Annual Report 2021/22

Shrewsbury and Telford Hospital NHS Trust Annual Report and Accounts 2021/22

Presented in accordance with the NHS Group Accounting Manual 2021/22 pursuant to the Companies Act 2006

Part 1: Performance Report

Performance Overview 8

Statement from the Chief Executive 9 Performance Analysis 18

Part 2: Accountability Report

Statement of Directors’ Responsibilities 113

Statement of Accounting Officer’s Responsibilities 114

Foreword from the Chair and Chief Executive

Dr Catriona McMahon Louise Barnett

We welcome the opportunity to reflect on the period 2021/22 and share with our patients, staff, and volunteers some of the key features of the Trust’s performance and activities throughout the period.

As you might expect, we begin with the reflection that the operational pressures described in last year’s Annual Report have not abated. The NHS has continued to face the greatest public health and operational challenge in its history due to the COVID-19 pandemic.

For the Trust, the year has been marked by a series of very challenging operational pressures. At periods throughout the year, with the continuing prevalence of COVID-19 and its variants in the community, the Trust responded to increased admissions of patients with the virus and the impact of staff absences. In December 2021, for example, a level 4 national incident was declared, requiring the Trust to mobilise its control centre, and to step down non-essential activities to enable us to focus on dealing with the challenges of the Omicron variant wave of the pandemic.

During this period, the Trust has experienced difficulties in achieving timely discharge of patients with care pathways into the community often compromised as a result of the impact of the pandemic, as well as some very significant surges in emergency department attendances requiring admission. Such were these pressures that the Trust declared two internal critical incidents requiring support from our partners across the system to manage the higher levels of demand.

All these operational pressures have, of course, taken place against the backdrop of the imperative to recover and restore our pre-pandemic elective waiting time performance. We have continued to work to ensure that our most clinically urgent patients can access our services, and to contain both the overall number of patients waiting, and the length of wait for patients.

While we continue to have a number of patients who have waited over 104 weeks, we are seeing

the number of patients waiting over 78 and 52 weeks reducing. We still have some way to go to recover our elective waiting times to pre-COVID 19 levels and are preparing plans for 2022/23 to further address these waits.

Despite these unprecedented pressures, the staff have remained tireless in their commitment in providing safe and compassionate patient care to patients during this period. In recognition of this, we have continued to actively support staff to improve their health and well-being as well as promoting the highly successful vaccination programmes for staff for both COVID-19 and influenza. We have continued to recognise the hard work and dedication of our staff. For example, during the year almost 800 staff nominated by colleagues, received COVID-19 Heroes awards. We were also able to hold our annual awards ceremony virtually at the beginning of July.

Again, this year, we need to acknowledge the contribution and value that our partners have brought to our work, including the Robert Jones and Agnes Hunt NHS Foundation Trust, Nuffield Health, Shropshire Community Health NHS Trust, Midlands Partnership NHS Foundation Trust, and our councils and commissioners.

We are also grateful for the massive support that we have continued to receive from many volunteers, members of the public and patients and their families. We have also continued to benefit as a Trust during the year through our improvement alliance with University Hospitals Birmingham NHS Foundation Trust and from our improvement partnership with Sherwood Forest Hospitals NHS Foundation Trust in relation to our maternity services improvement work.

The Trust has continued to implement ‘Getting to Good’, which is the programme of work focussed on our improvement journey. The transformation of maternity services continues to be a high priority in this programme.

Last year, we explained that a key event for the Trust had been the publication of the first Ockenden1 Report in December 2020 which set out the emerging findings and recommendations following a review of 250 maternity cases at the Trust. We confirmed our commitment to implementing all of the actions within this report. We also set out our aim to be

1 1 London UK: Crown Copyright; 10 December 2020, Emerging Findings and Recommendations from the Independent Review of Maternity Services at the Shrewsbury and Telford Hospital NHS Trust, ISBN 978-1-52862304-9

transparent in how we intended to hold ourselves to account and to monitor our progress in implementing the recommendations. To this end, we have held ten meetings of the Ockenden Report Assurance Committee which has been independently chaired, live streamed and its work regularly reported to monthly Board meetings. At the end of 2021/22, 45 (86%) of the actions from the first report have been delivered, 35 (67%) of actions that have been ‘evidenced and assured’ and 10 (19%) that have been delivered and not yet evidenced. Only seven (14%) actions were ‘not yet delivered’ of which six were Immediate and Essential Actions and one a Local Action for Learning, with all ‘on track’ but reliant for final delivery upon external dependencies.

The final report of ‘The Review of Maternity Services at The Shrewsbury and Telford Hospital NHS Trust’ chaired by Mrs Donna Ockenden, was published on 30 March 2022. The review examined cases involving 1,486 families between 2000 and 2019 and reviewed 1,592 clinical incidents where medical records and family consent was gained. The review found repeated failures in the quality of care and governance at the Trust throughout the last two decades. The review finds that these failures result from there not being enough staff, a lack of ongoing training, a lack of investigation and governance at the Trust and a culture of not listening to the families involved. The final report provides for more than 60 specific Local Actions for Learning for the Trust covering nine areas, and 15 Immediate and Essential Actions for all maternity services in England covering ten key areas.

The reports make harrowing reading and set out significant and major failings in maternity care services at the Trust. On the day of publication of the final report, on behalf of the Trust, we offered an unreserved apology and gave a continued commitment to implement all of the actions arising from the first and final reports of the review. Both the unreserved apology and this commitment were re-iterated at a meeting of the Board of Directors in April 2022, when the Board accepted the findings of the report and considered the actions that now need to be fully implemented.

We will approach this task with the same commitment and dedication that we have shown to implementing the required actions from the first report. We owe it to those families we failed and those we care for today and in the future to continue to make improvements, and through the pursuit of our improvement work, our aim is to achieve excellent care for our communities

Building on the Trust’s values that we refreshed last year and the need to listen, engage and

build trust with the communities which we serve, during the year we approved our Public Participation Plan which we have now started to actively implement. The Plan outlines how the Trust will support its clinical teams in engaging and involving the public and increasing the involvement of our communities in all aspects of service planning and delivery. We look forward to progressing and seeing the benefits of this approach.

We should also not under-estimate the role that capital expenditure has played in enabling us to deal with service pressures in year and, importantly, the impact that capital expenditure can have on transforming services.

In-year, we have seen the opening of the new CT and MRI pod and improvements made to the endoscopy unit to help us further increase our capacity. Importantly, as part of the strategic Hospitals’ Transformation Programme, we have seen the development of the revised Strategic Outline Case (supported by commissioners and stakeholders) which seeks final approval to move forward in implementing the Future Fit consultation decision to reconfigure services across the Royal Shrewsbury Hospital and the Princess Royal Hospital.

The task for the Trust now, as we look ahead, is to recover and restore, as far as possible, the service delivery and activity performance of the organisation that had been achieved prior to the very significant impact of the pandemic, and to deliver the service improvements, to which we are committed, to ensure that we deliver high quality care for our community.

To this end we will need to remain mindful of the significant role that our staff will, continue to play in enabling this recovery and in making these service improvements, and the paramount importance of their continued health and wellbeing. We recognise the significant support we receive from patients and families across the communities we serve and our partner organisations and stakeholders. We are grateful to everyone who has taken time to share their experiences with us, which help us learn and grow to ultimately provide the best care for the communities we serve.

Catriona McMahon Mrs Louise Barnett Trust Chair Chief Executive

Dr

Part one: Performance Report

Performance Overview

This section of our report provides detail as to what it is that we do here at Shrewsbury and Telford Hospital NHS Trust, who we are, and our values and ambitions. It outlines the principal risks that the Trust faces in the delivery of our strategy and objectives and provides some details on how we performed over the financial year, 1 April 2021 – 31 March 2022. (For a more detailed account, please look at our Performance Analysis, starting on page 18.)

Statement from the Chief Executive

This report covers my second complete year during the Covid pandemic and the effects of the virus continue to affect us to this day. On 4April 2022, the Trust had 169 inpatients with Covid on our wards – this is the highest number in over two years of the pandemic, just over our previous highest number of 165 inpatients on 29 January 2021.

It was only on 3 May 2022 that general visiting was introduced back onto our adult inpatient wards, albeit with some restrictions still in place. Restrictions to visiting was one of the most difficult decisions we have had to take over the last two years; whilst it was important that we protected patients from the spread of the virus as much as possible, we came to understand the profound effect that isolation had on our patients, their families and their carers. We had to adapt the ways in which we worked to allow patients to keep in touch

with their relatives as much as possible, as well as re-designing physical treatment areas and spaces to ensure that our patients received the best care possible.

Except for one MRSA bacteraemia reported in May 2021, the Trust achieved all its national HCAI targets for 2021/22. However, the infection prevention and control team had a very busy year due to management and control of Covid-19 throughout our hospitals.

Throughout 2021/22, the pandemic continued to impact our ability to provide services in several ways, which meant that we had operational pressures throughout the year. In order to minimise the risk of infection within our hospitals, access to parts of the sites were limited, and some treatment areas had to expand to cope with the capacity and demand for those patients requiring specialised care during the pandemic.

Our continuous recruitment of staff has reduced the volume of nursing vacancies and at the same time, our staff turnover has also reduced. While this has had a positive impact on our workforce, staff absences in part due to COVID-19, or COVID-19 related absences, remained particularly high and availability of bank and agency staff to cover gaps on our rosters increased. This had an overall negative impact on the time that staff had available to undertake mandatory training or to undergo annual appraisals, with priority given to the immediate care of patients presenting to us.

The flow out of the hospital to safely discharge our patients has continued to be constrained, necessitating us to continue with our surge plans until Q1 2022/23. Unfortunately, this resulted in the loss of some of our elective activity, which we have been working hard to recover with the support of our partners moving forwards.

The virtual ward we established in December 2021 began to receive a small number of admissions by the financial year end - this will be an increasingly important way of supporting patients to be released from hospital.

We have continued to work to ensure our most clinically urgent patients have been able to access our services We appreciate the distress and the pain that long waits for treatment has on individuals, and we continue to work towards reducing any suffering that our patients and their families experience. While we continue to have patients who have waited over 104 weeks, by the year end, the number of patients waiting over 78 and over 52 weeks, was

beginning to reduce. We have a long way to go to recover elective wait times to pre-COVID19 levels and have launched plans for 2022-23 to further address these waiting times.

Urgent and emergency care demand remained high throughout the year and A&E performance, including ambulance handover delays were a challenge. Joint work with West Midlands Ambulance Service (WMAS) provided vital mitigation, with WMAS staff supporting ‘cohorting’ of patients inside our A&Es, thereby releasing ambulance crews to respond to urgent calls elsewhere in the community.

The estate improvement work in Shrewsbury’s A&E moved into its final phase towards the end of the year, with the increased capacity for ambulance ‘pit-stop’ (a specialist area devoted to handover), a dedicated space for children and young people, and improved facilities for both ‘majors’ and resuscitation patients, which all helped to provide patient care in a far better environment. The ‘front-door’ teams continued to work closely together, optimising ‘streaming’ to the urgent treatment centres, using the same day emergency care pathways in medicine and surgery, as well as working with the new ‘single point of access’ routing for patients (building on the existing rapid response and 111 pathways).

Patient falls remains a specific risk area which we are working to improve, with 1,396 falls’ incidents during the year, against an organisational objective of no more than 1,074. This will continue to be an area of focus for us throughout 2022/23 under the leadership of the Director of Nursing and her team.

Another area with which the Trust currently struggles, is the timely responsiveness to complaints received by the organisation. We received 693 complaints during 2021/22, which was above our Trust target of less than 672. In comparison, the Trust received 498 letters of thanks from our patients and their families.

The publication of the first Ockenden Report on 10 December 20202 provided a watershed moment for maternity and neo-natal services at the Shrewsbury and Telford Hospital NHS Trust.

It was important to us that our improvement journey and progress with the improvement of

2 London UK: Crown Copyright; 10 December 2020, Emerging Findings and Recommendations from the Independent Review of Maternity Services at the Shrewsbury and Telford Hospital NHS Trust, ISBN 978-15286-2304-9

Performance Report

our maternity services were transparent, and so, monthly reporting through both our board meeting held in public, and a new Board Committee, the Ockenden Review Assurance Committee, comprising external membership and Chair, commenced in February 2021. Further work, arising from the publication of the second Ockenden Report on 30 March 2022, continues

One of our principal objectives during the year continued to be the development of the Hospitals Transformation Programme (HTP), which will support the reconfiguration of where and how we deliver our services and the modernisation of our facilities and infrastructure, so that we can deliver better quality care for all our communities. The revised draft Strategic Outline Case for the HTP was submitted to NHSEI for review in late 2021 and feedback provided a few weeks later.

Collaboration and relationships with our partners continue to strengthen as we move towards 1 July 2022 when the Shropshire, and Telford and Wrekin Integrated Care System, is put onto a statutory footing. The system – made up of NHS providers, commissioners, local authorities and other local partners brought together to plan, coordinate and commission health care services – has been in existence in shadow form for some time. However, the new Health and Care Bill, which was granted Royal Assent on 28 April 2022, will mark a milestone in the recovery and reform of how health and care services work together. Collaboration will allow for health inequalities to be challenged, and for barriers to be broken down so that our patients do not face unnecessary delays for treatment or discharge, and working together will support the development of better quality of care for all our communities.

The latest Inspection Report from the Care Quality Commission (CQC), published on 18 November 2021, highlighted a continuing “Inadequate” rating across the organisation. However, several improvements were also recognised by the CQC; in the areas inspected we saw a decrease from 24 to 11 ‘inadequate’ scores, and an increase from 7 to 18 ‘requires improvement’ scores, and an increase from 4 to 6 ‘good’ scores. The Trust fully understands that there is more that must be done to improve our services, and work is ongoing across the organisation to achieve this More details about our CQC ratings can be found from page 26 onwards.

The Shrewsbury and Telford Hospital NHS Trust was placed in CQC “special measures for quality” in November 2018 and remains rated by the CQC as ‘inadequate’.

During the financial year, NHSI introduced a new NHS System Oversight Framework which included a new integrated and system focused Recovery Support Programme (RSP) for the most challenged of providers. The RSP replaced the previously separate ‘quality’ and ‘finance’ ‘special measures’ regime for provider Trusts. The organisation was recognised as being especially challenged and was placed into ‘segment 4’ of the framework due to its continued rating as ‘inadequate’ by the CQC. This meant that the Trust has continued to be subject to increased scrutiny from the Trust’s two principal regulators, with a range of safety and improvement requirements, and appropriate support being provided.

Moving into 2022/23, the Trust continues to work closely with its regulators to improve its provision of healthcare, and to work towards its vision to provide excellent care for the communities we serve.

Organisational Structure

The organisation was established in its present form on 1 October 2003 and brought together healthcare organisations in Shrewsbury, Telford and elsewhere in Shropshire. The Trust is spread across several locations, with the main sites of the Royal Shrewsbury Hospital and the Princess Royal Hospital in Telford, being positioned approximately fifteen miles apart. Services managed by the Trust are also provided at Whitchurch Community Hospital, Bridgnorth Community Hospital, Ludlow Community Hospital, and the Wrekin Community Clinic, all of which provide healthcare to circa half a million service users across Shropshire, Telford and Wrekin, and mid-Wales.

The Trust’s management structure comprises four clinical divisions led by clinician and management partnerships, and one corporate division (including departments such as finance, estates, facilities, human resources, governance and risk, etc.):

Women and Children’s Services, Surgery Anaesthetics and Cancer, Medicine and Emergency Care, Clinical Support Services and Corporate Services.

The two main hospitals provide a wide range of acute hospital functions including accident and emergency, outpatients, diagnostics, critical care and inpatient medical care. The Trust has circa eight hundred beds in total.

The Princess Royal Hospital became the specialist centre for inpatient head and neck surgery in 2013, following the establishment of enhanced outpatient facilities and a

dedicated head and neck ward. It is also the main centre for inpatient women and children’s services following the opening of the Shropshire Women and Children’s Centre in 2014. The Royal Shrewsbury Hospital became the main specialist centre for acute surgery with a surgical assessment unit, surgical short stay unit and ambulatory care facilities.

The Trust continues to invest in the improvement of its estate to support patient safety and care. Recent improvements include the opening of the Trust’s SDEC (Same Day Emergency Care) centre in Shrewsbury in December 2020, and a new PAU (Priority Admissions Unit) in Telford a few weeks later, both of which support the increasing demand on services. The opening of a contemporary new fracture clinic at Shrewsbury in April 2021, not only provided improved facilities and an enhanced structure, but its relocation allowed more physical space to be freed up in the existing A&E department.

This programme of improvement continues with a £9.3m reorganisation and expansion of the Shrewsbury A&E department, which is due to be completed in early 2022/23. A modern, new Cataract Operating Suite opened in spring 2021, and £7m of improvements were made to our Radiology services at both hospitals, together with a new high-tech Diagnostic Pod which opened in October 2021. Work to create a new 32-bed modular ward in Shrewsbury is nearing completion and expected to be operational in May 2022. The Trust is also currently transforming its Endoscopy and Decontamination services, which will include additional procedure rooms and state-of-the-art decontamination facilities at both Shrewsbury and Telford Hospital sites. Finally, plans to move renal dialysis services from our Telford site to a new, £4.5m purpose-designed facility for lower risk patients, are underway. The new facility will allow the Trust to meet future demand, together with updating the previous facility into a new inpatient ward.

With 6,765 whole time equivalent members of staff, the number of substantive employees continues to increase, following the Trust’s ongoing recruitment campaigns. However, with circa 600 vacancies, the Trust remains below its targeted whole-time establishment and continues to rely on bank and expensive agency staff. There has been a significant increase in the use of agency health care support workers throughout the pandemic, which has been linked to an increase in acuity and 1-to-1 required care. In addition, increased staff sickness levels caused by the pandemic increased the need to use more agency staff across the Trust. Expenditure for temporary staff, including agency, for the 2021/22

financial year stood at £32,845m (2020/21: £29,902m) – as can be seen from note 8 to the accounts.

As reported in last year’s report, supported by NHSI, the Trust entered an “Improvement Alliance” with University Hospitals Birmingham NHS Foundation Trust with the alliance focussing on delivery the Trust’s Quality Improvement Plan (“Getting to Good”). Further support was provided by NHSI in the form of an Improvement Director placed at the Trust with us.

With assurance in place that the Trust has been achieving its improvement goals, the Improvement Alliance relationship formally ended on 31 March 2022 although the supportive relationship formed between the two organisations will continue. Our ‘Getting to Good’ framework will remain in place and will be further progressed with regular monitoring and oversight of further improvements to ensure that we continue to develop the quality of care which we provide.

The CQC’s last Inspection Report, published in November 2021, highlighted a continuing “Inadequate” rating across the organisation. However, several improvements were also highlighted by the CQC, showing a decrease from 24 to 11 ‘inadequate’ scores, and an increase from 7 to 18 ‘requires improvement’ scores, and an increase from 4 to 6 ‘good’ scores. In the areas inspected, there is still more to go, and this is dependent on our valued teams. Therefore, it was important that as leaders of the organisation, we emphasised to our colleagues the improvements that they had achieved, particularly against the backdrop of a pandemic. There is an understanding that there is more to do, but the morale and wellbeing of our staff, is a crucial element to achieving those improvements.

The Trust’s strategic direction, vision and values

Our Vision, to provide excellent care for the communities we serve, stems from the Trust’s ambition to continuously improve the services which we provide to our patients, their families and our communities.

With stakeholder input, our values were updated in summer 2020 to the following:

Partnering – working effectively together with patients, families, colleagues, the local health and care system, universities and other stakeholders and through our

improvement alliances.

Ambitious – setting and achieving high standards for ourselves personally, and for the care we deliver, both today and in the future. Embracing innovation to continuously improv the quality and sustainability of our services.

Caring – showing compassion, respect and empathy for our patients, families and each other, caring about the difference we made for our community.

Trusted – open, transparent and reliable, continuously learning, doing our best to consistently deliver excellent care for our communities.

We believe that by always working with our values in mind, we can behave in a way which will provide the foundation for the provision of safe, approriate care for the people who are very important to us – our patients and their families.

The Trust’s improvement journey for 2021/22 was based upon our five strategic goals:

Our Patients & Community:

We deliver safe and excellent care, first time, every time We work closely with our patients and communities to develop new models of care that will transform our services

Our People: Our staff are highly skilled, motivated, engaged and ‘live our values’. SaTH is recognised as a great place to work.

Our high performing and continuously improving teams constantly strive to improve the services that we deliver

Our Service Delivery:

Our services are extremely efficient, effective, sustainable and deliver value for money

We deliver our services utilising safe, high-quality estate and up to date digital systems and infrastructure.

Our Governance: We are a learning organisation that sets ambitious goals and targets, operates in an open and transparent way, and delivers what is planned.

Our Partners: We have outstanding relationships with our partners, working together to deliver best practice integrated care for our communities

Going Concern Disclosure

The accounting concept of Going Concern refers to the basis on which an organisation's assets and liabilities are recorded and included in the accounts. If an organisation is a going concern, it is expected to operate indefinitely and not go out of business or liquidate its assets in the foreseeable future.

Under International Financial Reporting Standards, management are required to assess, as part of the accounts process, the Trust’s ability to continue as a going concern. For public sector entities, the anticipated continuation of the provision of a service in the future, as evidenced by inclusion of financial provision for that service in published documents, is normally sufficient evidence of going concern. For this reason, the directors have adopted the going concern basis in preparing the accounts, following the definition of going concern in the public sector adopted by HM Treasury’s Financial Reporting Manual.

Performance Analysis

The section provides a detailed analysis of the Trust’s performance throughout 2021/22, and in doing so, brings together some of the principal performance measures that we use to determine the level of risk that we carry in the organisation.

The Board’s role in monitoring the performance of the organisation is supported by an accountability structure which enables visibility by the public, staff and external stakeholders through itsmonthlymeetings streamed in public. It remains the responsibility of the Board of Directors to design and then implement agreed priorities, objectives and the overall strategy of the Trust.

The Board considers performance against national priorities set out in the NHS System Oversight Framework, which describes how NHS Improvement works alongside trusts to support the delivery of high quality and sustainable services for patients.

The Board hasalsodeveloped a setof key performance indicators (KPIs), which are set out within a local performance management framework. These cover quality and safety measures as well as those performance, financial and workforce KPIs outlined in national framework.

An IntegratedPerformanceReport is presented to the Directors asthe monthlymeetingsofthe Board, in the form of a scorecard accompanied by exception reporting, and explanatory narrative. This information is provided for the previous month, trends over time, and, where available or relevant, against a benchmark. These are linked to the Trust’s strategic objectives, national priority indicators, and local priorities.

Supported by the work of the Quality Safety and Assurance Committee in monitoring performance against quality and workforce indicators, whilst the Finance and Performance Assurance Committee reviews operational and financial performance, the Board of Directors is also supported by the Audit and Risk Assurance Committee which provides assurance regarding the organisation’s risk and control framework.

The executive directors review the performance of the Trust monthly via regular executive meetings, and monthly meetings with divisional colleagues at the operational Performance Review Meetings.

NHS System Oversight Framework Metrics 2021/22:

Measurement (metric)

Discharges by 5pm (% discharged by 5pm daily)

end of Q1 end of Q2 end of Q3 end of Q4

2.10% 1.20% 3.50% 6.20%

Elective activity levels (Total elective IPDC activity) 15,655 16,119 15,846 15,134

Overall size of the waiting list (Includes English and Welsh patients) 33,739 34,443 35,008 36,433

Patients waiting more than 52 weeks to start consultant-led treatment 2,932 2,794 2,480 2,595

Cancer referral treatment times (2WW%- referral to treatment time) 82.20% 85.20% 77.40% 73.2%

Cancer patients waiting longer than 62 days (%referral to treatment time) 69.7% 65.7% 63.5% 51.3%

% 28-day meeting faster diagnosis standard (Data captured only from Aug 2021) 62.90% 56%

Patient-initiated follow-up activity levels (PIFU) 51,209 49,937 54,106 53,974

Advice and guidance and patientinitiated follow-up activity levels 2,020 1,927 20,58 2,165

% of all outpatient activity delivered remotely via telephone or video consultation (Consultant led acute specific only, excludes nurse led etc) 32% 27% 27% 24%

UEC performance measure (4-hour performance (excluding planned returns) 72% 61% 58% 56%

30-minute ambulance breaches (ambulance handover 30–60 minutes) 1,862 2,108 2,130 2,264 -10% -23% -30% -30%

60-minute ambulance breaches (ambulance handover > than 60 minutes) 1,117 2,431 2,844 2,699 -10% -23% -30% 30%

Ambulance response times (CAT 1) 0.4 0.5 0.5 0.5

% women on continuity of care pathway 11.30% 11.50% 11.60% 11.40%

% of zero-day length of stay admissions (as a proportion of total) 33.00% 33.10% 33.00% 33.70%

Summary hospital-level mortality indicator 95.7 104.35 108.27 not yet available

Overall CQC rating (provision of high-quality care)

Potential under-reporting of patient safety incidents nil

National Patient Safety Alerts not completed by deadline nil Methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia infection rate 1 0 0 0 Clostridium difficile infection rate 5 9 10 9

E. coli bloodstream infections 15 10 13 11

Venous thromboembolism (VTE) risk assessment 95.20% 94.50% 92.70% 93.8%*

Preventing ill health and reducing inequalities

Number of people receiving flu vaccination (cumulative)

Ethnicity and most deprived quintile proportions across service restoration and NHS Long Term Plan metrics

Proportions of patient activities with an ethnicity code

Leadership & Capability

People

8.8% 65.5% 67.6%

Data not currently available at this level but we will be including this as part of our reporting for 2022/23

Data not currently available at this level but we will be including this as part of our reporting for 2022/23

Quality of leadership Requires Improvement

Aggregate score for NHS Staff Survey questions that measure perception of leadership culture

Metric under development

People Promise Metric under development Health and Wellbeing index Metric under development

Proportion of staff who say they have personally experienced harassment, bullying or abuse at work from (a) managers, (b) other colleagues, (c) patients/ service users, their relatives or other members of the public in the last 12 months

(a) from managers = 0% (b) from other colleagues = 2% (c) from patients = 8%

Proportion of people who report that in the last three months they have come to work despite not feeling well enough to perform their duties 60%

Percentage of staff who say they are satisfied or very satisfied with the opportunities for flexible working patterns 46%

% of jobs advertised as flexible 2.2% 5.2% 4% 6.0%

% of jobs advertised as flexible, including staff bank roles 8% 10% 7.9% 10.6%

Staff turnover rate (Excluding Jnr Doctors & Students) 3.27% 4.26% 3.76% 4.03%

Sickness absence INCLUDING COVID 19 (calendar days lost to sickness) 25,757 31,215 34,270 38,267

Proportion of staff who say they have a positive experience of engagement 6.29

Proportion of staff in senior leadership roles who are (a) from a BME background 0%

Proportion of staff in senior leadership roles who are (b) women 50%

Proportion of staff who agree that their organisation acts fairly with regard to career progression /promotion, regardless of ethnic background, gender, religion, sexual orientation, disability or age

* to end of February 2022 only

(Data from CHKS)

50%

Once again, the Trust had an extremely busy year throughout 2021/22 despite Covid-19 restrictions being in place nationally, at varying levels, throughout the period

The third national lockdown began on 6 January 2021 with the peak for demand being reached at the end of January 2021 and then slowly reducing throughout the coming weeks. The ‘stay at home’ order was lifted by the Government on 29 March 2021; during the following months, more restrictions were lifted, and the population began to socialise more and more. On 14 September 2021, the Prime Minister unveiled his winter plan for the management of covid, but this was eventually delayed, and ‘Plan B’ was enacted from 8 December 2021 due to the rise in the new omicron variant which had led to ‘added pressures’ on the NHS. On 24 February 2022, all existing legal Covid-19 restrictions in England were lifted.

By the start of the financial year, the number of covid patients in our general adult and critical care units had reduced from their maximum number in January 2021, enabling us to release both our own, and partner organisation staff, to return to their substantive roles, and our critical care units began to operate within ‘normal’ capacity levels again.

The reduction in covid admissions enabled us to re-establish green elective pathways, reopen elective theatres and re-commence surgery, prioritising patients by clinical urgency.

In common with many other NHS organisation, the Trust had a considerable backlog of patients waiting for treatment, and plans were put in place to address the backlog as quickly as possible – the longer the wait, the more likely the risk of potential harm to the patient. Our elective performance in April 2021 exceeded the 70% national threshold for recovery and we had patients that had been waiting over a year for their treatment.

The ongoing provision of a Vanguard theatre for the year ahead enabled us to maintain an increased level of elective day surgery during the first half of 2021/22, the surgical sameday admissions unit had re-opened to increase support to ambulatory emergency care pathways, and we had invested in an insourcing provider to undertake additional theatre sessions throughout the week, including the recommencement of elective orthopaedic surgery. Our staff sickness levels had improved during this time with performance better than the national average.

A&E attendances temporarily returned to pre-covid levels, although our operational urgent and emergency care performance remained below target. The recent investment in our Same Day Emergency Care (SDEC) services was of benefit for patients, although we saw

an upturn in attendances during the summer months of 2021, exceeding the levels experienced prior to the pandemic and putting increased pressure on ambulance handover and the performance of our A&E departments.

It was anticipated that the number of COVID-19 infections would continue to reduce and the pressure on services would decrease. Whilst we re-established services, we continued to maintain social distancing and approved infection prevention practices in order to mitigate the risk of further infection within our hospitals. We continued to work with partners to support the vaccination programme, actively encouraging the take up of first and second doses in line with national guidance.

August saw an increase in the prevalence and the number of patients admitted with Covid19 although our vaccination programme continued to perform well. One of the consequences of the increase in Covid-19 numbers was the impact on elective services, in particular the loss of our elective orthopaedic capacity at Princess Royal Hospital (PRH), but we worked with The Robert Jones & Agnes Hunt Orthopaedic Hospital (RJAH) to improve the availability of services for patients.

As the NHS approached the beginning of Q3, recruitment of both nursing and medical staff had progressed well at the Trust with additional international nurses and radiographers helping to improve service sustainability in hard to recruit areas, such as theatres and x-ray. Of particular note was the commencement of 10wte midwives. However, staff shortages remained significant in a number of areas with actions being taken to augment staff numbers with the new recruits according to the needs and pressures of services.

In September 2021, we opened the new majors’ area in the emergency department at Royal Shrewsbury Hospital as part of the first phase of an expanded emergency department and we also received approval to proceed with the development of an additional 32-bedded modular ward (£7.1M) which we planned to open in April 2022, but which was opened in May 2022.

Entering Q3, our operational challenges intensified with a significant number of delays to discharges, resulting in difficulties with admissions to our wards - with patients waiting both in our emergency departments and within ambulances to access the emergency department. During this quarter, our BAF included a risk – The Trust is unable to meet the

required national urgent and emergency standards – risk scored = at 25, the highest score possible. This was to continue into Q4.

We continued to work as part of the whole system to address the unscheduled care pressures across the region, which, together with increasing staff sickness, began to affect the recovery of our elective capacity. We also brought back a mobile CT to site to improve waiting times for diagnostic patients.

In October, we worked with system partners to agree our activity plan for the remainder of the year. To offset the impact of internal constraints, we continued providing additional elective capacity through the independent sector and in partnership with RJAH. We delivered elective activity in accordance with our plans and began to see reductions in waits for diagnostics and planned care, but we knew there was still a long way to go.

The Cardiology Department experienced severe staffing shortages in both the consultant and cardiology nursing workforce as we approached winter 2021. The impact of the staffing shortages was acutely felt in the two Coronary Care Units (CCU’s), one on each ward (24 and 6). On occasion, the CCUs had been without a specialist cardiac nurse due to sickness. Numerous attempts to recruit substantively to the general cardiologist posts had proved unsuccessful due to the two-site model, and with further retirements imminent and the lack of successful recruitment drives, staffing two inpatient bed bases became a significant risk to the Trust. After engagement with colleagues, patient groups and partners, it was agreed that consolidation of the workforce would see greater service resilience for patients and enable more specialised job plans for consultants without cross-site working. It was therefore agreed that ward 24 at the Royal Shrewsbury Hospital be co-located with the cardiology ward 6 at the Princess Royal Hospital.

On 5 November 2021, the Government enacted a level 4 national incident situation, the highest level possible, due to increasing Covid-19 infection rates and increasing demand on hospitals, which was projected to intensify over the coming weeks. The Trust responded well in mobilising its control centre, stepping down non-essential activities and focussing on meeting the challenges created by the omicron wave of the Covid pandemic.

December saw a continuation in the prevalence of Covid in the community and the number of patients admitted with Covid This had significant impact on our staff availability and that of partner organisations, resulting in the Trust experiencing further, very significant

difficulties in discharging patients in a timely fashion to create the necessary capacity for newly admitted patients. The flow out of the hospitals to safely discharge our patients was constrained, necessitating the Trust to instigate its surge plans

By the end of December 2021, the whole capacity of the PRH Day Surgery Unit (DSU) was occupied as part of super-surge capacity, together with 14 additional covid beds for ‘amber’ patients in the Royal Shrewsbury Hospital DSU. This meant that by that stage, the Trust was working out of a severely reduced green covid footprint. Joint work with Robert Jones & Agnes Hunt Orthopaedic Hospital NHS Foundation Trust for orthopaedics inpatient elective cases increased, as clinical space at the Trust became further compromised due to the increase in Covid patients.

The Trust struggled to deliver plans for elective and non-elective activity although we had good patient take-up of opportunities to have some treatment in the independent sector. We also continued to make use of the Vanguard, new eye-suite facilities and the additional mobile CT scanner. We saw an increase in demand for cancer services, and we continued to clinically prioritise these patients. However, as a result of the capacity reduction, some long waiting P3 and P4 elective patients had to be cancelled by year end, increasing the risk of harm to the patients.

Our work on unscheduled care continued with a view to improve flow at our ‘front door’ by reducing the time from being medically fit for discharge, to being discharged. We worked closely with local authority and community partners to focus on discharge ready patients on pathways 1, 2 and 3 and to create earlier discharge times in the day to release beds to our emergency department admissions and enable ambulance handover to improve. We ran several multi-agency discharge events during the first half of January 2022 to further support this. Nevertheless, the Trust needed to declare two internal critical incidents in February 2022 and requested support from partners across the system to manage the high level of demand.

The Trust’s continuous recruitment of staff reduced the volume of nursing vacancies in the new year and at the same time, our staff turnover also reduced. While this has had a positive impact on our workforce, staff absences remained particularly high and availability of bank and agency staff to cover gaps on our rosters, increased. This had an overall negative impact of the time staff had available to undertake mandatory training.

During March 2022, operational pressures were so severe due to the rise of Covid in the community that severe staff shortages impacted on services, both at the Trust and in the provision of health and care community services.

Several non-critical planned services were stood down towards the end of March due to staff availability. More patients were admitted whilst also having Covid i.e. the admission being for a reason other than Covid. However, full infection prevention processes remained in place – including maintenance of red, amber, green Covid pathways, and as a result, the number of mixed sex breaches temporarily, but significantly, increased in March 2022.

As a result of the combined pressures, the Trust called a further internal critical incident in March; Shropshire, Telford and Wrekin (STW) called one system critical incident during March that was triggered by the numbers of Covid positive inpatients Once again, RJAH supported the organisation, and a number of their staff were deployed to support our A&Es and AMUs

The number of covid infections, continued to rise and on 1 April 2022, the figures from the Office for National Statistics indicated that 4.9 million people in the UK had covid in the week ending 26 March 2022, meaning that every one person in 13 had the virus. This was the highest recorded number of cases since records began in April 2020. https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bul letins/coronaviruscovid19infectionsurveypilot/1april2022

The national position was reflected in our own organisation when the Trust, on 4 April 2022, recorded the highest number of inpatients with Covid-19 (169), in over two years of the pandemic

More details regarding our quality of care performance details can be found in our Quality Account 2021/22. From 1 July 2022, this will become available on our website, although copies may be obtained by contacting our Communications Department at communications@sath.nhs.uk

The Care Quality Commission

The CQC carried out a series of inspections at the Trust, over July and August 2021, with their inspection report being published on 18 November 2021. A copy of the inspection report can be found on the CQC website at https://www.cqc.org.uk/provider/RXW

Whilst the Trust rating remained ‘Inadequate’ overall (table 1), some improvements in individual services were made

1

Table 2 shows the position for the Royal Shrewsbury Hospital after the inspections – with a comparison of the ratings before the inspections, appearing in table 3

The regulator recognised that the Trust had experienced significant challenges during the 18 months leading up to the inspections, due to the COVID-19 pandemic, but did recognise that some improvements had been made; safeguarding practices, medicines management, engagement and transparency with system partners, were examples of some of the areas highlighted, whilst outstanding practice was identified in maternity services.

As a result of the inspections, the CQC wrote to the Trust in February 2022 to advise that the regulator was removing / varying some of the conditions to the Trust’s licence that had been previously imposed. Across both main hospitals, more than 50 conditions were removed, 6 were varied with 5 now remaining. These relate to;

the restricted admission of mental health patients under the age of 18 who do not have need of inpatient care for physical reasons ((1)under the Assessment or Medical Treatment for Persons Detained under the Mental Health Act 1983, and (2) under the regulations regarding ‘treatment of disease, disorder and injury’); review and assessment of the systems and processes for care planning records across the Trust; submission of regular reports to the regulator relating to the emergency care pathway for those under the age of 18 years; and implementation of effective systems in both A&E’s to ensure that patients are assessed with a 15 minute period in accordance with national guidelines.

The Trust recognises that there is still much to be done to improve our services, and plans are in place for this work to be carried out. Some of these improvements are being progressed by our Quality Improvement Programme, using our Getting to Good methodology.

Phase 1 of our Getting to Good programme, the methodology which supports the organisation’s objective of achieving an overall CQC rating of ‘Good’ by 2023, ended in June 2021, with phase two continuing throughout 2021/22. The programme had 26 projects split into 9 programmes, aligned to the 12 key priorities in the Trust’s Quality Improvement Plan.

Getting to Good Programme phase 2 (2021/22)

Part 1: Performance Report

Oversight of delivery of our Getting to Good plans has been provided through a weekly Getting to Good Operational Delivery Group (ODG) to track and monitor progress in achieving this, supported by colleagues from the Programme Management Office, Service Improvement Team, Communications, Performance Team and NHSI. The Trust’s Improvement Director has chaired these meetings

External oversight has been through the Trust’s ‘Quality Improvement Committee in Common’ meeting with colleagues from University Hospitals Birmingham NHS Foundation Trust as part of the Improvement Alliance between the two organisations, and through reporting to the Board of Directors on a monthly basis With the formal arrangements for the Alliance ending in April 2022, monitoring will now take place through the executive team and board of directors.

Quality Priorities

A detailed narrative which describes our quality priorities and their outcomes for the year can be found in our Quality Account 2021/22.

The Board of Directors approved the Trust’s revised Quality Improvement Strategy 2021/24 in March 2021 and identified eight

appear below, alongside the responding quality domains:

Embedding

Framework in November 2021, which aims to reduce variation and increase standardisation across the Divisions, and to further support the Trust to undertake timely and proficient investigations into incidents/complaints and learning from deaths

The new Quality Governance teams support with embedding the learning from incidents, and the Patient Safety Specialist Officer (PSSO) and Clinical Patient Safety Lead are pivotal in the development of the new Patient Safety Incident Review Framework (PSIRF) which will be rolled out nationally during 2022.

During 2021/2022 the Trust saw an increase in the number of serious incidents reported compared to previous years (see table below).

Reporting

2019/2020 3 2 3 2 3 5 5 6 8 12 2 5 56

2020/2021 1 1 5 5 3 7 10 4 6 6 7 9 64 2021/2022 9 6 8 11 8 10 9 10 4 9 6 5 95

Some achievements:

The proportion of reported patient safety incidents that cause no or low harm reported to NRLS remains consistently above 97% and is better than the national average

We have increased patient safety incident reporting ratio per 1,000 bed days from 57% to 65%.

The % of patient safety incidents that result in severe harm or death remains below the national average.

In 2021/22, the Trust was in the top quartile of reporting organisations as measured by the National Reporting and Learning System data.

Quality Priority 2: The deteriorating patient

The Trust seeks to recognise deteriorating patients at the earliest opportunity and identify the most appropriate course of treatment for them in a timely manner. This includes identifying all aspects of deterioration and treating sepsis and Acute Kidney Injury (AKI) and Diabetic ketoacidosis (DKA) at the earliest opportunity to prevent avoidable deaths.

Compliance with sepsis screening on admission to our Emergency Departments during

2021/22 scored 96% compliance. Antibiotics administered within 60 minutes shows more variation but an average of 89% for 2021/22.

Sepsis peer review audits on our inpatient wards show that there has been an improvement since December 2021 in the percentage of patients screened for sepsis, but an overall decline in the percentage of patients who received their antibiotics within an hour.

Quality Priority 3: Inpatient Falls

Nationally, falls amongst inpatients are the most frequently reported safety incident in NHS hospitals with 50% of patients over the age of 80 years estimated to fall at least once a year and similarly for 30% of over 65’s. Approximately 30-50% of falls result in some form of injury, and fractures occur in 1 to 3% of incidents.

Falls 2018/19 2019/20 2020/21 2021/22

Total Number of falls

1185 1117 1194 1396

Falls per 1000 bed days 4.62 4.02 5.42 5.33

Falls with moderate harm or above per 1000 bed days 0.09 0.11 0.123 0.12

Although we have made some improvements at the Trust – more training for staff, education for patients, implementation of the ‘Post Falls Care Bundle’ and other measures - we have not seen a reduction in falls, falls per 1000 bed days, or in the number of falls which result in significant harm for our patients. Falls resulting in moderate harm or worse during the year increased from the previous year to 31 incidents (2020/21: 27). More focus is being put into this area, and regular reporting to the Board of Directors’ monthly meetings will continue

Quality Priority 4: Best clinical outcomes

The Trust’s four key themes of effectiveness are:

Ensure practice is based on ‘best practice’

Use our clinical audit programme as a force for sustained performance and improvement

Use outcome measures to inform us, our patients, public and commissioners on our performance

Innovate to improve outcomes in a safe, sustainable way.

To achieve these improvements, we developed sets of clinically owned standards for each

of our clinical specialties and used our new quality governance framework to monitor progress against each of these in a timely way. This was in conjuction with an assessment of Trust performance against the National Institute of Clinical Excellence (NICE) guidance within 28 days of the publication of the guidance, together with the use of clinical audit outcomes.

As a result, the Trust has seen a year on year improvement in timely implementation of NICE guidance, to 98% in 2021/22 (2020/21: 80%, 2019/20: 65%). It has also particiated in 98% of national clinical audits, and 100% of national confidential enquiries in which it was eligible to participate.

Quality Priority 5: Right care, right place, right time

All our patients should be located and cared for in the most appropriate place from admission to discharge, and we work with other local health and care providers to ensure that patients canto go directly to the right place of care at the right time.

All inpatients should have an estimated discharge date (EDD) for our multidisciplinary teams (MDT) to work towards. Weekly MDT meetings with system partners are now in place to review discharge plans for patients who remain in hospital for 14 days; this is led by the Deputy Medical Director.

Due to the ongoing operational pressures caused by the pandemic, progress has been poor. Infection control measures, staff sickness and other issues at healthcare orgnaisations across the region has meant that the Trust has often been left with high numbers of patients not meeting external admission criteria, on its wards during 2021/22.

Again, this is a priorty for the Trust to improve during 2022/23, with a focus on daily discharge before noon.

Quality Priority 6: Learning from experience

During the year, the Trust received 688 complaints (2019/20: 760 complaints, 2020/21: 587 complaints).

The key focus for this indicator in 2021/22 was to improve our complaints processes, and the times taken to respond to the concerns raised by our patients and their families. We

Part 1: Performance Report

had hoped to achieve 85% of responses within an agreed deadline. However, we achieved only 74%, which was an improvement on the previous year (2020/21: 60%).

In order to provide a better experience for those who had cause to raise complaints, we focussed on a more personalised approach, with increased communication and engagement.

One of the main areas of complaint that we received, concerned communication, often linked to restrictions for visiting; families have reported difficulties in accessing wards by telephone and obtaining updates on their loved ones. A number of measures were put in place to support increased interaction, including the use of communication books, developing virtual visiting, and assistance from our Trust volunteers.

Another theme running through the complaints received during the year was that of cancelled appointments for outpatients. The pandemic (mainly through sickness, or realocation of duties to more priority areas) had restricted the numbers of staff available in certain services, leading to last-minute cancellations. The Trust is addressing this issue through a number of measures.

Quality Priority 7: Vulnerable patients

Our goal is to continuously improve the care that we provide for our most vulnerable patients, who include those with mental health conditions, those with safe-guarding needs, learning disabilities (LD) and dementia.

We also aim to have arrangements in place to safeguard and promote the welfare of adults and children in line with national policy and guidance. We aim to be recognised as a Dementia Friendly Organisation and ensure that our patients with dementia, LD and mental health conditions have the best experience possible.

Training packages have been developed across the Trust which include face to face training and e-learning, with additional training resources - such as Trust specific e-learning module for Level 3 safeguarding (released in February 2022) – being added to our training library all the time, for staff to improve and update their knowledge in these areas.

Details of training compliance rates (per quarter) are provided in the following table.

Category of safeguarding training

Safeguarding Level 1 Adults & Children

% end of Q1

% end of Q2

% end of Q3 % end of Q4

98% 98% 98% 94%

Safeguarding Level 2 Adults 90% 89% 81% 84%

Safeguarding Level 2 Children 88% 81% 89% 84%

Safeguarding Level 3Children 97% 83% 85% 76%

Safeguarding Level 3 Adults 48% 54% 62% 60%

MCA & DoLS 74% 76% 77% 79%

Prevent – BPAT 84% 84% 84% 82%

Prevent – WRAP 83% 82% 81% 79%

Those inpatients with dementia should receive a personalised support plan to meet their needs (Patient Passport) within 48 hours of admission to hospital. In 2021/22 we achieved a performance rate of only 81% of this being completed within 24 hours of admission.

Quality Priority 8: End of life care

All patients at the end of their life should be treated according to their wishes, and with the utmost dignity and respect. An individualised approach to both them, and their loved ones, is something that we strive to achieve for each patient and family going through this difficult time.

To support this ambition, our Palliative Care, and End of Life Care Teams were brought together to become a unified PEoLC service and has continued to deliver the requirements of our End of Life Care Strategy (being updated during 2022/23).

Recognising patients who require end of life care has been improved with the use of an alert approach being implemented on our healthcare systems, with the alerts being followed-up by the PEoLC teams in-reaching to wards and attending daily meetings at which all ward managers attend and can raise issues.

A 7-day nursing service for PEoLC was implemented in September 2021, and a new EOL care plan for the last hours of life, was launched in February 2022. Both of these initiatives have been well received by colleagues, patients and their families.

Additional staff training – ‘ASK 5’ (a methodology that identifies 5 random members of staff on each ward across the Trust to be asked questions about safeguarding practice) - was

rolled out during the year, to raise awareness and knowledge of staff so that they are better equipped to care for these patients, and their loved ones.

Finally, a PEoPLC dashboard was developed in February 2022. This enables monitoring of key indicators to ensure that the Trust is providing the quality of care in this very specialised service provided to our patients.

Financial Performance 2021/22

The operational planning process for 2021/22 was split into two halves, the first six months of the year (H1) and the second six months (H2). This was the result of an agreed financial settlement by the government for only the first half of the year to respond to COVID-19.

Building on the planning process in 2020/21, the Trust worked with system partners to develop a triangulated plan across activity, workforce and finance for 2021/22 in response to the following priorities set out by NHS England:

Supporting the health and wellbeing of staff and taking action on recruitment and retention;

Delivering the NHS COVID vaccination programme and continuing to meet the needs of patients with COVID-19;

Building on what we learned during the pandemic to transform the delivery of services, accelerate the restoration of elective and cancer care and manage the increasing demand on mental health services;

Expanding primary care capacity to improve access, local health outcomes and address health inequalities; and

Transforming community, and urgent and emergency care to prevent inappropriate attendance at emergency departments (ED), improving timely admission to hospital for patients requiring emergency care, and reducing their length of stay.

The NHS continues to operate within a temporary finance regime for 2021/22 due to the COVID-19 pandemic. This regime, akin to the previous financial year, has been managed over two six-month periods (H1 and H2) linked to the timing of the funding settlements agreed with the Treasury. The Trust’s plan for H1 was to deliver a deficit of (£3.219m) and for H2 a planned deficit of (£3.824m) resulting in a full year planned deficit of (£7.043m)

The Trust recorded a full year deficit of (£10.890m), £3.847m adverse to the (£7.043m) full year deficit plan, but in line with the revised forecast formally reported at the end of quarter three.

The main source of income for the Trust was via contracting with commissioners for health care services. In 2021/22, most 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.

2021/22 £'000

Income from patient care activities 493,237

Other Operating Income 41,905 Operating Expenses (545,023)

Operating deficit (9,881) Other gains and (losses) (99)

Deficit before interest (9,980) Investment income 16 Finance costs 4

Public dividend capital dividends paid (6,694) Retained deficit (16,654) Adjusted for: Impairments 5,514

Adjustments in respect of Donations / Grants (178)

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 was distributed by local agreement and the Trust received £12.9m of funding to support elective waiting list recovery.

Remove net impact of inventories received from DHSC group bodies for COVID response 428

Adjusted financial performance (10,890)

Within Trust expenditure, the largest category is pay expenditure totalling £367.6m which is equivalent to 67% of total operating expenditure. Other significant components include £88m on drugs and clinical supplies (16%) and estates and premises costs of £22.8m (4%)

The Trust invested £43.683m of capital expenditure on medical equipment, digital infrastructure and improvements to existing buildings during the financial year. £14.460m of the capital programme was funded through the Trust’s internally generated funds. Key improvements were made because of this, including advances made to the digital infrastructure (£6.919m) and developments of the Trust’s physical estate (£4.754m).

The remainder of the capital expenditure of £27.625m was funded through Public Dividend Capital and included expanding the footprint of the Royal Shrewsbury Hospital A&E department (£9.363m), building a modular ward to increase inpatient capacity (£7.098m), and strengthening our digital services (£2.881m).

Taking the lessons learned and building on the progress from the 2021/22 planning cycle, the internal process was revised for 2022/23 to commence sooner and engage with key stakeholders from the beginning, starting at specialty level and progressing to include key Trust wide programmes for emergency and elective care.

The Trust has collaborated with all system partners in the ICS to develop a triangulated system plan for activity, workforce and finance that is supported by the detailed work ongoing at Trust level.

Culture and Staff Engagement

Our culture journey to improve working life at the Shrewsbury and Telford Hospital NHS Trust, continues. The aim of our culture work is to enable the Trust to be a psychologically safe place to work and for it to become the employer of choice within the region. A place where colleagues feel a sense of belonging.

Present in the strategy and everything we do, ‘The Golden Thread’.

All objectives and outcomes need to deliver the People Plan and link to the Winning Principles.

Consider and include the key elements of the Equality, Diversity and Inclusion Strategy.

To ensure all colleagues live and breathe the Trust’s values and are valued for their unique difference.

To demonstrate equitable and fair processes so that all colleagues feel valued and able to challenge discrimination.

The above diagram illustrates the Trust’s People Plan Winning Principles - these are the key areas highlighted in the People Strategy for the organisation. They are in place to ensure that we have direction and focus from the people perspective of the organisation. Under each principle there are actions and measures to ensure that we are delivering the strategy. They include:

To support the mechanisms in place to create, maintain and sustain a diverse and talented workforce;

To ensure all patients receive the best quality care regardless of their protected characteristics.

Culture Dashboard

We have undertaken numerous engagement conversations during the financial year, and we have implemented some changes after listening to the voices of our colleagues.

Goals & Performance

Health & Wellbeing

Working with the Kings Fund and NHSI, we designed a Culture Dashboard using the data from the staff survey results to provide an overview of our Trust’s cultural assessment benchmarked against national peer Trusts. The dashboard is being used to identify key areas for cultural intervention, which will then be measured to understand impact. This year, “Health and Wellbeing” has been added into the dashboard - this is an imperative area for the organisation.

Virtual Staff Awards

The Trust held its first Virtual Staff Awards, in July 2021. More than 400 entries were received, with almost 30 awards given out. Colleagues were bestowed with their awards in person by the executive directors, whilst the presentations were filmed and edited into an hour long ‘Staff Awards’ video which was live streamed, which added the surprise element for viewers.

Winners ranged from frontline clinical staff to cleanliness teams and behind-the-scenes services. Among the awards were a critical care nurse who trained more than 500 colleagues from across the Trust and the wider health system, to help in critical care at the height of the COVID-19 pandemic; one of the Trust’s youngest volunteers, who put herself

Vision & Values

Learning and Innovation National Average SaTH 2021 SaTH 2020

forward to help during the pandemic and showed great dedication; and a public recognition award for a matron who was described by the wife of a patient as her ‘lifeline’ when she could not visit because of COVID-19 visiting restrictions. A list of all our fabulous prize winners can be found below:

Shrewsbury and Telford Hospital NHS Trust, Staff Awards 2021 winners: Values Awards

Partnering: Frailty Team, PRH

Ambitious: Radiotherapy Team

Caring: Sara Moore, Ward 6 Coronary Care Unit (CCU)

Trusted: Ayaz Vantra, Paediatrics

COVID-19 Awards

Clinical Award (Team): Ward 32 (RSH) and Ward 17 (PRH) Clinical Award (Individual): is Heather Rushworth, Critical Care Non-clinical Award (Individual): Kath Titley, Health & Safety Team Manager and Paula Davies (Head of Procurement)

Leadership/People Award: Rebecca Houlston, Centre Manager for Emergency Care

Patient and Partners Awards

Quality Improvement Award: Dr Banchhita Sahu, Consultant Obstetrician and Gynaecologist

Innovation Award: Cancer Care Navigators

Volunteer of the Year: Anna Welsh Community Support & Fundraising Award: Shropshire, Telford & Wrekin COVID-19 Vaccination Programme, led by Angie Wallace

Community Partner Award: Macmillan Cancer Support, Lingen Davies Cancer Fund and League of Friends of RSH

Learning and Development Awards

Learning and Development Award (Individual): Nancy Moreton, Clinical Practice Educator Learning and Development Award (Team): International Nursing Team

Clinical Rising Star: Amy Louise Pattison, Ward 17 Non-Clinical Rising Star: Kayleigh Williams, International Nursing Co-ordinator

Public Recognition Award (in partnership with the Shropshire Star): Gill Joseph, Matron for Ward 25, Day Surgery Short Stay and Outpatients at RSH.

Chair’s Award: Critical Care Team, Theatres, Endoscopy, Day Surgery Unit and Mutual Aid

Chief Executive’s Award (individual): Moira Kaye, Consultant Clinical Scientist, Microbiology

Chief Executive’s Award (team): Cleanliness Team

Lifetime Achievement Award: Bruce Summers, Consultant Orthopaedic Surgeon

Over 800 colleagues were nominated for a ‘Covid Hero Award’ to recognise the support and hard work that they had provided during the earlier periods of the pandemic. And every member of staff received a bespoke ‘Covid Hero’ rainbow badge, and a ‘Care For You Day’ – and extra day off to take that was convenient to them.

We continue to celebrate with colleagues who have reached 25 or 40 years working for the NHS by presenting them with their Long Service Awards.

We are incredibly proud of all of our colleagues who were nominated, or received, Trust awards during 2021/22.

Equality, Diversity and Inclusion

In line with our Equality Objectives – Engage, Empower and Embed - we have been focussing on our cultural journey work and our commitment to engender a sense of belonging for all staff.

Shrewsbury and Telford Hospital NHS Trust remains a member of Employer Network for Equality & Inclusion (ENEI) which is the UK’s leading employer network covering all aspects of equality and inclusion issues in the workplace. We continue to embed and develop our staff networks and we would like to further expand our networks during 2022/23 to include other areas such as menopause, sleep, and men’s health.

We also developed and launched our ‘Change Team’ and philosophy. We have appointed sixteen champions to help and reinforce positive change by supporting colleagues across the Trust to use improvement techniques to make our organisation a better place to work for all.

Fourteen individuals have been supported to become Cultural Ambassadors via the RCM development programme. The role of the cultural ambassador is to identify any cultural issues or perceived bias (conscious or unconscious), less favourable treatment, or discrimination, within the workplace. The ambassadors will work with us to improve

recruitment and the employment relation experience and decision-making processes.

As part of the Trust’s Safer Recruitment Workshops, we continue to support the Disability Confident Scheme and our commitment to guaranteeing an interview for applicants who meet the essential requirements of the advertised role. We aim to become a Disability Confident Employer at level 2 later in 2022 and will be further reviewing our job adverts and templates to ensure they are fully inclusive in this way. We also continue to work with local partners to ensure we reach all communities to encourage and support careers in the NHS.

Throughout 2021/22, we delivered numerous wellbeing initiatives offering psychological, physical, emotional and financial support, as well as promoting the importance of a healthy lifestyle, as part of our overall offer. We continually review the support we offer, and we are progressing plans to make further improvements with the development of our psychological Wellbeing Hub and the introduction of a Health Passport for staff with health conditions.

The Trust continues to support our three staff networks, the ‘Race Equality & Inclusion Network’, The ‘Disability, Ability & Wellbeing Network’ (DAWN) and our own ‘Pride’ and ‘LGBTQ+’ networks. We believe that our staff networks provide a safe environment for colleagues to come together, share experiences and facilitate learning and development.

We are proud to report that the Trust joined the ‘Employer with Heart’ scheme to support colleagues by providing additional paid leave for mothers who give birth prematurely, provide partners the time they need to be with their baby in hospital, and to support parents returning to work following the birth of a premature baby.

In July 2021, we launched our new Leadership Development Programme with over 48 different programmes which incorporates monthly masterclasses for our leaders from band 3 to board to help us develop a more inclusive and diverse leadership approach at SATH. An example of these masterclasses includes courageous conversations, ‘Civility Saves Lives’ ethos and ‘Show Racism the Red Card’.

Freedom to Speak Up

We have a diverse ensemble of‘Freedom to Speak Up’ (FTSU) Championsand divisional FTSU groups who proactively raise awareness of their role. We have 39 FSTU

ambassadors whose experience ranges from a variety of clinical and non-clinical backgrounds and who represent the diversity of the workforce across our Trust; they undertake these roles on a voluntary basis in addition to their substantive posts.

In total the team carried out 858 visibility visits, team awareness sessions and drop-in sessions, as well as attendance at junior doctor forums, corporate induction, and student inductions. The team whilst promoting the FTSU mechanism, promote and educate colleagues on the importance of speaking up in general and highlighting the many routes available in the Trust that allow colleagues to “speak up” in a safe and welcoming environment.

Consequently, during 2021/22, 369 concerns were raised to the through the FTSU mechanism to the FTSU team, an increase of 67 on the previous year.

During 2021/22, 37% of the concerns brought to the attention of our FTSU teams were relating to behaviours/relationships, 15% related to concerns about patient safety, 21% of concerns were associated with systems and processes, 10% of concerns raised were regarding staff safety, and 7% to bullying and harassment. All the concerns raised were investigated.

Of those speaking up, 30% were nurses, 8% were healthcare assistants, 7% were midwives, 7% were doctors, 9% were allied health professionals, and the remaining 29% was made up of administrative, clerical, cleaning, catering, maintenance or ancillary colleagues.

The senior FTSU team continued to work closely with particular colleagues, including the executive team, non-executive directors, the senior nursing team, unions, workforce

department, organisational improvement team, the guardian of safe working and numerous clinical colleagues including junior doctor forums. The Chief Executive and Director of Nursing A series of drop-in sessions with executive directors across both the main hospital sites were also established to encourage staff to raise concerns directly with members of the board of directors

Finally, the Trust had a very active speak up month in October 2021 when the then National Guardian, Dr Henrietta Hughes, attended a Board Development Day, and Dr Chris Turner gave two masterclasses on Civility and Respect and his lived experience at Stafford Hospital which led to a public enquiry into poor patient care at the hospital, and publication of the Francis Report.

Learning and Development

The introduction of our new Learning Management System was launched during the year. The system ensures visibility of staff training. Our ambition for 2022/23 is that this technology platform will support improvements with compliance, and in turn improve quality and safety.

As part of our Behaviours and Values week in July 2021, our Behaviour Framework was launched. During the week, our new framework was integrated into the existing Corporate Induction Programme and development programmes. Colleagues were invited to convey their thoughts and experiences about the significance to them of the Trust values.

All our core leadership development programmes from aspiring leaders, supervisors, firstline, band 7 nursing, middle and senior managers have launched. Our new Improvement development programme will be launched later in 2022. Values Based Leadership is integral to the way that our leaders operate, and a number of team coaches are trained to support team leaders in developing teams.

A ‘SATH Improvement’ educational syllabus has been developed by our new Improvement Hub. The courses were launched in February 2022and have been designed ‘in house’ taking the principles of the Virginia Mason Institute methodology and other improvement courses. The range of courses include a 15-minute introduction video, a one-day fundamentals course, a practitioner course taken over six months, and also, a one-day ‘lean for leader top up’ course. Applicants to the courses are expected to undertake an improvement intervention and are accredited on completion of an improvement project.

Sustainability Report

Climate Change

Our everyday activities are having a profound impact on the environment with irrevocable consequences - biodiversity loss and mass extinction, plastics in our food chain, acidification of our seas and climate change that will bring about frequent and often disastrous weather events. We must therefore maintain momentum in minimising our contribution to carbon in the atmosphere, products that persist in nature, and the destruction of other species due to loss of natural habitats. Extreme weather events and infectious diseases are now a very real and tangible part of our lives. Human activities have already set in motion these occurrences and therefore, we must adapt.

“It is not the strongest, nor the most intelligent of species that survives, but the one that is most adaptable to change ” Charles Darwin (1808-1882), naturalist, biologist and geologist, born in Shrewsbury The NHS is responsible for circa 4% of the nation’s carbon emissions. In October 2020, NHS England published ‘Delivering a Net-Zero National Health Service’, a report that details the scale of the environmental problems faced by the NHS and the country. This report set ambitious targets requiring all NHS organisations to become net zero by 2040 for the NHS Carbon Footprint, and by 2045 for the NHS Carbon Footprint Plus.

Green Plan

An organisational Green Plan has been approved by Board of Directors. In addition, an ICS System Green plan has been developed and co-ordinated by the ICS Climate Change Group. The system plan is an agglomeration of organisational green plans in the system. This document will form the basis for performance against the national climate change agenda and will be the base for co-operation between system partners. The ICS Climate Change Group is also developing a system-wide Carbon Footprint assessment which will support the prioritisation of work going forward.

Measuring sustainability

One of the ways we have measured our impact is through the national Sustainable Development Assessment Tool (SDAT). Our ratings continue to improve, and in 2020 we scored 76% (a 4% improvement on 2019), however the tool is no longer available, and NHSE is developing a new tool which the Trust will adopt as soon as it becomes available.

Carbon Management

The Trust has procured REGO-certified renewable energy over the past 3 years and will continue to do so into 2022/23. The Trust will continue to procure zero emissions from electricity imported from the national grid.

We have continued to invest in our BMS system utilising computerised control systems to reduce any unwarranted use of energy in the Trust’s hospitals. We are therefore able to identify trends in energy consumption enabling better prediction of energy need and therefore more effective utilisation of the Combined Heat and Power (CHP).

Energy Management

A Zero Carbon Strategy for Shrewsbury Hospital site has been implemented and will inform future site infrastructure and backlog programmes In also includes a proposal for a new zero carbon energy centre and heat network. And we have also progressed proposals for electric vehicle charging points throughout all our sites, and conversion of our fleet cars to become electrically powered, is also being explored.

Energy Usage

The general pattern of energy consumption for the Trust in the following table. Electricity usage overall has increased slightly compared to 2020/21 and could be attributed to the reintroduction of services following the COVID-19 pandemic, with more staff returning to work on site. Whilst the cost of energy has increased compared to 2020/21, we also expect a further inflation in energy prices as a result of international cost pressures.

Waste

The Trust continues to ensure compliance with disposal of its waste. All our domestic waste is sent to an energy recovery facility to generate electricity and we segregate recyclable material, such as metal and cardboard, where possible.

Last year, we sent 1,251 tonnes of clinical waste to incineration. Of this, 86% of processed (temperature sanitation) clinical waste, was sent to an energy recovery facility to generate electricity.

Clinical Waste Bag 20212022 Tonnage Volumes

ORANGE BAG -> PROCESSED-> ENERGY RECOVERY

10.8 YELLOW BAG - INCINERATION

166

993

TIGER BAG -> PROCESSED -> ENERGY RECOVERY 0 200 400 600 800 1000 1200

The Trust also takes an environmentally friendly approach towards the disposal of ‘sharps’ waste, by employing a greener approach with the use of re-used sharps containers. Through this method, the Trust saved 40 tonnes of single use plastic bins from being burnt, leading to saving 229 tonnes of C02 by using this process.

Sharpsmart -Reusing containers Clinical Waste Tonnage

Sharps Waste Non Medicinal - Navy Sharps Waste Medicinal Yellow Pharmaceutical Waste Blue Lid Cytotoxic Waste Purple Lid

A furniture reuse system is in place across our sites to enable staff to internally exchange furniture between departments. Fourteen percent of staff are now active members of this reuse, reduce furniture and office stationery scheme. We are proud of the fact that use of this scheme saved the Trust £40,000 and 16 tonnes of CO2.

Transport

The daily commute of our staff has a huge impact on the local environment in terms of vehicle numbers, noise, air quality and the demand for parking. We have a car-share web portal to encourage staff to share their commute and we also actively encourage staff to use public transport and the local cycle routes as means to get to work.

Mode Share %

Travel mode 2011 2015/16 2018 2019 2021

Walk 4.7% 7.8% 7.8% 8.0% 6.8%

Cycle 1.3% 5.5% 3.8% 5.9% 6.5%

Cycle/Train 0.0% 0.6% 0.3% 0.0% 0.0%

Electric Bike 0.0% 0.0% 0.0% 0.2% 1.1%

Bus 1.6% 2.8% 3.1% 3.1% 4.1%

Train 1.2% 1.2% 0.4% 0.5% 0.5%

Motorcycle 0.1% 0.3% 0.4% 0.7% 0.9%

Lift in car that than goes elsewhere 0.0% 0.0% 0.6% 1.7% 2.9%

Taxi 0.0% 0.0% 0.5% 0.7% 0.9%

Car Share 4.6% 3.3% 5.3% 4.0% 2.0%

SOV-Single Occupancy Vehicle 86.5% 73.1% 77.8% 75.2% 74.4%

Approximately 23% of staff choose not to bring their car to work, and instead use buses, cycles, shared lifts, orwalking. The recent staff travel survey showed an increase in numbers of staff cycling to work to 7.6%, of which 1.1% of these cyclists were new electric bicycle owners. Over forty cycles were purchased through the Trusts cycle to work scheme during the year, and we have an active Bicycle User Group with 419 staff members.

Like most sectors, the Trust has also seen a significant increase in staff who can work from home, being able to do so, for at least part of their working week. The Trusts 2021 Staff Travel survey indicated that pre-pandemic 4.7% of staff worked from home, although this rose to 17% of colleagues now working one or more days from home.

To help all visitors to find their way around the Trust, including our staff, a successful mapping project was carried out on Google Maps. So far, the mapping edits to the Trust sites have generated over 2 million views. For example, the newly created Captain Tom’s Garden has received 5,526 views and the RSH A&E has received 215,839 views.

Biodiversity

The Trust is in the process of enhancing biodiversity at our sites, including the development and redesign of courtyards and gardens, tree planting and rewilding. The most recent developed areas which were opened in 2021/22, are the Captain Tom Courtyard at Princess Royal Hospital, and Captain Tom’s Garden at Royal Shrewsbury Hospital. We have plans

to further enhance the biodiversity across the site and are developing a Biodiversity Strategy for the Trust which will link to our Trust and System-wide Green Plans.

Louise Barnett, Chief Executive Officer Date: 16 June 2022

Part two: Accountability Report

Corporate Governance Report

The Directors Report

The Board of Directors present their report and audited financial statements for the financial year ended 31 March 2022.

In accordance with its Establishment Order, the Board of Directors comprises six nonexecutive directors, including the Chair, and five executive directors, one of whom is the Chief Executive. All Directors are required to comply with Trust policies, including the need to declare any actual or potential conflict of interest, and must comply with the Fit and Proper Persons Test requirements.

Whilst non-executive directors are not employees of the Trust and are appointed to provide independent challenge to the Board of Directors, each board member brings a variety of individuals skills and experience to the Board.

Directors serving during the year were: Non-executive directors Dr Catriona McMahon

Dr McMahon is Chair of the Trust, and chairs the Trust’s Remuneration Committee, Quality Improvement Committee in Common, and chairs, jointly with Jane Garvey (formerly of the BBC’s Woman’s Hour) the Trust’s Ockenden Report Assurance Committee.

Dr McMahon is passionate about the NHS, patient access to innovation and excellence in patientcare. She was the Chair of the Medical Expert Network and member of the Innovation Strategy Board and Reputation Strategy Group of the Association of British Pharmaceutical Industries (ABPI), and co-chairoftheMinisterial and Industry Strategy Group (MISG) Clinical Research Working Group until December 2014. In addition, she is a former member of the Institute of Health and Care Excellence (NICE) Appeals Panel and NICE Neuroscience Guidelines Review Panel.

As well as her role as Trust Chair, Dr McMahon is a Non-Executive Director for University Hospitals Birmingham NHS Foundation Trust and owner of, and executive coach within, her own coaching business, specialising in supporting the development and delivery of

senior leaders in the healthcare and life science sectors. She is also Lead Industry Member ontheScottishMedicines Consortium (SMC), working with both SMC and industry on health technology assessment processes and processes improvement.

Dr McMahon attended Edinburgh Medical School and, prior to joining the pharmaceutical industry, she practised anaesthetics and critical care medicine in the north-east of England for 9 years. She is a Fellow of the Faculty of pharmaceutical Medicine and holds a Master of Public Health (Healthcare Management; Liverpool University) and a Masters in Science (Executive Coaching; Ashridge Business School).

Tony Bristlin

Mr Bristlin was the deputy chair of the Trust until 30 April 2022 when he stepped down from his role to take up a new opportunity closer to his own community.

Mr Bristlin was a member of the Audit and Risk Assurance Committee, the Quality and Safety Assurance Committee, the Remuneration Committee, the Quality Improvement Committee in Common, and the Trust’s Ockenden Report Assurance Committee. He was also the Trust’s non-executive Maternity Champion and, as such, closely followed the recent improvements being made in our maternity services.

Teresa Boughey

Ms Boughey is the Chair of our Charitable Funds Assurance Committee, and member of our Finance and Performance Assurance Committee, Quality and Safety Assurance Committee, and Remuneration Committee.

She is the founder and CEO of Jungle HR, a national, award-winning strategic HR consultancy, and has more than 25 years’ of HR experience at senior manager and director level after working across a variety of sectors. Ms Boughey has served as a member of the Women and Work, and Women and Enterprise all-party Parliamentary Groups, and has authored the Amazon number 1 bestselling book, ‘Closing the Gap – 5 Steps to Creating an Inclusive Culture’.

Ms Boughey is a Chartered Fellow of CIPD, a member of the Institute of Directors and holds an MA in Human Resource Management.

David Brown

Mr Brown is a member of our Audit and Risk Assurance Committee, Finance and Performance Assurance Committee, Quality and Safety Assurance Committee, and Remuneration Committee.

Since retiring from military service in 2000 as a Colonel, Mr Brown has gained senior executive experience as an MD and CEO in the engineering, and oil and gas sectors. Since 2014, he has run his own consultancy, specialising in business turn-around, management of change, strategic assessment and improving staff motivation.

Mr Brown graduated from the University of London with a BSc Hons in Geology, and has an MSc in Guided Weapons Technology, and an MSc in Business Management, as well as a PGDip in The Management of Change. He is a Fellow of the CMI and a Chartered Manager, as well as being a member of the Institute of Directors.

Mr Brown is also Chair of the Trust’s Organ Donation Group, and from January 2022, the recently established Public Assurance Forum .

Professor Clive Deadman

Professor Deadman is Chair of the Finance and Performance Assurance Committee, and a member of Quality and Safety Assurance Committee, and Remuneration Committee.

He brings more than 30 years’ regional and national level experience from senior commercial, finance and business development roles.

He studied Chemistry at Cambridge University and worked in Africa before spending eight years in the Venture Capital industry.

Since joining the utility sector in 1992, Professor Deadman has held a range of executive director roles in electricity distribution, water and wastewater utilities. He also holds a number of directorships in the housing and utilities sector

Professor Deadman is the current Group Chair of Halton Housing, a social housing and commercial property enterprise in the North West of the UK and visiting professor at Cranfield University.

Dr David Lee

Dr Lee is the Senior Independent Director, Chair of the Quality and Safety Assurance Committee, and member of the Audit and Risk Assurance Committee, the former Quality Improvement Committee in Common (to April 2022), and the Remuneration Committee

Having worked in medical leadership roles within both the NHS and independent sector, Dr Lee brings with him over thirty years’ of experience as a GP. He is the Medical Director of CSC, a multi-national corporation providing information techology and professional services.

Dr Lee is a committed proponent of clinical leadership, and the benefit of effective clinical leadership for patients using health services, and for the organisations which provide or commission them.

In addition to his medical qualifications, Dr Lee also holds a MBA from Leeds University and is training as an executive coach assessor.

Professor Trevor Purt

Professor Purt is the Chair of the Audit and Risk Assurance Committee, member of the Charitable Funds Committee, the Trust’s Ockenden Report Assurance Committee, and the Remuneration Committee.

He is both a Chartered Engineer and Chartered Surveyor after having initially trained in architecture. Professor Purt has been a CEO or equivalent both in the public and private sectors for over 25 years, and as a senior NHS leader he has led some of the largest NHS organisations in the UK with experience from both the provider and commissioning sectors, as well as working at both regional and national levels, including ICS development.

Professor Purt’s last role was in the private sector where was was Vice President for IBM Watson’s Healthcare Comsultancy business for Europe, the Middle East and Asia, with a

specific remit around population health and wider social care system integration and service reconfiguration.

In addition, Professor Purt was a Secretary of State appointee to the NMC, has served as a trustee and board member of the NHS Confederation, and The Prince’s Trust.

Executive directors

Mrs Louise Barnett

Mrs Barnett joined the Board of Directors as Chief Executive Officer (CEO) in February 2020, bringing with her extensive experience from both public and private sector organisations. She is also the Accounting Officer of the Trust and is accountable to Parliament.

With the national restructure of the NHS taking place, Mrs Barnett is ideally placed to support the impending changes in the local health and care system. She has recent and relevant experience of working as a Chief Executive of an NHS Foundation Trust which was one of seven NHS providers in a large Integrated Care System, which included ‘place’ based models of care. She is committed to a multidisciplinary, multi-agency approach to system change in order to meet the challenges of delivering safe and sustainable services for the communities of Shropshire, Telford and Wrekin and mid-Wales.

Mrs Barnett is passionate about developing leaders of the future and supports a number of national and regional leadership programmes. Whilst working as an NHS Chief Executive in Yorkshire before joining the Trust, she was Chair of the Yorkshire and Humber Leadership Council. Mrs Barnett has held a variety of roles in the NHS, as Chief Executive, Director of Human Resources and Organisational Development, and as a non-executive director.

Mrs Hayley Flavell – Director of Nursing

A Registered Nurse with over 30 years’ experience of working in the NHS, Mrs Flavell has a board experience of working as a senior nurse leader in a variety of acute hospital trusts, and joined us from the University Hospitals Birmingham NHS Foundation Trust.

Originating from the West Midlands, Mrs Flavell is passionate about providing our patients and their families with safe, quality of care. She believes that this can be achieved only by developing a blended workforce that is fit for purpose now, and in the future, and by leading

others to be able to deliver to the best of their ability at all times. She can often be found on wards and in clinical areas whenever she has a spare moment, to listen to staff and patients about their experiences of being at the Trust.

Mr Nigel Lee – Chief Operating Officer (until 13 March 2022)

Beginning his career as a helicopter pilot in the RAF both in Search and Rescue and as part of Special Forces, Mr Lee served in Northern Ireland, the Falkland Islands and Iraq before starting his healthcare career in 2006 as a hospital director for a BUPA hospital in the Wirral. From there, he became divisional director at Alder Hey Children’s Hospital and Aintree University Hospital.

Mr Lee has had senior operational roles with the Cheshire and Merseyside Major Trauma Network as well as a range of service configuration developments in the Merseyside area. Before joining the Trust in March 2018, Mr Lee was working in his role as Director of Secondary Care for the North Wales Health Board, where he was respondible for three hospital sites, womens’ services and the specialist cancer centre. He led elective and diagnostics imporvement projects, and played a lead role in the whole-system urgent care development programme.

On 13 March 2022, Mr Lee temporarily stepped down from his executive COO role to concentrate on progressing the Trust’s strategic work.

Ms Sara Biffen – Chief Operating Officer (from 14 March 2022)

Ms Biffen joined the NHS in 1986, the last 16 years of which have been at senior manager level at the Trust She has worked operationally with clinical teams across several specialties/areas and was the Assistant Chief Operating Officer for planned Care for 5 years

Ms Biffen was appointed to the Deputy Chief Operating role in February 2016, where she led on 18-week RTT and cancer improvement and worked with the Divisions to improve emergency planning and business continuity. She took up her current role of Acting Chief Operating Officer in March 2022 before which, she covered the Divisional Director of Operations for Medicine and Emergency Care and was the Senior responsible officer (SRO) for urgent and emergency care.

Ms Helen Troalen – Director of Finance (from 1 April 2021)

Joining the Trust on a substantive basis from 1 April 2021, Mrs Troalen has just completed her first year as substantive Director of Finance with the Trust.

Ms Troalen joined the NHS in 2003 as a graduate trainee and qualified as a management accountant in 2007. Her career has spanned nearly twenty years in the NHS with roles in both the provider and commissioner sectors. She has also work in a regional role at NHS London.

Prior to joining the Trust Ms Troalen was deputy chief financial officer at The Royal Wolverhampton NHS Trust for four years. Prior to that she was the deputy chief finance officer at a large collaborative of clinical commissioning groups in north-west London also for four years.

Ms Troalen has a particular focus on improving services for patients and the role that robust financial stewardship can play in effective organisations. Being involved in the redesign of stroke and major trauma services in London remains a particular career highlight.

Dr John Jones – Acting Medical Director (from 1 October 2021)

Dr Jones has lived in Shropshire and worked the Trust for almost 20 years, primarily as a consultant physician and gastroenterologist.

Dr Jones was an undergraduate at Christ's College Cambridge University and then a clinical student at Oxford University. He has worked in hospitals in Gloucester, Oxford, Stoke-onTrent and the East Midlands before moving to Shropshire after completion of his PhD.

He has strong interest in medical education and regulation and carries out a number of roles for the GMC including as an educational visitor for new medical schools. He led the introduction of the first Keele University curriculum to our hospitals. He has previously worked for the Parliamentary and Health Service Ombudsman in Manchester.

Although the majority of Dr Jones’ time is now spent in the executive role, he continues in clinical practice with a particular focus on specialist endoscopy for patients with suspected cancer.

Directors who left the Board before 31 March 2022

Dr Arne Rose – Medical Director (to 30 September 2021)

Directors appointed after 31 March 2022

One new non-executive director, and two associate non-executive directors, took up post after the year-end. These were:

Mr Rajinder Dhaliwal – non-executive director from 1 May 2022 (two-year tenture)

Prof. Julie Green – associate non-executive director from 1 May 2022 (two-year tenure).

Ms Rosie Edwards – associate non-executive director from 1 June 2022 (two-year tenure).

The Board of Directors and Meetings

The Trust is governed by the Board of Directors and the overarching governance framework is described in detail in the organisation’s Standing Orders, Standing Financial Instructions and the Scheme of Delegation

The Chair proactively encourages Board members to constructively challenge and explore proposals made to the Board and assist in developing proposals on strategy, priorities, risk mitigations and standards.

Standing items on the meeting agenda relate to strategy, governance, patient feedback, integrated performance reports and summary reports of meetings of the Board committees, with the Board Assurance Framework reported on a regular basis as a standing agenda item at the Board. Detailed reports have been received on a broad range of strategic and governance issues.

The importance of the triangulation of understanding, challenge and assurance between Committees is recognised and reflected through cross-membership and reporting between the groups and through the receipt of summary reports to the Board of Directors.

Like other NHS organisations, meetings of the Board of Directors are usually held in public, but due to pandemic regulations, they have been live streamed to members of the public throughout the financial year. Members of the public can send in questions for the Board, the answers to which are then reported on the Trust website. Board papers are also published monthly on the Trust website before the meetings and can be found by following this link: https://www.sath.nhs.uk/about-us/trust-information/board-papers/

The Trust Board of Directors formally met eleven times during the year.

Voting Board Members

Catriona McMahon

Louise Barnett

Sara Biffen

Teresa Boughey

Tony Bristlin

David Brown

Dr John Jones

Dr David Lee

Nigel Lee

Trevor Purt

The Board received reports from five committees chaired / co-chaired by the Non-Executive Directors:

Audit and Risk Assurance Committee

Quality and Safety Assurance Committee Finance and Performance Assurance Committee

Ockenden Report Assurance Committee

Quality Improvement Committee in Common (last meeting held on 6 April 2022).

In addition, the Trust has a Remuneration Committee, its membership being made up of all the non-executive directors and chaired by the Trust Chair, and a Charitable Funds Assurance Committee, its authority being delegated from the Corporate Trustee.

Audit and Risk Assurance Committee

The Committee’s principal function is to advise the Board on the adequacy and effectiveness of the Trust’s systems of internal control and its arrangements for risk management, control and governance processes, and securing economy, efficiency and effectiveness.

The Committee met regularly throughout the year. Chaired by Non-Executive Director Professor Trevor Purt, the Committee comprises three Non-Executive Directors (including the committee chair). The other committee members during the year and their attendance is shown below:

2021/22 Meeting Dates 12 Apr 2021

5 May 2021

26 May 2021

9 Jun 2021

21 Jul 2021

6 Sept 2021

16 Dec 2021

Committee Members Professor Trevor Purt (Chair) √ √ √ √ √ √ √ √

16 Feb 2022

Tony Bristlin √ √ √ √ √ √ √ x David Brown √ √ √ √ √ √ √ √

Dr David Lee x √ √ √ √ √ √ √

The primary purpose of the Committee is to provide assurance to the Board of Directors about the continued effectiveness of the Trust’s system of integrated governance, risk management, financial reporting and internal control. The Committee receives reports from the Trust’s internal and external auditors and from the local counter fraud service.

The priorities for the Committee are to monitor the integrity of the Trust’s financial statements and to review the Trust’s financial and non-financial controls and management systems.

The Committee’s work has focussed on the register of risks, controls and related assurances underpinning the delivery of the Board’s objectives.

Executive directors, subject matter experts normally attend the meetings as well as the external auditor, KPMG LLP, and internal auditors, Merseyside Internal Audit (MIAA) Following a competitive tendering exercise MIA was appointed as the new internal auditor and counter fraud specialist in 2020. To provide assurance to the Committee, relevant colleagues from the Trust are also invited to attend certain meetings to provide a deeper level of insight into certain key issues and developments.

The Committee receives and monitors the policies and procedures associated with counter fraud and corruption and oversaw the review and production of new policies during the year

An independent local counter fraud service provided by MIAA produces a counter fraud progress report giving updates on both reactive and proactive work undertaken in the Trust.

The purpose of internal audit is to provide the Trust, via the Audit and Risk Assurance Committee and the Chief Executive, with an independent and objective opinion on risk management, control and governance and their effectiveness in achieving the Trust’s agreed objectives. To provide this opinion, the internal auditor reviews the risk management and governance processes annually within the Trust and on a three-year cyclical basis the operation of internal control systems within the Trust. More details regarding the work of the internal auditors are included in the Annual Governance Statement, starting on page 92

External Auditors’ Remuneration

Fees payable to the external auditors during the year for statutory audit services only amounted to £131,000 (2020/21: £129,000). No additional work was undertaken by the external auditors for the Trust.

Public Sector Payment Policy – Better Payment Practice Code

In accordance with the Better Payments Practice Code and government accounting rules, the Trust’s payment policy is to pay creditors by the due date, or within 30 days of receipt of a valid invoice, (whichever is the later) unless other terms have been agreed.

In 2021/22, the Trust paid 86.7% (2020/21: 92.1%) of non-NHS trade invoices within target, and 89.7% (2020/21: 88.9%) of NHS trade invoices within target. More details can be found in note 45 to the accounts.

Fraud, Bribery and Corruption

The Trust’s Anti-Fraud, Bribery and Corruption Policy & Response Plan was updated in September 2021 and sets out the arrangements that the Trust maintains to deter, prevent, detect and investigate instances of fraud, corruption and bribery carried out against the Trust, and the wider NHS

The Trust has a qualified Local Counter Fraud Specialist (contracted from MIAA) which ensures that the annual plan of proactive work minimises the risk of fraud within the Trust and is fully compliant with regulatory counter fraud standards for providers. Counter fraud reports are presented to the Audit and Risk Assurance Committee at each meeting.

Modern Slavery

Under Section 54 of the Modern Slavery Act, we are committed to ensuring that employees of the Trust are not exploited, that they are safe, that they have the right to work and remain in the country, and that their employment standards and human rights are adhered to. The Trust expects the same from its suppliers and is committed to working with them to ensure any issues are identified and proactively managed. Some controls in place include:

Employment checks of individuals and of agencies which supply temporary staff

Use of NHS General Terms and Conditions of Contract for Goods and Services which cover all suppliers to the Trust including medicines

Due diligence within our procurement and tendering processes to test that selected suppliers and third parties are complaint with the legislation.

Information Commissioners Office: Disclosure of Personal Data

The Trust reported two (2020/21:10) incidents to the Information Commissioners Office between 1 April 2021 to 31 March 2022 relating to information governance including data losses or confidentiality breaches.

The Information Commissioners Office has not taken action against the Trust for any of the reportable incidents to date

The Trust manages threats to cyber security on an ongoing basis. Weekly reports of progress in implementing recommendations regarding nationally circulated cyber security threat information is being issued to a number of leaders in the organisation with a role in the oversight of cyber threats and risks to the organisation.

Declaration from Directors as to audit information

The Directors are responsible for preparing the Annual Report and Accounts and consider the report to be a fair, balanced and understandable account of the performance for the year ended 2021/22.

Each director knows of no information which would be relevant to the auditors for the purpose of their audit report and of which, the auditors are not aware and, that they have taken all the

steps that he or she should have taken to make him or herself aware of any such information and to establish that the auditors are aware of it.

Register of Interests

Directors are asked to declare any interests that are relevant or material on appointment and as soon as possible should a conflict arise during their term. The agendas of the Board and meetings its committees contain an item allowing directors to declare any additional, or any change in, their interests. The Interest Register is also updated and presented to the Board of Directors at its meeting held in public on a twice annual basis.

Dr Catriona McMahon (Chair)

Owner and Director, CMMK Ltd. Owner and Director, TAC Ltd. Shareholder, AstraZeneca NED, University Hospital Birmingham NHS Foundation Trust

Mrs Teresa Boughey

Director, Jungle HR Ltd Oiagen, Client of Jungle HR Ltd Director, Inclusion 247 Ltd Business Board Member, Women and Enterprise All Party Parliamentary Group Strategic Advisory Group member, NHS Employers Diversity & Inclusion Partners Programme Advisory Board member, Royal Holloway, University of London, School of Business & Management Peter Jones Foundation Mentor Daughter, works at Robert Jones & Agnes Hunt

Mr David Brown

Trustee, Telford & Wrekin Carers Partnership Board adviser, MFL Engineering Ltd, Carlisle Director, Prosenge Limitada, Brazil. Governor, Charlton School, Telford Director, Jidkonstar Engineering Solutions Ltd. Nigeria

Prof. Clive Deadman

Chair, Energy Innovation Centre Investment Forum Chair and Shareholder, 1905 Investments Ltd Professor, Cranfield University Group Chair, Halton Housing Trust

Chief Medical Officer Clinical Safety, Dedalus Group (formerly Chief Medical Officer Clinical Safety Quality and Regulatory Affairs, DXC Technology)

Dr David Lee

Sessional GP, Shropshire, working principally at Alveley Medical Practice Director, Massive Heart Consulting Limited

Prof Trevor Purt Director, NHS Arden and Gem Commissioning Support Unit,

NON-EXECUTIVE DIRECTORS (All directors act as agent of the Trust’s Charity*)

EXECUTIVE

Effective Leadership Solutions

Advisory Board Member, University of Lincoln International Institute for Rural Health Wife, Non-Executive Director Shropshire Community NHS Trust Wife, Interim Director NHSE/I – Midlands

DIRECTORS (All directors act as an agent of the Trust’s Charity*)

Mrs Louise Barnett

Husband, Chair of NorthWest Anglia NHS Foundation Trust (From 1April 2022) Husband, Chair and Client Partner of SSG Health Ltd Husband, Visiting Professor of Cranfield University

Ms Sarah Biffen None

Mrs Hayley Flavell None

Dr John Jones

Director, Dr J I W Jones Limited Wife, Shropshire GP

Mr Nigel Lee None

Ms Helen Troalen

Director, Vadebeam Limited Close family friend is the Regional Director of Partnerships, Siemens.

*The Shrewsbury and Telford Hospital NHS Trust Charity (number 1107883)

Full details about the charity, including latest annual report and accounts, can be found on the Charity Commission website here: https://register-ofcharities.charitycommission.gov.uk/charity -search/-/charity-details/4013618

Engagement with our Community

Engagement with our community, patients and their families, and with healthcare and other community partners, is extremely important to the Trust. Services are provided for the benefit of service users, and the views of those who use, or who are interested in the care and delivery

of the public services we provide, matters to us.

To support increased engagement and transparency, the Trust held its inaugral meeting of the Public Assurance Forum, chaired by NED David Brown, in January 2022, following the approval and publication of the Trust’s Public Participation Strategy in October 2021.

The aim of the Public Assurance Forum is to bring a public and community perspective, and scrutiny of processes, decision making and wider work, that takes place at the Shrewsbury and Telford Hospital NHS Trust. It is an advisory group whose role is to ensure that decisions about services and the delivery of care are developed in partnership with our local communities.

Membership of the Public Assurance Forum is wide ranging:

Co-Chair – Non Executive Director / Public representative (Trust)

Deputy Chair – Director of Public Participation (Trust)

Head of Public Participation (Trust)

Community Engagement Facilitator (Trust)

Head of Patient Experience (Trust)

1 member from each of the four Trust clinical divisions (Trust)

1 member from Healthwatch Shropshire

1 member from Healthwatch T&W

1 member from Community Heath Council (CHC)

1 member from Shropshire Patient Group

1 member from Patients First Telford

1 member from the Telford Chief Officers Group (COG)

1 member from Maternity Voices

1 member of Shropshire Voluntary and Community Sector Assembly(VCSA)

1 member of Powys Association of Voluntary Organisations (PAVO)

1 member of the Trust’s PACE panel, and Equality Diversity and Inclusivity Public Advocates Group

1 member from each Health and Wellbeing Board Medical Director (Co-optee)

Members from other nominated groups (following feedback from stakeholders) representing the different communities and areas covering Shropshire, T&W and Powys’ The opportunity to co-opt members for specific issues that are taken to the Forum

Supporting the work that goes on behind the Forum, is the Public Participation Team, which is involved in community engagement activities, our volunteers, and management of the Trust’s charity.

A series of community meetings have been held during the year where the public across Shropshire, Telford & Wrekin and Powys are invited to join the Trust virtually to find out more about their hospitals. These included:

Monthly email update. A regular email update to our members and organisations Community Cascade. This is delivered twice a month following feedback from the public requesting an additional session in the evening Monthly Community drop-ins. We provide the opportunity for members of the community to ‘drop-ins’ so that they are able to meet directly with members of the engagement team and to share experiences and suggestions, and to provide feedback about our hospitals. About Health Events. This is an ongoing series of virtual health events for staff and the public to engage with.

The team have recently undertaken a gap analysis to support engagement with rural and ‘hard to reach’ communities. This social inclusion project is aimed to ensure that those from such communities have the opportunties to engage with us in a manner that is suitable to their needs and requirements. This is a massive project, and work will progress well into 2022/23 and beyond.

Volunteers

The Trust could not be without its marvellous volunteers who continue to support us in a variety of ways.

We are exceptionally proud that from our 272 volunteers, 85 are aged 16/17 years of age, and that over 50 applications in this age group alone were pending at year end. NHS Charities Together recent granted £86,000 for us to develop a 15-month long Young Volunteer Project which will enhance our existing scheme, and support these young men and women on their journey of becoming good corporate citizens.

The roles that our volunteers play, are incredibly important to the Trust. We are currently developing a voluntary service to support patient flow in our A&E’s, which will help the

discharge process. The roles will cover our two main sites on a 7 day basis, and volunteers have already provided 357 hours per month to these roles across our sites.

New volunteering opportunities have also recently been filled in Ophthalmology Outpatients, Cataract Suite, Audiology, Dietetics and Breastfeeding support. We will never have too many volunteers and continue to owe them all a great deal of gratitude for everything they do.

Remuneration Report

This Remuneration Report considers the senior managers of the organisation. ‘Senior Managers’ are defined as those persons in senior positions having the authority or responsibility for directing or controlling the major activities of the Trust. The means, those persons who influence the decisions of the organsiation as a whole, rather than those who take decisions at divisional or departmental level. For the purposes of this report, this covers the Trust’s nonexecutive directors and executive directors.

Remuneration Policy

The Trust’s approach to Remuneration Policy for Directors is in line with guidance issued by NHSI in order that directors’ pay remains both competitive and provides value for money. The Trust has a Remuneration Committee that agrees the remuneration packages for executive directors.

Remuneration figures in the following tables represent actual remuneration rather than full year effect, and the band of the highest paid directors’ remuneration excludes pension related benefits and is based on annualised, full time equivalent remuneration.

The Medical Director’s ‘Other Remuneration’ relates to their non-managerial clinical role.

The expense payments for the Chair and non-executive directors are ‘home to base’ mileage, taxed at source.

The tables on the following pages are subject to audit.

Table 1 – 2021/22

Name

Executive Directors:

2021/22

Louise Barnett Chief Executive 205-210 0-5 - - - 50-55 260-265

Sara Biffen∞

Acting Chief Operating Officer 5-10 - - - - 50-55 55-60

Hayley Flavell* Director of Nursing 125-130 - - - - 180-185 310-315

Dr John Jones** Acting Medical Director 55-60 50-55 - - - 145-150 250-255

Nigel Lee∞∞ Chief Operating Officer 135-140 0-5 - - -

Opted out of NHS pension scheme 135-140

Dr Arne Rose*** Medical Cases 110-115 25-30 Not in NHS pension scheme 135-140

Helen Troalen♯ Director of Finance 130-135 0-5 - - - 115-120 250-255

Dr Catriona McMahon

Chair 40-45 - 3,000 - - - 45-50

Teresa Boughey, NED 10-15 - - - - - 10-15

Anthony Bristlin, NED 10-15 - 700 - - - 15-20

David Brown, NED 10-15 - - - - - 10-15

Clive Deadman, NED 10-15 - 100 - - - 10-15

Dr David Lee, NED 10-15 - - - - - 10-15

Trevor Purt, NED 10-15 - 100 - - - 10-15

Name and Title

Executive Directors:

Louise Barnett

2020/21

Salary £000 Other Remuneration £000 Expense payments (taxable) £0 Performance pay

and bonuses £000 Long term performance pay

and bonuses £000

All pensionrelated benefits £000 TOTAL £000

Chief Executive 205-210 - - - - 85-87.5 290-295

Sara Biffen∞

Acting Chief Operating Officer - - - - - - -

Hayley Flavell* Director of Nursing 70-75 - - - - 217.5-220 290-295

Dr John Jones** Acting Medical Director - - - - - - -

Nigel Lee∞∞ Chief Operating Officer 140-145 - - - -

Dr Arne Rose*** Medical Director 210-215 40-45

Non-Executive Directors:

Opted out of NHS pension scheme 140-145

Not in NHS pension scheme 250-255

Dr Catriona McMahon Chair 20-25 - 700 - - - 25-30

Teresa Boughey, NED 10-15 - 400 - - - 10-15

Anthony Bristlin, NED 10-15 - 400 - - - 10-15

David Brown, NED 10-15 - 400 - - - 10-15

Clive Deadman, NED 10-15 - 200 - - - 10-15

Dr David Lee, NED 10-15 - - - - - 10-15

Trevor Purt, NED 10-15 - 500 - - - 10-15 For all remuneration tables in this section

Acting Medical Director from 01/10/2021

Medical Director to 30/09/2021

Acting Chief Operating Officer from 14 March 2022

Chief Operating Officer to 13 March 2022

Substantive Director of Finance from 1 April 2021

All Pension Related Benefits – subject to audit

The value of pension benefits accrued during the year is calculated as the real increase in pension multiplied by 20, less the contributions made by the individual. The real increase excludes increases due to inflation or any increase or decrease due to a transfer of pension rights. This value does not represent an amount that will be received by the individual. Rather, is a calculation that is intended to convey an estimation of the benefit that being a member of the pension scheme could provide. Table 3 below provides further information on the pension benefits accruing to the individual.

Salary and pension entitlements are provided in table 3. for the ‘executive directors’ as nonexecutive directors do not receive pensionable remuneration.

Table 3: 2021/22 2021/22

Name and Title

age (bands of £2,500)

pension at pension

Real increase in

£2,500)

pension age (bands of

pension lump sum at

Real increase in

£5,000)

March 2022 (bands of

at pension age at 31

Total accrued pension

2022 (bands of £5,000)

pension at 31 March

age related to accrued

Lump sum at pension

2022 (bands of £5,000)

pension at 31 March

age related to accrued

Lump sum at pension

Equivalent Transfer Value Cash Equivalent Transfer Value at 31

Real increase in Cash

March 2022 Employer's contribution to

stakeholder pension £000 £000 £000 £000 £000 £000 £000 £000

Louise Barnett Chief Executive 2.5-5 0-2.5 55-60 90-95 887 51 973 0

Sara Biffen∞ Acting Chief Operating Officer 0-2.5 0-2.5 50-55 115-120 976 0 1,052 0

Hayley Flavell* Director of Nursing 7.5 - 10 17.5-20 45-50 105-110 656 153 831 0

Dr John Jones** Acting Medical Director 2.5 - 5 2.5 - 5 65-70 150-155 1,157 53 1,317 0

Helen Troalen Director of Finance 5 - 7.5 10-12.5 30-35 55-60 369 80 469 0

The method used to calculate Cash Equivalent Transfer Value’s (CETV’s) changed on 8 August 2019, in order to remove the adjustment for Guaranteed Minimum Pension (GMP). If the indivdual concerned was entitled to a GMP, this will affect the calculation of the real

increase in CETV. The real increase in accrued pension, lump sum and CETV relate to the proportion for the time in post.

Fair Pay Disclosure – subject to audit

Reporting bodies are required to disclose the relationship between the remuneration of the highest-paid director in their organisation and the median remuneration of the organisation’s workforce.

The banded remuneration of the highest paid director at the Shrewsbury and Telford Hospital NHS Trust in the financial year 2021-22 was in the salary banding of £215,000 to £220,000 (2020-21: £250,000 to £255,000). This was 7.35 times (2020-21: 9.16 times) the median remuneration of the workforce, which was £28,915 (2020-21, £27,581).

In 2021/22, twelve (2020-21, 1) employees received remuneration in excess of the highest-paid director. Remuneration ranged from £0-£5,000 to £375,000-£380,000 in 2021/22 (2020-21, ranged from £0-£5,000 to £270,000-£275,000).

Total remuneration includes salary, non-consolidated performance-related pay, benefits-in-kind, but not severance payments. It does not include employer pension contributions and the cash equivalent transfer value of pensions.

The median remuneration ratio of the workforce reduced by 19.73%. The reduction in the median ratio is due to the NHS pay increase in year and reduction in the highest paid director's pay compared to last year.

The yearly percentage change in the highest paid director’s remuneration 10.29%

The yearly percentage change in the total average employee remuneration 3.14%

The ratio between the highest paid director's remuneration and the pay and benefits of the employee on the 25th percentile of pay and benefits of the Trust's employees for the financial year 10.03

The ratio between the highest paid director's remuneration and the pay and benefits of the employee on the 75th percentile of pay and benefits of the Trust's employees for the financial year 5.10

Part 2: Accountability Report

Exit Packages agreed in 2021/22

Table 1: Exit Packages 2021/22 – subject to audit

Reporting of compensation schemes - exit packages 2021/22

Exit package cost band (incl. any special payment element.)

Number of compulsory redundancies

Number of other departures agreed

Total number of exit packages

<£10,000 2 10 12

£10,000 - £25,000 £25,001 - £50,000 1 1 £50,001 - £100,000 1 1 £100,001 - £150,000 £150,001 - £200,000 >£200,000

Total number of exit packages by type 3 11 14

Total cost (£) £41,000 £101,000 £142,000

Table 2: Exit Packages 2020/21– subject to audit

Reporting of compensation schemes - exit packages 2020/21

Exit package cost band (incl. any special payment element.)

Number of compulsory redundancies

Number of other departures agreed

Total number of exit packages

<£10,000 6 6 £10,000 - £25,000 2 2 £25,001 - £50,000 1 1 £50,001 - £100,000 1 1 £100,001 - £150,000 £150,001 - £200,000 >£200,000

Total number of exit packages by type 2 8 10

Total cost (£) £101,000 £44,000 £145,000

This section provides an analysis of exit packages agreed with staff during the year and is subject to audit. Redundancy and other departure costs have been paid in accordance with the provisions of the NHS Scheme.

Table 3: Other non-compulsory departure payments – subject to audit

Reporting of compensation schemes – other non compulsory departure payments

2021/22 2020/21

Type

Number of payments agreed

Total value of agreements £000

Number of payments agreed

Total value of agreements £000

Voluntary redundancies including early retirement contractual costs - - -Mutually agreed resignations (MARS) contractual costs 1 76 - -

Early retirements in the efficiency of the service contractual costs - - - -

Contractual payments in lieu of notice 10 25 8 44 Exit payments following Employment Tribunals or court orders - - - -

Non-contractual payments requiring HMT approval - - - -

Total number 11 101 8 44

Of which, non-contractual payments requiring HMT approval made to individuals where the payment value was more than 12 months’ of their annual salary

- - - -

Reporting related to the Review of Tax Arrangements of Public Sector Appointees

Following the Review of the tax arrangements of public sector appointees published by the Chief Secretary to the Treasury on 23 May 2012, departments and their arm’s length bodies must publish information on their highly paid and/or senior off-payroll engagements.

The Trust is required to disclose:

All off-payroll engagements as of 31 March 2022, greater than £245 per day and that last longer than six months (see table A below).

All new off-payroll engagements, or those that reached six months in duration, between 1 April 2021 and 31 March 2022, greater than £245 per day and that last for longer than six months (see table B below).

Any off-payroll engagements of board members, and/or, senior officials with significant financial responsibility, between 1 April 2021 and 31 March 2022 (see table C below).

Table A:

For all off-payroll engagements as of 31 March 2022, for more than £245 per day and that last longer than six months: Number

Number of existing engagements as of 31 March 2022 10

Of which, the number that have existed: for less than one year at the time of reporting 1 for between one and two years at the time of reporting 4 for between 2 and 3 years at the time of reporting 5 for between 3 and 4 years at the time of reportingfor 4 or more years at the time of reporting -

Table B:

For all new off-payroll engagements, or those that reached six months in duration, between 1 April 2021 and 31 March 2022, for more than £245 per day and that last for longer than six months Number

Number of new engagements, or those that reached six months in duration, between 1 April 2021 and 31 March 2022 10

Of which: -

Number assessed as caught by IR35Number assessed as not caught by IR35 10

Number engaged directly (via PSC contracted to department) and are on the departmental payroll -

Number of engagements reassessed for consistency/assurance purposes during the year -

Number of engagements that saw a change to IR35 status following the consistency review -

Table C:

For any off-payroll engagements of board members, and/or, senior officials with significant financial responsibility, between 1 April 2021 and 31 March 2022

Number

Number of off-payroll engagements of board members, and/or senior officers with significant financial responsibility, during the financial year 0 Total number 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 includes both on payroll and off-payroll engagements.

Staff Report

Shrewsbury and Telford Hospital NHS Trust’s Recruitment and Retention Strategy supports the Trust’s ambitions to be a well led Trust, providing excellent care for the communities we serve. However, like most organisations, the national shortage of certain NHS roles means that workforce remains a challenge for the Trust. With its rural location, competition from organisations in nearby metropolitan areas, and reputational issues, the Trust is working hard to recruit and retain a competent, and agile workforce; this is a key priority for the Trust.

Average number of employees (WTE basis) – subject to audit

Type Permanent Number (WTE)

Other number (WTE)

2021/22 2020/21

Total number (WTE)

Total number (WTE)

Medical and dental 665 122 787 745 Ambulance staff 4 - 4 3

Administration and estates 1,203 3 1,206 1,249 Healthcare assistants and other support staff 1,186 245 1,431 1,360

Nursing, midwifery and health visiting staff 1,906 261 2,167 2,048 Nursing, midwifery and health visiting learners 9 - 9 28 Scientific, therapeutic and technical staff 667 46 713 692 Healthcare science staff 332 - 332 316

Social care staff - - -Other - 116 116 -

Total average numbers 5,972 793 6,765 6,441

Of which, Number of employees (WTE) engaged on capital projects 27 3 30 21

Recognising the importance of supporting new employees who join the Trust, we have provided an ‘onboarding service’ to include sending welcome cards, a revised welcome pack detailing key information, sending welcome cards, and contacting staff during the first 6 months of employment to support them settling in.

Staff Costs – subject to audit

2021/22 2020/21

Type Permanent £000 Other £000 Total £000 Total £000

Salaries and wages 264,492 1,706 266,198 248,966 Social Security Costs 26,118 - 26,118 22,656

Apprenticeship levy 1,273 - 1,273 1,152

Employer’s contributions to NHS pension scheme 42,723 - 42,723 39,737

Pension cost - other - - -

Other post employment benefits - - -Termination payments - - - -

Temporary Staff - 32,845 32,845 29,902

Total gross staff costs 334,606 34,551 369,157 342,413 Recoveries in respect of seconded staff - - -Total Staff Costs 334,606 34,551 369,157 342,413 of whichCosts capitalised as part of the assets 1,723 - 1,723 1,148

The Trust has now developed a monthly recruitment dashboard to provide key metrics on both medical and non-medical recruitment activity.

We have introduced a range of new programmes such as a Nursing Associate Top Up programme allowing development of Nursing Associates to become registered nurses.

Recruitment and Selection workshops have been implemented to support appointing managers during the hiring process. We have also re-introduced Trac (recruitment system) training sessions, which are delivered virtually.

In January 2022, the Trust launched an Academy to train Health Care Support Workers, alongside partner organisations within the county’s health and care system, and Telford College.

Our international nursing recruitment campaign was successfully completed in February 2022, with 190 WTE nurses joining the Trust. The programme included robust OSCE support, and development and enhanced onboarding assistance to include support with travel,

accommodation and overcoming the many challenges of the pandemic e.g. quarantine and delays with travel. In addition to the successful recruitment in year, the Trust’s available workforce at year-end also included 1782 staff on the Trust’s internal bank, in addition to staff working within the Trust via external agencies.

Analysis of staff numbers

The figures in the following tables are calculated based on headcount in the organisation as 31 March 2022, unless otherwise indicated.

Recruitment - disability

The Trust continues to demonstrate its commitment to disability, taking positive action by displaying the Disability Confident Committed symbol.

Staff with recorded disabilities

Headcount Percentage

No 6,009 84.87% Not Declared 705 9.96%

Prefer not to Answer 19 0.27% Not Known 104 1.47% Yes 243 3.43%

Grand Total 7080

This commitment includes:

Interviewing applicants with disabilities who meet the minimum job criteria

Consulting annually with individual staff with disabilities through the appraisal process about how the Trust can develop and support them

Making every effort to redeploy staff who become disabled and cannot continue in their current role

Raising awareness of disability amongst staff

Delivering Safer Recruitment workshops to staff involved in the recruitment process

Monitoring and communicate achievements in relation to commitments

During the financial year, the Trust received a total of 986 applications for jobs from candidates with disabilities. Of these, 445 (2020/21: 312) candidates were shortlisted, 313 interviewed and 118 (2020/21: 80) applicants were appointed.

Improvements that support our wider employment agenda have been introduced via these policies, for example:

Extension of the right to apply for flexible working from the first day employment A faster and simpler process to staff who wish to return to work after commencing their NHS pension benefits.

Promotion of informal and fast track

Turnover 2021/22

Turnover for the year increased to 15.20% (2020/21: 10.79%).

Sickness absence 2021/22

The Trust’s sickness rate (excluding sickness absence attributable to COVID 19) for the calendar year 2021/22 was 4.76% (2020/21: 3.99%), representing an increase of 0.77% over the previous reported period. Sickness

19 related absences have decreased by 1.21%, total FTE calendar days lost has decreased by 33% and the average FTE calendar days lost per employee decreased by 3 days.

Staff gender distribution 2021/22

A breakdown of the number of persons who were directors of the Trust, senior managers, and other employees is shown below.

Staff age distribution 2021/22

Breaking down our workforce into age bandings as shown here, illustrates that most of our workforce are under the age of 50 years old, although almost a fifth are between the ages of 51 – 60. This may pose a risk to the Trust in the future if many colleagues take retirement at a similar time. Recruitment mitigates some of this risk, and more integrated workforce planning across the system will become increasing required.

Age Band Headcount Percentage

<=20 Years 47 0.66% 21-25 481 6.79% 26-30 920 13.00% 31-35 997 14.08% 36-40 793 11.20% 41-45 748 10.57% 46-50 823 11.61% 51-55 896 12.66% 56-60 839 11.85% 61-65 426 6.02% 66-70 82 1.16% >=71 Years 28 0.40% Grand Total 7080

Staff ethnicity and religious belief 2021/22

Compared to the previous financial year there has been an increase in Asian or Asian British ethnicity in our workforce from 9% to 11%, and in numbers of Black or Black British from 2% to 4%, and a decrease in White from 83% to 80%. This is shown on the two tables on the next page, together with details of religious beliefs.

Ethnicity

Headcount Percentage

Control measures are in place to provide assurance that all obligations under equality, diversity and human rights legislation are complied with. Monitoring provides data which informs plans and strategies to achieve an inclusive workplace and make improvements to the working environment for all staff. The outcomes are reported to the Board annually, and the Equality and Diversity Action Plan is updated as appropriate.

Asian or Asian British 757 11% Black or Black British 251 4% Mixed 85 1% Not Stated 71 1% Other Ethnic Groups 223 3% White 5675 80% Not Known 18 0%

Grand Total 7080

During the financial year, we have continued to strengthen our partnership working across the Integrated Care System and with our partners As a system we have committed to 10 overarching pledges which includes tackling the problems of ill health, health inequalities and access to health care, improving our leadership and governance and making our system a great place to work.

Religious Belief Headcount Percentage

Atheism 1021 14% Buddhism 34 0% Christianity 3720 53% Hinduism 224 3% I do not wish to disclose my religion/belief 1407 20% Islam 170 2% Jainism 2 0% Judaism 3 0% Other 398 6% Sikhism 48 1% Not Known 53 1%

Grand Total 7080

Staff Survey

Between September and November 2021, the National NHS Staff Survey was undertaken; it is designed to collect the views of staff about their work and the Trust. The overall aim of the survey is to gather views and thoughts from our staff so that we can listen to what our people think about working for the Trust.

The information from the staff survey together with information from ‘Making a Difference Together’ the online conversation platform is used to inform action plans and help us to improve the working lives of our staff, and so provide better care for patients.

The questions from the staff survey were also aligned to the People Promise this year:

Sadly, the Trust did not score well against the indicators and was below average in all elements:

A total of 6,767 members of staff were eligible to respond to the survey, and 45% of staff completed the survey in line with the target in the People Strategy, which equated to a total of 3,011 respondents. This was the highest number of responses received since 2013, and an increase of 2% on the previous year. (See table 1 below)

Table 1

The staff engagement score has seen a steady decline over the last six years, from 6.9 in 2016 to 6.55 in 2020 and then to 6.29 in 2021. This was disappointing in view of the work that has been taking place to increase our listening to colleagues, and our visibility to colleagues.

This clearly indicates that we have not got this right yet, and that there is more work to do. This 6.29 compared against a national average of 6.8 and a best of 7.4 (See table 2 below)

Table 2

Morale also reduced from 5.62 in 2020 to 5.32 in 2021, compared with a national average of 5.7, and a best of 6.5. This score put us in the worse half dozen of Trusts in England and is an area of which we know that we must do more to support our colleagues (see table 3 below).

Table 3

We were thankful to see that none of the respondents from the Trust shared that they had personally experienced physical violence at work from a manager. Sadly, we learned from the Survey that nationally, 1% of colleagues elsewhere had experienced this type of violence at work.

We also undertook a bank staff survey as part of the Trust’s commitment to making the Trust an inclusive and great place to work, with 170 colleagues taking part. We were concerned to learn that almost 53% of respondents had indicated that they had to come to work despite not feeling well enough to perform their duties. The Trust is looking into this in more detail.

The National Staff Survey is an important method of data collection for us as it allows us to evaluate how we are doing as a Trust and to show that we are listening by acting on the issues that our staff anonymously say are important to them. The Trust has shared the 2021 results with all key stakeholders including the Board, managers and staff, and further work is being progressed in the 2022/23 financial year to address the findings and enhance staff engagement and development.

Data from the National Staff Survey feeds into the Trust’s Culture Dashboard (page 39) and our performance in relation to vision and values, goals and performance, learning and

innovation, compassion, teamwork and health and wellbeing.

The National Staff Survey measures are aligned to key targets in our People Strategy, which in turn, are set as individual performance targets for our senior leaders.

2020/21

% baseline 2021/22 % target 2021/22 % actual

Number of people experiencing discrimination at work in the staff survey 7.5% 6.9% 9%

People reporting effective leadership in the staff survey 57.9% 66.3% 56%

Staff survey engagement score (score not %) 6.6 6.8 6.29

% of staff recommending the Trust as a place to work or receive treatment 49% 55% 44%

NHS staff survey response rate 41% 45% 45%

The outcome of the National Staff Survey tells us that we made progress against questions relating to raising concerns on clinical safety. But some real challenges include our overall people promise, staff engagement and staff morale scores which are below average for our sector.

Health and Wellbeing

The wellbeing of our colleagues is of upmost importance to us.

During the year, the wellbeing team regularly walked around the hospital sites to speak to staff, offer support and promote health and wellbeing. Our Wellbeing Guardian also listens to staff feedback so that we can hear what our colleagues are saying from another source, and this can be integrated into future plans.

The wellbeing team wear distinct purple wellbeing t-shirts and give out wellbeing support packs which include all the health and wellbeing offer available to staff including psychological, physical, emotional, financial, and healthy lifestyles support.

The wellbeing team have worked closely with the ICS Wellbeing Group to create a wellbeing offer for staff across the system. This includes a week’s wellbeing festival, menopause and men’s health bi-monthly meet ups and burnout support sessions.

The team have worked to increase the offer, focussing on healthy eating and physical wellbeing by introducing a Trust recipe cookbook and Trust ‘couch to 5k’ support.

Wellbeing Conversations/ Manager HWB Briefings were delivered to support line managers to have one-to-one conversations focussed on looking after the wellbeing of all colleagues as well as raising awareness of our current health & wellbeing offer, peer support and mental health resources.

Health and Wellbeing Champions have been recruited to embed staff health and wellbeing into all we do as a Trust and to improve the understanding and importance of looking after ourselves.

Psychological support has continued to be a priority for the Trust as we have worked through the pandemic. Our own internal Mental Health First Aid (MHFA) trainer now delivers our mental health first training, and we have a number of MHFA across the Trust. We also have trained peer to peer listeners and coaches.

For people needing support following a traumatic incident we have been working with the ICS and have several trained TRiM Practitioners and provide access to a mental health support hub. Our Partnership with MPFT has meant we have continued to provide a psychological support service for our people.

This year’s Flu campaign has consisted of a mixture of co-delivery clinics (covid and flu), pop up Flu clinics and roving clinics. This has helped protect our staff against flu, with more than 4,900 staff received their flu vaccination.

COVID Pandemic – Support to our People

In addition to the above there have been several key achievements in our response to the pandemic that has contributed to supporting and engaging our people including: 91% of staff received 2 doses of the COVID 19 vaccine

Redeployment/Mutualaid of staff in response to staff needing to shield or supporting gaps due to high levels of absence. This included both corporate teams being redeployed (over 30 staff) on to ward and clinical areas and military aid to support teams across the Trust. We established a ‘listening ear’ service where our peer-to-peer listeners and coaches providing listening support. A counselling service was provided by ‘Care First’, we have

mental health first aiders and have over 25 trained Trauma and Resilience Management (TRiM) Practitioners to support our staff who have experienced a traumatic incident. 51 individuals have used this service.

We work with Shropshire Mental Health Services, the ICS TRiM Hub and the STW Staff Psychological Wellbeing Hub to provide additional psychological support for our people. Our partnerships with MPFT and Phoenix Psychology ensures that we have access to specialist clinical psychologists for supporting staff through traumatic incidents and posttraumatic stress.

A centralised absence line for all staff was set up during the year to help staff report sickness absence during the COVID pandemic. This has helped staff record absence, seek advice and submit a referral for testing. It also provided an accurate real-time picture of staffing gaps across the Trust.

Gender pay gap reporting and actions

Gender pay reporting legislation requires employers with 250 or more employees to publish statutory calculations every year showing how large the pay gap is between their male and female employees:

Average gender pay gap as a mean average

Average gender pay gap as a median average

Average bonus gender pay gap as a mean average

Average bonus gender pay gap as a median average

Proportion of males receiving a bonus payment and proportion of females receiving a bonus payment

Proportion of males and females when divided into four groups ordered from lowest to highest pay

The Trust’s latest gender pay gap information for 2020/21 is published on the Trust website via the link below: https://www.sath.nhs.uk/wp-content/uploads/2022/03/SaTH-Gender-Pay-Gap-Report2021-v2.pdf

Median women’s pay is 10.82% lower than men’s pay. The two key drivers of the pay gap are: the uneven distribution of men in our overall workforce, and the higher number of male consultants compared with female consultants in the upper quartile of our pay distribution –removing Consultants from the data set alters the median pay gap in favour of female staff

at 3.25%.

This pay gap is reflective of the pattern from the wider UK healthcare economy; traditionally the NHS has had a higher female workforce in caring roles in the workforce, which tend to be in the lower bandings, and a predominantly male workforce in the higher banded Medical & Dental professions.

The Trust is committed to ensuring an equitable workforce and our Gender Pay Gap Report has been reviewed and used to inform and update our EDI strategy, objectives and action plans for improvement.

Medical Leadership

Following a successful year recruiting into medical leadership roles in 2021 we have seen some changes in the senior medical leaders with a successful recruitment to substantive Deputy Medical Director role, secondments to GIRFT Lead role and other medical leaders stepping up into Divisional Medical Director roles in Surgery, Anaesthetics and Cancer, and Clinical Support Services. There has been an expansion to the Clinical Directors in Surgery Anaesthetic and Cancer with a new Clinical Director position for Gastroenterology, Elective MSK and Colorectal and Upper GI Surgery.

To support the Quality Governance Framework in Medicine and Emergency Care, there has been an additional Clinical Mortality Lead role advertised.

Women’s and Children’s have seen some changes in their Clinical Directors’ roles with new Consultants stepping up as long-standing Clinical Directors step down.

The organisation had 220 new starters across the Trust in medical roles over the last 12 months (up to March 2022), plus 173 Deanery doctors.

- Bank

Doctor

Speciality Doctor - Bank Bank 3

Senior Dental Officer Substantive 2 Speciality Registrar Substantive 142 Speciality Registrar Deanery 118

Speciality Registrar Bank 6 Foundation Level Substantive 1 Foundation Year 1 Deanery 43 Foundation Year 2 Deanery 12

Total 393

The Medical Leadership Programme continues into its second year with the Faculty of Medical Leadership and Management delivering the programme. It is now into Cohort 5 having delivered training to 83 medical leaders including senior medical leaders, Clinical Directors, aspiring Clinical Directors and Corporate Clinical Leads. The first cohort started in October 2020 with the final cohort, Cohort 5 due to complete in October 2022.

In addition, the first new Consultant induction took place in March 2022 over 2 days for 19 participants who began working with the organisation during the last 18 months. The programme was led by the Medical Director(s) and Deputy Medical Directors, providing comprehensive insights into the Integrated Care System, Public Health, Patient safety and much more. The aim is for consultant induction to be carried out twice a year, going forwards.

The Clinical Fellowship Programme (CFP) was introduced into the organisation in 2020 with two main aims:

1. To increase continuity of care by creating a stable clinical workforce

2. To decrease dependence upon employment of locum doctors and the corresponding costs

There are now 91 doctors on the programme: 75 of these doctors are Clinical Fellows (ST1-3 equivalent grades) and the remaining 16 are Senior Clinical Fellows (ST3+ equivalent). All doctors on the CFP have named clinical and educational supervisors. Bespoke inductions for doctors in the CFP occur every 6 months including workshops led by an acclaimed external cultural and linguistic consultant. Other areas of practice which may be new to overseas doctors

are presented by local consultant colleagues including appraisal and revalidation, introduction to medicine in the UK and aims of the CFP. The feedback from induction has been excellent. A Postgraduate Certificate in Clinical Education from the University of Keele is offered to CFP doctors on a competitive basis.

There is 1-1 consultant support for doctors aiming for a consultant role via the Certificate of Eligibility to Specialist Registration (CESR) route. Doctors have a formal review on a 6-monthly basis and workshops are offered via MS Teams for encouragement and support.

The department has been awarded the West Midlands Clinical Research Network ‘Research ECO-System’ Award for the collaborative and innovative approach to set up and deliver the SIREN study. This utilised a systems wide approach and was successful in offering all NHS staff across the Shropshire region the opportunity to participate in this study.

This year has provided a firm foundation for the continued development, expansion and growth of Research and Innovation at the Shrewsbury and Telford Hospital NHS Trust.

Louise Barnett, Chief Executive Officer

Date: 16 June 2022

Shrewsbury and Telford Hospital NHS Trust Organisation Code: RXW

Annual Governance Statement – 2021/22

Scope of Responsibility

As Accountable Officer, I have responsibility for maintaining a sound system of internal control that supports the achievement of The Shrewsbury and Telford Hospital NHS Trust 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 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 Shrewsbury and Telford 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 Shrewsbury and Telford Hospital NHS Trust (the Trust) for the year ended 31 March 2022 and up to the date of approval of the annual report and accounts.

Capacity to handle risk

I have the overall responsibility as Chief Executive and Accounting Officer, for the management of risk in the organisation.

To support me, each member of the executive team has an area of responsibility for risk

management in accordance with their portfolios and as reflected in their role descriptions, which supports me in my role as Accounting Officer.

I am also supported in my role through the assurance committees of the Board of Directors, each under the chairmanship of a Non-Executive Director, with appropriate membership or input from members of the Executive Team. Following a review of the board committee structure during the year, these committees were streamlined and now comprise the Audit and Risk Assurance Committee, Quality and Safety Assurance Committee, and the Finance and Performance Assurance Committee. Further details of the committees are provided on page 59 onwards of the annual report. The Audit & Risk Committee comprising of Non-Executive Directors, oversees the systems of internal control and the overall assurance process associated with managing risk.

In addition, in response the Ockenden Report3, the Ockenden Report Assurance Committee was also established and held its first meeting in March 2021. A framework of operational committees sits below the board assurance committees, which provide the process through which risks are monitored throughout the organisation and up to the Board. In addition, the Senior Leadership Committee (Operational and Transformation), and the new monthly communications cascade, and divisional and operational meetings, all provide forums at which risks to the organisation are considered.

The role of the Board of Directors is to effectively govern the organisation, and in doing so, to deliver high quality care for the population we serve. The Board of Directors receives the Chairs’ highlight reports and receives assurances from the Quality & Safety Assurance Committee relating to the management of all serious incidents, including Never Events, as well as receiving the monthly integrated performance report which includes performance on all quality and performance matters.

The Trust continues to face a journey of improvement, with conditions on its licence imposed by both principal healthcare regulators; with a change in a number of Non-

(2020) Ockenden Report – Emerging Findings and Recommendations from the Independent Review of Maternity Services at Shrewsbury and Telford NHS Trust; Our first Report following 250 Clinical Reviews.

Executive and Executive director posts in more recent years, also having an impact. Inyear changes to the voting directors can be found on pages 50 onwards of the annual report.

As reported last year (2020/21) the usual cycles of business of the Trust Board and its Committees were disrupted because of the significant impact of the Covid-19 pandemic. As a result, at that time the Trust adapted to a ‘command and control’ approach with board meetings and committees considering limited, yet critical, matters. To support this, the board established a Covid-19 Assurance Committee, made up of both executive and non-executive directors.

As reported last year (2020/21) the usual cycles of business of the Trust Board and its Committees were disrupted because of the significant impact of the Covid-19 pandemic.

As a result, at that time the Trust adapted to a ‘command and control’ approach with board meetings and committees considering limited, yet critical, matters. To support this, the board established a Covid-19 Assurance Committee, made up of both executive and non-executive directors.

Following the peak of the pandemic, and with the national vaccination programme underway, it was possible to resume a more usual cycle of business from April 2021, with meetings held in public albeit live streamed.

There are governance arrangements throughout the divisional triumvirate structures where divisional performance is overseen and monitored by the executive team, and key risks to delivery of services are identified. These Performance Review Meetings were stood down during the pandemic, with escalation of issues through the incident structure, with the meetings having now been fully reinstated.

The risk and control framework

The Trust seeks to manage and mitigate risk as far as possible. However, it is understood that delivering healthcare carries inherent risks that cannot be completely eradicated but can be reduced through effective identification and mitigation where possible. The process begins with the systematic identification of risks via structured risk assessments and incorporated within risk registers. All risks are assessed and

scored using an approved scoring matrix which considers the potential likelihood, consequence, and overall severity of each risk. This results in each risk being awarded a score of between 1 (very low) to 25 (high). The effectiveness of the existing control measures is assessed, and associated gaps and action plans agreed and monitored to ensure management of the risk.

The Board Assurance Framework provides the Trust with a system to identify and monitor risks which may affect achieving the strategic objectives. Each risk is mapped to corresponding controls and assurances, both internal and external.

As reported last year, following a review of the Trust’s risk management framework in 2020/21 improvements were made based on the review recommendations including a review of the IT system used to monitor and record risk (4Risk), a refresh of the Risk Management Strategy and Risk Management Policy (approved in Q1 2021/22), a proposal for the re-energised Board Assurance Framework (BAF) document, and the roles and responsibilities allocated to individuals and groups. It was further identified that training should be rolled out across the organisation to support the development of a robust risk management framework and the Trust’s capability to consistently manage and mitigate risk and which was progressed in 2021/22.

In addition, a revised process for the review and monitoring of the BAF and risk register by the Board of Directors for 2021/22 was implemented with presentation of the 2020/21-year end strategic and high-level operational risk registers, with the intention that they be presented to the board of directors on a quarterly basis going forwards, following a cycle of review through the board committees. It remains the case that whilst a working BAF is in place, there is still further work to be carried out to ensure that it properly aligns with an overall medium to long-term Trust strategy which includes the long-term clinical strategy.

The risk appetite is set by the board, forms part of the Risk Management Policy, and was last updated in March 2021.

Further changes were made towards this year’s end, including the re-introduction of the Operational Risk Management Committee, which was disestablished previously. This

provides a focussed forum for divisional teams to come together and focus on management and mitigations of risks across the organisation. The Trust is also in the process of transferring its risk registers to Datix from the 4Risk platform, with the new structure on course for its launch on 22 June 2022. This will provide a more integrated approach to management of risk, enabling the triangulation of with incidents and complaints.

We have a Senior Independent Director in place who is available to any colleague should they have concerns that they feel they are unable to raise via normal communication channels with the Chair, Chief Executive or any of the board members.

Major risks to the organisation

The Annual Governance Statement for 2020/21 identified a number of risks that would also be carried forward into 2021/22 and which continue to remain current. A commentary for each of these risks is provided below.

1. Quality of care, including standards of performance and licence conditions

This relates to the failure to deliver high quality patient care, leading to poor patient experience, avoidable harm and poor clinical outcomes.

Whilst there have been a number of areas where the Trust has been able to identify improvements in care (for example, VTE assessment, number of falls, Clostridium Difficile (c.diff) infections, and E.coli infections), the need for the Trust to progress with its improvement journey, remains essential.

This is reflected in the number of conditions that continue to be imposed on the Trust’s CQC registration since 2018. A number of CQC inspections have been carried out since 2018, the most recent in July and August 2021. The published report (dated 18 November 2021) following the most recent inspection confirms the overall CQC ratings as follows: Safe – Inadequate Effective – Requires Improvement Caring – Requires Improvement

Responsive – Inadequate Well-led – Requires Improvement Use of Resources – Requires Improvement

As previously reported at the end of March 2021, the Trust had a total of 35 Section 31 conditions against its registration, in addition to receiving 6 Section 29a warning Notices. Two Section 31 conditions relating to maternity were removed from the licence in October 2020. Furthermore, following an application to the CQC in April 2021 requesting the removal of 11 Section 31 conditions, four conditions were removed. Furthermore, as a result of the inspections in summer 2021, the CQC wrote to the Trust in February 2022 to advise that the regulator was removing / varying some further conditions to the Trust’s licence that had been previously imposed. Across both main hospitals, more than 50 conditions were removed, 6 were varied with 5 now remaining.

Again, as previously reported, in March 2021, the Trust received enforcement undertakings from NHSI, which built upon the actions which were agreed as a consequence of the Trust being placed in special measures for quality in November 2018 (as previously captured in the July 2019 undertakings). They also set out new actions to address issues which subsequently emerged, namely the matters arising through the Ockenden maternity review, and captured the NHS Improvement intensive support package, which including financial sustainability and operational performance measures, agreed with the Trust in August 2020. These are currently being updated.

In response to the quality concerns, the Trust developed a Getting to Good improvement plan which sets out the workstreams which the Trust is progressing in order to improve quality of care for patients. This includes a focus on clinical and corporate governance, as well as culture to support the required improvements.

Part of the NHS support package included the establishment of an Improvement Alliance, which was formed with the University Hospitals Birmingham NHS Foundation Trust (UHB) to support the sustainable delivery of improved care to our patients and communities. The resource and expertise provided by UHB was provided to support the Trust to deliver the changes necessary to improve the quality of care provided to our patients. The Trust continues to benefit from this arrangement.

Ongoing improvements to the Integrated Performance Report, provided to every meeting of the board of directors, has extended the breadth and range of indicators than had been provided at the beginning of the financial year (including the use of SPC charts). This has enabled the board to be better sighted, on performance issues which may affect the quality of care.

2. Access and waiting time performance

The Trust has also continued to struggle with A&E delivery performance targets and ended the year at 56% (2020/21: 75.8%) achievement for the 4-hour wait standard, with 2,699 (2020/21:2,093) ambulance waits of 60 minutes or more. However, the Trust saw fewer corridor waits, which had been a repeated event during 2019/20. The opening of our £6.3m SDEC (same day emergency care) facility in Shrewsbury in January 2021 will contribute to the measures that are in place to increase patient flow through the hospital, and our closer collaboration with partners will support improvement to urgent treatment pathways.

3 Implementing recommendations of the independent review of maternity services

In December 2020, the first report from the independent review of maternity services at the Trust4, was published by its Chair, Mrs Donna Ockenden (‘the Report’). The Report included-twenty-seven Local Actions for Learning which were specific ‘Must Do’ actions for the Trust, and seven Immediate and Essential Actions for all NHS providers of maternity care, including the Trust. These seven themes comprised 25 related actions. In total, there were 52 actions for the Trust to implement.

Accepting all the recommendations and required actions from the Report, the Trust immediately commenced work to cross reference all the actions against the ongoing work related to the Maternity Improvement Plan (MIP) and Maternity Transformation Plan (MTP) and, to incorporate the new actions that were not already in place.

In order to provide transparency and the opportunity for more public engagement, the Ockenden Report Assurance Committee was established and held its first monthly

4 www.gov.uk/official-documents. (2020) Ockenden Report – Emerging Findings and Recommendations from the Independent Review of Maternity Services at Shrewsbury and Telford NHS Trust; Our first Report following 250 Clinical Reviews.

meeting in March 2021, considering progress against the recommendations and actions, in more detail. For complete transparency, the Committee is co-chaired by Jane Garvey, former presenter of BBC 4’s Women’s Hour and an independent NED, alongside Catriona McMahon, the Trust’s Chair. Members include Trust colleagues, together with representatives from the Shropshire Telford &Wrekin CCG, Maternity Voices Partnership, and Healthwatch. Each of the meetings of the Committee has been livestreamed in public and, to date, it has met on ten occasions.

Progress from the Committee is reported monthly to the Board of Directors via a CoChairs’ Highlight Report which is in addition to the regular reporting of progress against each of the first Ockenden Report 52 actions. At the time of writing and at the date of the publication of the final Ockenden Report on 30th March 2022, 45 (86%) of the actions from the first report had been implemented, accounted for by 35 (67%) of actions that had been ‘evidenced and assured’ and 10 (19%) that had been delivered and noy yet evidenced. Only seven (14%) actions were ‘not yet delivered’ of which six were Immediate and Essential Actions and one a Local Action for Learning, with all ‘on track’ but reliant for final delivery upon external dependencies.

To support the Trust’s maternity improvement journey, a short-term Maternity Improvement Partnership arrangement with Sherwood Forest Hospitals NHS Foundation Trust was entered into in March 2021. This beneficial arrangement has acted as a benchmark for clinical standards and has supported the development of clinical leadership and managerial capability together with introducing changes to working practices and culture.

The second report of the Review chaired by Mrs Ockenden was published on 30 March 2022. The review has examined cases involving 1,486 families between 200 and 2019 and reviewed 1,592 clinical incidents where medical records and family consent was gained. The review found repeated failures in the quality of care and governance at the Trust throughout the last two decades, as well as failures from external bodies to effectively monitor the care provided. The review finds that these failures result from there not being enough staff, a lack of ongoing training, a lack of investigation and governance at the Trust and a culture of not listening to the families involved.

The final report provides for more than 60 specific Local Actions for Learning for the Trust covering nine areas, including:

Improving management of patient safety Patient and family involvement in care and investigations

Improving complaints management Care of vulnerable and high-risk women

Diabetes care

Multidisciplinary working Midwifery-led units and out-of-hospital births

Staffing, including anaesthetic staffing Communication with GPs.

In addition, there are 15 Immediate and Essential Actions for all maternity services in England covering ten key areas.

The report makes harrowing reading and sets out significant and major failings in maternity care services at the Trust. On the day of publication of the final report, on behalf of the Trust, I offered an unreserved apology and gave a continued commitment to implement all of the actions arising from the first and final reports of the review. Both the unreserved apology and this commitment were re-iterated at a meeting of the Board of Directors on the 15 April 2022, when the Board accepted the findings of the report and considered the actions that now need to be fully implemented. We will approach this task with the same commitment and dedication that we have shown to implementing the required actions from the first report. We owe it to those families we failed and those we care for today and in the future to continue to make improvements, so we are delivering the best possible care for the communities that we serve.

In addition, after the initial announcement of their intentions in June 2020, West Mercia Police continue to investigate allegations of poor maternity care at the Trust. The independent police investigation will explore whether there is evidence to support a criminal case against the Trust or any individuals involved. The Trust continues to cooperate fully with the investigation.

4. Improving financial performance

The key objective for the 2021/22 financial year was to continue to build on the prior year’s work developing much stronger financial foundations and to deliver our financial plan. The temporary financial framework that was put into place during financial year 2020/21 because of the Covid-19 pandemic was extended in 2021/22, initially for six months and then for the whole year.

The Trust’s plan for the first six months of the year was to deliver a deficit of (£3.219m) and for the second half a planned deficit of (£3.824m) resulting in a full year planned deficit of (£7.043m). The Trust recorded a full year deficit of (£10.890m), £3.847m adverse to the (£7.043m) full year deficit plan, but in line with the forecast formally reported at the end of quarter three.

The temporary financial framework which has been in place across the NHS for the past two years has inevitably had an impact on financial discipline and control mainly due to the lack of timely information about income to allow a structured planning process.

Notwithstanding this, the Trust has made good progress in strengthening financial controls, ownership and accountability during a period of sustained pressure. The most notable achievements in the year included:

Comprehensive review of the underlying drivers of cost at the Trust. This has allowed a re-set of recurrent financial budgets across the Trust and has informed the system recovery support programme. The cost base that the Trust presented was agreed by regulators and system partners as being accurate.

Significant improvement in internal and external financial credibility supported by evidence-based assumptions and a transparent open-book approach.

Relationships with regulators, system partners and other key external stakeholders substantially improved as a result of building this credibility.

Review and improvements to financial governance – most notably business investment approval process including best practice standardised documentation, detailed tracking, monitoring and benefit realisation reviews.

Review and re-set of outdated key workforce establishments, templates and rotas ensuring appropriate inclusion, engagement and ownership to enable effective performance management and accountability.

Review and developed key workforce metrics jointly with the Workforce Directorate,

building on the recurrent budget work, to ensure accurate Trust vacancy reporting. Developed integrated financial reporting information to ensure timely, clear and concise key financial information sharing.

Introduction of key operational financial performance management governance reviews.

Planned progression towards achieving Future Focussed Finance Level 2 accreditation following the achievement of Level 1 in May 2021.

Whilst good progress has been achieved during 2021/22, the Trust continues on a journey of financial improvement with a number of key projects planned through 2022/23 which will form part of the Trust’s Getting to Good programme. This is a planned programme of work in place to instil best practice ways of working in the finance programme, including strengthening financial controls and governance, and to also increase the financial acumen of staff across the Trust.

The NHS Provider Licence is the main tool for regulating providers of NHS services. While NHS Trusts are exempt from the requirement to apply for and hold the licence, directions from the Secretary of State require NHSI to ensure that NHS Trusts comply with conditions equivalent to the licence as it deems appropriate. Several additional undertakings applied in-year to the Trust by NHSI, have increased the number of requirements with which to comply.

The Board of Directors, as required under NHS Foundation Trust condition 4(8)(b) assures itself of the validity of its Corporate Governance Statement. The Board has complied with the relevant aspects of the HM Treasury/Cabinet Office Corporate Governance Code. The Board of Directors reviews the Corporate Governance Statement every year to ensure that declarations being made can be supported with evidence. It considers the risks and mitigating actions that management provided to support the statements and determine, both from its own work throughout the year and assurances provided from the work of internal, external auditors and other external audits or reviews, whether the statements are valid.

With reference to the requirements of the Trust’s Standing Orders and Standing Financial Instructions, no gaps in legal compliance have been identified.

The principal board assurance committee structure which discharges overall responsibilities for risk management is summarised below:

The Trust Board is responsible for establishing principal strategic and corporate objectives and for driving the organisation forward to achieve these. It is also responsible for ensuring that effective systems are in place to identify and manage the risks associated with the achievement of these objectives through the Board Assurance Framework and the Corporate Risk Register.

The Audit and Risk Assurance Committee, on behalf of the Board, reviews the establishment and maintenance of an effective system of internal control and risk management across the whole of the Trust’s activities (both clinical and non-clinical) that supports the achievement of the Trust’s objectives and also ensures effective internal and external audit.

The Quality and Safety Assurance Committee (QSAC) is set up to provide assurance to the Trust Board and the Audit and Risk Assurance Committee that there are adequate controls in place to monitor the care given to patients using the services provided by the Trust, and to ensure that their experience of our services and outcomes are as expected.

The Finance and Performance Assurance Committee (FPAC) is responsible for scrutinising aspects of financial performance as requested by the Board, as well as conducting scrutiny of major business cases, proposed investment decisions and regular review of contracts with key partners.

Risk assessment is a key feature of all ‘business-as-usual’ management processes. All areas of the Trust have an ongoing programme of risk assessment which inform local risk registers. Operational risks are identified and evaluated using a 5x5 risk matrix, which feeds into the risk appraisal process. The risk registers are reviewed regularly through governance structures at both operational and corporate level, dependent on the severity of each risk. Each risk and related action have an identified owner who is responsible for risk monitoring, reporting and for implementing actions to mitigate the risk within a specified period. Members of the Senior Leadership Committee regularly review the highest rated risks.

The Board of Directors is responsible for the approval of the Trust’s Risk Management Strategy. The strategy describes an integrated approach to ensure that all risks to the

achievement of the Trust’s objectives are identified, evaluated, monitored and managed appropriately. It defines how risks are linked to one or more of the Trust’s strategic or operational objectives, and clearly defines the risk management structures, accountabilities, and responsibilities throughout the Trust.

The Board Assurance Framework (BAF) is the mechanism which is used to identify and monitor the Trust’s strategic objectives and manage the associated risks that may compromise their achievement. The BAF is reviewed by the Executive Directors and will be formally reviewed quarterly by board assurance committees and the Board of Directors. Operational and other corporate risks with scores of 15 and above, are also reviewed by the Board as part of its monitoring of risk management.

There continues to be gaps in workforce that threaten service delivery. However, we have a number of mechanisms in place which allow us to monitor staffing levels to provide safe and effective care. Information about staffing levels is published monthly on our Trust external website, and we publish links to the Nursing & Midwifery Staffing papers discussed in public at our Trust Board meetings. The Trust also undertakes a nursing and midwifery establishment review every six months, which is reported to the Board of Directors.

We have considered the guidance and requirements set out within ‘Developing Workforce Safeguards’ published by NHS Improvement in October 2018. NHSI began assessing Trusts against the standards in April 2019. The Trust is ensuring compliance with these recommendations with its use of evidence-based workforce planning, implementation of People Strategy and Recruitment and Retention Strategy. We will continue to explore and develop new roles, including widening our offer of Apprenticeships across the organisation, which will support care delivery. We currently have several new roles and programmes in place including Nursing Associates, Operating Department Practitioners, Nurse Apprentices, Physician Associated and Advanced Clinical Practitioners.

The Shrewsbury and Telford Hospital NHS Trust is required to register with the Care Quality Commission (CQC). The Trust is not fully compliant with the registration requirements of the CQC and the current conditions and sanctions which have been imposed are described at page 26 onwards.

As described above, following a CQC inspection in July and August 2021 the Trust remains ‘Inadequate’ overall, with individual ratings against each domain as follows: Safe – Inadequate Effective – Requires Improvement Caring – Requires Improvement Responsive – Inadequate Well-led – Requires Improvement Use of Resources – Requires Improvement

Additional work continues to ensure that actions to improve the ratings, are embedded and consistently applied. Regular reporting has also been provided to the Care Quality Commission, which is shared with the Clinical Commissioning Group and NHSE/I. Regular reviews of progress were undertaken and presented to the board of directors, and externally to the System Oversight and Assurance Committee (SOAG).

All serious incidents (SI) are reported to Commissioners and other bodies in compliance with current reporting requirements. The establishment of two committees, the Review Action and Learning from Incidents Group (RALIG) and Nursing Incident Quality Assurance Meeting (NIQAM), has supported the timely review of incidents and learning by the organisation. RALIG reviews incidents and near misses in an objective, thematic and clinically focussed forum where actions are agreed and learning points implemented across all Divisions. NIQAM ensures oversight of the serious incident investigation process relating to falls, pressure ulcers and hospital acquired infections.

An incident reporting process is in place across the Trust via a web-based reporting system supplemented by paper forms. A network of safety advisers encourages reporting, and the Trust supports an open culture, enabling any concerns to be raised in confidence with our Freedom to Speak Up (FTSU) Guardians.

In accordance with the requirements of ‘Managing Conflicts of Interests in the NHS’ (June 2017), the Trust has published on its website an up-to-date register of interests, including gifts and hospitality for decision-making staff (as defined by the trust with reference to the guidance). A recent internal audit review in 2020/21 found that a low number of declarations had been made and a number of requirements as required by

the ‘Managing Conflicts of Interest in the NHS’ guidance had not been met. As a result, a number of internal audit recommendations were made, accepted by management, and an action plan put in place to address the shortcomings.

The Board receives monthly workforce data via the Integrated Performance Report reported to the Board. In addition, the Board receives six-monthly updates specifically on nurse staffing. In accordance with the recommendations of ‘Developing Workforce Safeguards’ the Trust uses a triangulated approach to maintaining assurance around workforce strategies and safe staffing systems.

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.

Control measures are in place to provide assurance that all obligations under equality, diversity and human rights legislation are complied with. Monitoring provides data which informs plans and strategies to achieve an inclusive workplace and make improvements to the working environment for all staff. The outcomes are reported to the Board annually, and the Equality and Diversity Action Plan is updated as appropriate.

The Equality Duty requires public bodies to have due regard to the need to eliminate discrimination, advance equality of opportunity, and foster good relations in the course of developing policies and delivering services. Equality analysis is completed on all policies, procedures, strategies and service developments. The Equality Delivery System is designed to specifically support service delivery that is fair, providing equality of access to employment and delivery that meets the needs of a diverse population.

The Trust holds an annual Equality, Diversity and Inclusivity Stakeholder event whereby groups are invited to discuss potential service improvements to meet the needs of the local community. A dedicated Equality, Diversity & Inclusion Lead is in post at the Trust in recognition of increasing BAME representation within our workforce and communities.

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.

Review of economy, efficiency, and effectiveness of the use of resources

The Trust Board and its assurance committees have a key role in review of the effective use of resources. The board of directors retains oversight of the overall business planning process, budgets and use of staffing resources and establishment.

The Finance and Performance Assurance Committee meets monthly and has a key role in review of operational and workforce matters, investment decisions, and monthly financial performance.

In 2021/22, the Audit and Risk Assurance Committee focused on the effectiveness of controls in relation to Key Financial Controls, ESR/Payroll, Cost Improvement Plans, Consultant Job Planning, Waiting List Management, Quality Spot Checks, Safeguarding, Medical Devices, Governance of Nurse Staffing Levels, Complaints Management, Serious Incidents (including Duty of Candour), and Critical Applications – ICNET Clinical Surveillance Software.

The Quality and Safety Assurance Committee provided assurance to the Trust Board on efficient and effective quality of patient care. The Committee monitored progress against the Trust’s quality improvement plan and key safety metrics.

Internal and external auditors provide assurance in respect of the internal control environment and the use of the organisation’s resources. Audit findings and recommendations are monitored and progressed by the committees of the Board and the Audit Committee has an overarching overview for assurance purposes through the internal audit progress reports

Any report which offers Limited assurance results in the development of a management

action plan with an agreed timescale for improvement, and progress is monitored by the Audit Committee. Serious issues are escalated to the Board of Directors.

The governance structure at Executive level and below provide opportunities for specific divisions, service lines and departments to be challenged on their efficient, effective and economic use of resources within the respective services which they provide. All budget holders are provided with monthly financial information to help them ensure resources are used economically, efficiently and effectively.

Information Governance

The Trust has an established process for managing the Information Governance agenda, led by the SIRO, the Medical Director as Caldicott Guardian, and supported by a Data Protection Officer.

The Information Governance Committee is responsible for monitoring and controlling risks relating to data security.

The Trust uses NHS Digital’s Data Security and Protection Toolkit (DSPT) to measure performance, and improvements over the previous year have been noted for 2021/22, although the Trust continues to work through its agreed improvement plan with NHS Digital.

The Trust reported two (2020/21:10) incidents to the Information Commissioners Office between 1 April 2021 to 31 March 2022 relating to information governance including data losses or confidentiality breaches.

The ICO has not taken action against the Trust for any of the reportable incidents to date.

The Trust manages threats to cyber security on an ongoing basis. Weekly reports of progress in implementing recommendations regarding nationally circulated cyber security threat information is being issued to a number of leaders in the organisation with a role in the oversight of cyber threats and risks to the organisation.

Data Quality and governance

Our data quality colleagues have continued to work with heads of service, line managers and health professionals across the Trust to support provision of accurate and complete input of data. During the year, the integrated performance report (IPR) was further developed and presented to the board on a monthly basis. The document continues to be developed in response to the requirements of the organisation.

Following a substantial audit opinion from the Internal Auditors on the Trust’s integrated performance reporting system and processes in 2020/21 – Data Quality Review - the Board of Directors is currently assured that there are effective processes and controls in place to ensure the accuracy of data at the end of the reporting year ending 31 March 2022. Continuous review and increased automated systems have assisted with continued assurance.

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 and the executive managers and clinical leads within the Shrewsbury and Telford Hospital NHS 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 board, the Audit and Risk Assurance Committee and a plan to address weaknesses and ensure continuous improvement of the system is in place

The Board of Directors and its committees have met regularly and kept arrangements for internal control under review through discussion and approval of policies and practice and monitoring of outcomes agreed as indicators of effective controls. The Board and its committees review the Integrated Performance Report monthly, which covers the key national priority and regulatory indicators and locally derived key performance indicators. The report provides more detailed briefings on any areas of adverse

performance. This report is supplemented by several more granular reports reviewed by board committees, and regular performance review meetings with the Divisions. The selection of appropriate metrics is subject to regular review, with changes in definitions or strategic priorities reflected in the selection.

Internal and external auditors provide assurance in respect of the internal control environment and the use of the organisation’s resources. Audit findings and recommendations are monitored and progressed by the committees of the Board and the Audit and Risk Assurance Committee has an overarching overview for assurance purposes through the internal audit progress reports.

The purpose of the Head of Internal Audit Opinion is to contribute to the assurances available to the Accounting Officer and the Board which underpin the Board’s own assessment of the effectiveness of the organisation’s system of internal control. The Opinion has assisted in the preparation of this Annual Governance Statement.

The Head of Internal Audit provides me with an opinion on the overall arrangements for gaining assurance through the Board Assurance Framework and on the controls reviewed as part of the internal audit work. The Head of Internal Audit opinion for 2021/22 gave a limited assurance opinion on the system of internal control in place during the year:

“Limited Assurance, can be given that there is a compromised system of internal control as weaknesses in the design and/or inconsistent application of controls impacts on the overall system of internal control and puts the achievement of the organisation’s objectives at risk.”

Issues relating to the formulation of the opinion included work conducted through the risk based internal audit plan for 2021/22:

Three substantial assurance opinions: Key Financial Controls

ESR/Payroll

Cost Improvement Plans

Two moderate assurance opinions: Consultant Job Planning

Waiting List Management

Seven limited assurance opinions: Quality Spot Checks

Safeguarding Medical Devices

Governance of Nurse Staffing Levels

Complaints Management Serious Incidents (including Duty of Candour)

Critical Applications – ICNET Clinical Surveillance Software

Zero no assurance opinions N/A

A report was produced at the conclusion of each audit assignment and, where scope for improvement is found, recommendations are made, and appropriate action plans agreed with management. 66 recommendations were raised during the year relating to the riskbased audits, all of which were accepted by management. None of the recommendations were critical, but 18 were high risk recommendations in relation to the reviews Consultant Job Planning, Waiting List Management, Quality Spot Checks, Safeguarding, Medical Devices, Governance of Nurse Staffing Levels, Complaints Management, Serious Incidents (including Duty of Candour), Critical Applications – ICNET Clinical Surveillance Software.

My review is also informed by:

Opinion and reports from our external auditors

Financial accounts and systems of internal control Matters brought before the Board of Directors, and Board Assurance Committees Trust risk registers

In-year submissions against performance to NHSI/E Department of Health performance requirements/indicators

Compliance with the Care Quality Commission essential standards for quality and safety for all regulated activities

Progress against the Information governance assurance framework including the Data Security and Protection Toolkit

Investigation reports and action plans following serious incidents (RALIG, NIQAM)

The work of the Trust’s Anti-Fraud Specialist who carries out a detailed work plan and specialist investigations.

Conclusion

As the Accountable Officer, I am reporting that there are no significant internal control issues that have been identified for 2021/22. However, as highlighted above, there are a number of significant risks which may affect delivery of the Trust’s objectives, which are reflective of the continued CQC ‘inadequate’ rating for the Trust, and the provision of NHSI’s oversight through their Recovery Support Programme

Formal action plans have been agreed to address the risks in all areas where these have been identified. Implementation of the recommendations are being tracked and reported to the Board of Directors, and regulators, on a continuing basis.

The system of internal control has been in place at the Trust for the year ended 31 March 2022 and up to the date of approval of the Annual Report and Accounts.

Accountable Officer: Louise Barnett

Organisation: The Shrewsbury and Telford Hospital NHS Trust

Louise Barnett, Chief Executive Officer

16 June 2022

Statement of directors’ responsibilties in respect of the accounts

The directors are required under the National Health Service Act 2006 to prepare accounts for each financial year. The Secretary of State, with the approval of HM Treasury, directs that these accounts give a true and fair view of the state of affairs of the Trust and of the income and expenditure, other items of comprehensive income and cash flows for the year. In preparing those accounts, the directors are required to: apply on a consistent basis accounting policies laid down by the Secretary of State with the approval of the Treasury make judgements and estimates which are reasonable and prudent state whether applicable accounting standards have been followed, subject to any material departures disclosed and explained in the accounts. Prepare the financial statement on a going concern basis and disclose any material uncertainties over going concern.

The directors are responsible for keeping proper accounting records which disclose with reasonable accuracy at any time the financial position of the Trust and to enable them to ensure that the accounts comply with requirements outlined in the above-mentioned direction of the Secretary of State. They are also responsible for safeguarding the assets of the Trust and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities.

The directors confirm to the best of their knowledge and belief they have complied with the above requirements in preparing the accounts.

The directors confirm that the annual report and accounts, taken as a whole, is fair, balanced and understandable and provides the information necessary for patients, regulators and stakeholders to assess the NHS Trust’s performance, business model and strategy.

By order of the Board

Date: 16 June 2022. Louise Barnett, Chief Executive:

Date: 16 June 2022. Helen Troalen, Director of Finance:

Statement of chief executive’s responsibilities as the accountableofficeroftheTrust

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: there are effective management systems in place to safeguard public funds and assets and assist in the implementation of corporate governance value for money is achieved from the resources available to the trust the expenditure and income of the trust has been applied to the purposes intended by Parliament and conform to the authorities which govern them effective and sound financial management systems are in place and annual statutory accounts are prepared in a format directed by the Secretary of State 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.

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.

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.

Date: 16 June 2022. Louise Barnett, Chief Executive:

INDEPENDENT AUDITOR’S REPORT TO THE BOARD OF DIRECTORS OF THE SHREWSBURY AND TELFORD HOSPITAL NHS TRUST REPORT ON THE AUDIT OF THE FINANCIAL STATEMENTS

Opinion

We have audited the financial statements of The Shrewsbury and Telford Hospital NHS Trust NHS Trust (“the Trust”) for the year ended 31 March 2022 which comprise the Statement of Comprehensive Income, Statement of Financial Position, Statement of Changes in Taxpayers Equity and Statement of Cash Flows, and the related notes, including the accounting policies in note 1.

In our opinion the financial statements:

• give a true and fair view of the state of the Trust’s affairs as at 31 March 2022 and of its income and expenditure for the year then ended; and

• have been properly prepared in accordance with the accounting policies directed by the Secretary of State with the consent of the Treasury as being relevant to NHS Trusts in England and included in the Department of Health and Social Care Group Accounting Manual 2021/22.

Basis for opinion

We conducted our audit in accordance with International Standards on Auditing (UK) (“ISAs (UK)”) and applicable law. Our responsibilities are described below. We have fulfilled our ethical responsibilities under, and are independent of the Trust in accordance with, UK ethical requirements including the FRC Ethical Standard We believe that the audit evidence we have obtained is a sufficient and appropriate basis for our opinion.

Going concern

The Directors have prepared the financial statements on the going concern basis as they have not been informed by the relevant national body of the intention to dissolve the Trust without the transfer of its services to another public sector entity They have also concluded that there are no material uncertainties that could have cast significant doubt over its ability to continue as a going concern for at least a year from the date of approval of the financial statements (“the going concern period”).

In our evaluation of the Directors’ conclusions, we considered the inherent risks to the Trust’s business model and analysed how those risks might affect the Trust’s financial resources or ability to continue operations over the going concern period.

Our conclusions based on this work:

• we consider that the Directors’ use of the going concern basis of accounting in the preparation of the financial statements is appropriate; and

• we have not identified, and concur with the Directors’ assessment that there is not, a material uncertainty related to events or conditions that, individually or collectively, may cast significant doubt on the Trust’s ability to continue as a going concern for the going concern period.

However, as we cannot predict all future events or conditions and as subsequent events may result in outcomes that are inconsistent with judgements that were reasonable at the time they were made, the above conclusions are not a guarantee that the Trust will continue in operation.

Fraud and breaches of laws and regulations – ability to detect

Identifying and responding to risks of material misstatement due to fraud

To identify risks of material misstatement due to fraud (“fraud risks”) we assessed events or conditions that could indicate an incentive or pressure to commit fraud or provide an opportunity to commit fraud. Our risk assessment procedures included:

• Enquiring of management, the Audit and Risk Assurance Committee and internal audit and inspection of policy documentation as to the Trust’s high-level policies and procedures to prevent and detect fraud including the internal audit function, and the Trust’s channel for “whistleblowing”, as well as whether they have knowledge of any actual, suspected or alleged fraud.

• Assessing the incentives for management to manipulate reported financial performance as a result of the need to achieve statutory break-even duties and/or control totals delegated to the Trust by NHS Improvement

• Reading Board and Audit and Risk Assurance Committee minutes.

• Using analytical procedures to identify any unusual or unexpected relationships.

• Reviewing the Trust’s accounting policies.

We communicated identified fraud risks throughout the audit team and remained alert to any indications of fraud throughout the audit.

As required by auditing standards, and taking into account possible pressures to meet delegated targets, we performed procedures to address the risk of management override of controls and the risk of fraudulent revenue recognition, in particular the risk that income outside of the Trust’s block contract funding is accounted for in the incorrect financial period and the risk that Trust management may be in a position to make inappropriate accounting entries.

In line with the guidance set out in Practice Note 10 Audit of Financial Statements of Public Sector Bodies in the United Kingdom we also recognised a fraud risk related to expenditure recognition, particularly in relation to year-end accruals

We did not identify any additional fraud risks

We also performed procedures including:

• Identifying journal entries to test based on risk criteria and comparing the identified entries to supporting documentation. These included unusual entries to cash and entries posted by individuals who would not be expected to post journals.

• Assessing significant estimates for bias.

• Inspecting transactions in the period prior to and following 31 March 2022 to verify revenue had been recognised in the correct accounting period.

• Inspecting transactions in the period after 31 March 2022 to verify expenditure had been recognised in the correct accounting period.

• Evaluating accruals posted as at 31 March 2022, comparing to accruals posted as at 31 March 2021 and verifying accruals are appropriate, complete and accurately recorded.

• Assessing the completeness of disclosed related party transactions and verifying they had been accurately recorded within the financial statements.

Identifying and responding to risks of material misstatement related to non-compliance with laws and regulations

We identified areas of laws and regulations that could reasonably be expected to have a material effect on the financial statements from our general sector experience and through discussion with the directors and other management (as required by auditing standards), and discussed with the directors and other management the policies and procedures regarding compliance with laws and regulations.

As the Trust is regulated, our assessment of risks involved gaining an understanding of the control environment including the entity’s procedures for complying with regulatory requirements.

We communicated identified laws and regulations throughout our team and remained alert to any indications of non-compliance throughout the audit.

The potential effect of these laws and regulations on the financial statements varies considerably.

The Trust is subject to laws and regulations that directly affect the financial statements including the National Health Service Act 2006 and financial reporting legislation. We assessed the extent of compliance with these laws and regulations as part of our procedures on the related financial statement items.

We are also required to make a referral to the Secretary of State under section 30 of the Local Audit and Accountability Act 2014 if we have reason to believe that the Trust, or an officer of the Trust, is about to make, or has made, a decision which involves or would involve the body incurring unlawful expenditure, or is about to take, or has begun to take a course of action which, if followed to its conclusion, would be unlawful and likely to cause a loss or deficiency.

As outlined in the section of this report dealing with other legal and regulatory matters, we made a Section 30 referral to the Secretary of State on 4 May 2022.

Whilst the Trust is subject to many other laws and regulations, we did not identify any others where the consequences of non-compliance alone could have a material effect on amounts or disclosures in the financial statements.

Context of the ability of the audit to detect fraud or breaches of law or regulation

Owing to the inherent limitations of an audit, there is an unavoidable risk that we may not have detected some material misstatements in the financial statements, even though we have properly planned and performed our audit in accordance with auditing standards. For example, the further removed non-compliance with laws and regulations is from the events and transactions reflected in the financial statements, the less likely the inherently limited procedures required by auditing standards would identify it.

In addition, as with any audit, there remained a higher risk of non-detection of fraud, as these may involve collusion, forgery, intentional omissions, misrepresentations, or the override of internal controls. Our audit procedures are designed to detect material misstatement. We are not responsible for preventing non-compliance or fraud and cannot be expected to detect noncompliance with all laws and regulations.

Other information in the Annual Report

The Accountable Officer is responsible for the other information presented in the Annual Report together with the financial statements Our opinion on the financial statements does not cover the other information and, accordingly, we do not express an audit opinion or, except as explicitly stated below, any form of assurance conclusion thereon

Our responsibility is to read the other information and, in doing so, consider whether, based on our financial statements audit work, the information therein is materially misstated or inconsistent with the financial statements or our audit knowledge Based solely on that work:

• we have not identified material misstatements in the other information; and

• in our opinion the other information included in the Annual Report for the financial year is consistent with the financial statements.

• in our opinion that report has been prepared in accordance with the requirements of the Department of Health and Social Care Group Accounting Manual 2021/22

Annual Governance Statement

We are required to report to you if the Annual Governance Statement has not been prepared in accordance with the requirements of the Department of Health and Social Care Group Accounting Manual 2021/22. We have nothing to report in this respect.

Remuneration and Staff Report

In our opinion the parts of the Remuneration and Staff Report subject to audit have been properly prepared in accordance with the Department of Health and Social Care Group Accounting Manual 2021/22.

Directors’ and Accountable Officer’s responsibilities

As explained more fully in the statement set out on page 113, the directors are responsible for the preparation of financial statements that give a true and fair view. They are also responsible for: such internal control as they determine is necessary to enable the preparation of financial statements that are free from material misstatement, whether due to fraud or error; assessing the Trust’s ability to continue as a going concern, disclosing, as applicable, matters related to going concern; and using the going concern basis of accounting unless they have been informed by the relevant national body of the intention to dissolve the Trust without the transfer of its services to another public sector entity. As explained more fully in the statement of the Chief Executive's responsibilities, as the Accountable Officer of the Trust, on page 114 the Accountable Officer is responsible for ensuring that annual statutory accounts are prepared in a format directed by the Secretary of State

Auditor’s responsibilities

Our objectives are to obtain reasonable assurance about whether the financial statements as a whole are free from material misstatement, whether due to fraud or error, and to issue our opinion in an auditor’s report Reasonable assurance is a high level of assurance, but does not guarantee that an audit conducted in accordance with ISAs (UK) will always detect a material misstatement when it exists Misstatements can arise from fraud or error and are considered material if, individually or in aggregate, they could reasonably be expected to influence the economic decisions of users taken on the basis of the financial statements.

A fuller description of our responsibilities is provided on the FRC’s website at www.frc.org.uk/auditorsresponsibilities

REPORT ON OTHER LEGAL AND REGULATORY MATTERS

Report on the Trust’s arrangements for securing economy, efficiency and effectiveness in its use of resources

Under the Code of Audit Practice, we are required to report if we identify any significant weaknesses in the arrangements that have been made by the Trust to secure economy, efficiency and effectiveness in its use of resources.

We have nothing to report in this respect.

Respective responsibilities in respect of our review of arrangements for securing economy, efficiency and effectiveness in the use of resources

As explained in the statement set out on page 114, the Chief Executive, as the Accountable Officer, is responsible for ensuring that value for money is achieved from the resources available to the Trust. We are required under section 21(3)(c), as amended, of the Local Audit

and Accountability Act 2014 to be satisfied that the Trust has made proper arrangements for securing economy, efficiency and effectiveness in its use of resources.

We are not required to consider, nor have we considered, whether all aspects of the Trust’s arrangements for securing economy, efficiency and effectiveness in its use of resources are operating effectively

We have undertaken our review in accordance with the Code of Audit Practice and related statutory guidance having regard to whether the Trust had proper arrangements in place to ensure financial sustainability, proper governance and to use information about costs and performance to improve the way it manages and delivers its services. Based on our risk assessment, we undertook such work as we considered necessary.

Statutory reporting matters

We are required by Schedule 2 to the Code of Audit Practice issued by the Comptroller and Auditor General (‘the Code of Audit Practice’) to report to you if we refer a matter to the Secretary of State under section 30 of the Local Audit and Accountability Act 2014 because we have reason to believe that the Trust, or an officer of the Trust, is about to make, or has made, a decision which involves or would involve the body incurring unlawful expenditure, or is about to take, or has begun to take a course of action which, if followed to its conclusion, would be unlawful and likely to cause a loss or deficiency

On 4 May 2022, we referred a matter to the Secretary of State under section 30(1)(a) of the 2014 Act in relation to the breach of the Trust’s breakeven duty due to the deficit of £10.890 million in 2021/22, and the cumulative breakeven duty position of a deficit of £130.858 million at 31 March 2022.

THE PURPOSE OF OUR AUDIT WORK AND TO WHOM WE OWE OUR RESPONSIBILITIES

This report is made solely to the Board of Directors of The Shrewsbury and Telford Hospital NHS Trust NHS Trust, as a body, in accordance with Part 5 of the Local Audit and Accountability Act 2014 Our audit work has been undertaken so that we might state to the Board of the Trust, as a body, those matters we are required to state to them in an auditor’s report and for no other purpose. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the Board of the Trust, as a body, for our audit work, for this report or for the opinions we have formed.

CERTIFICATE OF COMPLETION OF THE AUDIT

We certify that we have completed the audit of the accounts of The Shrewsbury and Telford Hospital NHS Trust NHS Trust for the year ended 31 March 2022 in accordance with the requirements of the Local Audit and Accountability Act 2014 and the Code of Audit Practice.

Andrew Cardoza for and on behalf of KPMG LLP

Chartered Accountants

One Snowhill

Snow Hill Queensway

Birmingham B4 6GH

22 June 2022

The Shrewsbury and Telford Hospital NHS Trust

Annual Accounts for the year ended 31 March 2022

Statement of Comprehensive Income

2021/22 2020/21

Note £000 £000

Operating income from patient care activities 3 493,237 434,109

Other operating income 4 41,905 77,334 Operating expenses 6, 8 (545,023) (503,081)

Operating surplus/(deficit) from continuing operations (9,881) 8,362

Finance income 11 16Finance expenses 12 4 2 PDC dividends payable (6,694) (4,644)

Net finance costs (6,674) (4,642)

Other gains / (losses) 13 (99) (233)

Share of profit / (losses) of associates / joint arrangements -Gains / (losses) arising from transfers by absorption 42 -Corporation tax expense -Surplus / (deficit) for the year from continuing operations (16,654) 3,487

Surplus / (deficit) on discontinued operations and the gain / (loss) on disposal of discontinued operations 14 -Surplus / (deficit) for the year (16,654) 3,487

Other comprehensive income

Will not be reclassified to income and expenditure:

Impairments 7 (1,337) 5,421 Revaluations 18 4,419 38,087

Share of comprehensive income from associates and joint ventures -Fair value gains / (losses) on equity instruments designated at fair value through OCI - -

Other recognised gains and losses -Remeasurements of the net defined benefit pension scheme liability / asset 37 -Gain / (loss) arising from on transfers by modified absorption 42 -Other reserve movements - -

May be reclassified to income and expenditure when certain conditions are met: Fair value gains/(losses) on financial assets mandated at fair value through OCI - -

Recycling gains/(losses) on disposal of financial assets mandated at fair value through OCI 13 - -

Foreign exchange gains / (losses) recognised directly in OCI - -

Total comprehensive income / (expense) for the period (13,572) 46,995

Adjusted financial performance (control total basis):

Surplus / (deficit) for the period (16,654) 3,487

Remove net impairments not scoring to the Departmental expenditure limit 5,514 (6,071)

Remove (gains) / losses on transfers by absorption - -

Remove I&E impact of capital grants and donations (178) (633)

Prior period adjustments - -

Remove non-cash element of on-SoFP pension costs - -

Remove net impact of inventories received from DHSC group bodies for COVID response 428 (535)

Remove loss recognised on return of donated COVID assets to DHSC -

Adjusted financial performance surplus / (deficit) (10,890) (3,752)

Statement of Financial Position

Non-current assets

31 March 2022 31 March 2021

Note £000 £000

Intangible assets 15 15,809 12,539 Property, plant and equipment 16 259,490 237,176

Investment property 19 -Investments in associates and joint ventures -Other investments / financial assets -Receivables 24 1,723 2,031 Other assets - -

Total non-current assets 277,022 251,746

Current assets

Inventories 23 9,039 9,310 Receivables 24 10,190 22,543

Other investments / financial assets -Other assets - -

Non-current assets for sale and assets in disposal groups - -

Cash and cash equivalents 27 15,889 15,405

Total current assets 35,118 47,258

Current liabilities

Trade and other payables 28 (66,175) (61,059) Borrowings 30 -Other financial liabilities 31 -Provisions 33 (321) (348) Other liabilities 29 (1,554) (1,512) Liabilities in disposal groups 26.2 - -

Total current liabilities (68,050) (62,919)

Total assets less current liabilities 244,090 236,085

Non-current liabilities

Trade and other payables 28 -Borrowings 30 -Other financial liabilities 31 -Provisions 33 (932) (1,292) Other liabilities 29 - -

Total non-current liabilities (932) (1,292)

Total assets employed 243,158 234,793

Financed by

Income and expenditure reserve

Total taxpayers' equity

Public dividend capital 344,753 322,816 Revaluation reserve 73,896 70,814 (175,491) (158,837) 243,158 234,793

The notes on pages 8 to 53 form part of these accounts.

Louise Barnett Chief Executive Officer 16-Jun-22

Statement of Changes in Equity for the year

ended 31 March 2022

Public dividend capital Revaluation reserve

Financial assets reserve Other reserves Merger reserve

Income and expenditure reserve Total

£000 £000 £000 £000 £000 £000 £000

Taxpayers' and others' equity at 1 April 2021 - brought forward 322,816 70,814 - - - (158,837) 234,793

At start of period for new FTs - - - - - -Surplus/(deficit) for the year - - - - - (16,654) (16,654)

Gain/(loss) arising from transfers by modified absorption - - - - - - -

Transfers by absorption: transfers between reserves - - - - - - -

Transfer from revaluation reserve to income and expenditure reserve for impairments arising from consumption of economic benefits - - - - - -Other transfers between reserves - - - - - -Impairments - (1,337) - - - - (1,337) Revaluations - 4,419 - - - - 4,419

Public dividend capital received 21,937 - - - - - 21,937

Public dividend capital repaid - - - - - - -

Public dividend capital written off - - - - - - -

Other movements in public dividend capital in year - - - - - - -

Other reserve movements - - - - - - -

Taxpayers' and others' equity at 31 March 2022 344,753 73,896 - - - (175,491) 243,158

Statement of Changes in Equity for the year ended 31 March 2021

Public dividend capital Revaluation reserve

Financial assets reserve Other reserves Merger reserve

Income and expenditure reserve Total

£000 £000 £000 £000 £000 £000 £000

Taxpayers' and others' equity at 1 April 2020 - brought forward 215,008 27,306 - - - (162,324) 79,990

Prior period adjustment - - - - - - -

Taxpayers' and others' equity at 1 April 2020 - restated 215,008 27,306 - - - (162,324) 79,990

At start of period for new FTs - - - - - - -

Surplus/(deficit) for the year - - - - - 3,487 3,487 Gain/(loss) arising from transfers by modified absorption - - - - - - -

Transfers by absorption: transfers between reserves - - - - - - -

Transfer from revaluation reserve to income and expenditure reserve for impairments arising from consumption of economic benefits - - - - - - -

Other transfers between reserves - - - - - - -

Impairments - 5,421 - - - - 5,421 Revaluations - 38,087 - - - - 38,087

Public dividend capital received 107,808 - - - - - 107,808

Public dividend capital repaid - - - - - - -

Public dividend capital written off - - - - - - -

Other movements in public dividend capital in year - - - - - -Other reserve movements - - - - - - -

Taxpayers' and others' equity at 31 March 2021 322,816 70,814 - - - (158,837) 234,793

Information on reserves

Public dividend capital

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.

Revaluation reserve

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

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.

Income and expenditure reserve

The balance of this reserve is the accumulated surpluses and deficits of the Trust.

Statement of Cash Flows

Cash flows from operating activities

2021/22 2020/21

Note £000 £000

Operating surplus / (deficit) (9,881) 8,362

Non-cash income and expense:

Depreciation and amortisation 6.1 14,744 11,956

Net impairments 7 5,514 (6,071)

Income recognised in respect of capital donations 4 (1,140) (1,642)

Amortisation of PFI deferred credit - -

Non-cash movements in on-SoFP pension liability - -

(Increase) / decrease in receivables and other assets 13,020 (5,039)

(Increase) / decrease in inventories 271 (887)

Increase / (decrease) in payables and other liabilities 3,554 21,599

Increase / (decrease) in provisions (383) 235

Tax (paid) / received - -

Operating cash flows from discontinued operations - -

Other movements in operating cash flows - -

Net cash flows from / (used in) operating activities 25,699 28,513

Cash flows from investing activities

Interest received 16 2

Purchase and sale of financial assets / investments - -

Purchase of intangible assets (5,964) (4,954)

Sales of intangible assets - -

Purchase of PPE and investment property (36,352) (31,908)

Sales of PPE and investment property 1,961 -

Receipt of cash donations to purchase assets 1,140 672

Net cash flows from / (used in) investing activities (39,199) (36,188)

Cash flows from financing activities

Public dividend capital received 21,937 107,808

Public dividend capital repaid - -

Movement on loans from DHSC - (82,554)

Movement on other loans - -

Other capital receipts - -

Capital element of finance lease rental payments - -

Capital element of PFI, LIFT and other service concession payments - -

Interest on loans - (167)

Other interest - -

Interest paid on finance lease liabilities - -

PDC dividend (paid) / refunded (7,953) (3,707)

Financing cash flows of discontinued operations - -

Cash flows from (used in) other financing activities - -

Net cash flows from / (used in) financing activities 13,984 21,380

Increase / (decrease) in cash and cash equivalents 484 13,705

Cash and cash equivalents at 1 April - brought forward 15,405 1,700

Prior period adjustments - -

Cash and cash equivalents at 1 April - restated 15,405 1,700

Cash and cash equivalents at start of period for new FTs - -

Cash and cash equivalents transferred under absorption accounting 42 - -

Unrealised gains / (losses) on foreign exchange - -

Cash and cash equivalents at 31 March 27.1 15,889 15,405

Note 1 Accounting policies and other information

Note 1.1 Basis of preparation

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.

Accounting convention

These accounts have been prepared in accordance with the Department of Health and Social Care Group Accounting Manual (GAM).The 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.

Note 1.2 Going concern

These accounts have been prepared on a going concern basis. The financial reporting framework applicable to NHS bodies, derived from the HM Treasury Financial Reporting Manual, defines that the anticipated continued provision of the entity’s services in the public sector is normally sufficient evidence of going concern. The directors have a reasonable expectation that this will continue to be the case.

The Board of Directors has carefully considered the principle of ‘Going Concern in the context of the Trust continuing to operate under the HM Treasury’s Financial Reporting Guidelines (FReM). For the year ending 31 March 2022, the Trust is reporting a deficit of £10.890m on an adjusted financial performance basis, against a planned deficit of £7.043m. The Trust achieved the control total against the revised forecast agreed at end of Quarter 3.

In 2021/22, the NHS funding regime continued to be an emergency financial regime as a result of the Covid19 pandemic, and therefore the majority of the trust’s income from NHS commissioners was in the form of block contract arrangements. The Trust also received additional income outside of the block payments to reimburse specific costs incurred and other income top-ups to support the delivery of services. 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.

The Trust maintains a high cash balance of £15.889m at the end of 2021/22 (2020/21: £15.405m). Historically the Trust has had low levels of internally generated funds underpinned by public dividend capital. Every ICS/STP received a 2021/22 capital spending envelope derived from the system-level allocation, with The Shrewsbury and Telford Hospital NHS Trust receiving a total system envelope of £21.934m in 2021/22.

In the financial landscape for 2022/23, the Trust’s income will be driven via an ‘allocative process’ with block payments and specific adjustments for growth and prices, COVID costs, Elective Recovery fund and convergence adjustments that adjust towards a fair share allocation. As the STW ICS is currently consuming more than their fair share there is a greater convergence ask for the 2022/23 financial year. Contracts will be constructed on an IFP basis within the ICS, this is an approach based on collaboration, concentrating on the cost of providing healthcare across the system in order to bring the health system back to clinical, operational and financial balance. Other contracts will either be constructed on a typical cost and volume contract or take an aligned incentive payment approach.

The Directors have concluded that whilst the financial position for 2022/23 is very challenging, based upon enquiries with NHS Improvement and the Department of Health and Social Care, they have a reasonable expectation that the Trust will have access to adequate resources (as in previous years) to continue in operational existence for at least 12 months from the date of approval of the financial statements and continue to provide services to its patients. Based on this expected continuation of services, the Trust continues to adopt the going concern basis in preparing the financial statements.

Note 1.3 Consolidation

The Trust is the Corporate Trustee to the Shrewsbury and Telford Hospital NHS Trust Charity. The Trust has assessed its relationship to the charitable fund and determined it not to be a subsidiary because the Trust is not exposed to, or has rights to, variable returns and other benefits for itself, patients and staff from its involvement with the charitable fund and does not have the ability to affect those returns and other benefits through its power over the fund.

The charitable fund’s statutory accounts are prepared to 31 March in accordance with the UK Charities Statement of Recommended Practice (SORP) which is based on UK Financial Reporting Standard (FRS) 102.

Note

1.4

Revenue from contracts with customers

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).

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.

Revenue from NHS contracts

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 2020/21 comparative year these blocks were set for individual NHS providers directly, but the revenue recognition principles are 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.

The Trust also receives additional income outside of the block payments to reimburse specific costs incurred and, in 2020/21, other income top-ups to support the delivery of services. Reimbursement and top-up income is accounted for as variable consideration.

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.

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.

NHS injury cost recovery scheme

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.

Note 1.5 Other forms of income

Grants and donations

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 grant 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.

Apprenticeship service income

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 1.6 Expenditure on employee benefits

Short-term employee benefits

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.

Pension costs

NHS Pension Scheme

Past and present employees are covered by the provisions of the two NHS Pension Schemes. Both schemes are unfunded, defined benefit schemes that cover NHS employers, general practices and other bodies, allowed under the direction of Secretary of State for Health and Social Care in England and Wales. The scheme is not designed in a way that would enable employers to identify their share of the underlying scheme assets and liabilities. Therefore, the scheme is accounted for as though it is a defined contribution scheme: the cost to the Trust is taken as equal to the employer's pension contributions payable to the scheme for the accounting period. The contributions are charged to operating expenses as and when they become due.

Additional pension liabilities arising from early retirements are not funded by the scheme except where the retirement is due to ill-health. The full amount of the liability for the additional costs is charged to the operating expenses at the time the Trust commits itself to the retirement, regardless of the method of payment.

Note 1.7 Expenditure on other goods and services

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.

Note 1.8 Discontinued operations

Discontinued operations occur where activities either cease without transfer to another entity, or transfer to an entity outside of the boundary of Whole of Government Accounts, such as private or voluntary sectors. Such activities are accounted for in accordance with IFRS 5. Activities that are transferred to other bodies within the boundary of Whole of Government Accounts are ‘machinery of government changes’ and treated as continuing operations.

Note 1.9 Property, plant and equipment

Recognition

Property, plant and equipment is capitalised where:

• 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

• the cost of the item can be measured reliably

• the item has cost of 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.

Where a large asset, for example a building, includes a number of components with significantly different asset lives, eg, plant and equipment, then these components are treated as separate assets and depreciated over their own useful lives.

Subsequent expenditure

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.

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 management.

Assets are measured subsequently at valuation. Assets which are held for their service potential and are in use (ie 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.

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:

• Land and non-specialised buildings – market value for existing use

• Specialised buildings – depreciated replacement cost on a modern equivalent asset basis.

For specialised 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 meeting the 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.

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.

Property, plant and equipment which has 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.

Revaluation gains and losses

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 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 expenses.

Gains and losses recognised in the revaluation reserve are reported in the Statement of Comprehensive Income as an item of ‘other comprehensive income’.

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.

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.

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.

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 assets

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.

Useful lives of property, plant and equipment

Useful lives reflect the total life of an asset and not the remaining life of an asset. The range of useful lives are shown in the table below:

Min life Max life Years Years

Land -Buildings, excluding dwellings 8 72

Dwellings 15 47

Plant & machinery 4 27

Transport equipment 10 10 Information technology 3 10 Furniture & fittings 10 23

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 1.10 Intangible assets

Recognition

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.

Internally generated intangible assets

Internally generated goodwill, brands, mastheads, publishing titles, customer lists and similar items are not capitalised as intangible assets.

Expenditure on research is not capitalised. Expenditure on development is capitalised where it meets the requirements set out in IAS 38.

Software

Software which is integral to the operation of hardware, eg 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, eg application software, is capitalised as an intangible asset.

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.

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.

Amortisation

Intangible assets are amortised over their expected useful lives in a manner consistent with the consumption of economic or service delivery benefits.

Useful lives of intangible assets

Useful lives reflect the total life of an asset and not the remaining life of an asset. The range of useful lives are shown in the table below:

Min life Max life Years Years

Information technology 5 12 Development expenditure -Websites -Software licences 5 10 Licences & trademarks -Patents -Other (purchased) -Goodwill - -

Note 1.11 Inventories

Inventories are valued at the lower of cost and net realisable value using the replacement cost formula. This is considered to be a reasonable approximation to fair value due to the high turnover of stocks.

In 2021/22, the Trust received 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.

Note 1.12 Investment properties

Investment properties are measured at fair value. Changes in fair value are recognised as gains or losses in income/expenditure.

Only those assets which are held solely to generate a commercial return are considered to be investment properties. Where an asset is held, in part, for support service delivery objectives, then it is considered to be an item of property, plant and equipment. Properties occupied by employees, whether or not they pay rent at market rates, are not classified as investment properties.

Note 1.13 Cash and cash equivalents

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 3 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.

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. Cash, bank and overdraft balances are recorded at current values.

Note 1.14 Financial assets and financial liabilities

Recognition

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 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, ie, when receipt or delivery of the goods or services is made.

Classification and measurement

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.

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 are classified as subsequently measured at fair value through income and expenditure.

Financial liabilities classified are subsequently measured at fair value through income and expenditure.

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 payable.

After 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 liability.

Interest 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 and 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.

Financial assets measured at fair value through other comprehensive income

A financial asset is measured at fair value through other comprehensive income where business model objectives are met by both collecting contractual cash flows and selling financial assets and where the cash flows are solely payments of principal and interest. Movements in the fair value of financial assets in this category are recognised as gains or losses in other comprehensive income except for impairment losses. On derecognition, cumulative gains and losses previously recognised in other comprehensive income are reclassified from equity to income and expenditure, except where the Trust elected to measure an equity instrument in this category on initial recognition.

Financial assets and financial liabilities at fair value through income and expenditure

Financial assets measured at fair value through profit or loss are those that are not otherwise measured at amortised cost or at fair value through other comprehensive income. This category also includes financial assets and liabilities acquired principally for the purpose of selling in the short term (held for trading) and derivatives. Derivatives which are embedded in other contracts, but which are separable from the host contract are measured within this category. Movements in the fair value of financial assets and liabilities in this category are recognised as gains or losses in the Statement of Comprehensive income.

Impairment of financial assets

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.

The Trust adopts a simplified approach to impairment for contract and other receivables, contract assets and lease receivables. All debts more than three months old are set up as potential credit losses except those that could be offset against any salary payments. All overseas accounts are set up as potential credit losses on a monthly basis. The Trust does not normally recognise expected credit losses in relation to other NHS bodies.

The Trust does not have any other financial assets that require impairment.

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.

Derecognition

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.

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.

The Trust as a lessee

Finance 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.

The asset and liability are recognised at the commencement of the lease. Thereafter the asset is accounted for an item of property, plant and equipment.

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.

Operating leases

Operating lease payments are recognised as an expense on a straight-line basis over the lease term. Lease incentives are recognised initially in other liabilities on the Statement of Financial Position 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.

Leases of land and buildings

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.

The Trust as a lessor

Finance leases

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

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.

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 riskadjusted cash flows are discounted using HM Treasury's discount rates effective from 31 March 2022:

Nominal rate Prior year rate

Short-term

Up to 5 years 0.47% Minus 0.02%

Medium-term After 5 years up to 10 years 0.70% 0.18%

Long-term After 10 years up to 40 years 0.95% 1.99%

Very long-term Exceeding 40 years 0.66% 1.99%

HM Treasury provides discount rates for general provisions on a nominal rate basis. Expected future cash flows are therefore adjusted for the impact of inflation before discounting using nominal rates. The following inflation rates are set by HM Treasury, effective from 31 March 2022:

Inflation rate Prior year rate

Year 1 4.00% 1.20%

Year 2 2.60% 1.60%

Into perpetuity 2.00% 2.00%

Early retirement provisions and injury benefit provisions both use the HM Treasury's pension discount rate of minus 1.30% in real terms (prior year: 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. 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 33.2 but is not recognised in the Trust’s accounts.

Non-clinical risk pooling

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 1.17 Contingencies

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 34 where an inflow of economic benefits is probable.

Contingent liabilities are not recognised, but are disclosed in note 34, unless the probability of a transfer of economic benefits is remote.

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

• 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.

Note 1.18 Public dividend capital

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 the Department of Health and Social Care.

This policy is available at https://www.gov.uk/government/publications/guidance-on-financing-available-to-nhs-Trustsand-foundation-Trusts.

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.

Note 1.19 Value added tax

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.

Note 1.20 Corporation tax

The Trust is not required to pay corporation tax as it is an NHS trust and has no trading company.

Note 1.21 Climate change levy

Expenditure on the climate change levy is recognised in the Statement of Comprehensive Income as incurred, based on the prevailing chargeable rates for energy consumption.

Note 1.22 Foreign exchange

The functional and presentational currency of the Trust is sterling.

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.

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.

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.

Exchange gains or losses on non-monetary assets and liabilities are recognised in the same manner as other gains and losses on these items.

Note 1.23 Third party assets

Assets belonging to third parties in which the Trust has no beneficial interest (such as money held on behalf of patients) are not recognised in the accounts. However, they are disclosed in a separate note to the accounts in accordance with the requirements of HM Treasury’s FReM.

Note 1.24 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 basis.

The losses 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 1.25 Gifts

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.

Note 1.26 Transfers of functions to/from other NHS bodies/local government bodies

There have been no functions that have been transferred to/from the Trust from/to other NHS/local government bodies.

Note 1.27 Early adoption of standards, amendments and interpretations No new accounting standards or revisions to existing standards have been early adopted in 2021/22.

Note 1.28 Standards, amendments and interpretations in issue but not yet effective or adopted

IFRS 16 Leases

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.

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.

On transition to IFRS 16 on 1 April 2022, the Trust will apply the standard retrospectively 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's incremental borrowing rate will be defined by HM Treasury. Currently this rate is 0.95% but this may change between now and adoption of the standard. 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. 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.

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 impact on 1 April 2022 statement of financial position

£000

Additional right of use assets recognised for existing operating leases 23,302

Additional lease obligations recognised for existing operating leases (22,264)

Changes to other statement of financial position line items -

Net impact on net assets on 1 April 2022 1,038

Estimated in-year impact in 2022/23

Additional depreciation on right of use assets (5,352)

Additional finance costs on lease liabilities (238)

Lease rentals no longer charged to operating expenditure 5,483

Other impact on income / expenditure -

Estimated impact on surplus / (deficit) in 2022/23 (108)

Estimated increase in capital additions for new leases commencing in 2022/23 4,822

Other standards, amendments and interpretations

IFRS 17 Insurance Contracts – the effective date for IFRS17 is now 2023/24 but work has not yet started on understanding its impact in the NHS.

Note 1.29 Critical judgements in applying accounting policies

The following are the judgements, apart from those involving estimations (see below) that management has made in the process of applying the Trust accounting policies and that have the most significant effect on the amounts recognised in the financial statements:

Charitable Funds: Following Treasury’s agreement to apply IAS 27 (Consolidation and Separate Financial Statements) to NHS Charities from 1 April 2013, The Shrewsbury and Telford Hospital NHS Trust has established that as the Trust is the Corporate Trustee of the linked NHS Charity, it effectively has the power to exercise control so as to obtain economic benefits so therefore may have needed to consolidate its NHS Charity Accounts into its NHS Trust Accounts. The Trust has considered the income, expenditure, assets and liabilities of the NHS Charity to be immaterial in the context of the accounts of the NHS Trust and have not consolidated these into the Trust's accounts.

Note 1.30 Sources of estimation uncertainty

In the application of the NHS 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 that are considered to be 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 the estimate is revised if the revision affects only that period or in the period of the revision and future periods if the revision affects both current and future periods.

Accruals: The Trust has used, wherever possible, advice from specialist providers or information from counterparty organisations to support estimated values within the accounts. If these were not available, the Trust has used own data and experience to calculate estimated amounts to reduce material errors from the estimated values included in these accounts.

Provisions: Provisions have been made for probable legal and constructive obligations of uncertain timings and amount as at the reporting date. These are based on estimates using relevant and reliable information as is available at the time the financial statements are prepared, These provisions are estimates of the actual costs of future cash flows and are dependent on future events. Any difference between expectations and the actual future liability will be accounted for in the period when such determination is made.

Revaluation: The Trust commissioned Cushman and Wakefield (“C&W”) to undertake a desktop update valuation of the Trust's estate as at 31 March 2022. Specialised buildings are valued at Depreciated Replacement Cost defined as Modern Equivalent Asset.

Land and building assets are valued on the basis explained in Notes 1.9 and 16. A professional firm of valuers has provided the Trust with a valuation based on estimated fair value and remaining useful life. As the Trust's land and buildings are infrastructural in nature, and thus do not have a conventional market value in use; the valuations are based on estimates provided by suitably qualified professionals in accordance with HM Treasury guidance. Future revaluations of property may result in further changes to the carrying values of non-current assets. The Trust's management determines the estimated useful lives and depreciation charges for all property, plant and equipment assets (with the exception of land). These estimates are based on past experience and practice across the health sector, as well as drawing on the technical expertise within the Trust. Management will increase the depreciation charges where useful lives are less than previously estimated lives, or it will write off or write down assets that are obsolete, abandoned or sold. Useful lives for land, buildings and dwellings are determined by independent valuers and management reviews these for reasonableness.

The COVID-19 pandemic and measures to tackle it continue to affect economies and real estate markets globally. Nevertheless, as at the valuation date property markets are mostly functioning, with transaction volumes and other relevant evidence at levels where enough market evidence exists upon which to base opinions of value. Accordingly - and for the avoidance of doubt, the valuation is not reported as being subject to ‘material valuation uncertainty’ as defined by VPS 3 and VPGA 10 of the RICS Valuation – Global Standards.

This explanatory note has been included to ensure transparency and to provide further insight as to the market context under which the valuation opinion was prepared. In recognition of the potential for market conditions to move rapidly in response to changes in the control or future spread of COVID-19 we highlight the importance of the valuation date.

Building Safety- Market Uncertainty

The aftermath of the Grenfell Fire on 14 June 2017 resulted in a wholesale review of the regime relating to building safety. A public inquiry commenced in 2018 with a report on the findings of the first phase of the inquiry published in October 2019. The second phase of the inquiry commenced in January 2020 and is still ongoing.

An Independent Review of Building Regulations and Fire Safety led by Dame Judith Hackitt was published in May 2018. This included recommendations for a new Building Regulations regime for residential buildings of 10 storeys (30m) or higher. The Government subsequently announced that Building Regulations would be amended from 21 December 2018 to ban the use of combustible materials on the external walls of new buildings over 18m containing flats, as well as, inter alia, buildings such as new hospitals, residential care homes and student accommodation. Due to the changes to the building regulations the ban will affect existing buildings undergoing major works or a change of use. On 20 January 2020 MHCLG published “Building safety advice for building owners, including fire doors” which consolidated the previously published advice notes including Advice Note 22. The advice note specifically deals with aluminium composite material panels, high pressure laminate panels, spandrel panels, balconies and external wall insulation systems as well as smoke control systems and fire doors. The advice note does not cover all types of wall systems for buildings below 18 metres, but consideration is to be given to the spread of fire externally through the fire risk assessment taken into consideration the buildings occupancy and other factors which may result in remedial actions being required.

The Fire Safety Act 2021 came into force in May and aims to improve fire safety in multi-occupancy domestic premises. The Act requires responsible persons to assess, manage and reduce the fire risks posed by the structure and external walls of the buildings for which they are responsible (including cladding, balconies and windows). It applies to all multi-occupied residential buildings and is not dependent on the height of the building. The Act allows the Fire & Rescue Service to enforce against non–compliance in relation to the external walls and the individual doors opening onto the common parts of the premises, but the Act does not address remediation costs in relation to cladding or its replacement.

Market participants continue to be affected by details of construction, health and safety, and particularly fire prevention, mitigation and means of escape from buildings where people sleep. The Government’s proposed legislation is far reaching and will provide a new regime for building regulations compliance. In the light of these circumstances, this valuation has been undertaken in the context of a changing regulatory environment and we would therefore recommend that it is kept under regular review.

Pensions: The NHS Pensions Scheme provides cover for past and present employees, and is subject to a full actuarial valuation every five years (see note 9). The Trust carries provisions in certain instances relating to early retirement, based on latest actuarial information provided by the NHS Pensions Agency. This is therefore subject to change which is recognised in the period to which it arises.

Insurance: The Trust maintains insurance against potential legal claims, which are managed by the NHS Resolution. The Trust makes provisions for the estimated excess liabilities due under this policy, in line with information provided by the NHS Resolution. Uncertainty in estimation may relate to the timing of potential settlements, although the liability to the Trust will be limited to the level of the excess.

3

Note 2 Operating Segments

The Trust operates in one material segment which is the provision of healthcare services with the Trust Board as its chief operating decision maker deciding how to allocate resources and assessing performance.

Note 3 Operating income from patient care activities

All income from patient care activities relates to contract income recognised in line with accounting policy 1.4.

3 Note 3.1 Income from patient care activities (by nature) 2021/22 2020/21 £000 £000

Acute services

Block contract / system envelope income 435,500 357,322

High cost drugs income from commissioners (excluding pass-through costs) 4,954 31,669 Other NHS clinical income 1,301 7

All services

Private patient income 1,257 836 Elective recovery fund 2,487 -

Additional pension contribution central funding* 12,950 12,029 Other clinical income 34,788 32,246

Total income from activities 493,237 434,109

*The employer contribution rate for NHS pensions increased from 14.3% to 20.6% (excluding administration charge) from 1 April 2019. Since 2019/20, NHS providers have continued to pay over contributions at the former rate with the additional amount being paid over by NHS England on providers' behalf. The full cost and related funding have been recognised in these accounts.

3 Note 3.2 Income from patient care activities (by source) 2021/22 2020/21

Income from patient care activities received from: £000 £000 NHS England 80,386 82,278 Clinical commissioning groups 375,505 318,742 Department of Health and Social Care -Other NHS providers 1,301 1,272 NHS other - 7

Local authorities - -

Non-NHS: private patients 1,257 836

Non-NHS: overseas patients (chargeable to patient) 87 39 Injury cost recovery scheme 904 869

Non NHS: other 33,797 30,066

Total income from activities 493,237 434,109

Of which:

Related to continuing operations 493,237 434,109 Related to discontinued operations - -

Note 3.3 Overseas visitors (relating to patients charged directly by the provider)

2021/22 2020/21 £000 £000

Income recognised this year 87 39

Cash payments received in-year 50 42

Amounts added to provision for impairment of receivables 51 (11)

Amounts written off in-year 43 5

Note 4 Other operating income

Contract income Non-contract income Total

Contract income Non-contract income Total £000 £000 £000 £000 £000 £000

Research and development 575 - 575 757 - 757 Education and training 14,497 - 14,497 13,478 - 13,478

Non-patient care services to other bodies 1,932 1,932 1,655 1,655 Reimbursement and top up funding 8,826 8,826 39,075 39,075

Income in respect of employee benefits accounted on a gross basis - - -Receipt of capital grants and donations - 1,140 1,140 - 1,642 1,642 Charitable and other contributions to expenditure* - 1,786 1,786 - 8,667 8,667

Support from the Department of Health and Social Care for mergers - - - - - -

Rental revenue from finance leases - - - - - -

Rental revenue from operating leases - - - - - -

Amortisation of PFI deferred income / credits - - - - -Other income** 13,148 - 13,148 12,060 - 12,060

Total other operating income 38,979 2,926 41,905 67,025 10,309 77,334

Of which:

Related to continuing operations 41,905 77,334

Related to discontinued operations - -

* This includes donated inventories and equipment below capitalisation threshold for COVID response.

2021/22 2020/21 ** The majority of 'Other Income' is for car parking, radiology, cardiorespiratory, dietetics and speech therapists.

Note 5.1 Additional information on contract revenue (IFRS 15) recognised in the period 2021/22 2020/21 £000 £000

Revenue recognised in the reporting period that was included in within contract liabilities at the previous period end 1,512 1,312

Revenue recognised from performance obligations satisfied (or partially satisfied) in previous periods - -

Note 5.2 Fees and charges

The Trust undertakes income generation schemes with an aim of achieving profit, which is then used in patient care. The Trust has no income generation activities whose full cost exceeded £1m.

Note 6.1 Operating expenses

2021/22 2020/21 £000 £000

Purchase of healthcare from NHS and DHSC bodies - -

Purchase of healthcare from non-NHS and non-DHSC bodies 265 378

Purchase of social care - -

Staff and executive directors costs 367,435 341,265

Remuneration of non-executive directors 133 135

Supplies and services - clinical (excluding drugs costs) 40,180 38,001

Supplies and services - general 6,296 6,431

Drug costs (drugs inventory consumed and purchase of non-inventory drugs) 47,931 43,110

Inventories written down 165 394

Consultancy costs 859 550

Establishment 6,217 7,522

Premises 22,814 31,704

Transport (including patient travel) 651 727

Depreciation on property, plant and equipment 12,901 10,976

Amortisation on intangible assets 1,843 980

Net impairments 5,514 (6,071)

Movement in credit loss allowance: contract receivables / contract assets 400 188

Movement in credit loss allowance: all other receivables and investments - -

Increase/(decrease) in other provisions 143 210

Change in provisions discount rate(s) (4) (5)

Fees payable to the external auditor*

audit services- statutory audit 131 129 other auditor remuneration (external auditor only) - -

Internal audit costs 114 114

Clinical negligence 15,470 13,294

Legal fees 193 606 Insurance 90 34

Research and development -Education and training 2,454 2,633

Rentals under operating leases 10,495 7,847

Early retirements - -

Redundancy - -

Charges to operating expenditure for on-SoFP IFRIC 12 schemes (e.g. PFI / LIFT) - -

Charges to operating expenditure for off-SoFP PFI / LIFT schemes - -

Car parking & security 720 697

Hospitality - -

Losses, ex gratia & special payments 12 26

Grossing up consortium arrangements -Other services, eg external payroll - -

Other 1,601 1,206

Total 545,023 503,081

Of which:

Related to continuing operations 545,023 503,081

Related to discontinued operations -*audit services- statutory audit of £109,193 plus £21,838.60 of VAT.

Note 6.2 Other auditor remuneration

Other auditor remuneration paid to the external auditor:

2021/22 2020/21 £000 £000

1. Audit of accounts of any associate of the Trust - -

2. Audit-related assurance services - -

3. Taxation compliance services - -

4. All taxation advisory services not falling within item 3 above - -

5. Internal audit services - -

6. All assurance services not falling within items 1 to 5 - -

7. Corporate finance transaction services not falling within items 1 to 6 above - -

8. Other non-audit services not falling within items 2 to 7 above - -

Total - -

Note 6.3 Limitation on auditor's liability

The limitation on auditor's liability for external audit work is £5 million (2020/21: £5 million).

Note 7 Impairment of assets

Net impairments charged to operating surplus / (deficit) resulting from:

2021/22 2020/21 £000 £000

Loss or damage from normal operations - -

Over specification of assets - -

Abandonment of assets in course of construction - -

Unforeseen obsolescence - -

Loss as a result of catastrophe -Changes in market price 5,514 (6,071)

Other - -

Total net impairments charged to operating surplus / (deficit) 5,514 (6,071)

Impairments charged to the revaluation reserve 1,337 (5,421) Total net impairments 6,851 (11,492)

The Trust commissioned Cushman and Wakefield to undertake a desktop update valuation of the Trust's Estate as at 31 March 2022. The valuation has resulted in impairments being charged as follows:

- impairments to the value of £6,116k have been charged to Statement of Comprehensive Income.

- previous impairments of £602k have been reversed, giving a net impairment of £5,514k to Statement of Comprehensive Income.

- impairments of £1,785k have been charged to the Revaluation Reserve and previous impairments of £448k have been reversed, giving a net impairment of £1,337k to the Revaluation Reserve.

Note 8 Employee benefits

2021/22 2020/21 Total Total £000 £000

Salaries and wages 266,198 248,966

Social security costs 26,118 22,656

Apprenticeship levy 1,273 1,152

Employer's contributions to NHS pensions 42,723 39,737

Pension cost - other - -

Other post employment benefits - -

Other employment benefits - -

Termination benefits -Temporary staff (including agency) 32,845 29,902

Total gross staff costs 369,158 342,413 Recoveries in respect of seconded staff - -

Total staff costs 369,158 342,413

Of which Costs capitalised as part of assets 1,723 1,148

Note 8.1 Retirements due to ill-health

During 2021/22 there were six early retirements from the Trust agreed on the grounds of ill-health (two in the year ended 31 March 2021). The estimated additional pension liabilities of these ill-health retirements is £554k (£53k in 2020/21).

These estimated costs are calculated on an average basis and will be borne by the NHS Pension Scheme.

Past and present employees are covered by the provisions of the two NHS Pension Schemes. Details of the benefits payable and rules of the Schemes can be found on the NHS Pensions website at www.nhsbsa.nhs.uk/pensions. Both are unfunded defined benefit schemes that cover NHS employers, GP practices and other bodies, allowed under the direction of the Secretary of State for Health and Social Care 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.

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 2022, is based on valuation data as 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 used.

The latest 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

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.

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 to 20.6% of pensionable pay.

The 2016 funding valuation also tested the cost of the Scheme relative to the employer cost cap that was set following the 2012 valuation. There was initially a pause to the cost control element of the 2016 valuations, due to the uncertainty around member benefits caused by the discrimination ruling relating to the McCloud case.

HMT published valuation directions dated 7 October 2021 (see Amending Directions 2021) that set out the technical detail of how the costs of remedy are included in the 2016 valuation process. Following these directions, the scheme actuary has completed the cost control element of the 2016 valuation for the NHS Pension Scheme, which concludes no changes to benefits or member contributions are required. The 2016 valuation reports can be found on the NHS Pensions website at https://www.nhsbsa.nhs.uk/nhs-pension-scheme-accounts-and-valuation-reports.

Note 10 Operating leases

Note 10.1 The Shrewsbury and Telford Hospital NHS Trust as a lessor

There are no operating lease agreements where The Shrewsbury And Telford Hospital NHS Trust is the lessor.

Note 10.2 The Shrewsbury and Telford Hospital NHS Trust as a lessee

This note discloses costs and commitments incurred in operating lease arrangements where The Shrewsbury and Telford Hospital NHS Trust is the lessee.

The Trust has a lease for computerised digital imaging and archiving service and diagnostic equipment leases in radiology across both sites.

The Trust has an operating lease relating to an investment in replacing the boiler plant at the Royal Shrewsbury Hospital.

The Trust has a managed print service contract for both hospitals.

The Trust has leases for off site office accommodation, off site sterile services, off-site medical records storage and off site accommodation for the Fertility department facility.

The Trust has entered into leases for the provision of staff and office accommodation facilities at the Royal Shrewsbury Hospital.

The Trust has several managed service contracts for the provision of services within the Pathology department.

The Trust leases various properties/units through NHS Property Services and other NHS organisations.

The Trust also has lease cars.

Operating lease expense

2021/22 2020/21 £000 £000

Minimum lease payments 10,495 7,847

Contingent rents -Less sublease payments received -Total 10,495 7,847

31 March 2022 31 March 2021

Future minimum lease payments due: £000 £000

On buildings leases:

- not later than one year; 1,435 1,436 - later than one year and not later than five years; 5,047 5,105 - later than five years. 4,796 3,322

Total 11,278 9,863

Future minimum sublease payments to be received 544 -

31 March 2022 31 March 2021

Future minimum lease payments due: £000 £000

On other leases:

- not later than one year; 7,485 5,587 - later than one year and not later than five years; 18,521 11,807 - later than five years. 9,629 532

Total 35,635 17,926

Future minimum sublease payments to be received -

31 March 2022 31 March 2021

Future minimum lease payments due: £000 £000

On all leases:

- not later than one year; 8,920 7,023 - later than one year and not later than five years; 23,568 16,912 - later than five years. 14,425 3,854

Total 46,913 27,789

Future minimum sublease payments to be received 544 -

Note 11 Finance income

Finance income represents interest received on assets and investments in the period.

2021/22 2020/21 £000 £000

Interest on bank accounts 16 -

Interest income on finance leases - -

Interest on other investments / financial assets - -

Other finance income - -

Total finance income 16 -

Note 12.1 Finance expenditure

Finance expenditure represents interest and other charges involved in the borrowing of money or asset financing. 2021/22 2020/21 £000 £000

Interest expense:

Loans from the Department of Health and Social Care - -

Other loans - -

Overdrafts - -

Finance leases - -

Interest on late payment of commercial debt - -

Main finance costs on PFI and LIFT schemes obligations - -

Contingent finance costs on PFI and LIFT scheme obligations - -

Total interest expense - -

Unwinding of discount on provisions (4) (2)

Other finance costs - -

Total finance costs (4) (2)

Note 12.2 The late payment of commercial debts (interest) Act 1998 / Public Contract Regulations 2015 2021/22 2020/21 £000 £000

Total liability accruing in year under this legislation as a result of late payments - -

Amounts included within interest payable arising from claims made under this legislation - -

Compensation paid to cover debt recovery costs under this legislation - -

Note 13 Other gains / (losses)

2021/22 2020/21 £000 £000

Gains on disposal of assets - -

Losses on disposal of assets (99) (233)

Total gains / (losses) on disposal of assets (99) (233)

Gains / (losses) on foreign exchange - -

Fair value gains / (losses) on investment properties - -

Fair value gains / (losses) on financial assets / investments - -

Fair value gains / (losses) on financial liabilities - -

Recycling gains / (losses) on disposal of financial assets mandated as fair value through OCI - -

Other gains / (losses) - -

Total other gains / (losses) (99) (233)

Note 14 Discontinued operations

There are no discontinued operations.

Note 15.1 Intangible assets - 2021/22

Software licences Licences & trademarks Patents Internally generated information technology

Development expenditure Goodwill Websites Intangible assets under construction

Other (purchased) Total

£000 £000 £000 £000 £000 £000 £000 £000 £000 £000

Valuation / gross cost at 1 April 2021 - brought forward 4,370 - - 7,803 - - - 4,389 - 16,562 Transfers by absorption - - - - - - - - - -

Additions 389 - - 2,419 - - - 2,274 - 5,082 Impairments - - - - - - - - - -

Reversals of impairments - - - - - - - - -Revaluations - - - - - - - - - -

Reclassifications 38 - - 1,233 - - - (1,240) - 31 Transfers to / from assets held for sale - - - - - - - - -Disposals / derecognition - - - - - - - - -Valuation / gross cost at 31 March 2022 4,797 - - 11,455 - - - 5,423 - 21,675

Amortisation at 1 April 2021 - brought forward 210 - - 3,813 - - - - - 4,023 Transfers by absorption - - - - - - - - -Provided during the year 561 - - 1,282 - - - - - 1,843 Impairments - - - - - - - - -Reversals of impairments - - - - - - - - -Revaluations - - - - - - - - - -

Reclassifications - - - - - - - - -Transfers to / from assets held for sale - - - - - - - - -Disposals / derecognition - - - - - - - - -Amortisation at 31 March 2022 771 - - 5,095 - - - - - 5,866

Net book value at 31 March 2022 4,026 - - 6,360 - - - 5,423 - 15,809 Net book value at 1 April 2021 4,160 - - 3,990 - - - 4,389 - 12,539

Note 15.2 Intangible assets - 2020/21

Software licences Licences & trademarks Patents

Internally generated information technology Development expenditure Goodwill Websites

Intangible assets under construction Other (purchased) Total £000 £000 £000 £000 £000 £000 £000 £000 £000 £000

Valuation / gross cost at 1 April 2020 - as previously stated 48 - - 4,654 - - - 4,751 - 9,453 Prior period adjustments - - - - - - - - - -

Valuation / gross cost at 1 April 2020 - restated 48 - - 4,654 - - - 4,751 - 9,453

Transfers by absorption - - - - - - - - -Additions 1,119 - - 1,351 - - - 4,389 - 6,859 Impairments - - - - - - - - - -

Reversals of impairments - - - - - - - - -Revaluations - - - - - - - - -Reclassifications 3,203 - - 1,798 - - - (4,751) - 250 Transfers to / from assets held for sale - - - - - - - - -Disposals / derecognition - - - - - - - - -Valuation / gross cost at 31 March 2021 4,370 - - 7,803 - - - 4,389 - 16,562

Amortisation at 1 April 2020 - as previously stated 20 - - 3,023 - - - - - 3,043 Prior period adjustments - - - - - - - - -Amortisation at 1 April 2020 - restated 20 - - 3,023 - - - - - 3,043

Transfers by absorption - - - - - - - - -Provided during the year 190 - - 790 - - - - - 980 Impairments - - - - - - - - - -

Reversals of impairments - - - - - - - - -Revaluations - - - - - - - - -Reclassifications - - - - - - - - -Transfers to / from assets held for sale - - - - - - - - -Disposals / derecognition - - - - - - - - - -

Amortisation at 31 March 2021 210 - - 3,813 - - - - - 4,023

Net book value at 31 March 2021 4,160 - - 3,990 - - - 4,389 - 12,539

Net book value at 1 April 2020 28 - - 1,631 - - - 4,751 - 6,410

Note 16.1 Property, plant and equipment - 2021/22

Land

Buildings excluding dwellings Dwellings

Assets under construction Plant & machinery Transport equipment Information technology Furniture & fittings Total

£000 £000 £000 £000 £000 £000 £000 £000 £000

Valuation/gross cost at 1 April 2021 - brought forward 13,500 170,651 1,447 14,976 54,114 388 16,267 2,141 273,484

Transfers by absorption - - - - - - - -Additions - 10,627 38 19,568 2,352 - 6,954 199 39,738 Impairments - (9,679) (37) - - - - - (9,716)

Reversals of impairments - 136 2 - - - - - 138 Revaluations - 1,298 - - - - - - 1,298 Reclassifications - 5,278 - (8,581) 3,009 - 234 29 (31) Transfers to / from assets held for sale - - - - - - - -Disposals / derecognition - - - - (5,735) - - - (5,735)

Valuation/gross cost at 31 March 2022 13,500 178,311 1,450 25,963 53,740 388 23,455 2,369 299,176

Accumulated depreciation at 1 April 2021 - brought forward - 338 - - 28,469 337 6,241 923 36,308

Transfers by absorption - - - - - - - -Provided during the year - 5,870 37 - 4,142 17 2,642 193 12,901 Impairments - (1,811) (4) - - - - - (1,815)

Reversals of impairments - (879) (33) - - - - - (912) Revaluations - (3,121) - - - - - - (3,121) Reclassifications - - - - - - - -Transfers to / from assets held for sale - - - - - - - -Disposals / derecognition - - - - (3,675) - - - (3,675)

Accumulated depreciation at 31 March 2022 - 397 - - 28,936 354 8,883 1,116 39,686

Net book value at 31 March 2022 13,500 177,914 1,450 25,963 24,804 34 14,572 1,253 259,490 Net book value at 1 April 2021 13,500 170,313 1,447 14,976 25,645 51 10,026 1,218 237,176

Note 16.2 Property, plant and equipment - 2020/21

Land

Buildings excluding dwellings Dwellings

Assets under construction Plant & machinery Transport equipment Information technology Furniture & fittings Total £000 £000 £000 £000 £000 £000 £000 £000 £000

Valuation / gross cost at 1 April 2020 - as previously stated 14,088 107,081 2,131 9,675 48,032 388 10,877 1,766 194,038

Prior period adjustments - - - - - - - - -

Valuation / gross cost at 1 April 2020 - restated 14,088 107,081 2,131 9,675 48,032 388 10,877 1,766 194,038

Transfers by absorption - - - - - - - - -

Additions - 13,688 - 11,051 8,552 - 4,086 374 37,751

Impairments (2,009) (10,752) (1,574) - - - - - (14,335) Reversals of impairments 1,421 20,471 890 - - - - - 22,782 Revaluations - 36,216 - - - - - - 36,216 Reclassifications - 3,947 - (5,750) 248 - 1,304 1 (250) Transfers to / from assets held for sale - - - - - - - -Disposals / derecognition - - - - (2,718) - - - (2,718)

Valuation/gross cost at 31 March 2021 13,500 170,651 1,447 14,976 54,114 388 16,267 2,141 273,484

Accumulated depreciation at 1 April 2020 - as previously stated - 273 - - 27,239 307 4,159 755 32,733 Prior period adjustments - - - - - - - -Accumulated depreciation at 1 April 2020 - restated - 273 - - 27,239 307 4,159 755 32,733

Transfers by absorption - - - - - - - -Provided during the year - 4,900 81 - 3,715 30 2,082 168 10,976 Impairments - (1,402) (68) - - - - - (1,470) Reversals of impairments - (1,562) (13) - - - - - (1,575)

Revaluations - (1,871) - - - - - - (1,871)

Reclassifications - - - - - - - - -

Transfers to / from assets held for sale - - - - - - - -Disposals / derecognition - - - - (2,485) - - - (2,485)

Accumulated depreciation at 31 March 2021 - 338 - - 28,469 337 6,241 923 36,308

Net book value at 31 March 2021 13,500 170,313 1,447 14,976 25,645 51 10,026 1,218 237,176 Net book value at 1 April 2020 14,088 106,808 2,131 9,675 20,793 81 6,718 1,011 161,305

Note 16.3 Property, plant and equipment financing - 2021/22

Net book value at 31 March 2022

Land

Buildings excluding dwellings Dwellings Assets under construction Plant & machinery Transport equipment Information technology Furniture & fittings Total £000 £000 £000 £000 £000 £000 £000 £000 £000

Owned - purchased 13,500 170,061 1,122 25,468 21,207 34 14,525 1,138 247,055

Finance leased - - - - - - - - -

On-SoFP PFI contracts and other service concession arrangements - - - - - - - - -

Off-SoFP PFI residual interests - - - - - - - - -

Owned - donated/granted - 7,853 328 495 3,597 - 47 115 12,435

NBV total at 31 March 2022

13,500 177,914 1,450 25,963 24,804 34 14,572 1,253 259,490

Note 16.4 Property, plant and equipment financing - 2020/21

Net book value at 31 March 2021

Owned - purchased

Buildings excluding dwellings Dwellings Assets under construction Plant & machinery Transport equipment Information technology Furniture & fittings Total £000 £000 £000 £000 £000 £000 £000 £000 £000

Land

13,500 162,781 1,115 14,944 20,879 51 9,954 1,088 224,312

Finance leased - - - - - - - - -

On-SoFP PFI contracts and other service concession arrangements - - - - - - - - -

Off-SoFP PFI residual interests - - - - - - - - -

Owned - donated/granted - 7,532 332 32 4,766 - 72 130 12,864

NBV total at 31 March 2021

13,500 170,313 1,447 14,976 25,645 51 10,026 1,218 237,176

Note 17 Donations of property, plant and equipment

During 2021/22 donations have been received from by Royal Shrewsbury Hospital League of Friends; Friends of Princess Royal Hospital; The Shrewsbury and Telford Hospital NHS Trust Charitable Funds and Lingen Davies Cancer Fund for the purchase of medical equipment, build and garden works.

Note 18 Revaluations of property, plant and equipment

The Trust commissioned Cushman and Wakefield to undertake a desktop update valuation of the Trust's Estate as at 31 March 2022. The properties were inspected internally and externally by Craig Chatwin BSc (Hons) MRICS, Adam Griffiths BSc (Hons) MRICS and Steven Gandley BSc (Hons) MRICS on 15 and 16 February 2021. David Wilson MRICS and Jonathan Crawford MRICS have been signatories of Valuation Reports for a continuous period since 31 March 2021. The valuation has been prepared in accordance with the RICS Valuation – Global Standards, which incorporate the International Valuation Standards (“IVS”) and the RICS UK National Supplement (the “RICS Red Book”), edition current at the Valuation Date. It follows that the valuation is compliant with IVS.

As a result of these revaluations the Net Book Value of the Estate was valued downwards by £2,432k as follows: Revaluation Reserve – total £3,081k increase, representing a revaluation upwards of £4,418k and net decrease of £1,337k relating to reversals and impairments charged - impairments charged of £1,785k and reversal of impairments of £448k. Impairments to the value of £6,116k have been charged to SoCI and previous impairments of £602k have been reversed, giving a net total of £5,514k.

The gross carrying amount of fully depreciated assets held by the trust is £12,893k.

Note 19 Investment Property

The Trust has no investment property that requires disclosure within this note.

Note 20 Investments in associates and joint ventures

The Trust has no investments in associates or joint ventures.

Note 21 Other investments / financial assets (current and non-current)

The Trust has no other current or non-current investments or financial assets.

Note 22 Disclosure of interests in other entities

The Trust has no interests in unconsolidated subsidiaries, joint ventures, associates or unconsolidated structured entities that require disclosures within this note.

Note 23 Inventories

31 March 2022 31 March 2021 £000 £000

Drugs 2,830 2,459

Work In progress - -

Consumables 5,941 6,705 Energy 268 146 Other - -

Total inventories 9,039 9,310 of which: Held at fair value less costs to sell - -

Inventories recognised in expenses for the year were £93,102k (2020/21: £81,831k). Write-down of inventories recognised as expenses for the year were £165k (2020/21: £394k).

The deemed cost of these inventories was charged directly to expenditure on receipt with the corresponding benefit recognised in income.

Note 24.1 Receivables

Current

31 March 2022 31 March 2021 £000 £000

Contract receivables 6,216 17,346

Contract assets - -

Capital receivables - -

Allowance for impaired contract receivables / assets (839) (844) Allowance for other impaired receivables -Deposits and advances - -

Prepayments (non-PFI) 2,535 1,619

PFI prepayments - capital contributions - -

PFI lifecycle prepayments - -

Interest receivable - -

Finance lease receivables - -

PDC dividend receivable 359 -

VAT receivable 1,767 2,880

Corporation and other taxes receivable - -

Other receivables 152 1,542

Total current receivables 10,190 22,543

Non-current

Contract receivables 904 869

Contract assets - -

Capital receivables - -

Allowance for impaired contract receivables / assets - -

Allowance for other impaired receivables -Deposits and advances -Prepayments (non-PFI) - -

PFI prepayments - capital contributions - -

PFI lifecycle prepayments - -

Interest receivable - -

Finance lease receivables -VAT receivable - -

Corporation and other taxes receivable - -

Other receivables* 819 1,162

Total non-current receivables 1,723 2,031

Of which receivable from NHS and DHSC group bodies:

Current 3,480 16,010 Non-current 819 1,162

*Non-current 'Other receivables' relate to the clinical pension tax reimbursement. A contra entry has been set up in Provisions (see Note 33.1). In 2021/22 £9k (2020/21: £nil) is included in Current 'Other receivables'.

Note 24.2 Allowances for credit losses

2021/22

Contract receivables and contract assets

All other receivables

2020/21

Contract receivables and contract assets

All other receivables

£000 £000 £000 £000

Allowances as at 1 April - brought forward 844 - 945 -

Prior period adjustments - -

Allowances as at 1 April - restated 844 - 945 -

Allowances at start of period for new FTs - - - -

Transfers by absorption - - - -

New allowances arising 439 - 232Changes in existing allowances - - - -

Reversals of allowances (38) - (44)Utilisation of allowances (write offs) (405) - (289)Changes arising following modification of contractual cash flows - - - -

Foreign exchange and other changes - - - -

Allowances as at 31 Mar 2022 839 - 844 -

Note 24.3 Exposure to credit risk Note 25 Other assets

The majority of the Trust’s revenue comes from contracts with other public sector bodies therefore the Trust has low exposure to credit risk. The maximum exposures as at 31 March 2022 are in receivables from customers, as disclosed in the trade and other receivables note.

The Trust has no other assets that require disclosure within this note.

Note 26 Liabilities in disposal groups

The Trust has no other liabilities in disposal groups that require disclosure within this note.

Note 27.1 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.

2021/22 2020/21 £000 £000

At 1 April 15,405 1,700

Prior period adjustments - -

At 1 April (restated) 15,405 1,700

Transfers by absorption -Net change in year 484 13,705

At 31 March 15,889 15,405

Broken down into:

Cash at commercial banks and in hand 16 16

Cash with the Government Banking Service 15,873 15,389 Deposits with the National Loan Fund - -

Other current investments - -

Total cash and cash equivalents as in SoFP 15,889 15,405

Bank overdrafts (GBS and commercial banks) -Drawdown in committed facility - -

Total cash and cash equivalents as in SoCF 15,889 15,405

Note 27.2

Third party assets held by the Trust

The Shrewsbury and Telford 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 March 2022 31 March 2021 £000 £000

Bank balances 1 3 Monies on deposit - -

Total third party assets 1 3

Note 28.1 Trade and other payables

Current

31 March 2022 31 March 2021

£000 £000

Trade payables 10,482 5,881

Capital payables 16,731 14,227

Accruals 38,218 35,536

Receipts in advance and payments on account 40 41

PFI lifecycle replacement received in advance -Social security costs 216 191

VAT payables - -

Other taxes payable 406 345

PDC dividend payable - 900 Other payables 82 3,938

Total current trade and other payables 66,175 61,059

Non-current

Trade payables - -

Capital payables -Accruals - -

Receipts in advance and payments on account - -

PFI lifecycle replacement received in advance - -

VAT payables -Other taxes payable -Other payables - -

Total non-current trade and other payables - -

Of which payables from NHS and DHSC group bodies:

Current 2,647 2,691 Non-current - -

Note

29

Other liabilities

Current

31 March 2022 31 March 2021 £000 £000

Deferred income: contract liabilities 1,554 1,512

Deferred grants - -

Deferred PFI credits / income -Lease incentives -Other deferred income - -

Total other current liabilities 1,554 1,512

Non-current

Deferred income: contract liabilities - -

Deferred grants - -

Deferred PFI credits / income -Lease incentives -Other deferred income - -

Net pension scheme liability - -

Total other non-current liabilities - -

Note 30.1 Borrowings

The Trust has no borrowings.

31 March 2022 31 March 2021 £000 £000

Current Bank overdrafts - -

Drawdown in committed facility -Loans from DHSC -Other loans - -

Obligations under finance leases -Obligations under PFI, LIFT or other service concession contracts -Total current borrowings - -

Non-current

Loans from DHSC -Other loans - -

Obligations under finance leases -Obligations under PFI, LIFT or other service concession contracts - -

Total non-current borrowings - -

Note 30.2 Reconciliation of liabilities arising from financing activities - 2021/22

Loans from DHSC Other loans Finance leases

PFI and LIFT schemes Total £000 £000 £000 £000 £000

Carrying value at 1 April 2021 - - - - -

Cash movements:

Financing cash flows - payments and receipts of principal - - - - -

Financing cash flows - payments of interest - - - - -

Non-cash movements:

Transfers by absorption - - - -Additions - - - - -

Application of effective interest rate - - - -Change in effective interest rate - - - - -

Changes in fair value - - - - -

Early terminations - - - - -

Other changes - - - - -

Carrying value at 31 March 2022 - - - - -

Note 30.3 Reconciliation of liabilities arising from financing activities - 2020/21

Loans from DHSC Other loans Finance leases

PFI and LIFT schemes Total £000 £000 £000 £000 £000

Carrying value at 1 April 2020 82,721 - - - 82,721

Prior period adjustment - - - - -

Carrying value at 1 April 2020 - restated 82,721 - - - 82,721

Cash movements:

Financing cash flows - payments and receipts of principal (82,554) - - - (82,554)

Financing cash flows - payments of interest (167) - - - (167)

Non-cash movements:

Transfers by absorption - - - -Additions - - - - -

Application of effective interest rate - - - -Change in effective interest rate - - - -Changes in fair value - - - - -

Early terminations - - - - -

Other changes - - - - -

Carrying value at 31 March 2021 - - - - -

Note 31 Other financial liabilities

The Trust has no other financial liabilities.

Note 32

Finance leases

The Shrewsbury and Telford Hospital NHS Trust have no finance leases where the Trust is the lessee or lessor.

Note 33.1 Provisions for liabilities and charges analysis

Pensions: early departure costs

Equal Pay (including Agenda for Change) Redundancy Other Total £000 £000 £000 £000 £000 £000 £000 £000

Pensions: injury benefits Legal claims Restructuring

At 1 April 2021 43 198 237 - - - 1,162 1,640

Transfers by absorption - - - - - - -Change in the discount rate - (4) - - - - - (4) Arising during the year 42 49 72 - - - - 163 Utilised during the year (42) (54) (92) - - - - (188) Reclassified to liabilities held in disposal groups - - - - - - -Reversed unused - - (20) - - - (334) (354) Unwinding of discount - (4) - - - - - (4)

At 31 March 2022 43 185 197 - - - 828 1,253

Expected timing of cash flows: - not later than one year; 43 72 197 - - - 9 321 - later than one year and not later than five years; - 113 - - - - 29 142 - later than five years. - - - - - - 790 790

Total 43 185 197 - - - 828 1,253

Early departure costs and injury benefits relate to a provision for future payments payable to the NHS Pensions Agency in respect of former employees. Legal claims relate to NHS Resolution non clinical cases with employees and members of the general public.

Clinicians who are members of the NHS Pension Scheme and who as a result of work undertaken face a tax charge in respect of the growth of their NHS pension benefits above their pension savings annual allowance threshold will be able to have this charge paid by the NHS Pension Scheme. A contra entry has been set up in Receivables (see Note 24.1).

Note 33.2 Clinical negligence liabilities

At 31 March 2022, £561,600k was included in provisions of NHS Resolution in respect of clinical negligence liabilities of Shrewsbury and Telford Hospital NHS Trust (31 March 2021: £406,841k).

Note 34 Contingent assets and liabilities

Value of contingent liabilities

31 March 2022 31 March 2021 £000 £000

NHS Resolution legal claims (76) (96) Employment tribunal and other employee related litigation -Redundancy -Other - -

Gross value of contingent liabilities (76) (96) Amounts recoverable against liabilities - -

Net value of contingent liabilities (76) (96) Net value of contingent assets - -

The contingent liabilities represent the difference between the expected values of provisions for legal claims carried at note 33.1 and the maximum potential liability that could arise from these claims.

Note 35 Contractual capital commitments

31 March 2022 31 March 2021 £000 £000

Property, plant and equipment 2,632 5,423 Intangible assets 78Total 2,710 5,423

Note 36 Other financial commitments

The Trust is not committed to making any payments under non-cancellable contracts which are not leases, PFI contracts or other service concession arrangements.

31 March 2022 31 March 2021 £000 £000 not later than 1 year -after 1 year and not later than 5 years -paid thereafter -Total - -

Note

37

Defined benefit pension schemes

The Trust has no other defined benefit pension schemes.

Note 38.1 Financial risk management

Note Financial risk management

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 its activities. Because of the continuing service provider relationship that the NHS Trust has with commissioners and the way those 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 the financial reporting standards mainly apply. The Trust has limited powers to borrow or invest surplus funds and financial assets and liabilities are generated by day-to-day operational activities rather than being held to change the risks facing the Trust in undertaking its activities.

The Trust’s treasury management operations are carried out 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.

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.

Interest rate risk

The Trust borrows from government for capital expenditure, subject to affordability as confirmed by NHS England & NHS Improvement. The borrowings are for 1 – 25 years, in line with the life of the associated assets, and interest is charged at the National Loans Fund rate, fixed for the life of the loan. The Trust therefore has low exposure to interest rate fluctuations.

The Trust may also borrow from government for revenue financing subject to approval by NHS England & NHS Improvement. Interest rates are confirmed by the Department of Health and Social Care (the lender) at the point borrowing is undertaken. The Trust has no revenue or capital loans in place as at 31 March 2022.

The Trust therefore has low exposure to interest rate fluctuations.

Credit risk

Because the majority of the Trust’s revenue comes from contracts with other public sector bodies, the Trust has low exposure to credit risk. The maximum exposures as at 31 March 2022 are in receivables from customers, as disclosed in the trade and other receivables note.

Liquidity risk

The Trust’s operating costs are incurred under contracts with Clinical Commissioning Groups, which are financed from resources voted annually by Parliament. The Trust funds its capital expenditure from funds obtained within its prudential borrowing limit. The Trust is not, therefore, exposed to significant liquidity risks subject to the availability of temporary revenue support funding and the demonstration of cash requirement.

Note 38.2 Carrying values of financial assets

Carrying values of financial assets as at 31 March 2022

Held at amortised cost

Held at fair value through OCI Total book value £000 £000 £000 £000

Held at fair value through I&E

Trade and other receivables excluding non financial assets 7,251 - - 7,251 Other investments / financial assets - - -Cash and cash equivalents 15,889 - - 15,889

Total at 31 March 2022 23,140 - - 23,140

Carrying values of financial assets as at 31 March 2021

Held at amortised cost

Held at fair value through OCI Total book value £000 £000 £000 £000

Held at fair value through I&E

Trade and other receivables excluding non financial assets 20,075 - - 20,075

Other investments / financial assets - - -Cash and cash equivalents 15,405 - - 15,405

Total at 31 March 2021 35,480 - - 35,480

Note

38.3

Carrying values of financial liabilities

Carrying values of financial liabilities as at 31 March 2022

Held at amortised cost

Held at fair value through I&E Total book value £000 £000 £000

Loans from the Department of Health and Social Care - - -

Obligations under finance leases - -Obligations under PFI, LIFT and other service concession contracts - -Other borrowings - - -

Total at 31 March 2022

Trade and other payables excluding non financial liabilities 65,513 - 65,513 Other financial liabilities - -Provisions under contract 197 - 197 65,710 - 65,710

Carrying values of financial liabilities as at 31 March 2021

Held at amortised cost

Held at fair value through I&E Total book value £000 £000 £000

Loans from the Department of Health and Social Care - - -

Obligations under finance leases - - -

Obligations under PFI, LIFT and other service concession contracts - -Other borrowings - - -

Total at 31 March 2021

Trade and other payables excluding non financial liabilities 59,582 - 59,582 Other financial liabilities - -Provisions under contract 237 - 237 59,819 - 59,819

Note

38.4

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 March 2022 31 March 2021 £000 £000

In one year or less 65,710 59,819

In more than one year but not more than five years - -

In more than five years - -

Total 65,710 59,819

Note 38.5 Fair values of financial assets and liabilities

The book value (carrying value) is a reasonable approximation of fair value for the Trust's financial assets and liabilities.

Note 39 Losses and special payments

2021/22 2020/21

Total number of cases Total value of cases Total number of cases Total value of cases Number £000 Number £000

Losses

Cash losses 1 0 - -

Fruitless payments and constructive losses - - -Bad debts and claims abandoned 406 406 344 289 Stores losses and damage to property 38 165 37 282

Total losses 445 571 381 571

Special payments

Compensation under court order or legally binding arbitration award - - - -

Extra-contractual payments - - -Ex-gratia payments 61 1,033 57 252 Special severance payments - - -Extra-statutory and extra-regulatory payments - - 1 4

Total special payments 61 1,033 58 256

Total losses and special payments 506 1,604 439 827

Compensation payments received - -

£92k of the ex-gratia payments in 2021/22 (£85k in 2020/21) are included in legal claims in Note 33.1 Provisions for liabilities and charges analysis rather than Note 6.1 Operating expenses.

The Flowers legal case relates to the treatment of overtime payments and in particular payments for voluntary overtime in the calculation of holiday pay and the interpretation of the Working Time Directive. Joint negotiations between NHS employers and NHS trade unions during 2021 agreed that a corrective payment would be made to those staff affected. Guidance was issued asking Trusts to accrue the cost of the nationally agreed corrective payments and associated income based on nationally generated estimates, and accordingly £737.4k was accrued within the 2020/21 accounts.

These payments are considered special payments for which HM Treasury approval was sought nationally by NHS England on Trusts' behalf. As the losses and special payments note is prepared on an accruals basis (excluding provisions), these amounts should have been disclosed within this note in the 2020/21 accounts. In line with the guidance set out at section 2.1.6 of the Trust Accounts Consolidation (TAC) schedules: Completion instructions month 12 2021/22 (March 2022), the Trust has the choice to include these within the 2021/22 disclosure or to revise the prior year disclosure. The Trust has therefore included these within the 2021/22 disclosure (£788k).

The actual payment made in 2021/22 was £788k which, whilst higher than the initial approval, is within a tolerance limit as set by HM Treasury so further approval is not required in this case.

Note 40 Gifts

2021/22 2020/21

Total number of cases Total value of cases Total number of cases Total value of cases Number £000 Number £000

Gifts made - - - -

Note 41 Related parties

The Department of Health and Social Care is regarded as the parent department. The main entities within the public sector that the trust has had dealings with during the year are:

NHS Shropshire, Telford and Wrekin CCG

NHS South East Staffs And Seisdon Peninsular CCG

NHS Stafford And Surrounds CCG

NHS Herefordshire and Worcestershire CCG

NHS England and NHS Improvement

Health Education England

NHS Property Services

NHS Resolution

Mid Cheshire Hospitals NHS Foundation Trust

Shropshire Community Health NHS Trust

St Helens and Knowsley Teaching Hospitals NHS Trust

The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust

The Royal Wolverhampton NHS Trust

University Hospitals Birmingham NHS Foundation Trust

University Hospitals of North Midlands NHS Trust

Powys Local Health Board

Betsi Cadwaladr University Local Health Board

Cwm Taf Local Health Board

NHS Pension Scheme NHS Blood and Transplant

HM Revenue and Customs

The Trust is linked to the Shrewsbury and Telford Hospital NHS Trust Charity. The Annual Report and Accounts for the Shrewsbury and Telford Hospital NHS Charity are submitted separately to the Charity Commission and are not consolidated into the Trust's Accounts.

The Trust is also linked to Royal Shrewsbury Hospital League of Friends, Friends of Princess Royal Hospital and Lingen Davies Cancer Fund, who donate various pieces of medical equipment to the Trust. The Trust hires facilities from Shropshire Education and Conference Centre.

Note 42 Transfers by absorption

There were no transfers by absorption in the year where the Trust has been either the receiving or divesting party.

Note 43 Prior period adjustments

The Trust has made no prior period adjustments where comparative information has been restated due to either a change in accounting policy or material prior period error.

Note 44 Events after the reporting date

There are no events after the reporting date that need to be included in this note.

Note 45 Better Payment Practice code

2021/22 2021/22 2020/21 2020/21

Non-NHS Payables Number £000 Number £000

Total non-NHS trade invoices paid in the year 137,133 209,477 127,194 186,294

Total non-NHS trade invoices paid within target 118,912 186,763 117,168 173,025

Percentage of non-NHS trade invoices paid within target 86.7% 89.2% 92.1% 92.9%

NHS Payables

Total NHS trade invoices paid in the year 1,921 13,854 2,041 13,771

Total NHS trade invoices paid within target 1,724 12,437 1,814 12,813

Percentage of NHS trade invoices paid within target 89.7% 89.8% 88.9% 93.0%

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 46 External financing limit

The Trust is given an external financing limit against which it is permitted to underspend

2021/22 2020/21 £000 £000

Cash flow financing 21,452 11,549

Finance leases taken out in year - -

Other capital receipts - -

External financing requirement 21,452 11,549

External financing limit (EFL) 31,212 23,821

Under / (over) spend against EFL 9,760 12,272

Note 47 Capital Resource Limit

2021/22 2020/21 £000 £000

Gross capital expenditure 44,820 44,610

Less: Disposals (2,060) (233)

Less: Donated and granted capital additions (1,140) (1,642)

Plus: Loss on disposal from capital grants in kind -Charge against Capital Resource Limit 41,620 42,735

Capital Resource Limit 45,672 42,816 Under / (over) spend against CRL 4,052 81

Note 48 Breakeven duty financial performance

2021/22 £000

Adjusted financial performance surplus / (deficit) (control total basis) (10,890)

Remove impairments scoring to Departmental Expenditure Limit -

Add back non-cash element of On-SoFP pension scheme charges -

IFRIC 12 breakeven adjustment -

Breakeven duty financial performance surplus / (deficit) (10,890)

Note 49 Breakeven duty rolling assessment

1997/98 to 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15

£000 £000 £000 £000 £000 £000 £000

Breakeven duty in-year financial performance 712 26 59 81 65 (12,130) Breakeven duty cumulative position (22,891) (22,179) (22,153) (22,094) (22,013) (21,948) (34,078)

Operating income 262,882 277,980 299,850 309,362 314,106 316,794

Cumulative breakeven position as a percentage of operating income (8.4%) (8.0%) (7.4%) (7.1%) (7.0%) (10.8%)

2015/16 2016/17 2017/18 2018/19 2019/20 2020/21 2021/22 £000 £000 £000 £000 £000 £000 £000

Breakeven duty in-year financial performance (14,649) (5,631) (17,400) (18,743) (25,715) (3,752) (10,890)

Breakeven duty cumulative position (48,727) (54,358) (71,758) (90,501) (116,216) (119,968) (130,858) Operating income 326,477 350,244 359,041 369,186 421,853 511,443 535,142

Cumulative breakeven position as a percentage of operating income (14.9%) (15.5%) (20.0%) (24.5%) (27.5%) (23.5%) (24.5%)

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