Statement from the Chief Executive

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

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’. 12

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.