1 ReportAnnual 2022-2021
2 Contents 3The performance report 2020-21 Contents The accountability report 2020-21 52 The financial statements 2020-21 87
The overview section provides a summary of our hospital, how we have performed over the year and the challenges we have faced.
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Foreword from the chair and chief executive
3 The
The performance report 2020-21
As we came together to write this foreword, we both reflected on the further year of unprecedented challenges and pressures that our people have faced managing the ongoing COVID-19 pandemic. It is also a welcome to and a first PAHT annual report for Hattie Llewelyn-Davies, our new chair, who joined in September 2021. Although, the past year has seen the lifting of most of the national COVID-19 restrictions and a shift to living with COVID, within the NHS the pandemic still feels very real. The ongoing infection rate in our local community is reflected in our numbers of COVID+ inpatients and the pressure of managing those with COVID as well as patients with other acute care Weneeds.are proud of our people and all that they continue to do to ensure that our patients receive the best care. We recognise how tired this makes our people and that this is reflected in the results of our annual NHS Staff Survey. We know that we have more to do and are pleased that our teams are working collaboratively to ensure that action plans are in place that will support further improvements. We have introduced a weekly, proudest moments briefing that is issued to all our people each week that highlights achievements and successes and which is also posted on our social media channels to share details of the achievements of our people with our Wefollowers.arealso proud to know how committed our people are to their patients and delivering high quality patient care. We see this reflected in the wide range of feedback we receive from our patients every week through cards, letters, emails and our social media channels. We know how tough the pandemic has been on our patients too and recognise how different hospitals have become - we thank our patients for their support and Manyunderstanding.changes to the way we provide care have been put in place, including over 105,000 virtual appointments in the last year that save the need for our patients to travel to a hospital clinic for an appointment. This includes a virtual fracture clinic that offers the benefit of more timely follow-up and rehabilitation guidance for patients. Our teams are also making a concerted effort to recover planned care appointments for patients who have had to wait as a result of the impact of COVID-19. We have introduced a wide range of new ways of working including growing our virtual appointments offer and virtual visiting. We continue to deliver our PAHT 2030 strategy, which was launched at our annual Event in a Tent in September 2021. In line with the PAHT 2030 goals, the year has been one of ongoing transformation and positive changes. One achievement has been the development and launch of our new organisational values and This is Us behaviours plan. Using a collaborative co-design approach, our people took the opportunity to take part in the focus groups to discuss and agree the language and approach we have adopted. Our new values are: y Patient at heart y Everyday excellence y Creative collaboration This is Us is the overarching title of our
Overview
4 reportperformanceThe values and behaviours and a standard that will be used in our appraisals and events for 2022/23. We also have invested further in our range of health and wellbeing initiatives and support available to all our people. Along with counselling and support Apps, one fantastic addition has been the opening of the Alex Lounge that provides a private and comfortable space for our people to take a break, catch-up with colleagues, rest and relax. We have also opened a bespoke Learning and Education Centre at The Princess Alexandra Hospital with a wide range of tailored spaces and rooms to train people in both practical clinical skills and academic learning too. The centre only opened its doors to users in April; a bright, cheerful space that has received great feedback from users. Many of you may have spotted news about delays to our new hospital programme in the local and national press. You might have read that the new hospital will now not be completed until at least 2028. For the last couple of years, we have been working towards a new hospital opening date in early 2026. However, following the appointment of the national team overseeing the New Hospital Programme in summer 2021, completion dates have been pushed back as the national team have realised there are even greater benefits for staff and patients by joining up common aspects of all the new hospital Lookingbuilds. at a shared approach to design, the procurement of contractors, and how we can all best use modern methods of construction will mean the new hospitals can be built faster, better and more Theefficiently.national team, with whom we are working closely, are currently writing a Programme Business Case (PBC) which will go the Treasury to secure the money for the new hospitals. Once approved, we will be able to continue with the development of our own outline business case for the new Princess Alexandra Hospital. In the meantime, we continue our programme of refurbishment of our current wards to provide refreshed spaces that are lighter and brighter and better environments to work in and to care for our patients. Our digital transformation continues with a significant step forward taken this year in agreeing a business case for moving to an electronic health record system for our patients that will reduce our use of paper notes and bring together all information in one place that can be accessed by clinicians providing care to a patient. This huge commitment will take place in stages and depend on collaboration across all teams in an exciting development. We have welcomed many new people to PAHT in 2021/22 including the following new Board members: Colin McCready, a non-executive director, and Liz Baker and Dr Rob Gerlis as associate non-executive directors. Darshana Bawa has also been appointed as an associate non-executive Thankdirector.you to all our people for everything that they have achieved; for their continued hard work and commitment to delivering high quality care and for making a difference to our patients and to the people they work with. Best wishes Hattie Llewelyn-Davies Chair Lance McCarthy Chief executive
The Trust operates over forty different services to meet the needs of its patients (see service portfolio below):
reportperformanceTheDirectory of services Adult emergencyandambulatoryincorporatingservicesassessmentcaresamedaycare Endocrinology surgeryMaxillo-facial Radiology Audiology Ear, nose and throat Medical oncology medicineRespiratory Breast screening Older liaisonassessmentpeopleand Neonatal critical care - special care baby unit and communityneonatalnurses Rheumatology Breast surgery Gastroenterology Newborn screeninghearing Specialist palliative care and end of life services
the main hospital site in Harlow, and also operates outpatient and diagnostic services out of the Herts and Essex Hospital, Bishop's Stortford and St Margaret’s Hospital, Epping.
The operation of these facilities forms part of the longer term strategy of bringing services closer to where patients live and making services, where appropriate, more accessible and easily available to patients.
5 The purpose and activities of the organisation
PAHT is a 400 bedded hospital with a full range of general acute services, including; a 24/7 Accident and Emergency Department (A&E), plus an Intensive Care Unit (ICU), a Maternity Unit (MU) and a Level II Neonatal Intensive Care Unit (NICU).
The Trust serves a core population of around 350,000 and is the natural hospital of choice for people living in West Essex and East Hertfordshire. In addition to the communities of Harlow and Epping, the Trust serves the populations of Bishop’s Stortford and Saffron Walden in the North, Loughton and Waltham Abbey in the South, Great Dunmow in the East, and Hoddesdon and Broxbourne in the West. Its extended catchment incorporates a population of up to The500,000.Trustowns
6 reportperformanceThe Cardiology General medicine Neurology Speech languageandtherapy Chemotherapy General surgery Obstetrics Surgery inpatientshaematologyClinical medicineGenito-urinary Ophthalmology servicesTransfusion Clinical serviceshysteroscopyColposcopyoncologyand Geriatrics Oral surgery Tongue tie service ambulatoryGynaecologyservicesofTerminationincluding:Gynaecologypregnancyservice Oncology services Trauma orthopaedicsand Community midwifery High dependency unit ambulatoryoutpatients-Paediatricsinpatients,andcare Urology Colorectal services Intensive care unit Paediatric diabetic medicine Vascular services Day surgery preventionInfection, and control services departmentemergencyPaediatric Blood tests Directory of services - continued
reportperformanceThe 7 Dermatology radiologyInterventional End of life care Diabetic medicine bloodCellularMicrobiology,Pathology:pathology,sciences, biochemistry Mortuary servicesbereavementand Dietetics Patient appliances Patient at home, adult and paediatric Early Pregnancy Unit Pharmacy services Research developmentand TreatmentincludingdepartmentEmergencyUrgentCentre Physiotherapy and therapyoccupational Tissue viability servicesEndoscopy (anaestheticsmedicinePerioperative and ICU) Clinical DeliveryMedicalUnit Chaplaincy Outpatients comprising:Maternity y Antenatal clinics y scanningUltrasound y Labour Ward y Antenatal Ward y Postnatal Ward y Unit)AssessmentTriage(MaternityCentreAssessmentMaternityandDay y Infant supportfeeding y Birth Centre y Community midwifery services y serviceHomebirth y servicesBereavement y Fetal medicine y screeningandAntenatalnewborn y Newborn screeninghearing y servicesantenatalSpecialist Directory of services - continued
To be integrated: working as one to provide joined-up healthcare that always puts patients first. To be outstanding: delivering healthcare that our patients deserve and that makes us proud.
Our vision To be modern: always using up to date treatments, technology and facilities.
Through our work developing PAHT2030 we have identified five areas of focus that we believe will deliver our ambition to be modern, integrated and outstanding: Transforming our care
Strategic objectives
The most up to date and expert care designed to meet the individual needs of the patient, where and when they need it. Our culture Fostering and nurturing an inclusive environment that champions diversity and equality, and where our people are engaged, supported and helped to learn and grow. Digital health Harnessing new technology and digital solutions to transform patient care and improve how we work.
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Corporate transformation Modernising our corporate services to support our clinical teams in providing outstanding care. Our new hospital A world-class hospital for the future, providing first-rate care for our patients and the best place to work for our people. What this means for our patients
Our patients are at the heart of this strategy, and we will provide them with the best care and work with system partners to improve outcomes. We will provide: y Quicker diagnosis and faster access to services whoever or wherever our patients are y Innovative and responsive care in different settings, including patients’ homes, the community and our new hospital
This year, after significant consultation with our people, we saw the launch of our new strategy, PAHT2030. It sets out a challenging transition for PAHT against a backdrop of NHS and system transformation, the relentless pace of scientific, technological and clinical innovation, and our amazing opportunity to build a brandnew hospital, it is a strategy that is big, bold and ambitious.
PAHT2030 is our organisational roadmap for the next 10 years. It is designed to inspire and challenge, to guide and unite, to help us work smarter and better to achieve our vision.
Our strategic priorities
Developed with and supported by our in integrated care systems (ICS) and local One Health and Care Partnership, our new models of care have provided a foundation to design our new hospital.
This digital strategy outlines how PAHT will deliver world class care, in a paperless world supported and transformed through a digital culture that is right at our core.
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Integrated care systems
Using the New Hospital Programme as a springboard, we have developed a comprehensive digital strategy keeping us focused on our ambition of becoming the most technological and digitally enabled hospital in the UK, allowing us to transform the care we deliver and the experience of our people.
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Accessible services tailored to the needs of our population with easy access and a seamless patient experience In summary, this is an ambitious strategy which will significantly improve outcomes for our patients and the working lives of our people. We will need to work across our system if we are to be successful, harnessing the strength of local partnerships to design new care pathways and deliver the personalised care our patients deserve.
Holistic care with increased self-management and prevention support to help them remain healthier for longer and out of hospital where it is safe to do so; and
1: Our patientswe will continue to improve the quality of care, outcomes and experiences that we provide our patients, integrating care with our partners and reducing health inequity in our local population. y 1.0 COVID-19: Pressures on PAHT and the local healthcare system due to the ongoing management of COVID-19 and the consequent impact on the standard of care delivered y 1.1 Variation in outcomes resulting in an adverse impact on clinical quality, safety, patient experience and 'higher than expected' mortality y 1.2. EPR: The current EPR has limited functionality resulting in risks relating to delivery of safe and quality patient care y 1.3 Recovery programme: Risk of poor outcomes and patient harm due to long waiting times for treatment
Key risks
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During the last year, good progress has been achieved on the new Princess Alexandra Hospital, despite the ongoing pressures of COVID-19. Everything is in place to get started on the detailed design phase of our new hospital, thanks to our continued close working with local authorities, health system partners and a wide range of local stakeholder and community groups: y our demand and capacity analysis is complete and aligned to the system y our clinical model is agreed with system partners y new ways of working are already underway y 1:200s design drawings have been signed off by our clinicians y planning performance agreement is agreed with the local authority y preparation for outline planning submission is in progress y outline business case is 60% drafted y joint modelling with local stakeholders to inform the highways and transport strategy The rapid progress made in the first half of 2021 was met with a noticeable slowdown in the second half. In summer 2021, the national team overseeing the new hospital programme announced that they would be undertaking a review to ensure the benefits of operating as a national programme are maximised going forward. This review is looking at ways to ‘join up’ common aspects of the new hospitals such as room design, procurement of contractors, and making the most of modern methods of construction. The main benefit of the review is to achieve greater value for the taxpayer; enabling the new hospitals to be built faster, better and more efficiently. On completion of the review we will be able to continue with the development of our outline business case using the guidance and information from the national team about the way forward for the new Princess Alexandra Hospital.
New hospital
The Trust has a Board Assurance Framework (BAF) which provides a mechanism for the Board to monitor risks to delivery of the Trust’s strategic objectives. The highest scoring risks on the BAF throughout 2021/22 were variation in clinical outcomes, our estate and delivery of the emergency department standard. The risks are reviewed monthly and progress is monitored by the relevant board committees and Trust Board every other month. The BAF is published within the Board papers on the Trust’s website. A summary of the BAF risks is below and overleaf: Board assurance framework risks Strategic2021/22objective
y 5.1: Revenue: The Trust has established an indicative annual breakeven budget for 21/22. For the first half of the financial year (H1) income allocations were linked to System envelopes and for the second half of the year (H2) was a function of prior year spend. For 2022/23, the regime is changing once again. The Trust will continue to work with regional and national colleagues to ensure it is working through these assumptions in delivery of current year objectives.
Strategic objective 3: Our places –we will maintain the safety of and improve the quality and look of our places and will work with our partners to develop an outline business case (OBC) for a new hospital, aligned with the further development of our local Integrated Care Partnership.
Strategic objective 5: Our pounds –we will manage our pounds effectively to ensure that high quality care is provided in a financially sustainable way.
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y 3.1: Estates and infrastructure: Concerns about potential failure of the Trust's estate and infrastructure and consequences for service delivery y 3.2: Capacity and capability to deliver long term financial and clinical sustainability across the health and social care system y 3.5: There is a risk that the new hospital will not be delivered to time and within the available capital funding Strategic objective 4: Our performancewe will meet and achieve our performance targets, covering national and local operational, quality and workforce indicators.
y 2.3 Workforce: Inability to recruit, retain and engage our people.
y 4.2: Failure to achieve emergency department (ED) standard resulting in increased risks to patient safety and poor patient experience
Strategic objective 2: Our people – we will support our people to deliver high quality care within a compassionate and inclusive culture that continues to improve how we attract, recruit and retain all our people. Providing all our people with a better experience will be evidenced by improvements in our Staff Survey results.
y 5.2: Capital: In year delivery of the Trust's Capital programme within the Capital Resource Limit and ICS allocations Going concern
The Trust Board has assessed the Trust’s ability to continue for the foreseeable future in accordance with the Department of Health and Social Care (DHSC) Group Accounting Manual. Consequently, as in previous years, the Trust has prepared its 2021/22 Annual Accounts on a going concern basis. In approving the Trust's annual accounts the board of directors has satisfied itself that the Trust has prepared the accounts on the basis of going concern. The directors of the Trust have considered whether there are any local or national policy decisions that are likely to affect the continued funding and provision of services by the Trust. The Trust is a member of the Hertfordshire and West Essex Integrated Care System (ICS). The ICS has published its Strategic Delivery Plan and NHS Long Term Plan response for the five year period 2020/21 to 202425 and this plan includes the continued provision of services by the Trust. Due to the unprecedented financial regime during the COVID-19 pandemic, funding flows have fluctuated in 2020/21 and 2021/22, however net investment within the Trust has remained above historic levels. In addition, the Trust continues to develop an Outline Business Case to build a new hospital, which is being supported by a variety of stakeholders. No circumstances were identified causing the directors to doubt the continued provision of NHS Forservices.the2021/22 financial year, the Trust achieved a surplus of £1.1m against a planned surplus of £0.4m. Income from our local Clinical Commissioning Groups was largely based on the adapted finance regime introduced in response to the COVID-19 pandemic and this provided predictability and improved cash flow with the Trust finishing the year with a £51.1m cash balance. Additional costs arising from
As the Trust has been in deficit for a number of years, this had previously led to significant constraints on being able to generate sufficient internally funded capital to be able to invest in our estate and facilities. Due to the Trust having achieved surpluses in 2020/21
FinancialanalysisPerformanceperformance
As part of the national response to COVID-19, operational planning arrangements for 2021/22 were suspended. Operational planning was replaced with an ‘adapted financial regime’. As part of these arrangements, all NHS organisations were required to deliver financial balance over the financial year. This was achieved by a move away from commissioner contracts based on activity payments mechanism (payment by results) and replaced with block/fixed contract arrangements, and additional support given for COVID-19 costs and other non-recurrent, ‘winter pressures funding’. These payments, along with winter pressures income ensured the Trust delivered a financial surplus of £1.1m.
The Trust made efficiency savings of £7.1m in 2021/22, of which 91% were non recurrent. These were delivered through our Cost Improvement Programme (CIP) without impacting the quality or safety of the care we provide.
The key financial results for 2021/22 are that the Trust delivered a surplus of £1.1m. This was some £0.7m below the surplus achieved in 2020/21, however the operating environment was not comparable due to developments within the ongoing pandemic response.
Cost improvement
Operating and financial review
The Trust’s income is predominantly made up from commissioner block contracts, annualised from the second half of the year of 2021/22, uplifted for inflation and growth, with an allocation for COVID-19 support income for 2022/23 (which has reduced from prior years by c. 57%). There are additional funding streams agreed by DHSC and NHSE/I to support (predominantly) rising inflationary costs across the NHS. The financial requirement for the year will be reducing the Trust’s underlying cost base and increasing efficiencies to achieve a breakeven plan. There will be a significant focus on delivering a costimprovement programme of £11.4m in year. In 2021/22, the Trust achieved £7.1m of cost improvements, principally on a non-recurrent basis.
12 reportperformanceThe the pandemic were incorporated into a block payment for the year. For 2022/23 the current financial funding arrangements are based on a roll over of the core block from the second half of 2021/22, adjusted for the national financial arrangements which were finalised in June 2022.
Capital investment
The Trust has prepared a cash forecast modelled on the above expectations for funding during the going concern period to 30 June 2023. The cash forecast shows sufficient liquidity for the Trust to continue to operate during that period with no need to borrow any additional funding. In addition, the Trust has access to working capital arrangements in line with the national ‘reforms to the NHS cash regime (1st April 2020) should the need for this arise, noting it does not forecast any need to access this service. In conclusion, these factors, and the anticipated future provision of services in the public sector, support the Trust’s adoption of the going concern basis for the preparation of the accounts.
Key financial results The following table shows a range of financial performance values taken from the accounts. Accounts highlights £000’s2021/22 £000’s2020/21 Surplus for year 1,110 1,816 Public Dividend Capital Dividend Payable 4,770 3,034 Value of Property, Plant and Equipment 149,131 137,845 Value of (includingborrowingsloans) 10 40 Cash at 31 March 51,050 65,242 Creditors – trade and other 42,635 49,070 Debtors – trade and others 11,265 8,381 Revenue from patient care activities 335,454 267,835 Clinical negligence costs 13,867 13,010 Gross employee benefits 220,112 203,722
13 reportperformanceThe and 2021/22, this has not been the case throughout the last two years.
In 2022/23, the Trust will be eligible to receive additional funding from an ‘Elective Recovery Fund’. This fund will be available to support the Trust in performing additional activity and to assist in accelerating the restoration of activity to pre-pandemic levels but will be earned at a system level. The Trust is working with ICS partners to understand what likely impacts this may have for the Trust in the current year.
Looking forward to 2022/23, the capital allocation nationally is constrained. The Trust capital allocation is £14.4m of internally generated resources for each of the next 3 years, with additional external funding of £1.1m being available to continue the development of the new hospital programme (in the form of Public Dividend Capital). We are planning major capital investment projects which will continue to transform the care that we are able to provide, whilst maintaining the existing hospital. We will continue to seek more capital investment to provide the best possible care to our local population now and into the future working with the Herts and West Essex system.
The Trust has made capital investments of £26.0m in 2021/22. In 2021/22 our key capital projects have included y upgrades to the Trust's ICT infrastructure y a new staff lounge facility y equipment to support the NHS COVID-19 response y critical infrastructure developments y continued investment in backlog maintenance to ensure our estate is safe y the development of our New Hospital Outline Business Case
Looking ahead Looking ahead to 2022/23, the current national guidance is to continue the principles of the ‘Adapted Financial Regime’. Block contract arrangements with commissioners will continue and will be uplifted for national inflationary uplifts offset by the required efficiency requirement to achieve breakeven.
The ICS will receive additional funding allocations e.g. growth and COVID-19 which will be distributed to ICS partners.
Better practicepaymentcode
The Trust is committed to providing and maintaining an absolute standard of honesty and integrity in dealing with its assets. We are committed to the elimination of fraud, bribery and illegal acts within the Trust and ensure rigorous investigation and disciplinary or other actions as appropriate if allegations are made. The Trust utilises best practice, as recommended by NHS Counter Fraud Authority.
Full elective operating was significantly reduced on the PAH main site in late October 2021 due to the transfer of bed capacity to COVID-19 facilities. Elective operating for the most critical cases was prioritised with 6 bed capacity until February when one ward was re-opened for elective patients followed by a second in March 2022. This limited capacity, along with mutual aid support from the independent sector, local hospitals and London tertiary centres ensured that cancer and high priority elective operating continued over the winter.
Anti-fraud and bribery
performanceOperational
The Trust’s operational performance against national and local standards is monitored and reviewed at: y Regular performance review meetings between members of the executive team and each division or department y The Urgent Care Board y The System Access Board y The Cancer Board y Senior management team meetings y The Performance and Finance Committee y Trust board meetings An Integrated Performance Report is presented to the Performance and Finance Committee, Quality and Safety Committee and Trust board meetings. Externally, the Trust is held to account for its operational performance by NHS England/Improvement and its commissioners. Targets and national standards
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The code sets out the following obligations for NHS organisations in respect of the payments it makes to its suppliersprincipally: y payment terms are to be agreed with suppliers before a contract commences y payment terms are not to be varied without prior agreement with a supplier y by default, bills are to be settled within 30 days unless other terms have been agreed During the COVID-19 pandemic, and where possible and appropriate the Trust accelerated payments to suppliers recognising its responsibility to support all businesses in sustaining cash flow. As such performance in 2021/22 was an improvement on 2020/21.
The Trust continues to work to maintain an anti-fraud, bribery and corruption culture and has a range of policies and procedures to minimise risk in this area.
Delivery of all national standards has continued to be significantly impacted by ongoing waves of COVID-19 and the increased volume of emergency patients requiring care. The requirement to maintain separate urgent COVID-19 and non-COVID-19 pathways and flows through the hospital, the change of many wards to focus on emergency care and the transfer of theatre staff to critical care significantly reduced the volume of elective activity that could be delivered.
15 reportperformanceThe The 18 week referral to treatment (RTT) standard has continued to be impacted by the restricted capacity to see and treat patients over the year. The Trust continues to book patients in clinical priority order and has been successful in ensuring the highest priority patients are being booked within a month of making a decision to treat (P2s). The Trust has also reduced the number of long waiting patients with patients over 78 weeks steadily reducing over the past six months and ensured that patients waiting two years for their treatment have been treated by 31 March 2022, (with the exception of 5 patients requiring a clinical recovery period due to DeliveryCOVID-19).ofthe national cancer standards was also impacted by COVID-19, however the Trust prioritised the maintenance of cancer services by implementing new treatment pathways such as day case treatment with post-operative nursing at home, using the limited bed capacity effectively and transferring activity to other trusts. A refreshed cancer recovery plan has been implemented across all specialties and this will lead to a second reduction in long waits for cancer treatments. The Trust’s cancer performance indicated was below the national average as it was more impacted by COVID-19 than other providers that had more flexible facilities to maintain elective activity during COVID-19 waves. The Trust is committed to the delivery of all national cancer standards and plans are now in place to reduce the backlog from the COVID-19 waves in 21-22. The 28 day faster diagnosis standard will be the main focus of improvement in 22-23 as the good performance in early 21-22 deteriorated over the autumn and winter.
The ongoing waves of COVID-19 admissions and increased pressures in the wider health and social care system have exacerbated the flow of patients through the hospital and returning to home and care settings. This also then impacted the time to admission on a ward and the ambulance handover performance. The 4 hour standard to ensure patients are treated, discharged or admitted within 4 hours of arrival in the emergency department has been below the national standard for the year, however the Trust has made some improvements over the year as a result of an intensive recovery programme.
The urgent care attendances during the year have fluctuated with reduced levels in the early part of the year due to the impact of COVID-19, some of the highest daily attendances in October 2021 and sustained high attendances for the rest of the year. The separate respiratory emergency department was maintained throughout the year and in November the Trust created a separate area to house the Urgent Treatment Centre with separate waiting areas for COVID, respiratory and other attendances. All walk-in patients were streamed to the most appropriate emergency service enabling the emergency department to concentrate on the most urgent cases.
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Diagnostic performance was also impacted by COVID-19 demand as routine appointments were paused once again during 2021/22. Cancer and urgent diagnostics continued and despite considerable staff absence levels over the winter, the diagnostics department delivered additional activity to both the emergency department and cancer pathways. Diagnostic services are performing above their recovery trajectory and the Trust is delighted to report that ultrasound reported 99% against the national standard in February 2022. The Trust aims to achieve the overall national standard by August 2022. The opening of the third CT machine and the replacement of the MRI equipment at St Margaret’s Hospital will ensure resilience in diagnostic capacity into 2022/23.
Urgent care and ED performance
performanceDiagnostic
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We have continued to work with our system partners to further develop streamlined services that can be delivered in the most effective location and to prevent attendances and admissions to hospital. The Local Delivery Board has continued to forge close working relationships across organisations and enabled improved service provision such as increased intermediate care capacity, patient at home support for patients with existing care packages and sharing of staff. This collaboration has been essential to support the various services across the wider health and social care
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Thesystem.Trust has continued to focus on reducing long length of stay for patients through collaborative work with the integrated care system (ICS). The Trust has been part of a national support scheme to improve discharges from the Trust into the community or social care.
As required nationally we undertook an assessment against the NHS England emergency preparedness, resilience and response core standards for which we were able to provide full assurance to NHS England. The coming year will see us working alongside our partners and a range of other organisations, as we face the continued challenges posed by the COVID-19 pandemic, and our work to recover, identify learning, and restore our services, in a way that reflects a dramatically different way of working.
Responding in an emergency
Throughout 2021/22 the resilience team focused predominantly on supporting colleagues across the organisation with the response to the COVID-19 pandemic, along with supporting the regional team. The response to COVID-19 has not been without its challenges, however, our people have gone above and beyond to demonstrate their ability to respond to challenges in a safe, coordinated and effective manner to ensure that our patients receive the best possible care. From the end of January 2020 a full ‘command and control’ structure was implemented to ensure a robust response to what has been at times a rapidly changing situation. This structure comprised a Strategic Command Cell, with tactical cells managing operational response, clinical response, infection prevention and control, supporting our people, communications response and the management of our estate and Alonginfrastructure.withour internal work we recognise the importance of multiagency working, and continue to actively engage in the work of the local health resilience partnership, the Essex resilience forum and local organisations within our care system to provide a coordinated approach to emergency preparedness, resilience and response.
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y Evaluation of ventilation including alternative technologies, operational capacity, and prevalence of infection and new variants were monitored y Patients were not transferred unnecessarily between care areas unless there was a change in infectious status, clinical need, or availability of services y The IPC Cell met regularly all year and reviewed reports on hand hygiene, PPE donning and doffing, IPC training, and cleaning and decontamination. Compliance with National Standards of Healthcare Cleanliness were monitored y The IPC Board Assurance Framework was kept under review
y Hierarchy of IPC controls were applied in order; elimination, substitution, engineering controls, administration and personal protective equipment (PPE)/respiratory protective equipment (RPE) y FFP3 resilience continued to be developed. Competent trained IPC associates provide fit testing that is compliant with HSE guidance, and a record of the mask type is maintained
Clinical performance
The COVID-19 pandemic has continued throughout the year. Maintaining patient safety and protecting staff and service users was an ongoing process at our Trust, as well as across the NHS. Our understanding of the virus continued to develop, and a COVID-19 vaccination programme was in place in England. Organisational compliance was monitored, and we sought regular assurance that quality standards were met using surveillance, audits and feedback to our Inteams.mid-December 2021 the Omicron variant had started replacing Delta infection at PAHT. Our respiratory physicians and critical care staff noted less severe clinical illness by the end of January 2022. The UK Health Security Agency (UKHSA) advised by the end of 2021, that the NHS should plan for a response to respiratory viruses including COVID-19, Influenza and Respiratory Syncytial virus (RSV). Evidence based decision making and application of national IPC guidance continued to be central to IPC recommendations made by the PAHT IPC Cell. Robust risk assessments with clinical and workplace risk mitigation continued. Close links with our staff health and wellbeing (SHaW) team, People Cell, communications teams and operational and site teams meant that IPC messages to protect staff and patients were disseminated and shared. A variety of strategies were put in place to control COVID-19 infections at PAHT. This was supported by the Trust Board. y Point of Care (POC) testing continued to be developed throughout 2021. We have 15 functional SAMBA units and by early 2022 purchased a further 15 Abbott ID units for rapid nucleic acid detection of SARS-CoV2 in our emergency department (ED). This was to further assist patient triage and placement. Maternity and paediatric ED were also supported with POC testing y Plans were in place for managing increasing case numbers where they occurred with acceleration of coordination, monitoring, and staff resource y A respiratory winter plan was developed with segregation of cases in isolation rooms or bays y Application of COVID-19 secure workplace requirements was ongoing throughout the year. This included recommendations for universal masking, COVID-19 screening of inpatients three times a week, assessments of physical distancing, bed spacing, screens between beds, and providing FFP3 masks for aerosol generating procedures, and in other circumstances after risk assessment of personal or work environment
Infection prevention and control COVID-19:(IPC)
20 reportperformanceThe Numbers of COVID-19 positive inpatients:Inpatient spells: 01/04/2021 up to 31/03/2022 Total inpatient spells (with a positive swab) 1354 Discharged home (with a positive swab in spell) 1041 Discharged other (with a positive swab in spell) 37 Inpatient deaths (with a positive swab in spell) 136 Transferred (with a positive swab in spell) 81 The above graph shows the number of new positive inpatients by day, and also the total cumulative number of positive patients admitted. Table 2 shows numbers of nosocomial COVID-19 at PAHT, using national definitions. 01/04/21 – 31/03/22 Q1 Q2 Q3 Q4 Patients testing positive for the first time 3-7 days after admission (indeterminate cases) 6 17 26 90 Patients positive for the first time 8-14 days after admission (probable nosocomial infection) 5 6 7 53 Patients positive for the first time >15 days after admission (definite nosocomial infection) 5 3 9 63
y Staff testing protocols, implementation of a staff vaccination programme for COVID-19 and Influenza, monitoring staff illness /absence/wellbeing, supporting pregnant, other at risk and BAME staff as required (including redeployment) were all in place, supported by SHaW and our people team. y Turnaround times for PCR and POC tests, recording of data, and screening for other potential infections were all monitored y Those being discharged to a care home were tested for COVID-19 (unless they had tested positive within the previous 90 days), and results were communicated y A negative PCR and 3 days selfisolation before elective procedures remained in place y Staff were supported in adhering to IPC policies for COVID-19 and other alert organisms y Safe spaces for staff breaks, and changing facilities were provided y Procedures were in place for identification and management of outbreaks of infection y Bank, agency, and locum staff followed the same deployment advice as permanent staff y Where possible there was reduced movement of staff and the crossover of care pathways between planned care pathways and emergency care pathways y CCG, ICS and public health engagement (from the consultant and lead nurses in Public Health, Essex Health Protection Unit) with the IPC team and executive team occurred on a regular basis y Data management (COVID-19 data, mortality, and operational data), IT support and remote working continued to be facilitated y Mortality reviews of all probable and definite nosocomial COVID-19 cases took place to learn lessons and implement improvements y Isolation of immuno-compromised patients using a side room priority isolation list stratified by pathogen and infection risk was implemented where possible y Maintenance of microbiology laboratory capacity and diagnostics was ongoing including participating in the UKHSA programme to detect new variants y Arrangements for antimicrobial stewardship were maintained
Notes: y Cases are defined as ‘indeterminate’ as it is possible these are community acquired and not hospital associated cases y Sequencing results showed patients had (almost exclusively) the more transmissible Omicron variant in Q4.
21 reportperformanceThe
As a result, nosocomial infection increased significantly despite outbreak control measures y Most nosocomial cases were noted to be asymptomatic infections. An audit carried out in January 2022, showed that 42% of patients with nosocomial infection were symptomatic of COVID-19, and 58% were asymptomatic Other strategies implemented by PAHT were: y Suitable information on infections was provided to service users, their visitors and carers in a timely manner y National guidance on visiting was implemented. Visitors with respiratory symptoms were not permitted to enter a care area. Compassionate visiting (e.g. end of life) and visits from other care givers was supported.
There were three HOHA MRSA bacteraemia cases in 2021-2022 (against a trajectory of zero), and no COHA cases this year. This was an unusually high number as the Trust has previously had good MRSA bacteraemia control for many years (0-2 cases per year). Prior to the first case in May 2021, there had not been any incidences of MRSA bacteraemia in the hospital since September 2019. It has been evidenced globally that the COVID-19 pandemic has contributed to an increase in blood stream infections, not just in MRSA, but in other organisms too. An action plan was developed to undertake a review of both MRSA and MSSA bacteraemia cases and determine what measures needed to be taken to address the situation and improve. (See below under MSSA).
Table 1: C.difficile – cases by month
MRSA bacteraemia
MRSA Bacteraemia cases 2021-2022 MSSA Bacteraemia Unlike with other organisms, there is no trajectory in place for MSSA bacteraemia, however, the Trust has continued to closely monitor and review its cases. During 2021-2022, there was a significant increase in the number of MSSA bacteraemia, with a total of 15 HOHA and five COHA cases. Previously, the Trust has had very few cases of MSSA, consistently being in the regional top quarter of hospitals with the lowest rates of infection and commended for this by the Care Quality Commission (CQC).
Clostridiodes difficile (C.difficile)
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Alert organisms
A total of 34 C. difficile cases were reported during the year 2021-2022 (against a threshold of 23 cases). Of these, 17 were hospital-onset, health care associated (HOHA) detected three or more days after admission, and 17 were community-onset healthcare associated (COHA) detected in the community or within two days of admissions, when the patient had been an inpatient in the Trust in the previous four weeks. This compares with a total of 54 cases in 2020-2021, 43 of which were HOHA, and 11 were COHA. In 2021-2022, a number of measures were implemented with the aim of reducing cases of C.difficile. As a result of these actions, the Trust managed to reduce its HOHA incidence by 25 cases since 2020-2021. The number of community incidences (where patients have not been in the Trust in the preceding 12 weeks, or they have been, but not in the last four weeks preceding the C.difficile diagnosis) stayed the same as in 2020-2021. The process remained in place for undertaking root cause analysis (RCA) investigations for all cases of HOHA and COHA C.difficile. The threshold for the coming year is not yet known. Control of C.difficile will remain a top priority for our clinical teams, the IPC Committee, and the Antimicrobial Stewardship Group in 2022-2023.
23 reportperformanceThe MSSA Bacteraemia cases 2021-2022
Norovirus
There were four outbreaks of norovirus in the Trust for the latter part of 20212022. Norovirus is a common cause of diarrhoea and vomiting outbreaks in hospitals (and other close contact settings) during the winter months. Incidences have risen at this time nationally, most likely because people are now having more contact again and reducing IPC precautions in the community. Influenza and other respiratory viruses Testing for influenza A and B, and RSV has been undertaken routinely this year in the emergency department (ED) and in clinical areas, as part of COVID-19 screening. The number of influenza A cases detected was low over the majority of the year; however, numbers significantly increased in the final month of March 2022, although there was minimal impact, with no outbreaks or transmissions as a result of this. Between July and December, a significant increase of RSV cases occurred. RSV was not routinely tested for on every patient prior to the pandemic. Patients were not seriously unwell from this virus, however, the higher numbers during this period did result in challenges for side room isolation capacity. Case
Total number of cases during the year 2021– 2022
Infection incidents and outbreaks
Gram Negative Blood Stream Infections (GNBSIs)
There is a whole health-care economy ambition for reducing healthcare associated GNBSIs by 50% by 2024. Thresholds for GNBSIs were assigned to individual organisations for the first time in July 2021. The thresholds allocated to the Trust were low (the lowest in the region for Klebsiella spp. and one of the lowest for E.Coli and P. aeruginosa). Average rates for all three organisms are similar to the East of England rate per 100,000 occupied bed days, although we remain slightly higher than the region for E.coli.
Incident reporting April 2021 – March 2022
Learning from patient safety incidents
Conclusion As the year comes to an end, we continue to review lessons learned from our response to the COVID-19 virus and are following the national steer towards ‘living with COVID-19’. In addition to COVID-19, we will continue to monitor other organisms, responding to these infections and enforcing robust measures to inhibit the spread and maintain control of IPC procedures and practices.
There were 7446 patient safety incidents (61%) reported in year, which is comparable with previous reporting. Other incident reporting categories were: y 895 staffing shortage (7.5%) y 682 staff related (6%) y 572 equipment related (5%) y 530 security (4.5%) y 546 environmental (4.5%) y 70 visitor related (0.5%) The increase in reporting is mainly related to the category of monitoring, which has increased to 1366 (11% from This3.7%).is due to the Datix system also being utilised to capture information required for the monitoring of deprivation of liberty, safeguarding referrals and operational issues. This category of incidents are not patient safety incidents.
Patient safety is a priority and we continuously work to ensure that incidents are managed effectively, promptly and most importantly that we learn and share the improvements from them.
A patient safety incident or adverse incident is defined as ‘any unintended or unexpected incident which could have, or did lead to harm for one or more patients receiving NHS funded care’. This includes all terms such as adverse incidents, adverse events and near misses, where an incident was recognised and averted. For the year 1 April 2021 to 31 March 2022, 12,107 incidents were reported on the Trust’s Datix incident management system; this is an 18% increase from All2020/21.serious incidents generate a sharing the learning report which is presented locally within our divisional teams and then quarterly in various Trust meetings to widely share learning. This is also presented at the Quality and Safety Committee; a Trust Board committee.
24reportperformanceThe numbers rapidly decreased after this, and numbers remained low towards the end of 2021-2022.
The top 10 categories of patient safety incidents reported in this financial year are summarised in the graph below. These are reported to the National Reporting and Learning System (NRLS) to enable learning and comparison with similar sized organisations across the country to occur.
Serious incidents 26 serious incidents (SIs) were reported by the Trust during 1 April 2021 to 31 March 2022. reported in year
Top 10 patient safety incidents
Serious incidents
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Changes implemented as part of learning from incidents y The Trust has an overarching action plan to reduce falls and has implemented changes: o Enhanced care team in place to provide one to one care for patients who require constant supervision o All patients are assessed if they are at risk for falling, and if high risk are given a yellow blanket and a yellow wristband. This is a visual aid for staff to see clearly high-risk patients y The Trust has put measures in place to help reduce/prevent patients getting pressure ulcers in the Intensive Care Unit (ICU). All of their patients are nursed on a special pressure reducing beds from the beginning of their admission to ICU y Simplified the COVID-19 routine swabbing requirements so all wards complete swabs on every inpatients on specific days of the week to ensure a mandatory number of swabs are completed weekly y To prevent delays in ophthalmology patients receiving follow-up appointments, these are booked into a clinic rather than added to a review list for an appointment to be arranged nearer the planned timeslot y The learning disabilities team has developed a carer’s contract. This is to ensure that risks are discussed and actions put in place to mitigate the risk y Maternity has set up a formal process for the review of anomaly scans to ensure that women are on the appropriate pathway y The Gastrointestinal (GI) policy has been put in place, which includes the pathway for out of hours management for a patient experiencing a GI bleed y Paediatric emergency department reception cover extended to 24 hours a day y Increase of healthcare support workers to support the children waiting for triage by completing observations within 15 minutes of arrival y Mental health trained nurses are now part of the emergency department team
26 reportperformanceThe The learning from the health care associated COVID-19 serious incidents has been effective as the Trust has had just one case during 2021/2022, compared to 60 during 2020/2021.
The Trust reported two never events in 2021/2022. The investigation has concluded on the first incident and a robust action plan was completed. A subsequent audit to confirm embedding of these actions was completed and are assured we could not have a repeat of this incident. The second never event occurred earlier this year and the investigation remains ongoing.
Friends and Family Test (FFT)
The year in patient experience
The Trust sends out 360,000 text messages per year to gather patient experience feedback and to use that data to make improvements in care. Patients are able to provide feedback on many different aspects of care, from hospital food, to end of life care, from our leaving hospital process, to children’s emergency care, all of these services are constantly being measured and reported on so we can pay attention to not just how many people value a services, but also what we can do to change services.
We closed 2021/22 with 263 complaints received, up 28% from 2020/21 and 4236 PALS cases received (vs. 3780), an increase of 12% since 2020/21. The main complaint theme was medical care expectations and communication issues.
y One of the most effective patient experience services is the Butterfly end of life volunteers. As of April 2022, the teams have visited 4037 patients during the pandemic.
Never events
Building back… kinder Changing services to meet local needs is critical to the Trust and patient experience services have consistently been at the forefront of addressing the response to the pandemic at PAHT, here are some examples.
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y A little known service called message to a loved one delivered over two thousand messages to patients during the pandemic, including many pictures of dogs and other beloved pets y 2986 video calls have been made since the service began y One of our newest services is our partnership with ‘Pets as Therapy’, a small local charity who support hospitals to host highly trained, specially selected, infection control approved dogs to be used as surrogate pets for patients with cognitive impairment where this would provide relief from their daily struggles (pictured with the team, right) y Development of a patient experience competency using training such as “patient experience concepts” which assess and develop skills related to kindness (process) y Developing ward level dashboards with a single kindness and compassion metric in addition to standard patient experience metrics We have also developed plans to renew our patient safety, experience and quality strategy and have been taking a closer look at the issues underlying our communication challenges. We know that caregivers and relatives play a significant role in raising concerns about the quality of care and communication. Concerns regarding information given to both patients and relatives appears to be a systemic issue and in addition to this telephone contact with relatives is a significant issue. Some examples of our response to these issues are below.
We said we would use a detailed analysis of the sub themes of communications issues in complaints to develop frameworks, so we are now: y Teaching: we now have 500 learning sessions available to staff to book on to a Foundation Level Skills module led by patient experience with palliative care services y Filming: working with our Patient Panel we have developed a series explaining the complaints process but also demonstrating how communication can be effective. y Rebuilding: we are connecting patients and their families with virtual visiting, messaging services, intensive treatment unit (ITU) information films and making compassionate care a reality through our volunteers Supporting the development of patient pathways: y We are working with our Patient Panel and clinical teams to hold two conferences, one on cancer services and another on diabetes care y We have worked with the voluntary sector and vulnerable groups to hold events such as the emergency department desensitisation event for people with learning disabilities as well as other events on wayfinding, hospital orientation and maternity service improvement events Creating the first draft of an integrated patient safety, experience and quality strategy launched in March 2022 with Aidan Fowler, national director of patient safety: y Addressing harms related to communication and ensuring we develop a culture of learning and psychological safety y Assessing and mediating the impact of technology on patient experience: reduction in evidence of concerns raised as a result of implementation of new technologies y Developing a culture of kindness and compassion to our patients and people which we can measure
Hospital Standardised Mortality Ratio (HSMR)
The Summary Hospital-level Mortality Indicator (SHMI) reports on mortality at Trust level across the NHS in England using a standard and transparent methodology. It is produced and published monthly as a National Statistic by NHS Digital. The SHMI is the ratio between the actual number of patients who die following hospitalisation at the Trust and the number that would be expected to die on the basis of average England figures, given the characteristics of the patients treated at the Trust.
The Trust’s rolling HSMR reported for the last 8 months has been ‘within expected’ – a position maintained for the last 8 months. For the period December 2020 to November 2021 the Trust’s HSMR was 98.4. It is anticipated that the HSMR will continue to improve.
Mortality Mortality governance is a key priority for the Trust board. The medical director has executive responsibility for the learning from deaths agenda and a non-executive director has responsibility for oversight of Thisprogress.year we have seen a sustained improvement in our organisation’s mortality indices (HSMR, SHMI - see below). Since 2018 PAHT has been ‘above expected’ for HSMR meaning that more patients have died than would have been expected. In the last year this position has significantly improved due to the sustained success of the work of the mortality improvement programmes.
The Hospital Standardised Mortality Ratio is the ratio of observed deaths to expected deaths for a basket of 56 diagnosis groups, which represent approximately 80% of in hospital deaths.
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Summary HospitalLevel IndicatorMortality(SHMI)
PAHT has a learning from deaths programme that meets national requirements. The programme reports to the Strategic Learning from Deaths Group (SLFD) which is held monthly. A Learning from Deaths report and the minutes of the SLFD group are presented to the Quality and Safety Committee by the medical director on a monthly basis. The medical director reports on mortality to public Board on a bimonthly basis. Risks are captured on the learning from deaths risk register which is reviewed quarterly at the SLFD group. New risks are reviewed, discussed and added to the risk register as they arise.
The Care an(CQC)CommissionQualityundertookunannounced focused inspection over the summer of 2021 including a Trust wide review of Well Led. The care services inspected were: y Maternity care y Medicine (including elderly care) y Urgent and emergency care (emergency department) The CQC report was published on 17 November 2021 and the ratings assigned to the Trust by the CQC are overleaf:
29 reportperformanceThe SHMI for the period November 2020 to October 2021 is 98.4 (within expected) and has remained at this level since October 2019.
Learning from Deaths Programme
Over the past year The Princess Alexandra Hospital medical examiners service has expanded to support the roll out of medical examiner scrutiny of all community deaths. PAHT are working with West Essex general practices and St Clare’s Hospice to pilot and support the community process.
Quality improvement
Medical examiners service
30 reportperformanceThe Our overall Trust rating Our overall ratings by service
31 reportperformanceThe CQC inspection
During the 2021 inspection, the CQC identified areas where improvements were achieved, these were: y Appointed a director of midwifery to strengthen clinical leadership y Sustainability of the medical rota in midwifery had improved following the cohort of doctors that started in summer of 2021 y Urgent and emergency care service leaders had made improvements in the governance meetings y Urgent and emergency care service had a good skill mix of staff on each shift and reviewed this regularly. Consultants were supported by a team of junior doctors with the shifts overlapping at middle and foundation grades y Trust has systems and processes in place to learn from incidents, complaints and safeguarding alerts to drive improvements. Utilising peer reviews and thematic deep dives. y All staff are committed to continually learning and improving services. They are developing a better understanding of quality improvement methods and the skills to use them. The Trust is enhancing its quality improvement capacity y Despite the challenges of the pandemic, the Trust continued to engage with staff, patients and their representatives and system partners in an open and transparent manner
The concerns identified by the CQC from their inspection were: 1. The Trust must ensure there are sufficient numbers of suitably qualified, skilled, competent and experienced nursing staff at all times to meet the needs of patients in the emergency department (ED). To meet this additional condition the Trust must submit weekly information detailing the planned and actual staffing figures, including skill mix. This is broken down by doctors, nurses and healthcare assistants. 2. The Trust must ensure every patient attending the ED has an initial assessment of their condition to enable staff to identify the most clinically urgent patients and ensure they are triaged, assessed and appropriately streamlined. The Trust should submit monthly information to show the outcomes of daily audits of compliance with triage, assessing and streamlining patients.
A summary of our recent
The recommendations have been collated into individual projects and are being updated by the relevant divisional teams using our quality improvement methodology to enable a consistent and sustained approach to the achievement of these objectives. Each project has a designated executive, a senior responsible officer (SRO) and we have appointed a quality project management team to Wesupport.areusing a quality improvement plan as a dynamic document; with additional topics added over the year, as we identified areas that required further improvement.
The quality improvement plan is monitored monthly through the clinical quality improvement group that reports into the Trust compliance group and onto the Quality and Safety Committee. Following this inspection, the CQC assigned the urgent and emergency care department (emergency department) a rating of inadequate in the domains of safe and well led. They issued a Section 31 warning notice that requires weekly and monthly submission of data to them.
The CQC noted outstanding practice in relation to the Patient Panel: y The Trust’s Patient Panel was the only model of its kind regionally. The Patient Panel is a voluntary group whose main objective is to provide support for patients and their relatives/carers. The Patient Panel receive funding from the Trust to ensure that patients’ voices are heard. The panel was awarded the Queen's Award for Voluntary Service in July 2021. The report detailed 29 recommendations for the Trust: y 18 must do actions y 11 should do actions
3. The Trust must devise a process to undertake a review of current and future
32 reportperformanceThe patients’ clinical risk assessments, care planning and psychological observations to ensure the level of patients’ needs are individualised, recorded and acted upon. Monthly data should be submitted of daily audits on staff compliance with the completion of patient risk assessment and associated actions.
Quality First team
The Trust has worked closely with the Health and Safety Executive to ensure it is compliant with its statutory responsibilities. In 2021/22 a detailed audit programme was designed along with a refreshed training approach to support manual handling in workplace locations and offsite training during the pandemic. The Trust was formally inspected by the Health and Safety Executive in October 2021 and a small number of areas were identified that required improvement. The Health and Safety Committee monitors the Trust’s compliance with the regulations and areas requiring improvement.
The Quality First team define their purpose as: ‘Inspiring our people to put quality first for the benefit of our patients, staff and wider community by building confidence and capability in quality improvement.’ The past year has been a very different year for everyone, especially those working and receiving care in the NHS. The Trust’s and NHS’s necessary response to the COVID-19 pandemic has seen some quality improvement initiatives and transformation projects not progress at the pace that had been hoped for or anticipated. However, in other areas our response to the pandemic has seen some changes taking place at an enhanced pace, due to the necessity to keep patients safe. This is evidenced by the ability of our teams to introduce non face-to-face outpatient services within two weeks. Our learning from such changes has supported the ability to sustain and enhance these changes for the benefit of our patients, people, performance, places and pounds. The Quality First team responded at pace to the pandemic and implemented changes to activity. This included redeployment of staff to areas such as critical care, introduction and delivery of lateral flow tests for staff and key patient groups as well as delivery of the COVID-19 vaccination service to circa 7000 local health and social care staff.
4. The Trust must ensure that it implements an effective system with the aim of ensuring all patients who present to the ED have observations completed within 15 minutes of arrival and then appropriately thereafter in line with Trust policy. The Trust must submit monthly audit data on staff compliance with completion of patients' psychological observations and appropriate action Immediatetaken. actions were implemented following receipt of the warning notice, with further actions underway. We are confident that the actions undertaken and planned in the coming weeks will ensure we continue to improve the safety of patients in our emergency department.
Health and safety
The improvement partnership The ‘Improvement Partnership’ is our programme for enrolling, engaging, involving and developing our staff in quality improvement. The quality first team runs leading change and leading projects learning and development sessions with the objective of enabling them to deliver
The CQC may complete a further unannounced inspection of the emergency department in 2022 to monitor our progress against the action plan and we look forward to the opportunity to show them the improvements we have made.
Our people have used the CQC inspection outcomes as the foundation upon which to critically examine our services and focus on how we plan and deliver the fundamental aspects of safe care. We have taken decisive action to change everyday activities, which have led to significant improvements.
Fractured neck of femur y Improved the time it takes for this cohort of patients to be transferred from the emergency department to Tye Green through early identification of patients, availability of escalation beds and early administration of fascia iliac block
Sepsis/AKI y
Virtual fracture clinic y
33 reportperformanceThe successful quality improvement projects. When the staff member completes a quality improvement project (capturing project outcomes in a poster), they become PAHT improvement partners:
The improvement partnership is an enabler to address the leadership, culture and organisational development required to embed quality improvement at PAHT. We continue to develop our people’s quality improvement skills, knowledge and capability with a focus on leading change and leading projects. 422 members of staff have completed the Leading Change programme, with 220 completing Leading Projects. We now have 76 Improvement Partners at PAHT.
Non-invasive ventilation (NIV) y Implementation of non-invasive ventilation (NIV) on Locke Ward
A summary of highlights from the year: Learning from deaths software and mortality dashboard y Delivery of the SMART software solution for our medical examiners, patient safety and quality teams, plus other key stakeholders, enabling us to learn more effectively from deaths in hospital y The ongoing development of an automated learning from deaths dashboard with SMART software
Successful pilot undertaken in April 2021 and electronic referral processes developed Advice and guidance y Consultant Connect pilot went live on 4 October 2021 to enable GPs to contact either local clinicians or the national team for advice and guidance
PatientOutpatientsinitiated follow up (PIFU) y This pathway allows patients to determine whether their condition requires clinical intervention and allows access to a specialist when needed. In turn this reduces the number of follow up appointments needed y Following successful pilots in fracture and neurology, further specialties have gone live including orthopaedics, paediatrics and ear, nose and throat, physiotherapy, endocrinology and diabetes, gastroenterology and gynaecology
Providing ongoing training and awareness with deep dives into sepsis and acute kidney injury (AKI) deaths to identify learning needs
Improving patient outcomes
Two way messaging y Two way messaging for our patients is live in nearly all outpatient specialities
End of life y Developed a YouTube video and mandatory e-training along with ward based training
Medication to Take Away (TTAs) y Multidisciplinary workshops were held to support improvements in process mapping of TTAs Stoma e-referral form y The project team have developed and implemented an e-referral form to streamline the stoma referral process in an aim to improve our turnaround times, to reduce length of stay and the risk of hospital acquired infection
Domestics and housekeeping
Housekeeping: y Implementing a housekeeping workforce to cover 11 hours per ward 7 days a week and development of training for the new housekeeping role y Housekeeper consultation completed and in place Urgent and emergency care improvement programme y Reviewed streaming and triage processes including enhanced ambulance handover and effective use of the Clinical Decision Unit to reduce non-admitted breaches y Established a clinical navigator role These actions have impacted positively on the time from arrival in A&E to initial assessment with the most clinically vulnerable patients being prioritised.
Medicines optimisation
y In November 2021 a Multi-Agency Discharge Event (MADE) event was held across the local health economy. The aim of the event was to bring local health and care system partners together to support efforts to improve patient flow across the system and reduce acute hospital bed occupancy
STOP IT y STOPIT supports pharmacists and doctors to systematically review continuing medication in individuals who come into hospital with medicine related problems. The STOPIT process is currently embedded on Lister Ward following a successful pilot that saw a reduction in 20% of medicines, and is currently being used in the Adult Assessment Unit (AAU). The team are working with a number of areas to embed the process throughout the Trust.
Antibiotic stewardship y Development of an antibiotic dashboard that identifies antibiotic prescribing habits throughout the Trust. The dashboard is being utilised by an antibiotic review panel working with clinicians to review prescribing habits across the Trust
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Domestics: y Cleaning services now provided 11 hours per day; 7 days a week on each inpatient ward and in the emergency department there is 24 hour cover
Equipment: y Purchase of new modern equipment and implementation of a comprehensive training programme for the new equipment
Nerve centre ED module y
Streamlined methods of documenting assessments and care with a digital solution ultimately improving oversight and coordination relating to patient safety in the emergency department Strategic realisation and system partnership
The Quality First team works in partnership with PAHT’s strategy team to support the facilitation of clinical strategy workshops and the quality improvement methodology is embedded into each of specialty level strategies ensuring that our plans have clear aims, measurable deliverables and achievable actions (tests of Wechange).alsowork with system partners in the development and delivery of the system transformation plans, supporting expert oversight groups (EOGs) in the delivery of quality improvement.
The office monitoredandensuremanagementthere2021.This
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The programme management office (PMO) This function was established in October 2021. The purpose of the PMO is to ensure there is an effective framework for the management of project deliverables to ensure sustainable change is implemented and that benefits are identified, managed, monitored and ultimately realised in a timely manner. The key deliverables and functions of the PMO can be broken down into the following areas: communication, reporting, programme management, monitoring, provision of tools and guidance, governance arrangements, risk management, challenge and support, facilitation, gateways, and delivery framework.
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In 2021/22, our people continued to face a number of ongoing challenges in response to the COVID-19 pandemic. Our staff rose to the challenge of working in different ways, different services and in some cases, different roles to support the needs of the services and keep our patients safe. During this time, the Trust continued to recruit substantively throughout the year, ending the year with a final vacancy position of 6.5%.
The last year has continued to pose challenges, however we have delivered on a number of key objectives to continue to create a place of work that our people feel is a joy to work at and where our patients feel safe and well cared for. Our NHS people plan focus is: y Looking after our people – with quality health and wellbeing support for everyone y Belonging in the NHS – with a particular focus on tackling the discrimination that some staff face y New ways of working and delivering care – making effective use of the full range of our people’s skills and experience y Growing for the future – how we recruit and keep our people, and welcome back colleagues who want to return Culture, health and wellbeing
The five key pillars of the people strategy are: y Culture, health and wellbeing y Workforce resourcing and planning y Learning, leadership and team development y New service and workforce models y Optimising technology
The key workforce indicators for the year are reflected in the table below: People KPI 2021/22 target Year to performancedate Vacancy rate 8.6% 6.5% Sickness absence 4.3% 3.9% Voluntary turnover 10.7% 15% Statutory and mandatory 92% 87% Appraisal 89% 79% Time to hire 42 days Average 48 days
Whilst we have seen an increase in our turnover, this is a challenge that has been faced by many Trusts following the previous two years. A number of retention interventions have been put in place and are being developed, these include the launch of a recruitment and retention steering group, learning steering group and health and wellbeing steering group, all attended by different divisions and staff groups.
Following an engagement programme across the organisation, the Trust launched its new values in September 2021. These are: y Patient at heart y Everyday excellence y Creative collaboration The values were launched at the annual three day ‘Event in a Tent’ which took place in September 2021. Event in a Tent saw the annual staff awards (Our Amazing People Awards) including Long Service Awards, the Annual General Meeting
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People performance
training
37reportperformanceThe and Trust wide quiz event. The event also featured a number of key speakers delivering sessions on topics including health and wellbeing and equality, diversity and inclusion. The Trust’s values and behaviours framework, This is Us, was also launched at Event in a Tent and a series of workshops were delivered and will continue over the next year embedding this framework. These workshops included an overview of This is Us, and how managers and staff could start to embed our new values and behaviours within their teams. Culture huddles were introduced into divisions to give space to talk about culture and gain a shared understanding of important matters affecting how we work together. One of the key priorities during 2021/22 was to continue to embed a sustainable health and wellbeing offer to our staff in response to the impact of COVID-19 and the ongoing challenges that have been Infaced.May 2021 a health and wellbeing steering group was established with the purpose of co-ordinating health and wellbeing activities in the Trust. During the last 10 months the group have introduced many initiatives including a menopause policy and support App and health and wellbeing champions are in place across the Theorganisation.AlexLounge (pictured below) is a staff only area providing a restful environment with free hot drinks and chilled, filtered water for our people. This area was designed and agreed with our people through the health and wellbeing steering group and opened in March 2022.
y We continued to welcome international staff into the Trust, facilitating the required isolation period with designated hospital accommodation. The nursing and midwifery staff group now has a vacancy rate of 5.7% and medical staff vacancy rate of 1%. The overall Trust vacancy rate is less than 6.5%
Project Wingman, resourced by volunteer pilots and cabin crew who were grounded at the time of the pandemic returned to the Trust in October 2021, this time with a self-contained bus providing a break out area for staff. All volunteers were mental health first aiders and provided support to our Thepeople.winterflu campaign saw 53% of all staff vaccinated (61% for staff that have patient contact), this is a decrease on 2020/21 figures, however this is consistent with low uptake for NHS staff Asnationally.partof the Hertfordshire and West Essex ICS, new services have been cocreated with the staff health and wellbeing team and implemented to provide additional support to our PAHT people; this work will continue in 2022/23. The COVID-19 booster programme was led by the occupational health department with the support of the quality first team. The third vaccination dose programme commenced in October 2021. In December 2021, the Trust supported the national booster vaccination drive and coordinated the redeployment of PAHT staff to the community provider in Harlow.
y We also continue to work with ICS colleagues on alternative ways of retaining staff within the ICS and are piloting rotational allied health professional posts across acute, mental health and community organisations
The Trust continues to implement agile working across the organisation and has developed more agile working spaces both on site and at Kao Park. The allocation of laptops and digital telephone systems across the Trust has supported the ability for more staff to work in an agile way and has enabled greater productivity efficiencies though re-evaluation of current processes and systems and has enabled specific objectives and targets to be set and measured more efficiently.
As part of the national support for mental health, a psychological health support service called Here for you was established within the Hertfordshire and West Essex ICS. This is a mental health and wellbeing service available to any Essex or Hertfordshire health and social care worker struggling with the direct or indirect impact of the COVID-19 pandemic and wider psychological support requirements. Established in April 2021, it has supported one to one referrals and onward support with primary care, group reflective sessions and webinars on wide ranging topics linked to mental health. This service has been well received by PAHT staff and the Here for you team are allocated to the Trust two days per week.
As part of the Trust’s commitment to support our people we have continued to invest in training for mental health first aiders and now have a multi-disciplinary team to support our people. A five day week first line absence reporting service was re-established within the staff health and wellbeing team in December 2021 during another peak of the pandemic to provide advice and guidance to staff and managers.
y The recruitment and retention steering group launched in 2022 and offers guidance, direction and support to areas with high vacancy or high turnover; ensuring that we implement effective methods and techniques to improve attraction and retention
reportperformanceThe
Workforce, resourcing and planning
y A change in our approach to recruiting healthcare support workers saw 70 recruited in 2021/22, bringing the current vacancy rate to 8.72%. Further collaborative work with the ICS is being undertaken to recruit into this staff group 38
y
y Corporate induction and managers induction programmes continued to run with sessions being delivered virtually via MS teams
Optimising technology
A number of leadership programmes are currently in development, aimed at different staff groups and bands. This includes implementation of a refreshed on boarding programme which will utilise a holistic and comprehensive approach that starts at the point of the offer letter and continues through the first six months of employment, embedding the Trust values and behaviour charter throughout the on boarding period.
y The Trust has continued to support NHS management graduates placed within the organisation and will continue to do this over the next 12 months y The Trust has 76 apprentices, this includes five 4-year degree nursing apprentices y The ICS Mary Seacole programme has continued throughout the year with 16 of our people currently in different stages of the programme
Learning, leadership and team development
y Quarter 4 of 2021/22 saw a roll out of training to support our divisions with manager self-service. Manager selfservice allows managers to complete pay and contractual changes online and supports a move away from paper forms
39
reportperformanceThe
The digital agenda continues to be a priority within the people division. The staff health and wellbeing service (SHaW) implemented a new occupational health system in 2021 that provides a seamless online referral process, negating the need for paper forms. This system also provides a text messaging service y We have continued to optimise Healthroster across the organisation within our medical staffing areas and will continue this over the next 12 months
40
There were 13 portfolio studies and studies open throughout 2021/22.
76 non-commercial
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Research, development and innovation
commercial
41reportperformanceThe Recruitment per speciality Recruitment Speciality Directorate CommercialCommercial/Non 4 Respiratory Medicine portfolioNon-commercial 1 Cancer Clinical servicessupport portfolioCommercial 26 Cancer Clinical servicessupport portfolioNon-commercial 39 Ophthalmology Surgery portfolioNon-commercial 21 Maternity Family women'sanddivision portfolioNon-commercial 14 Diabetes Medicine portfolioNon-commercial 120 Gastroenterology Surgery portfolioNon-commercial 26 Infection Clinical servicessupport portfolioCommercial 311 Infection Clinical servicessupport portfolioNon-commercial 45 T&O Surgery portfolioNon-commercial 65 Critical care Surgery portfolioNon-commercial 68 R&D Corporate portfolioCommercial 99 Emergency Urgent emergencyand care portfolioNon-commercial 110 Nursing and quality Corporate portfolioNon-commercial 3 Rheumatology Medicine portfolioNon-commercial 23 Anaesthetics Surgery portfolioNon-commercial Portfolio activity
Our huge capital programme this year was circa £18m, this included a £4.2m investment in backlog maintenance and £14m continued investment in our patients and people. Investing in places for our patients Our patients have benefited from the following completed schemes: y Penn Ward, Saunders Ward and Winter Ward have undergone major refurbishments, allowing us to better support patient care, experience and treatment y We have made huge improvements to our Adult Assessment Unit, building a new two-storey centre that increases patient capacity as well as improves flow and care pathways y Our Labour Ward has been refurbished. The unit has had upgrades on the birthing rooms and corridor, enhancing the patient experience of our pregnant women or birthing people y Our Endoscopy Unit has been upgraded to support patient experience, care and capacity. A third endoscopy suite was opened (pictured overleaf) “I would like to say a huge thank you for the care I received when I was admitted to the Adult Assessment Unit (AAU) from A&E. All of the staff that I had any dealings with were absolutely fantastic. There is not one person that I came into contact with that was not helpful. I really can’t thank you all enough.”
Patient feedback
42reportperformanceThe
To be a modern, integrated and outstanding hospital, our estate requires significant ongoing investment to enable us to provide the best services possible. During the last year the Trust invested in the estate, transforming a number of key sites that have since brought significant improvements to our operations. This is not just about investing in spaces and places, it is about investing in our people and our patients: listening to their needs, understanding what we can do better to provide and maintain the very best environment to deliver and receive care. We have a responsibility to invest to improve the health of the planet too, and during the last year we have introduced a number of initiatives to reduce our environmental impact in line with wider NHS green targets. Investment summary In 2021/22, we remodelled and maintained our estate to improve the experience for everyone in our hospital by: y improving the management of buildings and engineering systems y providing excellent and sustainable facilities y ensuring safety and security at all times
Improving our estate
43reportperformanceThe Endoscopy Unit - before Endoscopy Unit - after y We have invested in a new CT scanner, supporting the treatment of our patients coming through our emergency department CT scanner - before
44reportperformanceThe CT scanner - after y Our children’s ward (Dolphin Ward) has been completely refurbished, to the benefit of our patients, our people and visitors. Clinical bays have been upgraded and the outside terrace has been refurbished, providing a friendly, safe and inviting environment for our paediatric patients y The Frailty and Short Stay Assessment (OPAL Unit) has been refurbished, enhancing patient experience, care, flow and capacity OPAL Unit - before OPAL Unit - after
Our amazing people have benefited from the following completed schemes designed to support their welfare and wellbeing: y We have created the new Alex Lounge and Agile working space; a space that offers our people a calm space to relax as well as a modern, fresh and welcoming place to work (pictured overleaf)
45
The
y
Investing in places for our people
The Williams Day Unit - before Williams Day Unit - after
reportperformanceThe The mortuary department expansion and refurbishment has been completed, enhancing and supporting the dignity of our patients Our end of life facility, the Butterfly Unit has been refurbished, to continue to support patients, visitors and relatives with dignity and sensitivity Our cancer services have been upgraded with the Williams Day Unit expansion. The unit was completely refurbished, supporting patient care and enhancing capacity with the expansion in clinical space
y
y
Testimonials from our people Alex Lounge - after
46 The Alex Lounge - before The
“The space is lovely and open, well-lit and comfortable. We have very limited space to relax up on the wards and in our departments. This is a great space for all staff.”
“It’s really bright, airy and spacious. It’s very inviting and at the same time, it's calm. The colours are lovely and calming, with private spaces where you can get away and catch up with colleagues and friends.”
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reportperformanceThe 47 y Our clinical agile working space has been developed to allow our clinical teams a comfortable and inviting space to work from y The brand new Learning and Education Centre has been built to support the professional development of our people from all disciplines. The Learning and Education Centre offers modern training facilities, as well learning and study spaces, library and staff workspace The Learning and Education “ACentrefantastic, modern space which offers a vibrant environment for staff development, engagement and learning – a real opportunity for the Trust to develop itsTestimonialpeople."
reportperformanceThe 48 In addition to these flagship spaces, in 2021/22 we completed a large number of projects to manage maintenance backlog and critical infrastructural risks. These include: y Replacement of obsolete electrical switchgears across the organisation y New medical records build y Cardiology common areas upgrade with new seminar room y New laundry facility and storage supporting our domestics services team y Electrical infrastructural upgrade including installation of new electrical substation y Upgrade of plant rooms to include pumps; tank room floors; replacement of existing pipework; removal of redundant equipment and sealing plant room y Wireless nurse call system replacement y External security door sets y Urgent repair works have taken place on flat rooves across the Trust y Insulation of ventilation ductwork in theatres y Fire compartmentation works to main theatres and Dolphin Ward y Fabric upgrade of staff and seminar room to our Intensive Care Unit y Remedial works to ventilation systems site wide supporting patient, visitor and staff safety y Statutory asbestos - various remedial works have taken place site wide Investing in projects for a healthier planet Climate change poses a major threat to health. Tackling it will improve health and save lives. In the UK alone, air pollution is the single greatest environmental threat to human health. Reducing emissions means healthier lives, and so the NHS has committed to reaching net-zero carbon emissions by 2040. Before November’s COP26 summit, the UK government announced it will set the world’s most ambitious climate change target into law to reduce emissions by 78% by 2035 from 1990 baseline levels. In line with this, the NHS has set the following targets: y For the emissions we control directly (the NHS Carbon Footprint), we will reach net zero by 2040, with an ambition to reach an 80% reduction by 2028 to 2032 y For the emissions we can influence (our NHS Carbon Footprint Plus), we will reach net zero by 2045, with an ambition to reach an 80% reduction by 2036 to 2039
During the year, we undertook a sustainability assessment exercise with the support of a sustainability consultancy, to establish our carbon footprint for the 2021/22 financial year. Our carbon footprint as shown below is 22,000 tCO2e (equivalent of 22,000 units of hot air balloon). This will enable us to determine our trajectory and set our targets to achieve net zero by 2045.
Becoming a greener
To comply with our NHS Standard Contract requirement, we are well underway in the delivery of our three-year green plan. The plan has a number of bold initiatives to improve our sustainability and meet our statutory obligations.
BaseliningPAHT
The savings derived from the avoided costs are the comparison of recent available gas and electricity prices in comparison to those which were attained by the Trust through early hedging of our 3-year flexible supply contract.
Green Plan submission to the Integrated Care System (ICS) board We developed and submitted our Trust Board approved 3-year green plan to the integrated care system (ICS) board for compilation and onward submission to our regulators, NHS England (NHSE/I).
Waste Re-usemanagementscheme
Energy Energy markets have reached unprecedented highs due to both the impacts of recovery from COVID-19 and geopolitical/economic influencers causing demand to outstrip supply.
The Trust’s electricity supply is now 100% from renewable sources and Renewable Energy Guarantee Origin scheme (REGOS) certified. This is a great achievement for the organisation.
On-site energy generation From the Solar Photovoltaic (Solar PV) system installed on site we have generated a total of 547,484 kWh power leading to avoidance of 276 tonnes of CO2 emissions. This total energy generated is enough to boil water for 27,347,200 cups of tea.
reportperformanceThe 49
Energy carbon footprint
Re-use of walking aids: returned walking aids were taken through appropriate processes to ensure they can be reused by other patients thereby avoiding sending them to landfills. The Trust has re-used the following in this scheme: y 165 crutches returned – 139 recycled y 80 rollator walkers returned – 70 recycled y 1 gutter frame returned – 1 recycled y 4 walking frames returned – 4 recycled
Energy contract
The Trust completed a list of capital projects to enhance patient service provision and staff wellbeing. This led to an increase in the Trust’s square footage/ footprint. As a result, the expected reduction in carbon footprint following the installation of LED lighting across the site cannot be established without sophisticated carbon footprint calculation However,technics. despite the increase in square footage there is minimal increase in energy related carbon footprint in 2021/22 as demonstrated in the table below:
The green plan sets out our vision, strategy and objectives for delivering sustainable healthcare whilst considering our social and environmental impacts.
Waste recycling
Waste compliance and behavioural change We have started our waste compliance, audit and awareness programme with a specialist waste compliance partner. The programme will enhance our waste segregation at source and recycling agenda, as well as fulfil the waste training requirement for our domestic, portering and clinical staff. A recycling compactor has been installed on site and a bottle bank and clothing bank will be installed in 2022/23 for collection of the segregated waste to avoid sending waste to landfill.
The green zone project was successfully completed in June 2021, the outputs were well received by our people and it demonstrates the Trust’s commitment to reducing its carbon footprint whilst supporting staff welfare. The project deliverables are electric vehicle charging points, the cyclist changing facilities, cycle storage facilities and improved landscape/green outdoor Followingarea. the completion of the project, we have seen an increase in the number of electric vehicles owned by staff and establishment of a cyclist group that regularly uses the on-site cycling facilities.
Travel and transport Green zone project – electric vehicle charging points and cyclist facilities
Green zone - before Green zone - after
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The Trust recycled 148.65 tonnes (27%) of the total general/domestic waste it generated. In total 96% of all waste generated by the Trust does not go to landfill, it is incinerated for Energy Derived Fuel (EDF) where it cannot be recycled.
Fleet vehicles We are currently carrying out market research to enable converting our current fleet vehicles to electric. This will include the medical records delivery vans, estate vans, patient at home and the community midwives’ cars. Changing to electric vehicles will reduce both running costs and our carbon footprint. Green travel plan (GTP) To encourage sustainable and active travel to and from the hospital sites where possible and to reduce the carbon and air quality impacts of our organisation, we are developing a green travel plan for the existing hospital site. The GTP will review the car parking facilities amongst other aspects to support modal shift to active travel to/from site and to reduce our travel carbon footprint.
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We have switched all our restaurant single use plastic items to disposable alternatives such as wooden cutlery, paper cups and biodegradable ‘vegware’
51
Restaurant single use plastic
Lance McCarthy Chief executive
soup pots. We no longer give out straws and have changed our patient single use plastic tumblerssipping cups to reusable washable plastic cups. We will continue to work within our integrated care system (ICS) to implement our green plan and contribute to the NHSE/I goal to achieve net zero by 2045. Conclusion We have made significant investments in our estate this year and we will continue to ensure we maintain and develop the site to meet the needs of our patients and our people as we prepare for the new hospital and a net zero carbon future. This is, of course, a balancing act, working with the ICS and Trust leadership to allocate capital where needed to have the greatest impact. Our teams will continue to work tirelessly to ensure we have an as modern, integrated and outstanding physical environment as possible.
52reportaccountabilityThe Name Position Voting From To Executive directors McCarthyLance Chief executive officer Y 03.05.17 Current McNallySharon Director of nursing, midwifery and allied health professionals and deputy chief executive Y 01.10.18 Current LawtonStephanie Chief operating officer Y 02.03.16 Current Fay Gilder Medical director Y 01.11.20 Current Saba Sadiq Director of finance Y 14.12.20 02.05.22 James McLeish Director of improvementquality N 01.04.16 Current Michael Meredith Director of strategy N 04.06.18 Current Ogechi Emeadi Director of communicationsdevelopmentorganisationalpeople,and N 01.08.18 Current Phil Holland Chief information officer N 01.02.21 Current The Accountability Report Corporate2021/22governance report Our Trust Board The Trust Board meets bi-monthly in public. The times and venues are advertised on the hospital’s website (www.pah.nhs.uk) and board papers are published ahead of each meeting. The role of the Trust Board is to determine strategy and policy for the Trust, to monitor in-year performance against its plans and ensure the Trust is well governed. The Trust Board formally operates in accordance with its governance manual comprising the standing orders, standing financial instructions and scheme of delegation.
53reportaccountabilityThe Name Position Voting From To Non-executive directors DaviesLlewelyn-Hattie Trust chair Y 13.09.21 12.09.25 Steve Clarke Chairman Y 03.12.18 01.07.21 Helen Glenister Non-executive director and vice chair (chair of Quality and Safety Committee from 01.01.20) Y 01.04.18 31.03.23 George Wood Senior independent director (chair of Committee)Audit Y 01.07.19 30.06.22 Pam Court Non-executive director (chair of PAF from 01.01.20 – 31.12.21) Y 28.09.15 31.12.21 John Hogan Non-executive director (chair of 24.01.22)CommitteeTransformationStrategicfrom Y 01.08.17 03.07.23 Helen Howe Non-executive director (chair of 01.04.20)CommitteeWorkforcefrom Y 11.06.18 31.03.23 John Keddie Associate nonexecutive director (chair of Charitable Funds Committee from 01.01.20) N 01.07.19 30.06.22 Darrel Arjoon NExT NED N 04.01.21 03.06.21 BawaDarshana NExT AssociateNEDNED NN 01.02.2211.01.21 31.03.2331.01.22 Anne WafulaStrike Associate NED N 15.02.21 14.02.23 McCreadyColin Non-executive director (chair of PAF from 31.03.22) Y 01.02.22 31.01.25 Elizabeth Baker Associate nonexecutive director N 01.02.22 31.07.22
The Trust board has established the following committees to discharge its responsibilities on Board assurance: Audit Committee
performance and monitor achievement of national and local targets and recommend any re-basing or reforecasting of operational and financial performance trajectories to the board y Assure the board of directors that the Trust has robust processes in place to prioritise its finance and resources and make decisions about their deployment to ensure that they best meet patients’ needs, deliver best value for money and are efficient, economical, effective and affordable y Recommend the Trust’s cost improvement programme to the board and monitor its delivery including investigating reasons for variance from plan and recommend any re-basing or re-forecasting of the plan to the board y Monitor the management of the Trust’s asset base and the implementation of the Trust’s enabling strategies in support of the Trust ’s clinical strategy and clinical priorities y Review and monitor the management of finance, performance and contracting risks
The Audit Committee provides the board of directors with an independent and objective review of financial and corporate governance, assurance processes and risk management across the whole of the Trust’s activities (clinical and nonclinical) both generally and in support of the annual governance statement. In addition it oversees the work programmes for external and internal audit and receives assurance of their independence, monitoring the Trust’s arrangements for corporate governance.
The Remuneration and Nominations Committee determines the remuneration and terms of service of the Trust’s directors and senior managers; it also considers the overall skill mix and balance of the board of directors.
The purpose of the Performance and Finance Committee is: y Consider, challenge and recommend the Trust’s operating plan to the Board y Scrutinise operational and financial
Number of board members present at board meetings in 2021-22: Committees
The Quality and Safety Committee (QSC) functions as the Trust’s umbrella clinical governance committee. It enables the Trust board to obtain assurance that high standards of care are provided by the Trust and that adequate and appropriate governance structures, processes and
Attendance at board meetings
54
Remuneration and Nominations Committee
In terms of Board attendance please note the following: y Attendance for the year includes one Board Observer (GP – West Essex CCG) y Attendance for April/May includes two NExT NEDs until June 2021 when one NExT NED stepped down y The August/September meetings were chaired by the Trust ’s vice chair pending appointment of the new Trust chair y One NED left the Trust in December 2021 y Two new NEDs were appointed from February 2022
Performance and Finance Committee
SocialAllqualityaccordingtocontrols Workforce whichisandTois:The y y y
reportaccountabilityThe
Quality and Safety Committee
The PAHT New Hospital Committee is established under delegated authority from the Trust Board to oversee the strategic direction and progress of the new build and provide a forum to monitor progress of the new hospital programme, including mitigation of risks and management of financial elements. This committee was disestablished in 2021 and its remit was included in a newly established committee; the Strategic Transformation Committee.
The Charitable Funds Committee was established by the Trust Board to make and monitor arrangements for the control and management of the Trust’s charitable funds.
New Hospital Committee
Charitable Funds Committee
55reportaccountabilityThe controls are in place throughout the Trust to enable it to deliver a quality service according to each of the dimensions of quality set out in High Quality Care for All and enshrined through the Health and Social Care Act 2012.
Strategic CommitteeTransformation
The purpose of the Workforce Committee Tois: maintain oversight of the development and design of the workforce and ensure it is aligned with the strategic context within which the Trust is required to operate y Assure the Trust Board on all aspects of workforce and organisational development and provide leadership and oversight for the Trust on workforce issues that support delivery of the Trust’s annual objectives y Assure the Trust Board that the Trust has adequate staff with the necessary skills and competencies to meet both the current and future needs of the Trust and ensure delivery of efficient services to patients and service users y Assure the Trust Board that legal and regulatory requirements relating to workforce are met
The Strategic Transformation Committee (“the Committee”) is responsible for overseeing the delivery of the Trust’s strategy (PAHT2030) and transformation Theprogrammes.Committee will monitor the external strategic environment and developments across the integrated care system (ICS).
Workforce Committee
56reportaccountabilityThe Statement of board members' interests 2021-22 Name Title declaredInterests/memberships Hattie Llewelyn-Davis Trust chair y Chair, (untilHealthcareBuckinghamshireNHSTrustJanuary2022) y Board Member NHS Providers and Board Member of Trading Subsidiary y Chair, CommunityEastlightHomes y Minority shareholder in TIAA Pam Court Non-executive director y Chief executive officer of Saint Francis Hospice Helen Glenister Non-executive director y Chair of Accelerate CIC Limited y Chief executive of Isabel Hospice y Chair of Saffron Walden Orchestral Society Helen Howe Non-executive director y Trustee CharitableAddenbrooke’sofTrust y Trustee of Abington Institute y Honorary Englandfunded)advisoryregistrationofpharmacy/chairmanprofessorpharmacypre-traininggroup(HEEforEastof y Member grouppharmacyundergraduateUEAadvisory y Chair of governors at Great Abington Primary School John Hogan Non-executive director y Trustee of Charity, Whitefield DevelopmentAcademyTrust
57reportaccountabilityThe Name Title declaredInterests/memberships George Wood Non-executive director y Chairman of the King George's Hospital Charity y Associate NonExecutive Director BHRUT John Keddie Associate non-executive director y Governor, Anglia Ruskin University y Trustee, Anglia Trust y Chair, Harlow Growth Board y Chair, Discover Harlow Board y Deputy Chair, London Stansted ConsortiumCambridge y Chair, ARU Direct Ltd Colin McCready Non-executive director y Chief financial officer, NHS Supply Chain Darshana Bawa Associate non-executive director y Finance director for Micro Scooter Ltd y Company secretary at Kit Imports Ltd y Director and company secretary for Annandale InvestmentsPropertyLtd Anne Wafula-Strike Associate non-executive director y Founder of OlympiaWafula Foundation y Non-executive director for UK Athletics and England Athletics y Non-executive director for British AssociationParalympic y Non-executive director for Dimensions UK y Non-executive Director for Active Essex y Trustee, ChaplaincySportsUK Elizabeth Baker Associate non-executive director y No interests declared
Name Title declaredInterests/memberships
Each director knows of no information which would be relevant to the auditors for the purposes of their audit report, and of which the auditors are not aware, and; has taken “all the steps that he or she ought to have taken” to make himself/ herself aware of any such information and to establish that the auditors are aware of it.
Michael Meredith Director of strategy and estates y No interests declared Sharon McNally Director of nursing, midwifery and allied health professionals and deputy chief executive y No interests declared
The statement of accounting officer’s responsibilities
The full statement of directors' responsibilities is included in the financial statements.
The chief executive of NHS Improvement, in exercise of powers conferred on the NHS Trust Development Authority, has designated that the chief executive should be the accountable officer of the Trust. The relevant responsibilities of accountable officers are set out in the NHS Trust Accountable Officer Memorandum. These include ensuring that: y there are effective management systems in place to safeguard public funds and assets and assist in the implementation of corporate
Statement of responsibilitiesdirectors'
Lance McCarthy Chief executive officer y No interests declared Saba Sadiq Finance director y No interests declared Ogechi Emeadi Director of communicationsdevelopmentorganisationalpeople,and y No interests declared
Stephanie Lawton Chief operating officer y No interests declared James McLeish Director of improvementquality y Spouse is a clinical specialist paramedic for Isabel HertfordshireHospice y Daughter is student nurse, Anglia Ruskin University
Phil Holland Chief information officer y No interests declared
Fay Gilder Medical director y Director, Gilder Medical Ltd
58reportaccountabilityThe
59reportaccountabilityThe governance y value for money is achieved from the resources available to the Trust y the expenditure and income of the Trust has been applied to the purposes intended by Parliament and conform to the authorities which govern them y effective and sound financial management systems are in place and y annual statutory accounts are prepared in a format directed by the Secretary of State 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, other items of comprehensive income and cash flows for the year
Scope of responsibility
Delivering high quality, timely and cost effective care to our local community are core components of our strategic objectives, and the ICS and ICP both give clear clinically led focus on improving standards, financial stability and adapting services to a growing and changing community across West Essex and Hertfordshire. The Trust has received from the External Auditors an unqualified opinion on its financial statements in that the accounts present a true and fair view on the Trust’s financial position for the 2021/22 financial year. The key financial results for 2021/22 are that the Trust delivered a surplus of £1,110k. This was some £0.7m below the surplus achieved in 2020/21 however the operating environment was not comparable due to developments with the ongoing pandemic response.
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. Lance McCarthy Chief executive 31 May 2022 The StatementAnnualAlexandraPrincessHospitalGovernance2021/22
My Annual Governance Statement (AGS) has been written describing the governance arrangements in place at the Trust during 2021/22. During the year, we continued to review and strengthen our governance arrangements and took into account the findings of our CQC inspections together with continuing feedback and support from NHS England and Improvement. At the same time, we have taken a full and active role within the Hertfordshire and West Essex Integrated Care System (ICS) and the West Essex Integrated Care Partnership system (ICP).
As accountable officer, I have responsibility for maintaining a sound system of internal control that supports the achievement of the NHS Trust’s policies, aims and objectives, whilst safeguarding the public funds and departmental assets for which I am personally responsible, in accordance with the responsibilities assigned to me. I am also responsible for ensuring that the NHS Trust is administered prudently and economically and that resources are applied efficiently and effectively. I also acknowledge my responsibilities as set out in the NHS Trust Accountable Officer Memorandum. The purpose of the system of internal control The system of internal control is designed to manage risk to a reasonable
As far as I am aware, there is no relevant audit information of which the Trust’s auditors are unaware, and I have taken all the steps that I ought to have taken to make myself aware of any relevant audit information and to establish that the entity’s auditors are aware of that information.
Theofficerfollowing non-executive director appointments were made in the year: y Hattie Llewelyn-Davies was appointed as the trust chair on 13 September 2021, replacing Steve Clarke, the previous trust chair who stepped down on 1 July 2021. From 2 July 2021 until 12 September 2021, Helen Glenister, one of the non-executive directors, was the acting chair for the Trust y Darshana Bawa was appointed as an associate non-executive director on 1 February 2022; this followed her twelve month placement with the Trust as a NExT non-executive director y In December 2021, non-executive director Pam Court’s term ended, and following a recruitment campaign, Colin McCready was appointed as a nonexecutive director on 1 February 2022. Elizabeth Baker was also appointed as an associate non-executive director on 1 February 2022 No new executive appointments were made in the year 2021/22. Attendance at Board and committee meetings throughout 2021/22 has been monitored and is recorded in the Annual TheReport.Trust Board has established the following committees to discharge its responsibilities in relation to Board assurance: y Audit Committee y Quality and Safety Committee y Performance and Finance Committee y Workforce Committee y New Hospital (disestablishedCommitteeinDecember 2021) y Strategic Transformation Committee (established in January 2022) y Remuneration and Nominations Committee
60reportaccountabilityThe level rather than to eliminate all risk of failure to achieve policies, aims and objectives; it can therefore only provide reasonable and not absolute assurance of effectiveness. The system of internal control is based on an ongoing process designed to identify and prioritise the risks to the achievement of the policies, aims and objectives of The Princess Alexandra Hospital NHS Trust, to evaluate the likelihood of those risks being realised and the impact should they be realised, and to manage them efficiently, effectively and economically. The system of internal control has been in place in The Princess Alexandra Hospital NHS Trust for the year ended 31 March 2022 and up to the date of approval of the annual report and accounts. The governance framework of the organisation The governance framework describes the structure and systems that are in place for the direction and control of the Trust to fulfil the functions as set out in the Statutory Instrument 1994 No. 3179. These mechanisms include the Board, its Committees, management arrangements, Governance Manual and Risk Management Strategy. The Trust Board is responsible for making sure we provide safe, effective and compassionate care to our patients at the same time as supporting their families, relatives and carers. It does this by making the key decisions that affect our hospital and setting the values, aims and strategic direction for the Trust. It also reviews performance against our objectives, as well as against national standards and targets. It has overall responsibility for the effective control of the Trust and is accountable, through its Chairman, to NHS Improvement and the Secretary of State for Health and Social Care. The Trust Board consists of: y a chairman y five voting non-executive directors and four non-voting associate non-executive directors y five voting executive directors (chief executive officer, finance director, medical director, chief operating officer and director of nursing, midwifery and allied health professionals) and four further executive directors without voting rights; the director of people, organisational development and communications, the director of strategy and estates, the director of quality improvement and the chief information
61reportaccountabilityThe
The director of nursing, midwifery and allied health professionals has delegated authority and responsibility for the professional leadership of the nursing, midwifery and allied health professions. The role is also the executive lead for infection prevention and control with the director of infection prevention and control reporting to them. The role has delegated responsibility for reporting to the Trust Board on the achievement of quality and patient experience standards and complaints and claims management and is the Trust’s safeguarding lead y The medical director has overall accountability for operational and clinical risk and incident management. This includes the establishment and monitoring of assurance mechanisms and provision of associated risk reports to the Trust Board. The medical director also has delegated responsibility for co-ordinating and monitoring the Trust’s revalidation programme for medical staff in line with the ‘Maintaining High Professional Standards’ system for the NHS. The medical director is also the Caldicott Guardian for the Trust y The chief operating officer has delegated authority for managing the Trust’s performance delivery both against national operating standards and key performance indicators together with local contractual standards set by the Clinical Commissioning Groups (CCGs) y The director of people, organisational development and communications has delegated responsibility for overseeing all people functions across the Trust including recruitment, staff training and managing absence as well as embedding the Trust’s people strategy
y
The director of finance has delegated responsibility for co-ordinating the management of financial and business related risk, the Trust’s Capital programme and assisted me in ensuring that the Trust’s resources were managed efficiently, economically and effectively y
Capacity to handle risk
The Trust Board receives regular reports that detail quality, financial and operational performance risk, and, where required, the action being taken to reduce identified high-level risks. I am responsible for ensuring that the Trust is in a position to provide overall assurance that the organisation has in place the necessary controls to manage its risk exposure. In discharging these responsibilities I was assisted by the following directors during 2021/22: y
An annual effectiveness review of each committee is undertaken to ensure they continue to meet their terms of reference. The outcomes of the reviews are reported to the Trust Board. Following each meeting of the committees, the committee chairs present written and verbal reports to the next Board meeting. These reports provide a summary of the matters discussed at the meetings, areas of risk or concern as well as areas of good news or positive performance. Progress against the committees’ work plans is also included in each committee report to InBoard.response to the pandemic, a full ‘command and control’ structure was implemented from the end of January 2020 and this continued as the need arose during 2021/22. This consisted of a Strategic Command Cell, with tactical cells managing operational response, clinical response, infection prevention and control, supporting our people, communications response and the management of our estate and infrastructure. In the peak of the pandemic, the cells met daily and as the number of Covid patients reduced, the frequency of the meetings also reduced.
Charitable Funds Committee y Senior management team meeting
As chief executive officer, I am accountable for the overall risk management activity within the Trust. Committed leadership in the area of risk management is essential to maintaining sound systems of internal control required to manage risks associated with the achievement of the corporate goals of the Trust. The Trust’s Risk Management Strategy details my overall accountability to the Trust Board for risk management and makes it clear that managing risk is a key responsibility for the Trust and all staff employed by it.
The Risk Management Group meets on a monthly basis to review risks across all divisions as well as corporate departments. The group’s objectives are: y To champion and promote the identification, proactive management of risks and sound risk management practices across the Trust, facilitating and embedding a strong risk management process and culture y To ensure the identification of the burden of risks across the Trust by providing a critical review of risks on all risk registers y To offer constructive challenge, serving as risk moderators in the Trust’s risk
All our people receive risk management and related training at induction and further updates as required. The training covers topics such as risk assessments, health and safety at work, moving and handling, fire safety, incident reporting, information governance as well as infection prevention and control. In addition to providing staff with skills and knowledge to carry out their work safely, staff are actively encouraged to report incidents and escalate any identified risks in a timely manner. In addition, thematic learning from incidents is shared through newsletters, internal safety alerts, simulation sessions and/or case scenarios through the Trust’s Sharing the Learning sessions. We also support a programme of counter fraud training and awareness provided by the local counter fraud specialist team. The risk and control framework The role of the risk and control framework is to identify, evaluate and prioritise clinical and non-clinical risks and gain assurance that these are properly controlled to ensure safe and effective Withincare. the Trust, there are systems and processes in place for identifying, managing and monitoring risks. These include: y A Risk Management Strategy (for the effective management of clinical and non-clinical risk)
y A Board Committee structure with clear reporting lines to the Trust Board y A Risk Management Group reporting to the Trust Board via Senior Management Team Meetings y A Significant Risk Register and Board Assurance Framework, both of which are reviewed by the Risk Management Group and Trust Board y Monitoring systems for incidents and Thecomplaints.RiskManagement Strategy including the risk appetite statement is being revised and will be presented to Trust Board in Quarter 1 of 2022/23. Risk is managed at different levels of the organisation. Each division and corporate department has a risk register that is regularly reviewed, ensuring that risk scores are accurate and that risks are appropriately mitigated, managed and escalated. Each risk on the register has a risk owner accountable for that risk.
62reportaccountabilityThe and organisational development and culture programme y The director of quality improvement has delegated responsibility for managing the Trust’s transformation and modernisation programme as well as the Quality First team and implementing the quality improvement strategy y The director of strategy has delegated responsibility for managing the development of the new hospital and the estates strategy y The chief information officer has delegated responsibility for ensuring that information governance arrangements at the Trust are suitable, is the Trust’s Senior Information Risk Owner (SIRO) and is responsible for the development and implementation of the digital strategy for the Trust As chief executive I also hold responsibility for managing the strategic development and leadership of the Trust’s quality improvement agenda; ensuring the implementation of the quality management improvement agenda; and ensuring the safety and quality of the care provided to our patients.
The Trust has a Board Assurance Framework (BAF) which provides a mechanism for the Board to monitor the risks to delivery of the Trust’s strategic objectives as well as the effectiveness of the controls and assurance processes. The risks reflect the Trust’s in-year and future risks. Each risk on the BAF has an executive lead and a designated responsible committee. The risks are reviewed monthly with executive leads and are reviewed by the relevant committees and the Trust Board bi-monthly. The Risk Management Group reviews the BAF by Thereexception.are a number of high scoring risks on the BAF: y COVID-19: Pressures on PAHT and the local healthcare system due to the ongoing management of COVID-19 and the consequent impact on the standard of care delivered (risk score of 16) y Variation in outcomes resulting in an adverse impact on clinical quality, safety, patient experience and 'higher than expected' mortality (risk score of 16) y Electronic patient record (EPR): The current EPR has limited functionality resulting in risks relating to delivery of safe and quality patient care (risk score of 16) y Workforce: Inability to recruit, retain and engage our people (risk score of 16) y Estates and infrastructure: Concerns about potential failure of the Trust’s estate and infrastructure and consequences for service delivery (risk score of 20) y Capacity and capability to deliver long term financial and clinical sustainability across the health and social care system (risk score of 16) y Risk that the new hospital will not be delivered to time and within the available capital funding (risk score of 20) y Failure to achieve ED standard resulting in increased risks to patient safety and poor patient experience (risk score of 20)
Further detail on these risks and their management is outlined in this report. Following the annual review of the Trust’s risk management processes and BAF by the Trust’s Internal Auditors an overall assessment of reasonable assurance was provided. Quality arrangementsgovernance There is clear accountability at Board level for patient safety and clinical quality outcomes along with structured reporting of performance against these objectives. Executive oversight of quality improvement is through the director of nursing, midwifery and allied health professionals (AHPs) who, with the medical director, ensures an organisationwide approach to the integrated delivery of the quality governance agenda. For any transformational change required, they are supported by the Trust’s Quality First Eachteam.ofthe Trust’s divisions has a patient safety and quality group where themes and trends from reviews of incidents and complaints and learning are reported. Performance is reviewed at monthly performance review meetings and at the Quality and Safety Committee each division presents a quarterly overview of its performance on a rolling programme, in line with the CQC key lines of enquiry. Throughout 2021/22, the Quality and Safety Committee continued to receive updates on progress against the Quality Improvement Plan developed to address concerns raised by CQC during their inspection. Regular ‘Sharing the Learning’ reports providing an overview of themes, trends and learning arising from incidents, serious incidents and on-going quality improvement initiatives for topics such as
63reportaccountabilityThe escalation process and ensuring that significant risks are appropriately escalated y To support the delivery of the Trust’s objectives by obtaining assurance on the effectiveness of controls and actions identified to minimise risks y To improve the standard of decision making on risk management
Developing workforce safeguards
The Trust is compliant with the following NHS provider licence conditions: y The provider has taken all precautions necessary to comply with the licence, NHS acts and NHS Constitution (Condition G6 (3)). y The provider has complied with required governance arrangements (Condition FT4 (8)). In relation to General Condition 4 (Fit and proper persons) of the Provider Licence the Trust has a robust process for monitoring the Trust’s compliance with the regulations. Annual compliance checks, by way of annual selfdeclarations are undertaken and reported to the Workforce Committee.
The Trust ensures that short, medium and long-term workforce strategies and staffing systems are in place which provide assurance to the Trust Board that staffing processes are safe, sustainable and effective. Compliance with the ‘Developing Workforce Safeguards’ recommendations is demonstrated through the following systems: y The integrated performance report (IPR) is received at each public Trust Board meeting and details a range of staffing metrics including vacancy rates, sickness absence, turnover,
Mortalityreceived.ismonitored
The Trust reported two never events in 2021/22. The first, reported in October 2021 related to a retained foreign object. There was no harm to the patient and a root cause analysis was completed. In January 2022, a second never event was reported in relation to a patient who was given oral medication via an intravenous route. There was no harm to the patient and a root cause analysis is in progress.
A Trust-wide Mortality improvement programme was established which utilised QI methodology to deliver improvements in patient outcomes across a number of identified work streams. Medical examiners have been appointed and structured judgement reviews are undertaken. The Quality and Safety Committee receives monthly reports on mortality and learning from deaths whilst the Trust Board receives an update at every public Board meeting (held biThemonthly).Quality and Safety Committee, Workforce Committee and Trust Board receive reports on nursing and midwifery staffing levels in line with guidance received from NHS England and the Care Quality Commission on the delivery of the ‘Hard Truths’ commitments associated with publishing staffing data regarding nursing, midwifery and care staff levels.
Compliance with NHS Provider Licence
CEO Assurance Panels have been convened to provide enhanced oversight and assurance where high risk areas have been identified in relation to quality. Never events
Well-led reviews The Board commissioned an external review of the Well-led framework in March 2021 and the outcome of that review was reported to the Board in June 2021. An action plan was developed to address the recommendations made by the external team. The recommendations related to: y Ongoing Board, executive and divisional development y Embedding the divisional re-structure, governance and accountability framework y Continuing the overarching culture programme across the organisation Progress against the recommendations is being reported to the senior management team and Trust Board on a quarterly basis.
64reportaccountabilityThe falls, dementia and pressure ulcers are also by the Quality and Safety Committee as well as the Trust Board. The 12 month rolling HSMR is ‘as expected’ and SHMI is ‘as expected’.
The Trust’s Audit Committee monitors and approves the registers of interest.
The Trust has published an up-to-date register of interests, including gifts and hospitality for decision-making staff within the past twelve months, as required by the ‘Managing Conflicts of Interest in the NHS’ guidance.
Care Quality Commission
The Trust is not fully compliant with the registration requirements of the Care Quality Commission (CQC). In July and August 2021, CQC carried out unannounced inspections of the following services at the Trust: y Urgent and emergency care y Medical care (including older people’s care) y DuringMaternityAugust and September 2021, the CQC inspected the well-led question for the Trust overall. The Trust was formally served with a notice under Section 31 of the Health and Social Care Act 2008 on 16 August, imposing conditions on the Trust’s
65reportaccountabilityThe appraisal rates, friends and family test results, statutory and mandatory training compliance y A workforce report is presented to the Workforce Committee bi-monthly where the metrics listed above are scrutinised y The safer nurse staffing report is presented to the Quality and Safety Committee by exception and bimonthly to the Workforce Committee and Trust Board; this details the actions taken to provide safe, sustainable and productive staffing levels for nursing, midwifery and care staff as well as providing an update on nursing vacancy rates, and in 2021/22, the plans to further reduce the vacancy rate to achieve the target vacancy rate. y Trust Board reporting is underpinned by monthly performance review reports which detail a range of performance indicators including vacancy rates, sickness absence, turnover, maternity leave, training and average absence y Freedom to Speak Up Guardians and Guardian of Safe Working reports are presented to the Trust Board and Workforce Committee y Electronic job planning processes are in place for medical staff y Bi-annual nursing and midwifery establishment reviews are undertaken and reported to the Workforce Committee, Quality and Safety Committee and the Trust Board. The reviews utilise the Safer Nursing Care Tool (SNCT) for adult ward areas, the Baseline Emergency Staffing Tool (BEST) for the emergency department and Birthrate plus for the maternity department y The Trust’s workforce plan underpins the Trust’s annual operating plan which is reviewed by the Performance and Finance Committee and approved by the Trust Board y The Trust remains focused on increasing and retaining its core nursing workforce, utilising new roles such as nurse consultants, nursing associates, expanding our clinical nurse practitioners, clinical digital nurses and professional nurse advocates whilst continuing to further develop and embed new workforce models. Working with our ICS partners we will continue to explore opportunities for joint roles as we identify workforce models that support integrated working and the implementation of our new models of care y Throughout 2021/22 and during the peak periods of the pandemic, nursing staffing levels were monitored closely. Capacity planning meetings were increased to three times a week with attendance from the senior nursing leadership team to ensure alignment of capacity plans and safe staffing as well as detailed decision making on elective activity. Daily staffing huddles were increased to three times a day seven days a week led by the deputy director of nursing or an associate director of nursing. Safecare was used to guide all actions and mitigations, all of which were documented on staffing record sheets
Managing conflicts of interest
NHS Pension Scheme As an employer with staff entitled to membership of the NHS Pension Scheme, control measures are in place to ensure all employer obligations contained within the Scheme regulations are complied with. This includes ensuring that deductions from salary, employer’s contributions and payments into the Scheme are in accordance with the Scheme rules, and that member Pension Scheme records are accurately updated in accordance with the timescales detailed in the regulations. Equality, diversity and human rights Control measures are in place to ensure that all the organisation’s obligations under equality, diversity and human rights legislation are complied with.
Health and Safety Executive
66reportaccountabilityThe registration as a service provider: y To ensure there are sufficient numbers of suitably qualified, skilled, competent and experienced nursing staff at all times to meet the needs of patients within the emergency department (ED) y To operate an effective system which will ensure that every patient attending the ED has an initial assessment of their condition to identify the most clinically urgent patients y
The Trust is required to provide monthly progress reports and updates to the CQC and a range of weekly data returns. The urgent and emergency care team have clear plans for improving these areas as well as continuing their transformation work to ensure the provision of safe, effective and responsive care to all of our Thepatients.Trust’s internal governance and oversight processes for urgent and emergency care remain in place and progress is formally reported through Quality and Safety Committee. The ICS and NHSEI have oversight of the conditions and assurance of the improvement actions through the established quality and performance governance structures. The final CQC report was published on 17 November 2021. The Trust remained as ‘Requires Improvement’ overall and the core services of medicine and maternity remained ‘Requires Improvement’ and urgent and emergency care (UEC) services remained as ‘Inadequate’.
To undertake a review of current and future patients' clinical risk assessments, care planning and physiological observations and ensure that the level of patients’ needs are individualised, recorded and acted upon y To ensure that we implement an effective system for all patient observations to be completed within 15 minutes of arrival
The Trust met the recommendations and submitted evidence of compliance in all of the above areas within the deadline of 31 January 2022.
The Trust has undertaken risk assessments and has plans in place which take account of the ‘Delivering a Net Zero Health Service’ report under the Greener NHS Programme. The Trust ensures that its obligations under the Climate Change Act and the Adaptation Reporting requirements are complied with.
Carbon reduction
The Health and Safety Executive undertook a planned inspection of the Trust in October 2021. Following that visit the Trust received a notification of contravention letter related to seven elements: y Control of risk to lone workers y Ward specific risk assessments and training for violence and aggression y Risk assessment and training for lone workers y Completion of de-brief forms following violence and aggression y Core security cover y Manual handling – management arrangements for effective organisation, control, and review y Control of risk from COVID-19 (Junior Doctors’ mess).
Data quality and governance Data quality reports are produced and reviewed at the Data Quality Steering Group. This group reports to the senior management team and then onto Performance and Finance Committee and the Trust Board. Local audits on data quality are undertaken and quarterly data quality reports are presented to PAF with benchmarked data against national and local peer Trusts. The Information Governance Steering Group receives a monthly update on data quality. The Integrated Performance Report is discussed at each of the committees every month and at Trust Board bi-monthly.
The Trust reported three information governance (IG) data security breaches to the Information Commissioner's Office (ICO) during 2021/22. The first breach followed a concern raised by a member of staff who felt patient confidentiality was being compromised by a colleague through using their rolebased access rights to Trust health record systems inappropriately. The second breach related to a member of staff with next of kin status having accessed a patient’s medical record.
Elective waiting time data
Review of economy, efficiency and effectiveness of the use of resources
Information governance/data security risks
Patients who have been referred to the Trust on a cancer waiting time or referral to treatment (RTT) pathway are managed daily by the clinical and operational teams, in line with the hospital’s access policy. These pathways are reviewed at weekly patient tracker list (PTL) meetings, chaired by the performance manager where pathway trigger points are reviewed and remedial actions taken, if required. The PTL meetings report to the weekly elective care operational group meetings which are chaired by the head of performance and planning and then to the System Access Board. The System Access Board also reviews RTT data quality reports and determines required actions to ensure that processes maintain accurate data Inrecording.addition, a number of data quality reports are produced to enable the service management teams to monitor patients on non-RTT pathways. These are reviewed through the data quality steering group.
The third breach occurred when a patient, who was also a staff member, had raised a concern that fellow staff members had been accessing their medical records inappropriately during their inpatient stay.
The Trust was rated ‘good’ following the use of resources assessment in March 2019. More details of the Trust’s performance and some specific Trust projects aimed at increasing efficiency are included in the Annual Report. The Trust’s external auditors are required to consider whether the Trust has made proper arrangements for securing economy, efficiency and effectiveness in its use of resources. They report the results of their work to the Audit Committee.
All three breaches were investigated and closed by the ICO, with no further action taken against the Trust.
The Trust has a Governance Manual comprising standing orders and standing financial instructions, which provide the framework for ensuring appropriate authorisation of expenditure commitments in the Trust. The Board’s processes for managing its resources include approval of annual budgets for both revenue and capital, reviewing financial performance against these budgets, and assessing the results of the Trust’s cost improvement programme on a monthly basis. The Trust has a process for the development of business cases for both capital and revenue expenditure and, depending on the level of investment, these are reviewed by the senior management team, Performance and Finance Committee and Trust Board. The Performance and Finance Committee reviews productivity, operational and financial performance and use of resources both at Trust and divisional level.
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Both the System Access Board and the data quality steering group report to the senior management team and then onto Performance and Finance Committee and the Trust Board.
The Trust has an annual clinical audit programme in place including mandated audits addressing national and local issues, targets and performance. The Trust’s Internal Auditors provide an opinion on the overall arrangements for gaining assurance as part of the riskbased Annual Internal Audit Plan. During the year, the following internal audit reports received a limited assurance rating: y Temporary staffing y Waivers y Key financial systems (part I) y Pre-operative assessment y Tertiary pathways Action plans are in place to address Internal Audit’s recommendations for all audits undertaken. The Internal Auditors provide a progress report to the executive management team, senior management team and Audit Committee. The executive team as well as the Audit Committee continues to focus on the implementation of recommendations to ensure the Audit Committee is receiving adequate assurance that control weaknesses are being addressed. Head of internal audit opinion (HoIA) on the effectiveness of the system of internal control for the year ended 31 March 2022: The purpose of my annual HoIA opinion is to contribute to the assurances available to the accountable officer and the Board which underpin the Board’s own assessment of the effectiveness of the organisation’s system of internal control. This opinion will in turn assist the Board in the completion of its Annual Governance Statement (AGS). My opinion is set out as follows: 1. Overall opinion; 2. Basis for the opinion; 3. Matters that have had an impact on the opinion; and 4. TheCommentary.assurancegradings underpinning the interim opinion are set out at Appendix A. This includes one provisional opinion where the draft report is pending clearance with management. 1. My overall opinion is that reasonable assurance can be given that there is a generally sound system of internal control, designed to meet the organisation’s objectives, and that controls are generally being applied consistently. However, some weakness in the design and/or inconsistent application of controls, put the achievement of particular objectives at risk. 2. The basis for forming my opinion is as i.follows:Anassessment of the design and operation of the underpinning Assurance Framework and supporting processes; and ii. An assessment of the range of individual opinions arising from risk-based audit assignments, contained within internal audit risk-based plans that have been reported throughout the year. This
Review of effectiveness As accountable officer, I have responsibility for reviewing the effectiveness of the system of internal control. My review of the effectiveness of the system of internal control is informed by the work of the internal auditors, clinical audit, the executive team, managers and clinical leads within the Trust who have responsibility for the development and maintenance of the internal control framework. I have drawn on the information provided in this Annual Report and other performance information available to me. My review is also informed by comments made by the external auditors in their management letter and other reports. I have been advised on the implications of the result of my review of the effectiveness of the system of internal control by the Trust Board and Audit Committee and a plan to address weaknesses and ensure continuous improvement of the system is in place.
68reportaccountabilityThe
69reportaccountabilityThe assessment has taken account of the relative materiality of these areas and management’s progress in respect of addressing control weaknesses. Additional areas of work that may support the opinion will be determined locally but are not required for Department of Health purposes e.g. any reliance that is being placed upon Third Party Assurances.
The impact of the COVID-19 pandemic on the Trust’s services has been significant. As elective procedures were reduced during the pandemic, there has been an increase in the number of patients waiting for more than 52 weeks for routine surgery and a rise in demand for diagnostic services. Some patients requiring routine elective treatments have waited nearly two years for their treatments. However, the Trust has focused on supporting patients requiring urgent care and cancer treatments. The Trust has continued with expanded endoscopy, CT and MRI capacity to support the management of cancer patients and has continued to work closely with independent sector colleagues to maximise access to key services and maintain timely services for patients. In addition, increased elective capacity has been implemented over the summer to reduce the waiting lists. All patients who have been waiting for longer than
COVID-19: recovery and restoration
Significant issues
The following is a summary of three significant issues which were and will continue to be the focus of the Trust Board’s attention and direct the Trust’s management efforts during 2022 (and beyond); these issues are also reflected on the Board Assurance Framework: Urgent and emergency care
The Trust has struggled to deliver against the emergency department standard throughout the year. Year to date the Trust achieved 67.29% for all attendances. The urgent care attendances during the year have been unpredictable with decreased attendances during COVID -19 surges and sustained increased attendances in other months. The requirement to maintain a separate respiratory emergency department, increased attendances and the requirement for separate COVID-19 wards created pressure on bed capacity across the Trust and the urgent care department was unable to place patients on wards quickly enough to maintain the 4 hour standard. The Rapid Assessment Treatment (RAT) pathways continued to be in place over the year, but staff absence due to COVID-19 impacted the number of RAT teams available for this pathway. Patient experience and the flow of patients into and through the urgent care services has been further enhanced by the implementation of a separate streaming assessment area for walk-in attendances ensuring that patients are seen by the most appropriate urgent care service, GP, Urgent Treatment Centre, emergency department and same day emergency care. The Urgent Care Improvement Board meets on a weekly basis to review actions being taken to improve performance against all the emergency care standards. Recovery plans remain in place to address performance issues both internally and across the health and social care system. Weekly system priorities meetings address improvements across the west Essex health and social care organisations and a clinically led discharge working group has reviewed discharge pathways for Asimprovements.outlinedabove, following the CQC’s inspection of the urgent and emergency care service, a notice was served on the Trust under Section 31 of the Health and Social Care Act 2008 imposing conditions on the Trust’s registration as a service provider. Actions are being taken to address the areas of concern and to ensure the provision of safe, effective and responsive care to all of our patients. Progress against the actions is monitored through the Trust’s governance processes and the monthly oversight group with attendees from the ICS and Regional NHSE/I colleagues. A CEO Assurance Panel will be held in May 2022 to scrutinise the department’s progress against the actions and readiness for reinspection by the CQC.
These key risks and concerns drive our long term estate strategy which includes building a new hospital to address these challenges and enable the Trust to be successful in delivering integrated care as part of an Integrated Care Partnership. However, we still need to deliver high quality, efficient services from the current estate for at least the next 5 years as we continue to develop the outline business case for a new hospital in line with the national New Hospital Programme.
Estate The quality and safety of the estate remain significant challenges for us at a time of financial constraint. It has been well communicated that the current hospital estate has reached its limit in terms of capacity and development. A significant portion of the hospital site is more than 60 years old and falls short of modern day expectations with areas of key infrastructure in need of replacement. Our ability to keep up with the changing clinical landscape, technological advances and delivery of new models of care is limited by our current estate.
the scale of the challenge that lies ahead and continues to work with partners across the local health and care system to bring waiting lists down in a way that is transparent and equitable, that provides equity for patients and looks after the workforce. Despite a huge amount of hard work from everyone it will be some time before the Trust’s services are restored to pre-pandemic levels.
Conclusion As accountable officer, I receive information and assurance from a wide range of sources about the Trust’s internal control systems and structures in place to ensure the effective operation of the Trust. These facilitate the identification of strengths and areas in need of attention enabling appropriate action plans to be established and acted on.
Although significant issues have been identified as above, my review confirms that the Trust has a generally sound system of internal control that supports the achievement of its policies, aims and objectives and statutory duties. I and the Trust Board remain committed to achieving continuous improvement and enhancement of the systems of internal control. Lance McCarthy Chief executive 31 May 2022
70reportaccountabilityThe they would do normally continue to be reviewed by the relevant clinical team and reprioritised where relevant. An apology letter has been sent to all patients waiting longer than 18 weeks and a further set of communications is planned for the spring. The intensity of the response to the pandemic has had a marked impact on the Trust’s people. The same group of staff who worked through the pandemic are stepping up to recover elective backlogs and the Trust has launched a number of health and wellbeing initiatives to support Thecolleagues.Trustacknowledges
y The relationship between the highest paid director/member in the organisation against the 25th, median and 75th percentile of the total remuneration of the workforce.
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Pay ratio information
Staff report Pay multiples Reporting bodies are required to disclose 4 key indicators between years: y Percentage change in salary and allowances for highest paid director from previous year: y Percentage change in performance pay and bonuses for highest paid director from the previous year.
Remuneration and staff report
The banded remuneration of the highest paid director/member of staff in The Princess Alexandra Hospital NHS Trust in the financial year 2021-22 was £200,603 (2020-21, £189,419). The relationship to the remuneration of the organisation's workforce is disclosed in the table overleaf. The total range of staff remuneration in the financial year 2021-22 is between £18,521 to £301,041.
The Princess Alexandra Hospital NHS Trust is required to disclose the relationship between the total remuneration of the highest-paid director /member of staff in the organisation against the 25th percentile, median and 75th percentile of remuneration of the organisation’s workforce. Total remuneration of the employee at the 25th percentile, median and 75th percentile is further broken down to disclose the salary component.
y Percentage change in average salary and allowances for employees of the entity as a whole; and y Percentage change in average performance pay and bonuses for employees of the entity as a whole.
Background This report includes details regarding “senior managers” remuneration in accordance with paragraphs 3.31 to 3.78 of the DHSC (Department of Health and Social Care) Group Accounting Manual 2021/22. The Remuneration Report set out below is subject to audit by our external auditors. The Trust has established a Remuneration and Nominations Committee to advise and assist the Board in meeting its responsibilities to ensure appropriate remuneration, allowances and terms of service for the chief executive officer, executive directors and very senior managers. The Remuneration Committee is chaired by the Trust’s chairman and meets at least annually. Membership of the committee consists of Trust chairman and all nonexecutive directors with the director of people and others in attendance. The chief executive officer and directors remuneration is determined on the basis of reports to the Remuneration and Nominations Committee taking account of any independent evaluation of the post, national guidance on pay rates and market rates. Pay rates for the chair and non-executive directors of the Trust are determined in accordance with national Theguidance.Trust does not operate any system of performance related pay and no proportion of remuneration is dependent on performance conditions. The performance of non-executive directors is appraised by the chair. The performance of the chief executive officer is appraised by the chair. The performance of Trust executive directors is appraised by the chief executive officer. Annual pay increases are implemented in accordance with national pay awards for all other NHS staff.
72 Highest paid director averageEmployee Highest paid director averageEmployee Salary allowancesand 8.0% 13.3% -2.6% 0.0% bonusespayPerformanceand 0.0% 0.0% 0.0% 0.0% 2021/22 2020/21 For PAHT for 2021/22 (and 2020/21), these were: reportaccountabilityTheTrade Union disclosures Table 1 Relevant union officials What was the total number of your employees who were relevant union officials during the relevant period? Number of employees who were relevant union officials during the relevant period Full-time equivalent employee number 1 0.51 WTE Table Percentage2 of time spent on facility time How many of your employees who were relevant union officials employed during the relevant period spent a) 0%, b) 1%-50%, c) 51%-99% or d) 100% of their working hours on facility time? Percentage of time Number of employees 0%1-50% 1.00 51%-99%100% -
100 0.01%£220,101,000
Table 4 Paid trade union activities
As a percentage of total paid facility time hours, how many hours were spent by employees who were relevant union officials during the relevant period on paid trade union activities?
reportaccountabilityThe Table of pay bill spent on facility time Provide the figures requested in the first column of the table below to determine the percentage of your total pay bill spent on paying employees who were relevant union officials for facility time during the relevant period. Figures Provide the total cost of facility timeProvide the total pay bill £19,773.81 Provide the percentage of the total pay bill spent on facility time, calculated as: (total cost of facility time ÷ total pay bill) x
Percentage3
Time spent on paid trade union activities as a percentage of total paid facility time hours calculated as: (total hours spent on paid trade union activities by relevant union officials during the relevant period ÷ total paid facility time hours) x 100 50.67
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For all off-payroll engagements as of 31 March 2022, for more than £245(1) per day: Number Number of existing engagements as of 31 March 2022Of which, the number that have existed: for less than one year at the time of reportingfor between one and two years at the time of reportingfor between 2 and 3 years at the time of reportingfor between 3 and 4 years at the time of reportingfor 4 or more years at the time of reporting -
Off payroll engagement Table 1: Length of all highly paid off-payroll engagements
For all off-payroll engagements between 1 April 2021 and 31 March 2022, for more than £245(1) per day:
Note (1) The £245 threshold is set to approximate the minimum point of the pay scale for a Senior Civil Servant. (2) A worker that provides their services through their own limited company or another type of intermediary to the client will be subject to off-payroll legislation and the Department must undertake an assessment to determine whether that worker is in-scope of Intermediaries legislation (IR35) or out-of-scope for tax purposes
Note (1) The £245 threshold is set to approximate the minimum point of the pay scale for a Senior Civil Servant.
Table 3: Off-payroll board member/senior official engagements
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Table 2: Off-payroll workers engaged at any point during the financial year
For any off-payroll engagements of board members, and/or, senior officials with significant financial responsibility, between 1 April 2021 and 31 March 2022: 74 Number No. of temporary off-payroll workers engaged between 1 April 2021 and 31 March 2022Of which, No. not subject to off-payroll legislation(2)No. subject to off-payroll legislation and determined as in-scope of IR35(2)No. subject to off-payroll legislation and determined as out of scope of IR35(2)No. of engagements reassessed for compliance or assurance purposes during the yearOf which: no. of engagements that saw a change to IR35 status following reviewNumber of off-payroll engagements of board members, and/or senior officers with significant financial responsibility, during the financial year (1) Total no. of individuals on payroll and off-payroll that have been deemed “board members, and/or, senior officials with significant financial responsibility”, during the financial year. This figure must include both on payroll and off-payroll engagements (2) 9.00
75reportaccountabilityThe Consultancy and professional services spend 2021/22 total expenditure on consultancy and professional services was £5,508k (2020/21 £3,419k). Employee benefits and staff numbers (audited) Employee benefits expenditureGross employedPermanently Other total2021/22 2020/21 total £000’s £000’s £000’s £000’s Salaries and wages 142,951 530 143,481 137,950 Social security costs 14,723 - 14,723 12,456 levyApprenticeship 715 - 715 606 pensionstocontributionsEmployer'sNHS 24,288 - 24,288 23,171 Pension costs - other 33 - 33 36 staffTemporary - 38,382 38,382 33,141 employeeTotal benefits 182,710 38,912 221,622 207,360 EmployeeLess: costs capitalised 849 661 1,510 2,603 Redundancy 35 - 35 11 Note (1) There should only be a very small number of off-payroll engagements of board members and/or senior officials with significant financial responsibility, permitted only in exceptional circumstances and for no more than six months (2) As both on payroll and off-payroll engagements are included in the total figure, no entries here should be blank or zero In any cases where individuals are included within the first row of this table the department should set out: y Details of the exceptional circumstances that led to each of these engagements. y Details of the length of time each of these exceptional engagements lasted.
76reportaccountabilityThe Average staff numbers numberPermanent Other number 2021/22 total 2020/21 total Medical and dental 276 314 590 567 andAdministrationstaffAmbulanceestates 1,069 47 1,116 637 staffotherassistantsHealthcareandsupport 655 16 671 412 midwiferyNursing, and health visiting staff 1,154 30 1,184 1,099 midwiferyNursing, and health learnersvisiting - - - 466 staffandtherapeuticScientific,technical 251 8 259 239 scienceHealthcarestaff 96 7 103 79 Social care staff - - -Other 11 11 147 Total 3,512 422 3,934 3,646 Staff engaged on (includedprojectscapital in above) 15 12 27 34
77reportaccountabilityThe Staff sickness and ill health retirements Annual references for staff sickness absence relate to calendar years. For ill health retirements, year references relate to financial years. Staff sickness absence data can be accessed via NHS Digital - NHS Digital Staff Sickness Data. Ill health retirements 2021/22 2020/21 Number Number Number of persons retired early on ill health grounds 0 3 £000s £000s Total additional pensions liabilities accrued in the year 0 147 Reporting of compensation schemes - exit packages 2021/22 (audited)Exitpackagecostband(includinganyspecialpaymentelement) Number redundanciescompulsoryof Number of other agreeddepartures Total number of exit packages Less than £10,000 0 0 0 £10,000 - £25,000 0 0 0 £25,001 - £50,000 0 0 0 £50,001 £100,000- 0 0 0 £150,000£100,001- 0 0 0 £150,001£200,000 0 0 0 > £200,000 0 0 0 Total 0 0 0 Total resource cost (£) £0 £0 £0
and
the additional
Redundancy and other departure costs have been paid for in accordance with the provisions of the NHS Pensions Scheme. Exit costs in this note are accounted for in full in the year of departure. Where the Trust has agreed early retirements, costs are met by the Trust and not by the NHS Pensions Scheme. Ill–health retirement costs are met by the NHS Pensions Scheme are not included in the table.
78reportaccountabilityThe
Reporting of compensation schemes - exit packages 2020/21 (audited)Exitpackagecostband(includinganyspecialpaymentelement) Number redundanciescompulsoryof Number of other agreeddepartures Total number of exit packages Less than £10,000 0 0 0 £10,000 - £25,000 0 0 0 £25,001 - £50,000 0 0 0 £50,001 £100,000- 0 0 0 £150,000£100,001- 0 0 0 £150,001£200,000 0 0 0 > £200,000 0 0 0 Total 0 0 0 Total resource cost (£) £0 £0 £0
79reportaccountabilityThe Exit packages: other (non-compulsory) departure payments (audited) Agreements Total value agreementsof Agreements Total value agreementsof Number £000’s Number £000’s courttribunalsemploymentfollowingExitlieupaymentsContractualinofnoticepaymentsororders Total 2021/22 2020/21 Off payroll arrangements No individual holding a Board position was paid directly through an associated limited company. During 2021/22 there were no executive posts covered by off-payroll arrangements.
reportaccountabilityThe 80 Table of salaries - executive directors (audited) Table of salaries - non-executive directors (audited)
senior
Salary
2. Member retired in 2020/21.
1. Real increase to lump sum may be low/zero or negative as now a member of 2008/2015 scheme which does not provide automatic lump sum.
reportaccountabilityThe
81
3. Information for the medical director and acting chief medical officer is incorrectly excluded from the above table disclosing individual pensions benefits for 2020/2021. This is because the NHS Business Services Authority did not request the necessary information to allow for full pensions benefit disclosures to be made. This was on the pension entitlement of managers (audited)
82reportaccountabilityThe basis that their understanding was that Greenbury reporting applied only for members who had been contributing to the scheme during the current year. The medical director stopped contributing in CETV2020. is the actuarially assessed capital value of the pension scheme benefits accrued by a member at a particular point in time. The benefits valued are the member's accrued benefits and any contingent spouse's pension payable from the scheme. A CETV is a payment made by a pension scheme, or arrangement to secure pension benefits in another pension scheme or arrangement when the member leaves a scheme and chooses to transfer the benefits accrued in their former scheme. The pension figures shown relate to the benefits that the individual has accrued as a consequence of their total membership of the pension scheme, not just their service in a senior capacity to which the disclosure applies. The CETV figures and the other pension details include the value of any pension benefits in another scheme or arrangement which the individual has transferred to the NHS Pension Scheme. They also include any additional pension benefit accrued to the member as a result of their purchasing additional years of pension service in the scheme at their own CETVscost. are calculated within the guidelines and framework prescribed by the Institute and Faculty of Actuaries. Real increase / (decrease) in CETV - this reflects the increase in CETV effectively funded by the employer. It does not include the increase in accrued pension due to inflation, contributions paid by the employee (including the value of any benefits transferred from another scheme or arrangement) and uses common market valuation factors for the start and end of the period.
The National NHS Staff Survey
The results of the NHS Staff Survey 2020 were received in March 2021 and were categorised into ten key themes as reflected in the chart below, depicting a comparison of PAHT results against national average results from similar providers. Overall, we scored lower than the national average across all themes, with health and wellbeing a key concern. In addition, the following key areas for improvement were identified from the survey comments: management support, communication, experience of redeployment and supply of personal protective equipment (PPE). The following themes were identified from the comments about what had been working well in 2020: remote and flexible working options, team work/camaraderie/integrated working and communication, including regular trust-wide updates.
y
honest conversations about how
open
y Improvement
Workshops were held from March to April 2021 with leads from all divisions, to review the results and identify improvement suggestions. Improvement plans were developed (April 2021) targeting improvement actions linked to the Trust’s three key staff survey improvement priorities Here to hear virtual listening events were held from May to June 2021 to share these plans with wider staff and seek further feedback and suggestions actions were implemented at a local level, including for example, new thank you cards in the medicine division, increased senior management visibility in urgent and emergency care, and the introduction of staff check-ins as standard across all meetings in cancer, cardiology and clinical support wider range of health and wellbeing support resources were made available to all staff Introduction of a Back to better campaign, hosting a variety of interactive briefing sessions to support our people and services across four key themes: health and wellbeing; compassionate leadership; civility, values and behaviours and operational requirements values were refreshed to continue to create a culture to lead us forward behaviour framework was developed and introduced with over 150 managers attending workshops on how to begin embedding this into within support and it
reportaccountabilityThe
The following improvement priorities were agreed for action across the trust, for progressing during 2021/22: Priority one: improving the physical and mental health and wellbeing of our people
as an organisation y Our This is Us
feels to work in our teams y Introduction of AlexNet, our new Extranet, to improve the sharing of key information and updates for our people y The new Alex Lounge opened as a space for staff to rest and relax y The new Learning and Education Centre opened and has increased access to learning, education and development for our people Our staff breakdown March 2022 staff composition Male Female Executive directors 4 5 Other employees 865 3022 Total 869 3027
y
Priority two: improving our learning and safety culture, encouraging people to openly raise concerns and ensure they are acted upon - improving psychological safety Priority three: improving line manager effectiveness
83
y Our
teams to
team culture y Commencement of culture huddles
y
y A
How was improvement action taken during 2021/22?
reportaccountabilityThe 84 Turnover rate Turnover rate 2020/21 April 21 - February 22 Voluntary turnover 9.77% 15.03% Overall staff turnover 11.93% 16.14% Our workforce – gender profile Our workforce – ethnic profile
The Trust recruited its first head of equality, diversity and inclusion (EDI) in Key2022.actions of our EDI strategy include the development of new staff networks and a refresh of existing networks, identifying staff development opportunities for under-represented staff groups and reverse mentoring for staff. We will continue to work with the integrated care system (ICS) on our EDI strategy. Over the last year, the EDI steering group have: y Delivered an EDI session at Event in a Tent, developing greater staff awareness of protected characteristics and discussion of how teams can further develop EDI in their services y Launched a formal staff network – The Disability and Wellbeing Network (DAWN) y Launched the ICS anti-racism initiative within PAHT y Celebrated both International Women's and Men’s Days with sessions and guest speakers y Continued a programme of reverse mentoring sessions with Board members y Appointed a new Black, Asian and minority ethnic (BAME) Network Chair (Andrea Philip, director of operations for family and women’s services) y Continued partnership working with Krystal Alliance to strengthen and develop staff networks Hattie Llewelyn-Davies, the Trust chair, also became the Trust’s first board level equality, diversity and inclusion champion.
reportaccountabilityThe
Equality diversity and inclusion
85
Looking forward As we look forward to our next year, it is great to have so many exciting projects on the horizon alongside the opportunity to continue to develop and transform the way we provide care and the way we work together to improve all that we Wedo. have a wide range of improvements for us all to focus on and a clear plan to make coming to work a better experience for our people and also the experience of care better for our patients. These targets will need energy and collaboration across our teams and will see further development of integrated ways of working together across the local health and social care system as the integrated care systems (ICS) become formalised this summer and embedded in the months to come. The ICS approach will see new ideas and changes to the way we work alongside our health and social care colleagues that will aim to make the services we each provide work in a more integrated way and bring health and social care together in a more cohesive Recoveryway.from the COVID-19 pandemic and managing the ongoing pressures and impact is at the centre of our daily goals and putting our patients at the heart of our actions. You will be aware that there has been coverage in the media of waiting times for planned procedures across the NHS that have unavoidably built over the last two Weyears.will continue to work closely with the national New Hospital Programme team who are currently writing a Programme Business Case (PBC) which will go to the Treasury to secure the money for the new hospitals. The PBC will ensure the benefits of operating as a national programme are maximised going forward and once approved, we will be able to continue with the development of our own outline business case for the new Princess Alexandra Hospital. These national changes have, inevitably, resulted in a delay to our original completion deadline. Realistically, 2028 is the earliest we might now hope to deliver the new hospital. However, the good news is that an incredible amount of progress has been achieved on the case for a new Princess Alexandra Hospital, despite the ongoing pressures of COVID-19, and we are ready to go once the PBC has been Alongsideapproved.thenewhospital work, we have more transformation and changes to deliver as part of our PAHT 2030 work. This includes our electronic health record (EHR) that will move patient records to one system, accessible to each team providing care that can be uploaded directly without the need for paper. Going paperlite will be a significant and positive move forward for our people and our patients and their experience of care. Another forward-looking project is our Green Plan that will capture all that we already have in place to reduce CO2 as well as implementing additional actions to enable us as an organisation to become greener. Of course, we will also be building further options to support our people and their health and wellbeing. Our people are key to our future and we must ensure that they are in the best place to make a difference to our patients, the people they care for and each other.
Lance McCarthy Chief executive
86forwardLooking
87 The Princess Alexandra Hospital NHS Trust, Hamstel Road, Harlow, Essex, CM20 1QX 01279 44 44 @NHSHarlowNHSHarlow55@PrincessAlexandraNHSThePrincessAlexandraHospital NHS Trust
Annual accounts for the year ended
31 March 2022
1 The Princess Alexandra Hospital NHS Trust
2 Statement of comprehensive income Operating income from patient care activities Other operating income Operating expenses Operating surplus/(deficit) from continuing operations Finance income Finance expenses PDC dividends payable Net finance costs Surplus / (deficit) for the year from continuing operations Surplus / (deficit) for the year Note 4,326910 2021/22 2020/21 £000 £000 335,454 267,835 20,402 47,287 (349,782) (308,104) 6,074 7,018 29(6) (18) (4,770) (3,034) (4,747) (3,052) 1,327 3,966 1,327 3,966
3 Statement of financial position Note Financed by Public dividend capital 326,639 320,559 Revaluation reserve 1,201 591 Income and expenditure reserve (147,809) (149,136) Total taxpayers' equity The notes on pages 7 to 52 form part of these accounts. 180,031 172,014 The financial statements on pages two to six were approved by the board on 20 June 2022 and signed on its behalf by: Chief executive Date 31 March2022£000 31 March2021£000 Non current assets Intangible assets Property, plant and equipment Receivables Total non-current assets Current assets CashReceivablesInventoriesandcash equivalents Total current assets Current liabilities Trade and other payables OtherProvisionsBorrowingsliabilities Total current liabilities Total assets less current liabilities Non current liabilities ProvisionsBorrowings Total non-current liabilities Total assets employed 11 11,011 7,169 12 149,131 137,845 16 1,287 1,189 161,429 146,203 15 5,180 5,697 16 11,265 8,381 17 51,050 65,242 67,495 79,320 18 (42,635) (49,070) 20 (10) (30) 22 (953) (1,142) 19 (3,142) (2,180) (46,740) (52,422) 182,184 173,101 20 (10) 22 (2,153) (1,077) (2,153) (1,087) 180,031 172,014
Taxpayers' and others' equity at 31 March 2022 326,639 1,201 (147,809) 180,031
Statement of changes in equityfor the year ended 31 March 2022
Statement of changes in equityfor the year ended 31 March 2021
Public dividend capital received 186,696 186,696
dividendPubliccapital Revaluationreserve
dividendPubliccapital Revaluationreserve
Revaluations 796 796
Income expenditureandreserve Total £000 £000 £000 £000
Surplus for the year - - 1,327 1,327 Impairments (186) (186)
Taxpayers' and others' equity at 1 April 2021 - brought forward 320,559 591 (149,136) 172,014
Taxpayers' and others' equity at 1 April 2020 - brought forward 133,863 19,343 (153,107) 99 Surplus for the year 3,966 3,966
Other transfers between reserves - (5) 5Impairments (18,748) (18,748) Other recognised gains and losses - 1 - 1
Public dividend capital received 6,080 6,080
4
Taxpayers' and others' equity at 31 March 2021 320,559 591 (149,136) 172,014
Income expenditureandreserve Total £000 £000 £000 £000
5
This reserve comprises changes in the fair value of financial assets measured at fair value through other comprehensive income. When these instruments are derecognised, cumulative gains or losses previously recognised as other comprehensive income or expenditure are recycled to income or expenditure, unless the assets are equity instruments measured at fair value through other comprehensive income as a result of irrevocable election at recognition.
The balance of this reserve is the accumulated surpluses and deficits of the trust.
Revaluation reserve
Public dividend capital (PDC) is a type of public sector equity finance based on the excess of assets over liabilities at the time of establishment of the predecessor NHS organisation.
Additional PDC may also be issued to trusts by the Department of Health and Social Care.
A charge, reflecting the cost of capital utilised by the trust, is payable to the Department of Health as the public dividend capital dividend.
Increases in asset values arising from revaluations are recognised in the revaluation reserve, except where, and to the extent that, they reverse impairments previously recognised in operating expenses, in which case they are recognised in operating income.
Subsequent downward movements in asset valuations are charged to the revaluation reserve to the extent that a previous gain was recognised unless the downward movement represents a clear consumption of economic benefit or a reduction in service potential.
Financial assets reserve
Income and expenditure reserve
Information on reserves Public dividend capital
Net cash flows from / (used in) investing activities
Public dividend capital received Movement on loans from DHSC Capital element of finance lease rental payments
Cash flows from investing activities Interest
Net cash flows from / (used in) financing activities
Increase / ( Decrease) in receivables and other assets (Increase)/ Decrease in inventories
Purchasereceivedofintangible assets
Statement of cash flows
Interest on loans PDC dividend (paid) / refunded Cash flows from (used in) other financing activities
Cash and cash equivalents at 1 April brought forward Cash and cash equivalents at 31 March Note
17354
Cash flows from financing activities
Increase / (decrease) in cash and cash equivalents
2021/22 2020/21 £000 £000 6,074 7,018 11,984 10,451341 (500) (1,857) (3,257) 41,230 516 (1,132) 6,849 11,374 894 273 22,560 67,698 29 4 (5,485) (446) (33,339) (35,562) 500 (38,295) (36,004) 6,080 (150,467)186,696 (30) (461)(30) (4,495) (3,309) (12) (25) 1,543 32,404 (14,192) 64,098 65,242 1,144 51,050 65,242
Cash flows from operating activities Operating surplus Non cash income and expense: Depreciation and amortization Net Incomeimpairmentsrecognised in respect of capital donations
6
Purchase of PPE and investment property Receipt of cash donations to purchase assets
Net cash flows from / (used in) operating activities
Increase in payables and other liabilities Increase in provisions
Note 1 Accounting policies and other information
7
Note 1.1.1 Accounting convention
Note 1.1.2 Going concern
These accounts have been prepared under the historical cost convention modified to account for the revaluation of property, plant and equipment, intangible assets, inventories and certain financial assets and financial liabilities.
In addition, the trust continues to develop an Outline Business Case to build a new hospital, which is being supported by a variety of stakeholders. No circumstances were identified causing the directors to doubt the continued provision of NHS services For the 2021/22 financial year, the trust achieved a surplus of £1.3m against a planned breakeven, which is an adjusted financial performance of £1.1m against control total. Income from our local Clinical Commissioning Groups was largely based on the adapted finance regime introduced in response to the COVID 19 pandemic and this provided predictability and improved cash flow with the trust finishing the year with a £51.0m cash balance. Additional costs arising from the pandemic were reimbursed in the first half the year and incorporated into a block payment basis for the second half of the year.
These accounts have been prepared on a going concern basis, in accordance with the definition as set out in section 4 of the Department of Health and Social Care (DHSC) Group Accounting Manual (GAM) which outlines the interpretation of IAS1 'Presentation of Financial Statements'. IAS1 requires management to assess, as part of the Accounts preparation process, the trust's ability to continue as a going concern. The HM Treasury Financial Reporting Manual directs that in the context of non-trading entities in the public sector, the anticipated continuation of the provision of a service in the future is normally sufficient evidence of going concern. The financial statements should be prepared on a going concern basis unless there are plans for, or no realistic alternative other than, the dissolution of the trust without transfer to another entity. In approving the trust's annual accounts the board of directors has satisfied itself that the trust has prepared the accounts on the basis of going concern recognising the following:The directors of the trust have considered whether there are any local or national policy decisions that are likely to affect the continued funding and provision of services by the trust. The trust is a member of the Hertfordshire and West Essex Integrated Care System (ICS). The ICS has published its Strategic Delivery Plan and NHS Long Term Plan response for the five year period 2020/21 2024/25 and this plan includes the continued provision of services by the trust.
The Department of Health and Social Care has directed that the financial statements of the trust shall meet the accounting requirements of the Department of Health and Social Care Group Accounting Manual (GAM), which shall be agreed with HM Treasury. Consequently, the following financial statements have been prepared in accordance with the GAM 2021/22 issued by the Department of Health and Social Care. The accounting policies contained in the GAM follow International Financial Reporting Standards to the extent that they are meaningful and appropriate to the NHS, as determined by HM Treasury, which is advised by the Financial Reporting Advisory Board. Where the GAM permits a choice of accounting policy, the accounting policy that is judged to be most appropriate to the particular circumstances of the trust for the purpose of giving a true and fair view has been selected. The particular policies adopted are described below. These have been applied consistently in dealing with items considered material in relation to the accounts.
Note 1.1 Basis of preparation
8
For 2022/23 the funding arrangements have been revised with an element of a return to a mixture of blocked contract and activity based contracting, with additional COVID support included in the funding. The trust has agreed contacts with key commissioners for continuing delivery of NHS acute services in West Essex for 2022/23 and beyond. The trust has prepared a cash forecast modelled on the above expectations for funding during the going concern period to 31 March 2023 and beyond. The cash forecast shows sufficient liquidity for the trust to continue to operate during that period with no need to borrow. In addition, the trust has access to working capital arrangements should the need for this arise. In conclusion, these factors, and the anticipated future provision of services in the public sector, support the trust’s adoption of the going concern basis for the preparation of the accounts.
Note 1.2 Critical judgements in applying accounting policies
In the application of the trust's accounting policies, management is required to make judgements, estimates and assumptions about the carrying amounts of assets and liabilities that are not readily apparent from other sources. The estimates and associated assumptions are based on historical experience and other factors considered relevant. Actual results may differ from those estimates and the estimates and underlying assumptions are continually reviewed.
Revisions to accounting estimates are recognised in the period in which both the estimate is revised if the revisions affects only that period or in the period of the revision and future periods if the revision affects both current and future periods.
Department of Health and Social Care guidance specifies that the trust’s land and buildings should be valued on the basis of depreciated replacement cost, applying the Modern Equivalent Asset (MEA) concept. The MEA is defined as “the cost of a modern replacement asset that has the same productive capacity as the property being valued.”
Trust has considered whether there is a need for an impairment in PPE, for the current value of capitalised assets relating new hospital programme, and assessed that no impairment is required. The trust is assured that the new Hospital Programme is continuing, despite delays in the national new hospital programme. The trust has received a commitment from the new hospital programme, and continued funding for £1.1m in 2022/23.
Charitable funds
The following are the judgements, apart from those involving estimations (see below) that management has made in the process of applying the trust's accounting policies and that have the most significant effect on the amounts recognised in the financial statements:
Under the provisions of IAS 27 Consolidated and Separate Financial Statements, those Charitable Funds that fall under common control with NHS bodies are consolidated within the entity's financial statements. IAS 1 states that specific disclosure requirements as set out in individual standards or interpretations need not be satisfied if the information is not material, and on that basis the trust has not consolidated its charitable funds.
9
Note 1.3
Classification of leases as finance or operating leases. Leases have been reviewed to determine if they are classified as operating or finance leases in line with IAS17. Critical judgements include whether the ownership transfers at the end of the term, the level of risk transfer, whether the lease term is for a major part of the economic life of the asset and whether the present value of the minimum lease payment is substantially all of the fair value of the asset.
Therefore the MEA is not a valuation of the existing land and buildings that the trust holds, but a theoretical valuation for accounting purposes of what the trust could need to spend in order to replace the current assets. The MEA valuation approach continues to be adopted by the trust (Note 1.7.2). The valuer has continued to exercise professional judgement in providing the valuation and this remains the best information available to the trust. The valuation is not reported as being subject to ‘material valuation uncertainty’ as defined by VPS 3 and VPGA 10 of the RICS valuation.
10
Where income is derived from contracts with customers, it is accounted for under IFRS 15. The GAM expands the definition of a contract to include legislation and regulations which enables an entity to receive cash or another financial asset that is not classified as a tax by the Office of National Statistics (ONS).
The main source of income for the trust is contracts with commissioners for health care services. In 2021/22 and 2020/21, the majority of the trust’s income from NHS commissioners was in the form of block contract arrangements. The trust receives block funding from its commissioners, where funding envelopes are set at an Integrated Care System level. For the first half of the 2021/22 comparative year these blocks were set for individual NHS providers directly, but the revenue recognition principles are the same.
Revenue from contracts with customers
Revenue from NHS contracts
The trust also receives additional income outside of the block payments to reimburse specific costs incurred and, in 2021/22, other income top ups to support the delivery of services. Reimbursement and top up income is accounted for as variable consideration.
Note 1.4.1
Revenue in respect of goods/services provided is recognised when (or as) performance obligations are satisfied by transferring promised goods/services to the customer and is measured at the amount of the transaction price allocated to those performance obligations. At the year end, the trust accrues income relating to performance obligations satisfied in that year. Where the trust’s entitlement to consideration for those goods or services is unconditional a contract receivable will be recognised. Where entitlement to consideration is conditional on a further factor other than the passage of time, a contract asset will be recognised. Where consideration received or receivable relates to a performance obligation that is to be satisfied in a future period, the income is deferred and recognised as a contract liability.
In 2021/22, the elective recovery fund enabled systems to earn income linked to the achievement of elective activity targets including funding any increased use of independent sector capacity. Income earned by the system is distributed between individual entities by local agreement. Income earned from the fund is accounted for as variable consideration. Where the effects of practical expedients mandated by the GAM are material, these should be disclosed as accounting policies. These include: (1) Per paragraph 121 of the Standard the trust does not disclose information regarding performance obligations part of a contract that has an original expected duration of one year or less. (2) The GAM does not require the trust to disclose information where revenue is recognised in line with the practical expedient offered in paragraph B16 of the Standard where the right to consideration corresponds directly with value of the performance completed to date. (3) The GAM has mandated the exercise of the practical expedient offered in C7A of the
The accounting policies for revenue recognition and the application of IFRS 15 are consistently applied. The structure of setting funding envelopes in the NHS changed between the first and second half of 2020/21, from an individual NHS provider level to an Integrated Care System level. The funding setting structure remained at an Integrated Care System level during 2021/22. The revenue recognition policies in respect of the different funding structures remain the same.
The related performance obligation is the delivery of healthcare and related services during the period, with the trust’s entitlement to consideration not varying based on the levels of activity performed.
Standard that requires the trust to reflect the aggregate effect of all contracts modified before the date of initial application.
11
Revenue from research contracts
Where research contracts fall under IFRS 15, revenue is recognised as and when performance obligations are satisfied. For some contracts, it is assessed that the revenue project constitutes one performance obligation over the course of the multi year contract. In these cases it is assessed that the trust’s interim performance does not create an asset with alternative use for the trust, and the trust has an enforceable right to payment for the performance completed to date. It is therefore considered that the performance obligation is satisfied over time, and the trust recognises revenue each year over the course of the contract. Some research income alternatively falls within the provisions of IAS 20 for government grants.
Government grants are grants from government bodies other than income from commissioners or trusts for the provision of services. Where a grant is used to fund revenue expenditure it is taken to the Statement of Comprehensive Income to match that expenditure. Where the grants is used to fund capital expenditure, it is credited to the consolidated statement of comprehensive income once conditions attached to the grant have been met. Donations are treated in the same way as government grants.
Short-term employee benefits
Note 1.5 Expenditure on employee benefits
12
Note 1.6 Expenditure on other goods and services
Apprenticeship service income
Salaries, wages and employment-related payments such as social security costs and the apprenticeship levy are recognised in the period in which the service is received from employees. The cost of annual leave entitlement earned but not taken by employees at the end of the period is recognised in the financial statements to the extent that employees are permitted to carry forward leave into the following period.
Expenditure on goods and services is recognised when, and to the extent that they have been received, and is measured at the fair value of those goods and services.
Expenditure is recognised in operating expenses except where it results in the creation of a non-current asset such as property, plant and equipment.
The trust receives income under the NHS injury cost recovery scheme, designed to reclaim the cost of treating injured individuals to whom personal injury compensation has subsequently been paid, for instance by an insurer. The trust recognises the income when performance obligations are satisfied. In practical terms this means that treatment has been given, it receives notification from the Department of Work and Pension's Compensation Recovery Unit, has completed the NHS2 form and confirmed there are no discrepancies with the treatment. The income is measured at the agreed tariff for the treatments provided to the injured individual, less an allowance for unsuccessful compensation claims and doubtful debts in line with IFRS 9 requirements of measuring expected credit losses over the lifetime of the asset.
The value of the benefit received when accessing funds from the Government's apprenticeship service is recognised as income at the point of receipt of the training service. Where these funds are paid directly to an accredited training provider from the trust’s Digital Apprenticeship Service (DAS) account held by the Department for Education, the corresponding notional expense is also recognised at the point of recognition for the benefit.
Note 1.4.2 other income Grants and donations
NHS injury cost recovery scheme
Subsequent expenditure relating to an item of property, plant and equipment is recognised as an increase in the carrying amount of the asset when it is probable that additional future economic benefits or service potential deriving from the cost incurred to replace a component of such item will flow to the enterprise and the cost of the item can be determined reliably. Where a component of an asset is replaced, the cost of the replacement is capitalised if it meets the criteria for recognition above. The carrying amount of the part replaced is de recognised. Other expenditure that does not generate additional future economic benefits or service potential, such as repairs and maintenance, is charged to the Statement of Comprehensive Income in the period in which it is incurred.
Note 1.7.2 measurement Valuation
All property, plant and equipment assets are measured initially at cost, representing the costs directly attributable to acquiring or constructing the asset and bringing it to the location and condition necessary for it to be capable of operating in the manner intended by Assetsmanagement.aremeasured subsequently at valuation. Assets which are held for their service potential and are in use (i.e. operational assets used to deliver either front line services or back office functions) are measured at their current value in existing use. Assets that were most recently held for their service potential but are surplus with no plan to bring them back into use are measured at fair value where there are no restrictions on sale at the reporting date and where they do not meet the definitions of investment properties or assets held for sale.
the cost of the item can be measured reliably the item costs at least £5,000, or collectively, a number of items have a cost of at least £5,000 and individually have cost of more than £250, where the assets are functionally interdependent, had broadly simultaneous purchase dates, are anticipated to have similar disposal dates and are under single managerial control.
Property, plant and equipment
Revaluations of property, plant and equipment are performed with sufficient regularity to ensure that carrying values are not materially different from those that would be determined at the end of the reporting period. Current values in existing use are determined as follows:
Note 1.7.1 Recognition
it is held for use in delivering services or for administrative purposes
it is probable that future economic benefits will flow to, or service potential be provided to the trust it is expected to be used for more than one financial year
Property, plant and equipment is capitalised where:
Where a large asset, for example a building, includes a number of components with significantly different asset lives, e.g., plant and equipment, then these components are treated as separate assets and depreciated over their own useful economic lives.
Subsequent expenditure
13 Note 1.7
land and non specialised buildings market value for existing use
assets, current value in existing use is interpreted as the present value of the asset's remaining service potential, which is assumed to be at least equal to the cost of replacing that service potential. Specialised assets are therefore valued at their depreciated replacement cost (DRC) on a modern equivalent asset (MEA) basis. An MEA basis assumes that the asset will be replaced with a modern asset of equivalent capacity and location requirements of the services being provided. Assets held at depreciated replacement cost have been valued on an alternative site basis where this would meet the location requirements.
Properties in the course of construction for service or administration purposes are carried at cost, less any impairment loss. Cost includes professional fees and, where capitalised in accordance with IAS 23, borrowings costs. Assets are revalued and depreciation commences when the assets are brought into use.
14
Forbasisspecialised
Specialised buildings depreciated replacement cost on a modern equivalent asset
IT equipment, transport equipment, furniture and fittings, and plant and machinery that are held for operational use are valued at depreciated historic cost where these assets have short useful lives or low values or both, as this is not considered to be materially different from current value in existing use.
Depreciation Items of property, plant and equipment are depreciated over their remaining useful lives in a manner consistent with the consumption of economic or service delivery benefits. Freehold land is considered to have an infinite life and is not depreciated.
In applying the RICS Valuation Global Standards the valuer has recognised the ongoing impact of the COVID 19 pandemic during 2021/22. The valuer recognises the pandemic, and the measures taken to tackle COVID 19 continue to affect economies and real estate market. Nevertheless, as at the valuation date some property markets have started to function again, with transaction volumes and other relevant evidence returning to levels where an adequate quantum of market evidence exists upon which to base opinions of value. Accordingly, and for the avoidance of doubt, the valuer's valuation is not reported as subject to 'material uncertainty' as defined by the RICS valuation global standard.
Revaluation losses are charged to the revaluation reserve to the extent that there is an available balance for the asset concerned, and thereafter are charged to operating Gainsexpenses.and losses recognised in the revaluation reserve are reported in the Statement of Comprehensive Income as an item of ‘other comprehensive income’.
Impact of COVID-19 on valuation
The valuation exercise was carried out from 8 December 2021 to 31 March 2022 with the valuation date being 31 March 2022. Valuations were undertaken in accordance with International Financial Reporting Standards (IFRS) as interpreted, and applied by the HMT Treasury FReM compliant with Department of Health Group Manual for Accounts. They are also prepared in accordance with the professional standards of the Royal Institution of Chartered Surveyors: RICS Valuation Global Standards 2017 and RICS UK National Supplement, commonly known together as the 'Red Book'.
In respect of the total value of estate, being the aggregate of current values, including depreciated replacement cost, of operating properties, the fair values of non operational properties and excluding leased properties as at 31 March 2022 may be taken to be [£109.968m]. These values can be apportioned between land [£8.946m] and buildings [£101.022m].
Revaluation gains are recognised in the revaluation reserve, except where, and to the extent that, they reverse a revaluation decrease that has previously been recognised in operating expenses, in which case they are recognised in operating expenditure.
Revaluation gains and losses
On the basis, and for the reasons outlined above, the board of directors are content that the valuation used is reasonable and materially valid.
15
Property, plant and equipment which have been reclassified as ‘held for sale’ cease to be depreciated upon the reclassification. Assets in the course of construction and residual interests in off-Statement of Financial Position PFI contract assets are not depreciated until the asset is brought into use or reverts to the trust, respectively.
De-recognition Assets intended for disposal are reclassified as ‘held for sale’ once the criteria in IFRS 5 are met. The sale must be highly probable and the asset available for immediate sale in its present condition.
16
Impairments In accordance with the GAM, impairments that arise from a clear consumption of economic benefits or of service potential in the asset are charged to operating expenses. A compensating transfer is made from the revaluation reserve to the income and expenditure reserve of an amount equal to the lower of (i) the impairment charged to operating expenses; and (ii) the balance in the revaluation reserve attributable to that asset before the impairment. An impairment that arises from a clear consumption of economic benefit or of service potential is reversed when, and to the extent that, the circumstances that gave rise to the loss is reversed. Reversals are recognised in operating expenditure to the extent that the asset is restored to the carrying amount it would have had if the impairment had never been recognised. Any remaining reversal is recognised in the revaluation reserve. Where, at the time of the original impairment, a transfer was made from the revaluation reserve to the income and expenditure reserve, an amount is transferred back to the revaluation reserve when the impairment reversal is recognised. Other impairments are treated as revaluation losses. Reversals of ‘other impairments’ are treated as revaluation gains. 1.7.3
Note
Note 1.7.4
17
Donated and grant funded assets
Property, plant and equipment which is to be scrapped or demolished does not qualify for recognition as ‘held for sale’ and instead is retained as an operational asset and the asset’s useful life is adjusted. The asset is de recognised when scrapping or demolition occurs.
Donated and grant funded property, plant and equipment assets are capitalised at their fair value on receipt. The donation/grant is credited to income at the same time, unless the donor has imposed a condition that the future economic benefits embodied in the grant are to be consumed in a manner specified by the donor, in which case, the donation/grant is deferred within liabilities and is carried forward to future financial years to the extent that the condition has not yet been met. The donated and grant funded assets are subsequently accounted for in the same manner as other items of property, plant and equipment. In 2021/22, this includes assets donated to the trust by the Department of Health and Social Care as part of the response to the coronavirus pandemic. As defined in the GAM, the trust applies the principle of donated asset accounting to assets that the trust controls and is obtaining economic benefits from at the year end.
Following reclassification, the assets are measured at the lower of their existing carrying amount and their fair value less costs to sell. Depreciation ceases to be charged and the assets are not revalued, except where the 'fair value less costs to sell' falls below the carrying amount. Assets are de-recognised when all material sale contract conditions have been met.
Internally generated goodwill, brands, mastheads, publishing titles, customer lists and similar items are not capitalised as intangible assets.
14 Not Noteapplicable1.7.5Useful lives of property, plant and equipment
Years Years
Useful lives reflect the total life of an asset and not the remaining life of an asset. The range of useful lives is shown in the table below: Min life Max life Buildings Plant and machinery
Furniture and fittings
Intangible assets are recognised initially at cost, comprising all directly attributable costs needed to create, produce and prepare the asset to the point that it is capable of operating in the manner intended by management.
Intangible assets are non-monetary assets without physical substance which are capable of being sold separately from the rest of the trust’s business or which arise from contractual or other legal rights. They are recognised only where it is probable that future economic benefits will flow to, or service potential be provided to, the trust and where the cost of the asset can be measured reliably.
Expenditure on research is not capitalised. Expenditure on development is capitalised when it meets the requirements set out in IAS 38.
Note 1.8 Intangible assets
5 15
Internally generated intangible assets
Software
15 30
Note 1.8.1 Recognition
5 15 Transport equipment 3 7 Information technology 5 8
Finance leased assets (including land) are depreciated over the shorter of the useful life or the lease term, unless the trust expects to acquire the asset at the end of the lease term in which case the assets are depreciated in the same manner as owned assets above.
Note 1.8.2
Software which is integral to the operation of hardware, e.g. an operating system, is capitalised as part of the relevant item of property, plant and equipment. Software which is not integral to the operation of hardware, e.g. application software, is capitalised as an intangible asset.
Subsequently, intangible assets are measured at current value in existing use. Where no active market exists, intangible assets are valued at the lower of depreciated replacement cost and the value in use where the asset is income generating. Revaluations gains and losses and impairments are treated in the same manner as for property, plant and equipment. An intangible asset which is surplus, with no plan to bring it back into use, is valued at fair value where there are no restrictions on sale at the reporting date and where they do not meet the definitions of investment properties or assets held for sale. Intangible assets held for sale are measured at the lower of their carrying amount or "fair value less costs to sell".
Measurement
Amortisation
Intangible assets are amortised over their expected useful lives in a manner consistent with the consumption of economic or service delivery benefits.
14
Useful lives reflect the total life of an asset and not the remaining life of an asset. The range of useful lives is shown in the table below:
Min life Max life Years Years Information technology 5 8 Development expenditure 5 8
Note 1.8.3 Useful economic life of intangible assets
20
Cash is cash in hand and deposits with any financial institution repayable without penalty on notice of not more than 24 hours. Cash equivalents are investments that mature in three months or less from the date of acquisition and that are readily convertible to known amounts of cash with insignificant risk of change in value.
Financial assets or financial liabilities in respect of assets acquired or disposed of through finance leases are recognised and measured in accordance with the accounting policy for leases described below.
Financial assets and financial liabilities are initially measured at fair value plus or minus directly attributable transaction costs except where the asset or liability is not measured at fair value through income and expenditure. Fair value is taken as the transaction price, or otherwise determined by reference to quoted market prices or valuation techniques.
Note 1.10
Cash and cash equivalents
Financial assets and financial liabilities
Cash, bank and overdraft balances are recorded at current values.
Note 1.11.2
Inventories
Note 1.11
Financial assets are classified as fair value through income and expenditure. Financial liabilities are classified as fair value through income and expenditure.
In the Statement of Cash Flows, cash and cash equivalents are shown net of bank overdrafts that are repayable on demand and that form an integral part of the trust’s cash management.
Inventories are valued at the lower of cost and net realisable value. The cost of inventories is measured using the weighted average cost method. In 2020/21 and 2021/22, the trust received push inventories including personal protective equipment from the Department of Health and Social Care at nil cost. In line with the GAM and applying the principles of the IFRS Conceptual Framework, the trust has accounted for the receipt of these inventories at a deemed cost, reflecting the best available approximation of an imputed market value for the transaction based on the cost of acquisition by the department.
Financial assets and financial liabilities arise where the trust is party to the contractual provisions of a financial instrument, and as a result has a legal right to receive or a legal obligation to pay cash or another financial instrument. The GAM expands the definition of a contract to include legislation and regulations which give rise to arrangements that in all other respects would be a financial instrument and do not give rise to transactions classified as a tax by the Office of National Statistics (ONS). This includes the purchase or sale of non financial items (such as goods or services), which are entered into in accordance with the trust’s normal purchase, sale or usage requirements and are recognised when, and to the extent which, performance occurs, i.e., when receipt or delivery of the goods or services is made.
Note 1.9
Classification and measurement
Note 1.11.1 Recognition
Impairment
All outstanding non NHS receivables over one year old are included in the credit loss allowance. Any receivable relating to prescription charges that are over six months old plus any receivable where the trust considers there to be a high risk of being uncollectable are included. The amount included for Injury Cost Recovery receivables follows the DHSC GAM guidance (an allowance of 23.76% of outstanding receivables is included was previously 22.43% in 2020/21).
Note 1.11.3 De-recognition
21
Financial assets are de recognised when the contractual rights to receive cash flows from the assets have expired or the trust has transferred substantially all the risks and rewards of ownership. Financial liabilities are de-recognised when the obligation is discharged, cancelled or expires.
Expected losses are charged to operating expenditure within the Statement of Comprehensive Income and reduce the net carrying value of the financial asset in the Statement of Financial Position.
The trust adopts the simplified approach to impairment for contract and other receivables, contract assets and lease receivables, measuring expected losses as at an amount equal to lifetime expected losses. For other financial assets, the loss allowance is initially measured at an amount equal to 12 month expected credit losses (stage one) and subsequently at an amount equal to lifetime expected credit losses if the credit risk assessed for the financial asset significantly increases (stage two).
For all financial assets measured at amortised cost including lease receivables, contract receivables and contract assets or assets measured at fair value through other comprehensive income, the trust recognises an allowance for expected credit losses.
Financial assets and financial liabilities at amortised cost Financial assets and financial liabilities at amortised cost are those held with the objective of collecting contractual cash flows and where cash flows are solely payments of principal and interest. This includes cash equivalents, contract and other receivables, trade and other payables, rights and obligations under lease arrangements and loans receivable and Afterpayable.initial recognition, these financial assets and financial liabilities are measured at amortised cost using the effective interest method less any impairment (for financial assets). The effective interest rate is the rate that exactly discounts estimated future cash payments or receipts through the expected life of the financial asset or financial liability to the gross carrying amount of a financial asset or to the amortised cost of a financial Interestliability.
For financial assets that have become credit impaired since initial recognition (stage 3), expected credit losses at the reporting date are measured as the difference between the asset’s gross carrying amount and the present value of estimated future cash flows discounted at the financial asset’s original effective interest rate.
revenue or expense is calculated by applying the effective interest rate to the gross carrying amount of a financial asset or amortised cost of a financial liability as recognised in the Statement of Comprehensive Income and a financing income or expense. In the case of loans held from the Department of Health and Social Care, the effective interest rate is the nominal rate of interest charged on the loan. of assets
Where a lease is for land and buildings, the land component is separated from the building component and the classification for each is assessed separately.
Note 1.12.2 The trust as lessor Finance leases
Note 1.12
Note 1.12.1 The trust as lessee Finance leases
Operating lease payments are recognised as an expense on a straight line basis over the lease term. Lease incentives are recognised initially as a liability and subsequently as a reduction of rentals on a straight line basis over the lease term. Contingent rentals are recognised as an expense in the period in which they are incurred.
The asset and liability are recognised at the commencement of the lease. Thereafter the asset is accounted for as an item of property plant and equipment.
Amounts due from lessees under finance leases are recorded as receivables at the amount of the trust's net investment in the leases. Finance lease income is allocated to accounting periods to reflect a constant periodic rate of return on the trust's net investment outstanding in respect of the leases. Operating leases
Leases are classified as finance leases when substantially all the risks and rewards of ownership are transferred to the lessee. All other leases are classified as operating leases.
Where substantially all risks and rewards of ownership of a leased asset are borne by the trust, the asset is recorded as property, plant and equipment and a corresponding liability is recorded. The value at which both are recognised is the lower of the fair value of the asset or the present value of the minimum lease payments, discounted using the interest rate implicit in the lease. The implicit interest rate is that which produces a constant periodic rate of interest on the outstanding liability.
Leases of land and buildings
22
The annual rental charge is split between the repayment of the liability and a finance cost so as to achieve a constant rate of finance over the life of the lease. The annual finance cost is charged to finance costs in the Statement of Comprehensive Income.
Rental income from operating leases is recognised on a straight line basis over the term of the lease. Initial direct costs incurred in negotiating and arranging an operating lease are added to the carrying amount of the leased asset and recognised as an expense on a straight line basis over the lease term.
Operating leases
Leases
23
Note 1.14 Contingencies
Contingent liabilities are defined as: possible obligations arising from past events whose existence will be confirmed only by the occurrence of one or more uncertain future events not wholly within the entity’s control; or
Non-clinical risk pooling
Note 1.13 Provisions
The trust recognises a provision where it has a present legal or constructive obligation of uncertain timing or amount; for which it is probable that there will be a future outflow of cash or other resources; and a reliable estimate can be made of the amount. The amount recognised in the Statement of Financial Position is the best estimate of the resources required to settle the obligation. Where the effect of the time value of money is significant, the estimated risk- adjusted cash flows are discounted using the discount rates published and mandated by HM Treasury. The discount rate used by the trust for early retirements is minus 1.30% in real terms (2020/21 rate was minus 0.95%): Clinical negligence costs NHS Resolution operates a risk pooling scheme under which the trust pays an annual contribution to NHS Resolution, which, in return, settles all clinical negligence claims.
Contingent assets (that is, assets arising from past events whose existence will only be confirmed by one or more future events not wholly within the entity’s control) are not recognised as assets, but are disclosed in note 26 where an inflow of economic benefits is probable. Contingent liabilities are not recognised, but are disclosed in note 26, unless the probability of a transfer of economic benefits is remote.
present obligations arising from past events but for which it is not probable that a transfer of economic benefits will arise or for which the amount of the obligation cannot be measured with sufficient reliability.
Although NHS Resolution is administratively responsible for all clinical negligence cases, the legal liability remains with the trust. The total value of clinical negligence provisions carried by NHS Resolution on behalf of the trust is disclosed at note 25 but is not recognised in the trust’s accounts.
The trust participates in the property expenses scheme and the liabilities to third parties scheme. Both are risk pooling schemes under which the trust pays an annual contribution to NHS Resolution and in return receives assistance with the costs of claims arising. The annual membership contributions, and any excesses payable in respect of particular claims are charged to operating expenses when the liability arises.
Note 1.16 Value Added Tax (VAT)
Public Dividend Capital (PDC) is a type of public sector equity finance based on the excess of assets over liabilities at the time of establishment of the predecessor NHS organisation. HM Treasury has determined that PDC is not a financial instrument within the meaning of IAS 32. The Secretary of State can issue new PDC to, and require repayments of PDC from, the trust. PDC is recorded at the value received. A charge, reflecting the cost of capital utilised by the trust, is payable as public dividend capital dividend. The charge is calculated at the rate set by HM Treasury (currently 3.5%) on the average relevant net assets of the trust during the financial year. Relevant net assets are calculated as the value of all assets less the value of all liabilities, with certain additions and deductions as defined by in the PDC dividend policy issued by the Department of Health and Social Care. This policy is available at https://www.gov.uk/government/publications/guidance on financing-available-to-nhs-trusts- and-foundation-trusts.
Note 1.15 public dividend capital
In accordance with the requirements laid down by the Department of Health and Social Care (as the issuer of PDC), the dividend for the year is calculated on the actual average relevant net assets as set out in the “pre audit” version of the annual accounts. The dividend calculated is not revised should any adjustment to net assets occur as a result the audit of the annual accounts.
Most of the activities of the trust are outside the scope of VAT and, in general, output tax does not apply and input tax on purchases is not recoverable. Irrecoverable VAT is charged to the relevant expenditure category or included in the capitalised purchase cost of fixed assets. Where output tax is charged or input VAT is recoverable, the amounts are stated net of VAT.
24
Note 1.19
25
A transaction which is denominated in a foreign currency is translated into the functional currency at the spot exchange rate on the date of the transaction.
The functional and presentational currency of the trust is sterling.
and special payments note is compiled directly from the losses and compensations register which reports on an accrual basis with the exception of provisions for future losses.
Note 1.17 Foreign exchange
Exchange gains or losses on monetary items (arising on settlement of the transaction or on re-translation at the Statement of Financial Position date) are recognised in income or expense in the period in which they arise.
Third party assets
Note 1.20 Gifts
Note 1.18
Losses and special payments
Losses and special payments are items that Parliament would not have contemplated when it agreed funds for the health service or passed legislation. By their nature they are items that ideally should not arise. They are therefore subject to special control procedures compared with the generality of payments. They are divided into different categories, which govern the way that individual cases are handled. Losses and special payments are charged to the relevant functional headings in expenditure on an accruals
Thebasis.losses
Gifts are items that are voluntarily donated, with no preconditions and without the expectation of any return. Gifts include all transactions economically equivalent to free and unremunerated transfers, such as the loan of an asset for its expected useful life, and the sale or lease of assets at below market value.
Assets belonging to third parties (such as money held on behalf of patients) are not recognised in the Accounts since the trust has no beneficial interest in them. However, they are disclosed in a separate note to the Accounts in accordance with the requirements of HM Treasury’s FReM.
Exchange gains or losses on non monetary assets and liabilities are recognised in the same manner as other gains and losses on these items.
Where the trust has assets or liabilities denominated in a foreign currency at the Statement of Financial Position date: monetary items are translated at the spot exchange rate on 31 March non monetary assets and liabilities measured at historical cost are translated using the spot exchange rate at the date of the transaction and non-monetary assets and liabilities measured at fair value are translated using the spot exchange rate at the date the fair value was determined.
Additional lease obligations recognised for existing operating leases Net impact on net assets on 1 April 2022 £000 (22,448)23,097 649
The trust's incremental borrowing rate will be a rate defined by HM Treasury. For 2022, this rate is 0.95%. The related right of use asset will be measured equal to the lease liability adjusted for any prepaid or accrued lease payments. For existing peppercorn leases not classified as finance leases, a right of use asset will be measured at current value in existing use or fair value.
Note
No new accounting standards or revisions to existing standards have been early adopted in 2021/22. 1.22 Standards, amendments and interpretations in issue but not yet effective or adoptedIFRS16Leases
Lease rentals no longer charged to operating expenditure 2,170 Estimated impact on surplus / deficit in 2022/23 41
21 Note 1.21 Early adoption of standards, amendments and interpretations
IFRS 16 changes the definition of a lease compared to IAS 17 and IFRIC 4. The trust will apply this definition to new leases only and will grandfather its assessments made under the old standards of whether existing contracts contain a lease.
IFRS 16 Leases will replace IAS 17 Leases, IFRIC 4 Determining whether an arrangement contains a lease and other interpretations and is applicable in the public sector for periods beginning 1 April 2022. The standard provides a single accounting model for lessees, recognising a right of use asset and obligation in the statement of financial position for most leases: some leases are exempt through application of practical expedients explained below. For those recognised in the statement of financial position the standard also requires the remeasurement of lease liabilities in specific circumstances after the commencement of the lease term. For lessors, the distinction between operating and finance leases will remain and the accounting will be largely unchanged.
On transition to IFRS 16 on 1 April 2022, the trust will apply the standard retrospectively without restatement and with the cumulative effect of initially applying the standard recognised in the income and expenditure reserve at that date. For existing operating leases with a remaining lease term of more than 12 months and an underlying asset value of at least £5,000, a lease liability will be recognised equal to the value of remaining lease payments discounted on transition at the trust’s incremental borrowing rate.
The trust has estimated the impact of applying IFRS 16 in 2022/23 on the opening statement of financial position and the in year impact on the statement of comprehensive income and capital additions as follows:
Estimated in-year impact in 2022/23 Additional depreciation on right of use assets (1,930) Additional finance costs on lease liabilities (199)
The difference between the asset value and the calculated lease liability will be recognised in the income and expenditure reserve on transition. No adjustments will be made on 1 April 2022 for existing finance leases. For leases commencing in 2022/23, the trust will not recognise a right of use asset or lease liability for short term leases (less than or equal to 12 months) or for leases of low value assets (less than £5,000). Right of use assets will be subsequently measured on a basis consistent with owned assets and depreciated over the length of the lease term.
Estimated impact on 1 April 2022 statement of financial position Additional right of use assets recognised for existing operating leases
Provisions have been made for legal and constructive obligations of uncertain timing or amount as at the reporting date where the liability meets the recognition criteria of IAS 37. These are based on judgements and estimates of future cash flows and are dependent on future events. Any differences between expectations and the actual future liability will be accounted for in the period when such determination is made.
Note
21
Provisions
Other standards, amendments and interpretations 1.23 Sources of estimation uncertainty
The following are assumptions about the future and other major sources of estimation uncertainty that have a significant risk of resulting in a material adjustment to the carrying amounts of assets and liabilities within the next financial year:
Public liability claims are based on information received from the NHS Resolution (NHSR, previously NHS Litigation Authority) which handles claims on behalf of the trust. For cases not yet concluded, provision, or contingent liability, is made according to NHSR assessment of expected outcomes.
Pensions provisions are based on information received from NHS Pension Agency (part of NHS Business Services Authority). Other provisions for legal and constructive obligations (including employment) are made by management, and informed by professional opinion. Provisions are made where past events are known and settlement by the trust is probable and a reliable estimate can be made. As actual settlement is not known at the reporting date provisions are calculated on the best information available on likely settlement at the date the Accounts are approved. At the end of each accounting period management review expenditure items that are outstanding and estimate the amount to be accrued in financial statements. Accruals are generally based on estimates and judgements of historical trends and outcomes. Any variation in prior periods has not been material to the accounts.
22
Operating income from patient care activities
Note 2
All income from patient care activities relates to contract income recognised in line withaccounting policy 1.4
Note
Non patient care services to other bodies 3,682 3,682 2,782 2,782 and top up funding 2,028 2,028 27,454 27,454
Receipt of capital grants and donations - 500 500 - 1,857 1,857
Reimbursement
23 Note 2.3 Overseas visitors (relating to patients charged directly by the provider) 2021/22 2020/21 £000 £000 Income recognised this year 149 100 Cash payments received in year 55 92
Charitable and other contributions to expenditure - 802 802 - 4,888 4,888 Rental revenue from operating leases 458 458 801 801 Other income 3,239 - 3,239 1,318 - 1,318 Total other operating income 18,642 1,760 20,402 39,741 7,546 47,287 Of which: Related to continuing operations 20,402 47,287
Amounts added to provision for impairment of receivables 199 Amounts written off in-year 123 1 3 Other operating income 2021/22 2020/21 Non-contractincome Total Contractincome Non-contractincome Total £000 £000 £000 £000 £000 £000 Research and development 712 - 712 543 - 543 Education and training 8,981 8,981 7,644 7,644
Contractincome
24 Note 4 Operating expenses 2021/22 2020/21 £000 £000
Depreciation on property, plant and equipment 9,543 8,520 Amortisation on intangible assets 2,441 1,931 Net impairments 341 Movement in credit loss allowance: contract receivables / contract assets 62 526 Change in provisions discount rate(s) 5 Fees payable to the external auditor audit services statutory audit 198 138 Internal audit costs 139 89 Clinical negligence 13,867 13,010 Legal fees 965 382 Insurance 189 165 Education and training 817 710 Rentals under operating leases 2,461 2,624 Redundancy 11 35 Car parking & security 2,088 802 Hospitality 6 12 Losses, ex gratia & special payments 489 297 Other services, e g external payroll 247 199 Other 189 377 Total 349,782 308,104 Of which: Related to continuing operations 349,782 308,104
Remuneration of non executive directors 147 114 Supplies and services clinical (excluding drugs costs) 24,280 22,152 Supplies and services general 4,804 3,133 Drug costs (drugs inventory consumed and purchase of non inventory drugs) 25,737 21,087
Purchase of social care Staff and executive directors costs 220,101 203,722
Purchase of healthcare from NHS and DHSC bodies 5,966 2,426 Purchase of healthcare from non NHS and non DHSC bodies 11,506 4,768
Inventories written down 242 Consultancy costs 5,508 3,419 Establishment 2,695 2,249 Premises 14,257 14,219 Transport (including patient travel) 827 652
Net
Note 5 Impairment of assets 2021/22 2020/21
341 Total
186 19,089
186 18,748 Total
The limitation on auditor's liability for external audit work is £2 million (2020/21: £2 million). £000 £000 impairments charged to operating surplus / deficit resulting from: Changes in market price net impairments charged to operating surplus / deficit charged to the revaluation reserve net impairments
25 Note 4.1 Limitation on auditor's liability
341 Impairments
During 2021/22 there were no early retirements from the trust agreed on the grounds of ill health (3 in the year ended 31 March 2021). The estimated additional pension liabilities of these ill health retirements is 0k (£147k in 2020/21). These estimated costs are calculated on an average basis and will be borne by the NHS Pension Scheme.
26 Note 6 Employee benefits 2021/22 2020/21 Total Total £000 £000 Salaries and wages 143,481 136,950 Social security costs 14,723 12,456 Apprenticeship levy 715 606 Employer's contributions to NHS pensions 24,288 23,171 Pension cost other 33 36 Temporary staff (including agency) 38,382 33,141 Total gross staff costs 221,622 206,360 Of which Costs capitalised as part of assets 1,510 2,603 Note 6.1 Retirements due to ill-health
The latest actuarial valuation undertaken for the NHS Pension Scheme was completed as at 31 March 2016. The results of this valuation set the employer contribution rate payable from April 2019 at 20.6%, and the Scheme Regulations were amended accordingly.
27
Both are unfunded defined benefit schemes that cover NHS employers, GP practices and other bodies, allowed under the direction of the Secretary of State in England and Wales. They are not designed to be run in a way that would enable NHS bodies to identify their share of the underlying scheme assets and liabilities. Therefore, each scheme is accounted for as if it were a defined contribution scheme: the cost to the NHS body of participating in each scheme is taken as equal to the contributions payable to that scheme for the accounting period.
Note 7 Pension costs Past and present employees are covered by the provisions of the two NHS Pension Schemes.
In order that the defined benefit obligations recognised in the financial statements do not differ materially from those that would be determined at the reporting date by a formal actuarial valuation, the FReM requires that “the period between formal valuations shall be four years, with approximate assessments in intervening years”. An outline of these follows:
a) Accounting valuation A valuation of scheme liability is carried out annually by the scheme actuary (currently the Government Actuary’s Department) as at the end of the reporting period. This utilises an actuarial assessment for the previous accounting period in conjunction with updated membership and financial data for the current reporting period, and is accepted as providing suitably robust figures for financial reporting purposes. The valuation of the scheme liability as at 31 March 2021, is based on valuation data as at 31 March 2021, updated to 31 March 2022 with summary global member and accounting data. In undertaking this actuarial assessment, the methodology prescribed in IAS 19, relevant FReM interpretations, and the discount rate prescribed by HM Treasury have also been Thused.elatest assessment of the liabilities of the scheme is contained in the report of the scheme actuary, which forms part of the annual NHS Pension Scheme Accounts. These accounts can be viewed on the NHS Pensions website and are published annually. Copies can also be obtained from The Stationery Office.
b) Full actuarial (funding) valuation
Details of the benefits payable and rules of the Schemes can be found on the NHS Pensions website at www.nhsbsa.nhs.uk/pensions.
The 2016 funding valuation was also expected to test the cost of the Scheme relative to the employer cost cap set following the 2012 valuation. Following a judgment from the Court of Appeal in December 2018 Government announced a pause to that part of the valuation process pending conclusion of the continuing legal process.
The purpose of this valuation is to assess the level of liability in respect of the benefits due under the schemes (taking into account recent demographic experience), and to recommend contribution rates payable by employees and employers.
Where the trust offers an additional defined contribution workplace pension scheme (e.g. the National Employment Savings Scheme (NEST)), there should be additional disclosures in relation to this scheme as required by paragraph 50 onwards of IAS 19.
28
Where staff are not eligible for, or choose to opt out of, the NHS Pensions Scheme, they are entitled to join the National Employment Savings Trust (NEST) scheme. NEST is a government backed, defined contribution pension scheme set up to make sure that every employer can easily access a workplace pension scheme. The employer's contribution rate in 2021/22 was 3% (2020/21: 3%)
NEST Pension Scheme
29
Note Operating leases
8
30
Finance expenditure represents interest and other charges involved in the borrowing of money or asset financing. 2021/22 2020/21 £000 £000 Interest expense: Unwinding of discount on provisions (7) (7) Other finance costs 13 25 Total finance costs 6 18
Note 9 Finance income Finance income represents interest received on assets and investments in the period. 2021/22 2020/21 £000 £000 Interest on bank accounts 29 Total finance income 29
Note 10 Finance expenditure
Valuation / gross cost at 1 April 2021 - brought forward 1,583 15,295 16,878
Total £000 £000 £000
Valuation / gross cost at 31 March 2021 1,583 15,295 16,878
Additions 5,763 451 6,214
31
Note 11 Intangible assets - 2021/22
Valuation / gross cost at 31 March 2022 7,415 15,746 23,161
Amortisation at 31 March 2022 558 11,592 12,150
Total £000 £000 £000
Reclassifications 69 69
Net book value at 31 March 2022 6,857 4,154 11,011
informationgeneratedInternallytechnology Developmentexpenditure
Prior period adjustmentsAdditions 1,467 - 1,467
Note 11.1 Intangible assets - 2020/21
Provided during the year 3 1,928 1,931
informationgeneratedInternallytechnology Developmentexpenditure
Provided during the year 519 1,922 2,441
Valuation / gross cost at 1 April 2020 - as previously stated 116 15,295 15,411
Amortisation at 1 April 2020 - as previouslystated 36 7,742 7,778
Amortisation at 31 March 2021 39 9,670 9,709
Net book value at 1 April 2020 80 7,553 7,633
Amortisation at 1 April 2021 - brought forward 39 9,670 9,709
Net book value at 1 April 2021 1,544 5,625 7,169
Net book value at 31 March 2021 1,544 5,625 7,169
Transfers by absorption - - - - - - -Additions 9,762 25,018 9,064 4,169 36 48,049 Impairments - (19,089) - - - - - (19,089)
Accumulated depreciation at 1 April 2021 – brought forward - 3,761 - 21,944 136 15,057 1,136 42,034
Note 12.1 Property, plant and equipment2021/22 Land dwellingsexcludingBuildings Assets constructionunder Plant machinery& equipmentTransport Informationtechnology Furniturefittings& Total £000 £000 £000 £000 £000 £000 £000 £000
Accumulated depreciation at 31 March 2022 - 3,686 - 24,939 162 17,872 1,157 47,816
Valuation/gross cost at 31 March 2022 8,946 104,708 14,567 41,535 279 25,580 1,332 196,947
Revaluations 796 796 Reclassifications 4,684 (4,684) (69) (69)
Note 12.2 Property, plant and equipment - 2020/21 Land excludingBuildingsdwellings Assets constructionunder & fittings& Total £000 £000 £000 £000 £000 £000 £000 £000
Net book value at 31 March 2022 8,946 101,022 14,567 16,596 117 7,708 175 149,131 Net book value at 1 April 2021 8,150 84,428 19,251 15,212 143 10,592 69 137,845
Valuation/gross cost at 1 April 2021 - brought forward 8,150 88,189 19,251 37,156 279 25,649 1,205 179,879 Additions 15,782 4,379 127 20,288 Impairments - (186) - - - - - (186) Reversals of Depreciation (3,761) (3,761)
Reversal of Depreciation - (3,761) - - - - - (3,761)
32
Prior period adjustmentsValuation / gross cost at 1 April 2020 - restated 8,150 80,176 11,637 28,028 279 21,480 1,169 150,919
Provided during the year 3,686 2,995 26 2,815 21 9,543
Valuation / gross cost at 1 April 2020 - as previously stated 8,150 80,176 11,637 28,028 279 21,480 1,169 150,919
machinery equipmentTransport Informationtechnology Furniture
Plant
33
Transfers by absorption - - - - - - -Provided during the year 3,192 2,243 27 3,046 12 8,520
Net book value at 31 March 2021 8,150 84,428 19,251 15,212 143 10,592 69 137,845
Net book value at 1 April 2020 8,150 79,607 11,637 8,327 170 9,469 45 117,405
Reclassifications 17,340 (17,404) 64 -
Valuation/gross cost at 31 March 2021 8,150 88,189 19,251 37,156 279 25,649 1,205 179,879
Accumulated depreciation at 1 April 2020 - as previouslystated - 569 - 19,701 109 12,011 1,124 33,514
Accumulated depreciation at 31 March 2021 - 3,761 - 21,944 136 15,057 1,136 42,034
Note 12.4 Property, plant and equipment financing - 2020/21 Land dwellingsexcludingBuildings Assets constructionunder Plant machinery& equipmentTransport Informationtechnology Furniturefittings& Total £000 £000 £000 £000 £000 £000 £000 £000 Net book value at 31 March 2021 Owned purchased 8,150 84,428 19,251 13,071 143 10,592 69 135,704 Finance leased 71 71 Owned - donated/granted - - - 2,070 - - - 2,070 NBV total at 31 March 2021 8,150 84,428 19,251 15,212 143 10,592 69 137,845
34
Note 12.3 Property, plant and equipment financing - 2021/22 Land dwellingsexcludingBuildings Assets constructionunder Plant machinery& eTransportquipment Informationtechnology Furniturefittings& Total £000 £000 £000 £000 £000 £000 £000 £000 Net book value at 31 March 2022 Owned - purchased 8,946 101,022 14,567 14,729 117 7,708 175 147,264 Finance leased 10 10 Owned - donated/granted - - - 1,857 - - - 1,857 NBV total at 31 March 2022 8,946 101,022 14,567 16,596 117 7,708 175 149,131
Note 13 Donations of property, plant and equipment
Note 14 Revaluations of property, plant and equipment
Specialised properties
35
The standards define a specialised property as: “A property that is rarely, if ever, sold in the market, except by way of a sale of the business or entity of which it is part, due to the uniqueness arising from its specialised nature and design, its configuration, size, location or otherwise.”
A full commentary on the meaning of and implicit assumptions within this definition is included in the Standards and a copy of this can be provided on request.
The trusts received a £500k cash donation (SELEP Claim) from Essex County Council of property, plant and equipment received during the year in relation to our Learning and Education Centre, there were no restrictions or conditions imposed by the donor.
“The estimated amount for which an asset or liability should exchange on the valuation date between a willing buyer and a willing seller in an arm’s length transaction after proper marketing and where the parties had acted knowledgeably, prudently and without compulsion, assuming that the buyer is granted vacant possession of all parts of the asset required by the business, and disregarding potential alternative uses and any other characteristics of the asset that would cause its market value to differ from that needed to replace the remaining service potential at least cost.”
Operational property Table 6.2 of FReM ‘Interpretations and adaptations of IAS 16 for the public sector context’ states that: “Assets which are held for their service potential (i.e. operational assets) and are in use should be measured at current value in existing use. For non specialised assets current value in existing use should be interpreted as market value for existing use. In the RICS Red Book, this is defined as Existing Use Value (EUV).”
The valuations from GE have been carried out in accordance with the Valuation Global Standards (January 2022 edition) published by the Royal Institution of Chartered Surveyors (RICS) as at 31 March 2022. We refer in this report to those Global Standards and the national standards and guidance set out in the UK national supplement (November 2018 edition) collectively as “the Standards”.
Basis of valuations
Existing use value is defined in the standards as:
In the preparation of the valuation under IFRS, Gerald Eves have had regard to the Standards and in particular, reference to the following: In compliance with your requirements, the valuations have been prepared to comply with IFRS, specifically with regard to IAS 16 Property, Plant and Equipment, IAS 40 Investment Properties, Department of Health Group Manual for Accounts 2021/22 and to the Government Financial Reporting Manual (FReM) 2021 2022.
For valuations of property to be included in financial statements in accordance with IFRS, the International Valuation Standards prescribe a Fair Value basis, defined in IFRS 13 ‘Fair Value Measurement’ (at paragraph 9) as: “ .. the price that would be received to sell an asset, or paid to transfer a liability, in an orderly transaction between market participants at the measurement date.”
The trust appointed Gerald Eves (GE), independent firm of professional valuers, to provide a report on the movement in building costs and land values during 2021/22 in order to update the fair value of land and buildings
The lack of demand or market for the trust’s property in isolation from its own use means that the land and buildings identified at 5.1 qualify as a “specialised property” under the definitions in the current standards. The standards require such properties to be valued on a Depreciated Replacement Cost (DRC) method. Information on this valuation method is provided in the Depreciated Replacement Cost Method of valuation for financial reporting guidance note (the “DRC Guidance Note”). This guidance note quotes the international valuation standards definition of DRC as: “The current cost of replacing an asset with its modern equivalent asset less deductions for physical deterioration and all relevant forms of obsolescence and optimisation.”
36
“For specialised assets current value in existing use should be interpreted as the present value of the asset’s remaining service potential, which can be assumed to be at least equal to the cost of replacing that service potential.”
The FReM confirms at 6.2 that:
Non-specialised operational properties
For the trust’s non specialised operational properties we have reported. Existing Use Values (EUV) in line with the adaptation of IAS 16 as defined in the FReM.
Note 15 Inventories 31 March2022 31 March2021 £000 £000 Drugs 1,305 1,668 Consumables 3,539 3,983 Energy 253 46 Other 83 Total inventories 5,180 5,697
Inventories recognised in expenses for the year were £40,047k (2020/21: £34,467k). Writedown of inventories recognised as expenses for the year were £181k (2020/21: £0k). In response to the COVID 19 pandemic, the Department of Health and Social Care centrally procured personal protective equipment and passed these to NHS providers free of charge. During 2021/22, the trust received £802k of items purchased by DHSC (2020/21: £4,888k). These inventories were recognised as additions to inventory at deemed cost with the corresponding benefit recognised in income. The utilisation of these items is included in the expenses disclosed above. The deemed cost of these inventories was charged directly to expenditure on receipt with the corresponding benefit recognised in income.
allowances
Allowances as at 31 Mar 2022 1,344 1,689
andreceivablesContractcontractassets andreceivablesContractcontractassets £000
Utilisation
37 Note 16 Receivables 31 March 31 March 2022 2021 £000 £000 Current Contract receivables 7,816 6,242 Allowance for impaired contract receivables / assets (1,344) (1,689) Prepayments (non PFI) 2,887 1,725 PDC dividend receivable 275 VAT receivable 1,790 1,655 Other receivables 116 173 Total current receivables 11,265 8,381 Non current Contract receivables 576 576 Other receivables 711 613 Total non-current receivables 1,287 1,189 Of which receivable from NHS and DHSC group bodies: Current 4,908 3,607 Non current 711 613 Note 16.1 Allowances for credit losses 2021/22 2020/21
£000
Allowances as at 1 April brought forward 1,689 1,193 arising 62 555 Reversals of (29) of allowances (write offs) (407) (30)
New allowances
38
Note 17.1 Third party assets held by the trust
Note 17 Cash and cash equivalents movements
Cash and cash equivalents comprise cash at bank, in hand and cash equivalents. Cash equivalents are readily convertible investments of known value which are subject to an insignificant risk of change in value.
The Princess Alexandra Hospital NHS Trust held cash and cash equivalents which relate to monies held by the trust on behalf of patients or other parties and in which the trust has no beneficial interest. This has been excluded from the cash and cash equivalents figure reported in the accounts. 31 March2022 31 March2021 £000 £000 Bank balances 22 18 Total third partyassets 22 18
Total cash and cash equivalents as in SoFP Total cash and cash equivalents as in SoCF 2021/22 2020/21 £000 £000 65,242 1,144 (14,192) 64,098 51,050 65,242 209 12 50,841 65,230 51,050 65,242 51,050 65,242
At 1 April Net change in year At 31 BrokenMarchdown into: Cash at commercial banks and in hand Cash with the Government Banking Service
39 Note 18 Trade and other payables Current Trade payables 14,410 7,545 Capital payables 6,085 18,407 Accruals 20,622 18,781 Social security costs 143 2,008 Other taxes payable 119 1,719 Other payables 1,256 610 Total current trade and other payables 42,635 49,070 Of which payables from NHS and DHSC group bodies: Current 5,962 3,562 Non current 31 March2022£000 31 March2021£000
40 Note 19 Other liabilities
Note 20.2 Reconciliation of liabilities arising from financing activities - 2020/21 LoansfromDHSC Financeleases
Note 20.1 Reconciliation of liabilities arising from financing activities - 2021/22 LoansfromDHSC Financeleases
Cash movements: Financing cash flows payments and receipts of principal (150,467) (30) (150,497)
Financing cash flows payments of interest (461) (461) Carrying value at 31 March 2021 40 40
Total £000 £000 £000 Carrying value at 1 April 2021 40 40
41
Cash movements: Financing cash flows payments and receipts of principal (30) (30) Carrying value at 31 March 2022 10 10
Total £000 £000 £000 Carrying value at 1 April 2020 150,928 70 150,998
42 Note 21 Finance leases
Expected timing of cash flows: not later than one year; later than one year and not later than five years; later than five years. Total
43 Note 22 Provisions for liabilities and charges analysis
At 31 March 2022
Pensions:earlydeparturecosts
At 1 April 2021 Arising during the year Utilised during the year Reversed Unwindingunusedofdiscount
Legal claims Redundancy Other Total £000 £000 £000 £000 £000 531 806 35 847 2,219 47 519 11 880 1,457 (65) (335) - - (400) (10) (89) (64) (163) (7) - - - (7) 496 901 46 1,663 3,106 65 95 11 782 953 257 806 35 193 1,291 174 - - 688 862 496 901 46 1,663 3,106
At 31 March 2022, £183,537k was included in provisions of NHS Resolution in respect of clinical negligence liabilities of the trust (31 March 2021: £121,087k). capital commitments
Note 23 Contingent assets and liabilities Note 24 Contractual
Note
22.1
44
Clinical negligence liabilities
Financial reporting standard IFRS 7 requires disclosure of the role that financial instruments have had during the period in creating or changing the risks a body faces in undertaking activities. Because of the continuing service provider relationship that the trust has with Commissioners and the way Commissioners are financed, the trust is not exposed to the degree of financial risk faced by business entities. Also financial instruments play a much more limited role in creating or changing risk than would be typical of listed companies, to which financial reporting standards mainly apply.
Credit risk
Financial risk management
The Trust's operating costs are incurred under contracts with Commissioners, which are financed from resources voted annually by Parliament. The trust mainly funds its capital from internally generated funds. The trust is therefore not exposed to significant liquidity risks
The trust's cash management operations are undertaken by the finance department within parameters defined formally within the trust's standing financial instructions and policies agreed by the board of directors The trust's treasury activity is subject to review by the Trust's internal auditors.
The trust can borrow from the government for capital expenditure, subject to approval from NHS Improvement. The borrowings are for 1 25 years, in line with the life of the associated assets, and interest charges at the national loans fund rate, fixed for the life of the loan. The trust can also borrow from the government for revenue support funding, subject to approval form NHS Improvement. Interest rates are confirmed by the lender (Department of Health and Social Care) at the point borrowing is undertaken. The trust therefore has low exposure to interest rate fluctuations.
Currency risk
The trust is principally a domestic organisation with the great majority of transactions, assets and liabilities being in the UK and sterling based. The Trust has no overseas operations. The trust therefore has low exposure to currency rate fluctuations.
Liquidity risk
A majority of the trust's revenue comes from contracts with other public sector bodies, the trust has low exposure to credit risk.
Interest rate risk
45 Note 25 Financial instruments Note 25.1
Obligations under finance leases 40 40 Trade and other payables excluding non financial liabilities 45,343 45,343
Cash and cash equivalents 51,050 51,050
Carrying values of financial assets as at 31 March 2021 Held amortisedatcost
Total at 31 March 2021 45,383 45,383
Total at 31 March 2022 58,866 58,866
Carrying values of financial liabilities as at 31 March 2021 Held amortisedatcost
Total book value £000 £000 Trade and other receivables excluding non financial assets 5,915 5,915 Cash and cash equivalents 65,242 65,242
Obligations under finance leases 10 10 Trade and other payables excluding non financial liabilities 42,373 42,373
Note 25.3 Carrying values of financial liabilities Carrying values of financial liabilities as at 31 March 2022 Held amortisedatcost Total book value £000 £000
Total book value £000 £000
Total book value £000 £000 Trade and other receivables excluding non financial assets 7,816 7,816
Total at 31 March 2021 71,157 71,157
Note 25.2 Carrying values of financial assets Carrying values of financial assets as at 31 March 2022 Held amortisedatcost
Total at 31 March 2022 42,383 42,383
46
47
Note 26 Maturity of financial liabilities
The following maturity profile of financial liabilities is based on the contractual undiscounted cash flows. This differs to the amounts recognised in the statement of financial position which are discounted to present value. 31 March2022 31 March2021 £000 £000 one year or less 42,383 more than one year but not more than five years 10 Total 42,383
45,373 In
45,383
In
48 Note 27 Losses and special payments 2021/22 2020/21 Totalofnumbercases Total value Total number Total value of cases of cases of cases Number £000 Number £000 Losses Fruitless payments and constructive losses 2 126 Bad debts and claims abandoned 1,133 30 Stores losses and damage to property 13 66 3 47 Total losses 13 66 1,138 203 Special payments Compensation under court order or legallybinding arbitration award 10 29 8 47 Ex gratia payments 12 307 14 15 Total special payments 22 336 22 62 Total losses and special payments 35 402 1,160 265 Compensation payments received Details of cases individuallyover £300k There were no individual cases exceeding £300k for the current financial year under review
The Department of Health and Social OtherCare
Note 28 Related parties
During the year none of the DHSC Ministers, trust board members or members of the key management staff, or parties related to any of them, has undertaken transactions within The Princess Alexandra Hospital NHS Trust. The DHSC is regarded as related party. During the year, The Princess Alexandra Hospital 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 Relateddepartment.partiesmay include but are not limited to:
TheAuthoritiesServicesNHSEducationAgencyNHSServicesNHSandAuthorityNHSNHSEnglandHertfordshireNHSCCGNHSandProvidersNHSCCGsNHSEnglandWestEssexEastandNorthCCGNHSandImprovementResolutionBusinessServiceHMRevenueCustomsBloodandTransplantNHSProfessionalsPensionsHealthEnglandPropertyLocalPrincessAlexandraHospital
Charity (registered charity 10547745). The trust receives revenue and capital payments from this charity and certain trustees are also members of the trust board. The charity's objective is to provide support both generally and in certain areas of the trust's activities. During the year the charity contributed £242k (unaudited) to the trust (2020/21 £235k).
49
NHS Payables
Total NHS trade invoices paid in the year 2,538 53,975 2,247 46,030
Note 31 Capital Resource Limit
The Better Payment Practice code requires the NHS body to aim to pay all valid invoices by the due date or within 30 days of receipt of valid invoice, whichever is later. Note 30 External financing limit
Percentage of NHS trade invoices paid within target 88.1% 94.6% 86.7% 93.8%
Total NHS trade invoices paid within target 2,235 51,061 1,948 43,190
50
Non NHS Payables Number £000 Number £000
Note 29 Better payment practice code 2021/22 2021/22 2020/21 2020/21
Percentage of non NHS trade invoices paid within target 88.3% 85.5% 87.5% 84.2%
Cash flow financing Cash flow financing (from SoCF)
Total non NHS trade invoices paid within target 43,027 120,653 38,424 104,216
Gross capital expenditure Less: Disposals Less: Donated and granted capital additions Plus: Loss on disposal from capital grants in kind Charge against Capital Resource Limit 2021/22 2020/21 £000 £000 26,502 49,516 (500) (1,857) 26,002 47,659 Capital Resource Limit Under / (over) spend against CRL 26,002 47,659 -Adjusted financial performance surplus / (deficit) (control total basis) Breakeven dutyfinancial performance surplus / (deficit) 2021/22£000 1,110 1,110
Note 32 Breakeven dutyfinancial performance
External financing requirement 2021/22 2020/21 £000 £000 (20,242) (27,899) (20,242) (27,899) - -
Total non NHS trade invoices paid in the year 48,732 141,040 43,897 123,841
The trust is given an external financing limit against which it is permitted to underspend
Operating income of operating income 2015/16 2016/17 2017/18 2018/19 2019/20 2020/21 2021/22 £000 £000 £000 £000 £000 £000 £000 (37,714) (26,715) (28,435) (16,542) 418 1,816 1,110 (73,070) (99,785) (128,220) (144,762) (144,344) (142,528) (141,418) 196,124 209,742 213,231 236,700 288,491 315,122 355,856 (37.3%) (47.6%) (60.1%) (61.2%) (50.0%) (45.2%) (39.7%)
Breakeven duty cumulative position
Operating income of operating income 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 £000 £000 £000 £000 £000 £000 £000 511 415 461 122 (16,403) (21,998) 1,536 2,047 2,462 2,923 3,045 (13,358) (35,356) 172,171 179,388 180,790 184,568 177,739 190,478 1.2% 1.4% 1.6% 1.6% (7.5%) (18.6%)
51 Note 33
Breakeven duty in year financial performance
Breakeven duty rolling assessment
Breakeven duty cumulative position
Breakeven duty in year financial performance
52
In line with the HM Treasury requirements, some previous accounts disclosures relating to staff costs are now required to be included in the staff report section of the annual report instead. The following tables link to data contained in the TAC and are included here for ease of formatting for the annual report. They should not be included in the annual accounts and these tables are not a complete list of numerical disclosures for the staff report.
Staff costs
