Transcript Annual General Meeting 2013 - Rotherham NHS Foundation Trust

Annual General Meeting
Tuesday, 17th September 2013
Annual General Meeting
TUESDAY, 17TH SEPTEMBER 2013, COMMENCING AT 6PM
AGENDA
1.Welcome & Announcements - Christopher Langley, Interim Chairman
2. Annual Report and Accounts for 2012/13
• Michael Morgan, Interim Chief Executive
• John Somers, Chief Financial Officer
• Trisha Bain, Acting Executive Health Informatics Officer
• Clare Partridge, Director KPMG LLP
-
Looking Back and to the Future
Annual Accounts
Quality Accounts
Annual Audit Letter
3. Council of Governors - Jean Dearden, Lead Governor
• Elections 2013
4. Review of Service
5. Questions from the floor on matters relating to the business of the meeting - Christopher Langley, Interim
Chairman
By Order of the Board
Alan Lambourne
Interim Company Secretary
Looking Back and to the
Future
Michael Morgan
Interim Chief Executive
Looking Back
•
Difficult year due to Finances and Electronic Patient Records System (EPR) problems
•
Monitor declared Trust in Significant Breach of Authorisation – Finance, EPR, and Board
Governance Issues
•
Number of Changes at Board Level
•
Action/Recovery Plan drawn-Up and agreed with Monitor
•
Subsequent progress made with Action Plan
Recovery plan progressing well
Key results
•Reconnecting the executive with clinical / front line staff
•
Interim CEO: participative and inclusive management style
•Rebuilding functioning executive team
•
Restructuring clinical service units to reduce from 11 to 4
•
Replacement interim CEO to be recruited
•Reconnecting with commissioners and the local health economy
•Fixing electronic patient record system
•
Renegotiated contract (£8m savings in future years)
•Rapidly reducing the cost base in a safe way and managing liquidity
•
Corporate overhead reduced by £5m (£22m in FY13 to £17m in FY14)
•
Tactical controls saving up to £1.6m annually
•
As at month 4, £1.5m ahead of plan
•KPMG: External review of recovery plan
5
On track with Monitor requirements
•
Regular meetings & on-going communication
•
Recovery plan submitted
•
On track with focus areas:
•
•
•
Finance
•
Governance
•
Electronic patient records system
Future deliverables:
•
Revised 18 month forecast
submit by 1st October
•
Strategic plan
submit by 31st December
Additional work stream:
•
Zero based budgeting (bottom up budgeting, based on agreed data and assumptions with
clinical involvement) completed and approved by December
6
Next steps
Aug
Sept
Oct
A
B
Board Monitor
Reforecast & Zero Based
Budgeting
Nov
Dec
Jan
C
D
E
F
Board
Board
Board
Monitor
• Reforecast
 Option 0
ZBB
Strategic Planning
• Review Option 0
• High Level Option 1
• Detailed Option 1
• Confirm long list  short list
• High level Options 2 – 3
Option development is based on commissioning
intentions and changes to clinical delivery
• Review fully worked
up Options 0 – 3
• Confirm plan for
preferred option
• Final options / plan
based on Nov
board feedback
• Ready for Monitor
submission
7
Annual Accounts 2012 -13
John Somers
Chief Financial Officer
Financial Overview 2012/13
•
The Trust generated an underlying deficit of £0.7m, excl. restructuring costs and impairments (2011/12
£4.8m surplus); deficit of £6.5m including restructuring costs and impairments
•
Operating income £234.2m v plan £225.5m:
– £1.5m (0.6%) increase on 2011/12
– £8.7m (3.9%) above plan
•
Operating expenditure £237.8m; £232.0m excl. restructuring costs and impairments v plan £219.2m:
– £7.1m (3.2%) above 2011/12 (excl. restructuring costs and impairments)
– £12.8m (5.8%) above plan (excl. restructuring costs and impairments)
•
Non-operating costs £nil above 2011/12 and £0.2m below plan (reduced public dividend capital payment)
Financial Overview 2012/13
T & O Surplus / (Deficit)
£12
£10
£8
£6
Income / Cost
£4
£2
£0
Operating Income
-£2
Non-operating
expenditure
Impairment
Operating Expenditure
-£4
-£6
-£8
Cost Classification
Restructuring
Surplus / Deficit
Financial Overview 2012/13
• Of total operating income (£234.2m):
10%
patient related activities; of which circa 80% from NHSR £211.9m
from non-patient activities £22.3m
90%
• Of total operating expenditure (£232.0m excl. restructuring costs and
impairments):
3%
2%
2%
Employee costs £152.4m
5%
3%
Drug and clinical supply costs £33.1m
5%
Premises costs £10.8m
Depreciation and amortisation £7.5m
14%
Other supplies, services, transport & establishment costs £7.1m
66%
Services from other NHS bodies £5.7m
Clinical negligence claims premium (insurance) £4.1m
Other £11.3m
Financial Overview 2012/13
•
Cash and cash equivalents at year end of £15.8m (2011/12 £17.3m)
•
Circa £8.6m of cash generated from operating activities:
– £0.9m servicing of finance
– £2.6m loan repayments
– £4.4m capital investment (EPR, mortuary)
– £1.9m PDC dividends
•
Borrowings outstanding £21.8m, against a year-end Prudential Borrowing Limit of £32.6m, at year-end
•
Monitor Financial Risk Rating of 2 at year-end
Consolidated trading results (Month 4 YTD)
Rotherham Foundation Trust
Consolidated Trading Results (Jul-13)
actual
Current Month
plan
variance
Year to Date (Month 4)
actual
plan
variance
£m
£m
£m
£m
£m
£m
17.6
0.4
1.0
19.0
18.0
0.4
1.4
19.7
(0.3)
0.0
(0.3)
(0.7)
69.4
1.5
4.6
75.5
69.6
1.5
5.5
76.6
(0.2)
0.0
(0.9)
(1.1)
(12.3)
(5.2)
(17.6)
(12.9)
(5.4)
(18.3)
0.6
0.1
0.7
(49.2)
(21.4)
(70.6)
(51.2)
(21.8)
(73.0)
2.0
0.4
2.5
1.5
7.8%
1.4
7.1%
0.1
0.7%
4.9
6.5%
3.5
4.6%
1.4
1.9%
(0.4)
(0.4)
0.0
(1.6)
(1.7)
0.1
1.1
1.0
0.1
3.4
1.9
1.5
(0.6)
0.0
(0.0)
(0.2)
(0.8)
(0.6)
0.0
(0.0)
(0.2)
(0.9)
0.0
0.0
0.0
0.0
0.0
(2.6)
0.0
(0.2)
(0.7)
(3.5)
(2.5)
0.0
(0.2)
(0.7)
(3.4)
(0.0)
0.0
0.0
0.0
(0.0)
0.3
0.1
0.1
(0.1)
(1.6)
1.5
Revenue
Clinical Income
Education and Training
Other Operating Income
Expenditure
Pay
Non Pay
EBITDA (pre Exceptionals)
Restructuring Costs
EBITDA (post Exceptionals)
Depreciation
Asset Impairment
Interest
PDC
Net Surplus/(Deficit)
Forecast outturn for FY2014
Rotherham Foundation Trust
Analysis of Outturn (Based on Month - 04 Actuals)
Actual
Full Year Performance
Forecast
Forecast
Budget
Monthly Averages
Actual
Forecast
Change
4 Months
8 Months
FY
FY
4 Months
8 Months
£m
£m
£m
£m
£m
£m
£m
69.4
1.5
4.6
75.5
141.9
2.9
8.7
153.5
211.3
4.4
13.3
229.0
211.0
4.4
14.1
229.4
17.4
0.4
1.2
18.9
17.7
0.4
1.1
19.2
0.4
0.0
(0.1)
0.3
(49.2)
(21.4)
(70.6)
(100.3)
(45.6)
(145.9)
(149.5)
(67.0)
(216.5)
(152.4)
(66.6)
(218.9)
(12.3)
(5.3)
(17.6)
(12.5)
(5.7)
(18.2)
(0.2)
(0.4)
(0.6)
4.9
6.5%
7.6
5.0%
12.5
1.6%
10.5
3.4%
1.2
6.5%
1.0
5.0%
(0.3)
-1.6%
(1.6)
(3.0)
(4.6)
(5.0)
(0.4)
(0.4)
0.0
3.4
4.6
7.9
5.5
0.8
0.6
(0.3)
(3.5)
(6.8)
(10.2)
(10.3)
(0.9)
(0.8)
0.0
(0.1)
(2.2)
(2.3)
(4.8)
(0.0)
(0.3)
(0.3)
Revenue
Clinical Income
Education and Training
Other Operating Income
Expenditure
Pay
Non Pay
EBITDA (pre Exceptionals)
Restructuring Costs
EBITDA (post Exceptionals)
ITDA
Net Surplus/(Deficit)
Quality Accounts 2012 -13:
Overview of Performance
Dr Patricia Bain
Acting Executive Health
Informatics
Section 1:Patient Experience
• Increasing number of complaints, reduced severity
• Themes: National and Local Surveys
Staff Experience: Local Surveys
Response Category
2012/13
2011/12
Feeling valued
7.2
7.2
Learning and
Development
5.4
6.0
Performance/Stress*
5.6
6.1 Higher National
Health & Wellbeing
7.4
7.3
Communication from
Managers
6.4
6.6
Job Satisfaction
5.6
5.7
Conflict resolution*
7.1
7.0 Lower National
Overall Score
6.4
6.5
Section 2: Improvement
1a: NHS Safety Thermometer Benchmarking
Falls with harm
All Pressure Ulcers (new & old)
12.0%
1.6%
1.4%
10.0%
1.2%
8.0%
1.0%
6.0%
0.8%
0.6%
4.0%
0.4%
2.0%
0.2%
0.0%
Apr-12
100.0%
0.0%
Jun-12
Aug-12
Nationwide
Oct-12
Dec-12
NofE SHA cluster
Feb-13
Apr-13
TRFT
Jun-13
Apr-12
Aug-12
Nationwide
Oct-12
Dec-12
NofE SHA cluster
Feb-13
Apr-13
TRFT
Jun-13
‘Harm Free Care’ (overall)
VTE Assessment & Prophylaxis
94.0%
90.0%
92.0%
80.0%
90.0%
70.0%
88.0%
60.0%
86.0%
50.0%
84.0%
40.0%
82.0%
Apr-12
Jun-12
Jun-12
Aug-12
Oct-12
Assessment Nationwide
Assessment TRFT
Prpphylaxis NofE SHA cluster
Dec-12
Feb-13
Apr-13
Jun-13
Assessment NofE SHA cluster
Prophylaxis Nationwide
Prophylaxis TRFT
80.0%
Apr-12
Jun-12
Aug-12
Nationwide
Oct-12
Dec-12
NofE SHA cluster
Feb-13
Apr-13
TRFT
Jun-13
Improvements continued:
1b: Medications Management
To ensure that all Trust medicine management systems and processes adhere to The Royal Pharmaceutical
Society Safe and Secure Storage and Handling of Medicines guidance (2005):
•
•
Significant improvements have been made in most areas 30-40% across 6 areas
Improvement remains in terms of locking drugs trolleys and fridges, location of Drug Disposal Unitscontinued assessment ward accreditation
1c: Liverpool Care Pathway
Increasing compliance to 65% for 5 key measures of the Liverpool Care of the Dying Pathway (LCP) by April
2013:
•
•
Very significant improvement evident for the application of the 5 key measures, against 2011-12
performance
Areas where improvement needed : application of medication on a PRN (as required) basis
1d: Dementia F.A.I.R
To deliver the locally agreed improvement targets for early identification of patients with dementia – Find,
Assess/Investigate and Refer (F.A.I.R.)
•
•
•
Results did not achieve target
TRFT generated their own ‘stretch’ target in relation to this, for achievement for the 65+ age group
Recruitment of Dementia Lead
•
Continues to be a CQUIN this year
1e: Health Assessments for Looked After Children
Increasing the number of assessments carried out for looked after children and young people, from the April
2012 baseline
•
Data quality issues affected baseline
•
Changes to the data flow process implemented utilising SystmOne
•
Staff recruitment issues – difficulties still remain
•
Increase in assessments not met - continues to be a target for this year
Section 2b: National Mandate
•
National Quality Board Indicators
•
Zero Rule 43 notices from the coroner
•
Zero ‘Never Event’
•
CQC risk profile positive and no enforcements
•
IG Toolkit not met – training compliance
•
Quality Improvement Programmes 2013/14:
• Intra-operative/ward fluid management
• Dementia
• Death certification process
• Data Quality
The Rotherham NHS
Foundation Trust
Annual Audit Letter
2012/13
Presentation to the Council of Governors
17 September 2013
Clare Partridge
Director, KPMG LLP
Scope and Audit Approach
Financial
Statement
s Audit
Use of
Resources
Quality
Report
Annual Audit
Letter
© 2013 KPMG LLP, a UK limited liability partnership, is a subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent member firms
affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. KPMG and the KPMG logo are registered trademarks of KPMG International
Cooperative, a Swiss entity.
23
Key issues arising
•
Unqualified opinion
•
2 audit differences reported – neither
material to the financial statements
Financial •
Statement
s Audit
•
•
Only a number of minor disclosure changes
required
Annual Report is consistent with financial
statements
5 control recommendations raised – 0
classed as high risk
© 2013 KPMG LLP, a UK limited liability partnership, is a subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent member firms
affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. KPMG and the KPMG logo are registered trademarks of KPMG International
Cooperative, a Swiss entity.
24
Key issues arising
• Qualified opinion provided following
the Trust’s position of “significant
breach” as at 31 July 2013.
Use of
• The Annual Governance Statement
Resources reflects our understanding of the
Trust’s operations and risk
management arrangements
© 2013 KPMG LLP, a UK limited liability partnership, is a subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent member firms
affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. KPMG and the KPMG logo are registered trademarks of KPMG International
Cooperative, a Swiss entity.
25
Consistency of the Quality Report with
information specified by Monitor
• CQC quality and risk
Are significant
matters
included?
Quality
Report
Are significant
assertions
supported?
profile
• Board minutes and
papers
• Head of Internal Audit’s
annual opinion
• Feedback from
commissioners
• Feedback from
governors
• Quality reports to the
Board
• Complaints report
• Monitor best practice
© 2013 KPMG LLP, a UK limited liability partnership, is a subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent member firms
affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. KPMG and the KPMG logo are registered trademarks of KPMG International
Cooperative, a Swiss entity.
26
Key issues arising
• Achieved limited assurance opinion on
content of Quality Report
• Limited assurance opinion achieved
Quality
Report
on two mandated indicators
(clostridium difficile and 62 day
cancer)
© 2013 KPMG LLP, a UK limited liability partnership, is a subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent member firms
affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. KPMG and the KPMG logo are registered trademarks of KPMG International
Cooperative, a Swiss entity.
27
Key issues arising
• No opinion required this year on local
Quality
Report
indicator (incidents resulting in severe
harm). However, we concluded that
we would be unable to provide an
opinion in future years.
• Two (low priority) recommendations
raised and agreed with management
© 2013 KPMG LLP, a UK limited liability partnership, is a subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent member firms
affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. KPMG and the KPMG logo are registered trademarks of KPMG International
Cooperative, a Swiss entity.
28
Areas for consideration 2013/14
Audit Risk
Financial
Statements
Issues influencing our audit
• Delivery of year one recovery plan
• Valuation of EPR asset
• Successful actions against Monitors requirements
Use of
Resources
Quality
Report
to remove the Trust from position of significant
breach
• Achievement of cost improvement plans
• Achievement of national & local targets
• Compliance with Monitor’s new regulatory regime
• Quality Governance Framework
• Impact of Francis & Keogh reports
© 2013 KPMG LLP, a UK limited liability partnership, is a subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent member firms
affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved. KPMG and the KPMG logo are registered trademarks of KPMG International
Cooperative, a Swiss entity.
29
Council of Governors
Jean Dearden
Public Governor Wentworth South
& Lead Governor
Council of Governors
During 2013 the following were elected to the Council of Governors:
Public Governors
Rother Valley West
-
Jeffrey Gudgeon
Rotherham North
-
Sylvia Bird (re-elected)
Rotherham South
-
Terry Barker
Wentworth North
-
Ann Ashton
Wentworth Valley
-
Gordon Forster
& Abul-Abbas Zaidi
& Cynthia Shaw (re-elected)
Staff Governors
Other Health Professionals
-
Catherine Ripley
Other Staff
-
Sandra Lewis
On behalf of Council of Governor colleagues I would like to say thank you to those outgoing
Governors in 2013 for their contribution and support.
The Rotherham NHS
Foundation Trust Community
Continence Service
Joanne Mangnall
Clinical Nurse Specialist Continence / Service Lead
Continence...
• Toilet related activities are rarely discussed
and are a source of embarrassment, often
coped with through the use of humour.
• However continence is arguably the biggest
threat to individual dignity, the ability to
maintain bladder and bowel continence is an
elemental part of who we are
Rotherham leads the way!
• Over 1,000 people in Rotherham
require prescriptions for items such as
catheters
• Was anything wrong with the way it was
done before?
• Not really, but we knew if we were given
the opportunity we could do it better
A new way of working
• Prescribing responsibilities transferred
from GPs to Specialist Nurses
• New model offers the opportunity to
provide clinical advice and support each
time the patients contacts the service to
request a prescription
• Patients speak to staff who have
extensive product knowledge
Benefits
• Patients now have rapid access to
specialist clinical advice and support
• Effective product prescribing has
reduced costs
• Costs savings have been re-invested in
the service
• Reduces attendance at A&E
• Frees up GP time
Why is the model successful?
• The service model is responsive to
patient needs
• How do we know that?
• Our patients have played a key role in
the re-design process
Service User Group
• Meets quarterly
• Discuss service related
issues
• Bring new ideas to the
table – Hospital to
Home Pack
• Hold awareness raising
events
• Contract monitoring
from an end user
perspective
National Recognition for the
group
• Nursing Times
Awards
• Members of the
group attended the
award ceremony
What next?
• Adapting the model for patients who
required prescribed stoma appliances
• Partnership working with Infection
Prevention & Control team to reduce
catheter associated infections
• Research projects to improve product
design
Thank you
Questions from the floor