Torbay and South Devon NHS Foundation Trust Annual Report and Annual Accounts 2016/17 Torbay and South Devon NHS Foundation Trust Annual Report and Annual Accounts 2016/17 Presented to Parliament pursuant to Schedule 7, paragraph 25 (4) (a) of the National Health Service Act 2006. ©2017 Torbay and South Devon NHS Foundation Trust Annual Report and Annual Accounts 2016/2017 Incorporating the performance report, accountability report and quality report. Alternative formats If you require any assistance in communicating with us, or wish to receive information in an alternative format please contact our Patient Advice and Liaison Service on: Telephone: 01803 655838 | Free phone: 0800 028 20 37 | Email: [email protected] | 5 | P age Laid before Parliament This Annual Report 2016/17 has been produced to be laid before Parliament in July 2017, together with the full accounts for the same period, and to be presented to the Trust’s Council of Governors at its annual members’ meeting. It will be available on the Trust’s website www.torbayandsouthdevon.nhs.uk/ and Monitor’s website. A Summary Annual Review, based on this report will also be available later in the year. Torbay and South Devon NHS Foundation Trust Hengrave House Torquay TQ2 7AA Switchboard: 01803 614567 HQ Fax: 01803 616334 www.torbayandsouthdevon.nhs.uk/ 6 | P age Contents Part I: Performance Report 08 Overview of performance Chairman’s statement 08 Chief executive’s statement 09 A brief history about the foundation trust and its statutory background 10 Performance analysis 15 Part II: Accountability Report 21 Directors report 21 Remuneration report 31 Staff report 40 The disclosures set out in the NHS foundation trust code of governance 54 NHS Improvement’s Single Oversight Framework 61 Statement of accounting officer’s responsibilities 64 Annual governance statement 65 Part III: Quality Report 86 Includes the independent auditors’ limited assurance report to the Council of Governors of Torbay and South Devon NHS Foundation Trust on the annual quality report Annual Accounts 2016/17 165 7 | P age Part I: Performance Report Overview of performance Chair’s statement Richard Ibbotson It is my great pleasure to write this foreword as Chairman of our integrated care organisation Torbay and South Devon NHS Foundation Trust. This year has been extremely challenging but we have made good progress towards our vision of supporting more people to be able to be at home with the right support. We know this is what most people want, we also know that it is the most efficient way of providing care. It will not have escaped anybody’s attention that providing the highest quality services within the funding we receive is a huge challenge. To do this successfully we must use our resources as effectively as possible. And as a provider of integrated care we believe we are in the best possible place to be able to do this. After 18 months as a Trust that has integrated both acute and community care along with adult social care we are seeing the benefits that this brings. The benefits of this structure are clear in that we have the flexibility to put resource where it is most needed. This not only ensures we are able to provide good care centred around the person rather than organisational structure but it is also the most efficient. But with any change we know there is a degree of feeling unsettled. Moving away from the traditional reliance on bed-based care to supporting more people at home is, I strongly believe, the right thing to do but I also appreciate brings uncertainty to people who have grown up in a society where being in hospital was considered the best place to be. We now know this is not the case but we will have to demonstrate this is working. I would like to thank those who took the time and trouble to share their thoughts in the recent consultation on community services run by the local Clinical Commissioning Group that we supported in partnership. I would also like to thank all our staff. Throughout this year their commitment and passion to provide the best possible service has meant that we are that bit closer to realising our vision. During the year the Trust was offered targeted support from NHS Improvement due to concerns in relation to one or more of the Single Oversight Framework’s five themes. NHS Improvement offered the Trust assistance in the form of an NHS Improvement Very Senior Manager to support the Trust to deliver the 2016/17 revised deficit (improving that where possible) and to further improve the confidence in delivery of the 2017/18 plan. 8 | P age Chief Executive’s statement Mairead McAlinden Looking back on the past year, I feel very proud of what we have achieved. It has been difficult at times but I believe we are stronger and better because of the challenges we have faced and how we have responded as an integrated system of care. We have focused on doing our very best for the people we serve, taking difficult decisions to deliver our commitment to ‘right care, right place, right time’ better than we ever have. These achievements have been delivered through the commitment and dedication of our staff and the service of our Leagues of Friends and volunteers who work tirelessly to support the great care we provide. You all deserve thanks for your contribution to the improvements set out in this report and for delivering the reality of our new model of care. This was a difficult year financially, we have made choices to invest in new services and to live with a deficit that is larger than we had planned. Next year will also be challenging but, if we deliver our plans, we will return to surplus by April 2018. Then we can look forward to more investment in our estate, new technology, and more new services to provide high quality care for the future. Some changes have been difficult for our staff and local people, particularly the reductions in bed based care in the acute and community hospitals. I applaud how well our staff have managed these changes. The culture of compassionate and quality care lives on in the new services we now have in place. The positive impact of change is seen in our performance – over the winter of 2015/16 many services struggled to cope, our Care Quality Commission (CQC) inspection in February 2016 identified areas for improvement, and staff were under enormous pressure. We committed to making changes that would make things better by the following winter. These changes have significantly reduced risks to the safety of our care and also improved the timeliness of our care. There is always more to do but we coped much better this winter than last because our integrated system worked better at every level. In March 2017 we achieved 94.2 per cent against the four hour urgent care target – which I believe signals how the whole system is working. More of our community services are now available to support people seven days a week, and our senior clinicians are working differently, available to provide expert advice to avoid crisis and hospital admission, minimising the time our patients stay in hospital, and when they leave hospital they are well supported by our extended community teams which now include GPs with dedicated time to work with these teams. There are still challenges – some services are struggling to recruit the staff they need to deliver services in a safe and timely way, so we are working with our partners across Devon to make sure our population has fair and timely access to specialist treatment and care. We are working more closely with our partners in the care home and domiciliary care sector to support them as a key part of our care model. We are continuing to develop our partnership with the voluntary sector with more long term contracts and new investment to expand our joint working to support local people. I have been asked – when will we stop making changes? The simple answer is – we won’t and we shouldn’t. Health and social care must continue to change to meet the needs of our population, and do that in a way that is affordable and sustainable. So we will continue to change, and with the commitment of our staff and the partnerships we have developed I believe we will continue to change for the better and realise our vision of truly integrated, locally delivered, excellent care for the people of South Devon and Torbay. 9 | P age A brief history about the Foundation Trust and its statutory background A brief history In October 2015, the two successful organisations responsible for local health and social care services merged to create Torbay and South Devon NHS Foundation Trust. This brought together two Trusts to create a single integrated care organisation (ICO) covering acute and community health as well as adult social care. The Trust runs Torbay Hospital as well as community hospitals provide health and social care for local people. We have around 500,000 face-to-face contacts with patients in their homes and communities each year and see over 78,000 people in our A&E department annually. We serve a resident population of approximately 286,000 people, plus about 100,000 visitors at any one time during the summer holiday season. We employ approximately 6,000 staff including frontline health and social care staff, such as nurses, occupational therapists, social workers, consultants, and physiotherapists who work in people’s homes and community locations. We also have over 800 volunteers who make a difference each and every day to the people we care for. Our purpose is to provide safe, high-quality care and social care at the right time and in the right place to support the people of Torbay and South Devon to live their lives to the full. This means that as an organisation we want people to:  Be empowered to manage their own health and care needs  Work in partnership with professionals  Only tell us their story once  Access seamless care easily  Have care in or close to home, whenever appropriate  Work together as a community to look after health and care needs. We receive the majority of income from our commissioners, South Devon and Torbay NHS Clinical Commissioning Group, who receive an allocation of NHS money from the government each year and decide on healthcare priorities for the local population. The responsibility for the adult social care budget is delegated to us via Torbay Council, and we have a memorandum of understanding with Devon County Council to run social care services in a joined up way. The Trust is well supported by a number of Leagues of Friends in our hospitals, who work tirelessly to raise vital funds to support our work and help improve our services. 10 | P age