Annual Report and Accounts and Quality Account 2015/16

253 Pages·2016·4.69 MB·English

by  Richard Baum

Taunton and Somerset
NHS Foundation Trust
Annual Report and Accounts
and Quality Account 2015/16
Annual Report
and Accounts 2014/15
Annual Report
Presented to Parliament pursuant to Schedule 7, paragraph
25(4) (a) of the National Health Service Act 2006

Taunton and Somerset NHS Foundation Trust
Annual Report and Accounts and Quality Account 2015/16
Annual Report

©2016 Taunton and Somerset NHS Foundation Trust
Annual Report 2015/16

CONTENTS
Page
PART 1 INTRODUCTION
 Chairman’s Report 1

PART 2 PERFORMANCE REPORT

 Overview of Performance 5
 Statement from the Chief Executive 5
 Operating and Financial review 10
 Performance Analysis 14
 Going Concern Disclosure 16
 Sustainability Report 17
 Social, Community and Human Rights Issues 20
 Stakeholder Relations 20
 Research and Development 22
PART 3 ACCOUNTABILITY REPORT

 Directors’ Report 28
 About the Directors 29
 Directors’ Statement 36
 Enhanced Quality Governance Reporting 40
 Remuneration Report 2015/16 41
 Staff report 52
 NHS Foundation Trust Code of Governance 65
 Audit Committee Report 71
 Council of Governors and Membership 72
 Regulatory Ratings 80
 Statement of Accounting Officer’s responsibilities 82
 Annual Governance Statement (including personal 83
data related incidents)

Quality Account 2015/16 1-97
Annual Accounts 2015/16 1-50
Annual Report
Annual Report
PART ONE

INTRODUCTION – CHAIRMAN’S REPORT

Welcome to our annual report for 2015/16. I am now in my second year as chairman of
Taunton and Somerset NHS Foundation Trust (TSFT) and as I have grown to know the
hospital, colleagues, volunteers and governors better, I have been deeply impressed by their
commitment to do the best for patients, as well as their dedication to the hospital and the
wider community we support. My colleagues and I are deeply affected by the warmth of
support for the hospital in our local community which only makes us ever more determined
to provide the best possible service to the people of Somerset.

This year has been very challenging for almost all acute trusts in England particularly in
terms of finances and performance targets. The same was true for TSFT. As you will read,
the Trust has recorded a financial deficit, and we have struggled to meet national
targets such as the maximum four hour wait in accident and emergency and the target to
treat all patients within 18 weeks of referral. We are working hard and innovatively to
address these challenges. At the same time we will never forget that patient care is
fundamental to everything we do. I hope this report will give a clear perspective on the
challenges which we face as well as highlighting a number of significant successes.

Financial performance

We ended the year with a deficit of £9.8 million. Other parts of this report will explain the
various reasons for our deficit, one of the most important being that the funding we receive
has failed to keep pace with growing demand for our services. We also believe that the
national funding regime under which we operate does not adequately reflect the costs of
serving a relatively dispersed rural population with a high proportion of older people whose
care needs are greater. We are working hard with commissioners and other partners to try to
address these factors.

This is a disappointing financial position. In previous years, surpluses have paid for
improvements such as the Jubilee Building which opened in 2014. Deficits mean that similar
investments become much less affordable. In October our regulator, Monitor (now NHS
Improvement or NHSI), announced that it would be taking regulatory action against us
because of our finances. They have set out a number of key actions for us to take, including
appointing a turnaround advisor to work on delivering efficiencies. We appointed an advisor,
who started with us in December, and worked hard with him in the period through to April
to make efficiency savings, and draw up robust and realistic recovery plans. In April, NHSI
instituted a new Financial Improvement Programme which is available to trusts nationwide
and we have joined this programme which we believe will further assist with our financial
recovery plan.

Our vision for integrated health and social care

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Nationally and locally it has been recognised that the only way that health and social care
services are going to meet the challenges they face is by aligning services more, improving
pathways and delivering care closer to home focusing on the whole person rather than
specific conditions. In this way, services can provide better care within available budgets,
and improve outcomes.

This approach was reflected in NHS England's Five Year Forward View, which
was published in November 2014. The Five Year Forward View forms the basis of county-
wide plans for more integrated care which we are working to deliver in partnership with
Somerset CCG.

As part of this work we have set up Taunton Symphony, a ‘test and learn’ project which
seeks to test new ways of working and learn from them. This aligns the work of the hospital
closely with GPs and Somerset Partnership NHS Foundation Trust to provide better support
to people with three or more long-term conditions. Whilst this project is only in its pilot stage,
at the time of writing it is already helping to support approaching 400 people to manage their
conditions more actively, and to prevent escalation in care needs - including hospital
admissions. The project also helps to develop more joined up working practices between us
and our various partners.

This work is closely tied to our 2020 vision, which was launched to colleagues across the
hospital by the executive team in the autumn. Our vision sets out how we want to ‘join the
dots’ in all that we do for patients, across our care community, for each other as colleagues
and in how we perform and improve. The focus of our vision is to provide a more holistic
approach in all our care, both here at TSFT and across Somerset, working with partner
organisations, charities and the community to promote health management in the longer
term.

Operational performance

Although we have treated more than 90% of patients within 18 weeks of referral throughout
the year, we missed the national target of 92% in several months towards the end of the
year. In part, this was due to a significant increase in referrals. There is a robust action plan
in place to get performance back on track in 2016, although inevitably this may be impacted
by the degree of future referral growth. We have also struggled to maintain the four hour
A&E target since last summer, and our performance against national targets for cancer care
has been mixed, again in part due to a big rise in the number of referrals. As with all
services, we know how important it is to meet performance targets for A&E and cancer, and
there are action plans in place to improve service performance both within the hospital and
with partners.

In January we had our three-yearly inspection by the Care Quality Commission and are
delighted to have received an overall ‘Good’ rating. The inspection identified a number of
areas for improvement, highlighted several areas of excellence and particularly noted the
strong motivation of our staff and high level of satisfaction from our patients. We will address
areas of weakness and work hard to maintain the positive areas found by the team of
inspectors.

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There have been many improvements and successes across the hospital this year. There is
increasing recognition throughout the NHS that a positive culture which empowers staff is
critical to the delivery of the best patient care. We have been focussing heavily on this via
our LEAD programme as described last year. We were delighted that TSFT was in the top
five of acute trusts in the country for staff engagement. We would like to thank and pay
tribute to our colleagues for their positive attitude and culture, which I believe were
fundamental to achieving a good rating from the CQC.

As part of our work around the national Sign up to Safety campaign we have kept our focus
on infection control, pressure ulcers and falls as well as encouraging colleagues to speak up
when they see something requiring attention. This has seen improved infection control
practices and low instances of MRSA and clostridium difficile - although we acknowledge
there is still more that we can do. National NHS Staff survey results and our Pulse Check
surveys also show that our colleagues feel more confident about raising concerns, and more
knowledgeable about how to do so.

We have been working hard on our patient meals and nutrition. As well as reducing food
waste from 23% to 5%, we were also named as the 'Catering Service of the Year' by the
Hospital Catering Association.

Our joint emergency therapies team (JETT), which is now working seven days a week, has
prevented hundreds of admissions for people who could be better cared for in more
appropriate settings or even at home.

The feedback we receive from our patients, their families and carers, and the community we
serve is vitally important to us and we work hard to address all feedback we receive –
particularly concerns – swiftly and effectively. We were pleased that we were in the best 10
hospitals nationally for the number of complaints that are referred to the Health Service
Ombudsman. A key test for any hospital is whether patients would recommend us to their
friends and family. We score highly in the national “Friends and Family” test, with well over
90% of patients in all surveyed areas saying that they would recommend us. Performance in
inpatient areas was particularly high, with 98% of patients saying that they would
recommend us in the January 2016 survey.

Our volunteers and charity supporters

One area I do particularly want to acknowledge in this section is the fantastic work that
our numerous volunteers carry out across all areas of the hospital, and the wonderful
contribution made by the charities that support us.

Every day, in all areas of the hospital, a large number of dedicated volunteers carry
out duties, such as helping patients find their way, assisting with meals or giving comfort and
support to patients in the last days and hours of their lives. Their contributions really help us
deliver a care service above and beyond our day to day duties, which we could not deliver
without such help.

Thanks must also go to the charities that support us. Each year, charities such as the
League of Friends of the Taunton Hospital, Somerset Unit for Radiotherapy Equipment

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(SURE) and the Musgrove Leukaemic Group, raise tens of thousands of pounds for TSFT.
This money provides equipment to improve the quality of treatment we can give, helps us
deliver the latest treatment techniques, pays to improve the environment in which we care
for people, and is utilised to provide specific smaller items for patients such as slippers or
toiletries.
We are very humbled by the strength of generosity and local support from our community.
Board changes
During the year we have seen some changes to the board. Dr Sam Barrell has just
completed her first full year as chief executive and her patient focus, as well as her energy
and drive are apparent throughout the Trust. Chris Harvey, Vice-Chairman and Derek
Manuel both retired as non-executive directors (NEDs) and I would like to put on record our
thanks to them for all their contribution and to Gill McComas who has taken over as Vice-
Chairman. I welcome Kate Fallon, Stephen Otter and Huw Williams who joined us in the
summer as NEDs and who are already making an impact.

Carol Dight retired as Director of Nursing in September and David Hobdey as Finance
Director in January. I would like to thank them both for their long and invaluable service and
to welcome Hayley Peters who has taken over from Carol as Director of Patient Care. (We
are in the process of recruiting a permanent replacement as Finance Director and thank our
Deputy Chief Executive, Peter Lewis, who has overall control of the finance function pro
tem). Finally, after 21 years of service, including the last four as Medical Director, Dr Colin
Close will retire in May. I thank him for his major contribution to the Trust and welcome Dr
Stuart Walker, Consultant Cardiologist, as our new Medical Director.

I have touched on just a few areas of success and challenge for Taunton & Somerset NHS
Foundation Trust in this introduction. This report sets out in much greater detail how we have
been working to improve the quality and safety of the care we provide, in driving forward
improvements, developing our facilities and teams and working to deliver greater partnership
working with our local health and social care organisations.

My welcome to this report would not be complete without also thanking our dedicated and
talented staff. Over 4,000 people work at our hospital, delivering services to the local
community which continue to be safe and of high quality despite increasing pressures
throughout the NHS. I am immensely proud to chair an organisation with so many hard-
working colleagues who provide such important services to Somerset. Thank you to all my
colleagues for their continuing dedication to our cause.

I hope that you find this report informative and that it demonstrates to you just how hard we
are working to really focus on what matters to our patients.

Colin Drummond OBE
Chairman

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