2.5 - 5
10 - 15
30 - 35
222
176
37
0
0 - 2.5
2.5 - 5
20 - 25
60 - 65
313
277
21
0
0 - 2.5
0 - 2.5
30 - 35
90 - 95
557
504
27
0
Martin Connor - Chair of Audit Committee
Cash
equivalent
transfer
value at 31
March 2012
Cash
equivalent
transfer
value at 31
March 2011
Real
increase
in cash
equivalent
transfer
value
Employer’s
contribution
to
stakeholder
pension
Sandra Brennan,
Director of Quality
Jul 11
(0 - 2.5)
(0 - 2.5)
30 - 35
95 - 100
619
581
8
0
Susan Harris,
Director of Strategy and Business
Development
May 12
0 - 2.5
Nil
0-5
Nil
11
0
10
0
(0 - 2.5)
(0 - 2.5)
40 - 45
120 - 125
901
847
10
0
Robert Hipwell,
Company Secretary
1. Introduction
The Audit Committee is established
under Board delegation with approved
terms of reference that are aligned
with the Audit Committee Handbook
2005, published by the HFMA and
Department of Health. The Committee
consists of three Non-Executive
directors and has met on six occasions
throughout the financial year. It has
discharged its responsibilities for
scrutinizing the risks and controls
which affect all aspects of the
organisation’s business.
2. Principal review areas
This annual report is divided into six
sections reflecting the six key duties of
the Committee as set out of the terms
of reference.
2.1 G
overnance, risk
management and internal control
Reporting of other compensation schemes - exit packages
Exit package cost band
(including any special payment
element)
Number of compulsory
redundancies
< £10,001
2
2
£25,001 - £50,000
2
2
£50,001 - £100,000
1
1
Number of other departures
Total number of exit
packages by cost band
Number of departures where
special payments have been
made (special payment
element (totalled))
£10,001 - £25,000
£100,001 - £150,000
The Committee has reviewed relevant
disclosure statements, in particular the
Governance Statement together with
the Head of Internal Audit Opinion,
external audit opinion and other
appropriate independent assurances
and considers that the Governance
Statement is consistent with the
Committee’s view on the Trust’s system
of internal control. Accordingly the
Committee supports the Board’s
approval of the Governance Statement.
£150,001 - £200,000
>£200,000
Total number of
exit packages by type
5
0
5
0
Total
resource costs (£000s)
151
0
151
0
112 | Annual Report 2012/13
The Committee has reviewed the
Assurance Framework. It believes
that the Framework used during
the year was fit for purpose and has
reviewed evidence to support this. The
Framework is in line with Department
of Health expectations and has been
reviewed by internal audit and external
audit to give additional assurance that
this opinion is well founded.
The Committee has reviewed the
completeness of the risk management
system and the extent to which it is
embedded in the organisation. The
Committee believes that adequate
systems for risk management are in
place, and that these systems are now
embedded throughout the whole
organisation.
2.2 I nternal audit
throughout the year the Committee
has worked effectively with
internal audit to strengthen the
Trust’s internal control processes. The
committee has also in year:
• Received and considered the
effectiveness of internal audit, taking
into account self-assessment review
alongside that of the Committee’s
own review.
• Reviewed and approved the internal
audit strategy, operational plan and
more detailed programme of work at
its February meeting.
• Considered the major findings of
internal audit and are assured that
management have responded in an
appropriate manner and that the
Head of Internal Audit Opinion and
Governance Statement reflect any
major control weaknesses.
• Discussed and agreed the actions
required in 23 audit reports, 21 of
which confirmed a significant
assurance could be placed upon the
Trust’s controls. The initial exceptions
concerned the Trust’s Sickness
Absence Management, Electronic
Staff Records, and Risk ManagementTissue Viability, where controls were
considered moderate but were
subsequently revisited later in the
year and were found to be operating
effectively.
• Data Quality (Clinical coding)
and Data Quality (Mental Health
Clustering) were the 2 report areas
were controls were considered to be
operating at a moderate level.
• The Mental Health Act-Consent
Review for which a moderate
assurance was given by Audit in
2011/12 was re-examined in 2012/13
and procedures were considered to
be much improved. A detailed action
plan was reviewed by the April Quality
and Safety Committee and is due
to be considered by the June Audit
Committee.
2.3 External Audit
• The Committee reviewed and agreed
external audit’s annual plan.
• The Committee reviews and
comments on all the reports prepared
by external audit; including the
Annual Governance letter.
• The Committee will, on behalf of the
Trust Board, review and sign off the
2012/13 annual accounts, alongside
the External Audit Annual Governance
Report on the 6th June. No issues
have been raised to date, which give
rise to any concerns or issues of note.
• The Committee’s working assumption
is that an unqualified audit opinion
on the Annual Accounts and on the
Trust’s Value for Money will be issued
in early June 2013.
•Received and considered the
effectiveness of external audit, taking
into account a self-assessment review
alongside that of the Committee’s own
review.
113 | Annual Report 2012/13
Financial Accounts
2.4 Management
The Committee has continually
challenged the assurance process
when appropriate and has requested
and received assurance reports from
Trust management and various other
sources; both internally, and externally
throughout the year. This process
has also included calling managers to
account when considered necessary
to obtain relevant assurance. The
Committee also works closely with
the Trust’s Contracting, Information
and Performance Manager to ensure
that the assurance mechanism within
the Trust is fully effective and that a
robust process is in place to ensure that
actions falling out of external reviews
are implemented and monitored by the
Committee.
2.5 Financial Reporting
The Committee has reviewed the
annual financial statements before
submission to the Board and considers
them to be accurate.
On 9th May 2013 the Committee
received a detailed briefing on the
Trust’s final accounts for 2012/13, which
covered all the significant accounting
issues for the year, including the Trust‘s
accounting policies.
2.6 Counter Fraud Service
The Committee has reviewed and
approved the annual Counter Fraud
plan, terms of reference and its
progress reports. A separate annual
report is produced to cover the work of
the Local Counter Fraud Service.
114 | Annual Report 2012/13
Financial Accounts
3. Other matters worthy of
note
The Committee has reviewed the
process and controls the Trust have
put in place to achieve its financial
obligations throughout the year.
It further notes that the Trust has
achieved these financial obligations.
The Committee recognises the hard
work that delivered the financial
outcome for the year ending 31 March
2013. Both the financial surplus and
proximity of the actual outcome to
forecast are a reflection of sound
management.
4. Review of the
effectiveness and impact
of the Audit Committee
The Committee has been active
during the year in carrying out its
duty in providing the Board with
assurance that effective internal control
arrangements are in place. Specifically
the Committee has:• Reviewed the Assurance Framework
and Risk Register and has influenced
the drafting and ongoing
development of these tools.
• Reviewed its compliance with the
Audit Committee Handbook and
has undertaken a self-assessment.
Actions arising from this selfassessment will be included in the
Audit Committee action plan.
• Secured the delivery of a 97%
implementation rate on internal audit
recommendations with 219 actions
being implemented promptly against
a plan of 225.
• Ensured that satisfactory progress
is made with the implementation of
external Audit recommendations,
which by their nature are of a more
strategic nature.
• Managed the transition from the
Audit Commission to Grant Thornton
in a seamless manner, working closely
with the two service providers.
• Reviewed the Trust’s key financial
policies and procedures and ensured
that they are fit for purpose.
5. Conclusion
Details of Directors
The Board of Worcestershire Health and Care NHS Trust comprises of the nonexecutive Chairman, five non-executive directors (NEDs), six executive directors
and the Company Secretary. Both non-executive and executive directors are
required to provide scrutiny and challenge at Board meetings to ensure effective
decision making.
Pension Scheme and Chair of their Audit
and Governance Committee as well
as Treasurer of both DIAL, a disability
charity as well as Sampad, a South Asian
Arts organisation.
The Committee is of the opinion that
this first annual report is consistent
with the draft Governance Statement,
Head of Internal Audit Opinion and the
external audit review and there are no
matters that the Committee is aware
of at this time that have not been
disclosed appropriately.
Martin Connor
Chairman of Audit Committee
10th May 2013
Martin previously worked for the
Department of Work and Pensions and
spent 20 years working for the RAC in a
variety of senior management roles.
Chris Burdon
Sarah Dugan
Chairman
Chief Executive
Chris took up his appointment on 1 July
2011 having been Chairman designate
since February 2011. He is the Chair
of the Remuneration Committee.
Chris was appointed as NED with NHS
Worcestershire in December 2008 and
chaired their provider services Board.
Sarah took up post on 1 July 2011
having been Chief Executive designate
since March 2011. She is a member
of the Quality & Safety and Finance
& Performance Committees. Sarah
previously worked for NHS Dudley as
Chief Executive.
Chris held a series of senior executive
positions in the metal processing
sector. His last post was with
Bradken, an Australian PLC, where
he had responsibility for worldwide
activity in the power generation and
cement production markets and the
management of three sites in the UK.
Sarah is a trained nurse. She has held
a wide range of senior positions with
community and mental health service
providers and in commissioning
organisations.
Non-executive Director
Martin Connor
Jill is a Magistrate and is currently the
Chairman of the Kidderminster Bench;
she also chairs the West Mercia Justices’
Issue Group . She ran her own marketing
research company for over 30 years.
Non-executive Director
Martin has been a NED with the Trust
since 1 July 2011. He is the Chair of the
Audit and Charitable Funds Committees
and a member of the Quality & Safety
Committee. He is also a NED for the RAC
Jill Gramann
Jill has been a NED with the Trust since
1 July 2011. She chairs the Community
Engagement Committee. She was
previously appointed by Worcestershire
Mental Health Partnership NHS Trust to
hear appeals by patients on section under
the Mental Health Act. Jill is a former
director and trustee of disability charity
SCOPE, and also until recently fulfilled
the same roles with the British Institute of
Learning Disability.
115 | Annual Report 2012/13
Financial Accounts
Peter Lachecki
Non-executive Director
Peter has been a NED with the Trust since
1 July 2011. He is the Chair of the Quality
& Safety Committee and a member of the
Community Engagement Committee. He
has his own marketing and management
consultancy and has held previous senior
marketing and general management
roles at Kraft Foods, both in the UK and
Internationally.
Peter is also a NED for Gloucester
Cathedral Enterprises and is a member
of the governing body of King’s School in
Gloucester.
Financial Accounts
David Priestnall
Non-executive Director
David has been a NED with the Trust since
1 August 2011. He is a member of the
Audit Committee and chairs the Finance
& Performance Committee. He is also
Vice Chairman and Senior Independent
Director. David was previously a NED and
Vice Chairman of NHS Worcestershire.
Prior to this he was Chairman of Wyre
Forest Primary Care Trust and Assistant
Director of Housing for Birmingham City
Council.
Dr Bill Creaney
Medical Director
Bill took up post with the Trust in July 2011
as Medical Director. He is a member of the
Quality & Safety Committee. Previously
he worked for Worcestershire Mental
Health Partnership NHS Trust as Director
of Medical Development from October
2009 and, prior to this, as Consultant
Old Age Psychiatrist from October 2006.
Bill’s main responsibilities include clinical
governance, engagement of medical staff
with Trust’s strategic goals and the Mental
Health Act.
Bill’s previous experience includes
working as a Consultant Old Age
Psychiatrist and Associate Medical
Director at NHS Ayrshire & Arran,
Robert Mackie
Director of Finance
Robert took up post with the Trust on 1
July 2011 as Director of Finance. He is a
member of the Finance & Performance
Committee. He previously worked
for NHS Walsall, initially as Director of
Resources from October 2008 and then
from November 2010 as Interim Chief
Executive.
Robert is a qualified accountant and
joined the NHS with the 1998 cohort
of the national financial management training scheme, having previously
worked in general management within
the private sector. Susan Harris
Robert Hipwell
Director of Strategy and
Business Development
Company Secretary
Appointed in May 2012 Sue is a
member of the Finance & Performance
Committee. Prior to a secondment to
the Strategic Health Authority in 2011
Sue was, from 2009, Lead Commissioner
for mental health services in the Joint
Commissioning Unit in Worcestershire.
In this role she led on strategic planning,
performance management, resource
allocation and market reform to ensure
a sustainable commissioning platform
for Mental Health. Previously a national
director for Turning Point, Sue has 15 years
business development experience in the
health and social care field.
Robert was previously the Company
Secretary with Worcestershire Mental
Health Partnership NHS Trust. His
responsibilities include Board support,
corporate governance / assurance, risk
management, health and safety, and
claims handling.
Robert has over 30 years general
management experience in the NHS.
He has held director appointments in
community & mental health NHS trusts
between 1993 and 2001. From 2001 to
2005 he set up and led a Support Services
Agency which provided a broad range of
services to five NHS organisations.
Jan Ditheridge
Colin Phillips
Non-executive Director
Colin has been a NED with the Trust since 1
July 2011. He is Chair of the FT Programme
Board and a member of the Audit
Committee. He was previously a NED with
Worcestershire Mental Health Partnership
NHS Trust from November 2007. He is
a trustee and director of Sight Concern.
He is a former city councillor, Director of
Worcestershire YMCA and school governor.
Colin qualified and worked as a chancery/
commercial barrister. He has project
managed several merger and acquisition
deals for accountancy firms and has
advised them in relation to due diligence
and forensic accounting exercises.
116 | Annual Report 2012/13
Director of Service
Delivery
Jan took up post with the Trust on 1 July
2011. She is a member of the Finance &
Performance Committee. She previously
worked for Worcestershire Mental Health
Partnership NHS Trust, initially as Director
of Service Development & Exec Nurse from
2004 then as Chief Operating Officer from
2009.
Jan is an experienced, board level
strategic leader with a background in
health, social care and the private sector.
She also has expertise in organisational
development and turnaround, governance,
and effective performance management.
Sandra Brennan
Director of Quality and
Executive Lead Nurse
Sandra took up post with the Trust in July
2011 as Director of Quality (Executive
Nurse). She is a member of the Quality &
Safety Committee. She previously worked
for NHS Worcestershire from December
2006 as Director of Clinical Development
and Lead Executive Nurse. Prior to this
she was Director of Community Services
and Nursing at North Birmingham Primary
Care Trust.
Sandra has a background in nursing
management.
Dates of board meetings and accompanying papers and reports are available at www.hacw.nhs.uk
117 | Annual Report 2012/13
Financial Accounts
Financial Accounts
Glossary of terms used in Annual Report
A&E (Accident &
Emergency)
The emergency departments of
hospitals that deal with people
who need emergency treatment
because of sudden illness or
injury. Sometimes these services
are referred to as casualty
departments, or minor injury units.
Acute services
Medical and surgical interventions
usually provided in hospital. The
Trust only provided these services
up to 30th June 2011, after
which date these services were
transferred to the local acute Trust.
Capital
Expenditure on the acquisition
of land and premises, individual
works for the provision, adaptation,
renewal, replacement and
demolition of buildings, items or
groups of equipment and vehicles,
etc. In the NHS, expenditure on
items of the above nature are
classified as capital if in excess of
£5,000.
Capital charges
Capital charges are a way of
recognising the costs of ownership
and use of capital assets and
comprise depreciation and
interest/target return on capital.
Capital charges are funded through
a circular flow of money between
HM Treasury, the Department of
Health, primary care trusts and NHS
trusts.
Care Quality Commission
The Care Quality Commission uses
expert assessors to determine
annual ratings for NHS Bodies on
the quality of the services they
operate.
118 | Annual Report 2012/13
Clinical Commissioning
Groups (CCGs)
CCGs are clinically led groups that
include all of the GP groups in their
geographical area. The aim of this is
to give GPs and other clinicians the
power to influence commissioning
decisions for their patients. CCGs
will be overseen by NHS England
NHS Commissioning Board on 1
October 2012, NHS England is an
independent body at arm’s length
to the Government.
NHS Foundation Trusts
NHS hospitals that are run as
independent, public benefit
corporations, which are both
controlled and run locally.
Corporate Governance
The system and rules of delegation
by which organisations are directed
and controlled.
In-patient
A person admitted on to a hospital
ward for treatment.
International Financial
Reporting Standard
(IFRS)
Issued by the International
Accounting Standards Board,
financial reporting standards
govern the accounting treatment
and accounting policies adopted
by organisations. Generally
these standards apply to NHS
organisations.
Major Incident plan
The Trust is required to put in place
a major incident plan that is fully
compliant with the requirements
of the NHS Emergency Planning
Guidance 2005 and all associated
guidance.
NHS England
NHS England will play a key role
in the Government’s vision to
modernise the health service
with the key aim of securing the
best possible health outcomes for
patients by prioritising them in
every decision it makes.
Formally established as the
NHS Trusts
NHS trusts are hospitals,
community health services, mental
health services and ambulance
services which are managed by
their own boards of directors.
NHS trusts are part of the NHS
and provide services based on
the requirements of patients as
represented by primary care trusts
and GPs.
Out-patient
A person treated in a hospital but
not admitted on to a ward.
Payment by Results
(PbR)
Transparent rules based system
that sets fixed prices (a tariff ) for
clinical procedures and activity in
the NHS, enabling all trusts to be
paid the same for equivalent work.
PEAT
The PEAT (Patient Environment
Action Team) carries out
inspections every year and
comprises a team of health
professionals along with
an independent patient
representative. The team assesses
each hospital they visit in terms
of cleanliness, hygiene, privacy,
dignity, patient information, food
quality and service.
Performance indicator
Measures of achievement in
particular areas used to assess the
performance of an organisation.
Primary Care Trust (PCT)
An NHS primary care trust (PCT)
was a type of NHS trust, part
of the National Health Service
in England. PCTs were largely
administrative bodies, responsible
for commissioning primary,
community and secondary health
services from providers. Until
31 May 2011 they also provided
community health services directly.
Primary Care Trusts were abolished
on 31 March 2013 as part of the
Health and Social Care Act 2012,
with their work taken over by
clinical commissioning groups.
Provisions
Provisions are made when an
expense is probable but there is
uncertainty about how much or
when payment will be required, e.g.
estimates for clinical negligence
liabilities. An estimate of the likely
expense is charged to the Trust’s
Operating Cost Statement as
soon as the issue comes to light,
although actual cash payment
may not be made for many years,
or in some cases never. The
expense is matched by a balance
sheet provision entry showing
the potential liability of the
organisation.
QIPP
Quality, Innovation, Productivity
and Prevention schemes which
include medicines use and
procurement, staff productivity,
clinical support rationalisation and
the better planning of patient care
and management of long term
conditions.
Reference costs
Reference costs are the average
cost to the NHS of providing a
defined service in a given financial
year. Reference cost data allows
NHS trusts to compare their costs
to the NHS average and therefore
benchmark their relative efficiency.
Revenue
Revenue is expenditure other than
capital, for example, staff salaries
and drug budgets. Also known as
current expenditure.
Secondary care
Specialised medical services and
commonplace hospital care,
including out-patient and inpatient services. Access is often via
referral from primary care services.
Strategic Health
Authority (SHA)
Disbanded as part of the Health
and Social Care Act 2012, strategic
health authorities (SHA) were
responsible for enacting the
directives and implementing
fiscal policy as dictated by the
Department of Health at a regional
level.
Trust Development
Authority (TDA)
The NHS TDA exists to manage
the process of NHS Hospitals
becoming Foundation Trusts and
to performance manage those
hospital trusts that remain directly
accountable to the NHS.
119 | Annual Report 2012/13
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